专病论治 胡希如经验谈2

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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 (2)

 

Catalogue

 

经方治疗冠心病的经验 (Coronary Heart Disease)

从病例谈治疗脑病经验 (Brain-origin diseases)

美尼尔氏及癫痫水饮上犯最常见 (Meniere’s disease and epilepsy)

治疗血证经验 (Disease in blood system)

系统性红斑狼疮论治 (Lupus)

论治淋证 (Infectious disease in urinary system)

 

 前列腺炎治疗经验谈 (Prostatitis)

肾炎病初探 (Nephritis)

头痛的辨证论治 (Headache, migraine)

阑尾炎的治疗经验 (Appendicitis)

下利论治 (Diarrhea and dysentery)

慢性结肠炎 (Colonitis)

   

11.  经方治疗冠心病的经验

11. The treatment of coronary heart disease

短气未必都是虚  胸痹半表半里实

Short of breath may not always mean a weakness condition. The chest Bi syndrome is actually a half-surface, half-inside overwhelming condition.

60年代有了心电图机,冠心病诊断渐渐明确,以中西医结合探讨其临床经验论著逐渐增多。对冠心病多有胸闷、胸痛,认为是痰饮瘀血阻滞的病因病机,这一认识颇为一致。而怎样从整体上看待冠心病是虚还是实上存有分歧。其中有不少人提出:根据患者多有短气、四逆、末梢血循环不好,心电图提示供血不足、心肌梗塞等,冠心病患者多属虚证,其治疗则应以益气活血为主。胡老认为,冠心病多属于中医胸心痛范畴,在《金匮要略胸心痛短气病》第2条:"平人无寒热,短气不足以息者,实也。"正是说冠心病(胸痹心痛)多见邪实之证。胡老从六经辨证及辨方证上研究,常用大柴胡汤合桂枝茯苓丸治疗,认为本病以实证多见,今以治验病例分析之。

In 1960 years, with the development of CEG, the diagnosis of coronary heart disease became more and more clear. The articles and clinic research reports on the combination of western medicine and Chinese medicine gradually increased. For the fact that the coronary heart disease usually has choking feeling and pain in the chest, it is believed that the nature of the disease is the phlegm and blood stagnation in the chest (heart). This is a pretty common agreement. However, it did not come to a common agreement for whether the disease belongs to a weakness or a overwhelming condition. Quit many doctors believe that it is a weakness condition, for the fact that the patients usually have short of breath, cold hands and feet, poor circulation in the end of extremes, showing of poor blood supplication in CEG and heart infarction, etc. The principle of the treatment is therefore suggested to be Qi-nourishing and circulation-activating therapy. Dr. Hu believes that, the coronary heart disease belongs to the chest Bi syndrome in the Chinese medicine. As stated in the book <<Jing Kui Yao Luo, heart pain and short of breath>>, the second paragraph: “if a person has no cold or fever, but feels short of breath, it belongs to a overwhelming condition”. This means that the coronary heart disease (the Chest Bi syndrome with pain in heart area) often shows as Xie Qi overwhelming condition. Dr. Hu studied the six Jing diagnosis system and herbal indication diagnosis, often uses prescription of Da Chaihu Tang plus Guizhi Fuling Wan. Let’s discuss the treatment bellow:

1.  李某,男,67岁,病案号159790

Case 1. Li XX, male, 67 years of old. File number 159790.

初诊日期1965528日:气短、胸痛、胸闷一月余。423日某医院诊断为"心肌梗塞(愈合期)",曾服复方硝酸甘油、氨茶碱等无效。又找中医治疗,以益气活血,化痰通络(白人参、黄_、瓜萎、赤芍、降香、桃仁、薤白、郁金等)治疗近月,未见明显疗效。近症以左胸灼热痛,气短,动则明显,时寒时热,心下堵,口苦,时头胀,失眠,大便微干,舌苔黄,脉弦滑。胡老与大柴胡汤合桂枝茯苓丸加味:柴胡四钱,半夏三钱,黄芩三钱,自芍三钱,枳实三钱,生姜三钱,大枣四枚,桂枝三钱,茯苓四钱,桃仁三钱。大黄二钱,生石膏一两,炙甘草一钱。

First visit: May 28, 1965. The patient felt short of breath, pain and choking sensation in the chest for one month more. On April 23, he was diagnosed as heart infarction (recovering stage). He took various western medicine drugs in vain. He then tried Chinese medicine. The therapy used was to nourish the Qi, to improve blood circulation, to clear phlegm and to dredge the energy conduct. The herbs used were Bai Renshen, Huangqi, Guoluo, Chishao, Jiangxiang, Taoren, Xiebai, Yujing, etc. He used such therapy for months also in vain. Currently, he felt burning and hot pain in the left side of the chest, short of breath, which was worse when moving physically. He felt some times cold and some times hot, felt choking sensation in the stomach area, bitter in mouth, bloating feeling in head, and poor sleep. His stool was slightly dry. The tongue cover was yellow. The pulse was string and slippery. Dr. Hu gave him the Da Chaihu Tang and Guizhi Fuling Wan with some modifications: Chaihu 12 grams, Banxia 9 grams, Huangqin 9 grams, Baishao 9grams, Zhishi 9 grams, fresh ginger 9 grams, Chinese date 4, Guizhi 9 grams, Fuling 12 grams, Taoren 9 grams, Dahuang 6 grams, Shigao 30 grams, and roasted Gancao 3 grams.

二诊:61日:上药服三剂,各症均已,唯感夜间憋气,食后烧,大便干,舌苔黄,脉弦滑略数。上方增大黄为三钱。

The second visit: June 1. After the herbal therapy for three days, most of the symptoms subsided. The only remaining symptoms were choking feeling at night, heart burn sensation after meal and dry stool. His tongue cover was yellow and pulse was string, slippery and slightly frequent. To the prescription above, increased was the Dahuang to 9 grams.

三诊:1223日:上药服二剂夜间憋气已,外出活动仍感气短,但休息后症状渐渐消失,未再来诊。今咳一周而来诊,与半夏厚朴汤加味。

The third visit: on December 23, after the herbal therapy for additional two doses, the choking feeling at night subsided. He only felt short of breath when in activity out of the door, which could gradually disappeared after a rest. He did not continue the treatment from then. Today, he came for cough for one week. He was given Banxia Houpu Tang.

按:本例在前后治疗过程中,都用了活血理气药,但前医无效.而胡老治疗疗效明显,其关键是:前医未注意患者的寒热虚实,而胡老首先认清是实热,并定位在半表半里,再进一步辨出是大柴胡汤合桂枝茯苓丸方证,故效如桴鼓。类似这一治验是不胜枚举的,这里仅再看胡老回忆的一个病例,更可了解胡老治冠心病的特点和辨方证的准确。

Comments: For this case, during the previous and later treatment, he was given the circulation-improving and Qi-dredging therapy. But the previous treatment is in vain, but the one with Dr. Hu was very effective. The key point is: the previous doctor did not pay attention to the cold, hotness, weakness and overwhelming condition of the patient. While Dr. Hu considered the condition belonged to overwhelming hotness, which is again believed in the half-surface and half-inside portion of the body. Further more, it was diagnosed as the indication of Da Chaihu Tang and Guizhi Fuling Wan. Therefore, the result was excellent. There are many cases as such. Here let’s look at another case of Dr. Hu, so to understand the characteristics of Dr. Hu in the treatment of coronary heart disease and the accurate in the herbal indication diagnosis.

1950年冬,一个叫做齐兴华的东北人,时年50岁,平时有心脏病,常心悸,胸闷,两手肤色不同,一紫一白。一日起床时突然发作胸闷心痛,其痛如刀割,并大汗淋漓,不敢挪动,时时哀叫,其妻给服鸦片而不见效。请西医马大夫急诊,注射强心剂不效。胡老至,诊脉细弱而有神,因谓不要紧。马大夫闻言提起诊包欲走,被家属挽留,谓:"不是外人,不要见怪"。马大夫乃问道:"君何以言不要紧?"胡老答:"中医看脉象尚有神。"马大夫请胡老诊治,胡老处方与大柴胡汤合桃仁承气汤一剂,立即煎服,不久痛已。续服前方两剂,两手肤色变为一样,心绞痛未再作。本例因是回忆病例,当时无心电图可证,但据患者心区痛甚,并伴见大汗淋漓,很难排除心肌梗塞。但无论是否,胡老把这些症辨为实证、大柴胡汤合桃仁承气汤方证,是独具慧眼的。

In the winter of 1950, there was a man with name Qi Xinghua, 50 years of old. He had heart disease usually with palpitation and choking sensation in chest. The color of his hands were different, one was white and another purple. One day after got up bed, he felt sudden pain and choking feeling in the chest. The pain was so severe as knife cut. He had heavy sweat, fearing to move little bit, and crying. His wife gave him opium, which did not work at all. A western medicine doctor was invited urgently to see him. He was given heart-strengthening medicine, which again did not work. Then Dr. Hu was asked to come. His pulse was thin, weak but with spiritual sensation (e.g. with kind of life energy feeling). The patient was told the condition was not so bad. The western medicine doctor heard this, and went up to leave. The patient family advised him to stay and told him no worry, since the Dr. Hu was also very familiar to the patient. The doctor asked Dr. Hu why you said the condition is not so bad. Dr. Hu said, “This is because that, according to the Chinese medicine, the pulse is still with life energy feeling.” The western medicine doctor invited Dr. Hu to continue for the treatment. Dr. Hu give the prescription of Da Chaihu Tang plus Taoren Chenqi Tang, which was asked to cook as soon as possible. Soon later after the patient drunk the herbal extract, his pain subsided. The same herbal therapy was asked to continue for additional two doses, and the color in both hands turned the same. The chest pain did not come back later. This case was described by a memory. There was no CEG to aprove the diagnosis. Based on the very painful sensation in the chest, with heavy sweat, it is hard to exclude the possibility of heart infarction. No matter it is heart infarction or not, it is very smart that Dr. Hu contributed the condition as an overwhelming condition and the indiction to the Da Chaihu Tang plus Taoren Chenqi Tang.

痰饮瘀血阻胸阳 祛痰活血理应当

For there is phlegm or stagnated blood to block the Yang Qi circulation in the chest, it is reasonable to dissolve the phlegm and to improve the blood circulation.

冠心病常有血液循环不好,而出现四肢发凉、胸闷气短、面色苍白、疲乏无力等,中医辨证当属阳虚,但进一步分析,这种阳虚是标,而痰饮瘀血阻滞是本,胸阳被阻使阳气失运。即这种冠心病也是邪实之证。胡老也常治疗这类病证。

Patients with coronary heart disease usually have poor blood circulation. They feel cold in the hands and feet, choking sensation in the chest, short of breath, pale face, and chronic fatique, etc. In Chinese medicine, it should be regarded as Yang deficiency. Further more analysis, such Yang deficiency condition is a surface phenomenon, while the block of energy flow by phlegm and/or stagnated blood is the real cause. It is the block of the chest Yang that causes the disturbance of the Yang Qi circulation. This means that, such coronary heart disease is also a Xie Qi overwhelming condition. Dr. Hu has such cases often.  

2.  安某,女,74岁,病案号162346

Case 2. An XX, female, 74 years of old. File number: 162346.

初诊日期1965614日:患心绞痛一年多,常胸前剧痛,每发作则不能平卧,呼吸困难,经常服用硝酸甘油、氨茶碱等,大汗出,口干不思饮,大便干,舌苔白厚,脉弦细。证属痰饮阻胸,瘀血阻络,治以化痰通阳,祛瘀通脉,与瓜萎薤白半夏汤加味:瓜蒌一两半,薤白九钱,半夏二两半,白酒二两,桂枝三钱,枳实三钱,桃仁三钱,陈皮一两,白芍四钱。

The first visit: June 14, 1965. The patient had angina for more than one year. She often felt very much pain in the chest. Once in onset, she was unable to lay down in horizontal, and felt hard to have breath. She took various western medicine quite often. She had heavy sweat, felt dry in mouth but no desire to drink. The stool was dry, the tongue cover was thick and white, and the pulse was string and thin. Her condition was diagnosed as the block in chest by phlegm and by stagnated blood. The phlegm-dissolving and stagnation-clearing therapy was used to her. The prescription given was Guoluo Xiebai Banxia Tang with some additions: Guolou 45 grams, Xiebai 27grams, Banxia 75 grams, liquor 60 ml, Guizhi 9 grams, Zhishi 9 grams, Taoren 9 grams, Chenpi 30 grams, and Baishao 12 grams.  

结果:上药服三剂,痛减,但小劳则发心区痛。上方加茯苓四钱,继服六剂,胸痛时作时休,仍以上方加减,服一月后,胸痛不再发作。

Results: after the herbal therapy for three days, the pain was reduced, but it was still pain after little labor work. To the above formula, added was Fuling 12 grams. The prescription was continued for six days. The chest pain came and gone. The prescription was continued. After one month, there was no more pain in the chest at all.

按:本例与例1都是痰饮瘀血阻胸,治疗都用了祛痰活血的药,但例1标热明显,而本例标寒显著,故治疗用方明显不同。胡老在瓜蒌薤白半夏汤方解中讲道:瓜蒌开胸逐痰止嗽,薤白散结止痛,合以为方,故治胸痛而喘息咳唾者。煎以白酒,更使药力畅行无阻也。而用大量半夏,是因饮逆较甚之故。由两治疗验例可看出,祛除痰饮是治疗冠心病的重要之法。在《金匮要略胸心痛短气病》第1条就提出:"夫脉当取太过不及,阳微阴弦即胸而痛,所以然者,责其极虚也。今阳虚知在上焦,所以胸心痛者,以其阴弦故也。"就是说上焦阳虚,下焦的寒饮盛,寒饮上逆,故使胸而心痛也。说明中医早已认识到这一病因病理,也进一步说明冠心病以邪实多见。故治疗冠心病多以祛邪为主。这是胡老治疗该病的特点。

Comments: These two cases both belong to the block of phlegm and stagnated blood in the chest. For the treatment, both used phlegm-dissolving and stagnation-clearing therapy. However, in the case 1, the hotness symptoms is apparent, and in case 2, the cold symptoms. Therefore for the treatment, the herbal prescriptions were very different. Dr. Hu said, in his lecture for the Guolou Xiebai Banxia Tang, that the Guolou works to release the chest stagnation, to clear the phlegm and to stop cough. The herb Xiebai works to loose knob or mass, and to stop pain. When used in one prescription, they work to solve the chest Bi syndrome, chest pain with cough, asthma and phlegm spitting. When cooked the herbs with the liquor, the liquor makes the herbs move in the body smoothly. For the use of large amount of Banxia, is for the reason that the condensed water reverse phenomenon is apparent. It can be seen from these two cases that, it is the important principle in the treatment of coronary heart disease, the phlegm-dissolving therapy. In the book <<Jin Kui Yao Luo, heart pain and short of breath>>, in the first paragraph, it stated: “…”. This means that the upper Jiao is with Yang deficiency, and the lower Jiao is with Cold and condensed water overwhelming, the cold and condensed water reverse up to cause the chest Bi syndrome, e.g. the chest pain. This means that Chinese realized the cause of the coronary heart disease in quite early age. It also means that the coronary heart disease is more with overwhelming Xie Qi in the body. Therefore for the treatment, it should be focused on the dispelling of the Xie Qi. This is the characteristic in Dr. Hu’s treatment of this disease.

 

房室传导有阻滞   活血祛瘀可调理

For atrioventricular conduction disorder, the circulation-improving and phlegm-dissolving therapy works.

一般而论,脉结代见于外感病后期,由于汗、下、吐等治疗而津血枯燥所致。治疗多用炙甘草汤加减,但胡老不默守常规,而是辨方证用药。

Generally speaking, the rough pulse can be seen in the later stage of a external disease, which is due to the sweat, diarrhea, or vomit, all of which exhausts the body liquid portion. For the treatment, it is usually used the roasted Gancao Tang with modification. However, Dr. Hu not always follow such common rule, but use the herbal therapy based on syndrome diagnosis and herb indication diagnosis.

3朱某,男,48岁,病案号134621

Case 3. Zhu XX, male, 48 years of old. File number 134621.

初诊日期1964812日:近半年来心慌不适,在某p医院以补气养血治疗,曾用炙甘草汤、柏子养心丹、天王补心丹等方加减,多治无效,反出现恶热、喜冷、失眠等症。经做心电图提示:房室传导阻滞、心肌劳损。现在症状:心慌,失眠,纳差,胃脘疼,心区隐痛,手脚麻木,口苦涩,小便黄,大便于,舌苔白腻,脉结代。与大柴胡汤合桂枝茯苓丸加生龙牡:柴胡四钱,半夏三钱,黄芩三钱,桂枝三钱,茯苓三钱,白芍三钱,枳实三钱,桃仁三钱,红花二钱,大枣四枚,生姜三钱,大黄二钱,生龙骨五钱,生牡蛎五钱。

The first visit: Aug. 12, 1964. The patient had palpitation for half years. In a hospital, he was given the Qi-nourishing and blood-nourishing herbal therapy. He was given the Zhi Gancao Tang, Bozi Yangxing Dan, Tianwang Buxing Dan, and so on. No any improvement, but he started to have hot-disliking feeling, cold-liking feeling, and poor sleep. ECG showed that he had block in the atrioventricular conduct, degeneration of heart muscle. The current conditions when he visited Dr. Hu were: palpitation, poor sleep, poor appetite, pain in stomach, dull pain in the heart area, numb in hands and feet, bitter taste in mouth, yellow urine and dry stool. The tongue cover was white and greasy, the pulse was rough. He was given Da Chaihu Tang plus Guizhi Fuling Wan, plus Longgu and Muli: Chaihu 12 grams, Banxia 9 grams, Huangqin 9 grams, Guizhi 9 grams, Fuling 9 grams, Baoshao 9 grams, Zhishi 9 grams, Taoren 9 grams, Honghua 6 grams, Chinese date 4, fresh ginger 9 grams, Dahuang 6 grams, Longgu 15 grams, and Muli 15 grams.

结果:上药各个一剂,胃脘疼已,纳增,手脚麻木已,眠好转。上方去红花,加丹皮三钱。服六剂,胸痛减,眠佳,心慌不明显,脉结代已。

Results: After the herbal therapy for one day, the pain in stomach stopped. The appetite increased. The numb in hands and feet stopped. The sleep was improved. To the prescription above, removed was the Huanghua, added was Danpi 9 grams. After 6 doses, the chest pain stopped. Sleep was normal, and the palpitation was no longer apparent. The rough pulse did not show.

按:病有常有变,欲知其变,当细审其证。该患者有心慌、纳差、手脚麻木、脉结代等,似是虚证,初用炙甘草汤加减等补益无可厚非。但治疗后出现口苦涩、小便黄、大便干、隐痛等,证属少阳阳明合病挟瘀,故用大柴胡汤合桂枝茯苓丸加龙骨牡蛎和解少阳阳明,活血祛瘀,佐以安神,因药已对证,不久均安。

Comments: A disease may show as commonly showed, or it may show as a changed manner. To know its change, it is needed to carefully make the diagnosis. This patient had palpitation, poor appetite, numb in hands and feet, as well as rough pulse. All seemed to indicate a weakness condition. It is not wrong in the beginning to use Zhi Gancao Tang for the treatment. However, after the treatment, the patient started bitter taste in mouth, yellow urine, dry stool, and dull pain, etc, suggesting that the condition is Shaoyang-Yangming co-esixt phase with blood stagnation. Therefore, the Da Chaihu Tang, Guizhi Fuling Wan, Longgu and Muli were used in the same prescription to harmonize the Shaoyang and Yangming phase, to activate blood circulation, to clear the blood stagnation, with herbs to calm emotion. For the herbs match the body condition, the condition was improved soon.

痰饮停久致心衰   温阳利水本应该

The longer time remaining of phlegm in the body could cause heart failure. It is needed to use Yang-warming, and water-depleting therapy for the treatment.

长期的冠心病往往发生心功能不全,出现心悸、浮肿等症,已示正气明显虚时,也要据证用补,胡老也用理中汤、真武汤等方治疗。《金匮要略胸心痛短气病》第5条:",心中痞,气结在胸,胸满,胁下逆抢心,枳实薤白桂枝汤主之,人参汤亦主之。"胡老注解道:"心下痞。指心中痞塞气不通之意。气结在胸,谓气结于胸中而胸满闷也。胁下逆抢心,谓自觉有气自胁下而逆于心胸感。枳实薤白桂枝汤,功能降逆行气以消胀满,故主之。而人参汤亦主之者,以中气大虚,饮自下乘,亦可能有气结胸满的类似证候,但虚实不同耳。"可见胡老在治疗冠心病,遇到中寒气虚证时也用温补中气之法,而同时仍要祛除痰饮,因"中气大虚饮自下乘"。冠心病病久心衰,更易出现这些证候。

After a long history of coronary heart disease, there would be a trend to develop heart failure, showing palpitation and swelling and so on. When the condition shows the weakness in the body life energy, it should also use nourishing therapy. Dr. Hu, in this case, uses Lizhong Tang or Zhen Wu Tang for the treatment. It has been indicated in the book <<Jin Kui Yao Luo, heart pain and short of breath>> that … Dr. Hu explained, for choking sensation in the chest, the Zhishi Xiebai Guizhi Tang works to reverse the reversed Qi, so as to solve the bloating and choking sensation in the chest. The prescription Renshen Tang however works for the similar choking and bloating feeling that is due to the weakness of Qi in the middle of the body, so that the condensed water flows down to the stomach area. Therefore, the former prescription is used for a overwhelming condition, while the later Lizhong Tang (e.g. the Renshen Tang) is used for a deficient condition (a weakness condition). It can be seen that, whenever there is a middle Cold condition with Qi deficiency in coronary heart disease, Dr. Hu also uses warming therapy for the treatment, but which should be accompanied with phlegm-dissolving therapy, for there is down-flowing of condensed water in the body. After a long time coronary heart disease and when there is a heart failure, it is easy for patient to have such condition.

4贺某,男,62岁。

Case 4. Huo XX, male, 62 years of old.

初诊日期19651015日:双下肢浮肿、胸闷、喘满2月。有冠心病、心肌劳损已5年,近两月来胸闷、心悸加重,动则喘满,且出现双下肢浮肿。西医给服强心利尿药,未见明显疗效。又服中药10余剂,症亦不见好转,更感头晕、心悸明显,而找胡老治疗。近症:胸闷,心悸,头晕,气短,心下痞满,口唇紫绀,口干,大便干,小便少,双下肢浮肿明显,舌苔白腻,舌暗紫,脉沉弦细。胡老与木防己去石膏加茯苓芒硝汤:

The first visit: October 15, 1965. The patient had swelling in legs, choking feeling in chest, and asthma for two months. He had a history of coronary heart disease and myocardial strain for five years. For the later two months, he felt choking sensation in chest, worse palpitation, asthma with slight physical activity, as well as swelling in the legs. The western medicine treated him with heart-strengthening and urine-stimulating therapy, but in vain. He was also given herbal therapy for ten days without any improvement either. He felt further more dizziness, more palpitation, so came to Dr. Hu. The condition when he met Dr. Hu: choking feeling in chest, palpitation, dizziness, short of breath, bloating feeling in stomach area, purple color in the mouth lips, dry mouth, dry stool, less urine, and strong swelling in the legs. The tongue cover was white and greasy. The tongue per se was purple in color. The pulse was deep, string, and thin. Dr. Hu gave him Mu Fangji Tang with removal of Shigao, plus Fuling and Mangxiao Tang:

木防己四钱,桂枝三钱,党参六钱,茯苓六钱,芒硝四钱(分二次)

Mu Fangji 12 grams, Guizhi 9 grams, Dangshen 18 grams, Fuling 18 grams, and Mangxiao 12 grams (drink directly without cook).

结果:上药服三剂,下肢浮肿明显消退,头晕、喘满、心下痞满明显减轻。上方去芒硝,加生石膏一两,服六剂,浮肿已,胸闷、心悸各症亦不明显。

Results: After the treatment for three days, the swelling in legs subsided dramatically, the dizziness, asthma and bloating feeling in the stomach were dramatically less. From the above prescription, removed was Mangxiao, added was Shigao 30 grams. After six days of treatment, the swelling stopped, and the chest choking feeling and palpitation were no longer felt.

按:本例是中气虚寒非常明��的冠心病,因此以党参、桂枝温补中气。因中虚寒甚而饮邪上逆,故见胸闷、喘满、心悸等症。又因饮邪盛溢于下,故见双下肢浮肿。此时应温阳利水,用温补中气药理所当然,但痰饮停久,常易化热,乘虚上逆,治本应降逆,一些人常忽略于此,却囿于黄芪为补气之长,于此用其温补中气,使气升不降,饮邪亦随上逆,故使胸闷加重,更出现头晕等症。胡老辨证为木防已去石膏加茯苓硝汤,是本患者不但中气虚甚,而且气逆水盛也明显,同时又有心下痞满、二便不利、口干明显等症,因此,以党参温补中气为君,以桂枝温中降逆为臣,以防己茯苓利水化饮为佐,并使以芒硝清热除坚满,标本兼治,故见效迅速。这里更强调的是桂枝降冲逆的作用,是与黄芪升提正相反,一味之差,疗效迥。关于桂枝的降逆作用,胡老反复强调,熟读桂枝汤诸方证可自明。

Comments: This case is a typical coronary heart disease in Qi-deficient, middle-Cold condition. Therefore, the herb Dangshen and Guizhi were used to nourish the middle Qi. For the middle deficiency and Cold, there was condensed water reverse up, so the patient felt choking in chest, asthma, and palpitation.  For the condensed water spilling over, the patient has swelling in the legs. In this situation, it should be done to warm the Yang and to deplete the water. It is common to use herbs to nourish the Qi and to warm the middle. But after a long history, the phlegm is easy to develop Fire. The Fire flushes up when the body is in middle weakness condition. For the treatment, it should also pay attention to reverse the reversing. This is easy to be omitted by some doctors who paid more attention to use Huangqi to nourish the middle Qi. The Huangqi in this time would however make the Qi only lifting but not descending, so to make the reverse worse, to make worse the choking feeling and to cause more trouble as dizziness. That Dr. Hu diagnosed the condition as the indication of Mu Fangji Tang without Shigao, but plus Fuling and Mangxiao Tang, is for the reason that, the patient had not only clear middle Qi deficiency, but also Qi reverse and overwhelming water accumulation, and at the same time, the patient had bloating feeling in stomach area, rough urine and bowel movement, and dry mouth. For these reasons, the herb Dangshen is used to warm and to nourish middle Qi, as a key herb in the herbal prescription. The Guizhi is used to warm the middle Qi and to overturn the reversed Qi, as of an assistant. The Fangji and Fuling work to deplete extra water to dissolve the accumulated water, as of a helper. The Mangxiao works to clear Fire and to release the bloating feeling. By this way, both the symptoms and the cause of the disease are treated the same time, so the healing effect is very fast. Here it should be emphasized the overturning effect by the Guizhi. It is opposite of the raising effect of Huangqi. The difference in one herb makes the healing effect different dramatically. For the overturning effect of the herb Guizhi, Dr. Hu sai again and again that, it would be clearly understood after study the various Guizhi Tang in the book <<Shang Han Lun>>.

以上是胡老治疗冠心病最常用的方法,冠心病轻重不一变症多端,其治疗方法、所用方药也变化万千,用经方治疗该病也有许多方药,据证用药,当是定法。

The above is the commonly used herbs by Dr. Hu. The coronary heart disease is very different in terms of its severity and the accompanying symptoms. Therefore its treatment is also largely variable from patient to patient. There are many prescriptions in the Jing Fang for this disease. Use them, if there is indication for them. This is the rule.

12.   从病例谈治疗脑病经验

12. The treatment of brain disease

涉及脑病的中医病证很多,临床常见的有:头痛、眩晕、呕吐、昏迷、中风、痴呆、痫证、癫狂、郁证、不寐、耳鸣、耳聋、痉证、痿证等。现代医学可见于脑肿瘤、脑血栓、脑出血、癫痫、脑积水、脊髓灰质炎、更年期综合征、血管神经性头痛、抑郁症、精神分裂症等。胡老用经方治疗有不少独特经验。今从治验看其一斑。

There are many diseases that is associated to the brain. The commonly seen such diseases are headache, dizziness, nausea, coma, stroke, dementia, epilepsy, madness, stress, poor sleep, tinnitus, deafness, muscle paralysis or spasm, etc. In western medicine, they can be seen in brain tumor, thrombosis in brain, bleeding in brain, epilepsy, poliomyelitis, menopause syndrome, migraine, depression, schizophrenia, and so and so on. Dr. Hu has very special experience in the treatment of such diseases.

脑病繁烦何其多  治疗首推大柴胡

Though there are so many different diseases in brain system, the herbal prescription of Dai Chaihu Tang is the most recommended.

翻一翻胡老的经治病案,突出的印象是在治疗脑病中,使用最多的方剂是大柴胡汤合桂枝茯苓丸。通过这些病案分析,可看出胡老治疗脑病的特点。

If we have a review of the cases that Dr. Hu treated, the most impressive finding is that, for the brain diseases, he used most often is the herb prescription Dai Chaihu Tang plus Guizhi Fuling Wan. From analysis of these cases, we can find the characteristics of his experience.

1. (脑震荡后遗证) 蒋某,男,25岁,病案号110354

Case 1. (Post cerebral concusion syndrome). Jiang XX, male, 25 years of old. File number 110354.

初诊日期1964823日:于1957年因床倒受伤人事不知,六日后始苏醒,但后遗头晕、头痛、心烦躁等证,在当地先经西药治疗,不效,又找中医治疗,用药多是熟地、五味子、紫河车、核桃仁、龙眼肉、桑椹、丹参、川芎等所谓补肾填精之品,也一直未见好转而来京求治。近时犯头晕、头痛,颈项拘急且有上冲感,头痛如针刺,常心烦躁,心下堵,手足冷,眠差,每晚只能睡三四小时,大便干,舌苔白根腻,舌尖红,脉弦滑数。胡老与以大柴胡汤合桂枝茯苓丸加生石膏:柴胡四钱,半夏三钱,黄芩三钱,枳实三钱,大枣四枚,生姜三钱,茯苓三钱,桂枝三钱,自芍三钱,大黄二钱,丹皮三钱,桃仁三钱,生石膏一两半。

The first visit: August 23, 1964.  One day in year 1957, the patient fell off the bed and lost consciousness. Six days later, he waked up. But he felt dizziness, headache, and annoying feeling.  He had been treated in local hospital with western medicine but in vain. He also tried Chinese medicine. The herbs used were mostly the Shoudi, Wuweizi, Ziheche, Hetaoren, Longyanrou, Sangshen, Danshen, Chuanxiong, etc, such kidney-nourishing and Jing-supplying herbs. For no improvement, he came to Beijing to see Dr. Hu. On visit, he felt dizziness from time to time, headache, spasm and tightness feeling on the neck with gas pushing up feeling. The headache felt as thorn pounching. He felt often annoyed, bloating feeing in the stomach area, cold hands and feet, and poor sleep. He could only sleep for 3 to4 hours at night. The stool was dry. The tongue tip was red in color. The tongue cover was white and the root was greasy. The pulse was string, slippery and frequent. Dr. Hu gave him Da Chaihu Tang plus Guizhi Fuling Wan plus Shigao: Chaihu 12 grams, Banxia 9 grams, Huangqin 9 grams, Zhishi 9 grams, Chinese date 4, fresh ginger 9 grams, Fuling 9 grams, Guizhi 9 grams, Baishao 9 grams, Dahuang 6 grams, Danpi 9 grams, Taoren 9 grams, and Shigao 45 grams.

结果:上药服三剂,头晕头痛减,心烦躁减,心下堵已,大便如常,上方减生石膏为一两,又服三剂,诸证已。

Results: After the herbal therapy for three days, the dizziness and headache reduced, the annoyed feeling reduced too. The bloating feeling in stomach was subsided. The bowel movement turned normal. From the above prescription, Shigao was decreased to 30 grams. The new prescription was continued for three days and no any symptoms at all.

按:该患者病已七年,可谓久矣,前医者囿于病久必虚,且见头晕、肢冷、眠差等,往往辨证为肾精亏损,脑髓不足,故以地黄、山萸肉、龙眼肉、五味子、紫河车、核桃仁等补之,方中虽也加入丹参、赤芍等活血之品,但证属实而用补,大法错误,故使病久迁延不愈。据患者有心下堵、颈项拘急、大便千,知病在少阳阳明;病已七年并因外伤,常有头痛如针刺、眠差等,知为久有瘀血,故为大柴胡汤合桂枝茯苓丸方证,又因有心烦躁之症,故加生石膏解热除烦。因方药对证,药能直对病本,故头晕头痛、失眠皆应刃而解。

Comments: This patient had suffered from the problem for seven years. It is really a long history. The previous doctors focused on the saying that a long term disease must have a weakness condition, and on the symptoms as dizziness, cold hands and feet, and poor sleep, so they diagnosed the condition as kidney deficiency with Jing (micro-nutration material) deficiency syndrome. For the empty of the brain, they used Dihuang, Shanyurou, Longyanrou, Wuweizi, Ziheche, and Hetaoren. Though there were also Danshen and Chishao in the prescription, it is to use a nourishing therapy to a overwhelming condition, a principle mistake in the treatment, which makes the disease lasted for a long time without improvement. For the symptoms of bloating feeling in the stomach area, stiff neck and dry stool, it is known that the disease is in the Shaoyang-Yangming phase. For the disease has been there for seven years due to trauma, and for the fact that the patient felt headache as thorn pounching, and poor sleep, it is known that there is long term of blood stagnation. Therefore this is an indication of Da Chaihu Tang plus Guizhi Fuling Wan. For there is annoyed feeling, so added was Shigao to clear the annoyed feeling. For the herbs match the condition, and the herbs work to the cause of the disease, the symptoms subsided very soon.

 

2 (腮腺炎合并脑炎). 董某,女,7岁,病案号1790265

Case 2 (Mumps with cerebritis). Dong XX, female, 7 years of old. File number: 1790265.

初诊日期196592日:发烧、两腮肿痛一周。近几天来出现头痛、头晕、恶心、呕吐,经同仁医院腰穿确诊为"腮腺炎合并脑炎"。因是病毒性感染,西药无对症药物,嘱其找中医诊治。近症:两腮肿痛,左侧肿甚,红肿而硬,头晕、头痛,时恶心、呕吐,不欲食,往来寒热,体温382?。大便干燥,舌苔白黄,脉弦数。与大柴胡汤加银花、连翘、公英、甘草、生石膏:柴胡五钱,黄芩三钱,半夏三钱,枳实三钱,生姜三钱,白芍三钱,大枣四枚,大黄二钱,银花四钱,连翘五钱,公英八钱,炙甘草二钱,生石膏二两。

The first visit: September 2, 1965. The patient had fever, swelling and pain in the cheek for one week. For recent several days, she had headache, dizziness, nausea and vomit. In hospital, her condition was diagnosed as mumps with cerebritis. For being virus infection, there was no matching therapy in western medicine, she was suggested to see Chinese medicine. The current symptoms were: swelling and pain in cheek, which was more in the left side. The swelling side is also very much in red and hard when touch. She felt dizziness, headache, as well as nausea and vomit form time to time. She had no desire to eat, had cold-fever shift feeling and had constipation. The body temperature was 38.2 C. The tongue cover was white-yellow in color. The pulse was string and frequent. She was given Da Chaihu Tang plus Yinhua, Liangqiao, Pugongying, Gancao and Shigao: Chaihu 15 grams, Banxia 9 grams, Zhishi 9 grams, fresh ginger 9 grams, Baishao 9 grams, Chinese date 4, Dahuang 6 grams, Yinhua 12 grams, Liangqiao 15 grams, Pugongying 24 grams, Zhi Gancao 6 grams, and Shigao 60 grams.

结果:上药一剂,煎两次,分为两天服。服后,腮肿减轻,头痛已,仍头晕,恶心减,近两天仅呕吐一次,发热减,体温374?,上方去大黄继服一剂,呕吐已,头晕减。但自汗、嗜卧,与小柴胡汤加生石膏:柴胡二钱,黄芩二钱,半夏三钱,党参二钱,生姜三钱,大枣四枚,炙甘草一钱,生石膏一两。服三剂诸症已。

Results: The herbs were cooked twice. The extract was separated for two day’s intake. After two days, the swelling in cheek was reduced. The headache subsided. There was still remaining dizziness. The nausea was less. She only vomited once for the two days. The fever was reduced to 37. 4C. From the prescription above, reduced was Dahuang. The herbal tea was drunk for one day. The nausea stopped. The dizziness reduced but still with sweat and desire to lay down. She was then given Xiao Chaihu Tang plus Shigao: Chaihu 6 grams, Huangqin 6 grams, Banxia 9 grams, Dangshen 6 grams, fresh ginger 9 grams, Chinese date 4, Zhi Gancao 3grams, and Shigao 30 grams. After additional three doses, all the symptoms were away. 

按:本例脑炎,来诊时呈三阳合病,故以大柴胡和解三阳,加银花、连翘、公英、甘草、生石膏增强清热解毒之力,着重祛邪安脑。当邪却症减,正气也衰,故见自汗、嗜卧。因此用小柴胡汤加生石膏建中和胃,使中和而神安。

Comments: For this case, the patient’s condition was the Taiyang, Shaoyang and Yangming, the three Yang co-exist phases. Therefor she was given Da Chaihu Tang to solve the three Yang phases, with the addition of Yinhua, Liangqiao, Pugongying, Gancao and Shigao to increase the Fire-clearing and Toxic-detoxifying effect of the whole prescription. The prescription focused on the XieQi dispelling and brain-calming effects. When theXie Qi subsided, the body defence energy was also exhausted, so the patient had sweat and desire to have a sleep. For this reason, the prescription Xiao Chaihu Tang plus Shigao was used to harmonize the middle stomach, to calm the stomach so as to calm the spirit.

3 (癔病). 段某,女,14岁,病案号173651

Case 3. (Hysteria). Duan XX, female, 14 years of old. File number: 173651.

初诊日期1965929日:患者在"3月月经初潮,后未再潮,7月曾有一次鼻衄。于65423日突发四肢抽搐及昏厥。近来发作频繁,每发病前厌食,右上腹疼,胸闷,口吐酸水,当有气自腹向上冲时即发肢抽动,四肢发凉,并见呼吸急迫,大声喧喊,口苦,便干,意识朦胧,每针刺人中即清醒。平时恶喧嚷,看电影则头晕。近发作较频,常因饮食诱发,舌苔薄白,舌有瘀点,脉弦细稍数。与大柴胡汤合桃核承气汤:柴胡三钱,半夏三钱,黄芩三钱,枳实三钱,白芍三钱,桂枝三钱,桃仁三钱,茯苓三钱,大黄二钱,生姜三钱,大枣四枚,丹皮三钱,芒硝三钱(分冲)

The first visit: September 29, 1965. The patient had the first menstruation several years ago. It did not came later for years. On July this year, she had nose bleeding once. On April 23 this year, she suddenly had spasm in the arms and legs and had a coma. Such onset came more and more frequent lately. Before each onset, she had dislike feeling for food, pain in right upper side of the belly, choking feeling in chest, and spit acid water in mouth. Once she felt a gas pushing from lower belly up to the chest, she would have such spasm, cold in arms and legs, as well as frequent breath, crying loudly, bitter taste in mouth, dry stool, cloudy mind. She could wake up once acupuncture was performed on her Renzhong point. When she was not under the onset, she disliked noise. She felt dizziness when watch a film. Recently, the onset became more and more frequent. It was usually trigerred out by eating or drinking. The tongue cover is thin and white. There were purple spots on the tip of the tongue. The pulse was string, thin and slight frequent. She was given Da Chaihu Tang plus Taohe Chenqi Tang: Chaihu 9 grams, Banxia 9 grams, Huangqin 9 grams, Zhishi 9 grams, Baiahao 9 grams, Guizhi 9 grams, Toaren 9 grams, Fuling 9 grams, Dahuang 6 grams, fresh ginger 9 grams, Chinese date 4, Danpi 9 grams, and Mangxiao 9 grams (drink directly, without cook).

结果:上药一剂,抽搐及胃腹痛未作,吐酸水已,仍感头晕。改服小柴胡汤合当归芍药散:柴胡四钱,党参三钱,炙甘草二钱,当归三钱,白芍三钱,川二钱,半夏三钱,黄芩三钱,泽泻三钱,生姜三钱,大枣四枚,苍术三钱,茯苓三钱,吴茱萸三钱。先后加减服用三个月,诸症均消。

Results: After the herbal therapy for one dose, the convulsion and stomach pain did not happen again. The acid water spitting stopped. She still felt dizziness. The herbal prescription was changed to Xiao Chaihu Tang plus Danggui Shaoyao San: Chaihu 12 grams, Dangshen 9 grams, Zhi Gancao 6 grams, Danggui 9 grams, Baishao 9 grams, Chuanxiong 6 grams, Banxia 9 grams, Huangqin 9 grams, Zexie 9 grams, fresh ginger 9 grams, Chinese date 4, Cangzhu 9 grams, Fuling 9 grams, and Wuzhuyu 9 grams. The herbal prescription was modified in different ways several times and it was continued for three months. All the symptoms subsided.

按:病属神经官能性疾病,西药无对证良药,中医辨证论治多有良效。值得一提的是,脏腑辨证多认为肝气郁结、或痰郁气结等。张志纯老中医多把该病称为"肝痫",擅用逍遥散加减治疗,偏于养血、利水、疏气、温补为主,与胡老主用祛瘀、理气、攻下以祛实为主显然不同。但在会诊讨论病案时,认为柴胡剂对脑病有良效,两老中医却有共识,值得进一步探讨。

Comments: The hysteria belongs to neurosis. No proper medicine in western medicine to solve it. Chinese medicine, however, has pretty good results for its treatment. It is worthwhile to mentioned that, by the organ diagnosis system, it is believed to due to Liver Qi sluggish, or Phlegm blocking, etc. Dr, Zhichong Zhang (a very famous TCM doctor in current times) believed it is to the “Liver spasm/epilepsy”. He is good at using prescription Xiaoyao San for the treatment. This herbal prescription works more to nourish the blood, to deplete water, to dredge Qi circulation, and to warm nourishing. It is apparently different to the therapeutical principle by Dr. Hu, who uses Phlegm-dissolving, Qi-dredging, and colon-cleansing therapy. However, in consultation for patients, Dr. Zhang also believed that, the Chaihu-containing prescription has good therapeutic results to brain diseases, similar to what Dr. Hu believed. This is worthwhile to further study.

4. (癫痫) 张某,男,46岁。

Case 4. (Epilepsy).  Zhang XX, male, 46 years of old.

初诊日期1981313日:因19688月被电击伤、击倒,昏迷约一分钟,身体七处被灼伤,自此常发癫痫,大约每半月发一次,并每天头痛无休,在当地中西医治疗迄今 未愈。现症:胸胁苦满,胃腹胀满,早起恶心,后头痛,喜步忘,舌苔白根黄腻,脉沉弦。与大柴胡汤合桂枝茯苓丸加生石膏:柴胡六钱,半夏四钱,黄芩三钱,枳实三钱,生姜三钱,大枣四枚,桂枝三钱,桃仁三钱,白芍三钱,茯苓三钱,丹皮三钱,大黄二钱,炙甘草二钱,生石膏一两半。

The first visit: March 13, 1981. The patient came into coma for one minute after beat by electric force. His body was burned wound for seven spots. From then on, he usually had epilepsy. It was about once every half month, with continuous headache every day. He had had Chinese medicine treatment and western medicine treatment at local hospital, but in vain. The current conditions: he felt bloating and choking feeling in the chest, fullness and bloating feeling in the belly. He felt nausea and headache in back of head in early morning. He was easy to lose memory too. His tongue cover was white, but yellow and greasy on the root part. The pulse was string. He was given Da Chaihu Tang plus Guizhi Fuling Wan plus Shigao: Chaihu 18 grams, Banxia 12 grams, Huangqin 9 grams, Zhishi 9 grams, fresh ginger 9 grams, Chinese date4, Guizhi 9 grams, Taoren 9 grams, Baishao 9 grams, Fuling 9grams, Danpi 9 grams, Dahuang 6 grams, Zhi Gancao 6 grams, Shigao 45 grams.   

结果:上药服16剂,恶心、头痛已,癫痫发作较轻,约一月一次,仍喜忘。仍上方继服10剂,癫痫未再发,喜忘好转渐已。

Results: After the herbal therapy for 16 doses, the nausea and headache subsided. The epilepsy onset reduced in entensity, which was about once a month. She still felt easy to forget. The herbal therapy was continued for additional 10 doses, the epilepsy stopped to come. The poor memory gradually recovered.

按:傍观者奇,急索其方、记其案。胡老只是淡然回答:"他,是方药对证。"《伤寒论》第237条:"阳明证,其人喜忘者,必有蓄血,所以然者,本有久瘀血,故令喜忘。"胡老在注解该条时论述道:其人如狂、喜忘,为瘀血的要征,即《内经》所谓"血并于上则乱而喜忘"是也。久瘀血其来也渐,故令喜忘;新瘀血其来也暴,故令如狂。但新者易攻,桃仁承气汤辈即能治之;久者难拔,势须抵挡丸,方可克之。忘与狂均属精神神经症。以是可知,诸精神神经症,多因瘀血为患,治以祛瘀活血多能取效。由此也悟出,狂躁、癫痫等脑系病变,用祛瘀法治疗,是有效的方法之一。仅用大柴胡汤合桂枝茯苓丸加减治疗的病案也多不胜数,例如1975522日来一外地患者,男性18岁,突发痴呆,不能说话。经腰穿等检查未见异常,而治疗半年未见好转。胡老与大柴胡汤合桂枝茯苓丸回家治疗。待一月后,来信告知,患者服20剂后症状渐渐好转,已能说话。又有甄某,女,20岁,196712月来诊,其人如醉如痴,问话不答,在家也不言语,已多治无效,舌苔黄,脉微数,与大柴胡汤合桂枝茯苓丸加生石膏,连服10余剂,证已,上班工作,变得性格活泼爱说。

Comments: Other doctors/students felt interesting and urgently asked for prescription and made note for the case. Dr. Hu simply said: “This case, well, simply because the herbs and the body condition matched”. In book <<Shang Han Lun>>, the 237 paragraph, it indicated: … In the explanation of this paragraph, Dr. Hu said: That the person behaves as madness and tends to lose memory is the key sign of the presence of dead blood in the body. If the blood stagnation developed gradually and it takes a long time, it shows as loss of memory. If it formed quickly, it shows as madness. For newly developed blood stagnation, it is easy to solve, such as to use Taohe Chenqi Tang. If it developed gradually, it is difficult to solve. The prescription Didang Tang has to be used. The poor memory and madness both belong to the mental disease and neurosis. From this, it can be implied that, the various mental and neurosis problems might be due to stagnated blood in the body. The use of blood stagnation-dispelling therapy would mostly work. So, for madness, epilepsy, such mental disease, the blood stagnation-dissolving therapy would be one of the effective therapies. There are many cases with such mental diseases, who were successfully cured with the Da Chaihu Tang plus Guizhi Fuling Wan alone. For example, in May 22, 1975, there was a patient from other city. He was 18 years of old. He catched dementia suddenly, failed to speak. Lumbar pounching test found nothing wrong. He was treated in local hospital fof half year without any improvement. Dr. Hu gave him the Da Chaihu Tang plus Guizhi Fuling Wan, and let him bring home to continue. After one month, he told Dr. Hu by a letter that after 20 doses, he was gradually improved and now he could speak. Another example is a female, she was 20 years of old. She came in December 1967. She looked as drunk as foolishness. She had no answer when she was asked for a question. She did not speak at home. She had been treated for a long time but in vain. Her tongue cover was yellow. The pulse was slight frequent. She was given the Da Chaihu Tang plus Guizhi Fuling Wan plus Shigao. After a continuous ten doses of the herbal therapy, she turned completely normal. She started to work and became active and rich to talk.

5. (脑梗塞).  崔某,男,66岁,首都机场患者。

Case 5. (Cerebral infarction). Chui XX, male, 66 years of old. A patient of Capital airport.

初诊日期196635日:两周前病发脑梗塞,出现左半身不遂,麻木不仁,走路不稳,需人扶持,口干思饮,大便干,舌苔白根腻,脉弦滑数,血压190120毫米汞柱。与大柴胡汤合桂枝茯苓丸加生石膏:柴胡四钱,半夏三钱,黄芩三钱,白芍三钱,枳实三钱,大黄三钱,生姜三钱,大枣四枚,桂枝三钱,丹皮三钱,茯苓三钱,桃仁三钱,生石膏一两半。

The first visit: March 5, 1966. The patient got cerebral infarction two weeks ago. He had paralysis and numb on the left side of the body. The walk was unbalanced, needing help by others. He felt dry mouth and had desire to drink. The stool was hard. The tongue cover was white and it was greasy on the root. The pulse was string, slippery and frequent. The blood pressure was 190/120 mmHg. He was given Da Chaihu Tang pluse Guizhi Fuling Wan plus Shigao: Chaihu 12 g, Banxia 9 g, Huangqin 9 g, Baihsao 9 g, Zhishi 9 g, Dahuang 9 g, fresh ginger 9 g, Chinese date 4, Guizhi 9 g, Danpi 9 g, Fuling 9 g, Taoren 9 g, Shigao 45 g.

二诊41日:上药服6剂,走路已轻快,已不用他人扶持,大便日3--4行,血压160/100毫米汞柱。仍宗前方,大黄减为二钱。

The second visit: April 1. After the herbal therapy above for 6 doses, he could walk easily without others help. The bowel movement was 3 to 4 times a day. Blood pressure was 160/100 mmHg. The same prescription was continued with reduction of Dahuang to 6 g.

三诊48日:左半身不仁明显好转,唯左臂尚不遂,血压15096毫米汞柱,仍上方消息之。

The third visit: April 8. The left paralysis turned better. The left arm was not so flexible yet. Blood pressure was 150/96 mmHg. The same prescription was continued for a while for a maintenance.

按:以上是胡老治疗脑病的部分病案,无论是器质性和功能性病变,都有用大柴胡汤的机会,当然其前提是,当患者出现其方证时才能应用。

Comments: These cases were only some of the cases treated by Dr. Hu. No matter it is a organic disease or only a functional disorder of the brain, there is chance to use the Da Chaihu Tang. Of course the premise is that there is the indication to the prescription.

惊狂缘本于亡阳   桂枝救逆理应当

The real reason for hysteria is the exhaustion of Yang Qi. It is reasonable therefore to use herb Guizhi.

6 (癔病)  王某,女,26岁,空军翻译。

Case 6 (Hysteria). Wang XX, female, 26 years of old. Translator in air force.

旁观修理电线而受惊吓,出现惊悸、心慌、失眠、头痛、纳差、恶心。时有喉中痰鸣,每有声响则心惊变色,躁烦而骂人不能自控,逐渐消瘦,由两人扶持来诊。舌苔白腻,脉弦滑寸浮。此为寒饮上犯,治以温化降逆,与桂枝去芍药加蜀漆龙骨牡蛎汤加减:桂枝三钱,生姜三钱,炙甘草二钱,大枣四枚,半夏四钱,茯苓四钱,生龙骨五钱,生牡蛎五钱。

The patient was scared when she watched a repair of electrical line. She had scare, palpitation, poor sleep, headache, poor appetite, and nausea. She had phlegm noise in the throat from time to time. She would feel scare and her face would turn pale whenever there is sudden noise. She could not help from being annoyed, restless and sworing at people.  She gradually lost body weight. When she came to the clinic, her tongue cover was white and greasy. The pulse was string, slippery and on the Chun position, floating. Her condition was considered to be Cold-Water rushing up. The therapy used was to warm the phlegm and to overturn the reversed Qi. She was given Guizhi Tang without Shaoyao, but with Shuxi, Longgu and Muli: Guizhi 9 g, fresh ginger 9 g, Zhi Gancao 6 g, Chinese date 4, Banxia 12 g, Fuling 12 g, Longgu 15g, Muli 15 g.

结果:上药服三剂,心慌、喉中痰鸣减轻。服六剂,纳增。睡眠好转。再服10剂诸症皆消。

Results: After the herbal therapy for three doses, the palpitation and phlegm noise in throat were reduced. After six doses, the appetite and sleep were improved. After additional ten doses, no any more symptoms left. 

7 (癔病)  刘某,男,30岁。

Case 7. (Hysteria). Liu XX, male, 30 years of old.

初诊日期196645日:东北泰来地区出现一条疯狗。到处咬人,人人恐惧。一天患者不料遇到疯狗,虽未被咬伤,但被惊吓致病,出现心慌、惊悸、恐惧、失眠等症,用中西药治疗久不见效。经病人介绍而来京找胡老诊治。患者外观泰然。神色无异常,只是感心慌、胸闷、时有恐惧不能自主,常失眠盗汗,舌苔白腻,脉弦数。脉证合参,知为阳虚水逆而致心阳不振,为桂枝甘草龙骨牡蛎汤的适应证:桂枝四钱,炙甘草二钱,茯苓五钱,生龙骨一两,生牡蛎一两。

The first visit: April 5, 1966. In 1966, in the area of Tailai, the North-East part of China, there appeared a mad dog, who bite every people, which worried the resident very much. One day, the patient met the mad dog. Though he was not bitten, he was scared very much so to sick. He felt flustered, scared, palpitation, and poor sleep, etc. He was treated with both western medicine and Chinese medicine but in vain. He was introduced by other patient to come to see Dr. Hu. On visit, the patient looked calm. No special sick signs. He only felt flustered, and choking feeling in chest. From time to time, he felt scared, which he could not help to stop. He often had poor sleep with night sweat. His tongue cover was white and greasy. The pulse was string and frequent. Combined the findings from the tongue cover and the pulse, his condition was diagnosed as Yang deficiency with Water reverse up, so to cause the Heart Yang Qi is inactivated. It is the indication to Guizhi Gancao Longgu Muli Tang: Guizhi 12 g, Zhi Gancao 6 g, Fuling 15 g, Longgu 30 g, Muli 30 g.  

结果:上药服六剂,诸症已,高兴���原籍,并来信告之一年多也未复发。

Results: After the herbal therapy for 6 doses, all the symptoms went away. He felt glad to go home. He wrote a letter after one year and said there was no recurrence at all.

按:以上两例都是惊悸证,西医可明确诊断:可谓神经官能症,但用各种镇静安神药无效。中药有效,但必须方药对证。一般中医,往往见心慌、失眠、盗汗等,首先想到为阴血虚而阴虚阳亢。这可能缘于对《伤寒论》有关条文理解的不同。如《伤寒论》第112条:"伤寒脉浮,以火迫劫之,亡阳必惊狂,卧起不安者,桂枝去芍药加蜀漆牡蛎龙骨汤主之。"一些注家说什么:"本方中的亡阳和少阴证的亡阳不同。少阴亡阳是有汗出肢冷,筋惕肉晌的证侯;......因为前者所伤是肾阳,后者所伤是心阳。伤肾阳的宜四逆、真武;伤心阳的宜桂枝救逆。"只不过是说亡阳是亡阳气,"因火邪逼迫,心神耗散以致惊狂不安。所以用桂枝汤去芍药之苦平,加蜀漆之辛散(当主要是祛痰作用),目的是使火气与外邪一时并散。"一方面说亡阳气,一方面说治疗时要散火气与邪气,倒底病因病机是什么,让人越看越糊涂,桂枝去芍药加蜀漆牡蛎龙骨汤、桂枝甘草龙骨牡蛎汤的功能主治不明白,因此当遇此方证时不会用其方,而往往一见惊悸即想到是心血虚、心阳亢,治疗必以生地、白芍、酸枣仁、柏子仁、生龙骨、生牡蛎等养心潜阳。

Comments: The two cases above both are scared condition. The diagnosis with western medicine is clear: nervous disease. The treatment with various diazepam and similar remedies does not work at all. On the other side, the Chinese medicine works for such condition. For ordinary TCM doctors, they would consider Yin blood deficiency or Yin deficiency with Yang overwhelming, once they see the flustered, poor sleep and night sweat. This might be due to their different understanding of the book <<Shang Han Lun>>, the paragraph 112: … For the reason that they did not understand the indication of the Guizhi without Shaoyao but with Suxi Muli Longgu Tang and Guizhi Gancao Longgu Muli Tang, they would not be able to use this prescriptions when they meet such clinic conditions. Therefore, once they meet the scared condition, they would think it is the Heart Blood deficiency, or Heart Yang overwhelming condition. For the treatment, they would likely use the herb Shengdi, Baishao, Suanzaoren, Boziren, Longgu and Muli to nourish the Heart Yang and to dive-store the Yang Qi.

产生这一不同的认识主要原因,胡老明确指出,是《伤寒论》与<内经>为两个不同的理论体系。仅就关于狂的成因来看,《内经素问至真要大论》曰:"诸躁狂越,皆属于火。"<素向脉解篇>曰:"所谓甚则狂癫疾者,阳尽在上,而阴气从下,下虚上实,故狂癫疾也。"《难经二十难》曰:"重阳者狂,重阴者癫。"而《伤寒论》对惊狂的形成与《内经》完全不同,从具体条文看桂枝去芍药加蜀漆牡蛎龙骨救逆汤和桂枝甘草龙骨牡蛎汤方证即可明白。胡老对该两方证有明确的解释:伤寒脉浮,本宜麻黄汤发汗治之,而医以火迫使大汗出,乃错误的治疗,徒亡津液,不但表不解,且导致急剧的气上冲,并激动里饮,而发惊狂,以致卧起不安。《伤寒论》谓"太阳伤寒者,加温针必惊也"。是说伤寒本是热证,以火助热,邪因益盛,气冲饮逆,此惊狂奔豚之所以作也。桂枝去芍药加蜀漆牡蛎龙骨汤能治火劫亡阳的逆治证,故又特称之为救逆汤。此方为桂枝汤去芍药加驱痰的蜀漆、镇惊的龙牡,故治桂枝去芍药汤证有痰饮而惊狂不安者。

The main reason for such difference in the understanding of the book <<Shang Han Lun>>, as pointed out by Dr. Hu, that the book <<Shang Hang Lun>> and the <<Nei Jing>> belongs to different theoretical systems. Let’s just have a look at the explanations by these two books for the cause of the scared condition: …… 

For the Guizhi without Shaoyao but with Suxi Muli Longgu Tang and Guizhi Gancao Longgu Muli Tang, Dr. He explained: in the Shanghang disease and if the pulse feels floating, it should be treated by the use of Mahuang Tang to create sweat to dispel the Xie Qi. However, if the patient was to face a fire (by toast, by cover with hot towl, or by the use of moxibustion, etc.) to create a sweat, it is a wrong therapy. By this wrong way, the body liquid portion would be exhausted rather than the sweat would work to bring the Xieqi out of the body. Such sweat would trigger the gas/air rushing up, which again to stir out that liquid inside body to push up, so as to form madness, flustered, and scared feeling. This is the reason for the scared condition. The Guizhi without Shaoyao but with Suxia Muli Longgu Tang can solve such scared condition due to stirring of air/water inside body by facing to a fire therapy, so it is also called a “Reverse-saving herbal prescription”. This prescription is developed from the Guizhi Tang but removed is the Shaoyao, but added is Suxi (to dispel phlegm), Longgu and Muli (both are to calm down the scare). Therefore it is used for a Guizhi Tang condition with scared feeling.  

值得说明的是,蜀漆苦辛,平,为除痰、截疟药,并无解表散邪作用,胡老常以半夏、茯苓等代之,从以上两治验可看出,疗效颇佳,不用酸枣仁、柏子仁等安神,因饮去冲逆止则神安眠安。如按《内》《难》所述:"重阳者狂""阳尽在上",何以能用桂枝救逆汤治疗?胡老通过多年系统研究和教授《内经》《伤寒论》。提出两者理论体系不同,是有客观依据的,也是出于严肃的治学态度。

It should be pointed out that, the herb Suxi (the Chinese name means the painting oil produced in Sichuan province, China). It herbal nature is not so bitter or spicy. It works to dispel phlegm and to stop malaria. It has no surface-releasing effect. Dr. Hu usually uses herb Banxia and Fuling, etc. to replace it. From the two cases above, it can be seen that, the replacement works well in the prescription. He did not use any Suanzaoren or Boziren, such calming herbs, but use the herbs to dispel the reversed air-pushing force in the body. When the stirred air/gas downtuns to its original position, the emotion returns to calm again. …… That Dr. Hu pointed out that the <<Nei Jing>> and <<Shang Han Lun>> are different medical theory system is based on the concrete reasons. It also reflects his exact and precise scientific attitude in medical research – not follow every people’s believing. 

13.  眩晕并非肝阳亢    里外寒热更疯狂

13. The dizziness is not always due to the Liver Yang overwhelming. The inside Xie overwhelming condition could also make the condition worse and last a long time.

8 (高血压、中风) 刘某,女,65岁。

Case 8. (Hypertension, stroke) Liu XX, female, 65 years of old.

初诊131965119日:胡老赴延庆巡回医疗,遇一老者用两轮车拉其老伴来诊,该患者病急中风三日,头晕不起,烦躁不得眠,左半身不遂,前医以大剂平肝潜阳之品。并加羚羊角粉五分冲服。患者服一剂,症不但不减,反更烦躁,整夜不眠,并感明显热气上冲、胸闷懊侬,舌苔黄腻,舌红,脉弦滑数。血压260160毫米汞柱。其老伴问胡老:"能包治好吗?不包好就不治了,光羚羊角就花五元钱,治不起!"胡老回答:"包治不好说,但我开的药不过二角钱左右,您可试服一剂。"老者同意一试,于是胡老开方与大黄汤加生石膏:黄连二钱,黄芩三钱,栀子三钱,生石膏一两半,大黄 三钱。嘱:先以大黄浸汤,以其汤煎诸药。

The first visit: Nov. 9, 1965.  One day when Dr. Hu had a healthcare travelling in Yanqin district, China, one old man send his wife with a wheelchair to see Dr. Hu. The lady had stroke for three days. She felt dizziness, annoyed so as hard to fall into sleep. Her left half body failed to move. The previous doctor gave her herbal therapy to calm Liver, and to dive the Yang, in addition to have Lingyangjiao powder (5 fen) to drink directly. The patient drunk one time, all the symptoms became worse. She felt more annoyed and hard to fall into sleep all the night. She felt hot air rushing up, choke feeling in chest. Her tongue cover was yellow and greasy. The tongue was red in color. The pulse was string, slippery and frequent. The blood pressure was 260/160 mmHg. The husband asked Dr. Hu: “Can you promise to cure her condition? If not, we are not going to continue the treatment. The Lingyangjiao only costs 5 dollars. We cannot afford it at all.” Dr. Hu said: I can not promise you to cure. But the prescription I would like you to try costs only about 0.2 dollars. You can try one dose.” The old man agreed to try. So Dr. Hu gave her the prescription: Dahuang Tang plus Shigao: Huanglian 6 g, Huangqin 9 g, Zhizi 9 g, Shigao 45 g, and Dahuang 9 g. He reminded the old man: first to rinse the Dahuang in water. Use the water to cook other herbs.

结果:上药服一剂,第二天下午又来诊,老者进门即磕头作揖,并口中_道:"可遇到救命恩人了!"并请求再赐良方。胡老详问之,知其服药后,大便通一次,诸症明显减轻,血压为150100毫米汞柱。与服大柴胡汤合桂枝茯苓丸加生石膏调理。

Results: After one such dose treatment, the patient came back the afternoon next day. The old man bended his knee to Dr. Hu, said: “We meet our benefactor to save life!”. He begged Dr. Hu to continue the prescription. Dr. Hu asked the patient body reaction to the previous herbs and knew that, after drunk the herbal tea, the lady had a bowel movement. Most of the symptoms subsided dramatically. The blood pressure became 150/100 mmHg. She was given Da Chaihu Tang plus Guizhi Fuling Wan plus Shigao for maintenance.

9. (高血压).  赵某,男,53岁,病案号154112

Case 9. (Hypertension) Zhao XX, male, 53 years of old. File number:154112.

初诊日期1965126日发现高血压已20多年,常头痛头晕、失眠,于196542日来门诊治疗。前医以平肝潜阳、活血益气、滋阴养心等法治疗半年未见明显变化。近一月常头晕、失眠、烦躁、易怒、心慌、鼻衄、大便干,左半身麻木,血压170130毫米汞柱,舌苔黄,舌质红,脉弦数。证属阳明里热,治以清泄里热,与泻心汤加生地炭:大黄三钱,黄连二钱,黄芩三钱,生地炭三钱。

The first visit: December 6, 1965. The patient had hypertension for more than 20 years. He often felt headache, dizziness, and poor sleep. He came at April 2, 1965 for a treatment. The doctor at that time gave him herbs to balance the Liver, to dive the Yang, to activate circulation, to nourish the Qi, the Yin and the Heart. The treatment lasted for half year without apparent improvement. For the later one month, he often felt dizziness, poor sleep, annoyed, easy to feel upset, flustered, nose bleeding, dry stool, and paralysis in the left side of the body. His blood pressure was 170/130 mmHg. The tongue is red in color. The tongue cover was yellow. The pulse was string and frequent. His condition was diagnosed as Yangming phase with inside Fire. The therapy is to clear the inside Fire. He was given the prescription Xiexing Tang plus Shengdi Tan: Dahuang 9 g, Huanglian 6 g, Huangqin 9 g, Shengdi Tan 9 g.    

结果:上药服三剂,大便通畅,心烦、鼻衄已,睡眠好转,时有胸闷,改服大柴胡汤合桂枝茯苓丸加生石膏,一月,头晕痛等诸症皆已。血压在150160100110毫米汞柱波动。

Results: After drinking the herbal tea for three doses, the bowel movement became easier. The annoyed feeling and nose bleeding subsided. The sleeping was better. He felt chest choking feeling from time to time. The prescription was changed to Da Chaihu Tang plus Guizhi Fuling Wan plus Shigao. This herbal therapy was lasted for one month. The dizziness and headache and other symptoms were stopped. His blood pressure was 150-160/100-110 mmHg. 

按:治病不在用药多、用药贵,而在方药对证,从这两例可看清楚。例8用了大量平肝潜阳药,而且还用了羚羊角,结果服后更烦躁不得眠;而胡老仅用了五味普通常用药,即速收其功。例920年沉屙,前医长期用养阴、平肝、潜阳等法不效,胡老仅用普通四味即收显效。原因何在?实际道理很简单,前医只是治其标阳亢,未治其本邪实。而胡老不仅有丰富的临床经验,更重要的是仲景学说掌握到家,因此有鹰鹫之眼,一眼就看穿是阳明里实热,直投三黄泻心,捣其病本,用药精简准确,不必网络原野。

Comment: A cure or improvement of a disease does not depend on the use of more herbal ingredients in a prescription, but on the match of the prescription to the disease condition. This can be well proven by the two cases above. In case 8, the patient was given a lot of herbs to balance the Liver and to dive the Yang, as well as given Lingyangjiao. The patient however, did not feel any good but worse. Dr. Hu used only five ordinary herbs and solved the problem. In case 9, it was a 20-year long disease. The previous doctors used many different ways without any improvement. Dr. Hu used only 4 herbs and they works. What’s the reason for this difference? The reason is very simple. The previous doctors worked on the symptomatical Yang overwhelming, but not on the Xie overwhelming in nature, but Dr. Hu has not only very rich clinic experience but he also learnt the nature of the Dr. Zhongjing Zhang, the Shang Han Lun. It is him who find the clinic condition is a Yangming inside overwhelming condition, so used the Three Yellow XieXing Tang to focused on the nature and the core of the disease. The herbs are not many in the number but work very well.

 

14.  美尼尔氏及癫痫  水饮上犯最常见

14. For the Meniere’s disease and epilepsy, the water rushing-up is the very common cause.

1. (美尼尔氏综合征) 陈某,女,25岁,清华大学学生。

Case 1, (Meniere’s disease). Chen XX, female, 25 years of old. University student.

初诊日期19651016日:四五个月来头晕、目眩、恶心、心慌、不能进食、不能看书,西医诊断为美尼尔氏综合征,服西药治疗无效,查血压正常,口干不思饮,思睡,乏力,但行动自如,月经后期量少,舌苔白根腻,脉沉细弦。证属血虚水盛,治以养血利水,与当归芍药散合小半夏汤加吴茱萸:当归三钱,白芍三钱,川芎二钱,苍术三钱,泽泻五钱,茯苓三钱,半夏五钱,生姜四钱,吴茱萸三钱。

The first visit: Oct. 16, 1965. The patient felt dizziness, floating vision, nausea, flustered, no appetite, and hard to read book, all for four to five months. Western medicine diagnosed as Meniere’s disease and gave her various medicine for the treatment but no any improvement. Her blood pressure was normal. She felt dry in mouth, but no desire to drink. She felt sleepy, fatique but physical movement is normal. The menstruation was less volume in the later part of the circle. The tongue cover was white with greasy in the root. The pulse was deep, thin and string. Her condition was diagnosed as Blood deficiency with water overwhelming. She was given herbal therapy to nourish blood and to deplete water. The prescription was Danggui Shaoyao San plus Xio Banxia Tang plus Wuzhuyu: Danggui 9 g, Baisho 9g, Chuangxiong 6 g, Cangzhu 9 g, Zexie 15 g, Fuling 9 g, Banxia 15g, fresh ginger 12 g, Wuzhuyu 9 g.

结果:上药服三剂,证已。

Results: After the herbal therapy for three doses, all the symptoms subsided.

1 (美尼尔氏综合征)刘某,女,19岁,学生。

Case 1. (Meniere’s disease). Liu XX, female, 19 years of old. Student.

初诊日期1977103日:眩晕、耳鸣、耳聋二月.某医诊断为"美尼尔氏综合征",中西药治疗不效,已休学两月,托亲友而找胡老诊治。近头晕不能起,睁眼则晕甚,耳聋、耳鸣,口干不欲饮,时感胸闷心慌,舌苔白厚,脉沉细。此寒饮上犯,蒙闭清窍,治以温中化饮,与苓桂术甘汤:茯苓六钱,桂枝三钱,苍术三钱,炙甘草二钱。

The first visit: October 3, 1977. The patient had dizziness, tinnitus and deafness for two months. She was diagnosed as Meniere’s disease in hospital. She had been treated with both western medicine and Chinese medicine but no any improvement. She had stopped class for two months. So she asked her relatives to introduce her to Dr. Hu for treatment. The current condition when she saw Dr. Hu was heavy dizziness, so much so that she could not get up. The dizziness was more severe if she opened eyes. She felt deafness, tinnitus and dry mouth but no desire to drink. From time to time, she felt choking feeling in chest and felt flustered. Her tongue cover was thick and white. The pulse was deep and thin. Her condition was diagnosed as Cold-Water reverse up to attack the brain and to block the brain. The herbal therapy was given to warm the middle and to dissolve the water. She was given Ling Gui Zhu Gan Tang: Fuling 18 g, Guizhi 9 g, Cangzhu 9 g, Zhi Gancao 6 g.

二诊1012日:上方连服八剂,头晕已,耳鸣大减,耳聋好转。前方增桂枝为四钱、茯苓为八钱。

The second visit: October 12: After the herbal therapy for 8 doses, the dizziness subsided, the tinnitus reduced and the deafness was improved. To the prescription above, added was Guizhi to 12 g, and Fuling 24 g.

三诊1020日:上药服六剂,诸症已,因害怕再犯要求再服药巩固,嘱其不必服药。

The third visit: After the new prescription for 6 doses, no any symptoms left. For fear recurrence, the patient wanted to continue the herbal therapy. She was advised it is not necessary.

2. (癫痫).  王某,男,46岁,病案号136766

Case 2. (Epilepsy). Wang XX, male, 46 years of old. File number: 136766.

初诊日期196638日:癫痫发作3年。原发无定时,经服西药曾一度好转,近年来发作较频,大约每半月左右发作一次,发则四肢抽搐、口吐白沫、不省人事,在当地治疗无效,由新疆来京求治。近期发作已一周。自感咽干、胃脘微胀,有时头晕、耳鸣,别无明显不适,舌苔白,脉弦细。证属饮踞少阳,治以和解化饮,与小柴胡合苓桂术甘汤加生石膏:柴胡四钱,半夏四钱,党参三钱,黄芩三钱,生姜三钱,苍术三钱,茯苓三钱,桂枝三钱,大枣四枚,炙甘草二钱。生石膏一两半。

The first visit: March 8, 1966: The patient had epilepsy for three years. In the beginning, the onset came without rule. The condition had been improved for a while with western medicine. Lately, the onset came relatively more frequent, about once every half month. Once it comes, the patient had convulsion in arms and legs, spit white boubble from mouth, and lost consciousness. The treatment in the local hospital was no any effect, so he came from Xingjiang province to Beijing for treatment. Recently, the onset had been for one week. He felt dry mouth, slight bloating in stomach, from time to time dizziness, and tinnitus. No any other discomfort feeling. His tongue cover was white. The pulse was string and thin. His condition was diagnosed as Water sticks in the Shaoyang phase. He was given herbal therapy to harmonize the Shaoyang and to dissolve the water. The prescription Xiao Chaihu Tang plus Ling Gui Zhu Gan Tang plus Shigao was used: Chaihu 12 g, Banxia 12 g, Dangshen 9 g, Huangqin 9 g, fresh ginger 9 g, Cangzhu 9 g, Fuling 9 g, Guizhi 9 g, Chinese date 4, Zhi Gancao 6 g, Shigao 45 g.

结果:上药服六剂,头晕、胃脘微胀好转,癫痫未见发作。上方生石膏减为一两,停服西药,继服两周仍未见发作。嘱回家继服药,有病情变化再来信,但未见来信。

Results: After the herbal therapy for 6 doses, the dizziness and stomach bloating feeling were improved. The epilepsy did not come. The herb Shigao in the prescription was reduced to 30 g. The western medicine was asked to stop. After additional two weeks’ treatment, it still did no happen. He was asked to continue to drink the herbal tea at home, to write letter if there is any onset. But no any letter since then.

3. (癫痫).  胡某,14岁,病案号177285

Case 3. (Epilepsy). Hu XX, 14 years of old. File number: 177285.

初诊日期19651018日:4年前患急性黄疽性肝炎,经治疗黄疸退,但食纳不佳,肝功时有波动。时头晕目眩,近一年来大约每半月有一次癫痫发作,发作时先觉气上冲咽,旋即四肢抽搐,继则牙关紧闭,后则不省人事。口吐白沫,经常服西药镇静药,但仍每半月发作一次,常感乏力,每发作后尤为明显,因食欲不振而现身体瘦弱,舌净无苔,脉弦细稍数。此证属血虚水盛,治以养血利水,嘱停服西药镇静药,与柴胡桂枝干姜汤合当归芍药散:柴胡四钱,黄芩三钱,桂枝三钱,白芍三钱,川芎二钱,苍术三钱,茯苓三钱,泽泻五钱,花粉六钱。生龙骨五钱,生牡蛎五钱,炙甘草二钱。

The first visit: October 18, 1965. The patient had acute jaundice hepatitis. After treatment, the jaundice subsided but he felt no appetite and the lab test showed the liver function was fluttered. He, from time to time, felt dizziness and dazzled. For the recent one year, he had epilepsy onset almost once every half month. In the beginning of the onset, he first felt a are force pushed up to the throat, soon his arms and legs started to convulsion, followed by tight bite of teeth, then he falled into coma and spit white bubbles from mouth. He took western medicine sedative drugs quite often, but the onset still came once every half month. He was easy to feel fatique, especially after each onset. For poor appetite, his body was very slim. The tongue is clean without covering. The pulse was string, thin, and slight frequent. His condition was diagnosed as Blood deficiency with water overwhelming. He was asked to stop the western medicine, but given Chaihu Guizhi Ganjiang Tang plus Danggui Shaoyao San: Chaihu 12 g, Huangqin 9 g, Guizhi 9 g, Baishao 9 g, Chuanxiong 6 g, Cangzhu 9g, Fuling 9 g, Zexie 15 g, Tianhuanfeng 18 g, Longgu 15 g, Muli 5 g, Zhi Gancao 6 g.

二诊1025日:纳稍增,近几天咳嗽吐白痰,合用半夏厚朴汤:半夏四钱,厚朴三钱,苏子三钱,生姜三钱,茯苓三钱,柴胡四钱,黄芩三钱,花粉六钱,生龙骨五钱,生牡蛎五钱,桂枝钱,当归三钱,白芍三钱,川芎二钱,泽泻四钱,苍术四钱,炙甘草二钱。

The second visit: October 25: The appetite was improved slightly. Recent days, he coughed and spit white phlegm. The formula above was used again but with addition of Banxia Houpu Tang: Banxia 12 g, Houpu 9 g, Suzi 9 g, fresh ginger 9 g, Fuling 9 g, Chaihu 12 g, Tianhuafeng 18 g, Longgu 15 g, Muli 15 g, Guizhi 9 g, Danggui 9 g, Baishao 9 g, Chuanxiong 6 g, Zexie 12 g, Cangzhu 12 g, and Zhi Gancao 6 g. 

三诊1029日:咳已,小便频,失眠,与猪苓汤合当归芍药散:猪苓三钱,茯苓三钱,泽泻四钱,滑石五钱,白芍三钱,川芎二钱,酸枣仁五钱,阿胶三钱。

The third visit: October 29: The cough stopped. But he had frequent urination, and poor sleep. He was given Zhuling Tang plus Danggui Shaoyao Sang: Zhuling 9 g, Fuling 9 g, Zexie 12 g, Huashi 15 g, Baishao 9 g, Chuangxiong 6 g, Suanzaoren 15 g, Ajiao 9 g.

四诊112日:尿频已,头晕、失眠好转,右胁痛,纳稍差,继服1018 日方。

The forth visit: November 2: The frequent urination stopped. The dizziness and sleep were better. He felt pain in the right upper side of the belly, and had little less appetite. The above herbal tea of October 18 was continued. 

五诊1217日:胁痛已,未发癫痫,查肝功正常。嘱:停药观察。

The fifth visit: December 17: The belly side pain stopped. No onset of epilepsy. Lab test for liver function turned normal.  He was asked to stop herbal therapy.

按:以上四例,西医诊断都明确,即分属于美尼尔氏综合征和癫痫。从中医辨证来看,四者共同之处是痰饮上犯,但具体治疗则各有不同。例10因血虚明显,因而合用当归芍药散,又因阳虚胃中水逆明显,故又合用小半夏汤加吴茱萸。例1因里寒饮盛,为典型的里有水饮,冲气上犯的苓桂术甘汤方证,因此不用加减仅用原方,旨在温中化饮降逆,而很快收效。例2因少阳证明显,故以小柴胡汤和解半表半里,以苓桂术甘化饮降冲逆,并以生石膏佐清上热。例3也是血虚水盛为主,故也以养血利水为主法,但在治疗过程中变症较多,故变方也较多。这样不但治好了肝炎、咳嗽、泌尿系感染,同时也治好了癫痫。由此可看出,胡老治疗癫痫、美尼尔氏综合征属痰饮者,多是宗"病痰饮者,当以温药和之"之法,同时胡老治病不是据于一法,而是辨具体方证。

Comments: For the four cases above, the western medicine diagnosis were all clear and confirmed, e.g. they belong to Meniere’s disease and epilepsy. From the Chinese medicine diagnosis point view, the common point for all the four cases were the phlegm rushing up to affect brain function. However, the treatment for each case was different. In the case 10, the blood deficiency is apparent, so the Danggui Shaoyao Sang was used. For the Yang deficiency and accumulation fo water in the stomach, the Xiao Banxia plus Wuzhuyu was used. For the case 1, for apparent inside Cold and water overwhelming, it is a typical condition, in which there is inside water and the water rushes up to affect brain function, which was the indication of Ling Gui Zhu Gan Tang, therefore the original such prescription was used without any modification. This prescription is to warm the stomach, to dissolve the water and reverse the up-rushed water down. It worked very soon. For case 2, for the apparent Shaoyang phase, the Xiao Chaihu Tang is used to harmonize the half-surface and half-side phase of the body. The Ling Gui Zhu Gan Tang was used to clear the water, and to reverse the up-reversed water, as well as to use the Shigao to clear Fire in the upper part of the body. For case 3, it is also a water overwhelming condition, so the principle of the herbal therapy is also to nourish the blood and to dispel the overwhelming water. However, during the treatment, the symptoms changed again and again, so the herbal prescription was changed several times too. By this way, not only the hepatitis, cough, urinary system problems were solved, but also the epilepsy were solved. From these case reports, it can be seen that, Dr. Hu treats epilepsy and Meniere’s disease that belong to phlegm and water overwhelming, most of time he follows the “for disease that is caused by phlegm and water, use warm herbs to harmonize it.”. At the same time, Dr. Hu does not stick to only one herbal prescription for the treatment, but focuses on herb indications.

 

 15.  脑病头痛苦无边   方证对应皆能清

15. The headache is annoying very much. It can be cured however, if the herbal therapy matchs the clinic condition.

4. 韩某,男,35岁,病案号173044

Case 4. Han XX, male, 35 years of old. File number: 173044.

初诊日期19661016日:头痛、头晕五六年,多方检查,未查出器质性病变,常服西药止痛片暂缓其痛,而不能除其根。也曾多处求中医治疗而无寸效,吃过的蝎子、天麻、川芎等可用斤计。近头痛发作发无定时,但多发于受凉或受热后、疲劳或睡眠不足后,痛多发于两侧,左多于右。来诊刻下除感咽干思饮外,他无明显不适,舌苔白薄,脉弦细。此属少阳阳明合病,与小柴胡汤加生石膏:柴胡四钱,党参三钱,黄芩三钱,半夏四钱,生姜三钱,炙甘草二钱,大枣四枚,生石膏二两。

The first visit: October 16, 1966. The patient had headache and dizziness for more than five years. He had been checked by various ways but no any clear diagnosis. He took western medicine pain killer, which worked only temporally but no cure. He also tried various Chinese medicine therapies but in vain too. The herb Tianma, Chuanxiong, etc. that he took, could  be account to pounds. Recently, the headache came without fixed time but it happened mostly after catching cold or hot, tired or poor sleep. The pain usually came in the sides of the head, more on the left than on the right side. For the movement he saw Dr. Hu, he felt dry mouth and had desire to drink water. No any other symptoms. His tongue cover was thin and white. The pulse was string and thin. This is Shaoyang-Yangming co-exist phases. He was given Xiao Chaihu Tang plus Shigao: Chaihu 12 g, Dangshen 9 g, Huangqin 9 g, Banxia 12 g, fresh ginger 9 g, Zhi Gancao 6 g, Chinese date 4, and Shigao 60 g.

结果:上药服三剂,症已。

Results: After the herbal therapy for three doses, no any more symptoms.

按:本例虽西医诊断未明,但从症状、治疗方药、治疗效果看,不能排除慢性咽喉炎。但无论西医诊断为何病,凡辨证为少阳阳明合病,再进一步辨明是小柴胡汤加生石膏方证,据证用药,故多年痼疾却见捷效。反之不辨证、不辨方证一味地用所谓川芎、天麻、全蝎等止痛药,是很难收效的。

Comments: This case, though the diagnosis is not clear from western medicine point of view, might belong to chronic phyringolaryngitis. This is based on his symptoms, the herbs used and the healing result. No matter what is the western medicine diagnosis for him, his condition was diagnosed as Shaoyang-Yangming phases. Further diagnosis suggested it is the Xiao Chaihu Tang plus Shigao condition. For the condition so gave him the herbs. The many years’ problem was solved very soon. Otherwise, without proper diagnosis, just use so called Chanxiong, Tianma, and Quanxie, etc. it would be hard to solve the problem.

5. 陈某,男,44岁.病案号97771

Case 5. Chen XX, male. 44 years of old. File number: 97771.

初诊日期1965325日:经常头痛发作已5年,与气候变化及情绪和休息不好有关,西医诊断为"神经性头痛"。近一周来午后头痛明显,并感头沉如箍,以前额及后头明显,项背发紧或酸痛,咽于思饮;晚上睡觉时感鼻塞:失眠多梦,舌苔白根腻,脉沉弦细,左寸浮。此属太阳阳明合病,为大青龙汤加苍术方证:麻黄五钱,桂枝二钱,生姜三钱,大枣四枚,炙甘草二钱,杏仁二钱,桔梗三钱,苍术六钱,生石膏一两半。

The first visit: March 25, 1965. The patient had frequent headache for five years. The headache was related to the weather change, emotional flutte, and poor sleep. The western medicine diagnosed him as “nervous headache”. For recent one week, his afternoon headache became more severe. He also felt the head heavy as tightened by a ring. It felt more on the front and on the back of the headache. The neck and upper back of the body felt tight and sour. He felt dry throat and had desire to drink. He also felt nose stiff at night. He had poor sleep with more dream. The tongue cover was white with greasy in root. The pulse was deep, string and thin, with left side floating. His condition was diagnosed as Taiyang-Yangming co-exist phases. It was the indication of Da Qinglong Tang pus Cangzhu: Mahuang 15 g, Guizhi 6 g, fresh ginger 9 g, Chinese date 4, Zhi Gancao 6 g, Xingren 6 g, Jiegen 9 g, Cangzhu 18 g, Shigao 45 g.

结果:上药服三剂,头痛头沉减,晚上鼻塞轻,上方加生苡仁五钱继服六剂,诸症渐轻,前方继服约一月,头痛已不明显。

Results: After the herbal therapy for three days, the headache and heavy feeling in head were reduced. The nose stiffness at night was improved. To the above prescription, added was Yiyiren 15 g. This herbal prescription was used for 6 doses. The symptoms subsided gradually. After one month, the headache was no long apparent.

按:此类"神经性头痛"在临床常见,实际西医诊断应排除鼻窦炎、鼻炎等症,有不少经拍摄X平片而确诊鼻腔炎症。但无论诊断与否,中医根据证候可辨证为湿困于表,郁久化热,呈太阳阳阳明合病,为大青龙加苍术汤方证,故治其本。不用川芎、天麻等止痛而痛自去。

Comments: This kind of “nervous headache” is commonly seen in clinic. For western medicine, the diagnosis should exclude the possible sinusitis, and nasitis, etc. Many of such nervous headache are eventually diagnosed as the inflammation in the nose cavity, after X-ray detect. However, no matter what’s the western medicine diagnosis, in Chinese medicine, it can be diagnosed as the Wetness sluggished in the body surface, and it develops into fire after a long time of the sluggish. The condition belongs to Taiyang-Yangming co-exist phases. It is the indication of Da Qinglong Tang plus Cangzhu prescription. This is the cure of the cause of the disease. Therefore, the pain can be stopped without the use of herbs such as Chuanxiong and Tianma.

6. 叶某,女,43岁,病案号51575

Case 6. Ye XX. Female. 43 years of old. File number: 51575.

初诊日期196547日:反复发作左偏头痛10余年,常于疲劳、睡眠不好时发作,西医诊断为"神经性头痛",多治无效,服止痛片或喝浓茶可暂缓其痛,近发作较频,服止痛片多而出现恶心,伴见头晕、心悸,常失眠,��干思热饮,既往有卵巢、子宫切除史。舌苔白,舌质淡红,脉沉细。证属血虚水盛,郁热上扰,为当归芍药散加生石膏吴茱萸方证:当归三钱,白芍四钱,川芎三钱,苍术四钱,茯苓四钱,泽泻八钱,炙甘草二钱,吴茱萸三钱,生石膏一两半。

The first visit: April 7, 1965. The patient had recurrent left side headache for more than 10 years. It usually came out when she felt tired or had poor sleep. The western medicine diagnosed the condition as “nervous headache”. She had various treatment but no any improvement. The pain can be temporally reduced after taking pain killer or drink strong tea. Later, the onset came more frequently. She would feel nausea when taking pain killer. She had also dizziness, palpitation, poor sleep, dry mouth with desire to drink hot water. She has had a history of surgical removal of ovaries and uterus. Her tongue cover was white and tongue was pink in color. The pulse was deep and thin. Her condition belongs to blood deficiency with water overwhelming, and with choked fire rushing up to disturb the head. It is the indication to Danggui Shaoyao San plus Shigao and Wuzhuyu: Danggui 9 g, Baishao 12 g, Chuangxiong 9 g, Cangzhu 12 g, Zexie 24 g, Zhi Gancao 6 g, Wuzhuyu 9 g, and Shigao 45 g.

结果:上药服四剂,诸症已。

Results: After the herbal therapy for 4 doses, no any symptoms left.

按:此头痛常发于左,并有头晕、心悸、失眠等,知不但有血虚水盛,而且还有瘀血之征,因此用当归芍药散养血利水、养血活血。因病邪主要为里寒饮盛,故用大量苍本,茯苓、泽泻温中利水,因饮盛久郁上冲,故加吴茱萸温中降逆化饮。又因饮久化热,故加生石膏佐清上热,治疗头痛时常石膏、吴茱萸同用,这也是胡老用药的特点。

Comments: This headache comes on the left side. She had also dizziness, palpitation and poor sleep. It is therefore known that she had blood deficiency with water overwhelming, but also a blood stagnation. Therefore the Danggui Shaoyao San was used to nourish blood, to deplete water, and to activate blood circulation. For there was much more Cold and Water inside the body, large amount of herb Cangzhu, Fuling and Zexie were used to warm the stomach and to deplete water. For the water had been rushing up, the herb Wuzhuyu was used to warm the stomach and to reverse the rushing water. For the water had been developed into Fire, the Shigao was used to clear the upper Fire. In the treatment of headache, Shiggao and Wuzhuyu are usually used together. This is one of the characteristics of Dr. Hu in herbal therapy.

7. 许某,男,46岁,病案号155605

Case 7. Xu XX, male, 46 years of old. File number 155605.

初诊日期196548日:头痛头晕已三年,哈医大腰穿诊断为"蛛网膜炎、脑动脉硬化、基底动脉供血不全、慢性喘息性支气管炎",现症:每用脑则眼模糊,心下气上冲感,耳鸣,发热头痛,两太阳穴发胀,腰痛,左腿外侧痛,上楼即气短、喘息,近咳嗽、吐黄痰多已三月,手足心热,口干,舌苔白,脉沉弦。此为少阳阳明合病挟瘀,与大柴胡汤合桂枝茯苓丸加味:柴胡四钱,半夏四钱,黄芩三钱,赤芍三钱,生姜三钱,桂枝三钱,茯苓三钱,桃仁三钱,丹皮三钱,炙甘草二钱,红花三钱,生石膏一两半。

The first visit: April 8, 1965. The patient had headache and dizziness for three years. Western medicine diagnosed it was “arachnoiditis, cerebral arteriosclerosis, basilar artery poor circulation and chronic asthmatic bronchitis”. Currently, she felt blirring in eyes when she had mental work, felt as air pushing up from stomach, tinutis, fever with headache, bloating feeling in the temples both side, pain in lower back, pain in outside of left leg, short of breath and asthma when going up steps. Laterly, she had cough and spit yellow phlegm for three months. She had hot feeling in hands and feet, and dry mouth. The tongue cover was white. The pulse was deep and string. This is Shaoyang-Yangming co-exist phases with blood stagnation. It is the indication to the Da Chaihu Tang plus Guizhi Fuling Wan. The herbs used were: Chaihu 12 g, Banxia 12 g, Huangqin 9 g, Chishao 9 g, fresh ginger 9 g, Guizhi 9 g, Fuling 9 g, Taoren 9 g, Danpi 9 g, Zhi Gancao 2 g, Honghua 9 g, Shigao 45 g.

二诊415日:上药服三剂,头痛头晕俱减,上冲感亦轻,仍咳嗽多痰,两眼视物模糊。与半夏厚朴汤加味:半夏四钱,厚朴三钱,茯苓四钱,苏子三钱,橘皮五钱,生姜三钱,瓜蒌八钱,旋覆花三钱,竹茹二钱,杏仁三钱,生石膏一两半。

The second visit: April 15. After the herbal therapy for three days, the headache and dizziness both subsided. The up-pushing feel was reduced. He still had cough with more phlegm, and felt cloudy in vision. He was given Banxia Houpu Tang with additions: Banxia 12 g, Fuling 12 g, Suzi 9 g, Jupi 15 g, fresh ginger 9 g, Gualu 24 g, Xuanfuhua 9 g, Zhuru 6 g, Xingren 9 g, Shigao 45 g.  

三诊415日:咳嗽吐痰皆减,与48日方去大枣、红花,加生地三钱。

The third visit: April 15. The cough and phlegm were reduced. From the April 8 prescription, removed were Chinese date and Honghua, but added Shengdi 9 g.

四诊610日:经约两月宗大柴胡汤合桂枝茯苓丸加减治疗,头痛已,头晕轻微,耳鸣只在夜间偶作,可用脑小时,他症不明显。

The fourth visit: After two months of herbal therapy with Da Chaihu Tang plus Guizhi Fuling Wan, the headache stopped, the dizziness was slight only, the tinnitus happened only at night occasionally and he can work with mental ability for hours. No any other symptoms.

按:此案又是大柴胡汤合桂枝茯苓丸加减治疗,以头痛为主诉,而兼有脑血管、支气管等多种虚实挟杂病,在治疗时因抓住了病邪、病位,故每攻必克,阅此病例,可师其法。

Comments: In this case, it is again with the Da Chaihu Tang plus Guizhi Fuling Wan for the treatment. The headache is the main complain of patient, and the patient had also some other symptoms in the cerebral and bronchy systems. In the treatment, the herbal prescription matches the disease nature and location, so the healing effect is excellent. To study this case, we can learn such principle in the diagnosis and treatment of headache in clinic.

8. 李某,女,43岁,东北锦州人。

Case 8. Li XX, female. 43 years of old, living in the Jingzhou city, North-east of China.

头痛、呕吐已六七年,近两年视物模糊,到处求医,诊断为"慢性青光眼",而服中西药罔效。近一月左眼失明。因专程来京求治。近症:自感有物覆于眼上,常头痛如裂,伴呕吐,目干涩,心中发热,手足心热,口干不欲饮,舌苔薄白,脉弦细。证属血虚寒饮上犯,治以温中化饮,养血益精,与吴茱萸汤合柴胡桂枝干姜汤、当归芍药散:吴茱萸三钱,党参三钱,干姜二钱,大枣四枚,柴胡四钱,黄芩三钱,桂枝三钱,花粉四钱,当归三钱,白芍三钱,川芎三钱,泽泻六钱,生龙骨五钱,生牡蛎五钱,茯苓四钱,苍术三钱,炙甘草二钱。

The patient suffered from headache and nausea for 6 to 7 years. For later two years, she felt blirring in vision. She had tried various therapies here and there and the problem was diagnosed as “Chronic glaucoma”. She tried both western medicine and Chinese medicine without any improvement. For the recent one month, she lost vision in the left eye, so she came to Beijing for treatment. The current condition when she saw Dr. Hu: She felt there was something  covering on the eye, severe headache so that as the head is to split, which was accompanied with nausea, dry eyes, hot feeing in heart and in hands and feet, and dry mouth without desire to drink. Her tongue cover was thin and white. The pulse was string and thin. Her condition belonged to Blood deficiency with Cold water pushing up. The herbal therapy should focus to nourish the blood and to deplete the water, to nourish and blood and the micro-nutrition material to the body. She was given Wuzhuyu Tang plus Chaihu Guizhi Ganjiang Tang and Danggui Shaoyao San: Wuzhuyu 9 g, Dangshen 9 g, Ganjiang 6 g, Chinese date 4, Chaihu 12 g, Huangqin 9 g, Guizhi 9 g, Tianhuafeng 12 g, Danggui 9 g, Baishao 9g, Chuanxiong 9 g, Zexie18 g, Longgu 15 g, Muli 15 g, Fuling 12 g, Cangzhu 9 g, Zhi Gancao 6 g.

结果:上药服三剂,自感好转,连服21剂后,视物渐清,共治疗两月未易一药,左眼视物清晰,头痛等症皆消。

Results: After the herbal therapy for three days, the overall feeling was pretty good. After 21 days, the vision became gradually clear. For the two months, the same prescription wes kept the same. The left eye became clear. The headache stopped.

按:此头主因寒饮上犯,因有左眼失明、五心发热、目干涩等,知为津血虚不能充养,故以吴茱萸汤合柴胡桂枝干姜汤当归芍药散合方治之,能使头痛已、眼复明,可以说.是奇效。但就中医治疗来说并未超出其常理。胡老尚有不少类似治验例:有以吴茱萸汤单方治疗者,有以吴茱萸汤合当归芍药散合方治疗者,有以小柴胡汤合茱萸汤加生石膏治疗者,这里不再枚举。皆从证、从方尊古法,但必辨方证准确,此其要也。

Comments: This headache is due to Cold water pushing up to the head. For there was loss of vision in the left eye, hot feeling in the chest, hands and feet, and dry eyes, etc. it is known that the condition belongs to the deficiency of blood and micro-nutrition material in the body. Such deficient condition fails to nourish the eye. Therefore, the Wuzhuyu Tang, Chaihu Guizhi Ganjiang Tang, and Danggui Shaoyao San were all used, so as to make the headache subsided and the vision recovered. It can be said that this is mysterious result. However, for Chinese medicine, it does not exceeds its normal healing consequence range. Dr. Hu had a lot of such successful cases. For some, he uses the Wuzhuyu Tang plus Danggui Shaoyao San. For others, he may use only the Wuzhuyu Tang, or Xiao Chaihu Tang plus Wuzhuyu Tang plus Shigao. Here we are not going to list them more. All the treatment follow the principles in the diagnosis and treatment introduced by our old time doctors. The key point is: the herbal indication diagnosis must be accurate and precise.

9.  程某,女,33岁,病案号37488

Case 9. Chen XX, female, 33 years of old. File number: 37488.

初诊日期196737日:左偏头痛一年,西医诊为三叉神经痛。反复发作,时轻时重。既往有肝炎史。近日发作较重,左侧头面、眼眶皆痛,伴头眩而晕,大便溏泻,一日23行,经细问也大约一年,干不欲饮,舌苔白根腻,脉沉细弦。证属上热下寒,治以苦辛开降,与半夏泻心汤加吴茱萸: 半夏四钱,党参三钱,黄芩三钱,黄连二钱,干姜二钱,炙甘草二钱,大枣四枚,吴茱萸三钱。

The first visit: March 7, 1967. The patient suffered from left headache for one year. The western medicine diagnosed as trigeminal mialgia. It comes and goes and some time less and some times worse. He had history of hepatitis. Lately, the onset became more severe. The pain was felt on the left face, head, and around the left eye, with dizziness and dazzled. The bowel movement was loose, 2 to 3 times a day, which was said already for one year. She felt dry mouth but no desire to drink. The tongue cover was white with greasy in the root. The pulse was deep, thin and string. This condition belongs to upper-fire and lower-cold condition. The herbal therapy to be given should work to open and to descend with bitter and spicy herbs. She was therefore given Banxia Xiexing Tang plus Wuzhuyu: Banxia 12 g, Dangshen 9 g, Huangqin 9 g, Huanglian 6 g, Ganjiang 6 g, Zhi Gancao 6 g, Chinese date 4 and Wuzhuyu 9 g.

结果:上药服三剂,头痛、便溏皆好转,上方减黄芩为二钱,加生石膏一两,继服12剂,头痛已,大便如常。

Results: After the herbal therapy for three days, the headache and diarrhea both were improved. From the prescription, Huangqin was reduced to 6 g, with addition of Shigao 30 g. This prescription was continued for 12 days. The headache stopped, the bowel movement was normal.

按:此也为寒饮上犯之头痛,因郁久化热而呈上热下寒之证,单用吴茱萸汤则不能清上热,只用清热药又必加重下寒,故用半夏泻心汤加吴茱萸苦辛开降,治后下寒有去,故又加生石膏佐清上热,这样病邪尽除,则头痛自消。

Comment: This case is also a Cold Water pushing up to the head so to cause the headache. For a long time sluggish of the water, the water develops into Fire to form a upper Fire and lower Cold condition. Single Wuzhuyu Tang would not be able to clear the upper Fire. Only with the use of the Fire-clearing prescription, the inside Cold would be worse. So, the Banxia Xiexing Tang is used with the Wuzhuyu to cause a opening-descending effect, so the make the lower cold be able to deplete. With the addition of Shigao to clear the upper Fire, such combination works to solve both the Fire and Cold, so the headache could subside.

10. (颅咽管瘤术后)  杜某,女,58岁,病案号66405

Case 10.  (Post-surgical removal of craniopharyngeal duct tumor). Du XX, female, 58 years of old. File number: 66405.

初诊日期197861日:头痛、恶心、呕吐20年。自1962年起即常头痛、呕吐,19631217日在广安门医院诊断为"右眼球后视神经炎、部分视神经萎缩"19726月在协和医院手术切除颅咽管瘤。术后仍经常头痛,常服"凡拉蒙"镇痛。19775月出现突然抽风,头痛加剧,右眼失明,左眼胀痛,伴呕吐,口苦,舌苔白,脉弦细。与小柴胡汤合桂枝茯苓丸加生石膏、吴茱萸:柴胡四钱,黄芩三钱,半夏四钱,党参三钱,生姜三钱,大枣四枚,炙甘草二钱,桂枝三钱,茯苓三钱,丹皮三钱,桃仁三钱,生石膏一两半,吴茱萸四钱。

The first visit: June 1, 1978. The patient suffered from headache, nausea and vomit for 20 years. Since 1962, she often felt headache in the morning, and nausea. In December 17, 1963, she was diagnosed as retrobulbar optic neuritis, partial optic atrophy. In June 1972, she had surgical removal of craniopharyngeal duct tumor. After the surgery, she still often felt headache so she often took veramon to stop the pain. In May 1977, she suddenly had convulsion, severe headache, loss of vision on the right eye, bloating pain in the left eye, with nausea, and bitter taste in mouth. The tongue was white. The pulse was string and thin. She was given Xiao Chaihu Tang plus Guizhi Fuling Wan plus Shigao and Wuzhuyu: Chaihu 12 g, Huangqin 9 g, Banxia 12 g, Dangshen 9 g, fresh ginger 9 g, Chinese date 4, Zhi Gancao 6 g, Guizhi 9 g, Fuling 9 g, Danpi 9 g, Taoren 9 g, Shigao 45 g, and Wuzhuyu 12 g.

结果:上药服三剂症减轻,原方稍加减变化,继服25剂,诸症基本痊愈。

Results: After the herbal therapy for three days, the symptoms were better. The original prescription was modified little bit and asked to continue for 25 doses. After that, all the symptoms subsided.

按:本病为痰饮瘀血阻滞,而呈太少合病,故与小柴胡汤和解半表半里,以桂枝茯苓丸祛瘀化饮,并加吴茱萸化饮?降浊,再用生石膏佐清上热。生石膏、吴茱萸同用,这也是胡老的临床经验,病人自己也有体会,生石膏、吴茱萸治头痛、眼痛明显。

Comments: This case belongs to block of phlegm, blood stagnation, showing Taiyang-Shaoyang co-exist phases. Therefore, the Xiao Chaihu Tang was used to harmonize the in between phase of disease and the Guizhi Fuling Wan was to dissolve phlegm and deplete water. The additional Wuzhuyu was to deplete water and to down-move dirty thing and the Shigao to clear upper Fire. The use of Shigao and Wuzhuyu at the same time is the experience of Dr. Hu. The patient themselves also had experience: the Shigao and Wuzhuyu work excellent for the headache and pain in the eyes.

16.  血不养心眠难安   邪扰神明更堪忧

16. If the blood cannot nourish the heart, the sleeping would be poor. If there is Xie Qi disturb the emotion, the problem would be worse.

11张某,女,65岁,病案号16248

Case 11. Zhang XX, female, 65 years of old. File number: 16248.

初诊日期19651213日:多年失眠,久治无效,现症:常失眠,轻时能得暂寐,但梦扰不已;重时则连续一二天整夜不眠,常头晕,口干,心悸,心烦,自汗,舌苔白。舌质红而千,脉细数无力,右手为甚。证属阴血虚损,阳不得人于阴,治以敛阳入阴,与酸枣仁汤加生龙牡:生枣仁一两,知母四钱,茯苓五钱,川芎三钱,炙甘草二钱,生龙骨四钱,生牡蛎八钱。

The first visit: Dec. 13, 1965. The patient suffered from poor sleep for many years. She had had visited various doctors for the treatment but on any use. The current condition was: She had poor sleep. If the condition was not severe, she might be able to have a shallow sleep but with a lot of dream. If it was severe, she could not have any sleep for continuous one to two days. She often felt dizziness, dry mouth, palpitation, annoyed and flustered, and had sweat. The tongue was red in color and the tongue cover was white. The pulse was thin, frequent and weak, especially on right wrist. The condition was Ying Bood deficiency, so that the Yang could not dive in the Yin portion at night. The herbal therapy should focus to dive the Yang into the Yin. The herbal prescription was Suanzaoren Tang plus Longgu and Muli: Fresh Suanzaoren 30 g, Zhimu 12 g, Fuling 15 g, Chuanxiong 9 g, Zhi Gancao 6 g, Longgu 12 g, and Muli 24 g.  

二诊1217日:上药服三剂,睡眠已稍安,但仍心烦、心悸、自汗出、头晕、口干不欲饮明显,上方去生龙骨,加当归三钱,白芍四钱,桂枝三钱,白术三钱。

The second visit: December 17. After the herbal therapy for 3 doses, the sleep was slightly improved. She still felt annoyed, palpitation, sweat, dizziness and dry mouth without desire to drink. From the prescription above, removed was the Longgu, added the Danggui 9 g, Baishao 12 g, Guizhi 9 g, and Baishu 9 g.

三诊1222日:上方服三剂,一切症状均除,为巩固疗效,继服上方三剂。

The third visit: December 22. After additional three doses, all symptoms subsided. For a maintenance, the herbs were drunk for additional three doses.

按:此是常见的阴血虚而致阳不入于阴的失眠。酸枣仁为一收敛性的强壮药,尤其有强壮神经及安神作用,在本方用为主药,取其补虚敛神以安眠,复以川芎、甘草和血缓急,知毋、茯苓解烦安悸,更加生龙牡强壮收敛药,不仅敛汗固精,更能敛神定志,总之全方益阴和血,敛神定志,使阳入于阴,故为安眠常用方药。

Comments: This case is the commonly seen condition, in which the Yang could not dive into the Yin at night due to the Yin and Blood deficiency. The herb Suanzaoren is a very strong contracting nourishment herb. It is especially to strengthen the nerves and the emotion. In the prescription, it is used as the key herb ingredient, taking its advantage of nourishing the weakness, contracting the emotion, so to improve the sleeping. The use of Chuanxiong and Gancao are to harmonize and to buffer the spasm. The Zhimu and Fuling are to solve the annoyed and the palpitation. The Longgu and Muli are to strengthen the scattered emotion, to stop sweat and to seal the micro-nutritional material in the body, and to calm down emotion and enhance willingness. All herbs work together to nourish the Yin and Blood, to attract the emotion and to help the Yang to be able to dive into the Yin at night, so that the sleeping was improved.

12. 武某,男,31岁,首都机场病案号563

Case 12. Wu XX, Male, 31 years of old. File number: 563 (Capital airport file number)

初诊日期1966318日:3年来失眠、身热、自汗.西医诊断为汽油中毒后遗症。每晚睡34个小时,常有头痛、头晕,口干思饮,大便先干后溏,一日23行,小便黄赤,舌苔白微腻,脉虚数。此湿热上扰,治以利湿清热,与猪苓汤加枣仁:猪苓三钱,茯苓三钱,泽泻五钱,滑石五钱,阿胶三钱,酸枣仁八钱。

The first visit: March 18, 1966. The patient had poor sleep for three years. He felt warm in the body, had sweat during the day time. The western medicine diagnosis was post-poisoning syndrome (by gasulene). He could only have a sleep for 3 to 4 hours every night. He often felt headache, dizziness and dry mouth with desire to drink. The stool was first hard then loose, 2 to 3 times a day. His urine was yellow to red in color. The tongue cover was white with slight greasy. The pulse was weak and frequent. This condition belongs to the Up-stirring by Wetness-Fire. The herbal therapy should focus to clear the wetness and to clear the Fire. He was given Zhuling Tang plus Suanzaoren: Zhuling 9 g, Fuling 9 g, Zexie 15 g, Huashi 15 g, Ajiao 9 g, Suanzaoren 24 g.

二诊325日:上药服六剂,眠好转,可睡45小时,头痛头晕也减,大便溏日12行,上方加苍术三钱。

The second visit: March 25. After the herbal therapy for 6 days, the sleep was improved. He could have a sleep for 4 to 5 hours every night. The bowel movement was one to two times a day.  To the prescription above, added was Cangzhu 9 g.

三诊41日:睡眠基本如常,头痛已,有时头晕,他症已不明显,上方继服调理。

The third visit: April 1. The sleep was basically normal. The headache subsided. He felt dizziness some times. No any other symptoms. The prescription above was continued for a maintenance.

按:此是汽油中毒(铅中毒)引起的神经功能紊乱,因症状表现为少阴、太阴的并病,而呈猪苓汤方证,故用猪苓利水清热,与茯苓、泽泻、滑石为伍,协力利水,复用阿胶益阴润燥、酸枣仁收敛安神,故用于湿热上扰兼有阴血虚之不寐。

Comment: The poor sleep in this case was due to the poisoning by gasoline (lead poisoning), that causes disorder in nervous system. The condition showed as Shaoyin-Taiyin co-exist condition, and ws the indication to the Zhuling Tang, so the Zhuling Tang was used to clear water and to clear Fire. The herb Zhuling works with Fuling, Zexie, and Huashi, all together to clear the water. The use of Ajiao was to nourish the Yin and to humidify the dryness. The Suanzaoren worked to contract emotion and calm down emotion. Therefore, this prescription was used for the poor sleep that is caused by Wetness-Fire up-stirring with Yin and Blood deficiency.

13. 金某,女,29岁。

Case 13. Jing XX, female, 29 years of old.

初诊日期19651222日:失眠已十二三年,中西医治疗均无效,近两月几乎整夜不能入睡,虽感很困倦但脑子很清醒,白天则头昏脑胀,咽干,别无明显不适,但每经前腹痛明显,舌苔白微黄,脉沉实。此瘀血阻络,阳不入阴,与大柴胡汤合桃核承气汤加生龙牡:柴胡四钱,半夏四钱,黄芩三钱,枳壳三钱,白芍三钱,生姜三钱,大枣四枚,桂枝三钱,桃仁三钱,丹皮三钱,茯苓三钱,大黄二钱,炙甘草二钱,生龙骨一两,生牡蛎一两,芒硝三钱(分冲)

The first visit: December 22, 1965. The patient suffered from poor sleep for more than 12 years. The western medicine and Chinese medicine did not improve her condition at all. For the recent two months, she could almost have no any sleep for the whole night. She could feel tired but the mind was very clear. During the day time, she felt cloudy mind and bloating feeling in head, and dry mouth. No any other discomfort. She had severe pain in belly before menstruation. Her tongue cover was white and slight yellow. The pulse was deep with kind of force. This was blood stagnation condition, in which, the stagnated blood blocked the meridian (the energy flow), so that the Yang could not dive into the Yin. She was given Da Chaihu Tang plus Taohe Chenqi Tang plus Longgu and Muli: Chaihu 12 g, Banxia 12 g, Huangqin 9 g, Zhike 9g, Baishao 9 g, fresh ginger 9 g, Chinese date 4, Guizhi 9 g, Taoren 9 g, Danpi 9 g, Fuling 9 g, Dahuang 6 g, Zhi Gancao 6 g, Longgu 30 g, Muli 30 g, Mangxiao 9 g (direct drink, no cook with other herbs).

结果:上药服三剂,能睡一二小时,头昏头胀减,去芒硝继服六剂,月经行未见腹痛,睡眠如常。

Results: After the herbal therapy for three doses, She could fall into sleep for one to two hours. The cloudy mind and dizziness were reduced. From the prescription, Mangziao was deleted. It was continued for six doses. She had no longer had pain in the belly, and the sleep turned normal.

按:《伤寒论》第237条:"阳明证,其人喜忘者.必有蓄血。"是说蓄血、瘀血阻络,血不能上养于脑,脑神不足,放喜忘。同理血瘀血不能上养脑,阴血虚则阳不能人于阴,则难成眠。本患者有经前腹痛,瘀血证确凿,故主用活血祛瘀方药而收捷效。用大柴胡汤合桃核承气汤是临床经验,辨方证准确也非一日之功。

Comments: In the book <<Shang Han Lun>>, the paragraph 237, it states: “In the Yangming phase, if the person tends to lose memory, the condition belongs to blood stagnation remains in the body.” It means that, the stagnated blood would block energy flow (meridian), the blood could not circulate up to the brain to nourish the mind, so that the person tends to forget things. For the same reason, when the stagnated blood fails to circulate up to nourish the brain, the Yin deficiency in the brain would cause the Yang fails to dive into the Yin at night and to cause poor sleep. For this case, the patient had pain in belly before menstruation, indicating the presence of stagnated blood. Therefore, the blood circulation-improving and stagnation-clearing therapy works well. To use the Da Chaihu Tang plus Taohe Chenqi Tang is the clinic experience of Dr. Hu.

14.  张某,男,38岁,病案号182577

Case 14. Zhang XX, male, 38 years of old. File number: 182577.

初诊日期19651213日:失眠已一年多,左腹时痛。时心悸,常呵欠,流眼泪,舌苔白腻,脉弦。此血虚水盛,治以养血利水,与当归芍药散合苓桂术甘汤酸枣仁汤加减:当归三钱,白芍四钱,川芎三钱,苍术三钱,泽泻四钱,茯苓五钱,桂枝四钱,知毋三钱,炒枣仁五钱,炙甘草二钱,生龙骨一两,生牡蛎一两。

The first visit: December 13, 1965. The patient had poor sleep for more than one year. He felt pain some times in the left side of belly, and palpitation. He often had yawn, and tearing. His tongue cover was white and greasy, and the pulse was string. This is a blood deficiency and water overwhelming condition. The herbal therapy should focus to nourish the blood and to deplete water. He was given Danggui Shaoyao San plus Ling Gui Zhu Gan Tang and Suanzaoren Tang with some modification: Danggui 9 g, Baishao 12 g, Chuanxiong 9 g, Cangzhu 9 g, Zexie 12 g, Fuling 15 g, Guizhi 12 g, Zhimu 9 g, Chao Zaoren 15 g, Zhi Gancao 6 g, Longgu 30 g, and Muli 30 g.

二诊1220日:上药服三剂,仍失眠,胃脘感凉,嗳气多,食后心下满。上方去知母,加半夏、生姜各三钱,橘皮四钱。

The second visit: December 20. After the herbal therapy for 3 doses, he still felt poor sleep. He had cold feeling in the stomach, more belching, and bloating feeling in the stomach area. From the prescription above, herb Zhimu was removed, but Banxia 9 g, and fresh ginger 9 g, and Jupi 12 g were added. 

三诊196613日:左腹痛已,嗳气减,心悸、失眠好转,仍服上方调理。

The third visit: January 3, 1966. The belly pain stopped. The belching reduced. The palpitation and poor sleep were improved. The prescription was continued.

按:阴血虚之失眠,用酸枣仁汤补虚敛神以安眠。当血虚同时水饮盛时,必在养血的同时与以温阳化饮。当饮重阳虚明显时,益阴除烦的知毋因过于苦寒不宜服用,当依证加入半夏、生姜、陈皮温中化饮之品。

Comments: For a poor sleep due to Yin and blood deficiency, use Suanzaoren Tang to nourish the Yin and blood, so as to contract and bring the Yang and to improve sleep. When the blood deficiency is with water overwhelming, the Yang-warming and water-depleting therapy must be used together with the blood nourishing therapy. When the water overwhelming and Yang deficiency are apparent, the Zhimu that works to nourish the Yin and to calm mind should be be used for its too bitter-cold nature. In this case, it should be used the Banxia, fresh ginger, and Chenpi should be used to warm the stomach and to deplete water.

以上是胡老治疗脑系病部分病例,虽然不全面,但可以看出用经方可有效治疗各种功能性或器质性病变。同时还可看出,中药治疗脑系病之所以有效,是在中医理论指导下取得的,尤其是其病因病理、药物的作用原理,皆要遵循中医的理论。更值得说明的,胡老治脑系病,不论病情复杂简单,不论病程长短,皆用药少而精,且疗效突出,其关键是辨方证准确之功。

The case reports above show only partial cases that Dr. Hu saw for the patients with disease associated with the brain. Though they are not complete, we can find that the Jing Fang can be used to solve various organic or functional disorders. At the same time, it can be seen that the herbs work for the brain-associated diseases is because it is used following the TCM principle. Especially the cause and course of a disease and the functional mechanism of the herbs, all must follow the TCM theory. It should be emphasized that, Dr. Hu, when treat the brain-associated disease, uses no too mush numbers of herbs, no matter how complex the disease and how long the disease is in length, whereas the healing effect remains excellent. The most important reason for this is his precise herbal indication diagnosis.

 

17.  治疗血证经验

17. The treatment of blood system

血液病所赅病症甚多,胡老经治病例也很多,不能全面介绍,今就常见的出血证、贫血证、瘀血证的证治简介于下。

The diseases in the blood system (heamotopathy) include large amount of various diseases. Dr. Hu has a lot of such cases. It is not going to introduce all of them, but only the commonly seen bleeding, anemia, and blood stagnation.

17. 术后出血病垂危     经方一剂扭乾坤

The bleeding after surgery risks life. The Chinese Jing Fang therapy solve the problem.

1. 宋某,女,17岁,某医院住院病案号114533

Case 1. Song XX. Female. 17 years of old. File number (in a hospital): 114533.

初会诊日期19821011日:咽出血半月。患者出生时即有唇、_裂,2岁时将唇裂缝合,因有"先天性肝糖元累积症"GPT经常高,一直未进行_裂缝合,直至上月经内科多方检查,认为可以手术,方于925日全麻下进行了_裂缝合术,术中输少量血,手术顺利。术后第一二天除低热 (375C) 外无不良反应,但意想不到的事发生了,第三天伤口开始渗血,用碘纱布条填塞无效。继用止血敏、VCVK6一氨基乙酸、抗血纤溶芳酸等皆无效。又请中医会诊,给服益气止血汤药数剂未见疗效。因失血过多,不得不输新鲜血液维持生命。第一二天尚能维持24小时,但自第三天起,仅能维持12小时,因此每天要输血,至今输血已逾3000毫升,故急请会诊。

The first consultation: October 11, 1982. The patient had bleeding in nose for half month. The patient had, from the birth, the cleft lip and cleft palate. On her 2 years of old, she had the cleft lip treated by surgery. For the fact that she had congenital glycogenstorage disease, and increased GPT, she did not have the cleft palate treated. Up to the last month, after consultation with the agreement by the physicians for the surgical treatment, she had the surgery for the cleft palate. During the surgery, she had little blood transfusion and the surgery was successful. On the first and the second days after the surgery, she had only low fever (body temperature 37.5 C), and no any other symptoms or discomfort. However, surprisingly, on the third day, there was effusion of blood from the surgical wound. There was no any effect with the use of idione gauze, or various bleeding-stop medicines. TCM doctor was asked again for a consultation. She was given Qi-nourishing and Bleeding-stop herbs but still no effect. For lose of large amount of blood, she had had to have blood infusion to maintain life. On the first and second day, the blood transfusion can maintain for 24 hours. From the third day, it could only work for 12 hours. Thereafter, she needed blood transfusion everyday. So far to the time when Dr. Hu was asked for consultation, she had 3000 ml blood transfusion. Dr. Hu was urgently asked for consultation.

会诊时实验室检查所见:GPT11l单位,血红蛋白94克,白血球总数10400,血小板126000,血钾41,血钠140,血氨100,出血时间1分,凝血象检查:复钙时间2(对照230),凝血霉元时间15(对照145),第V因子19(对照21),第?因子195(对照205),凝血霉凝固试验21(对照18),血清剩余凝血3小时22秒。第?因子不少。

The condition on the consultation: … (The original Chinese text here are mostly the lab test reports).

会诊时症状神识尚清,但目喜闭合而不愿看人,烦躁汗出,面色苍白,双鼻孔见黑紫血块,口干思饮,常有饥饿感而思食。因伤口渗血未敢让其进食,大便溏稀而色黑,一日一行,舌质红无苔而见血染,脉细滑数。证属血虚热扰,急宜清热止血而兼补虚育阴之治,与芎归胶艾汤加减:生地30克,当归10克,10克,阿胶10克,艾叶10克,党参10克,白芍10克,炙甘草10克,白术6克,生石膏50克。

On the consultation, the girl was clear in consciousness but she preferred to close eyes and no willingness to see people. She felt annoying and sweat. She had pale face. There was black-purple color blood clot in the nose holes. She had dry mouth and had desire to drink water. She had hungry feeling and had desire to eat, but for fear of wound blood effusion, she was not allowed to eat. The stool was black and loose, once a day. The tongue was red without tongue cover. The pulse was thin, slippery and frequent. The condition belongs to blood deficiency with Fire stirring. She was urgently given herbal therapy to clear Fire, to stop bleeding, as well as to nourish the weakness and the Yin. The herb prescription was  Qiong Gui Jiao Ai Tang with modification: Shengdi 30 g, Danggui 10 g, Ajiao 10 g, Aiye 10 g, Dangshen 10 g, Baishao10 g, Zhi Gancao 10 g, Baizhu 10 g, Shigao 50 g.

结果:服药一剂血即止,第二天进流食,停止输血。第三天因感食欲较差,而改生地为15克,加生地炭15克,继服三剂,食欲如常,停止输液。至1018日复诊时,面色红润,两眼有神,除稍有汗出外,别无不适,继服二剂痊愈出院。

Results: After one dose, the bleeding stopped. On the second day, she could eat some fluid food and the blood transfusion stopped. On the third day, she felt less appetite, so the Shengdi in the prescription was changed to 15 g, with addition of Shengdi Tan 15 g. The prescription was continued for three days. The appetite was normal, and the in vein transfusion stopped to use. On October 18, her face was pint with humidity. There is spirit in eyes. Apart from slight sweat, no any other discomfort at all. The prescription was continued for additional two doses.

按:此大出血,西医诊治束手,输新鲜血也难维护。中医也曾益气止血,但因未针对病本之虚热上扰,故用大量止血药未收寸效。值会诊时,病情已危在旦夕,如药再不对症,则无挽回生命的机会。此刻胡老凭借多年经验和仲景学说的功底,诊即抓其本,并辨证为芎归胶艾汤方证,故一剂使其血止,医家病家无不称奇。

Comments: For such large amount of bleeding. There was no any way from western medicine, even if with large amount of blood transfusion. For Chinese medicine, the Qi and Blood nourishing therapy and the bleeding-stop therapy had been used too, but for the prescription did not target the clearance of upper Fire, the bleeding-stopping herbs did not work either. Upon consultation, the patient life risked seriously. If the further herbal therapy did not match the condition, there would have no change at all to save the life. At this movement, thanks for the rich clinic experience of Dr. Hu in the practice of theory of Dr. Zhongjing Zhang, he caught the point of the disease, and diagnosed the condition as Qiong Gui Jiao Ai Tang. Therefore, one dose worked excellent to stop the bleeding. It surprised all, the doctors and the family.

18.  尿血虽无症   辨证却从容

18.  Patient has urine bleeding without any discomfort. TCM can still make diagnosis and to solve it.

2. 林某,男,38岁,空军飞行员。

Case 2. Lin XX, male, 38 years of old. Pilot of airforce.

初诊日期1966219日:于1962年开始每56个月发一次尿血,因别无所苦,未予重视。但自今年116日尿血加重,服止血药不见效,方到医院检查,但经协和、301、北医等医院行膀胱镜、肾盂造影等检查均未见异常。查尿为血尿,色鲜红,红血球满视野,尿蛋白( ),怀疑肾癌,但又通过其他检查,未能确诊。舌苔白,脉细弦。胡老与芎归胶艾汤合桂枝茯苓丸:生地一两,当归三钱,桃仁三钱,丹皮三钱,桂枝三钱,白芍三钱,茯苓三钱,泽泻三钱,阿胶三钱,艾叶一钱,生苡仁八钱。

The first visit: February 19, 1966. The patient had bleeding in urine once every five to six months, since 1962. He had no any other discomfort or symptoms. Since January 16 this year, the urine bleeding became worse. It did stop after taking bleeding-stopping medicine. He then went to hospital for check. With various endoscope check and more other kinds of detect, they found nothing wrong. The urine is clear blood urine with fresh red in color. There were rich in red blood cells under microscope detect. Urine protein was . He was suspected to be kidney cancer. But it could not be confirmed with  other more detect or lab test. His tongue cover was white, and the pulse was thin and string. Dr. Hu gave him Qiong Gui Jiao Ai Tang plus Guizhi Fuling Wan: Shengdi 30 g, Danggui 9 g, Taoren 9 g, Danpi 9 g, Guizhi 9 g, Baishao 9 g, Fuling 9 g, Zexie 9 g, Ajiao 9 g, Aiye 3 g, Yiyiren 24 g.  

结果:上药服三剂,尿色变淡,而出现小血块。服七剂后,尿中血块消失,查尿蛋白(),红血球(),因有效连续服三十剂。410日来请教胡老今后治疗,胡老谓:即无尿血亦无症状,可停药,若有反复可再来诊。

Results: After the herbal therapy for three doses, the color of urine became lighter but started to have small clots. After seven doses, the blood clot disappeared. The urine protein became (-), red blood cells (-). For the herbal therapy worked, it was continued for 30 doses (30 days). On April 10 for consultation, Dr. Hu told him, for no bleeding in urine or any discomfort, the herbal therapy can be stopped. If there is any recurrence, the patient can come again.

按:此是无痛尿血,当首先怀疑癌症,但各项检查未能确诊,西医诊断确实不明。而中医辨证因无症状,也无从下一手,曾问胡老何从辨证,胡老指示两点,一是尿血色鲜红多为热;一是尿血已久多为瘀,故拟芎归胶艾汤合桂枝茯苓丸加生苡仁补虚凉血、祛瘀活血一试。有者求之,无者求之。真乃医者,意也。

Comments: This is no-pain urine bleeding. The first suspect was cancer, which however could not be confirmed by various detect or lab tests. For Chinese medicine, for no symptoms, it was also difficult to solve the problem. Dr. Hu had been asked how to do and what to do. Dr. Hu supervised and said, first, the urine was red in color, indicating it is a hotness; second, the long term urine suggests it is a blood stagnation. For this reason, the Qiong Gui Jiao Ai Tang and Guizhi Fuling Wan plus Yiyiren is indicated so as to nourish the weakness, to cold down the blood, to remove the blood stagnation and to activate blood circulation. For Chinese medicine, no matter there is the symptoms or not, a diagnosis can still be made. This is Chinese medicine: medicine is a “imagination and perception”.

19.  便血九年病缠绵   黄土九剂却能痊

19.  Patient had bleeding in stool for nine years. The herbal Huangtu Tang solved the problem by only nine doses.

3 王某,男,39岁,病案号185193

Case 3. Wang XX. Male. 39 years of old. File number: 185193.

初诊日期1968612日:反复发作胃脘疼、大便下血已九年。经各种检查诊断为"胆道感染""结肠炎出血"。近症:时有黑便,时有黑紫血,常左腹痛及胃脘疼,晚上心烦,干思饮,但饮不多,纳尚可,但食不香,时有头晕、乏力,自感四肢发凉,面色萎黄,舌苔白腻,脉细沉。证属饮久生热,伤络血溢,治以温化寒饮,养血清热,与黄土汤合理中汤加减:党参三钱,白术三钱,黄芩三钱,干姜二钱,当归三钱,川芎二钱,艾叶三钱,川附子二钱,炙甘草二钱,阿胶三钱,伏龙肝二两(煎汤代水)

The first visit: June 12, 1968. The patient had recurrent stomach pain and bleeding in stool for nine years. After various check, he was diagnosed as gall bladder infection, and colonitis with bleeding. The current condition: from time to time, he had black stool, which some times was black and purple in color. He often felt pain in left belly and in stomach area. He felt annoyed at night, dry mouth with desire to drink but being unable to drink a lot. The appetite was ok, but could not tasted delicious. From time to time, he felt dizziness and fatique, felt cold hands and feet. His face was withered yellow. The tongue cover was white and greasy. The pulse was deep and thin. The condition was diagnosed as a long term of water accumulation that developed into Fire. The Fire hurt the blood vessels, so to cause bleeding. The herbal therapy is used to warming the cold, to nourish the blood and to clear the Fire. He was given Huangtu Tang plus Lizhong Tang with modification: Dangshen9 g, Baizhu 9 g, Huangqin 9 g, dried ginger 6 g, Danggui 9 g, Chunxiong 6 g, Aiye 9 g, Chuan Fuzi 6 g, Zhi Gancao 6 g, Ajiao 9 g, Fulonggan 60 g (cook to get the water extract, which is then used to cook other herbal ingredients).

结果:上药服九剂,腹痛胃脘疼已,便血渐止。

Results: After the herbal therapy for nine doses, the pain in the stomach stopped, and bleeding in stool became less and less until no more at al.

按:前两例都是血虚有热之出血,故治疗补血兼清热而重于清热,本例则不但血虚,而更阳虚饮盛,血虚生热,饮久化热,故呈阴阳寒热交错之虚证,因此治疗以温阳为主,佐以清热为辅。方中伏龙肝,为温性收敛药而有止血的特能,伍以生地、阿胶、艾叶协力止血,佐以甘草、白术、干姜、附子、党参理中祛饮,辅以黄芩清热,故能温中补虚,生血化饮,兼清虚热,使九年便血九剂即能治愈。

Comments: For the first two cases, which are blood deficiency with Fire, it is the Fire that causes bleeding. For the treatment, the herbs should work to nourish the blood and to clear the Fire. It focused on the Fire clearance. In the case here, the patient had not only blood deficiency, but also Yang deficiency with water overwhelming, as well as the blood deficiency that developed into Fire; the long terms of water sluggishness causes also Fire. It is a complex condition with weakness. For the treatment, the main target is to warm the Yang, accompanied by Fire-clearing. Among the herbs used, the Fulinggan (Huangtu) is a warming-contracting herb able to stop bleeding. The Shengdi, Ajiao and Aiye work together to stop bleeding. The Gancao, Baizhu, dried ginger, Fuzi, and Dangshen work to nourish the middle stomach and to dispel water. The Huangqin helps to clear Fire. Therefore, the whole prescription is able to warm middle stomach, to nourish the weakness, to produce blood, to deplete water, as well as to clear the false Fire, so as to make the nine-year bleeding stopped.

 

20.  崩漏不止止之不止   小柴与之和之则和

20.  In uterine bleeding, the bleeding is hard to stop. The use of Xiao Chaihu Tang works to stop it.

4.  赵某,女,22岁,学生。

Case 4. Zhao XX. Female. 22 years of old. Student.

初诊日期196645日:2年来月经淋漓不断。16岁即来月经,前三个月不规律,但半年后大致正常。缘于年前撤暖气时,过于劳累而感冒,适月经正行,没想到感冒愈后,月经淋漓至今未止。曾到妇科多次检查,未查清病因,服用止血药毫无收效。又找中医治疗,服汤剂、丸剂等,症有增无减。托亲友介绍找胡老诊治。近来症状:月经淋漓不断,色淡红,有时见小血块,时有腹隐隐作痛,常乏力、头晕、或头痛,口干,纳差,或心烦,手足心热,舌苔薄白,舌质淡红,脉沉细。胡老与小柴胡汤合当归芍药散加生地艾叶:柴胡四钱,党参三钱,黄芩三钱,半夏四钱,生姜三钱,大枣四枚,当归三钱,川芎二钱,炙甘草二钱,茯苓三钱,苍术三钱,泽泻三钱,生地五钱,艾叶三钱。

The first visit: April 5, 1966. The patient had spotting bleeding from uterus for two years. She had first menstruation on her 16 years of old. The first three months, it was not regular but after half year, it turned pretty normal. In early this year, when she removed the warming system at home, for heavy labor work, she caught common cold. At that movement, it was the time her menstruation came. To unexpected, after the common cold subsided, the bleeding did not stop until now. She had been to hospital for check many times, no clear finding. She was given bleeding-stopping medicine too. No any therapy worked for her to stop bleeding. This was true when she visited Chinese medicine. Her symptoms did not reduce but became more and worse. She asked friends to introduce her to see Dr. Hu. The condition at that time: She had continous bleeding from uterus, the color of which was pink in color. Some times, there was small blood clots in the bleeding. She felt often doll pain in stomach, fatique, dizziness, or headache, dry mouth, poor appetite, or flustered and annoyed, and hot feeling in hands and feet. The tongue cover was white and thin. The tongue was slight red in color.  The pulse was deep and thin. Dr. Hu gave her Xiao Chaihu Tang plus Danggui Shaoyao San plus Shengdi and Aiye: Chaihu 12 g, Dangshen 9 g, Huangqin 9 g, Banxia 12 g, fresh ginger 9 g, Chinese date 4, Danggi 9 g, Chuanxiong 6 g, Zhi Gancao 6 g, Fuling 9 g, Cangzhu 9 g, Zexie 9 g, Shengdi 15 g,and Aiye 9 g.

结果:上药服10剂血止,嘱继服原方巩固疗效。三月后其同学告之月经正常。

Results After the herbal therapy for ten days, the bleeding stopped. She was asked to continue the prescription for a while for maintenance. After three months, her classmate told that she was normal.

按:本例辨证用方实耐人寻味。一般而论,长期月经淋漓不断,当首先考虑血虚、血瘀,脾不统血、肝不藏血、肾不摄血、气衰血脱等,本例何以用小柴胡汤?复习一下胡老对小柴胡汤的论述可冀拨云见日。《伤寒论》第101条:"伤寒中,有柴胡证,但见一证便是,不必悉具。"胡老在注解此条时写道:"外感初传少阳,柴胡证往往四证不备,医者不知用小柴胡汤,因使风寒小病久久不愈,此例甚多,宜注意。"又《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,此汤主之。"对此胡老注解谓:"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。"可见胡老对小柴胡汤的方证深深理解,一看本例症状就能判定为小柴胡汤合当归芍药散方证,故服之很快起沉屙。由此也可体会到,胡老所提出的"辨方证是六经八纲辨证的继续,亦即辨证的尖端"的观点是一生医学实践总结,是科学的论断。

Comments: It is very surprised for the herbs used in this case. Generally speaking, if the menstruation continued for a long time, it would be first of all considered to be due to blood deficiency, blood stagnation, spleen deficiency that fails to seal the blood within the blood vessels, the liver deficiency that fails to store blood in liver, kidney deficiency that fails to hold blood in the body, or due to Qi deficiency and blood escape to spill out, etc. How can use Xiao Chaihu Tang in this case? The answer would be clear after reviewing the explanation by Dr. Hu for this herbal prescription. In the book <<Shng Han Lun>>, paragraph 101: “For Shang Han disease with Wind attack, even if there is only one symptom for Chaihu Tang, use the Xiao Chaihu Tang, no need to wait until all the symptoms come to show.” In the explanation of this prescription, Dr. Hu wrote: “The external Xie Qi attacks the body, and it passes into the Shaoyang phase, in the beginning, the symptoms indicating the Xiao Chaihu Tang is not all shown. If the doctor does not know how to use Xiao Chaihu Tang, it would make the small disease lasts for a long and long time without cure. In clinic, there are a lot of such examples. This should be paid more attention.

In another book <<Jing Kui Yao Luo, Female after birth delivery>>, in the appendix prescription (1): the <<Qian Jing Fang>> San Wu Huangqin Tang works to female, who catches infection after attack by Wind, who feels annoying hotness in hands and feet. If the woman has headache, use Xiao Chaihu Tang. If no headache but annoying feeling, use the San Wu Hungqin Tang. Dr. Hu stated for this paragraph: “Wind-attack after birth delivery, for a improper treatment, the disease was not solved. After a long time, the disease develops into Fire. If the patient in such condition has headache, the use of Xiao Chaihu Tang works.”  From here, it can be seen the deep understanding by Dr. Hu for the indication to the Xiao Chaihu Tang. Once seeing the patient here, he could identify it is the indication of Xiao Chaihu Tang plus Danggui Shaoyao San. Therefore, the herbs worked excellent for this girl. From this case, we realized what Dr. Hu said: the herb indication diagnosis is the continue of traditional Chinese Liu Jing and Ba Gang diagnosis system, and it is the key and the most important part of the TCM diagnosis. His statement is the summary of his life-long clinic experience, and it is scientific comment.

21.  再障贫血症多凶 养血利水建奇功

21. Aplastic anemia is severe, but the herbal therapy to nourish blood and to remove water works excellent.

5.  赵某,男,26岁,密云县高岭赤脚医生。

Case 5. Zhao XX, Male, 26 years of old. Coutryside doctor in Miyun county, China.

初诊日期1977727 日:乏力、出血、贫血7年。不明原因感乏力、心慌、气短、鼻衄,经检查为贫血,经服中西药久不见效,后经骨髓穿刺检查确诊为"再生障碍性贫血"。自拟方开药也未见好转。现在症状:胸背痛,且感背如背冰,恶寒,气短,心悸,起则头眩,面色萎黄,口干, 午后手足心热,周身皮肤散在出血点,血色素9克,血小板35000,白细胞2900,舌苔白,舌质淡暗,脉细弱。此血虚水盛,为苓桂术甘合当归芍药散方证:桂枝三钱,白芍四钱,当归三钱,川芎三钱,茯苓四钱,苍术三钱,泽泻六钱,炙甘草二钱。

The first visit: July 27, 1977: The patient had fatique, bleeding, and anemia for seven years. For no clear reason, he felt fatique, flustered, short of breath, and nose bleeding. His condition was diagnosed as anemia. After various western medicine therapies and Chinese herbal therapy, no any improvement. Later, after bone marrow smear test, it was diagnosed as aplastic anemia. He prescribed herbal therapy for himself, which did not work either. The current condition: pain in the chest and back. He felt cold on the bac as ice, chilly, short of breath, palpitation, and dizziness when got up. His face was withered yellow. He felt dry mouth, hot feeling in hands and feet. There were scattered bleeding spots on the skin. Lab. test: Hb 9 g; platelet 35000, WBC 2900. His tongue cover was white. The tongue was slight dark. The pulse was thin and weak. This condition belongs to blood deficiency with water overwhelming. It was the indication for Ling Gui Zhu Gan Tang plus Danggui Shaoyao San: Guizhi 9 g, Baishao 12 g, Danggui 9 g, Chuanxiong 9 g, Fuling 12 g, Cangzhu 9 g, Zexie 18 g, Zhi Gancao 6 g.

二诊917日:上药服10剂,诸证减轻,又继服20余剂,周身肤出血点消失,但下肢酸、腹觉灼热。改服柴胡桂枝干姜汤合当归芍药散方:柴胡四钱,桂枝三钱,干姜二钱,当归三钱,白芍四钱,川芎三钱,茯苓四钱,泽泻六钱,苍术三钱,炙甘草二钱,花粉四钱,黄芩三钱,生牡蛎五钱。

The second visit: September 17. After the herbal therapy for 10 doses (10 days), all the symptoms were improved. After additional 20 days of the herbal therapy, the bleeding spots on skin disappeared. He felt sour in legs, burning feeling in belly. The herbal prescription was changed to Chaihu Guizhi Ganjiang Tang plus Danggui Shaoyao San: Chaihu 12 g, Guizhi 9 g, dried ginger 6 g, Danggui 9 g, Baishao 12 g, Chuanxiong 9 g, Fuling 12 g, Zexie 18 g,Cangzhu 9 g, Zhi Gancao 6 g, Tianhuafeng 12 g, Huangqin 9 g, Muli 15 g.

三诊1023日:自觉证已不明显,出血点亦未见,血色素131克,血小板50000,白细胞3500。继服上方巩固之。

The third visit: October 23. He had no any symptoms. No more bleeding spot on skin. Hb was 13.1 g, platelet 50000, WBC 3500. The same prescription was continued for a maintenance.

按:再障是由化学、物理、生物等因素及不明原因引起骨髓造血功能障碍的疾病。6070年代有不少专门研究、报道。因本病易患继发感染而出现热象,祛热治疗必不可少。但因提倡"以急劳与温热病论治"则往往偏重清热而忽略祛寒温补,本例的治疗过程正是说明这一问题。一般一见口干、午后手足心热、皮肤有出血点等,即认为是阴血虚而生内热。而忽略血虚水盛、饮久化热之虚热,如本例即如此。胡老用温补中气、养血利水的方法治愈多例患者,如治一徐姓成年女患者,贫血经年,血色素81克,主症有:胃脘疼,食欲不振,大便溏有粘液,给服茯苓饮合四逆散当归芍药散加吴茱萸,服一月后,胃脘疼已,食欲及大便俱好转,血色素108克。可见温补中气、养血利水是治疗再障、贫血不可忽略的重要方法。

Comments: Aplastic anemia is a kind of anemia caused by unknown causes, which might be due to some chemical, physical or biologica things. It is characterized by reduced blood cell production in bone marrow. There had been a lot of studies for the cause, the mechanism and the treatment of this disease during 1960 and 1970 period. For the fact that this disease is easy to be accompanied by infection and to cause fever, a Fire-clearing therapy is needed. However, for the idea that it should be treated considering it is an acute exhausting and Hotness disease, it is treated more with Fire-clearing therapy but less with Cold-dispelling and warm-nourishing therapy. This case is such example. Generally speaking, it would be considered as Yin and blood deficiency that cause inside Fire, when there are dry mouth, hot feeling in hands and feet in the afternoon, and bleeding spots on skin. People omit the possible blood deficiency with water overwhelming and long time of such water overwhelming could cause inside Fire too. This is true for this case. Dr. He used the warm-nourishing, blood-nourishing and water-depleting therapy cured a lot of patients. For example, there was lady with name Xu, who had anemia for many years. Her Hb was 8.1 g. She had stomach pain, poor appetite, and mucus material in her stool. She was given Fuling Yin plus Si Ni San, plus Wuzhuyu. After one month, the stomach pain stopped, the appetite and bowel movement were improved. Hb became 10.8 g. It can be seen that, the warm-nourishing, blood-nourishing and water-depleting therapy is one the most important therapies in the treatment of aplastic anemia. 

22.  紫癜未必全热证 下之温之皆治之

22. Purpura may not always be a Fire condition. A bowel-movement-stimulating therapy or a waming therapy might work for it too.

6. 李某,男,17岁。

Case 6. Li XX, male, 17 years of old.

在颐和园游泳时发现下肢皮肤有紫癜点点,继之腹痛、腹泄,紫癜延及遍身,人道济医院住院治疗,予止血针、止痛针等对症治疗,腹痛、紫癜不见明显好转,却人渐消瘦,以至骨瘦如柴。后因大便干结,予蓖麻油口服,便出大量污血而腹痛止,紫癜渐消,人也渐胖,而出院。但半年后病又复发,又人道济医院,再用蓖麻油则毫无疗效,无奈接回家拖延时日,后请胡老诊治。来诊时症状:皮肤紫癜散在,常少腹痛,大便干燥,烦躁,舌苔黄,舌紫,脉沉弦。认为是瘀血阻络,为抵当汤合大柴胡汤方证:水蛭二钱,虻虫二钱,桃仁二钱,大黄三钱,柴胡四钱,白芍三钱,生姜三钱,半夏四钱,枳壳三钱,黄芩三钱,大枣四枚。

When the patient had swimming in a lake, he found purpura spots on skin. Later he felt pain in belly, had diarrhea and the purpura spread to whole of the body. He was admitted in the ward in a hospital for treatment. He was given blood-stopping therapy, and pain killer, and so on for symptomatic treatment. The belly pain and skin purpura were not improved and he became slim and slim up to nearly only a bone skeleton. Later, for his hard stool, he was given castor oil orally. After having a lot of dirty blood from the stool, the stomach pain stopped, and the purpura gradually subsided. His body became gradually more in body weight. So he was discharged from hospital. Half years later, the disease had onset again. He was admitted into the same hospital and given the same castor oil for the treatment but in vain. For no choice, he was brought home and later he was brought to Dr. Hu for treatment. The current condition at that movement: there were scattered bleeding spots on skin all over the body. He often felt pain in stomach. His stool was hard to pass. He felt annoyed and irritable. The tongue was purple in color. The tongue cover was yellow. The pulse was deep and string. His condition was considered to be the block of blood vessels by stagnated blood. He was given Di Dang Tang plus Da Chaihu Tang: Shuizhi 6 g, Mangchong 6 g, Taoren 6 g, Dahuang 9 g, Chaihu 12 g, fresh ginger 9 g, Banxia 12 g, Zhike 9 g, Huangqin 9 g, and Chinese date 4.

结果:上药服一剂,泄下大便及黑血数升,腹痛已,紫癜随之好转,证已,身体健康,追访10年未见复发。

Results: After the herbal therapy for one day, he had several liters of black blood in his stool. The pain in belly stopped. The purpura gradually became better. The symptoms subsided. A following up 10 years later showed everything was normal.

按:本例是胡老在50年代的的治验例,诊余胡老曾讲述过该病例。尤其是讲到辨证时,胡老特别指出,患者服蓖麻油后大便泻下污血便,可证为内有瘀血,故果断投与抵当汤合大柴胡汤,仅服一剂沉屙向愈。

Comments: This case was the one Dr. Hu saw on 1050’s. After daily clinic work, Dr. Hu had introduced this case to us. Especially when he talked about the diagnosis, he emphasized that, it indicated the body had blood stagnation when he had dirty blood in stool after taking castor oil. If at that time, the doctor was brave to use the Di Dang Tang plus Da Chaihu Tang, one dose might solve all the problems.

7.  程某,女,33岁,病案号53892

Case 7. Chen XX, female, 33 years of old. File number: 53892.

初诊日期1964312日:皮肤有紫癜5年余。自59年夏发现皮肤有紫癜或瘀血,同时有口、鼻、齿龈、肠道等部位出血,在友谊医院检查谓"凝血活霉生成不良,血小板第三因子功能衰退所致过敏性紫癜",既往有肾下垂、关节炎、子宫内膜异位、慢性肝脾肿大等。治疗曾输血800毫升,未见明显好转。在本市某中医院辨证为气血双虚,予以黄_、当归、阿胶等曾有效而不巩固。近症:皮肤紫癜散在,时头晕头沉,口腔、鼻腔时出血,四肢浮肿,手足麻木,两胁痛,腰酸腿软,困乏无力,嗜睡,身无热而恶寒,有时自汗,饮食尚可,口干,便溏,舌苔白薄,舌质淡,脉左弦右沉细无力。此为少阳太阴合病,为柴胡桂枝汤合附子理中汤方证:柴胡四钱,黄芩三钱,生姜三钱,半夏三钱,桂枝三钱,白芍三钱,川附子三钱,党参三钱,当归四钱,川芎四钱,茯苓三钱,泽泻三钱,大枣四枚,炙甘草二钱。

The first visit: March 12, 1964. The patient had purpura on skin for 5 years. Since summer 1959, she found purpura or stagnated blood spots on skin. At the same time, she had bleeding from nose, mouth, gum and intestine. In Youyi Hospital in Beijing, she was diagnosed as allergic purpura, after various lab tests. She had a history of nephroptosis, arthritis, endometrosis, chronic enlargement of spleen and liver. She was given blood transfusion for 800 ml. The condition remained the same. She was diagnosed in a TCM hospital as Qi and Blood double deficiency condition. She was given Huangqi, Danggui and Ajiao and other herbs but the herbal therapy did work for a short time, but not for a long time. The current condition when she saw Dr. Hu: there were scattered purpura spots on skin. She felt from time to time dizziness, heavy head, sweat, dry mouth, loose bowel movement. Appetite was pretty normal. The tongue is pale in color. The tongue cover was thin and white. The pulse was string on left side and deep, thin and weak on right side. This was Shaoyang-Taiyin co-exist phases. It was the indication to Chaihu Guizhi Tang plus Fuzi Lizhong Tang: Chaihu 12 g, Huangqin 9 g, fresh ginger 9 g, Banxia 9 g, Guizhi 9 g, Baishao 9 g,Chuan Fuzi 9 g, Dangshen 9 g, Danggui 12 g, Chuanxiong 12 g, Fuling 9 g, Zexie 9 g, Chinese date 4, Zhi Gancao 6 g.  

二诊316日:上药服三剂,诸症减轻,上方去川附子,加丹参一两、阿胶三钱。

The second visit: March 16. After the herbal therapy for three days, all the symptoms were improved. From the prescription, removed was Chuan Fuzi, but added Danshen 30 g, and Ajiao 9 g.

三诊331日:下肢浮肿,紫癜又明显,少腹发凉,面色苍白,腹胀、口渴喜饮而小便不利,且自感浮肿明显时,紫癜及出血皆明显,以往浮肿明显时服双氢克尿塞,肿消不明显而心慌心跳显著,且紫癜、出血加重。与木防己汤合当归芍药散加黄_:木防己三钱,党参三钱,桂枝三钱,生石膏一两半,当归三钱,茯苓三钱,川芎三钱,苍术三钱,泽泻四钱,猪苓三钱,白芍三钱,生黄芪五钱。

The third visit: March 31: She had swelling in legs and the purpura became worse. She felt cold in lower belly, bloating in belly, dry mouth with desire to drink and difficult urination. Her face was pale. She said that her purpura and bleeding would be more whenever she felt strong swelling. Previously she took diuretics when the swelling was severe, but the swelling did not go much away but she would feel more flustered and palpitation, as well as more purpura and bleeding in skin. She was given Mufangji Tang plus Danggui Shaoyao San plus Huangqi: Mufangji 9 g, Dangshen 9 g, Guizhi 9 g, Shigao 45 g, Danggui 9 g, Fuling 9 g, Chuanxiong 9 g, Cangzhu 9 g, Zexie 12 g, Zhuling 9 g, Baishao 9 g, Huangqi 15 g.  

四诊47日:上药服六剂,效果满意,于44日上半身浮肿明显消退,下肢浮肿亦减,自感精神轻松,躺卧、入厕蹲着手足也不再感麻木,体力增加,做清洁办公室工作已不感累,关节疼亦减,腹胀已,两胁痛明显好转,食后胃脘及两胁稍有胀疼,紫癜大部在消退,仍口干喜热饮,小便多.上方加生地炭五钱、茜草四钱继服调理。

The forth visit: April 7. After the herbal therapy for 6 days, the healing results were satisfied. On April 4, the swelling in upper part of the body subsided clearly and that in the legs was also reduced. She felt more comfort in emotion. No more numb feeling in hands and feet when she lay down or bend on the knee. She felt more energy physically. Nore more tired feeling when she did clearing work in office. The pain in the knee was reduced. The bloating in belly stopped. The pain in the upper side of the belly was improved apparently. After eat, she had slight bloating and pain in the stomach area and on the upper side of the belly. Most of the purpura on skin was subsiding. She still felt dry mouth and had desire to drink warm water. She had frequent urination. To the prescription above, added was Shendi Tan 15 g, and Qiancao 12 g for a continuous maintenance.

按:从本案治疗过程中可看到,用柴胡桂枝汤合附子理中汤有效,但去温阳的附子,加凉血止血的丹参、阿胶病情 反增重,并发现水肿与紫癜密切相关,因此用木防己汤加黄_益气利水,能使水肿退紫癜消。由此胡老体验认为:水肿时则血液稀释,为出血、紫癜创造条件,祛水势在必行,此是特殊之法。当然整个病的治疗要综合分析,据症候辨证立法用药,本案主要表现为气血虚水饮盛,故治益气养血利水,为木己汤合当归芍药散加黄_方证,不用止血而血自止。

Comments: From the course of the treatment of this case, it can be seen that, it is effective when using Chaihu Guizhi Tang plus Fuzi Lizhong Tang. But it became worse after removal of the warming Fuzi, but adding the Blood-cooling and bleeding-stopping Danshen and Ajiao. It had also been found that, the swelling was related to the onset and severity of the purpura. For this reason, the use of Mufangji Tang plus Huangqi to nourish the Qi and to deplete water, could make the swelling dissolved and the purpura subsided. For this, Dr. Hu made a summary that, when there was swelling, the blood was diluted, which created chance for bleeding and for purpura. Therefore, the swelling was must be treated. This is a special and unique therapy for this case. However, the treatment of the disease needs a overall analysis. The herbs sould be given based on their indications (symptoms and clinic signs). This case showed as Qi-blood deficiency but water overwhelming. So, the herbal therapy should be given to nourish the Qi and the blood, and to deplete extra water. The condition in this case is the indication to the Mufangji Tang plus Danggui Shaoyao San plus Huangqi. By this way, the bleeding stopped without use of any bleeding-stopping herbs.

8. 何某,男,58岁,病案号160462

Case 8. He XX, male, 58 years of old. File number: 160462.

初诊日期1965920日:于644月间淋浴时,发现两小腿皮肤有紫癜,以后时轻时重,有时便血或尿血。曾到各大医院诊治均未见效。于65615日来我院门诊治疗,血液检查:白血球3500,血小板85000,出血时间130秒,凝血时间30秒,白血球分类:中性66%,淋巴34%,血色素134克,经用温中活血、和肝化瘀等法,前后服药300余剂未见明显效果,今日找胡老会诊。现症:两小腿紫癜满布,两膝上也散见,有时两手背亦出现,每劳累后紫癜增多,每药中有苍术亦增多,午后低热,口苦咽干,脐上微痛,舌苔薄白,脉弦细。胡老与四逆散合四物汤加味:柴胡四钱,赤芍四钱,枳实三钱,炙甘草二钱,当归三钱,川芎三钱,生地炭一两,桂枝三钱,茜草六钱,阿胶三钱,紫草二钱。

The first visit: September 20, 1965. On one day in April 1964, the patient found purpura on his crus, during a shower. The purpura was some times worse and some times better. From time to time, he had bleeding in stool or in urine. He had been treated in various big hospital, but no any improvement. On June 15, 1965, he came to the hospital where Dr. Hu worked. Lab test showed that, his blood WBC was 2500, platelet 85000, bleeding time 1’30”, cloting time 30”.  WBC: neutral 66%, lympha cells 34%. Hb: 13.4 g. He was given stomach-warming, blood circulation-activating, liver-harmanizing and stagnation-dissolving theray fro more than 300 doses, but no improvement. Dr. Hu was therefore asked for a consultation. The current condition on consultation: there were purpura spots all over the crus, which was scattered on the thighs. Some times, the purpura could also be seen on the back of the hands. The purpura became worse after physically exhausted (when he felt tired), or whenever there was herb Cangzhu in the herbal formula. He had hot feeling in the afternoon, felt dry in throat the bitter in mouth. He had slight pain little over the naval. The tongue cover was thin and white. The pulse was string and thin. Dr. Hu gave him Sini San plus Siwu Tang with some additions: Chaihu 12 g, Chishao 12 g, Zhishi 9 g, Zhi Gancao 6 g, Danggui 9 g, Chuanxiong 9 g, Shengdi Tan 30g, Guizhi 9 g, Qiancao 18 g, Ajiao 9 g, Zicao 6 g.

结果:上药服六剂,紫癜明显减退,脐上微痛减,仍口苦咽干,午后低热,上方加生石膏一两半,服一周后,低热已,减生地炭为五钱,服半月,诸症皆已。

Results: After the herbal therapy for six days, the purpura subsided dramatically. Pain over the naval was reduced. He still felt bitter in mouth and dry in throat. To the prescription above, added was Shigao 45 g. After one week, the low fever stopped. The Shengdi Tan was reducedto15 g. After additional half mouth, no any symptoms.

按:从症状看,本案有热有瘀,因此用四逆散合四物汤加味当属对证方药。关于四逆散,《伤寒论》第318条:"少阴病,四逆,其人或咳、或悸、或小便不利、或腹中痛、或泄利下重者,四逆散主之。"在讲述该条时胡老指出:本条所述明明是少阳病证,而冠之以少阴病者,可有以下二义:()原本少阴病,今传入半表里而转属少阳也;()由于热壅气郁,血行受阻,因致脉微细、四逆、形似少阴病的外观.因以少阴病冠之,教人加意鉴别也。本案口苦咽干、午后低热可知为少阳病;下肢紫癜可知为血行受阻。因此用四逆散合四物汤恰适其证。方中加桂枝、桃仁是有桂枝茯苓丸之意,又加茜草、紫草、阿胶也旨在凉血、活血、止血。用药虽平淡无奇,因方药对证而收捷效。

Comments: From the symptoms, there was both hotness and cold in this case. The use of Si Ni San and Si Wu Tang should be regarded to match the condition. For Si Ni San, it is stated in the book <<Shang Han Lun>>, paragraph 318, that: “For Shaoying Bing, the person has reverse cold from the hands and feet, and the person may have cough, or palpitation, or difficulty in urination, or pain in belly, or diarrhea. In this case, use Si Ni San.” In the explanation for the use of the Si Ni San, Dr. Hu said: “This state is clearly indicating a Shaoyang phase, but it is named as Shaoyin phase. The reason might be: (1), the original condition belongs to Shaoyin phase, now it develops into the Shaoyang phase (e.g. the phase between the body surface and the inside part of the body). (2), Due to stagnation of Hotness and Qi in the body, the blood circulation is affected, which causes the pulse being weak, hands and feet being reverse cold, similar to the phenomena of a Shaoyin phase condition, so it is named as Shaoyin condition, with the aim to remind a distinquishment diagnosis between the two similar clinic conditions. In this case, the person had bitter taste in mouth, dry in throat, and hot feeling in the afternoon, so it is known that his condition belongs to the Shaoyang phase. He had purpura in the crus, indicating that the blood circulation is hurt. For this reason, it is proper to give him the Si Ni San plus Si Wu Tang. In the prescription, the use of Guizhi and Fuling bears the meaning of Guizhi Fuling Wan. With addition of Qiancao, Zicao and Ajiao was to cool blood, to activate blood circulation and to stop bleeding. Though the herbs used were ordinary ones, they worked excellent for the herbs matching the clinic conditions.

23.  瘀血之证虽多见 下瘀血汤可称奇

23. Though blood stagnation condition was quite common in clinic, the herbal prescription Xia Yuxue Tang works surprisingly.

9. 杨某,女,30岁。

Case 9. Yang XX, female, 30 years of old.

时在北京解放前夕,因久病卧床不起,家中一贫如洗。邻人伶之,请胡老义诊之。望其骨瘦如柴,面色黧黑,扪其腹,少腹硬满而痛,大便一周未行,舌紫暗,苔黄褐,脉沉弦。胡老判为干血停聚少腹,治当急下其瘀,与下瘀血汤加麝香:大黄五钱,桃仁三钱,廑虫二钱,麝香少许。

At that time, it was before year 1949. The patient suffered from disease and had to lay down on bed all the day. Her family was very poor. Her neighbour felt pity for her, so the neighbour invited Dr. Hu to see the patient. The patent looked very slim, with black color and tint on her face. Her lower belly was hard, fullness and pain, when touched. She had bowel movement once a day. The tongue was purple and dark. The tongue cover was yellow to brown in color. The pulse was deep and string. Dr. Hu believed that her condition was due to a hidden dry blood clot in the lower belly. She need a herbal therapy to urgently remove the dry clot. She was given Xia Yuxue Tang plus Shexiang: Dahuang 15 g, Taoren 9 g, Zhechong 6 g, and Shexiang little.

结果:因其家境贫寒,麝香只找来一点点,令其用纱布包裹,汤药煎成,把布包在汤中一蘸,仍留下煎再用。服一剂,大便泻下黑紫粪便及黑水一大盆,腹痛减,饮食进,继服血府逐瘀汤、桂枝茯苓丸加减,一月后面色变白、变胖,如换一人。

Results: For her family was very poor, she got only little bit Shexiang. She was asked to fold the Shexiang in a gauze. Cook the herbs in water. Dip the gauze that contained the Shexiang in the herbal extract once and then took it out for use next time. She drunk one dose of the herbal tea. She had a bowel movement with black and purple stool and black water a big basin. The stomach pain was reduced, and the appetite was improved. She was then given Xuefu Zhuyu Tang, Guizhi Fuling Wan with some modification. After one month, her face became white, and she got body weight, as changed into an another person.

按:本案西医诊断不明,但病重已至危笃,中医椐证用药,寥寥几味,一剂即能扭转乾坤,这是中医的科学特点。这一科学的形成,不是一个人一生所能为,而是千万人、几代、几十代科学实践的总结。因此,胡老认为把张仲景称为 "医圣"是过誉之谈,把《伤寒论》视为一人之独创是不切实际的。在发展中医事业上,首先要在继承上下功夫。

Comments: In this case, the western medicine diagnosis was not clear. For her condition was up to very severe, the Chinese medicine treated her according to her current conditions. Only several herbs worked so excellent. This is the characteristics of Chinese medicine. It is not an achievement of a single doctor, but a clinic experience summary of thousands of thousands of doctors in generations. For this, Dr. Hu believed that, to praise Dr. Zhongjing Zhang as the medical sage is an overpraising. It is also overpraising that the book <<Shang Han Lun>> is the one person’s contribution. In the development of Chinese medicine, it is important to first of all learning the clinic experience of previous doctors.

24.  系统性红斑狼疮论治

24. The treatment of lupus

狼疮不治找中医    经方论治有苗头

If the lupus cannot be cured with conventional medicine, you can try the Chinese medicine. Among the TCM, the Jing Fang would be possible to help.

系统性红斑狼疮 (Systemic Lupus erythematosus SLE) 为自体免疫性疾病,病变部位在全身结缔组织,并可罹及皮肤、粘膜、浆膜、血管、心、肝、肾、肺、脑、胃肠、淋巴、血液等全身组织和器官。本病的临床主要症状是:发热、红斑皮疹、关节痛疼及水肿。发热见于绝大多数患者,尤其在急性发作期多见,热型不规律,时高时低,时长时短,很少见畏冷或寒战,发汗后热可暂退。长期低热者较多见,自汗多而少见盗汗、骨蒸之状。红斑皮疹以面颊部蝶形红斑、甲周红斑及指()甲远端下红斑最具特征性。红斑可现其他形状,如环形红斑、多形红斑、丘疹、斑丘疹、_疹、网状青斑等,红斑每遇阳光照射则加重。此外,手足掌可见瘀点,严重者可引起肢端坏死,口腔及咽部有无痛性顽固溃疡。90%以上的患者可见关节痛疼,很象类风湿。水肿亦常见,轻者可见腰酸、下肢轻度浮肿,重者则常见头痛头晕,甚则恶心呕吐,下肢可凹性浮肿或伴腹水。

Lupus is a self immunal disorder. The disease is located in the connective tissue of the body. It can involve the skin, mucus, blood vessels, heart, liver, kidney, lung, brain, stomach, intestine, lympha system, and blood, and so on. The main clinic condition of the patient are: fever, skin rash of red color, joint pain and swelling. Most patients have fever, especially in acute onset stage. The pattern of the fever is irregular, which is some times high and other times lower. The fever can last long time or short time. The patient rarely has chilly or feels cold. The fever can subsides after a sweat temporally. Most patients have long term low fever. The sweat happens mostly during the day time, and less at night. The skin rash shows more as butterfly shape on cheek, or red color around the nail. The skin rash can also be some other shapes, such as ring, multiple shapes, pimples,  maculopapule, or a net-shaped purple spot, etc. The skin rash is usually worse after sunshine exposure. In addition, it can be seen bruise spot on palm or on sole. In severe case, there could be stenosis of the fingers and toes, or no-pain obstacle ulcer in mouth and in throat. In more than 90% of cases, there is joint pain, similar to rheumatoid arthritis. The swelling is also very common. For mild cases, it may show as ache in the lower back and slight swelling in legs. In severe case, the patient may have headache and dizziness, even nausea and vomit, or pitting edema with ascites in belly.

本病的治疗,西医用激素有一定疗效尤其在急性期高热期能改善症状,但有的患者也无效。而且用激素治疗副作用大,难以撤除,故许多患者经西医治疗后,被告知已无法可医,方找中医。从其发病及临床特征来看,本病多属中医的病、饮证、丹疹、水肿证等病证范畴。从而通过辨证论治能取得一定疗效。有不少报道中医治疗可对抗激素的副作用、减少激素用量,有的报道中药可退红斑、减轻关节痛疼、改善肾功能、改善全身症状。通过六经辨证,并用经方治疗也有明显的疗效。

For the treatment of lupus, the use of hormone product in western medicine has some effect. Especially in the acute stage with high fever, it can improve symptoms. But it does not work in some cases. In addition, the use of hormone products has lots of severe side effects, which are hard to correct. Therefore, many patients were told there no any therapy to solve their problems, after they have been given the hormone product for the treatment. At that movement, they might come to Chinese medicine. From the clinic condition, its onset and symptoms, lupus mostly belongs to, in Chinese medicine, the Bi syndrome, Water syndrome, red color skin rash, and swelling, etc. By Chinese condition diagnosis and herb indication diagnosis, there would be some healing effect. There are many clinic reports stating that Chinese medicine helps to solve the side effects of hormone products, and to allow the reduction in the dose of the hormone products. In some other reports, it stated that the Chinese herbal therapy works to make skin rash disappear, to reduce pain in joints, to improve kidney function and to improve overall body condition. By six meridian diagnosis and by use the Jing Fang, there are also healing effects.

 

狼疮热殊红斑凶     养血利水建奇功

1.  李某,女,32岁。

Case 1. Li XX, female, 32 years of old.

初诊日期19671210日:发热、面部、背部起红斑一年余。不明原因发热、皮肤起红斑,到协和及北医检查,确诊为系统性红斑狼疮,曾用激素治疗未见明显疗效,经人介绍找胡老诊治。现症:不规则发热,面部、背部皮肤斑块或连成片状红肿,表皮有皮屑脱落甚似牛皮癣,常有颈、项、背、腰痛,时咽干心烦,头易汗出,舌苔薄白,脉弦细数。证属邪郁少阳,血虚水盛,治以疏解少阳,养血利水,与柴胡桂枝干姜汤合当归芍药散:柴胡五钱,黄芩三钱,花粉四钱,生牡蛎五钱,生龙骨五钱,桂枝三钱,白芍三钱,当归三钱,川芎三钱,苍术三钱。茯苓三钱,泽泻五钱,炙甘草二钱,生石膏一两半。

The first visit: Dec. 10, 1967. The patient had fever, skin rash on face and on back for more than one year. For his unknown reason fever and skin rash, she had been visiting some hospital in Beijing, and her condition was diagnosed as lupus. She was given hormone product treatment without clear improvement. After introduction by a friend, she visited Dr. Hu. The current condition at that time: she had irregular fever, skin rash in cheek and back, which was with falling scurf similar to psoriasis. She often had pain on the neck, back and lower back, dry mouth and annoying feeling. She was easy to have sweat on head. The tongue cover was thin and white. The pulse was string, thin and frequent. The condition was diagnosed as in Shaoyang phase, which was blood deficiency with water overwhelming. The herbal therapy was given to nourish the blood and to deplete water. The prescription was Chaihu Guizhi Ganjiang Tang plus Danggui Shaoyao San: Chaihu 15 g, Huangqin 9 g, Tianhuafeng 12 g, Muli 15 g, Longgu 15 g, Guizhi 15 g, Baishao 9 g, Danggui 9 g, Chuanxiong 9 g, Cangzhu 9 g, Fuling 9 g, Zexie 15 g, Shigao 45 g.

结果:上药服六剂自感有效,乃连服30剂后始来复诊。届时面部、背部红斑基本消失,查血象恢复正常,体温之低热不规则热已消失,颈项背腰已不感痛疼。到北大复查时,医生大为惊奇,对其治疗十分满意,并谆谆嘱其总结其病历,并嘱其不须吃药。但停药约半月,面部又出现红斑,其他症状不明显,又求胡老诊治,胡老仍与上方去生石膏消息之。

Results: After the herbal therapy for six days, she felt some healing effect. After 30 days of the therapy, the skin rash on cheek and back basically subsided. The lab test for blood was normal. The fever was stopped. No pain on the back or lower back. When rechecked in that hospital, the doctors there felt very surprised and satisfied. She was asked to keep the case file in a proper way and asked to stop the herbal therapy. After half month however, the skin rash recurred on cheek, without any other symptoms. She came back to Dr. Hu again. Dr. Hu prescribed her the same herbal prescription but without Shigao.  

按:本例远期疗效因故未能追踪,是个遗憾,但近期疗效让西医称奇也为之不易。这里也说明,中医中药治疗系统性红斑狼疮有效,用六经辨证、经方的理论方药治疗该病有效,胡老的治疗经验有参考价值。

Comments: It is pity that there was no way to keep following up with this case. However, it is not easy to make western medicine doctors felt surprising by the short term healing effects. This case suggests that, it works for Chinese herbal therapy in the treatment of lupus. It works by the six Jing diagnosis, the use of Jing Fang theory. The clinic experience of Dr. Hu is with reference value.

2.  宋某,女,40岁,北新桥帆布厂工人。

Case 2. Song XX, female, 40 years of old. Worker of a manufactory.

初诊日期1971725日:面部起红斑半年。半年前因牙痛到医院拔牙,牙科医生看到鼻上眉间有红斑,怀疑是红斑狼疮故不给拔牙,后经多次检查,找到狼疮细胞,告之为不治之症,建议中医治疗。现症:鼻上及眉间生两块红紫斑,上覆痂如白,偶有少量溢液,痒不明显,但见阳光后痒加重,自感全身酸软无力,食欲不正常,有时恶心呕吐,头痛头晕口干,时感身热而体温不高,二便调,舌苔白少津,脉细沉。证属血虚水盛,邪郁少阳。治以养血利水,和解少阳,与柴胡桂枝干姜汤合当归芍药散。

The first visit: July 25, 1971. The patient had skin rash on cheek for half year. Half year ago, she went to a dentist to pull of a tooth. The dentist doubted she might have lupus, after seeing a skin rash on the top of her nose, in between the eyebrow. She was refused to have any treatment for the tooth. After several times of checks, she was diagnosed as lupus, after finding the lupus cells. She was told that that was a hopeless disease to cure and was suggested to go to Chinese medicine. The current condition at that time to see Dr. Hu: there were two skin rash (red and purple color), on the top of the nose and in between the eyebrow. There was white crust, which looked as white frost, over the skin rash, and which was with little liquid secretion. It felt not very itch, but became severe after exposure to sunshine. She felt fatique, poor appetite, and nausea some times, headache and dizziness, and dry mouth. From time to time, she felt hot in the body but the temperature was not high. The bowel movement and urination were normal. The tongue cover was white with less humidity. The pulse was thin and deep. The condition belongs to blood deficiency and water overwhelming in Shaoyang phase. The herbal therapy was given to nourish the blood and to deplete extra water so to harmonize the Shaoyang phase. The prescription was Chaihu Guizhi Ganjiang Tang plus Danggui Shaoyao San.

柴胡四钱,黄芩三钱,花粉四钱,生牡蛎五钱,桂枝三钱,干姜二钱,当归三钱  川芎三钱,泽泻五钱,茯苓三钱,苍术三钱,白芍三钱,炙甘草二钱。

Chaihu 12 g, Huangqin 9 g, Tianhuafeng 12 g, Muli 15 g, Guizhi 9 g, dried ginger 6 g, Danggui 9 g, Chuanxiong 9 g, Zexie 15 g, Fuling 9 g, Cangzhu 9 g, Baishao 9 g, and Zhi Gancao 6 g.

二诊1972211日:自服用上方后,眉间处狼疮红斑逐渐缩小,一般情况均见改善,故一直服上方。

The second visit: Feb. 11, 1972. After the herbal therapy, the skin rash between the eyebrows shrunk. Overall condition was improved. The prescription was continued.

三诊197362日:患者全身症状好转明显,红斑仅在鼻尖上能看到一小块,其他一般情况良好。

The third visit: June 2, 1973. The overall physical conditions were much improved. There was only a small spot of skin rash on the top of the nose. No any other symptoms.

按:此例观察长达两年,资料难得。与前例有相同之处,即皆为血虚水盛,邪郁少阳,所不同者,例 1有心烦汗出,为水饮郁久化热之象,故治疗加用生石膏。通过两例的观察可以看到,当遇到系统性红斑狼疮表现为血虚水盛,邪郁少阳证时,治以养血利水、和解少阳这一方法是有效的。

Comments: This case has been followed up for two years. The data is very valuable. The similarity with the previous case is that both case belong to blood deficiency and water overwhelming. The difference is that, the case 1 had annoying feeling and sweat, which was the hotness developed from long term of water stagnation. In the treatment, the Shigao was therefore used. From these two cases, it can be seen that, when the lupus shows as blood deficiency and water overwhelming, which is in Shaoyang phase, the herbal therapy to nourish the blood and to deplete extra water, so to harmonize Shaoyang phase, works.

狼疮肾水泛滥激素技穷  开鬼门洁净府转机萌生

3. 周某,男,21岁,某医院会诊病人。

Case 3. Zhou XX, male, 21 years of old. A patient in a hospital ward.

初诊日期196614日:周身浮肿一年,在协和医院诊断为狼疮性肾炎,告之无根治方法,长期服用激素。曾去上海中医狼疮专门小组治疗三个月,未见明显疗效而返回,住院治疗,中西医多次会诊治疗,症状不见好转反越来越恶化,不得已再倍增激素量,强的松每日60毫克,同时服用双氢克尿塞,仍不见症状改善,其父母特来京请胡老会诊。因长期服用激素,致使体胖、周身严重水肿,面呈满月状.眼成一条小缝,尿中经常见蛋白、红血球、白球,经常疲劳,时心跳、汗出,尿少,时头痛,恶心,不能食,血压常高(160105毫米汞柱),非蛋白氮120毫克/毫升,舌苔薄白,舌质红,脉沉细数,胡老与越婢加术汤:麻黄六钱,生石膏二两,生姜三钱,炙甘草二钱,大枣五枚,苍术六钱。

The first time of consultation: January 4, 1966. The patient had overall body swelling for one year. It was diagnosed as lupus nephritis. He was told that there was no way to cure his disease and he needed to take long time of hormone therapy. He had been to TCM hospital in Shanghai to use herbal therapy for three months, without any clear improvement. When he returned back, he was admitted into the hospital ward again with both western medicine and Chinese herbal therapy. The condition was not improved but became worse. The dose of hormone had to be doubled. Cortisone was 60 mg per day, with dihydrochlorothiazide the same time. Still no any improvement. His parents so came to Beijing to ask Dr. Hu for a consultation. For long time intake of hormone products, his body was severely swelling. The face is full as round moon and the eye was as a thin line. There was often protein, red blood cells, and white blood cells in urine. He often felt fatique. From time to time he felt palpitation, sweat, little urine, headache, nausea and no desire to eat. Blood pressure was 160/105 mmHg. Non-protein nitrogen was 120 mg/ml. The tongue cover was thin and white. The tongue was red in color. The pulse was deep, thin and frequent. Dr. Hu gave him Yuebi puls Zhu Tang: Mahuang 18, Shigao 60 g, fresh ginger 9 g, Zhi Gancao 6 g, Chinese date 5, and Cangzhu 18 g.

结果:上方服三剂,尿增,肿减,恶心已,食欲好转。药后有头晕、身痒,其父母也在医界,让他医看处方后谓:"麻黄量太大!"而停服中药,但症仍不减,后停双氢克尿塞则症已,但又出现腹胀、恶心、呕吐、不能食、头痛、视力模糊,查血压仍高(150100毫米汞柱),眼底血管变细、眼底水肿,因再请胡老会诊,胡老与半夏厚朴汤加陈皮: 半夏四钱,厚朴三钱,生姜三钱,苏子三钱,茯苓四钱,陈皮一两。上方服一剂后,呕吐止,继服二剂,纳饮增加,因浮肿、心烦、眠差明显,与半夏厚朴汤合猪苓汤:半夏四钱,厚朴三钱,茯苓四钱,苏子三钱,生姜四钱,猪苓三钱,泽泻三钱,陈皮三钱,阿胶三钱。此方服三剂,腹胀已,小便增多,浮肿减,因面部肿消而显眼睁大,纳增,一餐可吃20个饺子。因口干、心烦、汗出明显,继服越婢加术汤。服一月余,人变瘦,浮肿不明显,非蛋白氮80毫克/毫升,强的松每日5毫克。仍与该方调理。

Results: After three days of herbal therapy above, the volume of urine increased. The swelling reduced. Nausea stopped and appetite was improved. After herba drinking, he had dizziness and skin itch. For his parents were also medical staff, they let other doctor see the prescription. The doctor said it is because the dose of herb Mahuang was too big. The herbal therapy was discontinued then. However, the symptoms remained. They also stop to use the dihydrochlorothiazide, then the dizziness and itch stopped, but he started to have belly bloating, nausea, vomit, hard to eat, headache and blirring vision. The blood pressure was 150/100 mmHg. The blood vessels in the bottom of eye became thin, with swelling there. Dr. Hu was asked again for consultation. Dr. Hu gave Banxia Houpu tang plus Chenpi: Banxia 12 g, Houpu 9 g, fresh ginger 9 g, Suzi 9 g, Fuling 12 g, Chenpi 30 g. After one dose, the vomit stopped. After two doses, the appetite was improved. For swelling, annoyed, and poor sleep, he was given Banxia Houpu Tang plus Zhuling Tang; Banxia 12 g, Houpu 9 g, Fuling 12 g, Suzi 9 g, fresh ginger 12 g, Zexie 9 g, Chenpi 9 g, Ajiao 9 g. After three days, the bloating stopped, the urine increased and the swelling reduced. For the reduction of swelling on face, the eye became bigger. The appetite was improved. He could eat 20 dumplings each meal. For he still had dry mouth, annoyed and sweat, he was asked to continue the Yubi plus Zhu Tang. After one month, the body shape became slimmer. The swelling was not very much. Non-protein nitrogen was 80 mg/ml. Prednisone was used 5 mg per day. The herbal tea was still using for a maintenance.

按:本例未能做到像例2那样长期系统观察,但能看出中药的明显效果,使激素撤到最小量。值得说明的是,胡老治疗该病,并不是说他找到了杀红斑狼疮细胞、抗过敏、改善免疫功能的方药,而是根据症状特点进行辨证论治而取得疗效。本患者主要表现为浮肿、肥胖,中医认为是水饮为患。但不同时期又有不同症状,因此治用方也有不同。初诊时浮肿甚,且见汗出、头痛、脉沉细数,为外邪里热之证,故用越婢加术汤治疗而显效;二诊时因头晕、呕吐、腹胀等明显,为痰饮气结所致,故与半夏厚朴汤加陈皮治疗亦收捷效;三诊时因小便不利、心烦、眠差明显,为里有水饮而津伤,故与半夏厚朴汤合猪苓汤治疗也显效;四诊后又现越婢加术汤方证,故又用越婢加术汤治疗使诸症好转,减少激素用量。有是证,用是方,是中医治疗学的特点。不过对于越婢加术汤治疗肾炎、水肿胡老体会尤深,指出:实践证明,本方所主水肿证,亦以肾机能障碍而致者为多,对于肾炎患者的水肿和腹水屡试皆验,尤其令人惊异者,不但水肿消除,而且肾炎本病亦得到彻底治愈。对于狼疮肾(水肿明显者)也可能有效,应进一步观察之。

Comments: This case was not followed up as the case 2. The healing effect of Chinese herbal therapy could anyway be noticed. The herbal therapy made it possible to use very low dose of hormone. It should be pointed out that, Dr. Hu did not treat this disease for the lupus cells found. It does not mean that he found a herb or herbal formula that could kill the lupus cells, to battle against allergic reaction or to improve immune system. He, in stead, make diagnosis according to patient’s symptoms and clinic conditions. For this patient, he had swelling, obesity. Chinese medicine considers he has condensed water in the body, which causes the various symtoms. However, in each difference phase of the disease, he had different symptoms, so the herbal prescriptions were also different. In the beginning, he had dramatic swelling, sweat, headache, deep-thin-frequent pulse, which was water-overwhelming and inside-fire condition. The prescription was Yubi plus Zhu Tang and the healing effect was pretty good. On the second visit, he had more dizziness, nausea and bloating in belly, which was phlegm and Qi stagnation condition. The prescription was Banxia Houpu Tang plus Chenpi. On the third visit, he had difficult in urine, annoyed and poor sleep, which was inside water accumulation and loss of liquid part in the body also. The prescription was changed to Banxia Houpu Tang plus Zhuling Tang. On the fourth visit, he again showed Yubi plus Zhu Tang, which made the condition became better soon. The herbs made it possible to reduce the dose of hormone therapy. No matter which was the diagnosis of western medicine, the herbs should be anyway used if there is indication to use that herbs or herbal prescriptions. This is the characteristics of Chinese medicine. However, Dr. Hu had very deep impression to use Yubi plus Zhu Tang for the treatment of nephronitis, and swelling. He pointed out that it is approven in clinic experience that this prescription works more if the swelling is due to functional damage in kidney. It works very well for swelling and ascites due to nephritis.  Many times it is surprising that, after subside of swelling, the nephritis is also cured radically. For the kidney damage in the lupus, it might also work. This needs further more observation.

 

25.  论治淋证

25. The treatment of Lin syndrome

热在下焦概其廓  变证兼证皆繁多

In most cases, the Lin syndrome is due Hotness accumulation in the lower cavity of the body. In clinic it can show as largely variable symptoms.

关于淋证的症状《金匮要略消渴小便不利淋病》151"淋之为病,小便如粟状,小腹弦急,痛引脐中。"《金匮要略.妇人妊娠病》称谓"小便难"。可知淋证是指小便频数、短涩、滴沥刺痛、欲出未尽、小腹拘急、或痛引腰腹的病证。《内经素问六元正纪大论》称谓"淋闷";《金匮要略.五脏风寒积聚病》称谓"淋秘"。该证多见于西医的泌尿系感染、泌尿系结石、乳糜尿等疾患,在古今皆是常见的疾病。关于淋证的病因,《金匮要略五脏风寒积聚病》认为是"热在下焦";《丹溪心法淋》篇谓"淋有五,皆属乎热";《诸病源候论淋病诸候》则认为"诸淋者,由肾虚而膀胱热故也"。后世医家认为本病多由于膀胱积热,但亦有由于气郁及肾虚而发者。其治疗多以利湿清热为主,但遇有变证、兼证时,又必以六经辨证定其大法,再具体辨方证用其方药。

For the symptoms of the Lin syndrome, in book <<Jin Kui Yao Luo: Xiaoke, difficulty in urine, and Lin syndrome>>, it states in paragraph 151: “ The syndrome of the Lin disease is: the urine is as rice soup. The patient felt spasm in lower stomach area, which tends to expand to the navel”. In book <<Jin Kui Yao Luo: Female and pregnancy disease>>, it says that the Lin syndrome is “hard in urination”. Therefore, it is known that, the Lin disease or Lin syndrome means that, patient has frequent urination, short and harsh urination, pain or pounch pain in urine duct, the urination is as drops by drops, there is urine retension feeling after urination, spasm in lower stomach or the pain can attract into the lower back. The Lin syndrome can be seen more in the infectious disease and stone in urinary system or chyluria. It is a quite common disease in human history. For the cause of the Lin syndrome, …. Most doctors believe that it is caused by Fire in urine bladder, though there is also some that is caused by kidney deficiency or by Qi stagnation. For the treatment, most herbal therapies focus on Wetness-clearing and Fire-clearing therapy. If there various  some other syndrome, it is needed to follow the six Jing diagnosis system and further more follow the herb indication diagnosis rule.

1. 丁某,男,36岁,病案号169559

Case 1. Ding XX, male, 36 years of old. File number: 169559.

初诊日期1965816日:尿痛、尿血、腰痛三个月,三月前长途乘坐火车,吃烧鸡、喝啤酒而喝水少,不久出现腹痛腰痛,痛如刀割又如撕裂,阵阵发作,初发作时喝水则腹胀而无小便,后发作时饮水后有少量小便而尿道剧痛,到医院检查:尿红血球满视野,泌尿系造影未见结石,用抗生素等治疗无效。现右腰亦痛,尿粉红色,红血球满视野,大便干,舌苔黄褐少津,脉左弦细,右沉细。与猪苓汤加大黄、生薏米:猪苓三钱,茯苓三钱,泽泻四钱,滑石五钱,阿胶三钱,生薏米一两,大黄四分。

The first visit: August 16, 1965. The patient had pain, bleeding in urine and pain in lower back for three months. Three months ago during a travel in a train, he ate chicken, drunk beer but less water. Soon later he felt pain in belly and in lower back. The pain felt as cut or tear. It came from time to time in a series. In the beginning, he felt bloating in belly without urine when he drunk water. Later, he had little urine but painful in urine duct, when drinking water. Exam in hospital showed: a lot of red blood cells in urine under microscope; no sign of stone in X-ray radiography. He was given antibiotics but no any improvement. Currently, he felt pain also on right side of back. The urine was pink in color. It was full of red blood cells under microscope in urine sample. He had constipation. The tongue cover was yellow-brown and dry. The pulse was string and thin on left side, deep and thin on right side. He was given Zhuling Tang plus Dahuang and Yiyiren: Zhuling 9 g, Fuling 9 g, Zexie 12 g, Huashi 15 g, Ajiao 9 g, Yiyiren 30 g, and Dahuang 1.2 g.

二诊819 日:上药服三剂,腰痛不明显而显酸沉,尿痛不明显,少腹两侧及两鼠蹊酸重,大便不干但不畅,与柴胡桂枝干姜汤合当归芍药散加味:柴胡四钱,黄芩三钱,花粉六钱,生牡蛎五钱,桂枝三钱,干姜二钱,白芍四钱,当归三钱,川芎三钱,茯苓三钱,苍术三钱,泽泻四钱,生薏米一两,炙甘草二钱,桑寄生一两。

The second visit: Aug. 19: After three days of treatment, the lower back pain was less but felt more as sour and heavy. No more pain in urine duct. He felt sour and heavy in the side of lower belly and on groves. The stool was no longer hard but it past not easily. He was given Chaihu Guizhi Ganjiang Tang plus Danggui Shaoyao San: Chaihu 12 g, Huangqin 9 g, Tianhuafeng 18 g, Muli 15 g, Guizhi 9 g, dried ginger 6 g, Baishao 12 g, Danggui 9 g, Chuanxiong 9 g, Fuling 9 g, Cangzhu 9 g, Zexie 12 g, Yiyiren 30 g, Zhi Gancao 6 g, Sangjisheng 30 g.

三诊825日:上药服三剂,诸症已,但行膀胱镜检查及拍X线片后,确诊右输尿管有结石。又出现尿道刺痛。与816日方加金钱草二两。

The third visit: Aug. 25: After another three days, the symptoms all subsided. However, after detect by urine bladder endoscope and X-ray check, it was confirmed a stone in right side ureter. He had pounching pain in urine duct again. To the herbal prescription (Aug. 16), added was Jinqiancao 60 g.

四诊830日:上药服二剂后,尿道剧痛,排尿困难,见血块、粘液,不久排出黄豆大结石,而排尿通畅。

The fourth visit: Aug. 30: After two days of the herbs, the urine duct felt very painful, with difficult to pass urine. In the urine, there was blood clots and mucus. Soon later, there was stone of soya bean size in urine. Later, the urination became smooth.

五诊97日:无任何自觉症状。

The fifth visit: Sept. 7: No any symptoms more.

按:本例初诊时,可属湿热下注,可视为本证,用猪苓汤加生薏米利湿清热,可视为正治。又因有右侧腰痛,为瘀血之征,可视为兼证,故加少量大黄以活血祛瘀,这是胡老用药特点。二诊时腰、腹痛及尿痛皆不明显,而酸重明显。为邪退正虚,证属血虚水盛,可视为变证,故与柴胡桂枝干姜汤合当归芍药散加味。当行膀胱镜检查后又出现尿道痛时,又现湿热下注之证,故又用猪苓汤加金钱草,使尿结石排出,诸症皆已。

Comments: In the begging of this case, the condition belonged to Wetness-Fire down-flowing. The use of Zhuling Tang plus Yiyiren can be regarded a correct therapy. For the pain in the right side, it can be regarded as a sing of blood stagnation, which was an accompanying symptom. So, a small of mount of Dahuang was used to activate blood circulation and to clear the blood stagnation. This is one of the characteristics in the herbal therapy by Dr. Hu. On the second visit, for the pain in the belly, the lower back and in the urine duct was not so much but more sour and heavy, which can be regarded as the deficiency in the body life energy after exhaustion by the disease. The condition belonged to blood deficiency and water overwhelming, which was regarded as unexpected syndrome during the disease course. He was therefore given Chaihu Guizhi Ganjiang Tang plus Danggui Shaoyao San. After found stone by urine bladder endoscope and later he felt pain again in urine duct, the condition was regarded as the sign of Wetness-Hotness down-flowing. For this, in the herbal formula, added was Zhuling Tang plus large amount of Jinqiancao, to help the excretion of the stone. After than, the disease was solved.

2. 韩某,女,31岁,病案号5157

Case 2. Han XX, female, 31 years of old. File number: 5157.

初诊日期:1965123日:13年前怀孕时患"压迫性肾炎",分娩后渐愈。但于1964911日又出现尿急、尿频、尿痛、腰痛、腹胀等症,诊为"肾炎复发及急性尿道炎和膀胱炎",屡用抗生素不效而找中医治疗,曾以肾虚心火盛、脾虚气弱论治而效不明显,今日请胡老会诊。近症:尿频,白天50余次,晚30余次,有时尿频滴漓而不能离盆。尿时痛如刀割。尿赤热,有时带血丝血块。左腰胀痛,时腹胀,下肢轻度浮肿,常感头晕、心悸、少腹里急、口干渴甚,既往有阴道滴虫史、人工流产史、痛经史,舌苔白,舌红,脉细数。证属湿热下注兼挟瘀血,与猪苓汤加生惹米、大黄:猪苓三钱,茯苓皮三钱,泽泻四钱,生薏米一两半,滑石五钱,阿胶珠三钱,大黄三分。

The first visit: January 23, 1965. The patient had “pressing nephritis” during pregnancy 13 year ago. It subsided after birth delivery. On September 11, 1964, she had frequent urine, urgent urine, pain in urine, pain on lower back and bloating feeling in belly, etc. It was diagnosed as “recurrent nephritis, acute urinary infection and urine bladder”. She was given anti-biotics but no improvement. Therefore she visited Chinese medicine. She was believed as kidney deficiency with heart fire overwhelming, spleen deficiency with Qi weakness. The corresponding herbal therapy however did not work either. She later went to Dr. Hu. The current condition: she had frequent urine, 50 times during the day time and 30 times more at night. Some times, the urine was continuous as drops so that she even could not leave the urine basin. She felt very painful in the urine duct, the hotness feeling in urine duct too. Some times, she had blood silk or blood clots in the urine. She felt bloating pain on the left lower back. From time to time, she also felt bloating in belly. She had slight swelling on legs. She often felt dizziness, palpitation, spasm in lower stomach, and very much dry mouth. She had had history of trichomonas vaginalis, abortion, painful menstruation. Her tongue was red in color. The tongue cover was white. The pulse was thin and frequent. The condition belonged to Wetness-Hotmess down-flowing with blood stagnation. The herbal Zhuling Tang plus Yiyiren were given: Zhuling 9 g, Fulingpi 9 g, Zexie 12 g, Yiyiren 45 g, Huashi 15 g, Ajiaozhu 9 g, Dahuang 0.9 g.

二诊127日:上药服三剂,尿频尿痛腰痛皆减,小便色变浅,尿道已无灼热感,口干渴已,仍腰痛及腹胀明显。脉仍细数,热去而湿重,与肾著汤:茯苓皮三钱,白术三钱,干姜三钱,炙甘草二钱。

The second visit: January 27. After the herbal therapy for three days, the frequent urine, painful urine, and lower back pain all were reduced. The color of urine was no longer dark. There was no hot or burning feeling in urine duct. She still felt lower back pain and stomach bloating. Pulse was still thin and frequent. All suggested that, the Fire has been removed but the Wetness remained the most problem. She was given Shenzhao Tang: Fulingpi 9 g, Baizhu 9 g, dried ginger 9 g, and Zhi Gancao 6 g.

三诊25 日:小便频数缓解,尿量亦显著增加,腰痛腹胀皆减轻,脉已不数,上两方交替服用。

The third visit: February 5: There was no more frequent urine. The vomule of urine increased dramatically. The lower back pain and stomach bloating were reduced. The puse was not frequent. She was asked to take the prescriptions above in turn.

四诊213日:尿道未痛,稍劳则腰酸痛,少腹里急,下肢轻度浮肿,脉又稍数,与肾气丸:生地八钱,山萸肉四钱,山药三钱,丹皮三钱,茯苓三钱,泽泻四钱,桂枝三钱,附子二钱。

The fourth visit: February 13: No more pain in urine duct. She felt sour and pain in lower back and spasm in lower stomach, after little labor work. She had slight swelling in leg. The pulse was slight frequent again. She was given Shenqi Wan: Shendi 24 g, Shanyurou 12 g, Shanyao 9 g, Danpi 9 g, Fuling 9 g, Zexie 12 g, Guizhi 9 g, and Fuzi 6 g.

五诊311日:上药服三剂,腰痛不明显,下肢肿消,食量倍增,仍以上方调理,偶有头晕、腰痛,他无明显不适。

The fifth visit: March 11: After drink of the herbal tea above for three days, there was no more lower back pain. The swelling in legs subsided. The appetite was improved. The same herbal tea was sked to continue. She had only accasionally dizziness and lower back pain, no more other symptoms.

按:此淋证反复发作经久不愈,急性发作及慢性症状交替出现,正邪胜衰也交替变换,因此治疗时要据证把握病机,该祛邪时当祛邪,该扶正时即扶正,使正能胜邪是病愈的关键。

Comments: This case of Lin syndrome has frequent onset of symptoms for a long time. The acute stage and the chronic stage comes and goes in turn. The body life energy and the disease energy changed in turn too. Therefore, the treatment needs to pay the attention to use the herbs according to the current conditions. When it is needed to dispel the Xie Qi, it should be used the Xie-dispelling therapy. When the body energy is deficient, the herbs should be used to nourish the Qi. This is the key point for the treatment.

结石在里见表证  解外化饮病全休

Whenever there is stone inside but also body surface syndrome, to release the body suface and to dissolve water overwhelming would make a radical healing for the condition

3. 李某,男,47岁,住院病案号17020

Case 3. Li XX, male, 47 years of old. File number: 17020.

初诊日期1975727日:自感上腹有肿物已两月多,因无不适未曾检查治疗。近一月来因感到左上腹痛疼而来门诊,经内外科检查,怀疑是肿瘤而收住院治疗。体查:上腹左右均可触及拳头大实性肿物,表面不光滑,轻度压痛,部位深在与体位无关。尿常规:蛋白,红血球15--20,白血球35。血沉61毫米纠、时。尿酚红排泄试验:一杯3%、二杯5%、三杯5%、四杯7%。静脉肾盂造影:左肾扩大,右肾未显影。临床诊断:双肾肿瘤?肾结核?动员手术治疗,尚等待按排手术,要求服中药一试,因找胡老会诊。依证所见:左腹胀痛,头晕心悸,汗出恶风。口干思饮,饮后渴仍不止,而心下水响,尿频、尿涩痛,舌苔白,脉浮数,心率100次/分。此属表虚心下停饮而兼津伤挟瘀之证,为五苓散合猪苓汤加大黄方证,与五苓散合猪苓汤加大黄:猪苓三钱,泽泻五钱,苍术三钱,茯苓四钱,桂枝三钱,滑石一两,阿胶三钱,生大黄一钱,生苡仁一两。

The first visit: July 27, 1975. The patient felt a mass on the upper belly for two months. For no any discomfort, he did not go to a doctor. For recent one month, he felt pain in the left upper belly and went to hospital for a check. He was suspected to have a tumor. …… After various lab test and other detect, he was diagnosed as “both side kidney tumor? Kidney tuberculosis?” For not confirmed, he was recommended to have a surgical treatment. For he needed to wait for the surgical schedule, he wanted to try Chinese herbal therapy first and went to Dr. Hu. The current at time: he had pain and bloating feeling on the left belly. He felt dizziness and palpitation, had sweat and disliked wind. He felt dry mouth and had desire to drink. After drink, he still felt thirsty but had water noise in the stomach. He had frequent urine, pain in urine duct. His tongue cover was white. The plus was floating and frequent. The heart beat was 100 time per min. This condition belonged to body surface weakness, water overwhelming in stomach, depletion of body liquid, and blood stagnation. All of the conditions indicated the Wuling San, Zhuling Tang plus Dahuang: Zhuling 9 g, Zexie 15 g, Cangzhu 9 g, Fuling 9 g, Guizhi 9 g, Huashi 30 g, Ajiao 9 g, Dahuang 3 g, Yiyiren 30 g.

结果:上药服二剂后,小便增多,尿中排出绿豆大结石。三剂服完后,连续四五天排出细砂样结石,腹部肿物消失,其他症状也全消失。追访五年未见复发。

Results: After the herbal therapy for two days, the urine was increased. There were big stone in urine of green bean size. After three doses, there were continuous stones in urine as sands for four to five days. The mass in the stomach disappeared. No more any other symptoms. Following up for five years found nothing wrong.  

按:结石病位在里,治疗时一般多从里证着想,很少注意祛外邪。胡老从六经辨证及辨方证的经验出发,在排石时,自然而然注意到外邪的辨证和治疗。众所共知,结石的形成与湿(饮、水)邪下注有关,而祛湿的治疗决不能忽视外邪的有否。胡老在讲解桂枝汤、大青龙汤、五苓散、苓桂术甘汤等方证时曾反复强调:水湿停于心下、停于里,则里有所阻,表亦不透,故如不兼利其水,则表必不解;如单独解表,强发其汗,则激动里饮、里湿,变证百出。此时唯有于解表方中,须兼用利尿逐水药,始收里和表解之效。即在外邪内饮证的治疗时,必须祛湿、祛饮的同时予以解表。本例不但外邪明显,里湿、里饮也明显,而且津伤已著,又兼挟瘀,故治疗必解表、利湿、生津、益阴、祛瘀为法,为五苓散合猪苓汤加大黄的适应证,方中似无专门排石药,服后却表解湿去而结石随湿而出。类似这种病例,在胡老治验例中,是数不胜数的。

Comments: The stone disease locates inside of the body. Generally speaking, in the treatment, the attention is paid mostly on the inside conditions, without more attention to dispel Xie Qi in the body surface condition. Dr. Hu. Based on the six Jing diagnosis and herbal indication diagnosis, naturally pays attention to the dispelling of Xie Qi in the body surface phase. As it is commonly known that, the formation of stone in the body is associated with the Wetness (Water, condensed water) down-flowing. However, during the dispelling of the Wetness should not omit the possible exist of external Xie Qi in body surface phase. During the lecture on the prescription Guizhi Tang, Da Qinglong Tang, Wuling San and Ling Gui Zhu Gan Tang, Dr. Hu emphasized again and again that, whenever the Water stops in the stomach, or in the inside of the body, there would be block inside. In this case, the body surface layer is neither released. Therefore, if not to dispel the water, the body surface-releasing therapy would not work; if only use the surface-releasing therapy, so to create a sweat, the inside water would be stirred up to create various unexpected syndrome. At such condition, the correct way is to use the body surface-releasing therapy and the water-dispelling therapy the same time. In the case here, he had both clear and strong external Xie Qi in the body Taiyang phase, and inside Wetness and inside water overwhelming, as well as dificiency in body liquid portion, and blood stagnation. For the treatment, the body surface-releasing, the wetness-dispelling, the liquid-nourishing, and blood stagnation-dissolving therapy, all must be used. This is the indication for Wuling San and Zhuling Tang plus Dahuang. In the herbal prescription, there was no specific herbs to improve the stone movement, but after drink of the herbal tea, the stone comes out along with the wetness-dispelling and body surface-releasing. Similar cases as such can be found in many case records by Dr. Hu.  

 

淋证里证阳气衰  温阳祛饮治也乖

The Lin syndrome belongs to inside condition, in which the Yang Qi is weak. To warm the Yang Qi and to dispel the Water work well.

4 王某,女,75岁,病案号15398

Case 4. Wang XX. Female, 75 years of old. File number: 15398.

初诊日期1964820日:尿频、遗尿、淋漓三个月,去年3月曾患尿急、尿痛、尿频,诊断为膀胱炎,用抗生素治疗而愈。今年5月又出现尿急、尿频、尿痛,又用抗生素治疗而疗效不佳,因长期口服西药,出现食欲差、恶心、头晕等而求中医诊治,曾服木通、车前子、黄柏、益智仁、桑螵蛸、芡实等药而未见明显效果。现症:尿频、遗尿、淋漓,小腹麻木胀痛,心悸,头晕,腰酸痛,恶心,纳差,恶寒,四逆,苔白润,舌质淡暗,脉沉细迟,证属里虚寒饮凝滞,治以温阳化饮,与真武汤:制附子三钱,生姜三钱,茯苓三钱,白术三钱,白芍三钱。

The first visit: August 20, 1964. The patient had frequent urine, leak of urine for three month. Last year in March, she had frequent urine, pain in urine, and urgent urine. She was diagnosed as infections in urine bladder and she was given antibiotics for treatment. The symptoms went away. This year in May, she had the same symptoms again but antibiotics did not work at all this time. For a long time use of western medicine, she had poor appetite, nausea, and dizziness, all which forced her to visit Chinese medicine. She had been given herb Mutong, Cheqianzi, Huangbo, Yizhiren, Sangpiaoxiao and Qianshi, etc. without any clear improvement. The current condition when she saw Dr. Hu: she had frequent urine, leak in urine, and continuous drop of urine after urination. She felt numb in lower stomach, palpitation, dizziness, nausea, poor appetite, chilly, reverse cold feeling in hands and feet, and numb and bloating feeling in lower stomach. Her tongue cover was white and wet. The tongue was slight dark red in color. The pulse was deep, thin and slow. Her condition belonged to inside Cold Water stagnation. The herapy was to warm the Yang Qi so to dissolve the Cold water. The herbal prescription was Zhenwu Tang: Zhi Fuzi 9 g, fresh ginger 9 g, Fuling 9 g, Baizhu 9 g, and Baishao 9 g.    

结果:上药服一剂,恶心、头晕已,食欲改善,小便频减,服三剂,诸症皆已。

Results: After the herbal therapy for one day, the nausea and dizziness stopped. The appetite was improved. The frequent urine was no more. After three doses, there is no any symptoms.

按:无论是急性还是慢性淋证,皆有热证和寒证之分, 本例一派虚寒,无明显表证,呈太阴里虚寒饮凝滞之证。一些慢性病的形成,多是治疗不及时、治疗不当,消耗人体津液、阳气,渐成里虚寒之证。《伤寒论》第82条:"太阳病发汗,汗出不解,其人仍发热,心下悸,头眩,身晌动,振振欲擗地者,真武汤主之。"316条:"少阴病,日不已,至四五日,腹痛,小便不利,四肢沉重疼痛,自下利者,此为有水气。其人或咳,或小便利,或下利,或呕者,真武汤主之。"此两条皆是论述里有水饮,而误发汗而造成的里虚寒饮证。前条是表阳证太阳病,后条是表虚寒证少阴病,皆是说由于误治而并于太阴。表证本宜发汗,但里有水气,若不兼驱其水,单纯发汗,则虽汗出而病不解,伤津液、耗正气,使病迁延不愈。淋证病人当有表证而呈外邪内饮时,治疗以解表化饮,即解表的同时化饮,使表解饮去病即愈,如病案3即如此。如不是在解表的同时又予化饮,或单解表、或单化饮、或单攻下,皆非善法,皆可拖延病情,加重病情,造成淋证迁延不愈,这一中医理论值得深思。

Comments: No matter for acute or for chronic Lin syndrome, there would be either a Fire or a Cold condition.  This case belongs to Cold condition without apparent body surface syndrome. It is a Taiyin phase condition with inside Cold and weakness condition. The formation of some chronic disease is due to in time treatment, or improper treatment, which exhaust body liquid portion and body Yang Qi, so as to form the inside cold and weakness condition. There were two paragraphs in the book <<Shang Han Lun>> to indicate such inside water condition transforms into inside cold and weakness condition, due to improper sweat therapy. …When a Lin syndrome is with the body surface condition and also inside water condition. We have already discussed above the importance to release the body surface and to dispel the inside water the same time.  

 

26.  前列腺炎治疗经验谈

26. Treatment of Prostatitis.

病系多证有关连  必须辨证方消灾

Prostatitis can show various symptoms. For the treatment, the correct and precise diagnosis is very important for a radical cure.

前列腺炎是临床常见病,它又分急性和慢性两种。急性前列腺炎,主要表现尿急、尿频、尿痛,会阴部坠胀疼痛,并向腰_部、阴茎、腹股沟部放射,常可出现高烧、恶寒、头痛、身痛等症,有如急性淋证。前列腺液化验,可见脓细胞。直肠指检,可扪及肿大的前列腺,灼热,触痛。如已化脓,可有波动感,脓肿破溃后可自后尿道、直肠或会阴部穿刺出稀薄带臭味的脓液,继而全身症状可迅速消退。慢性前列腺炎主要表现为:排尿不畅、尿频、尿急,排尿时感尿道灼热、或尿痛,或见血尿,或见排尿困难,或淋沥不爽,或排尿终末或大便时,尿道流出乳白色粘液,或会阴部坠胀疼,有时牵拉阴茎、睾丸痛,或出现小腹、腹股沟、大腿内侧等处痛。由于病情轻重不一,病程长短不同,临床症状也复杂多变。常见的症状为:身疲乏力,头晕,五心烦热,耳鸣,失眠多梦,腰酸膝软,性功能障碍,如阳痿、遗精、早泄等。值得注意的是,有不少患者,临床症状轻、不明显,因有遗精或早泄或阳痿而找中医看病,经检查方知有前列腺炎症。一般通过前列腺液检查可以确定诊断。

Prostatitis is quite common in clinic. It can be in a either acute or a chronic stage. For the acute prostatitis, the clinic manifestation is the urgent urine, frequent urine, pain in urine duct, bloating and heavy feeling and pain in the perineal region, which could expand to the lower back, the penis, and groin. The person could have fever, cold-dislike feeling, headache and body muscle pain, etc., similar to the acute Lin syndrome above. The lab test for the prostate fluid can show pus cells. Finger test on colon can find enlarged prostate, which feels hot or burning hot, and pain on touch, or feels a kind of floating feeling on the prostate. If the pus mass is broken, there could be thin pus fluid, of bad odor, when the prostate is pounched through the urine duct, colon, or perineal area. After that, the whole body symptoms could subside. The clinic manifestation of chronic prostatitis is sluggished urination, frequent urine, urgent urine, burning sensation in urine duct when passing the urine, or pain in urine duct, or bleeding in urine, or difficulty in urination, or continueous drops by drops after urination, or there is white fluid from urine duct at the end of urination or during bowel movement. The person may feel falling-bloating pain in perineal region, which may attract to the penis or testis, or feel pain in the lower belly, groin or inside part of thigh. For the severity of the disease is variable, and the disease history is long or short, the clinic condition is also very variable. The common body symptoms could be fatique, dizziness, hot feeling in inside of the chest, in palm and in sole, poor sleep, heavy dream, sour sensation in the knee and weakness in the lower back, disorder in sexual ability, such as impotency, spermatorhea, or premature ejaculation, etc. It is worthwhile to pointed out that, there are many patients who have very little clinic symptoms or almost no symptoms. They come to doctor for their spermatorhea or premature ejaculation. The diagnosis of prostatitis is confirmed only after various tests or checks above. Generally speaking, the lab test for prostate fluid is sufficient to establish the diagnosis.

中医古代无前列腺炎这一病名,但根据临床表现,中医古代早有类似的记载,如急性前列腺炎似属中医的"悬痈""穿裆发";慢性前列腺炎类属于中医的"白淫""精尿""精浊""劳淋""淋浊""白浊""遗精""早泄""阳痿"等病证范畴,由此也可知,前列腺炎可出现许多证,治疗该病也必须从证人手,辨证论治才能奏效。

In old Chinese medicine history, there is no term of prostatitis. However, the similar clinic conditions were described in medical literatures. In Chinese medicine, the acute prostatitis belongs to the “hanging carbuncle”. The chronic prostatitis belongs to …. From this, it can be seen that the prostatisis would have various clinic conditions/syndromes. For the treatment, it should also be paid attention to make correct six Jing diagnosis and precise herbal indication diagnosis to reach a radical cure.

炎是邪客证各异   虚实不同治有殊

1. 李某,男,46岁,病案号121641

Case 1. Li XX, male, 46 years of old. File number: 121641.

初诊日期1965531日:既往有慢性前列腺炎史,近一周来,出现头晕头痛,恶寒发热,无汗,身疲乏力,四肢酸软,曾服两剂桑菊饮加减,热不退,因有尿急、尿痛、尿浊,又给服八正散加减,诸症不减。今日仍恶寒发热,全身酸楚,有时汗出,尿急、尿痛、尿浊,下午体温38 C,大便如常,小便黄赤,尿常规检查:白细胞成堆,红血球810。舌质淡而有紫斑,舌苔白腻,脉细滑数,寸浮。此证极似湿热下注之象,但已用八正散不效,可知有隐情,故又细问其症,得知有口苦,胸满闷,由《伤寒论》第263条:"病人无表里证,发热七八日,脉浮数者,可下之"之句悟出,此证为湿热内结,辨方证为大柴胡汤合增液承气汤:柴胡四钱,白芍四钱,枳实三钱,半夏三钱,黄芩三钱,生姜三钱,大枣四枚,大黄二钱,炙甘草二钱,生地五钱,麦冬四钱,玄参四钱,生石膏二两。

The first visit: May 31, 1965. The patient had a history of chronic prostatitis. For the recent one week, he had dizziness and headache. He felt fever and disliked cold, no sweat, but fatique and weak in arms and legs. He drunk two doses of Sangju Yin with some modification, the fever remained. For there being urgent urine, pain in urine and cloudy urine, he was given Bazhen San with modification. The symptoms remained no improvement. Today, he still felt fever and chilly, sour in whole body, and fullness and choking feeling in the chest. He had sometimes sweat, urgent urine, pain in urine duct, and cloudy urine. The body temperature in the afternoon was 38C. The bowel movement was normal. The urine was yellow to red in color. The tongue was pink with purple spots. The tongue cover was white and greasy. The pulse was thin, slippery and frequent, with floating feeling on the left side. The lab test for the urine: Lots of WBC, RBC 8-10. His condition seemed to be the Wetness-Hotness down-flowing, but the herb Bazhen San did not work. It imples that there must be something hidden there. After detailed consultation, he said, he felt bitter in mouth, fullness and chocking feeling in chest. From the state in the book <<Shang Han Lun>>, paragraph 263, “if patient has no body surface syndrome, but fever for seven to eight days, and if the pulse is floating and frequent, the bowel movement-stimulating therapy can be used.”, it can be realized that, his condition belongs to the Wetness-Hotness chocking inside, which is the indication for Dai Chaihu Tang plus Zen Yi Chenqi Tang. The herbs so given were: Chaihu 12 g, Baishao 12 g, Zhishi 9 g, Banxia 9 g, Huangqin 9 g, fresh ginger 9 g, Chinese date 4, Dahuang 6 g, Zhi Gancao 6 g, Shengdi 15 g, Maidong 12 g, Xuanshen 12 g, and Shigao 60 g.

结果:上药服两剂,热退身凉和,因仍有尿痛、尿急,改服猪苓汤加大黄,连服六剂,诸症已。

Comments: After the herbal therapy for two days, the fever subsided. For he still having pain in urine duct and urgent urine, the herbal prescription was changed to Zhuling Tang plus Dahuang. This new prescription was continued for six days. All symptoms disappeared.

按:本证病灶、炎症在下、在前列腺,但症候反应却在半表半里及里,且已现津伤,此时如仅用利湿通淋于下,必致津更伤,邪更踞于里,正虚里实,津伤热更盛,病情益甚,局部可能化脓,有可能形成"穿裆发"。胡老秉承仲景医论并据临床经验仔细辨证,辨证准确,治疗得当,治从清里及和解半表半里,同时又益津增液,故能使热退身凉和。再进一步清理余邪,使病痊愈。

Comments: For this case, the disease location is in the prostate, but the condition is located in the Shaoyang and the Yangming phases, as well as with depletion of body liquid portion. At this movement, if the Wetness-clearing therapy is used alone, there would be more depletion of the liquid portion, which would make the Xie Qi sticking more tight inside of the body so as to damage more body defense energy. This further more may make the local prostate developing into pus mass, even to form fostula. Dr. Hu, based on the Mater Zhongjing Zhang, the Jing Fang system, in the diagnosis. His diagnosis was correct and precise and the herbs used matched the clinid conditions. The herbs used cleared the inside Fire and harmonized the in-between phase of the body, as well as nourished the body liquid portion, therefore, the herbs worked to reduce the body temperature. Additional herbal prescription worked to clear the remaining Xie Qi, so all the symptoms disappeared.

2. 刘某,男,45岁,病案号137865

Case 2. Liu XX, male, 45 years of old. File number: 137865.

初诊日期196639日:自上月25日发热,尿痛,诊断为慢性前列腺炎急性发作,已用抗生素治疗一周。效不明显而转中医治疗,曾服辛凉解表及利湿清热剂。汗出益甚而症不退,现症:汗出,恶风,头痛,身疼,口苦,胸闷,腰痛,大便干,溲赤,尿道灼痛,舌苔薄白,脉细弦滑。此为表虚犹未解,而里热已盛,呈三阳合病,为柴胡桂枝加黄芪生石膏方证:柴胡四钱,黄芩三钱,生姜三钱,半夏三钱,党参三钱,大枣四枚,桂枝三钱,白芍三钱,生黄芪五钱,炙甘草二钱,生石膏一两半。

The first visit: March 9, 1966. The patient started to have fever and pain in urine duct on February 25, 1966. His condition was diagnosed as acute onset of chronic prostatitis. He had been given western medicine for treatment for one week. For no clear improvement, he went to Chinese medicine for help. He had been given spicy-cooling herbs to release the body surface, and herbs to clear the Wetness and the Hotness. He got more sweat and the other symptoms remained the same. The current condition when he visited Dr. Hu: sweat, wind-disliking, headache, pain in the body, bitter in mouth, chocking feeling in chest, pain in the lower back, dry stool, red urine, and pain in the urine duct. His tongue cover was thin and white. The pulse was thin, string and slippery. This was a condition, in which the body surface syndrome remained and the inside Fire was overwhelming too, showing a threeYang co-exist phases. It is the indication for Chaihu Guizhi Tang plus Huangqi and Shigao: Chaihu 12 g, Huangqin 9 g, fresh ginger 9 g, Banxia 9 g, Dangshen 9 g, Chinese date 4, Guizhi 9 g, Baishao 9 g, Huangqi 15 g, Zhi Gancao 6 g, and Shigao 45 g.

结果:上药服三剂,头痛、身疼已,汗出恶风减,上方再加生苡仁六钱,麦冬四钱,服六剂,诸症已。

Results: After the herbal therapy for three days, the headache and pain in the body subsided. The sweat and wind-dislike feeling reduced. To the prescription above, added was Yiyiren 18 g, and Maidong 12 g. After another six doses, all the symptoms disappeared.

按:本证有大便干、溲赤、尿道灼痛等,乍看为里实热证,但胡老据汗出恶风、身疼等首辨为表虚证,表虚则营卫虚,可知胃不实,以是可知里热盛而不实,当为柴胡桂枝汤加生黄_生石膏方证。服之表解,半表半里和,里清,诸症随之亦消。不着眼消炎而炎自消。

Comments: In this case, there was dry stool, red urine and pain in the urine duct, all of which seemed to be inside Fire overwhelming condition. Dr. Hu, however, noticed that the patient had wind-dislike feeling, sweat and pain in the body, diagnosed it as body surface weakness condition. When the body surface is weak, the Yin and Wei Qi in the body surface were weak, so which implies that the stomach is also weak, so that the inside Fire is a weak fire, not a overwhelming fire. It is therefore the condition for Chaihu Guizhi Tang plus Huangqi and Shigao. After the herbal therapy, the body surface was released, the in-between phase was harmonized and so the symptoms disappeared. The herbal therapy did not focus on the anti-inflammation, while the inflammation subsided any way.

3. 王某,男,30岁,首都机场病案号3341

Case 3. Wang XX, male, 30 years of old. File number: 3341 (Capital airport file series)

初诊日期1966611:患前列腺炎已半年余,已服中西药治疗,疗效不理想。现症:腰痛,时小腹痛,或睾丸坠胀痛,时尿道涩痛,大便时,尿道口有乳白色粘液流出,尿频而量少,尿色红黄,口干思饮,舌苔白根腻,脉弦滑。证属湿瘀阻滞,治以利湿化瘀,与猪苓汤加生苡仁大黄:猪苓三钱,泽泻四钱,滑石五钱,生苡仁一两,生阿胶三钱,大黄一钱。

The first visit: June 11, 1966. The patient suffered from chronic prostatitis for half year. He took western medicine and Chinese herbal therapy for the treatment. There was no improvement. The current condition when he saw Dr. Hu: He had pain in the lower back, felt pain in the lower stomach from time to time, or felt falling and bloating pain in testis, or harsh pain in the urine duct. When he had bowel movement, there was white, milk-like fluid out of urine duct. The urine was frequent and the volume was less. The urine was red and yellow in color. He felt dry mouth and had desire to drink. The tongue cover was white with greasy on tongue root. The pulse was string and slippery. His condition was believed to belong to Wetness- and Blood-stagnation in prostate. The herbal therapy was to clear the Wetness and to dissolve the blood stagnation. He was given Zhuling Tang plus Yiyiren and Dahuang: Zhuling 9 g, Zexie 12 g, Huashi 12 g, Yiyiren 30 g, Ajiao 9 g, and Dahuang 3 g.  

结果:上药只服二剂,症大减,因腰痛明显,上方加柴胡桂枝干姜汤,服半月,症状基本消失。

Results: After the herbal therapy for only two days, the all symptoms reduced dramatically. For strong pain in the lower back, the prescription above was used together with Chaihu Guizhi Ganjiang Tang for half month. After that, all the symptoms subsided basically.

按:胡老常用猪苓汤加减,治疗肾盂肾炎、膀胱炎、急慢性前列腺炎,泌尿系感染等,其主要辨证依据是口渴,即属内热者。本例虽有腰痛,但无明显表证,而有口干思饮,尿道涩痛,尿黄等,以湿热挟瘀为著,故以猪苓汤加生苡仁、大黄,利湿化瘀,使邪去症已。

Comments: Dr. Hu often uses the Zhuling Tang (with some modification) for the treatment of pyelonephritis, cystitis, acute or chronic prostatitis, or inflammation in urinary system. The main point for the herbal indication diagnosis is thirsty, e.g. there is inside Fire condition. For this case, though there was pain in the lower back, the person had no clear body surface syndrome, but the thirsty, desire to drink, pain in the urine duct and yellow urine, all of which suggested the Wetness and Hotness with blood stagnation. So, he used the Zhuling Tang plus Yiyiren and Dahuang for the treatment.   

4. 方某,男,43岁,病案号132645

Case 4. Fang XX. Male. 43 years of old. Fine number: 132645.

初诊日期1965127日:三个月来尿不尽、尿频、阴囊抽缩,曾查前列腺液,白细胞1520,卵磷酯小体( ),诊断为慢性前列腺炎,西药治疗,疗效不明显。后转中医诊治,以补肾、舒肝等治疗,症不减反加重。近症:常腰痛,小便不畅,尿不尽,尿频,食后则少腹拘急。心中摆忙感、晕眩、阴囊和阴茎挛缩,现症恶寒、头晕加重,舌苔白,脉细弦。此外寒内饮为患,为五苓散方证:桂枝三钱,茯苓四钱,泽泻五钱,猪苓三钱,苍术三钱。

The first visit: December 7, 1965. The patient had continuous drops of urine after urination, frequent urine, and contracting sensation of testis for three months. The lab test for prostate fluid showed WBC 15-20, normal corpusclesoflecithin ( ). It was diagnosed as chronic prostatitis. He was given western medicine treatment, but the effect was not dramatic. Later, he was referred to Chinese medicine and he drunk herbal tea to nourish kidney, and to relax liver. The symptoms were not improved but worse. The current condition when he visited Dr. Hu: he often felt lower back pain, poor urine, urine retension feeling after urination, frequent urine and lower stomach spasm after eat. He also felt hanging-swing sensation in heart, dizziness and contracting sensation in the testis and penis. He felt chilly and more dizziness. The tongue cover was white and the pulse was thin and string. His condition was to be external Cold and internal Water overwhelming. He was given prescription Wuling San: Guizhi 9 g, Fuling 12 g, Zexie 15 g, Zhuling 9 g, and Cangzhu 9 g.

结果:上方服三剂症减,继原方服六剂,诸症基本消除。

Results: After the herbal therapy for three days, the symptoms all reduced. After six days, no any symptoms left.

按:前阴为宗筋所聚,肝肾所主,一般遇阴缩挛急,要想到补肝益肾。但本例慢性前列腺炎为水饮为患,且呈外寒内饮之证,补则激动内饮,饮邪上犯,故现心中摆忙、头晕、目眩,正邪相争,内外皆急,故恶寒、腹拘急、囊缩挛急。此时唯有在解表的同时利水,方能使表解水去,五苓散正是这种作用。这里也可看出,例3和本例同是慢性前列腺炎,因表现的方证不同,所以治疗用药也就不同。中医治疗有无疗效,关系所在,不可忽视。

Comments: The front perineal region is the accumulating area for Zong tendons, which is associated and dominated by the liver and kidney. Usually, once there is contracting feeling in the perineal region, the liver- and kidney-nourishing therapy should be considered. This case, however, is due to attack by Water inside, as well as is accompanied by external Cold. In this case, the nourishing therapy would stirs the inside water, to make the water reverse rushing up to cause hanging-swing feeling in heart, dizziness, and blirring vision. The body defense energy and the Xie energy combat together, so both the body surface and the inside are in an stress stage, and so the body feels chilly and spasm in stomach, testis and penis. At this time, the correct therapy should be to release the body surface and to dispel the water, the same time. This is exactly the function of Wuling San. From this case, it can be seen that, in case 3 and this case 4, though both being chronic prostatitis, for their difference in clinic conditions, the herbs used are also different. Whether Chinese herbal therapy works or not, depends on the disease nature diagnosis and also the herbal indication diagnosis. This needs always be remembered.

5.  陈某,男,36岁,病案号196986

Case 5. Chen XX, male, 36 years of old. File number: 196986.

初诊日期1967730日:自1963年来会阴常坠胀或痛,经西医诊断为慢性前列腺炎,中西药治疗未见明显效果,近一月来症状加重,会阴胀痛,晚上更甚,影响睡眠,时少腹挛痛,腰酸膝软,小便余沥,尿后或大便时尿道有乳白色粘液流出,舌苔白,脉沉弦细尺滑。此虚寒里急,为小建中汤加小茴香桑螵蛸乌药方证:桂枝三钱,白芍六钱,生姜三钱,大枣四枚,炙甘草二钱,饴糖二两,小茴香三钱,桑螵蛸三钱,乌药三钱。

The first visit: July 30, 1967. The patient often had falling and bloating sensation or pain in the perineal region, since 1963. His condition was diagnosed as chronic prostatitis by western medicine. He had been given both western medicine and Chinese herbal therapy for the treatment, but no any clear improvement. For the recent one month, the symptoms became worse. He felt bloating feeling in the perineal region, which was worse at night, so as to affect sleeping. From time to time, he felt spasm and pain in lower stomach, sour and weak in the lower back and in the knee. He felt continuous drops of urine after urination. There was white fluid flowing out of penis after urination or after bowel movement. His tongue was white. The pulse was deep, string, and thin, with slippery feeling on the Chi position. This condition belonged to inside weakness and Cold. It was the indication of Xiao Huixiang Sangpiaoxiao Wuyao Tang: Guizhi 9 g, Baishao 18 g, fresh ginger 9 g, Chinese date 4, Zhi Gancao 6 g, Yitang 60 g, Xiao Huixiang 9 g, Sangpiaoxiao 9 g, and Wuyao 9 g. 

结果:上方服六剂,会阴坠胀及痛减。上方加生苡仁、猪苓等服一月,诸症基本消失。

Results: After the herbal therapy for six days, the falling sensation and pain in the perineal region was reduced. To the prescription, added were Yiyiren and Zhuling. It was continued for one month. All the symptoms disappeared.

按:《金匮要略血痹虚劳病》第13条:"虚劳里急,悸衄,腹中痛,梦失精,四肢酸痛,手足烦热,咽干口燥,小建中汤主之。"多是指里虚寒引起腹中痛,有不少慢性前列腺炎患者出现该方证,用小建中汤加减治疗多取佳效。

Comments: It is stated in the book <<Jin Kui Yao Luo: Blood Bi syndrome and exhausting disease>>, the paragraph 13 that, if the person has weakness, exhausted condition with spasm sensation in stomach, palpitation and  nose bleeding, pain in stomach, loss of sperm fluid during dream, sour in arms and legs, hot feeling in palm and sole, dry mouth and throat, use Xiao Jianzhong Tang for the treatment.” It is mostly referring to the stomach pain due to inside weakness and cold condition. Many patients with chronic prostatitis have also such weakness and inside cold condition, indicating the use of Xiao Jianzhong Tang. The use of this herbal prescription usually works well. 

27.  性功障碍邪所为  但补肾虚必遭殃

27. Impotency might be caused by Xie Qi attack. The use of kidney-nourishing therapy might only make the condition worse.

6. 白某,男,35岁,病案号163411

Case 6. Bai XX, male, 35 years of old. File number: 163411.

初诊日期1965623日:自19614月出现失眠,且越来越重,相继出现头晕、耳鸣、早泄、遗精、小便不利。西医诊断为慢性前列腺炎、神经衰弱。服药治疗无效,而转中医诊治,曾服人参养荣丸、全鹿丸等不效,且症益重。来诊时症见:失眠,自汗盗汗,头昏脑胀,耳鸣。眩晕欲吐,不敢睁眼,少腹悸动,早泄,遗精一周三次,舌苔白根厚,脉沉细数。此阳气下虚,虚火上亢之证,为桂枝加龙骨牡蛎汤方证:桂枝三钱,白芍三钱,白薇三钱,生姜三钱,大枣三枚,生龙骨五钱,生牡蛎五钱,川附子三钱,炙甘草二钱。

The first visit: June 23, 1965. The patient had poor sleep since 1961, which became worse and worse. He felt dizziness, tinnitus, premature ejaculation, spermatorhea and poor urine. The western medicine diagnosis was chronic prostatis and nervous exhaustion. For no healing effect by the western medicine, he went to Chinese medicine. He was given Renshen Yangrong Wan, Quanlu Wan, etc. There was no effect either. The symptoms were worse and worse. The current condition when he visited Dr. Hu: He had poor sleep, sweat at night and during day time, cloudy mind and bloating sensation in head, tinnitus, dizziness, feeling to vomit, dare not to open eyes, palpitation feeling in lower stomach region, premature ejaculation, and spermatorhea three times a week. The tongue cover was white, with thick cover at tongue root portion. The pulse was deep, thin and frequent. This is a condition, in which the body Yang Qi is deficient in the perineal region, so the false fire reversing up. It is the indication for Guizhi Longgu Muli Tang: Guizhi 9g, Baishao 9g, Baiwei 9 g, fresh ginger 9 g, Chinese date 3, Longgu 15 g, Muli 15 g, Fuzi 9g, and Zhi Gancao 6 g.

结果:上方服六剂,睡眠好转,只遗精一次。72日改他医方,与知柏地黄丸,服后遗精、耳鸣皆加重,继与上方加酸枣仁加减,经两月治疗,遗精已,早泄减,余耳鸣,继合用酸枣仁汤服月余,症渐平。

Results: After the herbal therapy for six days, the sleep was improved, with only once seprmatorhea. On July 2, he himself turned to another doctor and changed herbal prescription to use Zhibo Dihuang Wan. The spermatorhea and tinnitus became worse. He returned to Dr. Hu. Dr. Hu gave him the previous prescription with the addition of Suanzaoren. After two months, the spermatorhea stopped. The premature ejaculation reduced. The tinnitus remained. He was given Suanzaoren Tang for months. The symptoms gradually reduced.

按:前列腺炎常引起性功能障碍,如遗精、早泄、阳痿等,改善这些症状,当然要治疗前列腺炎症。但治疗前列腺炎症必须辨证,本例在治疗初及治疗中已显示,一见遗精、早泄便以肾虚补治是不准确的,必须辨清病本,并与相应的方药,才能收效。本例因长期失眠、自汗、盗汗,营卫不固,外邪易侵,长此以往,出现阳虚于下,虚阳亢于上,区此治疗必须调和营卫以抗邪外出,同时用附子温补在下之降虚,用白薇、生龙骨、生牡蛎涩敛浮阳,这样有的放矢,才能治好慢性前列腺炎,才能治好遗精、早泄。

Comments: The prostatitis usually causes disorders in sexual function, such as spermatorhea, premature ejaculation and impotency, etc. To solve these problems, of course the prostatitis should be treated. For the treatment of prostatitis, the diagnosis is needed. In this case, it has been evidenced in the beginning and during the treatment that to give kidney-nourishing therapy right away is not a proper way, after seeing the spermatorhea and premature ejaculation. It is needed to make sure the nature of the disease, and cause for the prostatitis, and so to give corresponding herbs. In this case, for a long term of poor sleep, sweat at night and during the day, the body external defense system is weak, so external Xie Qi is easy to attack the body. For a long time, the body develops into Yang deficiency in the lower portion of the body, but floating false Fire on the upper portion of the body. For the treatment, it is needed to use herbs to re-balance the Yin and Wei Qi so as to dispel Xie Qi out of the body, and at the same time, to use herb Fuzi to warm-nourishing the lower portion of the body, by use of Baiwei, Longgu and Muli to attract the floating false fire down. By this way, it is possible to solve the prostatitis, as well as the spermatorhea and premature ejaculation.

7. 仓某,男,30岁,病案号98603

Case 7. Cang XX, male, 30 years of old. File number: 98603.

初诊日期1963228日:结婚即现阳痿、早泄,病已4年,经中西医诊治毫无起效。经查有慢性前列腺炎,迈服桂附地黄丸未见疗效。近症:阴茎勃起弱,举而不坚,且不持久而早泄,素动念见色流精,大便前后,每因腹压增加而有乳白色粘液流出,腰酸楚,耳鸣,舌苔白,脉弦细。此属营卫失和,上热下寒,治以调和营卫,温下敛上,与桂枝加龙骨牡蛎汤:桂枝三钱,白芍三钱,生姜三钱,大枣四枚,白薇三钱,川附子三钱,生龙骨八钱,生牡蛎八钱,炙甘草二钱。

The first visit: February 28, 1963. The patient had impotency, premature ejaculation for four years (since marriage). He had been given both western medicine and Chinese herbal therapy for the treatment, but no improvement. He was diagnosed to have chronic prostatitis. He was given for Gui Fu Dihuang Wan and still no improvement. The current condition when he visited Dr. Hu: impotency of penis. The penis could erect but not hard enough. It could not last for longer time, so there was premature ejaculation. There was leakage of sperm fluid whenever seeing a sex photo or picture, or had sexual mind. There was white fluid out of penis, before or after bowel movement. He felt sour in lower back, and tinnitus. The tongue cover was white. The pulse was string and thin. The condition was diagnosed as dis-harmany between the Yin and the Wei Qi in the body, with hotness in the upper portion of the body, but cold in the lower part of the body. For the treatment, the herbs should work to harmany the Yin Qi and the Wei Qi, to warm the lower part but cool the upper part of the body. It was the indication for Guizhi plus Longgu and Muli Tang: Guizhi 9 g, Baishao 9 g, fresh ginger 9 g, Chinese date 4, Baiwei 9 g, Chuan Fuzi 9 g, Longgu 24 g, Muli 24 g, and Zhi Gancao 6 g.  

结果:上方服三剂,耳鸣大减,见色流精、大便时尿道溢液亦减。上方加四逆散,服六剂,自觉症状皆好转,偶有耳鸣腰酸,精神好转。与四逆散合当归芍药散、二加龙骨牡蛎汤加减,服六剂,告之阳痿已。

Results: After the herbal therapy for three days, the tinnitus reduced dramatically. The sperm fluid leakage with sex stimulation and the white fluid out of penis during bowel movement were also reduced. To the prescription above, added was Si Ni San. After this new prescription for six days, the symptoms were improved, with occasional tinnitus and sour on lower back. The emotion was improved too. He was given Si Ni San plus Danggui Shaoyao San, Er Jia Longgu Muli Tang. After six days, the impotency was cured.

按:《内经》谓:"阴阳之要,阳密乃固",此患者长期患慢性前列腺炎,伴见阳痿、早泄,证现阳气虚于下,虚阳浮于上,其关键在阳虚不能密固,对于这种证,古人已有成熟的治疗经验,如《金匮要略血虚劳病》第8条:"夫失精家,少腹弦急,阴头寒,目眩,发落,脉极虚、芤迟,为清谷、亡血、失精,脉得诸芤动微紧,男子失精,女子梦交,桂枝龙骨牡蛎汤主之"。用桂枝加龙骨牡蛎汤的目的,在于温下寒,调和营卫,调和阴阳,收敛浮阳,潜阳入阴,阳能固密,阴亦能守,精亦不致外溢,阴阳和则功自调。又本患者,长期抱病情郁气滞,因此后期治疗,辅以四逆散舒肝理气,使阳气得舒,这样治愈慢性前列腺炎,也即治好了早泄、阳痿。

Comments: The patient had long term of chronic prostatitis, with impotency and premature ejaculation, which indicating that the Yang Qi is weak in the lower part of the body and false Yang floating in the upper part of the body. The point is that, the Yang is not sufficient to seal. For such clinic condition, doctors in old time had had quite mature experience in the treatment. …… The aim to use the Guizhi plus Longgu Muli Tang is to warm the lower cold, and to harmany the Yin and Wei Qi in the body, to attract the floating Yang and to dive it into the lower part of the body (the Yin). The Yang functions to seal and the Yin functions to hold, so to seal the sperm fluid from leakage. Again, for this patient, for a long time disease, he felt poor emotion. Therefore in the later treatment, the Si Ni San was used to release and to dredge the liver Qi, so to make the Yang Qi circulate smoothly. To treat chronic prostatitis as such allows also for the improvement of premature ejaculation and impotency.

 

28.  肾炎病初探

28. The treatment of nephritis

里水皮水皆相见  祛邪利水据证投

这里所说的肾炎,是指常见的急性肾小球肾炎(Acute glomeru1o nephritis)和慢性肾小球肾炎(Chronic g10meru10nephritis)。是由感染(以链球菌感染最常见)后免疫反应引起的急、慢性炎症。临床以水肿、尿少、尿中见红血球、,管型、蛋白、高血压等为主要症候。本病属中医的水气病范畴。《金匮要略水气病》第1条:"病有风水、有皮水、有正水、有石水、有黄汗。"肾炎属水气病哪一种? 5条云:"里水者,一身面目黄肿,其脉沉,小便不利,故令病水;假如小便自利,自亡津液,故令渴也,越婢加术汤主之。"急慢性肾炎常见这种方证。关于里水,有的注家认为是"皮水"之误,理由是越婢加术汤治外邪内饮,而里水当无外邪。实际这里的里水,是指水发自里,由于小便不利。因而病水,里有水饮,又见外邪在表,而呈外邪内饮之证,恰是肾炎常见的病在里而现外邪内饮证。这是肾炎常见的病证。并不是说里水就等于肾炎,肾炎在急、慢性发病过程中,可见到许多变证,出现许多方证,临床对于肾炎的治疗关键不是病名,而是辨具体方证,如《金匮要略水气病》第20条:"风水,脉浮,身重,汗出恶风者,防己黄_汤主之。"21条:"风水,恶风,一身悉肿,脉浮不渴,续自汗出,无大热,越婢加术汤主之。"两条都称风水,前者为表虚,后者为表实,因表虚实不同,治疗也就不同,前者固表利水,后者发汗利水。

Here the nephritis we are going to discuss refers to the acute glomerulo nephritis and chronic glomerulo nephritis. It refers to the acute or chronic nephritis after an immunal disorder following inflammation by streptococcus. In clinic, there is swelling, and low volume of urine. Under the microscope for urine test, it can be seen RBC, tubes and there is protein in the urine. The person could have high blood pressure and so on. This disease belongs to the Water disorder in Chinese medicine. In the book <<Jin Kui Yao Luo: Shui Qi Bing>>, paragraph 1: “The water disorder can be separated into wind water, skin water, Zhen Water, stone water, and yellow sweat.” Which kind of water disorder the nephritis belongs to? On the paragraph 5, it stated: “for the inside water disorder, the person has yellow color on the face, eyes and skin all over the body. The pulse is deep, the urine is poor, so to cause the water disorder; if the urine is easy to pass, to cause loss of body liquid portion and the person feels thirsty, use Yuebi plus Zhu Tang for the treatment.” The acute or chronic nephritis are usually with this condition. For the inside water disorder, some doctors believed that it should mean “skin water” or “surface water”. They think that, the Yuebi Jia Zhu Tang works to external Xie attack and inside water overwhelming and if the person has inside water overwhelming, there should have no external Xie attack. Actually, the “inside water” here should mean “the water comes from inside, e.g. due to poor urination.” Therefore, in the water disorder, there is water overwhelming inside and also external Xie Qi in the body surface phase, which is just the common seen phenomenon in the nephritis. It does not mean that the inside water condition means the nephritis. During the course of nephritis, there could be various clinic manifestations, so there could be various herbal indications too. For the treatment of nephritis, it is not importance for the term “nephritis”, but for the herbal indications. For example in the book <<Jin Kui Yao Luo: Water Qi Bing>>, paragraph 20: it states: “For the Wind water condition, the person’s pulse is floating. The person feels heavy in the body, sweat and dislikes wind. In this case, use Fangji Huangqi Tang.” In paragraph 21: “in the Wind water condition, if the person feels dislike wind, has swelling all over the body, the pulse is floating and the person does not feel thirsty, and has no strong hot feeling, use Yubi Jia Zhu Tang for the treatment.” These two paragraph both discuss the treatment of Wind water condition. The first one talks about body surface weakness condition and the later one discuss the body surface overwhelming condition. For the body surface is different in the weakness and the overwhelming, the herbs used is different. The previous herbal prescription works to enhance the body surface and to dispel water and the later prescription works to create sweat and to dispel water.

肾炎有急、慢之别,其症也变化多端,其适应方证也就很多,如四肢肿,水气在皮肤中,四肢聂聂动者,也为表虚里饮,为防己黄_汤的适应方证;如腰背痛,四肢肿,头晕,心悸,病在半表半里,而呈血虚水盛,为柴胡桂枝干姜汤合当归芍药散方证;如病久阳衰出现四肢肿冷,小便不利,少腹不仁,呈阳衰水停,为八味丸方证......具体方证很多,要在临床上细辨,这里不再一一悉举,从治验病例可看出其治疗规律。

There are many herbal prescriptions that can be used for the treatment of nephritis. For example, if the person has swelling in the arms and legs, the water Qi is located in the skin, the arms and legs shaking slightly, the condition belongs to body surface weakness and inside water overwhelming. It is the indication for Fangji Huangqi Tang. If the person has sour in the lower back, swelling in the arms and legs, dizziness, palpitation, the disease is located in-between the body (middle layer of the body). It is a blood deficiency and water overwhelming condition. It is the indication for Chaihu Guizhi Ganjiang Tang plus Danggui Shaoyao San. If the person, after a long time of disease, has swealing and cold feeling in the arms and legs, poor urine, discomfort in the lower stomach region, showing Yang deficiency and water overwhelming, it is the indication for BaWei Wan… There are lots of herbal formula to use.

1. 于某,男,35岁,病案号7246

Case 1. Yu XX. Male. 35 years of old. File number: 7246.

初诊日期196575日:慢性肾炎已两年,曾住院治疗三个月未见明显疗效,出院求中医诊治。全身浮肿。四肢乏力,腰痛,口不渴,尿蛋白在波动,舌苔薄白根黄,脉沉弦。与越婢加术汤加茯苓:麻黄六钱,生石膏一两半,生姜三钱,大枣四枚,炙甘草二钱,苍术四钱,茯苓三钱。

The first visit: July 5, 1965. The patient had chronic nephritis for two years. He had been admitted in hospital for the treatment for three months without improvement. He asked to leave the hospital to try Chinese herbal therapy. He had swelling all over the body. He felt tired in the arms and legs, pain in the lower back, and no thirsty in mouth. The content of urine protein was fluctuated. The tongue cover was thin and white with yellow in the root. The pulse was deep and string. He was given Yubi Jia Zhu Tang: Mahuang 18 g, Shigao 45 g, fresh ginger 9 g, Chinese date 4, Zhi Gancao 6 g, Cangzhu 12 g, and Fuling 9 g.

结果:上药服三剂,小便增多,浮肿减轻,自感身轻有力,即自继服原方,连服三月未更方,浮肿全消,查尿蛋白()

Results: After the herbal therapy for three days, the amount of urine increased, the swelling reduced. He felt light in the body. He decided to continue the herbal prescription and continued for three months without any change of the prescription. After that, the swelling subsided. Urine protein was (-).

按:此是肾炎常见典型的"里水"即越婢加术汤方证,虽病程长逾数年,但仍为外邪内饮证,故用越婢加术汤而收捷效。胡老所称该方不但能改善临床症状,而且能改善肾功能,这种经验之谈,确非虚言。值得说明的是,该患者自行服越婢加术汤三个月,虽属效不更方,但更主要是证无变化,因此能使方药对证,能获捷效。而当有变证时,也必随证变方。

Comments: This is typical case of “inside water” condition, e.g. the Yuebi Jia Zhu Tang. Though the disease course was several years, the condition was still the external Xie in the body surface and water overwhelming inside. Therefore it is the indication for Yuebi Jia Zhu Tang and it worked well. Dr. Hu said that, this prescription works not only to improve the symptoms, but also to improve kidney function. This is the experience, not only a guess. It should be pointed out that, this patient continued the prescription by him self for three months. Though it is due to the prescription worked so no need to change the herbs, it was continued for the symptoms did not change to new ones. Therefore, once the herbs match the body condition, they work very fast. If there is new symptoms or if the symptom become changed, the herbs should also be changed accordingly.

2.  马某,女,12岁,病案号171525

Case 2. Ma XX, female, 12 years of old. File number 171525.

初诊日期196594日:前天出现面目浮肿,头晕且胀,不欲食,大便干燥,小便黄少,查尿蛋白 ( ),血压150100毫米汞柱,诊断为急性肾炎,舌苔白厚,脉弦数。与越婢加术汤:麻黄六钱,生姜三钱,大枣四枚,炙甘草二钱,苍术八钱。生石膏二两。

The first visit: September 4, 1965. The patient had swelling on the face three days ago. She felt dizziness and bloating sensation on the head, no desire to eat. She had constipation with dry stool. The urine was yellow and little in volume. The tongue cover was thick, white. The pulse was string and frequent. The blood pressure was 150/100 mmHg. Protein in urine was ( ).  Her condition was diagnosed as acute nephritis. She was given Yuebi Jia Zhu Tang: Mahuang 18 g, fresh ginger 9 g, Chinese date 4, Zhi Gancao 6 g, Cangzhu 24 g, and Shigao 60 g.

二诊96日:药后面目浮肿已消,仍头晕,咳嗽明显,胸胁苦满,不欲食,舌苔白根黄,脉细数。与小柴胡汤合麻杏石甘汤:柴胡三钱,黄芩三钱,生姜三钱,半夏三钱,大枣四枚,党参二钱,麻黄二钱,杏仁三钱,炙甘草二钱,陈皮三钱,生石膏二两。

The second visit: September 6. After the herbal therapy for two days, the swelling subsided. She still felt dizziness and had strong cough, felt fullness and chocking feeling in the chest, no desire to eat. The tongue cover was white with yellow in the root. The pulse was thin and frequent. She was given Xiao Chaihu Tang plus Ma Xing Shi Gan Tang: Chaihu 9 g, Huangqin 9 g, fresh ginger 9 g, Banxia 9 g, Chinese date 4, Dangshen 6 g, Mahuang 6 g, Xingren 9 g, Zhi Gancao 6 g, Chenpi 9 g, and Shigao 60 g.

三诊98日:上药服三剂,咳嗽已不明显,胸胁苦满减,尚头晕,大便干燥,血压11070毫米汞柱,仍与前方,去麻黄,加川厚朴三钱,猪苓三钱。

The third visit: September 8. After the herbal therapy for three days, the cough subsided, the bloating feeling in chest was reduced. She still felt dizziness and had dry stool. Blood pressure was 110/70 mmHg. She was given the same prescription, but removal of Mahuang, with addition of Houpu 9 g and Zhuling 9 g.

四诊913日:头晕已,诸证悉除,唯脉数、苔白、溲黄。与当归芍散合猪苓汤加生石膏:当归三钱,白芍二钱,川芎三钱,茯苓三钱,泽泻三钱,苍术三钱,猪苓四钱,阿胶三钱,滑石四钱,生石膏一两。

The fourth visit: September 13. After the herbal therapy, the dizziness disappeared. No any other symptoms, though the pulse was frequent and the tongue cover was white, and urine wasy yellow. She was given Danggui Shaoyao San plus Zhuling Tang plus Shigao: Danggui 9 g, Baishao 6 g, Chuangxiong 9 g, Fuling 9 g, Zexie 9 g, Cangzhu 9 g, Zhuling 12 g, Huashi 12 g, Shigao 30 g.

五诊917日:自感无不适,化验尿蛋白()

The fifth visit: September 17. No any discomfort. Urine protein (-).

按:本患者虽病程不长,但出现变证较多,因而用方也变换较多。又本例患病初即由中医治疗,未用激素,收效快可能与此有关,但愿肾炎患者都能如此。

Comments: This case had short history of disease, but had various changes in the symptoms, so the herbal prescriptions were changed according to the clinic conditions. In addition, from the beginning of the disease, she had been treated by Chinese herbal therapy, no by western medicine with hormone therapy. That the recovery of the disease was so fast might be also related to this fact. Hope that all the patients with nephritis could be treated as such.

肾炎有邪补应慎  证现虚损益不疑

If there is evidence of Xie Qi in the body, it should be careful to use the nourishing therapy in the treatment of nephritis. If the condition is pure weakness condition, no hesitate to use the nourishing therapy.

3. 宋某,男,19岁,红卫兵接待站工作人员。

Case 3. Song XX. 19 years of old. A staff.

初诊日期1966726日:自720日始。出现咽痛、发烧、身冷、微咳,自服APC热不退,继尿红、尿少。于区医院诊治,仍以外感治疗,热仍不解,并出现眼睑浮肿、下肢浮肿、头痛、尿少,甚至一日无尿,体温38 C385 C,经友谊医院查尿:尿蛋白( ),白血球满视野,管型2--4,嘱其住院治疗,因无钱只注射一日消炎针,热减而诸症未已,经人介绍找胡老诊治。近症:面目及双下肢浮肿,头痛头晕,身热恶寒,腰微痛,小便黄少,舌苔白厚,脉细滑数。与越婢加术汤:麻黄六钱,生石膏二两,生姜三钱,大枣四枚,炙甘草二钱,苍术四钱。

The first visit: July 26, 1966. The patient had sour throat, fever, chilly, slight cough for 6 days. He took Aspirin but the fever remained. After he had red color in urine and little urine, he went to hospital, where he was diagnosed as a common cold. The treatment given to him did not work either. The fever remained, followed by swelling on eye lids, swelling on legs, headache and reduced urine even no urine. The body temperature was 38 to 38.5 C. Lab test for urine showed protein ( ), WBC in full view, tubes 2 – 4. He was asked to admit into the ward for treatment. No poor financial status, he only took the muscle injection for one day. The fever subsided but any other symptoms remained the same. He was introduced to see Dr. Hu. The current condition: He had swelling on face, eyes and legs. He felt headache and dizziness, fever and chilly, slight pain in lower back, and little volume and yellow urine. The tongue cover was thick and white. The pulse was thin, slippery and frequent. He was given Yuebi Jia Zhu Tang: Mahuang 18 g, Shigao 60 g, fresh ginger 9 g, Chinese date 4, Zhi Gancao 6 g, and Cangzhu 12 g.

结果:上药剂后,肿大减,尿量增加,服三剂后。肿全消。服六剂后,尿蛋白减为( ),仍感腰痛、乏力,与柴胡桂枝干姜汤合当归芍药散:柴胡三钱,黄芩三钱,花粉四钱,生牡蛎五钱,桂枝三钱,干姜二钱,当归三钱,白芍三钱,川芎三钱,泽泻三钱,苍术三钱,茯苓三钱,炙甘草二钱。服一月,尿蛋白为(-),休息一个月即参加工作。1966126日复查尿常规正常,自感良好。

Results: After the herbal therapy, the swelling reduced dramatically. The volume of the urine increased. After three days, the swelling disappeared completely. After six days, the urine protein was ( ). He still felt sour in lower back and fatique. He was given Chaihu Guizhi Ganjiang Tang plus Danggui Shaoyao San: Chaihu 9 g, Huangqin 9 g, Tianhuafeng 12 g, Guizhi 9 g, dried ginger 6 g, Danggui 9 g, Baishao 9 g, Chuanxiong 9 g, Zexie 9 g, Cangzhu 9 g, Fuling 9 g, Zhi Gancao 6 g. The herbal tea was drunk for one month. Urine protein was (-). After one month break, he returned to work. On December 6, 1966, the following up showed urine tests were normal. He felt comfort.

按:本例初诊时为外邪内饮,故以越婢加术汤驱邪为主;当肿消外邪不明显,而血虚水盛时,则以养血温阳利水为治。

Comments: For this case, in the beginning, the condition was external Xie Qi attack and water overwhelming inside. He was given Yuebi Jia Zhu Tang. When the swelling was no longer apparent but the condition showed blood deficiency and water overwhelming, the prescription changed to nourish the blood, to warm Yang Qi and to dispel the Water.

4.  姚某,男,23岁,病案号183376

Case 4. Yao XX. Male. 23 years of old. File: 183376.

初诊日期19651211日:自今年5月发现肾小球肾炎,用过维生素、氯化奎林、考的松等治疗未见明显效果。现症仍浮肿,腰酸痛,乏力,稍劳则气短,纳差,头晕,口干思饮,小便少黄,舌苔白腻,脉沉细滑。尿比重1020,尿蛋白( ),管型23,红细胞1520,白细胞13。与柴胡桂枝干姜汤合当归芍药散:柴胡四钱  桂枝三钱  黄芩三钱  花粉四钱  生牡蛎五钱  干姜二钱   当归三钱   白芍三钱  苍术三钱  川芎三钱  泽泻三钱  茯苓三钱  炙甘草二钱。

The first visit: December 11, 1965. Since May this year, the patient was found to have glomerulo nephritis. He was given vitamins, Chlorinated quinoline, and cortisone but no any effect. The current condition when he visited Dr. Hu: Swelling, sour in lower back, fatique, short of breath after little physical work, poor appetite, dizziness, dry mouth with desire to drink. The urine was little in volume and yellow in color. The tongue cover was white and greasy. The pulse was deep, thin and slippery. Urine density was 1.020. Urine protein was ( ), RBC 15-20, tubes 2-3, WBC 1-3. He was given  Chaihu Guizhi Ganjiang Tang plus Danggui Shaoyao San: Chaihu 12 g, Guizhi 9 g, Huangqin 9 g, Tianhuafeng 12 g, Muli 15 g, dried ginger 6 g, Danggui 9 g, Baishao 9 g, Cangzhu 9 g, Chuanxiong 9 g, Zexie 9 g, Fuling 9 g, Zhi Gancao 6 g.

结果:上药服六剂,腰痛、乏力好转,仍浮肿、纳差、小便少,近两天头晕、恶心、汗出恶风明显,与防己黄_汤合木防己汤:生黄_四钱,桂枝三钱,茯苓三钱,木防己三钱,党参三钱,生姜三钱,生石膏一两半,苍术三钱,炙甘草二钱。服六剂后,小便增多,浮肿、汗出恶风、腰痛皆减,恶心已,继服前方两月,诸症皆好转,仍时有头晕,查尿常规,尿蛋白( ),管型01,红细胞18,仍消息之。

Results: After the herbal therapy for 6 days, the lower back pain and fatique were improved. He still had swelling, poor appetite, less urine. The current days, he had dizziness, nausea, sweat and strong wind-disliking feeling. He was given Fangji Huangqi Tang plus Mufangji Tang: Huangqi 12 g, Guizhi 9 g, Fuling 9 g, Mufangji 9 g, Dangshen 9 g,fresh ginger 9 g, Shigao 45 g, Cangzhu 9 g, Zhi Gancao 6 g. After six days, the urine increased in volume. The swelling, sweat, wind-disliking feeling, and lower back pain, all were improved. Nausea stopped. After two months of the continuous herbal therapy, all the symptoms were improved. He felt occasional dizziness. Urine test showed urine protein ( ), tube 0-1, RBC 1-8. It is still under treatment.

按:本例初诊即现气血俱虚之证,故与柴胡桂枝千姜汤合当归芍药散养血利水,服六剂,虽有一定疗效,但症状改善不明显。经进一步辨证,认为表虚水盛明显,故改服防己黄芪汤合木防己汤而使症状得到明显好转。但经长期服药也未使肾功明显改善。这里的原因可能是:本例是慢性肾炎,须作长期治疗观察;服用激素后的患者,服中药难予见效。是否如此,当进一步探讨。

Comments: For this case, from beginning, it was a Qi- and Blood-deficiency condition. He was given Chaihu Guizhi Ganjiang Tang plus Danggui Shaoyao San to nourish the blood and to deplete water. After six doses, though having some healing effect, the symptoms did not change dramatically. After further diagnosis, it was believed to be body surface weakness with overwhelming inside. His prescription was changed to Fangji Huangqi Tang plus Mufangji Tang, which improved the symptoms dramatically. However, the kidney function was not further more improved after a long time of herbal therapy. The possible reason for this might be: for the chronic nephritis, it is needed to have long time treatment; or once patient has had hormone therapy, the Chinese herbal therapy would be hard to show effect. Whether this is true needs further observation.

 

29.  头痛的辨证论治

29. The treatment of headache

头痛多见太阳病  六经合病当审清

The headache is more seen in Taiyang phase. However, it should also be paid attention to identify if there is co-exist other phase.

头痛是临床上常见的自觉症状,可单独出现,亦可见于各种急慢性疾病中。脑系病常见头痛,已在前论述,这里重点介绍脑系病之外的头痛。关于头痛的病因病机,古今有许多探讨,如《素问五脏生成篇》曰:"头痛巅疾,下虚上实,过在足少阴、巨阳,甚则入肾。"《素问风论篇》:"风气循风府而上,则为脑风。"《济生方头痛论治》:"凡头痛者,血气俱虚,风寒暑湿之邪,伤于阳......又有风热痰厥,气虚肾厥,新沐之后,露卧当风,皆令人头痛。"《丹溪心法头痛》曰:"头痛多主于痰。"这些论述 在头痛的辨证论治上,给人们以启迪。这里应着重说明的是,《伤寒论》的六经辨证,在头痛的治疗上更能给予正确、快捷地指导。例如《伤寒论》第一条即指出:"太阳之为病,脉浮,头项强痛而恶寒。"这就指明了头痛多属于太阳病。值得说明的是,有人认为这只是指感冒头痛,这里的原因,第一是没有正确理解太阳病的实质。第二是后世习惯把头痛分为外感和内伤两大类,把太阳病视为外感病,把内伤头痛视为无外邪,这样只认为急性头痛才见太阳病,而慢性则不能有太阳病。

Headache is quite common in clinic. It can be a single symptom, or occurs in various acute and chronic diseses. Brain-origin diseases commonly have headache as one of their symptoms. This has been discussed before. Here we focus on the discussion of headache that is not caused by brain or by nerve system. For the cause of the headache, there are a lot of discusses in old medical books and literatures. …… It should be stated specifically that, the six Jing diagnosis system introduced in <<Shang Han Lun> could yield more correct and fast direction for the diagnosis and treatment of headache. For example, in the first paragraph of the book, it stated: “If a disease in the Taiyang phase, the person feels headache, stiff neck and chilly. The pulse is floating.” It implies that the headache is more likely related to the Taiyang phase. It should be pointed out that, someone think that this only means a headache in a common cold. The reason for such misunderstanding is that, firstly, they did not understand the real nature of a disease in the Taiyang phase. Secondly, it is due to the habit of doctors in later generations to separate the cause of the headache into the external common cold and inside damage. They regard the Taiyang phase/disease as external disease and consider the “inside’ headache as no external Xie Qi attack to the body. Therefore, they think the acute headache is associated with Taiyang disease/phase, while a chronic headache is not associated to Taiyang disease/phase.

实际各种急慢性病中皆可出现头痛,有头痛则说明有太阳病的存在,不过不少头痛者已不是单纯的太阳病,而是合病、并病,如太阳少阴合病;太阳少阳合病;太阳阳明合病;太阳太阴合病等。这样头痛的六经辨证既明,则治疗大法便可确定,这就是在太阳用汗法;太阳少阴合病用发表加温阳强壮法;太阳少阳合病用和解法;太阳太阴合病用解表温里法。在大法的指导下,再辨具体的方证,则头痛可得到正确的治疗。这里仅从几个治验案例分析、探讨之。

In fact, headache can occur in either an acute or a chronic disease. Headache suggests there is Taiyang disease (the disease is in Taiyang phase), though in many cases, the disease with headache is no longer only in Taiyang phase alone, but is with other phases too. For example, as in Taiyang-Shaoyin co-exist phase, Taiyang-Shaoyang phase, Taiyang-Yangming phase, or Taiyang-Taiyin phase, etc. By this way, the six Jing diagnosis of headache is clear and the principle in the treatment is so settled down. This means: if the headache is in Taiyang phase, use sweat therapy; if it is in Taiyang-Shaoyin phase, use body surface-releasing plus warming and strengthing therapy; if it is in Taiyang-Shaoyang phase, use harmonizing therapy; or if it is in Taiyang-Taiyin phase, use body surface-releasing therapy and inside-warming therapy the same time. Under such principle, choose proper herbal prescriptions by herbal indication diagnosis, the headache can be solved radically. Here we introduce several cases to discuss.

太阳汗法分虚实  少阴合病当温补

If the headache is in Taiyang phase, use sweating therapy. If it is also with Shaoyin phase, use warming therapy the same time.

1 任某,女,21岁,病案号49703

Case 1. Ren XX, female, 21 years of old. File number: 49703.

初诊日期19651221日:昨日感冒,头痛、身痛、腰痛、恶寒、无汗、恶心欲呕,素有腹泻腹痛,舌苔薄白,脉浮数。与葛根加半夏汤:葛根三钱,麻黄三钱,桂枝三钱,生姜三钱,白芍三钱,大枣四枚,炙甘草二钱,半夏三钱。

The first visit: Dec. 21, 1965. The person got common cold last night. She felt headache, pain all over the body, pain in the lower back, chilly, no sweat. She felt nausea and vomit. She usually had stomach pain and diarrhea. Her tongue cover was thin and white. The pulse was floating and frequent. She was given Gegen Tang plus Banxia: Gegen 9 g, Mahuang 9 g, Guizhi 9 g, fresh ginger 9 g, Baishao9 g, Chinese date 4, Zhi Gancao 6 g, Banxia 9 g.

结果:上服一剂,症大减,二剂症已。

Results: After the herbal therapy for one day, the symptoms were reduced dramatically. After the second dose, all the symptoms subsided.

按:此是太阳表实证为主的头痛,故用麻桂发汗;因有腹泻,实际合阳明病,故用葛根治利,并加半夏降逆。此头痛是近期感冒所患,故解表降逆即解。

Comments: This is the headache in Taiyang phase with body surface overwhelming condition. Therefore the herb Mahuang and Guizhi were used to stimulate a sweat. For there was diarrhea, it suggested to have Yangming phase the same time. So the herb Gegen was used to stop diarrhea and the Banxia is used to reverse the uprising stomach Qi, so to stop nausea. This headache is associated with a recent common cold. To release the body surface is therefore works well.

2. 张某,男,52岁,病案号123526

Case 2. Zhang XX, male, 52 years of old. File number: 123526.

初诊日期19651212日:2年来头痛,常服止痛片可缓解,但不能除根,且出现胃脘时痛,因而求服中药。近头痛多在顶部、后颈部,时身痛、膝关节痛,常身热,汗出恶风,舌苔薄白,脉缓细。与桂枝汤:桂枝三钱,白芍三钱,生姜三钱,大枣四枚,炙甘草二钱。

The first visit: Dec. 12, 1965. The person had headache for two years. Usually, to take pain killer could release the pain, but not prevent the recurrence. She also had often stomach pain and so want to use Chinese herbal therapy. Current condition: the headache was more on the top, the back neck. She felt body pain, and pain in the both knees. She often felt hot in the body, had sweat and wind-dislike feeling. The tongue cover was thin and white. The pulse was slow and thin. She was given Guizhi Tang: Guizhi 9 g, Baishao 9 g, fresh ginger 9 g, Chinese date 4, and Zhi Gancao 6 g.

结果:上药服二剂,诸症减,仍身痛、胁痛、便干、纳差、欲呕,与大柴胡汤合桂枝茯苓丸加生石膏:柴胡四钱,半夏三钱,白芍三钱,黄芩三钱,枳实三钱,生姜三钱,大枣四枚,桂枝三钱,桃仁三钱,丹皮三钱,大黄三钱,茯苓三钱,生石膏一两。

Results: After the herbal therapy for two days, all the symptoms were improved, though she still felt pain in the body, under the ribs. She had hard stool, poor appetite and willing to vomit. She was given Da Chaihu Tang plus Guizhi Fuling Wan plus Shigao: Chaihu 12 g, Banxia 9 g, Baishao 9 g, Huangqin 9 g, Zhishi 9 g, fresh ginger 9g, Chinese date 4, Guizhi 9 g, Taoren 9 g, Danpi 9 g, Dahuang 9 g, Fuling 9 g, Shigao 30 g.

服三剂,诸症已。

Results: After the herbal therapy for three days, all the symptoms subsided.

按:本例头痛初诊为太阳表虚证,故服桂枝汤二剂症减。但出现了少阳阳明合病,且见胁痛,虑其久病多瘀,故与大柴胡汤合桂枝茯苓丸加生石膏治之,二剂即愈。这里可看到,本例初为表虚,后现里实,正邪相争,证变则方变,不是一方治头痛,其他病也是如此。

Comments: In this case, it was initially diagnosed as Taiyang phase with body surface weakness condition, so she was given Guizhi Tang for the treatment. However, she showed Shaoyang-Yangming co-exist phases after the treatment. She had pain under ribs. Considering that she may have blood stagnation after a long term of disease, she was then given Dai Chaihu Tang plus Guizhi Fuling Wan plus Shigao. Two doses of the herbal therapy solved the all symptoms. From this case, it can be seen that, in this case, it was body surface weakness condition, and it was inside overwhelming condition, implying the struggling of the body defense energy and the Xie Qi energy in the body, which make the clinic condition changed. Once the clinic condition changes, the herbal prescription should also be changed accordingly. It is not true that there is one herbal prescription that works exclusively for headache. This is the truth for the treatment of any disease. 

3. 许某,男,47岁,病案号3752

Case 3. Xu XX, male, 47 years of old. File number: 3752.

初诊日期197854日:右头痛两天,自感无精神,两手逆冷,恶寒无汗,口中和,不思饮,舌质淡,舌苔薄白,脉沉细,咽红多滤泡增生。与麻黄附子甘草汤加川芎:麻黄10克,炮附子10克,炙甘草6克,川芎10克。

The first visit: May 4, 1978. The patient had headache on right side for two days. He felt no ambition and no energy, reverse cold feeling on hands, chilly and no sweat. No special taste in mouth. No desire to drink. The tongue was pink. The tongue cover was thin and white. The pulse was deep and thin. There was multiple enlargement of follicles in throat. He was given Mahuang Fuzi Gancao Tang plus Chuanxiong: Mahuang 10 g, Pao Fuzi 10 g, Zhi Gancao 6 g, Chuanxiong 10 g.

结果:上药服一煎,微汗出,头痛解,未再服药,调养两日,身体如常。

Results: After the herbal therapy for one day, he had slight sweat on head. The headache stopped. He did not continue the herbs. He had a break for two days. No any discomfort at all.

按:本例为少阴表虚寒证的头痛,以温阳强壮解表,表解则头痛去。这里需说明的是,这种虚寒表阴证即少阴病。不只是见于感冒的一两天,也可见于慢性头痛中,如喘证篇中的唐某病例,即是经常头痛和哮喘并见的病证,因现少阴表虚寒证,用麻黄附子细辛汤治疗而愈,正说明少阴表证之头痛也常见于慢性病。这里需说明的是,胡老认为表分阴阳,阳证为太阳,阴证为少阴,即是说太阳与少阴病位同在表,是正邪的盛衰决定了表证的性质,即表现为虚寒阴性者为少阴病,表现为实热阳性者为太阳病。太阳病可因误治,或病久而陷于少阴病,头痛更为多见,宜注意。

Comments: The headache in this case belonged to Shaoyin body surface weakness condition. The herbs given to him worked to warm the Yang, to strength the body defense system and to release the body surface. After the body surface was released, the headache went away. It should be pointed out that, such body Yin condition with body surface weakness and cold is the Shaoyin phase. It does not occur in the first or the second days of the common cold, but can happen in chronic headache. Such as the case introduced in the treatment of asthma, for case of Mr. Xu, is the common headache and asthma in the same patient. For it is Shaoyin body surface weak and cold condition, the Mahuang Fuzi Gancao Tang worked well. It suggests that the Shaoyin body surface weakness and cold condition can also be seen in chronic disease. Here it should be pointed out that Dr. Hu believed that, the body surface condition can be separated into the Yin and the Yang phase. The Yang phase is the Taiyang phase and the Yin phase is the Shaoyin phase, e.g. the Taiyang and the Shaoyin both located in the body surface layer. It is the strength of the body defense energy and the disease-causing Xie Qi, that determines the manifestation of the body surface phase (Yang phase of Yin phase). If the body condition shows as weakness and cold, it belongs to the Shaoyin phase. If it is overwhelming hotness, it is Taiyang phase. If the Taiyang phase is not treated correctly, or if the disease lasts for a long time, the disease can shrink into the Shaoyin phase with more possible headache.

头痛临证多变幻  合病合方伏苍龙

The symptoms of headache could be largely variable. It needs to use two or more herbal prescriptions together to solve the pain.

4. 刘某,女,36岁,病案号76443

Case 4. Liu XX, female, 36 years of ol. File number: 76443.

初诊日期196539日:反复发作头痛5年,多于午后、疲劳、睡眠不足时发作,多次到医院查无所获,多谓"神经性头痛",给镇静剂、止痛剂可暂时缓解而不能除根。近一月因前额痛明显,拍X线片诊断为鼻窦炎,用抗生素治疗无效而找中医治疗。近症:头痛多在前额,伴双眼胀痛、后颈紧胀感、头沉、背酸痛、咽干、易心烦,无鼻塞流涕,舌苔白根腻,脉沉细弦,左寸浮。与越婢加术半夏桔梗汤:麻黄四钱,生姜三钱,炙甘草二钱,大枣四枚,生石膏一两半,苍术五钱,半夏四钱,桔梗三钱。

The first visit: March 9, 1965. The patient had recurrent headache for 5 years. The headache occurred mostly in the afternoon, when she felt tired, or had poor sleep. She went to hospital for the treatment many times without any improvement. She was diagnosed as “nervous headache”. The use of pain killer or sedative medicine only release the pain for a while but no any radical result. For the headache became worse for recent one month mostly on the front head, the X-ray was performed and the result suggested she may have sinus infection. For no effect by the use of antibiotic, she went to Chinese medicine for the treatment. The current condition when she visited Dr. Hu: the headache was more in the front head, with bloating pain behind the eyes, tightness feeling on the back neck, heavy feeing in head, sour and pain on body back, dry throat, easy to feel annoyed, but no stiff nose or running nose. The tongue cover was white with greasy on root. The pulse was deep, thin and string with floating feeling on the left Chun position. She was given Yuebi Jia Zhu Tang plus Banxia and Jiegen Tang: Mahuang 12 g, fresh ginger 9 g, Zhi Gancao 6 g, Chinese date 4, Shigao 45 g, Cangzhu 15 g, Banxia 12 g, and Jiegen 9 g.

结果:上药服三剂,头痛减,服六荆头痛已。仍后颈紧,继服六剂,诸证已。

Results: After the herbal therapy for three days, the headache was improved dramatically. After six doses, the headache stopped. She still felt tightness on the back of the neck. After additional six doses, no any symptoms left.

按:本例显然为慢性病,但临床症状,仍表现为外邪里饮而呈现太阳阳明合病,故用越婢加术半夏桔梗汤解表化饮而使症解。

Comments: This case is apparently a chronic disease. The clinic condition showed as external Xie Qi but water overwhelming inside, e.g. a Taiyang-Yangming co-exist phases. She was then given the Yuebi Jia Zhu, Banxia and Jiegeng Tang to release the body surface and to dispel the inside water, so to solve the problem.

5.  程某,男,15岁,病案号135393

Case 6. Chen XX, male, 15 years of old. File number: 135393.

初诊日期196548日:近10日来,头痛发热、恶寒、欲呕、纳差、口干、自汗、身倦怠、下肢无力,舌苔薄白,脉弦细,体温38 C。与柴胡桂枝汤加味:柴胡四钱,黄芩三钱,半夏三钱,党参三钱,桂枝三钱,赤芍三钱,炙甘草二钱,生姜三钱,大枣四枚,苦桔梗二钱,生石膏一两半。

The first visit: April 8, 1965. For the recent ten days, the patient had headache, fever, chilly, desire to vomit, poor appetite, sweat, fatique, and weakness in legs. The tongue cover was thin and white. The pulse was string and thin. The body temperature was 38 C. He was given Chaihu Guizhi Tang with some addition: Chaihu 12 g, Huangqin 9 g, Banxia 9 g, Dangshen 9 g, Guizhi 9 g, Chishao 9 g, Zhi Gancao 6 g, fresh ginger 9 g, Chinese date 4, Jiegen 6 g, Shigao 45 g.

二诊49日:上药服一剂后,诸症均已,唯感身酸软无力,体温37 C。上方去桂枝、芍药,服一剂善后。

The second visit: April 9. After the herbal therapy for one day, all the symptoms subsided, except he felt sour and weakness in the body. The body temperature was 37C. To the above prescription, removed was Guizhi and Shaoyao for one day for a maintenance.

按:本例头痛,初诊有自汗出,发热恶寒,为表不解,说明邪胜精却,欲呕纳差,病已入少阳;因有咽干、心烦已现阳明证,故为三阳合病,因与柴胡桂枝汤加生石膏一剂症大解,因表除而里、半表半里证不了了,故再与小柴胡汤加生石膏善后。

Comments: The headache in this case was with sweat, fever and chilly, indicating the body surface was choking. The poor appetite and willing to vomit suggested the Xie Qi had moved into the Shaoyang phase. The dry throat and annoyed feeling suggested the condition was also in Yangming phase. Therefore, it is a three Yang co-exist phases. For this reason, he was given Chaihu Guizhi Tang plus Shigao. One dose made the symptoms solved dramatically. For the body surface had been released while the inside and the in-between phases both were not completely solved, so she was given Xiao Chaihu Tang plus Shigao for a maintenance.

6. 薛某,女,26岁,病案号228165

Case 6. Xue XX. Female, 26 years of old. File number 228165.

初诊日期196717日:左偏头痛六七年,在当地(长春)屡治无效,且近一年发作频繁,由朋友介绍来京找胡老诊治。近症:几乎每日皆发作头痛,多在左太阳穴以上,但时轻时重,严重时,疼作则恶心、呕吐、或腹泻,须卧床四五日不动,疼剧烈时则面部亦疼,又经常感头晕,舌苔白根腻,脉沉细。与小半夏合苓桂术甘吴茱萸汤:半夏四钱,生姜三钱,党参三钱,吴茱萸四钱,大枣四枚,桂枝三钱,白术三钱,茯苓三钱,炙甘草二钱。

The first visit: January 7, 1967. The patient had migraine for six to seven years. She was treated in local hospital for a long time without improvement. For the recent one year, the onset came more often. She was introduced by her friends to come to Dr. Hu in Beijing. The current conditions when she came: she had headache almost every day. The pain was more on and above the temple. It was some time less and some times severe. When it was severe, she felt nausea, vomit, or diarrhea. She had to lay down on bed for four to five days without movement. When the pain was severe, she could also feel pain on the face. She often felt dizziness. The tongue cover was white with greasy on root. The pulse was deep and thin. She was given Xiao Banxia Tang plus Ling Gui Zhu Gan Tang plus Wuzhuyu: Banxia 12 g, fresh ginger 9 g, Dangshen 9 g, Wuzhuyu 12 g, Chinese date 4, Guizhi 9 g, Baizhu 9 g, Fuling 9 g, Zhi Gancao 6 g. 

按:本例头痛已六七年,但仍表现为太阳与太阴合病,故治以解表温中。又因痰饮上逆明显,故以苓桂术甘汤合吴茱萸汤温中降逆。再因痰饮盛而呕吐明显,因此合用小半夏汤化饮降逆,全方的功能,解表化饮、温中降逆。这里应特别注意的是,凡是有外邪内饮同时存在的情况下,治疗必须在解表的同时予以化饮。如是单独解表,或单独化饮,不但使证不解,而且还要加重病情,这是胡老多次强调的观点,当珍视之。

Comments: In this case, the headache had been for six to seven years. It still showed as Taiyang-Yangming co-exist phases. For the treatment, she was given body surface-releasing and inside-warming therapy. For the phlegm over rushing-up severe, she was also given Ling Gui Zhu Gan Tang plus Wuzhuyu to warm the middle and to reverse the rushing phlegm. For the phlegm was very strong to cause severe vomit, she was also given Xiao Banxia Tang to dissolve the water and to directing the water down. It should be pointed out here that, once there is a condition, in which there is external Xie Qi in the body surface and overwhelming water inside, the body surface-releasing therapy must be used together with the water-depletion therapy the same time. In such case, if only the body surface-releasing therapy or only the water-dissolving therapy is used, not only the condition would not be improved, but also makes the disease condition worse. This opinion has been emphasized many times by Dr. Hu. It should be paid more attention to this opinion.

7.  李某,男,26岁,病案号152205

Case 7. Li XX. Male. 26 years of old. File number: 152205.

初诊日期196615日:头痛两年,盖因中学读书引起。素有胃病,现已渐趋平静,仅偶尔烧心、吞酸,但时有心下停饮、心下振水声。平时整天头昏、晕沉,头脑不清楚,并时头痛,眉间沉紧,下午常有热胀上冲头面之感。有时头痛为剌疼,如电由项部上蹿入脑,或偏左,或在巅顶,或在后脑,发作时,须以手按之一二分钟始能缓解,如此一日发作两三次,长期忍受头痛之苦,影响学习和工作,最使人恐怖者,似脑生异物,曾到各医院诊治,多谓"神经衰弱",整天吃药而不见效,反而副作用明显,时有恶心、或腹痛,睡眠不好。亦曾找中医诊治,以养血熄风安神等法,服天麻钩藤饮、镇肝熄风汤等加减,效不明显。舌苔白根腻,脉沉细弦。与吴茱萸汤加苓归芎:吴茱萸三钱,党参三钱,生姜三钱,大枣四枚,当归二钱,川芎二钱,茯苓四钱。

The first visit: January 5, 1966. The patient had headache for two years. It was due to study in middle school. He had a history of stomach disorder, which was gradually less and less now. Occasionally he would only feel heat burning, acid reflex, but he from time to time felt water accumulation (water noice) in the stomach. He usually felt cloudy in mind, heavy in head and kind of dizziness. The headache came from time to time with descending and tightness in between the eye brows. In the afternoon, he often had hot-bloating feeling rushing up to the head and face. Some times, the headache felt as thorn pain, or as electric from neck into the brain. The pain could be on the left side or on the top or on the back of the head. On onset, the pain needed to be pressed with hands for one to two min to subside. Such headache came two to three times a day. He suffered from such pain for a long time, so that his study and work were affected. The most scareful thing is that he felt as having a strang thing growing in the brain. He had been visiting various hospitals but most time he was diagnosed as “nerve headache”. He took medicine every day without improvement but with more side effects from the medicine. Some times he felt nausea, or stomach pain, or poor sleep. He did visit Chinese medicine, and was given blood-nourishing, wind-sedating, and emotion-calming therapies, by taking Tianma Gouteng Yin, Zhen Gan Xi Feng Tang, etc. without effect either. When he visited Dr. Hu, his tongue cover was white with greasy on root. The pulse was deep, thin and string. He was given Wuzhuyu Tang plus Ling Gui Xiong: Wuzhuyu 9 g, Dangshen 9 g, fresh ginger 9 g, Chinese date 4, Danggui 6 g, Chuanxiong 6 g, and Fuling 12 g.

结果:上药服三剂后,剧疼只发作一次,头晕胀、眉间紧感诸症均减,睡眠已有进步,并感看书记忆力提高,上方增党参为四钱,当归为三钱,川芎为三钱,服六剂诸症已。

Results: After the herbal therapy for three days, the severe headache came only once. The dizziness and bloating feeling in the head, and the tightness feeling in between the eyes were improved. The sleep was better. He could read book with improved memory. To the prescription above, added was Dangshen 12 g, Danggui 9 g, and Chuanxiong 9 g. After 9 days, all the symptoms subsided.

按:《伤寒论》第387条:"干呕吐涎沫、头痛者,吴茱萸汤主之。"是说里虚寒饮冲逆用吴茱萸汤治疗。本例为里虚寒饮,逆饮上犯的头痛,故以温中下气、降逆止呕为法;又因痛为刺疼,病久血虚血瘀,故加当归、川芎养血活血;再因心下停饮为著,故加茯苓以驱饮,合方治之,使胃安饮去血和,故头痛已。

Comments: In the book << Shang Han Lun>>, paragraph 387, it states: “If the person had nausea with spiting of air bubbles,  and with headache, use Wuzhuyu Tang.” It means that, for inside weakness and cold condition with water reverse rushing up, use Wyzhuyu Tang for the treatment. In this case, it was the inside weaknees and cold condition with water rushing up condition, which caused the headache. Therefore, the herbal therapy was used to warm the middle, to down-turning the Qi, to descending the reverse and to stop vomit. For the pain felt as thorn pain, and for the possibility that there would be blood stagnation in a long term disease course, the herb Danggui and Chuanxiong were added to nourish the blood and to activate the circulation. Also for the strong accumulation of water in the stomach region, the herb Fuling was used to dispel the water. All the herbs worked together, calmed down the stomach, harmonized the blood, so to solve the headache.

痰饮引起的头痛很多见,应用吴茱萸汤方加减治疗的机会很多。因痰饮变化多端,用药也要随之而变,当饮停久化热出现上热下寒时,可据证合用半夏泻心汤、生姜泻心汤、小柴胡汤、柴胡桂枝干姜汤、或加生石膏;当饮逆上冲明显时,可合用苓桂术甘汤。总之,适证加减多有良效。

It is quite common for a headache that is caused by phlegm. There are a lot of chance so to use the Wuzhuyu Tang. For the phlegm condition vary very much in the body, the herbal prescription should also be different from person to person and from disease stage to stage. When the water/condensed water/phlegm stays in the body for a long time and develops into fire, to cause upper fire and lower cold condition, we may choose herbal prescription Banxia Xiexing Tang, Shengjing Xiexing Tang, Xiao Chaihu Tang, Chaihu Guizhi Ganjiang Tang, or with addition of Shigao. When the water up-rush is apparent, use Ling Gui Zhu Gang Tang together. All in all, it works better with the addition or reduction of the herbal prescriptions.

8. 李某,女,36岁,病案号1915

Case 8. Li XX. Female. 36 year of old. File number: 1915.

初诊日期196656日:产后患左偏头痛,已三年未愈,时心下痛,左上下肢酸胀,口干不思饮,有时恶心吐清水,舌苔白润,脉弦细。证属表虚饮盛,治以建中和荣固卫,更以温中化饮。与当归四逆加吴茱萸生姜汤:当归三钱,桂枝三钱,自芍三钱,大枣六枚,炙甘草二钱,生姜五钱,细辛三钱,通草二钱,吴茱萸三钱。

The first visit: May 6, 1966. The patient had left side migraine after birth delivery for three years. From time to time she felt stomach pain, sour arm and leg on the left side, dry mouth but no desire to drink, nausea with spit of clear water. The tongue cover was white and wet. The pulse was string and thin. Her condition belongs to body surface weakness with water overwhelming. The herbal therapy was used to strengthen the middle stomach region, to harmonize the Yin and to enhance the Wei in the body, as well as to warm the middle and to dispel the water. She was given Duanggui Si Ni Tang plus Wuzhuyu and Shenjiang Tang: Danggui 9 g, Guizhi 9 g, Baishao 9 g, Chinese date 6, Zhi Gancao 6 g, fresh ginger 15 g, Xixin 9 g, Tongcao 6 g, Wuzhuyu 9 g. 

结果:上药服四剂,头痛明显减轻,心下痛未作,左上下肢酸胀亦减,上方增吴茱萸为四钱,继服七剂后,自感无不适。

Results: After the herbal therapy for four days, the headache subsided dramatically. No more pain in the stomach area. The sour arm and leg on the left side was reduced. To the prescription, increased was the Wuzhuyu to 12 g. After seven doses, no any discomfort left.

按:当归四逆汤,原主荣卫不利的外寒,本也有血虚饮盛在表,今里寒饮也明显,故时心下痛、恶心吐清水,实为太阳太阴合病,故要同时祛里寒饮,因此加吴茱萸生姜治之,使荣血和,寒饮去则头痛自解。

Comments: The Danggui Si Ni Tang is initially to treat the external cold due to the Yin and Wei disharmony. The person had had original blood deficiency and water overwhelming in the body surface, now there was clear cold water inside too. Therefore she felt pain in the stomach from time to time, nausea with spit of the clear water. It is actually a Taiyang-Taiyin co-exist conditions. For the treatment, it is needed to dispel the inside cold and water, so the herb Wuzhuyu and fresh ginger were added to harmonize the Rong blood and to dispel the cold water, and so as to solve the headache.

以上所述,多为虚寒头痛,而实热头痛也是多见的。因在脑病中重点论述,可互参,这里不再重复。

The discussion above is mostly for the headache of weakness and cold condition. In clinic, the headache due to fire overwhelming is also quite common. For the latter has been discussed in the brain disease, there is not more need to discuss it here.

近代中医教科书,在诊治头痛时多以外感、内伤为纲,在临床须熟悉脏腑辨证理论,同时必须掌握一定用药经验,方能治疗常见头痛症。而六经辨证治疗头痛,则以太阳病为纲,再据合病、并病情况,据证用方,只要熟悉《伤寒论》的方证,治疗各种头痛方能应用自如。

In the modern Chinese medicine textbook, the headache is separated into the external common cold and inside damages. In the clinic, the doctor must know well the organ diagnosis system and must have some experience in the use of herbal therapy, so as to be able to solve most of the headache. While if we apply the six meridian diagnosis system for the treatment of headache, the target of the diagnosis would be focused on the Taiyang phase, followed by verify the possible co-exist of other phases and to identify the herbal indications to choose herbal prescription. It only needs to get familiar to the herbal indications in the book <<Shang Han Lun>> in the treatment of headache.

 

30.  阑尾炎的治疗经验

30. The treatment of appendicitis

阑尾炎中医古称肠痈,有急性和慢性之分,它虽属外科疾病,但用内治法多能治愈。西医亦用内治法,即用抗生素消炎可使炎症消失,但往往易于复发,最终还是手术治疗。因此,西医把内治法称为保守疗法,言外之意手术治疗是非保守疗法、积极疗法、根治疗法。中医的内治法与西医的保守疗法不同,中医治疗见效快而很少复发,这应感谢祖先留下的宝贵经验。例如在《金匮要略疮痈肠痈浸淫病》第3条记载:"肠痈之为病,其身甲错,腹皮急,按之濡如肿状,腹无积聚,身无热,脉数,此为肠内有痈脓,薏苡附子败酱散主之。"是论述慢性阑尾炎的证治;又如《金匮要略疮痈肠痈浸淫病》第4条记载:"肠痈者,少腹肿痞,按之即痛如淋,小便自调,时时发热,自汗出,复恶寒,其脉迟紧者,脓未成,可下之,当有血;脉洪数者,脓已成,不可下也。大黄牡丹皮汤主之。"是论述急性阑尾炎的证治。就是说,不但有急性阑尾炎的治疗经验,而且还有慢性阑尾炎的治疗经验。这些治疗经验之所以宝贵,是因用之多验。当然要真正掌握其方证,并能适证加减用药,今从临床治验说明之。

Appendicitis is called intestine carbuncle in Chinese medicine. It though belongs to surgical disease, it can also be cured in many cases by non-surgical therapies. In western medicine, they use anti-biotics, which could make disappear the inflammation, but the appendicitis is easy to recur, and eventually it is still needed to have a surgical treatment. Therefore, western medicine terms such non-surgical treatment as conservative therapy. It means that the surgical treatment is not a conservative therapy, e.g. it is an active therapy or a radical therapy. Chinese herbal therapy is different from the western conservative therapy. The Chinese herbal therapy works fast and it is with less rate of recurrence, thanks for our doctors in old times. The experience in the treatment of appendicitis has well been documented in book <<Jin Kui Yao Luo>>…… This means that, the Chinese herbal therapy has not only the experience for the treatment of acute appendicitis, but also that of chronic appendicitis. That such experience is very valuable for the fact that it works in the use. Of course, it needs to be able to know really how to use this herbal prescription, and be able to modify the ingredients according to the clinic conditions.  Here let’s take some case examples to have a discussion.

病危群医不出方  鹫眼虎胆救苍生

1. 高某,男,35岁,复员军人,住靴子高铺胡同。

Case 1. Gao XX, male, 35 years of old. Veteran.

初诊日期1952815日:腹痛、高烧2天,在同仁医院确诊为急性阑尾炎,嘱其住院手术治疗,患者因战伤多次手术治疗,甚感手术苦痛,拒绝入院手术,致卧床不起,腹痛呻吟,而多次找中医诊治,来者皆不开方而归。患者亲友在同仁医院的滕医师请胡老会诊。胡老诊其病人:腹痛甚,呻吟叫喊不休,高烧体温40 C,身烫皮肤灼手而无汗,少腹剧痛,腹拒按,舌苔黄。舌质红,脉滑数。胡老当即认定,此是瘀血挟脓呈三阳合病,为大柴胡汤合大黄牡丹皮汤方证:柴胡八钱,黄芩三钱,白芍三钱,半夏三钱,生姜四钱,枳实四钱,大枣四枚,大黄二钱,牡丹皮四钱,桃仁三钱,冬瓜子四钱,芒硝四钱。

The first visit: Aug. 15, 1952. The patient had high fever and pain in belly for two days. He was diagnosed as acute appendicitis and was asked to admit in hospital for surgical operation treatment The patient had several times of surgical operations for hurt from a war before. For fear the pain and sufferings from surgical operation, he refused to have surgical treatment. His condition developed so that he had to lay down on bed with pain in belly and with crying. He had invited several Chinese medicine doctors to come for prescription, but none would like to start herbal therapy for him. His relatives later invited Dr. Hu to come for an consultation. His condition when Dr. Hu saw him: he had very much pain in belly, and crying without stop. Body temperature was 40 C. The body felt burning without sweat. The lower belly was very pain when touch, so he refused to be touched. The tongue was red in color and tongue cover was yellow. The pulse was slippery and frequent. Dr. Hu quickly had a believing that his condition was three Yang co-exist phases with blood stagnation and pus. He was given Da Chaihu Tang and Dahuang Mudanpi Tang: Chaihu 24 g, Huangqin 9 g, Baishao 9 g, Banxia 9 g, fresh ginger 12 g, Zhishi 12 g, Chinese date 4, Dahuang 6 g, Mudanpi 12 g, Taoren 9 g, Dongguazi 12 g, and Mangxiao 12 g.

结果:上药服一剂后,热退腹痛减,自己乘车到胡老诊所复诊,原方继服六剂痊愈。

Results: After the herbal therapy for one day, the fever reduced and the pain was less. The patient himself took bus to come to Dr. Hu. After six doses, there was no any symptoms.

按:该患者病急、病重,危在旦夕,如治疗不当,命若复卵。因此一般医者惧于责任谢绝出方。然若能看准其症结,认准其方证,就把握了疾病的转机,也就有鹰鹫之眼,猛虎之胆。胡老投一剂能转危为安,说明认证准确无误,用方药恰到好处。这里值得注意的是,胡老合用大柴胡汤,前面已提到:"肠痈者,少腹肿痞,按之即痛如淋,小便自调,时时发热......大黄牡丹皮汤主之。"单用大黄牡丹皮汤即可, 为何还合用大柴胡汤呢?这是因为该患者有三阳合病证,用大柴胡汤恰能方药对证,才能更好解热、祛瘀排脓,因而收效快捷。这是胡老的临床经验、用方药特点,但也是遵守了六经辨证规律。对于有高烧者合用大柴胡汤,而无高烧者也可合用,例2即如此。

Comments: The life condition of the patient in this case is very severe. If the treatment was improper, the lift would be lost. For this, ordinary doctors dared not to give prescription for treatment. However, if a doctor could identify the nature of the disease at that time and was able to identify the proper herbal prescription for the treatment, it was possible to solve such severe clinic condition. Dr. Hu was able to do this, indicating that he was very good at the Chinese medicine diagnosis and herbal indication diagnosis. It should be pointed out that, in the book <<Shang Han Lun>>, it stated that, the intestine carbuncle should be treated by Dahuang Mudanpi Tang. How Dr. Hu used the Da Chaihu Tang for the treatment? This is because the patient condition belongs to three Yang co-exist phases. It is the Da Chaihu Tang that matches the three Yang condition, so that it would be able to clear the Fire, to remove the blood stagnation and to dispel the pus very fast. This is the clinic experience of Dr. Hu and it is the characteristic of his use of herbs, but it also follows the six Jing diagnosis rules. If the patient has fever, the Da Chaihu Tang can be used. If the patient has no fever, the Da Chaihu Tang might also be used, as shown in case 2 bellow.

2. 曹某,男,40岁,病案号0063

Case 2. Cao XX, male, 40 years of old. File number:0063.

初诊日期1965610日:右小腹痛二三日。经西医检查诊为急性阑尾炎,麦氏点压痛明显,体温不高,白血球8800,刻下症:右小腹痛胀,咽干,口苦,微恶心,大便干,舌苔黄,脉弦滑。与大柴胡汤合大黄牡丹皮汤:柴胡四钱,半夏三钱,黄芩三钱,白芍三钱,枳实三钱,桃仁三钱,牡丹皮三钱,冬瓜子四钱,大黄二钱,芒硝三钱。

The first visit: June 10, 1965. The patient had pain in right side lower belly for two to three days. The western medicine diagnosis was acute appendicitis. The Mcburney’s point is positive. The body temperature was not high. Blood WBC: 8800. The current condition: he had pain on the right side of lower belly, dry throat, bitter taste in mouth, slight nausea, dry stool. The tongue cover was yellow in color. The pulse was string and slippery. He was given Da Chaihu Tang plus Dahuang Mudanpi Tang: Chaihu 12 g, Banxia 9 g, Huangqin 9 g, Baishao 9 g, Zhishi 9 g, Taoren 9 g, Mudanpi 9 g, Dongguazi 12 g, Dahuang 6 g, Mangxiao 9 g.

结果:上药服三剂,腹痛已,但右少腹仍痞胀,便前有腹痛,上方减芒硝为二钱,加炙甘草一钱,服六剂,症已。

Results: After the herbal therapy for three days, the stomach pain stopped, but there was a bloating feeling on the right side of lower belly, as well as a belly pain before bowel movement. The Mangxiao in the prescription above was reduced to 6 g, but Zhi Gancao 3 g was added. The herbal tea was drunk for six days. No any discomfort after that. 

按:本例虽无高烧,但因见右腹痛、咽干、口苦、微恶心、大便干等症,大柴胡汤证备,故合用之。又因无高烧,故柴胡的用量较前例明显少。可知方证同,用药当因具体症不同而异。又本患者为本院职工,周围人士常开玩笑说:"您早晚得开一刀!"其意是还要复发,必手术治疗,可是迄今未见复发。

Comment: In this case, the patient had no fever, but pain in the right side of belly, dry mouth, bitter taste in mouth, slight nausea, and dry stool, etc. which indicating the use of Da Chaihu Tang. Therefore it was used with Dahuang Mudanpi Tang. For no high fever, the amount of Chaihu used was dramatically less than in the pervious case. It is therefore known that, though the herbal indication was the same, the amount of herbal ingredients could be different. For the patient was the staff of the same hospital, friends and co-worker joked with him: “Soon or later you need a cut (by surgical operation)!” It means that his appendicitis would soon or later recur and the surgical operation would not be avoided. But so far no any recurrence. 

保守治疗已无功 中医亦须方对证

3齐某,男,19岁,病案号14296

Case 3. Qi XX, male, 19 years of old. File number: 14296.

初诊日期1965625日:右下腹痛4个月。4月前出现右下腹痛,在某医院诊断为"亚急性阑尾炎",用保守治疗法治疗一个月,症状缓解,不久又感头痛、头晕、口干欲饮、少腹疼痞,到我院门诊中医治疗,但服药两月而不愈,经人介绍由胡老诊治。问其症:右下腹痛;看其舌,苔白根腻;诊其脉,弦滑;按其腹,阑尾处拒按。知其为瘀血挟脓在少腹,治以祛瘀排脓,与大黄牡丹皮汤合芍药甘草汤加生薏仁:牡丹皮五钱,桃仁四钱,冬瓜子三钱,生薏苡仁八钱,白芍四钱,炙甘草二钱,大黄二钱,芒硝二钱。

The first visit: June 25, 1965. The patient had pain in the right side of lower belly for four months. Four months ago, she had pain in the right side of lower belly. It was diagnosed as “sub-acute appendicitis”. He was given conservative therapy in hospital for one month. The symptoms subsided. Soon later, he felt headache, dizziness, dry mouth with desire to drink, bloating pain in the right side of lower belly. He came to the same hospital as Dr. Hu worked, some other doctors gave him Chinese herbal therapy for two months but the condition was not improved. He later went to Dr. Hu for the treatment. He complained pain on the right side of the lower belly. The tongue cover was white with greasy in the root. The pulse was string and slippery. Upon press the belly, there was pain over the position of appendix, and he refused to touch there. It was known that there was stagnated blood and pus on the lower belly. The herbal therapy was  designed to dispel the stagnation and to dispel the pus. He was given Dahuang Mudanpi Tang plus Shaoyao Gancao Tang plus Yiyiren: Mudanpi 15 g, Taoren 12 g, Dongguazi 9 g, Yiyiren 24 g, Baishao 12 g, Zhi Gancao 6 g, Dahuang 6 g, and Mangxiao 6 g.

结果:服药二剂后,自感一切良好,但感阑尾部位按之仍痛,继服三剂而安。

Results: After the herbal therapy for two days, the patient felt very well, though there was still pain when pressing the appendix position. The herbal therapy was continued for additional three days and the disease was cured.

按:此例病程较长,而临床无合病、并病之证,而呈单独大黄牡丹皮汤方证,因而用该方主之。但因病久津血虚,故合用芍药甘草汤生津和血解挛急痛;又因病久湿滞脓固,故加生薏仁利湿排脓。本例治验又一次说明,治病不在药多、药贵,而在方药对证。

Comments: This case was with a long history. There was no evidence for the presence of any other phases or disease conditions, so the single Dahuang Mudanpi Tang was used. For a long time of disease course, the body was hurt by loss of the liquid part and the body was with blood deficiency, the Shaoyao Gancao Tang was used to produce more liquid portion to the body and to relax the spasm, so to stop the pain. For the wetness accumulation and the pus was fixed, the herb Yiyiren was added to clear the Wetness and to dispel the pus. This case further more indicates that, the cure of a disease does not depend on the number of the herbs or the cost of the herbs, but on the exact match of the herbs to the disease condition.

论治何必急慢分  一方功用内外同

4. 崔某,男,38岁,31846

Case 4. Chu XX, male, 38 years of old. File number: 31846.

初诊日期1967216日:右小腹痛10余日,65年秋出现右小腹痛,诊断为急性阑尾炎,注射青霉素及链霉素一周缓解。去年冬又发作右腹痛,注射青、链霉素两周缓解。本次因喝凉茶又引发右腹痛,仍注射青、链霉素两周而不见好转,医生劝其手术,因不愿开刀而找中医诊治。近症:右小腹痛,时轻时重,时为绞痛,时为刺痛,四肢发凉。时头晕、心悸,口干不思饮,大便如常,按其腹无肌紧张,但麦氏点压痛明显,舌苔白,舌质暗,脉沉细弦数。与薏苡附子败酱散合当归芍药散:薏苡仁八钱,川附子二钱,败酱草六钱,当归三钱,白芍六钱,白术三钱,泽泻四钱,川芎二钱。

The first visit: February 16, 1967. The patient had pain in the right and lower belly for ten days. He started to have pain in his right and lower belly on the fall of 1965. It was diagnosed as acute appendicitis. He was injected anti-biotic for one week and the symptoms subsided. In winter last year, he had similar pain again. He was given anti-biotic again and the pain subsided again. This time, for drinking cold tea, the pain recurred. The injection of anti-biotics no long worked. Doctors recommended him to have surgical operation for the treatment. For his hesitation, he went to Chinese medicine for help. The current condition: he had pain in the right and lower belly. The pain was severe some times but less for other times. It could feel as twist pain or thorn pain. The hands and feet felt cold. He also felt dizziness, palpitation, dry mouth without desire to drink, and stool was normal. Opon pressing his belly, there was no tightness on the muscle, but there was pressing pain on the Mcburney point. The tongue cover was white. The tongue was dark. The pulse was deep, thin, string and frequent. He was given Yiyi Fuzi Baijiang San plus Danggui Shaoyao San: Yiyiren 24 g, Fuzi 6 g, Baijiangcao 18 g, Danggui 9 g, Baishao 18 g, Baizhu 9 g, Zexie 12 g, Chuanxiong 6 g.

结果:上药服三剂,腹痛已,麦氏点按之微痛,再继服三剂巩固疗效。经追访三年未见复发。

Comments: After the herbal therapy for three days, the belly pain stopped. There was slight pressing pain on the Mcburney point. The herbal therapy was continued for additional three days. Following up for three years showed no recurrence.

按:此与例3同是慢性阑尾炎,但前者用大黄牡丹皮汤,而此患者用薏苡附子败酱散合当归芍药散,是因临床证候的虚实不同。即是说,中医治病,不是根据阑尾炎是急性还是慢性,而主要根据证的虚实寒热。中医治疗炎症,并不是见炎即用清热解毒,而是据证"热者寒之,寒者热之。"尤其是对慢性炎症,用温补的机会就更多,如本例用附子、当归、白术等,以温阳化湿消除炎症。这里的薏苡附子败酱散,是治疗瘀血痈脓而呈现寒热错杂证者。方中的薏苡仁味甘微寒,利湿排脓、解、解痉;败酱散祛瘀排脓;附子用量小,主振郁滞之气而利痈脓的排出。合用当归芍药散"以温中化湿养血祛瘀,共起祛瘀排脓作用。又胡老根据薏苡附子败酱散的适应证有"其身甲错",常用其治疗皮炎、痂癞等皮肤病,用之多验。也就是说,本方可用于在肠胃之里的痈脓,也可用于在皮肤之外的痈脓,胡老认为,中医辨证之表、里、半表半里,不是指病灶所在,而是指疾病所反映证的所在。一方治多病,能治内科病、外科病,其有效的基础和根据,仍不离辨证、辨方证。

Comments: This case and the case 3 both are chronic appendicitis. For the former, the Dahuang Mudanpi Tang was used, while in this case, the Yiyi Fuzi Baijiang San plus Danggui Shaoyao San was used. This is because the clinic conditions in the two cases were different. That means, for the Chinese medicine to treat a disease, it does not depend on whether the disease is acute or chronic, but on the clinic conditions, especially whether the body condition is Fire or Cold, weakness of overwhelming. Chinese medicine does not give Fire-clearing and Toxic-dispelling therapy once seeing an inflammation condition. It bases on the principle, on which the Cooling therapy is used for a Fire condition and a Warming therapy is given for a Cold condition. Especially for a chronic inflammation condition, there would be more chance to use the warming-nourishing therapy. For example in this case, it is the use of Fuzi, Danggui and Baizhu, etc. to warm the Yang Qi, and to dispel the wetness, so as to dissolve the inflammation. The Yiyi Fuzi Baijiang San used here is to treat the stagnated blood and pus, in which the body condition belongs to cold-fire mixture. The Yiyiren in the prescription, for its sweat and cold in herbal nature, works to clear the wetness and to dispel the pus, to solve the Bi syndrome and to relax the spasm. The Baijiangcao works to dispel the stagnation and to dispel the pus. The dose of Fuzi is small, which works to mostly activate the sluggished Qi, so to pump the dispelling of the pus. The co-use of Danggui Shaoyao San is to warm the middle, to clear the wetness, to nourish the blood and to dispel the pus. It works with the other herbal ingredients in the prescription together to dissolve the blood stagnation and to dispel the pus. Dr. Hu, based on the herb indication for the Yiyi Fuzi Baijiang San to work for “skin as fish scale”, uses for the treatment of skin inflammation and favus of the scalp (or similar skin diseases). It works well. It means that, it works for the pus and carbuncle in the stomach and intestine system, and also that out of skin. Dr. Hu said, the concept of the “body surface” the “body inside” or “in between the body”, does not mean the location of the disease, but mean the location of the “herbal indications”. That one single herbal prescription can work for disease in the non-surgical and a surgical disease. The reason for it is that it depends on the diagnosis of body condition, and herbal indication.

 

31.  下利论治

31. The treatment of diarrhea

下利证候分阴阳 泄泻痢疾本一体

下利之称,始见于《伤寒杂病论》,是该书讨论最多的症状之一。张仲景对下利很重视,有专篇论述,如《金匮要略.呕吐哕下利病》论及条文最多,介绍方证也很多。所介绍的方证,不但包括腹泻,后世多称泄泻,还包括后世称的痢疾。后世把《伤寒杂病论》分为《伤寒论》和《金匮要略》后,在《伤寒论》中有很多条文论述下利,太阴病的提纲则是"腹满而吐,、食不下,自利益甚""自利不渴者"。下利症状,对于辨证、预后是重要的依据。"死在太阴",这是胡老一生研究《伤寒论》所得出的结论性认识,主要依据是各种不治之证,临终前多出现太阴病之下利。后世的医书多称"汉唐时代称为下利,宋代以后统称泄泻"。实际宋代一一些医书仍称下利,如宋代的朱肱在《南阳活人书问下利者》提出:"伤寒下利多种,须辨识阴阳",发挥了张仲景对下利的辨证要点,并系统地论述了三阴三阳的下利治疗方药及治疗宜忌,对指导后世临床颇有裨益。这里要重点指出的是,朱肱所提出的"须辨阴阳",这是论治下利的总纲。熟读《伤寒论》不难发现,下利属于里证,而里证分阴阳,则阳证为阳明里证,阴证则为太阴里证。阳明下利多湿热实,治用葛根黄芩黄连汤、白头翁汤、大承气汤、大黄黄泻心汤等;太阴下利多饮寒虚,治用理中汤、吴茱萸汤等;若与太阳、少阳、少阴、厥阴合病,则用葛根汤、半夏泻心汤、真武汤、乌梅丸等治疗。这些证治论述精详、方药众多、疗效确切,论述的是下利,涵盖了泄泻、痢疾。实践证明,掌握了张仲景论治下利的经验,就自然会治疗泄泻、痢疾。因而,仲景对下利的论治不得不学。

The term of diarrhea (in Chinese) is first described in the book <<Shang Han Za Bing Lun>>. It one of the diseases that the book mostly discussed. Master Zhongjing Zhang paid very much attention to the diarrhea. He wrote a separate chapter to discuss it. In the book, there are many chapters for the diarrhea and there are many herbal prescriptions for the treatment of diarrhea. The herbal prescription does not only treat the diarrhea, but also dysentery. Doctors later than Master Zhongjing Zhang has separate the book <<Shang Hang Za Bing Lun>> into <<Shang Han Lun>> and <<Jin Kui Yao Luo>>. In the book <<Shang Han Lun>>, there are many paragraphs to discuss the treatment of diarrhea. For example, the outline for the diagnosis of disease in the Taiyin phase is “The person felt bloating in belly, had vomit, can not eat, and had diarrhea which is worse and worse”, and “the person had diarrhea but does not feel thirsty”. The symptom of diarrhea is important for the diagnosis and for the prediction of the healing result. That “people dies in the Taiyin phase” is the summarized recognition by Dr. Hu in study the <<Shan Han Lun>> for his whole life. The main reason is that, most people has diarrhea which belongs to the Taiyin phase, when the person dies. …… After carefully study the book <<Shang Han Lun>>, it is not hard to find that the diarrhea belongs to inside condition, which can be separated into the Yin and Yang conditions. The Yang phase means that the disease is in the Yangming inside overwhelming condition, and the Yin phase means the Taiyin inside weakness and cold condition. The Yangming diarrhea is more associated with the Wetness, the Fire and the overwhelming condition. In the treatment, the herbs are Gegen Huangqin Huanglian Tang, Baitouwen Tang, Da Chenqi Tang, Dahuang Huanglian Xiexin Tang, etc. For the Taiyin phase, the herbs used are Lizhong Tang, Wuzhuyu Tang, etc. If the Taiyin phase is co-exist with Taiyang, Shaoyang, Shaoyin, or Yueyin phase, the herbs used are Gegen Tang, Banxia Xiexin Tang, Zhenwu Tang, Wumei Wan, etc.  These discusses are very in detail. The herbal prescriptions are very rich in numbers and the healing effect is quite ensured. The diarrhea discussed includes ordinary loose stool and the dysentery. It is proven in practice that, after really know the experience of Master Zhongjing Zhang in the diagnosis of diarrhea, it would be possible to treat loosen bowel movement and dysentery. Therefore, the experience of Master Zhongjing Zhang for the treatment of diarrhea must be studied.

 

下利阳明证多凶   治疗得当症无踪

1.  (胃肠型感冒) 邬某,女,36岁,病案号211158

Case 1. Wu XX, female, 36 years of old. File number: 211158. (Common cold of digestive system style)

初诊日期196776日:感冒咳嗽、下利已20天,经注射青、链霉素,服西药未见效果。近症:咳嗽气短、恶风寒、口干、不欲饮、不欲食,大便溏稀日34行,舌苔白,脉细弦数。与葛根汤加生石膏:葛根三钱,桂枝三钱,白芍三钱,炙甘草二钱,大枣四枚,麻黄二钱,生姜三钱,生石膏一两半。

The first visit: July 6, 1967. The patient has common cold with cough and diarrhea for 20 days. He was given anti-biotic injection without effect. The current condition: cough, short of breath, chilly with dislike of wind and col, dry mouth with no desire to drink, no desire to eat. The bowel movement was three to four times a day with loose stool. The tongue cover was white, and the pulse was thin, string and frequent. She was given Gegen Tang plus Shigao: Gegen 9 g, Guizhi 9 g, Baishao 9 g, Zhi Gancao 6 g, Chinese date 4, Mahuang 6 g, fresh ginger 9 g, Shigao 45 g.

结果:上药服二剂,诸症即解。

Result: After the herbal therapy for two days, all the symptoms disappeared.

按:此是太阳阳明合病之下利,胡老常用葛根汤加生石膏治之。"腹泻下利还能用生石膏?"常有质疑者。《伤寒论》第4条:"伤寒一日,太阳受之,脉若静者,为不传;颇欲吐、若躁烦、脉数急者,为传也。"此患者有咳嗽、恶风寒、口干、脉数,提示太阳传阳明,下利主因阳明热,故用葛根汤加生石膏解表清阳明热,则表解下利除。不熟悉经方者,多用藿香正气汤加减,但临床对比使用,深感不如前者快捷,因此,特把本例列此以供研讨。

Comments: This case belongs to Taiyang-Yangming co-exist phases with diarrhea. Dr. Hu usually uses Gegen Tang plus Shigao to solve the condition. “Diarrhea is treated with Shigao?” This is a common question and suspection. In the book <<Shang Han Lun>>, it stated in paragraph 4: “on the first day of the Shang Han disease, the disease is in the Taiyang phase. If the pulse is calm, the disease would not pass into the deeper phase. If the person tends to have vomit, to feel annoyed and if the pulse is frequent and urgent, it would pass into the deeper phase”. In this case, the patient had cough, dislike wind and cold, dry mouth, and frequent pulse, suggesting that the common cold has develop deeper into the Yangming phase. The diarrhea is due to the Hotness in the Yangming phase. The Gegen Tang plus Shigao is used to clear the Yangming Fire, so that the body surface is released and the Yangming inside fire is cleared, and the diarrhea is so stopped. If the doctor is not familiar with the Jing Fang (the herbs in the Shang Han Lun), he may use Huoxiang Zhen Qi Tang. However, the comparison in clinic proved that, the later herbal prescription does not work faster than the former. Therefore, this case is introduced here for discussion.

2.  (急性胃肠炎) 刘某,女,50岁。

Case 2. Liu XX, female, 50 years of old. (Acute gastroenteritis)

初诊日期1965912日:昨日吃了一碗葡萄,今日上午感无力、口渴、下肢酸软,喝了三杯热茶后,即觉身热、头昏、恶寒,下午皮肤热如燔炭灼手,体温40.1 C,不思饮食,有温温欲吐之感,并感心烦,舌苔白厚而少津,脉数急。与葛根加半夏石膏汤:葛根四钱,麻黄三钱,炙甘草二钱,白芍三钱,桂枝二钱,生姜三钱,半夏四钱,大枣三枚,生石膏二两。

 

The first visit: September 12, 1965. The patient ate a bowl of grapes yesterday. This morning, she felt tired, dry mouth and sour and weak in legs. After drunk three cups of hot tea, she felt hot in the body, cloudy mind, and cold-dislike feeling. In the afternoon, her skin felt very hot as burning. Her body temperature was 40.1 C.  She had no desire to eat and tended to vomit. She felt annoyed. The tongue was thick and white with less wet. The pulse was frequent and urgent. She was given Gegen plus Banxia and Shigao Tang: Gegen 12 g, Mahuang 9 g, Zhi Gancao 6 g, Baishao 9 g, Guizhi 6 g, fresh ginger 9 g, Banxia 12 g, Chinese date 3, Shigao 60 g.

二诊913日:傍晚服药后,即呈昏睡状态,并发生呕吐,吐出大量清水,夜半出现腹泻,为大量水样便,色红,便后入睡,身热减轻,体温37.4 C,意识亦渐清。仍有腹泻,但量已少,仍有欲吐之情,与白头翁汤合黄芩加半夏生姜汤:白头翁二钱,黄芩三钱,黄柏三钱,黄连三钱,秦皮三钱,白芍三钱,甘草二钱,大枣三枚,半夏四钱,生姜三钱。

The second visit: September 13. After drunk of the herbal tea last night, she was in a trance-like sleep and had a vomit with large amount of clear water. In the middle night, she had diarrhea with large amount of water-like stool, of red in color. After diarrhea, she foll into sleep and the body hot feeling reduced. The body temperature was 37.4 C. The mind became graducally clear. She still had some diarrhea, but the volume was less. She still had trend to vomit. She was given Beitouwen Tang plus Hungqin, Banxia and fresh ginger: Baitouwen 6 g, Huangqin 9 g, Huangbo 9 g, Huanglian 9 g, Qinpi 9 g, Baishao 9 g, Gancao 6 g, Chinese date 3, Banxia 12 g, and fresh ginger 9 g.

三诊914日:昨日下午,诸症大减,呈脉静身凉之象,体温36 C,仍无力、不思饮食。今日,身微汗出,已进食。嘱饮食调理,不日而痊。

The third visit: September 14. Yesterday afternoon, the symptoms were much improved. The body is not hot, and the pulse was calm. The body temperature was 36 C. She still felt weak, no desire to eat. Today, she had little sweat and could eat. She was asked to take care of eating and have a rest. No more discomfort.

按:本例是急性下利,为急性胃肠炎可能性大,原病历记载有"水样便,色红",不能完全排除痢疾。但不论是痢疾还是肠炎,仲景时代,是根据症状特点用药的,这就是,病之初为太阳阳明合病,《伤寒论》第33条:"太阳与阳明合病,不下利,但呕者,葛根加半夏汤主之。"故与葛根加半夏汤。又因心烦,故加生石膏。第二天出现吐利,呈太少合病,据《伤寒论》第371"热利下重者,白头翁汤主之。"及第172条:"太阳与少阳合病,自下利者,与黄芩汤;若呕者,黄芩加半夏生姜汤主之。"故与白头翁汤合黄芩加半夏生姜汤。因方药对证,故药到病除。中医能治急性病久矣!

Comments: This case is acute diarrhea. Most possibly it is acute gastroenteritis. In the original case record, it wrote “water-like stool, red in color”. It can not exclude the dysentery. No matter it is dysentery or gantroenteritis, in the time of Master Zhongjing Zhang, the use of herbs depends on the clinic manifestations. In this case, in the beginning of the disease, it belongs to Taiyang-Yangming co-exist phases. In the book <<Shang Han Lun>., paragraph 33, it stated: “in the Taiyang-Yangming co-exist phases,  if the person has no diarrhea, but nausea, use Gegen plus Banxia to treat.” Therefore she was given the Gegen Tang plus Banxia. For she had annoyed feeling, the Shigao was added. On the second day, she had vomit and diarrhea, it was the Taiyang-Shaoyin co-exist phases. In the same book, it stated in paragraph 371: “If the person has hot-diarrhea with falling feeling in anus, use Baitouwen Tang” and in paragraph 172: “in the Taiyang-Shaoyang co-exist phase, if the person has diarrhea, give Huangqin Tang; if the person has nausea, give Huangqin plus Banxia and fresh ginger.” Therefore, she was give the Baitouwen Tang plus Huangqin, Banxia and fresh ginger. For the herbs matched the clinic condition, the herbs was used and the disease was cured. Chinese medicine of course can also be used in acute disease!

3. (急性肠炎) 彭某,女,30岁,病案号31221

Case 3. Peng XX, female, 30 years of old. File number 31221 (acute enteritis)

初诊日期1965826日:前天中午吃葡萄,晚上又受凉,今早感无力、腿酸、口渴,喝了四杯热茶即觉身热恶寒,下午心烦、汗出、腹痛、腹泻三次,而来门诊,舌苔白腻,脉滑数寸浮。与葛根芩连汤:葛根八钱,黄芩三钱,黄连二钱,炙甘草二钱。

The first visit: August 26, 1965. The patient had eaten grapes at the noon the day before yesterday. At that night, she caught cold. This morning, she felt tired, sour in legs, and dry mouth. After drunk four cups of hot green tea, she soon felt hot with cold-disliking feeling. This afternoon, she felt annoyed, sweat, pain in stomach and had diarrhea for three times. When she came for consulting, her tongue cover was white and greasy. The pulse was slippery, and frequent with floating feeling on the Chun position. She was given Gegen Qin Lian Tang: Gegen 24 g, Huangqin 9 g, Huanglian 6 g, Zhi Gancao 6 g.

结果:上药服一剂后,腹痛腹泻减,三剂后证已。

Results: After the herbal therapy for one day, the belly pain and diarrhea were reduced. After three doses, all the symptoms subsided.

按:本例与例2病因病程大致相同,都有阳明里热,但前例太阳表证明显,故先用葛根加半夏生石膏汤治疗,待表解后,继用白头翁汤合黄芩汤清阳明里热;本例邪热内陷,表虽未全解,但太阳表证已不明显而呈阳明里热证,故用葛根芩连汤清阳明热。同是急性下利,证不同,用药不同,这是中医治下利的特点。

Comments: This case is similar to the previous case 3, in terms of both had Yangming inside Fire condition. The case 2 had clear body surface condition as well, so the Gegen plus Banxia and Shigao was used first. After the body surface condition was released, used the Baitouwen Tang plus Huangqin to clear the Yangming inside Fire. In the case 3, however, the Xie Fire shrunk deep. Though the body surface condition had not been complete released, the body Taiyang phase is not so strong, and the Yangming inside Fire was very strong. Therefore the Gegen Qinliang Tang was used to clear the Yangming inside Fire. For the same acute diarrhea, the body condition is different, the herbs used are also different. This is the characteristics of Chinese medicine.

4. (噤口痢) 佟某,男,40岁,住黄化门17号。

Case 4. Tong XX, male, 40 years of old. (Diarrhea in which the patient can not drink water at all)

初诊日期1943715日:平素甚健,又白又胖,入夏染疫,高烧,腹痛,下利后重,便意频频,恶心,呕吐乃至水浆不入,以至大便日行30余次,所下血水,色黑灰暗,其味恶臭,最后所下仅为点滴血浆样血水,坐厕不起,曾去市大医院治疗无效,中医诸医束手,延胡老诊治。赴其家诊时,面色苍白而灰暗,舌苔白根腻少津,脉细数,病情如上述。危重已极,此时病已无表证,证属少阳阳明并病,汗、下均非所宜,唯有和解一法,与小柴胡汤加生石膏:柴胡八钱,黄芩三钱,党参三钱,半夏四钱,生姜三钱,大枣四枚,炙甘草二钱,生石膏三两。另西瓜一个,嘱其频频吃。

The first visit: July 15, 1943. The patient was generally healthy. He was white in skin color and with good body shape. In the summer, he got some kind of infectious disease. He felt pain in belly, had fever and diarrhea with falling feeing in anus and with frequent willing to go to have bowel movement. He felt nausea and vomited to much so that he could not drink any water. His bowel movement was up to 30 times a day with blood and water in the stool. The stool was black, grey in color with terrible bad odor. Later, the stool was only little blood-water as spasm. He could not even get up from the toilet. He had been treated in a big hospital. No any improvement. Most of the Chinese medicine doctors also felt no confidence to help, so Dr. Hu was invited for the treatment. When Dr. Hu went to his home, the patient was with pale face and with grey and dark tint on face. The tongue cover was white with greasy in root and with less wet on the tongue. The pulse was thin and frequent. The other body conditions were as described above. The condition was so severe to risk life. At that movement, there was no body surface condition. The body condition belongs to Shaoyang-Yangming co-exist phases. The sweating and the bowel movement stimulating therapy were not at all proper to use. The only way for the treatment is to use the Shaoyang harmonizing therapy. He was given Xiao Chaihu Tang plus Shigao: Chaihu 24 g, Huangqin 9 g, Dangshen 9 g, Banxia 12 g, fresh ginger 9 g, Chinese date 4, Zhi Gancao 6 g, Shigao 90 g. In addition, he was asked to eat one watermelon, slowly and little by little.

结果:开始吃西瓜与喝水一样,吃了即吐,嘱吐了继续吃。翌日即见效,二日后吐止,气力增,渐可坐起。家人苦其不能进食,胡老嘱其近两天万不可进食。至第七天,腹泻明显好转,一日23行,病人诉胃有凉感,知内热已去,与小柴胡汤去党参,加西洋参三钱。第八天即能吃,细心调养,半月痊愈。

Results: In the beginning, he ate the watermelon as he drunk water. Once eat, there was vomit. But after vomit, he still was asked to eat. The next day, the healing effect showed up. On the second day, the vomit stopped. He had better physical energy and could sit up. The family members worried he could not eat. Dr. Hu asked him do not eat any food for several days. On the seventh day, the diarrhea was dramatically improved. The diarrhea became two to three times a a day. The patient told he had cold feeling, indicating that the inside fire was reduced. He was given Xiao Chaihu Tang, with removal of Dangshen, but addition of Xiyangshen 9 g. On the eighth day, he could eat some. After a maintenance treatment for half month, everything turned normal.

按:此案是按照中医理论治疗的噤痢。西医谓痢疾是细菌感染,用杀菌药而无效。中医不从杀菌人手,而从当时的证候、方证人手,方药对证,而救危为安。

Comments: This case belongs to the mouth-closing dysentery. The western medicine regards the dysentery as bacteria infection but anti-biotics do not work. In Chinese medicine, based on the current clinic condition of each person to use herbs, it works and it saves life.

这里想到了汤本求真先生写的《皇汉医学》序:日本明治维新,发展西医,废除汉医。汤本学西医可谓优秀,怎料到自己的独生女患下利,西药全用尽,却毫无疗效,眼睁睁看着自己的女儿死去,心中无限悲伤,精神将至崩溃。恰友人拿了一本中医书让他看,书名为《医界铁锥》,他一见此书立刻被中国文化和中国医学所吸引,心中不再空虚,日夜研读,并应用于临床,得心应手,并把临床体会汇集成册,这便是有名的《皇汉医学》。

Here I remembered the introduction chapter of book <<Huang Han Yi Xue>> by Mr. Tang Ben Qiu Zhen: In the time of Japanese Ming Zhi Wei Xing, the Japanese made great efforts to develop western medicine and to delete Chinese medicine. Dr. Tang Ben was very great in western medicine. However, his only daughter got diarrhea. He used all the western medicine, but no any improvement. He looked his daughter to die in front of him. He felt very sad and sorrowful, so much so that he would fall into crashed down emotionally. His friend by chance brought a Chinese book to him. It was <<Yi Jie Tie Zhu>> (it means the strong skeleton of Chinese medicine). He was soon attracted by the Chinese culture and Chinese medicine. He no longer felt empty in heart. He studied the book day and night and used his learning in his clinic. He felt more success. He so cited his experience into a book. This is the famous <<Huang Han Yi Xue>> (the name of the book means the Medicine of the King Chinese).

这里一并感叹:如果汤本早学仲景之学,其女不致于死?本例如无仲景之学也能生乎?历史的教训无比深刻,但一些自认为高明、科学化的人,却往往犯明治维新同样的错误,例如其后有贺诚之流提出费止中医案;今也有持怀疑者:"小柴胡汤加生石膏能治噤口痢! 那味药能杀痢疾杆菌? 用于百分之几的人群有效?"按照西医的理论、方法验证无效,便得出结论:"治疗痢疾无效""这一例是瞎猫碰到了死耗子"。这里的主要原因,中医和西医是两个不同的理论体系,治疗用药是不同的思路。西医是杀菌,中医是辨证扶正抗邪。小柴胡汤加生石膏是应用于少阳阳明合病方证,可用于感冒、肺炎、肝炎、脑炎等各种疾病出现该方证时,用之皆效,但是不论是那种病,没有出现该方证时用之也是无效的。该方如用于前三例,因方不对证也绝无疗效,唯有象本例表现为少阳阳明合病用之才有效,这就是辨证论治精神。"越是民族的,它越是国际的",中医能自立于世界之林,因为中医是中国有特色的生命科学。

Here I also sigh with feeling: if the Dr. Tang Ben learned from Master Zhongjing Zhang, his daughter would not die? In the case 4, if there is no the knowledge system from Master Zhongjing Zhang, would he got alive? The lesson in history is so deep and strong but there are sill some people who bloat that they know since and who still catch the same mistakes as Japanese in their Ming Zhi Wei Xing time. The example is as the Mr. Hou Chen proposed to stop the Chinese medicine. Even today, there are some persons who doubt the use of Xiao Chaihu Tang plus Shigao could treat the dysentery in which the patient could not drink water at all? Which herb or herbs in the prescription work to kill the bacteria? How much percent of patients would be cure with the herbal prescription?”

According to the theory of western medicine, and if the therapy failed, they would make a summary: “The herbs do not work for dysentery.” This is really as a bind cat meets a died rat. The main reason for this is that, the Chinese medicine and western medicine belongs to different medical theory system. They follow the different mind in the treatment. Western medicine is to kill the bacteria and Chinese medicine is to help the body defense system so to struggle against the Xie Qi (in this case the bacteria). The herb prescription Xiao Chaihu Tang plus Shigao is used for any disease that are in the Shaoyang-Yangming phases. It can be used for common cold, pneumonia, hepatitis, cerebritis, etc, in which the disease is in the Shaoyang-Yangming phase and it works well. However, no matter which disease, if it is not in the Shaoyang-Yangming phase, the herbal prescription would not work. If this prescription is used in the first three cases above, it would not work at all. Only when the disease developed in the Shaoyang-Yangming phase, such as in the case 4, its use would work. This is the nature of the condition diagnosis or syndrome diagnosis of Chinese medicine. “The more typical in a nature, the more popular in the world”. That Chinese medicine stands alone in the medical systems in the world, for its unique Chinese phylosophy in the diagnosis and treatment. 

5.  (妊娠痢疾)  张某,女,31岁,病案号493431

Case 5. Zhang XX, female, 31 years of old. File number:493431. (Diarrhea with pregnancy)

初诊日期1965310日:自前日开始腹痛、腹泻,大便有红白粘液,白天二三次,晚上七次,里急后重明显,恶心,纳差,畏冷,溲黄,服西药无效。既往有血吸虫病史,今怀孕已7月。舌苔薄白,舌质稍红,脉沉细滑数。证属湿热滞下,伤及血分,治以清热凉血,兼以祛湿导滞,与白头翁加甘草阿胶汤:白头翁三钱,黄连二钱,黄柏一钱,秦皮一钱,甘草三钱,阿胶三钱。

The first visit: March 10, 1965. The patient started to have belly pain and diarrhea three days ago. There was red and white mucus in the stool. The diarrhea was two to three time during the day and seven times at night. She felt falling feeling in anus, nausea, poor appetite and felt cold. Her urine was yellow in color. Western medicine treatment did not work. She had a history of blood flucks disease. At the time she suffered from the diarrhea, she was in pregnancy for seven months. Her tongue cover was thin and white. The tongue was slight red in color. The pulse was deep, thin, slippery and frequent. The condition belongs to Wetness- and Hotness-down-flowing, which hurt the blood portion of the body. The herbal therapy should aim to clear the Fire, to cool blood, as well as to dissolve the wetness and to direct off the stagnation. She was given Baitouwen Tang plus Gancao Ajiao Tang: Baitouwen 9 g, Huanglian 6 g, Huangbo 3 g, Qinpi 3 g, Gancao 9 g, and Ajiao 9 g.

二诊312日:上药服一剂,昨日泄二次,无红粘液便。今晨泄二次,第二次稍带粘液。前方加茯苓三钱。

The second visit: March 12. After the herbal therapy for one day, the diarrhea reduced to twice a day, without red mucus in stool. This morning she had diarrhea twice. On the second time, there was little mucus in the stool. To the previous prescription, added was Fuling 9 g.

三诊313日:上药服一剂后,腹已不痛,昨夜便行二次,质溏,溲黄,纳可。上方加焦白术三钱,二剂消息之。

The third visit: After one dose of the herbal tea, the belly pain subsided. She had diarrhea twice last night. The stool was loosed. The urine was yellow. The appetite was well. To the second prescription above, added was Jiao Baizhu 9 g. The prescription was used for two days.

按:此也是阳明病下利,不过本例是孕妇得之,难免忧虑胎儿,而胡老已有成熟的经验,这就是:痢疾里急后重,下利赤白,用白头翁汤主之。如产后、孕妇、或虚乏少气者,宜加阿胶、甘草补虚。

Comments: This case also belongs to Yangming phase with diarrhea. The difference is that the patient was a woman with pregnancy. Therefore, in the treatment, it would be worry for the fetus. For this, Dr. Hu has mature experience. That is: if the dysentery is with falling feeling in anus, and if the stool is with red blood and white mucus, mostly use Baitouwen Tang. If the patient is after birth delivery or with pregnancy, and if such patients are with a weak condition with short of breath, add Ajiao and Gancao to nourish the weakness condition.

上热下寒下利多   辛开苦降泻心汤

6.  (慢性胃肠炎)  张某,男,29岁,病案号168767

Case 6. Zhang XX, male, 29 years of old. File number:168767. (Chronic ganstroenteritis)

初诊日期19651012日:腹泻、胃脘胀四个月。原有右胁痛已四五年,经检查谓慢性肝炎,因症状不重,故未重视治疗。近四个月来右胁背痛明显,且见胃脘疼痛、腹胀、头晕、恶心、大便溏稀日四五行,经查肝功正常,服中药治疗腹泻、胃脘疼等不见好转,并见吐酸、烧心、午后身热、口干、心跳,厌油腻,舌苔白,脉沉细。与半夏泻心汤:半夏四钱,党参三钱,黄芩三钱,黄柏三钱,干姜三钱,大枣四枚,炙甘草二钱。

The first visit: October 12, 1965. The patient had diarrhea and bloating feeling in stomach for 4 months. He had pain in right upper side of belly for 4 to 5 years, which was diagnosed as chronic hepatitis. For the symptoms were not severe, he did not pay much attention for the treatment. For recent 4 months, the pain became more severe, as well as he felt pain in stomach, bloating in belly, nausea and diarrhea which was four to five times a day.  The lab test showed that the liver function was normal. He had been given Chinese herbal therapy for the diarrhea and stomach pain but no effect. He had also acid reflex, hot feeling in the body in the afternoon, dry mouth, palpitation, and oily food-dislike feeling. His tongue cover was white. The pulse was deep and thin. He was given Banxia Xiexin Tang: Banxia 12 g, Dangshen 9 g, Huangqin 9 g, Huangbo 9 g, dried ginger 9 g, Chinese date 4, and Zhi Gancao 6 g. 

结果:上药服六剂,腹泻、腹痛、吐酸、身热已,烧心、口干、恶心、心跳、头晕、右胁痛减,纳增,上方加吴茱萸二钱,茯苓三钱继服,经服月余诸症已,右胁痛亦轻微。

Results: After the herbal therapy for six days, the diarrhea, pain in belly, acid reflex and hot feeling in the body, all subsided. The heart burn feeling, dry mouth, nausea, palpitation, dizziness and pain in the right upper belly all were reduced. The appetite was improved. To the previous prescription, added was Wuzhuyu 6 g, Fuling 9 g. After a few months, most of the symptoms stopped. He felt only slight pain on the right upper side of the belly.

按:此例为少阳太阴并病,而呈上热下寒证,用半夏泻心汤辛开苦降,使中健饮去热除,放下利止,诸症也随之好转。

Comments: This case is Shaoyang-Taiyin co-exist phases, which showed as upper hot and lower cold condition. The Banxia Xiexin Tang was used to a spicy-opening and bitter-descending effect. All the herbs worked to strengthen the stomach, to clear the fire, and to dispel the water, so as to stop the diarrhea and to clear any other symptoms.

7. (慢性痢疾) 任某,女,16岁,病案号185192

Case 7. Ren XX, female, 16 years of old. File number: 185192 (Chronic dysentery)

初诊日期19651230日:于1958年患痢疾,久治无效。现大便仍下脓状物,剧则日五六行,时腹痛、肠鸣,口干。心下痞,舌苔白根腻,脉弦细。与半夏泻心汤加芍药:半夏四钱,黄芩三钱,黄连三钱,党参三钱,干姜三钱, 大枣四枚,炙甘草三钱,白芍三钱。

The first visit: December 30, 1965. The patient had dysentery in 1958. For a long time, the treatment she got did not work at all. Currently, the stool was with mucus stuff. The diarrhea could be up to five to six times a day. She felt pain in belly, noise in intestine, dry mouth and bloating feeling in stomach region. Her tongue cover was white with greasy in root. The pulse was strintg and thin. She was given Banxai Xiexin Tang plus Shaoyao: Banxia 12 g, Huangqin 9 g, Huanglian 9 g, Dangshen 9 g, dried ginger 9 g, Chinese date 4, Zhi Gancao 9 g, and Baishao 9 g.

结果:上药服六剂,腹痛、心下痞皆减,便中脓状物不见大便溏稀日2--3行,原方再服七剂而诸症已。

Results: After the herbal therapy for six days, the belly pain and stomach bloating feeling reduced. There was no white pus-like stuff in stool. The bowel movement was two to three times a day. The same herbal prescription was continued for seven days. No any discomfort at all after that.

按:此下利为少阳太阴合病,其因胃气不振而致饮留邪聚。呈上热下寒之证。故以党参补中健胃,和之以大枣、甘草,并以半夏降逆和胃,以干姜温下寒驱饮、以黄芩.黄连清上热解痞止利,因腹痛明显,故加芍药缓急止痛。由本例治验可看出,半夏泻心汤可用于急性、慢性下利,也就是说,无论急性还是慢性下利,只要见本方证即可用之。

Comments: This case is Shaoyang-Taiyin co-exist phases. For the stomach Qi is not active, the water was accumulated, showing upper hot and lower cold condition in the body. For this reason, the herb Dangshen was used to nourish the middle Qi, and to enhance the stomach. Chinese date and Gancao worked to harmonize the stomach. The Banxia is to reverse the rushing up Qi and to calm the stomach. The dried ginger works to warm the middle stomach, to dispel the lower cold, and to dispel the Cold. The herb Huangqin and Huanglian worked to clear the upper fire, to release the bloating and to stop the diarrhea. For the belly pain is severe, the Shaoyao was used to clam down the intestine spasm. From the experience in this case, it can be seen that, the Banxia Xiexin Tang can be used for acute or chronic diarrhea. In another words, no matter the diarrhea is acute or chronic, the herbal prescription can be used if the clinic condition belongs to the Shaoyang-Taiyin co-exist phases.

8.  (慢性肠炎) 刘某,男,38岁,病案号178894

Case 8. Liu XX, male, 38 years of old. File number 178894 (Chronic enteritis)

初诊日期1965111日:腹泻四十余日,日行67次,泻前腹痛、肠鸣,常胃脘痞满,饮水则心下悸,时口苦、咽干、头昏、耳鸣,舌苔白,脉沉细。与生姜泻心汤:生姜四钱,半夏四钱,党参三钱,黄芩三钱,黄柏三钱,干姜一钱,大枣四枚,炙甘草二钱。

The first visit: November 1, 1965. The patient had diarrhea for 40 days. He had diarrhea six to seven times a day, with stomach pain, intestine noise before the bowel movement. He often felt bloating in the stomach region. Whenever he drunk water, he would feel palpitation in the stomach region. He had bitter taste in mouth, dry mouth, cloudy mind, and tinnitus. The tongue cover was white. The pulse was deep and thin. He was given Shengjiang Xixin Tang: fresh ginger 12 g, Banxia 12 g, Dangshen 9 g, Huangqin 9 g, Huangbo 9 g, dried ginger 3 g, and Zhi Gancao 6 g. 

二诊114日:上药服三剂,腹泻已,上方隔日服一剂调理。

The second visit: November 4. After the herbal therapy for three days, the diarrhea stopped. The previous herbal tea was drunken one dose once every other day for a maintenance.

按:本例因有饮水则心下悸,为寒饮证重,故用生姜泻心汤治之。方中黄柏是代黄连,因当时黄连无货不得已代用,以下同。

Comments: This case had palpitation in stomach region after water drink, indicating the cold condition was severe. Therefore the Shengjiang Xiexin Tang was used. In the prescription, the herb Huangbo is to replace Huanglian, for the huanglian was not available. This is the same reason in the case bellow.

9.  (急性肠炎)  荣某,女,70岁,病案号93184

Case 9. Rong XX, female. 70 years of old. File number: 93148 (Acute enteritis)

初诊日期19631027日:自昨日起腹泻,日三四行,腹痛已两周,口咽干,肠鸣甚,胃脘痞满,项强,头胀微痛,两眼干涩,舌苔白而少津,脉细数。与甘草泻心汤:炙甘草四钱,半夏四钱,黄芩三钱,黄柏三钱,党参三钱,干姜三钱,大枣四枚。

The first visit: October 27, 1963. From yesterday, the patient had diarrhea, which was three to four times a day. She had belly pain for two weeks already. She had dry mouth and throat, severe intestine noise, bloating in stomach region, stiff neck, slight pain and bloating feeing in head, and dry eyes. The tongue cover was white with little dryness. The pulse was thin and frequent. She was given Gancao Xiexin Tang: Zhi Gancao 12 g, Banxia 12 g, Huangqin 9 g, Huangbo 9g, Dangshen 9 g, dried ginger 9 g, and Chinese date 4.

结果:上药服三剂,腹泻止。项背痛、及腹痛未已,与柴胡桂枝干姜汤合当归芍药散消息之。

Results: After the herbal therapy for three days, the diarrhea stopped. The stiff neck and belly pain was not reduced yet. She was given Chaihu Guizhi Ganjiang Tang plus Danggui Shaoyao San for a maintenance.

按:此与前两例皆为上热下寒证,但本例胃气更虚,因用甘草泻心汤治之。

Comments: This case is the upper hot and lower cold condition, similar to the case above. In this case, the stomach Qi was more weak, so that the Gancao Xiexin Tang was used.

虚寒下利属太阴 寒热错杂见厥阴

10. (肠功能紊乱) 李某,男,58岁,病案号155413

Case 10. Li XX, male, 58 years of old. File number: 155413 (Functional disorder of intestine)

初诊日期196546日:受凉后腹泻已三月不愈,每日大便3--4行,大便有完谷不化,胃腹胀满,食后益甚,时有嗳气头晕,舌苔白润,脉细缓。证属里虚寒饮,升降失和,治以温中益气,和胃化饮。与理中汤加陈皮、扁豆:党参三钱,炮姜二钱,炙甘草二钱,苍术三钱,陈皮五钱,炒扁豆三钱。

The first visit: April 6, 1965. The patient got cold and had diarrhea for three months. He had diarrhea three to four times a day, with non-digested food in the stool. He felt bloating feeling in the belly, which would be worse after meal. Some times he would feel belching and dizziness. His tongue cover was white and wet. The pulse was thin and slow. The condition belongs to inside weakness and cold with water accumulation, which causes the disorder in the Qi movement and circulation. The principle in the treatment would be to warm the middle, to nourish the Qi, to harmonize the stomach and to dispel the extra water. He was given Lizhong Tang plus Cheni, Baibiandou: Dangshen 9 g, Pao ginger 6 g, Zhi Gancao 6 g, Cangzhu 9 g, Chenpi 15 g, and Chao Baibiandou 9 g.

结果:上药服六剂,腹泻基本已止,腹胀亦明显减轻,继服六剂而证已。

Results: After the herbal therapy for six days, the diarrhea was basically stopped. The bloating feeling in belly was less. With additional six doses, all the symptoms stopped.

: 本例为典型的里虚寒饮下利,也即太阴病下利,为理中汤方证,故与之即愈。

Comments: This case is typical inside weakness and cold condition with diarrhea, e.g. it belongs to Taiyin phase with diarrhea. It is the condition for Lizhong Tang, so it works very fast.

 

 

32.  慢性结肠炎

32. Chronic colonitis

1 (慢性结肠炎) 古某,男,54岁,病案号182864

Case 1. Gu XX, male, 54 years of old. File number: 182864 (Chronic colonitis)

初诊日期1965127日:腹泻六年。1959年患急性结肠炎,经治疗未能痊愈,腹泻时轻时重。今年4月在积水潭医院查出有早期肝硬化。近症:大便溏稀而不畅,时常便出一点点,时有便后失禁不守之象,常右胁隐痛,左侧卧位时明显,而肝功能正常。胃脘疼,乏力,口干,纳差,舌苔白,脉细弦稍数。证属太阴少阳合病,为吴茱萸汤合生姜泻心汤方证:吴茱萸三钱,生姜五钱,党参三钱,黄芩三钱,马尾连四钱,干姜三钱,大枣四枚,炙甘草二钱。

The first visit: December 7, 1965. The patient had chronic diarrhea for six years. In year 1959, he had acute colonitis. It was not cured after treatment. His diarrhea was light some times and severe some other times. In April this years, he was diagnosed as early stage of liver cirrhosis. The current condition: the stool was loosed and sticky. Stool was expelled out often as little by little. From time to time, he felt as no control of the stool after bowel movement. He often felt slight pain in the right rib region, which was worse when he laid down on left side. The lab test for liver function however was normal. He felt pain in stomach region, fatique, dry mouth and poor appetite. The tongue cover was white. The pulse was thin, string, and slight frequent. The condition belongs to Taiyin-Shaoyang co-exist with diarrhea. It is the indication for Wuzhuyu Tang plus Shengjing Xiexin Tang: Wuzhuyu 9 g, fresh ginger 15 g, Dangshen 9 g, Huangqin 9 g, Maweilian 12 g, dried ginger 9 g, Chinese date 4, and Zhi Gancao 6 g.

结果:上药服三剂,胃脘疼减,纳差好转,大便较畅,次数减少,大便量较多,但仍有大便不净感,上方去干姜,加炮姜二钱,黄柏二钱。继服六剂,大便明显好转,日23行,右胁隐痛亦好转,上方去马尾连续服六剂,下利症状已。右胁隐痛轻微。

Results: After the herbal therapy for three days, the stomach pain reduced. The appetite was better. The bowel movement was improved with less times and more volume. He still felt some kind of remaining feeling of stool inside the anus. From the prescription above, removed was dried ginger, but added Paojiang 6 g, Huangbo 6 g. The prescription was continued for six doses. The stool was dramatically better, which was two to three times a day. The pain in the right upper side of the belly was also less. From the prescription above, removed the Maweilian. It was used for six days. The diarrhea stopped. He only felt very slight pain in the right upper belly.

按:本例中寒饮盛因致下利,正邪相争,阳气尚旺,以现少阳太阴合病,故以吴茱萸汤合生姜泻心汤治之,温中化饮,佐清上热,使邪却而正安。

Comments: The diarrhea in this case was due to inside cold water overwhelming. The body defense energy was still sufficient, so showing as Shaoyang-Taiyin co-phases. He was therefore given Wuzhuyu Tang plus Shengjiang Xiexin Tang for the treatment, to warm the middle, to dispel the extra water, as well as to clear the upper fire, so to dispel the Xie Qin and calm the defense Qi in the body.

2.  (慢性肝炎) 孙某,男,38岁,病案号134809

Case 2. Sun XX, male, 38 years of old. File number: 134809 (Chronic hepatitis)

初诊日期196846日:1961年因腹泻诊断为无黄胆型肝炎,经治疗肝功能正常,但腹胀、胁痛、腹泻不已。于19648月来我院先找西医治疗无效,后找中医治疗,治疗三月,胁痛及胃脘疼好转,而腹泻不见好转,每日大便23次,有时56次,腹胀明显,饭后尤甚,肠鸣、矢气多,口苦,食欲差,自感腹中有凉气、腰腿冒凉气,四肢冷,平时冷,晚上常冻醒,舌苔白,脉沉细,查体:肝大一指,质中硬,压痛轻微,心下有振水声。此为里虚寒饮,为太阴下利,与附子粳米汤合人参汤:炮附子二钱,半夏三钱,生姜三钱,大枣四枚,炙甘草二钱,粳米五钱,党参三钱,苍术三钱。

The first visit: April 6, 1968. In year 1961, the patient was diagnosed as hepatitis without jaundice. After treatment, the lab test showed normal in liver function. However, he felt bloating in the belly, pain in the upper side of the belly, with continuous diarrhea. In August 1964, he had been given western medical treatment in our current hospital. For no effect, he went to Chinese medicine. After three months, his pain and bloating feeling were improved, but the diarrhea remained no change. It was two to three times a day, some time five to six times a day. The belly bloating was severe, especially after meal. He had intestine noise, frequent gas, bitter taste in mouth, poor sleep, and cold feeling in belly, in lower back and in the legs. He felt cold in arms and legs. He could be waken up at night by the cold feeling. His tongue was white. The pulse was deep and thin. Physical exam showed the liver was one finger enlarged. When pressed, the liver was middle level of hard. The pressing pain was slight. There was water noise in stomach region. This condition belongs to inside weakness and cold, e.g. it is Taiyin phase with diarrhea. He was given Fuzi Gengmi Tang plus Renshen Tang: Pao Fuzi 6 g, Banxia 9 g, fresh ginger 9 g, Chinese date 4, Zhi Gancao 6 g, Genmi 15 g, Dangshen 9 g, and Cangzhu 9 g.

结果:上药服三剂,自感有效,又连续服九剂,腹泻止,诸症痊愈。

Results: After the herbal therapy for three days, he felt improvement. After nine days, the diarrhea stopped and no any other discomfort.

按:此与例1 同是里虚寒饮太阴下利,但本例因虚寒更甚,因加炮附予以温阳。又因肠鸣、心下停饮明显。故易干姜为生姜温中化饮。此例虽病久、病重,却因方药对证,很快治愈。方证之学,必予重视。这里要说明的是,附子与半夏同用本是良好配剂,临床应用多收良效,汉代张仲景等书有记载,但不知何时出"十八反"在中药店中流传为禁忌配伍,毫无道理,有不少人专题研究,发表论文。多有共识,但权威机构尚无明确表态,甚是遗憾。

Comments: This case and the case 1 both belong to inside weakness and cold condition, e,g. the Taiyin phase with diarrhea. In this case, the inside weakness and cold is more severe, so Pao Fuzi was given to warm the Yang Qi. For the strong intestine noise, suggesting the inside water accumulation, the dried ginger was changed to fresh ginger to warm the middle and to dispel the water. Though the disease history of this case is very long and the condition was severe, for the herbs matched the clinic conditions, the symptoms were solved fast. The Jing Fang theory has to be really studied and mastered. Here it should be pointed out that, the Fuzi and the Banxia are very good couple. The use of them at the same time in clinic works very well, which has been well documented in the book <<Shang Han Lun>> by Master Zhongjing Zhang. However, it has been listed in the “Eighteen conflicting herbal couples” and refused to sell to patients by herbal shops. It is with no any meaning to be so. There have been a lot of doctors and scholars who studied this phenomenon and published a lot of articles to correct this mistake, but the medical authority did not express their own comments yet. It is very pity.  

3.  (过敏性结肠炎)  索某,男,57岁,某军参谋长。

Case 3. Suo XX, male, 57 years of old. (Allergic colonitis)

初诊日期1965716日:腹泻、腹痛3年,三年前患肺炎,经住院治疗,肺炎愈,但遗长期腹痛、腹泻,西医诊断为过敏性结肠炎,用各种药皆无效。曾找数名中医治疗,但经年无效,其方多为香砂六君子、参苓白术散、补中益气汤等加减。近症腹痛、腹泻,日23行,每吃油腻则加重,常胃脘疼、痞满、肠鸣,头痛,口苦、咽干思饮,四肢逆冷,舌苔白腻,脉沉弦细,左寸浮,体质肥胖。此寒热错杂证,为厥阴太阴合病,与乌梅丸,给予汤剂:乌梅五钱,细辛二钱,干姜二钱,黄连二钱,黄柏二钱,当归二钱,制附片三钱,川椒三钱,桂枝三钱,党参三钱。

The first visit: July 16, 1965. The patient had diarrhea and belly pain for three years. Three eayes ago, he suffered from pneumonia. He had been admitted in hospital for treatment. The pneumonia was cured, but he had long time of belly pain, diarrhea after that. Western medicine diagnosed it as allergic colonitis. Various treatments had been given but no one worked. He had also been given Chinese herbal therapy for the treatment for years, no any improvement either. The herbs he was given were mostly the Xiangsha Liu Jungzi Tang, Shen Ling Baizhu San, or Buzhong Yiqi Tang. Current condition: he had belly pain and diarrhea, which was two to three times a day, and which would be worse after oily meal. He often felt stomach pain, bloating in belly, intestine noise, headache, bitter taste in mouth, dry mouth and throat with desire to drink and cold arms and legs. His tongue cover was white and greasy. The pulse was deep, string, and thin, with floating feeling on the left Chun position. His body was bigger in size. His condition belongs to the mixture of Cold and Fire. It is the Jueyin-Taiyin co-exist condition. He was given Wumei Wan as cooked soup to drink: Wumei 15 g, Xixin 6 g, dried ginger 6 g, Huanglian 6 g, Huangbo 6 g, Danggui 6 g, Zhi Fuzi 9 g, Chuanjiao9 g, Guizhi 9 g, and Dangshen 9 g.

结果:上药服六剂,口苦减,四肢觉温,大便日12行,上方继服14剂,胃脘痛已,大便日一行。

Results: After the herbal therapy for six doses, the bitter taste in mouth reduced, and the arms and legs felt warm. The bowel movement became one to two times a dy. The herbal tea was continued for 14 days. The stomach pain subsided and the bowel movement became once a day.

按:此亦里虚寒饮下利,因寒饮久滞,正邪相争,饮郁久化热,出现寒热错杂之证。与例1不同的是,彼阳气、正气相对强,此阳气、正气明显虚,因呈半表半里虚寒证与太阴病合病,即为厥阴太阴合病,为乌梅丸方证,故与之愈。

Comments: This case is also a inside weakness and cold condition. For cold water accumulation for a long time, the water developed into Fire, so showing as the mixture of cold and fire. The difference from the case 1 is that, that in case 1, the body Yang Qi, the defense energy, it relatively sufficient, while in this case here, the body defense energy is clearly not sufficient, so that the disease is in half-surface and half-inside, weakness and cold condition, e.g, the co-exist of the Yueyin and Taiyin. It is the indication of the Wuwei Wan.

4.  (肠功能紊乱) 罗某,男,32岁,病案号99211

Case 4. Luo XX, male, 32 yeas of old. File number: 99211.

初诊日期19631016日:一年多来腹泻,多数医生诊为"神经官能症"。在本院已服中药三个多月,多为黄_建中汤、甘草泻心汤、参苓白术散等加减,皆未见明显疗效。近症:腹痛、腹泻,每早晨起床即腹泻,每天腹泻45次,伴肠鸣、腰酸腿软,身畏寒,无力,阳痿,时失眠、头晕,咽干而疼,而口不渴,小便清长,舌苔白腻,脉沉细。此证属少阳太阴合病,与四逆散加苓术附生姜:柴胡四钱,枳实四钱,白芍四钱,炙甘草二钱,川附子三钱,茯苓三钱,苍术三钱,生姜三钱。

The first visit: October 16, 1963. The patient had diarrhea for one year. Most doctors diagnosed it as “nervous exhaustion”. He had been treated in the current hospital for three months. The herbs used were mostly the Huangqi Jianzhong Tang, Gancao Xiexin Tang, Shenling Baizhu San, etc. No clear improvement. The current condition: He felt belly pain, diarrhea, which occurred mostly in the early morning, for four to five times a day. He had intestine noise, sour and weak in legs, cold in body, fatique, impotency and some times poor sleep, dizziness, dry mouth with pain, but no thirsty. His urine was clear as water. The tongue was white and greasy. The pulse was deep and thin. The condition was Shaoyang-Taiyin co-exist condition. He was then given Si Ni San plus Ling Zhu Fu Shengjiang: Chaihu 12 g, Zhishi 12 g, Baishao 12 g, Zhi Gancao 6 g, Chuan Fuzi 9 g, Fuling 9 g, Cangzhu 9 g, fresh ginger 9 g.

结果:上方服八剂,腹痛止,大便日一行,头晕好转,可以看报。眠好、精神好,唯饮食欠佳,胃脘胀闷,仍腰酸,上方加陈皮五钱,服六剂,症已。

Results: After the herbal therapy for eight days, the belly pain stopped. The bowel movement became once a day. The dizziness was improved. He could read newspaper. The sleep and emotion was normal. He felt no so good with diet, bloating in stomach region, sour in lower back. To the prescription above, added was Chenpi 15 g. After that, all the symptoms subsided. 

 

按:本例辨证较为复杂,必仔细审证方能明晰。该患者常有咽干而疼,每说出后,医生就给凉药,服后腹痛腹泻加重,所以后来看病时,不敢说有咽干而疼。实际这是少阳郁热的表现。《伤寒论》第318条:"少阴病,四逆,其人或咳、或悸、或小便不利、或腹中痛、或泄利下重者,四逆散主之。"此条冠之以少阴病,实质是原本是少阴病,今传人半表半里而转属少阳病,由于热壅气郁,血行受阻,因致脉沉细、四逆,形似少阴病的外观,实为少阳病。又本例有下利、口不渴,更明确为太阴下利。故整个病证为少阳太阴合病,因此以四逆散和解少阳,而加苓术附温中祛寒除饮.因肠鸣明显,故又加生姜温散寒饮。此虽也属少阳太阴合病,但不同于前面诸泻心汤证,因前者为明显上热,故用芩、连等清热;本例为少阳郁热,故但用柴胡、枳实、芍药,解郁清热。由本例曾用甘草泻心汤治疗不效可体会到:辨证只辨清六经是不够的,还必须辨清方证,才能做到药到病除。胡老用经方治疗急慢性下利皆有丰富经验,即使对霍乱也治愈不少,曾讲过用伏龙肝、白矾治疗有卓效。给服白矾水其觉甜,可徐徐饮之,待觉涩则止后服,可止泄、防止脱水。经验宝贵,惜未见治验病例,仅此简述。

Comments: The condition in this case is complex. It has to be carefully diagnosed. For his dry throat and pain in throat, once he told doctors, the doctors would use cold herbs. After use of the herbs, his diarrhea became worse. Therefore later when he visited doctor, he dared not to mention the dry and pain in throat. It is actually the Shaoyang choking Fire. In the book <<Shang Han Lun>>, paragraph 318, it stated: “In the disease is in Shaoyin phase, the person has cold hands and feet, or cough, or palpitation, or difficult urination, or stomach pain, or diarrhea with falling feeling inside the anus, use Si Ni Sang for the treatment.” This paragraph is titled as Shaoyin phase, but actually it implies that, the disease is initially the Shaoyin phase, now it develops or passes into the Shaoyang phase already. For the Fire sluggished and choking inside, the blood circulation is affected, so the pulse is deep and thin, and the person has reversely cold hands and feet, similar to the manifestation of Shaoyin phase, but it is actually Shaoyang phase. In this case, there is diarrhea and no thirsty, it is clearly Taiyin phase with diarrhea. So, the whole body condition is Shaoyang-Taiyin co-exist phases. Therefore, the Si Ni Sang was used to harmonize the Shaoyang phase, and the Ling Zhu Fu were used to warm the middle, to dispel the cold, and to dispel the extra water. For the intestine noise is strong, used the fresh ginger to warm and to dispel the cold water. Though this condition belongs to the Shaoyang-Taiyin co-exist phases, it is different to the previous varirous Xiexin Tang conditions. For the previous Xiexin Tang condition, the upper Fire is overwhelming, so the Huangqin and Huanglian were used to clear the Fire. In this case here, the Fire is due to Shaoyang choking, so only use Chaihu, Zhishi and Shaoyao to release the choking fire. From this case, in which the previous use of Gancao Xiexin Tang did not work, it can be recognized: it it not enough to make a correct six Jing diagnosis for the treatment. It is really needed to have a precise herbal indication diagnosis too. In this way, the herbs used, the disease can be cured. Dr. Hu has very rich experience in the treatment of acute and chronic diarrhea, as well as in that of cholera. He said he had used Fulong Gan and Baifan for the treatment of cholera. The patient would taste the Baifan water sweet, so he could drink it slowly. Let him stop to drink whenever the patient feels astringent. This is the way to prevent diarrhea and prevent dehydration. The experience is so valuable, but it is pity to find the case record. We can only mention it here.



[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.