丹溪治一人。六月投渊取鱼。至秋深雨凉。半夜小腹痛甚。大汗。脉沉弦细实。重取如
循刀责责然。与大承气汤加桂二服。微利痛止。仍连日于申酉时复痛。坚硬不可近。每与前
药。得微利。痛暂止。于前药加桃仁泥。下紫黑血升余。痛亦止。脉虽稍减。而责责然犹在
又以前药加川附子。下大便五行。有紫黑血如破絮者二升有余。又伤食。于酉时复痛在脐
腹间。脉和。与小建中汤。一服而愈。
震按小腹痛甚。大汗。脉如循刀责责。昧者必认为真脏脉矣。否则认其病因是寒。惟用
桂、附耳。丹溪连以温药下之。殊不可及。最难者痛止复作。不改前方。陡加桃仁。迨瘀下
痛止。仍不改前方。又加附子。至愈后伤食复痛。忽变前方而用建中。总由指下认得真。故
攻补毫无疑惑也。下条虞案受寒为重。又误于寒下。故先投温补及艾灸。而后进温下之药。
与前案稍别。然皆确切不移。彼此难换。若认脉不清。必至两误。
虞天民治一人。壮年寒月。入水网鱼。饥食冷粥。腹大痛。二昼夜不止。医用大黄丸、
大承气。下粪水而痛愈甚。诊其六脉沉伏而实。面青黑色。虞曰。此大寒证。及下焦有燥矢
作痛。先与丁附治中汤一帖。又灸气海穴二十一壮。痛减半。继以巴豆、沉香、木香作丸如
绿豆大。生姜汁送下五粒。下五七次而愈。
又一妇年五十余。小腹有块。作痛二月余。一医作死血治。与四物加桃仁等药。不效。
又以五灵脂、延胡索、乳香、没药、三棱、莪术等丸服。又不效。其六脉沉伏。两尺脉绝无
虞曰。乃结粪在下焦作痛耳。非死血也。用金城稻 。烧灰淋浓汁一盏服之。过一时许。
与枳实导滞丸一百粒催之。下黑粪如梅核者碗许。痛遂止。后以生血润肠之药十数帖。调理
平安。
震按尺脉沉实。则为下焦结粪。今两尺绝无而断结粪。又见取脉之巧。非出一途。若死
血则脉必涩。前已历载多案矣。
汪石山治一人。年五十余。瘦黑理疏。忽腹痛。午后愈甚。医治以快气之药。痛益加。
乃曰。午后血行于阴分。加痛者。血滞于阴也。四物加乳、没服之。亦不减。汪诊之。脉浮
细而结。或五七至一止。或十四五至一止。经论止。脉渐退者生。渐进者死。今止脉频则反
轻。疏则反重。与脉经实相矛盾。汪熟思少顷。曰。得之矣。止脉疏而痛甚者。以热动而脉
速。频而反轻者。以热退而脉迟故耳。病属阴虚火动无疑。且察其病起于劳欲。劳则伤心而
火动。欲则伤肾而水亏。以参、芍补脾为君。熟地、归身滋肾为臣。黄柏、知母、麦冬清心
为佐。山楂、陈皮行滞为使。人乳、童便出入加减。惟人参加至四五钱。遇痛进之则愈。或
问诸痛。与瘦黑人。及阴虚火动。参、 在所当禁。今用之顾效。何取。汪曰。诸痛禁用参
者。以暴病形实者言耳。若年高气血衰弱。不用补法。气何由行。痛何由止。经曰。壮
者气行则愈是也。
震按汪公之察病情。讲病因。精细无比。故参、 、归、地、麦冬、知、柏、乳、溺并
非腹痛门所列之方。而竟能奏效。愚者遇某病。即于某病门捡方以治。一望迷津。何尝得济
况诸书所载方法。此有彼无。彼详此略。将恃何种为宝筏耶。
一妇人年近五十。病腹痛。初从右手指冷起。渐上至头。头如冷水浇灌而腹大痛。则遍
身大热。热退则痛止。或过食。或不食。皆痛。每常或一年一发。近来二三日一发。远不过
六七日。医用四物加柴胡、香附。不应。更医用四君、木香、槟榔。亦不应。又用二陈加紫
苏、豆蔻。又用七气汤等剂。皆不应。汪诊脉皆微弱。似有似无。或一二至一止。或三五至
一止。乃阳气大虚也。独参五钱。陈皮七分。煎服十数帖而愈。夫四肢者诸阳之末。头者诸
阳之会。经曰。阳虚则恶寒。又曰。一胜则一负。阳虚阴往乘之则恶寒。阴虚阳往乘之则发
热。今指稍逆冷。上至于头。则阴胜阳负可知矣。阳负则不能健运而痛大作。痛作而复热者
物极则反也。及其阴阳气衰。两不相争。则热歇痛亦息矣。仲景曰。血虚气弱。以人参补
之。故用独参汤而数年之痛顿愈。
震按此条脉象。较上条为易认。然用参不用附。岂以其大冷后发大热。宜补不宜温耶。
学人亦当体会之。
一人面色苍白。年四十六。素好酒色犬肉。三月间。因酒兼有房事。遂病腹左痛甚。后
延腹右。续延小腹。以及满腹皆痛。日夜叫号。足不能伸。卧不能仰。汗出食阻。自用备急
丸。利二三行而随止。痛仍不减。汪诊其脉皆细快。右脉颇大于左。独脾脉弦而且滑。扶起
诊之。右脉亦皆细数。恐伤酒肉。用二陈加芩、楂、曲 进之。不效。再用小承气汤。仍不
利。蜜煎导之。仍不利。乃以大承气汤。利二三行。痛减未除。令其住药。只煎山楂汤饮之
次日烦躁呕恶。渴饮凉水。则觉恶止爽快。诘朝诊脉。皆隐而不见。四肢逆冷。烦躁不宁
时复汗出。举家惊愕。疑是房后阴证。拟进附子理中汤。汪曰。此治内寒逆冷也。活人书
云。四逆无脉。当察证之寒热。今观所患。多属于热。况昨日脉皆细数。面色近赤。又兼酒
后而病。六脉虽绝。盖由壮火食气也。四肢者。诸阳之末。气被壮火所食。不能营于四肢。
故脉绝而逆冷也。此类伤暑之证。正合仲景所谓热厥者多。寒厥者少。急用大承气汤下之之
例。
向虽下以大承气。其热尚未尽。难以四逆汤证与比。今用附子热药。宁不助火添病耶。如不
得已。可用通脉四逆汤。尚庶几焉。以其内有童便猪胆汁监制附毒。不得以肆其虐也。连进
二服。脉仍不应。逆冷不回。渴饮烦躁。小便不通。粪溏反频。腹或时痛。更进人参白虎汤
二帖。躁渴如旧。更用参、术各三钱。茯苓、麦冬、车前各一钱。五味、当归各五分。煎一
帖。脉渐见如蛛丝。汪曰。有生意矣。仲景论脉绝。服药微续者生。脉暴出者死是也。左手
足亦略近和。不致冰人。右足手逆冷如旧。但口尚渴。便尚溏。一日夜约十余度。小便不通
汪曰。渴而小便不利者。当利其小便。遂以天水散冷水调服。三四剂不应。再以四苓散加
车前、山栀。煎服二帖。小便颇通。但去大便而小便亦去。不得独利。汪曰。小便未利。烦
渴未除。尽由内热耗其津液也。大便尚溏者。亦由内热损其阳气。阳气不固而然也。遂用参
术各三钱。茯苓一钱五分。白芍、车前、门冬各一钱。山栀七分。五味五分。连进数服。
至第九日。逆冷回。脉复见。诸证稍减。渐向安。
震按此证反复甚多。所用之方。又皆重剂。然寒热互用。而卒能以补收功者。因其身不
热。神不昏。与伤寒温疫有别。故可从容挽救也。大抵腹痛由于停食。而房后元气必虚。连
下之则虚极。故逆冷脉绝。通脉四逆汤非误。白虎汤殊误。赖有人参。设不用人参。此证早
难活也。
王中阳治一燕人。久患冷气满腹。上攻下注。大痛不堪。痛阵拥上。即吐冷涎而止。一
日一作。饮食不进。遂成骨立。屡用温补不效。王诊之。六脉弦长劲急。两畔别有细脉。沸
然而作。状如烂绵。曰。此必胸膈有臭痰在内。病者曰然。众医皆作冷气。因补治下元。日
久无效。自觉胸中痞闷。今闻此说。令我大快。遂投滚痰丸。临睡服之。夜半。吐黑绿冷涎
败水无数。再服七十丸。其病如脱。以六君子调理而愈。
震按王隐君治病。不曰痰。即曰火。可作戴人之法嗣。但腹痛因痰诚有之。此种脉象。
更要留心。
薛立斋治太守朱阳山。因怒。腹痛作泻。或两胁作胀。或胸乳作痛。或寒热往来。或小
便不利。饮食不入。呕吐痰涎。神思不清。此肝木乘脾土。用小柴胡加山栀、炮姜、茯苓、
陈皮。合左金。一剂即愈。
震按立斋治腹痛。凡兼胸胁作胀。呕吐不食。或吞酸嗳腐。或手足厥冷。皆谓肝木乘脾
多用补中益气及六君子。间有吞左金丸者。或香砂六君子加木香、炮姜、吴茱。其载脉皆
曰弦紧。弦长。或弦洪。弦数。何均用参、术。不可易辙耶。
孙东宿治吴勉斋。年近五十。有腹痛疾。或作或止。性极急。多躁多怒。今痛在当脐。
不间昼夜。市里医者为下之。已五日。大便虽泻。痛则尤甚。饮食不进。手足清冷。形神俱
倦。脉仅四至。重按则伏而有力。此由攻克太过。寒凉伤脾。脾虚则中气不运。积反凝滞。
以故大便虽泻。而积不行。痛终不减也。治当创建中气为主。中气一回。痛当立止。先与王
海藏五神丸二钱。滚水送下。以止其痛。此丸补接元气。安和五脏。升降阴阳。极有神应。
故名五神。再用小建中汤。调肝养脾。盖脐下乃肝经部位。惟此汤乃对证剂也。但以桂心换
桂枝。加香附。服后痛止。次日进粥太频。且食鸭汁。撼动余积。腹又作痛。且加胀满。面
有浮气。里急后重。与四平丸而渐定。外以二陈加香附、砂仁、苍术、山楂。腹中始觉宽快
三日无恙。又纵恣口腹。大啖过饱。腹中大痛。欲吐之则食已下鬲。欲泻之则食未入肠。
自喊叫云。可取木香槟榔丸、大承气汤。急与我下之。虽死无撼。孙曰。据痛虽甚。腹则不
坚。顾今日适届冬节。礼曰。先王于至日闭关。安静以养微阳。安敢以大寒峻剂而汨天和乎
设不得已。只须 树东行根上白皮。长流水煎饮之。果泻三五行。痛减大半。再与小建中
汤和之。痛又旋减。惟脐下尚不脱然。常常以热手重熨之。大便欲行。及至厕则又不解。知
其血少而气不调。用熟地三钱。白芍一钱。杏仁二钱。乌药一钱。木香五分。煎服。下黑粪
甚多。十年腹痛沉 。从此再不复萌。
东宿曰。一染匠妇。腹痛两月矣。或以为寒为热。为气为虚。为食积为虫。愈医愈痛。
一医与大膏药一个。满腹贴之。痛益剧。乃揭去膏药。即粘牢不可起。火熨油调。百计不能
脱分寸。如生在肉上相类。无可奈何。买舟就诊。及抵岸而尽力搀扶。不能动一步。予往视
之。见其面色苍黑。手上皮肤燥若老松树皮。六脉皆洪数。叩其不能举步之由。妇曰。非力
弱不能行。乃左脚不可动。动即痛应于心。是以一步不能举也。予思色脉皆非死候。胡治而
益剧。此必肠痈。左脚莫能举。是其征也。与营卫返魂汤。加金银花为君。酒水各半煎。一
帖痛稍减。二帖下黑臭脓半桶。腹上膏药自脱。由热去而膏脱也。痛遂全减。调理而安。
震按前案用药巧。此案审病巧。俱可启迪后学。
缪仲淳曰。包海亭夫人。患腹痛。连少腹上支心。日夜靡间。百药不效。予诊其脉。两
寸关俱伏。独两尺实大。按之愈甚。询知其起自暴怒。风木郁于地中。投以川芎、(上)柴胡
(中)升麻。(下)下咽。嗳气数十声。痛立已。已而作喘。予知升之太骤也。以四磨饮与之。
遂平。
震按风木郁于地中。宜用逍遥散。去白术。加香附、郁金。为正治。或参入川楝、半夏
橘红、牡蛎等药。兹因两尺实大。按之愈甚。故用三样升提药。然已升之太骤而作喘。四
磨饮降得恰好。
喻嘉言治叶茂卿男。出痘未大成浆。其壳甚薄。两月后。尚有着肉不脱者。一夕腹痛。
大叫而绝。喻取梨汁入温汤灌之。少苏。顷复痛绝。灌之又苏。遂以黄芩二两煎汤。和梨汁
与服。痛止。令制膏子药频服。不听。其后忽腹大无伦。一夕痛叫。小肠突出脐外五寸。交
纽各二寸半。如竹节壶顶状。阳物绞折。长八九寸。明亮如灯笼。奇怪可畏。喻以黄芩、阿
胶二味。日进十余剂。三日后。始得小水。五日后。水道通利。脐收阳缩而愈。门人因询其
义。答曰。夫人一身之气。全关于肺。肺清则气行。肺浊则气壅。肺主皮毛。痘不成浆。肺
热而津不行也。壳着于肉。名曰甲错。甲错者多生肺痈。痈者壅也。岂非肺气壅而然欤。腹
痛叫绝者。壅之甚也。壅甚则并水道亦闭。是以其气横行于脐中。而小肠且为突出。至于外
肾弛长。尤其剩事矣。吾以黄芩、阿胶清肺之热。润肺之燥。治其源也。气行而壅自通。源
清斯流清矣。缘病已极中之极。惟单味多用。可以下行取效。故药止二味。而奏功甚捷耳。
试观禽畜之类有肺者有水。无肺者无尿。故水道不利而成肿满。以清肺为急。即此义通之。
后人以五苓五皮八正等方治水者。总之未悟此旨。至于车水放塘。种种劫夺膀胱之剂。则杀
人之事矣。尚可用欤。
周慎斋曰。一人年二十余。房事不节。因食酒店饮食。遂火挟脐起。上入胸膈。腹内痛
外皮抽进。如有物闭住胸中。用消导者有之。用温补者有之。服药愈多而病愈凶。自分以
为必死。予诊之。思相火自下冲上。直至于头面。今火起于脐。至胸而止。乃因色欲过度。
真阳不足。丹田有寒也。作痛者脾虚有寒。土无火生也。用乌药二钱。以制附子一枚。每用
附子三分。水煎服。盖附子扶阳。乌药破滞。只此一味煎汤极清。清则下行甚速。故五日见
效。服附子百枚而痛自愈。
震按喻公以黄芩阿胶。日进十余剂。周公以乌药制附子。每次用三分。皆五日见效。可
Zhu Danxi treated a patient. In June, he dove into the abyss to catch fish. By late autumn, when the rain turned cold, in the middle of the night, he suffered severe lower abdominal pain with profuse sweating. The pulse was deep, wiry, fine, and solid; upon heavy pressure, it felt sharp and cutting like touching a knife blade. He was given Da Cheng Qi Tang (Major Order the Qi Decoction) with added Guizhi (Cinnamon Twig). After two doses, there was mild diarrhea and the pain ceased. However, for several consecutive days, the pain recurred at Shen and You hours (3 PM to 7 PM), with the abdomen becoming hard and intolerant to pressure. Each time the previous medication was administered, mild diarrhea ensued, providing temporary relief. Peach Kernel Mud (Tao Ren Ni) was added to the previous prescription. More than one Sheng (approx. 500ml) of dark purple-black blood was discharged, and the pain stopped. Although the pulse slightly decreased, the sharp, cutting sensation persisted. Chuan Fuzi (Prepared Aconite Root) was then added to the previous prescription. Five bowel movements occurred, including more than two Sheng of dark purple-black blood clots resembling torn cotton. Later, due to food stagnation, pain in the umbilical and abdominal region recurred at You hour, but the pulse was harmonious. Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) was prescribed, resulting in recovery after one dose.
Yu Zhen commented: Severe lower abdominal pain accompanied by profuse sweating and a pulse feeling like touching a knife blade would be mistaken by ignorant practitioners as the pulse of the True Zang organs. Alternatively, they might attribute the cause to cold and use only warm herbs like Guizhi and Fuzi. Zhu Danxi’s continuous use of warm purgatives is truly admirable. The most difficult aspect was the recurrence of pain after cessation. Without changing the main formula, Tao Ren (Peach Kernel) was suddenly added. Once the blood stasis was expelled and pain ceased, the formula remained unchanged, and Fuzi was added. Only when pain recurred due to food stagnation after recovery was the formula changed to Jian Zhong Tang. This was entirely due to accurate pulse diagnosis, allowing for decisive use of both purging and tonifying methods. In the subsequent case by Yu Tianmin, cold invasion was heavier, and cold-purgatives were mistakenly used initially. Therefore, warm tonification and moxibustion were employed first, followed by warm purgatives. This differs slightly from the previous case, yet both are precise and not interchangeable. Unclear pulse diagnosis would inevitably lead to double errors.
Yu Tianmin treated a young man who went underwater to net fish in a cold month and ate cold porridge while hungry. This resulted in severe abdominal pain lasting two days and nights without relief. Physicians had used Da Huang Wan (Rhubarb Pill) and Da Cheng Qi Tang. After evacuating fecal water, the pain worsened. His six pulses were deep, hidden, and solid, and his face was cyanotic and black. Yu Tianmin said, “This is a severe cold syndrome with dry stool in the lower jiao causing pain.” First, Ding Fu Zhi Zhong Tang (Ding and Fuzi Regulate the Middle Decoction) was given for one dose. Moxibustion was applied to Qihai (CV6) for twenty-one moxa cones. Pain reduced by half. Then, pills made of Ba Dou (Croton Seed), Chen Xiang (Aquilaria Wood), and Mu Xiang (Aucklandia Root), sized like mung beans, were taken with ginger juice. Five to seven bowel movements led to recovery.
Another patient, a woman over fifty, had a mass in the lower abdomen causing pain for over two months. One physician treated it as fixed blood stasis (Si Xue) using Si Wu Tang (Four Substances Decoction) plus Tao Ren (Peach Kernel), which failed. Another treatment with Ling Zhi (Lingzhi Spore Powder? Note: likely Wu Ling Zhi/Trogopterus Dung), Yan Hu Suo (Corydalis Rhizome), Ru Xiang (Olibanum), Mo Yao (Myrrh), San Leng (Burreed Tuber), and E Zhu (Curcuma Rhizome) as pills also failed. Her six pulses were deep and hidden, with the two Chi (Kidney) pulses completely imperceptible. Yu Tianmin said, “This is constipation in the lower jiao causing pain, not fixed blood stasis.” Jin Cheng Dao (Jincheng Rice) was burned to ash, and a strong decoction was prepared. One cup was ingested. After an hour, Zhi Shi Dao Zhi Wan (Immature Bitter Orange Direct Stagnation Pill) was administered to induce evacuation. About a bowl of black stools like plum pits were passed, and pain ceased. Subsequently, blood-nourishing and intestinal-moistening herbs were used for over ten doses, leading to full recovery.
Yu Zhen commented: A deep and solid Chi pulse indicates constipation in the lower jiao. Determining constipation despite the complete absence of Chi pulses demonstrates skillful pulse diagnosis, showing that methods vary. If it were fixed blood stasis, the pulse would necessarily be choppy, as recorded in many previous cases.
Wang Shishan treated a man in his fifties, who was thin, dark-skinned, and had loose skin. He suddenly developed abdominal pain, worsening in the afternoon. Physicians used qi-regulating herbs, which increased the pain. Wang stated, “In the afternoon, blood circulates in the Yin aspects. Increased pain indicates blood stasis in the Yin.” Si Wu Tang (Four Substances Decoction) with Ru Xiang (Olibanum) and Mo Yao (Myrrh) was given but did not reduce the pain. Wang’s pulse diagnosis revealed floating, fine, and knotted qualities, with intermittent stops every five to seven beats or every fourteen to fifteen beats. Classics state that if the pulse gradually recedes, the patient lives; if it progresses, the patient dies. Here, frequent stops indicate mildness, while sparse stops indicate severity, contradicting the Mai Jing (Classic of Pulse). After deep thought, Wang said, “I understand. Sparse stops with severe pain occur because heat accelerates the pulse; frequent stops with mildness occur because heat recedes and the pulse slows. The disease is undoubtedly Yin deficiency with fire hyperactivity. Observing the onset from labor and sexual excess: labor injures the Heart causing fire hyperactivity; excess injures the Kidney causing water deficiency. Ginseng and White Peony Root are used as sovereigns to tonify the Spleen; Shu Di Huang (Prepared Rehmannia Root) and Dang Gui (Angelica Sinensis Root) as ministers to nourish the Kidney; Huang Bo (Phellodendron Bark) and Zhi Mu (Anemarrhena Rhizome) as assistants to clear the Heart; Shan Zha (Hawthorn Fruit) and Chen Pi (Tangerine Peel) as guides to move stagnation. Human milk and child urine are used for modifications. Specifically, Ginseng is used in doses of four to five Qian. Taken during pain, it brings cure.” Someone asked, “For various pains, especially in thin, dark individuals with Yin deficiency and fire hyperactivity, Ginseng and Astragalus are contraindicated. Why does it work here?” Wang replied, “The prohibition of Ginseng and Astragalus for pain applies to acute diseases with excess patterns. For the elderly with Qi and Blood deficiency, without tonification, how can Qi move and pain cease? The Classic says, ‘Those in vigor recover as Qi moves.’”
Yu Zhen commented: Mr. Wang’s observation of the condition and explanation of etiology are incredibly precise. Thus, Ginseng, Astragalus, Dang Gui, Shu Di Huang, Mai Dong (Ophiopogon Tuber), Zhi Mu, Huang Bo, human milk, and child urine, though not standard formulas for abdominal pain, proved effective. Ignorant practitioners blindly pick formulas from disease categories, lost and unable to help. Since methods vary across texts, what serves as the reliable guide?
A woman nearing fifty suffered from abdominal pain. It began with coldness in the right hand, ascending to the head, feeling like cold water poured on it, accompanied by severe abdominal pain and generalized high fever. Fever subsided, and pain stopped. Whether overeating or fasting triggered pain. Previously occurring once a year, it now occurred every two to three days, rarely exceeding six to seven days. Physicians tried Si Wu Tang with Chai Hu (Bupleurum Root) and Xiang Fu (Cyperus Rhizome) without effect. Others tried Si Jun Zi Tang (Four Gentlemen Decoction) with Mu Xiang (Aucklandia Root) and Bing Lang (Areca Seed) without effect. Er Chen Tang (Two-Cured Decoction) with Zi Su (Perilla Leaf) and Dou Kou (Black Cardamom) was tried, as was Qi Qi Tang (Seven Qi Decoction), all ineffective. Wang’s pulse was weak and faint, almost imperceptible, with stops every one to two beats or three to five beats. This indicated severe Yang deficiency. Du Shen Tang (Single Ginseng Decoction) with five Qian of Ginseng and seven Fen of Chen Pi was decocted and taken for over ten doses, resulting in recovery. The limbs are the extremities of all Yang meridians; the head is the meeting place of all Yang meridians. The Classic states, “Yang deficiency leads to aversion to cold.” Also, “When one wins, the other loses.” Yang deficiency allows Yin to invade, causing cold; Yin deficiency allows Yang to invade, causing heat. Now, finger coldness ascending to the head indicates Yin excess and Yang insufficiency. Yang insufficiency fails to transform and transport, causing severe pain. Pain accompanied by fever represents the principle of reversal at extremes. When Yin and Yang Qi decline and cease struggling, fever and pain subside. Zhang Zhongjing said, “For Blood deficiency and Qi weakness, tonify with Ginseng.” Hence, Du Shen Tang cured years of pain instantly.
Yu Zhen commented: This pulse presentation is easier to recognize than the previous one. However, why use Ginseng instead of Fu Zi? Is it because severe cold followed by high fever requires tonification rather than warming? Students should ponder this.
A man, forty-six years old, with a pale complexion, accustomed to alcohol, sex, and dog meat, fell ill in March after drinking and having intercourse. Severe pain started in the left abdomen, spreading to the right, then the lower abdomen, and finally the entire abdomen. He cried day and night, unable to extend his legs or lie flat, sweating with food blockage. He self-administered Bei Ji Wan (Emergency Pill), having two or three bowel movements which stopped quickly, but pain persisted. Wang’s pulse was fine and rapid throughout, with the Right pulse notably larger than the Left. The Spleen pulse specifically was wiry and slippery. Upon supporting him, the Right pulse was fine and rapid. Suspecting damage from alcohol and meat, Er Chen Tang with Huang Qin (Scutellaria Root), Shan Zha (Hawthorn Fruit), and Shen Qu (Medicated Leaven) was given without effect. Xiao Cheng Qi Tang (Minor Order the Qi Decoction) was tried, still no relief. Honey suppositories failed. Finally, Da Cheng Qi Tang was used, yielding two or three bowel movements, reducing but not eliminating pain. Medication was stopped, and only Shan Zha decoction was drunk. The next day, irritability, nausea, and thirst for cold water relieved the nausea. The following day, pulses were imperceptible, limbs were cold, irritability persisted, and sweating occurred. The family panicked, suspecting a Cold syndrome post-intercourse, planning Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction). Wang said, “This treats internal cold and cold limbs. The Huo Ren Shu says, ‘In Si Ni [Cold Extremities] with no pulse, observe cold and heat signs.’ Here, signs lean towards Heat. Yesterday’s pulse was fine and rapid, face reddish, illness started after drinking. Though pulses vanished, it is due to vigorous Fire consuming Qi. Limbs are extremities of Yang; consumed by Fire, Qi cannot nourish them, hence absent pulses and cold limbs. This resembles Summerheat injury, aligning with Zhongjing’s view that ‘Heat Jue [Cold Extremities due to Heat] is common, Cold Jue is rare,’ requiring immediate Da Cheng Qi Tang purgation.”
“Although Da Cheng Qi Tang was used previously, Heat remains unexhausted, unlike Si Ni Tang syndrome. Using hot Fu Zi now would aid Fire and worsen disease. If unavoidable, Tong Mai Si Ni Tang (Unblock the Pulse Si Ni Decoction) might suffice, as it contains Child Urine and Pig Gallbladder Juice to control Fu Zi toxicity.” Two doses were given, but pulses remained absent, cold limbs persisted, thirst and irritability continued, urination stopped, and loose stools increased. Abdominal pain fluctuated. Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) was given for two doses, with no change in irritability/thirst. Then, Ginseng and Bai Zhu (Atractylodes Macrocephala Rhizome) 3 Qian each, Fu Ling (Poria), Mai Dong (Ophiopogon Tuber), Che Qian Zi (Plantago Seed) 1 Qian each, Wu Wei Zi (Schisandra Berry) and Dang Gui (Angelica Sinensis Root) 0.5 Qian each, were decocted. Pulses became thread-like. Wang said, “Life force returns. Zhongjing states: ‘Pulse absent, slight continuation after medicine means life; sudden emergence means death.’” Left limbs warmed slightly, but Right limbs remained cold. Thirst and loose stools persisted. Wang said, “Thirst with difficulty urinating requires promoting urination.” Tian Shui San (Heavenly Water Powder) mixed with cold water was given for three to four doses without effect. Si Ling San (Four Poria Powder) plus Che Qian Zi and Shan Zhi (Gardenia Fruit) was decocted for two doses, improving urination. However, stool loss accompanied urine loss. Wang said, “Incomplete urination and persistent thirst/irritability result from Internal Heat consuming fluids. Loose stools result from Internal Heat damaging Yang Qi, failing to secure.” Ginseng and Bai Zhu 3 Qian each, Fu Ling 1.5 Qian, Bai Shao (White Peony Root), Che Qian Zi, Mai Dong 1 Qian each, Shan Zhi 0.7 Fen, Wu Wei Zi 0.5 Fen were given continuously. On the ninth day, cold limbs returned, pulses reappeared, symptoms lessened, and recovery progressed.
Yu Zhen commented: This case was highly recurrent, using heavy formulas. Yet, alternating cold and heat, ultimately succeeding with tonification, was possible because the body was not hot and spirit was not confused, differing from Cold Damage or Warm Epidemics, allowing calm rescue. Generally, abdominal pain from food stagnation combined with post-coital Yuan Qi deficiency leads to extreme deficiency after repeated purgation, causing cold limbs and absent pulses. Tong Mai Si Ni Tang was not wrong; Bai Hu Tang was indeed erroneous. Reliance on Ginseng saved the case; without it, survival would be unlikely.
Wang Zhongyang treated a man from Yan. He suffered long-term cold Qi filling the abdomen, attacking up and down, causing unbearable pain. Pain waves ascended, stopping after vomiting cold saliva. Occurring daily, with no appetite, leading to emaciation. Repeated warm tonification failed. Wang’s pulse was wiry, long, and tense, with fine pulses boiling on the sides, resembling rotten cotton. He said, “There must be foul phlegm in the chest and diaphragm.” The patient agreed. Other physicians treated it as cold Qi, tonifying the Lower Yuan without effect, causing chest stuffiness. Hearing Wang’s theory brought great relief. Gun Tan Wan (Rolling Phlegm Pill) was given at bedtime. At midnight, countless amounts of black-green cold saliva and bad water were vomited. Another seventy pills cured the disease. Liu Jun Zi Tang (Six Gentlemen Decoction) regulated the body to recovery.
Yu Zhen commented: Wang Yinjun treats diseases either as Phlegm or Fire, following Dai’s methods. Abdominal pain due to Phlegm does exist; such pulse presentations require careful attention.
Xue Lizhai treated Prefect Zhu Yangshan. Anger caused abdominal pain with diarrhea, distension in hypochondriums, pain in chest/breasts, alternating chills/fever, difficulty urinating, inability to eat, vomiting phlegm-saliva, and unclear spirit. This was Liver Wood overacting on Spleen Earth. Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Shan Zhi (Gardenia Fruit), Pao Jiang (Roasted Ginger), Fu Ling (Poria), and Chen Pi (Tangerine Peel), combined with Zuo Jin Wan (Left Metal Pill), cured him in one dose.
Yu Zhen commented: Lizhai treats abdominal pain with hypochondriac distension, vomiting/anorexia, acid regurgitation, or cold limbs as Liver Wood overacting on Spleen, mostly using Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) or Liu Jun Zi Tang. Occasionally Zuo Jin Wan or Xiang Sha Liu Jun Zi Tang with Mu Xiang, Pao Jiang, and Wu Zhu Yu is used. Pulses are described as wiry-tight, wiry-long, wiry-harmonic, or wiry-rapid. Why always use Ginseng and Bai Zhu without deviation?
Sunongsu treated Wu Mianzhai, nearly fifty, with intermittent abdominal pain, irritable and angry. Pain was at the umbilicus, day and night. Local physicians purged him for five days. Although bowels moved, pain worsened, anorexia persisted, limbs were cold, and spirit/body were exhausted. Pulse was four beats per breath, deep and forceful on heavy pressure. This resulted from excessive purgation, cold-herbs injuring Spleen, Spleen deficiency failing to move Middle Qi, causing accumulation stagnation. Bowels moved, but accumulation remained, so pain persisted. Treatment should focus on establishing Middle Qi. Once restored, pain stops. Wang Haicang’s Wu Shen Wan (Five Spirits Pill) 2 Qian was given with boiling water to stop pain. This pill tonifies Yuan Qi, harmonizes Zang-Fu, regulates Yin-Yang, and is miraculous. Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) was used to soothe Liver and nourish Spleen, as the area below the umbilicus belongs to the Liver meridian. Guixin (Cinnamon Heart) replaced Guizhi, plus Xiang Fu (Cyperus Rhizome). Pain stopped. Next day, frequent congee and duck soup disturbed residual accumulation, causing pain and distension, facial edema, and tenesmus. Si Ping Wan (Four Balance Pill) stabilized it externally. Er Chen Tang with Xiang Fu, Sha Ren (Amomum Fruit), Cang Zhu (Atractylodes Lancea Rhizome), and Shan Zha (Hawthorn Fruit) brought abdominal comfort. Three days symptom-free, he overate. Severe abdominal pain ensued. Vomiting was impossible as food passed the diaphragm; purging was impossible as food hadn’t reached intestines. He demanded Mu Xi Bing Lang Wan (Mu Xiang and Areca Pill) or Da Cheng Qi Tang. Sun said, “Pain is severe, but abdomen is not hard. Today is Winter Solstice. Rituals say: ‘Close gates to nurture subtle Yang.’ How dare I use harsh cold purgatives to disturb Heavenly Harmony? If necessary, use white bark from the east-growing root of Chu Tree (Cunninghamia), decocted in flowing water.” Three to five bowel movements reduced pain by half. Xiao Jian Zhong Tang harmonized, pain subsided. Umbilical area remained uncomfortable. Frequent hot hand compressions helped. Bowels wanted to move but didn’t at toilet. Knowing Blood deficiency and Qi disharmony, Shu Di Huang (Prepared Rehmannia Root) 3 Qian, Bai Shao (White Peony Root) 1 Qian, Xing Ren (Apricot Seed) 2 Qian, Wu Yao (Lindera Root) 1 Qian, Mu Xiang (Aucklandia Root) 0.5 Qian were decocted. Large amounts of black stool were passed. Ten-year chronic abdominal pain never recurred.
Sunongsu said: A dyer’s wife had abdominal pain for two months. Diagnosed as cold, heat, Qi, deficiency, food stagnation, or parasites, treatment worsened pain. A large plaster was applied to the whole abdomen, increasing pain. Removing it stuck firmly, requiring heat and oil to detach, seeming grown into the flesh. She traveled for consultation, unable to walk even with support. Her face was dark, hands dry like pine bark, six pulses洪数 (surging and rapid). She couldn’t lift her left foot due to heart-referred pain. Colors and pulses weren’t death omens. Why treat to worsen? Likely Intestinal Abscess (Chang Yong); inability to lift left foot is a sign. Ying Wei Fan Hun Tang (Ying and Wei Revive Soul Decoction) with Jin Yin Hua (Honeysuckle Flower) as sovereign, decocted in wine and water, reduced pain after one dose. Two doses evacuated half a bucket of black, foul pus. Plaster fell off as heat cleared. Pain ceased, recovery followed.
Yu Zhen commented: The previous case showed clever用药 (medication); this case showed clever diagnosis. Both inspire students.
Miu Zhongchun said: Lady Bao Haiting suffered abdominal pain radiating from lower abdomen to heart, day and night, unresponsive to medicines. Pulses at Cun and Guan positions were hidden; Chi pulses were solid and large, worse on pressure. Onset from rage, Wind-Wood depressed in the earth. Chuan Xiong (Sichuan Lovage Rhizome), Chai Hu (Bupleurum Root), and Sheng Ma (Cimicifuga Rhizome) were given. After swallowing, dozens of belches occurred, pain stopped immediately. Then wheezing started, indicating too rapid ascent. Si Mo Yin (Four Mortars Drink) settled it.
Yu Zhen commented: Wind-Wood depression in earth suits Xiao Yao San (Rambling Powder), removing Bai Zhu, adding Xiang Fu and Yu Jin (Curcuma Longa Rhizome) as standard treatment. Or add Chuan Lian (Melia Toosendan Fruit), Ban Xia (Pinellia Tuber), Ju Hong (Red Tangerine Peel), Mu Li (Oyster Shell). Here, solid/large Chi pulses warranted three ascending herbs. But rapid ascent caused wheezing; Si Mo Yin descended appropriately.
Yu Jiayan treated Ye Maoqing’s son. Smallpox pustules hadn’t fully formed, shells thin. Two months later, some adhered to flesh. One night, severe abdominal pain, screaming, and syncope. Yu poured pear juice in warm water to revive him briefly. Pain returned, syncope recurred, revived again. Huang Qin (Scutellaria Root) 2 Liang was decocted, mixed with pear juice, stopping pain. Paste medicine was recommended but refused. Later, abdomen enlarged enormously. Screaming pain, small intestine protruded 5 cun outside umbilicus, twisted 2.5 cun each, resembling bamboo joints or pot tops. Genitals twisted, 8-9 cun long, bright like lanterns, terrifying. Yu used Huang Qin and E Jiao (Donkey-hide Gelatin), ten+ doses daily. Small urination started after three days, urinary flow normalized after five days, umbilicus retracted, genitals shrank, recovery achieved. Disciples asked the rationale. Yu replied, “Qi of the body relies on Lung. Clear Lung allows Qi movement; turbid Lung causes Qi obstruction. Lung governs skin/hair. Smallpox failing to form pus indicates Lung Heat and fluid failure. Shells adhering to flesh is called Jia Cuo (Armor-like scaling), often preceding Lung Abscess. Abscess means obstruction, likely Lung Qi obstruction. Severe pain/syncope indicates severe obstruction. Obstruction closes water passages, forcing Qi horizontally at umbilicus, protruding small intestine. Genital elongation is secondary. Huang Qin and E Jiao clear Lung Heat and moisten Dryness, treating the source. Qi moves, obstruction clears; clear source yields clear flow. Disease was extreme; single herbs in high doses descend effectively. Hence only two herbs, swift results. Birds/beasts with lungs have urine; those without don’t. Water passage dysfunction causes edema. Clearing Lung is urgent. Later treatments using Wu Ling, Wu Pi, Ba Zheng etc. miss this point. Depriving Bladder via draining agents kills. Can they be used?”
Zhou Shenzhai said: A man in his twenties, irregular sexual activity, ate hotel food. Fire rose from umbilicus to chest/diaphragm, abdominal pain with skin twitching, sensation of blockage in chest. Digestives and warm tonics failed, worsening condition. He expected death. Zhou diagnosed: Ministerial Fire rushing up from below to head/face, but here fire starts at umbilicus, stops at chest. Due to sexual excess, True Yang insufficient, Cold in Dantian. Pain from Spleen deficiency with Cold, Earth lacking Fire generation. Wu Yao (Lindera Root) 2 Qian processed with one Fu Zi (Aconite Root), using 3 Fen of Fu Zi per dose, decocted. Fu Zi supports Yang, Wu Yao breaks stagnation. Single herb decoction is very clear, descending rapidly. Effect seen in five days, hundred Fu Zi doses cured pain.
Yu Zhen commented: Mr. Yu used Huang Qin and E Jiao, ten+ doses daily; Mr. Zhou used Wu Yao processed Fu Zi, 3 Fen per dose. Both effective in five days.