专病论治 胡希如经验谈1

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The experience in the use of Chinese herbal therapy

专病论治

胡希如经验谈

Introduction of clinic experience of Dr. Hu, Xiru (1)

 

Catalogue

 

感冒论治 (Common cold)

浅论肺炎的治疗 (Pneumonia)

治疗哮喘独特经验 (Asthma)

论治肝炎肝硬变 (Hepatitis and Cirrhosis)

有关肝硬化、肝腹水的论治 (Ascites)

痹证论治经验 (Arthritis)

 

 

治疗咳嗽的经验 (Cough)

黄汗刍议 (Yellow sweat)

治疗口糜的经验 (Oral ulcer)

古人善医狐惑病依证治愈白塞氏 (Ulcer in mouth and perineal region)

治疗胃、十二指肠溃疡的经验 (Gastric and duodenal ulcer)

 

   

1.  感冒论治

1. Common cold

感冒本属外感病   论治亦当用六经

感冒又称伤风,相当于西医的上呼吸道感染(鼻、咽、喉、扁桃腺炎症)。感冒之名何时形成尚无确论,一般教科书说始于北宋,系指杨士瀛《仁斋直指方诸风》引《和剂局方》之参苏饮:"治感冒风邪,发热头痛,咳嗽声重,涕唾稍粘",这里的感冒二字尚属动词。元代《丹溪心法中寒附录》:"凡证与伤寒相类者极多......初有感冒等轻症,不可便认作伤寒妄治。"这里正式提到感冒的名词。值得注意的是,朱丹溪这里所说的伤寒,系指《伤寒论》第3条:"太阳病,或已发热,或未发热,必恶寒、体痛、呕逆、脉阴阳俱紧者,名为伤寒。"其意是说感冒有轻有重,有可能是中风,有可能是伤寒,有可能是温病,不能都作伤寒看待。明代龚廷贤《万病回春》提出把感冒分为风寒、风热两证型为主,后世多有宗此者。明代张景岳《景岳全书伤风》:"伤风之病,本由外感,但邪甚而深者,遍传经络,即为伤寒;邪轻而浅者,只犯皮毛,即为伤风。一?他这里说的伤风,强调了病情轻,比伤寒轻。这段话给后人以误解,以至提出"感冒不同于伤寒"的论调。

历代各家对感冒不同认识的产生,一是用病因、感邪的性质来推理,分证型。一是用八纲来分证型。当然更受临床经验的影响,而临床经验丰富者,多认为感冒是外感病之属,有的症状就属伤寒,一些人提出"感冒不同于伤寒"含糊不清的概念,是不科学的。实际早在宋代就用六经辨证论治伤风。如陈无择将伤风列为专题论述,他在《三因极一病证方论叙伤风论》中,以六经辨证治疗伤风,如太阳伤风用桂枝汤,阳明伤风用杏子汤,少阳伤风用柴胡加桂枝汤,太阴伤风用桂枝加芍药汤,少阴伤风用桂附汤,厥阴伤风用八珍汤。也说明感冒、伤风临床症状可出现六经症状,不仅只现表证、太阳病。现代西医认为感冒是上呼吸道感染,所述临床表现也多有伤寒之属及六经各证。因此用六经辨证理论才能正确指导治疗感冒。

… From history, there are different believings about common cold, in terms of its cause and the treatment principles. Some diagnosis it and categorize it according to the Ba Gang diagnosis system[1], some according to Liu Jing diagnosis system. For example, in the Liu Jing diagnosis, the Wind-invading in Tai Yang phase is treated by herbal prescription Gui Zhi Tang; in Yang Ming phase, use Xing Zi Tang; in Shao Yang phase, use Chai Hu jia Gui Zhi Tang, in Yai Yin phase, use Gui Zhi jia Shao Yao Tang, in Shao Yin phase, use Gui Fu Tang, and in Jue Yin phase, use Ba Zhen Tang. It means that, the symptoms of a common cold can be found in all the six phases of a disease, not only in the Tai Yang phase as surface symptoms. Therefore, the Liu Jing diagnosis system can also be used for the dianosis and treatment of a common cold.  

感冒在表变匆匆  审证勿疏有合病

The common cold shows surface symptoms, which changes very fast in the development. In clinic, pay attention not only on the common cold per se, but also the complemetary diseases.

病例1.  陈某,男,24岁,病案号97771

Case 1, Mr. Chen, 24 years of old. File number: 97771.

初诊日期1965109日:昨天打篮球后用凉水洗澡,今早感恶寒身热(T 386 C)、无汗、头痛、身酸痛、口不渴、舌苔薄白,脉浮紧。此属太阳表实证,治以发汗解表,与麻黄汤。麻黄三钱,桂枝二钱,炙甘草二钱,杏仁三钱。

On Oct. 5, 1965: the patient had a cold shawer after basketball play yesterday. This morning, he felt chilly and hot (body temperature 38.6 C), no sweat, but had headache, sour in whole body, no thirsty feeling. The tongue cover was thin and white in color. The pulse was floating and tight. This condition belongs to Taiyang surface overwhelming. It has been treated with sweat-stimulating and surface-releasing therapy. The herbal prescription Ma Huang Tang was used: Ma Huang 9 grams, Gui Zhi 6 grams, Zhi Gan Cao 6 grams, and Xing Ren 9 grams. 

结果:上药急煎即服,并加盖棉被得微汗出,热渐退,未再服药,调养两天自愈。

Results: The above herbs were cooked in water right away. The patient drank the herbal tea. He was asked to lay down with covering. He got a slight sweat. Then his fever subsided gradually. The herbal tea was not continued any more. He was given diet therapy and a break for two days. He was recovered to normal then.

2.  刘某,女,28岁,病案号12517

Case 2: Mrs. Liu. 28 years of old. File number: 12517.

初诊日期1965830日:昨日受凉后,出现鼻流清涕、喷嚏、头痛、头晕、微恶风寒,咽痒,舌苔薄白浮黄,脉细数。证属太阳阳明合病,与桑菊饮加石膏。

The first visit: Aug. 30, 1965. The patient got cold yesterday. Later she felt headache, dizziness, had running nose, slightly wind-dislike and cold-dislike feeling, and itch in throat. Her tongue cover was thin and yellow in color. The pulse was thin and fast. This condition was diagnosed as Taiyang-Yangming co-exist condition. She was given herbal prescription Sang Ju Yin plus herb Shi Gao.

芦根五钱,桑叶三钱,菊花三钱,连翘三钱,薄荷二钱,杏仁二钱,炙甘草二钱,生石膏一两半。

The formula contains: Lu Gen 15 grams, Sang Ye 9 grams, Ju Hua 9 grams, Lian Qiao 9 grams, Bo He (mint) 6 grams, Xin Ren 6 grams, Zhi Gan Cao 6 grams, Shi Gao 45 grams.

结果:上药服二剂,症已。

Follow up: After drink this prescription for two days, everything became normal in terns of her health condition.

按:胡老常用经方,但遇感冒、咳嗽初起,阳明里热轻者(温病学派辨证多为风温表证时),常用桑菊饮加减,疗效亦颇佳。实不失六经辨证和辨方证之旨,又善学时方之意。

Comments: Doctor Hu uses the Jing Fang[2] quite often. However, in meet with patient with early stage common cold, or cough, and if the disease is in Yang Ming phase with only slight inner hotness (similar to the phase that Wen Bing Pai [3]regarded as Wind-Hotness surface phase), he would often use Sang Ju Yin with more or less modification. The result is pretty good. His such manner kept the principle of the Jing Fang style but also combined with the clinic experience of the Shi Fang[4] style.

3.  张某,男,44岁,病案号96718

Case 3 Ms. Zhang. 44 years of old. File number: 96718.

初诊日期1965325日:自昨日来,恶寒,无汗,项背强,头痛,腿痛,口唇干,舌苔薄白,脉浮紧。证属太阳阳明合病,与葛根汤加石膏。

The first visit: March 25, 1965. Since yesterday, the patient felt chilly, no sweat, tightness in neck and shoulder, headache and pain in legs, dry mouth lips. Her tongue cover was thin and while in color. Her pulse was floating and tight. This condition was diagnosed as Taiyang-Yangming co-exist condition. She was given herbal prescription Ge Geng Tang puls Shi Gao.

葛根三钱,桂枝三钱,麻黄三钱,白芍三钱,生姜三钱,大枣四枚,炙甘草二钱,生石膏一两。

The herbal prescription contains: Ge Gen 9 grams, Gui Zhi 9 grams, Ma Huang 9 grams, Bai Shao 9 grams, Sheng Jiang 9 grams, Chinse date 4 , Zhi Gan Cao 6 grams, and Shi Gao 30 grams.

结果:上药服一剂,感冒证解。

Follow up: After taking the herbal tea for one day, the common cold subsided.

按:以上三例,例1为单纯表实证,故用麻黄汤发汗得解。后两例,虽发病仅一天却都合病阳明里证,故治疗不能仅用汗法,必同时兼清阳明里热,因治疗得法,故很快皆愈。这里值得注意的是,同样是太阳阳明合病,例2用了桑菊饮加石膏,例3用了葛根汤加石膏,还有临床常见一发病即呈大青龙汤、麻杏石甘汤方证,这是因为临床所表现的方证不同,必须应用不同的适应方药治疗之故。这也就是胡老所强调的:临床辨证论治,不但要辨六经,更重要的是辨方证。这里也可看出,感冒与其他外感病一样,证在表时变化多端而快。感冒所呈现的表证是很短暂的,很快出现合病、并病,有的一发病就可能是合病,如例2、例3。因此一些教科书称感冒无传变是不符合临床实际的。

Comments: For the three cases above, the case I is a simple surface overwhelming condition, so the patient was given herbal prescription Ma Huang Tang to stimulate a sweat, through which the invading Wind and Cold was released out of the body, so the patient got recovered soon. For the later two cases, both developed into the Yang Ming phase though the disease was only one-day long, so the therapy should not be the sweat-stimulating therapy alone, but should be combined with Fire-clearing therapy to clear the inner Yang Ming hotness. For the proper treatment, they also got recovery in a short time. Here it should be emphasized that for same as in the Yang Ming phase, the case 2 was given Sang Ju Yin plus Shi Gao; while the Case 3 was given Ge Gen Tang plus Shi Gao. In clinic, it can be met a patient who should be given Da Wing Long Tang, or Ma Xin Shi Gan Tang, from beginning of a common cold. This is because the clinic syndrome is different so that the treatment should also be different. This is what Dr. Hu always emphasized: in clinic diagnosis, it is important not only to diagnosis which phase of the disease, according to the Liu Jing diagnosis system, but also, which herbal prescription should be used, e.g. which herbal prescription the clinic syndrome matched with. From here, it can been seen that, the treatment of a common cold is as same as that of any other disease. The clinic condition, e.g. the expression of the syndrome, changes very fast as well as variable. The surface syndrome of a common cold lasts very short. It will pretty soon develop into more deep phase, so the two phases might co-exist the same time, or the phases started and developed the same time. Such as it is shown in the case 2 and 3. For this reason, it is not correct in some TCM text book that stated no development of a common cold[5].   

感冒并非皆表证,治疗当忌都发汗

Not all common cold belongs to a surface condition. The sweat-stimulating therapy may not be proper for every patient  with common cold.

4.  唐某,男,35岁,病案号37867

Case 4:  Mr. Tang. 35 years of old. Fine number: 37867.

初诊日期1965424日:感冒三天,痛咽,口干,恶心,不欲食,头痛、头晕,咳则右上胸疼,舌苔白,脉弦细稍数。证属少阳阳明合病,为小柴胡加石膏桔梗汤方证。

The first visit: April 24, 1965:  The patient got common cold for three days. He felt sour throat, dry mouth, nausea, no appetite, headache and dizziness. When cough, he felt pain in the upper right chest. His tongue covering is white in color. His pulse feels string, thin and slight fast. His condition was diagnosed as Shaoyang-Yangming co-exist condition. He was given herbal prescription Xiao Chaihu Tang plus herb Shi Gao and Jie Gen.

柴胡四钱,半夏三钱,黄芩三钱,党参三钱,生姜三钱,大枣四枚,炙甘草二钱,苦桔梗三钱,生石膏一两半。

The herbal prescription contains: Chai Hu 12 grams, Ban Xia 9 grams, Huang Qin 9 grams, Dang Shen 9 grams, fresh ginger 9 grams, Chinese date 4, Zhi Gan Cao 6 grams, Jie Gen 9 grams, and Shi Gao 45 grams.

结果:上药服三剂,口干、咽痛已,咳嗽亦不明显,但感恶心、腰痛,下肢凉,上方去苦桔梗,加桂枝、赤芍各三钱。生龙骨、牡蛎各五钱,服三剂诸证已 

Following up: After three days of treatment, his dry mouth, sour throat and cough is no longer apparent. But he still felt nausea, pain in the lower back, and cold in the legs. The herb Jie Gen was removed from the prescription above, but added Gui Zhi 9 grams, Chi Shao 9 grams, Long Gu 15 grams, and Mu Li 15 grams. With additional three doses, everything is normal then.

按:此患者以咽炎为主的上感,是临床多见的感冒,因多数初起不来诊,故来诊时表证已不明显,而呈半表半里少阳证或少阳与阳明合病,故胡老常以小柴胡汤加减治疗小儿患者感冒更多呈现此方证。此时如用汗法解表,徒伤人体津液、正气,使感冒迁延不愈、加重,感冒后自服许多药,或治疗不当而长期不愈者屡见不鲜。这就告诫后人,感冒虽小病,治疗也要辨证论治。一见感冒就解表,是非常错误的。

Comments: This patient suffered from a common cold that is with sour throat as the major symptom. This is a quite common common cold type. Most patients do not come to clinic for a treatment. When they come, the initial surface symptoms are no longer apparent. Instead, they suffer from half-surface and half-inside symptoms, or the Shaoyang-Yangming co-exist condition. For such condition, Dr. Hu usually use Xiao Chaihu Tang with some modification. Such clinic phenomenon is more often with children.

5.  张某,女,27岁,病案号125

Case 5. Zhang. Female. 27 years of old. File number: 125.

初诊日期1965924日:一月来感冒,头晕、咽痛、咽痒、鼻塞、流涕等反复出现,前医曾诊为"秋燥"、风热束肺,用薄荷喉片、六神丸、桑菊饮、银翘散等,症状不减却越来越重,因而找胡老会诊。近症:头晕,头痛,背痛,恶寒,咽痒而咳,咯痰困难,晚上尤甚,口苦咽干,舌苔薄白,脉弦细数。胡老辨证为三阳合病,为柴胡桂枝汤合半夏厚朴汤加石膏方证。

The first visit: Sept. 24, 1965. The patient had suffered from common cold for one month. She felt dizziness, sour throat, itch throat, stiff nose, running nose, etc. These symptoms came and went. Previous doctor diagnosed her condition as “Fall Dryness”, Wind-Hotness in the Lung. She was given Bo He (mint) throat tablets, Liu Shen Pill, Sang Ju Yin, Yin Qiao San, etc. The symptoms became even worse and worse. Then Dr. Hu was invited for a consultation. At that movement of consultation, the patient felt dizziness, headache, pain in the back, chilly, itch throat that causes cough, hard to spil the phlegm that is especially worse at night. She also felt bitter taste in mouth, dry mouth. Her tongue covering is thin and white in color. Her pulse is string, thin and fast. Dr. Hu believed she had a Taiyang-Shaoyang-Yangming, the three Yang co-exist condition. She was given herbal prescription Chaihu Guizhi Tang together with Banxia Houpu Tang plus herb Shi Gao:

柴胡四钱,党参三钱,半夏四钱,黄芩三钱,桂枝三钱,白芍三钱,厚朴三钱,苏子二钱,苏叶二钱,生姜三钱,大枣四枚,茯苓三钱,炙甘草二钱,生石膏一两半。

Chai Hu 12 grams, Dang Shen 9 grams, Ban Xia 12 grams, Huang Qin 9 grams, Guizhi 9 grams, Bai Shao 9 grams, Hou Pu 9 grams, Su Zi 6 grams, Su Ye 6 grams, Fresh ginger 9 grams, Chinese date 4, Fu Ling 9 grams, Zhi Gan Cao 6 grams, and Shi Gao 45 grams.

结果:上药服三剂,头晕、头痛、口苦解,背痛、咳嗽减未已,仍微恶寒,脉已不数,与桂苓五味姜辛夏杏甘草汤,服六剂症已。

Following up: After three days of the herbal therapy, the symptoms of dizziness, headache, bitter mouth disappeared. The back pain and cough was reduced. She still feel slight chilly, and her pulse was no longer fast. She was then given Gui Ling Wuwei Jiang Xin Xia Gan Cao Tang. After six days of this herbal prescription treatment, everything became normal.

按:此患者初起为鼻炎、咽炎,西医诊断为上呼吸道感染,中医贯称感冒、伤风。前医称为"秋燥",而用清凉解表久不效,是因辨证不确,方药不对证。转至胡老会诊时,呈三阳合病挟饮,故以柴胡桂枝汤加石膏和解三阳,并加半夏厚朴汤化饮降逆,使三阳证很快解。后以桂苓五味姜辛夏杏甘草汤化痰降逆,遂使病愈。可见感冒、伤风并非只现表证,如不仔细辨证,凡见感冒悉用辛凉或辛温发汗解表,徒伤津液,伤人体正气,使病情迁延、加重,惟有以六经辨证,辨清方证,才能做到药到病除。

Comments: The patient, from beginning, had nose inflammation, and throat inflammation. Western medicine diagnosed it as upper respiratory inflammation and TCM diagnosed as common cold, Wind-invasion. The previous TCM doctor believed it was autumn Dryness syndrome, so used cooling and surface-relaxing therapy without effect. That is because the diagnosis is not correct and the herbs used did not match the clinic conditions. When turned to Dr. Hu, the clinic conditions became three Yang co-exist condition with additional Yin (water) in the body. So, the formula Chaihu Guizhi plus Shi Gao was given to her for the treatment of the three Yang conditions, and given the prescription Banxia Houpu Tang to dissolve the extra water and to reduce the reversed Qi. This made the three Yang co-exist symptoms disappeared very fast. Later, used the Gui Ling Wuweizi Jiang Xin Xia Xin Gancao Tang to dissolve the Phlegm and reduce the reversed Qi, the remaining symptoms also subsided soon. This example suggests: the common cold or Wind-invasion does not only show as a surface symptom. Without carefully diagnosis, simply give Spicy-Cold or Spicy-Hot herbal therapy to stimulate sweat and to relax the body surface, it will only exhaust the body liquid portion, to hurt body life energy, making the disease last longer time and become worse. Only with the Liu Jing diagnosis, to verify the herbal prescription that need to be used, the common cold can be solved in a short time.

表证阴证阳证分   论治温补发汗殊

For any disease, its surface phase, Yang phase or Yin phase should be clearly diagnosed. For the treatment, the use of warming or supplying therapy is quite different.

6.  贺某,男,8岁,病案号79322

Case 6. He XX, male, 8 years of old. File number: 79322.

初诊日期19651023日:感冒发热周,每日上午11点半出现发热 (38 C 左右),汗出,至夜12点后烧自退,饮食精神均好,大便隔一二日一行,他无不适,舌苔白润,脉虚数。证属太阳表阳证,为营卫失和之桂枝汤方证,与桂枝汤:

The first visit: Oct. 23, 1965. The child had fever for one week. Every morning at 11:30 am, he had slight fever (about 38 C), with sweat. After middle night, the fever subsided by it self. His appetite is normal. He had bowel movement once every day or every other day. No other discomfort. His tongue covering is white and wet and his pulse is weak-fast. His condition was diagnosed as Taiyang surface Yang condition. It is the Ying-Wei disharmony condition which needs Gui Zhi Tang. He was so given Gui Zhi Tang:

桂枝三钱,白芍三钱,生姜三钱,大枣四枚,炙甘草二钱。

Gui Zhi 9 grams, Bai Shao 9 grams, Fresh Jinger 9 grams, Chinese date 4, and Zhi Gan Cao 6 grams.

结果:上药上午已无发热,下午1点后尚有低热 (37.2 C 37.5 C),舌苔薄黄,脉��稍数,与桂枝汤合小柴胡汤加生石膏三剂,诸证解。

Following up: after drinking the herbal tea above, the morning fever subsided. He still had light fever in the afternoon (37.2C to 37.5C). His tongue covering was thin-yellow, and his pulse was little bit fast. He was given Gui Zhi plus Xiao Chai Hu Tang.

按:本例为小孩,因自我感觉及表述能力差,故症状表现不多,但抓住为太阳表阳证与桂枝汤调和营卫则解。

Comments: This case is a child. For her expression and description is poor, the symptoms are little. Dr. Hu paid more attention to his Taiyang surface weak condition and give the herbal prescription Gui Zhi Tang to harmonize the Ying-Wei, so he got better soon.

许某,男,47岁,病案号3752

Case 7. Mr. Xu, male, 47 years of old. File number: 3752.

初诊日期197854日:感冒2天,右头痛,自觉无精神,两手逆冷,无汗恶寒,口中和,不思饮,舌质淡,舌苔薄白,脉沉细,咽红滤泡增生多。此属虚寒表证,治以温阳解表,与麻黄附子甘草汤加川芎:麻黄三钱,制附子三钱,炙甘草二钱,川芎三钱。

The first visit: May 4, 1978. The patient got common cold for two days. He had headache on the right side, felt no ambition or energy to do things. Both hands felt reversing cold. He had no sweat but felt chilly. No special taste feeling in mouth. No desire to drink water. The tongue was pale, and tongue covering is thin-white. His pulse was deep and thin. The throat was red in color with multiple bubbles. This is a weak Cold surface condition. The treatment principle is to warm surface Yang  so as to relax the body surface. He was given herbal prescription Mahuang Fuzi Gancao Tang plus herb Chuan Xiong:

麻黄三钱,制附子三钱,炙甘草二钱,川芎三钱。

Ma Huang 9 grams, Zhi Fu Zi 9 grams, Zhi Gan Cao 6 grams, and Chuan Xiong 9 grams.

结果:上药服一煎,微汗出,头痛解,未再服药,调养两日,精神如常。

Following up: the herbal tea above was drunk once, he had slight sweat and his headache went away. He did not continue to drink the tea. After two day break, he was fine.

按:何廉臣的《重订全国名医类案》中就载有少阴感冒,认识到因体质的不同感冒出现的症状则不同,也即感冒与其他外感病一样表现为太阳病和少阴病。体质强壮者呈太阳病用发汗解表治疗,因太阳病又分表实(如例1)(无汗)、表虚(自汗恶风),发汗法又有所不同,例6即太阳表虚证,用桂枝汤调和营卫发汗解表。而例7是体质阳虚明显的咽炎感冒,呈现虚寒阴性表证,即少阴病,解表须用汗法。但须加温阳强壮的附子等才能驱除外邪。这就是《伤寒论》表证分阴阳,即分为太阳、少阴,治皆用汗法而有不同的实质。

Comments: in the book <<Chong Ding Quan Guo Ming Yi Lei An>>, Mr. Liang-Chen He mentioned such Shaoyin common cold. It had been recognized that, different body constitution would have different symptoms in common cold, e.g. the common cold, similar to any other external disease, could be shown as either Taiyang bing or Shaoyin bing. Strong body constitution may need sweat therapy to create sweat so to relax the body surface for treatment. The Taiyang bing can be separated further into surface overwhelming (such as in case 1, without sweat), and surface weak condition (with sweat and dislike wind). The sweat-stimulating therapy also differs: in case 6, which is Taiyang surface weakness condition, so herbal prescription Gui Zhi Tang is used to harmonize the Ying and Wei in the body surface. In case 7, it is throat type common cold in a Yang deficient body condition, which shows as weak-cold Yin surface condition, e.g. which is a Shaoyin common cold condition, the sweat therapy is needed but it must be accompanied with warming and strengthening therapy bu use of herb such as Fu Zi. By this way, the invading Xie Qi can be dispelled off the body. This is what has been emphasized in the book << Shang Han Lun>> that, the surface condition is separated into the Yin and the Yang condition, e.g. the Taiyang and the Shaoyang condition. They both need sweat therapy but the real nature of the sweat therapy is different.

 

2,  浅论肺炎的治疗

2. Treatment of pneumonia

病因病邪不必究,症状点滴必细求

No need to really find the reason for the pneumonia (e.g. if the pneumonia is due to bacteria or virus, or something else), but the symptoms should be checked very carefully to reach a correct TCM diagnosis.

诊余,一西学中者问胡老,怎样辨别风寒或风热引起的肺炎,胡老从西医和中医病因病理回答了这一问题。

One day after finish the clinic work, a doctor who was learning TCM asked Dr. Hu, how to tell a pneumonia that is caused by Wind-Cold or Wind-Hotness. Dr. Hu answered this question from the point of view of the pathogeny and TCM pathology of both western medicine and Chinese medicine.

从西医病理看,西医依据X线及血液、痰液检查及培养,可知是细菌或病毒或立克次体或支原体感染,这是由肉眼及通过实验室检查而定。而中医形成在千百年的远古时代,科学还不发达,没有精良的器械可依,只是由变化多端的症状反映上探求疾病发展规律,在长久的年代里和众多患病人体上,历经千万次的反复观察、反复实践、反复总结,才产生了辨证论治方法。不论是《伤寒论》的六经辨证,还是后世的脏腑辨证,都是通过症状特点来辨证。对于何种病因病邪致病,不可能具体得知。

From western medicine pathology point of view, the western medicine based on the X-ray check, the lab test, phlegm test and culture, could know that the pneumonia is caused by either bacteria, virus, mycoplasma, or rickettsia. The diagnosis is based on the native eye and on the lab tests. However, Chinese medicine developed from far longer history ago, at which time the science was not at all developed. There was no any fine machine or equipment could be used. Doctors have to search the disease rule throughout the complex and fast developing symptoms of a disease. Based on long time and on large number of patients, throughout many times of observation, treatment, and summary, the doctors developed the syndrome diagnosis system. No matter the Liu Jing diagnosis system in the Shang Han Lun or the later Organ diagnosis system, all are based on the syndrome of disease to make diagnosis. It is impossible for the TCM doctor to know which pathogeny is the cause of the disease.

叶天士提出:"温邪上受,首先犯肺",在论述热病上,强调温热之邪所出现的特点,有他独到之处,但后世一些人一见热病便认为是风温之邪所致,甚至有的人一见肺炎就与风温划等号,这种认识上的错误,必然造成辨证错误及治疗不当(如病例3)。这里顺便说一下温病与太阳病的关系,在《伤寒论》中,温病也是表证的一种,是在表的阳性证候,实际是太阳病的一个类型,这就是说,太阳病有三个类型,它们具体的概念是:

A famous doctor in TCM history, Dr. Ye Tian-Shi said: “a Hotness disease (infectious disease), once comes into the body, will first affect the lung”. Upon the theoretically description of a infectious disease, that he emphasized the clinic characteristics of a infectious disease is his great contribution. Later, doctors believe that pneumonia with fever diagnosed by western medicine is equal to the Wind-Hotness disease in Chinese medicine. Such wrong in recognition certainly cause the wrong diagnosis and the wrong treatment (such as in case 3). Here we, by the way, explain to readers, the relationship between the Hotness disease and the Taiyang disease. In book <<Shang Han Lun>>, the Hotness disease is one of the surface phase diseases. It is the Yang condition in the surface layer of the body, which is actually one group of the Taiyang disease (phase). This means: the Taiyang phase has three different groups, they are:  

中风:凡太阳病,若发热、自汗出、恶风、脉缓者;

Wind-invasion syndrome: if the disease is in the Taiyang phase, the patient has fever, sweat, wind-disliking feeling and the pulse is slow, it is the Wind-invading disease in the surface (Taiyang) phase.

伤寒:凡太阳病,无论发热与否,若无汗、身痛、腰痛、骨节痛疼、脉紧者;

Cold-invasion syndrome: if the disease is in Taiyang phase, the patient has no sweat, feels pain in the body, in the lower back, and in the joints, with or without fever, and if his pulse is tight, his condition belongs to the Cold-invasion syndrome.

温病:凡太阳病,若发热而渴,不恶寒者(与阳明病外证同)。也就是说肺炎有表证时,可表现为中风,可表现为伤寒,也可表现为温病,不只限于温病。这在指导辨证和治疗上是很重要的。

Hotness syndrome: if the disease is in Taiyang phase, the person has fever and feels thirsty, no chilly feeling (similar to the Yangming phase), this condition belongs to the Hotness syndrome in the Taiyang phase.

In another words, if the pneumonia has surface symptoms, it can belong to the Wind-invasion syndrome, or Cold-invasion syndrome, or a Hotness syndrome. This is very important to direct the diagnosis and treatment.

近代有了抗生素,一些人认为一诊断肺炎就用抗生素则治疗原则正确,如再加用对症的中药所谓中西医结合治疗就更万无一失。而临床实践远非如此.有许多肺炎患者,经这种所谓中西医结合治疗后往往不如人意,有的高烧不退、有的咳嗽连绵、有的纳差恶心,炎症没有控制却变症蜂起。孰不知肺炎有细菌引起者,也有病毒引起者,还有支原体、依原体等引起者。抗生素并不能包治所有肺炎,且渐渐产生抗药性、副作用,使肺炎变症此起彼伏,不少病人不得不求助于中医,而中医治疗不是靠什么秘密武器、秘方,而主要靠审证仔细、辨证正确、方药对证。这里强调的是,首要的功夫是辨证正确。凡遇肺炎患者都要耐心细心问诊、切脉、看舌苔等,切忌刚问12症,就自认为已能分辨风寒、风温(风热),即处方用药。要知道中医不论是六经辨证、还是脏腑辨证,都是依据许多症状而归纳总结的辨证规律。有时一个症状可能是辨证的关键,一个症状的疏漏,就有可能造成辨证的失误。肺炎是急性病更要求辨证要准,用药要对,这样才能显示中医治疗肺炎的疗效和特点。

In current times, there is anti-biotics. Some people think that it is correct to use anti-biotics when the diagnosis of a pneumonia is set up. It would be better to add some herbs to solve the symptoms, which way they call it so called the combination of the western medicine and Chinese medicine. However, in clinic, it does not always work as expected such way. There are many patients with pneumonia, the healing results are not at all satisfied by this way of treatment. Some had continuous fever that is hard to be reduced down. Some have continuous cough that is also hard to stop. Some others feel nausea and lose appetite. They do not know that the pneumonia could be caused by bacteria, virus, mycoplasma, or rickettsia. Anti-biotics can not solve all kinds of pneumonia. In addition, the pathogeny could develop resistance to drugs and the anti-biotics could cause side effects, all of which make the pneumonia worse: some symptoms go and some new symptoms come, from time to time. Not little number of patients have to eventually go to TCM treatment. However, there is no secret in the TCM to solve the pneumonia. It depends on careful clinic date collection, correct diagnosis and precisely matched herbal prescription used. It cannot be overemphasized that the first important thing is the correct diagnosis. Whenever meet a patient, the doctor should carefully have consultation, feel the pulse and see the tongue of patients. Remember: do not believe that you already know if the client condition belongs to a Wind-Cold or Wind-Hotness syndrome, after the patient tells you only one or two of his/her symptoms. Do not prescribe a herbal prescription just based on such as quick diagnosis. It should be known that, no matter for Liu Jing diagnosis or organ diagnosis system, the TCM syndrome diagnosis bases on the summary of many symptoms, tongue and pulse feeling. Sometimes, one symptom might is the key factor to set up the diagnosis. Miss of such symptom may result in a wrong diagnosis. The pneumonia is an acute disease, which needs more correct and precise diagnosis and correctly matching herb prescription for the treatment. By this way, the healing effect and the characteristics of TCM in the treatment of pneumonia can be shown.   

 

一方一法不可信,辨证选方必遵守

Do not believe that one herbal prescription can solve all kinds of pneumonia. It is important to follow syndrome diagnosis to choose proper herbal prescription.

一老妇患肺炎,住院治疗一周余不效,经胡老会诊两次而愈。其属军医登门感谢,并问胡老用了什么秘方,胡老笑曰:"哪里有什么秘方,用的是老祖宗用了几千年的草根树皮。这不是全写在上面呢!"随手指了指《伤寒论》那本书。那位军医看到《伤寒论》,顿时望而起敬,翻阅该书并问道:"我可以学吗?"胡老答曰:"当然可以!"自此,该军医自学中医,并常登门求教,不久便能用中药治疗肺炎,而且也能用中药治疗各种急慢性病,此是后话。

There was a old lady who suffered from pneumonia. She did not get better after living in hospital for one week. She got recovered after twice consultations with Dr. Hu. Her family member was a military doctor (western medicine doctor), who asked Dr. Hu which secret prescription he used for the treatment. Dr. Hu smiled and said: “No any secret. I only used the grass and barks of plants introduced by our Chinese ancestors. Now, all are here!”, while he pointed the book on the desk <<Shang Han Lun>>. The doctor saw that book, feeling respect very much to the book. He opened the book and asked, “Can I learn it?” Dr. Hu said, “Of course, you can!”. From then on, the doctor started to learn the Chinese medicine by himself and also visited Dr. Hu often. Soon later, he can treat pneumonia by himself, as well as treat various acute and chronic diseases with Chinese herbs. 

应该军医的请求,胡老专述了肺炎的证治规律。胡老首先讲了中医与西医治病的不同,西医是针对病因治疗,肺炎是细菌感染,用对其细菌敏感的抗生素治疗则疗效肯定。但有的肺炎不能明确是何种细菌、病毒、支原体、依原体,用抗菌素治疗就带有盲目性,故临床上治疗无效者,为数也不少。中医是依据症状特点来治病,症状是病邪与正气相争在人体的反映,分析症状所得出的证,是中医治疗处方的依据。依证处方用药是中医的主要实践过程,经过几代、几十代、几年几百年乃至几千年的反复实践,终于总结出了有效的辨证论治规律和有效方药。古代的《尹伊汤液经》《伤寒论》等是主要成书之一,其主要内容是讲辨证与处方用药。中医古代没有肺炎这一病名,但类似病症是有的,如发热、咳嗽等,中医治疗肺炎不是用一方一药,而是根据不同时期出现的不同症状来用药。用一方一药治��好肺炎。有的杂志报道用某方药治疗肺炎疗效云云,其主导思想仍是抗生素治疗框框,其方法值得商榷。肺炎是急性病,正气与邪气相争剧烈,症状变化多端,适应治疗的方药也就多变。

For the requesting by the military medical doctor, Dr. Hu explained the regularity in the treatment of pneumonia. He first explained the difference between the western medicine and Chinese medicine. The western medicine performs the treatment based on the verification of the pathogenic cause of the disease. The pneumonia, if caused by bacteria, can be well treated with anti-bacteria, to which the bacteria is sensitive. But, if the pneumonia is caused by unknown bacteria, or by virus, by mycoplasma, or rickettsia, the use of anti-biotics would be blind-treatment without clear indication. For this reason, the failure rate of biotics is not less. The traditional Chinese medicine bases on the clinic syndrome to make diagnosis and treatment. The syndrome is the reflection of the struggle, and mutual reaction between the pathogeny and the body. The syndrome diagnosed after analyzing the symptoms and the data collected from the tongue and pulse (and other aspects of the body) is the basis for how to use the herbs. In this way, the Chinese medicine is to diagnosis the syndrome, not the disease. Different syndrome needs different herbs or herbal prescription. Such clinic practice has been repeated after many generations, or several thousands of years and eventually comes to a summary of the content of the syndrome and the effective herbal therapy. The ancient book << Yin Yi Tang Ye Jing>> and <<Shang Han Lun>> are some of famous books. They mostly talk about the way for syndrome diagnosis and for the use of the herbs.  In ancient Chinese medicine, there is no such disease name “pneumonia”, but similar syndromes, such as fever and cough, etc. The Chinese medicine does not treat the pneumonia with only one herb or one herbal prescription, but uses various herbs and herbal prescription in different phase of the pneumonia. A single herbal prescription can not solve the pneumonia. There is some journal reports that talked about the healing effect of one herbal prescription in the treatment of pneumonia. Its main idea actually follows that of the use of anti-biotics. It is doubtable, in terms of using herbal therapy by that way. Pneumonia is an acute disease, in which the struggle between the pathogeny and the body defense force is very strong and the symptoms change very fast and variably, so that the proper and suitable herbal prescription should also be variable.

临床常见的方证如下:

The commonly used herbal prescription for the treatment of pneumonia are the followings:

1麻黄汤方证:初起症状很像感冒,主症:发热,胸闷气粗,恶寒,无汗,头项强痛,身痛,口中和,舌苔薄白,脉浮紧。此时病属太阳表实证,治以发汗解表。

1. Ma Huang Tang syndrome: In the beginning, the symptoms are similar to a common cold. The main symptoms are fever, fullness in chest, hard to breath, cold-disliking feeling, no sweat, stiffness and sour in the head and the neck, pain in the body, and no special taste in the mouth. The tongue covering is thin and white in color. The pulse is floating-tightness. This time, the condition belongs to the Taiyang body surface phase. The principle in the treatment is to stimulate sweat and to relax the body surface.

方药:麻黄三钱,桂枝二钱,杏仁三钱,炙甘草一钱。

Ma Huang 9 grams, Gui Zhi 6 grams, Xing Ren 9 grams, and Zhi Gan Cao 3 grams.

麻黄为一有力的发汗药,佐以桂枝更宜致汗。杏仁配麻 黄辛温发汗定喘。甘草缓急益中和胃,故治肺炎属太阳病表实无汗身痛而喘闷者。本方证出现很短暂,但能抓住这个方证时机及时用药,可有利于退烧,缩短肺炎病程。应该说明的是。这里所说麻黄为一有力的发汗药,是与其他药相对而言,实际发汗力并不大,即使与桂枝、杏仁同用也不出多大汗。这一点在麻黄汤煎服法说明可看出,即"温服,服药后盖棉被取微似汗"。一些人因对麻黄功能的误解,而不敢正确用其药,更不敢用麻黄汤治疗肺炎,甚是遗憾。

The herb Ma Huang is a strong herb to stimulate sweat, especially when the herb Gui Zhi is used the same time. When the Ma Huang is used with Xing Ren, both work as spicy-warm nature to stimulate sweat and stop asthma. The herb Gan Cao works as buffer to relax spasm, to nourish the stomach and to protect the middle digestive system from hurt by the disease and by the herbs. For this reasons, this prescription works for the pneumonia that belongs to the Taiyang phase, which further more belongs to the surface overwhelming syndrome without sweat, but with pain in the body and with short of breath and asthma and chest fullness feeling. This syndrome usually lasts only a short time. If we can identify the syndrome and use this prescription in time, it would help to reduce fever and shorten the disease period. It should be mentioned that, we say that the Ma Huang is a strong sweat-stimulating herb. It means it is powerful relative to other herbs. In fact, its sweat-stimulating power is not so powerful. Even if it is used together with Gui Zhi, and Xing Ren, there would have no big sweat. This can be implied from the way to cook the prescription, e.g. “to drink the herbal tea in warm. After that, cover the body to get slight sweat.”Some people fear to use the herb for such misunderstanding, nor to use it in the treatment of pneumonia. It is really pity.

2大青龙汤方:症见:发热恶寒、身痛身重,无汗出而烦躁,舌苔白,脉浮紧。方药:

2. Da Qinglong Tang syndrome: the person has fever and cold-disliking feeling, no sweat and feels anxiety. The tongue covering is white. The pulse is floating and tight. The prescription are:

麻黄六钱,桂枝二钱,杏仁二钱,生姜三钱,大枣四枚,炙甘草二钱,生石膏一两半至四两。

Ma Huang 18 grams, Gui Zhi 6 grams, Xing Ren 6 grams, Fresh ginger 9 grams, Chinese date 4, Zhi Gan Cao 6 grams, Shi Gao 45 grams to 120 grams.

此方证比较多见,可见于发病的第一天及一周内,甚至,一周后.此方证的特点是,外寒夹饮的太阳表证与阳热盛的阳明里证同时并见,故治疗时发汗、清热并举。当里热重时重用生石膏。

In clinic, this syndrome is pretty common. It can appear in the first day or within the first week, even one week later, of the disease. The typical characteristics of this syndrome is: the co-exist of the Taiyang phase (external Cold plus inner water) and the Yangming phase (inner Hotness). Therefore for the treatment, the sweat-stimulating therapy and the Fire-clearing therapy should be used the same time. When the inner Hotness is severe, the Shi Gao should be used in large amount.

3小柴胡加生石膏汤方证:主症:寒热往来,口苦咽干,胸胁苦满,或纳差恶心,咳嗽胸疼,舌苔白腻或黄,脉弦细数。

3. Xiao Chaihu plus Shi Gao Tang: the person has chily and fever in turn, feels bitter in mouth and dry in throat, annoying fullness feeling in the chest and in the upper side of the belly, or has poor appetite with nausea, cough with chest pain. His tongue covering is white and greasy or yellow. The pulse is string, thin and fast. 

方药:柴胡八钱,党参三钱,黄芩三钱,炙甘草三钱,生姜三钱,大枣四枚,半夏四钱,生石膏一两半 - 四两。

The foumual contains: Chai Hu 24 grams, Dang Shen 9 grams, Huang Qin 9 grams, Zhi Gan Cao 9 grams, fresh ginger 9 grams, Chinese date 4, Ban Xia 12 grams, Shi Gao 45 to 120 grams. 

此方证多见于肺炎23天至一周左右,多呈现三阳合病之证,故治疗重在和解少阳兼以清阳明。针对寒热往来,用大剂柴胡为主药,佐以黄芩除热止烦,无疑是和解少阳的要药,但《伤寒论》六经辨证理论告诉我们,病之所以传人少阳,主要是胃气失振、气血内却。补中滋液,增强胃气,实是祛邪的要著。故本方中用人参(党参)、大��、甘草、生姜、半夏温中健胃。徐灵胎谓:"小柴胡汤之妙在人参",确是见道之语。若咳嗽胸疼明显者,加桔梗、杏仁。若口渴、心烦明显者,加竹叶、麦门冬。或改用竹叶石膏汤加减。

This syndrome can be seen in the second to the third days, or in about one week, of the disease. It usually shows as a three Yang phases the same time. Therefore, the treatment should be focused on the harmonization of the Shaoyang, on the clear of the Yangming hotness. For the chilly and fever comes and goes, use large amount of Chai Hu as the main herbal ingredient, plus the use of Huang Qin to clear fever and to stop the annoying feeling. They are no doubt the main ingredients of the herbal prescription. However, it was implied from the book <<Shang Han Lun>> that, that the Xie Qi invading into the Shao Yang phase, is due to the weakness of the stomach Qi and the weakness of the Qi and blood in inside of the body. Therefore, to nourish the middle digestive system, to nourish the body with liquid part, and to improve the function of the digestive system are the main step to dispel the invading Xie Qi. For this reason, this prescription uses Ren Shen (ginseng), Chinese date, Gan Cao, ginger, and Ban Xia to warm up and to help the digestive system. Dr. Xu Ling-Tai said: “the secret of the Xiao Chai Hu Tang is on its use of herb Ren Shen”. It is really a smart comment. If the cough and chest pain is severe, add herb Jie Gen, Xing Ren. If the thirsty and annoying feeling is strong, add Zhu Ye and Mai Meng Dong, or use herbal prescription Zhu Ye Shi Gao Tang with some modification.  

4大柴胡加生石膏汤方证:主症:寒热往来,口苦烦躁,咽干口渴,胸胁苦满,心下痞硬拒按,大便干燥,舌苔黄,舌质红,脉弦数。

4. Da Chai Hu plus Shi Gao Syndrome: the person feels cold and fever in turn, bitter in mouth and feel annoyed, dry mouth and thirsty, annoying fullness or bloating feeling in chest or in upper sides of the belly, and constipation. The tongue is red in color. The pulse is string and frequent.  

方药:柴胡八钱,黄芩三钱,生姜三钱,大黄二钱,白芍三钱,大枣四枚,半夏四钱,枳实四钱,生石膏一两半~四两。

Prescription: Chai Hu 24 grams, Huang Qin 9 grams, fresh ginger 9 grams, Da Huang 6 grams, Bai Shao 9 grams, Chinese date 4, Ban Xia 12 grams, Zhi Shi 12 grams, Shi Gao 45 grams to 120 grams.

此方证多见于肺炎34天,更多见于强行发汗而热不退者。与前方相比,同是三阳合病,此是阳明里实热明显者。病初传少阳,势须人参、生姜、甘草等补中益气既防邪侵入里,又助正祛邪于外。但已并于阳明,则须大黄兼攻里,人参之补,甘草之缓反非所宜,故去之。又因里热明显而再加生石膏。若再见口渴甚者,可更加麦门冬、干地黄。若大便秘结甚者,加芒硝四钱冲服。

This syndrome is mostly seen on the third day to the forth day of the pneumonia. It is more seen in patient who was given strong sweat-stimulating therapy but failed to have sweat and had continuous fever. Compared with the previous three prescription, all are the three Yang syndrome the same time, this one is however the Yangming inner overwhelming Fire condition. When the disease is in the Shaoyang phase, it needs Ren Shen, ginger, and Gan Cao to nourish the middle digestive system (the stomach), so to prevent the further invasion of the Xie Qi deeper into the body, and to help the body defense system to dispel the Xie Qi out of the body. When the Xie Qi has been in the inner Yang Ming phase, it is needed to use herb Da Huang to attack the Xie Qi inside. The use Ren Shen to nourish and the Gan Cao to relax the muscle spasm is no longer proper therapy. So they are deleted. In addition, since the inner Fire is so severe, so add the Shi Gao again. If the thirsty is apparent, add Mai Men Dong and Sheng Di. If there is severe constipation, drink Mang Xiao powder (12 grams) directly without cooking in water. 

5大承气汤方证:主症:潮热汗出,身痛,身重,不恶寒,腹胀满,短气,喘息,大便秘结,腹痛拒按,烦躁口渴,昼夜思睡,甚则神昏谵语,舌苔白厚干燥或黄褐,舌质红,脉沉弦滑数。

5 Da Cheng Qi Tang syndrome: the main clinic manifestions are: waving hotness with sweat, body pain, body heaviness feeling, no cold-dislike feeling, bloating in belly, short of breath, asthma breath, constipation, pain in belly which the person refuse to touch, annoying and thirsty, desire to have sleep both day and night (in severe case, the person may lose contiousness with chattering). The tongue coverying is thick, white in color or yellow-brown. The tongue per se is red in color. The pulse feels deep, string, slippery and frequent.

方药:大黄四钱,厚朴六钱,枳实三钱,芒硝六钱(分两煎)

Prescription: Da Huang 12 grams, Hou Pu 18 grams, Zhi Shi 9 grams, Mang Xiao 12 grams.

按:本方证多见于肺炎23日后,此为阳明里实热证,老年人更为多见。肺炎呈现本方证,实热已达一定程度。又非此方不能救治。故当遇本方证时千万不能迟疑,要当机立断处方用药,要知不当用而用和当用而不用,均足以误人性命,关键所在须辨清方证。

Comments: this syndrome can been seen on the second day or the third day of the pneumonia. It belongs to the inner overwhelming Fire syndrome of the Yangming phase. It is more seen in elderly patients. Once pneumonia comes into this phase, the inner Fire has been in a pretty strong level. Without this herbal prescription, this condition is hardly solved. For this reason, once meet this condition, do not be hesitated to use this prescription. It should be known that, if the herbal therapy that should be use but is not used, or if it is used in an improper way, both will cause death. It is very important to recognize this syndrome.

应该说明的是,以上所列是肺炎常见的方证,因人体质的不同和感邪的不同,肺炎在各个时期的症状也就不同,所见方证也就很多,不但可见到麻杏石甘汤、白虎汤、桂枝加厚朴杏子汤、射干麻黄汤等三阳方证,而且还可见到麻黄附子细辛汤、理中汤、四逆汤、通脉四逆汤等三阴方证。临床实践中必须心中有数,对肺炎患者出现的各种方证,能及时适证用药,才能真正做到用中药治好肺炎。

It should be mentioned that, the syndromes and the herbal therapies above are commonly seen clinic conditions. For the fact that each person is diferent in terms of their body constitution and of the pathogeny, the clinic manifestation of pneumonia in eash phase is also different, so there would be many herbal prescription. The herbal prescription used in clinic are not only the Ma Xing Shi Gan Tang, Bai Hu Tang, Gui Zhi plus Hou Pu Xing Zi Tang, She Gan Ma Huang Tang, such herbal prescription used in three Yang co-exist phases, but also the Ma Huang Fu Zi Xi Xin Tang, Li Zhong Tang, Zi Ni Tang, Tong Mi Si Ni Tang, such herbal prescription that is suitable to be used in Three Yin phases. In clinic work, the doctor must be clear in mind for the diagnosis and the indications to the herbal prescription. They must be able to use proper herbal prescription according to the various syndromes during the pneumonia. By this way, the pneumonia can be cured by use of Chinese herbal therapy.

验案

Case reports

1. 杨某,男,16岁,病历号491385

Case 1. Yang, male, 16 years of old. File number: 491385

初诊日期196575日:发热寒战一天。昨日打蓝球汗出身热,用冷水冲洗,半夜即感恶寒、身痛、头痛、咳嗽,经饮热水加盖棉被,症未见好转,出现寒战,身热更明显,舌苔薄白,脉浮紧数。体温399C。胡老辨证为太阳表实的麻黄汤方���,用药与:麻黄三钱,桂枝二钱,杏仁三钱,炙甘草二钱。

The date of first visit: July 5, 1965: the patient felt fever and chilly for one day. Yesterday after playing basket ball, he felt very hot, so he had a cold water shower. Middle night last night he felt cold-disliking feeling, pain the body, headache, and cough. After drunk hot water and covered with more covering, the symptoms did not get any better. Soon he felt chilly and the fever became more severe. His tongue was thin and white, the pulse was floating, tight and frequent. The body temperature was 39.9 C. Dr. Hu believed his condition belongs to Taiyang phase, the surface overwhelming condition, e.g. the Ma Huang Tang syndrome. He was given the Ma Huang Tang: Ma Huang 9 grams, Gui Zhi 6 grams, Xing Ren 9 grams, Zhi Gan Cao 6 grams.

二诊77日。上药服后微汗出,恶寒、身痛减,体温385C。但因咳嗽、胸痛明显,而去医院检查,X线检查:右肺上叶大片阴影,诊断为肺炎,治疗欲青霉素,因药物过敏而仍求中医治疗。刻下症见:寒热往来,口苦咽于,右胸胁痛,咳嗽,吐黄粘痰,舌苔白微腻,脉弦细稍数。体温386C。此乃表邪已传人少阳阳明,与小柴胡加生石膏汤加减:柴胡五钱,黄芩三钱,生姜三钱,半夏四钱,党参三钱,大枣四枚,炙甘草二钱,桔梗二钱,瓜蒌五钱,生石膏二两。

The second visit: July 7: after drink the herbal tea, he had slight sweat, reduced chilly and reduce body pain. The body temperature reduced to 38.5C. For the severe cough and pain in the chest, he went to hospital and had a X-ray check, which showed cloudy image in the right side of the lung, that was soon diagnosed as pneumonia. It had been planned to use penicillin but the plan was given up for allergy to the penicillin. So he had come back to Chinese medicine again. On the time to the clinic: he had chilly and fever in turn, bitter in mouth and dry throat, pain in right lung, cough and spit yellow-sticky phlegm. His tongue was white and slight greasy. His pulse was string, thin and slight frequent. His body temperature was 38.6C. This condition was believed that the disease has developed into Shaoyang and Yangming phases. He was given Xiao Chai Hu Tang plus Shi Gao: Chai Hu 15 grams, Huang Qin 6 grams, fresh ginger 9 grams, Ban Xia 12 grams, Dang Shen 6 grams, Chinese date 4, Zhi Gan Cao 6 grams, Jie Gen 6 grams, Gua Lou 15 grams, and Shi Gao 60 grams.

三诊710日:上药服两剂,寒热往来、胸胁痛皆已,咳减,吐少量白痰,体温36.6 C。上方改柴胡为四钱,减生石膏为一两半,加杏仁三钱,基本痊愈。

The third visit: July 10: after two days of treatment above, the chilly-fever, and the pain in the chest and in upper side of belly subsided. The cough is reduced. He spitted little white phlegm. The body temperature was 36. 6C. The herbal prescription above was modified into Chai Hu 12 grams, Shi Gao down to 45 grams, with addition of Xing Ren 6 grams. The condition turned pretty normal.

2 张某,女,51岁。

Case 2. Mrs. Zhang, 51 years of old.

初诊日期1964925日:近几天因搬家劳累感疲乏无力,昨晚又感发热、恶寒,经急诊拍片诊为右上肺大叶性肺炎,因青霉素过敏而求中医治疗。今日仍身热、身痛、无汗、恶寒、口干、心烦、胸闷,时咳而胸痛,舌苔白根腻,脉浮紧。胡老辨证太阳阳明合病,与大青龙汤:麻黄六钱,桂枝二钱,杏仁三钱,生姜三钱,大枣四枚,炙甘草二钱,生石膏三两。

The date of first visit: September 25, 1964. The lady felt tired recently after moving to new house. Last night, she felt hot and chilly. After X-ray test, it was diagnosed as right upper lung pneumonia. For allergy to penicillin, she had to come to Chinese medicine. Today, she still felt hot, body pain, no sweat, chilly, dry mouth, annoyed, fullness feeling in chest, cough from time to time with chest pain. Her tongue was white with greasy in the tongue root. Her pulse was floating and tight. Dr. Hu believed she was in Taiyang-Yangming co-exist phase, which is Da Qing Long Tang syndrome.

Ma Huang 18 grams, Gui Zhi 6 grams, Xing Ren 9 grams, fresh ginger 9 grams, Chinese date 4, Zhi Gan Cao 6 grams, Shi Gao 90 grams.

结果:上药服一煎,汗出热退,尚余咳嗽,吐黄白痰。据证与半夏厚朴汤加减,调理一周而愈。

Following up: after one day herbal therapy, she had sweat and the fever went away. She still had little cough and spitted yellow-white phlegm. For this, she was given Ban Xia Hou Pu Tang with some modifications. This prescription was used for one week. The condition turned normal.

按:肺炎出现大青龙汤证者是非常多见的,用大青龙汤治疗疗效显著。惜患者先找西医,不好才再找中医,而症候已变为他证。医者应当知有是证,用是方。

Comments: It is very common to have the Da Qing Long Tang syndrome in pneumonia. The healing effect is very excellent. It is pity that the patient went to the western medicine first. She turned back to Chinese medicine only after the western medicine could do nothing for her. At the time she came to the Chinese medicine, her condition has become different ones. TCM doctor should learnt the conditions to use this prescription.

3.  吴某,男,22岁,住院病案号54

Case 3. Wu. Male. 22 years of old. File number: 054.

初诊日期19591215日:发热恶寒二天,伴头痛、咽痛、咳嗽、胸痛胸闷,经X线检查:为右肺下叶非典型肺炎。既往有肝炎、肺结核、肠结核史。常有胁痛、乏力、便溏、盗汗。前医先以辛凉解表(桑叶、银花、连翘、薄荷、羌活、豆豉等)一剂,服后汗出热不退,仍继用辛凉解表,急煎服,高烧、自汗、头痛、咳嗽、胸闷、恶风、胁痛诸症加重。血常规检查:白血球8100,中性70%。14日静脉输液用抗生素,当夜高烧仍不退,体温394C,并见鼻煽、头汗出。又与麻杏石甘汤加栀子豉等,服三分之一量至夜11时出现心悸、肢凉。因请胡老会诊。胡老椐:晨起体温382C,下午在39C以上,呈往来寒热,并见口苦,咽干,目眩、头晕、盗汗、汗出如洗、不恶寒,苔黄,舌红,脉弦细数,认为证属表已解,连续发汗解表,大伤津液,邪传少阳阳明。治以和解少阳兼清阳明,为小���胡加生石膏汤方证:柴胡五钱,黄芩三钱,半夏三钱,生姜三钱,党参三钱,大枣四枚,炙甘草二钱,生石膏二两。

The date of first visit: Dec. 15, 1959. The patient had fever and chilly for two days, with headache, sour throat, cough, chest pain and fullness feeling. X-ray showed atypical lower right side pneumonia. The patient had a previous history of hepatitis, lung tuberculosis, intestine tuberculosis. She had, from time to time, pain in the upper side of the belly, fatigue, loose bowel movement, and night sweat. The previous doctor had given her Spicy-Cold herbs to relax body surface (such as herb Sang Ye, Yin Hua, Liang Qiao, Bo He, Qiang Huo and Dou Zhi, etc.) one dose. After the herbal tea, she had sweat but the fever remained. She was given the Spicy-Cold herbs again and the herbal tea was drunk soon after cooled. She then got worse, in terms of high fever, self-sweat, headache, cough, fullness in chest, wind-dislike feeling, worse pain on the upper side of belly, etc. Blood test showed that, her WBC was 8100, neutral portion is 70%. The second day, she was given in vein infusion of anti-biotics. On the night her body temperature was still very high (39.4 C). She had nose flashing, sweat on head. She was then given herbal prescription Ma Xing Shi Gan Tang plus herb Zhi Zi, etc. After drunk one third of the herbal tea and on 11 pm, she felt palpitation, and cold in arm and feet. Dr. Hu was then invited for a consultation. Dr. Hu believed that her surface Taiyang phase has been released, however the disease were deeper into the Shaoyang-Yangming phase. This is because a continuous sweat therapy exhausted body water portion. The reasons for him to come to this comments are: the patient had body temperature 38.2C in the morning and more than 39 C in the afternoon, which showed as comes and goes the fever and chilly, had bitter mouth, dry throat, dizziness in eyes and head, night sweat, heavy sweat as shower, no cold-dislike feeling, red tongue, yellow tongue covering, and thin-string-frequent pulse. The patient was given herbal prescription Xiao Chai Hu Tang plus Shi Gao, to harmonize Shaoyang and clere the Fire in the Yangming phase: Chai Hu 15 grams, Huang Qin 9 grams, Ban Xia 6 grams, fresh ginger 6 grams, Dang Shen 6 grams, Chinese date 4, Zhi Gan Cao 6 grams, and Shi Gao 60 grams.

结果:上药服一剂,后半夜即入睡未作寒热及盗汗。16日仍头晕、咳嗽痰多带血。上方加生牡蛎五钱,服一剂。17日诸症消,体温正常。1222X线检查:肺部阴影吸收。

Following up: after the herbal therapy for one day, the patient came into sleep in the later middle night without chilly or fever or night sweat. On Dec. 16, she still felts dizziness, cough with more phlegm and with blood in phlegm. To the herbal prescription above, added Mu Li 15 grams. After one dose of the herbal tea, her body temperature turned normal. On Dec. 22, check by X-ray: everything was normal on the film.

4.  岳某,男,67岁,病案号:122745

Case 4. Mrs. Yue, male. 67 years of old. File number: 122745.

初诊日期196573日:恶寒发热五天,伴头痛、咳嗽、吐黄痰,体温395C。曾服桑菊饮加减(桑叶、菊花、连翘、薄荷、杏仁、桔梗、荆芥、芦根、黄芩、前胡、枇杷叶等)二剂,热不退经X线检查,诊断为左肺上叶肺炎。又用银翘散加减二剂,汗出而热仍不退。又与麻杏石甘汤加减一剂,汗大出而热更高,体温411 C。请胡老会诊时症见:汗出,烦躁不宁,时有谵语,咳嗽吐黄痰,腹胀,大便五日未行。舌红苔黄腻,脉弦滑数。胡老认为证属阳明里实证,为大承气汤方证,药用:大黄四钱(后下),厚朴六钱,枳实四钱,芒硝五钱(分冲)

The date of the first visit: July 3, 1965: the patient had chilly and fever for 5 days. He had headache, cough, phlegm of yellow color. His body temperature was 39.5C. He had drunken herbal tea Sang Ju Yin with modifications (Sang Ye, Ju Hua, Liang Qiao, Bo He, Xing Ren, Jie Gen, Jing Jie, Lou Gen, Huang Qin, Qian Hu, Bi Ba Ye, etc.) two days. His body temperature remained high. X-ray test showed he had left upp lung pneumonia. He was given Jing Qiao San with modifications for additional two days. He had sweat but the fever remains. He was then given herbal prescription Ma Xing Shi Gan Tang one day. The sweat was heavy but the fever became worse to 41.1 C. Dr. Hu was asked then for a consultation. On the time, the patient had sweat, annoyed, delirious speak from time to time, cough with yellow phlegm, floating in belly, no bowel movement for five days. His tongue was red in color and tongue covering was yellow and greasy. Pulse was string, slippery and frequent. Dr. Hu believed that his condition belongs to the Yangming phase of inner overwhelming condition, e.g. the Da Cheng Qi Tang syndrome. The herbs given were: Da Huang 12 grams (added latest in cook), Hou Pu 18 grams, Zhi Shi 12 grams, and Mang Xiao 15 grams (drink directly without cook).

结果:上药服一剂,大便通四次,热退身凉。余咳嗽吐黄痰,继与小柴胡加杏仁、桔梗、生石膏、陈皮,服三剂而愈。

Following up: after one day treatment, the patient had bowel movement for four times. His body temperature turned normal. He still had cough with yellow phlegm. He was given Xia Chai Hu Tang plus Xing Ren, Jie gen, Shi Gao, Chen Pi for three days. Then, everything was ok.

按:从以上论述和治疗验案皆可看出,胡老治疗肺炎所用都是《伤寒论》六经辨证和经方,且疗效确切,说明中医在古代已有治疗肺炎的经验。也就是说,如果真正掌握了《伤寒论》的六经辨证和方证,就能有效地治疗肺炎。

Comments: From the case reports and explanations above, we can see that, the herbal prescription used by Dr. Hu for the treatment of pneumonia all come from the Liu Jing syndrome diagnosis described in the book <<Shang Han Lun>>  and following the herbal prescription indications. The healing results are certain. It means that, the TCM doctor in ancient years have had experience in the treatment of pneumonia. In another way, if we understand how to use the Liu Jing diagnosis method in the <<Shang Han Lun>> and to recognize the herbal prescription indications, we should be able to solve the pneumonia.

这里应当提到的是,肺炎常见的大青龙汤方证,其证的特点是外寒挟饮的太阳表热与阳明里热盛同时并见,所用大青龙汤发汗解表行饮兼清里热。方中的麻黄、桂枝、杏仁、生姜、大枣辛温发汗解表行水,生石膏辛寒清里热,诸药配伍共起辛凉清热作用。值得注意的是,一些人把热病以病因归纳为风寒或风热,治疗用药则分为辛温或辛凉,于是有人认为《伤寒论》缺乏辛凉清热药物,这是没学透《伤寒论》的六经辨证理论和未能理解其方药功能的表现。

That it should be mentioned here is, the Da Qing Long Tang indication is very often seen in pneumonia. Its characteristics are the co-exist of the Taiyang surface hotness and the Yangming inner hotness, with invading Cold and pre-exist original water accumulation condition in the body.  The Da Qing Long Tang works to stimulate sweat to release the body surface, to clear the inner water accumulation, in addition to clear inner hotness. The herb ingredients, Ma Huang, Gui Zhi, Xing Ren, fresh ginger, Chinese date, all work to have a spicy-warming effect to stimulate sweat, release body surface, and to remove extra water in the body. The Shi Gao is spicy-Cold, which works to clear inner hotness. All together, the herbal prescription works to clear the hotness. It should be paid attention to that some people summarized the hotness disease into either Wind-Cold or Wind-hotness. In the treatment, they use spicy-Warm, or spicy-Cold. They then believe that there is no such spicy-Cold or spicy-warm herbal therapy in the <<Shang Han Lun>>. This means that these doctors did not really understand the Liu Jing diagnosis system in the <<Shang Han Lun>> and do not know the functions of the herbs in the herbal prescription in this book.

在会诊病例3时,胡老特别指出:辛凉解表只是定了一个大法,并没有进一步辨清具体的方证,因此治疗用药偏于盲目,过度解表津液大伤,造成汗出热不退或更甚。前已所述,把肺炎的发热分为风寒、风热所致是片面的,即是得知是风寒或风热,也要看患者所表现的症状,不论是风寒或还是风热,都可能在人体产生或热、或寒、或虚、或实、或表、或里的症状,分析这些症状所应归属的方证,才能明确当用方药。故胡老特别强调,中医治病辨证论治,不但要辨六经八纲、脏腑阴阳,更要辨方证,辨方证是六经八纲辨证的继续,它既是辨证的具体实施,也是辨证的基本功。也就是说,治病不能只有治疗大法如辛温发汗、辛凉清热、清阳明热、宣肺化痰......更重要的是要明确对证的方药。也就是说,辨方证比辨治疗大法更重要。对此,历代医家早有认识,如方有执研究《伤寒论》曾强调"守一法,不如守一方",即是强调辨方证。从胡老治疗肺炎的经验可看出,中医看似简单,但做到真正掌握,必须在继承上下功夫和必须在临床上反复体验,方能成为一个较高明的中医。

During the consultation for the case 3, Dr. Hu pointed specifically out that, the spicy-Cold therapy is given out only a outline, without outlined the practically exact prescription indications (e.g. in which clinic conditions the spicy-Cold therapy should be used). Therefore in the treatment, the indication to use this therapy is not so clear. An over sweat-stimulation could cause exhaust of body water portion, cause a sweat without fever reduced or the fever being even worse. As mentioned above, to classify the fever in pneumonia into Wind-Cold and Wind-hotness is not complete. Even if it is known that the pneumonia is due to a Wind-Cold, or Wind-Hotness, it is still needed to check the body syndrome. No matter it is the Wind-Cold or Wind-hotness, it could cause a fever, or a cold, or a weak, or a overwhelming, or a surface phase or a inner phase condition. To analyze these syndrome and contribute them into specific herbal prescription indications, it could then allow a decision to which herbal prescription should be used. For this reason, Dr. Hu specifically emphasized that, in the syndrome diagnosis of the Chinese medicine, ti should not only be diagnosed according to the Liu Jing system, the eight Gang system, the organ system, and the Yin and the Yang aspect, but also the indication diagnosis. It is a continuous step the herbal prescription indication diagnosis after the Liu Jing diagnosis or the eight Gang diagnosis system. It is the practical step, and also the basic skill of a doctor to use herbal therapy. In another words, it is not enough to know the healing principle, such as spicy-warm to stimulate sweat, spicy-Cold to reduce fever, or to expand lung to clear phlegm…. It is more important to know in which condition to use which herbal prescription (the prescription indications). It can be said that, it is more important to diagnose the indication to herbal prescription than to diagnose the healing principles. For this comments and experience, various doctors in history have realized. For example, Dr. You-Zhi Fang said, in his study of the <<Shang Han Lun>>, that “to verify the condition for a herbal prescription is more important than to verify a healing principle”. It appears to emphasize the indication diagnosis. From the experience of Dr. Hu in the treatment of pneumonia, it can be found that, the Chinese medicine seems simple, but it is actually not so easy in terms of really knowing how to use the herbal prescription. It needs thorough study the experience of previous doctors in the history, and repeat the practice in clinic again and again, so as to be a TCM expert.

 

 

3. 治疗哮喘独特经验

3. Treatment of asthma

治哮喘不用麻黄,却独崇大柴胡汤

For the treatment of asthma, the traditional herb Ma Huang is not used, in stead, the herb Da Chai Hu Tang is used exclusively.

刚跟随胡老学习,常感到其治病用药新奇。一天,遇到一位久治不愈的哮喘患者(),处方中既无补肾纳气的白果、五味子、肉桂、山萸肉、熟地等,亦无宣肺定喘的杏仁、麻黄,而用了大柴胡汤加味,因而问之:"治喘为何不用麻黄?"胡老答曰:"因无麻黄证。"又问:"何为麻黄证?"胡老笑而答曰:"这不是一句话能讲清楚的,待有时间再详细讲吧。"当时急待获得答案的学生,不免感到遗憾,但庆幸的是,自此每逢星期天,胡老就给我讲授他对经方的研究和临床经验,治疗哮喘不用麻黄,而常用大柴胡汤的道理也就应刃而解了。

In the beginning of following Dr. Hu for clinic practice training, I felt very interested for the herbs he used. One day, we saw a patient with long term of obstinate asthma. In the herbal prescription prescribed by Dr. Hu, there was no any herbs to nourish the Kidney so to attract the Qi downwards, such as Bai Guo, Wu Wei Zi, Rou Gui, Shan Yu Rou, Shou Di, etc. nor herbs that work to expand lung to stop asthma, such as Xing Ren and Ma Huang. Instead, he used prescription Da Chai Hu Tang with modification. I therefore asked him, “why you do not use herb Ma Huang to treat asthma?” He answered me: “because there is no indication to use Ma Huang.”I asked again, “What is the indication to use Ma Huang”Dr. Hu smiled and said: “This is a question that cannot be answered by one sentence. We can talk about it more later when we have time.”The students who were at the spot and who were so eager to know the answer could not prevent from feeling pity. However, we were lucky that, once in Sunday, Dr. Hu taught us about his research and experience in studying the Jing Fang.  The question why not use Ma Huang to treat asthma but use Da Chai Hu Tang became clear.

从六经辨证来看,哮喘常表现为太阳病或少阳病,尤以太阳少阳并病、少阳阳明并病和三阳并病为最多见,而且以实证为多见。中医所说的哮喘,一般多是指临床上的一个症状,以邪气实多见。有人观察了哮喘患者,除了给对证的方药外,同时采用了控制饮食、通腑涤肠等方法以消里实,使临床治愈率从20%~30%提高到70%~80%。元代的朱丹溪提出:"哮主于痰。"明代的张景岳提出:"喘有宿根,遇寒即发或遇劳即发,亦名哮喘。"都在说哮喘以实证多见。又据患者平时无咳喘、吐痰、头痛、身疼等症,知不在太阳;哮喘发作时有胸满、胁痛、汗出、咽干、便干等,多属少阳阳明合病;又据哮喘多发于夜晚,发作时及不发作时皆无咯痰,可排除痰饮为患,这样引起此类哮喘的主要原因当属瘀血阻滞。因此,此类哮喘多呈现少阳阳明合病兼挟瘀血,为大柴胡汤合桂枝茯苓丸方证。这便是胡老在治疗哮喘时,往往不用麻黄,而常用大柴胡汤加减的主要原因。这里必须强调一下,当然不是说,对所有的哮喘都不用麻黄,当病证在太阳有麻黄的适应证时也必用麻黄,这里仍是强调必须辨方证。

From the Liu Jing diagnosis system, asthma usually expresses as Taiyang phase or Shaoyang phase, especially a co-exist of the Taiyang-Shaoyang two phases, or Shaoyang-Yangming, or the three Yang co-exist condition. In addition, it shows more as an overwhelming syndrome. The asthma reffered in the Chinese medicine is usually a symptom in clinic. It commonly is a Xie Qi overwhelming condition. There is a study, in which the asthma patients were given corresponding herbal therapy, as well as diet control, bowel clearing therapies to clear the inner overwhelming, the success rate increased from 20% - 30% to 70% -  80%. Dr. Zhu Dan-Xi in Yuan dynasty of China proposed: “the asthma is associated to the phlegm”. Dr. Zhang Jing-Yue in Ming dynasty said: “the asthma has hidden root in the body. It comes to onset with outside cold or exhaustion labor stress.”Both doctors believed that the asthma is more with a overwhelming condition. Because the patient has no cough or asthma, no phlegm, no headache, or sour in body, it is known that it is not in the Taiyang phase. Once it starts, the patient feels chest fullness, sour in the upper side of the belly, sweat, dry throat, constipation, etc, it is more likely in the Shaoyang- Yangming co-exist phases. It happens more in the night, no phlegm no matter it shows asthma or not, it is not due to Phlegm condition. So, the main reason for the asthma should be due to blood stagnation. For this reason, such asthma more likely shows as the Shaoyang-Yangming phase with blood stagnation, which is the indication to herb prescription Da Chai Hu Tang plus prescription Gui Zhi Fu Ling Wan. This is the reason for Dr. Hu in the treatment of asthma, does not use Ma Huang, but use Da Chai Hu Tang mainly. Here it has to be emphasized: it does not mean that the herb Ma Huang is absolutely not used in the treatment of asthma. It is, of course, used in the treatment of asthma, if there is indication to use it, such as if the asthma is in the Taiyang phase. Here we emphasize the prescription indication diagnosis.  

哮喘病发虽在肺,痰饮瘀血为主因

Though the asthma expresses in the lung, the main reason is the phlegm and blood stagnation.

元代的朱丹溪提出:"哮主于痰",明确指出了痰阻气机,肺气不降是哮喘的主要病因病机,后世在这点上认识颇为一致。明代张景岳提出的"喘有宿根"这一观点也为后世所接受。值得注意的是:有的哮喘患者在非发作期或长期发作后出现了一些虚损现象,可以说是久病伤肾,有的人就把此当作形成哮喘的根本,这是很片面的。《证治准绳》说:"其元耗损,喘生于肾气上奔。"多是指肺气肿之属的气短、喘息,少见于喉中有痰鸣的哮喘。肾气上奔的哮喘,从理论上讲是有道理的,应予注意,但临床上这种哮喘是少见的,如果过于强调这一理论,就会造成对哮喘的成因及治疗的偏差。应明了哮喘以实证多见,也要注意虚证哮喘的存在。一般认为,实证哮喘的"宿根"多是指痰饮实邪,胡老通过长期临床观察、实践,认为瘀血是引起哮喘的重要因素之一。历代医家尚未明确提出瘀血能致哮喘,但《内经》有过类似的描述。如《素问脉要精微论》曰:"肝脉搏坚而长......当病坠若搏,因血在胁下,令人喘逆。"有似因瘀血在胸胁引发喘证。

Dr. Zhu Dan-Xi in the Yuan dynasty China said: “the asthma is due to the Phlegm in the body”. It clearly points out that the block of lung by Phlegm that prevents the lung Qi to descend is the reason to the asthma. This comment is pretty much agreed by most of doctors in later times. The comment by Dr. Zhang Jing-Yue in Ming dynasty China also said that the asthma has deep hidden root in the body is also well accepted by later doctors. It is worthwhile to know that, some asthma has weakness conditions during the no-onset period or after a long time of onset. It can be said that a long time disease hurts the kidney. Some doctors regard such weakness as the main cause of the asthma. This is not a complete understanding to the asthma. It is said in the book <<Zhen Zhi Zun Shen>> that: “Once the Yuan Qi is exhausted, the Kidney Qi reverses up, so to cause the asthma” Here it mostly refers to the short of breath, and asthma-like breath in a pneumonectasis condition. In little cases, it can been seen in an asthma with phlegm. That the Kidney Qi reversely pushes up to cause asthma-like breath is in theory possible, but in practice, it is not common. If we pay too much attention to such asthma-like condition, it will cause a improper understanding to the cause of asthma and a improper way for the treatment. It should be clear that, the asthma is more a overwhelming condition, not a weakness condition, though we should know there is a weakness condition. Commonly, it is believed that, the root for a overwhelming asthma is the phlegm (or a condensed water accumulation in the body), but Dr. Hu, after long time clinic observation and practice, believes that the blood stagnation is one of the major causes of asthma. In the history, there has no one who mentioned that the blood stagnation could cause asthma, but in the book <<Nei Jing>>, there is similar introduction and statement. For example in its sub-chapter <<Su Wen Mai Yao Jing Wei Lun>>, it said: “The liver pulse is hard, strong and long… the person would have been hurt by fall, since there is blood under the ribs, which makes one to asthma”, implying that a stagnated blood in the chest and under ribs can cause asthma.    

现代病理研究也说明:在慢性气管炎(包括哮喘性支气管炎)末稍细支气管及肺泡间隔的超微结构的改变,可看到小血管内有血栓形成,与中医的肺有瘀血、血在胁下是相吻合的。

Modern scientific research also indicates that: there is change in the micro-structure in the end fine bronchi and between the lung bobbles in the chronic bronchitis. It can also been seen blood clots in the blood micro-vessels there. It is compatible with the blood stagnation in the lung and the blood under the ribs.

更能说明问题的是,临床上用活血祛瘀的方法治疗哮喘多有良效。近代临床报道用地龙、瓦松、蛞蝓等治疗哮喘收到明显的疗效。这些单味药具有解痉、抗过敏作用,从中医药性来分析,这些药物都有活血祛瘀的作用,从而也可说明哮喘病人有瘀血里实的存在。
More convincing evidence is that, the stagnation-dissolving therapy works in the treatment of asthma. It has been reported in modern clinic studies that the use of herb Di Long, Wa Sun, Kuo Yu, etc. in the treatment of asthma improved the healing of asthma to clearly higher level. These herbs, each in alone, have effect of spasm-releasing and anti-allergic reaction. From the Chinese medicine point of view, they have blood stagnation-dissolving effect. This can confirm that there is blood stagnation condition in the asthma.

基于以上说明,胡老认为,哮喘的主因是痰饮、瘀血(所谓宿根),诱因是外感、伤食、物理、化学、七情等其他刺激。即当外邪侵袭人体及外在或内在的因素刺激人体后,与体内的痰饮、瘀血相互搏结,阻塞肺气,使肺气上逆而产生哮喘。这就是外邪引动内邪,也即外因引动内因而发病。当然也有单是瘀血,或单是痰饮阻肺而发病的情况。认识到这一病因病理,对于指导辨证治疗有重要意义。因此,以痰饮、瘀血为纲,则哮喘证治了如指掌,今简述于下:

Based on the discussion above, Dr. Hu believed that the main cause of asthma is phlegm, condensed water, and the blood stagnation. The triguring factors are common cold, improper diet, and physical, chemical and emotional stimulations. This means that, when the external Xie Qi invades the body, or when the stimulating factor start to stimulate the body, the Xie Qi or the stimulations entangle with the pre-exist phlegm, condensed water, or blood stagnation in the body. This results in the block of energy flow in the lung, causing the Lung Qi reverse up to form asthma. This is due to the triggering of asthma due to external factors. Of course, the inner phlegm or inner blood stagnation alone can also block the energy flow in the lung to cause the asthma. It is very important to understand this and realize this for the syndrome diagnosis and herb indication diagnosis. For this, taking the phlegm and stagnation as the therapeutical principle, it becomes very simple and straight forward for the treatment of asthma. They are outlined here:
        

() 以痰饮为主因的哮喘证治

The treatment of asthma that is mostly due to phlegm and condensed water:

外邪内饮,为常见的一种证。即是说,其人素有水饮、痰浊潜伏于体内,一旦遭受外邪侵袭,外邪激动里饮,塞逆于肺,则发为哮喘。即呈《伤寒论》所述伤寒表不解,心下有水气之证。治宜发汗解表,温化水饮。其中具体药证又分以下几种:

The syndrome of external Xie Qi plus the inner condensed water is commonly seen in clinic. In another words, if the person has pre-exist condensed water or phlegm hidden in the body, once he is attacked by external Xie Qi, the Xie Qi disturbs the inner water or phlegm, resulting in the block of energy flow in the lung to show as asthma. This is the condition described in the book <<Shang Han Lun>> “In the Cold-invading time, the body surface phase (Taiyang phase) remains with the presence of water under the heart (in stomach area). For the treatment, the principle should be to release the surface phase with sweat therapy, and dissolve the accumulated water by warming therapy. In practice, the most commonly used herbal conditions are the following.

1.射干麻黄汤方证主症见:恶寒,身痛,痰多,喉中痰鸣,射干麻黄汤主之。口干、舌燥、心烦者,宜更加生石膏。

1. She Gan Ma Huang Tang indication: The person has cold-disliking feeling, pain in the body, heavy phlegm, and phlegm noise in the throat. For such clinic syndrome, use She Gan Ma Huang Tang. If the person has also dry mouth and annoyed feeling, add herb Shi Gao too. 

2.小青龙汤方证主症见:恶寒,身痛,无汗,咳逆,倚息不得卧,咳唾白泡沫痰,小青龙汤主之。若见咽于、烦躁者,宜更加生石膏。

2. Xiao Qing Long Tang indication: The person has cold-disliking feeling, pain in the body, cough, hard to lay down for sleep, and spits white phlegm with air bubbles in the phlegm. For such syndrome, use Xiao Qing Long Tang. If the person has dry mouth and annoyed feeling, add herb Shi Gao.

3.葛根合小陷胸汤方证主症见:项背拘急,胸满闷或痛,发热恶寒而喘,葛根汤合小陷胸汤主之。若心烦明显者,亦宜加生石膏。

3. Ge Geng Tang plus Xiao Xian Xiong Tang indication: The person feels tightness and spasm on the neck and back, fullness or pain in the chest, fever, cold-dislike feeling, and short of breath as asthma. In such syndrome, use Ge Geng Tang plus Xiao Xian Xiong Tang. If the annoyed feeling is strong, add Shi Gao.

4苓甘五味姜辛夏杏汤方证 主症见:咳逆,喘满,唾白泡沫痰,口中和,苓甘五味姜辛夏杏汤主之。

4. Ling Gan Wuwei Jiang Xin Xia Xing Tang indication: The person feels cough, asthma, spit white bubble phlegm, and feels no special taste in mouth. In such condition, use Ling Gan Wuwei Jinag Xin Xia Xing Tang.

5.麻黄附子细辛汤方证,症见:恶寒,无汗,或背恶寒,四逆,精神疲惫,脉沉细,麻黄附予细辛汤主之。

5. Ma Huang Fu Zi Xi Xin Tang indication: The person has cold-dislike feeling, no sweat, or feels chilly on the back, cold in hands and feet, and tired. The pulse feels deep and thin. This is the indication to use Ma Huang Fu Zi Xi Xin Tang.

() 以瘀血为主因的哮喘证治

The treatment of asthma that is mostly due to blood stagnation:

原有瘀血潜伏于体内,一旦外感或伤食或七情变化,诱使瘀血变化,上犯肝肺而发哮喘。若不驱瘀,则哮喘经久不愈,故凡哮喘不论寒暑经年不已者,多属瘀血为患。具体常见方证如下:

If there is pre-exist blood stagnation in the body, and once there is external Xie Qi invasion or emotional stimulation, the stagnated blood is disturbed and moves up to the lung to block the energy flow in the lung to cause asthma. Without the dissolution of the stagnation, the asthma would last for long time in to chronic condition. Therefore, if a asthma lasts for years without improvement, it mostly is due to the stagnation. The herbal prescription used in this group are the followings:

1.大柴胡汤合桂枝茯苓丸方证 主症见:胸胁苦满,呼吸困难,心下急,口苦咽干,大便干燥。

1. Da Chaihu Tang plus Guizhi Fuling Wan indication: The person feels annoying fullness in the chest and in the upper side of belly, hard to breath, spasm in the stomach area, bitter in mouth and dry in throat, and constipation.

2.大柴胡汤合桃核承气汤方证 主症见:上证又见腹胀满,大便难通者。

2. Da Chaihu Tang plus Taohe Chenqi Tang indication: The person has the symptoms above, in addition to bloating belly and hard to have bowel movement.

以上二方证,若见口干舌燥或烦渴者,均宜加生石膏;若上证复有外感,发热恶寒而无汗者,则宜葛根汤,依证选用大柴胡汤、桂枝茯苓丸,或大柴胡汤合桃核承气汤三方合主之,见咽干烦躁者,亦宜加生石膏;若上证见汗出而喘明显者,则宜麻杏石甘汤,依证选用大柴胡汤合桂枝茯苓丸,或大柴胡汤合桃核承气汤三方合方主之。

For the above two indications, if the person feels dry mouth or annoying thirsty, add Shi Gao. If the person has common cold, feels fever and cold but no sweat, use Ge Gen Tang, in addition to choose either Dai Chaihu Tang, Guizhi Fuling Wan, or Dai Chaihu Tang plus Taohe Chengqi Tang. For all of these herbal prescription, if the person has dry throat and annoyed feeling, all need to add Shi Gao. If there is sweat and the same time asthma, use Ma Xing Shi Gan Tang, in addition to the use of Da Chaihu Tang plus Guizhi Fuling Wan, or Da Chaihu Tang plus Taohe Chengqi Tang.

() 痰饮瘀血二因俱备的哮喘证治

The treatment of asthma that is due to both phlegm and blood stagnation:

既有外邪内饮,复有瘀血在里的哮喘也屡有所见。如常见有小青龙汤方证,复见大柴胡汤合桂枝茯苓丸合方证者(证见前),即以小青龙汤、大柴胡汤、桂枝茯苓丸三方合方主之。大便难通者,可易桂枝茯苓丸为桃核承气汤;若现射干麻黄汤方证者,即以射干麻黄汤为主,依证选用大柴胡汤、桂枝茯苓丸,或大柴胡汤、桃核承气汤三方合方主之。以上各方证,若见口舌干燥或烦躁者,均宜加生石膏。哮喘治疗效卓著辨方证上下功夫。

It is also often seen that a person with asthma has external Xie Qi invasion, the inner water accumulation, and also the inner stagnation. For example, there is Xiao Qinglong Tang indication, but also an indication for the Da Chaihu Tang plus Guizhi Fuling Wan. In this case, use all the three prescription the same time. If there is constipation, stop to use Guizhi Fuling Wan, but use Taohe Chengqi Tang. If there is Shegan Mahuang Tang indication, use it, in addition to the use of other Da Chaihu Tang, Guizhi Fuling Wan, or Taohe Chengqi Tang according to the clinic conditions. For all these indications, if the person has dry mouth and throat, or has annoyed feeling, all need to add Shi Gao.

胡老非常强调,方证之学为医者的基本功。六经之分,只概括了为病的表里(含半表半里在内)阴阳,当然还须进行寒热虚实的分析,则六经八纲俱无隐情,辨证至此,已可制定施治的准则。是胡老特别强调,在临床应用上,这还是远远不够的。所谓准则,亦只是可汗、可下、可补等等法则而已,究竟宜用什么方药,还须进行方证之辨。方证者,即方剂的适应证,如《伤寒论》所载桂枝汤证、柴胡汤证、白虎汤证等等皆是也。辨方证为六经八纲辨证的继续,亦即辨证的尖端。中医治病有无疗效,其主要关键就在于辨方证是否正确。所以,医者必须对各种重要方剂要熟悉,无论是药物组成,还是药理作用,尤其具体的适应证,均须心中有数。今谨按病例分析于下:

Dr. Hu emphasizes very much that, it is the basic skill for a doctor to know the herb indication. The Liu Jing diagnosis system only outlines the separation of the surface or the inner, the Yin or the Yang phase of a disease. With additional Cold or Hotness, weakness of overwhelming diagnosis, the contents of the Liu Jing and eight Gang diagnosis become clear in mind. Based on such diagnosis, the principle of the treatment should be able to set up. However, Dr. Hu emphasized that in clinical practice, it is not al enough for the treatment yet. The so called the principle only tells us for the given disease condition/phase, the sweat therapy, or the bowel-cleansing therapy or the nourishing therapy can be used or not. To decide which herb or herbs or herbal prescription should be used, it is needed a further herb indication diagnosis. The herb indication means the indication(s) to the use of that specific herb or herbal prescription, such as the herbal prescription in the book <<Shang Han Lun>>, the Guizhi Tang, Chaihu Tang and Baihu Tang, etc. The herb indication diagnosis is the continue of the Liujing diagnosis and Ba Gang diagnosis, e.g. the final step of the whole diagnosis process. Whether a herbal therapy works or not, depends much more on the correct herb indication diagnosis. Therefore, a doctor must know the most commonly used herbs and herbal prescription. It should be kept in heart clear the composition of the herb prescription, its function, and it indication. Here we make an example for such explanation:

病例1. 康某,男,36岁,中学教师,病案号143153

Case 1. Mr. Tang. 36 years of old. Teacher. File number: 143153.

初诊日期1964429日:三年前因食青辣椒而引发哮喘,始终未离西药治疗迄今未愈,冬夏无休,每次发作,常因偶尔咳嗽或喷嚏引发。自觉消化不好,大便干燥即为将发之预兆。发作时喘满胸闷,倚息不得卧。曾在长春、沈阳、哈尔滨等各大医院治疗均不见效而来北京治疗。来京亦多处求医,曾用割治疗法,两侧颈动脉体手术等疗法,皆毫无效果。又多处找名中医诊治,一名中医以宣肺定喘、补肾纳气等方药治疗7个多月,证有增无减,并告之:"伤色太甚,虚不受补。"颇感精神痛苦,以至绝望。计返故里等死,后听别人介绍,到胡老这里最后一试。现在症状:喘闷,胸腹胀满,昼轻夜重,晚上哮喘发作,倚息不得卧,大汗淋漓,口干,便秘,心中悸烦,眠差易醒,舌苔薄白,脉沉缓。据证与大柴胡合桂枝茯苓丸加生石膏汤:柴胡四钱,黄芩三钱,半夏三钱,生姜三钱,枳实三钱,炙甘草二钱,白芍三钱,大枣四枚,大黄二钱,桂枝三钱,桃仁三钱,茯苓三钱,丹皮三钱,生石膏一两半。

The first visit: April 29, 1964. The patient started asthma three years ago after ate of hot pepper. He had to had western medicine after that for three years without cure. The asthma onsets summer and winter no end. Every time, it was triggered by cough or sneeze. He felt that, once he had poor digestion and constipation, there would be the prediction to the onset. When the asthma came, he felt fullness and annoyed in chest, hardly being able to lay down. He had visited various big hospitals in China but no any improvement. He also tried surgical removing therapy, and neck artery operation, etc, as well as visited various famous TCM doctors in the capital of China. One of the TCM doctor gave him the herbal therapy to release the lung and to nourish the kidney to improve breath for seven months, but the symptoms became even worse. He was then told: “Your body has been damaged by exhausting sexual activities. It is so weak to be nourished again”. He felt so sad to hopeless, planning to back to die. Later after introduced by others, he came to Dr. Hu for a last try. At that movement, he felt asthma and stuffy in chest, bloating in chest and belly, which are better in daytime but worse at night. At night, the asthma was so severe that he cannot lay down to sleep, with heavy sweat, dry mouth, constipation, palpitation and annoyed, shallow sleep to wake up easily. His tongue cover was thin and white in color. His pulse was deep and slow. According to his condition, he was given Da Chaihu Tang plus Guizhi Fuling Wan plus Shigao: Chaihu 12 grams, Huangqin 9 grams, Banxia 6 grams, fresh ginger 9 grams, Zhishi 9 grams, Zhi Gancao 6 grams, Baishao 9 grams, Chinese date 4, Dahuang 6 grams, Guizhi 9 grams, Taoren 9 grams, Fuling 9 grams, Danpi 9 grams, and Shigao 45 grams.

二诊53日:上药服第二剂后,症状减轻,服第三剂时,大便通畅,哮喘已,胸胁满、腹胀、心中悸烦均不明显,已不用西药氨茶碱等,上方继服三剂。

On the second visit on May 3th: after taking that herbal tea for two days, the symptoms were improved. On the third day, the bowel movement turned normal, the asthma stopped, and the fullness, bloating, palpitation and annoyed feeling, all were subside dramatically. The western medicine, such as Aminophilline, were stopped to use. The above herbal prescription were asked to continue for additional three days.

三诊1966925日:出差来京,告知病情,两年来曾数次感冒咳嗽,但未出现哮喘。

On the third visit on Sept 25, 1966: Having a business trip to this city, he so came for a consultation again. It was reported that, for the past two years, there were several times of common cold, but no asthma. 

按:本患者为支气管哮喘,三年来用中西药及手术治疗无效,关键是辨证不确,实用补治,方不对证,致使病长久不愈。初诊时证的特点:胸胁满闷,心中悸烦,汗出口干,大便秘结等.为少阳阳明合病证。发病既不为外感所诱发,又无痰饮证候,尤其昼轻夜重,多属瘀血为害。综台以上分析,为大柴胡合桂枝茯苓丸加生石膏汤方证,故予两解二阳合病,兼以驱瘀活血,因方药对证,故服之而收捷效。徐灵胎说:"用药如用兵,实邪之伤,攻不可缓,用峻厉之药,而以常药和之。"本患者为瘀血实邪所致的哮喘,治疗应急速攻逐瘀血里实之邪,故用大黄、枳实、桃仁等峻厉之药,而以大枣、甘草、茯苓、生姜等常药和之。故大柴胡合桂枝茯苓丸加生石膏汤治疗瘀血里实证属少阳阳明合病之哮喘,其攻邪速捷,但不伤正。临床屡用此方药皆不用麻黄,而治哮喘屡见显效。

Comments: This patient has asthma. For three years with various treatments, both with western medicine or Chinese medicine, there is no any improvement. The problem is that the diagnosis is incorrect. For a overwhelming condition, a nourishing therapy was given. The herbs did not match the body condition, which makes the disease lasts for a pretty long time. The characteristics on his first visit are: fullness in chest and on the upper side of belly, palpitation and annoyed, sweat with dry mouth, and constipation. It is the Shaoyang-Yangming co-exist phase. The asthma onse is not triggered by external common cold, nor there is sign of phlegm or water accumulation in the body. Especially the asthma is less severe in the daytime, but worse at night. All suggests that it is more a blood stagnation condition. The overall analysis indicates that it is an indication for the use of Dai Chaihu Tang plus Guizhi Fuling Wan plus Shigao. So the herbal formula was given to solve both the Shaoyang and Yangming phases, in addition to remove the blood stagnation. Due to the herbs match the body condition, so it worked very fast. Dr. Xu Ling-Tai said: “To use the herbs for a treatment is as to launch a war. If the body is hurt by overwhelming Xie Qi, the herbs to be used should function right away. When such herbs are used, also use common used other herbs to buffer it.” The asthma in this case is due to the overwhelming Xie Qi, e.g. the stagnated blood, so for the treatment, the herbal prescription choosen should also work fast and strong to attack the stagnated blood clots. For this reason, the herb Zhishi, Dahuang, Taoren, etc. such strong functioning herbs were used and their strong effects are buffered with the Chinese date, Gancao and Fuling, such commonly used herbs. This is the reason to use the Dai Chaihu Tang, Guizhi Fuling Wan and Shigao for the treatment. In clinic, these herbs were used without any addition of herb Mahuang but still had very effective healing result.

病例 2. 王某,女,62岁,病案号18161

Case 2. Mrs. Wang, 62 years of old. File number: 18161. 

初诊日期197954日:肺炎后患咳喘已10余年,每秋冬发作,春夏缓解,但本次自去年冬发至今未缓解,上月底感冒后,哮喘加重。现在症状:哮喘甚,夜不得平卧,喉中痰鸣,伴咳嗽吐白痰量多,恶寒背冷,口中和,大便溏泄,日二三行,舌苔白微腻,脉弦细,两肺满哮鸣音,左肺散在湿罗音。据证与射干麻黄汤加减:射干三钱,麻黄三钱,桑白皮三钱,生姜三钱,桂枝二钱,炙甘草二钱,五味子三钱,款冬花三钱,紫菀三钱,半夏三钱,杏仁三钱。

The first visit: May 4, 1979. The person has asthma for ten years. It comes to onset every autumn and winter, but released in spring and summer. However, this time since last winter, the asthma continued to now. Last month after a common cold, the asthma became worse. Current condition: asthma is severe, hard to lay down at night, with phlegm noise in throat, with heavy amount of white phlegm, chilly and cold feeling on the back, no special taste in mouth, diarrhea-similar bowel movement, which is two to three times a day. Her tongue was white with slight greasy. Her pulse was string and thin. There was asthma-noise in whole of the lung, and wet-bubble noise in the left lung. For this condition, she was given Shegan Mahuang Tang with some modifications: Shegan 9 grams, Mahuang 9 grams, Sangbaipi 9 grams, fresh ginger 9 grams, Guizhi 6 grams, Zhi Gancao 6 grams, Wuweizi 9 grams, Kuandonghua 9 grams, Ziyuan 9 grams, Banxia 9 grams, and Xingren 9 grams. 

结果:上药服三剂,喘平,咳嗽吐白痰仍多,左肺偶闻干鸣音,未闻湿罗音。上方继服。717日随诊,仅有胸闷、吐少量白痰。

Following up: After three days of treatment, the asthma subsided, but still spit white phlegm. There was occasional dry-bubble noise but no wet-bubble noise on the left lung. The above prescription was asked to continue. On July 17, she had only fullness in the chest and spit little white phlegm. 

按:本例为喘息性支气管炎,哮喘症久,但来诊时外邪明显.主症为喉中痰鸣,咳嗽吐白痰量多,恶寒背冷,证属外邪内饮无疑,法宜发汗解表,除痰平喘,因多痰喉中嘶鸣,为射干麻黄汤方证,加减与之,故用之则验。

Comments: This case belongs to asthmatic bronchitis with a long history of asthma. Upon come, there was clear sign of enternal Xie Qi invasion. The main complain is phlegm noise in throat, spitting large amount of white phlegm, cold feeling on the back and chilly feeling. This condition belongs, no doubt, the external Xie Qi invasion with inner condensed water. The healing principle is to stimulate sweat to release the surface syndrome, to clear the phlegm so to stop the asthma. For the phlegm noise in the throat, it is the indication for the Shegan Mahuang Tang. With some modification of the prescription, it works effectively.

病例3.  田某,女,20岁,本院学生,住院病案号129

Case 3. Ms. Qian, 20 years of old. Student. File number: 0129.

初诊日期1959115日:哮喘、咳嗽5天。自1956年冬受风寒后,常发作哮喘、咳嗽,本次发作重而住院治疗,诊断为支气管哮喘。已服中药三剂未见效而请会诊。现在症状:哮喘咳嗽,端坐抬肩,不能平卧,喉中痰鸣,住病房楼三层,在一层即能闻其声,哮喘多由一阵咳嗽后加重,自感胸闷憋气,呼气易而吸气难,声音嘶哑,咳嗽吐白泡沫痰,鼻塞流清涕,喷嚏,胃口不好,厌食油腻,大便干少,膝肘关节痛,舌苔薄黄,脉细数,两肺满哮鸣音。证属太阳阳明合病,与大柴胡汤、葛根汤、大青龙汤三方合方治之:柴胡四钱,枳实三钱,白芍三钱,黄芩三钱,酒军三钱,生姜三钱,大枣四枚,半夏三钱,麻黄三钱,葛根三钱,杏仁三钱,桂枝三钱,炙甘草一钱,生石膏一两半。

The first visit: January 15, 1959. The person had asthma and cough for five days. Since winter 1956 after catching Wind-Cold, she had onset of asthma and cough. This time, the onset was severe so was kept in hospital for treatment. Her condition was diagnosed as bronchial asthma. She was given herbal therapy somewhere without effect. So she went to Dr. Hu. The current condition: she had asthma and cough, sat in sitting position with shoulder rising when breath, hard to lay down, with phlegm in throat. The residence living in the first floor could hear her asthma (she was in the third floor). The asthma became worse mostly after a short time of continuous cough. She felt stuffy in chest. The breath out is easier than breath in. Her voice is harsh. She spit white bubble phlegm, with running nose, sneeze, poor appetite, dislike greasy food, constipation with less urine, pain in the knee and elbows. Her tongue cover is thin and yellow. Her pulse is thin and frequent. Her both lungs were full of asthmatic noise. Her condition was believed to be Taiyang-Yangming co-exist syndrome. She was then given Da Chaihu Tang, Gegen Tang, Da Qinglong Tang all together: Chaihu 12 grams, Zhishi 9 grams, Baishao 9 grams, Huangqin 9 grams, Jiu Dahuang 9 grams, fresh ginger 9 grams, Chinese date 4, Banxia 9 grams, Mahuang 9 grams, Gegen 9 grams, Xingren 9 grams, Guizhi 9 grams, Zhi Gancao 3 grams, Shigao 45 grams.

二诊116日:上药服一剂,哮喘平,声嘶哑也减,仍感胸闷气憋,咳吐白痰。易医开方:旋覆花三钱,苏子三钱,半夏二钱,橘红一钱,杏仁三钱,紫菀二钱,桑白皮三钱,炙甘草一钱。

The second visit: January 16. After one day treatment with the herbal tea above, the asthma subsided, the harsh voice was reduced, but still feel fullness in chest and short of breath, spit white phlegm. The patient went to a different TCM doctor however. She was given herbs: Xuanfuhua 9 grams, Suzi 9 grams, Banxia 6 grams, Juhong 3 grams, Xingren 9 grams, Ziyuan 6 grams, Sangbaipi 9 grams, Zhi Gancao 3 grams.

三诊117日:哮喘又作,喉中痰鸣,咳嗽吐白泡沫痰,声音嘶哑,自觉胸胁痛疼,喉中发紧,舌苔薄黄,脉小数。证仍属太阳阳明合病未解,与大柴胡合大青龙汤加减:柴胡四钱,枳实三钱,自芍三钱,半夏三钱,生姜三钱,大枣四枚,麻黄三钱,桂枝三钱,杏仁三钱,炙甘草一钱,生石膏一两半,山栀三钱,厚朴三钱。

The third visit: January 17. After drink of the new herbal tea from another doctor, her asthma came back with phlegm noise in her throat. She felt pain and fullness in the chest, and tightness feeling in the throat. Her tongue cover is thin and yellow in color. Her pulse was slight frequent. Her condition was believed by Dr. Hu still as Taiyang-Yangming co-exist syndrome. She was then given Da Chaihu Tang plus Da Qinglong Tang with some modifications: Chaihu 12 grams, Baishao 9 grams, Banxia 9 grams, fresh ginger 9 grams, Chinese date 4,

四诊121日:上药服三剂,喘平。昨天感受风寒,今早又感喉部发紧,轻度作喘,咳嗽吐白痰,两下肢起荨麻疹作痒,小便短赤,大便干,纳差,舌苔薄黄腻,脉细数。刻下外邪盛,里热轻,故重在解表化饮,佐清里热,与小青龙汤加生石膏:麻黄三钱,白芍三钱,桂枝二钱,半夏三钱,细辛二钱,炮姜二钱,五味子三钱,炙甘草一钱,生石膏一两半。

The fourth visit: January 21. After drink of the above herbal tea for three days, the asthma subsided. Yesterday, she got the attack by the Wind-Cold again, and this morning, she felt tight in the throat with slight asthma. She also spit white phlegm, felt itch in the legs as urticaria. Her urine was short and red in color. She had constipation and poor appetite. Her tongue cover was thin, yellow and greasy. Her pulse was thin and frequent. At this movement, the invading Xie Qi is overwhelming and the inner Fire is slight, so the emphasis on the treatment is to release the body surface layer and to clear the extra water inside, with complementary clearing of inner Fire. She was then given Xiao Qinglong Tang plus Shigao: Mahuang 9 grams, Baishao 9 grams, Guizhi 6 grams, Banxia 9 grams, Xixing 6 grams, Bao ginger 6 grams, Wuweizi 9 grams, Zhi Gancao 3 grams, and Shigao 45 grams.

五诊122日:上药服一剂,咳喘皆平。改专方治荨麻疹,调理胃口,两日出院。

The fifth visit: January 22. After drink of this herbal tea for one day, the asthma and cough both subsided to stop. New herbal prescription was given to solve urticaria and to improve appetite for two days. She would be able to leave hospital to home.

按:此患者始终有里实证,治疗只宣其肺,必引里邪上犯于肺加重喘逆。即使注意到泻里实,但用何种方药合适,还要进一步分辨。同时因不同的时期出现不同的变证、兼证。对此也必须选用相对应的方药,才能使药到病除,克期不衍。分析本例,初见哮喘、胸满、不能平卧、大便干少等,此为里实热证。鼻塞声嘶、关节痛疼等为外寒在表,属太阳阳明合病,为大柴胡汤、大青龙汤、葛根汤三方合方的适应证,故用一剂,哮即平。二诊时,他医开方,虽用宣肺化痰平喘之剂,因未治其里实,故哮喘发作又重。三诊时,虽仍有外寒,但因关节痛疼等症已不明显,而以咳喘吐痰等痰饮证及里实证明显,为大柴胡合大青龙汤的适应证,故加减服用三剂又使喘平。四诊时,因新受风寒,尚挟里热,为小青龙汤加生石膏的适应证,故进一剂哮即平。从其治疗兼证来看,三次处方都有兼治表证的方药,但有关节痛者,合用葛根汤;无关节痛而痰饮盛者合用大青龙汤加厚朴;有小便不利者,用小青龙汤。总之,治疗哮喘,表现的证不同,所用方药也就不同,方证对应,是见效的关键。由此也说明:进行辨证论治时,如能继承、掌握前人对方证的研究经验,再根据病人证的特点,选一相对应的方药,不但能确保疗效,而且能加深对方证的认识及对中医理论的认识。

Comment: For this patient, she had inner Fire condition all over the healing course. If the treatment only pays attention to relax the lung, it would trigger the inner Xie Qi reverse up to the lung to make the condition worse to cause more asthma and cough. Even if the treatment has paid attention to dispel the inner overwhelming condition, but it is still needed to consider which herbal prescription should be used. In different phase of the disease, there happened different new symptoms. For this, the herbal prescription should also be modified so as to match the condition. In this way, the herbal therapy would be able to solve the problems quickly without delay. For this case, from beginning, the patient had asthma, fullness feeling in the chest, hard to lay down, and constipation, etc. This is the signs for inner Fire overwhelming syndrome. She had also stiff nose, harsh voice, joint pain, which are the signs of external Cold in the body surface layer. The overall condition belongs to the Taiyang-Yangming co-exist phases and it is the indication to use Da Chaihu Tang, Da Qinglong Tang and Gegen Tang, the three herbal prescription. So, only one day treatment with this complex herbs, the asthma subsided. On the second visit, she was treated by another doctor, who gave her herbs to release the lung, to dissolve the phlegm, and to calm down the asthma, but he did not pay attention to clear the inner Fire, the asthma became worse again. On the third visit, though she still had external Cold syndrome, but since the pain in the joints were not much, while the inner overwhelming condition is apparent, such as indicated by the cough, asthma, and phlegm, such conditions are the indication to use the herbal prescription Da Chaihu Tang plus Da Qinglong Tang. Therefore, with only three of this herbal prescription with little modifications, the asthma became subsided again. On the fourth visit, she got a new attack by Wind and Cold, with remaining inner Fire, the overall condition is the indication to use the Xiao Qinglong Tang plus Shigao. So, one day herbal therapy made the asthma stopped. For the treatment of complementary symptoms, there were herbs to solve the body surface phase syndrome in all the three herbal prescriptions. For there was pain in joint, so the herbal prescription Gegen Tang was used in addition to the main herbal prescription. For there was no joint pain but overwhelming phlegm and extra water syndrome, Da Qinglong Tang was used together with herb Hou Pu. For there was difficult in urine, used was Xiao Qinglong Tang. All in all, in the treatment of asthma, the syndrome is different, the herbal prescription should also be different. That the herbal prescription matches the syndrome is the key to the success of the herbal therapy. From this, it indicates that, to learn and follow the experience from doctors in earlier times, and also to base on the patient individual symptoms and syndrome to use co-responding herbs, but ensure not only the higher successful rate in the treatment, but also increase the understanding of the herb therapy and the basic theory of the Chinese medicine.

病例4. 许某,女,30岁,住院病案号3965

Case 4. Mrs. Xu, female. 30 years of old. File number: 3965.

初诊日期1964629日:咳喘气短已10余年,每至冬季病剧。近两年来因爱人病故,心情不好,发病加重,曾两次吐血。今年春节后病情逐渐加重,至今未曾缓解,于今年526日住院治疗,诊断为哮喘性支气管炎合并肺气肿。经治疗一个多月,前后用苏子降气汤合定喘汤、麻杏石甘汤、桑杏汤等加减治疗皆不效。自619日至629日加服蛤蚧尾一对、西洋参60多克,病情越来越重,因要求请胡老会诊。现在症状:喘息抬肩,心悸气短,汗出淋漓,因咳喘而不能平卧,吐白泡沫痰,时夹有黄痰,面部潮红,形体疲惫,难以行动,语言无力,饮食减少,二便尚调,时腰背痛疼,心情抑郁,时常泣下,舌苔白腻,脉细微数。此属二阳合病,为大柴胡合桃核承气汤方证,与柴胡四钱,半夏三钱,黄芩三钱,白芍三钱,枳实三钱,大黄二

钱,生姜三钱,大枣三枚,桃仁三钱,桂枝二钱,丹皮三钱,炙甘草二钱,冬瓜子三钱,生石膏一两半。

First visit: June 29, 1964. The patient suffered from asthma and cough for more than ten years, which became worse in winter. For the past two years, due to death of her husband, she felt sadness, so that the disease became worse with two times of vomiting blood. This year after spring festival, the disease was worse and worse until now. She was admitted to the hospital and diagnosed as asthmatic bronchitis with emphysema. The condition remained no change after one month of treatment with herbal prescription either Suzi Jiangqi Tang plus Ding Chuan Tang, Ma Xing Shi Gan Tang, or Sang Xing Tang, etc. During June 19 to 29, she was given additional herb Hejie tail in the prescriptions, and North America gingshen 60 grams, the condition was even worse. So Dr. Hu was asked for a consultation. The symptoms at that time were: Asthma with shoulder rising, palpitation and short of breath, heavy sweat, hard to lay down due to cough and asthma, spit white phlegm with yellow phlegm sometimes, rad color in face, tired looking, hard to walk, low voice in speaking, poor appetite, relatively normal bowel movement and urine, pain in lower back from time to time, depression with tearing sometimes. Her tongue cover was white and greasy. Pulse was thin, weak and frequent. Her condition was diagnosed as Two Yang co-exist syndrome. She was given herbal prescription Da Chaihu Tang plus Tao He Chengqi Tang: Chaihu 12 grams, Banxia 9 grams, Huangqin 9 grams, Baishao 9 grams, Zhishi 9 grams, Dahuang 6 grams, fresh ginger 9 grams, Chinese date 3, Taoren 9 grams, Guizhi 6 grams, Zhi Gancao 6 grams, Donggua seeds 6 grams, Shigao 45 grams.

二会诊71日:上药服一剂,喘小平,汗大减,已能平卧。昨夜微冒风寒,晨起头痛,仍宗上方加减:上方去冬瓜子,加瓜蒌八钱。

On the second consultation on July 1: after the herbal therapy for one day, the asthma subside slightly, the sweat subsided dramatically, being able to lay down to have a sleep. Last year she caught slightly with Wind-Cold, and she felt headache. She was given the same herbs above with some modifications: delete the Donggua seeds, but added Gualu 24 grams.

三会诊72日:精神转佳,能慢步行走,自理生活,面部潮红之象略减,昨晚月经来潮,本次提前15日,量多色淡,无瘀血块,大便微溏,仍宗前法加减:柴胡四钱,白芍三钱,枳实三钱,半夏三钱,黄芩三钱,生姜三钱,大枣三枚,大黄二钱,炙甘草二钱,生地五钱,麦冬三钱,瓜蒌一两,生石膏二两。

On the third consultation on July 2: Her overall emotion was better, being able to walk slowly and could handle her daily life. The red color in face subsided slightly. She had menstruation last night, which was 15 days earlier than usual, which was heavy in volume, less red in color, and without blood clots in it. Her stool was slight loose. She was given the previous prescription with modification: Chaihu 12 grams, Baishao 9 grams, Zhishi 9 grams, Banxia 9 grams, Huangqin 9 grams, fresh ginger 9 grams, Chinese date 3, Dahuang 6 grams, Zhi Gancao 6 grams, Shengdi 15 grams, Maidong 9 grams, Shigao 60 grams.

四会诊74日:病情渐平稳,纳食稍香,喉中微有痰鸣,胸中时痛热,舌苔薄黄腻根厚,脉细滑,仍宗前法加减:柴胡四钱,白芍四钱,半夏三钱,黄芩三钱,生姜三钱,大枣三枚,枳实三钱,麦冬四钱,瓜萎两,大黄二钱,炙甘草二钱,竹茹二钱,茯苓三钱,桂枝三钱,生牡蛎八钱,生石膏二两。

On the forth visit on July 4: the condition was much improved. She could feel little bit delicious feeling on food. There was slight phlegm noise on throat. She had pain and hot feeling in chest from time to time. Her tongue cover is thin and yellow in color with thick layer on the tongue root. The pulse was thin and sliperry. The current prescription was continued with some modification: Chaihu 12 grams, Baishao 12 gramds, Banxia 9 grams, Huangqin 9 grams, fresh ginger 9 grams, Chinese date 3, Zhishi 9 grams, Maidong 12 grams, Gualou 30 grams, Dahuang 6 grams, Zhi Gancao 6 grams, Zhuru 6 grams, Fuling 9 grams, Guizhi 9 grams, Muli 24 grams, Shigao 60 grams.

五会诊711日:病情稳定,夜得安眠,纳食亦增,唯每早微喘、气短,继以上方加减,回家调养。

On the the fifth visit on July 11: the condition was stable. She could have nice sleep at night. Her appetite was increased. She felt slight asthma in the morning, and short of breath. The current herbal prescription was asked to continue with some modifications. She was discharged home for maintenance.  

按:此哮喘病人,正气虚衰确实存在,但因同时有里实和外感表证,前医未先解表和治里实,而反用人参、蛤蚧先补其虚,故使哮喘越来越重,以至大汗淋漓,卧床不起。表里皆实反补其里,犹如开门揖寇,正如徐灵胎所说:"虽甘草、人参,误用致害,皆毒药之类也。"初会诊时,表证已渐消,而以里有痰热挟瘀血为主,为大柴胡合桃核承气汤的适应证,故进一剂而喘小平,大汗亦减。三会诊时,里实去其大半,因大汗伤津、伤血,致使月经前期色淡,故加人生地、麦冬养血清热。此时扶正也不能忘祛邪。由此可知,哮喘有邪实者,务必先予驱邪为要。

Comments: For this patient with asthma, it in deed exist a low body energy level condition. For there also being a inner overwhelming and external Xie Qi invasion syndrome, the previous doctor did not pay attention to solve the inner overwhelming and body surface syndrome, but used Renshen and Hejie to nourish the deficient condition, the asthma became worse and worse, so that she had heavy sweat and hard to get up.  To nourish the inner weakness condition when there is overwhelming syndrome in both surface and inside of the body is as to open the door to welcome pirate. Dr. Xu Ling-Tai[6] said: Even for Gancao and Renshen, if used in an improper manner, they are also a poisoning.”  On the first visit, since the body surface syndrome subsided somehow, and there was stagnation, hot phlegm inside, and they are the indications for prescription Da Chaihu Tang plus Taohe Chengqi Tang, so one dose of treatment worked to subside the asthma and the heavy sweat. On the third visit, the inner overwhelming condition had been depleted dramatically, but since heavy sweat that hurt the liquid part of the body and the blood, which made the menstruation came earlier with light red color, so added the Shengdi and Maidong to nourish the blood and to clear inner fire. At this movement, It should not be forgetten to dispel the Xie Qi, when to nourish the body energy. From this case, it is known that if the asthma is with overwhelming Xie Qi, it is important priority to dispel the Xie Qi first.

病例 5. 王某,53岁,中学教师,病案号11188

Case 5. Wang XX, 53 years of old. Teacher in middle school. File number: 11188.

初诊日期19781124日:哮喘3年。1976年夏天因闻敌敌畏后患哮喘,伴咳嗽吐白痰,经治疗两个多月缓解。今年8月地上撒了大量敌敌畏又引发哮喘。曾两次住院治疗,用抗生素、激素等,症状暂时缓解,但出院后不久又发如初。常服西药朴尔敏、氨茶碱等,效果不理想。又服中药汤剂及胎盘、黄芩、紫花杜鹃片等,效果也不明显。现在症状:哮喘不能平卧,喉中痰鸣,咳嗽吐白痰,量多,咳嗽则遗尿,口苦咽干,思饮,心下满闷,每天服紫花杜鹃九片、三片氨茶碱,晚上可以平卧,大便如常,舌苔白根厚腻。脉沉细弦,右寸浮。心律齐,心率96次/分,血压150100毫米汞柱,末梢血象检查:白血球10400/立方毫米,嗜酸细胞1122/立方毫米,两肺满哮鸣音,西医诊断:支气管哮喘合并慢性支气管炎。中医辨证:痰热挟瘀,与大柴胡汤合桂枝茯苓丸加减:

First visit: Nov. 24, 1978. The patient had asthma for three years. One day in summer of year 1976, after smell of DDVP, she got asthma. She coughed with spitting white phlegm. After two months of treatment, that asthma onset subsided. This year in August, large amount of DDVP on ground triggered the asthma again. She had additional two times of residence in hospital. With the treatment with anti-biotics and cordisone, the symptoms subsided temporally. Soon after discharge from hospital, the symptoms came back again. She was taking several western medicine drugs without satisfied effects. She had also taken herbs and placenta product, herb Huangqi, Zihua Dujuan tablets,etc. without clear effect either. The current symptoms are: the asthma is so sever that the patient is hard to lay down. The asthma is with phlegm noise in throat, cough large amount of phlegm. Urine leaks when cough. He feels bitter in mouth and dry in throat, thirsty, fullness in upper stomach area. He is taking Zihua Dujuan tablets 9 tablets and Aminophilline 3 tablets a day, so he can have a sleep at night. The bowel movement is normal. His tongue cover is white in color, with thick greasy on root. The pulse is deep, thin, and string, with right pulse being floating. Heart rythm is normal. Heart beat is 96 time per minutes. Blood pressure is 150/100 mmHg … it is full of asthmatic noise in both lungs. The western medicine diagnosis is bronchitic asthma with chronic bronchitis. The Chinese medicine diagnosis is Hot Phlegm with blood stagnation. It is the indication for the prescription Da Chaihu Tang plus Guizhi Fuling Wan:

柴胡四钱,黄芩三钱,半夏三钱,枳实三钱,石韦五钱,白芍三钱,大黄一钱半,生姜三钱,桂枝二钱,桃仁三钱,大枣四枚,茯苓四钱,丹皮三钱。

Chaihu 12 grams, Huangqin 9 grams, Banxia 9 grams, Zhishi 9 grams, Shiwei 15 grams, Baishao 9 grams, Dahuang 4.5 grams, fresh ginger 9 grams, Guizhi 6 grams, Taoren 9 grams, Chinese date 4, Fuling 12 grams, and Danpi 9 grams.

二诊1128日:服第一剂咳嗽减轻,服第二剂痰消尽,遗尿已,喘已不明显,上二层楼亦不感喘,但每天仍服氨茶碱三片。心下满消,仍口苦咽干,思饮,身冷,纳差,大便日2--4行,舌苔白,脉弦细,右寸浮。坐位听诊:两肺未闻哮鸣音,卧位可闻哮呜音。血150100毫米汞柱,末梢血象检查:白血球7800/市方毫米,嗜酸性白血球440/立方毫米。上方加焦三仙各三钱。

The second visit on December 28: after taking the herbal tea for one day, the cough became less. After the second dose, the phlegm disappeared, and no urine leaked, and the asthma is not so much. He could walk up the second floor without short of breath but he still needs to take Aminophilline three tablets every day. No more fullness in the stomach but still feels bitter in mouth and dry in throat. He felt thirsty and poor appetite. The bowel movement is 2-3 times a day. Tongue cover is white. The pulse is string and thin with floating feeling on the right side. No asthmatic noise can be heard on sitting position but on laying down. Blood pressure is 150/100 mmHg. … He was given the herbs above with addition of herb Jiao Sanxian 9 grams each.

三诊128日:喘平,大便日34行,上四层楼不感喘,但昨天又感胸闷,早起口苦,舌苔白腻根厚,脉弦细。卧位听诊两肺散在哮鸣音。血压150100毫米汞柱。上方去大黄,加熟军二钱。

The third visit on December 8: the asthma stopped. The bowel movement was three to four times a day. No short of breath even if walk up the forth floor. However yesterday he felt fullness in chest again, felt bitter taste in mouth in the morning. The tongue cover was white with thick and greasy on root. The pulse was string and thin. On laying down position, there was scattered asthmatic noise in the lungs. Blood pressure was the same. The above prescription was kept to use with deletion of Dahuang, but added Shou Dahuang 6 grams.

四诊1979412日:追访患者,自觉良好,与学生一起跑步也不喘,两肺听诊(),卧位也未闻干湿性罗音及哮鸣音。血压140100毫米汞柱,血象检查:白血球770/立方毫米,嗜酸性白血球154/立方毫米。

The fourth visit on April 12, 1979: Following up with the patient, he feels well. There is no asthma or short of breath even running with students. No any noise can be heard from the lungs. Blood pressure is 140/100 mmHg. Blood test shows normal.

按:一般认为,支气管哮喘患者,约半数有轻度或中度嗜酸性白血球升高,其升高可反映人体的过敏状态,本患者是过敏性支气管哮喘,前医试图从中西医结合抗过敏(用朴尔敏、黄芩、胎盘等)治疗未见效,而胡老用大柴胡汤合桂枝茯苓丸加减收捷效,不但喘平,且见嗜酸性白血球恢复正常。因此,可以说该方药有抗过敏作用。但应说明的是,这一疗效的取得,是建立在辨证施治的基础上的,是方证对应的结果。据此,可以认为,在治疗哮喘上,中医的辨证施治,方证对应,目前确比西医的脱敏疗法及其他疗法有优越之处。因此,在中西医结合治疗哮喘时,有必要重视辨方证,以利于疗效的提高和中西医理论的阐明及发展。

Comments: Commonly it is believed that, for patients with bronchitic asthma, about half of them have slight or moderate increase in the blood acydocytes. The extent of the increase could reflect the level of allergic condition of the body. This patient is with an allergic bronchitic asthma. Previous doctor had tried to solve the problem from the combination of the western medicine and Chinese medicine but no any improvement of the condition. Dr. Hu used Da Chaihu Tang plus Guizhi Fuling Wan, which worked so much better. Not only the blood acydocytes number reduced, but also the asthma stopped. It indicates that these herbs have anti-allergic effects. However, it should mentioned that, the achievement is obtained on the basis of the syndrome diagnosis and indication diagnosis of the Chinese medicine. It is the result that the herbs match the clinic syndrome. For this, it can be said that, on the treatment of asthma, such way of Chinese medicine works better than the current western medicine, in terms of its anti-allergic therapy. So, in the treatment of asthma, even if with the combination of western medicine and Chinese medicine, it is needed to exercise the syndrome diagnosis and herb indication diagnosis, so as to increase the healing effect and to develop the theory of the Chinese medicine in the effort of combination of the two medical systems. 

病例6. 唐某,女,40岁,病案号81486

Case 6. Mrs. Tang, female, 40 years of old. File number: 81486.

初诊日期1980311日:自去年3月出现哮喘,经服中西药治疗不缓解,前医曾按三阳合病与服大柴胡汤合葛根汤加生石膏38剂不效。近期症状:白天无咳喘,但有鼻塞流涕,头痛,精神不佳,思睡,背恶寒,晚上胸闷喘息,喉中痰鸣,吐少量白痰,口干不思饮,大便干,舌苔薄黄,脉弦细沉。变态反应检查:对尘土、_、花生、芝麻、大豆等八种物质过敏;血流变学检查:全血比粘度625 mPas,血浆比粘度198,全血还原粘度1117,红细胞电泳1670S,红细胞压积47%。免疫球蛋白检查:IgG1.249LIgA1.109LIgM1.389L。血乙_胆碱449馏%。西医诊断:支气管哮喘。中医辨证:少阴表寒挟饮。治以温阳强壮化饮,与麻黄附子细辛汤:麻黄二钱,制附子二钱,细辛二钱。

The first visit was March 11. 1980. The patient had asthma since March last year. After treatment with both western medicine and Chinese medicine, the symptoms remained. The previous TCM doctor had diagnosed as three Yang co-exist syndrome, and used Da Chaihu Tang plus Gegen Tang also plus Shigao for 38 days without effect. The current conditions: there was no asthma during the daytime, but felt nose stiffness and running nose, headache, poor emotion and spirit, craving to lay down for sleep, chilly feeling on back. At night, she felt fullness in chest and short of breath. There was phlegm noise in throat. She spit little white phlegm. The mouth felt dry but no desire to drink water. There was constipation. Her tongue cover was thin and yellow in color. The pulse was string, thin and deep. The allergic reaction shows that she is allergic to dust, peanut, sesame, soya bean and so on up to eight kinds of stuff. … the western medicine diagnosis is bronchitic asthma. The Chinese medicine diagnosis is Shaoyin phase and body surface Cold condition with inner Water accumulation. She was given Yang-warming and Water-dissolving therapy. The herb prescription is Mahuang Fuzi Xixin Tang: Mahuang 6 grams, Zhi Fuzi 6 grams, and Xixin 6 grams.

结果:上药服三剂,鼻塞明显好转,头痛减轻,渐增加附子用量至四钱,经服两月,喘平。复查血流变学:全血比粘度486mPas,血浆比粘度1.94,全血还原粘度974,红细胞电泳1503S,红细胞压积40%。免疫球蛋白:IgG2349几。IgA0999LIgM2119L。血乙_胆碱6360t9%。经随访三年未见复发。

Following up: after three days of treatment, the nose stiffness became better and the headache was improved. The amount of Fuzi was increased gradually to 12 grams. After two months, the asthma stopped. … The following up after three years: there is no recurrence of the asthma at all. 

按:本例是虚寒性哮喘,前医因辨证不仔细而误认为三阳合病,故服了38剂汤药而不见效。患者长期有鼻塞流涕、头痛等症,可知病在表。但有背恶寒、精神不佳、白天思睡.当知表不属太阳而应属少阴。又据脉沉弦细、喉中痰鸣、咳嗽吐少量白痰、口干不思饮等,当判定为少阴挟饮,为麻黄附子细辛汤的适应证,故谨守病机,治疗两月而喘告愈。

Comments: This case belongs to Cold-weakness asthma. The previous doctor misbelieved it belongs to the Taiyang-Yangming-Shaoyang, the three Yang co-exist syndrome. So as much as 38 days of treatment showed no any improvement. The patient had nose stiffness, running nose and headache, etc. which indicates that the disease is on the body surface. But the chilly on the back, poor spirit,  and the craving to sleep, all suggest that the condition belongs to Shaoyin too. Referred from the pulse of deep and thin and string, phlegm noise in throat, cough with little white phlegm, dry mouth but no willing to drink water, all suggest that it is Shaoyin with water accumulation inside. They all are indications to Mahuang Fuzi Xixin Tang. So, the herbs are given for two months and the asthma stopped.  

俗有"内科不治喘,治喘丢了脸"之说,是说哮喘病难治。但是中医各代仁人至士并没有知难而退,而是知难而上,不断总结治疗经验,使一个个哮喘难证不断被攻克。这里应该注意的问题是,中医治疗哮喘是前人几代、几十代、几十年、几百年乃至几千年的经验总结,学习和继承前人的经验是非常重要的。胡老正是"勤求古训,博采众方",终生不辍。从以上六个病例可看出,治疗哮喘所用方药都是经方,用古方治今病疗效卓著。这里说明,在继承前人经验上,胡老的功夫深,在临床实践上胡老的功夫更深。从病例6还可以看到,临床辨证必须仔细,稍有疏漏,则功溃在即。本是少阴病,判为三阳病,治疗时不可能收效,服38剂药不见效,服50剂药也不会见效,所谓差之毫厘,谬之千里是也。而辨证、辨方证正确后,服三剂即见显效。这里也说明,哮喘症状复杂多变,因之治疗不易,但仍是有方药可医的,只是治疗时不能用一方一药,其治疗有效与否,取决于辨证准确与否,更取决于辨方证的准确与否。也可知,胡老认为中医治病有无疗效,其主要关键,就在于方证是否辨得正确。胡老首先在中医界提出"辨方证是辨证的尖端",决非虚言,而是一生心血的总结。

It is commonly said that “a TCM physician would not treat the asthma, otherwise he would feel shamed for failure and lose reputation”. It means that it is difficult to treat asthma. However, there are still doctors in various generations to try to solve this problem, even if they know well it is hard challenge. It should be pointed out that, the experience in the treatment of asthma is the accumulated summary of many doctors in previous generations back to even thousands of years ago. It is very important for us to learn the experience of our seniors. Dr. Hu did so. From the case report and discussions above, it can be seen that, the herbs he used all are the Jing Fang, e.g. the herbal prescription cited from book <<Shang Han Lun>>.  The old formula, when used to treat the current disease, the effect remains excellent. It shows that, the skill of Dr. Hu in learning the previous ancestors experience and in his own clinic practice is excellent. From the case 6, it suggests that, it must be very careful in diagnosis. This case belongs to Shaoyin phase, but was diagnosed as three Yang co-exist condition by previous doctor. It is impossible to solve the asthma based on the wrong diagnosis. It did not work after the 38 days of treatment (38 doses). It would not work either with even as much as 50 days of such wrong treatment. As said: a mistake for one millimeter could cause a wrong for thousands of miles. Once the syndrome diagnosis and herbal indication diagnosis are set up correctly, only the treatment for only three days works much well. It also means that, though the asthma is difficult, in terms of its complex syndrome and fast changes in the symptoms, there is still way to solve it. However, the treatment can not depend on a single herb or a single herbal prescription. The healing effect depends on the correct of syndrome diagnosis and also even more on the herb indication diagnosis. Dr. Hu believes that, the most important factor is the correct herb indication diagnosis. It is him who proposed in the TCM community that, the key point in the TCM practice is the herb indication diagnosis. It is not his impulse speaking, but his life-long summary.

 

3. 论治肝炎肝硬变

3. Treatment of hepatitis and cirrhosis

胡希恕老中医,在六十年代,曾治疗了大量肝炎和肝硬化患者,积累了不少宝贵经验,并多次做学术报告,其经验和学术思想也多次刊登于报刊、杂志。

In the 1960 years, Dr. Hu treated large amount of patients with hepatitis and cirrhosis with lots of valuable experience. He did many times of academic presentations and his experience and academic believings are also cited in news papers and magazines.

他治疗肝炎、肝硬变的特点:第一,不是用一方统治一病,而是据症状特点辨方证,用相应的方药治疗。第二,多用经方治疗。胡老所用经方很多,其论治经验丰富多彩,为了便于记忆,把其论治主要经验概括为三大法,这就是:急性黄疸型肝炎以利湿、清热、疏肝为大法;无黄疸型慢性肝炎以疏肝、祛瘀、和胃为大法;肝硬变、肝腹水以益气、淡渗、祛瘀为大法。

The characteristic in his treatment of hepatitis and cirrhosis are: (1), he does not use a single herb prescription for the treatment, but use corresponding herb prescription according the clinic syndrome changes; (2), he use mostly the Jing Fang, e.g. the herbal prescription introduced in the book <<Shang Han Lun>>. He used a lot of such prescriptions with very rich experience. To be memory easily here we summarize his main experience into three lines: first, in the treatment of acute jaundice hepatitis, use the herbs to clear Wetness, clear Hotness and to dredge the liver; second, in the hepatitis without jaundice, use herbs to dredge liver, to dissolve blood stagnation, and to harmonize stomach; the third, in the treatment of cirrhosis, use herbs to nourish the Qi (body energy), to evaporate wetness, and to dissolve blood stagnation.

利湿清热疏肝主退黄

To clear Wetness, to clear Hotness and to dredge liver so as to clear jaundice

()有关黄疸型肝炎的论治

The comments on the treatment of acute hepatitis

黄疸多见于急性肝炎,病因主为湿热。《伤寒论》第236条:"阳明病,发热、汗出者,此为热越,不能发黄也。但头���出、身无汗、剂颈而还、小便不利、渴饮水浆者,此为瘀热在里,身必发黄,茵陈蒿汤主之。"即是说,黄疸的形成,主为瘀热在里,即湿热相瘀于里不得外越之意。胡老精研《伤寒论》有关论述,又结合临床总结指出:若热胜于湿者,见大便难等症为阳明证,古人谓为阳黄;若湿胜于热者,见大便溏等症为太阴证,古人谓为阴黄。阳黄宜下,茵陈蒿汤、栀子大黄汤、大黄硝石汤等为治黄常用之良方。阴黄则但利其小便,宜茵陈五苓散等。不过以上诸方适证应用,虽能驱黄,但有的黄去,而肝炎常迁延不愈。因肝喜疏泄而恶郁滞,肝病则气郁不疏,肝气久郁,则血脉凝滞而致血瘀,故令不愈,法宜驱黄中兼以疏肝,则黄去肝炎亦治。

Jaundice hepatitis is commonly seen in acute hepatitis. The main reason is Wetness and Hotness in the body. It is stated in the book <<Shang Han Lun>>, chapter 236: “In the Yangming phase, the fever with sweat is called Hotness oppress and it would not show as jaundice. If the person has sweat only on the head, but not in the other part of the body, with difficulty in urine, feels thirsty and drinks lots of water, it means there is hotness inside the body. In this case, there will have jaundice and it indicates the use of Yinchenhao Tang.” This means that, the main reason for the jaundice is the oppression of hotness inside the body, e.g. the hotness and the wetness strangles inside the body without being able to release out. Dr. Hu, studied the book carefully and based on his own clinic practice, pointed out that if the hot is more than the wetness and if there is constipation, it is the Yangming phase of the disease, which is called Yang jaundice by old time doctors. If the wetness is more than the hotness, and if there is diarrhea, it belongs to the Taiyin phase of the disease. It is called the Yin jaundice by old time doctors. For the Yang jaundice, a bowel-clearing therapy should be used, such as the herbal prescription of Yinchenhao Tang, Zhizi Dahuang Tang, or Dahuang Xiaoshi Tang and so on. They are used commonly and often in the Yang jaundice conditions. For the Yin jaundice, a urine-improving therapy should be used. The herbs in this case are such s Yinchen Wu Ling San, and so on. However, when these herbs are used, the jaundice may be dissolved and subsided, but the hepatitis may not be cured, since the liver likes dredged, and hates oppressed. When the liver is in a disease status, the Qi would be oppressed. A long time of the Qi oppression causes blood stagnation, which prevent the cure of the hepatitis. Therefore, it should be used the liver-dredging therapy, in addition to the jaundice-clearing therapies. By this way, the jaundice is cleared and the hepatitis is also cured.

()常见方证

Commonly used herbal prescription

急性黄疽型肝炎临床症状变化多端,自有许多适应治疗的方证,胡老常用的是以下两个方:

The symptoms of acute jaundice hepatitis changes fast. Therefore there would be many herbal prescription to be chosen. Dr. Hu usually uses the following two prescriptions:

1大柴胡合茵陈蒿汤方证:主症:发黄,胸胁苦满,呕逆微烦不欲食,大便干燥,小便黄赤,腹胀满,舌苔白腻或黄,脉弦滑数。方药:柴胡八钱,半夏四钱,黄芩三钱,白芍三钱,枳实三钱,大黄二钱,栀子三钱,茵陈蒿六钱,生姜三钱,大枣四枚。加减法:若上证又见心中懊侬、发热者,上方再加豆豉六钱;若大实满、小便不通者,加黄柏三钱、硝石四钱。

1. Da Chaihu Tang plus Yinchenhao Tang: The person has jaundice, feels fullness in chest and in the upper side of the belly, nausea, slight annoyed feeling, no desire to eat, constipation, yellow or even red color in urine, and fullness in belly. The tongue cover is white-greasy or yellow. The pulse is string, slippery and frequent. The herbs are: Chaihu 24 grams, Banxia 24 grams, Huangqin 9 grams, Baishao 9 grams, Zhishi 9 grams, Dahuang 6 grams, Zhizi 9 grams, Yinchenhao 18 grams, fresh ginger 9 grams, Chinese date 4. Moditications: if there is annoyed feeling in chest and fever, add Douzhi 18 grams. If there is severe fullness and bloating feeling in the belly, with difficult in urine, add herb Huangbo 9 grams and Xiaoshi 12 grams.

2柴胡茵陈五苓散方证:主症见:心烦喜呕,不欲食,小便不利,大便溏薄,舌苔白,脉弦细。方药用:柴胡六钱,半夏四钱,黄芩三钱,党参三钱,生姜三钱,茵陈蒿六钱,猪苓三钱,茯苓三钱,苍术三钱,泽泻五钱,桂枝二钱,大枣四枚,炙甘草二钱。

2. Chaihu Yinchen Wu Ling San: The person feels annoyed, tends to nausea, no desire to eat food, hard in urine, and had loose stool. The tongue cover is white and the pulse is string and thin. The herbs are Chaihu 18 grams, Banxia 12 grams, Huangqin 9 grams, Dangshen 9 grams, fresh ginger 9 grams,Yinchenhao 18 grams, Zhuling 9 grams, Fuling 9 grams, Canzhu 9 grams, Zexie15 grams, Guizhi 6 grams, Chinese date 4 and Zhi Gancao 6 grams.

() 验案

Case reports

1. 刘某,男,63岁,病案号17879

Case 1. Mr. Liu, 63 years of old. File number: 17879.

初诊日期196531日:一周前高烧,不久两眼巩膜发黄,小便黄如柏汁。现兼见两胁胀满,纳差,口苦,恶心,舌苔白,舌质红,脉弦稍数。GPT219单位(正常值100单位),黄疸指数20单位。据证分析,此为大柴胡合茵陈蒿汤方证,用其加减:柴胡四钱,半夏三钱,黄芩三钱,白芍三钱,枳实三钱,栀子三钱,大黄二钱,茵陈蒿一两,生姜三钱,大枣四枚。

The first visit: March 1, 1965. The person had fever one week ago. Soon later, he had yellow color in the eyes and the urine became as yellow as a juice from cypress. Currently, he had fullness feeling on the upper side of the belly, poor appetite, bitter taste in mouth, and nausea. The tongue cover was red and the pulse was string with slight frequent. GPT was 219 unites (normal value is 100 unites). Jaundice parameter was 20 unites. Based on such clinic data, it was believed to be the indication for Da Chaihu Tang plus Yinchenhao Tang with some modification. The herbs were: Chaihu 12 grams, Banxia 9 grams, Huangqin 9 grams, Baishao 9 grams, Zhishi 9 grams, Zhizi 9 grams, Dahung 6 grams, Yinchenhao 30 grams, fresh ginger 9 grams, and Chinese date 4 .   

结果:上方服七剂,黄疸退,服二十一剂,症渐消,一个月后复查肝功正常。

Following up: after the herbal therapy for seven days, the jaundice subsidede. After 21 days, the symptoms disappears gradually. One month later to check the lab test for liver function: everything is normal.

2. 王某,男,25岁,病案号3343

Case 2. Wang XX, 25 years of old. File number: 3343.

初诊日期1978427日:两月前患痢疾,痢止后出现腹胀、腹水、下肢浮肿,经检查诊断为"肝���、肝硬化"。曾在某医院住院治疗两月不见好转。现症见:腹胀,低烧,纳差,乏力,头晕,便溏,尿黄,舌质红,舌苔薄白,脉弦数。巩膜轻度黄染,腹部膨隆,腹水征,下肢可凹性浮肿( )。实验室检查:GPT大于600单位,17单位,TFr( )HBsAgl32。蛋白电泳:白蛋白464%,0C1348%,a287%,t3149%,7267%。腹腔穿刺液:细胞总数310立,WBC280个/立方毫米。超声波检查:     气郁结,湿热内蕴,为大柴胡合己椒苈黄汤方证,药用:柴胡四钱,半夏三钱,黄芩三钱,枳壳三钱,白芍三钱,生姜三钱,大枣四枚,木防己三钱,椒目三钱,大黄二钱,葶苈子三钱,茵陈蒿八钱。

The first visit: April 27, 1978. The patient had diarrhea two months ago. After that, he got bloating in belly, ascites, swelling in legs. It was diagnosed as hepatitis, cirrhosis. He was treated in a hospital ward for two months without any improvement. Current condition on the visit: bloating in belly, low level of fever, poor appetite, dizziness, loose stool, yellow urine, red tongue, thin and white tongue covering, and string and thin pulse. His eye was slight in yellow, belly was bloating, with sign of ascites, and swelling in the legs. Lab test: … These conditions were diagnosed as Liver Qi opposed, Wetness-Hotness stagnated in the body. It is the indication for herb prescription Dai Chaihu Tang plus Ji Jiao Li Huang Tang. The herbs were: Chaihu 12 grams, Banxia 9 grams, Huangqin 9 grams, Zhike 9 grams, Baishao 9 grams, fresh ginger 9 grams, Chinese date 4, Mu Fangji 9 grams, Jiaomu 9 grams, Dahuang 6 grams, Qingli seeds 9 grams, and Yinchenhao 24 grams.

结果:上药服七剂后,因出现鼻衄、心中烦热而与三黄泻心汤四剂,鼻衄止、心中烦热消失,而以少腹坠痛、肝区痛、纳差、下肢浮肿为主,故与四逆散合当归芍药散加减,服药月余,纳增,面丰满而红润,症以肝区痛、气短、小便少、下肢浮肿为主,故改服柴胡桂枝干姜汤合当归芍药散加丹参、茵陈。半月后,查腹水已消,下肢浮肿也不明显,仍以大柴胡合己椒苈黄汤加减,治疗五个月余,查肝功正常,HRsA9116,蛋白电泳:白蛋白65%,14.09%,61%,p5%,y15%。

Following up: After taking the above herbal tea for seven doses (seven days), there were nose bleeding and annoyed hot feeling in his chest. He was given prescription San Huang Xie Xin Tang for four days. After that, the bleeding stopped and the hot feeing subsided. Then he felt falling feeling in the lower belly, pain in the right upper part of the body, poor appetite, and swelling. He was prescribed prescription Si Ni San plus Danggui Shaoyao San with some modifications. After about one month, the appetite was improved, and his face turned red and nourished. The remaining condition was the pain in the liver area, short of breath, less urine, and swelling in legs. The prescription was changed to Chaihu Guizhi Ganjiang Tang plus Danggui Shaoyao San, plus herb Danshen. After half month, the ascited disappeared, the leg swelling was not apparent too. The herbal prescription used then were Da Chaihu Tang plus Ji Jiao Li Huang Tang with some modifications. After such treatment for five months, lab test showed that the liver function was normal.

按:此患者治疗半年后,肝功正常,腹水大致消退,但每年春季以后,肝功逐渐升高,直至10月以后方逐渐恢复正常,连续观察两年,但腹水、浮肿未再出现,三年后失去联系。值得说明的是,急性黄疸型,炎多属阳黄:尤以例所见以大柴胡合茵陈蒿汤方证为常见。临床虽亦有阴黄,但以胃虚小便不利、大便溏薄为主的柴胡茵陈五苓散方证多见。而真正太阴虚寒下利者,则很少见。又据胡老多年经验认为:黄疸型肝炎并发腹水者为难治。例2是疗效较好的一例,惜观察时间较短。

Comments: This patient was treated for half year. The liver function turned normal and the ascites subsided. However, every year after spring, the parameter for liver function gradually increased until after October, then it turned to normal again. This has been followed up for two years. No ascites or swelling happened. After three years, no way to keep contact with the patient. It is worthwhile to say that, the acute jaundice hepatitis mostly belongs to Yang jaundice. It is commonly the indication for prescription of Da Chaihu Tang plus Yinchenhao Tang, as shown in this case. In clinic, though there is a Yin jaundice condition, showing poor appetite, bloating in stomach, difficult urination, loose stool, which indicates the use of Chaihu Yinchen Wu Iing San in most cases. It is rare for Taiyin weakness-cold syndrome. According to the Dr. Hu’a many years of clinic experience, the jaundice hepatitis with ascites is hard to treat. The case 2 is a good example, but it is pity that the following up period is somehow short.

 

疏肝祛瘀和胃使邪却

To dredge liver, to dissolve stagnation and to harmonize stomach, so as to dispel Xie Qi

() 有关无黄疸型慢性肝炎的论治

The treatment of no-jaundice chronic hepatitis

找中医看病的肝炎患者中,更多的是无黄疸型肝炎,其中也有急性肝炎,但多数则为慢性患者,其病程长,病情多变,治疗起来颇费心神。《灵枢五邪》篇有"邪在肝,则两胁中痛,寒中,恶血在内,行善掣节,时脚肿。取之行间,以引胁下,补三里以温胃中,取血脉以散恶血,取耳问青脉以去其掣"的记载,颇似对无黄疸型肝炎的证治论述。胡老治肝炎,即宗其义,确有良验。胡老译释这段论述认为,前段是述其证,后段是论其治。肝炎患者多有肝脾肿大则胁中痛,肝区在右,本应右胁痛,剧则涉及于脾,故两胁中痛。寒中,即胃中寒,因肝病传脾,胃不和而寒停于中。恶血,即瘀血。恶血在内者,肝藏血而喜疏泄,肝病气郁,血液凝滞,因致恶血在内。行善掣节者,谓下肢酸软,行动则觉关节牵掣不利,由气滞血瘀所致。时脚肿者,由于胃虚有寒,不能制水。取之行间,以引胁下者,谓刺行间穴,用泻法以疏肝。补三里以温胃中者,谓刺足三里穴,用补法以温胃中寒。取血脉以散恶血者,谓以针刺放血以散瘀血。取耳间青脉以去其掣者,谓放耳间静脉血以治行则掣节。此原是论述有关针灸的治疗大法,但其理也很近于内科的证治。

Among the patients with hepatitis, who come to the TCM, most of them are with no-jaundice hepatitis. Though there are some acute hepatitis, but most are chronic hepatitis. Their disease history is long and symptoms changed fast. The treatment is also hard. …  (here not translated)

基于以上的论述,结合临床观察,慢性无黄疸型肝炎病的形成,多为气郁而瘀,治疗既宜疏肝又须祛瘀。胃为生之本,肝病每使胃不和,治宜和之,和者当重视其胃气,不可使胃气有伤。胃气衰者,病必不除,胃气败则死。因此,疏肝、祛瘀、和胃三者,为治慢性肝炎的原则大法。不过胡老特别强调:具体证治,还须细辨方证,他一再指出:方证者,方药的适应证,此本出自仲景书,为用经方的准则。论中有桂枝汤证、柴胡汤证,柴胡汤证中又有小柴胡汤方证、大柴胡汤方证、柴胡桂枝干姜汤方证等,这些柴胡汤方证均有疏肝作用,然各有一定的适应证,如使用正确则得效益彰,如果用得其反,不但无益,反而有害。治疗肝炎,必须依据症状辨方证,然后选用适应的方药,才能治好肝炎。

Based on the above theory, combined with clinic observation, the chronic hepatitis is mostly due to Qi sluggish that causes blood stagnation. For the treatment, it is needed to dredge the liver and to dissolve the stagnation. The stomach is the key of the life energy. Liver disease usually affect the stomach function, so the stomach should be harmonized. To harmonize the stomach, it is needed to protect its Qi, e.g. do not allow herbs to hurt the stomach Qi. If the stomach Qi is hurt and damaged, the disease would not be cured. If the stomach Qi is died, the person is died. For this, to dredge liver, to dissolve blood stagnation and to harmonize stomach, all are the important principle in the treatment of chronic hepatitis. However, Dr. Hu emphasized that, for each individual, it is needed to carefully diagnose the herb indications. He said again and again that, the herb indication is the condition to use the herb(s). It comes from the book of Master Zhang Zhongjing, and it is the principle in the use of the Jing Fang. In that book, there are the indications for Guizhi Tang, Chaihu Tang and so on. In the Chaihu Tang, there are further more indications to the use of Xiao Chaihu Tang, Da Chaihu Tang, Chaihu Guizhi Ganjiang Tang, etc. All of the Chaihu-containing herbal prescription have a function to dredge liver, but they have their own more specific indications. When used in a proper way, it works very well. If not, it may make the clinic condition worse. To treat hepatitis, it is needed to make the herb indication diagnosis, then chose the proper prescription, to cure the hepatitis.

() 常见方证

Commonly used prescriptions

无黄疽型肝炎的方证常见以下几个:

For no-jaundice hepatitis, the commonly used herb prescriptions are the followings:

1.柴胡桂枝干姜汤合当归芍药散方证:

1. Chaihu Guizhi Ganjiang Tang plus Danggui Shaoyao San indications:

主症:胸满胁痛,渴而不呕,身倦乏力,下肢酸软,或肩背痛,或腰痛,或头晕,大便偏干,舌苔白,脉弦细。方药:柴胡八钱,黄芩三钱,花粉四钱,生牡蛎三钱,桂枝三钱,干姜二钱,白芍六钱,当归三钱,川芎二钱,丹参一两,茯苓四钱,苍术三钱,泽泻六钱,炙甘草三钱,茵陈蒿八钱。

The main condition: fullness and pain in the chest and in the upper side of belly, thirsty but no nausea, chronic fatigue, sour and weak in legs, or pain in shoulders or in lower back, or dizziness, and hard in bowel movement. The tongue cover is white. The pulse is sting and thin. The prescription are: Chaihu 24 grams, Huangqin 9 grams, Huafeng 12 gram, Muli 9 grams, Guizhi 9 grams, dried ginger 6 grams, Baishao 18 grams, Danggui 9 grams, Chuangxiong 6 grams, Dangshen 30 grams, Fuling 12 grams, Zexie 18 grams, Zhi Gancao 9 grams, and Yinchenhao 24 grams.

加减法:若上证见肝区痛剧者,加王不留行三钱、葱须三钱,旨在活血疏肝止痛;口舌干燥而烦渴不已者,加生石膏一两半;肝功已正常,而证犹不了了者,上方去丹参、茵陈蒿,适证加减他药,继服至症状消除为止。

Modification of the prescription: if the pain in the liver area is severe, add herb Wangbuliuxing 9 grams, fistula onion root 9 grams, to motivate the blood circulation, to dredge the liver, as as to stop the pain. If the person has dry mouth, thirsty and feels annoying thirsty, add Shigao 45 grams. If the lab test for liver function is normal, but the symptoms remained somehow, remove the Danshen and Yinchenhao from above prescription, add other proper herbs according to the symptoms. Take the prescription until the symptoms stop.

2.小柴胡当归芍药散茯苓饮方证:

2. Xiao Chaihu Tang plus Danggui Shaoyao San plus Fuling Yin conditions:

主症:胸胁苦满,心下逆满,痞硬,恶心,噫气,甚则吞酸,胃脘疼,不能食,大便时溏,舌苔白腻,脉弦细。方药:柴胡八钱,党参三钱,黄芩三钱,半夏四钱,枳实三钱,陈皮一两,生姜三钱,白芍六钱,当归三钱,川芎三钱,茯苓四钱,苍术三钱,泽泻六钱,丹参一两,茵陈蒿八钱,大枣四枚,炙甘草二钱。

The main symptoms are: annoying fullness in the chest, bloating and hard mass feeling in the stomach, nausea, belching, even acid reflex, pain the stomach, and loose stool from time to time. The tongue cover is white and greasy. The pulse is string and thin. The prescriptions are: Chaihu 24 grams, Huangqin 9 grams, Banxia 12 grams, Zhishi 9 grams, Chenpi 30 grams, fresh ginger 9 grams, Baishao 18 grams, Danggui 9 grams, Chuanxiong 9 grams, Fuling 12 grams, Canzhu 9 grams, Zexie 18 grams, Danshen 30 grams, Yinchenhao 24 grams, Chinese date 4, and Zhi Gancao 6 grams.   

加减法:肝区痛甚者,加王不留行三钱、苦桔梗二钱,旨在活血理气止痛;口渴明显者,加白茅根五钱。

Modifications for the prescription: if the pain in the liver area is severe, add herb Wangbuliuxing 9 grams, and bitter Jiegen 6 grams, with the aim to activate blood circulation, to release the sluggished Qi and so as to stop the pain. If the thirsty is apparent, add Baimaogen 15 grams.

3.小柴胡丹参茵陈甘草汤方证:

3. Xiao Chaihu Tang plus Danshen Yinchen Ganao Tang indications:

主症:食欲不佳,或无明显不适,但肝功不正常,小儿肝炎多见本方证。方药:柴胡八钱,党参三钱,黄芩三钱,半夏四钱,丹参一两,茵陈蒿八钱,生姜三钱,大枣四枚,炙甘草三钱。

The main symptoms: poor appetite, or no clear symptoms but the lab test for liver function is abnormal. Such condition is more seen in children. The herb prescription: Chaihu 24 grams, Dangshen 9 grams, Huangqin 9 grams, Banxia 12 grams, Danshen 30 grams, Yinchenhao 24 grams, fresh ginger 9 grams, Chinese date 4 and Zhi Gancao 9 grams.

加减法:腹胀明显或有嗳气者,加陈皮一两,理气和胃降逆;大便干而不爽者,加白术五钱,健中和胃。

Modifications for the prescription: if the stomach bloating feeling is strong and is with belching, add Chenpi 30 grams to dredge Qi, to harmonize stomach and to down-dredging the reversed Qi. If there is constipation and if the stool is sticky to pass, add Baizhu 15 grams, to nourish the stomach and to harmonize the stomach.

4.四逆散合当归芍药散方证:

4. Si Ni San plus Danggui Shaoyao San indications:

主症:胸胁及心下满,时有眩悸,肝区隐隐痛,不呕不渴,腹胀或痛,小便不利而大便溏频,舌苔薄白,脉弦。方药:柴胡四钱,白芍六钱,当归三钱,枳实四钱,川芎三钱,苍术三钱,泽泻六钱,炙甘草三钱,茯苓四钱。

The main symptoms: fullness in the chest, stomach or in the upper side of the belly. Dizziness from time to time, slight tender in the liver area, no nausea and no thirsty, pain or bloating in the belly, difficult urination and loosed stool. The tongue cover is thin and white. The pulse is string. The herbal prescription is: Chaihu 12 grams, Baishao 18 grams, Danggui 9 grams, Zhishi 12 grams, Chuangxiong 9 grams, Cangzhu 9 grams, Zexie 18 grams, Zhi Gancao 9 grams, and Fuling 12 grams.

加减法:肝区痛者,加王不留行三钱、三棱二钱、莪术二钱,理气活血止痛;肝功不正常者,加丹参一两、茵陈蒿八钱;肝脾肿大者,加鳖甲三钱、龟板三钱;面部色素沉着,或下肢皮肤色素沉着、黑斑、瘀斑明显者,合用大黄廑虫丸。

Modifications of the prescription: if the pain in the liver area is severe, add Wangbuliuxing 9 grams, Sanlen 6 grams, Ezhu 6 grams, to dredge the liver, activate blood stagnation and to stop pain. If the lab test for liver function is abnormal, add Danshen 30 grams and Yinchenhao 24 grams. If the liver and spleen are enlarged, add Biejia 9 grams, Guiban 9 grams. If there is pigment on the face, or there is pigment, black dots, or bruise in the legs, use prescription Dahuang Zhezhong Wan the same time.

5.大柴胡汤合桂枝茯苓丸方证:

5. Da Chaihu Tang plus Guizhi Fuling Wan indication

主症:胸胁苦满,心下急,微烦欲呕,肝区痛剧,大便干燥。GPT偏高,舌苔黄。方药:柴胡八钱,半夏四钱,黄芩三钱,枳实三钱,白芍三钱,桂枝三钱,桃仁三钱,丹皮三钱,茯苓三钱,大枣四枚,生姜三钱,茵陈蒿八钱,大黄二钱。

Main symptoms: Anoying fullness feeling in the chest and upper side of the belly. Tightness feeling in the stomach. Slight annoyed and feeling to have nausea. Pain in the liver area. Constipation. GPT is higher. The tongue cover is yellow.  The herb prescription is Chaihu 24 grams, Banxia 12 grams, Huangqin 9 grams, Zhishi 9 grams, Baishao 9 grams, Guizhi 9 grams, Taoren 9 grams, Danpi 9 grams, Fuling 9 grams, Chinese date 4, fresh ginger 9 grams, Yinchen 24 grams, and Dahuang 6 grams.

加减法:肝炎本多虚证,尤以血虚水盛多见,但在漫长病变过程中,或因气滞血瘀而实,或因外邪相加而实,故时有呈现大柴胡汤合桂枝茯苓丸方证者,当适证应用;若遇有里实燥结甚者,可加芒硝三钱冲服;而大便偏溏者,可去大黄;肝功不正常者,可加丹参一两、茵陈蒿八钱。

Modifications for the prescription: Most of the hepatitis is with a weakness condition, especially with blood deficiency and water overwhelming. Along the long term of disease course, the overwhelming condition is either due to the Qi sluggish and blood stagnation, or due to external Xie Qi invasion. From time to time, there is indication for the Da Chaihu Tang plus Guizhi Fuling Wan. If there is inner overwhelming condition with dryness, add Mangxiao 9 grams and drink it by direct swallow. If the stool is loose, the Dahuang can be removed. If the lab test for the liver function is abnormal, add Danshen 30 grams, and Yinchenhao 24 grams.

()  验案

Case reports

 

3. 伊某,女,26岁,病案号4216

Case 3. Yin XX, female, 26 years of old. File number 4216.

初诊日期1979518日:自19764月起肝功一不正常。经中西药治疗不见好转,后在本院门诊以清热利湿、活血解毒法治疗半年多亦未见效果。查肝功:删单位,( )GPT766单位(正常值100)。主要症状:下肢酸软,右胁痛疼,恶心,嗳气,纳差,夜间肠鸣,月经前期,舌苔薄微黄,脉弦细。证属肝郁血虚,水饮停滞,治以疏肝理气,养血利水,与柴胡桂枝干姜汤合当归芍药散加减:

The first visit: May 18, 1979. Since April 1976, the patient had an abnormal lab test for liver function. She had visited both western medicine and TCM treatment but no clear improvement. Later she was treated in this hospital by Fire-clearing, Wetness-clearirng, circulation-activating, and toxic-detoxifying therapy for half year also with any clear improvement. … Her condition at the visit to Dr. Hu was: weakness in legs, pain in right upper side of belly, nausea, belching, poor appetite, intestine noise at night, early menstruation. Her tongue cover was thin and slight yellow in color. Her pulse was strong and thin. Her condition was diagnosed as Liver stagnation with blood deficiency, and water accumulation in middle body. She was given liver-dredging, Qi-dredging, blood-nourishing and water-depleting therapy. The herbs given were Chaihu Guizhi Ganjiang Tang plus Danggui Shaoyao San:

柴胡六钱,黄芩三钱,生牡蛎三钱,天花粉四钱,桂枝三钱,干姜二钱,白芍三钱,川芎三钱,王不留行三钱,丹参一两,茵陈蒿八钱,茯苓五钱,苍术三钱,炙甘草三钱。

Chaihu 18 grams, Huangqin 9 grams, Muli 9 grams, Tianhuafeng 12 grams, Guizhi 9 grams, dried ginger 6 grams, Baishao 9 grams, Chuanxiong 9 grams, Wangbuliuxing 9 grams, Danshen 30 grams, Yinchenhao 24 grams, Fuling 15 grams, Cangzhu 9 grams, Zhi Gancao 90 grams.

结果:上药服三剂,因出现尿频、尿痛、尿急,改服猪苓汤加生苡仁三剂,症除。又因恶心腹胀,大便溏等,改服小柴胡汤合茯苓饮六剂,恶心腹胀消失,大便转常,再投与初诊时原方加减,服用二月。1217日查肝功正常,HBsAgl16

Following up: after taking the above herbs for three days, the patient had frequent urine, and pain in urine. The herbal prescription was changed to Zhuling Tang plus Yiyiren three days. Also, due to nausea and bloating in belly, and loose stool, the herbal prescription was changed to Xiao Chaihu Tang plus Fuling Yin for six doses. Then the nausea and bloating feeling in the belly subsided and the bowel movement turned normal. The initial herbal tea was re-started to use for two months. On Dec. 17, the lab test for liver function showed normal.

4. 索某,男,25岁。病案号43609

Case 4. Suo XX, male, 25 years of old. File number: 43609.

初诊日期197858日:自19774月诊断为肝炎。一直波动在300600单位,曾经住院服西药治疗一年无效。本月查肝功:GPT600单位以上,胆红质定量16毫克%,7nvr10单位,TFr( )HBsAgl32。主要症状:乏力,肝区痛,常咽痛,小便黄,舌苔薄白,脉弦数。胡老诊脉后指出:此证虽病久且见乏力,乍看为虚,但细看脉证,实为肝郁偏实热之证,故拟以疏肝祛瘀、清热利湿之法,与大柴胡汤合桂枝茯苓丸茵陈蒿汤:柴胡六钱,黄芩���钱,白芍三钱,大枣四枚,半夏四钱,桂枝三钱,大黄二钱,生姜三钱,枳壳三钱,桃仁三钱,丹皮三钱,茯苓四钱,炙甘草二钱,茵陈蒿八钱。

The first visit: May 8, 1978. Since April 1977, the patient was diagnosed as hepatitis. The GPT floated between 300-600 unites. He was hold in hospital for one year with western medicine treatment without improvement. This month, the lab test showed that the GPT was more than 600 unites. … Currently, he felt tired, pain the liver area, often sour throat. His urine was yellow in color. The tongue cover was thin and white. The pulse was string and frequent. Dr. He diagnosed his condition and said, his disease was a long term with tired, which seemed to be a weakness condition. However, if we pay more attention to his pulse, his condition should belong to liver stagnation which tends to the overwhelming hotness. So, he was prescribed liver-dredging, stagnation-clearing, Fie-clearing and Wetness-dissolving therapy. The indications are the Da Chaihu Tang plus Guizhi Fuling Wan, Yinchenhao Tang: Chaihu 18 grams, Huangqin 0 grams, Baishao 9 grams, Chinese date 4, Guizhi 9 grams, Dahuang 6 grams, fresh ginger 9 grams, Zhike 9 grams, Taoren 9 grams, Danpi 9 grams, Fuling 12 grams, Zhi Gancao 6 grams, and Yinchenhao 24 grams.

结果:上药加减服用三个月,咽痛已,肝区痛偶现。查肝功:2GPT143单位,T()(),胆红质定量09毫克%,HBsAgl32。但大便转溏,乏力腹胀明显,说明邪实去,而本虚明显,证为血虚水盛为主,故与柴胡桂枝干姜汤合当归芍药散加减,药用:柴胡六钱,桂枝三钱,黄芩三钱,天花粉四钱,生牡蛎四钱,干姜二钱,炙甘草二钱,白芍三钱,川芎三钱,当归三钱,苍术三镌,泽泻三钱,丹参一两,茵陈蒿八钱,茯苓四钱。又服一个月,症状消失,肝功正常,HrsAg

Following up: after the herbal therapy for three months, the sour throat subsided. He felt occasional pain in the liver area only. The lab test showed that the GPT was 143 unites…. His stool turns loose and he felt strong bloating feeling in the belly, indicating that the overwhelming Xie Qi has been dispelled, but the inner weakness condition is relatively more. It is the syndrome of blood deficiency and Water overwhelming, so the prescription given was Chaihu Guizhi Ganjiang Tang plus Danggui Shaoyao San with some modifications: Chaihu 18 grams, Guizhi 9 grams, Huangqin 9 grams, Tianhuafeng 12 grams, Muli 12 grams, dried ginger 6 grams, Zhi Gancao 6 gramsl, Chuangxiong 9 grams, Danggui 9 grams, Cangzhu 9 grams, Zexie 9 grams, Danshen 30 grams, Yinchenhao 24 grams, and Fuling 12 grams. This herbal tea was used for one month. The symptoms disappeared and the lab test for liver function was normal.

 

益气淡渗祛瘀保肝康

4.  有关肝硬化、肝腹水的论治

The treatment of hepatic cirrhosis and ascites

《金匮要略水气病》篇曰:"脉得诸沉,当责有水......肝水者,其腹大,不能自转侧,胁下腹痛。"揭示了肝硬化、肝腹水的脉证。胡老认为,该病主要是气虚血虚,血虚水盛,为本虚标实之证,治疗不能急于攻水而求近效,要特别注意慎用大戟、芫花、甘遂、黑白丑等攻伐逐水之品。这些都是毒性明显的药物,肝硬化、肝腹水多是慢性肝炎迁延不愈,肝功衰竭已极,已不能耐受这些药物的毒性刺激。肝脏本是重要的解毒器官,肝功衰竭,无能力解毒,有毒物质将进一步毒害肝、肾等器官,致使人体全身衰竭。此时的治疗,唯有益气养血、祛瘀利水治其标本,即以益气养血养肝保肝,以祛瘀活血软坚消肝脾肿大,以淡渗利水消腹水、浮肿。这样慢慢消息,以期望肝细胞再生、肝功趋向正常。常见方证:

… Dr. Hu believed that, the hepatic cirrhosis and ascites is the Qi deficiency with Blood deficiency, or Blood deficiency with water overwhelming. It is a weakness condition as true nature, and overwhelming surface expressions. For the treatment, we should not be eager to solve the water to have quick healing effect, not be eager to use herb Daji, Yuanhua, Gansui and Erchou, such very strong water-dispelling herbs. These herbs are apparent highly toxic herbs. The hepatic cirrhosis and ascites are mostly the results of a chronic hepatitis, in which the liver function has been in a very exhausted status, which is hardly to tolerate any more toxic attacks. The liver is originally a organ to detoxify. When the liver function is exhausted, without being able to detoxify, the toxic stuff would further more damage the liver and kidney and other organs to cause whole body exhaustion. At this movement for the treatment, it can only be done is to nourish the Qi and Blood, to dispel the blood stagnation and dredge the water. In another words, use the Qi-nourishing, Blood-nourishing therapy to nourish the liver and to protect the liver; use stagnation-clearing and circulation-improving and mass-softening therapy to solve the enlargement of the liver and spleen, and use water-filtrating and evaporating therapy to dispel the ascites. By this way to solve the problems slowly and gradually, to expect the liver cells being rejuvenated and the liver function being restored. The commonly used herbal prescriptions are the followings:

1茯苓饮合五苓当归芍药散方证:

1. Fuling Yin plus Wu Ling San

主症:乏力,纳差,消瘦,腹满腹水,面色萎黄或有色素沉着,舌苔白少津,脉沉滑。方药:

茯苓六钱,党参三钱,陈皮一两,生姜三钱,枳壳三钱,桂枝三钱,猪苓三钱,苍术五钱,泽泻五钱,当归三钱。白芍三钱,川芎三钱。

The main clinic conditions: the person feels tired, poor appetite, slim, water inside belly (ascites), withered face with yellow color or pigments on the face. The tongue cover is white with little bit dry. The pulse is deep and slippery. The herbs are: Fuling 18 grams, Dangshen 9 grams, Chenpi 30 grams, fresh ginger 9 grams, Zhike 9 grams, Guizhi 9 grams, Zhuling 9 grams, Cangzhu 15 grams, Zexie 15 grams, Danggui 9 grams, Baishao 9 grams, and Chuanxiong 9 grams.

加减法:腹胀、浮肿明显者,加大腹皮三钱、槟榔三钱;纳差者,加砂仁三钱;肝功不正常者,加丹参一两、茵陈蒿八钱;肝脾肿大者,加鳖甲五钱、龟板五钱,或加服鳖甲煎丸三钱,一日二次,或用大黄廑虫丸二钱,一日二次。

Modifications of the prescription: if the bloating and swelling are very strong, add Da Fupi 9 grams, and Binglang 9 grams. If there is poor appetite, add Sharen 9 grams. If the lab test shows the liver function is abnormal, add Danshen 30 grams and Yinchenhao 24 grams. If the liver and spleen are enlarged, add Biejia 15 grams, and Guiban 15 grams, or add Biejiajian Wan 9 grams, twice a day, or use Dahuang Zhechong Wan 6 grams, twice a day.

2小柴胡茵陈五苓散方证:

2. Xiao Chaihu Tang plus Yinchen Wu Ling San:

主症:口苦咽干,腹胀腹水,乏力纳差,小便黄少,舌苔白腻或黄,脉弦细。方药:柴胡五钱,党参三钱,桂枝三钱,茯苓四钱,苍术三钱,猪苓三钱,泽泻五钱,黄芩三钱,半夏三钱,生姜三钱,炙甘草二钱,茵陈蒿八钱,大枣四枚。

The main conditions are: Bitter taste in mouth and dry in throat. Bloating belly and ascites. Poor appetite and fatigue. Urine volume is less and shows yellow in color. The tongue cover is white-greasy or yellow in color. The pulse is string and thin. The herbs are: Chaihu 15 grams, Dangshen 9 grams, Guizhi 9 grams, Fuling 12 grams, Zhuling 9 grams, Zexie 15 grams, Huangqin 9 grams, Banxia 9 grams, fresh ginger 9 grams, Zhi Gancao 6 grams, Yinchenhao 24 grams, and Chinese date 4.

加减法:胁痛明显者,加白芍三钱、当归三钱、王不留行三钱;肝功不正常者,加丹参一两。

Modifications of the prescription: if the pain is sever in the upper side of the belly, add Baishao 9 grams, Danggui 9 grams, and Wangbuliuxing 9 grams. If the lab test shows abnormal liver function, add Danshen 30 grams.

验案

Case reports

5. 费某,男,46岁,住院病案号92282

Case 5. Fei XX, male, 46 years of old. File number 92282.

初诊日期1965820日:19616月发现急性黄疸型肝炎,不断治疗,病情反复。近半年来,出现腹胀、腹水,某医院查有食道静脉曲张、脾大,诊断为肝硬化腹水,服西药症状反而加重,而求中医治疗。现症:腹胀甚,胸胁满,纳差,暖气,头晕目花,口干稍苦,有时鼻衄,舌苔白,脉沉弦滑。证属血虚水盛,水郁久化热,治以养血利水,与柴胡桂枝干姜汤合当归芍药散加减:柴胡四钱,桂枝三钱,黄芩三钱,天花粉四钱,干姜二钱,炙甘草二钱,生牡蛎三钱,当归三钱,川芎三钱,白芍三钱,苍术三钱,泽泻五钱,茯苓四钱,生地炭三钱,阿胶三钱。

The first visit: Aug. 20, 1965. In June 1961, it was found that the patient suffered from acute jaundice hepatitis. He had continuous treatment but the symptom comes and goes. In recent half year, he had bloating in belly and ascites. It was diagnosed as esophageal varix and enlarged spleen, and hepatic cirrhosis with ascites. Western medicine made the condition worse, so came for TCM treatment. The current symptoms are: strong bloating in the belly, fullness in chest and in upper side of the belly, poor appetite, belching, dizziness and blurring vision, little bit bitter taste in mouth, and some times nose bleeding. His tongue cover is white. His pulse was deep, string, and slippery. The condition was diagnosed as blood-deficiency and water-overwhelming. The long term of water overwhelming created fire inside. It is to be treated with blood-nourishing and water-dredging therapy. The herbs are the Chaihu Guizhi Ganjiang Tang plus Danggui Shaoyao San with some modification: Chaihu 12 grams, Guizhi 9 grams, Huangqin 9 grams, Tianhuafeng 12 grams, dired ginger 6 grams, Zhi Gancao 6 grams, Muli 9 grams, Danggui 9 grams, Chuanxiong 9 grams, Baishao 9 grams, Cangzhu 9 grams, Zexie 15 grams, Fuling 12 grams, Shendi 9 grams, and Ajiao 9 grams.  

结果:上药服十四剂,94日复诊,口苦咽干已,鼻衄未作,腹胀稍减,改服茯苓饮合当归芍药散五苓散:茯苓四钱,党参三钱,枳壳三钱,陈皮一两,苍术三钱,当归三钱,白芍三钱,川芎二钱,桂枝三钱,砂仁三钱,木香三钱,大腹皮三钱,木瓜三钱。

Following up on Sept. 4. After 14 days of treatment with the prescription above, the bitter taste in mouth and the dry mouth subsided. No nose bleeding. The belly bloating subsided slightly. The prescription was changed to Fuling Yin plus Danggui Shaoyao San plus Wu Ling San: Fuling 12 grams, Dangshen 9 grams, Zhike 9 grams, old orange peel 30 grams, Cangzhu 9 grams, Danggui 9 grams, Baishao 9 grams, Chuanxiong 6 grams, Guizhi 9 grams, Sharen 9 grams, Muxiang 9 grams, Dafupi 9 grams, and Mugua 9 grams.  

上药加减治疗五月余,腹胀、腹满已不明显,下肢浮肿消,腹水明显减少。嘱其回原籍继续服药,并加服鳖甲煎丸,以图进一步好转。

Follow up: after the treatment with prescriptions above for five months, the bloating and fullness feeling was not much. The swelling in legs subsided completely. The ascites reduced dramatically. He was asked to go home for a maintenance, with addition of herb Biejia Jian Wan.

按:肝硬化、肝腹水多是慢性肝炎长期不愈变化而来,但是不少患者,在发现急性肝炎时就已经出现了肝硬化、肝腹水,如验案例2。因此,肝炎和肝硬化、肝腹水的病理和临床症状是虚实挟杂,交错出现,治疗上也就不能截然分开。急性黄疸型肝炎,以利湿、清热、疏肝为主;无黄疸型慢性肝炎,以疏肝、祛瘀、和胃为主;肝硬化、肝腹水,以益气、淡渗、祛瘀为主,这三大法是说治疗的一般规律大法,并不是一成不变的公式。每一法也可用于各型肝炎、肝硬化、肝腹水中,如验案例2有肝硬化、肝腹水而用了利湿、清热、疏肝法。这就是说,治疗时主要看具体症状所表现的方证,即有是证,用是方。

Comments: The hepatic cirrhosis and ascites are mostly developed from long term of chronic hepatitis. There are also some patients who are found to have the cirrhosis and ascites, when they are found to have acute hepatitis. Such as in the case 2. For this reason, the pathologic basis and the clinic conditions for the hepatitis, the hepatic cirrhosis and ascites are the mixture of the weakness and the overwhelming. In the treatment, the weakness and the overwhelming can not be exactly separated. For acute jaundice hepatitis, the main therapy is to clear the Wetness, to clear Fire, and to dredge the liver. For no-jaundice hepatitis, the main therapy should be dredge liver, dissolve blood stagnation and to harmonize the stomach. For the hepatic cirrhosis and ascites, the main therapy should be to nourish the Qi, to filter and to evaporate the water, and to dissolve the blood stagnation. These are the general principle in the treatment for each condition, but it is not a fixed principle. Every of the principle can also be used in another kind of stage of the disease. For example in the case 2, the patient had hepatic cirrhosis and ascites, but she was also given the therapy to clear the Wetness, to clear the Fire, and to dredge the liver. This means that upon the treatment, whatever therapy should be used bases on the clinic syndrome and the herb indications. The herbs should be used if there is indication to use it.

从以上的治疗经验中可看出,当肝功不正常时,胡老喜用大量的丹参、茵陈蒿;当有肝脾肿大时,常用鳖甲、龟板。这是来自于多年的经验总结,也是源自于经方的理论。如有关丹参的功能、主治,《神农本草经》认为:"味苦,微寒,无毒,主心腹邪气,肠呜幽幽如走水,寒热积聚,破癜,除瘕,止烦满,益气。"有关茵陈蒿的功能、主治,《神农本草经》谓:"味苦平,主风寒湿热邪气,热结黄疸。"这两味的主治功能,适应于肝炎的活动期,经长期观察确有良效,故常用之。应用鳖甲、龟板治疗肝脾肿大,也是依据了《神农本草经》的论述,如该书记载:"鳖甲,味咸,平,主心腹癜瘕,坚积,寒热,去痞。""龟板,味咸,平,主漏下赤白,破瘕瘕、_"。其主治功能很适宜肝脾肿大症。胡老经多年观察确有实效,因此常择证用之。至于针对某个化验指标,如降GPT、降Tl等,用某药某方,胡老认为,因无经验可循,有的药与中医辨证相抵牾,应慎用为妥,应以辨证用药为主。肝炎和肝硬化肝腹水,虽病在肝,但其病是全身病变,治疗也必着眼于人的整体,辨证论治、辨方证是其根本。

From the introductions and discussions above, it can be seen that, when the lab test for the liver function is abnormal, Dr. Hu likes to use large amount of herb Danshen and Yinchenhao. If there is enlarged liver and spleen, he uses Biejia and Guiban. This is the experience of many years’ clinic work, and also the introduction from Jing Fang (e.g. from the book <<Shang Han Lun>> and <<Shen Non Ben Cao Jing>>). … Dr. Hu have tried to use these herbs for many years and found it is true for the herb functions introduced in the books. For the treatment of some lab test parameter, such as for the increased blood GPT, and so on, there is idea to use some other herbs. Dr. Hu said there is no concrete experience in the TCM society yet and also some of the herbs may be conflict with the TCM theory in the treatment. They should be used with caution. The treatment should focus on the syndrome diagnosis and herb indication diagnosis. For the hepatitis, hepatic cirrhosis and ascites, though the disease happens in the liver, it is still a whole body problem. The treatment should also focus on the whole body too. It is the key to make the syndrome diagnosis and herb indication diagnosis for the correct treatment.

 

 

5. 痹证论治经验

5. Treatment of Be syndrome[7]

风湿相搏痛无休  六经辨清有止期

The Wetness and Wind entangled to cause pain in joints. With the Liu Jing diagnosis, there is hope to stop the pain.

痹证,《内经》多单称之为痹,如《素问痹论》曰:"风寒湿三气杂至,合而为痹也。"但《内经》又提出了不少复合痹名,如行痹、痛痹、著痹、五体痹、五脏痹等名称,涵盖了经络气血闭塞不通所引起的痛疼或麻痹等症。后世乃至今日所通称的痹证,主要是指关节及肌肤痛疼。历代医籍称谓的风湿、历节、热痹、痛风、白虎历节、鹤膝风、湿痹、风湿热痹等名称多属于此。本证常见于西医的风湿性关节炎、类风湿性关节炎、骨质增生、骨质疏松、强直性脊柱炎、皮肌炎等症。本章所述也概属此。

… The Bi syndrome is caused by the combination of the Wind, the Wetness and Cold in the joints. It can separated into Moving Bi syndrome, Pain Bi syndrome, Hot Bi syndrome, Cold Be syndrome, Heavy Bi syndrome, Five-body Bi, Five-organ Bi syndrome, etc. It mostly shows as pain in the joints. The Bi syndrome can be seen, in the western medicine, the rheumatoid arthritis, rheumatic arthritis, hyperosteogeny, osteoprosis, ankylosing spondylitis, and dermatomyositis, etc.

有关痹证的成因,《内经》提出了"风寒湿三气杂至,合而为痹"之说,故后世治多宗祛风寒湿之法。《伤寒论》提出了"风湿相搏""汗出当风""久伤取冷""汗出人水中""风血相搏""饮酒汗出当风"等多种成因。其治疗大法注意到祛风寒湿及养血活血,但更重要的是强调辨六经和方证。

The cause of the Bi syndrome is believed to be due to the combination of the Wind, Cold, and Wetness in the joint or muscle. In the book <<Shang Han Lun>>, it is pointed out that, it can be caused by “the entangle of Wind and Wetness”, “attacked by Wind when there is sweat in the body”, “exhausting labor work and the body touched cold”, “Body comes or meets the water when there is sweat”, “the entangle of the Wind and blood”, “When drink alcohol, has sweat and attacked by wind”. For the treatment, it paid attention to dispel the Wind, the Cold and the Wetness, as well as to nourish the blood and to activate the blood circulation, but more it emphasize the diagnosis of the six Jing and the indication for the herbs to use.

《伤寒论》有关痹证的论述和证治很多,如第1条:"太阳之为病,脉浮头项强痛而恶寒"。第35条:"太阳病,头痛,发热,身痛,腰痛,骨节疼痛,恶风,无汗而喘者,麻黄汤主之"。《金匮要略痉湿喝病》第20条:"湿家,身烦疼,可与麻黄加术汤",第21条:"病者一身尽疼,发热,日晡所剧者,名风湿。此病伤于汗出当风,或久伤取冷所致也。可与麻黄杏仁薏苡甘草汤。"387条:"吐利止而身痛不休者,当消息和解其外,宜桂枝汤小和之。"等,多指证在表的阳证,也即是太阳病。而在表的阴证,也即是少阴病更为多见,如第174条:"伤寒八九日,风湿相搏,身体痛疼烦,不能自转侧,不呕,不渴,脉浮虚而涩者,桂枝附子汤主之。",第316条:"少阴病,二三日不已,至四五日,腹痛,小便不利,四肢沉重疼痛,自下利者......真武汤主之。"《金匮要略中风历节病》第8条:"诸肢节疼痛、身体旭赢,脚肿如脱,头眩短气,温温欲吐,桂枝芍药知母汤主之"等,也就是说,从病位来看,痹证多见于表,从六经辨证来看,多属太阳或少阴。但也有不少见于太阳阳明合病者,如《金匮要略疟病》第4条:"温疟者,其脉如平,身无寒,但热,骨节烦疼,时呕,白虎加桂枝汤主之。"。也有见于太阳少阳合病者,如《伤寒论》第146条:"伤寒六七日。发热、微恶寒,肢节烦疼,微呕,心下支结,外证未去者,柴胡桂枝汤主之。"因此,治疗证,首先要分析患者的症状是属太阳病,还是少阴病,还是阳明病,还是太阳少阳合病,还是太阳阳明合病,再进一步认清是何方证。这样处方用药,治疗痹证多能有效。治疗痹证的方证很多,今择其要列于下:

… there are lots of introductions and discussions in the book <<Shang Han Lun>> about the diagnosis and the treatment of the Bi syndrome. … From the location of the disease, the Bi syndrome is more seen in the body surface layer. From the six Jing point of view, it belongs to the Taiyang or Shaoyin phase. Some times, it may belong to the Taiyang-Yangming co-exist phases, or a Taiyang-Shaoyang co-exist phases. Therefore, for the treatment of the Bi syndrome, first of all, it is needed to make the phase diagnosis, to see to which phase the Bi syndrome belongs., followed by diagnosis of which herbs should be used, e.g. the indication diagnosis. By this way, the treatment woud have higher chance to success. There are many herbs or herbal prescriptions that are used for the treatment. Here we introduce some of them:

1葛根加术汤方证

1. Gegen plus Zhu Tang

主症:项背强痛,发热恶寒,无汗恶风,腰酸身重,苔白,脉弦滑。方药:葛根四钱,麻黄三钱,桂枝二钱,生姜三钱,白芍二钱,炙甘草二钱,大枣四枚,苍术五钱。

The main clinic manifestation: the person feels stiff and pain in the neck and back, hot and chilly, no sweat, dislide wind or moving air, such air conditioning environment. Sour and heavy in the body. The tongue cover is white and the pulse is string and slippery. The herbs are: Gegen 12 grams, Mahuang 9 grams, Guizhi 6 grams, fresh ginger 9 grams, Baishao 6 grams, Zhi Gancao 6 grams, Chines date 4 and Cangzhu 15 grams.

《金匮要略痉湿喝病》第18条:"风湿相搏,一身尽疼痛,法当汗出而解,值天阴雨不止,医云:此可发汗,汗之病不愈者,何也? 盖发其汗,汗大出者,但风气去,湿气在,是故不愈也。若治风湿者,发其汗,但微微似欲出汗者,风湿俱去也。"微发汗是治疗痹证的重要原则,葛根汤清凉解肌、发汗,同时加入苍术利湿,这样湿从小便走,热也随湿解,使风湿俱去。发汗剂中加入利尿、利湿药,为小发汗、微发汗法,宜注意。本方用于急、慢性关节炎,尤其发热无汗而恶寒甚剧、身重的急性关节炎,不问有无项背强几几,多属本方证。他如腰肌劳损、骨质增生、强直性脊柱炎等慢性关节病皆有应用的机会。《神农本草经》谓葛根治诸痹、痉与痛,值得深讨。

… To create slight sweat is the key to solve the Bi syndrome. This prescription works to release and relax the muscle, to create sweat. With the Cangzhu addition to clear the Wetness, to make the Wetness deplete from the urine, so that the hotness is also depleted through the depletion of the Wetness. By this way, both the Wetness and Hotness deplete from the body. To add urine-simulating and Wetness-depleting herbs into the sweat-stimulating herbal prescription is mild sweat therapy. This should be remembered. This prescription is used in the acute and chronic arthritis, especially the person has fever, no sweat but strong chilly feeling, and feels heavy in the body. For such person, this herbal prescription is a proper choice, no matter if there is stiffness in the neck or back or not. It can be used also in other conditions, such as lumber muscle degeneration, hyperoesteogeny, and , ankylosing spondylitis, and so on. In the book <<Shen Non Ben Cao Jing>>, it said that, the herb Gegen works to solve Bi syndrome, the spasm and the pain. It should be paid attention to study.

2麻杏薏甘汤方证

2. Ma Xing Yi Gan Tang

主症:周身关节痛,发热午后明显。身重,或四肢关节肿,舌苔白腻,脉沉弦滑。方药:麻黄三钱,杏仁二钱,薏苡仁六钱,炙甘草二钱。

Main manifestations: The patient had pain in the joints, and fever or hotness that was more in the afternoon. Heavy feeling in the body, or swelling in the arms, legs, or joints. The tongue cover is white and the pulse is deep, string and slippery.  The herbs are: Mahuang 9 grams, Xingren 6 grams, Yiyiren 18 grams, and Zhi Gancao 6 grams.

本方以麻黄辛温发汗,用薏苡仁甘寒利湿,亦是小发汗之法。《神农本草经》谓:薏苡仁味甘微寒,主筋急拘挛,久风湿痹。痹证湿热明显时,更不可以发大汗退热,而是在发汗的同时利湿,本方即承此意,虽组成简单,但如方药对证则疗效卓著。本方证多见于急慢性风湿性关节炎而偏于湿热明显者。

In this prescription, the herb Mahuang is used to stimulate sweat for its spicy and warm nature, and the herb Yiyiren is to clear the Wetness for its sweet and cold nature. This belongs to mild sweat therapy. In the book <<Shen Non Ben Cao Jing>>, it said that, the herb Yiyiren is sweet and slight cold, works to solve tendon spasm, and long term of Wind-Wetness Bi syndrome. If the Bi syndrome is with strong Wetness and Hotness, the strong sweat that is to create strong sweat to reduce fever should not be used. The proper way is to deplete the Wetness at the same time to stimulate sweat. This is the aim of this prescription. It works very well if the herb indication matches the clinic condition, though its ingredients are so simple. The indication for this herb prescription is more seen in acute or chronic arthritis with relatively more Wetness and Hotness.

3桂枝芍药知母汤方证

3. Guizhi Shaoyao Zhimu Tang

主症:周身关节痛疼,四肢或膝关节肿、僵硬,或肢、指、趾关节变形,头眩气短,苔白,脉弦。

The main clinic manifestations: the person feels pain all over the body joints, swelling, or stiffness in the arms and legs, or disform of joints in the arms, legs, fingers, toes. The person feels dizziness, short of breath. The tongue cover is white, and the pulse is string. 

方药:桂枝四钱,麻黄二钱,白芍三钱,生姜五钱,白术五钱,知母四钱,防风四钱,炮附子二钱,甘草二钱。

The herbs are: Guizhi 12 grams, Mahuang 6 grams, Baishao 9 grams, fresh ginger 15 grams, Baizhu 15 grams, Zhimu 12 grams, Fangfeng 12 grams, Pao Fuzi 6 grams, Gancao 6 grams.

本方多用于慢性风湿、类风湿性关节炎呈现太阳少阴合病,尤其是见关节肿大变形而伴见气冲呕逆者。若风湿热关节红肿热明显者,可加生石膏。

This prescription is mostly used in chronic rheumatic or rheumatoid arthritis in Taiyang-Shaoying phase, especially if there is swelling and enlargement in the joints, and if the patient has nausea. If the joints are with very much hot, swelling and hot, add Shigao.

4桂枝加苓术附汤方证

4. Guizhi Tang plus Ling Zhu Fu Tang

主症:腰、膝、肘关节痛,头项强痛,或心悸,或胃脘痛,汗出恶风,四肢常冷,口中和,舌苔白,脉弦。

The main clinic manifestations: The patient has pain in the lower back, the knee and the elbow, has pain and stiff in the head and neck, or has palpitation, or has stomach pain, sweat and disliking wind, and feels cold arms and legs. No special taste is in mouth. The tongue cover is white and the pulse is string.

方药:桂枝三钱,白芍三钱,炙甘草三钱,生姜三钱,大枣四枚,苍术三钱,茯苓三钱,炮附子三钱。

The herb ingredients are: Guizhi 9 grams, Baishao 9 grams, Zhi Gancao 9 grams, fresh ginger 9 grams, Chinese date 4, Cangzhu 9 grams, Fuling 9 grams and Pao Fuzi 9 grams.

痹证之中,常见外有风寒在表、里有水湿停滞之证,里有所阻,表亦不透,故不兼利其水则表必不解,若强发其汗,激动里饮,变证百出。此时惟有于解表方中兼用利湿祛饮药,始收里和表解之效。本方证不仅是外寒里饮,而且也有陷于表虚寒的少阴证。因此治疗不但用桂枝汤及苓术解表和利水,同时更用了附子温阳强壮。胡老治疗痹证应用最多的是本方药。又当关节疼偏在一侧时,认为是瘀血阻滞,常加入少量大黄以活血通络,在其他方证见到一侧偏痛时也可加用大黄,也是经验之谈。

From time to time, it is found that, patient with the Bi syndrome has not only Wind-Cold in the body surface layer, but also a Water-Wetness accumulation inside the body. With such Water-Wetness inside, the body surface Xie Qi is hard to release. Without clear the inner Water, the body surface condition would be able to release. If use strong sweat therapy to create heavy sweat, it will stir out the inner Water-Wetness, causing various more symptoms. At this movement, the correct way is to add Wetness-clearing herbs into the original body surface-releasing prescription, so as to both release the body surface and to deplete the Water-Wetness inside. The prescription here works for both external Cold and Water inside, as well as the surface weakness-cold condition, e.g. the Shaoyin phase. For this, in the prescription, it is not only used the Guizhi Tang and Ling Zhu to release body surface and to clear the water, but also the Fuzi to warm up the Yang Qi in the body. This is the herbal prescription that Dr. Hu used mostly in the Bi syndrome. Whenever the joint pain is on one side of the joint, he believes that it is due to block of energy flow by blood stagnation, so usually he adds herb Dahuang in the prescription to activate blood circulation and to dredge the meridian. In the use of other herbal prescription, if there such lateral pain, he also uses Dahuang. This is one of his experience.

5桂枝加黄芪汤方证  

5. Guizhi Tang plus Huangqi

主症:长期关节疼痛,汗出恶风明显,四肢关节冷,或身热,或肢体麻木不仁,苔薄白,脉缓。

The main clinic manifestation: the person has long term of joint pain, has sweat and strong dislike of wind (air conditioning), cold in joints in arms and legs, or body hot, or numb in arms and legs. The tongue cover is thin and white. The pulse is slow. 

方药:桂枝三钱,白芍三钱,生姜三钱,大枣四枚,炙甘草二钱,黄芪三钱。

The herbal ingredients: Guizhi 9 grams, Baishao 9 grams, fresh ginger 9 grams, Chinese date 4, Zhi Gancao 6 grams, and Huangqi 9 grams.

本方与桂枝加苓术附汤都是桂枝汤的变方,但本方证病在太阳,而后者病在太阳少阴。本方重在固表祛湿,后者重在温阳祛饮,这便是黄芪、附子应用之别,很为重要,宜注意。黄芪味甘微温,《神农本草经》谓:"主痈疽久败疮,排脓止痛,大风癞疾,补虚。"从所主来看,均属肌肤间病,也可知补虚,主要是补表气的不足,故若是由于表虚水湿邪气不去,而形成的痹痛、麻木不仁、疮痍等,均有用本药的机会。

This prescription and the Guizhi plus Ling Zhu Fu both are developed from root prescription Guizhi Tang.  This prescription works for Taiyang phase, while the Guizhi plus Ling Zhu Fu works on Taiyang-Shaoyang co-exist phase. This one works mostly to strengthen body surface and to dispel Wetness, while the later focuses to warm Yang Qin and to dispel Water-Wetness from the body. This is the difference between the use of Huangqi or Fuzi. This concept is very important. … The function of the Huangqi is to nourish the body surface layer energy. Therefore, it can be used whenever the Water-Wetness accumulated in between the muscle due to body surface weakness, which causes the pain, numb, and ulcer, etc.

6柴胡桂枝干姜汤合当归芍药散方证

6. Chaihu Guizhi Ganjiang Tang plus Danggui Shaoyao San

主症:腰髋、项背酸痛,膝软无力,心悸,心下满,自汗盗汗,或下肢浮肿,舌苔白,脉沉弦细。

The main clinic manifestation: the person feels pain in the lower back and neck, weakness in the knee, palpitation, fullness in stomach area, sweat day or night, or swelling in legs. The tongue cover is white. The pulse is deep, string and thin.

方药:柴胡四钱;桂枝三钱,干姜二钱,黄芩三钱,花粉四钱,生牡蛎五钱,当归三钱,白芍三钱,川芎二钱,白术三钱,泽泻五钱,茯苓四钱,炙甘草二钱。

Herb ingredients: Chaihu 12 grams, Guizhi 9 grams, dried ginger 6 grams, Huangqin 9 grams, Tianhuafeng 12 grams, Muli 15 grams, Danggui 9 grams, Baishao 9 grams,Chuanxiong 6 grams, Baizhu 9 grams, Zexie 15 grams, Fuling 12 grams, and Zhi Gancao 6 grams.

痹证以腰背酸痛为主者,多见于腰颈椎骨质增生、骨质疏松、风湿、类风湿、强直性脊椎炎等病。病位多在太阳少阳,而呈血虚水盛之证,故治疗两解太少、养血利水。本方以柴胡桂枝干姜汤两解太少,当归芍药散养血利水,两方合用,是胡老长期临床总结出的经验。该方对长期慢性痹证,尤其是老年人出现的血虚水盛证,适证应用,疗效突出。

Whenever the Bi syndrome expresses mostly as the sour and pain in the lower back, it is more likely seen in the lumber or cervical hyperoseogeny, oseoperosis, rheumatic or rheumatoid arthritis, or ankylosing spondilosis, etc. The disease is mostly in the Taiyang and Shaoyang phases, and shows as blood deficiency with water overwhelming. So, in the treatment, it should be to release the Taiyang and Shaoyang phases, to nourish the blood and to deplete water. This prescription uses Chaihu Guizhi Ganjiang Tang to release the Taiyang and Shaoyang, and uses Danggui Shaoyao San to nourish the blood and deplete water. To combine the two prescriptions in the treatment of this syndrome is the summary of Dr. Hu from clinic work. When it is used to long terms of Bi syndrome, especially in elderly with blood deficiency and water overwhelming condition, it works very well.

验案

Case reports:

1. 丁某,男,病案号:03616

Case 1. Ding XX, male. File number: 03616.

初诊日期196655日:一年多来项背强急,头不得运转,头偏左歪,右臂疼痛且麻,尤其是头稍后仰则疼更 剧甚。于北京某医院检查确诊为"颈椎骨质增生",用多种治疗,迄今无效。曾行牵引治疗亦不见效。常恶寒无汗,舌苔白润,脉弦细寸浮。胡老辨证为太阳少阴合病,为葛根加苓术附汤方证:葛根四钱,桂枝三钱,麻黄三钱,白芍三钱,生姜三钱,大枣四枚,苍术四钱,茯苓三钱,川附子三钱,炙甘草二钱。

The first visit: May 5, 1966. For the past one year, the patient felt stiffness and spasm in the neck and back. The head is hard to turn. The head turned to the left side. The right arm was pain and numb, especially when the head turned back side even slightly. He was diagnosed as cervical hyperosteogeny, being given various remedies, including attracting therapy, without clear improvement. He usually felt cold and no sweat. The tongue cover was white and wet. The pulse was string, thin with floating feeling on the Chun position. His condition was diagnosed by Dr. Hu as Taiyang-Shaoyang co-exist phase and it is the indication of presription Gegen Tang plus Ling Zhu Fu. The herbs given were Gegen 12 grams, Guizhi 9 grams, Mahuang 9 grams, Baishao 9 grams, fresh ginger 9 grams, Chinese date 4, Cangzhu 12 grams, Fuling 9 grams, Chuan Fuzi 9 grams, and Zhi Gancao 6 grams.

结果:上药服一剂效不显,服第二剂后头疼减。四剂尽,项背强急已缓,而臂疼麻如故,改服桂枝加苓术附汤:桂枝三钱,白芍三钱,生姜三钱,大枣四枚,苍术四钱,茯苓三钱,炙甘草二钱,川附子三钱,大黄一钱。服五剂,项背强急、右臂疼痛均显著减轻,头可随意转动,除向后仰时右臂尚有麻木外,平时已无任何明显不适。再与上方加葛根三钱,三剂消息之。

Follow up: after the first day of the herbal therapy, the healing effect was hard to tell. After the second day, the headache on the back of the head subsided somehow. After the fourth day, the stiffness and spasm on the neck and back subsided dramatically, but the arm pain and numb remained. The herb prescription was changed to Guizhi Tang plus Ling Zhu Fu: Guizhi 9 grams, Baishao 9 grams, fresh ginger 9 grams, Chinese date 4, Cangzhu 12 grams, Zhi Gancao 6 grams, Chuan Fuzi 9 grams, Dahuang 3 grams. It was given for five days. After that, the stiffness and spasm, and the pain in the right arm, both subsided dramatically. The head could turn freely, except that there was numb on the right arm when the head turned back. Other wise there was almost no any symptoms. To the latest prescription was added the herb Gegen 9 grams, which was asked to take for additional three days.

 

2.  白某,男,45岁,病案号48239

Case 2. Bai XX, male. 45 years of old. File number: 48239.

初诊日期196793日:腰膝酸疼、右臂酸胀、背拘急一年多,经检查为"胸腰椎骨质增生",中西药治疗未见明显疗效。近一月来身热身重,午后加重,双下肢轻度浮肿。舌苔白腻,脉弦滑细。胡老辨证为太阳表实热挟湿,为麻杏薏甘汤方证,方药用:麻黄三钱,杏仁二钱,薏苡仁六钱,炙甘草二钱。

The first visit: Sept. 3, 1967. The patient felt sour in the lower back and knee, sour and bloating feeling in the right arm, and stiffness in the back, all for one year more. The condition was diagnosed as thoracic and lumber hyperosteogenhy. He tried various western medicine and Chinese medicine in vain. For the past one month, he felt hot and heavy in the body, especially in the afternoon. He had slight swelling in the legs. The tongue cover was white and greasy. The pulse was string, slippery and thin. Dr. Hu diagnosed it as Taiyang phase of body surface overwhelming hotness with Wetness. It is the indication of prescription Ma Xing Shi Gan Tang: Mahuang 9 grams, Xingren 6 grams, Yiyiren 18 grams, Zhi Gancao 6 grams.

结果:上药服三剂,身热身重减轻,又服三剂,身热已,腰膝酸疼减。又经检查确诊有"肾盂肾炎"。改服猪苓汤加防己、苍术等加减,治疗一月余,诸症皆消。

Results: after this herbal therapy for three days, the body hot and heavy feeling subsided. After additional three days, the fever feeling stopped and the sour on the lower back and knee subsided. He was then diagnosed as “pyelonephritis”. The herbal prescription was changed to Zhu Ling Tang plus Fangji and Cangzhu. After one month, all symptoms subsided.

3. 徐某,男,19岁,病案号189520

Case 3. Xu XX, male. 19 years of old. File number: 189520.

初诊日期1966215 日:左足肿痛已五六年,近两年加重。经拍X光片,证实为跟骨骨质增生。现症:左足肿痛,怕冷,走路则疼甚,口中和,不思饮,苔薄白,脉沉弦。此风湿属太阳少阴合病,为桂枝芍药知毋汤方证:桂枝四钱,麻黄二钱,白芍三钱,知毋四钱,生姜四钱,川附子二钱,防风四钱,苍术四钱,炙甘草二钱。

The first visit: Feb. 15, 1966. The person had pain and swelling on the left foot for five to six years, which became worse for the recent two years. X-ray detected being hyperosteogeny in heel. The current condition: the person felt pain and welling on the left foot, which was worse when walk. He feared cold. There was no special taste in mouth, and no desire to drink. The tongue cover was thin and white. The pulse was deep and string. It is diagnosed as Taiyang-Shaoyin co-exist phase and it is the indication to the Gui Shao Zhimu Tang. The herbs used were: Guizhi 12 grams, Mahuang 6 grams, Baishao 9 grams, Zhimu 12 grams, fresh ginger 12 grams, Chuan Fuzi 6 grams, Fangfeng 12 grams, Cangzhu 12 grams, and Zhi Gancao 6 grams.

结果:上药服七剂,左足跟疼减,走路后仍疼,休息后较治疗前恢复快。增川附子为三钱继服,一月后左足跟肿消。疼痛已不明显。

Results: After the herbal therapy for seven days, the pain in the left heel subsided, except the pain on walk, which however could get released sooner that before. To the previous prescription, added herb Chuan Fuzi 9 gram. After one month of further treatment, no more pain at all.

4. 马某,女,65岁,病案号178799

Case 4. Ma XX. Female. 65 years of old. File number: 178799.

初诊日期19651031日:右上下肢关节痛、两手麻木三个月。今年81日不慎跌倒,发生四肢不能动,十多天后虽能动,但出现右肩关节、右下肢疼,两手麻木不能紧握,汗出恶风,舌苔白,脉弦细。此血之病,属太阳表虚黄芪桂枝五物汤加苓术防己方证:生黄芪五钱,桂枝三钱,白芍三钱,生姜三钱,苍术三钱,茯苓三钱,防己三钱,大枣四枚。

The first visit: Oct. 31, 1965. The patient had pain in the right arms and legs, and numb in hands for three months. On August 1, this year, he fell down, which resulted in hard to move of arms and legs. After ten days, his right shoulder and right legs could move, but the hands felt numb and felt difficult to hold stuff. He had sweat and disliked wind. The tongue cover was white. The pulse was string and thin. This was diagnosed as Blood Bi syndrome, which belongs to Taiyang phase of body surface weakness condition, and which is the indication for prescription Huangqi Guizhi Wu Wo Tang plus Ling Zhu Fangji: Huangqi 15 grams, Guizhi 9 grams, Baishao 9 grams, fresh ginger 9 grams, Cangzhu 9 grams, Fuling 9 grams, Fangji 9 grams, and Chinese date 4.

结果:116日复诊,上药服六剂,汗出减少,右上肢疼减,两手麻木皆减轻,但仍握拳不紧,右臂时感刺痛。仍继服上方增生黄_为八钱。1120日三诊,汗出已很少。两手麻木明显减轻,左手已能正常握拳,右手仍不能紧握,右臂外侧刺痛减,仍继服上方12剂,诸症已。

Following up: on Nov. 6, after the above herbal therapy for six days, the sweat reduced, the pain in right arms subsided down, the numb in the hands reduced but still hard to hold, and the right arm felt pounch pain from time to time.  The above herbal prescription was continued with addition of more Huangqi up to 24 grams. On November 20, the sweat was very little, and the numb in the hands subsided dramatically. The left hand could hold stuff, though the right one still felt hard to hold. The pounching pain in the outside of the right arm reduced. The above prescription was continued for additional 12 days. Everything turned normal.

5. 蒋某,女,23岁,病案号20501

Case 5. Jiang XX, female. 23 years of old. File number: 20501.

初诊日期196031日:右上下肢疼痛、麻木肿胀月余,伴头晕头痛(多在左侧),心悸气冲,手足聂聂动,发则眩冒不能行,大便干,口干思饮,食则腹胀痛,脐上下左右均按痛,舌苔白润,脉沉迟而弦。此病为寒湿偏注,证属太阳少阴合病,为桂枝加苓术附大黄汤方证。

The first visit: March 01, 1960. The patient felt pain and number in the right arm and leg for about one month. She had also headache (most time on the left side), palpitation with kind of air rushing-up feeling, slight or mild shaking in hands and feet, which, when was severe, she could not walk due to dizziness. She had constipation, thirsty and want to drink. If eat, she felt bloating on belly. She felt pain when pressing the above or beneath the naval. The tongue cover was white and wet. The pulse was deep, slow and string. This condition was the flowing of Cold-Wetness in one side of the body, which belongs to Taiyang-Shaoyin phase. It is the indication for Guizhi Tang plus Ling Zhu Fu Dahuang:   

桂枝三钱,白芍三钱,生姜三钱,苍术四钱,川附子四 钱,大枣四枚,茯苓四钱,炙甘草二钱,大黄二钱。

Guizhi 9 grams, Baishao 9 grams, fresh ginger 9 grams, Cangzhu 12 grams, Chuan Fuzi 12 grams, Chinese date 4, Fuling 12 grams, Zhi Gancao 6 grams, Dahuang 6 grams.

结果:上药服六剂,腿肿痛减,大便如常,但头痛未已。上方去大黄,加吴茱萸三钱,服七荆,317日复诊时症状已不明显。

Results: After the the herbal therapy above for six days, the swelling and pain in the leg subsided. The bowel movement turned normal. The headache remained. To the above prescription, removed the Dahuang, and added Wuzhuyu 9 grams. After the use of the new prescription for seven days, and when followed up on March 17, the symptoms all stopped.

6. 吴某,女,58岁,病案号157498

Case 6. Wu XX, female. 58 years of old. File number: 157498.

初诊日期1965428日:腰髋肩背酸痛两年多,常有胸闷、心悸、自汗、盗汗、眠差易醒、头晕、膝酸乏力,舌苔白,舌质暗,脉沉弦细。此病为血虚水盛,为太阳少阳合病,证属柴胡桂枝干姜汤合当归芍药散方证:柴胡三钱,桂枝三钱,白芍三钱,茯苓四钱,黄芩三钱,花粉四钱,生牡蛎五钱,干姜二钱,当归三钱,川芎二钱,苍术四钱,泽泻五钱,炙甘草二钱。

The first visit: April 28, 1965. The patient had sour and pain on the lower back and shoulder for more than two years. She felt choking sensation in chest, palpitation, sweat at day and night, poor sleep and easy to wake up, dizziness, and sour and weak in the knee. The tongue was dark in color. The tongue cover was white. The pulse was deep, string and thin. This condition belongs to blood deficiency and water overwhelming, which belongs to Taiyang-Shaoyin phase. It is the indication of Chaihu Guizhi Ganjiang Tang plus Danggui Shaoyao San: Chaihu 9 grams, Guizhi 9 grams, Baishao 9 grams, Fuling 12 grams, Huangqin 9 grams, Tianhuanfeng 12 grams, Muli 15 grams, Ganjiang 6 grams, Danggui 9 grams, Chuan Xiong 6 grams, Cangzhu 12 grams, Zexie 15 grams, Zhi Gancao 6 grams.

结果:上药服六剂,胸闷心悸、乏力好转,上方加酸枣仁五钱,防己五钱,继服六剂,自汗盗汗睡眠好转。继续加减服用一月余,诸症已。

Results: after the herbal therapy above for six days, the choking sensation in chest and the palpitation, and fatigue were much better. To the above prescription, added Suanzaoren 15 grams, Fangji 15 grams. It was continued for six days. Then, the sweat during day time and at night, and sleep were much improved.

按:从治验案例可看出,胡老治疗痹证有三大特点:

Comments: from the case reports, it can be seen that there are three major characteristics in Dr. Hu’s treatment of Bi syndrome:

第一,注重了辨六经方证,即急性风湿性关节痛,常呈现表实热证,即太阳病,治疗多用葛根加术汤、麻黄加术汤、麻杏慧甘汤(如例2)、桂枝加黄芪汤(如例4)等。而慢性关节痛,常呈现表虚寒证,治疗多用桂枝加苓术附汤(如例5)、葛根加苓术附汤(如例1)、桂枝芍药知母汤(如例3)、桂枝加附子汤、小续命汤、麻黄附子细辛汤、麻黄附子甘草汤等。

First, He paid much attention to the six Jing diagnosis and the related herb indication diagnosis. For acute rheumatic arthritis, it usually shows as body surface overwhelming Hotness condition, e.g. the Taiyang phase disease. He often uses Gege Tang plus Zhu, Mahuang plus Zhu Tang, Ma Xing Yi Gan Tang (such as case 2), Guizhi plus Huangqi Tang (such as in case 4). For chronic joint pain, it usually shows as body surface weakness and Cold condition. In the treatment, the often used herbs are Guizhi plus Ling Zhu Fu (case 5), Gegen plus Ling Zhu Fu (case 1), Guizhi Shaoyao Zhimu Tang (case 3), Guizhi plus Fuzi Tang, Xiao Xu Ming Tang, Mahuang Fuzi Xixing Tang, Mahuang Fuzi Gancao Tang, etc.

由此也可看出,古人通过治疗痹痛,总结治疗规律,把表实热证称为太阳病,把表虚寒证称为少阴病,继之把里证和半表半里也分阴阳两类,这便是六经的由来。

From this, it can be seen that, the doctors in old time summarized the rule in the treatment of joint and muscle pain, through clinic experience, that body surface overwhelming hotness condition being called Taiyang phase, and that body surface weakness cold condition being called Shaoyin phase. Further more the diseases that located in the inside and in between the inside and the body surface, were also separated into the Yin and Yang, the two major categories. This is how the six meridians comes.  

第二,注重养血利水,例6也是常见的痹证,既见于风寒湿痹,也见于血痹。当血虚时水当相对盛,痹痛久不去主因血虚,故养血同时利水是治疗痹证的重要方法之一。胡老常用当归芍药散加于各适应方药中,当有热时加生地黄养血凉血。

Second, he pays much attention to nourish the blood and to deplete the water. The case 6 is also a common example that can be seen in clinic. The patient had the Bi syndrome of Wind, Cold and Wetness, but also in Blood (Blood Bi syndrome). When the blood is in deficient, the water in the  body is relatively overwhelming. The reason that the Bi syndrome lasts long time without improvement is due to the blood deficiency. Therefore, it is one of the important therapies in the treatment of Bi syndrome to nourish the blood and at the same time to deplete water. Dr. Hu usually uses Danggui Shaoyao San in various prescriptions. When there is hotness, he adds herb Shengdi to the prescription to nourish the blood and to cold down the blood.

第三,对于痹证出现的一侧痛疼,常加入小量大黄,起活血通络作用,临床确有实效。

Third, if there is pain in lateral of a joint, add small amount of herb Dahuang to active blood circulation and to dredge the meridian. It in deed works.

 

6. 治疗咳嗽的经验

6. The treatment of cough

咳嗽主因痰饮    治当温化降逆

The main reason for cough is phlegm and condensed water. For the treatment, the therapy used should be to warming up the condensed water and to suppress the reversed Qi.  

治咳嗽的方药很多,可以说成千上万,但胡老最常用的方药是半夏厚朴汤,问其由,主要是:咳嗽在《金匮要略》中与痰饮列为一专篇论述,是说痰饮与咳嗽有密切关系,许多咳嗽是因痰饮上犯、气逆不降而致。对痰饮的治疗,《金匮要略痰饮咳嗽病》篇提出"病痰饮者,当以温药和之",是治疗痰饮的重要原则,也是治疗咳嗽的重要原则。在这一原则指导下,如再选择适当的方药,临证多有捷效。如病例。

There are many herb prescriptions to treat cough. It can count to thousands in number. However, the mostly used prescription by Dr. Hu is the Banxia Houpu Tang. When asked him why, the answer is: the cough is listed and discussed in the chapter of the phlegm and condensed water (e.g. the Yin). It means that the phlegm and the condensed water are closely associated to the cough. Many times, the cough is due to the rushing up of the phlegm and the condensed water, that makes the lung Qi (Lung energy) floats in the upper part of the body without descending down (normally it should descend down the body). For the treatment of cough, it is proposed in the book <<Jing Kui Yao Luo : Tang Yin Ke Su Bing>> that, “for the phlegm and condensed water, it should be used the warming herbs”. This is the most important therapeutic principle for the treatment of the phlegm and the condensed water, as well as that of the cough. Following this principle to choose herbs often works in clinic, as the following case examples:

1. 黄某,女,38岁,病案号67951

Case 1. Huang XX, female. 38 years of old. File number: 67951.

初诊日期1966212日:一周来咳嗽,吐白痰,咽痒胸闷,口干不欲饮,两胁胀,已服汤药数剂而不效,苔白厚腻,脉滑细。此证属痰饮上犯,肺失宣降,治以温化降逆,与半夏厚朴汤加减:半夏四钱,厚朴三钱,茯苓四钱,苏子三钱,橘皮五钱,杏仁三钱,桔梗三钱,生姜三钱。

The first visit: February 12, 1966. The patient had cough for one week. She spit white phlegm, felt itch in throat and choke sensation in chest, dry mouth but no desire to drink water. She felt bloating in the upper side of the belly. She was given several days of herbal therapy in vain. Her tongue cover was thick, white, and greasy. The pulse was slippery and thin. Her condition belongs to the upper-rushing of phlegm and condensed water, that makes the lung Qi failing to expand or to descend. She was given Banxia Houpu Tang with some modifications: Banxia 12 grams, Houpo 9 grams, Fuling 12 grams, Suzi 9 grams, Jupi 15 grams, Xingren 9 grams, Jiegen 9 grams and fresh ginger 9 grams.

结果:上药服二剂,咳即止。

Results: after the above herbal therapy for two days, the cough stopped.

半夏厚朴汤原是《金匮要略妇人杂病》治疗"妇人咽中如有炙脔"症,胡老认为,本方是小半夏加茯苓汤更加厚朴、苏叶而成。用于痰饮气结所致的胸满、咽堵、咳逆,为温化痰饮、降逆理气之方。此患者是痰饮引起的咳嗽,故服之方药对证,很快见效。方中苏叶,胡老常用苏子。如表证明显者,可同时加苏叶,或据证合用桂枝汤或麻黄汤;如热象明显者,可加生石膏;如久咳寒饮明显,而表证不明显者,可用苓甘五味姜辛夏汤。

The prescription Banxia Houpu Tang is originally introduced in book <<Jing Kui Yao Luo: Female disease>> for the treatment of burning and choking sensation in throat of female. Dr. Hu believed that, this prescription is the combination of prescription Xiao Banxia Tang plus Houpu and Suzi. It is suitable for the treatment of fullness sensation in chest, choking sensation in throat, cough due to the stagnation of phlegm and condensed water. It is a prescription to warm the phlegm and the condensed water, and to suppress down the Qi. For this patient, her cough is due to the phlegm and condensed water, this prescription matches her condition, so it works very fast. In the original prescription, it uses herb Suye (the leaves of the plants). Dr. Hu changed it to Suzi (the seeds). It the body surface syndrome is more, he uses both the Suzi and Suye, or use Guizhi Tang or Mahuang Tang, according to the syndrome. If the hotness is more, add herb Shigao. If the cough lasts for a long time and the Cold condensed water is more, but the body surface symptoms are not apparent, he uses Ling Gan Wuwei Jing Xin Xia Tang.

痰饮郁久常化热    真寒假热要认清

After a long time stagnation of the phlegm and condensed water in the body, they tend to develop Fire. It should be verified clear the true Cold but false Fire condition.

临床可看到不少咳嗽患者,吃了许多药而症状不好转,甚至越来越重,其主要原因之一,是因未能辨清寒热。从治验例2可看清这一问题。

In clinic, it can be seen a lot of patients, who have taken a lot of medicine but the symptoms remain not change, even worse and worse. One of the main reasons for the vain is that the doctor failed to diagnose out the Cold or Fire condition of the body. This can be seen in case 2 bellow:

2. 李某,男,63岁,病案号156679

Case 2. Li xx, male. 63 years of old. File number 156679.

初诊日期196614日:咳嗽吐黄白痰已4个月,自去年10月患咳嗽、吐痰、咽痛,一直服汤药治疗,咳嗽不减反又加上喘。患者很细心,把服过药的处方都带来了,其主要处方是桑杏汤加减,患者自己说他吃川贝母都有一斤" 多了。刻下症状:咳嗽,吐黄自痰量多,心烦胸满,背恶寒,口干思饮,但饮水后胃脘不适,苔黄腻,舌尖红,脉弦滑细。胡老与小青龙加石膏汤:麻黄三钱,桂枝三钱,细辛二钱,干姜二钱,白芍三钱,炙甘草三钱,五味子三钱,半夏五钱,生石膏一两半。

The first visit: January 4, 1966. The patient had cough and spit white-yellow phlegm for 4 months. Since October last year, he got cough, spit phlegm and felt sour in throat. He had been given herbal therapy, but the cough did not subside but worse to have asthma. The patient was very careful and he collected all the prescription records with him. The main prescription is Sang Xing Tang. The patient said he himself ate the herb Chuan Beimu for almost more than one pound. The symptoms at the time to visit was cough, spit large amount of yellow phlegm, felt annoyed in chest and choking sensation in chest, felt cold on back. He felt thirsty and wanted to drink water, but after drinking, he could feel uneasy sensation in stomach. His tongue cover was yellow-greasy. The pulse was string, slippery and thin. Dr. Hu prescribed him the Xiao Qinglong Tang plus Shigao: Mahuang 9 grams, Guizhi 9 grams, Xixin 6 gram, Ganjiang 6 grams, Baishao 9 grams, Zhi Gancao 9 grams, Wuweizi 9 grams, Banxia 15 grams, Shigao 45 grams.

处方完后问胡老,患者热象明显,用这么多热药行吗?胡老说:"患者吃了那么多清热药而症状越来越重,已说明药不对证。再看他现在的症状,有背恶寒、饮水后胃脘不适,为内有停饮之征。本有寒饮内停,治用苦寒清热化痰,痰不但不去,反因人体阳气大伤而痰饮加重。痰饮重,停滞日久,郁久化热,上犯于心胸,故出现心烦胸满。故不去痰饮,则热不去,则咳无宁日。因证属外寒内饮兼有上热,为小青龙加石膏汤方证。用小青龙汤解表祛饮以治其本,用生石膏清上热以除其标,能否见效,还要看其服药后的反应"

After prescription, Dr. Hu was asked, the patient has evidence of a strong fire, how can we use so many Hot herbs? Dr. Hu said, the patient had tried so many Hotness-clearing herbs but the symptoms were worse, indicating that the herbs do not match his condition. Look at his current symptoms: cold sensation on the back, uneasy feeling in stomach after drinking water, both indicating the presence of water stocking in the body. Originally there is Cold in the body. The use of Fire-clearing herbs to clear the Fire and to clear the phlegm, not only the phlegm would not be depleted, but also the body Yang Qi is hurt to make the phlegm condition worse. The phlegm accumulated for a long time, resulting in the development of a Fire in the body. The Fire attacks the heart to cause annoyed feeling and choking sensation in the chest. For this reason, if the phlegm is not depleted, the Fire would be depleted either, so that the cough would be there for ever. Since the clinic condition belongs to the external Cold with condensed water inside, plus Fire inside, it is the indication to Xiao Qinglong Tang plus Shigao. The Xiao Qinglong Tang is used to release the body surface syndrome, to deplete condensed water, so as to solve the cause of the disease. The Shigao is used to clear Fire, so as to reduce the symptom. However, whether the prescription works or not, we have to wait and see.

结果:上药服三剂,心烦胸满减,咯黄痰减少,干减。舌苔白微腻,增细辛、干姜为三钱,减生石膏为一两,继服六剂,背恶寒已,吐痰减少,已不见黄痰,去生石膏,继服12剂症已。

Results: After the herbal therapy for three days, the annoyed feeling and choking sensation in chest subsided. The yellow phlegm reduced. The dry mouth reduced. The tongue cover was white and slight greasy. To the above prescription, added were herb Xixin 9 grams, Ganjiang 9 grams and reduced Shigao to 30 grams. This prescription was followed by six days. The cold feeling on back stopped. The phlegm reduced, without yellow phlegm. The Shigao was depleted from the prescription and the revised prescription was followed for 12 days.

 

外寒内饮常同犯   解表祛饮必并行

The external Cold and the inside condensed water often exist the same time. The surface-releasing and Water-depleting therapy should be used the same time too. 

一位慢性咳嗽病人,胡老开了小青龙汤加茯苓,一位进修医生问:"此病人是属外感咳嗽还是属内伤咳嗽?"胡老只是说:"这病人咳嗽属外寒内饮,为小青龙汤加茯苓方证。"处方完毕,结合本例的治疗,阐述了外寒内饮咳嗽的证治。指出了张景岳把咳嗽分为外感和内伤两类,这是从理论上分类,实际在临床上往往同时并存,内伤易招外感,外感也易导致内伤。因此,临床无必要究其是外感和内伤,只要看其具体症状辨证论治即可。把咳嗽分为外感和内伤两大类,对一些没有临床经验和初学者来说,这一分类当然便于记忆,但临床应用往往遇到一些问题,如一见咳嗽病人就截然分为外感或内伤,治疗也但分宣解或补益,往往忽略两者兼证的治疗。造成病情迁延不愈。如病例3就说明了这一问题。

To a patient with chronic cough, Dr. Hu prescribed Xiao Qinglong Tang plus Fuling. A doctor of career-refresh asked: “This patient had external cough or an inner cough?” Dr. Hu said: “His cough belongs to external Cold with condensed water inside, which is the indication for Xiao Qinglong Tang plus Fuling.” After prescription, he explained, taking example of that case, the diagnosis and treatment of such kind of cough. He said that, Dr. Zhang Jingyue separated the cough into external cough and internal cough. This is a category in theory. In practice and in clinic, both can exist the same time. The inner weakness could attract the external attack, and the external attack tends to cause inner weakness too. Therefore in clinic, no need to separate the cough as external or internal cause. It is enough to pay attention to the current symptoms, and to make proper diagnosis of the current condition. To separate the cough as such might be better for students to remember, but in clinic it meets problem to practice according that separation. If we tend to separate the cough into the external and internal cough, and for the treatment we separate the therapy into the dispersing or nourishing, we often tend to omit the treatment of their co-exist conditions, so as to cause the disease lasts for long time without cure. The case 3 following can tell this true.

3. 夏某,女,32岁,病案号106421

Case 3. Xia XX, female, 32 years of old. File number 106421.

初诊日期196617日:近3年来每年冬春犯咳嗽。本次咳嗽已发作两月。前医曾与三拗汤、杏苏散加减无效, 后又以止嗽散加减二十余剂亦无效,再以二陈汤合三子养亲汤加减效也不明显。近来症状:咳嗽,吐稀白痰量多,背恶寒,四肢凉,口干不思饮,胸闷,胃脘痞满,纳差,便溏,苔白滑,舌质暗,脉沉弦细。胡老处方:麻黄三钱,桂枝三钱,白芍三钱,细辛三钱,干姜三钱,炙甘草三钱,五味子四钱,半夏五钱,茯苓四钱。

The first visit: January 7, 1966. The patient had cough every winter and spring for the past three years. This time, the cough has lasted for two months. Previous doctor gave her herbs San Ao Tang, Xing Su San with modification. Later she was given Zi Su San with modification for 20 days in vain. Then she was given Er Chen Tang plus San Zi Yang Qing Tang without improvement either. The current symptoms were: cough, spit large amount of thin, white phlegm, chilly sensation on back, cold arms and legs, dry mouth without desire to drink water, chock feeling in chest, fullness feeling in stomach, poor appetite, and loose stool. The tongue was dark in color. The tongue cover was white and greasy.  The pulse was deep, string and thin. Dr. Hu prescribed: Mahuang 9 grams, Guizhi 9 grams, Baishao 9 grams, Xixin 9 grams, dried ginger 9 grams, Zhi Gancao 9 grams, Wuweizi 12 grams, Banxia 15 grams, Fuling 12 grams.

结果:上药服三剂,胸闷、吐痰减少,继服六剂,咳嗽明显减轻,再继服两周咳平,他症也随消。

Results: aftet the herbal therapy above for three days, the choking feeling in the chest reduced, and the phlegm reduced too. After continuous treatment for six days, the cough subsided dramatically. After following two weeks of the same herbs, the cough stopped, as well as any other symptoms.

治疗结束时,胡老又强调了一下外寒内饮的治疗原则。这一原则在讲解桂枝去芍药加茯苓白术汤、小青龙汤等方证时已反复强调,即本例也是这样:表有寒邪,里有水饮,水饮停于里,则里有所阻,表亦不透,故不兼利其水则表必不解,若强发其汗,强宣其表,激动里饮,变证百出;若单利其水,则引邪人里,等于闭门揖寇,引狼人室。此时惟有于解表方中,兼用利水逐饮药,始收里和表解之效。本治疗方中用麻黄、桂枝、白芍、甘草发汗以驱外邪,半夏、干姜、五味子、茯苓逐寒以祛里饮,故表解里饮去,则咳自止。

After clinic work, Dr. Hu emphasized the therapeutical principle in the treatment of external Cold but internal condensed water. This principle has been well emphasized when discussing the Guizhi without Shaoyao but plus Fuling Baizhu Tang, and Xiao Qinglong Tang. This is true in this case: when there is external Cold attack but there is also a condensed water inside, it would be that, the accumulated water inside would prevent the release of external Cold from the body surface. For this reason, without the depletion of the inside water, the body surface symptoms would not be solved. If the sweat therapy is vexedly used to release the external Cold in the body surface layer, it would stir up the inside water so to create lots of unexpected side effects. If only used the water-depleting therapy to deplete the inside condensed water, the external Cold would further more invade into the deep portion of the body. This makes as to open the door to welcome robber. The correct way to solve this complex problem is to add water-depleting herbs into the body surface-releasing therapy prescription. In the prescription in this case, the herb Mahuang, Guizhi, Baishao, Gancao work to create sweat so to dispel the external Xie Qi (Cold Xie Qi), while use Banxia, Ganjiang, Wuweizi and Fuling to deplete inside water, so as to eventually stop the cough.

干咳未必是无痰 化痰降气咳方止

Dry cough does not necessarily mean no phlegm. Only with depletion of phlegm, the cough would be stopped.

临床常常见到一些干咳患者,胡老却与化痰降逆药,如半夏厚朴汤、苓甘五味姜辛夏杏汤等,咳很快即止,因怪而问之:"干咳多是阴虚或火旺,治疗应滋阴或清热降火,为何反而治之?"胡老解释道:"此是正治不是反治。"并从临床观察讲述了其治疗经验:有不少干咳患者,一直服药,咳嗽却经月不解,略观其案,辨证谓肺火或肝火或阴虚,治用黄芩、山栀、生地、知母、贝母......却久治无效,原因何在? 其实道理也很简单,中医辨证论治是辨全身,并不是依据一个症状。痰饮上犯致咳,是咳喘的主要原因之一,所咯出之痰是辨证依据之一,但不是唯一症状。中医所述痰饮概念很广,无痰无咳者为数很多,有咳无痰者为数也不少,主要看整体辨证,从以下病例可看清楚。

In clinic, it is quite common to see some patient with dry cough (no phlegm cough), to whom Dr. Hu still gave phlegm-dissolving and reversed-Qi-descending herbal therapy, such as prescription of Banxia Houpu Tang, Ling Gan Wuwei Jiang Xin Xia Xing Tang, etc. The cough could stop pretty soon. For feeling strange, we asked him: “The dry cough usually belongs to the Yin deficiency or false Fire overwhelming. For the treatment, it should used the Yin-nourishing or Fire-clearing therapy. Why you use an opposite therapy?”  Dr. Hu explained: “This is a supposed therapy, not strange therapy.” He told his experience in clinic: there are some patients with dry cough, who continued to take herbs for months and months without any improvement for the cough. If we have a look at how they were treated, it would be found that their conditions were diagnosed as Lung Fire, or Liver Fire, or Yin deficiency. They were given herbs, such as Huangqin, Shanzhi, Shengdi, Zhimu, Baimu… for long time in vain. Why it happens as this? The reason is simple. The Chinese medicine diagnosis is a whole body diagnosis system, not basing on only a single symptom. The reverse invasion of phlegm to the lung is one of the major reasons for cough. The phlegm that is spit out is one of the parameter to set up a diagnosis, but not the only parameter. The concept of phlegm in Chinese medicine is very broad. There are many cases without cough or without phlegm, but their condition belongs to the phlegm. There are also many cases with cough but without phlegm, which also belongs to the phlegm that causes the cough. The diagnosis bases on the whole body condition. This can be tested in the following case reports.  

4.  黄某,女,38岁,病案号67951

Case 4. Huang XX, female, 38 year of old. File number: 67951.

初诊日期1966212日:干咳咽痒一月多。始服止嗽散加减,后服桑杏汤、麦门冬汤等加减,咳不但不减反而愈来愈重。近干咳,咽痒,口干,不思饮,嗳气,胸闷,大便溏稀日12行,舌苔白厚腻,脉滑细。与苓甘五味姜辛夏汤加减:茯苓四钱,细辛二钱,五味子四钱,半夏五钱,炙甘草二钱,陈皮五钱,生姜三钱,杏仁三钱,苦桔梗三钱,炙枇杷叶三钱。

The first visit: February 12, 1966. The person had dry cough and itch in troat for more than one month. From beginning, she tried prescription Zhi Su San, later the Sang Xing Tang, or Maimendong Tang with some modifications. The cough did not stop but became worse. Lately, the cough was without phlegm. She felt itch in troat, dry mouth, no desire to drink, belching, choking sensation in chest. The bowel movement was one to two times a day. The tongue cover was thick, white and greasy. The pulse was slippery and thin. She was given Ling Gan Wuwei Jiang Xin Xia Tang with some modification: Fuling 12 grams, Xixin 6 grams, Wuweizi 12 grams, Banxia 15 grams, Zhi Gancao 6 grams, Chenpi 15 grams, fresh ginger 9 grams, Xingren 9 grams, bitter Jiegen 9 grams, and Zhi Bipaye 9 grams.

结果:上药服一剂咳减,三剂咳即止。

Results: after taking the herbal tea for one day, the cough reduced. After three days, the cough stopped.

此患者干咳、咽痒、口干,这些症状常见于肺热、肝火或阴虚。但本患者有不思饮、嗳气、胸闷、大便溏稀、苔白厚腻、脉滑等,皆是痰饮之症。干咳主因乃是痰饮犯肺,肺失宣降。而口干、咽痒,是痰饮阻滞津液不能上承所致,因此,治疗这种干咳,用苦寒清热、甘寒滋阴皆是在加重痰饮阻滞,也即在加重痰饮上犯,故越治越重,迁延不愈。而按痰饮治疗,因方药对证,三剂即愈。

This patient had dry cough, itch in throat and dry mouth. These symptoms are commonly seen in Lung Fire, Liver Fire, or Yin deficiency condition. However she had also no desire to drink, belching, choking sensation in chest, loose stool, thick and greasy tongue cover, slippery pulse, etc. all of which are sings of phlegm in the body. The dry cough is due to the phlegm hotness attacks the lung, which makes the lung lose if descending function. The dry mouth, and the itch throat are due to the phlegm that blocks body liquid to wet the mouth and throat. For this reason, if the bitter cold herbs are used to clear the Fire, and the sweet cold herbs are used to nourish the Yin liquid, such therapies would enhance the phlegm and its attach to the lung and block of liquid up to the mouth and throats, so as to make the things worse and worse with continuous treatment. When treat such condition according to the accumulation of phlegm in the body, the herbs match the body condition, so three days treatment are sufficient to solve the dry cough. 

宣肺化痰皆无效   和解少阳建奇勋

When lung-expanding and phlegm-dissolving therapy do not work, to harmonize Shaoyang might work.

咳嗽多因痰饮上犯,肺失宣降,因此治疗宣肺化痰是其大法。但依法治疗,有时疗效难尽人意,分析其原因,主要是辨证不确切,方药不对证。有一些咳嗽患者,病邪既不在表也不在里,而是在半表半里,这种咳嗽如用宣肺化痰、解表化饮法治疗,当然不能见效,而应用和解少阳的方法,却能很快治愈。此在《伤寒论》已有明确记载,如第96条:"伤寒五六日中风,往来寒热,胸胁苦满,嘿嘿不欲饮食,心烦喜呕,或胸中烦而不呕,或渴,或腹中痛,或胁下痞硬,或心下悸小便不利,或不渴,身有微热,或咳者,小柴胡汤主之"。或咳者,是说许多出现小柴胡汤证者,不一定有咳嗽症,但具有典型的小柴胡汤证兼有咳嗽时,这种咳嗽则适用小柴胡汤治疗。因此,胡老常用本方治疗咳嗽。

The cough is usually due to the up attack by phlegm, which makes the lung fail to expand and to descend. The lung-expanding and phlegm-dissolving therapy therefore should be the main principle in the treatment of the cough. However in clinic, such therapy may not work as good as it is expected. On analyzing the reason, the problem is the incorrect diagnosis and the improper use of the herbs in the treatment. For some patients, their disease located no in the body surface or deep inside, but in between the surface and the inside. For such cough, it should be used the Shaoyang harmonizing therapy, which works very fast. This idea has been indicated in the book <<Shang Han Lun>>…. It means that, many patients, when are in the Shaoyang phase, may not have cough. But if there is cough and there is typical Shaoyang phase, treat the cough using Xiao Chaihu Tang. For this reason, Dr. Hu uses Xiao Chaihu Tang to solve cough in Shaoyang phase. 

5.  何某,女,34岁,病案号493816

Case 5. He XX, female, 34 years of old. File number: 493816.

初诊期1965312日:咳嗽断续2年。2年前感冒后患咳,四季皆作,冬重夏轻,咳嗽为阵发性,且以上午10点、午后34点、晚上8点为著,上月曾在某中医院服中药30余剂(多为宣肺化痰,如杏仁、桔梗、清半夏、瓜蒌、枇杷叶、前胡等)皆未见效。近咯吐白泡沫痰,恶心。咽干,无汗,两胁胀满,舌质红,苔薄白,脉弦滑。既往史:62年患肺结核。胡老与小柴胡汤加减:柴胡三钱,党参三钱,半夏三钱,黄芩三钱,大枣四枚,炙甘草二钱,生姜三钱,桔梗二钱,白芍二钱。

The first visit: March 12, 1965. The patient had cough for two years, which comes and goes. Two years ago, after a common cold, she got cough, which came and went all the seasons, but worse in winter and less in summer. The cough is a paroxymal manner, which were more at 10 am, 3 pm to 4 pm, and 8 pm of the day. Last month, she tried some herbs from another hospital (mostly the herb Xingren, Jigen, Banxia, Guolu, Pibaye, and Qianhu, etc.) in vain. Later, she spit white phlegm with air bubbles. She felt nausea, dry mouth, no sweat, fullness sensation in chest and in upper sides of the belly. The tongue cover was red, and the tongue cover was thin and white. The pulse was string and slippery. The past history of the patient: she had lung tuberculosis three years ago. Dr. Hu prescribed her Xiao Chaihu Tang with some modifications: Chaihu 9 grams, Dangshen 9 grams, Banxia 9 grams, Huangqin 9 grams, Chinese date 4, zhi Gancao 6 grams, fresh ginger 9 grams, Jiegen 6 grams, and Baishao 6 grams.  

结果:上药服六剂,咳减。上方去白芍,加枳实二钱、生龙牡各四钱,服六剂后两胁胀满已。继服半夏厚朴汤加减十 余剂,咳平。

Results: After the herbal therapy above for six days, the cough reduced. From the prescription, herb Baishao was deleted, added were Zhishi 6 grams, Longgu 12 grams, and Muli 12 grams. After additional six days, the fullness feeling in the chest and in the upper side of belly stopped.

本例特点:咳定时作、两胁胀满、恶心、咽干,少阳证具,说明此咳嗽之邪不在表,也不在里,而是在半表半里。也说明长期咳嗽,胃气及卫气虚,只用宣肺化痰药不能有效驱除外邪,此时必用党参、半夏、生姜、大枣、甘草以补中强卫,才能驱邪于外,邪去则咳自止。

The characteristics of this case: The cough comes on a pretty fixed time. There is bloating feeling on the upper side of the belly, nausea, dry throat, all of which indicates the presence of Shaoyang phase. It means that the Xie Qi that causes the cough is not in the body surface, the Taiyang phase, but in the in-between, e.g. the Shaoyang phase. It also means that, after a long term of cough, the Stomach Qi and the defense Qi both are in deficiency condition. The therapy only with lung-expanding and phlegm-dissolving is not enough to dispel the Xie Qi. At this movement, without the use herb Dangshen, Banxia, fresh ginger, Chinese date and Gancao to nourish the middle Qi and to enhance the defense Qi, the Xie Qi could not be dispelled off the body, so as to stop the cough.

按:以上所述,是以五个病例、五个方证介绍了胡老治疗咳嗽的主要经验。胡老是辨方证的,用于治疗咳嗽的方法是很多的,如桂枝加厚朴杏仁汤、麻杏石甘汤、桑菊饮、麻杏薏甘汤、泻心汤、麦门冬汤、苓甘五味姜辛夏杏大黄汤等,即遇到什么方证时,就用什么方药治疗,不局于一方一法,这里不再一一例举。

Comments: the disscution above are to introduce Dr. Hu’s clinic experience in the treatment of cough, based on the five case reports and five herbal prescriptions. Dr. Hu makes herbal indication diagnosis. There are many herbal prescriptions that are used for the treatment of cough, such as Guizhi plus Houpu Xingren Tang, Ma Xing Shi Gan Tang, Sang Ju Yin, Ma Xing Yi Gan Tang, Xie Xing Tang, Maimendong Tang, Ling Gan Wuwei Jiang Xin Xia Xing Dahuang Tang, etc. Whichever there is the herbal indication in the patient, whichever herbal prescription should be used.  It does not mean that only one herb prescription that can be used for the cough treatment.

 

7.  黄汗刍议

7. Preliminary discussion about the treatment of yellow sweat

黄汗本为水湿病   表虚湿郁津却虚

The yellow sweat belongs to the water-wetness disease. It is a condition in which the body surface is weak, the wetness is stagnated in the body surface but the liquid portion inside the body is deficient. 

黄汗是以汗出色黄而命名,首见于《金匮要略水气病》篇,是水气病证中的一种。原文论述计有五条,对黄汗的病因、病理、辨证治则作了概要说明。此证现代临床虽然少见。但仍有探讨的必要。原文第1条口:"病有风水,有皮水,有正水,有石水,有黄汗。"说明黄汗是水气病的一种,其病因是水湿之邪。水湿是怎样形成黄汗的呢?28条:"......汗出入水中浴,水从汗孔入得之。"说明了汗出表虚,而水湿之邪得以入侵,踞之不去发为黄汗。不过黄汗之病因并不仅由此,相反非汗出入水中浴而患黄汗者更多,此句不过是举隅之论,不能做为定律。如从本病的临床表现和用方选药的特点来分析,则更能深刻揭示其病因病理。原文第29条:"黄汗,其脉沉迟......桂枝加黄_汤主之"。脉沉迟说明正气不足,里有寒饮。桂枝加黄_汤主治表虚,因此,黄汗为正气不足的表虚证。原文第10条又说:"脉得诸。当责有水",说明脉沉主水湿,而水湿又可致发黄汗、风水、历节、痛、痰饮、咳喘等多种病证,所以形成黄汗,是有其特定的条件,这便是表虚湿侵盘踞于肌肤。湿性粘腻,久而不去,郁蒸为黄汗;若湿性就下,浸淫关节,则见"腰髋弛痛"、关节肿痛;外因表虚,则见"两胫自冷";湿��上冲,则见"胸中痛""胸中窒""不能食""暮躁不得眠""从腰以上,必汗出";黄汗表虚、汗出津伤,则见"汗出而渴";汗出表更虚,湿更乘虚而人,致使精虚邪胜,因见"汗出已,反发热",波及营血,日久则血枯液燥,因见"久久身必甲错""发热不止者,必生恶疮"。总之,黄汗是正气不足于表、水气郁蒸所致。

The yellow sweat condition is named by its yellow color in the sweat. It is one kind of the water-wetness diseases. According to the book <<Jing Kui Yao Luo>>, it is due to the person dive into the water when the person has sweat, so the water comes into the body through the sweat holes on the skin. It can also happen when the person does not have sweat. … All in all, the reason for the yellow sweat is due to the body surface weakness, the water accumulated and choked in the body surface.

治分正治和变治   知与胆汁无关系

关于黄汗的辨证要点,原文叙述较详,如第29条:"黄汗之病,两胫自冷;假令发热,此属历节"。又曰:"黄汗之为病,身体肿,发热,汗出而渴,状如风水,汗沾衣,色正黄如柏汁。"这说明黄汗与历节、风水相似,但历节两胫发热,风水无汗出、色黄,这也就阐明了三种水气病的辨证要点,在论治上也应有区别。如前所还,黄汗的病因病理,是表虚湿邪盘踞于肌肤,故其治则应是固表祛湿。其治疗特点更反映在所应用方剂的方证关系上,如桂枝加黄_汤证见:"两胫自冷......汗出......发热......腰髋弛痛......身痛重,烦躁,小便不利。"_芍药桂枝苦酒汤证见: "身体肿,发热汗出而渴,"可见两方证是以黄汗出、发热、身肿或痛三大证候为主。因表阳气虚,里寒湿盛,故不见口渴。其正治之法,应是调和营卫、益气固表,为桂枝加黄_汤的适应证。以桂枝汤调和营卫,复加黄_益气扶正固表,使正气足于内,气行则水行,则漫自去。卫气固于表,表固汗止则湿邪不复人,因而使黄汗之证得以全解。但黄汗久不解,汗、热伤津,津液大伤,故出现"汗出而渴"的见症。其治疗不但要益气固表,又必用苦酸敛汗救液之品,为黄_芍药桂枝苦酒汤的适应证,此即黄汗的变证和变治之方法。当然变证还有很多,并非只黄_芍药桂枝苦酒汤一方所能通治,应据证辨证施治。

有关黄汗的成因已如上述,即正气不足于表,水湿郁蒸所致。但以西医的诊断和病因病理来理解,尚不能得到明确答案。如人们首先所想到:黄汗的主要症状是"汗沾衣,色正黄如柏汁",这是胆汁溢于皮肤吧?  但从临床观察,与胆汁并无关系,胡老通过多年观察也是如此,其治验病例可供参考。

例韩某,女,41岁,哈尔滨人。

以肝硬变来门诊求治。其爱人是西医,检查详尽,诊断肝硬变已确信无疑。其人面色黧黑,胸胁串痛,肝脾肿大,腰髋痛重,行动困难,必有人扶持,苔白腻,脉沉细,黄疸指数、胆红质检查皆无异常,皮肤、巩膜无黄染。曾在当地多年服中西药不效特来京求治。初因未注意黄汗,数与舒肝和血药不效,后见其衣领黄染,细问乃知其患病以来即不断汗出恶风,内衣每日重换,每日黄染,遂以调和营卫,益气固表以止汗祛黄为法,与桂枝加黄_汤治之:桂枝三钱,白芍三钱,炙甘草二钱,生姜三钱,大枣四枚,生黄_三钱。嘱其温服之,并饮热稀粥,盖被取微汗。

结果:上药服三剂,汗出身痛减,服六剂黄汗止,能自己行走,继依证治肝病乃逐渐恢复健康,返回原籍。二年后特来告之仍如常人。

按:本例是肝硬变并见黄汗之证,黄汗不去,则肝病长期治疗不效,提示了仲景学说的"先表后里"治则的正确性、重要性。也提示医者必须掌握黄汗的证治。因本患者有汗出恶风、身痛身重等,为桂枝汤的适应证,故治疗以硅枝汤调和营卫。因表虚湿踞,故加黄_益气固表,使营卫协和,正气固于皮表,汗止湿消,黄汗自除,此是黄汗的正证和正治的方法。而对黄汗的变证和变治也当熟悉。

2李某,女,30岁,本市工人。因长期低烧来门诊治疗,屡经西医检查未见何器质性病变,经服中药未效。症见口渴,出黄汗,恶风,虚极无力,下肢肿重,舌苔薄白,脉沉细,查黄疸指数正常,身体皮肤无黄染。此为黄汗表虚津伤甚者,拟黄_芍药桂枝苦酒汤:生黄_五钱,白芍三钱,桂枝三钱,米醋一两。上药服六剂,诸证尽去。

按:黄汗因表虚汗出,汗出而津伤,但因津伤不重,又兼内有寒湿,故其正证不见口渴(如例1)。若病久汗出多,津液大伤,则可见口渴。本例即属于此,故治疗重用黄_益气固表,复以桂枝、芍药调其营卫。又特用米醋敛汗救液。因方药对证,使二年不愈之证得以治愈。值得说明的是:原文有"此劳气也",有的书认为"这是虚劳病的荣气内虚"。但从本例有"虚极无力"来看,当是黄汗的见证,由此可见结合临床才能正确理解仲景原文。

几个探讨的问题

() 黄汗与风水:两者皆属水气病,皆有身肿或痛、发热、汗出。至于两者的区别,有人认为"风水恶风,而黄汗不恶风",条文中虽有"不恶风者,小便通利,上焦有寒,其口多涎,此为黄汗"的语句,但有人认为"此为黄汗"四字是多余的,因此黄汗有无恶风存有争议。但从治疗黄汗的方药桂枝加黄_汤和黄_芍药桂枝苦酒汤来分析,可知应有恶风之证。前述两则治验病例也都证明了这个问题,故黄汗与风水只是有无出黄汗之别。

() 正证与变证:辨证施治,方以对证是仲景学说的精髓。黄汗因有汗出,多有津伤,如汗出无口渴者,属桂枝加黄_汤证,此虽有津伤,但以桂枝汤健胃生津、调和营卫、驱邪外出而津自还,复以黄_扶正固表,正气充足,卫气协调,黄汗亦愈。因此我们称桂枝加黄_汤证是黄汗的正证。调和营卫,益气固表是黄汗的正治法,而桂枝加黄_汤是黄汗正治的代表方。假如汗出而口渴者,津伤较重,这时需要重用益气固表和加入酸苦收涩的药物以止汗保津液。因此称黄_芍药桂枝苦酒汤证为黄汗的变证,其治为变治之法,其方为变治之方。

() 先表后里:治验例1说明,肝病并见黄汗,黄汗病在表,肝病病在里,不治愈黄汗,只治肝病,而长期不愈。此因黄汗不已,津伤湿留,营卫不和,正气继损,故无论用其他什么方法治疗肝病,都不能发挥效应。待治愈黄汗后。再以舒肝和血等法治疗肝病而取效。这就是仲景强调的"先表后里"、先外后内的原则。

() 黄汗与胆汁:有杂志报道,因肝炎出现黄汗者,但从以上治验两则可看出,黄汗是汗出色黄而身不黄,黄疸指数、胆红质等检查皆无异常,此与黄疸病显然不同,仲景将其列于水气病篇而不列于黄疸病篇,用意尤深。但今天看来,黄汗究属何病?黄自何来?都有待进一步探讨。

 

8.  治疗口糜的经验

8. The treatment of mouth ulcer

上热下寒为病本  苦辛开降除其根

The basic cause for mouth ulcer is upper-fire and lower-cold. The bitter and spicy herbs would work to open and to bring down the fire to solve the basic cause of the mouth ulcer.

一般老百姓把口舌生疮、口腔糜烂都称谓上火,而一些医书也多认为是上热或湿热,如《素问气厥论》:"膀胱移热于小肠,鬲肠不便,上为口糜"。《医宗金鉴杂病》。《法要诀口舌证》指出:"口舌生疮糜烂,名日口糜,乃心脾二经蒸热深也"。《医方考口病方论》:"口糜本于湿热"。临床确实有为上热者,以法治之当然有效,但有不少患者为上热下寒,如囿于上热,必医有不周,使不少人含冤受苦。胡老在讲解甘草泻心汤方证时,讲述了他1952年治验病例。

Common people regard the ulcer in mouth and tongue as upper Fire condition. In some medical books, it is also believed that, it is due to the upper Fire, or Wetness-Fire in mouth. … In clinic, it is true that there are such cases, whose mouth ulcer is due to the upper Fire. It works when using proper Fire-clearing therapy. However, there are much more patients, whose condition belongs to the upper Fire but lower Cold condition. If we stick to use herbs only to solve the upper Fire, there would be failure in the treatment from time to time, making the patients suffer from longer time of the trouble. In the teaching of his clinic experience in the use of prescription Gancao Xiexing Tang, Dr. Hu told one of his case in year 1952.

患者为36岁五个孩子的妈妈,家住北铁匠营。患口舌糜烂已两月不愈,多处投医无效。视其方皆为山栀、黄芩、黄连、知母等苦寒清热泻火之品。近口舌糜烂痛剧。难以进食,甚则饮水都难。患者见人就哭,缘因饮食不足,奶水已无,难以哺乳双胞胎,孩子将饿死。时感头晕,心下痞满,腹胀,便溏,咽干不思饮,舌红绛,口腔、舌严重糜烂及乎看不到正常粘膜。脉沉细。胡老与甘草泻心汤加生石膏、生阿胶。炙甘草五钱,半夏四钱,党参三钱,黄芩三钱,干姜二钱,黄连二钱,大枣三枚,生石膏一两半,生阿胶三钱。

The patient was a mother of a five children. … She suffered from mouth ulcer for two moths. She tried various doctors with various therapies but in vain.  By look, the herbs used in previous prescriptions all were Shanzhizi, Huangqin, Huaglian and Zhimu, such bitter and Cold herbs to clear Fire. Recently, the ulcer became worse with strong pain, hard to eat, even hard to drink water. She cried the movement she saw a person. For no enough diet, the breast milk is near empty, hard to feed the twins and the twins would be die to hungry. She felt dizziness, bloating and fullness sensation in the stomach, bloating in belly, and loose stool. She felt thirsty but no desire to drink. Her tongue was red to purple. The mouth and tongue were so severely in ulcer that it was hard to see a normal mucous. The pulse was deep and thin. Dr. Hu gave her prescription Gancao Xiexing Tang puls Shigao and Ajiao: zhi Gancao 15 grams, Banxia 12 grams, Dangshen 9 grams, Huangqin 9 grams, dried ginger 6 grams, Huangliang 6 grams, Chinese date 3, Shigao 45 grams, and Ajiao 9 grams.  

结果:上药服一剂即能进食,舌痛减,服三剂痊愈。

Results: After the herbal therapy for one day, she could start to eat. The pain was reduced. After three days of the treatment, the ulcer was cured.

胡老讲道:本患者来诊时已处危急关头,如投药再错,胃气大败,则危及三条人命,若投药正确,则使患者出现生机。因此辨证用药必十分小心。

Dr. Hu said, the patient was in a critical condition when come for consultation. If the herbs were prescribed wrong, her stomach Qi would be heavily damaged, which would risk the lives of three people. If the herbs were used in correct way, there would be hope for the client to survive.

分析患者症状特点:上火是明显的,但为什么不用三黄泻心汤,而用甘草泻心汤?一是前医已数用苦寒不效;二是有头晕、心下痞满等症,为饮留邪聚,已示胃气不振,故是上热下寒之证,且示中气显虚而急迫者,恰为甘草泻心汤方证。方中以半夏、干姜驱饮和胃,以党参、大枣补中健胃除痞满,用黄芩、黄连清上热,并用大量甘草缓急安中。因其标热也重,故加人生石膏以清热,因其阴伤而虚,故加入阿胶养阴生津。因方药对证,故见效也迅速。

To analyze the characteristics of this case: The Fire condition is apparent. But, why not use prescription San Huang Xie Xing Tang, but Gancao Xiexing Tang? The reason is, the previous doctors have used such bitter-Cold herbs but in vain. Second, the patient had dizziness and fullness sensation in stomach area, which is the indication for a condensed water accumulation in the stomach, and for a weakness condition in the Stomach Qi. Therefore it is a syndrome of upper Fire but lower Cold condition with middle Qi deficiency, which is the indication of Gancao Xiexing Tang. In the prescription, the herb Banxia and dried ginger work to dissolve the condensed water and to harmonize stomach. The Dangshen and Chinese date work to nourish the middle stomach and to solve the bloating feeling. The Huangqin and Huanglian work to clear the upper Fire. The Gancao functions to release the spasm and to calm down the stomach area. Since the symptom Fire is also overwhelming, the Shigao is used to clear the Fire. Since the Yin has been damaged and exhausted into a deficient status, the Ajiao is used to nourish the Yin and to produce more liquid portion to the body. For the herbs match the body condition, so it healing effect is also very fast.

胡老常用甘草泻心汤加减治疗口糜、口腔溃疡,跟其实习和进修者也多仿用,但一位实习生开了甘草泻心汤,胡老却改为三物黄芩汤。

Dr. Hu uses the Gancao Xiexing Tang very often to treat the ulcer in mouth. The visiting doctors and students were also mimic his way to treat the mouth ulcer with this prescription. One time, a student prescribed the Gancao Xiexing Tang, but Dr. Hu changed it into San Wu Huangqin Tang.

2  王某,女,32岁,病案号29654

Case 2. Wang XX, female, 32 years of old. File number: 29654.

初诊日期196542日:原有脾肿大,血小板减少,常鼻衄和口糜。311日曾患口糜,服半夏泻心汤加生石膏、生地黄三剂而愈。本次发作已一周。舌及下唇溃烂,痛甚,口苦咽干,心烦思饮,鼻衄,苔白,舌红,脉弦细数。胡老改方:生地黄八钱,苦参三钱,黄芩三钱,炙甘草二钱,茜草二钱。

The first visit: April 2, 1965. The patient previously had enlargement of spleen, and low number of blood platelet. She usually had nose bleeding and ulcer in mouth. On March 11, she was given Banxia Xieting Tang plus Shigao, Shengdi fo the treatment of mouth ulcer. Three doses solved her problem. This time, the mouth ulcer has been there for one week. There was ulcer on the tongue and under the tongue, which was very painful. She felt bitter in mouth and dry in throat. She had nose bleeding too. The tongue cover was white and the tongue was red in color. The pulse was string, thin and frequent. Dr. Hu changed that herb prescription by that student into: Shengdi 24 grams, Kushen 9 grams, Huangqin 9 grams, roasted Gancao 6 grams, and Qiancao 6 grams.  

二诊:49日:上药剂,口糜愈,鼻已。

The second visit: April 9. After the treatment above, the mouth ulcer was cured and nose bleeding stopped.

按:开完处方,学生曾问胡老,本患者为什么不用甘草泻心汤加减? 胡老只是说:"本例不是上热下寒的甘草泻心汤方证,而是里热、上热明显的三物黄芩汤方证,看一下方解便自明。"

Comments: After the prescription, the student asked Dr. Hu, why not use the Gancao Xiexing Tang: Dr. Hu only said: “This case does not belong to the upper Fire and lower Cold syndrome. There is no indication for the Gancao Xiexing Tang. It is however the upper Fire and inside Fire co-exist syndrome, indicating the San Wu Huangqin Tang. You can review the book for this prescription and you will know.” 

学生借此复习了三物黄芩汤方证。该方记载于《金匮要略妇人产后病》附方():《千金》三物黄芩汤:治妇人草褥自发露得风,四肢苦烦热,头痛者,与小柴胡汤;头不痛但烦者,与三物黄芩汤。胡老在注解此条时写道:"产后中风,由于失治使病久不解,因致烦热。若兼见头痛者,与小柴胡汤即解。如头不痛但烦热者,已成劳热,宜三物黄芩汤主之。虚劳及诸失血后多此证,宜注意。"读至此则豁然明了,该患者有鼻衄、心烦等,已说明里热明显,同时也明津液伤显,因此不但要清热,而且要生津,故治疗时以黄芩、苦参苦寒清热的同时,重用生地黄、茜草凉血清热,生津增液,药后热除津生,故使衄止、口糜已。

The student reviewed the book <<Jing Kui Yao Luo>> and learned that … This patient had nose bleeding, annoyed feeling, indicating that the inside Fire is apparent. At the same time, the body liquid portion is also hurt. At this time, it is not only needed to clear the Fire, but also to supply more liquid portion to the body. Therefore in the treatment, it is needed to use the Shengdi and Qiancao to cold down the blood and to clear the Fire, and to nourish the liquid portion, at the same time to use the Huangqin and Kushen to clear the Fire. In this way, the Fire is cleared and the liquid portion is supplied after the herbal therapy, so as to stop the nose bleeding and cure the mouth ulcer.

 

9. 狐惑病

9. Treatment of Fox-puzzled disease

古人善医狐惑病   依证治愈白塞氏

Doctors in old time were good at the treatment of fox-puzzled disease. Following the old experience, the Behcet’s disease.

在讲甘草泻心汤方证时,胡汤讲了一个有趣的故事:1970年夏他刚从河南归来,吕尚清院长告诉他,有一位某部女军人曾几次来找看病,说数年前曾患白塞氏综合征,经胡老治愈,但住意大利后病又复发,因特回国找胡老诊治。对于西医病名本无所知,乍听之,不禁愕然。不久患者果然前来,但事隔多年,胡老已记不清楚,经过一番问答,乃知数年前,该患者因口糜合并前阴蚀疮来门诊,服中药治愈。近复发,在意大利确诊为白塞氏综合征,主症仍是口腔及前阴俱有蚀疮,与服甘草泻心汤加生石膏,另与苦参汤嘱其熏洗下阴,不久均治。

In the lecture for the use of Gancao Xiexing Tang, Dr. Hu told a interesting story:  in the summer of 1970, he just went back from Henan province of China. The president of the hospital where Dr. Hu worked, told him that there was a female military staff who had tried several times to see Dr. Hu. The patient said that she had had a Behcet’s disease and Dr. Hu solved her problem before. Later, she moved to Italy and the disease recurred. She so came back China to see Dr. Hu for the treatment again. For not aware of the medical terms of western medicine, Dr. Hu surprised what disease it is. Later, the patient came in deed. For the previous treatment happened many years ago, Dr. Hu was unable to remember this case. After explanation for some time, He realized that this patient was there for the treatment of ulcer in both mouth and in the front vaginal area. She had been given some herbal therapy for the cure of the ulcer. Recently, the ulcer recurred. It was diagnosed in Italy the problem was Behcet’s disease. The current problem remained the same the ulcer in mouth and in vaginal area. She was then given prescription Gancao Xiexing Tang plus Shigao, in addition to use herb Kushen extract to wash the vaginal area. Soon later, the problem was solved.

以上是胡老口述的治验例,可惜原病历未能查到,其具体证治不详,但具体用药却记得清楚,今列于此:炙甘草五钱,半夏四钱,党参三钱,黄芩三钱,黄连二钱,大枣四枚,干姜二钱,生石膏一两半。

This is what Dr. Hu told us orally. It is pity that we are unable to find the file, so it is not clear the exact symptoms and the exact diagnosis Dr. Hu made at that time, but the exact herbs used are clear. They are: roasted Gancao 15 grams, Banxia 12 grams, Dangshen 9 grams, Huangqin 9 grams, Huanglian 6 grams, Chinese date 4, dried ginger 6 grams, and Shigao 45 grams. 

苦参汤即用苦参二两,煎汤坐浴。

The Kushen Tang is to use herb Kushen 60 grams. Cook in water to collect the water extract. Wash vaginal area with the herbal extract.

按:白塞氏综合征是1937年才出现的病名,中医没有专门的证治经验,但有关狐惑病的证治早在汉代的医籍详有记载,如《金匮要略百合狐惑阴阳毒病》第10条:"狐惑之为病,状如伤寒,默默欲眠,目不得闭,卧起不安,蚀于喉为惑。蚀于阴为狐......甘草泻心汤主之"。白塞氏综合征的中心证候是口、眼、前后二阴溃疡及皮肤、粘膜损害,其中口糜见于所有患者,其次以前阴溃疡为多见,因此,胡老依据治疗口糜、狐惑病而治愈了该病。应当说明的是,本例只是口腔、前阴溃疡,适于甘草泻心汤加生石膏治疗,而白塞氏综合征尚有眼、皮肤、血管、消化道等病变者,应依据证候特点用药,不能仅用甘草泻心汤,宜注意。

Comments: The medical term Behcet’s disease came as early in year 1937. There is no exact description of this disease in old time Chinese medicine. However, there are descriptions of fox-puzzled disease in medical literature as early as Han dynasty. For example, it is stated in the book <<Jing Kui Yao Luo>>, the 10th paragrath: “In the fox-puzzled disease, the person looks as chilly, or hot, or chilly-hot shift, quite and seems to fall into sleep but hard to close the eyes to fall into real sleep. If gets up, the person feels uneasy and hard to be calm. If the ulcer occurs in the mouth, it is named “Huo”, if it is happened in vaginal area, it is called “Hu”. … Use Gancao Xiexing Tang to treat.The main symptoms of the Behcet’s disease are the ulcer in the mouth, eyes, and in front or in the rear of the vaginal area, as well as ulcer in skin, mucous. Among the patients, the mouth ulcer can be seen in all of them, followed by the ulcer in the vagial area. For this similarity between the Fox-puzzled disease described in Chinese medicine and Behcet’s disease in western medicine, Dr. Hu solved the Behcet’s disease based on the knowledge on the Fox-puzzled disease. Here it should be pointed out that, in this case, the patient has only ulcer in the mouth and the vaginal area. It is suitable to use Gancao Xiexing Tang to treat, while the Behcet’s disease has also the ulcer in the eyes, skin, blood vessles, digestive system, etc. It should be treated according exact clinic syndrome, not only depended on the Gancao Xiexing Tang alone.

 

10. 治疗胃、十二指肠溃疡的经验

10. The treatment of gastric ulcer

外寒里虚胃脘痛   易攻为补常建中

For the stomach pain due to external Cold but weakness inside, use nourishing therapy such as Jiang Zhong Tang , in stead of dispelling therapy.

西医诊断胃、十二指肠溃疡,因有X线、内窥镜等检确诊,易形成统一认识,但中医辨证治疗,因临床经验不同、学术观点不同等原因,往往出现分歧。例如六十年代曾有一位老中医在杂志发表论文,说什么溃疡病多数是虚寒,治疗应用黄_建中汤,论文一出即受到众人质疑。说明多数中医重视辨证论治,并有较高的理论水平。但从杂志、书籍看,不少人往往忽略外邪与溃疡病的关系。胡老在临床研究中注意到这一问题。

In western medicine, the diagnosis of gastric ulcer or duodenal ulcer is based on the X-ray or endoscope. It is easy to come to an agreement for the diagnosis. For Chinese medicine, which depends on the syndrome diagnosis and herbal indication diagnosis, it is not so easy to come to an common agreement for a diagnosis, due to the difference between the clinic experience and scholar idea. For example in year 1960s, there was one old TCM doctor, who published an article in the medical magazine, stating that the gastric ulcer is more with weakness-Cold condition. For the treatment, it should be used is Huangqi Jiang Zhong Tang. It triggered lots of suspect. It means that most of the TCM doctors pay attention to TCM syndrome diagnosis and have higher theoretical level in TCM. However, from the TCM magazines and books, it can be seen that, there are still many TCM doctors who omit the relationship between the external Xie Qi invasion and the gastric ulcer. Dr. Hu noticed such relationship in his clinic research.  

1. 王某,男,46岁,病案号181985

Case 1. Wang XX, male, 46 years of old. File number: 181985.

初诊日期19651130日:10年多来胃脘痛疼,近来加重,在当地中西医治疗无效,中药多是温中理气、活血祛瘀之品。西药治疗无效,动员其做手术,因惧怕拒绝手术而来京治疗。近症:胃脘刺痛,饥饿时明显,背脊发热,午后手心发热,有时烧心,心悸,头晕,身冷畏寒,汗出恶风,口中和,不思饮,大便微溏,苔白舌尖红,脉细弦。X线钡剂造影检查:十二指肠球部溃疡,溃疡面积0.4 x 0.4 cm2。胡老与小建中汤,处方:桂枝三钱,白芍六钱,生姜三钱,大枣四枚,炙甘草二钱,饴糖一两半(分冲)

The first visit: November 30, 1965. The patient had stomach pain for ten years. It became worse lately. He was treated in local hospital with both western medicine and Chinese medicine but no improvement. The herbs used were mostly stomach-warming, Qi-dredging, circulation-activating and blood stagnation-clearing therapy. Since the western medicine did not work, he was advised to have surgical operation. For fear of the surgical treatment, he went to Dr. Hu in Beijing city. The body conditions at the visit were: prickle-like pain in stomach, which was worse when hungry. He felt hot on the back, hot sensation in hands in the afternoon. He felt burning in stomach from time to time, felt palpitation and dizziness, cold in the body and dislike cold. He had no special taste in mouth, no desire to drink water. The stool was loose. The tongue tip was red in color and tongue cover was white. The pulse was thin and string. Barium radiography showed ulcer in duodenal ball part, which was 0.4X0.4 Cm2. Dr. Hu gave him prescription of Xiao Jianzhong Tang. The herbs were: Guizhi 9 grams, Baishao 18 grams, fresh ginger 9 grams, Chinese date 4, roasted Gancao 6 grams, and malt sugar 45 grams (drink directly without cook with the herbs). 

二诊1965123日:疼减,手心发热亦减,但仍胃脘刺痛,背脊发热,大便日行一次。上方加炒五灵拿钱,元胡粉五分(分冲)

The second visit: December 3, 1965. After treatment, the pain was reduced. The hot feeling in hands were also reduced. There was still sticking pain in the stomach and hot feeling on the back. The bowel movement was once a day. To the herbal prescription above, added were herb fried Wulingzhi and Yuhuan powder 1.5 grams (drink directly without cook).

三诊1965129日:胃脘痛已不明显,唯食后心下痞,四肢发凉,夜寐不安。将返东北原籍,改方茯苓饮(茯苓五钱,党参三钱,枳壳三钱,苍术三钱,生姜三钱,陈皮一两,半夏四钱),带方回家调理。

The third visit: December 9, 1965. The stomach pain was not more. He only felt bloating after meal. The arms and legs felt cold. The sleeping was poor. He was to turn home, so he was given prescription Fuling Yin (Fuling 15 grams, Dangshen 9grams, Zhike 9 grams, Cangzhu 9 grams, fresh ginger 9 grams, old orange peel 30 grams, and Banxia 12 grams.) to bring home for maintenance.

按:胡老在患者走后讲道:当表邪存在时,治疗不解表,专温补或理气血,造成外邪久不去,且引邪人内,故胃脘痛长期不愈。当治以温中同时解表,则胃脘痛很快缓解。本患者因有汗出恶风、头晕心悸等症,即有邪在表,并现表虚证,因为小建中汤的适应证,故服药三剂即效,服九剂症状基本消除。小建中汤乃是桂枝加芍药再加饴糖而成,桂枝加芍药汤原治胃腹痛,今加大量甘温补虚缓急的饴糖,虽仍治胃腹痛,但已易攻为补,故名之为建中。谓之小者,以其来自于桂枝汤,仍兼解外,与专于温补的大建中汤则比较为小也。

Comments: After the patient left, Dr. Hu said: whenever there is surface Xie Qi and if we do not use the surface-releasing therapy, but use warming up or Qi-dredging or circulation-improving therapy, it would result in the long time stay of the Xie Qi in the body, and also in the deeper invasion of the Xie Qi into the body, so as to make the stomach pain for longer time. If we use the surface-releasing therapy at the same time use the stomach-warming up therapy, the stomach pain could be solved very soon. For this patient, he had sweat, wind-disliking feeling, dizziness and palpitation, etc. suggesting the presence of Xie Qi in the body surface and it shows as surface-weakness condition. For it is the indication to the Xiao Jianzhong Tang, so with only three days of treatment, the pain is reduced and after nine days of treatment, the pain comes to nearly stop. The Xiao Jianzhong Tang is the Guizhi Tang plus Shaoyao and plus malt sugar. The Guizhi plus Shaoyao is originally to solve pain in the stomach. Now, with addition of large amount of malt sugar, which is sweet and warm in herbal nature, to release the spasm in stomach, it is named as Jiang Zhong (e.g. to strength the stomach), though it is still working to solve the stomach pain but the function has been changed from to attack to nourish. With the name of “Xiao” (e.g. Xiao here means small in Chinese), for the reason that it is developed from Guizhi Tang and it remains the function to release the body surface Xie Qi, it is a comparison with the Da Jiangzhong Tang (the Da here means big in Chinese).

乍看是虚实是实  本是瘀血怎温中

By brief look, the patient’s condition seems to be a weakness condition, but it is actually an overwhelming condition. The cause for the problem is the blood stagnation. In this case, how can we expect the stomach-warming therapy would work?

一些人囿于溃疡病多是虚寒的认识,因此临床往往不仔细辨证,动辄就与温中补气之药,不见疗效则加大药量,患者难以忍受,不得不换他医诊治,胡老的医案中就有不少这样的病例。

Some doctors keep in mind that the gastric ulcer is a weakness-Cold syndrome, so in clinic, they do not make careful diagnosis but to use the stomach-warming and Qi-nourishing therapy. If there is no healing effect, they would increase the dose for the herbs, the dose of which is so large that the patient is hard to tolerate the herb stimulation, so that the patient has to change from one doctor to another. Among the patients with Dr. Hu, there are many of such cases.

2. 张某,男,40岁,病案号178517

Case 2. Zhang XX, male, 40 years of old. File number: 178517.

初诊日期19651028日:1962年即确诊为十二指肠球部溃疡,去年又查出有慢性肝炎,经常疲乏无力,纳差,右胁痛,胃脘痛,时有头晕、吐酸烧,怕冷,前医辨证为脾胃虚寒,投与黄_建中汤加味,服六剂,头晕加重,每早起右胁痛,胃脘痛更明显,咽干思饮,大便干,苔白腻浮黄,舌尖有瘀点,脉沉细。胡老认为是瘀血胃脘及胁痛,为大柴胡汤合桂枝茯苓丸方证,用药:柴胡四钱,枳实三钱,黄芩三钱,半夏三钱,赤芍三钱,桂枝三钱,桃仁三钱,生姜三钱,大枣三枚,大黄二钱。

The first visit: Oct. 28, 1965. The patient was diagnosed as duodenal ulcer three years ago. Last year, he was diagnosed with Chronic hepatitis too. He felt chronic fatique, poor appetite, pain in the right upper side of the belly, stomach pain, dizziness some times, heart burning sensation, and cold-fearing feeling. Previous doctor diagnosed as weakness-Cold syndrome in the stomach-spleen system. He was given Huangqi Jiangzhong Tang with some modifications for six doses. After that he felt more dizziness, felt pain in the right upper side of the belly, more pain in the stomach, dry mouth and willing to drink water, and constipation. His tongue cover was white with floating layer of yellow in color, and greasy. There was stagnated spot on the tongue tip. The pulse was deep and thin. Dr. Hu believed that his condition is blood stagnation in the stomach and in the upper side of the belly. It is the indication of herbal prescription Da Chaihu Tang plus Guizhi Fuling Wan. The herbs used were: Chaihu 12 grams, Zhishi 9 grams, Huangqin 9 grams, Banxia 9grams, Chishao 9 grams, Guizhi 9 grams, Taoren 9 grams, fresh ginger 9 grams, Chinese date 3, and Dahuang 6 grams. 

结果:上药隔日一剂,服第二剂后胃脘痛巳,服九剂后胁痛已,纳增,大便如常。

Results: after use of the herbs once every other day, the stomach pain subsided. After nine doses, the pain in the upper side of the belly stopped. The appetite was improved and the bowel movement was normal.

按:本例因有乏力、怕冷、纳差等,很易看作虚寒,但如能仔细辨证,则不难发现,患者有头晕、胁痛、咽干思饮等,其证当属:少阳阳明合病。又有头晕、吐酸、烧心、大便干等,为气上逆,胃气不降。此时应以降为法,用黄_升提中气,必然加重气逆,因此出现头晕、胁痛、胃脘痛更重。本例还有两个特点,即一是右胁痛,一是舌尖有瘀点,为有瘀血的特征,因此,本例证属少阳阳明合病并挟瘀血,故用大柴胡汤和解少阳阳明,并以桂枝茯苓丸祛除瘀血。其中有半夏、生姜、桂枝、大黄降逆和胃,全方标本兼顾,且方药对证,故见效迅速。回过头来再分析患者的乏力、怕冷、纳差等,可知并非因虚寒,而是瘀血,气滞不疏所致,辨证时当有所借鉴。

Comments: In this case, the patient had chronic fatique, cold-fearing feeling, and poor appetite, all of which are easy to be regarded as weakness-cold syndrome. However, if to make the diagnosis carefully, it is not difficult to find that the patient had dizziness, pain in the upper side of the belly, dry mouth and willing to drink water. Such conditions should belong to Shaoyang-Yangming co-exist syndrome. The symptoms of dizziness, heart burning feeling, acid reflex, dry stool, etc. all belong to the reverse of Qi, which means the stomach Qi does not descend. At this time, it should be to improve descending function of the body. If the herb Huangqi is used to lift the stomach Qi, it certainly would make the reverse of the Qi worse, so as to make worse the dizziness, pain in the upper side of the belly, and pain in the stomach. In addition, there are two other characteristics in this case: first, he had pain in the upper side of the belly; second, there is blood stagnation spot on the tongue tip, all of which indicate the presence of blood stagnation. Therefore, in this case, it is the Shaoyang-Yangming syndrome with blood stagnation condition. For this reason, the prescription Da Chaihu Tang is used to harmonize Shaoyang and Yangming phases, and the Guizhi Fuling Wan is used to clear the stagnation. Among the herbs, the Banxia, fresh ginger, Guizhi and Dahuang work to harmonize stomach. For the whole prescription, it works both for the symptoms and for the cause of the disease. The herbs match the body condition, so that it works very soon. Now, we turn back to see the symptoms of chronic fatique, cold-fearing feeling and poor appetite. It is known now that they are not the sign of weakness-cold, but that of stagnation, which causes sluggish of the Qi flow in the body. In future diagnosis, this can be a reference to for distinguishing diagnosis.

虚寒见证确实多    温补方药却不同

The weakness-Cold syndrome in deed is more seen in the gastric ulcer and duodenal ulcer.  However, the herbal prescription needed could be very different.

以上所述皆提到误用温补,是在强调注意解表()和祛瘀逐实(2),不是说溃疡病不用温补,相反因溃疡病虚寒证确实多见,用温补的方法也就很多。但胡老根据患者具体症状的不同,辨出不同的方证,而用不同的方药。常用的方证有:大建中汤、旋覆代赭汤、黄土汤、吴茱萸汤等。今择其治验病例列述于下:

The case reports above talk about the mis-use of warming therapy in the treatment of gastric ulcer. It is to emphasize the body surface-releasing therapy (case 1) and stagnation-clearing therapy (case 2). It does not mean that we do not use the warming therapy to solve gastric ulcer. In deed, in clinic, the gastric ulcer in the weakness-Cold condition is not rare, so the use of the warming therapy is quite common too. However, Dr. Hu, based on the exact clinic conditions of each individual patient, diagnose different herbal indications, so use variable herbal prescriptions for the treatment. The commonly used prescription used by him are: Da Jiangzhong Tang, Xuanfu Taizheshi Tang, Huangtu Tang, Wuzhuyu Tang, etc. Here we chose some of the prescription to show in bellowing:

3. 甄某,男,45岁.病案号61442

Case 3. Zhen XX, male, 45 years of old. File number: 61442.

初诊日期1965129日:1963年曾患胃脘痛,经X线钡剂检查确诊为胃溃疡,经治疗一度缓解,近一月来又常胃脘痛,饭前明显,口干不思饮,时感头晕、乏力,大便溏黑,潜血强阳性,苔白,脉沉弦细。与黄土汤。

The first visit: December 9, 1965. The patient suffered from stomach pain two years ago. It was diagnosed as gastric ulcer via X-ray detect. The symptoms subsided after some treatment. In recent one month, the pain came again. It was worse before meal. He felt dry in mouth but no desire to drink water. He felt dizziness, and fatique. The stool was loose and very black in color. The stool bleeding test is positive. The tongue cover was white. The pulse was deep, string and thin. He was given prescription Huangtu Tang.

伏龙肝三两,炮姜三钱,川附子三钱,党参兰钱,炒自术三钱,生地炭八钱,当归三钱,川芎二钱,白芍四钱,艾叶三钱,生阿胶三钱,炙甘草二钱,黄芩三钱。

The prescription ingredients were: Fulonggan 90 grams, toasted ginger 9 grams, chuan Fuzi 9 grams, Dangshen 9grams, fried Baizhu 9 grams, Shengdi charcoal 24 grams, Danggui 9 grams, Chuanxiong 6 grams, Baihshao 12 grams, Aye 9 grams, Ajiao 9 grams, roasted Gancao 6 grams, Huangqin 9 grams.

结果:上药服三剂胃脘痛已,六剂潜血转阴性。

Results: After the herbal therapy above for three days, the pain stopped. After six days of the treatment, the stool bleeding test turned negative.

4.  白某,男,32岁,病案号184285

Case 4. Bai XX, male, 32 years of old. File number: 184285.

初诊日期19651221日:胃脘痛反复发作已一年,近一月来加重,食前食后皆痛,常噫气,呕吐,心下痞,烧心,时脘腹胀满,苔白,脉弦细。X线钡剂检查确诊为十二指肠球部溃疡、胃下垂。与旋覆代赭汤合茯苓饮加乌贝散:旋覆花三钱,党参三钱,生姜五钱,代赭石三钱,炙甘草二钱,半夏五钱,大枣四枚,茯苓四钱,白术三钱,陈皮三钱,枳壳三钱,鸟贼骨三钱,川贝二钱。

The first visit: December 21, 1965. The patient had stomach pain, which came and gone, for one year. It became worse in recent one month. He felt pain before and after the meal. He had belching, vomit, bloating sensation in the stomach, heart burn, and from time to time bloating in the belly. His tongue cover was white and the pulse was string and thin. Barium radiography test showed duodenal ulcer and stomach ptosis. He was given prescription Xuanfu Daizheshi Tang plus Fuling Yin and plus Wu Bei San: Xuanfuhua 9 grams, Dangshen 9 grams, fresh ginger 15 grams, Daizheshi 9 grams, toasted Gancao 6 grams, Banxia 15 grams, Chinese date 4, Fuling 12 grams, Baizhu 9 grams, Chenpi 9 grams, Zhike 9 grams, Wuzei bone 9 grams, and chuan Beimu 6 grams.

结果:上药服三剂胃脘痛减,噫气、呕吐减。服六剂胃脘痛已,他症已不明显。

Results: After three days of the herbal therapy, the stomach pain was reduced, the belching and vomit reduced. After six days, the pain stopped. No any other symptoms either.

5. 李某,男,33岁,病案号478529

Case 5. Li XX, male, 33 years of old. File number: 478529.

初诊日期1965316日:于1963年发现十二指肠球部溃疡,近来常胃脘痛,饥饿时明显,泛酸,欲呕,吐白沫,时头痛,腹胀,苔白根腻,脉弦。与吴茱萸汤合半夏厚朴汤加陈皮:

The first visit: March 16, 1965. The patient was diagnosed as duodenal ulcer in duodenal ball part. Lately, he felt often pain in the stomach, which was worse with empty stomach. He had acid reflex, willing to vomit, spit white bubble, sometimes headache, and bloating in belly. The tongue cover was white and it was greasy in the tongue root part. The pulse was string. He was given prescription of Wuzhuyu Tang plus Banxia Houpu Tang, plus Chenpi:

吴茱萸二钱,党参三钱,生姜三钱,半夏四钱,厚朴三钱,茯苓四钱,苏子三钱,大枣四枚,陈皮四钱。

Wuzhuyu 6 grams, Dangshen 9 grams, fresh ginger 9 grams, Banxia 12 grams, Houpu 9 grams, Fuling 12 grams, Suzi 9 grams, Chinese date 4, old orange peel 12 grams.

二诊:325日:上药四剂,胃脘痛、呕吐白沫、头痛皆已,泛酸减。唯胃脘尚胀。上方去苏子,加木香三钱、砂仁二钱,增吴茱萸为三钱。

The second visit: March 25: after the herbal therapy for four days, the stomach pain, the white bubble spitting, and the headache, all subsided. The acid reflex reduced. The only symptom remained was stomach bloating. From the prescription above, deleted Suzi, added Muxiang 9 grams, and Sharen 6 grams, and increased the Wuzhuyu to 9 grams.

三诊:41日:药后诸症均已。

The third visit: April 1. No any symptoms remained.

按:以上是胡老常用的温中祛寒方药。除此之外,尚亦常用理中汤、附子理中汤、大建中汤等,这里不再一一例举。胡老还常用一些单方、验方,如在缺医少药的农村用热豆油或花生油治疗溃疡病急性胃脘痛等,但非常强调辨证、辨方证。同是温中祛寒,例3因有远血又有口干、头晕、乏力等寒热交错证,故用附子、白术、甘草温中祛寒,且用伏龙肝温中收敛止血,伍以生地炭、阿胶协力止血,佐以黄芩苦寒清上热。例4则以中寒停饮、胃气上逆明显,故用旋覆代赭汤合茯苓饮,又因烧心明显,故加乌贝散。而例5虽也是中寒停饮,但表现为饮邪上犯明显,且腹胀满明显,故用吴茱萸汤合半夏厚朴汤加陈皮。即温中祛寒治疗溃疡病、胃脘痛是治疗大法,在确定具体方药时,还要细辨具体方证。

Comments: The above are the herb prescriptions used commonly by Dr. Hu to warm the stomach and to dispel the Cold. Beside them, He also use Lizhong Tang, Fuzi Lizhong Tang, Da Jiangzhong Tang, etc. They are not introduced here any more. Dr. Hu also uses some single prescription or experienced herbal therapy. For example, in a countryside where is short of doctor, he used warm bean oil or peanut oil to solve acute pain in gastric ulcer. However, he still emphasized the herbal indication diagnosis in such situations. For the same Stomach-warming therapy, in case 3, for there is bleeding and also dry mouth, dizziness and fatique, such Fire-Cold mixture condition, he uses Fuzi, Baizhu and Gancao to warm, and use Fulonggan to warm the stomach, as well as to stop the bleeding by its contracting capacity.  In the same prescription, the Shengdi charcoal and Ajiao were used to help to stop the bleeding. The herb Huangqin was used to clear the upper Fire for its bitter and Cold herbal nature. In case 4, the condition is the Cold in stomach with water accumulated in stomach, and the stomach Qi reversed rushing up. In addition, the patient felt much bloating in the belly. Therefore, he was given the Wuzhuyu Tang, Banxia Houpu Tang plus Chenpi. This means, though the stomach-warming is the principle therapy for the gastric ulcer, we still should check the individual herbal prescription indication so to choose the proper prescription.   



[1] In the Ba Gang diagnosis system, a common cold is categorized into Wind-Hotness, Wind-Cold, Shu-Hotness, Dryness-Hotness, Cold-Dryness, or Phlegm-Wetness, Liver-Fire, etc.

[2] Jing Fang: the herbal prescription introduced in the book “Shang Han Lun”. Jing means principle. Fang means herbal prescription.

[3] Wen Bing Pai: a famous TCM style. Bing means disease. Pai means style, or group.

[4] Shi Fang: a TCM style differs from either Jing Fang style or Wen Bing style. Currently in China, this is more popular TCM style. However, it should be mentioned that, the “popular” does not mean it is the best style.

[5] If the common cold develops into deep stage as some other disease, such as pneumonia, the text book will not agree that it is a common cold in the beginning, but calls it a early stage of the pneumonia. The idea of Dr Hu here is: no matter the common cold eventually develop into other phase or not, if the clinic manifestation is similar to, the same as, a common cold, it should be regarded as a common cold. The treatment should follow the Liu Jing Diagnosis system.

[6] A very famous TCM doctor in China history.

[7] Bi syndrome is the syndrome, in which person feels pain or heavy in the joints. It can be the collective name of various arthritis, the term used by western medicine.