处方：
制附片120克(久煎) 干姜60克炙甘草60克白术30克茯苓30克 炮姜60克上肉桂15克(冲服)
[二诊]上方服一剂后，全身发痒，如虫爬行。连服四剂，身上开始感觉轻松，头木之感渐消。上方随证加减：遇有外感风寒、关节疼痛，加麻黄、桂枝、细辛；阳气渐回，则姜附酌减。其后，又酌加人参、黄芪、当归、菟丝子等，以增助阳益气、活血养血之效。如此坚持服药半年，面色渐转正常，浮肿消退，食欲倍增，四肢变温，精神好转。1972年4月已能起床，依靠拐杖或他人搀扶，能缓缓移步；到同年7月，即可丢掉拐杖而行。
1979年11月23日追访：患者已73岁，向来访者兴奋地介绍，从1972年底，在冬季继续服些温阳补肾药，七年来再未卧床不起。这几年一直能料理家务。
[按语]中风之发生，总不外乎阴阳失调，气血逆乱。本例初诊时，患者已成中风后遗证，偏枯达八年，病势沉重，显然不能按一般中风之常规论治。观其诸证，少阴寒化，阴盛阳衰已极。故投大剂四逆，随证加减，始终按少阴寒化证论治。
少阴证气厥
黄××，女，48岁。成都市街道居民。
[病史]经常头晕，咳嗽气紧，心累心悸，四肢乏力，头面及双膝以下腿足浮肿，迁延已有五年。严重时，自觉心往下坠，甚至短暂昏迷。1964年3月，因劳累后，突觉心累心悸加重，旋即昏迷， 不醒人事。邻友见危，欲急送医院；但家属恐途中颠簸而致气绝，遂来邀至家中急诊。
[初诊]昏迷不醒，四肢不温，面色苍白，呼吸微弱。脉沉微，舌淡苔黑润。此为少阴证气厥，立即以自制坎离丹五粒，温开水灌服，同时速煎温中扶阳之剂急救。
处方一：
川附片三份半上肉桂一份真琥珀二份
柏子仁二份 飞朱砂一份 麝香半份
研细末，水打丸。
处方二：炮干姜15克炙甘草10克一剂煎服。
[二诊]灌下坎离丹后，约时许，病人慢慢苏醒过来。然后急进汤剂，每二小时一服。次日，自己坐车前来就诊。心累心悸稍减，四肢微觉有力，精神亦好转。黑苔减少，脉沉弱。法宜温脾补肾，以干姜附子汤主之。
处方：干姜60克制附片60克(久煎)
三剂
[三诊]上方连服三剂，诸证虽有好转，但久病大衰，心气亏耗，肺脾肾皆虚。宜温阳益气，健脾补中为治，以脾胃着手，滋气血之源，以理中汤加味主之。
处方：
潞党参12克干姜片15克炒白术15克炙甘草6克 茯苓25克 法半夏15克连进十余剂，诸证显著好转，操持家务如常。1979年7月追访，患者已年逾六旬，十余年来仅复发过一次，但病情较轻，恢复正常后，一直比较稳定。
[辨证]患者元气素虚，久病更加衰惫，遇劳累诱发而病势沉重。呼吸弱，脉沉微，为心气亏耗；舌淡苔黑，浮肿，肢冷，属阳气不振，肾水上泛；突然昏迷，系一时气机逆乱，中气下陷，阴气上腾，心肾不交。所幸尚未发现下利、汗出、面赤、四肢厥逆、脉微欲绝之危候，故不必立投四逆，宜用温肾补心，安神利窍之剂，令坎离相济，再以温中扶阳之品，使清阳升，浊阴降，呼吸为之条畅，神志立转清醒。然后继进驱阴助阳，温补脾肾之方，培植根本，最终以温阳益气，滋养气血为治，逐渐康复而安。
[按语]《素问·方盛衰论篇》云： “是以少气之厥，令人忘梦，其极至迷”。论其治疗，因五脏气虚，阳气不足等皆可致病，主张应参合五脏见证，调和阴阳之气，据其经脉盛衰而f台之。本例患者，即属少气之候涉及五脏，而以心肾气虚为主。始终以温通之法，扶其心肾之阳，注意以“弃阴附阳，不知并合”为戒。得其要领，故沉疾较快扭转，十余年来颇为稳定。
少阴证寒厥
王××，男，28岁。成都市某厂工人。
(病史]患者性情比较孤僻，善愁多郁，日久成疾，未予医治。1947年初，发现胃脘长一包块，如拳头大，以手按之，活动、有声，但不痛。急赴某地，请中医治疗。所服之药，多系桃仁、红花、三棱、莪术等活血化淤之品。治疗约半年，疗效不显，食欲日减，形萎神衰。虽七月炎暑，穿绒衣，夜覆被，仍觉不暖。后就地改请他医治疗，至次年四月，病势更加沉重。某日突然昏厥，家人误认为暴死，将其放置屋外木板之上，待殓。此时范老恰在邻舍诊病，有人急忙叩门而入曰： “知先生在此，余邻友病危，似已断气，盼先生亲临视之，有无救药?”遂前往诊视。
[初诊]只见患者面色苍白，唇乌，四肢厥冷。当即用细灯芯探试鼻息，略有微动。触胸窝， 微热尚存。切脉，似有似无。日：犹有一毫生机， 可试服药，看能否救之。并留其家中，亲自指导用药，以观察疗效。
处方一：炙甘草30克炮干姜15克处方二：炙甘草60克干姜120克制附片120克(久煎) 党参45克童便为引。
令其家人，将以上两剂药，同时急火分罐煎煮。先取首方煎好之汤剂半盅，频频灌之。服后约一刻钟，患者逐渐发出轻微鼻息声，手足微微蠕动。待等二方煎成，又立即灌服。药后二时许，慢慢苏醒过来，神志逐渐清楚，方知已将自己抬出室外，家人正备后事。
[辨证]初诊时，患者已待殓。试鼻息，触胸窝，切其脉，观其色，问其病史，此乃属少阴病阳衰阴盛已极，尚存一丝微阳，有倾刻欲脱之危。应急投四逆汤驱阴回阳。但附子须久煎，恐失救逆之机，故先投以甘草干姜汤，辛甘合用，专复胸中之阳，肺气得温，呼吸通利，而垂绝之阳不致立断。然后再以大剂四逆加参，回阳益阴，救元气于垂绝之乡；加童便引阳入阴，使阳昌阴和而回生。
[二诊]语气低微，气不接续；阳气虽回，但气血虚衰已甚。再拟理中汤加味，补脾壮肾；又因其胃脘尚有寒凝积聚，故少佐驱寒散结之品。
处方：
党参18克干姜120克 炙甘草120克 白术18克制附片250克(久煎) 茯苓15克补骨脂12克枸杞60克吴茱萸10克山萸肉30克白胡椒10克上方服一剂，略知饥欲食，可进流质少许。原方再进四剂，病情大有好转，每餐能食稀粥一小碗。
[三诊]面色略有润泽，精神转佳，但萎黄未消，食欲不振。仍以理中汤加味，俾土气旺，以助生机。
处方一：
党参15克炒白术30克炙甘草60克干姜120克制附片250克(久煎) 上肉桂20克(冲服)
枸杞30克桂枝15克茯苓25克处方二：砂仁30克 白蔻30克共研细末，饭后冲服少许。
根据病情，上方加减共服两月余，诸证消除，身体复原。1979年追访，患者已五十九岁，三十多年来，能经常上夜班，身体一直较好。
[按语]“厥”证之病理，乃阴阳气不相贯通。轻者手足厥冷，猝然昏倒；重者一厥不复， 以致死亡。故《内经》论厥逆甚详， 《伤寒论》多救逆之法。但就厥之属性，非寒即热。故《素问·厥论篇》云： “阳气衰于下，则为寒厥；阴气衰于下，则为热厥”。临证救逆，必须详辨。
本例寒厥之证，审查内外，辨证求因，可知其寒不从外，皆从内。法宜调其阴阳，治其主经之病。此少阴病阳衰阴盛已极之证，急投辛甘复阳救逆之剂，使阴阳气得以顺接。故待殓之患者，顿时回春。
少阴证真寒假热
(高 热)
车××，男，74岁。成都市居民。
[病史]1975年4月初，感受风寒，全身不适。自以为年迈体衰，营卫不固，加之经济困难，略知方药，遂自拟温补汤剂服之。拖延十余日，病未减轻，勉强外出散步，受风而病情加重。头昏体痛，面赤高热，神志恍惚。邻友见之急送××医院。查体温39℃ ，诊为感冒高热，注射庆大霉素，并服西药，高烧仍不退，病势危重，邀范老至家中急诊。
[初诊]患者阵阵昏迷不醒，脉微欲绝。已高烧三日，虽身热异常，但重被覆盖，仍觉心中寒冷。饮食未进，二便闭塞。双颧潮红，舌淡润滑，苔厚腻而黑。患者年逾七旬，阴寒过胜，恐有立亡之危。虽兼太阳表证，应先救其里，急投通脉四逆汤抢救之。
处方：
生甘草30克干姜60克制附片60克(久煎) 葱白60克(辨证]患者高热，神昏，面赤，苔黑，二便不通，似阳热之象。虽高热，反欲重被覆身；身热面赤，而四肢厥冷。二便不通，却腹无所苦。苔黑厚腻，但舌润有津。高烧神昏，无谵妄狂乱之象，而脉现沉微。参之年已古稀，体弱气衰，实一派少阴孤阳飞越之候，生气欲离，亡在倾刻。故应急投通脉四逆加葱，直追其散失欲绝之阳。
(二诊)服上方二剂，热退，黑苔显著减少。阳回而阴霾之气初消，阴阳格拒之象已解。但头痛、身痛，表证仍在；肾阳虚衰，不能化气，故仍二便不利。以麻黄附子甘草汤驱其寒而固其阳，加葱生少阳生发之气。
处方：
麻黄10克制附片60克(久煎)
生甘草20克 葱白120克四剂
[三诊]上方服四剂，头不觉昏，二便通利，黑苔退尽。唯身痛未除。虽阳回、表解，仍舌淡， 肢冷，阴寒内盛，呈阳虚身痛之象。宜温升元m而祛寒邪，以四逆加辽细辛主之。
处方：
炙甘草20克干姜30克制附片60克(久煎) 辽细辛6克二剂
[四诊]服二剂，余证悉除。其大病瘥后，真阳虚衰，以理中汤加味调理之。
处方：
潞党参15克炒白术10克炙甘草10克干姜片15克 制附片30克茯苓12克1979年7月18日追访，患者已79岁高龄，自病愈后，几年来身体一直较好。
[按语]临证辨别寒热，并不太难。但物极必反， “寒极生热，热极生寒”。此等寒热真假之辨，一旦有误，危情叵测。前人对此，曾有较多之阐发。
本例证似阳热，而脉微欲绝，脉证不符。范老遇此寒热真假难分之际，全面审度，突出舌诊：其舌质淡，为阴寒盛；苔黑而润滑有津，乃肾水上泛。断不可误认为阳热，实为阴寒内盛已极，虚寒外露之假象。故遇此类危证，效仲景之法，敢于突破，常获显效。
少阴证下利虚脱
(正伤寒)
黄××，男，11岁。原四川成都市学生。
[病史]1948年秋，初感全身不适，以后病情逐渐加重，神志昏迷，高热至40。c以上，腹泻。当时正值肠伤寒流行季节，原四川省立医院确诊为“正伤寒”，某专家认为，病已发展至极期，全身性中毒过重，已属不治之症。后由中医会诊，曾以大量犀角．羚羊角、紫雪丹等抢救。患儿虽高热退，腹泻止，而病势却更加沉重，四肢冰冷，脉欲绝，终至垂危。最后来诊，按少阴证下利虚脱论治，初诊机转，数诊痊愈。
[初诊]患儿连日来昏迷踡卧，面色灰白乌暗，形体枯瘦。脉伏微细欲绝，唯以细灯草试双鼻孑L，尚有丝微气息。四肢厥逆，手冷过肘，足冷过膝，甚至通体肢肤厥冷。此为病邪已由阳入阴，发展为少阴阴寒极盛，阳气倾刻欲脱之险恶阶段。急用驱阴回阳，和中固脱之法，以大剂通脉四逆汤一剂灌服急救。
处方：
川附片120克(久煎)干姜120克炙甘草60克[二诊]上方，连夜频频灌服，至翌日凌晨，患儿家长慌忙赶来连声说： “坏了坏了，服药后鼻中出血了!”范老立即回答： “好了好了，小儿有救了!”遂再诊。患儿外形、病状虽与昨日相似，但呼吸已稍见接续、均匀，初露回生之兆。宜继守原法，以通脉四逆倍加用量再服。
处方：
川附片500克 干姜500克炙甘草250克先以肥母鸡一只熬汤，另以鸡汤煎附片一个半小时，再入姜、草。服药后约两小时，患儿忽从鼻中流出紫黑色凝血两条，约三寸长，口中亦吐出若干血块。这时缓缓睁开双眼，神志开始清醒，并开口说：“我要吃白糕!”全家顿时破涕为笑，皆大欢喜。遂遵原方，再进四剂。
[三诊]患儿神志已完全清醒，语言自如，每日可进少量鸡汤等流质。面色青暗。舌质淡白，乌暗，无苔。上肢可活动，开始端碗进食，下肢僵硬，不能屈伸，四肢仍厥冷。病已开始好转，阳气渐复；但阴寒凝聚已深，尤以下肢为甚。原方稍加大曲酒为引，再服。
上方又服一剂后，次日下肢即可慢慢屈伸。再服两剂，能下床缓步而行。服至十三剂，逐渐康复。
患者于1978年12月26日来函说： “三十年前，范老治好我的病以后，我于1953年参军，在部队还立了两次三等功，现在机械配件厂当钳工，身体一直很好。”
(按语]此例由于失治，病由阳入阴，阳气衰微，阴寒凝滞，即阴阳气血已不能充实于四肢叽肤，故现面色灰白乌暗，脉伏细微欲绝，四肢通体逆冷，甚至昏厥不省。显然，病势已发展至少阴寒化之危重阶段，属典型之四逆证。值此纯阴微阳之际，千钧一发之时，一切以阳气之存亡为转移。阳存可生，阳亡立死，非急投以大剂通脉四逆回阳救逆不可。
处方：
制附片120克（久煎） 干姜60克 炙甘草60克 白术30克 茯苓30克 炮姜60克 上肉桂15克（冲服）
[二诊]服用上方一剂后，全身发痒，感觉如虫爬行。连续服用四剂后，身上开始感觉轻松，头部麻木感逐渐消失。根据症状变化对上方进行加减：如果遇到外感风寒、关节疼痛的情况，加入麻黄、桂枝、细辛；如果阳气逐渐恢复，则酌情减少干姜和附子的用量。此后，又酌情加入了人参、黄芪、当归、菟丝子等药物，以增强助阳益气、活血养血的功效。坚持服药半年后，面色逐渐恢复正常，浮肿消退，食欲大增，四肢变暖，精神状态好转。1972年4月已能起床，依靠拐杖或他人搀扶，能够缓慢移动步伐；到同年7月，即可丢掉拐杖行走。
1979年11月23日随访：患者已73岁，向来访者兴奋地介绍，从1972年底起，在冬季继续服用一些温阳补肾的药物，七年来再也没有卧床不起。这几年一直能够料理家务。
[按语]中风的发生，总不外乎阴阳失调，气血逆乱。本例初诊时，患者已成中风后遗症，偏瘫达八年，病势沉重，显然不能按照一般中风的常规来论治。观察其各种症状，属于少阴寒化证，阴盛阳衰已达到极点。因此投以大剂量的四逆汤，随证加减，始终按照少阴寒化证来论治。
少阴证气厥
黄××，女，48岁。成都市街道居民。
[病史]经常头晕，咳嗽气紧，心慌心悸，四肢乏力，头面及双膝以下腿足浮肿，迁延已有五年。严重时，自觉心脏往下坠，甚至短暂昏迷。1964年3月，因劳累后，突然感到心慌心悸加重，随即昏迷，不省人事。邻居朋友见病情危急，想紧急送医院；但家属担心途中颠簸导致气绝，于是邀请医生到家急诊。
[初诊]昏迷不醒，四肢不温，面色苍白，呼吸微弱。脉象沉微，舌淡苔黑润。此为少阴证气厥，立即给予自制坎离丹五粒，用温开水灌服，同时迅速煎煮温中扶阳的药剂急救。
处方一：
川附片三份半 上肉桂一份 真琥珀二份
柏子仁二份 飞朱砂一份 麝香半份
研成细末，用水泛丸。
[二诊]灌下坎离丹后，约一小时左右，病人慢慢苏醒过来。然后急进汤剂，每两小时服用一次。次日，自己坐车前来就诊。心慌心悸稍减，四肢微觉有力，精神亦好转。黑苔减少，脉象沉弱。治法宜温脾补肾，以干姜附子汤为主方。
[三诊]上方连服三剂，诸证虽有好转，但久病大衰，心气亏耗，肺脾肾皆虚。宜温阳益气，健脾补中为治，从脾胃着手，滋生气血之源，以理中汤加味为主方。
处方：
潞党参12克 干姜片15克 炒白术15克 炙甘草6克 茯苓25克 法半夏15克 连续服用十余剂，诸证显著好转，操持家务如常。1979年7月随访，患者已年过六旬，十余年来仅复发过一次，但病情较轻，恢复正常后，一直比较稳定。
[辨证]患者元气素虚，久病更加衰惫，遇劳累诱发而病势沉重。呼吸弱，脉沉微，为心气亏耗；舌淡苔黑，浮肿，肢冷，属阳气不振，肾水上泛；突然昏迷，系一时气机逆乱，中气下陷，阴气上腾，心肾不交。所幸尚未发现下利、汗出、面赤、四肢厥逆、脉微欲绝之危候，故不必立即投用四逆汤，宜用温肾补心，安神利窍的药剂，令坎离相济，再以温中扶阳之品，使清阳升，浊阴降，呼吸为之条畅，神志立转清醒。然后继进驱阴助阳，温补脾肾的方剂，培植根本，最终以温阳益气，滋养气血为治，逐渐康复而安。
[按语]《素问·方盛衰论篇》云：“是以少气之厥，令人忘梦，其极至迷”。论其治疗，因五脏气虚，阳气不足等皆可致病，主张应参合五脏见证，调和阴阳之气，据其经脉盛衰而调之。本例患者，即属少气之候涉及五脏，而以心肾气虚为主。始终以温通之法，扶其心肾之阳，注意以“弃阴附阳，不知并合”为戒。得其要领，故沉疾较快扭转，十余年来颇为稳定。
少阴证寒厥
王××，男，28岁。成都市某厂工人。
[病史]患者性情比较孤僻，善愁多郁，日久成疾，未予医治。1947年初，发现胃脘长一包块，如拳头大，以手按之，活动、有声，但不痛。急赴某地，请中医治疗。所服之药，多系桃仁、红花、三棱、莪术等活血化瘀之品。治疗约半年，疗效不显，食欲日减，形萎神衰。虽七月炎暑，穿绒衣，夜覆被，仍觉不暖。后就地改请他医治疗，至次年四月，病势更加沉重。某日突然昏厥，家人误认为暴死，将其放置屋外木板之上，待殓。此时范老恰在邻舍诊病，有人急忙叩门而入曰：“知先生在此，余邻友病危，似已断气，盼先生亲临视之，有无救药？”遂前往诊视。
[初诊]只见患者面色苍白，唇乌，四肢厥冷。当即用细灯芯探试鼻息，略有微动。触胸窝，微热尚存。切脉，似有似无。曰：犹有一毫生机，可试服药，看能否救之。并留其家中，亲自指导用药，以观察疗效。
处方一：炙甘草30克 炮干姜15克
处方二：炙甘草60克 干姜120克 制附片120克（久煎） 党参45克 童便为引。
令其家人，将以上两剂药，同时急火分罐煎煮。先取首方煎好之汤剂半盅，频频灌之。服后约一刻钟，患者逐渐发出轻微鼻息声，手足微微蠕动。待等二方煎成，又立即灌服。药后二时许，慢慢苏醒过来，神志逐渐清楚，方知已将自己抬出室外，家人正备后事。
[辨证]初诊时，患者已待殓。试鼻息，触胸窝，切其脉，观其色，问其病史，此乃属少阴病阳衰阴盛已极，尚存一丝微阳，有顷刻欲脱之危。应急投四逆汤驱阴回阳。但附子须久煎，恐失救逆之机，故先投以甘草干姜汤，辛甘合用，专复胸中之阳，肺气得温，呼吸通利，而垂绝之阳不致立断。然后再以大剂四逆加参，回阳益阴，救元气于垂绝之乡；加童便引阳入阴，使阳昌阴和而回生。
[二诊]语气低微，气不接续；阳气虽回，但气血虚衰已甚。再拟理中汤加味，补脾壮肾；又因其胃脘尚有寒凝积聚，故少佐驱寒散结之品。
处方：
党参18克 干姜120克 炙甘草120克 白术18克 制附片250克（久煎） 茯苓15克 补骨脂12克 枸杞60克 吴茱萸10克 山萸肉30克 白胡椒10克
上方服一剂，略知饥欲食，可进流质少许。原方再进四剂，病情大有好转，每餐能食稀粥一小碗。
[三诊]面色略有润泽，精神转佳，但萎黄未消，食欲不振。仍以理中汤加味，俾土气旺，以助生机。
处方一：
党参15克 炒白术30克 炙甘草60克 干姜120克 制附片250克（久煎） 上肉桂20克（冲服）
枸杞30克 桂枝15克 茯苓25克
处方二：砂仁30克 白蔻30克 共研细末，饭后冲服少许。
根据病情，上方加减共服两月余，诸证消除，身体复原。1979年随访，患者已五十九岁，三十多年来，能经常上夜班，身体一直较好。
[按语]“厥”证的病理，乃阴阳气不相贯通。轻者手足厥冷，猝然昏倒；重者一厥不复，以致死亡。故《内经》论厥逆甚详，《伤寒论》多救逆之法。但就厥之属性，非寒即热。故《素问·厥论篇》云：“阳气衰于下，则为寒厥；阴气衰于下，则为热厥”。临证救逆，必须详辨。
本例寒厥之证，审查内外，辨证求因，可知其寒不从外，皆从内。法宜调其阴阳，治其主经之病。此少阴病阳衰阴盛已极之证，急投辛甘复阳救逆之剂，使阴阳气得以顺接。故待殓之患者，顿时回春。
少阴证真寒假热
(高热)
车××，男，74岁。成都市居民。
[病史]1975年4月初，感受风寒，全身不适。自以为年迈体衰，营卫不固，加之经济困难，略知方药，遂自拟温补汤剂服之。拖延十余日，病未减轻，勉强外出散步，受风而病情加重。头昏体痛，面赤高热，神志恍惚。邻居朋友见之急送××医院。查体温39℃，诊为感冒高热，注射庆大霉素，并服西药，高烧仍不退，病势危重，邀范老至家中急诊。
[初诊]患者阵阵昏迷不醒，脉微欲绝。已高烧三日，虽身热异常，但重被覆盖，仍觉心中寒冷。饮食未进，二便闭塞。双颧潮红，舌淡润滑，苔厚腻而黑。患者年逾七旬，阴寒过胜，恐有立亡之危。虽兼太阳表证，应先救其里，急投通脉四逆汤抢救之。
处方：
生甘草30克 干姜60克 制附片60克（久煎） 葱白60克
[辨证]患者高热，神昏，面赤，苔黑，二便不通，似阳热之象。虽高热，反欲重被覆身；身热面赤，而四肢厥冷。二便不通，却腹无所苦。苔黑厚腻，但舌润有津。高烧神昏，无谵妄狂乱之象，而脉现沉微。参之年已古稀，体弱气衰，实一派少阴孤阳飞越之候，生气欲离，亡在顷刻。故应急投通脉四逆加葱，直追其散失欲绝之阳。
(二诊)服上方二剂，热退，黑苔显著减少。阳回而阴霾之气初消，阴阳格拒之象已解。但头痛、身痛，表证仍在；肾阳虚衰，不能化气，故仍二便不利。以麻黄附子甘草汤驱其寒而固其阳，加葱生少阳生发之气。
处方：
麻黄10克 制附片60克（久煎）
生甘草20克 葱白120克 四剂
[三诊]上方服四剂，头不觉昏，二便通利，黑苔退尽。唯身痛未除。虽阳回、表解，仍舌淡，肢冷，阴寒内盛，呈阳虚身痛之象。宜温升元阳而祛寒邪，以四逆加辽细辛主之。
处方：
炙甘草20克 干姜30克 制附片60克（久煎） 辽细辛6克 二剂
[四诊]服二剂，余证悉除。其大病瘥后，真阳虚衰，以理中汤加味调理之。
处方：
潞党参15克 炒白术10克 炙甘草10克 干姜片15克 制附片30克 茯苓12克
1979年7月18日随访，患者已79岁高龄，自病愈后，几年来身体一直较好。
[按语]临证辨别寒热，并不太难。但物极必反，“寒极生热，热极生寒”。此等寒热真假之辨，一旦有误，危情叵测。前人对此，曾有较多之阐发。
本例证似阳热，而脉微欲绝，脉证不符。范老遇此寒热真假难分之际，全面审度，突出舌诊：其舌质淡，为阴寒盛；苔黑而润滑有津，乃肾水上泛。断不可误认为阳热，实为阴寒内盛已极，虚寒外露之假象。故遇此类危证，效仲景之法，敢于突破，常获显效。
少阴证下利虚脱
(正伤寒)
黄××，男，11岁。原四川成都市学生。
[病史]1948年秋，初感全身不适，以后病情逐渐加重，神志昏迷，高热至40℃以上，腹泻。当时正值肠伤寒流行季节，原四川省立医院确诊为“正伤寒”，某专家认为，病已发展至极期，全身性中毒过重，已属不治之症。后由中医会诊，曾以大量犀角、羚羊角、紫雪丹等抢救。患儿虽高热退，腹泻止，而病势却更加沉重，四肢冰冷，脉欲绝，终至垂危。最后来诊，按少阴证下利虚脱论治，初诊机转，数诊痊愈。
[初诊]患儿连日来昏迷踡卧，面色灰白乌暗，形体枯瘦。脉伏微细欲绝，唯以细灯草试双鼻孔，尚有丝微气息。四肢厥逆，手冷过肘，足冷过膝，甚至通体肢肤厥冷。此为病邪已由阳入阴，发展为少阴阴寒极盛，阳气顷刻欲脱之险恶阶段。急用驱阴回阳，和中固脱之法，以大剂通脉四逆汤一剂灌服急救。
[二诊]上方，连夜频频灌服，至翌日凌晨，患儿家长慌忙赶来连声说：“坏了坏了，服药后鼻中出血了！”范老立即回答：“好了好了，小儿有救了！”遂再诊。患儿外形、病状虽与昨日相似，但呼吸已稍见接续、均匀，初露回生之兆。宜继守原法，以通脉四逆倍加用量再服。
处方：
川附片500克 干姜500克 炙甘草250克
先以肥母鸡一只熬汤，另以鸡汤煎附片一个半小时，再入姜、草。服药后约两小时，患儿忽从鼻中流出紫黑色凝血两条，约三寸长，口中亦吐出若干血块。这时缓缓睁开双眼，神志开始清醒，并开口说：“我要吃白糕！”全家顿时破涕为笑，皆大欢喜。遂遵原方，再进四剂。
[三诊]患儿神志已完全清醒，语言自如，每日可进少量鸡汤等流质。面色青暗。舌质淡白，乌暗，无苔。上肢可活动，开始端碗进食，下肢僵硬，不能屈伸，四肢仍厥冷。病已开始好转，阳气渐复；但阴寒凝聚已深，尤以下肢为甚。原方稍加大曲酒为引，再服。
上方又服一剂后，次日下肢即可慢慢屈伸。再服两剂，能下床缓步而行。服至十三剂，逐渐康复。
患者于1978年12月26日来函说：“三十年前，范老治好我的病以后，我于1953年参军，在部队还立了两次三等功，现在机械配件厂当钳工，身体一直很好。”
[按语]此例由于失治，病由阳入阴，阳气衰微，阴寒凝滞，即阴阳气血已不能充实于四肢肌肤，故现面色灰白乌暗，脉伏细微欲绝，四肢通体逆冷，甚至昏厥不省。显然，病势已发展至少阴寒化之危重阶段，属典型之四逆证。值此纯阴微阳之际，千钧一发之时，一切以阳气之存亡为转移。阳存可生，阳亡立死，非急投以大剂通脉四逆回阳救逆不可。
Prescription:
Zhi Fupian (Prepared Aconite Lateralis Radix) 120g (decocted for a long time), Ganjiang (Dried Ginger Rhizome) 60g, Zhigancao (Honey-fried Licorice Root) 60g, Baizhu (Atractylodis Macrocephalae Rhizoma) 30g, Fuling (Poria) 30g, Paojiang (Charred Ginger Rhizome) 60g, Shang Rougui (Cinnamon Bark) 15g (dissolved in the decoction).
[Second Visit] After taking one dose of the above prescription, the whole body itched, feeling as if insects were crawling. After continuously taking four doses, the body began to feel relaxed, and the sensation of head numbness gradually disappeared. The prescription was modified according to symptoms: if external wind-cold invasion or joint pain occurred, Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), and Xixin (Asari Radix et Rhizoma) were added; as Yang Qi gradually recovered, the dosages of Jiang (Ginger) and Fu (Aconite) were酌情 reduced. Subsequently, Renshen (Ginseng Radix), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), and Tusizi (Cuscutae Semen) were added to enhance the effects of assisting Yang, benefiting Qi, invigorating blood, and nourishing blood. Persisting with this medication for half a year, the complexion gradually returned to normal, edema subsided, appetite increased significantly, limbs became warm, and mental state improved. By April 1972, the patient could get out of bed and take slow steps with the aid of a cane or someone supporting them; by July of the same year, they could walk without a cane.
Follow-up on November 23, 1979: The patient was 73 years old and excitedly introduced to visitors that since late 1972, they had continued taking some Yang-warming and Kidney-nourishing medicines during winter, and had not been bedridden for seven years. They have been able to manage household chores during these years.
[Commentary] The occurrence of stroke is generally due to disharmony of Yin and Yang and reversal of Qi and Blood. At the first visit, the patient already suffered from sequelae of stroke, with hemiplegia lasting for eight years. The condition was severe, and obviously, it could not be treated according to the routine methods for general stroke. Observing the various symptoms, it belonged to Shaoyin Cold Transformation Syndrome, where Yin Excess and Yang Deficiency had reached an extreme. Therefore, a large dose of Sini Tang (Frigid Extremities Decoction) was administered, modified according to symptoms, and always treated according to Shaoyin Cold Transformation Syndrome.
Shaoyin Syndrome: Qi Jue (Syncope due to Qi Reversal)
Huang XX, Female, 48 years old. Resident of Chengdu streets.
[Medical History] Frequent dizziness, cough with shortness of breath, palpitations, fatigue in limbs, edema of the face and legs below both knees, persisting for five years. In severe cases, a sensation of heart sinking, even brief coma. In March 1964, after overwork, palpitations suddenly worsened, followed immediately by coma and loss of consciousness. Neighbors wanted to send her to the hospital urgently; but family members feared that bumps during transport might cause death, so they invited the doctor to the home for emergency treatment.
[First Visit] Unconscious, limbs cold, pale complexion, weak breathing. Pulse deep and faint, tongue pale with black moist coating. This is Shaoyin Syndrome Qi Jue. Immediately administered five pills of self-made Kanli Dan, given with warm water, while simultaneously rapidly decocting a warming middle-jiao and supporting Yang agent for emergency rescue.
Prescription 1:
Chuan Fupian (Sichuan Prepared Aconite Lateralis Radix) 3.5 parts, Shang Rougui (Cinnamon Bark) 1 part, Zhen Hupo (True Amber) 2 parts, Baiziren (Biota Seed) 2 parts, Fei Zhusha (Prepared Cinnabar) 1 part, Shexiang (Musk) 0.5 part.
Grind into fine powder, make pills with water.
Prescription 2: Paojiang (Charred Ginger Rhizome) 15g, Zhigancao (Honey-fried Licorice Root) 10g. One dose, decocted and taken.
[Second Visit] About one hour after administering Kanli Dan, the patient slowly regained consciousness. Then, the decoction was administered urgently, once every two hours. The next day, she came to the clinic by car herself. Palpitations slightly decreased, limbs felt slightly stronger, and spirit improved. Black coating reduced, pulse deep and weak. The method should be warming spleen and tonifying kidney, using Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction) as the main formula.
Prescription: Ganjiang (Dried Ginger Rhizome) 60g, Zhi Fupian (Prepared Aconite Lateralis Radix) 60g (decocted for a long time).
Three doses.
[Third Visit] After taking three doses of the above prescription, although symptoms improved, the long-term illness caused great decline, Heart Qi consumption, and deficiency of Lung, Spleen, and Kidney. The treatment should focus on warming Yang, benefiting Qi, strengthening spleen, and tonifying middle jiao, starting from the spleen and stomach to nourish the source of Qi and Blood, using Lizhong Tang (Regulate the Middle Decoction) with modifications as the main formula.
Prescription:
Ludangshen (Codonopsis Radix) 12g, Ganjiang Pian (Sliced Dried Ginger) 15g, Chao Baizhu (Stir-fried Atractylodis Macrocephalae Rhizoma) 15g, Zhigancao (Honey-fried Licorice Root) 6g, Fuling (Poria) 25g, Fa Banxia (Processed Pinellia Tuber) 15g.
Continuously taken for more than ten doses, symptoms significantly improved, and household chores were managed normally. Follow-up in July 1979: The patient was over sixty years old, had only relapsed once in more than ten years, but the condition was mild, and after returning to normal, remained relatively stable.
[Differentiation] The patient's primordial Qi was originally deficient, and long-term illness further weakened them, triggered by overwork leading to severe condition. Weak respiration and deep/faint pulse indicate Heart Qi consumption; pale tongue with black coating, edema, and cold limbs belong to Yang Qi failing to rise and Kidney Water flooding upward; sudden coma is due to temporary reversal of Qi mechanism, sinking of Middle Qi, rising of Yin Qi, and failure of communication between Heart and Kidney. Fortunately, critical signs such as diarrhea, sweating, red face, cold extremities, and pulse nearly imperceptible were not yet present, so Sini Tang did not need to be administered immediately. Instead, agents warming Kidney, tonifying Heart, calming spirit, and opening orifices should be used to harmonize Kan and Li, followed by warming middle-jiao and supporting Yang agents to raise clear Yang and descend turbid Yin, making respiration smooth and consciousness clear. Then, continue with agents expelling Yin, assisting Yang, and warming/tonifying Spleen and Kidney to cultivate the root, finally treating with warming Yang, benefiting Qi, and nourishing Qi and Blood to gradually recover.
[Commentary] "Suwen: Fang Sheng Shuai Lun" states: "Therefore, syncope due to insufficient Qi causes forgetfulness and dreams, and its extreme leads to confusion." Regarding treatment, since deficiency of Qi in the five zang organs and insufficiency of Yang Qi can all cause disease, it is advocated to combine observations of the five zang manifestations, harmonize Yin and Yang Qi, and regulate based on the excess or deficiency of meridians. This patient belongs to the category of insufficient Qi involving the five zang organs, primarily Heart and Kidney Qi deficiency. Throughout, the method of warming and unblocking was used to support Heart and Kidney Yang, keeping in mind the warning against "abandoning Yin to attach to Yang without combining them." Grasping the key points allowed the chronic disease to reverse quickly and remain stable for over ten years.
Shaoyin Syndrome: Cold Jue (Cold Syncope)
Wang XX, Male, 28 years old. Worker at a factory in Chengdu.
[Medical History] The patient had a somewhat isolated personality, prone to sorrow and depression, which led to illness over time without treatment. In early 1947, a lump the size of a fist was found in the epigastrium; pressing it caused movement and sound, but no pain. Urgently sought TCM treatment elsewhere. The medicines taken were mostly blood-invigorating and stasis-resolving herbs like Taoren (Prunus Persica Seed), Honghua (Carthami Flos), Sanleng (Sparganii Rhizoma), and Ezhu (Curcumae Rhizoma). After about half a year of treatment, efficacy was poor, appetite decreased daily, physique wasted, and spirit declined. Even in the heat of July, wearing velvet clothes and covering with quilts at night, still felt cold. Later changed doctors locally, and by April of the following year, the condition worsened. One day, sudden syncope occurred; family mistook it for sudden death, placed him on a wooden board outside the house, preparing for burial. At this time, Master Fan happened to be treating patients in the neighborhood. Someone knocked urgently and said: "Knowing you are here, my neighbor is critically ill, seemingly dead, hoping you will come personally to see if there is any remedy?" So he went to examine.
[First Visit] Patient's complexion was pale, lips dark, extremities cold. Immediately tested nasal breath with a fine lamp wick, slight movement detected. Touched chest pit, slight warmth remained. Checked pulse, seemed present and absent. Said: There is still a trace of vitality; can try giving medicine to see if it can save him. Left him at home, personally guided medication use to observe efficacy.
Prescription 1: Zhigancao (Honey-fried Licorice Root) 30g, Paojiang (Charred Ginger Rhizome) 15g.
Prescription 2: Zhigancao (Honey-fried Licorice Root) 60g, Ganjiang (Dried Ginger Rhizome) 120g, Zhi Fupian (Prepared Aconite Lateralis Radix) 120g (decocted for a long time), Dangshen (Codonopsis Radix) 45g, Tongbian (Child's Urine) as guide.
Instructed family to decoct the above two prescriptions simultaneously in separate pots over high fire. First took half a cup of the decocted liquid from the first prescription, frequently administering it. About fifteen minutes after administration, the patient gradually emitted slight nasal breathing sounds, hands and feet twitched slightly. When the second prescription was ready, it was immediately administered. About two hours after medication, the patient slowly regained consciousness, mind gradually cleared, only then realizing he had been carried outside and family was preparing funeral affairs.
[Differentiation] At first visit, the patient was waiting for burial. Testing nasal breath, touching chest pit, checking pulse, observing color, asking medical history, this belongs to Shaoyin Disease with extreme Yang Decline and Yin Excess, retaining only a trace of faint Yang, with danger of instantaneous collapse. Emergency administration of Sini Tang (Frigid Extremities Decoction) to expel Yin and restore Yang is needed. But Aconite requires long decoction, fearing loss of the opportunity for rescue, so first administer Gancao Ganjiang Tang (Licorice and Ginger Decoction), combining pungent and sweet flavors to specifically restore Yang in the chest; Lung Qi warmed, respiration unobstructed, and dying Yang not instantly severed. Then, use a large dose of Sini Tang plus Ginseng to restore Yang, benefit Yin, save primordial Qi from the brink of death; add child's urine to guide Yang into Yin, making Yang prosperous and Yin harmonious to regain life.
[Second Visit] Voice low, breath discontinuous; although Yang has returned, Qi and Blood deficiency is severe. Again prescribe Lizhong Tang (Regulate the Middle Decoction) with modifications to tonify spleen and strengthen kidney; also, because there is still cold coagulation and accumulation in the epigastrium, add a small amount of cold-expelling and knot-resolving agents.
Prescription:
Dangshen (Codonopsis Radix) 18g, Ganjiang (Dried Ginger Rhizome) 120g, Zhigancao (Honey-fried Licorice Root) 120g, Baizhu (Atractylodis Macrocephalae Rhizoma) 18g, Zhi Fupian (Prepared Aconite Lateralis Radix) 250g (decocted for a long time), Fuling (Poria) 15g, Buguzhi (Psoraleae Fructus) 12g, Gouqi (Lycii Fructus) 60g, Wuzhuyu (Evodiae Fructus) 10g, Shanzhuyu (Corni Fructus) 30g, Baihujiao (White Pepper Fruit) 10g.
After taking one dose of the above prescription, slight hunger and desire to eat appeared, able to take a little liquid food. Continue original prescription for four more doses, condition greatly improved, able to eat a small bowl of thin porridge per meal.
[Third Visit] Complexion slightly lustrous, spirit better, but sallow yellow remains, poor appetite. Still use Lizhong Tang (Regulate the Middle Decoction) with modifications, so Earth Qi prospers to assist vital energy.
Prescription 1:
Dangshen (Codonopsis Radix) 15g, Chao Baizhu (Stir-fried Atractylodis Macrocephalae Rhizoma) 30g, Zhigancao (Honey-fried Licorice Root) 60g, Ganjiang (Dried Ginger Rhizome) 120g, Zhi Fupian (Prepared Aconite Lateralis Radix) 250g (decocted for a long time), Shang Rougui (Cinnamon Bark) 20g (dissolved in the decoction), Gouqi (Lycii Fructus) 30g, Guizhi (Cinnamomi Ramulus) 15g, Fuling (Poria) 25g.
Prescription 2: Sharen (Amomi Fructus Rotundus) 30g, Baiko (Cardamomi Fructus) 30g. Grind into fine powder, take a little dissolved in water after meals.
Based on condition, the above prescription modified was taken for over two months, all symptoms eliminated, body restored. Follow-up in 1979: Patient was 59 years old, for over thirty years, able to work night shifts regularly, body generally good.
[Commentary] The pathology of "Jue" syndrome is the lack of connection between Yin and Yang Qi. Mild cases involve cold extremities and sudden fainting; severe cases result in death as Jue does not reverse. Thus, "Neijing" discusses Jue Ni extensively, and "Shanghan Lun" contains many methods for rescuing emergencies. However, regarding the nature of Jue, it is either cold or hot. Thus, "Suwen: Jue Lun" states: "If Yang Qi declines below, it becomes Cold Jue; if Yin Qi declines below, it becomes Hot Jue." In clinical emergency rescue, careful differentiation is essential.
For this case of Cold Jue, examining internal and external factors and differentiating to find the cause, it is known that the cold does not come from outside but from within. The method should be regulating Yin and Yang, treating the disease of the primary meridian. This is a case of Shaoyin Disease with extreme Yang Decline and Yin Excess, urgently requiring pungent-sweet agents to restore Yang and rescue from emergency, allowing Yin and Yang Qi to connect smoothly. Thus, the patient waiting for burial instantly revived.
Shaoyin Syndrome: True Cold False Heat
(High Fever)
Che XX, Male, 74 years old. Resident of Chengdu.
[Medical History] In early April 1975, contracted wind-cold, feeling generally unwell. Believing himself elderly and frail, with insecure Ying and Wei defenses, plus economic difficulties and knowing some formulas, he self-prescribed a warming and tonifying decoction. After delaying for more than ten days, the illness did not improve. Reluctantly went out for a walk, caught wind, and condition worsened. Dizziness, body pain, red face, high fever, confused mental state. Neighbors sent him to XX Hospital urgently. Temperature checked at 39°C, diagnosed as cold with high fever, injected Gentamicin, and took Western medicine, but high fever persisted, condition critical, invited Master Fan for home emergency treatment.
[First Visit] Patient intermittently unconscious, pulse faint and nearly imperceptible. High fever for three days, although body extremely hot, still feels cold inside despite heavy blankets. No food intake, urination and defecation blocked. Malar flush, tongue pale and slippery, thick greasy black coating. Patient over seventy, Yin Cold excessive, fearing imminent death. Although accompanied by Taiyang exterior syndrome, should first rescue the interior, urgently administer Tongmai Sini Tang (Pulse-Returning Sini Decoction) for rescue.
Prescription:
Sheng Gancao (Raw Licorice Root) 30g, Ganjiang (Dried Ginger Rhizome) 60g, Zhi Fupian (Prepared Aconite Lateralis Radix) 60g (decocted for a long time), Congbai (Scallion White) 60g.
[Differentiation] Patient has high fever, coma, red face, black coating, blocked urination and defecation, resembling Yang Heat signs. Although high fever, desires heavy blankets; body hot and face red, but extremities cold. Blocked urination and defecation, yet abdomen suffers no discomfort. Thick greasy black coating, but tongue moist with fluid. High fever and coma, no delirium or mania, but pulse deep and faint. Considering age over seventy, weak constitution and declining Qi, this is actually a presentation of Shaoyin solitary Yang flying away, vital Qi about to depart, death imminent. Therefore, urgently administer Tongmai Sini Tang plus Scallion to directly pursue the scattered and nearly extinct Yang.
[Second Visit] After taking two doses of the above prescription, fever subsided, black coating significantly reduced. Yang returned, initial dissipation of Yin turbidity, image of Yin-Yang rejection resolved. But headache and body pain, exterior syndrome remains; Kidney Yang deficiency fails to transform Qi, thus urination and defecation still difficult. Use Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction) to drive out cold and secure Yang, add Scallion to generate Shaoyang generating Qi.
Prescription:
Mahuang (Ephedrae Herba) 10g, Zhi Fupian (Prepared Aconite Lateralis Radix) 60g (decocted for a long time),
Sheng Gancao (Raw Licorice Root) 20g, Congbai (Scallion White) 120g. Four doses.
[Third Visit] After taking four doses of the above prescription, head no longer dizzy, urination and defecation unobstructed, black coating completely faded. Only body pain remains. Although Yang returned and exterior resolved, tongue still pale, limbs cold, Yin Cold internally excessive, presenting as Yang deficiency body pain. Should warm and ascend Yuan Yang to dispel cold pathogens, using Sini Tang plus Liaoxixin (Asari Radix et Rhizoma) as the main formula.
Prescription:
Zhigancao (Honey-fried Licorice Root) 20g, Ganjiang (Dried Ginger Rhizome) 30g, Zhi Fupian (Prepared Aconite Lateralis Radix) 60g (decocted for a long time), Liaoxixin (Asari Radix et Rhizoma) 6g. Two doses.
[Fourth Visit] After taking two doses, remaining symptoms eliminated. After recovery from major illness, true Yang deficiency, regulate with Lizhong Tang (Regulate the Middle Decoction) with modifications.
Prescription:
Ludangshen (Codonopsis Radix) 15g, Chao Baizhu (Stir-fried Atractylodis Macrocephalae Rhizoma) 10g, Zhigancao (Honey-fried Licorice Root) 10g, Ganjiang Pian (Sliced Dried Ginger) 15g, Zhi Fupian (Prepared Aconite Lateralis Radix) 30g, Fuling (Poria) 12g.
Follow-up on July 18, 1979: Patient was 79 years old, since recovery, body has been generally good for several years.
[Commentary] Differentiating cold and heat in clinical practice is not too difficult. But things turn into their opposites when extreme, "Extreme cold generates heat, extreme heat generates cold." Differentiating true and false cold and heat, if mistaken once, the danger is unpredictable. Predecessors have elaborated much on this.
This case resembles Yang Heat, but pulse is faint and nearly imperceptible, pulse and symptoms do not match. When Master Fan encountered this difficulty in distinguishing true and false cold and heat, he comprehensively assessed, highlighting tongue diagnosis: tongue body pale indicates Yin Cold excess; coating black, slippery, and moist indicates Kidney Water flooding upward. Absolutely cannot mistake it for Yang Heat; it is actually extreme Yin Cold internally, a false appearance of deficiency cold exposed externally. Therefore, encountering such critical conditions, following Master Zhongjing's methods, daring to break through, often achieves significant effects.
Shaoyin Syndrome: Diarrhea with Void Collapse
(Proper Typhoid)
Huang XX, Male, 11 years old. Former student from Chengdu, Sichuan.
[Medical History] In autumn 1948, initially felt generally unwell, condition gradually worsened, coma, high fever above 40°C, diarrhea. At that time, it was the epidemic season for intestinal typhoid, confirmed by Sichuan Provincial Hospital as "Proper Typhoid". Some experts believed the disease had developed to the peak stage, systemic toxicity too severe, considered incurable. Later consulted by TCM, rescued with large amounts of Xijiao (Rhinocerotis Cornu), Lingyangjiao (Capricornis Cornu), and Zixue Dan (Purple Snow Pill). Although high fever subsided and diarrhea stopped, condition became heavier, limbs ice cold, pulse nearly absent, ultimately critical. Finally came for consultation, treated according to Shaoyin Syndrome Diarrhea with Void Collapse, initial visit showed turning point, cured after several visits.
[First Visit] Child comatose and curled up for days, gray-white-dark complexion, emaciated. Pulse hidden, faint, thin, nearly absent, only testing both nostrils with fine lamp grass revealed slight breath. Limbs cold reversal, hands cold past elbows, feet cold past knees, even entire body skin cold. This is pathogen moving from Yang to Yin, developing into Shaoyin extreme Yin Cold, Yang Qi about to collapse in an instant, a dangerous stage. Urgently use method of expelling Yin, restoring Yang, harmonizing middle, securing collapse, administer one dose of large-dose Tongmai Sini Tang (Pulse-Returning Sini Decoction) for emergency rescue.
Prescription:
Chuan Fupian (Sichuan Prepared Aconite Lateralis Radix) 120g (decocted for a long time), Ganjiang (Dried Ginger Rhizome) 120g, Zhigancao (Honey-fried Licorice Root) 60g.
[Second Visit] Above prescription, frequently administered overnight, until early morning next day, child's parents rushed in saying repeatedly: "Bad, bad, nose bleeding after taking medicine!" Master Fan immediately replied: "Good, good, child is saved!" Then examined again. Child's appearance and symptoms similar to yesterday, but breathing slightly connected and regular, showing initial signs of revival. Should continue original method, administer Tongmai Sini Tang with doubled dosage again.
Prescription:
Chuan Fupian (Sichuan Prepared Aconite Lateralis Radix) 500g, Ganjiang (Dried Ginger Rhizome) 500g, Zhigancao (Honey-fried Licorice Root) 250g.
First decoct one fat hen in soup, separately decoct Fupian in chicken soup for one and a half hours, then add Jiang and Cao. About two hours after taking medicine, child suddenly expelled two purple-black clots of blood from nose, about three inches long, and vomited some blood clots from mouth. At this time, slowly opened eyes, mind began to clear, and spoke: "I want to eat white cake!" Family instantly turned tears to laughter, very happy. Then followed original prescription, took four more doses.
[Third Visit] Child's mind completely clear, language fluent, able to take small amounts of liquid food like chicken soup daily. Complexion blue-dark. Tongue body pale white, dark, no coating. Upper limbs movable, started holding bowl to eat, lower limbs stiff, unable to bend and stretch, limbs still cold. Condition beginning to improve, Yang Qi gradually recovering; but Yin Cold coagulation deep, especially in lower limbs. Original prescription slightly increased Qujiu (Qu Distilled Liquor) as guide, take again.
After taking one more dose of the above prescription, next day lower limbs could slowly bend and stretch. Took two more doses, able to get out of bed and walk slowly. Took thirteen doses, gradually recovered.
Patient wrote letter on December 26, 1978: "Thirty years ago, after Master Fan cured my illness, I joined the army in 1953, received two third-class merits in the military, now working as a fitter at a mechanical parts factory, body has always been good."
[Commentary] This case, due to missed treatment, pathogen moved from Yang to Yin, Yang Qi declined, Yin Cold stagnated, meaning Yin-Yang Qi and Blood could no longer fill the limbs and skin, hence gray-white-dark complexion, hidden/faint/nearly absent pulse, entire body cold reversal, even coma and unconsciousness. Obviously, condition developed to the critical stage of Shaoyin Cold Transformation, belonging to typical Sini Syndrome. At this moment of pure Yin and faint Yang, critical juncture, everything depends on the survival of Yang Qi. If Yang survives, life continues; if Yang perishes, death follows instantly. Non-emergency administration of large-dose Tongmai Sini Tang to restore Yang and rescue from emergency is impossible.