Qimou Female 78 2009.10.15 Presenting complaint: recurrent cramps below both knees for 4 years Presenting history: recurrent cramps below both knees for 4 years, every morning around 4:00 am, no obvious effect with safflower foot soak, not cold, slightly painful, back sore, sometimes dizziness, sweating, fear of cold, do not eat cold, sour, spicy food, stool sometimes dry, sometimes thin, urine regulation, tongue dark red, little moss, pulse string. Analysis: deficiency of yin and yang, loss of nourishment of tendons and veins Analysis: deficiency of yin, loss of moistening of tendons and veins, resulting in foot contracture; deficiency of yang, resulting in excessive sweating and fear of cold. Treatment: sour and sweet to transform yin, pungent and sweet to transform yang, soften the tendons and slow down the urgency. Prescription: White peony 30, roasted licorice 10, Gui Zhi 12, dry ginger 6, Chuan Niu Kne 12, Radix et Rhizoma 10 (first decoction), 7 doses, decoction, second diagnosis: taking the fifth side of the above, no more cramps, fear of cold improved, dry lips, swelling of the face and lower limbs, unformed stools, urine is sometimes more and sometimes less, dark red tongue, less moss, string pulse. The condition improved after medication, but this time there were signs of Yang deficiency unable to transform water. Treatment is based on sour and sweet to transform yin, and yin and yang should be tonified together. The formula is Paeonia lactiflora and licorice soup combined with Zhen Wu Tang plus and minus prescription: Paeonia lactiflora 30, roasted licorice 10, ginger 10, Gui Zhi 10, Fu Ling 20, fried Atractylodes macrocephala 10, Radix et Rhizoma Pseudostellariae 10 (first decoction), Zhi Mu 10, Bamboo leaf 6, 7 doses, decoction: after taking the above, cramps at the ankle once, swelling disappeared, fear of cold, cold below both knees is especially obvious, easy diarrhea after cold, thin stool, normal urine, red tongue with little moss, sunken weak pulse. The patient has a deficiency of Yang in the lower jiao and a deficiency of Yin and fire in the upper jiao, with obvious signs of upward floating of deficiency fire. Prescription: Paeonia lactiflora 45, Glycyrrhiza glabra 15, Ginger 10, Dried ginger 6, Dendrobium 10, Radix et Rhizoma Phellodendron 12, Decoction first, Chuan Niu Knee 20, Fennel 10, Chen Pi 10, 7 doses, Decoction in water. Paeonia lactiflora and Glycyrrhiza glabra combined with Erxian Tang plus and minus to consolidate the cure. The patient was treated with a decoction of 7 doses of peony and licorice, 15 roasted licorice, 10 dried ginger, 6 dendrobium, 12 dendrobium, 10 cypress, 6 senna, 15 spleen, 15 bacopa monniera, 10 fried atractylodes, 10 poria, 20 chuan and huai niu knee, 15 cumin, 10. Note: Paeonia lactiflora and licorice soup is from Article 29 and 30 of the Treatise on Typhoid Fever, which is used to treat typhoid fever due to misuse of sweat, injury to yin and blood, resulting in contracture of the feet that cannot be extended, irritability, and vomiting. In this case, the patient is old, deficient in both yin and yang qi, deficient in yin and fluid, and the tendons and veins are not moistened, so he has cramps in both lower extremities, liver wood is the main tendon, Yin time is the time when the lung meridian of the hand Taiyin is in full swing, lung gold grinds wood, so the symptoms of cramps appear around Yin time; Yang qi is deficient, the guard is not solid, and cannot warm the limbs, so he is afraid of cold and sweats a lot. The treatment should be to nourish yin and produce fluid, slow down the pain, and at the same time to take the sapodilla, ginger and cinnamon branch to strengthen the warmth of yang, “the yang energy is nourished by the essence, and the softness is nourished by the yin”. The formula reuses white peony, sour, bitter and cold, acid into the liver, combined with roasted licorice sweet warm, sour sweet yin, “liver bitter and urgent, anxious to eat sweet to slow down”, the two drugs together, slowing the liver and softening tendons, in order to collect the spasm, pain relief. The addition of Radix et Rhizoma Pseudostellariae and Radix Ginger nourishes Yang, so that Yin is assisted by Yang and the source is inexhaustible, Gui Zhi guards Yang and Niu Knee draws the medicine downward. The combination of all the medicines together can play a wonderful role in tonicizing both yin and yang, and slowing down the urgency through the meridians, so that the yin fluid can be restored and the tendons and veins can be nourished, then the contracture will be healed. At the second consultation, the patient’s foot contracture had improved, but there were symptoms such as swelling of the face and lower limbs and unfavorable urination, which is a sign of Yang deficiency that cannot control water. This is a symptom of Yang deficiency that cannot control water. The treatment is still based on acid and sweetness to transform yin, and at the same time increase yang nourishing herbs to make yin and yang complement each other. The formula is based on Paeonia lactiflora, Glycyrrhiza glabra, combined with Zhen Wu Tang, plus and minus. On the basis of the initial diagnosis, the effect of warming the kidney and promoting diuresis is enhanced. The patient’s tongue was dark red, so Zhi Mu was added to the formula to clear heat and moisten dryness; bamboo leaves could clear heat and facilitate urination. At the third consultation, the patient’s swelling disappeared, his urine was normal, and his cramps were significantly improved, with coldness in the lower limbs as the main symptom. The treatment is to restore Yang and benefit Yin, and induce the fire to move downward. Compared with the initial consultation, increase the dosage of hyssop to induce the downward movement of fire. The patient is prone to diarrhea and loose stools after exposure to cold, which is a sign of deficiency cold in the spleen and stomach. Therefore, ginger and dry ginger are used in this formula to warm the middle jiao and encourage stomach qi. At the fourth consultation, the patient’s cramps had significantly improved, and the fear of cold in both knees was relieved, but the signs of deficiency cold in the middle Jiao, such as fear of cold in the stomach and abdomen and intestinal tingling, were still more obvious. Therefore, on the basis of the third consultation, we enhance the function of warming the spleen and kidney. The formula used is Paeoniae and Glycyrrhiza glabra Tang combined with Erxian Tang with addition of Fu Ling and Atractylodes macrocephala to strengthen the spleen and dry dampness.