脾宜升则健。胃宜降则和。盖太阴之土。得阳始运。阳明之土。得阴自安。以
脾喜刚燥。胃喜柔润。仲景急下存津。治在胃也。东垣大升阳气。治在脾也今能
食不运。医家悉指脾弱是病。但诊脉较诸冬春。盛大兼弦。据经论病。独大独小。
斯为病脉。脾脏属阴。胃肺属阳。脉见弦大。非脏阴见病之象。久病少餐。犹勉强
支撑。兼以大便窒塞。泄气不爽。坐谈片刻。嗳气频频。平素痔疮肠红。未尝安适。
此脉症全是胃气不降。肠中不通。腑失传导变化之司。古人云。九窍不和。都属
胃病六腑为病以通为补。经年调摄。不越参术桂附。而毫乏应效。不必再进汤
药。议仿丹溪小温中丸。服至七日。俾三阴三阳一周。再议治之。
小温中丸
汤食下咽。嗳噫不已。不饥不食。大便干坚若弹丸。大凡受纳饮食。全在胃
口。已经胃逆为病。加以嗔怒。其肝木之气。贯膈犯胃。斯病加剧。况平昔常似有
形骨梗脉得左部弦实。气郁血结甚肖。进商辛润方法。
桃仁 冬葵子 皂荚核 郁李仁 大黄 降香 郁金
服咸苦入阴。大便仍闭涩。针剌一次。病无增减。可谓沉锢之疾。夫病着深
远。平素饮酒浓味酿湿聚热。渍筋烁骨。既已经年不拔。区区汤液焉能通逐议
以大苦寒坚阴燥湿方法。参入酒醴引导。亦同气相求之至理。
黄柏 茅术 生大黄 干地龙 金毛狗脊 川连 萆 晚蚕砂 穿山甲 汉防已
仙灵脾 海金沙 川独活 北细辛 油松节 白茄根 黄酒烧酒各半浸七日
阳明脉大。环跳尻骨筋掣而痛。痛甚足筋皆缩。大便燥艰常秘。此老年血
枯。内燥风生。由春升上僭。下失滋养。昔喻氏上燥治肺。下燥治肝。盖肝风木横。
胃土必衰。阳明诸脉。不主束筋骨。流利机关也。用微咸微苦。以入阴方法。
鲜生地 阿胶 天冬 人中白 川斛 寒水石
肝血肾液久伤。阳不潜伏。频年不愈。伤延脾腑。由阴干及乎阳。越人且畏。
凡肝体刚。肾恶燥。问大便五六日更衣。小溲时间淋浊。尤非呆滞补涩所宜。
炒杞子 沙苑 天冬 桂拌酒白芍 茯苓 猪脊筋
少腹微胀。小便通利方安。大便三四日一通。而燥坚殊甚。下焦诸病。须推
肝肾。腑络必究幽门二肠。阅所服药。是香砂六君以治脾。不知肾恶燥耳。
当归 苁蓉 郁李仁 冬葵子 牛膝 小茴 茯苓 车前 蜜丸
The Spleen (Pi) functions healthily when its Qi ascends; the Stomach (Wei) harmonizes when its Qi descends. The Earth of Taiyin (Spleen) requires Yang to transform and transport; the Earth of Yangming (Stomach) finds peace through Yin nourishment. This is because the Spleen prefers dryness and firmness, while the Stomach prefers moistness and softness. Zhang Zhongjing's method of "drastic purgation to preserve fluids" targets the Stomach; Li Dongyuan's method of "greatly raising Yang Qi" targets the Spleen. Currently, the patient can eat but fails to digest and transport nutrients. Physicians attribute this to Spleen deficiency. However, upon palpating the pulse, it is fuller and larger than in winter and spring, with a Wiry (Xian) quality. According to classic theory, a pulse that is exclusively large or small indicates pathology. The Spleen belongs to Yin, while the Stomach and Lung belong to Yang. A Wiry and Large pulse is not an image of Zang-Yin pathology. Despite long-term illness and reduced intake, the body sustains itself barely. Accompanied by fecal impaction and difficult passage of gas, frequent belching occurs after sitting and talking for a short time. Historically, the patient has suffered from hemorrhoids and rectal bleeding, never feeling comfortable. These pulse and symptom patterns entirely indicate failure of Stomach Qi to descend and intestinal blockage, causing the Fu organs to lose their function of transmission and transformation. Ancients stated: "Disorder of the nine orifices all belong to Stomach disease." For diseases of the six Fu organs, unobstructed flow is considered tonification. Years of regulation have relied on Ginseng (Renshen), Atractylodes macrocephala (Baizhu), Cinnamon twig (Guizhi), and Aconite (Fuzi), yet yielded no effect. There is no need to continue decoctions. It is proposed to impute Danxi's Xiao Wen Zhong Wan (Small Warm Middle Pill). After seven days of administration, allowing one cycle of the Three Yin and Three Yang channels, further treatment will be discussed.
Xiao Wen Zhong Wan (Small Warm Middle Pill)
After swallowing soup and food, belching continues incessantly. There is no hunger and no desire to eat. Stool is dry and hard like pellets. Generally, receiving and accepting food depends entirely on the Stomach gate. Since Stomach Qi rebellion has occurred as a pathology, compounded by anger, Liver Wood Qi pierces the diaphragm and invades the Stomach, exacerbating the disease. Moreover, the patient often feels a sensation of a bone-like obstruction in the throat. The pulse at the left position is Wiry and Excess, resembling severe Qi stagnation and Blood congealment. Proceed with aromatic-acrid moistening methods.
Peach Kernel (Taoren), Okra Seed (Dongkuizi), Gleditsia Sinensis Pod Core (Zaojiaohe), Apricot Seed (Yuliren), Rhubarb (Dahuang), Rosewood (Jiangxiang), Curcuma aromatica (Yujin)
After administering salty-bitter herbs entering the Yin level, bowel movement remains obstructed. One acupuncture session resulted in no change in the condition. This can be described as a deeply entrenched disease. The pathogen lies deep and distant. Historically, alcohol consumption and rich flavors have brewed damp-heat, soaking sinews and scorching bones. Having been rooted for years, how can simple decoctions clear and expel it? It is proposed to use bitter-cold methods to consolidate Yin and dry Dampness, incorporating wine as a guide, which aligns with the principle of seeking resonance among similar energies.
Phellodendron bark (Huangbai), Atractylodes lancea (Maozhu/Cangzhu), Raw Rhubarb (Sheng Dahuang), Earthworm (Gandi Long), Drynaria fortunei (Jinmao Gouji), Coptis chinensis (Chuanlian), Dioscorea hypoglauca (Bixie), Silkworm frass (Wancansha), Pangolin scales (Chuanshanjia), Stephania tetrandra (Hanfangji), Epimedium (Xianlingpi), Semen Lepidii et Descurainiae (Haijinsha), Angelica dahurica (Chuan Duohuo), Asarum (Bei Xixin), Pine joint (Yousongjie), White Eggplant root (Baiqiegen), Soaked for seven days in half yellow wine and half sorghum liquor.
Yangming pulse is large. Pain and pulling sensations occur in the tendons around the Huantiao acupoint and sacrum. Severe pain causes foot tendons to contract. Stool is dry and difficult, often constipated. This is due to blood depletion in the elderly, generating internal dryness and wind. Rising Yang in spring overacts, failing to nourish the lower parts. Previously, Yu Jia Yan proposed: treat upper dryness via the Lung, lower dryness via the Liver. Because Liver Wind Wood acts horizontally, Stomach Earth must decline. The Yangming vessels fail to bind sinews and bones or facilitate joint movement. Use slightly salty and slightly bitter methods entering the Yin level.
Fresh Rehmannia root (Xian Shengdi), Donkey-hide gelatin (Ejiao), Asparagus tuber (Tiantong), Human tooth ash (Renzhongbai), Dendrobium nobile (Chuanhu), Niter (Hanshuishi)
Liver Blood and Kidney Essence have been damaged for a long time; Yang fails to reside securely. The illness persists for years, extending to the Spleen and Fu organs, affecting Yang from Yin. Even Yue Ren (Bian Que) would fear such cases. The Liver body is rigid; the Kidney detests dryness. Inquiry reveals bowel movements only once every five to six days, and urine is occasionally turbid and painful. Such conditions are unsuitable for stagnant astringent tonics.
Fried Goji berry (Qigouzi), Astragalus complanatus seed (Shayuan), Asparagus tuber (Tiantong), White Peony root soaked in wine with Cinnamon twig (Gui ban jiu Baishao), Poria (Fuling), Pig spinal cord (Zhujijin)
The lower abdomen is slightly distended; comfort is achieved only when urination is smooth. Bowel movements occur every three to four days, yet stool is extremely dry and hard. Diseases of the lower Jiao must be traced to the Liver and Kidneys; meridians must investigate the幽门 (Pylorus) and intestines. Reviewing prescribed medications, Xiang Sha Liu Jun Zi Tang (Aromatic Sand Six Gentlemen Decoction) was used to treat the Spleen, ignoring that the Kidney detests dryness.
Angelica sinensis (Danggui), Cistanche deserticola (Rongshu), Apricot Seed (Yuliren), Okra Seed (Dongkuizi), Achyranthes bidentata (Niuxi), Fennel (Xiaohui), Poria (Fuling), Plantago seed (Cheqian), Honey pills.