II. Slow Arrhythmias

Slow arrhythmias include sinus bradycardia, sick sinus syndrome, atrioventricular nodal rhythms, and various conduction blocks. Clinically, they often manifest as shortness of breath, dizziness, fatigue, chest tightness, and irregular pulses. Traditional Chinese medicine diagnoses often reflect yang qi deficiency and phlegm-fluid obstruction; treatment should focus on restoring yang qi and eliminating phlegm-fluid buildup. 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: With the primary focus on warming yang, benefiting qi, transforming phlegm, and resolving turbidity, the representative formula is Mahuang Fuzi Xixin Tang. In clinical practice,

if patients also experience chest pain and purplish-dark tongue spots with blood stasis, this formula should be used in combination with Guanxin No. 2; if patients also exhibit

insomnia, frequent dreams, shortness of breath, and a weak, slow pulse, this formula should be combined with Guipi Tang; if patients experience fullness and discomfort in the chest and upper abdomen, along with a thick, white tongue coating, this formula should be used in conjunction with Linggui Shugan Tang; if patients present with chills and cold limbs, abdominal distension, and edema with oliguria, this formula should be combined with Zhenwu Tang; if patients experience shortness of breath, excessive sweating, and dry mouth, this formula should be used in combination with Shengmai San. Additionally, the root and stem of tea trees grown in Longnan region (also known as tea tree roots) have shown good therapeutic effects for various types of slow-moving arrhythmias and can be used as appropriate.

Example 3: Xue, male, 61 years old. He experienced chest pain accompanied by shortness of breath and fatigue, and sought medical attention on October 7, 1997. Physical examination revealed a pulse rate of 52 beats per minute, blood pressure of 12/8 kPa. Heart sounds were clear, heart rate was 52 beats per minute, rhythm was regular, no pathological murmurs were heard in any valve, tongue was pale with a thin white coating, and pulse was wiry and slow. Electrocardiogram showed: ① myocardial ischemia; ② sinus bradycardia; ③ complete right bundle branch block. Western medical diagnosis: ① coronary heart disease; ② sinus bradycardia; ③ complete right bundle branch block. Traditional Chinese Medicine diagnosed the condition as deficiency of heart yang, with blood stasis due to blood deficiency, and treated with warming and activating heart yang, promoting blood circulation and resolving blood stasis. The treatment regimen consisted of Mahuang Fuzi Xixin Tang combined with Guanxin No. 2, modified: Mahuang 6 g, Fuzi 6 g, Dangshen 10 g, Mai Dong 10 g, Wujizhi 3 g, Koushan 15 g, Hanshenshi 3 g (to be taken in divided doses), Cha Shu Gen 30 g, Dansheng 6 g, Sharen 6 g. The herbs were decocted in water, one dose per day, divided into two doses. After taking the above medication for more than 20 doses, the chest pain had completely disappeared, though mild shortness of breath remained. Heart rate was 58 beats per minute, blood pressure was 13/8 kPa. The prescription was adjusted to remove Shui Zhi and Hanshenshi, adding Huangqi 30 g, Gui Zhi 10 g, Bai Zhu 12 g, Fu Ling 15 g. After another 30 doses, all symptoms had resolved, and a follow-up electrocardiogram showed normal results after 2 months.

Example 4: Ma, female, 50 years old. She suffered from shortness of breath, dizziness, chest tightness, and throat pain for 5 years, and sought medical attention on December 4, 1994. Her pulse rate was 54 beats per minute, blood pressure was 14/8 kPa. The patient’s throat was red and swollen, heart sounds were clear, heart rate was 56 beats per minute, and a diastolic murmur of grade II could be heard in the precordial area. Tongue was pale with a white coating, pulse was slippery and slow. Electrocardiogram showed sinus bradycardia. Western medical diagnosis: ① rheumatic heart disease (mitral stenosis); ② sinus bradycardia. Traditional Chinese Medicine diagnosed the condition as deficiency of heart yang, with phlegm and fluid retention, and treated with warming yang and transforming phlegm. The treatment regimen consisted of Linggui Shugan Tang combined with Mahuang Fuzi Xixin Tang, modified: Fu Ling 15 g, Gui Zhi 12 g, Bai Zhu 10 g, Gan Cao 8 g, Mahuang 6 g, Fuzi 6 g, Xixin 3 g, Ban Xia 6 g, Er Hua 15 g, Lian Qiao 15 g, Gong Ying 15 g, Baishang 15 g. The herbs were decocted in water, one dose per day, divided into two warm doses. After taking the medicine for more than 20 doses, the throat pain subsided, dizziness and fatigue eased, though she still felt chest tightness. Tongue was pale with a thin white coating, pulse was wiry. The prescription was adjusted to remove Er Hua, Lian Qiao, Gong Ying, and Baishang, adding Gua Lou 10 g and Xie Bai 10 g. After continuing to take the medicine for over 30 doses, her symptoms improved. Pulse rate was 68 beats per minute, blood pressure was 15/10 kPa, and electrocardiogram was normal.

Two Cases of Nutritional Megaloblastic Anemia

Example 1: Patient Li, female, 60 years old. She had a history of chronic gastritis and recurrent nasal bleeding for 2 years, which worsened over the past 3 days. Despite multiple treatments, none were effective. In August 1999, she sought treatment from Yu. Initial examination revealed that the patient was lethargic and fatigued, with a pale complexion, poor appetite, bitter taste in the mouth and dryness, abdominal distension and constipation, intermittent nasal bleeding, a deep, fine pulse, and a red tongue with little coating. Laboratory tests showed: RBC 2.01 × 10^12/L, MCV 120 fl, PLT 50 × 10^9/L, HGB 50 g/L, WBC 2.9 × 10^9/L. Bone marrow examination revealed a marked increase in nucleated cells, primarily characterized by megaloblastic erythrocytes. Western medical diagnosis: nutritional megaloblastic anemia.

In addition to administering vitamin B12 500 mg via intramuscular injection once daily and folic acid 30 mg orally once daily, the primary focus was on traditional Chinese medicine to regulate the spleen and stomach. The herbal formula included: Beisha Shen 15 g, Mai Dong 10 g, Yuzhu 6 g, Shihu 6 g, Danshen 10 g, Muxiang 6 g, Caodoukou 3 g, Bohe Tan 15 g, Danpi Tan 15 g, Xueyu Tan 15 g, Dahuang 6 g, Huanglian 3 g. The herbs were decocted in water and taken in two warm doses daily, one dose per day. After taking the formula for 10 doses, nasal bleeding significantly decreased, constipation eased, but she still experienced poor appetite and a bitter taste in her mouth. The formula was adjusted to remove Bohe Tan and Danpi Tan, adding Huanglian 3 g, Huangqin 10 g, Jiao San Xian each 6 g. After continuing to take the medicine for 10 doses, she stopped using vitamin B12 and folic acid, advised her to improve her nutrition and get adequate rest. At the third visit, after taking the original formula for another 10 doses, her symptoms had improved, though she still experienced mild fatigue, poor appetite, and abdominal distension, with occasional nasal bleeding. Her tongue was red with a thin yellow coating, and her pulse was wiry. Laboratory tests showed: RBC 3.03 × 10^12/L, MCV 92 fl, PLT 60 × 10^9/L, HGB 90 g/L, WBC 8.2 × 10^9/L. Treatment continued with strengthening the spleen and regulating the stomach, supplemented by liver-ventilation therapy. The herbal formula included: Muxiang 3 g, Caodoukou 3 g, Beisha Shen 10 g, Mai Dong 10 g, Yuzhu 6 g, Bai Zhu 10 g, Fu Ling 12 g, Chai Hu 10 g, Bai Shao 10 g, Danpi 10 g, Zhizi 10 g, Dang Gui 10 g, Huanglian 3 g, Huangqin 10 g. The herbs were decocted in water and taken in two warm doses daily. At the fourth visit, after taking the medicine for 20 doses, her symptoms had disappeared, blood counts and bone marrow examinations returned to normal, with very few instances of nasal bleeding, and her mental state and diet had also improved significantly.

Example 2: Wang, male, 50 years old. He experienced discomfort in the epigastric region, bloating after meals, dizziness and fatigue, and poor appetite for 3 years, sometimes accompanied by nausea and diarrhea. His tongue was pale with a thin white coating, and his pulse was wiry and fine. Laboratory tests showed: RBC 2.56 × 10^12/L, HGB 82 g/L, MCV 98 fl, and gastroscopy indicated chronic inflammation of the gastric body. He had previously tried Western medications such as vitamins, folic acid, and metronidazole for six months without success, so he sought treatment from Yu. The patient had a pale complexion, was lethargic, had a thin, pale body, a pale tongue with a thin white coating, and a slippery pulse. A bone marrow examination at another hospital had diagnosed him with nutritional megaloblastic anemia. Western medical diagnosis: ① chronic gastritis; ② nutritional megaloblastic anemia. Traditional Chinese Medicine diagnosed the condition as deficiency of spleen and stomach qi. Treatment focused on replenishing qi and strengthening the spleen, using Xiangsha Liu Junzi Tang, modified: Muxiang 3 g, Caodoukou 3 g, Dangshen 10 g, Bai Zhu 10 g, Fu Ling 12 g, Gan Cao 6 g, Ban Xia 6 g, Chen Pi 6 g, Zhi Shi 10 g, Bai Shao 10 g, Wu Chei Gu 15 g, Jiao San Xian each 6 g. This formula has the effects of tonifying the middle burner to benefit qi, strengthening the spleen and nourishing the stomach, regulating qi and eliminating stagnation, drying dampness and removing phlegm. The herbs were decocted in water and taken in two warm doses daily. At the second visit, after taking the formula for more than 10 doses, the patient reported significant relief from epigastric discomfort and post-meal bloating, though he still felt dizziness and fatigue, occasionally experiencing poor sleep. Tongue and pulse were similar to before. Laboratory tests showed: WBC 2.9 × 10^9/L, HGB 86 g/L, MCV 96 fl. Although the patient’s spleen and stomach functions had improved, his anemia had not yet resolved. The treatment was changed to focusing on treating both the spleen and stomach together, and nourishing qi and blood simultaneously, using Guipi Tang, modified: Huang Huang 30 g, Dang Gui 10 g, Dangshen 10 g, Bai Zhu 10 g, Fu Ling 12 g, Gan Cao 6 g, Yuan Zhi 6 g, Chao Suo Zao Ren 15 g, Muxiang 3 g, Yuan Rou 10 g, Sheng Di 12 g, He Shou Wu 15 g, Tu Da Huang 12 g, Nu Zhen Zi 12 g. The herbs were decocted in water and taken in two warm doses daily. At the third visit, after taking the formula for more than 10 doses, the patient’s epigastric discomfort further improved, and his diet, mental state, and sleep also improved significantly. A follow-up blood test showed: RBC 3.4 × 10^12/L, HGB 96 g/L, MCV 92 fl. Further adjustments were made to the formula, and after taking traditional Chinese medicine for more than 40 doses, the blood count returned to normal. At the fourth visit, the patient’s condition remained stable, but five days ago, due to dietary indiscretion, he experienced epigastric discomfort, nausea, loose stools four times a day, and poor appetite. Therefore, he visited again, considering that it might be chronic gastritis combined with acute gastritis, and treatment was mainly based on traditional Chinese medicine. The herbal formula included: Chen Pi 6 g, Fu Ling 12 g, Lian Qiao 15 g, Ban Xia 6 g, Jiao San Xian each 6 g, Cang Zhu 6 g, Huanglian 6 g, Muxiang 6 g. The herbs were decocted in water and taken in two warm doses daily, one dose per day. After taking the medicine for 5 doses, his nausea and diarrhea had disappeared, though he still experienced epigastric discomfort and poor appetite. A follow-up blood test showed: RBC 3.6 × 10^12/L, HGB 100 g/L, MCV 94 fl. Therefore, the treatment was changed to combining Xiangsha Liu Junzi Tang with Ban Xia Xie Xin Tang, to enhance the effects of harmonizing the stomach, descending rebellious qi, opening up the obstruction, and relieving痞. The herbs were decocted in water and taken in two warm doses daily, one dose per day. After taking the medicine for 10 doses, both blood counts and bone marrow examinations returned to normal, and after a three-year follow-up, there were no recurrences.

Two Cases of Primary Thrombocytopenic Purpura

Example 1: Peng ××, female, 27 years old, cook, first visited on September 8, 1983. One year earlier, she began experiencing nosebleeds, which occurred repeatedly, and scattered hemorrhagic spots appeared all over her body, varying in size, with some areas forming patchy purpura. Her menstrual flow was heavy and light in color, her face gradually became pale, accompanied by fatigue, dizziness, palpitations, lower back pain, tinnitus, fear of cold, and spontaneous sweating. She underwent bone marrow aspiration at a local hospital, where she was diagnosed with idiopathic thrombocytopenic purpura. Her body temperature was 36.7°C, blood pressure was 12/8 kPa (90/60 mmHg). Her face was pale, and spotted hemorrhagic spots were visible on her neck, anterior chest, and limbs, which did not blanch when pressed. Cardiac percussion was not enlarged, and a grade II systolic blowing murmur was audible in the apex area, with lungs (-), liver not palpated, spleen palpated 1.5 cm below the ribs. Her platelet count was 27,000/L, red blood cells 3.6 million/L, hemoglobin 10 g/L, white blood cells 5,600/L, neutrophils 72%, lymphocytes 28%. Bleeding time was 8 minutes, and clot formation was poor within 24 hours. Bone marrow examination showed that megakaryocytes were morphologically normal, with a slight increase in number, while platelet-forming megakaryocytes were markedly reduced. Diagnosis: idiopathic thrombocytopenic purpura. Traditional Chinese Medicine diagnosis: The patient’s tongue was plump and pale, with tooth marks, a slightly yellow and greasy coating, a deep, fine, and rapid pulse, especially deep in the left and right pulses. Combined with the symptoms of pale face, fatigue, dizziness, palpitations, lower back pain, tinnitus, and fear of cold, this was considered a condition of spleen and kidney qi deficiency, where qi fails to govern blood. Prolonged qi deficiency leads to dampness, blood stasis, and even fire. The treatment should focus on strengthening the spleen and supplementing the kidneys, replenishing qi and capturing blood, while also clearing heat, drying dampness, and promoting blood circulation and resolving blood stasis. The formula used was Shenma San Huang Tang, modified: Dangshen 10 g, Huangqi 20 g, Bai Zhu 6 g, Tu Da Huang 15 g, Huanglian 3 g, Huangqin 10 g, Zhi Lu Mo each 3 g, Bai Ti Li 20 g, Yuan Rou 10 g, Shan Yu 10 g, Po Gu Zhi 10 g, Tu Si Zi 10 g. The herbs were decocted in water and taken once daily. After taking the medicine for 10 doses, the overall purpura and hemorrhagic symptoms improved significantly, and dizziness, fatigue, fear of cold, and palpitations also improved. The formula was adjusted to remove Po Gu Zhi and Tu Si Zi, and after taking the medicine for 21 doses, all symptoms had subsided, platelet levels rose to 120,000/L, bleeding time and clot contraction both returned to normal, and bone marrow examination also normalized, with red blood cells 4.8 million/L and hemoglobin 14 g/L.

Example 2: Hua ×, female, 5 years old, first visited on February 17, 1984. Six months earlier, after a recent cold, she developed nosebleeds and purpura all over her body. She was diagnosed with “primary thrombocytopenic purpura” at a certain hospital. After treatment with hormones and other Western medications, her platelet levels temporarily increased, but the purpura and nosebleeds continued to recur. She grew increasingly thin and pale, accompanied by fatigue, thirst, spontaneous sweating, poor appetite, constipation, and palpitations—sometimes with anal bleeding during bowel movements. Her body temperature was 38.9°C, blood pressure was 10.7/6.7 kPa (80/50 mmHg), her face was pale, and large and small hemorrhagic spots were visible on her anterior chest, back, and limbs, which did not blanch when pressed. Cardiac percussion was not enlarged, no murmurs were heard in any valve area, lungs (-), liver palpated 2 cm below the xiphoid process, soft in texture with no tenderness, and spleen was not palpated. Her platelet count was 17,000/L, red blood cells 4.6 million/L, hemoglobin 12 g/L, white blood cells 5,600/L, neutrophils 78%, lymphocytes 21%, eosinophils 1%, bleeding time was 6 minutes, clot formation was poor within 24 hours, and bone marrow examination showed that megakaryocyte morphology was still relatively normal, though platelet-forming megakaryocytes were reduced. Traditional Chinese Medicine diagnosis: The patient’s tongue was red, with scattered ecchymoses, a slightly yellow and greasy coating, a deep, smooth, and rapid pulse, especially deep in the left and right pulses. Combined with symptoms like thinning, paleness, fatigue, spontaneous sweating, poor appetite, thirst, palpitations, fever, and constipation, the condition was characterized by deficiency of both qi and blood—qi failing to capture blood; when qi is deficient, yang is also deficient, leading to dampness; when blood is deficient, blood stasis occurs, and fire may arise. The treatment should address both the root and the symptoms, using Shenma San Huang Tang, modified: Dangshen 10 g, Huangqi 20 g, Bai Zhu 10 g, Gan Cao 6 g, Tu Fu Ling 19 g, Huangqin 10 g, Huanglian 3 g, Zhi Lu Mo each 3 g, Bai Ti Li 60 g, Sheng Shi Gao 30 g, Xian He Cao 15 g. The herbs were decocted in water and taken once daily. After taking the medicine for 5 doses, the patient’s fever subsided, thirst ceased, spontaneous sweating and fatigue lessened, and the purpura and nosebleeds throughout the body improved significantly. The formula was adjusted to remove Sheng Shi Gao and Xian He Cao, and after taking the medicine for another 22 doses, all symptoms had subsided, and the patient seemed to return to normal. Platelet count was 91,000/L, red blood cells 4.8 million/L, hemoglobin 14.5 g/L, white blood cells 6,200/L, neutrophils 71%, lymphocytes 28%, mononuclear cells 1%. Bleeding time and clot contraction within 24 hours were both normal. Bone marrow examination showed that platelet-forming megakaryocytes were approaching normal levels.

Two Cases of Traditional Chinese Medicine Rescue for Critical and Severe Conditions

Example 1: Wang ××, male, 51 years old, worker, sought emergency treatment on August 6, 1982. Three days earlier, he had experienced severe upper abdominal pain, described as cutting-like, radiating to the left chest, waist, shoulder, and back, accompanied by nausea and vomiting, and also exhibited pale face and cold extremities, with a drop in blood pressure. He was then referred for consultation with a traditional Chinese medicine practitioner. Physical examination revealed a body temperature of 37.8°C, a pulse rate of 102 beats per minute, a respiratory rate of 28 breaths per minute, blood pressure of 8.0/5.3 kPa (60/40 mmHg), a pale complexion, a distressed expression, a hazy state of consciousness, a soft neck, no abnormalities heard upon auscultation of both lungs, a cardiac boundary not enlarged, and a grade II systolic blowing murmur audible in the apex area. The abdomen was slightly distended, with marked tenderness and mild rebound tenderness in the upper left quadrant of the abdomen; liver and spleen were not palpated, extremities were cold, and pathological reflexes were not elicited. Laboratory tests showed: white blood cells 18,000/㎜³, neutrophils 84%, lymphocytes 16%, serum amylase 1260 U (Somogyi method), urine amylase 445 U (Winstow method). Diagnosis: acute pancreatitis complicated by shock. Traditional Chinese Medicine diagnosis: The tongue was red with a thick, greasy coating, the pulse was deep, fine, and rapid, with constipation and dry stools, combined with severe chest and abdominal pain, pale face, and cold extremities—this was a case of yang excess inside, yin trapped outside, with internal yang manifesting in the Yangming腑, and external yin being trapped in the feet, where heat intensifies, causing the cold to deepen. The treatment should focus on clearing heat and attacking excess to treat the root cause, using Dachengqi Tang, modified: rhubarb, mirabilite, jujube fruit, bupleurum, white peony each 10 g, yuanhu, chuanliezi, houpu, Huangqin each 6 g, Huanglian, muxiang, caodoukou each 3 g. The herbs were decocted in water and taken in two doses daily, while fluids were administered and penicillin and streptomycin were injected intramuscularly. The next visit showed that the patient’s abdominal pain had greatly diminished, his state of consciousness had cleared, and he had passed a large amount of dark black, foul-smelling stool—blood was present in the stool, with a total volume reaching half a bowl. He had been diagnosed with “bronchiectasis complicated by massive hemorrhage” at a certain hospital, with a history of chronic bronchitis, no history of tuberculosis, nor any history of heart disease or liver/gastric disorders. Physical examination revealed a body temperature of 38°C, a respiratory rate of 20 breaths per minute, a pulse rate of 102 beats per minute, blood pressure of 13.3/8.7 kPa (100/65 mmHg). The patient was thin and pale, with clear consciousness, symmetrical chest, slightly barrel-shaped, with widened intercostal spaces, clear percussion notes, deeper breathing on both sides, coarse breath sounds in both lungs, scattered dry rales, a cardiac boundary not enlarged, no obvious murmurs in any valve area, A2>P2, A2 slightly elevated. The abdomen was soft, with no tenderness in the gastric region. Liver and spleen were not palpated, and ascites was absent. Chest X-ray showed significantly thickened lung markings, increased transparency, and widened lung fields—indicating chronic bronchitis combined with emphysema and bronchiectasis. Laboratory tests showed: white blood cells 18,600/㎜³, neutrophils 82%, lymphocytes 18%, ESR 2 mm/h. Diagnosis: bronchiectasis, emphysema, and massive hemorrhage. Traditional Chinese Medicine diagnosis: The patient’s tongue was red with a thick, greasy coating, the pulse was洪大 and rapid, with constipation and chest tightness, coughing and wheezing, phlegm and sputum congested, and bloody sputum with foam. The condition was characterized by real heat in the lung and stomach, with fire raging and forcing blood. The treatment should clear heat from the lung and stomach, cool the blood and stop the bleeding—using Liangjie San, modified: rhubarb, mirabilite, lian qiao, Huangqin, shan zhi, baizhi, gua lou, ju hong each 10 g, Huanglian, beimu, gan cao each 6 g, bohe 3 g. The herbs were decocted in water and taken once daily, with a total of 6 doses. At the second visit, the patient’s condition improved, his blood pressure stabilized, the tongue coating thinned, and the pulse remained wiry, with only occasional dull pain in the upper left abdomen. Serum amylase dropped from 1260 U to 60 U, urine amylase dropped from 445 U to 120 U. The patient continued to take Shu Gan Wan (from Henan Yucheng Pharmaceutical Factory), 1 pill morning and evening, to support his recovery.

Example 2: Chen ××, male, 68 years old, retired worker, first visited on April 7, 1983. A day earlier, he had experienced chest tightness and coughing, followed suddenly by vomiting of bright red blood mixed with foam, with continuous bleeding over the course of a day—total volume reaching half a soup spoon. He had been diagnosed with “bronchiectasis complicated by massive hemorrhage” at a certain hospital, with a history of chronic bronchitis, no history of tuberculosis, nor any history of heart disease or liver/gastric disorders. Physical examination revealed a body temperature of 38°C, a respiratory rate of 20 breaths per minute, a pulse rate of 102 beats per minute, blood pressure of 13.3/8.7 kPa (100/65 mmHg). The patient was thin and pale, with clear consciousness, symmetrical chest, slightly barrel-shaped, with widened intercostal spaces, clear percussion notes, deeper breathing on both sides, coarse breath sounds in both lungs, scattered dry rales, a cardiac boundary not enlarged, no obvious murmurs in any valve area, A2>P2, A2 slightly elevated. The abdomen was soft, with no tenderness in the gastric region. Liver and spleen were not palpated, and ascites was absent. Chest X-ray showed significantly thickened lung markings, increased transparency, and widened lung fields—suggesting chronic bronchitis combined with emphysema and bronchiectasis. Laboratory tests showed: white blood cells 18,600/㎜³, neutrophils 82%, lymphocytes 18%, ESR 2 mm/h. Diagnosis: bronchiectasis, emphysema, and massive hemorrhage. Traditional Chinese Medicine diagnosis: The patient’s tongue was red with a thick, greasy coating, the pulse was洪大 and rapid, with constipation and chest tightness, coughing and wheezing, phlegm and sputum congested, and bloody sputum with foam. The condition was characterized by real heat in the lung and stomach, with fire raging and forcing blood. The treatment should clear heat from the lung and stomach, cool the blood and stop the bleeding—using Liangjie San, modified: rhubarb, mirabilite, lian qiao, Huangqin, shan zhi, baizhi, gua lou, ju hong each 10 g, Huanglian, beimu, gan cao each 6 g, bohe 3 g. The herbs were decocted in water and taken once daily, with a total of 4 doses. At the third visit, after taking the medicine for 5 doses, the patient’s symptoms had improved, except for chest tightness and wheezing, with a wiry pulse and a pale tongue with a thin yellow coating. The patient was advised to take Mai Wei Di Huang Wan twice daily, 1 pill each time, to support his recovery.

Two Cases of Severe Toxic Dysentery

Example 1: Chen ×, 21 years old, male, a middle school student. On February 16, 1969, at 14:00, he was admitted to the hospital after experiencing high fever, abdominal pain, coma, and convulsions for 2 hours. Around 7:00 a.m. that day, after getting out of bed to wash up, he felt abdominal pain and nausea, wanting to vomit. He took a small bottle of “Shi Di Shui” but found it ineffective, and was accompanied by high fever and chills. He soon fell asleep, and 2 hours later, his consciousness gradually became blurred, accompanied by intermittent convulsions. He was in good health prior to this incident. Physical examination revealed a body temperature of 40.1°C, a pulse rate of 120 beats per minute, a respiratory rate of 12 breaths per minute, blood pressure of 14.7/10.7 kPa (110/80 mmHg). The patient was comatose, with occasional convulsions, and no jaundice or ecchymoses were observed on his skin and mucous membranes.

Example 2: Zhang ××, male, 50 years old. He experienced severe abdominal pain, dizziness, and chest tightness, along with throat pain for 5 years, and sought medical attention on December 4, 1994. His pulse rate was 54 beats per minute, blood pressure was 14/8 kPa. The patient’s throat was red and swollen, heart sounds were clear, heart rate was 56 beats per minute, and a diastolic murmur of grade II could be heard in the precordial area. Tongue was pale with a thin white coating, and pulse was wiry and slow. Electrocardiogram showed: ① myocardial ischemia; ② sinus bradycardia; ③ complete right bundle branch block. Western medical diagnosis: ① coronary heart disease; ② sinus bradycardia; ③ complete right bundle branch block. Traditional Chinese Medicine diagnosed the condition as deficiency of heart yang, with blood stasis due to blood deficiency, and treated with warming and activating heart yang, promoting blood circulation and resolving blood stasis. The treatment regimen consisted of Mahuang Fuzi Xixin Tang combined with Guanxin No. 2, modified: Mahuang 6 g, Fuzi 6 g, Dangshen 10 g, Mai Dong 10 g, Wujizhi 3 g, Koushan 15 g, Hanshenshi 3 g (to be taken in divided doses), Huanglian 3 g, Beimu 6 g, Bai Zhu 12 g, Fu Ling 15 g. The herbs were decocted in water, one dose per day, divided into two doses. After taking the medicine for more than 20 doses, the chest pain had completely disappeared, though mild shortness of breath remained. Heart rate was 58 beats per minute, blood pressure was 13/8 kPa. The prescription was adjusted to remove Shui Zhi and Hanshenshi, adding Huangqi 30 g, Gui Zhi 10 g, Bai Zhu 12 g, Fu Ling 15 g. After continuing to take the medicine for 30 doses, all symptoms had resolved, and a follow-up electrocardiogram showed normal results after 2 months. 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: Clock spots, rashes, and petechial hemorrhages. No obvious enlargement of systemic lymph nodes was observed; both pupils were slightly dilated.

The throat was red, with tonsils enlarged at grade I, and the neck was stiff.

Heart: no abnormalities detected; both lungs had rhonchi, abdominal distension was mild, with a slight tenderness in the lower abdomen; liver (negative), spleen (negative).

Intestinal sounds were diminished, with no shifting dullness present; knee tendon reflex was slightly hyperactive, but pathological reflexes were not elicited. Blood routine: red blood cells 4.6 million/μL, hemoglobin 89 g/L, white blood cells 12,300/μL, neutrophils 80%, lymphocytes 18%, monocytes 1%; urine routine (catheterization): yellow in color, acidic, no glucose, no protein, only a small amount of epithelial cells; stool routine (anal swab): mucus (+++), pus cells (+++), red blood cells (+), ascaris eggs 0–3/low power magnification; cerebrospinal fluid: clear and transparent, Pandy’s test: (-), cells (-). Diagnosis: toxic bacterial dysentery (acute type). After admission, standard treatment for acute dysentery was administered, immediately followed by intramuscular injections of 50 mg each of diphenhydramine and phenazone, along with sub-hypothermia therapy. Additionally, 30 ml of 0.5% phenylbutazone suspension was administered via enema, 200 ml of 20% mannitol was infused intravenously, 200 mg of hydrocortisone, 1000 mg of vitamin C, while simultaneously administering 400,000 units of penicillin every 6 hours, 0.5 g of streptomycin intramuscularly every 8 hours, and 0.5 g of chloramphenicol intramuscularly every 8 hours. Following these treatments, the patient’s convulsions gradually subsided, though their coma worsened. Around midnight, they developed Cheyne-Stokes respiration, with unequal pupil sizes on both sides. Immediately, 10 μg of atropine was administered via intravenous infusion, once every 5 minutes. After more than 10 infusions, respiratory failure did not improve significantly; the family was informed that the patient was in critical condition, and atropine therapy was discontinued, switching to traditional Chinese medicine—“Xinzhuo Taoren Chengqi Tang” (nasal feeding) administered in 3 doses via gastric tube. After completing the first dose, the patient passed about 500 ml of viscous, pork-like material through the anus. Their breathing gradually became calmer, their pulse was stronger than before, though they remained in a deep coma. While continuing the aforementioned fluid therapy and antibiotic treatment, another dose of “Xinzhuo Taoren Chengqi Tang” was administered via nasal feeding. During the feeding process, the patient’s mental state gradually improved, their breathing returned to normal, and later, the dosage of rhubarb and mirabilite was increased to 15 g, with the addition of 20 g of angelica root, 15 g of white peony, and 4 g of cinnamon bark. The medication was administered once daily for 3 doses, after which the patient recovered.

Case 2: Wang ××, female, 1.5 years old. She presented with fever for half a day and had a seizure lasting one hour before being admitted. On that morning, the patient began experiencing fever, crying and fussing, though her family did not notice the symptoms. An hour earlier, she suddenly experienced continuous convulsions; the family was terrified and rushed her to the emergency department. Physical examination: body temperature 35.6°C, pulse unclear, breathing intermittent, altered mental status, cyanosis of the face, clenched teeth, foaming at the mouth, with episodes of convulsions that alternated between short and long durations; heart sounds were faint, rhythm irregular, breathing sometimes absent, no dry or moist rales heard. Abdomen was distended, intestinal sounds were absent, liver and spleen were unremarkable, and pathological reflexes were not elicited. Rapid stool analysis (anal swab): mucus (+++), pus cells (+++). Diagnosis: toxic dysentery (acute type). Immediate treatment included 500 ml of 10% glucose solution, 500 ml of 5% glucose saline, plus vitamin C via scalp vein infusion, 3 mg of lobeline intramuscularly, followed by a single dose of “Xinzhuo Taoren Chengqi Tang” via nasal feeding (prescription: 15 g of rhubarb, 15 g of mirabilite, 10 g of peach kernel, 10 g of cinnamon twig, 5 g of licorice, 8 g of coptis, 5 g of agastache, 10 g of scutellaria, 50 g of Portulaca oleracea, decocted in 1000 ml of water until 200 ml was obtained, administered in 3 doses over 2 hours). After the medication was administered, the child’s convulsions stopped, and large amounts of viscous material were passed through the anus. Breathing stabilized, and the next day, another dose of “Xinzhuo Taoren Chengqi Tang” was administered in 3 doses. By the following morning, the child’s spirits improved, appetite slightly increased, and the original formula was adjusted by removing rhubarb and mirabilite, adding quina, white peony, angelica root, and hawthorn. After taking one dose, the child recovered and was discharged.

Two Cases of Chronic Bronchitis

Case 1: Patient Gao, male, 67 years old, with a history of wheezing for 10 years accompanied by cough. A week ago, after catching a cold, his condition worsened; he produced thin, clear sputum, with difficulty expectorating. Physical examination: temperature 36.8°C, pulse 88 beats per minute, respiration 30 breaths per minute; blood pressure 18/10 kPa. The patient was alert, with cyanotic lips, a barrel-shaped chest, clear percussion borders in both lungs, rapid breath sounds, and vesicular breath sounds audible at the lung bases. The tongue was swollen, coated with white coating, and the pulse was floating and smooth. Laboratory results showed: WBC 11.2 × 10^9/L, neutrophils 0.78. Western medical diagnosis: ① acute exacerbation of chronic bronchitis; ② obstructive emphysema. Traditional Chinese Medicine diagnosis: cold-dryness affecting the lungs, with phlegm-tinged obstruction within the middle burner. Treatment should focus on warming and dispersing cold-dryness, moistening the lungs and resolving phlegm. The formula used was Xing Su San combined with Ma Xing Shi Gan Tang with modifications: 10 g of almond, 10 g of white peony, 12 g of poria, 10 g of platycodon, 3 g of schizandra, 3 g of asarum, 6 g of dried ginger, decocted in water and taken once daily, divided into doses. After administering the formula for more than 10 doses, the patient’s sputum production decreased, though he still experienced wheezing, which was particularly severe during activity. The tongue was pale with white coating, the pulse was slippery; the formula was modified by removing ma huang and raw gypsum, adding 6 g of sandalwood, 3 g of cinnamon, and 15 g of purple quartz. After administering the formula for more than 20 doses, all symptoms disappeared.

Case 2: Patient Wang, female, 50 years old, with a history of cough and thick sputum for 1 month, accompanied by dry mouth and sore throat. Physical examination: temperature 38°C, pulse 90 beats per minute, respiration 28 breaths per minute, blood pressure 16/10 kPa. Tonsils were enlarged at grade I, the chest was symmetrical, and rhonchi were audible in both lungs. The tongue was red with yellow coating, and the pulse was slippery and rapid. Laboratory results showed: WBC 16.2 × 10^9/L, neutrophils 0.82. Western medical diagnosis: chronic bronchitis complicated by infection. Traditional Chinese Medicine diagnosis: cold-dryness affecting the lungs, with phlegm-heat accumulating in the middle burner. The formula used was Xing Su San combined with Ma Xing Shi Gan Tang with modifications: 10 g of almond, 10 g of perilla leaves, 15 g of platycodon, 10 g of citrus peel, 3 g of ephedra, 30 g of raw gypsum, 6 g of licorice, 15 g of tree bark, 15 g of mulberry bark, 15 g of honeysuckle, 15 g of forsythia, 15 g of dandelion, 15 g of bitter wormwood, decocted in water and taken once daily, divided into doses. After administering the formula for more than 10 doses, the patient’s sputum production significantly decreased, though he still felt dry mouth and itchy throat. The tongue was red with little coating, the pulse was fine and rapid; the formula was modified by removing ephedra, tree bark, mulberry bark, honeysuckle, forsythia, adding 12 g of rehmannia, 12 g of xuan shen, 10 g of ophiopogon, 10 g of zhebei, 20 g of pear skin. After administering the formula for more than 10 doses, all symptoms disappeared.

One Case of Misdiagnosis and Correction in Tuberculous Peritonitis

In October 1982, a patient named Sun, female, 36 years old, an employee of Changfeng Factory, presented with abdominal pain and diarrhea for several months, with loose, mucoid stools that were black in color, occurring 6–7 times a day. Each time the abdomen hurt, the patient would feel the urge to go to the bathroom, and she would have a bowel movement once each morning. The abdominal pain was primarily located in the lower abdomen, with loss of appetite, good health, no feeling of coldness, though the lower abdomen felt cool. Her pulse was deep, fine, and slippery, with a pale coating on the tongue; she was diagnosed with deficiency of spleen and stomach due to cold, with dampness obstructing the middle burner. The prescription was Fuzi Lizhong Tang combined with Pingwei San with modifications: 6 g of aconite, 10 g of codonopsis, 10 g of poria, 6 g of licorice, 10 g of poria, 10 g of chuanxiong, 6 g of tangerine peel, 10 g of safflower, 3 g of wood fragrance, 5 g of grass nut, 3 g of coptis, 10 g of citrus peel, 10 g of Zhujian, 10 g of Huanglian, 10 g of Zhi Ke, 10 g of Ze Xie, 6 g of aconite, 3 g of coptis, 10 g of bitter wormwood, 15 g of white peony. The patient took the formula for 10 doses, decocted in water, and also received 0.125 g of rifampicin once daily.

At the second visit, after the patient took the above medication for 5 doses, there was no improvement in her symptoms, and the conditions remained unchanged. Upon further inquiry, the patient revealed that in addition to the above symptoms, she also experienced low-grade fever in the afternoon. Abdominal examination confirmed significant tenderness in the right lower quadrant near the umbilicus, with referred pain in the cecum. When asked about her medical history, she confirmed that the illness had lasted for six months. The erythrocyte sedimentation rate was 73 mm/h, the pulse was tense and slippery, the tongue was pale red with a thin, greasy coating. Western medical diagnosis: ① intestinal tuberculosis; ② tuberculous peritonitis. Traditional Chinese Medicine diagnosis: damp-heat accumulation in the middle burner. The doctor apologized for having overlooked a detailed examination due to busy clinical work. The prescription was formulated as follows: 6 g of wu yao, 12 g of poria, 6 g of curcuma, 6 g of yuan hu, 10 g of abdominal skin, 6 g of dried ginger, 3 g of sandalwood, 3 g of agarwood, 6 g of fragrant needle, 6 g of tangerine peel, 10 g of angelica root, 6 g of atractylodes, 6 g of chuanxiong, 6 g of poria, 10 g of citrus peel, 10 g of zeaxanthin, 6 g of aconite, 3 g of coptis, 10 g of white peony. After taking the formula for 10 doses, the patient’s symptoms improved significantly, and after another 10 doses, the symptoms completely disappeared. Throughout the entire course of this case, it demonstrated that doctors should adopt a pragmatic and factual approach to medical practice, always learning from both successes and failures to improve themselves.

Three Cases of Atrophic Gastritis

Case 1: Huang ××, male, 50 years old, cadre. Chief complaint: burning pain in the upper part of the stomach for 10 years, worsening for the past year. Each time alcohol consumption or improper diet triggered the pain, which was severe, accompanied by a burning sensation in the stomach, dry mouth and a desire to drink, preference for cold drinks and cold foods, constipation, a red tongue with a slightly yellow coating, and a pulse that was tense and rapid.

Physical examination: tenderness in the left lower region below the xiphoid process.

Gastroscopy: superficial gastritis, atrophy in the antrum, mild intestinal metaplasia.

Diagnosis: type B, characterized by excessive stomach fire.

Prescription: Pinxia, fresh ginger, scutellaria, coptis, North Shaoshan, jujube, wood fragrance, grass nut, licorice.

After administering the formula for more than 10 doses, the symptoms eased, and after another 10 doses, the symptoms disappeared. To this day, six years have passed without any upper abdominal pain.

Case 2: Wang ×, male, 50 years old, cadre. Chief complaint: abdominal distension and fullness for 10 years, worsening for the past six months. Symptoms became more pronounced in the evening, accompanied by fear of cold and chills, coldness in the back, fatigue, poor appetite, loose stools, a pale tongue with a thin white coating, and a pulse that was tense and fine.

Physical examination: distension in the left lower region below the xiphoid process.

Gastroscopy: the gastric mucosa showed mottled patterns. This suggested atrophic gastritis with severe intestinal metaplasia.

Diagnosis: type A, characterized by qi deficiency in the spleen and stomach.

Prescription: wood fragrance, amomum villosum, codonopsis, poria, pinxia, poria, tangerine peel, baizhang, fragrant needle, medicinal herb, roasted three-spirit herbs, licorice.

After administering the formula for 7 doses, the symptoms improved significantly; the abdominal distension and fullness were noticeably reduced, and other symptoms also improved. Subsequently, the prescription was adjusted, and the therapeutic effects were remarkable.

Case 3: Yang ××, male, 23 years old, worker. Chief complaint: abdominal distension and pain for 2 years, accompanied by acid reflux. Both abdominal distension and pain persisted, making it difficult to consume hot or cold foods, with acid reflux and discomfort, fear of cold, fatigue, and stools that were either dry or loose, a pale tongue with a thin yellow coating, and a pulse that was deep and fine.

Physical examination: tenderness in the left lower region below the xiphoid process.

Gastroscopy: the gastric antrum and gastric body showed mottled patterns. This suggested atrophic gastritis with severe intestinal metaplasia.

Diagnosis: mixed type of cold and heat, characterized by mutual accumulation of cold and heat.

Prescription: wood fragrance, amomum villosum, codonopsis, poria, poria, tangerine peel, zhishi, chuanxiong, pinxia, mianxia, coptis, licorice.

After administering the formula for 10 doses, all reported symptoms were alleviated. Continuing to adjust the prescription, the therapeutic effects were satisfactory.

Two Cases of Rheumatic Heart Disease

Case 1: Patient Zhang, female, 51 years old. She had been experiencing shortness of breath for more than 10 years, worsening for the past 5 days, accompanied by palpitations, chest tightness, fatigue, and increased severity with physical activity, unable to care for herself. She visited the clinic on October 10, 1996. Physical examination: the patient had a mitral face, sat upright with breathing, a pulse rate of 82 beats per minute, a cardiac boundary that had expanded to the left, heart sounds varying in strength, a heart rate of 90 beats per minute, irregular rhythm, a harsh, rough systolic murmur audible in the apex area, mild edema in both lower limbs, a swollen, large tongue with a thin white coating, a pulse that was weak and slow, and a pulse that was delayed.

Western medical diagnosis: ① rheumatic heart disease (mitral regurgitation); ② heart failure; ③ atrial fibrillation. Traditional Chinese Medicine diagnosis: phlegm-tinged obstruction. The prescription was Ling Gui Shu Gan Tang combined with Zhen Wu Tang with modifications: 15 g of poria, 12 g of cinnamon twig, 10 g of poria, 6 g of licorice, 6 g of aconite, 6 g of dried ginger, 10 g of white peony, 20 g of rehmannia, 20 g of salvia, 20 g of bitter wormwood. After administering the formula for more than 10 doses, the shortness of breath and sitting-up breathing lessened, though she still experienced palpitations, chest tightness, a pulse rate of 74 beats per minute, a heart rate of 84 beats per minute, irregular rhythm, a pale tongue with a thin white coating, a delayed pulse. Therefore, the aconite and white peony were removed from the formula, and 10 g of egg yolk, 4 jujubes, 10 g of codonopsis, 20 g of ophiopogon, 10 g of sesame seeds were added. After administering the formula for another 15 doses, the patient’s symptoms improved. Later, using Ling Gui Shu Gan Tang as the main component, the formula was adjusted and administered for more than 20 doses, and all symptoms disappeared, allowing the patient to live completely independently. The pulse rate was 72 beats per minute, the heart rate was 72 beats per minute, and the heart rhythm was more regular than before.

Case 2: Patient Lei, male, 30 years old. He had been experiencing shortness of breath for 5 years, often worsening after catching a cold or after exertion, accompanied by intermittent coughing and pink frothy sputum, fatigue, and pain in both knee joints. He visited the clinic in October 1995, with wheezing audible in both lungs, a cardiac boundary that had expanded to the left, clear heart sounds, a heart rate of 80 beats per minute, regular rhythm, a systolic murmur audible in the apex area, a pale tongue with a thin yellow coating, a pulse that was floating and rapid, and a chest X-ray showing enlargement of the left atrium. Western medical diagnosis: rheumatic heart disease (mitral stenosis). Traditional Chinese Medicine diagnosis: phlegm-tinged obstruction, lung dysfunction leading to stagnation. Treatment focused on warming yang, promoting water metabolism, and clearing the lungs to relieve asthma. The prescription was Ling Gui Shu Gan Tang combined with Ma Xing Shi Gan Tang with modifications: 15 g of poria, 12 g of cinnamon twig, 10 g of poria, 6 g of licorice, 6 g of grass seed, 4 jujubes, 15 g of honeysuckle, 15 g of forsythia, 6 g of ephedra, 10 g of almond, 30 g of raw gypsum. After administering the formula for more than 20 doses, the shortness of breath lessened, and the coughing and sputum production disappeared; however, joint pain persisted, and a low-grade fever was present. Therefore, the prescription was changed to Ling Gui Shu Gan Tang combined with Gui Zhi Shaoyao Zhi Mu Tang with modifications: 12 g of cinnamon twig, 12 g of white peony, 10 g of Zhi Mu, 10 g of poria, 10 g of Chuan Cao Wu each (first simmered for 60 minutes), 12 g of Fang Feng, 6 g of ephedra, 6 g of licorice, 4 jujubes, 15 g of poria, 15 g of tree bark. After administering the formula for more than 20 doses, the patient’s joint pain disappeared, and the erythrocyte sedimentation rate returned to normal. Subsequently, using Ling Gui Shu Gan Tang with modifications for 1 month, all symptoms were eliminated. A follow-up chest X-ray showed that the left atrium had decreased in size compared to the previous examination.

Three Cases of Hair Loss

Case 1: Li ××, male, 21 years old, from Hebei Province, a worker, visited the clinic in early September 1983. Four years ago, he suffered from hair loss, initially starting at the corners of both temples, gradually extending toward the crown. Two years ago, aside from a small amount of sparse hair remaining on the occipital region, most of his hair had fallen out; the scalp had an oily sheen, he felt itching, and occasional small flakes of dandruff fell off. He had a history of duodenal bulb ulcer, and recently he continued to experience stomach pain. Physical examination: moderate nutrition, good development, no abnormalities found in the heart or lungs; abdomen was flat, neither the spleen nor the liver were palpated; most of his hair had fallen out, the scalp was shiny and oily, with few wrinkles. Western medical diagnosis: seborrheic alopecia. Traditional Chinese Medicine diagnosis: a deep, fine pulse, a pale tongue with a thin white coating, complaints of fatigue and poor appetite, discomfort in the epigastric region. The condition was characterized by spleen and stomach deficiency, insufficient middle qi, and imbalance in the generation of vital energy and blood; early baldness was observed. The treatment should focus on strengthening the spleen and stomach, nourishing the spleen and stomach, and replenishing nutrients and blood. The formula used was Formula No. 1, administered once daily, and 60 g of cypress leaf was decocted in water for head washing, once daily. After administering the medication for 20 doses, new hair began to grow across the entire scalp, and after another 20 doses, the hairs turned black and thicker. Three months later, the patient’s scalp was covered in dark hair, indistinguishable from others.

Case 2: Xu ×, female, 16 years old, from Gansu Province, a middle school student, visited the clinic in early March 1978. One year ago, she suffered from hair loss, beginning with the entire hair on the occipital region and the crown. Physical examination: nutrition was adequate, development was good, no abnormalities were found in the heart or lungs, abdomen was flat, neither the liver nor the spleen were palpated. The forehead and crown were fully covered, the scalp was smooth with no wrinkles. Western medical diagnosis: alopecia areata. Traditional Chinese Medicine diagnosis: a pulse that was tense and fine, slightly weak in the two fingers, a red tongue with a thin white coating. She complained of bitter taste in the mouth, discomfort in the flank, dizziness, and lower back discomfort, as well as dark menstrual flow and abdominal pain. The condition was characterized by liver stagnation and kidney deficiency, with blood deficiency, leading to hair loss. The treatment should focus on soothing the liver, benefiting the kidneys, and nourishing qi and blood. The formula used was Formula No. 2, administered once daily, paired with 1 pill of Formula No. 3, taken twice daily, diluted in warm water. Three months later, after administering the formula for 20 doses and finishing the pill, the areas where hair had fallen out had grown dark hair, indistinguishable from others. Follow-up visits after 3 years showed no recurrence.

Case 3: Ning ××, male, 38 years old, from Gansu Province, visited the clinic in early April 1983. Half a month earlier, due to marital discord at home and a heavy emotional state, he discovered a patch of hair loss on the occipital region, roughly the size of a fingernail, which gradually expanded over the next half month. Within half a month, he lost all hair on his scalp and eyebrows, leaving the scalp shiny and feeling slightly itchy. Physical examination: a pale, yellowed face, poor nutrition, no abnormalities found in the heart or lungs, abdomen was flat, neither the liver nor the spleen were palpated. Western medical diagnosis: alopecia areata. Traditional Chinese Medicine diagnosis: a deep, fine pulse, a red tongue with a light coating, complaints of fatigue, dry mouth, deficiency, and qi and yin deficiency, with blood deficiency, leading to hair loss. The treatment should focus on nourishing qi and yin, greatly replenishing nutrients, and using Formula No. 3, taken twice daily, diluted in warm water; additionally, Formula No. 1 was administered once daily, and 60 g of cypress leaf and 3 g of fresh ginger were decocted in water for head washing, once daily, twice a week. On a certain day in December 1983, the patient’s scalp was covered in dark hair, his eyebrows and beard were fully grown, indistinguishable from others. He stated that he had taken the herbal formulas for 45 doses, the pills for 2 doses, and also used the washes for 2 months. In April 1985, a follow-up visit showed no recurrence.

Five Cases of Internal Injury Headaches

Case 1: Patient Zhao, male, 70 years old. He had a history of hypertension for more than 10 years, and had been experiencing headaches for 3 years, accompanied by trembling in both hands, blurred vision, and numbness in the limbs. His blood pressure was 21/16 kPa, his tongue was red with little coating, and his pulse was tense and rapid. The treatment should focus on calming the liver, lowering yang, and reversing the upward trend; the formula used was Qiju Dihuang Tang combined with modifications: 10 g of goji berries, 10 g of chrysanthemum, 12 g of rehmannia, 10 g of Chinese yam, 6 g of cornelian cherry, 12 g of poria, 10 g of alisma, 10 g of cassia bark, 20 g of green tea, 10 g of dried lotus leaf, 15 g of raw oyster, 15 g of raw turtle shell, 15 g of raw turtle plastron, 10 g of ophiopogon, 10 g of egg yolk, 10 g of hemp seeds, 6 g of ligusticum, 6 g of angelica root, 3 g of asarum, after administering the formula for 20 doses, his headaches, tremors in both hands, and blurred vision all subsided. His blood pressure was 20/14 kPa; the formula was modified by removing ligusticum, angelica root, and asarum, adding 15 g of raw ochre, 15 g of raw white peony, and 20 g of melilot. After administering the formula for more than 20 doses, all symptoms disappeared, and his blood pressure was 20/12 kPa.

Case 2: Patient Zhang, female, 68 years old. She had been experiencing headaches for 3 years, accompanied by dizziness, tinnitus, chest tightness, and memory impairment; she had tried medications like Weiboluotong without improvement. Her tongue was pale with a thin white coating, her pulse was tense and sluggish, her blood pressure was 18/13 kPa, and laboratory tests showed elevated blood viscosity compared to normal. Brain CT showed atrophy, and ECG indicated myocardial ischemia. Western medical diagnosis: ① cerebral arteriosclerotic headache; ② coronary heart disease. Traditional Chinese Medicine diagnosis: blood stasis causing headache. The treatment should focus on activating blood circulation and resolving blood stasis. The formula used was Xuefu Zhu Yu Tang combined with modifications: 10 g of peach kernel, 6 g of safflower, 10 g of angelica root, 10 g of rehmannia, 6 g of red peony, 10 g of bupleurum, 20 g of platycodon, 15 g of achyranthes, 10 g of citrus peel, 6 g of angelica root, 3 g of asarum, 10 g of frankincense, 10 g of salvia, after administering the formula for more than 10 doses, her headaches and chest tightness were significantly relieved, though she still felt dizziness and tinnitus. Therefore, the formula was modified by removing frankincense and salvia, adding 15 g of goji berries, 10 g of chrysanthemum, and 15 g of Acorus calamus, and administering the formula for more than 30 doses, all symptoms were alleviated. Repeated blood viscosity tests and ECG results returned to normal. Her blood pressure dropped to 16/12 kPa.

Case 3: Patient Guo, male, 51 years old. He had suffered from Meniere’s syndrome and chronic gastritis for 3 years; now he experienced headaches that worsened with movement, accompanied by nausea, poor appetite, abdominal distension, and frequent insomnia and dreams. His tongue was swollen, with a pale, thick coating, his pulse was slippery, and his blood pressure was 16/10 kPa. The treatment should focus on warming the middle burner, resolving phlegm, and reversing the upward trend. The prescription was: 10 g of wu yu, 10 g of codonopsis, 6 g of dried ginger, 6 g of licorice, 30 g of alisma, 3 g of schizandra, 10 g of Chinese yam. 10g, Dang Gui 10g, Yuan Rou 10g, Xuan Fu Hua 15g, Dai He Shi 20g, Ban Xia 6g, Chuan Xiong 6g, Bai Zhi

6g, Xi Xin 3g. After taking the above formula for more than 10 doses, the headache eased, sleep improved, but the patient still experienced vomiting, poor appetite, and chest discomfort with fullness and distension; stool was loose. Tongue was pale with a thick white coating, and pulse was slippery. Therefore, the treatment should focus on replenishing qi and strengthening the spleen, transforming phlegm and descending rebellious qi. The formula used was:

Xiang Sha Liu Jun Zi Tang with additions: Mu Xiang 3g, Sha Ren 3g, Dang Shen 10g, Bai Zhu 10g, Fu Ling 12g,

Gan Cao 6g, Ban Xia 6g, Chen Pi 6g, Ze Xie 30g, Xuan Fu Hua 10g, Dai He Shi 20g, Chuan Xiong 6g, Bai Zhi 6g, Xi Xin 3g, Che Qian Zi 10g, and Hou Ding 20g. After taking this formula for over 20 doses, all symptoms alleviated.

Example 4: Patient Wang, female, 32 years old. Headache worsened after exertion, accompanied by insomnia, frequent dreams, forgetfulness, fatigue, soreness and weakness in the lower back and knees, and excessive vaginal discharge. Blood pressure was 12/8 kPa, tongue was pale with little coating, and pulse was deep and fine. Western medical diagnosis:

① Hypotension; ② Menstrual irregularities. Treatment focused on nourishing qi and enriching blood. The prescription was: Huang Ji 30g, Dang Gui 10g, Dang Shen 10g, Bai Zhu 10g, Fu Ling 12g, Gan Cao 6g, Mu Xiang 3g, Yuan Rou 10g, Yuan Zhi 6g, Chao Zao Ren 12g, Sheng Long Mu 15g, Wu Che Gu 15g, Du Zhong 10g, Sheng Mao Ren 30g, Yin Yang Huo 15g. After taking the above medicine for more than 10 doses, vaginal discharge decreased, symptoms of lower back and knee soreness and weakness disappeared, and headaches eased.

Therefore, Du Zhong, Sheng Yi Ren, and Yin Yang Huo were removed, replaced with Chuan Ge 6g, Bai Zhi 6g, and Xi Xin 3g. After continuing to take the formula for 7 doses, all symptoms disappeared, and blood pressure was 13/7 kPa.

Example 5: Patient Qiu, male, 38 years old, had headaches of unknown cause for 2 years, which worsened recently after an external infection, accompanied by chills, general body aches and fatigue, dry throat, blood pressure 16/10 kPa, tongue was pale with a thin white coating, and pulse was floating. Western medical diagnosis:

① Vascular-neurotic headache; ② Common cold. Treatment focused on dispersing wind and releasing exterior pathogens while clearing heat from the interior. The formula was: Qiang Huo 10g, Fang Feng 12g, Cang Zhu 6g, Chuan Xiong 6g, Bai Zhi 6g, Xi Xin 3g, Sheng Di 12g, Huang Qin 10g, Gan Cao 6g, Jing Jie 6g, Ma Huang 6g. After taking the medicine for 3 doses, chills and general body aches disappeared, and headaches lessened. The above formula was modified by removing Sheng Di, Jing Jie, and Ma Huang, adding Dang Gui 10g, Man Jing Zi 10g, Chrysanthemum 12g, Mai Dong 10g. After taking the formula for over 10 doses, all symptoms subsided.

Three Cases of Diabetes

Example 1: Li ××, female, 52 years old, housewife. She visited the clinic in early June 1983. Since 1972, the patient had been found to have positive urine glucose levels, often experiencing dry mouth and frequent urination. She was diagnosed with diabetes at a local hospital and had taken drugs such as Jiang Ta Ling and D860, but her condition fluctuated. In recent years, her condition had worsened compared to previous years, with fasting blood glucose often ranging between ± and ++. One month ago, she came to the clinic due to an upper respiratory tract infection that led to a worsening of her condition. The patient presented with increased thirst, frequent drinking, spontaneous sweating, fatigue, palpitations, and hunger, along with frequent urination and large volumes of urine. Physical examination: body temperature 37°C. Facial skin was flushed, sclera showed no jaundice, and there were no ulcers or purulent lesions on the skin or mucous membranes throughout the body. Breath sounds were rough in both lungs, with no dry or moist rales heard. Heart size was normal, no murmurs were detected in the valve areas, abdomen was flat, liver and spleen were not palpated, and there were no abnormalities in the limbs or spine. Laboratory tests: hemoglobin 14.5 g/L, red blood cells 5.2 million/L, platelets 96,000/L, white blood cells 9,000/L, neutrophils 76%, lymphocytes 23%, monocytes 1%. Urine glucose (+++), urine ketones (±), fasting blood glucose 450 mg, blood ketones 5 mg, postprandial blood glucose 620 mg, CO₂-CP 58, urea nitrogen 16 mg. Western medical diagnosis: diabetes. Traditional Chinese Medicine diagnosis: pulse was洪大 and strong, tongue was red with a yellowish greasy coating, combined with increased thirst, frequent drinking, spontaneous sweating, and fatigue. The diagnosis was that Yangming fire was excessive; the treatment should clear heat and eliminate fire, while nourishing qi and nourishing yin. The formula used was Ren Shen Bai Hu Tang with additions: Sheng Shi Gao 30g, Zhi Mu 6g, Shan Yao 10g, Gan Cao 10g, Dang Shen 10g, Mai Dong 10g, Wu Wei Zi 10g, Huang Lian 6g, Hua Fen 10g, decocted in water and taken once daily. After taking the formula for 10 doses, all symptoms disappeared, the patient’s mental state returned to normal, pulse became firm and smooth, tongue color turned red, urine glucose (-), fasting blood glucose 140 mg, postprandial blood glucose 260 mg. Huang Lian and Hua Fen were removed from the formula, and Sheng Di was reduced to 10g. After continuing to take the formula for 30 doses, the patient’s symptoms of thirst and frequent urination reappeared, though blood glucose remained fluctuating between + and ++, with occasional thirst and frequent urination. At this point, the formula was adjusted by adding Huang Lian 6g, Hua Fen 10g, and increasing Sheng Shi Gao to 30g. After continuing to take the formula for 10 doses, the patient’s thirst and frequent urination disappeared again, urine glucose (-), fasting blood glucose 120 mg, postprandial blood glucose 190 mg. The patient was advised to regularly take Gui Fu Ba Wei Wan. Two years later, during follow-up visits, the patient was like a normal person, with urine glucose at ±, fasting blood glucose and postprandial blood glucose both within the normal range.

Example 2: Zhao ×, male, 29 years old, teacher. He visited the clinic in early March 1986. Five years earlier, the patient developed diabetes and had undergone various treatments, but the results were unsatisfactory. He had taken Yu Quan Wan, Jiang Ta Ling, You Jia Tang, and had even been hospitalized for insulin injections. His urine glucose levels consistently ranged between + and ++++. Through a friend’s recommendation, he came to our outpatient clinic.

The patient presented with frequent and abundant urination, fatigue, spontaneous sweating, dizziness, tinnitus, lower back pain, leg discomfort, and feeling cold. Physical examination: body temperature 36°C, facial skin was pale, and there were no ulcers or purulent infections on the skin or mucous membranes throughout the body. No abnormalities were found in the heart or lungs, and neither liver nor spleen were palpated. Laboratory tests: blood cells 11,000/L, neutrophils 72%, lymphocytes 28%, urine glucose (+++), urine ketones (±), fasting blood glucose 360 mg, blood ketones 3 mg, postprandial blood glucose 520 mg, urea nitrogen 16 mg. Western medical diagnosis: diabetes. Traditional Chinese Medicine diagnosis: pulse was deep and fine, with weak Chi-mou pulses, a large tongue with tooth marks, a thin white coating, combined with clinical manifestations such as dizziness, lower back pain, spontaneous sweating, and chills. The diagnosis was that kidney yang was deficient; the treatment should warm and tonify kidney yang. The formula used was Gui Fu Ba Wei Wan with additions: Sheng Di 10g, Shan Yu 6g, Shan Yao 10g, Dan Pi 6g, Fu Ling 12g, Ze Xie 10g, Rou Gui 10g, Fu Pian 6g, Wu Wei Zi 3g, Huang Lian 3g, Hua Fen 10g, decocted in water and taken once daily. After taking the formula for 10 doses, the patient’s symptoms were somewhat relieved compared to before, urine glucose dropped to (+), fasting blood glucose 140 mg. Adding Huang Qi 30g to the formula, and after continuing to take the formula for 30 doses, all symptoms were completely resolved, urine glucose (-), fasting blood glucose 100 mg, postprandial blood glucose 180 mg. By the autumn of 1989, the patient’s condition was stable, and no recurrence occurred.

Example 3: Bai ××, male, 61 years old, worker. He visited the clinic in early February 1981, having suffered from diabetes for 13 years. Recently, his body had become thinner, with hot flashes and night sweats, five internal organs felt hot and uncomfortable, thirst and frequent drinking, red and bitter urine, constipation, and bone pain throughout the body. He had been hospitalized multiple times, taking Yu Quan Wan, Jiang Ta Ling, D860, and had even received insulin injections several times during hospital stays, with the highest dose reaching 80 units per day (normal insulin). Three months ago, he experienced blurred vision and underwent ophthalmological examination, which revealed bilateral senile cataracts. Physical examination: body temperature 36.8°C, pulse 92 beats/min, blood pressure 24/13.3 kPa (180/100 mmHg), complexion was dull, body weight had decreased, bad breath was present, and there were no ulcers or infected foci on the skin or mucous membranes throughout the body. Breath sounds were rough in both lungs, with no dry or moist rales heard. Heart size was slightly enlarged to the left, P2>A2 with A2 elevated, and a grade II systolic blowing murmur could be heard in the apex area. Abdomen was flat, liver and spleen were not palpated, and there were no deformities in the limbs or spine. Laboratory tests: hemoglobin 10.2 g/L, red blood cells 352,000/L, platelets 120,000/L, white blood cells 1,000/L, neutrophils 79%, lymphocytes 21%, urine glucose (+++), urine ketones weakly positive, fasting blood glucose 190 mg, blood ketones 8 mg, postprandial blood glucose 580 mg, urea nitrogen 20 mg, CO₂-CP 65, blood cholesterol 270 mg, ester protein 110 mg, triglycerides 200 mg, retinal arteriosclerosis grade II. Western medical diagnosis: ① diabetes, ② hypertension with arteriosclerosis, ③ bilateral cataracts. Traditional Chinese Medicine diagnosis: tongue was red with little moisture and scattered bruise-like spots, coated with a thick yellowish greasy coating, pulse was stringy and rapid, combined with previous symptoms. The diagnosis was that the disease had long persisted and entered the meridians, generating fire that scorched fluids; the treatment should activate blood circulation, remove stasis, clear heat, and eliminate dampness. The formula used was Zeng Ye Tang with additions: Sheng Di 12g, Yuan Shen 10g, Mai Dong 10g, Chi Shu 10g, Chuan Xiong 6g, Hong Hua 3g, Jiang Xiang 10g, Dan Shen 20g, Dan Pi 6g, Ge Gen 10g, Zhi Mu 6g, Huang Bo 6g, Cang Zhu 6g, Huang Lian 6g, Hua Fen 10g, Ren Shen 3g, decocted in water and taken once daily. The patient retired and returned home to continue taking the formula. In September 1983, the patient came to the clinic, saying that he had continued to take the formula regularly because of its good effects, having taken over 200 doses. All previous symptoms had disappeared, his physical strength had recovered, and he was able to participate in ordinary work. Urine glucose was (-), fasting blood glucose was 100 mg, postprandial blood glucose 170 mg, triglycerides were within the normal range, blood pressure was 20/12 kPa (150/90 mmHg). The patient was advised to continue taking the formula, adding one pill of Gui Fu Ba Wei Wan daily. In March 1985, when the patient was visited, all symptoms had disappeared, urine glucose and blood glucose were both normal.

One Case of Chronic Pancreatitis Combined with Gallstones

Patient, male, 26 years old, was admitted to the hospital on August 26, 1963, due to severe upper abdominal pain. One day prior, around 3:00 p.m., he experienced sharp, continuous pain in the upper abdomen, radiating to the waist, back, left chest, and left shoulder, accompanied by nausea and vomiting. Multiple injections of atropine were ineffective. He had a history of right upper abdominal pain, and in 1960, gallbladder imaging revealed gallstones.

Physical examination: body temperature 38°C, blood pressure 10.7/8.0 kPa (80/60 mmHg), face was pale, passive position, upper abdomen was distended, soft to the touch, with significant tenderness, especially in the left side of the abdomen, with rebound tenderness. Bowel sounds were diminished, and no gas or stool was observed during the day. Liver, spleen, and gallbladder were not palpated, with no signs of non-specific changes. Skin, organs, heart, and lungs were all normal. Laboratory tests: white blood cells 13,600/㎜³, neutrophils 85%, acidophilic cells 2%, alkaline cells 1%, lymphocytes 11%, monocytes 1%; serum amylase 524 U (Somogyi method), urine amylase (Wina-LOW method) 256 U, blood glucose 120 mg, blood calcium 8 mg, urine glucose (-). Diagnosis: acute pancreatitis. Western medical treatments such as sedation, anti-inflammatory therapy, spasmolytics, and fluid resuscitation were administered, but the upper abdominal pain persisted and did not subside, instead radiating to the lower back, with pain intensifying after meals and when hungry. More than two months after onset, the patient developed chronic diarrhea, 7–8 times a day, with foul-smelling, watery, brown stools. Laboratory tests: fat droplets in stool (+++), urine amylase 64 U, blood amylase 226 U, blood glucose 125 mg, urine glucose (-), and the glucose tolerance test curve was elevated. Bile drainage from the duodenum contained small amounts of cholesterol crystals. Gallbladder imaging showed a negative stone shadow measuring 2 cm × 3 cm. Diagnosis: chronic pancreatitis combined with gallstones.

On November 2, 1963, traditional Chinese medicine treatment began. Examination revealed a stringy pulse, a greasy white tongue coating, persistent dull pain in the chest, radiating to both flanks, dizziness, fatigue, and shortness of breath. The diagnosis was liver and gallbladder stagnation, wood dominating earth, so the treatment should soothe the liver, benefit the gallbladder, strengthen the spleen, transform dampness, and regulate qi to relieve pain. The proposed formula was as follows:

Chai Hu 18g, Dang Gui 9g, Hang Shu 6g, Bai Zhu 9g, Fu Ling 9g, Zhi Ke 4.5g, Yu Jin 4.5g, Xiang Fu 4.5g, Qing Pi 3g, Fo Shou 6g, Dan Shen 9g, Tan Xiang 3g, Sha Ren 13g, Jin Ling Zi 6g, Qian Jin Cao 30g, Gan Cao 6g, decocted in water and taken once daily. After taking the formula for 2 doses, pain in both flanks gradually disappeared, bitterness in the mouth and dryness in the throat eased, but swelling in the chest and shoulders still persisted, radiating to the left shoulder. The patient preferred to be massaged and warmed, and diarrhea decreased to 3–4 times a day, with yellow, watery stools. The tongue coating was white and greasy, the pulse was stringy and fine; the condition still indicated liver-spleen disharmony and insufficient middle qi. To soothe the liver and stomach and replenish qi and blood, the following formula was proposed:

Dang Shen 10g, Huang Qi 12g, Gui Shen 9g, Sheng Ma 3g, Chai Hu 6g, Gan Cao 6g, Yu Jin 6g, Nei Jin 6g, Huang Qin 6g, Zhi Ke 6g, Bai Zhu 9g, Bai Shu 12g, Qian Jin Cao 30g, decocted in water and taken once daily. After using the formula for 73 doses, all symptoms significantly improved. On March 25, 1964, gallbladder imaging revealed that the stone shadows had disappeared. Further examination showed a delicate pulse, combined with subtle chest and shoulder pain, and loose, watery stools—this indicated qi and blood deficiency, liver stagnation, and spleen deficiency. To further strengthen the spleen and stomach and replenish qi and blood, the following formula was proposed:

Dang Shen 12g, Bai Zhu 9g, Huang Qi 20g, Dang Gui 10g, Bai Shu 9g, Yu Jin 6g, Mu Xiang 6g, Jiang Xiang 3g, Fo Shou 3g, Dan Shen 15g, Sha Ren 3g, Nei Hu 6g, Bai Xian Li 10g, Pei Lan 10g, decocted in water and taken once daily. After taking the formula for 95 doses, abdominal pain and chest tightness disappeared, diarrhea stopped, appetite increased, energy levels rose, and the patient was discharged in good health. Follow-up visits over the next 14 years showed no recurrence.

Note: In the acute phase, comprehensive Western medical treatment was effective in this case, but later it progressed to chronic stage. Although the treatment period was relatively long, the bile stones were eventually expelled, and the chronic pancreatitis was cured. Although traditional Chinese medicine does not have a specific term for this condition, through differentiation of syndromes, it is classified as liver qi stagnation and spleen-stomach qi deficiency. Therefore, the first and second formulas were based on the general formula Xiaoyao San, which focuses on soothing the liver and strengthening the spleen. Because damp-heat was present, the formula added Qian Jin Cao to clear heat and drain dampness. Nearly a hundred doses were taken, and the condition improved, demonstrating that proper differentiation and targeted medication were key. The third formula, however, focused on strengthening the spleen and stomach, supplemented by herbs that regulate qi and soothe the liver—this approach emphasized supporting the body’s righteous qi while eliminating pathogenic factors.

Three Cases of Chronic Nephritis

Example 1: Wang ××, male, 18 years old, a young man who had been sent to work in the countryside, was seen in early October 1976. Two years earlier, after a cold, he developed facial edema, fatigue, joint pain throughout his body. He was admitted to the Second Affiliated Hospital of Lanzhou Medical College with a diagnosis of acute nephritis. After more than 20 days of Western medical treatment, the edema subsided, and urinary protein dropped from (+++) to trace amounts. After discharge, repeated colds and tonsillitis caused the edema to recur, with urinary protein reaching (++++) again. Subsequently, the edema grew progressively worse, and he was admitted to the hospital twice six months ago for treatment. Diagnosis: chronic nephritis (nephrotic type). During his hospitalization, he received treatment with antibiotics, prednisone, cyclophosphamide, and diuretics. His condition improved temporarily, but recently it has recurred frequently. The patient requested to be discharged and sought traditional Chinese medicine treatment at our clinic.

Physical examination: body temperature 36.6°C, pulse 72 beats/min, blood pressure 16.0/12.0 kPa (120/90 mmHg), normal development, poor nutrition, pale complexion, with localized edema in the entire body, most notably in the feet and ankles. Heart and lungs were normal, liver and spleen were not palpated, abdomen was distended, with ascites (+), pulse was deep, fine, and weak, tongue was pale with a thick white coating.

Laboratory tests: urinalysis: protein (+++), red blood cells 2–5/low power view, white blood cells 1–2/low power view, a few transparent tubular casts. Complete blood count: hemoglobin 10 g/L, white blood cells 11,200/㎜³, neutrophils 66%, lymphocytes 34%. Cholesterol in blood: 490 mg/ml, NPN 40 mg/ml, total serum protein 4.5 g/L, albumin 2.1 g/L, globulin 2.4 g/L. Western medical diagnosis: chronic nephritis, nephrotic type.

Traditional Chinese Medicine diagnosis: the patient presented with pale complexion, fatigue, dizziness, tinnitus, lower back pain, leg discomfort, fear of cold with spontaneous sweating, generalized edema, and poor appetite. Pulse was deep and fine, with particularly weak pulses in the two lower regions. Tongue was swollen, pale with tooth marks, coated with a thin white coating.

Laboratory tests: urine routine: protein (+++), red blood cells 2–5/low power view, white blood cells 1–2/low power view, a few transparent tubular casts. Complete blood count: red blood cells 310,000/㎜³, hemoglobin 9 g/L, white blood cells 10,000/㎜³, neutrophils 79%, lymphocytes 21%. Cholesterol in blood: 660 mg, total serum protein 3.8 g/L, globulin 2.2 g/L, albumin 1.6 g/L. Ascites examination: appearance was clear, protein (±). Western medical diagnosis: chronic nephritis, nephrotic type, complicated by upper respiratory tract infection.

Traditional Chinese Medicine diagnosis: the patient presented with pale complexion, generalized edema, lower back pain, leg discomfort, dizziness, bitter taste in the mouth, sore throat, cough, chest discomfort, oliguria with red urine, slight fever and chills, combined with pulse and tongue color, indicating kidney deficiency and water retention, with wind-heat entering the interior. The formula used was Jisheng Shenqi Tang with additions: Sheng Di 10g, Shan Yu 6g, Shan Yao 10g, Dan Pi 6g, Fu Ling 12g, Ze Xie 10g, Rou Gui 10g, Fu Pian 6g, Niuxi 10g, Dang Shen 15g, Lian Qiao 15g, Gong Ying 15g, Baishang 15g, Xia Ku Cao 15g, Shi Wei. Decocted in water and taken once daily. After taking the formula for over a month, the edema basically disappeared, urinary protein remained (+++), red blood cells 0–1/low power view, white blood cells 0–1/low power view. The patient’s mental state and appetite improved compared to before, and his fear of cold and spontaneous sweating also improved. Pulse was deep and fine, with weak pulses in the two lower regions. Tongue was swollen, pale with tooth marks, coated with a thin white coating. The formula was modified by removing Ma Huang and Sheng Shi Gao, adding San Ling, E’zhu, Hai Zao, and Kun Bu each 6g. After taking this formula for over 150 doses, the patient felt energetic and physically strong. A follow-up examination in September 1977 showed normal urinalysis, and blood cholesterol was 200 mg/L. Subsequently, from 1979 to 1980, the patient was followed up many times, and his overall condition was good. Except for occasional white blood cells 0–1/low power view, other laboratory tests were normal.

Example 2: Liu ×, female, 43 years old, a cadre, was seen in early November 1980. One year earlier, she began experiencing generalized edema, accompanied by frequent urination, urgency, and dysuria. She was diagnosed with chronic pyelonephritis at Lanzhou Railway Center Hospital, spent more than a month in the hospital, and the pus cells in her urine disappeared, though protein levels remained around (+++). After discharge, her condition fluctuated, and four months ago she caught a cold, developed a sore throat, and the edema soon worsened. She was admitted to the Gansu Provincial Hospital of Traditional Chinese Medicine with a diagnosis of chronic nephritis (acute exacerbation). During her hospitalization, she received combined Chinese and Western medical treatment, but the edema never subsided, and urinary protein remained (+++). She voluntarily left the hospital one month ago, but after discharge, the edema worsened, accompanied by sore throat and cough, poor appetite, and oliguria with painful urination. She came to our clinic seeking traditional Chinese medicine treatment.

Physical examination: body temperature 37°C, pulse 90 beats/min, blood pressure 17.6/13.1 kPa (132/98 mmHg), normal development, poor nutrition, pale complexion, moderate edema throughout the body, red throat, tonsils enlarged to grade II. Heart size was not enlarged, but a grade II systolic blowing murmur could be heard in the apex area, lungs were normal, abdomen was distended, with ascites (+). Pulse was stringy, smooth, and rapid, with slightly weak pulses in the two lower regions. Tongue was red, coated with a slightly yellowish and greasy coating.

Laboratory tests: urinalysis: protein (++++), red blood cells (++) , pus cells (±), granular tubular casts 1–2/low power view. Complete blood count: red blood cells 310,000/㎜³, hemoglobin 9 g/L, white blood cells 10,000/㎜³, neutrophils 79%, lymphocytes 21%. Cholesterol in blood: 660 mg, total serum protein 3.8 g/L, globulin 2.2 g/L, albumin 1.6 g/L. Ascites examination: appearance was clear, protein (±). Western medical diagnosis: chronic nephritis, nephrotic type, complicated by upper respiratory tract infection.

Traditional Chinese Medicine diagnosis: the patient presented with pale complexion, generalized edema, lower back pain, dizziness, bitter taste in the mouth, sore throat, cough, chest discomfort, oliguria with red urine, mild fever and chills, combined with pulse and tongue color, indicating kidney deficiency and water retention, with wind-heat entering the interior. The formula used was Jisheng Shenqi Tang combined with herbs for clearing heat and detoxification: Sheng Di 10g, Shan Yu 6g, Shan Yao 10g, Dan Pi 6g, Fu Ling 10g, Ze Xie 10g, Rou Gui 10g, Fu Pian 6g, Niuxi 10g, Er Hua 15g, Lian Qiao 15g, Gong Ying 15g, Baishang 15g, Xia Ku Cao 15g, Shi Wei. 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: 20g、白茅根20g、麻黄10g、生石膏30g、蝉衣10g、苏梗10g、益母草30g，

服10剂咳喘渐平，全身浮肿略有消退，腹水征(+)。尿常规：蛋白(+++)，

红细胞(+)，颗粒管型1～2/低倍镜。患者仍见颜面晄白，全身浮肿，腰

酸腿困，耳鸣怕冷，脉沉仍弱，舌红苔白腻。证属肾阳虚损，水湿泛

溢，上方去二花、连翘、公英、败酱、夏枯草，加冬瓜皮20g、全葫芦20g、

大腹皮10g、海藻10g、昆布10g、半枝莲15g。服药100余剂，患者浮肿消

退，腹水消失，精神体力均较前明显好转。尿常规：蛋白(+)，红细胞0～

2/低倍镜，管型未见。血胆固醇300mg%，患者仍见颜面晄白，稍有怕

冷，腰酸腿困，晨起可见颜面浮肿，傍晚则见下肢浮肿，饮食欠佳，疑

腹时有胀满不舒，脉沉细，尺脉弱，舌胖淡。证属脾肾阳虚，方用济生

肾气汤合保元汤加味：生地12g、山萸肉6g、山药6g、丹皮6g、茯苓12g、

泽泻10g、肉桂10g、附子10g、党参10g、黄芪20g、甘草6g、破故纸10g、

淫羊藿10g、巴戟天10g、旱莲草10g、白茅根30g，服药30余剂，尿常规

未见异常，血常规：血红蛋白15g%，红细胞480万/㎜³，白细胞9800/

㎜³，中性68%、淋巴32%。血胆固醇220mg%。患者体力恢复，精力充

沛，痊愈参加工作。

例三：陈××，男，48岁，干部，1978年6月诊。患者10年前因浮肿、

腰痛、血压高在天水地区医院诊断为慢性肾炎，经住院治疗，病情曾

有好转，近几年来反复浮肿，并出现高血压、蛋白尿，多次以慢性肾

炎诊断住当地医院治疗。半年来浮肿持续不退，尿量长期较少，伴食

欲不振，腰酸腿困，自汗怕冷，体倦乏力，恶心欲呕，大便溏稀，头晕

眼花，近日来上述症状加重，血压亦持续不降，故来我处就诊。

査体：体温36.4℃，脉搏74次/min，血压24.0/13.3kpa(180/

100mmHg)。患者神志清晰，表情淡漠，全身浮肿以颜面及足胫部最为

明显。心尖区可闻及Ⅱ级收缩期吹风样杂音，肝(-)，脾(-)，腹部膨胀，

腹水征(++)。脉象：弦滑数。舌象：质红体胖有齿痕，苔薄白。

化验：尿常规，蛋白(+++)，红细胞(++)，白细胞0～2/低倍镜，透明

管型1～2/低倍镜。血常规：血红蛋白12.5g%，白细胞11 200/㎜³，中

性72%、淋巴27%、单核1%，血胆固醇390mg%，NPN146mg%，CO2结合

力25%，血清总蛋白5.5g%，白蛋白2.1g%，球蛋白3.4g%。西医诊断：慢

性肾炎合并尿毒症。

中医辨证：患者证见浮肿，头昏，腰酸脚困，怕冷自汗；又见食欲

不振，体倦乏力，恶心欲呕，大便溏稀，证乃脾肾阳虚、湿滞中焦、升

降失司。当用温肾降逆合健脾利水法，方用济生肾气汤合大黄、生赭

石、小半夏汤加味：生地10g、山萸10g、山药10g、丹皮6g、茯苓10g、泽

泻10g、肉桂10g附子10g、车前子10g、牛膝30g、大黄12g、生姜6g、半

夏6g、蝉衣10g、地龙12g、生龙牡各15g、生赭石15g、生白芍15g、生龟

板15g、白茅根30g、石苇20g、白术15g、猪苓10g，服10剂呕恶渐平，胃

纳稍进，尿量渐多，全身浮肿亦略见好转，血压20.0/12.0kpa(150/

90mmHg)，尿常规：蛋白(++)，红细胞2～5/低倍镜，透明管型1〜2/低倍

镜，NPN122mg%。上方去生龟板、生姜，加党参10g、陈皮6g、木香3g。

连续服用43剂，精神饮食转佳，浮肿明显消退，血压18.7/12.0kpa

(140/90mmHg)，尿常规：蛋白(+)，血NPN39mg%，CO2结合力57%，血

胆固醇310mg%，总蛋白5.7g%，白蛋白3.1g%，球蛋白2.6g%。血常规：

血红蛋白13.5g%，白细胞9000/㎜³，中性68%，淋巴32%。患者仍有苍

白，乏力，头晕，腰酸，怕冷诸证，继以济生肾气合香砂六君汤投之，

服90余剂，诸证悉平，尿蛋白㈠。

变应性亚急性败血症3例

例一：崔某某，男，20岁，病历号：08639，1994年3月3日入院。患

者1993年2月不明原因出现发热、咽喉肿痛、关节疼痛、颈部淋巴结

肿大，抗生素治疗无效，激素治疗后缓解，但停激素后再次复发，遂

来我院求治于余。体格检查：体温39.7T，脉搏83次/min，血压13.7/

8.4kpa（103/63mmHg）；满月脸，咽红，扁桃体皿度肿大，无分泌物，颈

部淋巴结肿大、质硬、无压痛，活检为慢性炎症。双下肢可见数处散

在性充血性皮疹，压之褪色；全身关节肌肉疼痛，无肿胀压痛及变

形。肝脏剑突下5cm大小，质软，无压触痛，脾脏胁下3cm可触及，质中

等硬度。实验室检査：白细胞27.8×10^9^/L，中性0.79，血红蛋白132g/L，

红细胞4.55×10^12^/L，血小板203×l0^9^/L，血沉90mm/h，总蛋白80.5g/L，

球蛋白51.0g/L，γ-球蛋白36.8g/L；尿常规、大便常规、肝功能、肾功

能均正常；骨髓象呈感染性骨髓象，且发现中性粒细胞大量明显变

性；反复血培养无细菌生长，结核菌素试验、抗核抗体、抗"O"、类风

风湿因子、C-反应蛋白、LE细胞及肥达氏反应均为阴性。西医诊断；变

应性亚败血症。治疗用强的松15mg口服（每日早晨顿服），青霉素480

万单位静脉滴注，15天后开始停强的松，每周减量5mg，3周减完。中

医辨证：主证为发热畏寒，全身骨节疼痛，气短乏力，呼吸气粗，皮疹

隐隐，口干欲饮，小便赤，大便濾，脉沉细，舌质红、苔黄少津。证属湿

热郁阻、寒凝经脉，治以消风除湿、散寒止痛。方选桂枝芍药知母汤

加减：桂枝10g、白芍15g、知母10g、麻黄6g、川乌草乌各15g（先煎

60min）、干姜6g、细辛3g、防风12g、生石膏60g、马钱子1个（油炸）、黄芪

30g、当归10g、惹茂仁30g。服药62剂后，再未发烧，颈淋巴结不肿大，

实验室复査血象正常，患者出院。在家继续服用中药20剂，诸症皆

去，追访4年无复发。

例二：张某某，男，41岁，病历号：16518，1998年3月19日入院。患

者1997年11月17日受凉后出现全身不适，发热（体温38℃），双下肢疼

痛以大关节为主，无晨僵，活动不受限，以抗风湿治疗无效，以激素

治疗1周后体格检查：体温39.0℃，面色潮红，咽红，扁桃体Ⅱ度肿大，

无分泌物，颈部、腋下、腹股沟无肿大淋巴结，关节无压痛，胸背部散

发皮疹，压之退色；肝脏未触及，脾脏肋下2cm可触及，质软，B超提示

脾脏肿大。实验室检查：血白细胞10.6×10VL，中性0.69，血红蛋白

148g/L，血红细胞2.11×10^12^/L，血小板214×10^9^/L，血沉132mm/h；血

清蛋白电泳：白蛋白39.1%，球蛋白α1112.2%，α2224.1%，β3.1%，

γ41.2%，乳酸脱氢酶326u/L，α-羟丁酸转肽酶99u/L，甘油三酯

3.89mmol/L，C-反应蛋白57.3mg/L，抗核抗体阴性、抗"O"<1：400，类

风湿因子（+）；尿常规、大便常规、肝功能、肾功能均正常；骨髓象提示基

本正常骨髓象；结核菌素试验、LE细胞及肥达氏反应均为阴性，3

次血培养无细菌生长。西医诊断：变应性亚败血症。治疗用强的松

30mg口服（每日早晨顿服），氧氟沙星0.2g静脉滴注，参芪扶正注射液

100ml静脉滴注。15天后强的松开始减量，方法同前，6周减完。中医

辨证：主证为发热畏寒，关节疼痛，少气懒言，面色潮红，皮疹隐隐，

纳差胃胀，小便清长，大便努责，脉大无力，舌淡苔白。证属风湿阻

络、中气不足。治以温经散寒、甘温除热。方选桂枝芍药知母汤加补

中益气汤：桂枝10g、白芍15g、知母10g、麻黄13g、川乌草乌各15g（先

煎60分钟）、干姜6g、细辛3g、防风12g、马钱子1个（油炸）、黄芪30g、当

归10g、白术10g、党参10g、升麻10g、柴胡10g、陈皮10g。服药32剂后患

者临床症状消失而出院，在家又服药55剂后实验室检査全部正常，

追访3年无复发。

例三：周某某，女，35岁，病历号：17366，1999年6月26日入院。患

者1998年2月因反复感冒3个月后出现发热、寒战、乏力、纳差、四肢

关节疼痛，用消炎痛治疗无效，用激素治疗效果明显，停激素则复

发，以影响正常工作，求治于我院。体格检查：体温38.6℃，贫血貌，咽

红，扁桃体无肿大，颈部、腋下、腹股沟无肿大淋巴结，关节疼痛无红

肿，无皮疹，肝脏、脾脏未触及。实验室检查：血白细胞8.7×10^9^/L，中

性0.52，血红蛋白108g/L，血红细胞4.13×10^12^/L，血小板167×10^9^/L，血

沉120mm/h；血清蛋白电泳：白蛋白29.5%，球蛋白α115.3%，α220.1%，

β2.9%，γ31.7%，C-反应蛋白、抗核抗体阴性，抗"O"<1：400，类风湿

因子阴性；尿常规、大便常规、肝功能、肾功能均正常；骨髓象提示基

本正常骨髓象；结核菌素试验、LE细胞及肥达氏反应均为阴性；反复

血培养无细菌生长。西医诊断：变应性亚败血症。治疗用10%葡萄糖

注射液500ml加维生素C 2g、维生素B02g、10%氯化钾5ml、地塞米松

5mg，静脉滴注7天后停药。中医辨证：主证为发热面赤，自汗盗汗，午

后为甚，咽红肿疼，关节疼痛，乏力纳差，头晕心悸，唇燥无华，小便

短赤，大便秘结，舌质红、苔薄黄，脉弦数。证属寒湿凝滞、营血受损。

治以温经散寒、凉血和营。方选桂枝芍药知母汤加当归六黄汤：桂枝

10g、白芍15g、知母10g、麻黄3g、川乌草乌各10g（先煎60分钟）、防风

12g、马钱子1个（油炸）、黄芪30g、当归10g、白术10g、生熟地黄各12g、

黄连6g、黄芩10g、黄柏10g、生龙骨15g、牡蛎15g。服药27剂后临床病

愈出院，追访1年余无复发。

皮肤病6案