朱良春先生临床经验谈!

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朱良春先生临床经验谈

邱志济 邱江东 邱江峰(浙江省瑞安市广益中医疑难病诊所 325200
 
Author: Zhiji Qiu, Jiangdong Qiu, and Jiangfeng Qiu

 

Catalogue

 
 

1. 朱良春先生应用乌梅的经验

1. The experience in the use of herb Wumei

2. 朱良春治疗外感久咳的经验和特色选析

2. Chronic cough

3. 朱良春治疗颜面黧黑斑经验的临床运用

3. Dark tint on face

4.  朱良春治疗口眼干燥关节炎综合征特色选析

4. Mouth-eye-joint dryness syndrome

5 朱良春治疗中风及后遗症用药经验特色选析

5. Stroke and post stroke

 

 

6. 朱良春治疗高血压用药经验特色选析

6. High blood pressure

7. 朱良春治疗慢性结肠炎临床经验和特色

7. Chronic diarrhea (ulcerative colonitis)

8.  朱良春治疗顽固荨麻疹的用药经验和特色选析

8. Chronic ulticaria

9. 朱良春治疗颈椎病经验和特色选析

9. Cervical spondylosis

 

 

1. 朱良春先生应用乌梅经验

1. Experience in the use of herb Wumei (Duck plum)

法宗锡纯用酸敛  乌梅敛肝任猛将

Following Master Xichun Zhang to use sour-restraining therapy, use Wumei (dark plum) as the main herb ingredient in the treatment.
http://www.ngotcm.com/forum/viewthread.php?tid=78887

朱师不但治疗中风急脱证选用酸敛之品,而在治疗中风后遗症亦加用酸敛之品,锡纯善用生白芍,朱师易用乌梅,法同而药异。乌梅敛肝舒脾,治脱疗瘫,疗效确切。朱师研究和应用张锡纯效方常有创见,如自拟加减镇肝熄风汤,药用:怀牛膝、生赭石各30g,生龙牡、乌梅、生龟板、玄参、天冬、黄芩、茵陈各15g,天麻10g,治疗中风急证,突然昏仆,口眼歪斜,神志模糊,头转向一侧,舌体与头向同侧歪斜,舌质较红,舌苔黄燥,脉弦大等症状者屡收著效。方中用乌梅易白芍,颇能提高疗效,乃是朱师善用酸敛的特色,有画龙点睛之妙,朱师指出,镇肝熄风汤 旨在镇、降、肃、敛、以镇、降、肃折其病势,以酸敛真阴而防其虚脱,益阴潜阳,敛正祛邪,用之对证,屡见效验。

Dr. Zhu not only use the sour-restraining herbs in the treatment of acute stage of stroke, but also use it in the post-stroke stage. Dr. Xichun Zhang is good at using herb Baishao for the sour-restraining aim, and Dr. Zhu is good at using herb Wumei for the same aim. The principle is the same but the herbs used is different. The healing effect of Wumei is for sure effective in the treatment of disorders of Liver and Spleen, and in that of coma and paralysis. Dr. Zhu usually has more development in the study of Dr. Xichun Zhang experience. For example, he developed herbal formula “Jiajian Zhen Gan Xi Feng Tang”.  The herbs used in this formula are Niuxi 30 g, Daizheshi 30 g, Longgu 15 g, Muli 15 g, Wumei 15 g, Guiban 15 g, Xuanshen 15 g, Tiandong 15 g, Huangqin 15 g, Yinchen 15 g, Tianma 10 g. It is used to treat acute phase of stroke. The patient falls down suddenly, with the mouth and eyes asymmetry, cloudy mind, and with head turning to one side. The tongue and the head contort to the same side. The tongue is relative red in color. The tongue cover is yellow and dry. The pulse was string and big. This herbal formula works very well for such clinic condition. In the formula, that the original herb Baishao is replaced with herb Wumei could increase the healing effect. This is the characteristic of Dr. Zhu in the use of sour-restraining therapy. Dr. Zhu said, this formula works to suppress, to create descending, and to create a restraining effect in the body. The sour-restraining and the descending effect are to retard the development of the disease. The sour-restraining  is to seal the true Yin in the body so as to prevent coma, to nourish the Yin and to dive the Yang, to enhance the body defense energy and to dispel the Xie Qi. Whenever it is used in accordance in the clinic, its healing effect is reproducible.  

笔者仿朱师之法,历年来,以此法治愈多例,因篇幅有限,病例从略。盖元气之脱,责之在肝,考锡纯之既济汤”“来复汤”“镇摄汤” 3方均为脱证而设,其中酸敛药有山茱萸、生白芍、生芡实、生龙牡等,张锡纯指出,凡人元气之脱,皆脱在肝肝胆虚极,而元气欲脱也。张锡纯此说,析其理乃元气之上行,原由肝而敷布,而元气之上脱,亦即由肝疏泄也。肝能为肾行气,即能泻元气自下出也,故元气之上脱由于肝,其下脱亦由于肝。力主酸敛之品以救欲脱之候,元气之虚,阴阳失和,心火暴甚,本气自病,湿土生痰,水不涵木等,乃张锡纯之独识卓见。

The author of this article followed the principle of Dr. Zhu for recent many years. The cure cases are lot. For the limited space of the article, the cases are not to be listed here. For the reason of escape of Yuan Qi in the body, the responsible organ is the Liver. When check the “Ji Ji Tang”, “Lai Fu Tang”, and “Zhen She Tang”, all of which are created by Dr. Xichun Zhang, are all used to solve the coma condition. Among the herbal ingredients in the formula, the sour-restraining herbs are Shanzhuyu, Baishao, Qianshi, Longgu and Muli. Dr. Xichun Zhang pointed out that the liver is responsible for any kinds of coma, and that it is due to the over weakness of the liver and gall bladder, that causes the escape of the body Yuan Qi. Dr. Xichun Zhang’s theory means that the upper-distribution of body Yuan Qi is originally and basically depending on the function of the liver. Therefore, the escape of the body Yuan Qi is due to the disorder of the liver in the Qi dredging. The liver can function to help the Kidney Qi to move, e.g. it helps the Yuan  Qi descending movement. Therefore, the escape of body Yuan Qi from the upper part of the body is due to the liver, and that from the lower part of the body, is also due to the liver. Dr. Xichun Zhang strongly recommended to use the sour-restraining herbs to save the escaping body Yuan Qi. …

张锡纯不但创敛肝救脱治中风,且以敛肝泻热治痛证,如曲直汤治疗因气血郁滞致四肢昼夜疼痛,卧床不能转侧,臂畏热而腿畏凉之证,方中用萸肉以敛肝补肝;配以知母泻热;选加柴胡、川芎、香附、生麦芽、乳香、没药以疏达肝郁,收到了敛肝治痛数日告愈的佳效。

Dr. Xichun Zhang not only created the sour-restraining therapy to restraining the liver for the treatment of stoke, but also used the sour-restraining therapy to dispel hotness or fire to solve pain. For example, his “Qu Zhi Tang” is used to solve the day-and-night around pain in the arms and legs due to the Qi and blood stagnation. The person can only lay down the bed, and can not turn the body. He dislikes hot in the arms but hates cold in the legs. In the formula, the herb Shanyurou works to restrain liver so as to nourish the liver; the herb Zhimu is to dispel hotness, and the choose of Chaihu, Chuanxiong, Xiangfu, Maiya, Ruxiang and Moyao work to dredge the liver stagnation. All work to solve the pain of such nature, after only several days, by restraining liver.

张锡纯从肝之疏泄以济肾之闭藏的观点,说明元气虚而欲上脱者,皆因肝之疏泄过甚而上脱,故朱师治疗中风脱证和治疗中风后遗症等重用敛肝猛将乌梅伍同龙牡等,使肝不疏泄过甚,即能挽回元气将脱之危。乌梅、山茱萸等酸敛之品,虽补气之力逊于人参,但挽救元气上脱之力,则胜于人参。

Dr. Xichun has the theory that the dredging function of the liver helps the nourishment of kidney. It means that the reason for escape of the body Yuan Qi from the upper part of the body is due to the over dredging of the liver. Therefore, Dr. Liangchun Zhu uses the strong sour-restraining herb, the Wumei, as well as the Longgu and Mul, to treat stroke with coma, and the post stroke conditions. The herbs prevent the over dredging of the liver, so to bring back the escaping body Yuan Qi. The sour-restraining herbs, the Wumei and Shanzhuyu, are better than Renshen (ginsheng) in the save of body Yuan Qi, though they are less so effective in the nourishment of body Qi.  

张锡纯力主酸敛以救欲脱之候,元气之虚,阴阳失和,自创镇肝熄风汤等方只用萸肉、白芍、龙骨、牡蛎等酸敛之品,而未用乌梅,乃因历代名医均喜用仲景芍药甘草汤作为敛肝法的圣药之故。

Dr. Xichun Zhang emphasized the use of sour-restraining herbs to save the escaping Yuan Qi. In his formula “Zhen Gan Xi Feng Tang” he only used herb Shanyurou, Baishao, Longgu and Muli, but not Wumei. The reason is that, for many generations of Chinese doctors, they got a habit to use the Shaoyhao Gancao Tang, which is created by Dr. Zhongjing Zhang, for the liver-restraining formula.

清代名医刘鸿恩(1821~1887)自号知梅学究,通过长期的临床实践,终于发现了乌梅敛肝的奇特功效,所著《医门八法》四卷十六篇,以善用乌梅治病为特色,惜因后人不知乌梅敛肝的奇特功效,使此书传世甚少。

The famous doctor Hong-en Liu, Qing dynasty 1821-1887, claimed that he was good at the study of Wumei. After a long time clinic practice, he found the mysterious function of Wumei. It is the characteristics of his book <<Yi Men Eight Principles>> to use the Wumei in the clinic treatment. It is pity however that, the later doctors do not know the mysterious function of Wumei, which made the book not pass popularly.

朱师治学兼收并蓄,博及各家,在深究张锡纯用药特色中,尤在仿张氏敛肝救脱用山萸肉、生白芍的临床实践中,发现乌梅敛肝远胜于生白芍,且涩精气功同山茱萸,故以乌梅易白芍,乃因白芍敛肝力���不易见功,拟乌梅、龙牡同用,疗效更胜一筹,颇能提高镇肝熄风汤治疗中风急证或治疗高血压等症的疗效。

Dr. Liangchun Zhu studied all of the experience of previous famous doctors in history. In his study of the characteristic of Dr. Xichun Zhang’s herbal therapy, especially in Dr. Zhang’s experience of using Shangyurou and Baishao in the restraining of liver so to save the escaping body Yuan Qi, Dr. Zhu found that, the function of Wumei is much better than the Baishao, and that the function of Wumei in the sealing of Jing Qi is the same as Shanyurou. Therefore, he uses Wumei, instead of Shaoyao, for the function of Shaoyao is less dramatic in the liver-restraining. He found that, the use of Wumei, Longgu and Muli at the same time would have better clinic effect. By such combination and replacement, the herbal formula “Zhen Gan Xi Feng Tang” works much better in the treatment of acute stage of stroke or of hypertension.

《本草经疏》云:“乌梅味酸能敛浮热,能吸气归元,《本草求真》云:“乌梅酸涩而温,似有类木瓜,但此药入肺则收,入肠则涩,入筋与骨则软,入虫则伏,入于死肌,恶肉,恶痣则除,刺入肉中则拨,故于久泻,久痢,气逆烦满,反胃骨蒸,无不因其收敛之性,而使下脱上逆皆治

It is stated in book <<Ben Cao Jing Shu>> that, the herb Wumei works to restrain the floating fire, and can absorb the Qi into the storing phase. In book <<Ben Cao Qiu Zhen>>, it stated that, the Wumei is sour and astringent, and warm in herbal nature, similar to herb Mugua (papaya), but it could contract when comes into the lung and restrain in the intestine, and to soften in the tendons and bones. It could make the worms to become quiet, to remove dead muscle and tissue after moving into the dead muscle or moles. It stimulates out of thorn in skin or in muscle. Therefore it is used in long terms of diarrhea or dysentery, reversing Qi, annoying bloating, burping, and hotness feeling in bone, all the effects were for its restraining and contracting effects, so as to make the upper-reverse and lower-escaping all solved.   

肝病宜敛不宜散,宜补不宜伐,正合《内经》治肝之旨,乌梅敛肝的奇特效果,不仅只用于中风急证,通过敛肝,同样可以达到疏肝理气,滋阴养血,补虚祛实的目的。刘鸿恩指出,肝无实证五脏皆无实证”“敛肝之功,擅之乌梅,盖乌梅最能补肝且能敛肝,肝敛则脾舒,此乃敛肝舒土之法,乌梅性温,温能通行,酸能入肝而敛虚热,气温而主补,味酸而主敛,故精气益则五脏自安。

The theory that, when the liver is in disorder, it needs to restrain but not to disperse, and it needs to be nourished but not to be attacked, matches the principles in the book <<Nei Jing>>. The mysterious effect of herb Wumei makes it not only used in the treatment of acute stroke, but also used to dredge the liver, to dredge the Qi, to nourish the Yin and blood, and to nourish the weakness and to dispel the overwhelming condition. Dr. Hong-en Liu believed that, there is no overwhelming condition in the liver disease and even there are no overwhelming conditions for all the five organs. He also believed that it is the herb Wumei that is good at restraining the liver. For the Wumei is most good at nourish the liver and to restrain the liver. When the liver is in restrained condition, the Spleen is in a relax condition. This is the mechanism to relax and to release the spleen by restrain the liver. The Wumei is warm in herbal nature. Warming nature enables movement. The sour can come into the liver to restrain the floating fire for the sour dominates the contracting and restraining in the body. Therefore, the Jing Qi is nourished and all the organs are in calm.

朱师对张锡纯力主酸敛治肝经寒热虚实诸证用药规律,躬亲验证,深悟妙理,但法宗锡纯,药有独擅,使吾辈受益颇多。笔者仿朱师经验,临床拟乌梅甘草汤独梅汤,随证加味广用于各种虚证杂病,如慢肝病长期低热,各种虚不受补之证,慢肝病长期不寐、早醒、胁痛、糖尿病、便血、遗精、滑精、阳萎、早泄、虚喘欲脱证、大虚之重证呃逆、支扩吐血急症、妇人崩漏、胃气痛、疝气、反胃噎膈、妇科肿瘤、息肉、久咳等,临床多年实践证明,乌梅敛肝补肝可与一切补剂并用。亦可与散结软坚,滋阴养血药同用。

Dr. Liangchun Zhu follows the Dr. Xichun Zhang. He tried in clinic practice the theory of the Dr. Zhang to use sour-restraining therapy to solve the cold-fire in the liver meridian, and he understood the theory very much in detail. Though he follows the principle of Dr. Xichun Zhang, but he had preferable herbs to use. This benefits we all the following doctors very much. I, the author of this article, followed the experience of Dr. Liangchun Zhu, developed my own “Wumei Gancao Tang” and “Single Wumei Tang”. I used it in the clinic, with some modifications of the formula, for the treatment of various diseases in weakness conditions, such as chronic liver disease with low fever, various weakness conditions which do not enable nourishing therapies, long term poor sleep in chronic liver disease, early wake up, pain under the ribs, diabetes, bleeding in stool, premature ejaculation, leakage of sperm fluid, impotency, early ejaculation, weak asthma with Qi escaping, hiccup in severe disease conditions, acute and severe vomit bleeding in bronchiectasis, heavy bleeding from uterus, stomach pain, hernia, burping, tumor in female system, polyps, chronic cough, etc. Many years clinic experience proved that, the liver-nourishing therapy with Wumei can be used together with any other kinds of weak-nourishing therapy. It can also be used together with mass-softening therapy to soften mass, lamp or tumor, or used with Yin-nourishing and blood-producing therapies.

前人有酸能敛邪之说,凡遇挟有外感之证,对诃子、乌梅、五味子等酸味药,列为禁忌,临床实践证明,慢性鼻窦炎、下痢及咳嗽,均有外邪未尽之病例,用诃子、五味子、乌梅等酸敛药,亦无敛邪之弊,知蒙医用诃子如同中医用甘草者,即知酸能敛邪之说实属片面

There was a saying by doctors in old time that “The sour could keep the Xie Qi in the body”. They said that, once there is external common cold, the use of herb Hezi, Wumei and Wuweizi, etc. would be forbidden. However, clinic practice showed that, in the case of chronic sinusitis, chronic diarrhea or cough, there could be reaming external Xie Qi in the body. In such cases, the use of Hezi, Wumei, and Wuweizi, such sour-restraining herbs, has no Xie Qi-remaining result. From the Mongolia medicine, in which the use of Hezi is as popular as the use of Gancao in Chinese medicine, it is known that, the statements above are not proper statements (not always correct).

当代中医耆宿邓铁涛先生指出,临床研究是中医药学最重要的实验室。我只想说明,不仅只有微观才能进行科学研究,根据中医药的宏观理论,也能进行科学研究,并且取得超现代的研究成果

Dr. Tietao Deng, a famous Chinese medicine doctor in modern time, pointed out: “The clinic practice is the most important laboratory for Chinese medicine. I only want to say that, it is not true that only a micro-study is scientific study. Based on the macro-theory of Chinese medicine, the scientific study can also be done and can achieve great results.”

 

2. 朱良春治疗外感久咳的经验和特色选析

2. Experience of Dr. Liangchun in the treatment of chronic cough

http://www.tcm369.com/html/zzlw/200810/16-213.html  


摘 要:

Abstract:

朱良春老师治疗外感,久咳的特色为通治方和辨证论治相结合,自拟清肺定咳汤结合辨证加减统治风热久咳诸证,自拟旋复夏麻芍草汤结合辨证加减统治风寒久诸证,疗效卓著,经得起临床反复验证,所拟方药,简朴轻灵,屡屡中病,效验如神,其通治方中寓仲景用药之刚,寓锡纯用药之朴,寓温病家用药之轻。且简朴轻灵之中,寓宣,清,润,降,和,补,涩七法,吾辈借浅析朱师之经验和特色,进而例举事实,探讨通治方和辨证论治相结合之途径,以论证中医现代化之必由之路,当代中医泰斗邓铁涛先生指出中医现代化,必须按中医的自身发展规律,沿着验便廉的方向发展此乃民族心声矣,吾辈为之拍手称好。 

The characteristics of Dr. Liangchun Zhu in the treatment of external common cold and chronic cough is to combine the herbal formula “Tong Zhi Fang” (Overall formula) with specific herbs directed by individual diagnosis. He developed herbal formula “Qing Fei Ding Chuan Tang” (Lung-clearing and asthma-stopping formula), combined with diagnosis of the clinic condition for each patient, to treat chronic cough due to Wind-Hotness. He also developed “Xuan Fu Xia Ma Shao Cao Tang”, combined with diagnosis of the clinic condition for each patient, to treat cough due to Wind-Cold invasion. The herbs work very well and reproducible too in clinic practice. The herbs used in the formula is simple, ordinary and light in dose. It works again and again as mystery. The Tong Zhi Fang bears the nature of strong from Zhongjing Zhang (Jing Fang), the simplicity from Dr. Xichun Zhang, and the light dose from Wenbing style. In its simplicity, light in dose, it also bears the expanding, releasing, humidifying, descending, harmonizing, nourishing and restraining effects. Now, we want to have a brief discuss on the characteristics and the experience of Dr. Liangchun Zhu. By clinic case reports, we furthermore study the way to combine the “Tong Zhi Fang” and individual diagnosis, to explore the pathway of the modernization of Chinese medicine. Dr. Tietao Deng said:  “The modernization of Chinese medicine must follow the rule of the Chinese medicine per se, and follow the path of effective, cheaper, and simplicity.” This is the heart sound of our nation.

久咳,有外感内伤之分。外感为实证, 分风寒、风热、燥热3型;内伤咳嗽为虚证,分痰湿咳嗽和阴虚咳嗽两证,外感久咳并非小恙.治不得法.则缠绵难愈,甚则变生大病。朱师临床辨证,思路宽广.法简效宏,常以轻灵中病,切中要害。并以宣、清、润、降、和、补、涩七法为纲,治久咳善熔数法于一炉,兼顾主证和夹证,并以辨证论治和通治方相结台(自拟之通治效方)既有主方,又有灵变。历代诸贤治咳经验虽圭璧琳琅,然各有所长.亦各有所弊,清一徐灵胎云:诸病之中,惟咳嗽之病因各殊而最难愈,浩或稍误,即遗害无穷。余以此证考求四十余年,而后始能措手。纵观历代医家论咳,多认为咳嗽乃是棘手的病症,吾辈整理选析朱师之治咳经验和特色,意为探讨通治方和辨证论治相结合的途径以论证中医现代化之路。 

The chronic cough can be separated into external and internal groups. The external Xie Qi invasion belongs to overwhelming condition. It can be further separated into Wind-Cold, Wind-Hotness, and Dryness-Hotness subgroups. The cough due to internal damage is a weakness condition. It can be separated into phlegm-wetness and Yin deficiency subgroups. The chronic cough developed from common cold is not at a mild disease. If the treatment is improper, it can last for a long time and develops into severe disease later. In clinic diagnosis, Dr. Liangchun Zhu has broad mind and open mind. His therapy is simple while the effect is excellent. He usually uses light dose to reach the healing aim. In his herbal therapy, he involved in one herbal formula the healing principles of expanding, clearing, humidifying, reducing, harmonizing, nourishing and contracting. The herbal formula takes care of the treatment of main cause of the cough as well as the complimentary symptoms. He uses his Tong Zhi Fang as basis for the treatment, combined with more or less modification of the formula by considering the diagnosis of each patient’s condition. For sure there are rich clinic experiences from the doctors in previous generations. However, for every thing, if something is good in one aspect, there would be some shortness in other aspects. Dr. Lingtai Xu, the famous doctor in Qing dynasty, said: “among all the diseases, the reasons for the cough are largely variable and the treatment is also critical. Once the treatment is not proper, the remaining cough may cause various big trouble in future. I have tried to solve this problem for 40 years and then could start to find some solution.” An overview of the statements from many different doctors in history, it can be found that most of them believe that it is not easy to solve cough. We here summarize the experience and characteristics of Dr. Zhu in the treatment of chronic cough, with the aim to understand how to combine the use of Tong Zhi Fang and the individual diagnosis, so as to explore the pathway of modernization of Chinese medicine.
  
(1)
风热久咳定咳汤   统以荞麦鱼腥加 
(1). For chronic cough due to Wind-Hotness, always use Ding Ke Tang (cough-stopping formula), with the addition of herb Qiaomai and Yuxingcao, for the treatment.
朱师自拟清肺定咳汤,药用:金荞麦20g ,鱼腥草(后下)15g,白花蛇舌草20g,天浆壳12g,化橘红6g,苍耳子、枇杷叶(去毛包)10g,生甘草5g,为基本方。治疗风热流感,支气管炎,肺炎久咳而偏于痰热者。有清肺、化痰、定咳退热之效。尤对风温(肺炎)咳嗽、痰多、发热、痰粘稠或黄脓痰,苔微黄、脉数、并口渴欲饮之证,颇有速效。高热咽喉肿痛,腮肿目赤加蝉衣、僵蚕(借两者疏风热,利咽化痰,抗过敏之用);恶寒者加炙麻黄3g ;高热便秘者加牛蒡子或生大黄;咳喘甚者加葶苈子、桑白皮。

Dr. Liangchun Zhu developed his own herbal formula Qing Fei Ding Ke Tang. It contains Jingqiaomai 20 g, Yuxingcao (add later in cook) 15 g, Baihuasheshecao 20 g, Tianjiangke 12 g, Huajuhong 6 g, Cangerzi 10 g, Pibaye (remove hair and fold in gauze) 10 g, Gancao 5 g. It is used to treat chronic cough in Wind-Hotness common cold, bronchitis, or pneumonia, which belongs to Phlegm-Hotness type cough. It works to clear the lung, to dissolve phlegm, to stop cough and to reduce fever. It is especially good for Wind-Fire cough (pneumonia), more phlegm, sticky phlegm, yellow-pus phlegm, and fever. The tongue cover is slight yellow. The pulse is frequent. The patient has thirsty and has desire to drink. If the patient has high fever, sour in throat, swelling in cheek and red color in eyes, add herb Chanyi, and Jiangcan to the formula (these two herbs work to clear Wind-Fire, to clear throat, to dissolve phlegm and to fight against allergy). If there is chilly feeling, add Zhi Mahuang 3 g. If there is high fever with constipation, add Niubangzi or Dahuang. If the cough and asthma are very severe, add Qinglizi and Sangbaipi.

清肺定咳汤,乃朱师自拟之通治风热久咳方,吾辈历年仿用,治疗上述诸证,屡收速效,此方对痰热蕴肺之久咳、痰多或痰粘阻滞、咳唾不爽之证极为合拍。方中金荞麦又称天荞麦、野荞麦、开金锁,名出《植物名实图考》性味甘寒,微苦涩,有清热解毒,祛风利湿,活血祛瘀功能。《分类草药性》谓其能补中气,养脾胃。治咽喉肿痛、肺脓疡、肝炎、筋骨酸痛、菌痢、白带等。有清化痰热之功,朱师治疗风热久咳,肺、呼吸道及肠道感染,喜以本品和鱼腥草为对。

We have used this formula in our own clinic practice for many years. When used to patients with the clinic conditions as above, it works very fast. It works much effective for the cough due to long term accumulation of Phlegm-Fire in the lung; the phlegm is much in volume; the phlegm is sticky and hard to spit out. The herb Jingqiaomai in the formula is also called Tianqiaomai, wild Qiaomai, Kaijingsuo. In book <<Zhiwu Ming Shi Tui Kao>>, it states that, the herb is sweet and cold, slight bitter and astringent in herbal nature. It works to clear fire and detoxify, to dispel Wind and to clear wetness, to improve blood circulation and to dissolve blood stagnation. In book <<Fenglei Caoyao Xing>>, it says that the herb works to nourish the middle Qi, and to nourish the Spleen and Stomach. It works for sour throat, lung pus, hepatitis, sour in tendons and bones, bacteria dysentery, and white discharge, etc. It has the function to clear hot phlegm. Dr. Zhu likes to use herb Yuxingcao together, when he uses is for the treatment of chronic Wind-Fire cough, and infection in the lung, respiratory tract, and intestine system.   

考鱼腥草性味辛寒,功能清热、解毒、利尿、消肿。《分类草药性》谓能去食积,补虚弱,亦是治疗肺及呼吸道感染的良药。药理研究有抗菌消炎,增强免疫功能,和利尿通淋三大作用。二药相伍,其清化痰热和利湿之功得益彰,盖无湿不生痰,无热不生痰,湿和热是酿痰之因,湿和热交混蕴结,则痰旋除旋生。今二药相伍同为清热祛湿,湿热二邪分化则痰无再生,不是祛痰,胜似祛痰,痰消则久咳自止。

Yuxingcao is spicy and cold in herbal nature. It works to clear Fire, to detoxify, to improve urination, and to dissolve swelling. It is stated in the book <<Fenglei Caoyao Xing>> that it works to dissolve accumulated food in stomach and to nourish weakness condition. It is therefore also a good herb ingredient in the treatment of diseases in respiratory and intestine systems. Pharmacologic study suggested that it bears function of fighting again bacteria, to reduce inflammation, to improve immune function, and to improve urination and to solve infections in urinary system. The combination of the Jingqiaomai and the Yuxingcao works much better to clear the hot phlegm, and to clear the wetness in the body. Since if there is no wetness, there would be no phlegm, and if there is no fire, there would be no phlegm either, the wetness and the fire is the reason for the development of the phlegm. Once the wetness and the fire tangle together, the phlegm is developed soon. Now with the use of these two herbs, the wetness and the fire are removed, the phlegm would not be produced any more. They do not work to dispel the phlegm but work much better than to directly dispel the phlegm. When the phlegm disappears, the cough would stop too. 

先师祖章次公言及祛痰古称宣肺,镇咳古称肃肺,故分化湿热二邪,即是杜绝痰热再生的治本之法。《分类草药性》谓金荞麦能补中气,益脾胃,鱼腥草能去食积补虚弱,确有其理,因甘可悦脾,甘寒能养阴补益肝肾,且鱼腥草微辛,金荞麦微苦涩,微辛能开、微苦能降,微涩能补。

Master Cigong Zhang said: “In old time, to dispel phlegm is called to depend the lung. To stop cough is called to cooling the lung”. Therefore, to dissolve the wetness and the fire, the two Xie Qi, is the radical healing to stop the development of hot phlegm. In the book <<Fenglei Caoyao Xing>>, it says that the Jingqiaomei could nourish middle Qi and to nourish the Spleen and Stomach, and that Yuxingcao works to remove stocked food in the stomach, so as to nourish the weakness. This is true, since the sweat herbal nature could nourish the spleen and the sweet and cold could nourish the Yin and to nourish the liver and the kidney. The Yuxingcao is slight spicy and the Yingqiaomai is slight bitter and astringent. The slight spicy works to open, and the slight bitter works to cause reduction effect, and the slight astringent works to nourish.

方中白花蛇舌草除助其分化湿热二邪和清化痰热之外,还能提高机体抗病能力和调节免疫功能。天浆壳亦名萝雌,性味咸平,能软坚、化痰、清肺、止咳、平喘。枇杷叶微苦辛,清肺和胃降气化痰,气下则火降痰顺,而逆者不逆,呕者不呕,咳者不咳矣。二药均镇咳平喘用量不可过大,此方有宣肃同用之妙。

The herb Baihuasheshecao in the formula works to dissolve the wetness and the fire, so to help to clear the hot phlegm. It also works to improve the body defense energy and to adjust the body immune function. The herb Tianjiangke is also called Luoxiong. It is salty in taste, and not so cold or hot in herbal nature. It works to soft hard mass in the body, to dissolve phlegm, to clear the lung, to stop cough and to stop asthma. Pibaye is slight bitter and spicy. It works to calm stomach, to downward reduce Qi and to dissolve phlegm. When the Qi downward moves, the fire would also downward moves and the phlegm is easy to be dispelled, so that the reversed Qi is no longer to reverse; the nausea is not longer to nausea, and the cough is no long to cough. To stop cough and asthma, the amount of the Baihuasheshecao and the Pibaye should not be large in the formula.
 
方中借苍耳子有抑制流感病毒和抗过敏之作用,又能祛湿升阳通督,朱师喜掺用流感方中意寓扶正。橘红调中化痰,甘草润肺止咳,共奏清肺定咳之功,朱师曾治汤某,咳嗽缠绵一月,服中西药多方未愈,咳呛胸痛,口干欲饮,纳食不香,痰多粘稠,夹黄脓痰,舌红苔黄腻,脉弦细。朱师诊为痰热蕴肺,外感误治,投清肺定喘汤5剂,咳止痰净,诸证如失。

Herb Cangerzi works to inhibit flu virus and inhibits allergic reaction. It can also dispel the Wetness, to raise the Yang Qi and to conduct the Qi movement in the Dou meridian. Dr. Zhu likes to use it in the formula for the aim to support the body defense energy. The herb Juhong (the skin of the orange) works to calm the middle stomach system, and to dissolve phlegm. The herb Gancao works to humidify the Lung and to stop cough. All the herbs work together to clear the lung, and to stop cough. There was one patient, Mr. Tang, who had cough which came and went for one month. He had been treated with both western medicine and Chinese medicine but none worked. He had strong cough with pain in chest, dry mouth with desire to drink water, poor appetite without delicious taste to food and lots of phlegm which was sticky and hard to spit out. Within the phlegm, there was yellow pus. His tongue was red in color. The tongue cover was yellow and greasy. The pulse was string and thin. Dr. Zhu considered his condition was accumulation of hot phlegm in the lung, which was due to mis-treatment in early common cold phase. Dr. Zhu prescribed the Qing Fei Ding Ke Tang for five doses (one day one dose). The cough stopped and the phlegm was not more there. No any other symptoms left after the five days.  


(2)
、风寒久咳经方加  旋复夏麻芍草汤

(2). For Wind-cold cough, use Jing Fang formula. It is the Xuan Fu Xia Ma Shao Cao Tang.

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朱师自拟旋复夏麻芍草汤,乃融仲景旋复代赭汤、小半夏加茯苓汤,芍药甘草汤,甘草麻黄汤于一炉,并以旋复花合小半夏汤为组方主药,药用:旋复花8g,生旱半夏6 10g,生麻黄1.5g,茯苓6g ,生姜3片,生白芍、甘草各3g,为基本方。

Dr. Liangcun Zhu also developed another formula for the treatment of Wind-Cold cough. It is the so called Xuan Fu Xia Ma Shao Cao Tang.  It is the modified mixtures of Dr. Zhongjing Zhang’s formula: Xuanfu Daizheshi Tang, Xiao Banxia plus Fuling Tang, Shaoyao Gancao Tang, and Gancao Mahuang Tang, but with the Xuanfuhua plus the Xiao Banxia Tang as the main part. The ingredients are: Xuanfuhua 8 g, Banxia 6-10 g, Mahuang 1.5 g, Fuling 6 g, fresh ginger 3 pieces, Baishao 3 g, Gancao 3 g.

咽痛喉痒者加桔梗、前胡各5g,薄荷2g;恶风、食少乏力,手足不温者加徐长卿l0g,荆芥6g;久咳痰少粘稠加浙贝、桑叶各6g;此方以其简朴轻灵而屡建奇功,通治风寒久咳,凡因中西医误治之外感风寒久咳不愈者,毋论新久虚实或寒热夹杂,甚至缠绵数月或半年未见化燥化火者,或遍用中西诸药未效者,投此方效验如神。310剂而愈,尤其对老弱虚人、小儿不耐抗生素或市售中西止咳药无效者,更为合拍。笔者仿朱师之法,历年来以此方化裁治疗风寒久咳,屡有一两剂霍然而愈者,3 l0剂治愈者多不胜举。

If the patient has pain and itch in throat, add herb Jiegen 5 g, Qianhu 5 g, and Bohe (mint) 2 g. If there is wind-disliking feeling, poor appetite, fatique and cold hands and feet, add herb Xuchangqin 10 g, Jingjie 6 g. If there is chronic cough with little phlegm only and the phlegm is sticky, add Zhe Beimu 6 g, and Sangye 6 g. This formula is light in herbal amount whereas it works very well for all Wind-Cold cough. Whenever the cough is due to an improper treatment by western medicine or Chinese medicine, and no matter it is acute cough or chronic cough, or with Fire-Cold complex, even if the cough has been there for months or half year without any evidence that the condition develops into Dryness and Fire condition, of if there is no any ways to treat it, use this formula and it works again and again for only three to five doses. It is especially good for old person, weak person or children who could not tolerate the antibiotics. I, the author of this article, have followed Dr. Linagchun, my master, to use this formula to patient with Wind-Cold cough. From time to time, it needed only one or two doses to solve the chronic cough. For most of the patients, they needed only three to ten doses (3 to 10- days) of treatment.

列医案一则,以举一反三,笔者于1985年探亲,住某省会,一亲戚之友人独生子8岁,因外感风寒咳嗽,在省儿童医院诊为急性支气管炎,住院治疗3个月,使用多种抗生素、激素,花费了数千元费用罔效,并亦用中药配合治疗,所谓中西医结合。杏苏散加减,止嗽散加减,桑菊、银翘加减,三拗汤加味,麻黄汤加味,小青龙汤等方杂投,了无寸效邀笔者诊时见咳呛阵怍,少有痰声,似燥咳而实非。咳声不爽,自述咽痒,咽痛痰难,舌淡苔白薄,脉沉细紧,大便二日一行,此乃风寒郁闭之久咳,仿朱师旋复夏麻芍草汤加味.药用:旋复花6g,半夏3g,生麻黄1g,茯苓6g,生姜3片,生白芍、甘草各3g,桔梗5g,前胡3g,薄荷2g,嘱放陶瓷有盖口杯隔水炖15min温服,2剂。服后诸证十去八九,嘱再服2剂以善后,仅花药费2元余。病家大赞中医药疗效之神奇,大赞中医药之简便廉验的特色。 

Here is one case, for example. In year 1985, I came home to visit my family. I lived in a provincial capital city and met a child, who was the sun of one of my friends there. The child got Wind-Cold common cold and had cough. He was diagnosed as acute bronchitis in the provincial children hospital. He was kept in the hospital ward for the treatment for three months. He was given various antibiotics and even hormones for the treatment. The family had spent several thousands of dollar but no any improvement. At that time, he was also given Chinese herbal therapy, so called the combination western medicine with Chinese medicine, by using Xingsu San, or Zhisou San, with addition of herb Sangju Yin, or Yinqiao San, San-ao Tang, Mahuang Tang, Xiao Qinglong Tang, etc. When I was invited to have a consultation, I saw that child had frequent cough, with little phlegm noise only. It seemed to be a dry-cough but actually it is not. The sound of the cough was not smooth. The child said he felt itch in throat, pain in throat and hard to spit phlegm out. The tongue was pink in color. The tongue cover was thin and white. The pulse was deep, thin and tight. The bowel movement is once or twice a day. His condition was considered to be long term of Wind-Cold sluggish in the body, that causes the chronic cough. I followed Dr. Zhu to use the Xuanfu Xia Ma Shao Cao Tang with some addition: Xuanfuhua 6 g, Banxia 3 g, Mahuang 1 g, Fuling 6 g, fresh ginger three pieces, Baishao 3 g, Gancao 3 g, Jiegen 5 g, Qianhu 3 g, Bohe 2 g. I asked the family to put the herbs into a clay pot to steam for 15 min. Drink the herbal tea for two days. After the therapy, the cough was reduced for 80 to 90%. I asked him to continue for additional two doses. The total cost for the treatment was only two dollars. The family praised the Chinese medicine very much for its mysterious effect and its cheap in cost and effective in healing. 


朱师治咳用药主张简朴轻灵,简朴轻灵之品能开达上焦,肺位上焦,上焦如羽,非轻不举风寒郁闭于肺,是外感久咳不愈之主要原因。临证中见风寒久咳者较多。

Dr. Liangchun Zhu recommended to use small dose of herbal therapy for the treatment of cough, since the light dose allows floating of the herbs in the upper Jiao, while the lung is located in this upper Jiao. “The upper Jiao is as a feather of a bird, the herbs must be also light so as to raise to the upper Jiao.” The sluggish and stagnation of the Wind-Cold in the Lung is the reason for chronic cough. In clinic, such Wind-Cold cough is more common.

究有外感风寒误投辛凉或甘寒之过,有早用镇咳肃肺之品至风寒郁闭于肺,更值一提的是时医 (指西医和自我从属西医的中医) 统以炎症为热证,不论寒热气管炎、流感、上呼吸道感染,统以消炎论治,均投类似寒凉中药之类的抗生素和消炎药,或以清热解毒中药统治炎症,殊不知中医的辛温疏散,宣肺祛痰,发汗温阳等均有��炎之奇效。

In clinic, there are cases, who have Wind-Cold cold but are given Spicy-Cold or Sweet-Cold herbs, and who was given cough-stopping and Lung-descending herbs too early so as to cause the Wind-Cold stocked in the lung. More worse thing is that doctors in western medicine and also some Chinese herbal therapist who actually belongs to the western medicine, regard all the inflammation condition as the Hot or Fire condition. They use antibiotics to all the conditions, such as bronchitis, flu, or upper respiratory infection, regardless of these conditions belong to Cold or Hot. In such conditions, they always use the western medicine, that belong to the Cold in Chinese medicine, or use the herbs, that also belong to Cold in Chinese medicine, for the aim to solve the “inflammation”.  They do not know that, the spicy-warming, the lung-expanding, the phlegm-dissolving, the sweat-creating and the Yang-warming therapies, all bear mysterious “inflammation-clearing” function.

经云:咳嗽之总病机为痰涎或水饮,聚于胃,关于肺上方辛开渗利,方中旋复花、旱半夏,降逆和胃之中,而又加茯苓以涤饮除痰,在仲景伤寒金匮中咳者加半夏,痰多加茯苓,几为定律。

In the medical bible, it states: “The key reason for cough is the phlegm or water, which accumulated in stomach, and associated to the lung”. The herbal formula above has spicy-opening and filtration-improving function. In the formula, the herb Xuanfuhua and Banxia work to suppress the reversed Qi, and to calm stomach. The Fuling works to dispel phlegm and water. It is almost a rule in the herbal formula in the <<Shang Han Lun>> and in <<Jing Kui Yao Luo>>, the book by Mater Zhongjing Zhang, to add herb Banxian for cough and add herb Fuling for rich-phlegm.  

盖旋复花、半夏降逆,则气降咳自止,茯苓利水则水去痰自除,观金匮痰饮咳嗽篇,半夏原治支饮,苓甘五味姜辛汤条下,咳者复内半夏以去其水,此乃半夏既能治咳又能利水之明证也,故半夏治咳,何尝不利水,水为痰之源,茯苓渗利行水,何尝不治咳,更妙在轻用生麻黄意在通阳于外,少用茯苓则通阳于内。水气搏于外,则用麻黄,水气搏于内,则用茯苓,两端兼顾,寓化气止咳,利水除痰之妙。

Xuanfuhuo and Banxia works to reverse the reversed Qi. Once the reversed Qi is returned down, the cough should stop. The herb Fuling works to dispel water. Once the water is removed, the phlegm is dissolved. In the chapter for cough and phlegm in the book <<Jing Kui Yao Luo>>, the herb Banxia is used to solve Zhi Yin (water accumulation in the Lung). Under the paragraph for the herbal formula Ling Gan Wuwei Jiang Xin Tang, it says “If there is cough, add Banxia to remove water”. These statements clearly indicates that the herb Banxia can both stop cough and to remove water. Therefore, the herb Banxia works to stop cough, and why it does not work to clear water too? The water is the source of phlegm. The herb Fuling works to remove water by improving water filtration, and how it does not works to stop cough too? More interesting thing is the use of small amount of herb Mahuang, which bears aim to conduct Yang Qi in the body surface. The use of small amount of herb Fuling bears aim to conduct the Yang Qi inside of the body. If the Water Qi is stuck in the body surface, use herb Mahuang. If it stuck in the inside, use Fuling. When both are used, the combination works to move the Qi to circulation, so as to stop the cough, and to filtrate the water, so as to dissolve the phlegm.

方中旋复花咸温微辛,功能消痰、下气、软坚、行水,《本草正义》云旋复花,其主治当以泄散风寒,疏通脉络为专主又云或谓旋复花降气,寒邪在肺,不宜早用,则止知疏泄之力足以下降,而不知其飞扬之性本能上升,伍半夏、生姜,又取三药之辛开,辛者能散能横行,故能携麻黄宣散肺气达于皮毛,降中有宣,宣中有降,肺之治节有权,取旋复花之味咸,咸能入肾,故能纳气下行以归根,俾胃中之痰涎或水饮下行,即无逆犯肺之害,方中少用生白芍、甘草,以酸甘合化,既益肺津,又轻敛肺气,且二药为伍,有缓解支气管平滑肌痉挛之功,故有止咳作用。

The herb Xuanfuhua (hua means flower in Chinese) works to dissolve phlegm, to down-reverse the Qi, to soften hard mass, and to conduct the movement of water. In the book <<Ben Cao Zhen Yi>>, it states that “ Xuanfuhua mostly works to dispel the Wind-Cold, and to relax the meridian”. It also states that “That Xuanfuhua works to down-moving the Qi. If the Cold Xie Qi is in the lung, it should be used in early phase of the disease. This statement only tells that the herb’s dredging function could cause descending function, but not knows that its expanding function could also cause the Qi to raise”. When the Xuanfuhuan is used together with herb Banxia and fresh ginger, all of which are with spicy-opening function, the spicy yields function of expanding and of horizontal movement, so as to help the herb Mahuang to  expand the lung Qi to the body surface layer. When there is expanding function among the down-descending, and there is descending function among the expanding, the lung works well (to open and to close). The herb Xuanfuhua is also salty in taste. The salty taste could come into the kidney, so the herb could work to direct body Qi down-move to be kept in store phase, which makes the water in the stomach down-movement, but not upper-movement to attack the lung. The use of herb Baishao and Gancao is to use their sour-sweat tastes, which tastes work to humidify the lung and to kindly contract the lung Qi. Also, the use of the these two herbs in the same formula enables to relax the spasm of bronchi muscle, so has cough-stopping function.

临床反复体会生半夏、旋复花、生姜、白芍、甘草五药在方中为举足轻重之品,不可代替,此方药简,剂小量轻,不取煎服,而取口杯加盖隔水炖服,亦是取效之关键。试以《伤寒论》太阳篇桂枝汤煎服法为例,煎前简单加工,火候、加水量、煎出量,服药量、服药温度、服后辅助措施,药效观察、重症服法、变证服法、饮食禁忌等。交代得详细备至。先圣医嘱之周全,足为吾人师法。

The experience in clinic practice again and again showed that, the herb Banxia, Xuanfuhua, fresh ginger, Baishao and Gancao, are most important ingredients. They could not be deleted. This formula is simple and the dose is little in amount. For preparation, it is not cooked as regular herbal formula, but is steamed in a cup with cover of the herb pot. This is another very important step. Let’s look at the Guizhi Tang in the book <<Shang Han Lun>>. It tells the way for the pretreatment of the  herbs before cooking, the level of the fire for cooking, the amount of water needed, the amount of the final extract, the amount to drink each time, the temperature of the herbal tea to drink, the procedures after the drink, observation after the drink, the way to drink for severe cases, the way to drink for patient who develops different symptoms, the proper diet needed during the herbal therapy, etc. All of the details are introduced in the book. Our ancestor cares us so much in the use of the herbal formula introduced, which we benefit a lot.

读《伤寒论>除学习仲景辨证论治法则外,务必注意细微之处。〈伤寒论〉中的煎药方法,服药方法均有妙意所在。更值一提的是仲师用半夏乃是今之生旱半夏,近年全国大多地区均用水半夏,二者功效甚殊,笔者早有专论,此乃医药分家和学者受毒药禁用缪论的三规五戒之害也。仲景之百年沉冤急待洗雪。方本中病,而药是伪品则效失过半。继承医学遗产。不能以伪代真。但在南方大多城市,千百家药铺均售伪品,医者本领再大,亦叹无耐,只有医必带药一途,清·徐大椿所言:医必带药,诚非我欺矣。 
In the study of <<Shang Han Lun>>, we need to learn the principles of Dr. Zhongjing Zhang in the dianosis, and we also need to pay attention to the details in the use of herbs. The way to cook the herbs and the way to drink the herb extract, both bear tips and tricks. It should be pointed out that, the herb Banxia that Dr. Zhongjing Zhang used at his time is the land Banxia, that plant grows in land, while the Banxia now used in most area of China is the water Banxia, that grows in water. Their therapeutic function is much different. I have had a special article discussed this matter. This mistake come from the wrong idea that the clinic application of the herbs and the herbal pharmacologist could be separated and could be performed by different practitioners, and that the land Banxia is toxic. Such mis-comment to Dr. Zhongjing Zhang’s use of herbs needs a urgent correction. Even the herbal formula is correct for the disease, but if the herb is false, the healing effect would be lost half. To inherit the medical heritage, false herbs should not be used to replace the true herbs. However, in most cities in South of China, the herbal shops sell the false herb. Therefore, even if the doctor is so good in clinic, he/she would not be able handle his/her clinic healing. The only solution is to let the doctor handles the herbs the same time, so the doctor would know if the herb works or not. As the doctor Dachun Xu, in the Qing dynasty, said: “Doctor should handle the herbs too”. It is not only me who recommend this.

按:药方不在太小,服药后有效就是好方,医生也不在有名无名,能诊病能愈病就是好医生。简朴轻灵之小方如建立在辨证论治的基础上,而屡有效验,即是少而精的通用良方,然而这又是一般医生所难做到的。

Comment: It would be a good herbal formula, if it solves the disease, no matter the ingredient is simple or complex. It would also a good doctor, if he could solve the disease, no matter he is famous or not. If a small formula with only several ingredients and with low doses works to solve the disease, based on TCM diagnosis, it can be regarded as a basic formula. However, it is not easy for an ordinary doctor to develop such formula.

简便廉验的通治方和辨证论治相结合,是中医学走出低谷,按自身发展规律,实现中医现代化的必走之路,祖国医学本有通治方和辩证论治的特点,这符合中医临床文献所反映的本来面目。历代医学家在重视辨证论治的同时,亦探求医者较易掌握的通治方,通治方的优点是便于医患者在仓卒之间,按病索方。以删繁就简的证治规律去寻求更切合病证的通治方,对常见病的治疗更具现实意义。

In Chinese medicine, there are some herbal formula that can be used as a basic formula. In the use of such basic formula, it is still needed to make a TCM diagnosis to see if the basic formula needs additional modification. This is the characteristics of the Chinese medicine. This the way the Chinese medicine must follow, so as to develop it self from the lower phase to higher phase, and to higher developing levels, and to finish the modernization of the old medical system. Doctors in history tried to set up herbal formula based on the TCM diagnosis and also tried to find “basic formula” that is easy to understand and simple to use. The benefit of the “basic formula” is to allow doctor to make a quick decision for the healing within a short time and to make the complex clinic practice simple. It is more useful for the treatment of commonly seen diseases.

考〈内经〉鸡矢醴方治臌胀;生铁落饮治狂病;四乌贼骨一芦茹丸治血枯。<伤寒杂病论》中乌头汤治历节;黄芪桂枝五物汤治血痹;茵陈五苓散治黄疸;桂枝茯苓治妇人症积;甘麦大枣汤治脏燥等,均可谓辨病论治之通治方,明·孙志宏《简明医彀》中对200多种病的论治,均只列主方一项,后附有详细的加减法,历代方书中类似通治方的多不胜举。

In the book <<Nei Jing>>, there is formula called Ji Shi Li, which is used more specific for belly bloating, formula Sheng Tie Luo Yin for the treatment of madness disease; formula Si Wuzeigu Yi Luru Wan for the treatment of Blood withered. In the book <<Shang Han Lun>>, the herbal formula Wutou Tang is specifically for the treatment of arthritis which is very painful in joints; formula Huangqi Guizhi Wu Wu Tang for the treatment of blood Bi syndrome; formula Yichen Wu Ling San for jaundice; formula Guizhi Fuling Tang for female toxic accumulation syndrome; Gan Mai Dazhao Tang for nervous exhaustion syndrome, and so on, all of which can be regarded as the treatment of individual disease with a basic formula. In the book <<Jianming Yi Ke>>, written by Dr. Zhihong Sun in Ming Dynasty, it listed only one formula for each disease (totally 200 different diseases listed in the book), but with more detail explanation for how to delete or to add a herb to the basic formula. There are many TCM books in history, in which the basic formula was introduced.

朱师自60年代初就发表辨证和辨病相结合的论述(<中医杂志)19623)。历年来,创制了许多通治方,如治疗类风关的益肾蠲痹丸,治疗慢性肝炎和早期肝硬化之复肝丸,治疗痛风之痛风冲剂,治疗高脂血症之通降散,治疗久泻和下痢之仙桔汤等数十种,临床中以通治方和辨证论治相结合既能提高疗效,又能执简驭繁。笔者在继承朱师通治方的基础上也创制了多种通治方,如治疗乙肝、丙肝和各种早期肝硬化和肝结石之系列消症复肝丸,治疗儿童身材短小和疳证之益智增高散颇有通治性和简便康验的优点。当代中医泰斗邓铁涛先生指出:为国家为人民减轻医疗费用过高。就要用廉验的中医药去取代日渐昂贵的抗生素,此乃符合国情之民族心声矣。

From the early 1960’ Dr. Liangchun Zhu published articles talked about the combination of a basic formula with modifications under the direction of TCM diagnosis (<<Chinese Medicine Journal>> 3:1962). For many years, he developed a lot of such “Basic formula”. For example, he had the Yi Shen Yi Bi Wan for the treatment of rheumatoid arthritis;  the Fu Gan Wan for chronic hepatitis and early stage of cirrhosis; the Tong Feng Heji for the treatment of gout; Tong Jiang San for hyperlipidemia; and Xian Jie Tang for chronic diarrhea and dysentery, etc. for tens of them. In the clinic practice, the use of the basic formula, in combination of some modifications under the direction of TCM diagnosis, could in crease the healing effects and also could make the complex clinic procedures simple. I followed Dr. Zhu, my master, also developed my own “Basic formula, based on Dr. Zhu’s basic formula. For example, I have the “Xilie Xiaozhen Fu Gan Wan” for the treatment of type B, type C hepatitis, early cirrhosis, and hepatic stone syndrome; the Yi Zhi Zen Gao San for the treatment of short body of children, and poor digestion syndrome in children. They are simple in ingredients, effective in healing results, and cheap in cost. The famous TCM doctor of current time, Dr. Tietao Deng said: “To reduce the healthcare cost for the people and for the nation, we must use the simple, the cheap while effective Chinese herbal therapy to replace the gradually costing anti-biotics”. This is heart sound that meets the current and urgent needs of the whole nation.   

 

3.朱良春治疗颜面黧黑斑经验的临床运用

3. The treatment of facial dark tint by Dr. Liangchun Zhu

邱志济 邱江东 邱江峰(浙江省瑞安市广益中医疑难病诊所 325200
 
Author: Zhiji Qiu, Jiangdong Qiu, and Jiangfeng Qiu

颜面黑变病,中医按黧黑斑论治,多因肝郁血滞或��肾不足,阴虚肾色外露所致,西医有诊为瑞尔氏黑变病或阿狄森氏病。治疗比较困难,无有效方药,近年来,一些医生多建议患者去做各种美容,殊不知颜面黑变病是肝肾虚、损、瘀、郁所致的脏腑阴阳失调之病,许多患者化费巨资,经多年美容,黑斑非但没有隐退,且有增加黑变面积,加深黑色素等副作用。吾师朱良春教授活用仲景方肾气丸或局方逍遥散加减治黧黑斑疗效显著,笔者在继承朱师经验中亦有心悟和发挥,今将笔者运用朱师经验治疗黧黑斑的体会简介如下:
For dark tint in face, Chinese medicine regards it as dark tint and spot. It is mostly caused by liver sluggish, blood stagnation, or liver-kidney deficiency, and Yin deficiency so that the Kidney color escaped out on the face. In western medicine, it is diagnosed as Riel melanosis, or Addison’s disease. It is difficult to cure and no effective medicine for it. Current times, some doctors recommend patients to go for facial beauty treatment. They do not know that it is the disorder of the liver-kidney deficiency, in combination of sluggish, stagnation and toxic accumulation in the body. Many patients spend a lot of many to have the beauty management. Not only the dart tint did not reduce or disappear but also they had the size of the dark tint increasing, and the extent of the tint became stronger. Dr. Liangchun Zhu, following Dr. Jingzhong Zhang, used “Shen Qi Wan” or later time formula “Xiao Yao San”, with some modifications, for the treatment of dark tint in face, with excellent healing results. We, in the following of Dr. Liangchun Zhu’s experience, had our own further experience and realization. Here we introduce our own experience.


(1)
、水亏血弱虚郁兼、活用肾气调阴阳

The reason for the dark tint on the face is the blood deficiency, liver sluggish and blood stagnation. Use kidney-Qi for correction.   
各种颜面黑斑、黑变病,笔者历年仿朱师之法,按虚、损、瘀、郁论治,每见黑斑消退较速。《外科正宗》云:黧黑斑者,水亏不能济火,血弱不能华肉,以致火燥结成斑黑。《医宗金鉴· 外科心法要诀》云:黧黑斑,初起如尘垢,日久黑似煤形,枯暗不泽。临床见证好发于中年女性,西医认为是一色素性皮肤病。因多久治不愈,故对女性的心理、情志当有一定影响,故笔者仿朱师用肾气丸或逍遥散加减汤方外,并从虚、损、瘀、郁着眼,自拟解郁肾气散治疗水亏血弱,虚中夹郁之证每收著效,基本方药由:制香附、红参、三七、鹿角霜、肉桂、熟地、山萸肉、怀山药、丹皮、泽泻、茯苓组成。11味药碾细末后,每次服810g,日3次,饭前服(分别用蜜水或红糖水调成干饭状嚼服),并据寒热偏胜及虚、损、瘀、郁随证增减每药的配伍比例,历年来经治数十例黑变病,黧黑斑,均收满意疗效。

For various black spot or dark tint changes on the face, I, followed my teacher, Dr. Liangchun Zhu, treated it as the deficiency, stagnation, exhaustion and sluggish. The healing results are very good. It is stated in the book <Waike Zhenzong>: “The reason for dark tint on the face is the Water (in Kidney) deficiency that cannot nourish the Fire (in Heart), e.g. the water would not be able to make the fire as hot humidified fire. Dry Fire is not good for life in body. It also means that blood deficiency (blood belongs to water too) would not be able to nourish the muscle, so that the fire burns to create char-dark on skin”. It also stated in book Yi Zong Jing Dian: Waike Xin Fa Yao Jue: “Initially, the dart tint is as dust. After a long time, it becomes as dark as smoking and withered tint.” The facial dark tint is commonly seen in middle aged women. Western medicine thinks it a pigment-related skin disease. For it is hard to cure, it affects the patient emotion very much. I followed the experience of Dr. Liangchun Chun to use herbal formula Shen Qi Wan and Xiao Yao San for the treatment of facial dark tint. At the same time, considering the mechanism of this disorder as sluggish, stagnation, weakness and exhaustion, I developed herbal formula “Jieyu Shenqi San” to treat the dark tint due to blood deficiency, water exhaustion, with stagnation among the weakness condition. It works very well. The basic formula is herb Zhi Xiangfu, Hongshen, Sanqi, Lujiaoshuan, Rougui, Shoudi, Shanyurou, Huai Shanyao, Danpi, Zexie, and Fuling. The herbs were grinded into powder. Drink it 8-10 grams each time, three times a day before each meal (add honey water, or brown sugar water, into cooked rice, eat the rice with the herbal powder). The formula needs to be modified according to the body weakness, stagnation, exhaustion, cold or hot condition. For recent years, I have tried this formula to tens of cases with skin dark tint. It worked very well.  

曾治郎姓妇,38岁,自述10年前产后无诱因,两颧颊、前额出现黑变、黑斑,黑斑逐年加深扩大,边界不清,似尘垢煤烟,伴失眠或夜寐不安,常有头晕、目眩、耳鸣、健忘、心悸、心烦、头面偶有烘热、神倦、腰膝酸软、性欲减退、小便清频、带多清稀等证,诊见舌淡苔薄白,切脉虚弦,曾经多方求治,西医有诊为瑞尔氏黑变病有诊为阿狄森氏病,证属中医黧黑斑,乃肝肾不足,虚中兼郁,阳气不伸,阴气弥漫,肾色外露所致。治以滋肾水、补脾气、解郁结、平阴阳,投自制解郁肾气散,方药如上,日服3次,每次810g,服散剂月余,诸证渐见好转,黑斑始见减退,嘱守服解郁肾气散”6个月,(方中红参、三七、制香附、鹿角霜剂量随证变化,每月复诊时,诸药剂量灵活调整。)黑斑全部消退无痕,追访3年无复发。

I treated on case. It is a 38 years-of-old lady with family name of Lang.  She claimed that ten years ago, after birth delivery, she had dark tint on her cheek and on front head, without any clear reasons. The dark tint became bigger and bigger year by year. The board of the tint was not clear. It looked as smoking char. She also had poor sleep, and from time to time dizziness, tinnitus, poor memory, palpitation, occasional hot feeling on face, fatique, sour and weakness on lower back and on the knee, reduced sexual ability, long and clear colored urine, and large volume of clear-colored discharge, etc. Her tongue cover was thin and white. The pulse was weak and string. She had tried various therapies. Western medicine diagnosed her condition as Riel melanosis, or Addison’s disease. In Chinese medicine, it belongs to the skin dark tint syndrome and her condition was due to the liver-kidney deficiency, with stagnation among the weakness condition. The Yang Qi is stagnated, the Yin Qi spreads with the kidney Qi (Dark color) exposed on the skin. The therapy is to given to her should work to nourish the kidney water, to nourish the spleen Qi, to release the stagnated Qi, and to balance the Yin and the Yang. She was given the Jieyu ShenQi Tang. After several months, all the symptoms gradually became better, and the dark tint stated to became less. She was asked to take the herbal powder for six months (the amount of the herb Hongshen, Sanqi, Zhi Xianfu and Lujiaoshuan in the formula was verified according to the body condition on consultation each month). The dark tint disappeared completely. Followed for three years, no recurrence.  

金匮·肾气丸,仲景所治虚劳腰痛、消渴、妇人转胞等疾病,究其所治病证本质概为肾阴阳虚损,后世医家从其方剂组成加上临床验证演变,扩展了肾气丸之功用,其实肾气丸是寒热并用,刚柔相济,阴阳调协,阴中求阳、阳中求阴,阴阳双调的方剂,尤怡在《金匮心典》中指出:八味肾气丸补阴之虚,可以生气;助阳之弱,可以化水;乃补下治下之良剂也。 肾气丸制方园熟严谨,深得内经阴平阳秘之意,历代医家用治阴阳两虚之长期低热,或高热不退、久喘、高血压、失眠、慢性腹泻、水肿(慢性肾炎)、淋病等确有较好的疗效。

“Jingkui Shenqi Wan” is created by Dr. Zhongjing Zhang to treat weakness and sour in the lower back, dry mouth and heavy thirsty, and scrap turn around in ovary or uterus. The nature of the disease it actually treats is the Kidney Yin and Yang both in deficiency. Doctors in later generations, by clinic experience and by modification of its ingredients, develop it into the Shenqi Wan. In fact, it works for both Cold and Hotness conditions, for balancing the Yin and the Yang. It nourishes the Yin from the Yang and supply the Yang from the Yin side. Therefore it balance and adjust both the Yin and the Yang. In the book Jingkui Jin Dian, Dr. Yi You said: “ The Bawei Shenqi Wan nourish the Yin deficiency, so as to create more (Yang) Qi; it helps the Yang deficiency, so as to also create more water. It is the best herbal formula to solve the disease in the lower Jiao (around the perineal zone)” The Shenqi Wan is organized in its ingredient in a perfect manner, suggesting that it completely matches the idea of “To keep the Yin sufficient and to hide the Yang in stored” as in the book Nei Jing. From history, doctors used it to solve long term and low level of fever, or continuous high fever, chronic asthma, high blood pressure, poor sleep, chronic diarrhea, swelling (chronic nephritis), and urinary infectious diseases, etc. It works very well for such diseases.    

朱师用肾气丸改汤加味治疗黧黑斑取得著效,笔者仿朱师之法而加减其药改成散剂,且能同汤剂一样,随证增减每药的配伍比率,使患者免除长期煎药之苦,俾患者乐意接受治疗,坚持服药,才能有稳定的疗效。

Dr. Liangchun Zhu changed the Shenqi Wan from its original pill form into the water extract form with some ingredient modification. It is used for the treatment of facial dark tint with very good results. I followed Dr. Liangchun Zhu, further changed the water extract form into the powder, also with modifications in its ingredients based on clinic body conditions. Such change makes the patients avoid the inconvenient in herb cooking every day for a long time of healing period, so that the therapy is easier to be followed by the patients to get the results.

解郁肾气散乃八味肾气丸去附子加香附、红参、参三七、鹿角霜四药组成,方中香附倍用,首解肝郁,俾木郁达之,以遂其生生之气。盖木郁则火郁,火郁则土郁,土郁则金郁,金郁则水郁,今首制木郁,则诸郁皆解也。且香附有疏肝郁、行气滞、通血瘀之效,《本草正义》云:香附味辛甚烈,香气颇浓……凡辛温气药,飚举有余,最易耗散元气,引动肝肾之阳,且多燥烈,则又伤阴。惟此物虽含温和流通作用,而物质既坚,则虽善走而亦能守,不燥不散,皆其特异之性,故可频用而无流弊。方中香附助红参、三七、鹿角霜、茯苓、怀山药健脾气,乃有四君子汤合六味地黄丸之意,一补后天之脾气以生血,一补先天之肾水以生精,盖精血充盈,水火既济,阴阳调和,脏腑经络气血畅达,故颜面肌肤肾色外露可收,燥结黑斑可消。

The formula Jieyu Shenqi San means to remove the herb Fuzi from original formula Shenqi Wan but add Xiangfu, Hongshen, Sanqi and Lujiaoshuan. In the formula, the herb Xiangfu is doubled in amount. It works first to solve liver sluggish, so to improve the liver Qi movement. If the liver Qi is in sluggish, the spleen Qi is also in sluggish; if the spleen Qi is in sluggish, the lung Qi is also in sluggish; if the lung Qi is in sluggish, the kidney Qi is in sluggish too. Now, to use the herb Xiangfu to solve the liver Qi sluggish first, all the organ sluggish would be solved too. In addition, the Xiangfu works to solve the liver stagnation, to smooth the Qi circulation, and to clear blood stagnation. In the book Ben Cao Zhen Yi, it stated that: “Xiangfu is strong in spicy taste and in fragrant odor…… Herbs of the spicy-warming nature is strong to move. They are easy to exhaust the body Qi, so trigger out the Yang Qi in the liver and kidney, and so to exhaust the Yin. The herb Xiangfu also belongs to such spicy-fragrant herb. However, its material is hard, so, thought it bears the function to move, but also has nature to keep, to hold and to store (the body Qi). The special characteristics of it is not so dryness or dispersing allows its long time of use without worry too much of exhaustion of the Yang and the Yin. The Xiangfu also helps the Hongshen, Sanqi, Lujiaoshuan, Fuling, and Shanyao to nourish the Spleen Qi, bearing the meaning of the use of Si Junzi Tang plus Liuwei Dihuang Wan. Therefore, the formula works to nourish the spleen Qi to produce blood in one aspect, and to nourish the kidney water to produce more Jing (micro-nutrition material) in another aspect. Once the blood and the Jing are sufficient, the Water and the Fire in the body could help each other, to make the Fire not a dry Fire, and the Water not a cold water. By this way, the blood and the Qi circulation in the body is smoothly, the skin is nourished in a proper way. The facial dart tint could be cured.

方中有肾气丸去附子加鹿角霜之意,乃取补虚兴阳,温而不烈,益气填精,敛虚阳,补肾督之功,较肾气丸用附子更能适应虚中夹郁之证。鹿角霜性温而不燥,助阳以生阴、生血以填精。如按黑斑部位分辨,前额属肾、两颧属脾、两颊属肝,故此症着眼肝、脾、肾之虚、损、瘀、郁对证下药,随证灵变,收到满意疗效,功在辨证施治。

The formula is as the Fuzi has be replaced with the Lujiaoshuan from original Shenqi Wan. It is with the aim to nourish the weakness and to help the Yang with warm but not violent herbs, to help the nourishment of Qi and to fill up the Jing, to contract the floating Yang, and to nourish kidney and the Dou meridian. It is better than to use the Fuzi in the condition, in which there is sluggish and stagnation among the weakness. The herb Lujiaoshuan is warm, but not violent hot. It helps the Yang to develop the Yin, to produce blood so to fill up the Jing. Since the front head belongs to kidney; cheekbone belongs to spleen; the cheek belongs to the liver, the treatment of this disease should focus on the kidney, spleen and liver. The important thing to reach high healing cure rate is to use the herbs following the TCM syndrome diagnosis.  

此方选药一仿朱师用肾气丸加减之法,二从邓铁涛老教授用六味地黄汤加高丽参治阴虚火旺体质,长期失眠,中西药久治不愈而邓老只用三剂药基本治愈之案悟出。故用红参、三七、鹿角霜、肉桂补元气合六味地黄汤补阴精,使阴阳调和,阳生阴长,此亦所谓活用仲景肾气���之意也。

My formula first of all follows the way of Dr. Liangchun Zhu to modify herbal formula Shenqi Wan, and second follows the way of Tietao Deng to add Gaolishen in the formula Liu Wei Dihuang Wan to treat Fire overwhelming in Yin deficient condition, in which the person had long time of poor sleep that is hardly be improved with either western medicine or Chinese medicine. In the later case, Dr. Deng used only three herbs and solved the problem. I used Hongshen (red ginsheng), Sanqi, Lujiaoshuan and Rougui to nourish the Yuan Qi, together with the use of Liuwei Dihuang Tang to nourish the Yin, so that both the Yin and the Yang are nourished and harmonized. Once the Yang is growing, the Yin is also developing. This is the smart way of using the Shenqi Wan developed by Dr. Zhongjing Zhang.

(2)
、肝郁血滞黑斑审,庶虫丸合逍遥身

(2). If the facial dark tint is due to liver stagnation and blood stagnation, use herbal formula Dahuang Zhechong Wan and Xiaoyao San.
此型黧黑斑患者多为生育期妇女,发病原因据临床见证分析多与月经、胎产有一定关系,如月经延期23月一行,量少,夹有瘀块;或产后恶血未清,早进滋补;或产后情志所伤肝郁气滞,不得及时疏解,此型色素沉着有深褐略带青蓝色,或黧黑色,部位多见颧颊。临床证状常有眩晕耳鸣,双目干涩、月经不调、经前乳房胀痛,或入夜视力减退,或大便多日一解。因药不对症久治不愈,伤及肝肾,故有眩晕耳鸣,因肝郁血滞、疏泄失职,脾土运传失常,故大便多日一解。

This kind of facial dart tint is more seen in women in pregnancy age. The reason for the disease is more related to the menstruation and pregnancy. For example, the menstruation might be once 2 to 3 months, with less menstrual blood and with blood clots in the blood. They may be given nourishing therapy before the dead blood in the uterus had been cleared after a birth delivery. Or they had emotional stress which causes liver sluggish. This type of dark tint shows as pigment with dark brown color with blue tint; or with dark color. The dark tint is more on the cheekbone and cheek area. In the clinic, the patients usually have dizziness, tinnitus, dry eyes, disorder in menstruation, bloating feeling in breast before menstruation. They may have reduced vision at night, or had bowel movement once for many days. … 

戴元礼谓:郁者,当升者不升,当降者不降,当传化者不得传化,此为传化失常,六郁之病见矣。故此症多见大便多日一解是一特点,笔者曾治一黄姓少妇,6年前生育一女,因夫家长辈重男轻女,故产后受夫家父母冷眼相看,经常受气,乃致肝郁血滞,两颧颊出现对称黧黑斑,6年来经多方求治,中西药叠进,因药不对症,苦无少效,近年来有医生亲戚建议做美容面膜,一年来化费巨资,非但无效,反而色素加深,黑斑面积加大,以致心情更加忧郁。经亲友介绍求诊笔者,证见两颧颊褐黄带黑斑成片连绵如地图分布,患者体质尚可,询无不适之感,只是长期便秘,45日一解,眠食均可,经期延后,经色较黑,时见瘀块,且常有双目干涩,迎风流泪之证,舌淡薄白苔,切脉弦细涩,证属肝郁血滞,法拟疏肝郁,通血瘀、清肝热,方拟逍遥桑叶散,药用:当归、生白芍、柴胡、茯苓、炒白术、生甘草、煨姜、薄荷、冬桑叶、大黄庶虫丸(日3g另吞),前9味药共碾为散。逍遥桑叶散每药剂量随证变化,偏于肝郁气滞倍柴胡,偏于血滞倍当归、偏于肝热倍白芍、桑叶,偏于脾胃虚寒者倍煨姜,日服2030g,分3次饭前用蜜水调成干饭状嚼服,患者服散丸半月,即见褐黑斑有些消退,俾信心倍增,坚持服逍遥桑叶散大黄庶虫丸”3个月,黑斑全消不留痕迹。追访5年无复发。

Mr. Yuanli Dai said: “The sluggish means that, the Qi should rise but not rise, and it should go down but not go down. It should pass from one organ to another or from one meridian to another, but not so. One sluggish in one part of the body could cause the sluggish in all part of the body.”. Therefore, its characteristic is the constipation. I treated a lady, her family name was Huang. She gave a birth delivery of a girl. Because the family treasured too much for a male rather than a female, she suffered from emotional stress from the husband’s family members, which caused her liver blood stagnation and she started to have dark tint which is evenly distributed on the face. For the past six years, she had had lots of treatments by western medicine and Chinese herbal therapy but without any improvement. Later, she was suggested to use facial beauty membrane on her face. For one year, she spend a lot of money for such things but the problem remained the same and it was even worse, which made her more stress and disappeared. She was introduced to me by her friend. When she came to me, her facial dark tint looked as dark map with brown-yellow zone and dark spot. The body constitution was not so bad and she did not feel any strong discomfort except long terms of constipation, which was once for every four to five days. Appetite and sleep was fine. The menstruation was delayed later. The menstruation blood was dark with clot some times. She had dry eyes and tearing upon wind. Her tongue was pink and tongue cover was thin and white in color. The pulse was string, thin and not smooth. Her condition was considered as liver sluggish and blood stagnation. The herbal therapy was to dredge the liver, to conduct the blood circulation, and to clear the fire. The herbal formula given to her was ‘Xiaoyao Sang Ju San”. The herbs were Danggui, Baishao, Chaihu, Fuling, Chao Baizhu, Gancao, Wei ginger, Bohe (mint), winter Sangye. The herbs were grinded into powder. The amount of the herbs in the formula was changed according to the clinic conditions: if there was more liver Qi sluggish, double the amount of herb Chaihu; if the blood stagnation was more, double the amount of Danggui; if the liver hotness was overwhelming, double the herb Baishao and Sangye; if there was more weakness and cold condition in the Spleen-Stomach system, double the amount of wei Ginger. The herbal powder was taken 20 to 30 grams per day. It was separated into three parts. Each part was mixed with honey water to make into mud form to chew before each meal. At the same time, she was asked to take “Dahuang Zhechong Wan”. After half month of treatment, the dark tint showed some reduction, which increased the confidence for the patient. She continued the herbal therapy for three months, and eventually no any dart tint left on her face. This case was followed up for five years and there is no any recurrence.

逍遥散乃和解方,以养血为主,调气为先,是调和肝脾、培土疏木之主方,乃有和血解郁、疏达肝气之意,古人制方乃遵木郁达之,以遂其生生之气之意,是故治肝郁首要顺其条达之性,开其郁遏之气。肝之病必先实脾,并宜养肝血以健脾土。

The herbal formula “Xiao Yao San” is a formula to calm and to harmonize. It focuses to nourish the blood but adjust the Qi movement first. It is the formula to balance the liver and the spleen system, to nourish the soil and to dredge the wood. It works to nourish the blood and to release the sluggish and to dredge the liver Qi. Doctor in old time followed the principle of “the wood sluggish should be dredged, so as to release the sluggish in any other part of the body”, to establish this formula. Therefore, to solve the liver sluggish, the first thing needs to do is to dredge its Qi, following its natural nature (liver likes dredging). If the liver is in disorder, it needs to first of all nourish and to help the spleen, and to nourish the liver blood so as to help the spleen soil.

此方配伍精当,当归、白芍、柴胡、薄荷治肝,包含和血养血解郁。归芍养血以补肝之体,柴胡、薄荷通心腹胃肠结气,芳香疏散,使木郁达之。茯苓、白术、炙草、煨姜治脾,醒脾实脾。其用药比率肝脾相等,因肝脾两者相互为用,肝木得脾土之培育而调节有度,脾土得肝木之疏泄则运化有常 。肝藏血,主疏泄,体阴而用阳,也就是说肝以阴血为本,而能调节一身之气机为用,肝气郁结后,一方影响藏血,一方又易化火动风阳,故方中加桑叶助薄荷凉肝,而又清肝热,且有疏风达表之功,大有加一味能善一剂之功。可谓画龙点睛之处。逍遥散为何用少量煨姜?因脾为湿土,肝郁必侮脾,脾土失运则湿聚,故以煨姜温中燥湿。古人制方思虑入微,用心良苦之处,吾辈应于发扬光大。

This formula is organized well. The herb Danggui, Baishao, Chaihu and Bohe work to solve the liver disorder, including to harmonize the blood, to nourish the blood and to release the liver sluggish. The Danggui and Baishao work to nourish the body of the liver. The Chaihu and Bohe work to conduct the sluggished Qi in the heart, stomach and intestine. They are fragrant so being able to dredge the liver Qi sluggish. The herb Fuling, Baishu, zhi Gancao, wei ginger, work to help the spleen, to activate the spleen and to strengthen the spleen. The herbs to help and spleen and to dredge the liver are pretty equal in amount, for the reason that, the liver and the spleen help each other. When the liver gets help from the spleen, it would be able to adjust and to dredge the Qi movement. When the spleen gets help from the liver to dredge the Qi circulation, the digestion functions in a proper manner. … the herb Sangye helps the Bohe (mint) to cool the liver, and to clear the liver fire, as well as functions to dispel the Wind out of the body surface. It works as a whole formula, though it is only a single herb. This is very smart in the herbal therapy. Why use little amount of Wei ginger? The spleen belongs to wet soil. If the liver is in sluggish, it would affect the function of the spleen. If the spleen function is affected, the wet would be accumulated in the body. The wei ginger is used to dispel such accumulated wetness. Doctors in old time were very careful in the herbal formula establishment, so as to make the herbs work to solve the problem but do not cause side effect. We should learn from them.

因黧黑斑多肝郁血滞,久治不愈,考虑久病入络,故合用大黄庶虫丸,大黄庶虫丸汇集虫药,除络中死血,本治面目黯黑,肌肤甲错,乃有重药轻投,缓缓斡旋,虽不用补,不啻是补,虽不大清,不啻是清之功,仲圣有缓中补虚之说。颜面为肝、脾、肾经络循行汇集之地,尤以颧、颊、前额或鼻部出现黯黑、黧黑斑、,或红斑、血丝缕缕,均与肝、脾、肾络脉瘀结有关,相似于肌肤甲错,只是程度部位不同,故笔者每以大黄庶虫丸合逍遥散而收到著效。只是今之市售大黄庶虫丸价格昂贵,真假能分,值得提示。中医用药应有随遇而变的能力。

For the fact that, the dark tint on the face is mostly due to liver sluggish and blood stagnation and it lasts for long time with difficult to cure, it is considered the disease has developed deep into the meridians. The herbal pill “Dahuang Zhechong Wan” is therefore used. This formula contains various insects as ingredients, which work to pick up dead blood. Originally, it is used for person with dark face and harsh skin. It is used here with low dose, with the aim to let it works slowly. Though it does not work as a nourishing herbal formula, it works as to nourish. Though it does not work as a strong clearing formula either, it actually works so. … The face is the zone where the liver, spleen and kidney meridian accumulated. Especially the dark tint, dark spot, of red spot, or blood micro-vessels,  in the cheekbone, cheek, front head and on the nose, are related to the meridian stagnation in the liver meridian, spleen meridian, and kidney meridian. Such skin change is similar to the harsh of the skin, though it is different on the extent and on the disorder location. For this reason, whenever I used the Xiaoyao San with the Dahuang Zhechong Wan, the therapy worked well. It should be pointed out that, the Dahuang Zhechong Wan is very expensive and there would be false product in the market. The Chinese herbal therapist should have the ability to use replacing herbs to solve this problem.
按:作为现代中医,要懂得西医的检查,诊断,对了解病情,观察疗效,判断转归等具有十分必要的意义,但决不可受西医的检查和诊断所束缚,而放弃中医的辨证论治。许多疑难杂病西医受机械唯物论的理论体系影响,判为不治或难治。当患者正在久治难愈疑无路时,转由中医辩证论治,即出现柳暗花明又一村的奇迹。颜面黧黑斑患者大多认为是治不愈的痼疾,殊不知祖国中医学这个国宝有神奇莫测的法力。治病之难,难于识病机,但审探病机宜精细,病机有微有著,著者易明,微者难知,故应不忽于细,必谨于微,如本文下案患者前医曾用逍遥散改汤剂服2月未见好转,笔者审方药之思路无误,据证加味后,以调整原方用药之比率,改汤为散,收到理想之疗效,此乃知常达变,可举一反三也。久病痼疾,治在缓图,黧黑斑应理解为气血郁结较深的痼疾,形色长期改变,可谓根深蒂固,欲冀其速效,实不可能,拟丸散缓图,简、便、廉、验,此乃祖国中医学之一大优势。本文上案乃仿吾浙名医章虚谷《医门棒喝初案·虚损论》中所提的治虚损妙法;利机枢、治虚损章氏根据虚损之人,气血既亏,阴阳运行不能循度的特点,据人体清气出肝胆,资源发脾胃的道理,强调欲培其根本,必先利机枢肝胆脾胃乃是关键。笔者仿其随证设法,拟解郁肾气散更令仲圣肾气丸发挥治疗虚损的作用收到理想疗效,章氏之利机枢,治虚损之妙法诚非我欺也。

Comment: It is important for a TCM doctor in modern time to under stand the lab tests, physical exam and detect, and diagnosis in the western medicine, so as to understand the disease, to observe the healing effect and to predict the progress of a disease. However, we should not be bound up by the western medicine detects and diagnosis and should not give up our TCM unique diagnosis. Many obstacle diseases were declared to be impossible to cure by the western medicine that follows the mechanic materialism. When the patients have no way to go and turn to Chinese medicine, the mysterious healing results make the find and feet hope again. The facial dark tint is usually believed to be none-cure disorder. People do not know that there is mysterious way in the Chinese medicine to solve it. The most difficulty in the medical practice is to find the reason for the disease. When searching the reason for the disease, it is needed to be very careful. Some times the reason for a disease is clear and apparent there to allow being found out. Some times, it is a cloudy and hard to clear it out. For example in this case, the patient had used the Xiaoyao San as a herbal water extract, prescribed from previous doctor, for two months. No effect by that formula in that extract way. I checked it and believed the diagnosis is correct but modified the herbal ingredients according the person’s body condition, and also changed the water extract form into the powder form to take. The healing effect came out. This is the way to know the common rule but also the changed situation. For a long term disease, it has to be treated with the aim to reach the healing effect slowly. The facial dark tint should be recognized as a deep disorder of Qi-blood stagnation. The color and the shape of the skin has been changed, so it implies a deep-rooted disease. It would be impossible to get a fast healing result. The change from herb pill form into the powder form is to get the slower achievement in healing. …     

 

 

4.  朱良春治疗口眼干燥关节炎综合征特色选析

4. The treatment of Sjogren's syndrome.

http://www.tcm369.com/html/zzlw/200809/28-186_2.html

作者:邱志济 
 By Doctor Zhiji Qiu.

口眼干燥关节炎综合证,祖国医学属燥痹范畴,其特点是,故本病征又称干燥综合征,中医临床诊断以眼干涩,口干,关节痛三联症中有两项较显,即可诊为本病证。口眼干燥关节炎综合征发病隐匿,常在外分泌显著萎缩后才发现,故西医归属于外分泌腺病变为主的全身慢性炎症性结缔组织自身免疫病,但至今尚无有效的治疗方药。吾师朱良春教授,治疗口眼干燥关节炎综合征有独到之处,今浅析朱师治疗之特色以飨同道。

The dry mouth, dry eye and dry joint syndrome belongs to dryness Bi syndrome in Chinese medicine. The characteristics is the “dry”, so it is also called “dry syndrome”. In Chinese medicine, whenever there is the dry phenomenon in two of the three spots, it can be diagnosed as the dry syndrome. This disease starts slow and gradually. It is noticeable only when the gland apparently shrunk. In western medicine, it is regarded as the a whole body chronic inflammation, auto-immune disorder in the connective tissue, which mostly affects the out excretive glands. So far, there is no effective therapy for the treatment of the dry syndrome by western medicine. My teacher, Dr. Liangchun Zhu, however, has specific experience in the treatment of the dry syndrome. Here we try to share his experience with other TCM doctors who are interested. 

(1)
、燥甚化毒甘寒平,辛凉甘润燥毒清 
(1). Overwhelming dryness could develop into toxic. To solve it, the herbs should be sweat-cold in nature, or spicy-cooling dispel the toxic.
燥甚化毒乃近代大医家冉雪峰所言。冉治燥毒拟有太素清燥救肺汤药用鲜竹叶,鲜银花,梨汁,柿霜,川贝,甜杏,鲜石斛,芦根等,其方编入《全国名医汇案》中,并谓稍加重浊,即为太素增一污点云云,朱师深究南冉北张之术,师其法而变其方,治疗燥毒为害之口眼干燥关节炎综合征疗效满意。如肺热阴伤之患者:多见其舌红少津,苔黄干燥,脉细数或弦细。析病位原本在肺,累及肝肾经络。肺热伤阴,治节无权,不能水津四布,脏腑经络、关节失荣,则口眼干燥关节炎诸症变生。证见口干,唾液少,饮水频频而不解,眼干涩,泪少或无泪,关节或肌肉疼痛,或有咽喉干燥,鼻腔粘膜反复溃疡,或眼角膜炎,结膜炎等等。

When the dryness is overwhelming, it could develop into toxic, is said by Dr. Xuefeng Ruan, a current time doctor. To solve the dry-toxic, he developed herbal formula “Tai Su Qing Zao Jiu Fei Tang”, which uses the herb fresh bamboo leaves, fresh Yinhua, pear juice, Shishuang, Chuan Beimu, sweat apricot, fresh Shihu, and lotus root, etc. His formula has been edited in the book <<Quanguo Mingyi Huian>>. He said, the addition of even little bit heavy-taste herbs, it would create a little dirty to the “Tai Su” (Tai Su here means clear and purity). Dr. Liangchun Zhu, who studied thoroughly the experience of Dr. Ruan (South of China) and Dr. Zhongjing Zhang (North of China), followed their principle in the treatment but modified their herbal formula. The herbal formula so developed to treat the dry syndrome worked very well. For example, for the dryness syndrome due to the Lung Fire that causes Yin exhaustion, the person’s tongue is red in color with dryness on the tongue. The tongue cover is yellow and dry. The pulse was thin and frequent or string and frequent. The original disease is in the lung and it later develops to affect the liver and kidney meridian. Due to lung fire that causes the Yin deficiency, the lung loses its function to direct water distribution in the body. The organs and the joints do not get sufficient water to lubricate, so as the dryness syndrome is developed. The person feels dry in mouth with less saliva in mouth. The dryness in mouth could not be reduced by frequent drinks. The person also feels dry in eyes with little or no tears. The joints or the muscle feel pain. The person may also feel dry in throat with nose mucus being in ulcer frequently, or have keratitis, or conjunctivitis.

朱师曾治白某,女,62岁,初诊诉全身关节疼痛,痛剧时难忍,号天哭地,病起数月,手脚,腕,踝肿胀如馒,不红不热,活动不利,行走困难,手不能握,口极干,每日不停饮水亦不解渴,面浮,唇绀,便秘,双目干涩,齿龈肿,牙根龋蚀,舌中干红,四畔白燥,脉弦涩,朱师诊为燥痹此即燥甚化毒,毒伤肺阴,治以清燥救肺,补虚治痛,仿一贯煎并冉氏太素清燥救肺汤之意化裁,药用穿山龙、生地各50g、北沙参、川石斛、杞菊、麦冬、银花、川贝、生白芍各10g 、土茯苓、寒水石各30g 、甘草6g,以此方出入连服30剂,关节肿痛大减,行走如常人,惟口干尚有,肿胀未全消,上方去穿山龙,寒水石,续服50剂,且每日加服扶正蠲痹胶囊每服5粒,日三次,饭后服。并嘱购雅梨盐水浸泡作为另食,药后,诸证基本消失,嘱以扶正蠲痹胶囊并食盐水梨,巩固疗效以善后。
Dr. Liangchun Zhu had a case of the dryness syndrome. It was a lady, 62 years of old. She complained in the first visit to Dr. Zhu that she felt pain in the joints all over the body, which was so painful that she could not prevent from crying loudly. Several months later, her wrists, ankles, hands and feet became swelling heavily. The swelling was not red in color, nor hot on touch. The joint movement was restricted. The walk was difficult and hold by hands was also difficult. She felt very dry in mouth. The gum was swelling. The teeth was heavily in decayed. The middle part of the tongue was dry-red. The edge of the tongue was white. The pulse was string and harsh. Dr. Zhu diagnosed her condition was “Dry Bi syndrome”. This is the case in which the dryness has developed into the toxic phase, which hurt the lung Yin liquid part. The herbal formula should work to clear the dryness so as to save the lung, and to nourish the weakness so to solve the pain. The herbal prescription used was to follow the idea of herbal formula “Yi Guan Jian” and Dr. Ruan’s “Tai Su Qing Zao Jiu Fei Tang”. The herbs used were: Chuanshanlong 50 g,Shendi 50 g, Bai Shashen 10 g, Chuan Shihu 10 g, Jiju 10 g, Maidong 10 g, Yinhua 10 g, Chuan Beimu 10 g, Baishao 10 g, Tu Fuling 30 g, Hanshuishi 30 g, Gancao 6 g. This formula was continued for 30 doses with somewhat modification during the course. The swelling and pain in the joints were dramatically reduced. She could walk as healthy person. The only problem was some level of dry mouth and swelling in gum. From the herbal prescription above, removed was the herbTufuling and Hanshuishi. The formula was continued for 50 doses, with additional use of “Fuzhen Yibi Jiaonang” (5 pills each time, three times a day, after each meal). She was also asked to drink pear juice (rinse the pear in salty water). After the 50 doses, the symptoms were basically solved. She was asked to continue the pills and the pear-water for a maintenance.   
按:朱师所拟上方辛凉甘润,清轻而不重浊,柔润而不滋腻,治疗燥甚化毒而伤肺肾颇为合拍。肺为清金,如感受外来燥邪,当生燥毒,加之内生之燥毒”(即脏腑功能失调,津生不足或津血大量亡失,或痰瘀湿浊等属中医邪毒概念内的致病物质不能及时排出体外)进而对机体产生急剧严重的损害,燥象蜂起,此即燥毒概念,冉氏所谓之燥甚化毒即寓二意。盖内外燥毒合邪,两燥相搏,肺肾俱伤,反复加重。故朱师宗温病家治火可用苦寒,治燥必用甘寒之说,方中不用辛烈恐张其邪焰,不入苦寒恐益其燥毒,更损其生机。惟甘凉润沃以泽枯涸。方中北沙参,川石斛,麦冬,川贝,生白芍甘寒养阴,润肺降火,沃燥增液,荣枯起朽,滋培肺脏阴精生化之源,凉而不滞,清而能透,且有甘凉培土以生金之意,

Comments: The formula that Dr. Zhu used for the case above is spicy-cool and sweet-wetness. It is light-pure and not heavy-foul. It is soft-humidifying but not greasy. It matches the therapeutical need of the dryness syndrome perfectly. The lung is pure metal. If it is attacked by external dryness Xie Qi, there would be the development of dryness toxic in the lung. In addition, there could also be the internally developed dryness toxic, such as that created when there is functional disorders in organs, so that there would have no enough body liquid to be produced, or there is loss of blood or  Jing (liquid part of the body), or there is phlegm, stagnation, wetness, which belongs to the Xie toxic concept in Chinese medicine, and which could not be dispelled out of the body so as to hurt the body function. This is the concept of the dryness toxic by Dr. Ruan. If there is the external and the internal dryness toxic in the body the same time, the combination of them would hurt the lung and the kidney. Dr. Zhu followed the idea of Wen Bing theory that, to treat Fire, use bitter-cold herbs and to treat dryness, use sweet-cold herbs. The spicy-violent herbs are not used in the formula for the consideration of not to triggering the Fire. The bitter-cold herbs were not used for the aim not to enhance the dryness-toxic. Only the herbs that are sweat-cool-humidifying in herbal nature would be able to sole the withered dryness. In the herbal formula, the herb Bei Shashen, Chuan Shihu, Maidong and Chuan Beimu are sweet-cool, so being able to nourish the Yin liquid part of the body, to nourish the Lung so as to clear the Fire in the lung, to irrigate the dryness and to restore the life energy of the withered parts of the body, all bearing the function to nourish the soil (spleen) so to produce more metal (lung). 

·喻嘉言称《金匮》之麦门冬汤,具有甘凉濡润生津养胃之功,悟出仲景以麦门冬汤治肺病,在于甘凉培土以生金。方中土茯苓,银花,甘草乃甘寒凉润以解燥毒,寒水石甘大寒微咸,除五脏伏火,燥毒,尤除阳明之邪热,故能治口干,口渴;杞子,菊花养目润燥解毒,益金水二脏,能制风木之横;生白芍泄肝以伐木横,合甘草亦缓急止痛,酸甘化阴以制燥毒。更值一提的是朱师用大剂量穿山龙和生地配伍是治疗虚性疼痛属不充,不荣,不润,不温等因的显效药。补虚治痛源于仲景黄芪健中汤”“理中汤”“桂枝新加汤

Mr. Jianyan Yu, in the Qing Dynasty of China, said that the Maimendong Tang in the book <<Jin Kui Yao Luo>> works, by its sweat-cool property, to humidify and to produce more liquid to nourish the stomach. From this formula, Mr. Yu realized that, Dr. Zhongjing Zhang used the Maimongdong Tang to treat lung disease, is to use its sweat-cool property to help the soil (spleen) so as to produce and nourish the metal (lung). In the formula, the herb Tufuling, Yinhua, and Gancao are sweet-cool to solve the dryness-toxic. The herb Hanshuishi is sweet, strong cold but slight salty. It works to clear the hidden fire and dryness-toxic in all the body organs. It especially is good to clear the Xie Fire in the Yangming phase, so that it works to solve the dry mouth and thirsty. The Goujizi and Juhua work to nourish the eyes, to humidify the dryness and to detoxify, so as to help the metal and the water organs (the lung and the kidney), and to inhibit the inviolate of the Wind Wood (the liver). The Baishao works to dispel the liver, to prevent the liver inviolate. Together with Gancao, the Baishao could relax the spasm. The sour-sweet of the two herbs could develop Yin, so as to clear the Dryness toxic. It is worthwhile to mention is the use of large amount of Chuanshanlong and Shengdi. They are the very herbal couple for the treatment of “weakness pain” due to poor nutrition, withered, poor humidity, less warm condition. The idea to solve the pain by nourish and by help of the weakness condition comes from the herbal formula Huangqi Jianzhong Tang and Guizhi Xingjia Tang used by Dr. Zhongjing Zhang.

魏氏一贯煎亦是甘凉培土,甘寒补虚治痛方,张景岳云:凡属诸痛之虚者,不可以不补也,燥痹症乃因虚而致的全身关节疼痛,当属津血不充,不荣,不润之因。

The herbal formula of “Yi Guan Jian” by Dr. Wei is also a sweet-cool herbs to nourish the soil (Spleen). Dr. Jingyue Zhang said: if the pain is due to a weakness condition, it can not be avoid to nourish the weakness to solve the pain. The dryness syndrome is due to a weakness condition in the body, which causes pain in whole of the body. It is caused by the disorder in the distribution of the blood and the Jing liquid in the body. (So, the nourishing therapy should be used for the treatment of the dryness syndrome).

大剂量穿山龙,生地一通一荣,荣中寓通,二药相伍可寒可热,可气可血,且穿山龙性平,通中有补,相得益彰。笔者历年治痹常以大剂量生地反佐生川乌或制附片,每收佳效,但生地均须大剂,此乃生地治痹之决窍

For the large amount of Chuanshanlong and the Shengdi, the Chuanshanlong works to conduct the circulation of the blood and the liquid in the body, and the Shengdi works to nourish the Yin. When used together, they can be used in either a fire or a cold condition, can work to nourish the blood and the Qi. It is especially good for the Chuanshanlong is not too hot or cold in herbal nature. It bears nourishing property among its conduction nature. Its two such functions benefit each other. For many years, I, the author of this article, also use large amount of Shengdi in the same time together with the use of herb Chuan Wu or Zhi Fuzi. The combination works very well. However, the amount of the herb Shengdi must be in large amount. This is the tip to use the Shengdi to treat Bi syndrome (various arthritis).

据历年报导,本病邪势猖獗,可引起肝损害者约25%,肾损害者约50%,肺功能异常者约6070%,因此清燥救肺,甘寒增液,甘凉培土当是治本之法。本方融益气润燥,通络润燥,蠲痹润燥,养目润燥,化痰软坚润燥,养阴润燥诸法于一炉,此乃朱师用药与众不同之独到之处。
Based on the clinic reports in later year, the incidence of the dryness syndrome is overwhelming. It can cause liver damage in 25% of patients, kidney damage in 50%, and lung disorder in 60% to 70% of patients. It is the radical therapy to clear the dryness and to save the lung, use sweet-cold to produce the liquid, and to use sweet-cool to nourish the spleen. This formula works to nourish the Qi, to humidify the dryness, to conduct the meridians, and solve the Bi syndrome, to nourish the eyes, to dissolve the phlegm, to soften the hard mass, and to nourish the Yin, etc. To mixture so many functions in one formula is the specific characteristics of Dr. Zhu’s herbal therapy.


(2)
、胃津枯涸脾阴虚,养胃生津甘淡主 

(2). If the dryness syndrome is caused by Stomach Jing withered and Spleen Yin exhaustion, the herbal formula should be used to nourish the stomach, to produce liquid with sweet-plain herbs.
 
朱师遵《素问·刺法论》欲令脾实……宜甘宜淡之训,推崇张锡纯淡养脾阴的观点,治疗燥痹不离甘寒益胃阴,甘淡实脾阴之法,组方遣药以存津液为要旨。

Dr. Liangchun Zhu followed the opinion in the book <<Su Wen: Ci Fa Lun>> “If the Spleen is to be strengthened, … use sweet-plain herbs”, and he also supports the idea of Dr. Xichun Zhang to nourish the Spleen Yin with plain-taste herbs. He always used “Sweet-cold” herbs to nourish the Stomach Yin, and the “Sweet-plain” herbs to strengthen the spleen Yin, in the treatment of the dryness Bi syndrome. The main aim for the treatment is to save the body liquid portion.

朱师指出口眼干燥关节炎综合征不同于一般内燥证和顽痹证,亦非实火亢炽,治疗中所见之阴虚诸象,乃与一般阴虚证不同,如以滋阴补液之常法治疗,颇难见效。盖燥之所成乃津血之枯涸,而津血之枯,又关于脾阴,脾胃乃后天气血津液生化之源,故甘淡实脾阴,甘寒养胃阴为治燥痹另辟一途耳!临床中见胃津严重枯涸,脾阴受损者,口干舌燥,口糜口臭,食物难咽,关节疼痛,目睛干涩,声音嘶哑,时有低热,四肢乏力,呼吸困难,烦躁失眠,舌质干红碎裂无苔,舌面干燥,脉象细数无力等症。

Dr. Liangchun Zhu pointed out that, the dryness syndrome is different from ordinary inner dry condition or obstacle Bi syndrome (arthritis). It does not belong to the overwhelming Fire. The Yin deficiency phenomenon seen in the Dry syndrome is also different from the ordinary Yin deficiency. The commonly used Yin-nourishing therapy usually does not work. The reason is that, the dryness is due to the withered of the Jing and Blood in the body, which is associated to the Spleen Yin deficiency. The Spleen-Stomach is the source of later life energy. Therefore, to use the sweet-plain herbs to nourish the spleen Yin, and use the sweet-cold herbs to nourish the stomach Yin is one of the special ways to solve the dryness syndrome! In clinic, if the person has severe Stomach Jing deficiency and the Spleen Yin has been affected, the person has dry mouth and throat, ulcer in mouth, dab odor form mouth, hard to swallow food, pain in joints, dry eyes, harsh voice. From time to time, the person may have also low level fever, fatique in arms and legs, hard in breath, annoyed and poor sleep. The Tongue is dry-red. The tongue cover is broken without any covering and dry on the surface of the tongue. The pulse is thin, frequent and weak, etc.

朱师曾治范某,女,41岁,就诊前病史:无明显诱因而出现四肢乏力,口眼干燥,伴两膝关节疼痛,继而出现呼吸困难,经住院治疗无效,转上海某医院治疗,确诊为干燥综合征,(唇腺活检病理符合)西医用复方环磷酰胺,保肾康,氯化钾等治疗一年有余无效,遂转南通求诊朱师,展示免疫指标检查均不正常,证见口眼干燥,口干欲饮水,膝关节酸痛,四肢乏力,口糜口臭,食物难咽,舌红燥裂无苔缺津,形瘦肤干肌削,并诉阴道干涩不适,脉象细数无力,朱师治以养胃津、益脾阴,药用:制黄精、蒲公英、生山药、南沙参各20g、鲜石斛、淮小麦各30g、玉蝴蝶、生白芍、甘草、生谷麦芽、甘杞子各10g、佛手花、绿萼梅各5g。服药30剂后,诸证好转,口干,口燥,口臭,目涩,饮水均大减,效不更方,以上方出入再服30剂,诸症状基本消除,复查免疫指标及各项检查指标均正常,乃处扶正蠲痹胶囊以善后。随访2年一切正常。

Dr. Liangchun Zhu had a case with the dryness syndrome. It was a female, 41 years of old. The patient started chronic fatique without any clear reason, the dry feeing in the eyes and in mouth, with pain in the knee both sides. Later, she had difficult in breath. She was admitted in hospital for the treatment but in vain. Her condition was later confirmed to be the dryness syndrome in a hospital in Shanghai, China. The diagnosis was confirmed by biopsy. The western medicine has been tried for one year. For no effect, the patient was transferred to Dr. Liangchun Zhu. The lab tests showed that there are abnormal in various immune tests. The person felt dry in the mouth and in eyes, thirsty with desire to drink water, pain in the knees, weak in arms and legs, ulcer in mouth and bad odor in mouth, hard to swallow food. Her tongue was red, dry, with broken. Her body is slim and dry. She also claimed to feel dry and harsh in vagina. The pulse was thin, frequent and weak. Dr. Zhu gave her herbs to nourish the Stomach Yin, the Spleen Yin: Huangjin 20 g, Pugongyin 20 g, Shanyao 20 g, Nan Shashen 20 g, fresh Shihu 30 g, Huai Xiaomai 30 g, Yuhutie 10 g, Baishao 10 g, Gancao 10 g, Guya 10 g, Maiya 10 g, Gan Jizi 10 g, Foshouhua 5 g, Lu-E-Mei 5 g. After 30 doses of treatment, the symptoms were improved. The herbs were continued for another 30 doses. All the symptoms were basically subsided. The lab tests were all improved to normal too. She was given the “Fuzhen Yi Bi capsule” for a maintenance. Two years later, the follow-up showed normal.  
按:本病例经西医多种药物治疗,疗效不显,朱师用中医辨证的手段,宏观的思维,系统的方法,与众不同的用药法则,不但在较短的时间里治愈了口眼干燥关节炎综合征所表现的诸症状,而免疫指标从长期异常复转正常,故称疗效满意。本案用生津健脾的甘淡平之剂,收到了似此疗效,且对免疫指标的改善效出意外,说明中医甘凉培土,甘淡健脾,甘寒养阴之类药及甘淡平之类的解毒药,对提高免疫功能,和抑制免疫的作用,疗效确切,是一种高级的免疫机制调节剂。

Comment: This patient had been treated by western medicine by various ways but in vain. Dr. Zhu used Chinese medicine, based on whole body view and systematic analysis of the disease condition, and use the therapy that is different from that used by most other doctors and solved her problem in a relatively short time and made the abnormal lab tests for immune disorders all normal. So, it can be said the healing effect is pretty satisfied. In this case, the herb therapy used contains the sweet-plain herbs to stimulate the production of body liquid and to nourish the Spleen Yin. It implies that the Chinese medicine of sweet-cool to nourish the soil (spleen) and sweet-plain to nourish the Spleen, and sweet-cold to nourish the Yin enables the correction of disorder in immune system, and the inhibition of immune reaction. It is a super way of correcting the immune disorders.  

笔者近年仿朱师之法先后治疗5例口眼干燥关节炎综合征患者,亦均收到满意疗效,乃和历年报导健脾益肾剂有提高机体免疫功能的作用相吻合,不过这里乃指甘淡平之健脾生津益肾之剂,与仲景培土生金法有甘温甘凉之异 (黄芪健中汤为甘温,麦门冬汤为甘凉) 。朱师于本例药选甘淡平之剂,养胃津益脾阴,当是培土养胃以复气血生化之源的妙法。方中制黄精,生山药,南沙参既补脾气,又补脾阴,且有养阴润肺生津止渴之功,《纲目》载:黄精补五劳七伤,益脾胃,润心肺,是滋补五脏之妙品;大剂量鲜石斛既能清热生津,滋养胃阴,更有补虚除痹之殊功,颇合津血枯涸,其状如羸,关节疼痛,甚至痿痹者的治疗。石斛养阴益精,强阴补虚,治痹,剂量是决窍,煎法是关键,要知石斛味淡难出,必须劈开先煎或另炖。《本草思辨录》载:石斛运清虚之气,而使肾阴上济,肺阴下输也。《本草经解》:谓石斛除痹,痹者,闭也。血枯而涩,则麻木而痹,甘平益血,故又除痹。《神农本草经读》:痹者脾病也,风寒湿三气,而脾先受之,石斛甘能补脾,故能除痹。

Recent years, the writer followed the way of Dr. Liangchun Zhu for the treatment of five cases with the dryness syndrome. The results were also very satisfied. Our result in coincidence with the clinic reports that the herbs that work to nourish the Spleen and the Kidney could improve the immune function in the body. However, there herbs used here are the sweet and plain herbs, which work to nourish the Spleen, to nourish the Jing liquid part, and to nourish the Kidney. They are different from the herbs used by Dr. Zhongjing Zhang, e.g. to produce Metal Lung by the use of the Soil-nourishing therapy, which used Sweet-warm and sweet-cool herbs (they are sweet-warm in the Huangqi Jiangzhong Tang and sweet-cool in Maimendong Tang). In the herb formula used by Dr. Zhu in this case, the herb Huangjng, Shanyao and Nan Shashen work to nourish the Spleen Qi and the Spleen Yin, so as to be able to nourish the Yin, to humidify the Lung, to produce more Liquid part and to stop thirsty. In the book <<Ben Cao Gang Mu>>, it stated that the herb Huangjing can solve the weakness in all the organ systems, to solve the damage and hurt in all the organs, to nourish the Spleen and Stomach, to humidify the Heart, and it is the mysterious herb to nourish all the organs. The large amount of herb fresh Shihu works to clear the Fire, and to create Jing (liquid), to nourish the Stomach Yin. It especially works to nourish the weakness condition and to solve the Bi syndrome (arthritis). It is therefore suitable to be used in such withered condition as the dryness syndrome. The important for the use of the herb Shihu is its dose and also the way to cook. It should know that it is difficult to bring out the taste of the Shihu through cook. It must be split open before cook (extract) in water, or it should be cooked in separate pot. In the book <<Ben Cao Si Bian Lu>>, it said: the herb Shihu works to transport pure Qi, so as to make the Kidney Yin moves up and the Lung Yin moves down. In book <<Ben Cao Jing Jie>>, it said: the herb Shihu works to solve the Bi Syndrome. Bi means close. When the blood is withered, the Bi would be felt as numb. The herb Shihu is sweet-plain. It nourishes the blood, so it works to solve the Bi syndrome. In another book <<Shen Nun Ben Cao Jing Du>>, it said: the Bi syndrome is the disorder in the Spleen. The Wind, the Cold and the Wetness Qi, when attack the body, it is the Spleen that would first be affected. The herb Shihu could nourish the Spleen, so it could work to solve the Bi syndrome.   

朱师熟谙药性,拟大剂量鲜石斛治燥痹,确是取效之关健,方中蒲公英甘平解毒和上案之土茯苓同为甘淡平之解毒或清热首选药,二药均不损土,久服无碍。且有健脾养阴之效,方选淮小麦,生谷麦芽养脾气,玉蝴蝶,佛手花,绿萼梅以调理脾胃气化之枢机。

Dr. Liangchun Zhu are very familiar with the property of the herbs. It is really the key point for her herbal therapy to solve the Dryness syndrome with large amount of herb Shihu. In the formula, the herb Pugongyin is sweet-plain in herbal nature. It works to detoxify. The Pugongyin and the herb Tufuling, both are sweet-plain herbs. The are the first choice to detoxify or to clear Fire. Both do not hurt the Spleen soil and no side effect for a long term of use. They also have function to nourish the Spleen Yin. In the formula, the Hai Xiaomai ( wheat), Guya and Maiya work to nourish the Spleen Qi. The Yuhutie, Fohouhua and Lu-E-Mei work to smooth and to lubricate the Spleen-Stomach Qi circulation and movement.

燥痹本属虚损,药选甘淡轻清,则气化易复,枢机运转,气复津还,燥痹自除。祖国医学具有辨证论治和辨病论治相结合的历史,朱师一贯提倡辨证论治和辨病论治相结合,冉雪峰氏治燥毒为害创太素清燥救肺汤其用药特点是甘淡健脾,甘凉培土,甘寒养阴,朱师不离三法而变其方,使治疗燥痹之用药更加熨贴,这种变化在心,不拘一格,遵法度而又不囿于法度的高超医术在本病治疗中,应归结到治燥痹勿忘甘淡,甘寒,甘凉。医贵通变,良医必精于用药矣。

The dryness syndrome belongs to weakness condition. The herbs used for the treatment should be sweet-plain, light and pure, so that the Qi movement and circulation would be easier to restore. Once the Qi movement and circulation is corrected, the body liquid part would be easier to produced, so the dryness is easier to be solved. There is a history in Chinese medicine to have both syndrome diagnosis (such as Eight principle diagnosis, Six Jing diagnosis) and disease diagnosis. Dr. Liangchun Zhu also emphasize the combination of the two kinds of diagnosis systems. To treat the dryness, Dr. Xuefeng Ruan created the “Tai Su Qing Zao Jiu Fei Tang” which uses sweet-plain herbs to nourish the Spleen, sweet-cool herbs to nourish the Soil, and sweet-cold herbs to nourish the Yin. Dr. Liangchun Zhu followed the three principles of Dr. Ruan, but changed the formula, making the formula more suitable for the dryness condition. The principles should be followed, but the formula and the herbs used can be modified.

 

 

4. 朱良春治疗中风及后遗症用药经验特色选析

4. Treatment of stroke and post-stroke syndrome

来源:广益中医 作者:邱志济 

Author: Dr. Zhiji Qiu

摘要:朱良春老师善用张锡纯效方治疗中风急症和治疗中风后遗症,其独到之处乃善用乌梅敛肝舒脾,颇能提高疗效。法宗锡纯而用药独擅,方本平淡而效出意外,其画龙点睛之妙,其用药之技巧,非粗工所能及。邓铁涛先生指出:中医学的精髓出自临床实践,……而实非出自实验研究。临床研究是中医药学最重要的实验室。”90年代以降,中医教育和科研的西化之深已积重难返,中医学术,〈尤其是临床愈病之简便廉验之术〉和中医临床人才观的西化令人深思 (职称加学位即谓人才),使中华民族的文化瑰宝,博大精深的中医药学,面临人才、学术、西化堕落的今天,每一个风风雨雨过来的老一辈中医学家无不忧心忡忡矣,吾辈能为明天中医学术的辉煌而奋���而感 到欣慰。

Abstract: Dr. Liangcun Zhu is good at using the herbal formula that is developed by Dr. Xichun Zhang, to treat acute stroke and post stroke syndrome. The characteristic for his herbal therapy is the use of herb Wumei (dark plum) to restrain the liver and to relax the spleen. It really increases the healing effect. Dr. Liangchun Zhu’s herbal therapy followed Dr. Xichun Zhang’s principle, but uses different herbs. His formula is plain (not special in the use of the herbal ingredients) but the healing effect is surprising. … Dr. Tietao Deng said: “The spirit and the most valuable part of the Chinese herbal therapy comes from clinic practice….. not from laboratory research. Clinic study is the most important laboratory for Chinese herbal pharmacology.” From 1990’s, the westernization of Chinese medicine, in terms of its education and research is very severe and very deep to be corrected. The westernization of the Chinese medicine in evaluating the level of scholars and the level of clinic healing effectiveness, e.g. to adapt the western medicine parameter to analyze the level of ability of a doctor in clinic, makes the great and mysterious Chinese medicine, the valuable culture, fall into withered in its doctors, the scholars and its knowledge system. All the old TCM doctors, who has had a lot of clinic success and failure, failure and success, can not prevent from worry the future of the Chinese medicine. We, our younger generation TCM doctors, would feel happy for we having chance to contribute a great effort to improve the current Chinese medicine.   
朱师指出:中风后遗症的辨治应从脏腑气血阴阳辨证,临床所见中风后遗症气虚血瘀固多,但阴虚血燥者亦复不少补阳还五汤只能适应气虚血瘀之证,不可统治其余。朱师喜用张锡纯之振颓汤() 加减治疗肢体痿废,痰浊壅塞经络,血脉闭阻的偏枯症,药用红参、炒白术、当归、杜仲、仙灵脾、巴戟肉、淡苁蓉、制乳香各100g,制马钱子、制附子、炮山甲各50g,上等鹿茸、蜈蚣、乌梅肉各25g,共粉碎蜜丸10g重,日服3丸,一味黄芪煎汤或黄酒送服。

Dr. Liangchun Zhu pointed out: “The diagnosis of post stroke syndrome should follow the organ, Qi-blood, Yin-Yang diagnosis system. Most cases of post stroke syndrome belong to the Qi-deficiency and blood-stagnation. However, many of the cases belong to Yin-deficiency and blood-dryness syndrome. The famous formula developed by Qingren Wang, the Bu Yang Huan Wu Tang, only suits to the use in the Qi-deficiency and Blood-stagnation condition, not good for all the cases.” Dr. Liangchun Zhu likes to use the herbal formula developed by Dr. Xichun Zhang, the Zhen Tui Tang, with some modifications, to treat the withered arms or legs, such paralysis, with phlegm accumulation in meridian and block in blood vessels.  The herbs used are Hongshen, Chao Baizhu, Danggui, Duzhong, Xianlingpi, Bajitian, Dan Roucongrong, Zhi Ruxiang, 100 g for each, Zhi Maqianzi 50 g, Zhi Fuzi 50 g, Pao Shanjia 50 g, top level Lurong 25 g, Wugong 25 g, Wumei 25 g. The herbs were grinded into powder and make into pills, 10 g for each pill. Take 3 pills each day. Swallow the pills with the drink of water extract of single Huangqi Tang or with that of cook wine.

朱师加减振颓丸不仅治疗脑血管意外后遗症有著效,而对外伤性截瘫,类风湿性关节炎等证均有理想的疗效,笔者体会中风后遗症,或谓中风”“急症缓解后,应注重燮理阴阳,调和气血,阴阳气血双调,是抓住治本的大法,盖阴阳互根,阴阳当有互损,治当阴阳双补,或偏于补阳,或侧重补阴,乃因人因证而异,再为兼证佐以行瘀,祛痰,通络等药,且应恪守刚柔相济,通润兼施。

The Jiajian Zhen Tui Wan developed by Dr. Liangchun Zhu, not only works for post stroke but also for paraplegia, or rheumatoid arthritis. I feel that, for the post stroke syndrome after acute stage, the attention should be paid to adjust both the Yin and Yang, to harmonize both the Qi and Blood the same time. This is the basic rule in the treatment. The Yin and Yang in the body is roots each other. If the Yin and the Yang both are damaged, they should be nourished the same time. Depending on each person’s body condition, either to supply more Yin or more Yang. At the same time, use herbs also to dissolve blood stagnation, to dispel the phlegm, and to conduct the meridian. The herbal formula should follow the rule to nourish and to dispel the same time, to conduct and to humidify the same time.

行瘀祛痰属”,   调理阴阳气血以安抚内脏属,此乃标本同治之谓。朱师用药主张以小心行其放胆,尤其使用马钱子等峻猛之品必须严加医嘱,笔者虽曾在朱师系列经验之(12)中详述朱师使用马钱子之经验,本文还要重复提及制马钱子入丸的药量应控制在每日0.6g以下。但临证中有少数患者颇耐峻猛药者,亦可试以稍予增大剂量,以提高疗效,但须知正常反应者,为轻度头晕,恶心或周身搔痒,可用肉桂10g煎汤服之缓解。似此反应,不可随意增加药量,有心脏病肝肾病者忌服,药量已足者服药中偶有轻微腰背肌肉僵直感,或偶有腰部肌肉轻微颤动均为正常反应,此象一周后逐渐消失,服药期间忌食海藻类、蛋类、虾蟹类及含碱、矾等食物,如油条、粉丝等。连续服含马钱子丸药23个月已见著效后,要去马钱子续服,比较稳当。以防马钱子碱的积蓄为害。

To dispel the phlegm and to dissolve the blood stagnation belong to the “violent therapy”. To nourish the Yin and Yang, the Qi and the Blood, so as to calm the inner organs, belongs to the “calm therapy”. To use both the “violent” and the “calm” therapy means to solve the cause and the symptoms of the disease the same time. Dr. Liangchun Zhu proposes to use violent herbs for the treatment but with very careful manner.  I have introduced the experience of Dr. Linagchun Zhu in the use of herb Maqianzi in another articles. Here I still mention again here to control the amount of the herb Maqianzi under 0.6 grams every day. However, if some patient can tolerate the violent herb, the dose can also be increased little bit more, so as to increase the effectiveness of healing. The normal reaction to the herb Maqianzi is slight dizziness, nausea or itch all over the body. If it happens, cook herb Rougui 10 grams to drink to solve the herbal reaction. For such patient, the amount of Maqianzi should not be increased at will. This herb Maqianzi is inhibited to be used in patients with heart disease or kidney disease. If the dose of the herb is sufficient, the patient might feel occasional and slight stiffness on the back, or slight muscle shaking on the back. This is normal reaction, which would disappear gradually after about one week. During the intake of the herb, the eating is inhibited the sea foods (shrimps, crabs), eggs, and something that contains alkaline or alum, such as   deep-fried dough sticks and vermicelli made from bean starch, etc. After continuous intake of the herb Maqianzi for 2 to 3 months and seeing the healing effect, the herb Maqianzi should be depleted from the formula but continue the remaining formula for some more time, so to prevent an accumulated toxic from Maqianzi.

现代药理研究制马钱子功能兴奋脊髓作用,强筋骨利关节,增强肌力兴奋中枢神经,提高延髓呼吸中枢和血管运动中枢的兴奋性等作用。方中马钱子合蜈蚣、炮山甲、制乳香,对痰瘀壅阻而形成的血栓,有消散化解的强力作用,有逐恶血、溶血栓、健脾胃、提脏器、通死肌之著效,马钱子虽峻猛有毒,但炮制得法,掌握有效剂量,讲究医嘱,每起沉疴痼疾,历代医家擅用马钱子愈痼疾者不乏其人。

Medical research showed that the herb Maqianzi works to stimulate and activate the spine nerve system, to strengthen the bone and the joints, to enhance the muscle and the cerebral nerve system, to increase the sensitivity of the respiratory center and the heart and blood vessel movement center in the medulla oblongata. In combination with the use of Wugong, Pao Shanjia, Zhi Ruxiang, the Maqianzi works to clear the blood clot that is caused by the block of phlegm. The mixture bears a strong effect to dissolve the clot, to dispel the dad blood, to nourish the spleen, to raise the muscle tone in the inner organs, and to clear off the dead muscle. The herb Maqianzi, though is strong toxic, works very good, if it is processed in a proper way and is used in a proper manner. There are many doctors in history who are good at the use of Maqianzi.

朱师加减振颓丸方中用仙灵脾益火生土,燮理阴阳,补肾壮阳,祛风醒脾除湿,以参、芪、术补脾胃,当归、制乳香等流通气血,治腰腿肢体疼痛,乃有治痿独取阳明之意,选红参、鹿茸,一以大补元神,一以峻补元阳, 参茸并用不但益阳,而且益阴,盖红参生用气凉,熟用气温,味甘补阳,微苦补阴,鹿茸温煦鼓荡,阴阳交融,气血俱充,大填髓汁更补髓气,健脑益肾,起废疗瘫,当有佳效。附子、杜仲、巴戟肉、淡苁蓉温肾回阳,补肾填精,收摄耗散。肝阳过甚中风,乃肝为标肾为本,苟非肾水不充,肝木亦必不横逆,以补肾为治中风后遗,乃意在固护根基,俾肝阳可无再动之虑。乌梅敛肝舒脾,补肝气即是实脾胃也,此较张锡纯氏单用黄芪补肝气更胜一筹。 
The herbal formula “Jia Jian Zhen Tui Wan” developed by Dr. Liangchun Zhu uses Xianlingpi to nourish the Fire and to produce soil, to adjust both the Yin and Yang, to nourish the Kidney and the Yang, to dispel the Wind, to stimulate function of Spleen, and to dispel the Wetness. It uses Dangshen, Huangqi, and Baizhu to nourish the Spleen and the Stomach, uses Danggui and Zhi Ruxiang to improve blood circulation, to solve pain in the lower back, the arms and the legs, having a meaning of solving the paralysis through working on the Yangming meridian. It uses Hongshen (red ginsheng) and Lurong (Pilose deer horn), to nourish the Yuan Spirit, and the Yuan Yang. They not only nourish the Yang, but also nourish the Yin. The reason is that, the Hongshen is cool in herbal nature when it is used without any cooking or process, but it is warm in herbal nature after process. Its sweet taste enables to nourish the Yang and the slight bitter taste to nourish the Yin. The Lurong (the deer horn) works to stirring the Yin and Yang to mix each other and to product sufficient Blood and the Qi, so to fill up the spine material part, to nourish the brain and the Kidney, and to solve the paralysis. The herb Fuzi, Duzhong, Bajitian, Rouchongrong, all work to warm Kidney, to restore the Yang QI, to nourish the Kidney and to fill up the Jing Qi (micro nutrition stuff in the body), to restrain the escaping Yang Qi. If the stroke is due to overwhelming Liver Wind, the Liver Wind is the symptoms and the kidney is the cause of the stroke. If the Kidney Water is not filling up, the Liver reverse would not be solved. Therefore, for a radical therapy of the stroke, the Kidney Water must be supplied to sufficient. This is to fix the basement of the body, so that the Liver Wind would not move in the body violently. The herb Wumei (dark plum) works to restrain the liver and to release the Spleen. To nourish the liver also means to nourish the Spleen-Stomach. Such idea is better than that by Dr. Xichun Zhang to only nourish the Liver by use of herb Huangqi.
按:朱师所拟加减振颓丸特别重视双向调治的功能,双向即双相”“阴阳两相之意。所谓双向调治,乃医者利用中药双向调节特性,通过机体内固有的调节系统,调节阴阳使其平衡,以达到愈疾目的,如本方的燮理阴阳,调和气血,敛肝舒脾,升清降浊,通补兼施,温阳益阴等。方中黄芪能升能降,乌梅敛肝补肝,鹿茸助阳生阴,附子、杜仲、巴戟、苁蓉既温肾回阳,又补肾填精,收摄耗散,均属双向调节之例。

Comment: The herb formula Jia Jian Zhen Tui Wan especially emphasizes the double adjustment of both the Yin and the Yang the same time. The double adjustment means to use the double adjusting property of herbs, through the body original double adjusting system, to re-balance the Yin and Yang in the body, so to get cure of a disease. This herb formula works as a double adjusting formula. The herb Huangqi in the formula works to improve both the rising and the descending movement in the body; the Wumei works to restrain the Liver and to nourish the Liver; the Lurong (deer thorn) works to help the Yang to produce the Yin; and the Fuzi, Duzhong, Bajitian and Roucongrong all work to warm the Kidney and to restore the Yang, to fill up the Kidney Jing, to restrain the escaping Yang Qi, all belonging to the double adjusting herbs.

王清任拟补阳还五汤以调左右平衡,还五者补还十之半也,或左瘫或右瘫,均以一方通治,亦是双向调治也,借中药双向调治之功,阴阳同时调理,如阴阳双补,双调是朱师治疗中风及其后遗症的用药经验。

Dr. Qingren Wang in the Qing dynasty China used herbal formula Bu Yang Huan Wu Tang to adjust the left and the right side of the body, to fill up the shortened part of the body. The formula is used for the paralysis either on the left side or on the right side of the body. It also belongs to the double adjusting formula. To solve the stroke by using double adjusting herbal formula is the experience of Dr. Liangchun Zhu.

中医用药,有时一张方子,疗效不著而药证相符,加一味药即可取得很好的疗效,老一辈的临床家均有此画龙点睛的神来之笔。裘沛然先生曾论述程门雪先生早年开业时治一慢性泄泻病人,用调理脾肾之法,久而无效,此患者带处方就诊于名医王仲奇先生(王为程的前辈),王诊后索阅程之处方,凝思片刻,即提笔在程的处方上写上批语此方可服,再加蛇含石4。病人只服了数剂,多年宿疾,霍然而愈。

In Chinese herbal therapy, some times, a herbal formula matches the body condition but the healing effect is not dramatic. After addition of a single herb as ingredient, it starts to work excellent. Many doctors in old generations have such clinic examples. Dr. Peiran Qiu mentioned a case by Dr. Menxue Chen. In the early years of Dr. Chen in his clinic work, he had a patient with chronic diarrhea. He used the herbal formula to adjust the Spleen and Kidney for a long time but no improvement. The patient then brought the formula to another doctor, Dr. Zhongqi Wang (Dr. Wang was the teacher of Dr. Chen). After seeing the formula, Dr. Wang had a consideration for a while, then he wrote on the formula to suggest the use of herb Shehanshi 12 grams. The patient followed this idea and used only several doses and the illness of many years disappeared.

名医杜雨茂先生在旋复代赭汤中加公丁香39g,治疗幽门不全性梗阻病人呈呕吐,嗳气不止者大大提高旋复代赭汤之功效。一味可变一剂功,在仲景方中亦例证较多,如附子、细辛配麻黄则解表,配大黄则通里,一味之差则治有表里之别,麻黄杏仁甘草配桂枝则散寒,配石膏则泄热,一味之差,则治有寒热之分。良医必精于药,如医者昧于药性,故弄玄虚,在有效的方中,误加一味药,反使有效的方子变无效,即有画蛇添足之遗憾。发表于《辽宁中医杂志》2002年第2 (邱志济

A famous doctor, Dr. Yumao Du, added herb Gongdingxiang (3-9 g) in the formula Xuanfu Daizhe Shi Tang, to treat patient with Incomplete obstruction of pylorus. The patient had nausea and continuous hiccup. Such addition increased the healing effect dramatically. That one herb could work as a whole formula can be seen in many formula by Dr. Zhongjing Zhang. For example, to add herb Mahuang to the Fuzi and Xixin, the formula works to release the body surface; and to add Dahuang in the mixture, the formula works to conduct the bowel movement. See, the difference for only one herb ingredient yields a different for the whole herbal formula works either on the body surface or in side. Another example as in the mixture of Mahuang, Xingren and Gancao, to add Guizhi in it, the whole formula works to dispel the Cold, and to add Shigao, the mixture works to dispel Fire. The difference in one herbal ingredient yields a creation of either a cold or a hot condition in the body. A good doctor must be good at the herbal nature. If the doctor has no such ability to pretend to know it and so to make prescription for a treatment, a mis-adding of a single herb would change the function of the herbal formula in a quite opposite direction and may make the formula do not work at all.

 

6. 朱良春治疗高血压用药经验特色选析

6. The treatment of high blood pressure by Dr. Liangchun Zhu

作者:邱志济 

By Dr. Zhiji Qiu

摘要:朱良春老师治疗高血压病经验丰富,疗效卓著,其独到之一乃从气虚和痰瘀着眼,自拟双降汤调气血之虚,去痰瘀之实,虚实同治,去瘀降压,降脂降粘。基本方由水蛭(胶囊吞)、地龙、黄芪、丹参、当归、赤芍、川芎、泽泻、生山楂、稀莶草、甘草组成,随证加减治疗气虚夹痰瘀见证之高血压病,伴高血粘,高血脂者每收著效。独到之二乃自拟乌梅甘草汤镇肝熄风汤加减,基本方由怀牛膝、生赭石、生龙牡、生龟板、乌梅、甘草、生麦芽、茵陈、川栋子、天冬、玄参组成,随证增损,治疗肝肾阴虚,肝阳上亢,或肝风内动,气血逆乱并走于上,上实下虚之高血压者亦屡屡奏效。独到之三乃妙创简便廉验之降压洗脚汤方由桑叶30g、桑枝30g、茺蔚子30g、明矾60g、米泔水10001500毫升煎汤泡脚,配合以上两法,颇能提高疗效。

Abstract: Dr. Liangchun Zhu has very rich experience in the treatment of high blood pressure (hypertension) with excellent result. One of the characteristic in his herbal therapy is to focus the Qi deficiency and phlegm stagnation. He developed his herbal formula “Shuang Jiang Tang” (it means “Double reducing herbal extract) to adjust both the Qi and Blood deficiency, to dispel the phlegm and the blood stagnation, to solve the body weakness and overwhelming condition the same time, to dispel phlegm and to reduce the blood pressure, to reduce the blood lipids and the blood viscosity. The basic ingredients of the formula uses herb Shuizhi (in capsule form), Dilong, Huangqi, Danshen, Danggui, Chishao, Chuanxiong, Zexie, Shanzha, Xiqiancao, and Gancao. It is used for patient with Qi deficiency and phlegm accumulation in the body. The patient has high blood pressure, high blood viscosity, and high blood lipid content. The another characteristics of his herbal therapy is to develop herbal formula “Wumei Gancao Tang” , which is used together with another herbal formula “Zhen Gan Xi Feng Tang”. The mixture of the two formula uses the herb Niuxi, Daizheshi, Longgu, Muli, Geiban, Wumei, Gancao, Maiya, Yinchen, Chuanlianzi, Tianmendong, and Xuanshen. It is used for patient with Liver and Kidney Yin deficiency, Liver Yang overwhelming, or Liver inner Wind stirring, which makes the Qi and Blood rushing up to the upper part of the body, causing the body upper part overwhelming but lower part weakness. The third characteristics is the development of “Jiang Ya Xi Jiao Tang”, which means to wash feet with herbal extract. The herbal ingredient of the foot-rinsing formula is Sangye 30 g, Sangzhi 30g, Cunweizi 30 g, Mingfan 60 g, Miganshui (e.g. the water that has been used to wash rice) 1000 to 1500 ml. To use this foot-washing formula with either of the above two formula for the treatment of high blood pressure could increase the healing effect.
祖国医学虽无高血压病名,但根据高血压病的症状表现:头晕、目眩、耳鸣、健忘、失眠、心悸、心烦、头面烘热或脊背升火、神倦、腰膝酸软、下肢浮肿、足胫不温、小便频清、妇人带下清稀等症状,应属中医眩晕”“头痛”“肝风”“中风等病证范围。今选朱师治疗经验和特色,加以浅析以飨同道。

In Chinese medicine, there is no such term as “high blood pressure- hypertension”.  Based on the clinic manifestation of symptoms, such as dizziness, vision blurring, tinnitus, poor memory, poor sleep, palpitation, annoyed, hot feeling on the face or on the back, fatique, sour and weak in the lower back and knee, swelling in the legs, cold feet, long and pure as clear water-like urine, or water-like clear discharge in female, it should belong to the “dizziness”, “headache”, “Liver Wind” or “ Stroke” in Chinese medicine.  Here we are to introduce the clinic experience of Dr. Liangchun Zhu in the treatment of high blood pressure.

(1)
、气虚痰瘀证候见,双降汤拟屡效验 
(1). If the patient has Qi deficiency and phlegm stagnation, the herbal formula Shuangjiang Tang works well.


朱师指出:高血压病因病机虽有多种,但总以肝肾阴阳平衡失调,阴虚阳亢为主要关键,临床证实气虚夹痰瘀亦是高血压之主要病机之一。故朱师自拟双降汤药由水蛭0.55g(粉碎装胶囊吞), 生黄芪、丹参、生山楂、稀莶草各30g,广地龙、当归、赤芍、川芎各10g,泽泻18g,甘草6g组成,治疗气虚、血瘀、痰浊兼夹之症,此型高血压患者往往伴高血粘,高血脂。盖气虚则血运无力,血流不畅久而成瘀;气虚则运化无能,膏梁厚味变生痰浊,乃致气虚痰瘀互为因果。如脂浊粘附脉络血管,络道狭窄,遂成高血压,脂浊溶于营血遂成高血粘,故变生诸症。

Dr. Liangchun Zhu pointed out: “Though there are several different causes for the high blood pressure, the main reason is the disorder in the Liver and the Kidney, in the Yin and the Yang and the most important reason is the Yin deficiency with Yang overwhelming. Clinically, it is proven that the Qi deficiency with phlegm stagnation is also one of the most important causes for the high blood pressure”. The herbal formula developed by Dr. Zhu uses Shizhi (0.5 to 5 g, in powder form, and add into capsule for intake), Huangqi 30 g, Danshen 30 g, Shanzha 30 g, Xiqiancao 30g, Dilong 10g, Danggui 10 g, Chishao 10g, Chuanxiong 10 g, Zexie 18 g, Gancao 6 g. It works for Qi deficiency with Blood stagnation and phlegm stagnation condition. The patient with this type of high blood pressure usually has high blood viscosity and hyperlipidemia. If the Qi is in deficient, it is not enough to direct the blood circulation, so to cause blood stagnation. If the Qi is not sufficient, the greasy food is easy to develop into foul and muddy phlegm. These are the cause and results for the high blood pressure. For example, the greasy and foul phlegm attaches to the blood vessels to block the blood circulation to form the high blood pressure. The presence of such muddy phlegm in the blood stream causes the high blood viscosity, so to cause various other problems in the body.  

当代临床家邓铁涛老师曾谓从高血压病的证候表现来看,其受病之脏主要属于肝的病变。高血压病多因情志失调而发生发展,情志失调则肝气郁结,血脉瘀滞。临床观察发现,高血压病的发生和变化多不同程度受情志因素的影响。因肝主疏泄,调气机,畅情志,肝之疏泄功能正常,则气血畅行无阻,血压即可保持正常。若情志失调,肝失疏泄,气机郁滞,一则瘀血内生,二因木郁则土壅,土壅则枢机失转,当升者不升,当降者不降。

Dr. Tietao Deng, a famous TCM doctor of current times, said: “From the clinic manifestations of the high blood pressure, the main organ involved is the Liver”. The higher blood pressure is usually due to disorders in the emotion, which causes sluggish of the Liver Qi, and blood stagnation. Clinic study showed that, the occur and the development of the high blood pressure is affected more or less by the emotional disorder. Normally, the Liver works to dredge the Qi circulation, so the blood circulation, so as to maintain the blood pressure in a normal level. If the emotion is in disorder, the Liver function would be in disorder too, which further more causes blood stagnation and also the disorder in the Spleen function, so that the Qi which supposes to rise would not rise and the Qi that supposes to go down would  not go down. 

张锡纯指出:肝气不升则先天之气化不能由肝上达,胃气不降则后天之饮食不能由胃下输故痰浊内生。临床所见气虚夹痰瘀即是高血压病常并发心、脑、肾、眼底病变的诱因。如心绞痛,心肌梗塞,脑血管意外,肾动脉硬化血管病,眼底病等。这些并发症的发生均和气虚,兼夹痰瘀密切联系。

Dr. Xichun Zhang said: “If the Liver Qi does not rise up, the original life Qi would not rise through the Liver channel. If the Stomach Qi does not go down, the life Qi from the diet would not go down either”.  In such conditions, the phlegm would develop in the body. In clinic, the Qi deficiency with phlegm and blood stagnation is the trigering cause for the damages in the heart, brain, kidney and eyes in patients with high blood pressure, such as for cardiac infarction, angina, cerebrial infarction, kidney arthritis, disorders in the blood vessels in the eyes, etc.

气虚兼夹痰瘀是高血压病的重要病机之一,亦被现代医学之病理学研究所证实,气虚夹痰瘀之病机从血液流变学和微循环的角度看,高血压病患者存在着血液流变学的浓、粘、聚、凝的异常变化和微循环障碍。临床所见高血压病多发生在男女更年期前后,有病程较长,反复发作,迁延难愈的特点,这又和中医学的年老久病,多虚、多痰、多瘀的规律相吻合。

That the Qi deficiency with phlegm and blood stagnation is one of the most important cause for high blood pressure is also proven by modern medical research. In the patient with high blood pressure, their blood is usually thick, sticky, condensed, and highly viscosic and their micro circulation network is usually in disorder. High blood pressure usually occur in male or femail around the menopause years. It lasts for many years and hard to cure and comes and goes. In Chinese medicine, such diseases are uaually associated to the weakness, the phlegm and the blood stagnation.

因此朱师从气虚夹痰瘀着眼,创双降汤治疗高血压、高血粘、高血脂是经得起中西医,理、法、方、药推究的治疗高血压、高血粘、高血脂的特色和临床宝贵经验。方中用水蛭、地龙破血逐瘀为主药,合丹参、当归、赤芍、川芎活血通脉,生山楂、泽泻、稀莶草降脂泄浊之外还有去瘀降压之效,重用黄芪补气降压,取其双相调节之妙,补气则血行畅达,补气则可免除破瘀伤正之弊。更要提及的是黄芪降压和升陷之理,此乃双相作用”. 如何掌握升降之机?邓铁涛老师曾介绍经验说:黄芪轻用则升压,重用则降压。为什么药理研究只得一个降压的结果?因为动物实验都是大剂量用药进行研究的

… In the formula Shuang Jiang Tang, the Shuizhi and Dilong are the main ingredients. They work to break the blood clot and stagnation. Herb Dangshen, Danggui, Chishao, and Chuanxiong work to conduct the blood circulation. The herb Shangzha, Zexie and Xiqiancao work to clear the foul and muddy lipids in the blood stream and to dissolve the blood stagnation, so as to reduce the blood pressure. The large amount of herb Huangqi works to nourish the Qi to reduce the blood pressure, taking its double adjusting function. To nourish the Qi is to make the blood movement more easier. To nourish the Qi is to solve the side effect of damaging the body life energy by breaking the blood stagnation. It is worthwhile to mention the function of the Huangqi to increase the blood pressure and to raise the “shrinking” Qi. How to control such function of the herb Huangqi? Dr. Tietao Deng once introduced his experience that, a light dose of Huangqi works to increase blood pressure and a large dose would reduce the blood pressure. Why pharmacological study shows only its blood pressure-reducing effect? It is because the animal study uses only the large amount of Huangqi in experiments.

邓老治低血压,在补中益气汤中仅用生黄芪15g,治气虚夹痰瘀型高血压黄芪用30g以上。临床研究证明本方具有改善微循环,增加血流量,改变血液粘稠度,改善脂质代谢等作用,服后既可降压降粘,降脂通脉,防止心脑血栓梗阻,又能减肥轻身.

Whenever use the Huangqi for the treatment of low blood pressure, Dr. Liangchun Deng uses only 15 grams. If he uses it for the treatment of high blood pressure of Qi deficiency with phlegm and blood stagnation, he uses more than 30- grams. Clinic study showed that this herbal formula works to improve blood micro-circulation, to increase blood supply to the end-net tissues, to change blood viscosity, to correct lipid metabolism, etc. It works to reduce blood pressure and blood viscosity, to prevent blood vessel block, as well as to lose body weight. 

笔者仿朱师之法,历年来治疗高血压合高血粘并高血脂病例甚众,均收满意疗效。兹举病案一例,以举一反三,曾治施某,男,58岁,形体肥胖多年,高血压8年病史,因头昏而重,全身乏力、口干,血压波动在170210/110130mmHg,四肢常有麻木,视物模糊,近旬日前加重而住某医院,入院检查,血压200130mmHg,血粘度高粘( ),总胆固醇9.5mmoI/L微循环重度障碍,舌红苔薄白,根微腻,脉细涩。诊为气虚夹痰瘀,投双降汤原方10剂,配合降压洗脚汤五剂(一剂用2天每日一次)服完10剂后,复诊诉头昏重,全身乏力等诸证消失,自觉腹肌肥大较前减小,去降压洗脚汤守内服方30剂停药观察10天,一切正常,血压稳定在130160/100110mmHg。复查血粘度正常,总胆固醇3.5mmoI/L,微循环基本正常,腹围减少6cm。原方稍于增减嘱隔日一剂以巩固疗效,再嘱注意饮食宜忌,守服一段时间。追访3年血压稳定在正常范围。(此方水蛭用量因人而异,少则0.5g多则35g,故不标出
I, the author of the article here, followed the herbal therapy of Dr. Liangchun Zhu, treated a lot of patients with high blood pressure and with the high blood viscosity and high blood lipids level, and got very satisfied results. Here is one of the examples. Patient Mr. Shi, a male of 58 years of old. He was overweighted, and had high blood pressure for 8 years. For his cloudy mind and heavy head feeling, fatique, and dry mouth, numb feeling in the hands and feet, cloudy vision, and fluttered blood pressure of  170
210/110130mmHg, he was admitted in a hospital for treatment. At time, the blood pressure was 200/130 mmHg. Blood viscosity was ; blood total lipids was 9.5 mmol/L;  the micro-circulation was severely damaged. His tongue was red in color. The tongue cover was thin and white with greasy in the root. The pulse was thin and harsh. His condition was diagnosed as Qi deficiency with phlegm and blood stagnation. He was given the Shuang Jiang Tang for ten doses. He was also asked to have the herbal washing formula to wash feet (as introduced above) for five dose (each dose is used for two days). After the ten days, he felt no more heavy feeling in head and no fatique. He felt smaller size in the belly around. He was asked to stop the herbal washing but continue the herbal oral formula for 30 days and then stop to use for 10 days. The follow up showed that he had no any discomfort. The blood pressure is stable between 130160/100110mmHg. The blood viscosity was normal. The total lipids was 3.5 mmol/L. The micro-circulation is basically normal. The belly circle was reduced 6 cm. The previous herbal formula was modified very little and asked to have it once every other day for a maintenance. Three years of follow up showed blood pressure normal. (the amount of herb Shuizhi used in the formula is deferent from patient to patient. It is usually 0.5 g or up to 3 to 5 g). 

 
(2)
、阳亢 肝风证候见  镇肝熄风重酸敛
(2). If there is Liver overwhelming and Live Wind syndrome, use herbal formula Zhen Gan Xi Feng Tang and use large amount of sour herbs to restrain the Liver.
朱师指出镇肝熄风汤并非对所有高血压均有效,其适应证为肝肾阴虚,肝阳上亢,或肝风内动,气血逆乱并走于上之上实下虚证

Dr. Liangchun Zhu said: “The herbal formula Zhen Gan Xi Feng Tang does not always work to all kinds of high blood pressure. It only suits for those who in Liver-Kidney deficiency, Liver Yang overwhelming-up, or Liver Wind stirring which cause the mass in the Qi and Blood circulation, and causes Upper-overwhelming and lower-weakness condition”.

张锡纯云肝木失和,风自肝起,又加肺气不降,肾气不摄,冲气,胃气又复上逆,于斯脏腑之气皆上升太过,张氏此说乃识得高血压病只是一种标象,其病机乃是多脏腑关系失调之故,与肺胃冲气,肾虚皆有关系,所拟镇肝熄风汤决非 头痛医头, 脚痛医脚。和今之时医见高血压则单纯降压不可同日而语,此方标本兼治诚为独识卓见。张锡纯方解云:重用牛膝以引血下行,此为治标之主药。而复究病之本源,用龙牡、龟板、白芍以镇肝熄风,赭石以降胃降冲,玄参、天冬以清肺气,肺中清肃之气下行,自能镇制肝木

Dr, Xichun Zhang said: “…..

朱师深究张氏力主酸敛以救欲脱之侯,元气之虚,阴阳失和,心火暴甚,本气自病,湿土生痰,水不涵木等治肝独识卓见,结合清代善用乌梅敛肝的知梅学究刘鸿恩经验,在镇肝熄风汤中用乌梅易白芍,因白芍敛肝力微,故重用乌梅以敛肝阳、肝风,使镇肝熄风汤添上敛肝熄风之猛将,颇能提高疗效。确有画龙点睛之妙。

Dr. Liangchun Zhu supports the idea of Dr. Xichun Zhang to use sour herbs to restrain liver to save the escaping Qi, to solve the Qi deficiency, to adjust the disorder in the Yin and the Yang, to solve the Heart Fire overwhelming. He also follows the Dr. Hong-En Liu, the Qing dynasty China, to use herb Wumei to restrain the liver. He used herb Wumei to replace the Baishao in the original formula with herb Wumei, for the reason that the function of Baishao in the restraining liver is not so strong enough. The large amount of Wumei used is to restrain the Liver, to suppress the Liver Wind, so to increase the effect of formula Zhen Gan Xi Feng Tang. Such addition of the herb Wumei is a key step to increase the healing effect.

朱师在中风篇镇肝熄风汤去麦芽、茵陈、川楝子乃因考虑中风证兼夹痰瘀或肾虚等因,而用镇肝熄风汤治肝阳上亢,肝风内动之高血压病则不去麦芽、茵陈、川楝子,乃因朱师遵张氏之说盖肝为将军之官,其性刚强,若但用药强制,或转激其反动之力。茵陈为青蒿之嫩者,得初春少阳生发之气,与肝木同气相求,泻肝热兼舒肝郁,实能将顺肝木之性。麦芽为谷之萌芽,生用之亦善将顺肝木之性使不抑郁。川楝子善引肝气下达,又能折其反动之力。此论乃正合肝阳上亢或肝风内动之高血压病的治疗用药规律,亦是谨守原方之理。

In the chapter for stroke, Dr. Liangchun Zhu depleted the herb Maiya, Yinchen and Chuanlianzi from the herb formula Zhen Gan Xi Feng Tang, for the consideration that in the stroke condition, the patient might also have phlegm and blood stagnation, or with kidney deficiency. When he uses this formula to treat high blood pressure, he does not remove these herbs. This is because he follows the opinion of Dr. Xichun Zhang that the Liver is a general organ with strong and violent nature. If the herbs used for the treatment is too strong, too push and too violent in nature, it may trigger strong reaction from the Liver, so may make things worse. The herb Yinchen is the young spring of a plant called Qinghao. It bears the growing nature of early spring, e.g. the Shaoyang phase, which is in association with the nature of the Liver in the body. It works to deplete Liver Fire and to dredge the Liver sluggish. The Maiya is the young spring of wheat. When used as original (e.g. without any processing), it smooth the nature of the Liver to prevent Liver sluggish. The herb Chuanlianzi can conduct the Liver Qi down movement, and to suppress down the reversed Liver Qi. …

邓铁涛老师谓治疗高血压,治肝是重要的一环,朱师指出:由于高血压的发病机制是以内因为主,其病变主要在肝,因此治肝,调肝,尤其是敛肝是治疗高血压的关键。临床所用治肝之法如凉肝熄风,镇肝潜阳,滋补肝肾,养血平肝,益气养肝等常用治法,均须不忘敛肝舒脾,肝病宜敛不宜散,宜补不宜伐,正合内经治肝之旨。盖乌梅最能补肝且能敛肝,其敛肝的奇特效果是通过敛肝而达到疏肝理气,滋阴养血,补虚祛实,平熄肝阳肝风。既敛虚热,又敛实热。以乌梅易白芍是朱师法宗锡纯而用药独擅,镇肝熄风汤去麦芽、茵陈、川楝子治中风和谨守原方治高血压,(肝阳上亢或肝风内动型)的用药技巧,均证明朱师对张锡纯氏之用药法则除继承之外而颇多发挥。

Dr. Tietao Deng said: “To treat high blood pressure, one of the important step is to work on the Liver”. For the consideration that, the cause for high blood pressure is from the inside of the body and the main target of the disorder is on the Liver, it is therefore a key step to treat the Liver, to adjust the Liver, and especially to restrain the Liver.” No matter which ways to solve the disorder in the Liver, such as to cool the liver and to calm the Wind; to suppress the Liver and to dive the Yang Qi; to nourish the Liver and Kidney; to nourish the blood and to calm the Liver, to nourish the Qi so to nourish the Liver, it should not be forgoten to restrain the Liver and to release the Spleen. That in the liver disorder, it should be used to restrain the liver, but not to disperse the liver; it should be used to nourish the liver, but not to fight against the liver, matches the statement in the book <<Nei Jing>> for the treatment of liver disorders. The herb Wumei has most strong ability to both restrain the Liver and to nourish the Liver. By restraining the Liver, so to dredge the Liver and to relax the Spleen, it works to nourish the Yin and the blood, to nourish the weakness and to dispel the overwhelming, to calm the Liver Yang and the Liver Wind. It restrain the weak Fire and the overwhelming Fire. To replace the Shaoyao with Wumei is the way of Dr. Liangchun Zhu to follow the principle of Dr. Xichun Zhang but use different herbs. That he removes the Maiya, Yinchen and Chuanlianzi from the herbsl formula Zhen Gan Xi Feng Tang for the treatment of stroke, but keep the same formula ingredients for the treatment of high blood pressure (the Liver Yang overwhelming-up or Liver Wind stirring type), indicates that He followed Dr. Xichun Zhang’s principile in the herbal therapy but had additional development for the herbal therapy.

笔者仿朱师之法,亦可谓多年验证朱师之法,临床中颇多受益,正如邓老80年代初指出:抢救老中医的学术与临床经验,已喊了二十多年,成绩并不使人满意,这是一个十分急迫的任务,应该主动去承担。值此中医学术,振兴或西化堕落的存亡之际,笔者整理发表朱师的系例经验,愿和同道共享,以表赤子之心。

I have followed the Dr. Liangchun Zhu’s way of herbal therapy for many years and I proved his way too. I benefited from Dr. Zhu a lot. As Dr. Tietao Deng pointed out in 1980’s: “ it has been cried for twenty years to save the knowledge system of Chinese medicine and clinic experience, but the result is not satisfying. This is a urgent taske and we should do by ourselves to save it.” It is time now the Chinese medicine is saved and awakened or goes downhill to die. I summarized the clinic experience of Dr. Liangchun Zhu and show here to my colleagues to show my willingness.
按:高血压是一常见病,多发病,不但老人有之,近20年来随着激素饲料喂养鱼类和禽畜,饮食结构合理性的破坏,青少年,中年人发病率大增,如何控制高血压病的发生和发展,应引起注意,某些中医受西化的影响,热衷于直接降压,忽视与发病因素有关的措施。只知单纯用直接降压药,一旦停药即反复发作。因此借此简谈饮食宜忌亦即防治常识。一要控制钠盐,调节饮食咸度。

Comment: Hypertension is a common disease and a popular disease in the society. It happens not only in elderly patients but more and more in younger generations, due to the feeding of fish and pig and chicken with hormones, and to the disturbance of normal diet structure. It should be brought to attention to the prevention of this disease. Some Chinese herbalists, who are more affected by the western medicine, are eager to reduce the blood pressure directly with herbs, but omit the reasons for the disease. They only know to reduce the blood pressure by using the herbs that works to reduce the blood pressure, but the blood pressure increases again after stop of the herbal therapy. For this reason, here we need to discuss some common sense for the prevention and the treatment of high blood pressure by diet, e.g. the diet salty must be controlled.

中医谓咸味入肾,但过咸则伤肾,肾受损后,肝木不得肾水的滋养,导致肝阴虚,则肝阳上亢,肝风内动,加剧或并发高血压。二要注重饮食结构,防止肥胖,中医认为肥胖就是病,少吃激素饲料饲养的鸡、鸭、鸽、猪肉、蛋类。少吃有防腐剂的饮料、方便面等。高血压病肥胖者多吃海带、海哲皮、蔬菜。要控制饭量,平素食量过大者,每顿进食八、九分为度,多食糙米或杂粮,如玉米、麦面等,节食糖类或动物脂肪如猪油、牛油、羊油、肥肉、骨髓等。高血压病人均应少食或不食动物内脏和高胆固醇食物如:脑、蛋黄、螃蟹、鳗鱼、带鱼、对虾等。多食萝卜及酸笋、豆制品、蔬菜等,更重要的是要坚持锻炼,散步、羽毛球、健美操、太极拳最为合适。三要戒烟、忌酒、少食辛辣之食物。控制七情,远房欲,调节阴阳平衡亦是防治高血压病的重要措施。以药粥辅助治疗亦是中医传统的方法,如芹菜粥(芹菜150g、米120g煮粥常食)、车前子粥(车前子60g布包煎汤代水煮粥,米120g)、菠菜粥(新鲜菠菜60g、米120g煮粥)、胡萝卜粥(胡萝卜120g切片,米200g煮粥常食)。总之中医治疗高血压病除辨证论治、用药熨贴之外,良医必须注重药外功夫。 (邱志济

In Chinese medicine, salty taste comes into kidney (It means any salty taste food or herbs would go to kidney to exercise its function or influence). However, over salty would hurt or damage the function of the kidney. When the kidney is damaged, the Liver wood would not get sufficient Kidney Water to nourish, causing Liver Yin deficiency, the Liver Yang overwhelming-up, the Liver Wind stirring, to make worse or to trigger out the high blood pressure. Second, we have to have a close look at our diet structure, to prevent overweight. Chinese medicine believes that the overweight per se is a disease. We should eat less the chicken, goose, pork, eggs, that animals were feed with hormones, and eat or drink less drinks that contains preservative stuff. Patients with high blood pressure and obesity should eat more kelp, sea jelly, and vegetables. The amount of meal should be controlled to less. It is best to eat about 80% to 90% of ordinary meal. Eat more harsh rise, such as corn, wheat, etc. Reduce the amount of sugar and candy, animal oil or fat, such as pig oil, cow oil, sheep oil, spine marrow, or oily pork. Patients with high blood pressure should eat less or do not eat animal organs or food that contains high amount of cholesterol, such as brain, egg yolk, crab, belt fish, eel, shrimp, etc. They should also eat less spicy food. They should eat more carrot, soya food, sour bamboo sheets, and vegetables. More important is that they should have regular physical exercise, walk, hike, or play badminton, practice Taiji, or practice calisthenics. The third, they should quit smoking and alcohol. They should learn to control their emotion, have less sexual activity. It is a complementary means to use rise soup for the treatment of high blood pressure, beside the herbal therapy. For example, to eat the celery soup (cook celery 150 g, rice 120 g), Cheqianzi soup (cook plantain seed 60 g (fold in gauze) and rice 120 g), Spinach soup (cook fresh spinach 60 g, rice 120 g), or carrot soup (chopped carrot 120 g, rice 200 g). All in all, a TCM herbalist should not only use the herbs for the treatment, but also pay attention to some other means for the treatment, which is beyond the herbal therapy.

 

7. 朱良春治疗慢性结肠炎临床经验和特色

7. The treatment of chronic colonitis by Dr. Liangchun Zhu

作者:邱志济  

Author: Dr. Zhiji Qiu

溃疡性结肠炎或过敏性结肠炎多为慢性非特异性肠病.中医属大瘕泄 (病名首见于(难经,五十七难)下和脏毒范畴。临床有急慢性之分,急者本文不加论述。慢性者缠绵难愈.反复发作,甚至多年不愈,故亦称久泻。主证为腹泻伴粘液或脓血便,有似痢非痢,似泻非泻之说.有轻度里急后重腹痛或无里急后重者。亦有久泻粘液无脓血者。其病位虽在肠。但相关多脏之功能,盏肺和大肠相表里,脾胃为气机升降之枢纽.相关大肠之传导,又因肝司疏泄,脾主运化,肝气横逆太过则伤脾,运化失司则痛泻由生,敌本病肝郁脾弱乃其本,痰瘀滞留乃其标。朱良春先生指出,久泻咎于脾虚,久泻病在气机。故注重运枢机、制肝木、健脾胃、化痰瘀、涩滑脱,首创仙桔汤等方应用临床,疗效颇著,其组方用药之妙试述如下。 

Ulcerative colitis or allergic colitis is more as a chronic non-special disease in intestine. In Chinese medicine, it belongs to Da Zhen Xie (see book <<Nan Jing: 57 Nan>>, or “Xia He”, or “Zang Du”. It can be an acute or a chronic. We do not discuss the treatment for the acute colitis. The chronic colitis can last for long time, it comes and goes for many years, so it is also called long term diarrhea. In clinic, it manifests as diarrhea with mucus or pus-blood in the stool. It seems as dysentery but not a dysentery, and it seems as diarrhea, but not a diarrhea either. The patient may have slight falling feeling within the anus with belly pain or no such feeling. For some, they may have no mucus or pus-blood in the stool. Though the disease is located in the large intestine, it involves several organs in the body. For example, the Lung and the Large intestine is the surface-inside relationship. The disorder in the Lung could affect the function of the Large intestine. The Spleen and the Stomach work to control the Qi in the digestive system moving up or down. If there is disorder in the Spleen-Stomach system, the bowel movement would also be affected. The Liver works to conduct the Qi circulation, and the Spleen dominates the transportation of the absorbed micro-nutrition stuff. If the Liver Qi is in violent motion, it would hurt the function of the Spleen. The disorder in the diet transportation causes pain and diarrhea. For this reason, there is a saying that the Liver sluggish and the weakness in the Spleen is the basic cause, while the accumulation of phlegm and blood stagnation cause the symptoms. Dr. Liangchun Zhu said, the reason for the long term diarrhea is the Spleen weakness and it is due to the disorder in the Qi movement. So, it should be focused on the adjustment and correction of the Qi movement, to restrain the Liver, to nourish the Spleen, to dissolve the phlegm and blood stagnation, to contract the slippery colon. For this aim, he developed the herbal formula “Xian Jie Tang”. When used in clinic, it works very well.

(1)
泄木制肝补脾土 仙桔汤方轻灵图
(1). To deplete Wood, to restrain the Liver and to nourish the Spleen, the herbal formula Xian Jie Tang works for chronic colitis though it is light in its ingredient doses.


朱师早年制订之仙桔拓由仙鹤草30g、桔梗8g、乌梅炭4.5g、白槿花(即木槿花)、炒自术各9g、广木香5g、炒白芍9g、秦艽l0g、炒槟榔1.2g,甘草4.5g组成。用治慢性结肠炎历验不爽。肝郁脾滞,湿热蕴结之候加柴胡5g以疏肝解郁;有失禁不固者加诃子肉12g,或石榴皮l0g;腹痛甚倍白芍;气虚甚加参芪、升麻,(无木槿花,笔者代以藿香、紫苏各6g,地锦草20g)

In early years, Dr. Liangchun Zhu developed his Xie Jie Tang, which contained Xianhecao 30 g, Jiegen 8 g, Wumeitang 4.5 g, Mujinghua 9 g, Chao Baizhu 9 g, Guangmuxiang 5 g, Chao Baishao 9 g, Qingjiu 10 g, Chao Binglang 1.2 g, and Gancao 4.5 g. It is used to treat chronic colitis and it works very well. For the Liver sluggish and Spleen sluggish, the Wetness-hotness accumulation condition, add herb Chaihu 5 g to dredge the Liver and the Spleen. If there is slippery anus, add Hezirou 12 g, or Shiliupi 10 g. If there is belly pain, double the amount of Baishao. If the Qi deficiency is severe, add Dangshen, Huangqi, Shenma. (If there is no herb Mujinghua, I use herb Huoxiang 6 g, and Zisu 6 g, Dijingcao 20 g. )

本方选仙鹤草为主药。乃固仙鹤草涩中有补,轻灵止泻,止中寓通,强壮强心,补脾健胃,对慢性泻痢虚实夹杂者有标本同治之功,如临床广用于治劳伤脱力、止汗、止咳、止血、止痢、止泻、眩晕、赤白带下、血小板减步性紫癜等,即是明证。亦以其味辛而,微温无毒,伍桔梗辛苦甘平,以其辛制其肝,开其肺,以其涩去其脱,除其滑。盏肺气开则府气通,故能治腹痛、下痢、久泻。

In this formula, the herb Xianhecao is the main ingredient, for its herbal nature to have nourishing function among its restraining ability, having conducting function among its restraining property, and to be able to nourish both the Spleen and the Stomach. For chronic diarrhea or dysentery with both weakness and overwhelming conditions, this formula works to solve the symptoms and also the cause. Such functions of the herb Xianhecao can be proven by its use to treat exhaustion by labor work, to stop sweat, cough, bleeding, dysentery, dizziness, discharge, purpura, etc. It is spicy and  astringent, slight warm and no toxic in herbal nature. It is used together with Jiegen, which is spicy and bitter, to restrain the liver with its spicy property, to open and to activate the Lung, and to stop the slippery anus with its astringent taste. Once the Lung Qi is open and activated, the intestine Qi is conducted smoothly to move, so to solve the belly pain, dysentery and long term of diarrhea.

古有(药性论)(奉草经疏)(重庆堂随笔)等均载桔梗治下痢。清代温病家柳宝诒最喜用桔梗伍枳壳治泻痢而多方不离,其疏畅气机。斡旋气化之用。更重于桔梗升挺肺气和排脓榜痰之功。朱师抄伍少量摈榔。一升一降,清升浊降则枢机运转如常,探得王孟英调正气化柩机之旨。久钙或久痢多清气下谎,清浊相混,运传失常,槟榔本散结破滞,下泄杀虫之药,但槟榔多服则泻至高之气,较枳壳、青皮尤甚之说,故朱师用量为1.2g,有久病用小方,以少胜多,事半功倍之用药特色,对久泻久痢腹痛较甚者亦有著效。

In old books, such as <<Yao Xing Lun>>, <<Feng Cao Jing Shu>> and <<Chongqing Tang Sui Bi>>, it was stated that the herb Jiegen could be used to solve diarrhea. Dr. Baoyi Liu, Qing dynasty China, was good at using the Jiegen and the Zhike together to solve dysentery in many of his formula, with the aim that the herbal couple could work to conduct the Qi circulation in the digestive system. In the formula, it is more focusing on the function of Jiegen to raise Lung Qin ad to dispel pus and phlegm. Dr. Liangchun Zhu also used little amount of Binglang. One herb works to raise the Qi (the Jiegen) and another to direct down the Qi (the Binglang), so the Qi circulation runs as normal. This way of using herbs by Dr. Zhu suggests that he really understand the meaning of Dr. Mengying Wang to solve diarrhea by adjusting the Qi circulation in the digestive system. During a long time of diarrhea, the pure Qi in the body may fall down to mix with foul Qi in the large intestine, so to disturb the digestive food moving down in the intestine. The herb Binglang initially works to disperse the mass, to break the sluggish, to improve bowel movement and to kill parasite in the intestine. However, if the Binglang is taken in a large amount, it would deplete the top pure Qi, which is stronger than the herb Zhike and Qingpi. For this reason, Dr. Liangchun Zhu uses only 1.2 g of Binglang in his formula. It means that, he uses smaller formula and little dose formula for long term disease, while it works much better, especially for chronic diarrhea with strong pain in the belly. This is one of the characteristics in his herbal therapy.

白槿花轻清滑利,能井能辟,拨动气机,上清肺热,下利水道,消积导滞,凉血和营,消肿排脓,止泻止痢,对清化下焦湿热颇有速效,故有消炎、退热、抗菌、通淋、止泻、止痢等功,朱师历年用白槿花治肾盂肾炎、菌痢,每每应手,是一明证。

The herb Baijinghua is light in weight, pure in odor and slippery in herbal nature. It works to activate the Qi movement, to clear the Fire in the Lung, and to conduct the water flow in the urine bladder, to help digestion, to dispel the sluggished food in digestive system, to cool the blood and to harmonize the Yin Qi in the body surface layer, to reduce the swelling and to dispel the pus, and to stop the diarrhea and dysentery. It works very fast to clear the Fire and Wetness accumulation in the lower part of the body (lower Jiao cavity). For this reason, Dr. Zhu uses for many years for the treatment of infections in the kidney and dysentery. It works again and again.

白术、术香健脾调气;白芍、乌梅、甘草酸甘敛阴,且泄木制肝。缓急止痛,圊脱止滑;秦艽有抗菌、消炎、镇痛和类激素之作用,能斡旋脾胃,拨动气机.助桔梗升提,大有喻氏逆流挽舟之意;乃与败毒散用防风、羌独等异曲同工耳。且能祛风、通络、理湿、清热、利尿,宣通诸府,引导湿热.直走二阴而出。一药多功,颇合慢性肠炎脾虚湿热型之病机,诸药共奏升清降浊.通塞互用,气营兼调,补脾敛阴,清化止泻之功。既无参芪之峻补,亦无芩连之苦降.更无硝黄之攻伐.对久病正虚,攻不胜攻,清不耐清,补不能补之久泻、便溏,夹有粘冻,纳呆腑呜,腹胀乏力.舌尖红,白腻苔,脉满细之慢性结肠炎、过敏性结肠炎及慢性痢疾,疗效确切。但朱师指出,对久泻久痢证属脾肾阳虚或肾阳不振者.或大寒凝内多年不愈者仙桔汤当不适用。 
 The herb Baizhu is fragrant in herbal nature. It works to nourish the Spleen and to conduct the Qi movement. The herb Baishao, Wumei and Gancao are sour and sweet, so they are able to restrain the Liver, to dispel the Liver and to suppress the Liver, so as to stop the pain and to restrain the slippery anus. The herb Qingjiu works as antibiotics, able to dissolve inflammation. It has function as steroid hormone. It works to push the Spleen-Stomach Qi to move, an to help the herb Jiegen to raise the Qi ….. It also works to dispel Wind, to conduct meridian, to dissolve Wetness, to clear Fire, to improve urination, to expand all the body cavity, and to conduct the Wetness-Fire to move out of the body through the colon and urinary tract. One herb has so multiple functions, matching the mechanism for the chronic colitis of Wetness-Fire type. All these herbs work together, to raise the pure Qi, and to conduct down the foul Qi, to open the block and to stop the slippery, to adjust both the Qi and the Yin in the body surface, to nourish the Spleen and to restrain the Yin, to clear the Fire and to stop the diarrhea. It has no side effect as over-nourishment by herb Dangshen or Huangqi; no side effect of bitter-descending by herb Huangqin and Huanglian; and no side effect of violent attack by herb Dahuang and Puxiao. The healing effect is sure for the long term diseases, in which the body condition cannot tolerate the violent dispelling, strong clearing, or strong nourishing therapy, such as in chronic loss bowel movement, chronic colitis, allergic colitis and chronic dysentery, in which the person may have sticky gel in the stool, poor appetite, intestine noise, belly floating, fatique, red color in the tongue, white-greasy tongue cover, and thin pulse. This herbal formula however is not suitable for the chronic diarrhea due to Spleen-Kidney Yang deficiency of Kidney Yang deficiency, or strong Cold accumulation in the intestine for long time.


曾治郭某,男,38岁。起病2年。泄泻1天多达20余次,少则10条次,肠鸣不停,作乙状镜检,确诊为溃疡性结肠炎,多次住院,中西药治疗罔效,诊见面色苍黄,神疲乏力,形体消瘦,纳呆肠鸣,腹泻有粘冻,无里急后重,时有失禁不固,舌尖红苔腻,脉细,证屠脾虚湿热,投仙桔汤加减.仙鹤草30g,桔梗6g,白槿花、炒白术各12g,乌梅炭5g,诃子肉12g,炙黄芪15g,党参l0g,升麻、柴胡各5g4剂药后,大便好转,日12次,粘冻消失,精神明显好转,原方再进l0剂,诸症全除,守原方l4剂善后,嘱愈后用参苓白术丸、香砂六君丸各500g守服以复脾胃功能。

Case report: Mr. Guo, male, 38 years of old. He had chronic diarrhea for two years. He had diarrhea as more as than 20 times a day, at least for 10 times a day. He had no-stop intestine noise. Colon escopy detection confirmed the condition as ulcerative colitis. He was admitted in hospital for treatment many times by using both western medicine and Chinese herbal therapy. His face looked pale-yellow withered, fatique, and slim. He had poor appetite, intestine noice, sticky gel stuff in the stool, no falling feeling inside the anus, but from time to time a slippery anus. His tongue was red on the tip. The tongue cover was greasy. The pulse was thin. His condition was diagnosed as Spleen deficiency with Wetness-Fire condition. He was given the Xian Jie Tang with some modification: Xianhecao 30 g, Jiegen 6 g, Baijinghua 12 g, Chao Baizhu 12 g, Wumeitan 5 g, Hezirou 12 g, Zhi Huangqi 15 g, Dangshen 10 g, Shenma 5 g, Chaihu 5 g. After four doses, the bowel movement was much better, which was once to twice a day without the sticky-gel stuff in stool. The emotion was much improved. The herbal formula was continued for ten doses (ten days), and all symptoms subsided. Additional 14 doses were asked to take. Later, he was asked to take herb pill: Shenling Baizhu Wan and Xiangsha Liujunzi Wan for a maintenance to restore the function of Spleen and stomach.

又治许某,男,52岁。大便溏泄4个月.日23次,杂有粘冻,脐左攻痛,叠进中西药物无技,舌中腻,尖红,右关脉弦按之弱,经乙状镜确诊为慢性结肠炎、肠痉挛,证嘱肝郁脾滞,予仙桔汤加减:仙鹤草l5g,桔梗8g,白槿花12g,炒白术15g,炒白芍18g,乌梅炭5g,秦艽l0g,萆解15g,广木香6g,柴胡5g,甘草3g,药服10剂,诸证悉除。 
Case report: Mr. Xu, male, 52 years of old. He had lose stool for 4 months, which was twice to three times a day, with sticky gel stuff in stool. He had belly pain on the left side of naval. He had tried both western medicine and Chinese herbal therapy for long time but in vain. His tongue cover was greasy in middle of the tongue. Tongue tip was red in color. The pulse was string and weak on right side the Guan position. Sigmoidoscope indicated the condition as chronic colitis and intestine spasm. The condition was diagnosed as Liver sluggish and Spleen sluggish. He was given Xian Jie Tang for ten doses: Xianhecao 15 g, Jiegen 8 g, Baijinghua 12 g, Chao Baizhu 15 g, Chao Baishao 18 g, Wumei Tan 5 g, Qingjiu 10 g, Pixie 15 g, Guang Muxiang 6 g, Chaihu 5 g, Gancao 3 g. After the treatment, all symptoms subsided.

按:久泻大便杂有粘冻,当有湿热留着。脾运失常气机阻滞,则纳呆肠鸣。脾胃虚弱,气化失常,清浊不分。水谷不化,则便次增多。如泄泻不爽,则内有积滞阻碍气机。肝强脾弱则弦脉独见于右关,按之细弱。 
Comment: When there is sticky-gel in the stool, it suggests that there is Wetness-Hotness in the body, which blocks the Qi circulation in the digestive system (conducted by Spleen), causing poor appetite and intestine voice. When the function of the Spleen-Stomach is poor, the Qi circulation is in disorder, the digestive system fails to separate the pure nutriation stuff from the foul waste stuff, and the water and the food would not be digested properly, so that the times of the bowel movement increases. That a bowel movement is not smooth suggests that there is accumulated block in the intestine to sluggish the stool movement down. When the Liver is overwhelming but the Spleen is weak, the pulse in the right side and on its Guan position feels string, thin and weak. 

王孟英强调,临证治病必须量体载衣,各求其是,提出了病同体异。难执成方的卓见。朱师告戒吾辈.不要死抱仙桔汤一成不变地用于临床,再好的方子也未必能符合千变万化的病情。故朱师谱成仙桔汤方的临证加减歌诀指导吾辈,对后学者颇有提示该方加减思路的作用,特拔露如下。

Dr. Mengying Wang emphasized that, in clinic for a treatment, the herbal formula must be formulated according to the difference among the patient. Each patient is different so the herbal formula should also be different. It would be difficult to use a fixed herbal formula for all patients though they have the same “disease”. Dr. Liangchun Zhu also reminded us not to hold the Xie Jie Tang for every patient with chronic diarrhea. Any good formula would not be able to solve the changeable disease conditions. For this reason, Dr. Zhu told us furthermore how to modify the Xian Jie Tang in clinic.  

歌曰:各种肠炎仙桔汤,南通朱氏良春方;仙桔白槿方必用,白术白芍乌梅炒;术香槟榔行积滞,消补通涩粘冻康;诃子榴皮滑脱放,需知加减化裁方;肝强脾弱湿下注,痛泻要方共成方;寒痛需配良附丸,热痛宜加金铃散;过敏长卿或地龙,瘀痛莪术失笑散;溃疡加用护膜法,重证可配灌肠方;寒湿欠困见便溏,四神掺入力增强;湿热互结宜清利,热重需加白头翁;湿盛白槿花宜重,酌加燥湿力尤彰;湿毒羁留难清利,芳化淡渗法优良;病久中虚见气滞,扶正调气逆流挽;便血蕊石云白药,故子诃槐芪淮山;上述诸注皆罔赦。大寒凝内巴豆炭;阿米巴痢鸦胆子,次吞5粒套胶囊。以上歌诀笔者稍有文字增减,以便于自诵习惯,并兼顾临证心得。 更希望读者按方言改谱, 便于记忆。 
Moditification of the Xie Jie Tang:

(1). If the condition belongs to the Liver Overwhelming but Spleen weakness, use the herbal formula Tong Xie Yao Fang the same time with the Xian Jie Tang.

(2). If the diarrhea is due to a Cold inside (e.g. the Cold diarrhea condition), use the formula Liang Fu Wan the same time.

(3). If the diarrhea is due to a Hotness, use the Jing Ling San the same time.

(4). If  the diarrhea is due to allergic to some food, add herb Xuchangqin or Dilong. If it is due to blood stagnation, add Ezhu, and herbal formula Shixiao San. If there is ulcer in colon, use membrance-protection therapy. In severe case, use coloclysis therapy too. If it is due to Cold-Wetness, and the person felt sleepy and drousy, add Si Shen Wan too. If it is due to Wetness-Hotness, and in this case if the Hotness is more overwhelming than the Wetness, add Baitouwen; if the Wetness is more overwhelming, add Baijinghua, as well as some other herbs to dry the wetness; if the Wetness is very difficult to clear, use fragrant and filtration therapy to clear the Wetness. If for a chronic condition and there is Qi sluggish condition, use nourishing therapy to increase the body life energy. If there is bleeding in the stool, add herb Huaxingshi and Yunnan Baiyao, Poguzhi, Hezi, Huaihua, Huangqi and Shangyao. If the condition is still difficult to solve, and if it is severe Cold condition, use Badou Tan. If the chronic diarrhea is due to ameba infection, use herb Yadanzi (fold it into capsules. Take five capsules each time).

朱师临证, 除注重详察明辨外. 并根据患者体质、嗜好、宿疾疾兼夹,以及饮食居住情况等。 结合病程远暂, 症情轻重,强调因人制宜。且抓住辨证要点。素体丰腴者,多见气弱湿滞,须注重气机的疏畅;形体瘦削者,常伴阴液暗耗,当顾及气阴的生化。凡久泻者,不可概以脾虚湿 热或脾肾虚寒论治。临证中因虚致泻的还有情志不遂,肝木乘土的泄泻;水土不合,肠胃功能紊乱的世泻; 食物或药物异体蛋白过敏的泻泄等,均不能忽视。如朱师昔日曾治一例土不合泄泻4个月,诸中西药治疗无效,投四君子加徐长卿、炙乌梅肉、木瓜、广木香、紫苏4剂即瘥。朱师的宝贵经验,笔者历年仿用,每每应手,深受其益矣。 

In clinic, Dr. Liangchun Zhu pays attention to the TCM various diagnosis, and also has close look at patient’s body constitution, cravings, disease history, living condition and habit, the terms of the disease, the severity of the disease, etc. to adjust the herbs in ingredients and in dose. For person with bit body shape and overweight, the condition is more as Qi deficiency with Wetness sluggish, he pays attention to dredge the Qi movement and circulation. For person who is slim, the body more tends to have Yin exhaustion, the attention is paid to nourish the Qi and the Yin. For chronic diarrhea, it should not always be treated as Spleen deficiency and Wetness, or Spleen-Kidney weakness-Cold condition. In clinic, the chronic diarrhea can also be caused by emotional disorders, as the Liver is over the Spleen; by the inconsistence between the body constitution and the environment conditions; or by allergic to some food or proteins.  For example, there was a case of chronic diarrhea for four months due to inconsist between the body and the environment. Either the western medicine of Chinese herbal therapy worked for him. Dr. Zhu used Si Jun Zi Tang plus Xuchangqing, Zhi Wumei, Mugua, Guang Muxiang, and Zisu for four days and the symptoms subsided. I have followed Dr. Zhu’s valuable experience in clinic for many years.

(2)
、肠炎便血湿热犯 缠绵顽疾要守方
(2). If the chronic diarrhea with bleeding in stool is due to Wetness and Hotness, the herbal formula has to be kept for a longer time to reach the healing effect. 
治久泄误热为寒,或用温补固涩以治脾虚湿热,所谓南辕北辙导致坏证,屡见不鲜。慢性结肠炎因误治导之便血是为重证, 虚、 瘀、 热夹杂, 病较顽固缠绵,治疗较为棘手 。朱师用药, 思路广博,缓中有奇。法拟益气和血止涩, 兼顾湿热伤络,疗效满意。

If the chronic diarrhea that is Hotness is mis-treated as Cold condition, or if the diarrhea that is due to Spleen deficiency with Wetness and Hotness, is mis-treated by warming and restraining therapy, it is big mistake and it would casue severe problem. It is a severe condition when a chronic colontitis is mis-treated to cause bleeding in stool. In this case, the weakness, the blood stagnation, and the Hotness all mixed together, forming a very difficult condition to solve. For such cases, Dr. Liangchun Zhu has broad idea for the treatment. He uses nourishing, blood-calming, and restraining therapies, with consideration of the meridian-damage by the Wetness-Hotness. His healing effect is excellent.  

1998年盂冬,朱师曾治管某,女,2 5岁。主诉年前便血,曾经治疗血止,肠镜检查确诊为结肠腔溃疡。2个月前大便每2 3 出血1次, 1个月,每天便血,呈血丝状,色鲜红与暗红杂见。大便中夹粘液,刻下 神疲乏力,面色苍白,纳少泄泻,服前医中药后,即唇肿腹痛,舌胖大有齿痕,脉细弦。证属脾虚湿热误治,伤及腑络出血。治以 益气和血,佐运脾固摄。

In the winter of 1998, Dr. Liangchun had a case. She was 25 years of old. She complained having bleeding in stool for some months. The bleeding stopped after a treatment. Colonescope detected she had ulcer in colon. Two months ago, she started to have bowel movement two to three times a day with bleeding once. For the last one month, she had bleeding every day, which looked as blood silk, fresh red in color or dark red in color. There was sticky mucus in the stool. At the movement she visited Dr. Zhu, her face was pale. She had poor appetite, and diarrhea. The herbal therapy she got from previous doctor caused her swelling in mouth lips and stomach pain. At this movement, her tongue was big with teeth index. Her pulse was thin and string. Her condition was considered to be due to mis-treatment, which damaged the organ meridian to cause bleeding. The herbal therapy then given was to nourish the Qi and to calm blood, to helps the Spleen to restrain the colon.

药用:仙鹤草30g 、煅花蕊石20g、白槿花12g 徐长卿15g、地榆炭、血余炭、诃子 肉、 炒白术各10g , 淮山药30g 、甘草6g,药服2周,诸证好转,便血减少,唯面色无华,脉细无力。原方加人参、 黄芪各15g,又服2周,大便成形,症情稳定。但大便仍夹有粘液和血丝,予原方加桔梗10g,再服2周,药后仍偶有粘液和血熊。又予原方加云南白药4盒,每服2粒,每日次,空腹服。加云南白药后,嘱守服20余剂, 便血粘液消失,唯纳谷欠香,面色无华,神疲乏力,舌脉如前。再原方出入,淮山药、仙鹤草各30 g、炒白术、谷麦芽、党参各15g、白槿花、补骨脂、乌梅炭各10 g、广木香6g、甘草4g。守服2个月,因诸证消失,病情稳定而停药。

 The herbs used was Xianhecao 30 g, Duan Huaruishi 20 g, Baijinghua 12 g, Xuchangqin 15 g, Diyu Tan 10 g, Xueyu Tan 10 g, Hezirou 10 g, Chao Baizhu 10 g, Huai Shanyao 30 g, Gancao 6 g. The herbal tea was drunk for two weeks. The symptoms were improved. The bleeding was reduced, but the face was still pale and the pulse was thin and weak. To the original formula, added was Renshen 15 g, Huangqi 15 g. The heral therapy was continued for two weeks. The stool became formed (not losed), and the overall body condition was stable. For there being still sticky mucus and blood in stool, to the original formula, added was Jiegen 10 g. Another two weeks later, there was still sticky in stool and blood in stool. She was requested to take Yunnan Baiyao, 2 pills each time, three times a day with empty stomach, for 20 days. Then the bleeding in stool disappeared. She stil had poor appetite, and pale in face, and chronic fatique. The tongue and the pulse was the same as before. The new herbal formula was Huai Shanyao 30 g, Xianhecao 30 g, Chao Baizhu 15 g, Guya 15 g, Maiya 15 g, Dangshen 15 g, Baijinghua 10 g, Buguzhi 10 g, Wumei Tan 10 g, Guang Muxiang 6 g, Gancao 4 g. The herbal formula was used for two months. All the symptoms subsided so the herbal therapy stopped.

但停药一段时间又复发,此例便血顽固缠绵,若非真知灼见者早己改弦异辙, 值朱师仍守原法,用健脾止血方加石榴皮10g、生白及15g。再配合外治灌腑 方:白头翁、秦皮、地榆炭、槐花炭、生白芍各 15g、地锦草30g 、川黄柏、炒乌梅各10g 煎取2 0 0ml,加锡类散1支,保留灌腑。每日1次,每次l h。配合灌肠方一个月余,诸证又消失,嘱去灌肠方继守服原方3个月。 停药至今随访未复发。
After stop of the herbal therapy for a whle, the symptoms came back again. In this case, the bleeding in stool was obstacle to solve. If the doctor has no real knowledge and confidence, he/she might change the herbal formula quite long time ago. Dr. Zhu, however, kept the same healing principle. He still used Spleen-nourishing, blood-stopping therapy, together with colonclysis therapy. For oral herbal therapy, to the previous formula, added was Shiliupi 10 g, Baiji 15 g. The herbs in the colonclysis: Baitouwen 15 g, Qingpi 15 g, Diyu Tan 15 g, Huaihua Tan 15 g, Baishao 15 g, Dijingcao 30 g, Chuan Huangbo 10 g, Chao Wumei 10 g. The herbs were cooked in water. About 200 ml of the water extract was collected, to which added was Xilei San one tube. This extract mixture was used for colonclysis, once a day, one hour each time. All the the symptoms disappeared again. The colonclysis was stopped but the herbal formula was continued for three months. Then the herbs were stopped. Follow up to now, no recurrence. 

按:本案便血色见鲜红夹紫, 显见肠有湿热夹瘀。服前医中药唇肿、腹痛, 可见前医误以温补治湿热,误以固涩治瘀滞。大便中夹有粘液则肠 中有湿热,如以温补治之、反助肝阳, 肝愈强则脾愈受克。味厚滋阴之品,更非土受木克,脾失健运之所宜。泄泻而纳少其病在脾。本案治疗先后历时1年,几次愈而复发。朱师始终守仙桔汤加减化裁,以健脾止血,益气和营兼顾湿热,调整气化枢机之法贯彻前后,关键时刻妙以外治灌肠方配合,终收治愈痼疾顽证之的。常法新用,有常有变,且执简驭繁,守法守方,灵活加减, 乃为高手也。如故不守方,心无定见, 朝方暮改, 寒热杂投,漫无边际,否认专方、效方和法外之法,定不能达到治愈痼疾难证之目的。 此乃吾辈之深深体会矣。

Comment: In this case, there was blood of fresh red and purple in color, strongly suggesting a condition of Wetness-Hotness with blood stagnation. The herbal therapy from previous doctor caused swelling on the mouth lips and stomach pain, indicating that the condition was mis-treated by a warming and restraining therapy for the true Wetness-Hotness. That sticky mucus in the stool suggests the presence of Wetness-Hotness in intestine. If the warming therapy is used, it would trigger the Liver Yang. When the Liver Yang is overwhelming, the Spleen would be more inhibited by the Liver. The herbs with greasy taste for a Yin nourishment should not be used in a condition, in which the Soil is inhibited by the Wood, so the Spleen loses its function for digestion. The poor appetite with diarrhea indicates the disease is in the Spleen. In this case, the herbal therapy was lasted for one year. It came and went. Dr. Zhu insisted on the basic Xie Jie Tang with some modifications from time to time, to nourish the Spleen, to stop the bleeding, to nourish the Qi, to calm down the Yin Xue, as well as to clear the Wetness-Hotness, and to adjust the Qi circulation all along the healing course. At critical time, the cononclysis was added to work together with the oral herbal therapy. Finally the therapy reached its healing goal. … He is really good at the herbal therapy and a master in the herbal therapy. If a doctor has no such deep understanding in the TCM clinic work and can not keep his/her mind, so to change the herbal formula again and again, it would not be able to solve such complex clinic condition eventually. We strongly realize this lesson.     

 

8.  朱良春治疗顽固荨麻疹的用药经验和特色选析

8. Treatnent of chronic and recurrent urticaria

http://www.tcm369.com/html/zzlw/200810/16-214.html

 

作者:邱志济

Author: Dr. Zhiji Qiu

摘要: 顽固等麻疹即慢性复发性荨麻疹,其病因复杂,缠绵难愈,是临床常见的皮肤病,如何根治荨麻疹,中医药具有明显优势。吾师朱良春教授治疗顽固荨麻疹颇有特色,法宗仲景,独具心得,活用经方,擅用虫药,审证求因,自创验方,发皇古义,融会新知,观朱师擅用件景方升麻鳖甲汤加味,和自拟验方顽固荨疹散及廉验简便方治疗慢性痼疾的特色,即知老一辈临床家的务实医风,相对今之空喊中医现代化,废医存药之说,自我从西化之牵强附会,令人感叹,邓铁涛老教授所言我们可以用中药或改变剂型的中药,去取代日益昂贵的抗生素,这样既发展了中医药又发展了我国经济。中医现代化,必须总结过去,开拓未来……也只有这样才能创造出有中国特色的社会主义医学来,否则只会发展成西医的一部分,就不是中华民族交给我们的任务了。古往今来,中医药的宏观优势千真万确,吾辈颇觉道经千载更光辉,实践乃是科学争鸣的最后裁判也。
Abstract: Obstinate urticaria refers to the chronic recurrent urticaria. Its causes are complex and it comes and goes and hard to cure. However, there is advantage for Chinese medicine to cure it. My  teacher, Dr. Liangchun Zhu has his unique ways to solve this problem. He followed Dr. Zhongjing Zhang and had his own understanding for the therapy. He used the Jing Fang herbal therapy in a very smart ways. He is good at the use of insect-origin herbs for the treatment. He used often the herbal formula “Shengma Biejia Tang”, which belongs to the Jing Fang, and developed his own formula “Wangu Xunmazhen San”. ……
 
顽固荨麻疹同中医学之瘾疹之说相似,俗称风疹块,西医属难以治愈的变态反应性皮肤病,归属中医疮疡范畴,疮者皮外也、疡者皮肉也,疮疡为皮肤疾患之总称。<外科启玄>云:凡疮疡皆由于五脏不和,六腑壅滞,则令经脉不通而生焉。〈病源候论>说:夫体受风热,湿毒之气,则生疮。又说诸疮生身体,皆是体虚感受风热,风热和血气相搏,故发疮。病形于外,而实发于内,究其因乃体虚感邪而得。据历年报道,罗列慢性荨麻疹常见证型治法有: 脾胃虚寒,表卫不固,风寒客留肌肤,治以益气固表散寒,用补中益气汤、玉屏风、麻桂各半汤等方加减; 气血两虚,风邪乘虚而入,郁于肌肤,治以益气养血疏风止痒,用八珍汤、四物消风散、当归饮子等方化裁; 肝肾阴亏,虚风内生,淫郁肌肤,治以调补肝肾,养血熄风,用一贯煎、六味地黄汤等方化裁; 气滞血瘀,致经络不通,治以活血化瘀,祛风止痒,方用血府逐瘀汤或桃红四物汤等方化裁; 妇女冲任失调,耗损气血肾精,治以调摄冲任,滋养肝肾,方用举元煎合二至丸加味化裁。盖人身之肌肤皮毛无不受营血滋润营养,顽固荨麻疹的发生与营血的关系甚为密切,故血热、血寒、血瘀、血虚皆能引起气血运行失常,肌肤失于濡养而发生本病。吾师朱良春先生治疗顽固荨麻疹颇具特色,法宗仲景,独具心得,擅用虫药,活用经方,审证求因,自创验方。今选析朱师治验,以飨同道。 

The obstinate urticaria is similar as the “Yin Zhen” (it means a hidden skin rash) in Chinese medicine. In western medicine, it belongs to an obstinate allergic immunal dermotosis. It belongs to ulcer and sour group in Chinese medicine. … Based on the clinic reports recent years, the principles in the treatment of chronic urticaria are: (1), Spleen-Stomach weakness and Cold condition, using Bu Zhong Yi Qi Tang, Yu Ping Feng San, Ma Gui Ge Ban Tang, etc; (2), Qi-Blood deficiency, using Ba Zhen Tang, Si Wu Xiao Feng San, Danggui Yinzi etc; (3), Liver-kidney Yin deficiency, using Yi Guan Jian, Liu Wei Dihuang Wan, etc; (4), Qi sluggish and blood stagnation, using Xuefu Zhuyu Tang, or Taohong Si Wu Tang; (5), Female Chong-Ren disorders, using Juyuan Jian plus Er Zhi Wang. For the skin on the body, nowhere is not nourished by the Ying blood. The occurance of the obstinate urticaria is therefore closely related to the Ying blood. The blood-hotness, blood-cold, blood stagnation and blood deficiency, all can cause disorder in the blood circulation in the skin, making the skin lost it nourishment, and so as to cause the urticaria. …

(1)
风热郁营创验方 妙拟顽固荨疹散
(1). Wind-Hotness style of urticaria is treated by Wangu Xunmazhen San


朱师治疗顽固荨麻疹,审证属风热久郁营分,反复发作多年,缠绵不愈者,自拟顽固荨疹散。药用:赤芍、荆芥、炙僵蚕、炙乌梢蛇、徐长卿各10g,白鲜皮、地肤子各15g,蝉衣、乌梅、生甘草各6g。此为发作时汤剂,水煎服,日1剂。笔者历年仿朱师之法,每收根治之佳效,少数久病体弱偶有复发者笔者在原方的基础上加地骨皮,土茯苓制成散剂,或合土茯苓丸”(笔者常备药,组成:土茯苓、苍耳子、金银花、白鲜皮、地肤子、蝉衣、苦参、升麻、生地)服数月予以巩固,亦均能根治。

For the treatment of obstinate urticaria that is due long term stock of Wind-Hotness in the Ying portion of the body, and which comes and goes for many years, and hard to cure, Dr. Liangchun Zhu developed his own herbal formula “Wan Gu Xunmazhen San” (Wan Gu means obstinate; Xunmazhen means urticaria; and San means powder in Chinese). The herbs are: Chishao 10 g, Jingjie 10 g, Zhi Jiangcan 10 g, Zhi Wushaoshe 10 g, Xuchangqing 10 g, Baixianpi 15 g, Difuzi 15 g, Chanyi 6 g, Wumei 6 g, Gancao 6 g. It is used for the acute phase of the urticaria. I have tried Dr. Zhu’s formula for years. It worked again and again for a radical cure. For small percentage of patients with weak body condition, or with little recurrence, we added herb Digupi and Tufulin into the original formula and made it into powder to take, or the original herbal formula was used together with “Tufuling Wan” (It is my rutine herbal formula, which consists of Tufulin, Cangerzi, Jingyinhua, Baixianpi, Difuzi, Chanyi, Kushen, Shenma, and Shengdi) to keep the healing effect. It was taken for several months and it could also reach the cure effect. 

方中荆芥、赤芍祛风凉营,蝉衣质轻性浮,达表驱风,味甘性寒,气清凉散,更有以皮行皮之功,但经验证明,衣用于止痒,安眠,搜透风热,必须捣细入汤剂,故蝉衣用于散剂,其功效更著。加地骨皮亦意取以皮行皮,且地骨皮清热凉血,降泻肺中伏火,甘寒养阴,乃清肝肾虚热,所谓热淫于内,泻以甘寒也。《本草汇言》云:甘寒清润,不泥不滞,非地黄,麦冬同流

The herb Jingjie and Chishao in the formula works to dispel the Wind and to cool the Ying. The herb Chanyi is light in weight and floating in herbal nature. It works to dispel Wind in the body surface. It is also sweet and cold in herbal nature. Its Qi is light and cooling to disperse. It also bears the meaning to treat the skin with  skin (it is the shell of cicada). The clinic experience proved that, when use its function to stop itch, improve sleeping, to research and dispel Wind-Hotness, it must be chopped and grinded to small pieces before adding to water for cooking with other herbs. That is why the Changyi, when used as powder, works better. To add herb Digupi is with the aim to clear the skin with skin (Digupi is the bark of a herb root). It works to clear hotness and cool blood, to down-dispel the hidden Fire in the Lung, to nourish Yin with its sweet-cooling herbal nature, so it works to clear the weakness-Fire in the Liver and the Kidney.  As it stated to clear the Fire which accumulates inside of the body, use sweet-cold herbs. In the book <<Ben Cao Hui Yan>>, it stated: “the sweat-cold herb is pure and wet, it is not sticky or greasy, not as the herb Dihuang or Maidong.”

方中赤芍去血中之热,加地骨皮去气中之热,地骨皮走表又走里之药,清肺热,导气火,亦引皮肤水气顺流而下,不嫌燥烈伤津,破耗正气,则与桑皮异曲同工。方中用白鲜皮、地肤子,亦取其善走皮肤,以皮行皮,祛风燥湿,清热解毒,白鲜皮确能通行经隧脉络,《本草正义》云:白鲜皮气味甚烈,故能彻上彻下,通利关节,胜湿除热,无微不至也。地肤子利小便。清湿热,去皮肤中积热,除皮肤外湿痒,益精强阴,除虚热。徐长卿祛风止痒,活血解毒,乃抗过敏之首选良药,方中乌梅亦取抗过敏之意。

The herb Chishao in the formula works to clear the Fire in the blood. The Digupi works to clear the Fire in the Qi portion of the body. Digupi is a herb which moves and goes into both the body surface and the inside, to clear the Lung Fire, to conduct the Qi-Fire, and also to conduct the water in the skin into the urinary system. It is not too dry to exhaust the liquid part of the body, not break the body defense energy Qi. In this case, it works similar to herb Sangbaipi. The herb Baixianpi and Difuzi are good at moving and working in the skin, to solve skin problem with skin (they are ‘Skin” of plants), to dispel Wind and to dry the Wetness, to clear the Fire and to detoxify. The herb Baixianpi in deed can conduct the energy meridian. In the book <<Ben Cao Zhen Yi>>, it stated: “Baixianpi is strong in its odor, so it can move up and down the body, to conduct the joints, to dispel the Wetness and to clear the Fire, all over the body”. The herb Difuzi improves urination, to clear the Wetness-Hotness, to remove the hidden Fire under skin, to stop secreation and itch in skin, to nourish the Jing and to enhance the Yin, and to clear the weakness-Fire. The herb Xuchangqin works to dispel Wind and to stop itch, to stimulate blood circulation and to detoxify. It is number one choice of herbs to fight against allergy. The use of Wumei in the formula is also to take its ability to stop allergic reaction.

顽固荨麻疹现代医学归属于过敏而引起的变态反应性皮肤病,异常的免疫反应,造成机体生理功能紊乱或组织损伤,发生疾病,就叫变态反应。中草药治疗过敏性疾病疗效显著,历验可证,如过敏煎”(柴胡、防风、五味子、乌梅、甘草、苍耳子、车前子)治疗多种过敏性疾病,疗效显著,朱师用顽固荨疹散治疗顽固荨麻疹众多病例,笔者仿朱师之法历年来亦治愈多例顽固荨麻疹,均未见复发。据报道中药在抗过敏反应中一能提高游离抗体,以中和过敏原,二能抑制IgE 的产生,三能提高细胞内CAMP环磷腺苷的浓度。具有其中任何一个作用,都可抑制过敏反应。又有报道大枣内含有多量的环磷腺苷CAMP 和环磷鸟苷CGM P样活性物质,吃大枣后,CAM P 样活性物质被消化道吸收。但CGMP样活性物质不易被吸收,分布到末梢组织,使这些组织CAMP CGMP的比值显著增高,这就是大枣抗过敏的药理,且大枣既能增强免疫,又能抑制免疫,故能调节免疫紊乱。

Obstinate urticaria belongs to allergic reaction in skin in western medicine, an immune disorder in skin. It is proven that Chinese medicine is good to solve such problem. For example, the herbal formula “Guomin Jian” (Chaihu, Fangfeng, Wuweizi, Wumei, Gancao, Cangerzi, Cheqianzi) works to solve various allergic reaction with very good results. Dr. Liangchun Zhu used the herbal formula “Wan Gu Xunmazhen San” to solve the obstinate urticaria in many cases. I, the author of this article, also tried this formula in my clinic for many years. It brought a radical cure effect for many cases. ……

笔者在治疗顽固荨麻疹善后巩固阶段,均嘱患者每日生食大枣30枚。开水洗净分3次空腹嚼服。乃取民间用大枣蜂房治风疹块的验方之意,取其补脾和胃、益气生津、调和营卫、解药毒之意。

In the later maintenance stage, I usually ask my clients to eat Chinese date 30 every day (separate into three times). This remedy comes from folk therapy to solve urticaria by Chinese date and bee net, to take its function to nourish the Spleen and Stomach, to nourish the Qi, to produce more liquid part of the body, to calm the Ying and Wei, and to detoxify.

朱师擅用虫类药,方中用僵蚕、蝉衣消散风热、解毒透表,乌梢蛇搜风通络、解毒止痒、外达皮肤,内通经络,其搜风透达之力最强,朱师指出,若病久顽疾、症势深痼,而风毒壅于血分之病,非此药不除,故有截风要药之称。凡瘾疹瘙痒难除者,可加用乌梢蛇、僵蚕、蝉衣等虫类药,以加强搜风之力,效更佳妙。朱师亦用此方治疗顽固荨麻疹审属肠胃湿热型,或热象较重者加生大黄以清泄之,颇可缩短疗程。但证有寒热虚实,法有温清补消,临证不可拘执于一法一方,顽固荨麻疹的主症为瘙痒,而无风不作痒,治风先理血,血行风自灭。故在祛风的同时,要着重调理营血,如凉血以散血,化瘀以活血。养血以疏血。温血与行血等理血法合益气、祛风等法灵活配合,达到正复邪自去,邪去而元气自复的目的。

 Dr. Liangchun Zhu is good at using insect-origin herbs. In the formula, the Jiangcang and Chanyi work to dispel Wind-Hotness, to release body surface and detoxify. The Wushaoshe works to search the Wind, to conduct meridian, to detoxify, and to stop itch. It could move in body surface and deep inside of the body. It has most powerful ability to dispel the Wind. Dr. Liangchun Zhu said, this herb must be used, if the disease is chronic for a long long time, if it is vey obstinate to cure, if the disease is very deep, and if the Wind-toxic is hidden and sticks in the blood portion of the body. So it is also called the Wind-stoping herb. When the urticaria is with very severe itch, add Wushaoshe, Jiangcan, and Chanyi, such insect ingredients, to increase the power of the herbal formula to dispel Wind and to increase the healing effect. If the Wetness-Hotness is more overwhelming in the stomach and intestine, or if the Hotnesss is overwhelming, Dr. Liangchun Zhu would also add Dahuang to clear the Hotness, so to increase the healing effect and to shorten the healing period. The main symptom of the obstinate urticaria is itch. In Chinese medicine, there would be no itch without presence of Wind. To solve Wind, it should first to nourish the blood, since once the blood is moving, the Wind would disappear. Therefore, at the time to dispel the Wind, it is emphasized to correct the Ying blood, such s to cool the blood to release the blood, and to dissolve the stagnated blood to motivate the blood circulation. To use the blood-warming and blood-activating therapy, together with the Qi-nourishing, and Wind-dispelling therapy, is to solve both the symptom and the cause of the disease, and the Xie Qi is over and the body defense energy is recovered.   

 

9. 朱良春治疗颈椎病经验和特色选析

9. Treatment of cervical spondylosis

http://www.tcm369.com/html/zzlw/200809/20-163.html

作者:邱志济

Author: Dr. Zhiji Qiu

   
颈椎病或谓颈椎综合征,症状繁杂,治法较多,见仁见智,后学者莫衷一是,吾师朱良春教授执简驭繁,法拟:通补兼施,益肾蠲痹;平肝通络,新痹治肝;虚损不营,平补阴血;顽痰深伏,峻药导痰。笔者概括其治颈椎为四法32字,颇具实用,结合历年验证临床,确有佳效,此乃朱师治疗痹证,辨轻重缓急,先因后果,真假同异之三要的具体运用。

Cervical spondylosis shows various symptoms. There are also largely variable therapies for it, which makes the later TCM doctors/graduates feel difficult to follow. Dr. Liangchun Zhu made the complex simple. The main principles of his herbal therapy for the cervical spondylosis are: to conduct the meridian and to nourish the body Qi and blood the same time, to nourish the Kidney so to solve the pain; to calm the Liver and to conduct the meridian, to work on the Liver to solve the newly developed pain; to nourish the Yin and blood to solve chronic pain; to dispel phlegm, so to solve pain that is due to deep hidden phlegm. The clinic experience Dr. Zhu, as summarized as such, have been proven in our clinic again and again.

朱师不囿于颈椎病按颈椎骨关节(包括椎间盘)退变增生之说论治,亦不囿于单纯的按肝肾不足论治。乃按虚、寒、湿、痰、瘀、热之轻重缓急,因果,同异之理拟定治法、方、药,此乃园活宜从三思,执持须有定见。既能执持,又能园活,其能方能园之谓也。徐灵胎有治病重在灵活之说,深究老一辈临床家之执持和园活,经验和特色,乃确有如入金谷之园,神色夺目,博而不繁,详而有要,综合究竟,直窥渊海,读者如细细品味,定别有洞天。
Dr. Liangchun Zhu is not trapped in the idea that the cervical spondylosis should be treated as the degeneration or bone spur on the cervical bones/joints, neither in the theory that the disorder should be treated as the Liver-Kidney deficiency. He treated the cervical spondylosis according to the weakness, Cold, Wetness, phlegm, stagnation and Hotness, as well as the mild or severe condition of the disease, the reason for the disease, etc. …..
颈椎病,属中医学之痹证、痿证范畴,颈椎及其椎间盘退行性变所引起的头颈、四肢、上胸背、内脏症候群,统称为颈椎病,或称颈椎综合征。

The cervical spondylosis belongs to the Bi syndrome, or paralysis syndrome in Chinese medicine. The cause is the degeneration of the cervical bones and/or the intervetebral disk, which causes the pain or numb in the neck, head, arms, upper chest, or some inner disorders in digestive system.

临床所见颈椎病轻重悬殊,症状复杂,今之伤科分型,大致有五: 神经根型:颈、肩、臂、手放射性疼痛。麻木及局部肌肉痉挛、无力、萎缩等; 脊髓型:下肢沉重、无力、腰酸、尿频、排便无力、步态不稳、渐致下肢痿瘫,甚者二便失控; 椎动脉型:证见头痛、眩晕、视力障碍、耳鸣耳聋、心悸不寐; 混合型:上述几型混合并见; 其它型:如交感神经或食道受压或刺激所致症型。

In clinic, the symptoms of cervical spondylosis are largely variable and complex. …


(1)
、通补兼施治颈痹 益肾蠲痹汤丸理
(1). Solve cervical spondylosis by “Yi Shen Yi Bi Wan”


益肾蠲痹丸是朱师七十年代的研究成果,是以温肾壮督、钻透逐邪、散瘀涤痰(地黄、当归、淫羊藿、肉苁蓉、鹿衔草、老鹳草、寻骨风、徐长卿)和血肉有情之虫类药(全蝎、蜈蚣、蜂房、炙乌梢蛇、地鳖虫、僵蚕)配伍而成,功能益肾壮督、蠲痹通络、标本兼顾、攻补兼施。对上述的颈椎病属神经根型,中医辨证属痹证型或混合型,配合汤剂,阳虚者配合阳和汤加减,阴虚者配合六味地黄汤加减疗效卓著。

The herbal formula “Yi Shen Yi Bi Wan” is developed by Dr. Liangchun Zhu in 1970s’. It works to warm kidney, to strengthen Dou meridian, to deeply search the Xie Qi, to dispel the Xie Qi, to dissolve the blood stagnation and to dissolve the phlegm. It uses herbs Dehuang, Danggui, Yinyanghuo, Roucongrong, Luxiancao, Laoguancao, Xungufeng, Xuchangqing, as well as animal-origin ingredients, such as Quanxie, Wugong, Fengfang, Zhi Wushaoshe, Dibiechong, and Jiangcan. It works very good for the patients who have shoting pain or numb in the neck, shoulder, arm and hands. If the person has Yang deficiency, this formula is used together with another formula Yang He Tang; if the person has Yin deficiency, use it together with Liuwei Dihuang Wan.

近人研究,颈椎椎体及椎间盘,(类似于筋骨)发生退行性变,颈椎长轴缩短,椎动脉长度相对增长,骨赘长期刺激,动脉相继发生慢性损伤或因长期劳损,血管硬化以至血栓形成。这说明椎动脉供血不足之病因是多方面的,也说明骨、筋、脉等必然因衰老而出现不适应,或不平衡状态。肝肾不足和衰老加外伤或风寒湿邪,则是本病发生和发展的原因。

Recent study shows that, in the cervical spondylosis, the cervical vetebra and its disk show degeneration changes, which makes the veteibral blood vessel relatively longer. Also the growth of a bone spur would hurt the surrounding blood vessels to cause blood vessel hardness even to cause the formation of blood clot. This means that the reason for the poor blood supply to the brain is multiple. It also means that due to the age, the bone, the tendons, and the blood vessels, must go to a disharmony, or imbalance each other. It is the major reason for the cervical spondylosis that the Liver-Kidney deficiency and the age process meet with the external Wind, Cold and Wetness.  

肾藏精,主骨,肝藏血,主筋,颈椎病的病损在于筋与骨。督脉循行脊背,贯颈项头顶,乃奇经八脉之一。八脉隶于肝肾,八脉虚证,多由肝肾亏损所致。此病乃标实而本虚之证,久病必虚,久病入络。肝肾不足是本虚,挛急痹痛,肝风络瘀,顽痰深伏为标实。急则治标,缓则治本。平肝通络,峻药导痰,行气血,祛风湿,熄肝风以缓其急。补肝肾,养阴血,填精髓以治其本。以补为主,以通为用,确是治疗本病之关键。

The Kidney dominates the Jing (reproductive material) and the bone. The Liver dominates the storage of blood and the tendons in the body. The cervical spondylosis is a disease of the tendons and bones in the neck. The Du meridian runs along the side of spine up to the top of the head, which is one of the eight mysterious meridian systems in the body. The eight mysterious meridians belong to the Liver and the Kidney. The weakness condition in the eight mysterious meridian systems is in most case due to the weakness of the Liver and the Kidney. The cervical spondylosis is a disease, which its symptoms belong to overwhelming but the core nature belongs to a weakness (deficiency). There must be a weakness condition in a chronic disease course. A long term disease will penetrate into the network of the meridian. The Liver-Kidney weakness is the real reason for the disease and the muscle spasm, the pain and the numb, the block and the stagnation in the meridian by the Liver Wind, the deep hidden phlegm is the overwhelming in the symptoms. One of the healing principles in Chinese herbal therapy is: in acute condition, solve the symptoms; and in the not acute condition, pay attention to solve the cause of the disease. To reduce the symptoms of the disease, it is needed to calm the Liver, to conduct the meridian, to dissolve phlegm with strong herbs, to motivate the Qi and blood, to dispel the Wind-Wetness, to stop the Liver Wind so to reduce the spasm. To solve the cause of the disease, it is needed to nourish the Liver and the Kidney, to nourish the Yin blood, to fill up the Jing in the bone marrow. To nourish is to solve the cause and to open, to conduct, is to solve the symptoms. This is the key in the treatment of the disease.

-王肯堂在《证治准绳》中指出,痹证之病因:有风、有湿、有寒、有热、有挫闪、有瘀血,有滞气、有痰积、皆标也、肾虚、其本也。因此,朱师拟用益肾壮督治其本,蠲痹通络治其标,乃意在改善局部组织的血液循环,增加受累神经和退行骨质营养物质的供应,此即取效之理。历年来,笔者仿朱师之法治愈多例颈椎病属痹症型者,均疗效巩固。

Dr. Kentang Wang pointed out in the book <<Zhen Zhi Zun Sheng>> that, the cause for the Bi syndrome could be the Wind, the Wetness, the Cold, the Hotness, the whiplash, the blood stagnation, the Qi sluggish, the phlegm accumulation. These are the cause of the symptoms. The Kidney deficiency is actually the real cause for the Bi syndrome. For this reason, Dr. Linagchuan Zhu used “Yi Shen Zhuang Gu” (to nourish the Kidney and to strengthen the bone) to solve the the cause, with the aim to improve the blood circulation in the local tissue, to increase the supply of nutrition material to the affected nerves and bones. For later many years, I have tried Dr. Zhu’s therapy and cured a lot of patients with the cervical spondylosis. 

曾治唐男,年届天命,颈项强痛,右肩臂酸重、疼痛、麻木,伴头晕,肢冷恶寒,经常失眠6年、血压、血脂、心电图、均属正常,颈椎摄片报告生理曲度僵直,颈椎47后下缘骨质增生,颈56椎间隙狭窄,查右侧颈部肌肉紧张,颈椎47椎体棘突偏右侧压痛明显。前医均诊为混合型(神经根型合椎动脉型)颈椎病,中医属痹证型,审舌暗苔白腻,脉沉弱。证属肝肾不足、风寒痹阻,治以益肾壮督,蠲痹通络。方用阳和汤加减合益肾蠲痹丸治之,药用:葛根、鹿角霜,熟地,当归、生黄芪、威灵仙各30g,麻黄、桂枝、补骨脂、木瓜各12g,甘草6g。日1剂,水煎服,另处益肾蠲痹丸(市售)8g3O包.每服8g,每日3次饭后服。服药1O剂,诸症明显减轻,继服30剂,诸症基本消失,颈项活动自如,嘱守服益肾蠲痹丸36个月。配合每日服鹿角胶10g,追访3年无复发。

I treated a patient, Mr. Tang, about 50 years of old. He suffered from pain and tight on the neck, sour, heavy feeling, pain, numb on the right shoulder for six years. He had dizziness, cold arm and legs, dislike cold, poor sleep. The blood pressure, CEG, blood lipids all were normal. X-ray detect showed disorder in the curve of the cervical vetebra … It was diagnosed as the mixed type of cervical spondylosis. Chinese medicine diagnosed as Bi syndrome on the neck. His tongue was dark in tint, the tongue cover was white and greasy. The pulse was deep and weak. The condition was considered to be Liver-kidney deficiency, with Wind-Cold block. The herbal therapy was used to nourish the Kidney, to strengthen the Du meridian, to dispel the Bi and to conduct the meridian. The herbal formula is the Yang He Tang plus Yi Shen Yi Bi Wan with some modification: Gegen 30 g, Lujiaoshuan 30 g, Shoudi 30 g, Danggui 30 g, Huangqi 30 g, Weilingxian 30 g, Mahuang 12 g, Guizhi 12 g, Buguzhi 12 g, Gancao 6 g. He was also given Yi Shen Yi Bi Wan (8 g for each pouch), one pouch each time and three times a day after meal. After ten days, his symptoms were much improved. After 30 days, all the symptoms basically subsided. The neck could move freely without pain to stiff. He was asked to continue the Yi Shen Yi Bi Wan (the pouch form) for 3-6 months, as well as to take Lujiaojiao 10g every day. Follow up for three years showed no recurrence.


(2)
、平肝通络治颈痹 稀莶芍草汤方理
(2). For the cervical spondylosis due to Liver Yin deficiency and the Liver Wind rushing up, use herbal formula Xiqian Shao Cao Tang


颈椎病证见肝阴不足致肝风上扰,而发于春令或恼怒之后,颈项胀痛,转侧不利,头痛眩晕,或头部冷感,呕恶胸闷,心烦易怒,口苦咽干,失眠便秘、舌红苔黄、脉细数者,多属新痹。<河间六书>云:头目眩晕者。由风木旺..... 而木复生火,风火皆阳,两阳相搏,则为之旋转。盖肝阴亏损,颈部经络失荣,虚不恋阳,肝风肝火上扰,故眩晕,头痛脑胀;水火不能既济,故失眠便秘;肝血虚不能上荣于脑,故头部冷感;肝阴不足。津亏液少。筋脉失养则筋挛颈强,转侧不利;肝火亢扰,则心烦易怒,口苦咽干;肝气肝火上逆致胃失和降,则胸闷呕恶,经云:东风生于春,病在肝,俞在颈项。故春气通于肝,若颈项痹痛发于春令或恼怒之后,当责之于肝,治宜柔肝、平肝、通络。

The cervical spondylosis with Liver Yin deficiency and Liver Wind rushing up usually occurs in spring or after upset. The patient feels bloating and pain on the neck, hard to turn the neck, headache and dizziness, or cold feeling on head, nausea, bloating in chest, annoyed, easy to get upset, bitter taste in mouth, dry in throat, poor sleep, constipation. The tongue is red in color and the tongue cover is yellow. The pulse is thin and frequent. It usually belongs to new Be syndrome. It is stated in the book <<He Jian Liu Shu>>: “The dizziness and blirring in eyes is caused by Liver Fire rushing up… The Wood (liver) produces and helps the Fire (heart). Both the Wood and the Fire belong to Yang phase. The two Yang come together to cause the turn (dizziness)”. When the Liver Yin is not sufficient, the meridian in the neck would not get proper nourishment. In the weak condition, the organ/tissue could not hold the Yang, so the Liver Wind and the Liver Fire rush up to disturb the head to cause the dizziness, headache and bloating feeling in the head. The Water and the Fire could not come to a harmony, so the person feels poor sleep and constipation. The Liver blood is in deficient condition, which can not circulate up to nourish the head, so there is cold feeling in the head. The Liver Yin is no sufficient, and the Jing liquid is not sufficient, the tendons could not get sufficient nourish, so the tendon becomes spasm and the person feels tight on the neck, with difficulty to turn the neck. The Liver Fire burns, so the person feels annoyed and easy to get upset. The Liver Qi and the Liver Fire rush, which makes the Stomach Qi fails to move down, so the person feels nausea and bloating in chest. In the medical bible <<Nei Jing>>, it says: “The east wind is produced in spring. If there is disease, it is located in the Liver, and associated on the neck”. Therefore, the spring Qi is connected to the Liver. If the neck pain comes in the spring, or after upset, the Liver should be considered being involved. For the treatment, the herbal therapy should aim to calm the Liver, to balance the Liver and to conduct the meridian.

 

朱师治疗此证型,主平肝通络之法,方拟稀莶芍草汤,药用:稀莶草、赤白芍、制首乌、葛根、牛蒡子、钩藤、刺蒺藜各15g,僵蚕、甘草、蝉衣各6g。笔者历年仿用,每收佳效。方中稀莶草、赤芍平肝化痰,通其脉络,清泻肝火、导其湿热。此症当属新疾,不同久病,取芍药甘草汤加味敛阴和阳,各极其妙。盖阴将竭未竭,无事大滋,阳将亡未亡,无事大温。大滋则逼其阳亡,大温则促其阴竭。芍药甘草汤乃伤寒误治,救其阴虚,证非寒实热实,亦非真正亡阳亡阴,用此方斡旋,恰如分际,朱师取此方加味,治新病颈痹,亦当轻重适应。

To treat this type of cervical spondylosis, Dr. Liangchun Zhu uses the herbal therapy to calm the Liver and to conduct the meridian. He developed the herbal formula “Xiqian Shao Cao Tang”. The herbs are Xiqiancao 15 g, Chishao 15 g, Baishao 15 g, Zhi Heshouwu 15 g, Gegen 15 g, Niupangzi 15 g, Gouteng 15 g, Baijili 15 g, Jiangcan 6 g, Gancao 6 g, Changyi 6 g. I followed Dr. Zhu to use this herbal formula in my clinic for many years. It worked excellent. In the formula, the herb Xiqiancao and Chishao work to calm the Liver and to dissolve the phlegm, and to conduct the meridian, to clear the Liver Fire, and to dispel the Wetness-Hotness. This type of cervical spondylosis belongs to a new disease, not a chronic disease. The Shaoyao Gancao Tang, which hides in the formula works to restrain the Yin and to calm the Yang. In this case, the Yin is to exhast but not exhaust yet, to no need to nourish the Yin. The Yang is to die, but not die yet, so no need to Warm the Yang. If it is hurry to nourish the Yin, it would speed up the death of the Yang. If it is hurry to warm the Yang, it would speed up the exhaustion of the Yin. The “Shaoyao Gancao Tang” is originally used to solve the mis-treatment during a Shanghan disease, is to save the Yin deficiency. The condition suitable for its use is not overwhelming Cold or overwhelming Hotness, is not true Yang to die or the true Yin to die condition. The Shaoyao Gancao Tang is the proper formula for such condition. For this reason, Dr. Liangchun Zhu uses this herbal formula, with so me other additions, to solve the cervical spondylosis of this type, the newly developed neck pain.  

 

方中伍以牛蒡子、僵蚕意取牛蒡子、俺蚕二药均化高处络中之风痰,通十二经脉,牛蒡子能升能降,主治上部风痰,颈项痰核,味辛能散结,味苦能泄热,且性冷滑,开上启下;蝉衣质轻性浮,达表驱风,气清凉散;又选钩藤、刺蒺藜手足厥阴之药,盖足厥阴主风,手厥阴主火,钩藤、刺蒺藜通心包于肝木,盖风静火熄,则诸证自除,钩藤不仅疏泄外风,亦能平熄内风。刺蒺藜镇肝风,泻肝火、益气化痰、散湿破血。亦有凉血养血、善行善破,专入肺、肝,宣肺之滞,疏肝之瘀之说。首乌养肝血、补肝肾、和阴阳,意取标本同治。首乌入通于肝,为阴中之阳药,故专入肝经以为益血祛风之用,其兼补肾者,亦因补肝而兼及也。

To use herb Niubangzi and Jiangcan is with the aim that the two herbs could dissolve the Wind phlegm that is located on the top of the body (head and neck), and could conduct all the meridians. The herb Niubangzi is able to move up and down, mainly works to solve the Wind phlegm in the upper part of the body, the knobs in the neck (such as Tuberculosis). Its spicy taste enables it to disperse the hard mass, and its bitter taste to clear the Fire, and its cold and slippery nature to open the upper and to open the lower part of the body too. The Chanyi is light in weight and floating in herbal nature. It travels to the body surface to dispel Wind. The Gouten and Baijili belong to the herbs that move in the Hand and feet Jueyin meridian. The feet Jueyin meridian dominates the Wind. The hand Jueyin meridian dominates the Fire. The Gouteng and Cijili conduct to the Heart shell meridian and the Liver Wood. Once the Wind subsides, the Fire subsides too, so that all the symptoms subside. The Gouteng not only works to dispel the external Wind, but also the inner Wind. The Cijili works to suppress the Liver Wind, to clear the Liver Fire, to nourish the Qi and to dissolve the phlegm, to dry the Wetness and to break the blood clot. It is also said in other book that it cold cool the blood, to nourish the blood, good at moving and breaking, mosty into the Lung, the Liver, so release the block in the Lung, and to dredge the Liver sluggish.  The herb Heshouwu works to nourish the Liver blood, to nourish the Liver and the Kidney, to harmonize the Yin and the Yang, with the aim to solve the symptoms and the cause the same time. “The Heshouwu conducts to the Liver, which is the Yang herbs among Yin herb group. It mostly travels into the liver to nourish blood and to dispel the wind. That to use its function to nourish the Kidney is due to it has this function at the same time to nourish the Liver.

颈椎病初发,当审风痰痰热,滞于颈项之络,项背为诸脉会通之处.乃是气血痰瘀最易凝结之地,督脉起于长强,入肾过腰、脊、颈椎,止于龈交。督乃总督一身之阳,敷布太阳,通行少阴,统帅颈脊经脉之气血,颈椎病必先出现肾督功能失常,使阳气不利,经络脉道气血不畅,渐成瘀滞,又因肾气虚乏,乃致太阳膀胱气化不利,三焦代谢失常,湿痰留滞经脉,亦成痰结,故颈椎病推其因是肝肾阴血亏虚,督脉失养,导致颈椎骨关节(包括椎间盘)退变增生。因此,平肝通络.补养肝血,标本兼顾,乃防微杜渐之治。

In the early stage of the cervical spondylosis, it should be paid attention to check if there is Wind, phlegm and Fire, which stick in the meridians in the neck. The neck is the mixing space for all the meridians. It is also the place where it is easy to accumulate the Qi, blood, phlegm, and the blood stagnation. The Du meridian starts from the Changqiang point on the perineum. It travels up along the spine from lower back, the spine, to the neck and ends at the Yingjiao points on the upper middle of the gum. The Du meridian dominate and govern the Yang in whole of the body. It works to disperse the Yang to the body, and conduct to the Shaoyin meridian. It controls the Qi and blood circulation around the neck and the spine. When the cervical vetebra is in disorder, it must happen first the disorder in the Du meridian, which makes the Yang Q fail to circulate smoothly, so the circulation of the Qi and blood in the spine and neck is affected, so to cause the stagnation and sluggish. Also due to the kidney Qi deficiency, there is disorder in the Urine bladder meridian to evaporate the Qi, which causes the disorder in the Three Jiao metabolism, so causes Wetness-phlegm accumulation in the meridian to form phlegm knob. Therefore, the cause of the cervical spondylosis is also the Liver-Kidney Yin Blood deficiency, which causes the poor nourish to the Du meridian, causes the bone and bone joints in the cervical vetebra become degenerated or spur formed. Therefore, to calm the Liver, to conduct the meridian, to nourish the Liver blood, so to handle both the symptoms and the cause, is the proper way to prevent the development of the disease.   

笔者曾治姚姓妇,年届不惑,时值孟春.颈项胀痛1月.活动不利,起于情志不遂,经医院x 光摄片检查,有轻度颈椎骨关节退变增生,血压正常,经中西药治疗1月少效,初诊自述,除颈项胀痛,转侧不利外,伴有头部冷感,烦躁失眠,口干苦,便秘等症,审舌红,苔薄黄,脉细数,诊为肝阴不足,肝风上扰证,投稀莶芍草汤加桑椹15g。水煎服,日1剂,5剂后复诊,诸症基本消失,再进5剂告愈,属以六味地黄丸善后,2年后因他病来诊谓无复发。

I had a case, Mrs. Yao, about 50 years of old. She had neck bloating feeling and pain in a spring season. The neck was hard to turn. The problem happened after bad emotional attack. X-ray detected slight degeneration and hyperplasia on the cervical vetebra. The blood pressure was normal. She had been treated with western medicine and Chinese medicine for one month. The symptoms were improved little. She complained bloating feeling and pain on the neck. The neck was hard to turn. She also felt cold feeling on the head, annoyed, poor sleep, bitter taste in mouth and constipation. Her tongue was red in color. The tongue cover was thin and yellow. The pulse was thin and frequent. Her condition was diagnosed as Liver Yin deficiency with Liver Wind rushing up. She was given this Xiqian Shao CaoTang with addition of Sangshen 15 g. After five days, the symptoms subsided basically. She was asked to take the herbal tea for additional five days. All the symptoms disappeared. She was requested to take Liuwei Dihuang Wan for a maintenance. Follow up for two years showed no recurrence when she came again for some other discomfort.

(3)
、顽痰深伏用峻药 导痰重用星夏效
(3). For deep hidden phlegm condition, use stronger herbs to dissolve the phlegm. The herb Nanxing and Banxia need to be used in large amount.
顽痰深伏或痰饮多年停伏中脘,逆之于上,乃有颈项或肩臂筋脉挛急痹痛,诸药不效之证,朱师选用导痰汤《济生方》合《千金方》指迷茯苓丸原名指迷丸加减,创加味导痰汤配合益肾蠲痹丸标本同治,笔者仿朱师之法,结合自己多年使用南星、半夏的经验,多收著效。

If there is deeply hidden phlegm or if the phlegm has been in the middle part of the body for a long time, once it rushes up, it could cause the pain, tightness in the neck, shoulder and arms, which is hard to be solved with ordinary herbal therapy. In this case, Dr. Liangchun Zhu uses “Dao Tang Tang (formula from book <<Ji Sheng Fang>>) plus Zhi Mi Fuling Wan (formula from book <<Qian Jing Fang>>) with some modification, and so developed the “Jiawei Dao Tang Tang”, which is used together with the Yi Shen Yi Bi Wan to solve the symptoms and the cause of this type of cervical spondylosis. I have followed this way of Dr. Liangchun Zhu for many years by using large amount of herb Nanxing and Banxia. It worked very well.

喻嘉言谓江河洄薄之处,秽浊从积,水道日隘,横流旁溢自所不免。颈椎病症状繁杂,有非常法所能除者,应着眼寒湿痰饮久伏中脘.横流旁溢,逆之于上,重用南星,半夏,导痰而下,多收奇效。

Mr. Jiayan Yu said: “In the shallow part of the curving part of the river, it is easy to have dirty stuff accumulated, which cause block of the river stream, so cause the spill of the water out of the river duct.”  The symptoms of the cervical spondylosis is complex. Once there is a case which is difficult to solve with ordinary herbal therapy, it should be considered if there is Cold, Wetness and phlegm, which hidden in the middle Stomach area for a long time, and which now spills out to rush up to the neck to cause the problem. In this case, use large amount of Nanxing and Banxia to direct the phlegm down the body. It usually works mysterious again.

笔者曾治汤男,年届天命,患颈椎病7年,屡经理疗、推拿、牵引、中西药多法治疗无效,时值长夏,自述月来诸症加剧,尤诉颈项并右上肢挛痛常发,酸麻无力,夜难入寐,纳差便溏。审舌淡苔白薄,脉沉滑,展视颈椎拍片,提示456椎增生肥大。椎间隙变窄,又索其前医处方,除西药外,中医亦曾用益肾壮督,活血化痰、通络蠲痹汤药多剂,诸症不减,遂按顽痰水饮深伏论治,投加味导痰汤药用:生半夏、穿山龙各60g,生制南星各15g,炒枳实18g,茯苓20g,风化硝(入煎)8g,陈皮、生姜、甘草各6g,威灵仙、肉苁蓉、当归、鹿角霜各30g。水煎服,日1剂。另处益肾蠲痹丸”(市售)8g6O包,每服1包,日3次,饭后服,服药5剂,诸症大减。续服15剂,诸症全除,嘱以益肾蠲痹丸善后巩固,追访2年无复发。

I have a case before. It was Mr. Tang, about 50 years of old. He had cervical spondylosis for seven years. He had had physical therapy, Tuina massage, dretching, western medicine and Chinese herbal therapy for a long time, without any major improvement. At that time when he came, it was middle summer. He said the problem became worse for the past month, especially he felt spasm-pain on the neck and on the right arm. The arm felt sour and numb. It made him hard to fall into sleep at night. He had poor appetite and had loss bowel movement. His tongue was pale and the tongue cover was thin and white. His pulse was deep and slippery. X-ray showed he had hyperplasia on the 4th, 5th, and 6th cervical vetebra. The space between the vetebra became narrow. The previous herbal formula was found also to nourish the Kidney and to strengthen the Du meridian, to activate the blood circulation and to dissolve the phlegm. It was the Tong Luo Yi Bi Tang. So, his condition was treated as the deep phlegm hiddening. He was given the Jiawei Daotang Tang: Banxia 60 g, Chuanshanlong 60 g,  Zhi Nanxing 15 g, Chao Zhishi 18 g, Fuling 20 g, Fenghuaxiao (cook) 8 g, Chenpi 6 g, fresh ginger 6 g, Gancao 6 g, Weilingxian 30g, Roucongrong 30 g, Danggui 30 g, Lujiashuan 30 g. He was also given the Yi Shen Yi Bi Wan (the pill form) to take. After five days, the symptoms were reduced dramatically. After additional 15 days of treatment, all the symptoms subsided. He was asked to continue the Yi Shen Yi Bi Wan for a maintenance. Fullow up for 2 years showed no recurrence.

导痰汤乃二陈汤加南星、枳实。二陈乃除寒痰湿痰正药,本方为治顽痰胶固或痰饮深伏,非二陈或指迷茯苓丸所能除者。二陈为和中平妥之方,可以理气,可以除痰,指迷丸原治痰饮停伏中焦所致的肩臂挛痛。导痰汤中南星以助半夏除痰,则除痰之力大,枳实以助陈皮理气,则理气之功宏。盖脾为生痰之源,肺为贮痰之器,脾湿生痰,上注于肺,乃由下逆之于上,此方则由上而导之使下。本方用半夏独多,降之即所以导之,故名导痰。生南星、生半夏为冲动性祛痰药,性力颇强,证见阴寒痼闭,湿痰坚凝,用之对证,功效颇著。

The herbal formula Dao Tan Tang is the herbal formula Er Chen Tang plus herb Nanxing and Zhishi. The Er Chen Tang is the standard formula that works to clear the Cold phlegm and Wet phlegm. The Jiawei Dao Tang Tang is used for the obstinate phlegm which is very sticky, or which is hidden very deep. Without the use of either Er Chen Tang or Zhi Mi Fuling Wan, such phlegm could not be dissolved. The Er Chen Tang is a moderately strong formula, which can dredge the Qi and to clear the phlegm. The formula Zhi Mi Fuling Wan is originally used to clear the spasm and pain in the shoulders and arms due to phlegm hidden in the middle part of the body (stomach area). The Nanxing in the Dao Tang Tang works to help the Banxia to clear the phlegm, so the overall ability of the formula increases dramatically. The herb Zhishi helps the Chenpi to dredge the Qi, so the overall ability of the formula to dredge the Qi increases too. It is known that the Spleen is the place to produce the phlegm and the lung is the phase to keep the phlegm that comes from the spleen. This is the phlegm from lower to the upper. The herbal formula here works to down direct the phlegm move from upper to the lower. In this formula, the amount of Banxia is specially large amount, so it directs the phlegm down. This is the meaning of the “Dao” in the name of the formula. The Nanxing and Banxia belong to a pulse-vibration herbs to dissolve the phlegm. They are powerful. When there is condition with Yin Cold stick and block and if the phlegm is hard and sticky, they work very well.

笔者曾在朱师系列经验连载中多次引证用药体会,自80年代初至今,历年使用生南星、生半夏,颇能提高疗效,今将使用生南星、生半夏总结三要:一要严嘱煎煮时间,大剂量半小时,小剂量20分钟,且1剂分3次服;二要辨属实证,体实,确属阴寒痼闭,湿痰坚凝;三要时时不忘扶正,生半夏、生南星毕竟是峻猛药,久用多用必伤正气,知三要者,万无一失也。古方的精华不可丢,观仲圣用生半夏剂量之大,古方三生饮、七生丸、大醒风汤等南星均生用,当代名医岳美中赞尝的浙江东阳金希聪先生用生南星、生半夏之实践,吾辈应大胆继承,细细品味,定别有洞天。
In the series of my articles to introduce the experience of Dr. Liangchun Zhu, I have mentioned many times my own experience in the use of Dr. Zhu’s herbal therapy. From 1980s’ I have used fresh Nanxing and not-processed Banxia and felt that they could really increase the healing effect. Here is my summery in use of these two herbs: (1). The herbs must be cooked for at least 20 min for small dose, and 30 min for a large a dose and one dose should be orally intake by separated three times; (2), the body condition should belong to the overwhelming condition with Yin Cold stick and block and with sticky and wet phlegm; (3), Do not forget to nourish the body defense energy (the Zhen Qi). The Nanxiang and Banxia belong to stronger herbs. A long time use of them may hurt the body normal Qi. Following these three points, it should be no problem to worry. The key point of the old formula should not be forgoten. See herbal formula by Dr. Zhongjing Zhang in the use of Banxia, the dose is large, such as in the formula San Sheng Yin, Qi Sheng Wan and Da Xing Feng Tang, in which the Nanxing is not processed before cook. Dr. Xichong Jin, whom Dr. Meizhong Yue praised very much, was good at the use of not-processed Naning and Banxia. We should learn from them and practice their clinic experience.  


(4)
、平补阴血治颈痹 六味加减汤方理
(4).  Nourish the Yin Blood to solve obstinate cervical spondylosis, by use of Liuwei Dihuang Tang.


颈椎病之主要病机为肝肾虚损,气血不足,风寒湿夹痰瘀闭阻经络,气血运行受阻或不畅而成此疾,因此,朱师对证见肝肾阴虚,气血不荣之颈椎病,拟补虚逐痹法,方选六味地黄汤加味,配合益肾蠲痹丸均收佳效。自拟加减六味汤,药用:生、熟地黄各15g,山茱萸、怀山药、鸡血藤各20g,茯苓、丹皮、泽泻、党参、木瓜、生白芍、川石斛各15g,日1剂,水煎服,另处益肾蠲痹丸每次8g,日2次,饭后服。

The main reason for the cervical spondylosis is the Liver-Kidney deficiency, the Qi and Blood deficiency, the Wind, the Cold and the phlegm block the meridian, which prevents the Qi and blood circulation. For this reason, Dr. Liangchun Zhu used weakness-nourishing and Bi-dispelling therapy, whenever he met a patient with cervical spondylosis who has the Liver-Kidney Yin deficiency, and the poor nourish of the Qi and blood to the neck. He used Liuwei Dihuang Tang with some modifications, which is used together with the Yi Shen Yi Bi Wan. He developed his own formula Jiajian Liuwei Tang, which uses herb Shengdi 15 g, Shoudi 15 g, Shanzhuyu 20 g, Huai Shanyao 20 g, Jixueteng 20 g, Fuling 15 g, Danpi 15 g, Zexie 15 g, Dangshen 15 g, Mugua 15 g, Baishao 15 g, Chuan Shihu 15 g. At the same time, he asks patient to take the Yi Shen Yi Bi Wan (the pill form) after each meal.

笔者仿朱师之法用上方治疗颈椎病审属肝肾阴虚型近20例.均收著效。肾藏精主骨,肝藏血主筋,颈椎病发于筋骨,缠绵难愈。加之本为肝肾阴虚之体,久病则肝肾阴虚更甚,阴虚者亦血虚,阴血均虚,不能荣养筋骨,加之湿热、痰浊、瘀结,即发于颈椎、肩、臂挛痛、眩晕、腰酸、耳鸣、少寐或失眠等证。生熟地、山茱萸、生白芍、鸡血藤、川石斛均是补虚逐痹之首选药,尤对肝肾阴虚证更加合拍,历代医家颇多论述,此证配合益肾蠲痹丸乃取动静结合,相反相成的配伍法则。朱师用药开必少佐以合,合必少佐以开,此乃阴阳相须之道也。因篇幅所限,此处病例从略。
I followed Dr. Liangchun Zhu to treat patient with cervical spondylosis which belongs to the Liver-Kidney Yin deficiency for 20 cases. All worked well. The kidney stores the Jing and dominates the bone; the Liver stores the blood and dominates the tendons. The cervical spondylosis is the disease of the bone and the tendon and it is obstinate to cure. The person is originally a body wth the Liver-Kidney Yin deficiency before the development of the disease. After a long term of the disease, the Yin deficiency is worse. When the Yin is in deficiency, the blood is also in deficiency. When the Yin and the blood both are deficiency, failing to nourish the tendon and the bone, together with the Wetness-Hotness, phlegm, the blood stagnation, the pain and stiffness starts on the neck and the shoulders. The patient has the spasm and pain, dizziness, sour on the lower back, tinnitus, and poor sleep. The herbs Shengdi, Shoudi, Shanzhuyu, Baishao, Jixueteng and the Shihu are among the first choose in the herbal formula to nourish the weakness and to dispele the Bi syndrome. They are more suitable for the Liver-Kidney Yin deficiency. There are many such statements by doctors in previous generations. The aim to combine the use of Yi Shen Yi Bi Wan is to create a moving and quiet combination, as to reach the one side by going to another side, which is one of the principles in the herbal therapy. Dr. Liangchun Zhu often uses little nourishing herbs when he uses major dispelling herbs, or uses little dispelling herbs when he uses major nourishing herbs. This is because in Chinese medicine, the Yin and the Yang helps and nourishes and produces each other. For the limited space in this article, it is not to be discussed with case examples here.


按:朱师为医,素有大志,治学之道,悟性超常。师谓:医理不明,则辨证不清;临证迷惑,药法失灵;不死于病,反死于医,为医者必需警悟也夫思贵专一,不容浅尝者问津;学贵沉潜,不容浮躁者涉猎。朱师博极医源,精勤不倦,于各家学说,入手必有所折衷;治学必明理.语出不掩耳。有谓:知其浅而不知其深,犹未知也;知其偏而不知其全,亦未知也。纵观古今,理明术高者,均无门户之见,朱师继先师祖章次公发皇古义,融会新知之道,汇集古今群言,总结古今精华,同老一辈的临床家携手开创出一条中医治疗疑难杂病的新路,给祖国医学的理论发展和I临床实践带来了一缕清新的曙光。盖中医学的各家学说,合之则见其全,分之则见其偏,张仲景详伤寒,刘河间详温热、温疫,李东垣详内伤、脾胃,朱丹溪详阴虚,张景岳论阴中求阳、阳中求阴,至程钟龄才综合各家精华,创八纲辨证,三因辨病,朱师创辨证和辨病相结合,创虫类药的广用,创各科疑难杂病的治疗新路,力走深而不浅,全而不偏的治学之路,相对今之专家不专、博士不博、高职无术、不中不西,中医之未来令人担忧也!

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