二诊：服上方2剂后，头晕消失，仍有身倦，腹部有跳动感，口苦有所加重。因头晕、恶心等主症消失，故上方去天麻、半夏。口苦加重为肝经有热之象，故宜去辛燥之半夏，而加入酸微寒之生白芍，以养血敛阴而平肝，抑木扶土而止痛。服药2剂后，口苦顿失。
按：此例眩晕系由脾虚痰湿中阻，兼肝阳上亢所致，故用六君子汤加苍术以健脾益气，燥湿化痰，天麻、菊花平肝潜阳，泽泻利水，利小便而实大便，白蔻仁化湿行气，温中止呕，共使痰湿除而呕恶止，肝阳平而眩晕停。二诊去辛燥之半夏及天麻，加白芍之酸寒养血柔肝，抑木扶土，以善其后。
案三 李某，女，36岁。门诊号：46905。
1961年9月18日初诊：近1周来头晕而胀，项强，关节疼痛，两足沉重，纳呆，恶心，喜热饮食，大便溏薄，小便黄，苔白腻，脉滑。此属风湿痹阻清窍之证。治宜健脾化痰，祛风胜湿。方用二陈汤加味：
陈皮7．5克 半夏9克 茯苓7．5克 羌活4。5克 独活4．5克 苍术6克 白术6克 生姜3片
服药2剂后，主症明显改善，再服2剂。头晕止而诸症除。
按：此案属脾虚痰湿中阻，兼外感风湿之眩晕。方中以二陈汤加苍术、白术燥湿健脾以化痰湿，羌活、独活祛周身上下之风湿而活络通窍，佐以生姜暖肠胃而助脾运以化痰湿。 治外感风热眩晕 用解表必兼活血 将活血化瘀疗法及活血化瘀药物广泛地运用于临床各科内伤杂证的治疗，是李老学术经验和用药方法的一大特色，并取得过重大成果，如活血化瘀非手术疗法治疗宫外孕，其中宫外孕工号方、宫外孕Ⅱ号方早已载入医学辞典和教科书中，为医学界所皆知。但将活血化瘀法用于外感病，特别是风热外感，如外感头痛、眩晕等，且一样取得神奇疗效的经验，则鲜为人知。在瘀血证方面，李老多主张“百病皆瘀”说，在瘀血成因上认为不但寒邪可以致瘀，热邪也同样可以致瘀。他说：《内经》多注重寒凝血瘀，而《伤寒论》则多注重热邪郁滞而致瘀，如“阳明证，其人善忘者，必有蓄血也”，“发热七八日……至六七日，不大便，有瘀血”，“太阳病不解，热结膀胱，其人如狂，血自下”等。这里所说的蓄血证、瘀热在里证、热人血室证等，皆属于因热致瘀血。叶天士说： “夏日热久入血，最多蓄血一证，谵语昏狂……”王清任《医林改错》更明确指出寒热均可致瘀，说： “血受寒则凝结成块，血受热则煎熬成块。”李老在挖掘继承前贤经验之基础上，将活血之法用于外感风热证上，每能获得奇效，可谓匠心独用。
附案：
案一 段某，女，45岁。门诊号：90727。
1965年5月31日初诊：头晕、头痛2日，颈部疼痛，转侧则更甚，自感发热恶寒，舌苔薄白，脉浮数。此系风热表证。治宜辛凉解表，清热解毒，兼以活血。处方：
杭菊花9克 连翘9克 薄荷4．5克 柴胡4．5克当归尾6克 赤芍6克 银花9克 蔓荆子6克 甘草3克
服上方1剂，主症明显减轻，2剂而愈。
按：本方以辛凉解表、疏风清热为主。方中银花、连翘清热解表，疏散温邪，薄荷、菊花疏风清热，清肝明目而治头痛头晕。柴胡透表解热，透达少阳之邪外出。在柴胡的用量上，李老颇多计较，发热重恶寒轻者用量轻，多为4．5克，恶寒重发热轻者用量重，多用9克。蔓荆子辛苦微寒，善治外感风热头痛，其辛能散风，苦微寒能清热，其药轻浮而易上行，可散头面之风邪。归尾、赤芍二味活血化瘀，针对风热致瘀而设，能使气血通而瘀滞除，头目清而眩晕止，妙用二味活血，可使疗效明显提高，疗程明显缩短，是为用药独特之处。
案二 屈某，女，30岁。门诊号：56999。
]962年11月26日初诊：头晕头痛2日，症见寒热往来，口苦咽干，恶心，腹痛，舌质暗，苔薄白，脉弦。此为少阳证。治宜和解少阳，疏风清热，兼以活血化瘀。方用小柴胡汤加减：
当归9克 生白芍9克 柴胡3克 茯苓3克 黄芩3克 杭菊花9克 半夏6克 五灵脂4．5克 生蒲黄4．5克
服药1剂而主症转轻，2剂而痊愈。
按：此案用小柴胡汤，主药柴胡、黄芩、半夏和解少阳，退热降逆；当归、白芍意在补血养阴以柔肝；五灵脂、生蒲黄为《局方》失笑散，功能活血化瘀，散结止痛。唐容川《血证论》言： “蒲生水中，花香行水，水即气也，水行则气行，气止则血止，故蒲黄能止刀伤之血。灵脂气味温以行血。二药合用，大能行血也。”李老常用此二味于内伤杂症之中，用其活血化瘀，散结止痛，每获良效，用于外感头晕头痛等证，同样神验。
神经衰弱
神经衰弱证 辨治从心肾
神经衰弱是西医之病名，属于神经官能症的一种，在中医属于内伤杂证范畴，常见于失眠等证，在脏腑经络方面，多力心、肝、肾、脾、胃的病变。一度时期，神经衰弱从肝论治的观点十分盛行。秦氏从本病各种症状的主次和多少以及脏腑之相互关系进行分析，认为本病中，肝的病变占居重要位置。因肝同心、肾、脾、胃有着生克关系，肝有病变往往会影响到各脏腑，而各脏腑有了病变也会影响到肝。但李老认为此说当属牵强。他认为，内伤脏腑类疾病的五行传变，生克乘侮，具有广泛的理论指导意义，所有的内伤杂证均可按五行传变模式传变转化，不独神经衰弱一病为然。古人云：“牵一发而动全身。”也就是说，人体任何一部分都是互有关联的，而没有独立存在的东西。本病肝脏的症状较多见。所以秦氏认为神经衰弱的机制首当责之于肝。而李老则根据多年的临床经验认为，神经衰弱属于心肾方面病变的症状较多。因为患本病之人，不是由于劳心过度，便是由于房室过度，或者二者兼而有之。而郁怒伤肝之人也必然兼有以上两种原因方能形成本病。当然，肝伤日久，亦会发展成为神经衰弱，但毕竟是少数的。
神经衰弱有关心肾的见症：
1．心血虚的症状：心慌，健忘，悸惕，思想不集中。
2．心火旺的症状：心烦闷乱，不易入睡。睡则易醒，多梦，多汗。
3．肾阴虚相火旺的症状：耳鸣，不寐，腰膝酸软。遗精早泄，咽喉干痛，手足心热，小便黄赤，脉象细数。
4．肾阳虚的症状：身体怕冷，手足不温，性欲减退，阳痿，小便频数、清长，脉沉迟无力。
5。心肾不交的症状：神思淡漠，困倦乏力，心悸，失眠，胸烦，悬饮。
神经衰弱临床上虽以心、肾方面的病变证候居多，但上述诸证，常非单独出现，而是多与其他脏腑的兼症同时出现，即是夹杂型者为多。如心脾两虚型，心肾两虚型，肝肾阴虚型，心胆气虚型，脾肾阳虚型等。
附案：
案一 王某，女，29岁。门诊号：46927。
1961年7月26日初诊：失眠，多梦，手足麻木，饮食减少，大便前腹痛。因流产后患病，已2月余。舌苔薄白，脉虚。证属心脾两虚。治宜健脾养心。处方：
生白术7．5克 党参7．5克 炙黄芪6克 当归7。5克茯神7．5克 远志6克 炒枣仁15克 广木香3克 元肉6克 生白芍了。5克 桂枝4．5克 炙甘草3克
2剂，水煎服。
按：心脾两虚，血不养心，脾为生化之源，化源不足，心失所养，故出现多梦易醒。脾虚不能统血，血不养心而不寐，血虚失养而见手足麻木。脾主运化，水谷运化失司而纳呆，流产失血过多而血虚，脾虚木克土故腹痛。选用归脾汤加味，健脾养心，益气补血，气旺则血生，血足心得其养，寐自安。方中党参、黄芪、白术、炙甘草健脾燥湿，益气补血；元肉、当归、茯神、远志养血补心而安神定志；炒枣仁养肝宁心，安神定志，对失血过多、忧思劳伤心脾所致之心烦不眠有特效；木香理气醒脾，补而不滞；白芍补血敛阴，平肝止痛，用于肝脾不和，腹中挛急作痛；桂枝通心脾之阳。《本经疏证》云： “桂枝色赤，条理纵横，宛如经脉系络。色赤属心，纵横通脉络，能利关节，温通经脉，此其本也。”辛能散结，甘可补虚，故能调和腠理，下气散逆，止痛除烦，此其用也．盖其用之之道有六：“曰和营，曰通阳，曰利水，曰下气，曰行瘀，曰补中。”此外，还有助心阳、温化水饮的功能。李老根据多年来的临床实践，采用归脾汤酌加桂枝治疗心脾两虚之不寐，充分体现了李老辨证灵活，增减用药丝丝人扣的精湛医道。
二诊：服药后，失眠多梦、腹痛和手足麻木均减轻，夜间睡眠时间延长约1小时，但感胸中憋闷，恶寒。处方：
生白术7．5克 党参7．5克 当归7．5克 茯神7．5克远志6克 炒枣仁15克 广木香3克 元肉6克 生白芍7．5克 生龙骨7．5克 生牡蛎7．5克 荆芥穗4．5克 炙甘草3克
2剂，水煎服。
按：心脾两虚所致的不寐、多梦，经服用益气健脾养血安神的归脾汤，已见成效。但因患者又患胸憋，故从一诊方中去黄芪。黄芪性微温，升清气，以其易助火，又可固表，所以凡外有表邪，内有积滞，以及气滞胸闷，阳盛阴虚，上热下寒，肝旺易怒，以及痈疽初起或溃后热毒尚盛等，均不宜用。加生龙牡有镇惊安神之功，治阴虚阳亢所致的烦躁、心悸和失眠，具有养阴清热除烦的作用。加荆芥穗辛温，轻扬疏散，能散风寒而治恶寒。
案二 张某，男，27岁。门诊号：37204。
1961年1月¨日初诊：不寐，睡眠不实，多梦易醒，伴腰困，左胯疼痛。舌苔薄白，脉紧。证属心肾两虚，心肾不交。治宜补肾养心，交通心肾。处方：
生龙牡各9克 炒枣仁15克 远志7．5克 熟地9克生山药15克 杜仲9克 续断6克 川牛膝4．5克 炙甘草3克
2剂，水煎服。
按：不寐兼腰困，是为肾虚不寐。腰为肾之府，肾主骨生髓，肾髓不足，而出现腰困。生龙牡重镇安神作用较强而治失眠；炒枣仁补肝宁心，治虚烦不眠，易醒多梦；远志交通心肾，治惊悸失眠；熟地滋补肾阴，能填精髓；山药补脾益肾，强肾固精；杜仲补肝肾、强筋骨、益腰膝，治肝肾阴虚所致的腰痛；续断补肝肾、续筋骨、通血脉，治肾虚腰酸痛；川牛膝逐瘀通经利关节而治腰痛。
案三 王某，男，46岁。门诊号：24132。
1959年12月22日初诊：不寐，头晕，耳鸣，腰困，手足心发烧，舌质红，脉虚数。证属肾阴虚。治宜滋补肾阴，宁心安神。方用六味地黄汤加味：
熟地9克 山萸肉9克 生山药15克 茯苓9克 丹皮9克 泽泻9克 炒枣仁15克 远志7．5克
2剂，水煎服。
二诊：服药后头晕、耳鸣、手足心烧、不寐均减轻，但自觉失眠时心烦加剧。上方中加栀子4．5克，淡豆豉9克。2剂，水煎服。
按：此系肾阴虚引起的不寐。肾阴不足，心肝火旺，虚火上炎，故见头晕，耳鸣，手足心发烧，以至失眠。舌质红、脉虚数均为阴虚有热之象。肾主骨，腰为肾之府，肾虚故见腰困。方用六味地黄汤滋阴补肾，加炒枣仁补肝宁心，治虚火上炎引起的失眠；远志交通心肾，镇惊安神。该方有补有泻，寓泻于补，有合有开，三阴并治。二诊在上方中加栀子、豆豉清泻三焦之火，除烦治不眠。
案四 刘某，女，40岁。门诊号：81928。
1964年11月6日初诊：失眠，多梦，易惊易醒，心悸，舌苔薄白，脉弦细。证属心胆气虚。治宜益气养心，安神定志。处方：
党参4．5克 炒枣仁15克 菖蒲4．5克 远志4．5克五味子4。5克 茯神4．5克 生龙骨4．5克 生牡蛎4。5克
2剂，水煎服。
按：此证系心胆气虚，心虚则神不安，胆虚则善惊多恐，故心悸多梦易醒。党参益气补血，补气健脾，以治气血两虚；生龙牡镇惊安神；炒枣仁养肝安神镇惊，肝与胆相表里，养肝可以补胆之不足；菖蒲、远志、茯神交通心肾而补心益肾，治惊悸失眠；五味子养心敛肺，益肾纳气，协助枣仁敛阴安神，治心气不足失眠。
痹
证
痹发之前 气血必亏
三气乘之 关节闭塞
痹证(病)者，是指人体关节部位或四肢、筋骨、肌肉一个部分或几个部分发生的固定或移动的肿痛或重着或麻木不仁或屈伸不利的疾病。
痹证的好发部位一般多在关节，有的固定在一个关节，有的游走无定处，或右或左，或上或下，有的兼肿兼重或酸困，或兼麻木，有的关节或强直或拘挛，或屈伸不利。除了后期丧失知觉，不知痛痒外，痹证鲜有不疼痛者。
痹证的发生，虽《素问·痹论》有“风寒湿三气杂至，合而为痹也”的论述，但邪之所凑，其气必虚。痹证虽由风寒湿热等外邪侵袭所致，但人身正气的偏虚，气血不足，腠理肌表不固，是引起痹证的内在因素。其主要病机为人身气血先虚，外邪乘虚入侵，阻滞经络，气血运行不畅，以致肌肉或关节疼痛、麻木、重着、屈伸不利而形成痹证。如《灵枢。五变》说：“粗理而内不坚者，善病痹。”《．临证指南。痹》说：“痹者，闭而不通之谓也，正气为邪所阻，脏腑经络不能畅达，皆由气血亏损，腠理疏豁，风寒湿之气得以乘虚外袭，留滞于内，致湿痰浊血流注凝涩而得之。”
二诊：服用上方两剂后，头晕症状消失，但仍感到身体疲倦，腹部有跳动感，口苦症状有所加重。由于头晕、恶心等主要症状已消失，因此去掉原方中的天麻和半夏。口苦加重是肝经有热的表现，所以应当去掉辛温燥烈的半夏，加入酸味且微寒的生白芍，以养血敛阴并平抑肝阳，通过抑制肝木来扶持脾土从而止痛。服药两剂后，口苦症状立刻消除。
按语：此例眩晕是由脾虚导致痰湿阻滞中焦，兼有肝阳上亢所致，因此使用六君子汤加苍术以健脾益气、燥湿化痰，配合天麻、菊花平肝潜阳，泽泻利水渗湿（通过利小便来使大便成形），白蔻仁化湿行气、温中止呕，共同作用使痰湿去除而呕吐恶心停止，肝阳平息而眩晕停止。二诊时去掉辛燥的半夏及天麻，加入白芍的酸寒之性以养血柔肝，抑制肝木、扶持脾土，以巩固疗效。
案三 李某，女性，36岁。门诊号：46905。
1961年9月18日初诊：近一周来头晕且伴有胀感，颈部僵硬，关节疼痛，双足沉重，食欲不振，恶心，喜欢热饮食，大便稀溏，小便黄，舌苔白腻，脉滑。这属于风湿痹阻清窍的病证。治疗宜健脾化痰，祛风胜湿。方用二陈汤加味：
陈皮7.5克 半夏9克 茯苓7.5克 羌活4.5克 独活4.5克 苍术6克 白术6克 生姜3片
服用两剂后，主要症状明显改善，再服两剂。头晕停止，其他症状全部消除。
按语：此案属于脾虚痰湿阻滞中焦，兼外感风湿引起的眩晕。方中以二陈汤加苍术、白术燥湿健脾以化痰湿，羌活、独活祛除周身上下之风湿而活络通窍，佐以生姜温暖肠胃而助脾运以化痰湿。
治外感风热眩晕 用解表必兼活血
将活血化瘀疗法及活血化瘀药物广泛地运用于临床各科内伤杂证的治疗，是李翰卿老先生的学术经验和用药方法的一大特色，并取得过重大成果，如运用活血化瘀非手术疗法治疗宫外孕，其中宫外孕I号方、宫外孕II号方早已载入医学辞典和教科书中，为医学界所皆知。但将活血化瘀法用于外感病，特别是风热外感，如外感头痛、眩晕等，且一样取得神奇疗效的经验，则鲜为人知。在瘀血证方面，李老多主张“百病皆瘀”说，在瘀血成因上认为不但寒邪可以致瘀，热邪也同样可以致瘀。他说：《内经》多注重寒凝血瘀，而《伤寒论》则多注重热邪郁滞而致瘀，如“阳明证，其人善忘者，必有蓄血也”，“发热七八日……至六七日，不大便，有瘀血”，“太阳病不解，热结膀胱，其人如狂，血自下”等。这里所说的蓄血证、瘀热在里证、热入血室证等，皆属于因热致瘀血。叶天士说：“夏日热久入血，最多蓄血一证，谵语昏狂……”王清任《医林改错》更明确指出寒热均可致瘀，说：“血受寒则凝结成块，血受热则煎熬成块。”李老在挖掘继承前贤经验之基础上，将活血之法用于外感风热证上，每能获得奇效，可谓匠心独用。
附案：
案一 段某，女性，45岁。门诊号：90727。
1965年5月31日初诊：头晕、头痛2日，颈部疼痛，转动头部则疼痛加剧，自感发热恶寒，舌苔薄白，脉浮数。这属于风热表证。治疗宜辛凉解表，清热解毒，兼以活血。处方：
杭菊花9克 连翘9克 薄荷4.5克 柴胡4.5克 当归尾6克 赤芍6克 银花9克 蔓荆子6克 甘草3克
服用上方一剂，主要症状明显减轻，两剂而愈。
按语：本方以辛凉解表、疏风清热为主。方中银花、连翘清热解表，疏散温邪，薄荷、菊花疏风清热，清肝明目而治头痛头晕。柴胡透表解热，透达少阳之邪外出。在柴胡的用量上，李老颇为讲究，发热重恶寒轻者用量轻，多为4.5克，恶寒重发热轻者用量重，多用9克。蔓荆子辛苦微寒，善治外感风热头痛，其辛能散风，苦微寒能清热，其药轻浮而易上行，可散头面之风邪。归尾、赤芍二味活血化瘀，针对风热致瘀而设，能使气血通而瘀滞除，头目清而眩晕止，妙用二味活血，可使疗效明显提高，疗程明显缩短，是为用药独特之处。
案二 屈某，女性，30岁。门诊号：56999。
1962年11月26日初诊：头晕头痛2日，症见寒热往来，口苦咽干，恶心，腹痛，舌质暗，苔薄白，脉弦。此为少阳证。治疗宜和解少阳，疏风清热，兼以活血化瘀。方用小柴胡汤加减：
当归9克 生白芍9克 柴胡3克 茯苓3克 黄芩3克 杭菊花9克 半夏6克 五灵脂4.5克 生蒲黄4.5克
服药一剂而主要症状转轻，两剂而痊愈。
按语：此案用小柴胡汤，主药柴胡、黄芩、半夏和解少阳，退热降逆；当归、白芍意在补血养阴以柔肝；五灵脂、生蒲黄为《局方》失笑散，功能活血化瘀，散结止痛。唐容川《血证论》言：“蒲生水中，花香行水，水即气也，水行则气行，气止则血止，故蒲黄能止刀伤之血。灵脂气味温以行血。二药合用，大能行血也。”李老常用此二味于内伤杂症之中，用其活血化瘀，散结止痛，每获良效，用于外感头晕头痛等证，同样神验。
神经衰弱
神经衰弱证 辨治从心肾
神经衰弱是西医之病名，属于神经官能症的一种，在中医属于内伤杂证范畴，常见于失眠等证，在脏腑经络方面，多涉及心、肝、肾、脾、胃的病变。一度时期，神经衰弱从肝论治的观点十分盛行。秦氏从本病各种症状的主次和多少以及脏腑之相互关系进行分析，认为本病中，肝的病变占居重要位置。因肝同心、肾、脾、胃有着生克关系，肝有病变往往会影响到各脏腑，而各脏腑有了病变也会影响到肝。但李老认为此说当属牵强。他认为，内伤脏腑类疾病的五行传变，生克乘侮，具有广泛的理论指导意义，所有的内伤杂证均可按五行传变模式传变转化，不独神经衰弱一病为然。古人云：“牵一发而动全身。”也就是说，人体任何一部分都是互有关联的，而没有独立存在的东西。本病肝脏的症状较多见。所以秦氏认为神经衰弱的机制首当责之于肝。而李老则根据多年的临床经验认为，神经衰弱属于心肾方面病变的症状较多。因为患本病之人，不是由于劳心过度，便是由于房室过度，或者二者兼而有之。而郁怒伤肝之人也必然兼有以上两种原因方能形成本病。当然，肝伤日久，亦会发展成为神经衰弱，但毕竟是少数的。
神经衰弱有关心肾的见症：
1．心血虚的症状：心慌，健忘，悸惕，思想不集中。
2．心火旺的症状：心烦闷乱，不易入睡。睡则易醒，多梦，多汗。
3．肾阴虚相火旺的症状：耳鸣，不寐，腰膝酸软。遗精早泄，咽喉干痛，手足心热，小便黄赤，脉象细数。
4．肾阳虚的症状：身体怕冷，手足不温，性欲减退，阳痿，小便频数、清长，脉沉迟无力。
5．心肾不交的症状：神思淡漠，困倦乏力，心悸，失眠，胸烦，悬饮。
神经衰弱临床上虽以心、肾方面的病变证候居多，但上述诸证，常非单独出现，而是多与其他脏腑的兼症同时出现，即是夹杂型者为多。如心脾两虚型，心肾两虚型，肝肾阴虚型，心胆气虚型，脾肾阳虚型等。
附案：
案一 王某，女性，29岁。门诊号：46927。
1961年7月26日初诊：失眠，多梦，手足麻木，饮食减少，大便前腹痛。因流产后患病，已2月余。舌苔薄白，脉虚。证属心脾两虚。治疗宜健脾养心。处方：
生白术7.5克 党参7.5克 炙黄芪6克 当归7.5克 茯神7.5克 远志6克 炒枣仁15克 广木香3克 元肉6克 生白芍7.5克 桂枝4.5克 炙甘草3克
两剂，水煎服。
按语：心脾两虚，血不养心，脾为生化之源，化源不足，心失所养，故出现多梦易醒。脾虚不能统血，血不养心而不寐，血虚失养而见手足麻木。脾主运化，水谷运化失司而纳呆，流产失血过多而血虚，脾虚木克土故腹痛。选用归脾汤加味，健脾养心，益气补血，气旺则血生，血足心得其养，寐自安。方中党参、黄芪、白术、炙甘草健脾燥湿，益气补血；元肉、当归、茯神、远志养血补心而安神定志；炒枣仁养肝宁心，安神定志，对失血过多、忧思劳伤心脾所致之心烦不眠有特效；木香理气醒脾，补而不滞；白芍补血敛阴，平肝止痛，用于肝脾不和，腹中挛急作痛；桂枝通心脾之阳。《本经疏证》云：“桂枝色赤，条理纵横，宛如经脉系络。色赤属心，纵横通脉络，能利关节，温通经脉，此其本也。”辛能散结，甘可补虚，故能调和腠理，下气散逆，止痛除烦，此其用也．盖其用之之道有六：“曰和营，曰通阳，曰利水，曰下气，曰行瘀，曰补中。”此外，还有助心阳、温化水饮的功能。李老根据多年来的临床实践，采用归脾汤酌加桂枝治疗心脾两虚之不寐，充分体现了李老辨证灵活，增减用药丝丝入扣的精湛医道。
二诊：服药后，失眠多梦、腹痛和手足麻木均减轻，夜间睡眠时间延长约1小时，但感胸中憋闷，恶寒。处方：
生白术7.5克 党参7.5克 当归7.5克 茯神7.5克 远志6克 炒枣仁15克 广木香3克 元肉6克 生白芍7.5克 生龙骨7.5克 生牡蛎7.5克 荆芥穗4.5克 炙甘草3克
两剂，水煎服。
按语：心脾两虚所致的不寐、多梦，经服用益气健脾养血安神的归脾汤，已见成效。但因患者又患胸憋，故从一诊方中去黄芪。黄芪性微温，升清气，以其易助火，又可固表，所以凡外有表邪，内有积滞，以及气滞胸闷，阳盛阴虚，上热下寒，肝旺易怒，以及痈疽初起或溃后热毒尚盛等，均不宜用。加生龙牡有镇惊安神之功，治阴虚阳亢所致的烦躁、心悸和失眠，具有养阴清热除烦的作用。加荆芥穗辛温，轻扬疏散，能散风寒而治恶寒。
案二 张某，男性，27岁。门诊号：37204。
1961年1月11日初诊：不寐，睡眠不实，多梦易醒，伴腰困，左胯疼痛。舌苔薄白，脉紧。证属心肾两虚，心肾不交。治疗宜补肾养心，交通心肾。处方：
生龙牡各9克 炒枣仁15克 远志7.5克 熟地9克 生山药15克 杜仲9克 续断6克 川牛膝4.5克 炙甘草3克
两剂，水煎服。
按语：不寐兼腰困，是为肾虚不寐。腰为肾之府，肾主骨生髓，肾髓不足，而出现腰困。生龙牡重镇安神作用较强而治失眠；炒枣仁补肝宁心，治虚烦不眠，易醒多梦；远志交通心肾，治惊悸失眠；熟地滋补肾阴，能填精髓；山药补脾益肾，强肾固精；杜仲补肝肾、强筋骨、益腰膝，治肝肾阴虚所致的腰痛；续断补肝肾、续筋骨、通血脉，治肾虚腰酸痛；川牛膝逐瘀通经利关节而治腰痛。
案三 王某，男性，46岁。门诊号：24132。
1959年12月22日初诊：不寐，头晕，耳鸣，腰困，手足心发烧，舌质红，脉虚数。证属肾阴虚。治疗宜滋补肾阴，宁心安神。方用六味地黄汤加味：
熟地9克 山萸肉9克 生山药15克 茯苓9克 丹皮9克 泽泻9克 炒枣仁15克 远志7.5克
两剂，水煎服。
二诊：服药后头晕、耳鸣、手足心烧、不寐均减轻，但自觉失眠时心烦加剧。上方中加栀子4.5克，淡豆豉9克。两剂，水煎服。
按语：此系肾阴虚引起的不寐。肾阴不足，心肝火旺，虚火上炎，故见头晕，耳鸣，手足心发烧，以至失眠。舌质红、脉虚数均为阴虚有热之象。肾主骨，腰为肾之府，肾虚故见腰困。方用六味地黄汤滋阴补肾，加炒枣仁补肝宁心，治虚火上炎引起的失眠；远志交通心肾，镇惊安神。该方有补有泻，寓泻于补，有合有开，三阴并治。二诊在上方中加栀子、豆豉清泻三焦之火，除烦治不眠。
案四 刘某，女性，40岁。门诊号：81928。
1964年11月6日初诊：失眠，多梦，易惊易醒，心悸，舌苔薄白，脉弦细。证属心胆气虚。治疗宜益气养心，安神定志。处方：
党参4.5克 炒枣仁15克 菖蒲4.5克 远志4.5克 五味子4.5克 茯神4.5克 生龙骨4.5克 生牡蛎4.5克
两剂，水煎服。
按语：此证系心胆气虚，心虚则神不安，胆虚则善惊多恐，故心悸多梦易醒。党参益气补血，补气健脾，以治气血两虚；生龙牡镇惊安神；炒枣仁养肝安神镇惊，肝与胆相表里，养肝可以补胆之不足；菖蒲、远志、茯神交通心肾而补心益肾，治惊悸失眠；五味子养心敛肺，益肾纳气，协助枣仁敛阴安神，治心气不足失眠。
痹证
痹发之前 气血必亏
三气乘之 关节闭塞
痹证是指人体关节部位或四肢、筋骨、肌肉一个部分或几个部分发生的固定或移动的肿痛或重着或麻木不仁或屈伸不利的疾病。
痹证的好发部位一般多在关节，有的固定在一个关节，有的游走无定处，或右或左，或上或下，有的兼肿兼重或酸困，或兼麻木，有的关节或强直或拘挛，或屈伸不利。除了后期丧失知觉，不知痛痒外，痹证鲜有不疼痛者。
痹证的发生，虽《素问·痹论》有“风寒湿三气杂至，合而为痹也”的论述，但邪之所凑，其气必虚。痹证虽由风寒湿热等外邪侵袭所致，但人身正气的偏虚，气血不足，腠理肌表不固，是引起痹证的内在因素。其主要病机为人身气血先虚，外邪乘虚入侵，阻滞经络，气血运行不畅，以致肌肉或关节疼痛、麻木、重着、屈伸不利而形成痹证。如《灵枢·五变》说：“粗理而内不坚者，善病痹。”《临证指南·痹》说：“痹者，闭而不通之谓也，正气为邪所阻，脏腑经络不能畅达，皆由气血亏损，腠理疏豁，风寒湿之气得以乘虚外袭，留滞于内，致湿痰浊血流注凝涩而得之。”
Second visit: After taking two doses of the above prescription, dizziness disappeared, but fatigue remained, with a pulsating sensation in the abdomen and worsening bitter taste in the mouth. Since the main symptoms such as dizziness and nausea had resolved, Tianma (Gastrodiae Rhizoma) and Banxia (Pinelliae Rhizoma) were removed from the original formula. The worsening bitter taste indicates heat in the Liver channel; therefore, the acrid-drying Banxia should be removed, and raw Baishao (Paeoniae Radix Alba) with its sour flavor and slight cold nature should be added to nourish blood and consolidate yin, thereby pacifying the Liver Yang. This suppresses Wood to support Earth and alleviates pain. After taking two doses, the bitter taste vanished immediately.
Commentary: This case of vertigo was caused by Spleen deficiency leading to phlegm-dampness obstruction in the middle jiao, accompanied by hyperactive Liver Yang. Therefore, Liujunzi Tang (Six Gentlemen Decoction) combined with Cangzhu (Atractylodis Rhizoma) was used to strengthen the Spleen, replenish Qi, dry dampness, and resolve phlegm. Tianma (Gastrodiae Rhizoma) and Juhua (Chrysanthemi Flos) were used to pacify the Liver and subdue Yang. Zexie (Alismatis Rhizoma) promotes urination to solidify the stool. Baixiangren (Amomi Fructus Rotundus) resolves dampness, moves Qi, warms the middle, and stops vomiting. Together, these actions eliminate phlegm-dampness, stopping vomiting and nausea, and calm Liver Yang, stopping vertigo. In the second visit, the acrid-drying Banxia and Tianma were removed, and Baishao was added for its sour-cold property to nourish blood and soften the Liver, suppressing Wood to support Earth, to consolidate the therapeutic effect.
Case 3: Patient Li, Female, 36 years old. Outpatient No.: 46905.
First visit on September 18, 1961: For the past week, she has experienced dizziness with a distending sensation, neck stiffness, joint pain, heavy sensations in both feet, poor appetite, nausea, preference for hot drinks, loose stools, yellow urine, white greasy tongue coating, and slippery pulse. This belongs to the syndrome of Wind-Dampness Bi obstructing the clear orifices. The treatment principle is to strengthen the Spleen, resolve phlegm, dispel Wind, and overcome Dampness. The formula used is Erchen Tang (Two Aged Herbs Decoction) with modifications:
Chenpi (Citri Reticulatae Pericarpium) 7.5g, Banxia (Pinelliae Rhizoma) 9g, Fuling (Poria) 7.5g, Qianghuo (Notopterygii Rhizoma et Radix) 4.5g, Duhuo (Angelicae Pubescentis Radix) 4.5g, Cangzhu (Atractylodis Rhizoma) 6g, Baizhu (Atractylodis Macrocephalae Rhizoma) 6g, Shengjiang (Zingiberis Rhizoma Recens) 3 slices.
After taking two doses, the main symptoms improved significantly. Two more doses were taken. Dizziness stopped, and all other symptoms resolved.
Commentary: This case involves vertigo due to Spleen deficiency with phlegm-dampness obstruction in the middle jiao, complicated by external Wind-Dampness invasion. In the formula, Erchen Tang combined with Cangzhu and Baizhu dries dampness, strengthens the Spleen, and resolves phlegm-dampness. Qianghuo and Duhuo dispel Wind-Dampness throughout the body, unblocking collaterals and orifices. Shengjiang is added to warm the stomach and intestines, assist Spleen transportation, and resolve phlegm-dampness.
Treating Vertigo from External Wind-Heat: Using Exterior-Releasing Methods Must Include Blood-Invigorating Strategies
Widely applying blood-invigorating therapies and herbs to the treatment of internal injury miscellaneous diseases in various clinical specialties is a major characteristic of Dr. Li Hanqing’s academic experience and medication methods, yielding significant results. For example, non-surgical blood-invigorating therapy for ectopic pregnancy, specifically Ectopic Pregnancy Formula I and Formula II, have long been included in medical dictionaries and textbooks, known widely within the medical community. However, the experience of using blood-invigorating methods for external contraction diseases, particularly external Wind-Heat, such as external headache and vertigo, achieving miraculous effects, is less known. Regarding blood stasis syndromes, Dr. Li often advocates the theory that "all diseases involve blood stasis." Regarding the causes of blood stasis, he believes that not only Cold pathogenic factors can cause stasis, but Heat pathogenic factors can also cause it. He stated: "Suwen" focuses mostly on Cold coagulating into blood stasis, while "Shanghan Lun" focuses mostly on Heat pathogenic factors causing stagnation leading to stasis, such as "Yangming syndrome, if the person suffers from forgetfulness, there must be stored blood," "Fever for seven or eight days... by the sixth or seventh day, no bowel movement, indicating blood stasis," "Taiyang disease unresolved, Heat結s in the Bladder, the person acts like a madman, blood comes out spontaneously," etc. The stored blood syndrome, Heat-stasis in the interior syndrome, and Heat entering the Blood Chamber syndrome mentioned here all belong to blood stasis caused by Heat. Ye Tianshi said: "In summer, prolonged Heat enters the blood, most commonly causing the stored blood syndrome, with delirium and coma..." Wang Qingren's "Yilin Gaicuo" further explicitly states that both Cold and Heat can cause stasis, saying: "When blood is affected by Cold, it condenses into masses; when blood is affected by Heat, it is boiled into masses." Building upon inheriting the experiences of former sages, Dr. Li applied blood-invigorating methods to external Wind-Heat syndromes, often achieving remarkable effects, demonstrating unique ingenuity.
Attached Cases:
Case 1: Patient Duan, Female, 45 years old. Outpatient No.: 90727.
First visit on May 31, 1965: Dizziness and headache for 2 days, neck pain worsened by turning the head, feeling feverish and aversion to cold, thin white tongue coating, floating and rapid pulse. This is an exterior Wind-Heat syndrome. The treatment principle is acrid-cool exterior-releasing, clearing heat and detoxifying, combined with blood invigoration. Prescription:
Hangjuhua (Chrysanthemi Flos) 9g, Lianqiao (Forsythiae Fructus) 9g, Bohe (Menthae Haplocalycis Herba) 4.5g, Chaihu (Bupleuri Radix) 4.5g, Dangguiwei (Angelicae Sinensis Radix Cauda) 6g, Chishao (Paeoniae Radix Rubra) 6g, Yinhua (Lonicerae Japonicae Flos) 9g, Manjingzi (Vittadiniae Fructus) 6g, Gancao (Glycyrrhizae Radix et Rhizoma) 3g.
After one dose of the above prescription, main symptoms reduced significantly; cured after two doses.
Commentary: This formula primarily uses acrid-cool exterior-releasing and wind-dispelling heat-clearing methods. Yinhua and Lianqiao clear heat and release the exterior, dispersing warm pathogens. Bohe and Juhua disperse wind and clear heat, brighten the Liver and eyes, treating headache and dizziness. Chaihu releases the exterior and clears heat, guiding Shaoyang pathogens outward. Dr. Li pays close attention to the dosage of Chaihu: for heavy fever and mild aversion to cold, a light dose is used, usually 4.5g; for heavy aversion to cold and mild fever, a heavier dose is used, usually 9g. Manjingzi is acrid, bitter, and slightly cold, effective for external Wind-Heat headache. Its acridity disperses wind, bitterness and slight cold clear heat. Being light and floating, it ascends easily, dispersing Wind pathogens in the head and face. Dangguiwei and Chishao invigorate blood and resolve stasis, designed for Wind-Heat causing stasis, allowing Qi and Blood to flow freely, eliminating stagnation, clearing the head and eyes, and stopping vertigo. The ingenious use of these two blood-invigorating herbs significantly improves efficacy and shortens treatment duration, representing a unique aspect of his medication.
Case 2: Patient Qu, Female, 30 years old. Outpatient No.: 56999.
First visit on November 26, 1962: Dizziness and headache for 2 days, alternating chills and fever, bitter taste and dry throat, nausea, abdominal pain, dark tongue body, thin white coating, wiry pulse. This is a Shaoyang syndrome. The treatment principle is harmonizing Shaoyang, dispelling wind and clearing heat, combined with blood invigoration and stasis resolution. The formula is Xiaochaihu Tang (Minor Bupleurum Decoction) with modifications:
Danggui (Angelicae Sinensis Radix) 9g, Sheng Baishao (Paeoniae Radix Alba) 9g, Chaihu (Bupleuri Radix) 3g, Fuling (Poria) 3g, Huangqin (Scutellariae Radix) 3g, Hangjuhua (Chrysanthemi Flos) 9g, Banxia (Pinelliae Rhizoma) 6g, Wulingzhi (Trogopterori Faeces) 4.5g, Sheng Puhuang (Typhae Pollen) 4.5g.
Main symptoms lightened after one dose; cured after two doses.
Commentary: This case uses Xiaochaihu Tang. The main herbs Chaihu, Huangqin, and Banxia harmonize Shaoyang, reduce fever, and direct rebellious Qi downward. Danggui and Baishao aim to tonify blood and nourish Yin to soften the Liver. Wulingzhi and Sheng Puhuang constitute Shixiao San (Smile Powder) from "Ju Fang," functioning to invigorate blood, resolve stasis, dissipate nodules, and alleviate pain. Tang Rongchuan in "Xue Zheng Lun" states: "Puhuang grows in water; its flower fragrance moves water. Water is Qi; when water moves, Qi moves; when Qi stops, Blood stops. Thus, Puhuang can stop bleeding from knife wounds. Wulingzhi has a warm aroma to move blood. These two herbs combined greatly move blood." Dr. Li frequently uses these two herbs in internal injury miscellaneous diseases for blood invigoration, stasis resolution, nodule dissipation, and pain relief, often achieving good results. Used for external contraction dizziness and headache, they are equally miraculous.
Neurasthenia
Syndrome Differentiation and Treatment of Neurasthenia Focuses on Heart and Kidney
Neurasthenia is a Western medical term, belonging to neurosis. In Traditional Chinese Medicine (TCM), it falls under the category of internal injury miscellaneous diseases, commonly presenting as insomnia and other syndromes. In terms of Zang-Fu organs and meridians, it mainly involves pathological changes in the Heart, Liver, Kidney, Spleen, and Stomach. At one time, the view of treating neurasthenia primarily from the Liver was very prevalent. Mr. Qin analyzed the primary and secondary symptoms and their frequency, as well as the interrelationships among Zang-Fu organs, believing that Liver pathology occupies an important position in this disease. Because the Liver has generating and controlling relationships with the Heart, Kidney, Spleen, and Stomach, Liver pathology often affects other organs, and vice versa. However, Dr. Li considered this view somewhat forced. He believed that the Five Elements transmission, generation, restriction, overacting, and counter-restriction in internal injury Zang-Fu diseases have broad theoretical guiding significance. All internal injury miscellaneous diseases can transform according to the Five Elements transmission model, not just neurasthenia. As the ancients said: "Pull one hair, and the whole body moves." This means that any part of the human body is interconnected, with nothing existing independently. Symptoms related to the Liver are common in this disease. Therefore, Mr. Qin believed the mechanism of neurasthenia should first be attributed to the Liver. Based on years of clinical experience, Dr. Li believed that neurasthenia presents more symptoms related to Heart and Kidney pathology. Patients suffering from this disease either suffer from excessive mental labor or excessive sexual activity, or both. Those whose Liver is injured by depression and anger must also have one or both of the above causes to develop this disease. Of course, long-term Liver injury can also develop into neurasthenia, but this is rare.
Symptoms of Neurasthenia Related to Heart and Kidney:
1. Symptoms of Heart Blood Deficiency: Palpitations, forgetfulness, palpitation with fear, lack of concentration.
2. Symptoms of Hyperactive Heart Fire: Mental restlessness and irritability, difficulty falling asleep. Easy awakening during sleep, frequent dreams, excessive sweating.
3. Symptoms of Kidney Yin Deficiency with Hyperactive Ministerial Fire: Tinnitus, insomnia, soreness and weakness of lower back and knees. Spermatorrhea and premature ejaculation, dry and painful throat, hot palms and soles, yellow-red urine, fine and rapid pulse.
4. Symptoms of Kidney Yang Deficiency: Fear of cold, cold hands and feet, decreased libido, impotence, frequent and clear urination, deep, slow, and forceless pulse.
5. Symptoms of Failure of Heart and Kidney Interaction: Indifference of mind, fatigue and weakness, palpitations, insomnia, chest discomfort, hanging fluid retention.
Although clinical manifestations of neurasthenia are mostly Heart and Kidney pathological syndromes, the above syndromes rarely appear alone but are often accompanied by syndromes of other Zang-Fu organs, making mixed types more common. Such as Heart-Spleen Dual Deficiency type, Heart-Kidney Dual Deficiency type, Liver-Kidney Yin Deficiency type, Heart-Gallbladder Qi Deficiency type, Spleen-Kidney Yang Deficiency type, etc.
Attached Cases:
Case 1: Patient Wang, Female, 29 years old. Outpatient No.: 46927.
First visit on July 26, 1961: Insomnia, frequent dreams, numbness in hands and feet, reduced diet, abdominal pain before defecation. Ill for over 2 months following a miscarriage. Thin white tongue coating, deficient pulse. Syndrome belongs to Heart-Spleen Dual Deficiency. Treatment principle: Strengthen Spleen and nourish Heart. Prescription:
Sheng Baizhu (Atractylodis Macrocephalae Rhizoma) 7.5g, Dangshen (Codonopsis Radix) 7.5g, Zhi Huangqi (Astragali Radix Praeparata cum Melle) 6g, Danggui (Angelicae Sinensis Radix) 7.5g, Fushen (Poria cum Radix Pinelli) 7.5g, Yuanzhi (Polygalae Radix) 6g, Chao Zaoren (Ziziphi Spinosomi Semen Praeparatum) 15g, Guangmuxiang (Costi Rhizoma) 3g, Yuanrou (Euphorbiae Lathyridis Arillus) 6g, Sheng Baishao (Paeoniae Radix Alba) 7.5g, Guizhi (Cinnamomi Ramulus) 4.5g, Zhi Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) 3g.
Two doses, decocted in water and taken orally.
Commentary: Heart-Spleen dual deficiency leads to Blood failing to nourish the Heart. The Spleen is the source of production and transformation; insufficient source fails to nourish the Heart, resulting in frequent dreams and easy awakening. Spleen deficiency fails to control Blood; Blood failing to nourish the Heart causes insomnia. Blood deficiency failing to nourish tissues causes numbness in hands and feet. The Spleen governs transportation and transformation; failure of grain and water metabolism causes poor appetite. Excessive blood loss from miscarriage causes Blood deficiency. Spleen deficiency allows Wood to overact on Earth, causing abdominal pain. GuiPi Tang (Restore the Spleen Decoction) with modifications is selected to strengthen the Spleen, nourish the Heart, tonify Qi and Blood. When Qi is vigorous, Blood is generated; when Blood is sufficient, the Heart is nourished, and sleep naturally calms. In the formula, Dangshen, Huangqi, Baizhu, and Zhi Gancao strengthen the Spleen, dry dampness, tonify Qi, and nourish Blood. Yuanrou, Danggui, Fushen, and Yuanzhi nourish Blood, tonify the Heart, calm the Spirit, and stabilize the Mind. Chao Zaoren nourishes the Liver, calms the Heart, stabilizes the Spirit, and is especially effective for irritability and insomnia caused by excessive blood loss, worry, and mental overwork damaging Heart and Spleen. Muxiang regulates Qi, awakens the Spleen, preventing tonification from causing stagnation. Baishao nourishes Blood, consolidates Yin, pacifies the Liver, and alleviates pain, used for Liver-Spleen disharmony with cramping abdominal pain. Guizhi unblocks the Yang of Heart and Spleen. "Ben Jing Shu Zheng" states: "Guizhi is red, with longitudinal and transverse patterns, resembling meridian networks. Red corresponds to the Heart; longitudinally and transversely connecting meridians, it benefits joints, warms and unblocks meridians; this is its root function." Acridity can dissipate nodules, sweetness can tonify deficiency, thus it can harmonize the skin and pores, descend rebellious Qi, alleviate pain, and remove irritability; this is its application. Its uses include six aspects: "harmonizing Ying, unblocking Yang, promoting urination, descending Qi, moving blood stasis, tonifying the Middle." Additionally, it assists Heart Yang and warms/transforms fluid retention. Based on years of clinical practice, Dr. Li treats Heart-Spleen dual deficiency insomnia using GuiPi Tang with added Guizhi, fully reflecting his flexible syndrome differentiation and precise modification of medications.
Second visit: After taking medicine, insomnia, frequent dreams, abdominal pain, and hand-foot numbness all reduced. Nighttime sleep duration extended by about 1 hour, but chest tightness and aversion to cold were felt. Prescription:
Sheng Baizhu (Atractylodis Macrocephalae Rhizoma) 7.5g, Dangshen (Codonopsis Radix) 7.5g, Danggui (Angelicae Sinensis Radix) 7.5g, Fushen (Poria cum Radix Pinelli) 7.5g, Yuanzhi (Polygalae Radix) 6g, Chao Zaoren (Ziziphi Spinosomi Semen Praeparatum) 15g, Guangmuxiang (Costi Rhizoma) 3g, Yuanrou (Euphorbiae Lathyridis Arillus) 6g, Sheng Baishao (Paeoniae Radix Alba) 7.5g, Sheng Longgu (Fossilia Ossis Maxillaris) 7.5g, Sheng Muli (Concha Ostreae) 7.5g, Jingjie Sui (Schizonepetae Spica) 4.5g, Zhi Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) 3g.
Two doses, decocted in water and taken orally.
Commentary: Insomnia and frequent dreams caused by Heart-Spleen dual deficiency showed effectiveness after taking GuiPi Tang which tonifies Qi, strengthens Spleen, nourishes Blood, and calms the Spirit. However, because the patient also suffered from chest tightness, Huangqi was removed from the first visit formula. Huangqi is slightly warm, raises clear Qi, but tends to aid Fire and consolidates the exterior. Therefore, it is unsuitable for cases with exterior pathogens, interior accumulation, Qi stagnation with chest fullness, excess Yang with deficient Yin, upper heat and lower cold, hyperactive Liver with irritability, and initial stage of carbuncles or post-ulceration with remaining heat toxins. Adding Sheng Longgu and Sheng Muli has the function of calming fright and anchoring the Spirit, treating irritability, palpitations, and insomnia caused by Yin deficiency with Yang hyperactivity, possessing the effect of nourishing Yin, clearing heat, and removing irritability. Adding Jingjie Sui, which is acrid and warm, lightly and diffusely disperses, can dispel Wind-Cold and treat aversion to cold.
Case 2: Patient Zhang, Male, 27 years old. Outpatient No.: 37204.
First visit on January 11, 1961: Insomnia, restless sleep, frequent dreams, easy awakening, accompanied by lower back fatigue, left hip pain. Thin white tongue coating, tight pulse. Syndrome belongs to Heart-Kidney Dual Deficiency and failure of Heart-Kidney interaction. Treatment principle: Tonify Kidney, nourish Heart, and facilitate Heart-Kidney interaction. Prescription:
Sheng Longgu (Fossilia Ossis Maxillaris) and Sheng Muli (Concha Ostreae) each 9g, Chao Zaoren (Ziziphi Spinosomi Semen Praeparatum) 15g, Yuanzhi (Polygalae Radix) 7.5g, Shudi (Rehmanniae Radix Praeparata) 9g, Sheng Shanyao (Dioscoreae Rhizoma) 15g, Duzhong (Eucommiae Cortex) 9g, Xuduan (Dipsaci Radix) 6g, Chuan Niuxi (Achyranthis Bidentatae Radix) 4.5g, Zhi Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) 3g.
Two doses, decocted in water and taken orally.
Commentary: Insomnia accompanied by lower back fatigue indicates Kidney deficiency insomnia. The waist is the house of the Kidney; the Kidney governs bones and generates marrow. Insufficient Kidney marrow leads to lower back fatigue. Sheng Longgu and Sheng Muli have strong sedative and spirit-anchoring effects for treating insomnia. Chao Zaoren tonifies the Liver and calms the Heart, treating empty irritability, insomnia, easy awakening, and frequent dreams. Yuanzhi facilitates Heart-Kidney interaction, treating palpitations and insomnia. Shudi nourishes and tonifies Kidney Yin, filling essence and marrow. Shanyao tonifies Spleen and benefits Kidney, strengthening Kidney and securing essence. Duzhong tonifies Liver and Kidney, strengthens sinews and bones, benefits waist and knees, treating lower back pain caused by Liver-Kidney Yin deficiency. Xuduan tonifies Liver and Kidney, connects sinews and bones, unblocks vessels, treating sore and weak lower back pain due to Kidney deficiency. Chuan Niuxi expels blood stasis, unblocks meridians, benefits joints, and treats lower back pain.
Case 3: Patient Wang, Male, 46 years old. Outpatient No.: 24132.
First visit on December 22, 1959: Insomnia, dizziness, tinnitus, lower back fatigue, burning sensation in palms and soles, red tongue body, deficient and rapid pulse. Syndrome belongs to Kidney Yin Deficiency. Treatment principle: Nourish and tonify Kidney Yin, calm the Heart and anchor the Spirit. Formula: Liuwei Dihuang Tang (Six-Ingredient Pill with Rehmannia) with modifications:
Shudi (Rehmanniae Radix Praeparata) 9g, Shanzhuyu (Corni Fructus) 9g, Sheng Shanyao (Dioscoreae Rhizoma) 15g, Fuling (Poria) 9g, Danpi (Moutan Cortex) 9g, Zexie (Alismatis Rhizoma) 9g, Chao Zaoren (Ziziphi Spinosomi Semen Praeparatum) 15g, Yuanzhi (Polygalae Radix) 7.5g.
Two doses, decocted in water and taken orally.
Second visit: After taking medicine, dizziness, tinnitus, burning in palms and soles, and insomnia all reduced, but irritability during insomnia intensified. Added Zhizi (Gardeniae Fructus) 4.5g and Danshi (Fermented Sojae Semen Preparatum) 9g to the above formula. Two doses, decocted in water and taken orally.
Commentary: This is insomnia caused by Kidney Yin deficiency. Insufficient Kidney Yin leads to hyperactive Heart and Liver Fire, with deficiency Fire flaming upward, causing dizziness, tinnitus, burning in palms and soles, and insomnia. Red tongue body and deficient-rapid pulse are signs of Yin deficiency with heat. The Kidney governs bones, and the waist is the house of the Kidney; Kidney deficiency causes lower back fatigue. Liuwei Dihuang Tang nourishes Yin and tonifies the Kidney. Chao Zaoren is added to nourish the Liver and calm the Heart, treating insomnia caused by deficiency Fire flaming upward. Yuanzhi facilitates Heart-Kidney interaction, calming fright and anchoring the Spirit. This formula contains both tonification and purging, embedding purging within tonification, combining opening and closing, treating the Three Yin simultaneously. In the second visit, Zhizi and Danshi were added to clear and purge Fire in the Triple Burner, remove irritability, and treat insomnia.
Case 4: Patient Liu, Female, 40 years old. Outpatient No.: 81928.
First visit on November 6, 1964: Insomnia, frequent dreams, easily startled and awakened, palpitations, thin white tongue coating, wiry and fine pulse. Syndrome belongs to Heart-Gallbladder Qi Deficiency. Treatment principle: Tonify Qi, nourish Heart, calm the Spirit, and stabilize the Mind. Prescription:
Dangshen (Codonopsis Radix) 4.5g, Chao Zaoren (Ziziphi Spinosomi Semen Praeparatum) 15g, Changpu (Acori Tatarinowii Rhizoma) 4.5g, Yuanzhi (Polygalae Radix) 4.5g, Wuweizi (Schisandrae Chinensis Fructus) 4.5g, Fushen (Poria cum Radix Pinelli) 4.5g, Sheng Longgu (Fossilia Ossis Maxillaris) 4.5g, Sheng Muli (Concha Ostreae) 4.5g.
Two doses, decocted in water and taken orally.
Commentary: This syndrome is Heart-Gallbladder Qi Deficiency. Heart deficiency leads to unsettled Spirit; Gallbladder deficiency leads to being easily startled and fearful, hence palpitations, frequent dreams, and easy awakening. Dangshen tonifies Qi and nourishes Blood, tonifies Qi and strengthens Spleen, treating Qi and Blood dual deficiency. Sheng Longgu and Sheng Muli calm fright and anchor the Spirit. Chao Zaoren nourishes the Liver, calms the Spirit, and anchors fright; since Liver and Gallbladder are interior-exterior paired, nourishing the Liver can supplement Gallbladder insufficiency. Changpu, Yuanzhi, and Fushen facilitate Heart-Kidney interaction, tonify Heart and benefit Kidney, treating palpitations and insomnia. Wuweizi nourishes the Heart, consolidates the Lungs, benefits the Kidney, and grasps Qi, assisting Zaoren to consolidate Yin and calm the Spirit, treating insomnia due to Heart Qi deficiency.
Bi Syndrome
Before Bi Onset, Qi and Blood Must Be Deficient
Three Pathogens Attack, Joints Become Obstructed
Bi Syndrome refers to diseases occurring in fixed or migrating swelling and pain, heaviness, numbness and insensitivity, or limited flexion and extension in the joints, limbs, bones, tendons, muscles, or parts thereof.
The predisposed sites for Bi syndrome are generally joints. Some are fixed in one joint, some wander without a fixed location, right or left, up or down. Some are accompanied by swelling, heaviness, soreness, or numbness. Some joints become stiff or spasmodic, or have limited flexion and extension. Except for the late stage where sensation is lost and pain/itch are unknown, Bi syndrome rarely lacks pain.
Regarding the occurrence of Bi syndrome, although "Suwen · Pi Lun" states "Wind, Cold, and Dampness three pathogens mix together, combining to form Bi," where pathogens gather, Qi must be deficient. Although Bi syndrome is caused by external pathogens such as Wind, Cold, Dampness, and Heat, the inherent factor causing Bi syndrome is the relative deficiency of healthy Qi in the body, insufficiency of Qi and Blood, and insecurity of the skin pores and muscle surface. Its main pathogenesis is the prior deficiency of Qi and Blood in the body, allowing external pathogens to invade through the deficiency, blocking the meridians, causing poor circulation of Qi and Blood, leading to muscle or joint pain, numbness, heaviness, and limited flexion and extension, forming Bi syndrome. As "Lingshu · Wu Bian" says: "Those with coarse texture and internal fragility are prone to Bi." "Linzheng Zhinan · Bi" says: "Bi means closure and obstruction. Healthy Qi is blocked by pathogens, Zang-Fu organs and meridians cannot flow smoothly, all due to Qi and Blood depletion, open skin pores, allowing Wind, Cold, and Dampness to invade vacuously, staying inside, causing damp-phlegm, turbid fluids, and blood stasis to flow and congeal, resulting in this condition."