例四虽以胁痛为主症，兼见脾虚湿困，胃失和降，热蕴血分等证候。经检查确诊为肝吸虫、慢性肝炎。此案证颇掣肘，关氏通过细辨诸证，斟酌方治。其中用明矾、鸦胆子，因其有解毒杀虫之功，对于改善症状及治肝吸虫均有良效，深值进一步研究。
(四十七）肝着黎ｘｘ，女，23岁，1957年春初诊。先由胸中痞闷，气息不畅，继则咽塞，目胀，烦躁易怒，近来胸中痞闷加剧，时发肢体抽搐，剧则昏不知人，日有发作，胸部重按，则痞闷稍舒，曾经某医院检查，诊为“癫痫”。其人体质壮实，仰卧太息，两目呆视不瞬，喉间噎噎吱鸣。脉沉弦，苔白腻。辨证：肝着。治法：行气散瘀，通阳活血。方药：旋覆花3O克茜草9克葱白5寸茯苓9克陈橘皮6克二诊：连服2剂，胸中痞闷，目胀，咽塞减轻，未发抽搐，原方再服2剂，诸症痊愈。
(《窦伯清医案》）
【评按】肝着病名见于《金匮要略》。系指肝脏气血郁滞，着而不行所致。《金匮要略·五脏风寒积聚病脉证并治》云：“肝著，其人常欲蹈其胸上，先未苦时，但欲饮热，旋覆花汤主之”。由于肝郁血滞，故见胸胁痞闷不舒，甚或胀痛。故喜人揉按其胸上，以求舒缓，由于初起病在气分，故得热饮则气机暂时通畅而胸满稍舒。但其病既成经脉凝滞，虽饮亦无益。本例证颇典型，其犹甚者肢体抽搐，昏不知人，因肝风内动所致，不可误为“癫痫”之作。其治当行气散瘀、通阳活血，方用旋覆花汤加减。唐容川云：“肝主血，肝着即是血粘着而不散也，血生于心而归于肝，今着于胸前隔膜中，故欲蹈其胸以通之也，故用葱白以通胸中之气，如胸痹而用薤白之例，用旋复花以降胸中之气，如胸满噫气而用旋复花之例也：唯新绛乃茜草所染，用以破血、正是治肝经血着之要药。”此方另加陈皮、茯苓，取其和中化痰。叶天士医案常以此方随证加归须、桃仁、泽兰、郁金之类以治胸胁板着胀痛，收效良好，可资临证参考。
(四十八）鼓胀
例一林左。年近花甲，思虑伤脾，脾阳不运，浊湿凝聚，以致大腹胀满，鼓之如鼓，小溲清白，脉象沉细，脾为太阴，湿为阴邪，当以温运分消。熟附子块3克淡干姜2．4克生白术9克陈皮3克制川朴3克大腹皮6克鸡金炭4．5克炒谷芽12克陈葫芦瓢12克清炙草1．5克二诊：前进温运分消之剂，脐腹胀满略松。纳谷减少，形瘦神疲。小瘦清长，腑行不实，脉沉细，良由火衰不能生土，中阳不运，浊阴凝聚，鼓之如鼓，中空无物，即无形之虚气散逆，而为满为胀也，乃拟益火消阴，补虚运脾，亦经胄塞因塞用之意。炒潞党参9克“熟附子4．5克淡干姜2．4克清炙草1．5克陈广皮3克大砂仁(研）2．4克葫芦巴4.5克炒补骨脂4．5克煨益智4．5克陈葫芦瓢u克
(丁济万整理：思补山房丁甘仁医案续肿胀门，《中医杂志》16：22，1925）
例二高ｘｘ、女，55岁。初诊：肝肿硬半载，近日气郁不达，面色晦黯，面浮足肿，肝痛气逆，喘促，大腹膨胀如鼓，按之绷急而痛，肢胀已成，治为难矣。甜葶苈1．5克龙胆草3克老苏梗9克青陈皮各6克茯苓皮15克干蟾皮9克九香虫9克大腹皮9克鸡金9克砂仁1．5克麦芽9克车前子12克(包）川椒目3克7剂另小温中丸120克，早晚各服6克二诊：药后，膨胀明显缩小，按之腹软而平，大便解下畅通，面晦转黄，惟近有低热。拟再疏肝调气，清热化湿。广霍香9克防己风各9克自薇前各9克白芍15克陈皮6克茯苓皮15克砂寇壳各1.5克泽泻9克车前子12克(包）川桂枝3克焦茅术5克7剂。
(《黄一峰医案医话集》）
例三关姓，男肝郁已久，邪气内逆，气运闭塞，使脾土受湿而不能制水，小溲极少而赤，大便溏秘不匀，肤色黯黑，目白睛浑黄，唇紫而焦，舌苔白腻，形冷，痞满膨胀，四肢微肿，气机不畅，俯时尤甚，右侧胸膺胁际环引腰肢均感刺痛。西医诊谓“肝硬化”“脾脏肿大”，治之数月未效。近呈膨胀之象，腹隆起而腰挺直不能俯仰，脉弦滑而数，亟宜柔肝化瘀、和中利水、化湿清热以建中央，而兼顾肾气治之。荆三棱15克蓬莪木15克炒二丑各9克北细辛1．5克川椒目1．5克生桃仁9克赤小豆(布包煎）30克干百合(苏叶2．1克同水煨）15克瞿麦12克萹蓄12克云苓皮9克旋复花(布包煎）12克代储石12克川萆薢12克生知柏各9克汉防己9克煨木香4．5克犀黄丸9克(冲服）禹余粮丸9克(冲）金匮肾气丸(布包煎）3克水煎温服，早晚各一次共诊30余次，服药114次，所患基本痊愈，后经医院检查，脾大已消，肝脏功能恢复正常。
(孔嗣伯介绍：孔伯华先生学术经验简介，《中医杂志》715，1962）
例四段××，男，37岁，住院号：165437。1975年5月初诊：××总医院诊为“乳糜胸水、腹水”一年余，兼有风湿性心脏病、二尖瓣狭窄，心功能代偿期”。曾用中西药治疗，未见减退。现症：胸腹胀满，气短不舒，纳呆食少，苔白腻，脉缓。证属脾运失职，水湿停聚。拟胃苓汤治之。方药：苍白术各1O克川朴5克陈皮10克茯苓皮10克泽泻6克猪苓10克大腹皮10克桂枝3克生姜皮2克甘草5克每日1剂。二诊：上方服20余剂，胸腹胀满减轻，惟尿量尚少。拟宗原方去苍术、川朴、甘草，加桑白皮，每日1剂。三诊：患者服药40余剂，诸症均减，乳糜胸水已痊，乳糜腹水明显好转，脉细退，舌苔自，阴阳皆虚，拟济生肾气丸作汤出院服用。上方服40余剂，症状皆除。
(段荣书整理：董德懋医疗经验琐谈，《中医杂志》2：10，1981）
【评按】鼓胀系指腹部膨胀如鼓而命名，又称“单腹胀”。据其病机又有“气鼓”、“血鼓”、“水鼓”、“虫鼓”之别。西医所谓肝硬化腹水属于本证范围。
例一脾阳不运，浊湿凝聚以致腹胀如鼓，证属阳虚气鼓，治以温运分消之剂，续以益火消阴、补虚运脾，亦即《内经》所谓之“塞因塞用”。
例二腹胀肢肿，面晦低热，湿热偏胜，故以清热利湿为主，辅以化痰利水而获效。盖鼓胀之因，因水、因血、因湿热均能导致肝脾损伤，气血凝滞，脉络瘀阻，水气泛滥遂成鼓胀。其病虽一，其因则异，故立法遣方亦有区别。
例三诊为肝硬化，孔氏认为：“西医所谓肝硬化病之后期者，即中医之膨胀病属也。……乃肝郁恚怒不节，气逆伤肝，渐蚀及脾，损于胆胃是其国也，至于瘀滞久而‘肝硬化’者，是其果也。盖肝伤则脾伤，气机滞阻，郁而为热，热留为湿，久之脾阴大伤而运化失司，运化失司则血行乖戾而络塞，络塞则‘肝可硬化’……渐至肝失所藏，脾失所统，水气泛滥遂成膨胀，若以疏肝化瘀、理脾调气、和脉达络、通调水道，则可清热化湿、逐瘀从
(生）新，使腹膨消失，肝硬变软……”。孔氏即按此法施治，获得基本痊愈。
例四证属脾失健运，水湿停聚。诊为乳糜胸水、腹水，又有心脏病，虽经中西药治疗而未效。证情较为复杂，董氏谨严遵守中医辨证法规，拟以健脾利湿为治。方用胃苓汤。本方原载《丹溪心法》，主治中暑伤湿，停饮挟食，腹痛泄泻等证。本案从脾论治，药证十分投契，并妙用桑白皮泻肺清热以推动水之上源，颇堪令人玩味。后以主治肾虚腰重脚肿、小便不利之济生肾气丸方煎服以治其本，确属高见。
(四十九）消渴
例一朱ｘｘ，男，初诊日期：1973年10月27日。近几年来，善饥能吃，1972年发现糖尿病。一年来体重下降，疲乏无力，口渴思饮，一天约喝10磅水左右，多尿，控制饮食日服八两左右，时感饥饿，后背搔痒，易生疖疮。血糖240毫克％，尿糖四个加号，血压130／90毫米汞柱，舌质偏红，脉缓。证属气阴两伤，肺胃火炽。拟益气养阴，清热为治。方药：生黄芪、山药、苍术、元参、石斛各15克太子参、花粉各30克生地、熟地各15克芡实米、知母、黄柏、乌梅各9克天冬、麦冬各9克枸杞子12克10剂。二诊：服药后，诸症均减。口不太干，饮水减少，只觉腿软无力，唇色暗，舌胖，苔白，脉缓。前方去石斛、乌梅、枸杞子、知母、黄柏，加五味子9克，功劳叶12克10剂。三诊：服药后，疲乏好转，“三消”症状全减，仍控制饮食。原方继服10剂。四诊：又服30剂，诸症显好，空腹尿糖阴性。但因饮白酒一斤，次日空腹尿糖两个加，口干思饮，大便溏，苔白，脉滑。方药：生黄芪、苍术、元参、太子参各15克山药12克五味子9克金樱子6克天冬、麦冬各9克生地、熟地各15克肉桂3克10剂。五诊：服药后尿糖转为阴性，血糖为100毫克％，“三消”症状消失，改服丸药。
(即上方加四倍量，研末，山药打糊为丸，如梧桐子大，饭后服6克）。患者服药一料后，血糖、尿糖正常，已不控制饮食，血糖、尿糖均正常。
(祝湛予：对糖尿病的治疗体会，《新医药杂志》5：36，1976）
例二岑××，男，46岁，初诊日期：1974年1月13日。素患夜间盗汗，全身尽湿。两个月前体检发现血糖175毫克％，尿糖三个加。证见两胁窜痛，手足心热，夜间盗汗，口于思次，大使偏溏，纳食差，皮肤搔痒，脉沉弦细，舌红。证属阴虚生热，气阴两伤。方用丹栀逍遥散加减。丹皮、山栀、柴胡、白术、茯苓、当归、麦冬、五味子各9克生龙骨、生牡蛎各24克生黄芪15克山药12克生麦芽30克二诊：服上方6剂后，盗汗减少，手足心热消失，仍口于思饮，脉沉弦，舌质红。方药：生黄芪30克天冬、麦冬各9克山药、太子参、元参、苍术各15克生地、葛根、天花粉各15克五味子9克乌梅6克茯苓12克肉桂3克绿豆12克三诊：上方连服13剂，除口稍干，微有盗汗外，其它症状全消。检查血糖已正常，尿糖
(-），脉沉弦，舌质偏红，改用丸药巩固。二诊方加四倍量，山药打糊为丸，如梧桐子大，每饭后服6克。
(祝湛予：对糖尿病的治疗体会，《新医药杂志》5：37，1976）
例三卢ｘｘ，男，59岁，住院号：58011，入院日期：1964年12月28日。12月9日，突然发冷发烧，头痛头昏，曾诊为感冒。服药后病势转重，恶寒战栗，体温38℃。服西药后，体温梢降。12月16日渐觉口中干渴，每日饮水2～3暖瓶，腰隐作痛，小溲频数，每日十余行，每次300～500毫升，尿色微黄，茎中微痛。检查确诊为泌尿系感染、糖尿病。检查月身体丰腴，面色赤若浮肿，舌绛，苔白厚而腻，苔心有黄苔，芪促善太息，脉象实大。化验：大便潜血(++），尿蛋自栅，红细胞、白细胞满视野，上皮细胞(+)，尿搪(+)，血糖240毫克％。辨证：心火亢盛，肾水亏耗。治法、补肾水，泄心火，清肠胃。方药：生石膏27克知母15克白人参6克甘草6克花粉9克山药12克川贝母9克4剂。1月5日：药后口渴心烦明显减轻，仍有腰痛，尿道微痛，心悸气短，全身乏力，四肢酸沉，舌质绛，苔白腻而厚，舌根黄苔，脉稍缓和，改以补肾扶正为主，方药如下：生地9克熟地12克山药15克山萸肉9克丹皮6克茯苓6克泽泻6克寸冬9克五味子3克枸杞9克3剂。1月9日:腰痛减轻，但心悸气短，全身无力，血糖208毫克％。改用下方：生地12克山药6克山萸6克茯苓6克丹皮6克泽泻6克寸冬6克知母6克元参6克黄芪15克花粉6克1月14日：面色红润，除心烦气短外，别无所苦，脉微见滑数，改用杞菊地黄汤加减。直至2月7日，复查尿糖
(-),血糖130毫克％，继服前方18剂、3月2日自觉症状基本消失。扶其正气，增其津液，以巩固疗效，方药如下：熟地12克生地12克山萸肉9克山药9克茯苓6克粉丹皮6克泽泻9克知母6克枸杞子6克花粉6克元参6克石菖蒲6克寸冬6克黄芪18克红人参6克共服24剂。5月3日停药，自觉症状完全消失，5月14日，血糖定量88毫克％，近期痊愈出院。
(高仲山主治，赵子明等整理：治愈糖尿病一例报告，《黑龙江中医》1121，1966）
例四张ｘ，男，49岁。1971年发现糖尿病，尿糖(++++)，血糖232毫克％，症见多食多尿，口干口渴，脉数，苔薄自。辨证属消渴，治法：滋阴清热，益气生津。方药：生石膏18克熟地45克当归15克菟丝子30克党参30克元参12克枸杞子15克二冬各9克川连6克乌梅12克泽泻12克花粉12克红人参9克每日：剂水煎服，共服30余剂，上述症状消失，血糖下降为156毫克％，连用药四个月，自觉症状消失，复查尿糖可疑，血糖下降为136毫克％。为巩固疗效，制成片剂继服。
(《赵锡武医疗经验》）
【评按】《临证指南》明言：“三消一证，虽有上、中、下之分，其实不越阴亏阳亢，津涸热淫而已。”若迁延日久，阴损及阳，导致肾阳亦虚，或素体阳虚，病后亦可兼见肾阳不足证候。
例四虽然以胁痛为主要症状，但兼见脾虚湿困、胃失和降、热蕴血分等证候。经检查确诊为肝吸虫病、慢性肝炎。此案的证候颇为棘手，关氏通过细致辨析各种证候，斟酌治疗方案。其中使用明矾、鸦胆子，是因为它们具有解毒杀虫的功效，对于改善症状及治疗肝吸虫病均有良好疗效，值得进一步研究。
(四十七）肝着病：患者黎某，女性，23岁，1957年春初诊。起初感到胸中痞闷，气息不畅，随后出现咽喉堵塞感，眼睛胀痛，烦躁易怒。近来胸中痞闷加剧，时常发生肢体抽搐，严重时昏迷不省人事，每天发作。重按胸部，则痞闷稍感舒缓。曾在某医院检查，诊断为“癫痫”。该患者体质壮实，仰卧时喜欢叹气，两眼呆滞凝视不动，喉间有痰鸣声。脉象沉弦，舌苔白腻。辨证：肝着病。治法：行气散瘀，通阳活血。方药：旋覆花30克，茜草9克，葱白5寸，茯苓9克，陈橘皮6克。二诊：连服2剂后，胸中痞闷、目胀、咽塞减轻，未再发生抽搐，原方再服2剂，诸症痊愈。
(《窦伯清医案》）
【评按】肝着病名见于《金匮要略》。系指肝脏气血郁滞，附着而不运行所致。《金匮要略·五脏风寒积聚病脉证并治》中说：“肝着，其人常欲蹈其胸上，先未苦时，但欲饮热，旋覆花汤主之”。由于肝郁血滞，故见胸胁痞闷不舒，甚至胀痛。所以喜欢让人揉按其胸部，以求舒缓。由于初起病在气分，所以喝热饮则气机暂时通畅而胸满稍舒。但其病既已形成经脉凝滞，即使喝热饮也无益处。本例证候颇典型，其中更严重的是肢体抽搐、昏不知人，这是因肝风内动所致，不可误认为是“癫痫”发作。治疗应当行气散瘀、通阳活血，方用旋覆花汤加减。唐容川说：“肝主血，肝着即是血粘着而不散也，血生于心而归于肝，今着于胸前隔膜中，故欲蹈其胸以通之也，故用葱白以通胸中之气，如胸痹而用薤白之例，用旋复花以降胸中之气，如胸满噫气而用旋复花之例也：唯新绛乃茜草所染，用以破血、正是治肝经血着之要药。”此方另加陈皮、茯苓，取其和中化痰之意。叶天士医案中常以此方随证加入归须、桃仁、泽兰、郁金之类来治疗胸胁板着胀痛，收效良好，可供临床参考。
(四十八）鼓胀
例一林某。年龄近六十岁，思虑伤脾，脾阳不运，浊湿凝聚，导致大腹胀满，叩之如鼓，小便清白，脉象沉细。脾属太阴，湿为阴邪，当以温运分消之法。熟附子块3克，淡干姜2.4克，生白术9克，陈皮3克，制川朴3克，大腹皮6克，鸡金炭4.5克，炒谷芽12克，陈葫芦瓢12克，清炙草1.5克。二诊：前进温运分消之剂，脐腹胀满略松。纳谷减少，形体消瘦，精神疲乏。小便清长，大便不成形，脉沉细。良由火衰不能生土，中阳不运，浊阴凝聚，鼓之如鼓，中空无物，即无形之虚气散逆，而为满为胀也。于是拟定益火消阴，补虚运脾之法，亦符合《内经》“塞因塞用”之意。炒潞党参9克，熟附子4.5克，淡干姜2.4克，清炙草1.5克，陈广皮3克，大砂仁（研）2.4克，葫芦巴4.5克，炒补骨脂4.5克，煨益智4.5克，陈葫芦瓢12克。
(丁济万整理：思补山房丁甘仁医案续肿胀门，《中医杂志》16：22，1925）
例二高某，女性，55岁。初诊：肝脏肿大变硬半年，近日气郁不达，面色晦暗，面部浮肿足部肿胀，肝区疼痛伴气逆，喘促，大腹膨胀如鼓，按之绷急而痛，四肢肿胀已成，治疗较为困难。甜葶苈1.5克，龙胆草3克，老苏梗9克，青陈皮各6克，茯苓皮15克，干蟾皮9克，九香虫9克，大腹皮9克，鸡金9克，砂仁1.5克，麦芽9克，车前子12克（包煎），川椒目3克。7剂。另服小温中丸120克，早晚各服6克。二诊：服药后，腹部膨胀明显缩小，按之腹软而平，大便解下畅通，面色晦暗转黄，惟近期有低热。拟再疏肝调气，清热化湿。广霍香9克，防己、防风各9克，白薇、前胡各9克，白芍15克，陈皮6克，茯苓皮15克，砂壳、蔻壳各1.5克，泽泻9克，车前子12克（包煎），川桂枝3克，焦茅术5克。7剂。
(《黄一峰医案医话集》）
例三关姓，男性。肝郁已久，邪气内逆，气运闭塞，使脾土受湿而不能制水，小便极少且色赤，大便溏泄与便秘交替，肤色黯黑，眼白浑浊发黄，嘴唇紫而干燥，舌苔白腻，身体发冷，痞满膨胀，四肢微肿，气机不畅，俯身时尤其严重，右侧胸膺胁际环引腰肢均感刺痛。西医诊断为“肝硬化”、“脾脏肿大”，治疗数月未见效。近期呈现膨胀之象，腹部隆起而腰部挺直不能俯仰，脉弦滑而数，亟宜柔肝化瘀、和中利水、化湿清热以建中央，同时兼顾肾气治疗。荆三棱15克，蓬莪木15克，炒二丑各9克，北细辛1.5克，川椒目1.5克，生桃仁9克，赤小豆（布包煎）30克，干百合（苏叶2.1克同水煨）15克，瞿麦12克，萹蓄12克，云苓皮9克，旋复花（布包煎）12克，代赭石12克，川萆薢12克，生知母、黄柏各9克，汉防己9克，煨木香4.5克，犀黄丸9克（冲服），禹余粮丸9克（冲），金匮肾气丸（布包煎）3克。水煎温服，早晚各一次。共诊30余次，服药114次，所患基本痊愈，后经医院检查，脾大已消，肝脏功能恢复正常。
(孔嗣伯介绍：孔伯华先生学术经验简介，《中医杂志》715，1962）
例四段某，男性，37岁，住院号：165437。1975年5月初诊：××总医院诊断为“乳糜胸水、腹水”一年余，兼有风湿性心脏病、二尖瓣狭窄，心功能代偿期”。曾用中西药治疗，未见减退。现症：胸腹胀满，气短不舒，纳呆食少，苔白腻，脉缓。证属脾运失职，水湿停聚。拟胃苓汤治之。方药：苍白术各10克，川朴5克，陈皮10克，茯苓皮10克，泽泻6克，猪苓10克，大腹皮10克，桂枝3克，生姜皮2克，甘草5克。每日1剂。二诊：上方服20余剂，胸腹胀满减轻，惟尿量尚少。拟宗原方去苍术、川朴、甘草，加桑白皮，每日1剂。三诊：患者服药40余剂，诸症均减，乳糜胸水已痊，乳糜腹水明显好转，脉细退，舌苔白，阴阳皆虚，拟济生肾气丸作汤出院服用。上方服40余剂，症状皆除。
(段荣书整理：董德懋医疗经验琐谈，《中医杂志》2：10，1981）
【评按】鼓胀系指腹部膨胀如鼓而命名，又称“单腹胀”。据其病机又有“气鼓”、“血鼓”、“水鼓”、“虫鼓”之别。西医所谓肝硬化腹水属于本证范围。
例一脾阳不运，浊湿凝聚以致腹胀如鼓，证属阳虚气鼓，治以温运分消之剂，续以益火消阴、补虚运脾，亦即《内经》所谓之“塞因塞用”。
例二腹胀肢肿，面晦低热，湿热偏胜，故以清热利湿为主，辅以化痰利水而获效。盖鼓胀之因，因水、因血、因湿热均能导致肝脾损伤，气血凝滞，脉络瘀阻，水气泛滥遂成鼓胀。其病虽一，其因则异，故立法遣方亦有区别。
例三诊为肝硬化，孔氏认为：“西医所谓肝硬化病之后期者，即中医之膨胀病属也。……乃肝郁恚怒不节，气逆伤肝，渐蚀及脾，损于胆胃是其国也，至于瘀滞久而‘肝硬化’者，是其果也。盖肝伤则脾伤，气机滞阻，郁而为热，热留为湿，久之脾阴大伤而运化失司，运化失司则血行乖戾而络塞，络塞则‘肝可硬化’……渐至肝失所藏，脾失所统，水气泛滥遂成膨胀，若以疏肝化瘀、理脾调气、和脉达络、通调水道，则可清热化湿、逐瘀从（生）新，使腹膨消失，肝硬变软……”。孔氏即按此法施治，获得基本痊愈。
例四证属脾失健运，水湿停聚。诊为乳糜胸水、腹水，又有心脏病，虽经中西药治疗而未效。证情较为复杂，董氏谨严遵守中医辨证法规，拟以健脾利湿为治。方用胃苓汤。本方原载《丹溪心法》，主治中暑伤湿，停饮挟食，腹痛泄泻等证。本案从脾论治，药证十分投契，并妙用桑白皮泻肺清热以推动水之上源，颇堪令人玩味。后以主治肾虚腰重脚肿、小便不利之济生肾气丸方煎服以治其本，确属高见。
(四十九）消渴
例一朱某，男性，初诊日期：1973年10月27日。近几年来，善饥能吃，1972年发现糖尿病。一年来体重下降，疲乏无力，口渴思饮，一天约喝10磅水左右，多尿，控制饮食日服八两左右，时感饥饿，后背搔痒，易生疖疮。血糖240毫克％，尿糖四个加号，血压130／90毫米汞柱，舌质偏红，脉缓。证属气阴两伤，肺胃火炽。拟益气养阴，清热为治。方药：生黄芪、山药、苍术、元参、石斛各15克，太子参、花粉各30克，生地、熟地各15克，芡实米、知母、黄柏、乌梅各9克，天冬、麦冬各9克，枸杞子12克。10剂。二诊：服药后，诸症均减。口不太干，饮水减少，只觉腿软无力，唇色暗，舌胖，苔白，脉缓。前方去石斛、乌梅、枸杞子、知母、黄柏，加五味子9克，功劳叶12克。10剂。三诊：服药后，疲乏好转，“三消”症状全减，仍控制饮食。原方继服10剂。四诊：又服30剂，诸症显好，空腹尿糖阴性。但因饮白酒一斤，次日空腹尿糖两个加，口干思饮，大便溏，苔白，脉滑。方药：生黄芪、苍术、元参、太子参各15克，山药12克，五味子9克，金樱子6克，天冬、麦冬各9克，生地、熟地各15克，肉桂3克。10剂。五诊：服药后尿糖转为阴性，血糖为100毫克％，“三消”症状消失，改服丸药。（即上方加四倍量，研末，山药打糊为丸，如梧桐子大，饭后服6克）。患者服药一料后，血糖、尿糖正常，已不控制饮食，血糖、尿糖均正常。
(祝湛予：对糖尿病的治疗体会，《新医药杂志》5：36，1976）
例二岑某，男性，46岁，初诊日期：1974年1月13日。素患夜间盗汗，全身尽湿。两个月前体检发现血糖175毫克％，尿糖三个加。证见两胁窜痛，手足心热，夜间盗汗，口干思饮，大便偏溏，纳食差，皮肤搔痒，脉沉弦细，舌红。证属阴虚生热，气阴两伤。方用丹栀逍遥散加减。丹皮、山栀、柴胡、白术、茯苓、当归、麦冬、五味子各9克，生龙骨、生牡蛎各24克，生黄芪15克，山药12克，生麦芽30克。二诊：服上方6剂后，盗汗减少，手足心热消失，仍口干思饮，脉沉弦，舌质红。方药：生黄芪30克，天冬、麦冬各9克，山药、太子参、元参、苍术各15克，生地、葛根、天花粉各15克，五味子9克，乌梅6克，茯苓12克，肉桂3克，绿豆12克。三诊：上方连服13剂，除口稍干，微有盗汗外，其它症状全消。检查血糖已正常，尿糖(-)，脉沉弦，舌质偏红，改用丸药巩固。二诊方加四倍量，山药打糊为丸，如梧桐子大，每饭后服6克。
(祝湛予：对糖尿病的治疗体会，《新医药杂志》5：37，1976）
例三卢某，男性，59岁，住院号：58011，入院日期：1964年12月28日。12月9日，突然发冷发烧，头痛头昏，曾诊为感冒。服药后病势转重，恶寒战栗，体温38℃。服西药后，体温稍降。12月16日渐觉口中干渴，每日饮水2～3暖瓶，腰隐作痛，小溲频数，每日十余行，每次300～500毫升，尿色微黄，茎中微痛。检查确诊为泌尿系感染、糖尿病。检查身体丰腴，面色赤若浮肿，舌绛，苔白厚而腻，苔心有黄苔，喜太息，脉象实大。化验：大便潜血(++），尿蛋白栅，红细胞、白细胞满视野，上皮细胞(+)，尿糖(+)，血糖240毫克％。辨证：心火亢盛，肾水亏耗。治法：补肾水，泄心火，清肠胃。方药：生石膏27克，知母15克，白人参6克，甘草6克，花粉9克，山药12克，川贝母9克。4剂。1月5日：药后口渴心烦明显减轻，仍有腰痛，尿道微痛，心悸气短，全身乏力，四肢酸沉，舌质绛，苔白腻而厚，舌根黄苔，脉稍缓和，改以补肾扶正为主，方药如下：生地9克，熟地12克，山药15克，山萸肉9克，丹皮6克，茯苓6克，泽泻6克，寸冬9克，五味子3克，枸杞9克。3剂。1月9日:腰痛减轻，但心悸气短，全身无力，血糖208毫克％。改用下方：生地12克，山药6克，山萸6克，茯苓6克，丹皮6克，泽泻6克，寸冬6克，知母6克，元参6克，黄芪15克，花粉6克。1月14日：面色红润，除心烦气短外，别无所苦，脉微见滑数，改用杞菊地黄汤加减。直至2月7日，复查尿糖(-),血糖130毫克％，继服前方18剂、3月2日自觉症状基本消失。扶其正气，增其津液，以巩固疗效，方药如下：熟地12克，生地12克，山萸肉9克，山药9克，茯苓6克，粉丹皮6克，泽泻9克，知母6克，枸杞子6克，花粉6克，元参6克，石菖蒲6克，寸冬6克，黄芪18克，红人参6克。共服24剂。5月3日停药，自觉症状完全消失，5月14日，血糖定量88毫克％，近期痊愈出院。
(高仲山主治，赵子明等整理：治愈糖尿病一例报告，《黑龙江中医》1121，1966）
例四张某，男性，49岁。1971年发现糖尿病，尿糖(++++)，血糖232毫克％，症见多食多尿，口干口渴，脉数，苔薄白。辨证属消渴，治法：滋阴清热，益气生津。方药：生石膏18克，熟地45克，当归15克，菟丝子30克，党参30克，元参12克，枸杞子15克，二冬各9克，川连6克，乌梅12克，泽泻12克，花粉12克，红人参9克。每日1剂水煎服，共服30余剂，上述症状消失，血糖下降为156毫克％，连用药四个月，自觉症状消失，复查尿糖可疑，血糖下降为136毫克％。为巩固疗效，制成片剂继服。
(《赵锡武医疗经验》）
【评按】《临证指南》明确说明：“三消一证，虽有上、中、下之分，其实不越阴亏阳亢，津涸热淫而已。”若迁延日久，阴损及阳，导致肾阳亦虚，或素体阳虚，病后亦可兼见肾阳不足证候。
Case 4, although presenting with hypochondriac pain as the main symptom, is accompanied by syndromes of Spleen deficiency with dampness encumbering, Stomach failing to harmonize and descend, and heat accumulating in the blood level. Examination confirmed liver fluke infection and chronic hepatitis. The syndrome presentation in this case was quite challenging. Mr. Guan, through careful differentiation of the various syndromes, deliberated on the treatment plan. Alum (Mingfan) and Belostoma eggs (Yadanzi) were used because of their efficacy in resolving toxicity and killing parasites; they are effective for improving symptoms and treating liver fluke infection, warranting further research.
(47) Gan Zhuo (Liver Fixation): Patient Li XX, female, 23 years old, first consultation in early spring 1957. Initially experienced chest oppression and dyspnea, followed by a sensation of throat obstruction, eye distension, irritability, and anger. Recently, chest oppression worsened, accompanied by occasional limb convulsions; during severe episodes, unconsciousness occurred. These episodes happened daily. Firm pressure on the chest provided slight relief from oppression. Previously diagnosed with "epilepsy" at a certain hospital. The patient had a robust constitution, preferred lying supine and sighing, stared blankly without blinking, and had phlegm-rattling sounds in the throat. Pulse was deep and wiry; tongue coating was white and greasy. Differentiation: Gan Zhuo (Liver Fixation). Therapeutic Method: Move Qi, dissipate stasis, unblock Yang, and invigorate blood. Prescription: Inula Flower (Xuanfuhua) 30g, Rubia Root (Qiancao) 9g, Scallion White (Congbai) 5 cun, Poria (Fuling) 9g, Aged Tangerine Peel (Chen Jupi) 6g. Second Consultation: After taking 2 doses, chest oppression, eye distension, and throat obstruction alleviated; no convulsions occurred. Continued with the original prescription for 2 more doses; all symptoms resolved.
(From *Medical Cases of Dou Boqing*)
[Commentary]: The term "Gan Zhuo" (Liver Fixation) appears in the *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet). It refers to stagnation of Qi and blood in the Liver, causing fixation and lack of movement. The chapter "Pulse, Syndrome, and Treatment of Wind-Cold and Accumulation Diseases of the Five Zang Organs" in the *Jin Gui Yao Lue* states: "In Gan Zhuo, the person often desires someone to tread upon their chest. Before suffering, they only desire hot drinks; Xuanfu Hua Tang (Inula Flower Decoction) is indicated." Due to Liver Qi depression and blood stasis, there is chest and hypochondriac oppression and discomfort, or even distending pain. Hence, they desire manual massage of the chest for relief. Since the disease initially affects the Qi level, drinking hot liquids temporarily promotes Qi mechanism smoothness, slightly relieving chest fullness. However, once the disease has formed meridian coagulation, even drinking hot liquids is of no benefit. This case is quite typical; the more severe manifestation of limb convulsions and unconsciousness is caused by internal stirring of Liver Wind and should not be mistaken for epilepsy. Treatment should focus on moving Qi, dissipating stasis, unblocking Yang, and invigorating blood, using modified Xuanfu Hua Tang (Inula Flower Decoction). Tang Rongchuan stated: "The Liver governs blood; Gan Zhuo means blood adhering and not dispersing. Blood is generated by the Heart and returns to the Liver. Now it is fixed in the diaphragm area of the chest, hence the desire to tread on the chest to unblock it. Therefore, Congbai (Scallion White) is used to unblock Qi in the chest, similar to using Xi Bai (Macrostemon Fruit) in Chest Bi (Chest Obstruction); Xuanfuhua (Inula Flower) is used to direct Qi downward, similar to its use in chest fullness and belching. Only Xin Jiang (New Crimson Silk), dyed with Qiancao (Rubia Root), is used to break blood stasis; it is indeed a key herb for treating blood fixation in the Liver Meridian." Chenpi (Tangerine Peel) and Fuling (Poria) were added to this prescription to harmonize the Middle and transform phlegm. Ye Tianshi frequently used this prescription with additions such as Danggui Xu (Angelica Sinensis Root Tip), Taoren (Peach Kernel), Zelán (Leonurus Herba), and Yujin (Curcuma Longa Rhizome) to treat chest and hypochondriac stiffness and distending pain, achieving good results, which can serve as a reference for clinical practice.
(48) Gu Zhang (Drum Distension)
Case 1: Lin Left. Near sixty years old. Overthinking injured the Spleen; Spleen Yang failed to transport, leading to accumulation of turbid dampness, resulting in abdominal distension, drum-like upon percussion, clear urine, and a deep, fine pulse. The Spleen belongs to Taiyin; dampness is a Yin pathogen. Treatment should employ warming and transporting methods to separate and eliminate. Prepared Aconite Root (Shu Fuzi) 3g, Dried Ginger (Dan Jiang) 2.4g, Raw Atractylodes Macrocephala Rhizome (Sheng Baizhu) 9g, Tangerine Peel (Chenpi) 3g, Processed Magnolia Bark (Zhi Chuanpu) 3g, Areca Seed (Dafupi) 6g, Charred Chicken Gizzard Lining (Jijin Tan) 4.5g, Fried Rice Sprout (Chao Guya) 12g, Old Gourd Scoop (Chen Hulu Piao) 12g, Honey-fried Licorice Root (Qing Zhigan) 1.5g. Second Consultation: After administering warming and transporting agents, umbilical and abdominal distension slightly relaxed. Appetite decreased, body emaciated, spirit fatigued. Urine clear and long, stools loose, pulse deep and fine. This is due to Fire failing to generate Earth, Middle Yang failing to transport, and turbid Yin accumulating. Drum-like distension, empty inside, indicates formless deficient Qi scattering and counterflow, causing fullness and distension. Thus, the strategy was to benefit Fire and eliminate Yin, tonify deficiency, and transport the Spleen, also reflecting the principle of "treating obstruction with obstruction" from the *Nei Jing*. Cultivated Codonopsis Root (Chao Lushen) 9g, Prepared Aconite Root (Shu Fuzi) 4.5g, Dried Ginger (Dan Jiang) 2.4g, Honey-fried Licorice Root (Qing Zhigan) 1.5g, Aged Tangerine Peel (Chen Guangpi) 3g, Large Amomum Fruit (Da Sharen, ground) 2.4g, Bladderpod Seed (Huluba) 4.5g, Fried Psoralea Fruit (Chao Buguzhi) 4.5g, Calcined Alpinia Oxyphylla Fruit (Wei Yizhi) 4.5g, Old Gourd Scoop (Chen Hulu Piao) 12g.
(Organized by Ding Jiwang: Continuation of Swelling Section in Ding Ganren's Medical Cases from Sibushanfang, *Chinese Journal of Traditional Medicine* 16:22, 1925)
Case 2: Gao XX, female, 55 years old. First Consultation: Liver enlarged and hardened for half a year. Recently, Qi depression failed to diffuse, complexion dull and dark, facial edema and foot swelling, liver pain with Qi counterflow, panting, massive abdominal distension like a drum, tense and painful upon pressure, limb swelling already present; treatment is difficult. Lepidium Seed (Tian Tingli) 1.5g, Gentian Root (Longdancao) 3g, Old Perilla Stem (Lao Sugeng) 9g, Green and Aged Tangerine Peel (Qing Chenpi) 6g each, Poria Cocos Sclerotium Peel (Fuling Pi) 15g, Dried Toad Skin (Gan Chanpi) 9g, Cyathula Fruit (Jiu Xiangchong) 9g, Areca Seed (Dafupi) 9g, Charred Chicken Gizzard Lining (Jijin) 9g, Amomum Fruit (Sharen) 1.5g, Malt (Maiya) 9g, Plantago Seed (Cheqianzi) 12g (wrapped), Sichuan Pepper Seed (Chuan Jiaomu) 3g. 7 doses. Additionally, Xiao Wen Zhong Wan (Minor Warming the Middle Pill) 120g, taken 6g morning and evening. Second Consultation: After medication, abdominal distension significantly reduced, abdomen soft and flat upon pressure, bowel movements smooth, complexion turned yellowish from dull, but recent low-grade fever. Strategy: Soothe Liver, regulate Qi, clear heat, and resolve dampness. Patchouli Herb (Guang Huoxiang) 9g, Fangfeng and Fangji 9g each, Bupleurum Root (Baixianpi - likely typo in source, usually Baixianpi is skin, here context suggests clearing heat/damp, possibly referring to specific variant or error, assuming standard herbs based on context of clearing heat/damp, but sticking to text: Ba Wei? Text says 'Bai Wei Qian', likely Bai Wei and Qian Hu? Text says 'Bai Wei Qian ge 9g'. Assuming Bai Wei and Qian Hu), White Peony Root (Baishao) 15g, Tangerine Peel (Chenpi) 6g, Poria Cocos Sclerotium Peel (Fuling Pi) 15g, Amomum Shell (Sha Kuo) and Cardamom Shell (Kou Kuo) 1.5g each, Alisma Rhizome (Zexie) 9g, Plantago Seed (Cheqianzi) 12g (wrapped), Cinnamon Twig (Chuan Guizhi) 3g, Fried Atractylodes Rhizome (Jiao Maoshu) 5g. 7 doses.
(From *Collected Medical Cases and Conversations of Huang Yifeng*)
Case 3: Guan, male. Long-standing Liver Qi depression, pathogenic Qi reversing internally, Qi transport blocked, causing Spleen Earth to be affected by dampness and unable to control water. Urine extremely scanty and red, stools alternating between loose and constipated, skin dark black, sclera cloudy yellow, lips purple and dry, tongue coating white and greasy, body cold, oppression and distension, mild limb swelling, Qi mechanism unsmooth, especially when bending forward. Right chest, hypochondrium, radiating to waist and limbs felt stabbing pain. Western medicine diagnosed "cirrhosis" and "splenomegaly"; months of treatment ineffective. Recent appearance of distension, abdomen protruding, waist straight and unable to bend or extend, pulse wiry, slippery, and rapid. Urgently needed to soften Liver, resolve stasis, harmonize Middle, promote urination, resolve dampness, clear heat to establish the Center, while attending to Kidney Qi. Sparganium Rhizome (Jing Sanleng) 15g, Curcuma Zedoaria Rhizome (Peng Ezhu) 15g, Fried Morning Glory Seed and Fried Pharbitis Seed (Chao Erchou) 9g each, Northern Asarum Root (Bei Xixin) 1.5g, Sichuan Pepper Seed (Chuan Jiaomu) 1.5g, Raw Peach Kernel (Sheng Taoren) 9g, Red Adzuki Bean (Chi Xiaodou, wrapped) 30g, Dry Lily Bulb (Gan Baihe, simmered with Perilla Leaf 2.1g) 15g, Dianthus Flower (Qumai) 12g, Shepherd's Purse (Bianxu) 12g, Poria Cocos Sclerotium Peel (Yun Ling Pi) 9g, Inula Flower (Xuanfuhua, wrapped) 12g, Hematite (Daizheshi) 12g, Dioscorea Hypoleuca Rhizome (Chuan Bibie) 12g, Raw Anemarrhena Rhizome and Phellodendron Bark (Sheng Zhibai) 9g each, Stephania Tetrandra Root (Han Fangji) 9g, Calcined Aucklandia Root (Wei Muxiang) 4.5g, Xi Huang Wan (Calculus Bovis Pill) 9g (dissolved), Yu Yu Liang Wan (Hematite Pill) 9g (dissolved), Jin Gui Shen Qi Wan (Kidney Qi Pill from Golden Cabinet) 3g (wrapped). Decoct in water, take warm, morning and evening. Total consultations over 30 times, took medicine 114 times; condition basically cured. Subsequent hospital examination showed splenomegaly resolved and liver function normalized.
(Introduced by Kong Sibo: Brief Introduction to Academic Experience of Mr. Kong Bohua, *Chinese Journal of Traditional Medicine* 715, 1962)
Case 4: Duan XX, male, 37 years old, Hospital No. 165437. First consultation May 1975: Diagnosed by XX General Hospital with "chylous pleural effusion, ascites" for over a year, complicated by rheumatic heart disease, mitral stenosis, compensated cardiac function". Previous Chinese and Western medicine treatments showed no reduction. Current symptoms: Chest and abdominal fullness, shortness of breath and discomfort, poor appetite, white greasy tongue coating, slow pulse. Differentiation: Spleen transportation failure, water-dampness retention. Proposed Weiling Tang (Stomach-Regulating and Water-Expelling Decoction). Prescription: White and Atractylodes Rhizomes (Cang Baizhu) 10g each, Magnolia Bark (Chuanpu) 5g, Tangerine Peel (Chenpi) 10g, Poria Cocos Sclerotium Peel (Fuling Pi) 10g, Alisma Rhizome (Zexie) 6g, Polyporus (Zhuling) 10g, Areca Seed (Dafupi) 10g, Cinnamon Twig (Guizhi) 3g, Ginger Peel (Shengjiang Pi) 2g, Licorice Root (Gancao) 5g. One dose daily. Second Consultation: After taking the above prescription for over 20 doses, chest and abdominal fullness alleviated, but urine volume still low. Strategy: Follow original formula, remove Cangzhu, Chuanpu, Gancao, add Mulberry Leaf (Sangbaipi), one dose daily. Third Consultation: After taking the prescription for over 40 doses, all symptoms reduced, chylous pleural effusion cured, chylous ascites significantly improved, pulse thinned, tongue coating white, both Yin and Yang deficient. Proposed Jisheng Shenqi Wan (Kidney Qi Pill for Benefiting Life) decocted for discharge. After taking the above prescription for over 40 doses, all symptoms disappeared.
(Organized by Duan Rongshu: Miscellaneous Talks on Medical Experience of Dong Demao, *Chinese Journal of Traditional Medicine* 2:10, 1981)
[Commentary]: Gu Zhang (Drum Distension) is named for abdominal distension resembling a drum, also known as "Single Abdominal Distension". Based on pathogenesis, it is categorized into "Qi Drum", "Blood Drum", "Water Drum", and "Parasite Drum". Western medicine's cirrhotic ascites falls within the scope of this syndrome.
Case 1: Spleen Yang failed to transport, turbid dampness accumulated causing drum-like abdominal distension. Syndrome belongs to Yang deficiency Qi Drum. Treatment employed warming and transporting agents, followed by benefiting Fire to eliminate Yin and tonifying deficiency to transport the Spleen, aligning with the *Nei Jing*'s principle of "treating obstruction with obstruction".
Case 2: Abdominal distension and limb swelling, dull complexion, low-grade fever indicate predominant damp-heat. Thus, clearing heat and promoting urination was primary, assisted by transforming phlegm and promoting urination, achieving effectiveness. The causes of Gu Zhang include water, blood, and damp-heat, all of which can damage Liver and Spleen, cause Qi and blood stagnation, meridian obstruction, and water flooding, resulting in Gu Zhang. Although the disease is one, the causes differ, so legislative principles and prescriptions vary.
Case 3: Diagnosed with cirrhosis, Mr. Kong believed: "The late stage of Western medicine's cirrhosis corresponds to TCM's expansion disease... It arises from unrestrained Liver depression and anger, Qi counterflow injuring the Liver, gradually eroding the Spleen, damaging Gallbladder and Stomach is its origin, while prolonged stasis leading to 'cirrhosis' is its result. When Liver is injured, Spleen is injured; Qi mechanism stagnates, transforms into heat, heat remains as dampness. Over time, Spleen Yin is greatly damaged, transportation fails. Transportation failure leads to abnormal blood flow and meridian blockage. Meridian blockage leads to 'liver hardening'... Gradually, Liver loses its storing function, Spleen loses its controlling function, water qi floods, resulting in expansion. If one uses soothing Liver, resolving stasis, regulating Spleen, moving Qi, harmonizing vessels, reaching collaterals, and regulating water passages, one can clear heat, resolve dampness, expel stasis and generate new tissue, making abdominal distension disappear and liver hardening soften..." Mr. Kong treated according to this method and achieved basic cure.
Case 4: Syndrome belongs to Spleen failing healthy transportation, water-dampness retention. Diagnosed with chylous pleural effusion and ascites, plus heart disease; ineffective despite previous treatments. Condition complex. Mr. Dong strictly followed TCM differentiation rules, proposing strengthening Spleen and promoting urination. Used Weiling Tang. Originally recorded in *Danxi Xinfa*, treating summerheat injuring dampness, retained fluid with food stagnation, abdominal pain and diarrhea. This case treated from the Spleen, matching symptoms and drugs perfectly. Ingeniously using Sangbaipi (Mulberry Leaf) to drain Lung and clear heat to move the upper source of water is noteworthy. Later, using Jisheng Shenqi Wan (Kidney Qi Pill for Benefiting Life) decocted to treat the root, addressing kidney deficiency with heavy lower limbs and poor urination, was indeed a high insight.
(49) Xiao Ke (Wasting-Thirst)
Case 1: Zhu XX, male, First Consultation: October 27, 1973. For several years, excessive hunger and eating ability. Diabetes discovered in 1972. Over the past year, weight loss, fatigue, thirst with desire to drink, consuming about 10 pounds of water daily, polyuria, controlling diet to about eight taels daily, occasional hunger, back itching, prone to furuncles. Blood sugar 240 mg%, urine sugar four plus signs, blood pressure 130/90 mmHg, tongue body slightly red, pulse slow. Differentiation: Qi and Yin dual injury, Lung and Stomach fire blazing. Strategy: Benefit Qi, nourish Yin, clear heat. Prescription: Raw Astragalus Root (Sheng Huangqi), Chinese Yam (Shanyao), Atractylodes Rhizome (Cangzhu), Scrophularia Root (Yuanshen), Dendrobium Stem (Shihu) 15g each; Pseudoginseng Root (Taizishen), Trichosanthes Root (Huafen) 30g each; Raw Rehmannia Root (Shengdi), Prepared Rehmannia Root (Shudi) 15g each; Euryale Seed (Qianshim), Anemarrhena Rhizome (Zhimu), Phellodendron Bark (Huangbai), Dark Plum (Wumei) 9g each; Asparagus Fern Stem (Tiandong), Ophiopogon Tuber (Maidong) 9g each; Goji Berry (Gouqizi) 12g. 10 doses. Second Consultation: After medication, all symptoms reduced. Mouth not too dry, water intake decreased, only feeling leg weakness, dark lip color, swollen tongue, white coating, slow pulse. From previous formula, remove Shihu, Wumei, Gouqizi, Zhimu, Huangbai; add Schisandra Berry (Wuweizi) 9g, Mahonia Leaf (Gonglaoye) 12g. 10 doses. Third Consultation: After medication, fatigue improved, "Three Xiao" symptoms completely reduced, continued diet control. Continue original formula for 10 doses. Fourth Consultation: Took another 30 doses, symptoms significantly improved, fasting urine sugar negative. But after drinking one jin of baijiu, next day fasting urine sugar two plus signs, dry mouth with desire to drink, loose stools, white coating, slippery pulse. Prescription: Raw Astragalus Root (Sheng Huangqi), Atractylodes Rhizome (Cangzhu), Scrophularia Root (Yuanshen), Pseudoginseng Root (Taizishen) 15g each; Chinese Yam (Shanyao) 12g; Schisandra Berry (Wuweizi) 9g; Cherokee Rose Fruit (Jinyingzi) 6g; Asparagus Fern Stem (Tiandong), Ophiopogon Tuber (Maidong) 9g each; Raw Rehmannia Root (Shengdi), Prepared Rehmannia Root (Shudi) 15g each; Cinnamon Bark (Rougui) 3g. 10 doses. Fifth Consultation: After medication, urine sugar turned negative, blood sugar 100 mg%, "Three Xiao" symptoms disappeared, changed to pills. (Original formula increased fourfold, ground to powder, Chinese Yam paste made into pills, size of paulownia seeds, take 6g after meals). After one course of medication, blood sugar and urine sugar normal, no longer need diet control, blood sugar and urine sugar remain normal.
(Zhu Zhanyu: Reflections on Treating Diabetes, *New Medicine Magazine* 5:36, 1976)
Case 2: Cen XX, male, 46 years old, First Consultation: January 13, 1974. Prone to night sweats, whole body wet. Two months ago, physical exam found blood sugar 175 mg%, urine sugar three plus signs. Symptoms: wandering pain in hypochondria, heat in palms and soles, night sweats, dry mouth with desire to drink, stools slightly loose, poor appetite, skin itching, pulse deep, wiry, and fine, tongue red. Differentiation: Yin deficiency generating heat, Qi and Yin dual injury. Prescription: Modified Danzhi Xiaoyao San (Moutan Cortex and Gardenia Fructus Rambling Powder). Moutan Cortex (Danpi), Gardenia Fructus (Shanzhi), Bupleurum Root (Chaihu), Atractylodes Macrocephala Rhizome (Baizhu), Poria (Fuling), Angelica Sinensis Root (Danggui), Ophiopogon Tuber (Maidong), Schisandra Berry (Wuweizi) 9g each; Raw Dragon Bone (Sheng Longgu), Raw Oyster Shell (Sheng Muli) 24g each; Raw Astragalus Root (Sheng Huangqi) 15g; Chinese Yam (Shanyao) 12g; Raw Barley Sprout (Sheng Maiya) 30g. Second Consultation: After taking above prescription for 6 doses, night sweats reduced, heat in palms and soles disappeared, still dry mouth with desire to drink, pulse deep and wiry, tongue body red. Prescription: Raw Astragalus Root (Sheng Huangqi) 30g; Asparagus Fern Stem (Tiandong), Ophiopogon Tuber (Maidong) 9g each; Chinese Yam (Shanyao), Pseudoginseng Root (Taizishen), Scrophularia Root (Yuanshen), Atractylodes Rhizome (Cangzhu) 15g each; Raw Rehmannia Root (Shengdi), Kudzu Root (Gegen), Trichosanthes Root (Tianhuafen) 15g each; Schisandra Berry (Wuweizi) 9g; Dark Plum (Wumei) 6g; Poria (Fuling) 12g; Cinnamon Bark (Rougui) 3g; Mung Bean (Lvdou) 12g. Third Consultation: After taking above prescription continuously for 13 doses, except slight dry mouth and minor night sweats, other symptoms completely disappeared. Exam blood sugar normal, urine sugar (-), pulse deep and wiry, tongue body slightly red, changed to pills for consolidation. Second consultation formula increased fourfold, Chinese Yam paste made into pills, size of paulownia seeds, take 6g after each meal.
(Zhu Zhanyu: Reflections on Treating Diabetes, *New Medicine Magazine* 5:37, 1976)
Case 3: Lu XX, male, 59 years old, Hospital No. 58011, Admission Date: December 28, 1964. On Dec 9, sudden chills and fever, headache and dizziness, previously diagnosed as cold. After medication, condition worsened, aversion to cold and shivering, temperature 38°C. After Western medicine, temperature slightly dropped. On Dec 16, increasingly felt dry mouth and thirst, drinking 2-3 thermoses daily, dull lower back pain, frequent urination, over ten times daily, 300-500ml each time, urine slightly yellow, slight pain in urethra. Exam confirmed urinary tract infection and diabetes. Physical examination: plump body, reddish face resembling edema, crimson tongue, thick white greasy coating with yellow center, likes to sigh, pulse solid and large. Lab tests: fecal occult blood (++), urine protein (+), RBCs and WBCs filling field, epithelial cells (+), urine sugar (+), blood sugar 240 mg%. Differentiation: Heart Fire hyperactive, Kidney Water depleted. Therapeutic Method: Tonify Kidney Water, drain Heart Fire, clear Intestines and Stomach. Prescription: Raw Gypsum (Sheng Shigao) 27g, Anemarrhena Rhizome (Zhimu) 15g, White Ginseng (Bairenshen) 6g, Licorice Root (Gancao) 6g, Trichosanthes Root (Huafen) 9g, Chinese Yam (Shanyao) 12g, Fritillaria Thunbergii Bulb (Chuan Beimu) 9g. 4 doses. Jan 5: After medication, thirst and vexation significantly reduced, still lower back pain, slight urethral pain, palpitations and shortness of breath, general fatigue, soreness and heaviness in limbs, crimson tongue body, thick white greasy coating, yellow coating at tongue root, pulse slightly relaxed. Changed to primarily tonifying Kidney and supporting Righteous Qi. Prescription: Raw Rehmannia Root (Shengdi) 9g, Prepared Rehmannia Root (Shudi) 12g, Chinese Yam (Shanyao) 15g, Cornus Fruit (Shanzhuyu) 9g, Moutan Cortex (Danpi) 6g, Poria (Fuling) 6g, Alisma Rhizome (Zexie) 6g, Ophiopogon Tuber (Cundong/Maidong) 9g, Schisandra Berry (Wuweizi) 3g, Goji Berry (Gouqi) 9g. 3 doses. Jan 9: Lower back pain reduced, but palpitations, shortness of breath, general weakness persist, blood sugar 208 mg%. Changed to below prescription: Raw Rehmannia Root (Shengdi) 12g, Chinese Yam (Shanyao) 6g, Cornus Fruit (Shanzhuyu) 6g, Poria (Fuling) 6g, Moutan Cortex (Danpi) 6g, Alisma Rhizome (Zexie) 6g, Ophiopogon Tuber (Cundong/Maidong) 6g, Anemarrhena Rhizome (Zhimu) 6g, Scrophularia Root (Yuanshen) 6g, Astragalus Root (Huangqi) 15g, Trichosanthes Root (Huafen) 6g. Jan 14: Complexion ruddy, except for vexation and shortness of breath, no other discomfort, pulse slightly slippery and rapid, changed to modified Qiju Dihuang Tang (Lycium Berry and Chrysanthemum Rehmannia Decoction). Until Feb 7, re-exam urine sugar (-), blood sugar 130 mg%, continued previous prescription for 18 doses. Mar 2: Self-reported symptoms basically disappeared. Support Righteous Qi, increase fluids to consolidate effect. Prescription: Prepared Rehmannia Root (Shudi) 12g, Raw Rehmannia Root (Shengdi) 12g, Cornus Fruit (Shanzhuyu) 9g, Chinese Yam (Shanyao) 9g, Poria (Fuling) 6g, Moutan Cortex (Fen Danpi) 6g, Alisma Rhizome (Zexie) 9g, Anemarrhena Rhizome (Zhimu) 6g, Goji Berry (Gouqizi) 6g, Trichosanthes Root (Huafen) 6g, Scrophularia Root (Yuanshen) 6g, Acorus Rhizome (Shichangpu) 6g, Ophiopogon Tuber (Cundong/Maidong) 6g, Astragalus Root (Huangqi) 18g, Red Ginseng (Hong Renshen) 6g. Total 24 doses. Stopped medication May 3, self-reported symptoms completely disappeared. May 14, quantitative blood sugar 88 mg%, discharged recently cured.
(Mainly treated by Gao Zhongshan, organized by Zhao Ziming et al.: Report on Cure of One Case of Diabetes, *Heilongjiang Traditional Chinese Medicine* 1121, 1966)
Case 4: Zhang X, male, 49 years old. Diabetes discovered in 1971, urine sugar (+++ +), blood sugar 232 mg%. Symptoms: polyphagia, polyuria, dry mouth and thirst, rapid pulse, thin white coating. Differentiation: Xiao Ke (Wasting-Thirst). Therapeutic Method: Nourish Yin, clear heat, benefit Qi, generate fluids. Prescription: Raw Gypsum (Sheng Shigao) 18g, Prepared Rehmannia Root (Shudi) 45g, Angelica Sinensis Root (Danggui) 15g, Dodder Seed (Tusizi) 30g, Codonopsis Root (Dangshen) 30g, Scrophularia Root (Yuanshen) 12g, Goji Berry (Gouqizi) 15g, Tiandong and Maidong 9g each, Coptis Rhizome (Chuanlian) 6g, Dark Plum (Wumei) 12g, Alisma Rhizome (Zexie) 12g, Trichosanthes Root (Huafen) 12g, Red Ginseng (Hong Renshen) 9g. One dose daily, decocted in water. Total taken over 30 doses, above symptoms disappeared, blood sugar dropped to 156 mg%. Medication continued for four months, self-reported symptoms disappeared, re-exam urine sugar doubtful, blood sugar dropped to 136 mg%. To consolidate effect, made into tablets for continued use.
(From *Medical Experience of Zhao Xiwu*)
[Commentary]: *Lin Zheng Zhi Nan* (Guide to Clinical Practice) explicitly states: "The syndrome of Three Xiao, although divided into Upper, Middle, and Lower, essentially does not exceed Yin deficiency with Yang hyperactivity, fluid depletion with heat invasion." If prolonged, Yin damage extends to Yang, leading to Kidney Yang deficiency, or if constitutionally Yang deficient, post-illness may also show Kidney Yang insufficiency syndromes.