东垣治一人。冬时忽有风气暴至。六脉弦甚。按之洪大有力。其证手挛急。大便秘涩。
面赤热。此风寒始至于身也。四肢者。脾也。以风寒之邪伤之。则搐如挛痹。乃风淫未疾而
寒在外也。内经曰。寒则筋挛。正谓此也。素饮酒。内有实热乘于肠胃之间。故大便秘涩而
面赤热。内则手足阳明受邪。外则足太阴脾经受风寒之邪。用桂枝二钱。甘草一钱。以却其
寒邪而缓其急缩。黄柏二钱苦寒。滑以泻实润燥。急救肾水。升麻、葛根各一钱。以升阳气
行手阳明之经。不令遏绝。桂枝辛热。入手阳明之经为引用润燥。复以甘草专补脾气。使不
受风寒之邪。而退贼邪。专益肺经也。佐以人参补气。当归和血润燥。作一帖。水煎服。令
暖房中摩搓其手。遂安。
震按此案寒热补散并用。恰与标本俱合。但东垣立方。分量甚轻。此却重用者。盖以风
寒大病。逐邪宜急。不比他证。调理脾胃。只取轻清以升发元气也。
丹溪治一少年。患血痢。用涩药取效。致痛风叫号。此恶血入经络也。血受湿热。久必
凝浊。所下未尽。留滞隧道。所以作痛。久则必成枯细。与四物汤加桃仁、红花、牛膝、黄
芩、陈皮、生甘草。煎入生姜汁研潜行散。入少酒饮之。数十帖。又刺委中。出黑血三合而
安。
震按此是痢后痛风。其法至今传用。但因涩药留滞湿热以成瘀血。故用此方。倘又有别
因者。不得以此概论。
一人贫劳。秋深浑身发热。手足皆疼如 。昼轻夜重。服风药愈痛。气药不效。脉涩而
数。右甚于左。饮食如常。形瘦如削。盖大痛而瘦。非病致也。用苍术、酒黄柏各一钱五分
生附一片。生甘草三分。麻黄五分。研桃仁九个。煎入姜汁令辣。热服四帖。去附。加牛
膝一钱。八帖后气喘促不得眠。痛略减。意其血虚。因多服麻黄。阳虚被发动而上奔。当补
血镇坠。以酸收之。遂以四物汤减川芎。倍芍药。加人参二钱。五味子十二粒。与二帖定。
三日后。数脉减大半。涩如旧。仍痛。以四物加牛膝、参、术、桃仁、陈皮、甘草、槟榔。
生姜三片。五十帖而安。后因负重复痛。再与前药加黄氏三分。又二十帖愈。
震按身发热。疼如 。脉涩而数。右甚于左。应属血虚有热。所谓热痹证也。宜用生地
龟板、天冬、黄柏、丹皮、黑栀、秦艽、防己、牛膝、红花、银花、木通等药可愈。或仲
景栀子柏皮汤大剂与之亦佳。若二妙之苍术。已不相宜。附子一片何用。麻黄五分太过。至
因多服麻黄。虚阳上升而喘。议与酸收是矣。遽用人参二钱。窃恐痹痛转增。然云喘定数脉
大减。异哉。或者脉数无力耶。则前之麻黄已误。后之桃仁、槟榔。义又何居。予素服膺丹
溪。此则不敢阿其所好也。再阅下案。讲究病因。传变道理。真不可及矣。
一人患背胛缝一线痛。起上胯骨至胸前侧胁而止。昼夜不住。脉弦而数。重取左豁大于
右。意其背胛。小肠经。胸胁。胆经也。必思虑伤心。心脏未病。而小肠府先病。故痛从背
胛起。及虑不能决。乃归之胆。故痛至胸胁。及小肠火乘胆木。子来乘母。是为实邪。询之
果因谋事不遂而病。用人参四分。木通二分。煎汤使吞龙胆丸。数服而愈。
一壮年浓味多怒。秋间于髀枢左右发痛一点。延及膝 。痛处恶寒。昼静夜剧。口或渴
膈或痞。医用补血及风药。至次年春痛甚。食减形瘦。膝肿如碗。脉弦大颇实。寸涩甚。
大率皆数。小便数而短。作饮食痰积在太阴阳明治之。以酒炒黄柏一两。生甘草梢、犀角屑
盐炒苍术各三钱。川芎二钱。陈皮、牛膝、木通、芍药各五钱。遇暄热。加黄芩二钱为末
每三钱。与姜汁同研细。煎令带热。食前服之。日夜四次。半月后。脉减病轻。去犀角。
加牛膝、龟板、归身尾各五钱。如前服。又半月。肿减食增。不恶寒。惟脚痿软。去苍术、
黄芩。夏。加炒柏一两五钱。余根据本方。内加牛膝。因中年。加生地黄五钱。冬。加桂枝、
茱萸。病遂愈。仍绝酒肉湿面胡椒。
震按此案现证甚杂。而作饮食痰积在太阴阳明治。诚为扼要之论。然方中无消食消痰药
想以醇酒浓味。酿成湿热耳。故湿热与风寒。乃痹证两大纲。
一人项强。动则微痛。脉弦而数实。右为甚。作痰热客太阳经治之。以二陈汤加酒洗黄
芩、羌活、红花而愈。
一村夫背伛偻。足挛。成废疾。脉沉弦而涩。以煨肾散与之。上吐下泻。过一月。又行
一次。凡三四帖而愈。
一人湿气。脚挛拳。伸不直。用当归拈痛汤加杜仲、黄柏、川芎、白术、甘草、枳壳。
愈。
震按此三条。亦皆从湿热治。但因所兼之证而变换其药。仍是殊途同归也。
薛立斋治一妇人。自汗盗汗。发热晡热。体倦少食。月经不调。吐痰甚多。已二年矣。
遍身作痛。天阴风雨益甚。用小续命汤而痛止。用补中益气、加味归脾汤。三十余剂。诸证
悉愈。此皆郁结伤脾。不能输养诸脏所致。故用前二汤专主脾胃。若用寒凉降火。理气化痰
复伤生气。多致不起。
一妇人因怒。月经去多。发热作渴。左目紧小。头项动掉。四肢抽搐。遍身疼痛。此怒
动肝火。肝血虚而内生风。用加味逍遥加钩藤。数剂。诸证渐愈。又八珍汤调理而安。
一妇人历节作痛。发热作渴。饮食少思。月经过期。诸药不应。脉洪大。按之微细。用
附子八物四剂而痛止。用加味逍遥而元气复。六味丸而月经调。
一妇体胖。素内热。月经失调。患痛风。下体微肿。痛甚。小便频数。身重脉缓。证属
风湿。而血虚有热。先用羌活胜湿汤四剂。肿渐愈。用清燥汤数剂。小便渐清。用加味逍遥
十余剂。内热渐愈。为饮食停滞。发热仍痛。面目浮肿。用六君子加柴胡、升麻而愈。又因
怒气。小腹痞闷。寒热呕吐。此木侮脾土。用前药加山栀、木香而安。惟小腹下坠。似欲去
后。此脾气下陷。用补中益气而愈。后因劳役怒气。作呕吐痰。遍身肿痛。月经忽来。寒热
用六君子加柴胡、山栀以扶元气。清肝火。肿痛呕吐悉退。用补中益气以升阳气。健营气
月经寒热渐瘥。
震按此四案。即于暗中摸索。亦知为薛派治法。然而散风寒。补元气。胜湿清燥。滋肝
益肾。平补温补诸法毕具。诚为对证发药之良工也。
汪石山治一妇。年逾五十。左脚膝挛痛。不能履地。夜甚于昼。小腹亦或作痛。诊其脉
浮细缓弱。按之无力。尺脉尤甚。病属血衰。遂以四物汤加牛膝、红花、黄柏、乌药。连进
十余帖而安。
震按石山亦长于补。如此案之脉。人尽知其宜补矣。投以此方。恐病深药浅。岂能十余
剂而安乎。
韩飞霞治一都司。因哭弟成疾。饮食全绝。筋骨百节皮肤无处不痛。而腰为甚。一云肾
虚宜补。或云风寒宜散。韩曰。此亦危证。其脉涩。正东垣所谓非十二经中正疾。乃经络奇
邪也。必多忧愁转抑而成。若痰上。殆矣。补则气滞。散则气耗。乃主以清燥汤。连进三瓯
遂因睡至五鼓。无痰。觉少解。脉之。减十之三。遂专用清燥汤加减与之。十剂而愈。
震按此证甚危。此论甚佳。乃以清燥汤一方收功者。盖五志过极。皆为火郁。此方连、
柏以清火。苍、曲以散郁。郁热能蒸湿。二苓、泽泻以渗湿。湿热甚则脾土衰。二术、人参
以助脾补元。湿热胜则肺金困。参、 、麦冬、五味助金以制木。使不生火。又火亢者水必
亏。故兼归、地养血。再合升、柴之升清。苓、泻之降浊。恰与经络奇邪吻合。所谓奇邪者
乃奇经之邪。故云非十二经中正疾也。
吴茭山治一男子。瘦弱。因卧卑湿之地。遂头目眩晕。畏见日光。寒热时作。四肢历节
疼痛。或作风治。或作虚治。将及半年。俱不效。吴诊脉曰。寸口脉沉而滑。两尺弦。此溢
饮湿痰也。当汗吐之。虽虚羸。不当用补药。乃以控涎丹一服。却用曝干棉子一斗燃之。以
被围之。勿令气泄。使患人坐。熏良久。倏然吐出黑痰升许。大汗如雨。痛止身轻。病遂愈
震按此系痹痛之由于痰饮者。叶氏医案亦曾用之。
李士材治盐贾叶作舟。遍体疼痛。尻髀皆肿。足膝挛急。曰。此寒伤荣血。筋脉为之引
急。内经所谓痛痹也。用乌药顺气散。七剂而减。更加白术、桂枝。一月而愈。
震按此案用温燥发散药。乃风寒湿三气成痹正治法。
孙东宿治行人孙质庵患痛风。手足节骱。肿痛更甚。痛处热。饮食少。诊之脉皆弦细而
数。面青肌瘦。大小腿肉皆削。曰。此病得之禀气弱。下虚多内以伤其阴也。在燕地又多寒
经云。气主煦之。血主濡之。今阴血虚。则筋失养。故营不荣于中。气为寒束。百骸拘挛
故卫不卫于外。荣卫不行。故肢节肿痛而热。病名周痹是也。治当养血舒筋。流湿润燥。
俟痛止后。继以大补阴血之剂。实其下元可也。乃以五加皮、苍术、黄柏、苍耳子、当归、
红花、苡仁、羌活、防风、秦艽、紫荆皮。二十剂而筋渐舒。肿渐消。痛减大半。更以生地
龟板、牛膝、当归、苍术、黄柏、晚蚕砂、苍耳子、秦艽、苡仁、海桐皮。三十剂而肿痛
全减。行人大喜。孙曰。公下元虚惫。非岁月不能充实。须痛戒酒色。则培补乃效。丸方以
仙茅为君。人参、鹿角胶、虎胫骨、枸杞、牛膝为臣。熟地、茯苓、黄柏、苍耳子、晚蚕砂
为佐。桂心、秦艽、泽泻为使。蜜丸。服百日。腿肉长完。精神复旧。
震按此案论治处方。俱极精当。叶案有蓝本于此者。
文学闵唇楼令室。躯肥性躁。患痛风。痛处略肿。呻吟喊叫。手足不能举动。医用归、
芍、地黄、人参、牛膝之类。其痛愈加。已逾七月。东宿曰。此乃湿痰凝滞经络作痛。须以
燥湿流动之剂疏决一番。但初服不效。须十帖见功耳。因用二陈加乌药叶、苍术、僵蚕、海
桐皮、南星。至六七帖。痛如故。乃以芫花醋炒过三分。海金砂一分。为末。白汤送下。至
晚。泻一次。下稠痰半盆。足痛减大半。稍能动止。更后。腹中大痛而厥。冷汗淋漓。面青
息断。举家以为死矣。执而诊之。手冷如冰。但六脉俱在。惟沉伏耳。知其为痛极使然。用
生姜汤灌之而苏。语侍女曰。适来腹中痛甚。耳后火光溅出。肛门如焚。大响一声。不知泻
下何物。群看之。乃血鳅一条。长六寸。阔半寸余。鳞目俱在。盆中尚能游动。众皆悚骇。
此证本由痰作。治者特为行痰。初不知其有虫如是。第药中有芫花。乃杀虫物。故偶中耳。
次日手足皆能动。仍以二陈汤加苡仁、红花、五加皮。四帖脱然。
震按此案末药方甚佳。所谓若药不暝眩。厥疾不瘳也。然其痛并不由于虫。虫下之时。
必痰血俱下。故得愈耳。且云血鳅则为湿热蒸其瘀血所成。复何疑耶。
祝茹穹治闽闱典试。半月前忽腿疼。两脚筋缩。脚跟缩粘至腿。寸步不能行。将一月。
屡药无效。咸以此为痿痹证。祝曰。非也。察其脉。左寸忽洪忽涩。迟数无定栖。因此人好
饮冷酒。酒新则性热燥。冷冻饮料又犯寒湿。寒热相搏。遂有此病。乃以川乌二钱去皮脐。麻黄
二钱。二股梢。一股根。苍术一钱。以甘草汁拌炒。白蒺藜一钱。去刺。酒蒸熟。焙干同为
末。每服一钱二分。用老酒热冲服。盖被出汗。一服即能行动。三服愈。
震按此病甚重。所用川乌。麻黄。虽属狠药。然以治痛风。亦甚平常。恐未必速效至此
〔附〕叶天士先生治嘉善周姓。体浓色苍。患痛风。膝热而足冷。痛处皆肿。夜间痛甚
发之甚时。巅顶如芒刺。根根发孔觉火炎出。遍身躁热不安。小便赤涩。口不干渴。脉沉
细带数。用生黄 五钱。生于术三钱。熟附子七分。独活五分。北细辛三分。汉防己一钱五
分。四剂而诸证皆痊。惟肿痛久不愈。阳痿不举。接用知、柏、虎膝、龟板、苁蓉、牛膝。
不应。改用乌头、全蝎各一两。穿山甲、川柏各五钱。汉防己一两五钱。麝香三钱。马料豆
生用二两。茵陈汤泛丸。每服一钱。开水下而全愈。
震按此与指南所载治鲍姓周痹。用蜣螂、全蝎、地龙、穿山甲、蜂房、川乌、麝香、乳
香。以无灰酒煮黑大豆汁法丸者。各有妙义。非浅见寡闻者所能窥测。后张路玉案用安肾丸
亦有巧思。又与叶案之蠲痛丹、木防己汤诸方。可谓同工异曲。
张路玉治包山劳俊卿。年高挛废。山中诸医。用木瓜、独活、防己、 、威灵仙之类
将半年余。乃致跬步不能动移。或令服八味丸。亦不应。诊其脉尺中微浮而细。时当九夏
自膝至足。皆寒冷如从水中出。知为肾虚。风雨所犯而成是疾。遂授安肾丸。终剂而能步
履。连服二料。绝无痿弱之状矣。
Li Dongyuan treated a patient. In winter, there was a sudden and violent invasion of wind qi. The six pulses were severely wiry (Xian), and forceful and large (Hong Da) upon deep pressure. The symptoms included spasticity and urgency in the hands, and dry, difficult defecation. The face was red and hot. This indicated that pathogenic wind and cold had just invaded the body. The four limbs belong to the Spleen. When injured by pathogenic wind and cold, spasms resembling contracture and bi-syndrome occur; this is when wind pathogen is excessive and cold pathogen is on the exterior. The *Neijing* states: "Cold causes tendon contracture." This refers precisely to this situation. The patient habitually drank alcohol, so there was excess heat accumulating between the Stomach and Intestines internally, causing dry, difficult defecation and a red, hot face. Internally, the Hand-Yangming Large Intestine Meridian and Foot-Yangming Stomach Meridian were affected; externally, the Foot-Taiyin Spleen Meridian was affected by wind-cold pathogens. The prescription used Guizhi (Cinnamon Twig) 2 qian and Gancao (Licorice Root) 1 qian to dispel cold pathogen and relieve contraction. Huangbai (Phellodendron Bark) 2 qian, bitter and cold, is slippery to drain excess and moisten dryness, urgently assisting Kidney Water. Shengma (Cimicifuga Rhizome) and Gegen (Pueraria Root) each 1 qian were used to raise Yang Qi and circulate it through the Hand-Yangming Meridian, preventing obstruction. Guizhi is pungent and hot, entering the Hand-Yangming Meridian as a guiding herb to moisten dryness; Gancao was used again to specifically tonify Spleen Qi, protecting it from wind-cold pathogens, thereby expelling the thief pathogen and specifically benefiting the Lung Meridian. Zushi (Assisting herbs) included Renshen (Ginseng Root) to tonify Qi and Danggui (Angelica Sinensis Root) to harmonize Blood and moisten dryness. Prepared as one decoction, taken with water, warm. The patient was instructed to massage and rub his hands in a warm room, after which he stabilized.
Yu Zhen commented: In this case, cold and heat, tonification and dispersion are used together, appropriately addressing both root and branch. However, Li Dongyuan's prescriptions typically use light dosages; here, heavy dosages were used. This is likely because wind-cold is a major disease, requiring urgent expulsion of pathogens, unlike other conditions where regulating the Spleen and Stomach only requires light, clear herbs to raise Yuan Qi.
Zhu Danxi treated a young man suffering from bloody dysentery. Using astringent herbs brought relief but caused gout-like pain and wailing. This was due to evil blood entering the collaterals. Blood affected by damp-heat eventually becomes turbid and coagulated. Residual dysentery remained stagnant in the tunnels (collaterals), causing pain. Over time, this leads to wasting and thinning. He prescribed Siwu Tang (Four Substances Decoction) plus Taoren (Peach Kernel), Honghua (Safflower), Niuxi (Achyranthes Root), Huangqin (Scutellaria Root), Chenpi (Tangerine Peel), and Sheng Gancao (Raw Licorice Root). Decocted with fresh ginger juice and Qianxing San (Hidden Walking Powder), taken with a little wine. After dozens of doses, acupoint Weizhong (BL-40) was pricked, releasing three he of dark blood, after which he stabilized.
Yu Zhen commented: This is post-dysentery gout. The method is still transmitted and used today. It is used because astringent herbs caused damp-heat stagnation leading to blood stasis. If other causes exist, this cannot be generalized.
Another case: A poor, overworked person suffered whole-body fever in late autumn, with hand and foot pain like needle pricks. Symptoms were lighter during the day and heavier at night. Wind-dispelling herbs worsened the pain; Qi-regulating herbs were ineffective. The pulse was choppy (Se) and rapid (Shu), more pronounced on the right than the left. Diet was normal, but the body was emaciated. Severe pain leading to emaciation is not necessarily caused directly by the disease. Prescription: Cangzhu (Atractylodes Rhizome) and Jiuhuangbai (Wine-processed Phellodendron Bark) each 1.5 qian, Sheng Fuzi (Raw Aconite Lateral Root) 1 slice, Sheng Gancao (Raw Licorice Root) 3 fen, Mahuang (Ephedra Herb) 5 fen, crushed Taoren (Peach Kernel) 9 pieces. Decocted with ginger juice to make it spicy, taken hot. After four doses, remove Fuzi, add Niuxi (Achyranthes Root) 1 qian. After eight doses, asthma became急促 (rapid/shortness of breath) and insomnia occurred, with slight pain reduction. Suspected Blood deficiency exacerbated by excessive Mahuang, causing deficient Yang to rush upward. Treatment should tonify Blood, anchor descending, and use sour astringents. Thus, Siwu Tang (Four Substances Decoction) minus Chuanxiong (Ligusticum Rhizome), doubled Shaoyao (Peony Root), added Renshen (Ginseng Root) 2 qian and Wuweizi (Schisandra Fruit) 12 grains. Two doses stabilized the condition. Three days later, the rapid pulse decreased significantly, returning to a choppy state, with persistent pain. Siwu Tang (Four Substances Decoction) plus Niuxi (Achyranthes Root), Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Taoren (Peach Kernel), Chenpi (Tangerine Peel), Gancao (Licorice Root), Binglang (Areca Seed), and three slices of fresh ginger were given. After fifty doses, he stabilized. Later, pain recurred due to carrying heavy loads; the previous prescription plus Huangqi (Astragalus Root) 3 fen was given. After twenty more doses, he recovered.
Yu Zhen commented: Whole-body fever, pain like needle pricks, choppy and rapid pulse, more pronounced on the right, should belong to Blood deficiency with heat, i.e., Heat Bi syndrome. Suitable herbs include Shengdi (Rehmannia Root), Guiban (Tortoise Shell), Tiandong (Asparagus Tuber), Huangbai (Phellodendron Bark), Danpi (Moutan Cortex), Heizhi (Black Gardenia Fruit), Qinjiao (Gentiana Macrophylla Rhizome), Fangji (Stephania Root), Niuxi (Achyranthes Root), Honghua (Safflower), Yinhua (Honeysuckle Flower), Mutong (Akebia Stem). Or Zhang Zhongjing's Zhizi Bopi Tang (Gardenia and Phellodendron Decoction) in large dosage would also be good. Cangzhu (Atractylodes Rhizome) from Ermiao San (Two Marvels Powder) is inappropriate; what use is one slice of Fuzi? Five fen of Mahuang is excessive. Regarding the asthma from excessive Mahuang causing deficient Yang to rise, suggesting sour astringents was correct. But hastily using 2 qian of Renshen might increase Bi pain. Yet, the text says asthma resolved and rapid pulse decreased greatly, which is strange. Perhaps the rapid pulse was weak? Then the previous Mahuang was a mistake, and the rationale for subsequent Taoren and Binglang is unclear. I have always admired Danxi, but here I dare not flatter him. Reading the next case, analyzing etiology and transmission, is truly unsurpassable.
One person suffered a line of pain in the scapular seam, starting from the upper hip bone to the lateral chest and胁 (hypochondrium). Unceasing day and night. Pulse was wiry and rapid. Heavy pressure revealed the left pulse wider and larger than the right. Speculated that the scapula belongs to the Small Intestine Meridian, and the hypochondrium to the Gallbladder Meridian. Likely mental worry damaged the Heart; although the Heart organ itself was not diseased, the Small Intestine Fu organ was diseased first, hence pain started in the scapula. When worry could not be resolved, it attributed to the Gallbladder, hence pain extended to the hypochondrium. Small Intestine Fire attacking Gallbladder Wood, child attacking mother, constitutes an Excess pathogen. Inquiry confirmed illness due to unsuccessful planning. Ren Shen (Ginseng Root) 4 fen, Mutong (Akebia Stem) 2 fen, decocted to swallow Longdan Wan (Gentian Pill). Several doses cured it.
A robust man who enjoyed rich foods and got angry easily developed a point of pain around the hip pivot in autumn, extending to the knees. The painful area feared cold; quiet by day, worse by night. Occasional thirst or chest oppression. Doctors used Blood-tonifying and Wind-dispelling herbs. By the following spring, pain intensified, appetite decreased, body emaciated, knees swollen like bowls. Pulse was wiry, large, and quite solid; Cun (inch) position very choppy; generally rapid. Urination frequent and scanty. Diagnosed as food retention and phlegm accumulation in Taiyin and Yangming meridians. Prescription: Jiuhuangbai (Wine-processed Phellodendron Bark) 1 liang, Sheng Gancao Gao (Raw Licorice Root Tip), Xijiao Xie (Rhinoceros Horn Shavings - note: modern substitute often used), Yanbaizhu (Salt-processed Atractylodes Rhizome) each 3 qian, Chuanxiong (Ligusticum Rhizome) 2 qian, Chenpi (Tangerine Peel), Niuxi (Achyranthes Root), Mutong (Akebia Stem), Shaoyao (Peony Root) each 5 qian. On warm/hot days, add Huangqin (Scutellaria Root) 2 qian. Powdered, 3 qian per dose, mixed with ginger juice, decocted warm, taken before meals, four times daily. After half a month, pulse improved, condition lightened; remove Xijiao, add Niuxi (Achyranthes Root), Guiban (Tortoise Shell), Danggui Shenyi (Angelica Sinensis Root and Tail) each 5 qian. Continue as before. Another half month, swelling reduced, appetite increased, no longer feared cold, only leg weakness. Remove Cangzhu, Huangqin. In summer, add Jiaohuangbai (Processed Phellodendron Bark) 1.5 liang. Rest based on original formula. Since middle-aged, add Shengdi (Rehmannia Root) 5 qian. In winter, add Guizhi (Cinnamon Twig) and Zhuyu (Cornus Fruit). Disease cured. Strictly avoid alcohol, meat, damp noodles, and pepper.
Yu Zhen commented: The current symptoms are complex, but diagnosing food retention and phlegm accumulation in Taiyin/Yangming is indeed crucial. However, the formula lacks digestive and phlegm-resolving herbs; likely strong wine and rich flavors brewed damp-heat. Thus, damp-heat and wind-cold are the two main categories of Bi syndrome.
One person had neck stiffness, slight pain on movement, pulse wiry, rapid, and solid, more on the right. Diagnosed as Phlegm-Heat lodging in the Taiyang Meridian. Cured with Erchen Tang (Two Aged Herbs Decoction) plus Jiuhuangqin (Wine-washed Scutellaria Root), Qianghuo (Notopterygium Rhizome), and Honghua (Safflower).
A village laborer had a hunched back and contracted feet, becoming disabled. Pulse was deep, wiry, and choppy. Given Weishen San (Baked Kidney Powder). Vomiting and diarrhea ensued. After a month, another bowel movement occurred. Cured after three to four doses.
One person with Dampness had contracted, curled feet that could not straighten. Cured with Danggui Niantong Tang (Angelica Pain-Relieving Decoction) plus Duzhong (Eucommia Bark), Huangbai (Phellodendron Bark), Chuanxiong (Ligusticum Rhizome), Baizhu (Atractylodes Macrocephala Rhizome), Gancao (Licorice Root), and Zhike (Aurantium Fruit).
Yu Zhen commented: These three cases all treated Damp-Heat, varying herbs based on accompanying syndromes, achieving the same goal via different paths.
Xue Lizhai treated a woman with spontaneous sweating, night sweats, afternoon fever, fatigue, poor appetite, irregular menstruation, and excessive phlegm production for two years. Whole-body pain, worsening on cloudy/rainy days. Pain stopped with Xiao Xuming Tang (Minor Continuation of Life Decoction). Stabilized with Buzhong Yiqi Tang (Middle-Boosting Qi-Enhancing Decoction) and Jiawei Guipi Tang (Modified Restore the Spleen Decoction) over thirty-plus doses. All symptoms resolved. This was due to depression injuring the Spleen, failing to nourish organs. Thus, these two formulas focused on Spleen/Stomach. Using cold/cool fire-draining or Qi-regulating/phlegm-resolving herbs would damage vital Qi, often leading to death.
A woman, angered, had heavy menstruation, fever, thirst, small left eye, head/neck tremors, limb convulsions, and whole-body pain. Anger stirred Liver Fire; Liver Blood deficiency generated internal Wind. Cured gradually with Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) plus Gouteng (Uncaria Ramulus) over several doses, then regulated with Bazhen Tang (Eight Treasures Decoction).
A woman suffered joint pain, fever, thirst, poor appetite, delayed menstruation, unresponsive to various drugs. Pulse was large and洪 (surging) but fine and subtle on pressure. Pain stopped after four doses of Fuzi Bawu Tang (Aconite Eight Substances Decoction). Vitality restored with Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder); menstruation regulated with Liuwei Wan (Six Ingredients Pill).
A fat woman, prone to internal heat, with irregular menstruation, suffered gout. Lower body slightly swollen, severe pain, frequent urination, heavy body, slow pulse. Syndrome: Wind-Damp with Blood deficiency and heat. First, Qianghuo Shengshi Tang (Notopterygium Damp-Overcoming Decoction) for four doses reduced swelling. Qingzao Tang (Moisture-Clearing Decoction) for several doses cleared urine. Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) for ten-plus doses cleared internal heat. Due to food stagnation, fever and pain returned with facial swelling. Cured with Liujunzi Tang (Six Gentlemen Decoction) plus Chaihu (Bupleurum Root) and Shengma (Cimicifuga Rhizome). Anger caused lower abdominal fullness, chills/fever, vomiting. Wood insulting Earth. Previous medicine plus Zhizi (Gardenia Fruit) and Muxiang (Vladimiria Root) stabilized. Only lower abdominal bearing-down sensation suggested Spleen Qi sinking; cured with Buzhong Yiqi Tang (Middle-Boosting Qi-Enhancing Decoction). Later, labor and anger caused vomiting phlegm, whole-body swelling/pain, sudden menstruation, chills/fever. Liujunzi Tang (Six Gentlemen Decoction) plus Chaihu (Bupleurum Root) and Zhizi (Gardenia Fruit) supported Yuan Qi and cleared Liver Fire. Swelling/pain/vomiting subsided. Buzhong Yiqi Tang (Middle-Boosting Qi-Enhancing Decoction) raised Yang Qi and strengthened Ying Qi. Menstrual chills/fever gradually improved.
Yu Zhen commented: These four cases reveal Xue's school methods even if guessed blindly. Dispelling wind-cold, tonifying Yuan Qi, overcoming dampness, clearing dryness, nourishing Liver/Kidney, flat/warm tonification—all present. Truly a skilled practitioner matching treatment to syndrome.
Wang Shishan treated a woman over fifty with left knee contracture/pain, unable to walk, worse at night, occasional lower abdominal pain. Pulse floating, fine, slow, weak, powerless on pressure, especially Chi (cubit) position. Disease: Blood deficiency. Prescribed Siwu Tang (Four Substances Decoction) plus Niuxi (Achyranthes Root), Honghua (Safflower), Huangbai (Phellodendron Bark), Wuyao (Lindera Root). Ten-plus doses brought stability.
Yu Zhen commented: Shishan excels in tonification. With such a pulse, everyone knows tonification is needed. Using this formula might seem too light for deep disease, yet it worked in ten doses.
Han Feixia treated a Du Si (Military Officer) ill from crying for his brother. Refused all food. Pain everywhere in bones/joints/skin, worst in waist. Some said Kidney deficiency needs tonification; others said wind-cold needs dispersion. Han said: Critical condition. Pulse is choppy, exactly Li Dongyuan's description of non-twelve-meridian regular disease, but odd-pathogen in collaterals. Caused by excessive worry/suppression. If phlegm rises, fatal. Tonification causes Qi stagnation; dispersion causes Qi consumption. Main treatment: Qingzao Tang (Dryness-Clearing Decoction). Three bowls cured sleepiness until dawn, no phlegm, feeling relieved. Pulse decreased by 30%. Continued Qingzao Tang (Dryness-Clearing Decoction) modified for ten doses, cured.
Yu Zhen commented: Critical condition, excellent analysis. Qingzao Tang (Dryness-Clearing Decoction) succeeded. Extreme emotions become Fire Depression. Lian (Coptis) and Bai (Phellodendron) clear fire; Cang (Atractylodes) and Qu (Medicated Leaven) scatter depression. Depressed heat steams dampness; Ling (Poria) and Ze (Alisma) drain damp. Damp-heat weakens Spleen Earth; Zhu (Atractylodes) and Renshen (Ginseng) assist Spleen/Yuan Qi. Damp-heat confuses Lung Metal; Renshen (Ginseng), Maidong (Ophiopogon Tuber), Wuweiizi (Schisandra) support Metal to control Wood, preventing Fire. Fire excess implies Water deficiency; Danggui (Angelica) and Dihuang (Rehmannia) nourish Blood. Combined with Sheng (Cimicifuga) and Chai (Bupleurum) raising clear Qi, Ling (Poria) and Ze (Alisma) lowering turbid Qi. Matches odd-pathogen perfectly. Odd-pathogen refers to odd vessels, hence "not twelve-meridian regular disease."
Wu Jiaoshan treated a thin, weak man lying on damp ground. Developed dizziness, photophobia, alternating chills/fever, whole-joint pain. Treated as Wind or Deficiency for nearly half a year, ineffective. Pulse: Cun (inch) deep and slippery, Chi (cubit) wiry. Diagnosis: Overflowing Drink, Damp-Phlegm. Should use sweating/vomiting methods. Despite weakness, no tonification. One dose of Kongyan Dan (Controlling Fluids Pill). Burned one dou of dried cotton seeds, covered patient with quilt to retain gas, seated patient, fumigated for a long time. Suddenly vomited about one sheng of black phlegm, profuse sweat like rain, pain stopped, body light, cured.
Yu Zhen commented: Bi pain due to Phlegm-Drink. Ye Tianshi's cases also used this.
Li Shicai treated salt merchant Ye Zuozhou with whole-body pain, swelling of buttocks/hips, foot/knee contracture. Said: Cold injuring Ying Blood, tendons/muscles pulling tight. Neijing calls this Tong Bi (Painful Bi). Used Uyao Shunqi San (Uyao Qi-Smoothening Powder) for seven doses, reduced. Added Baizhu (Atractylodes Macrocephala Rhizome) and Guizhi (Cinnamon Twig). Cured in one month.
Yu Zhen commented: Warm/dispersive herbs are the standard treatment for Bi caused by Wind-Cold-Damp.
Sun Dongsu treated pedestrian Sun Zhi'an with gout. Hand/foot joints swollen/painful, hot painful areas, poor appetite. Pulse wiry, fine, rapid. Face green, muscles wasted, calves/thighs emaciated. Said: Congenital weakness, lower deficiency damaging Yin. In Yan region, cold is prevalent. Classic: Qi warms, Blood moistens. Yin/Blood deficiency means tendons lose nourishment, Ying fails to nourish inside. Qi constrained by cold, hundred bones contract, Wei fails to protect outside. Ying/Wei circulation blocked, causing joint swelling/pain/heat. Named Zhou Bi (General Bi). Treatment: Nourish Blood, relax tendons, flow dampness, moisten dryness. After pain stops, continue with strong Yin/Blood tonics to fill lower Yuan. Prescription: Wujia Pi (Eleutherococcus Bark), Cangzhu (Atractylodes Rhizome), Huangbai (Phellodendron Bark), Cang'erzi (Xanthium Fruit), Danggui (Angelica Sinensis Root), Honghua (Safflower), Yiren (Coix Seed), Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root), Qinjiao (Gentiana Macrophylla Rhizome), Zijing Pi (Bauhinia Bark). Twenty doses relaxed tendons, reduced swelling, halved pain. Next prescription: Shengdi (Rehmannia Root), Guiban (Tortoise Shell), Niuxi (Achyranthes Root), Danggui (Angelica Sinensis Root), Cangzhu (Atractylodes Rhizome), Huangbai (Phellodendron Bark), Wancansha (Silkworm Frass), Cang'erzi (Xanthium Fruit), Qinjiao (Gentiana Macrophylla Rhizome), Yiren (Coix Seed), Haitong Pi (Sapium Bark). Thirty doses eliminated swelling/pain. Patient delighted. Sun said: Lower Yuan deficiency takes time to fill. Strictly avoid alcohol/sex for tonification to work. Pill formula: Xianmao (Curculigo Rhizome) as Sovereign; Renshen (Ginseng Root), Lujiaojiao (Deer Antler Glue), Hu Jinggu (Tiger Tibia Bone - note: protected species, historical context), Gouqi (Goji Berry), Niuxi (Achyranthes Root) as Ministers; Shudi (Prepared Rehmannia Root), Fuling (Poria), Huangbai (Phellodendron Bark), Cang'erzi (Xanthium Fruit), Wancansha (Silkworm Frass) as Assistants; Guixin (Cinnamon Heart), Qinjiao (Gentiana Macrophylla Rhizome), Zexie (Alisma Rhizome) as Guides. Honey pills. Taken for 100 days, leg muscles regenerated, spirit restored.
Yu Zhen commented: Analysis, treatment, and prescription are extremely precise. Ye Tianshi's cases have blueprints here.
Literary Min Chunlou's wife, fat and irritable, suffered gout. Slight swelling at pain sites, groaning/crying, immobile hands/feet. Doctors used Danggui (Angelica), Shaoyao (Peony), Dihuang (Rehmannia), Renshen (Ginseng), Niuxi (Achyranthes). Pain worsened. Over seven months. Sun Dongsu said: Damp-Phlegm stagnating collaterals causing pain. Need drying/damp-resolving, moving agents to vent. Initial doses ineffective; need ten doses for effect. Used Erchen Tang (Two Aged Herbs Decoction) plus Wuyaoye (Litsea Leaf), Cangzhu (Atractylodes Rhizome), Jiangcan (Bombyx Batryticatus), Haitong Pi (Sapium Bark), Nanxing (Pinellia Tuber). At six-seven doses, pain unchanged. Then used Yuanhua (Kadsura Flower) vinegar-fried 3 fen, Haijinsha (Lygodium Spore) 1 fen, powdered, taken with warm water. Evening: one bowel movement, half basin of thick phlegm. Foot pain halved, slight movement possible. Later, severe abdominal pain, syncope, cold sweat, cyanotic face, absent breathing. Family thought dead. Pulse held: hands ice-cold, six pulses present but deep/profound. Knew it was extreme pain reaction. Gave Shengjiang Tang (Fresh Ginger Decoction), revived. Told maid: severe abdominal pain, felt fire behind ears, anus burning, loud sound, didn't know what passed. Looked: a "blood leech" (bloodworm), 6 cun long, half cun wide, scales/eyes intact, swimming in basin. Crowd horrified. Syndrome originally Phlegm; treatment moved Phlegm; unknown presence of worm. Yuanhua kills worms, so accidental efficacy. Next day, hands/feet moved. Continued Erchen Tang (Two Aged Herbs Decoction) plus Yiren (Coix Seed), Honghua (Safflower), Wujia Pi (Eleutherococcus Bark). Four doses, completely recovered.
Yu Zhen commented: Final prescription is excellent. "If medicine does not cause dizziness, chronic disease does not heal." Pain wasn't due to worm; worm passage coincided with phlegm/blood discharge, hence cure. "Blood leech" formed by damp-heat steaming stasis. No doubt.
Zhu Ruqiong treated a Fujian examination official. Sudden leg pain half a month ago, calf muscle contraction, heel stuck to leg, unable to walk. Nearly one month, ineffective medicines. All considered Wei-Bi (Atrophy-Bi). Zhu said: No. Left Cun pulse fluctuates between surging/choppy, irregular speed. Patient likes cold wine. New wine is hot/dry; cold drink adds cold-damp. Cold-heat struggle causes this. Prescription: Chuanwu (Chuanwu Aconite Root) 2 qian peeled/cored, Mahuang (Ephedra Herb) 2 qian (two tips, one root), Cangzhu (Atractylodes Rhizome) 1 qian stir-fried with Gancao juice, Bajieli (Tribulus Fruit) 1 qian de-spined, wine-steamed, dried, powdered. Take 1.2 qian, mix with hot old wine. Cover, induce sweating. One dose enabled walking; three doses cured.
Yu Zhen commented: Serious disease. Chuanwu and Mahuang are harsh but common for gout. Speed of cure surprising.
[Appendix] Ye Tianshi treated Jia Shan Zhou surname. Robust build, dark complexion, gout. Hot knees, cold feet, swollen painful areas, worse at night. Severe attacks: vertex feels like thorns, pores feel fiery, whole body restless, red/scanty urine, no mouth thirst. Pulse deep, fine, slightly rapid. Sheng Huangqi (Astragalus Root) 5 qian, Sheng Baizhu (Atractylodes Macrocephala Rhizome) 3 qian, Shu Fuzi (Prepared Aconite Lateral Root) 7 fen, Duhuo (Angelica Pubescens Root) 5 fen, Beixixin (Asarum Root) 3 fen, Han Fangji (Stephania Tetrandra Root) 1.5 qian. Four doses cured all symptoms. Swelling/pain persisted, impotence. Switched to Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), Huxi (Panax Notoginseng Root - note: context implies tiger knee substitute or similar), Guiban (Tortoise Shell), Rongrong (Cistanche Stem), Niuxi (Achyranthes Root). Ineffective. Changed to Wutou (Aconite Root), Quanxie (Scorpion) each 1 liang, Chuanshanjia (Pangolin Scale), Chuanbai (Phellodendron Bark) each 5 qian, Han Fangji (Stephania Tetrandra Root) 1.5 liang, Shexiang (Musk) 3 qian, Maliaodou (Glycine Max Seed) raw 2 liang, Yichen Tang (Artemisia Decoction) pill base. Take 1 qian, warm water. Cured.
Yu Zhen commented: Similar to *Zhinan* treating Bao surname Zhou Bi with Dung Beetle, Scorpion, Earthworm, Pangolin Scale, Beehive, Chuanwu, Musk, Frankincense, boiled black soybean juice pills. Both have profound meanings, inaccessible to shallow observers. Later Zhang Luyu's Anshen Wan also shows ingenuity. Comparable to Ye's Juantong Dan and Mugufengji Tang—same skill, different approaches.
Zhang Luyu treated Bao Shan Lao Junqing. Elderly, contracted/disabled. Mountain doctors used Mugua (Chaenomeles Fruit), Duhuo (Angelica Pubescens Root), Fangji (Stephania Root), Weilingxian (Clematis Root) for over half a year. Result: unable to move step. Bajian Wan (Eight Flavors Pill) ineffective. Pulse Chi position slightly floating/fine. Summer season, knees/feet cold as if from water. Known as Kidney deficiency attacked by wind/rain. Prescribed Anshen Wan (Kidney-Anchoring Pill). One course enabled walking. Two courses eliminated atrophy signs.