Wang Sanhu’s Experience Using Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) to Treat Difficult Cases

Huan Wang Xin Quan LiHong Guo

Abstract: purpose Research on the applications of Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) to treat difficult cases. Methods: Summarizing Professor Wang Sanhu’s experience using Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) to treat difficult cases by observational learning and organizing case reports. Results: Professor Wang Sanhu utilizes the refined combination and wide applications of Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) to treat a wide variety of diseases effectively in clinical practice. Conclusion: Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) clears heat while nourishing yin and cools the blood while dissipating stasis. It has a reliable therapeutic effect on diseases with pattern diagnoses of heat entering the blood aspect.

Keywords：Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng), difficult cases, Wang Sanhu

Among the more than 6500 formulas in Qianjin Fang ［Thousand Gold Pieces Formulary］, Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) is one of the most iconic. It comes from volume 12, chapter 6 (entitled “Blood Ejection”) of Beiji Qianjin Yaofang ［A Thousand Gold Pieces Emergency Formulary］, which states: “To treat ［cases of］ cold damage and warm disease ［in which］ sweating should have been promoted but was not, ［with］ internal blood amassment as well as nosebleed, incessant blood ejection, internal excess of static blood, black stool, and a yellow face, ［use this］ blood stasis-dispersing formula.” The original formula consists of 1 liang of rhinoceros horn (xī jiǎo), 2 liang of dried rehmannia root (gān dì huáng), 3 liang of peony root (sháo yào), and 2 liang of moutan root bark (dān pí). With actions of clearing heat, resolving toxin, cooling blood, and dissipating stasis, this formula is commonly used to treat heat entering the blood aspect in warm disease. It is indicated in cases of heat entering the blood aspect with delirious speech and macular eruption, as well as blood ejection, nosebleed, bloody stool, and bloody urine due to heat damaging the blood network vessels. “The prescription’s rhinoceros horn (buffalo horn) is the main medicine for clearing heat, cooling blood, and detoxifying. The prescription’s rhinoceros horn (buffalo horn) is the main medicine for clearing heat, cooling blood, and detoxifying. In this formula, fresh rehmannia root (shēng dì) clears heat, cools blood, and nourishes yin humor in its role as minister. Peony root (sháo yào) harmonizes construction and discharges heat, while moutan root bark (dān pí) discharges latent heat in the blood aspect, cools blood, and disperses stasis; they serve as assistant and envoy respectively. The combination of these 4 medicinals is precise and appropriate, cleverly resolving the conflicts between cooling and quickening blood, as well as stopping bleeding and dispersing stasis. Because it clears heat while nourishing yin and cools the blood while dissipating stasis, allowing the heat to be cleared and bleeding to stop without the drawback of lingering stasis, it is a key formula for treating heat entering the blood aspect.”^［1］

Professor Wang Sanhu, the foremost tumor expert at Shaanxi Provincial Hospital of Chinese Medicine in the city of Xi’an, has extensive experience using Qianjin Fang ［Thousand Gold Pieces Formulary］to treat difficult cases^［2,3,4］and Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) is one of the formulas he uses most frequently. Professor Wang Sanhu utilizes the refined combination and wide applications of Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) to treat a wide variety of diseases effectively in clinical practice. A portion of his experience is described below:

Psoriasis

Psoriasis, also known as “oxhide lichen”, is a chronic skin disease characterized by redness and scaling that has a tendency to recur. It is the same as “white crust”, “pine bark lichen”, and “dry lichen” in TCM theory. Professor Wang Sanhu views psoriasis from the perspective of heat toxin in the blood, and primarily uses variant formulas of Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng). He uses 30 grams of water buffalo horn (shuǐ niú jiǎo) as a substitute for rhinoceros horn (xī jiǎo) in the formula, along with 30 grams of fresh rehmannia root (shēng dì) and 12 grams each of red peony root (chì sháo) and moutan root bark (dān pí). He often adds coptis root (huáng lián) and scutellaria root (huáng qín) to strengthen the formula’s ability to clear heat, drain fire, cool blood, and resolve toxin, as well as arnebia/lithospermum (zǐ cǎo) and isatis leaf (dà qīng yè) to enhance its blood-cooling and blood-quickening effects. Thus, he has created a basic formula for treating psoriasis: water buffalo horn (shuǐ niú jiǎo) 30 g, fresh rehmannia root (shēng dì)30 g, moutan root bark (dān pí) 12 g, red peony root (chì sháo) 12 g, arnebia/lithospermum (zǐ cǎo) 15 g, forsythia fruit (lián qiào) 15 g, sophora flower (huái huā) 15 g, scutellaria root (huáng qín) 12 g, saposhnikovia root (fáng fēng) 10 g, ligustrum fruit (nǚ zhēn zǐ) 12 g, eclipta (hàn lián cǎo) 12 g, licorice root (gān cǎo) 12 g, mulberry root bark (sāng bái pí) 12 g, tribulus fruit (jí lí) 30 g, cicada molting (chán tuì) 12 g, anemarrhena root (zhī mǔ) 12 g, and gypsum (shí gāo) 30 g. For cases with invasion of the stomach by liver qi or liver-stomach disharmony, he adds dandelion (pǔ gōng yīng) and forsythia fruit (lián qiào), which act to course the liver and harmonize the stomach in addition to clearing heat and resolving toxin. If there is thirst with liking for fluids and dry bound stool, he adds 30 to 60 grams of raw gypsum (shēng shí gāo). If there is damp heat in the lower burner, he adds phellodendron (huáng bǎi), flavescent sophora root (kǔ shēn), and sophora flower (huái huā). If there is stasis, he adds carthamus flower (hóng huā), salvia root (dān shēn), spatholobus stem (jī xué téng), and peach kernel (táo rén). If there is dampness, he combines the formula with Stomach-Calming Powder (píng wèi sǎn) and adds smooth greenbrier root (tǔ fú líng) and coix seed (yì rén). If there is phlegm, he adds pinellia rhizome (bàn xià), white mustard seed (bái jiè zǐ), and poria (fú líng). For cases with severe itching, he adds tribulus fruit (cì jí lí), silkworm (bái jiāng cán), kochia fruit (dì fū zǐ), and purslane (mǎ chǐ xiàn). If the face is primarily affected, dahurian angelica (bái zhǐ) and dictamnus bark (bái xiān pí) may be added. If the skin lesions are dark purple, he adds arnebia/lithospermum (zǐ cǎo) and isatis leaf (dà qīng yè). If the skin damage takes a long time to heal, he adds mume fruit (wū méi) or pomegranate rind (shí liú pí).

Professor Wang Sanhu has used Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) to successfully treat many cases of psoriasis, not all of which will be listed here. In September 2017, Professor Wang Sanhu was invited to teach in Australia, where he lectured on psoriasis. In October 2017, a student in Australia sent feedback via WeChat after getting good results using Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) to treat psoriasis: “Professor Wang, I listened to your class and used your formula, and it was really effective. For example, there was a female patient in her fifties who had suffered from oxhide lichen for over 30 years. She had skin lesions in multiple areas with itching and discomfort, and her skin was dry and flaky. When she left after the first visit, my red floor was covered in white ‘snow’ and I had to change everything on the table. By the second visit, the patient’s mental state had greatly improved. At the third visit, I asked the patient to follow a vegetarian diet. By the fourth visit, there was no itching and no more ‘snow’. I used scrophularia root (xuán shēn) instead of water buffalo horn (shuǐ niú jiǎo), and I only used one-third of the dose for all of the medicinals.”

Note：Professor Wang Sanhu believes that the formation of psoriasis has an important relationship with excessive mental stress, depression and anger with inflexibility, liver and gallbladder depression and stagnation, and lesser yang wind-fire. Therefore, in clinical practice, if there is depressed mood or sighing, or if he learns that the patient suffers from mental stress or other circumstances in the course of the intake, he adds Minor Bupleurum Decoction (xiǎo chái hú tāng) to the formula.

A case of encephalopathy after carbon monoxide poisoning

The patient, Ms. Ma, was a 52-year-old female from Heyang County in Shaanxi. On April 3, 2013, she came in for her first visit for gas poisoning. She had a headache and brain fog, and needed to be accompanied by a caregiver. Her face was red as if she was wearing makeup. Her electroencephalogram showed hypoxic-ischemic brain changes. Her tongue was red with yellow fur, and her pulse was stringlike and rapid. The pattern diagnosis was heat-toxin in the blood and phlegm clouding the clear orifices. The treatment was to clear heat, cool the blood, resolve toxin, transform phlegm, and open the orifices using a variation of Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) and Gallbladder-Warming Decoction (wēn dǎn tāng) (granules): 1 packet each of water buffalo horn (shuǐ niú jiǎo), rehmannia root (dì huáng), moutan root bark (dān pí), red peony root (chì sháo), acorus root (shí chāng pú), polygala root (yuǎn zhì), gardenia fruit (zhì zǐ), pro formula pinellia rhizome (fǎ bàn xià), poria (fú líng), tangerine peel (chén pí), unripe bitter orange (zhǐ shí), trichosanthes fruit (guā lóu), chuanxiong rhizome (chuān xiōng), gastrodia root (tiān má), white atractylodes root (bái zhú), white peony root (bái sháo), juncus pith (dēng xīn cǎo), and lotus leaf (hé yè), for a total of 30 preparations, 1 preparation a day, to be dissolved in boiling water and divided into 2 doses to be taken separately. On May 1, 2013, she visited the clinic again and reported that her symptoms had lessened. She continued to take the same formula for 2 months, and on August 7, 2013, she came to the clinic by herself and her appearance was normal. She had occasional headaches, a red tongue, and a stringlike pulse. She was given 30 more preparations of the same formula.

Note: Professor Wang Sanhu has gradually summarized his experience in the course of treating multiple cases. Early on, he believed that the pathomechanism was phlegm-heat harassing the heart, so he used Gallbladder-Warming Decoction (wēn dǎn tāng) variant formulas to clear heat, transform phlegm, and quiet the heart. Later, in practice, he discovered that blood-heat turning into toxin was also an important pathomechanism.^［5］ This gave him the idea to use Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) combined with Gallbladder-Warming Decoction (wēn dǎn tāng) to treat encephalopathy caused by carbon monoxide poisoning. He used a complex prescription for a complex case; his experience using combinations of formulas to treat difficult diseases is significant.

A case of aplastic anemia

The patient, Ms. Ju, was a 56-year-old married female cadre from Honghai Village in Bachu County, Xinjiang. She came for treatment on December 25, 2002.

In September 2002, the patient started to feel unwell for no apparent reason, with lack of strength and low appetite. After 1 week, her lack of strength worsened; she felt flustered and short of breath, with tremors in her limbs. She was admitted to the Bachu County hospital, where she was treated for anemia. Her condition worsened, so she was quickly transferred to the 12th Hospital of the People’s Liberation Army in the city of Kashi ［or Kashgar］. Based on her clinical presentation and peripheral blood smear, she was diagnosed with “acute aplastic anemia” and was given stanozolol, prednisone acetate, and cyclosporine. After undergoing nearly 3 months of treatment, requiring 1 blood transfusion every week, she came to the Cancer Research Institute at the Fourth Military Medical University ［now the Air Force Medical University］ in Xi’an.

At the initial intake, the patient had a lusterless facial complexion, with somber white lips and tongue. She was fatigued and her whole body was covered with maculopapular eruptions that were dark purple in color, some as large as a penny and others as small as a sesame seed, which were mainly concentrated on her chest. She felt sharp pain in her chest like being stabbed with a needle, along with tremors in her limbs, heart vexation, dry mouth, lumbar pain, limp legs, a crimson tongue, and a rapid pulse. Her disease was classified as vacuity consumption and the pattern diagnosis was toxic heat entering the blood, marrow depletion with desiccation of essence, and dual vacuity of qi and blood. The treatment methods were to cool and dissipate blood, stanch bleeding, and resolve toxin, along with supplementing blood, replenishing essence, and boosting qi. The formula used was a variation of Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng): water buffalo horn (shuǐ niú jiǎo) 30 g, fresh rehmannia root (shēng dì) 30 g, white peony root (bái sháo) 12 g, moutan root bark (dān pí) 12 g, arnebia/lithospermum (zǐ cǎo) 15 g, sophora flower (huái huā) 10 g, eclipta (hàn lián cǎo) 12 g, notoginseng root (sān qī) 5g (to be taken drenched), cooked rehmannia root (shú dì) 20 g, ass hide glue (ē jiāo) 10 g (melted), tortoise shell (guī bǎn) 12 g, cornus fruit (shān yú ròu) 12 g, and mix-fried astragalus root (zhì huáng qí) 40 g. One preparation was to be taken daily, decocted with water. The patient returned on January 10, 2003, after continuously taking 12 preparations of the above formula. She felt that her energy had increased and the bleeding spots on her skin had gradually disappeared. She had a low-grade fever at night, and while her tongue body was dark, it was lighter than it was before. Her pulse was rapid. This was caused by a gradual decrease in heat toxin with effulgent yin vacuity fire. The plan was to build on the foundation of clearing heat, resolving toxin, cooling blood, stanching bleeding, quickening the blood, transforming stasis, supplementing the kidneys, and replenishing marrow by adding medicinals that clear vacuity heat, using the following formula: water buffalo horn (shuǐ niú jiǎo) 30 g, fresh rehmannia root (shēng dì) 30 g, red peony root (chì sháo) 12 g, moutan root bark (dān pí) 12 g, arnebia/lithospermum (zǐ cǎo) 12 g, tortoise shell (guī bǎn) 12 g, cooked rehmannia root (shú dì) 30 g, cornus fruit (shān yú ròu) 12 g, ligustrum fruit (nǚ zhēn zǐ) 12 g, eclipta (hàn lián cǎo) 12 g, mulberry (sāng shèn) 12 g, ass hide glue (ē jiāo) 10 g, stellaria (yín chái hú) 12 g, lycium bark (dì gǔ pí) 12 g, scrophularia root (yuán shēn) 12 g, black swallowwort (bái wēi) 12 g, scutellaria root (huáng qín) 10 g, agrimony (xiān hè cǎo) 10 g, and flowery knotweed root (hé shǒu wū) 12 g. Variant: for convulsions of the hands and feet, add 12 g of gastrodia root (tiān má), 12 g of white peony root (bái sháo), 6 g of licorice root (shēng cǎo), 10 g of chaenomeles fruit (mù guā), and 30 g each of crude dragon bone and oyster shell (shēng lóng mǔ). One preparation was to be taken daily, decocted with water. The patient’s third visit was on March 6, 2003. She had continuously taken 30 preparations of the formula given above and felt that her symptoms had lessened. She had only 2 blood transfusions in February and the dose of her western medications had been gradually reduced due to the side effects.

Note: Aplastic anemia is considered a difficult disease for which modern medicine has not yet found a specific treatment. The success of this case lies in the fact that, from the initial observation of heat toxin entering the blood to the later stage presenting with kidney yang depletion, the treatment always targeted the essential nature of vacuity consumption, which is “marrow depletion with desiccation of essence, and dual vacuity of qi and blood”, and focused on the relationships among mutual transformation of essence and blood, mutual engendering of qi and blood, and yin growing when yang arises. Particular attention was paid to the application of focused and powerful medicinals with affinity to flesh and blood. This shows that TCM is not limited to pattern diagnosis, but also emphasizes the identification of diseases. Only when the disease has been clearly identified can one have a proactive, comprehensive, and in-depth grasp of the occurrence and development of a disease, as well as the changes in the pattern.

Author information:

Wang Huan, Xi’an Traditional Chinese Medicine Hospital, Shaanxi Province

Quan Xinkong, Xi Jing Hospital

References

1. Wang Sanhu, Zhang Zhonghai, Wang Changhai et al., eds. 120 shou Qianjin Fang yanjiu ［Research on 120 formulas from Thousand Gold Pieces Formulary］［S］. Shaanxi sheng kexue jishu chubanshe ［Shaanxi Science and Technology Press］, 1997:177.

2. Zhang Ruonan, Wang Xing. Wang Sanhu yingyong Qianjin Fang zhiliao aizheng jingyan ［Wang Sanhu’s experience applying Thousand Gold Pieces Formulary to treat cancer］［J］. Zhongyi zazhi ［Journal of traditional Chinese medicine］, 2004, 45(3):176-177.

3. Liu Xiaochao, Li Ling. Wang Sanhu jiaoshou zhiliao nao zhongliu de jingyan ［Professor Wang Sanhu’s experience treating brain tumors］［J］. Zhongguo minzu minjian yiyao ［Chinese journal of ethnomedicine and ethnopharmacy］, 2009, 18(8):52-53.

4. Qi Tao, Wang Huan. Wang Sanhu zhiliao xueguanliu jingyan ［Wang Sanhu’s experience treating angioma］［J］. Zhongguo zhongyiyao xinxi zazhi ［Chinese journal of information on traditional Chinese medicine］, 2009, 16(6):83.

5. Wang Sanhu. Zhongyiyao zhiliao yiyanghuatan zhongdu chifaxing naobing 2 li ［Treating 2 cases of delayed encephalopathy from carbon monoxide poisoning with Chinese medicine］［N］. Zhongguo zhongyiyao bao ［Chinese journal of Chinese medicine］, 2003-8-11 (6).

王三虎運用犀角地黃湯治療疑難病經驗

王歡 權鑫 郭黎紅

摘要

目的：犀角地黃湯在治療疑難病方面的應用研究。

方法：通過跟師學習及整理病案，總結王三虎教授運用犀角地黃湯在治療疑難病方面的經驗。

結果：王三虎教授抓住本方配伍精煉，適應面廣的特點，在臨床上運用犀角地黃湯治療多種疾病均獲良效。

結論：犀角地黃湯清熱之中兼以養陰，涼血之中又能散瘀，對於辨證屬熱入血分的疾病療效可靠。

關鍵詞：犀角地黃湯；疑難病；王三虎

犀角地黃湯是《千金方》6500餘首方劑中最具代表性的方劑之一。

它出自《備急千金要方·卷十二·吐血第六》：“治傷寒及溫病應發汗而不汗之內蓄血、及鼻衄、吐血不盡，內餘瘀血，大便黑、面黃，消淤血方。”

方中犀角（水牛角） 清熱涼血解毒為君藥，原方由犀角一兩、乾地黃八兩、芍藥三兩、丹皮二兩組成，具有清熱解毒，涼血散瘀之功，為溫熱病熱入血分的常用方。

主治熱入血分的譫語、發斑，熱傷血絡的吐血、衄血、便血、尿血。

“方中犀角（水牛角） 清熱涼血解毒為君藥,生地清熱涼血，滋養陰液為臣，芍藥和營泄熱，丹皮泄血分伏熱，涼血散瘀為佐使，四藥相合，配伍精當，巧妙地解決了涼血與活血，止血與散血的矛盾，清熱之中兼以養陰，涼血之中又能散瘀，是熱清血止而無留瘀之弊，故為治療熱入血分之要方。”^［1］

西安市中醫院首席腫瘤專家王三虎教授運用《千金方》治療疑難雜病經驗豐富，^［2,3,4］而犀角地黃湯則是他最常用的方劑之一。

王三虎教授抓住本方配伍精煉，適應面廣的特點，在臨床上運用犀角地黃湯治療多種疾病均獲良效，玆將部分內容闡釋如下。

銀屑病

銀屑病又叫牛皮癬是一種慢性具有復發傾向的紅斑鱗屑皮膚病，相當於中醫學說的白疕、松皮癬、乾癬。

王三虎教授對銀屑病從血中熱毒立論，以犀角地黃湯加減為主方。

方中犀角用水牛角30克代替，生地30克，赤芍、丹皮各12克。往往加黃連、黃芩加強清熱瀉火涼血解毒之力，紫草、大青葉增強涼血活血之效。

從而形成了銀屑病治療的基本方：

水牛角30g，生地30g，丹皮12g，赤芍12g，紫草15g，連翹15g，槐花15g，黃芩12g，防風10g，女貞子12g，旱蓮草12g，甘草12g，桑白皮12g，蒺藜30g，蟬蛻12g，知母12g，石膏30g。

若肝氣犯胃，肝胃不和者加蒲公英、連翹在清熱解毒中有疏肝和胃之功；口渴喜飲，大便乾結，加生石膏30～60克；兼下焦溼熱，加黃柏、苦參、槐花；挾瘀加紅花、丹參、雞血藤、桃仁；挾溼合平胃散，加土茯苓、薏仁；挾痰加半夏、白芥子、茯苓；搔癢甚者加刺蒺藜、白僵蠶、地膚子、馬齒莧；面部為主可加白芷、白鮮皮，斑色紫暗加紫草、大青葉；皮損久不收口加烏梅或石榴皮。

王三虎教授運用犀角地黃湯治愈的銀屑病病例非常多，在這裏不一一列舉。王三虎教授於2017年9月受邀去澳大利亞講學，其中就講到了銀屑病。

2017年10月有澳洲學員運用犀角地黃湯治療銀屑病取良效後微信回饋：“王老師，我聽您的課，用您的方，效果真好。舉個例子吧，病人50多歲，女，患牛皮癬30年多，多處皮疹，搔癢難受，皮膚乾燥掉屑，第一診離開時我的紅地板下了一場白雪覆蓋，全部床上用品換了。第二診病人精神狀態好很多，第三診我要求病人素食，第四診不癢，不下雪啦，玄參代替水牛角，全部藥我只用三分之一的量。”

按語：王三虎教授認為本病的形成與精神壓力過大，鬱怒難伸，肝膽鬱滯，少陽風火有很重要的關係，所以臨床上對心情抑鬱，喜嘆息，或者問診中得知精神壓力等情況時，均配合小柴胡湯。

一氧化碳中毒後腦病案

馬某某，女，52歲，陝西合陽縣人。

2013年4月3日以煤氣中毒4月初診。頭痛，頭腦不清，需要陪護，面赤如妝，腦電圖：腦缺血缺氧改變。舌紅，苔黃，脈弦數。證屬血中熱毒，痰蒙清竅。治當清熱涼血解毒，化痰開竅，犀角地黃湯和溫膽湯化裁（顆粒劑）：

水牛角，地黃，丹皮，赤芍，石菖蒲，遠志，梔子，法半夏，茯苓，陳皮，枳實，瓜蔞，川芎，天麻，白朮，白芍，燈芯草，荷葉各一袋，30劑，每天一劑，開水沖化，分兩次服。

2013年5月1日來診，自覺症減。

守方兩月，2013年8月7日單獨來診，貌如常人，偶頭痛，舌紅，脈弦。仍守前方30劑。

按語：王三虎教授也是在多個病例中逐漸總結經驗，早期認為其病機為痰熱擾心，方用溫膽湯加減以清熱化痰寧心，後來在實踐中發現血熱成毒也是重要病機之一。^［5］從而形成了以犀角地黃湯合溫膽湯治療一氧化碳中毒性腦病的思路。以複雜對複雜，合方治療疑難病的經驗值得重視。

再生障礙性貧血案

巨××，女，56歲。已婚，幹部。新疆巴楚縣紅海鄉人。2002年12月25日就診。

患者於2002年9月無明顯誘因出現身體不適，乏力，食欲差，1週後乏力加重，感覺心慌，氣短，並伴有四肢震顫，遂入巴楚縣醫院。

按貧血治療，病情加重急轉入喀什市解放軍十二醫院，結合臨床及周圍血象診斷為“急性再生障礙性貧血”。

給予司坦唑醇、醋酸尼潑松、環孢素等。治療近3個月，須每週輸血1次，遂前往西安第四軍醫大學腫瘤研究所。

初診：患者面色無華，唇舌蒼白，疲乏，全身皮膚斑疹，色紫暗，大如銅錢，小如芝麻，以胸部為主。胸口針扎樣劇痛，四肢震顫，心煩口乾，腰痛腿軟，舌絳，脈數。

病屬虛癆，證屬：毒熱入血，髓虧精枯，氣血兩虛。法當涼血散血止血解毒，佐以補血填精益氣。

方以犀角地黃湯化裁,

水牛角30g，生地30g，白芍12g，丹皮12g，紫草15g，槐花10g，旱蓮草12g，三七5g（沖服），熟地20g，阿膠10g（烊化），龜板12g，山芋肉12g，炙黃芪40g。每日1劑，水煎服。

2003年1月10日復診，上方連續服用12劑，患者自覺力增，皮膚出血點逐漸消失，夜間低熱，舌質暗較前變淺，脈數。系熱毒漸減，陰虛火旺造成，擬在清熱解毒，涼血止血，活血化瘀，補腎填精基礎上，佐以清虛熱藥。

擬方如下：

水牛角30g，生地30g，赤芍12g，丹皮12g，紫草12g，龜板12g，熟地30g，山芋肉12g，女貞子12g，旱蓮草12g，桑椹12g，阿膠10g，銀柴胡12g，地骨皮12g，元參12ｇ，白薇12ｇ，黃芩10ｇ，仙鶴草10ｇ，何首烏12ｇ。加減：手足抽搐，加天麻12ｇ、白芍12ｇ、生草6ｇ、木瓜10ｇ、生龍牡各30ｇ。每日1劑，水煎服。

2003年3月6日第三診，上方連續服用30劑左右，自覺症狀減輕，2月僅輸血兩次，西藥因副作用逐步減量。

按語：再生障礙性貧血屬疑難病之一，現代醫學尚無特效療法。本案的成功，在於無論初期兼見熱毒入血，還是後期兼見腎陽虧虛，始終針對虛癆這種疾病“髓虧精枯，氣血兩虛”的本質，注意精血互化，氣血相生，陽生陰長的關係。尤其注重應用力專效宏的血肉有情之品。提示中醫不僅辨證，也講究辨病。只有辨病清楚，才能對疾病的發生發展，證情的變化有主動的、全面的、見微知著的把握。

參考文獻

1. 王三虎，張仲海，王長海等主編.120首千金方研究［S］ .陝西省科學技術出版社，1997:177.

2. 張若男，王星，王三虎應用《千金方》治療癌症經驗.［J］.中醫雜誌，2004，45（3）：176-177.

3. 劉小超，李玲，王三虎教授治療腦腫瘤的經驗.［J］.中國民族民間醫藥，2009，18（8）：52-53.

4. 斯韜，王歡，王三虎治療血管瘤經驗.［J］.中國中醫藥信息雜誌，2009，16（6）：83.

5. 王三虎，中醫藥治療一氧化碳中毒遲發性腦病2例.［N］.中國中醫藥報，2003-8-11（6）.

作者簡介:

王欢,陕西省西安市中医医院

权鑫空,西京醫院