[初诊]闭经半年，白带多。全身轻度浮肿，下肢较重。周身疼痛，畏寒，多梦，纳差，血压有时偏高。小便不利，大便先结后溏。舌质淡，体胖嫩，边有齿痕，苔白滑，中间厚腻，脉沉。此为邪入少阴，火衰水旺，肾阳虚衰，经水不调之不孕证。首以真武汤加减，温阳化气行水为治。
处方：
制附片120克(久煎) 茯苓30克生姜30克桂枝15克炮姜30克炙甘草15克四剂
[二诊]服上方，全身浮肿显著消退， 食欲增加。原方再服四剂。
[三诊]神疲、恶寒等证虽有好转，但仍血枯经闭。原方并当归补血汤加减主之。
处方：
制附片60克(久煎) 茯苓20克 白术15克生姜30克桂枝10克 黄芪30克当归10克炙甘草10克炮姜30克[四诊]上方服至八剂时，月经来潮。色淡量少，有淤块。小腹发凉隐痛。仍有宫寒凝滞之象，以温经汤加减主之。
处方：
吴茱萸6克 当归10克川芎6克白芍10克血余炭20克炮姜20克炙甘草10克二剂
[五诊]小腹冷痛消失，淤血显著减少，诸证明显好转。嘱其忌生冷，戒房事半年。并书一方，回家缓服调养。
处方：
制附片60克(久煎) 上肉桂10克(冲服)
炮姜30克血余炭20克菟丝子20克肉苁蓉10克黄芪30克当归10克泡参15克炙甘草15克枸杞20克巴戟12克1979年7月26日追访：患者说，前后共服药百余剂，并遵范老所嘱调养，1967年怀孕，现已有两个孩子。
[按语]《素问·上古天真论篇》曰：“女子……任脉通，太冲脉盛，月事以时下，故有子。”本例月事不调，时行时止，显系冲任二脉损伤， 焉能妊娠?
导致阴脉血海之损害，原因很多。本例病根，在于少阴真火虚衰，肾阳不振，又累及于脾。故现龙飞水泛，后天生化乏源，日益气虚血枯，寒凝胞宫，经脉受阻，月事不下。故首投温阳化气行水之剂，重用姜附，镇纳群阴。再以补血益气，温经散寒为治。脾湿除，气血调，任脉通，血海盛，经期正，连生二子。
少阴证胎黄
吴××．男，新生儿，55天。成都某厂职工之子。
[诊治]1957年7月来诊。患儿足月顺产，初生即周身发黄。现已55天，体重1．5公斤，身长30多公分。身面长满黄色细绒毛，长约l公分，皮肤晦黄不退。精神萎靡，四肢不温，皮肤干涩，头发稀疏、黄糙，生殖器肿大。虽值炎暑，还须棉花厚裹。稍受微风或惊动，皆易引起呕吐。××医院诊为： “先天不足”，未予治疗。范老认为临床罕见，殊难入手。其母再三恳求，方同意试治。询其妊娠期间身体状况，得知怀孕后，嗜饮大量浓茶，每日约5至6磅，连茶叶均嚼食之。故脾阳受伤，湿从内生，湿邪久羁，遗于胞胎。致新生儿先天亏损，脾肾阳气衰微，气亏血败，经隧受阻，胆液浸淫，溢于全身肌肤，故发为胎黄，日久不退。精神萎靡，四肢不温，头发稀疏而黄糙，亦显为少阴阴盛阳微之征。法宜破阴回阳，以通脉四逆汤加味主之，配以针砂散，祛脾胃之湿浊。
处方一：
制附片15克(久煎) 干姜15克甘草10克辽细辛1克葱白30克处方二：
针砂散。
每日晨用米汤灌服O．6克，连服20日。
月余后，患儿身黄退，体重略增，逗之能笑。遂停药，嘱其细心调养，此后逐渐健康成长。
1978年12月18日追访：患儿已长成人，参加工作。体重110斤，身高1．64米。喜爱体育运动，在中学时为业余足球运动员。
[按语]此例虽属罕见，但按六经辨证，其主证既属少阴，并兼太阴寒湿；因此，病在何经，即可用其法其方施治。本案之获效，初看之，似某方某药之功，实则六经辨证生命力之所在。进而剖析，婴儿脾肾阳气不振，寒湿郁滞运化失常，胆汁被阻溢于肌肤；参之肢体不温，发育不良等，应属少阴阴黄。故投以通脉四逆，以助先天之元阳，配以针砂散除脾胃之湿浊。阳旺湿消，气机通畅，则邪去自安。
厥阴证头痛眩晕
(美尼尔氏综合症)
黄××，女，34岁。成都市某商店职工。
[病史]1970年以来，经常患头痛、眩晕、干呕，甚则晕倒，经数家医院皆诊断为“美尼尔氏综合症”。
[初诊]1972年1月来诊。头顶痛甚，干呕，吐涎沫；眩晕时，天旋地转，如坐舟中；四肢无力，手足清凉。面色萎白无华，舌淡润少苔，脉微细。此为肝胃虚寒，浊阴上逆，病属厥阴寒逆头痛眩晕。法宜暖肝温胃，通阳降浊，以吴茱萸汤主之。
处方：
吴茱萸10克潞党参20克生姜30克红枣30克四剂
[辨证]在《伤寒论》中，吴茱萸汤主治病证有三条：一属阳明之胃家虚寒；二属少阴吐利；三属厥阴寒证。其共同之点，皆有呕吐这一主证。阳明虚寒食谷欲呕；少阴吐利；厥阴干呕吐涎沫，其病机之共性，皆为中虚气逆，浊阴上犯。
但本例厥阴干呕吐涎沫，还有头痛一证，此乃病属厥阴经之显著特征。其所以成为特征，一是因为厥阴受邪，循经气而上逆巅顶，故头痛，且其部位常在头顶。二是厥阴受寒，肝木横逆，寒邪挟浊阴之气上逆而犯胃土，以致中气虚弱，脾气不升，胃气不降。清阳不足，干呕气逆上冲则头痛；其眩晕，正如《素问·至真要大论篇》所云： “诸风掉眩，皆属于肝。”总其要，厥阴肝寒为本，阳明胃寒为标，病属厥阴寒证。
[二诊]上方服四剂，呕吐止。头痛，眩晕，明显减轻。但仍眩晕，其所以眩晕者，因其病在肝，而其根在肾。宜继进温补脾肾之剂，以理中汤加味缓缓服之。
处方：
潞党参20克炒白术18克 炙甘草15克干姜30克制附片30克(久煎) 茯苓15克上肉桂10克(研末冲服)
服二十余剂，诸恙悉安。1979年7月追访， 自从痊愈以来，再未重犯，始终坚持全勤。
(按语]本例厥阴头痛眩晕之证，与美尼尔氏综合症相似。其病因现代医学至今尚未完全清楚。中医虽无此病名，但根据辨证，多属肝肾。 《灵枢·海论篇》云： “髓海不足，则脑转耳鸣，胫酸眩冒，目无所见”，亦即此理。邪入厥阴，从阴化者居多，常见干呕，吐涎。其标在胃寒，其病在肝寒，其根在肾寒，故先后投以燠土、暖肝、温肾之剂，病祛根除而晕痛皆止。
厥阴证肠游
(急性痢疾)
江××，男，39岁。成都市金牛区营门口乡，农民。
[病史]1977年8月下旬，在田间劳动忽感全身难受，四肢发凉，头冒冷汗，腹痛肠鸣。旋即昼夜腹泻，下利频繁，夹脓带血。9月2日急来求诊。按厥阴证肠澼论治，服药两剂痊愈。
[诊治]每日下利十余次，便稀带粘冻状，色黄赤，伴有腹痛，里急后重。兼见干呕、心烦、口渴、肢冷。舌质暗淡，尖部稍红，苔黄腻而厚。此为寒热错杂证肠澼，病在厥阴。法宜驱邪扶正，寒热并用，以乌梅丸主之。
处方：
乌梅30克辽细辛6克干姜30克黄连12克 当归10克制附片60克(久煎)
蜀椒6克 桂枝lO克党参12克
黄柏10克 二剂 忌食油荤、生冷。
上方连进两剂，肠游痊愈。1979年6月随访，患者说：一年前病愈后，至今未再复发。
[辨证]《素问·太阴阳明论篇》云： “贼风虚邪者，阳受之；食饮不节，起居不时者，阴受之。阳受之，则入六腑；阴受之，则入五脏……入五脏则膜满闭塞，下为飧泄，久为肠游。”可见肠游往往与阴阳乖和有关，并现寒热混淆诸证。
本例上热下寒之证十分明显。厥阴为风木之气，偏盛则风邪上窜。今患者干呕、心烦、恶心，舌尖较红，皆为上热。肢体厥冷，小腹冷痛，下利清稀，间夹乌白冷冻，其下寒诸证尤为明显。归根到底，其病机在于阴阳之气不能相互贯通。是以上为阳，阳自阳而为热；下属阴，阴自阴而为寒。亦即“厥阴之胜”所致之肠澼，故以乌梅丸移治之。
[按语]乌梅丸“又主久利”，本例并非久利，为何投此方?
一般而论，厥阴之证，非厥即利。久利多属寒热错杂之病，则宜寒温并用之法，力求寒热夹杂之方。本例虽非久利，因证属厥阴，寒热互见，乌梅丸恰为寒热温补并用，辛酸甘苦兼备之方，正与本例对证，故移用原方而获效。
实际上，古今医家曾将乌梅丸移治多种杂证，尤其对下利之治疗，更有不断扩展。以《千金方》为例，仿仲景“又主久利”之意，用乌梅、黄连治热利；配附子、干姜等治虚寒性久利。 《圣济总录》以乌梅丸治产后冷热利久不止。《证治准绳》用本方治胃腑发咳，呕出长虫。日人雉间焕说：反胃之证，世医难其治，此方速治之，实奇剂也(转引自《论伤寒论初稿》)。任应秋认为：乌梅丸有强壮胃肠机能和消炎杀虫作用，所以对慢性腹泻病亦有效(《伤寒论语译》)。不久前，曾有用本方治愈迁延十五年结肠炎之报道。可见乌梅丸之应用范围，并不局限于蛔厥与久利，在实践中已有不断发展。
厥阴证骨痹
刘××，男，60岁。成都某机关干部。
(病史]患腰腿关节疼痛已十余年，痛有定处，遇寒痛增。开始右膝关节较重，左腿及腰痛稍轻；1956年以后，更加冷痛沉重，下肢伸屈不利，以至不能下地活动。当地医院诊断为风湿性关节炎。1960年6月来诊，按厥阴寒证骨痹而获效。
(初诊]下肢冷、骨痛、麻木、拘挛、沉重，右腿尤甚。伸屈行动困难，须靠拐杖或搀扶方能移步。面黄晦黑，舌质微乌，苔薄灰白，脉沉细。此为气血皆虚，寒湿内搏于骨节所致。法宜养血通络，温经散寒。以当归四逆汤加味主之。
处方：
当归10克桂枝10克白芍10克辽细辛3克木通lO克红枣30克生姜10克苏叶10克甘草6克防风10克牛膝10克木瓜10克六剂
[二诊]上方连服六剂，右腿已能屈伸，开始着力缓缓而行；骨节冷痛、拘挛亦减。厥阴伤寒之外证初解，多年痼疾松动；但患者年已花甲，六脉沉细无力，舌质仍暗淡无华，久病衰弱之象益显。法宜驱阴护阳，温补脾肾，以理中汤加味主之。
处方：
党参15克 白术12克炙甘草15克干姜12克 肉桂3克制附片30克(久煎)
上方服二十余剂，从此行动自如，恢复正常工作。1979年8月6日追访：患者系红军干部，现已79岁。经范老于1960年治愈后，虽在1963年曾患肿病，有所反复；但当时腿仍能屈伸，关节疼痛不甚，尚可自由行动。至今能在室内外散步。
[辨证]此例明显之主证，为下肢关节拘挛冷痛，右腿屈伸履步尤艰。参之脉证，诊为痹证似无疑义。但为什么缠绵多年，几成废足?其病因、病位、病机之理何在?究属何经之病?必须详加辨证。
《素问·痹论篇》云： “风寒湿三气杂至，合而为痹也。其风气胜者为行痹；寒气胜者为痛痹；湿气胜者为著痹也。”这里既概括了引起痹证的三种外邪，又表明三痹不同的主证。不仅如此，根据风寒湿邪侵入之部位，进而分为骨、筋、脉、肌、皮五痹。又云： “痹在于骨则重；在于脉则血凝而不流；在于筋则屈不伸；在于肉则不仁；在于皮则寒。”可见三痹指病因，五痹言病位，并包括症状在内，互相联系而不可分割。
以本例患者而言，临床表现下肢疼痛较剧，且关节重着，固定不移。寒为阴邪，侵入人体， 阴经受之；客于筋骨肌肉之间，故迫使气血凝滞，遇冷则痛更增。参之面色青黄，舌质乌暗，苔现灰白，皆属寒主痛，可知寒凝痛痹，乃其主证。
患者自觉右腿发凉，骨重难举。可见寒湿阴邪，已深侵入骨。正如《素问·长刺节论篇》所说： “病在骨，骨重不可举，骨髓酸痛，寒气至，名日骨痹”。
《伤寒论》云： “手足厥寒，脉细欲绝者，当归四逆汤主之”。本例下肢冷痛，骨重难举， 麻木拘挛，参之舌质暗淡，脉象沉细，实为风寒中于血脉，血为邪伤，则营气阻滞，故病属厥阴寒证。郑重光曾指出； “手足厥寒，脉细欲绝，是厥阴伤寒之外证；当归四逆，是厥阴伤寒之表药也” (《中国医药汇海 ·伤寒论卷十六》)。这里不仅说明厥阴风寒中血脉而逆与四逆证不同，而且点出为何用当归四逆之理。今验之临床，初诊服药六剂，厥阴伤寒之外证遂除，血分之邪被逐，营气之阻滞即通，故下肢骨节冷痛掏挛诸证，迎刃而解。再进理中汤加味，培补先后二天，阴消阳长，从阴出阳，囚势利导而病获愈。
(按语]临床常见之风、寒、湿、热诸痹， 《内经》等古籍，按其病变部位分为骨、筋、脉、肌、皮五痹；若进而发展至脏腑机能障碍，则更为严重。范老认为：纵有千变万化，究其病因，不外风寒湿热诸邪闭阻之部位不同。总其要，皆不离六经之传变规律。这正是辨认此类不同病变与循经用药之关键所在。
[初诊]闭经半年，白带增多。全身轻度浮肿，下肢更为严重。周身疼痛，怕冷，多梦，食欲不佳，血压有时偏高。小便不畅，大便先干后稀。舌质淡，舌体胖嫩，边缘有齿痕，苔白滑，中间厚腻，脉沉。这是邪气侵入少阴，命门火衰水湿泛滥，肾阳虚衰，导致月经失调的不孕证。首先使用真武汤加减，以温补阳气、化气行水为治疗原则。
处方：
制附片120克（久煎） 茯苓30克 生姜30克 桂枝15克 炮姜30克 炙甘草15克 四剂
[二诊]服用上方后，全身浮肿显著消退，食欲增加。原方再服四剂。
[三诊]神疲乏力、恶寒等症状虽有改善，但血枯经闭仍未解决。在原方基础上合用当归补血汤加减主治。
处方：
制附片60克（久煎） 茯苓20克 白术15克 生姜30克 桂枝10克 黄芪30克 当归10克 炙甘草10克 炮姜30克
[四诊]上方服用至八剂时，月经来潮。经色淡、量少，有瘀块。小腹发凉隐痛。仍有宫寒凝滞之象，以温经汤加减主治。
处方：
吴茱萸6克 当归10克 川芎6克 白芍10克 血余炭20克 炮姜20克 炙甘草10克 二剂
[五诊]小腹冷痛消失，瘀血显著减少，诸症明显好转。嘱咐其忌食生冷，戒除房事半年。并开具一方，回家缓服调养。
处方：
制附片60克（久煎） 上肉桂10克（冲服）
炮姜30克 血余炭20克 菟丝子20克 肉苁蓉10克 黄芪30克 当归10克 泡参15克 炙甘草15克 枸杞20克 巴戟天12克
1979年7月26日追访：患者说，前后共服药百余剂，并遵照范老嘱咐进行调养，1967年怀孕，现已有两个孩子。
[按语]《素问·上古天真论篇》说：“女子……任脉通，太冲脉盛，月事以时下，故有子。”本例月经不调，时有时无，显然是冲任二脉受损，怎能妊娠？
导致阴脉血海损害的，原因很多。本例病根在于少阴真火虚衰，肾阳不振，又累及于脾。因此出现龙飞水泛（比喻阳气不能制约阴液，如水泛滥），后天脾胃生化之源匮乏，日益气虚血枯，寒凝胞宫，经脉受阻，月经不来。所以首先投用温阳化气行水的药剂，重用姜、附，镇纳群阴。再以补血益气、温经散寒为治。脾湿去除，气血调和，任脉通畅，血海充盈，经期正常，连生二子。
[诊治]1957年7月来诊。患儿足月顺产，出生即周身发黄。现已55天，体重1.5公斤，身长30多公分。身面长满黄色细绒毛，长约1公分，皮肤晦黄不退。精神萎靡，四肢不温，皮肤干涩，头发稀疏、黄糙，生殖器肿大。虽值炎暑，还须棉花厚裹。稍受微风或惊动，皆易引起呕吐。××医院诊断为：“先天不足”，未予治疗。范老认为临床罕见，殊难入手。其母再三恳求，方同意试治。询其妊娠期间身体状况，得知怀孕后，嗜饮大量浓茶，每日约5至6磅，连茶叶均嚼食之。故脾阳受伤，湿从内生，湿邪久羁，遗于胞胎。致新生儿先天亏损，脾肾阳气衰微，气亏血败，经隧受阻，胆液浸淫，溢于全身肌肤，故发为胎黄，日久不退。精神萎靡，四肢不温，头发稀疏而黄糙，亦显为少阴阴盛阳微之征。法宜破阴回阳，以通脉四逆汤加味主治，配以针砂散，祛脾胃之湿浊。
处方一：
制附片15克（久煎） 干姜15克 甘草10克 辽细辛1克 葱白30克
处方二：
针砂散。
每日晨用米汤灌服0.6克，连服20日。
月余后，患儿身黄退，体重略增，逗之能笑。遂停药，嘱其细心调养，此后逐渐健康成长。
1978年12月18日追访：患儿已长成人，参加工作。体重110斤，身高1.64米。喜爱体育运动，在中学时为业余足球运动员。
[按语]此例虽属罕见，但按六经辨证，其主证既属少阴，并兼太阴寒湿；因此，病在何经，即可用其法其方施治。本案之获效，初看之，似某方某药之功，实则六经辨证生命力之所在。进而剖析，婴儿脾肾阳气不振，寒湿郁滞运化失常，胆汁被阻溢于肌肤；参之肢体不温，发育不良等，应属少阴阴黄。故投以通脉四逆汤，以助先天之元阳，配以针砂散除脾胃之湿浊。阳旺湿消，气机通畅，则邪去自安。
厥阴证头痛眩晕
(美尼尔氏综合症)
黄××，女，34岁。成都市某商店职工。
[病史]1970年以来，经常患头痛、眩晕、干呕，甚则晕倒，经数家医院皆诊断为“美尼尔氏综合症”。
[初诊]1972年1月来诊。头顶痛甚，干呕，吐涎沫；眩晕时，天旋地转，如坐舟中；四肢无力，手足清凉。面色萎白无华，舌淡润少苔，脉微细。此为肝胃虚寒，浊阴上逆，病属厥阴寒逆头痛眩晕。法宜暖肝温胃，通阳降浊，以吴茱萸汤主治。
处方：
吴茱萸10克 潞党参20克 生姜30克 红枣30克 四剂
[辨证]在《伤寒论》中，吴茱萸汤主治病证有三条：一属阳明之胃家虚寒；二属少阴吐利；三属厥阴寒证。其共同之点，皆有呕吐这一主证。阳明虚寒食谷欲呕；少阴吐利；厥阴干呕吐涎沫，其病机之共性，皆为中虚气逆，浊阴上犯。
但本例厥阴干呕吐涎沫，还有头痛一证，此乃病属厥阴经之显著特征。其所以成为特征，一是因为厥阴受邪，循经气而上逆巅顶，故头痛，且其部位常在头顶。二是厥阴受寒，肝木横逆，寒邪挟浊阴之气上逆而犯胃土，以致中气虚弱，脾气不升，胃气不降。清阳不足，干呕气逆上冲则头痛；其眩晕，正如《素问·至真要大论篇》所云：“诸风掉眩，皆属于肝。”总其要，厥阴肝寒为本，阳明胃寒为标，病属厥阴寒证。
[二诊]上方服四剂，呕吐止。头痛，眩晕，明显减轻。但仍眩晕，其所以眩晕者，因其病在肝，而其根在肾。宜继进温补脾肾之剂，以理中汤加味缓缓服之。
处方：
潞党参20克 炒白术18克 炙甘草15克 干姜30克 制附片30克（久煎） 茯苓15克 上肉桂10克（研末冲服）
服二十余剂，诸恙悉安。1979年7月追访，自从痊愈以来，再未重犯，始终坚持全勤。
[按语]本例厥阴头痛眩晕之证，与美尼尔氏综合症相似。其病因现代医学至今尚未完全清楚。中医虽无此病名，但根据辨证，多属肝肾。《灵枢·海论篇》云：“髓海不足，则脑转耳鸣，胫酸眩冒，目无所见”，亦即此理。邪入厥阴，从阴化者居多，常见干呕，吐涎。其标在胃寒，其病在肝寒，其根在肾寒，故先后投以燠土、暖肝、温肾之剂，病祛根除而晕痛皆止。
厥阴证肠澼
(急性痢疾)
江××，男，39岁。成都市金牛区营门口乡，农民。
[病史]1977年8月下旬，在田间劳动忽感全身难受，四肢发凉，头冒冷汗，腹痛肠鸣。旋即昼夜腹泻，下利频繁，夹脓带血。9月2日急来求诊。按厥阴证肠澼论治，服药两剂痊愈。
[诊治]每日下利十余次，便稀带粘冻状，色黄赤，伴有腹痛，里急后重。兼见干呕、心烦、口渴、肢冷。舌质暗淡，尖部稍红，苔黄腻而厚。此为寒热错杂证肠澼，病在厥阴。法宜驱邪扶正，寒热并用，以乌梅丸主治。
处方：
乌梅30克 辽细辛6克 干姜30克 黄连12克 当归10克制附片60克（久煎）
蜀椒6克 桂枝10克 党参12克
黄柏10克 二剂 忌食油荤、生冷。
上方连进两剂，肠澼痊愈。1979年6月随访，患者说：一年前病愈后，至今未再复发。
[辨证]《素问·太阴阳明论篇》云：“贼风虚邪者，阳受之；食饮不节，起居不时者，阴受之。阳受之，则入六腑；阴受之，则入五脏……入五脏则膜满闭塞，下为飧泄，久为肠澼。”可见肠澼往往与阴阳乖和有关，并现寒热混淆诸证。
本例上热下寒之证十分明显。厥阴为风木之气，偏盛则风邪上窜。今患者干呕、心烦、恶心，舌尖较红，皆为上热。肢体厥冷，小腹冷痛，下利清稀，间夹乌白冷冻，其下寒诸证尤为明显。归根到底，其病机在于阴阳之气不能相互贯通。是以上为阳，阳自阳而为热；下属阴，阴自阴而为寒。亦即“厥阴之胜”所致之肠澼，故以乌梅丸移治之。
[按语]乌梅丸“又主久利”，本例并非久利，为何投此方？
一般而论，厥阴之证，非厥即利。久利多属寒热错杂之病，则宜寒温并用之法，力求寒热夹杂之方。本例虽非久利，因证属厥阴，寒热互见，乌梅丸恰为寒热温补并用，辛酸甘苦兼备之方，正与本例对证，故移用原方而获效。
实际上，古今医家曾将乌梅丸移治多种杂证，尤其对下利之治疗，更有不断扩展。以《千金方》为例，仿仲景“又主久利”之意，用乌梅、黄连治热利；配附子、干姜等治虚寒性久利。《圣济总录》以乌梅丸治产后冷热利久不止。《证治准绳》用本方治胃腑发咳，呕出长虫。日人雉间焕说：反胃之证，世医难其治，此方速治之，实奇剂也（转引自《论伤寒论初稿》）。任应秋认为：乌梅丸有强壮胃肠机能和消炎杀虫作用，所以对慢性腹泻病亦有效（《伤寒论语译》）。不久前，曾有用本方治愈迁延十五年结肠炎之报道。可见乌梅丸之应用范围，并不局限于蛔厥与久利，在实践中已有不断发展。
厥阴证骨痹
刘××，男，60岁。成都某机关干部。
[病史]患腰腿关节疼痛已十余年，痛有定处，遇寒痛增。开始右膝关节较重，左腿及腰痛稍轻；1956年以后，更加冷痛沉重，下肢伸屈不利，以至不能下地活动。当地医院诊断为风湿性关节炎。1960年6月来诊，按厥阴寒证骨痹而获效。
[初诊]下肢冷、骨痛、麻木、拘挛、沉重，右腿尤甚。伸屈行动困难，须靠拐杖或搀扶方能移步。面黄晦黑，舌质微乌，苔薄灰白，脉沉细。此为气血皆虚，寒湿内搏于骨节所致。法宜养血通络，温经散寒。以当归四逆汤加味主治。
处方：
当归10克 桂枝10克 白芍10克 辽细辛3克 木通10克 红枣30克 生姜10克 苏叶10克 甘草6克 防风10克 牛膝10克 木瓜10克 六剂
[二诊]上方连服六剂，右腿已能屈伸，开始着力缓缓而行；骨节冷痛、拘挛亦减。厥阴伤寒之外证初解，多年痼疾松动；但患者年已花甲，六脉沉细无力，舌质仍暗淡无华，久病衰弱之象益显。法宜驱阴护阳，温补脾肾，以理中汤加味主治。
处方：
党参15克 白术12克 炙甘草15克 干姜12克 肉桂3克制附片30克（久煎）
上方服二十余剂，从此行动自如，恢复正常工作。1979年8月6日追访：患者系红军干部，现已79岁。经范老于1960年治愈后，虽在1963年曾患肿病，有所反复；但当时腿仍能屈伸，关节疼痛不甚，尚可自由行动。至今能在室内外散步。
[辨证]此例明显之主证，为下肢关节拘挛冷痛，右腿屈伸履步尤艰。参之脉证，诊为痹证似无疑义。但为什么缠绵多年，几成废足？其病因、病位、病机之理何在？究属何经之病？必须详加辨证。
《素问·痹论篇》云：“风寒湿三气杂至，合而为痹也。其风气胜者为行痹；寒气胜者为痛痹；湿气胜者为著痹也。”这里既概括了引起痹证的三种外邪，又表明三痹不同的主证。不仅如此，根据风寒湿邪侵入之部位，进而分为骨、筋、脉、肌、皮五痹。又云：“痹在于骨则重；在于脉则血凝而不流；在于筋则屈不伸；在于肉则不仁；在于皮则寒。”可见三痹指病因，五痹言病位，并包括症状在内，互相联系而不可分割。
以本例患者而言，临床表现下肢疼痛较剧，且关节重着，固定不移。寒为阴邪，侵入人体，阴经受之；客于筋骨肌肉之间，故迫使气血凝滞，遇冷则痛更增。参之面色青黄，舌质乌暗，苔现灰白，皆属寒主痛，可知寒凝痛痹，乃其主证。
患者自觉右腿发凉，骨重难举。可见寒湿阴邪，已深侵入骨。正如《素问·长刺节论篇》所说：“病在骨，骨重不可举，骨髓酸痛，寒气至，名曰骨痹”。
《伤寒论》云：“手足厥寒，脉细欲绝者，当归四逆汤主之”。本例下肢冷痛，骨重难举，麻木拘挛，参之舌质暗淡，脉象沉细，实为风寒中于血脉，血为邪伤，则营气阻滞，故病属厥阴寒证。郑重光曾指出：“手足厥寒，脉细欲绝，是厥阴伤寒之外证；当归四逆，是厥阴伤寒之表药也”（《中国医药汇海 ·伤寒论卷十六》）。这里不仅说明厥阴风寒中血脉而逆与四逆证不同，而且点出为何用当归四逆之理。今验之临床，初诊服药六剂，厥阴伤寒之外证遂除，血分之邪被逐，营气之阻滞即通，故下肢骨节冷痛掏挛诸证，迎刃而解。再进理中汤加味，培补先后二天，阴消阳长，从阴出阳，顺势利导而病获愈。
[按语]临床常见之风、寒、湿、热诸痹，《内经》等古籍，按其病变部位分为骨、筋、脉、肌、皮五痹；若进而发展至脏腑机能障碍，则更为严重。范老认为：纵有千变万化，究其病因，不外风寒湿热诸邪闭阻之部位不同。总其要，皆不离六经之传变规律。这正是辨认此类不同病变与循经用药之关键所在。
[Initial Visit] Amenorrhea for half a year, with increased leukorrhea. Mild edema of the whole body, more severe in the lower limbs. Pain throughout the body, aversion to cold, frequent dreaming, poor appetite, and occasionally elevated blood pressure. Difficulty in urination, stool initially dry then loose. Tongue body pale, fat and tender with teeth marks on the edges, coating white and slippery, thick and greasy in the center, pulse deep. This is pathogenic factors invading the Shaoyin (Lesser Yin), fire decline leading to water abundance, kidney yang deficiency causing irregular menstruation and infertility. Initially treat with Zhenwu Tang (True Warrior Decoction) modified, using warming yang, transforming qi, and promoting water metabolism as the therapeutic principle.
Prescription:
Prepared Aconite Root (Zhi Fupian) 120g (decocted for a long time) Poria (Fuling) 30g Fresh Ginger (Shengjiang) 30g Cinnamon Twig (Guizhi) 15g Prepared Ginger (Paojiang) 30g Honey-fried Licorice Root (Zhigancao) 15g Four doses
[Second Visit] After taking the above prescription, whole-body edema significantly subsided, and appetite increased. Continue with the original prescription for another four doses.
[Third Visit] Although symptoms such as mental fatigue and aversion to cold have improved, blood depletion and amenorrhea persist. Combine the original prescription with Danggui Buxue Tang (Dong Quai Tonifying Blood Decoction) modified as the main treatment.
Prescription:
Prepared Aconite Root (Zhi Fupian) 60g (decocted for a long time) Poria (Fuling) 20g Atractylodes Rhizome (Baizhu) 15g Fresh Ginger (Shengjiang) 30g Cinnamon Twig (Guizhi) 10g Astragalus Root (Huangqi) 30g Dong Quai Root (Danggui) 10g Honey-fried Licorice Root (Zhigancao) 10g Prepared Ginger (Paojiang) 30g
[Fourth Visit] Upon taking eight doses of the above prescription, menstruation started. The flow was pale and scanty, with blood stasis clots. Lower abdomen felt cold with dull pain. Signs of uterine cold and stagnation remained. Treat with Wenjing Tang (Warming the Menses Decoction) modified.
Prescription:
Evodia Fruit (Wuzhuyu) 6g Dong Quai Root (Danggui) 10g Szechuan Lovage Rhizome (Chuanxiong) 6g White Peony Root (Baishao) 10g Charred Human Hair (Xuyutan) 20g Prepared Ginger (Paojiang) 20g Honey-fried Licorice Root (Zhigancao) 10g Two doses
[Fifth Visit] Cold pain in the lower abdomen disappeared, blood stasis significantly reduced, and all symptoms obviously improved. Advised to avoid raw and cold foods, and abstain from sexual intercourse for half a year. Prescribed another formula for slow administration and conditioning at home.
Prescription:
Prepared Aconite Root (Zhi Fupian) 60g (decocted for a long time) Cassia Bark (Rougui) 10g (dissolved in decoction)
Prepared Ginger (Paojiang) 30g Charred Human Hair (Xuyutan) 20g Dodder Seed (Tusizi) 20g Cistanche Stem (Roucongrong) 10g Astragalus Root (Huangqi) 30g Dong Quai Root (Danggui) 10g Codonopsis Root (Paoshen) 15g Honey-fried Licorice Root (Zhigancao) 15g Goji Berry (Gouqi) 20g Morinda Root (Bajitian) 12g
Follow-up on July 26, 1979: The patient stated that she took over a hundred doses of medicine in total and followed Dr. Fan's advice for conditioning. She became pregnant in 1967 and now has two children.
[Commentary] The *Suwen: Shanggu Tianzhen Lun* states: "In women... the Ren Mai (Conception Vessel) becomes unobstructed, the Chong Mai (Penetrating Vessel) becomes abundant, menstruation occurs at regular intervals, thus enabling conception." In this case, irregular menstruation, occurring intermittently, clearly indicates damage to the Chong and Ren vessels; how can pregnancy occur?
There are many reasons for damage to the yin vessels and the Sea of Blood. The root of this case lies in the deficiency of the True Fire of Shaoyin, failure of Kidney Yang to flourish, which further affects the Spleen. Thus, there is floating of dragon and flooding of water (metaphor for yang failing to control yin fluids), lack of source generation from the acquired foundation (Spleen), increasing qi deficiency and blood depletion, cold congealing in the uterus, obstruction of meridians, and absence of menstruation. Therefore, initially administer agents that warm yang, transform qi, and promote water metabolism, heavily using Ginger and Aconite to suppress and anchor the yin. Then treat by tonifying blood and qi, warming meridians, and dispersing cold. Once spleen dampness is removed, qi and blood are harmonized, the Ren Mai is unobstructed, the Sea of Blood is full, and the menstrual cycle is regular, resulting in the birth of two children.
Shaoyin Syndrome: Congenital Jaundice (Taihuang)
Wu XX, Male, Newborn, 55 days old. Son of an employee at a factory in Chengdu.
[Treatment] Consulted in July 1957. The infant was born full-term via normal delivery and had jaundice all over the body immediately after birth. Now 55 days old, weighing 1.5 kg, height over 30 cm. Yellow fine down hair covers the body and face, about 1 cm long, skin remains dull yellow. Mental lethargy, limbs not warm, skin dry and rough, hair sparse and yellow/rough, genital swelling. Even in hot summer, thick cotton wrapping is required. Slight breeze or startle easily induces vomiting. Diagnosed by XX Hospital as "Congenital Deficiency," no treatment was given. Dr. Fan considered it rare clinically and difficult to approach. After repeated pleas from the mother, he agreed to try treatment. Inquiry into the mother's condition during pregnancy revealed that after becoming pregnant, she developed a craving for drinking large amounts of strong tea, about 5-6 pounds daily, chewing the tea leaves as well. Thus, Spleen Yang was injured, dampness generated internally, damp pathogens lingered for a long time, and were transmitted to the fetus. This caused congenital deficiency in the newborn, extreme weakness of Spleen and Kidney Yang, qi and blood depletion, obstruction of meridians, infiltration of bile fluid, overflowing onto the whole body skin, thus developing congenital jaundice that did not recede for a long time. Mental lethargy, cold limbs, sparse yellow/rough hair also manifest signs of Shaoyin excess of yin and deficiency of yang. The method should be to break yin and restore yang, primarily using Tongmai Sini Tang (Revive the Pulse Sini Decoction) modified, combined with Zhensha San (Needle Sand Powder) to dispel damp-turbidity of the Spleen and Stomach.
Prescription 1:
Prepared Aconite Root (Zhi Fupian) 15g (decocted for a long time) Dried Ginger (Ganjiang) 15g Licorice Root (Gancao) 10g Asarum (Xixin) 1g Scallion White (Congbai) 30g
Prescription 2:
Zhensha San (Needle Sand Powder).
Administer orally with rice soup every morning, 0.6g per dose, for 20 consecutive days.
After more than a month, the infant's jaundice faded, weight slightly increased, and could smile when teased. Medication was stopped, advised careful conditioning, and subsequently grew up healthy.
Follow-up on December 18, 1978: The child has grown into an adult and is working. Weight 55 kg, height 1.64 m. Loves sports, was an amateur football player in middle school.
[Commentary] Although this case is rare, according to Six-Meridian differentiation, its main syndrome belongs to Shaoyin, accompanied by Taiyin cold-dampness; therefore, whichever meridian the disease is in, its methods and formulas can be used for treatment. The efficacy of this case, at first glance, seems like the merit of a certain formula or herb, but in reality, it lies in the vitality of Six-Meridian differentiation. Further analysis shows that the infant's Spleen and Kidney Yang were weak, cold-dampness stagnated impairing transformation and transportation, bile was obstructed and overflowed onto the skin; considering cold limbs and poor development, it should belong to Shaoyin Yin Jaundice. Thus, Tongmai Sini Tang was administered to assist the primordial yang of the congenital foundation, combined with Zhensha San to remove damp-turbidity of the Spleen and Stomach. When yang flourishes and dampness dissipates, qi mechanism flows smoothly, pathogens leave, and peace is restored.
Jueyin Syndrome: Headache and Vertigo
(Meniere's Disease)
Huang XX, Female, 34 years old. Employee at a store in Chengdu.
[History] Since 1970, frequently suffered from headache, vertigo, dry retching, even fainting. Diagnosed as "Meniere's Disease" by several hospitals.
[Initial Visit] Consulted in January 1972. Severe pain at the vertex of the head, dry retching, spitting out saliva/phlegm; during vertigo, the world spins as if sitting in a boat; limbs weak, hands and feet cool. Complexion sallow and lusterless, tongue pale moist with little coating, pulse minute and fine. This is Liver and Stomach deficiency-cold, turbid yin rising counterflow, belonging to Jueyin cold-reversal headache and vertigo. The method should be to warm the Liver and Stomach, unblock yang, and descend turbidity, primarily using Wuzhuyu Tang (Evodia Decoction).
Prescription:
Evodia Fruit (Wuzhuyu) 10g Codonopsis Root (Ludangshen) 20g Fresh Ginger (Shengjiang) 30g Red Dates (Hongzao) 30g Four doses
[Differentiation] In the *Shanghan Lun*, Wuzhuyu Tang treats three types of syndromes: one belongs to Yangming Stomach deficiency-cold; two belongs to Shaoyin vomiting and diarrhea; three belongs to Jueyin cold syndrome. Their common point is the main symptom of vomiting. Yangming deficiency-cold desires vomiting after eating; Shaoyin vomiting and diarrhea; Jueyin dry retching and spitting phlegm, their common pathogenesis is middle jiao deficiency with qi reversal, turbid yin attacking upward.
However, this Jueyin case of dry retching and spitting phlegm also has headache, which is a significant characteristic of Jueyin meridian disease. It becomes a characteristic for two reasons: First, because Jueyin is invaded by pathogens, following the meridian qi upward to the vertex, causing headache, often located at the top of the head. Second, Jueyin is invaded by cold, Liver Wood rebels horizontally, cold pathogens carry turbid yin qi upward to attack Earth (Stomach), resulting in weak Middle Qi, Spleen Qi failing to ascend, Stomach Qi failing to descend. Insufficient clear yang, dry retching and qi reversing upward cause headache; the vertigo, as stated in the *Suwen: Zhi Zhen Yao Da Lun*: "All wind, tremors, and vertigo belong to the Liver." In summary, Jueyin Liver cold is the root, Yangming Stomach cold is the branch, and the disease belongs to Jueyin cold syndrome.
[Second Visit] After taking four doses of the above prescription, vomiting stopped. Headache and vertigo significantly reduced. However, vertigo persists. The reason for vertigo is that the disease is in the Liver, but its root is in the Kidney. Should continue administering agents that warm and tonify Spleen and Kidney, slowly taking Lizhong Tang (Regulate the Middle Decoction) modified.
Prescription:
Codonopsis Root (Ludangshen) 20g Stir-fried Atractylodes Rhizome (Chao Baizhu) 18g Honey-fried Licorice Root (Zhigancao) 15g Dried Ginger (Ganjiang) 30g Prepared Aconite Root (Zhi Fupian) 30g (decocted for a long time) Poria (Fuling) 15g Cassia Bark (Rougui) 10g (powdered, dissolved in decoction)
After taking more than twenty doses, all ailments were resolved. Follow-up in July 1979: Since recovery, it has not recurred, maintaining full attendance at work.
[Commentary] The Jueyin headache and vertigo in this case is similar to Meniere's Disease. Its etiology is not yet fully clear in modern medicine. Although Traditional Chinese Medicine has no such disease name, based on differentiation, it mostly belongs to Liver and Kidney. The *Ling Shu: Hai Lun* states: "When the Sea of Marrow is insufficient, there is dizziness, tinnitus, soreness of the shins, vertigo, and blindness," which is the same principle. Pathogens entering Jueyin mostly transform into yin, commonly presenting with dry retching and spitting phlegm. Its branch is Stomach cold, its disease is Liver cold, its root is Kidney cold. Therefore, sequentially administer agents to warm Earth, warm Liver, and warm Kidney. Once pathogens are eliminated and roots removed, vertigo and pain cease.
Jueyin Syndrome: Intestinal Dysentery (Changpi)
(Acute Dysentery)
Jiang XX, Male, 39 years old. Farmer from Yingmenkou Township, Jinniu District, Chengdu.
[History] Late August 1977, while working in the fields, suddenly felt uncomfortable all over, limbs cold, head sweating cold, abdominal pain and borborygmus. Soon experienced diarrhea day and night, frequent defecation mixed with pus and blood. Urgently sought consultation on September 2. Treated according to Jueyin Changpi syndrome, cured after two doses of medicine.
[Treatment] More than ten defecations per day, loose stool with mucus-like consistency, yellow-red color, accompanied by abdominal pain, tenesmus. Also dry retching, irritability, thirst, cold limbs. Tongue body dark pale, tip slightly red, coating yellow greasy and thick. This is a cold-heat complex syndrome of Changpi, disease in Jueyin. The method should be to expel pathogens and support righteous qi, use cold and heat together, primarily using Wu Mei Wan (Mume Pill).
Prescription:
Mume Fruit (Wumei) 30g Asarum (Xixin) 6g Dried Ginger (Ganjiang) 30g Coptis Rhizome (Huanglian) 12g Dong Quai Root (Danggui) 10g Prepared Aconite Root (Zhi Fupian) 60g (decocted for a long time)
Sichuan Pepper (Shujiao) 6g Cinnamon Twig (Guizhi) 10g Codonopsis Root (Dangshen) 12g
Phellodendron Bark (Huangbai) 10g Two doses. Avoid oily, meaty, raw, and cold foods.
After taking two consecutive doses of the above prescription, intestinal dysentery was cured. Follow-up in June 1979, patient stated: After recovering a year ago, it has not recurred since.
[Differentiation] The *Suwen: Taiyin Yangming Lun* states: "Thieves' winds and empty evils are received by Yang; irregular diet and improper living habits are received by Yin. Received by Yang, they enter the Six Fu organs; received by Yin, they enter the Five Zang organs... Entering the Five Zang organs causes fullness and blockage, below leads to undigested food diarrhea, prolonged leads to intestinal dysentery." Thus, intestinal dysentery is often related to yin-yang disharmony and presents with confused cold-heat symptoms.
This case clearly shows upper heat and lower cold. Jueyin is the Qi of Wind-Wood; when excessive, wind pathogens crawl upward. Now the patient has dry retching, irritability, nausea, and a redder tongue tip, all indicating upper heat. Limb coldness, lower abdominal cold pain, loose watery diarrhea mixed with black-white frozen mucus, these lower cold symptoms are particularly obvious. Ultimately, the pathogenesis lies in the inability of yin and yang qi to communicate mutually. Thus, above is Yang, Yang generates heat; below is Yin, Yin generates cold. That is, "excess of Jueyin" causing Changpi, hence treating with Wu Mei Wan.
[Commentary] Wu Mei Wan "also treats chronic diarrhea," why administer this formula when this case is not chronic diarrhea?
Generally speaking, Jueyin syndromes are either cold reversals or diarrhea. Chronic diarrhea mostly belongs to cold-heat complex diseases, so the method of using both cold and warm agents is suitable, striving for formulas containing both cold and heat. Although this case is not chronic diarrhea, because the syndrome belongs to Jueyin, with intermixed cold and heat, Wu Mei Wan happens to be a formula combining cold, heat, warming, and tonifying, possessing sour, pungent, sweet, and bitter flavors, exactly matching this case, hence using the original formula achieved efficacy.
In fact, ancient and modern physicians have used Wu Mei Wan to treat various miscellaneous diseases, especially expanding its treatment for diarrhea. Taking *Qianjin Fang* as an example, imitating Zhongjing's "also treats chronic diarrhea," using Mume and Coptis to treat heat diarrhea; combining Aconite and Dried Ginger to treat deficiency-cold chronic diarrhea. *Shengji Zonglu* uses Wu Mei Wan to treat postpartum cold-heat diarrhea lasting long. *Zhengzhi Zhunsheng* uses this formula to treat stomach organ cough with expulsion of roundworms. Japanese physician Shimaken said: For retrograde vomiting, worldly physicians find it hard to treat, this formula treats it quickly, truly a miraculous agent (quoted from *Draft Discussion on Shanghan Lun*). Ren Yingqiu believes: Wu Mei Wan has the effect of strengthening gastrointestinal function and anti-inflammatory/anthelmintic action, so it is also effective for chronic diarrhea diseases (*Translation of Shanghan Lun*). Recently, there was a report of curing a fifteen-year persistent colitis with this formula. It can be seen that the application scope of Wu Mei Wan is not limited to ascariasis cold reversal and chronic diarrhea, and has continued to develop in practice.
Jueyin Syndrome: Bone Bi (Gu Bi)
Liu XX, Male, 60 years old. Cadre at an agency in Chengdu.
[History] Suffered from waist and leg joint pain for over ten years, pain fixed in location, worsened by cold. Initially right knee joint was heavier, left leg and back pain slightly lighter; after 1956, became colder, painful, and heavy, lower limb flexion and extension unfavorable, unable to walk on the ground. Local hospital diagnosed as Rheumatoid Arthritis. Consulted in June 1960, treated according to Jueyin cold syndrome Gu Bi and achieved efficacy.
[Initial Visit] Lower limbs cold, bone pain, numbness, spasms, heaviness, worse in the right leg. Difficult to flex, extend, and move, relying on crutches or assistance to step. Complexion sallow and dark, tongue body slightly purple-black, coating thin gray-white, pulse deep and fine. This is deficiency of both qi and blood, cold-dampness internal collision in bone joints. The method should be to nourish blood and unblock collaterals, warm meridians and disperse cold. Primarily use Danggui Sini Tang (Dong Quai Sini Decoction) modified.
Prescription:
Dong Quai Root (Danggui) 10g Cinnamon Twig (Guizhi) 10g White Peony Root (Baishao) 10g Asarum (Xixin) 3g Akebia Stem (Mutong) 10g Red Dates (Hongzao) 30g Fresh Ginger (Shengjiang) 10g Perilla Leaf (Suye) 10g Licorice Root (Gancao) 6g Saposhnikovia Root (Fangfeng) 10g Achyranthes Root (Niuxi) 10g Chaenomelis Fruit (Mugua) 10g Six doses
[Second Visit] After taking six consecutive doses of the above prescription, the right leg could flex and extend, beginning to bear weight and walk slowly; cold pain and spasms of bone joints also decreased. External manifestations of Jueyin Shanghan initially resolved, chronic illness loosened; but the patient is sixty years old, six pulses deep, fine, and powerless, tongue body still dark pale and lusterless, signs of chronic illness debility more obvious. The method should be to drive out yin and protect yang, warm and tonify Spleen and Kidney, primarily using Lizhong Tang (Regulate the Middle Decoction) modified.
Prescription:
Codonopsis Root (Dangshen) 15g Atractylodes Rhizome (Baizhu) 12g Honey-fried Licorice Root (Zhigancao) 15g Dried Ginger (Ganjiang) 12g Cassia Bark (Rougui) 3g Prepared Aconite Root (Zhi Fupian) 30g (decocted for a long time)
After taking more than twenty doses of the above prescription, movement became free, returning to normal work. Follow-up on August 6, 1979: The patient is a Red Army cadre, now 79 years old. After being cured by Dr. Fan in 1960, although he suffered from edema in 1963 with some recurrence; at that time, legs could still flex and extend, joint pain was not severe, and he could move freely. To this day, he can walk indoors and outdoors.
[Differentiation] The obvious main symptom of this case is lower limb joint spasms and cold pain, especially difficult to flex, extend, and walk with the right leg. Considering pulse and symptoms, diagnosing Bi Syndrome seems unquestionable. But why does it linger for years, almost becoming a useless foot? What are the principles of etiology, disease location, and pathogenesis? Which meridian does it belong to? Detailed differentiation is necessary.
The *Suwen: Bi Lun* states: "Wind, cold, and dampness three qi mix together, combining to form Bi. If Wind qi prevails, it is Xing Bi (Wandering Bi); if Cold qi prevails, it is Tong Bi (Painful Bi); if Dampness qi prevails, it is Zhu Bi (Fixed Bi)." Here, it summarizes the three external pathogens causing Bi syndrome and indicates the different main symptoms of the three Bis. Furthermore, based on the site of invasion of wind, cold, and dampness pathogens, it is further divided into five Bis: Bone, Sinew, Vessel, Muscle, Skin. It also states: "Bi in bone causes heaviness; Bi in vessel causes blood coagulation and non-flow; Bi in sinew causes inability to flex and extend; Bi in muscle causes insensitivity; Bi in skin causes cold." Thus, the three Bis refer to etiology, the five Bis refer to disease location, including symptoms, interconnected and inseparable.
For this patient, clinical manifestations include severe lower limb pain, and heavy, fixed joints. Cold is a yin pathogen, invading the human body, received by yin meridians; lodging between sinews, bones, muscles, and flesh, forcing qi and blood to stagnate, pain increases upon cold exposure. Considering blue-yellow complexion, dark purple tongue body, gray-white coating, all indicating cold governs pain, it is known that cold-congealed Painful Bi is its main symptom.
The patient feels the right leg is cold, bones heavy and hard to lift. It can be seen that cold-damp yin pathogens have deeply invaded the bone. As stated in the *Suwen: Chang Ci Jie Lun*: "Disease in bone, bone heavy cannot be lifted, marrow bone sore pain, cold qi arrives, named Gu Bi (Bone Bi)."
The *Shanghan Lun* states: "Cold hands and feet, pulse minute nearly absent, Danggui Sini Tang governs." This case of lower limb cold pain, heavy bones hard to lift, numbness and spasms, considering dark pale tongue body and deep fine pulse, is actually wind-cold striking the blood vessels, blood injured by pathogens, Ying Qi blocked, thus the disease belongs to Jueyin cold syndrome. Zheng Zhongguang once pointed out: "Cold hands and feet, pulse minute nearly absent, are external manifestations of Jueyin Shanghan; Danggui Sini is the exterior medicine for Jueyin Shanghan" (*China Medical Collection Sea · Shanghan Lun Volume 16*). This not only explains that Jueyin wind-cold striking blood vessels and reversing is different from Sini syndrome, but also points out the reason for using Danggui Sini. Now verified clinically, taking six doses of the initial prescription, external manifestations of Jueyin Shanghan were removed, blood-level pathogens expelled, Ying Qi blockage cleared, thus lower limb bone joint cold pain and spasms solved readily. Advancing Lizhong Tang modified again, cultivating the congenital and acquired foundations, yin dissipates and yang grows, emerging from yin to yang, guiding momentum to cure the disease.
[Commentary] Clinically common Wind, Cold, Damp, Heat Bi syndromes, *Neijing* and other ancient texts divide them into five Bis (Bone, Sinew, Vessel, Muscle, Skin) according to lesion sites; if further developing to organ dysfunction, it is more severe. Dr. Fan believes: Regardless of thousands of changes, ultimately the etiology is nothing but the different sites blocked by Wind, Cold, Damp, Heat pathogens. In summary, all do not depart from the transmission rules of the Six Meridians. This is precisely the key to identifying such different lesions and prescribing along the meridians.