例一证属气阴两伤，肺胃火炽。祝氏认为：“其病在肺、胃、肾，而根在于肾，病理是积热伤阴，所以一般都取滋阴清热法”。他结合其师施今墨氏的经验，以增液汤合生脉散，再加生黄芪配山药、苍术配元参为主方，治疗本病，疗效尚好。本案即在上述主方的基础上加强养阴清热之品。
例二阴虚蕴热。且有肝郁之征，故用丹栀逍遥散加减治之。通过上述二例不但简要阐明其治疗消渴的经验外，还介绍了施氏的心得体会。如生黄芪配山药、苍术配元参均有降血糖的临床效应。一般均认为苍术性燥，不宜选用，但施氏体会苍术有敛脾精作用，其性虽燥，如配用元参，可制其短而扬其长。
例三系因感受冬温时邪，又因素体阴虚，外表邪热失于清解，内传肠胃，引动心火，益伤肾阴而致消渴。始用参白虎加味，清肠胃、生津液，急治其标。待烦渴解除，用麦味、知柏、杞菊地黄之辈加减，培元滋阴补肾缓治其本。
例四治以滋阴清热，益气生津之法而获效。赵氏认为：消渴“临床多见热盛伤阴之证，且阴虚与燥热二因互为因果。”其治疗法则：早期多以养阴清热泻火为主，肺胃兼治；中期当纯用养阴益气为主，后期应针对阴阳俱虚证候，相应施治。本案的特点是在于辨证精当，方药简洁，标本兼顾，竟一方到底而获良效。
(五十）疟疾
例一王，男，30岁，8月。痰湿内伏，枢机不和，疟发间日而胱，先寒后热，头痛胸满欲呕，腹笥作胀，舌苔厚腻，脉象弦滑，治以清脾饮加味。制厚朴4．5克煨草果4．5克制茅术4．5克柴胡4．5克炒黄芩6克姜半夏7．5克威灵仙9克白蒺藜9克小青皮4．5克茯苓12克乌药9克生姜3片竹茹9克二诊：前方服后，疟发已轻，呕止，头痛、胸闷、腹胀俱瘥，苔腻转薄，脉仍弦滑。再宗原法。柴胡2．4克黄芩4．5克茯苓12克制川朴2．4克小青皮4．5克白蒺藜9克姜半夏7．5克生谷芽9克威灵仙9克煨草果2．4克制茅术4．5克台乌药6克(《叶熙春医案》）
例二徐××，女，34岁。每当天明即壮热汗出，烦躁不安，气粗，渴喜冷饮，午后渐退，烧退后精神萎靡，历时月余不已，屡治无效，发烧时肌肤灼热，面赤唇红，脉洪数，两尺微弱，舌质红绛，苔薄黄少津。据其脉证是为“瘅疟”。治宜甘寒生津，救阴清热。生石膏15克麦冬9克沙参15克生地15克鲜蔗汁一杯连翘9克天花粉9克五味子3克鲜京竹叶20片服三剂后烧退汗止，渴饮全解，二便正常，脉息和缓，舌红润，以归芍六味汤益血养阴以善其后。方药如下：生地15克淮山药15克山茱萸6克茯苓9克粉丹皮9克泽泻9克当归15克杭芍15克
(《李继昌医案》）
例三詹××，男，31岁。患牡疟20余日、、每日午后即作，寒战发抖，头痛体困，虽时值三伏，仍寒战踡卧，棉被毛毯加身亦不足以御其寒，冷汗自出，厌食胸闷，恶心欲吐，四肢厥冷，面青白，舌淡微青，苔白腻，六脉安细，两尺尤弱。方药：黑天雄120克(开水先煎透）炮姜30克炙草9克厚朴9克烧草果1个(去壳）苍术15克炒常山6克草寇6克浮小麦15克大枣5个(酒烧）复诊：上方服2剂后，诸症悉解，惟病久正气大虚，以辛温助阳，健脾补气之品调理善后。方药如下：黑天雄45克(开水先煎透）潞党参15克自术15克炮姜15克法半夏9克烧乌梅1个陈皮9克炙草9克茯苓9克烧草果1个(去壳）大枣5个(酒烧）
(《李继昌医案》）
例四黄ｘｘ，男，19岁。曾患痎疟，左胁下疼痛有痞块，日渐增大如拳，轻按漉漉有声，将有年余，小溲黄，近且茎痛。诊视左关弦结，右较软弱，舌苔灰自。此由寒湿凝紧，气血留滞于胸胁。“肝之积，名曰肥气，在左胁下如复杯，两胁痛引小腹。”如因疟疾而起，其邪结为症瘕，名曰“疟母”。肝病及脾，脾脏肿大，左右相移，治脾即所以治肝。法当消积化痞，疏肝软脾。制鳖甲15克云茯苓10克酒白芍10克金铃子(醋炒）10克生牡蛎10克制香附7克山楂炭7克延胡索(醋炒）7克醋青皮5克广木香3克北柴胡3克油安桂1克甘草梢2克复诊：胁痛减轻，小溲仍黄，茎痛，大使搪薄，积块顽硬。原方去牡蛎、楂炭，加酒炒黄芩、左金丸(分吞服）助脾以制肝。三诊：硬块软缩，胁痛可任轻按，小浚时茎痛亦减轻，睡眠后，腹内枳气转动不宁，此肝气散漫不收，脾机受制之故。按复诊方改金铃子7克，去黄芩、甘草梢，加当归身10克、山萸肉5克。续服多剂，块痛消失。
(《李聪甫医案》）
【评按】疟疾多因感受疟邪所致。是一种以间歇性寒战、高热、出汗为特点的病症，大多休作有时。早在《内经》中已有专论阐述。由于兼感病邪的不同和患者体质的差异，以致阴阳有所偏盛，故临床有一日一发、二日一发。或三日一发等不同证型。其热多寒少者称为温疟；但热不寒者称为瘅疟，寒多或但寒不热者称为牡疟，反复发作胁下有结块者称为疟母。
例一为正疟，间日而发，证属痰湿久蕴，脾为所困，少阳枢机不和，故用清脾饮加减，蠲化痰湿，和解枢机。方中乌药、威灵仙为叶氏经验用药，用于正疟尤宜。
例二为瘅疟，但热不寒为其临床特点，患者素有伏热，津气已伤，腠理空疏，邪热伏于肤内分肉之间，热为阳邪，而平旦至日中又为阳中之阳，两阳相合，故发作有时，阳气盛则但热不寒，热炽津伤。故用甘寒生津，救阴清热之剂，以忻其热，继以归芍六味汤养血益阴善其后。
例三为牡疟，但寒不热，四肢厥冷。患者阳气素虚，脾为阴邪所困，寒邪久伏少阴，加之饮冷贪凉更伤其阳，阴霾益盛，宗仲景四逆汤加味，使之阳长阴消，伏邪外透。
例四为疟母。证由寒湿凝聚，气血留滞胸胁所致。治以消积化痞疏肝软脾之剂。乃遵《内经》“大积大聚，衰其大半而止”之理，故久疟体虚，一般不用峻剂，以免伤耗气血。
例一王ｘｘ、女。患者沉默，偶或呆笑，所答非所问，口唇及四肢颤抖不休，有低热，据护者说：前夜自言自语，下床走到别人床上，吵闹整晚。当归9克白芍9克远志3克钩藤15克磁石9克丹皮9克朱茯神9克龙胆草6克龙齿9克天麻9克僵蚕9克服药24剂，言语仍稀、颤抖轻微，记忆稍减退，颅神经检查阴性，四肢运动，梢不灵活，肌张力稍增强，腱反射增高。二诊：原方加玉竹9克银花9克，10剂。精神状态完全正常，言语清楚，腱反射仍有增高，上肢肌张力仍有轻度增加，并有轻度颤抖。三诊：记忆稍差，言语稍不清，一般情况佳良。龙齿12克朱茯神9克龙胆草6克珍珠母30克天麻9克全蝎3支枣仁9克白芍9克玉竹9克钩藤15克天竺黄6克当归9克银花9克10剂。四诊：睡眠欠佳，四肢感觉乏力。珍珠母30克朱茯神9克移山参3克龙齿9克生地15克全蝎5支枣仁9克钩藤9克山药9克天竺黄3克合欢皮9克10剂完全复原。
(姜春华医案，《中医杂志》4：56，1959）
例二王××，女，52岁，门诊号：77／8475，初诊日期：1977年3月10日。左手足震颤已八年。始于左上肢，以后发展至左上下肢震颤抖动，但以手指部震颤最严重。经神经科检查诊为震颤麻痹
(帕金森氏病），服用各种中西药未显效。症见：左手足震颤，不能自主，行动缓慢，振振摇搐，纳谷不佳，睡眠不酣，口干便坚，脉弦细，苔薄腻，质偏红。震颤麻痹者，筋之病也。肝主筋，肝血充盈，才能淫气于筋；筋之病故属肝与血也。治拟平肝柔肝，养血熄风。生熟地各12克全当归9克赤白芍各9克花龙骨30克(先煎）生牡蛎30克(先煎）珍珠母30克
(先煎）生黄芪12克潞党参12克制首乌12克枸杞子9克川石斛12克(先煎）怀牛膝12克单桃仁9克杜红花6克玄精石18克仙灵脾18克上方加减服至1977年6月以后，左下肢震颤已明显好转。
(张羹梅《临证偶拾》）
【评按】颤抖或震颤系指肢体肌肉跳动发抖为主的证候。多因肝血虚、肝风内动，风动则肢摇，故见颤抖或震颤。
例一西医诊断为亚急性脑炎，原案命题“颤抖”，治以养血潜镇，清热熄风之剂，疗效尚好。
例二诊为震颤麻痹，肝血虚，血不养筋则肢摇震颤，治以平肝柔肝，养血熄风，虽未痊愈，但症状明显好转，尚有参考价值。
(五十二）无脉症患者女性，27岁，初诊日期：1959年4月5日。患者于1957年1月间忽然右手不能活动，双足发麻，曾住院检查，发现腕部脉沉伏，右臂血压180／130毫米汞柱，服降压药后，右手逐渐能动，其他症状好转出院。1958年4月间忽然口喑不能言而心中了了，再度住院，血压同上，又服西药降压药8～9天，恢复说话而出院。嗣后经常头痛、失眠，手冷无力，不能上班工作，屡治一年来仍无少愈。西医诊断无脉症。诊其脉象左伏右沉细，舌质暗红，苔薄腻，口渴，烦躁，头痛失眠，手冷无力，右臂血压150／130毫米汞往，左臂血压不能测到，月经3～4月一潮，亦无定期。1957年结婚。未曾怀孕。先予平肝熄风，凉血降逆为治。方药：干生地12克甘菊花6克青葙子9克夏枯草9克酒白芍6克粉丹皮3克北沙参6克钩藤9克川芎3克当归4．5克川牛膝4．5克4月12日：前方连服7剂，烦躁稍减，手冷未除，乃于前方去当归、沙参，加海藻、昆布各9克借以散结软坚。连服14剂。4月26比复诊时左脉仍伏，右脉软起，舌苔仍腻，头痛差减，乃去菊花、青葙，加元参9克，以去其浮游之火，连服14剂。5月10日：前方加减共服35剂，头痛失眠，烦躁诸症悉除，而脉象仍无明显好转，拟予活血逐瘀，软坚通络之剂，缓法图治。方药如下：全当归30克川芎30克酒白芍30克苏木12克牛膝9克红花12克丹皮30克钩藤3Q克海藻30克昆布30克香附30克麝香0．6克上共研细未，炼蜜为丸，重9克，每服1丸，每日2丸，空腹用葱头、生姜煎汤嚼服。6月14日，病情脉象无甚变化，原方去钩藤再增疏肝通窍之品，如柴胡30克，枳壳、细辛各12克，当归加至60克，苏木加至18克，麝香加倍，蜜丸服法如前。7月19日，左脉始出，但仍沉细而涩，右脉接近平脉，夜眠又感欠安，乃于前方去柴、枳、辛、附，加行血安神之品，如丹参30克。桃仁15克，枣仁、柏子仁各30克，远志、菖蒲各15克，蜜丸服法如前。8丹23日，经期比前提早，约40天左右一潮，夜眠较安，前方去远志、菖蒲，加青木香30克以调气，蜜丸服法如前。开始半日工作。10月4日，左脉已出，仍较沉细，右脉如平，右臂血压140／90～100毫米汞柱。左臂血压仍不易测到，经来微有酸痛，前方去柏子仁、苏木，加生蒲黄、五灵脂各15克。蜜丸服法如前。11月8日：左脉已出，右脉如平，夜眠已安，右臂血压130／90～100毫米汞柱，左臂血压仍不易测到。前方去枣仁再服。以后按前方加减，曾使用过于生地、旱莲草、女贞子等。至1961年2月26日，诸症悉除，左臂血压已能测到为90／80毫米汞柱。5月2日复诊，左脉仍沉细，右脉如平，舌有薄苔，血压左臂90／70毫米汞柱，右臂95／70毫米汞柱。前方生地改熟地，加阿胶30克，砂仁15克，减麝香至0．6克。蜜丸连续再服。8月20日，右臂血压114／78、左臂100／70毫米汞柱，月经30天左右一行，症状全消，停药观察，整日上班工作。随访至1962年7月17日，患者毫无所苦，继续整日上班工作。
(朱颜：无脉病一例报告，《中医杂志》1：11，1963）
【评按】无脉症又称大动脉炎，为西医病名。是主动脉及其分枝的慢性进行性、闭塞性炎症，故又称为缩窄性大动脉炎。由于受累的动脉不同，又分为上肢无脉症、下肢无脉症、肾动脉狭窄性高血压等类型。根据其症状表现，大致属于中医“眩晕”、“脉痹”，或“厥证”范围。其病多因先天不足，脾肾两虚，或后天失调，气血两亏所致。气虚则血行不畅，阴血亏则脉道不充，运行缓慢，日久则脉道瘀滞，甚则闭塞不通，以致脉涩如丝，甚或无脉。本案属于上肢型。由于血虚不能上荣于脑，加之虚风上扰，故见头痛、失眠；血脉瘀阻，气血运行不畅故手冷无力，甚而不能活动。治疗首用平肝熄风、逐瘀通络之剂。先服汤剂以求速效，待症状改善后，续以丸药长服，取其力缓持久。治疗两年余效果良好。停药随访一年，一切情况尚好，为治疗此类疑难病提供了有价值的例证。
(五十三）盗汗
例一：证候属于气阴两伤，肺胃火炽盛。祝氏认为：“其病位在肺、胃、肾，而根源在于肾，病理机制是积热损伤阴液，所以一般多采用滋阴清热法”。他结合其师施今墨的经验，以增液汤合生脉散为基础，再加生黄芪配山药、苍术配元参作为主方，治疗本病，疗效尚好。本案即是在上述主方的基础上加强养阴清热的药物。
例二：阴虚蕴藏内热。且有肝气郁结的表现，故用丹栀逍遥散加减治疗。通过上述两例，不仅简要阐明了其治疗消渴（糖尿病）的经验，还介绍了施氏的心得体会。如生黄芪配山药、苍术配元参均有降低血糖的临床效应。一般均认为苍术性燥，不宜选用，但施氏体会苍术有收敛脾精的作用，其性虽燥，如配用元参，可制约其短处而发扬其长处。
例三：系因感受冬温时邪，又因素体阴虚，外表邪热失于清解，内传肠胃，引动心火，进一步损伤肾阴而导致消渴。始用参白虎加味，清肠胃、生津液，急治其标。待烦渴解除后，用麦味地黄丸、知柏地黄丸、杞菊地黄丸之类的药物加减，培元滋阴补肾缓治其本。
例四：治以滋阴清热，益气生津之法而获效。赵氏认为：消渴“临床多见热盛伤阴之证，且阴虚与燥热二因互为因果。”其治疗法则：早期多以养阴清热泻火为主，肺胃兼治；中期当纯用养阴益气为主，后期应针对阴阳俱虚证候，相应施治。本案的特点在于辨证精当，方药简洁，标本兼顾，竟一方到底而获良效。
(五十) 疟疾
例一：王，男，30岁，8月就诊。痰湿内伏，枢机不和，疟疾隔日发作，腹部胀满，先寒后热，头痛胸满欲呕，腹部作胀，舌苔厚腻，脉象弦滑，治以清脾饮加味。制厚朴4.5克，煨草果4.5克，制茅术4.5克，柴胡4.5克，炒黄芩6克，姜半夏7.5克，威灵仙9克，白蒺藜9克，小青皮4.5克，茯苓12克，乌药9克，生姜3片，竹茹9克。二诊：前方服后，疟发已轻，呕吐止，头痛、胸闷、腹胀俱愈，苔腻转薄，脉仍弦滑。再宗原法。柴胡2.4克，黄芩4.5克，茯苓12克，制川朴2.4克，小青皮4.5克，白蒺藜9克，姜半夏7.5克，生谷芽9克，威灵仙9克，煨草果2.4克，制茅术4.5克，台乌药6克。（《叶熙春医案》）
例二：徐××，女，34岁。每当天明即壮热汗出，烦躁不安，气粗，渴喜冷饮，午后渐退，烧退后精神萎靡，历时月余不已，屡治无效，发烧时肌肤灼热，面赤唇红，脉洪数，两尺微弱，舌质红绛，苔薄黄少津。据其脉证是为“瘅疟”。治宜甘寒生津，救阴清热。生石膏15克，麦冬9克，沙参15克，生地15克，鲜蔗汁一杯，连翘9克，天花粉9克，五味子3克，鲜京竹叶20片。服三剂后烧退汗止，渴饮全解，二便正常，脉息和缓，舌红润，以归芍六味汤益血养阴以善其后。方药如下：生地15克，淮山药15克，山茱萸6克，茯苓9克，粉丹皮9克，泽泻9克，当归15克，杭芍15克。（《李继昌医案》）
例三：詹××，男，31岁。患牡疟20余日，每日午后即作，寒战发抖，头痛体困，虽时值三伏，仍寒战踡卧，棉被毛毯加身亦不足以御其寒，冷汗自出，厌食胸闷，恶心欲吐，四肢厥冷，面青白，舌淡微青，苔白腻，六脉沉细，两尺尤弱。方药：黑天雄120克（开水先煎透），炮姜30克，炙草9克，厚朴9克，烧草果1个（去壳），苍术15克，炒常山6克，草寇6克，浮小麦15克，大枣5个（酒烧）。复诊：上方服2剂后，诸症悉解，惟病久正气大虚，以辛温助阳，健脾补气之品调理善后。方药如下：黑天雄45克（开水先煎透），潞党参15克，白术15克，炮姜15克，法半夏9克，烧乌梅1个，陈皮9克，炙草9克，茯苓9克，烧草果1个（去壳），大枣5个（酒烧）。（《李继昌医案》）
例四：黄××，男，19岁。曾患痎疟，左胁下疼痛有痞块，日渐增大如拳，轻按漉漉有声，将有年余，小溲黄，近且茎痛。诊视左关弦结，右较软弱，舌苔灰白。此由寒湿凝紧，气血留滞于胸胁。“肝之积，名曰肥气，在左胁下如复杯，两胁痛引小腹。”如因疟疾而起，其邪结为症瘕，名曰“疟母”。肝病及脾，脾脏肿大，左右相移，治脾即所以治肝。法当消积化痞，疏肝软脾。制鳖甲15克，云茯苓10克，酒白芍10克，金铃子（醋炒）10克，生牡蛎10克，制香附7克，山楂炭7克，延胡索（醋炒）7克，醋青皮5克，广木香3克，北柴胡3克，油安桂1克，甘草梢2克。复诊：胁痛减轻，小溲仍黄，茎痛，大便溏薄，积块顽硬。原方去牡蛎、楂炭，加酒炒黄芩、左金丸（分吞服）助脾以制肝。三诊：硬块软缩，胁痛可任轻按，小便时茎痛亦减轻，睡眠后，腹内积气转动不宁，此肝气散漫不收，脾机受制之故。按复诊方改金铃子7克，去黄芩、甘草梢，加当归身10克、山萸肉5克。续服多剂，块痛消失。（《李聪甫医案》）
【评按】疟疾多因感受疟邪所致。是一种以间歇性寒战、高热、出汗为特点的病症，大多休作有时。早在《内经》中已有专论阐述。由于兼感病邪的不同和患者体质的差异，以致阴阳有所偏盛，故临床有一日一发、二日一发或三日一发等不同证型。其热多寒少者称为温疟；但热不寒者称为瘅疟，寒多或但寒不热者称为牡疟，反复发作胁下有结块者称为疟母。
例一为正疟，间日而发，证属痰湿久蕴，脾为所困，少阳枢机不和，故用清脾饮加减，蠲化痰湿，和解枢机。方中乌药、威灵仙为叶氏经验用药，用于正疟尤宜。
例二为瘅疟，但热不寒为其临床特点，患者素有伏热，津气已伤，腠理空疏，邪热伏于肤内分肉之间，热为阳邪，而平旦至日中又为阳中之阳，两阳相合，故发作有时，阳气盛则但热不寒，热炽津伤。故用甘寒生津，救阴清热之剂，以折其热，继以归芍六味汤养血益阴善其后。
例三为牡疟，但寒不热，四肢厥冷。患者阳气素虚，脾为阴邪所困，寒邪久伏少阴，加之饮冷贪凉更伤其阳，阴霾益盛，宗仲景四逆汤加味，使之阳长阴消，伏邪外透。
例四为疟母。证由寒湿凝聚，气血留滞胸胁所致。治以消积化痞疏肝软脾之剂。乃遵《内经》“大积大聚，衰其大半而止”之理，故久疟体虚，一般不用峻剂，以免伤耗气血。
例一：王××，女。患者沉默，偶或呆笑，所答非所问，口唇及四肢颤抖不休，有低热，据护者说：前夜自言自语，下床走到别人床上，吵闹整晚。当归9克，白芍9克，远志3克，钩藤15克，磁石9克，丹皮9克，朱茯神9克，龙胆草6克，龙齿9克，天麻9克，僵蚕9克。服药24剂，言语仍稀、颤抖轻微，记忆稍减退，颅神经检查阴性，四肢运动梢不灵活，肌张力稍增强，腱反射增高。二诊：原方加玉竹9克，银花9克，10剂。精神状态完全正常，言语清楚，腱反射仍有增高，上肢肌张力仍有轻度增加，并有轻度颤抖。三诊：记忆稍差，言语稍不清，一般情况佳良。龙齿12克，朱茯神9克，龙胆草6克，珍珠母30克，天麻9克，全蝎3支，枣仁9克，白芍9克，玉竹9克，钩藤15克，天竺黄6克，当归9克，银花9克，10剂。四诊：睡眠欠佳，四肢感觉乏力。珍珠母30克，朱茯神9克，移山参3克，龙齿9克，生地15克，全蝎5支，枣仁9克，钩藤9克，山药9克，天竺黄3克，合欢皮9克，10剂。完全复原。（姜春华医案，《中医杂志》4：56，1959）
例二：王××，女，52岁，门诊号：77／8475，初诊日期：1977年3月10日。左手足震颤已八年。始于左上肢，以后发展至左上下肢震颤抖动，但以手指部震颤最严重。经神经科检查诊为震颤麻痹（帕金森氏病），服用各种中西药未显效。症见：左手足震颤，不能自主，行动缓慢，振振摇搐，纳谷不佳，睡眠不酣，口干便坚，脉弦细，苔薄腻，质偏红。震颤麻痹者，筋之病也。肝主筋，肝血充盈，才能淫气于筋；筋之病故属肝与血也。治拟平肝柔肝，养血熄风。生熟地各12克，全当归9克，赤白芍各9克，花龙骨30克（先煎），生牡蛎30克（先煎），珍珠母30克（先煎），生黄芪12克，潞党参12克，制首乌12克，枸杞子9克，川石斛12克（先煎），怀牛膝12克，单桃仁9克，杜红花6克，玄精石18克，仙灵脾18克。上方加减服至1977年6月以后，左下肢震颤已明显好转。（张羹梅《临证偶拾》）
【评按】颤抖或震颤系指肢体肌肉跳动发抖为主的证候。多因肝血虚、肝风内动，风动则肢摇，故见颤抖或震颤。
例一西医诊断为亚急性脑炎，原案命题“颤抖”，治以养血潜镇，清热熄风之剂，疗效尚好。
例二诊为震颤麻痹，肝血虚，血不养筋则肢摇震颤，治以平肝柔肝，养血熄风，虽未痊愈，但症状明显好转，尚有参考价值。
(五十二) 无脉症患者女性，27岁，初诊日期：1959年4月5日。患者于1957年1月间忽然右手不能活动，双足发麻，曾住院检查，发现腕部脉沉伏，右臂血压180／130毫米汞柱，服降压药后，右手逐渐能动，其他症状好转出院。1958年4月间忽然口喑不能言而心中了了，再度住院，血压同上，又服西药降压药8～9天，恢复说话而出院。嗣后经常头痛、失眠，手冷无力，不能上班工作，屡治一年来仍无少愈。西医诊断无脉症。诊其脉象左伏右沉细，舌质暗红，苔薄腻，口渴，烦躁，头痛失眠，手冷无力，右臂血压150／130毫米汞往，左臂血压不能测到，月经3～4月一潮，亦无定期。1957年结婚。未曾怀孕。先予平肝熄风，凉血降逆为治。方药：干生地12克，甘菊花6克，青葙子9克，夏枯草9克，酒白芍6克，粉丹皮3克，北沙参6克，钩藤9克，川芎3克，当归4.5克，川牛膝4.5克。4月12日：前方连服7剂，烦躁稍减，手冷未除，乃于前方去当归、沙参，加海藻、昆布各9克借以散结软坚。连服14剂。4月26日复诊时左脉仍伏，右脉软起，舌苔仍腻，头痛差减，乃去菊花、青葙，加元参9克，以去其浮游之火，连服14剂。5月10日：前方加减共服35剂，头痛失眠，烦躁诸症悉除，而脉象仍无明显好转，拟予活血逐瘀，软坚通络之剂，缓法图治。方药如下：全当归30克，川芎30克，酒白芍30克，苏木12克，牛膝9克，红花12克，丹皮30克，钩藤30克，海藻30克，昆布30克，香附30克，麝香0.6克。上共研细末，炼蜜为丸，重9克，每服1丸，每日2丸，空腹用葱头、生姜煎汤嚼服。6月14日，病情脉象无甚变化，原方去钩藤再增疏肝通窍之品，如柴胡30克，枳壳、细辛各12克，当归加至60克，苏木加至18克，麝香加倍，蜜丸服法如前。7月19日，左脉始出，但仍沉细而涩，右脉接近平脉，夜眠又感欠安，乃于前方去柴、枳、辛、附，加行血安神之品，如丹参30克，桃仁15克，枣仁、柏子仁各30克，远志、菖蒲各15克，蜜丸服法如前。8月23日，经期比前提早，约40天左右一潮，夜眠较安，前方去远志、菖蒲，加青木香30克以调气，蜜丸服法如前。开始半日工作。10月4日，左脉已出，仍较沉细，右脉如平，右臂血压140／90～100毫米汞柱。左臂血压仍不易测到，经来微有酸痛，前方去柏子仁、苏木，加生蒲黄、五灵脂各15克。蜜丸服法如前。11月8日：左脉已出，右脉如平，夜眠已安，右臂血压130／90～100毫米汞柱，左臂血压仍不易测到。前方去枣仁再服。以后按前方加减，曾使用过于生地、旱莲草、女贞子等。至1961年2月26日，诸症悉除，左臂血压已能测到为90／80毫米汞柱。5月2日复诊，左脉仍沉细，右脉如平，舌有薄苔，血压左臂90／70毫米汞柱，右臂95／70毫米汞柱。前方生地改熟地，加阿胶30克，砂仁15克，减麝香至0.6克。蜜丸连续再服。8月20日，右臂血压114／78、左臂100／70毫米汞柱，月经30天左右一行，症状全消，停药观察，整日上班工作。随访至1962年7月17日，患者毫无所苦，继续整日上班工作。（朱颜：无脉病一例报告，《中医杂志》1：11，1963）
【评按】无脉症又称大动脉炎，为西医病名。是主动脉及其分枝的慢性进行性、闭塞性炎症，故又称为缩窄性大动脉炎。由于受累的动脉不同，又分为上肢无脉症、下肢无脉症、肾动脉狭窄性高血压等类型。根据其症状表现，大致属于中医“眩晕”、“脉痹”，或“厥证”范围。其病多因先天不足，脾肾两虚，或后天失调，气血两亏所致。气虚则血行不畅，阴血亏则脉道不充，运行缓慢，日久则脉道瘀滞，甚则闭塞不通，以致脉涩如丝，甚或无脉。本案属于上肢型。由于血虚不能上荣于脑，加之虚风上扰，故见头痛、失眠；血脉瘀阻，气血运行不畅故手冷无力，甚而不能活动。治疗首用平肝熄风、逐瘀通络之剂。先服汤剂以求速效，待症状改善后，续以丸药长服，取其力缓持久。治疗两年余效果良好。停药随访一年，一切情况尚好，为治疗此类疑难病提供了有价值的例证。
(五十三) 盗汗
Case 1: The syndrome belongs to Qi and Yin deficiency with blazing fire in the Lung and Stomach. Zhu believed: "The disease is located in the Lung, Stomach, and Kidney, but its root lies in the Kidney. The pathological mechanism is accumulated heat damaging Yin fluids; therefore, the general approach is to employ the method of nourishing Yin and clearing heat." Combining the experience of his teacher Shi Jinmo, he used Zengye Tang (Fluid-Generating Decoction) combined with Shengmai San (Generate the Pulse Powder), plus raw Huangqi (Astragali Radix) paired with Shanyao (Dioscoreae Rhizoma), and Baizhu (Atractylodis Rhizoma) paired with Xuanshen (Scrophulariae Radix) as the main formula for treating this disease, with satisfactory efficacy. This case further strengthened the herbs that nourish Yin and clear heat on the basis of the aforementioned main formula.
Case 2: Yin deficiency with latent internal heat, accompanied by signs of Liver Qi stagnation. Therefore, Danzhi Xiaoyao San (Moutan and Gardenia Ramified Free Wanderer Powder) was modified for treatment. Through these two cases, not only were the experiences in treating Xiao Ke (Wasting-Thirst Syndrome / Diabetes Mellitus) briefly elucidated, but also Shi's insights were introduced. For instance, the combination of raw Huangqi (Astragali Radix) with Shanyao (Dioscoreae Rhizoma), and Baizhu (Atractylodis Rhizoma) with Xuanshen (Scrophulariae Radix) both have clinical effects in lowering blood glucose. It is generally believed that Baizhu (Atractylodis Rhizoma) is drying and should not be selected, but Shi realized that Baizhu (Atractylodis Rhizoma) has the effect of consolidating Spleen essence. Although its nature is drying, when paired with Xuanshen (Scrophulariae Radix), its shortcomings can be restrained while its advantages are highlighted.
Case 3: Caused by contracting winter-warmth pathogenic factors, combined with a constitutionally Yin-deficient state. The exterior pathogenic heat failed to be cleared and resolved, transmitted internally to the Intestines and Stomach, stirring up Heart fire, and further damaging Kidney Yin, leading to Xiao Ke (Wasting-Thirst Syndrome). Initially, Shen Bai Hu Jia Jian (Ginseng White Tiger Decoction with Modifications) was used to clear the Intestines and Stomach, generate fluids, and urgently treat the branch symptoms. After the vexatious thirst was relieved, formulas such as Mawei Dihuang Wan (Lonicera and Schisandra Rehmannia Pill), Zhibai Dihuang Wan (Anemarrhena and Phellodendron Rehmannia Pill), and Qiju Dihuang Wan (Cornus and Chrysanthemum Rehmannia Pill) were modified to cultivate the source, nourish Yin, and tonify the Kidney to treat the root slowly.
Case 4: Effective treatment was achieved using the methods of nourishing Yin and clearing heat, benefiting Qi and generating fluids. Zhao believed: "Clinically, Xiao Ke (Wasting-Thirst Syndrome) often presents as syndromes where excessive heat damages Yin, and Yin deficiency and dryness-heat are mutually causal." Its treatment principles are: early stage mainly focuses on nourishing Yin, clearing heat, and purging fire, treating both Lung and Stomach; middle stage primarily uses nourishing Yin and benefiting Qi; late stage should address syndromes of dual deficiency of Yin and Yang accordingly. The characteristic of this case lies in precise syndrome differentiation, concise prescription, simultaneous treatment of root and branch, achieving good results by sticking to one formula throughout.
(50) Malaria
Case 1: Wang, male, 30 years old, August visit. Phlegm-dampness lurking internally, pivot mechanism disharmony, malaria occurring every other day with abdominal distension, chills followed by fever, headache, chest fullness, desire to vomit, abdominal bloating, thick greasy tongue coating, wiry-slippery pulse. Treatment with Qingpi Yin (Spleen-Clearing Drink) with modifications. Prepared Houpo (Magnoliae Officinalis Cortex) 4.5g, baked Cao Guo (Tsaoko Fructus) 4.5g, prepared Maoyu (Atractylodis Rhizoma) 4.5g, Chaihu (Bupleuri Radix) 4.5g, stir-fried Huangqin (Scutellariae Radix) 6g, ginger-processed Banxia (Pinelliae Rhizoma) 7.5g, Weilingxian (Sinopodophylli Hexandri Rhizoma) 9g, Baijili (Tribuli Fructus) 9g, Xiao Qingpi (Citri Reticulatae Pericarpium Viride) 4.5g, Fuling (Poria) 12g, Wuyao (Linderae Radix) 9g, fresh Ginger 3 slices, Zhuru (Bambusae Caulis in Taenia) 9g. Second visit: After taking the previous prescription, malaria attacks became lighter, vomiting stopped, headache, chest tightness, and abdominal distension all improved, greasy coating turned thin, pulse remained wiry-slippery. Continue with the original method. Chaihu (Bupleuri Radix) 2.4g, Huangqin (Scutellariae Radix) 4.5g, Fuling (Poria) 12g, prepared Chuanpu (Magnoliae Officinalis Cortex) 2.4g, Xiao Qingpi (Citri Reticulatae Pericarpium Viride) 4.5g, Baijili (Tribuli Fructus) 9g, ginger-processed Banxia (Pinelliae Rhizoma) 7.5g, raw Guya (Hordei Fructus Germinatus) 9g, Weilingxian (Sinopodophylli Hexandri Rhizoma) 9g, baked Cao Guo (Tsaoko Fructus) 2.4g, prepared Maoyu (Atractylodis Rhizoma) 4.5g, Tai Wuyao (Linderae Radix) 6g. (From *Ye Xichun Medical Cases*)
Case 2: Xu XX, female, 34 years old. Every morning at dawn, high fever with sweating, restlessness, coarse breathing, thirst preferring cold drinks, gradually subsiding in the afternoon, mental fatigue after fever subsides, lasting over a month, unresponsive to repeated treatments. During fever, skin feels burning hot, red face and lips, surging-rapid pulse, weak pulses at both Chi positions, crimson tongue body, thin yellow coating with little fluid. Based on pulse and symptoms, it is diagnosed as "Dan Nue" (Febrile Malaria). Treatment should employ sweet-cold to generate fluids and save Yin while clearing heat. Raw Shigao (Gypsum Fibrosum) 15g, Maidong (Ophiopogonis Radix) 9g, Shashen (Glehniae Radix) 15g, Shengdi (Rehmanniae Radix) 15g, fresh Sugarcane Juice one cup, Lianqiao (Forsythiae Fructus) 9g, Tianhuafen (Trichosanthis Radix) 9g, Wuweizi (Schisandrae Chinensis Fructus) 3g, fresh Jingzhuye (Lophatheri Herba) 20 leaves. After three doses, fever subsided, sweating stopped, thirst quenched, urination and defecation normal, pulse gentle and slow, tongue reddish and moist. Use Guishao Liujun Zi Tang (Angelica and Peony Six-Ingredient Decoction) to benefit blood and nourish Yin to conclude treatment. Prescription follows: Shengdi (Rehmanniae Radix) 15g, Huaishanyao (Dioscoreae Rhizoma) 15g, Shanzhuyu (Corni Fructus) 6g, Fuling (Poria) 9g, Fen Danpi (Moutan Cortex) 9g, Zexie (Alismatis Rhizoma) 9g, Danggui (Angelicae Sinensis Radix) 15g, Hangshao (Paeoniae Radix Alba) 15g. (From *Li Jichang Medical Cases*)
Case 3: Zhan XX, male, 31 years old. Suffered from Mu Nue (Cold Malaria) for over 20 days, starting daily in the afternoon with chills and shivering, headache and body fatigue. Even during the hottest days of summer (Sanfu), still shivering and curling up in bed; adding quilts and wool blankets was insufficient to ward off the cold. Cold sweat spontaneously appeared, anorexia, chest fullness, nausea with desire to vomit, cold limbs, blue-white complexion, pale tongue slightly bluish, white greasy coating, deep-thin pulses in all six positions, especially weak at both Chi positions. Prescription: Hei Tianxiong (Aconiti Lateralis Radix Preparata - Black Aconite) 120g (boil thoroughly in water first), Paojiang (Zingiberis Rhizoma Preparatum) 30g, Zhi Cao (Glycyrrhizae Radix et Rhizoma Preparatum) 9g, Houpo (Magnoliae Officinalis Cortex) 9g, roasted Cao Guo (Tsaoko Fructus) 1 piece (shell removed), Cangzhu (Atractylodis Rhizoma) 15g, Chao Changshan (Dichroae Radix) 6g, Cao Kou (Amomi Fructus Rotundus) 6g, Fu Xiaomai (Tritici Capilliformis Granum) 15g, Dazao (Jujubae Fructus) 5 pieces (roasted with wine). Follow-up: After taking the above prescription for 2 doses, all symptoms resolved, but due to long illness causing severe deficiency of healthy Qi, use acrid-warm to assist Yang, strengthen Spleen and benefit Qi for conditioning and follow-up. Prescription follows: Hei Tianxiong (Aconiti Lateralis Radix Preparata) 45g (boil thoroughly in water first), Luodangshen (Codonopsis Radix) 15g, Baizhu (Atractylodis Rhizoma) 15g, Paojiang (Zingiberis Rhizoma Preparatum) 15g, Fa Banxia (Pinelliae Rhizoma Preparatum) 9g, roasted Wumei (Mume Fructus) 1 piece, Chenpi (Citri Reticulatae Pericarpium) 9g, Zhi Cao (Glycyrrhizae Radix et Rhizoma Preparatum) 9g, Fuling (Poria) 9g, roasted Cao Guo (Tsaoko Fructus) 1 piece (shell removed), Dazao (Jujubae Fructus) 5 pieces (roasted with wine). (From *Li Jichang Medical Cases*)
Case 4: Huang XX, male, 19 years old. Previously suffered from Jie Nue (Intermittent Malaria), pain in the left hypochondrium with a mass, gradually enlarging to the size of a fist, gurgling sound upon light palpation, persisting for nearly a year. Urine yellow, recently penile pain. Palpation showed left Guan position wiry-knotted, right relatively weak, gray-white tongue coating. This is due to cold-dampness condensing tightly, Qi and Blood stagnating in the chest and hypochondrium. "The accumulation of the Liver is named Feiqi (Fat Qi), located under the left hypochondrium like an inverted cup, with pain in both hypochondria radiating to the lower abdomen." If arising from malaria, the pathogen forms a mass, named "Nuo Mu" (Malaria Mother). Liver disease affecting the Spleen, spleen enlargement, shifting left and right; treating the Spleen is treating the Liver. The method should be to eliminate accumulation and resolve masses, soothe the Liver and soften the Spleen. Prepared Biejia (Testudinis Carapax et Plastrum) 15g, Yun Fuling (Poria) 10g, Wine-shaoyao (Paeoniae Radix Rubra/Alba) 10g, Jinlingzi (Meliosmae Fructus - vinegar fried) 10g, Raw Muli (Conchae Margaritiferae Concha) 10g, Prepared Xiangfu (Cyperi Rhizoma) 7g, Shanzha Tan (Crataegi Fructus Carbonized) 7g, Yanhusuo (Corydalis Rhizoma - vinegar fried) 7g, Vinegar Qingpi (Citri Reticulatae Pericarpium) 5g, Guangmuxiang (Costi Rhizoma) 3g, Bei Chaihu (Bupleuri Radix) 3g, You Angui (Cinnamomi Cortex) 1g, Gancao Shao (Glycyrrhizae Radix et Rhizoma tip) 2g. Follow-up: Hypochondriac pain reduced, urine still yellow, penile pain, loose stools, mass hard. Original prescription remove Muli (Conchae Margaritiferae Concha) and Shanzha Tan (Crataegi Fructus Carbonized), add wine-fried Huangqin (Scutellariae Radix) and Zuojin Wan (Left Metal Pill - taken separately) to assist the Spleen to control the Liver. Third visit: Hard mass softened and shrunk, hypochondriac pain tolerable to light touch, penile pain during urination also reduced. After sleep, abdominal stagnant gas moves restlessly, indicating Liver Qi scattering and unrestrained, Spleen mechanism constrained. Modify the follow-up prescription: change Jinlingzi (Meliosmae Fructus) to 7g, remove Huangqin (Scutellariae Radix) and Gancao Shao (Glycyrrhizae Radix et Rhizoma tip), add Danggui Shen (Angelicae Sinensis Radix body) 10g, Shanyurou (Corni Fructus) 5g. Continue taking for many doses, mass pain disappeared. (From *Li Congfu Medical Cases*)
[Commentary] Malaria is mostly caused by contracting Malaria pathogens. It is a disease characterized by intermittent chills, high fever, and sweating, usually occurring at regular intervals. Special discussions on it already existed in the *Neijing* (Classic of Internal Medicine). Due to different co-contracted pathogens and variations in patient constitutions, resulting in excess of Yin or Yang, clinically there are different syndromes such as occurring once a day, once every two days, or once every three days. Those with more heat than chills are called Wen Nue (Warm Malaria); those with heat only and no chills are called Dan Nue (Febrile Malaria); those with more chills or only chills without heat are called Mu Nue (Cold Malaria); those with recurring episodes and masses under the hypochondrium are called Nuo Mu (Malaria Mother).
Case 1 is Zheng Nue (Regular Malaria), occurring every other day. The syndrome belongs to long-standing phlegm-dampness accumulation, trapping the Spleen, and disharmony of the Shaoyang pivot mechanism. Therefore, Qingpi Yin (Spleen-Clearing Drink) was modified to dispel phlegm-dampness and harmonize the pivot mechanism. Wuyao (Linderae Radix) and Weilingxian (Sinopodophylli Hexandri Rhizoma) in the formula are Ye's empirical herbs, particularly suitable for Zheng Nue (Regular Malaria).
Case 2 is Dan Nue (Febrile Malaria), with heat only and no chills being its clinical feature. The patient has latent heat since long, fluids and Qi already damaged, pores open, pathogenic heat lurking between skin and muscles. Heat is a Yang pathogen, and dawn to noon is Yang within Yang. The combination of two Yangs causes regular occurrence; when Yang Qi is abundant, there is heat only without chills, heat blazing damaging fluids. Therefore, sweet-cold to generate fluids, save Yin and clear heat agents were used to subdue the heat, followed by Guishao Liujun Zi Tang (Angelica and Peony Six-Ingredient Decoction) to nourish blood and benefit Yin to conclude treatment.
Case 3 is Mu Nue (Cold Malaria), with chills only and no heat, cold limbs. The patient's Yang Qi is inherently deficient, Spleen trapped by Yin pathogens, Cold pathogen lingering in Shaoyin for a long time, compounded by drinking cold and seeking coolness further damaging Yang, Yin pathogens becoming abundant. Following Zhang Zhongjing's Sini Tang (Frigid Extremities Decoction) with modifications, it promotes Yang growth and Yin reduction, allowing latent pathogens to emerge outward.
Case 4 is Nuo Mu (Malaria Mother). The syndrome is caused by cold-dampness condensation and Qi-Blood stagnation in the chest and hypochondrium. Treated with agents to eliminate accumulation, resolve masses, soothe the Liver, and soften the Spleen. Following the principle in the *Neijing* (Classic of Internal Medicine): "For large accumulations and masses, stop when they are reduced by more than half." Therefore, for long-term malaria with body deficiency, harsh agents are generally avoided to prevent damaging Qi and Blood.
(51) Trembling, Tremor
Case 1: Wang XX, female. Patient silent, occasionally laughing blankly, answering irrelevantly, lips and four limbs trembling incessantly, low-grade fever. According to caregivers: the previous night talking to oneself, getting out of bed walking to others' beds, making noise all night. Danggui (Angelicae Sinensis Radix) 9g, Baishao (Paeoniae Radix Alba) 9g, Yuanzhi (Polygalae Radix) 3g, Gouteng (Uncariae Ramulus cum Uncis) 15g, Cishi (Hematitum) 9g, Danpi (Moutan Cortex) 9g, Zhufushen (Poria cum Rizoma et Mycelium cinnabarine) 9g, Longdancao (Gentianae Radix) 6g, Longchi (Draconis Os) 9g, Tianma (Gastrodiae Rhizoma) 9g, Jiangcan (Bombyx Batryticatus) 9g. After taking medicine for 24 doses, speech still sparse, tremor slight, memory slightly decreased, cranial nerve examination negative, limb movement slightly inflexible, muscle tone slightly increased, tendon reflexes heightened. Second visit: Original prescription add Yuzhu (Polygonati Odorati Rhizoma) 9g, Yinhua (Lonicerae Japonicae Flos) 9g, 10 doses. Mental state completely normal, speech clear, tendon reflexes still heightened, upper limb muscle tone still slightly increased, with mild tremor. Third visit: Memory slightly poor, speech slightly unclear, general condition good. Longchi (Draconis Os) 12g, Zhufushen (Poria cum Rizoma et Mycelium cinnabarine) 9g, Longdancao (Gentianae Radix) 6g, Zhenzhumu (Margarita) 30g, Tianma (Gastrodiae Rhizoma) 9g, Quanxie (Scorpio) 3 pieces, Zaoren (Ziziphi Spinosae Semen) 9g, Baishao (Paeoniae Radix Alba) 9g, Yuzhu (Polygonati Odorati Rhizoma) 9g, Gouteng (Uncariae Ramulus cum Uncis) 15g, Tianzhuhuang (Bambusae Tabula in Taenia) 6g, Danggui (Angelicae Sinensis Radix) 9g, Yinhua (Lonicerae Japonicae Flos) 9g, 10 doses. Fourth visit: Poor sleep, limbs feel weak. Zhenzhumu (Margarita) 30g, Zhufushen (Poria cum Rizoma et Mycelium cinnabarine) 9g, Yishanshen (Panax Ginseng) 3g, Longchi (Draconis Os) 9g, Shengdi (Rehmanniae Radix) 15g, Quanxie (Scorpio) 5 pieces, Zaoren (Ziziphi Spinosae Semen) 9g, Gouteng (Uncariae Ramulus cum Uncis) 9g, Shanyao (Dioscoreae Rhizoma) 9g, Tianzhuhuang (Bambusae Tabula in Taenia) 3g, Hehuanpi (Albiziae Cortex) 9g, 10 doses. Completely recovered. (Jiang Chunhua Medical Cases, *Chinese Journal of Traditional Chinese Medicine* 4:56, 1959)
Case 2: Wang XX, female, 52 years old, Outpatient No.: 77/8475, Initial Visit Date: March 10, 1977. Left hand and foot tremor for eight years. Started in the left upper limb, later developed to left upper and lower limbs shaking and trembling, but most severe in fingers. Diagnosed by neurology department as Parkinson's Disease (Tremor Paralysis), various Chinese and Western medicines ineffective. Symptoms: Left hand and foot tremor, involuntary, slow movement, shaking and convulsing, poor appetite, unrestful sleep, dry mouth, hard stool, wiry-thin pulse, thin greasy coating, tongue body偏向red. Tremor paralysis is a disease of sinews. The Liver governs sinews; only when Liver Blood is abundant can it moisten the sinews; thus, diseases of sinews belong to the Liver and Blood. Treatment aims to calm the Liver, soften the Liver, nourish Blood, and extinguish Wind. Raw and Prepared Shudi (Rehmanniae Radix Preparata) each 12g, Quan Danggui (Angelicae Sinensis Radix) 9g, Chi Baishao (Paeoniae Radix Rubra/Alba) each 9g, Hualonggu (Corvis Ossis Draconis) 30g (decoct first), Raw Muli (Conchae Margaritiferae Concha) 30g (decoct first), Zhenzhumu (Margarita) 30g (decoct first), Sheng Huangqi (Astragali Radix) 12g, Luodangshen (Codonopsis Radix) 12g, Zhi Shouwu (Polygoni Multiflori Radix Preparata) 12g, Gouqizi (Lycii Fructus) 9g, Chuan Shihu (Dendrobii Caulis) 12g (decoct first), Huai Niuxi (Achyranthis Bidentatae Radix) 12g, Dan Taoren (Persicae Semen) 9g, Du Honghua (Carthami Flos) 6g, Xuanjingshi (Natrii Sulfas) 18g, Xianlinsi (Epimedii Folium) 18g. After modifying and taking the above prescription until after June 1977, left lower limb tremor significantly improved. (Zhang Gengmei *Lin Zheng Ou Shi*)
[Commentary] Trembling or tremor refers to syndromes mainly characterized by twitching and shaking of limb muscles. Mostly due to Liver Blood deficiency and internal stirring of Liver Wind; when Wind stirs, limbs shake, hence seeing trembling or tremor.
Case 1 Western diagnosis was Subacute Encephalitis. The original case titled "Trembling," treated with agents to nourish Blood, anchor and suppress, clear heat, and extinguish Wind, with good efficacy.
Case 2 diagnosed as Parkinson's Disease (Tremor Paralysis), Liver Blood deficiency, Blood failing to nourish sinews causing limb shaking and tremor. Treated with calming the Liver, softening the Liver, nourishing Blood, and extinguishing Wind. Although not fully cured, symptoms significantly improved, still having reference value.
(52) Pulseless Disease Patient Female, 27 years old, Initial Visit Date: April 5, 1959. In January 1957, suddenly unable to move right hand, numbness in both feet. Hospitalized for examination, found wrist pulse deep and hidden, right arm blood pressure 180/130 mmHg. After taking antihypertensive drugs, right hand gradually movable, other symptoms improved, discharged. In April 1958, suddenly aphasic but mind clear, hospitalized again, blood pressure same, took Western antihypertensive drugs for 8-9 days, recovered speech, discharged. Since then frequent headaches, insomnia, cold hands and weakness, unable to work, repeatedly treated for a year with no improvement. Western diagnosis: Pulseless Disease. Pulse diagnosis: Left hidden, Right deep-thin. Tongue body dark red, thin greasy coating, thirst, irritability, headache, insomnia, cold hands and weakness. Right arm blood pressure 150/130 mmHg, left arm blood pressure unmeasurable. Menstruation every 3-4 months, irregular. Married in 1957. Never pregnant. First given calming Liver, extinguishing Wind, cooling Blood, descending Rebellious Qi treatment. Prescription: Gan Shengdi (Rehmanniae Radix) 12g, Gan Juhua (Chrysanthemi Flos) 6g, Qingxiangzi (Phalaridis Semen) 9g, Xiakucao (Prunellae Spica) 9g, Jiu Baishao (Paeoniae Radix Alba) 6g, Fen Danpi (Moutan Cortex) 3g, Bei Shashen (Glehniae Radix) 6g, Gouteng (Uncariae Ramulus cum Uncis) 9g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 3g, Danggui (Angelicae Sinensis Radix) 4.5g, Chuan Niuxi (Achyranthis Bidentatae Radix) 4.5g. April 12: Taking previous prescription continuously for 7 doses, irritability slightly reduced, cold hands not removed. Remove Danggui (Angelicae Sinensis Radix) and Shashen (Glehniae Radix) from previous prescription, add Haizao (Sargassum) and Kunbu (Sargassum) each 9g to dissipate nodules and soften hardness. Take continuously for 14 doses. April 26 follow-up: Left pulse still hidden, Right pulse soft rising, tongue coating still greasy, headache slightly reduced. Remove Juhua (Chrysanthemi Flos) and Qingxiangzi (Phalaridis Semen), add Xuanshen (Scrophulariae Radix) 9g to remove floating fire. Take continuously for 14 doses. May 10: Total 35 doses of modified previous prescription taken, headache, insomnia, irritability all resolved, but pulse shows no obvious improvement. Plan to use activating Blood, driving out Stasis, softening hardness, and unblocking collaterals agents, treating slowly. Prescription follows: Quan Danggui (Angelicae Sinensis Radix) 30g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 30g, Jiu Baishao (Paeoniae Radix Alba) 30g, Sumu (Sappan Lignum) 12g, Niuxi (Achyranthis Bidentatae Radix) 9g, Honghua (Carthami Flos) 12g, Danpi (Moutan Cortex) 30g, Gouteng (Uncariae Ramulus cum Uncis) 30g, Haizao (Sargassum) 30g, Kunbu (Sargassum) 30g, Xiangfu (Cyperi Rhizoma) 30g, Shexiang (Moschus) 0.6g. All finely ground, refined honey made into pills, weight 9g per pill, take 1 pill each time, 2 pills daily, chew with decoction of Scallion Head and Fresh Ginger on empty stomach. June 14: Condition and pulse show little change. Remove Gouteng (Uncariae Ramulus cum Uncis) from original prescription, add more soothing Liver and unblocking orifice agents, such as Chaihu (Bupleuri Radix) 30g, Zhike (Aurantii Fructus) and Xixin (Asari Radix et Rhizoma) each 12g, increase Danggui (Angelicae Sinensis Radix) to 60g, Sumu (Sappan Lignum) to 18g, double Shexiang (Moschus), honey pill method as before. July 19: Left pulse finally emerges, but still deep-thin and choppy, Right pulse approaches normal pulse, night sleep feels uneasy again. Remove Chaihu (Bupleuri Radix), Zhike (Aurantii Fructus), Xixin (Asari Radix et Rhizoma), Xiangfu (Cyperi Rhizoma) from previous prescription, add Blood-moving and Spirit-calming agents, such as Danshen (Salviae Miltiorrhizae Radix) 30g, Taoren (Persicae Semen) 15g, Zaoren (Ziziphi Spinosae Semen) and Baiziren (Biotae Semen) each 30g, Yuanzhi (Polygalae Radix) and Changpu (Acori Tatarinowii Rhizoma) each 15g, honey pill method as before. August 23: Menstrual period earlier than expected, about once every 40 days, night sleep relatively peaceful. Remove Yuanzhi (Polygalae Radix) and Changpu (Acori Tatarinowii Rhizoma) from previous prescription, add Qingmuxiang (Aucklandiae Radix) 30g to regulate Qi, honey pill method as before. Start working half-day. October 4: Left pulse emerged, still relatively deep-thin, Right pulse like normal, right arm blood pressure 140/90-100 mmHg. Left arm blood pressure still difficult to measure, menstruation comes with slight soreness. Remove Baiziren (Biotae Semen) and Sumu (Sappan Lignum) from previous prescription, add Sheng Puhuang (Typhae Pollen) and Wulingzhi (Trogopterori Faeces) each 15g. Honey pill method as before. November 8: Left pulse emerged, Right pulse like normal, night sleep peaceful, right arm blood pressure 130/90-100 mmHg, left arm blood pressure still difficult to measure. Remove Zaoren (Ziziphi Spinosae Semen) from previous prescription and continue taking. Thereafter modify according to previous prescription, also used Yu Shengdi (Rehmanniae Radix), Hanliancao (Ecliptae Herba), Nvzhenzi (Ligustri Lucidi Fructus) etc. By February 26, 1961, all symptoms resolved, left arm blood pressure measurable at 90/80 mmHg. May 2 follow-up: Left pulse still deep-thin, Right pulse like normal, tongue has thin coating, blood pressure left arm 90/70 mmHg, right arm 95/70 mmHg. Change Shengdi (Rehmanniae Radix) to Shudi (Rehmanniae Radix Preparata) in previous prescription, add Ejiao (Asini Corii Colla) 30g, Sharen (Amomi Fructus) 15g, reduce Shexiang (Moschus) to 0.6g. Continuous honey pill intake. August 20: Right arm blood pressure 114/78, left arm 100/70 mmHg, menstruation about once every 30 days, symptoms all gone, stop medication observe, work full day. Follow-up until July 17, 1962, patient suffering nothing, continuing full-day work. (Zhu Yan: Report of One Case of Pulseless Disease, *Chinese Journal of Traditional Chinese Medicine* 1:11, 1963)
[Commentary] Pulseless Disease is also known as Takayasu Arteritis, a Western medical term. It is a chronic progressive occlusive inflammation of the aorta and its branches, hence also called constrictive aortitis. Due to different affected arteries, it is divided into upper limb pulseless disease, lower limb pulseless disease, renal artery stenosis hypertension, etc. Based on symptom manifestations, it roughly belongs to the scope of Chinese Medicine "Xuan Yun" (Vertigo/Dizziness), "Mai Bi" (Vessel Obstruction), or "Jue Zheng" (Revulsion Syndromes). The disease is mostly caused by congenital insufficiency, dual deficiency of Spleen and Kidney, or acquired imbalance, dual deficiency of Qi and Blood. Qi deficiency leads to poor blood circulation; Yin-Blood deficiency leads to unfull vessels, slow operation, long-term vessel stasis, even blockage, resulting in choppy pulse like silk, or even pulseless. This case belongs to the upper limb type. Due to Blood deficiency failing to nourish the brain upwards, plus deficient Wind disturbing upwards, seeing headache, insomnia; Blood vessel obstruction, poor Qi-Blood circulation causing cold hands and weakness, even inability to move. Treatment first uses calming Liver, extinguishing Wind, driving out Stasis, and unblocking collaterals agents. First take decoction for rapid effect, after symptoms improve, continue taking pills for long-term use, taking advantage of slow and lasting power. Treatment lasted over two years with good results. One year follow-up after stopping medication, everything still good, providing valuable evidence for treating such difficult diseases.
(53) Night Sweats