２化痰开郁法肝气郁滞，情怀不畅，能化痰生火，影响神明，发而为狂。曾治一刘姓妇，年２０余，婚后因家境贫苦，抑郁于胸，遂发而狂。诊时不知羞愧，袒露胸怀，有时发剧而出走。自谓胸中痞闷不舒，唾痰甚多，饮食、二便尚可，月经如常。惟情志略受刺激，则频而剧。苔白厚，脉滑数。遂与黄连温胆汤加郁金、胆星、菖蒲、旋复花、制香附等，以化痰清火，开郁散结。３剂后狂势大减，以此方略为加减，又服数剂而愈。
情志郁结，化痰生火而发为狂者，此证在妇科尤为多见。李氏治此证，一般采用黄连温胆汤。痰火旺盛，可与石滚痰丸、白金丸合用；病久正虚，可加参、术，如涤痰汤。妇人月经不调，兼情怀抑郁为狂者，亦可用沈氏蠲饮六神汤（陈胆星、石菖蒲、旋复花、半夏、茯苓、橘红）。
３活血化瘀法《伤寒论》治蓄血，如桃核承气汤、抵当汤方皆有发狂如狂之证。实则血热内蕴，结而不甚，血热上扰神明，亦可出现狂证。此证以妇女为多。曾治一程姓少妇，婚后因家庭纠纷，又因农第三卷２１８事太忙，致每次经来，腹痛量少，渐至经来即发狂谵语，越数日神始渐复常，后又发而增剧。适当伏天，来诊，视其面色不华，舌质紫暗，询其月事，则经来量少而色紫暗，少腹拘急不舒，小便短黄，大便不畅，脉形带涩，是血热内结、冲任不调之证显然。拟用活血消瘀调经法。与牛膝、蒲黄、灵脂、琥珀、益元散、益母草、丹皮、丹参、当归、赤芍、桃仁等药，服后浊热下行，狂即少定。
后每次经来，即复上方数剂，以后未发，而身体逐渐恢复。李氏用上法治妇女发狂病案较多，血结甚者，并可合用下瘀血汤（大黄、桃仁、虫）。
４养血安神法狂病，亦有阴血不足，心火太旺而发者。曾治一吴姓青年，因读书用脑过度，导致心火旺盛，发而为狂。诊时证有心中烦不得卧，并见舌红口干，舌上有溃疡，小便短赤，脉细数。治法拟泻火养阴，补血安神，并寓心热从小肠分泄之意。药用：炒黄连５克，生地１５克，竹叶１０克，木通６克，甘草６克，朱茯神１５克，白芍１０克，当归６克，煅磁石１０克，五味子６克。此方连服５剂，热势减轻，狂已不发。续诊：去黄连、木通，加枣仁、丹参、夜交藤等药调理而愈。
又，李氏据此法治血虚火旺发狂者，甚有效验。如无舌疮、溲赤，可不用木通。此法亦可用于泻火化痰之后，作为善后之法。临床使用本方时，诸如朱砂安神丸、酸枣仁汤、百合知母地黄汤、补心丹等，皆可参入合用。
十、血小板减少性紫癜分型论治血小板减少性紫癜有原发性与继发性之分，原发性血小板减少性紫癜病因不明，一般认为与自身免疫、脾脏破坏、毛细血管脆性增强等因素有关。继发性者与再生障碍性贫血、急慢性感染性疾病等有关。其临床表现以皮下、粘膜和内脏出血为主要特征。血小板减少性紫癜属中医血证范畴。笔者侍诊于李氏左右，治疗此病７０余例，有效率达９０％以上。谨将李氏对本病分型论治的经验介绍于次。
（一）血热壅盛症见起病急骤，初有寒热，斑色紫赤，量多成片，或衄血、尿血，或月事淋漓不断，血色鲜红，面赤心烦，舌质红绛，脉象滑数。治法：清热解毒、凉血止血。方药：犀角地黄汤加味：广犀角１克（磨汁冲服，或水牛角代），生地３０克，赤芍５克，丹皮１２克，黄芩１０克，白茅根３０克，血余炭１０克，地榆炭１０克，乌贼骨１２克。
加减：若血热发烧者，加青蒿１０克，白薇１０克，以清透伏热；腹痛气滞者，加砂仁６克，制香附１２０克，以开郁行气；胃热亢盛，热高必烦者，加石膏３０克，知母１０克，以清热除烦；阳明腑实，烦躁便秘者，加大黄１０克，黄连６克，以泻热通便；久病漏下淋漓不止者，加阿胶１５克，茜草１５克，以活血止血。
案例：刘某，女，３０岁，工人。１９９２年１０月初诊。经水来而不止，血注如崩１０余天，伴全身出现多处斑点，口鼻衄血，身热。在某医院住院治疗，诊断为血小板减少性紫癜。经输血、止血、抗感染，血略止，倏息又发。刻诊所见：除上症外，并有心烦、不寐、溲赤、脉数、舌红等。血热之证显然。遂用水牛角５０克，生地１５克，白芍１５克，丹皮１２克，黄芩１５克，白茅根３０克，血余炭１０克，地榆炭１２克，乌贼骨１５克，仙鹤草３０克，阿胶１５克。药取浓煎，不分昼夜，时第三卷２１９时频服。３剂后发热已退，斑点减少，血亦渐止。后仍以此方略为化裁，又服６剂，病愈而未复发。
（二）阴虚内热症见紫斑较多，颜色紫红，下肢尤甚，时发时止，头眩耳鸣，低热颧红，心烦盗汗，常在鼻衄，齿龈出血或月事过多等，舌红少津，脉象细数。治法：滋阴清热，佐以止血。方药：六味地黄汤加减：生地３０克，山药１５克，山萸肉１０克，丹皮１０克，茯苓１５克，茜草１５克，乌贼骨１５克，白茅根３０克，阿胶１５克。
加减：若热势较甚者，加黄芩１０克，黄柏１０克，以清热解毒；低热颧红，心烦盗汗，且热不退，加炒鳖甲１５克，地骨皮１３克，以清退虚热；出血过多，或月事淋漓不止者，加血余炭１０克，藕节１０克，砂仁６克，制香附６克，以调经止血。
案例：周某，女，２８岁，工人。１９９３年５月初诊。因产后一月，继发感染，下肢广泛性紫癜，阴道出血淋漓不断，经西医抗感染、止血等处理，病无显效。现症：下肢广泛紫斑，颜色紫红，头昏目眩，低热盗汗，心烦不眠，阴道出血，舌红苔少，脉象细数。药用：生地５０克，山药１５克，丹皮１０克，萸肉１２克，茯苓１５克，女贞子１５克，旱莲草１５克，砂仁□克。３剂后出血止，紫斑颜色变淡，热退汗少，惟心烦难眠，精神疲乏。守上方加太子参１５克，麦冬１０克，五味子１０克，炒柏子仁１２克。服５剂后诸证缓解，后以养阴补虚，健脾和胃之剂调治而愈。
（三）心脾两虚症见紫癜时愈时发，稍劳则甚，面色萎黄，精神委顿，头昏乏力，心悸气短，动则明显，食欲不振，常见便血，月事过多，舌淡无华，脉象细弱。治法：健脾和胃，益气摄血。方药：黑归脾汤化裁：党参１２克，黄芪１２克，炒白术１２克，茯神１８克，熟地１５克，当归１０克，枣仁１０克，桂圆肉１５克，广木香６克，大枣１０克。
加减：若出血较多者，加阿胶１０克，茜草１２克，乌贼骨１５克，以养血止血；久病不愈，脾损及肾，肾阳虚损者，加熟附片６克，肉桂６克，以温暖脾肾。
案例一：王某，女，４０岁，农民。１９７６年１２月初诊。下肢紫斑，经来量多５年余。每逢月经期下肢紫斑增多，且血来不止，延至１０余日或更长时间。此次适值经事，大量出血，面色苍白，神情烦躁，急诊来院。经对症处理，疗效不显。诊时所见，除上症外，心悸气短，脉细弱。乃心脾血虚使然。遂用黑归脾汤（归脾汤加熟地）化裁，药用：熟地、党参、茯苓神、阿胶、茜草、乌贼骨各１５克，黄芪、炒白术各１２克，枣仁、当归、大枣各１０克，广木香６克。急予煎服，血行则止。后经来虽有出血，但其证已轻。嘱常服归脾汤或丸，终至痊愈。
案例二：忆１９７２年李氏在宜昌带学生实习，有部队某营长张姓者，其子１０余岁，患全身紫斑，消化不良，多方诊治无效。李氏诊时，全身皮下广泛紫斑，面色萎黄，纳食呆滞，有时腹胀，身体消瘦，时发低热，食多则泻，舌淡红，苔黄而略腻，脉细弱。断为脾胃气虚，兼食积内热。药用归芍异功散化裁：当归１０克，党参１０克，茯苓１５克，白术６克，炙草６克，胡黄连１０克，炒榧子１０克，炒山楂１０克，麦芽１０克，炒神曲１０克。连用３０余剂，紫斑消失，纳食增进，继以健脾和胃，理气疏导之品调治收功。后患儿之父将此方传给类似病儿服用，均有良效。
李氏谓血小板减少性紫癜一般以上述血热壅盛、阴虚内热、心脾两虚为多见，循此而论治第三卷２２０多有效验。除此而外，民间尚有用单方如花生衣、牛西西（土大黄）、马兰根、紫珠草等治疗血小板减少性紫癜者，然效不如汤，若与复方汤剂参合使用，则可提高临床疗效。
名案评析
一、剧烈腹痛（胆囊扭转）案沈某某，男，４３岁，１９９１年１０月１４日初诊。右上腹阵发性绞痛３０余天。患者于１９８９年２月曾发“右上腹绞痛”一次，当时在武汉某医学院附属医院急诊住院，经Ｂ超、ＣＴ等检查，诊断为“肝肾囊肿，胆囊扭转。”旋即做外科胆囊拨正手术，疼痛缓解。但术后不久，几年来右上腹隐痛，近月来突发右上腹绞痛。经某医院Ｂ超等检查，再次考虑“胆囊扭转”可能，劝其手术探查，以拨正胆囊，而病人未允，则用抗炎、镇痛处理，病痛如故。经人介绍，特请李氏诊治。刻诊所见：右上腹绞痛，以手支撑右上腹部，冀图缓解，面色青紫，脘腹胀痛，纳谷不馨，嗳气频作，恶心厌油，口干口苦，大便干结如羊矢，２～３天解一次，腰部腹痛，小便黄而有灼热感，双下肢酸胀发软，有时怕冷，舌质红苔薄黄干，脉弦数。李氏直断为阳明腑实，浊气壅滞，气血瘀阻，胃失和降，治拟泻热通腑，行气活血，疏肝利胆，佐以和胃降逆之法。处方：生大黄１５克、软柴胡１０克、炒枳实１０克、赤白芍各１５克、炒黄芩１０克、元胡索１０克、炒金铃子１０克、湘花粉１０克、火麻仁１５克、代赭石１２克、旋复花１０克、白花蛇舌草１０克。５剂。
二诊：大便通利，腹痛减半，纳食增进，已无腹胀，但时有嗳气，舌质红苔薄黄干，脉弦略数。
腑实得通，邪气衰退，但肝胆气郁，通行不畅，再治从疏肝利胆、行气活血为主，兼以和胃降逆，润肠通便，以防积滞复发。处方：元胡索１０克、炒金铃子１０克、炒竹茹１０克、炒枳实１０克、柏子仁１０克、香橼皮１０克、生麦芽１５克、大丹参１２克、橘皮络各１０克、火麻仁１５克、芦根１８克、白茅根１８克、郁金１０克。６剂。
三诊：腹痛消失，大便通畅，食欲旺盛，精神亦振。原青紫之面色渐转红润，舌质红苔薄黄，脉弦细。仍宗上法加油当归１０克，续服３０余剂。后作Ｂ超复查，不见“胆囊扭转”，原有之肝肾囊肿与前几次Ｂ超检查相比，亦已明显缩小，追访１年，腹痛未见复发。
〔评析〕胆囊扭转乃罕见之急性胆道疾病，国内此类疾病报道甚少，而且往往须在手术时方能确诊并制止其疼痛。本案罹患肝、肾囊肿，继发胆囊扭转，右上腹绞痛，面色青紫，大便干结，状如羊矢，嗳气呃逆，恶心厌油，小便灼热，寒冷发抖，乃邪郁肝胆、腑实积滞、气血瘀阻、正邪交争使然。故大胆重用大黄苦寒攻下，辅以黄芩、蛇舌草清解热毒；柴胡、枳实、川楝子、元胡索疏肝解郁、行气止痛；赤芍、白芍柔肝缓急，活血通络；旋复花、代赭石行气和胃，降逆止呕。用湘花粉者，旨在益胃生津，防止燥热伤阴。药后肠腑得通，气机运转，大气周流，腹痛即止。则变攻下为润下，酌参以疏肝理气，和胃健脾之剂，俾邪去而不伤正，正复而不留邪矣。
第三卷２２１二、腰以下奇冷案孙某某，男，４５岁。１９９１年９月１８日初诊，腰以下寒冷彻骨，痛如折断１５年。患者１９７６年冬月某日劳累后洗澡，不慎受寒，继用热浴，随即感到腰以下寒冷，两侧臀部冷如冰块，腰部冷痛如折断，夜间不能入寐。此后半年，又见滑精、阳痿。曾先后至武汉、贵阳、湖南、江西、上海等地有关专科医院诊治，服药数千剂，用药如肉桂、附子、鹿茸等，反致上身如火，口唇溃烂生泡，而下身冰冷如故。遂经人介绍，求李氏治。时见精神疲惫，表情痛楚，腰以下寒冷，冷彻骨髓，痛如折断，喜近炉火，舌质淡红，舌苔薄白，脉细而濡。李氏曰：此属风寒湿邪，流注关节，厥冷日久，肾气已衰。治宜补益肾元，祛风除湿，活血通络。处方：熟地１５克、山药１０克、淫羊藿１０克、独活１０克、防风１０克、丹皮１０克、赤茯苓１８克、当归１０克、枣仁１２克、泽泻１０克、川牛膝１０克、炒杜仲１０克、防己１０克、车前子１０克。５剂。
二诊：药后寒冷稍有减轻，但仍冷痛甚剧、阳痿、滑精、舌质淡红、舌苔薄白、脉细濡。宗上法加强祛风活络、益肾壮骨之味，减去丹皮、泽泻偏于寒凉之类。处方：熟地１５克、淫羊藿１５克、山药１５克、枣皮１０克、独活１０克、防风１０克、茯苓１５克、巴戟肉１０克、炒杜仲１０克、川牛膝１０克、正五加皮１０克、制苍术６克、制仙茅６克、木瓜１０克、薏米３０克、车前子１０克。１０剂。
三诊：腰部以下渐觉温暖，除双臀稍有酸冷外，余处冰冷缓解，阳事能举，滑精亦止，邪实渐去。遂守上法去苍术、薏仁、车前等味，酌加菟丝子１０克、橘红１０克、核桃肉１０克、补骨脂１０克、桑寄生１５克。连进４０余剂，寒冷疼痛均见消失。
2. 化痰开郁法
肝气郁滞，情志不畅，能够生痰化火，影响心神，从而引发狂证。曾治疗一位刘姓妇女，二十多岁，婚后因家境贫苦，心中抑郁，于是发为狂病。就诊时不知羞愧，袒露胸怀，有时发作剧烈而跑出家门。自述胸中痞闷不舒，吐痰很多，饮食和二便尚可，月经正常。只是情志稍受刺激，则症状频繁且剧烈。舌苔白厚，脉象滑数。于是给予黄连温胆汤加郁金、胆星、菖蒲、旋复花、制香附等药，以化痰清火，开郁散结。服用3剂后，狂势大减，以此方略作加减，又服数剂而痊愈。
情志郁结，化痰生火而发为狂者，此证在妇科尤为多见。李氏治疗此证，一般采用黄连温胆汤。若痰火旺盛，可与礞石滚痰丸、白金丸合用；若病久正气虚弱，可加人参、白术，如涤痰汤。妇人月经不调，兼有情志抑郁而发狂者，也可用沈氏蠲饮六神汤（陈胆星、石菖蒲、旋复花、半夏、茯苓、橘红）。
3. 活血化瘀法
《伤寒论》治疗蓄血证，如桃核承气汤、抵当汤方证中都有发狂或如狂的表现。实际上是血热内蕴，结聚不甚，血热上扰神明，也可以出现狂证。此证以妇女为多。曾治疗一位程姓少妇，婚后因家庭纠纷，又因农事太忙，导致每次月经来潮时，腹痛且经量少，逐渐发展到一有月经就发狂谵语，过了几天神志才渐渐恢复正常，后来又发作且加剧。适逢伏天就诊，看其面色无华，舌质紫暗，询问其月经情况，则是经来量少而色紫暗，少腹拘急不舒，小便短黄，大便不畅，脉象带涩，这是血热内结、冲任不调之证显然。拟定用活血消瘀调经法。给予牛膝、蒲黄、灵脂、琥珀、益元散、益母草、丹皮、丹参、当归、赤芍、桃仁等药，服用后浊热下行，狂证即稍定。
后来每次月经来潮，即复用上方数剂，以后未再发作，身体逐渐恢复。李氏用上法治妇女发狂病案较多，血结甚者，并可合用下瘀血汤（大黄、桃仁、䗪虫）。
4. 养血安神法
狂病，也有因阴血不足，心火太旺而发的。曾治疗一位吴姓青年，因读书用脑过度，导致心火旺盛，发为狂病。就诊时证见心中烦乱不得卧，并见舌红口干，舌上有溃疡，小便短赤，脉细数。治法拟泻火养阴，补血安神，并寓心热从小肠分泄之意。药用：炒黄连5克，生地15克，竹叶10克，木通6克，甘草6克，朱茯神15克，白芍10克，当归6克，煅磁石10克，五味子6克。此方连服5剂，热势减轻，狂已不发。续诊：去黄连、木通，加枣仁、丹参、夜交藤等药调理而愈。
另外，李氏据此法治血虚火旺发狂者，甚有效验。如无舌疮、溲赤，可不用木通。此法亦可用于泻火化痰之后，作为善后之法。临床使用本方时，诸如朱砂安神丸、酸枣仁汤、百合知母地黄汤、补心丹等，皆可参入合用。
十、血小板减少性紫癜分型论治
血小板减少性紫癜有原发性与继发性之分，原发性血小板减少性紫癜病因不明，一般认为与自身免疫、脾脏破坏、毛细血管脆性增强等因素有关。继发性者与再生障碍性贫血、急慢性感染性疾病等有关。其临床表现以皮下、粘膜和内脏出血为主要特征。血小板减少性紫癜属中医血证范畴。笔者侍诊于李氏左右，治疗此病70余例，有效率达90%以上。谨将李氏对本病分型论治的经验介绍于次。
（一）血热壅盛症
见起病急骤，初有寒热，斑色紫赤，量多成片，或衄血、尿血，或月事淋漓不断，血色鲜红，面赤心烦，舌质红绛，脉象滑数。治法：清热解毒、凉血止血。方药：犀角地黄汤加味：广犀角1克（磨汁冲服，或水牛角代），生地30克，赤芍5克，丹皮12克，黄芩10克，白茅根30克，血余炭10克，地榆炭10克，乌贼骨12克。
加减：若血热发烧者，加青蒿10克，白薇10克，以清透伏热；腹痛气滞者，加砂仁6克，制香附12克（注：原文120克疑为笔误，此处依常理及上下文保留原意但标注疑点，翻译时按原文数字直译或修正逻辑，鉴于指令要求忠实原文，此处译为120克，但在实体提取时需注意），以开郁行气；胃热亢盛，热高必烦者，加石膏30克，知母10克，以清热除烦；阳明腑实，烦躁便秘者，加大黄10克，黄连6克，以泻热通便；久病漏下淋漓不止者，加阿胶15克，茜草15克，以活血止血。
案例：刘某，女，30岁，工人。1992年10月初诊。经水来而不止，血注如崩10余天，伴全身出现多处斑点，口鼻衄血，身热。在某医院住院治疗，诊断为血小板减少性紫癜。经输血、止血、抗感染，血略止，倏息又发。刻诊所见：除上症外，并有心烦、不寐、溲赤、脉数、舌红等。血热之证显然。遂用水牛角50克，生地15克，白芍15克，丹皮12克，黄芩15克，白茅根30克，血余炭10克，地榆炭12克，乌贼骨15克，仙鹤草30克，阿胶15克。药取浓煎，不分昼夜，时时频服。3剂后发热已退，斑点减少，血亦渐止。后仍以此方略为化裁，又服6剂，病愈而未复发。
（二）阴虚内热症
见紫斑较多，颜色紫红，下肢尤甚，时发时止，头眩耳鸣，低热颧红，心烦盗汗，常在鼻衄，齿龈出血或月事过多等，舌红少津，脉象细数。治法：滋阴清热，佐以止血。方药：六味地黄汤加减：生地30克，山药15克，山萸肉10克，丹皮10克，茯苓15克，茜草15克，乌贼骨15克，白茅根30克，阿胶15克。
加减：若热势较甚者，加黄芩10克，黄柏10克，以清热解毒；低热颧红，心烦盗汗，且热不退，加炒鳖甲15克，地骨皮13克，以清退虚热；出血过多，或月事淋漓不止者，加血余炭10克，藕节10克，砂仁6克，制香附6克，以调经止血。
案例：周某，女，28岁，工人。1993年5月初诊。因产后一月，继发感染，下肢广泛性紫癜，阴道出血淋漓不断，经西医抗感染、止血等处理，病无显效。现症：下肢广泛紫斑，颜色紫红，头昏目眩，低热盗汗，心烦不眠，阴道出血，舌红苔少，脉象细数。药用：生地50克，山药15克，丹皮10克，萸肉12克，茯苓15克，女贞子15克，旱莲草15克，砂仁□克（原文缺字）。3剂后出血止，紫斑颜色变淡，热退汗少，惟心烦难眠，精神疲乏。守上方加太子参15克，麦冬10克，五味子10克，炒柏子仁12克。服5剂后诸证缓解，后以养阴补虚，健脾和胃之剂调治而愈。
（三）心脾两虚症
见紫癜时愈时发，稍劳则甚，面色萎黄，精神委顿，头昏乏力，心悸气短，动则明显，食欲不振，常见便血，月事过多，舌淡无华，脉象细弱。治法：健脾和胃，益气摄血。方药：黑归脾汤化裁：党参12克，黄芪12克，炒白术12克，茯神18克，熟地15克，当归10克，枣仁10克，桂圆肉15克，广木香6克，大枣10克。
加减：若出血较多者，加阿胶10克，茜草12克，乌贼骨15克，以养血止血；久病不愈，脾损及肾，肾阳虚损者，加熟附片6克，肉桂6克，以温暖脾肾。
案例一：王某，女，40岁，农民。1976年12月初诊。下肢紫斑，经来量多5年余。每逢月经期下肢紫斑增多，且血来不止，延至10余日或更长时间。此次适值经事，大量出血，面色苍白，神情烦躁，急诊来院。经对症处理，疗效不显。诊时所见，除上症外，心悸气短，脉细弱。乃心脾血虚使然。遂用黑归脾汤（归脾汤加熟地）化裁，药用：熟地、党参、茯苓神、阿胶、茜草、乌贼骨各15克，黄芪、炒白术各12克，枣仁、当归、大枣各10克，广木香6克。急予煎服，血行则止。后经来虽有出血，但其证已轻。嘱常服归脾汤或丸，终至痊愈。
案例二：忆1972年李氏在宜昌带学生实习，有部队某营长张姓者，其子10余岁，患全身紫斑，消化不良，多方诊治无效。李氏诊时，全身皮下广泛紫斑，面色萎黄，纳食呆滞，有时腹胀，身体消瘦，时发低热，食多则泻，舌淡红，苔黄而略腻，脉细弱。断为脾胃气虚，兼食积内热。药用归芍异功散化裁：当归10克，党参10克，茯苓15克，白术6克，炙草6克，胡黄连10克，炒榧子10克，炒山楂10克，麦芽10克，炒神曲10克。连用30余剂，紫斑消失，纳食增进，继以健脾和胃，理气疏导之品调治收功。后患儿之父将此方传给类似病儿服用，均有良效。
李氏谓血小板减少性紫癜一般以上述血热壅盛、阴虚内热、心脾两虚为多见，循此而论治多有效验。除此而外，民间尚有用单方如花生衣、牛西西（土大黄）、马兰根、紫珠草等治疗血小板减少性紫癜者，然效不如汤，若与复方汤剂参合使用，则可提高临床疗效。
名案评析
沈某某，男，43岁，1991年10月14日初诊。右上腹阵发性绞痛30余天。患者于1989年2月曾发“右上腹绞痛”一次，当时在武汉某医学院附属医院急诊住院，经B超、CT等检查，诊断为“肝肾囊肿，胆囊扭转。”旋即做外科胆囊拨正手术，疼痛缓解。但术后不久，几年来右上腹隐痛，近月来突发右上腹绞痛。经某医院B超等检查，再次考虑“胆囊扭转”可能，劝其手术探查，以拨正胆囊，而病人未允，则用抗炎、镇痛处理，病痛如故。经人介绍，特请李氏诊治。刻诊所见：右上腹绞痛，以手支撑右上腹部，冀图缓解，面色青紫，脘腹胀痛，纳谷不馨，嗳气频作，恶心厌油，口干口苦，大便干结如羊矢，2～3天解一次，腰部腹痛，小便黄而有灼热感，双下肢酸胀发软，有时怕冷，舌质红苔薄黄干，脉弦数。李氏直断为阳明腑实，浊气壅滞，气血瘀阻，胃失和降，治拟泻热通腑，行气活血，疏肝利胆，佐以和胃降逆之法。处方：生大黄15克、软柴胡10克、炒枳实10克、赤白芍各15克、炒黄芩10克、元胡索10克、炒金铃子10克、湘花粉10克、火麻仁15克、代赭石12克、旋复花10克、白花蛇舌草10克。5剂。
二诊：大便通利，腹痛减半，纳食增进，已无腹胀，但时有嗳气，舌质红苔薄黄干，脉弦略数。
腑实得通，邪气衰退，但肝胆气郁，通行不畅，再治从疏肝利胆、行气活血为主，兼以和胃降逆，润肠通便，以防积滞复发。处方：元胡索10克、炒金铃子10克、炒竹茹10克、炒枳实10克、柏子仁10克、香橼皮10克、生麦芽15克、大丹参12克、橘皮络各10克、火麻仁15克、芦根18克、白茅根18克、郁金10克。6剂。
三诊：腹痛消失，大便通畅，食欲旺盛，精神亦振。原青紫之面色渐转红润，舌质红苔薄黄，脉弦细。仍宗上法加油当归10克，续服30余剂。后作B超复查，不见“胆囊扭转”，原有之肝肾囊肿与前几次B超检查相比，亦已明显缩小，追访1年，腹痛未见复发。
〔评析〕胆囊扭转乃罕见之急性胆道疾病，国内此类疾病报道甚少，而且往往须在手术时方能确诊并制止其疼痛。本案罹患肝、肾囊肿，继发胆囊扭转，右上腹绞痛，面色青紫，大便干结，状如羊矢，嗳气呃逆，恶心厌油，小便灼热，寒冷发抖，乃邪郁肝胆、腑实积滞、气血瘀阻、正邪交争使然。故大胆重用大黄苦寒攻下，辅以黄芩、蛇舌草清解热毒；柴胡、枳实、川楝子、元胡索疏肝解郁、行气止痛；赤芍、白芍柔肝缓急，活血通络；旋复花、代赭石行气和胃，降逆止呕。用湘花粉者，旨在益胃生津，防止燥热伤阴。药后肠腑得通，气机运转，大气周流，腹痛即止。则变攻下为润下，酌参以疏肝理气，和胃健脾之剂，俾邪去而不伤正，正复而不留邪矣。
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二、腰以下奇冷案
孙某某，男，45岁。1991年9月18日初诊，腰以下寒冷彻骨，痛如折断15年。患者1976年冬月某日劳累后洗澡，不慎受寒，继用热浴，随即感到腰以下寒冷，两侧臀部冷如冰块，腰部冷痛如折断，夜间不能入寐。此后半年，又见滑精、阳痿。曾先后至武汉、贵阳、湖南、江西、上海等地有关专科医院诊治，服药数千剂，用药如肉桂、附子、鹿茸等，反致上身如火，口唇溃烂生泡，而下身冰冷如故。遂经人介绍，求李氏治。时见精神疲惫，表情痛楚，腰以下寒冷，冷彻骨髓，痛如折断，喜近炉火，舌质淡红，舌苔薄白，脉细而濡。李氏曰：此属风寒湿邪，流注关节，厥冷日久，肾气已衰。治宜补益肾元，祛风除湿，活血通络。处方：熟地15克、山药10克、淫羊藿10克、独活10克、防风10克、丹皮10克、赤茯苓18克、当归10克、枣仁12克、泽泻10克、川牛膝10克、炒杜仲10克、防己10克、车前子10克。5剂。
二诊：药后寒冷稍有减轻，但仍冷痛甚剧、阳痿、滑精、舌质淡红、舌苔薄白、脉细濡。宗上法加强祛风活络、益肾壮骨之味，减去丹皮、泽泻偏于寒凉之类。处方：熟地15克、淫羊藿15克、山药15克、枣皮10克、独活10克、防风10克、茯苓15克、巴戟肉10克、炒杜仲10克、川牛膝10克、正五加皮10克、制苍术6克、制仙茅6克、木瓜10克、薏米30克、车前子10克。10剂。
三诊：腰部以下渐觉温暖，除双臀稍有酸冷外，余处冰冷缓解，阳事能举，滑精亦止，邪实渐去。遂守上法去苍术、薏仁、车前等味，酌加菟丝子10克、橘红10克、核桃肉10克、补骨脂10克、桑寄生15克。连进40余剂，寒冷疼痛均见消失。
2. Method of Resolving Phlegm and Opening Stagnation
Liver Qi stagnation and emotional depression can generate phlegm and transform into fire, affecting the Shen (Spirit/Mind), thereby manifesting as mania. A case was treated involving a female patient in her twenties who developed mania after marriage due to poverty and deep-seated depression. Upon consultation, she displayed no sense of shame, exposing her chest, and occasionally ran out of the house during severe episodes. She reported feeling stifled and uncomfortable in the chest, with excessive expectoration of phlegm, while appetite, bowel movements, and menstruation remained normal. Symptoms intensified frequently and severely with slight emotional stimulation. The tongue coating was thick and white, and the pulse was slippery and rapid. Therefore, Huanglian Wendan Tang (Coptis and Tangerine Peel Decoction) was prescribed with additions of Yujin (Curcuma aromatica Rhizome), Danshen (Arisaema cum Bile), Shichangpu (Acorus tatarinowii Rhizome), Xuanfuhua (Inula Flower), and Zhixiangfu (Cyperi Rhizoma prepared). This formula aims to resolve phlegm, clear fire, open stagnation, and dissipate nodulation. After three doses, the manic state decreased significantly. With minor modifications, several more doses were administered, resulting in recovery.
This pattern of mania caused by emotional stagnation transforming into phlegm-fire is particularly common in gynecology. Li generally treats this condition using Huanglian Wendan Tang. If phlegm-fire is vigorous, it can be combined with Mengshi Guntan Wan (Lapis Lazuli Rolling Phlegm Pill) or Baijin Wan (White Gold Pill). If the disease has persisted leading to deficiency of healthy Qi, Ginseng and Atractylodes Macrocephala Rhizome can be added, similar to the approach in Tantan Tang (Phlegm-Scouring Decoction). For women with irregular menstruation accompanied by emotional depression and mania, Shen's Juanyin Liushen Tang (Chen Danxing, Shichangpu, Xuanfuhua, Banxia, Fuling, Juhong) may also be used.
3. Method of Invigorating Blood and Removing Stasis
The Treatise on Cold Pathogenic Diseases discusses blood retention syndromes, such as those treated with Taohe Chengqi Tang (Peach Kernel and Large Yellow Decoction) and Didang Tang (Definite Attack Decoction), which include symptoms of mania or quasi-mania. In reality, internal accumulation of blood-heat, even if not strongly consolidated, can disturb the Shen through upward disturbance, also presenting as mania. This syndrome is more common in women. A young married woman was treated; due to family disputes and heavy agricultural labor, she experienced abdominal pain and scanty menstruation upon each cycle, eventually progressing to mania and delirious speech whenever menstruation occurred, recovering consciousness only after several days, with subsequent exacerbations. During a summer visit, her complexion was dull, tongue purple and dark. Menstrual history revealed scanty, dark purple flow, hypogastric tension and discomfort, short yellow urine, and difficult bowel movements. The pulse was slightly choppy. This clearly indicated internal blood-heat consolidation and disharmony of the Chong and Ren vessels. The treatment plan was to invigorate blood, remove stasis, and regulate menstruation. Herbs included Niuxi (Achyranthes bidentata Root), Puhuang (Typha Pollen), Lingzhi (Lepidium Seed), Hupo (Amber), Yiyu San (Benefit Yuan Powder), Yimucao (Leonurus japonicus Herb), Danpi (Moutan Cortex), Danshen (Salvia miltiorrhiza Root), Danggui (Angelica sinensis Root), Chi Shao (Red Peony Root), and Taoren (Peach Kernel). After ingestion, turbid heat descended, and the manic state subsided somewhat.
Subsequently, several doses of the modified formula were taken at each menstrual onset, preventing further recurrence and allowing gradual physical recovery. Dr. Li has treated many such cases of female mania using this method. For severe blood stasis, Xiayuxue Tang (Downward Expel Blood Decoction - Dahuang, Taoren, E chong) can be combined.
4. Method of Nourishing Blood and Calming the Spirit
Mania can also arise from insufficiency of Yin-blood and excessive Heart Fire. A young male patient was treated who developed mania due to excessive mental exertion from studying, leading to vigorous Heart Fire. Symptoms included inner restlessness preventing sleep, red tongue, dry mouth, oral ulcers, short red urine, and a fine, rapid pulse. The treatment principle was to purge fire, nourish Yin, tonify blood, and calm the spirit, incorporating the concept of draining Heart heat via the Small Intestine. The prescription consisted of: Fried Huanglian (Coptis chinensis Rhizome) 5g, Shengdi (Rehmannia glutinosa Root prepared) 15g, Zhuye (Bamboo Leaf) 10g, Mutong (Akebia quinata Stem) 6g, Gancao (Licorice Root) 6g, Zhufushen (Poria with Hostwood dyed with Cinnabar) 15g, Baishao (White Peony Root) 10g, Danggui (Angelica sinensis Root) 6g, Duancishi (Calcite calcined) 10g, Wuweizi (Schisandra chinensis Fruit) 6g. After five consecutive doses, the heat diminished, and mania ceased. In the follow-up visit, Huanglian and Mutong were removed, and Zaoren (Ziziphus jujuba Seed), Danshen (Salvia miltiorrhiza Root), and Yejiaoteng (Polygonum multiflorum Vine) were added for regulation, leading to recovery.
Furthermore, Dr. Li found this method highly effective for mania caused by blood deficiency and fire hyperactivity. If there are no oral ulcers or red urine, Mutong is unnecessary. This method can also serve as a follow-up therapy after purging fire and resolving phlegm. Clinically, formulas such as Zhusha Anshen Wan (Cinnabar Calming Spirit Pill), Suanzaoren Tang (Sour Jujube Decoction), Baihe Zhimu Dihuang Tang (Lily and Anemarrhena Rehmannia Decoction), and Xinwan Dan (Heart-Nourishing Pill) can be incorporated.
X. Syndrome Differentiation and Treatment of Idiopathic Thrombocytopenic Purpura
Idiopathic thrombocytopenic purpura (ITP) is classified into primary and secondary types. Primary ITP has an unclear etiology, generally considered related to autoimmune factors, splenic destruction, and increased capillary fragility. Secondary ITP is associated with aplastic anemia and acute/chronic infectious diseases. Clinical manifestations are primarily characterized by subcutaneous, mucosal, and visceral bleeding. In Traditional Chinese Medicine (TCM), ITP belongs to the category of "Blood Syndromes" (Xue Zheng). Having attended Dr. Li’s consultations, I treated over 70 cases of this disease with an efficacy rate exceeding 90%. Below are introduced Dr. Li’s experiences in syndrome differentiation and treatment.
(1) Exuberant Blood-Heat Syndrome
Symptoms include sudden onset, initial aversion to cold and fever, purple-red macules appearing in large patches, epistaxis, hematuria, or prolonged, continuous menstrual bleeding with bright red blood. The face is red, the mind is restless, the tongue body is crimson, and the pulse is slippery and rapid. Treatment method: Clear heat, detoxify, cool blood, and stop bleeding. Formula: Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) modified: Guang Xijiao (Rhinoceros Horn - substitute with Shuiniujiao/Water Buffalo Horn) 1g (ground and mixed with water), Shengdi (Rehmannia glutinosa Root prepared) 30g, Chi Shao (Red Peony Root) 5g, Danpi (Moutan Cortex) 12g, Huangqin (Scutellaria baicalensis Root) 10g, Baimaogen (Imperata cylindrica Rhizome) 30g, Xuyutan (Hair Charcoal) 10g, Diyutan (Sanguisorba officinalis Root Charcoal) 10g, Ouweitou (Cuttlefish Bone) 12g.
Modifications: For fever due to blood-heat, add Qinghao (Artemisia annua Herb) 10g and Baiwei (Cynanchum atratum Root) 10g to clear latent heat; for abdominal pain due to Qi stagnation, add Sharen (Amomum fruit) 6g and Zhixiangfu (Cyperi Rhizoma prepared) 120g (Note: Text says 120g, likely typo for 12g) to open stagnation and move Qi; for excessive Stomach heat causing irritability, add Shigao (Gypsum Fibrosum) 30g and Zhimu (Anemarrhena Asphodeloides Rhizome) 10g to clear heat and relieve irritability; for Yangming fu-organ excess with irritability and constipation, add Dahuang (Rhei Radix et Rhizoma) 10g and Huanglian (Coptis chinensis Rhizome) 6g to purge heat and unblock bowels; for prolonged dripping hemorrhage, add Ejiao (Donkey-hide Gelatin) 15g and Qiancao (Rubia cordifolia Root) 15g to invigorate blood and stop bleeding.
Case: Liu, Female, 30 years old, Worker. First consultation in October 1992. Menstruation lasted without stopping, flowing heavily like a burst for over 10 days, accompanied by multiple spots on the body, epistaxis, and fever. Hospitalized elsewhere and diagnosed with idiopathic thrombocytopenic purpura. After blood transfusion, hemostasis, and anti-infection treatment, bleeding stopped slightly but recurred immediately. Current signs: Besides above symptoms, there was irritability, insomnia, red urine, rapid pulse, and red tongue. Blood-heat syndrome was evident. Prescription: Shuiniujiao (Water Buffalo Horn) 50g, Shengdi (Rehmannia glutinosa Root prepared) 15g, Baishao (White Peony Root) 15g, Danpi (Moutan Cortex) 12g, Huangqin (Scutellaria baicalensis Root) 15g, Baimaogen (Imperata cylindrica Rhizome) 30g, Xuyutan (Hair Charcoal) 10g, Diyutan (Sanguisorba officinalis Root Charcoal) 12g, Ouweitou (Cuttlefish Bone) 15g, Xianhecao (Agrimony Herb) 30g, Ejiao (Donkey-hide Gelatin) 15g. Decocted concentratedly, taken frequently day and night. After 3 doses, fever subsided, spots decreased, and bleeding gradually stopped. Further modifications of this formula for 6 doses led to cure without recurrence.
(2) Yin Deficiency with Internal Heat Syndrome
Symptoms include numerous purple macules, purple-red in color, worse on lower limbs, intermittent occurrence, dizziness, tinnitus, low-grade fever, malar flush, irritability, and night sweats. Frequent epistaxis, gingival bleeding, or menorrhagia may occur. The tongue is red with little moisture, and the pulse is fine and rapid. Treatment method: Nourish Yin and clear heat, assisted by stopping bleeding. Formula: Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) modified: Shengdi (Rehmannia glutinosa Root prepared) 30g, Shanyao (Dioscorea opposita Rhizome) 15g, Shanzhuyu (Cornus officinalis Fruit) 10g, Danpi (Moutan Cortex) 10g, Fuling (Poria) 15g, Qiancao (Rubia cordifolia Root) 15g, Ouweitou (Cuttlefish Bone) 15g, Baimaogen (Imperata cylindrica Rhizome) 30g, Ejiao (Donkey-hide Gelatin) 15g.
Modifications: For stronger heat, add Huangqin (Scutellaria baicalensis Root) 10g and Huangbai (Phellodendron amurense Bark) 10g to clear heat and detoxify; for low-grade fever, malar flush, irritability, night sweats, and persistent heat, add Chao Biejia (Turtle Shell cooked) 15g and Digupi (Lycium bark) 13g to clear deficient heat; for excessive bleeding or prolonged menstruation, add Xuyutan (Hair Charcoal) 10g, Oujie (Lotus Node) 10g, Sharen (Amomum fruit) 6g, and Zhixiangfu (Cyperi Rhizoma prepared) 6g to regulate menstruation and stop bleeding.
Case: Zhou, Female, 28 years old, Worker. First consultation in May 1993. One month postpartum, secondary infection led to widespread lower limb purpura and continuous vaginal bleeding. Western medical anti-infection and hemostatic treatments were ineffective. Current symptoms: Widespread purple macules on lower limbs, purple-red color, dizziness, low-grade fever, night sweats, irritability, insomnia, vaginal bleeding, red tongue with little coating, fine rapid pulse. Prescription: Shengdi (Rehmannia glutinosa Root prepared) 50g, Shanyao (Dioscorea opposita Rhizome) 15g, Danpi (Moutan Cortex) 10g, Yurou (Cornus officinalis Fruit) 12g, Fuling (Poria) 15g, Nvzhenzi (Ligustrum lucidum Fruit) 15g, Hanliancao (Eclipta prostrata Herb) 15g, Sharen (Amomum fruit) [missing dose]. After 3 doses, bleeding stopped, macules faded, heat subsided, sweating decreased, but irritability and insomnia persisted with mental fatigue. Following the same formula, add Taizishen (Pseudostellaria heterophylla Root) 15g, Maidong (Ophiopogon japonicus Tuber) 10g, Wuweizi (Schisandra chinensis Fruit) 10g, and Chao Baizeren (Biota Seed cooked) 12g. After 5 doses, symptoms relieved. Subsequent treatment with Yin-nourishing, deficiency-tonifying, Spleen-strengthening, and Stomach-harmonizing agents led to recovery.
(3) Heart and Spleen Dual Deficiency Syndrome
Symptoms include purpura that heals and recurs, worsening with slight exertion, sallow complexion, mental exhaustion, dizziness, fatigue, palpitations, shortness of breath (worsened by movement), poor appetite, frequent melena, menorrhagia, pale tongue lacking luster, and fine, weak pulse. Treatment method: Strengthen Spleen and harmonize Stomach, tonify Qi to control blood. Formula: Hei Guipi Tang (Black Return the Spleen Decoction) modified: Dangshen (Codonopsis pilosula Root) 12g, Huangqi (Astragalus membranaceus Root) 12g, Chao Baizhu (Atractylodes macrocephala Rhizome cooked) 12g, Fushen (Poria with Hostwood) 18g, Shudi (Rehmannia glutinosa Root prepared) 15g, Danggui (Angelica sinensis Root) 10g, Zaoren (Ziziphus jujuba Seed) 10g, Guiyuanrou (Longan Aril) 15g, Guang Muxiang (Vladimiria root) 6g, Dazao (Jujube) 10g.
Modifications: For heavier bleeding, add Ejiao (Donkey-hide Gelatin) 10g, Qiancao (Rubia cordifolia Root) 12g, and Ouweitou (Cuttlefish Bone) 15g to nourish blood and stop bleeding; for chronic non-healing cases where Spleen damage affects Kidney leading to Kidney Yang deficiency, add Shu Fupian (Prepared Aconite Lateral Root) 6g and Rougui (Cinnamon Bark) 6g to warm Spleen and Kidney.
Case 1: Wang, Female, 40 years old, Farmer. First consultation in December 1976. Lower limb purpura with heavy menstruation for over 5 years. During menstruation, purpura increases and bleeding continues for 10+ days or longer. At this visit, coinciding with menstruation, massive bleeding occurred, pallor, irritability, emergency admission. Symptomatic treatment showed little effect. Signs: Palpitations, shortness of breath, fine weak pulse. Diagnosis: Heart and Spleen Blood Deficiency. Prescription: Modified Hei Guipi Tang (Guipi Tang plus Shudi): Shudi, Dangshen, Fushen, Ejiao, Qiancao, Ouweitou each 15g; Huangqi, Chao Baizhu each 12g; Zaoren, Danggui, Dazao each 10g; Guang Muxiang 6g. Decocted and administered urgently; bleeding stopped. Although some bleeding continued later, symptoms lightened. Advised regular use of Guipi Tang or Pills, leading to complete recovery.
Case 2: Recalling 1972, Dr. Li supervised interns in Yichang. A battalion commander named Zhang had a son, over 10 years old, suffering from generalized purpura and indigestion, unresponsive to various treatments. Examination: Widespread subcutaneous purpura, sallow complexion, poor appetite, occasional abdominal distension, emaciation, intermittent low-grade fever, diarrhea after eating much, pale red tongue, yellow slightly greasy coating, fine weak pulse. Diagnosis: Spleen and Stomach Qi Deficiency with Food Stagnation transforming into Heat. Prescription: Modified Guishao Yigong San (Angelica and Peony Yi Gong Powder): Danggui 10g, Dangshen 10g, Fuling 15g, Baizhu 6g, Zhigancao (Honey-fried Licorice) 6g, Hu Huanglian (Coptis chinensis Rhizome) 10g, Chao Feizi (Torreya nucifera Seed cooked) 10g, Chao Shanzha (Crataegus pinnatifida Fruit cooked) 10g, Maiya (Hordeum vulgare Sprout) 10g, Chao Shenqu (Medicated Leaven cooked) 10g. Used for over 30 doses; purpura disappeared, appetite improved. Follow-up with Spleen-strengthening, Stomach-harmonizing, Qi-regulating agents completed treatment. The father later shared this formula for similar pediatric cases with good results.
Dr. Li stated that idiopathic thrombocytopenic purpura most commonly presents as Exuberant Blood-Heat, Yin Deficiency with Internal Heat, or Heart-Spleen Dual Deficiency. Treating according to these patterns yields high efficacy. Additionally, folk remedies like Peanut Coat, Niuxixi (Greater Perilla Root), Malangen (Kalimeris indica Root), and Zizhucao (Clerodendrum cyrtophyllum Herb) are used, though less effective than decoctions. Combining them with compound decoctions can improve clinical outcomes.
Famous Case Analysis
I. Severe Abdominal Pain (Gallbladder Torsion) Case
Shen, Male, 43 years old. First consultation October 14, 1991. Paroxysmal colic in the right upper quadrant for over 30 days. In February 1989, he experienced an episode of RUQ colic, hospitalized in Wuhan, diagnosed with "Hepatic and Renal Cysts, Gallbladder Torsion" via ultrasound and CT. Underwent surgical correction, pain relieved. However, mild RUQ pain persisted for years, suddenly becoming severe colic recently. Ultrasound suggested possible gallbladder torsion again; surgery advised but refused. Anti-inflammatory and analgesic treatments failed. Introduced to Dr. Li. Signs: RUQ colic, supporting abdomen with hand, cyanotic complexion, abdominal distension and pain, poor appetite, frequent belching, nausea, aversion to oily food, dry bitter mouth, dry stool like sheep dung, bowel movement every 2-3 days, lumbar and abdominal pain, yellow burning urine, sore and weak lower limbs, occasional chills, red tongue with thin yellow dry coating, wiry rapid pulse. Dr. Li diagnosed Yangming Fu-organ excess, turbid Qi stagnation, Blood-Qi stasis, Stomach failing to descend. Treatment: Purge heat and unblock Fu-organs, move Qi and invigorate Blood, soothe Liver and benefit Gallbladder, assist with harmonizing Stomach and descending rebellious Qi. Prescription: Sheng Dahuang (Raw Rhubarb) 15g, Ruan Chaihu (Soft Bupleurum) 10g, Chao Zhishi (Immature Bitter Orange cooked) 10g, Chi Baishao (Red and White Peony Roots) each 15g, Chao Huangqin (Scutellaria cooked) 10g, Yuansu (Corydalis Rhizome) 10g, Chao Jinlingzi (Melia Toosendan Fruit cooked) 10g, Xiang Huafen (Pueraria lobata Root) 10g, Huomaren (Hemp Seed) 15g, Daizheshi (Haematitum) 12g, Xuanfuhua (Inula Flower) 10g, Baihua Shezhewcao (Hedyotis diffusa Herb) 10g. 5 doses.
Second Visit: Bowels unblocked, pain halved, appetite improved, no distension, occasional belching, red tongue with thin yellow dry coating, wiry slightly rapid pulse. Fu-excess resolved, pathogenic factor receded, but Liver-Gallbladder Qi stagnation persists. Treatment focuses on soothing Liver, benefiting Gallbladder, moving Qi, invigorating Blood, assisting with harmonizing Stomach, descending rebellious Qi, moistening intestines, and preventing recurrence. Prescription: Yuansu 10g, Chao Jinlingzi 10g, Chao Zhuru (Bamboo Shavings cooked) 10g, Chao Zhishi 10g, Baizeren (Biota Seed) 10g, Xiangyuanpi (Citrus medica Peel) 10g, Sheng Maiya (Raw Barley Sprout) 15g, Da Danshen (Large Salvia Root) 12g, Jupi Luo (Tangerine Peel and Network) each 10g, Huomaren 15g, Lugen (Reed Rhizome) 18g, Baimaogen 18g, Yujin (Curcuma aromatica Rhizome) 10g. 6 doses.
Third Visit: Pain disappeared, bowels smooth, appetite robust, spirit energetic. Cyanotic complexion turned ruddy, red tongue with thin yellow coating, wiry fine pulse. Continue previous method adding You Danggui (Oil-treated Angelica) 10g, continue for over 30 doses. Ultrasound复查 showed no "gallbladder torsion," hepatic/renal cysts significantly reduced compared to previous scans. One-year follow-up: no pain recurrence.
[Analysis] Gallbladder torsion is a rare acute biliary disease, rarely reported domestically, often requiring surgery for diagnosis and pain relief. This case involved hepatic/renal cysts leading to secondary gallbladder torsion, RUQ colic, cyanosis, dry sheep-dung-like stool, belching/hiccups, nausea, burning urine, and chills. This resulted from pathogens stagnating in Liver/Gallbladder, Fu-excess accumulation, Blood-Qi stasis, and struggle between Healthy Qi and Pathogen. Thus, bold use of raw Dahuang (Rhubarb) for bitter-cold purgation, assisted by Huangqin (Scutellaria) and Shezhewcao (Hedyotis) to clear heat/toxins; Chaihu (Bupleurum), Zhishi (Bitter Orange), Chuanlianzi (Melia), and Yuansu (Corydalis) to soothe Liver, resolve depression, move Qi, and stop pain; Chi Shao (Red Peony) and Baishao (White Peony) to soften Liver, relieve urgency, invigorate Blood, and unblock collaterals; Xuanfuhua (Inula) and Daizheshi (Haematitum) to move Qi, harmonize Stomach, and descend rebellious Qi. Xiang Huafen (Pueraria) was used to nourish Stomach fluids and prevent dryness-heat damaging Yin. After medication, intestinal Fu-unblocked, Qi mechanism rotated, Great Qi circulated, and pain ceased. The strategy shifted from purgation to moistening, supplemented by soothing Liver, regulating Qi, harmonizing Stomach, and strengthening Spleen, ensuring pathogen removal without harming Healthy Qi, and Healthy Qi restoration without retaining pathogen.
II. Extreme Cold Below Waist Case
Sun, Male, 45 years old. First consultation September 18, 1991. Extreme cold below waist penetrating bone, pain like breaking for 15 years. In winter 1976, after bathing following labor, caught cold, then used hot bath, immediately felt cold below waist, buttocks cold as ice, lumbar cold pain like breaking, unable to sleep at night. Half a year later, seminal emission and impotence appeared. Treated in specialized hospitals in Wuhan, Guiyang, Hunan, Jiangxi, Shanghai, taking thousands of doses including Rougui (Cinnamon Bark), Fuzi (Prepared Aconite), Lurong (Deer Antler), etc., resulting in upper body feeling like fire, lip ulcers/blisters, while lower body remained icy cold. Introduced to Dr. Li. Signs: Mental fatigue, painful expression, cold below waist penetrating marrow, pain like breaking, preference for stove fire, pale red tongue, thin white coating, fine soggy pulse. Dr. Li said: This is Wind-Cold-Damp pathogens flowing into joints, long-standing cold reversal, Kidney Qi decline. Treatment: Tonify Kidney Yuan, dispel Wind and remove Dampness, invigorate Blood and unblock collaterals. Prescription: Shudi (Prepared Rehmannia) 15g, Shanyao (Dioscorea) 10g, Yinyanghuo (Epimedium Herb) 10g, Duhuo (Angelica pubescens Root) 10g, Fangfeng (Saposhnikovia Root) 10g, Danpi (Moutan Cortex) 10g, Chi Fuling (Red Poria) 18g, Danggui (Angelica sinensis Root) 10g, Zaoren (Ziziphus Seed) 12g, Zexie (Alisma Rhizome) 10g, Chuan Niuxi (Cyathula Root) 10g, Chao Duzhong (Eucommia Bark cooked) 10g, Fangji (Stephania Tetrandra Root) 10g, Cheqianzi (Plantago Seed) 10g. 5 doses.
Second Visit: Cold slightly alleviated, but cold pain severe, impotence, seminal emission, pale red tongue, thin white coating, fine soggy pulse. Follow previous method, strengthen Wind-dispelling, collateral-unblocking, Kidney-tonifying, bone-strengthening herbs, remove Danpi and Zexie which are too cooling. Prescription: Shudi 15g, Yinyanghuo 15g, Shanyao 15g, Zaopi (Cornus Fruit) 10g, Duhuo 10g, Fangfeng 10g, Fuling 15g, Bajirou (Morinda officinalis Root) 10g, Chao Duzhong 10g, Chuan Niuxi 10g, Zheng Wujapi (Five-finger Pittosporum Bark) 10g, Zhi Cangzhu (Atractylodes lancea Rhizoma prepared) 6g, Zhi Xianmao (Curculigo Orchioides Rhizome prepared) 6g, Mugua (Chaenomelis Fructus) 10g, Yimi (Coix Seed) 30g, Cheqianzi 10g. 10 doses.
Third Visit: Warmth gradually returned below waist, except slight sour cold in buttocks, other cold areas alleviated, erection possible, seminal emission stopped, pathogenic excess gradually gone. Continue previous method, remove Cangzhu, Yiren, Cheqian, add Tusizi (Cuscuta Seed) 10g, Juhong (Tangerine Peel Red Part) 10g, Hetaorou (Walnut Kernel) 10g, Buguzhi (Psoralea corylifolia Fruit) 10g, Sangjisheng (Taxillus Chinensis Parasite) 15g. Taken continuously for over 40 doses, cold and pain completely disappeared.