例四方XX，男，25岁。患者因肝脾肿大，全身发黄已八年，曾住院治疗，效果不显著，继而出现腹水，黄疸指数100单位以上，并经肝脏活体检查证实为“胆汁性肝硬化”。患者消瘦，面色黄黯晦滞无光，巩膜深度黄染，周身皮肤呈深黯黄色，精神倦怠，声低息短，少气懒言，不思饮食，不渴饮，小便短少，色如浓茶，腹水臌胀，四肢瘦削，颜面及足跗以下浮肿，两胁疼痛。脉沉弦劲而紧，舌白滑厚腻而带黄色，少津。辨证：阳虚水寒，肝气郁结，湿浊中阻，发为“阴瘅症”。治法：扶阳抑阴，舒肝利胆，健脾除湿。方药：四逆茵陈五苓散加减。附片100克(煎2～3小时)干姜50克肉桂15克(研末泡水兑入)吴萸15克(炒)败酱草15克茵陈30克猪苓15克茯苓50克北细辛8克苍术20克甘草8克二诊：服上方10余剂后，黄疸已退十之八、九，肝脾肿大已缩小，小便色转清，黄疸指数降至20单位，食欲增加，大便正常，精神转佳。肝肾虚寒，脾气尚弱，寒湿邪阴尚未肃清，宜再扶阳温化主之：附片150克(先煎2～3小时)干姜80克茵陈80克茯苓30克苡仁20克肉桂15克(研末，泡水兑入)吴萸10克白术20克桂尖30克甘草10克三诊：服上方6剂后，经检查症状消失，化验检查恢复正常，继以扶阳温化调理，以巩固疗效。附子150克(先煎2～3小时)干姜80克砂仁15克郁金10克肉桂15克(研末，泡水兑入)苡仁30克佛手20克甘草10克服上方7、8剂后，已基本恢复健康，随访一年，情况良好。(《吴佩衡医案》)
例五张XX，男，36岁。仲夏。头昏，心跳，腿胀，溏泄，食欲减退，身目俱呈暗黄色，小便亦现微黄，舌苔薄白，脉象代缓。辨证，劳伤元气，脾失健运，寒湿在里不解，阻塞胆汁入肠，渗入血液，循环外溢。治法，温化沉寒，淡渗湿邪。方药：加减当归白术汤主之。当归9克白术12克茯苓12克桂枝4．5克法半夏6克陈皮3克茵陈30克苍术6克炙甘草3克鸡内金9克4剂脉平病减，黄退十之六，七，改加味附子理中汤治之，6剂康复。附片9克白术12克黄芪9克当归9克西茵陈24克炙甘草6克干姜3克党参12克(赖良蒲《蒲园医案》)
例六毕XX，男，26岁，病例号：247673。住院日期：1963年10月15日。患者于1961年9月因发黄而确诊为病毒性肝炎(黄疸型)。经中西药治疗，症状好转，黄疸未退尽。1963年10月15日又住院，自觉疲乏，右胁痛，劳累盾加重，面色无泽，巩膜微黄。黄疸指数20单位。舌苔薄白，脉沉缓。辨证，脾阳不振，寒湿凝聚，发为阴黄。治法：温振脾阳，祛湿散寒，活血退黄。方药：茵陈60克郁金10克生芪12克党参15克干姜6克炮附子10克茯苓15克白术10克生甘草3克服上方6剂后，加泽兰15克，续服14剂，症状稍有改善，复查肝功能：黄疸指数9单位，上方共服三月；症状消失，肝功能正常，临床痊愈。(《关幼波临床经验选》)[评按]黄疸系指以身黄、目黄、小便黄为主的证候。胎匮要略》分为五疸。自元代罗天益之后，根据黄疸的性质，分为阳黄与阴黄两类。前者多因湿热蕴蒸，熏染发黄；后者多因寒湿阻遏，脾阳不振所致。近些年来由于防治病毒性肝炎，对于黄疸的辨证论治更有所发挥。
例一湿热炽盛，肝胆郁结，腑气不通，营阴耗灼，心神受扰，证属急黄，病情危笃。治以清热通腑，凉血解毒。方用茵陈蒿汤加味，药后腑通神清，黄疸渐退。继以疏肝利胆、益气生津收功。
例二病势稍缓而黄疸较重，曾用中西药，并用过激素治疗。已见脾虚肝郁，肝阴亏损之证，使用健脾舒肝，养阴活血为法，继用通络活血，化湿清热而取效。
例三诊为粘液性(不全)阻塞性黄疸，属于阳黄范畴，始用利胆清热化湿之剂，方证尚称符合，服12剂后黄疸仍未消。关氏仍遵其常法，并重视疏肝利水，加用理气化痰、凉血活血、清热燥湿解毒之剂，迅速治愈，充分体现了他的治黄学术见解，亦即除常规治黄外，重视活血、化痰、解毒的独特看法，这是对于治黄理论方面的发挥。
例四为阴黄，证属阳虚水寒，寒湿内滞，肝气郁结不舒，阳虚则水邪泛滥，治以四逆、茵陈五苓散加减，
例五身目俱呈暗黄色。仲景曰“身目为黄，寒湿在里，以为不可下也，于寒湿中求之”。此与瘀热在里发黄，可用清下之剂者有别，故治以温化沉寒，淡渗湿邪之法，证方殊为合拍。然而从实际临床中经常会看到，始为阳黄，由于湿毒热邪耗伤正气，病久缠绵，气阴两伤，亦可由阳黄转为阴黄，如例六，目黄面晦无泽，经询问其病史，始于阳黄，而后转为阴黄。实乃病久正虚，由阳入阴之机。故当温振脾阳为主，兼以祛湿散寒，活血退黄，这一观点也是关氏对于阴黄的个人见解之一。
中医瑰宝苑 近现代名医验案类编er
(三十五)黑疸
例一赵XX，男，37岁。初诊日期，1973年5月16日。患者因过累和生气，在旅途中发高烧。此后经常头痛，头晕、腰痛、精神不佳，四肢无力，食欲减退，厌油，全身肌肉废痛，—脚后跟痛，脸色逐渐变黑，齿龈及口腔粘膜出现黑色斑块，明显消瘦、经西医检查诊为“阿狄森氏病”。服用强的松、甘草硫浸膏治疗。由家属推车送来，背至诊室，面色黧黑，精神淡漠，少气懒言，时而打嗝恶呕。脉弦数而虚。舌质红，苔厚腻而黄。辨证：阴虚阳亢，气滞夹瘀。治法：滋肾柔肝，佐以化瘀。方药：沙参12克细生地12克枸杞子9克鸡血藤18克黑故脂12克地鳖虫9克生蒲黄9克桑寄生15。克菟丝子15克女贞子24克旱莲草24克柿蒂9克制旋覆花12克鸡内金9克琥珀末6克一周6剂，连服两周。精神好转，恶呕减轻，此后共服药三个多月，随症加减的药物有：石斛、玄参、生牛蒡、槟榔，炒川楝，夜交藤、金樱子，蜈蚣、乌梢蛇等。8月25日某医院检查尿17酮7．3毫克，17羟5．5毫克，病情明显好转，色素减退。
(《王渭川临床经验选》)
例二区XX，女，24岁。住院号：72／58020、七、八年来，皮肤和粘膜色素沉着日益加深，现呈黧黑，枯槁，面部、乳头，手足背侧，阴部等处尤显。头晕，甚则昏仆，神疲乏力，纳呆，脉细，舌紫暗，苔根腻。黑属肾色，肾阳不足，则阴盛而气滞瘀阻，古称黑疸，拟益肾活血化瘀。仙茅12克仙灵脾12克全当归9克桃仁泥9克杜红花6克炒川芎4．5克粉萆薢12克云茯苓9克补骨脂12克焦楂曲各9克稍加减，服20余剂另：血余240克，猪肤500克，共熬膏，每日二次，每次一匙，长期服用。2月7日
(二诊)，近来因疲劳过度，昨日又昏倒，经急诊检查为血压低，对症处理后收入病房。现仍神疲头晕，脉细，舌紫暗，苔薄。气血两亏，虚风上旋，拟益肾化癣，调补气血，以平虚风。炒党参12克补骨脂12克仙茅12克仙灵脾12克全当归9克炒亦白芍各6克鸡血藤12克炒川芎4．5克紫石英18克鹿角霜9克怀牛膝15克7剂。2月14日
(三诊)：肤黑稍退，口干，四肢冷，艰寐，头晕欲恶，脉细，舌暗尖转红，阳气虚弱，脉行不利，不温四末，再守原法合当归四逆汤加减。全当归9克川桂枝4．5克赤白芍各6克细辛2．4克仙灵脾12克鹿角霜9克怀牛膝15克补骨脂12克紫石英18克
(先煎)夜交藤15克姜半夏9克连服30剂。3月14日
(四诊)：面部黑色转淡，口唇色紫红，手足背黑色稍退，头晕伯冷，脉沉细，苔薄白，舌边紫暗。再拟益肾通脉化瘀。制熟地15克制附片6克
(先煎)仙茅15克仙灵脾15克鹿角片9克当归尾9克制川芎9克川桂枝4．5克木通4．5克紫石英15克
(庶/虫）虫丸6克
(分吞)稍加减，服28剂。4月11日
(五诊)：面部黑色十退八，九，惟指、趾，乳头，阴部色退较缓，肢冷好转，心悸失眠，纳呆乏力，脉细，舌边紫，苔薄腻。阳气渐复，阴寒得减，瘀血见化，再守原法，久服取效。全当归12克木通4．5克制川芎4．5克川桂枝4．5克炙甘草3克熟附片4．5克
(《张伯臾医案》)[评按]黑疸为《金匮要略》病名，为五疸之一。多因疸证经久不愈，肝肾虚衰，气血瘀阻所致。多见身黄不泽，目青，面额色黑，大便黑等症。自黄疸分为阴黄、阳黄两大类后，黑疸之病名临证已很少引用。以上所载二例，西医诊断为阿狄森氏病，实际并非疸证。原案病名黑疸，列此仅供参考。
例二证属肾阳不足，瘀血内停，治以益肾化瘀为主，又因见有四肢厥逆，更用当归四逆汤合大黄(庶/虫）虫丸通脉化瘀，久服取效。两例诊断相同而辨证有异，同为虚证又有阴虚阳虚之分；同有血瘀又有轻重之别，临证者于溯因、审证、论治时当予注意。
(三十六)痞块刘XX，男，40岁，初诊日期：1952年7月31日。小腹内有块已多年，并不为害。近因动气食物不合，致大小便不畅，曾经医治，大便虽通而不畅，反觉心跳发热，小溲更觉不畅。此气食两滞，寒热混杂之病，新旧并发，当标本兼治。空沙参12克藿梗6克黄郁金6克大腹皮9克连水炒川朴6克沉香曲6克焦鸡金3克茯苓皮12克车前子9克炒扁豆衣9克焦冬术6克甘草梢9克鲜荷叶1角带梗5寸8月22日
(二诊)：素有胃病而肝旺肾虚，故动气则绕腹，右转向下，小腹胀痛，食物下胃，停滞不消，呃逆大作。病根已深，宜小心将护。台党参12克黄郁金9克沉香曲6克葶苈子9克大腹皮9克金狗脊12克(去毛)茯苓皮12克广木香6克焦鸡金9克佛手片9克生熟稻芽各9克甘草梢9克生藕节5枚大枣3枚8月24日
(三诊)；胃纳略能消化，但食后往上泛，腹中仍汨汨有声。按脐下痛处则思小便，脾肾两虚，寒湿未化，仍当从本治。台党参12克焦冬术6克朱茯神9克黄郁金9克大桂枝9克炒白芍12克厚附片9克广木香6克制香附6克金狗脊9克(去毛)佛手片9克焦鸡金9克冬瓜皮15克苦葶苈6克大枣2枚8月26日
(四诊)：服药尚安，痞块有化解之势，惟腹尚作痛，痛时遗溺少许则安。此乃湿热内挟为患，恐系寒邪所化，仍当从本治。(据述日来头昏流清涕，温度加高，当属感冒)台党参9克藿梗9克苦杏仁9克黄郁金9克厚附片9克狗脊9克去毛车前子12克冬瓜皮15克沉香曲9克酒芩柏各6克茯苓块12克甘草梢9克苦葶苈9克大枣3枚
五诊(无日期)，近日因感风化热，咳嗽吐黄痰，两肋仍胀痛，腹中亦难受，得虚恭始安。法当标本兼治。北沙参12克薄荷梗9克苦杏仁9克知贝母各9克制乳没各6克茯苓皮12克冬瓜皮15克大腹皮9克苦葶苈9克苦桔梗9克真郁金9克甘草9克生藕节5枚大枣3枚8月31日
(六诊)：据述服药后胸部胀闷，小腹发凉，包块作跳，小溲因腹痛其量甚少。肾部虚寒，心经有热，寒热相搏，故心跳而肾空疼。当从本治。台党参12克甘枸杞12克瞿麦9克萹蓄9克厚附片9克大桂枝12克生杭芍9克朱枣仁9克抱木茯神12克真郁金6克灵磁石12克
(七诊)：服前方病已痊愈，近因动气停食，胸部连腹又觉胀痛，包块跳动不安，两肋亦形膨胀。先治标病，再议固本。空沙参9克黄郁金9克焦鸡金9克佛手片9克老苏梗6克苦杏仁9克制乳没各9克冬瓜皮仁各15克丝瓜络9克云茯苓12克炒稻芽9克沉香曲9克生荷梗1尺甘草梢6克
(张绍重整理，萧龙友医案，《中医杂志》2：115，1958)
[评按]“痞块”一名见于《医宗必读》，按其性质或症状，’均可归入积聚范围。所谓积聚系指腹内结块，或胀或痛。积有形，固定不移，痛有定处，聚无形，聚散无常，痛无定处。本例应属“积”，始因动气食物不合而致气食两滞，寒热混杂，新旧并发，故当标本兼治，但以治本为主。溯其本，乃脾肾两虚，寒湿未化，故以健脾补肾、温化寒湿治其本。在治疗过程中，曾因外感、动气而症情复作，萧氏掌握先标后本辨治法则，方治又趋合拍。
(三十七)水肿
【背景信息】
书名：近现代名医验案类编 章节：正文(22/53) 类别：医论
【待处理原文】
案例四 XX，男，25岁。患者因肝脾肿大，全身发黄已八年，曾住院治疗，效果不显著，继而出现腹水，黄疸指数100单位以上，并经肝脏活体检查证实为“胆汁性肝硬化”。患者消瘦，面色黄黯晦滞无光，巩膜深度黄染，周身皮肤呈深黯黄色，精神倦怠，声低息短，少气懒言，不思饮食，不渴饮，小便短少，色如浓茶，腹水臌胀，四肢瘦削，颜面及足跗以下浮肿，两胁疼痛。脉沉弦劲而紧，舌白滑厚腻而带黄色，少津。辨证：阳虚水寒，肝气郁结，湿浊中阻，发为“阴瘅症”（阴黄）。治法：扶阳抑阴，舒肝利胆，健脾除湿。方药：四逆茵陈五苓散加减。附片100克(煎2～3小时)干姜50克肉桂15克(研末泡水兑入)吴萸15克(炒)败酱草15克茵陈30克猪苓15克茯苓50克北细辛8克苍术20克甘草8克二诊：服上方10余剂后，黄疸已退十之八、九，肝脾肿大已缩小，小便色转清，黄疸指数降至20单位，食欲增加，大便正常，精神转佳。肝肾虚寒，脾气尚弱，寒湿邪阴尚未肃清，宜再扶阳温化主之：附片150克(先煎2～3小时)干姜80克茵陈80克茯苓30克苡仁20克肉桂15克(研末，泡水兑入)吴萸10克白术20克桂尖30克甘草10克三诊：服上方6剂后，经检查症状消失，化验检查恢复正常，继以扶阳温化调理，以巩固疗效。附子150克(先煎2～3小时)干姜80克砂仁15克郁金10克肉桂15克(研末，泡水兑入)苡仁30克佛手20克甘草10克服上方7、8剂后，已基本恢复健康，随访一年，情况良好。(《吴佩衡医案》)
案例五 张XX，男，36岁。仲夏。头昏，心跳，腿胀，溏泄，食欲减退，身目俱呈暗黄色，小便亦现微黄，舌苔薄白，脉象代缓。辨证，劳伤元气，脾失健运，寒湿在里不解，阻塞胆汁入肠，渗入血液，循环外溢。治法，温化沉寒，淡渗湿邪。方药：加减当归白术汤主之。当归9克白术12克茯苓12克桂枝4．5克法半夏6克陈皮3克茵陈30克苍术6克炙甘草3克鸡内金9克4剂脉平病减，黄退十之六，七，改加味附子理中汤治之，6剂康复。附片9克白术12克黄芪9克当归9克西茵陈24克炙甘草6克干姜3克党参12克(赖良蒲《蒲园医案》)
案例六 毕XX，男，26岁，病例号：247673。住院日期：1963年10月15日。患者于1961年9月因发黄而确诊为病毒性肝炎(黄疸型)。经中西药治疗，症状好转，黄疸未退尽。1963年10月15日又住院，自觉疲乏，右胁痛，劳累盾加重，面色无泽，巩膜微黄。黄疸指数20单位。舌苔薄白，脉沉缓。辨证，脾阳不振，寒湿凝聚，发为阴黄。治法：温振脾阳，祛湿散寒，活血退黄。方药：茵陈60克郁金10克生芪12克党参15克干姜6克炮附子10克茯苓15克白术10克生甘草3克服上方6剂后，加泽兰15克，续服14剂，症状稍有改善，复查肝功能：黄疸指数9单位，上方共服三月；症状消失，肝功能正常，临床痊愈。(《关幼波临床经验选》)[评按]黄疸系指以身黄、目黄、小便黄为主的证候。胎匮要略》分为五疸。自元代罗天益之后，根据黄疸的性质，分为阳黄与阴黄两类。前者多因湿热蕴蒸，熏染发黄；后者多因寒湿阻遏，脾阳不振所致。近些年来由于防治病毒性肝炎，对于黄疸的辨证论治更有所发挥。
案例一湿热炽盛，肝胆郁结，腑气不通，营阴耗灼，心神受扰，证属急黄，病情危笃。治以清热通腑，凉血解毒。方用茵陈蒿汤加味，药后腑通神清，黄疸渐退。继以疏肝利胆、益气生津收功。
案例二病势稍缓而黄疸较重，曾用中西药，并用过激素治疗。已见脾虚肝郁，肝阴亏损之证，使用健脾舒肝，养阴活血为法，继用通络活血，化湿清热而取效。
案例三诊为粘液性(不全)阻塞性黄疸，属于阳黄范畴，始用利胆清热化湿之剂，方证尚称符合，服12剂后黄疸仍未消。关氏仍遵其常法，并重视疏肝利水，加用理气化痰、凉血活血、清热燥湿解毒之剂，迅速治愈，充分体现了他的治黄学术见解，亦即除常规治黄外，重视活血、化痰、解毒的独特看法，这是对于治黄理论方面的发挥。
案例四为阴黄，证属阳虚水寒，寒湿内滞，肝气郁结不舒，阳虚则水邪泛滥，治以四逆、茵陈五苓散加减，
案例五身目俱呈暗黄色。仲景曰“身目为黄，寒湿在里，以为不可下也，于寒湿中求之”。此与瘀热在里发黄，可用清下之剂者有别，故治以温化沉寒，淡渗湿邪之法，证方殊为合拍。然而从实际临床中经常会看到，始为阳黄，由于湿毒热邪耗伤正气，病久缠绵，气阴两伤，亦可由阳黄转为阴黄，如例六，目黄面晦无泽，经询问其病史，始于阳黄，而后转为阴黄。实乃病久正虚，由阳入阴之机。故当温振脾阳为主，兼以祛湿散寒，活血退黄，这一观点也是关氏对于阴黄的个人见解之一。
中医瑰宝苑 近现代名医验案类编er
(三十五)黑疸
案例一 赵XX，男，37岁。初诊日期，1973年5月16日。患者因过累和生气，在旅途中发高烧。此后经常头痛，头晕、腰痛、精神不佳，四肢无力，食欲减退，厌油，全身肌肉废痛，—脚后跟痛，脸色逐渐变黑，齿龈及口腔粘膜出现黑色斑块，明显消瘦、经西医检查诊为“阿狄森氏病”。服用强的松、甘草硫浸膏治疗。由家属推车送来，背至诊室，面色黧黑，精神淡漠，少气懒言，时而打嗝恶呕。脉弦数而虚。舌质红，苔厚腻而黄。辨证：阴虚阳亢，气滞夹瘀。治法：滋肾柔肝，佐以化瘀。方药：沙参12克细生地12克枸杞子9克鸡血藤18克黑故脂12克地鳖虫9克生蒲黄9克桑寄生15。克菟丝子15克女贞子24克旱莲草24克柿蒂9克制旋覆花12克鸡内金9克琥珀末6克一周6剂，连服两周。精神好转，恶呕减轻，此后共服药三个多月，随症加减的药物有：石斛、玄参、生牛蒡、槟榔，炒川楝，夜交藤、金樱子，蜈蚣、乌梢蛇等。8月25日某医院检查尿17酮7．3毫克，17羟5．5毫克，病情明显好转，色素减退。
(《王渭川临床经验选》)
案例二 区XX，女，24岁。住院号：72／58020、七、八年来，皮肤和粘膜色素沉着日益加深，现呈黧黑，枯槁，面部、乳头，手足背侧，阴部等处尤显。头晕，甚则昏仆，神疲乏力，纳呆，脉细，舌紫暗，苔根腻。黑属肾色，肾阳不足，则阴盛而气滞瘀阻，古称黑疸，拟益肾活血化瘀。仙茅12克仙灵脾12克全当归9克桃仁泥9克杜红花6克炒川芎4．5克粉萆薢12克云茯苓9克补骨脂12克焦楂曲各9克稍加减，服20余剂另：血余240克，猪肤500克，共熬膏，每日二次，每次一匙，长期服用。2月7日
(二诊)，近来因疲劳过度，昨日又昏倒，经急诊检查为血压低，对症处理后收入病房。现仍神疲头晕，脉细，舌紫暗，苔薄。气血两亏，虚风上旋，拟益肾化癣，调补气血，以平虚风。炒党参12克补骨脂12克仙茅12克仙灵脾12克全当归9克炒亦白芍各6克鸡血藤12克炒川芎4．5克紫石英18克鹿角霜9克怀牛膝15克7剂。2月14日
(三诊)：肤黑稍退，口干，四肢冷，艰寐，头晕欲恶，脉细，舌暗尖转红，阳气虚弱，脉行不利，不温四末，再守原法合当归四逆汤加减。全当归9克川桂枝4．5克赤白芍各6克细辛2．4克仙灵脾12克鹿角霜9克怀牛膝15克补骨脂12克紫石英18克
(先煎)夜交藤15克姜半夏9克连服30剂。3月14日
(四诊)：面部黑色转淡，口唇色紫红，手足背黑色稍退，头晕伯冷，脉沉细，苔薄白，舌边紫暗。再拟益肾通脉化瘀。制熟地15克制附片6克
(先煎)仙茅15克仙灵脾15克鹿角片9克当归尾9克制川芎9克川桂枝4．5克木通4．5克紫石英15克
(庶/虫）虫丸6克
(分吞)稍加减，服28剂。4月11日
(五诊)：面部黑色十退八，九，惟指、趾，乳头，阴部色退较缓，肢冷好转，心悸失眠，纳呆乏力，脉细，舌边紫，苔薄腻。阳气渐复，阴寒得减，瘀血见化，再守原法，久服取效。全当归12克木通4．5克制川芎4．5克川桂枝4．5克炙甘草3克熟附片4．5克
(《张伯臾医案》)[评按]黑疸为《金匮要略》病名，为五疸之一。多因疸证经久不愈，肝肾虚衰，气血瘀阻所致。多见身黄不泽，目青，面额色黑，大便黑等症。自黄疸分为阴黄、阳黄两大类后，黑疸之病名临证已很少引用。以上所载二例，西医诊断为阿狄森氏病，实际并非疸证。原案病名黑疸，列此仅供参考。
案例二证属肾阳不足，瘀血内停，治以益肾化瘀为主，又因见有四肢厥逆，更用当归四逆汤合大黄(庶/虫）虫丸通脉化瘀，久服取效。两例诊断相同而辨证有异，同为虚证又有阴虚阳虚之分；同有血瘀又有轻重之别，临证者于溯因、审证、论治时当予注意。
(三十六)痞块刘XX，男，40岁，初诊日期：1952年7月31日。小腹内有块已多年，并不为害。近因动气食物不合，致大小便不畅，曾经医治，大便虽通而不畅，反觉心跳发热，小溲更觉不畅。此气食两滞，寒热混杂之病，新旧并发，当标本兼治。空沙参12克藿梗6克黄郁金6克大腹皮9克连水炒川朴6克沉香曲6克焦鸡金3克茯苓皮12克车前子9克炒扁豆衣9克焦冬术6克甘草梢9克鲜荷叶1角带梗5寸8月22日
(二诊)：素有胃病而肝旺肾虚，故动气则绕腹，右转向下，小腹胀痛，食物下胃，停滞不消，呃逆大作。病根已深，宜小心将护。台党参12克黄郁金9克沉香曲6克葶苈子9克大腹皮9克金狗脊12克(去毛)茯苓皮12克广木香6克焦鸡金9克佛手片9克生熟稻芽各9克甘草梢9克生藕节5枚大枣3枚8月24日
(三诊)；胃纳略能消化，但食后往上泛，腹中仍汨汨有声。按脐下痛处则思小便，脾肾两虚，寒湿未化，仍当从本治。台党参12克焦冬术6克朱茯神9克黄郁金9克大桂枝9克炒白芍12克厚附片9克广木香6克制香附6克金狗脊9克(去毛)佛手片9克焦鸡金9克冬瓜皮15克苦葶苈6克大枣2枚8月26日
(四诊)：服药尚安，痞块有化解之势，惟腹尚作痛，痛时遗溺少许则安。此乃湿热内挟为患，恐系寒邪所化，仍当从本治。(据述日来头昏流清涕，温度加高，当属感冒)台党参9克藿梗9克苦杏仁9克黄郁金9克厚附片9克狗脊9克去毛车前子12克冬瓜皮15克沉香曲9克酒芩柏各6克茯苓块12克甘草梢9克苦葶苈9克大枣3枚
五诊(无日期)，近日因感风化热，咳嗽吐黄痰，两肋仍胀痛，腹中亦难受，得虚恭始安。法当标本兼治。北沙参12克薄荷梗9克苦杏仁9克知贝母各9克制乳没各6克茯苓皮15克冬瓜皮15克大腹皮9克苦葶苈9克苦桔梗9克真郁金9克甘草9克生藕节5枚大枣3枚8月31日
(六诊)：据述服药后胸部胀闷，小腹发凉，包块作跳，小溲因腹痛其量甚少。肾部虚寒，心经有热，寒热相搏，故心跳而肾空疼。当从本治。台党参12克甘枸杞12克瞿麦9克萹蓄9克厚附片9克大桂枝12克生杭芍9克朱枣仁9克抱木茯神12克真郁金6克灵磁石12克
(七诊)：服前方病已痊愈，近因动气停食，胸部连腹又觉胀痛，包块跳动不安，两肋亦形膨胀。先治标病，再议固本。空沙参9克黄郁金9克焦鸡金9克佛手片9克老苏梗6克苦杏仁9克制乳没各9克冬瓜皮仁各15克丝瓜络9克云茯苓12克炒稻芽9克沉香曲9克生荷梗1尺甘草梢6克
(张绍重整理，萧龙友医案，《中医杂志》2：115，1958)
[评按]“痞块”一名见于《医宗必读》，按其性质或症状，’均可归入积聚范围。所谓积聚系指腹内结块，或胀或痛。积有形，固定不移，痛有定处，聚无形，聚散无常，痛无定处。本例应属“积”，始因动气食物不合而致气食两滞，寒热混杂，新旧并发，故当标本兼治，但以治本为主。溯其本，乃脾肾两虚，寒湿未化，故以健脾补肾、温化寒湿治其本。在治疗过程中，曾因外感、动气而症情复作，萧氏掌握先标后本辨治法则，方治又趋合拍。
(三十七)水肿
Background Information
Book: Compilation of Verified Cases by Famous Modern and Contemporary Physicians
Chapter: Main Text (22/53)
Category: Medical Discourse
Case 4 XX, Male, 25 years old. The patient suffered from hepatosplenomegaly and generalized jaundice for eight years. He had been hospitalized for treatment with insignificant results. Subsequently, ascites developed, the jaundice index exceeded 100 units, and liver biopsy confirmed a diagnosis of "biliary cirrhosis." The patient was emaciated, with a dull, dark yellow complexion lacking luster, deep scleral icterus, and dark yellow skin all over the body. He presented with mental fatigue, low voice, shortness of breath, reluctance to speak, anorexia, absence of thirst, scanty urine dark as strong tea, abdominal distension due to ascites, emaciated limbs, edema below the face and feet, and pain in both hypochondria. The pulse was deep, wiry, forceful, and tight; the tongue coating was white, slippery, thick, greasy, with a yellow tint, and scanty fluids. Pattern differentiation: Yang deficiency with cold-water retention, stagnation of Liver Qi, obstruction of turbid dampness in the middle jiao, manifesting as "Yin Dan" (Yin Jaundice). Treatment principle: Support Yang to suppress Yin, soothe the Liver and promote bile flow, strengthen the Spleen and eliminate dampness. Prescription: Si Ni Yin Chen Wu Ling San modified. Prepared Aconite Root (Fupian) 100g (decocted for 2-3 hours), Dried Ginger (Ganjiang) 50g, Cinnamon Bark (Rougui) 15g (ground into powder and mixed with water before adding), Evodia Fruit (Wuyu) 15g (stir-fried), Patrinia Herb (Baijiangcao) 15g, Capillaris Herb (Yinchen) 30g, Polyporus (Zuling) 15g, Poria (Fuling) 50g, Asarum (Xixin) 8g, Atractylodes Rhizome (Cangzhu) 20g, Licorice Root (Gancao) 8g. Second visit: After taking more than 10 doses of the above prescription, jaundice receded by 80-90%, hepatosplenomegaly decreased, urine color cleared, jaundice index dropped to 20 units, appetite increased, bowel movements normalized, and spirit improved. Deficiency-cold of Liver and Kidney, weak Spleen Qi, and pathogenic cold-dampness have not yet been fully cleared. It is appropriate to again support Yang and warm transformation as the main approach: Prepared Aconite Root (Fupian) 150g (decocted first for 2-3 hours), Dried Ginger (Ganjiang) 80g, Capillaris Herb (Yinchen) 80g, Poria (Fuling) 30g, Coix Seed (Yiren) 20g, Cinnamon Bark (Rougui) 15g (ground into powder and mixed with water before adding), Evodia Fruit (Wuyu) 10g, Atractylodes Macrocephala Rhizome (Baizhu) 20g, Cassia Twig (Guizhi) 30g, Licorice Root (Gancao) 10g. Third visit: After taking 6 doses of the above prescription, symptoms disappeared upon examination, laboratory tests returned to normal. Continue supporting Yang and warming transformation for regulation to consolidate therapeutic effects. Prepared Aconite Root (Fuzi) 150g (decocted first for 2-3 hours), Dried Ginger (Ganjiang) 80g, Amomum Fruit (Sharen) 15g, Turmeric Tuber (Yujin) 10g, Cinnamon Bark (Rougui) 15g (ground into powder and mixed with water before adding), Coix Seed (Yiren) 30g, Bergamot Fruit (Foshou) 20g, Licorice Root (Gancao) 10g. After taking 7-8 doses of the above prescription, health was basically restored. Follow-up for one year showed good condition. (From *Medical Cases of Wu Peiheng*)
Case 5 Zhang XX, Male, 36 years old. Midsummer. Dizziness, palpitations, leg swelling, loose stools, decreased appetite, dark yellow discoloration of the body and eyes, slightly yellow urine, thin white tongue coating, intermittent and slow pulse. Pattern differentiation: Labor injury depleting Yuan Qi, Spleen failing in transportation and transformation, unresolved cold-dampness inside obstructing bile entry into the intestines, seeping into blood circulation and overflowing externally. Treatment principle: Warm transformation of deep-seated cold, mild diuresis to leach out dampness. Prescription: Modified Dang Gui Bai Zhu Tang as the main formula. Angelica Sinensis Root (Danggui) 9g, Atractylodes Macrocephala Rhizome (Baizhu) 12g, Poria (Fuling) 12g, Cassia Twig (Guizhi) 4.5g, Processed Pinellia Tuber (Banxia) 6g, Tangerine Peel (Chenpi) 3g, Capillaris Herb (Yinchen) 30g, Atractylodes Rhizome (Cangzhu) 6g, Honey-roasted Licorice Root (Zhigancao) 3g, Chicken Gizzard Lining (Jineijin) 9g. After 4 doses, pulse normalized, disease reduced, jaundice receded by 60-70%. Changed to Jia Wei Fu Zi Li Zhong Tang for treatment, recovered after 6 doses. Prepared Aconite Root (Fupian) 9g, Atractylodes Macrocephala Rhizome (Baizhu) 12g, Astragalus Root (Huangqi) 9g, Angelica Sinensis Root (Danggui) 9g, Western Capillaris Herb (Xi Yinchen) 24g, Honey-roasted Licorice Root (Zhigancao) 6g, Dried Ginger (Ganjiang) 3g, Codonopsis Root (Dangshen) 12g. (From *Pu Yuan Medical Cases* by Lai Liangpu)
Case 6 Bi XX, Male, 26 years old, Case No.: 247673. Hospitalization Date: October 15, 1963. In September 1961, the patient was diagnosed with viral hepatitis (icteric type) due to jaundice. Symptoms improved with Chinese and Western medicine treatment, but jaundice did not completely resolve. Re-hospitalized on October 15, 1963, feeling fatigued, right hypochondriac pain aggravated by exertion, sallow complexion, slight scleral icterus. Jaundice index 20 units. Thin white tongue coating, deep and slow pulse. Pattern differentiation: Spleen Yang not stirring, congealing of cold-dampness, manifesting as Yin Jaundice. Treatment principle: Warm and stir Spleen Yang, dispel dampness and scatter cold, invigorate blood and resolve jaundice. Prescription: Capillaris Herb (Yinchen) 60g, Turmeric Tuber (Yujin) 10g, Raw Astragalus Root (Sheng Huangqi) 12g, Codonopsis Root (Dangshen) 15g, Dried Ginger (Ganjiang) 6g, Prepared Aconite Root (Pao Fuzi) 10g, Poria (Fuling) 15g, Atractylodes Macrocephala Rhizome (Baizhu) 10g, Raw Licorice Root (Sheng Gancao) 3g. After taking 6 doses of the above prescription, add Lycopodium Herb (Zelan) 15g, continue taking for 14 doses. Symptoms slightly improved. Recheck liver function: jaundice index 9 units. Total course of the above prescription was three months; symptoms disappeared, liver function normal, clinical cure achieved. (From *Selected Clinical Experience of Guan Youbo*) [Commentary] Jaundice refers to a syndrome mainly characterized by yellow body, yellow eyes, and yellow urine. *Jin Gui Yao Lue* divides it into five types of Dan. Since Luo Tianyi of the Yuan Dynasty, based on the nature of jaundice, it has been divided into two categories: Yang Jaundice and Yin Jaundice. The former is mostly caused by damp-heat accumulation steaming and dyeing; the latter is mostly caused by cold-dampness obstruction and failure of Spleen Yang. In recent years, due to the prevention and treatment of viral hepatitis, the pattern differentiation and treatment of jaundice have been further developed.
Case 1 Damp-heat blazing, Liver and Gallbladder stagnation, Fu organ Qi blockage, consumption of Ying-Yin, disturbance of Heart Spirit. Pattern belongs to Ji Huang (Urgent Jaundice), critical condition. Treatment: Clear heat and unblock Fu organs, cool blood and detoxify. Prescription: Yin Chen Hao Tang modified. After medication, Fu organs unblocked, spirit clear, jaundice gradually receded. Then use soothing Liver, promoting bile flow, tonifying Qi and generating fluids to conclude treatment.
Case 2 Disease progression slightly slower but jaundice heavier. Previously treated with Chinese and Western medicines, including hormone therapy. Signs of Spleen deficiency and Liver stagnation, Liver Yin depletion already appeared. Method: Strengthen Spleen, soothe Liver, nourish Yin and invigorate blood. Then use unblocking collaterals, invigorating blood, transforming dampness and clearing heat to achieve effect.
Case 3 Diagnosed as mucinous (incomplete) obstructive jaundice, belonging to the category of Yang Jaundice. Initially used choleretic, heat-clearing, and damp-transforming agents. Formula matched pattern reasonably well, but after 12 doses, jaundice still did not subside. Dr. Guan still followed his routine method, emphasizing soothing Liver and promoting water metabolism, added Qi-regulating, phlegm-resolving, blood-cooling, blood-invigorating, heat-clearing, damp-drying, and detoxifying agents, rapidly cured. This fully embodies his academic views on treating jaundice, namely, besides conventional treatment, he attaches importance to unique views on invigorating blood, resolving phlegm, and detoxification. This is a development in the theory of treating jaundice.
Case 4 Is Yin Jaundice, pattern belongs to Yang deficiency with cold-water, internal stagnation of cold-dampness, unreleased Liver Qi stagnation. Yang deficiency leads to flooding of water evil. Treatment: Si Ni Tang and Yin Chen Wu Ling San modified.
Case 5 Body and eyes both present dark yellow color. Zhongjing said, "Body and eyes are yellow, cold-dampness is inside, consider it inadvisable to purge, seek within cold-dampness." This differs from yellowing due to stasis-heat inside, where purging agents can be used. Therefore, treat with warming transformation of deep-seated cold and mild diuresis to leach out dampness. The pattern and formula match perfectly. However, in actual clinical practice, it is often seen that initially Yang Jaundice, due to damp-toxin and heat-pathogen consuming healthy Qi, lingering disease damaging Qi and Yin, can also transform from Yang Jaundice to Yin Jaundice. Like Case 6, yellow eyes, sallow face without luster. Upon inquiry of medical history, started as Yang Jaundice, then transformed into Yin Jaundice. Actually, this is due to long-standing disease causing healthy Qi deficiency, the mechanism of entering Yin from Yang. Therefore, primarily warm and stir Spleen Yang, concurrently dispel dampness and scatter cold, invigorate blood and resolve jaundice. This viewpoint is also one of Dr. Guan's personal insights on Yin Jaundice.
TCM Treasure Pavilion - Compilation of Verified Cases by Famous Modern and Contemporary Physicians
(35) Black Dan
Case 1 Zhao XX, Male, 37 years old. First visit date: May 16, 1973. Patient developed high fever during travel due to overexertion and anger. Thereafter, frequent headache, dizziness, lower back pain, poor spirit, limb weakness, decreased appetite, aversion to oil, whole-body muscle wasting pain, heel pain, face gradually turning black, black patches appearing on gums and oral mucosa, significant emaciation. Diagnosed by Western medicine as "Addison's Disease." Treated with Prednisone and Glycyrrhiza Extract. Brought by family in a wheelchair, carried to consulting room. Complexion dark black, indifferent spirit, shortness of breath, reluctance to speak, occasional hiccups and retching. Pulse wiry, rapid, and deficient. Tongue body red, coating thick, greasy, and yellow. Pattern differentiation: Yin deficiency with Yang hyperactivity, Qi stagnation with blood stasis. Treatment principle: Nourish Kidney and soften Liver, assist with resolving stasis. Prescription: Glehnia Root (Shashen) 12g, Fine Rehmannia Root (Xi Shengdi) 12g, Goji Berry (Gouqizi) 9g, Spatholobus Stem (Jixueteng) 18g, Black Sesame (Hei Zhima/Guzhi) 12g, Ground Beetle (Dibiechong) 9g, Raw Coptis Sporangium (Sheng Puhuang) 9g, Mulberry Parasite (Sangjisheng) 15g, Dodder Seed (Tusizi) 15g, Privet Fruit (Nvzhenzi) 24g, Eclipta Herb (Hanliancao) 24g, Persimmon Calyx (Shidi) 9g, Processed Inula Flower (Xuanfuhua) 12g, Chicken Gizzard Lining (Jineijin) 9g, Amber Powder (Hupo) 6g. 6 doses per week, taken continuously for two weeks. Spirit improved, retching reduced. Took medicine for more than three months thereafter. Medicines added or subtracted according to symptoms included: Dendrobium (Shihu), Scrophularia Root (Xuanshen), Raw Burdock Fruit (Sheng Niubang), Betel Nut (Binglang), Stir-fried Sichuan Loranthus (Chao Chuanlian), Night-blooming Jasmine Vine (Ye Jiaoteng), Cherokee Rose Fruit (Jinyingzi), Centipede (Wugong), Zaocys Snake (Wushaoshe), etc. On August 25, a certain hospital checked urine 17-ketosteroids 7.3 mg, 17-hydroxycorticosteroids 5.5 mg. Condition significantly improved, pigmentation decreased. (From *Selected Clinical Experience of Wang Weichuan*)
Case 2 Ou XX, Female, 24 years old. Hospital No.: 72/58020. For seven or eight years, skin and mucous membrane pigmentation has deepened day by day, now presenting as dark black, withered. Especially prominent on face, nipples, dorsal aspect of hands and feet, genital area, etc. Dizziness, even fainting, mental fatigue and weakness, anorexia, fine pulse, purple-dark tongue, greasy root coating. Black belongs to Kidney color. Insufficient Kidney Yang leads to Yin excess, Qi stagnation, and blood stasis. Anciently called Black Dan. Plan to benefit Kidney, invigorate blood, and resolve stasis. Curculigo Rhizome (Xianmao) 12g, Epimedium Herb (Xianlingpi) 12g, Whole Angelica Sinensis Root (Quandanggui) 9g, Peach Kernel Paste (Taoren Ni) 9g, Cornus Flower (Duhonghua) 6g, Stir-fried Ligusticum Rhizome (Chao Chuanxiong) 4.5g, Powdered Dioscorea Hypoglauca Rhizome (Fen Bibai) 12g, Cloud Poria (Yun Fuling) 9g, Psoralea Fruit (Buguzhi) 12g, Charred Hawthorn and Malt (Jiao Zhaqu) 9g each. Slightly modified, take more than 20 doses. Additionally: Human Hair Ash (Xuyurong) 240g, Pig Skin (Zhufu) 500g, decocted together into paste, twice daily, one spoon each time, taken long-term. February 7
(Second visit): Recently due to excessive fatigue, fainted again yesterday. Emergency check showed low blood pressure. Admitted to ward after symptomatic treatment. Still mental fatigue and dizziness, fine pulse, purple-dark tongue, thin coating. Deficiency of both Qi and Blood, deficient Wind rising upward. Plan to benefit Kidney, transform stasis, regulate and tonify Qi and Blood, to calm deficient Wind. Stir-fried Codonopsis Root (Chao Dangshen) 12g, Psoralea Fruit (Buguzhi) 12g, Curculigo Rhizome (Xianmao) 12g, Epimedium Herb (Xianlingpi) 12g, Whole Angelica Sinensis Root (Quandanggui) 9g, Stir-fried White Peony Root (Chao Baishao) 6g each, Spatholobus Stem (Jixueteng) 12g, Stir-fried Ligusticum Rhizome (Chao Chuanxiong) 4.5g, Purple Quartz (Zishiying) 18g, Antler Frost (Lujiaoshuang) 9g, Huai Achyranthes Root (Huainiuxi) 15g. 7 doses. February 14
(Third visit): Skin blackness slightly receded, dry mouth, cold limbs, difficulty sleeping, dizziness with nausea, fine pulse, dark tongue tip turning red. Yang Qi weak, pulse movement unfavorable, failing to warm four extremities. Again adhere to original method combined with Dang Gui Si Ni Tang modified. Whole Angelica Sinensis Root (Quandanggui) 9g, Cassia Twig (Guizhi) 4.5g, Red and White Peony Roots (Chibaishao) 6g each, Asarum (Xixin) 2.4g, Epimedium Herb (Xianlingpi) 12g, Antler Frost (Lujiaoshuang) 9g, Huai Achyranthes Root (Huainiuxi) 15g, Psoralea Fruit (Buguzhi) 12g, Purple Quartz (Zishiying) 18g (decocted first), Polygonum Multiflorum Vine (Ye Jiaoteng) 15g, Processed Pinellia Tuber (Banxia) 9g. Take continuously for 30 doses. March 14
(Fourth visit): Facial blackness turned lighter, lips purple-red, blackness on dorsal hands and feet slightly receded, dizziness afraid of cold, deep fine pulse, thin white coating, purple-dark tongue edges. Again plan to benefit Kidney, unblock vessels, and resolve stasis. Prepared Rehmannia Root (Shudi) 15g, Prepared Aconite Slice (Fupian) 6g (decocted first), Curculigo Rhizome (Xianmao) 15g, Epimedium Herb (Xianlingpi) 15g, Deer Antler Slice (Lujiaopian) 9g, Angelica Tail (Dangguiwei) 9g, Processed Ligusticum Rhizome (Chuanxiong) 9g, Cassia Twig (Guizhi) 4.5g, Akebia Stem (Mutong) 4.5g, Purple Quartz (Zishiying) 15g (decocted first), Asarum (Xixin) 2.4g, Rhubarb (Dahuang), and Mylabris Pill (Dazhe Chong Wan) 6g (taken separately). Slightly modified, take 28 doses. April 11
(Fifth visit): Facial blackness receded by 80-90%, only fingers, toes, nipples, genital area color receded slowly. Limb coldness improved, palpitations and insomnia, anorexia and weakness, fine pulse, purple tongue edges, thin greasy coating. Yang Qi gradually recovering, Yin cold decreasing, blood stasis seeing resolution. Again adhere to original method, long-term intake to achieve effect. Whole Angelica Sinensis Root (Quandanggui) 12g, Akebia Stem (Mutong) 4.5g, Processed Ligusticum Rhizome (Chuanxiong) 4.5g, Cassia Twig (Guizhi) 4.5g, Honey-roasted Licorice Root (Zhigancao) 3g, Prepared Aconite Slice (Fupian) 4.5g (decocted first), Curculigo Rhizome (Xianmao) 12g, Epimedium Herb (Xianlingpi) 12g, Cinnabar Poria (Zhu Fuling) 12g, Purple Quartz (Zishiying) 18g (decocted first), Cornus Flower (Duhonghua) 6g, Raw Hawthorn Fruit (Sheng Shanzha) 12g. Slightly modified, take more than 30 doses, discharged. (From *Medical Cases of Zhang Boyu*) [Commentary] Black Dan is a disease name in *Jin Gui Yao Lue*, one of the five Dans. Mostly caused by Dan syndrome not healing for a long time, Liver and Kidney deficiency, Qi and Blood stasis. Commonly presents with body yellow without luster, blue eyes, black forehead, black stool, etc. Since jaundice was divided into Yin Jaundice and Yang Jaundice, the disease name Black Dan is rarely cited in clinical practice. The two cases recorded above were diagnosed by Western medicine as Addison's Disease, actually not Dan syndrome. The original case name Black Dan is listed here for reference only.
Case 1 Pattern belongs to Yin deficiency with Yang hyperactivity, Qi stagnation with blood stasis. Treatment: Nourish Yin and soften Liver, assist with resolving stasis.
Case 2 Pattern belongs to Kidney Yang insufficiency, internal retention of blood stasis. Treatment: Benefit Kidney and resolve stasis as main approach. Also, because signs of cold extremities were seen, additionally used Dang Gui Si Ni Tang combined with Da Huang Zhe Chong Wan to unblock vessels and resolve stasis, achieving effect with long-term intake. Both cases have the same diagnosis but different pattern differentiation; both are deficiency patterns with distinction between Yin and Yang deficiency; both have blood stasis with differences in severity. Clinicians should pay attention when tracing etiology, examining patterns, and discussing treatment.
(36) Pi Kuai (Abdominal Mass) Liu XX, Male, 40 years old, First visit date: July 31, 1952. Mass in lower abdomen for many years, not harmful. Recently due to emotional agitation and improper diet, causing difficult urination and defecation. Previously treated, although bowel movements passed, they were not smooth, instead felt heart palpitations and fever, urination felt even more difficult. This is a disease of Qi and Food stagnation, mixed cold and heat, new and old conditions occurring simultaneously. Should treat both root and branch. Glehnia Root (Kong Shashen) 12g, Agastache Stem (Huogeng) 6g, Yellow Turmeric Tuber (Huang Yujin) 6g, Greater Citron Fruit (Dafupi) 9g, Magnolia Bark (Chuanhoupo) 6g (stir-fried with water), Agarwood Fermented Rice (Chenxiangqu) 6g, Charred Chicken Gizzard Lining (Jiao Jijin) 3g, Poria Peel (Fulingpi) 12g, Plantago Seed (Cheqianzi) 9g, Stir-fried Broad Bean Husk (Chao Bian Dou Yi) 9g, Charred Winter Atractylodes Rhizome (Jiao Dongzhu) 6g, Licorice Tip (Gancaoshao) 9g, Fresh Lotus Leaf 1 corner with stem 5 cun. August 22
(Second visit): Suffering from stomach disease with hyperactive Liver and deficient Kidney, so emotional agitation causes winding abdominal pain, turning right downward, lower abdominal distension and pain. Food enters stomach, stagnates and does not digest, severe hiccups. Disease root is deep, should care carefully. Tai Codonopsis Root (Tai Dangshen) 12g, Yellow Turmeric Tuber (Huang Yujin) 9g, Agarwood Fermented Rice (Chenxiangqu) 6g, Lepidium Seed (Tinglizi) 9g, Greater Citron Fruit (Dafupi) 9g, Golden Dogwood Ridge (Jin Gouji) 12g (remove hairs), Poria Peel (Fulingpi) 12g, Amomum Fruit (Guangmuxiang) 6g, Charred Chicken Gizzard Lining (Jiao Jijin) 9g, Bergamot Slice (Foshoupian) 9g, Raw and Cooked Rice Sprout (Sheng Shu Daoya) 9g each, Licorice Tip (Gancaoshao) 9g, Raw Lotus Node (Sheng Oujie) 5 pieces, Jujube (Dazao) 3 pieces. August 24
(Third visit): Stomach intake slightly able to digest, but food refluxes upwards after eating, belly still gurgling sound. Pressing painful spot below navel makes one think of urinating. Spleen and Kidney both deficient, cold-dampness not transformed. Still should treat from root. Tai Codonopsis Root (Tai Dangshen) 12g, Charred Winter Atractylodes Rhizome (Jiao Dongzhu) 6g, Cinnabar Poria Spirit (Zhu Fushen) 9g, Yellow Turmeric Tuber (Huang Yujin) 9g, Large Cassia Twig (Da Guizhi) 9g, Stir-fried White Peony Root (Chao Baishao) 12g, Thick Aconite Slice (Hou Fupian) 9g, Amomum Fruit (Guangmuxiang) 6g, Processed Cyperus Rhizome (Zhi Xiangfu) 6g, Golden Dogwood Ridge (Jin Gouji) 9g (remove hairs), Bergamot Slice (Foshoupian) 9g, Charred Chicken Gizzard Lining (Jiao Jijin) 9g, Winter Melon Peel (Dongguapi) 15g, Bitter Lepidium Seed (Ku Tingli) 6g, Jujube (Dazao) 2 pieces. August 26
(Fourth visit): Taking medicine is relatively safe, Pi Kuai has trend of dissolving, only abdomen still hurts, passing small amount of urine relieves pain. This is damp-heat internally harboring causing harm, fear it is transformed from cold pathogen. Still should treat from root. (According to description, recently dizzy, running clear nose, temperature increased, should belong to common cold). Tai Codonopsis Root (Tai Dangshen) 9g, Agastache Stem (Huogeng) 9g, Bitter Apricot Kernel (Ku Xingren) 9g, Yellow Turmeric Tuber (Huang Yujin) 9g, Thick Aconite Slice (Hou Fupian) 9g, Dogwood Ridge (Gouji) 9g (remove hairs), Plantago Seed (Cheqianzi) 12g, Winter Melon Peel (Dongguapi) 15g, Agarwood Fermented Rice (Chenxiangqu) 9g, Wine-processed Scutellaria and Phellodendron (Jiu Qinbai) 6g each, Poria Block (Fulingkuai) 12g, Licorice Tip (Gancaoshao) 9g, Bitter Lepidium Seed (Ku Tingli) 9g, Jujube (Dazao) 3 pieces.
Fifth visit (No date), recently due to wind-pathogen transforming into heat, coughing with yellow sputum, both ribs still distending and hurting, abdomen also uncomfortable, relieved only after passing flatus. Method should treat both root and branch. Bei Glehnia Root (Bei Shashen) 12g, Mint Stem (Bohe geng) 9g, Bitter Apricot Kernel (Ku Xingren) 9g, Platycodon and Fritillaria (Zhi Beimu) 9g each, Processed Milk and Frankincense (Zhi Ru Mo) 6g each, Poria Peel (Fulingpi) 12g, Winter Melon Peel (Dongguapi) 15g, Greater Citron Fruit (Dafupi) 9g, Bitter Lepidium Seed (Ku Tingli) 9g, Bitter Platycodon Root (Ku Jiegeng) 9g, True Turmeric Tuber (Zhen Yujin) 9g, Licorice (Gancao) 9g, Raw Lotus Node (Sheng Oujie) 5 pieces, Jujube (Dazao) 3 pieces. August 31
(Sixth visit): According to description, after taking medicine chest feels distended and stuffy, lower abdomen feels cold, mass throbs, urine volume very little due to abdominal pain. Kidney region deficiency-cold, Heart Meridian has heat, cold and heat struggle, thus heart palpitations and empty kidney pain. Should treat from root. Tai Codonopsis Root (Tai Dangshen) 12g, Sweet Goji Berry (Gan Gouqi) 12g, Dianthus Flower (Qumai) 9g, Shepherd's Purse (Bianxu) 9g, Thick Aconite Slice (Hou Fupian) 9g, Large Cassia Twig (Da Guizhi) 12g, Raw Hangzhou White Peony Root (Sheng Hangshao) 9g, Cinnabar Ziziphus Seed (Zhu Zaoren) 9g, Wrapped Poria Spirit (Baomu Fushen) 12g, True Turmeric Tuber (Zhen Yujin) 6g, Spirit Magnetite (Ling Cishi) 12g (decocted first), Licorice Tip (Gancaoshao) 9g, Lotus Seeds with Plumule (Dai Xin Lianzi) 15 pieces. September 6
(Seventh visit): Taking previous prescription disease already cured, recently due to emotional agitation and stopped food, chest connected to abdomen feels distending and hurting, mass throbs uneasily, both ribs also appear swollen. First treat branch disease, then discuss solidifying root. Glehnia Root (Kong Shashen) 9g, Yellow Turmeric Tuber (Huang Yujin) 9g, Charred Chicken Gizzard Lining (Jiao Jijin) 9g, Bergamot Slice (Foshoupian) 9g, Old Perilla Stem (Lao Sugeng) 6g, Bitter Apricot Kernel (Ku Xingren) 9g, Processed Milk and Frankincense (Zhi Ru Mo) 9g each, Winter Melon Peel and Seed (Dongguapi Ren) 15g each, Loofah Network (Sigualuo) 9g, Cloud Poria (Yun Fuling) 12g, Stir-fried Rice Sprout (Chao Daoya) 9g, Agarwood Fermented Rice (Chenxiangqu) 9g, Fresh Lotus Stem (Sheng Hegeng) 1 chi, Licorice Tip (Gancaoshao) 6g. (Organized by Zhang Shaozhong, Xiao Longyou Medical Cases, *Chinese Journal of Traditional Medicine* 2:115, 1958)
[Commentary] The name "Pi Kuai" appears in *Yi Zong Bi Du*. According to its nature or symptoms, it can be classified into the scope of Ji Ju. Ji Ju refers to masses formed inside the abdomen, either distending or painful. Ji has form, fixed and immovable, pain has definite location; Ju has no form, gathering and scattering irregularly, pain has no definite location. This case should belong to "Ji", initially caused by emotional agitation and improper diet leading to Qi and Food stagnation, mixed cold and heat, new and old conditions occurring simultaneously, so should treat both root and branch, but mainly treat root. Tracing its root, it is Spleen and Kidney deficiency, cold-dampness not transformed, so use strengthening Spleen and tonifying Kidney, warming transformation of cold-dampness to treat root. During treatment, symptoms recurred due to external contraction and emotional agitation. Dr. Xiao mastered the principle of treating branch first then root, making the treatment match the pattern.
(37) Edema