例二洪XX，男，34岁。初诊日期：1964年6月5日。患感冒已20多天。现证两足趾热痛，痛甚不可忍，不敢着地，夜卧必置于被外，面黄赤，口唇舌质紫红，舌苔白腻，根部微黄，午后发热，脉濡数。辨证：湿热闭阻经络。治法：清热祛湿，活血开痹。方药：苍术12克防己12克通草12克苡米24克地龙12克牛膝12克苏木9克蒲公英30克甘草6克水煎服外用桃仁12克，杏仁12克，薄荷9克，荆芥9克，栀子12克，上药为面加白面少许，白酒合调糊状，外敷痛处。内服外糊并用，翌日痛止，服3剂能走路，8剂痊愈。(《老中医经验汇编》第一集，郑桥医案)
例三蔡XX，女，30岁。于1961年因关节疼痛全身发热，肌肤灼热(体温380(3上下)，烦渴引饮，大便秘结，盗汗颇多，住院治疗。罹病二月，四肢关节疼痛剧烈，手足不能举动，甚至不能触摸。脉弦大数，舌质绛，苔黄腻少津，曾服白虎加桂枝汤、独活寄生汤等均未效。辨证：阴血虚极，阴伤热炽，热甚灼筋，筋脉失养。治法：滋阴清热，固表止汗。方药；当归六黄汤加减。黄芪24克生地15克当归9克黄连4．5克黄芩6克黄柏6克花粉9克桑枝15克秦艽9克连服4剂，热象盗汗大减，舌苔渐润，又进3剂，燥屎下，上肢关节疼痛渐有好转，自能持杯饮水吃饭。效不更方，再连服4剂，关节疼痛减轻。半月后能下床步履，同时配合针灸隔日一次，二旬之间，身凉脉静，诸证悉愈。(《席梁丞治验录》)[评按]热痹系因湿热痹阻经络，或因素体阳盛，风寒湿邪侵袭经络，郁而化热所致。一般发病较急，除关节灼热肿痛外，多兼有热病证候。治以清热疏风、祛湿通络为法。
例一证属热痹而热胜于湿，故以清热泻火为主，佐以疏风祛湿，待热退痛减，续服蠲痹汤，以加强活血通络之功。
例二病值湿盛之际，素有蕴热而复感湿邪，由于透发不力而湿热互结下注，经络阻滞，治以清热祛湿、活血开痹通络，内外兼治而奏效。
例三虽为热痹而证候殊异，发热盗汗肢节剧痛，历时二月之久，汗愈出阴愈伤，阴愈伤而热愈炽，热甚灼筋，筋脉失养，故关节疼剧，服白虎加桂枝汤而热不解，用风药而痛愈剧，乃阴血虚极不能濡筋之故，复用独活寄生汤以致“风假火威，火乘风势”，痛热反而增剧，改用当归六黄汤以矫妄，滋阴清热、固表止汗而告愈。(二十五)血痹赵XX，女，34岁，初诊日期：1975年7月半月前因洗衣被等物30余件，劳累出汗，当天晚上卧床后，即觉右肘至肩部沉重，麻木、怕冷，酸痛，尤以肩部疼痛较甚。次日右上肢抬举困难，活动受限，入夜疼甚。望之患者痛苦病容，面色咣白少华。脉沉细无力，舌淡白而润。右臂欠温。辨证：寒湿侵伤，血行不畅，阳气痹阻而致血痹。治法：温阳行痹。方药：黄芪桂枝五物汤加味。黄芪30克桂枝9克白芍9克生姜15克大枣10枚姜黄12克羌活6克5剂复诊：右臂麻木沉重大减，但怕冷仍如前，且肩疼仍甚，脉细，舌苔白润。原方加制附片9克，嘱服5剂。三诊，臂已不麻，肩部酸痛，抬肩举臂自如，但仍伯冷，沉重，脉舌如前，原方加苡仁15克，蚕砂12克，以增除湿之功，嘱服5剂。四诊时病已痊愈。(《窦伯清医案》)[评按]血痹系指“卧出而风吹之，血凝于肤者为痹”(《素问·五藏生成篇》)，与风寒湿所致痹证不同。血痹以肌肉麻痹无痛感，痹证则麻痛并见。正虚之体劳而汗出，则阳气更虚，风邪侵袭则血行不畅，故见肌肉麻痹，若风邪较重，也可发生疼痛，故曰“如风痹状”。本病在《金匮要略》记述较详。本案证状尚属典型，方用黄芪桂枝五物汤加羌活、附子等辛温之晶，药证相符，疗效卓著。治法在遵古的基础上有所变化。
(二十六)瘘证附；重症肌无力
例一封X；女，温病后，阴液已伤，虚火灼金，肺热叶焦则生痿躄，两足不能任地，咳呛不爽，谷食减少，咽喉干燥，脉濡滑而数，舌质红，苔黄，延经数月，恙根已深，姑拟养肺阴、清阳明，下病治上，乃古之成法。南沙参9克川石斛9克天花粉9克生甘草1．5克川贝母9克肥知母4．5克瓜萎皮9克甜光杏9克络石藤9克怀牛膝6克嫩桑枝9克冬瓜子9克活芦根1尺(去节)二诊：前进养肺阴清阳明之剂，已服10剂，咳呛内热，均见减轻，两足痿软不能任地，痿者萎也，如草木之萎，无雨露以灌溉，欲草木之荣茂，必得雨露之濡润，欲两足之不萎，必赖肺液以输布，能下荫于肝肾，肝得血则筋舒，肾得养则骨强，阴血充足，络热自清，治痿独取阳明，清阳明之热，滋肺金之阴以阳明能主润宗筋而流利机关也。大麦冬6克北沙参9克抱茯神9克淮山药9克细生地12克肥知母4．5克川贝母6克天花粉9克络石藤6克怀牛膝6克嫩桑枝9克三诊，五脏之热，皆能成痿，书有五痿之称，不独肺热叶焦也，然而虽有五，实则有二，热痿也，湿痿也。如草木久无雨露则萎，草木久被湿遏亦萎，两足痿躄，亦犹是也，今脉濡数，舌质红绛，此热痿也，叠进清阳明、滋肺阴以来，两足虽不能步履，已能自行举起之象，药病尚觉合宜，仍守原法，加入益精养血之品，徐图功效。北沙参9克大麦冬6克茯神9克怀山药9克川石斛9克小生地9克肥知母4．5克怀牛膝6克络石藤9克茺蔚子9克嫩桑枝9克猪脊髓两条(酒洗，入煎)虎潜丸9克，清晨淡盐汤送服。(《丁甘仁医案》)
例二赵，男，31岁，10月。湿热久蕴，营卫受阻，气血无以润养诸筋，胭内消瘦，筋骨痿软，下肢不能伸缩，脉象濡细，舌苔薄白，治拟气血并补，舒筋通络。清炙黄芪15克酒炒当归12克桂枝尖2．4克炙广地龙9克炒天虫9克老钩藤12克丝瓜络15克杜红花3克酒炒川断9克伸筋草12克千年健6克二诊：经云“气主煦之，血主濡之”。气血俱亏，不能温润肌肉筋脉，故渐而成痿。脉证如前，仍守原意出入。清炙黄芪15克酒炒当归9克大熟地15克杜红花3克清炙广地龙9克桂枝尖2．4克炒赤白芍各6克泽泻9克茯苓12克炒怀牛膝9克炒黄柏4．5克三诊：湿热浸淫，气血不充，无以濡养肌筋，两足痿软，肌肉消瘦，伸缩活动略有好转，苔薄黄，脉仍濡细，再仿丹溪加味二妙散法：炒黄柏6克炒苍术4．5克酒炒当归9克防己9克川萆薜9克怀牛膝9克炙龟板15克熟地15克炙黄芪15克炙甘草4．5克茯苓12克四诊：前方服后，湿热日渐清化，筋脉得气血之濡养，下肢软痿好转，尚能任地移行，伸缩已趋正常，再拟补气血填肝肾继之。米炒上潞参9克炙黄芪15克酒炒当归9克熟地24克怀牛膝9克炒黄柏4．5克酒炒川续断9克炒白芍9克炙甘草4．5克防己6克盐水炒杜仲15克健步虎潜丸12克(分吞)(《叶熙春医案》)[评按]痿证系指肢体筋脉弛缓，手足痿软的病证。一般分为肺热熏灼、肝肾虚亏、湿热浸淫等证型，其发病且与脾胃津液枯槁有关，故痿证大多属热、属虚。
例一证属阴液已伤，虚火灼金，肺热叶焦而致痿躄，遂取养肺阴、清阳明，下病治上之法，见效后，加入益精养血之品，此即张介宾所谓：“善补阴者，必于阳中求阴，则阴得阳升而源泉不竭”之义。丁氏将痿证分为热痿与湿痿，在临床上较易掌握。
例二系因气血不足，筋肉失于濡养而致痿。盖治痿之法，古有独取阳明之说。叶氏认为，病起中焦，独取阳明可也，病起厥阴，则应填补旰肾。而本
例介于厥阴、太阴之间，故于补气血之中，增入化湿清热之味，可谓治痿之又一法。
附：重症肌无力
例一方XX，男，59岁，初诊日期c1976年3月11日。患者1973年以腹泻、疲劳为诱因，逐渐出现右眼睑下垂、复视，西医诊断为重症肌无力眼肌型，经中西药治疗缓解。1975年10月感冒发热后，又出现左眼睑下垂、复视，咀嚼吞咽困难，颈及肩胛无力，同年12月两次出现呼吸困难，诊为重症肌无力延髓型，用西药治疗至1976年1月5日，仍不能控制症状，1976年3月11日来诊。症状大致如前，偏胖体型，面微赤，眼睑下垂，眼裂变小，头低倾，不能正常直立，两手不能上举。舌嫩，有齿痕，稍红，苔薄白，中心稍黄腻，脉沉细无力。辨证：脾气虚衰，肝郁肾虚。治法：健脾补气，舒肝滋肾。方药：黄芪45克苍白术各12克陈皮9克党参15克柴胡12克升麻6克甘草6克生姜3克大枣12克熟地30克仙灵脾15克麦冬12克五味子9克服上方12剂后，自觉症状明显减轻(服三剂时即开始减吡啶斯的明剂量)，眼睑下垂基本恢复，进食不需休息，治疗半年，西药全撤，自觉症状完全消失。改予补中益气汤合益胃汤，制成丸剂调理，1977年4月14日复查，基本恢复正常，坚持半日工作，间断服上述丸药，基本治愈。(方药中：谈辨证论治的基本精神及其在临床运用中的步骤和方法，《新医药杂志》9c14，1977)
例二XXX，女，30余岁，1966年秋，病已半载，经多个医院检查均诊断为重症肌无力，治疗未效。初诊，面色咣白，且无表情，目胞均垂，不能睁开，少气懒言，挣扎半响才说出一句，语声低微，当面询问听不清晰，倦怠乏力，举动艰难，稍一行动，须人扶持。每餐不到二两，却需一小时余，吃吃歇歇，再吃再歇，咀嚼馒头、面条，好象嚼着硬质食物一样，吃不到两口，牙关酸困，即无力续嚼。有时把一口馒头，或一口汤水，咽到半截，也要暂时休息才能继续咽下。月经延期，量少色淡。脉虚弱，舌淡苔薄。证属脾虚中气不足，拟升阳补气法。方药：生黄芪24克当归身9克炙甘草9克土白术12克陈皮6克干姜6克党参15克升麻6克柴胡6克水煎服，1日1剂，连服4剂。复诊：服4剂后，倦怠稍减，余证如旧，嘱再服4剂。三诊：又服4剂后，除胞垂须用手上推，目才可睁，过2—3分钟，又复垂闭外，其余各症，均已明显好转，嘱再月艮4齐t。四诊；又服4剂后，二目开阖自如，但久睁尚有乏困感，他症基本消失。嘱将原方减半，续服几剂，以资巩固。五诊：续服6天，各症均失。(杨作棋《临证录》)[评按]重症肌无力为西医病名，为家族性、预后不良的疑难病。从其临床表现属于中医“脾虚”辨证范围。若为全身性肌无力亦属于“痿证”。
例一为重症肌无力眼肌型。证属脾气虚弱，旰郁肾虚。脾主肌肉，脾虚则肌痿无力，肾虚不能温煦脾阳，则后天失济。故以补中益气汤为主方，加补肾舒肝之品。初治时中西药合用，后单纯服用中药，获得基本治愈。
例二证情较前为重，方证相符，获效尚速。此病虽属疑难，但从以上二例的辨证，或用中药，或中西药互相配合，获得如此疗效，值得重视。
(二十七)奔豚气
例一崔XX，男，40岁。初诊日期；1971年4月20日。自觉腹部脐周有一积块，顶冲跳痛。急性发作时，上吐下泻，出冷汗。本病从六、七岁开始一直来愈。现在，食欲欠佳，腹痛畏冷，手足不温，二便一般。苔白，脉沉迟。辨证：此为沉寒痼冷，盘踞中焦之奔豚气。治法：大补阳气，温中散寒。方药；理中丸合附子汤加减。炒白芍10克焦白术10克干姜10克东参9克炮附子10克茯苓10克炙甘草5克4月29日(二诊)：上方二剂后，食欲、二便均好，手足转温，不畏冷，但仍脐腹疼痛，往上顶冲，不拒按。脉沉紧。宜继用暖肝降逆，温阳理气。方药如下：茯苓10克半夏10克陈皮10克炒白芍12克炙甘草5克川楝子10克荔枝10克良姜6克吴茱萸6克小茴香10克肉桂6克牛膝10克沉香5克5月1日(三诊)：上方2剂后，脐腹痛，顶·冲见好，腹内舒服，食欲增进。脉沉紧较缓。诸证向愈。继服原方4剂，以巩固疗效。(《张子琳医疗经验选辑》)
例二吴XX，男，31岁。1970年夏。患者脐周围作痛，扪之坚硬拒按，呈阵发性，痛时觉有物从脐下向上攻冲，发作欲死，移时自止。病已三年，发作无时。有时上下肢关节游走痛。诊脉沉弦而滑，舌苔白滑。臆断为寒湿水气著于肝肾二经，膀胱气化失司，至水寒之气上冲所致。治宜镇逆降气，温中散寒。桂枝10克茯苓30克吴萸10克炒白芍15克炙甘草10克白术10克炒枳实10克陈皮10克法半夏10克薏苡仁25克生姜3片大枣5枚投上方3剂而安。后因食思不振，加陈皮、神曲，再服而痊愈。(张梦侬《临证会要》)[评按]奔豚气系指自觉气从少腹上冲胸膈的一种证候。《内经》中就有记载，《金匮要略》有专篇论述。后世医家将其并入“积聚”类中。
例一为沉寒痼冷盘踞中焦，肝肾之气上逆冲心。方用理中汤合附子汤加减。药后阳气渐复而气上顶冲未愈，继用茯苓桂枝甘草大枣汤合程钟龄奔豚丸加减，因其气逆太甚，故加牛膝、沉香，数十年之陈疾，竟获良效。
例二 洪某某，男性，34岁。初诊日期为1964年6月5日。患感冒已20多天。现症见两足趾热痛，疼痛剧烈难以忍受，不敢着地，夜间睡觉时必须将脚放在被子外面，面色黄而带赤色，口唇和舌质紫红，舌苔白腻，根部微黄，午后发热，脉象濡数。辨证：湿热闭阻经络。治法：清热祛湿，活血开痹。方药：苍术12克，防己12克，通草12克，苡米24克，地龙12克，牛膝12克，苏木9克，蒲公英30克，甘草6克，水煎服。外用桃仁12克，杏仁12克，薄荷9克，荆芥9克，栀子12克，上药研为粉末，加少许白面，用白酒调和成糊状，外敷于疼痛处。内服与外敷并用，次日疼痛停止，服用3剂后能走路，8剂后痊愈。（《老中医经验汇编》第一集，郑桥医案）
例三 蔡某某，女性，30岁。于1961年因关节疼痛、全身发热、肌肤灼热（体温38℃上下）、烦躁口渴引饮、大便秘结、盗汗较多而住院治疗。患病两个月，四肢关节疼痛剧烈，手足不能活动，甚至不能触摸。脉象弦大数，舌质绛，苔黄腻少津，曾服用白虎加桂枝汤、独活寄生汤等均未见效。辨证：阴血虚极，阴伤热炽，热甚灼筋，筋脉失养。治法：滋阴清热，固表止汗。方药：当归六黄汤加减。黄芪24克，生地15克，当归9克，黄连4.5克，黄芩6克，黄柏6克，花粉9克，桑枝15克，秦艽9克。连服4剂，热象和盗汗大减，舌苔渐润，又进3剂，燥屎排出，上肢关节疼痛渐有好转，自能持杯饮水吃饭。效不更方，再连服4剂，关节疼痛减轻。半月后能下床行走，同时配合针灸隔日一次，二十天之间，身凉脉静，诸证悉愈。（《席梁丞治验录》）[评按]热痹系因湿热痹阻经络，或因素体阳盛，风寒湿邪侵袭经络，郁而化热所致。一般发病较急，除关节灼热肿痛外，多兼有热病证候。治以清热疏风、祛湿通络为法。
例一证属热痹而热胜于湿，故以清热泻火为主，佐以疏风祛湿，待热退痛减，续服蠲痹汤，以加强活血通络之功。
例二病值湿盛之际，素有蕴热而复感湿邪，由于透发不力而湿热互结下注，经络阻滞，治以清热祛湿、活血开痹通络，内外兼治而奏效。
例三虽为热痹而证候殊异，发热盗汗肢节剧痛，历时二月之久，汗愈出阴愈伤，阴愈伤而热愈炽，热甚灼筋，筋脉失养，故关节疼剧，服白虎加桂枝汤而热不解，用风药而痛愈剧，乃阴血虚极不能濡筋之故，复用独活寄生汤以致“风假火威，火乘风势”，痛热反而增剧，改用当归六黄汤以矫妄，滋阴清热、固表止汗而告愈。(二十五)血痹赵某某，女性，34岁，初诊日期：1975年7月半月前因洗衣被等物30余件，劳累出汗，当天晚上卧床后，即觉右肘至肩部沉重，麻木、怕冷，酸痛，尤以肩部疼痛较甚。次日右上肢抬举困难，活动受限，入夜疼甚。望之患者痛苦病容，面色㿠白少华。脉沉细无力，舌淡白而润。右臂欠温。辨证：寒湿侵伤，血行不畅，阳气痹阻而致血痹。治法：温阳行痹。方药：黄芪桂枝五物汤加味。黄芪30克，桂枝9克，白芍9克，生姜15克，大枣10枚，姜黄12克，羌活6克。5剂复诊：右臂麻木沉重大减，但怕冷仍如前，且肩疼仍甚，脉细，舌苔白润。原方加制附片9克，嘱服5剂。三诊，臂已不麻，肩部酸痛，抬肩举臂自如，但仍怕冷，沉重，脉舌如前，原方加苡仁15克，蚕砂12克，以增除湿之功，嘱服5剂。四诊时病已痊愈。（《窦伯清医案》）[评按]血痹系指“卧出而风吹之，血凝于肤者为痹”（《素问·五藏生成篇》），与风寒湿所致痹证不同。血痹以肌肉麻痹无痛感，痹证则麻痛并见。正虚之体劳而汗出，则阳气更虚，风邪侵袭则血行不畅，故见肌肉麻痹，若风邪较重，也可发生疼痛，故曰“如风痹状”。本病在《金匮要略》记述较详。本案证状尚属典型，方用黄芪桂枝五物汤加羌活、附子等辛温之品，药证相符，疗效卓著。治法在遵古的基础上有所变化。
例一封某，女性，温病后，阴液已伤，虚火灼金，肺热叶焦则生痿躄，两足不能任地，咳呛不爽，谷食减少，咽喉干燥，脉濡滑而数，舌质红，苔黄，延经数月，恙根已深，姑拟养肺阴、清阳明，下病治上，乃古之成法。南沙参9克，川石斛9克，天花粉9克，生甘草1.5克，川贝母9克，肥知母4.5克，瓜萎皮9克，甜光杏9克，络石藤9克，怀牛膝6克，嫩桑枝9克，冬瓜子9克，活芦根1尺（去节）。二诊：前进养肺阴清阳明之剂，已服10剂，咳呛内热，均见减轻，两足痿软不能任地，痿者萎也，如草木之萎，无雨露以灌溉，欲草木之荣茂，必得雨露之濡润，欲两足之不萎，必赖肺液以输布，能下荫于肝肾，肝得血则筋舒，肾得养则骨强，阴血充足，络热自清，治痿独取阳明，清阳明之热，滋肺金之阴以阳明能主润宗筋而流利机关也。大麦冬6克，北沙参9克，抱茯神9克，淮山药9克，细生地12克，肥知母4.5克，川贝母6克，天花粉9克，络石藤6克，怀牛膝6克，嫩桑枝9克。三诊，五脏之热，皆能成痿，书有五痿之称，不独肺热叶焦也，然而虽有五，实则有二，热痿也，湿痿也。如草木久无雨露则萎，草木久被湿遏亦萎，两足痿躄，亦犹是也，今脉濡数，舌质红绛，此热痿也，叠进清阳明、滋肺阴以来，两足虽不能步履，已能自行举起之象，药病尚觉合宜，仍守原法，加入益精养血之品，徐图功效。北沙参9克，大麦冬6克，茯神9克，怀山药9克，川石斛9克，小生地9克，肥知母4.5克，怀牛膝6克，络石藤9克，茺蔚子9克，嫩桑枝9克，猪脊髓两条（酒洗，入煎），虎潜丸9克，清晨淡盐汤送服。（《丁甘仁医案》）
例二赵某，男性，31岁，10月。湿热久蕴，营卫受阻，气血无以润养诸筋，腘内消瘦，筋骨痿软，下肢不能伸缩，脉象濡细，舌苔薄白，治拟气血并补，舒筋通络。清炙黄芪15克，酒炒当归12克，桂枝尖2.4克，炙广地龙9克，炒天虫9克，老钩藤12克，丝瓜络15克，杜红花3克，酒炒川断9克，伸筋草12克，千年健6克。二诊：经云“气主煦之，血主濡之”。气血俱亏，不能温润肌肉筋脉，故渐而成痿。脉证如前，仍守原意出入。清炙黄芪15克，酒炒当归9克，大熟地15克，杜红花3克，清炙广地龙9克，桂枝尖2.4克，炒赤白芍各6克，泽泻9克，茯苓12克，炒怀牛膝9克，炒黄柏4.5克。三诊：湿热浸淫，气血不充，无以濡养肌筋，两足痿软，肌肉消瘦，伸缩活动略有好转，苔薄黄，脉仍濡细，再仿丹溪加味二妙散法：炒黄柏6克，炒苍术4.5克，酒炒当归9克，防己9克，川萆薜9克，怀牛膝9克，炙龟板15克，熟地15克，炙黄芪15克，炙甘草4.5克，茯苓12克。四诊：前方服后，湿热日渐清化，筋脉得气血之濡养，下肢软痿好转，尚能任地移行，伸缩已趋正常，再拟补气血填肝肾继之。米炒上潞参9克，炙黄芪15克，酒炒当归9克，熟地24克，怀牛膝9克，炒黄柏4.5克，酒炒川续断9克，炒白芍9克，炙甘草4.5克，防己6克，盐水炒杜仲15克，健步虎潜丸12克（分吞）。（《叶熙春医案》）[评按]痿证系指肢体筋脉弛缓，手足痿软的病证。一般分为肺热熏灼、肝肾虚亏、湿热浸淫等证型，其发病且与脾胃津液枯槁有关，故痿证大多属热、属虚。
例一证属阴液已伤，虚火灼金，肺热叶焦而致痿躄，遂取养肺阴、清阳明，下病治上之法，见效后，加入益精养血之品，此即张介宾所谓：“善补阴者，必于阳中求阴，则阴得阳升而源泉不竭”之义。丁氏将痿证分为热痿与湿痿，在临床上较易掌握。
例二系因气血不足，筋肉失于濡养而致痿。盖治痿之法，古有独取阳明之说。叶氏认为，病起中焦，独取阳明可也，病起厥阴，则应填补肝肾。而本例介于厥阴、太阴之间，故于补气血之中，增入化湿清热之味，可谓治痿之又一法。
附：重症肌无力
例一方某某，男性，59岁，初诊日期：1976年3月11日。患者1973年以腹泻、疲劳为诱因，逐渐出现右眼睑下垂、复视，西医诊断为重症肌无力眼肌型，经中西药治疗缓解。1975年10月感冒发热后，又出现左眼睑下垂、复视，咀嚼吞咽困难，颈及肩胛无力，同年12月两次出现呼吸困难，诊为重症肌无力延髓型，用西药治疗至1976年1月5日，仍不能控制症状，1976年3月11日来诊。症状大致如前，偏胖体型，面微赤，眼睑下垂，眼裂变小，头低倾，不能正常直立，两手不能上举。舌嫩，有齿痕，稍红，苔薄白，中心稍黄腻，脉沉细无力。辨证：脾气虚衰，肝郁肾虚。治法：健脾补气，舒肝滋肾。方药：黄芪45克，苍白术各12克，陈皮9克，党参15克，柴胡12克，升麻6克，甘草6克，生姜3克，大枣12克，熟地30克，仙灵脾15克，麦冬12克，五味子9克。服上方12剂后，自觉症状明显减轻（服三剂时即开始减吡啶斯的明剂量），眼睑下垂基本恢复，进食不需休息，治疗半年，西药全撤，自觉症状完全消失。改予补中益气汤合益胃汤，制成丸剂调理，1977年4月14日复查，基本恢复正常，坚持半日工作，间断服上述丸药，基本治愈。（方药中：谈辨证论治的基本精神及其在临床运用中的步骤和方法，《新医药杂志》9c14，1977）
例二XXX，女性，30余岁，1966年秋，病已半载，经多个医院检查均诊断为重症肌无力，治疗未效。初诊，面色㿠白，且无表情，目胞均垂，不能睁开，少气懒言，挣扎半晌才说出一句，语声低微，当面询问听不清晰，倦怠乏力，举动艰难，稍一行动，须人扶持。每餐不到二两，却需一小时余，吃吃歇歇，再吃再歇，咀嚼馒头、面条，好象嚼着硬质食物一样，吃不到两口，牙关酸困，即无力续嚼。有时把一口馒头，或一口汤水，咽到半截，也要暂时休息才能继续咽下。月经延期，量少色淡。脉虚弱，舌淡苔薄。证属脾虚中气不足，拟升阳补气法。方药：生黄芪24克，当归身9克，炙甘草9克，土白术12克，陈皮6克，干姜6克，党参15克，升麻6克，柴胡6克，水煎服，1日1剂，连服4剂。复诊：服4剂后，倦怠稍减，余证如旧，嘱再服4剂。三诊：又服4剂后，除胞垂须用手上推，目才可睁，过2—3分钟，又复垂闭外，其余各症，均已明显好转，嘱再服4剂。四诊；又服4剂后，二目开阖自如，但久睁尚有乏困感，他症基本消失。嘱将原方减半，续服几剂，以资巩固。五诊：续服6天，各症均失。（杨作棋《临证录》）[评按]重症肌无力为西医病名，为家族性、预后不良的疑难病。从其临床表现属于中医“脾虚”辨证范围。若为全身性肌无力亦属于“痿证”。
例一为重症肌无力眼肌型。证属脾气虚弱，肝郁肾虚。脾主肌肉，脾虚则肌痿无力，肾虚不能温煦脾阳，则后天失济。故以补中益气汤为主方，加补肾舒肝之品。初治时中西药合用，后单纯服用中药，获得基本治愈。
例二证情较前为重，方证相符，获效尚速。此病虽属疑难，但从以上二例的辨证，或用中药，或中西药互相配合，获得如此疗效，值得重视。
(二十七)奔豚气
例一崔某某，男性，40岁。初诊日期：1971年4月20日。自觉腹部脐周有一积块，顶冲跳痛。急性发作时，上吐下泻，出冷汗。本病从六、七岁开始一直愈来。现在，食欲欠佳，腹痛畏冷，手足不温，二便一般。苔白，脉沉迟。辨证：此为沉寒痼冷，盘踞中焦之奔豚气。治法：大补阳气，温中散寒。方药：理中丸合附子汤加减。炒白芍10克，焦白术10克，干姜10克，东参9克，炮附子10克，茯苓10克，炙甘草5克。4月29日（二诊）：上方二剂后，食欲、二便均好，手足转温，不畏冷，但仍脐腹疼痛，往上顶冲，不拒按。脉沉紧。宜继用暖肝降逆，温阳理气。方药如下：茯苓10克，半夏10克，陈皮10克，炒白芍12克，炙甘草5克，川楝子10克，荔枝10克，良姜6克，吴茱萸6克，小茴香10克，肉桂6克，牛膝10克，沉香5克。5月1日（三诊）：上方2剂后，脐腹痛，顶冲见好，腹内舒服，食欲增进。脉沉紧较缓。诸证向愈。继服原方4剂，以巩固疗效。（《张子琳医疗经验选辑》）
例二吴某某，男性，31岁。1970年夏。患者脐周围作痛，扪之坚硬拒按，呈阵发性，痛时觉有物从脐下向上攻冲，发作欲死，移时自止。病已三年，发作无时。有时上下肢关节游走痛。诊脉沉弦而滑，舌苔白滑。臆断为寒湿水气著于肝肾二经，膀胱气化失司，至水寒之气上冲所致。治宜镇逆降气，温中散寒。桂枝10克，茯苓30克，吴萸10克，炒白芍15克，炙甘草10克，白术10克，炒枳实10克，陈皮10克，法半夏10克，薏苡仁25克，生姜3片，大枣5枚。投上方3剂而安。后因食思不振，加陈皮、神曲，再服而痊愈。（张梦侬《临证会要》）[评按]奔豚气系指自觉气从少腹上冲胸膈的一种证候。《内经》中就有记载，《金匮要略》有专篇论述。后世医家将其并入“积聚”类中。
例一为沉寒痼冷盘踞中焦，肝肾之气上逆冲心。方用理中汤合附子汤加减。药后阳气渐复而气上顶冲未愈，继用茯苓桂枝甘草大枣汤合程钟龄奔豚丸加减，因其气逆太甚，故加牛膝、沉香，数十年之陈疾，竟获良效。
Case 2: Hong XX, male, 34 years old. First visit date: June 5, 1964. Suffering from a common cold (Ganmao, 感冒) for over 20 days. Current symptoms: heat and pain in both big toes, severe pain intolerable to bear, unable to put feet on the ground, must keep feet outside the blanket at night; sallow complexion with redness, purple-red lips and tongue body, white greasy tongue coating with slight yellow at the root, afternoon fever, soggy and rapid pulse (Ru Shu Mai, 濡数脉). Syndrome differentiation: Damp-heat obstructing the meridians (Jingluo, 经络). Treatment method: Clear heat and dispel dampness, invigorate blood and open obstruction (Bi, 痹). Prescription: Cangzhu (Atractylodis Rhizoma) 12g, Fangji (Stephaniae Tetrandrae Radix) 12g, Tongcao (Tetrapanacis Medulla) 12g, Yimi (Coicis Semen) 24g, Dilong (Pheretima) 12g, Niuxi (Achyranthis Bidentatae Radix) 12g, Sumu (Sappan Lignum) 9g, Gongyingying (Taraxaci Herba) 30g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, decocted in water for oral administration. External use: Taoren (Persicae Semen) 12g, Xingren (Armeniacae Semen Amarum) 12g, Bohe (Menthae Haplocalycis Herba) 9g, Jingjie (Schizonepetae Herba) 9g, Zhizi (Gardeniae Fructus) 12g; these herbs are ground into powder, mixed with a little wheat flour and white wine to form a paste, applied externally to the painful area. Internal and external treatments combined; pain ceased the next day, walking possible after 3 doses, cured after 8 doses. (From *Compilation of Experienced Cases by Famous Modern Doctors*, Vol. 1, Zheng Qiao's Medical Case)
Case 3: Cai XX, female, 30 years old. In 1961, hospitalized due to joint pain, systemic fever, burning skin sensation (body temperature around 38°C), irritability with excessive thirst, constipation, and profuse night sweats. After two months of illness, severe pain in limbs joints, inability to move hands and feet, even inability to touch them. Pulse was wiry, large, and rapid; tongue body crimson, coating yellow and greasy with little fluid. Previously treated with Baihu Jia Guizhi Tang (White Tiger plus Cinnamon Twig Decoction) and Duhuo Jisheng Tang (Angelica Pubescens and Taxillus Decoction) without effect. Syndrome differentiation: Extreme deficiency of Yin and Blood, Yin injury with blazing heat, heat scorching sinews causing loss of nourishment to sinews and vessels. Treatment method: Nourish Yin and clear heat, secure the exterior and stop sweating. Prescription: Danggui Liuhuang Tang (Angelica Hexagon Decoction) modified. Huangqi (Astragali Radix) 24g, Shengdi (Rehmanniae Radix) 15g, Danggui (Angelicae Sinensis Radix) 9g, Huanglian (Coptidis Rhizoma) 4.5g, Huangqin (Scutellariae Radix) 6g, Huangbai (Phellodendri Cortex) 6g, Huafen (Trichosanthis Radix) 9g, Sangzhi (Mori Ramulus) 15g, Qinjiao (Gentianae Macrophyllae Radix) 9g. Taken continuously for 4 doses; heat signs and night sweats significantly reduced, tongue coating became moist. Another 3 doses taken; dry stool passed, upper limb joint pain improved, able to hold cup for drinking and eating independently. Formula unchanged as effective; continued for another 4 doses; joint pain alleviated. Half a month later, able to get out of bed and walk; combined with acupuncture every other day. Within 20 days, body cooled, pulse quieted, all symptoms resolved. (From *Xi Liangcheng's Verified Cases*) [Commentary]: Re-Bi (Heat Bi, 热痹) is caused by damp-heat obstructing meridians, or due to constitutive Yang excess where wind-cold-damp pathogens invade meridians, stagnate and transform into heat. Onset is generally acute; besides burning, hot, swollen, and painful joints, it often accompanies heat disease syndromes. Treatment focuses on clearing heat, dispersing wind, dispelling dampness, and unblocking collaterals.
Case 1 syndrome belongs to Re-Bi with heat predominating over dampness; thus, clearing heat and purging fire is primary, assisted by dispersing wind and dispelling dampness. Once heat subsides and pain decreases, continue with Juanbi Tang (Eliminate Bi Decoction) to enhance blood-invigorating and collateral-unblocking effects.
Case 2 occurred during a time of abundant dampness; the patient had latent heat internally and contracted dampness externally. Due to ineffective venting, damp-heat intertwined and descended, blocking meridians. Treatment focused on clearing heat, dispelling dampness, invigorating blood, opening obstruction, and unblocking collaterals, achieving efficacy through combined internal and external treatment.
Case 3, although Re-Bi, presented distinct symptoms: fever, night sweats, severe limb joint pain lasting two months. Sweating injured Yin further, leading to intensified heat; extreme heat scorched sinews, causing loss of nourishment to sinews and vessels, resulting in severe joint pain. Baihu Jia Guizhi Tang failed to resolve heat; wind-dispersing drugs exacerbated pain. This was due to extreme Yin-blood deficiency failing to moisten sinews. Using Duhuo Jisheng Tang again led to "wind borrowing fire's power, fire riding wind's momentum," worsening pain and heat. Switching to Danggui Liuhuang Tang corrected this; nourishing Yin, clearing heat, securing the exterior, and stopping sweating led to recovery. (25) Xuebi (Blood Bi, 血痹): Zhao XX, female, 34 years old. First visit: July 1975. Half a month prior, after washing over 30 items of clothes/bedding and sweating from exertion, felt heaviness, numbness, aversion to cold, and soreness in right elbow to shoulder upon lying down that night, with shoulder pain being most severe. Next day, difficulty raising right upper limb, limited movement, worse pain at night. Observation showed painful expression, pale lusterless complexion. Pulse deep, fine, and weak; tongue pale white and moist. Right arm lacked warmth. Syndrome differentiation: Cold-damp invasion impairing blood circulation, Yang qi obstruction causing Xuebi. Treatment method: Warm Yang and unblock Bi. Prescription: Huangqi Guizhi Wuwu Tang (Astragalus and Cinnamon Twig Five Substance Decoction) modified. Huangqi (Astragali Radix) 30g, Guizhi (Cinnamomi Ramulus) 9g, Baishao (Paeoniae Radix Alba) 9g, Shengjiang (Zingiberis Rhizoma Recens) 15g, Dazao (Jujubae Fructus) 10 pieces, Jianghuang (Curcumae Longae Rhizoma) 12g, Qianghuo (Notopterygii Rhizoma et Radix) 6g. After 5 doses, second visit: Heaviness and numbness in right arm significantly reduced, but aversion to cold and shoulder pain remained severe; pulse fine, tongue coating white and moist. Original formula added Zhi Fupian (Prepared Aconiti Lateralis Radix) 9g, instructed to take 5 doses. Third visit: Arm no longer numb, shoulder soreness present, lifting shoulder and arm freely, but still afraid of cold and feeling heavy; pulse and tongue unchanged. Original formula added Yiren (Coicis Semen) 15g, Can Sha (Bombyx Batryticatus) 12g to increase dampness-draining effect, instructed to take 5 doses. Fourth visit: Disease cured. (From *Dou Boqing's Medical Cases*) [Commentary]: Xuebi refers to "lying out exposed to wind, blood coagulates in the skin causing Bi" (*Suwen: Chapter on Generation of Five Viscera*), differing from Bi syndrome caused by wind-cold-damp. Xuebi presents muscle numbness without pain, whereas Bi syndrome presents both numbness and pain. In a constitutionally deficient person, exertion and sweating further deplete Yang Qi; wind pathogen invasion impairs blood circulation, causing muscle numbness. If wind pathogen is severe, pain may occur, hence described as "like Fengbi (Wind Bi)." This disease is detailed in *Jinkui Yaolue*. This case is typical; prescription Huangqi Guizhi Wuwu Tang added Qianghuo and Fuzi (Aconite) among other acrid-warm substances matched the syndrome and produced excellent results. Treatment methods varied slightly while respecting ancient principles.
(26) Wei Syndrome (Flaccidity Syndrome, 痿证) Appendix: Myasthenia Gravis
Case 1: Feng X, female. Post-warm disease, Yin fluids injured, deficient fire scorching Metal (Lung), Lung heat scorching leaves causing Wei Bi (Flaccidity), inability of both feet to bear weight, coughing with discomfort, reduced appetite, dry throat, soggy slippery rapid pulse, red tongue body, yellow coating. Illness persisted for months, roots deep. Tentatively prescribed to nourish Lung Yin, clear Yangming, treating lower disease from above, an ancient established method. NanShashen (Adenophorae Radix) 9g, Chuan Shihu (Dendrobii Caulis) 9g, Tianhuafen (Trichosanthis Radix) 9g, Sheng Gancao (Raw Glycyrrhizae Radix) 1.5g, Chuan Beimu (Fritillariae Cirrhosae Bulbus) 9g, Fei Zhimu (Anemarrhenae Rhizoma) 4.5g, Gualoupi (Trichosanthis Pericarpium) 9g, Tianguangxing (Prunus Armeniaca Seed) 9g, Luoshiteng (Trachelospermi Caulis) 9g, Huai Niuxi (Achyranthis Bidentatae Radix) 6g, Nen Sangzhi (Young Mori Ramulus) 9g, Dongguazi (Benincasae Semen) 9g, Huo Lugen (Reed Rhizome) 1 chi (remove nodes). Second visit: Previous prescription to nourish Lung Yin and clear Yangming taken for 10 doses; coughing and internal heat reduced, legs flaccid unable to bear weight. Wei means withering, like plants without rain/dew; to make plants lush, they need moisture; to prevent leg withering, rely on Lung fluids to distribute downward to Liver and Kidney. Liver gets blood so sinews relax; Kidney gets nourishment so bones strengthen. Abundant Yin-blood clears collateral heat. Treating Wei exclusively targets Yangming; clear Yangming heat, nourish Lung Yin because Yangming governs moistening Zongjin (Major Sinews) and facilitating joints. Da Maidong (Ophiopogonis Tuber) 6g, Bei Shashen (Glehniae Radix) 9g, Bao Fushen (Poria with Hostwood) 9g, Huai Shanyao (Dioscoreae Hypoglaucae Rhizoma) 9g, Xi Shengdi (Young Rehmanniae Radix) 12g, Fei Zhimu 4.5g, Chuan Beimu 6g, Tianhuafen 9g, Luoshiteng 6g, Huai Niuxi 6g, Nen Sangzhi 9g. Third visit: Heat in five viscera can cause Wei; texts mention five types of Wei, not just Lung heat scorching leaves. However, though five exist, essentially there are two: Heat Wei and Damp Wei. Like plants withering from lack of rain or being stifled by dampness, leg flaccidity is similar. Now pulse is soggy-rapid, tongue crimson; this is Heat Wei. Since repeatedly clearing Yangming and nourishing Lung Yin, although unable to walk, legs can lift themselves; medicine matches disease, stick to original method, add essence-nourishing and blood-enriching substances, plan for gradual efficacy. Bei Shashen 9g, Da Maidong 6g, Fushen 9g, Huai Shanyao 9g, Chuan Shihu 9g, Xiao Shengdi 9g, Fei Zhimu 4.5g, Huai Niuxi 6g, Luoshiteng 9g, Chongweizi (Leonuri Fructus) 9g, Nen Sangzhi 9g, Zhu Suijui (Porcine Spinal Cord) 2 strips (wine-washed, decocted), Huqian Wan (Tiger Crouching Pill) 9g, taken with light salt soup in morning. (From *Ding Ganren's Medical Cases*)
Case 2: Zhao, male, 31 years old, October. Long-standing damp-heat accumulation, Ying-Wei obstruction, Qi and Blood unable to moisten sinews, wasting in popliteal fossa, flaccid sinews and bones, lower limbs unable to flex/extend, soggy-fine pulse, thin white coating. Treatment proposed: Tonify Qi and Blood, relax sinews and unblock collaterals. Qing Zhi Huangqi (Qing-zhi processed Astragali Radix) 15g, Jiu Chao Danggui (Wine-fried Angelicae Sinensis Radix) 12g, Guizhi Jian (Cinnamon Twig Tip) 2.4g, Zhi Guang Dilong (Processed Pheretima) 9g, Chao Tianchong (Stemmacatris) 9g, Lao Gouteng (Old Uncariae Ramulus cum Uncis) 12g, Sigualuo (Luffae Retinervia) 15g, Du Honghua (Carthami Flos) 3g, Jiu Chuan Duan (Wine-fried Drynariae Rhizoma) 9g, Shenjin Cao (Lycopodii Herba) 12g, Qiannianjian (Cyathulae Root? Note: Likely Misnomer or specific local herb, usually associated with strengthening tendons/bones, here kept as name) 6g. Second visit: Classic says "Qi warms, Blood moistens." Both Qi and Blood deficient, unable to warm/moisten muscles/sinews, gradually becoming Wei. Pulse/syndrome same, stick to original intent with modifications. Qing Zhi Huangqi 15g, Jiu Chao Danggui 9g, Da Shudi (Large Prepared Rehmanniae Radix) 15g, Du Honghua 3g, Qing Zhi Guang Dilong 9g, Guizhi Jian 2.4g, Chao Chi Bai Shao (Fried Red and White Peony Roots) 6g each, Zexie (Alismatis Rhizoma) 9g, Fuling (Poria) 12g, Chao Huai Niuxi 9g, Chao Huangbai 4.5g. Third visit: Damp-heat soaking, Qi/Blood insufficient to nourish muscles/sinews, leg flaccidity, muscle wasting, slight improvement in flexion/extension, thin yellow coating, soggy-fine pulse. Again imitate Danxi's Modified Ermiao San method: Chao Huangbai 6g, Chao Cangzhu 4.5g, Jiu Chao Danggui 9g, Fangji 9g, Chuan Bibi (Dissabatis Rhizoma) 9g, Huai Niuxi 9g, Zhi Guiban (Processed Testudinis Carapax et Plastrum) 15g, Shudi 15g, Zhi Huangqi 15g, Zhi Gancao 4.5g, Fuling 12g. Fourth visit: After previous prescription, damp-heat gradually cleared/transformed, sinews/nerves nourished by Qi/Blood, lower limb weakness improved, able to bear weight and move, flexion/extension approaching normal. Further prescribe tonifying Qi/Blood and filling Liver/Kidney. Mi Chao Shang Lushen (Rice-fried Upper Party Ginseng) 9g, Zhi Huangqi 15g, Jiu Chao Danggui 9g, Shudi 24g, Huai Niuxi 9g, Chao Huangbai 4.5g, Jiu Chuan Xuduan (Wine-fried Dipsaci Radix) 9g, Chao Baishao 9g, Zhi Gancao 4.5g, Fangji 6g, Yan Shui Chao Duzhong (Salt-water fried Eucommiae Cortex) 15g, Jianbu Huqian Wan (Walking Tiger Crouching Pill) 12g (swallowed separately). (From *Ye Xichun's Medical Cases*) [Commentary]: Wei Syndrome refers to flaccidity of limb sinews/vessels, weakness of hands/feet. Generally divided into Lung heat scorching, Liver/Kidney deficiency, Damp-heat soaking types; onset relates to stomach/spleen fluid exhaustion, so Wei is mostly Heat and Deficiency.
Case 1 syndrome involves injured Yin fluids, deficient fire scorching Metal, Lung heat scorching leaves causing Wei Bi. Thus, nourishing Lung Yin, clearing Yangming, treating lower disease from above was used. After efficacy, essence-nourishing and blood-enriching substances were added, reflecting Zhang Jiabin's principle: "To goodtonify Yin, one must seek Yin within Yang, so Yin rises with Yang and the source does not dry up." Mr. Ding divides Wei into Heat Wei and Damp Wei, easier to grasp clinically.
Case 2 is caused by Qi/Blood insufficiency failing to nourish muscles/tendons. Ancient theory states treating Wei exclusively targets Yangming. Mr. Ye believes if disease originates in Middle Jiao, targeting Yangming is appropriate; if originating in Jueyin, Liver/Kidney should be filled. This case lies between Jueyin and Taiyin, so adding dampness-resolving and heat-clearing substances to Qi/Blood tonification constitutes another method for treating Wei.
Appendix: Myasthenia Gravis
Case 1: Fang XX, male, 59 years old. First visit: March 11, 1976. Patient developed right ptosis and diplopia gradually starting 1973 triggered by diarrhea/fatigue; Western diagnosis: Myasthenia Gravis Ocular Type, relieved by Chinese/Western meds. Oct 1975, post-cold/fever, left ptosis/diplopia appeared, chewing/swallowing difficulty, neck/scapular weakness. Dec 1975, two episodes of dyspnea; diagnosed Myasthenia Gravis Bulbar Type. Western meds until Jan 5, 1976 failed to control symptoms. Visited March 11, 1976. Symptoms largely same, overweight, slightly red face, ptosis, narrowed palpebral fissure, head tilted down, unable to stand upright normally, arms unable to raise. Tender tongue with teeth marks, slightly red, thin white coating, slightly yellow-greasy center, deep fine weak pulse. Syndrome differentiation: Spleen Qi failure, Liver Stagnation, Kidney Deficiency. Treatment method: Strengthen Spleen, tonify Qi, soothe Liver, nourish Kidney. Prescription: Huangqi 45g, Cang Baizhu (Atractylodes Macrocephala and Albida Rhizomes) 12g each, Chenpi (Citri Reticulatae Pericarpium) 9g, Dangshen (Codonopsis Radix) 15g, Chaihu (Bupleuri Radix) 12g, Shengma (Cimicifugae Rhizoma) 6g, Gancao 6g, Shengjiang 3g, Dazao 12g, Shudi 30g, Xianlingpi (Epimedii Folium) 15g, Maidong (Ophiopogonis Tuber) 12g, Wuweizi (Schisandrae Fructus) 9g. After 12 doses, subjective symptoms significantly reduced (Pyridostigmine dose reduced after 3 doses), ptosis basically recovered, eating without rest needed. After half year treatment, Western meds withdrawn completely, subjective symptoms disappeared. Changed to Buzhong Yiqi Tang combined with Yiwei Tang made into pills for regulation. April 14, 1977 follow-up: basically normal, persist half-day work, intermittent pill intake, basically cured. (Fang Yaozhong: Discussing Basic Spirit of Syndrome Differentiation and its Clinical Application Steps/Methods, *New Medicine Magazine* 9c14, 1977)
Case 2: XXX, female, 30+ years old, Autumn 1966. Ill for half a year, multiple hospitals diagnosed Myasthenia Gravis, treatment ineffective. First visit: Pale lusterless complexion, expressionless, eyelids drooping unable to open, shortness of breath, reluctance to speak, struggled to utter one sentence, low voice, unclear when asked directly, fatigue, difficult movement, needs support to move. Less than 2 liang per meal, took over an hour, eat-rest-eat-rest, chewing mantou/noodles felt like chewing hard food, couldn't finish two bites, jaw sore/weak, unable to continue chewing. Sometimes swallowing mantou/soup halfway required temporary rest to continue. Menstruation delayed, scanty pale color. Pulse weak, tongue pale thin coating. Syndrome: Spleen deficiency, Middle Qi insufficiency. Proposed method: Raise Yang, tonify Qi. Prescription: Sheng Huangqi 24g, Danggui Shen (Angelica Body) 9g, Zhi Gancao 9g, Tu Baizhu (Earth-processed Atractylodes Macrocephala) 12g, Chenpi 6g, Ganjiang (Zingiberis Rhizoma) 6g, Dangshen 15g, Shengma 6g, Chaihu 6g, decocted in water, 1 dose/day, 4 doses continuous. Second visit: After 4 doses, fatigue slightly reduced, other symptoms same, instructed to take 4 more doses. Third visit: After another 4 doses, except eyelids needing manual pushing to open, closing again after 2-3 mins, other symptoms significantly improved, instructed to take 4 more doses. Fourth visit: After 4 doses, eyes open/close freely, but long opening causes fatigue, other symptoms basically gone. Instructed to halve original formula, take several doses for consolidation. Fifth visit: After 6 days continuous, all symptoms lost. (Yang Zuochi *Clinical Records*) [Commentary]: Myasthenia Gravis is a Western medical term, a familial, poor-prognosis difficult disease. Its clinical manifestations belong to TCM "Spleen Deficiency" syndrome differentiation. Generalized muscle weakness also belongs to "Wei Syndrome".
Case 1 is Myasthenia Gravis Ocular Type. Syndrome: Spleen Qi deficiency, Liver Stagnation, Kidney Deficiency. Spleen governs muscles; Spleen deficiency causes muscle flaccidity/weakness; Kidney deficiency fails to warm Spleen Yang, causing posterior Heaven neglect. Thus, Buzhong Yiqi Tang as main formula, added Kidney-tonifying and Liver-soothing substances. Initially combined Chinese/Western meds, later pure Chinese medicine, achieved basic cure.
Case 2 condition heavier than previous, formula matched syndrome, efficacy fast. Although difficult, from these two cases' differentiation, using Chinese medicine alone or combined with Western medicine yielded such results, worthy of attention.
(27) Ben Tun Qi (Running Piglet Qi)
Case 1: Cui XX, male, 40 years old. First visit: April 20, 1971. Felt a mass around umbilicus, thrusting jumping pain. Acute attacks: vomiting, diarrhea, cold sweat. Disease started age 6-7, persistent. Now poor appetite, abdominal pain, aversion to cold, cold hands/feet, normal urination/defecation. White coating, deep slow pulse. Syndrome differentiation: Deep cold and chronic cold dwelling in Middle Jiao causing Ben Tun Qi. Treatment method: Greatly tonify Yang Qi, warm Middle and dispel cold. Prescription: Lizhong Wan combined with Fuzi Tang modified. Chao Baishao 10g, Jiao Baizhu 10g, Ganjiang 10g, Dongshen 9g, Pao Fuzi 10g, Fuling 10g, Zhi Gancao 5g. April 29 (Second visit): After 2 doses, appetite/urination/defecation good, hands/feet warm, no longer afraid of cold, but still umbilical/abdominal pain thrusting upward, non-tender. Pulse deep tight. Continue warming Liver, directing rebellion downward, warming Yang regulating Qi. Prescription: Fuling 10g, Banxia 10g, Chenpi 10g, Chao Baishao 12g, Zhi Gancao 5g, Chuanlianzi 10g, Lizhi 10g, Liangjiang 6g, Wuzhuyu 6g, Xiaohuixiang 10g, Rougui 6g, Niuxi 10g, Chenxiang 5g. May 1 (Third visit): After 2 doses, umbilical/abdominal pain/thrusting improved, abdomen comfortable, appetite increased. Pulse deep tight slower. All symptoms turning favorable. Continue original formula 4 doses to consolidate efficacy. (From *Selected Medical Experiences of Zhang Zilin*)
Case 2: Wu XX, male, 31 years old. Summer 1970. Pain around umbilicus, hard and tender to touch, paroxysmal, sensation of object attacking upward from below umbilicus during pain, attacks nearly fatal, stops after some time. Disease 3 years, unpredictable attacks. Sometimes wandering pain in upper/lower limb joints. Pulse deep wiry slippery, tongue coating white slippery. Presumed Cold-Damp Water Qi adhering to Liver/Kidney meridians, Bladder Qi transformation dysfunction, causing Cold Water Qi to rush upward. Treatment: Suppress rebellion, direct Qi downward, warm Middle, dispel cold. Guizhi 10g, Fuling 30g, Wuyu 10g, Chao Baishao 15g, Zhi Gancao 10g, Baizhu 10g, Chao Zhishi 10g, Chenpi 10g, Fa Banxia 10g, Yiyiren 25g, Shengjiang 3 slices, Dazao 5 pieces. Calmed after 3 doses of above prescription. Later due to poor appetite, added Chenpi, Shenqu, took again and cured. (Zhang Mengnong *Clinical Essentials*) [Commentary]: Ben Tun Qi refers to the symptom of feeling Qi rushing from Lower Abdomen to Chest/Diaphragm. Recorded in *Neijing*, dedicated chapter in *Jinkui Yaolue*. Later physicians merged it into "Accumulation/Mass" category.
Case 1 is Deep Cold/Chronic Cold dwelling in Middle Jiao, Liver/Kidney Qi rebelling upward striking Heart. Prescription: Lizhong Tang combined with Fuzi Tang modified. After medicine, Yang Qi gradually restored but upward thrusting unresolved. Continued with Fuling Guizhi Gancao Dazao Tang combined with Cheng Zhongling Ben Tun Wan modified; because Qi rebellion was too severe, added Niuxi and Chenxiang. Decades-old chronic disease surprisingly achieved good effect.