有声之谓呕，有物之谓吐。声者，气与火也。物者，痰与食也。或为寒气所干，或为暑气所中，或忿怒气逆，或酒食过伤，或蛔虫作痛，或久病胃虚，或积痰瘀血，凡此皆能呕吐。大抵脉虚而细者吉，脉实而大者凶。治以二陈汤为主。胃寒者，水浆下纳，脉息沉迟，加干姜、肉桂、丁香、益智之类。伤暑者，烦渴面垢，脉虚体热，加黄连、扁豆、香薷、厚朴之类。怒则肝火冲胃，呕而口苦，胸胁不利，脉弦而数，加香附、芍药、黄芩、黄连、乌梅、竹茹之类。伤食者，吐出酸臭，加山查、草果、神曲、麦芽、枳实、砂仁之类。饮酒过伤而呕吐者，加葛花、猪苓、泽泻、白豆蔻之类。蛔虫上攻而吐者，加乌梅、川椒、黄柏、干姜、白术之类。…··久病胃虚，闻谷气而呕者，加人参、白术、伏龙肝、藿香之类。积痰在胃而呕吐者，加南星、枳实、竹茹、姜汁之类。内伤瘀血而吐者，加桃仁泥、生姜汁之类。
一人过伤饮食，腹痛便秘，呕吐不止。予日；阳明之气，下行为顺，上行为逆，此因便秘胃气不得下行，故作呕吐，法当下之，用脾积丸一服而愈。
一人霍乱吐泻之后，饮食即吐，不得停留。予曰：吐泻者，气之滑也，当以涩剂治之，用烧针丸三服而愈。
二陈汤见7页
醋煮莪（术）（三）棱与良姜，青皮木香百草霜，江子（仁）研泥面糊丸，橘皮汤送效非常。
黄丹（水飞）、枯白矾、朱砂各等分，为末，枣肉为丸，芡实大，穿针尖上，烧之存性，为末。每服七分，凉水送下。或米泔水亦可。
丹溪曰："泄泻有湿、有火、有气虚、有痰积、有食积"。戴元礼①注曰："凡泻水腹不痛者是湿；饮食入胃不住，或完谷不化者是气虚；腹痛泻水肠鸣，痛一阵泻一阵者是火。或泻或不泻，或多或少者是痰积；腹痛甚而泻，泻后痛减者是食积"。
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①戴思恭、字元礼，明、浦江县人，朱丹溪弟子。著有《证治要诀》、《证治类元》、《类证用药》。
泄泻之病，四时感受不同，或因风寒暑湿所干，或因饮食所伤，动伤脾胃之气，故作泄泻。治当分其新久，审其原因，新则以伐邪之药为主，而健脾之药为佐；久则以补脾之药为君，而升发之药为使。予常辨其症而用药，确然有论者录之于后：泻下青色，腹痛脉浮者，挟风也，宜羌活、防风之类。泻下白色，腹痛、脉沉迟而弱，四肢清冷，小便澄彻者，挟寒也，宜干姜、肉桂、附子之类。泻下黄色，口渴、烦躁、脉虚、身热者，挟暑也，宜黄连、扁豆、香薷之类。泻下清水，或如陈腐水色，腹不痛、身体重、倦怠无力，脉沉而缓者，湿也，宜苍术、白术、厚朴之类。泻下完谷不化，酸臭异常，胸膈饱闷，恶闻食气者，伤食也，宜山查、草果、神曲、麦芽，莱菔子之类。泻下或多或少，或泻或不泻，或如鱼冻者，挟痰也，宜南星、半夏之类。泻下过多，小水不利者，当分利阴阳，使小水长而大便实也，宜茯苓、猪苓、滑石、泽泻之类。如久患泄泻者又不可用，用之则损阴气，当见眼胞下陷而病凶。此七条乃伐邪之药也。至于健脾者，莫如白术、茯苓、陈皮、白芍之类；而补脾者莫如人参、山药、扁豆、莲肉、薏苡仁、芡实之类。大抵脾胃之气，上升则为生长之令，下降则为收藏之令。泄泻日久，脾胃之气下陷，宜佐升发之药，如升麻、防风、柴胡、葛根、羌活之类。又有每夜子时后五更前作泻着，乃肾虚作泻也，宜肉蔻、破故纸、吴茱萸、五味子以补肾。
五苓散见16页
寒泻腹中痛，大小便利清，胃苓汤一盏，姜枣水煎成。（即平胃散合五苓散）
暑泻热如汤，心烦渴不安，薷苓汤八味，灯心用一团、（即黄连香薷饮合四苓散）
身热口中渴，更兼泻下频，柴苓汤一剂，施治捷如神。（即小柴胡汤合五苓散）
（人）参（茯）苓白术散，莲肉扁（豆）薏仁，砂仁甘（草）桔（梗）（山）药，久泻胃中虚。
按：泄泻日久，元阳亏损。健脾止泻不效者，当以补骨脂、吴茱萸、芡实、附子、干姜、肉桂、益智仁之类。补命门之火．若久泄肠滑、气虚下陷、脱肛或肛门不闭，宜人参、黄芪、白术、诃子、白芍、赤石脂、石榴皮、粉草、米壳等药，补益收脱。
卒然心腹疼痛，上吐下泻，谓之湿霍乱；腹绞痛，欲吐不吐，欲泻不泻者，谓之干霍乱。此症有寒热二种：属寒者，吐利腥秽，上下所出水液澄彻清冷，脉沉而迟，四肢厥冷，腹痛，不喜饮水，此阴邪胜也。属热者，吐利、烦热、有汗、口渴欲饮凉水，脉沉而数，四肢温暖，此阳邪胜也。总用藿香正气散加减治之。干霍乱，先用盐汤探吐，吐后亦以藿香正气散调理。如探吐不能出者，死在须臾也。
正气（半）（夏）曲（紫）苏藿（香），（茯）苓陈（皮）（白）术（白）芷（厚）朴，桔（梗）甘（草）腹（皮）（生）姜（大）枣，吐泻阴阳搏。
有热者加姜炒黄连。有寒者加干姜。腹痛加官桂，痛甚加吴茱萸去藿香。小便不利加车前子。转筋加木瓜。发热口渴加麦冬、淡竹叶。若频欲登圊①不通利者加枳壳。中暑者加香薷、扁豆。心下痞加枳实、青皮。肉食不化加山查。米谷不化加神曲、麦芽。
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①圊：qing1（音青）。厕所。
烧盐汤
盐一撮，放刀上用火烧红，热童便和服，或以新汲水和服，少顷即吐。
按：霍乱初起，用藿香正气散兼刺委中、尺泽放血，可以收效。如果吐泻太甚，失水过多，眼胞塌陷、汗出不止、肢冷脉微欲绝，则应急服王清任之急救回阳汤。万不可因其口渴，误认为热，坐误机宜。
党参（八钱）附子（八钱）干姜（四钱）白术（四钱）甘草（三钱）桃仁（二钱）红花（二线）水煎服。
痞满者，非痞块之痞，乃胸中痞闷而不舒畅也。因脾倦不能运化水谷，以致积湿成痰，留于中脘，而感痞闷也。治宜健脾顺气，气顺则痰利，脾健则食化痞消而通泰矣。方用二陈汤加枳实、白术、香附、砂仁、白豆蔻、藿香、厚朴之类。瘦人多郁热，加黄连去半夏。血虚加川芎、当归去半夏。食积加神曲、麦芽、山查去白术、半夏。肥人多湿多痰加苍术。气虚加人参去半夏。痰隔加瓜蒌、贝母、桔梗、竹沥、姜汁去白术、半夏。脾湿中满加苍术、芍药去半夏。
二陈汤见7页
呃逆①者，俗谓之发呃也。声短者，出于中焦，水谷之病也；声长者，出于下焦，虚邪相搏也。脉浮缓者吉，弦急者凶。伤寒失下，便闭而呃者用承气汤。吐泄后胃寒而呃者用丁香柿蒂汤。吐利后胃热而呃者用橘皮竹茹汤。气逆而呃者用木香调气散。病后发呃者难治。
承气汤见15页
木香调气散，丁香白蔻仁，藿（香）檀（香）砂（仁）甘草，盐汤送下吞。
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①呃：e（音遏）。呃逆：俗称打嗝。
洁古曰；"咳谓无痰而有声，肺气伤而不清也。嗽是无声而有痰，脾湿动而为痰也。咳嗽谓有痰而有声，盖因伤于肺气动于脾湿"。丹溪谓咳嗽之因有风寒、有痰饮、有火郁、有劳嗽、有肺胀。戴元礼注
曰：鼻塞声重恶寒者，风寒也。嗽动便有痰声，痰出嗽止者，痰饮也。有声痰少面赤者，火郁也。盗汗出痰多作寒热者，劳嗽也。动则喘满，气急息重者，肺胀也。
咳嗽之脉：浮紧虚寒，沉数实热，洪滑多痰，弦涩少血，浮大者吉，沉小者危。
风寒嗽用苏沉九宝饮。痰饮嗽用导痰汤，甚者用小胃丹。火郁嗽用参苏饮去人参加枯芩。劳嗽用知母茯苓汤，或用清离滋坎汤。久嗽不止用款冬花、紫菀、五味子、乌梅肉，等分为丸，噙化。肺胀嗽用清肺饮。
（紫）苏沉九宝饮，麻（黄）（肉）桂薄荷陈（皮），杏仁甘（草）大腹皮，寒嗽效如神。
导痰汤见7页
小胃丹用醋芫花，大戟甘遂（川）军（黄）柏加，白术煎膏和成丸，临卧空腹热汤下。
参苏饮见18页
知母茯苓汤，当归（白）芍地黄，天冬甘（草）白术，劳嗽是良方。
清肺饮栀（子）（黄）芩，桑（皮）（当）归茯（苓）（麦天）二门（冬），桔（梗）陈（皮）甘（草）杏（仁）（五）味（子），（生）姜（大）枣水煎吞。
劳嗽丹（皮）（白）术泽（泻），（白）芍萸（肉）（山）药（甘）草（茯）苓，（天麦）二冬（当）归（熟生）二地，知（母）（黄）柏坎离清。
嗳气者，胃中有痰有火，用南星、半夏、石膏、香附、炒山栀，或丸或煎皆可。胃寒嗳气，用二陈汤加干姜、益智、木香。妇人嗳气，连十余声不尽，嗳出则心宽，不嗳则紧闷，用越鞠丸效。
咽酸者，酸水刺心也。吐酸苦，吐酸水也。俱是脾虚不能运化饮食，郁积已久，湿中生热，湿热相蒸，遂作酸也。平胃散加神曲、麦芽、山查炭、草果、吴茱萸、黄连、枳实。或用六郁汤、越鞠丸尤妙。口吐清水，用苍术．白术、陈皮、茯苓、滑石各等分，水煎服效。
附：嘈杂症
嘈染者，俗谓之心嘈也。有痰因火动而嘈者，二陈汤加酒炒黄连、桅子仁。有心血少而嘈者，八珍汤加麦冬、栀子、陈皮、乌梅、炒米。有因食郁而嘈者，以越鞠丸治之。
平胃散见8页
六郁汤见24页
越鞠丸见24页
二陈汤见7页
八珍汤见6页
中满臌胀者，四肢不肿，单腹胀也。有似乎鼓，故名臌胀。仁斋直指谓其症有四：曰气臌、血臌、食臌、水臌。皆因脾虚不能运化水谷，以致停聚而为胀也。治宜顺气、和血、宽中、利水，各有攸当①，切不可用猛烈之药，致伤脾胃。若脐突肚大青筋或足背手掌俱平者，多为难治。女人臌胀，虽有因于气食而成者，然成于血分者居多。成于气食者，腹虽胀而经水不闭；成于血分者，经必闭也。胀满脉弦，脾制于肝。洪数为热，迟弱虚寒，浮为虚满，紧则中实。浮大可治，虚小危急。朝宽暮急着血虚。暮宽朝急着气虚；朝暮惧急者，气血惧虚也。
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①攸：you1（音优）。各有攸当：即各有所当。
分消汤治臌，（苍白）二术陈（皮）香附，（厚）朴（枳）实茯（苓）（木）香砂（仁），腹皮猪（苓）泽（泻）佐。生姜三片、灯心一团，水煎服。
气急加沉香。胁痛、面黑是气臌，加青皮去白术。胁满、小腹胀痛、身上有血丝缕是血臌，加当归、赤芍、红花、丹皮，去白术、茯苓。嗳气作酸、饱闷腹胀是食臌，加山查、神曲、麦芽、莱菔子，去白术、茯苓。恶寒手足厥冷、泻去清水是水臌，加官桂。胸腹胀满，有块如鼓者是痞散成臌，加山查、神曲、麦芽、半夏、青皮、归尾、元胡索、鳖甲，去白术、茯苓、猪苓、泽泻。
附：浮肿
《内经》曰；"诸湿肿满，皆属于脾。诸气膹郁，皆属于肺"。盖虚肿之由，皆脾虚不运，肺郁不通，以致水渍①三焦，而为浮肿，以手按之成窝，举手渐平也。身有热者，水气在表，治当汗之。身无热者，水气在里，治当下之。又云：腰以上肿者宜发汗，腰以下肿者宜利小便，兼以顺气和脾斯为良法。慎不可用大戟、芫花、甘遂等猛烈之剂，以攻其虚症，吾恐峻决者易，固闭者难，水气复来，而无可治之机矣。
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①渍：zi4（音恣）。浸泡。
风肿：皮肤麻木，走注疼痛，以分心气饮治之。气肿：四肢削瘦，腹胁胀满，以流气饮加减治之。水肿：腰以上肿者，分心气饮；腰以下肿者，五子十皮饮。血肿：皮间有红血丝，妇人多有此症，是败血化为水也，调经散治之。生疮肿者，败毒散加荆芥、防风、金银花，间服五子十皮饮。病后脾虚足跗肿者，由中气下陷也，补中益气汤。异乡不服水土而肿者，藿香正气散。大抵肿退，宜用白术煎膏，调理脾胃。
分心气二陈（汤），（木）通（官）桂腹皮青（皮），桑（皮）苏（梗）羌（活）芍药，（生）姜（大）枣共灯心。
流气饮（木）香（紫）苏，陈（皮）（茯）苓半（夏）（厚）朴（白）术，腹（皮）槟（榔）（木）瓜（枳）壳莪（术），（白）芷（官）桂藿香（菖）蒲。
What has sound is called "ou" (vomiting with sound), and what has substance is called "tu" (vomiting of matter). Sound represents Qi and Fire; substance represents Phlegm and Food. It may be caused by interference from Cold pathogen, invasion by Summerheat pathogen, reversal of Qi due to anger, damage from excessive alcohol or food intake, pain caused by roundworms, stomach deficiency due to chronic illness, or obstruction by accumulated Phlegm and Stasis Blood. All these can lead to vomiting. Generally, a deficient and fine pulse indicates a favorable prognosis, while a full and large pulse indicates an unfavorable one. Treatment should primarily use Er Chen Tang (Two-Cured Decoction). For Stomach Cold, characterized by immediate regurgitation of fluids and food, and a deep, slow pulse, add Gan Jiang (Dried Ginger), Rou Gui (Cinnamon Bark), Ding Xiang (Cloves), Yi Zhi Ren (Alpinia Oxyphylla Fruit), etc. For Summerheat injury, characterized by irritability, thirst, greasy complexion, deficient pulse, and body heat, add Huang Lian (Coptis Rhizome), Bian Dou (Hyacinth Bean), Xiang Ru (Mosla Herb), Hou Po (Magnolia Bark), etc. For Liver Fire attacking the Stomach due to anger, characterized by vomiting with bitter taste, chest and hypochondriac discomfort, and a wiry, rapid pulse, add Xiang Fu (Cyperus Rhizome), Shao Yao (Peony Root), Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), Wu Mei (Mume Fruit), Zhu Ru (Bamboo Shavings), etc. For Food Injury, characterized by vomiting sour and foul matter, add Shan Zha (Hawthorn Fruit), Cao Guo (Black Cardamom), Shen Qu (Medicated Leaven), Mai Ya (Barley Sprout), Zhi Shi (Immature Bitter Orange), Sha Ren (Amomum Fruit), etc. For vomiting due to excessive alcohol, add Ge Hua (Kudzu Flower), Zhu Ling (Poria), Ze Xie (Alisma Rhizome), Bai Dou Kou (White Cardamom), etc. For vomiting caused by roundworms attacking upward, add Wu Mei (Mume Fruit), Chuan Jiao (Sichuan Pepper), Huang Bo (Phellodendron Bark), Gan Jiang (Dried Ginger), Bai Zhu (Atractylodes Macrocephala Rhizome), etc. ... For stomach deficiency after chronic illness, where smelling grain causes vomiting, add Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Fu Long Gan (Stove Earth), Huo Xiang (Patchouli Herb), etc. For vomiting due to accumulated Phlegm in the Stomach, add Nan Xing (Arisaema Rhizome), Zhi Shi (Immature Bitter Orange), Zhu Ru (Bamboo Shavings), Jiang Zhi (Ginger Juice), etc. For vomiting due to internal injury from Stasis Blood, add Tao Ren (Peach Seed) paste, Sheng Jiang Zhi (Fresh Ginger Juice), etc.
One person suffered from dietary excess, abdominal pain, constipation, and incessant vomiting. I said: The Qi of the Yangming channel should descend; ascending is contrary. This vomiting occurs because constipation prevents Stomach Qi from descending. The treatment method should be purgation. One dose of Pi Ji Wan (Spleen Accumulation Pill) cured him.
One person, after Huoluan (Cholera-like syndrome) vomiting and diarrhea, vomited immediately upon eating, unable to retain anything. I said: Vomiting and diarrhea represent slipping Qi. Treatment should employ astringent agents. Three doses of Shao Zhen Wan (Burned Needle Pill) cured him.
Er Chen Tang see page 7.
Pi Ji Wan (Spleen Accumulation Pill)
E Zhu (Curcuma Rhizome) and Liang Jiang (Galangal Rhizome) boiled in vinegar, Qing Pi (Tangerine Peel), Mu Xiang (Aucklandia Root), Bai Cao Shuang (Charred Grass Ash), Jiang Zi (Ba Dou Ren/Ba Dou) ground into paste and formed into pills with wheat starch paste. Take with Chen Pi Tang (Tangerine Peel Decoction) for extraordinary effect.
Shao Zhen Wan (Burned Needle Pill)
Huang Dan (Lead Tetroxide, water-washed), Ku Bai Fan (Alum), and Zhu Sha (Cinnabar) in equal parts, ground into powder. Form pills with date pulp, size of Euryale Seed. Pierce with a needle tip, burn until carbonized but retaining nature, then grind into powder. Take 0.7 fen each time, washed down with cool water. Rice wash water is also acceptable.
Xie Xie (Diarrhea) results from Spleen Qi being injured and unbalanced.
Danxi said: "Diarrhea involves Dampness, Fire, Qi Deficiency, Phlegm Accumulation, and Food Accumulation." Dai Yanli annotated: "For diarrhea with watery stool and no abdominal pain, it is Dampness; for food remaining in the Stomach without staying or passing undigested, it is Qi Deficiency; for abdominal pain, watery diarrhea, borborygmus, where pain comes in waves followed by diarrhea, it is Fire. For intermittent diarrhea varying in amount, it is Phlegm Accumulation; for severe abdominal pain relieved after defecation, it is Food Accumulation."
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① Dai Sigong, courtesy name Yuanli, was from Pujiang County, Zhejiang, during the Ming Dynasty, and a disciple of Zhu Danxi. He authored *Zhengzhi Yaojue*, *Zhengzhi Lei Yuan*, and *Leizheng Yongyao*.
The disease of Diarrhea varies according to the pathogens contracted in the four seasons, whether due to Wind, Cold, Summerheat, or Dampness, or dietary injury, which disturbs Spleen and Stomach Qi, causing diarrhea. Treatment must distinguish between new and chronic cases and examine the cause. For new cases, expelling pathogens is primary, with Spleen-tonifying herbs as assistants. For chronic cases, tonifying the Spleen is primary, with Qi-lifting herbs as guides. I often differentiate symptoms to prescribe medication. Those with definite discussions are recorded below: Stool that is greenish, with abdominal pain and floating pulse, indicates Wind involvement; use Qiang Huo (Notopterygium Rhizome), Fang Feng (Saposhnikovia Root), etc. Stool that is white, with abdominal pain, deep-slow-weak pulse, cold limbs, and clear urine, indicates Cold involvement; use Gan Jiang (Dried Ginger), Rou Gui (Cinnamon Bark), Fu Zi (Aconite Lateral Root), etc. Stool that is yellow, with thirst, irritability, deficient pulse, and body heat, indicates Summerheat involvement; use Huang Lian (Coptis Rhizome), Bian Dou (Hyacinth Bean), Xiang Ru (Mosla Herb), etc. Watery stool, or resembling stale water color, with no abdominal pain, heavy body, fatigue, and deep-slow pulse, indicates Dampness; use Cang Zhu (Atractylodes Lancea Rhizome), Bai Zhu (Atractylodes Macrocephala Rhizome), Hou Po (Magnolia Bark), etc. Undigested food in stool, extremely sour and foul odor, chest/epigastric fullness, and aversion to food smells, indicates Food Injury; use Shan Zha (Hawthorn Fruit), Cao Guo (Black Cardamom), Shen Qu (Medicated Leaven), Mai Ya (Barley Sprout), Lai Fu Zi (Radish Seed), etc. Variable amounts of stool, or intermittent diarrhea, or jelly-like stool, indicates Phlegm involvement; use Nan Xing (Arisaema Rhizome), Ban Xia (Pinellia Tuber), etc. Excessive diarrhea with difficult urination requires separating Yin and Yang to promote urination and firm stools; use Fu Ling (Poria), Zhu Ling (Poria), Hua Shi (Talcum), Ze Xie (Alisma Rhizome), etc. These seven categories are for expelling pathogens. They should not be used for chronic diarrhea, as they damage Yin Qi, leading to sunken eye sockets and critical condition. For tonifying the Spleen, nothing is better than Bai Zhu (Atractylodes Macrocephala Rhizome), Fu Ling (Poria), Chen Pi (Tangerine Peel), Bai Shao (White Peony Root); for supplementing the Spleen, nothing is better than Ren Shen (Ginseng Root), Shan Yao (Dioscorea Rhizome), Bian Dou (Hyacinth Bean), Lian Rou (Lotus Seed), Yi Yi Ren (Coix Seed), Qian Shi (Euryale Seed). Generally, Spleen and Stomach Qi ascending governs growth, while descending governs storage. Chronic diarrhea causes Spleen and Stomach Qi to sink; assist with Qi-lifting herbs like Sheng Ma (Cimicifuga Rhizome), Fang Feng (Saposhnikovia Root), Chai Hu (Bupleurum Root), Ge Gen (Kudzu Root), Qiang Huo (Notopterygium Rhizome), etc. Diarrhea occurring every night after midnight before dawn is Kidney Deficiency diarrhea; use Rou Dou Kou (Nutmeg), Po Gu Zhi (Psoralea Fruit), Wu Zhu Yu (Evodia Fruit), Wu Wei Zi (Schisandra Berry) to tonify the Kidney.
Wu Ling San see page 16.
Wei Ling Tang (Stomach-Wu Ling Decoction)
Cold diarrhea with abdominal pain, clear bowel and bladder movements. One cup of Wei Ling Tang, decocted with Ginger and Jujube. (i.e., Ping Wei San combined with Wu Ling San).
Ru Ling Tang (Mosla-Wu Ling Decoction)
Summerheat diarrhea with intense heat, irritability, and thirst. Eight ingredients of Ru Ling Tang, plus a bundle of Deng Xin Cao (Juncus Medulla). (i.e., Huang Lian Xiang Ru Yin combined with Si Ling San).
Chai Ling Tang (Bupleurum-Wu Ling Decoction)
Body heat, thirst, and frequent diarrhea. One dose of Chai Ling Tang works swiftly like magic. (i.e., Xiao Chai Hu Tang combined with Wu Ling San).
Shen Ling Bai Zhu San (Ginseng-Poria-Atractylodes Powder)
Ren Shen (Ginseng), Fu Ling (Poria), Bai Zhu (Atractylodes), Lian Rou (Lotus Seed), Bian Dou (Hyacinth Bean), Yi Ren (Coix Seed), Sha Ren (Amomum), Gan Cao (Licorice), Jie Geng (Platycodon), Shan Yao (Dioscorea). For chronic diarrhea due to Stomach deficiency.
Note: Chronic diarrhea depletes Primordial Yang. If Spleen-tonifying and anti-diarrheal methods fail, use Bu Gu Zhi (Psoralea Fruit), Wu Zhu Yu (Evodia Fruit), Qian Shi (Euryale Seed), Fu Zi (Aconite), Gan Jiang (Dried Ginger), Rou Gui (Cinnamon Bark), Yi Zhi Ren (Alpinia) to tonify the Fire of the Gate of Vitality. For chronic loose stools, Qi sinking, rectal prolapse, or anal incontinence, use Ren Shen (Ginseng), Huang Qi (Astragalus), Bai Zhu (Atractylodes), He Zi (Chebula Fruit), Bai Shao (White Peony), Chi Shi Zhi (Red Halloysite), Shi Liu Pi (Pomegranate Rind), Gan Cao (Licorice), Mi Ke (Poppy Shell) to tonify and astringe.
Huoluan (Cholera-like Syndrome) is caused by Spleen Cold and Food Injury.
Sudden heart and abdominal pain with vomiting and diarrhea is Wet Huoluan. Severe abdominal colic with inability to vomit or defecate is Dry Huoluan. This syndrome has Cold and Heat types. Cold type: vomit/diarrhea are fishy/foul, excretions are clear/cold, deep-slow pulse, cold limbs, abdominal pain, no desire for water; this is Yin Pathogen dominance. Heat type: vomiting/diarrhea, irritability, sweating, thirst for cold water, deep-rapid pulse, warm limbs; this is Yang Pathogen dominance. Generally treat with modifications of Huo Xiang Zheng Qi San (Patchouli Harmonizing the Righteous Decoction). For Dry Huoluan, first induce vomiting with salt water, then regulate with Huo Xiang Zheng Qi San. If vomiting cannot be induced, death will occur shortly.
Huo Xiang Zheng Qi San (Patchouli Harmonizing the Righteous Decoction)
Zheng Qi (Ban Xia, Shen Qu, Zi Su, Huo Xiang), Fu Ling, Chen Pi, Bai Zhu, Bai Zhi, Hou Po, Jie Geng, Gan Cao, Fu Pi, Sheng Jiang, Da Zao. Treats vomiting/diarrhea from Yin-Yang conflict.
Add Ginger-fried Huang Lian for Heat. Add Gan Jiang for Cold. Add Guan Gui for abdominal pain, add Wu Zhu Yu (remove Huo Xiang) for severe pain. Add Che Qian Zi for difficult urination. Add Mu Gua for muscle cramps. Add Mai Dong, Dan Zhu Ye for fever/thirst. Add Zhi Ke for frequent urge to defecate with difficulty. Add Xiang Ru, Bian Dou for Summerheat. Add Zhi Shi, Qing Pi for epigastric fullness. Add Shan Zha for undigested meat. Add Shen Qu, Mai Ya for undigested grains.
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① Qing: qing1 (sound 'qing'). Toilet.
Shao Yan Tang (Burned Salt Decoction)
A pinch of salt, heated red on a knife, taken with hot child's urine or fresh well water. Vomiting ensues shortly.
Note: Early Huoluan can be treated effectively with Huo Xiang Zheng Qi San combined with bloodletting at Weizhong (BL40) and Chize (LU5). If vomiting/diarrhea are excessive, causing dehydration, sunken eyes, profuse sweating, cold limbs, and faint pulse, urgently administer Wang Qingren's Ji Huo Hui Yang Tang (Emergency Rescue Yang Decoction). Do not mistake thirst for Heat, delaying treatment.
Ji Huo Hui Yang Tang (Emergency Rescue Yang Decoction)
Dang Shen (Codonopsis, 8 qian), Fu Zi (Aconite, 8 qian), Gan Jiang (Dried Ginger, 4 qian), Bai Zhu (Atractylodes, 4 qian), Gan Cao (Licorice, 3 qian), Tao Ren (Peach Seed, 2 qian), Hong Hua (Safflower, 2 qian). Decoct in water and take.
Pi Man (Epigastric Fullness/Stuffiness) results from Spleen Fatigue and Damp Accumulation.
Pi Man refers not to a mass, but to epigastric stuffiness and discomfort. Due to Spleen deficiency failing to transform food/fluids, Dampness accumulates into Phlegm, lodging in Zhongwan, causing stuffiness. Treatment should tonify Spleen and regulate Qi. Regulated Qi resolves Phlegm; strong Spleen transforms food, resolving Pi Man. Use Er Chen Tang (Two-Cured Decoction) added with Zhi Shi (Immature Bitter Orange), Bai Zhu (Atractylodes), Xiang Fu (Cyperus), Sha Ren (Amomum), Bai Dou Kou (White Cardamom), Huo Xiang (Patchouli), Hou Po (Magnolia), etc. Thin people with depression-heat add Huang Lian (Coptis), remove Ban Xia (Pinellia). Blood deficiency add Chuan Xiong (Ligusticum), Dang Gui (Angelica), remove Ban Xia. Food accumulation add Shen Qu (Medicated Leaven), Mai Ya (Barley Sprout), Shan Zha (Hawthorn), remove Bai Zhu, Ban Xia. Obese people with much Damp/Phlegm add Cang Zhu (Atractylodes). Qi deficiency add Ren Shen (Ginseng), remove Ban Xia. Phlegm obstruction add Gua Lou (Trichosanthes), Bei Mu (Fritillaria), Jie Geng (Platycodon), Zhu Li (Bamboo Sap), Jiang Zhi (Ginger Juice), remove Bai Zhu, Ban Xia. Spleen Damp with central fullness add Cang Zhu, Shao Yao, remove Ban Xia.
Er Chen Tang see page 7.
E Ni (Hiccups) is due to Stomach Qi Disregulation.
E Ni, commonly known as hiccupping. Short sounds originate from Middle Jiao, related to food/water issues. Long sounds originate from Lower Jiao, related to deficiency-pathogen interaction. Floating-slow pulse is auspicious; wiry-tense pulse is ominous. For Taiyang disease neglected with constipation and hiccups, use Cheng Qi Tang (Descending Qi Decoction). For post-vomit/diarrhea Stomach Cold hiccups, use Ding Xiang Shi Di Tang (Clove Persimmon Sepal Decoction). For post-vomit/diarrhea Stomach Heat hiccups, use Ju Pi Zhu Ru Tang (Tangerine Peel Bamboo Shavings Decoction). For Qi reversal hiccups, use Mu Xiang Tiao Qi San (Costus Regulating Qi Powder). Post-illness hiccups are difficult to treat.
Cheng Qi Tang see page 15.
Ding Xiang Shi Di Tang (Clove Persimmon Sepal Decoction)
Ding Xiang (Clove), Shi Di (Persimmon Sepal), Ren Shen (Ginseng), Sheng Jiang (Fresh Ginger). Decoct. Safe for Stomach Cold after Taiyang vomiting/diarrhea.
Ju Pi Zhu Ru Tang (Tangerine Peel Bamboo Shavings Decoction)
Ju Pi (Tangerine Peel), Zhu Ru (Bamboo Shavings), Ren Shen (Ginseng), Gan Cao (Licorice), Sheng Jiang (Fresh Ginger), Da Zao (Jujube). Decoct. Safe for Stomach Heat.
Mu Xiang Tiao Qi San (Costus Regulating Qi Powder)
Mu Xiang (Aucklandia), Ding Xiang (Clove), Bai Kou Ren (White Cardamom Seed), Huo Xiang (Patchouli), Tan Xiang (Sandalwood), Sha Ren (Amomum), Gan Cao (Licorice). Swallow with salt water.
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① E: e (sound 'e'). E Ni: Commonly known as hiccupping.
Ke Sou (Cough) is due to Lung Qi Not Clear.
Jiegu said: "Ke (Cough) is sound without phlegm, indicating Lung Qi injury and lack of clarity. Sou (Clearing throat) is phlegm without sound, indicating Spleen Damp generating phlegm. Ke Sou is sound with phlegm, caused by Lung Qi injury interacting with Spleen Damp." Danxi stated cough causes include Wind-Cold, Phlegm-Fluid, Fire Depression, Labor Cough, and Lung Distension. Dai Yanli annotated: Nasal congestion, heavy voice, aversion to cold indicates Wind-Cold. Cough producing phlegm sound, stopping when phlegm exits, indicates Phlegm-Fluid. Sound with little phlegm, red face, indicates Fire Depression. Night sweats, profuse phlegm, alternating chills/fever, indicates Labor Cough. Dyspnea upon movement, rapid breathing, heavy respiration, indicates Lung Distension.
Cough Pulses: Floating-Tight-Deficient-Cold, Deep-Rapid-Full-Heat, Surging-Slippery (much phlegm), Wiry-Choppy (little blood). Floating-Large is favorable; Deep-Small is critical.
Wind-Cold Cough: Su Chen Jiu Bao Yin (Perilla Nine-Treasure Decoction). Phlegm-Fluid Cough: Dao Tan Tang (Guiding Phlegm Decoction), severe cases Xiao Wei Dan (Small Stomach Pill). Fire Depression Cough: Shen Su Yin (Ginseng-Perilla Drink) minus Ren Shen, add Ku Qin (Scutellaria). Labor Cough: Zhi Mu Fu Ling Tang (Anemarrhena-Poria Decoction) or Qing Li Zi Kan Tang (Clearing Li Nourishing Kan Decoction). Chronic Cough: Kua Dong Hua (Winter Flower), Zi Wan (Aster Root), Wu Wei Zi (Schisandra), Wu Mei Rou (Mume Flesh), equal parts, form pills, hold in mouth. Lung Distension Cough: Qing Fei Yin (Lung-Clearing Drink).
Su Chen Jiu Bao Yin (Perilla Nine-Treasure Decoction)
Zi Su (Perilla), Ma Huang (Ephedra), Rou Gui (Cinnamon), Bo He (Mint), Chen Pi (Tangerine Peel), Xing Ren (Apricot Seed), Gan Cao (Licorice), Da Fu Pi (Areca Peel). Effective for Cold Cough.
Dao Tan Tang see page 7.
Xiao Wei Dan (Small Stomach Pill)
Cu Yuan Hua (Vinegar-processed Genkwa Flower), Da Ji (Spurge Root), Gan Sui (Kansui Root), Jun (Da Huang/Rhubarb), Huang Bo (Phellodendron). Mix with Bai Zhu paste. Take at bedtime on empty stomach with hot water.
Shen Su Yin see page 18.
Zhi Mu Fu Ling Tang (Anemarrhena-Poria Decoction)
Zhi Mu (Anemarrhena), Fu Ling (Poria), Dang Gui (Angelica), Bai Shao (White Peony), Di Huang (Rehmannia), Tian Dong (Asparagus Root), Gan Cao (Licorice), Bai Zhu (Atractylodes). Good formula for Labor Cough.
Qing Fei Yin (Lung-Clearing Drink)
Zhi Zi (Gardenia), Huang Qin (Scutellaria), Sang Bai Pi (Mulberry Root Bark), Dang Gui (Angelica), Fu Ling (Poria), Mai Dong (Ophiopogon), Tian Dong (Asparagus), Men Dong (Ophiopogon), Jie Geng (Platycodon), Chen Pi (Tangerine Peel), Gan Cao (Licorice), Xing Ren (Apricot Seed), Wu Wei Zi (Schisandra), Sheng Jiang (Fresh Ginger), Da Zao (Jujube). Decoct in water.
Qing Li Zi Kan Tang (Clearing Li Nourishing Kan Decoction)
Dan Pi (Moutan Bark), Bai Zhu (Atractylodes), Ze Xie (Alisma), Bai Shao (White Peony), Yu Rou (Cornus), Shan Yao (Dioscorea), Gan Cao (Licorice), Fu Ling (Poria), Tian Dong (Asparagus), Mai Dong (Ophiopogon), Dang Gui (Angelica), Shu Di (Prepared Rehmannia), Sheng Di (Raw Rehmannia), Zhi Mu (Anemarrhena), Huang Bo (Phellodendron). Clears Kan and Li.
Note: Xiao Wei Dan contains potent drugs; only use for robust patients with excessive Phlegm-Fluid.
Ai Qi (Belching) is all due to Phlegm-Fire.
Belching indicates Phlegm and Fire in the Stomach. Use Nan Xing (Arisaema), Ban Xia (Pinellia), Shi Gao (Gypsum), Xiang Fu (Cyperus), Chao Shan Zhi (Fried Gardenia). Pills or decoction both work. Stomach Cold belching: Er Chen Tang plus Gan Jiang (Dried Ginger), Yi Zhi Ren (Alpinia), Mu Xiang (Aucklandia). Women's belching, continuous for over ten sounds, bringing relief after belching, tightness without: Yue Ju Wan (Six-Stagnation Pill) is effective.
Yan Suan (Acid Regurgitation) is entirely due to Food Stagnation.
Yan Suan is acid water piercing the heart. Tu Suan Ku (Vomiting Sour-Bitter) is vomiting acid water. Both result from Spleen deficiency failing to transform food, long-term stagnation, Damp generating Heat, Humidity-Heat steaming, creating acidity. Ping Wei San plus Shen Qu (Medicated Leaven), Mai Ya (Barley Sprout), Shan Zha Tan (Charred Hawthorn), Cao Guo (Black Cardamom), Wu Zhu Yu (Evodia), Huang Lian (Coptis), Zhi Shi (Immature Bitter Orange). Or Liu Yu Tang (Six-Stagnation Decoction), Yue Ju Wan (Six-Stagnation Pill) are excellent. Vomiting clear water: Cang Zhu (Atractylodes), Bai Zhu (Atractylodes), Chen Pi (Tangerine Peel), Fu Ling (Poria), Hua Shi (Talcum) equal parts, decoct in water.
Appendix: Cao Za (Restlessness/Gnawing Sensation)
Cao Za, commonly called Heart Gnawing. Caused by Phlegm stirred by Fire: Er Chen Tang plus Wine-fried Huang Lian (Coptis), Zhi Zi Ren (Gardenia Seed). Caused by Heart Blood Deficiency: Ba Zhen Tang (Eight-Treasure Decoction) plus Mai Dong (Ophiopogon), Zhi Zi (Gardenia), Chen Pi (Tangerine Peel), Wu Mei (Mume), Chao Mi (Fried Rice). Caused by Food Stagnation: Yue Ju Wan (Six-Stagnation Pill).
Ping Wei San see page 8.
Liu Yu Tang see page 24.
Yue Ju Wan see page 24.
Er Chen Tang see page 7.
Ba Zhen Tang see page 6.
Zhong Man Gu Zhang (Central Fullness Drum Distension) is Spleen Deficiency failing to transport.
Zhong Man Gu Zhang: Limbs not swollen, abdomen only distended. Resembles a drum, hence "Gu Zhang". Renzhai Zhizhi lists four types: Qi Gu, Blood Gu, Food Gu, Water Gu. All due to Spleen deficiency failing to transform food/fluids, leading to accumulation and distension. Treatment should regulate Qi, harmonize Blood, widen middle, promote urination. Each has its appropriate method. Do not use harsh drugs damaging Spleen/Stomach. Umbilical protrusion, large belly with visible veins, flat soles/palms indicate difficult cases. Female Gu Zhang, though sometimes Qi/Food origin, mostly Blood origin. Qi/Food origin: Abdomen distended but menstruation not closed. Blood origin: Menstruation definitely closed. Distension with wiry pulse: Spleen controlled by Liver. Surging-Rapid: Heat. Slow-Weak: Deficient Cold. Floating: Deficient Fullness. Tight: Interior Solid. Floating-Large: Treatable. Deficient-Small: Critical. Morning ease/evening urgency: Blood Deficiency. Evening ease/morning urgency: Qi Deficiency. Both times urgent: Qi and Blood both deficient.
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① You: you1 (sound 'you'). Ge You You Dang: Each has its proper place.
I treat obese people's abdominal distension with Wei Ling Tang (Stomach-Wu Ling Decoction), thin people's with Ru Ling Tang (Mosla-Wu Ling Decoction); both are very effective.
Fen Xiao Tang (Dividing and Eliminating Decoction)
Treats Gu Zhang. Cang Zhu, Bai Zhu, Chen Pi, Xiang Fu, Hou Po, Zhi Shi, Fu Ling, Mu Xiang, Sha Ren, Fu Pi, Zhu Ling, Ze Xie. Assist with 3 slices Sheng Jiang, 1 bundle Deng Xin Cao. Decoct in water.
Add Chen Xiang for Qi urgency. Hypochondriac pain, dark face is Qi Gu: add Qing Pi, remove Bai Zhu. Hypochondriac fullness, lower abdominal pain, red threads on skin is Blood Gu: add Dang Gui, Chi Shao, Hong Hua, Dan Pi, remove Bai Zhu, Fu Ling. Belching with acid, fullness/distension is Food Gu: add Shan Zha, Shen Qu, Mai Ya, Lai Fu Zi, remove Bai Zhu, Fu Ling. Aversion to cold, cold limbs, watery diarrhea is Water Gu: add Guan Gui. Chest/abdominal fullness, mass like drum is Pi San becoming Gu: add Shan Zha, Shen Qu, Mai Ya, Ban Xia, Qing Pi, Gui Wei, Yuan Hu Suo, Bie Jia, remove Bai Zhu, Fu Ling, Zhu Ling, Ze Xie.
Wei Ling Tang, Ru Ling Tang see page 27.
Appendix: Fu Zhong (Edema)
*Neijing* says: "All Dampness swelling/fullness belongs to Spleen. All Qi oppression/depression belongs to Lung." Generally, deficiency edema is due to Spleen deficiency failing to transport, Lung depression failing to diffuse, causing water to soak the Triple Burner, resulting in edema. Pressing leaves a pit, rising hand slowly flattens. Body heat: Water Qi in Exterior, treat by sweating. No body heat: Water Qi in Interior, treat by purging. Also: Edema above waist sweat; below waist promote urination. Combine with regulating Qi and harmonizing Spleen. Do not use harsh drugs like Da Ji (Spurge), Yuan Hua (Genkwa), Gan Sui (Kansui) to attack deficiency. Harsh draining is easy, consolidation is hard; if Water Qi returns, treatment fails.
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① Zi: zi4 (sound 'zi'). Soak.
Feng Zhong (Wind Edema): Skin numbness, wandering pain. Treat with Fen Xin Qi Yin (Dividing Heart-Qi Drink). Qi Zhong (Qi Edema): Emaciated limbs, abdominal/hypochondriac fullness. Treat with Liu Qi Yin (Flowing Qi Drink) modified. Shui Zhong (Water Edema): Above waist Fen Xin Qi Yin; below waist Wu Zi Shi Pi Yin (Five Seeds Ten Barks Decoction). Xue Zhong (Blood Edema): Red threads under skin, common in women,敗血 turning to water. Treat with Tiao Jing San (Regulate Menses Powder). Chuang Zhong (Sore Edema): Bai Du San (Resist Toxin Powder) plus Jing Jie (Schizonepeta), Fang Feng (Saposhnikovia), Jin Yin Hua (Honeysuckle). Intermittently take Wu Zi Shi Pi Yin. Post-illness Spleen Deficiency foot edema: Due to Middle Qi sinking. Treat with Bu Zhong Yi Qi Tang (Tonify Middle and Augment Qi Decoction). Foreign land水土不服 (unaccustomed climate/water) edema: Huo Xiang Zheng Qi San (Patchouli Harmonizing the Righteous Decoction). Generally, after edema subsides, use Bai Zhu paste to regulate Spleen/Stomach.
Fen Xin Qi Yin (Dividing Heart-Qi Drink)
Fen Xin Qi Er Chen Tang, Mu Tong (Akebia), Guan Gui (Cinnamon), Fu Pi (Areca Peel), Qing Pi (Tangerine Peel), Sang Bai Pi (Mulberry Root Bark), Su Geng (Perilla Stem), Qiang Huo (Notopterygium), Shao Yao (Peony), Sheng Jiang (Fresh Ginger), Da Zao (Jujube), Deng Xin Cao (Juncus).
Liu Qi Yin (Flowing Qi Drink)
Mu Xiang (Aucklandia), Zi Su (Perilla), Chen Pi (Tangerine Peel), Fu Ling (Poria), Ban Xia (Pinellia), Hou Po (Magnolia), Bai Zhu (Atractylodes), Fu Pi (Areca Peel), Bing Lang (Betel Nut), Mu Gua (Chaenomeles), Zhi Ke (Bitter Orange), E Zhu (Curcuma), Bai Zhi (Angelica Dahurica), Guan Gui (Cinnamon), Huo Xiang (Patchouli), Chang Pu (Acorus).
Wu Zi Shi Pi Yin (Five Seeds Ten Barks Decoction)①