[Case 1] Shi, male, 22 years old. The patient was found to have hepatosplenomegaly, cirrhosis and hypersplenism 3 months ago and underwent splenectomy. In the past 1 month, he had a distended abdomen, ascites, nausea, epistaxis, gum bleeding, chest tightness, abdominal distension, distension after meals, low fever in the afternoon, 37.5℃～38.5℃, restlessness at night, thin stools, 4 or 6 times a day, and little yellow urine. The abdomen was distended, with an abdominal circumference of 86 cm; the ascites sign was obvious, and the lower limbs were not swollen. Laboratory examination: jaundice index 6U, bilirubin 0.3mg%, globulin 2.55mg%, tongue red, pulse string. Chinese medicine diagnosis: Yin deficiency and blood heat, liver depression suppressing the spleen, no power of transportation and transformation, water stagnation in the middle jiao, resulting in abdominal fullness and diarrhea. Treatment: Nourishing Yin and cooling Blood, softening the Liver and regulating the Spleen, and promoting water retention and dampness. Prescription: Yin Chai Hu 3g, Artemisia annua 4.5g, Bai Wei 10g, Red and White Peony 10g each, Di Bark 10g, Dan Pi 10g, Sheng Zhi Bai 10g each, Gentiana macrophylla 12g, Bai Mao Root 30g, Forsythia lanceolata 15g, White Silkworm 10g, Cicada Sox 10g, Turtle A 10g, Raw Oyster 18g, Fried Citrus Aurantium 6g, Chuan Pu 4.5g, Ze Xie 10g, Fu Ling Pi 20g, Pig Ling 10g, Dong Gua The above formula was used as the main formula, with slight addition and reduction according to the symptoms. The patient’s diarrhea gradually stopped, epistaxis improved significantly, appetite was normal, body temperature was stable, ascites disappeared, abdominal circumference was 65 cm, liver was not palpable, jaundice index was 5 U, bilirubin 0.7 mg%, muscular turbidity 8 U, brain flocculence (-), Takada’s ( -), albumin 2.89g%, globulin 1.70g%, discharged from the outpatient clinic for continued observation. [Comment] In this case, after splenectomy for liver cirrhosis, due to internal heat for a long time, and because the operation injured Yin and consumed Blood, resulting in Yin deficiency and Blood heat, so see low fever, epistaxis, restlessness and sleeplessness, red tongue, etc., and due to the abnormal transportation and transformation, water-dampness stagnation and accumulation of dropsy. In such a case where Yin deficiency and water-dampness coexist, the doctor took the intention of Qing Bone San combined with Artemisia and Turtle Nail Tang, aiming at nourishing Yin and draining the volatile heat in Yin, and added water-relieving drugs that can clear deficiency heat without harming Yin to percolate water-dampness, which better handled the relationship between Yin deficiency and water-dampness, so that Yin regained heat and water-distension subsided. [Case 2] Zhou, male, 28 years old, first seen on February 27, 1963. Complaint: swelling, weakness, hypochondriacal pain and poor circulation for 1.5 years. Since the second half of 1961, the patient felt mild swelling of both lower extremities, fatigue and weakness. In February 1962, a blood test revealed abnormal liver function, glutamate transaminase 200 U, muscimol 12 U, and brain flocculence (++++). After September 1962, the symptoms worsened, with poor appetite, vague swelling and vague pain in the liver area, nausea and weakness, swelling of lower extremities, yellow urine, and liver in the second finger below the rib cage. 500 U, muscimol turbidity test 19 U, ceruloplasmin flocculence test (++++). He was hospitalized, and after hepatoprotective treatment, his symptoms and liver function improved, and he was discharged in December 1962, but his symptoms resurfaced and his liver function deteriorated again one month later. The liver was palpable under the ribs, the spleen was 1.5 cm below the ribs, moderately hard, with light tenderness, and mild concussive edema in both lower limbs. Liver function: normal glutamate transaminase, muscular turbidity 6U, cerebral flocculence (++++); blood routine: leukocytes 3.2×109/L, platelets 79×109/L; protein electrophoresis: globulin 29.5%; phenol tetrabromine sodium test: 15% in 30 minutes; liver puncture pathology confirmed as nodular cirrhosis. Esophagogram: varices in the lower esophagus. He was hospitalized for more than 2 months, and came to the hospital outpatient clinic after hepatoprotective treatment, but his symptoms did not decrease. The tongue coating is white, the tongue is red, and the pulse is sunken and slippery. The diagnosis is liver and kidney yin deficiency, spleen failure, Qi deficiency and blood stagnation, and blood stasis blocking the ligaments. The treatment is to nourish the liver and kidney, strengthen the spleen, tonify the qi, nourish the blood, soften the liver and activate the blood circulation. Herbs: Astragalus membranaceus 15g, Paeonia lactiflora 30g, Radix et Rhizoma Polygonati 15g, Radix Codonopsis pilosulae 12g, Semen Cuscutae 15g, Rhizoma Chuanji 15g, Papaya 12g, Agaricus blazei (melted) 9g, Rhizoma Atractylodis Macrocephalae 9g, Radix et Rhizoma Dioscoreae 15g, Radix et Rhizoma Inulae 15g, Patchouli 6g, Dandelion 15g, Radix et Rhizoma Dioscoreae 9g, Radix et Rhizoma Aromaticae 9g, Radix et Rhizoma Sinensis 15g, Radix et Rhizoma Urticae 3g. The above formula was used as the main formula with slight addition and subtraction. On June 22, 1963, the prescription was changed as follows: Astragalus membranaceus 30g, Radix Angelicae Sinensis 12g, Radix Rehmanniae 15g, Turtle Aegis 24g, Radix He Shou Wu 30g, Radix Paeoniae Alba 30g, Artemisia lactiflora 12g, Rhizoma Huang Lian 6g, Fructus Sibiricae 9g, Radix Yan Hu Suo 9g, Radix Papaya 12g, Radix Elm 15g, Radix Inulae 15g, Radix Thistle 15g, Umei 9g, Radix Glycyrrhiza Uralensis 3g. Up to the end of 1965, the above two prescriptions were used as the main treatment with addition and reduction. The symptoms improved and the liver function gradually recovered, and the varices were confirmed to have disappeared on two esophagograms. [The onset of this case was insidious, although he felt swelling, weakness, dysesthesia and poor appetite, the detailed date of onset was not available. The symptoms and liver function damage gradually worsened. The key to the treatment of this case is to grasp the essence of its pathology, which can never be helped by agents that activate blood circulation and break down blood stasis, and eliminate and attack the liver. Therefore, Prof. Guan Youbo has repeatedly emphasized the importance of supporting the deficiency and promoting the digestive function so that the patient can appetite and eat. Because “medicine is not as good as food”, the latter is abundant in water and grain, then the organs can be nourished, and then nourish the blood and soften the liver, the liver is full of Yin and blood, then the firm is cut and soft, and the function can be restored; therefore, Angelica sinensis and Peony are the most commonly used products to nourish the blood and soften the liver in the treatment of cirrhosis by Prof. Guan Youbo. If the Qi and Blood help each other, the blood stasis will be removed and the veins will be opened. Therefore, although hepatosplenomegaly and esophageal varices are seen, the prescription only uses turtle nail to nourish Yin and soften the firmness, and the dragon to invigorate Blood and open the channels, which is the beauty of the formula. In this case, because blood-heat has not yet been cleared and blood stasis has blocked the ligaments, spider nevus is present, so Shengdi, Huanglian, Xiaoxi and Diyu are used to cool the blood and detoxify the toxins. The treatment course of this case basically reflects Prof. Guan Youbo’s basic view on the treatment of early cirrhosis, which is to grasp the pathological essence of Qi deficiency and Blood stagnation and adjust it according to the substantial damage of the liver, spleen and kidney. Due to the functional impairment brought about by the substantial damage to the organs, it is characteristic to focus on supporting the righteousness, and to use products to dispel the evil separately in response to the remaining evil detention, and to prohibit grasping and attacking to avoid damaging the righteousness. Sometimes, due to the fight between evil and positive, the positive is weak and the evil is weak, the remaining evil is very little, still can be used to support the positive, the positive is strong enough to defend against evil. [Case 3] Liu, male, 49 years old, date of first consultation: April 4, 1972. The patient has been suffering from hepatitis without jaundice since February 1963, repeatedly. since October 1970, liver function has been significantly abnormal, which has lasted for 1.5 years, the latest liver function test results: glutathione aminotransferase 350 U, musculus 18 U, musculus (++), platelets 8.4 million / mm3. albumin ratio: 2.86 / 3.14, diagnosed as early cirrhosis. He had taken Chinese and Western medicine, but there was no significant change in symptoms and liver function tests. On April 4, 1972, he came to the hospital as an outpatient. At that time, he saw: yellowish white face, shortness of breath, weakness, generalized lethargy, little food, abdominal distension, loose stools, and cold feet. Tongue: white tongue coating and light tongue texture. Pulse: sunken and weak. Western medicine diagnosis: chronic hepatitis, early cirrhosis. The diagnosis belongs to spleen and kidney Yang deficiency, Qi deficiency and blood stagnation. The treatment is to warm the spleen and kidney, benefit Qi and nourish Blood to soften the liver. Treatment: Astragalus membranaceus 30g, Pseudostellaria pallidum 10g, Atractylodes macrocephala 10g, Radix Codonopsis pilosulae 12g, Radix Aromaticus 10g, Almond 10g, Radix Orange 10g, Radix Paeoniae Alba 15g, Radix Angelicae Sinensis 15g, Rhizoma Polygonati 12g, Radix et Rhizoma Inulae 15g. After 1 month of treatment, symptoms improved, both feet became warmer, abdominal distension decreased, stools were still dilute, food and appetite gradually improved. Review albumin 3.42g%, globulin 3.12g%, then still take the original formula, change raw astragalus to 45g, followed by 2 months long, review liver function: albumin 3.40g%, globulin 3.12g%, to January 1973 review albumin 3.16g%, globulin 2.82g%. Later, the raw astragalus was changed to 60g, and the light saprophytic tablets were used to 15g, and served until May 1973, when albumin was rechecked at 3.36g% and globulin at 2.3g%. By the end of treatment in August 1973, the albumin was 3.85g%, globulin was 2.13g%, glutathione aminotransferase was normal, musk turbidity was 8U, musk flocculence (+). The patient’s appetite improved, his bowel movements were normal, but he was easily fatigued, sleep deprived, and had a clear tongue and sunken pulse. [The case was diagnosed as chronic hepatitis and early cirrhosis in Western medicine. Based on the features of a deficiency of coldness, such as lassitude, loose stools, cold feet, and sunken and weak pulse, Guan identified the deficiency of spleen and kidney yang and stagnation of qi and blood, and used the method of strengthening the spleen and warming the kidney, benefiting qi and nourishing blood, and softening the liver. In this case, under the circumstances of severe liver function damage and albumin inversion, we insisted on using TCM theory as the guide, treating with evidence and using reasonable medicine, thus improving clinical symptoms and restoring liver function relatively smoothly, fully reflecting the importance and superiority of TCM evidence-based treatment in liver disease. Regarding the inversion of albumin, Guan believes that this is substantial damage to the liver and kidney, which is equivalent to deficiency of Qi and blood in Chinese medicine. Therefore, the treatment mostly starts with tonifying qi and blood, benefiting liver and kidney, and at the same time, according to their different yin and yang disease locations, the corresponding blood and flesh sentient class of drugs, such as Zi He Che and Agaricus, are used as appropriate, thus helping to raise and adjust serum protein. [Case 4] Xu, male, 27 years old. Complaint: 1 year of progressive abdominal distension, swelling of lower limbs, scanty urine, tea-red urine, frequent epistaxis. Laboratory tests: jaundice index 5U, bilirubin 0.4mg%, muscular turbidity 5U, muscular flocculence (+), Takada’s reaction (+), plasma protein 3.41g%, globulin 1.89g%. Western medicine diagnosed as cirrhotic ascites. Diagnosis: shortness of breath and weakness, loss of appetite, pain at the lower end of the left hypochondrium, abdominal distension, swollen limbs, yellow urine. The tongue is dark and pale, with white fur and sunken pulse. The diagnosis is a deficiency of Qi and Blood, liver depression and blood stasis, and internal stagnation of water and dampness. Treatment: Tonify Qi and nourish Blood, regulate Qi and invigorate Blood, and adjuvantly promote water retention. Prescription: Astragalus membranaceus 30g, Salvia miltiorrhiza 15g, Radix et Rhizoma catharanthus 4.5g, Radix Angelicae Sinensis 12g, Radix Paeoniae Alba 15g, Almond 10g, Rhizoma Orange 10g, Radix Aromaticus 10g, Eugenia 7.5g, Salviae Miltiorrhiza 10g, Safflower 6g, Zelenia 15g, Oyster 15g, Mucuna Pruriens 12g, Radix Achyranthes Bidentatae 10g, Mucuna 3g, Radix et Rhizoma Sanguinariae 3g, Radix et Rhizoma Ginger 3g, Radix et Rhizoma Dagastrodiae 12g, Radix et Rhizoma Tongcao 3g, Semen Coix 12g, Gourd 15g, Winter Melon Peel 12g each, Plantago ovata 12g (package). The above formula is the main formula, and then slightly added or subtracted according to the symptoms, a total of 3 months of medication. After the medicine, in addition to occasional gingival bleeding, there is no discomfort, food, sleep and stool are normal. Physical examination: ascites sign disappeared, abdominal circumference 80cm, spleen as large as before, liver not palpable, lower limbs not swollen. Laboratory tests: jaundice index 4U, bilirubin 0.8mg%, musculus 3U, musculus flocculus (-), Takada’s (-), plasma protein 3.54g%, globulin 2.16g%. Discharged from the hospital for outpatient observation and continued treatment. [Comment] Dropsy and ascites are mostly prolonged diseases, although there are real evil, the positive qi must be deficient, mixed with the real, it is difficult to seek near success. In this case, the patient has been ill for one year, and has shortage of breath and weakness, loss of appetite, and a weak tongue and thin pulse, so the deficiency is very obvious. And liver disease for a long time, qi and blood will not be able to flow, and the change of Qi stagnation and blood stasis. Guan’s method of tonifying Qi and nourishing Blood, regulating Qi and invigorating Blood, together with the method of promoting water circulation, is deeply based on the purpose of treating both the symptoms and the root cause. The formula uses astragalus, angelica, white peony and so on, replenish the qi and nourish the blood, support its righteousness; Chai Hu, Salvia, Radix et Rhizoma, Yu Jin and so on, regulate the qi and invigorate the blood, regulate its internal organs; adjuvant to the abdominal skin, winter melon skin, carthamus seeds and so on, expel its water evil. No fluke momentary effect, so that the March slow work to grasp the persistent disease of the year.