[主症]心烦,心悸,心痛,暴上气而喘,有时则恐,咽干噫气。
[诊断]以本病的主症为主,再参合病史是否曾有脉痹.血管变色,则不难诊断。
[治法]养心祛邪,活血通脉。
[方剂]
(1)三痹汤:主治心痹而气血虚者。
(2)独活寄生汤:本方即三痹汤去黄芪、续断,加桑寄生而成。为治痹证日久人脏,补血祛邪之方,可用于心痹正虚邪实者。
(3)加味五痹汤:五痹汤加远志、茯神、麦冬、犀角,倍白芍。主治心痹而正虚者。
李老认为,上述三方均为补正祛邪之剂,可用于心痹。三方区别在于三痹汤药力较大,寄生汤次之,五痹汤又次之.用时对证选择可也,如在用量上加以注意则更为确当。
15.肝痹
[释名]肝痹是因筋痹日久不愈,复感于邪,内犯于肝而成的一种内脏痹证。
[主症]喜饮,小便数多,夜卧则惊,太息。
[诊断]本病诊断不难,根据主症,再结合病史曾有筋痹(即筋挛关节屈伸不利之症状)即是。
[治法]扶正祛邪。
[方剂]
(1)三痹汤:补正祛邪,可用于肝痹之重症者。
(2)独活寄生汤:补正祛邪,可用于肝痹。
(3)加味五痹汤:五痹汤加酸枣仁、柴胡,倍白芍。治肝痹而肝郁、夜寐不宁者。
16.脾痹
[释名]脾痹是因肌痹日久不愈,复感于邪而形成的一种内脏痹证。
[主症]呕涎,心下痞硬,四肢懈惰。
[诊断]此病诊断不难,首先根据本病的主症,再参合以前曾否有过肌痹的肌肉麻木、不知痛痒等症状即可确诊。
[治法]以补正为主,斟酌加入祛邪之品。
[方剂]
(直)三痹汤。
(2)独活寄生汤。
(3)加味五痹汤:五痹汤加厚朴、枳实、砂仁、神曲,倍白术。
以上三方均以补正祛邪为主,其中三痹汤药力较大,寄生次之。五痹汤又次之。用时随证之轻重取去可也。
17.肺痹
[释名]肺痹是由皮痹日久不愈,复感于邪而形成的一种内脏痹证。
[主症]心烦,胸满,气喘,咳嗽,呕吐。
[诊断]本病诊断不难,根据本病的主症,再参合病史是否曾有皮肤麻木等皮痹症状即可确诊。
[治法]因属久病,仍以补正祛邪为主。
[方剂]
(直)三痹汤。
(2)独活寄生汤。
(3)加味五痹汤:五痹扬加半夏、紫菀、杏仁、麻黄。
以上三方都以补正祛邪为主,三痹汤药力较大,寄生汤次之。五痹汤又次之,用时据具体症状加以选择可也。
18.肾痹
[释名]肾痹是指骨痹日久不愈,复感于邪而形成的一种内脏痹证。
[主症]腹胀,尻以代踵,脊以代头。
[诊断]根据主症即可确定,参合病史曾有骨痹症状则更为准确。
[治法]补正祛邪。
[方剂]
(1)三痹汤。
(2)独活寄生汤。
(3)加味五痹汤:五痹汤加独活、官桂、杜仲、牛膝、黄芪、萆蘚,倍白芍。
以上三方都是补正祛邪之剂,三痹汤药力较大,独活寄生汤次之,五痹汤又次之。用时如能根据症状适当地加以裁剪则更好。
昏
迷
神昏辨治
神昏是临床上常见的危重证候之一。表现以神志不清、昏不知人为特征。但其具体病因、病机、临床见症较为复杂,当予细辨。神昏之属于阳明者,大渴,舌黄干燥,壮热,脉洪大,为白虎汤证。如舌黄干,腹满拒按,脉沉实而有力者,为承气汤证。若少阴病之神昏,特点为沉沉欲寐,郑声,舌润无苔,脉沉微,多兼厥冷,有兼热者,多属阴盛格阳,为病之后期多出现,如夹痰湿,舌苔腻,小便不利,属真武汤证,否则属四逆汤证(又,初期之热,应考虑为麻黄附子细辛汤证)。若邪入心包,多兼谵语舌绛,高热,温病神昏,多系此类型,为脑疾患。也有因瘀血的,曾治一产后昏不知人,少腹压痛,不发热,兼有强直,逐瘀之后即愈。若厥阴之神昏,多兼抽搐、强直、惊厥之征象,于清热剂中须加羚羊角、钩藤、全蝎、蜈蚣之属,这种抽搐有属于白虎汤证者,有属于邪入心营者,后者可用安宫牛黄丸、至宝丹或紫雪丹之类药品,辅以汤剂治之,以清心开窍,镇惊熄风。因其他疼痛原因而致神昏者,多为急性病,痛止之后,即可清醒。因癔病之神昏者,多不发热,由精神刺激而发,多伴有四肢拘挛。因痰浊蒙蔽清窍而致神昏者,其舌苔必然厚腻,湿温证多见之,宜菖蒲郁金汤合苏合香丸治之。
以上为神昏之大概也。凡属神昏,多为危证,当予高度注意。大凡脉象清晰有力者,多能治好;微弱细数,模糊不清者,预后堪忧。又有一种郁冒现象,多见于战汗之前,患者多突然人事糊涂,昏昏沉沉,为欲作战汗之阳郁现象,伴有肢冷脉伏,可从病情经过中衡量之,若无变坏之机,且与服药无关者,即可以向这方面考虑。
一氧化碳中毒
一氧化碳中毒 宜从痰瘀论治
李老认为,轻度、中度的一氧化碳中毒,有的不治自愈,有的必须急灌醋或酸菜汤才可恢复;若为重度者,特别是表现痴呆、木僵、瘫痪、失语、长期昏迷、惊厥者,治疗起来殊感棘手。一般来讲,痴呆、失语、昏迷多因秽浊蒙蔽心窍所致,瘫痪、惊厥者多因血不养肝或瘀血阻滞所致,前者主治以开窍化痰,后者主治以活血舒筋。如患者李某,男,60岁,煤气中毒60多天,经某院治疗后神志虽已清醒,但却遗留痴呆,言语謇涩,行动不便,肢体震颤,予饮食则吞咽不止,不予则不知索要食物,予局方至宝丹,1日2丸,10日愈。毛某,男,28岁,煤气中毒昏迷48天,先在某院住院治疗一直不效,乃转我院进行治疗。审其神志昏迷,全身痉挛性瘫痪,发热,舌质红绛,无苔,脉数。综合脉症,诊为秽浊蒙蔽心包,瘀血阻滞。治以凉血活血,开窍化浊。方用局方至宝丹开窍化浊,活络效灵丹加味活血凉血:
丹参15克 赤芍9克 乳香7.5克 没药7.5克 桑枝30克
20天后,患者神志基本清醒,但痴呆、失语、痉挛性瘫痪不见明显改善。因思张锡纯《医学衷中参西录》云:“有因身之拘挛,而不能伸者,盖人身之筋,以宗筋为主,而不能营养宗筋者,阳明也。其人脾胃素弱,不能化谷生液,以荣养宗筋,更兼内有蕴热以铄耗之。或更有风寒所袭,致宗筋之伸缩自由者,竟有缩无伸,浸成拘挛矣。有筋非拘挛,肌肉非痹木,惟觉足软不能履地者,乃骨髓枯涸,肾虚不能作强也。”“骨痿者加鹿胶,鹿胶取其以骨补骨也。”“若其痿专在下肢,可但用牛膝以引之下行。若其人手足并痿者,又宜加桂枝兼引之上行。”“有肌肉痹木,抑搔不知痛痒者,其人或风寒袭人经络,或痰涎郁塞经络,或风寒痰涎互相凝结经络之间,以致血脉闭塞,而其原因,实由于大气虚损。”故在活络效灵丹的基础上加入木瓜、鹿角胶、虎骨胶、黄芪等,瘫痪、失语逐渐好转,半年后果然诸症消失而愈。
虚
劳
血虚证治
血虚为血液不足或血的濡养功能减退的证候,亦称之为贫血、血亏,严重者为血枯、血脱。其形成责之于失血过多,或生血机能发生障碍,或造血材料供应不足等。血虚包括了心血虚、肝血虚、气血两虚、血虚生热、血枯、血脱及现代医学之再障等证候。
血周流循环,营养滋润全身,内至脏腑,外达皮肉筋骨,故血虚为全身或局部失荣失养、功能活动减退之证。李老将血虚证分主症及全身各部症分述:
主症:面色苍白。眼睑唇舌淡红,腹部压之不痛,脉细涩或无力。
全身各部症:身热,呈愈虚愈热,形体消瘦,皮肤干燥,毛发黄脆,筋脉拘挛,伸缩不能自如,性情急躁多怒,头晕痛,耳鸣,面色无华或苍白或淡黄,眼干目眩,视物昏花,惊悸怔忡,失眠健忘,肠燥便难,唇色苍白,舌嫩红而干或舌淡无苔,脉细涩无力或细缓或芤。在妇科表现为月经后期,经闭,经量少,色淡红或呈黄水样,经后腹痛,胎萎不长,胎动小产,产后易患血晕、发痉、大便难及恶露不下等。
[主症] 心烦,心悸,心痛,突然上逆气喘,有时伴有恐惧感,咽干嗳气。
[诊断] 以本病的主症为主要依据,再结合病史中是否有过脉痹、血管变色的情况,就不难做出诊断。
[治法] 滋养心脏,祛除邪气,活血化瘀,疏通脉络。
[方剂]
(1) Sanbi Tang (Three Obstructions Decoction, 三痹汤):主治心痹(Heart Bi Syndrome)且气血虚弱者。
(2) Duhuo Jisheng Tang (Angelica Pubescens and Taxillus Decoction, 独活寄生汤):本方即在三痹汤基础上去掉黄芪(Astragali Radix)、续断(Dipsaci Radix),加入桑寄生(Taxilli Herba)而成。这是治疗痹证日久侵入内脏,具有补血祛邪功效的方剂,可用于心痹正气虚弱而邪气实盛者。
(3) Jiawei Wubi Tang (Modified Five Obstructions Decoction, 加味五痹汤):在五痹汤基础上加入远志(Polygalae Radix)、茯神(Poria with Hostwood)、麦冬(Ophiopogonis Radix)、犀角(Rhinocerotis Cornu,现多用替代品),并加倍使用白芍(Paeoniae Radix Alba)。主治心痹且正气虚弱者。
李老认为,上述三方均为补益正气、祛除邪气的方剂,均可用于心痹。三方的区别在于:三痹汤药力较大,独活寄生汤次之,五痹汤又次之。使用时对证选择即可,如果在用量上加以注意则更为恰当。
15.肝痹(Liver Bi Syndrome)
[释名] 肝痹是因筋痹(Tendon Bi Syndrome)日久不愈,再次感受邪气,内犯于肝脏而形成的一种内脏痹证。
[主症] 喜欢饮水,小便次数多且量大,夜间睡眠时易惊醒,频繁叹气。
[诊断] 本病的诊断不难,根据主症,再结合病史中曾有筋痹(即筋脉挛急、关节屈伸不利等症状)即可确诊。
[治法] 扶持正气,祛除邪气。
[方剂]
(1) Sanbi Tang (Three Obstructions Decoction, 三痹汤):补益正气,祛除邪气,可用于肝痹的重症患者。
(2) Duhuo Jisheng Tang (Angelica Pubescens and Taxillus Decoction, 独活寄生汤):补益正气,祛除邪气,可用于肝痹。
(3) Jiawei Wubi Tang (Modified Five Obstructions Decoction, 加味五痹汤):在五痹汤基础上加入酸枣仁(Ziziphi Spinosae Semen)、柴胡(Bupleuri Radix),并加倍使用白芍(Paeoniae Radix Alba)。治疗肝痹且伴有肝气郁结、夜间睡眠不安者。
16.脾痹(Spleen Bi Syndrome)
[释名] 脾痹是因肌痹(Muscle Bi Syndrome)日久不愈,再次感受邪气而形成的一种内脏痹证。
[主症] 呕吐涎沫,胃脘部痞塞硬满,四肢倦怠无力。
[诊断] 此病诊断不难,首先根据本病的主症,再参考以前是否曾有过肌痹导致的肌肉麻木、不知痛痒等症状,即可确诊。
[治法] 以补益正气为主,斟酌加入祛除邪气的药物。
[方剂]
(1) Sanbi Tang (Three Obstructions Decoction, 三痹汤)。
(2) Duhuo Jisheng Tang (Angelica Pubescens and Taxillus Decoction, 独活寄生汤)。
(3) Jiawei Wubi Tang (Modified Five Obstructions Decoction, 加味五痹汤):在五痹汤基础上加入厚朴(Magnoliae Officinalis Cortex)、枳实(Aurantii Fructus Immaturus)、砂仁(Amomi Fructus)、神曲(Massa Medicata Fermentata),并加倍使用白术(Atractylodis Macrocephalae Rhizoma)。
以上三方均以补益正气、祛除邪气为主,其中三痹汤药力较大,独活寄生汤次之,五痹汤又次之。使用时可根据病情的轻重取舍应用。
17.肺痹(Lung Bi Syndrome)
[释名] 肺痹是由皮痹(Skin Bi Syndrome)日久不愈,再次感受邪气而形成的一种内脏痹证。
[主症] 心烦,胸部胀满,气喘,咳嗽,呕吐。
[诊断] 本病诊断不难,根据本病的主症,再结合病史中是否有过皮肤麻木等皮痹症状,即可确诊。
[治法] 因属于久病,仍以补益正气、祛除邪气为主。
[方剂]
(1) Sanbi Tang (Three Obstructions Decoction, 三痹汤)。
(2) Duhuo Jisheng Tang (Angelica Pubescens and Taxillus Decoction, 独活寄生汤)。
(3) Jiawei Wubi Tang (Modified Five Obstructions Decoction, 加味五痹汤):在五痹汤基础上加入半夏(Pinelliae Rhizoma)、紫菀(Asteris Radix)、杏仁(Armeniacae Semium Amarum)、麻黄(Ephedrae Herba)。
以上三方都以补益正气、祛除邪气为主,三痹汤药力较大,独活寄生汤次之,五痹汤又次之,使用时根据具体症状加以选择即可。
18.肾痹(Kidney Bi Syndrome)
[释名] 肾痹是指骨痹(Bone Bi Syndrome)日久不愈,再次感受邪气而形成的一种内脏痹证。
[主症] 腹胀,臀部着地代替脚跟行走,脊柱弯曲头部前倾代替头颈直立(形容脊背严重弯曲畸形)。
[诊断] 根据主症即可确定,再结合病史中曾有骨痹症状则更为准确。
[治法] 补益正气,祛除邪气。
[方剂]
(1) Sanbi Tang (Three Obstructions Decoction, 三痹汤)。
(2) Duhuo Jisheng Tang (Angelica Pubescens and Taxillus Decoction, 独活寄生汤)。
(3) Jiawei Wubi Tang (Modified Five Obstructions Decoction, 加味五痹汤):在五痹汤基础上加入独活(Angelicae Pubescentis Radix)、官桂(Cinnamomi Cortex)、杜仲(Eucommiae Cortex)、牛膝(Achyranthis Bidentatae Radix)、黄芪(Astragali Radix)、萆薢(Dioscoreae Hypoglaucae Rhizoma),并加倍使用白芍(Paeoniae Radix Alba)。
以上三方都是补益正气、祛除邪气的方剂,三痹汤药力较大,独活寄生汤次之,五痹汤又次之。使用时如果能根据症状适当地加以调整裁剪则更好。
昏迷与神昏的辨证论治
神昏是临床上常见的危重证候之一。其表现以神志不清、昏睡不知人为特征。但其具体的病因、病机及临床见症较为复杂,应当仔细辨别。
若神昏属于阳明经证者,表现为大渴、舌苔黄干燥、高热、脉象洪大,此为 Baihu Tang (White Tiger Decoction, 白虎汤) 的适应证。如果舌苔黄干,腹部胀满拒按,脉象沉实有力,此为 Chengqi Tang (Gut-Purging Decoction, 承气汤) 的适应证。
若是少阴病出现的神昏,特点为精神萎靡似睡非睡、语言重复低微(郑声)、舌润无苔、脉象沉微,多兼有四肢厥冷;若有兼热者,多属阴寒内盛格拒阳气于外(阴盛格阳),多见于疾病后期;若夹带痰湿,舌苔腻,小便不利,属于 Zhenwu Tang (True Warrior Decoction, 真武汤) 的适应证,否则属于 Sini Tang (Frigid Extremities Decoction, 四逆汤) 的适应证。(另外,初期的热证,应考虑为 Mahuang Fuzi Xixin Tang (Ephedra, Aconite and Asarum Decoction, 麻黄附子细辛汤) 的适应证)。
若邪气侵入心包络,多兼有胡言乱语、舌质深红、高热,温病中的神昏多系此类类型,属于脑部疾患。也有因瘀血导致的神昏,曾治疗一例产后神志昏迷不知人,小腹压痛,不发热,兼有肢体强直,在逐瘀之后即痊愈。
若是厥阴病的神昏,多兼有抽搐、强直、惊厥等征象,在清热剂中必须加入 Lingyangjiao (Saiga Tataricae Cornu, 羚羊角)、Gouteng (Uncariae Ramulus cum Uncis, 钩藤)、Quanxie (Scorpio, 全蝎)、Wugong (Scolopendra, 蜈蚣) 等药物。这种抽搐有的属于 Baihu Tang (White Tiger Decoction, 白虎汤) 的适应证,有的属于邪入心营者,后者可用 Angong Niuhuang Wan (Calculus Bovis Pill for Opening the Orifices, 安宫牛黄丸)、Zhibao Dan (Precious Treasure Pellet, 至宝丹) 或 Zixue Dan (Purple Snow Pellet, 紫雪丹) 等成药,辅以汤剂治疗,以清心开窍,镇惊熄风。
因其他疼痛原因而导致神昏者,多为急性病,疼痛停止后即可清醒。因癔病(Hysteria)导致的神昏者,多不发热,由精神刺激引发,多伴有四肢拘挛。因痰浊蒙蔽清窍而导致神昏者,其舌苔必然厚腻,湿温证多见此情况,宜用 Changpu Yujin Tang (Acorus and Curcuma Decoction, 菖蒲郁金汤) 合 Suhexiang Wan (Styrax Pill, 苏合香丸) 治疗。
以上是大致的神昏辨治方法。凡是属于神昏,多为危重证候,应当高度注意。大凡脉象清晰有力者,多能治愈;脉象微弱细数、模糊不清者,预后堪忧。
还有一种郁冒现象,多见于战汗(Shivering Sweat)之前,患者多突然人事糊涂,昏昏沉沉,这是欲作战汗时的阳气郁闭现象,伴有肢冷脉伏,可以从病情经过中衡量判断,若无恶化之机,且与服药无关,即可向这方面考虑。
一氧化碳中毒
一氧化碳中毒宜从痰瘀论治
李老认为,轻度、中度的一氧化碳中毒,有的不治自愈,有的必须急灌醋或酸菜汤才可恢复;若为重度者,特别是表现为痴呆、木僵、瘫痪、失语、长期昏迷、惊厥者,治疗起来殊感棘手。一般来讲,痴呆、失语、昏迷多因秽浊之气蒙蔽心窍所致,瘫痪、惊厥者多因血液不能濡养肝脏或瘀血阻滞所致,前者主治以开窍化痰,后者主治以活血舒筋。
如患者李某,男,60岁,煤气中毒60多天,经某院治疗后神志虽已清醒,但却遗留痴呆,言语謇涩,行动不便,肢体震颤,予饮食则吞咽不止,不予则不知索要食物。予 Jufang Zhibao Dan (Official Bureau's Precious Treasure Pill, 局方至宝丹),每日2丸,10日痊愈。
毛某,男,28岁,煤气中毒昏迷48天,先在某院住院治疗一直无效,乃转我院进行治疗。审其神志昏迷,全身痉挛性瘫痪,发热,舌质红绛,无苔,脉数。综合脉症,诊为秽浊蒙蔽心包,瘀血阻滞。治以凉血活血,开窍化浊。方用 Jufang Zhibao Dan (Official Bureau's Precious Treasure Pill, 局方至宝丹) 开窍化浊, Huoluo Xiaoling Dan (Collateral-Activating and Pain-Alleviating Decoction, 活络效灵丹) 加味以活血凉血:
Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 15克, Chishao (Paeoniae Radix Rubra, 赤芍) 9克, Ruxiang (Olibanum, 乳香) 7.5克, Moyao (Myrrha, 没药) 7.5克, Sangzhi (Mori Ramulus, 桑枝) 30克。
20天后,患者神志基本清醒,但痴呆、失语、痉挛性瘫痪不见明显改善。因思张锡纯《医学衷中参西录》云:“有因身之拘挛,而不能伸者,盖人身之筋,以宗筋为主,而不能营养宗筋者,阳明也。其人脾胃素弱,不能化谷生液,以荣养宗筋,更兼内有蕴热以铄耗之。或更有风寒所袭,致宗筋之伸缩自由者,竟有缩无伸,浸成拘挛矣。有筋非拘挛,肌肉非痹木,惟觉足软不能履地者,乃骨髓枯涸,肾虚不能作强也。”“骨痿者加鹿胶,鹿胶取其以骨补骨也。”“若其痿专在下肢,可但用牛膝以引之下行。若其人手足并痿者,又宜加桂枝兼引之上行。”“有肌肉痹木,抑搔不知痛痒者,其人或风寒袭人经络,或痰涎郁塞经络,或风寒痰涎互相凝结经络之间,以致血脉闭塞,而其原因,实由于大气虚损。”故在 Huoluo Xiaoling Dan (Collateral-Activating and Pain-Alleviating Decoction, 活络效灵丹) 的基础上加入 Mugua (Chaenomelis Fructus, 木瓜)、Lujiaojiao (Cervi Cornus Colla, 鹿角胶)、Hugu Jiaojiao (Pantheris Os Cum Cartilagine, 虎骨胶,现多用替代品)、Huangqi (Astragali Radix, 黄芪) 等,瘫痪、失语逐渐好转,半年后果然诸症消失而愈。
虚劳
血虚证治
血虚为血液不足或血的濡养功能减退的证候,亦称之为贫血、血亏,严重者为血枯、血脱。其形成责之于失血过多,或生血机能发生障碍,或造血材料供应不足等。血虚包括了心血虚、肝血虚、气血两虚、血虚生热、血枯、血脱及现代医学之再生障碍性贫血等证候。
血周流循环,营养滋润全身,内至脏腑,外达皮肉筋骨,故血虚为全身或局部失荣失养、功能活动减退之证。李老将血虚证分主症及全身各部症分述:
主症:面色苍白。眼睑唇舌淡红,腹部压之不痛,脉细涩或无力。
全身各部症:身热,呈愈虚愈热,形体消瘦,皮肤干燥,毛发黄脆,筋脉拘挛,伸缩不能自如,性情急躁多怒,头晕痛,耳鸣,面色无华或苍白或淡黄,眼干目眩,视物昏花,惊悸怔忡,失眠健忘,肠燥便难,唇色苍白,舌嫩红而干或舌淡无苔,脉细涩无力或细缓或芤。在妇科表现为月经后期,经闭,经量少,色淡红或呈黄水样,经后腹痛,胎萎不长,胎动小产,产后易患血晕、发痉、大便难及恶露不下等。
[Main Symptoms] Mental restlessness (Xin Fan), palpitations (Xin Ji), heart pain (Xin Tong), sudden onset of rebellious Qi with asthma (Bao Shang Qi Er Chuan), sometimes accompanied by fear (Kong), dry throat (Yan Gan), and belching (Yi Qi).
[Diagnosis] Based primarily on the main symptoms of this disease, combined with medical history regarding previous occurrences of Mai Bi (Vessel Bi Syndrome) or discoloration of blood vessels, diagnosis is not difficult.
[Therapeutic Method] Nourish the Heart, dispel pathogenic factors, invigorate blood circulation, and unblock meridians.
[Formulas]
(1) Sanbi Tang (Three Obstructions Decoction): Indicated for Xin Bi (Heart Bi Syndrome) accompanied by deficiency of Qi and Blood.
(2) Duhuo Jisheng Tang (Angelica Pubescens and Taxillus Decoction): This formula is derived from Sanbi Tang by removing Huangqi (Astragali Radix) and Xuduan (Dipsaci Radix), and adding Sangjisheng (Taxilli Herba). It is a formula for treating Bi Syndromes that have persisted for a long time and invaded the zang organs, possessing effects of tonifying blood and dispelling pathogens. It can be used for Xin Bi characterized by deficiency of healthy Qi and excess of pathogenic factors.
(3) Jiawei Wubi Tang (Modified Five Obstructions Decoction): Derived from Wubi Tang by adding Yuanzhi (Polygalae Radix), Fushen (Poria with Hostwood), Maidong (Ophiopogonis Radix), and Xijiao (Rhinocerotis Cornu - note: modern substitutes are used due to conservation laws), with doubled Baishao (Paeoniae Radix Alba). Indicated for Xin Bi with deficiency of healthy Qi.
Old Li believes that the above three formulas are all agents that tonify healthy Qi and dispel pathogens, and can be used for Xin Bi. The difference among the three lies in their potency: Sanbi Tang has the strongest effect, Duhuo Jisheng Tang is second, and Wubi Tang is third. Selection should be made according to the syndrome; paying attention to dosage would be even more appropriate.
15. Liver Bi Syndrome (Gan Bi)
[Etiology/Name Explanation] Liver Bi arises when Jin Bi (Tendon Bi Syndrome) persists for a long time without healing, followed by re-infection with pathogens, which then invade the Liver internally.
[Main Symptoms] Thirst with preference for drinking, frequent and copious urination, fright during sleep, and frequent sighing (Tai Xi).
[Diagnosis] Diagnosis is not difficult. Based on the main symptoms, combined with a history of Jin Bi (symptoms such as tendon spasms and limited flexion and extension of joints), it can be confirmed.
[Therapeutic Method] Support healthy Qi and dispel pathogens.
[Formulas]
(1) Sanbi Tang (Three Obstructions Decoction): Tonifies healthy Qi and dispels pathogens; can be used for severe cases of Liver Bi.
(2) Duhuo Jisheng Tang (Angelica Pubescens and Taxillus Decoction): Tonifies healthy Qi and dispels pathogens; can be used for Liver Bi.
(3) Jiawei Wubi Tang (Modified Five Obstructions Decoction): Derived from Wubi Tang by adding Suanzaoren (Ziziphi Spinosae Semen) and Chaihu (Bupleuri Radix), with doubled Baishao (Paeoniae Radix Alba). Treats Liver Bi accompanied by Liver Qi stagnation and restless sleep at night.
16. Spleen Bi Syndrome (Pi Bi)
[Etiology/Name Explanation] Spleen Bi arises when Ji Bi (Muscle Bi Syndrome) persists for a long time without healing, followed by re-infection with pathogens.
[Main Symptoms] Vomiting of saliva/phlegm, epigastric fullness and hardness (Xin Xia Pi Ying), and flaccidity/laziness of the four limbs.
[Diagnosis] Diagnosis is not difficult. First, based on the main symptoms of this disease, combined with whether there was a previous history of Ji Bi causing symptoms such as muscle numbness and insensitivity to pain and itch, confirmation can be made.
[Therapeutic Method] Primarily tonify healthy Qi,酌情 (judiciously) adding herbs to dispel pathogens.
[Formulas]
(1) Sanbi Tang (Three Obstructions Decoction).
(2) Duhuo Jisheng Tang (Angelica Pubescens and Taxillus Decoction).
(3) Jiawei Wubi Tang (Modified Five Obstructions Decoction): Derived from Wubi Tang by adding Houpo (Magnoliae Officinalis Cortex), Zhishi (Aurantii Fructus Immaturus), Sharen (Amomi Fructus), Shenqu (Massa Medicata Fermentata), with doubled Baizhu (Atractylodis Macrocephalae Rhizoma).
The above three formulas primarily focus on tonifying healthy Qi and dispelling pathogens. Among them, Sanbi Tang has the strongest effect, Duhuo Jisheng Tang is second, and Wubi Tang is third. They should be selected or modified according to the severity of the syndrome.
17. Lung Bi Syndrome (Fei Bi)
[Etiology/Name Explanation] Lung Bi arises when Pi Bi (Skin Bi Syndrome) persists for a long time without healing, followed by re-infection with pathogens.
[Main Symptoms] Mental restlessness, chest fullness, asthma, cough, and vomiting.
[Diagnosis] Diagnosis is not difficult. Based on the main symptoms, combined with whether there was a previous history of Pi Bi symptoms such as skin numbness, confirmation can be made.
[Therapeutic Method] Since it is a chronic disease, the primary approach remains tonifying healthy Qi and dispelling pathogens.
[Formulas]
(1) Sanbi Tang (Three Obstructions Decoction).
(2) Duhuo Jisheng Tang (Angelica Pubescens and Taxillus Decoction).
(3) Jiawei Wubi Tang (Modified Five Obstructions Decoction): Derived from Wubi Tang by adding Banxia (Pinelliae Rhizoma), Ziwan (Asteris Radix), Xingren (Armeniacae Semium Amarum), and Mahuang (Ephedrae Herba).
The above three formulas primarily focus on tonifying healthy Qi and dispelling pathogens. Sanbi Tang has the strongest effect, Duhuo Jisheng Tang is second, and Wubi Tang is third. Selection should be made based on specific symptoms.
18. Kidney Bi Syndrome (Shen Bi)
[Etiology/Name Explanation] Kidney Bi refers to a visceral Bi Syndrome formed when Gu Bi (Bone Bi Syndrome) persists for a long time without healing, followed by re-infection with pathogens.
[Main Symptoms] Abdominal distension, sitting on the buttocks instead of walking on heels (indicating severe spinal deformity), and bending the spine so the head replaces the neck position.
[Diagnosis] Determined based on main symptoms; accuracy is improved by combining with a history of Gu Bi symptoms.
[Therapeutic Method] Tonify healthy Qi and dispel pathogens.
[Formulas]
(1) Sanbi Tang (Three Obstructions Decoction).
(2) Duhuo Jisheng Tang (Angelica Pubescens and Taxillus Decoction).
(3) Jiawei Wubi Tang (Modified Five Obstructions Decoction): Derived from Wubi Tang by adding Duhuo (Angelicae Pubescentis Radix), Guanzi Gui (Cinnamomi Cortex), Duzhong (Eucommiae Cortex), Niuxi (Achyranthis Bidentatae Radix), Huangqi (Astragali Radix), and Bibai (Dioscoreae Hypoglaucae Rhizoma), with doubled Baishao (Paeoniae Radix Alba).
The above three formulas are all agents that tonify healthy Qi and dispel pathogens. Sanbi Tang has the strongest effect, Duhuo Jisheng Tang is second, and Wubi Tang is third. Better results are achieved if they are appropriately tailored to the symptoms during use.
Coma and Shen Hun (Loss of Consciousness) Differentiation and Treatment
Shen Hun (Loss of Consciousness) is one of the common critical syndromes in clinical practice. Its manifestation is characterized by unclear consciousness and unconsciousness. However, its specific etiology, pathogenesis, and clinical manifestations are complex and require careful differentiation.
If Shen Hun belongs to the Yangming channel/syndrome, presenting with extreme thirst, yellow and dry tongue coating, high fever, and a surging pulse, it is an indication for Baihu Tang (White Tiger Decoction). If the tongue coating is yellow and dry, the abdomen is full and tender to pressure, and the pulse is deep, solid, and forceful, it is an indication for Chengqi Tang (Gut-Purging Decoction).
If Shen Hun occurs in Shaoyin disease, the characteristics are lethargy (Chen Chen Yu Mei), monotonous speech (Zheng Sheng), a moist tongue with no coating, and a deep, faint pulse, often accompanied by cold extremities. If accompanied by heat, it often indicates Yin excess repelling Yang outward (Yin Sheng Ge Yang), appearing in the late stage of the disease. If complicated by phlegm-dampness, with greasy tongue coating and difficult urination, it is an indication for Zhenwu Tang (True Warrior Decoction); otherwise, it is an indication for Sini Tang (Frigid Extremities Decoction). (Note: Early-stage heat syndromes should consider Mahuang Fuzi Xixin Tang (Ephedra, Aconite and Asarum Decoction)).
If pathogenic factors enter the Pericardium, it is often accompanied by delirium, crimson tongue, and high fever. Shen Hun in warm diseases is mostly of this type, belonging to cerebral disorders. There are also cases caused by blood stasis. For example, a patient suffered postpartum coma, lower abdominal tenderness, no fever, and stiffness; recovery occurred after applying blood-dispelling methods.
If Shen Hun occurs in Jueyin disease, it is often accompanied by convulsions, stiffness, and seizures. Clearing heat formulas must be added with Lingyangjiao (Saiga Tataricae Cornu), Gouteng (Uncariae Ramulus cum Uncis), Quanxie (Scorpio), and Wugong (Scolopendra). Some convulsions belong to Baihu Tang (White Tiger Decoction) indications, while others belong to pathogenic factors entering the Ying (Nutritive) level of the Heart. The latter can be treated with Angong Niuhuang Wan (Calculus Bovis Pill for Opening the Orifices), Zhibao Dan (Precious Treasure Pellet), or Zixue Dan (Purple Snow Pellet), assisted by decoctions to clear the Heart, open the orifices, calm fright, and extinguish wind.
Shen Hun caused by other pains is mostly acute; consciousness returns once the pain stops. Shen Hun caused by hysteria (Yi Bing) usually presents without fever, triggered by emotional stimulation, and is often accompanied by limb contracture. Shen Hun caused by turbid phlegm obscuring the clear orifices必然 (inevitably) presents with thick and greasy tongue coating, commonly seen in damp-warmth syndromes. It should be treated with Changpu Yujin Tang (Acorus and Curcuma Decoction) combined with Suhexiang Wan (Styrax Pill).
The above is a general overview of Shen Hun treatment. Generally, Shen Hun is a critical condition requiring high attention. Cases with clear and forceful pulses are mostly curable; those with weak, fine, rapid, or indistinct pulses have a poor prognosis.
There is also a phenomenon called Yu Mao (Depression and Vertigo), often seen before Zhan Han (Shivering Sweat). Patients suddenly become confused and drowsy. This is a phenomenon of Yang depression欲 (desiring) to produce shivering sweat, accompanied by cold limbs and hidden pulse. It should be assessed based on the disease progression. If there is no deterioration and it is unrelated to medication, this consideration is valid.
Carbon Monoxide Poisoning
Treatment of Carbon Monoxide Poisoning from the Perspective of Phlegm and Stasis
Old Li believes that mild to moderate carbon monoxide poisoning may resolve spontaneously or require emergency administration of vinegar or pickled cabbage soup for recovery. Severe cases, especially those presenting with dementia, stupor, paralysis, aphasia, prolonged coma, and convulsions, are particularly difficult to treat. Generally, dementia, aphasia, and coma are caused by turbid pathogens obscuring the Heart orifices. Paralysis and convulsions are often caused by blood failing to nourish the Liver or by blood stasis obstruction. The former is primarily treated by opening orifices and resolving phlegm; the latter by invigorating blood and relaxing sinews.
Case 1: Patient Li, male, 60 years old, exposed to coal gas for over 60 days. After treatment at another hospital, consciousness returned, but he was left with dementia, dysarthria, mobility issues, limb tremors, continuous swallowing when fed, and no request for food when not fed. He was administered Jufang Zhibao Dan (Official Bureau's Precious Treasure Pill), 2 pills daily, and recovered in 10 days.
Case 2: Patient Mao, male, 28 years old, comatose from coal gas poisoning for 48 days. Hospitalization at another institution was ineffective, so he was transferred to our hospital. Examination revealed coma, generalized spastic paralysis, fever, crimson tongue with no coating, and rapid pulse. Synthesizing pulse and symptoms, the diagnosis was turbid pathogens obscuring the Pericardium and blood stasis obstruction. The treatment principle was cooling blood, invigorating blood, opening orifices, and resolving turbidity. Formula used: Jufang Zhibao Dan (Official Bureau's Precious Treasure Pill) to open orifices and resolve turbidity; Huoluo Xiaoling Dan (Collateral-Activating and Pain-Alleviating Decoction) modified to invigorate blood and cool blood:
Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 15g, Chishao (Paeoniae Radix Rubra) 9g, Ruxiang (Olibanum) 7.5g, Moyao (Myrrha) 7.5g, Sangzhi (Mori Ramulus) 30g.
After 20 days, the patient's consciousness basically returned, but dementia, aphasia, and spastic paralysis did not improve significantly. Recalling Zhang Xichun's "Records of Chinese Medicine Integrating Eastern and Western": "For those with body contractures unable to extend, the sinews of the body are mainly governed by the Zong Jin (General Sinews), which are nourished by the Yangming [Stomach/Spleen]. If the person has inherent weakness of the Spleen and Stomach, unable to transform grain into fluids to nourish the Zong Jin, compounded by internal latent heat consuming them, or attacked by wind-cold, causing the Zong Jin to lose free extension and only retract, resulting in contracture... For those whose sinews are not contracted, muscles are not numb, but feel weak legs unable to walk, this is due to exhaustion of bone marrow and Kidney deficiency failing to provide strength.' 'For Bone Wei (Atrophy), add Lujiaojiao (Cervi Cornus Colla), as deer horn uses bone to tonify bone.' 'If atrophy is specifically in the lower limbs, use Niuxi (Achyranthis Bidentatae Radix) to guide downward. If hands and feet are both atrophic, add Guizhi (Cinnamomi Ramulus) to guide upward.' 'For muscle numbness where scratching does not elicit pain or itch, the cause may be wind-cold invading collaterals, phlegm-saliva blocking collaterals, or wind-cold and phlegm-saliva condensing between collaterals, leading to blood vessel closure, the root cause being deficiency of Great Qi.'" Therefore, on the basis of Huoluo Xiaoling Dan (Collateral-Activating and Pain-Alleviating Decoction), Mugua (Chaenomelis Fructus), Lujiaojiao (Cervi Cornus Colla), Hugu Jiaojiao (Pantheris Os Cum Cartilagine - substitute used), and Huangqi (Astragali Radix) were added. Paralysis and aphasia gradually improved, and after half a year, all symptoms disappeared, resulting in recovery.
Deficiency Labor (Xu Lao)
Treatment of Blood Deficiency Syndrome
Blood Deficiency is a syndrome characterized by insufficient blood or reduced nourishing function of blood, also known as anemia or blood deficit. Severe cases are termed Blood Dryness (Xue Ku) or Blood Collapse (Xue Tuo). Its formation is attributed to excessive blood loss, dysfunction of hematopoiesis, or insufficient supply of hematopoietic materials. Blood Deficiency includes Heart Blood Deficiency, Liver Blood Deficiency, Qi and Blood Dual Deficiency, Blood Deficiency generating Heat, Blood Dryness, Blood Collapse, and modern medical conditions such as Aplastic Anemia.
Blood circulates throughout the body, nourishing and moistening the whole organism, reaching internally to the Zang-Fu organs and externally to the skin, flesh, sinews, and bones. Thus, Blood Deficiency is a syndrome of systemic or local loss of nourishment and reduced functional activity. Old Li describes Blood Deficiency by dividing it into main symptoms and symptoms in various parts of the body:
Main Symptoms: Pale complexion. Pale red eyelids, lips, and tongue. No pain upon abdominal pressure. Fine, choppy, or weak pulse.
Symptoms in Various Parts of the Body: Low-grade fever, becoming hotter as deficiency increases; emaciation; dry skin; yellow and brittle hair; sinew contracture with inability to extend/flex freely; irritable and angry temperament; dizziness and headache; tinnitus; lusterless, pale, or sallow complexion; dry eyes, vertigo, blurred vision; palpitations and fright; insomnia and forgetfulness; dry intestines with difficult defecation; pale lips; tender red and dry tongue or pale tongue with no coating; fine, choppy, weak, slow, or knotted pulse. In gynecology, it manifests as delayed menstruation, amenorrhea, scanty menses with pale red or watery yellow color, post-menstrual abdominal pain, fetal malnutrition, threatened miscarriage, and postpartum susceptibility to Blood Fainting, Convulsions, difficult defecation, and lochia retention.