(1) Connective Tissue Diseases

According to "Jin Gui Yao Lue," "For joint pain, emaciation, swollen feet like they've fallen off, dizziness, shortness of breath, and a desire to vomit, Guizhi Shaoyao Zhimu Tang is the principal formula." The symptoms described in this passage are similar to those of rheumatoid arthritis. I have long used this formula to treat rheumatoid arthritis with remarkable efficacy. The formula consists of the following ingredients:

Pei Zhengxue's Traditional Chinese Medicine—Discussion on Theory and Clinical Case Studies

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If you replace Fupian with Chuancaowu each 15 g (decocted for one hour), the efficacy will be even better. This formula not only alleviates pain and fever associated with rheumatoid arthritis, improving the patient's overall condition, but also gradually brings ESR back to normal. Some patients who have long used corticosteroids can gradually reduce their dosage after taking this formula, with very little rebound effect. Based on these experiences, I have applied Guizhi Shaoyao Zhimu Tang with modifications to treat systemic lupus erythematosus, systemic sclerosis, dermatomyositis, Raynaud's syndrome, and other connective tissue diseases, achieving varying degrees of effectiveness.

According to "Jin Gui Yao Lue," "For Shanghan eight or nine days, if wind-dampness clashes, causing body pain and discomfort, inability to turn over, no vomiting or thirst, and a floating, weak, and rough pulse, Guizhi Fuzi Tang is the principal formula." "For sweating, shortness of breath, difficulty urinating, aversion to clothing due to cold winds, or slight swelling, Gancao Fuzi Tang is the principal formula." "For exhaustion, palpitations, nosebleeds, abdominal pain, loss of dreams, limb soreness, hand and foot heat, dry throat and mouth, Xiao Jianzhong Tang is the principal formula." "For exhaustion, deficiency, Huangqi Jianzhong Tang is the principal formula." "For blood stasis, both yin and yang are weak, the cun and guan pulses are faint, the chi pulse is slightly tight, and the exterior shows numbness like wind paralysis, Huangqi Guizhi Wuwu Tang is the principal formula." The symptoms mentioned in these passages—body pain, difficulty urinating, sweating and shortness of breath, aversion to clothing due to cold winds, slight swelling, palpitations, abdominal pain, limb soreness, hand and foot heat, dry throat and mouth, and numbness—are all common symptoms of various connective tissue diseases. The formulas used, such as Guizhi Fuzi Tang, are composed similarly to Guizhi Shaoyao Zhimu Tang, all derived from Guizhi Tang with modifications, containing Guizhi, Baishao, Gancao, ginger, and dates.

(2) Cardiovascular Diseases

According to "Shanghan Lun," "For Shanghan, if the pulse is irregular and the heart beats erratically, Zhi Gancao Tang is the principal formula." "For Shanghan two or three days, if the heart beats erratically and there is restlessness, Xiao Jianzhong Tang is the principal formula." As previously mentioned, the composition of Xiao Jianzhong Tang is identical to Guizhi Tang, except that the dosage of Baishao is doubled. Zhi Gancao Tang is also formulated by adding flavors to Guizhi Tang, with the following composition:

• Guizhi 10 g
• Gancao 6 g
• Shengjiang 6 g
• Dazao 4 pieces
• Dangshen 10 g
• Ajiao 10 g (melted)
• Maidong 10 g
• Shengdi 10 g
• Huomaren 10 g (ground)

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This formula uses equal parts of sake and water, 600 ml in total, to decoct down to 300 ml. Then dissolve the donkey-hide gelatin in the liquid and divide into three doses to be taken throughout the day. The "palpitations and restlessness" described in Xiao Jianzhong Tang and the "irregular pulse and palpitations" in Zhigancao Tang are both common symptoms of cardiovascular diseases.

The author is satisfied with the therapeutic effects of using the above prescription to treat various heart diseases such as rheumatic heart disease, coronary heart disease, and pulmonary heart disease, accompanied by arrhythmia. Adding 30 g of Danshen and 30 g of Kushen to the formula, along with increasing Mai Dong and Sheng Di to 20 g each, further improves the efficacy.

In the "Shanghan Lun," it is stated: "If, after vomiting or purging in cases of Shanghan, there is reverse fullness below the heart, qi surges upward into the chest, dizziness occurs upon standing, the pulse is deep and tight, sweating causes the meridians to move, and the body trembles—this condition is treated with Fuling Guizhi Baizhu Gancao Tang." It also says: "If a patient with Taiyang disease sweats but does not recover, still has fever, palpitations below the heart, dizziness, trembling of the body, and feels like they are about to collapse, this condition is treated with Zhenwu Tang." Both Fuling Guizhi Baizhu Gancao Tang and Zhenwu Tang can be regarded as modifications of Guizhi Tang: removing Bai Shao and adding Baizhu and Fuling results in Fuling Guizhi Baizhu Gancao Tang; removing Guizhi and adding Baizhu and Fupian results in Zhenwu Tang.

The symptoms mentioned in these texts—reverse fullness below the heart, qi surging upward into the chest, dizziness upon standing, trembling of the body, palpitations below the heart, dizziness and trembling of the body, feeling like one is about to collapse—are similar to the symptoms of modern medical heart disease and heart failure. The author has long been satisfied with the therapeutic effects of using combinations of Fuling Guizhi Baizhu Gancao Tang and Zhenwu Tang to treat heart failure caused by various types of heart disease, including rheumatic heart disease, coronary heart disease, hypertensive heart disease, and pulmonary heart disease. Adding Shengmai San (Dangshen 10 g, Maidong 10 g, Wumeizi 3 g) and Guanxin No. 1 (Chishao 10 g, Chuanxiong 10 g, Honghua 6 g, Jiangxiang 10 g, Danshen 20 g) to the formula further enhances the efficacy.

(3) Gastrointestinal Diseases

In the "Shanghan Lun," it is written: "If a patient with Taiyang disease is mistakenly purged by the physician, resulting in abdominal fullness and intermittent pain, this belongs to the Taiyin category, and should be treated with Guizhi Jia Shaoyao Tang." It also states: "If acupuncture is used to induce sweating, and the acupoint area becomes cold, forming a hard nodule that turns red, this will inevitably lead to 'ben tun,' where qi surges from the lower abdomen up to the heart. This condition is treated with Guizhi Jia Gui Tang." Furthermore, "If there is fullness below the heart with mild pain and difficulty urinating, this condition is treated with Guizhi Qu Gui Jia Baizhu Fuling Tang." In the "Jingui Yaolue," it is said: "If there is qi stagnation, with a hard mass below the heart as big as a plate and edges like a spinning top, caused by drinking water, this condition is treated with Guizhi Qu Shaoyao Jia Maxin Fuzi Tang." The aforementioned passages all indicate that modifying Guizhi Tang can treat gastrointestinal pain, bloating, and discomfort. For general pain, increasing the amount of Shaoyao or adding Baizhu and Fuling can help; for severe pain accompanied by coldness and numbness in the hands and feet, add Wu Tou; if qi from the lower abdomen surges upward like a 'ben tun' (hyperactive intestinal peristalsis), increase the amount of Guizhi (or add Cinnamon); if the epigastric region feels hard like a plate, add Ma Huang Fu Zi Xi Xin Tang.

The author often bases clinical applications on these texts, using modified Guizhi Tang to treat chronic gastritis (superficial gastritis, atrophic gastritis), gastric and duodenal ulcers, with remarkable efficacy. The prescription involves doubling the amount of Bai Shao in Guizhi Tang (Guizhi 10 g, Bai Shao 20 g, Gancao 6 g, Shengjiang 6 g, Dazao 4 pieces), plus Danshen 10 g, Muxiang 3 g, and Caokou 3 g. When the tongue coating is thick and yellow, add Huanglian 3 g; when the tongue is pale and the coating thin, add Baizhu 10 g and Fuling 10 g; for acid reflux, add Shenglongmu 15 g each and Wuzi 20 g; for nausea, add Qianjiang 6 g and Banxia 6 g; for hiccups, add Xuanfuhua 10 g and Shengzhe 15 g. Guizhi Tang is particularly effective in treating gastric spasms, so the author often adds Ma Huang 10 g, Xi Xin 3 g, and Fupian 6 g to the formula, or incorporates Chuancaowu 3 g and Cinnamon 3 g. For patients with nausea and vomiting, adding Shengzhe 15 g and Banxia 6 g yields excellent clinical results. Some patients with autonomic nervous system dysfunction in the gastrointestinal tract present with loss of appetite, fatigue, intestinal rumbling, and loose stools; these can be treated with Guizhi Tang plus Baizhu 10 g, Fuling 10 g, and Cinnamon 3 g, with equally good results.

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Pei Zhengxue’s Traditional Chinese Medicine—Discussion on TCM Theory and Clinical Cases

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The author has long used modified Xiaochaihu Tang to treat chronic cholecystitis, chronic pancreatitis, hepatitis, adnexitis, appendicitis, pleurisy, and other conditions, achieving good therapeutic effects. In short, any chronic or subacute inflammation, regardless of which organ is affected, can be treated with modified Xiaochaihu Tang. In fact, the "seven symptoms of Chaihu" do indeed appear in the course of these diseases. In the author's hometown of Tianshui City, Gansu Province, there was a famous doctor named Wang who was skilled at using Xiaochaihu Tang to treat all kinds of illnesses. The author once collected dozens of his handwritten prescriptions and carefully examined them, finding that all the conditions he treated were chronic inflammations, and all the prescriptions were modified Xiaochaihu Tang. Mr. Wang lived to a ripe old age and passed away 40 years ago, yet even today, local middle-aged and elderly people still speak highly of his profound medical skills. The aforementioned passages in the "Shanghan Lun" state: "Sometimes coughing, sometimes abdominal pain, sometimes fullness and distension below the heart, sometimes palpitations, sometimes difficulty urinating, sometimes slight fever," indicating that Xiaochaihu Tang is suitable for chronic or subacute inflammatory conditions affecting the respiratory, digestive, hepatobiliary, cardiac, and renal systems. It would be more accurate to rename this syndrome the "Chronic Inflammatory Syndrome," but in any case, any chronic or subacute inflammatory disease can be treated with this formula, modified as needed.

In the "Shanghan Lun," it is written: "If there is fullness and pain under the ribs, yellowing of the face and body... then Xiaochaihu Tang is indicated." It also says: "If a patient with Shanghan has had the illness for four or five days, with fever, aversion to wind, stiffness of the head and neck, fullness under the ribs, warm hands and feet, and thirst, then Xiaochaihu Tang is indicated." These passages show that Xiaochaihu Tang is the primary prescription for treating liver and gallbladder diseases. If Xiaochaihu Tang is modified by removing Chaihu and replacing Shengjiang with Ganjiang, the resulting formula is called Banxia Xiexin Tang. In the "Shanghan Lun," it is stated: "If there is only fullness without pain, this is considered a痞, and Xiaochaihu Tang is not appropriate; Banxia Xiexin Tang should be used instead." If Banxia Xiexin Tang is further modified by adding Shengjiang, the resulting formula is called Shengjiang Xiexin Tang. In the "Shanghan Lun," it is written: "If there is disharmony in the stomach, fullness below the heart, belching with food odor, dampness under the ribs, and rumbling in the abdomen with diarrhea, then Shengjiang Xiexin Tang is indicated." If the amount of Gancao is increased in Banxia Xiexin Tang, the resulting formula is called Gancao Xiexin Tang. In the "Shanghan Lun," it is written: "If there is fullness and distension below the heart, dry heaving, restlessness... then Gancao Xiexin Tang is indicated." The aforementioned three formulas—Banxia Xiexin Tang, Shengjiang Xiexin Tang, and Gancao Xiexin Tang—are all modifications of Xiaochaihu Tang, and the main symptom of all three is "fullness and distension below the heart." Based on the author's experience, using these three formulas to treat chronic gastritis (superficial and atrophic gastritis) yields excellent results, demonstrating that modifying Xiaochaihu Tang is one of the primary methods for treating gastric diseases.

In the "Shanghan Lun," it is written: "If a patient with Shanghan has had the illness for eight or nine days and is purged, experiencing chest fullness, agitation, difficulty urinating, delirium, whole-body heaviness, and inability to turn over, then Chaihu Jia Longgu Muli Tang is indicated." The author has had profound personal experience with this passage, finding that Chaihu Jia Longgu Muli Tang is highly effective in treating early-stage coronary heart disease and various cardiovascular diseases characterized by chest tightness, difficulty urinating, and overall bodily heaviness. For coronary heart disease, additional blood-activating and stasis-resolving herbs such as Chishao, Chuanxiong, Honghua, Jiangxiang, Danshen, Han Sanqi, and Shuizhi Fen can be added; for hypertensive heart disease, Huainiu Xi, Shengzhe, Shengbai Shao, Shenggui Ban, Shengdi, and Huanglian can be added; for rheumatic heart disease, Fupian, Baizhu, Fuling, and Qianjiang can be added; and for arrhythmia, Kushen, Danshen, Shengdi, Maidong, and Ajiao can be added. The original formula for Chaihu Jia Longgu Muli Tang is: Chaihu, Huangqin, Dangshen, Banxia, Gancao, Shengjiang, Dazao, Shenglongmu, Guizhi, Fuling, Dahuang, and Liandan. The Liandan in the formula is a lead compound refined from black lead; although it can calm the mind and soothe the spirit when taken internally, it is toxic and can cause nausea and other gastrointestinal problems, so recent recommendations suggest replacing it with Shengzhe.

Given that several passages in the "Shanghan Lun" mention "difficulty urinating" or "coughing," later generations have used this formula, with added herbs, to treat acute and chronic nephritis and urinary tract infections, with numerous reports of effectiveness; there are also reports of using this formula, with modifications, to treat bronchial and pulmonary infections. The author believes that adding Longdancao, Shan Zhizi, Cheqianzi, and Mutong to Xiaochaihu Tang is the best prescription for treating urinary tract infections, with significant efficacy against acute nephritis and hematuria. In summary, the clinical application of Xiaochaihu Tang can cover inflammatory lesions in the heart, gallbladder, liver, stomach, kidneys, lungs, bladder, and other organs of the human body.

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Middle Section: Clinical Applications

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153 Pei Zhengxue’s Traditional Chinese Medicine—Discussion on TCM Theory and Clinical Cases

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The ingredients of Xiao Chengqi Tang are as follows:

+----------------------+--------+--------+--------+-----:+ | Da Huang 10g | > Zhi Shi | > 10g | > Hou Pu | 10 g | | The ingredients of Tiaoweichengqi Tang are as follows: | | | | | | Da Huang 10g | > Mangxiao | > 10 g | > Gancao | > 6g |

These three formulas all aim to promote bowel movement and purge the intestines, making them the first-choice prescriptions for Yangming organ syndromes. In the "Shanghan Lun," it is written: "If defecation is difficult and there is slight fever, this is a real condition, so urgent purging is required; Da Cheng is indicated." "If abdominal fullness does not decrease, or decreases insufficiently, purging is required; Da Chengqi Tang is indicated." "If the illness has lasted two or three days, the pulse is weak, there are no Taiyang Chaihu symptoms, there is restlessness, and there is fullness below the heart... then Xiao Chengqi Tang is indicated." "If there is dry stool, Da Chengqi Tang is indicated." "After major purging, if there is still constipation six or seven days later, and the abdominal pain persists, this indicates the presence of dry stool, which is due to retained food; therefore, Da Chengqi Tang is indicated." "If a patient with Shanghan has vomited and now has abdominal distension, then Tiaoweichengqi Tang is indicated." Later generations, based on these passages, have summarized the Chengqi Tang syndrome into four categories: pi, man, zao, and shi. Pi refers to fullness and mild pain below the heart; man refers to fullness of the entire abdomen; zao refers to dry stool; and shi refers to abdominal pain that cannot be relieved by pressing. These four syndromes can appear at the onset of many acute abdominal conditions; in modern medicine, conditions such as acute gastritis, gastric spasm, cholecystitis, gallstones, pancreatitis, intestinal obstruction, appendicitis, acute toxic dysentery, colitis, Crohn's disease, etc., can all present with these symptoms.

The author believes that the focus of Xiao Chengqi Tang is on pi and man, while Tiaoweichengqi Tang focuses on zao and shi, and Da Chengqi Tang covers all four symptoms—pi, man, zao, and shi. When treating acute gastritis and gastric spasms, the author often uses a combination of Xiao Chengqi Tang and Xuanfu Dai Zhe Tang; when treating cholecystitis (gallstones) and pancreatitis, a combination of Tiaoweichengqi Tang and Banxia Xiexin Tang is used; when treating intestinal obstruction, a combination of Da Chengqi Tang and Laifu Tongjie Tang is used; when treating appendicitis, a combination of Da Chengqi Tang and Da Huang Mudanpi Tang is used; when treating toxic dysentery and Crohn's disease, a combination of Da Chengqi Tang and Xianglian Tang is used; and when treating colitis, a combination of Tiaoweichengqi Tang and Lianli Tang is used.

These medication principles, combined with adjustments based on specific symptoms, form the main framework for TCM treatment of acute abdominal conditions. For severe pain, add Yuanhu, Chuanlianzǐ, and Zhi Rumen; for concurrent infections, add Erhua, Lianqiao, Gongying, Baijiang, Baihuasheshicao, and Banzhilian; for gastrointestinal infections, add Huanglian, Huangqin, Huangbo, Dahuang, Kushen, and Machichang. Muxiang, Zhi Shi, Binglang, and Erchou can relax smooth muscles, thereby alleviating gastric spasms and intestinal peristalsis, with effects of relieving bloating and easing pain; Chuanjiao, Qianjiang, and Xiaohui also have these effects, while additionally promoting secretion of digestive glands, so they can be used according to the condition. In the "Shanghan Lun," it is written: "If Taiyang disease is not resolved, heat accumulates in the bladder, the person becomes狂, blood flows out, and those who flow out are cured. If external symptoms are not resolved, they cannot be attacked yet; if external symptoms are resolved, but there is still acute blockage in the lower abdomen, then attack is possible, and Taohu Chengqi Tang is indicated." This passage indicates that "heat accumulation in the bladder, becoming狂, and blood flowing out" are indications for Taohu Chengqi Tang. The author has successfully used this formula to treat dozens of cases of toxic dysentery. It has also been used to treat hepatic encephalopathy, demonstrating that the Da Huang and Mangxiao in the formula have powerful purging effects, cleansing the intestinal cavity, increasing the excretion of toxins (blood ammonia), reducing toxin absorption, and simultaneously alleviating cerebral edema through water excretion. The "Wenbing Tiaobian" includes a formula called Zengye Chengqi Tang, composed of Shengdi, Yuanshen, Maidong, Dahuang, and Mangxiao, which treats Yangming organ excess combined with yin fluid depletion. From a modern medical perspective, this condition should be considered a prolonged febrile illness leading to dehydration and electrolyte imbalance.

Middle Section: Clinical Applications

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For patients with long-term fever, such as those with tuberculosis, rheumatism, blood diseases, connective tissue diseases, and subacute allergic sepsis, if they also have dry stools and thick, greasy tongue coating, the author treats them with this formula, modified as needed, and most cases are effective. Not only does it facilitate bowel movements, but it also alleviates restlessness, yellow tongue coating, and high fever accordingly. In Zengye Chengqi Tang, adding Ren Shen, Dang Gui, Hai Can, and ginger juice creates a new formula called Xinjia Huanglong Tang (from "Wenbing Tiaobian"), which treats Yangming organ excess combined with both qi and yin deficiency. From a modern academic perspective, in the late stages of a febrile illness, the patient's physical condition is severely depleted, nutrition is poor, blood pressure is low, breathing is shallow, and excessive sweating occurs with minimal movement. At this point, in addition to Western medical fluid replacement and correction of electrolyte imbalance, and possibly plasma, albumin, or whole-blood transfusions, TCM considers Xinjia Huanglong Tang the first choice. The author has used this formula to treat advanced febrile patients, and it is particularly effective for those whose appetite declines after the fever subsides.

Mr. Wang, male, 62 years old, suffered from lung cancer and experienced persistent high fever for two weeks after surgery. Despite antibiotic treatment and fluid replacement/transfusion, the fever persisted, but the patient was extremely weak, bedridden, and had no appetite. After taking five doses of the above formula, the patient gradually began eating again, his strength increased day by day, and the formula was adjusted by removing Mangxiao and using only 3 g of Da Huang. After another ten doses, the patient was finally able to get out of bed and move around, with an appetite comparable to normal.

Pei Zhengxue’s Traditional Chinese Medicine—Comparison of TCM Theory and Clinical Cases

Baijiu is originally brewed rice wine; it is usually acceptable to substitute with Huangjiu, but modern baijiu should not be mistaken for baijiu. If Guanxin Nos. I and II (Chishao, Chuanxiong, Honghua, Jiangxiang, Danshen) are added to the above formula, the efficacy will be even better. Some patients with myocardial infarction or unstable angina may need to add 2–10 g of Shuizhi and 1–6 g of Han Sanqi, taken in divided doses, to further enhance the effect.

Regarding the treatment of chest oppression, the "Jingui Yaolue" has introduced a series of effective modified formulas. For example, "If chest oppression prevents lying down and causes pain radiating to the back, then Gualou Xiebai Banxia Tang is indicated." "If there is a痞 in the heart, qi is stuck in the chest, causing fullness and reverse flow toward the heart, then Zhi Shi Xiebai Gui Zhi Tang is indicated; Ren Shen Tang is also indicated" (this Ren Shen Tang is identical in composition to Lizhong Tang). "If there is shortness of breath due to qi blockage in the chest, then Fuling Xingren Gancao Tang is indicated; Ju Zhi Jiang Tang is also indicated." "If chest oppression is acute or chronic, then Yiyi Fuzi San is indicated." "If the pain radiates to the back and the back pain radiates to the chest, then Wutou Chishi Zhi Wan is indicated." These five passages and seven formulas constitute the TCM prescription system for treating coronary heart disease. When treating coronary heart disease, the author usually builds on the foundation of Gualou Xiebai Baijiu Tang and supplements it with the aforementioned formulas, achieving excellent results.

In recent years, Western medicine has mainly advocated interventional therapy for acute myocardial infarction—whether it's coronary artery expansion, stenting, or bypass surgery—which has indeed shown remarkable efficacy in emergency situations. However, after surgery, most patients still experience various subjective symptoms, such as occasional palpitations, chest tightness, back pain, shortness of breath, mental fatigue, or anxiety about relapse. Moreover, some patients often experience recurrence 6–24 months after surgery, and repeated interventions still fail to achieve ideal results. For example, U.S. Vice President Cheney underwent cardiac intervention nearly 10 years ago and has experienced multiple recurrences and repeated interventions in recent years, indicating that the long-term efficacy of this method still needs further improvement. The author has long used the aforementioned traditional Chinese medicine formulas for patients with coronary heart disease after interventional procedures, which not only effectively alleviate symptoms but also ideally delay recurrence.

Middle Section: Clinical Applications

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In the "Jingui Yaolue," it is written: "If the pulse is deep and string-like, it indicates internal pain due to suspended fluid, and this condition is treated with Shizao Tang." This shows that the main symptom of suspended fluid is pain in the chest and rib area, because "when water flows under the ribs, the affected area experiences internal pain," which completely aligns with modern medical understanding of pleurisy. More importantly, Shizao Tang (Daji, Yuanhua, Gansui, Dazao) is highly effective in treating exudative pleurisy; judging by the formula, suspended fluid can be directly linked to pleural effusion. Shizao Tang is reliable in treating pleural effusion, but its mechanism is aggressive drainage, which can easily cause dehydration and electrolyte imbalance in patients with very poor physical condition, even posing risks. Compared with modern medical treatments such as antibiotics, thoracentesis, and corticosteroids, its safety is slightly inferior, so in recent years, Shizao Tang is rarely used for treating pleural effusion.

Regarding overflow fluid, the author believes it encompasses modern medical conditions such as renal edema, malnutrition-related edema, and endocrine-related edema. In the "Jingui Yaolue," it is written: "If a patient has overflow fluid, they should be made to sweat, and Da Qinglong Tang is indicated; Xiao Qinglong Tang is also indicated." "For all patients with water retention, if the lower body is swollen, they should be made to urinate; if the upper body is swollen, they should be made to sweat." This shows that inducing sweating and promoting urination are the main methods for treating such edema.

The author believes that Ma Huang Tang, Ma Xing Shi Gan Tang, and Da Xiao Qinglong Tang—these formulas that disperse lung qi and promote sweating—indeed have significant diuretic and anti-edema effects. Traditional Chinese medicine calls this approach "dispersing lung qi to promote water elimination," "highland water diversion," "lifting the pot lid to reveal the water," and "opening the ghost gate to cleanse the organs." Modern medical scholar Cao Yingfu once made the following analogy: "If there is a small hole on the tea pot lid, it's like the dispersal of lung qi, allowing water to pour out of the spout; if there is no small hole, water doesn't flow out easily, just like the non-dispersal of lung qi and the non-descending of kidney qi!"

Traditional Chinese medicine believes that the lung belongs to metal and the kidney belongs to water, and metal generates water, so metal and water mutually generate each other. Dispersing lung qi can promote water elimination, which is widely known. The author imagines the human body as a large, sealed entity, where the organs maintain dynamic osmotic balance through endocrine, metabolism, and fluid circulation. When lung qi is not dispersed, the pressure balance between the lung and the kidney tends to break down, leading to difficulty urinating and edema. Western medicines such as aminophylline and chloramphenicol, which are used to relieve cough and phlegm, also have strong diuretic effects. Could this be related to the above mechanism? Of course, this is just a hypothesis, and there is currently no experimental research to confirm it. Modern Western medicine continuously practices and refines its theories, constantly improving them, while Chinese medicine has accumulated thousands of years of experience. The core of practical experience in Chinese medicine is precisely the essence that modern medicine should learn from. The Western world has now fully recognized this point.

It is well known that Shenqi Wan can treat edema below the waist. This formula is the primary prescription for tonifying kidney yang in TCM, and TCM believes that "if yang is deficient, water will overflow," so only tonifying kidney yang is the fundamental way to treat water-related problems. Recent experimental studies have confirmed that "kidney yang" is actually the manifestation of the function of the hypothalamus-adrenal cortex axis. When kidney yang is deficient, the levels of 17-hydroxyprogesterone and 17-ketosteroids in urine decrease, indicating that the function of the hypothalamus-adrenal cortex is lower than normal. This includes not only the functions of the thyroid gland, adrenal gland, and sex glands, but also complex changes in the body's water-salt metabolism. The author uses warming and tonifying formulas such as Gui Fu Ba Wei Wan and Jisheng Shenqi Wan to treat chronic nephritis, renal syndrome, cirrhotic ascites, chronic pyelonephritis, vascular-neurogenic edema, and endocrine-related edema, achieving relatively good results.

As for "zhi yin," the author believes it encompasses modern medical conditions such as chronic bronchitis, asthmatic bronchitis, bronchial asthma, emphysema, pulmonary heart disease, and pulmonary-origin cardiac insufficiency—various respiratory diseases that cause different clinical manifestations. In the "Jingui Yaolue," it is written: "If a patient has coughing and wheezing and cannot lie down, then Xiao Qinglong Tang is indicated." "If zhi yin causes chest fullness, Hou Pu

158 Pei Zhengxue’s Traditional Chinese Medicine—Discussion on TCM Theory and Clinical Cases

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"It is treated with Da Huang Tang," "If there is zhi yin between the ribs, the person is short of breath, has a痞under the heart, and their complexion is dark. Their pulse is deep and tight, and they've had this condition for dozens of days... then Mu Fangji Tang is indicated." "If zhi yin makes it impossible to breathe, then Tingyi Dazao Xiefei Tang is indicated." Chronic respiratory diseases, over the long course of the illness, exhibit both "phlegm" characteristics and "edema" characteristics, thus falling under the category of "tan yin."

Xiao Qinglong Tang is composed of Ma Huang, Gui Zhi, Bai Shao, Gancao, Qianjiang, Xi Xin, Wu Wei Zi, Ban Xia, and other herbs. The author finds this formula particularly effective in treating chronic bronchitis, asthmatic bronchitis, and bronchial asthma. Adding Xingren and Shengshi to the formula embodies the spirit of Ma Huang Tang and Ma Xing Shi Gan Tang, and it also works well for treating external-cold-induced cough, wheezing, and fever. Ma Xing Shi Gan Tang is the ancestral formula for treating cough and wheezing in TCM, and it is effective whether used for acute or chronic conditions. The author's experience is that Ma Huang Tang treats external-cold-induced cough, adding Qianjiang, Xi Xin, Wu Wei Zi, and Ban Xia (Xiao Qinglong) when the patient is short of breath, adding Shengshi (Da Qinglong) when the patient has a fever, adding Tingyi Zi when the patient is coughing and wheezing, and adding Su Xing San when the patient produces a lot of phlegm.

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Woodfangji Decoction (Woodfangji, Raw Gypsum, Cinnamon Twig, Codonopsis) is a rarely used formula. Based on the main symptoms of "intercostal phlegm-dampness, wheezing and fullness, epigastric distention and hardness, and dark complexion," the author analyzes that this formula's syndrome is broadly similar to the clinical manifestations of cor pulmonale with heart failure, and thus frequently uses this formula with modifications to treat such cases with good results. Woodfangji is the root of Aristolochia manshuriensis, a perennial vine in the Aristolochiaceae family. According to "Herbal Medicine," it "dispels phlegm and resolves fluid retention, and treats lung qi cough," indicating that, in addition to its diuretic and anti-edema effects, this herb also has the functions of relieving asthma and cough and transforming phlegm—precisely meeting the therapeutic needs of cor pulmonale with heart failure. In recent years, there have been reports from abroad of renal failure caused by Aristolochiaceae plants such as Aristolochia fangchi; however, Woodfangji does not contain aristolochic acid, and based on the author's experience, Woodfangji has a stable medicinal nature with no observed adverse reactions.

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Part Two: Clinical Applications

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There are many causes of polyneuritis, but among them, deficiency of vitamin B seems to be analogous to the TCM concept of "blood deficiency giving rise to wind."

The syndrome of "deficiency-cold" is described in five formula patterns in "Jin Gui Yao Lue." The author broadly summarizes them as follows: for deficiency-cold with loss of essence, use Gui Zhi Long Gu Mu Li Tang; for deficiency-cold with urgency, use Xiao Jian Zhong Tang or Huang Qi Jian Zhong Tang; for deficiency-cold with low back pain and difficulty urinating, use Ba Wei Shen Wan; for deficiency-cold with insomnia, use Suan Zao Ren Tang; and for deficiency-cold with emaciation, abdominal distention, and skin lesions, use Da Huang Di Chong Wan.

According to "Jin Gui Yao Lue": "In cases of loss of essence, patients often present with tightness in the lower abdomen, coldness in the genital area, dizziness, and hair loss. If the pulse is extremely weak, wiry, and slow, it indicates depletion of grain, blood, and essence; if the pulse is wiry, thready, and slightly tense, and the patient is a man experiencing loss of essence or a woman having nocturnal emissions, Gui Zhi Long Gu Mu Li Tang is indicated." This passage provides a very vivid description of the symptoms of excessive essence loss and proposes a principal formula—Gui Zhi Jia Long Gu Mu Li Tang. The composition of this formula is taken by decocting in water.

| Cinnamon Twig | 10g | White Peony | 10g | Ginger | 6g | Licorice | 6g | Dragon and Oyster Shell | 15g |

In "Xiao Pin," white weigela and aconite, each 3g, are added to the above formula while cinnamon twig is omitted, resulting in Er Jia Long Gu Tang, which is used to treat essence loss, weakness, floating heat, and spontaneous sweating. The author believes this formula is indeed effective for treating those with spermatorrhea and physical weakness; the cinnamon twig can be omitted, and the amounts of white weigela and aconite should be small—about 3g is sufficient. If the white peony is doubled, the astringent effect will be enhanced, leading to even better therapeutic outcomes. After increasing the white peony, the formula takes on the characteristics of Xiao Jian Zhong Tang. According to "Jin Gui Yao Lue," Xiao Jian Zhong, in addition to treating "urgency due to deficiency-cold," can also treat "nocturnal emission due to deficiency-cold."

According to "Jin Gui Yao Lue": "For urgency due to deficiency-cold, palpitations, nosebleeds, abdominal pain, nocturnal emission, limb soreness, hand and foot heat, dry throat and mouth, Xiao Jian Zhong Tang is indicated"; "For urgency due to deficiency-cold and various deficiencies, Huang Qi Jian Zhong Tang is indicated." Here, "urgency due to deficiency-cold" refers to the cramping abdominal pain experienced by patients with deficiency-cold, including discomfort in the epigastric region as well as abnormal colonic motility causing lower abdominal discomfort. Palpitations, nosebleeds, limb soreness, hand and foot heat, and dry throat and mouth indicate the systemic manifestations accompanying deficiency-cold. The author has achieved good results using Xiao Jian Zhong Tang and Huang Qi Jian Zhong Tang to treat chronic gastritis, gastric and duodenal ulcers, chronic colitis, irritable bowel syndrome, and allergic colitis. Huang Qi Jian Zhong Tang differs from Xiao Jian Zhong Tang only in one ingredient—the former contains an additional dose of astragalus, enhancing its tonifying effect, making it more suitable for long-term, debilitated patients with the aforementioned conditions. As for Jian Zhong Tang, it is essentially Xiao Jian Zhong with the white peony doubled and 30g of honey added.

When treating gastritis and gastric ulcers, the author often adds salvia miltiorrhiza, costus root, and cardamom; for ulcers, raw dragon and oyster shell and cuttlefish bone are added; when stomach pain is severe, alum, rhizoma corydalis, fragrant nutgrass, and calcined brick are added. For colon diseases, greater quantities of rhubarb, citrus aurantium, magnolia bark, and coptis are used; for severe abdominal distention, magnolia bark, ginger, pinellia ternata, and codonopsis are added; for diarrhea, dried ginger, processed aconite, and plantago seeds are added; for urgency followed by tenesmus, costus root, citrus aurantium, and areca nut are added; for purulent bloody stools, angelica sinensis, red peony, dandelion, houttuynia, and sophora are added; for nausea and vomiting, raw ochre and cyclamen are added. In short, the key indicator for using Huang Qi Jian Zhong Tang and Xiao Jian Zhong Tang in treating gastrointestinal diseases is the word "deficiency"—patients with gastrointestinal disorders who are physically weak are more suitable for these formulas. Due to prolonged illness, gastrointestinal absorption function is poor, the body lacks nutrients, immunity is weakened, metabolism is disordered, autonomic nervous system function is impaired, leading to anemia, exhaustion, and other complications, which in turn cause palpitations, nosebleeds, restlessness, dry mouth, heat in the palms and soles, extremely weak pulse, or a large, hollow pulse—these are all symptoms of deficiency-cold. In ancient times, medical conditions were relatively poor; a common gastrointestinal disease, if left untreated or mismanaged, would persist for a long time and eventually lead to numerous complications and sequelae—this is easy to imagine.

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According to "Jin Gui Yao Lue": "For low back pain, lower abdominal tightness, and difficulty urinating due to deficiency-cold, Ba Wei Shen Qi Wan is indicated." This formula provided a principled guideline for later treatment of urinary system diseases. The composition of Ba Wei Shen Qi Wan is as follows:

| Rehmannia | 12g | Cornus | 6g | Moutan Bark | 6g | Dioscorea | 10g | | Poria | 12g | Alisma | 10g | Cinnamon Twig | 10g | Processed Aconite | 6g |

Decoct in water and take one dose daily. This formula treats various urinary tract infections; the author has used this formula with modifications to treat senile urethritis, acute and chronic prostatitis, acute and chronic cystitis, and chronic pyelonephritis with excellent results—especially for treating senile urethritis, which is truly outstanding. Gui Fu Ba Wei Wan with additions can also treat diabetes, cerebral infarction, chronic nephritis, emphysema, vasculoneurotic edema, and endocrine-related edema. The author’s experience is that for diabetes, add atractylodes, salvia miltiorrhiza, kudzu root, polygonatum, and raw gypsum; for cerebral infarction, add ophiopogon, schisandra, dendrobium, astragalus, calamus, and polygala; for chronic nephritis, add four substances of peach blossom and five flavors of disinfectant drink; for emphysema, add ophiopogon, schisandra, cinnamon, agarwood, and amethyst; for vasculoneurotic edema and endocrine-related edema, add achyranthes, plantago seeds, atractylodes, and poria. However, Gui Fu Ba Wei Wan is less effective for treating organic low back pain; according to the author’s experience, the low back pain treated by this formula is non-organic, such as that caused by elderly frailty, women during menstruation, or young adults engaging in excessive sexual activity—TCM calls this "kidney-deficiency-related low back pain." These types of low back pain are caused by endocrine, metabolic, and autonomic nervous system dysfunction; modern medicine has no specific cure, but TCM’s Gui Fu Ba Wei Wan, which strengthens the kidneys and fortifies the lower back, proves effective, precisely filling the gap left by Western medicine.

According to "Jin Gui Yao Lue": "For insomnia due to deficiency-cold, Suan Zao Ren Tang is indicated." This passage proposes a good formula for treating insomnia. The composition of Suan Zao Ren Tang is taken by decocting in water.

| Stir-fried Jujube Seed | 15g | Ligusticum | 6g | Poria | 12g | Anemarrhena | 20g | Licorice | 6g | Ginger | 6g |

This prescription has a simple yet refined flavor, with a focused and reliable effect, making it convenient for clinical adjustments. Whenever the author encounters insomnia—regardless of whether it is due to deficiency, excess, cold, or heat, and regardless of the Western medical diagnosis—they can add this formula to the treatment, and the effect is usually good.

According to "Jin Gui Yao Lue": "For extreme weakness and emaciation due to five types of overwork, accompanied by abdominal distention, inability to eat, food injury, emotional distress, drinking injury, sexual injury, hunger injury, labor injury, meridian and collateral circulation problems, internal blood stasis, skin lesions, darkened eyes, and sluggishness with deficiency-cold, Da Huang Di Chong Wan is indicated." The composition of Da Huang Di Chong Wan is as follows: all ingredients are ground into powder, mixed with honey to form pills, about the size of a soybean, five pills per dose, three doses per day.

| Rhubarb | 10g | Scutellaria | 10g | Licorice | 6g | Peach Kernel | 10g | Jujube Seed | 10g | White Peony | 10g | |------|-----|-----------|------|-----|------|-----|------|-----|--------|-----| | Rehmannia | 12g | Dried Algae | 3g | Worm | 6g | Leech | 10g | Wax Moth | 6g | Soil Beetle | 6g |

Based on the symptoms described in the above passage, they are similar to those of decompensated cirrhosis in modern medicine. Whenever the author encounters advanced cirrhosis, they often use this formula in liquid form, and the results are mostly satisfactory. The main function of this formula is to invigorate blood circulation, remove blood stasis, clear heat, and drain fire, which is particularly effective for patients with splenomegaly and ascites due to cirrhosis—especially for those with long-term liver dysfunction, endocrine imbalance, hormonal level disturbances, dark complexions, darkened eyes, and skin lesions, where the effect is best. This formula can significantly improve the complexion of patients with advanced cirrhosis, something no current Western medicine can achieve. The author once took this formula as a base, added larger doses of astragalus, salvia miltiorrhiza, angelica sinensis, white peony, and polygonum multiflorum, mixed them with honey to form pills, naming it "Shan Gan Zeng Rong Wan," which greatly improved the skin color of many patients with advanced cirrhosis, gradually alleviating their dull complexions and earning high praise from patients. Since the discoloration of the skin and face in cirrhosis patients is related to adrenal cortical insufficiency, rhubarb worm pills can dispel the patients’ dull complexion. Whether they can be used to treat Addison’s disease caused by adrenal cortical insufficiency remains to be further studied.

Chapter Seven: Treatment Formulas for Abdominal Distention, Cold Hernia, and Accumulated Food

In "Jin Gui Yao Lue," abdominal distention, cold hernia, and accumulated food are three distinct syndromes. Abdominal distention refers to fullness throughout the entire abdomen; if pressing on it does not cause pain, it is considered deficiency, whereas if it does cause pain, it is considered excess, indicating that abdominal distention can be both deficient and excessive. Cold hernia, on the other hand, is purely a cold syndrome; cold tends to contract, and contraction leads to blockage, which in turn causes pain. Therefore, a precise definition of cold hernia in TCM should be "abdominal pain caused by the accumulation of cold energy in the abdomen." This definition is the author’s personal view, and colleagues are welcome to further discuss and confirm it. In Western medicine, "hernia" refers to an organ protruding into another cavity or space, which has nothing in common with TCM’s cold hernia. Accumulated food, meanwhile, is purely an excess syndrome; the pulse is rapid and slippery, indicating that it should be expelled or transformed—this syndrome is different from the usual spleen-stomach deficiency and dampness stagnation in the middle jiao.

According to "Jin Gui Yao Lue": "For abdominal distention with fever lasting ten days, the pulse is floating and rapid, yet eating habits remain unchanged, Hou Pu Wu Wu Tang is indicated." "If the distention does not decrease, or decreases but then returns to normal, it must be relieved, and Da Cheng Qi Tang is recommended." "If the distention decreases temporarily but then returns to normal, it is cold, and warming herbs should be used." "In Shang Han Lun, after sweating, if the abdomen becomes distended, Hou Pu Sheng Jiang Ban Xia Gan Cao Ren Shen Tang is indicated." These three passages provide two formula patterns for abdominal distention—excess and deficiency. For excess, use Da Cheng Qi Tang; for deficiency, use Hou Pu Sheng Jiang Ban Xia Gan Cao Ren Shen Tang. The composition of Da Cheng Qi Tang is as follows: decoct in water, with rhubarb added last and mirabilite melted.

• Rhubarb 10g
• Mirabilite 10g
• Citrus Aurantium 10g
• Magnolia Bark 6g

The composition of Hou Pu Sheng Jiang Ban Xia Gan Cao Ren Shen Tang is as follows: decoct in water.

• Magnolia Bark 6g
• Ginger 6g
• Pinellia 6g
• Licorice 6g
• Codonopsis 10g

The author believes that the excess type of abdominal distention includes acute abdominal conditions in modern medicine such as intestinal obstruction, cholecystitis, and pancreatitis, and that Da Cheng Qi Tang with modifications is effective in treating these diseases. The author’s experience is that early-stage partial intestinal obstruction can be effectively treated with Da Cheng Qi Tang—for example, taking 100g of sesame oil half an hour before taking the medicine makes the effect more reliable; however, intestinal obstruction in its late stage, especially when intestinal necrosis has occurred, is contraindicated. For biliary diseases, it is advisable to add citrus aurantium, costus root, coptis, and scutellaria; for pancreatic diseases, add Sichuan pepper, dried ginger, turmeric, curcuma, coptis, scutellaria, citrus aurantium, and costus root; for those in pain, add rhizoma corydalis, chinaberry, and processed milkweed. The deficiency type of abdominal distention includes chronic gastritis, gastric and duodenal ulcers, gastrointestinal syndrome, irritable bowel syndrome, and gastric ptosis in modern medicine; the author’s experience is that Hou Pu Sheng Jiang Ban Xia Gan Cao Ren Shen Tang is effective in treating abdominal distention caused by these conditions. Depending on the specific clinical presentation, this formula can be combined and adjusted with Xiang Sha Liu Jun Zi Tang, Sha Shen Mai Men Dong Tang, Ye Shi Yang Wei Tang, Xiao Jian Zhong Tang, Ping Wei San, Salvia Drink, Si Mo Yin, and Si Wu Tang, but its main symptom should still be abdominal distention.

According to "Jin Gui Yao Lue": "For cold energy in the abdomen, thunder-like sharp pain, chest oppression and fullness, vomiting, Fu Zi Jing Mi Tang is indicated." "For pain accompanied by closure, Hou Pu San Wu Tang is indicated." "For severe cold pain in the chest and abdomen, unable to eat, cold energy in the abdomen, upward surging skin, visible head and feet, pain throughout the body that cannot be touched, Da Jian Zhong Tang is indicated." "For abdominal pain, with a taut and tight pulse, the pulse indicates that defensive qi is not circulating, meaning cold; if it is tight, one does not want to eat, and yin and yang are in conflict, which is cold hernia. For pain around the navel, if it occurs, one sweats profusely, hands and feet become cold, and the pulse is deep and tight, Da Wu Tou Tang is indicated." "For cold hernia, abdominal pain and navel pain accompanied by urgency, Dang Gui Sheng Jiang Yang Rou Tang is indicated." "For cold hernia with abdominal pain, coldness, numbness in the limbs, body pain, moxibustion, acupuncture, and other treatments that fail, Di Dang Wu Tou Gui Zhi Tang is indicated." The above five passages propose five formula patterns, and the common characteristic of these five patterns is abdominal pain, which is caused by cold, hence the name "cold hernia." The author believes that TCM’s cold hernia includes various non-organic abdominal pains in modern medicine, which are also collectively referred to as "cold-deficiency-related abdominal pain," i.e., TCM’s cold hernia. The primary drugs for treating cold hernia are wu tou, fu zi, and si chuan, three herbs that are pungent and highly warming, with strong effects in dispersing cold and relieving pain.

If accompanied by hyperactive bowel sounds and vomiting, use Fu Zi plus ban xia, gan cao, jing mi, and da zao as a formula, called Fu Zi Jing Mi Tang; if accompanied by upward surging skin, visible head and feet, and pain throughout the body that cannot be approached, use si chuan plus gan jiang, dang shen, and candy sugar, called Da Jian Zhong Tang; if accompanied by cold extremities, use wu tou plus ban xia, fu ling, and xi xin, make pills with honey, about the size of sesame seeds, called Chi Wan, or simply use wu tou alone, decoct it in water and take the juice, called Da Wu Tou Tang, or use wu tou plus gui zhi tang, called Wu Tou Gui Zhi Tang. For abdominal pain accompanied by flank pain and urgency, use Dang Gui, Sheng Jiang, and Yang Rou as a decoction, called Dang Gui Sheng Jiang Yang Rou Tang.

The author believes that the overall effect of the above Fu Zi Jing Mi Tang, Da Jian Zhong Tang, Chi Wan, Da Wu Tou Tang, Wu Tou Gui Zhi Tang, and Dang Gui Sheng Jiang Yang Rou Tang is to regulate the function of the gastrointestinal autonomic nervous system, suppress the overactivity of the parasympathetic nervous system, thereby reducing the tension of the gastrointestinal smooth muscles, decreasing gastrointestinal motility, and inhibiting the secretion of digestive glands, ultimately achieving the goal of relieving distention and pain. Among these formulas, wu tou and fu zi are essentially the same substance, with a pungent taste and strong warming properties, serving as powerful agents for warming the kidneys and dispersing cold; dispersing cold can relieve pain. The author’s experience is that the dosage of wu tou and fu zi can be between 10 and 30 grams, and it is advisable to decoct them for one hour first to remove their toxicity. It is generally believed that wu fu is a powerful agent for expelling wind and eliminating dampness, commonly used to treat rheumatism and rheumatoid arthritis; however, the author uses this drug to treat stomach-related distention and pain. Si chuan, gan jiang, and xi xin are all pungent-warm herbs, either warming the middle and dispersing cold, or reversing and stopping vomiting, and they work well in combination with wu fu. Gan jiang, xi xin, wu wei zi, and ban xia are the main ingredients of Xiao Qing Long Tang, which relieves asthma and stops wheezing; gan jiang, xi xin, si chuan, and ban xia are also excellent agents for stopping vomiting and relieving distention, differing by only one ingredient—the former focuses on calming the airways and reversing the flow, while the latter focuses on relieving distention and relaxing the gastrointestinal smooth muscles.

From a TCM perspective, expanding the airways and relaxing the gastrointestinal smooth muscles are both "cholinesterase inhibitors," reducing the tension of the parasympathetic nervous system, which shows the common mechanism and effect of cold hernia formulas in suppressing the parasympathetic nervous system of the gastrointestinal tract.

According to "Jin Gui Yao Lue": "If someone has accumulated food, how can it be distinguished? The master said: the pulse at the cun position is floating and large, but feels rough when pressed, and the pulse at the chi position is also faint and rough, so we know there is accumulated food, and Da Cheng Qi Tang is indicated." "If the pulse is rapid and slippery, it is excess, indicating accumulated food, and relief comes from using Da Cheng Qi Tang." "If someone has diarrhea and does not want to eat, it means there is accumulated food, and Da Cheng Qi Tang is recommended." "If accumulated food is in the upper part of the stomach, it should be vomited out, and Guai Di San is recommended." The above four passages explain that a large, rapid, slippery pulse that feels rough when pressed, along with diarrhea and lack of appetite, are the pulse signs of accumulated food, and the treatment options proposed are Da Cheng Qi Tang for expulsion and Guai Di San for vomiting—these are the choices for treating accumulated food.

The author’s experience is that the syndrome of accumulated food is mainly caused by restricted gastrointestinal emptying and digestive disorder, often stemming from autonomic nervous system dysfunction in the gastrointestinal tract; some patients also develop it due to chronic gastritis, gastric and duodenal ulcers, and other chronic conditions.

There are three characteristics: first, unwillingness to eat; second, discomfort in the stomach and abdomen; third, belching with foul-smelling food, and the pulse being slippery, rapid, and rough when pressed is only for reference. Whenever this syndrome occurs, a single dose of Da Cheng Qi Tang is enough, with definite effects; if the effect is not obvious or only slight, further examination can be conducted, combining it with treatment of the original disease, or Guai Di San can be used for vomiting to achieve recovery.

The composition of Guai Di San is as follows: boil and sun-dry, grind into powder, stir-fry fermented soybeans in water, and use this water to wash the powder before taking it, six grams per dose, with gradual increase for those who do not vomit. (Note: There is a type of red bean, and the red bean used in Guai Di San is commonly known as crab-eye bean, which has a sour-warm nature and induces vomiting.)

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After reviewing historical and contemporary medical records, no such case or report has been found. The clinical subjective symptoms of diabetes insipidus are similar to those of diabetes, characterized by excessive drinking and urination; Gui Fu Ba Wei Wan and Bai Hu Tang are effective against this disease, with particularly remarkable effects in individual cases—this is another clear proof of the TCM principle of treating different diseases with the same method.

According to "Jin Gui Yao Lue": "For dysuria, urine is like millet grains, the lower abdomen is tightly strained, and there is pain when urinating." "For difficulty urinating, there is water retention, and the person feels thirsty, so Gua Ti Ju Mai Wan is indicated." "For difficulty urinating, Pu Hui San is indicated, along with Shi Shi Bai Yu San and Fu Ling Rong Yan Tang." "For a floating pulse and fever, with a desire to drink water, and difficulty urinating, Zhu Ling Tang is indicated." The above four passages constitute a general discussion on dysuria. Dysuria refers to "urine like millet grains" and "tight strain in the lower abdomen with pain when urinating"—the millet-grain-like droplets are difficult to pass, and the tight strain and pain when urinating indicate severe abdominal pain and frequent movement in the lower abdomen. The descriptions in the text are entirely consistent with modern medical understanding of urinary tract infections, showing that Gua Ti Ju Mai Wan, Pu Hui San, Fu Ling Rong Yan Tang, and Zhu Ling Tang are all effective against urinary tract infections.

The composition of Gua Ti Ju Mai Wan is as follows: the five ingredients are ground into powder, mixed with honey to form pills, about the size of a walnut, take three pills three times a day, and it is unknown whether the dosage can be increased to seven or eight pills.

The composition of Pu Hui San is as follows: grind everything into powder, sift, take five grams three times a day.

The composition of Fu Ling Rong Yan Tang is as follows: decoct in water.

A Casual Discussion on Classic Formulas by Pei Zhengxue

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The formula is Da Xian Xiong Tang, with the main indication being "large chest constriction." Article 142 states: "Small chest constriction occurs in the epigastric region, and it hurts when pressed." This clearly defines the term "small chest constriction," which corresponds to the previously mentioned "large chest constriction." In summary, chest constriction can be divided into large chest constriction and small chest constriction. The former involves pain in the epigastric region and below, with fullness and pain that cannot be approached; the latter involves pain in the epigastric region, and it hurts when pressed.

Thus, it can be seen that the former’s pain covers a wider area and is more severe, while the latter’s pain covers a smaller area and is milder; therefore, the former is called "large chest constriction," and the latter is called "small chest constriction." The main formula for large chest constriction is Da Xian Xiong Tang, and the main formula for small chest constriction is Xiao Xian Xiong Tang. Why is it called "chest-constriction soup"? Article 138 of "Shang Han Lun" states: "If the exterior pattern has not been resolved, but the doctor mistakenly prescribes a purgative, the pulse becomes rapid and irregular, there is intense pain inside the chest, the stomach is empty, external qi moves into the chest, shortness of breath and irritability occur, there is inner regret, yang qi is trapped, and the lower abdomen is affected by whipping—this is chest constriction, and Da Xian Xiong Tang is indicated." From this, it can be seen that the trapping of yang qi in the chest and diaphragm is the main pathological basis for chest constriction, hence the name "chest-constriction soup." Since chest constriction is caused by the trapping of yang qi, it must be yang and hot; Article 134 of "Shang Han Lun" states: "If a disease originates from yang and is mistakenly treated with a purgative, heat enters and causes chest constriction," which explains this point. As it is a yang-hot syndrome, treatment should follow the principle of cooling down—whether it is Da Xian Xiong Tang or Xiao Xian Xiong Tang, the composition is mainly cool and refreshing, which is entirely reasonable. The composition of Da Xian Xiong Tang is rhubarb, mirabilite, and gypsophila; the composition of Xiao Xian Xiong Tang is gourd, coptis, and pinellia. The former is more aggressive, striking at the root of the problem, suitable for large chest constriction; the latter is gentler, broadening the chest and lowering qi, suitable for small chest constriction.

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The author has previously used Daxianxiong Tang to treat exudative pleurisy and Xiaoxianxiong Tang to treat dry pleurisy, achieving good therapeutic effects. Moreover, since Dajie Xiong is characterized by fullness and pain from the epigastrium to the lower abdomen, this formula has proven effective in treating certain cases of intestinal obstruction; similarly, because Xiaojie Xiong presents with tenderness upon palpation in the epigastrium, this formula has been effective in treating atrophic gastritis. In Daxianxiong Tang, adding Tengli Zi and Xingren to form pills, known as Daxianxiong Wan, is used to treat the "stiff neck, resembling a soft burial" associated with Jie Xiong (Shanghan Lun, Article 135). The addition of Tengli Zi, which helps eliminate phlegm and promote diuresis, and Xingren, which relieves cough and expels phlegm, clearly enhances the effect on water-phlegm accumulation in the chest, making it particularly suitable for conditions like exudative pleurisy. Taking these pills allows for gradual treatment, but they are not appropriate for patients experiencing fullness and pain from the epigastrium to the lower abdomen. As for the condition of Dajie Xiong, its symptoms include "fullness and pain in the epigastrium and lower abdomen that cannot be touched," as well as "pain in the epigastrium that feels like a stone when pressed" (Shanghan Lun, Article 139). Based on these symptoms, it can be inferred that, in addition to the aforementioned intestinal obstruction, this condition may also involve gastric perforation or acute peritonitis. Therefore, relying solely on formulas like Daxianxiong may not be sufficient to treat such severe cases. Consequently, Shanghan Lun, Article 136 states: "If all the symptoms of Jie Xiong are present and the patient is agitated, they will die." It further notes: "For patients with Jie Xiong whose pulse is floating and large, purgation should not be administered; if it is, they will die."

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Due to malabsorption, hypoglycemia often occurs, so appetite does not decrease but rather increases.

Although no prescription for treating Zangjie can be found in Shanghan Lun, Jin Gui Yao Lue, Chapter on Abdominal Fullness and Cold Hernia, states: "When there is severe cold pain in the heart and chest, vomiting prevents eating, there is cold in the abdomen, upward rushing qi, skin eruptions with heads and feet visible, and pain throughout the body that cannot be touched, Da Jianzhong Tang is the primary treatment." This passage emphasizes the characteristic of pain caused by cold stagnation in the chest and abdomen, where vomiting prevents eating—this is not due to a lack of desire to eat—and is quite similar to the aforementioned Zangjie syndrome, especially the features of "cold in the abdomen" and "pain throughout the body that cannot be touched," which closely resemble the clinical manifestations of chronic pancreatitis. Shanghan Lun, Article 172, says: "If there is a痞in the flank that extends to the side of the bladder and causes pain radiating to the lower abdomen and into the yin meridians, this is called Zangjie, and the patient will die." This indicates that some cases of Zangjie involve severe pain radiating from the navel to the lower abdomen, with a very poor prognosis and life-threatening risk.

This is very similar to the acute attack of chronic pancreatitis. Because definitive diagnostic tests for chronic pancreatitis are still lacking, Western medicine often misdiagnoses it, especially mild cases, which are easily mistaken for chronic gastritis. Through decades of clinical experience, the author has found that using the TCM principle of "Zangjie" to prescribe treatment for chronic pancreatitis yields remarkable results. The main formula selected is Da Jianzhong Tang, supplemented with Chaihu Shugan San, with the aim of dispersing cold stagnation in the liver meridian. For severe pain, add Jinlingzi San; for abdominal distension and discomfort, add Fupian. Over the past 30 years, whenever this condition arises, the author has always prescribed this formula, and it has consistently been effective.

(Chinese-Western Medicine Integration Research, 1993.1)

Observation on the Therapeutic Effects of Traditional Chinese Medicine in Treating 289 Cases of Chronic Active Hepatitis B

Cheng Jie, Zhong Xu, Zhang Huifang, Ji Jianjun

Chronic active hepatitis B (referred to as chronic active hepatitis B) currently lacks specific effective treatments. Since May 1984, when our institute established a research group on hepatitis B, up until February 1988, we successively treated 289 patients with chronic active hepatitis B using TCM syndrome differentiation and treatment, while also setting up a control group for comparative observation, achieving relatively satisfactory therapeutic effects.

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(Continued)

Therapeutic Effects

1. Criteria for Efficacy

Recent cure: Self-reported symptoms disappear, hepatosplenomegaly remains stable or decreases without tenderness, all liver function indicators return to normal, HBsAg(-), HBeAg(-), HBV-DNA-P(-); during maintenance therapy or after one year of observation, none of these indicators show recurrence.

Improvement: Self-reported symptoms improve, liver function tests show significant improvement compared with before treatment, or HBsAg levels decrease, or HBV-DNA-P turns negative, or HBeAg turns negative.

No effect: Neither self-reported symptoms nor liver function, the three systems, or HBV-DNA-P indicators show any improvement.

2. Statistical Analysis of Efficacy

Out of 429 cases, the treatment group included 289 cases, with 101 recent cures, accounting for 34.94%; 152 improvements, accounting for 52.59%; 36 cases with no effect, accounting for 12.47%; overall effectiveness rate of 87.53%.

HBsAg seroconversion rate was 39.9%, and anti-HBe seroconversion rate was 68.57%. In the control group, there were 12 recent cures, accounting for 8.57%; 52 improvements, accounting for 37.14%; 76 cases with no effect, accounting for 54.28%. The treatment group had higher cure and improvement rates than the control group. Statistical analysis showed P<0.01, indicating a highly significant difference.

Recovery of Symptoms and Signs: Before treatment, there was no significant difference in symptoms and signs between the two groups (P>0.05); after treatment, except for susceptibility to colds and jaundice, where P<0.05, all other items (fatigue, loss of appetite, abdominal distension, liver pain, nausea, aversion to oil, bitter taste in mouth, low-grade fever, gingival bleeding, hepatomegaly, splenomegaly) showed highly significant differences between the two groups (P<0.01), with an overall P<0.01 for both groups.

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Liver function improvement: Before treatment, there was no significant difference between the two groups (P<0.05); after treatment, except for TFT, where P<0.05, all other items—SGPT (King’s units), TTT, ZNTT, r-globulin—showed significant differences between the two groups (P<0.01), with an overall P<0.01 for both groups.

Improvement of the three systems: Before treatment, there was no significant difference between the two groups (P>0.05); after treatment, the two groups showed highly significant differences (P<0.01).

Relationship between efficacy and syndrome type: See Table 1. Relationship between efficacy and disease course: See Table 2. Relationship between efficacy and treatment duration: See Table 3.

Table 2 Comparison of Treatment Group and Control Group Efficacy with Disease Course

Table 3 Comparison of Treatment Duration for Cured Patients in Treatment Group and Control Group

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Discussion

This article's comparative observation of TCM syndrome differentiation treatment for 289 cases of chronic active hepatitis B demonstrates that TCM syndrome differentiation treatment is more effective than Western medicine. All test indicators show significant or highly significant differences after statistical analysis. TCM syndrome differentiation not only effectively eliminates hepatitis B symptoms and improves liver function (with an overall effectiveness rate of 87.53%), but also plays a more prominent role in HBsAg seroconversion (seroconversion rate of 39.9%), e-antigen seroconversion (seroconversion rate of 68.51%), and HBV-DNA-P seroconversion (seroconversion rate of 56.43%). This shows that TCM syndrome differentiation treatment for chronic active hepatitis B is not merely symptomatic treatment; in essence, it addresses the root cause of the disease. This embodies the TCM academic view that "what exists internally must manifest externally," as well as the TCM spirit of "treating disease requires seeking its root."

Chronic active hepatitis B is diagnosed based on microscopic test indicators combined with hepatosplenomegaly and disease severity. In contrast, TCM syndrome differentiation mainly starts from another angle—the patient's subjective symptoms, pulse diagnosis, and tongue color—both of which are macroscopic aspects. Even for the same case of chronic active hepatitis B, there can be different presentations: Qi-Yin deficiency, invasion of pathogenic factors into Shaoyang, blood stasis, or Yang deficiency with water excess. Patients with Qi-Yin deficiency usually have better compensatory functions, with mild subjective symptoms; their formula No. 1 is a product that tonifies Qi and nourishes Yin while clearing heat and detoxifying. Patients with invasion of pathogenic factors into Shaoyang often show recent aggravation or recurrence; their formula No. 2 is a product that soothes the liver and clears heat and detoxifies. Patients with blood stasis often have obvious hepatosplenomegaly, marked liver pain, and severe liver function impairment; their formula No. 3 is a product that promotes circulation, nourishes the liver, and clears heat and detoxifies. Patients with Yang deficiency and water excess are mostly already in cirrhosis or early-stage cirrhosis, with obvious physical weakness and clear signs of portal hypertension; their formula No. 4 is a product that tonifies the middle jiao, warms Yang, and promotes diuresis.

Clearing heat and detoxifying is an important principle in treating chronic active hepatitis B. Medicines such as tiger stick, wild chrysanthemum, artemisia, indigo plant, and nightshade are used for patients who are positive for hepatitis B antigens (surface antigen and e-antigen). While improving symptoms, the surface antigen ratio often decreases or even turns negative, and the e-antigen also frequently turns negative. When SGPT is elevated and hepatitis B antigens are positive, it indicates pathogenic toxins, judged by the acute heat manifestation of hepatitis B. Such toxins are considered heat toxins, so clearing heat and detoxifying is the appropriate method. Abnormalities such as reduced albumin levels and excessive mucus secretion are considered deficiency syndromes. According to the Inner Canon, "deficiency should be supplemented," so tonifying Qi and nourishing Yin is the appropriate approach. Clearing heat and detoxifying complement each other, enhancing their mutual effects.

(Chinese Medical Journal, April 1989)

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Clinical Report on TCM Syndrome Differentiation Treatment for 100 Cases of Hepatitis B

Cheng Shenchun, Peng Xiang, Zhong Xu

Hepatitis B is an infectious immune disease caused by the hepatitis B virus (HBV). Due to its high infectivity, long incubation period, and tendency to become chronic, with a higher risk of developing cirrhosis and liver cancer compared to other viral hepatitis, research and treatment of this disease have recently attracted widespread attention in the medical community. The author has treated 100 cases of this disease using TCM syndrome differentiation, achieving satisfactory results, as reported below:

Pei Zhengxue’s Traditional Chinese Medicine——Discussion on TCM Theory and Clinical Cases

174 Published by Hepei Fragrance Publishing House

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