[二诊]上方服三剂，下肢渐能屈伸，诸证皆有好转。守原法加辽细辛再服两剂。
[三诊]膝关节及脚肿消，膝面硬结缩小．变软。全身关节仍有轻微疼痛，原方加减续服。
处方：
桂枝10克赤芍12克麻黄10克生姜10克白术12克甘草3克 防风10克茯苓12克川芎10克柴胡10克前胡10克羌活10克独活10克辽细辛3克嘱服数剂，可停药，注意生活调养，忌食生冷和预防风寒。
月余后，其父来告，小儿关节已不疼痛，双膝硬结消失，病已痊愈。1979年7月追访，其母日： 玉儿已长成人，身体很健壮。自范老告戒后，不准他洗冷水澡、食生冷之物，四年来病未复发。
[按语]以上四例太阳证，西医辨病大体相同。但范老临床施治方药，各有所异：田例风湿之邪，留洼肌腠，下肢局部气血阻滞，以桂枝汤加味轻取之；杨例风湿相搏，卫阳已虚，腰剧痛不能转侧，桂枝附子汤中重用附子，温经逐邪，助肾阳而立卫阳之基；汤例风寒湿邪久留骨节，又突然转重，甘草附子汤中重用附子，速开筋骨之痹；柴例病属历节，兼有风从热化之象，故去附子，后加羌独柴前而收功。四例皆属太阳证之范畴，或称太阳类似证，病因与病位相似，但理、法、方、药有所不同。可见范老既重“辨证”，又严“论治”，且善于“同病异治”。
太阳证风寒湿痹
(坐骨神经痛)
李××，男，4J6岁。铁道部某厂干部。
[病史]1974年底，腰臀部痛引双下肢，左侧为甚，行动日益困难。××职工医院诊断为风湿性坐骨神经痛。经针灸、中西药治疗，其效不显。遂发展至下肢难以行动，生活不能自理。于1975年2月底， 由工厂派专人护送来成都求治。
[初诊]患者卧床不起，翻身需由他人协助，腰臀部及下肢麻痛沉重，左下肢尤甚，活动患肢则疼痛加重。恶风寒，头痛，小腹胀满，小便不利，双下肢凹陷性水肿。面黄无泽，舌质淡红，苔白滑厚腻，根部微黄。此证属风寒湿痹，湿邪为胜。急当温阳化气行水，以五苓散加味主之。
处方：
猪苓10克茯苓20克泽泻10克砂仁10克白术15克桂枝15克上肉桂10克五加皮12克三剂
[二诊]服上方后，小便量增多，腹部及下肢肿胀减，但疼痛无明显改变。针对主证，以助阳胜湿，散风止痛之甘草附子汤加味主之。
处方：
炙甘草30克 制附片120克(久煎)桂枝15克生白术20克生姜60克云苓30克四剂
[三诊]服上方后，全身关节疼痛减轻，扶杖可下地缓步而行。宜原法再少佐麻黄、辽细辛，以增强开闭、散寒、行水之力。
处方：
炙甘草30克 制附片120克(久煎) 生白术20克桂枝15克 生姜60克麻黄10克辽细辛4克云苓20克五剂
[四诊]头痛，腰臀部及下肢疼痛大减，离杖能行。肢肿基本消失，尚有寒湿凝聚、经络受阻之象，继以活血通络、舒筋散淤之品调理之。
处方；
桂枝木通红藤威灵仙 当归 川芎
猴骨海马松节牛膝木瓜乳香
没药苏木辽细辛羌活独活柴胡
前胡血竭伸筋草
以上各10克，共为细末，水打丸。每晚睡前用白酒兑服3克。
服药20余日后，病愈恢复工作。 1979年7月20日追访，至今未复发。
[按语]本例太阳痹证，以湿为胜。急投五苓散加味，不仅急则治标，同时化气行水，即为治本。前贤曾称“五苓散，逐内外水饮之首剂。”而桂枝则为此方之关键，故重用之，以增强通阳化气行水之力。另加上肉桂，补命门真火，助气化，散寒凝；加砂仁醒脾化湿，行气宽中以消胀满，且能纳气归肾以助膀胱之气化；再用五加皮祛风湿之痹痛，疗经络之拘挛，且有利小便、消水肿之效。服药三剂而病获转机。然后抓住风寒湿致疼痛之主证，继用甘草附子汤。 白术、附子，顾里胜湿；桂枝、甘草，顾表胜风；重用附子，温里扶阳，除痹止痛。冠以甘草者，意在缓而行之。最终，再用活血通络之法以善其后。
太阳证风寒湿痹
(周期性麻痹)
刘××，男，45岁。辽宁省抚顺市某局干部。
[病史]1975年2月，参加抗震救灾工作。 当时气温降至零下20度，在雪地临时架设帐篷办公和食宿。2月17日深夜，起床接长途电话， 衣着单薄，持续约20分钟，后感下肢冷麻。翌日，遂不能站立。经医疗队以抗风湿治疗无效，第五日即四肢瘫痪。2月24日送回抚顺，××职工医院外科诊断为“筋肌纤维质炎”。又转××医院治疗，当时膝关节红肿，诊断为“急性风湿症”。
此后三年内，时好时坏，反复发作。多次住院，有一次长达200多天。1979年1月9日瘫痪复发后， 病情加重，每日反复发病，大腿肌肉呈阵发性游走疼痛，轻则起立困难，重则卧床不起。经辽宁省某中医医院内科，先后诊断为： “痹证”、 “痿证”、 “痿痹兼证”、 “风痱”。沈阳××医院内科、神经内科会诊，诊断为“发作性瘫痪待诊”，并建议转北京诊冶。在北京××医学院附院确诊为：“周期性麻痹”。1979年4月13日前来就诊。
[初诊]由专人陪伴来诊，步履困难。周期性下肢瘫痪每日发作，轻时蹲下后即不能起立，重则四肢皆瘫；发作时间约半小时到1小时，有时长达8小时以上。不服药也可以暂行缓解，次日又突然发作。受凉或疲乏后较易引发。两腿肌肉游走疼痛，并有凉麻感，四肢关节及腰部亦时觉痛胀。头晕痛，口干，无汗。舌质稍红，根部薄黄苔，脉浮紧。此为太阳证风寒湿痹，外邪郁闭，阻滞经络，长期凝聚不解。法宜解表开闭，散寒除湿，以麻黄汤加减主之。
处方：
麻黄10克杏仁12克苏叶10克防风10克法夏12克甘草15克因稍有热象，去桂枝，重用甘草；为加强祛风散寒除湿之力，加苏叶、防风、半夏以佐之。从4月13日至5月18日，月余内，每日一剂， 基本以此方加减。犯病程度逐渐减轻，时间缩短，能独立自由行动。
[辨证]患者病情复杂，周期性麻痹缠绵不愈，迁延数年，日益沉重。
《素问·痹论篇》云： “所谓痹者， 各以其时重感于风寒湿之气也。”本例病发于严冬，风寒湿邪，互相交织。肌肉关节疼痛，游走不定，为风痹之象；下肢时觉冷痛，遇寒加重，乃寒痹之候；肢体关节，尤其是双腿重着疼痛，又为湿痹之征。从主证来看，风寒湿痹，兼而有之。
《素问·痹论篇》还指出：“痹，或痛，或不痛，或不仁，或寒，或热，或燥，或湿”， “痛者，寒气多也，有寒，故痛也。其不痛、不仁者，病久入深，荣卫之行渣，经络时疏，故不通，皮肤不营，故为不仁”。本例患者时痛、时不痛，时麻木不仁，或寒、或热、或湿，虽证候纷纭，错综复杂，但其为太阳痹证则一也。
从病因病机分析，此证仍从太阳伤寒传变而来。’初诊证候，尚具头痛、肢体关节痛、无汗、脉浮紧，表明太阳伤寒表邪郁滞未解。不论病程长短，证候如何复杂，仍遵仲景“外证未解”， “当先解表”之旨。虽然本例表里相兼，亦应先解表而后治里，以期获“表解里自和”、或表轻里亦减之效。
[二诊]近日来间隔二、三日发作一次。未出现四肢瘫痪，仅下肢突然不能抬起，或蹲下不能站立，持续约2至3小时缓解。两腿肌肉串痛，凉麻较甚，只上半身出汗。邪中血脉，气血凝滞之象仍重。法宜活血通络，温经散寒，以当归四逆汤加味主之。
处方：
当归12克桂枝10克 白芍10克辽细辛3克木通10克 炙甘草6克 大枣20克生姜10克苏叶10克防风10克 牛膝10克木瓜10克(三诊)从5月22日至6月13日，以上方随证加减治之。发病间隔延长至五至七天，发作时间缩短，仅感四肢痿软无力，疼痛与凉麻亦减轻。为增强疗效，改投桂枝附子汤，进一步温其经脉，逐其风寒。并配服针砂丸荡涤湿邪。
处方一：
桂枝10克 制附片20克(久煎) 生姜20克炙甘草10克 大枣30克茯苓18克 白术15克处方二：
针砂硼砂绿矾 白矾神曲麦芽
木通广香甘草各30克研末为丸，每日一次，每次约5克。
服上方后，疼痛减，近日来仅有轻度发病。又间以麻黄汤、桂枝汤加减，散寒开闭，通阳解肌，并收通经络，开痹阻之效。
[四诊]7月14日。发病时，下肢疼痛痿弱进一步减轻，可自行站立； 发病时间缩短至1小时左右。7月11日犯病时，只觉左腿沉重，行步困难， 半小时后即缓解。病现向愈之佳兆，以五通散加味，舒筋通络为治。
处方：
血通12克木通10克通草6克 桂枝10克茯苓20克法夏20克苏叶10克防风lO克牛膝12克木瓜12克苡仁15克甘草3克伸筋草15克 五加皮15克 丝瓜络10克上方加减连服27剂，30余日未犯病；其后，曾交替服用当归四逆汤、桂枝附子汤及五通散加减。共25日未发病。
[五诊]9月以后。遇有外感或劳累，仅间有发病。平时下肢肌肉略有凉麻疼痛之感，腰微痛：10月中旬，病已显著好转，要求回单位工作。行前嘱其避风寒，忌生冷，注意调养，并拟五通散加味，令其缓服以资巩固。
处方：
血通10克木通10克通草6克桂枝6克白芍10克灵仙15克牛膝10克木瓜10克 。
钩藤10克 防风10克乳香10克 没药10克茯苓20克法夏20克甘草5克 生姜20克[按语]本例周期性麻痹，前医曾众说纷纭。从中医临证看，主要分歧，在于或痹或痿，或痹痿相兼?
一般说来， “痹”与“痿”应属两类病变：痹属寒与实；痿属热与虚。患者虽有肢体痿弱之象，乃由痹病痛久而废用，并非“五脏因肺热叶焦，发为痿躄”(《素问·痿论篇》)。当然，致痿的原因甚多，但其主因为五脏，如肺脏之热。而本案主要为“风、寒、 湿三气杂至，合而为痹” (《素问·痹论篇》)，属太阳证。故坚持温通之法为治。
太阳证水疝
何××，男，6个月。成都某局职工之子。
[诊治]1960年8月。患儿连日来，哭啼不休，饮食大减，面青黄，体消瘦，父母不知何故。某日突然发现小儿阴囊肿胀，如鸡子大，似水晶重坠，少腹按之有水声，急来求诊。此为寒湿凝聚，经脉不通，气滞于下，水湿浸渍于阴囊。法宜化气行水，温肾散寒，以五苓散加味主之。
[第二次就诊]服用上方三剂后，下肢逐渐能够屈伸，各种症状都有好转。遵循原法，加入辽细辛再服两剂。
[第三次就诊]膝关节及脚部的肿胀消退，膝面的硬结缩小、变软。全身关节仍有轻微疼痛，在原方基础上加减继续服用。
处方：
桂枝10克 赤芍12克 麻黄10克 生姜10克 白术12克 甘草3克 防风10克 茯苓12克 川芎10克 柴胡10克 前胡10克 羌活10克 独活10克 辽细辛3克
嘱咐服用数剂后可停药，注意生活调养，忌食生冷食物并预防风寒侵袭。
一个多月后，患者的父亲前来告知，小儿的关节已不再疼痛，双膝硬结消失，疾病已经痊愈。1979年7月随访时，其母亲说：玉儿已经长成大人，身体非常健壮。自从范老告诫后，不准他洗冷水澡、吃生冷之物，四年来疾病未复发。
[按语]以上四个病例均为太阳证（Taiyang syndrome，指外感病初期，邪在肌表所表现的证候），西医辨病大体相同。但范老临床施治的方药各不相同：田例为风湿之邪滞留于肌腠（肌肉与皮肤之间的空隙），导致下肢局部气血阻滞，用桂枝汤（Cinnamon Twig Decoction）加味轻取之；杨例为风湿相搏，卫阳（Defensive Yang，指运行于体表具有防御功能的阳气）已虚，腰部剧痛不能转侧，在桂枝附子汤（Cinnamon Twig and Aconite Root Decoction）中重用附子（Aconiti Lateralis Radix Praeparata，炮制过的侧根），以温经逐邪，助肾阳而立卫阳之基；汤例为风寒湿邪久留骨节，又突然加重，在甘草附子汤（Licorice and Aconite Root Decoction）中重用附子，速开筋骨之痹阻；柴例病属历节（Lijie，一种以关节剧烈疼痛、变形为特征的痹证），兼有风从热化之象，故去掉附子，后来加入羌活、独活、柴胡、前胡而收功。这四例皆属于太阳证的范畴，或称为太阳类似证，病因与病位相似，但理、法、方、药有所不同。可见范老既重“辨证”（Syndrome differentiation，根据症状判断证候类型），又严“论治”（Treatment based on syndrome differentiation，根据证候制定治疗方案），且善于“同病异治”（Treating the same disease with different methods）。
太阳证风寒湿痹（Sciatica，坐骨神经痛）
李××，男，46岁。铁道部某厂干部。
[病史]1974年底，腰臀部疼痛放射至双下肢，左侧更为严重，行动日益困难。××职工医院诊断为风湿性坐骨神经痛。经过针灸、中西药治疗，效果不明显。遂发展至下肢难以行动，生活不能自理。于1975年2月底，由工厂派专人护送来成都求治。
[初次就诊]患者卧床不起，翻身需由他人协助，腰臀部及下肢麻木疼痛沉重，左下肢尤为严重，活动患肢则疼痛加重。恶风寒（怕冷怕风），头痛，小腹胀满，小便不利（排尿困难），双下肢凹陷性水肿。面色黄而无光泽，舌质淡红，苔白滑厚腻，根部微黄。此证属风寒湿痹（Bi syndrome caused by wind, cold, and dampness，因风、寒、湿邪闭阻经络引起的肢体关节疼痛、重着、屈伸不利等症），湿邪偏胜。急当温阳化气行水，以五苓散（Wuling Powder，利水渗湿方剂）加味主之。
处方：
猪苓10克 茯苓20克 泽泻10克 砂仁10克 白术15克 桂枝15克 上肉桂10克 五加皮12克 三剂
[第二次就诊]服用上方后，尿量增多，腹部及下肢肿胀减轻，但疼痛无明显改变。针对主证，以助阳胜湿、散风止痛的甘草附子汤加味主之。
处方：
炙甘草30克 制附片120克（久煎） 桂枝15克 生白术20克 生姜60克 云苓30克 四剂
[第三次就诊]服用上方后，全身关节疼痛减轻，扶杖可下地缓步而行。宜用原法，再少佐麻黄、辽细辛，以增强开闭、散寒、行水之力。
处方：
炙甘草30克 制附片120克（久煎） 生白术20克 桂枝15克 生姜60克 麻黄10克 辽细辛4克 云苓20克 五剂
[第四次就诊]头痛，腰臀部及下肢疼痛大减，离杖能行。肢肿基本消失，尚有寒湿凝聚、经络受阻之象，继以活血通络、舒筋散淤之品调理之。
处方：
桂枝木 通草 红藤 威灵仙 当归 川芎
猴骨 海马 松节 牛膝 木瓜 乳香 没药 苏木 辽细辛 羌活 独活 柴胡 前胡 血竭 伸筋草
以上各10克，共为细末，水打丸。每晚睡前用白酒兑服3克。
服药20余日后，病愈恢复工作。1979年7月20日随访，至今未复发。
[按语]本例太阳痹证，以湿邪偏胜。急投五苓散加味，不仅急则治标，同时化气行水，即为治本。前贤曾称“五苓散，逐内外水饮之首剂。”而桂枝为此方之关键，故重用之，以增强通阳化气行水之力。另加上肉桂，补命门真火（Mingmen true fire，指肾阳的根本动力），助气化，散寒凝；加砂仁醒脾化湿，行气宽中以消胀满，且能纳气归肾以助膀胱之气化；再用五加皮祛风湿之痹痛，疗经络之拘挛，且有利小便、消水肿之效。服药三剂而病获转机。然后抓住风寒湿致疼痛之主证，继用甘草附子汤。白术、附子，顾里胜湿；桂枝、甘草，顾表胜风；重用附子，温里扶阳，除痹止痛。冠以甘草者，意在缓而行之。最终，再用活血通络之法以善其后。
太阳证风寒湿痹（Periodic Paralysis，周期性麻痹）
刘××，男，45岁。辽宁省抚顺市某局干部。
[病史]1975年2月，参加抗震救灾工作。当时气温降至零下20度，在雪地临时架设帐篷办公和食宿。2月17日深夜，起床接长途电话，衣着单薄，持续约20分钟，后感下肢冷麻。翌日，遂不能站立。经医疗队以抗风湿治疗无效，第五日即四肢瘫痪。2月24日送回抚顺，××职工医院外科诊断为“筋肌纤维质炎”。又转××医院治疗，当时膝关节红肿，诊断为“急性风湿症”。
此后三年内，时好时坏，反复发作。多次住院，有一次长达200多天。1979年1月9日瘫痪复发后，病情加重，每日反复发病，大腿肌肉呈阵发性游走疼痛，轻则起立困难，重则卧床不起。经辽宁省某中医医院内科，先后诊断为：“痹证”、“痿证”（Wei syndrome，以肢体筋脉弛缓、软弱无力为主要表现的病证）、“痿痹兼证”、“风痱”。沈阳××医院内科、神经内科会诊，诊断为“发作性瘫痪待诊”，并建议转北京诊治。在北京××医学院附院确诊为：“周期性麻痹”。1979年4月13日前来就诊。
[初次就诊]由专人陪伴来诊，步履困难。周期性下肢瘫痪每日发作，轻时蹲下后即不能起立，重则四肢皆瘫；发作时间约半小时到1小时，有时长达8小时以上。不服药也可以暂行缓解，次日又突然发作。受凉或疲乏后较易引发。两腿肌肉游走疼痛，并有凉麻感，四肢关节及腰部亦时觉痛胀。头晕痛，口干，无汗。舌质稍红，根部薄黄苔，脉浮紧。此为太阳证风寒湿痹，外邪郁闭，阻滞经络，长期凝聚不解。法宜解表开闭，散寒除湿，以麻黄汤（Ephedra Decoction，发汗解表方剂）加减主之。
处方：
麻黄10克 杏仁12克 苏叶10克 防风10克 法夏12克 甘草15克
因稍有热象，去桂枝，重用甘草；为加强祛风散寒除湿之力，加苏叶、防风、半夏以佐之。从4月13日至5月18日，月余内，每日一剂，基本以此方加减。犯病程度逐渐减轻，时间缩短，能独立自由行动。
[辨证]患者病情复杂，周期性麻痹缠绵不愈，迁延数年，日益沉重。
《素问·痹论篇》云：“所谓痹者，各以其时重感于风寒湿之气也。”本例病发于严冬，风寒湿邪，互相交织。肌肉关节疼痛，游走不定，为风痹之象；下肢时觉冷痛，遇寒加重，乃寒痹之候；肢体关节，尤其是双腿重着疼痛，又为湿痹之征。从主证来看，风寒湿痹，兼而有之。
《素问·痹论篇》还指出：“痹，或痛，或不痛，或不仁，或寒，或热，或燥，或湿”，“痛者，寒气多也，有寒，故痛也。其不痛、不仁者，病久入深，荣卫之行涩，经络时疏，故不通，皮肤不营，故为不仁”。本例患者时痛、时不痛，时麻木不仁，或寒、或热、或湿，虽证候纷纭，错综复杂，但其为太阳痹证则一也。
从病因病机分析，此证仍从太阳伤寒传变而来。初诊证候，尚具头痛、肢体关节痛、无汗、脉浮紧，表明太阳伤寒表邪郁滞未解。不论病程长短，证候如何复杂，仍遵仲景“外证未解”，“当先解表”之旨。虽然本例表里相兼，亦应先解表而后治里，以期获“表解里自和”、或表轻里亦减之效。
[第二次就诊]近日来间隔二、三日发作一次。未出现四肢瘫痪，仅下肢突然不能抬起，或蹲下不能站立，持续约2至3小时缓解。两腿肌肉串痛，凉麻较甚，只上半身出汗。邪中血脉，气血凝滞之象仍重。法宜活血通络，温经散寒，以当归四逆汤（Angelica Sinensis Decoction for Frigid Extremities，养血通脉、温经散寒方剂）加味主之。
处方：
当归12克 桂枝10克 白芍10克 辽细辛3克 木通10克 炙甘草6克 大枣20克 生姜10克 苏叶10克 防风10克 牛膝10克 木瓜10克
[第三次就诊]从5月22日至6月13日，以上方随证加减治之。发病间隔延长至五至七天，发作时间缩短，仅感四肢痿软无力，疼痛与凉麻亦减轻。为增强疗效，改投桂枝附子汤，进一步温其经脉，逐其风寒。并配服针砂丸荡涤湿邪。
处方一：
桂枝10克 制附片20克（久煎） 生姜20克 炙甘草10克 大枣30克 茯苓18克 白术15克
处方二：
针砂 硼砂 绿矾 白矾 神曲 麦芽 木通 广香 甘草 各30克 研末为丸，每日一次，每次约5克。
服上方后，疼痛减，近日来仅有轻度发病。又间以麻黄汤、桂枝汤加减，散寒开闭，通阳解肌，并收通经络，开痹阻之效。
[第四次就诊]7月14日。发病时，下肢疼痛痿弱进一步减轻，可自行站立；发病时间缩短至1小时左右。7月11日犯病时，只觉左腿沉重，行步困难，半小时后即缓解。病现向愈之佳兆，以五通散加味，舒筋通络为治。
处方：
血通 木通 通草 桂枝 茯苓 法夏 苏叶 防风 牛膝 木瓜 苡仁 甘草 伸筋草 五加皮 丝瓜络
上方加减连服27剂，30余日未犯病；其后，曾交替服用当归四逆汤、桂枝附子汤及五通散加减。共25日未发病。
[第五次就诊]9月以后。遇有外感或劳累，仅间有发病。平时下肢肌肉略有凉麻疼痛之感，腰微痛；10月中旬，病已显著好转，要求回单位工作。行前嘱其避风寒，忌生冷，注意调养，并拟五通散加味，令其缓服以资巩固。
处方：
血通 木通 通草 桂枝 白芍 灵仙 牛膝 木瓜 钩藤 防风 乳香 没药 茯苓 法夏 甘草 生姜
[按语]本例周期性麻痹，前医曾众说纷纭。从中医临证看，主要分歧，在于或痹或痿，或痹痿相兼？
一般说来，“痹”与“痿”应属两类病变：痹属寒与实；痿属热与虚。患者虽有肢体痿弱之象，乃由痹病痛久而废用，并非“五脏因肺热叶焦，发为痿躄”（《素问·痿论篇》）。当然，致痿的原因甚多，但其主因为五脏，如肺脏之热。而本案主要为“风、寒、湿三气杂至，合而为痹”（《素问·痹论篇》），属太阳证。故坚持温通之法为治。
太阳证水疝（Hydrocele，鞘膜积液）
何××，男，6个月。成都某局职工之子。
[诊治]1960年8月。患儿连日来，哭啼不休，饮食大减，面青黄，体消瘦，父母不知何故。某日突然发现小儿阴囊肿胀，如鸡子大，似水晶重坠，少腹按之有水声，急来求诊。此为寒湿凝聚，经脉不通，气滞于下，水湿浸渍于阴囊。法宜化气行水，温肾散寒，以五苓散加味主之。
[Second Visit] After taking three doses of the previous prescription, the lower limbs gradually became capable of flexion and extension, and all symptoms showed improvement. Adhering to the original method, Liaoxixin (Asari Radix et Rhizoma) was added, and two more doses were taken.
[Third Visit] The swelling at the knee joints and feet subsided, and the hard nodules on the knees shrank and softened. There was still slight pain in the whole body's joints; the original prescription was modified and continued.
Prescription:
Guizhi (Cinnamomi Ramulus) 10g, Chishao (Paeoniae Radix Rubra) 12g, Mahuang (Ephedrae Herba) 10g, Shengjiang (Zingiberis Rhizoma Recens) 10g, Baizhu (Atractylodis Macrocephalae Rhizoma) 12g, Gancao (Glycyrrhizae Radix et Rhizoma) 3g, Fangfeng (Saposhnikoviae Radix) 10g, Fuling (Poria) 12g, Chuanxiong (Chuanxiong Rhizoma) 10g, Chaihu (Bupleuri Radix) 10g, Qianhu (Peucedani Radix) 10g, Qianghuo (Notopterygii Rhizoma et Radix) 10g, Duhuo (Angelicae Pubescentis Radix) 10g, Liaoxixin (Asari Radix et Rhizoma) 3g.
Instructions: Take several doses, then stop medication. Pay attention to lifestyle regulation, avoid raw and cold foods, and prevent wind-cold invasion.
More than a month later, the patient's father reported that the child's joints no longer hurt, the hard nodules on both knees had disappeared, and the illness was cured. In July 1979, during follow-up, the mother stated: "Yu'er has grown into an adult and is very healthy. Since Fan Lao's advice, he was not allowed to take cold showers or eat raw/cold foods, and the illness has not recurred in four years."
[Commentary] The above four cases are all Taiyang syndromes (Taiyang syndrome), which are broadly similar in Western medical diagnosis. However, Fan Lao's clinical prescriptions varied for each case: In Tian's case, wind-damp pathogens remained in the muscle-cou li (interstices between skin and muscle), causing local qi-blood stagnation in the lower limbs; Guizhi Tang (Cinnamon Twig Decoction) with modifications was used to gently resolve it. In Yang's case, wind-damp were struggling, and defensive yang (Wei Yang) was deficient, causing severe waist pain preventing turning; Aconitum (Fuzi) was heavily used in Guizhi Fuzi Tang (Cinnamon Twig and Aconite Root Decoction) to warm meridians, expel pathogens, and support kidney yang to establish the foundation of defensive yang. In Tang's case, wind-cold-damp pathogens had lingered in bone joints for a long time and suddenly worsened; Aconitum (Fuzi) was heavily used in Gancao Fuzi Tang (Licorice and Aconite Root Decoction) to quickly open bone-joint bi-obstruction. In Chai's case, the illness belonged to Lijie (a type of bi-syndrome characterized by severe joint pain and deformity), with signs of wind transforming into heat; thus, Aconitum (Fuzi) was removed, and Qianghuo, Duhuo, Chaihu, and Qianhu were added later to achieve success. All four cases belong to the category of Taiyang syndrome, or can be called Taiyang-like syndromes. Although the etiology and location are similar, the theory, method, prescription, and herbs differ. This shows that Fan Lao emphasizes both "syndrome differentiation" and strict "treatment based on syndrome differentiation," and is skilled in "treating the same disease with different methods."
Taiyang Syndrome Wind-Cold-Damp Bi (Sciatica)
Li XX, Male, 46 years old. Cadre at a certain factory under the Ministry of Railways.
[Medical History] At the end of 1974, pain in the waist and buttocks radiated to both lower limbs, worse on the left side, making movement increasingly difficult. Diagnosed as rheumatic sciatica at XX Workers' Hospital. Acupuncture and Chinese/Western medicines showed little effect. It progressed to the point where walking was difficult and self-care was impossible. In late February 1975, sent by the factory with a dedicated escort to Chengdu for treatment.
[First Visit] The patient was bedridden, needing assistance to turn over. Numbness, pain, and heaviness in the waist, buttocks, and lower limbs, especially severe in the left leg; moving the affected limb aggravated the pain. Aversion to wind and cold, headache, fullness in the lower abdomen, difficulty urinating, pitting edema in both lower limbs. Sallow complexion without luster, pale-red tongue coating, thick greasy white coating, slightly yellow at the root. This syndrome belongs to Wind-Cold-Damp Bi, with dampness being predominant. Urgent warming of yang, transformation of qi, and promotion of water metabolism are required; Wuling San (Wuling Powder) with modifications is the main treatment.
Prescription:
Zhuling (Polyporus) 10g, Fuling (Poria) 20g, Zexie (Alismatis Rhizoma) 10g, Sharen (Amomi Fructus Rotundus) 10g, Baizhu (Atractylodis Macrocephalae Rhizoma) 15g, Guizhi (Cinnamomi Ramulus) 15g, Shangrougui (Cinnamomi Cortex) 10g, Wujiapi (Acanthopanacis Cortex) 12g. Three doses.
[Second Visit] After taking the previous prescription, urine volume increased, and abdominal and lower limb swelling decreased, but pain did not change significantly. Addressing the main symptom, Gancao Fuzi Tang (Licorice and Aconite Root Decoction) with modifications to assist yang, overcome dampness, dispel wind, and relieve pain was used.
Prescription:
Zhi Gancao (Prepared Licorice) 30g, Zhi Fupian (Prepared Aconite Slice) 120g (long decoction), Guizhi (Cinnamomi Ramulus) 15g, Sheng Baizhu (Raw Atractylodes) 20g, Shengjiang (Zingiberis Rhizoma Recens) 60g, Yunling (Poria) 30g. Four doses.
[Third Visit] After taking the previous prescription, whole-body joint pain decreased, and the patient could walk slowly with a cane. The original method should be continued, adding small amounts of Mahuang (Ephedrae Herba) and Liaoxixin (Asari Radix et Rhizoma) to enhance the power of opening closure, dispelling cold, and promoting water metabolism.
Prescription:
Zhi Gancao (Prepared Licorice) 30g, Zhi Fupian (Prepared Aconite Slice) 120g (long decoction), Sheng Baizhu (Raw Atractylodes) 20g, Guizhi (Cinnamomi Ramulus) 15g, Shengjiang (Zingiberis Rhizoma Recens) 60g, Mahuang (Ephedrae Herba) 10g, Liaoxixin (Asari Radix et Rhizoma) 4g, Yunling (Poria) 20g. Five doses.
[Fourth Visit] Headache, waist/buttock/lower limb pain greatly reduced; the patient could walk without a cane. Limb swelling basically disappeared, but there were still signs of cold-damp accumulation and meridian obstruction. Continue regulating with herbs that invigorate blood, unblock collaterals, relax sinews, and dissipate stasis.
Prescription:
Guizhimu (Cinnamomi Ramulus Pulp), Tongcao (Tetrapanacis Medulla), Hongteng (Sargentodoxae Caulis), Weilingxian (Salviae Miltiorrhizae Radix et Rhizoma - *Note: Usually refers to Clematidis Radix et Rhizoma in this context*), Danggui (Angelicae Sinensis Radix), Chuanxiong (Chuanxiong Rhizoma).
Hougou (Monkey Bone), Haima (Seahorse), Songjie (Pinus Node), Niuxi (Achyranthis Bidentatae Radix), Mugua (Chaenomelis Fructus), Ruxiang (Olibanum), Moyao (Myrrha), Sumu (Pterocarpi Santalinus Lignum), Liaoxixin (Asari Radix et Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Chaihu (Bupleuri Radix), Qianhu (Peucedani Radix), Xuexie (Dracaenae Sanguis), Shenjincacao (Lycopodium Herb).
All 10g each, ground into fine powder, made into pills with water. Take 3g mixed with white wine before bed every night.
After taking the medicine for more than 20 days, the illness was cured, and work resumed. Follow-up on July 20, 1979, showed no recurrence since.
[Commentary] This case of Taiyang Bi syndrome is dominated by dampness. Urgently administering Wuling San with modifications not only treats the branch symptoms urgently but also transforms qi and promotes water metabolism, addressing the root. Ancients called "Wuling San the first formula for driving out internal and external fluid retention." Guizhi is the key to this formula, so it was heavily used to enhance the power of unblocking yang, transforming qi, and promoting water metabolism. Additionally, Shangrougui (Cinnamon Bark) was added to tonify Mingmen true fire, assist qi transformation, and disperse cold coagulation; Sharen (Amomi Fructus) was added to awaken the spleen, transform dampness, move qi, broaden the middle to reduce fullness, and guide qi back to the kidney to assist bladder qi transformation; Wujiapi (Acanthopanax Bark) was used to dispel wind-damp bi-pain, treat meridian spasms, and promote urination and reduce edema. After three doses, the condition turned. Then, grasping the main symptom of pain caused by wind-cold-damp, Gancao Fuzi Tang was continued. Baizhu and Fuzi protect the interior and overcome dampness; Guizhi and Gancao protect the exterior and overcome wind; heavy use of Fuzi warms the interior, supports yang, removes bi, and relieves pain. Prefacing with Gancao intends to act gently. Finally, blood-invigorating and meridian-unblocking methods were used to conclude the treatment.
Taiyang Syndrome Wind-Cold-Damp Bi (Periodic Paralysis)
Liu XX, Male, 45 years old. Cadre at a certain bureau in Fushun City, Liaoning Province.
[Medical History] In February 1975, participated in earthquake relief work. The temperature dropped to minus 20 degrees Celsius, setting up temporary tents for office and living in the snow. Late at night on February 17, got up to answer a long-distance call, wearing thin clothes for about 20 minutes, subsequently feeling cold numbness in the lower limbs. The next day, unable to stand. Anti-rheumatic treatment by the medical team was ineffective; by the fifth day, quadriplegia occurred. Returned to Fushun on February 24; XX Workers' Hospital Surgery diagnosed "myofibrositis." Transferred to XX Hospital for treatment; knee joints were red and swollen, diagnosed as "acute rheumatism."
Over the next three years, fluctuating and recurring. Multiple hospitalizations, one lasting over 200 days. After paralysis recurred on January 9, 1979, the condition worsened, with daily recurrent episodes, paroxysmal wandering pain in thigh muscles, difficulty standing when mild, and bedridden when severe. Diagnosed sequentially by Internal Medicine at a TCM Hospital in Liaoning as: "Bi Syndrome," "Wei Syndrome" (Wei syndrome), "Combined Wei-Bi Syndrome," "Fengfei." Consultations at Internal Medicine and Neurology at Shenyang XX Hospital diagnosed "Paroxysmal Paralysis Pending Diagnosis," suggesting transfer to Beijing for treatment. Confirmed as "Periodic Paralysis" at the Affiliated Hospital of XX Medical College in Beijing. Came for consultation on April 13, 1979.
[First Visit] Accompanied by staff, difficult to walk. Periodic lower limb paralysis occurs daily; mildly, unable to stand after squatting; severely, quadriplegia; duration about half an hour to one hour, sometimes over 8 hours. Temporary relief without medication, sudden recurrence the next day. More likely triggered by cold exposure or fatigue. Wandering pain in leg muscles with cold/numb sensation; occasional pain/swelling in limb joints and waist. Dizziness/headache, dry mouth, no sweat. Slightly red tongue, thin yellow coating at root, floating-tight pulse. This is Taiyang Syndrome Wind-Cold-Damp Bi, external pathogens trapped, blocking meridians, accumulating long-term unresolved. Method: Release exterior, open closure, dispel cold, remove dampness; Mahuang Tang (Ephedra Decoction) with modifications is the main treatment.
Prescription:
Mahuang (Ephedrae Herba) 10g, Xingren (Armeniacae Semen Amarum) 12g, Ziye (Perillae Folium) 10g, Fangfeng (Saposhnikoviae Radix) 10g, Faxia (Pinelliae Rhizoma Preparatum) 12g, Gancao (Glycyrrhizae Radix et Rhizoma) 15g.
Due to slight heat signs, Guizhi was removed, and Gancao was heavily used; to strengthen wind-dispelling, cold-resolving, and damp-removing power, Ziye, Fangfeng, and Banxia were added as assistants. From April 13 to May 18, over a month, one dose daily, basically modifying this prescription. Severity gradually decreased, duration shortened, able to move independently.
[Syndrome Differentiation] The patient's condition is complex; periodic paralysis persists unremittingly, dragging on for years, becoming increasingly severe.
The *Suwen: Pi Lun Pian* states: "What is called Bi is repeatedly contracting wind-cold-damp qi at their respective seasons." This case started in deep winter, with wind-cold-damp pathogens intertwining. Muscle/joint pain, wandering不定, indicates Wind-Bi; lower limbs feeling cold/pain, worsening with cold, indicates Cold-Bi; limb joints, especially heavy/painful legs, indicate Damp-Bi. From the main symptoms, Wind-Cold-Damp Bi is present simultaneously.
The *Suwen: Pi Lun Pian* also points out: "Bi may present with pain, no pain, numbness, cold, heat, dryness, or dampness... Pain is due to excessive cold qi; having cold causes pain. No pain/numbness means the disease has entered deeply over a long time, Ying-Wei flow becomes stagnant, meridians are occasionally sparse, thus no blockage, skin lacks nourishment, hence numbness." This patient experiences intermittent pain/no pain, numbness, cold/heat/dampness. Although symptoms are chaotic and complex, it remains a Taiyang Bi syndrome.
From etiology and pathogenesis analysis, this syndrome still evolved from Taiyang Cold Damage. Initial symptoms included headache, limb/joint pain, no sweat, floating-tight pulse, indicating Taiyang Cold Damage exterior pathogens were trapped and unresolved. Regardless of disease duration or complexity, adhering to Zhongjing's principle of "if exterior syndrome is unresolved, resolve the exterior first" is essential. Although this case involves both exterior and interior, resolving the exterior first and then treating the interior aims for "when exterior resolves, interior harmonizes" or reducing interior symptoms as exterior lightens.
[Second Visit] Recently, episodes occur every two to three days. No quadriplegia, only sudden inability to lift lower limbs or stand from squatting, relieving after 2-3 hours. Wandering pain in leg muscles, severe cold/numbness, sweating only on upper body. Pathogens entered blood vessels, signs of qi-blood stagnation remain heavy. Method: Invigorate blood, unblock collaterals, warm meridians, dispel cold; Danggui Sini Tang (Angelica Sinensis Decoction for Frigid Extremities) with modifications is the main treatment.
Prescription:
Danggui (Angelicae Sinensis Radix) 12g, Guizhi (Cinnamomi Ramulus) 10g, Baishao (Paeoniae Radix Alba) 10g, Liaoxixin (Asari Radix et Rhizoma) 3g, Mutong (Akebiae Caulis) 10g, Zhi Gancao (Prepared Licorice) 6g, Dazao (Jujubae Fructus) 20g, Shengjiang (Zingiberis Rhizoma Recens) 10g, Ziye (Perillae Folium) 10g, Fangfeng (Saposhnikoviae Radix) 10g, Niuxi (Achyranthis Bidentatae Radix) 10g, Mugua (Chaenomelis Fructus) 10g.
[Third Visit] From May 22 to June 13, treated with modifications of the above prescription. Episode interval extended to five to seven days, duration shortened, only feeling flaccid weakness in limbs, pain and cold/numbness also decreased. To enhance efficacy, switched to Guizhi Fuzi Tang (Cinnamon Twig and Aconite Root Decoction) to further warm meridians and expel wind-cold. Also prescribed Zhensha Wan (Needle Sand Pill) to wash away dampness.
Prescription 1:
Guizhi (Cinnamomi Ramulus) 10g, Zhi Fupian (Prepared Aconite Slice) 20g (long decoction), Shengjiang (Zingiberis Rhizoma Recens) 20g, Zhi Gancao (Prepared Licorice) 10g, Dazao (Jujubae Fructus) 30g, Fuling (Poria) 18g, Baizhu (Atractylodis Macrocephalae Rhizoma) 15g.
Prescription 2:
Zhensha (Hematitum), Pengsha (Borax), Lvfan (Chalcanthitum), Baijian (Alumen), Shenqu (Massa Medicata Fermentata), Maiya (Hordei Fructus Germinatus), Mutong (Akebiae Caulis), Guangxiang (Costi Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma) 30g each, ground into powder, made into pills. Once daily, approx. 5g per dose.
After taking the above, pain decreased, only mild episodes recently. Intermittently using modified Mahuang Tang and Guizhi Tang to dispel cold, open closure, unblock yang, release muscle, and achieve meridian unblocking and bi-opening effects.
[Fourth Visit] July 14. During episodes, lower limb pain/flaccidity further decreased, able to stand independently; episode duration shortened to about 1 hour. On July 11, during an episode, only felt left leg heaviness, difficulty walking, relieved after half an hour. Good signs of recovery; Wutong San (Five Unblocking Powder) with modifications to relax sinews and unblock collaterals is the treatment.
Prescription:
Xuetong (Spatholobi Caulis), Mutong (Akebiae Caulis), Tongcao (Tetrapanacis Medulla), Guizhi (Cinnamomi Ramulus), Fuling (Poria), Faxia (Pinelliae Rhizoma Preparatum), Ziye (Perillae Folium), Fangfeng (Saposhnikoviae Radix), Niuxi (Achyranthis Bidentatae Radix), Mugua (Chaenomelis Fructus), Yiren (Coicis Semen), Gancao (Glycyrrhizae Radix et Rhizoma), Shenjincacao (Lycopodium Herb), Wujiapi (Acanthopanacis Cortex), Sigualuo (Luffae Fructus Retinervus).
Taking the above modified prescription continuously for 27 doses, no episodes for over 30 days; thereafter, alternately took modified Danggui Sini Tang, Guizhi Fuzi Tang, and Wutong San. No episodes for 25 days total.
[Fifth Visit] After September. Only occasional episodes upon catching cold or fatigue. Normally, slight cold/numb/pain sensation in lower limb muscles, slight waist pain; mid-October, condition significantly improved, requested to return to work. Before leaving, advised to avoid wind-cold, avoid raw/cold foods, pay attention to regulation, and prescribed modified Wutong San to take slowly for consolidation.
Prescription:
Xuetong (Spatholobi Caulis) 10g, Mutong (Akebiae Caulis) 10g, Tongcao (Tetrapanacis Medulla) 6g, Guizhi (Cinnamomi Ramulus) 6g, Baishao (Paeoniae Radix Alba) 10g, Lingxian (Salviae Miltiorrhizae Radix et Rhizoma - *Note: Often refers to Weilingxian/Clematidis Radix et Rhizoma in common parlance, but character is Lingxian*), Niuxi (Achyranthis Bidentatae Radix) 10g, Mugua (Chaenomelis Fructus) 10g, Gouteng (Uncariae Ramulus cum Uncis) 10g, Fangfeng (Saposhnikoviae Radix) 10g, Ruxiang (Olibanum) 10g, Moyao (Myrrha) 10g, Fuling (Poria) 20g, Faxia (Pinelliae Rhizoma Preparatum) 20g, Gancao (Glycyrrhizae Radix et Rhizoma) 5g, Shengjiang (Zingiberis Rhizoma Recens) 20g.
[Commentary] For this case of periodic paralysis, previous doctors had various opinions. From a TCM clinical perspective, the main divergence lies in whether it is Bi or Wei, or a combination of Bi and Wei?
Generally, "Bi" and "Wei" belong to two types of lesions: Bi belongs to cold and excess; Wei belongs to heat and deficiency. Although the patient showed signs of limb flaccidity, it was due to prolonged Bi pain leading to disuse, not "five zang organs suffering from lung heat drying leaves, developing into Wei Bi" (*Suwen: Wei Lun Pian*). Of course, there are many causes of Wei, primarily involving the five zang organs, such as lung heat. But this case is mainly "wind, cold, damp three qi mixing together, combining to form Bi" (*Suwen: Pi Lun Pian*), belonging to Taiyang syndrome. Therefore, persisting with warming and unblocking methods for treatment.
Taiyang Syndrome Water Hernia (Hydrocele)
He XX, Male, 6 months old. Son of a staff member at a certain bureau in Chengdu.
[Treatment] August 1960. The infant cried incessantly for days, appetite greatly reduced, face greenish-yellow, emaciated, parents unaware of the cause. One day, suddenly discovered scrotal swelling like an egg, heavy and hanging like crystal, water sound heard upon pressing the lower abdomen, urgently seeking consultation. This is cold-damp accumulation, meridian blockage, qi stagnation below, water-damp soaking the scrotum. Method: Transform qi, promote water metabolism, warm kidney, dispel cold; Wuling San (Wuling Powder) with modifications is the main treatment.