[一诊]1978年8月1日。腹时痛，喜温喜按。下利稀薄，口不渴，不思饮食。神疲体弱，面色苍黄无泽。舌质淡，苔白厚腻。触诊肢冷甚。证属太阴虚寒证泄泻，法宜祛寒除湿，实脾固肾。先以四逆汤，继以理中汤加味主之。
处方一：
制附片60克(久煎) 干姜30克炙甘草30克处方二：
制附片60克(久煎) 干姜18克炒白术24克茯苓15克炙甘草30克上肉桂6克红枣30克各五剂
(辨证]《伤寒论》日：“自利不渴者，属太阴，以其脏有寒故也，当温之，宜服四逆辈”。患者肢冷，口不渴，舌质淡，苔白而厚腻，皆湿寒阻滞之象，为太阴虚寒之证。
太阴在脏为脾，脾主运化，脾虚邪陷，则中阳不振；寒湿不化，气机阻滞，故腹满时痛；脾气不升，寒湿下注，故下利益甚；脾失健运，后天失调，故不思饮食。但必须指出，此证不仅在中州；长期泄泻，不可单责之于脾。所谓“五脏之伤，穷必及肾”。患者神疲恶寒，面色苍黄，显系下元亏损，命门火衰，肾阳不振。王和安云：“但温其中宜理中，温其中兼温其下宜四逆。”故一诊即投之以四逆、理中相继为治。
(二诊]8月23日。服药后，腹泻止，精神、睡眠均好转，食量增加。面色略转红润，舌淡红，白腻苔减。多年陈疾，初获显效。但久病后，脾肾阳虚，不能骤复，宜继守原法，效不改方，加减再进。
处方：
制附片60克(久煎) 炒白术24克 干姜18克炙甘草15克 红枣30克 上肉桂6克(冲服)
茯苓15克[三诊]8月26日。近半月来，大便趋于正常。上方加减，嘱其续服一段时间，并注意忌食生冷，防止受凉，以资巩固。
1979年4月20日追访，患者说：自去年8月服药后，从此未再腹泻。
太阴证睑废
(重症肌无力眼肌型)
文××，女，6岁。卫生部职工之女。
[病史]1976年1月20日晚，家长突然发现患儿眼缝缩小，眯眼斜视。旋即右眼胞下垂，无力睁开，复视。1976年2月，中国人民解放军总医院肌注“新斯的明”试验，呈阳性反应，诊为“重症肌无力(眼肌型)”，待查。同年3月28日，北京同仁医院确诊为眼睑“重症肌无力”。1977年3月29日，转××医院．中医诊治一年。虽曾短暂开大睑裂，但上胞重新下垂后，反复治疗无效。1978年5月10日来诊，按太阴证睑废论治，三月基本治愈，现已巩固一年余。
[初诊)右眼睑下垂而肿，视物困难，复视，午后尤重。面色微黄，乏力。舌质润红而暗；苔白灰黄、根部厚腻浊密布。此系脾湿之邪，蕴积已久，表实未解，上窜眼胞所致。证属足太阴睑废，法宜开闭除湿，宗仲景甘草麻黄汤方意主之。
处方：
麻黄3克法夏12克 甘草6克三剂
[辨证]眼睑属脾。脾主肌肉四肢，不仅专司运化水谷之精微，且-仃传导水湿之功用。患儿面黄乏力，乃脾困之象。更以舌象分析，苔虽白黄粘腻，但质淡湿润，显系表实未解，寒邪久闭；脾湿之邪，蕴积益深。眼睑既属于脾，今水湿之邪不得外泄，而循经上窜于眼睑，以致眼睑肿垂，无力开裂，故属足太阴之证。
《金匮要略》云： “里水……甘草麻黄汤亦主之”。吴谦等按：里水之“里”字，当是“皮”字。其意乃皮水表实无热者，则当用此发其汗，使水从皮毛而去。今本其意而变通其法：以麻黄之辛温，开诸闭，驱水邪；半夏性燥而去湿，脾胃得之而健；甘草味甘，火土之色，补太阴大有奇功；配麻黄，更有通利寒湿之效，麻黄、半夏、甘草配伍，辛甘化阳，阳盛则湿消；甘草倍麻黄，化湿而不伤元气。
上方服三剂后，眼皮稍可活动。原方加桂枝，温通经脉，辛以散邪；配杏仁，疏理肺窍，入手太阴以利水之上源。再服一剂，患儿眼睑开裂稍大，后随证加减。
6月初，患儿曾有一整日可略微睁开右眼睑。苔浊腻始退，脾湿稍减。原方损益续服十二剂。
[二诊]舌质转淡红，白腻苔续减。湿浊内困已有消退之象，惟眼睑变化无进展。改服自制“针砂散”，加强疗效(后又以甘草麻黄汤加减配合服)。
处方： “针砂散”方每味10克，共研细末。第一周，每日晨空腹眼一次，每次2克；一周后，三天服一次，每次2克，共服三周。
[三诊]舌质淡红，白腻苔大有减退。脾湿渐化，脉络始通，眼睑开合较前自如。但余邪未尽，应益土行水。本苓桂术甘并小半夏汤方意主之。
处方：
茯苓15克桂枝6克 白术12克法夏12克苍术9克大腹皮9克十剂
[四诊]病情大有好转，原患眼午后较重，近日晚间观察，双目基本一致。舌质已正常，白厚腻苔已退。患眼睑稍厚，开裂较正常眼略小。病虽向愈，参之舌象等，尚属脾湿之邪未尽解，输化功能仍嫌不足。亟应抓住转机，健脾化湿，理气和中，助其运化之力，上方加减续服十五剂。
[五诊]1978年8月初， “睑废”基本治愈，视物已正常。惟眼胞仍稍厚，乃脾虚兼湿之象。以五苓散利水健脾，再除余邪。
处方：
猪苓10克茯苓15克泽泻10克 白术12克桂枝6克五加皮10克三剂
其后，曾间服上方汤剂；或服剩余之针砂散(有时间隔二、三周服一次)。
1979年3月8日，患儿再赴同仁医院复查：未见异常，为重症肌无力恢复期。1979年7月18日访问家长，患者眼睑恢复良好。
(按语]现代医学所称重症肌无力，是以骨骼肌无力为特征的一种神经肌肉间传递功能障碍性疾病。相当于中医之上胞下垂，因其难治难愈，又名“睑废”。目为五官之一，“五脏六腑之精气，皆上注于目”。十二经脉，亦均与眼部密切关联。眼病虽为局部疾患，多由内脏病变而引起，内服药则重于整体考虑。大体说来，此证可分为先天与后天两大类：先天性患者，往往因发育不全而形成，常发于双眼；后天性多由于脾弱气虚，脉络失和等所致，常发于一目。本病例，当属后者。
本例睑废，以六经辨证应属太阴证。太阴者，土也。在脏为脾，在气为湿。寒邪侵入太阴与湿相搏，于是寒湿阻滞经络，精微物质不得上呈，眼睑失养，以致上胞肿垂，无力开合。寒湿内困于阴土难以消除之际，仅用补中益气，升阳举陷之常规方药，不能除其寒湿之邪，故效果不显；应散寒除湿以祛邪，脾阳得伸，运化复常，精微物质得以上呈，此才是治病之本。故遵仲景太阴病亦可以从外而解之变法， “于寒湿中求之”。先投以甘草麻黄汤，促使邪从皮毛速去(现代医学认为，加注麻黄素亦可加强“新斯的明”疗效)；并以五苓散除余邪而收功。
太阴少阴证睑废
(重症肌无力眼肌型)
撒××，女，17岁。北京市中学生。
[病史]1978年4月22日，忽觉眼不能睁，视物双影，眼胞肿胀不适。在首都医院检查，做“新斯的明”试验和肌电图检查，确诊为“重症肌无力眼肌型”。转××医院治疗，服中药半年余，未获效。同年10月18日来诊，经治五个月，眼睑开始恢复正常。
(初诊]左眼胞下垂，无力睁开。双眼胞皆浮肿，双膝关节疼痛，月经色暗，有乌黑淤血块。面色萎白无华，额面部湿疹较多。唇色淡白，舌淡暗微红，边缘有齿痕，苔灰白夹淡黄，根部厚腻而紧密，脉沉细。此为太阴少阴合病睑废，兼有太阳表邪未去，先宜温经解表为治，以麻黄细辛附子汤加味主之。
处方：
麻黄10克制附片30克(久煎) 辽细辛3克桂枝6克炮姜20克血余炭20克‘甘草15克[二诊]服上方二剂，关节痛稍减。眼肌有轻微跳动感。苔转灰白腻，余证如前。精神萎靡，四肢不温，虽值年少，但肾阳小足，须从根本入手，峻补先天，以四逆汤主之。
【初诊】1978年8月1日。腹部时常疼痛，喜欢温热和按压。大便稀薄，口不渴，没有食欲。精神疲倦，身体虚弱，面色苍黄且无光泽。舌质淡，苔白厚腻。触诊四肢冰冷严重。证候属于太阴虚寒证泄泻（脾阳虚衰，寒湿内盛所致的腹泻），治法应当祛散寒邪、除湿气，充实脾气、固护肾阳。先用四逆汤（回阳救逆的基础方），继用理中汤（温中健脾的代表方）加味治疗。
处方二：
制附片60克（久煎） 干姜18克 炒白术24克 茯苓15克 炙甘草30克 上肉桂6克 红枣30克
各五剂
【辨证分析】《伤寒论》说：“自利不渴者，属太阴，以其脏有寒故也，当温之，宜服四逆辈”。患者四肢冰冷，口不渴，舌质淡，苔白而厚腻，都是湿寒阻滞的表现，属于太阴虚寒的证候。
太阴在脏腑对应脾，脾主运化，脾虚导致邪气内陷，则中焦阳气不振；寒湿不能化解，气机阻滞，所以腹部胀满、时常疼痛；脾气不能上升，寒湿下注，所以腹泻更加严重；脾失去健运功能，后天之本失调，所以不想吃东西。但是必须指出，此证不仅仅在中焦脾胃；长期腹泻，不能只责怪于脾。所谓“五脏之伤，穷必及肾”（五脏受损严重，最终会波及肾脏）。患者精神疲倦、怕冷，面色苍黄，明显是下元亏损，命门火衰，肾阳不振。王和安说：“只温其中焦适宜用理中汤，温其中焦兼温下焦适宜用四逆汤。”所以在初诊时就投用四逆汤、理中汤相继治疗。
【二诊】8月23日。服药后，腹泻停止，精神、睡眠都好转，食量增加。面色略微转红润，舌淡红，白腻苔减少。多年的陈旧疾病，初次获得显著疗效。但是久病之后，脾肾阳虚，不能立刻恢复，应当继续坚守原法，效不更方，加减后再进。
处方：
制附片60克（久煎） 炒白术24克 干姜18克 炙甘草15克 红枣30克 上肉桂6克（冲服）
茯苓15克
【三诊】8月26日。近半个月来，大便趋于正常。上方加减，嘱咐其继续服用一段时间，并注意忌食生冷，防止受凉，以巩固疗效。
1979年4月20日随访，患者说：自去年8月服药后，从此未再腹泻。
太阴证睑废（重症肌无力眼肌型）
文××，女，6岁。卫生部职工之女。
【病史】1976年1月20日晚，家长突然发现患儿眼缝缩小，眯眼斜视。随即右眼睑下垂，无力睁开，出现复视。1976年2月，中国人民解放军总医院肌注“新斯的明”试验，呈阳性反应，诊断为“重症肌无力（眼肌型）”，待查。同年3月28日，北京同仁医院确诊为眼睑“重症肌无力”。1977年3月29日，转至××医院，中医诊治一年。虽然曾短暂开大睑裂，但上眼睑重新下垂后，反复治疗无效。1978年5月10日来诊，按太阴证睑废论治，三个月基本治愈，现已巩固一年余。
【初诊】右眼睑下垂且肿胀，视物困难，复视，午后尤其严重。面色微黄，乏力。舌质润红而暗；苔白灰黄、根部厚腻浊密布。这是脾湿之邪，蕴积已久，表实未解，向上窜扰眼睑所致。证候属于足太阴睑废（眼睑废用不用），治法应当开闭除湿，遵循仲景甘草麻黄汤方意为主治疗。
【辨证分析】眼睑属于脾。脾主肌肉四肢，不仅专门主管运化水谷的精微，而且有传导水湿的功能。患儿面黄乏力，是脾困顿的表现。再从舌象分析，苔虽白黄粘腻，但舌质淡湿润，明显是表实未解，寒邪久闭；脾湿之邪，蕴积更深。眼睑既属于脾，如今水湿之邪不得外泄，而循经向上窜扰于眼睑，以致眼睑肿胀下垂，无力开裂，所以属于足太阴的证候。
《金匮要略》说：“里水……甘草麻黄汤亦主之”。吴谦等按语：里水之“里”字，应当是“皮”字。其意思是皮水表实无热者，则应当用此方发汗，使水从皮毛而去。如今秉承其意而变通其法：用麻黄的辛温，开通各种闭塞，驱除水邪；半夏性燥而能去湿，脾胃得到它而健运；甘草味甘，具火土之色，补益太阴大有奇功；配合麻黄，更有通利寒湿的效果，麻黄、半夏、甘草配伍，辛甘化阳，阳气旺盛则湿气消除；甘草倍于麻黄，化湿而不损伤元气。
上方服用三剂后，眼皮稍可活动。原方加桂枝，温通经脉，辛以散邪；配合杏仁，疏理肺窍，入手太阴以利水之上源。再服用一剂，患儿眼睑开裂稍大，后来随证加减。
6月初，患儿曾有一整日可略微睁开右眼睑。苔浊腻始退，脾湿稍减。原方损益续服十二剂。
【二诊】舌质转淡红，白腻苔继续减少。湿浊内困已有消退之象，惟眼睑变化无进展。改服自制“针砂散”，加强疗效（后又以甘草麻黄汤加减配合服用）。
处方：“针砂散”方每味10克，共研细末。第一周，每日早晨空腹服用一次，每次2克；一周后，三天服一次，每次2克，共服三周。
【三诊】舌质淡红，白腻苔大有减退。脾湿渐化，脉络始通，眼睑开合较前自如。但余邪未尽，应益土行水（健脾利水）。本苓桂术甘并小半夏汤方意为主治疗。
处方：
茯苓15克 桂枝6克 白术12克 法夏12克 苍术9克 大腹皮9克
十剂
【四诊】病情大有好转，原患眼午后较重，近日晚间观察，双目基本一致。舌质已正常，白厚腻苔已退。患眼睑稍厚，开裂较正常眼略小。病虽向愈，参之舌象等，尚属脾湿之邪未尽解，输化功能仍嫌不足。亟应抓住转机，健脾化湿，理气和中，助其运化之力，上方加减续服十五剂。
【五诊】1978年8月初，“睑废”基本治愈，视物已正常。惟眼睑仍稍厚，乃脾虚兼湿之象。以五苓散利水健脾，再除余邪。
处方：
猪苓10克 茯苓15克 泽泻10克 白术12克 桂枝6克 五加皮10克
三剂
其后，曾间服上方汤剂；或服剩余之针砂散（有时间隔二、三周服一次）。
1979年3月8日，患儿再赴同仁医院复查：未见异常，为重症肌无力恢复期。1979年7月18日访问家长，患者眼睑恢复良好。
【按语】现代医学所称重症肌无力，是以骨骼肌无力为特征的一种神经肌肉间传递功能障碍性疾病。相当于中医之上胞下垂，因其难治难愈，又名“睑废”。目为五官之一，“五脏六腑之精气，皆上注于目”。十二经脉，亦均与眼部密切关联。眼病虽为局部疾患，多由内脏病变而引起，内服药则重于整体考虑。大体说来，此证可分为先天与后天两大类：先天性患者，往往因发育不全而形成，常发于双眼；后天性多由于脾弱气虚，脉络失和等所致，常发于一目。本病例，当属后者。
本例睑废，以六经辨证应属太阴证。太阴者，土也。在脏为脾，在气为湿。寒邪侵入太阴与湿相搏，于是寒湿阻滞经络，精微物质不得上呈，眼睑失养，以致上胞肿垂，无力开合。寒湿内困于阴土难以消除之际，仅用补中益气，升阳举陷之常规方药，不能除其寒湿之邪，故效果不显；应散寒除湿以祛邪，脾阳得伸，运化复常，精微物质得以上呈，此才是治病之本。故遵仲景太阴病亦可以从外而解之变法，“于寒湿中求之”。先投以甘草麻黄汤，促使邪从皮毛速去（现代医学认为，加注麻黄素亦可加强“新斯的明”疗效）；并以五苓散除余邪而收功。
太阴少阴证睑废（重症肌无力眼肌型）
撒××，女，17岁。北京市中学生。
【病史】1978年4月22日，忽觉眼不能睁，视物双影，眼睑肿胀不适。在首都医院检查，做“新斯的明”试验和肌电图检查，确诊为“重症肌无力眼肌型”。转××医院治疗，服中药半年余，未获效。同年10月18日来诊，经治五个月，眼睑开始恢复正常。
【初诊】左眼睑下垂，无力睁开。双眼睑皆浮肿，双膝关节疼痛，月经色暗，有乌黑淤血块。面色萎白无华，额面部湿疹较多。唇色淡白，舌淡暗微红，边缘有齿痕，苔灰白夹淡黄，根部厚腻而紧密，脉沉细。此为太阴少阴合病睑废，兼有太阳表邪未去，先宜温经解表为治，以麻黄细辛附子汤加味为主治疗。
处方：
麻黄10克 制附片30克（久煎） 辽细辛3克 桂枝6克 炮姜20克 血余炭20克 甘草15克
【二诊】服用上方二剂，关节痛稍减。眼肌有轻微跳动感。苔转灰白腻，其余证候如前。精神萎靡，四肢不温，虽值年少，但肾阳不足，须从根本入手，峻补先天，以四逆汤为主治疗。
[First Visit] August 1, 1978. Abdominal pain occurs intermittently, relieved by warmth and pressure. Loose stools, no thirst in the mouth, loss of appetite. Mental fatigue, physical weakness, sallow complexion lacking luster. Pale tongue body, thick white greasy coating. Palpation reveals severe coldness of the limbs. The syndrome is diagnosed as Taiyin deficiency-cold diarrhea (diarrhea caused by spleen yang deficiency and internal accumulation of cold-dampness). The treatment principle should be to dispel cold, remove dampness, strengthen the spleen, and secure the kidney. Initially administer Sini Tang (Cinnamon Twig and Prepared Aconite Decoction, a basic formula for rescuing devastated yang), followed by Lizhong Tang (Ginseng and Dried Ginger Decoction, a representative formula for warming the middle and strengthening the spleen) with modifications.
Prescription 1:
Prepared Fuzi (Aconiti Lateralis Radix Praeparata) 60g (decocted for a long time)
Dried Ginger (Ganjiang, Zingiberis Rhizoma) 30g
Honey-fried Licorice Root (Zhigancao, Glycyrrhizae Radix et Rhizoma) 30g
Prescription 2:
Prepared Fuzi (Aconiti Lateralis Radix Praeparata) 60g (decocted for a long time)
Dried Ginger (Ganjiang, Zingiberis Rhizoma) 18g
Stir-baked Atractylodes Rhizome (Baizhu, Atractylodis Macrocephalae Rhizoma) 24g
Poria (Fuling, Polyporus) 15g
Honey-fried Licorice Root (Zhigancao, Glycyrrhizae Radix et Rhizoma) 30g
Cassia Bark (Rougui, Cinnamomi Cortex) 6g
Red Dates (Hongzao, Jujubae Fructus) 30g
Five doses each.
[Syndrome Differentiation] The *Shanghan Lun* states: "Spontaneous diarrhea without thirst belongs to Taiyin, because there is cold in the zang organs; it should be warmed, and formulas similar to Sini Tang are suitable." The patient's cold limbs, lack of thirst, pale tongue body, and thick white greasy coating are all signs of cold-dampness obstruction, constituting a Taiyin deficiency-cold syndrome.
Taiyin corresponds to the Spleen in the zang organs. The Spleen governs transportation and transformation. When spleen deficiency allows pathogenic factors to sink inward, the middle jiao yang fails to flourish; when cold-dampness cannot be transformed and qi mechanism is obstructed, abdominal fullness and intermittent pain occur; when spleen qi fails to ascend and cold-dampness flows downward, diarrhea worsens; when the spleen loses its healthy function and the acquired foundation is disordered, appetite is lost. However, it must be pointed out that this syndrome is not limited to the middle jiao (spleen and stomach); chronic diarrhea cannot be blamed solely on the spleen. As the saying goes, "Injuries to the five zang organs, when extreme, inevitably affect the Kidney" (severe damage to the five zang organs ultimately extends to the Kidneys). The patient's mental fatigue, aversion to cold, and sallow complexion clearly indicate depletion of the lower origin, decline of Mingmen fire, and invigoration of kidney yang. Wang He'an said: "To warm only the middle jiao, Lizhong Tang is appropriate; to warm the middle jiao while also warming the lower jiao, Sini Tang is appropriate." Therefore, at the first visit, Sini Tang and Lizhong Tang were administered successively.
[Second Visit] August 23. After taking the medicine, diarrhea stopped, spirit and sleep improved, and food intake increased. Complexion turned slightly ruddy, tongue became pale red, and the white greasy coating decreased. For a chronic disease of many years, significant efficacy was initially achieved. However, after prolonged illness, spleen and kidney yang deficiency cannot recover abruptly; it is advisable to continue adhering to the original method, maintaining the effective prescription with modifications.
Prescription:
Prepared Fuzi (Aconiti Lateralis Radix Praeparata) 60g (decocted for a long time)
Stir-baked Atractylodes Rhizome (Baizhu, Atractylodis Macrocephalae Rhizoma) 24g
Dried Ginger (Ganjiang, Zingiberis Rhizoma) 18g
Honey-fried Licorice Root (Zhigancao, Glycyrrhizae Radix et Rhizoma) 15g
Red Dates (Hongzao, Jujubae Fructus) 30g
Cassia Bark (Rougui, Cinnamomi Cortex) 6g (taken with decoction)
Poria (Fuling, Polyporus) 15g
[Third Visit] August 26. Over the past half-month, bowel movements have tended toward normal. With modifications to the above prescription, instructed to continue taking it for a period, paying attention to avoiding raw and cold foods, and preventing chilling, to consolidate the effect.
Follow-up on April 20, 1979: The patient stated that since taking the medicine in August last year, diarrhea has not recurred.
Taiyin Syndrome Blepharoptosis (Myasthenia Gravis Ocular Type)
Wen XX, Female, 6 years old. Daughter of a Ministry of Health employee.
[Medical History] On the evening of January 20, 1976, the parents suddenly noticed the child's palpebral fissure narrowing and squinting strabismus. Subsequently, the right upper eyelid drooped, unable to open forcefully, accompanied by diplopia. In February 1976, the General Hospital of the Chinese People's Liberation Army conducted an intramuscular injection test with Neostigmine, which yielded a positive reaction, diagnosing "Myasthenia Gravis (Ocular Type)," pending further investigation. On March 28 of the same year, Beijing Tongren Hospital confirmed the diagnosis of eyelid "Myasthenia Gravis." On March 29, 1977, transferred to XX Hospital for one year of Traditional Chinese Medicine (TCM) treatment. Although the palpebral fissure briefly widened, the upper eyelid drooped again afterward, and repeated treatments were ineffective. Came for consultation on May 10, 1978, treated according to Taiyin syndrome blepharoptosis, basically cured in three months, and consolidated for over a year.
[First Visit] Right eyelid drooping and swelling, difficulty seeing, diplopia, especially severe in the afternoon. Slightly yellow complexion, fatigue. Moist, reddish-dark tongue body; coating white-gray-yellow, thick, greasy, turbid, and densely distributed at the root. This is due to spleen-dampness pathogen accumulating for a long time, exterior excess unresolved, climbing upward to invade the eyelids. The syndrome belongs to Foot-Taiyin blepharoptosis (eyelid dysfunction). The treatment principle should be to open blockages and remove dampness, following the intent of Zhang Zhongjing's Gancao Mahuang Tang (Licorice and Ephedra Decoction).
Prescription:
Ephedra Herb (Mahuang, Ephedrae Herba) 3g
Prepared Pinellia Tuber (Faxia, Pinelliae Rhizoma Preparatum) 12g
Licorice Root (Gancao, Glycyrrhizae Radix) 6g
Three doses.
[Syndrome Differentiation] The eyelids belong to the Spleen. The Spleen governs muscles and four limbs, not only specializing in transporting and transforming the essence of water and grain but also having the function of conducting water-dampness. The child's yellow face and fatigue are signs of spleen entrapment. Analyzing from the tongue image, although the coating is white-yellow and sticky-greasy, the tongue body is pale and moist, clearly indicating unresolved exterior excess and long-standing closure by cold pathogen; spleen-dampness pathogen accumulates deeper. Since the eyelids belong to the Spleen, now water-dampness pathogen cannot discharge outward but climbs along the meridians to the eyelids, causing eyelid swelling and drooping, inability to open, thus belonging to the Foot-Taiyin syndrome.
The *Jingui Yaolue* states: "Internal water... Gancao Mahuang Tang also governs it." Wu Qian et al. annotated: The character "internal" (Li) in internal water should be "skin" (Pi). The meaning is that for skin-water with exterior excess and no heat, this formula should be used to induce sweating, allowing water to leave through the skin and hair pores. Now inheriting this intent and varying the method: using the acrid-warm nature of Mahuang to open various blockages and drive out water pathogen; Banxia is dry and removes dampness, making the spleen and stomach vigorous; Gancao is sweet, possessing the color of fire and earth, greatly benefiting Taiyin with miraculous effect; combined with Mahuang, it has the effect of unblocking and draining cold-dampness. The combination of Mahuang, Banxia, and Gancao transforms acrid and sweet into yang; when yang flourishes, dampness dissipates. Gancao doubled compared to Mahuang transforms dampness without damaging primordial qi.
After taking the above prescription for three doses, the eyelids could move slightly. Add Guizhi (Cinnamon Twig) to the original prescription to warm and unblock meridians, using acridity to scatter pathogens; combine with Xingren (Apricot Seed) to ventilate lung orifices, entering Hand-Taiyin to benefit the upper source of water. Take another dose, the child's eyelid opening becomes slightly larger, then modified according to symptoms.
In early June, the child could slightly open the right eyelid for a whole day once. Turbid-greasy coating began to recede, spleen-dampness slightly reduced. Original prescription modified and continued for twelve doses.
[Second Visit] Tongue body turned pale red, white greasy coating continued to decrease. Signs of resolving internal stagnation of damp-turbidity appeared, but eyelid changes showed no progress. Changed to self-made "Zhen San San" (Needle Sand Powder) to enhance efficacy (later combined with modified Gancao Mahuang Tang).
Prescription: "Zhen San San" formula: each ingredient 10g, ground into fine powder together. First week, take once daily on an empty stomach in the morning, 2g each time; after one week, take once every three days, 2g each time, total three weeks.
[Third Visit] Tongue body pale red, white greasy coating significantly reduced. Spleen-dampness gradually transformed, collaterals beginning to unblock, eyelid opening and closing more free than before. But residual pathogens remain, should tonify earth to promote water movement (strengthen spleen and promote diuresis). Following the intent of Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) combined with Xiao Banxia Tang (Minor Pinellia Decoction).
Prescription:
Poria (Fuling, Polyporus) 15g
Cinnamon Twig (Guizhi, Ramulus Cinnamomi) 6g
Atractylodes Rhizome (Baizhu, Atractylodis Macrocephalae Rhizoma) 12g
Prepared Pinellia Tuber (Faxia, Pinelliae Rhizoma Preparatum) 12g
Atractylodes Rhizome (Cangzhu, Atractylodis Rhizoma) 9g
Areca Peel (Dafupi, Arecae Pericarpium) 9g
Ten doses.
[Fourth Visit] Condition greatly improved. Originally worse in the afternoon, recent evening observation shows both eyes basically consistent. Tongue body normalized, white thick greasy coating receded. Affected eyelid slightly thick, opening slightly smaller than normal eye. Although the disease tends toward cure, referring to the tongue image etc., spleen-dampness pathogen is not yet fully resolved, transport and transformation function still insufficient. Urgently seize the turning point, strengthen spleen and transform dampness, regulate qi and harmonize middle, assist its transportation power. Continue original prescription with modifications for fifteen doses.
[Fifth Visit] Early August 1978, "blepharoptosis" basically cured, vision normal. Only eyelids still slightly thick, sign of spleen deficiency combined with dampness. Use Wuling San (Five-Ingredient Powder with Poria) to promote diuresis and strengthen spleen, removing residual pathogens.
Prescription:
Polyporus (Zhuling, Polyporus) 10g
Poria (Fuling, Polyporus) 15g
Alisma Rhizome (Zexie, Alismatis Rhizoma) 10g
Atractylodes Rhizome (Baizhu, Atractylodis Macrocephalae Rhizoma) 12g
Cinnamon Twig (Guizhi, Ramulus Cinnamomi) 6g
Acanthopanax Bark (Wujia Pi, Acanthopanacis Cortex) 10g
Three doses.
Thereafter, occasionally took the above decoction; or took remaining Zhen San San (sometimes taken once every two or three weeks).
On March 8, 1979, the child went to Tongren Hospital for re-examination: no abnormalities seen, recovery phase of myasthenia gravis. On July 18, 1979, visited parents, patient's eyelids recovered well.
[Commentary] Myasthenia gravis, as termed in modern medicine, is a disease characterized by skeletal muscle weakness, a disorder of neuromuscular transmission. It corresponds to upper eyelid ptosis in TCM. Due to its difficult treatment and cure, it is also called "blepharoptosis" (eyelid abandonment). The eye is one of the five sense organs; "the essence of the five zang and six fu organs all ascend to the eyes." The twelve meridians are also closely associated with the eyes. Although eye diseases are local disorders, they are mostly caused by internal organ lesions; internal medication emphasizes holistic consideration. Generally speaking, this syndrome can be divided into two major categories: congenital and acquired. Congenital patients often develop due to incomplete development, usually affecting both eyes; acquired cases are mostly caused by spleen weakness and qi deficiency, disharmony of collaterals, etc., usually affecting one eye. This case belongs to the latter.
This case of blepharoptosis, differentiated by Six Meridians, belongs to Taiyin syndrome. Taiyin is Earth. In the zang organs, it is the Spleen; in qi, it is dampness. Cold pathogen invading Taiyin combats with dampness, thus cold-dampness blocks the collaterals, essence substances cannot ascend, eyelids lose nourishment, resulting in upper eyelid swelling and drooping, inability to open and close. When cold-dampness is internally trapped in Yin-Earth and difficult to eliminate, merely using routine formulas for tonifying middle and boosting qi, raising yang and lifting collapse, cannot remove the cold-dampness pathogen, hence efficacy is not obvious; one should dispel cold and remove dampness to expel pathogens, allow spleen yang to extend, restore transportation and transformation, enable essence substances to ascend, this is the root of treating the disease. Thus, following Zhang Zhongjing's variant theory that Taiyin disease can also be resolved from the exterior, "seek within cold-dampness." First administer Gancao Mahuang Tang to hasten the expulsion of pathogens from skin and hair pores (modern medicine believes adding ephedrine can also enhance the efficacy of neostigmine); then use Wuling San to remove residual pathogens and conclude treatment.
Taiyin-Shaoyin Syndrome Blepharoptosis (Myasthenia Gravis Ocular Type)
Sa XX, Female, 17 years old. Middle school student in Beijing.
[Medical History] On April 22, 1978, suddenly felt unable to open eyes, double vision, eyelid swelling and discomfort. Checked at Capital Hospital, performed Neostigmine test and electromyography, confirmed diagnosis of "Myasthenia Gravis Ocular Type." Transferred to XX Hospital for treatment, took Chinese herbal medicine for over half a year without effect. Came for consultation on October 18 of the same year, after five months of treatment, eyelids began to return to normal.
[First Visit] Left eyelid drooping, unable to open forcefully. Both eyelids edematous, bilateral knee joint pain, dark menstrual blood with black clots. Sallow and dull complexion,较多 eczema on forehead and face. Pale lips, pale-dark-red tongue body with slight redness, teeth marks on edges, coating gray-white mixed with light yellow, thick, greasy, and tightly distributed at the root, pulse deep and fine. This is Taiyin-Shaoyin combined syndrome blepharoptosis, combined with unresolved Taiyang exterior pathogen. Initially should warm meridians and resolve exterior, primarily treating with Maxhuan Xixin Fuzi Tang (Ephedra, Asarum, and Prepared Aconite Decoction) with modifications.
Prescription:
Ephedra Herb (Mahuang, Ephedrae Herba) 10g
Prepared Fuzi (Aconiti Lateralis Radix Praeparata) 30g (decocted for a long time)
Liao Asarum Root (Liaoxixin, Asari Radix et Rhizoma) 3g
Cinnamon Twig (Guizhi, Ramulus Cinnamomi) 6g
Roasted Ginger (Paojiang, Zingiberis Rhizoma Preparatum) 20g
Charred Human Hair (Xuyutanh, Capillaris Carbonisata) 20g
Licorice Root (Gancao, Glycyrrhizae Radix) 15g
[Second Visit] After taking two doses of the above prescription, joint pain slightly decreased. Eye muscles had slight twitching. Coating turned gray-white greasy, other symptoms remained as before. Listless spirit, cold extremities, although young, kidney yang is insufficient, must start from the root, vigorously tonify the先天 (primordial origin), primarily treating with Sini Tang (Cinnamon Twig and Prepared Aconite Decoction).