例九原案题为“实中阳厥”，其高明处在于摒除假虚，而从其真实。若真假虚实不辨，则动手便错，而犯“虚虚实实”之过。若实以虚治，则未有不留偏枯废痿之证者，此乃医事之过，不可忽略。(十九)偏风高X，女，45岁，已婚。初诊日期：1970年5月13日。左上半身感觉减退、麻木、无汗五年多。自1965年春，先发现左手感觉减退、麻木，并相继发现左侧头面部、胸背部及上肢不出汗，局部发凉，肢体麻木，感觉减退，逐渐加重，常不自觉被烫伤。左手握力差，不能持重物。经某医院神经科检查，左侧头面部、上肢及左侧躯干3～4胸椎以上平面，痛、温觉减退，皮肤较健侧明显干燥。主动运动及生理反射，均无特殊改变。诊断为脊髓空洞症、神经根炎。多年来常有腹泻，每天大便两三次，较稀，便前有时腹痛，腹泻常与情绪改变有关，未治疗。患者发育营养一般，面黄，精神不振，舌质淡红，舌苔薄白，脉沉细而弱。辨证：脾肾不足，气血两虚，风寒内袭，阻闭经络。治法；温肾健脾，补气养血，温经通阳。方药：山药30克熟地15克麻黄4．5克炮姜9克鹿角胶(烊化，也可用阿胶代之)12克桂枝9克补骨脂12克白术(土炒)15克陈曲(炒)9克醋香附12克当归12克熟附子9克山茱萸12克木香9克生黄芪12克骨碎补12克鸡血藤12克水煎两遍，兑在一起，早晚各1次，温服。5月26日(二诊)：服药六剂，感觉舒适，食欲好转，食量增加，余证同前。舌苔、脉象同前。原方去木香、黄芪继服。6月3日(三诊)；药后病情明显好转，食量增加，大便已转正常，左上半身麻木感减轻，舌苔薄白，脉沉细，较前有力。仍以原方加减继服。方药：山药30克熟地15克麻黄4．5克炮姜9克鹿角胶(烊化)15克桂枝9克补骨脂12克陈曲(炒)9克白术(土炒)15克醋香附12克当归12克熟附子12克淫羊藿12克枸杞子15克生黄芪15克生菟丝子24克骨碎补15克鸡血藤15克，1977年11月30日随访：先后间断服药半年多，左上肢麻木感逐渐减轻，患部痛、温觉较以前逐渐灵敏，左手握力大增，与健侧无明显差别，出汗如常，左上肢功能已恢复正常。现已五年，未再服药治疗。(《刘惠民医案》)[评按]偏风首见于《诸病源候论·风病诸候》云：“偏风者，风邪偏客于身一边也。人体有偏虚者，风邪乘虚而伤之……或不知痛痒”、“风不仁者，由荣气虚，卫气实，风寒入于肌肉，使血气行不宣流，其状搔之皮肤如隔衣是也。”述证与本案颇有相似之处。偏风与中风半身不遂有别，此案肢体活动尚可，而痛温不觉，且患肢体麻木发凉、无汗。西医诊断脊髓空洞症。根据中医辨证属于脾肾不足、气血两虚，风寒内袭，阻闭经络。故以温肾健脾、益气养血，温经通络之法。症虽奇特而疗效尚称满意，值得重视。
(二十)眩晕
例一潘XX，女，初诊日期：1954年2月。体本虚弱，多年来襟怀不适，因遭事故，致肝木上升而头目眩晕，肝木侮土而呕吐不休。右脉弦劲，饮食不思，二便不利，舌绛苔薄，情势颇急，可能发痉。宜凉肝安胃，服观后效再商。桑叶9克杭菊花9克粉丹皮9克黑栀子9克大白芍9克细生地24克姜川连2．1克法夏6克姜竹茹12克黄郁金9克羚羊镑1．2克另煎兑苦丁茶9克服上方左脉见平，舌绛见淡，苔薄见宣，眩晕立止，唯呕吐如前，纳食不香，二便未调。依前法去羚羊加安胃品以止呕吐。桑叶9克菊花9克丹皮9克栀子炭9克夏枯草9克苦丁茶9克细生地18克大白芍9克法夏6克姜竹茹12克干苇根15克左金丸4．5克(分二次送服)。上方服两剂，呕吐为止，舌苔已消，胃纳已香，二便正常，再以小剂泄肝安胃善后。(张菊人：《菊人医话》)
例二魏XX，男，60岁。患头晕目眩，兼有耳鸣，鼻亦发塞，嗅觉不佳。病有数载，屡治不效，颇以为苦。切其脉弦，视其舌则胖大无伦，苔则水滑而白。辨证：此证心下有饮，上冒清阳，是以头冒目眩，其耳鸣、鼻塞，则为浊阴踞上，清窍不利之所致。治法：渗利水饮之邪。方药；泽泻24克白术10克此方服1剂而有汗，不改方，共服五剂，则头晕、目眩、耳鸣、鼻塞等证愈其大半，转方用五苓散温阳利水而收全功。(刘渡舟；谈谈《金匮》的泽泻汤证，《中医杂志》9c17，1980)
例三伍XX，女，74岁。初诊日期；1977年5月23日。头目昏眩，颈项强痛，四肢无力，鼻痂干结，大便干燥，尿多而黄，脉沉细，尺部弱，舌有裂纹，苔微白。血压250／160毫米汞柱。辨为肾阴不足，肝阳上亢。方药：玄参、麦冬、牛膝、茯苓各12克代赭石24克生龙骨、生牡蛎各15克钩藤、菊花、远志、蝉蜕各6克二诊；服上方3剂，头晕见减，大便仍干，小便略少，血压降至230／110毫米汞柱。又有心悸胸闷，脉弦细。前方去代赭石、蝉蜕、玄参、麦冬、茯苓，加菖蒲、白蒺藜、女贞子、茺蔚子各9克，丹参、首乌各12克，磁石15克。三诊：投药3剂，血压降至190／100毫米汞柱，头晕便干胸闷心悸略减，但下肢关节肿痛，脉细数有歇止，舌剥。前方除茺蔚子、牛膝、龙骨、女贞，加羌活、独活、鸡血藤各9克，随访一月，血压趋于稳定，身体轻松有力。(陆文彬整理，沈仲圭老中医临床治验选析，《中医杂志》4；13，1980)
例四杨X，女，44岁。血压高亢，胸闷泛恶，头晕痛殊甚，脉弦滑，苔薄腻，厥阴为风脏，相火寄焉。风火相煽，上窜于巅，故致晕痛。兼之胃失和降，则胸闷泛恶，症情非轻(血压达230／135毫米汞柱)，须防突变，急予平旰潜阳，和胃降逆，势见缓和乃吉。玳瑁片6克(先煎)姜半夏9克生石决明15克(先煎)菊花6克竹茹6克薄荷炭3克(后下)炙僵蚕9克姜黄连2．4克钩藤9克(后下)牛黄清心丸1粒(化服)二诊：头晕痛，纳呆泛恶，心悸气短，苔腻薄黄，脉沉而小滑，与症状未合，是因脾土失运则痰生，因痰生热，因热生风，血压过高，风阳亢逆，故拟予化痰浊，和胃平肝，不斤斤于泻肝也。北沙参9克竹茹6克竹沥半夏9克陈皮6克白蒺藜9克北秫米9克橹豆衣9克炒枳壳4．5克菊花6克生石决明15克(先煎)钩藤9克(后下)生苡米9克朱茯苓9克三诊：用和胃平肝化浊法，中焦痞闷顿舒，脉象亦起，头晕痛渐瘥，纳渐增，泛恶亦止，然腻苔尚未尽化，再宗原法损益之。北沙参9克生石决明15克(先煎)竹茹6克陈皮逆于胆。法当解热清中，利胆安胃。鲜竹茹10克赤茯苓10克煅赭石(布包)10克枇杷叶(生姜汁炒)10克旋复花(布包)7克金铃子(酒炒)7克左秦艽7克广陈皮5克酒黄芩5克炒山栀5克炒枳实5克川黄连(吴萸水炒)2克益元散(布包)10克(《李聪甫医案》)[评按]厥证系指突然昏倒，不省人事，面色苍白，四肢厥冷，移时逐渐苏醒的病证。有时也可一厥不复而导致死亡。《内经》论述颇多，后世更分为气厥、痰厥、血厥、食厥等。
例一证属寒痰厥逆，状若假死，惊为怪病，以三生饮作汤一剂神效。三生饮中均为辛烈有剧毒，并能令人麻醉，近世医家用者稀少，但大病当前，出奇应变，往往可以化险为夷。
例二为食厥，系因食非所宜致令中毒而致。本例食用生附子、醇酒，毒热炽于胃而逆于胆，虽见四肢厥冷，憎寒腹痛，但舌质干赤，呕吐苦水，决非阴寒之证。治宜解热清中，利胆安胃、方中陈皮、竹茹、枳实清中，黄连、黄芩，栀子清热解毒，茯苓运脾；杷叶和胃。审证求因，辨别寒热之真伪，立法遣药，别开生面，药后转危为安。
(二十二)肢厥
例一姚XX，男，37岁。患周围神经炎已一年多。初因铁锤击伤右手中指，发生疼痛麻痹，经久不愈。至今年三月，渐觉两脚板如有物挤压，脚心冰冷，并逐渐向上发展，奇痒，手足麻木冰冷，尤以两足为甚，经治后上肢症消，上下肢麻木冰冷，尤以下肢脚心为甚，不知痛痒，饮食日益减少，体重明显下降，脉细弦而缓。拟以当归四逆汤：当归15克桂枝10克白芍30克炙甘草10克细辛3克木通10克生姜10克红枣30克生黄芪30克鹿茸末1．5克冲服上方连服11剂，手足麻木明显减退，脚心由冷转热，胃纳仍差。二诊守上方加党参、白术，茯苓各15克，又进5剂，病情更见好转。三诊守上方加重白芍为60克，炙甘草为30克。再进3剂，手足知觉基本恢复，冷感全除，胃纳已开，饮食增进。用上方10剂蜜丸，巩固疗效，随访四年未复发。(万友生：桂枝汤及其加减法的临床体会，《江西中医药》2：6，1981)
例二李XX，男，43岁。初诊日期：1980年1月11日。于1978年10月，无明显诱因而自觉双下肢发凉，厂医诊为肾阳虚证，曾用金匮肾气丸，虎骨酒、青娥丸等大量温补药，而病情未能控制，仍逐渐发展。冷感向上至腰部，向下则冷至足心，如赤脚立冰上，寒冷彻骨。同时伴有下肢麻，痒如虫行，小便余沥与阳萎等症。曾先后在XX等医院检查，均未见异常，而建议中医治疗。虽服补肾壮阳，益气和血等中药二百余剂，未能见效。就诊时：患者素体健康，面部丰腴，面目有神，舌质色绛，少苔，脉弦而略数。问其饮食如故，大便不爽，小便短少而发黄。初投四逆散，按阳厥之证治之，药进三剂，厥冷依然，乃又反复追询其病情，患者才说出睡眠不佳，且多乱梦，而心时烦，容易汗出。视其舌尖红如杨梅，脉来又数。证属阴虚于下而心火独旺于上。其证与黄连阿胶汤颇为合拍，乃疏下方治疗。黄连9克黄芩3克白芍6克阿胶9克(烊化)鸡子黄2枚(自加)以上五味，用水三碗，先煮三物，取一碗；去滓，纳胶烊尽，小冷，纳鸡子黄，搅合相得，分两次服下。服药3剂后，患者即觉下肢寒冷麻木之感逐渐消退，心烦、汗出、失眠多梦等证，均有明显好转，小便余沥和阳萎亦有所改善。察其舌，仍红赤而少苔，脉弦而微数，继宗原法治之。方药，黄连9克阿胶10克(烊化)黄芩3克白芍9克鸡子黄2枚(自加)丹皮6克6剂，煎服法同前。1月30日，适值降雪，寒风凛冽，但患者并无异常寒冷之痛苦，腰以下厥冷证基本告愈。一个月后，据患者言，未再复发。(刘渡舟主治，尉敏廷整理：下肢厥冷治验，《中医杂志》12：19，1980)[评按]肢厥又称四肢厥冷或手足逆冷，或称“四逆”；系指四肢发凉至膝肘以上的病症。有寒热之分。寒证由阴寒内盛，阳气衰微不能达于四末；热证系由热盛伤津，热邪阻遏，阳气不能外达四肢所致。
例—证属气血不足，阳气虚衰不能温煦而致肢厥，以当归四逆汤为治，加生芪、鹿茸益气温阳，通达肌表营卫，壮阳补精活血，以加强温通之效。
例二肢厥逆冷为病之假象，虽屡用温肾助阳而厥冷如故，经详询病情，始得真象。证属阴阳上下阻绝不通，水火不相既济。心火亢盛则心烦、汗出，失眠多梦，舌红少苔，脉数，在下则厥冷，小便余沥、阳萎。投以黄连阿胶汤，泻南补北，交通心肾，使之水火既济，心火得以下行，肾水得以上滋，心肾得交，阴阳调和则诸证自愈。由此可知临证详审病情的重要性。(二十三)痹证
例一陈XX，男，56岁，初诊日期：1974年9月4日。周身关节疼痛已历4年有余，诊为风湿性关节炎。平素畏寒怯冷，疼痛游走不定，每遇寒冷则疼痛加剧，两腿可见红斑结节，查血沉70毫米／一小时，抗“O”正常，舌苔薄腻，舌质偏淡，脉细。辨证:风寒湿痹(乃风湿活动而体质偏虚者)治法：温经通络。方药：制川乌(先煎)10克全当归10克仙灵脾15克川桂枝(后下)8克寻骨风20克稀莶草20克徐长卿15克生甘草5克8剂。9月11日：药后结节明显减少，此乃佳象。舌苔白腻，脉细，效不更方，循原法进治之。上方加炙蜂房10克，炙全蝎(研末分吞)2克。6剂。9月19日：复查血沉为21毫米／一小时末，周身关节痛稳定，腿部红斑结节消失，为巩固疗效，嘱其原方再服10剂。)976年6月5日随访，患者已痊愈，未再复发，并已正常上班。(朱良春主治，陈淑媛等整理：朱良春老中医、治疗痹证的经验，《中医杂志》12：15，1980)
【背景信息】
书名：近现代名医验案类编 章节：正文(17/53) 类别：医论
例九 原案标题为“实中阳厥”，其高明之处在于排除假虚之象，而抓住疾病的真实本质。如果不能辨别真假虚实，那么动手治疗就会出错，从而犯下“虚虚实实”（使虚者更虚，实者更实）的错误。如果用治虚的方法去治疗实证，那么没有不留下偏枯废痿（半身不遂、肢体萎缩无力等后遗症）病症的，这是医疗上的过失，不可忽略。
(十九) 偏风 患者高X，女性，45岁，已婚。初诊日期：1970年5月13日。左上半身感觉减退、麻木、无汗五年多。自1965年春季起，先发现左手感觉减退、麻木，随后相继发现左侧头面部、胸背部及上肢不出汗，局部发凉，肢体麻木，感觉减退，症状逐渐加重，常因感觉迟钝而不自觉被烫伤。左手握力差，不能持重物。经某医院神经科检查，左侧头面部、上肢及左侧躯干第3～4胸椎以上平面，痛觉、温觉减退，皮肤较健侧明显干燥。主动运动及生理反射均无特殊改变。诊断为脊髓空洞症、神经根炎。多年来常有腹泻，每天大便两三次，质地较稀，便前有时腹痛，腹泻常与情绪改变有关，此前未进行治疗。患者发育营养状况一般，面色黄，精神不振，舌质淡红，舌苔薄白，脉沉细而弱。辨证：脾肾不足，气血两虚，风寒内袭，阻闭经络。治法：温肾健脾，补气养血，温经通阳。方药：山药30克，熟地黄15克，麻黄4.5克，炮姜9克，鹿角胶12克（烊化，也可用阿胶替代），桂枝9克，补骨脂12克，白术15克（土炒），神曲9克（炒），醋香附12克，当归12克，熟附子9克，山茱萸12克，木香9克，生黄芪12克，骨碎补12克，鸡血藤12克。水煎两次，混合药液，早晚各服一次，温服。
5月26日（二诊）：服药六剂后，感觉舒适，食欲好转，食量增加，其余症状同前。舌苔、脉象同前。原方去掉木香、黄芪继服。
6月3日（三诊）：服药后病情明显好转，食量增加，大便已转为正常，左上半身麻木感减轻，舌苔薄白，脉沉细，较前有力。仍以原方加减继服。方药：山药30克，熟地黄15克，麻黄4.5克，炮姜9克，鹿角胶15克（烊化），桂枝9克，补骨脂12克，神曲9克（炒），白术15克（土炒），醋香附12克，当归12克，熟附子12克，淫羊藿12克，枸杞子15克，生黄芪15克，菟丝子24克，骨碎补15克，鸡血藤15克。
1977年11月30日随访：先后间断服药半年多，左上肢麻木感逐渐减轻，患部痛觉、温觉较以前逐渐灵敏，左手握力大增，与健侧无明显差别，出汗如常，左上肢功能已恢复正常。至今已五年，未再服药治疗。（摘自《刘惠民医案》）
[评按] “偏风”一词首见于《诸病源候论·风病诸候》，书中云：“偏风者，风邪偏客于身一边也。人体有偏虚者，风邪乘虚而伤之……或不知痛痒”、“风不仁者，由荣气虚，卫气实，风寒入于肌肉，使血气行不宣流，其状搔之皮肤如隔衣是也。”所述症状与本案颇有相似之处。偏风与中风导致的半身不遂不同，此案患者肢体活动尚可，但痛温觉缺失，且患侧肢体麻木发凉、无汗。西医诊断为脊髓空洞症。根据中医辨证属于脾肾不足、气血两虚，风寒内袭，阻闭经络。故采用温肾健脾、益气养血、温经通络之法。症状虽奇特，但疗效尚称满意，值得重视。
(二十) 眩晕
例一 患者潘XX，女性，初诊日期：1954年2月。体质本虚弱，多年来胸怀不适，因遭遇事故，导致肝气上升而引起头目眩晕，肝木克制脾土而导致呕吐不止。右脉弦劲，饮食不思，大小便不通利，舌绛苔薄，情势颇为紧急，可能引发痉证。宜采用凉肝安胃之法，服药后见效再作商议。桑叶9克，杭菊花9克，牡丹皮9克，黑栀子9克，大白芍9克，细生地24克，姜川连2.1克，法半夏6克，姜竹茹12克，黄郁金9克，羚羊角粉1.2克（另煎兑入），苦丁茶9克。服用上方后，左脉见平，舌绛转淡，苔薄变宣，眩晕立即停止，唯呕吐如前，纳食不香，二便未调。依前法去掉羚羊角，加入安胃药物以止呕吐。桑叶9克，菊花9克，丹皮9克，栀子炭9克，夏枯草9克，苦丁茶9克，细生地18克，大白芍9克，法半夏6克，姜竹茹12克，干苇根15克，左金丸4.5克（分二次送服）。服用上方两剂后，呕吐停止，舌苔已消，胃纳已香，二便正常，再以小剂量泄肝安胃药物善后。（张菊人：《菊人医话》）
例二 患者魏XX，男性，60岁。患头晕目眩，兼有耳鸣，鼻子堵塞，嗅觉不佳。病程已有数年，多次治疗无效，颇为痛苦。切其脉弦，视其舌则胖大无比，苔水滑而白。辨证：此证心下有痰饮，上冒清阳，所以头昏目眩；其耳鸣、鼻塞，则是浊阴占据上部，清窍不利所致。治法：渗利水饮之邪。方药：泽泻24克，白术10克。此方服用1剂后有汗出，不改方，共服五剂，则头晕、目眩、耳鸣、鼻塞等症状痊愈大半，转方使用五苓散温阳利水而收全功。（刘渡舟：谈谈《金匮》的泽泻汤证，《中医杂志》1980年第9期）
例三 患者伍XX，女性，74岁。初诊日期：1977年5月23日。头目昏眩，颈项强痛，四肢无力，鼻痂干结，大便干燥，尿多而黄，脉沉细，尺部弱，舌有裂纹，苔微白。血压250／160毫米汞柱。辨为肾阴不足，肝阳上亢。方药：玄参、麦冬、牛膝、茯苓各12克，代赭石24克，生龙骨、生牡蛎各15克，钩藤、菊花、远志、蝉蜕各6克。
二诊：服用上方3剂，头晕见减，大便仍干，小便略少，血压降至230／110毫米汞柱。又有心悸胸闷，脉弦细。前方去掉代赭石、蝉蜕、玄参、麦冬、茯苓，加石菖蒲、白蒺藜、女贞子、茺蔚子各9克，丹参、何首乌各12克，磁石15克。
三诊：投药3剂，血压降至190／100毫米汞柱，头晕、便干、胸闷、心悸略减，但下肢关节肿痛，脉细数有歇止，舌剥。前方除去茺蔚子、牛膝、龙骨、女贞子，加羌活、独活、鸡血藤各9克。随访一月，血压趋于稳定，身体轻松有力。（陆文彬整理，沈仲圭老中医临床治验选析，《中医杂志》1980年第4期第13页）
例四 患者杨X，女性，44岁。血压高亢，胸闷泛恶，头晕痛殊甚，脉弦滑，苔薄腻。厥阴为风脏，相火寄寓其中。风火相煽，上窜于巅顶，故致晕痛。加之胃失和降，则胸闷泛恶，症情非轻（血压达230／135毫米汞柱），须防突变，急予平肝潜阳，和胃降逆，势见缓和乃吉。玳瑁片6克（先煎），姜半夏9克，生石决明15克（先煎），菊花6克，竹茹6克，薄荷炭3克（后下），炙僵蚕9克，姜黄连2.4克，钩藤9克（后下），牛黄清心丸1粒（化服）。
二诊：头晕痛，纳呆泛恶，心悸气短，苔腻薄黄，脉沉而小滑，与症状未合，是因脾土失运则痰生，因痰生热，因热生风，血压过高，风阳亢逆，故拟予化痰浊，和胃平肝，不斤斤于泻肝也。北沙参9克，竹茹6克，竹沥半夏9克，陈皮6克，白蒺藜9克，北秫米9克，橹豆衣9克，炒枳壳4.5克，菊花6克，生石决明15克（先煎），钩藤9克（后下），生苡米9克，朱茯苓9克。
三诊：用和胃平肝化浊法，中焦痞闷顿舒，脉象亦起，头晕痛渐瘥，纳渐增，泛恶亦止，然腻苔尚未尽化，再宗原法损益之。北沙参9克，生石决明15克（先煎），竹茹6克，陈皮...（此处原文似有缺漏或排版错误“陈皮逆于胆”，结合下文评按推测为另一案例或续方，但根据上下文逻辑，此处应接续上文或为独立片段，鉴于原文结构，此处暂按原文转录并依据评按理解）...法当解热清中，利胆安胃。鲜竹茹10克，赤茯苓10克，煅赭石（布包）10克，枇杷叶（生姜汁炒）10克，旋复花（布包）7克，金铃子（酒炒）7克，左秦艽7克，广陈皮5克，酒黄芩5克，炒山栀5克，炒枳实5克，川黄连（吴萸水炒）2克，益元散（布包）10克。（《李聪甫医案》）
[评按] 厥证系指突然昏倒，不省人事，面色苍白，四肢厥冷，移时逐渐苏醒的病证。有时也可一厥不复而导致死亡。《内经》论述颇多，后世更分为气厥、痰厥、血厥、食厥等。
例一证属寒痰厥逆，状若假死，惊为怪病，以三生饮作汤一剂神效。三生饮中均为辛烈有剧毒，并能令人麻醉，近世医家用者稀少，但大病当前，出奇应变，往往可以化险为夷。
例二为食厥，系因食非所宜致令中毒而致。本例食用生附子、醇酒，毒热炽于胃而逆于胆，虽见四肢厥冷，憎寒腹痛，但舌质干赤，呕吐苦水，决非阴寒之证。治宜解热清中，利胆安胃。方中陈皮、竹茹、枳实清中，黄连、黄芩、栀子清热解毒，茯苓运脾，杷叶和胃。审证求因，辨别寒热之真伪，立法遣药，别开生面，药后转危为安。
(二十二) 肢厥
例一 患者姚XX，男性，37岁。患周围神经炎已一年多。初因铁锤击伤右手中指，发生疼痛麻痹，经久不愈。至今年三月，渐觉两脚板如有物挤压，脚心冰冷，并逐渐向上发展，奇痒，手足麻木冰冷，尤以两足为甚，经治后上肢症消，上下肢麻木冰冷，尤以下肢脚心为甚，不知痛痒，饮食日益减少，体重明显下降，脉细弦而缓。拟以当归四逆汤：当归15克，桂枝10克，白芍30克，炙甘草10克，细辛3克，木通10克，生姜10克，红枣30克，生黄芪30克，鹿茸末1.5克（冲服）。上方连服11剂，手足麻木明显减退，脚心由冷转热，胃纳仍差。二诊守上方加党参、白术、茯苓各15克，又进5剂，病情更见好转。三诊守上方加重白芍为60克，炙甘草为30克。再进3剂，手足知觉基本恢复，冷感全除，胃纳已开，饮食增进。用上方10剂制蜜丸，巩固疗效，随访四年未复发。（万友生：桂枝汤及其加减法的临床体会，《江西中医药》1981年第2期第6页）
例二 患者李XX，男性，43岁。初诊日期：1980年1月11日。于1978年10月，无明显诱因而自觉双下肢发凉，厂医诊为肾阳虚证，曾用金匮肾气丸、虎骨酒、青娥丸等大量温补药，而病情未能控制，仍逐渐发展。冷感向上至腰部，向下则冷至足心，如赤脚立冰上，寒冷彻骨。同时伴有下肢麻，痒如虫行，小便余沥与阳痿等症。曾先后在XX等医院检查，均未见异常，而建议中医治疗。虽服补肾壮阳、益气和血等中药二百余剂，未能见效。就诊时：患者素体健康，面部丰腴，面目有神，舌质色绛，少苔，脉弦而略数。问其饮食如故，大便不爽，小便短少而发黄。初投四逆散，按阳厥之证治之，药进三剂，厥冷依然，乃又反复追询其病情，患者才说出睡眠不佳，且多乱梦，而心时烦，容易汗出。视其舌尖红如杨梅，脉来又数。证属阴虚于下而心火独旺于上。其证与黄连阿胶汤颇为合拍，乃疏下方治疗。黄连9克，黄芩3克，白芍6克，阿胶9克（烊化），鸡子黄2枚（自加）。以上五味，用水三碗，先煮三物，取一碗；去滓，纳胶烊尽，小冷，纳鸡子黄，搅合相得，分两次服下。服药3剂后，患者即觉下肢寒冷麻木之感逐渐消退，心烦、汗出、失眠多梦等证，均有明显好转，小便余沥和阳痿亦有所改善。察其舌，仍红赤而少苔，脉弦而微数，继宗原法治之。方药：黄连9克，阿胶10克（烊化），黄芩3克，白芍9克，鸡子黄2枚（自加），丹皮6克。6剂，煎服法同前。1月30日，适值降雪，寒风凛冽，但患者并无异常寒冷之痛苦，腰以下厥冷证基本告愈。一个月后，据患者言，未再复发。（刘渡舟主治，尉敏廷整理：下肢厥冷治验，《中医杂志》1980年第12期第19页）
[评按] 肢厥又称四肢厥冷或手足逆冷，或称“四逆”；系指四肢发凉至膝肘以上的病症。有寒热之分。寒证由阴寒内盛，阳气衰微不能达于四末；热证系由热盛伤津，热邪阻遏，阳气不能外达四肢所致。
例一证属气血不足，阳气虚衰不能温煦而致肢厥，以当归四逆汤为治，加生芪、鹿茸益气温阳，通达肌表营卫，壮阳补精活血，以加强温通之效。
例二肢厥逆冷为病之假象，虽屡用温肾助阳而厥冷如故，经详询病情，始得真象。证属阴阳上下阻绝不通，水火不相既济。心火亢盛则心烦、汗出，失眠多梦，舌红少苔，脉数，在下则厥冷，小便余沥、阳痿。投以黄连阿胶汤，泻南补北，交通心肾，使之水火既济，心火得以下行，肾水得以上滋，心肾得交，阴阳调和则诸证自愈。由此可知临证详审病情的重要性。
(二十三) 痹证
例一 患者陈XX，男性，56岁，初诊日期：1974年9月4日。周身关节疼痛已历4年有余，诊为风湿性关节炎。平素畏寒怯冷，疼痛游走不定，每遇寒冷则疼痛加剧，两腿可见红斑结节，查血沉70毫米／一小时，抗“O”正常，舌苔薄腻，舌质偏淡，脉细。辨证：风寒湿痹（乃风湿活动而体质偏虚者）。治法：温经通络。方药：制川乌（先煎）10克，全当归10克，仙灵脾15克，川桂枝（后下）8克，寻骨风20克，稀莶草20克，徐长卿15克，生甘草5克。8剂。
9月11日：药后结节明显减少，此乃佳象。舌苔白腻，脉细，效不更方，循原法进治之。上方加炙蜂房10克，炙全蝎（研末分吞）2克。6剂。
9月19日：复查血沉为21毫米／小时末，周身关节痛稳定，腿部红斑结节消失，为巩固疗效，嘱其原方再服10剂。
1976年6月5日随访，患者已痊愈，未再复发，并已正常上班。（朱良春主治，陈淑媛等整理：朱良春老中医治疗痹证的经验，《中医杂志》1980年第12期第15页）
Background Information
Book: Compilation of Verified Cases by Famous Modern Doctors Chapter: Main Text (17/53) Category: Medical Discussion
Case 9 The original case title is "Shi Zhong Yang Jue" (True Excess with Yang Reversal). Its brilliance lies in discarding the false deficiency and adhering to the true nature of the disease. If one cannot distinguish between true/false and excess/deficiency, treatment will be erroneous, committing the fault of "making deficiency more deficient and excess more excessive." Treating an excess condition as a deficiency will inevitably result in sequelae such as hemiplegia and muscular atrophy. This is a medical error that cannot be ignored.
(19) Pian Feng (Hemiplegic Wind / Asymmetric Wind Strike) Patient Gao X, Female, 45 years old, married. First visit date: May 13, 1970. Decreased sensation, numbness, and anhidrosis on the left upper half of the body for over five years. Starting from spring 1965, decreased sensation and numbness were first noticed in the left hand, followed sequentially by anhidrosis, local coolness, limb numbness, and decreased sensation on the left side of the head, face, chest, back, and upper limbs. Symptoms gradually worsened, often leading to unconscious burns due to sensory loss. Grip strength in the left hand was poor, unable to hold heavy objects. Neurological examination at a certain hospital revealed decreased pain and temperature sensation on the left side of the head, face, upper limbs, and the left trunk above the T3-T4 vertebral level. Skin was significantly drier compared to the healthy side. Voluntary movement and physiological reflexes showed no special changes. Diagnosed with Syringomyelia and Radiculitis. For many years, the patient suffered from diarrhea, passing stool two to three times daily with loose consistency. Abdominal pain sometimes occurred before defecation, and diarrhea was often related to emotional changes; no prior treatment was received. Development and nutrition were average. The complexion was sallow, spirit was listless. Tongue body was pale red with thin white coating. Pulse was deep, fine, and weak. Pattern Differentiation: Spleen and Kidney insufficiency, Qi and Blood dual deficiency, internal invasion of Wind-Cold obstructing the meridians. Treatment Method: Warm the Kidney and strengthen the Spleen, tonify Qi and nourish Blood, warm the meridians and unblock Yang. Prescription: Dioscoreae Rhizoma (Shanyao) 30g, Rehmanniae Radix Preparata (Shudi) 15g, Ephedrae Herba (Mahuang) 4.5g, Zingiberis Rhizoma Preparatum (Paojiang) 9g, Cornu Cervi Degelatinatum (Lujiao Jiao) 12g (melted, can be replaced by Euphorbiae Humanae Placenta or Colla Corii Asini/Ajiao), Cinnamomi Ramulus (Guizhi) 9g, Psoraleae Fructus (Buguzhi) 12g, Atractylodis Macrocephalae Rhizoma (Baizhu) 15g (soil-fried), Moutan Cortex (Chenqu/Shenqu) 9g (fried), Cyperi Rhizoma Vinegar-processed (Cuxiangfu) 12g, Angelicae Sinensis Radix (Danggui) 12g, Aconiti Lateralis Radix Preparata (Shufuzi) 9g, Corni Fructus (Shanzhuyu) 12g, Aucklandiae Radix (Muxiang) 9g, Astragali Radix (Sheng Huangqi) 12g, Drynariae Rhizoma (Gusuibu) 12g, Spatholobi Caulis (Jixueteng) 12g. Decoct twice in water, mix the decoctions, take orally once in the morning and once in the evening, warm administration.
May 26 (Second Visit): After taking six doses, the patient felt comfortable, appetite improved, and food intake increased. Other symptoms remained the same. Tongue coating and pulse remained unchanged. Continue with the original prescription after removing Aucklandiae Radix (Muxiang) and Astragali Radix (Huangqi).
June 3 (Third Visit): Condition improved significantly after medication. Food intake increased, bowel movements normalized, numbness on the left upper half of the body decreased. Tongue coating thin white, pulse deep and fine, stronger than before. Continue with modified original prescription. Prescription: Dioscoreae Rhizoma (Shanyao) 30g, Rehmanniae Radix Preparata (Shudi) 15g, Ephedrae Herba (Mahuang) 4.5g, Zingiberis Rhizoma Preparatum (Paojiang) 9g, Cornu Cervi Degelatinatum (Lujiao Jiao) 15g (melted), Cinnamomi Ramulus (Guizhi) 9g, Psoraleae Fructus (Buguzhi) 12g, Moutan Cortex (Chenqu/Shenqu) 9g (fried), Atractylodis Macrocephalae Rhizoma (Baizhu) 15g (soil-fried), Cyperi Rhizoma Vinegar-processed (Cuxiangfu) 12g, Angelicae Sinensis Radix (Danggui) 12g, Aconiti Lateralis Radix Preparata (Shufuzi) 12g, Epimedii Folium (Yinyanghuo) 12g, Lycii Fructus (Gouqizi) 15g, Astragali Radix (Sheng Huangqi) 15g, Cuscutae Semen (Tusizi) 24g, Drynariae Rhizoma (Gusuibu) 15g, Spatholobi Caulis (Jixueteng) 15g.
Follow-up on November 30, 1977: After intermittent medication for over half a year, numbness in the left upper limb gradually decreased. Pain and temperature sensation in the affected area became more sensitive than before. Grip strength in the left hand increased significantly, showing no obvious difference from the healthy side. Sweating returned to normal. Function of the left upper limb recovered to normal. It has been five years since then, without further medication. (From *Medical Cases of Liu Huimin*)
[Commentary] "Pian Feng" first appeared in *Zhu Bing Yuan Hou Lun · Disorders of Wind Diseases*, stating: "Pian Feng refers to wind pathogen lodging asymmetrically on one side of the body. When the human body has asymmetrical deficiency, wind pathogen takes advantage of this weakness to injure it... or results in loss of pain and itch sensation." "Feng Bu Ren (Wind Insensitivity) occurs when Ying Qi is deficient and Wei Qi is solid; Wind-Cold enters the muscles, causing blood and Qi circulation to be stagnant. Its manifestation is that scratching the skin feels like scratching through clothing." The described symptoms are quite similar to this case. Pian Feng differs from hemiplegia caused by Stroke (Zhong Feng). In this case, limb movement was still possible, but pain and temperature sensations were absent, accompanied by numbness, coolness, and anhidrosis in the affected limbs. Western medicine diagnosis: Syringomyelia. According to TCM pattern differentiation, it belongs to Spleen and Kidney insufficiency, Qi and Blood dual deficiency, internal invasion of Wind-Cold obstructing the meridians. Therefore, the method of warming the Kidney, strengthening the Spleen, benefiting Qi, nourishing Blood, and warming the meridians to unblock collaterals was used. Although the symptoms were peculiar, the curative effect was satisfactory, which deserves attention.
(20) Xuan Yun (Vertigo/Dizziness)
Case 1 Patient Pan XX, Female. First visit date: February 1954. Constitution was inherently weak. For many years, there had been chest discomfort. Due to an accident, Liver Wood rose upward causing vertigo and dizziness, and Liver Wood overacting on Earth (Spleen/Stomach) caused incessant vomiting. Right pulse was wiry and forceful. No desire for food, difficulty in urination and defecation. Tongue was crimson with thin coating. The situation was urgent, possibly leading to convulsions. Suitable to cool the Liver and calm the Stomach. Effectiveness to be discussed after taking the medicine. Tussilaginis Flos (Sangye) 9g, Chrysanthemi Flos (Hang Juhua) 9g, Moutan Cortex (Fen Danpi) 9g, Gardeniae Fructus Carbonized (Heizhizi) 9g, Paeoniae Radix Alba (Da Baishao) 9g, Rehmanniae Radix (Xi Shengdi) 24g, Coptidis Rhizoma Ginger-processed (Jiang Chuanlian) 2.1g, Pinelliae Tuber Processed (Fa Xia) 6g, Bambusae Mesocarpum Ginger-processed (Jiang Zhuru) 12g, Curcumae Radix (Huang Yujin) 9g, Antelopis Cornu Powder (Lingyang Jiao) 1.2g (decocted separately and mixed), Bupleuri Radix (Kudingcha) 9g. After taking the above prescription, the left pulse flattened, tongue color changed from crimson to pale, coating became thinner and smoother, vertigo stopped immediately. Only vomiting persisted as before, appetite was poor, and bowel/bladder functions were not regulated. Following the previous method, remove Antelopis Cornu and add stomach-calming herbs to stop vomiting. Tussilaginis Flos (Sangye) 9g, Chrysanthemi Flos (Juhua) 9g, Moutan Cortex (Danpi) 9g, Gardeniae Fructus Carbonized (Zhizi Tan) 9g, Prunellae Spica (Xiakucao) 9g, Bupleuri Radix (Kudingcha) 9g, Rehmanniae Radix (Xi Shengdi) 18g, Paeoniae Radix Alba (Da Baishao) 9g, Pinelliae Tuber Processed (Fa Xia) 6g, Bambusae Mesocarpum Ginger-processed (Jiang Zhuru) 12g, Phragmitis Rhizoma (Ganweigen) 15g, Zuo Jin Wan 4.5g (taken in two divided doses). After taking two doses of the above prescription, vomiting stopped, tongue coating disappeared, appetite improved, and bowel/bladder functions normalized. Use a small dose of Liver-draining and Stomach-calming herbs for follow-up care. (Zhang Juren: *Juren's Medical Conversations*)
Case 2 Patient Wei XX, Male, 60 years old. Suffering from dizziness and vertigo, accompanied by tinnitus, nasal congestion, and poor olfaction. The illness lasted several years, with multiple ineffective treatments, causing great distress. Pulse was wiry. Tongue was extremely enlarged/puffy, with slippery white coating. Pattern Differentiation: Fluid retention (Phlegm-Fluid) in the epigastrium rising to obscure the Clear Yang, causing dizziness and vertigo. Tinnitus and nasal congestion are caused by turbid Yin occupying the upper jiao, obstructing the clear orifices. Treatment Method: Percolate and drain the fluid retention pathogen. Prescription: Alismatis Rhizoma (Zexie) 24g, Atractylodis Macrocephalae Rhizoma (Baizhu) 10g. After taking one dose of this prescription, sweating occurred. Do not change the prescription. After taking a total of five doses, more than half of the symptoms (dizziness, vertigo, tinnitus, nasal congestion) resolved. Change prescription to Wuling San to warm Yang and promote diuresis to achieve complete cure. (Liu Duzhou: Discussing the Zexie Tang Syndrome in *Jin Gui*, *Chinese Journal of Traditional Chinese Medicine*, Issue 9, 1980)
Case 3 Patient Wu XX, Female, 74 years old. First visit date: May 23, 1977. Dizziness and vertigo, stiff and painful neck, weakness in four limbs, dry crusts in nose, dry stool, frequent yellow urine. Pulse was deep and fine, weak at the Chi position. Tongue had cracks, slightly white coating. Blood pressure 250/160 mmHg. Differentiated as Kidney Yin insufficiency and Liver Yang hyperactivity. Prescription: Scrophulariae Radix (Xuanshen), Ophiopogonis Radix (Maidong), Achyranthis Bidentatae Radix (Niuxi), Poria (Fuling) each 12g, Gastrodiae Rhizoma (Daizheshi - *Note: Daizheshi is Ochre/Hematite, likely typo in source or specific usage, usually Hematitum*), Ochre (Daizheshi) 24g, Raw Longgu (Sheng Longgu), Raw Muli (Sheng Muli) each 15g, Uncariae Ramulus cum Uncis (Gouteng), Chrysanthemi Flos (Juhua), Polygalae Radix (Yuanzhi), Cicadae Periostracum (Chantui) each 6g.
Second Visit: After taking three doses of the above prescription, dizziness decreased, stool remained dry, urine volume slightly decreased, blood pressure dropped to 230/110 mmHg. Palpitations and chest tightness appeared. Pulse was wiry and fine. Remove Ochre, Cicadae Periostracum, Scrophulariae Radix, Ophiopogonis Radix, and Poria from the previous formula. Add Acori Tatarinowii Rhizoma (Changpu), Tribuli Fructus (Bajili), Ligustri Lucidi Fructus (Nvzhenzi), Leonuri Fructus (Chongweizi) each 9g, Salviae Miltiorrhizae Radix (Danshen), Polygoni Multiflori Caulis (Shouwu) each 12g, Magnetitum (Cishi) 15g.
Third Visit: After taking three doses, blood pressure dropped to 190/100 mmHg. Dizziness, dry stool, chest tightness, and palpitations slightly decreased. However, swelling and pain in lower limb joints appeared. Pulse was fine, rapid, with intermissions. Tongue was peeled. Remove Leonuri Fructus, Achyranthis Bidentatae Radix, Longgu, and Ligustri Lucidi Fructus from the previous formula. Add Notopterygii Rhizoma et Radix (Qianghuo), Angelicae Pubescentis Radix (Duhuo), Spatholobi Caulis (Jixueteng) each 9g. Follow-up after one month: Blood pressure stabilized, body felt light and strong. (Organized by Lu Wenbin, Analysis of Clinical Experience of Old TCM Doctor Shen Zhonggui, *Chinese Journal of Traditional Chinese Medicine*, Issue 4, Page 13, 1980)
Case 4 Patient Yang X, Female, 44 years old. High blood pressure, chest fullness, nausea, severe dizziness and headache. Pulse was wiry and slippery, coating thin and greasy. Jueyin is the Wind organ, housing Ministerial Fire. Wind and Fire stir each other, ascending to the vertex, causing dizziness and pain. Additionally, Stomach fails to descend properly, causing chest fullness and nausea. The condition is serious (Blood pressure up to 230/135 mmHg), beware of sudden changes. Urgently apply calming Liver and subduing Yang, harmonizing Stomach and descending rebellion. Hope for缓和 (relief/stabilization). Testudinis Carapax et Plastrum (Daimao) 6g (decoct first), Pinelliae Tuber (Jiang Banxia) 9g, Concha Arcae (Sheng Shijueming) 15g (decoct first), Chrysanthemi Flos (Juhua) 6g, Bambusae Mesocarpum (Zhuru) 6g, Menthae Haplocalycis Herba Charred (Bohe Tan) 3g (add later), Bombyx Batryticatus (Zhi Jiangcan) 9g, Coptidis Rhizoma (Jiang Huanglian) 2.4g, Uncariae Ramulus cum Uncis (Gouteng) 9g (add later), Niuhuang Qingxin Wan 1 pill (dissolved and taken).
Second Visit: Dizziness and pain, poor appetite, nausea, palpitations, shortness of breath. Coating greasy and thin yellow, pulse deep and slightly slippery. Does not match symptoms perfectly. This is because Spleen Earth fails to transport, generating Phlegm; Phlegm generates Heat; Heat generates Wind. High blood pressure causes Wind-Yang hyperactivity. Therefore, plan to resolve Phlegm-Turbidity, harmonize Stomach, and calm Liver, focusing less on draining Liver. Glehniae Radix (Beishashen) 9g, Bambusae Mesocarpum (Zhuru) 6g, Pinelliae Tuber with Bamboo Sap (Zhuli Banxia) 9g, Citri Reticulatae Pericarpium (Chenpi) 6g, Tribuli Fructus (Baijili) 9g, Sorghum Vulgare (Beishumi) 9g, Glycine Max Seed Coat (Ludouyi) 9g, Aurantii Fructus Immaturus Stir-fried (Zhao Zhiqiao) 4.5g, Chrysanthemi Flos (Juhua) 6g, Concha Arcae (Sheng Shijueming) 15g (decoct first), Uncariae Ramulus cum Uncis (Gouteng) 9g (add later), Coicis Semen (Sheng Yimi) 9g, Cinnabar-coated Poria (Zhu Fuling) 9g.
Third Visit: Using the method of harmonizing Stomach, calming Liver, and resolving Turbidity, epigastric fullness instantly relieved, pulse rose, dizziness and pain gradually subsided, appetite increased, nausea stopped. However, greasy coating not fully resolved. Continue with the original method with modifications. Glehniae Radix (Beishashen) 9g, Concha Arcae (Sheng Shijueming) 15g (decoct first), Bambusae Mesocarpum (Zhuru) 6g, Citri Reticulatae Pericarpium (Chenpi)... [Text seems fragmented here in source regarding "Chenpi ni yu dan", inferred continuation based on commentary] ...Method should be clearing heat, purifying the middle, benefiting Gallbladder, and calming Stomach. Fresh Bambusae Mesocarpum (Xian Zhuru) 10g, Red Poria (Chi Fuling) 10g, Calcined Ochre (Duan Daizheshi, wrapped in cloth) 10g, Eriobotryae Folium (Pi Pa Ye, stir-fried with ginger juice) 10g, Inulae Flos (Xuanfuhua, wrapped in cloth) 7g, Meliae Fructus (Jinlingzi, wine-fried) 7g, Gentianae Macrophyllae Radix (Zuo Qinjiao) 7g, Citri Reticulatae Pericarpium (Guang Chenpi) 5g, Scutellariae Radix Wine-processed (Jiu Huangqin) 5g, Gardeniae Fructus Stir-fried (Zhao Zhizi) 5g, Aurantii Fructus Immaturus Stir-fried (Zhao Zhishi) 5g, Coptidis Rhizoma (Chuan Huanglian, stir-fried with Evodiae Fructus water) 2g, Yi Yuan San (wrapped in cloth) 10g. (From *Medical Cases of Li Congfu*)
[Commentary] Jue Syndrome refers to a sudden collapse, loss of consciousness, pale complexion, cold extremities, with gradual recovery after some time. Sometimes it may lead to death if the Jue does not reverse. *Nei Jing* discusses this extensively, and later generations divided it into Qi Jue, Phlegm Jue, Blood Jue, and Food Jue.
Case 1 belongs to Cold-Phlegm Jue Ni (Reversal), resembling fake death, surprising people as a strange disease. San Sheng Yin decocted as one dose produced miraculous effects. San Sheng Yin contains only pungent, fierce, highly toxic herbs that can cause anesthesia. Few doctors use them nowadays, but in critical illnesses, unexpected measures can often turn danger into safety.
Case 2 is Food Jue, caused by eating inappropriate substances leading to poisoning. This case involved consuming raw Aconite and strong wine. Toxic heat blazed in the Stomach and reversed into the Gallbladder. Although presenting with cold extremities, aversion to cold, and abdominal pain, the tongue body was dry and crimson, vomiting bitter water, definitely not a Yin-Cold syndrome. Treatment should clear heat, purify the middle, benefit the Gallbladder, and calm the Stomach. Chenpi, Zhuru, and Zhishi clear the middle; Huanglian, Huangqin, and Zhizi clear heat and detoxify; Fuling strengthens the Spleen; Pipaye harmonizes the Stomach. Investigate the cause, distinguish the true/false nature of cold and heat, establish laws and prescribe drugs innovatively. After medication, the critical condition turned safe.
(22) Zhi Jue (Extremity Cold/Cold Extremities)
Case 1 Patient Yao XX, Male, 37 years old. Had peripheral neuritis for over a year. Initially injured the right middle finger with a hammer, causing pain and numbness, which did not heal for a long time. By March of this year, gradually felt as if something was squeezing the soles of both feet, cold soles, spreading upwards, with intense itching. Hands and feet were numb and cold, especially the feet. After treatment, upper limb symptoms disappeared, but numbness and coldness in all four limbs persisted, especially the soles of the feet. Loss of pain and itch sensation. Diet decreased day by day, weight dropped significantly. Pulse was fine, wiry, and slow. Prescribed Danggui Sini Tang: Angelicae Sinensis Radix (Danggui) 15g, Cinnamomi Ramulus (Guizhi) 10g, Paeoniae Radix Alba (Baishao) 30g, Glycyrrhizae Radix et Rhizoma Preparated (Zhigancao) 10g, Asari Radix et Rhizoma (Xixin) 3g, Akebiae Caulis (Mutong) 10g, Zingiberis Rhizoma Recens (Shengjiang) 10g, Ziziphi Jujubae Fructus (Hongzao) 30g, Astragali Radix (Sheng Huangqi) 30g, Cervi Cornu Pantotrichum Powder (Lurong Mo) 1.5g (mixed in). Take the above prescription continuously for 11 doses. Numbness in hands and feet significantly decreased, soles turned from cold to warm, but appetite remained poor. Second Visit: Stick to the above prescription, add Codonopsis Radix (Dangshen), Atractylodis Macrocephalae Rhizoma (Baizhu), and Poria (Fuling) each 15g. Take another 5 doses. Condition improved further. Third Visit: Stick to the above prescription, increase Paeoniae Radix Alba (Baishao) to 60g, Glycyrrhizae Radix et Rhizoma Preparated (Zhigancao) to 30g. Take another 3 doses. Sensation in hands and feet basically restored, coldness completely eliminated, appetite opened, diet increased. Make honey pills from 10 doses of the above prescription to consolidate efficacy. Follow-up for four years showed no recurrence. (Wan Yousheng: Clinical Experience with Guizhi Tang and its Modifications, *Jiangxi Journal of Traditional Chinese Medicine*, Issue 2, Page 6, 1981)
Case 2 Patient Li XX, Male, 43 years old. First visit date: January 11, 1980. In October 1978, without obvious trigger, felt coldness in both lower limbs. Factory doctor diagnosed Kidney Yang Deficiency. Used large amounts of warming and tonifying medicines such as Jin Gui Shen Qi Wan, Tiger Bone Wine, and Qing E Wan, but condition could not be controlled and gradually developed. Cold sensation extended up to the waist and down to the soles of the feet, feeling like standing barefoot on ice, bone-chilling cold. Accompanied by lower limb numbness, itching like insects crawling, dribbling urine, and impotence. Checked at various hospitals with no abnormalities found, advised to seek TCM treatment. Took over 200 doses of herbs for tonifying Kidney, strengthening Yang, benefiting Qi, and nourishing Blood, with no effect. At consultation: Patient was generally healthy, plump face, bright eyes. Tongue body was crimson with little coating. Pulse was wiry and slightly rapid. Asked about diet: normal. Bowel movements unsatisfactory. Urine was scanty and yellow. Initially prescribed Six-Ingredient Powder with Prepared Aconite Root (Sini San), treating as Yang Jue. After three doses, cold extremities remained. Repeatedly questioned the patient, who then reported poor sleep, many chaotic dreams, occasional heart vexation, and easy sweating. Observed tip of tongue red like a bayberry, pulse rapid. Pattern: Yin deficiency below, Heart Fire blazing alone above. This pattern matches Huanglian Ejiao Tang closely. Prescribed the following: Coptidis Rhizoma (Huanglian) 9g, Scutellariae Radix (Huangqin) 3g, Paeoniae Radix Alba (Baishao) 6g, Colla Corii Asini (Ejiao) 9g (melted), Chicken Egg Yolk (Jizihuang) 2 eggs (self-added). These five ingredients, use three bowls of water. First decoct the first three items, obtain one bowl. Strain, add gelatin and melt completely. Let cool slightly, add chicken egg yolk, mix well. Divide into two doses. After taking three doses, the patient felt the coldness and numbness in lower limbs gradually recede. Vexation, sweating, insomnia, and chaotic dreams improved significantly. Dribbling urine and impotence also improved. Observe tongue: still crimson and little coating. Pulse wiry and slightly rapid. Continue with the original method. Prescription: Coptidis Rhizoma (Huanglian) 9g, Colla Corii Asini (Ejiao) 10g (melted), Scutellariae Radix (Huangqin) 3g, Paeoniae Radix Alba (Baishao) 9g, Chicken Egg Yolk (Jizihuang) 2 eggs (self-added), Moutan Cortex (Danpi) 6g. Six doses, decoction method same as before. On January 30, during snowfall and biting cold wind, the patient felt no abnormal cold pain. Cold extremities below the waist basically cured. One month later, according to the patient, no recurrence. (Mainly treated by Liu Duzhou, organized by Wei Minting: Successful Treatment of Lower Limb Cold Extremities, *Chinese Journal of Traditional Chinese Medicine*, Issue 12, Page 19, 1980)
[Commentary] Zhi Jue, also known as Four Limbs Cold or Hand-Foot Reverse Cold, or "Si Ni"; refers to the symptom of limbs cooling down to above the knees and elbows. It is divided into Cold and Heat types. Cold type is caused by internal excess of Yin-Cold and decline of Yang Qi failing to reach the extremities. Heat type is caused by heat damaging fluids, heat pathogen obstructing, and Yang Qi failing to reach the limbs externally.
Case 1 belongs to Qi and Blood insufficiency, where declining Yang Qi fails to warm, causing Zhi Jue. Treated with Danggui Sini Tang, adding Astragali Radix (Sheng Huangqi) and Cervi Cornu Pantotrichum (Lurong) to benefit Qi and warm Yang, unblocking Ying and Wei in the muscle surface, strengthening Yang, tonifying essence, and invigorating blood to enhance the warming and unblocking effect.
Case 2 Zhi Jue cold extremities is a false appearance of the disease. Despite repeated use of warming Kidney and assisting Yang, cold extremities remained. Only after detailed inquiry was the true nature revealed. Pattern: Blockage and non-communication between Upper and Lower Yin and Yang, Water and Fire not interacting. Hyperactive Heart Fire causes vexation, sweating, insomnia, chaotic dreams, red tongue with little coating, rapid pulse. Below, cold extremities, dribbling urine, and impotence occur. Administer Huanglian Ejiao Tang to drain South (Heart/Fire) and tonify North (Kidney/Water), communicating Heart and Kidney, achieving interaction of Water and Fire. Heart Fire descends, Kidney Water ascends. Heart and Kidney communicate, Yin and Yang harmonize, and symptoms self-resolve. This shows the importance of careful clinical assessment.
(23) Bi Syndrome
Case 1 Patient Chen XX, Male, 56 years old. First visit date: September 4, 1974. Joint pain throughout the body for over 4 years, diagnosed as Rheumatoid Arthritis. Usually afraid of cold, pain wanders不定 (irregular/migratory), worsening with cold exposure. Red nodules visible on both legs. ESR 70 mm/hour, Anti-Streptolysin O (ASO) normal. Tongue coating thin and greasy, tongue body pale, pulse fine. Pattern Differentiation: Wind-Cold-Damp Bi (Rheumatic activity with deficient constitution). Treatment Method: Warm the meridians and unblock collaterals. Prescription: Prepared Aconiti Lateralis Radix (Zhi Chuanwu, decoct first) 10g, Angelicae Sinensis Radix (Quan Danggui) 10g, Epimedii Folium (Xianlingpi) 15g, Cinnamomi Ramulus (Chuan Guizhi, add later) 8g, Solani Capsi-fructus (Xungufeng) 20g, Siegesbeckiae Herba (Xixiancao) 20g, Cynanchi Paniculati Radix (Xuchangqing) 15g, Glycyrrhizae Radix et Rhizoma (Sheng Gancao) 5g. 8 doses.
September 11: Nodules significantly reduced after medication, which is a good sign. Tongue coating white and greasy, pulse fine. Effect achieved, do not change prescription, continue with the original method. Add Honey-comb (Zhi Fengfang) 10g, Scorpio (Zhi Quanxie, powder, taken separately) 2g. 6 doses.
September 19: Re-examination ESR 21 mm/hour end. Joint pain stable, leg red nodules disappeared. To consolidate efficacy, instructed to take the original prescription for another 10 doses.
Follow-up on June 5, 1976: Patient cured, no recurrence, returned to normal work. (Mainly treated by Zhu Liangchun, organized by Chen Shuyuan et al.: Experience of Old TCM Doctor Zhu Liangchun in Treating Bi Syndrome, *Chinese Journal of Traditional Chinese Medicine*, Issue 12, Page 15, 1980)