1．必须有感受不顺意刺激的事实(有经常感受刺激的，有一时一事感受刺激过甚，无法释解，迁延日久的)。
2。必须有长时期郁郁不乐的表现，如不苟言笑，多哭善怒，长嘘短叹等。
3．必须有胸满(也有兼痛的，轻者自觉胸中不舒，往往在诊脉时有太息的现象)、胁痛(左边痛的最多，也有两边都痛，或右边痛的)、寒热(有早凉暮热的，也有早不发凉，但午后一度发热的，这一症状必须注意“阴虚”的兼证)的症状．
4。必须有左手脉沉(最多是关尺部分，也有六脉俱沉的)的脉象。
说明：以上四条症状，轻重多少虽有不同，但缺者很少。
[副症]
1．头面部的症状：头晕，头痛(其痛多在左半边，两半边痛的也有，但都是慢性的、有时间性的)，颊部发赤。
2．耳目部的症状：耳鸣，耳痄痛。目眩，眼花，两目干涩，目暗。
3．鼻部的症状：鼻孔干燥。
4．咽喉口舌部的症状：咽干，喉痛，口苦，口酸，口燥，口渴，恶心欲吐，呕吐，吞酸。
5．颈项乳部的症状：瘰疬，乳岩。
6．全身及四肢部的症状：手足心发热，五心烦热，肢体发疼(血不荣筋)，骨蒸潮热。
7．腹部的症状：小腹重坠或闷胀，腹中满痛，胃部嘈杂不舒。
8．饮食方面的症状：食少，喜冷性饮食，喜饮，但喝得不多。
9．大小便方面的症状：大便燥，大便溏，小便不利或涩痛，尿道肿痛出脓。
10。睡眠方面的症状：嗜睡，失眠。
11。皮肤方面的症状：皮肤瘙痒，皮肤干燥。
12．呼吸方面的症状：干咳。
13．月经方面的症状：月经赶前、错后、前后错杂，崩漏，经闭，青带，赤带，白带。
[禁忌证]
凡不是由于不顺意的刺激所引起的病证，都不得使用本方。即使是因受不顺意刺激引起的病证，如果不是郁结日久，以致形成如主症栏所表现的一切症状，而是因暴怒形成的猝厥或吐血，以及阴虚、肝阳上逆等证，也不得使用本方。
[慎重证]
头晕、头痛、午后发热等症，都需要慎重。因为这几种症状多兼阴虚或火盛，这种病如用柴胡稍多，即会加重。
[药品]
生白芍9～30克， 当归6～15克 生白术6～9克 云茯苓3～9克 薄荷1．5～3克 甘草3～4．5克 柴胡1.5～4．5克
煨姜引。
[服法]
用水煎服，或做成水丸丫用开水或姜水送服。
[用药大意]
白芍：和肝养血，滋阴清热，足本方的主药。除产后和肠胃虚者可炒用或少用外，一般多是生用大量，对崩漏有时用醋炒白芍。
当归：补血。性滑润而温，大便燥者町多用，溏者配合苓术用之，血热吝可佐生地或其他滋阴之品，如元参、麦冬等，或用：二地、丹参代之。
白术：补脾，便溏脾虚者可多用，但不宜炒。便燥者不宜用，或以石斛、苡仁、生山药代之，或用乳制。
茯苓：利水渗湿，心悸不安者，有痰饮或小便不利，或大便溏者，都可用．心悸或代以茯冲，或可加麦冬以助其清心降火，便溏可配合白术 大便燥者不用。
柴胡：升达肝胆的郁热，有寒热胸满胁痛等症者必用。 有外感者可用，阴虚肝阳上逆者禁用。所以头晕头痛等症必须注意这一点。在疑似之间，叫少用之。如兼便燥行，配合酒军用之亦可。
薄荷：解热，有头痛发热者可用，但不宜多。
煨姜：取其守中，不致辛散上僭，有外感或呕吐症可生用。
甘草：兼泻兼缓，除呕吐或中满者可以不用或少用外，一般的证候都可用。脾虚者须炙用。
[加减择要]
1．偏头痛者，加川芎、防风、白芷、半夏、玉竹，便燥者，加酒军。
2．眩晕者，加天麻、菊花，或合二陈汤，更加防风、玉竹，便秘者也须加酒军。
3．耳鸣耳聋者，酌加蔓荆子、菖蒲、葱管之类，火盛者兼服当归龙荟丸。
4．口苦鼻干颊赤内热甚者，加黄芩或丹、栀、麦、地，重者兼服当归龙荟丸。
5．吐衄者，纵有寒热柴胡不宜多用，因为多用往往会有引起大出血的危险。热轻者可酌加生地、贡胶、蒲黄、茅根之类，热其者可酌合泻心汤之类。
6．眼干涩者，兼服六味地黄丸或杞菊地黄丸或归芍地黄丸等。
7．咽干喉痛者，可加元参、生地、麦冬等滋阴药品，柴胡不可多用。
8．呕吐者酌加陈皮、半夏、黄连、砂仁、生赭石等药。
9．吞酸吐酸者，加吴萸、黄连，或间服左金丸。
]0．瘰疬乳岩等症，可酌加连翘、银花、香附、夏枯草、乳香、没药等药，瘰疬可间服消瘰丸。
11．气滞甚胸胁满者，酌加香附、广木香、沉香、枳壳等药。
12。干咳者多系火郁证，最难治，先服本方加蜜制陈皮以发之，继服补阴清肺等药，如冬、地一类。
13．左胁痛者，可加香附、青皮、乳香、没药，痛甚者加川棟子、元胡，痛久脉虚，服疏气药，痛更甚者必须加生口芪，右胁痛者加片姜黄。
14．小腹部胀痛者，可加香附、元胡、乳香、没药等药。
工5．大便秘结者，除兼头痛、头晕及肠中热结等症，可加大黄，燥甚酌加元胡粉外，一般地多用疏气润燥药，如香附、木香、当归、苁蓉等，并减去苓、术。
16．手足心热者，加丹皮、地骨皮。
17．骨蒸潮热者，柴胡换为银柴胡，更加地骨皮、青蒿、生鳖甲等药，也可加丹、栀、知、柏等药。
18．皮肤瘙痒等症，可加何首乌、白蒺藜之类。
19．月经超前者，加清热药，如丹皮、栀子等；错后者，加疏气药，如香附、木香、元胡等；错杂者，加补养气血药，如参、芪等；经闭者，加桃仁、红花、香附等药；崩漏者，去茯苓，加生地、丹皮、三七、黑荆芥，傅氏名平肝开郁止血汤；白带，加生山药、龙骨、牡蛎等；青带，去当归、白术，加茵陈、栀子、陈皮，傅氏名加味逍遥散。
说明：以上这些加减法不是固定的，只不过列举了一些方向而已。如要丝丝入扣的话，必须一方面分析各种症状的需要，一方面体会各种药品的效能，对证施治，才可能达到比较完善的地步。
[常用的辅助方剂]
1．归脾汤或归脾丸：这是治兼心脾两虚证的辅助方剂。如惊悸、怔忡、失眠、少食等症，在本方加减扣不住的时候，用之最宜，早晚间服。
2．六味地黄丸：兼肾阴虚，而不便在方中加熱地时多用之，有的早晚间服，有的用在本方收功之时，都是按照病的需要为标准。
3．舒肝丸：是对于肚腹胀痛的辅助方子，在本方疏气力量不能胜任时用之，也是间服为宜。
4．左金丸：这是用于兼左胁痛及吞酸、吐酸的辅助方剂，但不宜多服，恐苦寒伤胃。
阳和汤治疗骨关节结核
李老认为，骨关节结核基本上是一个虚证，因此，治疗时应该着重于补，或补阴补阳，或补气补血，阳和汤即是一个较好的方剂。
阳和汤适用于局部平坦、皮色不变或局部紫暗而冷，或流清水，无发热，无盗汗，脉不数的骨关节结核，不适用于阳证或半阴半阳证，如面色胱白，面颊时有嫩红，自汗盗汗，身热者，绝不可用。阳和汤应用时一定要注意每味药之间的比例。例如：熟地可用至30克以上，麻黄仅可用0．6～1．5克，否则伤气伤血，其病必剧。若气血俱虚者，宜改用托里定痛汤加黄芪，十全大补汤加白芥子、白芷。若面色胱白，汗多，脉虚数者，宜改用补气养阴法。方药：黄芪15克，当归6克，麦冬9克，石斛9克，赤芍9克。若脓色转黄稠，脉滑数者，加银花9克，连翘9克。
细辛的用法用量
细卒，味辛性温，人肺经、肝经、肾经。功能散寒止痛，镇咳祛痰，温肺化饮，通鼻窍而止泪。主治外感寒邪或寒邪人里或寒而兼湿引起的头痛、面痛、齿痛、身痛，以及咳嗽时发、鼻窍不通、不闻香臭、迎风流泪等症。其主要功能有二：一个是散寒，一个是止痛。散寒，指在表之寒邪，或由表人里之寒邪，而非阳虚所生之内寒； 止痛，是指由风寒、风湿引起的头、面、身、腹、齿诸痛而言。由于细辛善于使在表特别是由表人里的寒邪外达，因此，应将其划归辛温解表药类。
在细辛的用量上，古人素有“细辛不过钱”之说，讲义亦规定用量为1．5～3克．但临床每遇有寒邪人里过甚的特殊情况时，可以酌情增加至4．5～9克。临床运用，虽然阴虚、热甚的疾病属于禁忌范围，但也不是绝对的，在里热与表寒相兼出现时，可以大胆使用。如对于阴虚或热盛兼有表寒之头身疼痛，牙痛者，可配合滋阴及清热药用之，如六味地黄汤加细辛，治肾阴虚兼风寒头痛，生石膏与细辛同用，治内火外寒之风火牙痛。另外，细辛常与附子配伍应用，这是仲景方中治疗寒邪人里过甚，邪伏于阴分的常用药对。如麻黄附子细辛汤中，辛、附与解表药麻黄同用，意在助阳，散寒解表；大黄附子汤，为细辛、附子同大黄配伍，大黄寒下，细辛温散，且有大剂附子温阳相助，用治阴寒内伏、阳气闭郁不通之冷积便秘，效如桴鼓。正如《成方便读·卷一》张秉成所言：“治胁下偏痛，发热，其脉弦紧，此阴寒成聚，偏着一处，虽有发热，亦是阳气被郁所致?是以非温不能散其寒，非下不能去其积，故以细辛、附子之辛热善走者搜散之，而后大黄得以行其积也。”
附子论
虞抟称：“附子禀雄壮之质，有斩关夺将之气，能引补气药行十二经以追复散失之元阳，引补血药入血分以滋养不足之真阴，引发散药开腠理以驱逐在表之风寒，引温暖药达下焦以祛除在里之冷湿。”吴绶说：附子“有退阴回阳之力，起死回生之功”。《中药学讲义》称：“(附子)为补元阳之主药，其力能升能降，能内达能外散，凡凝寒痼冷之结于脏腑，着于筋骨，痹于经络血脉者，皆能开通之。而温通之中，又大具收敛之力，故治汗多亡阳，肠冷泄泻，下焦阳虚阴走，精寒自遗。论者谓善补命门相火，而服之能使心脉跳动加速，是于君相二：火皆能大有补益也。”张景岳称：“(附子)气味辛甘，腌者大咸，性大热，阳中之阳也，有毒。畏人参、黄芪、甘草、黑豆、绿豆、犀角、童便、乌韭、貼风。其性浮中有沉，走而不守，因其善走诸经，故曰与酒同功。能除表里沉寒厥逆寒噤，暖五脏回阳气，除呕秽反胃，噎膈，心腹疼痛，腹满，泻利，肢体拘挛，寒邪湿气，胃寒蛔虫，寒痰寒疝，风湿麻痹。阴疽痈毒，久漏阴疮，格阳喉痹，阳虚二便不通，及妇人经寒不凋，小儿慢惊等证，大能引火归原，制伏虚热。善助参芪成功，尤赞地术建效。无论表里证，但脉细无神，气虚无热者，所当急用。”总之，附子对心阳虚或沉寒痼冷的胸脘疼痛、心悸多寐或不眠，脾胃 虚寒的肮腹冷痛、泄泻、食欲不振，阳虚水饮不化的水肿、吞咽不利，肾阳不足的腰痛腰冷．以及亡阳厥逆，都有较好的疗效。
其一，从回阳救逆看。对心脾肾的阳衰欲亡者有卓效，可以说是中药中回阳救逆的最好药物。其与干姜、炙甘草配伍，治疗脾肾阳衰的四肢厥冷，泄泻如稀水或失禁，脉微欲绝者；若舌苔黄，或兼口苦者，为阴盛格阳之象，可再配寒凉之药。如附子理中汤加黄连或猪胆汁；若兼大汗出者，为气脱，宜加人参。前人治疗亡阳厥脱时用四逆汤、参附汤的主要区别是汗出与否，泄泻有无，即汗多者必用人参，泄泻者必配干姜，若汗、泻并见，则人参、干姜同时配用。
其二，从温心肾来看，由于心和肾有阴亦有阳，阳虚者阴亦不足，故补心或肾之阳时，必佐以补阴之品。正如《素问》所说： “壮火之气衰，少火之气壮；壮火食气，气食少火，壮火散气，少火生气。”其如真武汤之用白芍，八味地黄丸之用地黄就是如此。另外，在本证应用附子时宜小量为佳，大者用4．5克，小者仅1克即可。
其三，从温脾肾来看，由于脾胃属土，虚寒时容易生湿。心肾属火，火能生土，所以脾虚寒时多用附子，如附子理中汤。由于脾肾虚寒容易生湿，所以脾肾虚寒者不像心肾阳虚时必须配合一定量的养阴药。附子理中汤以具有指趾厥冷、脉沉细迟缓的胃脘冷痛，或胃脘、胸胁疼痛者效果为最好；若脉见虚大，虚阳外越者，因附子有走有守，能内达外散，温中而敛阳，故大量用之常有很好效果。
其四，从温阳利水看，附子本身没有利尿的作用，但对脾肾阳虚或心肾阳虚的水肿却有好的效果。若单纯从通阳利水的作用看，附子的作用不如肉桂，但在脾肾阳虚、心肾阳虚、肾水凌心、肾水凌肺证的浮肿、心悸、咳喘、四肢厥冷、脉沉细微的治疗上附子又优于肉桂。若单纯肾阳亏损所致的水肿，肉桂、附子配合补肾阳常能提高利水的疗效。
其五，从除寒止痛来看，附子不但温脾肾心，且能温肝，所以，治疗寒实证，脉紧胁痛者，用大黄附子汤，胃脘冷痛、脐腹冷痛、疝痛、寒厥心痛者亦用附子。又因附子偏重于人肾，所以癖痛、胃痛、腹痛等用附子时以兼有肾阳虚者的效果最好，至若单纯由于肝寒所致疝痛、腹痛则不如小茴香、吴茱萸，单纯胃寒所致诸症则不如干姜。
1．必须有遭受不愉快刺激的事实（包括经常受到刺激，或某时某事受到过度刺激且无法释怀，迁延日久的情况）。
2．必须有长期情绪抑郁、不快乐的表现，如不爱说笑，多哭易怒，长吁短叹等。
3．必须有胸中胀满的症状（有的兼有疼痛，轻者自觉胸中不适，往往在诊脉时有叹息的现象）、胁痛（左侧疼痛最多见，也有两侧都痛，或右侧疼痛的）、寒热往来（有的早晨凉晚上热，也有早晨不发凉，但午后一度发热的，这一症状必须注意是否兼有“阴虚”证候）。
4．必须有左手脉沉（多见于关部和尺部，也有六脉皆沉的）的脉象。
说明：以上四条主要症状，虽然轻重程度和数量有所不同，但很少完全缺失。
[副症]
1．头面部的症状：头晕，头痛（疼痛多在左半边，两半边痛的也有，但都是慢性的、有时间规律的），脸颊发红。
2．耳目部的症状：耳鸣，耳部肿痛。目眩，眼花，两眼干涩，视力昏暗。
3．鼻部的症状：鼻孔干燥。
4．咽喉口舌部的症状：咽干，喉痛，口苦，口酸，口燥，口渴，恶心欲吐，呕吐，吞酸。
5．颈项乳部的症状：瘰疬（颈部淋巴结结核），乳岩（乳腺癌）。
6．全身及四肢部的症状：手足心发热，五心烦热，肢体疼痛（因血虚不能濡养筋脉所致），骨蒸潮热。
7．腹部的症状：小腹重坠感或闷胀，腹部满痛，胃部嘈杂不适。
8．饮食方面的症状：食欲减退，喜食生冷食物，喜欢喝水，但饮水量不多。
9．大小便方面的症状：大便干燥，大便稀溏，小便不利或涩痛，尿道肿痛流脓。
10．睡眠方面的症状：嗜睡，失眠。
11．皮肤方面的症状：皮肤瘙痒，皮肤干燥。
12．呼吸方面的症状：干咳。
13．月经方面的症状：月经提前、推后、先后不定期，崩漏（非经期大量出血或淋漓不尽），经闭，青带，赤带，白带。
[禁忌证]
凡不是由于不愉快刺激引起的病证，都不得使用本方。即使是因受不愉快刺激引起的病证，如果不是郁结日久，以致形成如主症栏所表现的一切症状，而是因暴怒形成的猝然昏厥或吐血，以及阴虚、肝阳上逆等证候，也不得使用本方。
[慎重证]
头晕、头痛、午后发热等症状，都需要慎重对待。因为这几种症状多兼有阴虚或火盛，这种病如果柴胡用量稍多，就会加重病情。
[药品]
生白芍 9～30克，当归 6～15克，生白术 6～9克，云茯苓 3～9克，薄荷 1.5～3克，甘草 3～4.5克，柴胡 1.5～4.5克。
以煨姜为引。
[服法]
用水煎服，或制成水丸，用开水或姜水送服。
[用药大意]
白芍：调和肝脏，养血，滋阴清热，是本方的主药。除产后和肠胃虚弱者可炒用或少用外，一般多是生用大量，对于崩漏有时用醋炒白芍。
当归：补血。性质滑润而温，大便干燥者可多用，大便稀溏者配合茯苓、白术使用，血热者可佐以生地或其他滋阴之品，如玄参、麦冬等，或用二地、丹参代替。
白术：补脾，便溏脾虚者可多用，但不宜炒制。大便干燥者不宜用，或以石斛、薏苡仁、生山药代替，或用乳制。
茯苓：利水渗湿，心悸不安者，有痰饮或小便不利，或大便稀溏者，都可用。心悸者可代以茯神，或可加麦冬以助其清心降火，便溏可配合白术，大便干燥者不用。
柴胡：升达肝胆的郁热，有寒热、胸满、胁痛等症状者必用。有外感者可用，阴虚肝阳上逆者禁用。所以头晕头痛等症状必须注意这一点。在疑似之间，应少用。如兼有大便干燥，配合酒大黄使用亦可。
薄荷：解热，有头痛发热者可用，但不宜多用。
煨姜：取其守中之性，不至于辛散上行僭越，有外感或呕吐症状可生用。
甘草：兼具泻火和缓急的作用，除呕吐或中焦痞满者可以不用或少用外，一般的证候都可用。脾虚者须炙用。
[加减择要]
1．偏头痛者，加川芎、防风、白芷、半夏、玉竹，大便干燥者，加酒大黄。
2．眩晕者，加天麻、菊花，或合用二陈汤，更加防风、玉竹，便秘者也须加酒大黄。
3．耳鸣耳聋者，酌加蔓荆子、石菖蒲、葱管之类，火盛者兼服当归龙荟丸。
4．口苦鼻干、脸颊红、内热甚者，加黄芩或丹皮、栀子、麦冬、生地，重者兼服当归龙荟丸。
5．吐血衄血者，纵有寒热，柴胡不宜多用，因为多用往往会有引起大出血的危险。热轻者可酌加生地、阿胶、蒲黄、茅根之类，热重者可酌合泻心汤之类。
6．眼干涩者，兼服六味地黄丸或杞菊地黄丸或归芍地黄丸等。
7．咽干喉痛者，可加玄参、生地、麦冬等滋阴药品，柴胡不可多用。
8．呕吐者酌加陈皮、半夏、黄连、砂仁、生赭石等药。
9．吞酸吐酸者，加吴茱萸、黄连，或间服左金丸。
10．瘰疬、乳岩等症，可酌加连翘、银花、香附、夏枯草、乳香、没药等药，瘰疬可间服消瘰丸。
11．气滞甚导致胸胁满闷者，酌加香附、广木香、沉香、枳壳等药。
12．干咳者多系火郁证，最难治，先服本方加蜜制陈皮以发散之，继服补阴清肺等药，如冬虫夏草、生地一类。
13．左胁痛者，可加香附、青皮、乳香、没药，痛甚者加川楝子、元胡，痛久脉虚，服疏气药，痛更甚者必须加生黄芪，右胁痛者加片姜黄。
14．小腹部胀痛者，可加香附、元胡、乳香、没药等药。
15．大便秘结者，除兼头痛、头晕及肠中热结等症，可加大黄，燥甚酌加元胡粉外，一般地多用疏气润燥药，如香附、木香、当归、肉苁蓉等，并减去茯苓、白术。
16．手足心热者，加丹皮、地骨皮。
17．骨蒸潮热者，柴胡换为银柴胡，更加地骨皮、青蒿、生鳖甲等药，也可加丹皮、栀子、知母、黄柏等药。
18．皮肤瘙痒等症，可加何首乌、白蒺藜之类。
19．月经超前者，加清热药，如丹皮、栀子等；错后者，加疏气药，如香附、木香、元胡等；错杂者，加补养气血药，如人参、黄芪等；经闭者，加桃仁、红花、香附等药；崩漏者，去茯苓，加生地、丹皮、三七、黑荆芥，傅氏名平肝开郁止血汤；白带，加生山药、龙骨、牡蛎等；青带，去当归、白术，加茵陈、栀子、陈皮，傅氏名加味逍遥散。
说明：以上这些加减法不是固定的，只不过列举了一些方向而已。如要丝丝入扣的话，必须一方面分析各种症状的需要，一方面体会各种药品的效能，对证施治，才可能达到比较完善的地步。
[常用的辅助方剂]
1．归脾汤或归脾丸：这是治疗兼有心脾两虚证候的辅助方剂。如惊悸、怔忡、失眠、少食等症状，在本方加减扣不住的时候，用之最宜，早晚间服。
2．六味地黄丸：兼肾阴虚，而不便在方中加入熟地黄时多用之，有的早晚间服，有的用在本方收功之时，都是按照病的需要为标准。
3．舒肝丸：是对于肚腹胀痛的辅助方子，在本方疏气力量不能胜任时用之，也是间服为宜。
4．左金丸：这是用于兼左胁痛及吞酸、吐酸的辅助方剂，但不宜多服，恐苦寒伤胃。
阳和汤治疗骨关节结核
李老认为，骨关节结核基本上是一个虚证，因此，治疗时应该着重于补，或补阴补阳，或补气补血，阳和汤即是一个较好的方剂。
阳和汤适用于局部平坦、皮色不变或局部紫暗而冷，或流清水，无发热，无盗汗，脉不数的骨关节结核，不适用于阳证或半阴半阳证，如面色㿠白，面颊时有嫩红，自汗盗汗，身热者，绝不可用。阳和汤应用时一定要注意每味药之间的比例。例如：熟地黄可用至30克以上，麻黄仅可用0.6～1.5克，否则伤气伤血，其病必剧。若气血俱虚者，宜改用托里定痛汤加黄芪，十全大补汤加白芥子、白芷。若面色㿠白，汗多，脉虚数者，宜改用补气养阴法。方药：黄芪15克，当归6克，麦冬9克，石斛9克，赤芍9克。若脓色转黄稠，脉滑数者，加金银花9克，连翘9克。
细辛的用法用量
细辛，味辛性温，入肺经、肝经、肾经。功能散寒止痛，镇咳祛痰，温肺化饮，通鼻窍而止泪。主治外感寒邪或寒邪入里或寒而兼湿引起的头痛、面痛、齿痛、身痛，以及咳嗽时发、鼻窍不通、不闻香臭、迎风流泪等症。其主要功能有二：一个是散寒，一个是止痛。散寒，指在表之寒邪，或由表入里之寒邪，而非阳虚所生之内寒；止痛，是指由风寒、风湿引起的头、面、身、腹、齿诸痛而言。由于细辛善于使在表特别是由表入里的寒邪外达，因此，应将其划归辛温解表药类。
在细辛的用量上，古人素有“细辛不过钱”之说，讲义亦规定用量为1.5～3克。但临床每遇有寒邪入里过甚的特殊情况时，可以酌情增加至4.5～9克。临床运用，虽然阴虚、热甚的疾病属于禁忌范围，但也不是绝对的，在里热与表寒相兼出现时，可以大胆使用。如对于阴虚或热盛兼有表寒之头身疼痛，牙痛者，可配合滋阴及清热药用之，如六味地黄汤加细辛，治肾阴虚兼风寒头痛，生石膏与细辛同用，治内火外寒之风火牙痛。另外，细辛常与附子配伍应用，这是仲景方中治疗寒邪入里过甚，邪伏于阴分的常用药对。如麻黄附子细辛汤中，辛、附与解表药麻黄同用，意在助阳，散寒解表；大黄附子汤，为细辛、附子同大黄配伍，大黄寒下，细辛温散，且有大剂附子温阳相助，用治阴寒内伏、阳气闭郁不通之冷积便秘，效如桴鼓。正如《成方便读·卷一》张秉成所言：“治胁下偏痛，发热，其脉弦紧，此阴寒成聚，偏着一处，虽有发热，亦是阳气被郁所致？是以非温不能散其寒，非下不能去其积，故以细辛、附子之辛热善走者搜散之，而后大黄得以行其积也。”
附子论
虞抟称：“附子禀雄壮之质，有斩关夺将之气，能引补气药行十二经以追复散失之元阳，引补血药入血分以滋养不足之真阴，引发散药开腠理以驱逐在表之风寒，引温暖药达下焦以祛除在里之冷湿。”吴绶说：附子“有退阴回阳之力，起死回生之功”。《中药学讲义》称：“(附子)为补元阳之主药，其力能升能降，能内达能外散，凡凝寒痼冷之结于脏腑，着于筋骨，痹于经络血脉者，皆能开通之。而温通之中，又大具收敛之力，故治汗多亡阳，肠冷泄泻，下焦阳虚阴走，精寒自遗。论者谓善补命门相火，而服之能使心脉跳动加速，是于君相二火皆能大有补益也。”张景岳称：“(附子)气味辛甘，腌者大咸，性大热，阳中之阳也，有毒。畏人参、黄芪、甘草、黑豆、绿豆、犀角、童便、乌韭、贴风。其性浮中有沉，走而不守，因其善走诸经，故曰与酒同功。能除表里沉寒厥逆寒噤，暖五脏回阳气，除呕秽反胃，噎膈，心腹疼痛，腹满，泻利，肢体拘挛，寒邪湿气，胃寒蛔虫，寒痰寒疝，风湿麻痹。阴疽痈毒，久漏阴疮，格阳喉痹，阳虚二便不通，及妇人经寒不调，小儿慢惊等证，大能引火归原，制伏虚热。善助参芪成功，尤赞地术建效。无论表里证，但脉细无神，气虚无热者，所当急用。”总之，附子对心阳虚或沉寒痼冷的胸脘疼痛、心悸多寐或不眠，脾胃虚寒的脘腹冷痛、泄泻、食欲不振，阳虚水饮不化的水肿、吞咽不利，肾阳不足的腰痛腰冷，以及亡阳厥逆，都有较好的疗效。
其一，从回阳救逆看。对心脾肾的阳衰欲亡者有卓效，可以说是中药中回阳救逆的最好药物。其与干姜、炙甘草配伍，治疗脾肾阳衰的四肢厥冷，泄泻如稀水或失禁，脉微欲绝者；若舌苔黄，或兼口苦者，为阴盛格阳之象，可再配寒凉之药。如附子理中汤加黄连或猪胆汁；若兼大汗出者，为气脱，宜加人参。前人治疗亡阳厥脱时用四逆汤、参附汤的主要区别是汗出与否，泄泻有无，即汗多者必用人参，泄泻者必配干姜，若汗、泻并见，则人参、干姜同时配用。
其二，从温心肾来看，由于心和肾有阴亦有阳，阳虚者阴亦不足，故补心或肾之阳时，必佐以补阴之品。正如《素问》所说：“壮火之气衰，少火之气壮；壮火食气，气食少火，壮火散气，少火生气。”其如真武汤之用白芍，八味地黄丸之用地黄就是如此。另外，在本证应用附子时宜小量为佳，大者用4.5克，小者仅1克即可。
其三，从温脾肾来看，由于脾胃属土，虚寒时容易生湿。心肾属火，火能生土，所以脾虚寒时多用附子，如附子理中汤。由于脾肾虚寒容易生湿，所以脾肾虚寒者不像心肾阳虚时必须配合一定量的养阴药。附子理中汤以具有指趾厥冷、脉沉细迟缓的胃脘冷痛，或胃脘、胸胁疼痛者效果为最好；若脉见虚大，虚阳外越者，因附子有走有守，能内达外散，温中而敛阳，故大量用之常有很好效果。
其四，从温阳利水看，附子本身没有利尿的作用，但对脾肾阳虚或心肾阳虚的水肿却有好的效果。若单纯从通阳利水的作用看，附子的作用不如肉桂，但在脾肾阳虚、心肾阳虚、肾水凌心、肾水凌肺证的浮肿、心悸、咳喘、四肢厥冷、脉沉细微的治疗上附子又优于肉桂。若单纯肾阳亏损所致的水肿，肉桂、附子配合补肾阳常能提高利水的疗效。
其五，从除寒止痛来看，附子不但温脾肾心，且能温肝，所以，治疗寒实证，脉紧胁痛者，用大黄附子汤，胃脘冷痛、脐腹冷痛、疝痛、寒厥心痛者亦用附子。又因附子偏重于入肾，所以癖痛、胃痛、腹痛等用附子时以兼有肾阳虚者的效果最好，至若单纯由于肝寒所致疝痛、腹痛则不如小茴香、吴茱萸，单纯胃寒所致诸症则不如干姜。
1. There must be a factual history of exposure to unpleasant stimuli (including cases of frequent exposure, or excessive exposure at a specific time or event that cannot be resolved and has persisted for a long time).
2. There must be manifestations of long-term depression and unhappiness, such as reluctance to speak or smile, tendency to cry and anger, frequent sighing, etc.
3. There must be symptoms of chest fullness (sometimes accompanied by pain; in mild cases, the patient feels discomfort in the chest, often exhibiting sighing during pulse diagnosis), hypochondriac pain (most commonly on the left side, but can also affect both sides or just the right side), and alternating chills and fever (some experience morning chilliness and evening heat, while others do not feel chilly in the morning but have a single episode of heat in the afternoon; this symptom requires attention to potential concurrent Yin deficiency patterns).
4. There must be a deep pulse (Chen Mai) on the left hand (most commonly at the Guan and Chi positions, though all six pulses may be deep).
Note: Although the severity and number of the above four main symptoms may vary, it is rare for any of them to be completely absent.
[Accessory Symptoms]
1. Head and face symptoms: Dizziness, headache (pain is mostly on the left side, though bilateral pain occurs, but is chronic and periodic), redness of the cheeks.
2. Ear and eye symptoms: Tinnitus, ear swelling and pain. Vertigo, blurred vision, dry eyes, dim vision.
3. Nasal symptoms: Dryness of the nostrils.
4. Throat, mouth, and tongue symptoms: Dry throat, sore throat, bitter taste in the mouth, sour taste, dry mouth, thirst, nausea with urge to vomit, vomiting, acid regurgitation.
5. Neck and breast symptoms: Scrofula (Luo Li), breast cancer (Ru Yan).
6. General and limb symptoms: Heat sensation in the palms and soles, five-palm heat, body pain (due to blood failing to nourish the sinews), bone-steaming tidal fever.
7. Abdominal symptoms: Heaviness or distension in the lower abdomen, abdominal fullness and pain, gastric discomfort (gastric burning/irritation).
8. Dietary symptoms: Poor appetite, preference for cold foods/drinks, desire to drink water but with small intake volume.
9. Excretion symptoms: Dry stools, loose stools, difficult or painful urination, urethral swelling/pain with pus discharge.
10. Sleep symptoms: Hypersomnia, insomnia.
11. Skin symptoms: Pruritus, dry skin.
12. Respiratory symptoms: Dry cough.
13. Menstrual symptoms: Early menstruation, delayed menstruation, irregular cycles, metrorrhagia/metrostaxis (Beng Lou), amenorrhea, green leukorrhea, red leukorrhea, white leukorrhea.
[Contraindications]
This formula should not be used for conditions not caused by unpleasant stimuli. Even if caused by unpleasant stimuli, if the condition has not been stagnant for a long time to produce all the main symptoms listed above, but rather results from sudden rage causing syncope or hematemesis, or presents as Yin deficiency or Liver Yang rising, this formula is contraindicated.
[Precautions]
Symptoms such as dizziness, headache, and afternoon fever require caution. These symptoms are often accompanied by Yin deficiency or excess fire; using too much Chai Hu (Bupleuri Radix) in such cases may aggravate the condition.
[Ingredients]
Raw Bai Shao (Paeoniae Radix Alba) 9–30g, Dang Gui (Angelicae Sinensis Radix) 6–15g, Raw Bai Zhu (Atractylodis Macrocephalae Rhizoma) 6–9g, Yun Fu Ling (Poria) 3–9g, Bo He (Menthae Haplocalycis Herba) 1.5–3g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 3–4.5g, Chai Hu (Bupleuri Radix) 1.5–4.5g.
Use Wei Jiang (Roasted Ginger) as a guide.
[Administration]
Decoct in water and take orally, or prepare as water pills, taken with warm water or ginger water.
[Principles of Medication]
Bai Shao: Harmonizes the Liver, nourishes Blood, clears heat by nourishing Yin. It is the principal herb of this formula. Except for postpartum cases or those with Spleen/Stomach deficiency where fried or reduced doses are used, it is generally used raw in large amounts. For Beng Lou, vinegar-fried Bai Shao is sometimes used.
Dang Gui: Nourishes Blood. Its nature is slippery, moist, and warm. It can be used in larger doses for dry stools; combined with Fu Ling and Bai Zhu for loose stools; or assisted with Shu Di Huang (Rehmanniae Radix Preparata) or other Yin-nourishing herbs like Xuan Shen (Scrophulariae Radix) and Mai Dong (Ophiopogonis Radix) for Blood heat. Alternatively, Er Di (Shu Di Huang and Sheng Di Huang) or Dan Shen (Salviae Miltiorrhizae Radix) can substitute.
Bai Zhu: Tonifies the Spleen. Can be used in larger doses for loose stools due to Spleen deficiency, but should not be stir-fried. Not suitable for dry stools; can be substituted with Shi Hu (Dendrobii Caulis), Yi Yi Ren (Coicis Semen), or Sheng Shan Yao (Dioscoreae Rhizoma), or processed with milk.
Fu Ling: Promotes urination and leaches out dampness. Suitable for palpitations, phlegm-fluid retention, difficult urination, or loose stools. For palpitations, Fu Shen (Poria with Hostwood) can be substituted, or Mai Dong added to clear Heart heat. Combine with Bai Zhu for loose stools; avoid in dry stool cases.
Chai Hu: Ascends and disperses constrained heat in the Liver and Gallbladder. Essential for chills/fever, chest fullness, and hypochondriac pain. Usable for exterior syndromes; contraindicated for Yin deficiency with Liver Yang rising. Caution is needed for dizziness/headache. Use sparingly in doubtful cases. If accompanied by dry stools, combine with Jiu Jun (Wine-processed Da Huang).
Bo He: Clears heat. Usable for headache and fever, but should not be used in large amounts.
Wei Jiang: Retains its middle-jiao stabilizing property, preventing acrid dispersion from ascending excessively. Raw Jiang can be used for exterior syndromes or vomiting.
Gan Cao: Has draining and moderating effects. Usable in most patterns except for vomiting or middle-jiao fullness, where it may be omitted or reduced. Zhi Gan Cao (Honey-fried) is required for Spleen deficiency.
[Key Modifications]
1. For migraine, add Chuan Xiong, Fang Feng, Bai Zhi, Ban Xia, Yu Zhu. Add Jiu Jun for dry stools.
2. For vertigo, add Tian Ma, Ju Hua, or combine with Er Chen Tang, plus Fang Feng, Yu Zhu. Add Jiu Jun for constipation.
3. For tinnitus/deafness, add Man Jing Zi, Shi Chang Pu, Cong Guan. For excess fire, concurrently use Dang Gui Long Hui Wan.
4. For bitter taste, dry nose, red cheeks, and severe internal heat, add Huang Qin, or Dan Pi, Zhi Zi, Mai Dong, Sheng Di Huang. Severe cases: concurrently use Dang Gui Long Hui Wan.
5. For hematemesis/epistaxis, even with chills/fever, avoid large amounts of Chai Hu due to risk of massive hemorrhage. For mild heat, add Sheng Di Huang, E Jiao, Pu Huang, Mao Gen. For severe heat, consider combining with Xie Xin Tang.
6. For dry eyes, concurrently use Liu Wei Di Huang Wan, Qi Ju Di Huang Wan, or Gui Shao Di Huang Wan.
7. For dry throat/sore throat, add Xuan Shen, Sheng Di Huang, Mai Dong. Avoid large amounts of Chai Hu.
8. For vomiting, add Chen Pi, Ban Xia, Huang Lian, Sha Ren, Sheng Zhe Shi.
9. For acid regurgitation, add Wu Zhu Yu, Huang Lian, or intermittently use Zuo Jin Wan.
10. For scrofula/breast masses, add Lian Qiao, Yin Hua, Xiang Fu, Xia Ku Cao, Ru Xiang, Mo Yao. Intermittently use Xiao Luo Wan for scrofula.
11. For severe Qi stagnation with chest/hypochondriac fullness, add Xiang Fu, Guang Mu Xiang, Chen Xiang, Zhi Ke.
12. Dry cough is often due to Fire constraint, difficult to treat. First use this formula with Honey-processed Chen Pi to disperse, then follow with Yin-nourishing Lung-clearing herbs like Dong Chong Xia Cao, Di Huang.
13. For left hypochondriac pain, add Xiang Fu, Qing Pi, Ru Xiang, Mo Yao. Severe pain: add Chuan Lian Zi, Yuan Hu. Chronic pain with deficient pulse: after using Qi-moving herbs, add Sheng Huang Qi if pain worsens. For right hypochondriac pain, add Pian Jiang Huang.
14. For lower abdominal distension/pain, add Xiang Fu, Yuan Hu, Ru Xiang, Mo Yao.
15. For constipation, unless accompanied by headache/dizziness/intestinal heat (where Da Huang is added) or extreme dryness (add Yuan Hu Fen), generally use Qi-moving and moistening herbs like Xiang Fu, Mu Xiang, Dang Gui, Rong Rong, and reduce/remove Fu Ling, Bai Zhu.
16. For heat in palms/soles, add Dan Pi, Gu Pi.
17. For bone-steaming tidal fever, replace Chai Hu with Yin Chai Hu, add Gu Pi, Qing Hao, Sheng Bie Jia. May also add Dan Pi, Zhi Zi, Zhi Mu, Huang Bai.
18. For pruritus, add He Shou Wu, Bai Ji Li.
19. For early menstruation, add clearing-heat herbs like Dan Pi, Zhi Zi. For delayed menstruation, add Qi-moving herbs like Xiang Fu, Mu Xiang, Yuan Hu. For irregular cycles, add Qi/Blood tonics like Ren Shen, Huang Qi. For amenorrhea, add Tao Ren, Hong Hua, Xiang Fu. For metrorrhagia, remove Fu Ling, add Sheng Di Huang, Dan Pi, San Qi, Hei Jing Jie (Fu’s Ping Gan Kai Yu Zhi Xue Tang). For white leukorrhea, add Sheng Shan Yao, Long Gu, Mu Li. For green leukorrhea, remove Dang Gui, Bai Zhu, add Yin Chen, Zhi Zi, Chen Pi (Fu’s Jia Wei Xiao Yao San).
Note: These modifications are not fixed rules but directions. Precise application requires analyzing symptom needs and understanding herb efficacy to treat the pattern appropriately.
[Common Auxiliary Formulas]
1. Gui Pi Tang/Wan: Auxiliary for concurrent Heart-Spleen deficiency. Ideal when the main formula fails to address palpitations, anxiety, insomnia, or poor appetite. Take intermittently morning and evening.
2. Liu Wei Di Huang Wan: Used for concurrent Kidney Yin deficiency when adding Shu Di Huang to the main formula is inconvenient. Taken intermittently or at the end of treatment, based on need.
3. Shu Gan Wan: Auxiliary for abdominal distension/pain when the main formula’s Qi-moving power is insufficient. Intermittent use is preferred.
4. Zuo Jin Wan: Auxiliary for left hypochondriac pain with acid regurgitation/vomiting. Do not overuse to avoid damaging the Stomach with bitter-cold properties.
Yang He Tang for Tuberculosis of Bone and Joints
Old Master Li believes tuberculosis of bone and joints is fundamentally a deficiency syndrome. Therefore, treatment should focus on tonification—tonifying Yin/Yang or Qi/Blood. Yang He Tang is an effective formula.
Yang He Tang applies to localized flat areas with unchanged skin color, or locally purplish-dark and cold, oozing clear fluid, without fever, night sweats, or rapid pulse. It is unsuitable for Yang syndromes or half-Yin half-Yang syndromes, such as sallow complexion, occasional tender redness on cheeks, spontaneous/night sweats, or body heat; it is absolutely contraindicated in these cases. When applying Yang He Tang, pay strict attention to the ratio of each herb. For example: Shu Di Huang can be used up to 30g+, while Ma Huang should only be 0.6–1.5g; otherwise, it damages Qi and Blood, worsening the disease. For dual Qi and Blood deficiency, switch to Tuo Li Ding Tong Tang plus Huang Qi, or Shi Quan Da Bu Tang plus Bai Jie Zi, Bai Zhi. For sallow complexion, profuse sweating, and deficient-rapid pulse, switch to tonifying Qi and nourishing Yin method: Huang Qi 15g, Dang Gui 6g, Mai Dong 9g, Shi Hu 9g, Chi Shao 9g. If pus turns yellow/thick and pulse becomes slippery-rapid, add Jin Yin Hua 9g, Lian Qiao 9g.
Usage and Dosage of Xi Xin
Xi Xin is acrid and warm, entering the Lung, Liver, and Kidney meridians. Functions: dispel cold and relieve pain, suppress cough and resolve phlegm, warm the Lung and transform fluids, open nasal passages and stop tearing. Indications: headache, facial pain, toothache, body pain caused by exterior cold, cold penetrating inward, or cold with dampness; intermittent cough, nasal obstruction, loss of smell, tearing in wind. Its two main functions are dispelling cold and relieving pain. "Dispelling cold" refers to exterior cold or cold moving from exterior to interior, not internal cold generated by Yang deficiency. "Relieving pain" refers to head, face, body, abdomen, and tooth pain caused by Wind-Cold or Wind-Damp. Since Xi Xin effectively expels exterior cold (especially moving from exterior to interior), it is classified as an Acrid-Warm Exterior-Resolving herb.
Ancients said "Xi Xin should not exceed one qian." Lectures specify 1.5–3g. However, in clinical practice with severe cold penetrating inward, dosage can be increased to 4.5–9g. Although Yin deficiency and excess heat are generally contraindications, they are not absolute. When interior heat coexists with exterior cold, bold use is possible. For Yin deficiency/excess heat with exterior cold causing head/body pain or toothache, combine with Yin-nourishing/clearing-heat herbs. Example: Liu Wei Di Huang Tang plus Xi Xin for Kidney Yin deficiency with Wind-Cold headache; Sheng Shi Gao with Xi Xin for internal fire with external cold causing wind-fire toothache. Xi Xin is often paired with Fu Zi, a common pair in Zhang Zhongjing’s formulas for severe cold penetrating inward and pathogen hiding in Yin levels. In Ma Huang Fu Zi Xi Xin Tang, Xi Xin and Fu Zi are used with Ma Huang to assist Yang, dispel cold, and release the exterior. In Da Huang Fu Zi Tang, Xi Xin and Fu Zi are paired with Da Huang; Da Huang drains cold, Xi Xin warms and disperses, aided by large-dose Fu Zi warming Yang. This treats cold accumulation constipation due to hidden Yin cold and blocked Yang, with excellent effect. As Zhang Bingcheng stated in *Cheng Fang Bian Du*: "For lateral hypochondriac pain, fever, and string-tight pulse, this indicates Yin cold gathering in one area. Fever is due to constrained Yang. Thus, non-warming cannot dispel cold, non-draining cannot remove accumulation. Hence, Xi Xin and Fu Zi, being acrid-hot and mobile, search and disperse, allowing Da Huang to move the accumulation."
Discussion on Fu Zi
Yu Tun stated: "Fu Zi possesses a heroic quality and spirit of breaking through gates and capturing generals. It guides Qi-tonifying herbs through the twelve meridians to recover lost Primordial Yang; guides Blood-nourishing herbs into the Blood level to nourish deficient True Yin; guides dispersing herbs to open pores to expel exterior Wind-Cold; guides warming herbs to the Lower Jiao to remove interior cold-dampness." Wu Shou said: Fu Zi has the power to retreat Yin and restore Yang, bringing the dead back to life. *Lectures on Materia Medica* states: "(Fu Zi) is the principal herb for tonifying Primordial Yang. Its force ascends and descends, reaches internally and disperses externally. It opens obstructions caused by congealed cold and stubborn cold in organs, bones, sinews, collaterals, and vessels. Within its warming and unblocking action, it possesses strong astringent power, thus treating excessive sweating leading to Yang collapse, intestinal cold diarrhea, Lower Jiao Yang deficiency with Yin leakage, and seminal emission. Critics say it benefits Mingmen Minister Fire;服用 it accelerates heart pulse, greatly benefiting both Sovereign and Minister fires." Zhang Jingyue stated: "(Fu Zi) tastes acrid-sweet, pickled ones are very salty, nature is extremely hot, Yang within Yang. Toxic. Averse to Ren Shen, Huang Qi, Gan Cao, Hei Dou, Lv Dou, Xi Jiao, Tong Bian, Wu Jiu, Tie Feng. Its nature floats yet sinks, moves without staying. Because it travels well through all meridians, it is said to work like wine. It removes deep cold, reversal cold, and chills inside and outside; warms five Zang organs and restores Yang; treats retching, reverse vomiting, dysphagia, epigastric/abdominal pain, abdominal fullness, diarrhea, limb spasms, cold-damp pathogens, stomach cold with roundworms, cold phlegm, cold hernia, wind-damp numbness. Yin abscesses, toxic sores, chronic leaking yin ulcers, floating Yang throat bi, Yang deficiency with urinary/fecal retention, women’s menstrual cold with irregularity, pediatric slow convulsion, etc. It greatly guides fire back to its source and controls deficient heat. It assists Ren Shen and Huang Qi successfully, especially praises Di Huang and Bai Zhu’s effectiveness. Regardless of interior/exterior patterns, if pulse is fine without spirit and Qi is deficient without heat, it should be urgently used." In summary, Fu Zi is effective for Heart Yang deficiency or deep cold/stubborn cold causing chest/epigastric pain, palpitations, hypersomnia/insomnia; Spleen-Stomach deficiency cold causing epigastric/abdominal cold pain, diarrhea, anorexia; Yang deficiency with fluid metabolism failure causing edema/swallowing difficulty; Kidney Yang insufficiency causing low back pain/cold; and Yang collapse with reversal cold.
First, regarding restoring Yang and rescuing from collapse: It is highly effective for declining Heart/Spleen/Kidney Yang nearing collapse, arguably the best herb for this purpose. Paired with Gan Jiang and Zhi Gan Cao, it treats Spleen-Kidney Yang deficiency with cold limbs, watery/incontinent diarrhea, and faint pulse. If tongue coating is yellow or bitter taste exists (Yin excess repelling Yang), combine with cold herbs, e.g., Fu Zi Li Zhong Tang plus Huang Lian or Pig Bile. If accompanied by profuse sweating (Qi collapse), add Ren Shen. The main difference between Si Ni Tang and Shen Fu Tang in treating Yang collapse is sweating and diarrhea: profuse sweating requires Ren Shen; diarrhea requires Gan Jiang; both require both.
Second, regarding warming Heart and Kidney: Heart and Kidney contain both Yin and Yang; Yang deficiency implies Yin insufficiency. Thus, tonifying Heart/Kidney Yang requires assisting with Yin tonics. As *Su Wen* states: "The energy of vigorous fire declines; the energy of gentle fire strengthens. Vigorous fire consumes Qi; Qi feeds gentle fire. Vigorous fire dissipates Qi; gentle fire generates Qi." Examples include Bai Shao in Zhen Wu Tang and Di Huang in Ba Wei Di Huang Wan. When using Fu Zi in these patterns, small doses are better: 4.5g max, 1g min.
Third, regarding warming Spleen and Kidney: Spleen/Stomach belong to Earth; deficiency cold easily generates dampness. Heart/Kidney belong to Fire; Fire generates Earth. Thus, Spleen deficiency cold often uses Fu Zi, e.g., Fu Zi Li Zhong Tang. Unlike Heart-Kidney Yang deficiency requiring Yin tonics, Spleen-Kidney deficiency cold does not strictly require them due to dampness generation. Fu Zi Li Zhong Tang is most effective for epigastric cold pain with cold extremities and slow-deep pulse, or epigastric/hypochondriac pain. If pulse is deficient-large with floating deficient Yang, large doses of Fu Zi are effective due to its ability to move and stay, reach internally and disperse externally, warm the middle, and astringe Yang.
Fourth, regarding warming Yang and promoting diuresis: Fu Zi itself lacks diuretic action but effectively treats edema due to Spleen-Kidney or Heart-Kidney Yang deficiency. Purely for unblocking Yang and promoting diuresis, Rou Gui is superior. However, for edema, palpitations, cough/wheeze, cold limbs, and deep-fine pulse due to Spleen-Kidney/Heart-Kidney Yang deficiency, Water overflowing to Heart/Lungs, Fu Zi is superior to Rou Gui. For edema solely due to Kidney Yang loss, pairing Rou Gui and Fu Zi with Kidney Yang tonics improves diuretic efficacy.
Fifth, regarding dispelling cold and relieving pain: Fu Zi warms Spleen, Kidney, Heart, and Liver. For cold-excess patterns with tight pulse and hypochondriac pain, use Da Huang Fu Zi Tang. For epigastric/umbilical cold pain, hernia pain, cold-reversal Heart pain, Fu Zi is used. Since Fu Zi focuses on the Kidney, it is most effective for abdominal/gastric pain when accompanied by Kidney Yang deficiency. For pure Liver cold hernia/abdominal pain, Xiao Hui Xiang and Wu Zhu Yu are better; for pure Stomach cold, Gan Jiang is better.