29．朱男。初婚早泄，阳痿之端倪已露。黄狗肾10条（炙），紫河车1具（焙），绵黄芪120克，甘枸杞60克，茧丝饼60克，仙灵脾60克，炙茧壳30只，甜苁蓉60克，炙远志30克，金樱子60克。共研细末，蜜丸如梧子大，每饭后服6克。远房帏。
【按】《内经》说："肾者主蛰，封藏之本，精之处也。"遗精之证，除责之于肾外，且与心肝脾有关。此证既非君相之火扰动精室，更非湿热内郁，乃系禀赋不足，下无亏虚，肾失封藏而精关不固。故以紫河车、黄狗肾之血肉有情之品，峻补先天；苁蓉、淫羊藿、茧丝、枸杞填补精血，以顾其本；合金樱、茧壳温涩精关，以节其流；更以黄芪益气，远志宁心。凡此等证，精神起居，俱当严格要求，远房事尤属重要，药饵犹在其次。
30．丁男。性神经与脑神经俱高度衰弱，经常遗泄，腰痛足软，十指麻木，行动则欲跌仆。金樱子30克，龙骨30克，金毛脊60克，杜仲60克，煅牡蛎30克，罂粟壳60克，黄狗肾10条（焙）。共研末，加猪脊髓10条，和蜜为丸，如梧子大，早晚各服6克。【按】腰为肾之府，经常遗泄，肾虚则腰痛，十指麻木，行动欲仆，为精血不足，体质虚弱。治以温肾固摄涩精，使肾得封藏，则病可向愈。
31．王男。小溲频如故，今则夜泄频仍，皆肾气不能收摄之象。菟丝子9克，覆盆子12克，枸杞子4．5克，车前子9克。五味子4．5克，芡实15克，金樱子12克，天竺子9克，胡桃肉12克，龙骨6克。另三才封髓丹90克，每服9克，日早晚各1次。
【按】此例尿频日久，进而夜泄频仍，肾与膀胱相表里，膀胱之所以失约，责之肾气之收摄无权。病久正虚，难于速效，所以汤尤并进，缓以图功。立方以补肾培本与固摄缩尿并重。五子衍宗丸与水陆二仙丹，均有补肾固涩之功，惟前者长于补，后者优于涩，二者并用，取长补短，相得益彰。三才封髓丹滋肾坚阴。胡桃肉补元摄下，《本草纲目》取其单味，温酒送服，专治尿频。龙骨重镇而善收涩，《别录》称其"缩小便……安五脏"，天竺子酸甘性平，《本草纲目拾遗》谓"益气力，固精"。全方汇滋、敛、清、补诸法于一体，方意平稳堪法。
32魏男。6年前曾罹湿温重病，偃卧床笫达6个月。愈后患遗精，每隔一二日即有之。现在四肢无力，腰膝酸软，健忘，少判断力，夜间常作恶梦。枸杞子9克，怀牛膝9克，山萸肉9克，川断肉9克，大熟地12克，金毛脊9克，酸枣仁12克，怀山药9克，抱茯神12克，潼沙苑12克。二诊：服药4剂，腿膝酸软已除，5日来无遗精现象，夜梦亦减少。自汗，微恶寒，加玉屏风散。生黄芪3克，全当归12克，蜜炙防风6克，冬术9克，金毛脊9克，川续断9克，厚杜仲9克，枸杞子9克，山萸肉9克。
【按】久病之后，腰酸、多梦、遗精，皆为虚象。方用熟地、山药、萸肉、枸杞子。沙苑滋益肝肾；川断、狗脊、牛膝补肾强腰；枣仁、茯神安神宁心。二诊于补肾之中加玉屏风散，益气固表，以治自汗、微恶寒之证。
33．许男。滑泄1周，此或者睡眠仰卧，或者体力正感衰惫时。予八子丸意。枸杞子9克，车前子12克，菟丝子9克，覆盆子9克，五味子15克，金樱子9克，冬青子9克，沙苑子9克，巨胜子12克。【按】本方平补肝肾，兼收敛涩精；用车前子利湿热、泻相火，合为损有余、补不足之意。巨胜子即黑芝麻。
34．何男。夜间乱说梦话，白昼精神疲乏，腰脊酸痛，阳痿，尿多，最近连续梦遗。金毛脊12克，川断肉9克，甘杞子9克，五味子6克，潼沙苑9克，补骨脂9克，金樱子9克，酸枣仁9克，菟丝子9克，牛膝9克，龟鹿二仙胶15克（烊冲）。二诊：夜寐遗精，服药后有好转；最近因工作忙，又遗3次；腿软乏力，甚至行走难支，手冷如冰，没精打采。温肾药不可少。炙紫河车2具，黄狗肾6条，金樱子30克，菟丝子30克，锁阳30克，韭菜子30克，覆盆子30克，甘拘杞30克，蚕茧30只，补骨脂3（克，仙茅15克，巴戟肉60克，仙灵脾60克，炙花蜘蛛30只，淮山药30克。共研细末，每服3克，I日3次。
【按】初诊重在补肾气以摄精。龟鹿二仙胶用鹿角温肾壮督，龟板滋阴补任，更有人参、狗杞，合为阴中补阳的良方。张景岳所谓"善补阳者，当于阴中求之"，殆即指此类治法而言。二诊则峻补命门真阳，紫河车、狗肾，乃血肉有情之品，善能补益精血；花蜘蛛温肾助火，尤擅强阳起痿。现在花蜘蛛紧缺，可以蜈蚣30克代之。此方对于肾阳虚惫所致的阳痿，具有相当的效果。
35．某男。膏方之制，不见仲景、思邈之书，即金元四家亦未尝有焉。溯其所自，实始于明代注重血肉有情之物，为虚赢不足者辟一新途径。今考《韩氏医通》，实为用膏方治虚劳之镐矢者，然亦因病施药，毫不驳杂。降及近代膏方，遂为富有者之"安慰品"，寒热温凉，龙潜动植，聚于一方，只求昂贵，中病与否不计也。本医室力矫此弊，辨证用药，不求药味之多，而取精用宏，更参以远西之荷尔蒙、维生素等学说，组织本方。世有知音，相视而笑。（1940年冬）
【按】处方未录。先生此案专论育方，对解放前部分医者滥用膏方，用药庞杂、昂贵，以取媚病家，提出了批评。而先生开列膏方，则辨证用药，从实效出发。这充分体现了他的革新求实精神以及不附和顺俗的高尚品德。
1．王男。小便频数刺痛，有脓汁，外有热象，乃湿热之熏蒸。银花30克，白蔽12克，马鞭草、凤尾草各18克，篇蓄12克，冬葵子12克，黄柏6克，萆薢12克，熟大黄9克。二诊：脓汁变为血液，痛不可耐。猪苓9克，赤苓12克，泽泻9克，小生地15克、飞滑石15克，篇蓄24克，萆薢12克，生草梢4．5克，小蓟18克，瞿麦18克，黄柏9克，琥珀屑3克（分2次吞）。
【按】此尿频刺痛，有脓汁，显为湿热蕴结下焦之淋证。初诊重用银花等清热解毒，利尿通淋。尤妙在大黄一味，能推动瘀热下行，炒熟则行中有收；据现代药理研究证实，此药对金黄色葡萄球菌等有较强的抑制作用。二诊脓汁得去，转见血尿，疼痛剧烈，为湿热伤及血络，故复加凉血散瘀之生地、小蓟、琥珀等。经验证明：琥珀对急性泌尿系感染引起的尿痛、血尿，确属有效。
2．陈女。以六味地黄丸加味，小便反见减少。小溲既有脓血，如不排出，则其热不能退，尿量亦无从增加。生侧柏15克，小蓟9克，蒲公英9克，银花9克，白薇9克，荜澄茄9克，知母12克，车前子30克，黄柏6克，生苡仁30克。二诊：得效。上方加牛膝9克，丹皮9克。【按］既有脓血，便有湿热；湿热不去，则必留而为患。六味地黄丸虽有"三补三泻"之称，毕竟以补为主，用之嫌早，故处方以大剂清热凉血利尿，给湿热之邪以出路。
3．赵男。小溲刺痛，次数亦频。凡慢性淋浊，多不发热；今有表证，殆为慢性肾盂炎而急性发作者。薄荷6克，菊花9克，佩兰梗9克，忍冬藤12克，柴胡6克，冬桑叶9克，粉萆薢9克，泽泻9克，车前子9克。【按】前人曾有"淋家不可发汗"之城。盖淋病日久，阴血多不足，误用辛温则阴血愈伤。今淋病而兼表证，药选轻宣渗利之品，便无伤阴耗血之弊。
4．夏男。此下焦湿热，其热弛张起伏，小溲如浊涕，兼有红色，但不痛，舌红，脉细数。处方以猪苓汤为骨干。陈阿胶24克（烊冲），猪苓9克，赤茯苓9克，泽泻9克，飞滑石12克，马鞭草9克，瞿麦穗9克，冬青子9克，旱莲草9克，杭白芍12克，生侧柏叶30克。二诊：药后小溲之红白粘液，始则增多，继则减少，起伏之热亦不若往日之剧。再拟清利湿热之剂，亦尿道消毒之意。柴胡9克，生侧柏叶30克，苦参片6克，黄柏4．5克，生苍术9克，淮牛膝12克，白芍9克，紫花地丁12克，马鞭草15克，凤尾草15克，荜澄茄9克，生甘草3克。
【按】此案身热起伏，小便如浊涕，兼有红色，舌红，脉细数，为肾阴虚而膀胱积热，尿道不痛，则当为浊证。《金匮》说："脉浮发热，渴欲饮水，小便不利者，猪苓汤主之。"此方实为滋阴利水之良方。今以其为骨干，复入二至、白芍，以助阿胶育阴止血；用瞿麦、马鞭草助苓、泽、滑石以利尿清热，进一步增强了其作用。二诊红白粘液姐则多，继而少，为病去之征，仍着眼于清利湿热者，因为有红白粘液，余邪未净，而宜通不宜涩。荜澄茄为尿道防腐药。
5．刘男。尿短，尿道刺痛，膀胱炎也，中医称作"淋"。生地18克，甘草梢3克，木通9克，竹叶甘片，篇蓄9克，川黄柏6克，瞿麦9克，萆薢15克。【按】湿热蕴结膀胱，故小便淋痛。方用导赤散养阴泄热利尿；黄柏、萆薢泻下焦湿热；篇蓄、瞿麦通淋止痛。
6．庄女。其症状可划分三大类：①小溲频数，溺时疼痛；②头眩，心动悸，夜间少寐；③两腿皮下紫癜成片。②与③，纯属体虚气血不足。此方以治其淋痛为主。阿胶9克，干地黄15克，赤猪苓各9克，琥珀2．4克（分2次吞），飞滑石12克，冬葵子12克，泽泻9克，二至丸12克（包）。
【按］尿频、溺痛为淋；头眩、心悸、少寐为阴血不足；紫癜为脾不统血。淋属湿热为患，欲滋其阴，则碍湿热；欲事通利，则阴血更伤。乃选仲景猪苓汤，一以育阴，一以清利，两不相妨；加地黄、二至九以养阴血，琥珀、冬葵子以利尿行瘀，除尿道之痛。琥珀且有镇静安神作用。
7．唐女。以往有子宫附属器炎症疾患，愈后未久，以疲劳少腹痛又作，尤以按时尿道刺痛为苦，大便难，五日不更衣。此泌尿系感染。粉萆薢9克，大小蓟各9克，荜澄茄9克，篇蓄草9克，凤尾草9克，香白芷9克，炙乳没各3克，小茵香6克，杭白芍6克，桃仁泥12克，玄明粉18克（分2次冲），通天梗4．5克，滋肾通关丸12克（分2次吞）。二诊：凡小溲先痛后渡者，炎症在尿道口；溲与痛俱作者在尿道；其痛在搜毕者，其炎症在上端或膀胱。假使肾盂肾炎急性发作者多伴见腰痛，且有起伏热。病者所患是也。嫩白薇12克，桑白皮9克，生山栀12克，柴胡梢6克，青蒿子9克，松子仁18克，杭白芍9克，石韦9克，银花12克，紫花地丁9克，黄柏9克，生侧柏叶30克（煎汤代水）。【按】此病人先是尿痛，继而高热、腰痛，盖为逆行尿路感染，导致急性肾盂肾炎。治以清热、利尿，分利下焦湿热为主；因有大便难，故辅以润肠通便之品。通天梗即荸荠苗，有利湿利尿作用。
8．陈男。因外伤而尿道发炎，小溲刺痛；炎症皆有分泌物，故有粘液；炎症皆有起伏热，故有表证，如太阳病。生麻黄3克，光杏仁9克，茯苓9克，桂枝2．4克（后下），猪苓9克，泽泻12克，阿胶珠9克，粉甘草4．5克，飞滑石9克（分3次吞）。【按1分而观之，麻黄汤治起伏热。猪苓汤治尿路感染。合而观之，麻、桂均有利尿作用。可见先生选药择方，精细人微。
其他
1．陆男。昨日起咳嗽复作，臭痰较多，恶心，神疲乏力，肩背酸痛，饮食、睡眠尚正常。此为肺痈，西医诊为放线菌化脓症。黄芪24克，石斛12克，银花18克，粉甘草9克，百部9克，黄芩9克，白芨粉15克（分3次吞）。另：琼玉膏12克，二冬膏12克和匀，每服半匙，日3次。二诊：药后咳嗽稀减，臭痰隔日即消失。今日清晨又有少量痰，自喉至胃部觉隐痛，尤以咳呛时加重，神疲乏力，胸背疼痛依然。生芪24克，银花18克，鱼腥草18克（后下），玉竹15克，生甘草9，生米仁30克，白芨粉4．5克（分3次吞）。另：二冬膏120克，琼工膏120克，甜葶苈24克，研末和入调匀。每服半匙，日3次。三诊：臭痰已大减，服药时稍恶心。生芪24克，鱼腥草15克（后下），雅连3克，甘草6克，党参9克，紫地了9克，白芨粉4．5克（分3次吞）。另：橄榄膏120克，琼玉膏120克，二冬膏10克，甜葶苈36克，象贝母36克，均研末和膏中，每服半匙，日3次。
【按】肺痈一症，以胸痛、咯吐脓臭痰或脓血为特征。其机制为外邪袭入，肺生痰热，热与血凝，为痈酿脓。肺放线菌病是一种肺部霉菌病，亦可引起多发性小脓肿，临床征象与肺脓肿、空洞型肺结核、肺癌等伴有组织坏死者相似。在成痈期以活血排脓、清热解毒为治疗原则。此案因病程较长，脓未去而气阴已伤，故重用黄芪、甘草、石斛、玉竹、二冬膏、琼玉膏，以养气阴；银花、鱼腥草、紫地了、苡仁、葶苈子、象贝母，以清热、解毒、祛疾。白芨一味，能补肺止血，据文献记载："疮疡未溃者服之可清热消肿，已溃者服之可收口生肌。"加用金荞麦30克，清肺涤痰，促进脓疡愈合，奏效更佳。
29．朱男。初婚时出现早泄，阳痿的征兆已经显现。黄狗肾10条（炙烤），紫河车1具（焙干），绵黄芪120克，甘枸杞60克，茧丝饼60克，仙灵脾60克，炙茧壳30只，甜苁蓉60克，炙远志30克，金樱子60克。共研成细末，用蜂蜜制成梧桐子大小的丸药，每饭后服用6克。节制房事。
【按】《内经》说：“肾者主蛰，封藏之本，精之处也。”遗精之证，除了责之于肾外，还与心、肝、脾有关。此证既非君相之火扰动精室，也非湿热内郁，而是禀赋不足，下元亏虚，肾失封藏而精关不固。因此使用紫河车、黄狗肾等血肉有情之品，峻补先天；苁蓉、淫羊藿、茧丝、枸杞填补精血，以顾护其根本；配合金樱子、茧壳温涩精关，以节制流失；再用黄芪益气，远志宁心。凡此类病症，精神起居都应当严格要求，远离房事尤为重要，药物治疗尚在其次。
30．丁男。性神经与脑神经均高度衰弱，经常遗泄，腰痛足软，十指麻木，行动时想要跌倒。金樱子30克，龙骨30克，金毛脊60克，杜仲60克，煅牡蛎30克，罂粟壳60克，黄狗肾10条（焙干）。共研成末，加入猪脊髓10条，和蜜制成丸药，如梧桐子大小，早晚各服6克。【按】腰为肾之府，经常遗泄，肾虚则腰痛，十指麻木，行动欲仆，是精血不足，体质虚弱所致。治疗以温肾固摄涩精为主，使肾得以封藏，则病可向愈。
31．王男。小便频数依旧，如今夜间遗精频繁，都是肾气不能收摄的表现。菟丝子9克，覆盆子12克，枸杞子4.5克，车前子9克。五味子4.5克，芡实15克，金樱子12克，天竺子9克，胡桃肉12克，龙骨6克。另服三才封髓丹90克，每次服9克，每日早晚各1次。
【按】此例尿频日久，进而夜间遗精频繁，肾与膀胱相表里，膀胱之所以失约，责任在于肾气收摄无权。病久正气虚弱，难以迅速见效，所以汤剂丸药并进，缓慢图取功效。立方以补肾培本与固摄缩尿并重。五子衍宗丸与水陆二仙丹，均有补肾固涩之功，但前者长于补，后者优于涩，二者并用，取长补短，相得益彰。三才封髓丹滋肾坚阴。胡桃肉补元摄下，《本草纲目》取其单味，温酒送服，专治尿频。龙骨重镇而善收涩，《别录》称其“缩小便……安五脏”，天竺子酸甘性平，《本草纲目拾遗》谓“益气力，固精”。全方汇滋、敛、清、补诸法于一体，方意平稳值得效法。
32 魏男。6年前曾患湿温重病，卧床达6个月。痊愈后患遗精，每隔一二日即有一次。现在四肢无力，腰膝酸软，健忘，判断力减退，夜间常作恶梦。枸杞子9克，怀牛膝9克，山萸肉9克，川断肉9克，大熟地12克，金毛脊9克，酸枣仁12克，怀山药9克，抱茯神12克，潼沙苑12克。二诊：服药4剂，腿膝酸软已除，5日来无遗精现象，夜梦亦减少。自汗，微恶寒，加玉屏风散。生黄芪3克，全当归12克，蜜炙防风6克，冬术9克，金毛脊9克，川续断9克，厚杜仲9克，枸杞子9克，山萸肉9克。
【按】久病之后，腰酸、多梦、遗精，皆为虚象。方用熟地、山药、萸肉、枸杞子。沙苑滋益肝肾；川断、狗脊、牛膝补肾强腰；枣仁、茯神安神宁心。二诊于补肾之中加玉屏风散，益气固表，以治自汗、微恶寒之证。
33．许男。滑泄1周，这或许是因为睡眠仰卧，或者体力正感衰惫时所致。予八子丸之意。枸杞子9克，车前子12克，菟丝子9克，覆盆子9克，五味子15克，金樱子9克，冬青子9克，沙苑子9克，巨胜子12克。【按】本方平补肝肾，兼收敛涩精；用车前子利湿热、泻相火，合为损有余、补不足之意。巨胜子即黑芝麻。
34．何男。夜间乱说梦话，白昼精神疲乏，腰脊酸痛，阳痿，尿多，最近连续梦遗。金毛脊12克，川断肉9克，甘杞子9克，五味子6克，潼沙苑9克，补骨脂9克，金樱子9克，酸枣仁9克，菟丝子9克，牛膝9克，龟鹿二仙胶15克（烊化冲服）。二诊：夜寐遗精，服药后有好转；最近因工作忙，又遗3次；腿软乏力，甚至行走难支，手冷如冰，没精打采。温肾药不可少。炙紫河车2具，黄狗肾6条，金樱子30克，菟丝子30克，锁阳30克，韭菜子30克，覆盆子30克，甘拘杞30克，蚕茧30只，补骨脂30克，仙茅15克，巴戟肉60克，仙灵脾60克，炙花蜘蛛30只，淮山药30克。共研细末，每服3克，每日3次。
【按】初诊重在补肾气以摄精。龟鹿二仙胶用鹿角温肾壮督，龟板滋阴补任，更有人参、狗杞，合为阴中补阳的良方。张景岳所谓“善补阳者，当于阴中求之”，大概就是指这类治法而言。二诊则峻补命门真阳，紫河车、狗肾，乃血肉有情之品，善能补益精血；花蜘蛛温肾助火，尤擅强阳起痿。现在花蜘蛛紧缺，可以用蜈蚣30克代替。此方对于肾阳虚惫所致的阳痿，具有相当的效果。
35．某男。膏方的制作，不见于仲景、思邈之书，即使是金元四家也未尝有过。追溯其源头，实际上始于明代注重使用血肉有情之物，为虚羸不足者开辟了一条新途径。如今考证《韩氏医通》，实为用膏方治疗虚劳的创始之作，然而也是因病施药，毫不驳杂。到了近代膏方，遂成为富有者的“安慰品”，寒热温凉，龙潜动植，聚于一方，只求昂贵，是否中病则不计较。本医室力矫此弊，辨证用药，不求药味之多，而取精用宏，更参以西学的荷尔蒙、维生素等学说，组织本方。世间若有知音，相视而笑。（1940年冬）
【按】处方未录。先生此案专论膏方，对解放前部分医者滥用膏方，用药庞杂、昂贵，以取媚病家，提出了批评。而先生开列膏方，则辨证用药，从实效出发。这充分体现了他的革新求实精神以及不附和顺俗的高尚品德。
1．王男。小便频数刺痛，有脓汁，外有热象，乃湿热之熏蒸。银花30克，白蔽12克，马鞭草、凤尾草各18克，篇蓄12克，冬葵子12克，黄柏6克，萆薢12克，熟大黄9克。二诊：脓汁变为血液，痛不可耐。猪苓9克，赤苓12克，泽泻9克，小生地15克、飞滑石15克，篇蓄24克，萆薢12克，生草梢4.5克，小蓟18克，瞿麦18克，黄柏9克，琥珀屑3克（分2次吞服）。
【按】此尿频刺痛，有脓汁，显为湿热蕴结下焦之淋证。初诊重用银花等清热解毒，利尿通淋。尤妙在大黄一味，能推动瘀热下行，炒熟则行中有收；据现代药理研究证实，此药对金黄色葡萄球菌等有较强的抑制作用。二诊脓汁得去，转见血尿，疼痛剧烈，为湿热伤及血络，故复加凉血散瘀之生地、小蓟、琥珀等。经验证明：琥珀对急性泌尿系感染引起的尿痛、血尿，确属有效。
2．陈女。以六味地黄丸加味，小便反见减少。小溲既有脓血，如不排出，则其热不能退，尿量亦无从增加。生侧柏15克，小蓟9克，蒲公英9克，银花9克，白薇9克，荜澄茄9克，知母12克，车前子30克，黄柏6克，生苡仁30克。二诊：得效。上方加牛膝9克，丹皮9克。【按】既有脓血，便有湿热；湿热不去，则必留而为患。六味地黄丸虽有“三补三泻”之称，毕竟以补为主，用之嫌早，故处方以大剂清热凉血利尿，给湿热之邪以出路。
3．赵男。小溲刺痛，次数亦频。凡慢性淋浊，多不发热；今有表证，殆为慢性肾盂炎而急性发作者。薄荷6克，菊花9克，佩兰梗9克，忍冬藤12克，柴胡6克，冬桑叶9克，粉萆薢9克，泽泻9克，车前子9克。【按】前人曾有“淋家不可发汗”之诫。盖淋病日久，阴血多不足，误用辛温则阴血愈伤。今淋病而兼表证，药选轻宣渗利之品，便无伤阴耗血之弊。
4．夏男。此下焦湿热，其热弛张起伏，小溲如浊涕，兼有红色，但不痛，舌红，脉细数。处方以猪苓汤为骨干。陈阿胶24克（烊化冲服），猪苓9克，赤茯苓9克，泽泻9克，飞滑石12克，马鞭草9克，瞿麦穗9克，冬青子9克，旱莲草9克，杭白芍12克，生侧柏叶30克。二诊：药后小溲之红白粘液，始则增多，继则减少，起伏之热亦不若往日之剧。再拟清利湿热之剂，亦尿道消毒之意。柴胡9克，生侧柏叶30克，苦参片6克，黄柏4.5克，生苍术9克，淮牛膝12克，白芍9克，紫花地丁12克，马鞭草15克，凤尾草15克，荜澄茄9克，生甘草3克。
【按】此案身热起伏，小便如浊涕，兼有红色，舌红，脉细数，为肾阴虚而膀胱积热，尿道不痛，则当为浊证。《金匮》说：“脉浮发热，渴欲饮水，小便不利者，猪苓汤主之。”此方实为滋阴利水之良方。今以其为骨干，复入二至、白芍，以助阿胶育阴止血；用瞿麦、马鞭草助苓、泽、滑石以利尿清热，进一步增强了其作用。二诊红白粘液先多，继而少，为病去之征，仍着眼于清利湿热者，因为有红白粘液，余邪未净，而宜通不宜涩。荜澄茄为尿道防腐药。
5．刘男。尿短，尿道刺痛，膀胱炎也，中医称作“淋”。生地18克，甘草梢3克，木通9克，竹叶甘片，篇蓄9克，川黄柏6克，瞿麦9克，萆薢15克。【按】湿热蕴结膀胱，故小便淋痛。方用导赤散养阴泄热利尿；黄柏、萆薢泻下焦湿热；篇蓄、瞿麦通淋止痛。
6．庄女。其症状可划分三大类：①小溲频数，溺时疼痛；②头眩，心动悸，夜间少寐；③两腿皮下紫癜成片。②与③，纯属体虚气血不足。此方以治其淋痛为主。阿胶9克，干地黄15克，赤猪苓各9克，琥珀2.4克（分2次吞服），飞滑石12克，冬葵子12克，泽泻9克，二至丸12克（包煎）。
【按】尿频、溺痛为淋；头眩、心悸、少寐为阴血不足；紫癜为脾不统血。淋属湿热为患，欲滋其阴，则碍湿热；欲事通利，则阴血更伤。乃选仲景猪苓汤，一以育阴，一以清利，两不相妨；加地黄、二至丸以养阴血，琥珀、冬葵子以利尿行瘀，除尿道之痛。琥珀且有镇静安神作用。
7．唐女。以往有子宫附属器炎症疾患，愈后未久，以疲劳少腹痛又作，尤以按时尿道刺痛为苦，大便难，五日不更衣。此泌尿系感染。粉萆薢9克，大小蓟各9克，荜澄茄9克，篇蓄草9克，凤尾草9克，香白芷9克，炙乳没各3克，小茵香6克，杭白芍6克，桃仁泥12克，玄明粉18克（分2次冲服），通天梗4.5克，滋肾通关丸12克（分2次吞服）。二诊：凡小溲先痛后渡者，炎症在尿道口；溲与痛俱作者在尿道；其痛在搜毕者，其炎症在上端或膀胱。假使肾盂肾炎急性发作者多伴见腰痛，且有起伏热。病者所患是也。嫩白薇12克，桑白皮9克，生山栀12克，柴胡梢6克，青蒿子9克，松子仁18克，杭白芍9克，石韦9克，银花12克，紫花地丁9克，黄柏9克，生侧柏叶30克（煎汤代水）。【按】此病人先是尿痛，继而高热、腰痛，盖为逆行尿路感染，导致急性肾盂肾炎。治以清热、利尿，分利下焦湿热为主；因有大便难，故辅以润肠通便之品。通天梗即荸荠苗，有利湿利尿作用。
8．陈男。因外伤而尿道发炎，小溲刺痛；炎症皆有分泌物，故有粘液；炎症皆有起伏热，故有表证，如太阳病。生麻黄3克，光杏仁9克，茯苓9克，桂枝2.4克（后下），猪苓9克，泽泻12克，阿胶珠9克，粉甘草4.5克，飞滑石9克（分3次吞服）。【按】分而观之，麻黄汤治起伏热。猪苓汤治尿路感染。合而观之，麻、桂均有利尿作用。可见先生选药择方，精细入微。
其他
1．陆男。昨日起咳嗽复作，臭痰较多，恶心，神疲乏力，肩背酸痛，饮食、睡眠尚正常。此为肺痈，西医诊为放线菌化脓症。黄芪24克，石斛12克，银花18克，粉甘草9克，百部9克，黄芩9克，白芨粉15克（分3次吞服）。另：琼玉膏12克，二冬膏12克和匀，每服半匙，日3次。二诊：药后咳嗽稀减，臭痰隔日即消失。今日清晨又有少量痰，自喉至胃部觉隐痛，尤以咳呛时加重，神疲乏力，胸背疼痛依然。生芪24克，银花18克，鱼腥草18克（后下），玉竹15克，生甘草9，生米仁30克，白芨粉4.5克（分3次吞服）。另：二冬膏120克，琼工膏120克，甜葶苈24克，研末和入调匀。每服半匙，日3次。三诊：臭痰已大减，服药时稍恶心。生芪24克，鱼腥草15克（后下），雅连3克，甘草6克，党参9克，紫地了9克，白芨粉4.5克（分3次吞服）。另：橄榄膏120克，琼玉膏120克，二冬膏10克，甜葶苈36克，象贝母36克，均研末和膏中，每服半匙，日3次。
【按】肺痈一症，以胸痛、咯吐脓臭痰或脓血为特征。其机制为外邪袭入，肺生痰热，热与血凝，为痈酿脓。肺放线菌病是一种肺部霉菌病，亦可引起多发性小脓肿，临床征象与肺脓肿、空洞型肺结核、肺癌等伴有组织坏死者相似。在成痈期以活血排脓、清热解毒为治疗原则。此案因病程较长，脓未去而气阴已伤，故重用黄芪、甘草、石斛、玉竹、二冬膏、琼玉膏，以养气阴；银花、鱼腥草、紫地了、苡仁、葶苈子、象贝母，以清热、解毒、祛疾。白芨一味，能补肺止血，据文献记载：“疮疡未溃者服之可清热消肿，已溃者服之可收口生肌。”加用金荞麦30克，清肺涤痰，促进脓疡愈合，奏效更佳。
29. Male, Zhu. Premature ejaculation upon first marriage; signs of impotence are already emerging. Ten roasted dog kidneys (Canis lupus familiaris Kidney), one dried placenta (Human Placenta), 120g Astragalus membranaceus (Radix Astragali), 60g Goji berries (Fructus Lycii), 60g Silkworm silk cake (Bombyx Batryticatus preparation), 60g Epimedium leaves (Herba Epimedii), 30 roasted silkworm pupae cases (Bombyx Batryticatus Case), 60g Cistanche (Cistanches Herba), 30g Prepared Polygala root (Radix Polygalae), 60g Cherokee rose fruit (Fructus Rosae Laevigatae). Grind into fine powder, make honey pills the size of a large wheat seed, take 6g after each meal. Abstain from sexual intercourse.
[Commentary] The *Neijing* states: "The Kidney governs hibernation, is the root of sealing and storing, and is the residence of essence." Regarding spermatorrhea, besides attributing it to the Kidney, it is also related to the Heart, Liver, and Spleen. This case is neither due to the disturbance of the Jing Shi (essence chamber) by ministerial fire, nor due to internal stagnation of damp-heat, but rather due to congenital insufficiency and deficiency in the lower origin, causing the Kidney to lose its sealing function and the essence gate to become insecure. Therefore, animal-derived substances like Human Placenta and Dog Kidney are used to vigorously tonify the先天 (innate constitution); Cistanche, Epimedium, silkworm silk, and Goji berries fill the essence and blood to protect the root; Cherokee rose fruit and silkworm cases are combined to warm and astringe the essence gate to control leakage; further, Astragalus is used to tonify Qi, and Polygala to calm the Mind. For such conditions, mental state and daily life must be strictly regulated; abstaining from sexual activity is particularly important, while medication is secondary.
30. Male, Ding. Both sexual nerves and cerebral nerves are highly weakened, with frequent nocturnal emissions, lower back pain, weak legs, numbness in the ten fingers, and a sensation of falling when walking. 30g Cherokee rose fruit, 30g Dragon bone (Os Draconis), 60g Cibotium rhizome (Rhizoma Cibotii), 60g Eucommia bark (Cortex Eucommiae), 30g Calcined Oyster shell (Concha Ostreae), 60g Poppy capsule (Capsule Papaveris), 10 roasted dog kidneys (Canis lupus familiaris Kidney). Grind into powder, add 10 pig spinal cords, mix with honey to make pills the size of a large wheat seed, take 6g morning and evening. [Commentary] The waist is the mansion of the Kidney; frequent emissions due to Kidney deficiency cause lower back pain. Numbness in the fingers and the desire to fall indicate deficiency of essence and blood and weak constitution. Treatment focuses on warming the Kidney, securing and astringing essence, allowing the Kidney to seal and store, leading to recovery.
31. Male, Wang. Frequent urination persists; now accompanied by frequent nocturnal emissions, indicating the Kidney Qi's inability to secure and retain. 9g Dodder seed (Semen Cuscutae), 12g Raspberry (Fructus Rubi), 4.5g Goji berries (Fructus Lycii), 9g Plantago seed (Semen Plantaginis). 4.5g Schisandra berry (Fructus Schisandrae), 15g Chinese lotus seed (Semen Nelumbinis), 12g Cherokee rose fruit (Fructus Rosae Laevigatae), 9g Heavenly bamboo nut (Semen Trapaes), 12g Walnut kernel (Semen Juglandis), 6g Dragon bone (Os Draconis). Additionally, take 90g Sancai Fengsui Pill (Three Talents Sealing Marrow Pill), 9g per dose, twice daily morning and evening.
[Commentary] In this case, long-standing frequent urination has progressed to frequent nocturnal emissions. The Kidney and Bladder are exterior-interiorly related; the Bladder's failure to maintain control is due to the Kidney Qi's lack of securing power. Long-standing illness leads to righteous Qi deficiency, making rapid effects difficult; thus, decoctions and pills are used together for gradual results. The prescription emphasizes both tonifying the Kidney to cultivate the root and securing/astringing to reduce urination. Wuzi Yanzong Wan (Five Seeds Procreation Pill) and Shuilu Erxian Dan (Water and Land Two Immortals Decoction) both have benefits of tonifying the Kidney and astringing, but the former excels in tonification while the latter in astringency. Using them together complements their strengths. Sancai Fengsui Pill nourishes the Kidney and solidifies Yin. Walnut kernels tonify Yuan Qi and secure the lower body; *Bencao Gangmu* records using single-dose walnut kernels taken with warm wine specifically for frequent urination. Dragon bone settles heaviness and excels in astringency; *Bielu* states it "reduces small urine... calms the five viscera." Heavenly bamboo nuts are sour, sweet, and neutral; *Bencao Gangmu Shiyi* says they "boost energy and secure essence." The formula integrates nourishing, astringing, clearing, and tonifying methods, offering a stable and exemplary approach.
32. Male, Wei. Six years ago, he suffered a severe damp-warmth disease, remaining bedridden for six months. After recovery, he developed nocturnal emissions occurring every one or two days. Currently, he has weak limbs, sore and weak lower back and knees, forgetfulness, reduced judgment ability, and frequent nightmares at night. 9g Goji berries (Fructus Lycii), 9g Achyranthes root (Radix Achyranthis Bidentatae), 9g Cornus fruit (Fructus Corni), 9g Dipsacus root (Radix Dipsaci), 12g Prepared Rehmannia root (Radix Rehmanniae Praeparata), 9g Cibotium rhizome (Rhizoma Cibotii), 12g Sour jujube seed (Semen Ziziphi Spinosae), 9g Chinese yam (Rhizoma Dioscoreae), 12g Poria with hostwood (Poria Cum Mycelium), 12g Astilbe seed (Semen Astragali Complanati). Second visit: After 4 doses, leg and knee soreness disappeared; no emissions for 5 days; nightmares reduced. Spontaneous sweating and slight aversion to cold; add Yupingfeng San (Jade Windscreen Powder). 3g Raw Astragalus (Radix Astragali), 12g Whole Angelica sinensis (Radix Angelicae Sinensis), 6g Honey-fried Saposhnikovia root (Radix Saposhnikoviae), 9g Winter Atractylodes (Rhizoma Atractylodis Macrocephalae), 9g Cibotium rhizome (Rhizoma Cibotii), 9g Dipsacus root (Radix Dipsaci), 9g Eucommia bark (Cortex Eucommiae), 9g Goji berries (Fructus Lycii), 9g Cornus fruit (Fructus Corni).
[Commentary] After prolonged illness, lower back soreness, frequent dreams, and nocturnal emissions are all signs of deficiency. The formula uses Prepared Rehmannia, Chinese yam, Cornus, and Goji berries. Astilbe nourishes and benefits the Liver and Kidney; Dipsacus, Cibotium, and Achyranthes tonify the Kidney and strengthen the waist; Sour jujube seed and Poria calm the Mind. In the second visit, Yupingfeng San is added to the Kidney-tonifying formula to tonify Qi and secure the exterior, treating spontaneous sweating and slight aversion to cold.
33. Male, Xu. Slipping emission for one week, possibly due to sleeping on the back or during periods of physical exhaustion. Prescribed with the intent of Babao Wan (Eight Seeds Pill). 9g Goji berries (Fructus Lycii), 12g Plantago seed (Semen Plantaginis), 9g Dodder seed (Semen Cuscutae), 9g Raspberry (Fructus Rubi), 15g Schisandra berry (Fructus Schisandrae), 9g Cherokee rose fruit (Fructus Rosae Laevigatae), 9g Ilex seed (Fructus Ilicis Purpureae), 9g Astilbe seed (Semen Astragali Complanati), 12g Sesame seed (Sesami Fructus). [Commentary] This formula gently tonifies the Liver and Kidney while astringing and securing essence; Plantago seed drains damp-heat and clears ministerial fire, combining to reduce excess and tonify insufficiency. Sesame seed is black sesame.
34. Male, He. Talking nonsense in sleep at night, mental fatigue during the day, sore and painful lower back and spine, impotence, frequent urination, and recent continuous nocturnal emissions. 12g Cibotium rhizome (Rhizoma Cibotii), 9g Dipsacus root (Radix Dipsaci), 9g Goji berries (Fructus Lycii), 6g Schisandra berry (Fructus Schisandrae), 9g Astilbe seed (Semen Astragali Complanati), 9g Psoralea fruit (Fructus Psoraleae), 9g Cherokee rose fruit (Fructus Rosae Laevigatae), 9g Sour jujube seed (Semen Ziziphi Spinosae), 9g Dodder seed (Semen Cuscutae), 9g Achyranthes root (Radix Achyranthis Bidentatae), 15g Guilu Erxian Jiao (Turtle and Deer Antler Two Immortals Gelatin) (melted and taken with liquid). Second visit: Nocturnal emissions improved after medication; recently, due to busy work, emitted 3 more times; legs soft and weak, difficulty walking, hands cold as ice, listless. Warming Kidney herbs are indispensable. 2 prepared Human placentas (Human Placenta), 6 dog kidneys (Canis lupus familiaris Kidney), 30g Cherokee rose fruit (Fructus Rosae Laevigatae), 30g Dodder seed (Semen Cuscutae), 30g Yangstemon stem (Cynomorii Herba), 30g Leek seed (Fructus Allii Tuberosi), 30g Raspberry (Fructus Rubi), 30g Goji berries (Fructus Lycii), 30 silkworm cases (Bombyx Batryticatus Case), 30g Psoralea fruit (Fructus Psoraleae), 15g Curculigo rhizome (Rhizoma Curculiginis), 60g Morinda root (Radix Morindae Officinalis), 60g Epimedium leaves (Herba Epipedii), 30 roasted flower spiders (Araneus preparation), 30g Chinese yam (Rhizoma Dioscoreae). Grind into fine powder, take 3g per dose, three times daily.
[Commentary] The first visit focused on tonifying Kidney Qi to secure essence. Guilu Erxian Jiao uses deer antler to warm the Kidney and strengthen the Du vessel, turtle shell to nourish Yin and tonify the Ren vessel, combined with Ginseng and Goji, forming an excellent formula for tonifying Yang within Yin. Zhang Jingyue said, "Those skilled in tonifying Yang should seek it within Yin," likely referring to this treatment method. The second visit vigorously tonifies the True Yang of the Mingmen Gate. Human placenta and dog kidney are animal-derived substances that effectively tonify essence and blood; flower spiders warm the Kidney and assist Fire, especially good for strengthening Yang and curing impotence. Due to scarcity of flower spiders, 30g Centipede (Scolopendra) can be substituted. This formula has considerable effect on impotence caused by Kidney Yang deficiency and exhaustion.
35. Certain Male. The preparation of paste formulas (Gao Fang) is not found in the works of Zhang Zhongjing or Sun Simiao, nor did the Four Masters of Jin-Yuan use them. Tracing its origin, it actually began in the Ming Dynasty, focusing on animal-derived substances to open a new path for those with deficiency and emaciation. Examining *Han Shi Yi Tong*, it is indeed the pioneer in using paste formulas for treating consumptive diseases, yet prescribing medicine according to the disease without杂乱 (disorder). In modern times, paste formulas have become "comfort items" for the wealthy, mixing cold, heat, warm, cool, dragon,潛 (hidden), moving, and still substances into one formula, seeking only high price, disregarding whether it treats the disease. Our clinic strives to correct this弊端 (malpractice), prescribing based on syndrome differentiation, not seeking many ingredients but selecting refined and effective ones, incorporating Western concepts of hormones and vitamins to organize the formula. If there are kindred spirits in the world, we smile at each other. (Winter 1940)
[Commentary] The prescription is not recorded. Mr. Zhang's case discusses paste formulas, criticizing some physicians before liberation for abusing paste formulas, using complex and expensive medications to flatter patients. However, Mr. Zhang's prescription of paste formulas was based on syndrome differentiation and practical efficacy. This fully reflects his spirit of innovation and pragmatism, as well as his noble character of not conforming to vulgar customs.
Linzhuo (Strangury and Turbid Urine)
1. Male, Wang. Frequent and painful urination with pus, external signs of heat, due to steaming of damp-heat. 30g Honeysuckle flower (Flos Lonicerae Japonicae), 12g White pepper fruit (Fructus Piperis Longi - note: text says Bai Bi, likely refers to a specific herb, context suggests clearing heat/damp), 18g each of Verbena herb (Herba Verbenae) and Pteris fern (Herba Pteridis), 12g Knotgrass herb (Herba Polygoni Avicularis), 12h Hollyhock seed (Semen Malvae), 6g Phellodendron bark (Cortex Phellodendri), 12g Dioscorea hypoglauca rhizome (Rhizoma Dioscoreae Hypoglaucae), 9g Cooked Rhubarb (Radix Rhei Preparata). Second visit: Pus turned to blood, unbearable pain. 9g Polyporus (Sclerotium Poriae), 12g Red Poria (Poria cum Rubo), 9g Alisma tuber (Rhizoma Alismatis), 15g Small Raw Rehmannia root (Radix Rehmanniae), 15g Talcum (Talcum), 24g Knotgrass herb (Herba Polygoni Avicularis), 12g Dioscorea hypoglauca rhizome (Rhizoma Dioscoreae Hypoglaucae), 4.5g Raw Licorice tip (Radix Glycyrrhizae), 18g Small Thistle herb (Herba Cirsii Japonici), 18g Dianthus flower (Flos Dianthi), 9g Phellodendron bark (Cortex Phellodendri), 3g Amber powder (Electrum) (taken in 2 doses).
[Commentary] Frequent, painful urination with pus clearly indicates strangury due to damp-heat accumulating in the Lower Jiao. The first visit heavily used Honeysuckle etc. to clear heat and detoxify, promoting urination and unblocking strangury. Particularly clever is the use of Rhubarb, which pushes stasis and heat downward; cooked, it moves while retaining. Modern pharmacological studies confirm its strong inhibitory effect on Staphylococcus aureus etc. In the second visit, after pus removal, hematuria appeared with severe pain, indicating damp-heat damaging blood vessels; thus, cooling-blood and dispersing-stasis herbs like Raw Rehmannia, Small Thistle, and Amber were added. Experience proves Amber is effective for dysuria and hematuria caused by acute urinary tract infections.
2. Female, Chen. Taking modified Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), urine output反而 (instead) decreased. Since urine contains pus and blood, if not expelled, heat cannot subside, and urine volume cannot increase. 15g Fresh Platycladus orientalis leaf (Cacumen Platycladi), 9g Small Thistle herb (Herba Cirsii Japonici), 9g Dandelion herb (Herba Taraxaci), 9g Honeysuckle flower (Flos Lonicerae Japonicae), 9g Anemarrhena rhizome (Rhizoma Anemarrhenae) - Note: Text says Bai Wei, usually Clematidis Rootlet, but context implies clearing heat/blood. Let's stick to text: 9g Clematidis Rootlet (Radix Clematidis), 9g Black Pepper fruit (Fructus Piperis), 12g Anemarrhena rhizome (Rhizoma Anemarrhenae), 30g Plantago seed (Semen Plantaginis), 6g Phellodendron bark (Cortex Phellodendri), 30g Coix seed (Semen Coicis). Second visit: Effective. Added to above formula: 9g Achyranthes root (Radix Achyranthis Bidentatae), 9g Moutan bark (Cortex Moutan). [Commentary] Presence of pus and blood indicates damp-heat; if damp-heat is not removed, it will remain and cause harm. Although Liuwei Dihuang Wan is known for "three tonifications and three purgations," it is primarily tonifying, so using it was premature. Thus, the prescription used large doses of heat-clearing, blood-cooling, and diuretic herbs to provide an exit for damp-heat pathogens.
3. Male, Zhao. Painful urination, frequent frequency. Chronic linzhuo usually does not involve fever; now with exterior symptoms, it is likely acute exacerbation of chronic pyelonephritis. 6g Mint herb (Herba Menthae), 9g Chrysanthemum flower (Flos Chrysanthemi), 9g Eupatorium stem (Caulis Eupatorii), 12g Honeysuckle vine (Caulis Lonicerae Japonicae), 6g Bupleurum root (Radix Bupleuri), 9g Mulberry leaf (Folium Mori), 9g Dioscorea hypoglauca rhizome (Rhizoma Dioscoreae Hypoglaucae), 9g Alisma tuber (Rhizoma Alismatis), 9g Plantago seed (Semen Plantaginis). [Commentary] Ancients stated, "Lin patients should not be sweated." Because Lin disease lasts long, Yin and blood are often insufficient; mistakenly using acrid-warm herbs damages Yin and blood further. Now, with Lin disease combined with exterior symptoms, selecting light, dispersing, and draining herbs avoids damaging Yin and consuming blood.
4. Male, Xia. Damp-heat in the Lower Jiao, fever fluctuating, urine turbid like mucus with red color, but no pain, red tongue, thin and rapid pulse. Prescription based on Zhuling Tang (Polyporus Decoction). 24g Donkey-hide gelatin (Colla Corii Asini) (melted and taken with liquid), 9g Polyporus (Sclerotium Poriae), 9g Red Poria (Poria cum Rubo), 9g Alisma tuber (Rhizoma Alismatis), 12g Talcum (Talcum), 9g Verbena herb (Herba Verbenae), 9g Dianthus flower (Flos Dianthi), 9g Ilex seed (Fructus Ilicis Purpureae), 9g Eclipta herb (Herba Eclipsae), 12g White Peony root (Radix Paeoniae Alba), 30g Fresh Platycladus orientalis leaf (Cacumen Platycladi). Second visit: Red and white mucus in urine initially increased, then decreased; fluctuating fever was less severe than before. Again prescribed heat-clearing and damp-draining agents, also implying urethral disinfection. 9g Bupleurum root (Radix Bupleuri), 30g Fresh Platycladus orientalis leaf (Cacumen Platycladi), 6g Sophora flavescens root (Radix Sophorae Flavescentis), 4.5g Phellodendron bark (Cortex Phellodendri), 9g Raw Atractylodes rhizome (Rhizoma Atractylodis), 12g Achyranthes root (Radix Achyranthis Bidentatae), 9g White Peony root (Radix Paeoniae Alba), 12g Violet flower (Flos Violaee), 15g Verbena herb (Herba Verbenae), 15g Pteris fern (Herba Pteridis), 9g Black Pepper fruit (Fructus Piperis), 3g Raw Licorice root (Radix Glycyrrhizae).
[Commentary] This case features fluctuating fever, urine turbid like mucus with red color, red tongue, thin rapid pulse, indicating Kidney Yin deficiency with Bladder heat accumulation. No urethral pain suggests Zhuo Zheng (turbid urine). *Jingui Yaolue* states: "Pulse floating with fever, thirst wanting to drink water, and difficult urination are treated with Zhuling Tang." This formula is an excellent choice for nourishing Yin and promoting urination. Using it as the base, adding Erzhi Wan (Two Solstices Pill) and White Peony helps Ejiao nourish Yin and stop bleeding; Dianthus and Verbena assist Polyporus, Alisma, and Talcum in promoting urination and clearing heat, further enhancing its effect. In the second visit, red and white mucus first increased then decreased, a sign of disease resolving. Still focusing on clearing heat and draining dampness because residual pathogens remain; thus, unblocking is preferred over astringing. Black pepper fruit is a urethral antiseptic.
5. Male, Liu. Short urine, painful urethra, cystitis, termed "Lin" in TCM. 18g Raw Rehmannia root (Radix Rehmanniae), 3g Licorice tip (Radix Glycyrrhizae), 9g Akebia stem (Caulis Akebiae), 9g Bamboo leaf (Folium Bambusae), 9g Knotgrass herb (Herba Polygoni Avicularis), 6g Phellodendron bark (Cortex Phellodendri), 9g Dianthus flower (Flos Dianthi), 15g Dioscorea hypoglauca rhizome (Rhizoma Dioscoreae Hypoglaucae). [Commentary] Damp-heat accumulating in the Bladder causes painful urination. The formula uses Daochi San to nourish Yin, drain heat, and promote urination; Phellodendron and Dioscorea drain Lower Jiao damp-heat; Knotgrass and Dianthus unblock strangury and relieve pain.
6. Female, Zhuang. Symptoms divided into three categories: ① Frequent urination, pain during urination; ② Dizziness, palpitations, insomnia at night; ③ Petechiae on both legs. Categories ② and ③ are purely due to Qi and Blood deficiency from weak constitution. This formula mainly treats strangury pain. 9g Donkey-hide gelatin (Colla Corii Asini), 15g Dry Rehmannia root (Radix Rehmanniae), 9g each of Red Poria (Poria cum Rubo) and Polyporus (Sclerotium Poriae), 2.4g Amber powder (Electrum) (taken in 2 doses), 12g Talcum (Talcum), 12g Hollyhock seed (Semen Malvae), 9g Alisma tuber (Rhizoma Alismatis), 12g Erzhi Wan (Two Solstices Pill) (wrapped).
[Commentary] Frequent urination and pain constitute Lin; dizziness, palpitations, and insomnia indicate Yin and Blood deficiency; petechiae indicate Spleen failing to control blood. Lin is caused by damp-heat; nourishing Yin hinders damp-heat, while promoting urination damages Yin and Blood. Thus, Zhang Zhongjing's Zhuling Tang was selected to nourish Yin and clear/draining simultaneously without conflict; Rehmannia and Erzhi Wan nourish Yin and Blood; Amber and Hollyhock seed promote urination and move stasis to relieve urethral pain. Amber also has sedative and calming effects.
7. Female, Tang. History of adnexitis; shortly after recovery, lower abdominal pain recurred due to fatigue, especially painful timed urethral pain, difficult defecation, no bowel movement for five days. This is a urinary tract infection. 9g Dioscorea hypoglauca rhizome (Rhizoma Dioscoreae Hypoglaucae), 9g each of Large and Small Thistle herbs (Herba Cirsii Japonici et Herba Cirsii), 9g Black Pepper fruit (Fructus Piperis), 9g Knotgrass herb (Herba Polygoni Avicularis), 9g Pteris fern (Herba Pteridis), 9g Angelica dahurica root (Radix Angelicae Dahuricae), 3g each of Prepared Frankincense (Resina Incensi) and Myrrh (Resina Myrrhae), 6g Fennel fruit (Fructus Foeniculi), 6g White Peony root (Radix Paeoniae Alba), 12g Peach kernel semen (Semen Persicae), 18g Mirabilite (Natrii Sulfas) (taken in 2 doses), 4.5g Water chestnut stem (Caulis Eleocharis), 12g Zishen Tongguan Wan (Kidney-Nourishing Passage-Opening Pill) (taken in 2 doses). Second visit: If urination pain precedes flow, inflammation is at the urethral meatus; if pain and flow occur together, it is in the urethra; if pain occurs after completion, inflammation is at the upper end or bladder. Acute pyelonephritis is often accompanied by lower back pain and fluctuating fever. The patient suffers from this. 12g Young Anemarrhena rhizome (Rhizoma Anemarrhenae) - Note: Text says Bai Wei, usually Clematidis Rootlet. Let's use Clematidis Rootlet (Radix Clematidis), 9g Mulberry bark (Cortex Mori), 12g Raw Gardenia fruit (Fructus Gardeniae), 6g Bupleurum tip (Radix Bupleuri), 9g Artemisia annua seed (Fructus Artemisiae Annuae), 18g Pine nut (Semen Pinus), 9g White Peony root (Radix Paeoniae Alba), 9g Pyrrosia leaf (Folium Pyrrosiae), 12g Honeysuckle flower (Flos Lonicerae Japonicae), 9g Violet flower (Flos Violaee), 9g Phellodendron bark (Cortex Phellodendri), 30g Fresh Platycladus orientalis leaf (Cacumen Platycladi) (decocted to replace water). [Commentary] The patient first had dysuria, followed by high fever and lower back pain, likely retrograde urinary tract infection leading to acute pyelonephritis. Treatment focuses on clearing heat, promoting urination, and separating/draining Lower Jiao damp-heat; due to difficult defecation, moistening intestines and promoting bowel movement herbs were supplemented. Water chestnut stem (Eleocharis stem) has damp-draining and diuretic effects.
8. Male, Chen. Urethritis due to trauma, painful urination; inflammation produces secretions, hence mucus; inflammation causes fluctuating fever, hence exterior symptoms, resembling Taiyang disease. 3g Raw Ephedra herb (Herba Ephedrae), 9g Apricot seed (Semen Armeniacae Amarum), 9g Poria (Sclerotium Poriae), 2.4g Cinnamon twig (Ramulus Cinnamomi) (added later), 9g Polyporus (Sclerotium Poriae), 12g Alisma tuber (Rhizoma Alismatis), 9g Fried Donkey-hide gelatin (Colla Corii Asini), 4.5g Powdered Licorice root (Radix Glycyrrhizae), 9g Talcum (Talcum) (taken in 3 doses). [Commentary] Viewed separately, Mahuang Tang treats fluctuating fever; Zhuling Tang treats urinary tract infection. Viewed together, Ephedra and Cinnamon both have diuretic effects. This shows the doctor's meticulous selection of herbs and formulas.
Other
1. Male, Lu. Cough recurred yesterday, with much foul sputum, nausea, mental fatigue, weakness, shoulder and back soreness; diet and sleep normal. This is Fei Yong (Lung Abscess), diagnosed by Western medicine as Actinomycotic abscess. 24g Astragalus root (Radix Astragali), 12g Dendrobium stem (Caulis Dendrobii), 18g Honeysuckle flower (Flos Lonicerae Japonicae), 9g Powdered Licorice root (Radix Glycyrrhizae), 9g Stemona root (Radix Stemonae), 9g Scutellaria root (Radix Scutellariae), 15g Bletilla powder (Tuber Bletillae) (taken in 3 doses). Additionally: Qiongyu Gao (Qiongyu Paste) 12g, Erdong Gao (Two Winter Pastes) 12g mixed evenly, take half spoon, three times daily. Second visit: Cough slightly reduced after medication, foul sputum disappeared every other day. Early morning today, small amount of sputum again, dull pain from throat to stomach, worsened by coughing, mental fatigue, weakness, chest and back pain persist. 24g Raw Astragalus (Radix Astragali), 18g Honeysuckle flower (Flos Lonicerae Japonicae), 18g Houttuynia herb (Herba Houttuyniae) (added later), 15g Polygonatum rhizome (Rhizoma Polygonati), 9g Raw Licorice root (Radix Glycyrrhizae), 30g Coix seed (Semen Coicis), 4.5g Bletilla powder (Tuber Bletillae) (taken in 3 doses). Additionally: Erdong Gao 120g, Qiong Gong Gao 120g, Sweet Descurainia seed (Semen Descurainiae) 24g, ground and mixed evenly. Take half spoon, three times daily. Third visit: Foul sputum greatly reduced, slight nausea when taking medicine. 24g Raw Astragalus (Radix Astragali), 15g Houttuynia herb (Herba Houttuyniae) (added later), 3g Coptis rhizome (Rhizoma Coptidis), 6g Licorice root (Radix Glycyrrhizae), 9g Codonopsis root (Radix Codonopsis), 9g Violet flower (Flos Violaee), 4.5g Bletilla powder (Tuber Bletillae) (taken in 3 doses). Additionally: Olive paste 120g, Qiongyu Gao 120g, Erdong Gao 10g, Sweet Descurainia seed 36g, Fritillaria bulb (Bulbus Fritillariae Cirrhosae) 36g, all ground and mixed into paste. Take half spoon, three times daily.
[Commentary] Fei Yong (Lung Abscess) is characterized by chest pain and expectoration of purulent, foul-smelling sputum or pus-blood. Its mechanism involves external pathogens invading, generating phlegm-heat in the Lung, where heat coagulates with blood to form pus. Pulmonary actinomycosis is a fungal lung disease that can also cause multiple small abscesses; clinical manifestations are similar to pulmonary abscess, cavitary tuberculosis, and lung cancer with tissue necrosis. In the stage of abscess formation, the treatment principle is activating blood to discharge pus and clearing heat to detoxify. In this case, due to the long duration, pus remains while Qi and Yin are damaged; thus, heavy doses of Astragalus, Licorice, Dendrobium, Polygonatum, Erdong Gao, and Qiongyu Gao are used to nourish Qi and Yin; Honeysuckle, Houttuynia, Violet, Coix seed, Descurainia, and Fritillaria are used to clear heat, detoxify, and remove pathogens. Bletilla alone can tonify the Lung and stop bleeding; literature records: "For non-ulcerated sores, it clears heat and reduces swelling; for ulcerated sores, it promotes healing and generates flesh." Adding 30g Fagopyrum dibotrys rhizome (Rhizoma Fagopyri Dibotrysis) clears the Lung, washes away phlegm, and promotes abscess healing, yielding better results.