天津范××，年三十二岁，得黄胆证。
病因 连日朋友饮宴，饮酒过量，遂得斯证。
证候 周身面目俱黄，饮食懒进，时作呕吐，心中恒觉发热，小便黄甚，大便白而干涩，脉象
左部弦而有力，右部滑而有力。
诊断 此因脾中蕴有湿热，不能助胃消食，转输其湿热于胃，以致胃气上逆（是以呕吐），胆
火亦因之上逆（黄坤载谓，非胃气下降，则胆火不降），致胆管肿胀不能输其汁于小肠以化食，遂
溢于血中而成黄胆矣。治此证者，宜降胃气，除脾湿，兼清肝胆之热则黄胆自愈。
处方 生赭石（一两轧细） 生薏米（八钱捣细） 茵陈（三钱） 栀子（三钱）
生麦芽（三钱） 竹茹（三钱） 木通（二钱） 槟榔（二钱） 甘草（二钱）
煎汤服。
效果 服药一剂，呕吐即止，可以进食，又服两剂，饮食如常，遂停药，静养旬日间黄胆皆退净。
沧县杨××，年三十五岁，于季秋因下痢成肠溃疡证。
病因 因业商赔累歇业，心中懊 ，暗生内热，其肝胆之热，下迫致成痢疾。痢久不愈，又转为肠溃疡。
证候 其初下痢时，后重腹疼，一昼夜十七八次，所下者赤痢多带鲜血，间有白痢。延
医治疗阅两月，病益加剧。所下者渐变为血水，杂以脂膜，其色腐败，其气腥臭，每腹中一觉疼即
须入厕，一昼夜二十余次，身体羸弱，口中发干，心中怔忡，其脉左右皆弦细，其左部则
弦而兼硬，一分钟九十二至。
诊断 此乃因痢久不愈，肠中脂膜腐败，由腐败而至于溃烂，是
以纯下血水杂以脂膜，即西人所谓肠溃疡也。其脉象弦细
者，气血两亏也。其左脉细而硬者，肝肾之阴亏甚也。其口干心中怔忡者，皆下血过
多之所致也。此宜培养其气血而以解毒化瘀生新之药佐之。
处方 龙眼肉（一两） 生怀山药（一两） 熟地黄（一两） 金银花（四钱）
甘草（三钱） 广三七（三钱轧细）
药共六味，将前五味煎汤，送服三七末一半，至煎渣再服时，仍送服其余一半。
方解 龙眼肉为补益脾胃之药，而又善生心血以愈怔忡，更善治肠风下血，治此证当为主药。
山药亦善补脾胃，而又能上益肺气下固肾气，其所含多量之蛋白质，尤善滋阴养血，凡气
血两虚者，洵为当用之药。熟地黄不但补肾阴也，冯楚瞻谓能大补肾中元气，要亦气血双补
之品也。此三味并用，久亏之气血自能渐复，气血壮旺自能长肌肉排腐烂。又佐以金银
花甘草以解毒，三七以化瘀生新，庶能挽回此垂危之证也。
复诊 将药煎服三剂，病大见愈，一昼夜大便三四次，间见好粪，心中已不怔忡，脉象犹
弦而左部不若从前之硬。因所服之药有效，遂即原方略为加减，又服数剂，其大便仍一日数
次，血粪相杂，因思此证下痢甚久，或有阿米巴毒菌伏藏于内，拟方中加消除此毒菌之药治之。
处方 龙眼肉（一两） 生怀山药（一两） 熟地黄（一两） 甘草（三钱）
生硫黄（八分研细） 鸦胆子（成实者六十粒去皮）
药共六味，将前四味煎汤一大盅，送服鸦胆子硫黄末各一半，至煎渣再服时，仍送服其余一半。
方解 方中用鸦胆子、硫黄者，因鸦胆子为治血痢要药，并善治二便下血；硫黄为除阿米巴痢之
毒菌要药，二药并用，则凉热相济，性归和平奏效当速也。
三诊 将药煎服两剂，其大便仍血粪相杂一日数行。因思鸦胆子
与硫黄并用虽能消除痢中毒菌，然鸦胆子化瘀之力甚大，硫黄又为润大便之药（本草谓其能使大便润、
小便长，西人以硫黄为轻下药），二药虽能消除痢中毒菌，究难使此病完全除根，拟去此二药，
于方中加保护脂膜固涩大便之品。
处方 龙眼肉（一两） 生怀山药（一两） 大熟地黄（一两） 赤石脂（一两捣细）
甘草（三钱） 广三七（三钱轧细）
药共六味，将前五味煎汤一大盅，送服三七细末一半，至煎渣再服时，仍送服其余一半。
效果 将药连服五剂，下血之证全愈，口中已不发干，犹日下溏粪两三次，然便时腹中分毫
不疼矣。俾用生怀山药轧细末，每用两许煮作茶汤，调以白糖令适口，当点心服之，其大便久自能固。
Fan XX from Tianjin, aged thirty-two, suffered from jaundice.
Etiology: Due to attending banquets with friends for several consecutive days and drinking excessively, he contracted this disease.
Symptoms: The entire body and face were yellow; appetite was poor; vomiting occurred intermittently; the chest felt constantly hot; urine was very dark yellow; stools were white, dry, and difficult to pass. The pulse was wiry and forceful on the left side, and slippery and forceful on the right side.
Diagnosis: This condition arises from damp-heat accumulating in the spleen, which fails to assist the stomach in digesting food. Instead, it transmits damp-heat to the stomach, causing stomach qi to rebel upward (resulting in vomiting). Gallbladder fire also rebels upward (Huang Kunzai stated that if stomach qi does not descend, gallbladder fire will not descend), leading to swelling of the bile ducts. Consequently, bile cannot be transported to the small intestine to aid digestion and overflows into the blood, forming jaundice. Treatment should focus on descending stomach qi, eliminating spleen dampness, and clearing heat from the liver and gallbladder, after which jaundice will resolve spontaneously.
Prescription: Sheng Zhe Shi (Ochre, one liang, finely ground) Sheng Yi Mi (Coix Seed, eight qian, crushed) Yin Chen (Artemisiae Scopariae Herba, three qian) Zhi Zi (Gardeniae Fructus, three qian) Sheng Mai Ya (Hordei Fructus Germinatus, three qian) Zhu Ru (Bambusae Caulis in Taenia, three qian) Mu Tong (Akebiae Caulis, two qian) Bing Lang (Arecae Semen, two qian) Gan Cao (Glycyrrhizae Radix et Rhizoma, two qian)
Decoct in water and take orally.
Outcome: After one dose, vomiting ceased, and eating became possible. After two more doses, dietary habits returned to normal, so medication was stopped. After ten days of rest, the jaundice completely resolved.
Yang XX from Cangxian, aged thirty-five, developed intestinal ulceration due to dysentery in late autumn.
Etiology: Business losses led to the closure of his trade, causing mental frustration and hidden internal heat. Heat from the liver and gallbladder descended and forced its way downward, resulting in dysentery. Prolonged dysentery failed to heal and transformed into intestinal ulceration.
Symptoms: Initially, during dysentery, there was a sensation of heaviness in the anus and abdominal pain, occurring seventeen or eighteen times per day and night. The excreta were mostly red dysentery mixed with fresh blood, occasionally white dysentery. Medical treatment lasted two months, yet the condition worsened. Excreta gradually changed to bloody fluid mixed with mucous membranes, appearing putrid and foul-smelling. Every time abdominal pain arose, immediate defecation was required, occurring more than twenty times daily. The body was emaciated, the mouth dry, and palpitations present. The pulse was wiry and fine on both sides, with the left side being wiry and hard, beating ninety-two times per minute.
Diagnosis: This is caused by prolonged dysentery leading to the putrefaction of intestinal mucous membranes, progressing to ulceration. Hence, pure bloody fluid mixed with mucous membranes is discharged, corresponding to what Western medicine calls intestinal ulceration. The wiry and fine pulse indicates deficiency of both qi and blood. The wiry and hard left pulse indicates severe deficiency of yin in the liver and kidneys. Dry mouth and palpitations are consequences of excessive blood loss. Treatment should nourish qi and blood, assisted by herbs that detoxify, invigorate blood, eliminate stasis, and generate new tissue.
Prescription: Long Yan Rou (Longan Aril, one liang) Sheng Huai Shan Yao (Dioscoreae Rhizoma, one liang) Shu Di Huang (Rehmanniae Radix Praeparata, one liang) Jin Yin Hua (Lonicerae Japonicae Flos, four qian) Gan Cao (Glycyrrhizae Radix et Rhizoma, three qian) Guang San Qi (Notoginseng Radix et Rhizoma, three qian, finely ground)
Six ingredients in total. Decoct the first five ingredients, and take half of the San Qi powder with the decoction. When decocting the dregs for the second administration, take the remaining half of the San Qi powder.
Formula Analysis: Long Yan Rou tonifies the spleen and stomach and generates heart blood to cure palpitations; it is particularly effective for treating wind-intestinal bleeding and should be the principal herb here. Shan Yao also tonifies the spleen and stomach, benefits lung qi upwards, and secures kidney qi downwards. Its high protein content is especially good for nourishing yin and blood, making it suitable for cases of dual qi and blood deficiency. Shu Di Huang not only tonifies kidney yin but, as Feng Chuzhan noted, can greatly tonify primordial qi in the kidney; it is also a dual tonic for qi and blood. Using these three together allows chronically deficient qi and blood to gradually recover. Robust qi and blood promote muscle growth and expel necrotic tissue. Jin Yin Hua and Gan Cao are added to detoxify, and San Qi to invigorate blood and generate new tissue, thereby rescuing this critical condition.
Second Visit: After three doses, the condition improved significantly. Defecation occurred three or four times daily, with occasional normal stools, and palpitations ceased. The pulse remained wiry, but the left side was no longer as hard as before. Since the medication was effective, slight modifications were made to the original formula, and several more doses were taken. However, defecation continued multiple times daily, with blood and stool mixed. Considering the long duration of dysentery, it was hypothesized that amoebic pathogens might be latent internally. Therefore, herbs to eliminate these pathogens were planned to be added.
Prescription: Long Yan Rou (Longan Aril, one liang) Sheng Huai Shan Yao (Dioscoreae Rhizoma, one liang) Shu Di Huang (Rehmanniae Radix Praeparata, one liang) Gan Cao (Glycyrrhizae Radix et Rhizoma, three qian) Sheng Liu Huang (Sulfur, eight fen, finely ground) Ya Dan Zi (Brucea Fructus, sixty ripe kernels, peeled)
Six ingredients in total. Decoct the first four ingredients in a large cup of water, and take half of the Ya Dan Zi and Liu Huang powder with the decoction. When decocting the dregs for the second administration, take the remaining half.
Formula Analysis: Ya Dan Zi is a key herb for treating bloody dysentery and hematochezia/melena. Liu Huang is a key herb for eliminating amoebic pathogens. Used together, their cooling and warming properties balance each other, resulting in mild nature and rapid efficacy.
Third Visit: After two doses, defecation still consisted of mixed blood and stool, occurring multiple times daily. Although Ya Dan Zi and Liu Huang can eliminate dysenteric pathogens, Ya Dan Zi has strong blood-invigorating power, and Liu Huang moistens the intestines (Bencao states it moistens bowels and increases urination; Westerners consider it a mild laxative). While they eliminate pathogens, they may not completely eradicate the root cause. Thus, these two herbs were removed, and herbs to protect mucous membranes and astringe the bowels were added.
Prescription: Long Yan Rou (Longan Aril, one liang) Sheng Huai Shan Yao (Dioscoreae Rhizoma, one liang) Da Shu Di Huang (Rehmanniae Radix Praeparata, one liang) Chi Shi Zhi (Kaolinite, one liang, crushed) Gan Cao (Glycyrrhizae Radix et Rhizoma, three qian) Guang San Qi (Notoginseng Radix et Rhizoma, three qian, finely ground)
Six ingredients in total. Decoct the first five ingredients in a large cup of water, and take half of the San Qi powder with the decoction. When decocting the dregs for the second administration, take the remaining half.
Outcome: After five consecutive doses, bleeding completely ceased, and dry mouth disappeared. Loose stools still occurred two or three times daily, but without any abdominal pain. It was advised to use Sheng Huai Shan Yao powder, boiled in water like tea, sweetened with sugar to taste, and taken as a snack. Over time, bowel movements would naturally become firm.