例一祝ｘｘ，男，58岁。十多年来，每夜盗汗，身体强壮，面赤唇绛，脉数，相火易动，阳常举。当归9克熟地30克生地15克黄柏9克黄芩9克黄连1．5克元参9克7剂。二诊：前方服一剂盗汗即上，有咳嗽痰多，前方加黄芪9克，元参9克，7剂。三诊：阅读流泪，面仍红，因过度疲劳：有盗汗一次。当归9克熟地30克生地15克白芍9克黄芩9克黄芪9克黄连1．5克牡蛎15克望江南9克黄柏9克七剂后汗止停诊。
(姜春华医案，《中医杂志》4：56，1959）
例二张××，女，51岁，初诊日期：1963年3月6日。胃中苦冷，时唾清涎，头晕心悸，口干，虚烦难眠，阖目则汗出，小溲热赤不畅，大便昨起未通。舌绛无苔，脉虚弦小数。初拟苦辛甘合化治法，取半夏泻心汤为主方加减，诊治三次，加减法液汤，均未获效。3月12日，诸症如故。至此大便已5日未通，且因连续盗汗，精神更加疲惫。细辨其脉舌，脉虽小数，然重按无根；舌虽绛无苔，但滑润而不干，口虽燥，但只漱水而不欲咽。因悟此证乃系龙雷之火不安其位，虚火浮越，真火衰微。因其虚火妄动，故口干、舌绛，脉数；因其真火衰微，中土失澳，饮食水谷不化津液而成痰水为害，是以胃中苦冷，时吐清涎。盗汗不已者，脾虚营卫失调之故。头晕心悸，虚烦难眠者，一因脾失转输，精微不继：一因汗出过多，营阴不足，相火妄动。溲赤便秘者，津液内竭无以下输使然。种种见证，均由脾胃失职所致。此证此时，首重培土，尤须益火。无如病将一月，纳少汗多，不仅阳微，抑且液亏。若进辛温则伤阴，若与滋润复碍阳。拟但取和胃理脾之品，别加炮制，意在“以火益火”，又使诸药存其性而变其气，庶期温而不劫阴液，柔而不遏中阳。白术(上炒）、淮山药(炒令黄）、扁豆(炒黑）、山楂炭各9克半夏、姜炭各6克左金丸6克(送服）3月13比口吐清涎茴除，他症随减。唯大便未通。再步前法，去温涩之药，加温润之品。前方去山楂炭、姜炭，加麦门冬(炒令黄）12克、熟地炭9克。3月14日：汗敛，便通，口干，心悸并除，再按前意处方，服2剂而安。
(俞长荣：益火生土法则的认识与实践，《中医杂志》11：25，1964）
例三田××，男，35岁，初诊日期：1964年3月10日。春温卧床已半月，病情已转入痊愈阶段，神识已清，呛咳已减，胃纳已现增进，惟早晚体温相差甚巨，成峻峭的体温曲线，每夜仍在39℃左右，睡中大汗如浴，衣被全湿，醒后头目昏眩，困倦不支，经注射解热敛汗剂，均无效，脉数大无力，舌色红而干燥，口渴思饮。方药：当归身9克生地黄12克熟地黄12克炒川连6克炒黄芩6克炒黄柏6克炙黄芪15克天花粉9克麦门冬9克麻黄根6克五味子3克生龙骨9克生牡蛎9克服5剂，热退汗止，继用导功散加炙芪、山药、石斛、谷芽、糯稻根等，调理数日而安，
(裴慎：用当归六黄汤加减治愈盗汗的体会，《江西医药杂志》5⑥：852，1965）
【评按】盗汗为常见的汗证之一。《内经》名为“寝汗”。《金匮要略》曰：“男子平人，脉虚弱细微者，喜盗汗也。”盗汗系指入睡则汗出，醒后即止。多属虚劳之证，尤以阴虚者多见，或可因肝热、阴火所致。
例一证属阴虚火旺，故见盗汗。面赤、唇绛，方用当归六黄汤加减，后加生芪、元参以助益气养阴之功，药证相符，十多年之痼疾，三诊而愈。
例二除合目则汗出外，兼见虚烦难眠，头晕心悸，胃中苦冷等证，因治不得法，而病情迁延。后以益火生土之法，但取和胃理气之品，加意炮制，旨在“以火益火”，又使诸药存其性而变其气，庶期温而不劫阴液，柔而不遏中阳。
例三为春温后继发盗汗，盖温为阳邪，缠绵不愈最易伤阴，王肯堂有“大病后，阴气未复，遗热尚留”而为盗汗之说。故用当归六黄汤滋阴液、降邪火，佐以清润敛汗之品而获良效。
(五十四）无汗症蒋调，男，28岁，初诊日期：1977年7月12日。患者自幼就有汗闭症，暑天烦热难忍，伴有低热，精神疲乏，口干，肢麻甚则作痛，浚多而清。历年来服中西药未效。刻诊：肌肤干燥，脉弦细而数，满舌裂纹、苔剥，体温37．4℃辨证：肺气、肺阴不足，不能宣散皮毛，汗源亦少。治法：益气养阴，清燥润肺。方药：生石膏30克(先煎）玄参12克知母9克鸡苏散30克(包煎）太子参15克生地12克葛根9克山药9克桑白皮12克阿胶9克(烊冲）7月22日
(复诊）：服前药7剂后，皮肤潮湿，有出汗感，其他诸症尽减，脉弦细不数，效不更方，洽从原法，再服7剂。服药14剂后，汗闭症痊愈，暑天炎热汗出溱溱，肌肤湿润，低烧也退。
【评按】无汗症系指暑热之际饮热奔跑，阳气蒸发，当汗不汗之证。有全身无汗。半身无汗或局部无汗之别。多因肺气不足，不能宣散皮毛，汗不得出，或因心肺阴亏，汗源匮乏，无汗可发。若因寒邪束表，卫阳被遏，腠理闭塞，汗不得出，则属邪客为害，又当别论。本案自幼即有汗闭，病发时烦热难忍，伴有低烧，证属肺气虚不能宣散皮毛，因其肺阴不足，汗源匮乏。故为汗闭。方从清燥救肺汤化出，清燥热、补气阴以治其本，佐葛根、薄荷解肌疏表以治其标，标本兼顾，奏效颇速。
(五十五）夜游症
例一姜××，男，42岁。病经四载，1974年因每夜外游，家人务必锁门，经治后夜游已不发作，近倾夜寐惊叫吵闹。辨证：肝火挟痰，蒙闭清窍。治法：豁痰、平肝、通窍。方药：霍香9克龙胆草2克陈胆星9克远志6克僵蚕9克制半夏9克陈皮6克竹茹9克茯苓12克代储石30克桔梗5克生紫菀5克干菖蒲5克另服白金丸90克每晚3克礞石滚痰丸45克每晨1．5克上药加减连服三个月，夜游已三年未再发，一度稍觉头晕，续服温胆汤加杞菊、真珠母、壮蛎、白芍。桑椹子等调治而释。
(《黄一峰医案医话集》）
例二ｘｘｘ，男，27岁，1967年秋初诊。
(其母代诉）十几年来，患者不断在夜晚入睡之后，突然起床，不论冬夏都穿好衣服鞋袜，不言不语，也不开灯，便下床活动。有时扫地，有时擦擦桌椅，别人叫他，他也不答，约10～20分钟，他又脱衣而睡，次日问他，他说未曾起床，日子久了，习以为常，曾诊为梦游症。住在二楼，他一人独居一室，半夜起床后，常常先生火炉，然后开门，拿上桶担，下楼挑水，回来又把门关好，将水倒入缸里，又把铁壶灌满，放在火上，有时随即复睡，有时把水烧开(？），灌热水瓶，从未发现他吃喝过，干起活来轻手轻脚，从不碰撞。所以别人很难发觉，有时问他，仍一无所知。患者自诉，除感经常头晕，有时心烦外，别无不适。但察其神色似有萎靡，表情略呈淡漠，寡语少言，目光无神，从无癫痫发作及癔病史，历经治疗效果不著。舌边、舌尖红而少苔，脉细弦而稍数。辨证：肝阴不足，肾气上逆，火扰心神，伤阴生痰，以致魂不随神而动。治法：养血安神，清热法痰。方药：以酸枣仁汤加减。炒枣仁30克柏子仁15克合欢皮12克夜交藤12克川芎10克知母12克茯神12克生龙骨12克生牡蛎12克朱砂末1．5克(分二次冲）水煎服，5剂。药后复诊，症脉似无改变，原方再进5剂，嘱其家人细为观察。服药10剂后，自述头晕，心烦大减，其母说，夜仍起床活动，但不外出，仍以原方稍变用量，续给5剂。服药后，据称已不每夜起床活动，但过二至三夜仍犯一次。不过时间似短，活动亦少。嘱将上方连服半月。再来复诊。又诊称：经细观察，近一周来，再未犯病，精神较前亦佳，有时还主动找人说话。遂嘱可间日服药：剂，继服10余剂，以巩固疗效。翌年夏季，其母告知患者已十月有余，未再复犯。《杨作楳，《临症录》》
【评按】本症系因经常夜间外出行走、操作，随后仍能入睡，毫不自觉而得名。黄一峰氏认为本症大多属于“癫痫”范畴。由于思虑太过，肝木不得疏泄，肝气被郁，脾气不升，气郁痰结，阻蔽神明而致。或认为系因肝阴不足，肾气上逆，火扰神明，伤阴生痰，以致魂不随神而动。夜间属阴，心神当以守舍而入睡，其所以夜间动作、行步，乃魂亦有所主，并无神昏妄动之意。例一属于前者；例二属于后者，其病机相同之处在于有“痰”。前贤有云“怪病责之于痰”，而怪病之治亦当从治痰入手。例一证属肝火挟痰，蒙蔽清窍，治以豁痰平肝通窍之剂，方用温胆汤加减，神识不清者加白金丸(自矾、郁金)，痰火偏盛者加礞石滚痰丸。
例二源于肝阴不足，龙雷之火升腾，方用酸枣仁汤，养血安神，清热除烦，另加龙骨牡蛎养阴镇逆安神，效果均佳。
三、妇产科病类医寨
(一）月经先期、后期
例一王女，平素经先期，掌心热，阴虚肝热不能藏血也。地黄12克牛膝9克山药9克萸肉9克阿胶9克丹皮9克泽泻9克赤苓9克车前子12克炒续断9克女贞子12克旱莲草15克
(《章次公医案》）
例二李ｘｘ，女，27岁。初诊日期：1972年5月19日。主诉：月经后错、行经腹痛二年余。现病史：1970年底开始月经后错8、9天，色黑紫有血块，经行小腹疼痛，下肢瘦软。结婚1年多未孕，测基础体温为单相型，西医诊断为无排卵性月经，妇科检查，子宫前倾前屈，大小、活动均正常。苔薄白，脉细缓。辨证：血虚肾亏，下焦寒冷。治法：养血补肾，温暖下焦。方药：当归9克炒白芍9克川芎3克熟地12克覆盆12克菟丝子12克山药15克巴戟天9克荔枝核9克7月5日复诊时称：于5～6月间共服上方20剂，6月27日行经，血量增多，基础体温为双相，说明已有排卵现象，月经周期正常，量中等，色正，血块减少，无腹痛。
(《刘奉五妇科经验》）
例三陈××，女，39岁。1973年5月24日初诊。1963年起月经后期，40余天一行，经量涩少，历程三天，伴有凝块，每行经前一、二天自觉寒热，腹痛恶心。现月经逾数天未行，寒热又作，少腹疼痛，腰酸，脉细弦，舌质淡，苔薄白。辨证：厥阴气滞，寒温不化，营卫不调。治法：和血调营。方药：毛柴胡4．5克小桂枝6克
(后入）枯黄芩6克泡吴萸4．5克北干姜4石克香藁本6克元胡索9克煮半夏9克秦当归6克(后入）川芎6克淡茯苓12克京丹参12克。次诊：服3剂后，于5月30日月经来潮，量中等，未见寒热，今值经行第三天，少腹微痛，舌脉如上。上方加苏梗4．5克，香附9克，服3剂后，观察三个月，经期均无寒热发作。
(《孙浩铭妇科临床经验》）
【评按】月经先期多热，后期多寒。热证以清热凉血为主，寒证以温经为大法。
例一月经先期，章氏抓住“掌心热”的症候特点，诊为阴虚肝热，故治以滋阴补肝法。
例二为月经后期，常错后八九天而经色黑紫、有血块，西医诊为无排卵性月经。刘氏诊为血虚肾亏，下焦虚寒，治以养血补肾，温暖下焦法。方治标本兼顾，最后获得月经期正常
(有排卵）的满意效果。
例三月经后期兼有寒热，少腹痛，腰酸，诊为厥阴气滞，寒湿不化，营卫不调。治以和血调营，温寒行气。其方治即滑伯仁所说的“辛散苦温血药”对经行愆期和经前、经行寒热均有良效。清·宝辉认为：用行气药于散寒方中，其效倍捷(见《医医小草》）。从例三的治效，大致可以看到这个学术理论的实践性。
(二）痛经
例一林氏，20岁。据云每月经胱，预先胸骨、乳房胀痛，胃呆作呕，纳食不进。经将至，则小腹发剧烈疼痛，面唇脱色。病已三年，经中西医诊治未效。授以行气化瘀法。当归6克白芍6克香附6克延胡6克青皮3克乌药4·5克柴胡3克川楝6克丹参9克桃仁6克牛膝6克嘱于月经前七日，服药至行经时，诸疼如失……。
(《刘铁庵医案》）
例二蔡女正值经行，骤逢拂逆，从此经少而少腹胀痛。古人谓木不条达，正对此等症候而言。全当归9克白芍9克丹参9克柴胡9克云苓12克薄荷尖3克(后下）甘草2．1克生姜3片另：五灵脂、香附、莪术、肉桂各6克研未，每服1.5克。
(《章次公医案》）
【评按】：痛经以月经前后或行经中少腹部疼痛伴有腰酸痛为主症，临床又以气滞血瘀为常见病理。另有寒湿凝滞，气血虚弱，肝肾亏损等情况，须根据不同的病闺、病理确立治法。
例一为气血瘀滞，肝气郁结，治以行气化瘀疏肝法，是痛经较常见类型的一种治法。
例二以“木不条达”为主要病机，治以逍遥散合当归芍药散加减以疏肝调经养血，另以四药研未配合治疗，有温经法瘀之功，是为章氏的经验方，此案治法对读者权衡临证用药，颇有启发。
(三)经闭
例一：患者祝某某，男性，58岁。十多年来，每晚入睡后出汗（盗汗），身体强壮，面色红赤，嘴唇深红，脉搏快，相火容易妄动，阳气经常处于勃起状态。处方：当归9克、熟地黄30克、生地黄15克、黄柏9克、黄芩9克、黄连1.5克、玄参9克。服用7剂。二诊：服用前方第一剂后，盗汗即止，但出现咳嗽、痰多症状，在前方基础上加黄芪9克、玄参9克，再服7剂。三诊：阅读时流泪，面部仍然发红，因过度疲劳，出现一次盗汗。处方：当归9克、熟地黄30克、生地黄15克、白芍9克、黄芩9克、黄芪9克、黄连1.5克、牡蛎15克、望江南9克、黄柏9克。服用七剂后，汗止，停止诊治。
（姜春华医案，《中医杂志》4:56，1959）
例二：患者张某某，女性，51岁，初诊日期：1963年3月6日。胃中感觉寒冷，时常吐出清稀涎沫，头晕，心悸，口干，心中虚烦难以入睡，闭眼则出汗，小便热且颜色深红、排尿不畅，大便从昨天起未通。舌质深红无苔，脉象虚弦而细数。初拟苦辛甘合化治法，以半夏泻心汤为主方进行加减，诊治三次，改用加减法液汤，均未见效。3月12日，各种症状依旧。至此，大便已五天未通，且因连续盗汗，精神更加疲惫。仔细辨别其脉象和舌象，脉象虽然细数，但重按无力；舌象虽然深红无苔，但滑润而不干燥，口虽燥，但只想含水漱口而不想咽下。由此领悟此证乃是龙雷之火不安于其位，虚火浮越，真火衰微。因为虚火妄动，所以口干、舌质深红、脉数；因为真火衰微，中焦脾胃失于温煦，饮食水谷不能化为津液而成痰水为害，因此胃中感觉寒冷，时常吐出清稀涎沫。盗汗不止的原因，是脾虚导致营卫失调。头晕、心悸、心中虚烦难以入睡，一方面是因为脾失转输功能，精微物质供应不足；另一方面是因为出汗过多，营阴不足，相火妄动。小便赤红、便秘，是因为津液内竭，无法向下输布所致。种种见证，均由脾胃失职所致。此时此证，首要任务是培补脾胃（土），尤其需要益火（补肾阳）。无奈病情已持续一个月，进食少、出汗多，不仅阳气微弱，而且阴液亏损。如果使用辛温药物则会损伤阴液，如果使用滋润药物又会阻碍阳气。拟定只取和胃理脾的药物，并特别加以炮制，意在“以火益火”，又使诸药保留其本性而改变其气性，期望达到温补而不劫夺阴液，柔润而不遏制中阳的效果。炒白术9克、炒淮山药9克、炒黑扁豆9克、山楂炭9克、半夏6克、姜炭6克、左金丸6克（送服）。3月13日，口中吐出清稀涎沫的症状消除，其他症状随之减轻。唯独大便仍未通畅。继续遵循前法，去掉温涩的药物，加入温润的药物。前方去掉山楂炭、姜炭，加入炒麦门冬12克、熟地炭9克。3月14日：汗止，大便通畅，口干、心悸并除，再次按照前意处方，服用2剂后病情安定。
（俞长荣：《益火生土法则的认识与实践》，《中医杂志》11:25，1964）
例三：患者田某某，男性，35岁，初诊日期：1964年3月10日。患春温病卧床已半个月，病情已转入痊愈阶段，神志已清醒，呛咳已减轻，胃纳已现增进，惟早晚体温相差很大，呈峻峭的体温曲线，每夜仍在39℃左右，睡中大汗如浴，衣被全湿，醒后头目昏眩，困倦不支，经注射解热敛汗剂，均无效，脉数大无力，舌色红而干燥，口渴思饮。方药：当归身9克、生地黄12克、熟地黄12克、炒川连6克、炒黄芩6克、炒黄柏6克、炙黄芪15克、天花粉9克、麦门冬9克、麻黄根6克、五味子3克、生龙骨9克、生牡蛎9克。服用5剂，热退汗止，继用导功散加炙黄芪、山药、石斛、谷芽、糯稻根等，调理数日而安。
（裴慎：《用当归六黄汤加减治愈盗汗的体会》，《江西医药杂志》5(6):852，1965）
【评按】盗汗是常见的汗证之一。《内经》称为“寝汗”。《金匮要略》说：“男子平人，脉虚弱细微者，喜盗汗也。”盗汗是指入睡则汗出，醒后即止。多属虚劳之证，尤以阴虚者多见，或可因肝热、阴火所致。
例一证属阴虚火旺，故见盗汗。面赤、唇绛，方用当归六黄汤加减，后加生黄芪、玄参以助益气养阴之功，药证相符，十多年之痼疾，三诊而愈。
例二除闭眼则汗出外，兼见虚烦难眠，头晕心悸，胃中苦冷等证，因治不得法，而病情迁延。后以益火生土之法，但取和胃理气之品，加意炮制，旨在“以火益火”，又使诸药存其性而变其气，庶期温而不劫阴液，柔而不遏中阳。
例三为春温后继发盗汗，盖温为阳邪，缠绵不愈最易伤阴，王肯堂有“大病后，阴气未复，遗热尚留”而为盗汗之说。故用当归六黄汤滋阴液、降邪火，佐以清润敛汗之品而获良效。
(五十四) 无汗症：患者蒋调，男性，28岁，初诊日期：1977年7月12日。患者自幼就有汗闭症，暑天烦热难忍，伴有低热，精神疲乏，口干，肢麻甚则作痛，尿多而清。历年来服中西药未效。刻诊：肌肤干燥，脉弦细而数，满舌裂纹、苔剥，体温37.4℃。辨证：肺气、肺阴不足，不能宣散皮毛，汗源亦少。治法：益气养阴，清燥润肺。方药：生石膏30克（先煎）、玄参12克、知母9克、鸡苏散30克（包煎）、太子参15克、生地12克、葛根9克、山药9克、桑白皮12克、阿胶9克（烊冲）。7月22日复诊：服前药7剂后，皮肤潮湿，有出汗感，其他诸症尽减，脉弦细不数，效不更方，仍从原法，再服7剂。服药14剂后，汗闭症痊愈，暑天炎热汗出溱溱，肌肤湿润，低烧也退。
【评按】无汗症系指暑热之际饮热奔跑，阳气蒸发，当汗不汗之证。有全身无汗、半身无汗或局部无汗之别。多因肺气不足，不能宣散皮毛，汗不得出，或因心肺阴亏，汗源匮乏，无汗可发。若因寒邪束表，卫阳被遏，腠理闭塞，汗不得出，则属邪客为害，又当别论。本案自幼即有汗闭，病发时烦热难忍，伴有低烧，证属肺气虚不能宣散皮毛，因其肺阴不足，汗源匮乏。故为汗闭。方从清燥救肺汤化出，清燥热、补气阴以治其本，佐葛根、薄荷解肌疏表以治其标，标本兼顾，奏效颇速。
(五十五) 夜游症
例一：患者姜某某，男性，42岁。病经四载，1974年因每夜外游，家人务必锁门，经治后夜游已不发作，近顷夜寐惊叫吵闹。辨证：肝火挟痰，蒙闭清窍。治法：豁痰、平肝、通窍。方药：藿香9克、龙胆草2克、陈胆星9克、远志6克、僵蚕9克、制半夏9克、陈皮6克、竹茹9克、茯苓12克、代赭石30克、桔梗5克、生紫菀5克、干菖蒲5克。另服白金丸90克，每晚3克；礞石滚痰丸45克，每晨1.5克。上药加减连服三个月，夜游已三年未再发，一度稍觉头晕，续服温胆汤加杞菊、真珠母、牡蛎、白芍、桑椹子等调治而释。
（《黄一峰医案医话集》）
例二：患者XXX，男性，27岁，1967年秋初诊。
（其母代诉）十几年来，患者不断在夜晚入睡之后，突然起床，不论冬夏都穿好衣服鞋袜，不言不语，也不开灯，便下床活动。有时扫地，有时擦擦桌椅，别人叫他，他也不答，约10～20分钟，他又脱衣而睡，次日问他，他说未曾起床，日子久了，习以为常，曾诊为梦游症。住在二楼，他一人独居一室，半夜起床后，常常先生火炉，然后开门，拿上桶担，下楼挑水，回来又把门关好，将水倒入缸里，又把铁壶灌满，放在火上，有时随即复睡，有时把水烧开，灌热水瓶，从未发现他吃喝过，干起活来轻手轻脚，从不碰撞。所以别人很难发觉，有时问他，仍一无所知。患者自诉，除感经常头晕，有时心烦外，别无不适。但察其神色似有萎靡，表情略呈淡漠，寡语少言，目光无神，从无癫痫发作及癔病史，历经治疗效果不著。舌边、舌尖红而少苔，脉细弦而稍数。辨证：肝阴不足，肾气上逆，火扰心神，伤阴生痰，以致魂不随神而动。治法：养血安神，清热化痰。方药：以酸枣仁汤加减。炒枣仁30克、柏子仁15克、合欢皮12克、夜交藤12克、川芎10克、知母12克、茯神12克、生龙骨12克、生牡蛎12克、朱砂末1.5克（分二次冲）。水煎服，5剂。药后复诊，症脉似无改变，原方再进5剂，嘱其家人细为观察。服药10剂后，自述头晕，心烦大减，其母说，夜仍起床活动，但不外出，仍以原方稍变用量，续给5剂。服药后，据称已不每夜起床活动，但过二至三夜仍犯一次。不过时间似短，活动亦少。嘱将上方连服半月。再来复诊。又诊称：经细观察，近一周来，再未犯病，精神较前亦佳，有时还主动找人说话。遂嘱可间日服药1剂，继服10余剂，以巩固疗效。翌年夏季，其母告知患者已十月有余，未再复犯。（杨作楳：《临症录》）
【评按】本症系因经常夜间外出行走、操作，随后仍能入睡，毫不自觉而得名。黄一峰氏认为本症大多属于“癫痫”范畴。由于思虑太过，肝木不得疏泄，肝气被郁，脾气不升，气郁痰结，阻蔽神明而致。或认为系因肝阴不足，肾气上逆，火扰神明，伤阴生痰，以致魂不随神而动。夜间属阴，心神当以守舍而入睡，其所以夜间动作、行步，乃魂亦有所主，并无神昏妄动之意。例一属于前者；例二属于后者，其病机相同之处在于有“痰”。前贤有云“怪病责之于痰”，而怪病之治亦当从治痰入手。例一证属肝火挟痰，蒙蔽清窍，治以豁痰平肝通窍之剂，方用温胆汤加减，神识不清者加白金丸（白矾、郁金），痰火偏盛者加礞石滚痰丸。
例二源于肝阴不足，龙雷之火升腾，方用酸枣仁汤，养血安神，清热除烦，另加龙骨牡蛎养阴镇逆安神，效果均佳。
三、妇产科病类医案
(一) 月经先期、后期
例一：王某，平素月经先期，掌心热，阴虚肝热不能藏血也。处方：地黄12克、牛膝9克、山药9克、萸肉9克、阿胶9克、丹皮9克、泽泻9克、赤苓9克、车前子12克、炒续断9克、女贞子12克、旱莲草15克。
（《章次公医案》）
例二：患者李某某，女性，27岁。初诊日期：1972年5月19日。主诉：月经后错、行经腹痛二年余。现病史：1970年底开始月经后错8、9天，色黑紫有血块，经行小腹疼痛，下肢瘦软。结婚1年多未孕，测基础体温为单相型，西医诊断为无排卵性月经，妇科检查，子宫前倾前屈，大小、活动均正常。苔薄白，脉细缓。辨证：血虚肾亏，下焦寒冷。治法：养血补肾，温暖下焦。方药：当归9克、炒白芍9克、川芎3克、熟地12克、覆盆子12克、菟丝子12克、山药15克、巴戟天9克、荔枝核9克。7月5日复诊时称：于5～6月间共服上方20剂，6月27日行经，血量增多，基础体温为双相，说明已有排卵现象，月经周期正常，量中等，色正，血块减少，无腹痛。
（《刘奉五妇科经验》）
例三：患者陈某某，女性，39岁。1973年5月24日初诊。1963年起月经后期，40余天一行，经量涩少，历程三天，伴有凝块，每行经前一、二天自觉寒热，腹痛恶心。现月经逾数天未行，寒热又作，少腹疼痛，腰酸，脉细弦，舌质淡，苔薄白。辨证：厥阴气滞，寒温不化，营卫不调。治法：和血调营。方药：毛柴胡4.5克、小桂枝6克（后入）、枯黄芩6克、泡吴茱萸4.5克、北干姜4.5克、香藁本6克、元胡索9克、煮半夏9克、秦当归6克（后入）、川芎6克、淡茯苓12克、京丹参12克。次诊：服3剂后，于5月30日月经来潮，量中等，未见寒热，今值经行第三天，少腹微痛，舌脉如上。上方加苏梗4.5克，香附9克，服3剂后，观察三个月，经期均无寒热发作。
（《孙浩铭妇科临床经验》）
【评按】月经先期多热，后期多寒。热证以清热凉血为主，寒证以温经为大法。
例一月经先期，章氏抓住“掌心热”的症候特点，诊为阴虚肝热，故治以滋阴补肝法。
例二为月经后期，常错后八九天而经色黑紫、有血块，西医诊为无排卵性月经。刘氏诊为血虚肾亏，下焦虚寒，治以养血补肾，温暖下焦法。方治标本兼顾，最后获得月经期正常（有排卵）的满意效果。
例三月经后期兼有寒热，少腹痛，腰酸，诊为厥阴气滞，寒湿不化，营卫不调。治以和血调营，温寒行气。其方治即滑伯仁所说的“辛散苦温血药”对经行愆期和经前、经行寒热均有良效。清·宝辉认为：用行气药于散寒方中，其效倍捷（见《医医小草》）。从例三的治效，大致可以看到这个学术理论的实践性。
(二) 痛经
例一：林氏，20岁。据云每月经前，预先胸骨、乳房胀痛，胃呆作呕，纳食不进。经将至，则小腹发剧烈疼痛，面唇脱色。病已三年，经中西医诊治未效。授以行气化瘀法。处方：当归6克、白芍6克、香附6克、延胡6克、青皮3克、乌药4.5克、柴胡3克、川楝6克、丹参9克、桃仁6克、牛膝6克。嘱于月经前七日，服药至行经时，诸疼如失……。
（《刘铁庵医案》）
例二：蔡女正值经行，骤逢拂逆，从此经少而少腹胀痛。古人谓木不条达，正对此等症候而言。处方：全当归9克、白芍9克、丹参9克、柴胡9克、云苓12克、薄荷尖3克（后下）、甘草2.1克、生姜3片。另：五灵脂、香附、莪术、肉桂各6克研末，每服1.5克。
（《章次公医案》）
【评按】：痛经以月经前后或行经中少腹部疼痛伴有腰酸痛为主症，临床又以气滞血瘀为常见病理。另有寒湿凝滞，气血虚弱，肝肾亏损等情况，须根据不同的病因、病理确立治法。
例一为气血瘀滞，肝气郁结，治以行气化瘀疏肝法，是痛经较常见类型的一种治法。
例二以“木不条达”为主要病机，治以逍遥散合当归芍药散加减以疏肝调经养血，另以四药研末配合治疗，有温经化瘀之功，是为章氏的经验方，此案治法对读者权衡临证用药，颇有启发。
(三) 经闭
Case 1: Patient Zhu XX, male, 58 years old. For over ten years, he has experienced night sweats (night sweats) every night while sleeping. His physique is strong, his face is red, his lips are dark red, his pulse is rapid, the ministerial fire (Ministerial Fire) tends to move easily, and his yang qi is often in a state of erection. Prescription: Danggui (Angelicae Sinensis Radix) 9g, Shudi (Rehmanniae Radix Preparata) 30g, Shengdi (Rehmanniae Radix) 15g, Huangbai (Phellodendri Cortex) 9g, Huangqin (Scutellariae Radix) 9g, Huanglian (Coptidis Rhizoma) 1.5g, Xuanshen (Scrophulariae Radix) 9g. Taken for 7 doses. Second visit: After taking the first dose of the previous prescription, the night sweats stopped immediately, but coughing and excessive phlegm appeared. Astragali Radix (Huangqi) 9g and Scrophulariae Radix (Xuanshen) 9g were added to the previous prescription, taken for another 7 doses. Third visit: Tears flowed when reading, the face remained red, and due to overexertion, one episode of night sweats occurred. Prescription: Danggui (Angelicae Sinensis Radix) 9g, Shudi (Rehmanniae Radix Preparata) 30g, Shengdi (Rehmanniae Radix) 15g, Baishao (Paeoniae Radix Alba) 9g, Huangqin (Scutellariae Radix) 9g, Huangqi (Astragali Radix) 9g, Huanglian (Coptidis Rhizoma) 1.5g, Muli (Ostreae Concha) 15g, Wangjiangnan (Gardeniae Fructus) 9g, Huangbai (Phellodendri Cortex) 9g. After taking seven doses, the sweating stopped, and treatment was discontinued.
(Case by Jiang Chunhua, "Journal of Traditional Chinese Medicine" 4:56, 1959)
Case 2: Patient Zhang XX, female, 51 years old, first visit date: March 6, 1963. She felt coldness in the stomach, frequently spat clear saliva, suffered from dizziness and palpitations, had dry mouth, felt empty irritability and difficulty sleeping, sweated upon closing her eyes, had hot and dark-red urine with difficult urination, and had not had a bowel movement since yesterday. The tongue was deep red without coating, and the pulse was deficient, wiry, thready, and rapid. Initially, the bitter-pungent-sweet harmonization method was proposed, using Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium) as the main formula with modifications. After three treatments and switching to a modified Faye Tang (Method Fluid Decoction), there was no effect. On March 12, all symptoms persisted. By then, she had not had a bowel movement for five days, and due to continuous night sweats, her spirit was even more exhausted. Carefully analyzing her pulse and tongue, although the pulse was thready and rapid, it lacked root upon heavy pressure; although the tongue was deep red without coating, it was slippery and moist, not dry; although her mouth was dry, she only wanted to rinse with water without swallowing. It was realized that this condition was caused by the Dragon-Lei Fire (Fire of the Kidney and Liver) being unsettled in its position, with deficient fire floating upward and true fire being weak. Because of the reckless movement of deficient fire, there was dry mouth, deep red tongue, and rapid pulse; because of the weakness of true fire, the middle jiao (Spleen and Stomach) lost warmth, causing food and fluids to fail to transform into body fluids, instead forming phlegm and water which became harmful, hence the feeling of coldness in the stomach and frequent spitting of clear saliva. The reason for persistent night sweats was spleen deficiency leading to disharmony between Ying (Nutritive) and Wei (Defensive) Qi. Dizziness, palpitations, empty irritability, and difficulty sleeping were due to two reasons: first, the Spleen failed to transport and transform, leading to insufficient supply of essence; second, excessive sweating led to insufficiency of Ying Yin (Nutritive Yin) and reckless movement of ministerial fire. Dark-red urine and constipation were due to the exhaustion of internal body fluids failing to flow downward. All these manifestations resulted from the dysfunction of the Spleen and Stomach. At this stage, the priority was to cultivate the Earth (Spleen/Stomach), especially to benefit the Fire (Kidney Yang). Unfortunately, the illness had lasted for a month, with poor appetite and excessive sweating, indicating not only weak Yang but also depleted fluids. If pungent-warm herbs were used, Yin would be damaged; if moistening herbs were used, Yang would be obstructed. It was decided to use only herbs that harmonize the Stomach and regulate the Spleen, specially processed, aiming to "benefit Fire with Fire," allowing the herbs to retain their nature while changing their qi, hoping to achieve warming without depleting Yin fluids and softening without obstructing Middle Yang. Stir-fried Atractylodis Macrocephalae Rhizoma (Baizhu) 9g, stir-fried Dioscoreae Hypoglaucae Rhizoma (Huai Shanyao) 9g, charred black Euryales Semen (Bian Dou) 9g, Hawthorn Charcoal (Shanzha Tan) 9g, Pinelliae Tuber (Banxia) 6g, Ginger Charcoal (Jiang Tan) 6g, Zuojin Wan (Left Metal Pill) 6g (taken with water). On March 13, the symptom of spitting clear saliva disappeared, and other symptoms decreased accordingly. Only the constipation remained. Continuing the previous method, astringent-warm herbs were removed, and moistening-warm herbs were added. From the previous formula, Hawthorn Charcoal and Ginger Charcoal were removed, and stir-fried Ophiopogonis Tuber (Maimendong) 12g and Rehmanniae Radix Preparata Charcoal (Shudi Tan) 9g were added. On March 14: Sweating stopped, bowel movement resumed, dry mouth and palpitations were eliminated. Prescribing again according to the previous intent, after taking 2 doses, the condition stabilized.
(Yu Changrong: "Understanding and Practice of the Principle of Benefiting Fire to Generate Earth," "Journal of Traditional Chinese Medicine" 11:25, 1964)
Case 3: Patient Tian XX, male, 35 years old, first visit date: March 10, 1964. He had been bedridden with Spring-Warmth disease for half a month. The condition had entered the recovery stage, consciousness was clear, choking cough had decreased, and appetite was improving. However, there was a large difference between morning and evening temperatures, forming a steep temperature curve, staying around 39°C every night. During sleep, he sweated profusely like bathing, wetting clothes and bedding completely. Upon waking, he felt dizzy and exhausted. Injections of antipyretic and antiperspirant agents were ineffective. The pulse was rapid, large, and forceless; the tongue was red and dry, with thirst and desire to drink. Formula: Dangguishen (Radix Angelicae Sinensis Stem) 9g, Shengdihuang (Rehmanniae Radix) 12g, Shudihuang (Rehmanniae Radix Preparata) 12g, Chuanlian (Coptidis Rhizoma) 6g, Huangqin (Scutellariae Radix) 6g, Huangbai (Phellodendri Cortex) 6g, Zhi Huangqi (Prepared Astragali Radix) 15g, Tianhuafen (Trichosanthis Radix) 9g, Maimendong (Ophiopogonis Tuber) 9g, Mahuanggen (Ephedrae Radix et Rhizoma) 6g, Wuweizi (Schisandrae Chinensis Fructus) 3g, Sheng Longgu (Fossilia Ossis Mastodi) 9g, Sheng Muli (Ostreae Concha) 9g. Taken for 5 doses, fever subsided, sweating stopped. Subsequently, Dao Gong San (Guide Out Exhaustion Powder) was used with additions of Zhi Huangqi, Shanyao, Shihu, Guya, and Nuodaogen for several days until stability was achieved.
(Pei Shen: "Experience in Treating Night Sweats with Modified Danggui Liu Huang Tang," "Jiangxi Medical Journal" 5(6):852, 1965)
[Commentary] Night sweats are one of the common sweating disorders. The *Neijing* calls it "Qin Han" (sweat during sleep). The *Jingui Yaolue* states: "In men who appear normal, if the pulse is weak, fine, and subtle, they are prone to night sweats." Night sweats refer to sweating during sleep and stopping upon waking. They mostly belong to deficiency consumptive diseases, especially common in Yin deficiency, or can be caused by Liver heat or Yin fire.
Case 1 belongs to Yin deficiency with hyperactive fire, hence night sweats. Red face and dark red lips indicate the need for Danggui Liu Huang Tang (Danggui Six-Huang Decoction) with modifications. Later, Sheng Huangqi (Raw Astragali Radix) and Xuanshen (Scrophulariae Radix) were added to assist in benefiting Qi and nourishing Yin. The prescription matched the syndrome, curing a decade-long chronic disease in three visits.
Case 2, besides sweating upon closing eyes, included empty irritability, difficulty sleeping, dizziness, palpitations, and cold sensation in the stomach. Due to improper treatment, the condition dragged on. Later, the method of benefiting Fire to generate Earth was used, selecting herbs to harmonize the Stomach and regulate Qi, carefully processed, aiming to "benefit Fire with Fire," allowing herbs to retain their nature while changing their qi, hoping to warm without depleting Yin fluids and soften without obstructing Middle Yang.
Case 3 is night sweats secondary to Spring-Warmth. Warmth is a Yang pathogen, and lingering illness easily damages Yin. Wang Kentang stated that "after severe illness, if Yin Qi has not recovered and residual heat remains, night sweats occur." Therefore, Danggui Liu Huang Tang was used to nourish Yin fluids and descend pathogenic fire, assisted by clearing, moistening, and astringent herbs, achieving good results.
(Fifty-four) Anhidrosis: Patient Jiang Diao, male, 28 years old, first visit date: July 12, 1977. The patient had congenital anhidrosis since childhood. In summer, he endured unbearable heat, accompanied by low-grade fever, mental fatigue, dry mouth, limb numbness or pain, and frequent clear urination. Western and Chinese medicines taken over the years were ineffective. Current examination: dry skin, wiry-thready-rapid pulse, cracked tongue surface with peeling coating, body temperature 37.4°C. Syndrome Differentiation: Deficiency of Lung Qi and Lung Yin, inability to disperse through skin and hair, insufficient source of sweat. Treatment Method: Benefit Qi and nourish Yin, clear dryness and moisten Lungs. Formula: Sheng Shigao (Prepared Gypsum Fibrosum) 30g (decocted first), Xuanshen (Scrophulariae Radix) 12g, Zhimu (Anemarrhenae Rhizoma) 9g, Jisu San (Chicken Su Powder) 30g (wrapped and decocted), Taizishen (Pseudostellariae Radix) 15g, Shengdi (Rehmanniae Radix) 12g, Gegen (Puerariae Lobatae Radix) 9g, Shanyao (Dioscoreae Rhizoma) 9g, Sangbaipi (Mori Cortex) 12g, Ejiao (Colla Corii Asini) 9g (melted and mixed). July 22 Follow-up: After taking 7 doses of the previous medicine, the skin became moist, with a sensation of sweating, and other symptoms decreased significantly. The pulse was wiry-thready but not rapid. Since effective, do not change the formula; continue the original method for another 7 doses. After taking 14 doses, anhidrosis was cured. In hot summer weather, he sweated profusely, skin was moist, and low-grade fever subsided.
(Case by Jin Shoushan from "Selected Experiences of Old TCM Doctors in Shanghai," compiled by Zhang Yuping et al.)
[Commentary] Anhidrosis refers to the condition where, during summer heat, despite sweating efforts, sweat does not come out. It can be generalized, hemibody, or local. It is mostly due to insufficient Lung Qi failing to disperse through skin and hair, preventing sweat release, or Heart-Lung Yin deficiency leading to lack of sweat source. If caused by Cold pathogen binding the exterior, suppressing Wei Yang, and closing pores, it is considered pathogenic invasion and should be treated differently. This case involves congenital anhidrosis. When symptomatic, unbearable heat and low-grade fever occur, indicating Lung Qi deficiency failing to disperse through skin and hair, and Lung Yin deficiency leading to lack of sweat source. Hence, anhidrosis. The formula is derived from Qingzao Jiufei Tang (Clear Dryness Rescue Lung Decoction), clearing dryness-heat and benefiting Qi-Yin to treat the root, assisted by Gegen and Bohe to resolve muscle layer and vent the exterior to treat the branch, addressing both root and branch, achieving rapid results.
(Fifty-five) Sleepwalking
Case 1: Patient Jiang XX, male, 42 years old. Illness duration four years. In 1974, due to nightly wandering outside, family members had to lock doors. After treatment, sleepwalking ceased, but recently he screams and makes noise during sleep. Syndrome Differentiation: Liver Fire carrying Phlegm, clouding the clear orifices. Treatment Method: Resolve Phlegm, calm Liver, open orifices. Formula: Huoxiang (Agastaches Herba) 9g, Longdancao (Gentianae Radix et Rhizoma) 2g, Chen Danning (Aged Arisaematica Cum Bile) 9g, Yuanzhi (Polygalae Radix) 6g, Jiangcan (Bombyx Batryticatus) 9g, Zhi Banxia (Prepared Pinelliae Tuber) 9g, Chenpi (Citri Reticulatae Pericarpium) 6g, Zhuru (Bambusae Caulis in Taeniam) 9g, Fuling (Poria) 12g, Daizheshi (Haematitum) 30g, Jiegeng (Platycodonis Radix) 5g, Sheng Zi'ou (Asteris Radix) 5g, Gan Changpu (Acori Tatarinowii Rhizoma) 5g. Additionally take Baijin Wan (White Gold Pill) 90g, 3g nightly; Mengshi Gun Tan Wan (Mengshi Rolling Phlegm Pill) 45g, 1.5g every morning. With modifications, taken continuously for three months. Sleepwalking did not recur for three years. Once experiencing slight dizziness, Wen Dan Tang (Warm Gallbladder Decoction) was continued with additions of Qiju (Lycium and Chrysanthemum), Zhenzhumu (Pearl Mother), Muli (Oyster Shell), Baishao (White Peony Root), Sangshenz (Mulberry Fruit), etc., for regulation until resolution.
(Cases and Conversations of Huang Yifeng)
Case 2: Patient XXX, male, 27 years old, first visit in Autumn 1967.
(Mother reported) For over ten years, the patient suddenly gets up after falling asleep at night, wearing clothes and shoes regardless of season, speaking neither words nor sounds, not turning on lights, and getting out of bed to move around. Sometimes sweeping, sometimes wiping tables and chairs. When others call him, he does not respond. After about 10-20 minutes, he takes off clothes and sleeps. The next day, when asked, he says he did not get up. Over time, it became habitual, diagnosed as somnambulism. Living on the second floor, living alone, after getting up at midnight, he often starts a stove, opens the door, takes bucket and pole, goes downstairs to carry water, returns, closes the door, pours water into the vat, fills the iron kettle, places it on the fire. Sometimes he goes back to sleep immediately, sometimes boils water, fills hot water bottles. Never seen eating or drinking. Moves lightly, never colliding. Thus, others rarely notice. When asked, he knows nothing. Patient reports only frequent dizziness and occasional irritability, no other discomfort. Observation shows listless expression, slightly indifferent demeanor, few words, dull eyes. No history of epilepsy or hysteria. Previous treatments ineffective. Tongue edges and tip red with scant coating, pulse thready-wiry and slightly rapid. Syndrome Differentiation: Liver Yin deficiency, Kidney Qi rebellion, Fire disturbing Heart Spirit, damaging Yin generating Phlegm, causing Hun (Ethereal Soul) to not follow Shen (Spirit). Treatment Method: Nourish Blood and calm Spirit, clear Heat and resolve Phlegm. Formula: Modified Suanzaoren Tang (Ziziphus Seed Decoction). Chao Zaoren (Stir-fried Ziziphus Seed) 30g, Bairen (Biota Seed) 15g, Hehuanpi (Albizia Bark) 12g, Yejiaoteng (Polygonum Multiflorum Vine) 12g, Chuanxiong (Ligusticum Rhizome) 10g, Zhimu (Anemarrhenae Rhizoma) 12g, Fushen (Poria with Hostwood) 12g, Sheng Longgu (Fossilized Bone) 12g, Sheng Muli (Oyster Shell) 12g, Zhusha Mo (Cinnabar Powder) 1.5g (divided into two doses, mixed in). Decocted in water, 5 doses. Follow-up after medication: Symptoms and pulse seemed unchanged. Continue original formula for another 5 doses, instruct family to observe carefully. After 10 doses, patient reports significant reduction in dizziness and irritability. Mother says he still gets up at night but does not go out. Same formula with slight dosage changes, given for another 5 doses. After medication, reportedly no longer gets up every night, but relapses once every two to three nights. Time seems shorter, activity less. Instruct to continue above formula for half a month. Come for follow-up. Next visit: Careful observation shows no relapse in the past week, spirit better than before, sometimes initiates conversation. Instruct to take medicine every other day, continue for over 10 doses to consolidate efficacy. Next summer, mother informed that patient had not relapsed for over ten months. (Yang Zuomei: "Clinical Records")
[Commentary] This syndrome is named so because the patient frequently walks and operates at night, then falls asleep again without awareness. Huang Yifeng believes this syndrome mostly belongs to the category of "epilepsy." Due to excessive thinking, Liver Wood cannot be freely diffused, Liver Qi becomes depressed, Spleen Qi fails to ascend, Qi stagnation generates Phlegm accumulation, blocking the Spirit and causing disturbance. Or it is believed to be due to Liver Yin deficiency, Kidney Qi rebellion, Fire disturbing Spirit, damaging Yin generating Phlegm, causing Hun to not follow Shen. Night belongs to Yin, Heart Spirit should stay in residence to sleep. The reason for nighttime actions and walking is that Hun also has its master, without loss of consciousness or wild movement. Case 1 belongs to the former; Case 2 belongs to the latter. Their pathogenesis shares the presence of "Phlegm." Ancients said "Strange diseases are blamed on Phlegm," and treatment of strange diseases should start with resolving Phlegm. Case 1 belongs to Liver Fire carrying Phlegm, clouding clear orifices, treated with Phlegm-resolving, Liver-calming, orifice-opening agents, using Wen Dan Tang with modifications. For unclear consciousness, add Baijin Wan (Bai Fan, Yu Jin); for excess Phlegm-Fire, add Mengshi Gun Tan Wan.
Case 2 originates from Liver Yin deficiency, with Dragon-Lei Fire rising. Suanzaoren Tang is used to nourish Blood and calm Spirit, clear Heat and relieve irritability, plus Longgu and Muli to nourish Yin, suppress rebellion, and calm Spirit, achieving good results.
III. Obstetrics and Gynecology Cases
(I) Early and Late Menstruation
Case 1: Ms. Wang usually has early menstruation, hot palms, Yin deficiency with Liver Heat unable to store Blood. Prescription: Dihuang (Rehmanniae Radix) 12g, Niuxi (Achyranthis Bidentatae Radix) 9g, Shanyao (Dioscoreae Rhizoma) 9g, Yurou (Corni Fructus) 9g, Ejiao (Colla Corii Asini) 9g, Danpi (Moutan Cortex) 9g, Zexie (Alismatis Rhizoma) 9g, Chiling (Poria with Coir) 9g, Cheqianzi (Plantaginis Semen) 12g, Chao Xuduan (Prepared Dipsaci Radix) 9g, Nvzhenzi (Ligustri Lucidi Fructus) 12g, Hanliancao (Ecliptae Herba) 15g.
(Cases of Zhang Cigong)
Case 2: Patient Li XX, female, 27 years old. First visit date: May 19, 1972. Chief Complaint: Delayed menstruation and dysmenorrhea for over two years. History of Present Illness: Starting late 1970, menstruation delayed by 8-9 days, color dark purple with blood clots, lower abdominal pain during menstruation, weak lower limbs. Married for over one year, unsuccessful in pregnancy. Basal body temperature measured as monophasic type. Western diagnosis: Anovulatory menstruation. Gynecological examination: Uterus anteverted and anteflexed, size and mobility normal. Coating thin white, pulse thready and slow. Syndrome Differentiation: Blood deficiency and Kidney depletion, Cold in Lower Jiao. Treatment Method: Nourish Blood and tonify Kidney, warm Lower Jiao. Formula: Danggui (Angelicae Sinensis Radix) 9g, Chao Baishao (Stir-fried Paeoniae Radix Alba) 9g, Chuanxiong (Ligustici Rhizoma) 3g, Shudi (Rehmanniae Radix Preparata) 12g, Fupenzi (Rubiae Fructus) 12g, Tusizi (Cuscutae Semen) 12g, Shanyao (Dioscoreae Rhizoma) 15g, Bajitian (Morindae Officinalis Radix) 9g, Lizhihe (Litchi Seed) 9g. July 5 Follow-up: Reported taking 20 doses of the above formula between May-June. Menstruation occurred on June 27, increased volume, basal body temperature became biphasic, indicating ovulation phenomenon. Menstrual cycle normalized, moderate volume, normal color, reduced clots, no abdominal pain.
(Liu Fengwu's Gynecological Experience)
Case 3: Patient Chen XX, female, 39 years old. First visit May 24, 1973. Since 1963, late menstruation, occurring every 40+ days, scant flow lasting three days, with clots. One to two days before menstruation, feels chills and fever, abdominal pain, nausea. Currently, menstruation overdue by several days, chills and fever recurring, lower abdominal pain, sore back, pulse thready-wiry, tongue pale, coating thin white. Syndrome Differentiation: Jueyin Qi stagnation, failure of Cold-Warm transformation, disharmony of Ying and Wei. Treatment Method: Harmonize Blood and regulate Ying. Formula: Mao Chaihu (Bupleuri Radix) 4.5g, Xiao Guizhi (Cinnamomi Ramulus) 6g (added later), Ku Huangqin (Scutellariae Radix) 6g, Pao Wuyu (Prepared Evodiae Fructus) 4.5g, Bei Ganjiang (Zingiberis Rhizoma Recens) 4.5g, Xianggaoben (Ligustici Wallichii Rhizoma et Radix) 6g, Yuanhusuo (Cyperi Rhizoma) 9g, Zhu Banxia (Boiled Pinelliae Tuber) 9g, Qin Danggui (Angelicae Sinensis Radix) 6g (added later), Chuanxiong (Ligustici Rhizoma) 6g, Dan Fuling (Poria) 12g, Jing Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 12g. Second Visit: After taking 3 doses, menstruation started on May 30, moderate volume, no chills/fever. Now third day of menstruation, slight lower abdominal pain, tongue and pulse as above. Added Suzhu (Perillae Caulis) 4.5g, Xiangfu (Cyperī Rhizoma) 9g to the formula. After taking 3 doses, observed for three months, no chills/fever episodes during menstruation.
(Sun Haoming's Gynecological Clinical Experience)
[Commentary] Early menstruation is mostly Heat; late menstruation is mostly Cold. Heat syndromes focus on clearing Heat and cooling Blood; Cold syndromes focus on warming the meridians as the major principle.
Case 1: Early menstruation. Dr. Zhang seized the symptom characteristic of "hot palms," diagnosed as Yin deficiency with Liver Heat, thus treating with nourishing Yin and tonifying Liver method.
Case 2: Late menstruation, often delayed 8-9 days, dark purple color with clots, Western diagnosis of anovulatory menstruation. Dr. Liu diagnosed as Blood deficiency, Kidney depletion, and Lower Jiao deficiency-cold, treating with nourishing Blood, tonifying Kidney, and warming Lower Jiao methods. The formula addresses both root and branch, finally achieving satisfactory results of normal menstruation (with ovulation).
Case 3: Late menstruation accompanied by chills/fever, lower abdominal pain, sore back, diagnosed as Jueyin Qi stagnation, failure of Cold-Damp transformation, disharmony of Ying and Wei. Treated with harmonizing Blood, regulating Ying, warming Cold, and moving Qi. The formula treatment corresponds to Hua Boren's saying that "pungent-dispersing and bitter-warm blood-invigorating herbs" are effective for menstrual irregularities and pre-menstrual/during-menstrual chills/fever. Qing Dynasty Bao Hui believed: using Qi-moving herbs in cold-dispersing formulas doubles the efficacy (see *Yi Yi Xiao Cao*). From the therapeutic effect of Case 3, we can roughly see the practicality of this academic theory.
(II) Dysmenorrhea
Case 1: Ms. Lin, 20 years old. Reports that before every menstruation, pre-existing sternum and breast distending pain, gastric stagnation with vomiting, inability to eat. As menstruation approaches, severe lower abdominal pain occurs, face and lips lose color. Illness duration three years, ineffective with Chinese and Western medicine. Prescribed Qi-moving and Blood-stasis-resolving method. Prescription: Danggui (Angelicae Sinensis Radix) 6g, Baishao (Paeoniae Radix Alba) 6g, Xiangfu (Cyperī Rhizoma) 6g, Yanhu (Corydalis Rhizoma) 6g, Qingpi (Citri Reticulatae Pericarpium Viride) 3g, Wuyao (Linderae Radix) 4.5g, Chaihu (Bupleuri Radix) 3g, Chuanlian (Meliosmae Fructus) 6g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 9g, Taoren (Persicae Semen) 6g, Niuxi (Achyranthis Bidentatae Radix) 6g. Instructed to take medicine from seven days before menstruation until menstruation begins, all pains disappear...
(Cases of Liu Tie'an)
Case 2: Ms. Cai, currently menstruating, suddenly encountered frustration,从此 (from then on) scant menstruation with lower abdominal distending pain. Ancients said "Wood not flowing smoothly," precisely describing such symptoms. Quan Danggui (Whole Angelicae Sinensis Radix) 9g, Baishao (Paeoniae Radix Alba) 9g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 9g, Chaihu (Bupleuri Radix) 9g, Yunling (Poria) 12g, Bohejian (Menthae Haplocalycis Herba) 3g (added later), Gancao (Glycyrrhizae Radix et Rhizoma) 2.1g, Shengjiang (Zingiberis Rhizoma Recens) 3 slices. Additionally: Wulingzhi (Trogopterori Faeces), Xiangfu (Cyperī Rhizoma), Ezhu (Curcumae Rhizoma), Rougui (Cinnamomi Cortex) each 6g, ground into powder, 1.5g per dose.
(Cases of Zhang Cigong)
[Commentary]: Dysmenorrhea primarily presents as lower abdominal pain accompanied by lumbar soreness before, during, or after menstruation. Clinically, Qi stagnation and Blood stasis are the most common pathological patterns. There are also cases of Cold-Damp coagulation, Qi-Blood deficiency, and Liver-Kidney depletion. Treatment methods must be established based on different causes and pathologies.
Case 1: Qi-Blood stasis and Liver Qi depression. Treated with Qi-moving, Blood-stasis-resolving, and Liver-soothing method, a common treatment type for dysmenorrhea.
Case 2: Main pathogenesis is "Wood not flowing smoothly." Treated with Xiaoyao San combined with Danggui Shaoyao San with modifications to soothe Liver, regulate menstruation, and nourish Blood. Additionally, four herbs ground into powder combined for treatment, having warming meridian and resolving stasis effects. This is Dr. Zhang's empirical formula. This case's treatment method offers inspiration for readers weighing clinical medication choices.
(III) Amenorrhea