RE: GZT Case study

[Guest guest]

Yes Stephan this is from fairly famous SHL case study book from China. I

unfortunately do that have the book here, and haven¡¯t look at the case in

maybe years, hence am a bit hesitant to comment too much from memory. Maybe

someone out there has a copy and could help us out. I think it is from É˺®

ÃûÒ½Ñé°¸¾«Ñ¡.

 

 

 

But I remember it talking about the line in the SHL that " strength in the

defensive " ¨C and how this applies. Since there are multiple explanations of

what this means, this at least ties it to a real case and how it applies

clinically. Basically the ¡®strength¡¯ is seen by all the obvious skin

manifestations, hence pathogenic factors, it is stagnation. Basically the

author¡¯s point is that there is nutritive qi weakness not supporting the

defensive yang ¨C this ¡®strength¡¯ of course it not good and blocks the

pores, this is why there is no sweat.

 

 

 

It is clear there is no internal heat because there is lack of internal

signs of heat (thirst, bowels, urine etc). This is a common theme in SHL

thinking to decide where the pathogen lies. This brings up one of the issues

I have had with some approaches to dermatology. Before I continue this is

just my personal observation, and AM not saying I am better than anyone, I

am not saying that these other system¡¯s don¡¯t work, just a simple

observation, hopefully people don¡¯t get into a tizzy¡­

 

 

 

To continue, some people do not spend enough time understanding the internal

dynamics and pathomechanism and focus mostly on the way the skin looks. This

latter issue is of course important, but sometimes is emphasized over the

internal. Just something to think about.

 

 

 

But this case shows that understanding the mechanism is most important. Many

times formulas (or treatment strategies) that do one thing can be used for

opposite problem. For example many times a formula used for diarrhea can be

used for constipation and vice versa. Here a formula that normally treats

sweating can treat a lack of sweating. One can resolve sweating or promote

sweating by harmonizing the nutritive and defensive, this promotes the

normal flow of qi in muscle layer and the removal of stagnation which

eliminates the ¡®heat signs¡¯. It is a fascinating case that I have

contemplated for some time now¡­

 

 

 

Hope that helps¡­

 

 

 

-

 

 

 

 

 

Editors comments: In this case there is no sweat, since childhood and there

was no history of external contraction of wind-cold. Moreover there was no

aversion to cold, floating pulse seen. It is a mistake (?? not to see that

This is not to think that this is a wind-cold exterior excess pattern of

construction and defensive stagnation(???). It is still " weak construction

and strong defensive " are gui zhi patterns. If there is construction qi

internal weakness not aiding defensive yang then defensive qi not

construction(???) stagnation in the mysterious mansion (sweat pore) giving

free reign to the influence of " strength in the defensive [qi] "

 

 

 

if there is construction qi internal weakness, blockage of the pores, then

you will see no sweat, defensive qi " external strength " stagnation in the

interstices and seeing red skin, itching, and when extreme oozing blood and

scabbing, dryness, floating rapid pulse are heat signs in 1 school of

thought. But, this after all has a different intrinsic quality than excess

internal heat with thirst with intake of fluids, red urine, bound stool???,

be sure not to bitter cold directly break???, this will (??) damage the

construction and . Also one should avoid ma huang opening the interstices,

because this will damage the construction and defensive. Only suitable to

give gui zhi tang to promote a sweat and resolve the flesh, aid the

construction and smooth the defensive. When you deal with the construction

and defensive which mutually aid (one another)??? each performs its own

functions, then sweat ensues and flesh is uninhibited, heat vexation

spontaneously resolves. Honestly gui zhi tang's success in promoting sweat

resides in resolving the flesh and harmonizing the ying and defensive.???

 

 

 

base: 270.11.53/2054 - Release 04/11/09 10:51:00

 

 

 

 

[Guest guest]

Hi Jason

You can find most of these case studies at

http://www.shanghan.com/bbs/archiver/tid-19940.html

Gabe

 

 

--- On Thu, 4/16/09, wrote:

 

 

 

RE: GZT Case study

 

Thursday, April 16, 2009, 6:10 PM

 

 

 

 

 

 

 

 

Yes Stephan this is from fairly famous SHL case study book from China. I

unfortunately do that have the book here, and haven’t look at the case in

maybe years, hence am a bit hesitant to comment too much from memory. Maybe

someone out there has a copy and could help us out. I think it is from 伤寒

å医验案精选.

 

But I remember it talking about the line in the SHL that " strength in the

defensive " – and how this applies. Since there are multiple explanations of

what this means, this at least ties it to a real case and how it applies

clinically. Basically the ‘strength’ is seen by all the obvious skin

manifestations, hence pathogenic factors, it is stagnation. Basically the

author’s point is that there is nutritive qi weakness not supporting the

defensive yang – this ‘strength’ of course it not good and blocks the

pores, this is why there is no sweat.

 

It is clear there is no internal heat because there is lack of internal

signs of heat (thirst, bowels, urine etc). This is a common theme in SHL

thinking to decide where the pathogen lies. This brings up one of the issues

I have had with some approaches to dermatology. Before I continue this is

just my personal observation, and AM not saying I am better than anyone, I

am not saying that these other system’s don’t work, just a simple

observation, hopefully people don’t get into a tizzy…

 

To continue, some people do not spend enough time understanding the internal

dynamics and pathomechanism and focus mostly on the way the skin looks. This

latter issue is of course important, but sometimes is emphasized over the

internal. Just something to think about.

 

But this case shows that understanding the mechanism is most important. Many

times formulas (or treatment strategies) that do one thing can be used for

opposite problem. For example many times a formula used for diarrhea can be

used for constipation and vice versa. Here a formula that normally treats

sweating can treat a lack of sweating. One can resolve sweating or promote

sweating by harmonizing the nutritive and defensive, this promotes the

normal flow of qi in muscle layer and the removal of stagnation which

eliminates the ‘heat signs’. It is a fascinating case that I have

contemplated for some time now…

 

Hope that helps…

 

-

 

Editors comments: In this case there is no sweat, since childhood and there

was no history of external contraction of wind-cold. Moreover there was no

aversion to cold, floating pulse seen. It is a mistake (?? not to see that

This is not to think that this is a wind-cold exterior excess pattern of

construction and defensive stagnation(? ??). It is still " weak construction

and strong defensive " are gui zhi patterns. If there is construction qi

internal weakness not aiding defensive yang then defensive qi not

construction( ???) stagnation in the mysterious mansion (sweat pore) giving

free reign to the influence of " strength in the defensive [qi] "

 

if there is construction qi internal weakness, blockage of the pores, then

you will see no sweat, defensive qi " external strength " stagnation in the

interstices and seeing red skin, itching, and when extreme oozing blood and

scabbing, dryness, floating rapid pulse are heat signs in 1 school of

thought. But, this after all has a different intrinsic quality than excess

internal heat with thirst with intake of fluids, red urine, bound stool???,

be sure not to bitter cold directly break???, this will (??) damage the

construction and . Also one should avoid ma huang opening the interstices,

because this will damage the construction and defensive. Only suitable to

give gui zhi tang to promote a sweat and resolve the flesh, aid the

construction and smooth the defensive. When you deal with the construction

and defensive which mutually aid (one another)??? each performs its own

functions, then sweat ensues and flesh is uninhibited, heat vexation

spontaneously resolves. Honestly gui zhi tang's success in promoting sweat

resides in resolving the flesh and harmonizing the ying and defensive.?? ?

 

base: 270.11.53/2054 - Release 04/11/09 10:51:00

 

 

[Guest guest]

Jason,

 

Thank you for the explanation. I studied some similar cases in school when

learning the SHL. My teacher, Dr Yin, loved to use the SHL case study text

books. I have always been fascinated by the simplicity, but unfortunately have

not really been able to see many using this style in clinic.

 

My question is: Great thinking, but can you or anyone else present their own

clinical experience proving this system?

 

I completely agree with you that one has to understand the pathomechanism within

the internal body that is manifesting on the skin. This is obviously very

important and as we all know, skin disease for the most part is a systemic

problem and needs internal treatment. (besides many fungal problems that resolve

just fine with external Tx).

 

Although I think you are correct in saying that " some people do not spend enough

time understanding the internal dynamics and pathomechanism and focus mostly on

the way the skin looks " , I would actually say that the majority of practitioners

that I talk to do NOT look at the skin enough. They cannot diagnose many

problems at the skin level and do not even use skin observation as a tool in

their intakes.

 

Most comments I have seen in relation to describing the manifestation of a skin

problem are very simple and lack proper descriptive depth. Most practitioners

that I have spoken to cannot explain very clearly the difference between many

skin problems, nor can they explain the patho-mechanism as to why it is

manifesting.

 

For example, thinking that everyone with red cheeks has yin deficiency heat,

when in fact they could have Rosacea, Tinea, eczema, seborrheic dermatitis,

lupus, or just be plain flushing from jogging up the clinic stairs. All of which

manifest very differently, have differing levels of colour, presence of

telengectasia, different types of scale - its shape, colour, and how it attaches

to the skin. All will have very different patho-mechanisms that will require

very different treatments, nourishing yin may or may not be a part of it.

 

By simple educated observation of the skin, a practitioner can gain many facts

about the internal environment. But obviously a detailed investigation of all

the patients symptoms will be needed and evaluated, beyond just skin

observation.

 

 

Trevor

 

 

 

 

, " " wrote:

>

> Yes Stephan this is from fairly famous SHL case study book from China. I

> unfortunately do that have the book here, and haven¡¯t look at the case in

> maybe years, hence am a bit hesitant to comment too much from memory. Maybe

> someone out there has a copy and could help us out. I think it is from É˺®

> ÃûÒ½Ñé°¸¾«Ñ¡.

>

>

>

> But I remember it talking about the line in the SHL that " strength in the

> defensive " ¨C and how this applies. Since there are multiple explanations of

> what this means, this at least ties it to a real case and how it applies

> clinically. Basically the ¡®strength¡¯ is seen by all the obvious skin

> manifestations, hence pathogenic factors, it is stagnation. Basically the

> author¡¯s point is that there is nutritive qi weakness not supporting the

> defensive yang ¨C this ¡®strength¡¯ of course it not good and blocks the

> pores, this is why there is no sweat.

>

>

>

> It is clear there is no internal heat because there is lack of internal

> signs of heat (thirst, bowels, urine etc). This is a common theme in SHL

> thinking to decide where the pathogen lies. This brings up one of the issues

> I have had with some approaches to dermatology. Before I continue this is

> just my personal observation, and AM not saying I am better than anyone, I

> am not saying that these other system¡¯s don¡¯t work, just a simple

> observation, hopefully people don¡¯t get into a tizzy¡­

>

>

>

> To continue, some people do not spend enough time understanding the internal

> dynamics and pathomechanism and focus mostly on the way the skin looks. This

> latter issue is of course important, but sometimes is emphasized over the

> internal. Just something to think about.

>

>

>

> But this case shows that understanding the mechanism is most important. Many

> times formulas (or treatment strategies) that do one thing can be used for

> opposite problem. For example many times a formula used for diarrhea can be

> used for constipation and vice versa. Here a formula that normally treats

> sweating can treat a lack of sweating. One can resolve sweating or promote

> sweating by harmonizing the nutritive and defensive, this promotes the

> normal flow of qi in muscle layer and the removal of stagnation which

> eliminates the ¡®heat signs¡¯. It is a fascinating case that I have

> contemplated for some time now¡­

>

>

>

> Hope that helps¡­

>

>

>

> -

>

>

>

>

>

> Editors comments: In this case there is no sweat, since childhood and there

> was no history of external contraction of wind-cold. Moreover there was no

> aversion to cold, floating pulse seen. It is a mistake (?? not to see that

> This is not to think that this is a wind-cold exterior excess pattern of

> construction and defensive stagnation(???). It is still " weak construction

> and strong defensive " are gui zhi patterns. If there is construction qi

> internal weakness not aiding defensive yang then defensive qi not

> construction(???) stagnation in the mysterious mansion (sweat pore) giving

> free reign to the influence of " strength in the defensive [qi] "

>

>

>

> if there is construction qi internal weakness, blockage of the pores, then

> you will see no sweat, defensive qi " external strength " stagnation in the

> interstices and seeing red skin, itching, and when extreme oozing blood and

> scabbing, dryness, floating rapid pulse are heat signs in 1 school of

> thought. But, this after all has a different intrinsic quality than excess

> internal heat with thirst with intake of fluids, red urine, bound stool???,

> be sure not to bitter cold directly break???, this will (??) damage the

> construction and . Also one should avoid ma huang opening the interstices,

> because this will damage the construction and defensive. Only suitable to

> give gui zhi tang to promote a sweat and resolve the flesh, aid the

> construction and smooth the defensive. When you deal with the construction

> and defensive which mutually aid (one another)??? each performs its own

> functions, then sweat ensues and flesh is uninhibited, heat vexation

> spontaneously resolves. Honestly gui zhi tang's success in promoting sweat

> resides in resolving the flesh and harmonizing the ying and defensive.???

>

>

>

> base: 270.11.53/2054 - Release 04/11/09 10:51:00

>

>

>

>

[Guest guest]

Hi Gabe,

 

 

 

Nice Find! I will check it out when I find some time…

 

 

Thanks,

 

 

 

-Jason

 

 

 

 

 

 

 

 

On Behalf Of Gabriel Fuentes

Friday, April 17, 2009 8:36 AM

 

RE: GZT Case study

 

 

 

 

 

 

 

 

Hi Jason

You can find most of these case studies at

http://www.shanghan.com/bbs/archiver/tid-19940.html

Gabe

 

--- On Thu, 4/16/09, <

<%40Chinese Medicine> > wrote:

 

<

<%40Chinese Medicine> >

RE: GZT Case study

 

<%40>

Thursday, April 16, 2009, 6:10 PM

 

Yes Stephan this is from fairly famous SHL case study book from China. I

unfortunately do that have the book here, and haven’t look at the case in

maybe years, hence am a bit hesitant to comment too much from memory. Maybe

someone out there has a copy and could help us out. I think it is from 伤寒

å医验案精选.

 

But I remember it talking about the line in the SHL that " strength in the

defensive " – and how this applies. Since there are multiple explanations of

what this means, this at least ties it to a real case and how it applies

clinically. Basically the ‘strength’ is seen by all the obvious skin

manifestations, hence pathogenic factors, it is stagnation. Basically the

author’s point is that there is nutritive qi weakness not supporting the

defensive yang – this ‘strength’ of course it not good and blocks the

pores, this is why there is no sweat.

 

It is clear there is no internal heat because there is lack of internal

signs of heat (thirst, bowels, urine etc). This is a common theme in SHL

thinking to decide where the pathogen lies. This brings up one of the issues

I have had with some approaches to dermatology. Before I continue this is

just my personal observation, and AM not saying I am better than anyone, I

am not saying that these other system’s don’t work, just a simple

observation, hopefully people don’t get into a tizzy…

 

To continue, some people do not spend enough time understanding the internal

dynamics and pathomechanism and focus mostly on the way the skin looks. This

latter issue is of course important, but sometimes is emphasized over the

internal. Just something to think about.

 

But this case shows that understanding the mechanism is most important. Many

times formulas (or treatment strategies) that do one thing can be used for

opposite problem. For example many times a formula used for diarrhea can be

used for constipation and vice versa. Here a formula that normally treats

sweating can treat a lack of sweating. One can resolve sweating or promote

sweating by harmonizing the nutritive and defensive, this promotes the

normal flow of qi in muscle layer and the removal of stagnation which

eliminates the ‘heat signs’. It is a fascinating case that I have

contemplated for some time now…

 

Hope that helps…

 

-

 

Editors comments: In this case there is no sweat, since childhood and there

was no history of external contraction of wind-cold. Moreover there was no

aversion to cold, floating pulse seen. It is a mistake (?? not to see that

This is not to think that this is a wind-cold exterior excess pattern of

construction and defensive stagnation(? ??). It is still " weak construction

and strong defensive " are gui zhi patterns. If there is construction qi

internal weakness not aiding defensive yang then defensive qi not

construction( ???) stagnation in the mysterious mansion (sweat pore) giving

free reign to the influence of " strength in the defensive [qi] "

 

if there is construction qi internal weakness, blockage of the pores, then

you will see no sweat, defensive qi " external strength " stagnation in the

interstices and seeing red skin, itching, and when extreme oozing blood and

scabbing, dryness, floating rapid pulse are heat signs in 1 school of

thought. But, this after all has a different intrinsic quality than excess

internal heat with thirst with intake of fluids, red urine, bound stool???,

be sure not to bitter cold directly break???, this will (??) damage the

construction and . Also one should avoid ma huang opening the interstices,

because this will damage the construction and defensive. Only suitable to

give gui zhi tang to promote a sweat and resolve the flesh, aid the

construction and smooth the defensive. When you deal with the construction

and defensive which mutually aid (one another)??? each performs its own

functions, then sweat ensues and flesh is uninhibited, heat vexation

spontaneously resolves. Honestly gui zhi tang's success in promoting sweat

resides in resolving the flesh and harmonizing the ying and defensive.?? ?

 

base: 270.11.53/2054 - Release 04/11/09 10:51:00

 

 

[Guest guest]

From what I understand, Mazin has been working on his derm textbook for probably

the past ten years. He is such a total perfectionist and does not want to

publish anything less the that. Everytime I bring it up with him he declares it

should be done in the next 6 months or so..... that has been going on for the

past few years and others have told me he has been saying that for a long time

before me:-)

 

The text will probably be expensive but well worth it. I imagine it will cover

most of the common skin problems with very detailed colour photos, differential

diagnosis- ie how to tell lichen planus from psoriasis or lichen simplex, etc.

The different manifestations of one particular skin disorder, ie photos of

psoriasis due to blood heat with wind, blood heat with fire toxin, damp heat,

blood stasis, Yin vacuity, etc. And I am most certain that it will be chalk full

of his case studies, which is where the real learning takes place.

 

Mazin tends to theorize only on topics that he himself has gained good clinical

success with. Meaning, he lets his work speak for itself. Because of this, his

book will be a very valuable resource indeed.

 

Trevor

[Guest guest]

Hi Jason,

 

I think it is not too difficult to understand how Ying/Wei disharmony

patho-mechanisms could give rise to the symptoms of this case - especially

severe itching with no sweat. What I don't understand, from what you wrote of

the intake, is what lead the doctor to know that, in this case, Ying/Wei

disharmony was the root disharmony. I know this question may not be answerable

given that you don't have the text with you (if you remember what book it was or

who the doctor is, maybe I have it and could find it?) Given that the key signs

for Gui Zhi Tang pattern are often floating moderate pulse, sweating, aversion

to wind etc. it is curious to consider how this doctor knew that the root was a

Ying/Wei disharmony. Perhaps it was the body type of the child? Is there

something else not mentioned? The details of the intake you gave do not shed

any light on this for me. Am I missing something?

 

After a formula works, we can describe the patho-mechanisms to explain why it

worked. What may be more helpful is to see how the doctor got to the formula

BEFORE he gave it to the patient as opposed to how he explained it after it

worked. This would make this case a learning tool. I would love to learn, as

I'm sure others would, how to get to the same diagnosis- but as the case stands,

I can only see that sometimes Gui Zhi Tang may be effective for pediatric

itching but I don't know under what circumstances it would be the right choice.

I would guess that this doctor doesn't use Gui Zhi Tang for all cases of

pediatric itching - so what made him go there with this case?

 

Any thoughts?

 

I know that the point of the discussion was just to show that small doses of

unmodified classic formulas can work exceptionally well for all kinds of

problems for which we might normally want to bring out bigger formulas. This

case is a good example of that for sure. Yet, when an amazing doctor has an

amazing case, the results are, most likely, not mystical. They are because the

doctor has a reason for giving the formula. Sometimes the cases don't reveal

the actual reason so the results seem mystical and beyond the grasp of us

ordinary practitioners.

 

Sharon

[Guest guest]

Hi Sharon

Here is the chapter on Gui zhi tang:

Gabe

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处方：桂æžæ¢¢9克，æ­ç™½èŠ9克，炙甘è‰3克，大枣7校，生姜9å…‹\

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水一碗煎六分。清晨ç¡é†’æ—¶æœä¸‹ï¼Œå˜±å°‘é¡·å†åƒçƒ­ç²¥ä¸€ç¢—，以åŠ\

©è¯åŠ›ï¼Œé™å§æ•°å°æ—¶ï¼Œé¿é£Žã€‚æœè¯åŽå…¨èº«æ¸©æš–，四肢舒畅，汗å\

·²æ­¢ã€‚ä»ç…§åŽŸæ–¹åŠ é»„芪15克，æœæ³•å¦‚å‰ï¼Œä½†ä¸å¸ç²¥ï¼Œè¿žè¿›2剂，\

竞获全功。其åŽä½“æ¸å¥å£®ï¼Œä¸ƒå¹´æœªå‘。

   

按语：病起于腠ç†ç–æ¾ä¹‹æ—¶ï¼Œæ°´æ¹¿ç›´æµ¸è¥å«ä¹‹é—´ï¼Œå«ä¸Žè¥åˆ†ï¼\

Œæ¬²â€œå¸å¼€åˆâ€è€Œä¸èƒ½ï¼Œè‡´æ¯›å­”æ´žå¼€ä¸æ”¶ï¼Œæ•…自汗ä¸æ­¢ã€‚然病å\

»¶æ—¢ä¹…，当察有无è¯å˜ï¼Œæ‰€å¹¸â€œæ±—虽多但å£ä¸è¤â€ã€â€œè„‰ä»æµ®\

缓â€ï¼Œå¯çŸ¥â€œè„气末伤â€ï¼Œç—…ä»åœ¨å¤ªé˜³è¥å«ä¹‹é—´ï¼Œæ­¤æ‰€è°““ç—\

…常自汗音，……以å«æ°”ä¸å…±è£æ°”è°åˆæ•…尔。故治ä»å®¤æ¡‚æžæ±¤â\

€œå¤å‘其汗â€ï¼Œä»Šå«ä¸Žè¥å’Œåˆ™æ„ˆã€‚

 

 

 

å››ã€æ±—出åæ²®

 

 

 刘渡舟医案：孙æŸï¼Œç”·ï¼Œ39å²ã€‚患病为左åŠèº«ç»å¸¸å‡ºæ±—，而å\

³åŠèº«åˆ™å无汗，界é™åˆ†æ˜Žï¼Œä½™æ— ä¸é€‚。脉缓而略浮，舌苔薄\

白。此左å³é˜´é˜³æ°”è¡€ä¸ç›¸å和，此应调和阴阳，令气血和则æ„\

ˆï¼Œå®œæ¡‚æžåœºï¼š

   桂æž9克，白èŠ9克，生姜9克，大枣l

2枚，炙甘è‰6克，3剂。

   æœè¯åŽæš‡çƒ­ç²¥ï¼Œå¾—微汗而愈。

   (《ç»æ–¹ä¸´è¯æŒ‡å—》1993：2)

 

 按语：《京问·阴阳应象大论》云：“左å³è€…，阴阳之é“è·¯ä\

¹Ÿâ€ã€‚è¥å«é˜´é˜³äºŽå‘¨èº«å¾ªçŽ¯å¾€å¤ï¼Œå‘¨è€Œå¤å§‹ã€‚本案汗出å沮，\

乃è¥å«ä¸å’Œï¼Œé˜´é˜³å¤±è°ƒä¹‹ä¾‹è¯ã€‚如ä¸åŠæ—¶æ²»ç–—则è¥å«ç›¸æ‚–，é˜\

´é˜³ä¸ç»´ï¼Œå°±å¯èƒ½å¯¼è‡´åŠèº«ä¸é‚之“å枯â€è¯ã€‚《素问·生气é€\

šå¤©è®ºã€‹æ‰€è°““汗出å沮，使人å枯â€ï¼Œå³ä¸ºæ­¤æ„。本病往往ç\

”±å¤–感风邪引起，用桂æžæ±¤ç¥›é£Žè§£è‚Œï¼Œè°ƒå’Œè¥å«ï¼Œé¡ºå¤é˜´é˜³ï¼Œ\

ä¸å¤±ä¸ºæ­£æ²»ä¹‹æ³•ï¼Œæ–¹è¯ç›¸å¯¹ï¼Œæ•…三投而愈。

 

 

 

   五ã€æ— æ±—(æ¤ç‰©ç¥žç»åŠŸèƒ½ç´Šä¹±)

 

 孙百善医案：侣æŸç”·ï¼Œ9å²ï¼Œ1985å¹´7月5æ—¥åˆè¯Šã€‚å…¶æ¯ä»£è¯‰ï¼šæ‚\

£å„¿è‡ªå¹¼æœªæœ‰æ±—出，æ¯è‡³æš‘月则全身皮肤å‘红，干燥，瘙痒，ç\

»å¸¸æŠ“破皮肤结血痂，痛苦难å¿ï¼Œæ›¾å¤šæ¬¡åˆ°å½“地医院求治，诊\

为æ¤ç‰©ç¥žç»åŠŸèƒ½ç´Šä¹±ï¼Œæœç”¨è°·ç»´ç´ ç­‰è¯ä¸æ•ˆã€‚刻诊：全身皮è‚\

¤å‘红ã€å¹²ç‡¥ï¼Œå››è‚¢ã€èƒ¸è…¹éƒ¨è§æœ‰æ¡çŠ¶è¡€ç—‚åŠå‡ºè¡€ç—•è¿¹ï¼Œå‘¼å¸æ\

°”粗，时烦èºï¼Œå£é¼»å¹²ç‡¥ï¼ŒèˆŒè´¨æ·¡çº¢ï¼Œè‹”薄白，脉浮数。患儿\

呈现一派热象，然审è¯æ±‚因，此éžå†…有实热，乃è¥å«ä¸è°ƒï¼Œæ±\

—液ä¸å¾—宣泄之故。治以调和è¥å«ï¼Œå¼€å‘2ç†ï¼Œå¤„以桂æžæ±¤ï¼š

 

 

 桂æž5克，白èŠ5克，甘è‰5克，生姜3片，大枣5枚。水煎5剂。

 

 

 æœè¯åŽï¼Œå”¯è…‹ä¸‹èµ‚有汗液泌出，肌肤较å‰æ„Ÿèˆ’æœæŸ”和。因患\

者æœç”¨æ±¤è¯å›°éš¾ï¼Œæ”¹ç”¨æ¡‚æžã€ç™½èŠã€ç”˜è‰å„等分，共研æžç»†æœ\

«ï¼Œè£…入空心胶囊，æ¯æ—¥ä¸¤æ¬¡ï¼Œæ¯æ¬¡10克，用生姜ã€å¤§æž£ç…Žæ±é€\

下，æœç”¨äºŒâ€”日，患儿é身èœæ±—出，诸症皆除，如åŒå¸¸äººï¼Œé\

šè®¿ä¸‰ä¸ªæœˆæœªæœ‰å‘。

   (山东中医æ‚å¿—1989ï¼›(5＞r 45)

 

 按语：本案无汗，自幼å³è§ï¼Œå¹¶æ— å¤–感风寒之病å²ï¼Œåˆæ— æ¶\

寒脉浮紧之è§ï¼ŒçŸ¥éžè¥å«éƒæ»žä¹‹é£Žå¯’表实è¯ï¼Œä»ä¸ºâ€œè£å¼±å«å¼\

ºâ€ä¹‹æ¡‚æžè¯ä¹Ÿã€‚è¥æ°”内弱，ä¸æµŽå«é˜³ï¼Œåˆ™å«æ°”ä¸è¥ï¼Œæ»žäºŽçŽ„å\

ºœè€Œé€žå…¶â€œå«å¼ºâ€ä¹‹åŠ¿ã€‚è£æ°”内弱，汗孔闭塞，则è§æ— æ±—ï¼›å«\

气“外强â€ï¼ŒéƒäºŽè… ç†ï¼Œè€Œè§çš®è‚¤å‘红ã€æ”ç—’ã€ç”šåˆ™æ¸—血结ç—\

‚ã€çƒ¦èºã€è„‰æµ®æ•°ä¸€æ´¾çƒ­è±¡ã€‚但此与烦渴引饮，溲赤便结之实ç\

ƒ­å†…存毕竟ä¸åŒæœ¬è´¨ï¼Œåˆ‡å‹¿è‹¦å¯’直折，衰败è¥å«ï¼Œåˆå¿Œéº»é»„æ´ž\

开胺ç†ï¼ŒæŸä¼¤è¥å«ã€‚åªå®œæ¡‚æžæ±¤å‘汗解肌，济è¥ç•…å«ã€‚å¾…è¥å\

«ç›¸æµŽï¼Œå„å¸å…¶èŒï¼Œåˆ™æ±—出肌利，烦热自除。诚信桂æžæ±¤å‘æ±—ä\

¹‹åŠŸå¯“于解肌与调和è¥å«ä¹‹ä¸­ä¹Ÿã€‚

 

 

 

   六ã€ç•å¯’

 

 

 ç¥è¯ºäºˆåŒ»æ¡ˆï¼šéª†æŸï¼Œç”·ï¼Œ50å²ï¼Œ1971å¹´8月æŸæ—¥åˆè¯Šã€‚时届盛æš\

‘ä»ç€æ£‰è¡£æ£‰è£¤ï¼Œæ®äº‘æžç•é£Žå¯’，自汗时时，越出汗越ç•é£Žï¼Œè\

„±åŽ»æ£‰è¡£å³æ„Ÿé£Žå¹é€éª¨ï¼Œé身冷汗，因而虽盛暑亦ä¸æ•¢è„±åŽ»æ£‰\

衣，深以为苦。其人乎素纳食少，ä¹åŠ›å€¦æ€ ã€‚我诊为正气虚å¼\

±ï¼Œè¥å«å¤±è°ƒã€‚予桂æžæ±¤5剂。

 

 五天åŽæ¥è¯Šï¼Œå·²ä¸ç•é£Žï¼Œèƒ½éª‘自行车æ¥ï¼Œä¸”已脱去棉衣改穿\

夹衣，汗也å‡å°‘，瞩å†æœ3剂，痊愈。(中级医刊1979241＞，45)

 

 

 按语；è¥å«ä¸å’Œä¹‹è¯ã€‚å«ä¸å¤–因，则è¥ä¸å†…守而汗出；汗出\

既多，å«é˜³éšä¹‹å¤–越，“分肉â€æ— é˜³ï¼Œå¿…åˆç•æ¶é£Žå¯’。与桂æž\

汤益è¥å’Œå«ï¼Œä¸¤ç›¸å…¼é¡¾ã€‚

 

 

   

 

   七ã€é£Žæ¸©åˆèµ·

 

 

 任继学医案：å´æŸï¼Œå¥³ï¼Œ63å²ã€‚1987å¹´11月21日因晨起外出跑æ­\

¥é”»ç‚¼ï¼Œæ±—出去衣，至晚觉头痛头晕，鼻塞æµæ¶•ï¼Œå’³å—½å–‰ç—’，è\

º«é…¸æ¥šï¼Œè‚¢èŠ‚ä¸èˆ’，动则身汗放出而ä¸è¾¾ï¼Œé¢œé¢ä¸çº¢ï¼Œå£å”‡çº¢\

润，舌谈红，咽ä¸èµ¤ï¼Œè‹”薄白而润，尺肤微热，脉沉缓无力ã€\

‚ç—…å‘于å°é›ªå‰ä¸¤æ—¥ï¼Œä¸ºè¿æ°”正值终之气è¿ï¼Œä¸ºé¡ºåŒ–之季，候å\

温，其病温，治宜咸补，以甘泻之，以酸收之。

   桂æž15克，èŠè¯10克，甘è‰5克，生姜3片，大枣3枚。

   æœè¯åŽå¸çƒ­ç²¥ä»¥åŠ©è¯åŠ›ï¼Œ1剂而痊。 (江西中医è¯l

988；(2＞：10)

 

 按语：本è¯ä¹ƒé£Žæ¸©åˆèµ·ä¹‹å€™ï¼Žç”±æ­£è™šå¤–感风热所致。《温病\

æ¡è¾©ã€‹æ›°ï¼šâ€œå¤ªæ˜Žé£Žæ¸©ã€æ¸©çƒ­ã€æ¸©ç–«ã€å†¬æ¸©ï¼Œåˆèµ·æ¶é£Žå¯’者ï¼\

Œæ¡‚æžæ±¤ä¸»ä¹‹ã€‚â€ç›–温病åˆèµ·ï¼Œè™½æœ‰é£Žå¯’之状，亦ä¸å¯â€œæ±—而å\

‘之â€ï¼Œä½†å®œè§£è‚Œæ³•é‚ªï¼Œè°ƒå’Œé˜´é˜³ã€‚正如å´ç‘­æ‰€è¯´ï¼›â€œç›–温病\

忌汗，最喜解肌，桂æžæ‰¬æœ¬ä¸ºè§£è‚Œï¼Œä¸”æ¡‚æžèŠ³é¦™åŒ–浊，èŠè¯æ”\

¶é˜´æ•›æ±—，甘è‰è´¥æ¯’和中，姜枣调和è¥å«ã€‚温病åˆèµ·ï¼ŒåŽŸå¯ç”¨ä\

¹‹ã€‚â€æ®ä»»æ°ç»éªŒï¼Œæ¡‚æžæ±¤ä¸ä½†å–„治虚人外感风寒之病，而且\

善治虚人外感风热之羔，临床上常用于治疗冬春两季感冒(风å\

¯’或风热侵袭)，æ¯èŽ·ä½³æ•ˆã€‚

 

 

   八ã€å¥”豚气

 

 

 秦伯末医案；æŸåŸï¼Œ70å²ã€‚因女暴亡，悲哀过甚，先呕å，ç\

»§åˆå‘作性腹痛一年余，å°è…¹ç—žå—作痛，å—æ¸å¢žå¤§ï¼Œç—›äº¦æ¸å‰§\

，气从å°è…¹ä¸Šå†²å¿ƒä¸‹ï¼Œè‹¦é—·æ¬²æ­»ï¼Œç»§è€Œå†²æ°”æ¸é™ï¼Œç—›æ¸å‡ï¼Œç—\

…为奔豚。å­æ¡‚æžæ±¤ï¼Œå…±16剂，奔豚大为å‡è½»ã€‚

   (《谦斋医学讲稿》1964；144)

 

 按语：阳虚弱，å镇无æƒï¼Œåˆ™ä¸‹ç„¦å¯’水之气上冲，病å‘奔豚\

。桂æžæ±¤æ¸©æŒ¯å¿ƒé˜³ï¼Œå¹³å†²é™é€†ï¼Œæ­£ä¸ºç›¸å®œã€‚若更加桂二两．åˆ\

™å…¶æ•ˆæ›´æ·ã€‚

 

   

   ä¹ã€ä¸‹åˆ©

 

 

 中神ç´æºªåŒ»æ¡ˆï¼šä¸€å¦‡äººæ‚£ä¸‹åˆ©æ•°å¹´ï¼Œä¸è¿›é£Ÿï¼Œå½¢ä½“赢瘦，肌\

肤甲错，ä¸èƒ½èµ·å§ï¼ŒåŒ»æ—¶ä»¥å‚ã€é™„ã€è¯ƒã€ç½‚之类治之。先生è¯\

Šä¹‹æ›°ï¼šç™¾åˆç¯‡æ‰€è°“è§äºŽé˜´è€…，以阳法拯之者也。乃与大剂之æ\

¡‚æžæ±¤ï¼Œä½¿è¦†è€Œå–汗，下利止。更与百åˆçŸ¥æ¯åœºï¼Œä»¥è°·é£Ÿè°ƒç†\

之，æ¸æ¸å¤åŽŸã€‚

   (《呈汉医学)1956：54)

 

 按语；下利日久，è§å½¢ä½“消瘦，肌肤甲错之è¯ï¼Œä¹ƒè¥å«ã€æ°”\

è¡€ä¸å’Œä¹‹è±¡ã€‚è¥å«ä¸å’Œï¼Œæ°”血乖乱，传导失常，则è§ä¸‹åˆ©ä¸æ­\

¢ã€‚用桂æžæ±¤å‘汗解肌，调和è¥å«ä»¥æ­¢åˆ©ï¼Œä¹ƒâ€œé€†æµæŒ½èˆŸâ€ä¹‹å\

ˆä¸€æ³•ä¹Ÿã€‚

 

 

 

åã€é‡ç—‡è™šåŠ³

 

刘渡舟医案；刘æŸç”·ï¼Œ18å²ã€‚早婚，素体气怯，婚åŽåŠå¹´è§è…°\

酸腿软，头晕耳鸣，å°ä¾¿é¢‘数而短，浙浙æ¶å¯’，åŒä¸‹è‚¢æœ‰éº»å†\

·æ„Ÿï¼Œå¤ä¼å¤©è£¹æ£‰è¡£ä»æ„Ÿè‚¢å†·ï¼ŒåŠ¨åˆ™æ±—出，纳差腹胀，å£ä¸­ç”œè\

…»ï¼Œå¤œå¯å¤šæ¢¦ï¼Œæ€è‰²æ¬²åŠ¨ï¼Œä½“质日衰，进人å‚ã€é¹¿èŒ¸åŸ¹è¡¥æ— æ•ˆ\

。刻诊：形瘦气怯，é¢èŽç¥žè¡°ï¼Œè¯­å£°ä½Žå¾®ï¼Œåˆ‡ä¸¤è„‰æ²‰ç»†è€Œå¼±ï¼\

ŒéªŒèˆŒè´¨çº¢å«©ï¼Œè‹”少。脉è¯åˆå‚，谓斯疾因房劳过度，耗气伤ç\

²¾ï¼Œè„腑功能失调，阴阳äºæŸæ‰€è‡´ã€‚ç†åº”补肾以培本，但å‚å‰\

医用人å‚ã€é¹¿èŒ¸ä¸æ•ˆï¼Œä¸”以桂æžæ±¤è°ƒç†é˜´é˜³ç€æ‰‹ã€‚

   

处方：桂æž15克，白èŠ15克，炙甘è‰6克，生姜6克，大枣10枚。\

5剂。

   

è¯åŽè¯¸ç—‡å¤§å‡ï¼Œä½†ç—…员虚æŸï¼Œè‡ªéš¾é€Ÿæ•ˆï¼Œç»§æœä¸Šæ–¹åŠ æ€€å±±è¯15\

克，炒白术12克，鸡内金10克，以培补åŽå¤©ï¼Œå¹¶åŠ æœæ¡‚附八味ä\

¸¸ä»¥è¡¥è‚¾æ°”，åŠæœˆåŽå‘Šæ›°ï¼šè¯åŽç²¾åŠ›å……沛，饮食å€å¢žï¼Œè¯¸ç—…皆\

除。(湖北中医æ‚å¿—1992ï¼›(5＞：6)

 

 按语：本案因早婚，纵欲伤精，æ¸æˆè™šåŠ³ã€‚观其å¤å¤©è£¹è£˜ï¼Œ\

动则汗出，舌质红嫩，脉象沉弱，乃阳虚之å¾ï¼›åˆè…°é…¸è…¿è½¯ï¼\

Œå¤´æ™•è€³é¸£ï¼Œå¤œå¯æ¢¦å¤šï¼ŒèˆŒçº¢å°‘苔，为阴虚之象。阴阳ä¸è°ƒï¼Œå\

ˆ™è¥å«éš¾å’Œï¼Œæ³•å½“调和阴阳为治，ä¸ç„¶ï¼Œéš¾ä»¥å¥æ•ˆï¼Œå‰åŒ»ç”¨äºº\

å‚ã€é¹¿èŒ¸å¤§è¡¥å³æ˜¯æ˜Žé‰´ã€‚刘è€è¯†è¯çœŸåˆ‡ï¼Œå·§ç”¨æ¡‚æžæ±¤æ»‹é˜´å’Œé˜\

³ï¼Œè°ƒå’Œè¥å«ï¼Œæ­£ä¸­ç—…鹄。待阴平阳秘，精神内守，则虚劳å¯æ\

„ˆã€‚åˆäºŽç—…去七八，增培土å¥è„¾ä¹‹å“，æ„在培åŽå¤©ä»¥å…»å…ˆå¤©ä¹Ÿ\

，俾肾之阴阳充盈，而顽疾尽拔。

 

 

   å一ã€åŽ¥è¯(排尿性晕厥)

 

 金树武医案：孟æŸæŸï¼Œå¥³ï¼Œ12å²ï¼Œ1987å¹´6月4æ—¥åˆè¯Šã€‚近两个æ\

œˆæ¥æŽ’å°¿æ—¶ç»å¸¸æ˜å€’，ä¸çœäººäº‹ï¼Œæ— å«å£°ï¼Œæ— å涎，晕照3—5å\

ˆ†é’Ÿï¼Œé†’åŽæ‰‹è¶³æ¬ æ¸©ï¼Œè‚¢ä½“汗出，头晕，倦怠ä¹åŠ›ï¼Œä¼‘æ¯ç‰‡åˆ»\

åŽï¼Œæ— æ˜Žæ˜¾ä¸é€‚，已ç»å½±å“上学。到æŸåŒ»é™¢æ£€æŸ¥æ— é˜³æ€§ä½“å¾ï¼\

Œè¯Šæ–­ï¼šæŽ’尿性晕æœã€‚ç»™æœå®‰å®šã€è°·ç»´ç´ ã€ç»´ç”Ÿç´ B1，é™ç‚¹åˆºäº\

”加ã€å‚附汤ã€å››æ˜§å›žé˜³é¥®ç­‰è¯ä¸æ•ˆã€‚查：神志清楚，é¢åŒ…红æ\

¶¦ï¼ŒèˆŒæ·¡çº¢ï¼Œè‹”薄白，脉弦缓。诊断：厥è¯ã€‚中医辨è¯å‘¨é˜´é˜³\

之气ä¸èƒ½é¡ºæŽ¥ï¼Œæ‹Ÿç”¨å’Œæ³•ï¼Œä»¥å¹³ä¸ºæœŸï¼Œè°ƒå’Œé˜´é˜³ã€‚投桂æžæ±¤ï¼\

š

 

   桂æž15克，白èŠ15克，炙甘è‰I

o克，生姜3片，大枣4枚。3剂，水煎æœã€‚

 

 

 æœè¯åŽæ™•è´¨æ¬¡æ•°æ˜Žæ˜¾å‡å°‘，仅于早晚5—7点(å¯ã€é…‰)å‘作，å\

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éšè®¿äºŒå¹´æœ«è§å¤å‘。

 

 按语：伤寒大论云：“凡æœè€…，阴阳之气ä¸ç›¸é¡ºæŽ¥ï¼Œä¾¿ä¸ºåŽ¥\

。â€æ¡‚æžæ±¤è°ƒå’Œé˜´é˜³ï¼Œé¡ºæŽ¥ä¸Šä¸‹ï¼Œé€šè¾¾å†…外，故能治厥。尤è§\

汗出脉缓者，其效更æ·ã€‚

 

 

 

   å二ã€å™Žè†ˆ(弥漫性食管痉挛)

 

 俞世伟医案：黄æŸP5，56å²ï¼Œ1984å¹´6月18æ—¥åˆè¯Šã€‚å‘作性咽下å\

›°éš¾ä¸¤å¹´ä½™ã€‚病起时因情志ä¸èˆ’æ¸æ„Ÿåžå’½å¹²ç‡¥é£Ÿç‰©å›°éš¾ï¼Œè¿‘æ—¥\

加é‡ã€‚到çœåŒ»é™¢æ ¡æŸ¥è¯Šæ–­ä¸ºå¼¥æ¼«æ€§é£Ÿç®¡ç—‰æŒ›(食é“官能症)，用\

亚ç¡é…¸ç›ç±»è¯ç‰©ã€æš—示疗法末è§è‰¯æ•ˆã€‚刻诊自述失眠多梦，çº\

³å‘†è…¹èƒ€ï¼Œå¤´æ˜è‡ªæ±—，咽食便喳，食åŽèƒƒä¸­å’½é™ˆï¼Œå‘¢æ°”数声，ç\

”šæ—¶æ°”从鼻出苔薄白，脉缓。è¯å±žé˜´é˜³å¤±è°ƒï¼Œèƒƒæ°”ä¸åˆ©ã€‚处方\

：

 

 桂æž9克，白èŠ9克，炙甘è‰6克，生姜9克，大枣12枚  乌è¯10\

克，沉香1D克，水煎æœï¼Œæ—¥1剂。

 

 æœè¯4剂，症状改善，åžå’½é¡ºåˆ©ï¼Œç»§æœ20余刑，è¯ç—‡çš†é™¤(å±±è¥\

¿ä¸­åŒ»1992ï¼›45＞；50)

 

 按语：åžå’½å›°éš¾è§æ±—出脉缓ã€é¼»å‘œå¹²å‘•è€…，病本在于阴阳失\

调，气机ä¸åˆ©ï¼Œç”±èƒƒæ°”本虚，åˆåŠ æƒ…志所伤形æˆï¼Œç”¨æ¡‚æžåœºè°\

ƒå’Œé˜´é˜³ï¼Œèˆ’展脾胃气机，å¯è°“抓ä½äº†ç–¾ç—…的关键。

 

 

 

å三ã€é£Žéšç–¹(è‰éº»ç–¹)

 

刘渡舟医案：一男性患者，60å²ï¼Œæ‚£ç­‰éº»ç–¹ï¼Œæ”痒钻心，数月\

ä¸æ„ˆã€‚切其脉浮而缓，并è§æ±—出æ¶é£Žï¼ŒèˆŒè‹”薄白而润。è¯å±žé£\

Žé‚ªç¨½ç•™è‚Œè†œï¼Œè¥å«ä¸å’Œï¼Œå› å‘为风疹。治宜法风调和è¥å«ï¼Œæ\

–¹ç”¨æ¡‚æžæ±¤ï¼š

 

 桂æž9克，白èŠ9克，生姜9克，大枣12枚．炙甘è‰6克，3剂。

   æœè¯åŽå¸çƒ­ç¨€ç²¥ï¼Œæ¸©è¦†å–汗，则疹消痒止。

 

 按语：痒者，阳也，风为阳邪，侵于肌肤，稽留ä¸åŽ»è€Œä½œç—’\

疹。åŒæ—¶ï¼Œé£Žä¸­ä»¤è¥å«ä¸å’Œï¼Œåˆ™æ±—出æ¶é£Žï¼Œè„‰æµ®è€Œç¼“，诸症è¿\

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¶ˆã€ç—’自止也。

 

 

åå››ã€æœˆç»ç–¹

张伯åŽåŒ»æ¡ˆï¼šæŽæŸæŸï¼Œ22å²ï¼Œ1988å¹´10月20日诊。l

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，缠绵至今。è¯è§ï¼šå…¨èº«æ•£å¸ƒçº¢è‰²ç–¹å—，痞痒，舌淡，苔白ï¼\

Œè„‰æµ®è€Œå¼±ã€‚辨为：阳浮阴弱，è¥å«ä¸å’Œã€‚治以桂æžæ±¤è°ƒå’Œè¥å\

«ã€‚

   桂æžã€ç™½èŠã€ç”Ÿå§œå„10克，大枣12枚，甘è‰6克。3剂。

 

 è¯æ­¢ç—’消。嘱下次月ç»æ¥æ½®å‰ä¸€å‘¨ç»­æœä¸Šæ–¹2剂．其疹未å‘ã€\

‚éšè®¿åŠå¹´ï¼Œæœªå¤å‘。

 

 按语：月ç»æ¥æ½®ï¼Œé˜´è¡€äºè™šï¼Œé˜³æ°”浮动，致è¥å«ä¸å’Œï¼Œçš®æš–\

气血éƒæ»žè€Œå‘痒疹。桂æžæ±¤æœ‰è§£è‚Œä½œç”¨ï¼Œèƒ½è°ƒå’Œè‚¤åºŸä¹‹è¥å«æ°\

”血，消除痒疹。åæ„Ÿå—风邪，è¥å«ä¸å’Œï¼Œæ°”血失调之痒疹，ç\

š†å¯ä½¿ç”¨æœ¬æ–¹ã€‚

 

 

 

å五ã€å¦Šå¨ å‘热

 

大场敬节医案：一妇女，自妊娠七月始，æ¯æ—¥åˆåŽçƒ­æ¯’上å‡ï¼\

Œè¾¾38℃许，历å数日而末治愈。一医诊断为结核热，乃人工æµ\

产适应è¯ï¼Œè€Œæ‚£è€…ä¸æ¬²æ‰‹æœ¯ï¼Œæ±‚余往诊。诊察所è§ï¼šè„‰æµ®å¤§è\

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明有浸润。余投以桂æžæ±¤ï¼ŒåŽ†æ—¶ä¸‰å‘¨é—´ï¼Œçƒ­å§‹ä¸‹é™ï¼Œç»ˆäºŽæ­£å¸\

¸åˆ†å¨©ã€‚……

 

 

 按语：本案妊娠å‘热血äºè™šï¼Œä¹ƒé˜³æµ®é˜´å¼±æ‰€è‡´ã€‚阳气浮动则\

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‚æžæ±¤è°ƒå’Œå«é˜³ã€ç›Šè¥é˜´è€Œæ„ˆ

 

 

 

 

åå…­ã€å°å„¿æƒŠé£Ž

   

 

 å´ä½©è¡¡åŒ»æ¡ˆï¼šä½•æŸä¹‹é•¿å­ï¼Œå¹´ä¸€å²åŠã€‚1922年阴历ä¹æœˆåˆå…­æ—\

¥æ™¨ï¼Œå¯é†’抱出，冒风而惊，å‘热，自汗，沉迷，角弓å张，æ\

‰‹è¶³æŠ½æ，目上视。指纹赤而浮，唇赤舌谈白。脉æ¥æµ®ç¼“。由\

于风寒阻é太阳ç»æ°”è¿è¡Œä¹‹æœºï¼ŒåŠ ä»¥å°å„¿è¥å«æœªå……，è„腑柔è½\

¯ï¼Œä¸è€é£Žå¯’，以致å’然抽æ而æˆæ€¥æƒŠé£ŽçŠ¶ã€‚此为太阳肌表之è\

¯ï¼Œä»¥ä»²æ™¯æ¡‚æžæ±¤ä¸»ä¹‹ï¼Œä½¿ä¸­äºŽå¤ªé˜³è‚Œè… ä¹‹é‚ªï¼Œå¾—微汗而解。

   桂æž10克，æ­èŠ10克，甘è‰6克，生姜10克，å°æž£7枚。

 

 加粳米一å°æ’®åŒç…Žï¼Œå˜±æœåŽæ¸©è¦†è€Œå§ï¼Œä½¿å¾—微汗。一剂尽，\

å³ç†Ÿå¯ï¼Œæ±—出热退，次日éœç„¶ã€‚(《å´ä½©è¡¡åŒ»æ¡ˆã€‹l 983：2)

 

 按语：å°å„¿è„腑娇嫩，è¥å«æœªå……．åˆåŠ å¯é†’之åŽï¼Œè‚ŒåºŸç–æ¾\

，故çªå—风邪，使太阳ç»è„‰åŠ²æ€¥ä¸æŸ”，而è§è§’弓å张，手æŽç›\

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‚所幸å‘热汗出，脉æ¥æµ®ç¼“，仅为太阳肌表之è¯ï¼Žæ•…宜桂æžæ±¤æ\

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。

 

 

 

   å七ã€å°å„¿å°¿é¢‘

 

 

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 é‡ï¼Œæ¯å°æ—¶è¾¾3—5次。æ¯å‡ å¹³ç´ ç•å¯’ã€è‡ªæ±—ã€æœ‰å°¿åºŠå²ã€‚诊è§\

舌质淡，苔薄白，脉沉细。查尿常规阴性。治以补肾因涩，æ\

Š•ç¼©æ³‰ä¹åŠ æ˜§ã€‚æœè¯3剂é˜æ•ˆã€‚虑有自汗，故改投桂æžæ±¤ä»¥è°ƒå’\

Œè¥å«ã€‚æ–¹è¯ï¼š

 

 桂æž4克，白èŠ6克，生姜3克，甘è‰4克，大枣3枚。水煎æœï¼Œ1\

日l剂。

 

 æœ6剂，ç•å¯’ã€ç™½æ±—消失，尿频å‡åŠï¼Œæ•ˆä¸æ›´æ–¹ï¼Œç»§æœåŽŸæ–¹10\

剂而愈。

 

 按语：《素问·脉è¦ç²¾å¾®è®ºã€‹äº‘；“水泉ä¸æ­¢è€…，是膀胱ä¸è\

—也。â€è†€èƒ±ä¸è—，起因较多，虚实皆有。本案尿频兼有自汗\

ã€ç•å¯’等太阳表è¯ï¼Œä¹ƒå«æ°”ä¸ä¸Žè¥å’Œä¹‹å¾ã€‚ç›–å«æ°”“温分肉ï¼\

Œå……皮肤，肥膀ç†ï¼Œå¸å¼€åˆâ€ï¼Œå¼€åˆå¤±å¸ï¼Œå¤ªé˜³ç»æ°”ä¸çº¦ï¼Žåˆ™å\

¤–而自汗．内而尿频；åˆæ¸©å…»ä¸å¾—，自感ç•å¯’。当此之时，缩\

固无用，唯调和è¥å«æ˜¯ä¸ºæ­£æ³•ï¼ŒæŠ•æ¡‚æžåœºåˆ™ä½¿è¥å……å«å›ºï¼Œåè°\

ƒäº’用，是为方è¯ç›¸å¯¹ï¼ŒæžœèŽ·ä½³æ•ˆã€‚

 

 

 

 

   åå…«ã€èšæ˜Ÿéšœ(å•ç–±ç—…毒性角膜炎)

 

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›¾åœ¨ä»–院治疗无效，l

990å¹´3月20日就诊。检查：å³çœ¼è¿œè§†åŠ›o．6，近视力o．6ï¼30cm。\

çƒç»“膜混åˆå……è¡€(åå)，角膜中央è§ç‚¹çŠ¶ç°ç™½è‰²æµ¸æ¶¦ï¼Œ2ï¼…è§å…\

‰ç´ æŸ“色(åå)，角膜知觉å‡é€€ï¼ŒKP(一)，房闪(一)。兼è§é¼»å¡žæµ\

涕，æ¶é£Žæ±—出，舌质谈红，苔白滑，脉浮缓。诊断：å³çœ¼å•ç\

–¤ç—…毒性角膜炎。è¯å±žï¼šå³çœ¼èšæ˜Ÿéšœã€‚治宜ç‰é£Žç¥›é‚ªï¼Œè°ƒå’Œè¥\

å«ï¼Œé€€ç¿³æ˜Žç›®ã€‚处方，

 

 

 桂æžã€ç™½èŠå„9克，生姜3片，炙甘è‰3克，大枣5枚，è‰è¡£6å…‹ï\

¼Œæ¯æ—¥l剂，水煎æœã€‚

 

 

 æœ6剂，远视力o．8，çƒç»“膜充血å‡è½»ï¼Œè§’膜轻度混浊，2ï¼…ç›\

®å…‰ç´ æŸ“色(å)，鼻通涕止。åˆæœ5剂，远视力1．o，çƒç»“膜充è¡\

€å¤±ï¼Œè§’膜é€æ˜Žï¼Œ2ï¼…è§å…‰æŸ“色(一)。追踪观察2年以上未è§å¤å‘\

。

 

 

 按语：èšæ˜Ÿéšœå±žç›®éšœèŒƒç•´ï¼Œç—…å˜å¤æ‚，病情缠绵且易å¤å‘，\

严é‡è€…å¯è‡´å¤±æ˜Žï¼Œä¸´åºŠå°šæ— ç‰¹æ•ˆç–—法。本案由感å—风邪所致ï¼\

Œå…¶è¾¨è¯çœ¼ç›®åœ¨äºŽä¼´æœ‰æ±—出æ¶é£Žã€è„‰æ¥æµ®ç¼“等症。故用桂æžæ±¤å\

Š è‰è¡£ä»¥ç¥›é£Žæ˜Žç›®ã€‚若因其他原因所致目障者，则åˆå½“æ®è¯è€Œ\

论，çµæ´»ç”¨è¯ï¼Œä¸å¿…拘泥。

 

 

 

 

 

   åä¹ã€ç›®ç›²

 

 

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   桂æž9克，白èŠ9克，生姜9克，大枣18克，甘è‰9克，6剂。

 

 

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€å¹´æ˜¯éšè®¿ï¼Œæœªå¤å‘。

 

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¾èƒƒå¾—补，è¥å«èŽ·å……，精气上注，而目æ¸å…‰æ˜Žã€‚

 

 

 

--- On Fri, 4/17/09, swzoe2000 <sweiz wrote:

 

 

swzoe2000 <sweiz

Re: GZT Case study

 

Friday, April 17, 2009, 9:14 AM

 

 

 

 

 

 

 

 

Hi Jason,

 

I think it is not too difficult to understand how Ying/Wei disharmony

patho-mechanisms could give rise to the symptoms of this case - especially

severe itching with no sweat. What I don't understand, from what you wrote of

the intake, is what lead the doctor to know that, in this case, Ying/Wei

disharmony was the root disharmony. I know this question may not be answerable

given that you don't have the text with you (if you remember what book it was or

who the doctor is, maybe I have it and could find it?) Given that the key signs

for Gui Zhi Tang pattern are often floating moderate pulse, sweating, aversion

to wind etc. it is curious to consider how this doctor knew that the root was a

Ying/Wei disharmony. Perhaps it was the body type of the child? Is there

something else not mentioned? The details of the intake you gave do not shed any

light on this for me. Am I missing something?

 

After a formula works, we can describe the patho-mechanisms to explain why it

worked. What may be more helpful is to see how the doctor got to the formula

BEFORE he gave it to the patient as opposed to how he explained it after it

worked. This would make this case a learning tool. I would love to learn, as I'm

sure others would, how to get to the same diagnosis- but as the case stands, I

can only see that sometimes Gui Zhi Tang may be effective for pediatric itching

but I don't know under what circumstances it would be the right choice. I would

guess that this doctor doesn't use Gui Zhi Tang for all cases of pediatric

itching - so what made him go there with this case?

 

Any thoughts?

 

I know that the point of the discussion was just to show that small doses of

unmodified classic formulas can work exceptionally well for all kinds of

problems for which we might normally want to bring out bigger formulas. This

case is a good example of that for sure. Yet, when an amazing doctor has an

amazing case, the results are, most likely, not mystical. They are because the

doctor has a reason for giving the formula. Sometimes the cases don't reveal the

actual reason so the results seem mystical and beyond the grasp of us ordinary

practitioners.

 

Sharon

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[Guest guest]

Even in the Beijing Dermatology department Mazin was a bit of a legend and this

was several years ago. The doctors there told me about this Westerner (!) who

spent hours and hours in the Nanjing (?) library doing research. The final

complement was that Chinese doctors would ask his advice.

Having spent some time studying the subject and having worked with some

colleagues specializing in it I look forward to seeing what he has put together.

Doug

 

 

 

, " Trevor Erikson " <trevor_erikson

wrote:

>

> From what I understand, Mazin has been working on his derm textbook for

probably the past ten years. He is such a total perfectionist and does not want

to publish anything less the that. Everytime I bring it up with him he declares

it should be done in the next 6 months or so..... that has been going on for the

past few years and others have told me he has been saying that for a long time

before me:-)

>

> The text will probably be expensive but well worth it. I imagine it will cover

most of the common skin problems with very detailed colour photos, differential

diagnosis- ie how to tell lichen planus from psoriasis or lichen simplex, etc.

The different manifestations of one particular skin disorder, ie photos of

psoriasis due to blood heat with wind, blood heat with fire toxin, damp heat,

blood stasis, Yin vacuity, etc. And I am most certain that it will be chalk full

of his case studies, which is where the real learning takes place.

>

> Mazin tends to theorize only on topics that he himself has gained good

clinical success with. Meaning, he lets his work speak for itself. Because of

this, his book will be a very valuable resource indeed.

>

> Trevor

>

[Guest guest]

Hi Jason

 

Thanks for the addition of the editor’s comments! – nice touch

 

Yeah, the way that I was taught was that this kind of

manifestation was akin to yang deficiency being too weak to open

the pores so the condition becomes lodged in the interstices. But

in that situation, I learned that it was due to a lack of shaoyin

warmth so that only the growing of yang in Nature during summer

could bring this problem to the surface and thus the rash in

summer…but the treatment had to warm shaoyin with something like

fuzi added to the guizhi tang.

 

Was it that kids are so yang that, at 9 years, guizhi tang alone

was enough?

 

This would be similar to the thinking of the author of Liuwei

Dihuang Wan – Qian Yi, who wrote:

 

" Derived from Zhongjing's original intention of yang

(engendering), but for children with abundant yang qi, I created

this pill by eliminating Guizhi and Fuzi, which is now a specific

medicinal for kidney supplementation for children. "

 

If so, we have to chalk it up to the doctor’s experience – even

though the signs and symptoms that would allow us to see this

aren’t presented in the case

 

Still, it’s interesting and a great example of the thinking of

Shang Han Lun style practitioners

 

 

Thanks

 

Stephen Woodley LAc

 

--

 

www.shanghanlunseminars.com

 

--

http://www.fastmail.fm - Accessible with your email software

or over the web

 

 

 

 

[Guest guest]

Sounds like Mazin. He visits China quite regularly and usually sits in with the

different Docs there. He graduated from the University in Nanjing back in the

early 80's.

 

Just to let everyone know, Mazin will be lecturing in North America in the fall.

It will be a great opportunity, as he rarely comes here. (I had to fly to London

England many times to do my studies with him).

 

I believe he is in Seattle and Vancouver, teaching different topics each place.

I plan on being at both. The link for the Vancouver lecture is here:

http://www.prodseminars.net/store/allergic-and-autoimmune-diseases-3-day-seminar

 

Trevor

 

 

, " "

wrote:

>

> Even in the Beijing Dermatology department Mazin was a bit of a legend and

this was several years ago. The doctors there told me about this Westerner (!)

who spent hours and hours in the Nanjing (?) library doing research. The final

complement was that Chinese doctors would ask his advice.

> Having spent some time studying the subject and having worked with some

colleagues specializing in it I look forward to seeing what he has put together.

> Doug

>

>

>

> , " Trevor Erikson " <trevor_erikson@>

wrote:

> >

> > From what I understand, Mazin has been working on his derm textbook for

probably the past ten years. He is such a total perfectionist and does not want

to publish anything less the that. Everytime I bring it up with him he declares

it should be done in the next 6 months or so..... that has been going on for the

past few years and others have told me he has been saying that for a long time

before me:-)

> >

> > The text will probably be expensive but well worth it. I imagine it will

cover most of the common skin problems with very detailed colour photos,

differential diagnosis- ie how to tell lichen planus from psoriasis or lichen

simplex, etc. The different manifestations of one particular skin disorder, ie

photos of psoriasis due to blood heat with wind, blood heat with fire toxin,

damp heat, blood stasis, Yin vacuity, etc. And I am most certain that it will be

chalk full of his case studies, which is where the real learning takes place.

> >

> > Mazin tends to theorize only on topics that he himself has gained good

clinical success with. Meaning, he lets his work speak for itself. Because of

this, his book will be a very valuable resource indeed.

> >

> > Trevor

> >

>

[Guest guest]

Thanks Gabe,

 

The Chinese came out all gobly gook in the message but the link worked and I

found the case.

 

What stands out to me about the case notes is the fact that the tongue was pale

red. For something as mean and red and even bloody as this boy's skin

irritation, if it was true heat, would not the tongue be red? The floating

pulse put the issue on the surface. I wonder if this, maybe along with the body

type of the boy, were the keys that pointed to Gui Zhi Tang. It would make

sense to me. With the pale red tongue, he knew that the heat was heat due to

stagnation as opposed to true heat.

 

Just thoughts. Thanks for the link!

 

Sharon

[Guest guest]

Trevor,

 

 

 

Do you have information or a link for the Seattle dates?

 

 

 

-Jason

 

 

 

 

On Behalf Of Trevor Erikson

Saturday, April 18, 2009 1:03 AM

 

Re: GZT Case study

 

 

 

 

 

 

 

 

Sounds like Mazin. He visits China quite regularly and usually sits in with

the different Docs there. He graduated from the University in Nanjing back

in the early 80's.

 

Just to let everyone know, Mazin will be lecturing in North America in the

fall. It will be a great opportunity, as he rarely comes here. (I had to fly

to London England many times to do my studies with him).

 

I believe he is in Seattle and Vancouver, teaching different topics each

place. I plan on being at both. The link for the Vancouver lecture is here:

http://www.prodseminars.net/store/allergic-and-autoimmune-diseases-3-day-sem

inar

 

Trevor