失音3(急性喉炎)
杨某，男，78岁，1989年8月10日初诊。家属代述：患者于半月前因感冒发烧，体温腋下38 5℃，咽喉疼痛，服用板蓝根冲剂、喉症丸、抗生素等药，体温下降，两天后体温上升为39℃，声音开始嘶哑，发音费力，继而失音，咽喉干堵难忍+总想用手抠。近7日来滴水未进，也未大便。怀疑咽中有肿物，准备后事，遂请赵老以决预后。诊时见：形体瘦弱，面红目赤，身热无汗，胸闷懊依，眼欲闭，时寐时醒，时有谵语，小便短赤，口中干涩粘腻秽浊，舌苔白腻垢厚，脉濡数。体温腋下38.5℃。
皆是暑热湿浊郁滞之象，先以芳香化浊宣郁之法。处方；藿香10克，佩兰10克，苏叶10克，茅芦根各10克，水煎，试服3剂，少量多次服用。
二诊
当天中午药入口中，难以咽下，良久才咽下几口，腹中几声肠呜，到晚上1剂服完，微有汗出，夜寐较安。第2天精神好转，神志转清，能喝下少许白术稀粥，并能发出低微的声音，下午解大便几枚如干球状。舌苔白腻，脉滑数，体温腋下37.5℃，气机渐舒，暑热渐减，声音渐复，仍用芳香宣化，佐咀消导之品。处方：藿香10克，苏叶1旷克，茅芦根各10克，炒山栀6克，佩兰10克，淡豆豉10克，杏仁10克，大腹皮10克。槟榔10克，滑石10克，焦三仙各10克，4剂，水煎服。
三诊
精神较好，声音完全恢复，并能下地活动，饮食二便如常，体温36.5℃，再以前法进退，以固其效。饮食当慎，防其食复。处方：炒山栀6克，淡豆豉10克，炒枳壳6克，苏梗6克，竹茹6克，茅芦根各10克，焦三仙各10克，水红花子10克，7剂。
[按]：本患者素体较差，又感受暑湿之邪，本应轻宣疏表，芳香宣解，而反投板蓝根冲剂、喉症丸等寒凉之品，阻滞气机，邪无外达之路，壅塞清窍而致失音。病人身热无汗，胸闷懊依，眼欲闭，时寐时醒，时有谵语小便短赤，脉数，此非邪陷心包，火扰心神，实乃暑热湿浊之邪蒙闭上焦，阻塞清窍之象。饮食不纳，大便不下，舌苔白腻垢厚，乃属湿浊停滞，气机不畅。
因此赵师先以芳香化湿，宣郁开闭，灵动气机为治。方用苏叶、藿香、佩兰芳香化浊，宣畅气机；芦根清热利咽，又能宣阳疏表；茅根清热利湿。待暑湿渐减，气机渐舒，声音渐复后，再配以淡豆豉，炒山栀苦宣折热，杏仁、苏叶宣肺利窍，开上焦气机；炒枳壳、苏梗、大腹皮、槟榔，焦三仙健脾和胃，消食导滞，通调中焦气机；茅根，滑石清热利湿，使湿热从小便而去，诸药相合，三焦气机宣畅，暑热外泄，湿浊内化，清升浊降，病获痊愈。
失音4(慢性喉炎)
王某，女，36岁，中学教师
1991年4月4日初诊
患者声音嘶哑，时轻时重已半年余。某医院诊断为“慢性喉炎、声带肥厚”，先用胖大海有效，后来亦无济于事。曾用中药汤剂、清音丸、六神丸以及抗生素等效果不明显。现咽干且痒，声音嘶哑，咳嗽痰少，心烦梦多，腰膝酸软，大便干结，舌红苔白且干，脉细数。证属肺肾阴虚，治宜滋补肺肾之阴，以复其音。处方：沙参10克，天麦冬各10克，生地10克，五味子10克，浙贝母10克，桔梗10克，前胡6克，苏叶6克，瓜萎20克，枇杷叶10克，5剂，水煎服。嘱其饮食清淡，忌辛辣刺激食物，晨起走路1～2小时，注意禁声。
二诊
服药后，上午声音清亮，下午仍暗哑明显，轻度咽干，夜寐不安，再以前法进退。处方；沙参20克，天麦冬各10克，生熟地各15克，山药10克，阿胶10克(烊化)，五味子10克，浙贝母10克，芦根10克，白芷6克，苏梗6克，焦麦芽10克，7剂，水煎服。
服上方后，声音恢复，喑哑消失，饮食二便正常，夜寐较安，余症皆去。再咀上方10剂，分两周服用，以巩固疗效。
患者于1991年7月3日，又带病人来看病告知，一直授课，失音未复发，并坚持早晚锻炼，清淡饮食。
[按]：此患者系中学教师，由于发音过多，声带运用过度，耗伤肺阴，日久而致肾阴亦亏。肺脉通会厌，肾脉挟舌本，肺肾不足，阴液不能上承，咽喉失其濡养，而喑哑咽干，甚则失音。
肺气不清，则干咳少痰；阴虚生内热，虚火扰动心神，则心烦梦多；肾虚精亏，则腰膝酸软，舌红且干，脉细数，大便干结，均为阴亏有热之象。赵老治以滋补肺肾之阴，使金水相生，水源不竭。方中先以苏叶、前胡、桔梗、枇杷叶宣肺通窍，调畅气机；沙参、麦冬、天门冬、生地黄滋肺阴清肺热；五味子生津敛肺气；渐贝母宣肺软坚散结；瓜萎润肺宽中通便。待喑哑取效后，再以生熟地、山药滋补肾阴，阿胶养阴润肺；苏梗宣畅气机，芦根宣肺生津润喉利咽，麦芽健脾。赵老更妙用白芷，白芷虽为驱风药，但性滑润i使大队滋补之品补而不腻，调和诸药，又能载药上达于咽喉。因此诸药相配，取效甚佳。
又[按]：失音是临床常见的病证，其病因病机比较复杂，《内经》名目“疳”或“暗”，《医学正传》则称“喉喑”，因肺脉通会厌，而肾脉挟舌本，“会厌者，音声之户也”(《灵枢?忧恚无言》)。本病虽属声遭、喉咙的局部疾患，实与啼肾有密切关系，因此古人有“金水相生，病在肺肾”之说。《直指方》曰：“肺为声音之门，肾为声音之根”，前人叶天士则譬作：“金实则无声，金破亦无声”，都说明了这个道理。其病因当有内伤、外感之分，其病机应有虚实之不同。故张景岳说：“喑哑之病，当知虚实。实者其病在标，因窍闭而喑也；虚者其病在本，内夺而暗也”其辨证施治，当以病势的缓急，一般分为暴喑、久喑两大类。大抵暴喑者，多因风寒客热壅遏而致窍闭，其病属实，治当宣散清疏；久暗者，多因阴血耗伤，精气内夺而喑，其病属虚，治当清润滋养。
从目前临床所见，失音一症的病机属实者多而属虚者少。实者乃邪气阻滞，肺气失宣，金实则不鸣，治以宣肃散邪为主，邪去则金鸣；虚者精气内虚，金破亦不鸣，治以滋填为法，佐以宣畅肺气，亦不宜纯补蛮补，如上案用金水相生之法，仍须佐苏叶、枇杷叶、前胡、桔梗、浙贝母，即是例证。此外还须注意：
(1)失音的治疗，始终要注意气机的调畅，赵老常说：“治病之要，调畅气机”，(2)中焦是气机升降的枢纽，赵老治病非常重视脾胃之气的升降，胃气降浊气下行，有助于脾气的上升，有利于失音的康复。(3)失音的治疗，饮食调养至关重要。如饮食寒凉，则闭郁肺气，甜食壅塞气机，辛辣刺激食物则助热邪伤阴液，都不利于暗哑的恢复。因此药物治疗与饮食调养相互配合，才可收到比较满意的疗效。
鼻鼽(肥厚性鼻炎)
赵某某，女，35岁
初诊
自述患鼻炎五年余，经某医院五官科检查诊断为肥厚性鼻炎。终日鼻塞，浊涕长流，张口呼吸。脉象滑数，舌红苔黄，热在肺胃，先用清宣方法。
辛荑花10克，苍耳子10克，白芷6克，黄芩6克，前胡6克，苏叶子各10克，浙贝母10克，杏仁10克，枇杷叶10克，焦三仙各10克，茅芦根各10克，七付
二诊
近日感冒，鼻塞流涕，咳嗽痰多，脉仍滑数，舌红苔黄，热郁于内，仍用宣肺化痰，清热止浊方法。
苏叶子各10克，前胡6克，牛蒡子10克，白前6克，百部6克，辛荑花10克，苍耳子10克，黄芩6克，白芷6克，焦三仙各10克，七付
三诊
药后咳嗽已愈，咯痰大减，惟鼻塞流涕尚在，热郁未清，仍用前法进退。
辛荑花10克，苍耳子10克，白芷6克，黄芩10克，川楝子6克，前胡6克，白前6克，牛蒡子10克，七付
四诊
鼻塞较前减轻，大部时间用鼻呼吸不感困难，时有如物堵塞之感，药已见效，前法增损。
辛荑花10克，苍耳子10克，白芷6克，防风6克，黄芩6克，茅芦根各10克，沙参10克，七付。
五诊
鼻塞已通，时有浊涕流出。肺家郁热尚未全清，脉象滑数，舌红苔黄，仍用宣肺涤浊方法。
辛荑花10克，苍耳子10克，白芷6克，荆芥6克，牛蒡子10克，冬瓜子10克，苏叶10克，芦根10克，桔梗10克，七付
患者依上方续服一个月，鼻塞流涕皆愈。半年后患者前来医治他病，询之鼻炎未复发。
[按]：肺开窍于鼻，故鼻之病多从肺治。鼻塞浊涕者多为肺热；鼻塞清涕者多为肺寒。本案鼻塞浊涕黄稠，脉象滑数，舌红苔黄，显然肺热之象。肺热宜清，然不可寒凉直清，因寒则涩而不流，恐闭塞气机，致郁热反难散出。故治宜宣清结合。本案前后五诊，方中皆用辛荑花、苍耳、白芷，此三味辛香通气上达，升清气于头面，亦清阳出上窍之意；又用前胡、杏仁、枇杷叶等开宣肺气，肺气开Ⅲ4郁热易散}又用苏子、浙贝母、冬瓜子等化痰涤浊，使热无依附之邪则易祛；其余苏叶、防风、牛蒡子、桔梗、白前、百部、焦三仙、茅芦根、黄芩等各对症选用，加减出入。无非宣通肺气，祛除有形浊邪，则热自易散。不专以清热立论，此赵师辨治鼻病之大法也。
鼻痔(鼻息内)
王某某，女，67岁
初诊
患鼻息肉10余年，两侧鼻孔皆有，初起较细小，近年来渐次长粗复长，现已长出鼻孔。左侧息肉略长于鼻孔边缘，右侧息肉长出鼻孔约0.5cm，粗如箸头，色暗红，触之不痛，时有黄水从鼻孔流出。多年来，不能用鼻呼吸。因其暴露于外，患者自觉寒碜，不愿外出与人见。今由女儿陪同前来求治。诊脉弦滑且数，舌红苔黄根厚，心烦梦多。热郁日久，络脉不通，清窍为之壅塞，先用清宣，以观其效。
辛荑花10克(后下)，苍耳子10克(后下)，白芷6克(后下)，防风6克，生地榆10克，黄芩10克，大黄1克，小蓟10克，水红花子10克，茅芦根各10克，大青叶10克，沙参10克 七付
二诊
上方七付后，自觉心烦减轻，鼻部尚无变化，夜寐梦多，大便仍偏干燥，舌红且干，脉象弦滑且数，病已延久，热郁较深，仍用清宣郁热方法。
辛荑花10克(后下)，苍耳子10克(后下)，白芷6克(后下)，防风6克，黄芩6克，川楝子6克，大黄2克，生地榆10克，炒槐花10克，焦三仙各10克，茅芦根各10克，沙参10克，麦门冬10克，七付。
三诊
上方续服三周，鼻中黄水减步，触之鼻痔略软。脉仍弦滑，舌红苔黄，大便略干，仍用清化方法。
辛荑花10克(后下)，苍耳子10克(后下)，防风6克，白芷克(后下)，黄芩10克。川楝子6克，生地榆10克，炒槐花10克，大黄3克，十四付
四诊
湿热久郁，深入血分，久而成瘀，化生有形，占居清窍，非旦夕可以成功。继用清宣化瘀方法。
辛荑花10克(后下)，苍耳子10克(后下)，白芷6克(后下)，黄芩10克，赤芍10克，丹参10克，茜草10克，生地榆10
克，焦三仙各10克，水红花子10克，大黄2克，十四付
五诊
患者服上方后自觉疗效明显，息肉有回缩之迹象，遂按方坚持服用1年零6个月。现左侧息肉已完全消失，左鼻孔通畅，可自由呼吸。右侧息肉已缩入右鼻孔内，时有黄水流出。诊脉弦滑，仍带数意，舌红且干，仍用前法加减。
辛荑花10克(后下)，苍耳子10克(后下)，白芷6克(后下)，防风6克，丹参10克，赤芍10克，茜草10克，焦三仙各10克，水红花子10克，十四付。
[按]：鼻息肉生长10余年，已长出鼻孔之外数分，按一般常识推测，若不用手术摘除，仅靠内服中药恐陷难以消除。然而，事实证明，中医辨证论治能够解决疑难问题，成功的关键是要以中医理论为指导。鼻为肺之外窍，为清气出入之通道，鼻息肉乃有形之赘生物，浊邪之结聚所成。必是肺热壅塞日久，深入血分，络脉阻滞。故此病不独属肺，而且涉及血分，为血分瘀阻之病。赵师治疗此病，治则十分明确，一是治肺，宣通肺气，二是治心，凉血化瘀。治肺用辛荑花、苍耳子、白芷等辛香通气之品，既能宣肺开郁结，通清窍，又能辛香引入络中，透邪外出。治心用丹参、茜草、赤芍、生地榆等凉血化瘀。古人云：“鼻塞治心”，心主血脉，今治在血分，即治心也。除此二者为主治疗外，还兼用了疏调三焦之品，如焦三仙、水红花子、大黄等，以三焦少阳，上连于肺，下通于肾，为气机之通道。古云：九窍不通，肠胃之所生也，慨指此言。此外，川楝子、黄芩泄肝肺之热，茅芦根清肺胃之热渺参、麦门冬养阴清肺，各适时用之，体现了中医定法之中又灵活多变的特点。总之，赵师此案为临床治疗鼻部疑难病提供了宝贵的思路和经验，值得我们细心揣摩。
失音3（急性喉炎）
杨某，男，78岁，1989年8月10日初诊。家属代述：患者于半月前因感冒发烧，体温腋下38.5℃，咽喉疼痛，服用板蓝根冲剂、喉症丸、抗生素等药，体温下降，两天后体温上升为39℃，声音开始嘶哑，发音费力，继而失音，咽喉干堵难忍，总想用手抠。近7日来滴水未进，也未大便。怀疑咽中有肿物，准备后事，遂请赵老以决预后。诊时见：形体瘦弱，面红目赤，身热无汗，胸闷懊侬，眼欲闭，时寐时醒，时有谵语，小便短赤，口中干涩粘腻秽浊，舌苔白腻垢厚，脉濡数。体温腋下38.5℃。
皆是暑热湿浊郁滞之象，先以芳香化浊宣郁之法。处方：藿香10克，佩兰10克，苏叶10克，茅芦根各10克，水煎，试服3剂，少量多次服用。
二诊
当天中午药入口中，难以咽下，良久才咽下几口，腹中几声肠鸣，到晚上1剂服完，微有汗出，夜寐较安。第2天精神好转，神志转清，能喝下少许白术稀粥，并能发出低微的声音，下午解大便几枚如干球状。舌苔白腻，脉滑数，体温腋下37.5℃，气机渐舒，暑热渐减，声音渐复，仍用芳香宣化，佐以消导之品。处方：藿香10克，苏叶10克，茅芦根各10克，炒山栀6克，佩兰10克，淡豆豉10克，杏仁10克，大腹皮10克，槟榔10克，滑石10克，焦三仙各10克，4剂，水煎服。
三诊
精神较好，声音完全恢复，并能下地活动，饮食二便如常，体温36.5℃，再以前法进退，以固其效。饮食当慎，防其食复。处方：炒山栀6克，淡豆豉10克，炒枳壳6克，苏梗6克，竹茹6克，茅芦根各10克，焦三仙各10克，水红花子10克，7剂。
[按]：本患者素体较差，又感受暑湿之邪，本应轻宣疏表，芳香宣解，而反投板蓝根冲剂、喉症丸等寒凉之品，阻滞气机，邪无外达之路，壅塞清窍而致失音。病人身热无汗，胸闷懊侬，眼欲闭，时寐时醒，时有谵语，小便短赤，脉数，此非邪陷心包，火扰心神，实乃暑热湿浊之邪蒙闭上焦，阻塞清窍之象。饮食不纳，大便不下，舌苔白腻垢厚，乃属湿浊停滞，气机不畅。
因此赵师先以芳香化湿，宣郁开闭，灵动气机为治。方用苏叶、藿香、佩兰芳香化浊，宣畅气机；芦根清热利咽，又能宣阳疏表；茅根清热利湿。待暑湿渐减，气机渐舒，声音渐复后，再配以淡豆豉，炒山栀苦宣折热，杏仁、苏叶宣肺利窍，开上焦气机；炒枳壳、苏梗、大腹皮、槟榔，焦三仙健脾和胃，消食导滞，通调中焦气机；茅根，滑石清热利湿，使湿热从小便而去，诸药相合，三焦气机宣畅，暑热外泄，湿浊内化，清升浊降，病获痊愈。
失音4（慢性喉炎）
王某，女，36岁，中学教师
1991年4月4日初诊
患者声音嘶哑，时轻时重已半年余。某医院诊断为“慢性喉炎、声带肥厚”，先用胖大海有效，后来亦无济于事。曾用中药汤剂、清音丸、六神丸以及抗生素等效果不明显。现咽干且痒，声音嘶哑，咳嗽痰少，心烦梦多，腰膝酸软，大便干结，舌红苔白且干，脉细数。证属肺肾阴虚，治宜滋补肺肾之阴，以复其音。处方：沙参10克，天麦冬各10克，生地10克，五味子10克，浙贝母10克，桔梗10克，前胡6克，苏叶6克，瓜蒌20克，枇杷叶10克，5剂，水煎服。嘱其饮食清淡，忌辛辣刺激食物，晨起走路1～2小时，注意禁声。
二诊
服药后，上午声音清亮，下午仍暗哑明显，轻度咽干，夜寐不安，再以前法进退。处方：沙参20克，天麦冬各10克，生熟地各15克，山药10克，阿胶10克(烊化)，五味子10克，浙贝母10克，芦根10克，白芷6克，苏梗6克，焦麦芽10克，7剂，水煎服。
服上方后，声音恢复，喑哑消失，饮食二便正常，夜寐较安，余症皆去。再予上方10剂，分两周服用，以巩固疗效。
患者于1991年7月3日，又带病人来看病告知，一直授课，失音未复发，并坚持早晚锻炼，清淡饮食。
[按]：此患者系中学教师，由于发音过多，声带运用过度，耗伤肺阴，日久而致肾阴亦亏。肺脉通会厌，肾脉挟舌本，肺肾不足，阴液不能上承，咽喉失其濡养，而喑哑咽干，甚则失音。
肺气不清，则干咳少痰；阴虚生内热，虚火扰动心神，则心烦梦多；肾虚精亏，则腰膝酸软，舌红且干，脉细数，大便干结，均为阴亏有热之象。赵老治以滋补肺肾之阴，使金水相生，水源不竭。方中先以苏叶、前胡、桔梗、枇杷叶宣肺通窍，调畅气机；沙参、麦冬、天门冬、生地黄滋肺阴清肺热；五味子生津敛肺气；浙贝母宣肺软坚散结；瓜蒌润肺宽中通便。待喑哑取效后，再以生熟地、山药滋补肾阴，阿胶养阴润肺；苏梗宣畅气机，芦根宣肺生津润喉利咽，麦芽健脾。赵老更妙用白芷，白芷虽为驱风药，但性滑润，使大队滋补之品补而不腻，调和诸药，又能载药上达于咽喉。因此诸药相配，取效甚佳。
又[按]：失音是临床常见的病证，其病因病机比较复杂，《内经》名目“疴”或“暗”，《医学正传》则称“喉喑”，因肺脉通会厌，而肾脉挟舌本，“会厌者，音声之户也”(《灵枢·忧恚无言》)。本病虽属声道、喉咙的局部疾患，实与肺肾有密切关系，因此古人有“金水相生，病在肺肾”之说。《直指方》曰：“肺为声音之门，肾为声音之根”，前人叶天士则譬作：“金实则无声，金破亦无声”，都说明了这个道理。其病因当有内伤、外感之分，其病机应有虚实之不同。故张景岳说：“喑哑之病，当知虚实。实者其病在标，因窍闭而喑也；虚者其病在本，内夺而暗也”其辨证施治，当以病势的缓急，一般分为暴喑、久喑两大类。大抵暴喑者，多因风寒客热壅遏而致窍闭，其病属实，治当宣散清疏；久喑者，多因阴血耗伤，精气内夺而喑，其病属虚，治当清润滋养。
从目前临床所见，失音一症的病机属实者多而属虚者少。实者乃邪气阻滞，肺气失宣，金实则不鸣，治以宣肃散邪为主，邪去则金鸣；虚者精气内虚，金破亦不鸣，治以滋填为法，佐以宣畅肺气，亦不宜纯补蛮补，如上案用金水相生之法，仍须佐苏叶、枇杷叶、前胡、桔梗、浙贝母，即是例证。此外还须注意：
(1)失音的治疗，始终要注意气机的调畅，赵老常说：“治病之要，调畅气机”，(2)中焦是气机升降的枢纽，赵老治病非常重视脾胃之气的升降，胃气降浊气下行，有助于脾气的上升，有利于失音的康复。(3)失音的治疗，饮食调养至关重要。如饮食寒凉，则闭郁肺气，甜食壅塞气机，辛辣刺激食物则助热邪伤阴液，都不利于喑哑的恢复。因此药物治疗与饮食调养相互配合，才可收到比较满意的疗效。
鼻鼽（肥厚性鼻炎）
赵某某，女，35岁
初诊
自述患鼻炎五年余，经某医院五官科检查诊断为肥厚性鼻炎。终日鼻塞，浊涕长流，张口呼吸。脉象滑数，舌红苔黄，热在肺胃，先用清宣方法。
辛荑花10克，苍耳子10克，白芷6克，黄芩6克，前胡6克，苏叶子各10克，浙贝母10克，杏仁10克，枇杷叶10克，焦三仙各10克，茅芦根各10克，七付
二诊
近日感冒，鼻塞流涕，咳嗽痰多，脉仍滑数，舌红苔黄，热郁于内，仍用宣肺化痰，清热止浊方法。
苏叶子各10克，前胡6克，牛蒡子10克，白前6克，百部6克，辛荑花10克，苍耳子10克，黄芩6克，白芷6克，焦三仙各10克，七付
三诊
药后咳嗽已愈，咯痰大减，惟鼻塞流涕尚在，热郁未清，仍用前法进退。
辛荑花10克，苍耳子10克，白芷6克，黄芩10克，川楝子6克，前胡6克，白前6克，牛蒡子10克，七付
四诊
鼻塞较前减轻，大部时间用鼻呼吸不感困难，时有如物堵塞之感，药已见效，前法增损。
辛荑花10克，苍耳子10克，白芷6克，防风6克，黄芩6克，茅芦根各10克，沙参10克，七付。
五诊
鼻塞已通，时有浊涕流出。肺家郁热尚未全清，脉象滑数，舌红苔黄，仍用宣肺涤浊方法。
辛荑花10克，苍耳子10克，白芷6克，荆芥6克，牛蒡子10克，冬瓜子10克，苏叶10克，芦根10克，桔梗10克，七付
患者依上方续服一个月，鼻塞流涕皆愈。半年后患者前来医治他病，询之鼻炎未复发。
[按]：肺开窍于鼻，故鼻之病多从肺治。鼻塞浊涕者多为肺热；鼻塞清涕者多为肺寒。本案鼻塞浊涕黄稠，脉象滑数，舌红苔黄，显然肺热之象。肺热宜清，然不可寒凉直清，因寒则涩而不流，恐闭塞气机，致郁热反难散出。故治宜宣清结合。本案前后五诊，方中皆用辛荑花、苍耳、白芷，此三味辛香通气上达，升清气于头面，亦清阳出上窍之意；又用前胡、杏仁、枇杷叶等开宣肺气，肺气开则郁热易散；又用苏子、浙贝母、冬瓜子等化痰涤浊，使热无依附之邪则易祛；其余苏叶、防风、牛蒡子、桔梗、白前、百部、焦三仙、茅芦根、黄芩等各对症选用，加减出入。无非宣通肺气，祛除有形浊邪，则热自易散。不专以清热立论，此赵师辨治鼻病之大法也。
鼻痔（鼻息肉）
王某某，女，67岁
初诊
患鼻息肉10余年，两侧鼻孔皆有，初起较细小，近年来渐次长粗复长，现已长出鼻孔。左侧息肉略长于鼻孔边缘，右侧息肉长出鼻孔约0.5cm，粗如箸头，色暗红，触之不痛，时有黄水从鼻孔流出。多年来，不能用鼻呼吸。因其暴露于外，患者自觉寒碜，不愿外出与人见。今由女儿陪同前来求治。诊脉弦滑且数，舌红苔黄根厚，心烦梦多。热郁日久，络脉不通，清窍为之壅塞，先用清宣，以观其效。
辛荑花10克(后下)，苍耳子10克(后下)，白芷6克(后下)，防风6克，生地榆10克，黄芩10克，大黄1克，小蓟10克，水红花子10克，茅芦根各10克，大青叶10克，沙参10克 七付
二诊
上方七付后，自觉心烦减轻，鼻部尚无变化，夜寐梦多，大便仍偏干燥，舌红且干，脉象弦滑且数，病已延久，热郁较深，仍用清宣郁热方法。
辛荑花10克(后下)，苍耳子10克(后下)，白芷6克(后下)，防风6克，黄芩6克，川楝子6克，大黄2克，生地榆10克，炒槐花10克，焦三仙各10克，茅芦根各10克，沙参10克，麦门冬10克，七付。
三诊
上方续服三周，鼻中黄水减少，触之鼻痔略软。脉仍弦滑，舌红苔黄，大便略干，仍用清化方法。
辛荑花10克(后下)，苍耳子10克(后下)，防风6克，白芷6克(后下)，黄芩10克，川楝子6克，生地榆10克，炒槐花10克，大黄3克，十四付
四诊
湿热久郁，深入血分，久而成瘀，化生有形，占居清窍，非旦夕可以成功。继用清宣化瘀方法。
辛荑花10克(后下)，苍耳子10克(后下)，白芷6克(后下)，黄芩10克，赤芍10克，丹参10克，茜草10克，生地榆10克，焦三仙各10克，水红花子10克，大黄2克，十四付
五诊
患者服上方后自觉疗效明显，息肉有回缩之迹象，遂按方坚持服用1年零6个月。现左侧息肉已完全消失，左鼻孔通畅，可自由呼吸。右侧息肉已缩入右鼻孔内，时有黄水流出。诊脉弦滑，仍带数意，舌红且干，仍用前法加减。
辛荑花10克(后下)，苍耳子10克(后下)，白芷6克(后下)，防风6克，丹参10克，赤芍10克，茜草10克，焦三仙各10克，水红花子10克，十四付。
[按]：鼻息肉生长10余年，已长出鼻孔之外数分，按一般常识推测，若不用手术摘除，仅靠内服中药恐难以消除。然而，事实证明，中医辨证论治能够解决疑难问题，成功的关键是要以中医理论为指导。鼻为肺之外窍，为清气出入之通道，鼻息肉乃有形之赘生物，浊邪之结聚所成。必是肺热壅塞日久，深入血分，络脉阻滞。故此病不独属肺，而且涉及血分，为血分瘀阻之病。赵师治疗此病，治则十分明确，一是治肺，宣通肺气，二是治心，凉血化瘀。治肺用辛荑花、苍耳子、白芷等辛香通气之品，既能宣肺开郁结，通清窍，又能辛香引入络中，透邪外出。治心用丹参、茜草、赤芍、生地榆等凉血化瘀。古人云：“鼻塞治心”，心主血脉，今治在血分，即治心也。除此二者为主治疗外，还兼用了疏调三焦之品，如焦三仙、水红花子、大黄等，以三焦少阳，上连于肺，下通于肾，为气机之通道。古云：九窍不通，肠胃之所生也，慨指此言。此外，川楝子、黄芩泄肝肺之热，茅芦根清肺胃之热，沙参、麦门冬养阴清肺，各适时用之，体现了中医定法之中又灵活多变的特点。总之，赵师此案为临床治疗鼻部疑难病提供了宝贵的思路和经验，值得我们细心揣摩。
Hoarseness 3 (Acute Laryngitis)
Patient Yang, male, 78 years old, first consulted on August 10, 1989. According to the family member: Half a month ago, the patient suffered from a cold with fever, axillary temperature of 38.5°C, and sore throat. He took Banlangen Granules (Isatis Root Granules), Houzheng Wan (Throat Syndrome Pills), antibiotics, etc. His temperature dropped, but rose again to 39°C two days later. His voice began to hoarse, pronunciation became laborious, and eventually he lost his voice. His throat felt dry and blocked, unbearable, and he constantly wanted to scratch it with his hand. For the past seven days, he had consumed neither water nor food, nor had he defecated. Suspecting a tumor in the pharynx, he prepared for his death and asked Master Zhao to predict the prognosis. On examination: The body was emaciated, face red and eyes bright, body heat without sweat, chest tightness with stifling sensation, eyes wanting to close, alternating sleep and wakefulness, occasional delirium, short and dark urine, mouth dry, sticky, greasy, and foul, tongue coating white, greasy, thick, and dirty, pulse soggy and rapid. Axillary temperature 38.5°C.
These are all signs of summer-heat, dampness, turbidity, and stagnation. First, use the method of aromatic transformation of turbidity and venting of depression. Prescription: Huoxiang (Agastache Herba) 10g, Peilan (Eupatorii Herba) 10g, Zisuye (Perilla Leaf) 10g, Maolugen (Imperatae Rhizoma) and Lugen (Phragmitis Rhizoma) 10g each. Decoct in water, try taking 3 doses, take small amounts frequently.
Second Visit
At noon on the same day, the medicine entered the mouth but was difficult to swallow; after a long while, only a few sips were swallowed. There were a few bowel sounds in the abdomen. By evening, one dose was finished, slight sweating occurred, and night sleep was relatively peaceful. On the second day, spirit improved, consciousness cleared, he could drink a little coarse congee with Yam (Dioscoreae Rhizoma), and could emit a low voice. In the afternoon, he passed several stools like dry balls. Tongue coating white and greasy, pulse slippery and rapid, axillary temperature 37.5°C. Qi mechanism is gradually relaxing, summer-heat is gradually decreasing, voice is gradually recovering. Continue with aromatic venting and transformation, assisted by digestion-promoting agents. Prescription: Huoxiang (Agastache Herba) 10g, Zisuye (Perilla Leaf) 10g, Maolugen (Imperatae Rhizoma) and Lugen (Phragmitis Rhizoma) 10g each, Chao Shanzhi (Stir-fried Gardenia Fructus) 6g, Peilan (Eupatorii Herba) 10g, Dandouchi (Sojae Praeparata) 10g, Xingren (Armeniacae Semen Amarum) 10g, Dafupi (Arecae Pericarpium) 10g, Binglang (Arecae Semen) 10g, Huashi (Talcum) 10g, Jiao Sanxian (Charred Three Immortals: Shenqu, Maiya, Shanazha) 10g each. 4 doses, decoct in water and take orally.
Third Visit
Spirit is better, voice completely recovered, able to get out of bed and move around, diet and urination/defecation are normal, temperature 36.5°C. Adjust the previous method to consolidate the effect. Diet should be cautious to prevent relapse due to dietary indiscretion. Prescription: Chao Shanzhi (Stir-fried Gardenia Fructus) 6g, Dandouchi (Sojae Praeparata) 10g, Chao Zhike (Stir-fried Aurantii Fructus) 6g, Sugeng (Perillae Caulis) 6g, Zhuru (Bambusae Caulis in Taenia) 6g, Maolugen (Imperatae Rhizoma) and Lugen (Phragmitis Rhizoma) 10g each, Jiao Sanxian (Charred Three Immortals) 10g each, Shuihonghuazi (Hydrocotyles Seed) 10g. 7 doses.
[Commentary]: This patient has a constitutionally weak physique and contracted summer-damp pathogenic factors. Originally, light venting and releasing the exterior, aromatic venting and resolving, should have been used. Instead, cold-cooling agents like Banlangen Granules and Houzheng Wan were administered, obstructing the Qi mechanism, leaving no pathway for pathogens to exit externally, causing congestion of the clear orifices and resulting in loss of voice. The patient's body heat without sweat, chest tightness with stifling sensation, eyes wanting to close, alternating sleep and wakefulness, occasional delirium, short and dark urine, and rapid pulse indicate not that pathogens have sunk into the Pericardium or fire disturbing the Heart Spirit, but rather that summer-heat, dampness, and turbidity pathogens are covering and blocking the Upper Jiao, obstructing the clear orifices. Inability to eat, inability to defecate, and white, greasy, thick, dirty tongue coating belong to stagnation of damp-turbidity and unsmooth Qi mechanism.
Therefore, Master Zhao first treated with aromatic transformation of dampness, venting depression and opening closure, and activating the Qi mechanism. The formula uses Zisuye (Perilla Leaf), Huoxiang (Agastache Herba), and Peilan (Eupatorii Herba) to aromatically transform turbidity and smooth the Qi mechanism; Lugen (Phragmitis Rhizoma) clears heat and benefits the throat, and can also vent Yang and release the exterior; Maogen (Imperatae Rhizoma) clears heat and promotes diuresis to drain dampness. After summer-dampness gradually decreases, Qi mechanism relaxes, and voice recovers, add Dandouchi (Sojae Praeparata) and Chao Shanzhi (Stir-fried Gardenia Fructus) to bitterly vent and reduce heat, Xingren (Armeniacae Semen Amarum) and Zisuye (Perilla Leaf) to vent Lung and benefit orifices, opening the Upper Jiao Qi mechanism; Chao Zhike (Stir-fried Aurantii Fructus), Sugeng (Perillae Caulis), Dafupi (Arecae Pericarpium), Binglang (Arecae Semen), and Jiao Sanxian (Charred Three Immortals) strengthen Spleen and harmonize Stomach, digest food and guide stagnation, regulating Middle Jiao Qi mechanism; Maogen (Imperatae Rhizoma) and Huashi (Talcum) clear heat and promote diuresis to drain dampness, allowing damp-heat to exit via urine. All herbs combined, the Qi mechanism of the Triple Burner is smoothed, summer-heat vents externally, damp-turbidity transforms internally, clear rises and turbid descends, and the disease is cured.
Hoarseness 4 (Chronic Laryngitis)
Patient Wang, female, 36 years old, middle school teacher.
First consulted on April 4, 1991.
The patient has had hoarseness, fluctuating in severity, for over half a year. A certain hospital diagnosed "Chronic Laryngitis, Vocal Cord Hypertrophy." Pangdahai (Sterculia Lychnophora Seed) was initially effective, but later useless. Traditional Chinese Medicine decoctions, Qingyin Wan (Clear Voice Pill), Liushen Wan (Six Divine Pills), and antibiotics were ineffective. Currently, dry and itchy throat, hoarseness, cough with scanty sputum, vexation and frequent dreaming, soreness and weakness of waist and knees, dry stool, red tongue with white and dry coating, fine and rapid pulse. Syndrome belongs to Yin deficiency of Lung and Kidney. Treatment should nourish Lung and Kidney Yin to restore voice. Prescription: Shashen (Glehniae Radix) 10g, Tianmaidong (Asparagi Radix) and Maidong (Ophiopogonis Radix) 10g each, Shengdi (Rehmanniae Radix) 10g, Wuweizi (Schisandrae Fructus) 10g, Zhebeimu (Fritillariae Thunbergii Bulbus) 10g, Jiegeng (Platycodonis Radix) 10g, Qianhu (Peucedani Radix) 6g, Zisuye (Perilla Leaf) 6g, Gualou (Trichosanthis Fructus) 20g, Pipaye (Loquat Leaf) 10g. 5 doses, decoct in water and take orally. Advised light diet, avoid spicy and stimulating foods, walk 1-2 hours in the morning, and observe voice rest.
Second Visit
After taking the medicine, voice was clear in the morning, still significantly hoarse in the afternoon, mild dry throat, restless night sleep. Adjust the previous method. Prescription: Shashen (Glehniae Radix) 20g, Tianmaidong (Asparagi Radix) and Maidong (Ophiopogonis Radix) 10g each, Shengdihuang (Rehmanniae Radix Recens) and Shudihuang (Rehmanniae Radix Preparata) 15g each, Shanyao (Dioscoreae Rhizoma) 10g, Ejiao (Colla Corii Asini) 10g (melted), Wuweizi (Schisandrae Fructus) 10g, Zhebeimu (Fritillariae Thunbergii Bulbus) 10g, Lugen (Phragmitis Rhizoma) 10g, Baizhi (Angelicae Dahuricae Radix) 6g, Sugeng (Perillae Caulis) 6g, Jiao Maiya (Charred Hordei Fructus Germinatus) 10g. 7 doses, decoct in water and take orally.
After taking the above prescription, voice recovered, hoarseness disappeared, diet and urination/defecation normal, night sleep relatively peaceful, other symptoms gone. Give another 10 doses of the above prescription, taken over two weeks, to consolidate efficacy.
On July 3, 1991, the patient brought someone else to see the doctor and reported that she continued teaching, hoarseness did not recur, and she persisted in morning and evening exercise and light diet.
[Commentary]: This patient is a middle school teacher. Due to excessive vocalization and overuse of vocal cords, Lung Yin was damaged, and over time, Kidney Yin was also depleted. The Lung meridian connects with the epiglottis, and the Kidney meridian clamps the root of the tongue. Insufficiency of Lung and Kidney causes Yin fluids unable to ascend, throat loses nourishment, resulting in hoarseness, dry throat, and even loss of voice.
Unclear Lung Qi leads to dry cough with scanty sputum; Yin deficiency generates internal heat, deficient fire disturbs Heart Spirit, leading to vexation and frequent dreaming; Kidney deficiency and essence depletion lead to soreness and weakness of waist and knees. Red and dry tongue, fine and rapid pulse, dry stool are all signs of Yin deficiency with heat. Master Zhao treated by nourishing Lung and Kidney Yin, promoting Metal-Water mutual generation, ensuring the source of water does not dry up. In the formula, first use Zisuye (Perilla Leaf), Qianhu (Peucedani Radix), Jiegeng (Platycodonis Radix), Pipaye (Loquat Leaf) to vent Lung and open orifices, smooth Qi mechanism; Shashen (Glehniae Radix), Maidong (Ophiopogonis Radix), Tianmaidong (Asparagi Radix), Shengdihuang (Rehmanniae Radix Recens) nourish Lung Yin and clear Lung heat; Wuweizi (Schisandrae Fructus) generates fluids and astringes Lung Qi; Zhebeimu (Fritillariae Thunbergii Bulbus) vents Lung, softens hardness, and dissipates nodules; Gualou (Trichosanthis Fructus) moistens Lung, widens middle, and unblocks bowels. After hoarseness improves, use Shengdihuang (Rehmanniae Radix Recens) and Shudihuang (Rehmanniae Radix Preparata), Shanyao (Dioscoreae Rhizoma) to nourish Kidney Yin, Ejiao (Colla Corii Asini) to nourish Yin and moisten Lung; Sugeng (Perillae Caulis) smooths Qi mechanism, Lugen (Phragmitis Rhizoma) vents Lung, generates fluids, moistens throat and benefits throat, Maiya (Hordei Fructus Germinatus) strengthens Spleen. Master Zhao cleverly used Baizhi (Angelicae Dahuricae Radix). Although Baizhi is a wind-dispelling herb, its nature is slippery and moistening, making the large group of tonifying herbs tonify without cloying, harmonizing various herbs, and carrying drugs upward to the throat. Therefore, the combination of these herbs yields excellent results.
Further [Commentary]: Hoarseness is a common clinical syndrome with complex etiology and pathogenesis. *Neijing* calls it "Ke" or "An", *Yixue Zhengchuan* calls it "Hou Yin". Since the Lung meridian connects with the epiglottis and the Kidney meridian clamps the root of the tongue, "The epiglottis is the gate of sound" (*Ling Shu: You Hui Wu Yan*). Although this disease is a local disorder of the vocal tract and larynx, it is closely related to Lung and Kidney. Thus, ancients said "Metal-Water mutual generation, disease in Lung and Kidney." *Zhizhi Fang* says: "Lung is the gate of sound, Kidney is the root of sound." Ye Tianshi compared it as: "When Metal is solid, there is no sound; when Metal is broken, there is no sound," all illustrating this principle. Etiology should be divided into internal injury and external contraction; pathogenesis should differ in deficiency and excess. Zhang Jingyue said: "For hoarseness, one must know deficiency and excess. Excess: disease is at the branch, due to orifice closure causing aphonia; Deficiency: disease is at the root, due to internal depletion causing muteness." Differentiation and treatment should be based on the urgency of the disease course, generally divided into sudden aphonia and chronic muteness. Generally, sudden aphonia is mostly caused by wind-cold or pathogenic heat obstructing and closing the orifices, belonging to excess, treatment should be dispersing and clearing; chronic muteness is mostly caused by consumption of Yin-blood and depletion of essence-Qi, belonging to deficiency, treatment should be clearing, moistening, and nourishing.
From current clinical observations, hoarseness is mostly excess and rarely deficiency. Excess: pathogenic factors obstruct, Lung Qi fails to vent, Metal is solid and does not ring, treatment focuses on venting,肃 (descending), and dispersing pathogens; once pathogens leave, Metal rings. Deficiency: internal deficiency of essence-Qi, Metal is broken and does not ring, treatment focuses on filling and nourishing, assisted by smoothing Lung Qi, and should not be purely tonifying or brute force tonification. As in the above case using Metal-Water mutual generation, still need to assist with Zisuye (Perilla Leaf), Pipaye (Loquat Leaf), Qianhu (Peucedani Radix), Jiegeng (Platycodonis Radix), Zhebeimu (Fritillariae Thunbergii Bulbus), which is an example. Additionally, note:
(1) In treating hoarseness, always pay attention to smoothing the Qi mechanism. Master Zhao often said: "The key to treating disease is smoothing the Qi mechanism."
(2) The Middle Jiao is the pivot of Qi ascending and descending. Master Zhao attaches great importance to the ascending and descending of Spleen and Stomach Qi. Stomach Qi descending turbid Qi helps Spleen Qi ascend, benefiting recovery from hoarseness.
(3) Dietary care is crucial in treating hoarseness. Cold diet closes and depresses Lung Qi, sweet food obstructs Qi mechanism, spicy and stimulating foods help heat pathogens and damage Yin fluids, all unfavorable for recovery of hoarseness. Therefore, drug treatment and dietary care must cooperate to achieve satisfactory results.
Bi Qiu (Hypertrophic Rhinitis)
Patient Zhao, female, 35 years old.
First Visit
Self-reported rhinitis for over five years, diagnosed as hypertrophic rhinitis by the ENT department of a certain hospital. Nasal congestion all day, profuse turbid discharge, breathing through mouth. Pulse slippery and rapid, red tongue with yellow coating, heat in Lung and Stomach. First use clearing and venting method.
Xinyinhua (Magnolia Flower) 10g, Cang'erzi (Xanthii Fructus) 10g, Baizhi (Angelicae Dahuricae Radix) 6g, Huangqin (Scutellariae Radix) 6g, Qianhu (Peucedani Radix) 6g, Zisuye (Perilla Leaf) 10g each, Zhebeimu (Fritillariae Thunbergii Bulbus) 10g, Xingren (Armeniacae Semen Amarum) 10g, Pipaye (Loquat Leaf) 10g, Jiao Sanxian (Charred Three Immortals) 10g each, Maolugen (Imperatae Rhizoma) and Lugen (Phragmitis Rhizoma) 10g each. Seven doses.
Second Visit
Recent cold, nasal congestion and discharge, cough with profuse sputum, pulse still slippery and rapid, red tongue with yellow coating, heat constrained internally. Still use venting Lung, transforming phlegm, clearing heat, and stopping turbidity method.
Zisuye (Perilla Leaf) 10g each, Qianhu (Peucedani Radix) 6g, Niubangzi (Arctii Fructus) 10g, Baiqian (Cynanchi Stauntonii Rhizoma et Radix) 6g, Baibu (Stemonae Radix) 6g, Xinyinhua (Magnolia Flower) 10g, Cang'erzi (Xanthii Fructus) 10g, Huangqin (Scutellariae Radix) 6g, Baizhi (Angelicae Dahuricae Radix) 6g, Jiao Sanxian (Charred Three Immortals) 10g each. Seven doses.
Third Visit
After medicine, cough cured, expectoration greatly reduced, only nasal congestion and discharge remain, heat constraint not cleared. Still adjust previous method.
Xinyinhua (Magnolia Flower) 10g, Cang'erzi (Xanthii Fructus) 10g, Baizhi (Angelicae Dahuricae Radix) 6g, Huangqin (Scutellariae Radix) 10g, Chuanlianzi (Toosendan Fructus) 6g, Qianhu (Peucedani Radix) 6g, Baiqian (Cynanchi Stauntonii Rhizoma et Radix) 6g, Niubangzi (Arctii Fructus) 10g. Seven doses.
Fourth Visit
Nasal congestion relieved compared to before, most of the time nasal breathing is not difficult, occasionally feeling like something is blocking. Medicine is effective, increase/decrease previous method.
Xinyinhua (Magnolia Flower) 10g, Cang'erzi (Xanthii Fructus) 10g, Baizhi (Angelicae Dahuricae Radix) 6g, Fangfeng (Saposhnikoviae Radix) 6g, Huangqin (Scutellariae Radix) 6g, Maolugen (Imperatae Rhizoma) and Lugen (Phragmitis Rhizoma) 10g each, Shashen (Glehniae Radix) 10g. Seven doses.
Fifth Visit
Nasal congestion cleared, occasional turbid discharge flows. Lung home constraint heat not fully cleared, pulse slippery and rapid, red tongue with yellow coating. Still use venting Lung and washing away turbidity method.
Xinyinhua (Magnolia Flower) 10g, Cang'erzi (Xanthii Fructus) 10g, Baizhi (Angelicae Dahuricae Radix) 6g, Jingjie (Schizonepetae Spica) 6g, Niubangzi (Arctii Fructus) 10g, Dongguazi (Benincasae Semen) 10g, Zisuye (Perilla Leaf) 10g, Lugen (Phragmitis Rhizoma) 10g, Jiegeng (Platycodonis Radix) 10g. Seven doses.
Patient continued taking the above prescription for one month, nasal congestion and discharge both cured. Half a year later, patient came to treat other diseases, inquired that rhinitis did not recur.
[Commentary]: Lung opens into the nose, so nasal diseases are mostly treated from the Lung. Nasal congestion with turbid discharge is mostly Lung heat; nasal congestion with clear discharge is mostly Lung cold. This case has nasal congestion with yellow and thick turbid discharge, pulse slippery and rapid, red tongue with yellow coating, obviously signs of Lung heat. Lung heat should be cleared, but cannot be directly cleared with cold-cooling agents, because cold causes stagnation and non-flow, fearing obstruction of Qi mechanism, causing constrained heat to be harder to disperse. Therefore, treatment should combine venting and clearing. In the five visits of this case, Xinyinhua (Magnolia Flower), Cang'erzi (Xanthii Fructus), and Baizhi (Angelicae Dahuricae Radix) were used in all formulas. These three herbs are pungent and aromatic, venting Qi and reaching upwards, raising clear Qi to head and face, meaning clear Yang exits upper orifices; also used Qianhu (Peucedani Radix), Xingren (Armeniacae Semen Amarum), Pipaye (Loquat Leaf) etc. to open and vent Lung Qi, when Lung Qi opens, constrained heat easily disperses; also used Su Zi (Perillae Fructus), Zhebeimu (Fritillariae Thunbergii Bulbus), Dongguazi (Benincasae Semen) etc. to transform phlegm and wash away turbidity, so heat has no pathogenic factor to attach to and is easily dispelled; remaining Zisuye (Perilla Leaf), Fangfeng (Saposhnikoviae Radix), Niubangzi (Arctii Fructus), Jiegeng (Platycodonis Radix), Baiqian (Cynanchi Stauntonii Rhizoma et Radix), Baibu (Stemonae Radix), Jiao Sanxian (Charred Three Immortals), Maolugen (Imperatae Rhizoma), Lugen (Phragmitis Rhizoma), Huangqin (Scutellariae Radix) etc. were selected according to symptoms, added and subtracted. Nothing but venting and unblocking Lung Qi, removing tangible turbid pathogens, so heat naturally disperses. Not specifically establishing theory on clearing heat, this is Master Zhao's major principle in differentiating and treating nasal diseases.
Bi Zhi (Nasal Polyps)
Patient Wang, female, 67 years old.
First Visit
Suffered from nasal polyps for over 10 years, present in both nostrils, initially smaller, in recent years gradually grew thicker and longer, now protruding out of the nostrils. Left polyp slightly longer than the nostril edge, right polyp protrudes about 0.5cm out of the nostril, thick as a chopstick head, dark red color, painless on touch, occasionally yellow fluid flows from nostrils. For many years, unable to breathe through nose. Because exposed externally, patient feels ashamed, unwilling to go out and meet people. Accompanied by daughter to seek treatment today. Pulse string-slippery and rapid, red tongue with yellow coating, thick at root, vexation and frequent dreaming. Heat constrained for a long time, collaterals unblocked, clear orifices congested. First use clearing and venting, to observe effect.
Xinyinhua (Magnolia Flower) 10g (add later), Cang'erzi (Xanthii Fructus) 10g (add later), Baizhi (Angelicae Dahuricae Radix) 6g (add later), Fangfeng (Saposhnikoviae Radix) 6g, Sheng Diyu (Sanguisorbae Radix) 10g, Huangqin (Scutellariae Radix) 10g, Dahuang (Rhei Radix et Rhizoma) 1g, Xiaoji (Cirsii Herba) 10g, Shuihonghuazi (Hydrocotyles Seed) 10g, Maolugen (Imperatae Rhizoma) and Lugen (Phragmitis Rhizoma) 10g each, Daqingye (Isatidis Folium) 10g, Shashen (Glehniae Radix) 10g. Seven doses.
Second Visit
After seven doses of the above prescription, self-feeling vexation reduced, nasal part no change, night sleep with frequent dreams, stool still slightly dry, red tongue and dry, pulse string-slippery and rapid. Disease has prolonged, heat constraint deeper. Still use clearing and venting constrained heat method.
Xinyinhua (Magnolia Flower) 10g (add later), Cang'erzi (Xanthii Fructus) 10g (add later), Baizhi (Angelicae Dahuricae Radix) 6g (add later), Fangfeng (Saposhnikoviae Radix) 6g, Huangqin (Scutellariae Radix) 6g, Chuanlianzi (Toosendan Fructus) 6g, Dahuang (Rhei Radix et Rhizoma) 2g, Sheng Diyu (Sanguisorbae Radix) 10g, Chao Huaihua (Stir-fried Sophorae Flos) 10g, Jiao Sanxian (Charred Three Immortals) 10g each, Maolugen (Imperatae Rhizoma) and Lugen (Phragmitis Rhizoma) 10g each, Shashen (Glehniae Radix) 10g, Maimendong (Ophiopogonis Radix) 10g. Seven doses.
Third Visit
Continued taking the above prescription for three weeks, yellow fluid in nose reduced, touching nasal polyp slightly softer. Pulse still string-slippery, red tongue with yellow coating, stool slightly dry. Still use clearing and transforming method.
Xinyinhua (Magnolia Flower) 10g (add later), Cang'erzi (Xanthii Fructus) 10g (add later), Fangfeng (Saposhnikoviae Radix) 6g, Baizhi (Angelicae Dahuricae Radix) 6g (add later), Huangqin (Scutellariae Radix) 10g, Chuanlianzi (Toosendan Fructus) 6g, Sheng Diyu (Sanguisorbae Radix) 10g, Chao Huaihua (Stir-fried Sophorae Flos) 10g, Dahuang (Rhei Radix et Rhizoma) 3g. Fourteen doses.
Fourth Visit
Damp-heat constrained for a long time, deeply entering Blood level, forming stasis over time, generating tangible form, occupying clear orifices, cannot succeed in a day or night. Continue using clearing, venting, and transforming stasis method.
Xinyinhua (Magnolia Flower) 10g (add later), Cang'erzi (Xanthii Fructus) 10g (add later), Baizhi (Angelicae Dahuricae Radix) 6g (add later), Huangqin (Scutellariae Radix) 10g, Chi Shao (Paeoniae Radix Rubra) 10g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 10g, Qiancao (Rubiae Radix) 10g, Sheng Diyu (Sanguisorbae Radix) 10g, Jiao Sanxian (Charred Three Immortals) 10g each, Shuihonghuazi (Hydrocotyles Seed) 10g, Dahuang (Rhei Radix et Rhizoma) 2g. Fourteen doses.
Fifth Visit
Patient self-feels obvious efficacy after taking the above prescription, polyps show signs of shrinking. Persistently took the prescription according to the formula for 1 year and 6 months. Now left polyp completely disappeared, left nostril patent, free breathing. Right polyp shrunk into right nostril, occasional yellow fluid flows. Pulse string-slippery, still with rapid intention, red tongue and dry. Still adjust previous method.
Xinyinhua (Magnolia Flower) 10g (add later), Cang'erzi (Xanthii Fructus) 10g (add later), Baizhi (Angelicae Dahuricae Radix) 6g (add later), Fangfeng (Saposhnikoviae Radix) 6g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 10g, Chi Shao (Paeoniae Radix Rubra) 10g, Qiancao (Rubiae Radix) 10g, Jiao Sanxian (Charred Three Immortals) 10g each, Shuihonghuazi (Hydrocotyles Seed) 10g. Fourteen doses.
[Commentary]: Nasal polyps grown for over 10 years, protruding several fen outside the nostril. According to general common sense, if surgical removal is not used, relying solely on internal Chinese medicine may be difficult to eliminate. However, facts prove that TCM syndrome differentiation and treatment can solve difficult problems. The key to success is to be guided by TCM theory. Nose is the external orifice of Lung, passage for clear Qi entry and exit. Nasal polyps are tangible excrescences, formed by aggregation of turbid pathogens. Must be Lung heat congested for a long time, deeply entering Blood level, collaterals obstructed. Thus, this disease does not only belong to Lung, but involves Blood level, being a disease of Blood stasis obstruction. Master Zhao's treatment principle for this disease is very clear: first, treat Lung, vent and unblock Lung Qi; second, treat Heart, cool Blood and transform stasis. Treating Lung uses Xinyinhua (Magnolia Flower), Cang'erzi (Xanthii Fructus), Baizhi (Angelicae Dahuricae Radix) and other pungent and aromatic Qi-venting herbs, which can not only vent Lung and open depression, clear orifices, but also introduce pungent aroma into collaterals, penetrating pathogens outward. Treating Heart uses Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Qiancao (Rubiae Radix), Chi Shao (Paeoniae Radix Rubra), Sheng Diyu (Sanguisorbae Radix) and other cooling Blood and transforming stasis herbs. Ancients said: "Nasal congestion treats Heart." Heart governs Blood vessels. Now treating in Blood level is treating Heart. Besides these two main treatments, also used herbs to regulate Triple Burner, such as Jiao Sanxian (Charred Three Immortals), Shuihonghuazi (Hydrocotyles Seed), Dahuang (Rhei Radix et Rhizoma) etc., because Triple Burner Shaoyang connects upwards to Lung and downwards to Kidney, being the channel of Qi mechanism. Ancients said: "Nine orifices unblocked, generated from intestines and stomach," referring to this statement. In addition, Chuanlianzi (Toosendan Fructus) and Huangqin (Scutellariae Radix) drain Liver and Lung heat, Maolugen (Imperatae Rhizoma) and Lugen (Phragmitis Rhizoma) clear Lung and Stomach heat, Shashen (Glehniae Radix) and Maimendong (Ophiopogonis Radix) nourish Yin and clear Lung, each used at appropriate times, reflecting the characteristic of flexibility within fixed methods in TCM. In short, Master Zhao's case provides valuable ideas and experience for clinical treatment of difficult nasal diseases, worthy of careful study.