以本例厥阴证骨痹而论，其主要脉证亦不外“手足厥寒，脉细欲绝”。这本来是四逆辈之主证，为何仲景反用当归四逆汤主之?古今学者，对此颇多争议。因当归四逆汤，实为桂枝汤之变方。即桂枝本方易当归为君，去生姜，加细辛、通草组成(古之通草即今日之木通)。故争论之焦点，在于为何不用姜附。钱潢说： “方名日四逆，而方中并无姜附，不知何以挽回阳气，是以不能无疑也。”柯韵伯甚至认为： “此条证在里，当是四逆本方加当归，如茯苓四逆之例。若反用桂枝汤攻表误矣。”罗东逸等注家，又借厥阴主肝之说，对本方委曲顺解。提出“厥阴之脏，相火游行其间，经虽受寒，而脏不即寒”，故虽“见其手足厥冷，脉细欲绝者，不得遂认为寒，而用姜附也”。以上诸说皆不能令人信服。
喻嘉言《伤寒论尚论篇》，对当归四逆汤颇具卓见。他说： “四逆之名多矣。寒甚而厥，四逆汤；里寒外热，通脉四逆汤；热邪传里，四逆散。此用当归四逆汤何故‘?盖四逆之故不同，有因寒而逆，有因热而逆；此则因风寒中血脉而逆，乃当归为君之所以立也”。高学山著《伤寒论尚论辨似》进而阐明桂枝汤之变法云： “至其桂枝之变法，神妙莫测，真有上下九天九地之幻。夫桂枝汤之号召阴阳，其义已见本汤下。乃忽焉加芍药，则使下引内入以畅脾阳。忽焉加芍药、而并加胶、饴，则使之内引上托，而建中气。忽焉加当归、增大枣，只以细辛、通草为使，则使之深入肝肾，而为温之润之之剂。长沙制方之意，可因此而悟其余矣!”这种观点比较符合仲景原意。范老在多年临床实践中，治愈不少厥阴证，常用当归四逆等厥阴诸方。此例仅为其中一个代表，它在理论和实践上，都涉及历代医学家提出过的一些问题，将有待于继续深入探讨。
厥阴证骨痹
(坐骨神经痛)
王××，男，29岁。四川省某汽车队职工。
[病史]1965年，在解放军某部因公负伤，左下肢股骨骨折，送××医疗队急救。整复后用石膏固定。因当时条件所限，石膏不干，曾采取烘烤措施。50余日出院，病未痊愈，又感风寒。患肢筋骨麻木疼痛，步行约100米则难以坚持。1966年，××医院诊为“坐骨神经痛”。1968年转业到地方。经多方治疗疼痛有缓解，遇天气变化，病又加剧。1971年6月来诊。
[诊治]患者跛行，左下肢筋骨沿后侧呈放射性疼痛近六年，时有刺痛感。左足凉麻甚。舌质淡红稍暗，苔白根部微腻。询其数年来诊治情况，均按一般风湿论治，舒筋活血，散寒除湿等品所用颇多。范老反复思考：此例虽属风寒湿痹，但骨折后未痊愈又受风寒，其入侵部位已深入下肢筋骨，参之疼痛、麻木、肢凉等，病属厥阴骨痹。以当归四逆汤并五通散合为一方，养血通络，温经散寒，祛风除湿，活血化淤，并用酒醴以行药势。再以自制不二丹配合服之。
一，酒醴处方：
当归 桂枝赤芍木通辽细辛通草
淮通血通香通干姜牛膝木瓜
川乌羌活独活灵仙草乌川芎
川断橘络丝瓜络伸筋草防风
血竭猴骨土鳖红花桃仁三棱
莪术海马甘草
以上各10克共为粗末，用白酒五斤浸泡一周后，每晚睡前服10克。
二，丹药方：
生松香四份血竭二份硼砂二份琥珀二份
共为细末，炼制成丹。每周服一次，每次3克。
遵上法服用约五月，病痊愈。1979年8月追访：七年来工作常年在外，东奔西跑，原患肢一直良好。
[按语]本例属厥阴证骨痹。因患者原身体强壮，主要为暴力骨折后，寒湿乘隙深入筋骨，拖延日久，汤剂难达病所。故以酒醴之剂，以助药力，但仍嫌不足，另以不二丹通利关节，散淤除痹以助之。
古“臀”字本从酉(酒)，即由酒能治病演化而来。《素问·汤液醪醴论篇》云： “古圣人之作汤液醪醴者，以为备耳。”至今仍有“酒为百药之长”的说法。可见酒醴用之得法，常获著效。
厥阴证寒痹
(坐骨神经痛)
郝×，男，70岁。四川某图书馆干部。
[病史]曾有风湿性关节痛史。1973年冬，臀部及右腿冷痛难忍，不能坚持工作。经××医院检查，诊为“坐骨神经痛”。于1974年3月中旬来诊。
[初诊]少腹及下肢发凉，膝关节以下微肿，行走困难，自右侧臀部沿腿至足抽掣冷痛。神疲，头昏，舌质淡红稍乌暗，苔白滑腻满布，脉细弱。证属厥阴寒痹筋痛。以当归四逆汤加味，养血活络，温经散寒为治。
处方：
当归12克桂枝15克白芍12克辽细辛5克木通12克炙甘草6克大枣20克牛膝12克木瓜12克独活lO克三剂
[辨证]风寒入肝则筋痛，入肾则骨痛，入脾则肉痛。正如《内经))所说： “寒痹之为病也，留而不去”。又云： “病在筋，筋挛节痛，不可以行”。可见本证显系邪入厥阴肝经，寒邪凝滞，气血受阻所致。又本例冷痛，自臀部痛引下肢，小腹及四肢末端发凉。此为厥阴证之血虚寒凝。气血运行不畅，不通则痛。 “欲续其脉，必益其血，欲益其血，必温其经”。故不以四逆姜附回阳，而以当归四逆温经散寒，养血活络为治。
[二诊]服上方，肢痛减轻。原方续服四剂。
(三诊]患者可缓步而行，疼痛大减。仍守原方，加苏叶10克，入血分散寒凝；加防风10克，祛经络之风邪。再服十剂。
[四诊]半月后，疼痛基本消失，神疲、头晕显著好转．滑腻苔减。唯下肢稍有轻微麻木感，时有微肿。寒邪虽衰，湿阻经络之象未全解，上方酌加除湿之品，以增强疗效。嘱其再服五剂。
处方：
当归12克桂枝10克 白芍12克 木通12克牛膝12克茯苓15克白术15克苍术10克苡仁15克炙甘草6克一月后病基本治愈，步履自如。
1979年7月15日追访：七年来病未复发，今年已七十七岁，身体尚好。
[按语]以上厥阴骨痹、寒痹二例，虽病情、病位不尽相同，但主证皆因血虚寒郁所致，故皆以当归四逆汤主之。
《伤寒论》所载当归四逆汤，原主治“手足厥寒，脉细欲绝者”。其病机在于血虚寒滞。由于血被寒邪凝滞之程度和部位不同，则临床见证各异。后世医家对此多有发挥。范老在临证中，据《伤寒论》之学术思想及后贤经验，灵活运用于多种疾病，常获显著疗效。其辨证要点，从主证看：一是少腹或腰、臀部以下发凉，或四肢末端冷；二是少腹、腰、臀以下疼痛，包括阴器、睾丸、下肢筋骨、关节疼痛，以及痛经等。除以上主证外，还可能出现某些兼证。而脉象多细弱，舌质常暗红无泽，或有淤斑，苔灰白或腻或紧。以上诸证，不必悉具，皆可用之。
后记
医案整理小组的成员，除执笔者外，还有吴贵木、范开明、宁瑞盈和张秀琴同志。协助医案整理工作的，有程继贤、刘元灼、刘元堃等同志。
本书初稿承蒙印会河教授、戴佛延、邓明仲、郭子光、陈治恒、陈潮祖副教授以及洪梦浒讲师审阅，并提出宝贵意见，谨表示衷心地感谢!
以本例厥阴证骨痹为例，其主要脉象和症状也不外乎“手足寒冷，脉搏细弱似有若无”。这本来是四逆汤类方剂的主要适应证，为什么张仲景反而使用当归四逆汤作为主方？古今学者对此有很多争议。因为当归四逆汤，实际上是桂枝汤的变方。即用桂枝汤原方，将君药改为当归，去掉生姜，加入细辛、通草组成（古代的通草就是现在的木通）。所以争论的焦点在于，为什么不使用干姜和附子。钱潢说：“方名叫四逆，但方中并没有干姜和附子，不知道如何挽回阳气，因此不能不怀疑。”柯韵伯甚至认为：“这条条文中的证候在里，应该是四逆汤本方加上当归，就像茯苓四逆汤的例子。如果反而用桂枝汤去解表就错了。”罗东逸等注家，又借用厥阴主肝的说法，对本方进行曲折的解释。提出“厥阴之脏，相火在其中游走，经脉虽然受寒，但脏腑并不立即受寒”，所以虽然“见到手足冰冷，脉搏细弱似有若无，也不能就认为是寒证，而使用干姜和附子”。以上各种说法都不能令人信服。
喻嘉言在《伤寒论尚论篇》中，对当归四逆汤颇有独到见解。他说：“叫作四逆的方子很多。寒气极重导致四肢厥冷，用四逆汤；里寒外热，用通脉四逆汤；热邪传入体内，用四逆散。这里为什么使用当归四逆汤呢？”大概是因为四逆的原因不同，有的因寒而逆，有的因热而逆；这里则是由于风寒侵入血脉而导致逆乱，这就是确立以当归为君药的原因。”高学山在《伤寒论尚论辨似》中进而阐明桂枝汤的变法说：“至于桂枝汤的变法，神妙莫测，真有上下九天九地的变幻。桂枝汤调和阴阳的道理，已经在本书该汤条下见过。忽然加上芍药，则是引导下行内入以通畅脾阳。忽然加上芍药，并且加入阿胶、饴糖，则是引导内收上托，以建立中气。忽然加上当归、增大枣用量，只用细辛、通草作为使药，则是引导深入肝肾，成为温补滋润的方剂。长沙先生（指张仲景）制方的意图，可以由此推知其余了！”这种观点比较符合张仲景的原意。范中林老在多年的临床实践中，治愈了不少厥阴证患者，常用当归四逆等治疗厥阴证的方剂。此例只是其中一个代表，它在理论和实践上，都涉及历代医学家提出过的一些问题，有待于继续深入探讨。
厥阴证骨痹
（坐骨神经痛）
王××，男，29岁。四川省某汽车队职工。
[病史]1965年，在解放军某部因公负伤，左下肢股骨骨折，送往××医疗队急救。整复后用石膏固定。因当时条件所限，石膏未干，曾采取烘烤措施。50多天后出院，病未痊愈，又感受风寒。患肢筋骨麻木疼痛，步行约100米则难以坚持。1966年，××医院诊断为“坐骨神经痛”。1968年转业到地方。经多方治疗疼痛有所缓解，遇到天气变化，病情又加剧。1971年6月来诊。
[诊治]患者跛行，左下肢筋骨沿后侧呈放射性疼痛近六年，时有刺痛感。左足冰凉麻木严重。舌质淡红稍暗，苔白根部微腻。询问其数年来诊治情况，均按一般风湿论治，舒筋活血，散寒除湿等药物所用颇多。范老反复思考：此例虽属风寒湿痹，但骨折后未痊愈又受风寒，其入侵部位已深入下肢筋骨，参考疼痛、麻木、肢凉等症状，病属厥阴骨痹。用当归四逆汤并五通散合为一方，养血通络，温经散寒，祛风除湿，活血化瘀，并用酒醴以助药势。再以自制不二丹配合服用。
一，酒醴处方：
当归 桂枝 赤芍 木通 辽细辛 通草
淮通 血通 香通 干姜 牛膝 木瓜
川乌 羌活 独活 灵仙 草乌 川芎
川断 橘络 丝瓜络 伸筋草 防风
血竭 猴骨 土鳖 红花 桃仁 三棱
莪术 海马 甘草
以上各10克共研为粗末，用白酒五斤浸泡一周后，每晚睡前服10克。
二，丹药方：
生松香四份 血竭二份 硼砂二份 琥珀二份
共研为细末，炼制成丹。每周服一次，每次3克。
遵上法服用约五月，病痊愈。1979年8月追访：七年来工作常年在外，东奔西跑，原患肢一直良好。
[按语]本例属厥阴证骨痹。因患者原本身体强壮，主要为暴力骨折后，寒湿乘隙深入筋骨，拖延日久，汤剂难达病所。故以酒醴之剂，以助药力，但仍嫌不足，另以不二丹通利关节，散淤除痹以助之。
古“酉”字本从酒（注：原文此处可能有误，通常解释为酒与酉的关系），即由酒能治病演化而来。《素问·汤液醪醴论篇》云：“古圣人之作汤液醪醴者，以为备耳。”至今仍有“酒为百药之长”的说法。可见酒醴用之得法，常获著效。
厥阴证寒痹
（坐骨神经痛）
郝×，男，70岁。四川某图书馆干部。
[病史]曾有风湿性关节痛史。1973年冬，臀部及右腿冷痛难忍，不能坚持工作。经××医院检查，诊为“坐骨神经痛”。于1974年3月中旬来诊。
[初诊]少腹及下肢发凉，膝关节以下微肿，行走困难，自右侧臀部沿腿至足抽掣冷痛。神疲，头昏，舌质淡红稍乌暗，苔白滑腻满布，脉细弱。证属厥阴寒痹筋痛。以当归四逆汤加味，养血活络，温经散寒为治。
处方：
当归12克 桂枝15克 白芍12克 辽细辛5克 木通12克 炙甘草6克 大枣20克 牛膝12克 木瓜12克 独活10克 三剂
[辨证]风寒入肝则筋痛，入肾则骨痛，入脾则肉痛。正如《内经》所说：“寒痹之为病也，留而不去”。又云：“病在筋，筋挛节痛，不可以行”。可见本证显系邪入厥阴肝经，寒邪凝滞，气血受阻所致。又本例冷痛，自臀部痛引下肢，小腹及四肢末端发凉。此为厥阴证之血虚寒凝。气血运行不畅，不通则痛。“欲续其脉，必益其血，欲益其血，必温其经”。故不以四逆姜附回阳，而以当归四逆温经散寒，养血活络为治。
[二诊]服上方，肢痛减轻。原方续服四剂。
[三诊]患者可缓步而行，疼痛大减。仍守原方，加苏叶10克，入血分散寒凝；加防风10克，祛经络之风邪。再服十剂。
[四诊]半月后，疼痛基本消失，神疲、头晕显著好转，滑腻苔减。唯下肢稍有轻微麻木感，时有微肿。寒邪虽衰，湿阻经络之象未全解，上方酌加除湿之品，以增强疗效。嘱其再服五剂。
处方：
当归12克 桂枝10克 白芍12克 木通12克 牛膝12克 茯苓15克 白术15克 苍术10克 苡仁15克 炙甘草6克 一月后病基本治愈，步履自如。
1979年7月15日追访：七年来病未复发，今年已七十七岁，身体尚好。
[按语]以上厥阴骨痹、寒痹二例，虽病情、病位不尽相同，但主证皆因血虚寒郁所致，故皆以当归四逆汤主之。
《伤寒论》所载当归四逆汤，原主治“手足厥寒，脉细欲绝者”。其病机在于血虚寒滞。由于血被寒邪凝滞之程度和部位不同，则临床见证各异。后世医家对此多有发挥。范老在临证中，据《伤寒论》之学术思想及后贤经验，灵活运用于多种疾病，常获显著疗效。其辨证要点，从主证看：一是少腹或腰、臀部以下发凉，或四肢末端冷；二是少腹、腰、臀以下疼痛，包括阴器、睾丸、下肢筋骨、关节疼痛，以及痛经等。除以上主证外，还可能出现某些兼证。而脉象多细弱，舌质常暗红无泽，或有淤斑，苔灰白或腻或紧。以上诸证，不必悉具，皆可用之。
后记
医案整理小组的成员，除执笔者外，还有吴贵木、范开明、宁瑞盈和张秀琴同志。协助医案整理工作的，有程继贤、刘元灼、刘元堃等同志。
本书初稿承蒙印会河教授、戴佛延、邓明仲、郭子光、陈治恒、陈潮祖副教授以及洪梦浒讲师审阅，并提出宝贵意见，谨表示衷心地感谢！
Taking the case of bone bi (bone obstruction) in Jueyin syndrome as an example, its main pulse and symptom manifestations are no different from "coldness of the hands and feet, with a fine pulse that seems on the verge of disappearing". This is originally the primary indication for Si Ni Tang (Four Counterflow Decoction) category formulas. Why did Zhang Zhongjing instead use Dang Gui Si Ni Tang (Angelica Sinensis Four Counterflow Decoction) as the principal formula? Scholars ancient and modern have much controversy regarding this. Because Dang Gui Si Ni Tang is actually a modified form of Gui Zhi Tang (Cinnamon Twig Decoction). That is, taking the original Gui Zhi Tang formula, changing Dang Gui to be the sovereign herb, removing Sheng Jiang (Fresh Ginger), and adding Xi Xin (Asarum) and Tong Cao (Tetrapanax Papyrifer Stem) to compose it (ancient Tong Cao is today's Mu Tong/Akebia Stem). Thus, the focus of the debate lies in why not use Gan Jiang (Dried Ginger) and Fu Zi (Aconite Root). Qian Huang said: "The formula is named Si Ni, yet there is no Gan Jiang or Fu Zi in it; I do not know how it can restore Yang Qi, so I cannot help but doubt." Ke Yunbo even believed: "This clause describes a syndrome located in the interior; it should be the original Si Ni Tang added with Dang Gui, similar to the example of Fu Ling Si Ni Tang. To use Gui Zhi Tang to attack the exterior would be a mistake." Luo Dongyi and other commentators, borrowing the theory that Jueyin governs the Liver, offered convoluted explanations for this formula. They proposed that "the viscera of Jueyin contain Xiang Huo (Ministerial Fire) circulating within; although the meridians suffer cold, the viscera do not immediately become cold." Therefore, even though one sees "cold hands and feet and a fine pulse on the verge of disappearing," one must not simply consider it a cold syndrome and use Gan Jiang and Fu Zi." None of the above explanations are convincing.
Yu Jiayan, in *Shang Han Lun Shang Lun Pian* (Supplementary Discussion on Treatise on Cold Damage), had profound insights into Dang Gui Si Ni Tang. He said: "There are many formulas named Si Ni. When cold is severe causing counterflow cold, Si Ni Tang is used; when there is interior cold and exterior heat, Tong Mai Si Ni Tang (Pulse-Resuscitating Four Counterflow Decoction) is used; when heat pathogen transmits inward, Si Ni San (Four Counterflow Powder) is used. For what reason is Dang Gui Si Ni Tang used here?" It is because the causes of counterflow differ: some arise from cold, some from heat; here, however, it arises from Wind-Cold invading the blood vessels causing counterflow, which is why Dang Gui is established as the sovereign herb." Gao Xueshan, in *Shang Han Lun Shang Lun Bian Si*, further elucidated the modified methods of Gui Zhi Tang: "As for the modified methods of Gui Zhi Tang, they are divine and unpredictable, possessing illusions of heaven and earth high and low. The principle of Gui Zhi Tang calling forth Yin and Yang has been seen under this formula itself. Suddenly adding Shao Yao (Peony Root) guides downward and inward to unblock Spleen Yang. Suddenly adding Shao Yao and simultaneously adding E Jiao (Donkey-Hide Gelatin) and Yi Tang (Maltose) guides inward and upward to support Middle Qi. Suddenly adding Dang Gui and increasing the amount of Da Zao (Jujube), using only Xi Xin and Tong Cao as guiding herbs, leads them deep into the Liver and Kidney, becoming a warming and moistening agent. One can understand the intent behind Chang Sha's [Zhang Zhongjing's] formula creation from this!" This viewpoint aligns more closely with Zhang Zhongjing's original intent. Elder Fan Zhonglin, through years of clinical practice, cured numerous patients with Jueyin syndrome, frequently using Dang Gui Si Ni Tang and other Jueyin formulas. This case is merely one representative; it involves issues raised by physicians throughout history in both theory and practice, awaiting continued in-depth exploration.
Bone Bi (Bone Obstruction) in Jueyin Syndrome
(Sciatica)
Wang XX, Male, 29 years old. Employee of a bus fleet in Sichuan Province.
[Medical History] In 1965, he was injured on duty in a unit of the People's Liberation Army, suffering a fracture of the left femur, and was sent to the XX Medical Team for emergency treatment. After reduction, it was fixed with plaster. Due to limited conditions at the time, the wet plaster was baked dry. Discharged after more than 50 days, the illness was not cured, and he contracted Wind-Cold again. The affected limb's muscles and bones felt numb and painful; walking about 100 meters made it difficult to persist. In 1966, XX Hospital diagnosed him with "Sciatica". In 1968, he transferred to local work. Pain was alleviated through various treatments, but worsened with weather changes. He came for consultation in June 1971.
[Diagnosis and Treatment] The patient walked with a limp. For nearly six years, he had radiating pain along the posterior aspect of the left lower limb's muscles and bones, with occasional stabbing pain. His left foot was severely cold and numb. The tongue body was pale red and slightly dark, with a white coating that was slightly greasy at the root. Inquiring about his medical history over the past few years, he had been treated generally for Wind-Damp Bi, using many herbs for relaxing sinews, invigorating blood, dispelling cold, and drying dampness. Elder Fan pondered repeatedly: Although this case belongs to Wind-Cold-Damp Bi, since the fracture was not fully healed before contracting Wind-Cold, the pathogen invaded deeply into the lower limb muscles and bones. Considering the pain, numbness, and cold limbs, the disease belongs to Jueyin Bone Bi. He combined Dang Gui Si Ni Tang with Wu Tong San (Five Unblocking Powder) into one formula to nourish blood and unblock collaterals, warm meridians and dispel cold, expel wind and dry dampness, invigorate blood and resolve stasis, and used Jiu Li (Medicinal Wine) to promote the action of the drugs. He also prescribed his self-made Bu Er Dan (Two-Unmatched Pills) to be taken concurrently.
I. Medicinal Wine Prescription:
Dang Gui (Angelicae Sinensis Radix), Gui Zhi (Cinnamomi Ramulus), Chi Shao (Paeoniae Radix Rubra), Mu Tong (Akebiae Caulis), Liao Xi Xin (Asari Radix et Rhizoma), Tong Cao (Tetrapanacis Medulla);
Huai Tong (Tetrapanacis Medella), Xue Tong (Spatholobi Caulis), Xiang Tong (Linderae Radix), Gan Jiang (Zingiberis Rhizoma干燥), Niu Xi (Achyranthis Bidentatae Radix), Mu Gua (Chaenomelis Fructus);
Chuan Wu (Aconiti Radix), Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Ling Xian (Spatholobi Caulis - *Note: Context implies Wei Ling Xian/Clematidis Radix*), Cao Wu (Aconiti Kusnezoffii Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma);
Chuan Duan (Dipsaci Radix), Ju Luo (Citri Reticulatae Pericarpium Reticulatum), Si Gua Luo (Luffae Fructus Retinervia), Shen Jin Cao (Lycopi Herba), Fang Feng (Saposhnikoviae Radix);
Xue Jie (Santalum Album Resina), Hou Gu (Simiae Os), Tu Bie (Eupolyphaga Seu Steleophaga), Hong Hua (Carthami Flos), Tao Ren (Persicae Semen), San Leng (Sparganii Rhizoma);
E Zhu (Curcumae Rhizoma), Hai Ma (Hippocampus), Gan Cao (Glycyrrhizae Radix et Rhizoma).
All ingredients at 10 grams each, coarsely powdered. Soaked in 5 jin (approx. 2.5 kg) of Baijiu (white liquor) for one week. Take 10 grams before bed every night.
II. Pill Prescription:
Sheng Song Xiang (Colophonium), four parts; Xue Jie (Santalum Album Resina), two parts; Peng Sha (Borax), two parts; Hu Po (Electrum), two parts.
Grind into fine powder, refine into pills. Take once a week, 3 grams each time.
Following the above method for approximately five months, the illness was cured. Follow-up in August 1979: For seven years, he worked outdoors, running east and west, and the originally affected limb remained in good condition.
[Commentary] This case belongs to Jueyin Bone Bi. Because the patient was originally physically strong, the primary cause was cold-dampness penetrating deeply into the muscles and bones after violent fracture, lingering for a long time where decoctions could hardly reach the site of disease. Therefore, medicinal wine was used to assist drug potency, but this was still considered insufficient. Bu Er Dan was additionally used to unblock joints, resolve stasis, and remove bi obstruction to aid the treatment.
The ancient character "You" (酉) is related to wine, evolving from the idea that wine can cure diseases. *Su Wen: Tang Ye Lao Li Lun Pian* states: "The ancient sages made Tang Ye (decoctions) and Lao Li (fermented wines) as preparations." Even today, there is a saying that "wine is the chief of all medicines." It is evident that when medicinal wine is used correctly, significant effects are often achieved.
Cold Bi (Obstruction) in Jueyin Syndrome
(Sciatica)
Hao X, Male, 70 years old. Cadre of a library in Sichuan Province.
[Medical History] History of rheumatic joint pain. In winter 1973, unbearable cold pain in the buttocks and right leg prevented him from working. Examined at XX Hospital and diagnosed with "Sciatica". Came for consultation in mid-March 1974.
[First Visit] Cold sensation in the lower abdomen and lower limbs, slight swelling below the knee joints, difficulty walking, drawing cold pain from the right buttock down the leg to the foot. Fatigue, dizziness. Tongue body pale red and slightly dark purple, coating white, slippery, greasy, and covering the entire surface. Pulse fine and weak. Syndrome belongs to Jueyin Cold Bi with tendon pain. Treated with Dang Gui Si Ni Tang modified to nourish blood, activate collaterals, warm meridians, and dispel cold.
Prescription:
Dang Gui 12g, Gui Zhi 15g, Bai Shao 12g, Liao Xi Xin 5g, Mu Tong 12g, Zhi Gan Cao 6g, Da Zao 20g, Niu Xi 12g, Mu Gua 12g, Du Huo 10g. Three doses.
[Differentiation] When Wind-Cold enters the Liver, tendons hurt; when it enters the Kidney, bones hurt; when it enters the Spleen, flesh hurts. As stated in *Nei Jing*: "When Cold Bi occurs, it remains and does not depart." It also says: "When disease is in the tendons, tendons contract and joints hurt, making movement impossible." Clearly, this syndrome results from pathogens entering the Jueyin Liver Meridian, with cold pathogen stagnation obstructing Qi and Blood. Furthermore, this case features cold pain radiating from the buttocks to the lower limbs, with coldness in the lower abdomen and extremities. This is Blood Deficiency and Cold Stagnation characteristic of Jueyin Syndrome. Poor circulation of Qi and Blood causes pain due to blockage. "To restore the pulse, one must benefit the blood; to benefit the blood, one must warm the meridians." Therefore, instead of using Si Ni Tang with Gan Jiang and Fu Zi to restore Yang, Dang Gui Si Ni Tang is used to warm meridians, dispel cold, nourish blood, and activate collaterals.
[Second Visit] After taking the above prescription, limb pain decreased. Continue the original prescription for four more doses.
[Third Visit] The patient could walk slowly, and pain was greatly reduced. Stick to the original prescription, add Su Ye (Perillae Folium) 10g to enter the blood level and disperse cold stagnation; add Fang Feng (Saposhnikoviae Radix) 10g to expel Wind pathogen from the meridians. Take ten more doses.
[Fourth Visit] Half a month later, pain basically disappeared, fatigue and dizziness significantly improved, and slippery/greasy coating decreased. Only slight mild numbness in the lower limbs remained, with occasional slight swelling. Although the cold pathogen declined, signs of dampness obstructing the meridians were not fully resolved. Add damp-resolving herbs to the original prescription to enhance efficacy. Instructed to take five more doses.
Prescription:
Dang Gui 12g, Gui Zhi 10g, Bai Shao 12g, Mu Tong 12g, Niu Xi 12g, Fu Ling 15g, Bai Zhu 15g, Cang Zhu 10g, Yi Yi Ren 15g, Zhi Gan Cao 6g. One month later, the illness was basically cured, and walking was free and easy.
Follow-up on July 15, 1979: The illness did not recur for seven years. Now 77 years old, his health is still good.
[Commentary] In the above two cases of Jueyin Bone Bi and Cold Bi, although the severity and location of the disease differed somewhat, the main syndromes were all caused by Blood Deficiency and Cold Stagnation. Therefore, Dang Gui Si Ni Tang was used as the principal formula in both.
*Dang Gui Si Ni Tang* recorded in *Shang Han Lun* originally treats "coldness of the hands and feet, with a fine pulse on the verge of disappearing". Its pathogenesis lies in Blood Deficiency and Cold Stagnation. Due to differences in the degree and location of blood stagnation caused by cold pathogen, clinical manifestations vary. Later physicians have expanded upon this. Elder Fan, in clinical practice, flexibly applied this to various diseases based on the academic thoughts of *Shang Han Lun* and the experience of later experts, often achieving significant curative effects. Its key points for differentiation, looking at the main symptoms: First, coldness below the lower abdomen, waist, or buttocks, or cold extremities; Second, pain below the lower abdomen, waist, or buttocks, including pain in the genitalia, testicles, lower limb muscles/bones/joints, and dysmenorrhea, etc. Besides these main symptoms, certain accompanying symptoms may appear. The pulse is mostly fine and weak, the tongue body is often dark red without luster, possibly with stasis spots, and the coating may be gray-white, greasy, or tight. All these symptoms need not be present entirely; the formula can be used regardless.
Postscript
Members of the Medical Case Compilation Group, besides the author, included Comrades Wu Guimu, Fan Kaiming, Ning Ruiying, and Zhang Xiuqin. Assisting in the compilation work were Comrades Cheng Jixian, Liu Yuanzhuo, Liu Yuankun, etc.
The first draft of this book was reviewed by Professor Yin Huihe, Associate Professors Dai Foyan, Deng Mingzhong, Guo Ziguang, Chen Zhiheng, Chen Chaozu, and Lecturer Hong Menghu, who provided valuable opinions. We sincerely express our gratitude!