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TCM Grand Consultation Report — 千古名医天团会诊报告

Date: 2026-08-24
Patient Chief Complaint: Morning fatigue and drowsiness, aversion to cold.
Tongue: Pale, swollen with teeth marks, white greasy coating.
Constitution: Yang-deficiency type (spleen-kidney yang deficiency with internal dampness retention).

"This old physician observes: the tongue is pale and swollen with teeth marks, the coating white and greasy — this is spleen deficiency with dampness excess. Morning fatigue and aversion to cold indicate yang deficiency failing to warm and nourish. The patient reports no thirst, preference for warm drinks, cold extremities, and a deep-thready pulse. This precisely matches the 'harmonious mouth' (口中和) criterion from the Shang Han Lun, excluding Yangming heat excess. Cold extremities and deep pulse correspond to Shaoyin 'fine and deep pulse' (脉微细). This is a combined Taiyin-Shaoyin pattern: spleen-kidney yang deficiency with internal cold-dampness. I prescribe Fuzi Tang (Aconite Decoction) combined with Lizhong Wan (Middle-Rectifying Pill) — warming the channels to assist yang, dispelling cold and eliminating dampness, while simultaneously strengthening the spleen and warming the middle."

"I respectfully dissent. This case is like a dike breached by ants, causing flooding downstream — spleen yang is the dike, kidney yang is the source. While the source may be low, the immediate crisis is the breached dike. Master Zhang's Fuzi Tang is like dredging the source before repairing the dike. Aconite is intensely pungent and hot, directly warming the life gate; but if spleen earth is not strengthened, clear yang cannot ascend, and cold-dampness has no exit — instead it congests the middle burner, causing dry mouth, restlessness, and poor appetite. My approach uses Buzhong Yiqi Tang (Tonify the Middle & Augment Qi Decoction) combined with Shengyang Qushi Tang (Raise Yang & Eliminate Dampness Decoction) — Astragalus, Ginseng, Atractylodes, and Licorice gently warm and strengthen the spleen; Cimicifuga and Bupleurum raise clear yang and distribute fluids; Atractylodes dries dampness and activates the spleen. Strengthen the dike first, then dredge the channels — qi abundance naturally disperses dampness, and cold resolves without directly warming the kidney."

"Upon reviewing both approaches, Master Zhang's Fuzi Tang combined with Lizhong Wan is well-suited for the Shaoyin cold pattern. However, Master Li's insight on 'clear yang not ascending' is profound. I propose a middle path: begin with Lizhong Wan to warm the middle and strengthen the spleen as the foundation; add a small amount of Fuzi (3-6g) to assist kidney yang without overwhelming the spleen. For the 'morning fatigue,' add a small amount of Cimicifuga and Bupleurum to raise clear yang — this combines the strengths of both masters. The formula should be modified Lizhong Tang with added Fuzi and Shengma."

"The channels indicate: the Taiyin Spleen channel and Shaoyin Kidney channel are both affected. I recommend acupuncture as auxiliary treatment: Pishu (BL20), Weishu (BL21), Shenshu (BL23), Guanyuan (CV4), and Zusanli (ST36). Apply reinforcing technique with moxibustion — 20 minutes needle retention. Moxa at Shenshu and Guanyuan is particularly important for warming kidney yang. For spleen yang deficiency, Pishu and Zusanli with warm needle technique can directly warm and tonify spleen-stomach qi."

"Swift action is needed, but not solely through internal medicine. I recommend the Five-Animal Frolics — specifically the Bear exercise — to strengthen the spleen and harmonize the stomach. Practice in the morning when yang qi is ascending. For diet: avoid cold, raw, and greasy foods; consume warm porridge with Chinese yam, Job's tears, and red dates. Warm foot baths with ginger before sleep to guide fire back to the source."

"According to Bencao Gangmu: Aconite (Fuzi) is 'pungent, sweet, very hot, toxic — warms the middle, disperses cold, restores yang, supplements fire.' For this pattern, processed Fuzi (Zhi Fuzi) should be used, decocted for 30-60 minutes to reduce toxicity. Ginseng (Ren Shen) in Lizhong Wan is 'sweet, slightly warm — greatly supplements original qi, strengthens the spleen, benefits the stomach.' For yang-deficiency constitution, red ginseng or processed ginger is preferable. Dried Ginger (Gan Jiang) 'warms the middle, disperses cold, restores yang and unblocks the vessels' — this is the monarch herb for this pattern. I caution: Fuzi must never be used raw, and the decoction time must be sufficient."

【Diagnosis】

Pattern: Taiyin-Shaoyin combined pattern — Spleen-Kidney Yang Deficiency with Internal Cold-Dampness
Pathogenesis: Spleen yang deficiency fails to transform and transport; kidney yang deficiency fails to warm and nourish; cold-dampness accumulates internally, clear yang cannot ascend.

【Internal Medicine】

Formula: Modified Lizhong Tang (理中汤加减)
Composition:

• ●Zhi Fuzi (Processed Aconite) 6g — warms kidney yang, assists spleen fire
• ●Gan Jiang (Dried Ginger) 9g — warms the middle, disperses cold (monarch herb)
• ●Dang Shen (Codonopsis) 12g — tonifies middle qi, strengthens the spleen
• ●Bai Zhu (White Atractylodes) 12g — dries dampness, strengthens the spleen
• ●Zhi Gan Cao (Honey-fried Licorice) 6g — harmonizes the middle, moderates other herbs
• ●Sheng Ma (Cimicifuga) 3g — raises clear yang (small amount)

Decoction Method: Soak herbs in cold water for 30 minutes. Bring to boil, then simmer for 45-60 minutes (especially important for Fuzi). Take warm, twice daily before meals.

【Acupuncture & Moxibustion】

Points: Pishu (BL20), Shenshu (BL23), Guanyuan (CV4), Zusanli (ST36)
Technique: Reinforcing method with warm needle or moxibustion. 20 minutes retention. 2-3 sessions per week.

【Dietary & Lifestyle Therapy】

• ●Diet: Warm, cooked foods. Chinese yam and Job's tears porridge; ginger and red date tea. Avoid cold drinks, raw salads, greasy foods.
• ●Exercise: Bear exercise from Five-Animal Frolics, 15-20 minutes morning practice.
• ●Foot bath: Warm water with fresh ginger slices, 15 minutes before bed.
• ●Sleep: Early to bed, avoid late nights to preserve kidney essence.

【Course of Treatment】

Initial course: 7-14 days. Reassess tongue and energy levels. If aversion to cold improves but fatigue persists, consider adding Astragalus and Bupleurum to strengthen qi-raising function.

【Contraindications】

1. ●Food incompatibility: Avoid cold foods (watermelon, ice cream, raw vegetables) while taking warm-tonifying herbs. Do not consume tea immediately after taking medicine.
2. ●Special populations: This formula contains warming herbs. Use with caution in patients with yin deficiency, internal heat, or high fever.
3. ●Drug interactions: Fuzi is incompatible with Ban Xia (Pinellia), Gua Lou (Trichosanthes), Bei Mu (Fritillaria), and Bai Lian/Bai Ji. Do not combine.
4. ●Fuzi toxicity: Must be decocted for at least 45 minutes. Never use raw Fuzi. Discontinue if experiencing numbness of tongue or extremities.
5. ●Pregnancy & lactation: This formula contains ginseng-family tonifying herbs. Pregnant women (especially first trimester), women trying to conceive, and nursing mothers should consult a licensed TCM practitioner before use.
6. ●Western Medicine Interaction: If you are taking any western medicine (including but not limited to blood pressure medication, diabetes medication, anticoagulants, antibiotics, or psychiatric medication), please take TCM formulas at least 2 hours apart from your western medicine, or follow your physician's guidance on timing. Never take TCM and western medicine simultaneously without professional advice.

Zhang Zhongjing vs. Li Dongyuan: The core divergence lies in whether to prioritize warming kidney yang (Fuzi Tang) or raising spleen yang (Buzhong Yiqi Tang). Zhang emphasizes the Shaoyin cold pattern requiring strong warming; Li argues that spleen deficiency is the root, and clear yang must ascend before cold-dampness can resolve. Sun Simiao's mediation: Begin with Lizhong Wan (warming middle) with small Fuzi (assisting kidney), avoiding heavy doses of Aconite until spleen function recovers. This represents a staged approach — first strengthen the spleen, then warm the kidney if needed.

Recommendation: Given the patient's constitution (yang-deficiency type), start with the modified Lizhong Tang approach. If after 7-10 days aversion to cold remains severe, gradually increase Fuzi dosage or add Rou Gui (Cinnamon Bark) to enhance kidney warming.

Disclaimer: This consultation is for reference only. Please consult a licensed TCM practitioner for in-person diagnosis and treatment. Do not self-prescribe, especially formulas containing Aconite.

千古名医天团会诊报告

日期： 2026-08-24
患者主诉： 晨起困倦、怕冷
舌象： 舌淡胖有齿痕，苔白腻
体质辨识： 阳虚质（脾肾阳虚、水湿内停）

"善信所述之症，老朽已详加辨析。舌淡胖有齿痕、苔白腻，乃脾虚湿盛；晨起困倦、怕冷，乃阳虚不能温煦、清阳不升。患者口不渴、喜热饮，正合《伤寒论》『口中和』之旨，排除阳明热盛；手足不温、脉沉细，乃少阴病『脉微细』之具体化。此属太阴少阴合病，脾肾阳虚、寒湿内停。当以附子汤合理中丸——温经助阳、散寒除湿，兼温中健脾、燥湿运脾。二方合用，少阴太阴并治，标本兼顾，此正老朽『勤求古训』之方证对应法也。"

"老朽谨表异议。此案犹如堤溃于蚁穴，水患于下流——脾阳如堤，肾阳如源；堤溃则水泛，源竭则流枯。仲景附子汤之法，犹如未修堤防而决源导流。附子大辛大热，直温命门，然脾土未健，清阳不升，寒湿无出路，反壅滞中焦，致口干咽燥、心烦失眠、腹胀纳呆之弊。吾当以补中益气汤合升阳除湿汤加减——黄芪、人参、白术、甘草甘温健脾，升麻、柴胡升清阳、布津液，苍术燥湿运脾、羌活祛风胜湿。健脾则堤防固，升阳则沟渠通，气旺则水湿自散，不治寒而寒自散，不温肾而阳自复。"

"老朽细审二家之法，仲景附子汤合理中丸，于少阴寒证甚合；然东垣『清阳不升』之论，确有见地。老朽主张取其中道：以理中丸温中健脾为本，少佐附子（3-6克）以助肾阳，不使过燥；晨起困倦者，少加升麻、柴胡以升清阳。方用理中汤加附子、升麻，兼取两家之长。"

"经络所过，主治所及。太阴脾经、少阴肾经俱病。老朽建议针灸辅助治疗：脾俞、胃俞、肾俞、关元、足三里。补法加灸，留针二十分钟。肾俞、关元宜重灸，以温肾阳；脾俞、足三里用温针法，直接温补脾阳。"

"元化观此证，非独药石可疗。宜练五禽戏之熊戏，以健脾胃、和气血。晨起阳气升发之时练习最佳。饮食忌生冷油腻，宜食山药薏米粥、姜枣茶。睡前以生姜水泡脚，引火归元。"

"据《本草纲目》：附子『辛甘大热，有毒——温中散寒，回阳补火』。此案宜用制附子，先煎三十至六十分钟以减毒性。人参『甘微温——大补元气，健脾益胃』，阳虚体质宜用红参或炮姜。干姜『温中散寒，回阳通脉』，为此方君药。切记：附子不可生用，煎煮时间必须充足。"

【诊断】

证型： 太阴少阴合病——脾肾阳虚、寒湿内停
病机： 脾阳不足，运化失司；肾阳亏虚，温煦无权；寒湿内停，清阳不升。

【内服】

方名： 理中汤加减
组成：

• ●制附子 6克 —— 温肾助阳，益脾火
• ●干姜 9克 —— 温中散寒（君药）
• ●党参 12克 —— 补中益气，健脾和胃
• ●白术 12克 —— 燥湿健脾
• ●炙甘草 6克 —— 调和诸药
• ●升麻 3克 —— 升清阳（少量）

煎服法： 冷水浸泡三十分钟，武火煮沸后文火煎煮四十五至六十分钟（附子尤须久煎）。温服，每日两次，饭前服用。

【针灸】

穴位： 脾俞、肾俞、关元、足三里
手法： 补法加温针或艾灸，留针二十分钟。每周二至三次。

【调养】

• ●食疗： 温热熟食为主。山药薏米粥、姜枣茶。忌冷饮、生冷沙拉、油腻食物。
• ●运动： 五禽戏之熊戏，晨起练习十五至二十分钟。
• ●泡脚： 生姜水泡脚，睡前十五分钟。
• ●起居： 早睡早起，避免熬夜伤肾。

【疗程】

初诊疗程：七至十四日。观察舌象及精力变化。若怕冷减轻而困倦未除，可加黄芪、柴胡以增强升提之功。

【禁忌】

1. ●食物相克： 服药期间忌食生冷（西瓜、冰淇淋、生菜等）。服药后不宜立即饮茶。
2. ●特殊人群： 本方偏温燥，阴虚内热、高热患者慎用。
3. ●药物配伍禁忌： 附子反半夏、瓜蒌、贝母、白蔹、白及，不可同用。
4. ●附子毒性： 必须久煎四十五分钟以上。禁用生附子。若出现舌麻、肢麻，立即停药就医。
5. ●妊娠及哺乳期： ⚠️ 孕妇及哺乳期妇女用药须知：本方含人参类补气药材，孕妇（尤其妊娠前三个月）、备孕期及哺乳期妇女请在持证中医师指导下使用，勿自行服用。
6. ●西药间隔： ⚠️ 服用西药者须知：如您正在服用任何西药（包括但不限于降压药、降糖药、抗凝药、抗生素、精神类药物），请在服用中药前间隔 2 小时以上，或遵医嘱调整服药时间。切勿自行同时服用中药与西药。

张仲景 vs. 李东垣： 核心分歧在于先温肾阳（附子汤）还是先升脾阳（补中益气汤）。仲景强调少阴寒凝需大力温阳；东垣认为脾虚为本，清阳不升则寒湿无出路。孙思邈调停： 先以理中汤温中健脾为本，少佐附子助肾阳，避免大量附子壅滞中焦。此为分阶段论治——先健脾，后视情况加温肾之品。

建议： 鉴于患者阳虚体质，先以理中汤加减起步。若七至十日后怕冷仍甚，逐步增加附子用量或加肉桂以增强温肾之力。

⚠️ 免责声明： 本会诊仅供参考，请咨询持证中医师进行面诊。切勿自行处方，尤其含附子的方剂须在专业医师指导下使用。

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