VI. Hepatitis B (HB)

In 1963, American scholar Blumberg discovered the "Australian antigen." In 1968, Japanese researchers Arakawa et al. established a link between the Australian antigen and blood transfusions and hepatitis. Later, many scholars proved that the Australian antigen was not merely a non-specific product shed during hepatocyte destruction, but rather a pathogenic factor with viral characteristics. In 1970, the Fourth International Conference on Liver Diseases adopted a resolution designating the Australian antigen as "hepatitis-related antigen" (HAA). In September 1972, at a conference on viral liver diseases convened by the United Nations, the name "hepatitis-related antigen" was abandoned in favor of "hepatitis B antigen" (HBsAg). The hepatitis B antigen is also known as the hepatitis B virus, abbreviated as HBV. Many scholars have demonstrated that HBsAg is found exclusively in the cytoplasm of hepatocytes; in fact, it serves as the outer protein shell of the hepatitis B virus, hence it is referred to as the hepatitis B surface antigen. Additionally, HBsAg is also present in the nuclei of hepatocytes. In 1977, the World Health Organization’s Liver Disease Expert Committee officially published the names of hepatitis antigens and antibodies: HBsAg, HBsAb, HBeAg, HBcAb, HBcAg, HBcAb—commonly known as the “three-system” approach. However, due to the difficulty in detecting HBeAg, this antigen is not readily visible in peripheral blood; it can only be detected in the nuclei of hepatocytes using immunoelectron microscopy. Typically, clinical institutions lack such equipment, so HBeAg is often absent, leading to the common term “two-and-a-half.”

1. LHBsAg and HBsAb

HBsAg typically appears in a patient’s serum several weeks before the onset of clinical symptoms of hepatitis B; it can even be detected as early as 3 months after the onset of disease. The presence of this marker indicates that the patient is infected with hepatitis B. The positivity rate for HBsAg in hepatitis B is 100%; after 3 months, the rate drops to 25%, while those who tested negative 3 months earlier are considered to have acute hepatitis B, suggesting that the HBsAg positivity in acute hepatitis B is transient. If HBsAg remains positive after six months, it indicates that the patient has progressed to chronic hepatitis C (CPH) or chronic hepatitis A (CAH). The level of HBsAg is generally not positively correlated with the severity of hepatitis B, nor is it positively correlated with ALT levels. The appearance of HBsAb often signifies that HBsAg is about to turn negative; with prolonged treatment, especially through effective traditional Chinese medicine therapies, HBsAb can turn positive. This is an important indicator of the impending recovery from hepatitis B. Healthy individuals who receive routine hepatitis B vaccinations often experience HBsAb turning positive, reflecting the body’s production of antibodies against HBV—and the successful outcome of immune interventions. Patients who test positive for HBsAg but do not undergo effective, long-term treatment often see HBsAb turn positive within 3–6 months of onset; these patients may be diagnosed with acute hepatitis B. Some scholars have also reported that a transient positive turn in HBsAb in cases of CAH or CPH does not necessarily indicate recovery.

2. HBcAg and HBcAb

In the nuclei of hepatocytes of hepatitis B patients, HBeAg can be detected using specialized immunoelectron microscopy—but it must be examined under an electron microscope. Peripheral blood generally lacks this antigen, though antibodies against it—HBcAb—can be detected. Core antibodies appear in peripheral blood relatively quickly after infection with hepatitis B virus; most studies indicate that the appearance of these antibodies occurs about 1–2 months after HBcAg, though their duration can be quite long. While HBsAg in acute hepatitis B is transient, HBcAb persists for a longer time, indicating that the virus is still present in small amounts. The hallmark of chronic hepatitis B is persistent positivity of HBcAb, while all other markers have already turned negative.

In summary, the presence of core antibodies (HBcAb) indicates that the body is carrying the virus. Though called “antibodies,” these antibodies do not provide protective effects and are not necessarily a sign of hepatitis B recovery. Most studies suggest a positive correlation between HBcAb and HBV-DNA, and some studies also indicate a positive correlation between elevated transaminases and HBcAb.

3. HBeAg and HBeAb

HBeAg is an important and reliable indicator of active HBV replication within the body; like HBV-DNA, it represents viral replication. However, HBV-DNA testing is more advanced and directly quantitative, making it more intuitive and reliable. The appearance of anti-HBe (HBeAb) indicates that HBV replication has subsided or weakened; at this point, HBeAg usually turns negative. People refer to this as “small three-positive,” while “large three-positive” refers to cases where HBeAg is positive but infectious, with a higher risk of liver damage. Conversely, “small three-negative” indicates low infectivity or near-zero infectivity, with minimal liver damage.

4. HBV-DNA and HBV-DNA-P

HBV-DNA (hepatitis B virus deoxyribonucleic acid) is the fundamental component of the virus. Using molecular biology techniques such as dot blot hybridization, HBV-DNA testing is one of the most advanced methods available today. More recently, the introduction of PCR-based cloning technology has further enhanced the accuracy and efficiency of HBV-DNA testing. A positive HBV-DNA result indicates viral replication; due to its extremely high sensitivity, HBV-DNA testing holds great diagnostic significance. Quantitative HBV-DNA testing is even more clinically relevant—typically, levels below 1×10³ are considered negative, while levels above 1×10³ are considered positive. Changes in quantification can help assess treatment effectiveness, making HBV-DNA testing a crucial tool in the field of hepatitis B management.

DNA-P (hepatitis B deoxyribonucleic acid polymerase) is another indicator of viral replication. It is generally believed that this enzyme exists in the body for a short time, with acute hepatitis B lasting about 2–4 weeks, while chronic hepatitis B can persist for much longer. Because this enzyme is not always detectable throughout the entire course of the disease, its significance is somewhat less than that of HBV-DNA.

PHSA-R (polyprotein receptor) is a product of the pre-S segment of the hepatitis B virus genome, possessing antigenic properties. Its positivity is closely associated with e-antigen, HBV-DNA, and DNA-P; due to the relatively simple requirements for clinical testing, this method can be widely adopted in primary healthcare settings.

5. Anti-HBc IgM and Anti-HBsAg IgM

Both are responses of the body’s antiviral immune system, reflecting the state of HBV replication. A positive anti-HBc IgM often indicates an acute episode or a potential acute episode in the patient; the presence of anti-HBsAg IgM suggests chronic hepatitis B.

6. C-Pre Region Mutations and YMDD Mutations

During treatment, hepatitis B can undergo two types of mutations. C-Pre region mutations result in “small three-positive” cases, where HBV-DNA levels are significantly elevated and replication is active. Meanwhile, YMDD mutations cause sustained elevations in ALT levels, despite conventional and other specific treatments. These two situations indicate refractory hepatitis B, with poor prognoses and a higher likelihood of developing liver cirrhosis or hepatocellular carcinoma. There are three main routes of hepatitis B transmission: ① Mother-to-child transmission—this is a critical route of transmission, often referred to as vertical transmission, involving blood-to-fetal transmission and perinatal transmission. However, the root cause lies in genetic factors; genetic inheritance does not mean inheriting the hepatitis B virus itself, but rather inheriting susceptibility to infection. Individuals with susceptible genes are more likely to become infected with HBV. When mothers and fathers are hepatitis B patients, their children may inherit susceptibility genes through genetics. Factors such as fetal blood and the birth canal create opportunities for infection, making them more likely to become hepatitis B carriers. ② Blood transfusion transmission or contact transmission—often referred to as horizontal infection. Approximately 60%–80% of these infections can be cleared by the body’s own immune function, while only 5%–10% of infected individuals develop the disease. In conclusion, the HBV infection rate in China reaches 50%–80%, while only 5%–12% of cases develop the disease. This highlights the profound impact of individual susceptibility and immune clearance mechanisms on hepatitis B incidence.

Review of Antiviral Treatment for Chronic Hepatitis B

Hepatitis B virus (HBV) is a hepatotropic virus; there are currently six well-known hepatotropic viruses: A, B, C, D, E, and G. Among these, hepatitis C and hepatitis B are the most likely to lead to chronic infection. Although hepatitis C tends to be more severe than hepatitis B and has a poorer prognosis, hepatitis C is far less common in China compared to hepatitis B. Moreover, the government has recently placed greater emphasis on the production, use, and management of blood transfusions and blood products, leading to a gradual decrease in hepatitis C incidence. Hepatitis B remains prevalent across China, with an infection rate of 50%–70% among the general population. Estimates suggest that the average infection rate is around 57.6%, and over 100 million people are estimated to have chronic hepatitis B, with annual deaths from hepatitis B-related diseases reaching 270,000. As such, antiviral treatment for hepatitis B—especially chronic hepatitis B—is a pressing issue of great concern for the medical community today.

Complete recovery from hepatitis B is indeed challenging, as HBV enters the liver, fuses with the hepatocyte membrane through its outer shell (HBsAg), and then enters the cytoplasm before eventually migrating into the nucleus, where it transforms intocccDNA. cccDNA serves as a template for hepatitis B virus replication; this template continuously produces mRNA, allowing the virus to replicate e-antigen, core antigen, and surface antigen within the cytoplasm. Because cccDNA has a long half-life—almost equal to the half-life of hepatocytes—when hepatocytes divide and replicate, cccDNA is passed along to daughter cells. To date, no medication has been able to eliminate the existence of the cccDNA template. As long as cccDNA exists, it can continuously release large quantities of HBeAg, HBcAg, and HBsAg. Beyond its hepatotropic properties, cccDNA can also infect cells in other peripheral organs, particularly mononuclear cells in peripheral blood, thereby establishing immune tolerance. As the saying goes, “the higher the Dao, the greater the demon”; cccDNA constantly mutates, evading immune clearance. Common mutations occur in the pre-C and C regions of the HBV genome, known as pre-C region mutations. These patients may have “small three-positive” results, but the functionality of cccDNA remains highly active, with ongoing viral replication and high HBV levels, making them more prone to chronic infection and cancerous transformation. Such mutations are often resistant to various treatments. Another type of mutation occurs in the YMDD region of the HBV genome; this mutation is characterized by persistent elevated ALT levels, resistance to conventional treatments, and the presence of “small three-positive” results—indicating no viral rebound. These mutations are also prone to chronic infection and cancerous transformation.

The aforementioned characteristics of hepatitis B make it a difficult disease to treat. Although various therapeutic drugs are currently available, their efficacy remains unsatisfactory.

1. Alpha Interferon: 3 million units, administered three times a week for a 24-week course, followed by a 48-week course. The HBsAg conversion rate is only 10%–12%, while the HBeAg conversion rate is around 40%.

2. Pegylated Interferon: A combination of pegylated polyethylene glycol and interferon, characterized by slow release and a longer half-life, thus improving treatment efficacy. Administered via intramuscular injection once a week, this approach greatly reduces the burden of injections for patients. Currently, there are two commercial formulations of this product: Pegasys and Peferon. Pegasys consists of 40 kD of alpha-molecular-weight polyethylene glycol combined with one alpha-interferon 2α, typically at 180 µg, administered once a week. After 24 weeks, HBsAg conversion rates reach 33%. This medication’s efficacy is comparable to that of conventional treatments. Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input: The efficacy of interferon is 23% higher. Pelienu is a linear combination of polyethylene glycol interferon, with functions largely similar to those of Pirohine.

3. Lamivudine (Hepsera): It is rapidly absorbed orally, reaching peak levels within 1 hour. A single dose of 100 mg once daily can result in an HBeAg seroconversion rate of 22% over one year; however, for patients with YMDD mutations, this rate drops to 10%. The oral administration of this medication for one year yields a HBsAg seroconversion rate that is roughly equivalent to that of standard alpha-interferon, ranging from approximately 10% to 12%.

4. Adefovir dipivoxil: This is a recent antiviral drug for the treatment of hepatitis B. Preliminary data indicate that after 48 weeks of treatment, a single dose of 100 mg once daily resulted in a significant difference compared to the control group’s Hepsera. Some studies have found that 70% of patients experienced HBsAg seroconversion after a 98-week course of treatment, among whom 79% showed improvements in liver biopsy findings, and ALT levels also improved more markedly than with conventional medications. Currently, this drug is undergoing clinical trials abroad, and it is said that China is also developing it. If production begins soon, it could benefit many people.

Other medications used to treat hepatitis B include glycyrrhizin, Ganli Xin, oxidized matrine, and even traditional Chinese medicine formulations like “Ant” preparations, which have shown efficacy lower than that of alpha-interferon. Additionally, there are nucleoside analogs such as acyclovir, whose efficacy is also inferior to alpha-interferon.

Traditional Chinese medicine offers a rich variety of treatments for hepatitis B. However, treatment outcomes vary significantly from region to region. Some practitioners engage in fraudulent practices, deceiving patients and seeking financial gain—such as claiming to achieve 100% seroconversion or offering refunds if treatment fails. These practices have become increasingly common in society, with advertisements promoting “100% surface antigen seroconversion,” which has greatly influenced public perception of traditional Chinese medicine for hepatitis B. After more than 20 years of experience treating hepatitis B, I developed two pure traditional Chinese medicine formulations for hepatitis B: Hepatitis B No. 2 and Hepatitis B Kang. The former is available as granular powder, while the latter comes in honey pills, both of which are easy to take and convenient to carry. Given that treating hepatitis B is a long-term, systematic endeavor, these formulations can be taken continuously over several years. Over the past 20 years, we have treated more than 100,000 hepatitis B patients, including around 3,000 cases with detailed medical records. Among these patients, over 1,000 continued taking the medications for more than a year. Out of the 1,000 patients, 207 achieved surface antigen seroconversion, representing 20.7%; 402 patients experienced e-antigen seroconversion, accounting for 40.2%. Patients can simply take the above-mentioned powders or pills for hepatitis B treatment. However, when liver function is severely impaired, or when patients experience severe pain in the liver area or other symptoms, they may also consider taking traditional Chinese medicine decoctions. I typically use formulas like Xiao Chai Hu, Dan Zhi Xiao Yang San, Qiang Gan Tang, Yi Gui Tong Yuan Yin, Gui Pi, and Xiang Sha Liu Jun Zi Tang, adjusting the prescriptions based on individual syndromes, often achieving the desired therapeutic effects.

Myasthenia Gravis and Polyradiculitis

Both conditions can cause weakness or mild paralysis in one side of the body or in a single limb, along with mild or severe impairment of limb movement. Due to these symptoms, myasthenia gravis and polyradiculitis are often confused in clinical practice. Myasthenia gravis is an autoimmune disorder primarily affecting the neuromuscular junction, characterized by prolonged muscle weakness and fatigue before onset, which severely impacts voluntary movements. Some cases may develop severe progressive atrophy. The primary sites of onset include facial muscles (affecting speech, chewing, smiling, and biting), muscles surrounding the eyes (impacting eye movement, double vision, strabismus, etc.), tongue muscles (affecting mouth and nose, speech), shoulder muscles (affecting upper limb movement), pelvic muscles (affecting lower limb movement), and even muscles in the limbs such as the triceps brachii and quadriceps femoris, exacerbating muscle dysfunction in the limbs. In addition, myasthenia gravis can trigger various sudden, life-threatening crises. During a crisis, patients may experience dilated pupils, reduced secretion from the lacrimal and salivary glands, and even no secretions at all; patients may become extremely weak and fall into a coma—a condition known as adrenergic crisis. Another type of crisis is called acetylcholine crisis, where patients experience constricted pupils, increased secretions, enhanced intestinal peristalsis, abdominal pain, diarrhea, and profuse sweating. Both types of crises are characterized by muscle weakness; the former is due to heightened sympathetic nervous system activity, while the latter is due to heightened parasympathetic nervous system activity. Both conditions are referred to as myasthenic crisis. Polyradiculitis, on the other hand, is caused by inflammation of the nerve roots due to influenza viruses or various infections. Initially, patients experience muscle pain in the areas innervated by the affected nerve roots, followed by muscle atrophy, motor disorders, and functional impairments. This condition is relatively common in clinical practice, whereas myasthenia gravis is much less frequently observed!

Modern medicine still lacks effective treatments for these two conditions. As myasthenia gravis is an autoimmune disease, hormone therapy or immunosuppressive drugs like cyclophosphamide offer only temporary relief. Surgical intervention is recommended if the patient also suffers from thymoma. When a crisis occurs, targeted treatments such as neostigmine or epinephrine may be administered. Previously, the primary treatment for polyradiculitis was hormone therapy and immunosuppressive drugs; however, recent studies have yielded mixed results regarding the long-term efficacy of these therapies. Vitamin B1, B2, B6, and B12 are essential supplements that can provide some therapeutic benefits.

Given that Western medicine's effectiveness for these conditions remains uncertain, traditional Chinese medicine and other alternative therapies have gained widespread attention. Since 1995, I have treated dozens of patients with these conditions, all of whom were treated according to traditional Chinese medicine diagnostic principles. First, it should be noted that traditional Chinese medicine does not distinguish between these two conditions strictly; however, polyradiculitis tends to be associated with blood deficiency and wind, while myasthenia gravis is often linked to qi deficiency. I often prescribed Feng Yian Tang from Jin Kui, the Fuzi Compound Tao Hong Si Wu Tang from Zhao Xin Bo, and the Zhen Sui Tang from Zhang Xichun for the former; while for the latter, I used Bu Zhong Yi Qi Tang, Ba Xian Chang Shou Wan, and Ba Zhen Tang with additions. One patient presented with drooping scapulae and weakness in the left arm; another patient had weakness in both legs, making walking difficult. Both patients reported numbness in their limbs. Initially, I treated them for myasthenia gravis, but since qi deficiency was not addressed, I tried Bu Zhong Yi Qi Tang and Ba Xian Chang Shou Wan, but these treatments did not yield satisfactory results. I then turned to Feng Yian Tang from Jin Kui: raw gypsum, cold water stone, purple quartz, white quartz, raw dragon and cowrie shells, red stone fat, white stone fat, talc, cinnamon twig, rhubarb, dried ginger, nodding yam, papaya, qin tiao, wuling xian, rehmannia root, angelica sinensis—these ingredients were decocted and taken once daily for 10 doses. The patient showed significant improvement; after 15 doses, the second patient also saw marked improvement. Both patients were women, middle-aged or elderly, with a history of multiple pregnancies. One patient was frail and frequently caught cold, while the other suffered from chronic stomach pain and weight loss. I also treated a patient with myasthenia gravis who had drooping eyelids on one side, occasional double vision, and weak, flaccid muscles in the limbs—making it difficult to raise hands or feet. This patient had previously undergone surgery for a thymoma 10 years ago, and his serum IgG levels were elevated, along with positive antibodies against serum cholinesterase and citrate extract from skeletal muscle, as well as positive antibodies against striated muscle. Diagnosis: myasthenia gravis. I then prescribed Bu Zhong Yi Qi Tang with additions: codonopsis, atractylodes macrocephala, astragalus, citrus peel, licorice, bupleurum, ascendens, dodder seed, goji berries, late silkworm sand, deer antler glue, eucommia bark, cassia bark, and cinnamomum cassia—these ingredients were decocted and taken once daily for 10 doses. After 10 doses, the patient felt better mentally, double vision had disappeared, and limb movement improved compared to before.

Appendix 1: Blood-Nourishing and Wind-Dispelling Formulas

① Additions to Feng Yian Tang: raw gypsum, cold water stone, purple quartz, white quartz, raw dragon and cowrie shells, red stone fat, talc, cinnamon twig, rhubarb, dried ginger, nodding yam, papaya, qin tiao, wuling xian, rehmannia root, angelica sinensis.

② Zhao Xin Bo’s Formula: peach kernels, safflower, angelica sinensis, rehmannia root, red peony, chuanxiong, qin tiao, chuan duan, nodding yam, ginger insect, whole scorpion, cypress leaf, papaya, stretching grass—these ingredients were decocted and taken once daily.

③ Zhang Xichun’s Zhen Sui Tang: codonopsis, atractylodes macrocephala, astragalus, jinyu, fresh ginger, processed milk vetch, hawthorn fruit, round flesh, raw dragon and cowrie shells, nodding yam, wuling xian—these ingredients were decocted and taken once daily.

Appendix 2: Qi-Nourishing and Wind-Dispelling Formulas

① Bu Zhong Yi Qi Tang with additions of dodder seed, goji berries, black nightshade, and polygonum cuspidatum—these ingredients were decocted and taken once daily.

② Mai Wei Di Huang Wan with additions of cinnamon, raw cortex, eucommia bark, chuan duan, locky, large mulberry, deer antler glue, turtle shell glue—these ingredients were decocted and taken once daily.

③ Ba Zhen Tang with additions of ginger insect, whole scorpion, centipede, leech, cicada, these ingredients were decocted and taken once daily.

Treatment Experiences with Multiple Liver Cysts

Since the advent of ultrasound, CT scans, and MRI imaging techniques, our understanding of liver cysts has become much clearer. Generally speaking, liver cysts are considered congenital conditions—single or few liver cysts do not require special treatment. If patients experience symptoms such as pain in the liver area, symptomatic treatment may be employed, or appropriate liver-protective therapies can be administered. If no symptoms are present, the cysts may be left alone, allowing them to naturally resolve. Of course, patients should pay attention to alcohol consumption and excessive intake of fatty or sweet foods to avoid harming their liver. Multiple liver cysts can sometimes lead to serious complications, especially when the cysts are densely packed throughout the entire liver tissue. The liver may enlarge, the bile ducts may become compressed, leading to worsening jaundice; the portal system may also be affected, resulting in portal hypertension.

In the autumn of 1995, I treated two patients with liver cysts in my outpatient clinic. One patient had an enlarged liver extending down to the upper opening of the pelvis, yet the patient moved as normally as anyone else; their spleen was not enlarged, there was no ascites, and no jaundice was present. Ultrasound and CT scans confirmed the diagnosis of “multiple liver cysts.” Another patient presented with jaundice, enlarged liver, ascites, enlarged spleen, and a darkened complexion. Initially, the patient was diagnosed with cirrhosis (after treatment for ascites and jaundice failed, and ultrasound and CT scans confirmed the diagnosis of “multiple liver cysts”). Both patients had liver cysts; the former had no additional symptoms beyond the enlarged liver extending into the pelvis, and the patient reported no discomfort whatsoever. Upon careful examination of the CT scans, it was evident that the cysts were evenly distributed throughout the liver, covering the entire organ, with healthy liver tissue clearly visible between the cysts. The other patient, however, exhibited both bile duct obstruction and splenic enlargement, along with ascites—and upon closer inspection of the CT scans, it became clear that the cysts in this case had fused together, leaving little healthy liver tissue remaining in certain areas. Although both patients had multiple liver cysts, their clinical presentations differed dramatically. The first patient had no history of hepatitis B, while the second patient had a history of hepatitis B spanning over 10 years. I concluded that the second patient’s liver cysts were likely secondary to liver cirrhosis caused by hepatitis B. The first patient, having no symptoms, lived in a financially disadvantaged household and had never taken any medication for treatment; the second patient had previously used interferon and underwent a cesarean section three years ago. During the surgery, no mass lesions were identified, and the patient was discharged. However, as the patient’s condition worsened, jaundice deepened, ascites increased, and overall health deteriorated. I admitted the patient to the hospital, administering liver-protective, anti-inflammatory, and diuretic medications. At the same time, I prepared the following formula: 10 g of bupleurum, 10 g of fructus aurantii, 10 g of paeonia lactiflora, 6 g of licorice, 6 g of chuanxiong, 6 g of ligusticum chuanxiong, 10 g of rhubarb, 10 g of scutellaria baicalensis, 3 g of coptis chinensis, 10 g of agastache, 10 g of amomum villosum, 20 g of ligusticum chuanxiong, 3 g each of fructus aurantii, rhubarb, and amomum villosum, 10 g of gardenia, 10 g of gardenia, 16 g of lonicera japonica, all decocted and taken once daily. After 10 doses, the patient reported feeling more comfortable in the upper abdomen, and added 20 g of herbaceous snake tongue and 20 g of half-moon vine to the formula, allowing the patient to return home for recovery. Three months later, the patient returned for a follow-up visit, reporting that after more than 70 doses of medication, their condition had improved day by day: jaundice had subsided, ascites had resolved, the liver was softer, and the spleen was similarly enlarged as before. CT scans revealed multiple liver cysts in the liver. Liver function was normal. The albumin-to-globulin ratio remained imbalanced. As the patient’s condition began to improve, I formulated a pill using honey as a binder to support long-term treatment: 100 g of gentiana, 100 g of gardenia, 100 g of lonicera, 100 g of angelica sinensis, 100 g of paeonia lactiflora, 60 g of bitter orange peel, 60 g of ligusticum chuanxiong, 200 g of oyster, 30 g of safflower, 100 g of hawthorn, 100 g of atractylodes macrocephala, 100 g of rhubarb, 3 g of coptis chinensis, 100 g of scutellaria baicalensis, 200 g of salvia miltiorrhiza, 100 g of agastache, 100 g of amomum villosum, 300 g of astragalus, 100 g of angelica sinensis, 100 g of quercetin, 100 g of ginseng, 100 g of angelica sinensis, 100 g of qin tiao, 100 g of indigo plantain, all ground into a fine powder, sifted through a sieve, and made into pills weighing 7 g each, taken three times daily after meals with warm boiled water. Two years later, the patient returned for a follow-up visit, reporting that they were as healthy as a normal person. Ultrasound confirmed only multiple liver cysts, with no abnormalities found in the spleen, pancreas, or gallbladder. Liver function tests were all within the normal range.

Looking at the treatment of these two cases, we see that although liver cysts themselves can cause significant liver enlargement, if liver function can be protected from further damage over time—by avoiding excessive alcohol consumption, preventing accidents, and refraining from taking medications that harm the liver—then liver cysts are, after all, congenital conditions, and the liver’s compensatory mechanisms can still be maintained. However, if other liver diseases are triggered on top of liver cysts, such as acute hepatitis B infection, or if other factors that damage the liver are present, liver cysts can quickly develop clinical symptoms. The second patient was one such case; after receiving immediate, symptomatic treatment combining traditional Chinese and Western medicine, the patient recovered remarkably. By the time of the final follow-up visit, all symptoms had resolved, except for the persistent presence of “multiple liver cysts.”

A Brief Overview of Autoimmune Diseases

In the mid-20th century, a group of non-bacterial infectious diseases were classified under the umbrella of “collagen diseases,” as they often led to widespread damage of the collagen fiber system throughout the body. Examples include lupus erythematosus, rheumatoid arthritis, and nodular periarteritis. Later, researchers discovered that these diseases not only affect the collagen system but also the entire connective tissue system, so in the 1970s, the term “connective tissue diseases” was adopted. Over the past 30 years, as our understanding of immune function has deepened, we’ve come to recognize that these diseases share a common characteristic: defects in the body’s immune system. The immune system’s role is to distinguish between “self” and “non-self,” and normal immune responses only target “non-self” by producing antibodies to eliminate it. However, in autoimmune disorders, the immune system mistakenly attacks the body’s own healthy tissues, triggering pathological immune responses. Although these diseases come in many forms and exhibit diverse symptoms, they share a common trait: rapid erythrocyte sedimentation rate, joint pain, high fever, skin rashes, and other symptoms. Almost all connective tissue diseases—formerly known as collagen diseases—are part of this category. Recently, as our understanding of these diseases has grown, conditions such as myasthenia gravis, necrotizing lymphadenitis, sarcoidosis, cholestatic cirrhosis, allergic purpura, multiple sclerosis, Crohn’s disease, subacute bacterial endocarditis, and AIDS—all fall under this category and are collectively referred to as autoimmune diseases. Some scholars have even proposed that hepatitis B may also be an autoimmune condition. This is because hepatitis B exhibits strong familial susceptibility; according to evidence-based medical statistics, in families where multiple individuals are infected with the hepatitis B virus, at least one or two healthy members will never contract hepatitis B, even if they live with the patient for extended periods, sharing meals and living together. For autoimmune diseases, Western medicine primarily uses hormones as first-line treatments, but these medications often lead to a rebound effect of up to 100%, and they are highly addictive—increasing dependence as usage continues, ultimately resulting in adverse effects such as central obesity, a full moon face, a buffalo-like abdomen, excessive hair growth, sodium and water retention, and a weakened immune system. Besides hormones, immunosuppressive agents like cyclophosphamide and methotrexate can also be used in clinical treatment, but their long-term efficacy remains debated, and complete cures are still rare.

How do traditional Chinese medicine and other alternative therapies view autoimmune diseases? While I haven’t yet seen any valuable reports on this topic, based on my more than 40 years of experience, I believe these conditions fall within the scope of “wind” syndrome in traditional Chinese medicine. According to the principle that “wind is a disease that moves easily and changes frequently,” “wind is the root of all diseases,” and “when wind combines with cold, heat, or dampness, it finds its natural path,” joint disorders are often attributed to wind-related conditions; renal edema is often associated with wind-water; high fever that doesn’t subside is often caused by wind-fire interaction; bacterial diarrhea is often due to wind-dampness causing blood to flow out of the intestines; skin rashes are often caused by wind toxins or measles… Whenever I encounter these conditions, I always employ methods that dispel wind, remove dampness, unblock the pathways of wind, and clear heat—methods that have proven effective. The “Gui Zhi Shao Yao Zhi Mu Tang” formula from Jin Kui is widely known in medical circles for treating rheumatic and rheumatoid arthritis; the formula states, “For all joint swelling and pain, accompanied by physical weakness, leg swelling as if they’re being pulled off, dizziness, shortness of breath, and a feeling of wanting to vomit, Gui Zhi Shao Yao Zhi Mu Tang is the main remedy.” This formula treats not only joint swelling and pain but also physical weakness, dizziness, shortness of breath, and a desire to vomit. Based on my 40 years of clinical experience, whenever I encounter autoimmune diseases—such as lupus erythematosus, purpuric nephritis, Sjögren’s syndrome, rheumatoid arthritis, subacute bacterial endocarditis—when I ask about the symptoms, I often find that patients frequently respond well to Gui Zhi Shao Yao Zhi Mu Tang. In the autumn of 2000, I treated two patients with systemic lupus erythematosus, both of whom responded effectively to treatment plans primarily based on Gui Zhi Shao Yao Zhi Mu Tang.

Ms. Ma, female, 52 years old, an employee at Lanzhou Railway College, experienced joint pain, edema, anemia, liver function impairment, long-term proteinuria in her urine (++ to +++), occult blood in her urine (++ to +++), blood pressure of 24/13.3 kPa (180/100 mmHg), frequent fevers, and a temperature reaching 39–40°C during colds. Her erythrocyte sedimentation rate was 98 mm/h. She had been hospitalized multiple times in Beijing and other places, and was diagnosed with systemic lupus erythematosus. The patient had been taking hormones for a long time, and her face had become full moon-shaped, with central obesity, and her overall health was extremely weak. When I examined her pulse, I found two pulses—tense and rapid, with a weaker radial pulse. Her tongue was red and swollen, with a thick, yellowish coating. Traditional Chinese medicine diagnosed her as suffering from wind combined with heat entering the interior, with chronic illness affecting the liver and kidneys. I prescribed Gui Zhi Shao Yao Zhi Mu Tang with additions: 10 g of bupleurum, 10 g of paeonia lactiflora, 10 g of coptis chinensis, 6 g of dried ginger, 6 g of licorice, 12 g of Fangfeng, 10 g of ephedra, 10 g of atractylodes macrocephala, 6 g of raw rehmannia root, 10 g of hawthorn, 10 g of mountain yam, 10 g of red peony, 6 g of cicada, 6 g of ginger insect, 10 g of ligusticum chuanxiong, 10 g of peach kernels, 6 g of safflower, 10 g of bupleurum, 10 g of coptis chinensis, 6 g of rhubarb—these ingredients were decocted and taken once daily. After 20 doses, her ALT dropped from 128 U/L to 48 U/L, and her urine protein levels decreased to (+), while her urine occult blood test came back negative. I added 30 g of astragalus and 30 g of salvia miltiorrhiza to the formula, ground them into a fine powder, sifted through a sieve, and made pills weighing 6 g each, taken three times daily with warm boiled water. Six months later, the patient returned for a follow-up visit, reporting that her condition had remained stable since starting the medication—she had not experienced any major flare-ups, her body temperature was normal, and her erythrocyte sedimentation rate had dropped to 36 mm/h. Traditional Chinese medicine teaches that “to treat wind, first activate blood circulation; when blood is active, wind naturally dissipates.” When treating autoimmune diseases, I often use blood-activating and stasis-resolving herbs, and I have found success. Since 1997, I have treated nearly 100 patients with allergic purpura, all of whom benefited from formulas that cleared heat, detoxified, and activated blood circulation—often adding Gui Zhi Shao Yao Zhi Mu Tang to these formulas, with exceptionally satisfying results. The basic ingredients of the formulas are as follows: honeysuckle 15 g, Forsythia 15 g, Dandelion 15 g, Bidens pilosa 15 g, Polygonum cuspidatum 15 g, white peony 10 g, black sesame seeds 20 g, white horsetail 20 g, Fangfeng 12 g, Alisma 10 g, red peony 10 g, cicada 6 g, ginger insect 6 g, ligusticum chuanxiong 10 g, peach kernels 10 g, safflower 6 g, bupleurum 10 g, coptis chinensis 10 g (decocted for 1 hour), dried ginger 6 g, atractylodes macrocephala 10 g—these ingredients were decocted and taken once daily, diluted with warm boiled water.

From my perspective, wind is a disease rooted in allergic reactions, and it also shares characteristics of autoimmune defects. I use Gui Zhi Shao Yao Zhi Mu Tang to treat rheumatism, and I use Tao Hong Si Wu Tang to treat rheumatism that has entered the internal organs—using cicada and ginger insect to stop wind-induced spasms. The basic formula includes these components: the large dose of aconite in Gui Zhi Shao Yao Zhi Mu Tang serves as a powerful tonic to replenish yang energy and restore yang vitality. Coptis chinensis is also crucial; without it, patients who take large doses of aconite may experience unbearable burning sensations throughout the body. Without this large dose of aconite, yang energy becomes too abundant and harms yin; without bupleurum, yang energy cannot be properly gathered in the internal organs. Given this, the three ingredients in Gui Zhi Shao Yao Zhi Mu Tang—bupleurum, paeonia lactiflora, and coptis chinensis—act as auxiliary tonics for aconite. Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input: 发挥作用之重臣耳。阳盛则若阳光之普照，补阳乃"益火之源以消阴

翳"，阴翳之邪深入血脉，非活血化瘀之品无以胜之，桃红四物汤堪

当此任耳，蝉衣、姜虫乃血肉有情之品，深入血络以搜其风也，古云

"治风先活血，血活风自灭"，此之谓也。

痛风漫谈

痛风乃西医之病名，此病系血清中尿酸超过正常界线所致。尿

酸为蛋白质代谢之终末产物之一，通常在血清中有一定含量，男

450µmol/L、女350µmol/L之内，高于此则说明尿酸过剩。血中之尿酸

系待排之废品，一方面自尿中排泄，另一方面又产生新的尿酸，二者处

于动态平衡中，因而常人之血尿酸处于一定水平。血尿酸之增高说

明蛋白质代谢过剩，蛋白质饱含于肉蛋类食物，故而此病易出现于

过食肥甘之肥胖人、通常不参加体力劳动者、脑力劳动而缺乏体育

锻炼者。鉴于此痛风与糖尿病、高血压、动脉粥样硬化、冠心病、胆结

石、胆囊炎等病之发病人群基本相同。以上高尿酸、高血糖、高血脂、

高血粘、高血压被称为发生动脉粥样硬化之五大因素，通常称为五

高症。高尿酸引致痛风，痛风之主要症状是关节痛，通常称之为痛风

性关节炎，此种关节炎最易发生于脚之大指及无名指，次则踝关节、

膝关节，亦有全身关节普遍疼痛者，盖尿酸之质重向下，沉积于下肢

关节者多也。沉积于皮下则形成痛风结石，沉积于胆、肾者亦有之，

与通常之胆、肾结石无异。痛风性关节炎之特点和一般炎症一样也

具有红热肿痛四证候，并呈现反复发作或周期性发作之特点。晚期

可因尿酸在肾脏沉积而出现肾炎样改变，最终形成慢性肾功能衰

竭。痛风之西医治疗，急性发作期首选秋水仙碱口服1mg，---日3次，

痛重者可2小时1次，首剂lmg，继则每次0.5mg，每日最高剂量为6mg，

痛在48小时内通常可以缓解，缓解后每日0.5mg维持之。另外别嘌呤、

丙磺舒亦为治疗此病之常用西药，前者100mg，一日3次；后者0.25g，

一日2次，可逐渐增加至一日3～4次。上述三药均有发热、皮疹、胃肠

不舒等副作用，仅在部分患者出现。三药均可减少尿酸之产生，同时

增加尿酸之排泄。

中医中药对痛风之治疗尚有较好之疗效。常用方药如下：①复

方当归拈痛汤：当归10g、赤芍10g、苍术6g、忍冬10g、羌独活各10g、防

己10g、防风12g、木瓜20g、猪苓10g、油松节20g、葛根10g、茵陈15g、虎

杖15g、甘草6g，水煎服，一日1剂。②消痛饮：当归10g、赤芍10g、牛膝

10g、钩丁20g、忍冬15g、防己10g、防风12g、木瓜20g、桑枝30g、猪苓

10g、泽泻10g，水煎服，一日1剂。③复方二妙散：苍术施、黄柏6g、独羌

活各15g、桑枝30g、寄生15*赤小豆20g、晚蚕砂10g、木瓜30g、汉防己

10g、土茯苓15g、丹参20g虎杖10g、泽泻20g、猪苓10g，水煎服，一日1

剂。

上述三方中，当归拈痛汤方出李东恒《兰室秘藏》，消痛汤为笔

者经验方，二妙散方出朱丹溪《丹溪心法》，三方之共同药物为猪苓、

泽泻、羌活、独活、防风、防己、苍术等味，说明此证之治疗必先以猪

苓、泽泻、防己通利小便，使湿热自小便而去；同时以羌活、独活、防

风祛风胜湿以去滞留于关节、肌肤之湿热之邪。笔者认为痛风一病

之中医用药应抓住胜湿、利水、祛风三个环节，始能药中病的。

亚急性甲状腺炎与慢性淋巴性甲状腺炎

亚急性甲状腺炎为自身免疫性疾患，近年来由于核素检查之临

床应用，诊断率较前增加，各地报告之发病较前大增。此病之病因目

前尚未明确，一般认为与病毒感染有关。甲状腺体可因嗜中性粒细

胞、淋巴细胞之浸润而肿大，伴有局部之疼痛和全身之不舒和发烧。

一部分患者可出现心悸、多汗、四肢振颤；一部分患者则可出浮肿、

乏力、怕冷、停经。前者为甲亢症状，后者为甲减症状。此病之发病女

性多于男性，二者之比例约为1.6：1，好发于20～40岁之年轻人，检验

方面主要是血沉增快，T3T4时有增高，血清蛋白结合碘增高，甲状腺

吸碘率明显低于正常。西医治疗此病以激素强的松为首选，局部疼

痛可给非螢体清热止痛药消炎痛、布洛芬等，有时可给一段抗生素

以预防感染。总体看西医之上述治疗仅取一时之效，并无根治之法。

中医中药对此病之治疗尚称满意，综观国内治疗此病之中医方药，

大体不出清热解毒、消療散结、扶正固本、祛风胜湿诸法。笔者积40

余年之临床经验，认为此病乃风邪外犯，入里化火，湿热相合，久病

入络之所致。盖此病始起于感冒者居多也，感冒者非风寒即风热，二

者入里皆可化火，常人之正气充胜，风邪弗能入里，正虚之患者则风

邪入里也，此与现代医学所述自身免疫之缺陷不无相合耶？现代免

疫学认为当机体自身免疫系统之识别"自我"、"非我"功能紊乱时，

则发生所谓自身免疫性疾患，亚甲炎之发病亦有斯说。自身免疫性

疾患之实质乃机体自身所产生之一种错误之变态反应，如红斑性狼

疮、类风湿性关节炎等。笔者采用治疗类风湿性关节炎公认有明显

疗效之《金匮要略》经典方剂桂枝芍药知母汤加味治疗亚甲炎屡获

大效。用方基本组成如下：桂枝10g、白芍10g、知母10g、干姜6g、甘草

6g、防风12g、麻黄10g、白术10g、附片5g、银花20g、连翘20g、地龙15g、

夏枯草15g、元参10g、生龙牡各15g、黄芪20g、当归10g、生地12g，水煎

服，一日1剂。

2000年（庚辰）3月，一女，32岁，教师，近1月来颈前疼痛，忽冷忽

热，全身骨节时有不舒，口干咽痛，大汗，心悸，手指振颤，经査丁3工

均略高于正常。前医曾以抗生素静脉点滴10余日无效，余令补查血

清蛋白结合碘及甲状腺吸碘率，结果前者高于正常，后者低于正常。

诊断：亚急性甲状腺炎。遂以前方10剂投之，2周后复诊，谓诸症皆

轻，尤其颈前甲状腺之疼痛已完全消失。此患者未用激素而病情迅

速好转，余高兴之至，自忖前方中之桂枝芍药知母汤具激素之调节

作用，此后每遇斯病总以桂枝芍药知母汤加味投之，总是获效者多。

在桂枝芍药知母汤之基础上每加银花、连翘辈以清热解毒，盖风邪

入里化火，散则热、聚则毒，清热解毒势在必行也；加元参、浙贝、生

龙牡者消癘丸也，病发于瘿体之上，癥痕积聚于斯，非消療丸无以胜

之，加黄芪、生地、当归者扶正固本也，亦具调节免疫功能之作用。

亚急性甲状腺炎反复发作不愈，最后残留甲状腺之肿大，形成

慢性甲状腺炎之过程，亦有不经甲状腺亚急性炎症过程而直接以慢

性起病者，此名慢性淋巴细胞性甲状炎，亦称乔本氏病。亚甲炎与慢

性淋巴细胞性甲状腺炎间之根本不同是病程之快、慢和病状之缓

急，然而二者共同点却显而易见，二者共同特点为：①甲状腺球蛋白

抗体阳性，②血清蛋白结合碘增高而甲状腺吸碘率低下，③白球蛋

白比例失调、γ球蛋白增加，④血沉增快，⑤T3、T4随病变状况可高可

低，二病均为慢性病程，其间可见甲亢症状，亦可见甲减症状，见甲

亢者T3、T4增高，见甲减者T3、T4降低。余之经验：①发作期呈甲亢状，

静止期呈甲减状，②伴外感者多见甲亢，不伴外感者多伴甲减，③亚

甲炎伴甲亢者多，慢性淋巴细胞性甲状腺炎伴甲减者多。总之亚甲

炎与乔本氏病（慢性淋巴细胞性甲状腺炎）之根区别是病理活检，临

床上实不易区分之。1956年日本学者乔本氏首先报告了慢性淋巴细

胞性甲状腺炎，因而此病曾命名为乔本氏病。后来发现了与此相类

同，但甲状腺之炎性浸润以嗜中性多形核为主，而非淋巴细胞为主

者则称为亚甲炎。西药治疗此二病已如上述，首选激素，曾有人认为

乔本氏病仅在早期可用激素（肾上腺皮质激素），余之经验晚期亦当

用之，盖该病之晚期约大半呈甲减状态，所谓甲减状态大体有下列

五类症状：①乏力、怕冷、嗜睡、脱毛等均属代谢低下所致。②腹胀、

纳呆、便秘、肠鸣少或缺如等均为植物神经功能紊乱（副交感神经占

优势）。③皮肤腊黄色、少光泽、干燥脱屑、非凹陷性浮肿、眼裂变小、

鼻翼宽厚、舌体肥大等黏液性水肿症状。④反应迟钝，智力低下，视、

听、触、嗅均退钝，个别人出现幻觉、精神失常。⑤心音低钝，心电图

表现P-R间期延长、QRS波增宽。以上五类证候之辨明对诊断乔本氏

病意义重大，对诊断亚甲炎亦具一定意义，盖当今发病之成人甲状

腺功能减退症大部来源于乔本氏病及亚急性甲状腺炎之后遗症，尤

其是乔本氏病更是引致成人甲减之最主要原因。甲减之西医治疗恒

以甲状腺激素替代疗法，可予甲状腺片，亦可予甲状素（T4)或甲状腺

原氨酸（T3)治疗。但此疗法之实质是暂时替代，充其量意在对症，仅为

治标之法。中医中药对本病之治疗有较好之疗效，笔者常以桂附八

味丸加味治疗斯证而获效。盖前五类证候用中医观点看统属肾阳虚

之范畴，桂附八味补肾壮阳，温化水湿，强腰膝，壮筋骨正中病的。越

婢汤、大补阴丸、二仙汤亦属常用之方。中医谓"孤阴不生，孤阳不

长"，"善补阳者必于阴中求阳；善补阴者必于阳中求阴。"上述各方

投治此病，均符合此一尊旨，故每获疗效。现将笔者用治甲状腺功能

减退症之基本方药公诸于下，以飨读者。生地12g、山萸10g、山药10g、

丹皮10g、知母10g、黄柏10g、茯苓10g、泽泻10g、桂枝10g、附片6g、仙

茅10g、淫羊»10g、巴戟夭10g、麻黄10g生石膏30g、猪苓10g、白术

10g、车前子10g、怀牛膝20g，水煎服，一日1剂。鉴于此病属慢性进程，

此方可加大10倍，共研为末，炼蜜为丸，6g重，每日3次，饭后温开水

冲服，以期缓效。

类风湿性关节炎之常用方药

类风湿性关节炎为常见病、多发病。此病以多发性、进行性关节

疼痛、变形、功能障碍为特征，常因感冒而加重，活动期可见发热、血

沉增快、C反应蛋白增加、类风湿因子（RF)增加，约10%之患者外周血

涂片染色可检出红斑性狼疮细胞。20世纪40年代已将此病列入"胶

原病"中，后来列入"结缔组织病"及自身免疫病类。

中医对此病之认识总不离"风寒湿三气杂至，合而为痹"之说，

病因乃风、寒、湿相合，故有风则多变、寒则疼痛、湿则病久不去诸多

特点。病久入络，伤及血络则血瘀积聚，关节变形。

西医对本病治疗有各种解热止痛药可治，如通常之水杨酸类及

非甾体清热止痛药，如消炎痛、布洛芬、芬必得、炎痛喜康、罗非昔

布、塞来昔布等。肾上腺皮质激素、免疫抑制药如甲氨蝶吟、青霉胺

等均可应用于临床，但皆属治标而非治本。中医中药对此病之治疗

历数千年历史，积淀了数以千计之有效方药，下面只以笔者临床最

常用之效方做一简单论述，以供广大医者参考之。

⑴九味羌活汤：羌独活各10g、防风12g、细辛3g、苍术6g、白芷3g、

川芎6g、黄芩10g、生地12g、甘草6g、生姜6g、葱白2寸（方出张元素）。

⑵大秦艽汤：知母20g、羌独活各10g、荆芥10g、防风12g、苍术6g、

黄柏6g、生熟地各12g、当归10g、川芎6g、赤芍10g、厚朴6g、柴胡10g、

黄芩10g、白芷6g、秦艽10g、生石膏30g（方出《医学发明》）。

⑶桂枝芍药知母汤：桂枝10g、白芍10g、干姜6g、甘草6g、防风

12g、麻黄10g、白术10g、附片6g、知母20g（方出《金匮要略》）。

（4）桑枝汤：桑枝30g、清风藤20g、海风藤20g、鸡血藤20g、羌独活

各15g、防风12g、秦艽10g防己10g、威灵仙10g（裴慎先生经验方）。

（5）麻杏茂甘汤：麻黄10g、杏仁10g、生苡仁10g、甘草6g（方出《金

匮要略》）。

（6）独活寄生汤：杜仲15g、防风12g、秦艽10g、桂枝10g、细辛3g、怀

牛膝10g、当归10gJH<6g、生地12g、白芍15g、白术10g、茯苓12g、党

参10g、甘草6g（方出《千金要方》）。

⑺金牛汤：金毛狗脊1北、川牛膝10g、白芍15豪白芷6g、羌独活

20g、生茂仁20g、桂枝10g、鸡血藤20g（裴正学经验方）。

（8）五米合剂：五加皮20g、茂仁20g、川牛膝20g、骨碎补10g、薄荷

6g、苍术6g、海风藤10g清风藤10g、何首乌10g、寻骨风12g（裴正学经

验方）。

（9）鸡鸣散：苏梗10g、槟榔10g、木瓜10g、陈皮6g、甘草6g、桂枝

10g、附片施、半夏6g、吴朱萸10g何首乌10g（方出《朱氏经验集》）。

（10）五积散：当归10g、白芍10g、川芎6g、苍术6g、厚朴6g、陈皮6g、

半夏6g、茯苓12g、麻黄10g、白术10g、桔梗20g、干姜6g、肉桂3g、枳壳

10g（方出《局方》）。

（11）复方芍药甘草汤：白芍20g、甘草6g、清风藤10g、海风藤10g、

鸡血藤10g、木瓜20g、生苡仁20g、川牛膝10g、威灵仙10g、党参10g、黄

茂20g、红花10g（方出《伤寒论》）。

（12）活络效毒丹：当归10g、丹参10g、制乳没各施、红花3g、桃仁

10g、姜黄6g、连翘15g、桂枝10g（方出《衷中参西录》）。

上述12个方剂为余治疗类风湿性关节炎常用方药，有经方、有

时方，目的总以治疗关节疼痛为主，然而各方之适应证又有一定倾

斜。九味羌活汤与大秦艽汤适应感冒引发之类风关发作，时感冒尚

存，关节痛著，兼有头痛发热等证，如咳嗽，则可与麻杏菠甘汤合用

之；桂枝芍药知母汤与桑枝汤则适应类风湿性关节炎日久不愈，关

节变形，活动及运动障碍者，桂方适应怕冷、虚寒之个体，桑方则适

合于怕热阴虚之个体；独活寄生汤与鸡鸣散、五积散之应用常在类

风湿性关节炎之疼痛已得到一定程度之控制，机体气血两亏，急需

药物调补者；五米合剂与金牛汤则适合合并骨关节退行性变、脊柱

强直、坐骨神经痛之患者。上述各方中尚可根据患者病情之变化作

如下加减：疼痛剧烈加川草乌各15g（先煎1小时）；下肢痛重加马钱子

1个（油炸）；上肢痛重加细辛20g（先煎1小时）；头痛加羌独活各10g、防

风10g；腰痛加杜仲15g、川牛膝10g、川断10g、桑寄生15g；神经痛加清

风藤10g海风藤10g、鸡血藤10g；背痛加羌独活各10g；肩痛加姜黄10g。

病毒性肝炎浅谈

病毒性肝炎是世界流行最广泛、历史最悠久之传染病，在我国

之流行最少也有100多年。人们对这类疾病的认识虽然已历来久之，

但只是在近50年来由于分子生物学、分子免疫学、细胞生物学的发

展，才有了较高水平的认识。目前国际公认本类疾患有A、B、C、D、E、

G等六种病原体导致之不同类型，我国之命名则定为甲、乙、丙、丁、

戊、庚，即甲型肝炎、乙型肝炎、丙型肝炎、丁型肝炎、戊型肝炎、庚型

肝炎等六个类型。

甲型肝炎(HA)从20世纪40年代起就在我国大规模流行，当时人 Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input: 们习惯称它为"黄疸型传染性肝炎"，此病之特点为传染性强、黄疸

多见，预后良好，中药疗效尤佳。1967年德国学者丁哈德首先分离出

了甲肝病毒(HAV)，1973年美国学者芬斯托来在患者粪便中培养出

了甲肝病毒，并在电镜下观察，确定该病毒为直径27～30nm，认为该

病毒具有传染性、嗜肝性、自抑性、免疫性、非慢性等五个特性。从此

阐明了本病之发病：①具有强大之传染性，由消化道经水、手、苍蝇

进行传播。②鉴于病毒之嗜肝故该病之主要罹病器官是肝脏，其余

脏器一般不受侵犯。③病毒性之自抑性决定了本病之预后良好。④

病毒之免疫性决定了病毒对个体之侵犯可获得终身免疫，因此甲型

肝炎通常发病一次后，患者可获得免疫。⑤非慢性化决定甲肝转入

慢性，形成肝硬化之几率较小。

甲肝之临床症状根据1959年黄山肝病研讨会之精神，首先是厌

食、腹胀，然后才是肝区疼痛，再其次是黄疸、发热等。《金匮要略》

"见肝之病知肝传脾"之论述与此完全吻合，说明祖国医学在1800年

前所揭示之肝病证候群与现代医学之观点全同。

西医对此病之治疗仅系保肝，不提倡使用针对病原之病毒抑制

剂。中医对本病之治疗堪称最佳，通常可在1～2周内产生明显疗效。

总以邪客少阳、肝气郁结、肝木克土、肝郁化火、脾虚生湿、湿热相合

发为黄疸等为基本理论格局。采用和解少阳、疏肝利胆、健脾化湿、

清热补肝等法，方药采用小柴胡汤、丹栀逍遥散、茵陈蒿汤、香砂六

君汤、强肝汤、三黄泻心汤等。笔者常用下列方药治疗甲肝，现抄录

于后，以飨读者。柴胡10g、黄芩10g、半夏6g、党参10g、甘草6g、生姜

6g、大枣4枚、大黄6g、黄连3g、黄芩10g、茵陈20g、山栀10g、丹参10g、

木香6g、草蔻6g，水煎服，一日1剂。胃脘胀满加白术10g、茯苓12g；恶

心呕吐加旋覆花10g、生赭石20g；肝区疼痛加元胡10g、川楝子10g、制

乳没6g；转氨酶高加银花15g、连翘15g、公英15g、败酱20g、白花蛇舌

草20g、半枝莲15g、五味子粉6g(分冲)；黄疸重者加金钱草20g、虎杖

20g、蚤休20g；发热加生石膏30g、知母20g、粳米30g；夜热早凉、骨蒸

加秦艽10g、鳖甲15g、地骨皮15g、青蒿20g；背痛加羌独活10g、防风

12g；厌食加焦三仙各6g、炒莱殖子10g；大便秘结加大黄量至10～20g；

腹泻加干姜6g、附片6g；肠鸣加川椒10g。

乙型肝炎与甲型肝炎不同，主要是此型肝炎之传染性大，因无

自抑性故病程漫长，经久不愈，预后欠佳。乙型肝炎之发现始于20世

纪60年代初，最先是美国学者布鲁姆伯格于1963年发现了"澳大利

亚抗原"。1968年日本学者阿考克确定了该抗原之致病性，并认为输

血与此抗原有着密切的关系。1970年国际肝病会议将"澳大利亚抗

原"定名为"肝炎相关抗原"(HAA)。1972年国际肝病会议根据大量临

床观察报告，确认此抗原导致之肝病为"乙型肝炎"，遂将"肝炎相关

抗原(HAA)"之命名取消，明确命名为"乙肝病毒表面抗原(HBsAg)"。

1977年世界各地对乙型肝炎之大量报告和研究材料引起联合国卫

生组织(WHO)之重视，遂召开了世界各地肝病专家对乙型肝炎有关

问题进行认真讨论，并公布了乙肝抗原、抗体的系列名称，HBsAg、

HBsAb、HBcAg、HBcAb、HBeAg、HBeAb，通常称为三系统，但因

HBcAg之检测须经肝脏穿刺，取肝脏活组织检测，必须经电镜观察，

周围血中无此抗原，因而难度较大，故通常缺如。因而前述三系统之

检测，实为五项，俗称两对半。乙肝在20世纪后半期在世界范围内广

泛流行，传染性强，很快进入慢性化，治疗效果欠佳，一时在亚洲、非

洲、北美洲大量流行，引起医界之极大关注。正当乙型肝炎在世界流

行并引起各界关注之时，我国却因文化大革命而停止了一切科研和

流行病学方面之观察和研究，对乙肝之传播听之任之，因而在我国

形成了乙肝之大量传播，发病率跃居世界前茅。乙型肝炎之慢性化

倾向较大，有5%～15%之患者发展为肝硬化(LC)，有0.5%～1.5%患者

最后合并肝癌(HCC)。慢迁肝(CPH)、慢活肝(CAH)之病程可长达终

生。当前治疗乙肝之西药主要有α干扰素、贺普丁、苦参素、甘草甜素

等，但疗效均欠理想。其中干扰素之表面抗原1年治疗转阴率仅10%～

15%，略高于乙型病毒之自然转阴率；贺普丁之表面抗原转阴率略低

于α干扰素；其余药物则更逊一筹。最近有关α干扰素缓释剂之报道

给人一线希望，该药系利用纳米技术使α干扰素在分子结构泛与聚

乙二醇分子相结合，由此使α干扰素在人体内之半衰期延长数千倍，

新药名称暂定为派罗欣；另一种名佩洛能，通常180万单位肌肉注

射，一周1次，据初步材料证明表面抗原一年转阴率可达40%～60%。

中医中药对乙型炎之治疗目前仍属最佳之选择，笔者从事这方面之

临床研究已达40余年，积累临床病例不下数十万人次。乙肝乃热毒

客于少阳，久病则肝气郁结，继则横逆犯胃，迁延不愈则化火生湿，

最后气滞血郁，气血双虚，阳虚水泛。慢迁肝之治疗重在和解少阳，

方用小柴胡汤加味；慢活肝之治疗因临床证候较多，如肝痛为主则

以柴胡疏肝散加味；如肝功损坏为主则以强肝汤加味为主(当归、白

芍、川芎、生地、黄芪、丹参、郁金、党参、泽泻、甘草、山药、秦艽、神

曲、板蓝根)；转氨酶高者加清热解毒药银花、连翘、公英、败酱及五味

子粉等；肝硬化合并腹水则给予实脾饮、五皮饮、五苓散；黄疸重者

加用茵陈、山栀、大黄。总之乙肝之中医治疗是在病证结合的前提下

进行的，宜辨证施治，对症下药。在辨证中应注意到传统的理、法、

方、药之统一，同时也应注意到微观指标之辨证。譬如肝功能之检测

对中医辨证也是十分重要的，总蛋白及白蛋白之减少是人体精微之

缺乏，乃不足也、虚也；转氨酶之升高，乃有余也，实也。前者之治疗

当补其不足，后者则宜损其有余也，《素问》"毋虚虚毋实实"即此意

也。笔者在治疗乙型慢活肝或肝硬化时，恒以黄芪、当归、丹参、首

乌、葛根、仙鹤草、生地、旱莲草等补益之剂使低蛋白血症或白球蛋

白之倒置恢复；又恒以银花、连翘、公英、败酱、白花蛇舌草、半枝莲

等清热解毒之剂使转氨酶之升高获效。表面抗原之出现因常伴有核

心抗体及e抗体等之应答性免疫反应，因此其中医辨证当为虚实相

兼之证，笔者主张以和解为大法、补泻兼施为宜，通常以小柴胡合强

肝汤加减，每能在稳中取效。通常须服药1～3年，表面抗原转阴率可

达30%～32%，e抗原转阴率可达50%～60%，如能延长疗程，疗效还有

望提高。总之乙肝之中药治疗是一项慢性工程，欲速则不达。这就必

须医患相互配合，建立长期的信赖、共同努力，才能达到预期效果。

近来社会游医信口编造自制药物的疗效，有人通过新闻媒体宣称

"表面抗原转阴率达100%"、"3个月不转退款"等等，均为无稽之谈，

严重破坏了中医学术之声誉，给社会及人群带来了损失。

丁肝和乙肝经常同时发病。早在20世纪70年代末意大利学者査

瑞劳在乙肝患者之肝细胞核中检测到一种不同于HBsAg的新抗原，

当时称为8因子。1980年发现8因子具有肯定的致病性，1984年国际

肝病会议定名为丁型肝炎病毒(HDV)。而丁型肝炎被确认为是一种

与乙型肝炎并发，但又不同于乙型肝炎之一种传染性肝炎。丁型肝

炎之病状与乙肝完全相同，只是症状略重，慢性化之几率略高于乙

肝。20世纪80年代曾在我国广泛流行，上海、北京、天津等大城市亦

曾流行，但发病较农村低。本病之治疗尚无特效疗法，不论中医还是

西医，其治疗均与乙肝相同，诊断之特点系HDV之检测，HDV之直径

较HBV稍大，约35～37nm，因其无核无壳，故不能单独传染致病，须借

助乙肝病毒为载体共同侵入人体。

丙型肝炎和戊型肝炎原来统称为非甲非乙型肝炎，1987年2月

联合国卫生组织把非甲非乙型肝炎分为经肠道传播和经输血传播

两种。1989年在日本召开的国际肝病会议上把经肠道传播者定名为

戊型肝炎；经输血传染者定名为丙型肝炎。此前两种肝病的病毒均

已分离培养成功。戊肝病毒(HEV)属杯状病毒科，是RNA病毒之第三

亚组，在环境中极不稳定，怕冷、怕酸、怕盐。通过水、手、苍蝇，由消

化道进行传染。丙肝病毒则系猴泡沫病毒，通过输血及血液制品传

染者几占80%，在环境中相对稳定，在人体内亦较稳定，不易被机体

免疫系统清除。戊肝像甲肝一样有自限性、嗜肝性、免疫性、非慢性、

传染性等特点，通常在发病后1～1.5月可自行痊愈，一旦痊愈终身免

疫。因而虽然有较强之传染性，对人类及社会不能造成重大危害，治

疗方法与甲型肝炎大同。丙型肝炎则不同，此病因系输注血液及血

制品而传染，故传染威胁性不大，但因其病毒之相对稳定性和慢性

致病性，使患病机体久治不效，最终慢性化而导致肝硬化(LC)或肝癌

(HCC)。日本学者对20例丙肝(HC)患者随访观察26年，除一例ALT正

常外，其余均持续异常，可以说20例患者在28年中无一例康复，其中

5例转为肝癌已相继去世，4例转为肝硬化亦多去世。丙肝患者之临

床缺乏症状，仅乏力一项达全部患者之20%～50%，有人认为丙肝患

者之80%未见自觉不舒，一旦不舒则已进入肝硬化期。前述之乙型肝

炎慢性倾向者仅占全部患者之10%～20%；而丙肝之慢性化者占全部

患者之50%～70%，由此可见丙型肝炎虽然传染性不强，但给人类社

会造成之危害性堪称大焉！丙肝之治疗目前仅α干扰素可用，而治疗

效果极差，HCV转阴率仅10%左右，前述日本人观察28年，20例中无

一人痊愈。中医中药对丙肝确有疗效，笔者曾接治丙肝患者近百人

次，因系门诊治疗因而大部分患者未能坚持长期服药，中途离去。在

坚持服药1年以上之10余例患者中，竟有3例HCV转阴，肝功能正常，

无任何自觉症状。此说明中医中药之整体调节作用对丙肝是有效

的。笔者惯用之方药抄录如下，以供读者参考。当归10g、白芍10g、川

夸6g、生地12引黄芪20g、丹参20g、黄精20g、郁金6g、党参10g、泽泻

10g、甘草6g、柴胡10g、黄芩10g、半夏6g、生姜6g、大枣4枚、秦艽10g、

板蓝根10g、茵陈20g，水煎服，一日1剂，60天为1疗程，最少需服用3～

6个疗程。

庚型肝炎是1995年美国医生哈亚门对法国学者早在1969在甲

肝患者血清中发现的一种异常颗粒重新检测，并证实此颗粒有显著

之致病性，经国际肝病会议认同，并命名庚肝病毒(HGV)。此病毒颗

粒较大，直径在100nm以上，我国人群中此病毒之检岀率约为16.2%，

美国为9%，其发病则较少，仅在少数儿童中发病，称为巨细胞性肝

炎，此病之主要传播途径为血液传播，通过输血、输注血液制品、血

液透析、血脉吸毒、母婴传染、器官移植等。此病在我国尚未见到流

行和大病例发病。

后颅窝蛛网膜炎

1995年（乙亥）冬，余应邀赴白银市为白银有色金属总公司葵某

总经理会诊。其时彼头痛4月余，以后枕部之阵发性疼痛，伴颈项强

直，呕吐恶心为特点。曾有反复感冒、高烧1月余之病史。1月前专程

赴京，住院于中国人民解放军总医院（301医院），经CT、核磁、核素、腰

穿、生化及各项常规之检査，确定仅系颈椎增生，一期高血压合并轻

度脑动脉硬化。然而各种治疗未见疗效。笔者会诊时患者之阵发性

头痛毫无减意，于咳嗽时头痛加重，深吸气时头痛亦加重，同时合并

颈项强直，恶心呕吐。査体：两肺呼吸音粗平，心音正常无杂音，颈部

有轻微抵抗感，瞳孔对称等大，四肢活动自如，无偏瘫及口眼歪斜。

神经反射：浅反射略迟钝，深反射略亢进，巴彬斯克征弱阳性。鉴于

上述病候和体征，笔者认为虽然在301医院曾经过全面检査，未发现

脑部及脑膜病变，但仍须考虑脑膜炎性疾患：①病毒性脑炎，②脉络

膜丛炎，③后颅窝蛛网膜炎。据此余建议立即腰穿，再取脑脊液急

査。鉴于患者在京住院期间检査过于频繁，本人拒绝腰穿，笔者再三

动员说服亦未能奏效，因此笔者决定施以下列治疗方案：①菌必治

2g加入生理盐水250ml静脉点滴，每日3次。②20%甘露醇200ml，静脉

点滴（快速），每日1次。③中药水煎服，一日1剂。处方如下：石决明

20g白英藜30g、生地12g、枸杞子12g、桑叶10g、菊花20g、丹皮10g、山

栀10g、天麻10g、钩丁20g、半夏6g、陈皮6g、川芎6g、白芷6g、细辛3g、

黄芩10g、蔓荆子10g、当归10g、麦冬10g、甘草6g、羌独活各15g、防风

12g。以上法治疗10天后患者头痛大减，诸症亦轻。嘱暂停西药，中药

处方中去桑叶、菊花、丹皮、山栀、半夏、陈皮，加吴萸、生姜，继服。2

周后患者由白银来兰州门诊复査，自谓诸症悉平，如常人。拟六味地

黄汤加味服之，以善其后。

此例患者之诊断，因患者本人拒绝腰穿而未能获得确切依据，

但从病史、临床症状来看，可确认颅内炎性病变无疑。①阵发性头

痛，伴突发性呕吐，②病始于反复外感样发热，③咳嗽及深吸气时头

痛加重，说明颅内压高，④虽在京曾作脑脊液检査(-)，因系发病初

期，不能排除颅内炎性疾患，⑤以颅内炎性疾患治疗而获效，⑥由头

痛之部位和性质及由普通感冒起病判断，后颅窝蛛网膜炎之可能性

最大。

阳强不倒治验

1995年（乙亥）之末，兰州市一领导同志患阳强不倒，百医无效，

求治于余。其时患者正在某大医院住院治疗，其妻谓2周前患者偶感

风寒，微热、头痛、鼻塞、咳嗽，曾经服用感冒药并输注抗生素及葡萄

糖盐水之类。因工作忙碌，连日开会，疲劳过度，1周前出现阳强不

倒，终夜不眠。曾在市内医院行镇静、冬眠诸法无效，转省级大医院

后曾2次阴茎抽血合计约200ml，仍未见效。并向301医院泌尿生殖科

电话请教会诊，被谓如再无缓解迹象可进行局部血管再造架桥，必

要时派专家专程来兰协助手术。鉴于患者及家属拒绝手术治疗故求

助于余。

笔者接诊时，患者1周未眠，疲惫不堪，时见惊恐不安之状。掀被

观其下身，见阴茎肿大如丝瓜状，色紫红兼暗，触之痛感剧烈。余对

家属曰：此证乃因工作过于繁忙，心理压力太大，致七情失和、阴阳

错乱，阴不涵阳，阳强不倒。西医之观点乃过度疲劳及精神压力导致

全身植物神经功能紊乱，偏于交感神经亢奋。总之此证之主因、主证

在于功能性障碍，有否器质性改变？尚无显著指征，当然两次局部抽

血可能已造成局部感染，阴茎之疼痛、色红灼热均提示之。鉴于此日

前之治疗应改变环境，解除思想恐惧，在和平宽松之气氛中，以中药

慢慢调理以求痊愈，此时此刻万万不可频频采用局部措施，诸如抽

血、血管再造之类。盖阳器者乃可大可小之特别器官也，大则如茄如 Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input:

棒，小则如粟如桑，其大其小乃中枢神经、植物神经系统之使然也!精

精神因素起着至关重要之作用，局部之任何刺激均可增加患者之羞

涩、恐惧，精神更趋紧张，阳强更趋不倒。两次局部抽血已使病人惊

恐万状，局部并未见效，仅在抽血200ml之当时阴茎似乎稍软，须臾

即复大坚如前，由此证明精神压力不除，阳强决无宁日。局部之措施

已证明无效，再行进一步之血管再造乃错上加错，诚雪上加霜也。余

之观点博得了患者及家属之大力赞同，乃一致决定出院在家由余调

治。余贸然宣讲了上述观点，一挨到大家都同意按此意见治疗，自己

始觉责任之重大非同一般，已作了过河之卒，只能义无返顾，乃作如

下治疗：①中药1剂，水煎服；②菌必治3g加入200ml生理盐水，静滴，

一日1次；③甲硝哩250ml静滴，一日1次；④每日在家静卧听听音乐、

看看电视，力求环境宽松，心中平和，一日三餐皆清淡饮食。中医辨

证处方如下：患者口苦咽干，胸满烦惊，一身尽重，起卧不安，心中懊

，辰，下身肿痛，少腹急结，大便干结，小便赤涩，脉沉弦滑数，舌质红、

苔黄厚腻。证乃少阳之邪入里化火，热结膀胱，下焦血瘀，阴不涵阳，

阳强不倒之证；治宜和解少阳、攻下泻火、镇重潜阳；方宜柴胡龙骨

牡蛎加味：柴胡10g、黄芩10g、半夏10g、党参10g、炙甘草10g、大黄6g、

枳实10g、白芍15g、丹皮10g、桃仁10g、桂枝10g、茯苓12g、山栀10g、豆

豉10g、生龙牡各20g、生铁落200g（先煎）、浮小麦30g、大枣4枚，水煎

服。并令其每晚肌注冬眠灵、非那根各25m10服药仅3剂，治疗仅3天，

患者阴茎已完全变软，自觉全身渐渐舒适、情绪亦渐趋安定，家属高

兴异常，对余之赞词不绝于口。前方去生铁落、山栀、豆豉，加焦三仙

各6g、生大黄3g继服。西药甲硝哩亦停输，每晚睡前之冬眠灵、非那根

亦停用，病人能安然入睡。3天后患诸证皆退，下身已如常人，惟色泽

尚黑，出现大量脱皮与皱褶，因患者公务繁忙，旋即上班。嘱常服六

味地黄丸以善其后。

痛风之治疗

痛风乃血中尿酸之增加超限所致也，尿酸乃蛋白质代谢之终末

产物，通常随尿排泄，血清中通常之含量在(2～4)mg%，即每100ml血

中含尿酸2～4mg，若换算为当量浓度，则为(150～450)mg%。尿酸之超

量经常见于肥胖、营养过胜、缺乏体力锻炼者，此种人即同样是高血

压动脉硬化、冠心病、糖尿病、胆道结石等病之好发人群，因此高尿

酸症经常与上述疾病相伴而生。尿酸之质量下沉，通常最易沉淀于

最下位之骨节滑膜之上，因此最早之发病部位通常是足之大趾及无

名趾，次则为踝、膝、髏等处之关节。疼通之主要原因是尿酸沉积于

皮下关节腔之骨膜之上，甚则形成结石，刺激神经或导致变态反应

而疼痛。痛呈间歇性发作，时隔数日或数月发作一次，每次发作可持

续数日，常在过食肥甘或饮酒赴宴之后。除前述疼痛部位之外全身

任何关节均可罹患，最后晚期之痛风因肾脏受累而现痛风性肾炎，

一部分病例可出现肾功能衰竭。

西医对此病之治疗药物有秋水仙碱，lmg注射，痛著时2小时1

次，亦可静脉滴注，直至痛至，可连续应用3〜5次。此外丙磺舒、别隙

吟醇、苯磺哩酮、苯漠马龙均可应用。中医对此病之治疗注重辨证施

治，盖此病之发生常见于营养过胜而肥胖者。《金匮要略》"夫尊荣人

骨弱肌肤盛"，因其骨弱而虚，湿热乘虚而至，湿热相合阻滞气机，不

通则痛。湿热善于下注，故足趾之疼痛每见先发。中医以湿热下注为

辨证之主要框架，首选方剂有四妙散加味、桃兰合剂、身痛逐瘀汤、

加味芍药甘草汤。

1.四妙散加味：苍术9g、黄柏9g、羌独活各10g、桑寄生12g、野赤

豆15g、晚蚕砂12g、丝瓜络6g、臭梧桐12g、汉防己12g、土茯苓30g、丹

参12g、虎杖12g，水煎服，一日1剂。

此方为已故上海龙华医院著名老中医顾伯华教授著名方剂，笔

者已应用于临床20余年，治疗痛风患者无数，大多数皆能见效。惟方

中之冰球子究属何物?遍査古今典籍未能得到解答，顾老早已谢世，

亦无从问津，笔者临床以川草乌各15g，先煎1小时代之疗效似更佳。

2.桃兰合剂：羌独活各15g、防风12g、知母10g、麦冬10g、忍冬藤

15g、桃仁10g、泽兰10g、竹茹6g、血竭3g（冲服），水煎服，一日1剂。

此方为先父慎公之经验方，先父乃陇上名医，以善治杂病而闻

名秦陇，曾以此方授予，谓此方治足趾疼痛如神，可珍而藏之。近10

余年来，余遇痛风之证辄予之，每多获效。

3.身痛逐瘀汤加味：当归10g、川芎6g、桃仁10g、红花3g、没药

10g、五灵脂6g、甘草6g、地龙15g、秦艽15g、羌独活各10g、香附6g、川

牛膝20g，水煎服，一日1剂。

此方为《医林改错》王清任之方，王氏谓此方治"凡肩痛、臂痛、

腰痛、腿疼，或周身疼痛，总名曰痹症......如古方不效可用此方。"笔

者以此方长期治疗痛风晚期，除足趾及下肢疼痛外，全身关节泛泛

疼痛者，每获良效，伴肾脏损坏之血尿、蛋白尿，亦常见效。

加味芍药甘草汤：白芍20g、甘草6g、清风藤15g、海风藤15g、鸡

血藤15g、木瓜20g、生汝仁20g、怀牛膝20g、威灵仙15g、当归10g、党参

10g、黄芪20g、红花3g、川草乌各15g（先煎lh）、桂枝10g、桑枝20g，水煎

服，一日1剂。

此方为余之经验方，40年来遇痛风之引致坐骨神经痛者，用此

方恒效，方中之川草乌务必先煎1小时，否则有乌头中毒之虞。

#皮肌炎漫谈

皮肌炎是皮肤异色性皮肌炎之简称，此病之英文符号为DM，是

一种主要累及四肢近端横纹肌，同时形成多样皮肤损害之慢性疾

患。其发病原因尚未明确，但医界统一认为此病应属于自身免疫性

疾患。本病可发生于任何年龄，女性多于男性，二者之比约2：1。病变

通常表现在两方面：①皮肤病变：多样性红斑及结节，结节大小不

一，可在数毫米至数厘米之间。②肌病变：四肢之横纹肌变硬，疼痛，

自觉无力、疼痛，可有明显之压痛、运动痛，最后出现严重之肌无力，

因伴有肌肉疼痛可资与重症肌无力鉴别。全身任何部位之肌肉均可

受累，如眼肌、颈肌。前者见眼睑下垂，后者则见颈项偏倾。晚期尚可

累及心、肺、肝、肾等重要脏器，消化系统、造血系统亦均可波及，心

衰、间质性肺炎、视网膜渗岀等亦常出现。此病之检验诊断以下列阳

性表现为主：①γ球蛋白增加，②约半数患者可见抗核抗体(ANA)及

类风湿因子(RF)阳性，③转氨酶升高。三项检验指标均非特异性指

标，亦非绝对性指标，仅提供参考。抗核抗体(ANA)是一切自身免疫

性疾患之有诊断价值之指标，尤其对红斑性狼疮(SIE)之诊断价值更

大，其阳性率可达约95%，但因此指标在众多病疾中均可为阳性，如

各种慢性炎症，所有B细胞免疫功能之缺陷均可出现阳性，因此淡化

了此项指标对皮肌炎之诊断意义。皮肌炎之治疗西医恒以激素(肾上

腺皮质酮)为首选，免疫抑制剂氨甲蝶吟亦为常用之药。

中医中药对此病之认识总以肺主皮毛，脾主肌肉，风寒之邪自

皮毛而入为病机。化火兼湿，皮毛则红肿热痛，肌肉则僵硬、热痛，治

宜祛风胜湿，健脾宣肺。笔者常用方药如下。

（1）桂枝芍药知母汤：桂枝10g、白芍10g、甘草6g、知母10g、干姜

6g、甘草6g、防风12g、麻黄10g、白术10g、附片6g、生苡仁20豪桃仁

10g，水煎服，一日1剂。方出《金匮要略》，用于皮肌炎早期，皮肤红

斑，硬肿热痛者。

（2）阳和汤加味：麻黄10g、白芥子10g、鹿角胶10g、生地12g、肉桂

3g、姜炭10g、甘草6g、制乳没各6g、公英15g、败酱15g，水煎服，一日1

剂。方出《外科全生集》，用于肌肉僵硬、肿痛、发热，肢体无力。

（3）托里透浓汤：黄芪20g、当归10g、白术10g、党参10g、升麻6g、

山甲10g、皂刺10g、白芷6g、青皮6g、甘草6g，水煎服，一日1剂。方出

《医宗金鉴》，用于皮肤肿、硬、痛反复不愈，已累及内脏，出现眼睑下

垂、内脏下垂、颈项倾斜等。

（4）内补黄芪汤加味：党参10g、白术10g、茯苓10g、甘草6g、当归

10g、熟地12g、白芍10g、川芎6g、黄芪30g、肉桂3g、麦冬10g、远志6g，

水煎服，一日1剂。方出《外科发挥》，用于皮肌炎之晚期，患者出现重

症肌无力，乏力，纳呆，卧床不起者。

（5）消风除湿胶囊：此为笔者积40余年之临床体验研制而成，主

要成分为川草乌、雷公藤，水煎多次，收汁再煎，浓缩为浸膏状，加元

胡、水蛭细粉而成，主治一切结缔组织病，如类风湿性关节炎、红斑

性狼疮、硬皮病、皮肌炎、干燥综合征等。0.25g之胶囊，日服3次，每次

2粒，饭后服用。

上述方药中消风除湿胶囊可作为常服剂，其余各方应依据患者

之临床表现，通过辨证施治选方加减使用之。余40年来治疗此病百

余例，大部能取得满意之疗效。

分子生物学漫谈

近年来随着分子生物学之发展，人们对生命科学的认识逐步加

深。早在20世纪，恩格斯就说过："生命是蛋白质存在的形式"，这句

话的真正含义只有在分子生物学高度发展的现在才能够窥透其真

谛。18世纪中期，魏尔啸首倡细胞病理学，认为人体是由无数个细胞

组成的"细胞王国"，所有疾病都是因为细胞罹患之结果。这一结论

经过了100多年的发展与充实，到目前为止，由于分子生物学的长足

发展，人们深入到细胞结构中来探讨疾病的始末，使医学科学上升

到一个前所未有的水平。

人体细胞由细胞核、细胞浆、细胞器、细胞膜四部分组成。细胞

器包括线粒体、内质网、高尔基体。细胞核是细胞的核心所在，是脱

氧核糖核酸(DNA)和核糖核酸(RNA)之集中体现，二者直接关系到细

胞代谢、活性、生长、分裂、增殖。通常情况下DNA作为载体将相关信

息转录给RNA，通过RNA之表述，达到细胞之增生、成长或凋亡。一

部分抗肿瘤药物之所以能抑制肿瘤细胞之分裂与增殖，其原因在于

药物直接嵌入癌细胞之DNA中，DNA作为模版，其上之小沟是RNA

聚合酶之通道，该酶由此通道向RNA表达信息，使RNA之链偶加长，

从而达到细胞增长之目的。抗癌药物进入DNA后阻塞其上之小沟，

致使DNA聚合酶无法通过小沟向RNA表达信息，RNA则无法延长其

链偶，肿瘤细胞则无法得到足够的RNA和DNA，从而使癌细胞无法

得到增殖，由此便得到了通常所谓之抗肿瘤作用。DNA和RNA可统

称为核酸，虽然前者称之为脱氧核糖核酸，后者称之为核糖核酸，二

者之组成序列同属核酸序列。核酸由核首组成，核昔由碱基和核糖

两个部分组成，碱基通常具有嘌呤和嘧啶两种，嚎吟又分有腺嘍吟、

鸟嘌呤，嘧啶又分为胞嘧啶、尿嘧啶、胸腺嘧啶等。上述五种碱基通

常以A、G、C、U、T五个英文字母代表。核糖又称戊糖，亦有叫五碳糖

的，它作为碱基的固定成分，使核酸具有一定的稳定性。核酸之间靠

磷酸二酯键之接连，组成了一级、二级、三级脱氧核糖核酸(DNA)和

核糖核酸(RNA)之高层次多肽结构，人体内众所周知的高层次多肽

核酸如二磷酸腺昔、三磷酸腺昔等均属此类。

核内尚有一些物质可被染色剂着色，这些物质统称为染色体，

也叫做染色质。染色质经常是以成对的形式存在，称为二倍体，它的

重要性在于决定不同机体之遗传基因，人体的染色体有23对，计46

条，其中22对是常染色体，1对是性染色体，男性的一对性染色体中

有一条是X染色体，另一条是y染色体；而女性一对则同是X染色体，由

此决定了男女性别的不同。染色体的组成基础是DNA。20世纪人们

习惯于很多DNA组成一条染色体之观念；但21世纪以来由于先进的

凝胶电流技术的应用，人们探明了每条染色体只含一条线性DNA。

除DNA外每条染色体中还包含着2倍于所含DNA量之蛋白质。这种

蛋白质中的大部分与DNA紧密结合，名曰组蛋白，少部分未曾与

DNA结合之蛋白质称为非组蛋白。组蛋白与基因之转录相关；而非

组蛋白则在染色质中，参与维护染色质之结构。总之组蛋白与非组

蛋白均是染色体中不可缺少的组成部分，它们参与了染色体的全部

机能，包括遗传基因表达的转录。20世纪末人们观察到了细胞凋亡

之过程，这是一个崭新的概念。此前通常认为细胞之衰亡只有死亡

一途，由于电镜荧光镜、琼脂糖凝胶电流技术、流式细胞仪等之应

用，人们已完全探明了细胞凋亡的全部过程。细胞死亡是整个细胞

包括细胞膜、核、质等组成部分在短时期内完全崩溃，最后面目全

非，无形体可言；而细胞凋亡则在细胞膜完整保存的前提下缓慢进

行的细胞衰竭。

综观上述分子生物学之认识，中医传统病因学说可与之相吻合

也！中医谓"正气存内，邪不可干"，"邪之所凑，其气必虚"，由此证明

了中医之"正虚发病"学说，所谓正虚，乃人体之正气虚损也！正气则

指自体之生理功能，这种功能之维持依靠现代分子生物学之研究，

已证明最基本之变化发生在细胞结构之内，包括基因之突变、细胞

之凋亡、脱氧核糖核酸和核糖核酸、嘌呤、嚅暄等之微小变化，中医

之正气包括中气、卫气、营气、肾气......对发生于细胞内之微小变化

则可以"正气之虚"统而括之，扶正固本对前述之微观改变可辨证治

之。中医谓"形于内而诸于外"，内部之变化，包括极其微小之分子结

构之变化，必然会引起人体自觉和客观之表面改变。凋亡首先表现

出凋亡细胞之容积缩小，继而致使凋亡细胞与临界之健康细胞脱离

接触，细胞膜起皱，表面泡状突起，胞浆致密，细胞器最初尚无显著

改变。细胞核内之变化极为明显，主要是染色体萎缩，并开始裂解，

向胞核之边缘集中靠拢，形成半月状，核仁亦开始破损。最后胞膜内

陷，将一个细胞分裂成多个外被包膜内含细胞器之小体，称为凋亡

小体。凋亡小体在残存期间尚有一定功能，如胞膜之通透功能等，但

最后必然被内皮组织吞噬。细胞凋亡之概念证明了中医传统之"阳

化气、阴成形"，"阴阳离绝，精气乃散"之理论是符合凋亡理论的。细

胞膜之完整说明阴之尚存，凋亡之过程之开始，说明阳之消逝，形仍

在而阳离缺，此阴阳离绝之象也。

几千年来，中医虽然没有条件利用微观手段洞察分子生物学的

改变，但是仅依据疾病外在的表现治好了无数病证，从而积累了大

量的、非常宝贵的、行之有效的方药和辨证施治之理论。近年来随着

中西医结合实验研究的开展，证明了许多中医方剂可明显地提高细

胞内端粒酶的功效，增强超氧化物歧化酶之功效，改善NF-KB之功

率......已充分说明"祖国医学是一个伟大宝库，应该努力发掘，加以

提高。"

食道癌小记

食道癌即食管癌，为最常见恶性肿瘤之一。我国以华北、西北诸

省发病率最高，甘肃省则以河西三地区之发病最高。目前食道癌之 Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input: Treatment still primarily involves surgical procedures combined with radiation and chemotherapy, but for upper and middle esophageal cancer, surgical treatment often yields poor prognoses and presents significant challenges. Many rural farmers in grassroots areas lack access to surgical options, and even patients with relatively limited financial resources often miss out on surgical treatments as well as radiotherapy and chemotherapy. Therefore, traditional Chinese medicine (TCM) remains a preferred treatment option for some patients with esophageal cancer.

Over more than 40 years of practice, I have treated nearly a hundred patients with esophageal cancer using TCM and traditional Chinese herbal remedies. My experience has shown that TCM-based therapies can indeed yield certain therapeutic benefits for this condition, with some cases achieving complete recovery.

In the spring of 1997, a farmer named Li, aged 56 from Jiuquan, was diagnosed with mid-esophageal cancer at a hospital in the Jiuquan area. The diagnosis was confirmed as squamous cell carcinoma of the mid-esophagus. Due to high hospitalization costs and financial difficulties at home, he came to Lanzhou seeking treatment from me. He only hoped to receive a traditional Chinese herbal formula to take home and follow it closely; he had no other expectations beyond whether he would survive or not. The patient experienced difficulty swallowing, weight loss, fatigue, a dull complexion, a deep, tense, and rapid pulse, a weak pulse on the little finger, a red tongue with enlarged teeth-like marks, and a yellow, thick, and greasy coating on the tongue. His condition was characterized by insufficient kidney yin, liver qi rising upward into the chest due to wood excess, damp-heat accumulating in the middle burner, and stomach qi struggling to descend while spleen qi failing to ascend. The treatment should focus on nourishing water to nurture wood, harmonizing the stomach to reduce upward movement of qi, and regulating qi and blood. The formula used was “Liwei Dihuang He Qie San,” which included: rehmannia root 12g, cornelian cherry 10g, Chinese yam 10g, peony bark 10g, poria 10g, alisma 10g, cinnamon twig 10g, turmeric 6g, salvia 10g, fritillary bulb 10g, amomum villosum 6g, dried lotus leaf 10g, tangerine peel 10g, pinellia 6g, magnolia cortex 10g, citrus peel 10g, prunella vulgaris 15g, Chinese wolfberry 10g, coptis root 6g, scutellaria root 10g, dried ginger 6g, polygala root 6g, and white atractylodes rhizome 10g—all decocted in water and taken once daily. The patient left the clinic with the prescription, and I did not expect much from his case, so I did not say much to him. More than a year later, in the autumn of 1998, the patient returned for a follow-up visit. I saw him holding a prescription in his hand, now worn down to almost illegible, its characters blurred and faded. He appeared to be in good spirits, with a healthy complexion and fluent speech, and he exclaimed loudly, “Doctor Pei, you saved my life!” He then began to speak at length, praising me endlessly. After a long look at him, I could not recognize the man before me. Finally, I took the prescription in hand and examined it carefully—then it suddenly occurred to me that I had treated him a year earlier. Upon closer inspection, I realized that the man was indeed the same patient who had been diagnosed with mid-esophageal cancer a year ago. The patient said that after his previous consultation, he had taken the prescription home, hoping to try it out. He had taken a few doses, and after finishing them, he felt somewhat relieved. He continued to take the medicine one dose at a time, like a blind cat catching a dead mouse. By February, he was able to swallow without difficulty, his confidence grew, and his family was overjoyed. They cut back on their diet to raise funds for his medication, and he ultimately persisted in taking the medicine for over 300 doses. This summer, the fields were abundant with a bountiful harvest, and he sold more than a thousand jin of grain, raising several hundred yuan to come to Lanzhou—to thank the doctor for saving his life and to undergo another checkup to confirm whether he had fully recovered. I conducted a general inquiry and physical examination, finding no abnormalities. A barium swallow and gastroscopy also showed no signs of disease. I asked him to bring the X-ray and gastroscopy reports from the hospital in Jiuquan, which had previously confirmed the absence of esophageal cancer. This case gave me great encouragement. Since then, whenever I encounter patients with esophageal cancer who are unwilling to undergo surgery or lack the necessary surgical conditions, I have always prescribed this formula, adjusted and modified as needed, and achieved certain therapeutic results.

When discussing TCM treatment for esophageal cancer, we find that there are many single formulas, experimental prescriptions, and treatment experiences. Below, I have compiled some effective formulas that I have personally tried, offering them for readers' reference.

(1) Zeng Junshan’s Formula: Astragalus 30g, Angelica sinensis 15g, White Peony 20g, Salvia miltiorrhiza 10g, prepared Fructus aurantii 6g each, Manchurian tiger beetle 10g, Sichuan peppercorn 10g, Chinese wolfberry 10g, Clematis armandii 10g, Polygala tenuifolia 6g, Prunella vulgaris 15g—decocted in water and taken once daily. Zeng Junshan is a professor at Lanzhou Medical College, renowned for both his academic achievements and practical experience. He is a humble and honest man with the demeanor of an elder, and in 2000, he specially came to my clinic to demonstrate this formula, saying that he had cured many patients with esophageal cancer. I treasured this formula and kept it in my clinic, where it proved to be highly effective in clinical practice.

(2) Shennong Pill and General’s Powder: ① Shennong Pill: 10g of Platycodon grandiflorus powder, 2g of licorice, and 3g of glutinous rice—each pill is about 0.25g, taken 6–12 pills each night, dissolved in warm boiled water. ② General’s Powder: 6g of cinnabar, 6g of cinnabar, 6g of borax, 15g of Amomum villosum, 6g of indigo, 6g of leeches, 9g each of black and white snakehead, 15g of ginseng, 10 centipedes, 30g of clam powder, 15g of persimmon cakes, 15g of Aster yomena, 60g of sugar, 15g of rhubarb, 15g of magnesium sulfate, 6g of licorice—all ground into a fine powder, taken 5g three times daily with warm boiled water after meals. This formula is a commonly used remedy by Dr. Shilan Ling at the Shandong Academy of Traditional Chinese Medicine, featured in the book “Traditional Chinese Medicine Treatment of Tumors” (People’s Health Publishing House, 1995). Shennong Pill and General’s Powder can be used in combination; the former is a preparation made from Platycodon grandiflorus, taken only once each evening before bed, as Platycodon grandiflorus carries significant toxicity and dosage must be strictly controlled—overdosing is not recommended. The General’s Powder contains mainly sandworms and insect components, which are not highly toxic, so it is formulated as a powder, taken three times daily with warm boiled water after meals.

(3) Compound Xuanfu Daihe Decoction: Xuanfu flower 9g, raw Hematite 30g, Pinellia 9g, Bamboo Shoot 9g, Agarwood 9g, Clove 9g, Sandalwood 9g, Gardenia 9g, Coptis chinensis 9g, Eucommia ulmoides 15g, Black Dragon 15g, Calcined Oyster 30g, Prunella vulgaris 15g, Seaweed 15g, Kelp 15g—decocted in water and taken once daily. This formula is based on the experience of Professor Zeng Yongzhong at Shanghai University of Traditional Chinese Medicine; I have used it clinically and found it to be effective for patients with severe nausea associated with esophageal cancer. I once created a mnemonic to help remember the formula: “Xuanfu Daihe, two golden fragrances, bamboo, thick, urgent, calcined grass, black dragon.”

(4) Half-Chen Combination: Half a piece of Pinellia 6g, half a piece of Citrus peel 6g, 10g of Citrus peel, 6g of Agarwood, 12g of Trichosanthes kirilowii, 12g of Curcuma aeruginosa, 10g of Salvia miltiorrhiza, 10g of Amomum villosum, 12g of Coptis chinensis, 10g of Eucommia ulmoides, 7g of Rhubarb, 12g of Magnolia cortex, 30g of Paeonia lactiflora, 6g of Licorice—decocted in water and taken once daily. This formula is based on the experience of Professor Wei Wenhan at Tianjin University of Traditional Chinese Medicine; I have used it clinically and found it effective, so I created the following mnemonic: “Half against Three, Citrus peel, large sand, and Amomum villosum—Magnolia cortex, black dragon.”

In summary, traditional Chinese medicine’s understanding of esophageal cancer remains largely confined to conditions such as dysphagia and nausea, with the primary pathological mechanism being gastric qi not descending and spleen qi not ascending. Commonly used formulas include the Six Gentlemen Decoction, Half-Chen Decoction, Four-Seven Decoction, and Xuanfu Daihe Decoction. The five formulas mentioned above are personal favorites of mine, drawn from contemporary experience, incorporating a large number of insect-based ingredients, metallic elements, heat-clearing and fire-draining agents, qi-regulating and blood-promoting agents, and anti-inflammatory and mass-dispersing agents. In addition, I believe that reinforcing the body’s vital energy and strengthening the fundamental foundation remain crucial principles—not to be overlooked. As stated in “The Classic of Surgery”: “When accumulation occurs, it is due to deficiency of righteous qi; when righteous qi is deficient, accumulation arises.” Thus, the use of the Six Flavors Decoction, Bao Yuan, and the Six Gentlemen Decoction should never be neglected.

Revisiting Myasthenia Gravis

This condition is not uncommon in clinical practice. While Western medicine and pharmaceuticals have shown some effectiveness in treating myasthenia gravis, there are no drugs capable of addressing the root cause of the disease. Traditional Chinese medicine, however, holds tremendous potential. In clinical practice, it is essential to first clearly distinguish between myasthenia gravis and radiculitis in order to differentiate diagnoses and tailor treatment accordingly. Both conditions share similar symptoms—weakness or mild paralysis affecting one side or a single limb, along with functional impairments. These symptoms are often easily confused in clinical practice, yet traditional Chinese medicine’s diagnostic approach differs significantly.

Myasthenia gravis is an autoimmune disorder characterized by lesions primarily located at the neuromuscular junction. It is marked by chronic muscle fatigue and weakness, often making it difficult to move muscles freely. Some cases exhibit chronic, progressive disability. The most common sites of onset include eye muscles, muscles involved in speech, muscles related to swallowing, chewing, and biting—any muscle group in the head, face, neck, or cervical region may become affected. If any muscle group in these areas becomes weak or dysfunctional, myasthenia gravis should be considered as a possible diagnosis. Shoulder muscles and cranial muscles are also frequently involved. Occasionally, myasthenia gravis can trigger critical episodes, characterized by increased sympathetic nerve tension, manifesting as a series of clinical signs of sympathetic hyperactivity, such as dilated pupils, reduced secretions (tears, saliva, phlegm), and in some cases, excessive sweating, increased intestinal peristalsis, increased secretion, abdominal pain and diarrhea, nausea, vomiting, and constricted pupils. Radiculitis, on the other hand, is caused by viral infection affecting the nerve roots. The viruses responsible are often influenza viruses, so patients often report a history of recurrent colds and fever. Over a long period of time, people mistakenly believed that this condition might result from high fever leading to excessive consumption of B vitamins, ultimately causing radiculitis. The site of onset for radiculitis is typically the limbs, beginning with muscle pain and numbness, followed by muscle atrophy and eventual functional impairment, leading to limb paralysis. While this condition is quite common in clinical practice, myasthenia gravis is far less frequent! Traditional Chinese medicine has historically classified these two conditions under terms such as “withered Qi,” “blood stasis,” or “deficiency-related blood stasis,” with the underlying mechanisms often rooted in “qi deficiency,” “blood not nourishing tendons,” or “blood deficiency leading to wind.” These conditions primarily affect the spleen, kidneys, liver, and lungs—since the spleen governs central qi, the lungs control zong qi, the liver controls tendons, and the kidneys govern bones.

Myasthenia gravis is often caused by qi deficiency; the treatment should focus on tonifying the lungs and strengthening the spleen, as well as replenishing both qi and blood. The “Buzhong Yiqi Tang” and “Bazhen Tang” are often chosen as first-line treatments. When the disease persists for a long time, qi is depleted, and lung qi is deficient—especially when kidney qi is also compromised, the “Eight Immortal Longevity Pills” are often used as a main formula with additions. Additionally, Zhang Xichun’s “Shengxian Tang” is also an effective treatment for this condition. Radiculitis, however, is often attributed to “blood not nourishing tendons” or “blood deficiency leading to wind.” The “Jin Gui”’s “Feng Yin Tang,” the recent work of Zhao Xintian’s “Taohong Siwu He San Chong,” and Zhang Xichun’s “Zhen Wei Tang” are all excellent formulas for treating this condition. Through more than 40 years of clinical experience, I have come to believe that the diagnostic approaches to these two conditions should not be completely separated. The autoimmune changes in myasthenia gravis fall under the category of deficiency in traditional Chinese medicine; although radiculitis is often triggered by influenza viruses, once lesions form, the virus’s influence is already minimal—“when evil gathers, qi must be deficient.” The reason the virus can invade nerve roots is precisely because of qi deficiency. Both conditions belong to the realm of deficiency in traditional Chinese medicine; when qi is deficient, it is necessary to tonify it, and tonification is the principle of treating the root cause. I believe that the treatment of both conditions generally focuses on tonifying the center and strengthening the kidneys—other treatments are merely symptomatic adjustments. The formulas for tonifying the root cause have already been discussed above; the symptomatic adjustments will now be described in detail: (1) Tonifying herbs: Dodder seed, goji berry, cinnamon, medicinal herb slices, fructus polygoni cuspidati, female ginseng, Polygonum cuspidatum, deer antler gelatin, turtle shell gelatin, locky, large mulberry; (2) Circulation-enhancing herbs: Angelica sinensis, peach kernel, safflower, green vine, sea grape vine, chicken blood vine, Chinese angelica, cinnamon twig, mulberry branch; (3) Wind-dispelling herbs: ginger, scorpion, centipede, leech, kudzu, wind-resistant herb, mulberry branch, creeping buttercup, and vinca.

Multiple Hepatic Cysts

Since the development of imaging diagnostics, the detection rate of hepatic cysts has increased dramatically, and these lesions have been widely identified, attracting widespread attention. In the 1970s, surgeons often performed surgical interventions for large hepatic cysts, and they would drain fluid from within the cysts via percutaneous liver puncture—but the outcomes were often unsatisfactory. Later, through extensive clinical observations, it became clear that hepatic cysts are congenital conditions—most cysts persist throughout a person’s lifetime without affecting their work or daily life. Only in three specific situations do hepatic cysts grow larger, develop, or worsen: (1) excessive exertion (exceeding one’s own tolerance), (2) emotional excitement and anger—commonly known as “great anger harming the liver,” and (3) improper diet, especially alcohol consumption, which undoubtedly exacerbates hepatic cysts. These three factors are the primary causes of cyst enlargement and progression; therefore, small, solitary hepatic cysts can be managed by maintaining a light, low-fat diet, avoiding alcohol, refraining from anger, and minimizing excessive strain—allowing the cysts to remain benign for life. Larger cysts may require local intervention via puncture. Multiple hepatic cysts, when present in large numbers, can lead to compression of liver tissue, jaundice, portal hypertension, and ascites; such cases often require hospitalization. I have treated two patients with severe multiple hepatic cysts in outpatient clinics. In the autumn of 1995 (Year of the Pig), Mr. Ding, a 38-year-old man, presented with abdominal distension as large as a clay pot, with the lower edge of his liver extending into the pelvic cavity. However, he was still able to move and live normally, and a CT scan and ultrasound confirmed the presence of multiple hepatic cysts. I proposed a formula: Chaihu 10g, Zhishi 10g, White Peony 20g, Chuanxiong 6g, Xiangfu 6g, Licorice 6g, Rhubarb 10g, Phellodendron 10g, Salvia miltiorrhiza 10g, Agarwood 6g, Cinnamon 6g, Herba Curcumae 6g, Honghu 10g, Chuanlian 10g, Prepared Fructus Aurantii 6g, Dry Ginger 6g—decocted in water and taken once daily. After 10 doses, the patient’s liver visibly shrank, and his abdominal distension was noticeably alleviated compared to before. Mr. Ding was a farmer from Wushan County in Gansu Province; due to his impoverished family circumstances, he lacked the funds for further examinations. He reported feeling well mentally and with a good appetite, and he simply wished to make adjustments to the original formula. I removed Honghu, Chuanlian, Chuanjie, and Dry Ginger, adding 6g of Pinellia, 10g of Trichosanthes kirilowii, 10g of Curcuma aeruginosa, 10g of Seaweed, 10g of Kelp—decocted in water and taken once daily. Six months later, the patient returned for a follow-up visit, reporting feeling well mentally and physically, and stating that the massive mass in his abdomen had significantly shrunk. An ultrasound and CT scan revealed that the liver, which had previously extended into the right subcostal region, had returned to 3 cm below the right rib margin. We suggested further ultrasound and CT scans, but the patient refused due to financial constraints. I reduced the amount of Rhubarb to the minimum and instructed him to continue taking the formula. That winter, another patient, Ms. Li, a 42-year-old woman, presented with jaundice, hepatomegaly, and ascites. She had undergone a partial hepatectomy at a provincial hospital six months earlier, where a biopsy confirmed hepatic cysts. Following this surgery, her condition deteriorated rapidly; her liver grew larger, her jaundice worsened, and ascites developed. She came to me for treatment, and after admission to the integrated Chinese and Western medicine ward, both ultrasound and CT scans confirmed multiple hepatic cysts and cirrhosis (decompensation). I administered two capsules of the ancient “Gusheng II” formula three times daily, diluted in warm boiled water after meals, and then prescribed the following formula: Chaihu 10g, Zhishi 10g, White Peony 10g, Licorice 6g, Chuanxiong 6g, Xiangfu 6g, Rhubarb 10g, Phellodendron 10g, Artemisia annua 20g, Gardenia 10g, Herba Scutellariae 20g, Herba Lysimachiae 20g, Herba Echinacea 15g, Herba Leonuri 20g, Herba Plantago 15g, Herba Patrinia 20g, Herba Plantago 15g, Herba Plantago 15g, Herba Plantago 15g—decocted in water and taken once daily. I also administered high-osmolar glucose, vitamins, energy supplements, and antibiotics intravenously. After half a month, the patient’s ascites subsided, her jaundice improved, her mental state improved, her appetite increased, and an ultrasound confirmed the diagnosis: although the condition remained the same, the ascites had resolved, the liver had shrunk, and the portal vein diameter had decreased from 15 mm to 12 mm, while the spleen had reduced from 63 mm to 52 mm. The ancient “Gusheng II” formula is available in 0.25g capsules, derived from the formulation of “Jin Gui Yao Lü”’s Nitrate and Iron Stone Powder—a culmination of decades of clinical experience. This formula is highly effective at promoting diuresis and boasts remarkable efficacy; it has been used clinically for over 20 years, particularly for treating hepatic and renal edema and ascites, earning high praise in Shaanxi, Gansu, Qinghai, and Ningxia provinces.

Through the treatment and observation of these two cases, we can see that hepatic cysts are, after all, benign lesions. Although multiple cysts can sometimes compress the liver, causing portal hypertension or bile duct obstruction, leading to ascites and jaundice, over time they may progress to cirrhosis. With proper treatment, the condition can improve quickly—not like liver cancer, which can be fatal in a short period of time, nor like liver cirrhosis following hepatitis, which can linger for years and ultimately lead to death. Whether single or multiple hepatic cysts, it is important to maintain a light diet, avoid excessive fat intake, and abstain from alcohol. At the same time, ensure adequate rest and exercise, maintain a positive mindset, and seek timely treatment if any symptoms arise—generally, the prognosis is favorable.

Necrotizing Lymphadenitis of the Neck

In recent years, this condition has become increasingly common in clinical practice and is often misdiagnosed, as it progresses rapidly and has a very high mortality rate. In recent years, I have encountered three cases, which I will describe in detail below. Case One involved Chen, a 42-year-old employee of our hospital, who presented with persistent high fever, swollen and painful lymph nodes in the neck, ulceration, a erythrocyte sedimentation rate of 120 mm/h, positive C-reactive protein levels, and a peripheral blood count showing a decrease in all three blood cell types, accompanied by bleeding and anemia. A biopsy of the cervical lymph nodes confirmed necrotizing lymphadenitis. After treatment with the traditional Chinese medicine formula “Wu Wei Xiao Du Yin” combined with “Gui Zhi Shao Ya Zhu Mu Tang” and “Xiao Wen Wan,” along with comprehensive Western medical treatments such as antibiotics and corticosteroids, the patient’s condition improved somewhat. However, the patient eventually developed mononucleosis (M., a severe condition that rapidly deteriorated; despite chemotherapy and traditional Chinese medicine treatment, the patient died. Case Two involved Liu, a 41-year-old pharmacist from Shouyang Town in Longxi, who initially presented with swollen lymph nodes in the neck and supraclavicular region, each about the size of a walnut, with localized redness, heat, and swelling. After more than two months of treatment at a local hospital, the local masses continued to grow and harden, eventually rupturing and oozing bloody fluid. The patient sought medical attention at our hospital. After admission and a biopsy, she was diagnosed with necrotizing lymphadenitis. Her temperature was low (37.5°C–38.2°C), with an erythrocyte sedimentation rate of 23 mm/h, and her peripheral blood count was normal. After treatment with antibiotics and traditional Chinese medicine, the patient’s local symptoms eased, the lymph nodes shrank, and the ulcerations healed. The traditional Chinese medicine prescription was as follows: Astragalus 20g, Angelica sinensis 10g, White Peony 15g, Manchurian tiger beetle 10g, Sichuan peppercorn 10g, prepared Fructus Aurantii 3g each, Cinnamon twig 10g, Cortex Moutan 10g, Medicinal Herb Slice 6g, Dried Ginger 10g, White Atractylodes Rhizome 10g, Fangfeng 12g, Ephedra 10g, White Mustard Seed 10g, Deer Antler Gelatin 10g—decocted in water and taken once daily. After 20 doses, the patient’s spirits improved, her appetite increased, the wounds healed, and she was discharged. Two years later, she was readmitted with persistent high fever. I had gone away for a lecture, and upon my return, I learned that the patient had been admitted with acute lymphocytic leukemia combined with systemic lymph node necrosis. Despite chemotherapy and supportive care, the patient died—her condition had not improved. Another case involved the daughter of Bao, a farmer from Malí Township in Wushan County, aged 9. She presented with persistent high fever, swollen lymph nodes in the neck and throughout her body, necrosis, and pain. A bone marrow aspiration confirmed malignant lymphoma (non-Hodgkin’s), and the patient had shown some improvement with the COPP chemotherapy regimen. However, the necrosis and ulceration of the cervical lymph nodes and oral lymph nodes failed to heal. A lymph node biopsy confirmed necrotizing lymphadenitis. In addition to Western medications for inflammation, chemotherapy, and supportive care, the patient was treated with traditional Chinese medicine: Ephedra 10g, White Mustard Seed 10g, Deer Antler Gelatin 10g (dissolved), Cinnamon 3g, Dried Rehmannia Root 12g, Astragalus 30g, Angelica sinensis 10g, Manchurian tiger beetle 10g, prepared Fructus Aurantii 6g, Prunella vulgaris 20g, Herba Lysimachiae 20g—decocted in water and taken once daily. The oral ulcers were treated with Bingbo Powder mixed with refined honey. After 20 doses, the local lymph nodes closed, and the ulcerations healed. This patient survived for more than three years, but due to repeated recurrences and financial difficulties, she was unable to receive timely treatment and passed away at home.

Necrotizing lymphadenitis is a new type of disease discovered and named in recent years—it is an autoimmune disorder. More than half of the patients with this condition are also diagnosed with malignant lymphoma or leukemia. Among the three patients in this group, two had leukemia, and one had malignant lymphoma. Although none of them were successfully treated, I learned through clinical practice that: (1) traditional Chinese medicine is effective in alleviating this condition; formulas like Yang He Tang, Tu Li Tou Nong San, and Wu Wei Xiao Du Yin are particularly effective in targeting necrotic tissues; Cinnamon Twig and Peony Bark are effective in reducing necrotic tissue. Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input: Zhi Mu Tang has a certain effect on fever and can help alleviate overall condition. ② The use of antibiotics is also very important; for controlling anaerobic bacteria, metronidazole and tinidazole are recommended. ③ The effect of chemotherapy does not seem significant, although when combined with M5, L2, or HD, the efficacy of chemotherapy is still not pronounced.

A Comprehensive Discussion on Arrhythmias

Arrhythmias can arise from various cardiac conditions, such as rheumatic heart disease, coronary heart disease, hypertensive heart disease, pulmonary heart disease, hyperthyroidism, pericarditis, cardiomyopathy, and anemia-related heart conditions. Cardiac structural abnormalities can all lead to arrhythmias; however, non-structural causes sometimes also trigger arrhythmias. Therefore, arrhythmia is a common clinical symptom. Common types of arrhythmias include premature beats, sinus bradycardia, sinus tachycardia, supraventricular tachycardia, sinus tachycardia, atrial fibrillation, atrial flutter, ventricular fibrillation, ventricular flutter, and conduction blocks. Among these, the most frequent arrhythmias are premature beats, sinus bradycardia, and sinus tachycardia—these three types of arrhythmias generally present with milder symptoms such as chest tightness, palpitations, and shortness of breath. In traditional Chinese medicine, these conditions are referred to as "pulse irregularities and delayed pulse" and "palpitations," which can be treated with herbal remedies. With over 40 years of experience, I have often used the following formulas in combination to treat arrhythmias.

(1) Zhi Gan Cao Tang with Additions: 10g of Dang Shen, 10g of Gui Zhi, 10g of Jiao E (processed), 20g of Mai Dong, 20g of Sheng Di, 20g of Huo Ma Ren (ground), 6g of Sheng Jiang, 4 dates, 30g of Dan Shen, and 30g of Ku Shen. Brew the herbs in water and take one dose daily. This formula originates from the Shang Han Lun, where it is stated: "In cases of cold-induced fever, if the pulse is irregular and there are palpitations, Zhi Gan Cao Tang should be used." A slow, intermittent pulse is called 'jie,' a rapid, intermittent pulse is called 'chu,' and a pulse that stops at regular intervals is called 'dai.' This formula's treatment scope encompasses various types of premature beats, double-beat rhythms, triple-beat rhythms, and atrioventricular escape beats. The author added 30g of Dan Shen and 30g of Ku Shen to this formula, increasing the amounts of Sheng Di and Mai Dong to 20g each, which significantly enhanced clinical efficacy and surpassed many Western medications like Pulsar, Isordil, and Bisoprolol.

(2) Zhuan Lü Tang: 4 dates, 20g of Chao Zao Ren, 20g of Dan Shen, 20g of Bei Sha Shen, 20g of Dang Shen, 3g of Suo Huang (used in powder form), 10g of Che Qian Zi. Brew the herbs in water and take one dose daily. This formula was commonly used by my father, Mr. Pei Shen, and features a simple formulation with remarkable therapeutic effects. My father believed that the three types of Dang Shen—Qi-tonifying and Heart-calming—were the core components of the formula, while Chao Zao Ren and Suo Huang were both calming and soothing agents that served as auxiliary ingredients. I have tried this formula clinically many times, and it has proven effective; in some cases, combining it with Zhi Gan Cao Tang yielded even better results.

Overbeat Pulse Soup: 30g of Huang Qi, 10g of Dang Gui, 10g of Dang Shen, 10g of Mai Dong, 6g of Wu Wei Zi, 20g of Dan Shen, 10g of Zhi Ke, 20g of Jie Geng, 30g of Ku Shen, 20g of Chi Shao, 20g of Hong Hua, and 10g of Xiang Xiang. Brew the herbs in water and take one dose daily. This formula was developed based on the experiences of my late father, Mr. Pei Shen, who was a renowned physician in Shanghai. He was a close disciple of Mr. Ding Gan Ren, a leading figure in modern Chinese medicine, known for his expertise in cardiovascular and cerebrovascular diseases, and he once served as the Dean of Shanghai College of Traditional Chinese Medicine. The tea tree root in this formula was first developed by Mr. Huang. I often use this formula myself, particularly for patients with coronary heart disease and normal blood pressure who experience chest tightness, shortness of breath, or palpitations, or those who suffer from frequent ventricular premature beats.

(4) Ban Wei Xiang Tang: 6g of Ban Xia, 10g of Gua Lou, 6g of Xiang Fu, 12g of Xia Ku Cao, 6g of Chen Pi, 10g of Gui Zhi, 20g of Chi Shao, 6g of Yu Jin, 60g of Cha Shu Gen. Brew the herbs in water and take one dose daily. This formula was developed by the late renowned Shanghai TCM doctor, Professor Huang Wende, who was a highly regarded student of Mr. Ding Gan Ren, a prominent TCM practitioner of modern times, known for his expertise in cardiovascular and cerebrovascular diseases and widely recognized in Shanghai. The tea tree root in this formula was a pioneering discovery of Professor Huang. I often use this formula myself, primarily for arrhythmias associated with hypertensive heart disease. Tea tree root has sedative, diuretic, hypotensive, and cardiotonic properties, making it a key ingredient in this formula.

The four formulas mentioned above can be combined in various ways—either as a whole or individually, or even by selecting specific herbs to create new formulations. Over decades, these formulas have been used to treat various arrhythmias, and they have always provided effective relief.

Based on clinical diagnosis, these formulas can be used together, separated into different combinations, or even by choosing the most suitable herbs to create new formulations. For decades, these formulas have been used to treat various arrhythmias, and they have always provided effective relief.

My experience suggests that among the four herbs—Dan Shen, Ku Shen, Sheng Di, and Mai Dong—those with larger doses are preferred, ideally between 20–40g. The amount of tea tree root should be between 20–100g, especially for patients with hypertension-related coronary heart disease. Additionally, herbs like Chang Shan and Yuan Hu are often used to treat arrhythmias, with dosages ranging from 8–15g.

Recently, in the Chinese Journal of Traditional Chinese Medicine, dozens of scholars have published articles discussing the use of Ku Shen, with unanimous agreement that Ku Shen is remarkably effective in regulating heart rhythm. Mr. Tang Yipeng from Anhui College of Traditional Chinese Medicine prepared a Ku Shen soup containing 50g of Ku Shen and 50g of Sheng Di; Professor Wang Shujun from China Medical University noted that Ku Shen, Gui Zhi, and Xian Ling Mi are not only effective in treating arrhythmias but also excellent treatments for myocarditis and pericarditis; Dr. Xia Jiande from Wuxi Coal Mine Hospital’s Five-Ingredient Soup contained Bei Sha, Nan Sha, Dang Shen, Gui Zhi, Sheng Long Mu, Bai Zi Ren, and others, and was found to be highly effective in treating various arrhythmias; Dr. Yue Maoqing from Shanghai Malu Hospital’s Ku Shen Repulse Soup included Ku Shen, Dan Shen, Xuan Shen, Gui Zhi, Mai Dong, and other herbs.

In conclusion, I would like to summarize the treatment approaches for arrhythmias using Zhi Gan Cao Tang, Sheng Mai San, Ku Shen, and other five-ingredient formulas, along with large doses of Sheng Di, Mai Dong, Ku Shen, Dan Shen, Chang Shan, Yuan Hu, and tea tree root. These formulas are ideal for patients with coronary heart disease, who may experience chest tightness, shortness of breath, or palpitations, or those who suffer from frequent ventricular premature beats.