涩脉少血，或中寒湿，反胃结肠，自汗厥逆。
《灵枢》决气篇曰∶中焦取汁，变化而赤，是谓血。壅遏营气，令无所避，是
谓脉。脉之与血，同质异名，是二而一。况体为阴液，多则滑利，少则枯涩，理势
之必然者。（枯涩、虚涩血少，宜四物汤之类。）寒湿袭人，肌腠痹着，气道不利，脉安得不涩。
（滞涩之涩，宜和剂渗湿汤、百一除湿汤、三因肾着汤之类。）反胃，则朝食暮吐，暮食朝吐，或随食随
吐。胃无余液，以致肠中枯燥而大便秘结，脉安得不涩。（枯涩之涩，宜六君子汤、宝鉴人参利膈
丸、统旨滋血润肠汤、滋阴清膈饮之类。）自汗者，汗时时自出也。出则液耗，是谓脱液。漏而不
止，卫气散失，四肢厥寒，是谓亡阳。阳亡液脱，脉又安得不涩。（虚涩之涩，宜十全大补汤、
济生 附汤、黄 建中汤之类。）一涩脉也，而有虚涩、滞涩、枯涩之分，是又在诊之者，自为灵通耳。
四物汤 治肝脾肾血虚发热，或寒热往来，或日晡热甚，头目不清，或烦躁不寐，
胸膈作胀，胁肋疼痛等症。凡血虚诸病，以此为主治。若脾气虚而不能生血，宜
四君子。若脾气郁而血虚，宜归脾汤。若肾水涸而不生肝血，宜六味丸。
当归（二钱） 白芍药（一钱） 熟地黄（三钱） 川芎（钱半）
上水煎服。
和剂渗湿汤（见第十七）
百一除湿汤 治寒湿所伤，身体重着，腰脚 疼，大便溏泄，小便或涩或利。
半夏曲（炒） 浓朴（姜制） 苍术（米泔制，各二两） 藿香叶 陈皮（去白） 白茯苓（去
皮，各一两） 甘草（炙七钱） 白术（生用一两）
上 咀。每服四钱。水一盏，姜七片，枣一枚，煎七分。食前温服。
三因肾着汤 治肾虚伤湿，身重腰冷，如坐水中，不渴，小便自利。
干姜（炮） 茯苓（各四两） 甘草（炙） 白术（各二两）
每服四钱，水一盏，煎七分，空心温服。
六君子汤（见第十六）
宝鉴人参利膈丸 治胸中不利，大便结燥，痰嗽喘满，脾胃壅滞，推陈致新，治膈
气之圣药也。
木香 槟榔（各七钱半） 人参 当归（酒洗） 藿香 甘草 枳实（麸炒黄，各一两） 大黄
（酒湿蒸熟） 浓朴（姜制，各二两）
上为细末，滴水为丸，如桐子大。每服三、五十丸。食后诸饮下。
统旨滋血润肠汤 治血枯及死血在膈，饮食不下，大便燥结。
当归（酒洗，三钱） 芍药（炒） 生地黄（各一钱半） 红花（酒洗） 桃仁（去皮尖炒） 大黄（酒
煨） 枳壳（麸炒各一钱）
水一钟半，煎七分，入韭菜汁半酒盏，食前服。
滋阴清膈饮（统旨） 治阴火上冲，或胃火太盛，食不入，脉洪数者。
当归 芍药（煨） 黄柏（盐水炒） 黄连（各一钱半） 黄芩 山栀 生地黄（各一钱） 甘草（三分）
水二钟，煎七分，入童便、竹沥各半酒盏，食前服。
十全大补汤（见第十六）
济生 附汤 治气虚阳弱，虚汗不止，肢体倦怠。
黄 （去芦、蜜炙） 附子（炮、去皮脐，各等分）
上 咀。每服四钱。水一盏，生姜十片，煎八分。食前温服。未应，更加之。
黄 建中汤 治血气不足，体常自汗。
黄 桂（各一钱半） 白芍药（三钱） 甘草（一钱）
每服五钱。水一钟半，姜五片，枣二枚，煎八分。去滓，入稠饧一大匙，再煎服。旧有微溏或呕者，不用饧。
The Choppy pulse (Se, 涩) indicates a deficiency of blood, or it may be caused by the invasion of cold-dampness. It is associated with regurgitation (fanwei, 反胃), constipation due to intestinal dryness, spontaneous sweating, and cold extremities with reversal (jue ni, 厥逆).
The *Ling Shu* (Spiritual Pivot), chapter "Jue Qi" (Determination of Qi), states: "The middle jiao extracts the essence from food and drink, transforms it, and turns it red; this is called Blood." "It confines the Ying (Nutrient) Qi, preventing it from wandering freely; this is called the Pulse." The pulse and blood share the same substance but have different names; they are two in appearance but one in essence. Furthermore, since the pulse body belongs to Yin fluids, when abundant, it flows smoothly (Hua, 滑); when deficient, it becomes withered and choppy (Se, 涩). This is an inevitable consequence of natural principles. (For choppy pulses due to withered/choppy or deficient/choppy conditions indicating blood deficiency, formulas such as Siwu Tang [Four Substances Decoction] are appropriate.) When cold-dampness invades the human body, it causes bi-obstruction in the muscle layers and interstices, leading to impaired flow of Qi channels; how can the pulse not be choppy? (For choppy pulses due to stagnation/stagnant-choppy conditions, formulas such as Heji Shen Shi Tang [Formulary Office Damp-Draining Decoction], Baiyi Chu Shi Tang [Hundred-One Damp-Expelling Decoction], and Sanyin Shen Zhuo Tang [Three Causes Kidney-Attaching Decoction] are appropriate.) Regurgitation refers to eating in the morning and vomiting in the evening, or eating in the evening and vomiting in the morning, or vomiting immediately after eating. Because there is no residual fluid in the stomach, the intestines become dry and depleted, resulting in constipation; how can the pulse not be choppy? (For choppy pulses due to withered/choppy conditions, formulas such as Liujunzi Tang [Six Gentlemen Decoction], Baojian Renshen Lige Wan [Treasure Mirror Ginseng Throat-Unblocking Pill], Tongzhi Zixue Runchang Tang [Unified Principles Nourishing-Blood Intestine-Moistening Decoction], and Ziyin Qingge Yin [Nourishing-Yin Clearing-Throat Infusion] are appropriate.) Spontaneous sweating refers to sweat flowing out continuously on its own. When sweat flows, fluids are consumed, which is termed Fluid Depletion (Tuo Ye, 脱液). If leakage does not stop, Wei (Defensive) Qi dissipates, leading to cold extremities, which is termed Yang Collapse (Wang Yang, 亡阳). When Yang collapses and fluids deplete, how can the pulse not be choppy? (For choppy pulses due to deficient/choppy conditions, formulas such as Shiquan Dabu Tang [Ten Thousand Complete Tonifying Decoction], Jisheng Fuzi Tang [Benefiting Life Aconite Decoction], and Huangqi Jianzhong Tang [Astragalus Middle-Reinforcing Decoction] are appropriate.) Although it is the same Choppy pulse, it is divided into Deficient-Choppy, Stagnant-Choppy, and Withered-Choppy types. This distinction relies on the diagnostician's flexibility and insight.
Siwu Tang [Four Substances Decoction] treats fever due to blood deficiency of the Liver, Spleen, and Kidney, alternating chills and fever, severe heat in the afternoon (Shen hour), cloudiness of the head and eyes, irritability and insomnia, distension in the chest and diaphragm, and pain in the hypochondrium. For all diseases of blood deficiency, this formula serves as the primary treatment. If Spleen Qi deficiency fails to generate blood, Sizijunzi Tang [Four Gentlemen Decoction] is appropriate. If Spleen Qi stagnation leads to blood deficiency, Guipi Tang [Restore the Spleen Decoction] is appropriate. If Kidney Water is exhausted and fails to generate Liver Blood, Liuwei Dihuang Wan [Six-Ingredient Pill with Rehmannia] is appropriate.
Danggui (Radix Angelicae Sinensis, 2 qian) Baishao (Radix Paeoniae Alba, 1 qian) Shudihuang (Prepared Rhizoma Anemarrhenae, 3 qian) Chuanxiong (Rhizoma Chuanxiong, 1.5 qian)
Decoct in water and take orally.
Heji Shen Shi Tang [Formulary Office Damp-Draining Decoction] (See Chapter 17)
Baiyi Chu Shi Tang [Hundred-One Damp-Expelling Decoction] treats injury from cold-dampness, characterized by a heavy sensation in the body, pain in the waist and legs, loose stools, and urination that is either obstructed or normal.
Banxiaqu (Fermented Radix Pinelliae, stir-fried) Houpo (Cortex Magnoliae Officinalis, processed with ginger juice) Cangzhu (Rhizoma Atractylodis Macrocephalae, processed with rice wash water, each 2 liang) Huoxiangye (Herba Agastaches) Chenpi (Pericarpium Citri Reticulatae, white pith removed) Baifuling (Poria, peeled, each 1 liang) Gancao (Licorice Root, honey-fried, 7 qian) Baizhu (Rhizoma Atractylodis Macrocephalae, raw, 1 liang)
Cut the herbs into small pieces. Take 4 qian per dose. Add 1 zhan of water, 7 slices of ginger, and 1 date. Decoct until 0.7 zhan remains. Take warm before meals.
Sanyin Shen Zhuo Tang [Three Causes Kidney-Attaching Decoction] treats kidney deficiency complicated by dampness injury, characterized by heaviness of the body, coldness in the waist (as if sitting in water), absence of thirst, and free urination.
Ganjiang (Dried Ginger, processed) Fuling (Poria, each 4 liang) Gancao (Licorice Root, honey-fried) Baizhu (Rhizoma Atractylodis Macrocephalae, each 2 liang)
Take 4 qian per dose. Add 1 zhan of water. Decoct until 0.7 zhan remains. Take warm on an empty stomach.
Liujunzi Tang [Six Gentlemen Decoction] (See Chapter 16)
Baojian Renshen Lige Wan [Treasure Mirror Ginseng Throat-Unblocking Pill] treats obstruction in the chest, dry and hard stools, cough with phlegm, asthma, and chest fullness, as well as stagnation in the Spleen and Stomach. It promotes the elimination of turbidity and generation of new qi, and is considered a miraculous medicine for treating Ge Qi [Diaphragmatic Qi Disturbance].
Muxiang (Radix Aucklandiae) Binglang (Semen Arecae, each 7.5 qian) Renshen (Radix Ginseng) Danggui (Radix Angelicae Sinensis, wine-washed) Huoxiang (Herba Agastaches) Gancao (Licorice Root) Zhishi (Fructus Aurantii Immaturus, bran-fried yellow, each 1 liang) Dahuang (Radix et Rhizoma Rhei, steamed with wine) Houpo (Cortex Magnoliae Officinalis, ginger-processed, each 2 liang)
Grind into fine powder. Mix with drops of water to form pills the size of paulownia seeds. Take 30–50 pills per dose after meals, washed down with various drinks.
Tongzhi Zixue Runchang Tang [Unified Principles Nourishing-Blood Intestine-Moistening Decoction] treats blood depletion and dead blood (stasis) lodged in the diaphragm, inability to swallow food, and dry, hard stools.
Danggui (Radix Angelicae Sinensis, wine-washed, 3 qian) Shaoyao (Radix Paeoniae, stir-fried) Shengdihuang (Raw Rhizoma Rehmanniae, each 1.5 qian) Honghua (Flos Carthami, wine-washed) Taoren (Semen Persicae, skin and tip removed, stir-fried) Dahuang (Radix et Rhizoma Rhei, wine-roasted) Zhike (Fructus Aurantii, bran-fried, each 1 qian)
Add 1.5 zhong of water. Decoct until 0.7 zhong remains. Add half a wine cup of leek juice. Take before meals.
Ziyin Qingge Yin [Nourishing-Yin Clearing-Throat Infusion] (From *Tongzhi*) treats rising of Yin-Fire or excessive Stomach Fire, inability to ingest food, and a洪数 (Surging-Rapid) pulse.
Danggui (Radix Angelicae Sinensis) Shaoyao (Radix Paeoniae, roasted) Huangbai (Cortex Phellodendri, salt-water fried) Huanglian (Rhizoma Coptidis, each 1.5 qian) Huangqin (Radix Scutellariae) Shanzhi (Fructus Gardeniae) Shengdihuang (Raw Rhizoma Rehmanniae, each 1 qian) Gancao (Licorice Root, 3 fen)
Add 2 zhong of water. Decoct until 0.7 zhong remains. Add half a wine cup of child's urine and half a wine cup of bamboo sap. Take before meals.
Shiquan Dabu Tang [Ten Thousand Complete Tonifying Decoction] (See Chapter 16)
Jisheng Fuzi Tang [Benefiting Life Aconite Decoction] treats Qi deficiency and weak Yang, incessant spontaneous sweating, and limb fatigue.
Huangqi (Radix Astragali, remove root neck, honey-fried) Fuzi (Radix Aconiti Lateralis Preparata, processed, remove skin and navel, equal parts)
Cut the herbs into small pieces. Take 4 qian per dose. Add 1 zhan of water and 10 slices of fresh ginger. Decoct until 0.8 zhan remains. Take warm before meals. If ineffective, increase the dosage.
Huangqi Jianzhong Tang [Astragalus Middle-Reinforcing Decoction] treats insufficiency of Qi and Blood, accompanied by frequent spontaneous sweating.
Huangqi (Radix Astragali) Guizhi (Ramulus Cinnamomi, each 1.5 qian) Baishao (Radix Paeoniae Alba, 3 qian) Gancao (Licorice Root, 1 qian)
Take 5 qian per dose. Add 1.5 zhong of water, 5 slices of ginger, and 2 dates. Decoct until 0.8 zhong remains. Strain the dregs. Add one large spoonful of thick malt sugar. Re-decoct and take. For those who already have mild diarrhea or vomiting, do not use malt sugar.