例三沈X，女，56岁，初诊日期：1965年7月18日。失眠经久不瘥，已逾五载。轰热上升，两目干涩，心悸不宁。脉虚弦，当以半夏秫米、黄连阿胶合温胆汤三方出入之。仙半夏6克(杵)北秫米12克<包)大生地12克杭白芍6克珍珠母30克(先煎)灵磁石24克(先煎)小川连1．5克藕粉炒阿胶9克朱茯苓12克炒竹茹6克小枳实3克橘皮4。5克柏子仁12克7月21日(二诊)，阳跷为病，胆失清宁，失眠经久不瘥。两目干涩，虚烦心悸，遇事惊慌，脉来虚弦。再以半夏秫米、黄连阿胶合温胆汤三方并治之。仙半夏6克(杵)北秫米12克(包)大生地12克杭白芍6克灵磁石24克(先煎)小川连1．5克藕粉炒阿胶9克朱茯苓12克炒竹茹6克小枳实3克橘皮4．5克泡远志4．5克炒枣仁12克(研)3剂。7月25日(三诊)；迭服半夏秫米、黄连阿胶合温胆汤三方之后，经久之失眠巳得安睡，心悸已宁，两目重涩，脉小弦，再循前治。仙半夏6克(杵)北秫米12克(包)大生地12克杭白芍6克珍珠母30克(先煎)灵磁石24克霜桑叶9克黑芝麻12克小川连1．5克藕粉炒阿胶9克炒竹茹6克小枳实3克橘皮4．5克泡远志4．5克炒枣仁12克(研)3剂。7月28日(四诊)：阳能入阴，得半夏秫米之交通阴阳，温胆之宁胆化痰，黄连阿胶之清心养血，故经久之失眠巳安然入睡，两目重涩巳瘥，脉小弦，再以前法治之。仙半夏6克(杵)北秫米12克(包)大生地12克杭白芍6克霜桑叶9克黑芝麻12克滁菊花9克拌炒女贞子9克小川连1，6克藕粉炒阿胶9克白茯苓12克炒竹茹6克小枳实3克橘皮4．5克泡远志4．5克炒枣仁12克(研)S剂。嗣后，仍以上述方意，再适当配苍龙齿，朱灯芯、柏子仁、合欢皮、血琥珀等，以加强养心安神作用，调治一月而收功。1975年3月随访，睡眠良好，十年来未复发。(《内科临证录》陈道隆医案)
例四XXX，男，40岁，初诊日期：1962年12月。失眠、多梦心悸，偏头痛，耳鸣，为时较久。常服用解痛片及巴比妥一类镇痛安眠药，但至今仍时时发作。胸腹胀闷，间或作痛，午后为甚。睡眠之中常有鼻阻塞，呼吸不利感。目瞀花，咽干。最感痛苦者，为大便不正常已久，坚实为多，溏泻较少，每日一、二次或二、三日一次。口臭，时有泛酸。小溲次频而滴沥不尽，时感疲倦软乏，要求冬令进补。经诊其舌苔微黄而厚，尤其于舌根部，脉细劲。辨证：胃有燥火，肺胃津伤。治法：降胃为主，甘凉濡润。方药：太子参60克麦冬90克北沙参90克杏仁(去皮尖)90克白芍60克金石斛90克玉竹60克茯神120克火麻仁60克焦六曲60克泽泻60克白扁豆60克知母60克乌玄参90克北秫米120克川贝母15克生甘草30克生地黄120克红枣90克阿胶60克龟板胶60克蜜500克，冰糖250克收膏。服上膏方后，大便十分舒畅，已能每日一次，头痛、失眠等症，均轻减若失。(何任：胃腑以通为用，《新中医》3：16，1979)
例五徐XX，壮年。患者操劳忧虑，心神交瘁，久之酿成失眠往往终宵不能合目。西药治疗可取眠数小时，然梦魂颠倒，过后益增疲乏。今岁入夏以来，失眠变本加厉，历经医治罔效，自8月14日起至今已达3夜还未入睡，头脑懵懵，衣不知热，食不知味，……面虽皓白而神采飞扬，谈笑自若，双目隐隐现红丝，脉象两关均弦长，舌边有青纹。方药：桃仁12克红花9克当归9克川芎9克淮牛膝9克参三七9克大生地9克柴胡6克京赤芍9克炒枳壳6克炙甘草3克一剂后即夜卧贴然，连服15剂，未见再发。后此二月，复来求治，言旬日来又苦失眠，但不若前次之甚。……两关仍弦，依然实证也，因有头痛目赤，胁胀等肝火上炎症象，改用龙胆泻肝汤。方药：黄芩9克龙胆草4．5克小生地9克泽泻9克车前子9克生甘草3克柴胡6克黑山栀9克当归6克木通9克上方共服5剂而夜眠全安，肝火上炎症象亦除。(孙幼立整理：范文虎先生失眠医案一则，《中医杂志》7：15，1963)[评按]不寐即一般所谓失眠，系指以经常不易入寐为主的证候。多因思虑劳倦，损伤心脾；或心肾不交、阴虚火旺，肝阳扰动，或胃不和等因素而发病。
例一证属水火不济，肝阳上亢，法当滋阴与安神并用，涵肝木而潜浮阳，标本同治。
例二乃阴虚肝旺而致不寐。治以滋柔和化合清滋抑化，药用精当，疗效尚佳。
例三素体营阴亏损，且年逾五十，太冲脉衰，天癸竭，肾阴不足，肝阳偏亢，肝气郁结，胆气不宁，诸证悉见，病情错综复杂，故用黄连阿胶汤清心养血，温胆汤补心气、宁胆怯，半夏秫米汤交通阴阳，引阳入阴。审证求因，合理使用复方是本
例取效之关键。
例四病程日久，兼症颇多，然又以大便不利为突出症状，患者口臭泛酸，苔黄而厚，脉细劲，为胃有燥火，肺胃津伤之证。经云“胃不和则卧不安”，故以降胃为主，弃用刚燥苦降下夺之晶，以甘凉濡润之剂，重在和胃，胃因和则卧而得安。
例五系因瘀血内阻而致失眠。范氏辨瘀血证重视望诊，凡见有双目红丝，舌边有青纹者，乃瘀血之征。患者爰因思虑郁结日久，气与血进而为瘀，瘀血不去则眠终不安，故连投血府逐瘀汤而获效，实乃对活血化瘀法应用之发挥。两月后复诊时证见肝火上炎，正如柯韵伯所说‘肝火旺，则上走空窍，不得睡”，改用龙胆泻肝汤而愈，是故同病异证而异治尔。
(十七)癫痫
例一张XX，男，40岁，门诊号：89155。初诊日期：1972年3月16日。(代诉)1966年间，患者因事思虑太过，久而成疾。初见精神抑郁，继则出现一侧头重痛，心中烦热，胸闷失眠，有时或喃喃乱语，或呆若木鸡。1971年昏倒一次，曾在当地中医治疗，服药未效。因症状逐渐加重，遂由家人陪同来诊。当时患者表情淡漠，神态呆滞，不欲言语，心中烦热，胸闷不适，头痛失眠，须服安眠药才能入睡，并见手颤，胁痛，牙痛，胃纳欠佳，大便秘结，小便频数。诊见脉数而沉实，舌苔霉酱色。辨证：痰火内郁，扰乱心神。治法：清心除烦，消痰化浊。方药：栀子豉汤加味；淡豆豉9克山栀子“克石菖蒲9克莱菔子9克桔梗9克橘皮6克紫金锭1．5克(冲服)3月20日(二诊)：服上药3剂后，患者自觉心胸舒畅，症状明显好转，两胁痛，头痛均减，大便已通，尚见手颤，失眠，下午仍觉烦热，脉数，苔霉酱色。前方已效，继服3齐JJ。3月23日(三诊)：患者上述各症俱已日减，病有好转，精神较开朗，已能自述病情，脉转弦数，舌苔灰黄，但痰火仍未全消，继用消痰清热法。方药：山栀子15克胆南星9克枳实9克川厚朴9克淡豆豉9克．莱菔子9克瓜萎仁15克石菖蒲9克甘草6克S剂。3月27日(四诊)：患者下午胸中仍烦热，下半夜已能入睡，头痛胁痛俱已消解，胃纳转好，脉舌如前。继用前法而加重清心除烦之品。方药：法半夏12克胆南星9克黄连3克竹茹9克枳实9克莱菔子9克川厚朴9克瓜蒌仁12克石菖蒲9克3剂。3月30日(五诊)：患者精神好，睡眠安宁，各症基本消失，惟觉时有头胀，继用前方加减，再服丸剂而愈。(刘赤选主治，何国良整理：癫证，《新中医》2：25，1974)
例二汤XX，男，38岁。初诊日期；1972年9月10日。因患血吸虫病，今春口服锑剂疑中毒，经中西医多次治疗。半年以来，多次发作，每次发作约两、三分钟，痉挛咬牙，口吐白沫。患者体格瘦长，面容忧郁，六脉沉细，舌苔白腻，舌尖红。胸胁苦满，腹肌拘挛悸动，头痛甚剧，心慌，睡眠不安，二便如常。曾经神经科检查诊为癫痫。服多种西药，虽能昏睡，但醒后头痛更甚，近一个月来连续发作四次，发病前头痛更剧，患者焦急惊怖。柴胡10克白芍10克黄芩5克制半夏5克党参8克桂枝6克甘草6克龙骨9克生牡蛎9克钩藤9克淮小麦30克大枣6枚生姜3片11月23日：服药14剂后，头痛大减，癫痫未发，略有心慌，夜梦纷扰，原方再服14剂。12月10日症状均消失，原方略事加减，随访四年，未闻复发。(叶橘泉主治，马永华整理c癫痫治验，《浙江中医学院学报》2：45，198D[评按]癫与痫均属神志失常病证。癫证沉默痴呆，语无伦次，静而多喜，痫证则为发作性神志异常(又名癫痫)，多为突然仆倒，昏不知人，口吐涎沫，两目上视，四肢抽搐，或口中如猪羊叫声，醒后如常人。癫证多因七情所伤，痰气郁结，痫证则因肾虚肝失濡养，脾虚痰涎内结，肝风挟痰随气上逆，蒙蔽清窍而突然发作。癫证经久，痰郁化火，可以出现狂证，故常癫狂并称。
例一为癫证。《灵枢·癫狂》云“癫疾始生，先不乐，头重痛，视举目赤，甚作极，已而烦心”。本案系因痰火内郁，扰乱心神而致。治以清心除烦、消痰化浊。方用栀子豉汤加胆星、莱菔子、陈皮、瓜蒌仁除痰化浊，：另用紫金锭送服，取其辟秽化浊，治法颇得要领。
例二为痫证，系因气郁痰阻而致。方用柴胡桂枝汤加味，实属经验用法。《伤寒论》柴胡桂枝汤原为太少兼病而设，功能和解太少之邪。叶氏指出：主要抓住胸胁苦满和腹肌拘挛紧张之证，前者系少阳主症之一，后者即所谓“心下支结”，亦即心下感觉有物支撑结聚之意。据报导日本人曾用柴胡桂枝汤治疗癫痫433例。125例治愈，79例显效。脑电图消失者64％。其辨证亦以上述二症为重点，列此以供临证参考。
(十八)中风
例一陈XX，男，52岁。躯体肥胖，常感眩晕。近忽口眼喁斜，舌强语涩，眼角流泪，口角流涎，手足麻木无力。脉弦滑，苔白腻。据了解因情绪抑郁而发。东垣有言；“凡人年逾四十气衰之际，或因忧思忿怒伤其气者多有此疾，若肥盛则间有之，亦是形盛气衰而如此”。今患者形体既盛，又值忧伤其气，肝郁生风，脾虚困湿，风痰内动，首中经络。东垣主气，丹溪主痰，互有因果。法当达郁调气，郁舒则风熄，气和则痰消。朱茯神10克制半夏10克瓜蒌仁(炒)10克姜竹茹10克双钩藤10克旋复花(布包)7克川郁金7克左秦艽?克胆南星5克明天麻7克远志肉(水炙)5克九节蒲3克炒枳实3克复诊：连服4剂，呕吐痰涎如丝，遂能语言，但不甚清晰，自诉头侧掣痛，面肌痉挛，手足麻木，极感不适。法当濡血熄风，“血行风自灭”。按上方去九节蒲、枳实，加当归身10克、稀签草10克。三诊：口眼牵正，语言清晰，但仍头晕，虚风夹湿，上扰清空，再拟涤痰定风法。按复诊方改远志肉3克，去瓜蒌仁、郁金，加枸杞10克、滁菊花7克。四诊：眩晕平定，舌能辨味，胃气渐复。三诊方去胆南星，加酸枣仁10克，服至数十剂而安。(《李聪甫医案》)
例二贾XX，男，67岁，门诊号；158230形盛体胖，头晕而昏，舌謇，语言不灵，口吐涎沫，四肢麻，行路略不稳，舌淡苔黄腻，两目微亦，切脉弦硬。老年水亏木旺之体，痰湿内蕴，肝阳引动浊痰闭窍所致。治以补中气、化痰湿，熄风镇静为主。半夏白术天麻汤加减。决明子15克茯神12克制半夏9克白术9克灵磁石9克钩藤9克刺蒺藜9克僵蚕9克明天麻6克石菖蒲3克复诊：服药8剂，头昏显瘥。但大便欲解时失禁，有呃逆等症，属中气不足，改用补中气和脾胃兼熄风化痰药。服九剂，四肢和，便下止。后加桃仁，红花及补肝肾活血方善后，共服药25剂病愈。(张丽珍整理：魏长春老医师治疗中风验案，《浙江中医杂志》4：27，1966)
【背景信息】
书名：近现代名医验案类编 章节：正文(15/53) 类别：医论
案例三 沈某，女性，56岁，初诊日期：1965年7月18日。失眠经久不愈，已超过五年。自觉热气上冲，双眼干涩，心悸不安。脉象虚弦，治疗应以半夏秫米汤、黄连阿胶汤合温胆汤三方为基础进行加减。仙半夏6克（捣碎），北秫米12克（包煎），大生地12克，杭白芍6克，珍珠母30克（先煎），灵磁石24克（先煎），小川连1.5克，藕粉炒阿胶9克，朱茯苓12克，炒竹茹6克，小枳实3克，橘皮4.5克，柏子仁12克。
7月21日（二诊）：阳跷脉为病，胆失清宁，导致失眠经久不愈。双眼干涩，虚烦心悸，遇事惊慌，脉象虚弦。继续以半夏秫米汤、黄连阿胶汤合温胆汤三方并治。仙半夏6克（捣碎），北秫米12克（包煎），大生地12克，杭白芍6克，灵磁石24克（先煎），小川连1.5克，藕粉炒阿胶9克，朱茯苓12克，炒竹茹6克，小枳实3克，橘皮4.5克，泡远志4.5克，炒枣仁12克（研碎）。共3剂。
7月25日（三诊）：连续服用半夏秫米汤、黄连阿胶汤合温胆汤三方后，长期的失眠已能安睡，心悸已平，双眼沉重干涩，脉象小弦，继续遵循前法治疗。仙半夏6克（捣碎），北秫米12克（包煎），大生地12克，杭白芍6克，珍珠母30克（先煎），灵磁石24克，霜桑叶9克，黑芝麻12克，小川连1.5克，藕粉炒阿胶9克，炒竹茹6克，小枳实3克，橘皮4.5克，泡远志4.5克，炒枣仁12克（研碎）。共3剂。
7月28日（四诊）：阳气能入于阴分，得益于半夏秫米汤的交通阴阳作用，温胆汤的宁胆化痰作用，以及黄连阿胶汤的清心养血作用，因此长期的失眠已安然入睡，双眼沉重干涩也已痊愈，脉象小弦，继续以前法治之。仙半夏6克（捣碎），北秫米12克（包煎），大生地12克，杭白芍6克，霜桑叶9克，黑芝麻12克，滁菊花9克，拌炒女贞子9克，小川连1.6克，藕粉炒阿胶9克，白茯苓12克，炒竹茹6克，小枳实3克，橘皮4.5克，泡远志4.5克，炒枣仁12克（研碎）。共5剂。此后，仍以上述方义为基础，适当配伍苍龙齿、朱灯芯、柏子仁、合欢皮、血琥珀等药物，以加强养心安神的作用，调理一个月而收效。1975年3月随访，睡眠良好，十年来未复发。（《内科临证录》陈道隆医案）
案例四 XXX，男性，40岁，初诊日期：1962年12月。失眠、多梦、心悸，偏头痛，耳鸣，病程较长。常服用解痛片及巴比妥类等镇痛安眠药，但至今仍时常发作。胸腹胀闷，间或作痛，午后加重。睡眠中常有鼻阻塞感，呼吸不畅。视物模糊，咽干。最感痛苦的是大便不正常已久，多为干结，溏泻较少，每日一至二次或二至三日一次。口臭，时有泛酸。小便次数频繁且滴沥不尽，时常感到疲倦乏力，要求冬季进补。诊察舌苔微黄而厚，尤其在舌根部，脉象细劲。辨证：胃有燥火，肺胃津液受损。治法：以降胃为主，甘凉濡润。方药：太子参60克，麦冬90克，北沙参90克，杏仁（去皮尖）90克，白芍60克，金石斛90克，玉竹60克，茯神120克，火麻仁60克，焦六曲60克，泽泻60克，白扁豆60克，知母60克，乌玄参90克，北秫米120克，川贝母15克，生甘草30克，生地黄120克，红枣90克，阿胶60克，龟板胶60克，蜂蜜500克，冰糖250克，熬制成膏。服用上述膏方后，大便十分通畅，已能每日一次，头痛、失眠等症状均减轻若无。（何任：胃腑以通为用，《新中医》3：16，1979）
案例五 徐某，壮年。患者操劳忧虑，心神交瘁，久而久之酿成失眠，往往整夜不能闭目。西药治疗可勉强睡眠数小时，然而梦境颠倒，过后更加疲乏。今年入夏以来，失眠变本加厉，历经医治无效，自8月14日起至今已达3夜还未入睡，头脑昏沉，穿衣不知冷热，进食不知滋味，……面色虽白但神采飞扬，谈笑自若，双目隐隐现红丝，脉象两关均弦长，舌边有青纹。方药：桃仁12克，红花9克，当归9克，川芎9克，淮牛膝9克，参三七9克，大生地9克，柴胡6克，京赤芍9克，炒枳壳6克，炙甘草3克。一剂后即夜间卧倒即安，连服15剂，未见再发。此后两个月，又来求治，言旬日来又苦于失眠，但不如前次严重。……两关脉仍弦，依然是实证，因有头痛目赤、胁胀等肝火上炎的症状，改用龙胆泻肝汤。方药：黄芩9克，龙胆草4.5克，小生地9克，泽泻9克，车前子9克，生甘草3克，柴胡6克，黑山栀9克，当归6克，木通9克。上方共服5剂而夜间睡眠完全安宁，肝火上炎的症状也消除了。（孙幼立整理：范文虎先生失眠医案一则，《中医杂志》7：15，1963）[评按]不寐即一般所谓失眠，系指以经常不易入寐为主的证候。多因思虑劳倦，损伤心脾；或心肾不交、阴虚火旺，肝阳扰动，或胃不和等因素而发病。
案例一 证属水火不济，肝阳上亢，法当滋阴与安神并用，涵肝木而潜浮阳，标本同治。
案例二 乃阴虚肝旺而致不寐。治以滋柔和化合清滋抑化，药用精当，疗效尚佳。
案例三 素体营阴亏损，且年逾五十，太冲脉衰，天癸竭，肾阴不足，肝阳偏亢，肝气郁结，胆气不宁，诸证悉见，病情错综复杂，故用黄连阿胶汤清心养血，温胆汤补心气、宁胆怯，半夏秫米汤交通阴阳，引阳入阴。审证求因，合理使用复方是本例取效之关键。
案例四 病程日久，兼症颇多，然又以大便不利为突出症状，患者口臭泛酸，苔黄而厚，脉细劲，为胃有燥火，肺胃津伤之证。经云“胃不和则卧不安”，故以降胃为主，弃用刚燥苦降下夺之品，以甘凉濡润之剂，重在和胃，胃因和则卧而得安。
案例五 系因瘀血内阻而致失眠。范氏辨瘀血证重视望诊，凡见有双目红丝，舌边有青纹者，乃瘀血之征。患者爰因思虑郁结日久，气与血进而为瘀，瘀血不去则眠终不安，故连投血府逐瘀汤而获效，实乃对活血化瘀法应用之发挥。两月后复诊时证见肝火上炎，正如柯韵伯所说‘肝火旺，则上走空窍，不得睡”，改用龙胆泻肝汤而愈，是故同病异证而异治尔。
(十七) 癫痫
案例一 张某，男性，40岁，门诊号：89155。初诊日期：1972年3月16日。（代诉）1966年间，患者因事思虑太过，久而成疾。初见精神抑郁，继则出现一侧头重痛，心中烦热，胸闷失眠，有时或喃喃乱语，或呆若木鸡。1971年昏倒一次，曾在当地中医治疗，服药未效。因症状逐渐加重，遂由家人陪同来诊。当时患者表情淡漠，神态呆滞，不欲言语，心中烦热，胸闷不适，头痛失眠，须服安眠药才能入睡，并见手颤，胁痛，牙痛，胃纳欠佳，大便秘结，小便频数。诊见脉数而沉实，舌苔霉酱色。辨证：痰火内郁，扰乱心神。治法：清心除烦，消痰化浊。方药：栀子豉汤加味；淡豆豉9克，山栀子9克，石菖蒲9克，莱菔子9克，桔梗9克，橘皮6克，紫金锭1.5克（冲服）。3月20日（二诊）：服上药3剂后，患者自觉心胸舒畅，症状明显好转，两胁痛，头痛均减，大便已通，尚见手颤，失眠，下午仍觉烦热，脉数，苔霉酱色。前方已效，继服3剂。3月23日（三诊）：患者上述各症俱已日渐减少，病有好转，精神较开朗，已能自述病情，脉转弦数，舌苔灰黄，但痰火仍未全消，继用消痰清热法。方药：山栀子15克，胆南星9克，枳实9克，川厚朴9克，淡豆豉9克，莱菔子9克，瓜蒌仁15克，石菖蒲9克，甘草6克，5剂。3月27日（四诊）：患者下午胸中仍烦热，下半夜已能入睡，头痛胁痛俱已消解，胃纳转好，脉舌如前。继用前法而加重清心除烦之品。方药：法半夏12克，胆南星9克，黄连3克，竹茹9克，枳实9克，莱菔子9克，川厚朴9克，瓜蒌仁12克，石菖蒲9克，3剂。3月30日（五诊）：患者精神好，睡眠安宁，各症基本消失，惟觉时有头胀，继用前方加减，再服丸剂而愈。（刘赤选主治，何国良整理：癫证，《新中医》2：25，1974）
案例二 汤某，男性，38岁。初诊日期：1972年9月10日。因患血吸虫病，今春口服锑剂疑似中毒，经中西医多次治疗。半年以来，多次发作，每次发作约两、三分钟，痉挛咬牙，口吐白沫。患者体格瘦长，面容忧郁，六脉沉细，舌苔白腻，舌尖红。胸胁苦满，腹肌拘挛悸动，头痛甚剧，心慌，睡眠不安，二便如常。曾经神经科检查诊为癫痫。服多种西药，虽能昏睡，但醒后头痛更甚，近一个月来连续发作四次，发病前头痛更剧，患者焦急惊怖。柴胡10克，白芍10克，黄芩5克，制半夏5克，党参8克，桂枝6克，甘草6克，龙骨9克，生牡蛎9克，钩藤9克，淮小麦30克，大枣6枚，生姜3片。11月23日：服药14剂后，头痛大减，癫痫未发，略有心慌，夜梦纷扰，原方再服14剂。12月10日症状均消失，原方略事加减，随访四年，未闻复发。（叶橘泉主治，马永华整理：癫痫治验，《浙江中医学院学报》2：45，1980）[评按]癫与痫均属神志失常病证。癫证沉默痴呆，语无伦次，静而多喜，痫证则为发作性神志异常（又名癫痫），多为突然仆倒，昏不知人，口吐涎沫，两目上视，四肢抽搐，或口中如猪羊叫声，醒后如常人。癫证多因七情所伤，痰气郁结，痫证则因肾虚肝失濡养，脾虚痰涎内结，肝风挟痰随气上逆，蒙蔽清窍而突然发作。癫证经久，痰郁化火，可以出现狂证，故常癫狂并称。
案例一 为癫证。《灵枢·癫狂》云“癫疾始生，先不乐，头重痛，视举目赤，甚作极，已而烦心”。本案系因痰火内郁，扰乱心神而致。治以清心除烦、消痰化浊。方用栀子豉汤加胆星、莱菔子、陈皮、瓜蒌仁除痰化浊，另用紫金锭送服，取其辟秽化浊，治法颇得要领。
案例二 为痫证，系因气郁痰阻而致。方用柴胡桂枝汤加味，实属经验用法。《伤寒论》柴胡桂枝汤原为太少兼病而设，功能和解太少之邪。叶氏指出：主要抓住胸胁苦满和腹肌拘挛紧张之证，前者系少阳主症之一，后者即所谓“心下支结”，亦即心下感觉有物支撑结聚之意。据报导日本人曾用柴胡桂枝汤治疗癫痫433例。125例治愈，79例显效。脑电图消失者64％。其辨证亦以上述二症为重点，列此以供临证参考。
(十八) 中风
案例一 陈某，男性，52岁。躯体肥胖，常感眩晕。近忽口眼歪斜，舌强语涩，眼角流泪，口角流涎，手足麻木无力。脉弦滑，苔白腻。据了解因情绪抑郁而发。东垣有言：“凡人年逾四十气衰之际，或因忧思忿怒伤其气者多有此疾，若肥盛则间有之，亦是形盛气衰而如此”。今患者形体既盛，又值忧伤其气，肝郁生风，脾虚困湿，风痰内动，首中经络。东垣主气，丹溪主痰，互有因果。法当达郁调气，郁舒则风熄，气和则痰消。朱茯神10克，制半夏10克，瓜蒌仁（炒）10克，姜竹茹10克，双钩藤10克，旋复花（布包）7克，川郁金7克，左秦艽?克，胆南星5克，明天麻7克，远志肉（水炙）5克，九节蒲3克，炒枳实3克。复诊：连服4剂，呕吐痰涎如丝，遂能语言，但不甚清晰，自诉头侧掣痛，面肌痉挛，手足麻木，极感不适。法当濡血熄风，“血行风自灭”。按上方去九节蒲、枳实，加当归身10克、稀签草10克。三诊：口眼牵正，语言清晰，但仍头晕，虚风夹湿，上扰清空，再拟涤痰定风法。按复诊方改远志肉3克，去瓜蒌仁、郁金，加枸杞10克、滁菊花7克。四诊：眩晕平定，舌能辨味，胃气渐复。三诊方去胆南星，加酸枣仁10克，服至数十剂而安。（《李聪甫医案》）
案例二 贾某，男性，67岁，门诊号：158230。形盛体胖，头晕而昏，舌謇，语言不灵，口吐涎沫，四肢麻，行路略不稳，舌淡苔黄腻，两目微眯，切脉弦硬。老年水亏木旺之体，痰湿内蕴，肝阳引动浊痰闭窍所致。治以补中气、化痰湿，熄风镇静为主。半夏白术天麻汤加减。决明子15克，茯神12克，制半夏9克，白术9克，灵磁石9克，钩藤9克，刺蒺藜9克，僵蚕9克，明天麻6克，石菖蒲3克。复诊：服药8剂，头昏显瘥。但大便欲解时失禁，有呃逆等症，属中气不足，改用补中气和脾胃兼熄风化痰药。服九剂，四肢和，便下止。后加桃仁，红花及补肝肾活血方善后，共服药25剂病愈。（张丽珍整理：魏长春老医师治疗中风验案，《浙江中医杂志》4：27，1966）
Background Information
Book: Compilation of Verified Cases by Famous Modern Doctors Chapter: Main Text (15/53) Category: Medical Discussion
Case 3 Shen X, Female, 56 years old, First visit date: July 18, 1965. Insomnia has persisted for over five years without improvement. Sensation of heat rushing upward, dry and gritty eyes, palpitations with restlessness. Pulse is deficient and wiry. Treatment should involve modifications of the combination of Banxia Shumi Tang (Pinellia and Millet Decoction), Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction), and Wendan Tang (Gallbladder-Warming Decoction).
Prescription: Xian Banxia (Pinelliae Rhizoma Preparatum) 6g (crushed), Bei Shumi (Panicum miliaceum) 12g (wrapped), Da Shengdi (Rehmanniae Radix) 12g, Hang Baishao (Paeoniae Radix Alba) 6g, Zhenzhumu (Margarita) 30g (decocted first), Ling Cishi (Magnetitum) 24g (decocted first), Xiao Chuanlian (Coptidis Rhizoma) 1.5g, Ou Fen Chao Ejiao (Asini Corii Colla stir-fried with lotus root starch) 9g, Zhu Fuling (Poria with Cochineal) 12g, Chao Zhuru (Bambusae Caulis in Taeniam stir-fried) 6g, Xiao Zhishi (Aurantii Fructus Immaturus) 3g, Jupi (Citri Reticulatae Pericarpium) 4.5g, Baiziren (Biota Semen) 12g.
July 21 (Second Visit): Disease of the Yang Qiao vessel, Gallbladder losing its clarity and tranquility, causing persistent insomnia. Dry and gritty eyes, empty irritability and palpitations, panic when encountering events, pulse is deficient and wiry. Continue treating with the combination of Banxia Shumi Tang, Huanglian Ejiao Tang, and Wendan Tang.
Prescription: Xian Banxia 6g (crushed), Bei Shumi 12g (wrapped), Da Shengdi 12g, Hang Baishao 6g, Ling Cishi 24g (decocted first), Xiao Chuanlian 1.5g, Ou Fen Chao Ejiao 9g, Zhu Fuling 12g, Chao Zhuru 6g, Xiao Zhishi 3g, Jupi 4.5g, Pao Yuanzhi (Polygalae Radix soaked) 4.5g, Chao Zaoren (Ziziphi Spinosae Semen stir-fried) 12g (ground). 3 doses.
July 25 (Third Visit): After continuously taking the combination of Banxia Shumi Tang, Huanglian Ejiao Tang, and Wendan Tang, long-standing insomnia has resolved into peaceful sleep, palpitations have subsided, eyes feel heavy and dry, pulse is small and wiry. Continue following the previous treatment method.
Prescription: Xian Banxia 6g (crushed), Bei Shumi 12g (wrapped), Da Shengdi 12g, Hang Baishao 6g, Zhenzhumu 30g (decocted first), Ling Cishi 24g, Shuang Sangye (Mori Folium frosted) 9g, Hei Zhima (Sesami Fructus niger) 12g, Xiao Chuanlian 1.5g, Ou Fen Chao Ejiao 9g, Chao Zhuru 6g, Xiao Zhishi 3g, Jupi 4.5g, Pao Yuanzhi 4.5g, Chao Zaoren 12g (ground). 3 doses.
July 28 (Fourth Visit): Yang energy can enter Yin, benefiting from the interaction of Yin and Yang by Banxia Shumi Tang, calming the Gallbladder and resolving phlegm by Wendan Tang, and clearing the Heart and nourishing blood by Huanglian Ejiao Tang. Thus, long-standing insomnia has been peacefully resolved, and the heaviness and dryness of the eyes have healed. Pulse is small and wiry. Continue with the previous method.
Prescription: Xian Banxia 6g (crushed), Bei Shumi 12g (wrapped), Da Shengdi 12g, Hang Baishao 6g, Shuang Sangye 9g, Hei Zhima 12g, Chu Juhua (Chrysanthemi Flos) 9g, Ban Chao Nvzhenzi (Ligustri Lucidi Fructus stir-fried mixed) 9g, Xiao Chuanlian 1.6g, Ou Fen Chao Ejiao 9g, Bai Fuling (Poria) 12g, Chao Zhuru 6g, Xiao Zhishi 3g, Jupi 4.5g, Pao Yuanzhi 4.5g, Chao Zaoren 12g (ground). 5 doses. Subsequently, still based on the above prescription logic, appropriately combined with Cang Longchi (Draconis Os), Zhu Dengxin (Typhae Pollen cinnabarized), Baiziren, Hehuanpi (Albiziae Cortex), and Xue Hupo (Succinum), to strengthen the effects of nourishing the Heart and calming the Spirit. After one month of regulation, the treatment was successful. Follow-up in March 1975 showed good sleep, with no recurrence in ten years. (From "Internal Medicine Clinical Records", Case of Chen Daolong)
Case 4 XXX, Male, 40 years old, First visit date: December 1962. Insomnia, excessive dreaming, palpitations, migraine, tinnitus, lasting for a relatively long time. Often takes analgesics and barbiturate-type sedative-hypnotics, but symptoms still occur frequently. Chest and abdominal distension and stuffiness, occasional pain, worse in the afternoon. During sleep, often feels nasal obstruction and difficulty breathing. Blurred vision, dry throat. The most distressing symptom is chronic abnormal bowel movements, mostly hard stools, less diarrhea, once or twice daily or once every two to three days. Bad breath, occasional acid regurgitation. Frequent urination with dribbling, feeling tired and weak, requesting winter tonic therapy. Tongue coating is slightly yellow and thick, especially at the root; pulse is fine and firm. Syndrome differentiation: Dry fire in the Stomach, injury to Lung and Stomach fluids. Treatment principle: Primarily descending Stomach Qi, using sweet-cool moistening methods. Prescription: Taizishen (Codonopsis Radix) 60g, Maidong (Ophiopogonis Radix) 90g, Bei Shashen (Glehniae Radix) 90g, Xingren (Armeniacae Semen Amarum, peeled and tip removed) 90g, Baishao 60g, Jin Shihu (Dendrobii Caulis) 90g, Yuzhu (Polygonati Odorati Rhizoma) 60g, Fushen (Poria with Hostwood) 120g, Huomaren (Cannabis Fructus) 60g, Jiao Liuqu (Massa Medicata Fermentata carbonized) 60g, Zexie (Alismatis Rhizoma) 60g, Bai Biandou (Dolichoris Semen) 60g, Zhimu (Anemarrhenae Rhizoma) 60g, Wu Xuanshen (Scrophulariae Radix) 90g, Bei Shumi 120g, Chuan Beimu (Fritillariae Cirrhosae Bulbus) 15g, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 30g, Sheng Dihuang (Rehmanniae Radix Preparata) 120g, Hongzao (Jujubae Fructus) 90g, Ejiao 60g, Guibanjiao (Testudinis Carapacis et Plastratis Colla) 60g, Honey 500g, Rock sugar 250g, prepared as an electuary. After taking this electuary, bowel movements became very smooth, occurring once daily, and symptoms such as headache and insomnia were significantly reduced. (He Ren: The Stomach Fu Organ Functions through Unblocking, "New Chinese Medicine" 3:16, 1979)
Case 5 Xu X, Adult male. The patient suffered from overwork and worry, exhausting both Heart and Spirit, leading to insomnia where he could not close his eyes all night. Western medicine allowed for a few hours of sleep, but dreams were chaotic, followed by increased fatigue. Since entering summer this year, insomnia worsened significantly. Despite various treatments, it remained ineffective. From August 14 until now, he had not slept for three nights. His head felt muddled, he did not feel hot or cold despite clothing, and food had no taste... Although his face was pale white, he appeared energetic, talking and laughing naturally, with faint red threads visible in his eyes. Both Guan positions of the pulse were wiry and long; there were blue-green markings on the sides of the tongue. Prescription: Tao Ren (Persicae Semen) 12g, Hong Hua (Carthami Flos) 9g, Danggui (Angelicae Sinensis Radix) 9g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 9g, Huai Niuxi (Achyranthis Bidentatae Radix) 9g, Shen Sanqi (Notoginseng Radix et Rhizoma) 9g, Da Shengdi 9g, Chaihu (Bupleuri Radix) 6g, Jing Chishao (Paeoniae Radix Rubra) 9g, Chao Zhike (Aurantii Fructus Immaturus stir-fried) 6g, Zhi Gancao (Glycyrrhizae Radix et Rhizoma honey-fried) 3g. After one dose, he slept peacefully at night. After taking 15 doses consecutively, there was no recurrence. Two months later, he returned seeking treatment, stating that he had suffered from insomnia for ten days again, but not as severely as before... The Guan pulses were still wiry, indicating an excess syndrome. Due to symptoms of Liver Fire flaring upward such as headache, red eyes, and hypochondriac distension, Longdan Xiegan Tang (Gentiana Decoction to Drain the Liver) was used instead. Prescription: Huangqin (Scutellariae Radix) 9g, Longdancao (Gentianae Scabrae Radix et Rhizoma) 4.5g, Xiao Shengdi 9g, Zexie 9g, Cheqianzi (Plantaginis Semen) 9g, Sheng Gancao 3g, Chaihu 6g, Hei Shanzhi (Gardeniae Fructus charred) 9g, Danggui 6g, Mutong (Akebiae Caulis) 9g. After taking these prescriptions for a total of 5 doses, nighttime sleep was completely peaceful, and symptoms of Liver Fire flaring upward were eliminated. (Organized by Sun Youli: A Case of Insomnia by Mr. Fan Wenhu, "Chinese Journal of Traditional Medical Science and Technology" 7:15, 1963) [Commentary]: Bu Mei refers to what is generally called insomnia, a syndrome characterized primarily by frequent difficulty falling asleep. It is often caused by overthinking and labor damaging the Heart and Spleen; or non-interaction between Heart and Kidney, Yin deficiency with Fire hyperactivity, Liver Yang disturbance, or disharmony of the Stomach.
Case 1: The syndrome belongs to failure of Water and Fire to interact, with Hyperactive Liver Yang. The method should combine nourishing Yin and calming the Spirit, subduing Liver Wood and anchoring floating Yang, treating both root and branch simultaneously.
Case 2: This is Bu Mei caused by Yin deficiency and Liver hyperactivity. Treatment employed harmonizing nourishment and clearing/nourishing to suppress transformation. The medication was precise, and the efficacy was good.
Case 3: The constitution had always lacked Ying (Nutritive) Yin, and being over fifty, the Taichong vessel declined, Tian Gui exhausted, Kidney Yin insufficient, Liver Yang partially hyperactive, Liver Qi stagnated, Gallbladder Qi unsettled. All symptoms were present, and the condition was complex. Therefore, Huanglian Ejiao Tang was used to clear the Heart and nourish blood, Wendan Tang to tonify Heart Qi and calm Gallbladder fear, and Banxia Shumi Tang to facilitate communication between Yin and Yang, guiding Yang into Yin. Examining the syndrome to seek the cause and reasonably using compound formulas was the key to success in this case.
Case 4: The disease course was long with many accompanying symptoms, but irregular bowel movements were the prominent symptom. The patient had bad breath, acid regurgitation, yellow and thick coating, and a fine, firm pulse, indicating Dry Fire in the Stomach and injury to Lung and Stomach fluids. The Classics state, "If the Stomach is not harmonious, sleep will not be tranquil." Therefore, the treatment focused on descending Stomach Qi, abandoning harsh, drying, bitter, descending, and purging agents, using sweet-cool moistening agents instead, focusing on harmonizing the Stomach. When the Stomach is harmonious, sleep becomes tranquil.
Case 5: This was insomnia caused by internal obstruction of Blood Stasis. Fan emphasized inspection in diagnosing Blood Stasis; seeing red threads in the eyes and blue-green markings on the tongue sides are signs of Blood Stasis. Because the patient had suffered from prolonged worry and depression, Qi and Blood transformed into Stasis. If Stasis is not removed, sleep cannot be tranquil. Thus, continuous administration of Xuefu Zhuyu Tang (Drive Out Stasis in the Mansion of Blood Decoction) achieved effect, representing an expansion in the application of the method of invigorating Blood and resolving Stasis. At the follow-up two months later, the syndrome showed Liver Fire flaring upward. As Ke Yunbo said, "When Liver Fire is hyperactive, it moves upward to the orifices, preventing sleep." Using Longdan Xiegan Tang cured him. Thus, the same disease with different syndromes requires different treatments.
(XVII) Epilepsy
Case 1 Zhang X, Male, 40 years old, Outpatient No.: 89155. First visit date: March 16, 1972. (Reported by others) In 1966, due to excessive worrying about matters, the illness developed over time. Initially presenting with mental depression, subsequently appearing as unilateral heavy head pain, inner heat and irritability, chest tightness, and insomnia. Sometimes muttering incoherently or staring blankly like a wooden chicken. Fainted once in 1971, treated locally with TCM, but medication was ineffective. Due to gradually worsening symptoms, accompanied by family to consult. At that time, the patient's expression was indifferent, demeanor dull, unwilling to speak, inner heat and irritability, chest tightness and discomfort, headache and insomnia, requiring sedatives to sleep. Also observed hand tremors, hypochondriac pain, toothache, poor appetite, constipation, and frequent urination. Pulse was rapid and deep-solid; tongue coating was moldy-soy sauce colored. Syndrome differentiation: Internal depression of Phlegm-Fire disturbing the Heart Spirit. Treatment principle: Clear the Heart and relieve irritability, eliminate Phlegm and transform turbidity. Prescription: Zhizi Chi Tang (Gardeniae and Fermented Soybean Decoction) modified; Dan Douchi (Sojae Semen Preparatum) 9g, Shan Zhizi (Gardeniae Fructus) 9g, Shichangpu (Acori Tatarinowii Rhizoma) 9g, Laifuzi (Raphani Semen) 9g, Jiegeng (Platycodonis Radix) 9g, Jupi 6g, Zijin Ding (Purple Gold Pill) 1.5g (taken with decoction). March 20 (Second Visit): After taking 3 doses of the above medicine, the patient felt comfortable in the chest and heart, symptoms improved significantly, bilateral hypochondriac pain and headache decreased, bowels opened. Still observed hand tremors, insomnia, and feeling of irritability in the afternoon. Pulse rapid, coating moldy-soy sauce colored. Previous prescription effective, continue taking 3 doses. March 23 (Third Visit): All aforementioned symptoms gradually decreased, condition improved, spirit more open, able to describe condition himself. Pulse turned wiry-rapid, tongue coating gray-yellow, but Phlegm-Fire not yet fully eliminated. Continue eliminating Phlegm and clearing Heat. Prescription: Shan Zhizi 15g, Dantanxing (Arisaema cum Bile) 9g, Zhishi 9g, Chuan Houpo (Magnoliae Officinalis Cortex) 9g, Dan Douchi 9g, Laifuzi 9g, Gualouren (Trichosanthis Semen) 15g, Shichangpu 9g, Gancao 6g, 5 doses. March 27 (Fourth Visit): Patient still felt irritability in the chest in the afternoon, able to fall asleep in the second half of the night, headache and hypochondriac pain resolved, appetite improved, pulse and tongue as before. Continue previous method while increasing agents for clearing Heart and relieving irritability. Prescription: Fa Banxia (Pinelliae Rhizoma preparatum) 12g, Dantanxing 9g, Huanglian (Coptidis Rhizoma) 3g, Zhuru 9g, Zhishi 9g, Laifuzi 9g, Chuan Houpo 9g, Gualouren 12g, Shichangpu 9g, 3 doses. March 30 (Fifth Visit): Patient's spirit good, sleep peaceful, various symptoms basically disappeared, only occasionally feeling head distension. Continue modifying previous prescription, take pills to cure. (Mainly treated by Liu Chixuan, organized by He Guoliang: Dian Syndrome, "New Chinese Medicine" 2:25, 1974)
Case 2 Tang X, Male, 38 years old. First visit date: September 10, 1972. Due to schistosomiasis, oral antimony agents suspected of poisoning in spring this year, treated multiple times by both Western and Chinese medicine. For half a year, multiple episodes occurred, each lasting about two to three minutes, spasms, teeth grinding, foaming at the mouth. Patient is thin and tall, melancholic appearance, six pulses deep and fine, tongue coating white and greasy, tongue tip red. Chest and hypochondrium fullness and distress, abdominal muscle spasm and palpitation, severe headache, palpitations, restless sleep, normal urination and defecation. Previously diagnosed with epilepsy by neurology department. Taking various Western medicines, although inducing coma/sleep, headache was worse upon waking. In the past month, four consecutive episodes occurred, headache more severe before onset, patient anxious and terrified. Chaihu (Bupleuri Radix) 10g, Baishao 10g, Huangqin 5g, Zhi Banxia (Pinelliae Rhizoma preparatum) 5g, Dangshen (Codonopsis Radix) 8g, Guizhi (Cinnamomi Ramulus) 6g, Gancao 6g, Longgu (Fossilia Ossis Mastodi) 9g, Sheng Muli (Concha Ostreae) 9g, Gouteng (Uncariae Ramulus cum Uncis) 9g, Huaixiaomai (Tritici Fructus) 30g, Dazao (Jujubae Fructus) 6 pieces, Shengjiang (Zingiberis Rhizoma Recens) 3 slices. November 23: After taking 14 doses, headache greatly reduced, epilepsy did not recur, slight palpitations, disturbed dreams at night. Original prescription taken for another 14 doses. December 10: Symptoms disappeared, original prescription slightly modified, followed up for four years, no recurrence heard. (Mainly treated by Ye Juquan, organized by Ma Yonghua: Successful Treatment of Epilepsy, "Journal of Zhejiang College of Traditional Chinese Medicine" 2:45, 1980) [Commentary]: Dian and Xian both belong to disorders of consciousness. Dian syndrome involves silence, dementia, incoherent speech, quietness with much smiling. Xian syndrome is episodic abnormal consciousness (also called epilepsy), often sudden collapse, unconsciousness, foaming at the mouth, eyes rolling up, limb convulsions, or sounds like pigs/sheep, returning to normal after waking. Dian syndrome is often caused by emotional injury and Phlegm-Qi stagnation. Xian syndrome is due to Kidney deficiency and Liver malnourishment, Spleen deficiency with internal accumulation of Phlegm-Saliva, Liver Wind carrying Phlegm rising with Qi, clouding the clear orifices causing sudden attack. Long-standing Dian syndrome, Phlegm stagnation transforms into Fire, potentially manifesting as Kuang (Mania) syndrome, hence Dian and Kuang are often mentioned together.
Case 1 is Dian syndrome. "Ling Shu · Dian Kuang" states, "When Dian disease begins, one first feels unhappy, head heavy and painful, eyes red when looking up, extreme exhaustion, then inner irritability." This case was caused by internal depression of Phlegm-Fire disturbing the Heart Spirit. Treatment cleared the Heart and relieved irritability, eliminated Phlegm and transformed turbidity. Prescription used Zhizi Chi Tang added with Dantanxing, Laifuzi, Chenpi, Gualouren to eliminate Phlegm and transform turbidity; additionally, Zijin Ding was taken with the decoction for its ability to dispel filth and transform turbidity. The treatment method grasped the essentials well.
Case 2 is Xian syndrome, caused by Qi stagnation and Phlegm obstruction. Prescription used Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) modified, which is indeed an empirical usage. The original Chaihu Guizhi Tang in "Shanghan Lun" was designed for concurrent Taiyang and Shaoyang diseases, functioning to harmonize pathogens in both layers. Ye pointed out: mainly grasp the symptoms of chest/hypochondriac fullness/distress and abdominal muscle spasm/tension. The former is one of the main symptoms of Shaoyang; the latter is the so-called "sub-accumulation below the heart," meaning a sensation of support and accumulation below the heart. Reports indicate Japanese doctors used Chaihu Guizhi Tang to treat 433 cases of epilepsy. 125 cases cured, 79 cases markedly effective. EEG normalization rate 64%. Their syndrome differentiation also focused on the above two symptoms. Listed here for clinical reference.
(XVIII) Stroke
Case 1 Chen X, Male, 52 years old. Obese body, often feels dizzy. Suddenly developed facial deviation, stiff tongue and slurred speech, tearing from eye corners, drooling from mouth corners, numbness and weakness in hands and feet. Pulse wiry and slippery, coating white and greasy. Understood to be triggered by emotional depression. Dongyuan stated: "Anyone over forty whose Qi declines, if injured by worry, thought, anger, or rage, often suffers this disease. If obese, it occurs occasionally, also due to robust form but declining Qi." Now the patient has robust form, and Qi was injured by sorrow/worry. Liver stagnation generates Wind, Spleen deficiency traps Dampness, Wind-Phlegm moves internally, first affecting the collaterals. Dongyuan emphasizes Qi, Danxi emphasizes Phlegm, they have mutual causality. Method should resolve stagnation and regulate Qi; when stagnation relaxes, Wind extinguishes; when Qi harmonizes, Phlegm dissipates. Zhu Fushen (Poria with Hostwood) 10g, Zhi Banxia 10g, Gualouren (stir-fried) 10g, Jiang Zhuru (Bambusae Caulis in Taeniam with Ginger) 10g, Shuang Gouteng (Uncariae Ramulus cum Uncis) 10g, Xuanfuhua (Inulae Flos wrapped in cloth) 7g, Chuan Yujin (Curcumae Radix) 7g, Zuo Qinjiao (Gentianae Macrophyllae Radix)?g, Dantanxing 5g, Ming Tianma (Gastrodiae Rhizoma) 7g, Yuanzhi Rou (Polygalae Radix water-fried) 5g, Jiuji Pu (Acori Tatarinowii Rhizoma nine-steamed) 3g, Chao Zhishi 3g. Follow-up: After taking 4 doses consecutively, vomited phlegm-saliva like silk, then able to speak, but not very clearly. Reported pulling pain on side of head, facial muscle spasms, numbness in hands and feet, extremely uncomfortable. Method should moisten Blood and extinguish Wind, "When Blood flows, Wind self-extinguishes." According to previous prescription, remove Jiuji Pu, Zhishi, add Danggui Shen (Angelicae Sinensis Radix root part) 10g, Xixiancao (Siegesbeckiae Herba) 10g. Third visit: Facial deviation corrected, speech clear, but still dizzy. Deficient Wind carrying Dampness disturbs the clear orifices upwards. Again propose method of eliminating Phlegm and stabilizing Wind. Modify third visit prescription: change Yuanzhi Rou to 3g, remove Gualouren, Yujin, add Gouqi (Lycii Fructus) 10g, Chu Juhua 7g. Fourth visit: Dizziness stabilized, tongue can distinguish tastes, Stomach Qi gradually recovered. Remove Dantanxing from third visit prescription, add Suanzaoren (Ziziphi Spinosae Semen) 10g, took dozens of doses to stabilize. (From "Li Congfu Medical Cases")
Case 2 Jia X, Male, 67 years old, Outpatient No.: 158230. Robust and fat, dizzy and confused, stiff tongue, inarticulate speech, foaming at mouth, limb numbness, slightly unsteady walking, tongue pale with yellow-greasy coating, eyes slightly squinted, pulse wiry and hard. Elderly constitution with Water deficiency and Wood hyperactivity, internal accumulation of Phlegm-Dampness, Liver Yang stirring turbid Phlegm to block orifices. Treatment primarily tonifies Middle Qi, eliminates Phlegm-Dampness, extinguishes Wind and calms agitation. Modified Banxia Baizhu Tianma Tang (Pinellia, Atractylodes, and Gastrodia Decoction). Jumingzi (Cassiae Semen) 15g, Fushen 12g, Zhi Banxia 9g, Baizhu (Atractylodis Macrocephalae Rhizoma) 9g, Ling Cishi 9g, Gouteng 9g, Cijili (Tribuli Fructus) 9g, Jiangcan (Bombyx Batryticatus) 9g, Ming Tianma 6g, Shichangpu 3g. Follow-up: After taking 8 doses, dizziness significantly improved. However, fecal incontinence when attempting to defecate, hiccups etc., belonging to Middle Qi deficiency. Changed to tonifying Middle Qi, harmonizing Spleen and Stomach, and simultaneously extinguishing Wind and transforming Phlegm medicine. Took 9 doses, limbs harmonized, defecation stopped. Later added Tao Ren (Persicae Semen), Hong Hua, and formula tonifying Liver and Kidney, invigorating Blood, to conclude treatment. Total 25 doses, disease cured. (Organized by Zhang Lizhen: Old Physician Wei Changchun's Verified Case of Treating Stroke, "Zhejiang Journal of Traditional Chinese Medicine" 4:27, 1966)