也。治痢之担，，大忌收涩补益。当雌行气活血清热导滞为法。
所谓调气则Ei重自除，行血则便脓自愈。攻积导滞，在所必用。
初诊方中木香、香附、枳壳行气宽肠，赤芍凉血活血，鸡内金、莱菔子、槟榔、大黄攻积导滞，葛根、防风、升麻升阳明清气，黄芩、黄连苦寒燥湿清热坚阴止痢。如此则升清降浊，积滞去，气机畅，后重自除目i痢止矣。
痢疾3(妊娠菌痢
钱某，女，31岁
妊娠三月，痢下赤白，腹痛下坠后重，脉象弦滑有力，舌红苔腻垢厚，胃纳欠佳，病已5日，湿热积滞互阻中焦，先以升和分化止痢方法，防其困坠胎下。饮食寒暖诸宣小心。
葛根10克，升麻6克，黄芩10克，白芍10克，藿香10克(后下)，苏梗10克(后下)-焦三仙各10克，木香6克，黄连2
克，三付
药后痢止食进，足月分娩，母子垒安。
[按]：妊娠患痢，恐伤胎元。俗手当加保胎。今仍以治痢为主，痢愈则胎元自固。即《内经》“有故无殒，亦无殒也，衰其大半而止”原则的体现。若加扶正固胎，必致痢疾迁延，恐反伤胎元，不可不知。
泄泻1(过敏性结肠炎)
刘某，男，43岁。患五更泄3年余，服四神丸、金匮肾气丸、附子理中丸等不效，1990年10月求治于师。其证每日清
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晨起床后必直奔厕所，泻势甚急，有刻不容缓之感，早起则早泻，晚起则晚泻，不起则不泻，泻后甚感舒适。伴见心烦急躁、夜寐梦多，脉象弦滑且数，舌红边赤，苔黄而干。合参脉证，辨为肝胆郁热，下迫阳明，治以疏调木土之法，用痛泻要方加减。
药用陈皮10克，防风6克，白术10克，白芍10克，葛根10
克，黄芩10克，黄连3克，荆芥炭10克，灶心土30克，7剂，水煎服。初诊后病人未复诊。1994年2月患者因其他疾病前来就诊，告知上药服3剂后晨泻即止，迄今未复发。
[按]：五更泄又称肾泄，传统认为属肾虚而需用四神丸治之。赵师用葛根芩连汤治疗五更泄有其独到的见解。其认为五更泄发生于黎明之时，以晨起即泄为特征，其泄势急迫，刻不容缓，泄下如注，顷刻而毕，《内经》所谓“暴注下迫，皆属于热”是也。或有蝮痛者，泄后痛减，或无腹痛者，泄后亦感舒适，此皆邪实之征，何虚之有!况黎明为阳气发动之时，于四季为春，肝胆所主之时，病发于此时，岂非木旺克土，又有何疑哉!故定其病机为肝胆郁热下迫阳明，方用葛根芩连汤合痛泻要方为治。葛根芩连汤泻阳明之热而坚阴止利，痛泻要方抑木扶土，二方合用以治五更泄疗效甚佳。又如治李某，患五更泄6
年余，屡服四神丸之属不效。赵师诊其脉弦数，观其面苍形瘦，舌红，苔黄，询其心烦急躁，夜寐梦多，其泻势急不可待，泻而后快。故辨为木郁乘土，热迫阳明之证。为疏葛根芩连汤合瘴泻要方加灶心土、荆芥炭。亦3剂而愈。此法不独治疗五更泄，凡泄泻如暴注下迫者，无问远近，皆当作热利治之，用此方法必效。
泄泻2(过敏性结肠炎)
牛某，女，50岁
1992年6月26日初诊
患每晨必泻之苦已有年余。曾用四神丸、参苓白术丸、黄连素以及汤剂等治疗，均无效，专程来京求老师医治。现每晨起泻泄必作，中脘堵闷，两胁胀痛，心烦急躁液寐梦多。苔白厚腻，脉弦滑且数。
辨证：肝胆郁热，木郁克土。
治法：疏调木土，以泻肝热。
方药：蝉衣6克，僵蚕10克，姜黄6克，荆芥炭10克，防风6克，陈皮10克，白芍10克，灶心土30克(先煎)，猪苓10克，冬瓜皮10克，焦三仙各10克，白蔻仁4克，7剂
二诊
药后症减，中脘堵闷见舒，展泻已止，大便成形，仍有夜寐梦多。脉弦滑，苔白腻。上方去冬瓜皮，焦三仙，加川楝子6克，7剂，以善其后。
[按]：五更泻又称为展泻。一般认为由肾阳虚衰而致，故又称为肾泻。然而赵老师认为，因肾虚而晨泻者有之。但更多的是肝经郁热之证，临证必须详诊细参，切不可轻率而断之。
妄投温补则反增其热郁，南辕北辙，病无愈期。肝经郁热之晨泻，虽是久泻不止，但其脉弦滑数，弦为肝郁，滑散为是郁热化火，同时伴有心烦急躁，夜寐梦多等症。寅卵属木，厥阴阴尽少阳初生，肝经郁热暴发，辄乘土位，脾胃升降失司，故而腹痛泻泄。老师用升降散加减，以宣郁清热，升清降浊。再“防风、陈
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皮、白芍乃痛泻要方去白术，以泻肝木补脾土，缓痛止泻。冬瓜皮、猪苓健脾利湿止泻。中焦脾失健运，湿阻气滞，用白蔻仁辛温芳香，化湿行气，灶心土健脾和胃止泻，焦三仙梢食导滞。荆芥辛温芳香，醒脾开胃，胜湿化浊，并能疏肝郁，通阳和血，其炭可治肠风便血，湿热下迫等。诸药相合，肝热清，脾胃和，晨泻止。老师常用之而无不效验。
一 泄泻3(过敏性结肠炎)
何某某，年逾6甸，患腹泻两年余。每展泄泻必作。近半年来常自汗出，夜间尤甚，常致被褥全湿，夜不能寐。纳食渐减，形体日削，面色干黑，心烦急燥。近月余来病势有增无减，服药百剂，毫无效验。诊其脉象弦细，按之有力，沉取略有数意{面黑形瘦而两目炯炯，舌红质干糙老，苔厚腻，舌尖红刺满布。其腹泻每于五更即作，入厕即泄，其势如注，泻前必腹中绞痛，泻后痛止且舒。检视其前医脉案，皆谓年老体衰，脾肾两虚，所用不外温补益气之剂。此证果若中气不足，脾肾两虚，其面色当淡白，四肢当清冷，脉象当虚弱无力。今面苍黑，脉来弦数，舌红起刺，一派肝热之象，知其木郁克土也。五更乃步阳初升之时，若肝郁厥阴下迫犯土，则泄作发于黎明，其泻势如注，非虚证也。前医见其年逾6旬，汗出日久，断为脾肾两虚，不知其因工作繁重，五志化火，肝热夹湿，蕴郁不化，又屡服温补，故病延久而日重。此汗非虚汗，乃热汗、湿汗，泻非虚泻，乃热泻、火泻。治疗不可少事补养，当先泻其肝热，热去则木土和调，诸症自平。方用黄连、黄芩、黄柏、阿胶、生白芍、灶心土、葛根、焦三仙等为剂，七剂而泻止汗减，继用上方加减调理一月
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而痊。
[按]：五更泄按肝热治，是赵师的创见，打破了五更泻属肾虚的传统观点。自宋代以来，一直把五更泻看作肾虚，用四神丸治之，鲜有佳效者。中医的特点是讲辨证，不可认定某病一定属虚，某病一定属实。要紧的是依据脉舌色症合参而断之。本案患者色苍，舌红+脉弦数，症暴泻如注，全是一派热象。
病机十九条云；诸呕吐酸，暴注下迫，皆属于热。凡暴泻如注，势不可挡者，皆火热泻也。其泻发于黎明步阳初升之时，其为肝热犯土明矣。故治先泻其肝热。方中又有白芍、阿胶者，寓养阴之意，因汗出日久，其阴必伤，故用此甘酸之味敛而养之。
药合病机，故能显效。
泄泻4(过敏性结肠炎)
朱某，女，50岁
1993年10月20日初诊
患者晨起即泻已年余，曾用四神丸、黄连素、参苓自术散等药治疗均无效。并伴有中脘堵闷，两胁胀痛，心烦急躁，夜寐梦多，舌红苔白厚腻，脉弦滑且数。证属肝经郁热，木郁克土。
治以疏调木土，以泻肝热。方药：蝉衣、片姜黄、防风、白蔻仁各6克，僵蚕、荆芥炭、陈皮、白芍、猪苓各10克，冬瓜皮、灶心土各30克(先煎)。服药7剂后晨泻止，大便成形，中脘堵闷见舒，仍心烦梦多，再以上方去冬瓜皮、猪苓加川楝子6克，调服1周，以巩固疗效。
[按]：晨起即泻，欲称五更泄，又名肾泻，古法作肾阳虚，习用四神丸之类，然获效者鲜。此案患者心烦急躁、夜寐梦多、
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两胁胀痛，皆是肝经郁热之象，其中脘堵满乃是脾胃不运，合而观之，证属肝经郁热，木郁克土，故用升降散合痛泻要方为治。古人云，痛泄之证，泄责之脾，痛责之肝，故腹痛即泻，泻后痛减，明是肝木克土之征。故当疏调木土为治。岂可一味温补兜涩耶。虽久泻未必皆虚，凡泻势急暴、出黄如糜、肛门灼热者虽无腹痛，亦作肝郁火迫看。不可妄投补涩。
便秘(习惯性便秘)
陆某，女，26岁，1992年6月30日初诊。患者自1992年元月初产后，大便一直3～7日一行，经常服用麻仁丸，润肠丸等。就诊时，体质肥胖，头目眩晕，心烦急躁，脘腹胀满，纳食不佳，下肢轻度浮肿，大便近2周未行，舌红苔白腻，脉濡滑且数。证属湿热积滞于胃肠，升降失常。治以疏调气机升降，除湿清热通便。方药：蝉衣、片姜黄、枳壳、防风各6克，僵蚕、大腹皮、槟榔、焦三仙各10克，瓜蒌30克，大黄2克。嘱其忌食肥甘厚腻。服药7剂后，大便日行2次，偏稀，余症皆减。原方改大黄1克，去瓜萎加莱菔子10克，隔目1剂，连服3周，诸症皆愈，体重亦有所减轻。
[按]：便秘而常服麻仁丸、润肠丸，此常法也，必有效验，然不能根除也。以致服药则便畅，不服药则便秘，久而久之，必赖药以通便，必增大剂量始效，终有服药亦不便之日矣。此为肠胃传导之病，湿热积滞壅阻，致三焦气机不畅。戴元礼云；“郁者，结聚而不得发越也，当升者不得升，当降者不得降当变化者不得变化，此为传化失常，六郁之病见矣。”故治疗用升降散疏调气机，调整升降，加大腹皮、槟榔、焦三仙、枳壳疏导
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三焦，气机调畅则传导自分。故药后便秘即除，肥胖亦减矣，
又[按]：本案与上案一为便秘，一为泄泻证，似相反，而皆以升降散加减琉效，盖其证虽异而病机则一，故异病同治也。
眩晕1(低血压)
李某，男，36岁
1992年5月7日初诊
自述血压偏低已近2年，迭服补剂而愈重。现头目眩晕，神疲乏力，心烦急躁，夜寐梦多，心慌气短，饮食无味，大便偏干，舌红苔厚且干，脉沉细滑数，BP10／7kPa。证属湿热郁滞，气机不畅。治以芳香宣化，疏调气机。方药：蝉衣、片姜黄、川楝子各6克，僵蚕、藿香、佩兰、大腹皮、槟榔、焦三仙、水红花子各10克，大黄1克。嘱其停服一切营养补品，饮食清淡，每天散步2小时，服药7剂后，诸症减而大便偏稀，BP13／9kPa，原方加荆芥炭10克，防风6克，灶心土30克(先煎)。以此方加减服用20余剂后，精神爽，纳食香，血压维持在13～16／9
～10kPa。而告病愈。
[按]：患者头目眩晕，神疲乏力，心慌气短似乎虚证，再结合血压偏低，则更以为虚矣。故患者自以为虚而服营养补品，饮食厚味；医生断之以虚则朴剂频投，然愈补愈重，而不知其所以然。此证心急烦躁，夜寐梦多，是肝经郁热之象；舌红苔厚，脉沉细滑数，是郁热内伏之征；服补剂而证愈重，是实以虚治所致。析其病机乃气机郁滞，三焦不畅，故用升降散疏调气机，加藿香、佩兰芳香化湿，大腹皮、槟榔、焦三仙、水红花子疏利三焦，则气机畅行，而血压复常，诸证告愈矣。
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眩晕2(高血压)
韩某，男，39岁
1992年8月14日初诊
患高血压病已半年，一直服用复方降压片、心痛定等，血压仍24～26／l9～17kPa。证见头痛目眩，心烦急躁，失眠梦多，大便干结，舌红苔白，脉弦滑且数。证属肝经部热，气机阻滞。治以清泻肝经郁热，调畅气机。方药；蝉衣、片姜黄、白芷、防风各6克，僵蚕，苦丁茶、晚蚕砂、炒槐花各10克，大黄2
克。服药7剂后，BP18／l3kPa，余症减轻，停用西药。原方加川楝子6克，服药7剂，血压正常。又以前方加减每周3剂，连服3周以巩固疗效。于1993年2月12日复诊，血压稳定在16／l1kPa，未再升高。
[接]；此高血压眩晕头痛，脉、舌、色、证俱属肝火，故甚为易辨，不致误诊。然治法不用平肝潜阳，或直清肝胆，而仍以疏调气机为主，是何遭理?盖此为肝经郁火，源于气机郁滞，升降不得其所。肝郁化火，当以解郁为先。解郁之法，首选升降散。
此案加防风、白芷尤妙，立意甚深。盖疏肝以风药，助肝木之升发，遂其条达之性则不郁矣。故服之即效。
又按：上案低血压眩晕，此案高血压眩晕，一高一低，截然相反，然治疗皆以升降散疏解肝郁而效。中医异病同治之义，于此可见矣。
也。治疗痢疾，最忌讳使用收敛固涩和补益的药物。应当以行气、活血、清热、导滞为基本治法。
所谓“调气则后重自除，行血则便脓自愈”。攻逐积滞、引导排泄，是必须采用的方法。
初诊方中，木香、香附、枳壳用于行气宽肠；赤芍用于凉血活血；鸡内金、莱菔子、槟榔、大黄用于攻积导滞；葛根、防风、升麻用于升发阳明清气；黄芩、黄连苦寒燥湿、清热坚阴止痢。这样就能升清降浊，积滞去除，气机通畅，后重感自然消除，痢疾也就停止了。
痢疾3（妊娠菌痢）
钱某，女性，31岁
怀孕三个月，出现下痢赤白，腹痛伴有下坠感和里急后重，脉象弦滑有力，舌质红，苔腻垢厚，胃口不好，病程已5天。辨证为湿热积滞互结阻滞于中焦。先采用升清分化止痢的方法，以防病情加重导致胎元下坠流产。饮食寒暖各方面都要小心注意。
处方：葛根10克，升麻6克，黄芩10克，白芍10克，藿香10克（后下），苏梗10克（后下），焦三仙各10克，木香6克，黄连2克。共3付。
服药后痢疾停止，食欲恢复，足月分娩，母子平安。
[按语]：妊娠期患痢疾，担心损伤胎元。世俗医生往往加上保胎药。现在仍以治疗痢疾为主，痢疾痊愈则胎元自然稳固。这体现了《内经》“有故无殒，亦无殒也，衰其大半而止”的原则。如果加入扶正固胎的药物，必然导致痢疾迁延不愈，恐怕反而损伤胎元，这一点不可不知。
泄泻1（过敏性结肠炎）
刘某，男性，43岁。患有五更泄（黎明前腹泻）3年多，服用四神丸、金匮肾气丸、附子理中丸等药无效，1990年10月求治于老师。其症状表现为每天清晨起床后必直奔厕所，泻势非常急迫，有刻不容缓之感，早起则早泻，晚起则晚泻，不起则不泻，泻后感到非常舒适。伴有心烦急躁、夜间睡眠多梦，脉象弦滑且数，舌质红边赤，苔黄而干。综合脉证分析，辨为肝胆郁热，下迫阳明大肠。治以疏调肝脾（木土）的方法，用痛泻要方加减。
药用：陈皮10克，防风6克，白术10克，白芍10克，葛根10克，黄芩10克，黄连3克，荆芥炭10克，灶心土30克，7剂，水煎服。初诊后病人未复诊。1994年2月患者因其他疾病前来就诊，告知上药服3剂后晨泻即止，至今未复发。
[按语]：五更泄又称肾泄，传统认为属于肾虚，需用四神丸治疗。赵绍琴老师用葛根芩连汤治疗五更泄有其独到的见解。他认为五更泄发生于黎明之时，以晨起即泄为特征，其泄势急迫，刻不容缓，泻下如水注，顷刻结束，这正是《内经》所说的“暴注下迫，皆属于热”。有的伴有腹痛，泻后痛减，或者没有腹痛的，泻后也感到舒适，这都是邪气实盛的征象，怎么说是虚证呢！况且黎明是阳气发动之时，在四季对应春季，是肝胆所主的时间，病发于此时，岂不是木旺克土，还有什么可疑的呢！所以确定其病机为肝胆郁热下迫阳明，方用葛根芩连汤合痛泻要方治疗。葛根芩连汤泻阳明之热而坚阴止利，痛泻要方抑木扶土，两方合用以治五更泄疗效甚佳。又如治疗李某，患五更泄6年多，屡服四神丸之类无效。赵老师诊其脉弦数，观其面色苍白形体消瘦，舌红，苔黄，询问其心烦急躁，夜寐梦多，其泻势急不可待，泻后畅快。所以辨为木郁乘土，热迫阳明之证。为其开具葛根芩连汤合痛泻要方加灶心土、荆芥炭。也是3剂而愈。此法不仅治疗五更泄，凡是泄泻如暴注下迫者，无论病程长短，都当作热利治疗，用此方法必定有效。
泄泻2（过敏性结肠炎）
牛某，女性，50岁
1992年6月26日初诊
患有每晨必泻的痛苦已有年余。曾用四神丸、参苓白术丸、黄连素以及汤剂等治疗，均无效，专程来北京求老师医治。现每晨起泻泄必作，中脘部堵闷，两胁胀痛，心烦急躁，夜寐梦多。苔白厚腻，脉弦滑且数。
辨证：肝胆郁热，木郁克土。
治法：疏调肝脾，以泻肝热。
方药：蝉衣6克，僵蚕10克，姜黄6克，荆芥炭10克，防风6克，陈皮10克，白芍10克，灶心土30克（先煎），猪苓10克，冬瓜皮10克，焦三仙各10克，白蔻仁4克，7剂。
二诊
服药后症状减轻，中脘堵闷见舒，晨泻已止，大便成形，仍有夜寐梦多。脉弦滑，苔白腻。上方去冬瓜皮、焦三仙，加川楝子6克，7剂，以善其后。
[按语]：五更泻又称为晨泻。一般认为由肾阳虚衰所致，故又称为肾泻。然而赵绍琴老师认为，因肾虚而晨泻者确实存在。但更多的是肝经郁热之证，临证必须详细诊断仔细参考，切不可轻率断定。
盲目投予温补药物则反而增加其热郁，南辕北辙，病无痊愈之日。肝经郁热之晨泻，虽是久泻不止，但其脉弦滑数，弦为肝郁，滑数为郁热化火，同时伴有心烦急躁，夜寐梦多等症状。寅卯时属木，厥阴肝经气尽少阳胆经初生，肝经郁热暴发，辄乘犯脾土位，脾胃升降失司，故而腹痛泻泄。老师用升降散加减，以宣郁清热，升清降浊。再加“防风、陈皮、白芍乃痛泻要方去白术，以泻肝木补脾土，缓痛止泻。冬瓜皮、猪苓健脾利湿止泻。中焦脾失健运，湿阻气滞，用白蔻仁辛温芳香，化湿行气，灶心土健脾和胃止泻，焦三仙消食导滞。荆芥辛温芳香，醒脾开胃，胜湿化浊，并能疏肝郁，通阳和血，其炭可治肠风便血，湿热下迫等。诸药相合，肝热清，脾胃和，晨泻止。老师常用之而无不效验。
泄泻3（过敏性结肠炎）
何某某，年过六旬，患腹泻两年余。每晨泄泻必作。近半年来常自汗出，夜间尤甚，常致被褥全湿，夜不能寐。纳食渐减，形体日削，面色干黑，心烦急躁。近月余来病势有增无减，服药百剂，毫无效验。诊其脉象弦细，按之有力，沉取略有数意，面黑形瘦而两目炯炯有神，舌红质干糙老，苔厚腻，舌尖红刺满布。其腹泻每于五更即作，入厕即泄，其势如注，泻前必腹中绞痛，泻后痛止且舒。检视其前医脉案，皆谓年老体衰，脾肾两虚，所用不外温补益气之剂。此证果若中气不足，脾肾两虚，其面色当淡白，四肢当清冷，脉象当虚弱无力。今面苍黑，脉来弦数，舌红起刺，一派肝热之象，知其木郁克土也。五更是阳气初升之时，若肝郁厥阴下迫犯土，则泄作发于黎明，其泻势如注，非虚证也。前医见其年逾6旬，汗出日久，断为脾肾两虚，不知其因工作繁重，五志化火，肝热夹湿，蕴郁不化，又屡服温补，故病延久而日重。此汗非虚汗，乃热汗、湿汗，泻非虚泻，乃热泻、火泻。治疗不可少事补养，当先泻其肝热，热去则木土和调，诸症自平。方用黄连、黄芩、黄柏、阿胶、生白芍、灶心土、葛根、焦三仙等为剂，七剂而泻止汗减，继用上方加减调理一月而痊。
[按语]：五更泄按肝热治，是赵绍琴老师的创见，打破了五更泻属肾虚的传统观点。自宋代以来，一直把五更泻看作肾虚，用四神丸治之，鲜有佳效者。中医的特点是讲辨证，不可认定某病一定属虚，某病一定属实。要紧的是依据脉舌色症合参而断之。本案患者色苍，舌红，脉弦数，症暴泻如注，全是一派热象。
病机十九条云：“诸呕吐酸，暴注下迫，皆属于热。”凡暴泻如注，势不可挡者，皆火热泻也。其泻发于黎明阳气初升之时，其为肝热犯土明矣。故治先泻其肝热。方中又有白芍、阿胶者，寓养阴之意，因汗出日久，其阴必伤，故用此甘酸之味敛而养之。
药合病机，故能显效。
泄泻4（过敏性结肠炎）
朱某，女性，50岁
1993年10月20日初诊
患者晨起即泻已年余，曾用四神丸、黄连素、参苓白术散等药治疗均无效。并伴有中脘堵闷，两胁胀痛，心烦急躁，夜寐梦多，舌红苔白厚腻，脉弦滑且数。证属肝经郁热，木郁克土。
治以疏调肝脾，以泻肝热。方药：蝉衣、片姜黄、防风、白蔻仁各6克，僵蚕、荆芥炭、陈皮、白芍、猪苓各10克，冬瓜皮、灶心土各30克（先煎）。服药7剂后晨泻止，大便成形，中脘堵闷见舒，仍心烦梦多，再以上方去冬瓜皮、猪苓加川楝子6克，调服1周，以巩固疗效。
[按语]：晨起即泻，欲称五更泄，又名肾泻，古法作肾阳虚，习用四神丸之类，然获效者鲜。此案患者心烦急躁、夜寐梦多、两胁胀痛，皆是肝经郁热之象，其中脘堵满乃是脾胃不运，合而观之，证属肝经郁热，木郁克土，故用升降散合痛泻要方为治。古人云，痛泄之证，泄责之脾，痛责之肝，故腹痛即泻，泻后痛减，明是肝木克土之征。故当疏调肝脾为治。岂可一味温补兜涩耶。虽久泻未必皆虚，凡泻势急暴、出黄如糜、肛门灼热者虽无腹痛，亦作肝郁火迫看。不可妄投补涩。
便秘（习惯性便秘）
陆某，女性，26岁，1992年6月30日初诊。患者自1992年元月初产后，大便一直3～7日一行，经常服用麻仁丸，润肠丸等。就诊时，体质肥胖，头目眩晕，心烦急躁，脘腹胀满，纳食不佳，下肢轻度浮肿，大便近2周未行，舌红苔白腻，脉濡滑且数。证属湿热积滞于胃肠，升降失常。治以疏调气机升降，除湿清热通便。方药：蝉衣、片姜黄、枳壳、防风各6克，僵蚕、大腹皮、槟榔、焦三仙各10克，瓜蒌30克，大黄2克。嘱其忌食肥甘厚腻。服药7剂后，大便日行2次，偏稀，余症皆减。原方改大黄1克，去瓜蒌加莱菔子10克，隔日1剂，连服3周，诸症皆愈，体重亦有所减轻。
[按语]：便秘而常服麻仁丸、润肠丸，此常法也，必有效验，然不能根除也。以致服药则便畅，不服药则便秘，久而久之，必赖药以通便，必增大剂量始效，终有服药亦不便之日矣。此为肠胃传导之病，湿热积滞壅阻，致三焦气机不畅。戴元礼云：“郁者，结聚而不得发越也，当升者不得升，当降者不得降当变化者不得变化，此为传化失常，六郁之病见矣。”故治疗用升降散疏调气机，调整升降，加大腹皮、槟榔、焦三仙、枳壳疏导三焦，气机调畅则传导自分。故药后便秘即除，肥胖亦减矣。
又按：本案与上案一为便秘，一为泄泻证，似相反，而皆以升降散加减奏效，盖其证虽异而病机则一，故异病同治也。
眩晕1（低血压）
李某，男性，36岁
1992年5月7日初诊
自述血压偏低已近2年，迭服补剂而愈重。现头目眩晕，神疲乏力，心烦急躁，夜寐梦多，心慌气短，饮食无味，大便偏干，舌红苔厚且干，脉沉细滑数，BP10/7kPa。证属湿热郁滞，气机不畅。治以芳香宣化，疏调气机。方药：蝉衣、片姜黄、川楝子各6克，僵蚕、藿香、佩兰、大腹皮、槟榔、焦三仙、水红花子各10克，大黄1克。嘱其停服一切营养补品，饮食清淡，每天散步2小时，服药7剂后，诸症减而大便偏稀，BP13/9kPa，原方加荆芥炭10克，防风6克，灶心土30克（先煎）。以此方加减服用20余剂后，精神爽，纳食香，血压维持在13～16/9～10kPa。而告病愈。
[按语]：患者头目眩晕，神疲乏力，心慌气短似乎虚证，再结合血压偏低，则更以为虚矣。故患者自以为虚而服营养补品，饮食厚味；医生断之以虚则补剂频投，然愈补愈重，而不知其所以然。此证心急烦躁，夜寐梦多，是肝经郁热之象；舌红苔厚，脉沉细滑数，是郁热内伏之征；服补剂而证愈重，是实以虚治所致。析其病机乃气机郁滞，三焦不畅，故用升降散疏调气机，加藿香、佩兰芳香化湿，大腹皮、槟榔、焦三仙、水红花子疏利三焦，则气机畅行，而血压复常，诸证告愈矣。
眩晕2（高血压）
韩某，男性，39岁
1992年8月14日初诊
患高血压病已半年，一直服用复方降压片、心痛定等，血压仍24～26/19～17kPa。证见头痛目眩，心烦急躁，失眠梦多，大便干结，舌红苔白，脉弦滑且数。证属肝经郁热，气机阻滞。治以清泻肝经郁热，调畅气机。方药：蝉衣、片姜黄、白芷、防风各6克，僵蚕，苦丁茶、晚蚕砂、炒槐花各10克，大黄2克。服药7剂后，BP18/13kPa，余症减轻，停用西药。原方加川楝子6克，服药7剂，血压正常。又以前方加减每周3剂，连服3周以巩固疗效。于1993年2月12日复诊，血压稳定在16/11kPa，未再升高。
[按语]：此高血压眩晕头痛，脉、舌、色、证俱属肝火，故甚为易辨，不致误诊。然治法不用平肝潜阳，或直清肝胆，而仍以疏调气机为主，是何道理？盖此为肝经郁火，源于气机郁滞，升降不得其所。肝郁化火，当以解郁为先。解郁之法，首选升降散。
此案加防风、白芷尤妙，立意甚深。盖疏肝以风药，助肝木之升发，遂其条达之性则不郁矣。故服之即效。
又按：上案低血压眩晕，此案高血压眩晕，一高一低，截然相反，然治疗皆以升降散疏解肝郁而效。中医异病同治之义，于此可见矣。
It is so. In treating dysentery, astringents and tonics are strictly contraindicated. The method should be to regulate Qi, invigorate blood, clear heat, and guide out stagnation.
As it is said, "When Qi is regulated, the tenesmus will be removed; when blood is invigorated, the pus and blood in stool will heal." Attacking accumulation and guiding out stagnation are indispensable methods.
In the initial prescription, Mu Xiang (Aucklandiae Radix), Xiang Fu (Cyperi Rhizoma), and Zhi Qiao (Aurantii Fructus) are used to regulate Qi and broaden the intestines; Chi Shao (Paeoniae Radix Rubra) cools blood and invigorates blood; Ji Nei Jin (Galli Gigerii Endothelium Corneum), Lai Fu Zi (Raphani Semen), Bing Lang (Arecae Semen), and Da Huang (Rhei Radix et Rhizoma) attack accumulation and guide out stagnation; Ge Gen (Puerariae Lobatae Radix), Fang Feng (Saposhnikoviae Radix), and Sheng Ma (Cimicifugae Rhizoma) raise the clear Qi of the Yangming channel; Huang Qin (Scutellariae Radix) and Huang Lian (Coptidis Rhizoma) use bitter-cold properties to dry dampness, clear heat, firm the Yin, and stop dysentery. In this way, clear Qi is raised and turbid Qi is descended, accumulation is removed, Qi mechanism flows smoothly, tenesmus is naturally removed, and dysentery stops.
Dysentery 3 (Bacillary Dysentery during Pregnancy)
Qian, Female, 31 years old
Three months pregnant, presenting with passage of red and white dysenteric stools, abdominal pain with bearing-down sensation and tenesmus, pulse string-slippery and forceful, tongue red with thick greasy coating, poor appetite, illness duration 5 days. Syndrome differentiation: Damp-heat and accumulation obstructing the Middle Jiao. Initially employ the method of raising clear Qi and differentiating to stop dysentery, preventing fetal expulsion due to severe bearing-down. Care must be taken regarding diet, cold/warmth, etc.
Prescription: Ge Gen (Puerariae Lobatae Radix) 10g, Sheng Ma (Cimicifugae Rhizoma) 6g, Huang Qin (Scutellariae Radix) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Huo Xiang (Agastaches Herba) 10g (added later), Su Geng (Perillae Caulis) 10g (added later), Jiao San Xian (Charred Three Immortals) each 10g, Mu Xiang (Aucklandiae Radix) 6g, Huang Lian (Coptidis Rhizoma) 2g. 3 doses.
After medication, dysentery stopped, appetite returned, full-term delivery occurred, mother and child safe.
[Commentary]: Pregnancy complicated by dysentery risks damaging the fetal origin. Folk doctors often add fetal-preserving herbs. Here, the focus remains on treating dysentery; once dysentery heals, the fetal origin naturally stabilizes. This embodies the principle from *Nei Jing*: "If there is an excess pathogen, there will be no injury [to the healthy Qi], nor injury to the fetus; reduce the pathogen by more than half and then stop." If one adds Qi-tonifying and fetal-stabilizing herbs, it will inevitably prolong the dysentery, potentially harming the fetal origin, which must not be overlooked.
Diarrhea 1 (Allergic Colitis)
Liu, Male, 43 years old. Suffering from "Wu Geng Xie" (pre-dawn diarrhea) for over 3 years, ineffective treatment with Si Shen Wan, Jin Gui Shen Qi Wan, Fu Zi Li Zhong Wan, etc. Sought treatment from the teacher in October 1990. Symptoms: Must rush to toilet immediately upon rising in the morning, urgent diarrhea with a sense of immediacy, early rise leads to early diarrhea, late rise leads to late diarrhea, no rise means no diarrhea, feeling comfortable after defecation. Accompanied by irritability, frequent dreams at night, pulse string-slippery-rapid, tongue red with reddish edges, yellow and dry coating. Comprehensive analysis of pulse and symptoms indicates Liver-Gallbladder Qi Stagnation transforming into Heat, pressing downward to Yangming. Treatment: Regulate Liver-Spleen (Wood-Earth) relationship, using Tong Xie Yao Fang (Essential Formula for Painful Diarrhea) modified.
Medicinals: Chen Pi (Citri Reticulatae Pericarpium) 10g, Fang Feng (Saposhnikoviae Radix) 6g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Ge Gen (Puerariae Lobatae Radix) 10g, Huang Qin (Scutellariae Radix) 10g, Huang Lian (Coptidis Rhizoma) 3g, Jing Jie Tan (Schizonepetae Spica Carbonisata) 10g, Zao Xin Tu (Caulis Argillae Ustus) 30g. 7 doses, decocted in water. Patient did not return for follow-up after initial visit. In February 1994, patient visited for other issues, reporting that morning diarrhea stopped after 3 doses and has not recurred since.
[Commentary]: Wu Geng Xie is also known as Kidney Diarrhea. Traditionally considered Kidney Deficiency, treated with Si Shen Wan. Teacher Zhao Shaoqin has unique insights using Ge Gen Qin Lian Tang (Kudzu, Coptis, and Scutellaria Decoction) for Wu Geng Xie. He believes Wu Geng Xie occurs at dawn, characterized by immediate diarrhea upon rising, with urgent flow, like a gush, ending quickly. This aligns with *Nei Jing*: "Violent purging and bearing down all belong to Heat." Some have abdominal pain relieved after defecation, or no pain but comfort after defecation; these are signs of Excess pathogens, not Deficiency! Moreover, dawn is when Yang Qi activates, corresponding to Spring in the four seasons, governed by Liver and Gallbladder. Illness occurring at this time suggests Wood Overacting on Earth, leaving no doubt. Thus, the pathogenesis is determined as Liver-Gallbladder Stagnant Heat pressing downward to Yangming. Formula: Ge Gen Qin Lian Tang combined with Tong Xie Yao Fang. Ge Gen Qin Lian Tang clears Yangming Heat and firms Yin to stop diarrhea; Tong Xie Yao Fang suppresses Wood and supports Earth. The combination is highly effective for Wu Geng Xie. For example, treating Li, who had Wu Geng Xie for over 6 years, ineffective with Si Shen Wan. Teacher Zhao diagnosed string-rapid pulse, pale face, thin body, red tongue, yellow coating, irritability, frequent dreams, urgent diarrhea relieved after defecation. Diagnosed as Wood Stagnation invading Earth, Heat pressing Yangming. Prescribed Ge Gen Qin Lian Tang combined with Tong Xie Yao Fang plus Zao Xin Tu and Jing Jie Tan. Cured in 3 doses. This method treats not only Wu Geng Xie but any diarrhea resembling violent purging, regardless of duration, as Heat Diarrhea, ensuring efficacy.
Diarrhea 2 (Allergic Colitis)
Niu, Female, 50 years old
Initial visit June 26, 1992
Suffering from mandatory morning diarrhea for over a year. Treated with Si Shen Wan, Shen Ling Bai Zhu Wan, Berberine, and herbal decoctions without effect. Specifically came to Beijing for treatment. Current symptoms: Mandatory diarrhea every morning, stuffiness in Zhongwan (Epigastrium), distending pain in both hypochondria, irritability, frequent dreams. White thick greasy coating, string-slippery-rapid pulse.
Syndrome Differentiation: Liver-Gallbladder Stagnant Heat, Wood Stagnation Overacting on Earth.
Treatment Method: Regulate Liver-Spleen, clear Liver Heat.
Prescription: Chan Yi (Bombyx Batryticatus) 6g, Jiang Can (Bombyx Batryticatus) 10g, Jiang Huang (Curcumae Longae Rhizoma) 6g, Jing Jie Tan (Schizonepetae Spica Carbonisata) 10g, Fang Feng (Saposhnikoviae Radix) 6g, Chen Pi (Citri Reticulatae Pericarpium) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Zao Xin Tu (Caulis Argillae Ustus) 30g (decocted first), Zhu Ling (Polyporus) 10g, Dong Gua Pi (Benincasae Exocarpium) 10g, Jiao San Xian (Charred Three Immortals) each 10g, Bai Kou Ren (Amomi Fructus Rotundus) 4g. 7 doses.
Second Visit
Symptoms improved after medication, epigastric stuffiness relieved, morning diarrhea stopped, stool formed, still frequent dreams. String-slippery pulse, white greasy coating. Remove Dong Gua Pi and Jiao San Xian from previous formula, add Chuan Lian Zi (Toosendan Fructus) 6g. 7 doses, to conclude treatment.
[Commentary]: Wu Geng Xie is also called Morning Diarrhea. Generally believed to result from Kidney Yang Deficiency, hence also called Kidney Diarrhea. However, Teacher Zhao believes that while some morning diarrhea is due to Kidney Deficiency, most cases are due to Liver Channel Stagnant Heat. Clinical diagnosis must be detailed; do not judge rashly.
Blindly administering warming tonics increases Heat Stagnation, going in the wrong direction, delaying recovery. Morning diarrhea due to Liver Channel Stagnant Heat, though chronic, presents with string-slippery-rapid pulse (string indicates Liver Stagnation, slippery-rapid indicates Heat transforming from Stagnation), accompanied by irritability and frequent dreams. Yin-Mao hours belong to Wood, end of Jueyin Liver, beginning of Shaoyang Gallbladder. Liver Stagnant Heat erupts and attacks Earth, disrupting Spleen-Stomach ascending-descending functions, causing abdominal pain and diarrhea. Teacher uses Sheng Jiang San (Ascending and Descending Powder) modified to vent Stagnation, clear Heat, raise clear, and descend turbid. Added "Fang Feng, Chen Pi, Bai Shao are Tong Xie Yao Fang minus Bai Zhu, to drain Liver Wood and tonify Spleen Earth, relieve pain and stop diarrhea. Dong Gua Pi, Zhu Ling strengthen Spleen, promote dampness removal, and stop diarrhea. Middle Jiao Spleen fails to transport, dampness obstructs Qi stagnation; Bai Kou Ren is pungent-warm and aromatic, dries dampness and moves Qi; Zao Xin Tu strengthens Spleen, harmonizes Stomach, and stops diarrhea; Jiao San Xian digests food and guides out stagnation. Jing Jie is pungent-warm and aromatic, awakens Spleen, opens appetite, overcomes dampness, transforms turbidity, vents Liver Stagnation, unblocks Yang, harmonizes Blood; its carbonized form treats intestinal wind bleeding and damp-heat pressing downward. All medicinals combined, Liver Heat clears, Spleen-Stomach harmonizes, morning diarrhea stops. Teacher uses this frequently with consistent efficacy.
Diarrhea 3 (Allergic Colitis)
He XX, over 60 years old, suffering from diarrhea for over two years. Morning diarrhea always occurs. For the past six months, spontaneous sweating, worse at night, soaking bedding, insomnia. Gradual decrease in appetite, emaciation, dark dry complexion, irritability. Worsening over the past month, taking over 100 doses of medicine with no effect. Pulse string-thin, forceful on pressure, slightly rapid on deep pressure. Dark face, thin body, bright eyes, red tongue with dry rough texture, thick greasy coating, red prickles covering the tip. Diarrhea starts at Wu Geng (3-5 AM), immediate upon entering toilet, gushing flow, severe colic before defecation, relief after. Reviewing previous medical records, all attributed to elderly frailty, Spleen-Kidney Dual Deficiency, using only warming and Qi-tonifying agents. If this were truly Middle Qi Deficiency and Spleen-Kidney Deficiency, complexion would be pale, limbs cold, pulse weak and powerless. Now, dark complexion, string-rapid pulse, red tongue with prickles, all indicate Liver Heat, knowing it is Wood Stagnation Overacting on Earth. Wu Geng is when Yang Qi begins to rise; if Liver Stagnation from Jueyin presses downward attacking Earth, diarrhea occurs at dawn, gushing flow, not a Deficiency syndrome. Previous doctors saw age over 60 and long-term sweating, diagnosed Spleen-Kidney Deficiency, unaware that heavy work caused Five Emotions to transform into Fire, Liver Heat mixed with Dampness, stagnating and not resolving, compounded by repeated warming tonics, prolonging and worsening the disease. This sweat is not Deficiency sweat, but Heat sweat and Damp sweat; this diarrhea is not Deficiency diarrhea, but Heat diarrhea and Fire diarrhea. Treatment must avoid unnecessary tonification; first clear Liver Heat. Once Heat is gone, Wood and Earth harmonize, symptoms resolve. Prescription: Huang Lian (Coptidis Rhizoma), Huang Qin (Scutellariae Radix), Huang Bo (Phellodendri Cortex), E Jiao (Colla Corii Asini), Sheng Bai Shao (Paeoniae Radix Alba), Zao Xin Tu (Caulis Argillae Ustus), Ge Gen (Puerariae Lobatae Radix), Jiao San Xian (Charred Three Immortals). 7 doses, diarrhea stopped, sweating reduced. Continue modified formula for one month, fully recovered.
[Commentary]: Treating Wu Geng Xie according to Liver Heat is Teacher Zhao's innovation, breaking the traditional view of Kidney Deficiency. Since Song Dynasty, Wu Geng Xie was viewed as Kidney Deficiency, treated with Si Shen Wan, rarely effective. TCM emphasizes syndrome differentiation; do not assume a disease is always Deficiency or always Excess. Crucial is combining pulse, tongue, complexion, and symptoms. This patient has dark complexion, red tongue, string-rapid pulse, violent gushing diarrhea, all Heat signs.
The Nineteen Pathomechanisms states: "All vomiting and acid regurgitation, violent purging and bearing down, all belong to Heat." Any violent diarrhea like a gush, unstoppable, is Fire-Heat diarrhea. Occurring at dawn when Yang rises, it is clearly Liver Heat attacking Earth. Thus, treat by clearing Liver Heat first. The formula includes Bai Shao and E Jiao, implying nourishing Yin, because long-term sweating damages Yin, so sweet-acid flavors are used to astringe and nourish.
Medicinals match pathogenesis, thus showing obvious efficacy.
Diarrhea 4 (Allergic Colitis)
Zhu, Female, 50 years old
Initial visit October 20, 1993
Patient has had morning diarrhea for over a year, ineffective treatment with Si Shen Wan, Berberine, Shen Ling Bai Zhu San, etc. Accompanied by epigastric stuffiness, distending pain in hypochondria, irritability, frequent dreams, red tongue with white thick greasy coating, string-slippery-rapid pulse. Syndrome: Liver Channel Stagnant Heat, Wood Stagnation Overacting on Earth.
Treatment: Regulate Liver-Spleen, clear Liver Heat. Prescription: Chan Yi (Bombyx Batryticatus), Pian Jiang Huang (Curcumae Longae Rhizoma), Fang Feng (Saposhnikoviae Radix), Bai Kou Ren (Amomi Fructus Rotundus) each 6g; Jiang Can (Bombyx Batryticatus), Jing Jie Tan (Schizonepetae Spica Carbonisata), Chen Pi (Citri Reticulatae Pericarpium), Bai Shao (Paeoniae Radix Alba), Zhu Ling (Polyporus) each 10g; Dong Gua Pi (Benincasae Exocarpium), Zao Xin Tu (Caulis Argillae Ustus) each 30g (decocted first). After 7 doses, morning diarrhea stopped, stool formed, epigastric stuffiness relieved, still irritable with dreams. Remove Dong Gua Pi and Zhu Ling from previous formula, add Chuan Lian Zi (Toosendan Fructus) 6g, take for 1 week to consolidate efficacy.
[Commentary]: Morning diarrhea, called Wu Geng Xie or Kidney Diarrhea, traditionally treated as Kidney Yang Deficiency with Si Shen Wan, rarely effective. This patient's irritability, frequent dreams, hypochondriac pain are signs of Liver Channel Stagnant Heat; epigastric fullness indicates Spleen-Stomach failure to transport. Combined, syndrome is Liver Channel Stagnant Heat, Wood Stagnation Overacting on Earth. Thus, use Sheng Jiang San combined with Tong Xie Yao Fang. Ancients said: In painful diarrhea, diarrhea blames Spleen, pain blames Liver. Abdominal pain followed by diarrhea, pain relieved after defecation, clearly shows Liver Wood Overacting on Earth. Thus, regulate Liver-Spleen. How can one simply use warming astringents? Although chronic diarrhea is not necessarily Deficiency, any diarrhea with urgent violent flow, yellow mushy stool, burning anus, even without pain, is viewed as Liver Stagnation Fire Pressing. Do not blindly administer tonics and astringents.
Constipation (Habitual Constipation)
Lu, Female, 26 years old, Initial visit June 30, 1992. Since postpartum in January 1992, bowel movements every 3-7 days, frequently taking Ma Ren Wan, Run Chang Wan. At consultation, obese constitution, dizziness, irritability, abdominal distension, poor appetite, mild lower limb edema, no bowel movement for nearly 2 weeks, red tongue with white greasy coating, soggy-slippery-rapid pulse. Syndrome: Damp-Heat and Accumulation in Stomach-Intestines, abnormal ascending-descending. Treatment: Regulate Qi mechanism ascending-descending, remove dampness, clear heat, unblock bowels. Prescription: Chan Yi (Bombyx Batryticatus), Pian Jiang Huang (Curcumae Longae Rhizoma), Zhi Qiao (Aurantii Fructus), Fang Feng (Saposhnikoviae Radix) each 6g; Jiang Can (Bombyx Batryticatus), Da Fu Pi (Arecae Pericarpium), Bing Lang (Arecae Semen), Jiao San Xian (Charred Three Immortals) each 10g; Gua Lou (Trichosanthis Fructus) 30g, Da Huang (Rhei Radix et Rhizoma) 2g. Advised to avoid rich/greasy foods. After 7 doses, bowel movement twice daily, loose stool, other symptoms reduced. Modify original formula: Da Huang 1g, remove Gua Lou, add Lai Fu Zi (Raphani Semen) 10g, one dose every other day, continue for 3 weeks, all symptoms resolved, weight reduced.
[Commentary]: Constipation commonly treated with Ma Ren Wan, Run Chang Wan, which works but does not cure root. Leads to dependency on laxatives, requiring increased dosage, eventually becoming ineffective. This is a disorder of gastrointestinal transmission, Damp-Heat accumulation blocking, causing San Jiao Qi mechanism obstruction. Dai Yuanli said: "Stagnation is clustering without release; what should ascend cannot ascend, what should descend cannot descend, what should transform cannot transform. This is abnormal transmission, manifesting as Six Stagnations." Thus, treatment uses Sheng Jiang San to regulate Qi mechanism, adjust ascending-descending, plus Da Fu Pi, Bing Lang, Jiao San Xian, Zhi Qiao to dredge San Jiao. When Qi mechanism flows smoothly, transmission normalizes. Thus, constipation removed, obesity reduced.
Another Commentary: This case (constipation) and the previous case (diarrhea) seem opposite, yet both responded to modified Sheng Jiang San. Although syndromes differ, pathogenesis is the same, illustrating "Different Diseases, Same Treatment."
Vertigo 1 (Hypotension)
Li, Male, 36 years old
Initial visit May 7, 1992
Self-reported low blood pressure for nearly 2 years, worsened with repeated tonics. Current symptoms: Dizziness, fatigue, irritability, frequent dreams, palpitations, shortness of breath, tasteless appetite, dry stool, red tongue with thick dry coating, deep-thin-slippery-rapid pulse, BP 10/7 kPa. Syndrome: Damp-Heat Stagnation, Qi mechanism obstruction. Treatment: Aromatic transformation, regulate Qi mechanism. Prescription: Chan Yi (Bombyx Batryticatus), Pian Jiang Huang (Curcumae Longae Rhizoma), Chuan Lian Zi (Toosendan Fructus) each 6g; Jiang Can (Bombyx Batryticatus), Huo Xiang (Agastaches Herba), Pei Lan (Eupatorii Herba), Da Fu Pi (Arecae Pericarpium), Bing Lang (Arecae Semen), Jiao San Xian (Charred Three Immortals), Shui Hong Hua Zi (Alternantherae Semen) each 10g, Da Huang (Rhei Radix et Rhizoma) 1g. Advised to stop all nutritional supplements, light diet, walk 2 hours daily. After 7 doses, symptoms reduced, stool loose, BP 13/9 kPa. Add Jing Jie Tan (Schizonepetae Spica Carbonisata) 10g, Fang Feng (Saposhnikoviae Radix) 6g, Zao Xin Tu (Caulis Argillae Ustus) 30g (decocted first) to original formula. Take modified formula for over 20 doses, spirit refreshed, appetite good, BP maintained at 13-16/9-10 kPa. Reported cured.
[Commentary]: Patient's dizziness, fatigue, palpitations seem like Deficiency, especially with low BP. Patient self-medicates with tonics/rich food; doctors prescribe tonics, yet condition worsens, unaware of the cause. Irritability and frequent dreams indicate Liver Channel Stagnant Heat; red tongue, thick coating, deep-thin-slippery-rapid pulse indicate latent Stagnant Heat; worsening with tonics confirms treating Excess as Deficiency. Pathogenesis is Qi Stagnation, San Jiao obstruction. Use Sheng Jiang San to regulate Qi, add Huo Xiang, Pei Lan for aromatic damp-resolving, Da Fu Pi, Bing Lang, Jiao San Xian, Shui Hong Hua Zi to dredge San Jiao. Qi mechanism flows, BP normalizes, symptoms resolve.
Vertigo 2 (Hypertension)
Han, Male, 39 years old
Initial visit August 14, 1992
Hypertension for half a year, taking Compound降压片 (Compound Antihypertensive Tablets), Nifedipine, BP still 24-26/19-17 kPa. Symptoms: Headache, dizziness, irritability, insomnia, frequent dreams, dry stool, red tongue with white coating, string-slippery-rapid pulse. Syndrome: Liver Channel Stagnant Heat, Qi mechanism obstruction. Treatment: Clear Liver Channel Stagnant Heat, smooth Qi mechanism. Prescription: Chan Yi (Bombyx Batryticatus), Pian Jiang Huang (Curcumae Longae Rhizoma), Bai Zhi (Angelicae Dahuricae Radix), Fang Feng (Saposhnikoviae Radix) each 6g; Jiang Can (Bombyx Batryticatus), Ku Ding Cha (Ilicis Kudingchae Folium), Wan Can Sha (Bombyx Batryticatus), Chao Huai Hua (Sophorae Flos) each 10g, Da Huang (Rhei Radix et Rhizoma) 2g. After 7 doses, BP 18/13 kPa, other symptoms reduced, stop Western medicine. Add Chuan Lian Zi (Toosendan Fructus) 6g to original formula, take 7 doses, BP normal. Continue modified formula, 3 doses weekly, for 3 weeks to consolidate. Follow-up Feb 12, 1993, BP stable at 16/11 kPa, no further elevation.
[Commentary]: Hypertension vertigo/headache, pulse, tongue, complexion, symptoms all indicate Liver Fire, easy to diagnose, unlikely misdiagnosis. However, treatment does not use calming Liver and subduing Yang, or directly clearing Liver/Gallbladder, but focuses on regulating Qi mechanism. Why? This is Liver Channel Stagnant Fire, originating from Qi Stagnation, improper ascending-descending. Liver Stagnation transforming into Fire requires resolving Stagnation first. The preferred method for resolving Stagnation is Sheng Jiang San.
Adding Fang Feng and Bai Zhi is particularly clever, profound intent. Using Wind herbs to soothe Liver assists Liver Wood's ascending-nourishing nature, allowing free flow without stagnation. Hence immediate efficacy.
Another Commentary: Upper case hypotension vertigo, this case hypertension vertigo, high vs low, opposite, yet both treated effectively with Sheng Jiang San to resolve Liver Stagnation. The meaning of "Different Diseases, Same Treatment" in TCM is evident here.