（二诊）：药后双眼视物较前清晰，黑影减少，大使通畅，近日食欲不振。检查：双眼视力0．9，近视力耶格表右眼4，左眼3。双眼晶状体混浊大致同前，眼底所见正常。脉细，苔薄腻，仍守前方加焦三仙各10克，每日或隔日1剂。30剂。6月3日
（末诊）：双眼视力自觉很好。检查：双眼视力1．0，近视力耶格表3。晶伏体和眼底同前。（《韦文贵眼科临床经验选》）
【评按】老年性白内障相当于枣花翳内障。多系肝肾不足，精血不能上荣，或年老体弱，肾精日衰，气血两亏，目失儒养所致。治则多以滋补肝肾、益气养血为主，辅以退翳明目。韦氏强调早期给药，部分病人可以制止病情发展，延长失明时间，又可提高视力。本案以杞菊地黄丸为主方，疗效尚好。
（八）鼻鼽苏ｘｘ，男，36岁。每当吹风着凉之后，即鼻塞不通，鼻孔发痒，喷嚏连连，流出清涕不已，此病起已三年，久治不效，曾在某医院诊为过敏性鼻炎。体常畏寒，口不渴，脉不数，舌苔白。辨证：卫阳不固，素禀不耐，外邪易侵，病属鼻鼽。治法：益卫阳，法风寒。方药：玉屏风散合桂枝汤治之生芪15克防风6克白术10克桂枝5克党参10克诃子肉10克炙甘草3克生姜3片红枣5枚上方连服13剂，其病痊愈。两年后又作，仍以原法投之，亦应手而效。（《许履和外科医案医话集》）
【评按】鼻鼽的病名，初见于《素问·金匮真言论》，即鼻流清涕。系因肺气虚亏，卫气失固，感受寒邪所致。本案病已三年，使用玉屏风散益卫阳，桂枝汤散风寒、和营卫；诃子肉敛肺气。藩篱固则外邪无可乘之机，此亦安内攘外之法。
（九）鼻衄陈ｘ，女，44岁。突然左侧鼻孔出血如注，双侧填塞后，又从口眼外溢，服凉血清热剂未效。来诊时面色苍白，目视少神，目睛晕黄，头晕，睡眠差，不思饮食，四肢乏力，口渴，盗汗，小便色黄，怔仲惊悸，短气少言，脉细而弱，舌质淡，苔薄黄。辩证：心脾两虚，气血不足。治法：心脾两补，引血归脾而止鼻衄。方药：大红参6克黄芪15克白术9克白芍12克当归9克生地炭12克荆芥炭9克茯神9克远志肉6克阿胶9克（另烊）龙眼肉9克广木香6克黑姜6克大枣3枚甘草3克2剂。服上方2剂后，鼻衄即止。睡眠饮食均有改善，目睛晕黄已退，仍以上方加减调理而愈、多年随访未见复发。
（李斯炽主治，李克涂整理：鼻衄重症之治疗心得，《湖南医药杂志》2：31，198Q）
【评按】鼻衄系指以鼻出血为主的证候。一般分实证、虚证两大类。实证多因风温外感入肺，肺有蕴热，或肝火上炎、气逆而上，虚证多因气虚、血虚等。本案证属心脾两虚，气血不足，心虚不能主血，脾虚不能统血，则鼻衄如注。治以心脾两补，引血归经，而鼻衄立止。本案重在洽本，药用颇有巧思。
（十）鼻渊
例一王××，男，49岁。经常头痛，鼻塞流清涕，气味臭秽，每日须更换手帕数块。经ｘｘ医院检查，确诊为慢性鼻窦炎。近增咳呛气急，两胁引痛。辨证：新邪外袭，痰热内蒸。治法：疏散风邪，化痰泄热。方药：前胡10克牛蒡子10克荆芥6克防风6克土霍香10克辛英6克苍耳子10克炒自芷5克制半夏10克竹茹10克陈皮10克桔梗5克茯苓12克杏仁9克焦芩10克另用鼻渊散塞鼻。鼻渊散处方（黄氏经验方）：土霍香15克苍耳子15克青木香15克鱼脑石15克辛莫15克鹅不食草9克共研细末塞鼻用。二诊：经内服煎剂，外搐鼻渊散后，头痛鼻塞较松，每日仅换手帕一块，咳喘胁痛消失。再循前方加减，拟以疏风利窍，清化痰热。细辛1．2克荆芥6克防风6克苍耳子9克辛荑6克炒白芷3克制半夏9克陈皮6克茯苓12克薄荷3克焦芩9克竹茹9克白蒺藜9克服药3剂后，诸症减轻。原方续进3剂，头脑清醒，鼻通神宁，浊涕全无，病得痊愈。迄今数年未见复发。（《黄一峰医案医话集》）
例二×××，女，成，1963年夏初诊。近四、五年来，因鼻塞时流脓涕，声音异常，不便唱歌，曾经××医院治疗，诊为慢性上颔窦炎。先后穿刺冲洗过20多次。来诊时，涕呈脓性，每隔二、三天，即从一侧或双侧鼻腔内擤出状如两端被剪掉的花生外壳，长约半寸余，粗似小指的管状黄色脓性腥臭鼻涕干痂，外粘内干，有时带血，鼻塞，说话声音俨如重感冒之状：因久不愈，现已改业不能作演员。常感头部闷闷不清，喜凉恶热，热则昏昏欲睡。苔薄黄，舌边尖红，脉浮弦而数。辨证：内火上炎，肺心之热尤甚。治法：宗“高者抑之”法，予清火滋阴，兼以排脓之剂。方药：生地18克丹皮12克赤芍9克黄芩9克白茅根21克银花18克连翘18克桔梗12克桑白皮18克苍耳子9克灯芯1．5克竹叶9克川连3克4剂。复诊：脓涕大减，原方去苍耳子，加苡仁30克，再给4剂。三诊：管状脓涕干痂已无，涕变白色，但质仍粘，已无腥臭味。原方仍去苍耳子，再去川连，仍加苡仁30克，再加山栀9克，嘱服4剂。四诊：涕清，量亦很少，除头部仍有闷感外，余证基本消失。嘱再取4剂，两日煎服一剂，共服八天。药后数月，未复犯。（杨作楳：《临证录》）
【评按】鼻渊系指以浊涕如渊的病证。也称“脑漏”。如《素问·气厥论》云“鼻渊者，浊涕下不止也。”相当于西医的慢性鼻窦炎。多因风热
例一证属新邪外袭，痰热内蒸，治以疏散风邪，化痰泄热，除内服药外，尚配合黄氏经验方塞鼻，局部与整体治疗相结合，效果良好。
例二病程已久，证属内火上炎，肺心热甚，兼见阴亏之象，予以清火滋阴兼以排脓之剂，以托毒外出。
（十一）脓耳童ｘｘ，男，5岁。左耳流脓，且发热体温39．7℃，诊为中耳炎，曾用青霉素等药，发热未减，流脓依然。症见：左耳中有清稀脓液渗出，精神萎顿，有“但欲寐”之势。二便通畅，舌质青滑，苔薄白，脉沉细。四诊合参，断为寒邪入于少阴肾经。肾开窍于耳，经气柏通，今寒邪侵入肾经，滞于耳窍，故现上述诸证。治法先宜温经散寒，鼓邪外出。方用《伤寒论》麻黄附子细辛汤。方药：附片20克麻黄6克细辛3克二诊：服上方1剂后，发热即退，体温正常，患儿面色唇转红，脓液转稠，脉转弦数，舌质转红，病已由寒化热，所谓“阴证转阳”其病易治，宜用清肝降火之剂。乃予龙胆泻肝汤加减。方药：龙胆草6克栀子3克黄芩6克车前子6克柴胡6克生地15克泽泻6克服3剂后，耳中流脓渐止而愈。（《戴丽三医疗经验选》）
【评按】脓耳系指耳内红肿掀热，耳膜溃破，耳道出脓，脓水呈黄色者称“聤耳”，白色者称“缠耳”。多因风热毒邪侵袭，入于耳中，壅聚不散，腐肉成脓，穿蚀耳膜，以致脓液外溢。本案虽见发热而精神萎顿，脉沉细，有“但欲寐”之势。证属寒邪入于少阴肾经，先宜温经散寒，鼓邪外出。凡遇寒邪抑遏，宜先温经散寒，待阴证转阳，方能施以清凉之剂，否则初用寒凉泻火，则寒邪凝滞，变生他证，病难速愈。本案不为西医诊断所惑，严格按照中医辨证。实为获效之关键。
（十二）耳聋张××，男，25岁。1951年修路作石，放炮时，不慎震伤双耳，当即感到耳道如棉花堵塞，继则耳鸣嗡嗡声，忽大忽小，持续不止，渐至耳聋重听，在××医院诊断为“神经性耳聋”。经多方医治未愈，诊察患者年青体壮，发育营养佳良，脉弦劲有力，舌苔正常。此足少阳经闭阻之故，因足少阳经脉，由眼外眺向上至颞部，向下至耳后，沿颈至肩，今巨音震动，损伤足少阳经脉，是致耳道瘀阻，清窍不利。治宜和解少阳枢机，活血化瘀通络，以开清窍。方用小柴胡汤加减：柴胡15克法半夏9克炒黄芩6克石菖蒲9克胡连6克川芎9克郁金9克磁石15克
（醋淬）五味子9克甘草6克生姜3片二诊：上方连服3剂后，耳鸣减轻，知药中病所。宗前方加柴胡为18克，续服3剂。三诊：耳鸣声音减低，时鸣时止，耳道阻塞感已消失，唯耳聋重听如前，宗前方减磁石、五味子，加广血竭9克、苏木9克，并加柴胡量至24克，以增其法瘀通络之力，续服3剂。四诊：耳鸣基本停止，耳聋重听亦减半，守前方减苏木，加桃仁9克（捣），川红花6克，并将柴胡量加为30克，配合苏合香丸，每日早晚各服半丸。五诊：上方连服3剂，共服苏合香丸3丸后，耳聋重听大为好转，对面讲话基本能听见，嘱停药，改用针刺翳风、听官、听会等穴治疗，每日一次，二月而愈。（《李继昌医案》
【评按】本案发病骤然，故称暴聋。西医诊为“神经性耳聋”。证属足少阳经脉闭阻，采用和解少阳枢机，活血化瘀通络之品，以开清窍，方用小柴胡汤加减，重用活血化瘀，并配合苏合香丸开窍，病愈大半，又改用针刺法而愈，治法独特而有理法可循，颇堪令人玩味。
（十三）眩晕
例一李××，女，20岁，初诊日期：1974年12月13日。头晕耳鸣，房屋旋转，胸闷泛恶，时作时止，喉间痰多。病历数月，前医迭进平肝潜阳之剂，病清未减，脉细数，苔白腻。辨证蠢肝阳挟痰，上扰清窍。治法：平肝和胃，化痰降逆。方药：真珠母30克橹豆衣9克菊花9克白芍9克姜竹茹9克茯苓9克青陈皮各9克白蒺藜9克旋覆花9克（包）代储石30克生姜3片佛手9克12月20日
（二诊）：前进平肝和胃、化痰降逆之剂，咯痰增多，呕吐已瘥，眩晕亦减，惟二颞跳痛。苔、脉如前。痰浊渐化，肝阳未平。再宗前意。原方去姜竹茹，6剂。12月27日
（三诊）：眩晕渐平，胸闷亦减，但觉倦怠嗜睡，脉细软，苔薄白。在肝阳痰浊扰动之后，脾胃未健，精神未复，前法加入健脾和胃之品。旋复花9克（包）青陈皮各9克白术9克茯苓9克佛手9克白蒺藜9克真珠母30克白芍9克菊花9克7剂。（《黄文东医案》）
例二史××，男，39岁。头晕已十余年，曾疗养二年。每年有1～2个月头晕，呕吐加剧，经神经科检查无特殊异常。当时头晕为甚，晕剧呕吐，食欲不振，手足麻木，耳鸣，血压正常。脉弦细，舌苔白，舌质边有齿痕。西医诊断为美尼尔氏怔。辨证：水邪上逆，肝阳不潜。治法：温阳利水。方药：泽泻汤、苓桂术甘汤化裁。云茯苓15克自术12克桂枝9克甘草9克生龙骨30克（先煎）泽泻15克生姜6克大枣5枚生牡蛎30克（先煎）陈皮9克半夏12克钩藤12克服7剂后，头晕欲吐等证已大减，仅感体痛乏力，治用前方佐以疏风通络之品，加防己、秦艽再进7剂。嗣后相隔一月，头晕欲吐复作，但较前有所减轻，即又投入首方10剂而愈。（《赵锡武医疗经验》）
【评按】眩晕是临床常见症候之一，此处所列为耳源性眩晕（或称美尼尔氏综合征）。《内经》中多次提到眩晕、耳鸣同时发生的病证，后世医家也多论及。如《丹溪心法》云“身转耳聋，如立舟船之上”，即可包括此证在内。例一证属肝阳挟痰，上扰清窍。前医进平肝潜阳之剂未效，加入竹茹、陈皮、复花等化痰降逆之品，始见效果，符合“无痰不作眩”之说。例二的病因、病理有所不同，赵氏认为：“本证并非风痰之邪，实属水饮内阻，阳应风化所致”，着重于脾胃，故用温阳蠲饮、健脾利水为法，使水气循流，则眩晕自愈。故以泽泻汤、苓桂术甘汤化裁，温阳化水，其观点似与西医“迷路水肿”之说，不谋而合。
（十四）乳蛾沈ｘ，男，34岁，初诊日期：1972年6月19日。病起急剧，恶寒壮热（体温39．5℃），经西医检查诊为急性化脓性扁桃体炎，曾用西药治疗未效。刻诊两侧喉蛾红肿痛，并有腐点，吞咽困难，胸闷不舒，大便不通，口气秽臭，纳谷不香，苔黄腻，脉浮数。治法：清肺解毒，散结消肿。方药：元参、前胡、麦冬、川贝、菊花、牛蒡子、板蓝根各6克连翘、射干各4.5克桔梗3克薄荷2．4克瓜蒌9克复诊：服前方一剂，热退，大便畅行，胃纳亦增，检查喉蛾虽仍红肿，但腐点已消，继以前方出入2剂，诸恙均愈。
（陆文彬整理：沈仲圭老中医临床经验选析，《中医杂志》4：13，1980）
【评按】乳蛾相当于扁桃体炎，由风热外邪结于咽喉，或因虚火上炎，气血凝滞而致。本案曾经西药治疗未效，使用清热解毒、散结消肿法，1剂而热退，3剂而诸恙悉愈。《温病条辨》论温毒咽痛喉肿之病机谓“少阴主君火，少阳主相火，相济为灾……治法总不能出李东垣普济消毒饮之外，其方之妙，妙在以凉膈散为主”。本案用薄荷、菊花、牛蒡、前胡疏风清热；玄参、麦冬、板蓝根、连翘、桔梗清肺胃而利咽喉：瓜蒌、贝母涤痰热而散结。因取清热解毒、宣肺散结，俾轻可去实也。
（十五）喉痧
（第二次复诊）：服药后双眼视物比之前清晰，黑影减少，大便通畅，最近食欲不振。检查：双眼视力0.9，近视力耶格表右眼4，左眼3。双眼晶状体混浊程度大致与之前相同，眼底所见正常。脉象细，舌苔薄腻，仍守原方加入焦三仙各10克，每日或隔日服用1剂。共30剂。6月3日
（最后一次复诊）：双眼视力自觉很好。检查：双眼视力1.0，近视力耶格表3。晶状体和眼底情况同前。（《韦文贵眼科临床经验选》）
【评按】老年性白内障相当于中医的枣花翳内障。多因肝肾不足，精血不能上荣于目，或因年老体弱，肾精日渐衰退，气血两亏，目失濡养所致。治疗原则多以滋补肝肾、益气养血为主，辅以退翳明目。韦氏强调早期给药，部分病人可以制止病情发展，延长失明时间，又可提高视力。本案以杞菊地黄丸为主方，疗效尚好。
（八）鼻鼽苏某，男，36岁。每当吹风着凉之后，即鼻塞不通，鼻孔发痒，喷嚏连连，流出清涕不止，此病起已三年，久治不效，曾在某医院诊为过敏性鼻炎。体质常畏寒，口不渴，脉不数，舌苔白。辨证：卫阳不固，素禀不耐，外邪易侵，病属鼻鼽。治法：益卫阳，祛风寒。方药：玉屏风散合桂枝汤治之。生黄芪15克，防风6克，白术10克，桂枝5克，党参10克，诃子肉10克，炙甘草3克，生姜3片，红枣5枚。上方连服13剂，其病痊愈。两年后又发作，仍以原法投之，亦应手而效。（《许履和外科医案医话集》）
【评按】鼻鼽的病名，初见于《素问·金匮真言论》，即鼻流清涕。系因肺气虚亏，卫气失固，感受寒邪所致。本案病已三年，使用玉屏风散益卫阳，桂枝汤散风寒、和营卫；诃子肉敛肺气。藩篱固则外邪无可乘之机，此亦安内攘外之法。
（九）鼻衄陈某，女，44岁。突然左侧鼻孔出血如注，双侧填塞后，又从口眼外溢，服凉血清热剂未效。来诊时面色苍白，目视少神，目睛晕黄，头晕，睡眠差，不思饮食，四肢乏力，口渴，盗汗，小便色黄，怔忡惊悸，短气少言，脉细而弱，舌质淡，苔薄黄。辩证：心脾两虚，气血不足。治法：心脾两补，引血归脾而止鼻衄。方药：大红参6克，黄芪15克，白术9克，白芍12克，当归9克，生地炭12克，荆芥炭9克，茯神9克，远志肉6克，阿胶9克（另烊），龙眼肉9克，广木香6克，黑姜6克，大枣3枚，甘草3克。2剂。服上方2剂后，鼻衄即止。睡眠饮食均有改善，目睛晕黄已退，仍以上方加减调理而愈。多年随访未见复发。
（李斯炽主治，李克涂整理：鼻衄重症之治疗心得，《湖南医药杂志》2：31，1980）
【评按】鼻衄系指以鼻出血为主的证候。一般分实证、虚证两大类。实证多因风温外感入肺，肺有蕴热，或肝火上炎、气逆而上，虚证多因气虚、血虚等。本案证属心脾两虚，气血不足，心虚不能主血，脾虚不能统血，则鼻衄如注。治以心脾两补，引血归经，而鼻衄立止。本案重在治本，药用颇有巧思。
（十）鼻渊
例一王某，男，49岁。经常头痛，鼻塞流清涕，气味臭秽，每日须更换手帕数块。经某医院检查，确诊为慢性鼻窦炎。近增咳呛气急，两胁引痛。辨证：新邪外袭，痰热内蒸。治法：疏散风邪，化痰泄热。方药：前胡10克，牛蒡子10克，荆芥6克，防风6克，土藿香10克，辛夷6克，苍耳子10克，炒白芷5克，制半夏10克，竹茹10克，陈皮10克，桔梗5克，茯苓12克，杏仁9克，焦黄芩10克。另用鼻渊散塞鼻。鼻渊散处方（黄氏经验方）：土藿香15克，苍耳子15克，青木香15克，鱼脑石15克，辛夷15克，鹅不食草9克。共研细末塞鼻用。二诊：经内服煎剂，外搐鼻渊散后，头痛鼻塞较松，每日仅换手帕一块，咳喘胁痛消失。再循前方加减，拟以疏风利窍，清化痰热。细辛1.2克，荆芥6克，防风6克，苍耳子9克，辛夷6克，炒白芷3克，制半夏9克，陈皮6克，茯苓12克，薄荷3克，焦黄芩9克，竹茹9克，白蒺藜9克。服药3剂后，诸症减轻。原方续进3剂，头脑清醒，鼻通神宁，浊涕全无，病得痊愈。迄今数年未见复发。（《黄一峰医案医话集》）
例二某，女，1963年夏初诊。近四、五年来，因鼻塞时流脓涕，声音异常，不便唱歌，曾经某医院治疗，诊为慢性上颌窦炎。先后穿刺冲洗过20多次。来诊时，涕呈脓性，每隔二、三天，即从一侧或双侧鼻腔内擤出状如两端被剪掉的花生外壳，长约半寸余，粗似小指的管状黄色脓性腥臭鼻涕干痂，外粘内干，有时带血，鼻塞，说话声音俨如重感冒之状。因久不愈，现已改业不能作演员。常感头部闷闷不清，喜凉恶热，热则昏昏欲睡。苔薄黄，舌边尖红，脉浮弦而数。辨证：内火上炎，肺心之热尤甚。治法：宗“高者抑之”法，予清火滋阴，兼以排脓之剂。方药：生地18克，丹皮12克，赤芍9克，黄芩9克，白茅根21克，银花18克，连翘18克，桔梗12克，桑白皮18克，苍耳子9克，灯芯1.5克，竹叶9克，川黄连3克。4剂。复诊：脓涕大减，原方去苍耳子，加苡仁30克，再给4剂。三诊：管状脓涕干痂已无，涕变白色，但质仍粘，已无腥臭味。原方仍去苍耳子，再去川黄连，仍加苡仁30克，再加山栀9克，嘱服4剂。四诊：涕清，量亦很少，除头部仍有闷感外，余证基本消失。嘱再取4剂，两日煎服一剂，共服八天。药后数月，未复犯。（杨作楳：《临证录》）
【评按】鼻渊系指以浊涕如渊的病证。也称“脑漏”。如《素问·气厥论》云“鼻渊者，浊涕下不止也。”相当于西医的慢性鼻窦炎。多因风热（或风寒化热）久蕴肺鼻，窍道不利，郁遏成涕，而致漏下不止。
例一证属新邪外袭，痰热内蒸，治以疏散风邪，化痰泄热，除内服药外，尚配合黄氏经验方塞鼻，局部与整体治疗相结合，效果良好。
例二病程已久，证属内火上炎，肺心热甚，兼见阴亏之象，予以清火滋阴兼以排脓之剂，以托毒外出。
（十一）脓耳童某，男，5岁。左耳流脓，且发热体温39.7℃，诊为中耳炎，曾用青霉素等药，发热未减，流脓依然。症见：左耳中有清稀脓液渗出，精神萎顿，有“但欲寐”之势。二便通畅，舌质青滑，苔薄白，脉沉细。四诊合参，断为寒邪入于少阴肾经。肾开窍于耳，经气畅通，今寒邪侵入肾经，滞于耳窍，故现上述诸证。治法先宜温经散寒，鼓邪外出。方用《伤寒论》麻黄附子细辛汤。方药：附片20克，麻黄6克，细辛3克。二诊：服上方1剂后，发热即退，体温正常，患儿面色唇转红，脓液转稠，脉转弦数，舌质转红，病已由寒化热，所谓“阴证转阳”，其病易治，宜用清肝降火之剂。乃予龙胆泻肝汤加减。方药：龙胆草6克，栀子3克，黄芩6克，车前子6克，柴胡6克，生地15克，泽泻6克。服3剂后，耳中流脓渐止而愈。（《戴丽三医疗经验选》）
【评按】脓耳系指耳内红肿掀热，耳膜溃破，耳道出脓，脓水呈黄色者称“聤耳”，白色者称“缠耳”。多因风热毒邪侵袭，入于耳中，壅聚不散，腐肉成脓，穿蚀耳膜，以致脓液外溢。本案虽见发热而精神萎顿，脉沉细，有“但欲寐”之势。证属寒邪入于少阴肾经，先宜温经散寒，鼓邪外出。凡遇寒邪郁遏，宜先温经散寒，待阴证转阳，方能施以清凉之剂，否则初用寒凉泻火，则寒邪凝滞，变生他证，病难速愈。本案不为西医诊断所惑，严格按照中医辨证。实为获效之关键。
（十二）耳聋张某，男，25岁。1951年修路作石，放炮时，不慎震伤双耳，当即感到耳道如棉花堵塞，继则耳鸣嗡嗡声，忽大忽小，持续不止，渐至耳聋重听，在某医院诊断为“神经性耳聋”。经多方医治未愈，诊察患者年青体壮，发育营养佳良，脉弦劲有力，舌苔正常。此足少阳经闭阻之故，因足少阳经脉，由眼外眦向上至颞部，向下至耳后，沿颈至肩，今巨音震动，损伤足少阳经脉，是致耳道瘀阻，清窍不利。治宜和解少阳枢机，活血化瘀通络，以开清窍。方用小柴胡汤加减：柴胡15克，法半夏9克，炒黄芩6克，石菖蒲9克，胡黄连6克，川芎9克，郁金9克，磁石15克（醋淬），五味子9克，甘草6克，生姜3片。二诊：上方连服3剂后，耳鸣减轻，知药中病所。宗前方加柴胡为18克，续服3剂。三诊：耳鸣声音减低，时鸣时止，耳道阻塞感已消失，唯耳聋重听如前，宗前方减磁石、五味子，加广血竭9克、苏木9克，并加柴胡量至24克，以增其化瘀通络之力，续服3剂。四诊：耳鸣基本停止，耳聋重听亦减半，守前方减苏木，加桃仁9克（捣），川红花6克，并将柴胡量加为30克，配合苏合香丸，每日早晚各服半丸。五诊：上方连服3剂，共服苏合香丸3丸后，耳聋重听大为好转，对面讲话基本能听见，嘱停药，改用针刺翳风、听宫、听会等穴治疗，每日一次，二月而愈。（《李继昌医案》）
【评按】本案发病骤然，故称暴聋。西医诊为“神经性耳聋”。证属足少阳经脉闭阻，采用和解少阳枢机，活血化瘀通络之品，以开清窍，方用小柴胡汤加减，重用活血化瘀，并配合苏合香丸开窍，病愈大半，又改用针刺法而愈，治法独特而有理法可循，颇堪令人玩味。
（十三）眩晕
例一李某，女，20岁，初诊日期：1974年12月13日。头晕耳鸣，房屋旋转，胸闷泛恶，时作时止，喉间痰多。病历数月，前医迭进平肝潜阳之剂，病情未减，脉细数，苔白腻。辨证：肝阳挟痰，上扰清窍。治法：平肝和胃，化痰降逆。方药：真珠母30克，橹豆衣9克，菊花9克，白芍9克，姜竹茹9克，茯苓9克，青陈皮各9克，白蒺藜9克，旋覆花9克（包），代赭石30克，生姜3片，佛手9克。12月20日
（二诊）：前进平肝和胃、化痰降逆之剂，咯痰增多，呕吐已瘥，眩晕亦减，惟二颞跳痛。苔、脉如前。痰浊渐化，肝阳未平。再宗前意。原方去姜竹茹，6剂。12月27日
（三诊）：眩晕渐平，胸闷亦减，但觉倦怠嗜睡，脉细软，苔薄白。在肝阳痰浊扰动之后，脾胃未健，精神未复，前法加入健脾和胃之品。旋覆花9克（包），青陈皮各9克，白术9克，茯苓9克，佛手9克，白蒺藜9克，真珠母30克，白芍9克，菊花9克。7剂。（《黄文东医案》）
例二史某，男，39岁。头晕已十余年，曾疗养二年。每年有1～2个月头晕，呕吐加剧，经神经科检查无特殊异常。当时头晕为甚，晕剧呕吐，食欲不振，手足麻木，耳鸣，血压正常。脉弦细，舌苔白，舌质边有齿痕。西医诊断为美尼尔氏综合征。辨证：水邪上逆，肝阳不潜。治法：温阳利水。方药：泽泻汤、苓桂术甘汤化裁。云茯苓15克，白术12克，桂枝9克，甘草9克，生龙骨30克（先煎），泽泻15克，生姜6克，大枣5枚，生牡蛎30克（先煎），陈皮9克，半夏12克，钩藤12克。服7剂后，头晕欲吐等证已大减，仅感体痛乏力，治用前方佐以疏风通络之品，加防己、秦艽再进7剂。嗣后相隔一月，头晕欲吐复作，但较前有所减轻，即又投入首方10剂而愈。（《赵锡武医疗经验》）
【评按】眩晕是临床常见症候之一，此处所列为耳源性眩晕（或称美尼尔氏综合征）。《内经》中多次提到眩晕、耳鸣同时发生的病证，后世医家也多论及。如《丹溪心法》云“身转耳聋，如立舟船之上”，即可包括此证在内。例一证属肝阳挟痰，上扰清窍。前医进平肝潜阳之剂未效，加入竹茹、陈皮、旋覆花等化痰降逆之品，始见效果，符合“无痰不作眩”之说。例二的病因、病理有所不同，赵氏认为：“本证并非风痰之邪，实属水饮内阻，阳气风化所致”，着重于脾胃，故用温阳蠲饮、健脾利水为法，使水气循流，则眩晕自愈。故以泽泻汤、苓桂术甘汤化裁，温阳化水，其观点似与西医“迷路水肿”之说，不谋而合。
（十四）乳蛾沈某，男，34岁，初诊日期：1972年6月19日。病起急剧，恶寒壮热（体温39.5℃），经西医检查诊为急性化脓性扁桃体炎，曾用西药治疗未效。刻诊两侧喉蛾红肿痛，并有腐点，吞咽困难，胸闷不舒，大便不通，口气秽臭，纳谷不香，苔黄腻，脉浮数。治法：清肺解毒，散结消肿。方药：元参、前胡、麦冬、川贝、菊花、牛蒡子、板蓝根各6克，连翘、射干各4.5克，桔梗3克，薄荷2.4克，瓜蒌9克。复诊：服前方一剂，热退，大便畅行，胃纳亦增，检查喉蛾虽仍红肿，但腐点已消，继以前方出入2剂，诸恙均愈。
（陆文彬整理：沈仲圭老中医临床经验选析，《中医杂志》4：13，1980）
【评按】乳蛾相当于扁桃体炎，由风热外邪结于咽喉，或因虚火上炎，气血凝滞而致。本案曾经西药治疗未效，使用清热解毒、散结消肿法，1剂而热退，3剂而诸恙悉愈。《温病条辨》论温毒咽痛喉肿之病机谓“少阴主君火，少阳主相火，相济为灾……治法总不能出李东垣普济消毒饮之外，其方之妙，妙在以凉膈散为主”。本案用薄荷、菊花、牛蒡、前胡疏风清热；玄参、麦冬、板蓝根、连翘、桔梗清肺胃而利咽喉；瓜蒌、贝母涤痰热而散结。因取清热解毒、宣肺散结，俾轻可去实也。
（十五）喉痧
(Second Visit): After taking the medicine, vision in both eyes became clearer than before, the black spots decreased, bowel movements were smooth, but appetite was poor recently. Examination: Visual acuity in both eyes 0.9; near vision Jaeger chart Right Eye 4, Left Eye 3. Opacity of the lens in both eyes was roughly the same as before; fundus examination was normal. Pulse was fine (Xi), tongue coating was thin and greasy. The previous prescription was retained with Jiao San Xian (Scorched Three Immortals) added at 10g each. One dose per day or every other day. Total 30 doses. June 3rd.
(Last Visit): Subjective visual acuity in both eyes felt very good. Examination: Visual acuity in both eyes 1.0; near vision Jaeger chart 3. Lens and fundus status remained the same as before. (Selected Clinical Experience of Wei Wengui in Ophthalmology)
[Commentary]: Senile cataract corresponds to Zao Hua Yi Nei Zhang (Date Flower Internal Cataract) in Traditional Chinese Medicine (TCM). It is mostly caused by insufficiency of the Liver and Kidney, where Jing and Blood cannot nourish the eyes from above, or due to old age and physical weakness, where Kidney Jing declines daily, leading to deficiency of both Qi and Blood, causing the eyes to lose nourishment. The treatment principle mainly focuses on tonifying the Liver and Kidney, benefiting Qi and nourishing Blood, assisted by methods to remove nebulae and brighten the eyes. Mr. Wei emphasized early medication; some patients could have their condition development halted, blindness delayed, and vision improved. This case used Qi Ju Di Huang Wan (Lycium, Chrysanthemum and Rehmannia Pill) as the main formula, with satisfactory efficacy.
(Eight) Bi Qiu (Allergic Rhinitis): Su XX, Male, 36 years old. Whenever exposed to wind and cold, he experiences nasal congestion, itching in the nostrils, continuous sneezing, and unceasing flow of clear nasal discharge. This illness has lasted for three years, resistant to long-term treatment, and was diagnosed as allergic rhinitis in a certain hospital. The constitution often feels aversion to cold, mouth is not thirsty, pulse is not rapid, tongue coating is white. Syndrome Differentiation: Defensive Yang is insecure, innate intolerance makes external pathogens easily invasive; the disease belongs to Bi Qiu. Treatment Method: Benefit Defensive Yang, dispel Wind-Cold. Formula: Yu Ping Feng San (Jade Windscreen Powder) combined with Gui Zhi Tang (Cinnamon Twig Decoction). Sheng Huang Qi (Raw Astragalus Root) 15g, Fang Feng (Saposhnikovia Root) 6g, Bai Zhu (Atractylodes Macrocephala Rhizome) 10g, Gui Zhi (Cinnamon Twig) 5g, Dang Shen (Codonopsis Root) 10g, He Zi Rou (Terminalia Chebula Fruit Flesh) 10g, Zhi Gan Cao (Honey-fried Licorice Root) 3g, Sheng Jiang (Fresh Ginger) 3 slices, Hong Zao (Jujube) 5 pieces. Taken continuously for 13 doses, the illness was cured. Two years later it recurred, treated again with the original method, yielding prompt efficacy. (Collected Medical Cases and Conversations of Xu Lühe in Surgery)
[Commentary]: The term Bi Qiu first appeared in *Su Wen: Jin Gui Zhen Yan Lun*, referring to the flow of clear nasal discharge. It is caused by deficiency of Lung Qi, insecurity of Wei Qi, and contraction of Cold Pathogens. In this case, lasting three years, Yu Ping Feng San was used to benefit Defensive Yang, Gui Zhi Tang to dispel Wind-Cold and harmonize Ying and Wei; He Zi Rou astringes Lung Qi. When the defensive barrier is solid, external pathogens have no opportunity to invade; this is also a method of stabilizing the interior to repel the exterior.
(Nine) Bi Nu (Epistaxis): Chen X, Female, 44 years old. Suddenly, bleeding from the left nostril gushed like a stream. After bilateral packing, blood overflowed from the mouth and eyes. Taking cooling-blood and clearing-heat agents was ineffective. At consultation, complexion was pale, eyes lacked spirit, sclera had yellow halos, dizziness, poor sleep, loss of appetite, limb fatigue, thirst, night sweats, yellow urine, palpitations and fright, shortness of breath and reluctance to speak, pulse was fine and weak, tongue body was pale, coating was thin and yellow. Syndrome Differentiation: Deficiency of both Heart and Spleen, insufficiency of Qi and Blood. Treatment Method: Tonify both Heart and Spleen, guide blood back to the Spleen to stop epistaxis. Formula: Da Hong Shen (Large Red Ginseng) 6g, Huang Qi (Astragalus Root) 15g, Bai Zhu (Atractylodes Macrocephala Rhizome) 9g, Bai Shao (White Peony Root) 12g, Dang Gui (Angelica Sinensis Root) 9g, Sheng Di Tan (Charred Rehmannia Root) 12g, Jing Jie Tan (Charred Schizonepeta Spike) 9g, Fu Shen (Poria with Hostwood) 9g, Yuan Zhi Rou (Polygala Root Flesh) 6g, E Jiao (Donkey-hide Gelatin) 9g (melted separately), Long Yan Rou (Longan Aril) 9g, Guang Mu Xiang (Costus Root) 6g, Hei Jiang (Black Ginger) 6g, Da Zao (Jujube) 3 pieces, Gan Cao (Licorice Root) 3g. 2 doses. After taking 2 doses of the above formula, epistaxis stopped immediately. Sleep and diet improved, yellow halos on sclera faded. Continued regulation with modifications of the above formula led to recovery. Follow-up over many years showed no recurrence.
(Mainly treated by Li Sichi, organized by Li Ketu: Insights into the Treatment of Severe Epistaxis, *Hunan Medical Journal* 2:31, 1980)
[Commentary]: Bi Nu refers to syndromes primarily characterized by nosebleeds. Generally divided into Excess and Deficiency types. Excess types are mostly due to Wind-Warmth external invasion entering the Lung, with accumulated heat in the Lung, or Liver Fire flaming upward with rebellious Qi. Deficiency types are mostly due to Qi deficiency, Blood deficiency, etc. This case belongs to Deficiency of both Heart and Spleen, insufficiency of Qi and Blood. Heart deficiency fails to govern blood, Spleen deficiency fails to control blood, resulting in gushing epistaxis. Treatment involves tonifying both Heart and Spleen, guiding blood back to its vessels, stopping epistaxis promptly. This case focuses on treating the root cause, with clever use of herbs.
(Ten) Bi Yuan (Sinusitis)
Case 1 Wang XX, Male, 49 years old. Frequent headache, nasal congestion with clear discharge, foul odor, requiring changing handkerchiefs several times a day. Examined at a certain hospital, confirmed as chronic sinusitis. Recently increased coughing, wheezing, and pain radiating to both hypochondria. Syndrome Differentiation: New external pathogens attacking, Phlegm-Heat steaming internally. Treatment Method: Disperse Wind pathogens, transform Phlegm and drain Heat. Formula: Qian Hu (Peucedani Radix) 10g, Niu Bang Zi (Arctii Fructus) 10g, Jing Jie (Schizonepetae Herba) 6g, Fang Feng (Saposhnikoviae Radix) 6g, Tu Huo Xiang (Agastaches Herba) 10g, Xin Yi (Magnoliae Flos) 6g, Cang Er Zi (Xanthii Fructus) 10g, Chao Bai Zhi (Stir-baked Angelicae Dahuricae Radix) 5g, Zhi Ban Xia (Prepared Pinellia Tuber) 10g, Zhu Ru (Bambusae Caulis in Taenia) 10g, Chen Pi (Citri Reticulatae Pericarpium) 10g, Jie Geng (Platycodonis Radix) 5g, Fu Ling (Poria) 12g, Xing Ren (Prunus Semen) 9g, Jiao Qin (Scorched Scutellariae Radix) 10g. Additionally, use Bi Yuan San (Nasal Powder) for nasal insufflation. Bi Yuan San Prescription (Mr. Huang's Empirical Formula): Tu Huo Xiang 15g, Cang Er Zi 15g, Qing Mu Xiang (Aucklandiae Radix) 15g, Yu Nao Shi (Fish Brain Stone) 15g, Xin Yi 15g, E Bu Shi Cao (Centipedas Herb) 9g. Pulverized into fine powder for nasal insufflation. Second Visit: After internal decoction and external nasal insufflation of Bi Yuan San, headache and nasal congestion loosened, only one handkerchief changed daily, cough/wheeze/hypochondriac pain disappeared. Continue modifying the previous formula, intending to disperse Wind, open orifices, clear Phlegm-Heat. Xi Xin (Asari Radix et Rhizoma) 1.2g, Jing Jie 6g, Fang Feng 6g, Cang Er Zi 9g, Xin Yi 6g, Chao Bai Zhi 3g, Zhi Ban Xia 9g, Chen Pi 6g, Fu Ling 12g, Bo He (Menthae Haplocalycis Herba) 3g, Jiao Qin 9g, Zhu Ru 9g, Bai Ji Li (Tribuli Fructus) 9g. After 3 doses, all symptoms alleviated. Continue original formula for 3 more doses, mind cleared, nose patent, spirit calm, turbid discharge completely gone, illness cured. No recurrence seen for years since. (Collected Medical Cases and Conversations of Huang Yifeng)
Case 2 XXX, Female, First visit Summer 1963. For nearly four or five years, due to nasal congestion and occasional purulent discharge, abnormal voice, unable to sing properly. Treated at a certain hospital, diagnosed as chronic maxillary sinusitis. Puncture and irrigation performed over 20 times. At consultation, discharge was purulent. Every two or three days, tubular yellow purulent foul-smelling nasal dry crusts, resembling peanut shells cut off at both ends, about half an inch long, thickness similar to little finger, were blown out from one or both nasal cavities. Outer part sticky, inner part dry, sometimes bloody. Nasal congestion, speech sounded like severe cold. Due to prolonged non-healing, changed profession, unable to act. Often felt heavy and unclear head sensation, preferred coolness, disliked heat, sleepy when hot. Tongue coating thin yellow, tongue edges and tip red, pulse floating, wiry and rapid. Syndrome Differentiation: Internal Fire flaming upward, Heat in Lung and Heart particularly severe. Treatment Method: Following the method "Suppress what is high," provide Fire-clearing and Yin-nourishing agents, combined with pus-draining formulas. Formula: Sheng Di (Rehmanniae Radix) 18g, Dan Pi (Moutan Cortex) 12g, Chi Shao (Paeoniae Radix Rubra) 9g, Huang Qin (Scutellariae Radix) 9g, Bai Mao Gen (Imperatae Rhizoma) 21g, Yin Hua (Flos Lonicerae Japonicae) 18g, Lian Qiao (Forsythiae Fructus) 18g, Jie Geng 12g, Sang Bai Pi (Mori Cortex) 18g, Cang Er Zi 9g, Deng Xin (Junci Medulla) 1.5g, Zhu Ye (Bambusae Folium) 9g, Chuan Lian (Coptidis Rhizoma) 3g. 4 doses. Revisit: Purulent discharge greatly reduced. Remove Cang Er Zi from original formula, add Yi Yi Ren (Coicis Semen) 30g, give another 4 doses. Third Visit: Tubular purulent crusts gone, discharge turned white but still viscous, no longer foul-smelling. Still remove Cang Er Zi from original formula, remove Chuan Lian, still add Yi Yi Ren 30g, add Shan Zhi (Gardeniae Fructus) 9g, instructed to take 4 doses. Fourth Visit: Discharge clear, volume very small, except for slight heaviness in head, remaining symptoms basically disappeared. Instructed to get another 4 doses, decoct and take one dose every two days, total 8 days. Several months after medication, no recurrence. (Yang Zuomei: *Lin Zheng Lu*)
[Commentary]: Bi Yuan refers to syndromes characterized by turbid discharge flowing like an abyss. Also called "Brain Leak." As stated in *Su Wen: Qi Jue Lun*: "Bi Yuan is unceasing downward flow of turbid discharge." Equivalent to Western medicine's chronic sinusitis. Mostly due to Wind-Heat (or Wind-Cold transforming into Heat) lingering in the Lung and Nose for a long time, orifice obstruction failing to regulate, suppressing formation of discharge, leading to continuous leakage.
Case 1 syndrome belongs to new external pathogens attacking, Phlegm-Heat steaming internally. Treatment disperses Wind pathogens, transforms Phlegm and drains Heat. Besides internal medicine, combined with Mr. Huang's empirical formula for nasal insufflation, combining local and systemic treatment, with good results.
Case 2 course is long, syndrome belongs to Internal Fire flaming upward, severe Heat in Lung and Heart, accompanied by signs of Yin deficiency. Provided Fire-clearing, Yin-nourishing, and pus-draining agents to expel toxins outward.
(Eleven) Nong Er (Otitis Media with Suppuration): Tong XX, Male, 5 years old. Left ear flowing pus, fever temperature 39.7°C, diagnosed as otitis media. Previously used Penicillin etc., fever did not subside, pus flow continued. Symptoms: Clear thin pus exuding from left ear, spirit listless, showing tendency of "only wanting to sleep" (Dan Yu Mei). Bowel and bladder movements smooth, tongue body blue and slippery, coating thin white, pulse deep and fine. Combining Four Diagnostic Methods, diagnosed as Cold Pathogen entering the Shaoyin Kidney Meridian. Kidney opens into the ears, meridian Qi flows smoothly. Now Cold Pathogen invades Kidney Meridian, stagnates in ear orifice, thus presenting the above symptoms. Treatment Method: First suitable to warm meridians and scatter Cold, drum pathogens outward. Formula uses *Shang Han Lun* Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite and Asari Decoction). Formula: Fu Pian (Prepared Aconiti Lateralis Radix) 20g, Ma Huang (Ephedrae Herba) 6g, Xi Xin (Asari Radix et Rhizoma) 3g. Second Visit: After taking 1 dose of the above formula, fever subsided immediately, temperature normal, child's facial color and lips turned red, pus thickened, pulse turned wiry and rapid, tongue body turned red. Disease transformed from Cold to Heat, so-called "Yin Syndrome turning Yang," easier to treat. Suitable to use Liver-clearing and Fire-descending agents. Prescribed Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction) modified. Formula: Long Dan Cao (Gentianae Radix) 6g, Zhi Zi (Gardeniae Fructus) 3g, Huang Qin 6g, Che Qian Zi (Plantaginis Semen) 6g, Chai Hu (Bupleuri Radix) 6g, Sheng Di 15g, Ze Xie (Alismatis Rhizoma) 6g. After taking 3 doses, ear pus flow gradually stopped and healed. (Selected Medical Experience of Dai Lisan)
[Commentary]: Nong Er refers to redness, swelling, heat, eardrum rupture, and pus in the ear canal. Yellow pus is called Ting Er, white pus is called Chan Er. Mostly due to Wind-Heat-Toxin invasion entering the ear, accumulating and not dispersing, rotting flesh into pus, eroding eardrum, causing pus overflow. Although this case shows fever, spirit is listless, pulse deep and fine, with tendency of "only wanting to sleep." Syndrome belongs to Cold Pathogen entering Shaoyin Kidney Meridian. First suitable to warm meridians and scatter Cold, drum pathogens outward. Whenever encountering Cold Pathogen suppression, should first warm meridians and scatter Cold. Wait for Yin Syndrome to turn Yang before applying cooling agents. Otherwise, initially using Cold-Cooling Fire-Draining will cause Cold Pathogen stagnation, generating other syndromes, illness difficult to heal quickly. This case was not confused by Western medical diagnosis, strictly following TCM syndrome differentiation. This is the key to obtaining efficacy.
(Twelve) Er Long (Deafness): Zhang XX, Male, 25 years old. In 1951, while road construction involved stone blasting, accidentally injured both ears with explosion shock. Immediately felt ear canals blocked like cotton, followed by buzzing tinnitus, fluctuating in intensity, continuous, gradually progressing to deafness and heavy hearing. Diagnosed as "Nerve Deafness" in a certain hospital. Treated by various means without cure. Examination showed patient young and strong, good development and nutrition, pulse stringy and vigorous, tongue coating normal. This is due to closure/blockage of the Foot-Shaoyang Meridian. Because the Foot-Shaoyang Meridian runs from the outer canthus upward to the temporal region, downward behind the ear, along the neck to the shoulder. Now giant sound vibration damaged the Foot-Shaoyang Meridian, causing ear canal stasis and blockage, clear orifices unfavorable. Treatment suitable to harmonize Shaoyang pivot mechanism, activate Blood and resolve Stasis, unblock collaterals, to open clear orifices. Formula uses Xiao Chai Hu Tang (Minor Bupleurum Decoction) modified: Chai Hu 15g, Fa Ban Xia (Prepared Pinellia Tuber) 9g, Chao Huang Qin 6g, Shi Chang Pu (Acori Tatarinowii Rhizoma) 9g, Hu Lian (Coptidis Rhizoma) 6g, Chuan Xiong (Ligustici Chuanxiong Rhizoma) 9g, Yu Jin (Curcumae Radix) 9g, Ci Shi (Hematitum) 15g (vinegar-quenched), Wu Wei Zi (Schisandrae Chinensis Fructus) 9g, Gan Cao 6g, Sheng Jiang 3 slices. Second Visit: After taking above formula continuously for 3 doses, tinnitus alleviated, knowing medicine hits the target. Follow original formula, increase Chai Hu to 18g, continue taking 3 doses. Third Visit: Tinnitus sound reduced, intermittent, ear canal blocking sensation disappeared, only deafness/heavy hearing remains as before. Follow original formula, reduce Ci Shi and Wu Wei Zi, add Guang Xue Jie (Dragon's Blood Resin) 9g, Su Mu (Daemonorops Draco) 9g, and increase Chai Hu amount to 24g, to enhance resolving Stasis and unblocking collaterals power, continue taking 3 doses. Fourth Visit: Tinnitus basically stopped, deafness/heavy hearing also halved. Keep original formula, reduce Su Mu, add Tao Ren (Persicae Semen) 9g (crushed), Chuan Hong Hua (Carthami Flos) 6g, and increase Chai Hu amount to 30g, combined with Su He Xiang Wan (Styrax Pill), take half pill morning and evening daily. Fifth Visit: After taking above formula continuously for 3 doses, total 3 pills of Su He Xiang Wan taken, deafness/heavy hearing greatly improved, basically able to hear conversation face-to-face. Instructed to stop medication, switch to acupuncture at Yingfeng (TE17), Tinggong (SI19), Tinghui (GB2) etc. points, once daily, healed in two months. (Li Jichang Medical Cases)
[Commentary]: This case onset was sudden, hence called Bao Long (Sudden Deafness). Western medicine diagnosed as "Nerve Deafness." Syndrome belongs to closure/blockage of Foot-Shaoyang Meridian. Adopted harmonizing Shaoyang pivot mechanism, activating Blood and resolving Stasis, unblocking collaterals agents, to open clear orifices. Formula uses Xiao Chai Hu Tang modified, heavily using Blood-activating and Stasis-resolving agents, combined with Su He Xiang Wan to open orifices. Illness largely cured, then switched to acupuncture method to heal. Unique treatment method with logical principles, worth pondering.
(Thirteen) Xuan Yun (Vertigo/Dizziness)
Case 1 Li XX, Female, 20 years old, First visit date: December 13, 1974. Dizziness and tinnitus, room spinning, chest tightness and nausea, intermittent, excessive phlegm in throat. Illness history several months, previous doctors repeatedly administered Liver-calming and Yang-subduing agents, condition did not alleviate, pulse fine and rapid, coating white and greasy. Syndrome Differentiation: Liver Yang carrying Phlegm, disturbing clear orifices upward. Treatment Method: Calm Liver and harmonize Stomach, transform Phlegm and direct rebellion downward. Formula: Zhen Zhu Mu (Margarita) 30g, Lou Dou Yi (Sojae Semen Praeparatum) 9g, Ju Hua (Chrysanthemi Flos) 9g, Bai Shao 9g, Jiang Zhu Ru (Ginger-processed Bambusae Caulis in Taenia) 9g, Fu Ling 9g, Qing Chen Pi (Green Tangerine Peel) 9g each, Bai Ji Li 9g, Xuan Fu Hua (Inulae Flos) 9g (wrapped), Dai Zhe Shi (Haematitum) 30g, Sheng Jiang 3 slices, Fo Shou (Citrus Sarcodactylis Fructus) 9g. December 20th
(Second Visit): Previous administration of Liver-calming/Stomach-harmonizing, Phlegm-transforming/Rebellion-directing agents, expectoration increased, vomiting ceased, vertigo also reduced, only bilateral temporal throbbing pain remains. Coating, pulse as before. Phlegm-Turbidity gradually transforming, Liver Yang not yet calmed. Again follow previous intent. Original formula remove Jiang Zhu Ru, 6 doses. December 27th
(Third Visit): Vertigo gradually calmed, chest tightness also reduced, but feel fatigue and嗜睡 (drowsiness), pulse fine and soft, coating thin white. After disturbance by Liver Yang and Phlegm-Turbidity, Spleen and Stomach not yet healthy, spirit not yet recovered. Previous method add Spleen-tonifying and Stomach-harmonizing agents. Xuan Fu Hua 9g (wrapped), Qing Chen Pi 9g each, Bai Zhu 9g, Fu Ling 9g, Fo Shou 9g, Bai Ji Li 9g, Zhen Zhu Mu 30g, Bai Shao 9g, Ju Hua 9g. 7 doses. (Huang Wendong Medical Cases)
Case 2 Shi XX, Male, 39 years old. Dizziness for over ten years, convalesced for two years. Annually 1-2 months of dizziness, vomiting intensified. Neurological examination showed no special abnormalities. At that time dizziness was severe, dizzy with violent vomiting, loss of appetite, numbness in hands and feet, tinnitus, blood pressure normal. Pulse stringy and fine, tongue coating white, tongue body edges have teeth marks. Western medicine diagnosed as Meniere's Syndrome. Syndrome Differentiation: Water-Evil rebelling upward, Liver Yang not submerging. Treatment Method: Warm Yang and promote urination. Formula: Ze Xie Tang (Alisma Decoction), Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes and Licorice Decoction) modified. Yun Fu Ling 15g, Bai Zhu 12g, Gui Zhi 9g, Gan Cao 9g, Sheng Long Gu (Fossilized Mammoth Bone) 30g (decoct first), Ze Xie 15g, Sheng Jiang 6g, Da Zao 5 pieces, Sheng Mu Li (Concha Ostreae) 30g (decoct first), Chen Pi 9g, Ban Xia 12g, Gou Teng (Uncariae Ramulus cum Uncis) 12g. After taking 7 doses, dizziness and urge to vomit etc. symptoms greatly reduced, only feeling body ache and fatigue. Treatment uses previous formula assisted by Wind-dispersing and Collateral-unblocking agents, add Fang Ji (Stephaniae Tetrandrae Radix), Qin Jiao (Gentianae Macrophyllae Radix) advance another 7 doses. Subsequently, interval one month, dizziness and urge to vomit recurred, but less severe than before, immediately administered first formula 10 doses and healed. (Zhao Xiwu Medical Experience)
[Commentary]: Xuan Yun is one of common clinical syndromes. Listed here are otogenic vertigo (or Meniere's Syndrome). *Nei Jing* mentions multiple times syndromes occurring simultaneously with vertigo and tinnitus, later generations of physicians also discussed much. As *Dan Xi Xin Fa* states "Body turns, deafness, like standing on a boat," which can include this syndrome within. Case 1 syndrome belongs to Liver Yang carrying Phlegm, disturbing clear orifices upward. Previous doctor administered Liver-calming/Yang-subduing agents without effect, adding Zhu Ru, Chen Pi, Xuan Fu Hua etc. Phlegm-transforming/Rebellion-directing agents, finally seeing effect, conforming to the saying "No Phlegm, No Vertigo." Case 2 etiology and pathology differ. Mr. Zhao believes: "This syndrome is not Wind-Phlegm pathogen, actually belongs to Water-Drink internal obstruction, Yang Qi failing to transform," focusing on Spleen and Stomach, thus using Warm-Yang/Dispelling-Drink, Spleen-tonifying/Water-promoting method, allowing Water-Qi to circulate, then vertigo heals spontaneously. Thus using Ze Xie Tang, Ling Gui Zhu Gan Tang modified, Warm-Yang/Transforming-Water, his viewpoint seems coincident with Western medicine's "Labyrinth Edema" theory.
(Fourteen) Ru E (Tonsillitis): Shen X, Male, 34 years old, First visit date: June 19, 1972. Illness onset acute, aversion to cold and high fever (temperature 39.5°C). Examined by Western medicine diagnosed as acute suppurative tonsillitis, previously used Western medicine treatment without effect. Current examination: Both sides throat tonsils red, swollen, painful, with necrotic spots, difficulty swallowing, chest tightness and discomfort, constipation, foul breath, poor appetite, coating yellow and greasy, pulse floating and rapid. Treatment Method: Clear Lung and detoxify, dissipate nodules and reduce swelling. Formula: Yuan Shen (Scrophulariae Radix), Qian Hu, Mai Dong (Ophiopogonis Tuber), Chuan Bei (Fritillariae Cirrhosae Bulbus), Ju Hua, Niu Bang Zi, Ban Lan Gen (Isatidis Radix) each 6g, Lian Qiao, She Gan (Belamcandae Rhizoma) each 4.5g, Jie Geng 3g, Bo He 2.4g, Gua Lou (Trichosanthis Fructus) 9g. Revisit: Took previous formula one dose, fever subsided, bowel movement smooth, stomach appetite also increased. Examination throat tonsils still red and swollen, but necrotic spots eliminated. Continue previous formula variations 2 doses, all ailments cured.
(Organized by Lu Wenbin: Analysis of Old TCM Physician Shen Zhonggui's Clinical Experience, *Chinese Journal of Traditional Medical Science and Technology* 4:13, 1980)
[Commentary]: Ru E corresponds to tonsillitis, caused by Wind-Heat external pathogens knotting in throat, or due to Deficient Fire flaming upward, Qi and Blood stagnation. This case previously used Western medicine treatment without effect, using Clear-Heat/Detoxify, Dissipate-Nodule/Reduce-Swelling method, 1 dose fever subsided, 3 doses all ailments cured. *Wen Bing Tiao Bian* discusses pathogenesis of Warm-Toxin sore throat and throat swelling stating "Shaoyin governs Minister Fire, Shaoyang governs Ministerial Fire, mutually exacerbating disaster... Treatment methods cannot go beyond Li Dongyuan's Pu Ji Xiao Du Yin, the brilliance of its formula lies in using Liang Ge San as main component." This case uses Bo He, Ju Hua, Niu Bang, Qian Hu to disperse Wind and clear Heat; Xuan Shen, Mai Dong, Ban Lan Gen, Lian Qiao, Jie Geng clear Lung and Stomach and benefit throat; Gua Lou, Bei Mu cleanse Phlegm-Heat and dissipate nodules. Because adopting Clear-Heat/Detoxify, Diffuse-Lung/Dissipate-Nodule, allowing light agents to remove excess.
(Fifteen) Hou Sha