例二张XX，男，36岁，已婚，门诊号40317。初诊日期：1963年12月12日。患者于1963年11月25日起，阴茎勃起不适，26日则阴茎强硬疼痛非常，是晚通夜不眠，小便短涩频数，呈深黄色，一夜十余次，疼痛难忍。曾经针灸、腰椎麻醉、阴茎海绵体穿刺，术后感染较重，曾服龙胆泻肝汤不应，又作肾虚，用夏子由奇方(治玉茎长硬不痿、精出，捏之则脆痒如刺针。。方用补骨脂、家韭子各30克为末，每服9克)，服后胀痛更甚。又用六味地黄等滋肾，皆不见效。1963年12月12日下午来诊。患者阴茎勃起强硬肿大，小便不利阴囊及少腹胀痛难忍已18天，诊得寸关脉弦滑，两尺沉弱，舌苔淡黄。治法：补阴以治阳，兼泻肝火，清利湿热为辅。方药：川萆薢，生地黄、熟地(盐水浸)各30克肥知母(盐炒)9克黄柏(盐炒)9克广木香3克车前子9克泽泻6克牛膝9克败龟板60克寸冬15克茯苓15克甘草梢9克八剂，日服1剂针灸关元，长强二穴，俱用泻法。12月20日复诊：服上方至第6剂后，阴茎肿渐消，稍软，能侧卧及坐起，小便已通。八剂后阴茎见软，可下床步行。寸关脉微弦。依原方龟板减30克萆薢减至9克熟地减15克黄柏减至6克。去生地、知母，车前、泽泻。加山药15克，丹参9克，丹皮9克，乌药4。5克，续断6克，山萸9克以扶脾凉血散瘀，再进7剂。12月28日，服上药后阴茎软下，肿消大半，疼痛明显减轻。寸关脉转缓，黄苔退尽。依上方减黄柏至3克，加芍药9克以敛盱清热去其余邪。1964年1月5日治愈出院，随访至5月未再发。
(梁赐明整理：蒋玉伯医案，《广东医学》1：37，1965)[评按]阳强系指阳事举而不收，多因受热而致。如《灵枢经·经筋》云：‘足厥阴之筋，……伤于寒则阴缩入，伤于热则纵挺不收”。
例一因湿热毒火为病，故初用大剂苦寒泻降宣通，续以滋阴抑阳、降火补水为主，并加用清热解毒消肿散结之剂，内外治相结合而愈。
例二证属肾虚肝旺，单用滋阴则缓不应急，纯泻肝而不填阴则欲速不达。故用大剂滋阴为主，佐以平肝清热利湿，冀以两全，并配合针灸治疗，针药并用，以解病家难言之苦。凌波按：阳强尚属易治，若一味苦寒，则戕伐正气，往往在阳强之后又继以阳蒌，此又学者不可不知。
(四十)癃闭
例一何XX，女，50岁，初诊日期；1978年7月15日。患者小便黄少，有时小便不通，胃部及腹部两侧胀满，自觉有水停滞于内，饮食很差，常嗳气，多矢气，喉中时觉有痰，头部昏重，手足发烧，晚上口干，出气觉热，有时心慌心跳，曾服香燥清利汤药均未奏效，反觉胀满愈甚，小便更加不通，诊得脉象微弱，舌质淡萎。辨证：气血不足，脾肾阳虚。治法：补气益血，扶脾强肾，佐以润肺。方药：泡参9克炒白术9克茯苓9克黄芪12克当归9克川芎6克白芍9克菟丝子12克补骨脂9克肉桂3克砂仁6克广木香6克麦冬9克甘草3克益智仁9克，上方服6剂后，诸症大减，小溲已得通利，腹亦不胀，—后续服至30余剂，自觉康复。随访二年多，情况良好。
(李克淦整理，李斯炽医案《新医药学杂志》?：22，1978)
例二任XX，男，56岁，门诊号；7528055，初诊日期，1975年6月25日。有前列腺肥大史，尿少色黄且痛，足肿按之如泥，；凹陷不起，面色灰滞，眼睑浮肿，本月6日起尿闭，曾三次导尿，刻下小便不畅，尿频量少，夜5～6次，舌边红，苔白干燥，脉沉细涩，超声波检查：膀胱积水500毫升。辨证：湿热瘀阻于下焦，膀胱宣化失司，发为淋沥而痛。—治法：清利通淋。方药：炒知柏各9克肉桂丸1．5克(分吞)木通9克篇蓄草18克块滑石30克金钱草30克红藤30克败酱草30克桃仁12克防己12克虎杖30克生升麻9克7月2日
(二诊)，小溲较利，量亦增多，尿痛亦止，足肿亦消三分之二，苔薄白，脉沉细，尿利肿消，水湿已得下泄。超声波复查：膀胱余尿仅100毫升，原方再进。?月9日
(三诊)：足肿又退，小便次数减至每夜1～2次，但尿色深黄且混，味臭，纳呆乏力，脉沉细，苔薄，舌质红。下焦湿热未楚，再守原意进退。炒知柏各9克肉桂丸1．2克(分吞)红藤30克粉萆薢12克败酱草30克米仁15克木通4．5克竹叶9克虎杖30克生黄芪15克防己9克六一散30克(包煎)7月22日
(四诊)：上方服14剂。年逾半百，脾肾两亏，阳不足则阴无以化，故服通利之剂，足肿虽减而未能尽退，观其尿色黄混，量不多，而色灰黄。乃湿热尚未清彻之故也。法当标本兼顾。炒知柏各9克肉桂丸1．8克红藤30克败酱草30克熟附片6克白术芍各9克猪茯苓各12克泽泻18克椒目6克虎杖30克7剂。服本方后，足肿退净，水湿得泄故也，尿量多，色淡黄，超声波检查：膀胱积水已消，下焦湿热已得净化，患者已无自觉症状，再以前方续服，巩固疗效。
(《张伯臾医案》)[评按]癃闭系指排尿困难、少腹胀痛，甚则小便闭塞不通的证候。多因膀胱气化不利所致。亦可因尿道阻塞而发。
例一以小便黄少，时有小便不通为主症。服香燥清利之剂，反觉癃闭胀满愈甚。详审其脉证，乃虚证类实之候。气血不足，脾肾阳虚，故服用益气血、温补脾肾之品而迅速获效。此为真寒假热之证。
例二为前列腺肥大、尿潴留。患者年逾半百，脾肾两虚阳气不足，阴无以化，又因下焦湿热，瘀血内停，膀胱宣化失司，以致虚实错杂，小便淋沥不通。治宜权衡轻重缓急。若湿热未尽而补之过早则有害无益，故用知、柏、篇蓄、金钱草清利湿热，肉桂温阳以助膀胱气化，红藤、败酱草清热活血消肿，升麻、虎杖既能清热解毒，又能升清降浊，通调气机，古有虎杖散一方，独用虎杖，功能散精通利，故用之殊宜。此案先治其标而后治其本，标本兼顾而效验巩固。
(四十一)五淋
例一魏XX，女，52岁。患者高热，血淋五天，头晕腰胀痛，小便频数，短赤、涩痛，纳呆，腹胀烧心，口渴喜冷饮，大便干燥，继而脸，足肿，腿痛，遂入院治疗。诊为“肾盂肾炎”。体温38．9℃；尿蛋白(+++)，红细胞5—10，白细胞6—8。脉沉弦滑，舌质红，苔黄腻。辨证：下焦湿热，膀胱蕴毒。治法：清化湿热，通淋止痛。方药，银花、鲜茅根各30克滑石24克苍术、桑寄生、黄柏各15克茜草根12克生地榆、木通，蒲黄、山栀各9克甘草梢、黄连，大黄各6克二诊，服药2剂后，体温降至正常，腰不痛，小便不红，尿时稍痛，脉右弦细数，舌质红、苔腻。三诊：又连服18剂。小便已正常，脉沉弦，舌苔正常。但因吃无盐饮，患者食欲不好，喜酸食，遂给以清利湿热，健脾开胃之品。方药，银花30克生山药，薏苡仁各15克黄柏12克白术，佩兰叶、半夏曲、炒麦芽各9克建曲6克茯苓粉0．9克服3剂后，食欲佳，诸症消失。
(《邢锡波医案选》)
例二夏，男。此下焦湿热，其热弛张起伏，小溲如浊涕，兼有红色，但不痛，舌红，脉细数。处方以猪苓汤为骨干。陈阿胶24克(烊冲)猪苓9克赤茯苓9克泽泻9克飞滑石12克马鞭草9克瞿麦穗9克冬青子9克旱莲草9克杭白芍12克生侧柏叶30克二诊，药后小溲之红白粘液，始则增多，继则减少，起伏之热亦不若往日之剧。再拟清利湿热之剂，亦尿道消毒之意。柴胡9克生侧柏叶30克苦参片6克黄柏4．5克生苍术9克淮牛膝12克白芍9克紫花地丁12克马鞭草15克凤尾草15克毕澄茄9克生甘草3克
(《章次公医案》)
例三杜XX，女，28岁。1966年秋。病方数月，尿如乳汁，腰酸腿软，头昏目眩，形容憔悴，气短音低，脉沉细迟，舌苔白厚而滑。辨证，湿盛阳弱，脾肾俱虚。治法：温补脾肾，散寒利湿。方药：炙黄芪、党参、白术，萆薜、杜仲，菟丝子各15克干姜，益智仁、炙甘草、贯仲、升麻各10克白芷12克茯苓25克服上方1Q剂，小便由混浊转黄而至正常。头昏，目眩，腰痛都减，续服数剂以善后。
(张梦侬，《临证会要》)
例四姚XX，女，30岁，初诊日期c1963年8月15日，于1960年患过急性膀胱炎，服呋喃西林与合霉素等已好转。今年3～6月先后复发四、五次。现在尿短频，尿道灼热感，腰痛，食纳正常。脉右寸关弦虚，右尺微弱，左寸尺沉数，左关弦数，舌质暗红，苔黄腻。辨证；湿热蕴于下焦，清浊互结。’治法：升清降浊。方药：萆薢9克益智仁4．5克石菖蒲6克赤茯苓6克山茵陈6克泽泻4．5克黄柏(盐水炒)4．5克知母4．5克上肉桂(去粗皮，细末冲服)0，6克白通草3克8月27日
(复诊)；服中药6剂，并自用六一散代茶饮，尿频及尿道灼热感均减轻。脉沉细微数，左关弦数，舌淡，苔白腻。仍宜和脾利湿。原方去菖蒲，加滑石9克，甘草梢1．5克，生白术3克。5剂，服药后症状消失。
(《蒲辅周医疗经验》)[评按]淋病系指小便频数短涩、尿急，尿痛、尿道不利等证。包括石淋、气淋、血淋、‘膏淋、劳淋等合称五淋。其中石淋相当于泌尿系结石，列入外科范围。若仅有小便混浊，白如泔浆而无尿痛者称谓尿浊。淋证虽分有五，但临床多相混杂或交替出现，故应抓住主证认真辨析。
例一为血淋，证属下焦湿热，故以清化湿热为主。首方药重剂大，取其势猛力捷，两剂后热退溺清。继以清利湿热、健脾开胃而收功。
例二原案题为“淋浊”，观其脉证属于下焦湿热，热势弛张起伏，尿如浊涕，兼有红色，似应属于血淋。舌红脉细数，乃肾阴虚而膀胱积热，但尿道不灼痛，颇类浊证。故用《金匮要略》猪苓汤为骨干。猪苓汤证乃水热互结，气不化津之候。用此方以利水滋阴。方中加白芍助阿胶育阴止血，瞿麦、马鞭草助苓、泽、滑石利尿清热，着眼于清热利湿，宜通不宜涩，淋浊得清，阴虚得复。
例三原案题为“乳糜尿”，观其脉证属于膏淋范围，病虽不久，但虚象毕露，证属湿盛阳衰，脾肾俱虚，治以温补脾肾，散寒利湿之法，且以温补脾肾为主，兼以利湿。
例四为急性膀胱炎，治以升清降浊法。蒲氏认为：淋证初期当以祛邪为主，中期则应扶正与祛邪兼施，后期则应以扶正为主。若为急性发作则适当加以清利。本案时值急性发作，始用当归芍药散合桂枝茯苓丸，易以猪苓汤疏导清利，后以济生肾气丸，层次清晰，疗效可观。
(四十二)头痛
例一若X，忽病头痛，干呕，服吴茱萸汤，痛益甚，眠则稍轻，坐则满头剧痛，咳嗽引腹中痛，按之则益不可忍，身无热，脉微弱，但恶见火光，口中燥，不类阳明腑实证状。盖病不专系肠中，而所重在脑，此张隐庵所谓阳明悍热之气上循入脑之证也。……及其身无热、脉微弱之时而急下之，所谓釜底抽薪也。若身有大热，脉大而实，然后论治，晚矣。生川军9克芒硝9克枳实12克厚朴3克服本方后约三小时即下，所下非燥矢，盖水浊也，而恙乃悉除，不须再诊。
(曹颖甫《经方实验录》)
例二金XX，女，63岁，住院号：74／4721，初诊日期：1974年2月17日。头痛反复发作史历二年余，昨起突然头痛如劈，颈项板滞，不能转侧，伴呕吐二次，口干尿频量少，脉弦小，舌光红。辨证：年逾花甲，肝阴已亏，肝阳上扰巅顶则痛，症情沉重。
(西医诊断：蛛网膜下腔出血)治法：平肝潜阳，滋阴熄风，以观动静。方药：羚羊粉0．6克(分吞）生石决30克(先煎）生地18克地龙9克炒白芍18克炙甘草3克鲜竹茹9克炒黄芩9克钩藤12克炒丹皮9克广郁金9克2剂。2月19日
(二诊）：头部剧痛得减，呕吐亦止，左目模糊，颈项板滞，身热口渴，大便不畅，小溲不爽，次数减少，舌红绛而干，脉弦小数。风阳化火，伤阴劫津，症势仍属重笃，再拟育阴镇潜，三甲复脉汤加减。羚羊粉0．6克(分吞）生牡蛎30克(先煎）生龟板15克(先煎）生鳖甲15克(先煎）鲜生地30克鲜沙参30克鲜铁皮石斛30克(先煎）阿胶9克(烊冲）生白芍12克生石决30克麻仁15克(打）西洋参6克另煎代茶另：鲜竹沥1支2月20日
(三诊）：头痛较昨日减轻，腑气已通，尿滞亦爽，身热略减，颈项板滞，左目红赤，舌光干练，尖边紫，脉弦细数。阴伤络损，营血两燔，血热挟瘀，拟凉血化瘀，育阴潜阳熄风，三甲复脉汤合犀角地黄汤出入。羚羊粉0．9克(分吞）水牛角30克(先煎）生地15克赤白芍各9克丹皮9克丹参9克龟板15克(先煎）鳖甲15克(先煎）牡蛎30克(先煎）阿胶9克(烊化）麻仁9克炙草3克后虽续诊数次，均以本方进退，未予更张，共服7剂，头痛渐平，身热退清，舌红较润，风阳得以潜熄，津液亦得恢复，终入坦途。
(《张伯臾医案》）
【背景信息】
书名：近现代名医验案类编 章节：正文(24/53) 类别：医论
【待处理原文】
案例二 张XX，男，36岁，已婚，门诊号40317。初诊日期：1963年12月12日。患者自1963年11月25日起，阴茎勃起不适，26日则阴茎强硬疼痛剧烈，当晚通宵未眠，小便短少涩滞且频数，呈深黄色，一夜十余次，疼痛难忍。曾接受针灸、腰椎麻醉、阴茎海绵体穿刺治疗，术后感染较重，曾服用龙胆泻肝汤（清泻肝胆实火、清利肝经湿热之方）无效，又按肾虚论治，使用夏子由奇方（主治玉茎持续勃起不痿、精液流出，捏之感觉脆痒如针刺……方用补骨脂、家韭子各30克研为末，每次服9克），服药后胀痛更加严重。又使用六味地黄丸等滋补肾阴的药物，均不见效。1963年12月12日下午就诊。患者阴茎勃起强硬肿大，小便不利，阴囊及少腹胀痛难忍已18天，诊得寸关脉弦滑，两尺脉沉弱，舌苔淡黄。治法：补阴以制约阳亢，兼泻肝火，辅以清利湿热。方药：川萆薢、生地黄、熟地黄（盐水浸泡）各30克，肥知母（盐炒）9克，黄柏（盐炒）9克，广木香3克，车前子9克，泽泻6克，牛膝9克，败龟板60克，麦冬15克，茯苓15克，甘草梢9克。共八剂，每日服一剂。针灸关元穴、长强穴，均用泻法。12月20日复诊：服用上方至第六剂后，阴茎肿胀逐渐消退，稍软，能侧卧及坐起，小便已通。八剂后阴茎变软，可下床行走。寸关脉微弦。依原方，龟板减30克，萆薢减至9克，熟地减15克，黄柏减至6克。去掉生地黄、知母，车前子、泽泻。加入山药15克，丹参9克，牡丹皮9克，乌药4.5克，续断6克，山茱萸9克，以扶助脾气、凉血散瘀，再进七剂。12月28日，服用上药后阴茎疲软下垂，肿胀消去大半，疼痛明显减轻。寸关脉转缓，黄苔退尽。依上方将黄柏减至3克，加入芍药9克以收敛肝气、清热去除其余邪。1964年1月5日治愈出院，随访至5月未再复发。
（梁赐明整理：蒋玉伯医案，《广东医学》1：37，1965）[评按] 阳强是指阳事举而不收，多因受热所致。如《灵枢经·经筋》云：“足厥阴之筋，……伤于寒则阴缩入，伤于热则纵挺不收”。
案例一因湿热毒火致病，故初用大剂量苦寒药物泻降宣通，继以滋阴抑阳、降火补水为主，并加用清热解毒、消肿散结之剂，内外治相结合而愈。
案例二证属肾虚肝旺，单用滋阴则缓不应急，纯泻肝而不填阴则欲速不达。故用大剂量滋阴为主，佐以平肝清热利湿，冀求两全其美，并配合针灸治疗，针药并用，以解病家难言之苦。凌波按：阳强尚属易治，若一味苦寒，则戕伐正气，往往在阳强之后又继发阳痿，这是学者不可不知的。
(四十) 癃闭（排尿困难或闭塞不通）
案例一 何XX，女，50岁，初诊日期：1978年7月15日。患者小便黄少，有时小便不通，胃部及腹部两侧胀满，自觉有水停滞于内，饮食很差，常嗳气，多矢气（放屁），喉中时觉有痰，头部昏重，手足发烧，晚上口干，出气觉热，有时心慌心跳，曾服香燥清利汤药均未奏效，反觉胀满愈甚，小便更加不通，诊得脉象微弱，舌质淡萎。辨证：气血不足，脾肾阳虚。治法：补气益血，扶脾强肾，佐以润肺。方药：泡参9克，炒白术9克，茯苓9克，黄芪12克，当归9克，川芎6克，白芍9克，菟丝子12克，补骨脂9克，肉桂3克，砂仁6克，广木香6克，麦冬9克，甘草3克，益智仁9克。上方服6剂后，诸症大减，小溲已得通利，腹亦不胀，后续服至30余剂，自觉康复。随访二年多，情况良好。
（李克淦整理，李斯炽医案《新医药学杂志》?：22，1978）
案例二 任XX，男，56岁，门诊号：7528055，初诊日期：1975年6月25日。有前列腺肥大史，尿少色黄且痛，足肿按之如泥，凹陷不起，面色灰滞，眼睑浮肿，本月6日起尿闭，曾三次导尿，刻下小便不畅，尿频量少，夜5～6次，舌边红，苔白干燥，脉沉细涩，超声波检查：膀胱积水500毫升。辨证：湿热瘀阻于下焦，膀胱宣化失司，发为淋沥而痛。治法：清利通淋。方药：炒知母、黄柏各9克，肉桂丸1.5克（分吞），木通9克，篇蓄草18克，块滑石30克，金钱草30克，红藤30克，败酱草30克，桃仁12克，防己12克，虎杖30克，生升麻9克。
7月2日（二诊）：小溲较利，量亦增多，尿痛亦止，足肿亦消三分之二，苔薄白，脉沉细，尿利肿消，水湿已得下泄。超声波复查：膀胱余尿仅100毫升，原方再进。
7月9日（三诊）：足肿又退，小便次数减至每夜1～2次，但尿色深黄且混，味臭，纳呆乏力，脉沉细，苔薄，舌质红。下焦湿热未清，再守原意进退。炒知母、黄柏各9克，肉桂丸1.2克（分吞），红藤30克，粉萆薢12克，败酱草30克，米仁15克，木通4.5克，竹叶9克，虎杖30克，生黄芪15克，防己9克，六一散30克（包煎）。
7月22日（四诊）：上方服14剂。年逾半百，脾肾两亏，阳不足则阴无以化，故服通利之剂，足肿虽减而未能尽退，观其尿色黄混，量不多，而色灰黄。乃湿热尚未清彻之故也。法当标本兼顾。炒知母、黄柏各9克，肉桂丸1.8克，红藤30克，败酱草30克，熟附片6克，白术、白芍各9克，猪苓、茯苓各12克，泽泻18克，椒目6克，虎杖30克，7剂。服本方后，足肿退净，水湿得泄故也，尿量多，色淡黄，超声波检查：膀胱积水已消，下焦湿热已得净化，患者已无自觉症状，再以前方续服，巩固疗效。
（《张伯臾医案》）[评按] 癃闭系指排尿困难、少腹胀痛，甚则小便闭塞不通的证候。多因膀胱气化不利所致。亦可因尿道阻塞而发。
案例一以小便黄少，时有小便不通为主症。服香燥清利之剂，反觉癃闭胀满愈甚。详审其脉证，乃虚证类实之候。气血不足，脾肾阳虚，故服用益气血、温补脾肾之品而迅速获效。此为真寒假热之证。
案例二为前列腺肥大、尿潴留。患者年逾半百，脾肾两虚阳气不足，阴无以化，又因下焦湿热，瘀血内停，膀胱宣化失司，以致虚实错杂，小便淋沥不通。治宜权衡轻重缓急。若湿热未尽而补之过早则有害无益，故用知母、黄柏、篇蓄、金钱草清利湿热，肉桂温阳以助膀胱气化，红藤、败酱草清热活血消肿，升麻、虎杖既能清热解毒，又能升清降浊，通调气机，古有虎杖散一方，独用虎杖，功能散精通利，故用之殊宜。此案先治其标而后治其本，标本兼顾而效验巩固。
(四十一) 五淋（五种淋证的总称）
案例一 魏XX，女，52岁。患者高热，血淋五天，头晕腰胀痛，小便频数，短赤、涩痛，纳呆，腹胀烧心，口渴喜冷饮，大便干燥，继而脸、足肿，腿痛，遂入院治疗。诊为“肾盂肾炎”。体温38.9℃；尿蛋白(+++)，红细胞5—10，白细胞6—8。脉沉弦滑，舌质红，苔黄腻。辨证：下焦湿热，膀胱蕴毒。治法：清化湿热，通淋止痛。方药：银花、鲜茅根各30克，滑石24克，苍术、桑寄生、黄柏各15克，茜草根12克，生地榆、木通、蒲黄、山栀各9克，甘草梢、黄连、大黄各6克。二诊，服药2剂后，体温降至正常，腰不痛，小便不红，尿时稍痛，脉右弦细数，舌质红、苔腻。三诊：又连服18剂。小便已正常，脉沉弦，舌苔正常。但因吃无盐饮食，患者食欲不好，喜酸食，遂给以清利湿热，健脾开胃之品。方药：银花30克，生山药、薏苡仁各15克，黄柏12克，白术、佩兰叶、半夏曲、炒麦芽各9克，建曲6克，茯苓粉0.9克。服3剂后，食欲佳，诸症消失。
（《邢锡波医案选》）
案例二 夏，男。此下焦湿热，其热弛张起伏，小溲如浊涕，兼有红色，但不痛，舌红，脉细数。处方以猪苓汤为骨干。陈阿胶24克（烊冲），猪苓9克，赤茯苓9克，泽泻9克，飞滑石12克，马鞭草9克，瞿麦穗9克，冬青子9克，旱莲草9克，杭白芍12克，生侧柏叶30克。二诊，药后小溲之红白粘液，始则增多，继则减少，起伏之热亦不若往日之剧。再拟清利湿热之剂，亦尿道消毒之意。柴胡9克，生侧柏叶30克，苦参片6克，黄柏4.5克，生苍术9克，淮牛膝12克，白芍9克，紫花地丁12克，马鞭草15克，凤尾草15克，毕澄茄9克，生甘草3克。
（《章次公医案》）
案例三 杜XX，女，28岁。1966年秋。病方数月，尿如乳汁，腰酸腿软，头昏目眩，形容憔悴，气短音低，脉沉细迟，舌苔白厚而滑。辨证：湿盛阳弱，脾肾俱虚。治法：温补脾肾，散寒利湿。方药：炙黄芪、党参、白术、萆薢、杜仲、菟丝子各15克，干姜、益智仁、炙甘草、贯仲、升麻各10克，白芷12克，茯苓25克。服上方10剂，小便由混浊转黄而至正常。头昏，目眩，腰痛都减，续服数剂以善后。
（张梦侬，《临证会要》）
案例四 姚XX，女，30岁，初诊日期：1963年8月15日，于1960年患过急性膀胱炎，服呋喃西林与合霉素等已好转。今年3～6月先后复发四、五次。现在尿短频，尿道灼热感，腰痛，食纳正常。脉右寸关弦虚，右尺微弱，左寸尺沉数，左关弦数，舌质暗红，苔黄腻。辨证：湿热蕴于下焦，清浊互结。治法：升清降浊。方药：萆薢9克，益智仁4.5克，石菖蒲6克，赤茯苓6克，山茵陈6克，泽泻4.5克，黄柏（盐水炒）4.5克，知母4.5克，上肉桂（去粗皮，细末冲服）0.6克，白通草3克。
8月27日（复诊）：服中药6剂，并自用六一散代茶饮，尿频及尿道灼热感均减轻。脉沉细微数，左关弦数，舌淡，苔白腻。仍宜和脾利湿。原方去菖蒲，加滑石9克，甘草梢1.5克，生白术3克。5剂，服药后症状消失。
（《蒲辅周医疗经验》）[评按] 淋病系指小便频数短涩、尿急，尿痛、尿道不利等证。包括石淋、气淋、血淋、膏淋、劳淋等合称五淋。其中石淋相当于泌尿系结石，列入外科范围。若仅有小便混浊，白如泔浆而无尿痛者称谓尿浊。淋证虽分有五，但临床多相混杂或交替出现，故应抓住主证认真辨析。
案例一为血淋，证属下焦湿热，故以清化湿热为主。首方药重剂大，取其势猛力捷，两剂后热退溺清。继以清利湿热、健脾开胃而收功。
案例二原案题为“淋浊”，观其脉证属于下焦湿热，热势弛张起伏，尿如浊涕，兼有红色，似应属于血淋。舌红脉细数，乃肾阴虚而膀胱积热，但尿道不灼痛，颇类浊证。故用《金匮要略》猪苓汤为骨干。猪苓汤证乃水热互结，气不化津之候。用此方以利水滋阴。方中加白芍助阿胶育阴止血，瞿麦、马鞭草助苓、泽、滑石利尿清热，着眼于清热利湿，宜通不宜涩，淋浊得清，阴虚得复。
案例三原案题为“乳糜尿”，观其脉证属于膏淋范围，病虽不久，但虚象毕露，证属湿盛阳衰，脾肾俱虚，治以温补脾肾，散寒利湿之法，且以温补脾肾为主，兼以利湿。
案例四为急性膀胱炎，治以升清降浊法。蒲氏认为：淋证初期当以祛邪为主，中期则应扶正与祛邪兼施，后期则应以扶正为主。若为急性发作则适当加以清利。本案时值急性发作，始用当归芍药散合桂枝茯苓丸，易以猪苓汤疏导清利，后以济生肾气丸，层次清晰，疗效可观。
(四十二) 头痛
案例一 若X，忽病头痛，干呕，服吴茱萸汤，痛益甚，眠则稍轻，坐则满头剧痛，咳嗽引腹中痛，按之则益不可忍，身无热，脉微弱，但恶见火光，口中燥，不类阳明腑实证状。盖病不专系肠中，而所重在脑，此张隐庵所谓阳明悍热之气上循入脑之证也。……及其身无热、脉微弱之时而急下之，所谓釜底抽薪也。若身有大热，脉大而实，然后论治，晚矣。生川军9克，芒硝9克，枳实12克，厚朴3克。服本方后约三小时即下，所下非燥矢，盖水浊也，而恙乃悉除，不须再诊。
（曹颖甫《经方实验录》）
案例二 金XX，女，63岁，住院号：74／4721，初诊日期：1974年2月17日。头痛反复发作史历二年余，昨起突然头痛如劈，颈项板滞，不能转侧，伴呕吐二次，口干尿频量少，脉弦小，舌光红。辨证：年逾花甲，肝阴已亏，肝阳上扰巅顶则痛，症情沉重。
（西医诊断：蛛网膜下腔出血）治法：平肝潜阳，滋阴熄风，以观动静。方药：羚羊粉0.6克（分吞），生石决明30克（先煎），生地18克，地龙9克，炒白芍18克，炙甘草3克，鲜竹茹9克，炒黄芩9克，钩藤12克，炒丹皮9克，广郁金9克。2剂。
2月19日（二诊）：头部剧痛得减，呕吐亦止，左目模糊，颈项板滞，身热口渴，大便不畅，小溲不爽，次数减少，舌红绛而干，脉弦小数。风阳化火，伤阴劫津，症势仍属重笃，再拟育阴镇潜，三甲复脉汤加减。羚羊粉0.6克（分吞），生牡蛎30克（先煎），生龟板15克（先煎），生鳖甲15克（先煎），鲜生地30克，鲜沙参30克，鲜铁皮石斛30克（先煎），阿胶9克（烊冲），生白芍12克，生石决明30克，麻仁15克（打），西洋参6克另煎代茶。另：鲜竹沥1支。
2月20日（三诊）：头痛较昨日减轻，腑气已通，尿滞亦爽，身热略减，颈项板滞，左目红赤，舌光干练，尖边紫，脉弦细数。阴伤络损，营血两燔，血热挟瘀，拟凉血化瘀，育阴潜阳熄风，三甲复脉汤合犀角地黄汤出入。羚羊粉0.9克（分吞），水牛角30克（先煎），生地15克，赤白芍各9克，丹皮9克，丹参9克，龟板15克（先煎），鳖甲15克（先煎），牡蛎30克（先煎），阿胶9克（烊化），麻仁9克，炙草3克。后虽续诊数次，均以本方进退，未予更张，共服7剂，头痛渐平，身热退清，舌红较润，风阳得以潜熄，津液亦得恢复，终入坦途。
（《张伯臾医案》）
Background Information:
Book Title: Compilation of Verified Cases by Famous Modern and Contemporary Physicians; Chapter: Main Text (24/53); Category: Medical Discussion
Case 2: Zhang XX, male, 36 years old, married, outpatient number 40317. Initial visit date: December 12, 1963. The patient began experiencing discomfort with penile erection on November 25, 1963. On the 26th, the penis became rigid and severely painful, keeping him awake all night. Urine was scanty, difficult to pass, frequent, dark yellow, occurring more than ten times a night, with unbearable pain. He had previously undergone acupuncture, lumbar anesthesia, and puncture of the corpus cavernosum of the penis. Post-operative infection was severe. Longdan Xiegan Tang (Gentian Liver-Draining Decoction) was ineffective. Treatment for Kidney Deficiency using Xia Ziyu's Miracle Formula (for persistent penile erection without flaccidity, seminal emission, feeling brittle and itchy like needle pricks when pinched... formula uses Psoralea Fructus [Buguzhi] and Allium Tuberosum Seed [Jiuzi], each 30g ground into powder, 9g per dose) resulted in worsened distension and pain. Sixwei Dihuang Wan (Six-Ingredient Rehmannia Pill) and other kidney-nourishing formulas were also ineffective. He visited the clinic on the afternoon of December 12, 1963. The patient presented with a rigid, swollen, and enlarged penis, difficulty urinating, and unbearable distending pain in the scrotum and hypogastrium for 18 days. Pulse was wiry and slippery at the Cun and Guan positions, deep and weak at both Chi positions. Tongue coating was pale yellow. Therapeutic Principle: Nourish Yin to restrain Yang, simultaneously clear Liver Fire, assisted by clearing and draining Damp-Heat. Prescription: Rhizoma Dioscoreae Hypoglaucae [Bixie], Raw Radix Rehmanniae [Shengdihuang], and Prepared Radix Rehmanniae [Shudihuang] (soaked in salt water), each 30g; Rhizoma Anemarrhenae [Zhimu] (salt-fried), 9g; Cortex Phellodendri [Huangbai] (salt-fried), 9g; Aromatic Magnolia Bark [Muxiang], 3g; Semen Plantaginis [Cheqianzi], 9g; Rhizoma Alismatis [Zexie], 6g; Radix Achyranthis Bidentatae [Niuxi], 9g; Carapax et Plastrum Testudinis [Beiguiban], 60g; Radix Ophiopogonis [Maidong], 15g; Poria [Fuling], 15g; Radix Glycyrrhizae [Gancao Shao], 9g. Eight doses, one dose daily. Acupuncture at Guanyuan (CV-4) and Changqiang (GV-1) acupoints, both using the reducing method. Follow-up on December 20: After taking six doses of the above prescription, penile swelling gradually subsided, becoming slightly softer, allowing side-lying and sitting up. Urination resumed. After eight doses, the penis softened, allowing the patient to walk out of bed. Pulse at Cun and Guan was slightly wiry. Adjusted original prescription: Beiguiban reduced by 30g, Bixie reduced to 9g, Shudihuang reduced by 15g, Huangbai reduced to 6g. Removed Shengdihuang, Zhimu, Cheqianzi, and Zexie. Added Rhizoma Dioscoreae [Shanyao], 15g; Radix Salviae Miltiorrhizae [Danshen], 9g; Cortex Moutan [Danpi], 9g; Rhizoma Linderae [Wuyao], 4.5g; Radix Dipsaci [Xuduan], 6g; Fructus Corni [Shanzhuyu], 9g, to support Spleen Qi, cool blood, and dissipate stasis. Seven additional doses. December 28: After taking the medicine, the penis became flaccid and descended, swelling reduced by more than half, and pain significantly decreased. Pulse at Cun and Guan became moderate; yellow coating disappeared. Adjusted prescription: Huangbai reduced to 3g, added Radix Paeoniae Alba [Shaoyao], 9g, to astringe Liver and clear heat, removing residual pathogenic factors. Cured and discharged on January 5, 1964. No recurrence during follow-up until May.
(Compiled by Liang CIMing: Case of Jiang Yubo, *Guangdong Medical Journal* 1:37, 1965) [Commentary]: Yang Qiang refers to persistent penile erection without detumescence, often caused by Heat. As stated in *Ling Shu Jing · Jing Jin*: "The sinews of Foot Jueyin... injury from Cold causes retraction, injury from Heat causes prolonged erection without retraction."
Case 1 was caused by Damp-Heat, Toxic Fire. Initially treated with large doses of bitter-cold herbs to drain, descend, and unblock. Subsequently focused on nourishing Yin to suppress Yang and descending fire to replenish water, combined with herbs that clear heat, detoxify, reduce swelling, and dissipate nodules. Internal and external treatments combined led to recovery.
Case 2 presented as Kidney Deficiency with Liver Excess. Solely nourishing Yin is too slow for urgent conditions; solely purging the Liver without tonifying Yin leads to haste failing to achieve results. Therefore, large doses of Yin-nourishing herbs were used primarily, supplemented by calming the Liver, clearing heat, and draining dampness, aiming for a balanced approach, combined with acupuncture. Needle and drug therapy together alleviated the patient's unspeakable suffering. Ling Bo notes: Yang Qiang is relatively easy to treat. If purely bitter-cold herbs are used indiscriminately, they damage healthy Qi, often leading to Yang Wei (impotence) following Yang Qiang. This is knowledge scholars must possess.
(40) Long Bi (Dysuria / Urinary Retention)
Case 1: He XX, female, 50 years old. Initial visit date: July 15, 1978. Patient had scanty, yellow urine, sometimes unable to urinate. Distension in the stomach and both sides of the abdomen, feeling of water stagnation internally. Poor appetite, frequent belching, flatulence. Sensation of phlegm in the throat. Heavy sensation in the head. Hot hands and feet. Dry mouth at night. Breath felt hot. Occasional palpitations. Previously treated with aromatic-drying and diuretic decoctions without effect; instead, distension worsened, and urination became more obstructed. Pulse was faint; tongue body was pale and withered. Syndrome Differentiation: Qi and Blood Deficiency, Spleen and Kidney Yang Deficiency. Therapeutic Principle: Tonify Qi and nourish Blood, strengthen Spleen and Kidney, assist with moistening the Lung. Prescription: Paoshen (Prepared Codonopsis), 9g; Chao Baizhu (Stir-fried Atractylodes Macrocephala Rhizome), 9g; Fuling, 9g; Huangqi, 12g; Danggui, 9g; Chuanxiong, 6g; Baishao, 9g; Tusizi, 12g; Buguzhi, 9g; Rougui, 3g; Sharen, 6g; Muxiang, 6g; Maidong, 9g; Gancao, 3g; Yizhiren, 9g. After six doses of the above prescription, symptoms greatly reduced, urination became smooth, abdominal distension resolved. Continued for over 30 doses, patient felt recovered. Follow-up for over two years showed good condition.
(Compiled by Li Kegan, Case of Li Sichi, *New Medical Science Magazine* ? :22, 1978)
Case 2: Ren XX, male, 56 years old. Outpatient number: 7528055. Initial visit date: June 25, 1975. History of prostatic hyperplasia. Scanty, yellow, painful urine. Edema in feet, pitting upon pressure, not rebounding. Ashen complexion. Eyelid edema. Urinary retention started on the 6th of this month. Catheterized three times. Currently, urination is difficult, frequent but scanty, 5-6 times at night. Tongue edges red, coating white and dry. Pulse deep, fine, and choppy. Ultrasound examination: Bladder fluid accumulation 500ml. Syndrome Differentiation: Damp-Heat and Blood Stasis obstructing the Lower Jiao, failure of Bladder distribution and transformation, resulting in dribbling and painful urination. Therapeutic Principle: Clear and drain to promote urination. Prescription: Chao Zhimu and Huangbai, each 9g; Rougui Wan (Cinnamon Pill), 1.5g (swallowed separately); Mutong, 9g; Pianxu Cao, 18g; Kuahuaishi (Block Talcum), 30g; Jinqiancao, 30g; Hongteng, 30g; Baijiangcao, 30g; Taoren, 12g; Fangji, 12g; Huazhang, 30g; Sheng Shengma, 9g.
July 2 (Second Visit): Urination improved, volume increased, pain stopped. Foot edema reduced by two-thirds. Coating thin white, pulse deep and fine. Urination smooth, edema subsided, water-dampness drained downward. Ultrasound re-examination: Bladder residual urine only 100ml. Continue original prescription.
July 9 (Third Visit): Foot edema further reduced. Urination frequency decreased to 1-2 times per night. However, urine color deep yellow and turbid, foul smell. Poor appetite and fatigue. Pulse deep and fine, coating thin, tongue body red. Lower Jiao Damp-Heat not yet cleared. Stick to original principle with adjustments. Chao Zhimu and Huangbai, each 9g; Rougui Wan, 1.2g (swallowed separately); Hongteng, 30g; Fen Bixie, 12g; Baijiangcao, 30g; Yiren (Coix Seed), 15g; Mutong, 4.5g; Zhuye, 9g; Huazhang, 30g; Sheng Huangqi, 15g; Fangji, 9g; Liuyisan (Six-to-One Powder), 30g (wrapped and decocted).
July 22 (Fourth Visit): Took 14 doses of the above prescription. Over fifty years old, Spleen and Kidney both deficient. Insufficient Yang cannot transform Yin. Thus, after taking diuretic agents, foot edema reduced but did not completely resolve. Urine color yellow-turbid, small amount, ash-yellow hue. This indicates Damp-Heat not yet thoroughly cleared. Method should address both root and branch. Chao Zhimu and Huangbai, each 9g; Rougui Wan, 1.8g; Hongteng, 30g; Baijiangcao, 30g; Shu Fupian (Prepared Aconite Lateral Root), 6g; Baizhu and Baishao, each 9g; Zhuling and Fuling, each 12g; Zexie, 18g; Jiaomu, 6g; Huazhang, 30g. Seven doses. After taking this prescription, foot edema completely resolved due to drainage of water-dampness. Urine volume increased, color pale yellow. Ultrasound examination: Bladder fluid accumulation eliminated. Lower Jiao Damp-Heat purified. Patient no longer had subjective symptoms. Continue previous prescription to consolidate efficacy.
(Case of Zhang Boyu, *Zhang Boyu Medical Cases*) [Commentary]: Long Bi refers to the syndrome of difficult urination, lower abdominal distension and pain, or even complete urinary obstruction. It is mostly caused by dysfunction of Bladder Qi transformation. It can also occur due to urethral obstruction.
Case 1's main symptoms were scanty yellow urine and intermittent inability to urinate. Taking aromatic-drying and diuretic agents反而 worsened the Long Bi and distension. Detailed examination of pulse and symptoms revealed a deficiency pattern mimicking excess. Qi and Blood deficiency, Spleen and Kidney Yang deficiency. Thus, taking herbs to benefit Qi and Blood and warm-tonify Spleen and Kidney yielded rapid effects. This is a True Cold False Heat syndrome.
Case 2 is Prostatic Hyperplasia with Urinary Retention. The patient is over fifty, with Spleen and Kidney deficiency and insufficient Yang, unable to transform Yin. Additionally, Lower Jiao Damp-Heat and internal Blood Stasis cause Bladder distribution failure, resulting in mixed deficiency and excess, causing dribbling and obstruction. Treatment requires weighing severity and urgency. If tonification is applied too early while Damp-Heat remains, it is harmful. Thus, Zhimu, Huangbai, Pianxu, and Jinqiancao were used to clear Damp-Heat. Rougui warms Yang to assist Bladder Qi transformation. Hongteng and Baijiangcao clear heat, invigorate blood, and reduce swelling. Shengma and Huazhang clear heat, detoxify, ascend clear Yang, descend turbid Yin, and regulate Qi mechanism. Ancient text mentions Huazhang San; using Huazhang alone functions to disperse blockage and promote urination, making it suitable here. This case treated the branch first, then the root, addressing both for stable efficacy.
(41) Wu Lin (Five Types of Lin Syndrome)
Case 1: Wei XX, female, 52 years old. High fever, Blood Lin for five days. Dizziness, waist and back distension/pain. Frequent urination, short and red, difficult and painful. Poor appetite, abdominal distension, heartburn. Thirst preferring cold drinks. Dry stool. Subsequently facial and foot edema, leg pain. Admitted for treatment. Diagnosed as "Pyelonephritis". Temperature 38.9°C; Urine protein (+++), RBC 5-10, WBC 6-8. Pulse deep, wiry, slippery. Tongue body red, coating yellow and greasy. Syndrome Differentiation: Damp-Heat in Lower Jiao, Toxin accumulating in Bladder. Therapeutic Principle: Clear and transform Damp-Heat, promote urination and relieve pain. Prescription: Jinyinhua (Honeysuckle Flower) and Xian Maogen (Fresh Imperata Rhizome), each 30g; Huashi, 24g; Cangzhu, Sangjisheng, Huangbai, each 15g; Qiancaogen, 12g; Shengdiyü, Mutong, Puhuang, Shanzhi, each 9g; Gancao Shao, Huanglian, Dahuang, each 6g. Second Visit: After two doses, temperature normalized, waist pain ceased, urine no longer red, slight pain during urination. Right pulse wiry, fine, rapid. Tongue body red, coating greasy. Third Visit: Continued for 18 doses. Urination normalized. Pulse deep, wiry. Tongue coating normal. Due to salt-free diet, poor appetite, preference for sour food, prescribed herbs to clear Damp-Heat, strengthen Spleen, and open stomach. Prescription: Jinyinhua, 30g; Sheng Shanyao and Yiyiren, each 15g; Huangbai, 12g; Baizhu, Peilan Ye, Banxia Qu, Chao Maiya, each 9g; Jianqu, 6g; Fuling Fen, 0.9g. After three doses, appetite improved, all symptoms disappeared.
(Cases Selected from Xing Xibo, *Selected Cases of Xing Xibo*)
Case 2: Xia, male. Lower Jiao Damp-Heat, fever fluctuating. Urine like turbid mucus, mixed with red, but painless. Tongue red, pulse fine and rapid. Prescription based on Zhuling Tang. Chen Ejiao, 24g (melted and mixed); Zhuling, 9g; Chifuling, 9g; Zexie, 9g; Fei Huashi, 12g; Mabiancao, 9g; Qumai Sui, 9g; Dongqingzi, 9g; Hanliancao, 9g; Hang Baishao, 12g; Sheng Cebeiye, 30g. Second Visit: Red and white mucus in urine initially increased, then decreased. Fluctuating fever less severe than before. Prescribed again to clear and drain Damp-Heat, also for urethral disinfection. Chaihu, 9g; Sheng Cebeiye, 30g; Kushen Pian, 6g; Huangbai, 4.5g; Sheng Cangzhu, 9g; Huai Niuxi, 12g; Baishao, 9g; Zihuadiding, 12g; Mabiancao, 15g; Fengweicao, 15g; Bidengqie, 9g; Sheng Gancao, 3g.
(Cases of Zhang Cigong, *Zhang Cigong Medical Cases*)
Case 3: Du XX, female, 28 years old. Autumn 1966. Ill for several months. Urine like milk. Sore waist and soft legs. Dizziness and vertigo. Emaciated appearance. Shortness of breath, low voice. Pulse deep, fine, slow. Tongue coating white, thick, and slippery. Syndrome Differentiation: Abundant Dampness, Weak Yang, Spleen and Kidney both deficient. Therapeutic Principle: Warm and tonify Spleen and Kidney, dispel Cold and drain Dampness. Prescription: Zhi Huangqi, Dangshen, Baizhu, Bixie, Duzhong, Tusizi, each 15g; Ganjiang, Yizhiren, Zhi Gancao, Guanzhong, Shengma, each 10g; Baizhi, 12g; Fuling, 25g. After ten doses of the above prescription, urine turned from turbid to yellow, then normal. Dizziness, vertigo, and waist pain reduced. Continued for several doses for convalescence.
(Zhang Mengnong, *Lin Zheng Hui Yao*)
Case 4: Yao XX, female, 30 years old. Initial visit date: August 15, 1963. Had acute cystitis in 1960, improved with Furacillin and Chloramphenicol. Recurred 4-5 times between March and June this year. Currently, short and frequent urination, burning sensation in urethra, waist pain. Normal appetite. Right Cun and Guan pulse wiry and deficient; Right Chi pulse weak. Left Cun and Chi pulse deep and rapid; Left Guan pulse wiry and rapid. Tongue body dark red, coating yellow and greasy. Syndrome Differentiation: Damp-Heat accumulating in Lower Jiao, Clear and Turbid mixing. Therapeutic Principle: Ascend Clear and Descend Turbid. Prescription: Bixie, 9g; Yizhiren, 4.5g; Shichangpu, 6g; Chi Fuling, 6g; Shan Yinchen, 6g; Zexie, 4.5g; Huangbai (salt-fried), 4.5g; Zhimu, 4.5g; Shang Rougui (remove bark, fine powder taken with water), 0.6g; Bai Tongcao, 3g.
August 27 (Follow-up): Took 6 doses of Chinese medicine, plus self-administered Liuyisan as tea. Frequency of urination and burning sensation in urethra both reduced. Pulse deep, fine, slightly rapid. Left Guan pulse wiry and rapid. Tongue pale, coating white and greasy. Still appropriate to harmonize Spleen and drain Dampness. Remove Shichangpu from original prescription. Add Huashi, 9g; Gancao Shao, 1.5g; Sheng Baizhu, 3g. Five doses. Symptoms disappeared after medication.
(Medical Experience of Pu Fuzhou, *Pu Fuzhou Medical Experience*) [Commentary]: Lin Bing refers to syndromes of frequent, short, difficult urination, urgency, pain, and urethral discomfort. Including Stone Lin, Qi Lin, Blood Lin, Gao Lin, and Lao Lin, collectively called Wu Lin. Stone Lin corresponds to urinary system calculi, classified under Surgery. If urine is merely turbid, white like rice water, without pain, it is called Niao Zhuo. Although Lin Syndrome is divided into five types, clinically they often mix or alternate, so one must grasp the main symptoms for careful differentiation.
Case 1 is Blood Lin, syndrome of Lower Jiao Damp-Heat, thus primarily clearing and transforming Damp-Heat. The first prescription had heavy doses for potent and rapid effect. After two doses, heat subsided, urine cleared. Then cleared Damp-Heat, strengthened Spleen, opened stomach to conclude treatment.
Case 2 original title "Lin Zhuo". Pulse and symptoms indicate Lower Jiao Damp-Heat, fluctuating fever, urine like turbid mucus mixed with red, resembling Blood Lin. Tongue red, pulse fine and rapid indicates Kidney Yin Deficiency with Bladder Heat Accumulation. But urethra not burning/painful, resembling Zhuo Syndrome. Thus, Zhuling Tang from *Jin Gui Yao Lue* was used as backbone. Zhuling Tang syndrome is Water-Heat binding, Qi failing to transform fluids. Used here to promote urination and nourish Yin. Added Baishao to assist Ejiao in nourishing Yin and stopping bleeding. Qumai and Mabiancao assist Fuling, Zexie, and Huashi in diuresis and clearing heat. Focus on clearing heat and draining dampness, promoting flow rather than astringency. Once Lin and Zhuo are cleared, Yin deficiency recovers.
Case 3 original title "Chyluria". Pulse and symptoms fall within Gao Lin scope. Though illness duration not long, deficiency signs fully exposed. Syndrome is Abundant Dampness, Declining Yang, Spleen and Kidney both deficient. Treatment focuses on warming and tonifying Spleen and Kidney, dispersing Cold and draining Dampness, primarily tonifying Spleen and Kidney, assisting with draining dampness.
Case 4 is Acute Cystitis, treated with Ascending Clear and Descending Turbid method. Mr. Pu believes: Early stage of Lin Syndrome should focus on expelling pathogens; middle stage combines supporting healthy Qi and expelling pathogens; late stage focuses on supporting healthy Qi. If acute attack, appropriately add clearing and draining. This case occurred during acute attack. Initially used Danggui Shaoyao San combined with Guizhi Fuling Wan, changed to Zhuling Tang for guiding and clearing. Later used Jisheng Shenqi Wan. Clear hierarchy, considerable efficacy.
(42) Tou Tong (Headache)
Case 1: Ruo X, suddenly developed headache, dry heaving. Took Wuzhuyu Tang, pain worsened. Sleep provided slight relief. Sitting caused severe full-head pain. Cough drew pain into abdomen. Pressure made it unbearable. Body no heat, pulse faint. Only feared seeing firelight. Mouth dry. Did not resemble Yangming Fu Organ Excess syndrome. The disease was not solely related to intestines, but focused on the brain. This is what Zhang Yinan called the syndrome of Yangming fierce Heat Qi ascending into the brain... When body has no heat and pulse is faint, urgently purge it, known as "drawing firewood from under the cauldron". If body has high heat and pulse is large and solid, then discussing treatment would be too late. Sheng Chuanjun (Da Huang), 9g; Mangxiao, 9g; Zhishi, 12g; Houpo, 3g. About three hours after taking this prescription, defecation occurred. What passed was not dry feces, but turbid water. The illness was completely removed, no further visit needed.
(Cao Yingfu, *Jing Fang Shi Yan Lu*)
Case 2: Jin XX, female, 63 years old. Inpatient number: 74/4721. Initial visit date: February 17, 1974. History of recurrent headaches for over two years. Suddenly started splitting headache yesterday. Neck and nape stiff, unable to turn head. Accompanied by two episodes of vomiting. Dry mouth, frequent urination with small volume. Pulse wiry and small. Tongue bare and red. Syndrome Differentiation: Over sixty years old, Liver Yin already deficient. Liver Yang disturbing the vertex causes pain. Condition is serious.
(Western Diagnosis: Subarachnoid Hemorrhage) Therapeutic Principle: Calm Liver and subdue Yang, nourish Yin and extinguish Wind, observe dynamics. Prescription: Lingyang Fen (Antelope Horn Powder), 0.6g (taken separately); Sheng Shijueming (Oyster Shell), 30g (decocted first); Shengdi, 18g; Dilong, 9g; Chao Baishao, 18g; Zhi Gancao, 3g; Xian Zhuru, 9g; Chao Huangqin, 9g; Gouteng, 12g; Chao Danpi, 9g; Guang Yujin, 9g. Two doses.
February 19 (Second Visit): Severe head pain reduced, vomiting stopped. Left eye blurred. Neck and nape stiff. Body heat and thirst. Difficult bowel movement. Urination uncomfortable, frequency decreased. Tongue crimson and dry. Pulse wiry, slightly rapid. Wind-Yang transforming into Fire, injuring Yin and seizing fluids. Condition still critical. Again prescribe nourishing Yin and suppressing/subduing, modified Sanjia Fumai Tang. Lingyang Fen, 0.6g (taken separately); Sheng Muli, 30g (decocted first); Sheng Guiban, 15g (decocted first); Sheng Biejia, 15g (decocted first); Xian Shengdi, 30g; Xian Shashen, 30g; Xian Tiepishihu, 30g (decocted first); Ejiao, 9g (melted and mixed); Sheng Baishao, 12g; Sheng Shijueming, 30g; Maren, 15g (crushed); Xiyangshen, 6g (decocted separately as tea). Additionally: Xian Zhuli (Fresh Bamboo Juice), 1 vial.
February 20 (Third Visit): Headache reduced compared to yesterday. Bowel Qi unblocked. Urinary stagnation relieved. Body heat slightly reduced. Neck and nape stiff. Left eye red. Tongue bare, dry, tip and edges purple. Pulse wiry, fine, rapid. Yin injured, collaterals damaged. Ying and Blood both blazing. Blood Heat carrying Stasis. Prescribe cooling Blood and resolving Stasis, nourishing Yin, subduing Yang, extinguishing Wind. Modified Sanjia Fumai Tang combined with Xijiao Dihuang Tang. Lingyang Fen, 0.9g (taken separately); Shuiniujiao (Water Buffalo Horn), 30g (decocted first); Shengdi, 15g; Chi Baishao and Baishao, each 9g; Danpi, 9g; Danshen, 9g; Guiban, 15g (decocted first); Biejia, 15g (decocted first); Muli, 30g (decocted first); Ejiao, 9g (melted); Maren, 9g; Zhi Cao, 3g. Subsequent visits adjusted this prescription without major changes. Total seven doses. Headache gradually平息ed, body heat cleared. Tongue redder and moister. Wind-Yang subdued, fluids restored. Finally entered a smooth path.
(Case of Zhang Boyu, *Zhang Boyu Medical Cases*)