年轻时嗜烟，５０年前即发咳嗽，每年冬春季或气候变化明显时症状加重。当时用一般止咳药如咳必清、甘草合剂等可见效。后发作频繁，尤其近３年来，咳嗽加重，甚时不能平卧，用咳必清及螺旋霉素、麦迪霉素等罔效。１９８９年２月到省某医学院附属医院住院２月，经胸片、心电图等检查，诊断为慢性支气管炎、肺气肿、肺心病、心力衰竭Ⅱ°。用抗炎、化痰、止咳、强心、利尿等治疗出院。１９９２年元月以频繁发作，胸闷憋气欲死，再至该院住院，经胸片等检查，发现左侧胸腔积液，用抗痨、激素及中药治疗月余出院。现症：咳嗽喘气，活动后加剧，痰白粘稠，不易咳出，胸闷憋气，脘腹作胀，纳谷不馨，小便量少，口唇青紫，颜面下肢轻度水肿，舌体稍胖，舌质暗红苔白黄略腻，脉弦而数。此素嗜吸烟，毒邪入肺，肺失清肃，痰湿内阻，血脉瘀滞，水道不利；且肺病日久，影响于脾，脾胃失运，气滞水停，而有咳喘、水肿等症。治当宣肺化痰、利水除湿、活血理气。处方：炙麻黄１０克、杏仁１０克、苡仁３０克、桑皮１０克、腹皮１０克、川厚朴１０克、防己１０克、茯苓皮３０克、丹参３０克、紫苏子１０克、炒莱菔子１０克、车前子１０克。
二诊：服上方７剂，咳喘明显减轻，颜面下肢水肿消退，纳食增进，小便通利，舌质暗红苔白略腻，脉弦略数。续上方略为出入予之。处方：炙麻黄６克、杏仁１０克、陈皮１０克、苡仁３０克、桑皮１０克、大腹皮１０克、厚朴１０克、防己１０克、茯苓皮３０克、苏子１０克、炒莱菔子１０克、香椽皮１０克。连进７剂，咳喘即平，诸证缓解，继以宣肺利气，健脾和胃之剂调治善后。
（四）痰热结实宣上通下慢性支气管炎、支气管哮喘、肺炎等在痰病发展的过程中，若误用辛燥太过，或外邪入里化热，易形成痰热壅结，肺气不降，胃肠里实，肺气不通。盖肺与大肠相表里，肺失肃降，则大肠传导失职，反之腑气不通，肺气亦势必壅滞，而使咳喘等症加重。对此，李氏常采用宣通肺气，通下里实之法，亦即宣上通下，脏腑合治之法，以宣白承气汤或陷胸、白虎、承气并用之法予以治疗，有较好的效果。
案例：李某，男，４８岁，农民。咳喘反复发作１０年，加重伴发热１０天。１０年前病罹咳喘，冬春较甚，服用中药止咳平喘剂可以缓解。１０天前又患风湿，发热喘咳不止，延医诊治，服药数剂无效，请李氏治。现症：病人身热颇甚，喘咳气逆，不能平卧，细询知目不交睫两天，咳痰极黄稠，有臭气，胸部胀满，腹部膨急，大便未得畅通。口渴，然因腹满不敢多饮。苔中心黄而边缘白，脉滑数有力。索视前方，均属辛凉宣化之品。李氏曰：病属风温，药亦对证，服而无效，是因患者素有痰饮，一感温邪，内外俱病，遂较常人为重。其次，本证不仅上焦阻痹，肺气不宣，且第三卷２０８从舌脉测之，肠胃热结，亦为重要因素。徒治其上，病重药轻，而喘愈促，气愈逆，是由不知釜底抽薪之故。其起病至此，病逾旬日，便未畅行，热未退净，治当宣上、清中、导下，熔陷胸、白虎、承气三法于一炉，庶痰热结实，一齐尽蠲，否则病势缠绵，轻者迁为痈脓，重侧可危及生命。遂仿宣白承气汤法，以全瓜蒌１５克、生杏仁１０克、生石膏３０克、旋复花（布包）１０克、川贝１０克、枇杷叶１５克、白前１０克、炙紫菀１０克、炒葶苈子１０克、黄芩１０克。水煎。另以生大黄１５克，开水泡汁，分３次兑入前药中合服。服２剂后，泻水颇多，中有结粪，喘逆大平，胸腹软舒，热势渐降，脉象亦和，口渴舌苔黄亦减。惟咳痰颇多，臭气仍有，乃以竹叶石膏汤去半夏，合千金苇茎汤加川贝、旋复花、枇杷叶、瓜蒌皮、白前、紫菀、忍冬藤、蒲公英、鱼腥草、橘叶、橘络之属，以宣肺通降，降逆化痰，清热解毒。此方加减前后服至２０余剂而病愈。
诊治咳喘宿疾，李氏善用经方、时方，在辨证论治的基础上，灵活化裁，随证运用，有时亦常用单捷小剂而获效。如曾在丰店带学生实习时，一小儿患支气管肺炎，高烧月余，喘咳不止，医用氨苄青霉素抗炎无效而邀诊。视其肌肤灼热，神情烦躁，咳嗽喘逆，痰液黄稠，难以咯出，呼吸不利，舌红苔黄腻，脉来滑数。其断为痰热壅肺，肺失宣肃。遂用单捷小方，以陈胆星（以生南星研末，放入牛胆汁风干而成）６克，鱼腥草３０克煎汤与服。５剂后，发热即退，咳喘已平，继以清肺化痰、健脾和胃之剂调理而愈。后用此法治疗类似病证者亦有效。
六、慢性肝炎辨治经验慢性肝炎属中医胁痛、黄疸、虚劳等范畴。李氏于临床上采用辨证论治的方法治疗本病取得较好效果。
（一）肝胆湿热清热化湿急性肝炎迁延不愈，或慢性进行性肝病加上反复发作的活动性病变，消化道功能紊乱明显，胆道功能障碍严重，极易湿热蕴结，熏蒸肝胆，肝失疏泄，气机不畅，胆汁外溢，形成肝胆湿热证。临床表现有右胁胀痛，脘腹胀满，发热口苦，渴欲饮水，或饮而不多，纳呆厌油，恶心欲呕，身目俱黄，或无黄疸，小便黄赤，身困乏力，大便粘腻臭秽不爽，或大便干结，舌红苔黄腻，脉弦滑数。治宜清利湿热，利胆退黄。药用：茵陈、栀子、大黄、茯苓、猪苓、茅根、车前草、虎杖、黄柏、丹参、赤芍、香橼皮、郁金等。若肝气郁滞，脘腹胀满者，加柴胡、炒枳壳、厚朴、大腹皮以疏肝行气；气滞血瘀，胁肋刺痛者，加金铃子、元胡索、桃仁、玫瑰花以行气活血；食少纳差，恶心欲呕，脾胃失和者，加竹茹、炒神曲、炒二芽或炒三仙以和胃降逆止呕；湿热内蕴，小便短赤，有灼热感者，加木通、滑石、龙胆草、金钱草以泄热利尿通淋；湿热积滞，腑气不通，大便秘结者，加重大黄用量，另加芒硝适量冲服，以通下积滞。李氏认为，肝胆湿热为慢性肝炎中常见证候，治疗本证关键，要解决黄疸与降低转氨酶。据李氏经验，茵陈与大黄协同使用退黄之效较为理想，茵陈、板蓝根、虎杖、连翘、龙胆草、糯稻根、白薇等清热解毒药与五味子对降低转氨酶有肯定疗效。但凡湿热蕴结者，用清热解毒药较好，体虚而湿热不甚者，以用五味子相宜。另湿热蕴结，往往伴有热毒积滞阻结肠道，而使腑气不通，极易导致伤阴动血，内陷心包等证，故临证之时，应尽快清理肠道，酌用通里攻下之法，重用大黄或承气汤之类，使毒邪从大便排出，冀以阻止疾病的演变。
第三卷２０９案例：蒙某，女，３８岁，工人。１９９３年３月１９日初诊。肝区作胀、纳差乏力１年，身目发黄２０天。１年前因饮食不慎，邪毒内侵，病发肝区不适，纳差乏力，在当地市人民医院诊治，肝功检查：ＧＰＴ３０ｕ／赖氏，ＨＢＶ－Ｍ：ＨＢＳＡｇ、抗－ＨＢＣ、ＨＢｅＡｇ均为阳性，服用肌苷片、ＡＴＤ片及中药清热解毒疏肝解郁之剂，时好时坏。近１月来因劳顿太过，肝区作胀，身目发黄，小便黄，纳呆厌油，到该市某医院门诊，肝功检查：ＴＢ２．０ｍｇ／ｄｌ，ＩＢ５μｍｏｌ／Ｌ，ＡＬＴ６０ｕ／赖氏。ＨＢＶ－Ｍ检查同上。
诊断为慢性活动性肝炎，用保肝、护肝剂及输液等治疗半月，未见好转。刻诊所见：身目发黄，小便深黄如浓茶，肝区不适，纳呆，恶心厌油，舌暗红苔黄略腻，脉弦细。辨属湿热内蕴，熏蒸肝胆，疏泄失常，胆汁横溢，治以清热化湿，利胆退黄。处方：茵陈３０克、炒栀子１０克、茯苓３０克、泽泻１０克、猪苓１５克、炒竹茹１０克、郁金１０克、陈皮１０克、赤芍３０克、丹参３０克、白花蛇舌草３０克、炒山楂１５克。
二诊：服用上方２０余剂，身目不黄，纳食增进，肝功能检查正常，但ＨＢＳＡｇ、抗ＨＢＣ、ＨＢｅＡｇ仍为阳性。小便淡黄，舌红苔薄黄而干，脉细弦。是湿热未尽，而又有热邪伤阴之象。治用上法适当参入清热生津之品。处方：茵陈３０克、炒栀子１０克、赤白芍各１５克、丹参１８克、蛇舌草３０克、败酱草３０克、制香附１０克、香橼皮１０克、炒山楂１５克、橘皮１０克、茅根１８克、芦根３０克。连服１０剂，黄疸尽退，小便清利，惟劳累后精神疲惫，肢体乏力，舌质暗红，苔薄黄脉弦细。
则用清热解毒，理气活血，健脾益气之治，前后加减服药１４０余剂，诸证消失，肝功正常，ＨＢｓＡｇ、抗ＨＢＣ、ＨＢｅＡｇ复查均为阴性，病即告愈。随访半年，未见复发。
（二）肝郁脾虚疏肝健脾慢性肝炎之恢复阶段，由于肝气郁结，疏泄失常，横逆犯脾，脾失健运，常见有肝郁脾虚之证。临床表现有右胁肋胀满疼痛，胸闷善太息，精神抑郁或性情急躁，纳食减退，脘痞腹胀，四肢倦怠，少气懒言，大便溏泻，肠鸣矢气，舌淡苔白，脉沉细或弦细。治宜疏肝解郁，健脾益气。
药用：柴胡、白芍、当归、茯苓、白术、陈皮、香附、甘草等。若气滞血瘀胁痛明显者，加元胡、赤芍、丹参、川楝以行气活血；纳呆腹胀脘痞甚者，加枳壳、厚朴、莱菔子、大腹皮、蒌皮等以理气消痞；脾虚泻泄者，加葛根、川连、木香、苡仁、砂仁等以清热健脾止泻；湿热内蕴，口苦尿黄者，加茵陈、败酱草、蛇舌草等清热化湿；肝肾阴虚，口燥咽干，舌红少津者，如生地、麦冬、枸杞等以滋养肝肾；气血不足者，加熟地、党参、黄芪等养血益气。李氏认为，肝郁脾虚证，其证多有兼夹，故临证不可固守一法一方，而应以疾病之证候变化随证增损用药。如肝失调达脾失健运者，常可见水湿内停而膨胀，则治宜疏肝理气，除湿散满，用柴胡疏肝散合胃苓汤化裁。若肝郁日久，证见化热者，则又当疏肝健脾清热为主，用逍遥散加龙胆草、黄芩等。针对具体证候及实验检查指标，尚可选用一些具有降酶、降浊、退黄、调控免疫等作用的中草药，如白花蛇舌草、夏枯草、土茯苓、茵陈、赤芍、丹参、郁金、人参、黄精等，以提高临床疗效。
案例：李某，男，１２岁，学生。１９９２年１２月１１日初诊。腹胀纳差反复发作６年。６年前因饮食不洁，病发脘腹胀气，纳食减退。当时到该地市人民医院诊治，肝功能检查：ＧＰＴ４０ｕ／赖氏、ＨＢｓＡｇ、ＨＢｅＡｇ、ＨＢｃＡｂ均为阳性，诊断为乙型肝炎。予服肌苷片、ＡＴＰ片及中药肝炎春和煎剂等，时好时坏。经人介绍来诊，时见面色萎黄，纳食呆滞，脘腹稍胀，性情急躁，小便色黄，舌淡红，苔薄白，脉细弦。肝功：ＧＰＴ４５ｕ／赖氏，ＨＢＶ－Ｍ检查同前。断为肝气郁滞，脾虚失运，兼夹湿热。治以疏肝理气，健脾益气，清热化湿解毒。处方：太子参１０克、五味子６克、柴第三卷２１０胡６克、云苓１５克、炒白术１０克、当归６克、赤白芍各１５克、陈皮１０克、蛇舌草１８克、虎杖１０克、炒山楂１２克、连翘１２克、炒二芽１５克。二诊：服用上方３０余剂，面色较前红润，腹胀缓解，纳食增进，惟食后胃脘稍有不适，舌红苔薄白，脉弦细。守上法适当参入益气养阴、和胃消滞之品。处方：太子参１０克、麦冬６克、五味子６克、丹参１５克、炒神曲１０克、炒山楂１２克、鸡内金６克、郁金６克、陈皮１０克、虎杖１２克、贯仲１０克、蛇舌草１０克、连翘１０克、茯神１５克、茅根１５克。前后加减服用１５０余剂，腹胀消失，食欲旺盛，面色润泽，二便通利，肝功能检查正常，ＨＢＳＡｇ、ＨＢｅＡｇ、ＨＢｃＡｂ均为阴性。随访１０个月未见复发。
（三）肝肾阴虚滋养肝肾黄疸、胁痛等病，迁延日久，湿热未尽，蕴遏化热，热耗阴血，或攻伐太过，或误用辛燥，易伤津耗液，致肝肾阴虚，证见右胁隐痛，食少纳差，口燥咽干，失眠多梦，五心烦热，腰膝酸软，或面色晦暗，齿鼻衄血，舌红苔少，或有裂纹，脉细数无力或细弱或虚弦。治宜滋养肝肾，舒肝理气，能使肝阴得养，肝气调达，机体康复。药用：生地、沙参、枸杞、麦冬、当归、川楝子、制首乌、丹参等。若内热口干舌绛少津者，加玄参、石斛、芦根等以清热生津；热扰心烦者，加川连、炒栀子、柴胡等以清热除烦；湿热内结，小便不利者，加猪苓、泽泻、茅根等通利小便；纳差腹胀者，加茯苓、白术、陈皮、炒三仙等以健脾理气和胃；齿鼻衄血者，加仙鹤草、白茅根、三七粉等凉血止血；失眠多梦者，加炒枣仁、合欢皮、夜交藤等以养心安神。
年轻时嗜好吸烟，50年前就开始出现咳嗽症状，每年冬春季节或气候发生明显变化时症状加重。当时使用一般的止咳药物如咳必清、甘草合剂等可以看到疗效。后来发作变得频繁，尤其是近3年来，咳嗽加重，严重时甚至无法平卧，使用咳必清及螺旋霉素、麦迪霉素等药物均无效。1989年2月，患者到省某医学院附属医院住院2个月，经胸片、心电图等检查，被诊断为慢性支气管炎、肺气肿、肺心病、心力衰竭Ⅱ°。采用抗炎、化痰、止咳、强心、利尿等治疗后出院。1992年1月，因病情频繁发作，胸闷憋气感到濒死感，再次到该院住院，经胸片等检查，发现左侧胸腔积液，经过抗结核、激素及中药治疗一个多月后出院。目前症状：咳嗽气喘，活动后加剧，痰液白且粘稠，不易咳出，胸闷憋气，胃脘腹部胀满，食欲不佳，尿量减少，口唇青紫，颜面及下肢轻度水肿，舌体稍胖大，舌质暗红苔白黄略腻，脉象弦而数。此病由于素来嗜好吸烟，毒邪侵入肺部，导致肺失去清肃功能，痰湿内阻，血脉瘀滞，水道不通利；且肺病日久，影响脾胃，脾胃运化失职，气滞水停，从而出现咳喘、水肿等症状。治疗应当宣通肺气、化痰、利水除湿、活血理气。处方：炙麻黄10克、杏仁10克、苡仁30克、桑皮10克、腹皮10克、川厚朴10克、防己10克、茯苓皮30克、丹参30克、紫苏子10克、炒莱菔子10克、车前子10克。
二诊：服用上方7剂后，咳喘明显减轻，颜面及下肢水肿消退，食欲增进，小便通畅，舌质暗红苔白略腻，脉象弦略数。继续在原方基础上稍作加减给予治疗。处方：炙麻黄6克、杏仁10克、陈皮10克、苡仁30克、桑皮10克、大腹皮10克、厚朴10克、防己10克、茯苓皮30克、苏子10克、炒莱菔子10克、香椽皮10克。连续服用7剂后，咳喘平息，各种症状缓解，随后以宣肺利气、健脾和胃的方剂调理善后。
（四）痰热结实，宣上通下：慢性支气管炎、支气管哮喘、肺炎等在痰病发展的过程中，如果误用过于辛燥的药物，或者外邪入里化热，容易形成痰热壅结，肺气不降，胃肠里有实邪，肺气不通畅。因为肺与大肠相表里，肺失去肃降功能，则大肠传导失职；反之，腑气不通，肺气也势必壅滞，从而使咳喘等症状加重。对此，李氏常采用宣通肺气、通下里实的方法，也就是宣上通下、脏腑合治的方法，以宣白承气汤或陷胸汤、白虎汤、承气汤并用之法进行治疗，有较好的效果。
案例：李某，男，48岁，农民。咳喘反复发作10年，加重伴发热10天。10年前患病咳喘，冬春季节较重，服用中药止咳平喘剂可以缓解。10天前又患风湿，发热喘咳不止，延请医生诊治，服药数剂无效，请李氏治疗。目前症状：病人身体热度很高，喘咳气逆，不能平卧，仔细询问得知两天没有睡觉，咳痰极黄稠，有臭气，胸部胀满，腹部膨急，大便未得畅通。口渴，但因为腹部胀满不敢多饮水。查看前方处方，均属辛凉宣化之品。李氏说：病属风温，药也对证，服用却无效，是因为患者素有痰饮，一感受温邪，内外俱病，所以比常人更重。其次，本证不仅上焦阻痹，肺气不宣，而且从舌脉推测，肠胃热结也是重要因素。只治疗上部，病重药轻，导致喘促更甚，气逆更厉害，这是不知道“釜底抽薪”的缘故。其起病至此，病程超过十天，大便未畅行，热未退净，治疗应当宣上、清中、导下，将陷胸、白虎、承气三法熔于一炉，这样痰热结实才能一齐消除，否则病势缠绵，轻者迁延为痈脓，重者可危及生命。于是仿照宣白承气汤法，以全瓜蒌15克、生杏仁10克、生石膏30克、旋复花（布包）10克、川贝10克、枇杷叶15克、白前10克、炙紫菀10克、炒葶苈子10克、黄芩10克。水煎。另以生大黄15克，开水泡汁，分3次兑入前药中合服。服用2剂后，泻下大量水样便，其中有结粪，喘逆基本平息，胸腹软舒，热势渐降，脉象亦和缓，口渴舌苔黄亦减轻。只是咳痰颇多，臭气仍有，于是以竹叶石膏汤去半夏，合千金苇茎汤加川贝、旋复花、枇杷叶、瓜蒌皮、白前、紫菀、忍冬藤、蒲公英、鱼腥草、橘叶、橘络等药物，以宣肺通降，降逆化痰，清热解毒。此方加减前后服用20余剂而病愈。
诊治咳喘宿疾，李氏善用经方、时方，在辨证论治的基础上，灵活化裁，随证运用，有时也常用单捷小剂而获效。例如曾在丰店带学生实习时，一小儿患支气管肺炎，高烧月余，喘咳不止，医用氨苄青霉素抗炎无效而邀诊。视其肌肤灼热，神情烦躁，咳嗽喘逆，痰液黄稠，难以咯出，呼吸不利，舌红苔黄腻，脉来滑数。其断为痰热壅肺，肺失宣肃。遂用单捷小方，以陈胆星（以生南星研末，放入牛胆汁风干而成）6克，鱼腥草30克煎汤与服。5剂后，发热即退，咳喘已平，继以清肺化痰、健脾和胃之剂调理而愈。后用此法治疗类似病证者亦有效。
六、慢性肝炎辨治经验：慢性肝炎属于中医胁痛、黄疸、虚劳等范畴。李氏于临床上采用辨证论治的方法治疗本病取得较好效果。
（一）肝胆湿热，清热化湿：急性肝炎迁延不愈，或慢性进行性肝病加上反复发作的活动性病变，消化道功能紊乱明显，胆道功能障碍严重，极易湿热蕴结，熏蒸肝胆，肝失疏泄，气机不畅，胆汁外溢，形成肝胆湿热证。临床表现有右胁胀痛，脘腹胀满，发热口苦，渴欲饮水，或饮而不多，纳呆厌油，恶心欲呕，身目俱黄，或无黄疸，小便黄赤，身困乏力，大便粘腻臭秽不爽，或大便干结，舌红苔黄腻，脉弦滑数。治宜清利湿热，利胆退黄。药用：茵陈、栀子、大黄、茯苓、猪苓、茅根、车前草、虎杖、黄柏、丹参、赤芍、香橼皮、郁金等。若肝气郁滞，脘腹胀满者，加柴胡、炒枳壳、厚朴、大腹皮以疏肝行气；气滞血瘀，胁肋刺痛者，加金铃子、元胡索、桃仁、玫瑰花以行气活血；食少纳差，恶心欲呕，脾胃失和者，加竹茹、炒神曲、炒二芽或炒三仙以和胃降逆止呕；湿热内蕴，小便短赤，有灼热感者，加木通、滑石、龙胆草、金钱草以泄热利尿通淋；湿热积滞，腑气不通，大便秘结者，加重大黄用量，另加芒硝适量冲服，以通下积滞。李氏认为，肝胆湿热为慢性肝炎中常见证候，治疗本证关键，要解决黄疸与降低转氨酶。据李氏经验，茵陈与大黄协同使用退黄之效较为理想，茵陈、板蓝根、虎杖、连翘、龙胆草、糯稻根、白薇等清热解毒药与五味子对降低转氨酶有肯定疗效。但凡湿热蕴结者，用清热解毒药较好，体虚而湿热不甚者，以用五味子相宜。另湿热蕴结，往往伴有热毒积滞阻结肠道，而使腑气不通，极易导致伤阴动血，内陷心包等证，故临证之时，应尽快清理肠道，酌用通里攻下之法，重用大黄或承气汤之类，使毒邪从大便排出，冀以阻止疾病的演变。
第三卷209 案例：蒙某，女，38岁，工人。1993年3月19日初诊。肝区作胀、纳差乏力1年，身目发黄20天。1年前因饮食不慎，邪毒内侵，病发肝区不适，纳差乏力，在当地市人民医院诊治，肝功检查：GPt 30u/赖氏，HBV-M：HBsAg、抗-HBc、HBeAg均为阳性，服用肌苷片、ATD片及中药清热解毒疏肝解郁之剂，时好时坏。近1月来因劳顿太过，肝区作胀，身目发黄，小便黄，纳呆厌油，到该市某医院门诊，肝功检查：TB 2.0mg/dl，IB 5μmol/L，ALT 60u/赖氏。HBV-M检查同上。
诊断为慢性活动性肝炎，用保肝、护肝剂及输液等治疗半月，未见好转。刻诊所见：身目发黄，小便深黄如浓茶，肝区不适，纳呆，恶心厌油，舌暗红苔黄略腻，脉弦细。辨属湿热内蕴，熏蒸肝胆，疏泄失常，胆汁横溢，治以清热化湿，利胆退黄。处方：茵陈30克、炒栀子10克、茯苓30克、泽泻10克、猪苓15克、炒竹茹10克、郁金10克、陈皮10克、赤芍30克、丹参30克、白花蛇舌草30克、炒山楂15克。
二诊：服用上方20余剂，身目不黄，纳食增进，肝功能检查正常，但HBsAg、抗HBc、HBeAg仍为阳性。小便淡黄，舌红苔薄黄而干，脉细弦。是湿热未尽，而又有热邪伤阴之象。治用上法适当参入清热生津之品。处方：茵陈30克、炒栀子10克、赤白芍各15克、丹参18克、蛇舌草30克、败酱草30克、制香附10克、香橼皮10克、炒山楂15克、橘皮10克、茅根18克、芦根30克。连服10剂，黄疸尽退，小便清利，惟劳累后精神疲惫，肢体乏力，舌质暗红，苔薄黄脉弦细。
则用清热解毒，理气活血，健脾益气之治，前后加减服药140余剂，诸证消失，肝功正常，HBsAg、抗HBc、HBeAg复查均为阴性，病即告愈。随访半年，未见复发。
（二）肝郁脾虚，疏肝健脾：慢性肝炎之恢复阶段，由于肝气郁结，疏泄失常，横逆犯脾，脾失健运，常见有肝郁脾虚之证。临床表现有右胁肋胀满疼痛，胸闷善太息，精神抑郁或性情急躁，纳食减退，脘痞腹胀，四肢倦怠，少气懒言，大便溏泻，肠鸣矢气，舌淡苔白，脉沉细或弦细。治宜疏肝解郁，健脾益气。
药用：柴胡、白芍、当归、茯苓、白术、陈皮、香附、甘草等。若气滞血瘀胁痛明显者，加元胡、赤芍、丹参、川楝以行气活血；纳呆腹胀脘痞甚者，加枳壳、厚朴、莱菔子、大腹皮、蒌皮等以理气消痞；脾虚泻泄者，加葛根、川连、木香、苡仁、砂仁等以清热健脾止泻；湿热内蕴，口苦尿黄者，加茵陈、败酱草、蛇舌草等清热化湿；肝肾阴虚，口燥咽干，舌红少津者，如生地、麦冬、枸杞等以滋养肝肾；气血不足者，加熟地、党参、黄芪等养血益气。李氏认为，肝郁脾虚证，其证多有兼夹，故临证不可固守一法一方，而应以疾病之证候变化随证增损用药。如肝失调达脾失健运者，常可见水湿内停而膨胀，则治宜疏肝理气，除湿散满，用柴胡疏肝散合胃苓汤化裁。若肝郁日久，证见化热者，则又当疏肝健脾清热为主，用逍遥散加龙胆草、黄芩等。针对具体证候及实验检查指标，尚可选用一些具有降酶、降浊、退黄、调控免疫等作用的中草药，如白花蛇舌草、夏枯草、土茯苓、茵陈、赤芍、丹参、郁金、人参、黄精等，以提高临床疗效。
案例：李某，男，12岁，学生。1992年12月11日初诊。腹胀纳差反复发作6年。6年前因饮食不洁，病发脘腹胀气，纳食减退。当时到该地市人民医院诊治，肝功能检查：GPT 40u/赖氏、HBsAg、HBeAg、HBcAb均为阳性，诊断为乙型肝炎。予服肌苷片、ATP片及中药肝炎春和煎剂等，时好时坏。经人介绍来诊，时见面色萎黄，纳食呆滞，脘腹稍胀，性情急躁，小便色黄，舌淡红，苔薄白，脉细弦。肝功：GPT 45u/赖氏，HBV-M检查同前。断为肝气郁滞，脾虚失运，兼夹湿热。治以疏肝理气，健脾益气，清热化湿解毒。处方：太子参10克、五味子6克、柴胡6克、云苓15克、炒白术10克、当归6克、赤白芍各15克、陈皮10克、蛇舌草18克、虎杖10克、炒山楂12克、连翘12克、炒二芽15克。二诊：服用上方30余剂，面色较前红润，腹胀缓解，纳食增进，惟食后胃脘稍有不适，舌红苔薄白，脉弦细。守上法适当参入益气养阴、和胃消滞之品。处方：太子参10克、麦冬6克、五味子6克、丹参15克、炒神曲10克、炒山楂12克、鸡内金6克、郁金6克、陈皮10克、虎杖12克、贯仲10克、蛇舌草10克、连翘10克、茯神15克、茅根15克。前后加减服用150余剂，腹胀消失，食欲旺盛，面色润泽，二便通利，肝功能检查正常，HBsAg、HBeAg、HBcAb均为阴性。随访10个月未见复发。
（三）肝肾阴虚，滋养肝肾：黄疸、胁痛等病，迁延日久，湿热未尽，蕴遏化热，热耗阴血，或攻伐太过，或误用辛燥，易伤津耗液，致肝肾阴虚，证见右胁隐痛，食少纳差，口燥咽干，失眠多梦，五心烦热，腰膝酸软，或面色晦暗，齿鼻衄血，舌红苔少，或有裂纹，脉细数无力或细弱或虚弦。治宜滋养肝肾，舒肝理气，能使肝阴得养，肝气调达，机体康复。药用：生地、沙参、枸杞、麦冬、当归、川楝子、制首乌、丹参等。若内热口干舌绛少津者，加玄参、石斛、芦根等以清热生津；热扰心烦者，加川连、炒栀子、柴胡等以清热除烦；湿热内结，小便不利者，加猪苓、泽泻、茅根等通利小便；纳差腹胀者，加茯苓、白术、陈皮、炒三仙等以健脾理气和胃；齿鼻衄血者，加仙鹤草、白茅根、三七粉等凉血止血；失眠多梦者，加炒枣仁、合欢皮、夜交藤等以养心安神。
In his youth, he was addicted to smoking. Coughing began 50 years ago and worsened during winter and spring or when the weather changed significantly. At that time, general antitussive drugs such as Benproperine (Ke Bi Qing) and Glycyrrhiza Mixture showed efficacy. Later, attacks became frequent. Especially in the past three years, coughing intensified, and at times, it was so severe that he could not lie flat. Drugs like Benproperine, Spiramycin, and Midecamycin were ineffective. In February 1989, he was hospitalized for two months at a provincial medical college affiliated hospital. Diagnosed with chronic bronchitis, emphysema, cor pulmonale, and grade II heart failure after chest X-ray and electrocardiogram examinations, he was discharged after treatment with anti-inflammatory, expectorant, antitussive, cardiotonic, and diuretic therapies. In January 1992, due to frequent attacks, severe chest tightness, and suffocation feeling near death, he was readmitted. Chest X-ray revealed left-sided pleural effusion. After more than a month of anti-tuberculosis, hormonal, and traditional Chinese medicine (TCM) treatments, he was discharged. Current symptoms: coughing and wheezing, aggravated by activity; white, sticky sputum difficult to expectorate; chest tightness and suffocation; abdominal distension; poor appetite; oliguria; cyanosis of lips; mild edema of face and lower limbs; slightly enlarged tongue body; dark red tongue substance with slightly greasy white-yellow coating; wiry and rapid pulse. This condition stems from long-term smoking, where toxic pathogens invade the lungs, causing loss of lung's clearing and descending function, internal obstruction of phlegm-dampness, blood stasis, and impaired water passage. Furthermore, prolonged lung disease affects the spleen and stomach, leading to dysfunction of transportation and transformation, qi stagnation, and water retention, resulting in coughing, wheezing, and edema. Treatment should focus on diffusing the lungs, resolving phlegm, promoting urination to remove dampness, invigorating blood, and regulating qi. Prescription: Roasted Ephedrae Herba (Mahuang, 麻黄) 10g, Apricot Seed (Xingren, 杏仁) 10g, Coix Seed (Yiren, 薏苡仁) 30g, Mulberry Bark (Sangpi, 桑白皮) 10g, Tangerine Peel (Fupi, 腹皮) 10g, Magnolia Officinalis Bark (Chuan Houpo, 川厚朴) 10g, Stephania Tetrandra (Fangji, 防己) 10g, Poria Cocos Peel (Fuling Pi, 茯苓皮) 30g, Salvia Miltiorrhiza (Danshen, 丹参) 30g, Perilla Seed (Zisu Zi, 紫苏子) 10g, Fried Radish Seed (Laifuzi, 莱菔子) 10g, Plantago Seed (Cheqianzi, 车前子) 10g.
Second visit: After taking the above prescription for 7 doses, coughing and wheezing significantly decreased, facial and lower limb edema subsided, appetite improved, urination became smooth, tongue substance remained dark red with slightly greasy white coating, and pulse was wiry and slightly rapid. The previous prescription was continued with minor modifications. Prescription: Roasted Ephedrae Herba (Mahuang, 麻黄) 6g, Apricot Seed (Xingren, 杏仁) 10g, Tangerine Peel (Chenpi, 陈皮) 10g, Coix Seed (Yiren, 薏苡仁) 30g, Mulberry Bark (Sangpi, 桑白皮) 10g, Areca Peel (Dafupi, 大腹皮) 10g, Magnolia Officinalis Bark (Houpo, 厚朴) 10g, Stephania Tetrandra (Fangji, 防己) 10g, Poria Cocos Peel (Fuling Pi, 茯苓皮) 30g, Perilla Seed (Suzi, 苏子) 10g, Fried Radish Seed (Laifuzi, 莱菔子) 10g, Citron Peel (Xiangyuapi, 香椽皮) 10g. After continuously taking this for 7 doses, coughing and wheezing ceased, and various symptoms alleviated. Subsequently, formulas for diffusing lungs, promoting qi flow, strengthening spleen, and harmonizing stomach were used for convalescence.
(IV) Phlegm-Heat Accumulation and Solidification, Diffusing Upper and Purging Lower: During the development of phlegm diseases such as chronic bronchitis, bronchial asthma, and pneumonia, if overly acrid-warming drugs are misused, or external pathogens enter the interior and transform into heat, phlegm-heat accumulation may occur. This leads to failure of lung qi to descend, intestinal excess, and blocked lung qi. Since the Lung and Large Intestine are exterior-interior related, loss of lung descending function causes large intestine transmission dysfunction; conversely, blocked fu-organ qi inevitably stagnates lung qi, worsening coughing and wheezing. For this, Dr. Li often employs methods to diffuse lung qi and purge intestinal excess, i.e., diffusing upper and purging lower, treating zang-fu organs together. He uses Xuanbai Chengqi Decoction or combined use of Xiongtang Decoction, Baihu Decoction, and Chengqi Decoction, achieving good results.
Case: Li, male, 48 years old, farmer. Recurrent coughing and wheezing for 10 years, aggravated with fever for 10 days. Ten years ago, he suffered from coughing and wheezing, worse in winter and spring, relieved by TCM antitussive and antiasthmatic agents. Ten days ago, he contracted rheumatism, with persistent fever, coughing, and wheezing. Several doses of prescribed medicines were ineffective, so he consulted Dr. Li. Current symptoms: High body heat, wheezing and coughing with rebellious qi, inability to lie flat; upon inquiry, he had not slept for two days; sputum is extremely yellow, thick, and foul-smelling; chest fullness; abdominal distension and urgency; unsmooth bowel movements. Thirsty, but dares not drink much due to abdominal fullness. Previous prescriptions consisted mainly of acrid-cool diffusing agents. Dr. Li stated: The disease is Wind-Warmth, and the medication matches the syndrome, yet it was ineffective because the patient has pre-existing fluid retention. Upon contracting warm pathogens, both interior and exterior are affected, making it more severe than usual. Secondly, this syndrome involves not only upper jiao obstruction and lung qi diffusion failure but also, based on tongue and pulse, intestinal-heat accumulation is a crucial factor. Treating only the upper part results in heavy disease and light medication, exacerbating wheezing and rebellious qi, due to ignorance of the "pulling firewood from under the cauldron" principle. With onset lasting over ten days, unsmooth bowels, and unresolved heat, treatment should diffuse upper, clear middle, and guide lower, integrating Xiongtang, Baihu, and Chengqi methods. This will eliminate phlegm-heat accumulation entirely; otherwise, the disease will linger, potentially becoming abscesses or life-threatening. Thus, imitating Xuanbai Chengqi Decoction method, using Whole Trichosanthes Fruit (Quangualou, 全瓜蒌) 15g, Raw Apricot Seed (Sheng Xingren, 生杏仁) 10g, Raw Gypsum (Sheng Shigao, 生石膏) 30g, Inula Flower (Xuanfuhua, 旋覆花) wrapped in cloth 10g, Fritillaria Bulb (Chuanbei, 川贝) 10g, Loquat Leaf (Pipaye, 枇杷叶) 15g, White Antennaria (Baiqian, 白前) 10g, Roasted Aster Root (Zhi Ziwan, 炙紫菀) 10g, Fried Lepidium Seed (Tongli Zi, 葶苈子) 10g, Scutellaria Root (Huangqin, 黄芩) 10g. Decoct in water. Additionally, Raw Rhubarb (Sheng Dahuang, 生大黄) 15g is soaked in boiling water, and the juice is divided into three doses and mixed with the decoction. After two doses, significant watery diarrhea occurred, containing hard feces; wheezing and rebellious qi largely subsided, chest and abdomen softened, heat gradually decreased, pulse became harmonious, thirst and yellow tongue coating reduced. However, copious sputum with foul odor persisted. Therefore, Zhuye Shigao Decoction minus Pinellia Tuber (Banxia, 半夏) was combined with Qianjin Weijing Decoction plus Fritillaria Bulb (Chuanbei, 川贝), Inula Flower (Xuanfuhua, 旋覆花), Loquat Leaf (Pipaye, 枇杷叶), Trichosanthes Peel (Gualou Pi, 瓜蒌皮), White Antennaria (Baiqian, 白前), Aster Root (Ziwan, 紫菀), Honeysuckle Stem (Jinteng, 忍冬藤), Dandelion (Gongying, 蒲公英), Houttuynia (Yuxingcao, 鱼腥草), Tangerine Leaf (Juye, 橘叶), and Tangerine Network (Jieluo, 橘络). This formula diffuses lungs, promotes descending, reduces rebellion, resolves phlegm, clears heat, and detoxifies. After approximately 20 doses with modifications, the illness resolved.
In treating chronic coughing and wheezing, Dr. Li skillfully uses classical and contemporary formulas, flexibly modifying them based on syndrome differentiation. Sometimes, simple and potent small prescriptions achieve efficacy. For instance, while supervising students in Fengdian, a child with bronchopneumonia had high fever for over a month and persistent coughing and wheezing. Ampicillin anti-inflammatory treatment was ineffective. The child presented with burning skin, irritability, coughing and wheezing with rebellious qi, yellow-thick sputum difficult to expectorate, breathing difficulty, red tongue with yellow-greasy coating, and slippery-rapid pulse. Dr. Li diagnosed phlegm-heat obstructing the lungs with loss of diffusion and descending functions. He used a simple small prescription: Aged Arisaema Cum Bile (Chen Danning, 陈胆星) 6g and Houttuynia (Yuxingcao, 鱼腥草) 30g decocted in water. After five doses, fever subsided, and coughing/wheezing ceased. Subsequent treatment with lung-clearing, phlegm-resolving, spleen-strengthening, and stomach-harmonizing agents led to recovery. This method proved effective for similar cases later.
VI. Experience in Differentiating and Treating Chronic Hepatitis: Chronic hepatitis belongs to the categories of hypochondriac pain, jaundice, and deficiency consumptive disease in TCM. Dr. Li achieves good clinical effects using syndrome differentiation and treatment.
(I) Liver-Gallbladder Damp-Heat, Clearing Heat and Resolving Dampness: Acute hepatitis persisting without cure, or chronic progressive liver disease with recurrent active lesions, accompanied by obvious digestive dysfunction and severe biliary dysfunction, easily leads to damp-heat accumulation steaming the liver and gallbladder. This causes liver failure to soothe and discharge, qi mechanism obstruction, bile overflow, forming liver-gallbladder damp-heat syndrome. Clinical manifestations include distending pain in right hypochondrium, abdominal fullness, fever and bitter taste in mouth, thirst with desire to drink or drinking little, anorexia and aversion to oil, nausea and vomiting, yellowing of body and eyes (or no jaundice), yellow-red urine, fatigue, sticky/foul/unsmooth stools or dry constipation, red tongue with yellow-greasy coating, and wiry-slippery-rapid pulse. Treatment should clear and drain damp-heat, promote bile flow, and resolve jaundice. Medicines include Yinchen (Artemisiae Scopariae Herba), Zhizi (Gardeniae Fructus), Dahuang (Rhei Radix et Rhizoma), Fuling (Poria), Zhuling (Polyporus), Maogen (Imperatae Rhizoma), Cheqiancao (Plantaginis Herba), Huzhang (Polygoni Cuspidati Rhizoma et Radix), Huangbai (Phellodendri Cortex), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Chishao (Paeoniae Radix Rubra), Xiangyuapi (Citri Reticulatae Pericarpium), Yujin (Curcumae Radix), etc. If liver qi stagnation causes abdominal distension, add Chaihu (Bupleuri Radix), fried Zhiqiao (Aurantii Fructus), Houpo (Magnoliae Officinalis Cortex), Dafupi (Arecae Pericarpium) to soothe liver and move qi; if qi stagnation and blood stasis cause stabbing hypochondriac pain, add Jinlingzi (Meliae Semen), Yuanhusuo (Corydalis Rhizoma), Taoren (Persicae Semen), Meiguihua (Rosae Rugosae Flos) to move qi and invigorate blood; if poor appetite, nausea, and spleen-stomach disharmony exist, add Zhuru (Bambusae Caulis in Taenia), fried Shenqu (Massae Fermentatae Medicamentae), fried Erya (Hordei Fructus Germinatus) or Sanxian (Three Fried Grains) to harmonize stomach, direct rebellious qi downward, and stop vomiting; if damp-heat accumulates internally causing short red urine with burning sensation, add Mutong (Akebiae Caulis), Huashi (Talcum), Longdancao (Gentianae Radix), Jinqiancao (Lysimachiae Herba) to drain heat, promote urination, and relieve strangury; if damp-heat stagnation blocks fu-organ qi causing constipation, increase Dahuang dosage and add appropriate amount of Mangxiao (Natrii Sulfas) to be taken with water to purge stagnation. Dr. Li believes liver-gallbladder damp-heat is common in chronic hepatitis. Key treatment involves resolving jaundice and lowering transaminases. According to his experience, combining Yinchen and Dahuang effectively resolves jaundice. Yinchen, Banlangen (Isatidis Radix), Huzhang, Lianqiao (Forsythiae Fructus), Longdancao, Nuodaogen (Glucosidis Glutinosa Radix), Baiwei (Cleistanthi Radix) and other heat-clearing, detoxifying herbs, along with Wuweizi (Schisandrae Chinensis Fructus), effectively lower transaminases. For damp-heat accumulation, heat-clearing, detoxifying herbs are preferred; for deficient constitution with mild damp-heat, Wuweizi is suitable. Additionally, damp-heat accumulation often involves heat-toxin stagnation blocking intestines, causing fu-organ blockage, easily leading to yin injury, bleeding, or pathogen sinking into pericardium. Thus, clinically, clearing the intestines promptly using purgative methods, heavily using Dahuang or Chengqi Decoction-like formulas, allows toxin expulsion via stool, hoping to halt disease progression.
Page 209 Vol 3 Case: Meng, female, 38 years old, worker. First visit March 19, 1993. Hypochondriac distension, poor appetite, and fatigue for 1 year; yellowing of body and eyes for 20 days. One year ago, improper diet led to pathogenic invasion, causing hypochondriac discomfort, poor appetite, and fatigue. Local hospital liver function tests: GPT 30 U/Lait氏, HBV-M: HBsAg, Anti-HBc, HBeAg all positive. Treated with Inosine tablets, ATD tablets, and TCM heat-clearing, detoxifying, liver-soothing, depression-relieving agents, with fluctuating results. Over the past month, excessive labor caused hypochondriac distension, jaundice, yellow urine, anorexia, and oil aversion. Outpatient liver function tests: TB 2.0 mg/dl, IB 5 μmol/L, ALT 60 U/Lait氏. HBV-M same as before. Diagnosed with chronic active hepatitis. Treated with hepatoprotective agents and infusion for half a month without improvement. Current signs: Jaundice of body and eyes, deep yellow urine like strong tea, hypochondriac discomfort, anorexia, nausea, oil aversion, dark red tongue with slightly greasy yellow coating, wiry-thin pulse. Syndrome differentiation: Internal damp-heat accumulation steaming liver and gallbladder, abnormal dispersion and excretion, bile overflowing. Treatment: Clear heat, resolve dampness, promote bile flow, resolve jaundice. Prescription: Yinchen (Artemisiae Scopariae Herba) 30g, fried Zhizi (Gardeniae Fructus) 10g, Fuling (Poria) 30g, Zexie (Alismatis Rhizoma) 10g, Zhuling (Polyporus) 15g, fried Zhuru (Bambusae Caulis in Taenia) 10g, Yujin (Curcumae Radix) 10g, Chenpi (Citri Reticulatae Pericarpium) 10g, Chishao (Paeoniae Radix Rubra) 30g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 30g, Baishe Shecao (Hedyotis Diffusae Herba) 30g, fried Shanzha (Crataegi Fructus) 15g.
Second visit: After taking the above prescription for over 20 doses, jaundice resolved, appetite improved, liver function normalized, but HBsAg, Anti-HBc, HBeAg remained positive. Urine pale yellow, red tongue with thin dry yellow coating, fine-wiry pulse. Damp-heat not fully cleared, with signs of heat damaging yin. Treatment: Continue previous method, appropriately adding heat-clearing and fluid-generating herbs. Prescription: Yinchen (Artemisiae Scopariae Herba) 30g, fried Zhizi (Gardeniae Fructus) 10g, Chishao (Paeoniae Radix Rubra) and Baishao (Paeoniae Radix Alba) 15g each, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 18g, Sheye Cao (Hedyotis Diffusae Herba) 30g, Baijiangcao (Patriniae Herba) 30g, Zhi Xiangfu (Cyperi Rhizoma) 10g, Xiangyuapi (Citri Reticulatae Pericarpium) 10g, fried Shanzha (Crataegi Fructus) 15g, Ju Pi (Citri Reticulatae Pericarpium) 10g, Maogen (Imperatae Rhizoma) 18g, Lugeng (Reedi Rhizoma) 30g. Taken continuously for 10 doses, jaundice completely retreated, urine clear and smooth. Only mental fatigue and limb weakness after exertion remained, with dark red tongue substance, thin yellow coating, wiry-thin pulse.
Treatment then focused on clearing heat, detoxifying, regulating qi, invigorating blood, strengthening spleen, and tonifying qi. After over 140 doses with modifications, all symptoms disappeared, liver function normalized, and HBsAg, Anti-HBc, HBeAg rechecked negative. Disease cured. Six-month follow-up showed no recurrence.
(II) Liver Stagnation and Spleen Deficiency, Soothing Liver and Strengthening Spleen: In the recovery stage of chronic hepatitis, liver qi stagnation and abnormal dispersion can invade the spleen, causing spleen transport dysfunction, commonly presenting as liver stagnation and spleen deficiency syndrome. Clinical manifestations include distending pain in right hypochondrium, chest tightness with frequent sighing, mental depression or irritability, reduced appetite, epigastric/fullness, limb fatigue, shortness of breath and reluctance to speak, loose stools, borborygmus and flatus, pale tongue with white coating, and deep-thin or wiry-thin pulse. Treatment should soothe liver, resolve stagnation, strengthen spleen, and tonify qi. Medicines include Chaihu (Bupleuri Radix), Baishao (Paeoniae Radix Alba), Danggui (Angelicae Sinensis Radix), Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Xiangfu (Cyperi Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), etc. If qi stagnation and blood stasis cause obvious hypochondriac pain, add Yuanhu (Corydalisis Rhizoma), Chishao (Paeoniae Radix Rubra), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Chuanlian (Meliae Fructus) to move qi and invigorate blood; if severe anorexia, abdominal distension, and epigastric fullness exist, add Zhiqiao (Aurantii Fructus), Houpo (Magnoliae Officinalis Cortex), Laifuzi (Raphani Semen), Dafupi (Arecae Pericarpium), Loupi (Trichosanthis Pericarpium) to regulate qi and dissipate fullness; if spleen deficiency causes diarrhea, add Gegen (Puerariae Lobatae Radix), Chuanlian (Coptidis Rhizoma), Muxiang (Aucklandiae Radix), Yiren (Coicis Semen), Sharen (Amomi Fructus) to clear heat, strengthen spleen, and stop diarrhea; if damp-heat accumulates internally causing bitter taste and yellow urine, add Yinchen (Artemisiae Scopariae Herba), Baijiangcao (Patriniae Herba), Sheye Cao (Hedyotis Diffusae Herba) to clear heat and resolve dampness; if liver-kidney yin deficiency causes dry mouth and throat, red tongue with little moisture, add Shengdi (Rehmanniae Radix), Maidong (Ophiopogonis Radix), Gouqi (Lycii Fructus) to nourish liver and kidney; if qi and blood deficiency exist, add Shudi (Rehmanniae Radix Preparata), Dangshen (Codonopsis Radix), Huangqi (Astragali Radix) to tonify blood and qi. Dr. Li believes liver stagnation and spleen deficiency syndromes often have mixed patterns, so one must not rigidly stick to one method or formula but adjust medications according to syndrome changes. For example, if liver fails to soothe and spleen fails to transport, water-dampness may accumulate causing distension; treatment should soothe liver, regulate qi, remove dampness, and dissipate fullness, using Chaihu Shugan San combined with Weiling Tang modified. If liver stagnation persists and transforms into heat, treatment should primarily soothe liver, strengthen spleen, and clear heat, using Xiaoyao San plus Longdancao (Gentianae Radix), Huangqin (Scutellariae Radix). Based on specific syndromes and laboratory indicators, some Chinese herbs with enzyme-lowering, turbidity-reducing, jaundice-resolving, and immune-regulating effects can be selected, such as Baishe Shecao (Hedyotis Diffusae Herba), Xiakucao (Prunellae Spica), Tufuling (Smilacis Glabrae Rhizoma), Yinchen (Artemisiae Scopariae Herba), Chishao (Paeoniae Radix Rubra), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Yujin (Curcumae Radix), Renshen (Ginseng Radix), Huangjing (Polygonati Rhizoma), to improve clinical efficacy.
Case: Li, male, 12 years old, student. First visit December 11, 1992. Recurrent abdominal distension and poor appetite for 6 years. Six years ago, unclean diet caused epigastric distension and gas, reduced appetite. Local hospital liver function tests: GPT 40 U/Lait氏, HBsAg, HBeAg, HBcAb all positive, diagnosed with Hepatitis B. Treated with Inosine tablets, ATP tablets, and TCM Hepatitis Chunhe Decoction, with fluctuating results. Introduced to consultation, presenting with sallow complexion, sluggish appetite, slight abdominal distension, irritability, yellow urine, pale red tongue with thin white coating, fine-wiry pulse. Liver function: GPT 45 U/Lait氏, HBV-M same as before. Diagnosis: Liver qi stagnation, spleen deficiency with failed transportation, complicated by damp-heat. Treatment: Soothe liver, regulate qi, strengthen spleen, tonify qi, clear heat, resolve dampness, detoxify. Prescription: Taizishen (Codonopsis Radix) 10g, Wuweizi (Schisandrae Chinensis Fructus) 6g, Chaihu (Bupleuri Radix) 6g, Yunling (Poria) 15g, fried Baizhu (Atractylodis Macrocephalae Rhizoma) 10g, Danggui (Angelicae Sinensis Radix) 6g, Chishao (Paeoniae Radix Rubra) and Baishao (Paeoniae Radix Alba) 15g each, Chenpi (Citri Reticulatae Pericarpium) 10g, Sheye Cao (Hedyotis Diffusae Herba) 18g, Huzhang (Polygoni Cuspidati Rhizoma et Radix) 10g, fried Shanzha (Crataegi Fructus) 12g, Lianqiao (Forsythiae Fructus) 12g, fried Ernya (Hordei Fructus Germinatus) 15g. Second visit: After taking the above prescription for over 30 doses, complexion became ruddy, abdominal distension alleviated, appetite improved, but slight epigastric discomfort after meals remained, red tongue with thin white coating, wiry-thin pulse. Adhering to previous method, appropriately added qi-tonifying, yin-nourishing, stomach-harmonizing, and stagnation-resolving herbs. Prescription: Taizishen (Codonopsis Radix) 10g, Maidong (Ophiopogonis Radix) 6g, Wuweizi (Schisandrae Chinensis Fructus) 6g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 15g, fried Shenqu (Massae Fermentatae Medicamentae) 10g, fried Shanzha (Crataegi Fructus) 12g, Ji Neijin (Galli Gigerii Endothelium Corneum) 6g, Yujin (Curcumae Radix) 6g, Chenpi (Citri Reticulatae Pericarpium) 10g, Huzhang (Polygoni Cuspidati Rhizoma et Radix) 12g, Guanzhong (Dryopteridis Crassirhizoma Rhizoma) 10g, Sheye Cao (Hedyotis Diffusae Herba) 10g, Lianqiao (Forsythiae Fructus) 10g, Fushen (Poria cum Radix) 15g, Maogen (Imperatae Rhizoma) 15g. After over 150 doses with modifications, abdominal distension disappeared, appetite vigorous, complexion lustrous, urination and defecation smooth, liver function normal, HBsAg, HBeAg, HBcAb all negative. Ten-month follow-up showed no recurrence.
(III) Liver-Kidney Yin Deficiency, Nourishing Liver and Kidney: Diseases such as jaundice and hypochondriac pain, persisting for a long time, with unresolved damp-heat transforming into heat, consuming yin-blood, or due to excessive attack, or misuse of acrid-warming drugs, easily damage fluids and yin, leading to liver-kidney yin deficiency. Symptoms include dull pain in right hypochondrium, poor appetite, dry mouth and throat, insomnia with many dreams, five-palm heat, soreness and weakness of waist and knees, or dark complexion, gum and nasal bleeding, red tongue with little coating or cracks, fine-rapid-weak, fine-weak, or empty-wiry pulse. Treatment should nourish liver and kidney, soothe liver, and regulate qi, allowing liver yin to be nourished, liver qi to flow smoothly, and body to recover. Medicines include Shengdi (Rehmanniae Radix), Shashen (Glehniae Radix), Gouqi (Lycii Fructus), Maidong (Ophiopogonis Radix), Danggui (Angelicae Sinensis Radix), Chuanlianzi (Meliae Fructus), Zhi Shouwu (Polygoni Multiflori Preparated Radix), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), etc. If internal heat causes dry mouth and crimson tongue with little moisture, add Xuanshen (Scrophulariae Radix), Shihu (Dendrobii Caulis), Lugeng (Reedi Rhizoma) to clear heat and generate fluids; if heat disturbs mind causing irritability, add Chuanlian (Coptidis Rhizoma), fried Zhizi (Gardeniae Fructus), Chaihu (Bupleuri Radix) to clear heat and relieve irritability; if damp-heat accumulates internally causing difficult urination, add Zhuling (Polyporus), Zexie (Alismatis Rhizoma), Maogen (Imperatae Rhizoma) to promote urination; if poor appetite and abdominal distension exist, add Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), fried Sanxian (Three Fried Grains) to strengthen spleen, regulate qi, and harmonize stomach; if gum and nasal bleeding occur, add Xianhecao (Agrimoniae Herba), Baimaogen (Imperatae Rhizoma), Sanqi Fen (Notoginseng Powder) to cool blood and stop bleeding; if insomnia with many dreams exists, add fried Zaoren (Ziziphi Spinosae Semen), Hehuanpi (Albiziae Cortex), Yejiaoteng (Polygoni Multiflori Caulis) to nourish heart and calm spirit.