一瓢医案
清·薛 雪生白著
清·吴金寿子音篡
建档：juzhuo
--------------------------------------------------------------------------------
骨小肉脆，定非松柏之姿。脉数经停，已现虚劳之候。先天既弱而水亏，壮火复炽而金燥。岁气一周一损，岂容再损？秋风乍荐已伤，难免重伤。证具如前，药惟补北，非敢说梦，聊以解嘲：生地、沙参、地骨皮、麦冬、金石斛、生鳖甲。
苏禄国贡使久咳不能卧案：辨八方之风，测五土之性，大率贵邦偏在中华之巽上，箕尾之前，翼轸之外，阳气偏泄，即有风寒，易感易散。来此华夏，已属三焦。况不得卧下，肺气大伤，止宜润降而已：蜜炙枇杷叶、麦冬、川贝、甜杏仁、经霜桑叶、米仁。
《内经》谓:骨肉柔脆之人，其质本弱。然以脉症较之，其咳原属手太阴得之。闻先一人补之，后一人泻之，邪则从补而升，元则由泻而虚，竟成庙兵出而岸兵入也。亦参末议，共博一笑:
少腹有形隆起如阜，上至心下则厥逆。来疾去驶，虽大力人拒之不能却。上则人身为之上窜，下则人身为之下坠，不能强挣。一翕一辟，一上一下，乃至人身上下如舂杵。口鼻两阴之血，随其上下溢出，群医不能治。余思此症载在《难经》，特未曾缕晰示人耳。且云:"此物伏在脐旁上下则少楚，伏入脐中则少安。"可见脐旁两穴，亦与此条相合，且弗揭明其义，一任群公思而得之可也。
用薄荷汤送下神秘丸。以病人自思此汤饮之，其物倏伏而不动，故亦用之。
素来扰亏根本，不特病者自嫌，即操医师之术者，亦跋前疐后之时也。值风木适旺之令，病目且黄，已而遗精淋浊。少间，则又膝胫肿痛不能行。及来诊时，脉象左弦数，右搏而长，面沉紫而时时作呕。静思其故，从前纷纷之病，同一邪也，均为三病，次第缠绵耳。由上而下，由下而至极下，因根本久拨之体，复蒸而上为胃病，是肾胃相关之故也。倘不稍为戢除一二，但取回阳返本，窃恐剑关苦拒，而阴平非复汉有也。谨拟一法，略效丹溪，未识何如:
疬劳得愈，如麟毛兔角。或叩之琼台丹扃间，求金光一叶，庶几悦然:
小建中汤。
脉象右三部洪数弦急并现，左上数中紧。先患阳精不升，次及于阳络不固。盖至阴生阳，不屯失精为先天，至阳出阴，失蒙吐红为后天。是有形始兆之后，复现先后天俱病。即察至真有余之躯，亦不足以供其渐耗。今将投味厚入阴者乎?抑投味薄清阳者耶?窃恐山川草木，皆不足以还返金品。莫夫大药金丹，周天火候耳。然又不可不以服食之方佐之，拟候尊师同订，终惭布鼓。希谅之:
建莲肉一斤(带心扑如麻子大，饭上蒸、晒九次为末)，麦冬肉一斤，嫩荷叶半斤，顶生地四两，金樱子半斤(去毛)。
以上四味熬膏，同莲肉粉杵为丸几，秋石汤送五钱。
抑郁顿挫，侘傺无聊，心乃偏倚，十二官皆无主，则阴气并于阳也。投以重镇之剂:
阳极升而不入，阴郁沉而不附，是以有昼无夜，离明当午而睡，水渐衰矣。治以交阴阳，引卫入营。毋云血家忌半夏也:
暑热时邪，病经二十日。诸法具备，何必问途于蹇足，既承触暑相招，勉尔挥汗撰方:
此症原属胃乏冲和之气而起。要之冲和之气，即太和元气。位天地，育万物，无非此气。少有不足，已非所宜，况大有所损乎?拙见宜谢绝一切，高养山斋，饵以药石，廓然世外，庶几霍然。若在操觚莲幕，非所宜也。吾闻君子赠人以言，爱人以德，故琐屑及此:
病更节后，医历多人，朝张言热，暮李论寒。脏腑各有受盛，运气各有翕辟。渺尔一躯，遍尝补泻，不病亦病矣。宜守正持法，幸勿好大喜功：
脉弦劲如循刀刃，全无冲和之气。水气太过，金令不及。从后来者，谓之贼克。苟非致太和之气，以消乖戾，必至阴失潜藏，阳无所倚。履霜坚冰至，岂可不未雨而绸缪乎?老子云:"齿刚则折"，殆其是也。切嘱切嘱。此方存之，期于左券。
中土以嵩高而定八方之位，是蜀在坤矣。毓斯境者，脉宜缓而流利。今洪搏太过，面黄气重，幸在浙已久，若处故乡，是脉象当血溢。即日回蜀，宜早服丸以滋之:
清贵之脉，类多六阳，次则六阴，是皆纯淳之象。今体禀六阳，是一征也。息分九候，位分三部。虽一部之中，均察脏腑，而左部显然者，心肝肾三脏。今寸来空大，是心不藏神也;关脉滑数，木无水养也;尺来浮大，水气不衡也。火以木为体，木以水为母，先天一气，由是通明。故知离中偶画生阴，心气日欲下交;坎中奇画生阳，肾气日欲上承。是即心肾一交也。丹诀云："水火相交永不老"者，此也。无非寻常日用之间，心欲宁，肝欲和，肾欲实。庶无恍惚悸动以及肢末不利，而四体泰然矣。谨疏一方，先滋营卫，颐养之法，再图疏呈:
人参、枣仁、远志、当归、炙草、熟地、茯神、元参、白芍、木香。
脉象较前稍和，两手平均，俱就六阳本体，可卜无外来之气，惟营卫少虚耳。但观簿书旁午，是心阴不得不养，肾阳不得不藏，以供日用之精神，以副临民之至意。先配汤药，带往省中，日进一剂培补;随配膏丸相继。宪体精神，自当日臻康泰矣:
人参、枣仁、归身、炙草、茯神、元参、白芍、杞子、熟胡桃、桂圆肉。
《内经》称三阳结乃成膈者，单指太阳、阳明、少阳也。今从脉色较之，少阴与厥阴亦病。若以填补下焦为首务，固所当然，但胃关一部，从何飞渡?且有一团郁火，挟木邪横亢于中州，得热为伍，愈肆猖狂。苦寒势所不容，甘寒势不容缓。倘令肺不生津，大肠不生液，津液愈亏，为病愈繁矣。且逆上者，肝邪也，水不生之耳;不纳者，胃病也，肺气不降耳。一身之中，津液真精，皆为切要。愚见专事于此，未识如何?先进五汁饮，次商投药可也:
芦根汁、甘蔗汁、茅根汁、鲜藕汁、水梨汁各一杯，生姜汁、沉香汁各一小匙。
诊得脉象，惟有虚细无力，弦象俱退。手足颤振，此元气亏弱之征。前此投药，俱无少效者，盖为元气不克载药行令耳。今元气一日不复，则病机一日不退。病机与元气本不并峙，此长彼消，理之常也。据愚见，汤药在乎其次，必以直走先天之品剂为膏丸，朝斯夕斯，久久自足。元气元精，一朝而复，后天饮食，不强自强矣。因此症非暴感内伤，不必数更方，以苦阳明胃口。且经不云乎"适于胃者为补"。煎药久服，适于胃者否耶？愚自吴中承给谏公之命，来斯一诊色脉，固知不出此理。勉为镇台留三日者，一则感镇台下士之隆，一则为给谏公笃亲之爱，而欲浙中诸医，一批隙导窾，以报镇台。今参脉症，毋事更张，直补先天可也。议呈煎膏丸三方。煎则暂用，膏则时时频服，丸则清晨为定。俟填补二十日外，便有消息。尚当叩阶复诊如何?(方未见。)
尊体本阴虚，阳气并邪独发，热廿余日不解。盖阴液枯，不能作汗，邪亦不解也。连剂养阴之后，邪少松则大汗泄，是云行雨施，品物咸亨之候，何疑其脱耶？但弱体久病不解，元气愈亏，此邪稍出，大汗作，亦属接补关头，不容少懈耳。心静，则气定而神住，切不可忧扰神气，致阳气上升。至嘱至嘱:
人参四钱，熟地一两，抱木茯神二钱，天冬三钱，制首乌五钱，左顾牡蛎六钱。
粗桂枝一钱，没药五分，白芍二钱炒黄，甘草一钱炒黑，琥珀一钱，饴糖钱半。
骨小肉脆，本非松柏之质;补泻温凉杂投，岂是济生之术?幸能食便实，秋令尚可扶持。然破（月困）脱肉，侧眠经阻，医者犹然梦梦，何也?仆老不谈医，聊书数语，并拟一方:
熟地、炙草、当归、生左牡蛎。
十二经皆有咳，胃病安得不咳?况此土病于金脏，而腑亦病，于此而求其痛与泻，一在于胃之上脘，一在于肺之腑，所以无从踪迹也。仰屋图维，必须分兵合剿。乃得拟一法，请诸道长。以此而益精之，或当刍荛可采，为虾力于行舟何如:
江西赤石脂六两(缎)，炒黑干姜一两。二味为末，黄米饭为丸。
人参一钱，炙黑甘草一钱，大枣五钱，饴糖五钱，桂木一钱，酒炒白芍二钱，煨熟生姜一钱。水煎一次，去渣，送服前桃花丸三钱。
病本湿温，元气不能载邪外出，有直犯中焦之势矣。拟栀、豉上下分开之，姜、芩左右升降之，芳香之草横解之，以冀廓清诸邪。未识得奏肤功否:
黑山栀、淡芩、川郁金、生香附、炒香豉、生姜、鲜石菖蒲、生甘草。
病久绪紊，终不离乎厥阴一脏。今商佐金气以暗制之，营滋气以抚绥之，实太阴以堵御之。亦子贡存鲁，霸越灭吴之意:
诊得真气久不周于四肢，又暴受暑邪类中，遗溺目瞑，脉弦数而上承鱼际。肝风为足厥阴，暑风为手厥阴，手足两经得病，瘖而不能言者不治。且移至近地凉处为病室，外解暑邪，内用对证之药以救其逆:
人生五十，一脏衰，况向六乎？所患聚讼者，皆主肾脏。盖以所述，大旨在扼定脾此，则枢机得，而四运成矣:
独术膏，先用十斤可也。
真气已漓，病何能愈?有愈之方者，其仙乎:
此太阴被湿气熏蒸，无清肃之权，木无畏，右肩臂渐显不仁之象。曲蘖伤生，而尚甘之，我不解也:
人身之脉，胸走手，腹走足，八十丈周于一身。未有沉寒筋之损而不及于下者，先后异时，为患则一。非鲍姑之艾，文伯之针不能愈。内服八味汤可也:
佞布之人多嗜，积郁之人多火。久而久之，佛郁之性，飙发波掀，若狂若魅。药石既不能与，先与丹药焚于室中，以辟易其狂悖可也:
如意丹七丸。
须眉自落，皮毛淖泽，脉来浮涩，此风也，非衰白也。三十六种，同出异名，非浅可之疾。夏月宜食香风蛇(即俗名黑风蛇也)，与鸡煮食之:
白归身、白麻、赤芍、生地、早莲草、僵蚕、银花、茺蔚子、夏枯草。
头痛，窅不见人为一忌；肝风，呕吐胆汁为一忌。相与有年，知已惟此一人，岂宜坐视。务得挽回为妙，然国有数存焉者矣:
是证究属肝风，则厥阴一经，未易制也。在古法:有镇摄一法，有培土御之一法。所以东垣有半夏天麻汤，而景岳又撰左归以补其阙略。今二法皆不能纯用之矣，拟出入一方备采:
人参、焦术、茯苓、柏子仁、半夏、陈皮、熟地、白归身、炙草、鳖甲。
水梨去心带皮捣烂，丝绵滤清，慢火熬成膏，收入磁瓶内，蜡封口。每日开水送五钱。
阳明脉实，气急而喘，壮火食气，消烁真阴。夏气开张而剧，剥枣时坦境也。此刻不能他图，姑与温胆汤，少衰其热，以保伤金。
温胆汤。
体盛之人气必弱，寒热乍起，即现小便短数，头项瞤动，舌干齿燥，气促，脉左弦右弱，渴不欲饮。皆元不胜邪之象。恐其乘津液之衰，遽而内陷，宜谨慎斟酌，缘此时正当燥令故耳：
脉数，五六日不更衣，舌黄唇焦。胃热炽矣。况前服之药，皆辛温耗阴之品，今非寒凉不可。然宜小心保护为主，因热邪深入阴中，而阳气独亢耳：
病之原，由食柿过多，得寒而起。于兹二十余年矣。要知柿为西方之木，其实禀秋金之气而成，其与肺金同气相求，可知其邪入肺，发为气哮，久则肾水无本，虚而上泛为痰。胃为贮痰之器，所以降气汤、六君子，由肺及胃，皆得小效。而不除要莒，与即墨不拔，齐地终非燕有，况脉象尚悍，当深入病所为是。拟仲景方法:
嗽而失血，已逾三载，缠绵不已，色黯脉弦，嗽益甚，环口色黄。由于肝脾，及于肾，上藏为其所取，给而不能应矣。饮亦从而为患，逐之不得，滋之无功，迁延日损，莫可弥缝。当取其中以冀流布，庶几近之。拟宗建中法，加以涤饮之品，俟阳明升而继以大补太阴，然后渐入纯阴之法，否则非治也：
Yi Piao Medical Cases
Authored by Xue Xue (Courtesy Name: Shengbai) of the Qing Dynasty
Compiled by Wu Jinshou (Courtesy Name: Ziyin) of the Qing Dynasty
--------------------------------------------------------------------------------
The bones are small and the flesh fragile, indicating a constitution that is definitely not like the resilience of pine and cypress. The pulse is rapid with intermittent pauses, already revealing signs of Xu Lao (Deficiency Consumption). Since the congenital foundation is weak and Kidney Water is deficient, while the vigorous fire blazes causing Lung Metal to dry out, each annual cycle of Qi causes a loss; how can it tolerate further damage? The autumn wind has just begun to blow, causing injury, so severe injury is inevitable. The symptoms are as previously described; the medication should only tonify the North (Kidney/Water), not speaking empty words, but merely for self-mockery: Sheng Di Huang (Rehmanniae Radix), Sha Shen (Glehniae Radix), Di Gu Pi (Lycii Cortex), Mai Dong (Ophiopogonis Tuber), Jin Shi Hu (Dendrobii Caulis), Sheng Bie Jia (Testudinis et Chelydis Carapax et Plastrum).
Case of the Envoy from Sulu suffering from chronic cough unable to lie down: Distinguishing the winds of the eight directions and measuring the nature of the five soils, generally your country lies in the Southeast (Xun) position of China, before the Ji and Wei constellations, and outside the Yi and Zhen constellations. Yang Qi tends to leak out; even if Wind-Cold is contracted, it is easy to contract and easy to dissipate. Coming to Huaxia (China), the pathogen has already entered the San Jiao (Triple Burner). Moreover, being unable to lie flat indicates significant injury to Lung Qi; treatment should only focus on moistening and descending: Mi Zhi Pi Pa Ye (Loquat Leaf processed with honey), Mai Dong (Ophiopogonis Tuber), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Tian Xing Ren (Pruni Semen), Jing Shuang Sang Ye (Mulberry Leaf after frost), Yi Yi Ren (Coicis Semen).
The *Neijing* states: People with soft and fragile bones and flesh have an inherently weak constitution. However, comparing the pulse and symptoms, this cough originally belongs to the Hand-Taiyin Lung Meridian. I heard that one doctor used tonification, while another used purgation; the pathogen rose due to tonification, and the Yuan Qi became deficient due to purgation, resulting in chaos like soldiers going out and defenders coming in. Offering a minor suggestion to provoke a smile: Bei Sha Shen (Glehniae Radix), Yan Wo (Swallow's Nest), Sang Ye (Mori Folium), Bing Tang (Rock Sugar), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Zi Wan (Asteris Radix).
There is a palpable elevation in the lower abdomen like a mound, extending up to the epigastrium where Jue Ni (Cold Reversal) occurs. It comes swiftly and departs rapidly; even a strong man cannot repel it. Upward, the body feels as if rushing up; downward, as if falling down, unable to struggle against it. One moment contracting, the next expanding, up and down, making the whole body move like a pestle in a mortar. Blood flows from the mouth, nose, and both yin orifices, following these up-and-down movements. Many doctors could not treat it. I pondered that this condition is recorded in the *Nanjing*, but has never been clearly explained to people. It says: "This entity lurks beside the umbilicus; when moving up and down, there is slight pain; when entering the umbilicus, there is slight relief." Thus, the two acupoints beside the umbilicus also correspond to this description. I will not explicitly reveal its meaning, leaving it for the gentlemen to think and understand.
Administer Shen Mi Wan (Mysterious Pill) delivered with Bo He Tang (Mint Decoction). Because the patient thought that drinking this soup would make the entity suddenly hide and remain still, this method was also used.
Since the root was originally depleted, not only does the patient feel ashamed, but even those practicing medicine find themselves treading carefully between advancing and retreating. At a time when Wood Qi is flourishing, eye disease appeared with yellowing, followed by spermatorrhea and cloudy urine. Soon after, knee and shin swelling and pain prevented walking. Upon consultation, the pulse was wiry and rapid on the left, forceful and long on the right; the complexion was deep purple with frequent vomiting. Contemplating the cause, the previous chaotic illnesses were all the same pathogen, manifesting as three diseases in succession. From upper to lower, from lower to extreme lower, because the root had long been disturbed, steaming upward caused Stomach disease; this is due to the connection between Kidney and Stomach. If we do not slightly curb and remove some, but only seek to return Yang and restore the root, I fear the sword pass will bitterly reject it, and Yin Ping (balance of Yin) will no longer be as in the Han dynasty. Cautiously proposing a method, slightly imitating Danxi: Ling Yang Jiao (Capricornis Cornu), Mu Gua (Chaenomelis Fructus), Jiu Chao Huang Bai (Phellodendri Cortex processed with wine), Fu Long Gan (Caulis Argillae Rubrae), Sheng Yi Yi Ren (Coicis Semen), Ju Hong (Citri Reticulatae Pericarpium), Ma Liao Dou (Sojae Semen Praeparatum).
Healing Li Lao (Scrofula/Tuberculous lymphadenitis) is as rare as Qilin hair or Rabbit horn. Perhaps knocking on the gates of the Jade Terrace, seeking a leaf of golden light, might bring joy: Xiao Jian Zhong Tang (Minor Construct the Middle Decoction).
The pulse shows Hong (Surging), Shuo (Rapid), Xian (Wiry), and Ji (Urgent) simultaneously in the three positions on the right, and Shuo (Rapid) with Jin (Tight) in the middle-left. Previously, Yang Essence did not ascend, subsequently affecting the security of Yang Collaterals. Since Extreme Yin generates Yang, losing essence constitutes Congenital deficiency; Extreme Yang emerges from Yin, losing blood in vomiting constitutes Acquired deficiency. After visible signs appear, both Congenital and Acquired deficiencies are present. Even observing a body with true excess, it is insufficient to supply gradual depletion. Now, should we administer flavors that are thick and enter Yin? Or flavors that are thin and clear Yang? I fear that mountains, rivers, plants, and trees are insufficient to restore precious qualities. Nothing compares to Great Medicine Golden Elixir, focusing on Zhou Tian Fire Timing. However, dietary prescriptions must assist. I plan to wait for your esteemed teacher to co-draft it, though I am ashamed to display a drum made of cloth before a thunderous audience. Please forgive me: Lian Rou (Nelumbinis Semen) one jin (processed with heart, pounded like hemp seeds, steamed and sun-dried nine times into powder), Mai Dong Rou (Ophiopogonis Tuber) one jin, Nen He Ye (Nelumbinis Folium) half jin, Ding Sheng Di (Fresh Rehmanniae Radix) four liang, Jin Ying Zi (Chrysanthemi Fructus) half jin (deprived of hairs).
The above four ingredients are boiled into a paste, mixed with Lotus Seed powder and formed into pills, taken with Qiu Shi Tang (Autumn Stone Decoction), 5 qian per dose.
Depression and frustration, feeling lost and bored, the Heart leans to one side, and the Twelve Officials lack a master, causing Yin Qi to merge with Yang. Administer heavy sedatives: Sheng Tie Luo (Ferrum Depuratum), Yu Jin (Curcumae Radix), Ban Xia (Pinelliae Rhizoma), Ku Shen (Sophorae Flavescentis Radix), Ju Hong (Citri Reticulatae Pericarpium), Fu Ling (Poria).
Yang rises excessively without entering; Yin sinks depressively without attaching. Hence, there is day but no night; sleeping at noon when Li Ming (Sun/Heart Fire) is peak, Water gradually declines. Treat by communicating Yin and Yang, guiding Wei Qi into Ying Blood. Do not say that Ban Xia is contraindicated in blood disorders: Ban Xia (Pinelliae Rhizoma), Suan Zao Ren (Ziziphi Spinosae Semen), Sheng Di Huang (Rehmanniae Radix), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma), Nuomi (Oryzae Sativae Semen glutinosum), Fu Ling (Poria), Yi Yi Ren (Coicis Semen), Ru Xiang (Olibanum) deprived of oil.
Summer-heat and pathogenic heat, illness lasting twenty days. All methods have been employed; why ask a lame person for directions? Since you invited me despite the summer heat, I reluctantly wrote this prescription sweating: Huang Lian (Coptidis Rhizoma), Ban Xia (Pinelliae Rhizoma), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma), Dan Qin (Scutellariae Radix), Fu Ling (Poria), Sheng Jiang (Zingiberis Rhizoma Recens).
This condition originally arose from the Stomach lacking Chun He Qi (Harmonious Qi). In short, Chun He Qi is Tai He Yuan Qi (Supreme Harmony Original Qi). It positions Heaven and Earth, nurtures all things; nothing exists without this Qi. A slight deficiency is already unsuitable, let alone significant damage. My humble opinion suggests rejecting all affairs, cultivating oneself in a high mountain hermitage, taking medicinal stones, remaining detached from the world, perhaps recovering quickly. If one continues to manage official documents in a幕府 (military office), it is unsuitable. I heard that a gentleman gives words to others and loves others with virtue, hence these trivial remarks: Xuan Fu Hua (Inulae Flos), Mu Gua (Chaenomelis Fructus), Sheng Gu Ya (Hordei Fructus Germinatus), Zhi Cao (Glycyrrhizae Radix et Rhizoma preparata), Dai Zhe Shi (Haematitum), Bai Shao (Paeoniae Radix Alba), Nuomi Zhi (Juice of Glutinous Rice).
The condition worsened after the festival; many doctors treated him. In the morning, Zhang spoke of Heat; in the evening, Li discussed Cold. Each Zang-Fu has its own reception and storage; each Yun Qi has its own opening and closing. A tiny body, subjected to various tonifying and purging methods, would become ill even if not already sick. One should uphold righteousness and hold fast to principles; fortunately, avoid loving grand achievements: Dang Gui Jian Zhong Tang (Angelica Sinensis Decoctio to Construct the Middle).
The pulse is wiry and tough like touching a blade, completely lacking harmonious Qi. Water Qi is excessive, Metal Command is insufficient. That which comes from behind is called Ze Ke (Thief Overcoming). Unless Tai He Qi is achieved to eliminate perversity, Yin will lose its ability to store, and Yang will have no support. Stepping on frost implies hard ice is coming; how can one fail to prepare before the rain? Laozi said: "Teeth are rigid and thus break," which seems correct. Earnestly urging, earnestly urging. Keep this prescription, expecting it to be as reliable as a left voucher.
Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma), Bei Sha Shen (Glehniae Radix), Dou Pi (Sojae Semen Tegumentum), Dong Sang Ye (Mori Folium), Sheng Bai Shao (Raw Paeoniae Radix Alba), Mai Dong Rou (Ophiopogonis Tuber).
The Central Earth stabilizes the positions of the Eight Directions like Song Gao Mountain; thus, Shu is in Kun. Those nurtured in this region should have a slow and smooth pulse. Now it is surging and forceful excessively, with yellow complexion and heavy Qi. Fortunately, having lived in Zhe for a long time; if in the hometown, the pulse would indicate blood overflow. Returning to Shu immediately, one should take pills early to nourish: Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia).
Noble pulses are mostly Liu Yang (Six Yang), followed by Liu Yin (Six Yin); these are images of purity. Now the constitution embodies Liu Yang, which is one sign. Respiration divides into Nine Probes, positions divide into Three Parts. Although within one part, Zang-Fu are observed, the Left part clearly shows Heart, Liver, and Kidney. Now the Cun position is hollow and large, indicating Heart does not store Shen; Guan position is slippery and rapid, indicating Wood lacks Water nourishment; Chi position is floating and large, indicating Water Qi imbalance. Fire takes Wood as its body; Wood takes Water as its mother. The First Qi of Congenital origin becomes bright through this. Thus, knowing that the even line in Li (Heart) generates Yin, Heart Qi desires to descend daily; the odd line in Kan (Kidney) generates Yang, Kidney Qi desires to ascend daily. This is Heart-Kidney Intersection. The Alchemical formula says: "When Water and Fire intersect, one never ages." This is it. It is nothing more than in daily life: Heart desires tranquility, Liver desires harmony, Kidney desires solidity. Thus avoiding恍惚 (trance) and palpitations, and limb immobility, leading to peaceful limbs. Carefully listing a prescription to first nourish Ying and Wei; the method of nurturing will be presented later: Ren Shen (Ginseng Radix), Zao Ren (Ziziphi Spinosae Semen), Yuan Zhi (Polygalae Radix), Dang Gui (Angelicae Sinensis Radix), Zhi Cao (Prepared Glycyrrhizae Radix et Rhizoma), Shu Di (Prepared Rehmanniae Radix), Fu Shen (Poria with Hostwood), Yuan Shen (Scrophulariae Radix), Bai Shao (Paeoniae Radix Alba), Mu Xiang (Aucklandiae Radix).
The pulse is slightly more harmonious than before, both hands are average, returning to the Liu Yang body. It can be predicted that there is no external Qi, only slight deficiency in Ying and Wei. But seeing the busy paperwork, Heart Yin must be nourished, Kidney Yang must be stored, to supply daily spirit and fulfill the intent of governing people. First prepare decoction, take to the provincial capital, advance one dose daily for tonification; subsequently prepare paste and pills. Your physique and spirit will naturally reach health daily: Ren Shen (Ginseng Radix), Zao Ren (Ziziphi Spinosae Semen), Gui Shen (Angelicae Sinensis Radix), Zhi Cao (Prepared Glycyrrhizae Radix et Rhizoma), Fu Shen (Poria with Hostwood), Yuan Shen (Scrophulariae Radix), Bai Shao (Paeoniae Radix Alba), Qi Zi (Lycii Fructus), Shu Hu Tao (Juglandis Semen), Gui Yuan Rou (Longan Arillus).
The *Neijing* states that Jie (Knotting) of San Yang leads to Ge (Regurgitation/Dysphagia), referring solely to Taiyang, Yangming, and Shaoyang. Now comparing pulse and color, Shaoyin and Jueyin are also diseased. If filling the Lower Jiao is the primary task, it is indeed appropriate, but how to cross the Gate of Stomach? Moreover, a mass of stagnant fire, carrying Wood pathogen, dominates the Central Region; accompanied by Heat, it becomes more rampant. Bitter Cold is intolerable; Sweet Cold cannot be delayed. If Lung fails to generate fluids and Large Intestine fails to generate liquids, fluid deficiency increases, and pathology becomes complex. Ascending rebellion is Liver pathogen, due to Water not generating it; failure to receive is Stomach disease, due to Lung Qi not descending. Throughout the body, fluids and true essence are crucial. My view focuses on this; unknown how it works? First advance Wu Zhi Yin (Five Juice Drink), then discuss medication: Lu Gen Zhi (Reed Rhizome Juice), Gan Zhe Zhi (Sugarcane Juice), Mao Gen Zhi (Imperatae Rhizoma Juice), Xian Ou Zhi (Fresh Nelumbinis Rhizoma Juice), Shui Li Zhi (Pear Juice) each one cup; Sheng Jiang Zhi (Fresh Ginger Juice), Chen Xiang Zhi (Aquilariae Resina Juice) each one small spoon.
Diagnosed pulse is only Xu Xi (Deficient and Fine) and powerless; Xian (Wiry) image has retreated. Trembling of hands and feet is a sign of Yuan Qi deficiency. Previous medications had no effect because Yuan Qi could not carry the medicine to execute its function. As long as Yuan Qi does not recover in a day, the disease mechanism will not retreat in a day. Disease mechanism and Yuan Qi do not stand together; one grows, the other fades, which is the norm. In my view, decoctions are secondary; one must use products that go directly to the Congenital source to make pastes and pills, morning and night, until sufficient over time. When Yuan Qi and Yuan Jing recover overnight, postnatal diet will strengthen itself without forcing. Since this condition is not acute contraction or internal injury, there is no need to frequently change prescriptions to bitter the Yangming Stomach gate. Does the classic not say "What suits the Stomach is tonification"? Will long-term decoction suit the Stomach? I came to diagnose color and pulse under the order of Official Ganjian, knowing this logic holds. Reluctantly staying for three days for General Zhen, firstly grateful for his humility towards scholars, secondly for Ganjian's love for relatives, and wanting to guide Zhejiang doctors to hit the key points to repay the General. Now combining pulse and symptoms, no need to change; directly tonify the Congenital. Proposing three prescriptions: Decoction for temporary use, Paste for frequent consumption, Pills for fixed morning intake. Wait twenty days of tonification for changes. Shall I visit again for re-diagnosis? (Prescription not seen.)
Your constitution is originally Yin Deficient; Yang Qi and Pathogen act alone, Heat unresolved for over twenty days. Yin fluids are dried up, unable to produce sweat, so pathogen is not resolved. After consecutive doses of nourishing Yin, pathogen loosens slightly then massive sweat occurs; this is like clouds moving and rain falling, all things prospering. Why doubt collapse? But weak body, long illness unresolved, Yuan Qi increasingly deficient. As pathogen exits slightly, massive sweat occurs; this is also a critical moment for接续 (connecting/replenishing) tonification, allowing no slack. Calm the Heart, then Qi settles and Shen resides. Do not worry or disturb Shen Qi, causing Yang Qi to rise. Earnestly urging, earnestly urging: Ren Shen (Ginseng Radix) 4 qian, Shu Di (Prepared Rehmanniae Radix) 1 liang, Bao Mu Fu Shen (Poria with Hostwood wrapped in wood) 2 qian, Tian Dong (Asparagi Radix) 3 qian, Zhi He Shou Wu (Polygoni Multiflori Preparata Radix) 5 qian, Zuo Gu Mu Li (Ostreae Concha) 6 qian.
Pulse is Kong Xian (Hollow and Wiry), abdominal urgent pain, Liver disease. If treating Liver fails, treating Spleen is also a good method: Cu Gui Zhi (Cinnamomi Ramulus rough) 1 qian, Mo Yao (Myrrha) 5 fen, Bai Shao (Paeoniae Radix Alba) 2 qian stir-fried yellow, Gan Cao (Glycyrrhizae Radix et Rhizoma) 1 qian stir-fried black, Hu Po (Electrum) 1 qian, Yi Tang (Maltose) 1.5 qian.
Bones small, flesh fragile, originally not pine/cypress quality; mixing tonification, purgation, warming, and cooling, how is this a life-saving art? Fortunately able to eat and stool solid, Autumn command can still support. However, emaciation, side-sleeping obstructs meridians, doctors still dreamlike, why? I am old and do not discuss medicine, merely writing a few words and proposing a prescription: Shu Di (Prepared Rehmanniae Radix), Zhi Cao (Prepared Glycyrrhizae Radix et Rhizoma), Dang Gui (Angelicae Sinensis Radix), Sheng Zuo Mu Li (Raw Ostreae Concha).
Twelve meridians all have cough; how should Stomach disease not have cough? Moreover, this Earth disease affects Metal Zang, and Fu organs are also diseased. Seeking pain and diarrhea here, one is in Upper Wan of Stomach, one is in Lung Fu, hence no trace can be found. Looking up at the roof planning, must divide troops and combine suppression. Thus proposing a method, asking masters. Refining this, perhaps it may be collected like commoner advice, how about shrimp strength in rowing a boat: Jiang Xi Chi Shi Zhi (Kaolinite) 6 liang (wrapped in silk), Chao Hei Gan Jiang (Stir-fried Black Zingiberis Rhizoma) 1 liang. Two ingredients powdered, Yellow Rice Ball formed into pills.
Ren Shen (Ginseng Radix) 1 qian, Zhi Hei Gan Cao (Stir-fried Black Glycyrrhizae Radix et Rhizoma) 1 qian, Da Zao (Jujubae Fructus) 5 qian, Yi Tang (Maltose) 5 qian, Gui Mu (Cinnamomi Ramulus) 1 qian, Jiu Chao Bai Shao (Stir-fried with Wine Paeoniae Radix Alba) 2 qian, Wei Shu Sheng Jiang (Baked Raw Ginger) 1 qian. Decoct once in water, remove dregs, send with 3 qian of previous Tao Hua Wan (Peach Blossom Pill).
The disease is originally Shi Wen (Damp-Warmth); Yuan Qi cannot carry pathogen out, showing trend of directly attacking Middle Jiao. Proposing Zhi and Chi to separate up and down, Jiang and Qin to ascend and descend left and right, aromatic herbs to resolve horizontally, hoping to clear pathogens. Unknown if skin-deep success will be achieved: Hei Shan Zhi (Black Gardenia Fruit), Dan Qin (Light Scutellariae Radix), Chuan Yu Jin (Curcumae Radix), Sheng Xiang Fu (Cyperi Rhizoma), Chao Xiang Chi (Stir-fried Fermented Soybean), Sheng Jiang (Fresh Ginger), Xian Shi Chang Pu (Fresh Acori Tatarinowii Rhizoma), Sheng Gan Cao (Raw Glycyrrhizae Radix et Rhizoma).
Long illness, chaotic thoughts, ultimately not leaving the Jueyin Zang. Now discussing assisting Metal Qi to secretly control it, nourishing Ying Qi to pacify it, strengthening Taiyin to block and defend. Also like Zigong saving Lu, Ba Yue destroying Wu: Ling Yang Jiao (Capricornis Cornu), Ren Shen (Ginseng Radix), Zhi He Shou Wu (Polygoni Multiflori Preparata Radix), Qing E Jiao (Clear Donkey-Hide Gelatin), Mai Dong (Ophiopogonis Tuber), Yun Fu Shen (Poria cloud-like).
Diagnosed True Qi has long not circulated to four limbs, and suddenly suffered Summer-heat pathogen resembling stroke, enuresis, eyes closed, pulse wiry and rapid ascending to Yu Ji. Liver Wind is Foot-Jueyin, Summer-heat Wind is Hand-Jueyin. Both hand and foot meridians diseased, aphasia and inability to speak is untreatable. Move to a cool place nearby as sickroom, externally resolve summer-heat pathogen, internally use symptomatic medicine to save rebellion: Ling Yang Jiao (Capricornis Cornu), Zhu Ru (Bambusae Caulis in Taenia), Lian Qiao Ren (Forsythiae Fructus), Xian Sang Zhi (Fresh Mori Ramulus), Ban Xia (Pinelliae Rhizoma), Xian Shi Chang Pu Gen (Fresh Acori Tatarinowii Rhizoma Root).
Human life at fifty, one Zang declines, let alone approaching sixty? The disputed complaints all focus on Kidney Zang. Because what is described, the main point is grasping Spleen, then pivot is obtained, and four transports are completed: Du Shu Gao (Single Atractylodes Macrocephalae Paste), using ten jin first is acceptable.
True Qi has leaked away, how can illness heal? If there is a healing prescription, it must be immortal: Gui Shao Liu Jun Qu Gan Cao (Gui Shao Liu Jun Decoction minus Licorice), Xian Sang Zhi (Fresh Mori Ramulus) decocted as water substitute.
This Taiyin is steamed by dampness, lacking clear and肃 (descending) authority; Wood has no fear. Right shoulder and arm gradually show numbness. Alcohol damages life, yet still enjoys it; I do not understand: Sheng Yi Yi Ren (Raw Coicis Semen), Xian Lu He (Fresh Reed Node), Sheng Di Huang (Raw Rehmanniae Radix), Nen Sang Zhi (Young Mori Ramulus), Bai Gui Shen (White Angelicae Sinensis Radix), Chi Shao (Red Paeoniae Radix).
Human body pulses, chest goes to hands, abdomen goes to feet, eighty zhang circulate the body. There is no damage of deep cold in sinews that does not affect the lower parts. Different times, same harm. Only Bao Gu's Moxibustion and Wen Bo's Acupuncture can cure. Internal服用 Ba Wei Tang is acceptable: Gui Fu Ba Wei Wan (Cinnamon and Aconite Six-Ingredient Pill).
Flattering people often have addictions; accumulated depression people often have fire. Over time, suppressed nature erupts wildly, like madness or demons. Medicines cannot be given; first burn丹药 (Elixirs) in the room to dispel and replace madness. Here: Ru Yi Dan (Ru Yi Elixir) seven pills.
Eyebrows and beard fall off, skin and hair are greasy, pulse floats and choppy. This is Wind, not aging white. Thirty-six types, same origin different names, not a superficial disease. Summer month should eat Xiang Feng She (commonly known as Black Wind Snake), cooked with chicken: Bai Gui Shen (White Angelicae Sinensis Radix), Bai Ma (White Hemp Seed - likely Bai Zhi or similar contextually, but literal White Hemp), Chi Shao (Red Paeoniae Radix), Sheng Di Huang (Raw Rehmanniae Radix), Zao Lian Cao (Ecliptae Herba), Jiang Can (Bombyx Batryticatus), Yin Hua (Chrysanthemi Flos), Chong Wei Zi (Leonuri Fructus), Xia Ku Cao (Prunellae Spica).
Headache, deep invisibility of people is one taboo; Liver Wind, vomiting bile is one taboo. Associated for years, confidant is only this one person, how can one sit idle? Must strive to reverse it, but state has numbers existing: Zu Dan Tang (Gallbladder Suppressing Decoction) minus Zhi Shi, add Tian Ma (Gastrodiae Rhizoma), Gou Teng (Uncariae Ramulus cum Uncis), Sang Ye (Mori Folium).
This condition ultimately belongs to Liver Wind, then Jueyin meridian is not easily controlled. In ancient methods: there is Sedation method, there is Fortifying Earth to resist method. Hence Dong Yuan has Ban Xia Tian Ma Tang, and Jing Yue wrote Zuo Gui to supplement omissions. Now neither method can be purely used; proposing modified prescription for reference: Ren Shen (Ginseng Radix), Jiao Zhu (Charred Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Bai Zi Ren (Platycladi Semen), Ban Xia (Pinelliae Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Shu Di (Prepared Rehmanniae Radix), Bai Gui Shen (White Angelicae Sinensis Radix), Zhi Cao (Prepared Glycyrrhizae Radix et Rhizoma), Bie Jia (Testudinis et Chelydis Carapax et Plastrum).
Chronic cough transfers pathogen to Stomach; due to cough, Lung肃 (descending) power is lost, so Qi ascends rebelliously. Do not use medicines that purge and damage Lung Qi: Water Pear core removed, peel intact, mashed, filtered through silk cotton, slow fire boiled into paste, stored in ceramic bottle, wax sealed. Daily send with boiling water, 5 qian.
Yangming pulse is solid, Qi urgent and panting, Vigorous Fire consumes Qi, burning True Yin. Summer Qi opens and worsens, date-palm season is calm state. At this moment cannot plan otherwise, temporarily give Wen Dan Tang to slightly reduce heat, to protect injured Metal.
Wen Dan Tang (Warm the Gallbladder Decoction).
People with bulky bodies must have weak Qi. Sudden chills and fever, immediately show short and frequent urination, head and neck twitching, dry tongue and teeth, shortness of breath, pulse wiry left and weak right, thirst but no desire to drink. All are signs of Yuan unable to overcome pathogen. Fear it will take advantage of fluid decline to suddenly sink inward; cautious deliberation is suitable, because this time coincides with Dry Command: Tian Hua Fen (Trichosanthis Radix), Juan Zhu Ye (Bambusae Folium), Hou Ju Hong (Thick Citri Reticulatae Pericarpium), Qing Hao Geng (Artemisiae Annuae Caulis), Mai Dong (Ophiopogonis Tuber), Liu Yi San (Six-to-One Powder).
Pulse rapid, five to six days without bowel movement, yellow tongue, scorched lips. Stomach Heat is blazing. Moreover, previous medicines were all acrid-warm consuming Yin substances; now non-cold is impossible. However, careful protection is primary, because Heat pathogen deeply enters Yin, and Yang Qi stands alone exalted: Chuan Huang Lian (Coptidis Rhizoma), Zhi Shi (Aurantii Fructus Immaturus), Gua Lou (Trichosanthis Fructus), Chi Shao (Red Paeoniae Radix), Sheng Gan Cao (Raw Glycyrrhizae Radix et Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Xing Ren (Armeniacae Semen Amarum), Mu Tong (Akebiae Caulis).
Origin of illness, due to eating too many persimmons, arising from Cold. For over twenty years. Know that persimmon is Western Wood, its fruit bears Autumn Metal Qi, seeking same Qi with Lung Metal,可知 pathogen enters Lung, develops into Asthma, long term Kidney Water has no root, deficiency floats up as Phlegm. Stomach is vessel storing phlegm, so Jiang Qi Tang (Descend Qi Decoction), Liu Jun Zi (Six Gentlemen), from Lung to Stomach, all get small effect. But not removing key Ju, like Jimo not captured, Qi land finally not Yan possession, moreover pulse still fierce, should deepen into disease location. Propose Zhongjing method: Tian Ting Li (Sweet Descurainiae Semen), Ku Ting Li (Bitter Descurainiae Semen), Da Zao (Jujubae Fructus).
Cough with blood loss, exceeding three years, lingering endlessly, dark complexion, wiry pulse, cough worse, yellow around mouth. Due to Liver-Spleen, reaching Kidney, Upper Zang taken by it, supplying but unable to respond. Fluids also become harmful, expelling gets nothing, nourishing achieves merit, delaying daily loss, cannot mend. Should take middle to hope flow, nearly close. Propose following Jian Zhong method, adding Phlegm-flushing substances, wait Yangming ascend then continue to greatly tonify Taiyin, then gradually enter Pure Yin method, otherwise not treatment: Xiao Jian Zhong Tang minus Ginger, add Fu Ling (Poria), Jiang Pi (Zingiberis Pericarpium).
Ancients created characters, two fires exerting force for Lao (Consumption), thus speaking for Sovereign and Minister Fires. Warm and tonify Middle State, to quiet source of Phlegm, tonify Lower Jiao to benefit source of Water. But disease depth is deep, fear not one strike can break: Shu Di (Prepared Rehmanniae Radix), Gou Qi Zi (Lycii Fructus), Yuan Shen (Scrophulariae Radix), Niu Xi (Achyranthis Bidentatae Radix), Fu Ling (Poria), Zi Shi Ying (Psilomeli Pulvis).