绍奇谈医(转自民间中医网 )3

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Millwoods Acupuncture Center
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Edmonton AB,   Canada

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 绍奇谈医(简略版)

何绍奇 转自民间中医网

(Part III)

 

 

16.  梅核气

16. Globus hysteriocus (Discomfort feeling in throat)

17.  面瘫

17. Facial paralysis

18. 对更年期综合征的认识和治疗

18. Understanding of menopause syndrome and its treatment

19.  瓜蒌红花治带状

19. Gualu and Honghua for the treatment of herpes zoster (Shingles)

20.  咽炎茶

20. Pharyngitis tea

21.  带状

21. Shringles

22.  蜂房治尿床有特效

22. Bee hive works well for bed-wetting

23.  我治糖尿病

23. My way to treat diabetes

24.  关于糖尿病的若干问题答读者问

24. Some questions and answer about the treatment of diabetes

25.  复发性口腔溃疡

25. Recurrent mouth ulcer

26.  肩关节周围炎

26. Frozen shoulder

27.  外感咳嗽的辨证与治疗

27. External cough

 

 

16.  梅核气

16. Globus hysteriocus (Discomfort feeling in throat)

 

《金匮要略》谓:妇人咽中如有炙脔,半夏厚朴汤主之,这就是后世所称之梅核气。如宋?杨仁斋《直指方》说:七气相干,痰涎凝结,如絮如膜,甚如梅核,窒碍于咽喉之间,咯不出,咽不下;明?孙一奎《三吴治验》载张溪亭乃眷案喉中梗梗有物如炙脔,吞之不下,吐之不出此梅核气症也。清代《医宗金鉴》乃正式命名为梅核气病,至今沿用。《金匮》载入妇人病篇中,其病亦确以女性为多,但男子亦间有之。

It is stated in the book <<Jin Kui Yao Luo>>: “if a woman has a feeling as toasted, small crumb meat in her throat, use Banxia Houpu Tang for the treatment”. This is the disease condition that is called “Mei He Qi” by people in later times. (Here Mei means plum; He: nukleus; and Qi: an air mass, so it means a feeling in throat as a plum nucleus). Dr. Ren-zai Yang (Song dynasty) said in his book <<Zhi Zhi Fang>>: “ When the all Qi in the body conflict each other, cause phlegm entangled as a kind of membrance, or as of something as cotton pieces, even hard as a plum nucleus, that sticks in the throat, hard to spit out or to swallow down.” Dr. Yi-kui Sun, Ming dynasty, said in book <<San Wu Zhi Yang>>, by citing case of Dr. Xi-qing Zhang: “There is a feeling in throat as something as a toasted meat crumb, hard to spit out or to swallow down. This is the Mei He Qi condition. In the Qing dynasty, in the book <<Yi Zong Jin Dian>>, this clinic condition is formerly termed as “Mei He Qi disease”. The term is used up to today. In the book <<Yi Zong Jin Dian>>, it is listed in the chapter for woman disease. In deed, it more happens in women, but it can also be seen in men from time to time.

半夏厚朴汤用半夏、茯苓化痰散结,紫苏、厚朴理气行滞,用于梅核气之由凝痰结气,阻于咽嗌者,确有良效。《三因方》把方名改为大七气汤,《易简方》又改作四七汤,谓药仅四味(生姜是药引不算),能治七情郁气也。但笔者临床所见,气郁日久而化火者甚多,其证除咽部异物感外,兼见烦躁易怒,面赤火升,口苦口臭,脉多弦滑而数,舌红,苔黄腻而干。此乃肝郁化火,灼津为痰,半夏厚朴汤用药偏于温燥,用之就非其所宜了。我尝于此等证自拟有一方,以清润疏利为法,药用栝楼皮、枳壳、天花粉、川贝、蒺藜、生麦芽、绿萼梅、薄荷等。痰火胶结者,加服礞石滚痰丸69g,一日二次吞服。此方用火硝、锻礞石化顽痰、老痰,大黄、黄芩清热泻火,沉香行气开郁,上病下取,得效甚捷。

The Banxia Houpu Tang uses herb Banxia, Fuling to dissolve phlegm and to disperse entangled mass, uses Zisou and Houpu to dredge Qi and to lose the stagnated Qi. When used for the treatment of wet phlegm that is entangled in throat, it works well. In the book <<San Yin Fang>>, the name of the formula was changed to “Da Qi Qi Tang” (meaning the decoction that works for all Qi disease). In book <<Yi Jian Fang>> it is called “Si Qi Tang” (meaning four herb ingredients used for the treatment of all Qi disease). Here the herbal ingredients are only four (fresh ginger works as a herbal director only. It is not a ingredient.) but works for all kinds of Qi stagnated disorders. However, according to my own clinic observation, it is quite common for a condition, in which the Qi is stagnated for a long time so that it develops into a Fire condition. The patient feels as strang feeling in the throat, and also has annoying, anxiety, easy to get upset, red face, bitter taste in mouth, bad odor from mouth. The pulse feels more as string, slippery and frequent. The tongue is extraordinarily red in color. The tongue cover is yellow, greasy and dry. This is Liver stagnation that has developed into Fire. The Fire burns the liquid into phlegm. In this case, the herbal formula Banxia Houpu Tang is more as warm and dry. It is not suitable for the treatment for a condition as such. I developed a formula of my own for such condition. It works to clear Fire and to wet the dryness, as well s to dredge the Qi. It uses herb Gualupi, Zhike, Tianhuanfeng, Chuan Beimu, Baijili, Maiya, Lu Emei, and mint. For phlegm-fire entangle condition, swallow Mengshi Gongtan pill 6-9 g, twice a day. This pill is made by using Huoxiao and Duan Mengshi to clear obstinate phlegm, old phlegm, Dahuang and Huangqin to clear Fire and Hotness, Chenxiang to dredge Qi and open the stagnating Qi. The illness is in the upper part of the body, while the herbs work in the lower part of the body. It works very fast.

礞石滚痰丸并不峻烈,即体虚者亦可量用。如田某,女,60岁。老年丧夫,婆媳不睦,情怀失畅,气滞痰凝,自觉咽部有物,咯之不出,咽之不下,颇以为苦,此梅核气也。初诊曾予半夏厚朴汤,不效。再诊,察其烦躁,大便干结,舌红苔黄,脉滑数。此用套方而弃辨证之误也。病属气郁化火,火灼津液为痰,阻于咽嗌,当清肝火而化痰涎,改用夏枯草、栀子、全栝楼、川贝、白芍、川楝子、泽泻、香附、降香,佐吞礞石滚痰丸6g,日二,饭后服。药后得畅泻数次,泻出物多泡沫,胶黏如痰涎,其后咽部即觉宽舒。三诊停用汤药,仅每晚用礞石滚痰丸6g,淡茶水送服,连进一周,其病爽然若失。

The Mengshi Gongtan Pill is not a violent pill formula. It can be used to person with weak body condition. For example in a case, the patient was a female, 60 years of old, who lost her husband in her old age, had conflicting relationship with her daughter-in-law, felt depression, so that she felt something in her throat, which was hard to spit out of swallow down. It bothered her very much. It is the Mei He Qi condition. In the beginning, I have tried to use the Banxia Houpu Tang for the treatment. It did not work. On the following consultation, it was noticed that she was very anxiety and irritable and had constipation. Her tongue was extraordinarily red in color, and the tongue cover was yellow in color. The pulse was slippery and frequent. The failure was due to use of formula in habituation, but did not check the clinic exact condition, or check the exact diagnosis of the condition. Her condition then belonged to the Qi stagnation that develops into Fire. The Fire burned the body liquid into phlegm that blocked in the throat. The herbs should be used to clear the Liver Fire and to dissolve the phlegm. The herbs were changed into Xiakucao, Zhizi, Whole Gualu, Chuan Beimu, Baishao, Chuan Lianzi, Zexie, Xiangfu and Jiangxiang, in addition to the use of Mengshi Gongtang Pill 6 g, twice a day after each meal. After use of the herbs, she got bowel movement several times. The released substance was with lot of air bubbles, was very sticky as glue as phlegm. After that, she felt much released in the throat. After the third consultation, the herbal therapy was stopped, except the use of the pills, which was taken 6 g, every night, which was swallowed with the help of drink of light salty water for one week. The disease felt almost completely disappeared.

梅核气也有由阴虚痰火而起者。体质属阴虚的人多瘦而多火,或病久失治,肝郁化火,劫烁津液,或长期服温燥药而伤阴。其证咽干,咽痛,咽部异物感,兼见心烦,舌红,脉细数,大便干。此证半夏厚朴汤、滚痰丸俱当忌用,我常用一贯煎百合地黄汤加减,其中北沙参、细生地、玄参、麦冬、百合养心阴,栝楼、川贝、旋覆花、枇杷叶、海浮石、绿萼梅化痰开郁,热加知母。举凡苦寒、香燥之品,原则上忌用。

The Mei He Qi condition can also be caused by Yin deficiency and Phlegm-fire overwhelming. The person who belongs to Yin deficiency is more likely to be slim and is with more Fire. The Yin deficiency with more phlegm-fire condition can also be due to a long term of a illness, in which the Liver is stagnated so as to develop Fire in the body. The Fire burns the body liquid part. It can also be due to a long time use of warm-dry herbs that damages the Yin portion of the body. The person has usually dry throat, sour throat, strange feeling in the throat, with annoying feeling emotionally. The tongue is extraordinarily red in color. The pulse is thin and frequent. There is constipation. For such condition, the herbal formula Banxia Houpu Tang and Gongtan Wan both should not be used. I commonly use Yi Guan Jian and Bai He Dihuang Tang with some modification. Among the ingredients, Bei Shashen, Xi Shengdi, Xuanshen, Maidong, and Baihe work to nourish the Heart Yin; Gualu, Chuan Beimu, Xuanfuhua, Pibaye, Haifushi, and Lu Emei work to dissolve phlegm and to open the stagnation. If there is hotness, add herb Zhimu. For herbs with nature of bitter, cold, fragrant, and dryness, they should not be used principally.

梅核气病起于七情,以劝慰患者胸怀宽广,凡事想开些为要,药饵犹在其次也。

Mei He Qi starts from emotional disorders. It should be recommended to the patients to take things easy. The herbal therapy should be regarded as a complementary means to solve the problem.

 

 

17. 面瘫

17. Facial paralysis

 

面瘫多因卒受风寒而致,因此多发生在严冬,或春寒料峭时,或顶风冒雪,或开窗睡觉,风寒之邪袭于阳明之经。如今亦多由盛夏开空调睡觉而发病,此外,也有因拔牙感染而致者。

Facial paralysis is commonly due to sudden attack by Wind and Cold Xie Qi. Therefore it happens more in the very cold winter, or in the early spring when the weather is still very cold, or when the person walks in strong wind and snow, or has sleep with open windows. In these conditions, the Wind and Cold Xie Qi penetrates into the Yangming meridian. In the monden times, it also happens in hot summer when the person has sleep with air conditioning in the room. In addition, there are also cases that happen due to tooth and gum infection following a tooth extract. 

古方牵正散 (全蝎、僵蚕、白附子) 是有效方,但方中有两味虫类药,作散剂效果好,作汤剂则药力大减,因此我常用僵蚕、全蝎等分研末,装入0.25胶囊中,每服2g13次,因风寒外袭者,多兼形寒,汤剂常用祛风散寒药使邪从表解,药如荆芥、防风、羌活、葛根、秦艽、白附子、桑枝、赤芍、甘草、生姜,体质壮实者,可用葛根汤 (麻黄、桂枝、杏仁、葛根、赤芍、甘草、大枣、生姜)

The old formula Qian Zheng San is an effective one (it contains Quan Xie, Jiangcan and white Fuzi). However, the two insect ingredients in it work better if they are used as powder form. If they are concocted, the healing effect would be reduced dramatically. Therefore, I usually grind the Jiangcan and Quanxie into powder, filling them into capsules (0.25 g in each capsule). It is used for 2 g each time, three three times a day. If the facial paralysis is due to Wind and Cold attacks, the person in most cases shows body cold condition, the herbal decoction is used to dispel the Wind and to disperse the cold, so to release the Xie Q from the body surface. The herbs used are Jingjie, Qianghuo, Gegen, Qingjiu, Baifuzi, Sangzhi, Chishao, Gancao, fresh ginger. For person with strong body constitution, use Gegen Tang (it contains Mahuang, Guizhi, Xingren, Gegen, Chishao, Gancao, Chinese date, and fresh ginger).

但近年临床所见,多为外受风寒,内蕴痰火者,用上述祛风散寒通络多无效,此类病人,形体多较肥胖,食多肥甘厚味,吸烟饮酒,痰火阻于经隧,症见多痰,胸闷腹胀,舌红,苔黄腻,脉滑数,须清痰火,药如葛根、黄芩、石膏、栝楼、牛蒡子、钩藤、姜半夏、白芥子、荆芥、防风、羌活、独活,大便秘结者可酌用大黄、芒硝。因拔牙感染所致者,再加白花蛇舌草、蒲公英、连翘、栀子。面瘫不治或失治时间超过半年者,即难以恢复,其治也不能和急性期一样,多为气虚血络瘀滞,宜扶正祛邪,常用黄赤风汤(黄芪、赤芍、防风)加桑枝、全蝎、蜈蚣、蝉衣、葛根、红花、白芥子。

However, in recent years, it was found in clinic that most patients have external Wind-cold attack and have also inner phlegm-fire accumulated. The herbal therapy above did not work in most cases. For this group of patients, they show more fatty body condition. They are craving to eat sweet and strong taste food. They smoke and drink alcohol. The phlegm and Fire block in the meridians. In clinic, they have lots of phlegm, feel choking in chest and bloating in belly. The tongue is extraordinarily red in color. The tongue cover is slippery and frequent. Their conditions need to clear phlegm and Fire. The herbs should be as such as Gegen, Huangqin, Shigao, Gualu, Niubangzi, Gouteng, Jiang Banxia, Baijiezi, Jingjie, Fangfeng, Qianghuo, and Duhuo. If there is constipation, use Dahuang and Mangxiao. If the paralysis is due to infection after tooth extraction, add Baihuasheshecao, Pugongying, Lianqiao, and Zhizi. If the paralysis was not treated, or it was not improved after half year, it would be difficult to cure. For the treatment of such chronic cases, the treatment should not be as the same as for an acute case. The body condition for such patients in the chronic phase is usually in a Qi deficiency, blood stagnation condition. The herbal therapy should aim to support the defense Qi and to dispel the Xie Qi. The commonly used herbal formula is Huangqi Chi Feng Tang (Huangqi, Chishao, and Fangfeng), with addition of Sangzhi, Quanxie, Wugong, Chanyi, Gegen, Honghua, and Baijiezi.

面瘫外治法颇多,最有效的是用马钱子粉、白附子粉等分撒布在胶布或市售伤湿止痛膏 (只用半张)上。贴于嘴角地仓穴,向左歪者贴右边,向右歪者贴左边,24小时一换。荷兰埃因霍温广东酒楼李老太,8年前在家乡温州患左侧面瘫,已愈,此次却在右侧,我即用马钱子粉外贴,兼用汤药、散剂,1周即愈。不到半月,其小孙女又病面瘫,因在上学,不愿在面部贴药,只能服汤药,1周后也好了。而另一老太太,从埃因霍温赶来阿姆斯特丹门诊,既不愿服药,更惧怕针灸,我只好用马钱子、白附子粉给她外贴,很快也好了。

There also many ways to treat the facial paralysis with external use of the herbs. The most effective way is to use Maqianzi powder and Baifuzi powder (equal amount). Spread the powder mixture on to a tape or a herbal patch. Stick the tape or patch on to the edge of the mouth (the Dicang point of acupuncture). Stick it to the right side if the face twists in the left side, or to the left, if the face twists in the right side. The herbal tape or patch should be changed every 24 hours. I met a old lady in Eindhoven, Holland, who suffered from facial paralysis on her left side, 8 years ago when she was in Wenzhou city, China. It was cured at that time. This time, the paralysis is on the right side. I used the Maqianzi powder apllying on her face, with additional use of herbal decoction and powders. After only one week, her condition is solved. Later, less than half month, her grand daughter-in-law also got facial paralysis. For she went to school, she did not want to use herbal tape on her face, but could drink herbal tea. After one week, she got recovered too. There was another old lady in Eindhoven, Holland. She came to my clinic in Amsterdam for her facial paralysis too. She did not want to drink herbal decoct, neither the acupuncture needle for pain. I had to use the Maqianzi powder and Baifuzi powder to her face. Pretty soon, she got recovered too.

因拔牙感染而致者,大致与痰火同法,如患者肖玉_,女,30岁。2000911日初诊。拔牙一周后出现左侧面瘫,曾用牵正散、维生素B1注射及针灸,已16天,口歪,舌麻,眼皮跳,耳后疼痛,大便秘结,舌红,脉滑数。证属痰热阻络,拟清泻痰热,疏通经隧:大黄6g,黄芩10g,栀子10g,钩藤15g,白蒺藜10g,天麻10g,薄荷3g (后下),僵蚕10g,菊花10g,炮南星10g,白芥子6g,赤芍10g,川芎10g,红花10g,荆芥10g,防风10g,秦艽10g,丹参10g,外用马钱子粉贴地仓穴,7帖而愈。

For facial paralysis due to tooth extraction and infection, the treatment is pretty much the same as for the phlegm-fire condition. For example, there is a case, whose name is Xiao, female, 30 years of old. Her first visit was September 11, year 2000. She got facial paralysis on her left face, one weeks after tooth extraction. She had been given herbal formula Qian Zheng San, injection of Vitamin B1, as well as the use of acupuncture for 16 days. Her current condition was mouth twist, numb in tongue, jumping feeling in eyelids, pain behind her ears and constipation. Her tongue was extraordinarily red. Her pulse was slipperry and frequent. Her condition belongs to phlegm-fire block in the meridian. The herbal therapy is used to clear the phlegm and Fire and to conduct the the meridian tract. The herbs used were: Dahuang 6 g, Huangqin, 10 g, Zhizi 10 g, Gouteng 15 g, Baijili 10 g, Tianma 10 g, Bohe 3 g (added last), Jiangcan 10 g, Juhua 10 g, processed Nanxing 10 g, Baijiezi 6 g, Chishao 10g, Chuanxiong 10 g, Honghua 10 g, Jingjie 10g, Fangfeng 10 g, Qingjiu 10 g and Danshen 10 g. Externally used was the Maqianzi powder to stick to the Dicang point at the side of mouth. Her condition was solved after 7 days.

 

 

18. 对更年期综合征的认识和治疗

18. Understanding of menopause syndrome and its treatment

 

 

更年期综合征,在中医妇科教材中作绝经前后诸证经断前后诸证,确指其病与绝经经断相关。此病虽以妇女为多,而男子也有,加之更年期的概念早已被一般人广泛地接受,所以我主张采用更年期综合征这个病名。

(This paragraph is not translated)

《素问.阴阳应象大论》有关男女生长、发育,由盛而衰以及生育的论述,当是我们认识更年期综合征的先导:女子二七而天癸至,任脉通,太冲脉盛,月事以时下,七七,任脉虚,太冲脉衰,天癸竭,地道不通男子二八肾气盛,天癸至,精气溢泻,八八天癸竭,精少,肾脏衰。从中我们可以得出以下认识:天癸的,决定了人一生的盛与衰。在十天干中为水,有与生以来就有之义,故天癸实际上就是肾精。在女子,主血海与主胞胎的冲任脉占重要地位。但八脉皆附丽于肝肾,冲任不能例外。在男子,强调肾和肾精。天癸竭的年龄段,女子在49岁左右,男子在64岁以前。

(This paragraph is not translated)

 

一、更年期综合征的临床表现复杂,对其症状及舌脉、体征进行分析归纳,再结合患者的年龄、体质、境遇等情况,可归纳为:

一. The clinic manifestation for the menopause syndrome is very complex. According to its symptoms, sign of tongue, pulse and body indications, also in consideration of person age, body constitution, and life environment, and so on, its clinic characteristics can be summarized as followings: 

 

(一)定位在肾

() The location of the disease is in Kidney

肾虚精亏,进而导致阴虚火旺,是其基本病理。也就是说,人体阴阳水火的动态平衡被打乱了。临床所见烘热、面赤、手足心热、自汗盗汗、头晕耳鸣、腰酸背痛、月经紊乱、大便干结等,皆阴虚火旺之症。当然,由于阴阳互根,阴虚精亏,亦可影响到肾阳而出现阴阳两虚。

A body condition as Kidney deficiency and Kidney Jing deficiency would further more cause Yin deficiency and Fire overwhelming. This is the basic reason for the menopause syndrome. In another words, the menopause condition is a body condition, in which the balance of body Yin and Yang is damaged. The clinic observation, such as hot flash, red face, hot in the plam and sole, sweat during day time and at night, dizziness and ear ringing, sour on the lower back, disorder in menstruation, and constipation, and so on, are all the sign for Yin deficiency with Fire overwhelming. Of course, due to the Yin and the Yang is the source each other, when the Yin is in deficiency, the Kidney Yang would also come into a deficient condition, so that the body has both Yin and Yang double deficient condition

 

(二)累及四脏

(二)The disease affects other four organs too (the Heart, Liver, Spleen and the Lung)

肾虚精亏,则根本动摇,其余四脏皆受其累,只不过在不同病人身上,可能有不同侧重而已。

When the Kidney and its Jing is in deficient condition, it means the body basic organ is in a weak condition. So, the other four organs would be affected too. However, for different person, the level of damage to each organ could be different, so the clinic manifestation would be also different.

肝:精血同源。肝为乙木,癸属肾水,故又有乙癸同源之说。肾阴久亏,水不涵木,木少滋荣,则阳亢化风;而肝气郁滞,久而化火,又下汲肾水而伤阴。临床所见心烦易怒,易激动,头目眩晕,失眠,胸胁苦满,血压波动,月经异常,皆阴虚肝旺之症。

  When the Liver is affected, the person would have annoyed feeling, easy to get upset, easy to be anxiety, feel dizzy in head and in eyes, poor sleep, strong bloating feeling in chest, fluttering blood pressure, disorder in menstruation. All of these are the signs of Yin deficiency with Liver overwhelming.

心:肾水匮乏,无以上升,心肝火燔,不肯下降;心肾不交,则怔忡、失眠、心悸诸症作矣。

… When the Heart is affected, the person feels annoyed, palpitation, poor sleep, and so on.

肺:肾与肺为金水互生之脏,而从来论者多强调本病与肝脾肾的关系而不及于肺。事实上,不仅本病之无缘无故的哭泣这一表现属肺,自汗、盗汗虽多为阴虚火迫,而皮毛为肺所主,又岂能与之无关?

… In many medical literatures, it is emphasized the relationship between the menopause syndrome with the Liver, the Spleen and Kidney, but not with the Lung. In fact, only only a cry without clear reason is related to the Lung, but also the sweat.  The sweat during daytime and at night though mostly is due to Yin deficiency with Fire pushing. Because skin is dominated by the Lung, how can we say that the Lung is not related to the occurence of the sweat?

脾:食少、便溏、面目肢体浮肿、多痰、乏力、数欠伸等脾虚症状,多继发于阴损及阳,釜底无薪,火不暖土,亦可见于肝气横逆,木贼土虚。

Spleen: poor appetite, lose bowel movement, swelling on face and arms and legs, more phlegm, chronic fatique, yawn, etc. are mostly due to the Yang deficiency that following the Yin deficiency. This is because the Kidney Yang is not sufficient to warm the Spleen Yang (soil). It however can also be seen in the Liver attacting the Spleen that cause the weakness in the Spleen.

 

(三)多见兼挟

(三)The menopause syndrome is usually with other pathological conditions

更年期综合征最常见的兼挟是肝气郁滞,其次是瘀血、痰浊,这三种兼挟往往互为因果,如由肝气郁滞而化火,由气滞而血瘀;不惟肝木乘土,脾失健运而生痰,肝郁气滞、津液不行也会导致痰浊产生,而痰浊既会阻遏气血的运行,又可因久聚化火而为痰热、痰火等等。

The most accompanying pathological phenomenon is Liver Qi stagnation, followed by blood stagnation, and phlegm accumulation. These three accompanying pathological phenomenon can be reasons and results each other. For example, a Liver Qi sluggish could develop a Fire condition, and the Qi sluggish could cause blood stagnation. Not only that the Liver could attack the Spleen, the Spleen fails to transport liquid, so as to produce accumulation of phlegm in the body, but also the Liver Qi sluggish, the liquid fails to circulate in the body, so as also to cause accumulation of phlegm. The phlegm can block the Qi and Blood circulation, and can also develop into Fire to cause phlegm-hotness and phlegm-fire condition.

二、基于以上认识,我治疗更年期综合征的方法,大略有四:

二、Based on the understanding above, I have four ways to treat the menopause syndrome:

 

(一)填补肾精,远刚用柔

(一)Fill up Kidney Jing with mild remedy (not urgent or violent therapy)

这是针对本病基本病机肾精亏乏而设的。肾恶燥,正因为肾精亏乏,所以药宜柔润,刚燥则有助火劫阴之弊。一般多以六味地黄汤为基础,此方为大补肝脾肾三脏、真阴不足、精血亏损的基础方,柯琴更指其滋化源、奉生气,天癸居其所矣,壮水制火之功,特此一端耳。但张介宾认为真阴不足,去掉丹皮、泽泻、茯苓,始可收育阴潜阳之功。

This is designed for the basic cause of the menopause syndrome: the Kidney Jing deficiency. Kidney dislides dryness. For the Kidney Jing deficiency, the herbs should be soft and wetness. The herbs with nature of violent, strong function tend to stimulate Fire so to deplete more Yin portion of the body. Usually the herbal formula Liu Wei Dihuang Wan is used as a basis. It is the base to strongly nourish the Liver, the Spleen and the Kidney, to nourish the true Yin, and to solve the Jing and Blood deficiency. …

我认为以下二方更好:回生丸(紫河车、熟地、山萸肉、杞子、怀牛膝、菟丝子、山药、茯苓、莲子、天冬、麦冬、五味子、酸枣仁、黄牛肉膏、桂元肉、莲须、玄参、地骨皮、女贞子、龟版、鳖甲、鱼鳔胶);保阴煎(生熟地、天冬、麦冬、玉竹、茯苓、怀牛膝、龟板、鳖甲)。此二方都是清初吴门名医顾松园之方。保阴煎系缪仲淳集灵方加味,回生丸则兼取于六昧、集灵、左归,壮水制火而不犯苦寒,补肾填精而三阴兼调,更有血肉有情之品,以充养形质,填补肾精,远刚用柔,顾氏自谓此二方功在六味、左归之上。

However, I feel that the following two formulae work even better: Hui Sheng Wan (using Ziheche, Shoudi, Shanzhuyu, Gouqizi, Huai Niuxi, Tusizi, Shanyao, Fuling, Lianzi, Tiandong, Maidong, Wuweizi, Suanzaoren, Huangniu Rougao, Guiyuanrou, Lianxu, Xuanshen, Digupi, Nuzhengzi, Guiban, Biejia and Yupiaojiao) and Bao Yin Jian (Shengdi, Shoudi, Tiandong, Maidong, Yuzhu, Fuling, Huai Niuxi, Guiban, and Biejia). Both herbal formulae are developed by famours Dr. Song-yuan Gu (early time of the Qing dynasty). The Bao Yin Jian is developed from the Ji Ling Fang of Dr. Zhong-chun Liao, whereas the Gui Sheng Wan is the combination of Liu Wei Dihuang Wan, Jiling Fang, Zuo Gui Wan. It works to nourish the water part so to depress the Fire but not so bitter or cold. It works to nourish the Kidney Jing but also nourish the three Yin (Liver Yin, Heart Yin, and Spleen Yin). Also, it contains the animal parts, so to nourish the body with body part, so to fill up the Kidney Jing. It uses mild working herbs, not violent effect herbs. Dr. Gu said that these two herbal formulae work better than the Liu Wei Dihuang Wang and Zuo Gui Wan.

 

(二)滋阴降火,甘苦合化

(二)To nourish the Yin so as to clear the Fire, by using the bitter and the sweet herbs together

滋阴己如上述,水足则可制火,但火旺者,又须结合降火,因为在火旺之时降火即是最有效的保阴和养阴。不过降火药多苦燥,苦燥伤阴,所以原则上可暂用而不可久用。此外,降火药如与滋阴药同用,有甘苦合化之效,也就是说,这两组药同用不致伤阴。常用降火药中的苦寒药多用知母、黄柏、功劳叶;甘寒药除地黄外,常选玄参、北沙参、麦冬、糯稻根须、石斛。

The therapy to nourish the Yin has been introduced above. Whenever the water (the Yin) is sufficient, the water can depress the Fire. But if the Fire is too overwhelming, the Fire has to be depressed directly, since when the Fire is overwhelming, to reduce the Fire is the most effective way to save the Yin and to nourish the Yin. The commonly used Fire-reducing herbs are mostly bitter and dry in herbal nature. Bitter-dry hurts the Yin, so that in principle, the bitter-dry herbs should not be used, or can only be used temporally. In addition, if the Fire-reducing herbs are used together with the Yin-nourishing herbs. There would have sweet and the bitter harmonization effect. It means that the use of them together would not hurt the Yin. The commonly used Fire-reducing bitter-cold herbs are Zhimu, Huangbo, Gonlaoye; the sweet-cold herbs are, beside Dihuang, the Xuanshen, Baishashen, Maidong, Nuodaogen and its tassel, and Shihu.

(三)水中疏木,不虑伤阴

(三)Dredge the Wood (the Liver) from and in the Water (Kidney), without worry to hurt Yin

更年期综合征患者多有肝郁气滞,但阴虚精血俱亏者,疏之无功,反有酿燥助火之弊,所以前人乃提出水中疏木一法,高鼓峰之疏肝益肾汤、滋水清肝饮、滋肾生肝饮三方俱可取法。三方都取六味地黄汤合逍遥散:疏肝益肾汤用六味全方,取逍遥散的柴胡、芍药;滋水清肝饮取丹桅逍遥散的柴胡、白芍、丹皮、栀子,加酸枣仁;滋肾生肝饮则取逍遥散的柴胡、当归、白术、甘草,再加五味子。我治疗���年期综合征之属阴虚肝旺者,常仿高氏三方,我认为水中疏木的思路很好,用药上则不必完全拘泥于他。

Person with menopause syndrome is more likely with Liver Qi stagnation and Qi sluggish. However, when the body condition is also with Yin deficiency and Jing and Blood deficiency, it is hard to dredge the Qi. To dredge the Qi may even help the overwhelming of the Fire. For this reason, doctors in old time proposed the remedy to dredge the Qi by taking care of the nourishment of the Kidney Water. The herbal formulae of Dr. Gu-feng Gao, the Shu Gan Yi Shen Tang, Zi Shui Qing Gan Yin, and Zi Shen Sheng Gan Yin can be all recommended. All the three formulae use the Liu Wei Dihuang Tang and the Xiao Yao San. The Shu Gan Yi Shen Tang uses all the ingredients of the Liu Wei Dihuang Tang, but only use Chaihu and Shaoyao from the Xiao Yao San. The Zi Shui Qing Gan Tang uses Chaihu, Baishao, Danpi, and Zhizi from Danzhi Xiao Yao San, with addition of Suanzaoren. The Zi Shen Sheng Gan Yin uses the Chaihu, Danggui, Baizhu, and Gancao, with addition of Wuweizi. When I treat the menopause syndrome with Yin deficiency but Liver overwhelming condition, I usually learn the Dr. Gao’s such three ways. I believe that, to dredge the Wood by nourishing the Water is a good idea, though the herbs used may not need to follow him exactly.   

 

(四)五脏兼调,不忘兼挟

(四)Treat the main problem with care of the other organs, with care of the other pathological factors (such as phlegm, blood stagnation, etc.)

如前所述,更年期综合征以肾阴亏损为基本病机而累及五脏,其治当以滋肾养阴为主,兼调他脏,如降火、平肝、疏肝、健脾、宁神、清金、和胃诸法,俱当根据具体病情,斟酌用药。而气滞、痰浊、瘀血等兼挟,也应视其轻重缓急,恰当地予以处理,有时甚至还不得不暂时放下主证。否则往往虚不受补,久补无功,因有邪碍之故也。

As mentioned before, the basic reason for the menopause syndrome is the Kidney Yin deficiency, which later affects the function of other organs. For the treatment, it should be focused on the nourishment of Kidney and the Yin, with care of also other organs, for example to clear Fire, to calm down Liver, to nourish Spleen, and calm heart spirit, to cool down the Lung, and to harmonize the Stomach, etc. All depend on the body condition of each person. For the Qi sluggish, phlegm accumulation and entangle, and blood stagnation, all need to be treated according to their severity. Some times, they have to be treated in priority, otherwise, the weakness condition would not be really nourished as expected. A long time nourishment does not work at all, for the Xie Qi in the body, which prevent the nourishing therapy.

三、针对更年期综合征出汗、烘热、烦躁、失眠四个主症,谈谈个人的治疗体会。

三、For the four main symptoms of menopause syndrome, the sweat, the hot flash, the anxiety, and poor sleep, here I introduce my own experience in the treatments.

(一)出汗:多为阴虚火旺所致,常伴见心烦、目赤、舌红、口干、手足心热,患者往往在一阵烘热后汗出如雨,或盗汗多,甚至衣被俱湿。曾治一更年期男子,为盗汗所苦,每天起床,被窝里赫然一个人形,就是他的汗水印出的。阴虚火旺,常用当归六黄汤,我每取其甘苦合化的思路,而不泥于其方。因为在此当归不免助火,黄芪更属蛇足。大补阴丸这张方也不错,地黄、龟板滋阴,知柏泻火,也属甘苦合化。

(一)Sweat: The sweat in menopause syndrome is commonly due to Yin deficiency with Fire overwhelming. The person usually has annoyed, anxiety, red eyes, hot feeling in palm and sole, and dry mouth. The tongue is extraordinarily red in color. The patient usually has a flurry of hot flash, then has a heavy sweat as raining, or has sweat at night after sleep, which is so severe that the cover is all in wet. I had a male patient with menopause syndrome. He was bothered by the night sweat very much. Every morning after getting up, there was a human being body shape on the bed, which is formed by his sweat. For Yin deficiency with Fire overwhelming, commonly used herbal formula is Danggui Liu Huang Tang. I adapt its idea of sweet-bitter combination, but do not stick to the exact herbs used, because here, the use of Danggui may increase the level of the Fire and the use of Huangqi is useless. The formula Da Bu Yin Wan works also well. The Dihuang and Guiban work to nourish the Yin, Zhimu and Huangbo work to reduce Fire. It also belongs to the sweet-bitter combination.

此外,我常配用两张外治方:

Beside this, I also usually use two externally used ways:

1.玉米茎心:即玉米茎去粗皮后白色的髓心,每用12尺,切断,煎水代茶。

1. The inner part of the maize: use one to two feet of the inner white part of maize, chop in pieces, boil it in water. Drink it as regular tea.

2.五倍子、朱砂等分研末,蜂蜜调匀,填满肚脐中,外用胶布固定,3天一换。

2. Wubeizi and Zhusha: grind them into powder (equal amount), mix it with honey. Fill the mixture into naval. Seal it with medical tape. Change it every three days.

以上两方对自汗盗汗都有效。但也有患者表现为舌淡脉弱、汗出畏风,属营卫不调或藩篱不固者,不可拘于滋阴降火一途,要考虑桂甘龙牡汤、桂枝加龙牡汤、桂枝汤加黄芪、桂枝汤合玉屏风散、玉屏风加附子、姜、枣这一类处方了。

These two formulae work for the sweat either during day time or at night after sleep. However, if the patient’s tongue looks pale, and the pulse feels weak, and if the patient has sweat and dislikes wind (fast air moving), the body condition belongs to disharmony of the Yin Qi and Wei Qi. We should not stick to the only way of nourishing yin and clearing Fire. It is needed to consider the use of Gui Gan Long Mu Tang, Guizhi plus Longgu and Muli Tang, Guizhi Tang plus Huangqi, Guizhi Tang with Yu Ping Feng San, or Yu Ping Feng San plus Fuzi, ginger, or Chinese date, such formulae. 

更年期综合征的多汗,重在治本,一般止汗药往往无效或暂时有效,不久就复发,因此,如浮小麦、炙麻根、龙骨、牡蛎、碧桃干等,只能作辅助药用,不能依靠它们去解决问题。不清除病因,徒用止汗,止也止不住。

The heavy sweat in menopause syndrome needs treatment of the basic reason. Commonly used sweat-stopping herbs usually do not work or only work temporally. For this reason, the herbs, such as Fuxiaomai, Zhi Mahuanggen, Longgu, Muli, or Bitaogan, can only be used as complimentary means. They can not be used to solve the sweat from the root. Without removal of the basic reason, but with the therapy to stop the sweat, the sweat is hard to be sopped.

(二)烘热:总的说来,滋阴则虚热可去,重点在滋肾阴。但五脏之阴,相互渗灌,所以往往须结合滋脾阴、养肺阴、育肝阴、补心阴。此外要注意五志均可化火,五脏之火又以肝火为最横,因此当火盛之时,又须兼用泻火平肝。处理烘热,须注意滋阴与泻火的分寸,一般说,要避免过用苦燥。

(二)Hot flash: Generally speaking, to nourish the Yin, the weak Hotness can be reduced. The key point is to nourish the Kidney Yin. Since the Yin of all the five organs irrigate each other, it is needed to also nourish the Spleen Yin, Lung Yin, Liver Yin, and Heart Yin. In addition, disordered emotional feelings can also develop Fire. Among the Fire in the five organs, the Liver Fire is the most violent. Therefore, when the Fire is very overwhelming, it is needed to clear Fire and to calm down Liver. To solve the hot flash, it is needed to handle the relationship between the Yin-nourishing and the Fire-clearing. Generally speaking, it should be avoided to use too bitter and too dry herbs.  

也有部分病人,在劳累后即觉烘热,伴见汗出、头昏心悸、困乏无力、食少便溏、舌淡脉弱。偏于气虚者可用补中益气汤加麦冬、五味子;既有气虚又兼肝郁气滞者,可用补中益气合逍遥散;气郁化火,常用丹栀逍遥散,去白术之壅,加郁金、生麦芽。

There are some patients, who had hot flash after getting tired. They have sweat, dizziness, palpitation, chronic fatique, poor appetite, lose bowel movement. The tongue is pale, and the pulse is weak. If the condition is with more Qi deficiency, use Bu Zhong Yi Qi Tang plus Maidong and Wuweizi. IF there is both the Qi deficiency and Liver Qi sluggish, use the Bu Zhong Yi Qi Tang plus Xiao Yao San. If the Qi sluggish has developed into Fire, commonly used herbal formula is Dan Zhi Xiao Yao San, with removal of Baizhu, but with addition of Yujin and not processed Maiya (malt)

(三)烦躁:更年期综合征较多表现为烦躁、易触怒、坐卧不安等,甚至做出常人不可理喻的事来。大凡水亏火旺者,宜滋阴泻火��常以百合地黄汤、百合知母汤为主方。生地黄养阴而壮水,百合清金以平木,知母泻火以除烦,仲景笔下之百脉一宗,悉致其病意欲食复不能食,常默默,欲卧不能卧,欲行不能行,饮食或有美时,或有不用闻食臭时,如寒无寒、如热无热、口苦小便赤,历历如绘。

(三)Anxiety: Menopause syndrome expresses more as anxiety, easy to get upset, restless, and so on. The patient may do some hardly understandable things or behavior strange. Mostly, for a condition of Water-poor but Fire-overwhelming, it is needed to nourish the Yin and to clear the Fire. Commonly, the Baihe Dihuang Tang and Baihe Zhimu Tang is the main formula. The Sheng Dihuang nourishes the Yin, so as to fill up the Water. Baihe clear the Metal (Lung), so as to calm down the Wood (Liver). The Zhimu works to clear Fire, so as to stop anxiety. Master Zhong-jing Zhang had described such disease condition as “largely variable pulse feelings. All can cause this disease”. The patient has willing to eat but soon hardly to eat; usually keeps silent with low ambition, has a willing to lay down, but hard to have rest on bed; has a willing to walk, but hardly to walk a little longer time. Sometimes the person may enjoy the food very much, sometimes has no appetite at all. The body seems cold but not actually cold; seem hot, but actually not hot. The person has bitter taste in mouth and the urine is red in color.” His description is so vivid.

 

更年期综合征也有表现为多疑、敏感,甚至无故悲伤哭泣,伴见乏力、肢软、汗出者,属脏躁甘麦大枣汤为有效之方。方中小麦宁心除烦,单用也有效,但量须大,一般用60g煮水(不能煮破)代茶。汗多者改用浮小麦。如果气阴都虚,可用百合地黄汤、甘麦大枣汤合方

The menopause syndrome can also show as rich in suspension, easy to be irritable, even sad and crying without clear reasons. The person has also chronic fatique, weak in arms and legs, and sweat, which belongs to the “Zhang Zao condition” in Chinese medicine. The herbal formula Gan Mai Dazao Tang is the effective formula. In the formula, Xiaomai (wheat) works to calm down Heart and to remove annoying and irritable feeling. Xiaomai alone also works, but the large dose is needed. Commonly use it 60 grams to cook in water (not to cook break the shell) and drink it as tea. If the sweat is heavy, use Fu Xiaomai. If the Qi and Yin both in deficiency, use Baihe Dihuang Tang and Gan Mai Dazao Tang together.  

(四)失眠:有很多更年期综合征患者为失眠所苦。其病机大都为阴虚阳亢。阴不足则阳无处可潜,阳不能入于阴,所以失眠或夜梦纷纭。我治此类失眠,多用酸枣仁汤(知母、茯苓、酸枣仁、川芎、甘草),对夜不成寐伴见心烦者较有效。但真是肝肾阴虚,此方滋阴之力不足;真是火旺,此方泻火之力亦不足,所以对阴虚火旺者,须加重滋阴药,如生地、玄参、麦冬,泻火药如黄连、竹叶。

(四)Insomnia: many people with menopause syndrome are bothered by poor sleep. The mechanism for the poor sleep is the Yin defficiency with Yang rushing-up. When the Yin is not sufficiency, the Yang would have no place to stay (to have a rest). When the Yang fails to dive into the Yin, it would float to cause insomnia or cause continuous dream at night. For such kind of poor sleep, I usually use Suanzaoren Tang (the herbal ingredients are Zhimu, Fuling, Suanzaoren, Chuanxiong, and Gancao). It works for the poor sleep with annoying or irritability feeling. However, if the body condition is a real Liver-Kidney Yin deficiency, this formula is less sufficient to nourish the Yin. If the condition is a real Fire rushing-up, this formula is less strong enough to clear the Fire. Therefore, for Yin deficiency with Fire overwhelming, it is needed to use stronger herbs to nourish the Yin, such as  Shengdi, Xuanshen, Maidong, and stronger herbs to clear the Fire, such as Huanglian and Zhuye.

考前人治疗阴虚内热,恒多生地、黄连同用,如东垣的朱砂安神丸(生地、当归、黄连、甘草、朱砂),唐容川的益气安神汤(生地、麦冬、黄连、胆星、竹叶、酸枣仁、茯神、远志、人参、黄_),今人黄寿人的三子养阴汤(生地、黄连、女贞子、枸杞子、沙苑子、菊花、枣仁、柏子仁)皆是,如此则滋阴清热的力量大大加强了。

Checking the treatment of Yin deficiency with inner hotness by doctors in old times, the Shengdi and Huanglian were commonly used. For example, the Zhusha An Shen Wan by Dr. Dong-yuan Li contains Shengdi, Danggui, Huanglian, Gancao, Zhusha. The Yi Qi Yang Shen Tang by Dr. Rong-chuan Tang contains Shengdi, Maidong, Huanglian, Dannanxing, Zhuye, Suanzaoren, Fushen, Yuanzhi, Renshen, and Huangqi. The San Zi Yang Yin Tang by Dr. Shou-ren Huang contains Shengdi, Huanglian, Nuzhenzi, Gouqizi, Shayuanzi, Juhua, Zaoren, and Boziren. For this way, the ability to clear hotness is much increased.

我治疗失眠,亦常多用重镇安神方药,如许叔微的真珠丸(珍珠粉、熟地、人参、酸枣仁、柏子仁、犀角、茯神、沉香、龙齿、朱砂),费伯雄甲乙归脏汤亦用珍珠母、龙齿、夜交藤、合欢皮及合欢花之类。

When I treat the poor sleep, I also usually use herbal ingredients, which belong to heavy and falling nature and work to calm down heart spirit. The formulae are as the Zheng Zhu Wan by Dr. Shu-wei Xu (using Zhenzhu powder, Shoudi, Renshen, Suanzaoren, Boziren, Xijiao, Fushen, Chenxiang, Longci and Zhusha), and the Jia Yi Gui Zang Tang by Dr. Bo-xiong Fei (using Zhenzhumu, Longci, Yejiaoteng, Hehuanpi and Hehuanhua and so con.

至于夹痰夹瘀者,则当兼顾之,如唐氏益气安神汤,用黄连、竹叶、胆星除痰热。痰盛苔腻、胸闷者,多取《三因方》温胆汤;瘀血久著,则参用王清任血府逐瘀之法。

If the body condition is with phlegm accumulation and blood stagnation, they should also be treated at the same time. For example in the Yi Qi An Shen Tang, it uses Huanglian, Zhuye, and Dannanxing to clear phlegm-fire. If the person has lot of phlegm, and feels choking feeling in the chest, and if his tongue cover is white and greasy, it is often used the Wen Dan Tang (from book <<San Yin Fang>>). If the blood stagnation condition has been for a long time, consider the use of Xue Fu Zhu Yu Tang (from Dr. Qing-ren Wang).   

此外,更年期综合征阴损及阳,以至阴阳俱虚者,也不少见。这是因为病程长,而不同患者又存在不同体质的缘故。其表现除前述阴虚内热证外,还时有畏寒怯冷或畏寒与潮热交替出现,患者既怕热,又怕冷,兼见头晕,腰酸、神疲、乏力、尿频(夜尿尤多),性欲淡漠。上海的二仙汤(仙茅、仙灵脾、巴戟、当归、知母、黄柏)燮理阴阳,双向调节、立意不错。对阴阳两虚证,我常在二仙汤方中加入熟地、杞子、制首乌、紫河车之类益肾填精之品,精充则肾阴肾阳皆可得功。

In addition, in the menopause syndrome, it is also common that a Yin deficiency could damage the Yang (less transform of Yin into the Yang), so the body condition becomes Yin-Yang both in deficiency. This is because the disorder is a long time course, and different person has different body constitution. In clinic, the patient has, beside the symptoms of the Yin deficiency with inner hotness as discussed above, the chilly feeling, or the shifting chilly and hot flash. The patient dislikes hot environment, neither the cold one, in addition to dizziness, sour in lower back, chronic fatique, tired easily, frequent urination (especially more night urination), and poor sex desire. The herbal formula Er Xian Tang (developed by doctors in Shanghai city) (using Xianmao, Xianlingpi, Bajitian, Danggui, Zhimu, and Huangbo) adjusts both Yin and Yang, doing a double side adjust. It is a good idea. For the Yin-Yang both deficiency, I usually also add, to the Er Xian Tang, the herb Shoudi, Gouqizi, Zhi Heshouwu, and Ziheche, such herbs to nourish the Kidney Jing. When the Jing is sufficient, the Kidney Yin and Yang can be easily supplied.    

 

 19.  瓜蒌红花治带状

19. Gualu and Honghua for the treatment of herpes zoster (Shingles)

 

明代名医孙一奎《医旨绪余》载:其弟性多暴躁,于夏季途行过劳,又受热,突发左胁痛,皮肤上一片红如碗大,发水疮三五点,脉弦数,其痛夜甚于昼。医作肝经郁火治之,用黄连、青皮、香附、川芎、柴胡之类,愈甚。又加青黛、胆草,其夜痛苦不已,叫号之声,彻于四邻,胁中痛如钩摘之状,次早观之,其红已及半身矣,水_疮又增至百数。从他记述的病情看,当为带状疹无疑。孙一奎乃求教于他的老师黄古潭先生,黄哂曰:切脉认证则审矣,制药订方则未也。改用大瓜蒌一枚,重一、二两,连皮捣烂,加甘草二钱,红花五分,一剂而愈。这张处方,我定名为瓜蒌甘草红花汤,多年以来,用以治疗带状疹,多在一、二周之内见效。

In the book <<Yi Zhi Xu Yu>>, the famous doctor, Dr. Yi-kui Sun (Ming dynasty), wrote: his brother was very short-tempered. In a summer, he had long distance walk, got very exhausted, together with exposure in the hot weather, he suddenly got pain on the left upper side of the belly. “There was a big skin rash, a size of a bowl, with 3 to 5 water blisters on it”. His pulse was string and frequent. The pain was more at night than during the daytime. Doctor had treated his problem as Fire stagnation in the Liver meridian, using Huanglian, Qingpi, Xiangfu, Chuanxiong, and Chaihu, as such. The pain however was ever worse. Herb Qingdai and Longdancao were also added. “The patient felt very much pain at that night. His crying was so loudly that even the neighbours could hear his painful crying. The pain in the side of belly felt as a hook to hook. Next morning, his half body turned red in color and the water blister increased to hundred in number.” From his description, the disease is no doubt the shringles. Dr. Yi-kui Sun asked his teacher Dr. Gu-tang Huang for consultation. Dr. Huang said: “The diagnosis is correct, but the herbs used are not proper.” He then used one big Gualu, about 30 g to 60 g. It was chopped into mud form. Add herb Gancao 6 g, Honghua 1.5 g, for decoction preparation. After only one dose, the shringles subsided. For this formula, I named it as “Gualu Gancao Honghua Tang”. For many years, I used it for the treatment of shringles. In most case, it works within one to two weeks.

带状疹多见于胁、肋,这正是足厥阴肝经部位,患处红灼热,痛如针刺刀割,诸痛痒疮,皆属于心(火),更因其人性多暴躁,更兼受热,因此从肝经郁火治,本来应该是不错的,但五脏之火以肝火为最横,肝阴肝血不亏者,用之固无不可,反之,则因苦药皆燥,苦寒直折其火,便是以燥治火,则肝火愈炽,至于升散、香燥之品,更无异于火上加油了,所以黄古潭说认证不错,方药则欠妥。瓜蒌甘草红花汤乃以瓜蒌一枚(约合今30~50克)为主药,瓜蒌性味甘寒,不唯以清化热痰、通腑开结见长,且能舒肝郁,润肝燥,平肝逆,缓肝急(《重庆堂随笔》),《药性类明》更说甘合于寒,能和、能降、能润,故郁热自通。因瓜蒌用大量易滑肠而引起腹泻,故用甘草甘缓和中,虽说痛随利减,但毕竟泄多伤正,故乃重用甘草;些许红花,则取其入络行瘀。药虽寥寥三味,而用意颇为周到,所以取效甚捷。

The shringles is more on the side of chest and belly. This is the pathway of Liver foot Jueyin meridian on the body. The diseased location is fresh red in color and it feels burning pain, as painful as needle punch or knife cut. “As indicated in book <<Nei Jing>> that all the pain, itch and skin sour, are associated and related to the Heart (Fire)”. Also due to the short-tempered, and to the suffering in hot weather, it should not be wrong to treat the shringles aiming the stagnated Fire in the Liver meridian. However, among the fire in the five organs, the Liver fire is the most violent one. If the Liver Yin and Liver blood are not in deficiency, such bitter-cold herbs can be used without problem. However, the bitter herbs are all bearing drying nature. To use the bitter-cold herb to suppress the Fire is as to use the Dryness to clear the Fire, the Liver Fire would be more overwhelming. For the herbs that bearing rising and dispersing nature, they work even as to pour oil on a fire (to make thing even worse). For this reason, Dr. Huang thought that the previous diagnosis is not wrong, but the use of the herbs is not proper. The Gualu Gancao Honghua Tang uses Gualu (about 30 to 50 g the weight of nowadays) as the main ingredient. The Gualu is sweet and cold in herbal nature. It does not only work to clear hot-phlegm, to open the intestine tract and break the entangled mass, but also to “dredge Liver Qi, moisten Liver dryness, calm down reversed Liver Qi, and to ease the Liver spasm.” (<<Chongqing Tang Sui Bi>>). In the book <<Yao Xing Lei Ming>> it even said: “The sweet is combined with the Cold, so as able to harmonize, to cause descending, to moisten, so the stagnated hotness subsides.” Because large amount of Gualu may cause diarrhea, the Gancao is used to buffer and to calm the intestine by using its sweet nature. Though “the pain is to subside along with bowel movement, heavy diarrhea could hurt body Qi, so large amount of Gancao is used. Little Honghua used is to take its advantage to penetrate into the meridian to disperse blood stagnation. Though there are only three herbs, the opinion is very smart to take care every aspects, so that the healing effect is very fast.

于此可证:疗效欠佳,由于辨证不确者固多,由于方药使用不当者亦复不少。此外,虽确属肝经郁火,但在用药上却有苦寒、甘寒之分,说明名医既洞悉病理,用药亦精细入微,诚非偶尔幸中者。学者当于此用心体味,其所获者当不止此一有效成方而已。

This case proves: whenever the healing effect is not satisfied, though in most cases it is due to the diagnosis is not correct, it could be due to improper use of the herbs, or herbal formula. In addition, though the condition belongs to the Fire-stagnation in the Liver meridian, the herbs can be chosen are either bitter-cold or sweet-cold in nature, suggesting that our doctors in old times monitored the pathological disorders, and observe the herbal healing effects, very careful and in much detail. It happens not as a ocasional phenomenon. TCM beginners should try to understand the meaning and the way to set up herbal formula, rather than only to mimic a ready formula.

最近读到余瀛鳌先生一篇回忆其师秦伯未先生的文章(《古医籍各家证治抉微》),文章说:1959年仲夏某日,一人因缠腰火丹(带状疹)来诊,发病已三日,已用过中药,无效,左胁下、腰部疹继续增多,痛甚,索阅前医处方,与龙胆泻肝汤相近。秦用瓜蒌一枚、红花一钱半,生甘草三钱,过了几天,患者电话告知:服药后当天晚上疼痛已然减轻,得以安眠,共服四剂而愈。秦先生用的方,就是孙一奎此方。附录于此,以供临证者参考。

Recently I read an article by Mr. Yin-ao Yu in memory of his teacher, Dr. Bo-wei Qin (in book <<Gu Yi Ji Ge Jia Zheng Zhi Jue Wei>>). It said: one day in the summer of year 1959, a person suffered from shringles. He came for the treatment three days later. He had been given herbal therapy, no effect. The shringles under left side of ribs and on the lower back continued to increase, which was very painful. When check the formulae used by previous doctors, it was found that it was similar to the Long Dan Xie Gan Tang. Dr. Qin used one Gualu, 4.5 g of Honghua, and 9 g of Gancao. After several days, the patient called and said: “on the night he started to drink the herbal decoct, the pain was reduced and he could fall into sleep. After four doses (four days), the shringles was cured. The formula used by Dr. Qin is the one by Dr. Yi-kui Sun. The story is cited here for the reference for doctors in clinic.  

 

 

20.  咽炎茶

20. Pharyngitis tea

 

处方:桔梗10克、生甘草6克、麦冬6克、玄参6克、薄荷2克、藏青果6(打碎)、乌梅3克、木蝴蝶1克、升麻2克、蜂蜜适量。 用法:开水浸半小时,代茶饮。

The herbal formula for the pharyngitis tea: Jiegen 10 g, Gancao 6 g, Maidong 6 g, Xuanshen 6 g, Bohe 2 g, Tibet Qingguo 6 g (break), Wumei (pulm) 3 g, Muhudie 1 g, Shenma 2 g, honey some amount. Usage: rinse the herbs into boiled water for half hour. Drink it as regular tea.

说明:1.桔梗、甘草,即《伤寒论》之桔梗汤,用甘草泻火解毒,桔梗祛痰利咽,王旭高说,此方乃治咽痛之主方。教师及歌者,因讲话、唱歌过用嗓子而耗伤津液,故加麦冬之甘寒润燥,玄参清浮游之火,是为玄麦甘桔汤。在此基础上,更加升麻、青果协甘草清热解毒,木蝴蝶利咽振闭,乌梅、薄荷止咽痒。蜂蜜则既用以矫味,又用以润燥。以泡代煎,便于患者在较长时间内服用。

Explanation: (1). The Jiegen and Gancao, are the Jiegen Tang in book <<Shang Han Lun>>. The Gancao is used to clear fire and to detoxify. The Jiegen is to clear phlegm and to clear the throat. Dr. Xu-gao Wang said, this formula is the main formula for sour throat. For teachers, singers, and those who need to talk, sing, or cry too much so as the body liquid is hurt, the Maidong is added to moisten the dryness in throat, for its sweet-cold nature, the Xuanshen is added to clear the floating Fire. Thereafter the Ganjie Tang is changed into the Xuan Mai Gan Jie Tang. Under this base, Shenma and Qingguo are added to help Gancao to clear Fire and to detoxify; Muhudie is to clear throat and to open block of voice; Wumei and Bohe are to stop itch in the throat. The honey is to reduce the bitter taste of the herbal decoct, and also to moisten the dryness in throat. To prepare the herbs into a tea to drink is to allow for a long time drink.

2.此方不仅用于慢性咽炎,亦用于急性咽喉炎、急性扁桃体炎,但须改为汤剂用,咽肿、充血、发热者,再加金莲花6克、银花10克、连翘10克、蒲公英、板蓝根各15克、僵蚕10克、山豆根10克,水煎,一日一剂,分三次服,一般三、五剂可愈。

(2). This formula is not only to be used for the chronic pharyngitis, but also for acute pharyngitis, acute tonsillitis, but it should be changed into decoction form. If there is swelling and congestion in throat, and the person has fever, add Jinlianhua 6 g, Yinhua 10 g, Lianqiao 10 g, Pugongying 15 g, Banlangen 15 g, Jiangcan 10 g, Shandougen 10 g, decoct in water. One day one dose. Drink it three times a day. Generally speaking, it needs three to five doses to cure.

3.此方多年使用有效。但必须指出:咽炎、扁桃体炎、咽喉炎亦有因寒邪外束,郁于咽喉所致,非辛温不效者;有阴虚火浮,当用滋阴降火或稍佐热药引火归原者;还有痰气交结,咽中有异物感当用消痰降气者,则皆非此方所宜,望识者鉴之。

(3). This formula has been used by me for many years. It works. However, it should be pointed out that the pharyngitis and tonsillitis can also be caused by external Cold attack to the body surface and entangled in the throat. Only spicy-warm herbs can work to solve it. For Yin deficiency with Fire floating condition, little hot herbs can be added to bring the Fire back to kidney. If there is phlegm and Qi entanglement and there is feeling in throat as some foreign matter, use herbs to clear the phlegm and to descend the Qi. In these cases, the herbal formulae discussed above are not proper to use.   

 

 

21.  带状

21. Shringles

 

带状疹患者最痛苦的是难以忍受的疼痛,其疼痛持续的时间,可数月,数年甚至十余年。

The most bothering suffering by a patient with shringles is the hardly tolerable pain. The pain can last for several months, several years, even tens of years.

疹分布的部位看,如颞侧、眼、耳前后、胁、少腹,皆属肝经;疹色鲜红或暗红,周围皮肤红灼热,其脉弦滑数,其痛如针刺刀割,归结起来,则为肝经郁火无疑。

From the distribution point of view of the shringles, such as in the side of face, eyes, front and rear of the ears, side of chest and belly, lower belly, all belong to the Liver meridian. The sringles are fresh red in color or dark red. The surrounding skin is red and is with burning sensation. The pulse feels string, slippery and frequent. The pain feels as knife cut or needle punch. All together, it is no doubt that the shringles are the stagnated Fire in the Liver meridian.

我治带状疹的方法,系从明代孙一奎《医旨绪余》得来。方用大栝楼12两,甘草2钱,红花5分。常以此为基础方,酌加大青叶、板蓝根、僵蚕、桑寄生、银花清热解毒,赤、白芍,延胡索,丹参,七厘散()活血止痛,多年以来,经治数十例患者,多能在几服药内止痛,疹亦随之消失。病延日久者,则要从久痛入络考虑,酌加桃仁、当归须、全蝎、蜈蚣。

My way to treat the shringles comes from Dr. Yi-kui Sun’s book <<Yi Zhi Xu Yu>>. The formula uses big Gualu 30 to 60 g, Gancao 6 g, Honghua 1.5 g. This formula is usually used as a basic formula, with addition of proper amount of Daqingye, Banlangen, Jiangcan, Sangjisheng, and Yinhua to clear Fire and to detoxify, Shishao, Baishao, Yuanhusuo, Danshen, Qili San (swallow directly) to activate blood circulation and to stop pain. For many years, I treated tens of patients. In most cases, the pain can be stopped by several doses of the herbal therapy and the shringles could subside completely. If the disease has lasted for a long time, it should be considered as long term pain that already penetrates into the meridian. It is needed then to add  proper amount of Taoren, Dangui Xu, Quanxie, and Wugong.

在带状疹两端拔火罐,也有助于止痛。在疹上亦可拔罐,如破溃滋水者,涂以龙胆紫即可,有的疼痛不在疹部位,则另在痛点 (阿是穴) 拔罐。

To perform a cupping therapy at the two ends of the shringles can help to stop pain. If the cupping is performed over the shringles, and if the blister break with water out, it only needs to smear some getian violet. If the pain spot is not on the blister, do cupping on the painful spot only.

近案三例:

Clinic case report of three recent cases

黄某男,87岁,因带状疹住院5天,痛一直未止,入夜更甚,通霄无寐,用过多种止痛药、抗病毒药无效,患者曾多次向家人表示不愿活下去了。其女黄以平电话上询问有什么方法,我即口授一方:栝楼30g,赤、白芍各10g,延胡索10g,僵蚕10g,红花6g,板蓝根20g,桑寄生20g,浙、川贝各10g,服1剂即痛减,至第2剂痛即全止。

Patient Mr. Dong, 87 years of old. Male. He was admitted in hospital for five days due to shringles, but the pain continued, which was worse at night so as no any sleep at all. He had been given various pain-killers, anti-virus medications, but no any improvement. The patient had expressed to his family members that he would not want to continue the life. His daughter called me asking if there is any way to solve her father’s problem. I told her to use Gualu 30 g, Chishao 10g, Baishao 10 g, Yuanhusuo 10g, Jiangcan 10 g, Honghua 6 g, Banlangen 20g, Sangjisheng 20 g, Zhi Beimu 10 g, Chuan Beimu 10 g. He tried. After only one dose, the pain was reduced. After two doses, the pain subsided completely.

朱某女,70岁,病带状疹近两月,曾用过多种抗病毒药、镇痛药(可待因),痛仍不止,或暂止1~2天,又复疼痛,不堪其苦。疹在后腰部位,隐伏不现,舌红,脉弦数。我用栝楼,红花,丹参,薏苡仁,川、浙贝,桔梗,僵,赤、白芍,甘草,配吞七厘散,1周而愈。

Patient Zhu, female, 70 years of old. She suffered from shringles for two months. She was given various anti-virus drugs, and pain killers, without any improvement, or the pain stopped for one to two days, but recurred afterwards. She was so bothered very much. The shringles are on her lower back part, which can only be seen slightly. Her tongue was extraordinarily red in color. The pulse was string and frequent. I used Guoalu, Honghua, Danshen, Yiyiren, Chuan Beimu, Zhe Beimu, Jiegen, Jiangcan, Chishao, Baishao,and Ganco. She was also asked to swallow Qi Li San. After one week, the shringles subsided.  

郭某女,52岁。患带状7天,位置在左眼,痛不可忍,想撞墙,口苦,心烦,舌红,舌边齿痕明显,脉弦滑数。用全栝楼30g,黄芩15g,板蓝根30g,银花15g,僵10g,赤、白芍各15g,延胡索15g,龙胆草6g,红花10g,丹参30g,蒲公英30g。七厘散10支,13次,每次1支吞服。23剂后疼即减轻,但药后腹泻,左眼视力下降到0.5,医院诊为继发病毒性角膜炎。治拟清热解毒,活血祛瘀,予白花蛇舌草、板蓝根、七叶一枝花、黄芩、栀子、野菊花、僵蚕、桂枝、延胡索、赤芍、红花、丹参、白芷、白蒺藜。三诊,停用栝楼后腹泻仍不止,此脾胃气虚故也;眼眶周围夜痛又甚,甚则痛如针扎,眶黑,拟肝脾分治之法,健脾燥湿,疏肝活血,少用苦寒。苍、白术各10g,陈皮6g,炙甘草3克,车前子10g,柴胡6g,赤芍12g,延胡索15g,川芎30g,丹参30g,珍珠母30g,石决明30g,白芷12g,桃仁10g,红花10g,僵蚕10g,白蒺藜10g,蒲公英30g。四诊,痛止,其面始有笑容矣,视力恢复到0.8,易方调理而安。

Patient Guo, female, 52 years of old. She got shringles for 7 days. The shringles were in her left eye, which was very painful and hardly to tolerate. It was so painful that she would want to pouch wall with her head. She felt bitter in mouth, annoyed in heart. Her tongue was extraordinarily red in color with clear teeth index on the edge of the tongue. The pulse felt string, slipperry, and frequent. The herbs I used to her were whole Gualu 30 g, Huangqin 15 g, Banlangen 30 g, Yinhua 15 g, Jiangcan 10 g, Chishao 15 g, Baishao 15 g, Yuanhusuo 15 g, Longdancao 6 g, Honghua 10 g, Danshen 30 g, and Pugongying 30 g. She was also asked to swallow Qi Li San, three times a day, one tube each time. After two to three doses, the pain was reduced, but there was diarrhea after that. The vision on her left eye was reduced to 0.5. Doctors in hospital diagnosed that she got virus cornetitis. The principle of the herbal therapy was considered to clear Fire, to detoxify, to activate blood circulation, and to dissolve blood stagnation. The herbs used were Baihuasheshecao, Banlangen, Qiyeyizhihua, Huangqin, Zhizi, wild Juhua, Jiangcan, Guizhi, Yuanhusuo, Chishao, Honghua, Danshen, Baizhi, Baijili. On the third consulation, the diarrhea continued after stop of Gualu. This means the body was in Spleen-Stomach Qi deficiency. She also had pain around the eye, which was worse at night. The pain could feel as needle punch. Her eye frame looked black. It was decided to treat the Liver and Spleen separately, to nourish the Spleen, to dry the wetness, to dredge Liver and to activate blood circulation. It was to use less bitter-cold herbs. The herbs used then were: Canzhu 10 g, Baizhu 10 g, Chenpi 6 g, Zhi Gancao 3 g, Cheqianzi 10 g, Chaihu 6 g, Chishao 12 g, Yuanhusuo 15 g, Chuanxiong 30 g, Danshen 30 g, Zhengzhumu 30 g, Shijueming 30 g, Baizhi12g, Taoren 10 g, Honghua 10 g, Jiangcan 10 g,Baijili 10 g, and Pugongying 30 g. On the fourth consultation, the pain stopped. Her face started to have a smile, and the vision restored up to 0.8. The herbal formula was modified again for a maintenance.

按:用孙氏栝楼方加味治疗带状疹疼痛有卓效,此例初用亦效,但服后腹泻不止,不得不停用,改用其他清热活血剂痛不止,腹仍泻,察患者有明显齿痕舌,脾胃本虚,于是改用健脾燥湿合活血化瘀法,少用苦寒,果收捷效,不仅痛止,病毒性角膜炎亦在短时间内治愈。此棘手之案说明经验方也不是万能的,还是要辨证论治,对具体情况作具体的分析和处理。

Comments: The Sun’s Jiawei Gualu formula works very well for the treatment of shringles. It also worked for this case in the beginning, but it happened the diarrhea after use of the formula, so that it had to be stopped and changed to other herbs to clear Fire and to activate blood circulation. The pain remained not improved and the diarrhea continued. By check, it was noticed that there was clear tooth index on the edge of the tongue, indicating that it was Spleen-stomach deficiency condition. Therefore the herbal formula was changed to nourish Spleen, to dry the wetness, to activate blood circulation and to dissolve blood stagnation, with little use of bitter-cold herbs. It indeed worked fact. Not only the pain was stopped, but the virus cornitis was also improved within a short time. This obstinate case indicates that an experienced formula is not at working in every case. It still needs a correct diagnosis of the body condition of exact person so as to decide a proper therapy.

 

22.  蜂房治尿床有特效

22. Bee hive works well for bed-wetting

 

蜂房有强阳起痿、开止痛之功,常用来治疗阳痿、痹证、鼻炎、龋齿痛、肿瘤、远年咳嗽。吾师朱良春先生经验,用于顽固难愈的尿床尤具特效。其方法是将蜂房(中药店有售)100g,剪碎,放铁锅中慢慢加热,直至松脆时趁热碾成细末,每日早晚各服4g(可混入白糖开水中冲服)。

Bee hive functions to improve sex ability, to open the block and to stop pain. It is usually used for impotency, Bi syndrome, nasitis, tooth decay, tumor, chronic cough. My teacher, Dr. Liang-chun Zhu, has experience that it works especially well for obstinate bed-wetting. The way to use it is to chop the bee hive 100 g (you can get it from herbshop), put it in iron pot. Heat the pot slowly, until the hive becomes soft and fragile. Grind it into fine powder when it is still warm. Drink the powder 4 g each time, twice a day (you can add some white sugar in the cup to drink with the hive powder together).

成人尿床是很痛苦的事,记得三十多年前,我在甘肃碧口工作时,有一同事,从小患此病,偏偏此君又天生奇懒,尿了床,不洗不晒,以至室内尿气冲天,人皆掩鼻。他自己也是做医生的,用过肾气丸、缩泉丸之类,毫无用处,因此对于治疗失去了信心。

It is very bothering for an adult to have the bed-wetting. I remembered that, about 30 years ago, when I worked in Bikou city, Gansu province, there was co-worker, who had such problem from his childhood. This guy however was also very lazy. After bed-wetting, he did not wash the sheet or put it under sunshine to dry, so that it was terrible odor in the room. Everyone had to hold his nose. He himself was a doctor. He used Shen Qi Wan, Suo Quan Wan and so on. No of them worked. Therefore he lost confidence for the treatment.

我过去治疗此病,也颇下过一番功夫,有效者少,不效者多,或暂时有效,停药又犯。后来在补益脾肾方中加甘草、麻黄、龙骨、效果好一些,但也不理想。后来读我们四川中医耆宿李斯炽先生的一本书,发现李老有一单方:公鸡肠一具,洗净,加调料汤吃,试用以后,有一定疗效,但因为加工麻烦,又要天天吃,除非开饭馆的,否则哪有那么多鸡肠?加之北方人本来就不喜吃肠杂,所以观察到的病例很少。

I previously had also treated this disease with great effort. Some worked, but most not, or it worked only for a short time, after stop of the herbal therapy, the bed-wettintg recurred. Later, I added Gancao, Mahuang, Longgu, into the basic Spleen- and Kidney-nourishing herbal formulae. It worked better, but still not so satisfied. Later, I read a book by Dr. Si-zhi Li, a Chinese medicine doctor in Sichuan province, I found Dr. Li had a formula: use intestine of a rooster. Wash it clear, add some spicy to decoct as soup to drink and to eat. I tried it. It worked somehow to some level, but it is not so convenient to prepare the decoction and it needs to eat every day. Unless the person is associated with a restaurant, who would have such chance and lucky to get so many rooster intestine? In addition, Northman tends dislike to eat the intestine such things, so the case that I could observe is very little.

1998年春,我与朱老在厦门海外中医培训中心讲学、门诊,当谈及此病时,朱老说不妨用用蜂房散。一年前,有一高中女生宗某来诊,患尿床二年多,花了很多钱都没治好,心情之压抑自不待言,且因此而无法住校,学习成绩下降。我即用蜂房散,服药当天即无尿床,观察至今,其间仅有两次尿床,基本治愈,患者及其父母均大喜过望。

In the spring of 1998, Dr. Zhu and I were giving seminars and worked in clinic in a TCM training center in Xiamen city. When I mentioned the treatment of his disease, Dr. Zhu said it might be good to use the Feng Fang San (Here, Feng Fang means bee hives). One year ago, there was a girl, who was student in high school, having the bed-wetting for two more years. She spend lots of monery for the treatment but no any improvement. It can be understood how bad her emotion would be. For this, she could not live in school and her study was poor too. I used the Feng Fang San. On the night she drunk the herb powder, she did not have bed-wetting. I monitored her so far for two years, she had only two times of bed-wetting. Her condition was basically cured. Her parents and her self were extremely happy.

 

 

23.  我治糖尿病

23. My way to treat diabetes

 糖尿病的病理是气阴两虚,病及五脏,以脾肾为重点。

The key reason for the diabetes is the Qi- and Yin-defficiency, which involves and affects all the organs, but mostly the Spleen and Kidney.

气虚责之于脾。脾虚的形成与饮食直接有关, 还和缺少运动与体力劳动、精神紧张压抑有一定关系。脾虚者形盛气弱,痰湿内盛,血行迟缓,常见表现有疲倦乏力、肥胖等。

The reason for Qi deficiency is related to the Spleen. The occurrence of Spleen deficiency is related to the diet, as well as insufficient physical exercise and physical activity, and also to the emotional stress. The person with the Spleen deficiency looks big in body constitution but weak in physical energy level, with phlegm and wetness accumulated and rich inside the body. Their blood circulation is slow. They commonly have chronic fatique and overweight.

阴虚责之于肾。中老年的阴虚, 多为肾阴亏耗 (年幼的糖尿病患者, 则为先天不足), 可由五脏六腑虚损引起。这就是张介宾说的久病不已,穷必及肾,害必归阴。阴虚则阳亢无制, 水火失衡, 五内燔灼。肾阴虚表现为渴而多饮多尿,夜尿多,头晕目眩,腰酸脚软,体重骤减等。

The Yin deficiency is due to something wrong in the Kidney. The Yin deficiency in the middle aged or old aged person is mostly due to Kidney Yin exhaustion (Diabetes occurring in young age is due to genetic weakness/insufficiency), which can be due to exhaustion from any of the organs. This is what Dr. Jie-bin Zhang said “if a disease lasts for a long time without improved, it would affect kidney and would affect the Yin aspect of the body”. In Yin deficient condition, the Yang loses the Yin to combat, to balance, or to suppress it. The Water and Fire loses balance. The Fire would burn and overrunning inside the body.  In the Kidney Yin deficiency, the person has thirsty, frequent drink, frequent urination, frequent night urination, dizziness, sour lower back and weak legs, and fast reduced body weight, and so on.

基于糖尿病缘于气阴两虚及兼挟瘀血、痰浊的认识,我治糖尿病,常用自拟四桑汤为基本方(桑叶、桑椹、桑白皮、桑寄生)加减治疗。方中桑叶甘寒微苦, 古方如桑杏汤、清燥救肺汤都用它来治疗燥热伤肺。现代药理研究认为其所含脱皮固酮能促进葡萄糖转化为糖元,可降血糖。桑椹甘寒, 滋肝肾, 补阴血, 润肠道。《本草经疏》云:甘寒益血而除热,为凉血补阴之药,唐以前即用它治疗消渴。桑白皮性寒凉, 有清泻肺火之功, 《别录》说它能疗热渴, 宋人方书中常用以之治疗消渴。桑寄生苦而甘平,除了可祛风湿、补肝肾、降血压、抗病毒外,还有活血化瘀的作用。

Based on the understanding that diabetes is due to Qi-Yin both in deficiency, with more or less level of blood stagnation and phlegm accumulation, when I treat diabetes, I usually use my own formula “Si Sang Tang”[1] as basic formula (it uses Sangye, Sangshen, Sangbaipi, and Sangjisheng[2]). In the formula, the mulberry leaves are sweet and slight bitter, and cold in herb nature. In old formulae, such as Sang Xing Tang and Qing Zao Jiu Fei Tang, it is used to solve lung damage due to dryness-hotness. Current scientific research showed that it improves glucose transform into glycogen, so as to reduce blood glycose level. Sangshen is sweet and cold. It works to nourish the Liver and Kidney, to supply Yin Blood, and to lubricate intestine-colon tract. It is said in book <<Ben Cao Jing Shu>> that it “is sweet and cold, works to clear Fire, is herb to cold blood and nourish the Yin”. It was used for the treatment of Xiao Ke disease[3] in times before the Tang dynasty. Sangbaipi is cold in nature, works to clear Lung Fire. In book <<Bie Lu>>, it stated that it works for “hot thirsty” condition. People lived in the Song dynasty usually used it for the treatment of thirsty. Sangjisheng is bitter and sweet, neither hot or cold in herbal nature. It works to dispel Wind-wetness (arthritis), to nourish Liver and Kidney, to reduce blood pressure, to combat virus, as well as to improve blood circulation and to dissolve blood stagnation.

经十多年使用,初步验证了此方对降低血糖、改善症状有一定作用。后来, 我又在方中加用了苦瓜, 是谓四桑苦瓜煎。苦瓜不仅可降糖,也能降压、降脂,苦而不燥,凉而不,可用鲜者榨汁,112,12次服用,怕苦者以之入煎剂中。气虚者加黄、黄精、山药、白术、苍术(二术用来健脾助运化);阴虚者加生地、熟地、麦冬、天冬、枸杞子、玄参、女贞子、五味子、仙人杖; 燥热者加石膏、黄连、天花粉、知母、地骨皮、功劳叶; 血瘀者加丹参、鬼箭羽、葛根、赤芍、川芎、当归、益母草或茺蔚子;血脂高者加泽泻、干荷叶、虎杖、草决明、首乌、山楂。

My experience for more than ten years of clinic practice with this formula proved that this formula works to reduce blood sugar and to improve symptoms related to diabetes. Later, I added bitter gourd in the formula. It is so called “Si Sang Ku Gua Jian”[4] The bitter gourd can not only work to reduce blood sugar, but also to reduce blood pressure, blood lipids. It is bitter but not dry, cold but not to cause congeal. It can be used fresh bitter gourd. Press it to get juice (prepare from 12 gourds each time). Drink the juice twice a day. If worrying the bitter taste, it can be added into herbal decoct to drink together. In Qi deficiency, add Huangqi, Huangjing, Shanyao, Baizhu and Canzhu (the later two are used to improve function of Spleen in digestion and absorption). In Yin deficiency, add Shengdi, Shoudi, Maidong, Tiandong, Gouqizi, Xuanshen, Nuzhengzi, Wuweizi, Xianrenzhang; In Dry-hotness condition, add Shigao, Huanglian, Tianhuafeng, Zhimu, Digupi, Gonglaoye. For blood stagnation condition, add Danshen, Guijianyu, Gegen, Chishao, Chuanxiong, Danggui, Yimucao or Chunweizi. For high blood lipids, add Zexie, dried Heye, Huzhang, Caojueming, Heshouwu, and Shanzha. 

2型糖尿病患者若能坚持服药23个月, 可停用西药降糖药, 血糖恢复正常, 症状也相应得到改善。治疗过程中,应适当地控制主食、戒酒, 适当体育运动也很重要。

If patient with type II diabetes can continue to take the herbs for two to three months, the western medicine blood sugar-reducing drugs can be stopped. Their blood glucose level could become normal and the symptoms would also be improved. During the treatment, it should be to restrict amount of main diet, and quit alcohol. A proper amount of physical exercise is also very important.  

曾治李某,,52,2000723日初诊。既往有高血压、哮喘、冠心病病史, 近两个月来体重骤减, 乏力,口干, 常有饥饿感, 大便干, 尿多。查空腹血糖15 mmol/L, 餐后血糖 24 mmol/L,面色黯黑, 舌红, 脉滑数, 拟养阴益气、清热活血方: 生地15, 黄连6, 天花粉15, 知母10, 丹参15, 益母草20, 僵蚕10,山药30, 黄芪30, 党参12, 桑白皮30, 川芎10, 赤芍10, 鬼箭羽15, 石膏30, 五倍子10, 12剂水煎服。另用苦瓜汁, 12杯。2: 药后空腹血糖下降到8.2 mmol/L, 餐后2小时血糖为17.9 mmol/L,舌净红,口渴减轻,上方加麦冬、枸杞子、五味子,12剂水煎服。苦瓜汁12杯。3: 空腹血糖及餐后血糖分别为5.7 mmol/L13 mmol/L, 舌净, 口不渴, 无他苦。

I had a patient, Mr. Li, who was a male, 52 years of old. He had a history of high blood pressure, asthma, and coronary heart disease. For the recent two months, he had had quick reduction in body weight, chronic fatique, dry mouth, frequent hungry feeling, hard stool, frequent urination. The blood glucose level at empty stomach was 15 mmol/L, that after meal was 24 mmol/L. His face was black in tint. His tongue was more red than normal. The pulse was sliperry and frequent. A herbal therapy was considered to nourish Yin and Qi, to clear Fire and improve blood circulation: Shengdi 15 g, Huanglian 6 g, Tianhuafeng 15 g, Zhimu 10 g, Danshen 15 g, Yimucao 20 g, Jiangcan 10 g, Shanyao 30 g, Huangqi 30 g, Dangshen 12 g, Sangbeipi 30 g, Chuanxiong 10 g, Chishao 10 g, Guijianyu 15 g, Shigao 30g, Wupeizi 10 g. He was asked to try 12 doses (12 days). In addition, he was asked to drink the bitter gourd juice, two cups every day. On the second consultation, his blood glucose level at empty stomach was reduced to 8.2 mmol/L, and that 2 hours after meal was 17.9 mmol/L. His tongue was clean, and thirsty feeling was reduced. To the above formula, added were Maidong, Gouqizi, and Wuweizi. Again 15 doses were asked to continue. (The bitter gourd juice was drunk the same way as before). On the third visit, the blood glucose before meal was 5.7 mmol/L, that after meal was 13 mmol/L. The tongue was normal in look, no thirsty and no any other symptoms.

原方加葛根30,玄参12,12剂水煎服,苦瓜汁照服。4:疲乏,舌红,眼眶周围黯黑,空腹血糖及餐后血糖分别为5.7 mmol/L13.9 mmol/L,口已不干,腹部受凉后腹泻,此时重点改为治气虚:黄芪50,枸杞子15,黄精15,丹参15,鬼箭羽30,葛根30,益母草25,苍白术10,熟地12,石斛30,锻牡蛎30,党参20,五倍子10,山药30,赤芍10,桑白皮30,12剂水煎服,苦瓜汁照服。5:精神、体力见好,大便次数减为112,脉转缓柔,舌红,眼眶黑渐退,空腹血糖4.3 mmol/L,餐后血糖7.7 mmol/L。上方加桑椹20, 桑寄生15, 鸡血藤20, 继续服药80, 血糖已恢复至正常水平。停汤药及苦瓜 (因时已冬季,苦瓜较贵), 服六味加黄丸, 早晚各服9g。随访至本文成文之时, 血糖稳定, 精神、体力好, 体重亦稳定。

To the original formula, added Gegen 30g, Xuanshen 12 g. Twelve doses were asked to continue, so was the bitter gourd juice drink. On the forty visit, he was fatique, the tongue was red beyond normal, and his eye frame was dark. The blood glucose level before and after meal was 5. 7 and 13.9 mmol/L, respectively. There was no thirsty feeling. Since he had diarrhea whenever his stomach was exposed to cold, the formula was changed with aim to nourish the Qi: Huangqi, 50 g, Gouqizi 15 g, Huangjing 15 g, Danshen 15 g, Guijianyu 30 g, Gegen 30 g, Yimucao 25 g, Canzhu 10 g, Baizhu 10 g, Shoudi 12 g, Shihu 30 g, Duan Muli 30 g, Dangshen 20 g, Wubeizi 10 g, Shanyao 30 g, Chishao 10 g, Sangbaipi 30 g, for 12 doses again. The bitter gourd juice drink was the same way. On the fifth visit: the emotion and physical ability were better. The bowel movement was 1 to 2 times a day. The pulse felt softer and calm. The tongue was still red than normal. The black color around eyes reduced somehow. The blood sugar levels before and after meal were 4.3 and 7.7 mmol/L, respectively. To the formula above, added Sangshen 20 g, Sangjisheng 15 g, Jixueteng 20 g. This formula was asked to continue for 80 doses (80 days). The blood sugar level turned to normal. The herbal therapy and the bitter gourd drink were stopped (because it was in winter, the gourd was expensive). He was given Liu Wei Dihuang Wan (pill form) to continue, 9 g each time, twice a day, for a maintenance. Up to today when this article was ready for publication, the blood sugar level remained normal. The emotional and physical conditions were good. The body weight was also constant.    

又治闫某,,60,2002212日初诊。病人患糖尿病多年,口渴, 面色灰滞, 舌质红, 舌体胖大,大便干, 夜尿多。查空腹血糖 10 mmol/L,甘油三脂 3.7 mmol/L, 胆固醇 6.9 mmol/L,自述血压高(不详)。自发现糖尿病后, 体重减轻十余斤, 但形体仍较胖。辨证属气阴两虚, 挟热及痰浊瘀滞, 治宜从本,兼顾其标,药用:黄芪30,山药15,生地30,玄参15,丹参30,桑白皮30,益母草30,葛根30,黄连6,苍白术各12,泽泻30,干荷叶30,苦瓜一根。414日复诊:上方已坚持服至55, 未用降糖、降脂、降压西药。空腹血糖5.9 mmol/L,餐后血糖6.4 mmol/L,血压160/90mmHg,血脂未查。诊脉匀滑, 已无明显临床症状,面有光泽。易方用六味地黄丸加荷叶、桑椹、桑白皮、桑叶、桑寄生、黄精、枸杞子、丹参巩固疗效。5263:最近查空腹血糖5.3 mmol/L,血脂正常,口不渴,不乏力,面有光泽,夜尿仅每夜一次, 因工作劳累而腰酸。予四桑汤加续断、杜仲、黄芪、枸杞子、葛根、生熟地、菟丝子、山药、山萸肉、泽泻、丹参,治疗至今仍坚持每日生吃苦瓜12,血糖稳定。

Another patient, Mr. Yan, male, 60 years of old. The first visit was Feb. 12, 2002. He suffered from diabetes for many years. He felt thirsty. His face was grey. His tongue was more red than normal. The tongue was bigger. The stool was dry and hard to pass. He had frequent urination at night. His blood sugar level was 10 mmol/L, triglyceride was 3.7 mmol/L, and cholesterol was 6.9 mmol/L. He claimed his blood pressure not high (no sure). After he was diagnosed as diabetes, his body weight reduced for 10 pounds. The body shape looked overweight. His condition was considered to be Yi-and Yin both in deficiency, with accompanying hotness, phlegm, and blood stagnation. The herbal therapy was aimed to solve the root reason for the disease, as well as to solve the accompanying hotness, phlegm and blood stagnation. The herbs used were: Huangqi 30 g, Shanyao 15 g, Shengdi 30 g, Xuanshen 15 g, Danshen 30 g, Sangbeipi 30 g, Yimucao 30 g, Gegen 30 g, Huanglian 6 g, Canzhu 12 g, Baizhu 12 g, Zexie 30 g, dried Heye 30 g, as well as one bitter gourd. On April 14, he had used the above formula for 55 days, without use of any medicine for blood sugar, cholesterol, or blood pressure. His blood sugar level before and after meal was 5.9 and 6.4 mmol/L, respectively. Blood pressure was 160/90 mmHg. The triglyceride was not checked. His pulse was smooth and calm. No apparent symptoms. His face turned to have bright tint. The formula was changed to Liu Wei Dihuang Tang plus Heye, Sangshen, Sangbeipi, Sangye, Sangjisheng, Huangjing, Gouqizi, and Danshen for a maintenance. On the third visit on May 26, his blood sugar level before meal was 5.3 mmol/L. The cholesterol level was normal. He had no thirsty, no fatique. His face was with bright tint. He had only one time urination at night. For hard wark, he had sour on his lower back. He was given the Si Sang Tang, with addition of Xuduan, Duzhong, Huangqi, Gouqizi,Gegen, Shengdi, Shoudi, Tusizi, Shangyao, Shanyurou, Zexie, and Danshen. The herbal therapy was continued up to now, with eating one to two bitter gourd every day. Now, the blood sugar level was normal.

 

 

 

24.  关于糖尿病的若干问题答读者问

24. Some questions and answer about the treatment of diabetes

 

拙作《我治糖尿病》发表以后,许多读者来信来电询问有关中医对糖尿病的认识和治疗问题,这些读者中,有医生,也有患者或其家属,兹一并作答:

After I published my article <<My way to treat diabetes>>, there are many letters from readers asking about the diagnosis and treatment of diabetes by Traditional Chinese medicine. Among the readers, some are doctors, some others are patients or their relatives. Here are my answers to all of them: 

一.糖尿病古称消渴,但杂病中的消渴是一个以症状命名的疾病,除了糖尿病,还包括以消渴为主要症状的其他疾病(如尿崩证),但毫无疑问主要是指糖尿病。

1. The diabetes is called “heavy thirsty condition” in old times. It refers to various disease conditions, in which patients feel very thirsty, such as in diabetes insipidus. However, there is no doubt that it mostly means the diabetes.

二.糖尿病是一个古老的疾病,早在公元前2世纪左右成书的《黄帝内经》一书中就明确指出:此人必数食甘美而多肥也,肥者令人内热,甘者令人中满,故其气上溢,转为消渴(《素问.奇病论》),这一认识极其精辟。引起糖尿病的原因很多,但主要还是饮食因素。最早发现糖尿病人的尿是甜的,见于唐初立言《古今录验方》,至今也有1400多年了。

2. Diabetes is a old disease. It has been clearly indicated as early in 2 century BC in book <<Huang Di Nei Jing>> “the person must eat lots of sweet and oily food. Fat makes people having inner Hotness, and sweet makes people feel fullness/bloating, so as Qi reversely spilling up and form the heavy thirsty (e.g. the Xiao Ke condition in Chinese) condition. This is a very smart and wisdom recognition to the heavy thirst condition. Though there are many causes for diabetes, imbalanced diet is anyway the main cause. In the very early time, it was found that the urine of the diabetes patients was sweet, as seen in book <<Gu Jin Lu Yan Fang>> by Dr. Li-yan Zhen (early Tang dynasty). It is 1400 years so far.   

中医对糖尿病不仅有精辟的理论认识,更有极其丰富的经验。汉代张仲景《金匮要略》有专篇论述消渴,其所拟之人参白虎汤、肾气丸这两张处方至今还用于治疗糖尿病。

Not only that Chinese medicine understood the diabetes, it has also rich experience in the treatment. In the book <<Jin Kui Yao Luo>> by Dr. Zhongjing Zhang (Han dynasty), there is a single chapter talking about the heavy thirsty condition. The herbal formulae described in the book, such as the Renshen Baihu Tang and Shen Qi Wan, are still used nowadays in clinic for the treatment of diabetes.

三.糖尿病初、中期多为气阴两虚,其病在脾;中、后期则肾、心、肝、肺四脏皆受其累。

3. In the early and middle stage of diabetes, the body condition of patient is usually the Qi- and Yin-deficiency, with the disorder localizing on the Spleen. In the middle and later stage, the Kidney, Heart, Liver and Lung are all involved and affected.

中医的脾,其主要功能是主运化,也就是把饮食物的精微,通过肺的气化作用而敷布全身,这一功能,又叫转输散精。脾虚则运化失职,于是上奉者少,流失者多,糖尿病之糖尿,就是精微的流失。

The function of the Spleen in Chinese medicine is mostly to “transport fine nutrition material in the body, under the help by the Lung Qi, which works to conduct the fine nutrition materials moving”. This function is called, in Chinese medicine, to disperse or to irrigate. When the Spleen is in disorder in its function, the absorption of the fine nutrition material would not be transported into the body, but be lose from urine. The sugar in the urine in the diabetes patients is the loss of the fine nutritional material.

至于脾虚的原因,主要有四:一���饮食,二是劳倦,三是缺少运动(金代刘河间称之为逸病),四是肝气郁滞,影响及脾(古称木乘土)。饮食因素实居其首位。

There are four major causes for the Spleen deficiency, first is the improper diet; the second, the fatique; the third, the short of physical exercise (Dr. He-jian Liu in Jin dynasty called it as a “relaxing disease”); and the fourth is the Liver Qi sluggish, which affects the Spleen (e.g. the Wood insults the Soil). The diet factor is on the key position.

脾与胃相表里。胃主纳,饮食太多、太好,或暴饮暴食,远远超过脾胃负担,初尚不觉,久之则必然伤胃损脾,既伤脾胃之气,也伤脾胃之阴。气虚则功能衰减,纳化皆失其常,阴虚则热自内生,津液为之消烁。于是三多(多饮多食多尿)、一少(体重减轻)、一乏(乏力)的典型症状就渐渐出现了,其合并症如肥胖、高血脂、高血压也纷至沓来,甚至出现得更早,且往往和糖尿病互为因果。应当指出:西医所说的包括在中医的功能中。因此,中医治,也包含了治在内。如前所述,中医学的,主要是一个主运化的功能单位,而非西医的解剖学单位。

The Spleen and the Stomach is the outside and inside relationship, or a brother-sister relationship. The Stomach works to hold the food. If the person eats too much, and too fine food, it is beyond the ability of stomach for digestion. In the beginning, the person may not notice anything wrong or anything bothers him, after a long time, the function of the stomach and Spleen would be anyway hurt. It would hurt the Qi and the Yin of the Spleen and Stomach. When the Qi is in deficient condition, the function of the digestion and the absorption is affected. When the Yin is in deficiency, the inner Hotness would be developed, and the Jing Liquid of the body would be exhausted. Therefore, the typical symptoms of diabetes, such as “three heavy” (Heavy drink, heavy eat, and heavy urination), “one less” (reduction in body weight), and “one fatique” (chronic fatique), would gradually show up.  Its complications, such as over weight, high blood lipids, and high blood pressure, would also come later, even earlier. The complications usually can also be the cause for diabetes. It should be pointed out that, the function of “Spleen” in Chinese medicine includes that of pancreas in anatomy. Therefore, to solve disease in the Spleen in Chinese include the treatment of the disease in the pancreas too. As discussed before, the “Spleen” in Chinese medicine is a functional group, not an anatomic part in the Western medicine.

四.今日临床所见的糖尿病,并不一定都因有了三多一少的表现才被发现,很多患者是在体检时偶然发现血糖高、尿糖阳性才被戴上糖尿病帽子的。也有潜在糖尿病而不自知,先是发现冠心病心绞痛、心律失常、脑血栓、高血压、高血脂、白内障等糖尿病并发症,然后才得知早已患有糖尿病。

4. The diabetes cases that are found in clinic are not all way diagnosed after the patients have the typical diabetes symptoms or clinic phenomenon. Many of them are found to have diabetes during a regular or a annual body check, after they are found to have higher blood sugar and positive indication for sugar in urine. Some of them had hidden diabetes, but they do not known it until they are found to have coronary heart disease, angina, arhthmia, cerebral thrombosis, high blood pressure, high blood lipids, and cataract, such complications of diabetes.

既然先进的检测技术,可以在上述可怕的并发症出现之前发现糖尿病,那么,此时得到及时、有效治疗,就可以预防或推迟并发症的发生,使坏事好事

Since there are such advanced detect tools that could detect out the diabetes before the occurence of such terrible complications, the early, proper and effective treatment should be able to prevent or retard the occurrence of the complications, making the “bad thing” into a “good thing”.

五.我治疗糖尿病的思路是基于糖尿病多见脾胃气阴两虚的认识。但有偏于气虚的,有偏于阴虚的,亦多气阴两虚的。此外,糖尿病亦多夹瘀、夹痰、夹湿或湿热、夹气滞,但气虚、阴虚是本,这些都是标。原则上是以治本为主,标证突出者,有时也需要先处理标证。病情复杂者尤须具体情况作具体地分析和处理,不能拘于任何一法、一方、一药。

5. My way to treat diabetes bases on the recognition and understanding that the patients with diabetes usually have Spleen-stomach Qi- and Yin-deficiency. However, some patients are more with the Qi deficiency and some with more Yin deficiency. Some others are more with both deficiency. Also, such patients are usually with more or less presence of blood stagnation, phlegm, wetness, wetness-hotness, or Qi sluggish. The Qi deficiency and Yin deficiency are the basic and fundamental cause for the disease, and the blood stagnation… are all the accompanying pathological causes. In principle, the treatment should target on the basic cause, but if the accompanying factors are overwhelming, they should be treated in priority some times. For those with complex conditions, the treatment should be decided according to each individual and at each specific time of the disease. It should be avoided to use a single formula for all the patients.

兹大略而言之:偏于气虚的,表现为乏力,腿软,稍活动即觉累,口不甚渴甚至根本不渴,饮水多则腹胀,食不多,多食即胀,大便溏或便次增多,但饿了又极难受,甚至会心慌,出汗,消瘦(体重锐减)或肥胖,腹大,肌肉绵软,舌体胖大,齿痕,苔白腻,脉弱。偏于阴虚的,表现为口渴,虽饮很多水也不解渴,心烦易怒,消谷善饥,消瘦,尿多,大便干结,甚至数日一行,舌红苔少,脉细数或滑数。气阴两虚的,则兼气虚和阴虚两种证候。

Generally speaking, if the condition is with more Qi deficiency, the patient feels chronic fatique, weak in legs, easy to feel tired after a little physical activity, no very thirsty or even no thirsty at all, stomach bloating after little water drink, eat little, stomach bloating after little more eating, lose bowel movement or more times of bowel movement, easy to feel hungry, easy to feel palpitation, sweat, loss of body weight (sharp reduction in body weight), or overweight, big belly in size, soft muscle, bigger tongue in size, tooth index, white and greasy tongue covering, and weak in pulse. If with more Yin deficiency, the patient feels thirsty, which is hardly to be solved after drink a lot of water, annoying feeling and easy to get upset, easy to feel hungry, slim body in size, frequent urine, dried stool, which could be once every several days, more red than normal tongue color, lillte tongue covering, thin and frequent pulse, or slippery and frequent pulse. If with both Qi and Yin deficiency, the clinic conditions show the symptoms of both deficiencies.  

气虚为主者,我常用补脾益气为主,常用药如生黄芪、党参、红人参、黄精、山药、苍白术;脾气下陷,便溏,便次多者,加干荷叶、葛根以升清阳。此外,适当佐以养阴药,如玄参、旱莲草、女贞子。

If the Qi deficiency is the main condition, I usually use herbs to nourish the Spleen and to support the Qi as the main therapy. The commonly used herbs are Dangshen, Hong Renshen, Huangjing, Shanyao, Cangzhu, Baizhu. In the condition of Spleen Qi sink, the person has lose stool, frequent bowel movement, add herb dried Heye and Gegen to rise the Yang Qi. In addition, it is needed to add some other herbs to nourish the Yin, such as Xuanshen, Hanliancao, and Nuzhenzi.

阴虚为主者,以养脾胃之阴为主,常用药如麦冬、玄参、生地、五味子、枸杞子、玉竹、天花粉、西洋参、石斛、白芍、桑白皮、地骨皮等;阴虚燥热而渴饮无度者,加石膏、知母;心烦,消谷善饥,加黄连、十大功劳叶。由于脾失健运,既不能输布饮食精微,又不能将水湿排出,故亦常见脾虚湿盛或脾虚湿热之证。前者饮水不化,饮后、食后胀满不适,食不多,大便稀溏,苔腻舌淡,脉濡。后者渴不思饮,心中嘈杂,似饥非饥,似饱非饱,痞满,恶心便溏,大便黏滞不爽,舌红苔黄腻,脉濡数。前者宜温化健脾,常用苍白术、厚朴、陈皮、薏苡仁、扁豆、木瓜、藿香、谷芽、山楂、建曲、车前草、茯苓、泽泻。后者宜清化湿热,常用薏苡仁、藿香、佩兰、黄芩、茯苓、泽泻、车前草、建曲、豆卷、鸡内金、杏仁(通利三焦)、枇杷叶(醒胃)。可以认为这是糖尿病的变证变法,但就辨证论治的角度说,变法也是常法。脾虚湿盛,补阴药如地黄、麦冬,嫌其腻;益气药如党参、黄芪,嫌其壅,都不可概投。

If the Yin deficiency is the main condition, the herbal therapy aims to nourish the Spleen Yin and Stomach Yin. The commonly used herbs are Maidong, Xushan, Shengdi, Wuweizi, Gouqizi, Yuzhu, Tianhuanfeng, Xiyangsheng (North America gensing), Shihu, Baishao, Sangbaipi, Digupi, etc. If the Yin deficiency is with dryness-hotness, the person feels very thirsty and drinks a lot of water, add Shigao, Zhimu. If the person is very easy to feel hungry, add Huanglian, Shidagonglaoye. If the Spleen is in disorder to absorb and transport fine nutritions material, and to dispel extra water out of the body, the person would be in a condition with overwhelming wetness or wetness-hotness. In the former condition, the person feels bloating in stomach area after drink or eat. He/she eat little, has loss stool. The tongue is pale, and the tongue covering is greasy. The pulse was soft. In the later condition, the person feels thirsty but no desire to drink. There is discomfort feeling in stomach, which is hard to describe. It feels as hungry, but no typical hungry; feels as full, but not as full after eat. The stomach feels fullness, nausea, loss stool, sticky stool that is hard to clear completely. The tongue is more red than normal. The tongue cover is yellow and greasy. The pulse is soft and frequent. For the former condition, it should be aimed to warm and to nourish the Spleen, commonly using Canzhu, Baizhu, Houpu, Chenpi, Yiyiren, Baibiandou, Mugua, Huoxiang, Guya, Shanzha, Jianqu, Cheqiancao, Fuling, and Zexie. For the later condition, it should be aimed to clear the Wetness-hotness, commonly using Yiyiren, Huoxiang, Pailan, Huangqin, Fuling, Zexie, Chexiancao, Jianqu, Doujuan, Jineijin, Xingren (to conduct all the three Jiao cavities), and Pibaye (to stimulate appetite). These modifications can be regarded as the alternative ways for the treatment of diabetes. From the diagnosis-oriented treatment point of view, the modified therapy is also a common way in the Chinese herbal therapy. In the Spleen deficiency condition, the herbs to nourish the Yin should not be used, such s Dihuang, Maidong for their sluggish effect; neither Qi nourishing herbs, such s Dangshen, Huangqi, for their stagnation effect[5].

如彭某,男,52岁,体检发现空腹血糖 12.2mmol/L,餐后 22mmol/L三多一少症状不明显,惟觉腿软乏力而已。平素喜饮茶水,但最近饮后觉胀,食不多,多郁怒,两胁胀,大便不成形,每日3次,舌淡苔白腻,脉濡,左关弦。拟疏肝健脾,用柴胡、郁金、姜黄、蒺藜、生麦芽、山楂、建曲、苍术、蒲公英、鸡内金、薏苡仁、茯苓等,抄方医生痛诋此非糖尿病方,而服药期间空腹血糖渐降至8.3mmol/L再降到 5.3mmol/L,餐后血糖亦下降至正常,不过一个月时间,精神体力均大有进步,现仍在观察治疗中。

Case example: Patient Peng, male, 52 years of old. On annual physical exam, it was found that his blood sugar before meal was 12.2 mmol/L, that after meal was 22 mmol/L. The “three more and one less” symptoms of diabetes are not apparent. He only felt weak in the legs. He usually likes to drink green tea, but latterly he felt bloating in stomach after drink. He ate little. He was easy to get upset, with bloating feeling on the upper side of the belly. The stool was not in formed shape, which was three times a day. The tongue was pale and the tongue cover was white and greasy. The pulse felt string on the Guan position of the left wrist. The herbal therapy was designed to dredge the Liver, and to nourish the Spleen. The herbs used was Chaihu, Yujin, Jianghuang, Baijili, not processed malt, Shangzha, Jiangqu, Canzhu, Pugongyin, Jineijin, Yiyiren, and Fuling, etc. The doctor who was working to copy this formula criticized that this formula is not for the treatment of diabetes. However, after use of the herbs, the blood sugar level before meal was reduced down to 8.3 mmol/L, then to 5.3 mmol/L, that after meal also down to normal level. With less than one month, his physical ability was much improved. He is now still under observation.

六.我的验方四桑汤,用桑叶、桑椹、桑白皮、桑寄生,对糖尿病无明显症状,仅化验血糖高者,配合苦瓜(每天1根榨汁服),有降糖之效。后来因为真桑寄生少,市售者多是杂树寄生,乃改用或加入桑枝。对有阴虚、气虚症状者,还当结合辨证用药,四桑一瓜酌情配合使用。惟苦瓜苦凉,用于阴虚燥热者较佳,而气虚便溏者用苦瓜会腹泻,所以对气虚者后来我不用苦瓜,改用每日或隔日用猪胰子一具煨汤,或猪胰子研粉吞服。

6. My “Si Sang Tang”, using Sangye, Sangshen, Sangbaipi, and Sangjisheng, with accompanying drink of bitter gourd juice (one gourd every day, press it into juice to drink) works to reduce blood sugar level for those who has no clear symptoms of diabetes. Later, because the true Sangjisheng is rare, those sold in market are not picked up and collected from the exact desired trees, it is changed to use Sangzhi, in stead. For those who have symptoms of Yi deficiency and/or Qi deficiency, it is needed to use herbs following TCM diagnosis, with the “Si Sang Yi Gua Tang’ used the same time. Because the bitter gourd is bitter and cold in herbal nature, it is better to be used in the Yin deficiency with dryness-hotness. If it is used in Qi deficiency, the patient may have diarrhea. Therefore, it is not used in patient with Qi deficiency. In such patient with Qi deficiency, the bitter gourd is changed to pig pancreas, every day or once every other day, in decoction form, or in dried powder form.  

七.糖尿病初、中期,特别是2型糖尿病人,重点治脾,已如上述。晚期则因久虚不复,伤及真阴真阳,重点就要放在治肾上,所谓久病不已,穷必及肾也。1型糖尿病亦重点治肾,兼调四脏。肾阴虚多见消瘦,面色黧黑,耳轮枯焦,渴饮尿多,盗汗潮热,心烦腰酸,大便干结,舌红无苔,脉细数,治宜壮水之主,以制阳光,麦味地黄汤加减,常用药如生地、地骨皮、枸杞子、菟丝子、玄参、麦冬、石斛、桑椹、桑叶、山萸肉、山药、首乌、白芍。肾阳虚多见畏寒足冷,腰酸足软,乏力短气,阳痿,大便溏或五更泻,舌淡,脉细弱,宜阴阳兼调,金匮肾气丸加减,常用药如鹿茸(1g,研细冲吞,每日2次)、熟地、山药、山萸肉、菟丝子、杜仲、补骨脂、淫羊藿、附子、肉桂(桂附用小量)、葫芦巴。阴虚阳虚夹瘀者都可酌加活血化瘀药,阳虚气弱加人参、黄芪,阴虚燥热口渴者加知母、石膏、天花粉,方如玉女煎等。

7. During the early and middle stage, especially for the type II diabetes, it is focused to treat Spleen,as discussed above. In the later stage, for long term of weak body condition, which damages the true Yin and true Yang, it should focus to treat the Kidney. This is because after a long time of disease course, the disease would affect and impact the Kidney. For the type I diabetes, the focus is also on the Kidney, with also attention to take care of other four major organs. In Kidney Yin deficiency, it is common that the person is slim with dark face, charred color on the ears, has thirsty, frequent urination, night sweat, hot flash, annoying feeling, sour in lower back, dried stool (constipation). The tongue is more red than normal without tongue cover. The pulse is thin and frequent. The herbal therapy should be used to nourish the Water in principle so as to depress the overwhelming Yang. The herbal formula is Mai Wai Dihuang Tang with some modifications. The commonly used herbs are Shengdi, Digupi, Gouqizi, Tusizi, Xuanshen, Maidong, Shihu, Sangshen, Sangye, Shanyurou, Shanyao, Heshouwu, and Baishao. For Kidney Yang deficiency, the patient feels usually dislikes or fears cold, has cold feet, sour in lower back, weak in legs, chronic fatique, short of breath, impotency, loss stool or diarrhea in early morning. The tongue is pale, and the pulse is thin and weak. For the treatment, both the Yin and the Yang should be nourished. The herbal formula is Jin Kui Shen Qi Wan with some modifications. The commonly used herbs are Lurong  (velvet antler) (1 g, grind into powder to swallow directly without decoction, twice a day), Shoudi, Shangyao, Shanyurou, Tusizi, Duzhong, Buguzhi, Yinyanghuo, Fuzi, Rougui (the Guizhi and Fuzi are used in small amount), and Huluba. If the Yin-Yang deficiency is with blood stagnation, it can be added in some proper amount the herbs that work to improve blood circulation. In Yang deficiency with short of breath, add Renshen and Huangqi. In Yin deficiency with dryness, hot, and thirsty, add Zhimu, Shigao and Tianhuanfeng, such as in formula Yu Nu Jian, etc.   

糖尿病的发病与瘀血有相当关系。在古代文献中,甚少这方面的记载,但金代李东垣《兰室秘藏消渴》活血益气汤、生津甘露饮子已有桃仁、红花、当归与生地、知母、石膏、黄柏等配伍的用药;清末唐容川《血证论》也提到过因瘀而致渴。今人祝谌予先生从临床实践到实验研究两方面均明确提出活血化瘀方药在糖尿病治疗上的意义。我也观察到患者有手足麻木、眼眶黯黑、舌下静脉怒胀、脉涩或结代等瘀血症状,所以,我学祝先生的经验,常配合活血药如桃仁、红花、丹参、益母草、鬼箭羽、葛根、赤芍、川芎、蒲黄等。特别是在气虚阴虚症状缓解或消失之后,血糖不降者,我都常从此入手,以促进血糖下降,并改善瘀血阻络的症状。但是,活血化瘀的方法我并不单用,而是视其病情配合益气或养阴药用,治病求本也。盖瘀血是继发于气虚或阴虚的,气虚者血必瘀,阴虚者血必滞。

The occurrence of diabetes is with some relationship with blood stagnation. In the medical literatures in old times, there are little records for this. In the Jin dynasty, Dr. Dong-yuan Li, in his book <<Lan Shi Mi Can – Xiao Ke>>, introduced herbal formulae Huo Xue Yi Qi Tang, and Sheng Jin Gan Lu Yin, in both of which there are herb Taoren, Honghua, Danggui, together with Shengdi, Zhimu, Shigao, and Huangbo. It has also been mentioned by Dr. Rong-chuan Tang in his book <<Xue Zheng Lun>> that the blood stagnation could cause thirsty. Dr. Chen-yu Zhu emphasized the importance of blood circulation-improving therapy in the treatment of diabetes, from both the clinic practice and lab research point of view. I also noticed that patient with diabetes has numn feeling in the hands and feet, dark color around the eyes, thick veins under tongue, harsh or not consistent feeling on pulse, such signs for blood stagnation. Therefore, I learnt from Dr. Zhu, add circulation-improving herbs into the basic formula for diabetes, such as herb Taoren, Huanghua, Danshen, Yimucao, Guijianyu, Gegen, Chishao, Chuanxiong, and Puhuang, etc. Especially after the disappear of the symptoms for Qi-Yin deficiency, the blood sugar level does not fall to normal, I do this way, to enhance the reduction of blood sugar level, and to improve the symptoms due to the blood stagnation. However, the circulation-improving therapy is not used alone. It is used in combination with the Qi-nourishing or the Yin-nourishing therapies, since a disease should be treated to its root/cause. The blood stagnation is anyway due to the Qi deficiency or the Yin deficiency. For Qi deficiency would cause blood circulation slow and the Yin deficiency could sluggish the blood circulation.   

八.并发高血脂、肥胖、脂肪肝者,多从痰浊考虑,燥湿健脾是有效方法。常用药如干荷叶、苍术、白术、枳壳、泽泻、山楂、首乌、决明子、丹参、川芎、虎杖等。有时用明矾,每日1次,吞服米粒大一枚(约1.5g),连用1个月。如白某,34岁,糖尿病家族史。血糖偏高,甘油三脂、胆固醇亦高,脂肪肝,体重 95kg 多,察其舌淡有齿痕,脉滑大,乏力,有时心烦易怒。即用上方加黄芪、太子参益气,柴胡、姜黄、郁金疏肝,2个月后,血糖已恢复正常水平,体重平稳下降约10kg,现仍在治疗中。

8. For those with hyperlipidemia, obesity, and fatty liver, treat the condition by targeting the phlegm. It works with wetness-drying and Spleen-nourishing therapy. The commonly used herbs are dried Heye (lotus leaves), Cangzhu, Baizhu, Zhiqiao, Zexie, Shanzha, Heshouwu, Juemingzi, Danshen, Chuanxiong, Huzhang, etc. Some time,  Mingfan (Alums) is used 1.5 g each time, once a day by swallow directly (without decocting), for one month. For example, patient Bai, 34 years of old, with family history of diabetes, is with slightly higher blood sugar level. The blood triglucerides and cholesterol were also high, with fatty liver. The body weight was 95 kg more. There was tooth index on the edge of the tongue. The pulse was slippery and bigger. The patient felt fatique with some times easy to have annoying feeling and upset. After use of the above formula with addition of Huangqi and Taizishen to nourish the Qi, Chaihu, Jianghuang and Yujin to dredge the Liver, the blood sugar level was reduce to normal after two months, and body weight also down by 10 kg. Now the patient is still under treatment.  

九.并发高血压者,多为阴虚肝旺,常结合使用滋清潜降法,药如夏枯草、磁石、代赭石、决明子、野菊花、黄芩、桑寄生、石决明、珍珠母、益母草、川牛膝。另用益母草60g,桑寄生、桑叶各30g,煎汤早晚浸足20分钟。但高血压也有气虚、阳虚的,不在此例。

9. Diabetes accompanying high blood pressure is usually due to Yin deficiency with Liver Yang overwhelming. It is commonly combined with the Fire-clearing and –descending therapy. The commonly used herbs are such as Xiakucao, Cishi, Daizheshi, Juemingzi, wild Juhua, Huangqin, Sangjisheng, Shijueming, Zhengzhumu, Yimucao, and Chuanniuxi. Additionally, decoct herb Yimucao 60g, Sangjisheng 30 g, Sangye 30 g, to rinse feet, 20 min each time, twice a day (morning and evening). If the diabetes is with Qi deficiency or Yang deficiency, the treatment is different.

十.中药治疗糖尿病,其优点不仅是降低血糖,而是辨证论治,整体调节,对减轻或消除症状,提高生活质量,预防和推迟糖尿病并发症的发生都有积极意义,西药降糖药则起不到这些好的作用,副作用也多,而且有些患者用后血糖也不见下降。

10. For the treatment of diabetes with herbal therapy, its advantage is not only to reduce blood sugar level, but also to correct whole body condition, based on TCM diagnosis. It is very important to reduce or to delete body symptoms, to improve life quality, to prevent or to retard diabetic complications. The medicine used by Western medicine has no such good effect, and its side effects are also a lot. In addition, for some patients, the blood sugar level does not fall down with the treatment by western sugar-reducing drugs.

北京医科大学林志彬教授在《北京晚报》上多次指出:长期服用降糖药产生的毒副作用是造成糖尿病合并症的重要原因之一,比如因长期服用降糖药物造成的白细胞减少、肝肾损伤、消化系统功能紊乱等都会直接引发各种合并症;长期的低糖饮食往往不能维持正常生理的需要,造成患者体质弱,免疫力低下,营养缺乏,也是引起各种并发症的重要原因。他还说:用降糖方法控制血糖,掩盖了病情发展的事实。糖是机体的主要能量,高血糖的本质是心、脑、肾等重要器官能量供求不平衡,持续使用降糖药压制血糖,并不能帮助身体解决这些矛盾,反而促使心、脑、肾等重要器官能量供求矛盾加剧,引起全身性、系统性病变,而表面正常的血糖往往使患者产生糖尿病已被控制住的错误概念,忽略内部系统的整体变化,错失防治良机,一旦合并症发作,对其身心打击很大,病情极易恶化。

Professor Zhi-bing Lin, Beijing Medical university, stated many times in <<Beijing Evening>> that: “The toxic and side effects of blood sugar-reducing drugs, after long term use, are one of the important reasons to cause diabetes complications. For example, the reduction in blood white cells, damage to the liver and kidney, disorder in the digestive system, after long time intake of the blood sugar-reducing drugs, can cause various complications directly; long term sugar-low diet usually can not meet the need of body to maintain a normal life, so as to cause weak body constitution, lower function of immune system, poor nutrition condition, as well as various complications.” He also said: “To control the blood sugar level by use of sugar-reducing drugs hides the truth of the development of the diabetes. Sugar is the main energy source of the body. The nature of the diabetes is the disorder in the sugar supply to the important organs in the body, such as heart, brain, and kidney. Continuous use of sugar-reducing drugs to control the blood sugar level could not help body to solve this disorder, but rather, to make worse of the disorder, so as to cause more disease development in the body. The apparent reduction of blood sugar level makes patient have a wrong impression that the “diabetes has been under control”, so to omit the overall true changes in the the inner body, to miss the chance to treat the root of the disease. Once the complications occur, it hurts the patient very much physically and emotionally, to make the overall body condition worse very much.    

解放军301医院潘长玉教授也指出:英国著名的UKPDS研究发现,对糖尿病患者严格控制血糖,确可减少眼睛和肾脏并发症,但威胁生命的心脏病和脑卒中并没有显著减少,因为糖尿病仅是代谢紊乱的一种表现,只有控制血压、血脂,同时控制血糖,才能综合控制糖尿病及心脑血管病的发展。两位西医专家的观点与中医整体调节的观点可谓不谋而和。

The professor Chang-yu Pang in the 301 Hospital of PLA also pointed out: “It was found in the UKPDS England that to strictly control the blood sugar level in diabetes patients in deed can reduce the complications in the eyes and kidney, but that of life-threatening heart disease and stroke does not reduce dramatically”, since “the diabetes is only a phenomenon of body metabolic disorder. Only to control the blood pressure, blood lipids, and the same time the blood sugar, could be comprehensively control the development of the diabetes and its heart and brain complications.”

The opinions of the two Western medicine experts are similar to that of overall whole body treatment of the diabetes by Traditional Chinese medicine.  

我的经验是:如果没用过胰岛素或其它西药降糖药的,用中药后血糖即降得快,有的患者服药后一周血糖即直线下降;用了胰岛素和降糖药的,中药降糖作用就慢,这可能与药物依赖性有关。因此,一般要在服中药一段时间后逐渐减少西药用量再逐渐停用,不要一下子停用。如辽宁一位女士,来电说她母亲患糖尿病,空腹血糖8.9mmol/L,餐后11mmol/L,饥饿,一点力气也没有,睡眠不实,长期服达美康等降糖药,血糖不降,服我介绍的处方(黄芪45g,黄精15g,桑寄生30g,苍白术各10g,山药30g,葛根30g,桑椹10g,桑皮、桑叶各10g,丹参15g,熟地15g,枸杞子10g,山楂10g,苦瓜1根。)服30余剂,精神体力都很好,也不饿了,但血糖只降了一点,太慢,我认为降糖药已服2年,已形成药物依赖性,建议她在服中药的同时逐渐停服降糖西药。

My experience is: “If the patient did not use insulin or other sugar-reducing medicine, the blood sugar level is reduced very fast after use of herbal therapy. For some patients, their blood sugar can be reduced to normal linely after the use of herbs for one week. The speed of the reduction is slower by herbal therapy in those who used the Insulin or other Western medicine sugar-reducing drugs. This might be related to the addiction of body to the western medicine. Therefore, it is asked to gradually reduce and eventually stop the use of the western medicine drugs after use of herbal therapy for some times. Do not stop the Western medicine right away. For example, there was a lady from Liaoning province. She phoned and said that her mother was with diabetes. The blood sugar level before and after meal was 8.9 and 11 mmol/L, respectively. She felt hungry, no energy at all, poor sleep. She had been using blood sugar-reducing medicine, such as Diamicron, for a long time, but the blood sugar did not fall. After take my formula (Huangqi 45 g, Huangjing 15 g, Sangjisheng 30 g, Canzhu 10 g, Baizhu 10 g, Shangyao 30 g, Gegen 30 g, Sangshen 10g, Sangpi 10 g, Sangye 10 g, Danshen 15 g, Shoudi 15 g, Gouqizi 10 g, Shangzha 10 g, Bitter gourd one) for 30 doses, the physical and emotional ability became very good, no hungry feeling, but the blood sugar was reduced to only half, too slow. I thought that the blood sugar-reducing medicine has been used for 2 years, the body has developed drug addiction, so reccomend her to continue the herbal therapy while reducing the Western medicine gradually.

而另一例石家庄_城县的宋某,男,25岁,空腹血糖14.9mmol/L,餐后20.9mmol/L,尿糖++++,未接受西医治疗。来诊时口不渴,也不饿,惟以乏力、脱发为主要表现,治以益气为主。用黄_、党参、山药、苍白术、黄精配以活血养阴药当归、丹参、玄参、桑椹、黑芝麻、桑枝、桑白皮、桑叶、桑寄生等,1周内空腹血糖即下降至12.1mmol/L,两周后降至8.6mmol/L4周后降至5.5mmol/L,且不再乏力,精神也好。

Other case is from Patient Song, Shijiazhuang city, who is a male, 25 years of old. His blood sugar before and after meal was 14.9 and 20.9 mmol/L, respectively. Urine sugar was . He did not have any treatment from Western medicine yet. When he came to me, he had not hungry feeling, but only with fatique and hair loss as the main complain. The herbal therapy I used was with aim to nourish Qi. The herbs were Huangqi, Dangshen, Shanyao, Canzhu, Baizhu and Huangjing, in addition with the Yin-nourishing and circulation-improving herbs, such as Danggui, Danshen, Xuanshen, Sangshen, black sesame, Sangzhi, Sangbaipi, Sangye, Sangjisheng, ect. After one week, the blood sugar before meal was reduced to 12.1 mmol/L. After two weeks, it was 8.6 mmol/L. After four weeks, it was 5.5 mmol/L. He was no longer feeling fatique and the emotion was also in good condition.  

这两例病人都是最近的案例,都还在治疗中,目的在于说明用没用过西药,中药的疗效就不一样。记得祝谌予老师生前曾明确地提到这一问题,谨以事实供临床者参考。

These two cases are current cases. They are still under treatment. The aim to cite them here is to explain that, if the patient does not use Western medicine, the effect of the herbal therapy is very good. I remember that Dr. Zhu also clearly mentioned this observation before he died. This is a reference from clinic fact.

十一.中药治疗糖尿病是有效的,以中医为业者要自重自爱,不要妄自菲薄,轻言放弃。祖先们在2千年前就有那么深刻认识,2千年至今积累的经验非常丰富,亟当努力发掘,加以整理、研究、提高,并在实践中总结新的经验,以造福于人民。有的中医同道认为,中医治不好糖尿病目前中药降糖的效果是无法与西药相比的。他们为中医设计的可用武之地,就是针对治疗引起的副作用以及一些并发症的处理。你治不好,只能说你还需努力,不等于中医治不好。西医专家对于降糖药的使用还在反思,还在探索综合、有效、无害的防治糖尿病的方法,而在我们中医界却出现这样的观点,难道不值得深思吗?

11. It is effective with Chinese herbal therapy for the treatment of diabetes. As a TCM doctor, we should value ourselves, and respect ourselves. Do not give up easily, and do not be aggrogant. Our ancestors had so deep recognization to the diabetes two thousand years ago, and there are so rich clinic experience for the treatment too, we should work hard to summarize, to study, and to further develop the herbal therapy in the treatment of diabetes, so to work better for people. Some TCM doctors think that “Chinese medicine can not treat diabetes”, “Currently, the effect by Chinese medicine can not be as good as that by Western medicine”. The area they designed for Chinese medicine is to “solve the side effect by the sugar-reducing drugs, and the complications of diabetes”. I would like to say to them: if you can not treat diabetes, it means that you need to study and work harder, it does not mean that Chinese medicine can not work. Even the Western medicine experts is still under consideration the use of sugar-reducing medicine, is still trying more comprehensive, effective, and no-side effect remedies, how would we Chinese medicine deny our original principle to solve the problem from a whole body aspect?

十二.糖尿病人的饮食和运动。糖尿病人在用中药治疗期间,主食控制在每天0.5kg以下较为适宜,一般早餐用50g,午餐、晚餐各100g,这样,也就是七分饱的样子,饥饿时可以辅以牛奶、炒黄豆、豆制品、蔬菜(苦瓜、黄瓜、南瓜、西红柿及绿色蔬菜)。大多数糖尿病病人也不必过严限制水果,可以每天吃1个水果,如1个小苹果或1根香蕉或1片西瓜。有的广告吹嘘想吃就吃是不对的,还得有所限制。限制的目的在于减轻既病的脾胃负担,促进其功能的恢复。

12. The diet and the physical activity of diabetes patients. During the treatment with herbal therapy, it would be proper to control the main diet of the patient under 0.5 kg every day. Generally speaking, breakfast takes 50 g, the lunch and the dinner, 100 g, each time. So, it would be about 70% of the usual amount of diet. When feeling hungry, the patient can drink cow’s milk, fried soya bean, bean-made food, and vegetables (bitter gourd, cucumber, pumpkin, tomato, and green vegetables). For most patients, the fruits are not needed to be extremely restricted. They can eat one fruit every day, for example a small apple, or a banana, or one piece of water melon. It is not correct that some advertising said “if you want to eat, just eat whatever you want”. There is some need to control diet. The aim to restrict the diet is to reduce the burdon to the digestive system, so to improve its recovery.  

如前所述,缺少运动,则气血呆钝,脾胃的运化也失健,所以运动对糖尿病人很重要。如无严重的心脑并发症,每天都要坚持运动。最方便的运动是步行,可从每天300500米逐步增加到1.52.5千米,先是慢走,适应后改为快走。当然也可以再选择一些适合自己体力和兴趣的运动,如太极拳、广播操、乒乓球、台球、器械运动等,要量力而行,更要持之以恒。

As mentioned before, short of physical activity causes sluggish in the Qi and Blood circulation, as well as poor function of digestive system. If there are no severe complications in the heart or brain, the patient should have continuous physical exercise every day. The easiest way for physical exercise is to walk. It can be 300 to 500 meters every day, gradually up to 1.5 to 2.5 km. Slow walk first, then faster walk. Of course patient can also chose whatever kind of exercise that he/she is interesting or whatever meets his/her physical ability, such as Taiji Quan, broadcast gymnastics, table tennis, tennis, or something else. The amount of exercise should meet the body energy level and it needs to be in a persistent way too.

 

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在古代有关糖尿病的文献中,尚未见到糖尿病与瘀血关系的明确记载。有之,则始于前年才去世的祝谌予先生。他在临床实践中,观察到糖尿病人多有血瘀表现,如面部色素沉着、舌质紫暗、舌边瘀斑瘀点,舌下青筋(静脉)怒张、肢体麻木、耳廓萎缩晦暗等,结合患者常合并动脉粥样硬化,胰腺微血管闭塞不通、微血管病变导致的微循环障碍、血液黏度高等病理变化,倡用活血化瘀的方法治疗血瘀型糖尿病,活血降糖方(广木香、当归、益母草、赤芍、川芎、丹参、葛根、苍术、玄参、生地、黄芪)即祝先生自拟之方。

我学习祝先生的经验,初步体会到糖尿病之血瘀现象,是在气阴两虚的基础上继发的,盖气虚则无力推送血液循行,阴虚则血少而血液留滞,所以其治以益气养阴为主。气虚为主者用黄芪、黄精、白术,阴虚为主者重用生地、玄参、麦冬,佐以活血化瘀药如葛根、丹参、桑寄生、赤芍、鬼箭羽以及清热药桑白皮、桑叶、地骨皮、苦瓜、花粉等组成复方,既有助于降低血糖,又可以改善临床症状,使患者面部由晦暗而光洁,黑眼圈渐消除。

南京7212厂的甘宪先生,因20年顽固不愈的全身泛发性湿疹来京求治,证属血瘀挟风,我用桃红四物汤加紫草、丹皮、徐长卿、白藓皮、蝉衣之类,服20剂后湿疹仅余头部几点,再服20剂,基本痊愈。意外的是他惊喜地来电话说,他的血糖在服药后竟然恢复正常(我不知道他有糖尿病),谢顶的头部也长出一些黑发来了。可证活血化瘀药的确是有助于降糖的。

特别应该指出的是,中医药治疗糖尿病,不仅可以有效地控制血糖的指标,更具有整体调理的优点,诸如益气、养阴、补肾、调理脾胃、活血降脂等多种方法,因证而施,因人制宜,对于控制或改善临床症状,延缓、预防和治疗糖尿病的诸多并发症,也是极有意义并且大有潜力可挖的。

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25.  复发性口腔溃疡

25. Recurrent mouth ulcer

 复发性口腔溃疡,在中医文献中概称为口疮口疳

诸疮疡毒,皆属于心(火)。而火有虚实之分:实火多由饮食积滞,或烟酒过度,辛辣厚味,脾胃积热化火,熏灼口舌而致,也有肝郁气滞化火,挟胃热上冲引起的。虚火多属阴虚火旺,但也有气虚、阳虚而致阴火上浮者,兹分述之。

“Every kinds of ulcer, abscess, carbuncle, is related or due to Heart Fire”. The Fire can be separated into a true Fire (Overwhelming Fire), or a false Fire (weak Fire). True Fire is mostly due to accumulation of diet, or over intake of alcohol or cigarette smoking, or eat too much spicy and oily food. All of these factors develops Fire in the Spleen-Stomach area, which burns the tongue and mouth. It can also be due to Liver Qi sluggish, so that the sluggished Qi develops into Fire too. A false Fire is mostly due to a Yin deficiency that further more develops a Fire condition. Thirdly, it can be due to a Qi deficiency, or a Yang Qi, which cause a Yin Fire floating up.

实火口疮患者多为中青年,身体较壮实,口疮一个或多个,此伏彼起,疡面呈鲜红色,周围黏膜色黄,伴见心烦易怒,口臭口渴,腹胀便秘,尿黄,舌红,苔黄腻或夹黑苔而干,脉象洪大滑数。治宜清泻,常用凉膈散(栀子、黄芩、连翘、薄荷、竹叶、大黄、玄明粉、生甘草)加减。

The patients with true Fire are mostly those of middle aged persons. Their bodies are usually strong. The mouth ulcer can be one or more in number. The ulcer can subside in this spot but start on another spot. The surface of the ulcer is fresh red in color, which is surrounded by yellow color mucus. The person feels easy annoying, easy upset, bad odor in mouth, thirsty, and has belly bloating, constipation, yellow color in urine. The tongue is more red than normal. The tongue cover is yellow and greasy, or with black and dry cover. The pulse is big, slippery and frequent. For the treatment, it should be aimed to clear the Fire. The commonly used herbal formula is Liang Ge San (Zhizi, Huangqin, Lianqiao, Bohe, Zhuye, Dahuang, Xumingfeng, and Gancao) with some more or less modification.

病案举例:

Case example:  

蒋和平,男,34岁,北大教师。患口疮已年余,以其病久而反复发作,前医遂从中虚脾胃治,始终用甘草泻心汤,服药已逾百服,察患者饮食享用过丰,且常饮酒,动辄半斤,脾胃积热可知,口渴,心烦,舌赤如血,苔黄厚腻而干,脉滑数,无一非实热之象,甘草泻心汤内虽有黄芩、黄连,而不敌参、姜、枣、甘之温补,所以其效欠佳。改拟清泻之方,药予大黄10g,黄芩15g,黄连6g,连翘15g,大青叶20g,天花粉15g,栀子10g,丹皮10g,滑石20g,升麻6g,竹叶10g,芦根30g6服。药后上半身发出热疖甚多,其大者数枚,有脓头,患者复诊时说他有洁癖,每天洗澡换衣,如何会生疮?是不是用药有差?我说此热毒自里发外,病将愈矣。原方去大黄,合五味消毒饮(银花、连翘、野菊花、紫地丁、冬葵子),又6服,口疮与热疖果愈。嘱饮食清淡,少饮酒,避免复发。随访一年余,有时还会起口疮,但不几天只要注意饮食,不饮酒,即自愈。

Patient He-ping Jiang is a male, 34 years of old, a teacher from Beijing University. He suffered from mouth ulcer for years. For his long history of the recurrence of the disease, previous doctors treated his condition as middle Spleen deficiency, with continuous use of Gancao Xie Xing Tang, which has been close to hundred of doses. I noticed that he ate lots of high-neutration food, and he always drank alcohol, which commonly came up to half pounds. Therefore it was known that he has accumulated Fire in the Spleen-Stomach. The thirsty, annoying feeling, dark red color in tongue (as dark as blood), the dry, greasy and yellow tongue cover, and the slippery and frequent pulse, all indicate that it is a true Fire condition. In the formula Gancao Xie Xing Tang, though it contains Huangqin and Huanglian, their cold nature could not combat against the warm from the Dangshen, ginger, date and Gancao. Therefore it did not work properly. The formula was then changed to clear the Fire, using Dahuang 10 g, Huangqin 15 g, Huanglian 6 g, Lianqiao 15 g, Daqingye 20 g, Tianhuanfeng 15 g, Zhizi 10 g, Dangpi 10 g, Huashi 20 g, Shengma 6 g, Zhuye 10 g, Lugen 30 g, for six doses (6 days). After use of the herbs, there came a lot of hot furuncles on the upper half part of the body. Several furuncles were bigger ones with some pus on the top. On the following visit, the patient said that he has over the top clean habit. He had shower and changed dressing every day, how he could get the skin rash? Is it because some thing wrong in the herbs? I explained to him that this is the disperse of the hotness-toxic from inside out, indicating the improvement and cure of the skin problem. To the original formula, removed the Dahuang, add Wu Wei Xiao Du Yin (the herbs are Yinhuang, Lianqiao, wild Juhua, Zihua Diding, and Dongkuizi), for another 6 doses. After that, the mouth ulcer and hot skin rash both subsided, as expected. He was asked to eat light-taste diet, less alcohol, to prevent recurrence. Followed by one year, though from time to time, he still had mouth ulcer, the ulcer could subside by itself after sever days of taking care of diet, no alcohol.

实火口疮可配合外用药,常用枯矾研细外抹,一日数次。或用青黛、黄柏、冰片、枯矾、人中白、儿茶等份研末,蜜调外抹。

For the mouth ulcer of true Fire nature, it can be treated together with the use of external use of herbs. Commonly, it is used the Kufan (dried alum). Grind it into fine powder. Smear it on the ulcer, several times a day. Or, use Qingdai, Huangbo, Bingpian, Kufan, Renzhongbai, Ercha, all of which are equal amount. Grind all into fine powder too. Add honey to make the mixture into mud form. Smear it onto the ulcer.

虚火口疮以阴虚火炎最为多见,但多挟热湿,其原因多因素体阴虚,或常熬夜,或多忧思郁怒,而致营阴暗耗,也有因肠胃长期有实火劫烁津液伤阴的。其证心烦、口舌干燥、口臭,舌质红,脉细数,兼见乏力、纳差、大便干结或初头硬,尿黄。甘露饮(生地、熟地、天冬、麦冬、黄芩、石斛、枇杷叶、枳壳、茵陈、甘草)为常用之方,我常用玄参易熟地,因玄参善清无根浮游之火;清热可加绿豆衣、银花、蒲公英,不可过用苦寒;口干渴酌加石膏、天花粉。此外,可加牛膝以引火下行。不效,可用肉桂2g反佐,往往有效。唐人方含煎(升麻、大青叶、射干、竹叶、栀子、黄柏、生地、玄参、蔷薇根皮、蜜)也是阴虚心胃有热的适用方。

The mouth ulcer of false Fire is mostly due to Yin deficiency with Fire rushing up, which is also commonly with Hotness-wetness. The reason is that the person is usually a body constitution of Yin deficiency, due to work overnight, or to worrying, or unexpressed angry, the body Yin is exhausted. It could also be due to long term of overwhelming Fire in the Stomach-intestine, which also exhausts the body Yin portion. The person feels annoyed, dry in mouth and tongue, bad odor in mouth. The tongue is more red than normal. The pulse was thin and frequent. The symptoms are accompanied by chronic fatique, poor appetite, dry stool, or the stool is dry and hard in the beginning, and has yellow urine. The herbal formula Gan Lu Yin is the commonly used formula (it contains Shengdi, Shoudi, Tianmendong, Maimengdong, Huangqin, Shihu, Pibaye, Zhike, Yinchen, and Gancao). I usually use Xuanshen to replace the Shoudi, since Xuanshen is good at clearing no-root Fire. To clear Fire, it can be added green bean shell, Yinhua, Pugongying. Do not use too bitter and cold herbs. To solve dry mouth, add Shigao, and Tianhuafeng. In addition, add Niuxi to direct the Fire down. If it does not work, add 2 grams of Rougui as a reverse help. It usually works. The herbal formula to be hold in mouth, that was from Tang dynasty, using herbs Shenma, Daqingye, Shegan, Zhuye, Zhizi, Huangbo, Shengdi, Xuanshen, Qiangweigengpi, and honey, also works for the mouth ulcer due to Yin deficiency with Hotness in the Heart and Stomach.

段秀兰,女,49岁。198416日初诊。患复发性口腔溃疡两年余,常因生气、感冒而发作,此次发作已历两周,服清热解毒中药七、八剂无效。检见上、下唇各有一黄豆粒大小溃疡,表面呈黄白色,周围黏膜色红。自诉口腔疼痛,遇热食疼剧,口臭,口干,但饮不多,饮食尚可,大便干结,尿黄,舌边尖红,脉细数带滑。证属脾胃阴虚,虚火上炎,兼挟湿热,拟养阴以治其本,清利以治其标。方用甘露饮加减:北沙参、细生地、石斛、枇杷叶、枳壳、滑石、丹皮、川楝子、白芍、升麻、生甘草、黄芩、淡竹叶。服四剂,口腔疼痛明显减轻,已不渴,饮食增进,大便转畅,但溃疡未见愈合。复诊仍用原方,少加砂仁、黄柏,4服而愈。后因生气又复发作,用初诊方加蒺藜、钩藤、蒲公英、生麦芽,又4服即平复。

Patient Xiu-lan Xu, is a female, 49 years of old. She visited first on January 6, 1984. She suffered from recurrent mouth ulcer for two years. It usually happened after angry or a common cold. This time, it lasted for 2 weeks. It was still there after taking herbs for 7 to 8 doses, that worked aiming to clear Fire and deplete toxic. On consultation, it was found an ulcer on the upper lip and another one on the lower lip, both were soya bean in size. The surface was yellow-white, with surrounding mucus red in color. She complained sour in the mouth. The pain became worse when eat hot food. She had bad odor and dry in mouth, but did not drink more water. The appetite was normal. The urine was yellow. There was constipation. The tongue tip was more red than normal. The pulse was thin, frequent with slippery feeling. The condition was considered to belong to Spleen-Stomach Yin deficiency, in which the false Fire rushing up with Hotness-Wetness. The herbal therapy was designed to nourish the Yin to solve the root cause, and to clear the Fire to solve the symptoms. The herbal formula Gan Lu Yin was modified somehow: Bei Shashen, Xi Shengdi, Shihu, Pibaye, Zhike, Huashi, Danpi, Chuanlianzi, Baishao, Shengma, Gancao, Huangqin, Dan Zhuye, for four doses. The sour in mouth was dramatically reduced. No thirsty. The appetite was improved. The bowel movement was easier. The ulcer was however not improved yet. On the second visit, she was given the same formula, with little addition of Sharen, Huangbo. After four doses, the ulcer completely subsided. Later, the ulcer recurred after angry. The first formula was used with addition of Baijili, Gouten, Pugongyin, Maiya (malt). After 4 days of the herbal therapy, the ulcer was cured again.

虚火口疮亦有因气虚、阳虚、阴火上浮而致者,笔者于此究心多年,我认识到:此类口疮,多长期反复发作,病程最长者甚至数十年之久;追溯患者病史,大都属气虚或气阴两虚之体,其中尤以乏力、易于疲劳汗出、食少、便溏等慢性脾胃病见证为多;发作时的诱因,与工作、学习劳累,紧张或郁怒有明显关系;溃疡凹陷平塌,表面及周围黏膜颜色淡红或灰白(如其色由白转红,即接近愈合);舌淡并有明显齿痕,脉虚细或大而无力;服一般清热解毒剂效果多不佳。

The false Fire ulcer can also be caused by Qi deficiency, Yang deficiency, which cause the Yin Fire rushing up. I have been paying attention to such clinic condition for many years and realized that, such kind of mouth ulcer can come and go for many years. The longest term was tens of years. Check the history of the disease, most of the patients is with Qi deficiency, or Qi-Yin both deficiency. Especially, the patients usually have chronic fatique, easy to have sweat after work and after getting tired, poor appetite, near-diarrhea bowel movement, such symptoms of chronic Spleen and Stomach disease. The recurrence is clearly related to the exhaustion after labor or emotional work, stress, or non-expressed upset. The ulcer is with hollow, not rising on surface. The surface and surrounding area were pale red or grey-white in color (if the color changes from white to red, it indicates a close to healing). The tongue was pale, with clear tooth index. The pulse was weak, thin, or big but weak. The ordinarily used herbs, that work to clear Fire and to detoxify, usually do not work.

如就以上脉证而论,似与东垣所论脾虚阴火相吻合。李氏云:若饮食失节,寒温不适,则脾胃乃伤,喜怒忧恐,损耗元气脾胃气虚,则下流于肾,阴火得以乘其土位脾胃之气下流,使谷气不得升浮,是春生之令不行,虽然原文中没有提及口疮这一病证,但其所论气虚阴火,与本病病机若合符节。因此我治疗这类患者,往往师法东垣以辛甘温之剂,补其中而升其阳大忌苦寒之药损其脾胃之意处方用药:

If the pulse as above is concerned, the condition is similar to the Spleen deficiency with Yin Fire, as described by Dr. Dong-yuan Li. Dr. Li said: “if the diet is not regular in amount or in frequency, and if the stomach is exposed to either extreme cold or hot, the Spleen-Stomach would be hurt. Emotional stimulation as over happy, angry, or sad, or scare, would exhaust Yuan Qi, to cause Spleen-Stomach Qi deficiency. The Qi flows down to the Kidney, so Yin Fire can rush up to take the space of the Yuan Qi (the space of the soil). “When the Spleen-Stomach Qi flows down, making the diet Qi hard to rise up, meaning the Spring Qi can not rise up”. Though in the original text, it does not mention the symptom of mouth ulcer, the Qi deficiency with Yin Fire matches the mechanism of the mouth ulcer we discuss now here. Therefore, to treat such kind of patient, I usually follow Dr. Dong-yuan Li to use spicy-sweet warm herbs, to nourish Spleen and to rise its Spleen Yang Qi, and avoid the bitter cold herbs since they hurt the Spleen and Stomach. The herbs used are:    

 

1.复发性口腔溃疡兼见脾胃功能一般性衰减者,以四君子汤(党参、白术、茯苓、炙甘草)为基础,加黄芪、山药、当归、升麻、乌贼骨、荷叶。

1. Recurrent mouth ulcer with general weakness in the digestive system: use Si Jun Zi Tang (Dangshen, Baizhu, Fuling, Zhi Gancao) as basic formula, add Huangqi, Shangyao, Danggui, Shengma, Wuzeigu, and Heye (lutus leaves).

2.证见短气,乏力,大便次数增多等中气下陷表现者,用补中益气汤(党参、黄芪、白术、陈皮、升麻、柴胡、当归、炙甘草)。

2. If there is middle Qi shrinking symptoms, such as short of breath, chronic fatique, frequent bowel movement, us Bu Zhong Yi Qi Tang (Dangshen, Huangqi, Baizhu, Chenpi, Shengma, Chaihu, Danggui, and Zhi Gancao).

3.证见腹痛喜暖喜按,大便澄彻清冷或完谷不化,肢凉,脉弱,舌淡者,为中虚寒证,用附子理中汤(党参、白术、干姜、炙甘草、制附片);胃、十二指肠溃疡患者以中虚寒证为临床表现者,用黄芪建中汤(黄芪、白芍、肉桂、炙甘草、饴糖、炮干姜)。

3. If the patient has stomach pain, the stomach likes being pressed and being warmed, with water like stool, or with non-digestive food in the stool, the pulse is weak, the tongue is pale, and the hands and feet are fold, it is middle weak and cold condition. Use Fuzi Li Zhong Tang (Dangshen, Baizhu, dried ginger, Zhi Gancao, Zhi Fuzi). For gastric and duodenal ulcer with the middle weakness and cold condition, use Huangqi Jiang Zhong Tang (Huangqi, Baishao, Rougui, Zhi Gancao, Yitang, Pao dried ginger).

应当指出,由于本病病程长,又易于为医者误认为实证口疮而用清热泻火,或以为虚火即指阴虚火炎而泛投凉润之剂,皆损伤脾胃之阳,并且往往因日久而累及肾阳,脾肾两虚,阴寒内盛,则逼阳上泛,证见口腔溃疡久不愈合,两足冰凉,下利清谷,舌淡,脉虚细或大而无力,两颧独红,故其治亟宜温补脾肾,破阴返阳,使火安其位,而口疮自愈。

It should be pointed out that, due to a long term of the disease, also due to the fact that it is easier for a doctor to misbelieve a false Fire ulcer as a overwhelming true Fire, so to use Fire-clearing herbs to clear the the Fire, or mis-believe that the “false Fire” is the Yin deficiency with Fire rushing up, so to use cooling and wetness herbs, all such therapies would hurt the Spleen and Stomach Yang. After a long time, the hurt would involve the Kidney Yang, to cause the Spleen- and Kidney both Yang deficiency, the Yin Cold would be overwhelming inside, which pushes the Yang rushing up. The patient would have recurrent onset of mouth ulcer, which is hard to heal, cold hands and feet, diarrhea with non-digested food in stool, pale tongue in color, weak and thin pulse or big but weak pulse, isolated red color on the cheek. It is extremely needed to warmly nourish the Spleen and Kidney, to break the Yin and to restore the Yang, to make the Fire back to its original place (kidney), so the mouth ulcer can be cured by itself.

4.病久气阴两虚者,可用四君子汤合生脉散,如再加升麻、玄参、当归、白芍,即《证治准绳.口舌门》之清热补气汤,日本学者矢数道明就常用此方治口疮、口糜。

4. For Qi-and Yin- both deficiency after a long term of disease, use Si Jun Zi Tang plus Sheng Mai San. With addition of Shengma, Xushen, Danggui, and it becomes the Qing Re Bu Qi Tang as introduced in the book <<Zheng Zhi Zun Sheng – Chapter of Mouth and Tongue>>. Japanese doctor Shi Shu Dao Ming usually used it for the treatment of mouth ulcer.

病案举例:

Case example:

邓巨悦,男,56岁,内蒙古乌兰察布后旗贲红公社玉印山村农民。1984110初诊。

Patient Ju-yue Deng was a male, 56 years of old, a farmer in Neimenggu province. The date for his first consultation: January 10, 1984.

患者5年来,口疮反复发作,长期服用泻火解毒药。最近一年之久,口疮一直不愈合。198312月来京求治,医院诊断为复发性口腔溃疡,予西药(不详)及清热解毒养阴中药内服,外用漱口药,治疗一月无效。

For the past five years, his has his mouth ulcer recurrence again and again. He used Fire-clearing and Toxic-depleting herbs for a long time, but the ulcer remained not healed. He came to Beijing on December 1983 for the treatment. His condition was diagnosed as “recurrent mouth ulcer”. He was given western medicine (not clear for the name), as well as Fire-clearing and Yin-nourishing herbal therapy, for one month. No improvement at all.

患者自诉舌、咽疼痛,妨碍进食,食欲差,经常泛吐清水、酸水,头皮发痒,时觉热气上冲头面,大便初硬后溏,尿时清时黄,小便后阴疼,少腹有拘急感,足底长期冰凉。检见:右侧舌缘有一沟状深在溃疡,其色淡红间白,咽_弓亦有一条状溃疡;颊黏膜水肿。面部颧突处独红。脉象六部俱沉弱,舌胖嫩,色淡,齿痕,苔白滑。综合脉证及口腔溃疡反复发作病史,认为病属脾肾阳虚,阴寒内盛,迫火上浮,虚火上炎,熏于口舌所致。治拟温补脾肾,俾阴霾消而火归其位。用附子理中汤加味:党参15g,白术15g,干姜10g,炙甘草6g,制附片15g(先煎40分钟),黄芪25g,当归10g,砂仁6g,山药20g,乌贼骨10g,牡蛎25g4服。

The patient complained sour in the tongue and throat, which prevented the intake of food. He had poor appetite, often spit water, acidic water in mouth, itching scalp. He felt from time to time hot are rusing up to the head and face. The stool was first hard then loss. The urine was clear as water, with yellow from time to time. He felt pain in the perineum region after urination. There was tightness feeling in the lower belly. The sole felt cold for a long time. It was found by physical exam that there was a deep linear ulcer on the right side of the tongue edge. It was pale in color. There was another linear ulcer on the throat. The mucus around it was swelling. The cheek was extremely red in color. The pulse was deep and weak in all parts. The tongue was big and looked young, with pale color and tooth index on the edge. The tongue cover was white and slippery. Combining the pulse, symptoms, and disease history, his condition was considered to be Spleen-Kidney Yang deficiency, the Yin Cold was overwhelming inside, which pushes the Fire up to burn the tongue. The herbal therapy was designed to warmly nourish the Spleen and the Kidney and to deplete the Yin and to restore the Yang. The herbal formula used was Fuzi Li Zhong Tang with some modifications: Dangshen 15 g, Baizhu 15 g, dried ginger 10 g, Zhi Gancao 6 g, Zhi Fuzi 15 g (decoct first for 40 min), Huangqi 25 g, Danggui 10 g, Sharen 6 g,, Shangyao 20 g, Wuzeigu 10 g, Muli 25 g, for 4 doses (4 days therapy).

二诊:服完3服,舌缘溃疡开始愈合,已不觉疼痛,唯_弓部在进食时仍有痛感。饮食增加,泛酸减少,大便仍先干后溏,颧红,足冷,尿时小腹拘急,阴疼如前。原方加肉桂3g、龙骨12g,黄芪增至35g

On the second visit: he finished the three doses. The ulcer on the tongue edge started to heal. No pain feeling. Only on the throat, there was a pain feeling during eat. The appetite was improved. Acid reflex was reduced. The bowel movement was the same. The cheek was red, and the foot was cold. There was tight feeling in the lower belly during urination. The pain in the perineum area remained. To the previous formula, added were Rougui 3 g, Longgu 12 g. Huangqi was increased to 35 g.   

三诊:服药10服,两处溃疡均愈合,疼痛消失。每日主食1斤左右,不吐酸,头皮也不再发痒,大便基本成形,少腹拘急感及阴疼已愈,唯颧红仍在,晚间足心仍有凉感,久病初愈,患者及其子均欣喜过望,因春节将至,要求带药回家,拟方用参、、桂、附、砂仁、干姜、白术、山药、炙甘草、当归、龙骨、牡蛎、牛膝,一月后患者来信,告诸症悉愈,问善后治法,回信为拟补中益气丸 6g 晨服,金匮肾气丸 9g 晚服。

On the third visit: after ten doses of treatment, the two ulcers were healed. The pain subsided. He could eat about one pound food every day. No acid reflex. No itch on scalp. The stool was in a formed shape. The tightness in the lower belly during urination and pain in the perineum area stopped. Only the red color in the cheek remained. There was still cold feeling in the sole. For much improvement after a long time, the patient and his son felt very happy, also because it was near the Spring festival, the patient asked to bring herbs home for continuous treatment. The herbal formula contained: Dangshen, Huangqi, Guizhi, Fuzi, Sharen, dried ginger, Baizhu, Shangyao, Zhi Gancao, Danggui, Longgu, Muli and Niuxi. After one month, the patient wrote a letter telling that all the ulcer were cured and asking for future more maintenance. He was responded to take Bu Zhong Yi Qi Wan 6 g to take every morning and Jin Kui Shen Qi Wan 9 g every night.

按:此案为鄙人平生治验中得意之案,曾报道于《湖北中医杂志》19843期,有关气虚、阳虚、阴火的认识也同时刊出。近年读尤怡《金匮翼》及《静香楼医案》,云:胃虚食少,肾水之气逆而承之,则为寒中,脾胃虚衰之火,被迫上炎,发为口疮,其症饮食少思,大便不实,或手足逆冷,肚腹作痛宜附子理中汤,参、术、甘草补其中,干姜、附子散其寒,使土温则火自敛也。可见古人早有这样的认识和经验了。

Comments: This case is one of my very proud cases in my clinic life. It has been reported in <<Hubei Chinese Medical Journal>> 1984:3. The opinion about the Qi deficiency, Yang deficiency, and Yin Fire, are all introduced in the same article. Recently, when I read the book <<Jin Kui Yi>> by Dr. Yi You, and book <<Jing Xiang Lu Yi An>>. It stated: “In a condition in which the Stomach is weak and the person has poor appetite, the Kidney Water would reverse up to take the space. It is the Cold Middle condition. The Fire due to Spleen-Stomach weakness is forced to rush up, to cause the mouth ulcer. The person feels low in appetite, lose stool, or cold hands and feet, or pain in the belly. Herbal formula Fuzi Li Zhong Tang should be used. The Dangshen, Baizhu and Gancao are to nourish the middle; the dried ginger and Fuzi are to warm off the Cold, to make the Soil (Spleen) warm and then the Fire is restrained by itself.” Apparently, doctors in old time have already had such knowledge and experience.

 

 

26.  肩关节周围炎

26. Frozen shoulder

 

肩周炎属于中医学痹证范围,但古代文献亦有在痹证之外,另立肩背痛臂痛名目者。民间称之为漏肩风五十肩冻结肩。一般对肩周炎多按痹证治疗,效果欠佳。其原因就在于大多数肩周炎患者以虚为本,风寒湿痰瘀为标,如果仅仅祛风散寒逐湿化痰行瘀,则本末倒置。《素问.生气通天论》说女子六七三阳脉衰于上,男子六八阳气衰竭于上,学中医的人何人不知?但每每将此二语草草读过。

… Frozen shoulder is usually treated as the Bi syndrome of Chinese medicine. The healing effect is not satisfied. The reason is that, in most cases, the root reason is the weakness condition in the shoulder, and the Wind, the Cold, the Phlegm and the Wetness is the triggering factors. If the herbal therapy is aimed to dispel the Wind, to disperse the Cold, to dissolve the wetness, and to deplete the phlegm only, it would not touch the core of the disease. …

古往今来,唯清人叶天士能于此会意,提出阳明络虚的观点,如《临证指南医案.肩臂背痛》: 五旬又四,阳明脉衰,肩胛筋缓。不举而痛,治当通补脉络,莫攻风。 俞妪高年阳明气乏,肩胛痛,难屈伸,法当理卫阳通补。

From old time, only Dr. Tian-shi Ye in Qing dynasty understood and realized this. He proposed the idea of “Yangming meridian weakness”. Such as he mentioned in the book <<Lin Zheng Zhi Nan Yi An – Pain in the shoulder, arm, and back>>: Patient Zou was 54 years of old. His Yangming meridian was weak. The tendons around the shoulder and shoulder bladder was weak. He felt pain even without lift the arm. For the treatment, it should nourish the meridian, not attack the Wind. Patient Yu was old. Her Yangming meridian was weak in the Qi. She felt pain in the shoulder, which was hard to stretch or to bend. It is needed to nourish the Yang and conduct the meridian.

我在叶氏启发下,进一步考虑到肩周炎的病变,在骨、筋和肌肉,而肾主骨,肝主筋,脾主肌肉。人至中年以后,脏气渐亏,气血不足,尤为突出的是阳虚而失温煦,筋骨肌肉皆失温养,营卫空疏,风寒湿邪乃得乘虚而入,病久,留连不去,则更变生痰浊、瘀血,以至有形之邪,阻于经隧,故肩周疼痛不已,上举、外展、内旋、外旋受限。

Under the remind by Dr. Ye, I further more considered that, the disease of the frozen shoulder is the bone, the tendon, and the muscle. The Kidney dominates the bone; the Liver dominates the tendon/ligment; and the Spleen dominates the muscle. After middle age, human being starts to come into an exhausted condition, in which the Qi and Blood are not sufficient. The most apparent phenomenon is the Yang deficiency, due to which the body has no sufficient warming up. The tendon, the muscle, and the bone, all have less nourishment, so that the body surface Yin and Wei Qi is not enough to defense the body. The Wind, Cold, and Wetness, all could find chance to penetrate into the body. After a long time, the Xie Qi sticks in the body and develops into phlegm, stagnated blood, to form formed Xie, which blocks the meridians, to cause pain around the shoulder and affects its functions.

这样,我治疗中老年肩周炎,便确定了以通补为法,以健脾益气、补肾、养肝为主体,佐以温阳散寒、活血、化痰、通经络、调营卫。常用药如黄芪、白术、淫羊藿、山萸肉、赤白芍、桂枝、附子、姜黄、海桐皮、羌活、当归、防风、鹿角片(或鹿角胶)、甘草、生姜、大枣。这里面包含了益气温阳固表的芪附汤(黄芪、附子),玉屏风散(黄芪、白术、防风),调和营卫的桂枝汤(桂枝、芍药、炙甘草、大枣、生姜),两补气血的当归补血汤(黄芪、当归),宣痹止痛的舒筋汤(赤芍、海桐皮、片姜黄、羌活、当归、白术、炙甘草)和桂枝附子汤(桂枝、附子、炙甘草、生姜、大枣)几张方子。

For this reason, when I treat the middle and older aged patients with frozen shoulders, I set up the principle of the treatment to conduct and to nourish. Mostly it is to nourish the Spleen, the Kidney and the Liver, accompanied by warming Yang, dispersing Cold, improving blood circulation, dissolving phlegm, adjusting the Yin and Wei Qi in the surface of the body. The commonly used herbs are Huangqi, Baizhu, Yiyanghuo, Shanyurou, Chishao, Baishao, Guizhi, Fuzi, Jianghuang, Haitongpi, Jianghuo, Danggui, Fangfeng, Lujiaopian (or Lujiaojiao), Gancao, fresh ginger, and Chinese date. The herbs include the Qi Fu Tang that is to nourish Qi and Yang (Huangqi and Fuzi), Yu Ping Feng San (Huangqi, Baizhu and Fangfeng), Gui Zhi Tang that is to adjust the Yin and Wei (Guizhi, Shaoyao, Zhi Gancao, Chinese date, and fresh ginger), Danggui Bu Xue Tang that is to nourish both Qi and Blood (Hungqi and Danggui), Shu Jing Tang that is to dispel the Bi syndrome and to stop pain (Chishao, Haitongpi, Pianjianghuang, Qianghuo, Danggui, Baizhu, and Zhi Gancao), and Guizhi Fuzi Tang (Guizhi, Fuzi, Zhi Gancao, fresh ginger, and Chinese date).

体丰,多湿多痰,苔厚腻者,去山萸肉、黄芪,加苍术(燥湿健脾)、炮南星(善去经络之痰)、炒白芥子(善去皮里膜外之痰);用力不当或外伤后而致瘀血阻络,痛剧而痛点固定者加红花、威灵仙、川芎、乳香、没药(当归、丹参、乳香、没药,即活络效灵丹);寒盛,畏寒,患处冷感,每于睡觉时肩露于被子外即痛剧,舌淡脉沉者加制川乌、细辛、生姜温经通阳。

For person with obesity, with more wetness and more phlegm, and with thick and greasy tongue cover, remove Shangyurou, Huangqi, but add Canzhu (todry the wetness and to nourish the Spleen), processed Nanxing (it is good at removing phlegm in the meridian), fried Baijiezi (it is good at move phlegm inside the skin but out side of the tendons). If the pain follows a trauma or after an improper physical acticity, that causes the stagnated blood block in the meridian, and if the person feels pain in fixed spot, add herb Huonghua, Weilingxian, Chuanxiong, Ruxiang, Moyao (the Danggui, Danshen, Ruxiang and Moyao is the ingredients of formula Huo Luo Xiao Ling Dan). If the person has very cold feeling, dislides cold environment, or feels cold on the pain spot, and if the pain is worse at night when the shoulder is exposed out of the cover, and if the tongue is pale in color and the pulse feels deep, add Zhi Chuanwu, Xixing and fresh ginger to warmly conduct the meridian and improve the Yang Qi circle.

附子为方中要药,应予重用,一般从10g开始,不知,可渐增至30g,均需先煎40分钟以上,以策安全。

Fuzi is the key ingredient in the formula. It should be used with emphasis. Generally speaking, it starts from 10 g. If there is no sign of working, add gradually up to 30 g. All the time, it should be first decocted for more than 40 min, to ensure safe.

病案举例:

Case example:

李某,女,49岁,左肩痛,延及肩胛,屈伸上举不便,兼右侧网球肘,疼痛不能负重。手足常冷,畏寒,舌淡,苔白,脉沉弦。疼痛夜甚于昼,睡觉时被子稍一漏风,疼痛即加剧。年近50,阳明脉衰,营卫失调,风寒外袭,其诱因也,拟温阳气、调营卫、养肝肾、通经络。制附片30g(先煎半小时),桂枝10g,细辛6g,炙黄_30g,炒白术15g,防风10g,赤芍10g,淫羊藿15g,姜黄10g,赤芍10g,海桐皮10g,威灵仙10g,当归12g,山萸肉12g,川芎12g,羌活10g,炙甘草6g,大枣15g,生姜3片,蜂房6g。服30余服,痛止。此后断续服用此方约百服而活动自如,手足从此亦不再冷矣。

Patient Li is a female, 49 years of old. She had left shoulder pain which expanded to the shoulder bladder. It was hard to up lift the arm. She had also a tennis elbow, which feels pain and hard to hold heavy stuff. Her hands and feet are usually cold. She disliked cold. Her tongue was pale in color and the pulse was deep and string. Her pain was more at night than in the day time. During sleep, once there was little leak of wind, the pain would be worse. She was near 50 years of old, in which age the Yangming meridian is weak, and the Yin and Wei Qi in the body surface layer was in disorder. The Wind and Cold attack is only a triggering factor to her pain. For the treatment, the herbal therapy was designed to warm Yang Qi, adjust the Yin and Wei Qi in body surface, to nourish the Liver and Kidney, and to conduct the meridian. The herbs used were Zhi Fuzi 30 g (decocted first for half hour), Guizhi 10 g, Xixing 6 g, Zhi Huangqi 30 g, Chao Baizhu 15 g, Fangfeng 10 g, Chishao 10 g, Yinyanghuo 15 g, Jianghuang 10 g, Chishao 10 g, Haitongpi 10 g, Weilingxian 10 g, Danggui 12 g, Chuanxiong 12 g, Qianghuo 10 g, Zhi Gancao 6 g, Chinese date 15 g, fresh ginger three pieces, bee nest 6 g. She was asked to take the herbal therapy for 30 doses (30 day). After that, the pain stopped. Later, she took this formula from time to time for up to hundred of doses, the shoulder could move freshly and the hand and feet felt no more cold.

肩周炎可配合针灸推拿等外治法,患者也可以在医生指导下进行功能锻炼。我在德国时曾买过一种叫ABC的膏药,其成分即是辣椒(脱去色素)。据德国医生告诉我,他们在多种药物试验中,发现以辣椒效果为最好。所以我采用我国自制的伤湿止痛膏之类膏药,嘱患者撒上一层辣椒粉再贴,效果不错。热熨药包我也常用,能饮酒者也可以饮用药酒。

The frozen shoulder can also be treated with acupuncture, tuina, etc. The patient can also do physical exercise under the guide of doctor. When I was in Germany, I bought a herbal patch called ABC. Its ingredient is the hot pepper (deplete the pigment). According to the Germany doctor, they found that the pepper works the best, among the stuff they tested. I use the Shang Shi Zhi Tong Gao that is made in China, with smear of some hot pepper powder on it before applying it on to the pain spot of patient. It works well. I also use herbal bag as hot press. If the patient can drink alcohol, they can try herbal liquor.

热熨方及药酒方如后:

The ingredients for the hot press and herbal liquor are:

热熨方:生川乌,生草乌,刘寄奴,伸筋草,红花,乳香,没药,白芷,羌、独活,赤芍,骨碎补,细辛,桂枝,干姜各等分,研为粗末,白酒四两拌匀,装入布袋内,每袋重约150g,放锅上蒸1015分钟,取出,稍晾一下,趁热熨患处(注意不要烫伤),早晚各1次。

Hot press: fresh Chuanqu, fresh Caowu, Liujinu, Shengjingcao, Honghua, Ruxiang, Moyao, Baizhi, Qianghuo, Duhuo, Chishao, Gusuibu, Xixing, Guizhi, dried ginger, eaqual amount. Grind into powder, mix it with liquor 200 ml, put into a cotton bag, with 150 g in each bag. Steam it over water vapour for 10 to 15 min. Take it out, cool for a while. Apply on to the painful spot (note not to burn the skin). Do it once every morning and once at night.

酒药方:桑莶酒。姜黄45g,桑枝100g,当归60g,三七30g,五加皮60g,红花60g,海桐皮60g,骨碎补45g,羌、独活各30g,川芎30g,赤芍45g,肉桂30g,苍术30g,炮附子30g,豨莶草100g,木瓜45g,乳香15g,炮南星30g,黄芪100g,黄酒或白酒5斤浸泡10天后取饮,每次一两,12次。

Herbal liquor: Sang Qian Liquor: Jianghuang 45 g, Sangzhi 100 g, Danggui 60 g, Sanqi 30 g, Wujiapi 60 g, Honghua 60 g, Haitongpi 60 g, Gusuibu 45 g, Qianghuo 30 g, Duhuo 30 g, Chuanxiong 30 g, Chishao 45 g, Rougui 30 g, Canzhu 30 g, Pao Fuzi 30 g, Xiqiancao 100 g, Mugua 45 g, Ruxiang 15 g, Pao Nanxing 30 g, Huangqi 100 g. Add wine or liguor 2500 ml, rinse for 10 days. Drink it 50 ml each time, twice a day.

 

27 外感咳嗽的辨证与治疗

27. External cough

 

咳嗽当分外感内伤。外感咳嗽,责之于六淫,内伤则有虚有实,或虚实兼见为多。本文专就外感咳嗽的辨证与治疗,谈我的体会。

The cough should be separated as internal or external causes. The external cough is caused by the invasion of external Xie Qi into the body (the lung). The internal cough can be caused by with a weakness or an overwhelming condition inside of the body, or by both at the same time. Here we focus on the diagnosis and treatment of cough due to external causes. 

既云外感,则离不开风寒暑湿燥火(火��括温邪),目前倾向,只分寒热二型,未免简单化了。咳嗽虽非大病,但辨证不清,治疗不当,却不易见效,有的一咳就是十天半月甚至数月之久。清代名医叶天士说:治嗽当分六气(),就是指外感咳嗽而言。兹分述之:

When we mention external common cold, it can not be avoided the external Xie Qi, such as Wind, Cold, Hotness, Wetness, Dryness, and Fire. Currently in TCM society, it tends to separate into either a Cold or a Hotness. It is however too simple. Though the cough is not a severe disease, if the diagnosis is not correct, and if the treatment is not proper, it is not easy to stop it. For some patients, the cough can last for ten days or even several months. The famous doctor, Dr. Tian-shi Ye (Qing dynasty), said: “To treat cough, it is needed to separate the six Xie Qi, to see which is the cause of the cough.” This means the treatment of the external cough.

1. 伤风咳嗽即是风寒咳嗽的轻证。恶寒发热都不明显,或微恶风,喉必痒,一痒就咳,鼻必塞,咳出的痰呈风泡样,舌象一般无特殊,脉浮滑。其治宜用辛平疏解为主,稍稍佐一点降气祛痰药。所谓,即既不能太温,也不要太凉之意。常用顾松园疏风利肺汤 (荆芥、防风、前胡、杏仁、橘红、桔梗、甘草)。头胀痛加薄荷,鼻塞加辛夷,痰多加浙贝,气逆加苏子。恶寒加麻黄少许,咽干加天花粉。

1. The cough due to Wind attack is the mild type of the Wind-cold cough. The person does not have chilly or fever, or has slight wind-dislike feeling. The throat must feel itch. Once it is itch, there will start the cough. The nose must feel stiff. The phlegm looks as air bubble. There is no specific change in the tongue. The pulse feels floating and slipperry. The treatment should aim to use spicy and not-hot-not-cold herbs to dredge the body surface, with little bit addition of Qi-descending herbs and phlegm-dissolving herbs. The commonly used herbal formula is the Shu Feng Li Fei Tang, by Dr. Song-yuan Gu (Jingjie, Fangfeng, Qianhu, Xingren, Juhong, Jiegen, Gancao). If there is head ache or head bloating feeling, add Bohe (mint). If there is nose stiffness, add Xinyi. If there is lot of phlegm, add Zhe Beimu. For asthma, add Suzi. For chilly, add Mahuang little bit. For dry throat, add Tianhuafeng.

当然,对于伤风咳嗽,《医学心悟》的止嗽散也可用,惟其疏风解外之力不够,宜加薄荷、杏仁、牛蒡子。肺位最高,药宜轻清,故药量不宜大,煎煮时间也不要太长,否则就会药过病所。把药物研成粗末,合匀,每用2030g作煮散,只煎几分钟,去渣服,一日二三服,效果好。风咳其来也速,其去也快,如无兼挟及宿恙者,一二付即愈。

Of course, for the Wind-attack cough, the Zhi Su San, introduced in book <<Yi Xue Xing Wu>>, can also be used. The only weakness for this formula is its not strong effect to disperse Wind. To it, it should be added Bohe, Xingren, and Niubangzi. The Lung is on the highest position of the body. The herbs should be light in dose. The time for decoction should not be too long either. Otherwise, the herbs would go over the diseases space (the lung). The herbs can be grinded into powder, mix it well, take 20 to 30 g each time for decoction, for only several minutes. Remove the residue, drink two to three times a day. It works well. The Wind cough comes fast and goes also very fast. If there is no other accompanying problem, one to two dose is enough to solve the cough.

2  风寒咳嗽风寒之邪伤人,多在冬令严寒之时,但春季天气多变,忽而春光明媚,忽而春寒料峭,使人很难适应,一不小心就受凉了。夏天虽说很热,但偏偏易于受寒,古人多责诸睡卧贪凉,今天外则空调冷气,内则冰水雪糕,这就应了古人长夏善病洞泄寒中这句话了。风寒咳嗽,或有兼恶寒,发热无汗之表证者,更多只有恶寒而无发热者,或只有背心发冷者,咳痰清稀,舌淡脉浮。其治宜辛温之药解其外,稍佐化痰降气。

2. Wind-cold cough. The Wind and Cold Xie Qi attack the body usually in the very cold winter. In spring, the weather changes very fast. This time it is sun shine and warm, and next time soon it can be very cold. The body is also easy to be attacked by the Cold. In summer, though it is basically hot, the body is also easy to catch Cold. In old time, it can be due to sleep in a cold place. In current life, it can be due to stay in an air conditioned room for a long time, or to the intake of ice cream. This is as what the doctors in old time said: “in the peak summer, people is easy to get very cold inside the body and to have diarrhea”. For the Wind-Cold cough, the patient may feel cold-dislike feeling, fever without sweat, such body surface syndrome, but in most cases, the patients have only chilly, but no fever, or have only cold feeling on the back, cough water-like phlegm, with pale tongue and floating pulse. For the treatment, it should aim to use spicy-warm herbs to release body surface, with little addition of herbs that work to dissolve phlegm and to down move the Qi.

轻者在麻黄汤、桂枝汤二方中选择,如寒不甚,麻黄汤减桂枝,即为三拗汤;背冷即咳,叶天士常用桂枝汤去芍药加杏仁,同属辛温法而用药却有所弃取。重则苏陈九宝汤(麻黄、肉桂、杏仁、甘草、苏子、陈皮、薄荷、桑白皮、大腹皮)加乌梅、生姜,此方看似用麻黄汤为底子,但麻桂用量均较轻,一般只用3g,取轻可去实之效,方中桑白皮、乌梅,略同于小青龙汤之芍药、五味,寓发中有收的意思。呕,加半夏;痰多加苏子、白芥子。此证当然亦可用小青龙汤或射干麻黄汤,只要中外皆寒,即无痰饮宿恙者也可以用。我学习宁波范文虎先生的经验,小青龙汤除半夏外,其余的药都只用23g,颇验。

For mild case, choose either Mahuang Tang or Guizhi Tang. If the Cold is not severe, remove Guizhi from the Mahuang Tang, so that it becomes San Ao Tang. For those of patient who have cough when expose to cold, Dr. Tian-shi Ye usually used Guizhi Tang but with removal of Shaoyao, but addition of Xingren. The two ways both belong to the spicy-warming therapy but the herbs are different. In severe case, use Su Chen Jiu Bao Tang (Mahuang, Rougui, Xingren, Gancao, Suzi, Chenpi, Bohe, Sangbaipi, and Dafupi) with addition of Wumei, fresh ginger. This formula can be regarded as using Mahuang Tang as the basic formula, but the amount of Mahuang and Guizhi are low in amount. Generally they are used for only 3 g, with the consideration that “Light can remove the hard core stuff”. The use of the Sangbaipi and Wumai in the formula are similar to the use of Shaoyao and Wuweizi in the formula of Xiao Qinglong Tang. It bears the meaning of restraining within dispersion. If there is nausea, add Banxia. With lot of phlegm, add Suzi and Baijiezi. For this kind of cough, of course, the formula Xiao Qinglong Tang or Shegan Mahuang Tang can also be used. They can be used whenever there is Cold in both body surface and inside, evenif there is no original phlegm condition inside the body. I learned from Dr. Wen-Hu Fang that, except the Banxia, any other herbs in the formula of Xiao Qinglong Tang can be used with only 2 to3 g. It works well.

寒咳可不可以不用麻桂? 甚者必用,寒不甚者,就可以变通。诚如明人缪仲淳说:仲景之法不可改,其用药则有时可改,淮扬荆广,虽值冬令,也不甚寒,就可以从时从地而调整用药。新安吴楚常用的温肺汤(苏叶、防风、前胡、杏仁、半夏、茯苓、生姜、桔梗、甘草、细辛) 的用药就可以参考。寒咳也多由误治引起,最常见的就是误用、久用寒凉之剂,伤及中阳,当然这已经是内伤咳嗽,离开我的议题了。

Can herb Mahuang and Guizhi be used in Cold cough? In severe cough, they must be used. If the Cold is not so severe, they can be replaced with other herbs. As Dr. Zhong-chong Liao (Ming dynasty) said: the principle set up by Master Zhong-jing Zhang can not be changed, the herbs in his formula can be modified sometimes. In the south of China, it is not so cold even in the deep winter. The herbs can be modified in some way. Such modification can refer to the Wen Fei Tang (Suye, Fangfeng, Qianhu, Xingren, Banxia, Fuling, fresh ginger, Jiegen, Gancao and Xixing), use by … Cold cough can also be caused by a mal-treatment. The common reason is a mis-use and a long time use of Cold herbs, which hurt the middle Yang Qi. This belongs to the internal cough, beyong my topic here.

此外还有一点要说明,有些寒咳表现并不典型,杏苏散、小青龙汤、华盖散大家都学过,可一到临床,遇到具体的病人,说是寒又非寒,说是热又非热,很拿捏不住。我的经验,五个字:无热便是寒。也就是说,没有明显的热象,如舌不红,口不渴,尿不黄,就可以照寒证处理。这不是我的发明,是我从张介宾的书中学到的。

In addition, one point that I need to mention is that, some Cold cough is not typical in clinic. The herbal formula Xing Su San, Xiao Qinglong Tang, and Hua Gai San, we all have leant. However once in clinic with a given patient, it is hard to diagnosis if the clinic condition is a cold or a hot. My experience is five words (Chinese words): If no hot, it would be cold. In another words, if there is no clear evidence indicating a hot condition, such as the tongue is not more red than normal, there is no dry mouth, the urine is not yellow. The condition can be regarded and treated as Cold condition. This is not my development. It is what I learnt from Dr. Jiebing Zhang. 

3  咳嗽暑是夏天的主气。暑热同气,在天为热,在地为暑,但热在一年四季都可见到,暑则专主于夏天。暑热挟风,袭于肺卫,也就是夏季感冒,其以咳嗽为主证者,即暑风咳。夏暑发自阳明,是说暑热由口鼻吸受,但初起仍多兼表卫症状,如头额胀痛,无汗畏风。其治宜清暑泻热,挟湿者兼用利湿,勿拘拘乎止咳,忌大发散。常用六一散加香薷、杏仁、蒌皮、天花粉、西瓜翠衣,此叶天士药法。热盛加黑山栀、黄芩,伤阴加沙参、地骨皮,咳甚加川贝、枇杷叶。香薷,前人称为夏月之麻黄,实际上它发汗作用并不强,只微有发汗作用,但可以化湿(其气芳香),兼去缩水,实为暑热证初起较理想之药。吾乡农民,夏季在农田劳作时,自采香薷煮水代茶饮,一大碗喝下去,一汗而暑湿顿消。

3. Summer cough. Shu (hotness) is the dominate Qi in the summer. The Shu and the Hot is the the same Qi. In the sky, it is the Hot Qi; under the earth, it is the the Shu Qi. The Hotness can be seen in any time of the year. The Shu however can only be seen in summer. The Shu Hotness, with including Wind, attacks the Lung. This is the summer common cold. If the patient has the cough as the main symptom, it it the Shu Wind cough. The summer Shu starts from the Yangming meridian, e.g. the Shu Hotness is inhaled from the mouth and nose. In the beginning, the person however has still some body surface Wei symptoms, such as head bloating and ache, no sweat and dislikes wind. The herbal therapy should aim to clear the Shu and the Hotness. If the Hotness is with wetness, use herbs also to clear the Wetness. Do not pay much attention only to stop the cough. Do not use herbs to create strong disperse effect. The commonly used herbal formula is Lui Yi San with addition of Xiangru, Xingren, Gualupi, Tianhuafeng, and watermelon skin. This is the way by Dr. Tian-shi Ye. If the Hotness is too severe, add black Zhizi and Huangqin. With Yin hurt, add Shashen, Digupi. If the cough is very severe, add Chuan Beimu and Pibaye. The herb Xiangru is called the Mahuang in summer by doctors in old times. It is actually not a herb to create strong sweat, but it works to dissolve the wetness (for its fragrant odor), as well as to deplete water. It is the ideal herb used in summer. The farmers in my hometown, in summer when work in the field, decoct it as tea to drink. After drink of one big bowl, the hotness feeling disappears.  

4  咳嗽其发病不惟长夏,四季均可见,病者皆多湿多痰之体,有烟酒茶嗜好者居多,平时咯痰,痰滑易出,不一定咳,咳则由风寒外邪,引动在里伏痰。其证憎寒喜暖,面色黄晦,或兼头重身痛,或兼发热,胸闷呕恶,腹胀纳呆,便溏尿少,苔腻脉滑,即丁甘仁医案所谓外寒袭于表卫,湿痰内蕴中焦,太阳阳明为病者。

4. The Shu cough not only occurs in the summer. It can be seen in any time of the year. The patient is usually with a body constitution of more wetness and more phlegm in the body. They usually have craving for smoke, alcohol and tea. Usually when they spit phlegm, the phlegm is easy to spit out. They may have no cough. The cough is caused by external invasion of Wind and Cold, that triggerred out the inner phlegm to cause cough. The person likes warm but not cold. The face is yellow-dirty, or the person may have heavy feeling on the head or body, or the person has fever, bloating or fullness in the chest with nausea, bloating feeling in the belly, lose stool and less urine. The tongue cover is greasy and the pulse was slippery. This is what Dr. Gan-ren Ding described in his case report “External Cold attacks the body surface, the wet phlegm accumulated inside the body, causing the Taiyan and Yangming both in sick”.

其治,在外解散风寒,在里燥湿化痰,和胃行滞,常用平胃散 (苍术、厚朴、陈皮、甘草)二陈汤(半夏、茯苓、陈皮、甘草)合方,是为平陈汤,加苏叶、防风、羌活、独活一二味解外,白蔻、杏仁、苡仁、建曲、紫苑、前胡、枳壳、车前仁、桔梗畅中,多效。

For the treatment, the therapy should aim to disperse the external Wind and Cold, to dry the inner wetness and to dissolve the phlegm, to harmony the stomach and to conduct the food accumulation in the stomach. The commonly used herbal formula is the Ping Wei San (Cangzhu, Houpu, Chenpi, and Gancao), Er Chen Tang (Banxia, Fuling, Chenpi, Gancao) together, e.g. the Ping Chen Tang, with addition of Suye, Fangfeng, Qianghuo, and Duguo, one or two of them to solve the body surface condition, add Baiku, Xingren, Yiyiren, Jianyu, Ziyuan, Qianhu, Zhike, Cheqianzi, and Jiegen to calm the middle stomach area.

 

5 燥咳

5. Dry cough

燥是秋天的主气,在北方,因天气干燥,燥咳尤为多见。如从时序而论,诚如沈目南所说燥为次寒。叶天士则说秋燥很像春月风温化燥。吴鞠通来个折衷,从胜复立论,大旨胜气属凉,复气属热,而有凉燥温燥之分。证之实际,秋气凉劲肃杀,感之者即为凉燥;若久晴无雨,又碰上二十四个秋老虎,感之者即为温燥。而据我从南到北四十年的观察,燥邪不仅出现在秋季,全年都可见,其原因很多,如居处几十层高楼,接不到地气(水泥地上泼水即干),空气污染,尤其是大城市汽车尾气的污染以及饮食积热吸烟(包括二手烟)等,故以温燥为多。其证呛咳,气促痰少而黏,音哑,喉痒,唇干,鼻干,渴喜凉饮,舌红而干,脉细数。初起或兼恶风,发热等表证。治宜清凉甘润,轻宣肺燥,药如桑杏汤(桑叶、杏仁、北沙参、象贝、栀皮、梨皮、豆豉),恶风加薄荷,热甚加连翘、石膏,咳甚咽痒加枇杷叶、瓜萎,口干加天花粉、玉竹、麦冬。豆豉根本无解表作用,可去;梨皮不如将整个的梨连皮切开入煎,也可用麦门冬汤去半夏、人参加天花粉、北沙参、梨、枇杷叶

Dryness is the dominating Qi in autumn. In north, due to dry weather, the dry cough is very common. … when the august is cold, the cold attacks the body to cause cold dryness cough; if it is long time sunshine without rain, and if it is very hot, the hotness attacks the body to cause hotness-dryness cough. According to my observation from Sough to North of China for the past 40 years, the dryness Xie Qi does not only occur in the autumn, but any time of the year. There are many reasons. For example, the high level room in a high rising building does not contact the soil ground (the Soil Qi), if water is spilled on the floor, it is easy to dry. Another example is aire pollution, especially the waste gas from cars in big cities; cigarette smoking, or accumulated Fire in stomach from diet. Therefore the hotness dryness is more common. The person has urgent cough with shot of breath. The phlegm is little and sticky. The voice is harsh, the throat is itch, with dry lips and dry nose. The person likes to drink cold water. The tongue is more red than normal, and dry. The pulse is thin and frequent. In the beginning, there is wind-dislike feeling or fever, such body surface symptoms. The herbal therapy should aim to cool, to wet, to lightly release the lung. The herbal formula is as Sang Xing Tang (Sangye, Xingren, Bei Shashen, Xiangbei, Zhizi, Lipi (pear skin), and Douchi). If there is wind-dislike feeling, add Bohe. With fever, add Liangqiao and Shigao. With severe cough and itch in throat, add Pibaye, and Gualu. With dry mouth, add Tianhuanfeng, Yuzhu and Maidong. The Douchi has no any effect to release the body surface symptoms, so it can be removed. It is also better to chop the pear with its skin and add it into the decoction to decoct. It can also be used the Maimengdong Tang, with removal of Banxia and Renshen,but addition of Tianhuafeng, Bei Shashen, pear, and Pibaye.

凉燥之证,恶寒、头痛、无汗、鼻塞,咳痰清稀而多,舌淡,脉弦或浮滑,与风寒袭表无异而较轻,所异者,鼻干咽干而己。可用杏苏散(杏仁、苏叶、半夏、茯苓、橘皮、甘草、枳壳、桔梗、前胡、姜枣),我常用此方合止嗽散或只取止嗽散的紫苑、百部,以增强湿润止咳之功。

For the cold dryness condition, the person dislikes cold, feels headache, no sweat, has stiff nose, cough with lots of water-like clear phlegm. The tongue is pale. The pulse is string or floating and slippery. This is similar to the Wind-cold attack to the body. The difference is that the person feels dry in nose and throat. The herbal formula Xing Su San can be used (Xingren, Suye, Banxia, Fuling, Jupi, Gancao, Zhike, Jiegen, Qianhu, ginger and Chinese date). I usually use this formula together with Zhi Su San or only use the herb Ziyuan, Beibu in the Zhi Su San, to increase formula function to wet the throat and to stop the cough.

 

6  温邪咳嗽

6. Wen Xie cough

指风温、春温、冬温引致的咳嗽。温邪上受,首先犯肺。风温为新感,即风与温合,风挟温热;春温为伏邪,其热自里发外,甫病则里热亢盛,热多由新感引发,所以初起都可有不同程度的表证。冬温则多属客寒包火。其证恶风,发热汗出、头痛、咳嗽、鼻干、口干或渴,或声音嘶哑,或咽痛舌红,脉浮数,右寸(肺)独大。其治宜清泻肺热,然必兼用透表,清热是针对温邪,透表的意义不仅是解除恶风头痛症状,散热,更重要的是给病邪以出路,减削病邪对机体的损害,使病邪外解,不至深入。一般地说,风去热撤,消除了病因,咳嗽亦可随之而愈。轻者桑菊饮,重则银翘散,万友生先生主张重证可合桑菊、银翘于一方,收效较捷。实际上,两方用药都不必拘泥,更不宜原方照搬,因为两方对于肺胃郁热者,清热之力都不足,而邪在卫分,恶风寒而无汗者,即叶天士所说的冷束,解表之力也嫌不足。

The Wen Xie cough means the cough that is caused by the Wind Wen, Spring Wen, or the Winter Wen Xie. The Wen Xie tends to attack the upper part of the body. It first attacks the lung. The Wind Wen is a new attack of the Wind Xie and the Wen Xie combine together. The Spring Wen is an Xie Qi that has been previously hidden inside the body and now starts to cause symptoms. The Hotness of the Spring Wen comes from inside to outside. Once it starts, the person has strong hotness inside the body. The hotness is triggered out by external Xie Qi. Therefore there is also some more or less body surface syndrome. The Winter Wen is usually the Fire that is fold by Cold condition, in which the person dislikes wind, has fever and sweat, headache, cough, dry nose, dry mouth or thirsty, or hoarse voice, or sour throat and red tongue. The pulse is floating and frequent, with the Chun position on the right wrist (the lung position) stronger feeling. The herbal formula should aim to clear the lung Fire, as well as to release the body surface. To clear the Fire is to solve the Wen Xie; to release the body surface is not only to solve the symptoms, such as wind-disliking and headache, to reduce fever, but also to create a escaping pathway for the Xie Qi to leave the body, so as to reduce its damage to the body. Let the Xie Qi goes out, not to go deep into the body. Generally speaking, when the Wind goes away and the fever subsides, after removal of the cause of the disease, the cough would stop. In mild case, use Sang Ju Yin. In severe case, use Yin Qiao San. Dr. You-shou Wan recommended to use both together in severe cases, to speed up the healing. In fact, it is not needed to just use either of the formulae, neither to use the herbs in both formula exactly, since both formulae are not sufficient to remove the Fire in the Lung and in the Stomach. When the Xie Qi is in the Wei portion of the body, the person dislikes wind and cold environment and has no sweat. This is what Dr. Tian-shi Ye said “Cold-folding” condition. For such condition, the two formulae are not sufficient to release the body surface either.

我对于温邪咳嗽,首选麻杏石甘汤。麻杏石甘汤之麻黄,在方中用量轻,其用意也不在发汗,而在宣肺;石膏用量约为麻黄的10倍,是此方的用药秘诀。胸闷加枳壳、桔梗(一降一升)。里热亢盛者,加银花、连翘、鱼腥草、黄芩、知母、芦根,痰多加桔梗、萎皮、车前仁祛痰,咳剧加枇杷叶、浙贝,肺气上逆加射干、桑白皮,口干加天花粉。初起恶寒无汗,合葱豉汤,或只加头,表解则去之,不可再用。

To treat the Wen Xie cough, I firstly choose Ma Xing Shi Gan Tang. The Mahuang in this formula is light in dose. Its aim is not to create sweat either, but to disperse lung. The amount of Shigao is ten folds that of Mahuang. This is the secret of this formula. With chest bloating feeling, add Zhike and Jiegen (one is to depressing and another is to rising). With inner overwhelming Fire, add Yinhua, Lianqiao, Yuxingcao, Huangqin, Zhimu, Lugen. With lots of phlegm, add Jiegen, Galupi, and Cheqianzi to deplete phlegm. With strong cough, add Pibaye, Zhe Beimu. With asthma, add Shegan, Sangbaipi. With dry mouth, add Tianhuafeng. In the beginning with cold-disliking feeling without sweat, use Chun Chi Tang together, or only add stem of scallion. It is removed from the formula after the body surface syndrome is depleted. Do not use it again.

总之,温邪咳嗽,无论风温、春温、冬温,重点不在咳嗽,而在温邪。透之,清之,病邪去,咳嗽就不成大问题。但痰热留连不解,亦颇费周章。痰热不去,则气化不展,所以反复发热,咳嗽不爽,痰黄而黏,胸闷,尿赤、舌红、苔黄腻,脉滑数,时间长了,阴也伤了。治宜清热化痰,通利三焦,俾气化得展,治节乃复,阴虚也才有可能慢慢恢复。常用小陷胸汤(黄连、半夏、瓜萎仁)、千金苇茎汤(桃仁、苡仁、冬瓜仁、鲜苇茎或芦根)、温胆汤(半夏、茯苓、陈皮、枳壳、竹茹、甘草)等方化裁,胸闷加郁金、菖蒲,发热加石膏、竹叶,发热持续加黄芩,重加草、鱼腥草。虎杖既能透表,又有清热活血,化痰通腑之力,我也常用。

In short, for the cough due to the Wen Xie, no matter if its Wind Wen, Spring Wen, Winter Wen, the focus is not the treatment of the cough, but the Wen Xie. By conducting, clearing, once the Xie Qi is away, the cough is no longer a big problem. However, if the Phlegm-Hotness remains, it is hard to treat. If the Phlegm-Hotness remains not depleted, the body Qi could not circle smoothly, so the person has recurrent fever, hoarse cough, bloating in chest, red in urine. The phlegm is yellow and sticky. The tongue is more red than normal. The pulse is slippery and frequent. After a long time, the Yin portion of the body is damaged. The herbal therapy should aim to clear the Fire and the phlegm, to open and dredge the Three Jiao spaces of the body, so as to make the Qi circule smoothly and the Yin be restored gradually. The commonly used herbal formula is Xiao Xian Xiong Tang (Huanglian, Banxia, and Gualuren), Qian Jin Wei Jing Tang (Taoren, Yiyiren, Dongguaren, fresh Weijing or Lugen), Wen Dan Tang (Banxia, Fuling, Chenpi, Zhike, Zhuyu, Gancao), with more or less modification. With pain and bloating feeling in the chest, add Yujin, Shichangpu. With fever, add Shigao and Zhuye. With continuous fever, add more Lucao and Yuxingcao. The herb Huzhang works to open the body surface layer, and to clear Fire and to improve blood circulation, to dissolve phlegm and to open the body inner spaces. I use it often too.  

前面已经说过痰热久羁,其阴必伤,此际若多用滋腻,则适以动痰,所以不能早用滋腻,惟北沙参养阴而不腻滞,且有祛痰作用,可在清化痰热的同时用以护阴。草又名拉拉秧、过沟龙、锯锯藤,乡村田野,路边荒地,处处有之。最早见于《别录》,谓主瘀血,《唐本草》亦载,谓主五淋,并说占方时亦用之。《三因方》用治血淋。性味甘苦寒,无毒。有清热、利尿、清瘀、解毒之功。近世始有草及其花治肺活核(叶橘泉),肺病咳嗽,大叶肺炎(《贵州中草药》)及呼吸道炎症、气管炎、菌痢的报道。我体会草清肺泄热,利水活血,故用于温热性质的咳嗽是比较适宜的。但用量宜大,常用量鲜者可用至120g(煎汤代水)。

It has been mentioned that, when the phlegm-hotness remains for long time, the Yin must be damaged. In this time, if use more greasy herbs, it would create more phlegm. Therefore it should not be used in earlier stage the greasy herbs. Only the Bei Shashen works to nourish the Yin but not greasy, as well as to dissolve phlegm. It can protect the Yin, in the same time to clear the phlegm and fire…. I understand that, the herb Lucao works to clear the Lung, to deplete Fire, to improve water depletion, and to improve blood circulation. It is proper to be used in the treatment of cough of Hotness or Fire. Its dose should be bigger. The commonly used dose for a fresh Lucao can be up to 120g (decoct in water and use water to decoct other herbs).

 

7. 火热咳嗽

7. Fire cough

如前所述,六淫皆可化火:伤寒由表及里,温病由卫入气,燥邪化火,暑风化火,痰热化火不一而足。火为热之极,万物者莫过于火。其证面赤、发热、汗多、烦躁、口渴引冷,咳嗽痰少、痰色或黄或白,但无论黄痰白痰,必黏而稠,难咳出,痰中带血,咽痛、声音嘶哑或胸痛,便秘。舌红、苔黄、脉洪大滑数。古方有泻白散,泻白者,泻肺也。出钱乙。但此方适用于小儿,而且是热势不盛者,用于火咳则病重药轻矣。但后世许多治疗火热咳嗽的方子,多从此方衍化而出,如《医学统旨》的清金化痰汤(黄芩、栀子、桑白皮、知母、贝母、桔梗、麦冬、茯苓、橘红、甘草),《景岳全书》的桑白皮汤(黄芩、黄连、桑白皮、栀子、贝母、杏仁、半夏、生姜、苏子),《医宗金鉴》的加味泻白散(黄芩、桑白皮、地骨皮、知母、贝母、麦冬、桔梗、薄荷、甘草)。但火热太盛,里热成实者,仅用清热却如扬汤止沸,凉隔散(大黄、玄明粉、甘草、桅子、连翘、黄芩、薄荷、白蜜)可收釜底抽薪之效,不治咳而咳自止。

As discusses above, all the six Xie Qi can develop into Fire. For Shanghan disease, the Cold Xie Qi penetrates from body surface layer into the body. In the Wen disease, the Xie Qi starts from the Wei phase into the Qi phase. The Dryness Xie develops into Fire, and Shu-Wind Xie Qi develops into Fire, and the Phlegm-Hotness also develops into Fire, so and so on. For the Fire cough, the patient has red face, fever, lot of sweat, annoyed, thirsty and desires to drink cold water, sour throat, hoarse voice, or chest pain, constipation, and cough with only little phlegm. The phlegm is little. It can be yellow or white, but it is sticky and thick, hard to spit out. In the phlegm, there is blood. The tongue is more red than normal. The pulse is big, slippery and frequent. In the old herbal formula, there is one called Xie Bai San. Xie Bai means to deplete the Lung. This is herbal formula of Dr. Yi Qian. However, this formula is proper to use in child, and it should be used when the Fire is not severe. However, the formulae created in later tims are mostly developed from this formula. For example, the formula Qing Jin Hua Tang Tang in book <<Yi Xue Tong Zhi>> (Huangqin, Zhizi, Sangbaipi, Zhimu, Beimu, Jiegen, Maidong, Fuling, Juhong, and Gancao), formula Sangbaipi Tang in book <<Jing Yue Quan Shu>> (Huangqin, Huanglian, Sangbaipi, Zhizi, Beimu, Maidong, Jiegen, Bohe, and Gancao), and Jia Wei Xie Bai San in book <<Yi Zhong Jin Dian>> (Huangqin, Sangbaipi, Digupi, Zhimu, Beimu, Maidong, Jiegen, Bohe, and Gancao). However, if the inner Fire is too high so that the overwhelming condition has been developed inside the body, such Fire-clearing therapy is too far from sufficient. In such case, the herbal formula Liang Ge San (Dahuang, Xuanmingfeng, Gancao, Zhizi, Liangqiao, Huangqin, Bohe and white honey) can be used to deplete the Fire thoroughly. By this way, the cough would be stopped without any specific treatment for the cough per se.



[1] Si Sang Tang: Si means figure 4; Sang means mulberry ; Tang, decoction.

[2] Sangye means mulberry leaves; Sangshen: mulberry fruit; Sangbaipi: white bark of mulberry; Sangjisheng: mistletoe.

[3] A clinic condition, in which the patient feels very thirst and drink a lot and frequently. It is a similar clinic condition as the diabetes.

[4] Ku Gua: bitter gourd.

[5] The Qi nourishing herbs are not the same as Qi dredging herbs. The later could be Chenpi, Muxiang, Sharen, etc.