2. Cheng Qi Tang

Cheng Qi Tang includes Da Cheng Qi, Xiao Cheng Qi, Wei Dao Cheng Qi, and Tao He Cheng Qi. Tao He Cheng Qi was specifically designed in the "Shang Han Lun" for solar diseases with heat trapped in the bladder. The representative formulas of Cheng Qi Tang are Da Cheng Qi, Xiao Cheng Qi, and Wei Dao Cheng Qi. The composition of Da Cheng Qi is: Da Huang 10 g, Mang Xiao 10 g, Zhi Shi 10 g, Hou Pu 10 g; the composition of Xiao Cheng Qi is: Da Huang 10 g, Zhi Shi 10 g, Hou Pu 10 g; the composition of Wei Dao Cheng Qi is: Da Huang 10 g, Mang Xiao 10 g, Gan Cao 6 g. These three formulas all follow the principle of promoting bowel movement and clearing the bowels, making them the preferred medicines for Yangming腑symptoms. The "Shang Han Lun" states: "If one has difficulty defecating and a slight fever, it is a real problem, and one should quickly administer purgatives; Da Cheng Qi is recommended." "If abdominal distension does not decrease, and the reduction is insufficient, one should administer purgatives; Da Cheng Qi is recommended." "If one has been ill for two or three days, with a weak pulse and no solar Chai Hu symptoms, feeling restless, with epigastric fullness,...... Xiao Cheng Qi is recommended." "If there is dry stool, Da Cheng Qi is recommended." "If, after a major purge, one still feels uncomfortable and has abdominal pain six or seven days later, it is because there is still residual food in the stomach, so Da Cheng Qi is recommended."

"If, after vomiting during a cold, one has abdominal distension, use Wei Dao Cheng Qi." Later generations, based on the above passages, summarized the indications for Cheng Qi Tang as four symptoms:痞,满,燥,和实. 痞 refers to epigastric fullness with mild pain, 满 refers to fullness of the entire abdomen, 燥 refers to dry stool, and 实 refers to abdominal pain that cannot be relieved by pressing. These four symptoms can appear at the beginning of many acute abdominal conditions; modern medicine considers acute gastritis, gastric spasm, cholecystitis, cholelithiasis, pancreatitis, intestinal obstruction, appendicitis, acute toxic dysentery, colitis, Crohn's disease, and other conditions as examples of these symptom groups. The author believes that the focus of Xiao Cheng Qi is on痞and满, Wei Dao Cheng Qi focuses on燥and实, and Da Cheng Qi covers all four symptoms. The author treats acute gastritis and gastric spasms by combining Xiao Cheng Qi with Xuan Fu Dai Zhe Tang; treats cholecystitis (cholelithiasis) and pancreatitis by combining Wei Dao Cheng Qi with Ban Xia Xie Xin Tang; treats intestinal obstruction by combining Da Cheng Qi with Lai Fu Tong Jie Tang; treats appendicitis by combining Da Cheng Qi with Da Huang Mu Dan Pi Tang; treats toxic dysentery and Crohn's disease by combining Da Cheng Qi with Xiang Lian Tang; treats colitis by combining Wei Dao Cheng Qi with Lian Li Tang. These medication principles, combined with clinical adjustments, form the main framework for traditional Chinese medicine treatment of acute abdominal conditions. For severe pain, add Yuan Hu, Chuan Lian Zi, and Zhi Ru Mu Mei; for concurrent infections, add Er Hua, Lian Qiao, Gong Ying, Bai Jiang, Bai Hua She She Cao, and Ban Zhi Lian; for gastrointestinal infections, add Huang Lian, Huang Qin, Huang Bai, Da Huang, Ku Shen, and Ma Chi Xian. Mu Xiang, Zhi Shi, Bin Lang, and Er Chou can relax smooth muscles, thereby alleviating gastric spasms and intestinal peristalsis, with effects of relieving distension and easing pain; Chuan Jiao, Gan Jiang, and Xiao Hui Xiang also have similar effects, while additionally promoting secretion of digestive glands, so they can be used according to the condition. The "Shang Han Lun" states: "If a solar disease is not resolved, with heat trapped in the bladder, the person becomes狂, blood flows out, and the more it flows out, the better. If the external symptoms are not yet resolved, one should not attack yet; if the external symptoms are resolved, but the lower abdomen is still tightly contracted, one can attack, and Tao He Cheng Qi is recommended." The passage indicates that "heat trapped in the bladder, with the person becoming狂 and blood flowing out" is an indication for Tao He Cheng Qi. The author has successfully used this formula to treat toxic dysentery several times. It has also been used to treat hepatic encephalopathy, demonstrating that the Da Huang and Mang Xiao in the formula aggressively clear the intestines, eliminate toxins (ammonia), reduce toxin absorption, and simultaneously alleviate brain edema by promoting water excretion. The "Wen Bing Tiao Bian" version of Zeng Ye Cheng Qi Tang is composed of Sheng Di, Yuan Shen, Mai Dong, Da Huang, Mang Xiao, and other ingredients, mainly used to treat Yangming腑real problems 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. The author treats patients with long-term fever, such as those with tuberculosis, rheumatism, blood disorders, connective tissue diseases, and subacute allergic sepsis, who also have dry stools and thick, greasy tongues, with this formula, mostly achieving good results. Not only does the stool become regular, but irritability, yellow tongue coating, and high fever are also alleviated accordingly. In Zeng Ye Cheng Qi Tang, adding Ren Shen, Dang Gui, Hai Can, and ginger juice creates a new formula called Xin Jia Huang Long Tang (from "Wen Bing Tiao Bian"), mainly used to treat Yangming腑real problems combined with both qi and yin damage. From a modern medical perspective, in the late stages of febrile illness, the patient's physical condition is severely depleted, nutrition is poor, blood pressure is low, breathing is shallow, and one sweats profusely with movement. At this point, in addition to Western medical fluid replacement and correction of electrolyte imbalance, and sometimes plasma, albumin, and whole-blood transfusions, traditional Chinese medicine recommends Xin Jia Huang Long Tang as the first choice. The author finds this formula particularly effective in treating patients in the late stages of febrile illness, especially those whose appetite is poor after the fever subsides. Mr. Wang, male, 62 years old, a high-ranking official, suffered from lung cancer and underwent surgery, followed by a two-week-long high fever. After antibiotics, fluid replacement, and blood transfusions, the fever finally subsided, but the patient remained extremely weak, bedridden, and with no appetite. After taking five doses of the above formula, the patient gradually began to eat, his strength increased day by day, and the formula removed Mang Xiao, reducing Da Huang to only 3 g. After another ten doses, the patient was finally able to get out of bed and move around, with an appetite like a normal person.

IV. Treatment for Chest Tightness, Heart Pain, and Shortness of Breath

The "Jin Gui Yao Lue" provides a total of ten prescriptions for chest tightness, heart pain, and shortness of breath, and the author has confirmed through clinical practice that these passages refer to modern medical coronary heart disease. The "Jin Gui Yao Lue" states: "For chest tightness, the main symptoms are shortness of breath, coughing, chest and back pain, and shortness of breath, with a deep and slow pulse at the cun position and a tight pulse at the guan and chi positions; Ku Lao Xie Bai Bai Jiu Tang is the main prescription." This indicates that the main symptoms of "chest tightness" are shortness of breath and coughing, along with chest and back pain, which are broadly consistent with the clinical manifestations of modern medical coronary heart disease. Shortness of breath means difficulty breathing, and coronary

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The most common early symptom of the disease is shortness of breath after activity; the term "cough and expectoration" differs from the commonly referred to "cough," with emphasis on the word "expectoration," indicating frequent phlegm that needs to be spat out. It is well known that many patients with coronary heart disease produce excessive phlegm, often due to poor left ventricular function and long-term chronic pulmonary congestion.

Chest and back pain refers to chest pain radiating to the back, which includes both the brief chest pain of angina pectoris and the severe chest pain of myocardial infarction, as well as the long-term dull and distending sensation in the chest caused by chronic myocardial ischemia. The author believes that ancient physicians were able to succinctly describe the characteristics of coronary heart disease using only the above-mentioned few words, demonstrating their rich medical experience and precise use of language. "The cun pulse is deep and slow, while the guan pulse is small, tight, and rapid." There are various interpretations of this statement. The author believes that "cun" refers to the upper jiao, and "guan" refers to the middle jiao; the former focuses on the heart, while the latter focuses on the stomach. A deep and slow cun pulse indicates that yin pathogenic factors have invaded the heart, whereas a tight and rapid guan pulse suggests an excess of cold and turbid pathogenic factors in the middle jiao, allowing these turbid yin pathogenic factors to ascend—this is what is meant by "yin occupying the yang position." Modern medicine holds that the occurrence of coronary heart disease is related to the deposition of atherosclerotic plaques in the coronary arteries. These atherosclerotic plaques can be regarded as "turbid yin pathogenic factors," and their deposition in the coronary arteries can be seen as "yin occupying the yang position." Where do these "turbid yin pathogenic factors" come from? They originate from the spleen and stomach, since the source of blood lipids ultimately comes from diet. In summary, the ancient understanding of the syndrome of chest obstruction is largely consistent with modern medical understanding of coronary heart disease, indicating that both perspectives are observing the same disease occurring in the human body. Beyond the aforementioned discussion, the most convincing evidence lies in the outstanding therapeutic efficacy of Gualou Xiebai Baijiu Tang in treating coronary heart disease; the author has repeatedly achieved good results using this formula. The composition of Gualou Xiebai Baijiu Tang is: 10 grams of Gualou, 10 grams of Xiebai, and 50 milliliters of baijiu, decocted in water and taken orally. Baijiu refers to freshly brewed rice wine; it is usually acceptable to substitute with huangjiu, but not with today's distilled spirits mistakenly labeled as baijiu. If Guanxin II (red peony, chuanxiong, safflower, agarwood, dan shen) is added to the above formula, the therapeutic effect will be even better. For some patients with myocardial infarction or unstable coronary heart disease, adding 2–10 grams of leeches and 1–6 grams of hanzhisan, taken in divided doses, can further enhance the efficacy. Regarding the treatment of chest obstruction, the "Jingui Yaolue" presents a series of effective modified formulas. For example, "For chest obstruction accompanied by inability to lie down and severe chest pain, Gualou Xiebai Banxia Tang is prescribed." "For chest fullness and qi stagnation in the heart, with chest fullness and discomfort radiating to the sides, and qi rushing upward causing pain, Zhi Shi Xiebai Gui Zhi Tang is prescribed; Renshen Tang is also prescribed." (Here, Renshen Tang is essentially the same as Lizhong Tang.) "For chest qi blockage and shortness of breath, Fuling Xingren Gancao Tang is prescribed; Ju Zhi Jiang Tang is also prescribed." "For mild and moderate chest obstruction, Yiyi Fuzi San is prescribed." "For severe chest pain and back pain radiating to the chest, Wutou Chishizhi Wan is prescribed." These five passages and seven formulas constitute the TCM pharmacological system for treating coronary heart disease. When treating coronary heart disease, the author typically supplements Gualou Xiebai Baijiu Tang with the aforementioned formulas, making adjustments based on individual patient conditions, with very good results. In recent years, Western medicine has generally advocated interventional therapy for acute myocardial infarction, which involves either expanding the coronary arteries, placing stents, or performing bypass surgery. This approach does indeed demonstrate remarkable efficacy in emergency situations; however, most patients still experience various subjective symptoms after surgery, such as occasional palpitations, chest tightness, back pain, shortness of breath, fatigue, or even hallucinations and delusions. What’s more, some patients frequently relapse within 6–24 months after surgery, and repeated interventions still fail to deliver ideal results. For instance, U.S. Vice President Dick Cheney has undergone nearly ten years of cardiac intervention, yet he has experienced multiple recurrences and repeated procedures in recent years, indicating that the long-term efficacy of this method still needs further improvement.

The author has long used the aforementioned Chinese herbal formula modifications for patients with coronary heart disease following interventional procedures, achieving significant relief of symptoms and effectively delaying recurrence.

V. Treatment of Phlegm-Dampness and Cough Diseases

The "Jingui Yaolue" discusses the syndromes and prescriptions for "phlegm" and "dampness" in its section on phlegm-dampness and cough diseases. Traditional Chinese Medicine collectively refers to these conditions as "phlegm-dampness," broadly categorized into four types. According to the "Jingui Yaolue," "When water flows between the intestines and makes a gurgling sound, it is called phlegm-dampness (narrow definition); when fluid flows under the ribs after drinking and causes pain upon coughing or expectorating, it is called suspended dampness; when drinking water circulates throughout the body and accumulates in the limbs, leading to difficulty sweating and resulting in heaviness and pain, it is called overflowing dampness; and when coughing and breathing become difficult, shortness of breath prevents lying down, with swelling resembling edema, it is called supporting dampness." The author believes that among these four types of dampness, phlegm-dampness (narrow definition) primarily refers to a group of gastrointestinal disorders caused by autonomic nervous system dysfunction, including chronic gastritis, chronic enteritis, and gastrointestinal syndrome. The "Jingui Yaolue" states, "If there is phlegm-dampness in the lower abdomen, accompanied by chest and flank fullness and dizziness, Linggui Zhugan Tang is prescribed." "If shortness of breath is accompanied by slight dampness, it should be eliminated through urination, and Linggui Zhugan Tang is prescribed." These provide the main symptoms and primary prescription for treating phlegm-dampness. The author has long used Linggui Zhugan Tang to treat chronic gastritis, chronic colitis, and chronic gastrointestinal syndrome with relatively satisfactory results. For epigastric distension and pain, add danshen, muxiang, and caokou; for increased bowel sounds, add chuanjiao and ganjiang; for diarrhea and loose stools, add ganjiang and fuzi; for shortness of breath and dizziness, add dangshen, maidong, and wuweizi; for abdominal fullness, add juecan, banxia, and chenpi; for epigastric pain, add muxiang and caokou again. As for suspended dampness, the author believes it refers to exudative pleurisy or pleural effusion caused by various etiologies. The "Jingui Yaolue" states, "If the pulse is deep and dizzy, it indicates internal pain from suspended dampness; patients with suspended dampness should take Zaotang." This shows that the main symptom of suspended dampness is pain in the chest and flanks, because when "fluid flows under the ribs," it causes internal pain at the site of the disease—this is entirely consistent with modern medical understanding of pleurisy. More importantly, Zaotang (da ji, yuan hua, gansui, and jujube) is highly effective in treating exudative pleurisy; judging by the prescription, suspended dampness can be equated with pleural effusion. Zaotang is reliable in treating pleural effusion, but its mechanism is to forcefully drain water. If the patient's constitution is extremely weak, it often leads to dehydration and electrolyte imbalance, even posing a danger. Compared with modern medical applications such as antibiotics, thoracentesis, and hormones, its safety is far inferior. Therefore, in recent years, Zaotang has rarely been used to treat pleural effusion. Regarding overflowing dampness, the author believes it encompasses modern medical conditions such as renal edema, malnutrition-related edema, and endocrine-related edema. The "Jingui Yaolue" states, "For patients with overflowing dampness, they should sweat, and Daqinglong Tang or Xiaoqinglong Tang is prescribed." "For those with water accumulation below the waist, they should promote urination; for those with water accumulation above the waist, they should induce sweating." This demonstrates that inducing sweating and promoting urination are the two main principles for treating such edema. The author believes that Ma Huang Tang, Ma Xing Shi Gan Tang, and the large and small Qinglong Tangs—medicines that disperse lung qi, relieve asthma, and induce sweating—are indeed highly effective in promoting diuresis and reducing edema. Traditional Chinese Medicine calls this method "dispelling lung qi to promote diuresis," "raising the plateau to guide water," "lifting the lid of the pot to reveal the hidden water," or "opening the ghost gate to cleanse the organs." Modern physician Cao Yingfu once made the following analogy: if there is a small hole in the lid of a teapot, just like the unobstructed flow of lung qi, water can easily pour out of the spout; but if there is no small hole, water struggles to flow out of the spout, just like blocked lung qi and stagnant kidney qi! The author also gives an example: if the vent tube of an infusion set is blocked, the liquid cannot drip smoothly, which is due to the need to maintain a certain air pressure inside the infusion bottle. Traditional Chinese Medicine believes that the lungs belong to metal and the kidneys belong to water; metal generates water, and metal and water mutually generate each other. Dispersing lung qi to promote diuresis is a widely recognized practice. The author envisions the human body as a large, sealed whole, where the organs maintain dynamic osmotic balance through endocrine, metabolic, and fluid circulation processes. When lung qi is not dispersed, the pressure balance between the lungs and kidneys tends to break down, leading to difficulty urinating and edema. Western medicines such as aminophylline and ammonium chloride, which are used to relieve cough and dissolve phlegm, also have strong diuretic effects. Could this be related to the aforementioned mechanism? Of course, this is only a hypothesis, and there has been no experimental research to confirm it yet. Modern Western medicine continuously enriches its theories through practice, constantly improving them, while traditional Chinese medicine has accumulated thousands of years of experience, with practical core elements that modern medicine should learn from. The Western world has now fully recognized this point. Shenqi Wan for treating edema below the waist is already a well-known fact; this formula is the main prescription for tonifying kidney yang in TCM. TCM believes that "when yang is deficient, water overflows," so only tonifying kidney yang is the fundamental principle for treating water-related problems. Recent experimental studies have confirmed that "kidney yang" is actually the manifestation of the function of the pituitary-adrenal cortex axis. When kidney yang is deficient, the levels of 17-hydroxycorticosteroids and 17-ketocorticosteroids decrease, indicating that the function of the pituitary-adrenal cortex is lower than normal. This includes not only the functions of the thyroid, adrenal glands, and sex glands, but also complex changes in the body's overall water-salt metabolism. The author has used Guifu Bawei Wan and Jisheng Shenqi Wan to tonify kidney yang and treat chronic nephritis, nephrotic syndrome, cirrhosis with ascites, chronic pyelonephritis, vascular-neurogenic edema, and endocrine-related edema, all with good results. As for supporting dampness, the author believes it encompasses modern medical conditions such as chronic bronchitis, asthmatic bronchitis, bronchial asthma, emphysema, cor pulmonale, and pulmonary-origin heart failure—various clinical manifestations caused by respiratory tract diseases. The "Jingui Yaolue" states, "For patients with coughing and breathing difficulties who cannot lie down, Xiaoqinglong Tang is prescribed." "For supporting dampness with chest fullness, Houpu Dahuang Tang is prescribed." "For supporting dampness with intercostal pain, the person is short of breath, has a hard lump in the lower abdomen, dark complexion, and a deep, tight pulse—after dozens of days... Mufangji Tang is prescribed." "For supporting dampness with difficulty breathing, Tingli Dazao Xiefei Tang is prescribed." Chronic respiratory diseases, during their long course, exhibit both "phlegm" characteristics and "edema" characteristics, thus falling under the category of "phlegm-dampness." Xiaoqinglong Tang consists of ma huang, gui zhi, bai shao, gan cao, gan jiang, xi xin, wu wei zi, and banxia. The author uses this formula to treat chronic bronchitis, asthmatic bronchitis, and bronchial asthma with excellent results. Adding apricot kernels and raw gypsum to this formula embodies the spirit of Ma Huang Tang and Ma Xing Shi Gan Tang, and it is also effective against external wind-cold coughs, wheezing, and fever. Ma Xing Shi Gan Tang is the ancestral formula for treating cough and asthma in TCM; whether administered acutely or chronically, it always works. The author's experience is to use Ma Huang Tang for external wind-cold coughs, adding gan jiang, xi xin, wu wei zi, and banxia for severe cases (Xiaoqinglong), adding raw gypsum for high fever (Daqinglong), adding tingli zi for urgent cough and asthma, and adding su xing san for excessive phlegm. Mufangji Tang (mufangji, raw gypsum, gui zhi, dangshen) is a formula that is seldom used, but based on the main symptom analysis of "intercostal supporting dampness, the person is short of breath, has a hard lump in the lower abdomen, dark complexion," the author finds that this formula's clinical presentation is broadly similar to that of cor pulmonale and heart failure, so using this formula to treat cor pulmonale and heart failure yields good results. Mufangji is the root of Guangfangji, a perennial vine in the Aristolochiaceae family. According to "Herbal Pharmacology," "It disperses phlegm and calms lung qi cough," indicating that besides promoting diuresis and reducing edema, this medicine also has the effect of relieving cough and dissolving phlegm, which is exactly what is needed for treating cor pulmonale and heart failure. Recently, there have been reports abroad of kidney failure caused by Aristolochiaceae plants such as Guanmutong, but the author's experience shows that Mufangji has stable medicinal properties and has not shown any adverse reactions.

VI. Formulas for Treating Blood Stasis and Consumption Disease

Both "blood stasis" and "consumption" in the "Jingui Yaolue" fall under the category of "deficiency syndromes." They are mostly caused by prolonged illness and physical exhaustion, resulting in deficiency of qi, blood, yin, and yang. "Blood stasis is characterized by deficiency of both yin and yang, with a faint pulse at the cun and guan positions and a tight pulse at the chi position, along with numbness in the body, similar to wind-stasis. Huangqi Guizhi Wuwu Tang is prescribed." It is well known that "wind-stasis" is one of the three types of stasis—wind, cold, and damp—and its external symptoms include not only numbness but also joint stiffness and generalized wandering pain, indicating that "wind, cold, and damp qi have combined to form stasis." This condition is a case of deficiency in the root and excess in the manifestation. "Blood stasis" is a pure deficiency syndrome characterized by "deficiency of both yin and yang." The author believes that "blood stasis" falls under the category of polyneuritis and radiculitis in modern medicine. "Wind-stasis," on the other hand, belongs to rheumatoid and rheumatic arthritis. The author has repeatedly achieved remarkable results using Huangqi Guizhi Wuwu Tang to treat polyneuritis, often adding xixin, mutong, and chuancaowu to the formula for even better effects. The dosage of xixin and chuancaowu should be relatively high, up to 15–20 grams. First decoct for one hour, then continue decocting with the other herbs for another half hour as the first decoction; the second decoction should also last half an hour. Mix the two decoctions evenly and divide into two doses to be taken morning and evening after meals. The author has also used this formula to treat several cases of Guillain-Barré syndrome, adding not only large amounts of chuancaowu and xixin, but also insect-based medicines such as jiangchong, quanxie, and wugong. After soaking, concentrating, and extracting, the mixture is made into pills named "Xiaofeng Chushi Wan," specifically for treating peripheral neuritis, connective tissue diseases, and rheumatic pain, with remarkable efficacy. Although "blood stasis" is a deficiency syndrome, due to its characteristic of numbness in the limbs and the ever-changing location of the affected area, it is also associated with wind—blood deficiency generates wind, so blood stasis should be considered as blood deficiency generating wind. Blood deficiency can be regarded as a lack of certain substances in the blood. There are many causes of polyneuritis, but the deficiency of vitamin B seems to be similar to the concept of blood deficiency generating wind in TCM. The "Jingui Yaolue" proposes five formulas for deficiency syndromes, which the author summarizes as follows: for consumption with loss of essence, use Guizhi Longgu Muli Tang; for consumption with urgency, use Xiaojianzhong Tang or Huangqi Jianzhong Tang; for deficiency with lower back pain and difficulty urinating, use Bawei Shenqi Wan; for consumption with insomnia, use Suanzaoren Tang; for consumption with thinness and abdominal fullness, use Dahuang Shenchong Wan. The "Jingui Yaolue" states, "For those with loss of essence, there is dizziness and urgency in the lower abdomen, cold in the genital area, and dizziness and hair loss. The pulse is extremely weak and wiry, indicating blood loss and essence depletion; if the pulse is wiry and slightly tight, it means men have lost essence and women have had nocturnal emissions, and Guizhi Longgu Muli Tang is prescribed."

This passage provides a very vivid description of the symptoms of excessive essence loss and proposes a principal prescription—Guizhi Longgu Muli Tang. The composition of this formula is: 10 grams of guizhi, 10 grams of bai shao, 6 grams of sheng jiang, 6 grams of gan cao, and 15 grams each of sheng long and mu li, decocted in water and taken orally. In the "Xiaopin," white wei and fu zi are added, each at 3 grams, removing guizhi and renaming it "Er Jia Longgu Tang," which treats essence loss, weakness, low-grade fever, and excessive sweating. The author believes that this formula is indeed effective for treating people with essence loss and physical weakness, and that the guizhi in the formula does not necessarily need to be removed; the amount of white wei and fu zi should be small, preferably around 3 grams. If the amount of bai shao is doubled, its astringent nature will increase, making the effect even more ideal. After increasing the amount of bai shao, the formula takes on the meaning of Xiaojianzhong; according to the "Jingui Yaolue," Xiaojianzhong can not only treat "consumption with urgency" but also "those who lose essence in their dreams." The "Jingui Yaolue" states, "For consumption with urgency, palpitations, blood issues, abdominal pain, dream loss of essence, limb soreness, hand and foot heat, dry throat and mouth, Xiaojianzhong Tang is prescribed." "For consumption with urgency, all deficiencies, Huangqi Jianzhong Tang is prescribed." So-called consumption with urgency refers to the urgent abdominal pain experienced by patients with consumption, including discomfort in the gastric region and abnormal intestinal peristalsis leading to lower abdominal discomfort. Palpitations, nosebleeds, limb soreness, hand and foot heat, dry throat and mouth—all indicate the systemic manifestations accompanying consumption. The author has used Xiaojianzhong Tang and Huangqi Jianzhong Tang to treat chronic gastritis, gastric and duodenal ulcers, chronic colitis, stress-induced colitis, and allergic colitis, all with good results. The composition of Huangqi Jianzhong Tang differs from Xiaojianzhong Tang by only one ingredient—the former contains more Huangqi, enhancing its tonifying effect, which seems more suitable for patients with long-term illnesses and physical weakness. So-called Jianzhong Tang is simply doubling the white portion in Guizhi Tang, adding 30 grams of maltose. When treating gastritis and gastric ulcers, the author often adds danshen, muxiang, and caokou; for ulcers, adds sheng long and mu li; for obvious gastric pain, adds mingfan, yuanhu, xiangfu, and cuanwaling. When treating colon diseases, increases the amount of dahuang, zhi shi, houpu, and huolian; for severe abdominal fullness, adds houmu, shengjiang, banxia, and dangshen; for diarrhea, adds ganjiang, fupian, and cheqianzi; for urgency and heaviness, adds muxiang, jishi, and binlang; for pus and blood in the stool, adds danggui, chishao, baigang, kushen; for nausea and vomiting, adds sheng zhe shi and xuanyufhua. In short, the key indicator for treating gastrointestinal diseases with Huangqi Jianzhong Tang and Xiaojianzhong Tang is the character "deficiency"—patients with gastrointestinal diseases who are physically weak seem more suited to this formula. Due to long-term illness, gastrointestinal absorption function is poor, the body lacks nutrition, immunity is low, metabolism is abnormal, and autonomic nervous system function is disrupted, leading to anemia, exhaustion, and other complications, which in turn cause palpitations, nosebleeds, essence loss, restlessness, dry mouth, hot hands and feet, and extremely weak or wiry pulses—these are all symptoms of consumption. In ancient times, medical conditions were poor; a simple gastrointestinal disease, if left untreated or misdiagnosed, could linger for a long time and lead to numerous complications and sequelae—this is easy to imagine. The "Jingui Yaolue" states, "For consumption with lower back pain, urgent abdominal discomfort, and difficulty urinating, Bawei Shenqi Wan is prescribed." This formula provides a principled guideline for future treatment of urinary system diseases. Bawei Shenqi Wan consists of: 12 grams of shengdi, 6 grams of shanyu, 6 grams of danshen, 10 grams of shanyao, 12 grams of fuling, 10 grams of zexie, 10 grams of guizhi, and 6 grams of fupian, decocted in water and taken once daily. This formula is highly effective in treating various urinary tract infections; the author has used it with adjustments to treat senile urethritis, acute and chronic prostatitis, acute and chronic cystitis, and chronic pyelonephritis, with excellent results—especially in treating senile urethritis, which is truly exceptional. Guifu Bawei Wan can also be used to treat diabetes, cerebral infarction, chronic nephritis, emphysema, vascular-neurogenic edema, and endocrine-related edema. The author's experience shows that for diabetes, adding cangshu, danshen, ge gen, yuan shen, and sheng shixiao; for cerebral infarction, adding mai ming wuwei zi, jingshi hu, dayun, changpu, and yuanzhi; for chronic nephritis, adding taohong siwu, wuyi disinfection drink; for emphysema, adding maidong, wuwei zi, rou gui, chenxiang, and zishiying; for vascular-neurogenic edema and endocrine-related edema, adding niuxi, cheqianzi, baishu, and zhuling. However, Guifu Bawei Wan is less effective in treating organic lower back pain; the author's experience shows that the lower back pain treated by this formula is non-organic, such as that caused by elderly physical weakness, women during menstruation, or young adults engaging in excessive sexual activity—TCM calls this "kidney-deficient lower back pain." The aforementioned lower back pain is caused by endocrine, metabolic, and autonomic nervous system imbalances, for which modern medicine has no specific cure, while TCM's Guifu Bawei Wan, which strengthens the kidneys and fortifies the lower back, proves effective, precisely filling the gap left by Western medicine. The "Jingui Yaolue" states, "For consumption with extreme restlessness and insomnia, Suanzaoren Tang is prescribed." This passage proposes a good prescription for treating insomnia. The composition of Suanzaoren Tang is: 15 grams of fried zaoren, 6 grams of chuanxiong, 12 grams of fuling, 20 grams of zhimu, 6 grams of gan cao, and 6 grams of sheng jiang, decocted in water and taken orally. This formula has a simple yet refined taste, a focused and definite effect, and is easy to adjust during clinical practice. Whenever the author encounters insomnia, regardless of whether it is real or imagined, cold or hot, or whatever diagnosis Western medicine gives, he can always add this formula to the treatment plan, and the results are usually good. The "Jingui Yaolue" states, "For those with five kinds of exhaustion, extreme emaciation, abdominal fullness, inability to eat, food injury, emotional injury, drink injury, sexual injury, hunger injury, labor injury, damage to meridians and vital energy, internal dried blood, skin with scales, dark eyes, and slow replenishment of deficiency, Dahuang Shenchong Wan is prescribed." The composition of Dahuang Shenchong Wan is: 10 grams of dahuang, 10 grams of huangqin, 6 grams of gan cao, 10 grams of taoren, 10 grams of zaoren, 10 grams of bai shao, 12 grams of shengdi, 3 grams of dried algae, 6 grams of fly larvae, 10 grams of leeches, 6 grams of grub worms, and 6 grams of soil beetles, all ground into powder, mixed with honey to make pills, about the size of soybeans, five pills per dose, three times a day.

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, he invariably uses the soup version of this formula, and the results are mostly satisfactory. The main function of this formula is to activate blood circulation, remove stasis, clear heat, and reduce fire, making it particularly suitable for patients with cirrhosis, splenomegaly, and ascites—especially those with long-term liver dysfunction, endocrine disorders, hormonal imbalances, dark complexion, and dark eyes.

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The best therapeutic effect is observed in patients with skin and nail abnormalities. This formula can significantly improve the complexion of patients with advanced liver cirrhosis, which is something no Western medicine can achieve at present. Based on this formula, the author has added large doses of Astragalus, Salvia miltiorrhiza, Angelica sinensis, White Peony Root, Polygonum multiflorum, and other herbs, then processed them into pills with honey as a binder, naming it "Shan Gan Zeng Rong Pills." As a result, many patients with advanced liver cirrhosis have seen their skin color improve, and the dullness and sallow appearance on their faces gradually disappear, earning high praise from patients. It is believed that the pigmentation of the skin and face in patients with liver cirrhosis is closely related to the dysfunction of the adrenal cortex. Since Dahuang Zhichong Wan can both dispel the dark complexion of patients, whether it can be used to treat Addison's disease caused by adrenal cortical insufficiency remains to be further studied.

VII. Treatment Formulas for Abdominal Distension, Cold Hernia, and Accumulated Food

In "Jin Gui Yao Lue," abdominal distension, cold hernia, and accumulated food are three distinct syndromes. Abdominal distension refers to fullness and distension throughout the entire abdomen; if pressing on it does not cause pain, it is considered deficiency, whereas if it does, it is considered excess, indicating that abdominal distension can be either real or虚. Cold hernia, on the other hand, is purely a cold syndrome. Cold tends to contract and move inward, and when it cannot pass through, pain arises. Therefore, a precise definition of cold hernia in traditional Chinese medicine should be: "abdominal pain caused by the accumulation of cold qi in the abdomen." This definition is the author's personal view and is open to further discussion among colleagues. In Western medicine, "hernia" refers to an organ protruding into another cavity or space, which has nothing in common with cold hernia in traditional Chinese medicine. Accumulated food, meanwhile, is purely a real syndrome, characterized by a rapid and slippery pulse; in such cases, purging or transforming the accumulation is indicated. This syndrome differs from the usual conditions of spleen-stomach deficiency and dampness stagnation in the middle jiao.

In "Jin Gui Yao Lue," it is stated: "If there is abdominal distension, fever for one day, a floating and rapid pulse, yet diet remains normal, then Houpu Wuwu Tang is the main prescription." "If abdominal distension does not decrease, or decreases only slightly, then purging is necessary, and Dachengqi Tang is recommended." "If abdominal distension decreases temporarily but then returns to its original state, this indicates cold, and warming herbs should be used." In "Shanghan Lun," it is written: "After sweating, if there is abdominal distension, then Houpu Shengjiang Banxia Gansao Ren Shen Tang is the main prescription." These three passages provide two different patterns of abdominal distension—real and虚. The real pattern is treated with Dachengqi Tang, while the虚 pattern is treated with Houpu Shengjiang Gansao Ren Shen Tang. The composition of Dachengqi Tang is: 10 grams of rhubarb, 10 grams of mirabilite, 10 grams of citrus aurantium fruit, and 6 grams of magnolia bark, all decocted in water, with rhubarb added last and mirabilite dissolved separately. The composition of Houpu Shengjiang Banxia Gansao Ren Shen Tang is: 6 grams of magnolia bark, 6 grams of ginger, 6 grams of pinellia ternata, 6 grams of licorice, and 10 grams of codonopsis pilosula, all decocted in water. The author believes that the real pattern of abdominal distension includes acute abdominal conditions in modern medicine, such as intestinal obstruction, cholecystitis, and pancreatitis, and that Dachengqi Tang, with appropriate modifications, is effective in treating these diseases. According to the author's experience, early-stage partial intestinal obstruction responds well to Dachengqi Tang; moreover, taking 100 grams of sesame oil half an hour before taking the medicine can further enhance its effectiveness. However, intestinal obstruction in its late stage, especially when accompanied by intestinal necrosis, is contraindicated. For biliary tract diseases, it is advisable to add citrus aurantium fruit, agarwood, coptis, and scutellaria; for pancreatic diseases, add Sichuan pepper, dried ginger, turmeric, curcuma, coptis, scutellaria, citrus aurantium fruit, and agarwood; for severe pain, add Corydalis, Melia toosendan, and processed myrrh. The虚 pattern of abdominal distension includes chronic gastritis, gastric and duodenal ulcers, gastrointestinal syndrome, stress-induced enteritis, and gastric ptosis in modern medicine. The author's experience shows that Houpu Shengjiang Banxia Gansao Ren Shen Tang is effective in treating abdominal distension caused by these conditions. Depending on the specific clinical presentation, this formula can be combined and modified with Xiangsha Liujunzi Tang, Shashen Mai Men Dong Tang, Ye's Yangwei Tang, Da Xiao Jianzhong Tang, Pingwei San, Danshen Yin, Si Mo Yin, and Si Wu Tang, but its primary symptom should always be distension. In "Jin Gui Yao Lue," it is written: "If there is cold qi in the abdomen, accompanied by rumbling and sharp pain, chest and flank distension, vomiting, then Fuzi Jingmi Wei San, Danshen Yin, Si Mo Yin, and Si Wu Tang can be used in combination, but the main symptom should still be distension." "If there is cold qi in the abdomen, accompanied by rumbling and sharp pain, chest and flank distension, vomiting, then Fuzi Jingmi Tang is the main prescription." "If the pain is severe and accompanied by blockage, then Houpu Sanwu Tang is the main prescription." "If there is severe cold pain in the heart and chest, accompanied by inability to eat or drink, cold in the abdomen, upward surging of qi causing skin rashes, visible head and feet, and uncontrollable facial swelling, then Da Jianzhong Tang is the main prescription." "If there is abdominal pain, with a tense and tight pulse, where the tension indicates that defensive qi is not circulating, leading to aversion to cold, and the tightness indicates a lack of appetite due to the conflict between pathogenic and righteous qi, then it is cold hernia. If there is pain around the navel, accompanied by spontaneous sweating and cold extremities, and the pulse is deep and tight, then Da Wu Tou Tang is the main prescription." "For cold hernia, if there is abdominal pain and urgent flank pain, then Danggui Shengjiang Yangrou Tang is the main prescription." "If there is cold hernia, abdominal pain, cold extremities, and body pain, accompanied by burning and stinging sensations, and no medication works, then Di Dang Wu Tou Gui Zhi Tang is the main prescription." These five passages present five different patterns of cold hernia, all of which share the common characteristic of abdominal pain caused by cold, hence the name "cold hernia." The author believes that cold hernia in traditional Chinese medicine includes various non-organic abdominal pains in modern medicine, which can also be collectively referred to as deficiency-cold abdominal pain, i.e., cold hernia in traditional Chinese medicine. The primary drugs for treating cold hernia are aconite, fuzi, and Sichuan pepper—three pungent and intensely hot herbs that are highly effective in dispersing cold and relieving pain. If accompanied by hyperactive bowel sounds and vomiting, then fuzi combined with pinellia, licorice, japonica rice, and jujube is recommended, known as Fuzi Jingmi Tang; if accompanied by upward surging of qi causing skin rashes, visible head and feet, and uncontrollable facial swelling, then Sichuan pepper combined with dried ginger, codonopsis pilosula, and maltose is recommended, known as Da Jianzhong Tang; if accompanied by cold extremities, then aconite combined with pinellia, poria, and asarum, made into pills with honey as a binder, small in size, known as Chi Wan, or aconite alone, decocted in water to extract the juice for drinking, known as Da Aconite Tang; alternatively, aconite can be combined with gui zhi to make Gui Zhi Tang. For abdominal pain accompanied by urgent flank pain, then Danggui, ginger, and lamb are boiled together, known as Danggui Shengjiang Yangrou Tang. The author believes that the overall effect of Fuzi Jingmi Tang, Da Jianzhong Tang, Chi Wan, Da Aconite Tang, Gui Zhi Tang, and Danggui Shengjiang Yangrou Tang is to regulate the function of the gastrointestinal autonomic nervous system, particularly suppressing overactivity of the parasympathetic nervous system, thereby reducing tension in the gastrointestinal smooth muscles, decreasing gastrointestinal peristalsis, and inhibiting secretion from digestive glands, ultimately achieving the goal of relieving distension and alleviating pain. Among these formulas, aconite and fuzi are essentially the same substance, both pungent and intensely hot, serving as powerful agents for warming the kidneys and dispersing cold; dispersing cold can relieve pain. According to the author's experience, the dosage of aconite and fuzi can range from 10 to 30 grams, and they should be decocted for one hour first to remove their toxicity. It is generally believed that aconite and fuzi are powerful agents for expelling wind and eliminating dampness, commonly used to treat rheumatism and rheumatoid arthritis-related joint pain; however, the author believes that these herbs are equally effective in treating abdominal distension caused by gastrointestinal issues. Sichuan pepper, dried ginger, and asarum are all pungent and warm herbs, either dispersing cold in damp environments or reversing nausea and relieving distension, and their combination with aconite and fuzi yields new benefits. Dried ginger, asarum, schisandra, and pinellia are the main ingredients of Xiao Qinglong Tang, used to relieve asthma and wheezing; dried ginger, asarum, Sichuan pepper, and pinellia are excellent for relieving nausea and distension, differing only in the specific herb used—while the former focuses on expanding the airways and reversing nausea, the latter focuses on relieving distension and relaxing gastrointestinal smooth muscles. From the perspective of traditional Chinese medicine, expanding the airways and relaxing gastrointestinal smooth muscles are both forms of "inhibiting cholinesterase" and reducing parasympathetic nervous system activity, thus revealing the common mechanism of action among cold hernia formulas and their ability to suppress the parasympathetic nervous system in the gastrointestinal tract. In "Jin Gui Yao Lue," it is stated: "If someone has accumulated food in the stomach, how can it be distinguished? The master said: if the cun pulse is floating and large, but feels rough when pressed, and the chi pulse is also weak and rough, then if there is accumulated food, Dachengqi Tang is the main prescription." "If the pulse is rapid and slippery, then it is ordinary food, and purging will cure it, so Dachengqi Tang is recommended." "If diarrhea occurs and there is no desire to eat, then it is accumulated food, so Dachengqi Tang is recommended." "If accumulated food is located in the upper part of the stomach, it should be vomited out, so Guati San is recommended." These four passages explain that a large, rapid, slippery pulse that feels rough when pressed, along with diarrhea and lack of appetite, are the diagnostic signs of accumulated food, and suggest that Dachengqi Tang for purging and Guati San for inducing vomiting are the treatment options for accumulated food. The author's experience shows that accumulated food is often caused by restricted gastrointestinal emptying and digestive disorders, mostly stemming from disturbances in the gastrointestinal autonomic nervous system, while some cases are due to chronic conditions such as chronic gastritis and gastric and duodenal ulcers. This condition has three main characteristics: first, lack of appetite; second, discomfort in the epigastric region; third, belching and bad breath. The slippery, rapid, and rough pulse when pressed is only for reference. Whenever this condition occurs, a single dose of Dachengqi Tang usually does the trick, with definite results; if it doesn't work or only works partially, further examination and treatment based on the underlying disease may be necessary, or Guati San can be used to induce vomiting and achieve recovery. The composition of Guati San is: 10 grams of melon seeds and 10 grams of adzuki beans, boiled and sun-dried, ground into powder, mixed with fermented soy sauce, and taken with water, 6 grams each time, with gradual increase for those who don't vomit. Note that there are two types of adzuki beans, and the adzuki beans used in Guati San are commonly known as crab-eye beans, which are sour and warm and have a vomiting-inducing effect.

VIII. Treatment of Diabetes Insipidus and Urinary Tract Infections

In "Jin Gui Yao Lue," diabetes insipidus and urinary tract infections are discussed together, with the former referring to modern medical diabetes and the latter to modern medical urinary tract infections. In "Jin Gui Yao Lue," it is written: "If a man has diabetes insipidus, with excessive urination—drinking one dou of water and urinating one dou—then Shenqi Wan is the main prescription." "If someone is thirsty and has dry mouth and tongue, then Baihu Jia Ren Tang is the main prescription." "If someone is constantly thirsty and wants to drink more, then Wenha San is the main prescription." These three passages provide three basic prescriptions for treating diabetes insipidus. The author believes that diabetes insipidus in traditional Chinese medicine encompasses both diabetes and diabetes insipidus in modern medicine, and over the years the author has achieved good results using Gui Fu Ba Wei Tang and Baihu Tang to treat diabetes. Gui Fu Ba Wei Tang is considered the fundamental treatment, while Baihu Tang is the symptomatic treatment. The composition of Gui Fu Ba Wei Tang is: 10 grams of cinnamon twig, 6 grams of fuzi slices, 12 grams of rehmannia root, 6 grams of shanying, 10 grams of yam, 10 grams of danpi, 10 grams of poria, and 10 grams of ze xie, which can be made into pills or decocted in water. The composition of Baihu Tang is: 30 grams of raw gypsum, 10 grams of zhimu, 30 grams of millet, and 6 grams of licorice, all decocted in water. During the acute phase of diabetes, with intense thirst, frequent urination, fever, and profuse sweating, Baihu Tang is recommended, with additional use of codonopsis pilosula, pollen, and coptis for better efficacy; during the chronic phase of diabetes, with less obvious thirst but symptoms such as lower back pain, leg weakness, fatigue, sensitivity to cold, spontaneous sweating, and frequent urination, Gui Fu Ba Wei Tang is recommended, or long-term pill therapy. The author has found that adding Taohong Si Wu Tang and cangzhu, gepeng, yuan shen, dan shen, and other herbs to these formulas can further enhance their effectiveness. Overall, traditional Chinese medicine treatment for diabetes focuses on regulating the body's reactivity, emphasizing long-term adherence—slow and steady wins the race—and the longer one adheres to the treatment, the more satisfactory the results. Unlike Western medicines such as insulin, sulfonylureas, and biguanides, which may produce immediate effects but whose efficacy gradually diminishes with prolonged use, Gui Fu Ba Wei Tang and Baihu Tang are the main prescriptions for treating this disease. The author's experience shows that both type 1 and type 2 diabetes respond well to these formulas, with significant therapeutic effects. The composition of Wenha San is: 5 grams of wenha powder, ground and sieved, taken 2–3 times a day. The wenha in this formula is the shell of a marine clam, bitter in taste and neutral in nature, used to clear heat and soften hard masses, typically for phlegm-fire coughs and goiter-related phlegm nodules. The author has tried using this formula to treat several cases of diabetes, but without obvious results; reviewing historical medical records also reveals no such cases or reports. The clinical symptoms of diabetes insipidus are similar to those of diabetes, characterized by excessive drinking and urination, and Gui Fu Ba Wei Tang and Baihu Tang are effective against this condition, with particularly remarkable results in some individual cases—another clear demonstration of the principle of treating different diseases with the same approach in traditional Chinese medicine.

In "Jin Gui Yao Lue," it is written: "If someone has a urinary tract infection, the urine appears cloudy, the lower abdomen is tense and painful, and the pain radiates toward the navel." "If urination is difficult, there is water retention, and the person is thirsty, then Gualou Qumai Wan is the main prescription." "If urination is difficult, then Pu Hui San is the main prescription, along with Huashi Baiyu San and Poria Rongyan Tang." "If the pulse is floating and feverish, and the person is thirsty and wants to drink, but urination is difficult, then Zhu Ling Tang is the main prescription." These four passages constitute the general outline for discussing urinary tract infections. The term "urinary tract infection" refers to "cloudy urine," "tense and painful lower abdomen radiating toward the navel," and the difficulty in passing urine, with the pain being severe and often localized in the lower abdomen. The description in these passages is entirely consistent with modern medical understanding of urinary tract infections, and the prescriptions mentioned—Gualou Qumai Wan, Pu Hui San, Poria Rongyan Tang, and Zhu Ling Tang—are all effective against urinary tract infections. The composition of Gualou Qumai Wan is: 10 grams of pollen, 12 grams of poria, 10 grams of yam, 6 grams of fuzi slices, and 20 grams of qumai, all ground and sieved, then made into pills with honey as a binder, about the size of a walnut, taken three times a day, with the possibility of increasing to seven or eight pills. The composition of Pu Hui San is: 60 grams of pu hui and 40 grams of huashi, ground into powder, sieved, and taken 5 grams three times a day. The composition of Poria Rongyan Tang is: 15 grams of poria, 10 grams of white atractylodes, and 10 grams of salt, all decocted in water. The composition of Zhu Ling Tang is: 12 grams of poria, 10 grams of zhu ling, 10 grams of ze xie, 15 grams of huashi, and 10 grams of gelatin (melted), all decocted in water. The author's experience shows that Gualou Qumai Wan is extremely effective against senile urethritis, often producing noticeable results after just a few doses. The pu hui in Pu Hui San is actually scorched pu huang, a superior ingredient for stopping bleeding, promoting diuresis, and resolving blood stasis, and when combined with huashi, its cooling and diuretic effects are enhanced, making it highly effective against both acute and chronic urinary tract infections, as well as focal nephritis. The white fish in Huashi Baiyu San is actually a bookworm, also known as a woodworm, which has the effect of promoting blood circulation and diuresis, and when used together with huashi, the intention is to promote blood circulation, diuresis, and cooling while stopping bleeding, with huashi facilitating the process, resulting in remarkable efficacy. The author has successfully used this formula to treat senile prostatic hypertrophy complicated by infection. Poria Rongyan Tang is effective in treating sequelae of urinary tract infections.

(From "Chinese Medicine Journal," 2002, Supplement)

A Casual Discussion on Classic Prescriptions by Pei Zhengxue

I. Clinical Applications of Xiao Chai Hu Tang

Through more than 30 years of clinical experience, the author has come to realize that what is known as "Xiao Chai Hu syndrome" is essentially a chronic or subacute inflammatory syndrome in modern Western medicine. The common manifestations of this syndrome include "alternating chills and fever, fullness and discomfort in the chest and flanks, irritability and nausea, reluctance to eat, bitter taste in the mouth, dry throat, and dizziness." Virtually any chronic or subacute inflammatory disease exhibits the characteristics of Xiao Chai Hu syndrome, and can therefore be treated with Xiao Chai Hu Tang, with appropriate modifications. The author has used this formula, with adjustments and adaptations, to treat chronic and subacute cholecystitis, pelvic inflammatory disease, urinary tract infections, hepatitis, gastritis, pleurisy, arthritis, appendicitis, pharyngitis, otitis media, sinusitis, and so on.

In short, any chronic or subacute inflammation anywhere in the body can be effectively treated with Xiao Chai Hu Tang, provided that the dosage and modifications are carefully tailored to the specific condition. For example, patients with gallbladder disease can be given extra rhubarb, coptis, and moneywort; those with pelvic inflammatory disease can be given extra cinnamon twig, danpi, peach kernel, erhua, and lianqiao; those with urinary tract infections can be given extra mu tong, che qian zi, pian xu, and qu mai; those with liver disease can be given extra dang gui, bai shao, qin jiao, ban lan gen, dan shen, and yin chen; those with chronic gastritis can be given extra dan shen, mu xiang, cao kou, and coptis; those with pleurisy can be given extra gua lou and coptis, and if there is fluid, they can be given extra jujube soup; those with arthritis can be given extra bai jiang, yi yi ren, and wu wei xiao du yin; those with pharyngitis can be given extra sheng di, yuan shen, mai dong, zhe bei mu, and shan dou gen; those with otitis media can be given extra wu wei xiao du yin and bai hua she she cao; those with sinusitis can be given extra ji shi, cang er zi, gong ying, bai zhi, qiang huo, and fang feng.

In addition to treating the aforementioned subacute and chronic inflammatory syndromes, Xiao Chai Hu Tang can also regulate disturbances in the autonomic nervous system, particularly those caused by chronic or subacute inflammatory lesions. The main manifestation of such disturbances is "chest fullness and restlessness," which is the primary symptom treated by Chai Hu Jia Long Gu Mu Li Tang. Given that patients with this symptom often have a history of chronic or subacute inflammation somewhere in their bodies, "chest fullness and restlessness" still falls within the scope of the aforementioned inflammatory syndromes. Looking at the original text of "Shanghan Lun," the passage begins with the words "Shanghan Wu Liu Ri Zhong Feng," indicating that the external pathogenic factor of cold has persisted for five or six days, the acute phase has passed, but there is still a hint of subacute or chronic conditions.

II. On the Syndrome and Prescription of "Jie Xiong"

"Jie Xiong" is a well-known syndrome in classical prescriptions. Throughout history, medical scholars have offered numerous interpretations of this syndrome, but few have been truly comprehensive. In "Shanghan Lun," section 132 states: "If pressing causes pain, the cun pulse is floating, and the guan pulse is sinking, then it is called 'Jie Xiong'." The text mentions "pain upon pressing," but where exactly is the pain? The meaning remains somewhat unclear. Section 141 of "Shanghan Lun" says: "If someone has a solar disease, receives heavy sweating again, and then undergoes purging, and hasn't had a bowel movement for five or six days, with a dry and thirsty tongue, and a slight afternoon fever, and experiences fullness and pain from the heart down to the lower abdomen, to the point where it's unbearable to approach, then Da Xian Xiong Tang is the main prescription." This passage clearly specifies that the pain associated with "Jie Xiong" is located "from the heart down to the lower abdomen," and since the main prescription for this condition is Da Xian Xiong Tang, the primary symptom must be "large Jie Xiong." Section 142 further states: "If someone has a small Jie Xiong, the pain is located in the heart area, and it hurts when pressed," clearly introducing the term "small Jie Xiong," which corresponds to the previously mentioned "large Jie Xiong." Therefore, "Jie Xiong" can be divided into two categories: ① large Jie Xiong, ② small Jie Xiong. The former involves pain from the heart down to the lower abdomen, with fullness and pain that is unbearable to approach; the latter involves pain in the heart area, with pain upon pressing. It is evident that the former covers a larger area and is more severe, while the latter covers a smaller area and is milder, hence the names "large Jie Xiong" and "small Jie Xiong." The main prescription for large Jie Xiong is Da Xian Xiong Tang, while the main prescription for small Jie Xiong is Xiao Xian Xiong Tang. Why is it called "Xian Xiong Tang"? Section 138 of "Shanghan Lun" states: "If the exterior pathogen has not been resolved, but the doctor mistakenly performs purging, causing the pulse to become slow and irregular, with severe pain in the diaphragm, emptiness in the stomach, qi moving up and down the diaphragm, shortness of breath, restlessness, regret in the heart, and yang qi sinking, resulting in pain in the lower abdomen, then it is called 'Jie Xiong,' and Da Xian Xiong Tang is the main prescription." From this, we can see that the sinking of yang qi and its accumulation in the chest and diaphragm is the main pathogenesis of "Jie Xiong," hence the name "Xian Xiong Tang." Since "Jie Xiong" is caused by the sinking of yang qi, it must be yang and hot in nature. Section 134 of "Shanghan Lun" states: "If a disease originates from yang and is then mistakenly purged, the heat inside the body will lead to 'Jie Xiong,'" confirming this point. As a yang and hot syndrome, it should be treated with cold purging, regardless of whether it's Da Xian Xiong Tang or Xiao Xian Xiong Tang—their compositions are mainly cold and cool, which is entirely consistent with this principle. The composition of Da Xian Xiong Tang is rhubarb, mirabilite, and gan sui; the composition of Xiao Xian Xiong Tang is gualou, coptis, and pinellia. The former is more potent and directly addresses the root cause, suitable for large Jie Xiong; the latter is milder and more gentle, suitable for small Jie Xiong. The author has tried using Da Xian Xiong Tang to treat exudative pleurisy and Xiao Xian Xiong Tang to treat dry pleurisy, with good results. Moreover, since large Jie Xiong involves fullness and pain from the heart down to the lower abdomen, using its prescription to treat some cases of intestinal obstruction has been effective; and since small Jie Xiong involves pain in the heart area that worsens when pressed, using its prescription to treat atrophic gastritis has also been effective. In Da Xian Xiong Tang, adding tinglezi and apricot kernels to make pills, named Da Xian Xiong Wan, treats the "neck stiffness and spasm-like rigidity" associated with "Jie Xiong" (Section 135 of "Shanghan Lun"). Adding tinglezi, which helps eliminate phlegm and promote diuresis, and apricot kernels, which help relieve cough and clear phlegm, clearly enhances the effect on phlegm and fluid in the chest, making it suitable for exudative pleurisy. Taking the pills slowly allows for gradual treatment, which is ideal for chronic exudative pleurisy, where there is fullness and pain in the lower abdomen, but not suitable for this pill. Large Jie Xiong, with its "fullness and pain in the lower abdomen that is unbearable to approach" and its "pain in the heart area that worsens when pressed" (Section 139 of "Shanghan Lun"), suggests that, in addition to intestinal obstruction, it may also involve gastric perforation or acute peritonitis. Therefore, relying solely on Da Xian Xiong Tang may not be sufficient to treat this condition, which is why Section 136 of "Shanghan Lun" states: "If someone has 'Jie Xiong,' and is restless, they will die." It also states: "If someone has 'Jie Xiong,' and their pulse is floating and large, they should not be purged, because purging will lead to death."

III. On the Syndrome of "Zang Jie"

Section 132 of "Shanghan Lun" states: "What is 'Zang Jie'? The answer is: it's like 'Jie Xiong,' but the person eats normally, has occasional diarrhea, the cun pulse is floating, and the guan pulse is small, thin, and tight—this is called 'Zang Jie.' Those with white coating on the tongue are difficult to treat." Section 133 states: "Zang Jie has no yang syndrome, no alternating chills and fever, the person is quiet, and those with white coating on the tongue should not be attacked." These two passages discuss the symptoms and treatment of Zang Jie, explaining that Zang Jie is different from Jie Xiong. Jie Xiong involves the sinking of yang qi in the chest and diaphragm, while Zang Jie involves the accumulation of yin cold qi in the lower abdomen. Therefore, Zang Jie has no yang syndrome, and unlike Jie Xiong, it does not involve the sinking of yang qi.

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The above syndrome is similar to the chronic pain of chronic pancreatitis, and "frequent diarrhea" is pancreatic diarrhea. The absence of fever and infection in chronic pancreatitis precisely matches the description of "clear evidence" and "no chills or fever." Chronic pancreatitis often leads to hypoglycemia due to malabsorption, so appetite not only does not decrease but may even increase. Although no specific formula for treating Zangjie is found in the Treatise on Cold Damage, the chapter on Abdominal Fullness and Cold Hernia in the Synopsis of Prescriptions of the Golden Chamber states: "Severe cold pain in the heart and chest, with vomiting that prevents eating. Cold in the abdomen, rising up through the skin, causing pain in the head and feet, with pain throughout the body that cannot be touched, treated with Dajianzhong Decoction." This passage highlights the characteristic of cold stagnation in the chest and abdomen causing pain, accompanied by vomiting that prevents eating—rather than a lack of desire to eat—which 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 further resemble the clinical manifestations of chronic pancreatitis. Article 172 of the Treatise on Cold Damage states: "If there is a pre-existing mass under the ribs that extends to the area around the navel and causes pain radiating to the lower abdomen and into the yin meridians, this is called Zangjie, and it is fatal." This indicates that some cases of Zangjie syndrome involve severe pain radiating from the navel to the lower abdomen, with extremely poor prognosis and life-threatening consequences, which is very similar to acute attacks of chronic pancreatitis. Due to the lack of definitive diagnostic tests for chronic pancreatitis, Western medicine often misdiagnoses it, especially mild cases, which are easily mistaken for chronic gastritis and other conditions. Through several years of clinical experience, the author has achieved remarkable therapeutic effects in treating chronic pancreatitis using the principles, methods, and formulas of TCM for Zangjie. The main prescription selected is Dajianzhong Decoction, supplemented with Chaihu Shugan San, aiming to disperse cold stagnation in the liver meridian. For severe pain, Jinlingzi San is added; for abdominal distension and discomfort, Fupian is added. Over the past 30 years, whenever encountering such cases, the author has always used these formulas, with immediate and effective results.

(Research on Integrated Traditional Chinese and Western Medicine, 1993.1)

Clinical Observation on the Efficacy of Traditional Chinese Medicine Treatment for 289 Cases of Chronic Hepatitis B

Pei Zhengxue, Cheng Jiechen, Zhong Xu, Zhang Huifang, Ji Jianjun

Chronic active hepatitis B (referred to as chronic active hepatitis B) still lacks a specific cure to date. Since the establishment of the hepatitis B research group in May 1984 until February 1988, I have successively adopted TCM syndrome differentiation treatment for 289 patients with chronic active hepatitis B, while also setting up a control group for comparative observation, achieving relatively satisfactory therapeutic effects.

I. General Information

All 429 cases were confirmed patients with chronic active hepatitis B (according to the 1983 National Viral Hepatitis Prevention and Control Program diagnostic criteria). Random grouping was employed, with 289 cases assigned to the treatment group and 140 cases to the control group. The two groups were carefully matched in terms of age, gender, disease course, and severity of illness to ensure comparability. Treatment group: 163 males and 126 females; 36 under 15 years old, 91 aged 16–30, 121 aged 31–45, 40 aged 46–60, and 1 over 60; disease course of 1–2 years in 127 cases, 2–3 years in 86 cases, and more than 3 years in 76 cases. Control group: 78 males and 62 females; 10 under 15, 53 aged 16–30, 48 aged 31–45, 27 aged 46–60, and 2 over 60; disease course of 1–2 years in 66 cases, 2–3 years in 49 cases, and more than 3 years in 25 cases. All cases underwent liver function tests, three-system examinations, HBV-DNA-P testing, protein electrophoresis, and other examinations upon admission, and met the diagnostic criteria for chronic active hepatitis B.

II. Treatment Methods

1. Syndrome Differentiation and Prescribed Formulas

The 429 cases were classified into the following four types based on TCM syndrome differentiation:

Qi-Yin Initial Deficiency Type: Symptoms include fatigue, poor appetite, tidal heat, restlessness, a deep and thin pulse, a red tongue body, and a thin coating. The prescribed formula is Shengshan Baige Decoction (Type 1): composed of 17 herbs including Cimicifuga, Chinese yam, Atractylodes, Astragalus, Salvia miltiorrhiza, Angelica sinensis, Gentiana macrophylla, Isatis indigotica, etc., decocted in water and taken once daily.

Shaoyang Pathogen Invasion Type: Symptoms include bitter taste in the mouth and dry throat, flank pain, abdominal distension, irritability, a wiry and rapid pulse, a red tongue body, and a slightly yellowish greasy coating. The prescribed formula is Compound Chaihu Decoction (Type 2): composed of 18 herbs including Bupleurum, Pinellia ternata, Scutellaria baicalensis, Codonopsis pilosula, Glycyrrhiza uralensis, Salvia miltiorrhiza, Aucklandia lappa, Polygonum cuspidatum, Isatis indigotica, Artemisia capillaris, etc., decocted in water and taken once daily.

Qi Stagnation and Blood Stasis Type: Symptoms include dull complexion, distending pain in both flanks, severe right flank pain, hepatosplenomegaly, abdominal distension, a rapid pulse, a red tongue body with blood stasis spots and scant coating. The prescribed formula is Yi Yin Jian Plus (Type 3): composed of 15 herbs including Achyranthes bidentata, Moutan cortex, Salvia miltiorrhiza, Ophiopogon japonicus, Rehmannia glutinosa, Paeonia lactiflora, Astragalus, Isatis indigotica, Angelica sinensis, etc., decocted in water and taken once daily.

Yang Deficiency and Water Overflow Type: Symptoms include fatigue, exhaustion, abdominal distension, ascites, lower limb edema, aversion to cold with spontaneous sweating, a deep, thin, and slippery pulse, and a plump tongue body. The prescribed formula is Compound Liu Junzi Decoction (Type 4): composed of 15 herbs including Codonopsis pilosula, Atractylodes, Poria cocos, Glycyrrhiza uralensis, Pinellia ternata, Salvia miltiorrhiza, Astragalus, Citrus reticulata, Dry ginger, and Fuzi, decocted in water and taken once daily.

Treatment Group: Based on syndrome differentiation, for those with liver pain, add 10g of Yuanhu and 10g of Chuanlianzǐ to the prescribed formula; for severe pain, further add 3g each of processed Myrrha and Frankincense; for poor appetite, add 6g each of焦三仙 and Chicken Gizzard Stone; for abdominal distension, add 10g of Zhishi, 10g of Houpu, and 3g of Dahuang; for edema, add 20g of Dafulpi and 20g of Hulu Pi.

Control Group: Regardless of type, all received Ganbifu 2 tablets, taken orally three times a day, plus 20g of Huangqi powder, taken twice daily after breakfast and dinner.

Both the treatment group and the control group used a 20-day course as one treatment cycle. Patients in the treatment group stopped taking decoctions after symptoms disappeared and liver function returned to normal, then chose the prescribed formula made into granules for maintenance treatment for one cycle.

III. Treatment Outcomes