TCM Difficult Illness Formulas and Medicines Handbook

Author: None
Publisher:
Publish Date: 1997-07-01
Features: The book invites nearly 60 renowned Chinese medicine experts from China to systematically discuss the treatment methods for 104 difficult diseases from the perspectives of pathogenesis, drug therapy, drug research, single-prescription empirical formulas, dietary therapy, and case studies from various medical schools. It is the first large-scale monograph in China and abroad that integrates medicine and pharmacy to research and treat difficult diseases. This book is a must-read manual for clinical doctors in various disciplines, drug researchers, producers, developers, and faculty and students of higher medical institutions.
Excerpt:
III. Syndrome Differentiation and Treatment (I) Key Points of Syndrome Differentiation The primary differentiation for this disease is to identify whether jaundice is present. Jaundice is categorized based on the balance of yin and yang. Yang jaundice is primarily characterized by damp-heat, with bright yellow discoloration of the eyes and skin; Yin jaundice is primarily characterized by cold-dampness, with dull yellow discoloration of the eyes and skin, resembling smoky smoke. Within Yang jaundice, there are two subtypes: heat predominant over dampness and dampness predominant over heat. The former is characterized by fever, thirst, bitter taste in the mouth, and constipation, while the latter is characterized by heavy head, body fatigue, stuffy chest and abdomen, nausea, vomiting, and abdominal distension. For Yin jaundice, attention should be paid to the combination of deficiency and excess, as well as the interplay of qi and blood. Some cases of Yin jaundice result from improper treatment of Yang jaundice, prolonged illness, or excessive use of bitter-cold herbs, which damage spleen yang and transform into cold-dampness jaundice. Others develop over time due to pathogenic obstruction and qi stagnation, gradually leading to qi stagnation and blood stasis, resulting in fixed, painful masses in the hypochondria. For cases without jaundice, differentiation should focus on the balance of qi and blood deficiency/excess. In the early stages, the disease manifests in the qi, gradually progressing to the blood, showing symptoms of liver qi stagnation or qi stagnation and blood stasis, such as or in the hypochondria, which are mostly. In the later stages, yin-blood deficiency and liver insufficiency lead to symptoms that are mostly. Additionally, there are mixed patterns of deficiency and excess, such as spleen deficiency and dampness accumulation, characterized by abdominal distension, fatigue, poor appetite, and loose stools. Clinical differentiation must be clear to correctly guide treatment methods and prescriptions. (II) Syndrome Differentiation and Types 1. Jaundice Type (1) Yang jaundice with heat predominant over dampness: Symptoms include yellow discoloration of the eyes and skin, bright yellow color, fever, thirst, abdominal distension, restlessness, bitter taste in the mouth, dark yellow urine, constipation, yellow greasy tongue, and wiry, rapid pulse. Dampness predominant over heat: Symptoms include yellow discoloration of the body and skin, but less bright than the former, heavy head and body fatigue, stuffy chest and abdomen, nausea, vomiting, abdominal distension, or greasy stools and sticky mouth. Thick greasy, slightly yellow tongue, and wiry, slow or slippery pulse. (2) Yin jaundice: Yellow discoloration of the eyes and skin, dull yellow or smoky, fatigue, aversion to cold, poor appetite, stuffy abdomen, or abdominal distension, loose stools, and lack of thirst. Pale tongue, greasy coating, and slippery or deep slow pulse. 2. Non-Jaundice Type (1) Liver qi stagnation: Pain in the hypochondria that moves unpredictably, worsened by emotions, stuffy chest, shortness of breath, reduced appetite, frequent belching. Thin coating, wiry pulse. (2) Spleen deficiency and dampness accumulation: Abdominal distension and discomfort, fatigue, poor appetite, loose stools, and hypochondriac pain. White greasy coating, slow or wiry pulse. (3) Insufficient liver yin: Dull pain in the hypochondria, dizziness, vertigo, restlessness, irritability, and heat in the palms and soles. Red tongue, thin coating, wiry and rapid pulse. (4) Qi stagnation and blood stasis: Severe pain in the right hypochondria with masses, dizziness, numb limbs, emaciation, poor appetite, abdominal distension, dark complexion, and blood moles (spider angiomas). Red or dark purple tongue with stasis, deep and wiry or deep and stringy pulse. (III) Treatment Methods and Prescriptions 1. Type-Specific Treatment (1) Jaundice Type Yang jaundice with heat predominant over dampness: Treat with clearing heat and resolving dampness, with auxiliary purgation. Prescription: Modified Chen Pi Huang Lao Tang. Chen Pi Huang is used in large quantities to clear heat and resolve dampness; Gentian and Rhubarb clear heat and purge. Add Fu Ling, Zhu Ling, and Slender Stone to promote dampness elimination through urination. Dampness predominant over heat: Treat with resolving dampness and transforming turbidity, with auxiliary clearing heat. Prescription: Modified Chen Pi Wu Ling San combined with Gan Lu Xie Duan Dan. Chen Pi Huang clears heat and resolves dampness; Wu Ling San transforms qi and resolves dampness, promoting elimination through urination. Scutellaria and Woodford clear heat and resolve dampness; Patchouli and Cardamom transform turbidity and promote qi circulation. Combined use resolves dampness, transforms turbidity, and clears heat. Yin jaundice: Treat with strengthening the spleen and harmonizing the stomach, and warming to resolve cold-dampness. Prescription: Modified Chen Pi Zhu Fu Tang. Chen Pi and Fu Zi are used together to warm and resolve cold-dampness jaundice; Bai Zhu, Gan Jiang, and Gan Cao strengthen the spleen and warm the middle. Add Yu Jin, Hu Pu, Fu Ling, and Ze Xie to promote qi circulation and resolve dampness. (2) Non-Jaundice Type Liver qi stagnation: Treat with soothing the liver and regulating qi. Prescription: Modified Chai Hu Shu Gan San. Chai Hu soothes the liver, paired with Xiang Fu, Zhi Ke, and Chen Pi to regulate qi; Chuan Xiong promotes blood circulation; Shaoyao and Gan Cao relieve pain. Spleen deficiency and dampness accumulation: Treat with drying dampness and strengthening the spleen. Prescription: Ping Wei San. Cang Zhu dries dampness and strengthens the spleen; Hu Pu descends qi, resolves dampness, and alleviates fullness; Chen Pi regulates qi and broadens the chest; Gan Cao harmonizes and nourishes qi; Jiang and Jujube regulate the spleen and stomach. Liver yin deficiency: Treat with nourishing yin and softening the liver. Prescription: Yi Guan Jian. Sheng Di Huang and Goji Berry nourish the kidneys and liver; Sha Shen and Mai Dong nourish yin and generate body fluids; Dang Gui nourishes blood and softens the liver; Chuan Liao Zi soothes the liver and regulates qi to relieve pain. Qi stagnation and blood stasis: Treat with promoting blood circulation and resolving stasis. Prescription: Tao Hong Si Wu Tang. Shu Di Huang, Dang Gui, Chuan Xiong, and Bai Shaoyao nourish blood and promote blood circulation; Tao Ren and Hong Hua resolve stasis. Add Chai Hu and Yu Jin to soothe the liver and regulate qi. 2. Selected Prescriptions (1) Commonly Used Prescriptions ① Qiang Gan Tang No. 1 Composition: Astragalus 12–30g, Salvia Miltiorrhiza 12–30g, Angelica Sinensis 6–15g, White Peony Root 6–15g, Codonopsis 6–15g, White Atractylodes 5–15g, Poria 6–15g, Polygonatum 6–15g, Rehmannia 6–15g, Polygonum 3–12g, Chen Pi 6–15g, Isatis Root 8–12g, Alisma 5–15g, Crataegus 6–15g, Dioscorea 6–15g, Licorice 3–12g. Indications: This formula is primarily used for chronic hepatitis, with symptoms of qi-blood deficiency, kidney deficiency, liver qi stagnation, spleen deficiency, or qi deficiency and blood stasis. Dosage and Administration: Oral, decocted, one dose per day, decocted twice, taken in the morning and evening. Use for 6 days, then take a break for 1 day. One course lasts 8 weeks, and 2–3 courses can be taken. After basic recovery, continue taking the medicine for a period to consolidate the effect. Clinical Application: For qi-blood deficiency with fatigue, use more Astragalus and Codonopsis, or add Coix Seed and Jujube. For dampness accumulation with body heaviness, add Cang Zhu and Chen Pi. For poor appetite, add Gleditsia and Chicken Gizzard or Cardamom. For liver area pain, add Chai Hu, Bupleurum, Xiang Fu, and Chuan Liao Zi. For jaundice, use more Chen Pi, or add. For bleeding tendency, add Polygonum, White, and Chen Pi. For hepatosplenomegaly, use more Salvia Miltiorrhiza, or add Carapace, Ostrea, and TCM. Used to treat 204 cases, including 109 with 1–2 years of illness, 62 with 3–5 years, 26 with 5–10 years, and 7 with over 10 years. The short-term clinical cure rate was 86.3%, the effective rate was 95.6%, and the normalization rate of liver function was 87.3%. Precautions: "Tonify deficiency without obstructing pathogens, tonify the spleen without stagnation, nourish yin without greasiness," with tonification as the primary approach, incorporating elimination within tonification, and addressing lingering pathogens. Pharmacological Experiments: This formula protects liver cells, alleviates fatty liver, mildly inhibits liver fibrosis, promotes liver cell regeneration, and suppresses abnormal elevation of serum ALT. It also promotes serum albumin synthesis and inhibits abnormal elevation of serum gamma globulin, with no effect on normal liver. Reference: Han Jinghuan, Research on Integrated Traditional Chinese and Western Medicine in Treating Liver Diseases, Beijing, People's Medical Publishing House, 1989: 19.