辽细辛3克茯苓15克当归10克上方服十余剂后，病基本治愈。1979年7月20日追访，近年来身体一直良好。
[按语]《金匮要略·水气病脉证并治篇》云：“气分，心下坚，大如盘，边如旋杯，水饮所作，桂枝去芍药加麻辛附子汤主之”。本例并无“心下坚，大如盘”之证，又非单纯水气所作，为何移用之?因此证系真阳不足，寒湿之邪乘产后阳虚而逆僭清阳之位，故不必拘泥“坚”与“盘”及水气之轻与重，亦可辨证投以本方。既解太阳之邪，又温少阴之经。阳气升，气化行，寒凝解，胸痹诸证自平。
太阳少阴证瘿病
(甲状腺左叶囊肿)
宋××，女，36岁。成都市某厂工人。
[病史]体质素弱，常患感冒。1977年5月，患外感咳嗽，服清热止咳中药数剂后，表证解。但越数日，忽发现颈部左侧有一包块，约2×3厘米，触之稍硬，随吞咽活动，无痛感。自觉心累，无其他明显症状。曾注射青霉素，服消炎药，后加服中药。同年6月，经××医学院附院诊断为“甲状腺左叶囊肿”，建议手术治疗。患者未接受，同年7月初转来求诊。
[初诊]左侧颈部出现包块已两月。神疲乏力，食欲不振，入夜难寐，手足清冷，恶寒，头昏。舌暗淡，苔淡黄而腻。此为瘿病，主证在少阴，兼太阳伤寒之表，法宜扶正驱邪，温经解表，以麻黄细辛附子汤加味主之。
处方：
麻黄10克制附片60克(久煎) 辽细辛6克桂枝10克 于姜30克甘草30克三剂
(二诊]上方服三剂后，包块开始变软，心累乏力略有好转。药证相符，重剂方能速效。上方姜、附、草三味加倍，再服三剂。包块明显变小，舌质稍转淡红，苔黄腻减。又以初诊方续进十剂，包块逐渐消失。
1979年7月13日，患者来信说：服药十余剂颈下包块消失，食欲睡眠大为好转。两年来未再复发。
(按语]本例患者颈侧长包块，触之硬结，不与皮肤粘连，皮色如常，随吞咽而动，系瘿病之主要证候。《灵枢·寒热篇》谈及寒热瘰疬、鼠瘘之类，病在颈腋者，其病理之本： “皆在于脏，其末上出于颈腋之间”。本例瘿病，正是如此。太阳与少阴相表里，风寒湿邪，日久深入少阴，表里同病。阳气渐衰，营卫不固，寒凝气滞，日益壅于颈侧而成结。故此案未泥于一般瘿肿多属痰气郁结，或火郁伤阴之常规。以太阳少阴证论治，温经解表，以畅气血；通阳散寒，以开凝聚。同样可收软坚散结之效。
太阳少阴证咳喘并二便失禁
(慢性气管炎、肠炎、尿道萎缩)
叶××，男，68岁。成都市居民，盲人。
[病史]患慢性气管炎十余年，经常头昏头痛，咳喘痰多，不能平卧；其后，二便失禁五、六载，每日大小便约二十余次，每解小便，大便即出，时稀时秘。成都某医院曾诊断为慢性支气管炎并发感染、慢性肠炎、尿道萎缩。经常服用氨茶碱及多种抗菌素等，病情未见改善，自觉全身发凉，四肢乏力，恶心呕吐不已。1975年转某院就诊，曾服清热中药及抗菌素后，至深夜，忽感心烦，四肢冰冷，大小便顿失控制，神志昏迷约半小时方苏醒，数日后又出现口眼歪斜，诊断为“面神经麻痹”。经针灸治疗，口眼歪斜有好转，余证如故。长期病魔缠身，痛苦不可言状。1975年12月来诊，按太阳少阴同病论治，服药两月基本痊愈。
[初诊]时腹痛，每日大便频繁，常呈灰白粘液；间有秘结，如筷头状，临厕努挣，憋胀难忍。小便淋漓不尽，量少刺痛，欲解而不畅。咳嗽、痰多，稀白。心累喘急，只能半卧；头昏头痛，恶寒乏力，四肢清冷。面色苍白，体虚胖。舌质淡，微紫暗，前半部无苔，舌根部白腻夹黄而厚，脉沉微。此为太阳寒实郁久，阴邪深结于脏，肺失肃降，肾气内伤，下焦不固，以致二便失常。乃少阴寒化，兼太阳表实证。法宜内护元阳而散寒，外开腠理而固中。以麻黄附子甘草汤主之，
处方：
麻黄10克制附片30克(久煎)
甘草15克四剂
[辨证]患者早年双目失明，生活艰苦无人照顾，以致沉疾迁延，病情日益复杂，阴阳及表里虚实交错；患者面苍白，舌质偏淡微现紫暗，苔白厚腻；加以脉沉微，肢冷、恶寒、心累、乏力，显系心肾阳衰，气血不足。应属阴、寒、里、虚，病入少阴之证。
察其腹胀痛之证，虽非阴证虚寒所独有，但阳证实热则与此又不同。本例腹胀，时痛时止， 时利时秘，恶寒无热，口不渴；舌质淡，前半部无苔，舌根部白滑而腻，显然，此为阴盛腹痛胀满之象。
二便失其约制，又与热迫大肠或热结旁流而下利者不同。患者多年来时溏时秘，常有便意；秘而并不坚硬，溏而排泄不尽。解小便时，大便憋胀欲行；解大便时，小便复觉淋漓不尽。由此可知，此证当属少阴寒化，下焦失固之二便失禁无疑。
病入少阴，必损及心肾与膀胱诸脏腑。以本例而言，其根本首在肾阳虚衰。今久病之后，肾气日衰，开阖失司，二便排泄随之失调。肾累及脾， 脾失健运，故更增腹胀满。脾湿盛，致大便色白；上泛为痰，阻塞气机而咳嗽痰多。肾之元阳衰微，必影响肺气之肃降，加重气机之不畅，致使患者不能平卧：此乃患者多年以来，诸证蜂起，相互缠绵，迁延不愈之病根。
患者初诊时，恶寒、头痛，舌质淡润而苔白夹黄，乃兼有太阳外感表实之邪。单解表则里证不去，单治里则表实不解。为此，投以麻黄附子甘草汤，兼顾阴阳表里。附子与麻黄并用，寒气散而不伤元阳，救其里而及其表；且以甘草缓之，微发其汗也。此与单纯治疗少阴虚寒里证，或病仅属太阳表实，脉阴阳俱紧而发汗者，径庭也。
(二诊]上方服四剂，恶寒、咳嗽、头痛等减轻。太阳表寒初解，腹胀、便难等稍有好转。但阴寒凝聚于里，非通下不足以破其结。惟大便不通，当分阳结阴结。查前人固有少阴急下三证之说，但有严格之界限。此证与少阴三急下证又不相同，应为少阴寒证阴结为主的二便失常，乃少阴之变，而非少阴之常，当用温通之法。为此投以阴阳共济，寒热同炉之大黄附子汤主之。
处方：生大黄9克 川附片45克(久煎)
辽细辛3克四剂
服药四剂，二便皆觉通畅；憋胀、急迫等多年痛楚消失；咳喘、痰涎亦进而减轻。以后改服理中汤，随证加减，又服药月余，调理而安。
1978年12月10日，至患者家中访问，得知几年来身体一直良好。老人兴奋地说：往年冬季， 早已卧床；病愈至今，既无手足清冷，又无恶寒咳喘之病，二便亦已正常，对范老十分感激。
[按语]本例上、中、下三焦，肺、脾、肾、胃、大小肠、膀胱等多脏腑皆已受病，互相连累和交织。病之症结，在于肾阳虚衰，致使下焦佚固，咳喘缠绵。病邪传变之趋向，为寒湿浸入太阳，日久失治，阳消阴长，邪进正衰；病传少阴，则寒化益深，机体抗病力更弱，以致缠绵数载，变证蜂起。病情虽然如此复杂，由于紧紧抓住六经辨证的基本线索，故其特征、本质和各个阶段之主要症结清晰可见，从而为临床施治提供了可靠的依据。
太阳少阴证鼻衄
冉××，女，72岁。成都市居民。
[病史]1975年4月，感冒后鼻内出血。就近至某医院请中医治疗，诊为肺热。连服清热解表剂，病势不减。家人急用云南白药塞鼻内，用三、四瓶后，血仍渗出不止。延至第六日，到××医院五官科诊治，无效，遂来就诊。
[初诊]鼻衄已十日，鼻腔出血仍阵阵外渗，血色暗红，面色苍白。饮食难下，四肢逆冷，恶寒身痛，微咳。舌质暗淡，苔白滑，根部微黄腻。阳虚之 人，外感寒邪，正气虚弱，失血统摄，阳气被遏，脉络淤滞，血不循常道而外溢。此属太阳少阴证鼻衄。法宜助阳解表，温经摄血，以麻黄附子细辛汤加味主之。
处方：
麻黄10克制附片60克(久煎)
辽细辛3克炮姜30克荷叶10克(醋炒) 炙甘草20克二剂
[二诊]上方服一剂，出血减；二剂后，血全止。因年迈体弱，难以复元，再以四逆汤加益气之品续服。
处方：
制附片30克(久煎) 炮姜15克炙甘草10克党参10克上肉桂10克(冲服)
大枣30克三剂
(三诊]精神好转，饮食增加。但气血亏甚，嘱其以生姜羊肉汤加当归、黄芪炖服调补。
1979年2月追访：患者已76岁，病愈后身体尚好。
[按语]本例鼻衄，证属寒中少阴，外连太阳。治以表里双解，佐以温经摄血，三诊而衄止。
或问：仲景有“衄家不可汗”之戒，此例何以用麻黄?因患者兼有太阳伤寒之表，具麻黄证。方巾重用附子，温少阴之经，解表而不伤阳气；麻黄不配桂枝，并重用炙甘草以制之，则不发汗而祛邪。临床所见，衄家并非皆不可汗；亦有用汗法而愈者。不同病情，须具体分析。
少阴证鼻衄
刘××，男，5岁。成都市某厂职工之子。
[病史j 1948年春，其父背来就诊时说： “小儿一人在家，中午忽发现他鼻出血不止，倦怠无力，躺在椅上，面色苍白。曾频频用凉水冷敷，流血反而加剧，急请范老诊治”。
[初诊]患儿精神萎靡，四肢逆冷，唇舌淡白。此为少阴寒证，阳气衰微，不能摄血，阴气较盛，势必上僭。徒止血，岂能止?法宜壮阳驱阴，温经摄血。急投四逆以救其里。
处方：
天雄片30克炮姜30克炙甘草20克一剂
嘱急火煮半小时许，先取少量服之；余药再煮半小时，续服。
患儿父亲将处方拿回家中，其母见之，大吵大闹： “从古到今，未见鼻流血用干姜附片!”。其父仍坚持服用。一剂未尽，血立止。傍晚，患儿在院内玩耍如常。
[按语]鼻衄一证，现代医学认为，鼻腔疾病与全身性疾病均可引起。祖国医学认为，与肺、胃、肝、肾等脏腑，关系尤为密切。通常外感风邪，肺郁化热；过食辛辣厚味，胃火上逆；暴怒气逆，肝火妄动；肾阴耗损，虚火上炎等等，均可热伤脉络，迫血妄行，治则常以清热凉血为主。但临证确属虚寒，因血失统摄而致衄者，亦菲罕见。后者若误用凉药每成偾事。范老对虚寒型鼻衄，治验颇多，今选两例，以资参考。
少阴证头痛
张××，男，38岁。成都某厂工会干部。
[病史]1970年患头痛，逐渐加重，看书、写字时，头痛目胀尤甚。先后经几处医院，未明确诊断。至1976年，病情转剧，10月来诊，按少阴证论治而愈。
(初诊]数日前，头暴痛如裂，不敢睁眼。卧床休息并服药，未见减轻，仍阵阵发作。心烦、气短、四肢厥冷；面色青暗萎白，舌质淡而鸟暗，边缘有明显齿痕，苔灰白薄润，脉沉微。此少阴阳衰阴盛证头痛，有阴阳格拒之象。法宜通脉回阳，宣通上下，以白通汤主之。
处方：
葱白头60克 干姜30克制附片60克(久煎)
四剂
[辨证]按《伤寒论》白通汤，原为少阴病阴盛戴阳并下利而设。为什么本例头痛，却用白通汤?
考白通汤证之下利，是下焦虚寒不能制水；而戴阳面赤，乃虚阳浮越于上。无论下利或面赤，其病因和病机，皆属于阴寒内盛，阴阳格拒。从本例来看，不仅阴寒内盛十分突出，而且阴阳格拒之象比较明显。其面色青暗，四肢厥冷，全身乏力，舌淡乌暗，苔白灰滑，脉微，反不恶寒，而心烦气短；此属阳为阴困，阴盛于内，格阳于外之象。虽不表现于下焦虚寒不能制水，却体现在阳气不能镇纳，浊阴腾越于上。这与真阳不能内守而致格阳于上，只属证候上之差别，其病机皆应归于阴阳格拒。由此可见，投白通汤仍药证相符。以附子补先天之火种；佐干姜温中焦之土气；葱白能通上下之阳气。姜附并用，逐阴回阳。阴阳交媾，浊降清升，即可通其被格之阳。
[二诊]连进四剂，头痛和精神好转。但阳衰阴盛日久，须温补少阴，兼顾太阴。法宜继用驱阴助阳，温中益气，以四逆合理中加味，配成丸药服用。
处方：
制附片60克干姜30克炙甘草20克生晒参
30克炒白术30克茯苓30克 上肉桂15克宁枸杞20克菟丝子30克十剂、水打为丸。
1979年7月追访，三年来，虽经常加夜班，头痛始终未犯。
[按语]或问：太阴少阴，本无头痛一证，为何此例病属少阴阳虚阴盛而头暴痛如裂?
对这个问题，历史上某些医学家曾有过不同意见。有的认为，头痛证只及太阳．少阳、厥阴。还有人提出，头为诸阳之会，与厥阴肝脉会于巅，诸阴寒邪不能上逆。
另一种意见与此不同。有人认为： “太阴、少阴二经，虽不上头，然痰与气逆壅于膈，头上气不得畅而亦痛。” (《冷庐医话》)还有人明确提出；三阳三阴皆有头痛，内伤日久，七情过度，亦作头痛，其中： “因阳虚日久，不能镇纳浊阴，阴气上腾，有头痛如裂，如劈，如泰山压顶，有欲绳索紧捆者，其人定见气喘唇舌青黑，渴饮滚汤，此属阳脱于上，乃属危候，法宜回阳收纳为要，如大剂白通四逆之类，缓则不救”。 (《医法圆通》)
范老根据多年经验认为，后一种意见，比较符合临床实际。在临证中，头痛一证十分普遍，属少阴病头痛者，亦屡见不鲜。一般来说，少阴寒化证头痛，必须具备少阴病之主证，参之舌现淡白，皆应以白通、四逆辈主之。
少阴证哮喘
(支气管哮喘、肺气肿)
刘××，男，49岁。安徽省某局干部。
辽细辛3克，茯苓15克，当归10克。上方服用十余剂后，疾病基本治愈。1979年7月20日随访，近年来身体状况一直良好。
[按语]《金匮要略·水气病脉证并治篇》记载：“气分证，心下痞坚，大如盘，边缘如倒扣的杯子，由水饮所致，用桂枝去芍药加麻黄细辛附子汤主治。”本例患者并没有“心下痞坚，大如盘”的症状，也不是单纯的水气病，为什么可以移用此方呢？因为这个证候属于真阳不足，寒湿之邪乘产后阳气虚弱而逆犯清阳之位，所以不必拘泥于是否有“坚”与“盘”的表现以及水气的轻重，也可以辨证投以此方。该方既能解除太阳经的表邪，又能温通少阴经的里寒。阳气升发，气化运行，寒凝解散，胸痹等诸证自然平息。
太阳少阴证瘿病
(甲状腺左叶囊肿)
宋××，女，36岁。成都市某厂工人。
[病史]体质素来虚弱，经常患感冒。1977年5月，患外感咳嗽，服用清热止咳中药数剂后，表证解除。但过了几天，突然发现颈部左侧有一个包块，约2×3厘米，触摸稍硬，随吞咽动作活动，无疼痛感。自觉心慌劳累，无其他明显症状。曾注射青霉素，服用消炎药，后来加服中药。同年6月，经××医学院附属医院诊断为“甲状腺左叶囊肿”，建议手术治疗。患者未接受，同年7月初转来求诊。
[初诊]左侧颈部出现包块已有两个月。精神疲倦乏力，食欲不振，入夜难以入睡，手足清冷，恶寒，头昏。舌质暗淡，苔淡黄而腻。此为瘿病，主证在少阴，兼有太阳伤寒的表证，治法宜扶正驱邪，温经解表，以麻黄细辛附子汤加味为主方。
处方：
麻黄10克，制附片60克（久煎），辽细辛6克，桂枝10克，干姜30克，甘草30克。三剂。
[二诊]上方服用三剂后，包块开始变软，心慌乏力略有好转。药证相符，重剂方能速效。上方中干姜、附子、甘草三味加倍，再服三剂。包块明显变小，舌质稍转淡红，苔黄腻减轻。又以初诊方继续服用十剂，包块逐渐消失。
1979年7月13日，患者来信说：服药十余剂后颈下包块消失，食欲睡眠大为好转。两年来未再复发。
[按语]本例患者颈侧长包块，触摸有硬结，不与皮肤粘连，皮色如常，随吞咽而动，这是瘿病的主要证候。《灵枢·寒热篇》谈及寒热瘰疬、鼠瘘之类，病位在颈腋部的，其病理根本在于内脏：“皆在于脏，其末上出于颈腋之间”。本例瘿病正是如此。太阳与少阴相表里，风寒湿邪日久深入少阴，导致表里同病。阳气渐衰，营卫不固，寒凝气滞，日益壅塞于颈侧而成结。因此此案没有拘泥于一般瘿肿多属痰气郁结，或火郁伤阴的常规认识。而是以太阳少阴证论治，温经解表以畅气血；通阳散寒以开凝聚。同样可收软坚散结之效。
太阳少阴证咳喘并二便失禁
(慢性气管炎、肠炎、尿道萎缩)
叶××，男，68岁。成都市居民，盲人。
[病史]患慢性气管炎十余年，经常头昏头痛，咳喘痰多，不能平卧；其后，二便失禁五、六年，每日大小便约二十余次，每次解小便时，大便即出，时稀时秘。成都某医院曾诊断为慢性支气管炎并发感染、慢性肠炎、尿道萎缩。经常服用氨茶碱及多种抗菌素等，病情未见改善，自觉全身发凉，四肢乏力，恶心呕吐不止。1975年转某院就诊，曾服清热中药及抗菌素后，至深夜，忽感心烦，四肢冰冷，大小便顿失控制，神志昏迷约半小时才苏醒，数日后又出现口眼歪斜，诊断为“面神经麻痹”。经针灸治疗，口眼歪斜有好转，其余症状依旧。长期病魔缠身，痛苦不可言状。1975年12月来诊，按太阳少阴同病论治，服药两月基本痊愈。
[初诊]时而腹痛，每日大便频繁，常呈灰白粘液；间有便秘，粪便如筷头状，临厕努挣，憋胀难忍。小便淋漓不尽，量少刺痛，欲解而不畅。咳嗽、痰多，稀白。心慌喘急，只能半卧；头昏头痛，恶寒乏力，四肢清冷。面色苍白，体虚胖。舌质淡，微紫暗，前半部无苔，舌根部白腻夹黄而厚，脉沉微。此为太阳寒实郁久，阴邪深结于脏腑，肺失肃降，肾气内伤，下焦不固，以致二便失常。乃少阴寒化证，兼太阳表实证。治法宜内护元阳而散寒，外开腠理而固中。以麻黄附子甘草汤为主方。
[辨证]患者早年双目失明，生活艰苦无人照顾，以致沉疾迁延，病情日益复杂，阴阳及表里虚实交错；患者面色苍白，舌质偏淡微现紫暗，苔白厚腻；加以脉沉微，肢冷、恶寒、心慌、乏力，显系心肾阳衰，气血不足。应属阴、寒、里、虚，病入少阴之证。
察其腹胀痛之证，虽非阴证虚寒所独有，但阳证实热则与此又不同。本例腹胀，时痛时止，时利时秘，恶寒无热，口不渴；舌质淡，前半部无苔，舌根部白滑而腻，显然，此为阴盛腹痛胀满之象。
二便失其约制，又与热迫大肠或热结旁流而下利者不同。患者多年来时溏时秘，常有便意；秘而并不坚硬，溏而排泄不尽。解小便时，大便憋胀欲行；解大便时，小便复觉淋漓不尽。由此可知，此证当属少阴寒化，下焦失固之二便失禁无疑。
病入少阴，必损及心肾与膀胱诸脏腑。以本例而言，其根本首在肾阳虚衰。今久病之后，肾气日衰，开阖失司，二便排泄随之失调。肾累及脾，脾失健运，故更增腹胀满。脾湿盛，致大便色白；上泛为痰，阻塞气机而咳嗽痰多。肾之元阳衰微，必影响肺气之肃降，加重气机之不畅，致使患者不能平卧：此乃患者多年以来，诸证蜂起，相互缠绵，迁延不愈之病根。
患者初诊时，恶寒、头痛，舌质淡润而苔白夹黄，乃兼有太阳外感表实之邪。单解表则里证不去，单治里则表实不解。为此，投以麻黄附子甘草汤，兼顾阴阳表里。附子与麻黄并用，寒气散而不伤元阳，救其里而及其表；且以甘草缓之，微发其汗也。此与单纯治疗少阴虚寒里证，或病仅属太阳表实，脉阴阳俱紧而发汗者，径庭也。
[二诊]上方服用四剂，恶寒、咳嗽、头痛等减轻。太阳表寒初解，腹胀、便难等稍有好转。但阴寒凝聚于里，非通下不足以破其结。惟大便不通，当分阳结阴结。查前人固有少阴急下三证之说，但有严格之界限。此证与少阴三急下证又不相同，应为少阴寒证阴结为主的二便失常，乃少阴之变，而非少阴之常，当用温通之法。为此投以阴阳共济，寒热同炉之大黄附子汤为主方。
服药四剂，二便皆觉通畅；憋胀、急迫等多年痛楚消失；咳喘、痰涎亦进而减轻。以后改服理中汤，随证加减，又服药月余，调理而安。
1978年12月10日，至患者家中访问，得知几年来身体一直良好。老人兴奋地说：往年冬季，早已卧床；病愈至今，既无手足清冷，又无恶寒咳喘之病，二便亦已正常，对范老十分感激。
[按语]本例上、中、下三焦，肺、脾、肾、胃、大小肠、膀胱等多脏腑皆已受病，互相连累和交织。病之症结，在于肾阳虚衰，致使下焦失固，咳喘缠绵。病邪传变之趋向，为寒湿浸入太阳，日久失治，阳消阴长，邪进正衰；病传少阴，则寒化益深，机体抗病力更弱，以致缠绵数载，变证蜂起。病情虽然如此复杂，由于紧紧抓住六经辨证的基本线索，故其特征、本质和各个阶段之主要症结清晰可见，从而为临床施治提供了可靠的依据。
[病史]1975年4月，感冒后鼻内出血。就近至某医院请中医治疗，诊为肺热。连服清热解表剂，病势不减。家人急用云南白药塞鼻内，用三、四瓶后，血仍渗出不止。延至第六日，到××医院五官科诊治，无效，遂来就诊。
[初诊]鼻衄已十日，鼻腔出血仍阵阵外渗，血色暗红，面色苍白。饮食难下，四肢逆冷，恶寒身痛，微咳。舌质暗淡，苔白滑，根部微黄腻。阳虚之人，外感寒邪，正气虚弱，失血统摄，阳气被遏，脉络淤滞，血不循常道而外溢。此属太阳少阴证鼻衄。治法宜助阳解表，温经摄血，以麻黄附子细辛汤加味为主方。
处方：
麻黄10克，制附片60克（久煎），辽细辛3克，炮姜30克，荷叶10克（醋炒），炙甘草20克。二剂。
[二诊]上方服用一剂，出血减少；二剂后，血全止。因年迈体弱，难以复元，再以四逆汤加益气之品续服。
处方：
制附片30克（久煎），炮姜15克，炙甘草10克，党参10克，上肉桂10克（冲服），大枣30克。三剂。
[三诊]精神好转，饮食增加。但气血亏甚，嘱其以生姜羊肉汤加当归、黄芪炖服调补。
1979年2月追访：患者已76岁，病愈后身体尚好。
[按语]本例鼻衄，证属寒中少阴，外连太阳。治以表里双解，佐以温经摄血，三诊而衄止。
或问：仲景有“衄家不可汗”之戒，此例何以用麻黄？因患者兼有太阳伤寒之表，具麻黄证。方中重用附子，温少阴之经，解表而不伤阳气；麻黄不配桂枝，并重用炙甘草以制之，则不发汗而祛邪。临床所见，衄家并非皆不可汗；亦有用汗法而愈者。不同病情，须具体分析。
[病史]1948年春，其父背来就诊时说：“小儿一人在家，中午忽发现他鼻出血不止，倦怠无力，躺在椅上，面色苍白。曾频频用凉水冷敷，流血反而加剧，急请范老诊治”。
[初诊]患儿精神萎靡，四肢逆冷，唇舌淡白。此为少阴寒证，阳气衰微，不能摄血，阴气较盛，势必上僭。徒止血，岂能止？治法宜壮阳驱阴，温经摄血。急投四逆汤以救其里。
嘱急火煮半小时许，先取少量服之；余药再煮半小时，续服。
患儿父亲将处方拿回家中，其母见之，大吵大闹：“从古到今，未见鼻流血用干姜附片！”。其父仍坚持服用。一剂未尽，血立止。傍晚，患儿在院内玩耍如常。
[按语]鼻衄一证，现代医学认为，鼻腔疾病与全身性疾病均可引起。祖国医学认为，与肺、胃、肝、肾等脏腑，关系尤为密切。通常外感风邪，肺郁化热；过食辛辣厚味，胃火上逆；暴怒气逆，肝火妄动；肾阴耗损，虚火上炎等等，均可热伤脉络，迫血妄行，治则常以清热凉血为主。但临证确属虚寒，因血失统摄而致衄者，亦非罕见。后者若误用凉药每成偾事。范老对虚寒型鼻衄，治验颇多，今选两例，以资参考。
[病史]1970年患头痛，逐渐加重，看书、写字时，头痛目胀尤甚。先后经几处医院，未明确诊断。至1976年，病情转剧，10月来诊，按少阴证论治而愈。
[初诊]数日前，头暴痛如裂，不敢睁眼。卧床休息并服药，未见减轻，仍阵阵发作。心烦、气短、四肢厥冷；面色青暗萎白，舌质淡而乌暗，边缘有明显齿痕，苔灰白薄润，脉沉微。此少阴阳衰阴盛证头痛，有阴阳格拒之象。治法宜通脉回阳，宣通上下，以白通汤为主方。
处方：
葱白头60克，干姜30克，制附片60克（久煎）。四剂。
[辨证]按《伤寒论》白通汤，原为少阴病阴盛戴阳并下利而设。为什么本例头痛，却用白通汤？
考白通汤证之下利，是下焦虚寒不能制水；而戴阳面赤，乃虚阳浮越于上。无论下利或面赤，其病因和病机，皆属于阴寒内盛，阴阳格拒。从本例来看，不仅阴寒内盛十分突出，而且阴阳格拒之象比较明显。其面色青暗，四肢厥冷，全身乏力，舌淡乌暗，苔白灰滑，脉微，反不恶寒，而心烦气短；此属阳为阴困，阴盛于内，格阳于外之象。虽不表现于下焦虚寒不能制水，却体现在阳气不能镇纳，浊阴腾越于上。这与真阳不能内守而致格阳于上，只属证候上之差别，其病机皆应归于阴阳格拒。由此可见，投白通汤仍药证相符。以附子补先天之火种；佐干姜温中焦之土气；葱白能通上下之阳气。姜附并用，逐阴回阳。阴阳交媾，浊降清升，即可通其被格之阳。
[二诊]连进四剂，头痛和精神好转。但阳衰阴盛日久，须温补少阴，兼顾太阴。治法宜继用驱阴助阳，温中益气，以四逆合理中加味，配成丸药服用。
处方：
制附片60克，干姜30克，炙甘草20克，生晒参30克，炒白术30克，茯苓30克，上肉桂15克，枸杞20克，菟丝子30克。十剂，水打为丸。
1979年7月追访，三年来，虽经常加夜班，头痛始终未犯。
[按语]或问：太阴少阴，本无头痛一证，为何此例病属少阴阳虚阴盛而头暴痛如裂？
对这个问题，历史上某些医学家曾有过不同意见。有的认为，头痛证只及太阳、少阳、厥阴。还有人提出，头为诸阳之会，与厥阴肝脉会于巅，诸阴寒邪不能上逆。
另一种意见与此不同。有人认为：“太阴、少阴二经，虽不上头，然痰与气逆壅于膈，头上气不得畅而亦痛。”（《冷庐医话》）还有人明确提出：三阳三阴皆有头痛，内伤日久，七情过度，亦作头痛，其中：“因阳虚日久，不能镇纳浊阴，阴气上腾，有头痛如裂，如劈，如泰山压顶，有欲绳索紧捆者，其人定见气喘唇舌青黑，渴饮滚汤，此属阳脱于上，乃属危候，法宜回阳收纳为要，如大剂白通四逆之类，缓则不救”。（《医法圆通》）
范老根据多年经验认为，后一种意见，比较符合临床实际。在临证中，头痛一证十分普遍，属少阴病头痛者，亦屡见不鲜。一般来说，少阴寒化证头痛，必须具备少阴病之主证，参之舌现淡白，皆应以白通、四逆辈主之。
Liao Xixin (Asari Radix et Rhizoma Preparatum) 3g, Fuling (Poria) 15g, Danggui (Angelicae Sinensis Radix) 10g. After taking the above prescription for more than ten doses, the illness was basically cured. Follow-up on July 20, 1979, showed that his physical condition had been good in recent years.
[Commentary] The *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet), Chapter "Water Qi Disease Pulse and Symptom Treatment," states: "In Qi Fen syndrome, there is hardness below the heart, large as a plate, with edges like an inverted cup, caused by water retention; it should be treated with Guizhi Qu Shaoyao Jia Mahuang Xixin Fuzi Tang (Cinnamon Twig Decoction minus Peony plus Ephedra, Asari, and Aconite)." This case did not present with symptoms of "hardness below the heart, large as a plate," nor was it purely a water qi disease. Why could this formula be applied? Because this syndrome belongs to deficiency of True Yang, where cold-damp pathogens take advantage of postpartum Yang deficiency to rebel against and occupy the position of clear Yang. Therefore, one need not rigidly adhere to the presence of "hardness" and "plate-like" manifestations or the severity of water retention; instead, one can prescribe this formula based on syndrome differentiation. This formula resolves exterior pathogens of the Taiyang channel while warming the Shaoyin channel. When Yang Qi rises and Qi transformation proceeds, cold coagulation dissolves, and various symptoms of chest bi (chest obstruction) naturally subside.
Taiyang-Shaoyin Syndrome Ying Disease
(Left Lobe Thyroid Cyst)
Song XX, Female, 36 years old. Worker at a factory in Chengdu.
[Medical History] Constitutionally weak, prone to common colds. In May 1977, she suffered from exogenous cough. After taking several doses of heat-clearing and cough-stopping Chinese herbs, the exterior syndrome resolved. However, after a few days, a lump was suddenly discovered on the left side of her neck, approximately 2x3 cm, slightly hard to touch, moving with swallowing, and painless. She felt palpitations and fatigue, with no other obvious symptoms. She had received penicillin injections and taken anti-inflammatory drugs, followed by additional Chinese medicine. In June of the same year, she was diagnosed with "Left Lobe Thyroid Cyst" at the Affiliated Hospital of XX Medical College, and surgical treatment was recommended. The patient declined, and in early July of the same year, she transferred here for consultation.
[First Visit] A lump appeared on the left side of the neck two months ago. Mental fatigue and weakness, poor appetite, difficulty sleeping at night, cold hands and feet, aversion to cold, dizziness. Tongue body dark and dull, coating pale yellow and greasy. This is Ying disease, with the main syndrome located in Shaoyin, accompanied by an exterior Taiyang Cold Damage syndrome. The treatment method should be to support healthy Qi and expel pathogens, warm the channels and release the exterior, primarily using Mahuang Xixin Fuzi Tang (Ephedra, Asari, and Aconite Decoction) with modifications.
Prescription:
Mahuang (Ephedrae Herba) 10g, Zhi Fupian (Prepared Aconiti Lateralis Radix) 60g (decocted for a long time), Liao Xixin (Asari Radix et Rhizoma Preparatum) 6g, Guizhi (Cinnamomi Ramulus) 10g, Ganjiang (Zingiberis Rhizoma) 30g, Gancao (Glycyrrhizae Radix et Rhizoma) 30g. Three doses.
[Second Visit] After taking three doses of the above prescription, the lump began to soften, and palpitations and fatigue improved slightly. The medicine matches the syndrome; heavy doses can produce rapid effects. The dosages of Ganjiang, Fuzi, and Gancao in the above prescription were doubled, and another three doses were taken. The lump shrank significantly, the tongue body turned slightly pale red, and the yellow greasy coating decreased. The initial prescription was continued for ten more doses, and the lump gradually disappeared.
On July 13, 1979, the patient wrote saying that after taking more than ten doses, the lump under the neck disappeared, and appetite and sleep greatly improved. There has been no recurrence for two years.
[Commentary] The lump on the side of the neck in this case is hard to touch, does not adhere to the skin, has normal skin color, and moves with swallowing, which are the main symptoms of Ying disease. The *Ling Shu: Han Re Pian* (Spiritual Pivot: Chapter on Cold and Heat) discusses conditions like cold-heat scrofula and rat fistula occurring in the neck and axilla, stating that their pathological root lies in the zang organs: "All reside in the zang organs, and their branches emerge upwards between the neck and axilla." This case of Ying disease is exactly so. Taiyang and Shaoyin are interior-exterior paired; wind-cold-damp pathogens penetrate deeply into Shaoyin over time, causing simultaneous exterior and interior disease. Yang Qi gradually declines, Ying and Wei Qi fail to secure the surface, cold coagulates and Qi stagnates, increasingly obstructing the side of the neck to form a nodule. Therefore, this case did not stick to the conventional view that most Ying swellings belong to phlegm-Qi stagnation or fire stagnation injuring Yin. Instead, it was treated as a Taiyang-Shaoyin syndrome, warming the channels and releasing the exterior to unblock Qi and Blood; unblocking Yang and dispersing cold to resolve accumulation. Similarly, softening hardness and dissipating nodules can be achieved.
Taiyang-Shaoyin Syndrome Cough and Asthma with Incontinence of Urine and Feces
(Chronic Bronchitis, Enteritis, Urethral Atrophy)
Ye XX, Male, 68 years old. Resident of Chengdu, blind.
[Medical History] Suffered from chronic bronchitis for over ten years, frequently experiencing dizziness, headache, cough with excessive sputum, and inability to lie flat; subsequently, incontinence of urine and feces persisted for five or six years, with about twenty bowel and bladder movements daily. Bowel movements occurred whenever urination took place, alternating between loose and constipated stool. A hospital in Chengdu had diagnosed chronic bronchitis with concurrent infection, chronic enteritis, and urethral atrophy. He frequently used aminophylline and various antibiotics, but his condition did not improve. He felt whole-body chilliness, limb weakness, and incessant nausea and vomiting. In 1975, he visited another hospital. After taking heat-clearing Chinese medicine and antibiotics, late at night he suddenly felt mental restlessness, cold limbs, and lost control of urine and feces. He fell into a coma for about half an hour before regaining consciousness. Several days later, facial paralysis developed, diagnosed as "Facial Nerve Paralysis." Acupuncture treatment improved the facial deviation, but other symptoms remained. Long-term suffering from illness brought indescribable pain. In December 1975, he came for consultation. Treated according to simultaneous Taiyang and Shaoyin disease, he was basically cured after two months of medication.
[First Visit] Intermittent abdominal pain, frequent daily bowel movements, often presenting as gray-white mucus; occasionally constipation, stools like chopstick heads, straining during defecation, unbearable bloating. Urination is dribbling and incomplete, small amount, stinging pain, difficult to pass. Cough with excessive thin white sputum. Palpitations and panting, able only to sit semi-recumbent; dizziness, headache, aversion to cold, fatigue, cold limbs. Pale complexion, flabby obesity. Tongue body pale, slightly purple-dark, no coating on the anterior part, thick white greasy coating with yellow tinge at the root, pulse deep and minute. This is prolonged stagnation of Taiyang Cold Excess, with Yin pathogens deeply rooted in the zang organs, loss of Lung Descending function, internal injury to Kidney Qi, insecurity of the Lower Jiao, leading to abnormal urination and defecation. It is a Shaoyin Cold Transformation syndrome, accompanied by Taiyang Exterior Excess syndrome. The treatment method should protect Yuan Yang internally to disperse cold, and open the pores externally to secure the Middle Jiao. Primarily use Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction).
Prescription:
Mahuang (Ephedrae Herba) 10g, Zhi Fupian (Prepared Aconiti Lateralis Radix) 30g (decocted for a long time), Gancao (Glycyrrhizae Radix et Rhizoma) 15g. Four doses.
[Syndrome Differentiation] The patient became blind in early life, lived in hardship without care, leading to persistent severe illness and increasingly complex conditions, with interlacing Yin-Yang and interior-exterior deficiency-excess. The patient's face is pale, tongue body slightly pale with slight purple-darkness, coating white thick and greasy; combined with deep minute pulse, cold limbs, aversion to cold, palpitations, and fatigue, it clearly indicates Heart-Kidney Yang decline and Qi-Blood insufficiency. It should be classified as Yin, Cold, Interior, Deficiency, entering the Shaoyin syndrome.
Observing the abdominal distension and pain, although not unique to Yin deficiency-cold syndromes, it differs from Yang excess-heat syndromes. This case's abdominal distension is intermittent pain, alternating diarrhea and constipation, aversion to cold without fever, no thirst; tongue body pale, no coating anteriorly, white slippery and greasy at the root. Obviously, this is a manifestation of Yin excess causing abdominal pain and fullness.
Loss of control over urine and feces differs from diarrhea caused by heat forcing the Large Intestine or heat binding with peripheral flow. For many years, the patient has had alternating loose and constipated stools, always with the urge to defecate; when constipated, stools are not hard; when loose, evacuation is incomplete. During urination, there is a sensation of rectal urgency; during defecation, urination feels dribbling. Thus, this syndrome undoubtedly belongs to Shaoyin Cold Transformation and insecurity of the Lower Jiao causing incontinence.
Disease entering Shaoyin inevitably damages the Heart, Kidney, and Bladder organs. In this case, the root lies first in Kidney Yang deficiency. After long-term illness, Kidney Qi declines daily, failing to regulate opening and closing, leading to dysregulation of excretion. Kidney affects the Spleen; Spleen fails to transport and transform, increasing abdominal fullness. Spleen dampness causes white stool; rising upward as phlegm, obstructing Qi mechanism causing cough and excessive sputum. Declining Yuan Yang of the Kidney necessarily affects the Descending function of Lung Qi, worsening Qi stagnation, causing inability to lie flat. This is the root cause of the myriad symptoms arising together, intertwining, and persisting for years.
At the first visit, aversion to cold, headache, pale moist tongue with white coating mixed with yellow, indicated concurrent Taiyang exterior cold excess pathogen. Resolving only the exterior leaves the interior syndrome unresolved; treating only the interior fails to resolve the exterior excess. Therefore, Mahuang Fuzi Gancao Tang was administered to address both Yin-Yang and interior-exterior. Using Fuzi and Mahuang together disperses cold without damaging Yuan Yang, saving the interior while addressing the exterior; supplemented by Gancao to moderate, inducing slight sweating. This is vastly different from solely treating Shaoyin deficiency-cold interior syndrome or Taiyang exterior excess syndrome with tight pulses requiring sweating.
[Second Visit] After four doses of the above prescription, aversion to cold, cough, and headache alleviated. Taiyang exterior cold initially resolved, abdominal distension and difficulty defecating slightly improved. However, Yin-cold condensed in the interior cannot be broken without purgation. Regarding constipation, one must distinguish Yang binding from Yin binding. Predecessors indeed spoke of three urgent purgation syndromes in Shaoyin, but with strict boundaries. This case differs from the three urgent Shaoyin purgation syndromes; it should be considered incontinence mainly due to Yin binding in Shaoyin Cold syndrome, a variation of Shaoyin rather than its norm, requiring warming and unblocking methods. Therefore, Dahuang Fuzi Tang (Rhubarb, Aconite, and Asari Decoction), balancing Yin-Yang and combining cold and heat, was prescribed.
Prescription:
Sheng Dahuang (Rhei Radix et Rhizoma) 9g, Chuan Fupian (Aconiti Lateralis Radix Praeparata) 45g (decocted for a long time), Liao Xixin (Asari Radix et Rhizoma Preparatum) 3g. Four doses.
After four doses, urination and defecation became smooth; years of pain such as bloating and urgency disappeared; cough, asthma, and sputum further alleviated. Later, Lizhong Tang (Regulate the Middle Decoction) was taken with modifications according to symptoms for over a month, leading to recovery through regulation.
On December 10, 1978, a home visit revealed that his physical condition had been good for years. The elderly man said excitedly: "In previous winters, I would already be bedridden; since recovering, I have had neither cold hands and feet nor diseases of aversion to cold, cough, and asthma, and my urination and defecation are normal. I am very grateful to Old Man Fan."
[Commentary] In this case, the Upper, Middle, and Lower Jiao, and multiple organs including Lung, Spleen, Kidney, Stomach, Small and Large Intestines, and Bladder were all affected, interfering with and entangling each other. The crux of the disease lies in Kidney Yang deficiency, causing insecurity of the Lower Jiao and persistent cough and asthma. The trend of pathogen transmission was cold-damp invading Taiyang; untreated for a long time, Yang declined and Yin grew, pathogens advanced while healthy Qi weakened; transmitting to Shaoyin, cold transformation deepened, and the body's resistance weakened further, resulting in lingering for years and numerous variations. Although the condition was so complex, by firmly grasping the basic clues of Six Channel syndrome differentiation, its characteristics, essence, and main cruxes at each stage became clearly visible, thereby providing reliable basis for clinical treatment.
Taiyang-Shaoyin Syndrome Epistaxis
Ran XX, Female, 72 years old. Resident of Chengdu.
[Medical History] In April 1975, nasal bleeding occurred after a cold. Seeking TCM treatment at a nearby hospital, she was diagnosed with Lung Heat. Taking heat-clearing and exterior-releasing agents consecutively, the disease progression did not subside. Family urgently used Yunnan Baiyao stuffed into the nose; after using three or four bottles, blood still seeped continuously. On the sixth day, diagnosis at the ENT department of XX Hospital was ineffective, so she came for consultation.
[First Visit] Epistaxis has lasted ten days, with intermittent seepage from the nasal cavity, dark red blood color, pale complexion. Difficulty eating, reversed cold limbs, aversion to cold and body pain, slight cough. Tongue body dark and dull, coating white slippery, slightly yellow greasy at the root. In individuals with Yang deficiency, exogenous cold pathogens invade, healthy Qi is weak, failure of Blood containment, Yang Qi is suppressed, meridians are stagnant, Blood does not follow normal pathways and spills out. This belongs to Taiyang-Shaoyin syndrome epistaxis. The treatment method should assist Yang and release the exterior, warm the channels and contain Blood, primarily using Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asari Decoction) with modifications.
Prescription:
Mahuang (Ephedrae Herba) 10g, Zhi Fupian (Prepared Aconiti Lateralis Radix) 60g (decocted for a long time), Liao Xixin (Asari Radix et Rhizoma Preparatum) 3g, Pao Jiang (Prepared Zingiberis Rhizoma) 30g, Heye (Nelumbinis Folium) 10g (stir-fried with vinegar), Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma) 20g. Two doses.
[Second Visit] After one dose of the above prescription, bleeding decreased; after two doses, bleeding stopped completely. Due to advanced age and weakness, recovery is difficult, so Six Recovery Decoction (Sini Tang) with Qi-tonifying ingredients was continued.
Prescription:
Zhi Fupian (Prepared Aconiti Lateralis Radix) 30g (decocted for a long time), Pao Jiang (Prepared Zingiberis Rhizoma) 15g, Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma) 10g, Dangshen (Codonopsis Radix) 10g, Rougui (Cinnamomi Cortex) 10g (dissolved), Dazao (Jujubae Fructus) 30g. Three doses.
[Third Visit] Spirit improved, diet increased. But Qi and Blood were severely deficient; instructed to stew Lamb Soup with Fresh Ginger, adding Danggui and Huangqi for regulation and tonification.
Follow-up in February 1979: The patient was 76 years old, and her health was good after recovery.
[Commentary] This case of epistaxis belongs to Cold entering Shaoyin, connecting externally to Taiyang. Treatment involved resolving both interior and exterior, assisted by warming channels and containing Blood; epistaxis stopped after three visits.
One might ask: Zhongjing has the warning "those with frequent nosebleeds should not sweat," why was Mahuang used in this case? Because the patient concurrently had Taiyang Cold Damage exterior syndrome, possessing Mahuang indications. The formula heavily uses Fuzi to warm the Shaoyin channel, releasing the exterior without damaging Yang Qi; Mahuang is not paired with Guizhi, and Zhi Gancao is heavily used to restrain it, thus dispelling pathogens without inducing sweating. Clinical observations show that those with frequent nosebleeds are not all prohibited from sweating; some are cured using sweating methods. Different conditions require specific analysis.
Shaoyin Syndrome Epistaxis
Liu XX, Male, 5 years old. Son of a worker at a factory in Chengdu.
[Medical History] In Spring 1948, his father carried him for consultation, saying: "The child was alone at home; at noon, we suddenly found his nose bleeding uncontrollably, lethargic and weak, lying on a chair, face pale. We frequently applied cold water compresses, but bleeding worsened. Urgently requested Old Man Fan to treat."
[First Visit] The child's spirit was listless, limbs reversed cold, lips and tongue pale white. This is a Shaoyin Cold syndrome, Yang Qi declining and weak, unable to contain Blood, Yin Qi relatively strong, inevitably rebelling upwards. Merely stopping blood cannot stop it? The treatment method should strengthen Yang and drive out Yin, warm the channels and contain Blood. Urgently administer Six Recovery Decoction (Sini Tang) to save the interior.
Prescription:
Tianxiong Pian (Aconiti Radix Preparata) 30g, Pao Jiang (Prepared Zingiberis Rhizoma) 30g, Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma) 20g. One dose.
Instructed to boil rapidly for about half an hour, take a small amount first; decoct the remaining medicine for another half hour, then continue taking.
The child's father took the prescription home. His mother saw it and made a great fuss: "From ancient times to now, never heard of using Dried Ginger and Prepared Aconite for nosebleeds!" The father insisted on administering it. Before finishing one dose, bleeding stopped immediately. In the evening, the child played in the courtyard as usual.
[Commentary] Epistaxis, modern medicine believes, can be caused by nasal diseases and systemic diseases. Traditional Chinese Medicine believes it is particularly closely related to the Lung, Stomach, Liver, and Kidney organs. Usually, exogenous wind pathogens cause Lung stagnation transforming into heat; excessive consumption of spicy and rich foods causes Stomach Fire rebellious upward; sudden anger causes Liver Fire reckless movement; Kidney Yin depletion causes deficiency Fire flaming upward, etc., all can damage vessels with heat, forcing Blood to move recklessly; treatment principles usually focus on clearing heat and cooling blood. However, in clinical practice, cases truly belonging to deficiency-cold, where nosebleeds result from failure of Blood containment, are not rare. If the latter are mistakenly treated with cooling medicines, disasters often ensue. Old Man Fan has many successful treatments for deficiency-cold type epistaxis; two cases are selected here for reference.
Shaoyin Syndrome Headache
Zhang XX, Male, 38 years old. Union cadre at a factory in Chengdu.
[Medical History] Suffered from headache starting in 1970, gradually worsening, especially severe head pain and eye distension when reading or writing. Visited several hospitals successively without a clear diagnosis. By 1976, the condition worsened; consulted in October, cured by treating as a Shaoyin syndrome.
[First Visit] A few days ago, sudden severe headache like splitting, afraid to open eyes. Resting in bed and taking medicine did not alleviate it; attacks still occurred intermittently. Mental restlessness, shortness of breath, cold limbs; face dark green and withered pale, tongue body pale and dark black, distinct teeth marks on edges, thin moist gray-white coating, pulse deep and minute. This is a Shaoyin Yang decline and Yin excess syndrome headache, with signs of Yin-Yang repulsion. The treatment method should unblock vessels and restore Yang, promote circulation between upper and lower, primarily using Baitong Tang (Scallion Juice Decoction).
Prescription:
Congbai (Allii Fistulosi Bulbus) 60g, Ganjiang (Zingiberis Rhizoma) 30g, Zhi Fupian (Prepared Aconiti Lateralis Radix) 60g (decocted for a long time). Four doses.
[Syndrome Differentiation] According to *Shang Han Lun*, Baitong Tang was originally designed for Shaoyin disease with Yin excess, Floating Yang, and diarrhea. Why use Baitong Tang for this case's headache?
Examining the diarrhea in Baitong Tang syndrome, it is due to Lower Jiao deficiency-cold failing to control water; and Floating Yang causing red face is due to deficient Yang floating upwards. Regardless of diarrhea or red face, the etiology and pathology belong to Yin-cold excess internally and Yin-Yang repulsion. From this case, not only is Yin-cold excess prominent, but the signs of Yin-Yang repulsion are also quite obvious. Dark green face, cold limbs, whole-body fatigue, pale dark tongue, white-gray slippery coating, minute pulse, yet contrary to aversion to cold, feeling mental restlessness and shortness of breath; this belongs to Yang being trapped by Yin, Yin excess internally, repelling Yang externally. Although it does not manifest as Lower Jiao deficiency-cold failing to control water, it manifests as Yang failing to anchor and turbid Yin surging upwards. This differs from True Yang failing to remain internal and repelling Yang upwards only in symptom presentation; the pathology should both be attributed to Yin-Yang repulsion. Thus, administering Baitong Tang still matches the medicine and syndrome. Using Fuzi to supplement the fire seed of congenital constitution; assisting Ganjiang to warm the earth Qi of the Middle Jiao; Congbai can unblock Yang Qi between upper and lower. Using Ginger and Aconite together drives out Yin and restores Yang. Yin and Yang interact, turbid descends and clear ascends, thereby unblocking the repelled Yang.
[Second Visit] Continuing four doses, headache and spirit improved. But Yang decline and Yin excess persisted for a long time, requiring warming and tonification of Shaoyin, attending to Taiyin. The treatment method should continue driving out Yin and assisting Yang, warming the Middle and benefiting Qi, using Six Recovery Decoction combined with Regulate the Middle Decoction (Lizhong Tang) with modifications, prepared as pills.
Prescription:
Zhi Fupian (Prepared Aconiti Lateralis Radix) 60g, Ganjiang (Zingiberis Rhizoma) 30g, Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma) 20g, Shengshaishen (Panacis Quinquefolii Radix) 30g, Chao Baizhu (Stir-fried Atractylodis Macrocephalae Rhizoma) 30g, Fuling (Poria) 30g, Rougui (Cinnamomi Cortex) 15g, Gouqi (Lycii Fructus) 20g, Tusizi (Cuscutae Semen) 30g. Ten doses, processed into pills with water.
Follow-up in July 1979: Over three years, despite frequent night shifts, headaches never recurred.
[Commentary] One might ask: Taiyin and Shaoyin originally do not have headache syndromes; why does this case, belonging to Shaoyin Yang deficiency and Yin excess, present with sudden severe headache like splitting?
Regarding this issue, certain medical experts in history had different opinions. Some believed headache syndromes only involve Taiyang, Shaoyang, and Jueyin. Others proposed that the head is the meeting point of all Yang meridians, converging with the Jueyin Liver meridian at the vertex, so all Yin-cold pathogens cannot ascend.
Another opinion differs. Some believe: "Although the Taiyin and Shaoyin meridians do not go up to the head, if Phlegm and Qi rebellion obstruct the diaphragm, Qi in the head cannot circulate freely, causing pain." (*Leng Lu Yi Hua*). Others explicitly state: All Three Yang and Three Yin meridians can have headaches; long-term internal injury and excessive seven emotions also cause headaches, among which: "Due to long-term Yang deficiency, failing to anchor and contain turbid Yin, Yin Qi surges upward, causing headaches like splitting, like chopping, like Mount Tai pressing down, or like ropes tightly binding; the person will definitely see panting, blue-black lips and tongue, craving boiling hot drinks, this belongs to Yang escaping upwards, a critical condition, the treatment method should prioritize restoring Yang and collecting [it], such as large doses of Baitong Tang and Six Recovery Decoction; if delayed, rescue is impossible." (*Yi Fa Yuan Tong*).
Old Man Fan, based on years of experience, believes the latter opinion is more consistent with clinical reality. In clinical practice, headache is very common, and Shaoyin disease headaches are also frequently seen. Generally speaking, Shaoyin Cold Transformation syndrome headaches must possess the main symptoms of Shaoyin disease; referring to the tongue appearing pale white, all should be primarily treated with Baitong Tang or Six Recovery Decoction categories.
Shaoyin Syndrome Asthma
(Bronchial Asthma, Emphysema)
Liu XX, Male, 49 years old. Cadre at a bureau in Anhui Province.