腹痛1(肠痉挛)
余某某，女，37岁
初诊
腹痛阵阵发作，以手按之则舒，脉象弦细带滑，按之急教，舌白苔润，纳食欠佳，心烦梦多。中年禀质薄弱，木土不和，气机郁滞，络脉失养，先用养血育阴，疏调木土方法。
当归10克，白芍10克，炙甘草10克，桂枝木6克，生牡蛎20克，木瓜10克，何首乌10克，生地黄10克，益母草10
克，乳香2克，七剂
二诊
药后腹痛未再发生，精神已觉振奋，胃口尚未全开，再以前法进退。寒凉肥甘在所当忌。
当归10克，白芍10克，炙草10克，桂枝6克，木瓜10
克，焦三仙各10克，香稻芽10克，陈皮6克，炒枳壳6克，水红花子10克，七剂
药后胃口大开。嘱其停药，饮食调理，以防复发。
[按]：腹痛阵作，其来也暴，故责之肝；按之得舒，禀赋素弱，则为血虚。小建中汤法以温中阳，咖当归、地黄、何首乌养血育阴，乳香少用以活血定痛。此案从虚论治，得效后改调理脾胃，开胃进食，以壮后天，斯可防其复发。
腹痛2(慢性盆腔炎)
郁某，女，30岁
初诊
少腹隐隐作痛，喜温喜按，形瘦面白，四肢不温，自觉疲乏无力病已年余，经妇科检查有慢性盆腔炎症，诊脉沉弱无力，舌白精润。此中阳不足，后天乏力，致气血双亏。先用益气养血方法，温经缓痛。
柴胡6克，党参6克，黄芪10克，荆芥炭10克，防风6克，杏仁10克，淡吴萸6克，炮姜6克，炒官桂6克，茯苓10克，半夏10克，香附10克，七剂
药后腹痛大减，精力有加，前后共服药30余剂，诸症消失。身体较前强壮，判若两人。
[按]：本案患者病腹痛一年余，因其慢性盆腔炎，曾服多种消炎西药，中医治疗也往往加入清热利湿以为消炎之用。先生临床并来拘于西医慢性炎症的诊断，而是根据脉舌色症的特征，判断为中阳不足，气血双亏，用益气补中方法，正气旺盛，自可驱邪外出。所谓养正积自除，此之谓也。但必须舌润、脉弱、症不足，形气、病气皆虚，是用补之征也。若拘于西医炎症之说，或拘于中医痛无补法之说，用清泄攻伐，日久必伤正气，正伤则邪愈盛，迁延难愈，咎由此也。
腹痛3(肠粘连)
李某某，女，42岁
初诊
腹痛如绞，难以忍耐，每日必作，大便干结，数日一行，形如羊矢。病已10余年。曾经腹部手术，术后肠粘连较重。面色苍黑，舌红苔黄根厚，脉象沉弦滑数，按之有力。性情急躁，夜寐梦多。此肝郁化火。疏泄不利，肠间燥矢，阻碍气机，不得升降，故腹痛阵作，痛则如绞。先用疏调，令气机通畅，大便则下而痛止矣。
柴胡6克，黄芩10克，川楝子10克，元胡10克，炒枳壳6克，龙胆草3克，焦三仙各10克，水红花子10克，大腹皮10克，槟榔10克，大黄3克，瓜萎仁30克，七剂
二诊
药后大便即通，仍较干，腹痛减缓。据述多年以来，大便干结难下，数日一行，凡便通之日，腹痛即轻，若无大便，其痛必重。此传化之病，继用疏调三焦方法。
焦三仙各10克，水红花子10克，大腹皮10克，槟榔10克，大黄5克(后下)，瓜蒌仁30克，炒枳壳6克，厚朴6克，川楝于10克，元胡10克，防风6克，七剂
三诊
大便二日一行，腹痛之势大减，心中烦急渐轻，夜寐亦安。病已久延，宜用丸药调理。并须坚持运动。每日散步早晚各1次1～2小时。若能坚持，可望大便复常，腹痛渐止。
丸药方：柴胡10克，升麻10克，防风10克，川楝子20克，元胡20克，厚朴10克，枳枳壳10克，枳实10克，白术20克，本香10克，青陈皮各20克，黄芩20克，龙胆草10克，焦三仙各30克，水红花子30克，大腹皮30克，槟榔30克，大黄30克，芒硝20克，三棱20克，莪术20克
上药共研细末，炼蜜为丸，每丸重10克，每服1丸，每日早晚各1次，以便通为度，若不知，可加至2、3丸。
患者依法配药1料，服之大便逐渐转为正常，腹痛渐轻，其问坚持运动锻炼，一年后腹痛消失。
[按]：患者腹痛，大便干结，便后痛减，说明疼痛是由便结引起的。当治便结，便通则痛止。其面苍，脉沉弦，性急暴，为肝经郁火，用柴胡、黄芩、川楝子泻之；便结为传导之证，疏调三焦，用焦三仙、水红花子、大腹皮、槟榔；热结便坚，用大黄、瓜萎仁攻之润之。先用汤剂救急，待证缓，制丸药缓图之。并辅以运动锻炼，以促进肠蠕动，持久以收全功。
腹痛4(附件炎)
吴某某，女，31岁
初诊
小腹作痛，经常发作，经期加重，经妇科检查，认为系附件炎症。经色深紫成块，舌白质红，脉象弦细。按之无力。营血不足，肝经郁热，气分不畅，先拟疏调八脉，以缓腹痛。
炒艾叶6克，阿腔珠10克，当归10克，川楝子6克，炒官桂6克，漩吴萸3克，乌药6克，柴胡6克，黄芩6克，香附10克，七剂
二诊
腹痛轻减，癸事适来，腹痛并未加重，经色探红，仍有小块，苔白质红，脉仍弦细，血分瘀滞，再以活瘀通络方法。
炒艾叶6克，阿胶球10克，当归10克，川楝子6克，赤白芍各10克，生蒲黄10克，炒五灵脂10克，红花6克，柴胡6克，黄芩6克，香附10克，七剂
上方加减续服20余剂，月经复来，色正红，无血块，腹痛未作。病告愈。
[按]：妇女腹痛腰痛，多与月经异常有关，血热、血寒、血虚、血瘀，各有征象。此案为血脉瘀滞，兼有血虚。经色深紫成块，是血分瘀热的表现，脉细按之无力，舌白而润，又属血少，气分不足，故用药则两调之。初诊用柴胡、黄芩、川楝子泻肝热}用当归、阿胶珠养血生血；用吴茱萸、官桂，炒艾叶温经止痛；用乌药、香附调气机。全方既泻郁热，又温通经脉，避免了寒凝气机之弊。二诊方加强了活血化瘀通络的力量，增入失笑散(生蒲黄、炒五灵脂)并用赤白芍、红花活血化瘀。经过一个月经周期的调治，经色、量、质均已复常，腹痛痊愈。但凡月经为病，一般都应该调治一个或几个周期，务令月经正常，则其病自然痊愈。否则，病本未除，恐暂愈而将复发也。
呕吐1(中暑)
张某某，男，24岁
头晕恶心，呕吐酸腐痰水，舌白滑腻，脉象灞滑且数。暑热外受，痰浊中阻，用芳香宣化方法，以定其吐。
佩兰10克(后下)，藿香10克(后下)，香薷6克，川连6克，半夏10克，苏梗10克，竹茹6克，枳壳6克，厚朴6克，白芷6克(后下)，炙枇杷叶10克，焦三仙各10克，茅芦根各10克，三剂
药后吐止，头晕恶心皆除，停药观察，休息数日而愈。
[按]：此暑热引动痰湿，故用温病中暑湿治法。佩兰、藿香、白芷皆后下取其芳香以化湿浊，川连、半夏、苏梗三药相配为下气降逆定吐之圣剂要药，枳壳、厚朴行气消痰，竹茹、杷叶和胃清热，香薷消暑热于外，茅芦根利暑湿于下，焦三仙和脾胃于中。用药虽多，各有所用，互相协同，以奏全功，治暑热痰湿者，可仿此用药。
呕吐2(神经性呕吐)
陈某，女，31岁初诊
呕吐经年未愈，心烦急躁，夜寐不安，胃不思纳，食入即吐，几乎每日必作，甚至呕吐黄苦水液。曾住院检查治疗，未获阳性结果，定为神经性呕吐。中西药物及针灸按摩，莫不备尝而皆无效。脉象弦细而数，按之则无力，舌红苔白且干，久病呕吐，胃气必伤，中气不足，本当补土安中，但脉象弦细而数，弦则主郁，细为阴虚，数乃热象，按之无力则主本虚，是证本虚标热，故当先治其标热以定其吐，候热清再议补中安胃。
灶心黄土30克(先煎汤代水煎药)，藿香梗10克，苏叶梗各10克，半夏10克，竹茹6克，石斛10克，白芍10克，生石决明20克，生牡蛎20克，代赭石10克，生姜3克，三剂
二诊
药后呕吐减轻，心中仍觉烦急，大便干结，数日未行，舌红苔干。郁热日久，宜导之下行。前方加减。
灶心黄土30克(先煎代水)，苏藿梗各10克，半夏10克，黄连3克，竹茹6克，枇杷叶10克，石斛10克，白芍10克，代赭石10克，大黄2克，三剂
三诊
药后大便畅行，呕恶明显减轻，夜寐渐安，胃纳有增。脉仍弦细。按之力弱，舌红苔白，仍用前法进退。
灶心黄土30克(包煎)，苏藿梗各10克，黄连2克，半夏10克，竹茹6克，陈皮10克，焦三仙各10克，大黄2克，茅芦根各10克，香砂六君子丸10克(包煎)，七剂。
上药服后呕吐垒止，胃纳渐增，遂停汤药。续服香砂六君子，并注意饮食规律，以善其后。
[按]：呕吐经年，胃气必伤，然食入即吐，是有火也，当先治其标热。故用降逆和胃泄热之法。药虽小效，终不若二诊加凡大黄，使胃家郁热下泻有路，疗效始著。阳明胃土以降为顺以通为补，三焦通畅，传导自分，何吐之有?呕吐3(神经性呕吐)
王某某，女，39岁
初诊
肝木逆郁，脾土受克，恶心呕吐不止，脘腹逆满，舌白润滑，脉象弦滑。病由恼怒而起，先用降逆定呕止吐方法。
旋复花6克，代赭石10克，半夏10克，竹茹6克，枳壳6
克，香附10克，生牡蛎20克，佛手片6克，绿萼梅2克，三付
另：白蔻仁2克，食盐2克，二味同研细末袋胶囊分两次吞服。
二诊
药后恶心呕吐减轻，脘腹胀满渐宽，暖气不舒，脉仍弦滑，舌白且润，前法进退。
旋复花6克，代赭石10克，半夏10克，竹茹6克，枳壳6
克，青陈皮各6克，香附10克，厚扑6克，白蔻仁6克(后下)，佛手6克，三付
药后吐止食进，病愈。
[按]：怒则肝旺，肝气犯胃则吐逆，故用平肝理气法而赦。
白蔻、食盐为末吞服乃止吐妙方，凡激饮中阻，气逆作吐者皆可用之。
107
痢疾1(急性细菌性痢疾)
巩某某，男，28岁
初诊
身热恶寒一日，头晕恶心，腹痛阵作，里急后重，大便带有脓血粘液。两脉濡滑而数，舌红苔白根厚而腻。病属暑热积滞互阻不化，势将成痢，先以芳香宣化、逆流挽舟方法。
苏叶10克，藿香10克(后下)，佩兰10克(后下)，香薷6
克(后下)，葛根10克，黄芩10克，黄连6克，木香6克，桂枝6
克，白芍10克，川军3克，二付
二诊
药后腹痛止而身热亦退，恶心已除，大便基本恢复正常，下坠感消失。脉象弦精，舌红苔白，再以升降分化方法，清其余邪，以善其后。
葛根10克，川连6克，黄芩10克，秦皮6克，木香6克，香附10克，焦三仙各10克，白芍10克，丹参10克，三付
[按]：凡痢疾初起有表证者，其邪路未深，可选用风药提出其邪，使由表外达，谓之逆流挽舟之法。喻嘉言倡用败毒散治痢疾初起即是此法。赵师惯以葛根芩连汤加风药，本案中用香蔫、苏叶、桂枝、葛根等，达邪出表；用芩、连、大黄苦寒下行，直清里热，一升一降，故谓之升降分化。藿香、佩兰芳香化湿，透邪外出，术香调气，白芍和营。配伍恰当，两付即愈。
108
痢疾2(慢性茵痢)
邓某，女，67岁
初诊
痢疾缠绵三月未愈，腹痛后重，大便带有脓血，日便5～6
次。曾服参芪归芍等补益气血之品及罂粟壳等收涩之剂。药后下坠之势增重，心烦急躁，口渴欲饮，舌苔黄垢根厚，脉象精数有力。病属湿热积滞互结，蜜塞肠道，气机痹阻而为后重，热迫血分则为脓血，宜用清化湿热，消导积滞方法。饮食当慎。
煨葛根10克，升麻炭6克，黄芩10克，黄连3克，术香6
克，香附10克，防风6克，赤芍10克，鸡内金10克，莱菔子10
克，槟榔10克，炒枳壳6克，大黄3克，三付
二诊
药后大便排泄甚多，脓血减步，后重已除，大便一日二次，尚未成形。脉象精数，舌红苔黄，仍用前法加减。
葛根10克，黄芩6克，黄连3克，赤芍10克，炒枳壳6
克，木香6克，焦三仙各10克，水红花子10克，三付
三诊
大便已转成形，每日1次。唯纳谷欠香，用醒脾导滞开胃进食方法。
焦三仙各10克，水红花子10克，香稻芽10克，术香3
克，青陈皮各6克，黄连2克，赤芍10克，槟榔10克，三付
[按]：痢疾迁延，已成慢性，前医按久病为虚，治以益气补中，并用收涩，致病情加重。痢疾本属积滞与邪毒互结，故有无积不作痢之说。积滞不去则痢疾难愈，此慢性痢疾之所由生
109
腹痛1（肠痉挛）
余某某，女性，37岁。
初诊：
腹痛呈阵发性发作，用手按压后感到舒适，脉象弦细且带滑象，重按时感觉紧急，舌苔白而湿润，食欲不佳，心烦且多梦。患者中年体质薄弱，肝木与脾土不和，气机郁滞，络脉失于濡养，先采用养血育阴、疏调肝脾的方法治疗。
处方：当归10克，白芍10克，炙甘草10克，桂枝木6克，生牡蛎20克，木瓜10克，何首乌10克，生地黄10克，益母草10克，乳香2克，共七剂。
二诊：
服药后腹痛未再发生，精神已觉振奋，但胃口尚未完全恢复，继续以前法加减调整。忌食寒凉及肥甘厚味之品。
处方：当归10克，白芍10克，炙甘草10克，桂枝6克，木瓜10克，焦三仙各10克，香稻芽10克，陈皮6克，炒枳壳6克，水红花子10克，共七剂。
服药后胃口大开。嘱咐停药，通过饮食调理，以防复发。
[按语]：腹痛阵作，发病急骤，故责之于肝；按压后得舒，因禀赋素弱，属于血虚。小建中汤法用于温补中阳，此处加入当归、地黄、何首乌以养血育阴，少量使用乳香以活血定痛。此案从虚证论治，见效后改为调理脾胃、开胃进食，以强壮后天之本，从而防止复发。
腹痛2（慢性盆腔炎）
郁某，女性，30岁。
初诊：
少腹部隐隐作痛，喜温喜按，形体消瘦面色苍白，四肢不温暖，自觉疲乏无力，病程已一年多。经妇科检查诊断为慢性盆腔炎症，诊脉沉弱无力，舌苔白且津液润滑。此为中阳不足，后天脾胃乏力，导致气血双亏。先采用益气养血的方法，温经缓痛。
处方：柴胡6克，党参6克，黄芪10克，荆芥炭10克，防风6克，杏仁10克，淡吴茱萸6克，炮姜6克，炒官桂6克，茯苓10克，半夏10克，香附10克，共七剂。
服药后腹痛大减，精力增加，前后共服药30余剂，诸症消失。身体较前强壮，判若两人。
[按语]：本案患者腹痛一年余，因患慢性盆腔炎，曾服用多种消炎西药，中医治疗也往往加入清热利湿以为消炎之用。先生临床并不拘泥于西医“慢性炎症”的诊断，而是根据脉、舌、色、症的特征，判断为中阳不足、气血双亏，用益气补中的方法，正气旺盛，自然可驱邪外出。所谓“养正积自除”，说的就是这个道理。但必须舌润、脉弱、症状表现为不足，形气、病气皆虚，才是用补法的指征。如果拘泥于西医炎症之说，或拘泥于中医“痛无补法”之说，使用清泄攻伐之法，日久必伤正气，正伤则邪愈盛，迁延难愈，过错就在这里。
腹痛3（肠粘连）
李某某，女性，42岁。
初诊：
腹痛如绞，难以忍耐，每日必发，大便干结，数日一行，形状如羊屎。病程已10余年。曾经接受腹部手术，术后肠粘连较重。面色苍黑，舌红苔黄根部厚，脉象沉弦滑数，重按有力。性情急躁，夜间睡眠多梦。此为肝郁化火，疏泄不利，肠道间燥屎阻碍气机，不得升降，故腹痛阵作，痛时如绞。先用疏调方法，令气机通畅，大便下行则疼痛停止。
处方：柴胡6克，黄芩10克，川楝子10克，元胡10克，炒枳壳6克，龙胆草3克，焦三仙各10克，水红花子10克，大腹皮10克，槟榔10克，大黄3克，瓜蒌仁30克，共七剂。
二诊：
服药后大便即通，但仍较干，腹痛减缓。据述多年来大便干结难下，数日一行，凡大便通畅之日，腹痛即轻，若无大便，其痛必重。此为传导失常之病，继用疏调三焦的方法。
处方：焦三仙各10克，水红花子10克，大腹皮10克，槟榔10克，大黄5克（后下），瓜蒌仁30克，炒枳壳6克，厚朴6克，川楝子10克，元胡10克，防风6克，共七剂。
三诊：
大便二日一行，腹痛之势大减，心中烦急渐轻，夜间睡眠亦安。病已久延，宜用丸药调理。并须坚持运动。每日早晚各散步1～2小时。若能坚持，可望大便复常，腹痛渐止。
丸药方：柴胡10克，升麻10克，防风10克，川楝子20克，元胡20克，厚朴10克，枳壳10克，枳实10克，白术20克，木香10克，青皮陈皮各20克，黄芩20克，龙胆草10克，焦三仙各30克，水红花子30克，大腹皮30克，槟榔30克，大黄30克，芒硝20克，三棱20克，莪术20克。
上药共研细末，炼蜜为丸，每丸重10克，每次服1丸，每日早晚各1次，以便通为度，若不通，可加至2、3丸。
患者依法配药1料，服之大便逐渐转为正常，腹痛渐轻，其间坚持运动锻炼，一年后腹痛消失。
[按语]：患者腹痛，大便干结，便后痛减，说明疼痛是由便结引起的。当治便结，便通则痛止。其面苍，脉沉弦，性急暴，为肝经郁火，用柴胡、黄芩、川楝子泻之；便结为传导之证，疏调三焦，用焦三仙、水红花子、大腹皮、槟榔；热结便坚，用大黄、瓜蒌仁攻之润之。先用汤剂救急，待证缓，制丸药缓图之。并辅以运动锻炼，以促进肠蠕动，持久以收全功。
腹痛4（附件炎）
吴某某，女性，31岁。
初诊：
小腹作痛，经常发作，经期加重，经妇科检查，认为系附件炎症。经色深紫成块，舌白质红，脉象弦细，按之无力。营血不足，肝经郁热，气分不畅，先拟疏调八脉，以缓腹痛。
处方：炒艾叶6克，阿胶珠10克，当归10克，川楝子6克，炒官桂6克，淡吴茱萸3克，乌药6克，柴胡6克，黄芩6克，香附10克，共七剂。
二诊：
腹痛轻减，月经适来，腹痛并未加重，经色深红，仍有小块，苔白质红，脉仍弦细，血分瘀滞，再以活血化瘀通络方法。
处方：炒艾叶6克，阿胶珠10克，当归10克，川楝子6克，赤白芍各10克，生蒲黄10克，炒五灵脂10克，红花6克，柴胡6克，黄芩6克，香附10克，共七剂。
上方加减续服20余剂，月经复来，色正红，无血块，腹痛未作。病告愈。
[按语]：妇女腹痛腰痛，多与月经异常有关，血热、血寒、血虚、血瘀，各有征象。此案为血脉瘀滞，兼有血虚。经色深紫成块，是血分瘀热的表现，脉细按之无力，舌白而润，又属血少，气分不足，故用药则两调之。初诊用柴胡、黄芩、川楝子泻肝热，用当归、阿胶珠养血生血；用吴茱萸、官桂、炒艾叶温经止痛；用乌药、香附调气机。全方既泻郁热，又温通经脉，避免了寒凝气机之弊。二诊方加强了活血化瘀通络的力量，增入失笑散（生蒲黄、炒五灵脂）并用赤白芍、红花活血化瘀。经过一个月经周期的调治，经色、量、质均已复常，腹痛痊愈。但凡月经为病，一般都应该调治一个或几个周期，务令月经正常，则其病自然痊愈。否则，病本未除，恐暂愈而将复发也。
呕吐1（中暑）
张某某，男性，24岁。
头晕恶心，呕吐酸腐痰水，舌白滑腻，脉象濡滑且数。暑热外受，痰浊中阻，用芳香宣化方法，以定其吐。
处方：佩兰10克（后下），藿香10克（后下），香薷6克，川连6克，半夏10克，苏梗10克，竹茹6克，枳壳6克，厚朴6克，白芷6克（后下），炙枇杷叶10克，焦三仙各10克，茅根芦根各10克，三剂。
药后吐止，头晕恶心皆除，停药观察，休息数日而愈。
[按语]：此暑热引动痰湿，故用温病中暑湿治法。佩兰、藿香、白芷皆后下取其芳香以化湿浊，川连、半夏、苏梗三药相配为下气降逆定吐之圣剂要药，枳壳、厚朴行气消痰，竹茹、杷叶和胃清热，香薷消暑热于外，茅芦根利暑湿于下，焦三仙和脾胃于中。用药虽多，各有所用，互相协同，以奏全功，治暑热痰湿者，可仿此用药。
呕吐2（神经性呕吐）
陈某，女性，31岁。
初诊：
呕吐经年未愈，心烦急躁，夜寐不安，胃不思纳，食入即吐，几乎每日必作，甚至呕吐黄苦水液。曾住院检查治疗，未获阳性结果，定为神经性呕吐。中西药物及针灸按摩，莫不备尝而皆无效。脉象弦细而数，按之则无力，舌红苔白且干，久病呕吐，胃气必伤，中气不足，本当补土安中，但脉象弦细而数，弦则主郁，细为阴虚，数乃热象，按之无力则主本虚，是证本虚标热，故当先治其标热以定其吐，候热清再议补中安胃。
处方：灶心黄土30克（先煎汤代水煎药），藿香梗10克，苏叶梗各10克，半夏10克，竹茹6克，石斛10克，白芍10克，生石决明20克，生牡蛎20克，代赭石10克，生姜3克，三剂。
二诊：
药后呕吐减轻，心中仍觉烦急，大便干结，数日未行，舌红苔干。郁热日久，宜导之下行。前方加减。
处方：灶心黄土30克（先煎代水），苏藿梗各10克，半夏10克，黄连3克，竹茹6克，枇杷叶10克，石斛10克，白芍10克，代赭石10克，大黄2克，三剂。
三诊：
药后大便畅行，呕恶明显减轻，夜寐渐安，胃纳有增。脉仍弦细，按之力弱，舌红苔白，仍用前法进退。
处方：灶心黄土30克（包煎），苏藿梗各10克，黄连2克，半夏10克，竹茹6克，陈皮10克，焦三仙各10克，大黄2克，茅芦根各10克，香砂六君子丸10克（包煎），七剂。
上药服后呕吐全止，胃纳渐增，遂停汤药。续服香砂六君子丸，并注意饮食规律，以善其后。
[按语]：呕吐经年，胃气必伤，然食入即吐，是有火也，当先治其标热。故用降逆和胃泄热之法。药虽小效，终不若二诊加大黄，使胃家郁热下泻有路，疗效始著。阳明胃土以降为顺以通为补，三焦通畅，传导自分，何吐之有？
呕吐3（神经性呕吐）
王某某，女性，39岁。
初诊：
肝木逆郁，脾土受克，恶心呕吐不止，脘腹逆满，舌白润滑，脉象弦滑。病由恼怒而起，先用降逆定呕止吐方法。
处方：旋覆花6克，代赭石10克，半夏10克，竹茹6克，枳壳6克，香附10克，生牡蛎20克，佛手片6克，绿萼梅2克，三付。
另：白蔻仁2克，食盐2克，二味同研细末装胶囊分两次吞服。
二诊：
药后恶心呕吐减轻，脘腹胀满渐宽，嗳气不舒，脉仍弦滑，舌白且润，前法进退。
处方：旋覆花6克，代赭石10克，半夏10克，竹茹6克，枳壳6克，青陈皮各6克，香附10克，厚朴6克，白蔻仁6克（后下），佛手6克，三付。
药后吐止食进，病愈。
[按语]：怒则肝旺，肝气犯胃则吐逆，故用平肝理气法而愈。白蔻、食盐为末吞服乃止吐妙方，凡痰饮中阻，气逆作吐者皆可用之。
痢疾1（急性细菌性痢疾）
巩某某，男性，28岁。
初诊：
身热恶寒一日，头晕恶心，腹痛阵作，里急后重，大便带有脓血粘液。两脉濡滑而数，舌红苔白根厚而腻。病属暑热积滞互阻不化，势将成痢，先以芳香宣化、逆流挽舟方法。
处方：苏叶10克，藿香10克（后下），佩兰10克（后下），香薷6克（后下），葛根10克，黄芩10克，黄连6克，木香6克，桂枝6克，白芍10克，川军3克，二付。
二诊：
药后腹痛止而身热亦退，恶心已除，大便基本恢复正常，下坠感消失。脉象弦精，舌红苔白，再以升降分化方法，清其余邪，以善其后。
处方：葛根10克，川连6克，黄芩10克，秦皮6克，木香6克，香附10克，焦三仙各10克，白芍10克，丹参10克，三付。
[按语]：凡痢疾初起有表证者，其邪路未深，可选用风药提出其邪，使由表外达，谓之逆流挽舟之法。喻嘉言倡用败毒散治痢疾初起即是此法。赵师惯以葛根芩连汤加风药，本案中用香薷、苏叶、桂枝、葛根等，达邪出表；用芩、连、大黄苦寒下行，直清里热，一升一降，故谓之升降分化。藿香、佩兰芳香化湿，透邪外出，木香调气，白芍和营。配伍恰当，两付即愈。
痢疾2（慢性菌痢）
邓某，女性，67岁。
初诊：
痢疾缠绵三月未愈，腹痛后重，大便带有脓血，日便5～6次。曾服参芪归芍等补益气血之品及罂粟壳等收涩之剂。药后下坠之势增重，心烦急躁，口渴欲饮，舌苔黄垢根厚，脉象沉数有力。病属湿热积滞互结，壅塞肠道，气机痹阻而为后重，热迫血分则为脓血，宜用清化湿热，消导积滞方法。饮食当慎。
处方：煨葛根10克，升麻炭6克，黄芩10克，黄连3克，木香6克，香附10克，防风6克，赤芍10克，鸡内金10克，莱菔子10克，槟榔10克，炒枳壳6克，大黄3克，三付。
二诊：
药后大便排泄甚多，脓血减少，后重已除，大便一日二次，尚未成形。脉象沉数，舌红苔黄，仍用前法加减。
处方：葛根10克，黄芩6克，黄连3克，赤芍10克，炒枳壳6克，木香6克，焦三仙各10克，水红花子10克，三付。
三诊：
大便已转成形，每日1次。唯纳谷欠香，用醒脾导滞开胃进食方法。
处方：焦三仙各10克，水红花子10克，香稻芽10克，木香3克，青陈皮各6克，黄连2克，赤芍10克，槟榔10克，三付。
[按语]：痢疾迁延，已成慢性，前医按久病为虚，治以益气补中，并用收涩，致病情加重。痢疾本属积滞与邪毒互结，故有无积不作痢之说。积滞不去则痢疾难愈，此慢性痢疾之所由生。
Abdominal Pain 1 (Intestinal Spasm)
Patient Yu, female, 37 years old.
First Visit:
Paroxysmal abdominal pain, relieved by pressure; pulse is wiry, fine, and slippery, feeling tense upon deep pressure; tongue coating is white and moist; poor appetite; irritability and frequent dreaming. The patient has a weak constitution in middle age, with disharmony between Liver Wood and Spleen Earth, Qi stagnation, and collaterals lacking nourishment. Initially, treat by nourishing blood and yin, and regulating Liver and Spleen.
Prescription: Danggui (Angelicae Sinensis Radix) 10g, Baishao (Paeoniae Radix Alba) 10g, Zhigancao (Glycyrrhizae Radix et Rhizoma Preparatum) 10g, Guizhimu (Cinnamomi Ramulus) 6g, Shengmuli (Ostreae Concha) 20g, Mugua (Chaenomelis Fructus) 10g, Heshouwu (Polygoni Multiflori Radix) 10g, Shengdihuang (Rehmanniae Radix) 10g, Yimucao (Leonuri Herba) 10g, Ruxiang (Boswelliae Resina) 2g. Seven doses.
Second Visit:
Abdominal pain did not recur after medication; spirit has improved, but appetite has not fully recovered. Continue with the previous method, adjusting as needed. Avoid cold foods and rich, sweet, or greasy items.
Prescription: Danggui 10g, Baishao 10g, Zhigancao 10g, Guizhi (Cinnamomi Ramulus) 6g, Mugua 10g, Jiaosanxian (Fried Sanxian: Shenqu, Maiya, Laifuzi) 10g each, Xiangdaoya (Orzyae Semen Germinatum Aromaticum) 10g, Chenpi (Citri Reticulatae Pericarpium) 6g, Chao Zhiqiao (Aurantii Fructus Preparatus) 6g, Shuihonghuazi (Alternantherae Sessilis Fructus) 10g. Seven doses.
Appetite opened up significantly after taking the medicine. Advised to stop medication and regulate diet to prevent recurrence.
[Commentary]: Paroxysmal abdominal pain with sudden onset is attributed to the Liver; relief upon pressure indicates blood deficiency due to innate weakness. The Xiao Jianzhong Tang method warms the Middle Yang; here, Danggui, Dihuang, and Heshouwu are added to nourish blood and yin, and a small amount of Ruxiang activates blood and relieves pain. This case was treated from the perspective of deficiency. After efficacy was achieved, treatment shifted to regulating the Spleen and Stomach, opening the appetite, and strengthening the Post-Heaven Foundation to prevent recurrence.
Abdominal Pain 2 (Chronic Pelvic Inflammatory Disease)
Patient Yu, female, 30 years old.
First Visit:
Dull pain in the lower abdomen, preferring warmth and pressure; emaciated with pale complexion; cold limbs; fatigue for over a year. Gynecological examination diagnosed chronic pelvic inflammatory disease. Pulse is deep, weak, and forceless; tongue coating is white and moist. This indicates insufficient Middle Yang and weak Post-Heaven Spleen, leading to dual deficiency of Qi and Blood. Initially, use methods to tonify Qi and nourish Blood, warming meridians and relieving pain.
Prescription: Chaihu (Bupleuri Radix) 6g, Dangshen (Codonopsis Radix) 6g, Huangqi (Astragali Radix) 10g, Jingjie Tan (Schizonepetae Spica Carbonized) 10g, Fangfeng (Saposhnikoviae Radix) 6g, Xingren (Armeniacae Semen Amarum) 10g, Dan Wuyu (Evodiae Fructus) 6g, Paojiang (Zingiberis Rhizoma Preparatum) 6g, Chao Guangui (Cinnamomi Cortex Preparatus) 6g, Fuling (Poria) 10g, Banxia (Pinelliae Rhizoma) 10g, Xiangfu (Cyperi Rhizoma) 10g. Seven doses.
Abdominal pain decreased significantly after medication; energy increased. After taking over 30 doses in total, all symptoms disappeared. The body became stronger than before, looking like a different person.
[Commentary]: The patient suffered from abdominal pain for over a year. Due to chronic pelvic inflammation, she had taken various Western anti-inflammatory drugs. Traditional Chinese Medicine (TCM) treatments often add herbs that clear heat and drain dampness for anti-inflammatory purposes. However, Mr. Zhao did not adhere strictly to the Western diagnosis of "chronic inflammation." Instead, based on the characteristics of pulse, tongue, color, and symptoms, he judged it as insufficient Middle Yang and dual deficiency of Qi and Blood. By using methods to tonify Qi and strengthen the Middle, when Zheng Qi (Upright Qi) becomes robust, it naturally expels pathogens. As the saying goes, "Nourish the upright, and accumulation will be eliminated." However, this requires signs such as a moist tongue, weak pulse, and insufficiency symptoms, where both physical constitution and disease pathology are deficient. If one adheres to the Western concept of inflammation or the TCM notion that "pain has no tonification method," and uses clearing, draining, and attacking methods, Zheng Qi will be damaged over time, allowing pathogens to thrive and making the condition difficult to cure.
Abdominal Pain 3 (Intestinal Adhesion)
Patient Li, female, 42 years old.
First Visit:
Colicky abdominal pain, unbearable, occurring daily; dry stool, once every few days, shaped like sheep droppings. Duration: over 10 years. History of abdominal surgery with significant postoperative intestinal adhesions. Complexion is dark and sallow; tongue red with yellow, thick root coating; pulse is deep, wiry, slippery, and rapid, forceful upon pressure. Irritable temperament, frequent dreams at night. This is Liver Qi stagnation transforming into Fire, impairing free flow. Dry feces in the intestines obstruct Qi mechanism, preventing ascending and descending, causing paroxysmal colicky pain. Initially, use methods to regulate and unblock, allowing Qi mechanism to flow freely so that stool passes and pain stops.
Prescription: Chaihu 6g, Huangqin (Scutellariae Radix) 10g, Chuanlianzi (Meliae Fructus) 10g, Yuanhu (Corydalidis Rhizoma) 10g, Chao Zhiqiao 6g, Longdancao (Gentianae Radix) 3g, Jiaosanxian 10g each, Shuihonghuazi 10g, Dafupi (Arecae Pericarpium) 10g, Binglang (Arecae Semen) 10g, Dahuang (Rhei Radix et Rhizoma) 3g, Gualouren (Trichosanthis Semen) 30g. Seven doses.
Second Visit:
Stool passed immediately after medication but remained dry; abdominal pain alleviated. Patient reported long-term difficulty passing dry stool. On days when stool passed, pain was mild; without stool, pain was severe. This is a disorder of transmission and transformation. Continue with methods to regulate and unblock the Triple Burner.
Prescription: Jiaosanxian 10g each, Shuihonghuazi 10g, Dafupi 10g, Binglang 10g, Dahuang 5g (added later), Gualouren 30g, Chao Zhiqiao 6g, Houpo (Magnoliae Officinalis Cortex) 6g, Chuanlianzi 10g, Yuanhu 10g, Fangfeng 6g. Seven doses.
Third Visit:
Stool passed every two days; abdominal pain greatly reduced; mental irritability lightened; sleep improved. Since the illness has persisted for a long time, pills should be used for regulation. Exercise must be persisted in. Walk for 1-2 hours morning and evening. Persistence may lead to normal bowel movements and gradual cessation of pain.
Pill Prescription: Chaihu 10g, Shengma (Cimicifugae Rhizoma) 10g, Fangfeng 10g, Chuanlianzi 20g, Yuanhu 20g, Houpo 10g, Zhiqiao 10g, Zhishi (Aurantii Fructus Immaturus) 10g, Baizhu (Atractylodis Macrocephalae Rhizoma) 20g, Muxiang (Aucklandiae Radix) 10g, Qingchenpi (Citri Reticulatae Pericarpium) 20g each, Huangqin 20g, Longdancao 10g, Jiaosanxian 30g each, Shuihonghuazi 30g, Dafupi 30g, Binglang 30g, Dahuang 30g, Mangxiao (Natrii Sulfas) 20g, Sanleng (Sparganii Rhizoma) 20g, Ezhu (Curcumae Rhizoma) 20g.
Grind all herbs into fine powder, make pills with honey, each pill weighing 10g. Take one pill twice daily (morning and evening), adjusting dosage to achieve bowel movement. If ineffective, increase to 2-3 pills.
The patient prepared one dose according to the prescription. Bowel movements gradually normalized, abdominal pain lightened. With persistent exercise, abdominal pain disappeared after one year.
[Commentary]: Abdominal pain with dry stool, relieved after defecation, indicates pain caused by constipation. Treat the constipation; once stool passes, pain stops. Dark complexion, deep wiry pulse, and irritable temper indicate Liver Meridian stagnant fire, treated with Chaihu, Huangqin, and Chuanlianzi to purge it. Constipation is a disorder of transmission; regulate the Triple Burner with Jiaosanxian, Shuihonghuazi, Dafupi, and Binglang. Heat-induced hard stool is treated with Dahuang and Gualouren to purge and moisten. Decoctions were used first for emergency relief; once symptoms eased, pills were made for slow resolution. Exercise was supplemented to promote peristalsis, achieving full results through persistence.
Abdominal Pain 4 (Adnexitis)
Patient Wu, female, 31 years old.
First Visit:
Lower abdominal pain, recurring frequently, worsening during menstruation. Gynecological examination indicated adnexal inflammation. Menstrual blood is dark purple with clots; tongue coating white, substance red; pulse wiry and fine, forceless upon pressure. Ying-Blood deficiency, Liver Meridian stagnant heat, Qi mechanism unsmooth. Initially, plan to regulate the Eight Extraordinary Vessels to alleviate abdominal pain.
Prescription: Chao Aiye (Artemisiae Argyi Folium Preparatum) 6g, Ejiaozhu (Asini Corii Colla Prepared with Sand) 10g, Danggui 10g, Chuanlianzi 6g, Chao Guangui 6g, Dan Wuyu 3g, Wuyao (Linderae Radix) 6g, Chaihu 6g, Huangqin 6g, Xiangfu 10g. Seven doses.
Second Visit:
Abdominal pain slightly reduced; menstruation arrived, pain did not worsen; menstrual blood deep red with small clots; tongue coating white, substance red; pulse still wiry and fine. Blood stasis in the Blood level. Use methods to invigorate blood, resolve stasis, and unblock collaterals.
Prescription: Chao Aiye 6g, Ejiaozhu 10g, Danggui 10g, Chuanlianzi 6g, Chibaishao (Paeoniae Radix Rubra et Alba) 10g each, Sheng Puhuang (Typhae Pollen) 10g, Chao Wulingzhi (Trogopterori Faeces Preparatum) 10g, Honghua (Carthami Flos) 6g, Chaihu 6g, Huangqin 6g, Xiangfu 10g. Seven doses.
Continued taking modified prescriptions for over 20 doses. Menstruation returned with normal red color and no clots; abdominal pain did not occur. The illness was cured.
[Commentary]: Women's abdominal and lower back pain is often related to menstrual abnormalities, presenting differently depending on blood heat, blood cold, blood deficiency, or blood stasis. This case involves blood vessel stasis combined with blood deficiency. Dark purple menstrual blood with clots indicates blood-level stagnant heat; fine pulse, forceless upon pressure, and white moist tongue indicate blood scarcity and Qi insufficiency. Therefore, the medication balanced both aspects. First visit: Chaihu, Huangqin, and Chuanlianzi purged Liver heat; Danggui and Ejiaozhu nourished and generated blood; Wuzhuyu, Guanggui, and Chao Aiye warmed meridians and stopped pain; Wuyao and Xiangfu regulated Qi mechanism. The formula cleared stagnant heat while warming and unblocking meridians, avoiding the drawback of cold congealing Qi. Second visit strengthened blood-invigorating, stasis-resolving, and collateral-unblocking power, adding Shixiaosan (Sheng Puhuang and Chao Wulingzhi) along with Chibaishao and Honghua. After one menstrual cycle of regulation, menstrual color, volume, and quality normalized, and abdominal pain was cured. For menstrual disorders, treatment generally requires one or several cycles to ensure normal menstruation, after which the illness naturally resolves. Otherwise, the root cause remains, and temporary relief may lead to recurrence.
Vomiting 1 (Heatstroke)
Patient Zhang, male, 24 years old.
Dizziness, nausea, vomiting of sour, foul phlegm-water; tongue coating white, slippery, and greasy; pulse soft, slippery, and rapid. External summer-heat invading, turbid phlegm obstructing the Middle. Use aromatic diffusion and transformation methods to stop vomiting.
Prescription: Peilan (Eupatorii Herba) 10g (added later), Huoxiang (Agastaches Herba) 10g (added later), Xiangru (Elsholtziae Herba) 6g, Chuanlian (Coptidis Rhizoma) 6g, Banxia 10g, Sugeng (Perillae Caulis) 10g, Zhuru (Bambusae Caulis in Taenia) 6g, Zhiqiao 6g, Houpo 6g, Baizhi (Angelicae Dahuricae Radix) 6g (added later), Zhipipaye (Loquat Leaf Preparatum) 10g, Jiaosanxian 10g each, Maolugen (Imperatae Rhizoma) and Lugen (Phragmitis Rhizoma) 10g each. Three doses.
Vomiting stopped after medication; dizziness and nausea resolved. Stop medication, observe, and rest for a few days to recover.
[Commentary]: Summer-heat triggered phlegm-dampness, so the warm disease method for summer-heat dampness was used. Peilan, Huoxiang, and Baizhi were added later to utilize their aromatic properties to transform damp-turbidity. Chuanlian, Banxia, and Sugeng form a potent combination for descending rebellious Qi and stopping vomiting. Zhiqiao and Houpo move Qi and eliminate phlegm; Zhuru and Paye harmonize the Stomach and clear heat; Xiangru dissipates summer-heat externally; Malgen and Lugen promote urination to drain summer-dampness downward; Jiaosanxian harmonizes the Spleen and Stomach internally. Although many herbs were used, each had its specific role, working synergistically for complete effect. This prescription can serve as a model for treating summer-heat and phlegm-dampness.
Vomiting 2 (Neurotic Vomiting)
Patient Chen, female, 31 years old.
First Visit:
Vomiting persisting for years without cure; irritability and restlessness; insomnia; loss of appetite; immediate vomiting after eating; almost daily occurrence; even vomiting yellow bitter fluid. Hospitalized for examination and treatment with no positive findings; diagnosed as neurotic vomiting. Tried Western/Chinese medicines, acupuncture, and massage without success. Pulse is wiry, fine, and rapid, forceless upon pressure; tongue red with white, dry coating. Chronic vomiting damages Stomach Qi and Middle Qi, suggesting a need to tonify Earth and calm the Middle. However, the wiry, fine, rapid pulse indicates depression, Yin deficiency, and heat respectively; forcelessness indicates root deficiency. Thus, the pattern is root deficiency with branch heat. Treat the branch heat first to stop vomiting; once heat clears, discuss tonifying the Middle and calming the Stomach.
Prescription: Zaixinhuangtu (Kaolin) 30g (decocted first to replace water), Huoxiang geng (Agastaches Caulis) 10g, Suzhugeng (Perillae Caulis) 10g each, Banxia 10g, Zhuru 6g, Shihu (Dendrobii Caulis) 10g, Baishao 10g, Sheng Shijueming (Haliotidis Concha) 20g, Sheng Muli 20g, Daizheshi (Haematitum) 10g, Shengjiang (Zingiberis Rhizoma Recens) 3g. Three doses.
Second Visit:
Vomiting reduced; mental irritability persists; dry stool, not passed for several days; tongue red with dry coating. Long-standing depressed heat should be guided downward. Modify previous prescription.
Prescription: Zaixinhuangtu 30g (decocted first), Suzhuogeng 10g each, Banxia 10g, Huanglian (Coptidis Rhizoma) 3g, Zhuru 6g, Pipaye (Loquat Leaf) 10g, Shihu 10g, Baishao 10g, Daizheshi 10g, Dahuang 2g. Three doses.
Third Visit:
Stool passed smoothly; nausea and vomiting significantly reduced; sleep improved; appetite increased. Pulse still wiry and fine, forceless upon pressure; tongue red with white coating. Continue previous method, adjusting as needed.
Prescription: Zaixinhuangtu 30g (wrapped), Suzhuogeng 10g each, Huanglian 2g, Banxia 10g, Zhuru 6g, Chenpi 10g, Jiaosanxian 10g each, Dahuang 2g, Maolugen and Lugen 10g each, Xiangsha Liujunzi Wan (Pilula Xiangsha Liujunzi) 10g (wrapped). Seven doses.
Vomiting completely stopped after taking the medicine; appetite gradually increased. Stop decoction. Continue taking Xiangsha Liujunzi Wan, pay attention to regular diet, and conclude treatment.
[Commentary]: Chronic vomiting inevitably damages Stomach Qi. Immediate vomiting after eating indicates Fire; thus, treat branch heat first. Use methods to descend rebellious Qi, harmonize the Stomach, and purge heat. While the initial effect was modest, adding Dahuang in the second visit provided a pathway for Stomach heat to descend, significantly improving efficacy. The Yangming Stomach Earth follows descending as smoothness and unobstructed flow as tonification. When the Triple Burner is unobstructed, transmission functions normally, eliminating vomiting.
Vomiting 3 (Neurotic Vomiting)
Patient Wang, female, 39 years old.
First Visit:
Liver Wood rebellious and depressed, overcoming Spleen Earth; incessant nausea and vomiting; epigastric and abdominal distension and fullness; tongue coating white and slippery; pulse wiry and slippery. Illness started from anger. Initially, use methods to descend rebellious Qi, stabilize vomiting, and stop retching.
Prescription: Xuanfuhua (Inulae Flos) 6g, Daizheshi 10g, Banxia 10g, Zhuru 6g, Zhiqiao 6g, Xiangfu 10g, Sheng Muli 20g, Foshoupian (Bergamot Fruit Slice) 6g, Lvemei (Camellia Green Flower) 2g. Three doses.
Separately: Baixiaren (Cardamomi Semen) 2g, Salt 2g. Grind together into fine powder, fill capsules, take twice orally.
Second Visit:
Nausea and vomiting reduced; epigastric and abdominal distension widened; belching discomfort persists; pulse still wiry and slippery; tongue white and moist. Adjust previous method.
Prescription: Xuanfuhua 6g, Daizheshi 10g, Banxia 10g, Zhuru 6g, Zhiqiao 6g, Qingchenpi 6g each, Xiangfu 10g, Houpo 6g, Baixiaren 6g (added later), Foshou 6g. Three doses.
Vomiting stopped, appetite returned, and illness cured.
[Commentary]: Anger causes Liver hyperactivity; Liver Qi invading the Stomach leads to vomiting and rebellion. Thus, pacify the Liver and regulate Qi to achieve cure. Baixiren and salt ground into powder and swallowed is an excellent formula for stopping vomiting, applicable to cases where phlegm-fluid obstructs the Middle and rebellious Qi causes vomiting.
Dysentery 1 (Acute Bacillary Dysentery)
Patient Gong, male, 28 years old.
First Visit:
Fever and aversion to wind for one day; dizziness and nausea; paroxysmal abdominal pain; tenesmus; stool containing pus, blood, and mucus. Pulses are soft, slippery, and rapid; tongue red with white coating, thick and greasy at the root. The disease belongs to summer-heat and food stagnation mutually obstructing and failing to transform, likely developing into dysentery. Initially, use aromatic diffusion and transformation, and "pulling against the current to save the boat" methods.
Prescription: Sueye (Perillae Folium) 10g, Huoxiang 10g (added later), Peilan 10g (added later), Xiangru 6g (added later), Gegen (Puerariae Lobatae Radix) 10g, Huangqin 10g, Huanglian 6g, Muxiang 6g, Guizhi (Cinnamomi Ramulus) 6g, Baishao 10g, Chuanjun (Dahuang) 3g. Two doses.
Second Visit:
Abdominal pain stopped, fever subsided, nausea removed; stool basically returned to normal, sensation of bearing down disappeared. Pulse wiry and refined; tongue red with white coating. Use ascending-descending differentiation method to clear remaining pathogens and conclude treatment.
Prescription: Gegen 10g, Chuanlian (Huanglian) 6g, Huangqin 10g, Qinpi (Fraxini Cortex) 6g, Muxiang 6g, Xiangfu 10g, Jiaosanxian 10g each, Baishao 10g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 10g. Three doses.
[Commentary]: For early-stage dysentery with exterior symptoms, the pathogen path is not deep. Wind herbs can be selected to extract the pathogen, guiding it out from the exterior, known as the "pulling against the current to save the boat" method. Yu Jiayan advocated using Baidu San for early dysentery, which is this method. Master Zhao usually uses Gegen Qinlian Tang plus wind herbs. In this case, Xiangru, Sueye, Guizhi, and Gegen guide pathogens out of the exterior; Huangqin, Huanglian, and Dahuang use bitter-cold nature to descend directly clearing interior heat. One ascending, one descending, hence called "ascending-descending differentiation." Huoxiang and Peilan aromatically transform dampness and vent pathogens outward; Muxiang regulates Qi; Baishao harmonizes Ying. Properly combined, cured in two doses.
Dysentery 2 (Chronic Bacillary Dysentery)
Patient Deng, female, 67 years old.
First Visit:
Dysentery lingering for three months without cure; abdominal pain and tenesmus; stool containing pus and blood; 5-6 times daily. Previously took tonics for Qi and Blood (Renshen, Qihuang, Danggui, Baishao) and astringents (Poppy Shell). After medication, bearing-down sensation worsened; irritability, thirst with desire to drink; tongue coating yellow, dirty, thick at root; pulse deep, rapid, and forceful. The disease belongs to damp-heat and food stagnation mutually binding, blocking the intestines, obstructing Qi mechanism causing tenesmus; heat forcing Blood level causing pus and blood. Use methods to clear and transform damp-heat, and digest and guide out stagnation. Diet must be cautious.
Prescription: Wei Gegen (Prepared Puerariae Lobatae Radix) 10g, Shengmacarbon (Cimicifugae Rhizoma Carbonized) 6g, Huangqin 10g, Huanglian 3g, Muxiang 6g, Xiangfu 10g, Fangfeng 6g, Chishao (Paeoniae Radix Rubra) 10g, Jineijin (Galli Gigerii Endothelium Corneum) 10g, Laifuzi (Radish Seed) 10g, Binglang 10g, Chao Zhiqiao 6g, Dahuang 3g. Three doses.
Second Visit:
Large amount of stool excreted; pus and blood reduced; tenesmus removed; stool twice daily, not yet formed. Pulse deep and rapid; tongue red with yellow coating. Continue previous method with adjustments.
Prescription: Gegen 10g, Huangqin 6g, Huanglian 3g, Chishao 10g, Chao Zhiqiao 6g, Muxiang 6g, Jiaosanxian 10g each, Shuihonghuazi 10g. Three doses.
Third Visit:
Stool formed, once daily. Only poor appetite. Use methods to awaken Spleen, guide stagnation, open appetite, and promote eating.
Prescription: Jiaosanxian 10g each, Shuihonghuazi 10g, Xiangdaoya 10g, Muxiang 3g, Qingchenpi 6g each, Huanglian 2g, Chishao 10g, Binglang 10g. Three doses.
[Commentary]: Dysentery prolonged has become chronic. Previous physicians treated it as deficiency due to chronicity, using methods to tonify Qi and strengthen the Middle, along with astringents, worsening the condition. Dysentery fundamentally belongs to the mutual binding of stagnation and pathogenic toxins; hence the saying "no stagnation, no dysentery." If stagnation is not removed, dysentery is difficult to cure; this is how chronic dysentery arises.