天津黄××，年二十岁，得神经错乱病。
病因 因心中忿郁，久之遂致神经错乱。
证候 心中满闷发热，不思饮食，有时下焦有气上冲，并觉胃脘之气亦随之上冲，遂致精神
昏瞀，言语支离，移时觉气消稍顺，或吐痰数口，精神遂复旧。其左脉弦而硬，右脉弦而
长，两尺皆重按不实，一息五至。
诊断 此乃肝火屡动，牵引冲气胃气相并上冲，更挟痰涎上冲以滞塞于喉间并冲激其脑部，是以
其神经错乱而精神言语皆失其常也。其左脉弦硬者，肝血虚而火炽盛也。右脉弦长者，冲气挟胃气上
冲之现象也。方书论脉有直上直下冲脉昭昭之语，所谓直上直下者，即脉弦且长之形状也。其两尺不实
者，下焦之气化不固也，因下焦有虚脱之象，是以冲气易挟胃气上冲也。此当治以降胃、敛冲、镇
肝之剂，更兼用凉润滋阴之品，以养肝血，清肝热，庶能治愈。
处方 生赭石（一两轧细） 灵磁石（五钱轧细） 生怀山药（八钱） 生龙骨（八钱捣碎）
生杭芍（六钱） 玄参（五钱） 柏子仁（五钱） 云苓片（三钱）
清半夏（三钱） 石菖蒲（三钱） 生远志（二钱） 镜面砂（三分研细）
药共十二味，将前十一味煎汤一大盅，送服朱砂细末。
复诊 将药连服四剂，满闷发热皆大见愈，能进饮食，有时气复上冲而不复上干神经至于
错乱，左右之脉皆较前平和，而尺部仍然欠实，拟兼用培补下元之品以除病根。
处方 生赭石（一两轧细） 熟怀地黄（八钱） 生怀山药（八钱） 大甘枸杞（六钱）
净萸肉（五钱） 生杭芍（四钱） 玄参（四钱） 云苓片（二钱）
共煎汤一大盅，温服。
效果 将药连服六剂，诸病皆愈，脉亦复常。
或问 地黄之性粘腻生痰，胃脘胀满，有痰者多不敢用，今重用之何以能诸病皆愈？答曰∶用药
如用兵，此医界之恒言也，如宋八字军最弱，刘 将之即为劲卒，遂能大败金人奏顺昌
之捷，以斯知兵无强弱，在用之者何如耳。至用药亦何独不然，忆曾治一李姓媪，胃口
满闷有痰，其脉上盛下虚，投以肾气丸作汤服，为加生赭石八钱，服后觉药有推荡之力，须
臾胸次豁然，肾气丸非重用地黄者乎？然如此用药非前无师承而能有然也。《金匮》云∶短气有微饮
当从小便去之，苓桂术甘汤主之，肾气丸亦主之。夫饮即痰也，气短亦近于满
闷，而仲师竟谓可治以肾气丸，愚为于《金匮》曾熟读深思，故临证偶有会心耳。
Tianjin patient Huang XX, aged twenty, suffered from mental derangement (neurosis).
Etiology: Due to prolonged resentment and depression in the heart, this eventually led to mental derangement.
Symptoms: The patient experienced fullness, oppression, and heat in the chest, loss of appetite, and sometimes Qi rushing upward from the lower Jiao. He also felt that Qi from the epigastrium rushed up along with it, leading to mental confusion and disjointed speech. After a while, when the Qi subsided slightly, he would feel more comfortable, or after expectorating a few mouthfuls of phlegm, his spirit would return to normal. His left pulse was wiry and hard; the right pulse was wiry and long; both Chi pulses were empty upon heavy pressure. The breathing rate was five beats per respiration cycle.
Diagnosis: This is caused by Liver Fire repeatedly stirring, dragging the Chong Qi and Stomach Qi to rush upward together, further carrying Phlegm-Fluids upward to obstruct the throat and irritate the brain. Consequently, the nerves are deranged, and both spirit and speech lose their normal state. The wiry and hard left pulse indicates Liver Blood deficiency with blazing Fire. The wiry and long right pulse is a manifestation of Chong Qi carrying Stomach Qi upward. Medical texts describe the pulse as "straight up and down, clearly showing the Chong Mai"; what is meant by "straight up and down" is the shape of a wiry and long pulse. The emptiness of both Chi pulses indicates instability of Qi transformation in the lower Jiao. Because there is a sign of collapse in the lower Jiao, the Chong Qi easily carries Stomach Qi upward. Treatment should employ agents to descend Stomach Qi, restrain Chong Qi, and pacify the Liver, combined with cooling, moistening, and Yin-nourishing herbs to nourish Liver Blood and clear Liver Heat, so that a cure may be achieved.
Prescription:
Sheng Zhe Shi (Raw Hematite, 1 liang, finely crushed)
Ling Ci Shi (Spiritual Magnetite, 5 qian, finely crushed)
Sheng Huai Shan Yao (Raw Chinese Yam, 8 qian)
Sheng Long Gu (Raw Dragon Bone, 8 qian, crushed)
Sheng Hang Shao (Raw White Peony Root, 6 qian)
Xuan Shen (Scrophulariae Radix, 5 qian)
Bai Zi Ren (Biota Seed, 5 qian)
Yun Ling Pian (Poria Slices, 3 qian)
Qing Ban Xia (Processed Pinellia Tuber, 3 qian)
Shi Chang Pu (Acori Tatarinowii Rhizome, 3 qian)
Sheng Yuan Zhi (Raw Polygala Root, 2 qian)
Jing Mian Sha (Refined Cinnabar, 3 fen, finely ground)
Twelve ingredients in total. Decoct the first eleven ingredients in one large bowl of water, and take with fine powder of Zhu Sha (Cinnabar).
Follow-up Visit: After taking four doses consecutively, the fullness and heat largely resolved, and the patient could eat. Although Qi occasionally rushed upward again, it no longer interfered with the nerves to cause derangement. The pulses on both sides became more peaceful compared to before, but the Chi position remained insufficient. It is proposed to additionally use herbs to tonify the Lower Origin to eliminate the root of the disease.
Prescription:
Sheng Zhe Shi (Raw Hematite, 1 liang, finely crushed)
Shu Huai Di Huang (Prepared Rehmannia Root, 8 qian)
Sheng Huai Shan Yao (Raw Chinese Yam, 8 qian)
Da Gan Gou Qi (Large Sweet Goji Berry, 6 qian)
Jing Yu Rou (Clean Cornus Fruit, 5 qian)
Sheng Hang Shao (Raw White Peony Root, 4 qian)
Xuan Shen (Scrophulariae Radix, 4 qian)
Yun Ling Pian (Poria Slices, 2 qian)
Decoct all ingredients in one large bowl of water and take warm.
Outcome: After taking six doses consecutively, all diseases were cured, and the pulse returned to normal.
Question: The nature of Di Huang (Rehmannia Root) is sticky and cloying, prone to generating Phlegm; patients with epigastric distension and Phlegm often dare not use it. How can its heavy use here lead to the cure of all diseases?
Answer: Using medicine is like using troops; this is a common saying in the medical field. For example, the Song Dynasty's Eight Character Army was the weakest, but under the command of Liu Qi, they became elite soldiers and defeated the Jin army decisively at Shunchang. From this, we know that troops have no inherent strength or weakness; it depends on how they are used. Is it not the same for medicine? I recall treating an elderly surnamed Li who had epigastric fullness and Phlegm, with a pulse indicating excess above and deficiency below. I prescribed Shen Qi Wan (Kidney Qi Pill) modified as a decoction, adding 8 qian of Sheng Zhe Shi (Raw Hematite). After ingestion, she felt the pushing and draining power of the medicine, and suddenly her chest felt open and clear. Did Shen Qi Wan not heavily use Di Huang? However, such prescription logic cannot be achieved without prior transmission of knowledge. *Jin Gui Yao Lue* states: "For shortness of breath accompanied by slight fluid retention, it should be eliminated through urination; Ling Gui Zhu Gan Tang is the primary formula, and Shen Qi Wan is also indicated." Fluid retention is Phlegm, and shortness of breath is close to fullness/oppression. Yet Master Zhang Zhongjing explicitly stated it could be treated with Shen Qi Wan. Having studied and pondered deeply over *Jin Gui Yao Lue*, I occasionally gained insight during clinical practice.