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。
例二病程稍短，以《伤寒论》茯苓桂枝甘草大枣汤加味，3剂而安，5剂而愈。对于奔豚气重在识证，大凡沉寒痼冷，非附子、肉桂等大辛大热之品，无济于事。(二十八)反胃谢XX，女，55岁，住院号；763221。初诊日期c1976年9月31日。胃病史十余年，一月来未复发。中腹痛，拒按，三日来食后二小时呕吐食物、痰涎、酸水，大便艰秘，背恶寒，口干脉细，舌前红，苔根腻。辨证；胃失和降，痰饮内停，肝热乘之，下关既湿，势必上涌。治法；先拟清肝化饮通泄法。方药：姜川连2．4克炒吴萸1．5克炒黄芩4，5克枳实12克制半夏9克防己12克椒目6克生大黄4．5克煅瓦楞30克(先煎)10月4日(--诊)：大便溏软，腹痛止，稍感不舒，呕吐得瘥，并思纳食，苔根腻渐化。肝热减而痰饮已得下泄，梗阻已有缓解之象，仍守前法叠进。原方3剂。10月7日(三诊)：大便已正常，呕吐未复发，纳增，食后无不适，唯口多清涎，下腹时或胀气。脉细，舌红口不干。反胃之疾，已有向愈之势，再拟和胃化饮理气，以善后巩固。炒黄连1．8克炒吴萸0．9克川石斛12克茯苓12克防已12克椒目6克制半夏9克炒枳壳9克大腹皮12克佛手片4．S克7剂。(《张伯臾医案》)[评按]反胃系指食物进入，不能消化，终至尽吐而出的病证。多因气郁、积滞、血瘀，生冷酒食或胃阴耗伤、脾肾阳衰，以致胃失通降，故而“食入反吐”。古人虽有“食入反出，是无火也”之说，但临床所见仍有虚实寒热之别。本案西医诊断为幽门梗阻，临床表现与中医“反胃”相合。此例症见腹痛、食后两小时即吐，大便艰秘。证属胃失和降，食物挟饮交阻中焦，又见呕吐酸水、舌红等证。乃肝热犯胃之征。故用左金丸辛开苦降以清肝和胃，又用己、椒、苓、黄等辛苦通泄治法，使之胃复通降而愈。
(二九)呃逆
例一王XX，男，31岁。呃逆连连，已达八日之久。便秘亦已数日，上次排便干结，致肛痛出血甚多，脐右侧如拳攻起，胃脘亦痛。旋复花9克代赭石9克公丁香3克大黄6克芒硝9克柿蒂5只复诊：服药1剂，呃逆即停，今日胃痛减，排便三、四次，稍里急。川朴9克川连3克广木香3克陈皮6克黄芩6克二剂停诊。(姜春华医案，《中医杂志》4：56，1959)
例二邵XX，男，63岁。初诊日期：1952年7月11日。食物下胃不化，呃逆时作，滞而作痛，入腹之后，其痛更剧。此乃肝脾不和，气食两滞为患；业经月余，亟当和化，勿使成为膈证。空沙参12克焦冬术9克炒枳壳9克连水烧川朴3克黄郁金9克制乳没各9克沉香曲9克·生熟稻芽各9克佛手片9克焦鸡金9克白蔻仁9克甘草梢6克鲜荷梗1尺生荸荠3枚捣?月13日(二诊)：腹痛已愈，惟尚作呃逆，咽物下胃，尚微作痛。肝胃未和，当依法再进。南沙参12克五味槟榔9克郁金9克炒枳壳9克焦鸡金9克佛手片9克蔻仁6克六神曲9克炒稻芽9克土炒杭芍9克甘草3克鲜荷梗1尺·7月18日(三诊)：据述服药尚安，惟不能平睡，睡下则胃部发梗而气不通。气食两滞，均尚未化，当依法再进。空沙参12克姜川朴3克六神曲9克山楂炭9克五味槟榔9克盐砂仁6克青木香6克炒稻芽9克黄郁金6克藿香梗6克焦鸡金9克佛手片9克鲜荷梗1尺7月22日(四诊)：药后病已轻，因劳乏忽又反复，胃部作梗而更痛，仍当从本治。空沙参9克苦桔梗9克沉香曲9克真郁金9克广木香6克盐砂仁6克川牛膝9克蔻仁3克花槟榔9克首乌藤12克炒稻芽9克甘草梢3克鲜荷梗1尺8月1日(五诊)：食物下胃，仍上泛作吐，腹痛不减，入夜睡后更甚。肠脾不和，故时发时止，仍当从本治。南沙参12克连水炒川朴3克六神曲9克焦鸡金9克佛手片9克生熟稻芽各9克川黄连木香各1．5克制乳没各6克盐砂仁6克五味槟榔9克灵磁石12克(先煎)赤芍药9克生荷梗1尺—-8月4日(六诊)：各病皆轻，惟胃钝不开，食滞不化，食物下咽，往往停蓄脘间，作胀且痛。法当从本治。空沙参12克黄郁金9克沉香9克盐砂仁9克麸炒积实6克焦鸡金9克炒稻芽12克腹皮9克盐炒槟榔9克苦杏仁9克广木香9克皮茯苓12克佛手片9克干藕节5枚8月7日(七诊)；各病皆愈，惟尚吐痰涎，不吐则呃逆上冲难受。胃热脾湿，当从本治。南沙参12克焦冬术9克炒枳壳9克白蔻仁9克黄郁金9克连水炒川朴3克酒黄芩9克六神曲9克五味槟榔9克青竹茹9克盐砂仁6克甘草梢6克生荷叶1角带梗5寸(张绍重整理：萧龙友医案，《中医杂志》2：115，1958)[评按]呃逆系指气逆上冲，呃声连作，不能自制的证候。一般均能自愈，但也有连续不断达数日或半月之久者。
例一呃逆连连已周余，便秘数日。证属胃气上逆，腑气不通。故用旋复、代赭、丁香，柿蒂降逆气，大黄、川朴，芒硝通腑气，1剂而愈。
例二证属肝脾不和，气、食两滞而致胃痛呃逆。萧氏曾多次强调“仍当从本治”，此例何者为本?气食两滞，肝、脾、胃三脏失和为本。盖气滞则痛，气逆则哕。调气化滞即为治本之法，气顺滞通，则胃痛、呃逆方能平息。
(三十)呕吐
例一童XX，女，35岁。候诊时呕吐不止，披发槌胸，面赤，舌厚腻，白中带黄，诉胸中难进，如火焚，有气上冲。柴胡9克竹沥30克茯苓9克珍珠母30克青皮6克川连2．4克苏子9克白芍9克钩藤9克瓜蒌皮9克桂枝3克复诊，服药1剂，所患全失，昨今判若两人，舌尚腻白，胸间气闷。柴胡9克白芍9克苏子9克桂枝6克广郁金9克陈皮6克茯苓9克瓜萎皮9克香附6克3剂后不再作，停诊。(姜春华医案，《中医杂志》4c56，1959)
例二郑XX，男，32岁。初诊日期；1964年3月21日。两年来不时发生朝食暮吐或暮食朝吐。近来发作更频，每一、二日便呕吐一次。除吐食物外，尚有多量酸水，平时口淡无味，食后胃脘胀满，郁闷不舒，心中嘈杂，腰疼，肢末欠温。大便尚可，小便清长，次数增多。面色正常，唇色红赤，舌质红、舌苔薄白而滑，脉沉细弱，X线透视报告胃下垂4厘米。本
例口淡，脘胀，肢末欠温，小便清长而频，脉沉细弱，乃一派寒象，治宜温补中阳，但唇舌质红，吐多酸水，心中嘈杂，又系内有郁火征象。总缘脾肾虚寒，膈间有热，形成上热下寒，虚实并见之候。下寒宜温，上热宜清，先用半夏泻心汤加味以调和之。白皮参、煮半夏各9克黄连、黄芩、干姜、吴茱萸各6克炙甘草3克大枣3枚连服4剂。4月9日：治疗以来，只轻微呕吐两次，吐出物系清水，痰涎，仅夹少许饭物，无酸味，心中嘈杂已除，但时清涎自涌，肢末欠温，大便正常，小便仍清长频多，唇舌色正常，苔薄白而滑。上热已清，宜专温其中下。破故纸、炒白术，菟丝子各9克吴茱萸、煨肉蔻各4．5克干姜、炙甘草各3克明党参15克生姜6克服5剂。4月29日：半个月来又先后吐水三次，但均未挟有食物。其他症状与上次相同。连进温中收效不显者，因益火之力不足之故，与桂附理中加味。制川乌、炒白术、补骨脂、煮半夏各9克白晒参、煨肉蔻、干姜、炙甘草各6克肉桂1．2克(研冲)方中川乌同干姜、炙草先煎，一小时后入其它各药。每三日服一剂，连服10剂，诸症基本消失。随访三个月，症状基本控制。(俞长荣，益火生土法则的认识与实践，《中医杂志》11：25，1964)[评按]呕吐系指胃失和降，气逆于上所引起的证候。其病因诸如外感、饮食过多、情志不遂、或热病后胃阴已伤等，均可伤胃而致吐。
【背景信息】
书名：近现代名医验案类编 章节：正文(19/53) 类别：医论
【待处理原文】
案例一：方XX，男性，59岁，初诊日期为1976年3月11日。患者于1973年因腹泻、疲劳为诱因，逐渐出现右眼睑下垂、复视（看东西有重影），西医诊断为重症肌无力眼肌型，经中西药治疗症状缓解。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，颈部及肩胛部无力，同年12月两次出现呼吸困难，诊断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，遂于1976年3月11日来诊。症状大致如前，体型偏胖，面色微红，眼睑下垂，眼裂变小，头低倾，不能正常直立，双手不能上举。舌质嫩，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（服三剂时即开始减少吡啶斯的明剂量），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》1977年第4期）
案例二：XXX，女性，30余岁，1966年秋季，患病已半年，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，好像嚼着硬质食物一样，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
案例一：崔XX，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》）
案例二：吴XX，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。
例二病程稍短，以《伤寒论》茯苓桂枝甘草大枣汤加味，3剂而安，5剂而愈。对于奔豚气重在识证，大凡沉寒痼冷，非附子、肉桂等大辛大热之品，无济于事。
(二十八)反胃
案例：谢XX，女性，55岁，住院号：763221。初诊日期：1976年9月31日（注：原文日期有误，应为9月某日）。胃病史十余年，一月来未复发。中腹痛，拒按，三日来食后二小时呕吐食物、痰涎、酸水，大便艰秘，背恶寒，口干脉细，舌前红，苔根腻。辨证：胃失和降，痰饮内停，肝热乘之，下关既湿，势必上涌。治法：先拟清肝化饮通泄法。方药：姜川连2.4克，炒吴萸1.5克，炒黄芩4.5克，枳实12克，制半夏9克，防己12克，椒目6克，生大黄4.5克，煅瓦楞30克（先煎）。10月4日（二诊）：大便溏软，腹痛止，稍感不舒，呕吐得瘥，并思纳食，苔根腻渐化。肝热减而痰饮已得下泄，梗阻已有缓解之象，仍守前法叠进。原方3剂。10月7日（三诊）：大便已正常，呕吐未复发，纳增，食后无不适，唯口多清涎，下腹时或胀气。脉细，舌红口不干。反胃之疾，已有向愈之势，再拟和胃化饮理气，以善后巩固。炒黄连1.8克，炒吴萸0.9克，川石斛12克，茯苓12克，防己12克，椒目6克，制半夏9克，炒枳壳9克，大腹皮12克，佛手片4.5克，7剂。（《张伯臾医案》）[评按]反胃系指食物进入，不能消化，终至尽吐而出的病证。多因气郁、积滞、血瘀，生冷酒食或胃阴耗伤、脾肾阳衰，以致胃失通降，故而“食入反吐”。古人虽有“食入反出，是无火也”之说，但临床所见仍有虚实寒热之别。本案西医诊断为幽门梗阻，临床表现与中医“反胃”相合。此例症见腹痛、食后两小时即吐，大便艰秘。证属胃失和降，食物挟饮交阻中焦，又见呕吐酸水、舌红等证。乃肝热犯胃之征。故用左金丸辛开苦降以清肝和胃，又用己、椒、苓、黄等辛苦通泄治法，使之胃复通降而愈。
(二十九)呃逆
案例一：王XX，男性，31岁。呃逆连连，已达八日之久。便秘亦已数日，上次排便干结，致肛痛出血甚多，脐右侧如拳攻起，胃脘亦痛。旋复花9克，代赭石9克，公丁香3克，大黄6克，芒硝9克，柿蒂5只。复诊：服药1剂，呃逆即停，今日胃痛减，排便三、四次，稍里急。川朴9克，川连3克，广木香3克，陈皮6克，黄芩6克，二剂停诊。（姜春华医案，《中医杂志》1959年第4期：56）
案例二：邵XX，男性，63岁。初诊日期：1952年7月11日。食物下胃不化，呃逆时作，滞而作痛，入腹之后，其痛更剧。此乃肝脾不和，气食两滞为患；业经月余，亟当和化，勿使成为膈证。空沙参12克，焦冬术9克，炒枳壳9克，连水烧川朴3克，黄郁金9克，制乳没各9克，沉香曲9克，生熟稻芽各9克，佛手片9克，焦鸡金9克，白蔻仁9克，甘草梢6克，鲜荷梗1尺，生荸荠3枚捣碎。7月13日（二诊）：腹痛已愈，惟尚作呃逆，咽物下胃，尚微作痛。肝胃未和，当依法再进。南沙参12克，五味槟榔9克，郁金9克，炒枳壳9克，焦鸡金9克，佛手片9克，蔻仁6克，六神曲9克，炒稻芽9克，土炒杭芍9克，甘草3克，鲜荷梗1尺。7月18日（三诊）：据述服药尚安，惟不能平睡，睡下则胃部发梗而气不通。气食两滞，均尚未化，当依法再进。空沙参12克，姜川朴3克，六神曲9克，山楂炭9克，五味槟榔9克，盐砂仁6克，青木香6克，炒稻芽9克，黄郁金6克，藿香梗6克，焦鸡金9克，佛手片9克，鲜荷梗1尺。7月22日（四诊）：药后病已轻，因劳乏忽又反复，胃部作梗而更痛，仍当从本治。空沙参9克，苦桔梗9克，沉香曲9克，真郁金9克，广木香6克，盐砂仁6克，川牛膝9克，蔻仁3克，花槟榔9克，首乌藤12克，炒稻芽9克，甘草梢3克，鲜荷梗1尺。8月1日（五诊）：食物下胃，仍上泛作吐，腹痛不减，入夜睡后更甚。肠脾不和，故时发时止，仍当从本治。南沙参12克，连水炒川朴3克，六神曲9克，焦鸡金9克，佛手片9克，生熟稻芽各9克，川黄连木香各1.5克，制乳没各6克，盐砂仁6克，五味槟榔9克，灵磁石12克（先煎），赤芍药9克，生荷梗1尺。8月4日（六诊）：各病皆轻，惟胃钝不开，食滞不化，食物下咽，往往停蓄脘间，作胀且痛。法当从本治。空沙参12克，黄郁金9克，沉香9克，盐砂仁9克，麸炒枳实6克，焦鸡金9克，炒稻芽12克，腹皮9克，盐炒槟榔9克，苦杏仁9克，广木香9克，皮茯苓12克，佛手片9克，干藕节5枚。8月7日（七诊）：各病皆愈，惟尚吐痰涎，不吐则呃逆上冲难受。胃热脾湿，当从本治。南沙参12克，焦冬术9克，炒枳壳9克，白蔻仁9克，黄郁金9克，连水炒川朴3克，酒黄芩9克，六神曲9克，五味槟榔9克，青竹茹9克，盐砂仁6克，甘草梢6克，生荷叶1角带梗5寸。（张绍重整理：萧龙友医案，《中医杂志》1958年第2期：115）[评按]呃逆系指气逆上冲，呃声连作，不能自制的证候。一般均能自愈，但也有连续不断达数日或半月之久者。
例一呃逆连连已周余，便秘数日。证属胃气上逆，腑气不通。故用旋复、代赭、丁香，柿蒂降逆气，大黄、川朴，芒硝通腑气，1剂而愈。
例二证属肝脾不和，气、食两滞而致胃痛呃逆。萧氏曾多次强调“仍当从本治”，此例何者为本？气食两滞，肝、脾、胃三脏失和为本。盖气滞则痛，气逆则哕。调气化滞即为治本之法，气顺滞通，则胃痛、呃逆方能平息。
(三十)呕吐
案例一：童XX，女性，35岁。候诊时呕吐不止，披发槌胸，面赤，舌厚腻，白中带黄，诉胸中难进，如火焚，有气上冲。柴胡9克，竹沥30克，茯苓9克，珍珠母30克，青皮6克，川连2.4克，苏子9克，白芍9克，钩藤9克，瓜蒌皮9克，桂枝3克。复诊，服药1剂，所患全失，昨今判若两人，舌尚腻白，胸间气闷。柴胡9克，白芍9克，苏子9克，桂枝6克，广郁金9克，陈皮6克，茯苓9克，瓜萎皮9克，香附6克，3剂后不再作，停诊。（姜春华医案，《中医杂志》1959年第4期：56）
案例二：郑XX，男性，32岁。初诊日期：1964年3月21日。两年来不时发生朝食暮吐或暮食朝吐。近来发作更频，每一、二日便呕吐一次。除吐食物外，尚有多量酸水，平时口淡无味，食后胃脘胀满，郁闷不舒，心中嘈杂，腰疼，肢末欠温。大便尚可，小便清长，次数增多。面色正常，唇色红赤，舌质红、舌苔薄白而滑，脉沉细弱，X线透视报告胃下垂4厘米。本例口淡，脘胀，肢末欠温，小便清长而频，脉沉细弱，乃一派寒象，治宜温补中阳，但唇舌质红，吐多酸水，心中嘈杂，又系内有郁火征象。总缘脾肾虚寒，膈间有热，形成上热下寒，虚实并见之候。下寒宜温，上热宜清，先用半夏泻心汤加味以调和之。白皮参、煮半夏各9克，黄连、黄芩、干姜、吴茱萸各6克，炙甘草3克，大枣3枚，连服4剂。4月9日：治疗以来，只轻微呕吐两次，吐出物系清水，痰涎，仅夹少许饭物，无酸味，心中嘈杂已除，但时清涎自涌，肢末欠温，大便正常，小便仍清长频多，唇舌色正常，苔薄白而滑。上热已清，宜专温其中下。破故纸、炒白术，菟丝子各9克，吴茱萸、煨肉蔻各4.5克，干姜、炙甘草各3克，明党参15克，生姜6克，服5剂。4月29日：半个月来又先后吐水三次，但均未挟有食物。其他症状与上次相同。连进温中收效不显者，因益火之力不足之故，与桂附理中加味。制川乌、炒白术、补骨脂、煮半夏各9克，白晒参、煨肉蔻、干姜、炙甘草各6克，肉桂1.2克（研冲）。方中川乌同干姜、炙草先煎，一小时后入其它各药。每三日服一剂，连服10剂，诸症基本消失。随访三个月，症状基本控制。（俞长荣，益火生土法则的认识与实践，《中医杂志》1964年第11期：25）[评按]呕吐系指胃失和降，气逆于上所引起的证候。其病因诸如外感、饮食过多、情志不遂、或热病后胃阴已伤等，均可伤胃而致吐。
Background Information
Book: Compilation of Verified Cases by Famous Modern and Contemporary Physicians
Chapter: Main Text (19/53)
Category: Medical Discourse
Case 1: Fang XX, Male, 59 years old. First visit date: March 11, 1976. The patient gradually developed right ptosis (drooping of the upper eyelid) and diplopia (double vision) starting in 1973, triggered by diarrhea and fatigue. Western medicine diagnosed him with ocular myasthenia gravis. Symptoms were relieved after treatment with both Chinese and Western medicines. After catching a cold and fever in October 1975, he developed left ptosis and diplopia again, along with difficulty chewing and swallowing, weakness in the neck and scapulae. In December of the same year, he experienced dyspnea (difficulty breathing) twice and was diagnosed with bulbar myasthenia gravis. Western medicine treatment continued until January 5, 1976, but symptoms remained uncontrollable. He visited on March 11, 1976. Symptoms were roughly as before. He had a slightly overweight build, a slightly reddish complexion, ptosis, narrowed palpebral fissures, head inclination downwards, inability to stand upright normally, and inability to raise both hands. The tongue was tender with teeth marks, slightly red, with a thin white coating that was slightly yellow and greasy in the center. The pulse was deep, fine, and weak. Syndrome differentiation: Spleen Qi deficiency and decline, Liver stagnation, Kidney deficiency. Treatment method: Strengthen the Spleen and tonify Qi, soothe the Liver and nourish the Kidney. Prescription: Huangqi (Astragali Radix) 45g, Baizhu (Atractylodis Rhizoma) and Chuanxiong (Ligustici Chuanxiong Rhizoma) 12g each, Chenpi (Citri Reticulatae Pericarpium) 9g, Dangshen (Codonopsis Radix) 15g, Chaihu (Bupleuri Radix) 12g, Shengma (Cimicifugae Rhizoma) 6g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Shengjiang (Zingiberis Rhizoma Recens) 3g, Dazao (Jujubae Fructus) 12g, Shudi (Rehmanniae Radix Praeparata) 30g, Xianlingpi (Epimedii Folium) 15g, Maidong (Ophiopogonis Radix) 12g, Wuweizi (Schisandrae Chinensis Fructus) 9g. After taking 12 doses of the above prescription, self-perceived symptoms significantly decreased (starting from the third dose, the dosage of Pyridostigmine was reduced). Ptosis basically recovered, eating no longer required rest. After half a year of treatment, Western medicines were completely withdrawn, and self-perceived symptoms disappeared completely. The prescription was changed to Buzhong Yiqi Tang (Spleen-Raising Qi-Boosting Decoction) combined with Yiwei Tang (Stomach-Nourishing Decoction), made into pills for regulation. On April 14, 1977, follow-up examination showed basic recovery; he persisted in working half-days and intermittently took the aforementioned pills, achieving a basic cure. (Fang Yaozhong: Discussion on the Basic Spirit of Syndrome Differentiation and Treatment and its Steps and Methods in Clinical Application, *New Medicine Magazine*, 1977, Issue 4)
Case 2: XXX, Female, over 30 years old. Autumn 1966. The illness had lasted for half a year. Multiple hospital examinations all diagnosed myasthenia gravis, but treatment was ineffective. At the first visit, the complexion was pale and expressionless, eyelids drooped and could not open, there was shortness of breath and reluctance to speak, struggling for a long time to utter a single sentence, voice was low and faint, difficult to hear clearly when asked face-to-face, fatigue and lack of strength, difficult movement, requiring support from others even with slight activity. Each meal was less than two liang (approx. 100g), yet took over an hour, eating and resting repeatedly. Chewing steamed buns or noodles felt like chewing hard food; after less than two bites, the jaw became sore and tired, lacking strength to continue chewing. Sometimes, swallowing a bite of bun or soup halfway required temporary rest to continue. Menstruation was delayed, scanty flow, pale color. The pulse was weak, the tongue was pale with a thin coating. Syndrome belongs to Spleen deficiency and insufficiency of Middle Qi. Proposed treatment: Raise Yang and tonify Qi. Prescription: Sheng Huangqi (Raw Astragali Radix) 24g, Dangguishen (Angelicae Sinensis Radix Corperis) 9g, Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) 9g, Tu Baizhu (Atractylodis Rhizoma) 12g, Chenpi (Citri Reticulatae Pericarpium) 6g, Ganjiang (Zingiberis Rhizoma) 6g, Dangshen (Codonopsis Radix) 15g, Shengma (Cimicifugae Rhizoma) 6g, Chaihu (Bupleuri Radix) 6g. Decoct in water, one dose per day, taken continuously for 4 doses. Follow-up visit: After 4 doses, fatigue slightly decreased, other symptoms remained unchanged. Advised to take another 4 doses. Third visit: After another 4 doses, except for ptosis requiring manual lifting to open eyes, which would close again after 2-3 minutes, all other symptoms had significantly improved. Advised to take another 4 doses. Fourth visit: After another 4 doses, eye opening and closing were normal, though prolonged opening caused fatigue; other symptoms basically disappeared. Advised to halve the original prescription and take a few more doses for consolidation. Fifth visit: After continuing for 6 days, all symptoms vanished. (Yang Zuoqi, *Lin Zheng Lu*) [Commentary] Myasthenia gravis is a Western medical term, a hereditary, difficult disease with poor prognosis. Based on clinical manifestations, it falls within the scope of "Spleen Deficiency" syndrome differentiation in Traditional Chinese Medicine (TCM). If generalized muscle weakness occurs, it also belongs to "Wei Syndrome" (Flaccidity Syndrome).
Case 1 is ocular myasthenia gravis. The syndrome is Spleen Qi deficiency, Liver stagnation, and Kidney deficiency. The Spleen governs muscles; Spleen deficiency leads to muscle flaccidity and weakness. Kidney deficiency fails to warm Spleen Yang, causing the acquired foundation to lack nourishment. Therefore, Buzhong Yiqi Tang (Spleen-Raising Qi-Boosting Decoction) was used as the main formula, adding herbs to tonify the Kidney and soothe the Liver. Initially, Chinese and Western medicines were used together; later, only Chinese medicine was taken, achieving a basic cure.
Case 2's condition was heavier than the previous case. The prescription matched the syndrome, and efficacy was relatively fast. Although this disease is considered difficult, the syndrome differentiation in these two cases, whether using Chinese medicine alone or in combination with Western medicine, achieved such good results, which deserves attention.
(27) Ben Tun Qi (Rushing Pig Gas)
Case 1: Cui XX, Male, 40 years old. First visit date: April 20, 1971. Felt a mass around the umbilicus with upward thrusting and throbbing pain. During acute attacks, there was vomiting and diarrhea, and cold sweats. This illness started around age six or seven and has recurred since. Currently, appetite is poor, abdominal pain with aversion to cold, cold hands and feet, bowel and bladder functions are average. Coating is white, pulse is deep and slow. Syndrome differentiation: This is Ben Tun Qi caused by deep-seated cold and stubborn cold stagnating in the Middle Jiao. Treatment method: Greatly tonify Yang Qi, warm the Middle and dispel cold. Prescription: Lizhong Wan (Regulate the Middle Pill) combined with Fuzi Tang (Aconite Decoction) modified. Chao Baishao (Stir-fried Paeoniae Radix Alba) 10g, Jiao Baizhu (Charred Atractylodis Rhizoma) 10g, Ganjiang (Zingiberis Rhizoma) 10g, Dongshen (Dangshen/Codonopsis Radix) 9g, Pao Fuzi (Processed Aconiti Lateralis Radix Praeparata) 10g, Fuling (Poria) 10g, Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) 5g. April 29 (Second visit): After two doses of the above prescription, appetite and bowel/bladder functions improved, hands and feet turned warm, no longer afraid of cold, but still had umbilical and abdominal pain with upward thrusting, not refusing pressure. Pulse was deep and tight. Should continue using methods to warm the Liver, direct rebellious Qi downward, warm Yang, and regulate Qi. Prescription: Fuling (Poria) 10g, Banxia (Pinelliae Rhizoma) 10g, Chenpi (Citri Reticulatae Pericarpium) 10g, Chao Baishao (Stir-fried Paeoniae Radix Alba) 12g, Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) 5g, Chuanlianzi (Toosendan Fructus) 10g, Lizhi (Litchi Chinensis Fructus) 10g, Liangjiang (Alpiniae Officinarum Rhizoma) 6g, Wuzhuyu (Evodiae Fructus) 6g, Xiaohuixiang (Foeniculi Fructus) 10g, Rougui (Cinnamomi Cortex) 6g, Niuxi (Achyranthis Bidentatae Radix) 10g, Chenxiang (Aquilariae Lignum Resinatum) 5g. May 1 (Third visit): After two doses of the above prescription, umbilical and abdominal pain and upward thrusting improved, abdomen felt comfortable, appetite increased. Pulse was deep and tight but slower. All symptoms tended towards recovery. Continue taking the original prescription for 4 doses to consolidate efficacy. (*Selected Medical Experiences of Zhang Zilin*)
Case 2: Wu XX, Male, 31 years old. Summer 1970. Patient had pain around the umbilicus, hard upon palpation and refusing pressure, paroxysmal. During pain, felt something attacking upwards from below the umbilicus, attacks were severe ("wanting to die"), stopping after a while. Illness had lasted three years, attacks occurred at any time. Sometimes wandering pain in upper and lower limb joints. Pulse was deep, wiry, and slippery. Tongue coating was white and slippery. Hypothesized as Cold-Dampness and Water-Qi adhering to the Liver and Kidney meridians, failure of Bladder Qi transformation, leading to upward rushing of Cold-Water Qi. Treatment should calm rebellion, direct Qi downward, warm the Middle, and dispel cold. Guizhi (Cinnamomi Ramulus) 10g, Fuling (Poria) 30g, Wuzhuyu (Evodiae Fructus) 10g, Chao Baishao (Stir-fried Paeoniae Radix Alba) 15g, Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) 10g, Baizhu (Atractylodis Rhizoma) 10g, Chao Zhishi (Stir-fried Aurantii Fructus Immaturus) 10g, Chenpi (Citri Reticulatae Pericarpium) 10g, Fa Banxia (Processed Pinelliae Rhizoma) 10g, Yiyiren (Coicis Semen) 25g, Shengjiang (Zingiberis Rhizoma Recens) 3 slices, Dazao (Jujubae Fructus) 5 pieces. Three doses of the above prescription brought peace. Later, due to poor appetite, added Chenpi (Citri Reticulatae Pericarpium) and Shenqu (Medicated Leaven), taken again for recovery. (Zhang Mengnong, *Lin Zheng Hui Yao*) [Commentary] Ben Tun Qi refers to a syndrome where the patient feels Qi rushing from the Lower Abdomen up to the Chest and Diaphragm. It is recorded in the *Neijing* (Classic of Internal Medicine) and discussed in a dedicated chapter in the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet). Later physicians incorporated it into the category of "Ji Ju" (Accumulations and Masses).
Case 1 involves deep-seated cold and stubborn cold stagnating in the Middle Jiao, with Liver and Kidney Qi rebelling upwards striking the Heart. The prescription used Lizhong Tang (Regulate the Middle Decoction) combined with Fuzi Tang (Aconite Decoction) modified. After medication, Yang Qi gradually recovered, but upward Qi thrusting did not resolve. Subsequently, Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) combined with Cheng Zhongling's Ben Tun Wan (Rushing Pig Pill) modified was used. Because Qi rebellion was too severe, Niuxi (Achyranthis Bidentatae Radix) and Chenxiang (Aquilariae Lignum Resinatum) were added. A chronic disease of decades surprisingly achieved good efficacy.
Case 2 had a slightly shorter course. Using modified Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) from the *Shanghan Lun* (Treatise on Cold Damage Disorders), peace was achieved in 3 doses, and recovery in 5 doses. For Ben Tun Qi, recognizing the syndrome is key. Generally, for deep-seated cold and stubborn cold, without large acrid-hot herbs like Fuzi (Aconiti Lateralis Radix Praeparata) and Rougui (Cinnamomi Cortex), there is no help.
(28) Fan Wei (Reverse Stomach / Regurgitation)
Case: Xie XX, Female, 55 years old, Hospital No.: 763221. First visit date: September 31, 1976 (Note: Date error in original text). History of stomach disease for over ten years, no recurrence for one month. Mid-abdominal pain, refusing pressure. For the past three days, vomiting food, phlegm-saliva, and sour water two hours after eating. Bowel movements were difficult and constipated. Back felt cold, mouth dry, pulse fine. Anterior part of tongue red, root coating greasy. Syndrome differentiation: Stomach fails to descend harmoniously, Phlegm-Fluid retention internally, Liver Heat takes advantage, Lower gate is damp, inevitably surging upwards. Treatment method: First propose clearing Liver Heat, resolving Fluids, and purging unblocking. Prescription: Jiang Chuanlian (Ginger-processed Coptidis Rhizoma) 2.4g, Chao Wuzhuyu (Stir-fried Evodiae Fructus) 1.5g, Chao Huangqin (Stir-fried Scutellariae Radix) 4.5g, Zhishi (Aurantii Fructus Immaturus) 12g, Zhi Banxia (Processed Pinelliae Rhizoma) 9g, Fangji (Stephaniae Tetrandrae Radix) 12g, Jiaomu (Semen Trichosanthis) 6g, Sheng Dahuang (Raw Rheae Radix et Rhizoma) 4.5g, Duan Waleng (Calcined Margarita Concha) 30g (decocted first). October 4 (Second visit): Stool became soft, abdominal pain stopped, slight discomfort, vomiting improved, desire to eat returned, root coating gradually transformed. Liver Heat decreased, Phlegm-Fluids were purged downwards, obstruction showed signs of relief. Still adhere to the previous method and advance. Original prescription for 3 doses. October 7 (Third visit): Bowel movements normalized, vomiting did not recur, appetite increased, no discomfort after eating, only excessive clear saliva in mouth, occasional lower abdominal bloating. Pulse fine, tongue red, mouth not dry. The disease of Fan Wei (Reverse Stomach) shows signs of recovery. Again propose harmonizing Stomach, resolving Fluids, and regulating Qi for consolidation and follow-up. Chao Huanglian (Stir-fried Coptidis Rhizoma) 1.8g, Chao Wuzhuyu (Stir-fried Evodiae Fructus) 0.9g, Chuan Shihu (Dendrobii Caulis) 12g, Fuling (Poria) 12g, Fangji (Stephaniae Tetrandrae Radix) 12g, Jiaomu (Semen Trichosanthis) 6g, Zhi Banxia (Processed Pinelliae Rhizoma) 9g, Chao Zhike (Stir-fried Aurantii Fructus) 9g, Dafupi (Arecae Pericarpium) 12g, Foshoupian (Bergamiae Fructus) 4.5g, 7 doses. (*Zhang Boyu Medical Cases*) [Commentary] Fan Wei (Reverse Stomach) refers to a disease where food enters but cannot be digested, eventually being vomited out completely. It is mostly caused by Qi stagnation, accumulation, blood stasis, consumption of raw/cold/alcoholic foods, or consumption of Stomach Yin/Spleen-Kidney Yang decline, leading to failure of Stomach descending and unblocking, hence "food enters and is thrown back." Although ancients said "food enters and comes out, this is lack of Fire," clinical observations show differences between deficiency/excess and cold/heat. This case was diagnosed with pyloric obstruction by Western medicine, and clinical manifestations match TCM "Fan Wei." This case presented with abdominal pain, vomiting two hours after eating, and difficult stools. Syndrome belongs to Stomach failing to descend harmoniously, food mixed with Fluids obstructing the Middle Jiao, plus vomiting sour water and red tongue indicating Liver Heat invading the Stomach. Therefore, Zuojin Wan (Left Metal Pill) was used for acrid-opening and bitter-descending to clear Liver and harmonize Stomach, combined with Fangji (Stephaniae Tetrandrae Radix), Jiaomu (Semen Trichosanthis), Fuling (Poria), Huanglian (Coptidis Rhizoma) etc., using bitter-acrid unblocking methods, restoring Stomach descending and unblocking for recovery.
(29) E Ni (Hiccups)
Case 1: Wang XX, Male, 31 years old. Continuous hiccups for eight days. Constipation for several days. Last bowel movement was dry, causing anal pain and significant bleeding. Right side of umbilicus felt like a fist attacking upwards, epigastric pain also present. Xuanfuhua (Inulae Flos) 9g, Daizhe Shi (Haematitum) 9g, Gong Dingxiang (Eugeniae Flos) 3g, Dahuang (Rhei Radix et Rhizoma) 6g, Mangxiao (Natrii Sulfas) 9g, Shidi (Kaki Calyx) 5 pieces. Follow-up: After one dose, hiccups stopped. Today, stomach pain decreased, bowel movements 3-4 times, slight tenesmus. Chunghou (Magnoliae Officinalis Cortex) 9g, Chuanlian (Coptidis Rhizoma) 3g, Guangmuxiang (Aucklandiae Radix) 3g, Chenpi (Citri Reticulatae Pericarpium) 6g, Huangqin (Scutellariae Radix) 6g. Two doses, then stop consultation. (Jiang Chunhua Medical Case, *Chinese Journal of Traditional Medical Science and Technology* 1959, Vol 4: 56)
Case 2: Shao XX, Male, 63 years old. First visit date: July 11, 1952. Food entering the stomach is not digested, hiccups occur intermittently, stagnation causes pain, pain intensifies after entering the abdomen. This is due to Liver-Spleen disharmony, Qi and Food stagnation causing harm; having lasted over a month, urgently need to harmonize and transform, do not let it become Ge Syndrome (Obstruction Syndrome). Kong Shashen (Glehniae Radix) 12g, Jiao Dongzhu (Charred Atractylodis Macrocephalae Rhizoma) 9g, Chao Zhike (Stir-fried Aurantii Fructus) 9g, Lianshui Shao Chunghou (Water-decocted Magnoliae Officinalis Cortex) 3g, Huang Yujin (Curcumae Longae Radix) 9g, Zhi Rumai (Processed Commiphora Myrrha and Boswellia Olibanum) 9g each, Chenxiangqu (Aquilariae Lignum Resinatum Qu) 9g, Sheng Shu Daoya (Raw and Fried Oryzae Fructus Germinatus) 9g each, Foshoupian (Bergamiae Fructus) 9g, Jiao Jijin (Charred Gallus Gallus Gizzard Membrane) 9g, Baokouren (Amomi Fructus Rotundus) 9g, Gancaoshao (Licorice Tip) 6g, Xian Hegeng (Fresh Nelumbinis Nodus) 1 chi (approx. 33cm), Sheng Biqi (Raw Dioscoreae Hypoglaucae Rhizoma) 3 pieces, crushed. July 13 (Second visit): Abdominal pain healed, only still hiccupping, swallowing food into stomach still causes slight pain. Liver-Stomach not harmonized, should proceed according to method again. Nan Shashen (Glehniae Radix) 12g, Wuwei Binglang (Arecae Semen with Arecae Pericarpium) 9g, Yujin (Curcumae Longae Radix) 9g, Chao Zhike (Stir-fried Aurantii Fructus) 9g, Jiao Jijin (Charred Gallus Gallus Gizzard Membrane) 9g, Foshoupian (Bergamiae Fructus) 9g, Kouren (Amomi Fructus Rotundus) 6g, Liushenqu (Six Gods Medicated Leaven) 9g, Chao Daoya (Stir-fried Oryzae Fructus Germinatus) 9g, Tu Chao Hangshao (Earth-stir-fried Paeoniae Radix Alba) 9g, Gancao (Glycyrrhizae Radix et Rhizoma) 3g, Xian Hegeng (Fresh Nelumbinis Nodus) 1 chi. July 18 (Third visit): Reports taking medicine safely, but cannot sleep flat, lying down causes stomach blockage and Qi不通 (blockage). Qi and Food stagnation have not resolved, should proceed according to method again. Kong Shashen (Glehniae Radix) 12g, Jiang Chunghou (Ginger-processed Magnoliae Officinalis Cortex) 3g, Liushenqu (Six Gods Medicated Leaven) 9g, Shan Zha Tan (Crataegi Fructus Charred) 9g, Wuwei Binglang (Arecae Semen with Arecae Pericarpium) 9g, Yan Sharen (Salt-processed Amomi Fructus) 6g, Qingmuxiang (Aucklandiae Radix) 6g, Chao Daoya (Stir-fried Oryzae Fructus Germinatus) 9g, Huang Yujin (Curcumae Longae Radix) 6g, Huoxiang Geng (Pogostemonis Herba) 6g, Jiao Jijin (Charred Gallus Gallus Gizzard Membrane) 9g, Foshoupian (Bergamiae Fructus) 9g, Xian Hegeng (Fresh Nelumbinis Nodus) 1 chi. July 22 (Fourth visit): Condition lightened after medicine, but suddenly relapsed due to fatigue, stomach blockage and worse pain, still should treat from the root. Kong Shashen (Glehniae Radix) 9g, Ku Jiegeng (Platycodonis Radix) 9g, Chenxiangqu (Aquilariae Lignum Resinatum Qu) 9g, Zhen Yujin (Curcumae Longae Radix) 9g, Guangmuxiang (Aucklandiae Radix) 6g, Yan Sharen (Salt-processed Amomi Fructus) 6g, Chuan Niuxi (Achyranthis Bidentatae Radix) 9g, Kouren (Amomi Fructus Rotundus) 3g, Hua Binglang (Arecae Semen) 9g, Shouwuteng (Polygoni Multiflori Caulis) 12g, Chao Daoya (Stir-fried Oryzae Fructus Germinatus) 9g, Gancaoshao (Licorice Tip) 3g, Xian Hegeng (Fresh Nelumbinis Nodus) 1 chi. August 1 (Fifth visit): Food entering stomach still refluxes and vomits, abdominal pain not reduced, worse after sleeping at night. Intestine-Spleen disharmony, so attacks come and go, still should treat from the root. Nan Shashen (Glehniae Radix) 12g, Lianshui Chao Chunghou (Water-decocted Stir-fried Magnoliae Officinalis Cortex) 3g, Liushenqu (Six Gods Medicated Leaven) 9g, Jiao Jijin (Charred Gallus Gallus Gizzard Membrane) 9g, Foshoupian (Bergamiae Fructus) 9g, Sheng Shu Daoya (Raw and Fried Oryzae Fructus Germinatus) 9g each, Chuan Huanglian (Coptidis Rhizoma) and Muxiang (Aucklandiae Radix) 1.5g each, Zhi Rumai (Processed Commiphora Myrrha and Boswellia Olibanum) 6g each, Yan Sharen (Salt-processed Amomi Fructus) 6g, Wuwei Binglang (Arecae Semen with Arecae Pericarpium) 9g, Ling Cishi (Magnetitum) 12g (decocted first), Chi Shaoyao (Paeoniae Radix Rubra) 9g, Sheng Hegeng (Fresh Nelumbinis Nodus) 1 chi. August 4 (Sixth visit): All diseases lightened, only stomach dull and not opening, food stagnation not transforming, food swallowed often stays in epigastrium, causing bloating and pain. Method should treat from the root. Kong Shashen (Glehniae Radix) 12g, Huang Yujin (Curcumae Longae Radix) 9g, Chenxiang (Aquilariae Lignum Resinatum) 9g, Yan Sharen (Salt-processed Amomi Fructus) 9g, Fu Chao Zhishi (Bran-stir-fried Aurantii Fructus Immaturus) 6g, Jiao Jijin (Charred Gallus Gallus Gizzard Membrane) 9g, Chao Daoya (Stir-fried Oryzae Fructus Germinatus) 12g, Fupi (Arecae Pericarpium) 9g, Yan Chao Binglang (Salt-stir-fried Arecae Semen) 9g, Ku Xingren (Pruni Semen) 9g, Guangmuxiang (Aucklandiae Radix) 9g, Pi Fuling (Poria with Hostwood) 12g, Foshoupian (Bergamiae Fructus) 9g, Gan Oujiem (Dried Lotus Rhizoma Node) 5 pieces. August 7 (Seventh visit): All diseases healed, only still vomiting phlegm-saliva, if not vomited, hiccups rush up uncomfortably. Stomach Heat and Spleen Dampness, should treat from the root. Nan Shashen (Glehniae Radix) 12g, Jiao Dongzhu (Charred Atractylodis Macrocephalae Rhizoma) 9g, Chao Zhike (Stir-fried Aurantii Fructus) 9g, Baokouren (Amomi Fructus Rotundus) 9g, Huang Yujin (Curcumae Longae Radix) 9g, Lianshui Chao Chunghou (Water-decocted Stir-fried Magnoliae Officinalis Cortex) 3g, Jiu Huangqin (Wine-processed Scutellariae Radix) 9g, Liushenqu (Six Gods Medicated Leaven) 9g, Wuwei Binglang (Arecae Semen with Arecae Pericarpium) 9g, Qing Zhuru (Green Bamboo Sap) 9g, Yan Sharen (Salt-processed Amomi Fructus) 6g, Gancaoshao (Licorice Tip) 6g, Sheng Heye (Fresh Nelumbinis Folium) 1 corner with stem 5 cun (approx. 16cm). (Organized by Zhang Shaozhong: Xiao Longyou Medical Cases, *Chinese Journal of Traditional Medical Science and Technology* 1958, Vol 2: 115) [Commentary] E Ni (Hiccups) refers to a syndrome where Qi rebels upwards, hiccup sounds occur continuously, unable to control oneself. Generally can heal spontaneously, but sometimes continuous for several days or half a month.
Case 1 hiccups continuous for over a week, constipation for several days. Syndrome belongs to Stomach Qi rebelling upwards, Fu-organ Qi not unblocking. Therefore, Xuanfu (Inulae Flos), Daizhe (Haematitum), Dingxiang (Eugeniae Flos), Shidi (Kaki Calyx) were used to direct rebellious Qi downward, Dahuang (Rhei Radix et Rhizoma), Chunghou (Magnoliae Officinalis Cortex), Mangxiao (Natrii Sulfas) to unblock Fu-organ Qi. One dose cured it.
Case 2 syndrome belongs to Liver-Spleen disharmony, Qi and Food stagnation causing stomach pain and hiccups. Mr. Xiao repeatedly emphasized "still should treat from the root." What is the root in this case? Qi and Food stagnation, disharmony of Liver, Spleen, and Stomach organs is the root. Qi stagnation causes pain, Qi rebellion causes hiccups. Regulating Qi and resolving stagnation is the method of treating the root. When Qi flows smoothly and stagnation unblocks, stomach pain and hiccups can subside.
(30) Ou Tu (Vomiting)
Case 1: Tong XX, Female, 35 years old. While waiting for consultation, vomiting incessantly, hair disheveled, beating chest, face red, tongue thick and greasy, white with yellow tint, complained of difficulty in chest, feeling like burning, Qi rushing upwards. Chaihu (Bupleuri Radix) 9g, Zhuli (Bambusae Succus) 30g, Fuling (Poria) 9g, Zhenzhumu (Margarita) 30g, Qingpi (Citri Reticulatae Pericarpium Viride) 6g, Chuanlian (Coptidis Rhizoma) 2.4g, Suzi (Perillae Fructus) 9g, Baishao (Paeoniae Radix Alba) 9g, Gouteng (Uncariae Ramulus cum Uncis) 9g, Gualoupi (Trichosanthis Pericarpium) 9g, Guizhi (Cinnamomi Ramulus) 3g. Follow-up: After one dose, all ailments lost, yesterday and today like two different people, tongue still greasy white, chest Qi stuffiness. Chaihu (Bupleuri Radix) 9g, Baishao (Paeoniae Radix Alba) 9g, Suzi (Perillae Fructus) 9g, Guizhi (Cinnamomi Ramulus) 6g, Guang Yujin (Curcumae Radix) 9g, Chenpi (Citri Reticulatae Pericarpium) 6g, Fuling (Poria) 9g, Gualoupi (Trichosanthis Pericarpium) 9g, Xiangfu (Cyperi Rhizoma) 6g. After 3 doses, no longer occurs, stop consultation. (Jiang Chunhua Medical Case, *Chinese Journal of Traditional Medical Science and Technology* 1959, Vol 4: 56)
Case 2: Zheng XX, Male, 32 years old. First visit date: March 21, 1964. For two years, occasionally morning food vomited in evening or evening food vomited in morning. Recently attacks more frequent, vomiting once every one or two days. Besides vomiting food, also large amount of sour water. Usually tasteless mouth, epigastric fullness after eating, depressed and uncomfortable, heartburn, lower back pain, extremities not warm. Bowel movements acceptable, urine clear and long, frequency increased. Complexion normal, lips red, tongue body red, coating thin white and slippery, pulse deep, fine, and weak. X-ray fluoroscopy report: Gastroptosis 4 cm. This case: Tasteless mouth, epigastric fullness, cold extremities, clear and frequent urine, deep fine weak pulse, presents a picture of Cold syndrome, treatment should warm and tonify Middle Yang. But lips and tongue body red, vomiting much sour water, heartburn, indicates internal stagnant Fire. Overall due to Spleen-Kidney deficiency cold, Heat between Diaphragm, forming Upper Heat Lower Cold, Deficiency-Excess coexisting syndrome. Lower Cold should be warmed, Upper Heat should be cleared. First use Banxia Xiexin Tang (Pinellia Decoction for Draining the Epigastrium) modified to harmonize. Baipiren (Codonopsis Radix) and Zhu Banxia (Boiled Pinelliae Rhizoma) 9g each, Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Ganjiang (Zingiberis Rhizoma), Wuzhuyu (Evodiae Fructus) 6g each, Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) 3g, Dazao (Jujubae Fructus) 3 pieces. Taken continuously for 4 doses. April 9: Since treatment, only slight vomiting twice, vomitus was clear water, phlegm-saliva, only mixed with small amount of rice, no sour taste, heartburn removed, but clear saliva occasionally wells up, extremities not warm, bowel movements normal, urine still clear, long and frequent, lip and tongue color normal, coating thin white and slippery. Upper Heat cleared, should specifically warm Middle and Lower. Poguzhi (Psoraleae Fructus), Chao Baizhu (Stir-fried Atractylodis Rhizoma), Tusizi (Cuscutae Semen) 9g each, Wuzhuyu (Evodiae Fructus), Wei Roudoukou (Nutmeg wrapped in ash) 4.5g each, Ganjiang (Zingiberis Rhizoma), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) 3g each, Ming Dangshen (Codonopsis Radix) 15g, Shengjiang (Zingiberis Rhizoma Recens) 6g. Taken for 5 doses. April 29: Vomited water three times in half a month, but none mixed with food. Other symptoms same as last time. Continuous warming of Middle yielded little effect because power to benefit Fire was insufficient. Used Guifu Lizhong Tang (Cinnamon, Aconite, Regulate Middle Decoction) modified. Zhi Chuanwu (Processed Aconiti Kusnezoffii Radix), Chao Baizhu (Stir-fried Atractylodis Rhizoma), Buguzhi (Psoraleae Fructus), Zhu Banxia (Boiled Pinelliae Rhizoma) 9g each, Bai Shaishen (Codonopsis Radix), Wei Roudoukou (Nutmeg wrapped in ash), Ganjiang (Zingiberis Rhizoma), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) 6g each, Rougui (Cinnamomi Cortex) 1.2g (powdered and taken with decoction). In the prescription, Chuanwu (Aconiti Kusnezoffii Radix) decocted first with Ganjiang (Zingiberis Rhizoma) and Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) for one hour, then add other herbs. One dose every three days, taken continuously for 10 doses, all symptoms basically disappeared. Follow-up for three months, symptoms basically controlled. (Yu Changrong, Understanding and Practice of the Principle of Benefiting Fire to Generate Earth, *Chinese Journal of Traditional Medical Science and Technology* 1964, Vol 11: 25) [Commentary] Ou Tu (Vomiting) refers to a syndrome caused by Stomach failing to descend harmoniously and Qi rebelling upwards. Etiology such as external contraction, excessive diet, emotional frustration, or Stomach Yin injury after febrile disease, can all damage the Stomach and cause vomiting.