某，女，59岁， 体重；身高168cm, 体重

初诊：2015/5/24

病史：咳血、甲亢10年，手心发热，黄斑、便溏、纳呆、失眠、舌白腻、阴道炎、白带、肺部有结节，稍见钙化。胃酸发热。嗓子咽干、发烧、子宫肌瘤、阴痒、异味。小腹后腰极度不适，虚每日老公按摩。夜尿勤。中西医久治乏效，患者丧失信心，已经放弃治疗多年，体质日下。

刻诊：体瘦、手心热甚、面部黄斑、蜘蛛痣、每晚2点左右醒来难睡。舌红苔少、唇色深、脉沉、左寸弱、神可。无尿痛。

印象：肺胃阴虚，伤血，阴血虚，络脉灼伤咳血，阳气不升

治则：分步治疗，益肺胃之阴、清上焦火、温下焦水，兼治妇科

2015.6.1   药后矢气重，奇臭无比，甚觉舒服。咯血减少，色变淡，胃热大减，睡眠仍难。至6.5日以后再无咯血。纳增。至7.19 嗓子热痛减少70%，胃已不觉热。睡眠大有改善。酷暑停药。2015.9.8日开始继续服药。9.13日电告，药后浑身舒服，无任何不适。期间有过2次清晨痰里有黑色血点，夹杂鲜红色血点。2015.10.29咽干嗓子热痛消失，胃已无不适。大便好转，间有便溏，自觉阴道清爽，恶臭大减，夜尿减少至1次。腰部不适大减。本人如获再生，医患配合默契，电称‘让我吃砒霜我都敢吃’。但睡眠改善不大。仍在治疗中。

这是一个老朋友。20年前，因为服笔者的药后出现排病现象：满脸疹子。虽病有好转，因是貌美少妇，爱美胜于爱身，遂不再服药。后来病情越来越多，越来越重，才于20年后又回来，期间走过很多弯路。所以情况比较熟悉，除第一次面诊外，全部是网诊。因为这类病脉搏通常变动很小，主诉为主，完全可以网诊。但一般不可过剂，恐证有变。随时跟诊，当不致失治。中医是时间医学。只要患者有耐心，坚持服药，最终可以实现临床治愈的目标。



Female, 59 years old, weight; height 168cm, weight

Initial visit: 2015/5/24

Medical history: Hemoptysis, hyperthyroidism for 10 years, hot palms, jaundice, loose stools, poor appetite, insomnia, white and greasy tongue coating, vaginitis, leukorrhea, nodules in the lungs with slight calcification. Stomach acid reflux and fever. Dry throat, fever, uterine fibroids, vaginal itching, and odor. Extreme discomfort in the lower abdomen and lower back, requiring daily massage by her husband. Frequent urination at night. Long-term treatment with both traditional Chinese and Western medicine has been ineffective, leading to loss of confidence and abandonment of treatment for many years, resulting in a decline in her physical condition.

Current examination: Thin, very hot palms, jaundice on the face, spider angiomas, waking up around 2 AM every night and having difficulty falling back asleep. Red tongue with little coating, dark lips, deep pulse, weak left Cun pulse, alert. No dysuria.

Impression: Lung and stomach yin deficiency, blood deficiency, yin and blood deficiency, blood stasis due to burns in the collaterals, hemoptysis, and failure of yang qi to rise.

Treatment Principle: Step-by-step treatment, nourishing lung and stomach yin, clearing upper burner fire, warming lower burner water, and also treating gynecological issues.

June 1, 2015: After taking the medicine, the patient experienced heavy, extremely foul-smelling flatulence, but felt very comfortable. Hemoptysis decreased, the color became lighter, stomach heat greatly reduced, but sleep remained difficult. Hemoptysis ceased after June 5th. Appetite increased. By July 19th, throat burning and soreness decreased by 70%, and the stomach no longer felt hot. Sleep greatly improved. Medication was discontinued due to the hot summer. Medication resumed on September 8, 2015. A telegram was sent on September 13th stating that the patient felt comfortable all over after taking the medicine, with no discomfort. During this period, there were two instances of black blood spots mixed with bright red blood spots in the sputum in the morning. October 29, 2015: Dry throat and throat burning and soreness disappeared, and stomach discomfort subsided. Bowel movements have improved, with occasional loose stools. The patient feels a refreshing vaginal cleanliness, with significantly reduced odor. Nocturia has decreased to once a night. Lower back discomfort has greatly lessened. The patient feels reborn, with excellent doctor-patient cooperation; the patient even jokingly said, "I'd take any poison if you asked me to." However, sleep has not improved much. Treatment is still ongoing.

This is an old friend. Twenty years ago, after taking my medication, she experienced a detoxification process: her face was covered in rashes. Although her condition improved, as a beautiful young woman, she prioritized appearance over health and stopped taking the medication. Later, her condition worsened and recurred, leading to her return after 20 years, having gone through many detours. Therefore, I am quite familiar with her case, and all consultations except the first in-person visit were conducted online. Because the pulse for this type of illness usually changes very little, and the patient's complaints are primary, online consultations are perfectly feasible. However, it is generally important not to overdose, as the condition may change. Regular follow-up is necessary to prevent mistreatment. Traditional Chinese medicine is a time-dependent medicine. As long as the patient is patient and persists with medication, a clinical cure can ultimately be achieved.