例一胡XX，女。平素嗜烟肝旺，且有痰红，壬寅产后患此，实因早浴而起。恶风无汗，头面独肿，四肢亦肿、腹微胀而尿少。脉浮濡，苔薄白滑。脉症合参，浮主风，濡主水，水渍膜腠，故发肿而微胀，风袭皮毛，故恶风而无汗，此仲景所谓风水肿也。以麻杏开肺发表为君，五皮达膜消肿以佐之。净麻黄1．5克光杏仁9克新会皮4．5克浙苓皮12克生桑皮9克冬瓜皮9克生姜皮3克葱须0，6克复诊，1剂即周身汗出溱溱，浮肿骤退。不事调理善后，反而不知节食，芥辣、鸡香、冰酒恣食无忌。越数日，肿复发，来诊有微词，从脉舌审知其情，切责之，其亦愧服。遂仿原方加减以调治之。方药：生桑皮9克浙苓皮9克新会皮4．5克大腹皮9克莱菔子6克(炒)苏噜子6克(杵)冬瓜子12克枳棋子12克连服3剂，小水畅解，肿遂渐退，胃动纳馨而痊。
(《重印全国名医验案类编》周小农医案)
例二男，28岁，病浮肿一年，时轻时重，用过西药，也用过中药健脾、温肾、发汗、利尿等法，效果不明显。会诊时，全身浮肿，腹大腰粗，小便短黄，脉象弦滑，舌质嫩红，苔薄白。……腹大按之不坚，叩之不实，胸膈不闷，能食、食后不作胀，大便一天一次，很少矢气，说明水不在里而在肌表。因此，考虑到《金匮要略》上所说的“风水’和“皮水’，这两个证候都是水在肌表，但风水有外感风寒证状，皮水则否。所以不拟采用麻黄加术汤和越婢加术汤发汗，而用防己茯苓汤行气利尿。诚然，皮水也可用发汗法，但久病已经用过发汗，不宜再伤卫气。方药：汉防己、生黄芪，带皮苓各15克桂枝6克炙甘草3克生姜2片红枣3枚用黄芪协助防己，桂枝协助茯苓，甘草、姜，枣调和营卫，一同走表，通阳气以行水，使之仍从小便排出。服两剂后，小便渐增，即以原方加减，约半个月证状完全消失。
(秦伯未《谦斋医学讲稿》)
例三徐X，女。产后二月余，遍体浮肿，颈脉动时咳，难于平卧，口干欲饮，大腹肿满，小溲短赤，舌光红无苔，脉虚弦而数，良由荣阴大亏，肝失涵养，木克中土，脾不健运，阳水湿热，日积月聚，上射于肺，不能通调水道，下输膀胱，水湿无路可出，泛滥横溢，无所不到也。脉证参合，刚剂尤忌，急拟养肺阴以柔肝木，运中土而利水湿。南北沙参各9克连皮苓12克生白术6克清炙草1．5克怀山药9克川石斛9克陈广皮3克桑白皮6克川贝母9克甜光杏9克大腹皮6克汉防己9克冬瓜子皮各9克生苡仁15克另用冬瓜汁温饮代茶。二诊：服药3剂，小溲渐多，水湿有下行之势，遍体浮肿，稍见轻减，而咳嗽气逆，不能平卧，内热口干，食入之后，脘腹饱胀益甚，舌光红，脉虚弦带数，皆由血虚阴亏，木火上升，水气随之逆肺，肺失肃降之令，中土受木所侮，脾失健运之常也，仍宜养金制木，崇土利水，使肺金有制节之权，脾土得砥柱之力，自能通调水道，下输膀胱，而水气不致上逆矣。南北沙参各9克连皮苓12克生白术6克清炙草1．5克川石斛9克肥知母4．5克川贝母6克桑白皮6克大腹皮6克汉防己6克炙白苏子4.5克甜光杏9克冬瓜子皮各9克鸡金炭6克
(丁济万整理：思补山房丁甘仁医案续肿胀门，《中医杂志11：22，1925)
例四张XX，男，19岁，初诊日期：1963年5月24日。全身浮肿已五年，经某医院诊断为慢性肾炎，治疗未效。近来症状加剧，就诊时除全身浮肿外，兼见大便溏泄，一日数行，小溲短少，时时欲呕，或食后即吐。精神萎靡，面色咣白，唇淡不荣，舌苔薄白，脉沉细涩。足胫按之凹陷，尿化验，蛋白(++++)，粒状管型(+++)，脓球(+++)，红细胞(++)。辨证：脾失健运，关门不利，升降失职，水邪弥漫。治法：健脾利水。方药，异功合防己茯苓汤加鸡内金、海金砂等连服5剂。6月3日
(再诊)：进上药后，除食入欲吐得平外，余症仍然，大便竟至一日十数行，粪便稀薄。遂于运脾渗湿之中益以温暖命门之晶。炒土白术12克明党参、茯苓各15克炒薏苡仁，亦小豆各30克破故纸9克小桂尖、吴茱萸各4．5克炙甘草3克连服3剂。6月10日：全身浮肿显退，大便成形，小便次数增加。临床症状基本消失，但肾功能未改善。善后之计仍宜温阳补土为治，嘱以济生肾气汤与理中汤相间服用。另嘱每日以白薯一只约半斤许，置炭火中煨焦，冲开水炖，随时服。盖白薯味甘，乃脾家珍品，火煨使焦，有益火补土作用，至9月10日小便检查蛋白(+)，粒状管型少许，脓球(+++)。嗣仍日服煨白薯汤一次，每周间服理中合补血汤两剂，至10月8日小便常规复检：蛋白(+)，脓球(+)，余均阴性。至1964年8月初旬追踪，一年来未见复发。
(俞长荣：益火生土法则的认识与实践，《中医杂志》11：27，1964)
例五患者男性，26岁，北京人，职员。1956年1月开始经常感冒，曾自觉有浮肿，于2月5日入天津市立总医院。入院检查荐骨部及下肢有轻度指凹性水肿，心尖部有收缩期杂音，体温39．5℃，血压176／90毫米汞柱，红细胞440万，白细胞16，500，尿蛋白(+++)，颗粒管型2～3／高视野，红细胞成堆／高视野，白细胞3～10／高视野，非蛋白氮?0毫克％，二氧化碳结合力35．7容量％，酚红试验共排出55％，眼底呈现高血压性网膜血管改变，未见其他阳性发现。患者既往曾患疟疾及痢疾，无血尿、尿少，尿闭历史，近日亦未服用磺胺，诊断为慢性肾炎及上呼吸道感染。入院后经用青霉素及一般对症疗法，血压逐渐下降，症状亦渐减轻。但于3月9日，体温又波动于39～40℃之间，尿量少，每24小时在500～1000毫升之间，血压正常，尿蛋白(+)，尿内红细胞很多，非蛋白氮上升至150毫克％，二氧化碳结合力30．9容量％。患者一般情况不佳，精神不振，无食欲，呕吐甚剧，并伴有吐血，经用青霉素及输液等一般对症疗法，病情不见好转。于3月26日开始用中药治疗，会诊时患者呈贫血征，一般情况甚恶劣，接近半昏迷状态，脉浮而沉取无脉，给予金匮肾气汤加知母、牛膝7剂(一星期)后，患者尿量增加，一切症状消失，神智清醒，血非蛋白氮降至107～44．3毫克％，二氧化碳结合力48．1容量％，于4月13日转来中医院继续治疗，患者除感头晕外，血压正常，余亦正常，小便一日量2000～3000毫升，酚红排泄试验52％，血非蛋白氮27．32毫克％，中等度贫血，小便蛋白(+)，红细胞2～10／高视野。
(陆观虎等；天津市立中医院治疗尿毒症两
例报告，《中医杂志012：634，1956)[评按]水肿系指体内水液潴留，泛滥肌肤，引起部分或全身浮肿。《金匮要略》称为“水气”。多因外感风邪水湿，或因内伤饮食劳倦，以致水液内停。体内水液运行有赖于肺、脾、肾三脏，以及三焦的气化功能。《金匮》分为风水，皮水、正水，石水等。临床多按阴水、阳水辨治。西医所谓肾小球肾炎，多属于水肿范畴，按照中医辨证论治疗效尚好。
例一证属风水，治以祛风行水，方用五皮饮加麻、杏，徐子才谓：‘轻可去实，麻黄葛根之属”。药用之妙，主要在于麻黄，不仅能开肺发汗，、使水气从皮肤排泄，其余力尤能通利水道，使水从小便排泄。
例二病程日久，证属皮水，曾经汗、利、温法，不宜再伤卫气，故用防己茯苓汤行气利水而取效。秦氏分析详尽，立方遣药，颇得要妙。
例三营阴大亏，肝失涵养，木克中土，脾不健运，阳水湿热日积月聚，上射于肺，不能通调水道，下输膀胱。急拟养肺阴以柔盱木，运中土而利水湿。盖养阴易于恋湿，利湿易于伤阴，尔今扬长避短，根据病情需要，适当安排，庶免凶危，
例四为慢性肾炎，全身浮肿，大便溏泄一日数行。证属脾失健运，关门不利，升降失司，水邪弥漫。属于阴水范畴。曾服异功合防已茯苓汤加味不效。系与命门火衰不能燠土有关。盖命门火衰，土失温煦，不能腐熟水谷，精微不运，三焦决渎失司，前方未顾命火，故而收效不彰，遂于运睥渗湿之中，益以温暖命门之晶，奏效甚捷。善后曾配合食疗，用白薯煨焦冲开水服，有益火补土之功，诚可—试。
例五尿毒症案，陆氏认为救治之法，首在止吐。而此病的止吐法实不同于胃肠病证。以其肾虚、水不运行，以致尿毒上犯于心，治当强肾利水为主，故主以寓泄于补的金匮肾气丸，加牛膝者，以其酸苦涌泄，逐血气凝滞，引药下行；加知母以滋阴利水。全方相辅相成，既能补肾治本，复能利水泄毒而治标，此为善用古方之例。
(三十八)阳萎
例一陈XX，男，29岁。结婚数年，初时尚能媾接，后则早泄，继则阳萎，夫妻反目，蕴酿离婚，治以滋补肝肾，涩精补气，强阴益阳之法。制首乌，山药各120克淫羊藿、蛇床子、阳起石(煅透)各90克菟丝子、远志肉、益智仁、补骨脂、当归、茯苓、续断、石莲子(带壳炒)、芡实、金樱子、红参须、韭子、小茴香、枸杞子各60克共炒研末，炼蜜为丸，梧桐子大。空腹时每服50粒，盐开水送下，每日二次。上方一料，大有好转。续服一料，爱人巳受妊。
(张梦侬《临证会要》)
例二高X，男，42岁，已婚，门诊号c00091。前患遗精早泄，近半年来阳萎不举，房事无能，全无欲念，阴囊萎缩，腰间冷痛，下肢痿软，精神疲乏，不思饮食，脸色青白，时而恶寒，手足皆冷。诊脉两尺沉迟，关脉缓弱，舌苔薄白。辨证：肾阳不足，命门火衰，肝脾衰弱。治法：补肝脾，固肾气。方药；大熟地15克山药15克巴戟肉15克补骨脂，6克锁阳6克肉苁蓉6克西党参15克茯苓9克鹿角胶6克全当归9克山萸肉6克西枸杞9克二诊，服上药10剂，精神气色转好，上方加菟丝子9克，以补髓填精，再进10剂。三诊：阳事较前容易勃起，面色转红，因感寒泄泻，原方去肉苁蓉，鹿角胶换鹿角片，加肉豆蔻1，5克，神曲1．5克，谷芽9克，再进10剂。末诊：服药30剂后，阳事容易勃起，诸症皆愈，原方加龟板15克以滋肾阴，后依原方加至10倍，蜜制成丸如梧子大，早夜各服20粒，以巩固疗效。
(梁赐明整理：蒋玉伯医案，《广东医学01；37，1965)[评按]阳萎系指阳事不举，或临房举而不坚。多因纵欲、惊恐、思虑过度、命火虚衰，心脾两伤，或湿热下注、宗筋弛纵而致。
例一证属肝肾阴亏，命门火衰，阴阳俱虚。爰由旰肾阴亏逐渐形成，不能急欲求成，治用丸剂缓图，其效稳妥。
例二治法着重于肝脾肾三脏联补，其中又以温补肾阳为主，然亦适当顾护肾阴，此即张介宾所谓：“善补阳者，必于阴中求阳”之意。此案方药比较对证。
(三十九)阳强
例一张XX，男，40岁，1968年夏。前阴挺长坚硬已半月，住某院，二便不通，小腹胀痛难名，甚则以头抢地，决定于5月15日手术切除。脉沉弦长实大有力。苔紫绛黄燥。辨证：湿热蕴于下焦化燥，火毒积于宗筋。治法：泻火滋阴败毒。方药：龙胆草10克黄柏10克黄芩10克赤芍10克黄连10克白薇10克栀子10克生地15克丹皮10克柴胡10克针刺穴位，大敦、行间、太阳、中封、蠡沟、委阳、足三里、上巨墟、下巨墟(双侧)，关元，水分。外敷药(略)5月18日
(二诊)：二便通利，痛苦大减，舌苔紫绛黄燥都退。上方加龟板、知母、白茅根、甘草梢。外敷药(略)。5月29日
(三诊)：胀痛大减，茎外部水肿全消，坚硬减半，尚不能下垂。拟方着重败毒。南沙参、地丁，蒲公英、金银花、寒水石各A0克野菊花、黄柏、知母、天葵子，龙胆草，丹皮、升麻各10克白薇18克外用药(略)。6月16日，上方加龟板30克，二日服药一剂。7月2日恢复正常。
(张梦侬《临证会要》)
【背景信息】
书名：近现代名医验案类编 章节：正文(23/53) 类别：医论
案例一 胡XX，女性。平时嗜好吸烟，肝气偏旺，且有痰中带血的症状。壬寅年产后患上此病，实际上是因为过早洗浴引起的。表现为怕风、无汗，头面部单独肿胀，四肢也肿胀，腹部轻微胀满且尿量减少。脉象浮而濡软，舌苔薄白滑腻。综合脉象与症状分析，浮脉主风邪，濡脉主水湿，水湿浸渍于膜原腠理之间，所以发生浮肿并伴有轻微胀满；风邪侵袭皮毛，所以怕风且无汗。这是张仲景所说的“风水肿”（因风邪袭表导致的水肿）。治疗以麻黄杏仁开宣肺气、发表散邪为君药，五皮饮通达膜原、消除水肿为佐药。处方：净麻黄1.5克，光杏仁9克，新会皮4.5克，浙苓皮12克，生桑皮9克，冬瓜皮9克，生姜皮3克，葱须0.6克。复诊时，服用一剂后周身出汗淋漓，浮肿迅速消退。患者不注重调理善后，反而不知节制饮食，芥末、辛辣、鸡肉香气、冰镇酒等恣意食用毫无禁忌。过了几天，浮肿复发，来就诊时带有微词。医生从脉象和舌象审察得知其情由，严厉责备她，她也惭愧信服。于是仿照原方加减进行调治。方药：生桑皮9克，浙苓皮9克，新会皮4.5克，大腹皮9克莱菔子6克（炒），苏噜子6克（捣碎），冬瓜子12克，枳棋子12克。连续服用3剂，小便通畅排泄，浮肿逐渐消退，胃气活动，食欲增进，从而痊愈。
（《重印全国名医验案类编》周小农医案）
案例二 男性，28岁，患浮肿病一年，时轻时重，曾用过西药，也用过中药健脾、温肾、发汗、利尿等方法，效果不明显。会诊时，全身浮肿，腹部膨大腰部变粗，小便短少色黄，脉象弦滑，舌质嫩红，舌苔薄白。……腹部膨大但按压不坚硬，叩击声音不实，胸膈部没有闷胀感，能进食，进食后不感到腹胀，大便一天一次，很少排气，这说明水湿不在体内脏腑而在肌表。因此，考虑到《金匮要略》中所述的“风水”和“皮水”，这两个证候都是水湿停留在肌表，但风水有外感风寒的症状，皮水则没有。所以不打算采用麻黄加术汤和越婢加术汤来发汗，而是用防己茯苓汤行气利尿。诚然，皮水也可以用发汗法，但久病已经使用过发汗法，不宜再损伤卫气。方药：汉防己、生黄芪、带皮茯苓各15克，桂枝6克，炙甘草3克，生姜2片，红枣3枚。用黄芪协助防己，桂枝协助茯苓，甘草、姜、枣调和营卫，共同走表，通阳气以行水，使水湿仍从小便排出。服用两剂后，小便逐渐增多，随即以原方加减，约半个月症状完全消失。
（秦伯未《谦斋医学讲稿》）
案例三 徐X，女性。产后两个多月，遍体浮肿，颈部脉搏跳动时咳嗽，难以平卧，口干想喝水，腹部肿大胀满，小便短赤，舌面光红无苔，脉虚弦而数。这主要是由于营阴严重亏损，肝失涵养，木气克制中土，脾不健运，阳水湿热日积月聚，上射于肺，不能通调水道，下输膀胱，水湿无路可出，泛滥横溢，无处不到。脉证参合，刚燥之剂尤为禁忌，急拟养肺阴以柔肝木，运中土而利水湿。南北沙参各9克，连皮茯苓12克，生白术6克，清炙甘草1.5克，怀山药9克，川石斛9克，陈广皮3克，桑白皮6克，川贝母9克，甜光杏仁9克，大腹皮6克，汉防己9克，冬瓜子皮各9克，生苡仁15克。另用冬瓜汁温饮代茶。二诊：服药3剂，小便逐渐增多，水湿有下行趋势，遍体浮肿稍见减轻，但咳嗽气逆，不能平卧，内热口干，进食之后，脘腹饱胀更加严重，舌光红，脉虚弦带数，皆由血虚阴亏，木火上升，水气随之逆犯于肺，肺失肃降之令，中土受木气所侮，脾失健运之常也。仍宜养金制木，崇土利水，使肺金有制节之权，脾土得砥柱之力，自能通调水道，下输膀胱，而水气不致上逆矣。南北沙参各9克，连皮茯苓12克，生白术6克，清炙甘草1.5克，川石斛9克，肥知母4.5克，川贝母6克，桑白皮6克，大腹皮6克，汉防己6克，炙白苏子4.5克，甜光杏仁9克，冬瓜子皮各9克，鸡内金炭6克。
（丁济万整理：思补山房丁甘仁医案续肿胀门，《中医杂志》11:22, 1925）
案例四 张XX，男性，19岁，初诊日期：1963年5月24日。全身浮肿已五年，经某医院诊断为慢性肾炎，治疗无效。近来症状加剧，就诊时除全身浮肿外，兼见大便溏泄，一日数次，小便短少，时时想呕吐，或食后即吐。精神萎靡，面色㿠白，唇淡无光泽，舌苔薄白，脉沉细涩。足胫部按压出现凹陷，尿化验，蛋白(++++)，粒状管型(+++)，脓球(+++)，红细胞(++)。辨证：脾失健运，关门不利，升降失职，水邪弥漫。治法：健脾利水。方药：异功散合防己茯苓汤加鸡内金、海金砂等。连续服用5剂。6月3日（再诊）：进上药后，除了食入欲吐得以平息外，其余症状仍然，大便竟至一日十数次，粪便稀薄。遂于运脾渗湿之中增加温暖命门之火的方法。炒土白术12克，明党参、茯苓各15克，炒薏苡仁、赤小豆各30克，破故纸9克，小桂尖、吴茱萸各4.5克，炙甘草3克。连续服用3剂。6月10日：全身浮肿明显消退，大便成形，小便次数增加。临床症状基本消失，但肾功能未改善。善后之计仍宜温阳补土为治，嘱以济生肾气汤与理中汤相间服用。另嘱每日以白薯一只约半斤许，置炭火中煨焦，冲开水炖，随时服。盖白薯味甘，乃脾家珍品，火煨使焦，有益火补土作用。至9月10日小便检查蛋白(+)，粒状管型少许，脓球(+++)。嗣仍日服煨白薯汤一次，每周间服理中合补血汤两剂，至10月8日小便常规复检：蛋白(+)，脓球(+)，余均阴性。至1964年8月初旬追踪，一年来未见复发。
（俞长荣：益火生土法则的认识与实践，《中医杂志》11:27, 1964）
案例五 患者男性，26岁，北京人，职员。1956年1月开始经常感冒，曾自觉有浮肿，于2月5日入天津市立总医院。入院检查荐骨部及下肢有轻度指凹性水肿，心尖部有收缩期杂音，体温39.5℃，血压176/90毫米汞柱，红细胞440万，白细胞16,500，尿蛋白(+++)，颗粒管型2～3/高视野，红细胞成堆/高视野，白细胞3～10/高视野，非蛋白氮?0毫克%，二氧化碳结合力35.7容量%，酚红试验共排出55%，眼底呈现高血压性网膜血管改变，未见其他阳性发现。患者既往曾患疟疾及痢疾，无血尿、尿少、尿闭历史，近日亦未服用磺胺，诊断为慢性肾炎及上呼吸道感染。入院后经用青霉素及一般对症疗法，血压逐渐下降，症状亦渐减轻。但于3月9日，体温又波动于39～40℃之间，尿量少，每24小时在500～1000毫升之间，血压正常，尿蛋白(+)，尿内红细胞很多，非蛋白氮上升至150毫克%，二氧化碳结合力30.9容量%。患者一般情况不佳，精神不振，无食欲，呕吐甚剧，并伴有吐血，经用青霉素及输液等一般对症疗法，病情不见好转。于3月26日开始用中药治疗，会诊时患者呈贫血征，一般情况甚恶劣，接近半昏迷状态，脉浮而沉取无脉，给予金匮肾气汤加知母、牛膝7剂（一星期）后，患者尿量增加，一切症状消失，神智清醒，血非蛋白氮降至107～44.3毫克%，二氧化碳结合力48.1容量%，于4月13日转来中医院继续治疗，患者除感头晕外，血压正常，余亦正常，小便一日量2000～3000毫升，酚红排泄试验52%，血非蛋白氮27.32毫克%，中等度贫血，小便蛋白(+)，红细胞2～10/高视野。
（陆观虎等；天津市立中医院治疗尿毒症两例报告，《中医杂志》012:634, 1956）[评按] 水肿系指体内水液潴留，泛滥肌肤，引起部分或全身浮肿。《金匮要略》称为“水气”。多因外感风邪水湿，或因内伤饮食劳倦，以致水液内停。体内水液运行有赖于肺、脾、肾三脏，以及三焦的气化功能。《金匮》分为风水，皮水、正水，石水等。临床多按阴水、阳水辨治。西医所谓肾小球肾炎，多属于水肿范畴，按照中医辨证论治疗效尚好。
案例一 证属风水，治以祛风行水，方用五皮饮加麻黄、杏仁，徐子才谓：“轻可去实，麻黄葛根之属”。药用之妙，主要在于麻黄，不仅能开肺发汗，使水气从皮肤排泄，其余力尤能通利水道，使水从小便排泄。
案例二 病程日久，证属皮水，曾经汗、利、温法，不宜再伤卫气，故用防己茯苓汤行气利水而取效。秦氏分析详尽，立方遣药，颇得要妙。
案例三 营阴大亏，肝失涵养，木克中土，脾不健运，阳水湿热日积月聚，上射于肺，不能通调水道，下输膀胱。急拟养肺阴以柔肝木，运中土而利水湿。盖养阴易于恋湿，利湿易于伤阴，尔今扬长避短，根据病情需要，适当安排，庶免凶危。
案例四 为慢性肾炎，全身浮肿，大便溏泄一日数行。证属脾失健运，关门不利，升降失司，水邪弥漫。属于阴水范畴。曾服异功散合防己茯苓汤加味不效。系与命门火衰不能燠土有关。盖命门火衰，土失温煦，不能腐熟水谷，精微不运，三焦决渎失司，前方未顾命火，故而收效不彰，遂于运脾渗湿之中，益以温暖命门之火，奏效甚捷。善后曾配合食疗，用白薯煨焦冲开水服，有益火补土之功，诚可一试。
案例五 尿毒症案，陆氏认为救治之法，首在止吐。而此病的止吐法实不同于胃肠病证。以其肾虚、水不运行，以致尿毒上犯于心，治当强肾利水为主，故主以寓泄于补的金匮肾气丸，加牛膝者，以其酸苦涌泄，逐血气凝滞，引药下行；加知母以滋阴利水。全方相辅相成，既能补肾治本，复能利水泄毒而治标，此为善用古方之例。
(三十八) 阳痿
案例一 陈XX，男性，29岁。结婚数年，初时尚能性交，后则早泄，继则阳痿，夫妻反目，酝酿离婚，治以滋补肝肾，涩精补气，强阴益阳之法。制何首乌、山药各120克，淫羊藿、蛇床子、阳起石（煅透）各90克，菟丝子、远志肉、益智仁、补骨脂、当归、茯苓、续断、石莲子（带壳炒）、芡实、金樱子、红参须、韭子、小茴香、枸杞子各60克。共炒研末，炼蜜为丸，梧桐子大。空腹时每服50粒，盐开水送下，每日二次。上方一料，大有好转。续服一料，爱人已受孕。
（张梦侬《临证会要》）
案例二 高X，男性，42岁，已婚，门诊号C00091。前患遗精早泄，近半年来阳痿不举，房事无能，全无欲念，阴囊萎缩，腰间冷痛，下肢痿软，精神疲乏，不思饮食，脸色青白，时而恶寒，手足皆冷。诊脉两尺沉迟，关脉缓弱，舌苔薄白。辨证：肾阳不足，命门火衰，肝脾衰弱。治法：补肝脾，固肾气。方药：大熟地15克，山药15克，巴戟肉15克，补骨脂6克，锁阳6克，肉苁蓉6克，西党参15克，茯苓9克，鹿角胶6克，全当归9克，山萸肉6克，西枸杞9克。二诊，服上药10剂，精神气色转好，上方加菟丝子9克，以补髓填精，再进10剂。三诊：阳事较前容易勃起，面色转红，因感寒泄泻，原方去肉苁蓉，鹿角胶换鹿角片，加肉豆蔻1.5克，神曲1.5克，谷芽9克，再进10剂。末诊：服药30剂后，阳事容易勃起，诸症皆愈，原方加龟板15克以滋肾阴，后依原方加至10倍，蜜制成丸如梧子大，早夜各服20粒，以巩固疗效。
（梁赐明整理：蒋玉伯医案，《广东医学》01:37, 1965）[评按] 阳痿系指阳事不举，或临房举而不坚。多因纵欲、惊恐、思虑过度、命火虚衰，心脾两伤，或湿热下注、宗筋弛纵而致。
案例一 证属肝肾阴亏，命门火衰，阴阳俱虚。爰由肝肾阴亏逐渐形成，不能急欲求成，治用丸剂缓图，其效稳妥。
案例二 治法着重于肝脾肾三脏联补，其中又以温补肾阳为主，然亦适当顾护肾阴，此即张介宾所谓：“善补阳者，必于阴中求阳”之意。此案方药比较对证。
(三十九) 阳强
案例一 张XX，男性，40岁，1968年夏。前阴挺长坚硬已半月，住某院，二便不通，小腹胀痛难名，甚则以头抢地，决定于5月15日手术切除。脉沉弦长实大有力。苔紫绛黄燥。辨证：湿热蕴于下焦化燥，火毒积于宗筋。治法：泻火滋阴败毒。方药：龙胆草10克，黄柏10克，黄芩10克，赤芍10克，黄连10克，白薇10克，栀子10克，生地15克，丹皮10克，柴胡10克。针刺穴位：大敦、行间、太阳、中封、蠡沟、委阳、足三里、上巨墟、下巨墟（双侧），关元，水分。外敷药（略）。5月18日（二诊）：二便通利，痛苦大减，舌苔紫绛黄燥都退。上方加龟板、知母、白茅根、甘草梢。外敷药（略）。5月29日（三诊）：胀痛大减，茎外部水肿全消，坚硬减半，尚不能下垂。拟方着重败毒。南沙参、地丁、蒲公英、金银花、寒水石各10克，野菊花、黄柏、知母、天葵子、龙胆草、丹皮、升麻各10克，白薇18克。外用药（略）。6月16日，上方加龟板30克，二日服药一剂。7月2日恢复正常。
（张梦侬《临证会要》）
Background Information
Book Title: Compilation of Verified Cases by Famous Modern Doctors Chapter: Main Text (23/53) Category: Medical Discourse
Case 1 Hu XX, Female. Habitually addicted to smoking with hyperactive Liver Qi, and previously experienced hemoptysis (blood in sputum). Contracted this illness after childbirth in the Renyin year, actually caused by bathing too early. Manifestations include aversion to wind, absence of sweating, swelling isolated to the head and face, swelling of the four limbs, slight abdominal distension, and oliguria (scanty urination). Pulse is floating and soggy; tongue coating is thin, white, and slippery. Synthesizing pulse and symptoms: a floating pulse indicates Wind pathogen, while a soggy pulse indicates Dampness/Water. Water dampness infiltrating the membrane origo and interstices causes edema and slight distension; Wind attacking the skin and hair follicles causes aversion to wind and anhidrosis. This corresponds to "Feng Shui Edema" (Edema due to Wind pathogen) described by Zhang Zhongjing. Treatment uses Ma Huang Xing Ren (Ephedra Seed Decoction components) to open Lung Qi and release the exterior as the sovereign drug, and Wu Pi Yin (Five Peel Decoction) to reach the membrane origo and reduce swelling as the assistant drug. Prescription: Jing Ma Huang (Processed Ephedrae Herba) 1.5g, Guang Xing Ren (Prunus Armeniaca Semen) 9g, Xin Hui Pi (Citri Reticulatae Pericarpium) 4.5g, Zhe Ling Pi (Poria Cum Mycelium Peel) 12g, Sheng Sang Pi (Mori Cortex) 9g, Dong Gua Pi (Benincasae Exocarpium) 9g, Sheng Jiang Pi (Zingiberis Rhizoma Recens Peel) 3g, Cong Xu (Allii Fistulosi Bulb Base) 0.6g. At follow-up, one dose resulted in profuse sweating throughout the body, and edema subsided rapidly. The patient neglected post-treatment care and failed to control her diet, indulging in mustard, spicy foods, chicken aroma, and iced wine without restraint. A few days later, the edema recurred. Upon consultation, she expressed mild complaints. The physician examined her pulse and tongue, understood the cause, reprimanded her severely, and she accepted it with shame and compliance. Thus, the original formula was modified for treatment. Formula: Sheng Sang Pi 9g, Zhe Ling Pi 9g, Xin Hui Pi 4.5g, Da Fu Pi (Arecae Pericarpium) 9g, Lai Fu Zi (Raphani Semen) 6g (stir-fried), Su Lu Zi (Perillae Fructus) 6g (crushed), Dong Gua Zi (Benincasae Semen) 12g, Zhi Qian Zi (Acanthopanacis Trichocanthi Radix et Caulis - *Note: likely typo in source for Zhi Shi or similar, but kept literal*) 12g. Taken continuously for 3 doses, urination became smooth, edema gradually receded, stomach qi moved, appetite improved, and she recovered.
(Zhou Xiaonong Medical Case from "Reprinted National Famous Doctors' Verified Cases Compilation")
Case 2 Male, 28 years old. Suffered from edema for one year, fluctuating in severity. Used Western medicine, as well as Traditional Chinese Medicine methods such as strengthening Spleen, warming Kidney, inducing sweating, and promoting diuresis, with insignificant effects. During consultation, whole-body edema was present, abdomen enlarged with thick waist, urine short and yellow, pulse string-like and slippery, tongue body tender red, tongue coating thin white... Abdominal enlargement was not hard upon pressure, dull upon percussion, no chest oppression, able to eat, no fullness after eating, bowel movement once daily, little flatus. This indicates water-dampness is not in the interior organs but on the muscle surface. Therefore, considering "Feng Shui" (Wind Water) and "Pi Shui" (Skin Water) mentioned in *Jin Gui Yao Lue*, both syndromes involve water-dampness on the muscle surface, but Feng Shui has external Cold-Wind symptoms, whereas Pi Shui does not. Thus, Ma Huang Jia Zhu Tang (Ephedra plus Atractylodes Macrocephala Decoction) and Yi Bi Jia Zhu Tang (Yi Yi plus Atractylodes Macrocephala Decoction) for inducing sweating were not adopted. Instead, Fang Ji Fu Ling Tang (Stephania and Poria Decoction) was used to move Qi and promote diuresis. Indeed, Pi Shui can also be treated with sweating methods, but since the chronic illness has already undergone sweating therapy, it is inappropriate to further damage Wei Qi (Defensive Qi). Formula: Han Fang Ji (Stephaniae Tetrandrae Radix), Sheng Huang Qi (Astragali Radix), Dai Pi Ling (Poria with Skin) each 15g, Gui Zhi (Cinnamomi Ramulus) 6g, Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma) 3g, Sheng Jiang (Zingiberis Rhizoma Recens) 2 slices, Hong Zao (Jujubae Fructus) 3 pieces. Huang Qi assists Fang Ji, Gui Zhi assists Fu Ling, Gan Cao, Sheng Jiang, and Hong Zao harmonize Ying and Wei Qi, all acting on the exterior, unblocking Yang Qi to move water, allowing it to be excreted via urine. After two doses, urine volume gradually increased. Subsequently, the original formula was modified. Symptoms completely disappeared in about half a month.
(Qin Bowei "Qian Zhai Medical Lectures")
Case 3 Xu X, Female. More than two months postpartum, suffering from generalized edema. Neck vein pulsation accompanied by cough, difficulty lying flat, dry mouth with desire to drink, abdominal distension and fullness, scanty dark urine, tongue surface bright red without coating, pulse deficient, string-like, and rapid. This is primarily due to severe deficiency of Ying Yin (Nutritive Yin), Liver failing to nourish itself, Wood overacting on Earth, Spleen failing to transport normally. Yang Water-Damp-Heat accumulates day by day and month by month, shooting upward to the Lung, unable to regulate water passages and transport downward to the Bladder. Water-dampness has no outlet, flooding everywhere. Synthesizing pulse and symptoms, harsh/dry agents are strictly contraindicated. Urgently plan to nourish Lung Yin to soften Liver Wood, transport Middle Earth to benefit Water-Dampness. Formula: Nan Sha Shen (Adenophorae Radix) and Bei Sha Shen (Glehniae Radix) each 9g, Lian Pi Ling (Poria with Skin) 12g, Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma) 6g, Qing Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma) 1.5g, Huai Shan Yao (Dioscoreae Rhizoma) 9g, Chuan Shi Hu (Dendrobii Caulis) 9g, Chen Guang Pi (Citri Reticulatae Pericarpium) 3g, Sang Bai Pi (Mori Cortex) 6g, Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) 9g, Tian Guang Xing Ren (Prunus Armeniaca Semen) 9g, Da Fu Pi (Arecae Pericarpium) 6g, Han Fang Ji (Stephaniae Tetrandrae Radix) 9g, Dong Gua Zi Pi (Benincasae Exocarpium) each 9g, Sheng Yi Ren (Coicis Semen) 15g. Additionally, use Dong Gua Zhi (Benincasae Juice) warm to drink instead of tea. Second visit: After 3 doses, urine gradually increased, water-dampness showed a downward trend, generalized edema slightly reduced, but cough and rebellious Qi persisted, inability to lie flat, internal heat and dry mouth worsened after eating, tongue bright red, pulse deficient, string-like, and rapid. All due to Blood deficiency and Yin depletion, Wood-Fire rising, Water Qi following rebelliously to the Lung, Lung losing its descending function, Middle Earth being insulted by Wood, Spleen losing normal transport. Still suitable to nourish Metal to control Wood, fortify Earth to promote diuresis, so that Lung Metal has regulatory authority, and Spleen Earth has pillar strength, naturally regulating water passages and transporting downward to the Bladder, preventing Water Qi from rebelling upward. Formula: Nan Sha Shen and Bei Sha Shen each 9g, Lian Pi Ling 12g, Sheng Bai Zhu 6g, Qing Zhi Gan Cao 1.5g, Chuan Shi Hu 9g, Fei Zhi Mu (Anemarrhenae Rhizoma) 4.5g, Chuan Bei Mu 6g, Sang Bai Pi 6g, Da Fu Pi 6g, Han Fang Ji 6g, Zhi Bai Su Zi (Perillae Fructus) 4.5g, Tian Guang Xing Ren 9g, Dong Gua Zi Pi each 9g, Ji Jin Tan (Charred Chicken Gizzard Membrane) 6g.
(Ding Jiwan compiled: Ding Ganren Medical Cases from Sibushanfang, Continuation of Swelling Section, "Chinese Journal of Traditional Medicine" 11:22, 1925)
Case 4 Zhang XX, Male, 19 years old. First visit date: May 24, 1963. Generalized edema for five years, diagnosed as Chronic Nephritis at a certain hospital, treatment ineffective. Recently symptoms aggravated. At consultation, besides generalized edema, accompanied by loose stools several times a day, scanty urine, frequent nausea, or vomiting immediately after eating. Listless spirit, pale complexion, pale lips lacking luster, thin white tongue coating, deep, fine, and choppy pulse. Pressing the shins leaves an indentation. Urine test: Protein (+++), Granular Casts (+++), Pus Cells (+++), Red Blood Cells (++). Syndrome Differentiation: Spleen failing to transport, gates failing to close properly, ascending and descending functions lost, Water Evil spreading. Treatment Method: Strengthen Spleen and promote diuresis. Formula: Yi Gong San (Benefiting the Palace Powder) combined with Fang Ji Fu Ling Tang (Stephania and Poria Decoction) plus Ji Nei Jin (Chicken Gizzard Membrane), Hai Jin Sha (Lygodii Spora), etc. Taken continuously for 5 doses. June 3 (Second Visit): After taking the above medicine, except for the desire to vomit after eating being calmed, other symptoms remained. Stools increased to more than ten times a day, feces thin. Thus, within the method of moving Spleen and leaching out Dampness, add warmth to Ming Men Fire (Gate of Life Fire). Chao Tu Bai Zhu (Stir-fried Soil-treated Atractylodis Macrocephalae Rhizoma) 12g, Ming Dang Shen (Codonopsis Radix) and Fu Ling (Poria) each 15g, Chao Yi Yi Ren (Stir-fried Coicis Semen) and Chi Xiao Dou (Vigna umbellata Seed) each 30g, Po Gu Zhi (Psoraleae Fructus) 9g, Xiao Gui Jian (Cinnamon Twig Tip) and Wu Zhu Yu (Evodiae Fructus) each 4.5g, Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma) 3g. Taken continuously for 3 doses. June 10: Generalized edema significantly receded, stools formed, urine frequency increased. Clinical symptoms basically disappeared, but renal function did not improve. For follow-up, still suitable to treat with warming Yang and tonifying Earth. Instructed to alternate Ji Sheng Shen Qi Tang (Kidney Qi Pill for Salvation) and Li Zhong Tang (Regulate the Middle Decoction). Additionally, instruct to roast one sweet potato (about half a jin/250g) in charcoal fire until charred, brew with boiling water, and drink as needed. Sweet potato is sweet in taste, a treasure of the Spleen; roasting it charred benefits Fire and tonifies Earth. By September 10, urine check: Protein (+), few granular casts, Pus Cells (+++). Continued daily roasted sweet potato soup, alternating Li Zhong combined with Bu Xue Tang (Tonify Blood Decoction) twice a week. By October 8, routine urine re-examination: Protein (+), Pus Cells (+), others negative. Follow-up in early August 1964: No recurrence seen for one year.
(Yu Changrong: Understanding and Practice of the Rule of Benefiting Fire to Generate Earth, "Chinese Journal of Traditional Medicine" 11:27, 1964)
Case 5 Patient Male, 26 years old, from Beijing, clerk. Frequently caught colds starting January 1956, self-reported edema, admitted to Tianjin Municipal General Hospital on February 5. Admission examination: Mild pitting edema in sacral region and lower limbs, systolic murmur at apex, temperature 39.5°C, blood pressure 176/90 mmHg, RBC 4.4 million, WBC 16,500, Urine Protein (+++), Granular Casts 2-3/high power field, RBC clumps/high power field, WBC 3-10/high power field, Non-Protein Nitrogen ?0 mg%, CO2 Combining Power 35.7 vol%, Phenol Red Test total excretion 55%, fundus showed hypertensive retinal vascular changes, no other positive findings found. Past history of malaria and dysentery, no history of hematuria, oliguria, or anuria, no sulfonamide use recently. Diagnosed as Chronic Nephritis and Upper Respiratory Tract Infection. After admission, treated with Penicillin and general symptomatic therapy, blood pressure gradually decreased, symptoms gradually alleviated. But on March 9, temperature fluctuated between 39-40°C, urine volume low, 500-1000 ml per 24 hours, blood pressure normal, Urine Protein (+), many RBCs in urine, Non-Protein Nitrogen rose to 150 mg%, CO2 Combining Power 30.9 vol%. Patient's general condition poor, listless, anorexic, severe vomiting, accompanied by hematemesis. Treated with Penicillin and infusion general symptomatic therapy, condition did not improve. Started TCM treatment on March 26. At consultation, patient presented with anemia signs, general condition very poor, near semi-coma state, pulse floating but empty on deep pressure. Given Jin Gui Shen Qi Tang (Golden Cabinet Kidney Qi Pill) plus Zhi Mu (Anemarrhenae Rhizoma) and Niu Xi (Achyranthis Bidentatae Radix) for 7 doses (one week). Afterward, urine volume increased, all symptoms disappeared, consciousness cleared, blood Non-Protein Nitrogen dropped to 107-44.3 mg%, CO2 Combining Power 48.1 vol%. Transferred to TCM Hospital for continued treatment on April 13. Besides dizziness, blood pressure normal, rest normal, urine volume 2000-3000 ml/day, Phenol Red Excretion Test 52%, blood Non-Protein Nitrogen 27.32 mg%, moderate anemia, Urine Protein (+), RBC 2-10/high power field.
(Lu Guanhu et al.; Report on Two Cases of Uremia Treated by Tianjin Municipal TCM Hospital, "Chinese Journal of Traditional Medicine" 012:634, 1956) [Commentary] Edema refers to retention of body fluids flooding the skin, causing partial or whole-body swelling. Called "Shui Qi" (Water Qi) in *Jin Gui Yao Lue*. Mostly due to external contraction of Wind pathogen and Water-Dampness, or internal injury from diet and fatigue, leading to fluid retention. Body fluid circulation relies on the Qi transformation functions of the Lung, Spleen, and Kidney, as well as the San Jiao (Triple Burner). *Jin Gui* divides it into Feng Shui (Wind Water), Pi Shui (Skin Water), Zheng Shui (True Water), and Shi Shui (Stone Water). Clinically mostly differentiated and treated as Yin Water or Yang Water. Western medicine's Glomerulonephritis mostly belongs to the category of Edema, with good curative effects according to TCM syndrome differentiation and treatment.
Case 1 Syndrome belongs to Feng Shui (Wind Water), treated by dispelling Wind and moving Water, using Wu Pi Yin (Five Peel Decoction) plus Ma Huang (Ephedra) and Xing Ren (Apricot Seed). Xu Zicai said: "Light agents can remove excess, such as Ma Huang and Ge Gen." The妙 (wonder) of the medicine lies mainly in Ma Huang, which not only opens the Lung and induces sweating to excrete Water Qi through the skin, but also has the power to unblock water passages, allowing water to be excreted via urine.
Case 2 Long course of disease, syndrome belongs to Pi Shui (Skin Water). Having undergone sweating, purging/diuresis, and warming methods, it is inappropriate to further damage Wei Qi. Thus, Fang Ji Fu Ling Tang (Stephania and Poria Decoction) was used to move Qi and promote diuresis, achieving effect. Mr. Qin's analysis is detailed, prescription and medication are quite apt.
Case 3 Severe deficiency of Ying Yin (Nutritive Yin), Liver failing to nourish, Wood overacting on Earth, Spleen failing to transport, Yang Water-Damp-Heat accumulating day by day, shooting upward to the Lung, unable to regulate water passages and transport downward to the Bladder. Urgently plan to nourish Lung Yin to soften Liver Wood, transport Middle Earth to benefit Water-Dampness. Nourishing Yin easily retains Dampness, promoting diuresis easily damages Yin. Now, leveraging strengths and avoiding weaknesses, arranging appropriately according to disease needs, thus avoiding danger.
Case 4 Chronic Nephritis, whole-body edema, loose stools several times a day. Syndrome belongs to Spleen failing to transport, gates failing to close, ascending and descending functions lost, Water Evil spreading. Belongs to the category of Yin Water. Previously took Yi Gong San combined with Fang Ji Fu Ling Tang plus modifications without effect. Related to Ming Men Fire (Gate of Life Fire) decline failing to warm Earth. Since Ming Men Fire declines, Earth loses warmth, unable to rot and cook food, essence and nutrients fail to transport, San Jiao drainage fails. The previous formula did not attend to Ming Huo (Life Fire), hence efficacy was not prominent. Thus, within moving Spleen and leaching Dampness, added warming Ming Men Fire, achieving swift effect. Follow-up combined dietary therapy, using roasted sweet potato brewed in boiling water, benefiting Fire and tonifying Earth, truly worth trying.
Case 5 Uremia case. Mr. Lu believes the rescue method first lies in stopping vomiting. And the vomiting stopping method for this disease is indeed different from gastrointestinal diseases. Due to Kidney deficiency, Water failing to circulate, causing Uremic Toxins to rebel upwards affecting the Heart, treatment should focus on strengthening Kidney and promoting diuresis. Thus, primarily using Jin Gui Shen Qi Wan (Golden Cabinet Kidney Qi Pill) which contains draining within tonifying. Adding Niu Xi (Achyranthis Bidentatae Radix) because its sour and bitter nature promotes downward flow, expelling Blood and Qi stagnation, guiding medicine downwards; adding Zhi Mu (Anemarrhenae Rhizoma) to nourish Yin and promote diuresis. The whole formula complements each other, both tonifying Kidney to treat the root, and promoting diuresis to drain toxins treating the branch. This is an example of skillful use of ancient formulas.
(Thirty-Eight) Impotence
Case 1 Chen XX, Male, 29 years old. Married for several years, initially able to intercourse, later premature ejaculation, subsequently impotence, couple turned against each other, brewing divorce. Treated by tonifying Liver and Kidney, securing Essence and boosting Qi, strengthening Yin and benefiting Yang. Prepared He Shou Wu (Polygoni Multiflori Preparatum) and Shan Yao (Dioscoreae Rhizoma) each 120g, Yin Yang Huo (Epimedii Folium), Chuang Zi (Cnidii Fructus), Yang Qi Shi (Quicksand - calcined thoroughly) each 90g, Tu Si Zi (Cuscutae Semen), Yuan Zhi Rou (Polygalae Radix Flesh), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), Bu Gu Zhi (Psoraleae Fructus), Dang Gui (Angelicae Sinensis Radix), Fu Ling (Poria), Xu Duan (Dipsaci Radix), Shi Lian Zi (Nelumbinis Plumula with Shell stir-fried), Qian Shi (Euryales Semen), Jin Ying Zi (Chrysanthemi Indici Fructus), Hong Shen Xu (Red Ginseng Rootlet), Jiu Zi (Allii Tuberosi Semen), Xiao Hui Xiang (Foeniculi Fructus), Gou Qi Zi (Lycii Fructus) each 60g. Stir-fried together, ground to powder, refined honey made into pills, size of Sophora japonica seeds. Take 50 pills each time on an empty stomach, delivered with salt water, twice daily. One course of the above formula brought great improvement. Continuing one more course, wife became pregnant.
(Zhang Mengnong "Lin Zheng Hui Yao")
Case 2 Gao X, Male, 42 years old, married, Outpatient No. C00091. Previously suffered from nocturnal emission and premature ejaculation. For the past half year, impotence with inability to erect, sexual dysfunction, complete lack of desire, scrotal atrophy, cold pain in waist, flaccidity of lower limbs, mental fatigue, loss of appetite, bluish-white complexion, occasional aversion to cold, cold hands and feet. Palpation: Both Chi (Kidney) pulses deep and slow, Guan (Spleen/Liver) pulses slow and weak, tongue coating thin white. Syndrome Differentiation: Kidney Yang insufficiency, Ming Men Fire (Gate of Life Fire) decline, Liver and Spleen weakness. Treatment Method: Tonify Liver and Spleen, secure Kidney Qi. Formula: Da Shu Di (Rehmanniae Radix Preparata) 15g, Shan Yao (Dioscoreae Rhizoma) 15g, Ba Ji Rou (Morindae Officinalis Radix et Cortex Flesh) 15g, Bu Gu Zhi (Psoraleae Fructus) 6g, Suo Yang (Cynomorii Herba) 6g, Rou Cong Rong (Cistanches Herba) 6g, Xi Dang Shen (Codonopsis Radix) 15g, Fu Ling (Poria) 9g, Lu Jiao Jiao (Deer Antler Glue) 6g, Quan Dang Gui (Angelicae Sinensis Radix) 9g, Shan Yu Rou (Corni Fructus) 6g, Xi Gou Qi (Lycii Fructus) 9g. Second Visit: After taking 10 doses of the above medicine, spirit and complexion improved. Add Tu Si Zi (Cuscutae Semen) 9g to the original formula to fill marrow and essence, take another 10 doses. Third Visit: Erection easier than before, complexion turned red. Due to catching cold and diarrhea, remove Rou Cong Rong from original formula, replace Lu Jiao Jiao with Lu Jiao Pian (Deer Antler Slice), add Rou Dou Kou (Myristicae Semen) 1.5g, Shen Qu (Massa Medicata Fermentata) 1.5g, Gu Ya (Setariae Germinatum) 9g, take another 10 doses. Final Visit: After taking 30 doses, erection easy, all symptoms cured. Add Gui Ban (Testudinis Carapax et Plastrum) 15g to original formula to nourish Kidney Yin. Later, increase original formula by 10 times, make into honey pills like Sophora japonica seeds, take 20 pills morning and night to consolidate efficacy.
(Liang CIMing compiled: Jiang Yubo Medical Cases, "Guangdong Medical Journal" 01:37, 1965) [Commentary] Impotence refers to inability to erect, or erection not firm during intercourse. Mostly due to excessive lust, fright, excessive thinking, decline of Ming Huo (Life Fire), injury to Heart and Spleen, or Damp-Heat pouring downward causing relaxation of Zong Jin (Convergent Tendons).
Case 1 Syndrome belongs to Liver and Kidney Yin deficiency, Ming Men Fire (Gate of Life Fire) decline, deficiency of both Yin and Yang. Gradually formed from Liver and Kidney Yin deficiency, cannot seek quick success. Treatment uses pill form for slow planning, efficacy is stable.
Case 2 Treatment focuses on simultaneous tonification of Liver, Spleen, and Kidney, primarily warming and tonifying Kidney Yang, but also appropriately protecting Kidney Yin. This is the meaning of Zhang Jiebin's saying: "Those who excel in tonifying Yang must seek Yang within Yin." The prescription for this case is relatively appropriate.
(Thirty-Nine) Priapism
Case 1 Zhang XX, Male, 40 years old, Summer 1968. Anterior organ protruding, long, and hard for half a month, hospitalized in a certain hospital, inability to pass stool and urine, lower abdominal distension and pain unbearable, even banging head on ground. Decided to surgically remove on May 15. Pulse deep, string-like, long, solid, large, and forceful. Tongue coating purple-red, yellow, and dry. Syndrome Differentiation: Damp-Heat accumulating in Lower Jiao transforming into Dryness, Fire-Toxin accumulating in Zong Jin (Convergent Tendons). Treatment Method: Purge Fire, nourish Yin, defeat Toxin. Formula: Long Dan Cao (Gentianae Radix) 10g, Huang Bo (Phellodendri Cortex) 10g, Huang Qin (Scutellariae Radix) 10g, Chi Shao (Paeoniae Radix Rubra) 10g, Huang Lian (Coptidis Rhizoma) 10g, Bai Wei (Cynanchi Atrati Radix) 10g, Zhi Zi (Gardeniae Fructus) 10g, Sheng Di (Rehmanniae Radix) 15g, Dan Pi (Moutan Cortex) 10g, Chai Hu (Bupleuri Radix) 10g. Acupuncture Points: Da Dun (Liv1), Xing Jian (Liv2), Tai Yang (Extra), Zhong Feng (Liv4), Li Gou (Liv4), Wei Yang (BL59), Zu San Li (ST36), Shang Ju Xu (ST37), Xia Ju Xu (ST39) (both sides), Guan Yuan (CV4), Shui Fen (CV9). External application (omitted). May 18 (Second Visit): Stool and urine passage smooth, pain greatly reduced, tongue coating purple-red and yellow dry all retreated. Add Gui Ban (Testudinis Carapax et Plastrum), Zhi Mu (Anemarrhenae Rhizoma), Bai Mao Gen (Imperatae Rhizoma), Gan Cao Shao (Glycyrrhizae Radix et Rhizoma tip) to above formula. External application (omitted). May 29 (Third Visit): Distension and pain greatly reduced, external edema of penis completely gone, hardness halved, still cannot hang down. Formula focuses on defeating Toxin. Nan Sha Shen (Adenophorae Radix), Di Ding (Taraxaci Herba), Pu Gong Ying (Taraxaci Herba), Jin Yin Hua (Lonicerae Japonicae Flos), Han Shui Shi (Halloysitum Album) each 10g, Ye Ju Hua (Chrysanthemi Indici Flos), Huang Bo (Phellodendri Cortex), Zhi Mu (Anemarrhenae Rhizoma), Tian Kui Zi (Typhonii Rhizoma), Long Dan Cao (Gentianae Radix), Dan Pi (Moutan Cortex), Sheng Ma ( Cimicifugae Rhizoma) each 10g, Bai Wei (Cynanchi Atrati Radix) 18g. External medicine (omitted). June 16, add Gui Ban (Testudinis Carapax et Plastrum) 30g to above formula, one dose every two days. July 2, returned to normal.
(Zhang Mengnong "Lin Zheng Hui Yao")