七月二十一日 生石膏（三钱） 生甘草（一钱） 半夏（六钱） 茯苓皮（六钱） 杏仁（四
钱） 苦桔梗（四钱）
八月初四日 右寸脉独大，金实无声，已效而未全愈，照前方再服三剂。前后共服三十
余帖，计石膏三百数十两。
严 三十九岁 五月初二日 六脉弦细短涩，吐血三年不愈，兼有痰饮咳嗽，五更出汗
。经
谓阳络伤则血上溢。要知络之所以伤者，有寒有热，并非人之有络，只许阳火伤之，不许寒
水伤之也。今人见血投凉，见血补阴，为医士一大痼疾。医士之疾不愈，安望病家之病愈哉
。此症阳欲亡矣，已难数治，勉照脉症立方。
半夏（六钱） 干姜炭（三钱） 五味子（二钱） 云苓（五钱） 小枳实（二钱） 桂枝木（三
钱） 广皮炭（三钱） 焦白芍（三钱）
初六日 据云饮食已增，午后五心烦热如故，脉和缓，诸病必究眠食，得谷者昌，方无
可转。至午后之热，方即甘温除大热法也。因脉稍和缓，去干姜炭。
十三日 前后共服过十帖，汗敛食增，血亦不吐，头中发空，得甜食则咳减，中气虚也
。加
甘草三钱以补中气，再服四帖，以其脉仍紧也。前后共服十四帖，诸症向安。惟脉之弦紧
如故，咳甚则欲呕，于原方去五味，减甘草，再服四帖。
二十一日 诸症皆渐减，痰亦渐浓，心悸甚。加∶
枳实（一钱）
四帖。
二十五日 脉弦细如故，咳嗽日减，夜甚阳微，阴盛可知，午后身热已减，惟食后反觉
嘈杂，胸中有水状，少时即平，于原方加∶
干姜（一钱） 枳实（二钱）
三十日 汗停嗽减，五心烦热亦减，脉弦数，夜间咳甚，服热药反不渴，饮尚重也。病
痰饮者，冬夏难治。
桂枝（三钱） 半夏（六钱） 枳实（五钱） 白芍（三钱） 云苓块（五钱） 苡仁（五钱） 炙
甘草（一钱） 干姜（一钱） 五味子（钱半） 广皮炭（三钱）
六月初四日 前方已服四帖，脉弦紧不数，仍不知渴，于前方加∶
甘草（钱半） 干姜（二钱）
再服三帖。
初八日 脉弦紧如故，呛咳如故，舌苔白滑，加桂枝二钱，再加干姜二钱。
十二日 脉之短涩退而弦细如故，痰饮仍重，再加桂枝二钱，干姜二钱，茯苓三钱，以
化饮。
十七日 夜咳已止，是其佳处，咳来日减，亦是最好。左脉沉细，右脉弦紧，饮未尽除
，至
遍身骨痛，久病之故。古人云劳者温之，甘温调营卫而复胃气，气旺进食，久久自愈，病减
者减其治。
桂枝（三钱） 半夏（五钱） 枳实（五钱） 炙甘草（二钱） 干姜（三钱） 广皮（三钱） 五
味子（钱半）
蠲饮丸，痰饮久骤，未能一时猝去，业已见效，与丸药缓化可也。戒生冷恼怒。
桂枝（半斤） 广皮（十二两） 益智仁（四两） 干姜（六两） 小枳实（四两） 苍术炭（六
两） 半夏（一斤） 炙甘草（六两） 云苓（二十四两）
神曲法丸梧子大，每日三服，每服三钱，饮甚时服小青龙汤。
陈 五十一岁 五月初十日 人尚未老，阳痿多年，眩冒昏迷，胸中如伤油腻状，饮水
多则
胃不快，此伏饮眩冒状也。先与白术泽泻汤逐其饮，再以缓治湿热之阳痿。岂有六脉俱弦细
，而恣用熟地久服六味之理哉。
于术（二两） 泽泻（二两）
煮三杯，分三次服。
十三日 已效而未尽除，再服原方十数帖而愈。
李 四十八岁 五月初一日 其人向有痰饮，至冬季水旺之时必发，后因伏暑成痢，痢
后便
溏，竟夜不寐者多日，寒热饥饱，皆不自知，大便不通。按暑必夹湿，况素有痰饮。饮即湿
水之所化。医者毫不识病，以致如此，久卧床褥而不得起。议不食，不饥，不便，不寐，九
窍不和，皆属胃病例，与《灵枢》半夏汤令得寐再商。
姜半夏（二两） 秫米（二合）
急流水八杯，煮三杯，三次服，得寐为度。
十一日 诸窍不和，六脉纯阴，皆痰阴为腻补药所闭，昨用半夏汤，已得寐而未熟，再
服前
方三帖，续用小青龙去表药，加广皮、枳实，以和其饮。盖现下面色光亮，水主明也。六脉
有阴无阳，饮为阴邪故也。左脉弦甚，经谓单弦，饮 也。有一症必有一症之色脉，何医者
盲无所知，不知伊芳一生所学何事，宁不愧死。
桂枝（五钱） 姜半夏（六钱） 白芍（三钱，炒） 五味子（二钱） 炙甘草（三钱） 小枳实
（五钱） 干姜（二钱） 广皮（三钱）
甘澜水八碗，煮成三杯，三次服。
十八日 胃之所以不和者，土恶湿而阳困也。昨日纯刚大燥，以复胃阳，今诊脉象较前
生动
，胃阳已有生动之机，但小便白浊，湿气尚未畅行，胃终不得和也。与开太阳阖阳明法。
半夏（二两） 猪苓（六钱） 滑石（三钱） 秫米（一合） 泽泻（六钱） 白通草（一钱） 广
皮（三钱） 桂枝（四钱） 云苓皮（六钱）
急流水十一碗，分二次煮成四碗，分四次服。
五月初三日 去滑石、通草，加∶
川椒（三钱，炒去汗）
高五十二岁 乙酉五月十六日 脉弦痰饮喘咳，与小青龙去麻辛，加广皮、枳实。
桂枝（五钱） 姜半夏（六钱） 白芍（三钱） 广皮（三钱） 炙甘草（三钱） 小枳实（五钱）
干姜（二钱） 五味子（二钱）
煮三杯，分三次服。二帖。
十八日 已见小效，汗多，加∶
净麻黄根（三钱）
又三帖。
病减者减其制，去∶
桂枝 枳实（各二钱）
二十四日 服前药汗少，惟喜嚏，周身酸痛，于原方减干姜一钱，加∶
杏仁 防己（各三钱）
董 五十四岁 五月二十七日 脉沉细弦弱，咳嗽夜甚，久而不愈，饮也。最忌补阴，
补阴必死。以饮为阴邪，脉为阴脉也，经曰无实。
桂枝（六钱） 广皮（三钱，炒） 白芍（四钱） 半夏（五钱） 炙甘草（一钱） 五味子（一
钱） 干姜（三钱） 小枳实（二钱）
四帖。
六月初一日 加云苓（三钱） 小枳实（二钱）
十七日 其人本有痰饮喘咳，服小青龙，胃口已开。连日午后颇有寒热，正当暑湿流行
之际，恐成疟疾，且与宣通三焦。
杏仁（三钱） 半夏（四钱） 云苓皮（五钱） 白蔻仁（钱半） 枳实（三钱） 苡仁（五钱）
广皮（三钱） 藿梗（三钱） 青蒿（二钱）
二帖。
十九日 寒热已止，脉微弱，去蔻仁、青蒿，加桂枝、干姜，以治其咳。
二十二日 咳减寒热止，胃开，嗽未尽除，脉尚细小，效不更方，服至不咳为度。
周 二十二岁 正月初七日 六脉弦紧，右脉沉取洪大，先从腰以上肿例。舌白滑喘而
咳无汗，从溢饮例之大青龙汤，去甘药，为其重而滞也。
麻黄（六钱，去节） 细辛（二钱） 生姜（三钱） 杏仁（五钱，去皮留尖） 生石膏末（一
钱） 炙甘草（二钱） 桂枝（五钱） 大枣（二枚，去核）
煮成三杯，先服一杯，覆被令微汗佳。得汗即止后服，不汗再服第二杯，如上法。
十一日 溢饮，脉紧，无汗，喘咳，浮肿，昨用大青龙汗出，肿消，喘咳减，与开太阳
阖阳明法。
半夏（五钱） 苍术炭（二钱） 桂枝（钱半） 广皮（三钱） 猪苓（三钱） 茯苓块（五钱）
苡仁（五钱） 泽泻（三钱） 飞滑石（五钱）
煮三杯，分三次服。已服十数帖，后加∶
益智仁（二钱） 莲子（五钱）
陈 七十六岁 正月初十日 悬饮脉弦，左胁不快，为水在肝法，当用十枣汤。近八旬
之老人，难任药力，与两和肝胃可也。
半夏（五钱） 青皮（三钱） 旋复花（三钱，包） 广皮（三钱） 香附（五钱） 小枳实（三
钱） 淡吴萸（三钱）
煮三杯，分三次服，已服十数帖。
二十三日 脉结加∶杏泥（六钱）
三帖。
觉罗 六十二岁 壬戌正月十三 酒客痰饮哮喘，脉弦紧数，急与小青龙去麻辛，加枳
实橘
皮汤不应。右胁痛甚，此悬饮也，故与治支饮之小青龙不应，应与十枣汤。以十枣大峻，降
用控涎丹。
甘遂（五钱） 大戟（五钱） 白芥子（五钱）
神曲糊丸梧子大，先服十三丸不知，渐加至二十一丸，以得快便下黑绿水为度，三服而
水下喘止，继以和胃收功。
汪 室女 伏暑夹痰饮，与三仁汤重加半夏、广皮，屡效而热不退。痰不除，右脉微结
，中
有块痰，堵塞隧道。因延郏芷谷兄针中泉穴，紫血出后，继咳老痰二口。以后用药无不见效
，半月后伏暑痰饮皆愈矣。
钱 三十二岁 甲子八月初十日 咳嗽胃中停水，与小青龙去麻辛，重加枳实、广皮五
帖，
已愈八九。因回母家为父祝寿，大开酒肉。其父亦时医也，性喜用人参，爱其女，遂用六君
子汤，服关东参数十帖。将近一年，胃中积水胀而且痛。又延其父治之，所用之药，大抵不
出守补中焦之外。治愈胀而愈痛，以致胸高不可以俯，夜坐不可以卧，已数日不食。其翁见
势已急，力辞其父，延余治之。余视其目欲努出，面色青黄，胸大胀痛不可忍，六脉弦急七
八至之多，余曰∶势急矣，断非缓药所能救。因服巴霜三分，下黑水将近一桶，势稍平，以
和脾胃药调之。三四日后渐平，胃大开，于是吃羊肉饺三十二枚，胃中大痛一昼夜。又用巴
霜一分五厘，下后痛止。严禁鱼肉，一月而安。
赵 四十六岁 正月三十日 太阳痹则腰脊痛，或左或右，风胜则引也。或喘或不喘者
，中
焦流饮，上泛则喘，不泛则不喘也。切戒猪肉生冷，与一切补药，周年可愈。六脉洪大已极
，石膏用少，万不见效，命且难保。
生石膏（六两） 云苓皮（五钱） 白通草（一钱） 桂枝（五钱） 半夏（五钱） 黄柏炭（二
钱） 杏仁（五钱） 小枳实（五钱） 生苡仁（五钱） 防己（四钱）
煮三杯，三次服。四帖。
二月初二日 于前方加∶
猪苓（三钱） 滑石（一两） 小枳实（三钱）
四帖。
初七日 于前方去黄柏炭，加∶
半夏（五钱） 桑皮（三钱） 石膏（四两）
二十七日 减石膏止留一两。
二十八日 石膏仍用四两，因拜扫停药六天。
二十九日 右脉洪大已减，右膏只用一两。
三月一日 石膏每日用二两。
十一日 石膏每日用一两，因感燥气，停药五天。
十二月十三日 石膏每日用二两，共服九帖。
十四日 石膏每日用三两，停药十天。
二十二至三十日、四月初一至初五日 自淮安复至绍兴，又诊得洪大之脉，较前已减七
八，
然较之平脉，仍大而有力。现下小便赤浊，阴痿，牙缝臭味复出。痹痛虽止，阳明太阳二经
湿热未净，太阴化气未复。
十五日 生石膏（四两） 杏仁（四钱） 云苓皮（五钱） 苡仁（五钱） 晚蚕砂（三钱） 海
金砂（五钱） 滑石（六钱） 木通（三钱）
四帖。
十九日 脉渐退，减石膏至二两，加∶
姜夏（五钱） 广皮（三钱）
二十至二十二日 每日用石膏一两。
二十三至二十六日 每日用石膏二两。
二十七日 小便不利。
杏仁（四钱） 云苓皮（五钱） 生苡仁（五钱） 海金砂（五钱） 木通（三钱） 飞滑石（六
钱） 姜半夏（五钱） 陈皮（三钱） 生石膏（四两）
四帖。
五月初一日 感风寒，服桂枝汤。
初四日 仍服前二十七日方。三帖。
内饮招外风为病。
桂枝（四钱） 广皮（三钱） 杏仁（三钱） 白芍（二钱） 枳实（五钱） 半夏（五钱） 炙甘
草（钱半） 干姜（一钱） 防己（三钱）
煮三杯，先服一杯，即啜稀热粥一碗，覆被令微汗即解，得汗后余药不必啜粥。四帖。
十一日 前因风寒夹饮之故，用小青龙法。现下风寒解而饮未除，脉复洪大，仍与大青
龙与木防己汤合法，兼治饮与痹也。
桂枝（六钱） 杏仁（四钱） 防己（四钱） 半夏（六钱） 广皮（三钱） 飞滑石（六钱） 云
苓皮（六钱） 木通（三钱） 小枳实（三钱） 生石膏（六钱）
八帖。
十四日 其人本有痹症痰饮，现下盛暑发泄，暑湿伤气，故四肢酸软少气，口中胶腻欲
呕，与局方消暑丸意。
云苓块（一两，连皮） 炙甘草（三钱） 姜夏（六钱） 鲜荷叶（一张去蒂） 姜汁（每杯三
匙）
煮三杯，三次服。三帖。（十九至二十三日停药）
二十四日 仍服十一日方，至六月初七日止，共服十一帖。
六月初八日 停药。
十八日 气急欲喘，新感暑湿之故，于原方加∶
广皮（二钱） 小枳实（二钱）
五帖。
二十二日 桂枝（四钱） 杏仁（四钱） 防己（四钱） 半夏（六钱） 广皮（三钱） 枳实（
三钱） 滑石（六钱） 云苓皮（六钱） 木通（三钱） 生石膏（六两）
四帖。
二十七日 于原方减石膏三两，加滑石六钱，共成一两二钱，木通二钱，共成五钱，蚕
砂三钱。
四帖。
July 21: Sheng Shi Gao (Raw Gypsum Fibrosum, 3 qian), Sheng Gan Cao (Raw Glycyrrhizae Radix et Rhizoma, 1 qian), Ban Xia (Pinelliae Rhizoma, 6 qian), Fu Ling Pi (Poria Peel, 6 qian), Xing Ren (Armeniacae Semen, 4 qian), Ku Jie Geng (Stemonae Radix, 4 qian).
August 4: The right Cun pulse is exclusively large. This indicates "Jin Shi Wu Sheng" (Phlegm-fluid obstructing the Lung Qi causing voice loss or hoarseness). The condition has improved but is not fully cured. Continue taking the previous prescription for three doses. In total, more than thirty doses were taken, amounting to over 300 liang of Gypsum.
Yan, 39 years old. May 2: All six pulses are wiry, thin, short, and choppy. Hematemesis has persisted for three years without healing, accompanied by phlegm-fluid cough and sweating at dawn (Wu Geng Han). The *Classic of Internal Difficulty* states that injury to Yang collaterals leads to blood overflowing upwards. It must be understood that collateral injury can be caused by both cold and heat; it is not that collaterals are only susceptible to Yang fire and immune to Cold water. Currently, physicians see bleeding and immediately use cooling herbs, or see bleeding and immediately nourish Yin. This is a stubborn malpractice among physicians. If this malpractice is not cured, how can one expect the patient's disease to heal? In this case, Yang Qi is on the verge of collapse, making repeated treatments difficult. I will tentatively prescribe based on the pulse and symptoms.
Ban Xia (Pinelliae Rhizoma, 6 qian), Gan Jiang Tan (Charred Dried Ginger, 3 qian), Wu Wei Zi (Schisandrae Fructus, 2 qian), Yun Ling (Poria, 5 qian), Xiao Zhi Shi (Immature Bitter Orange, 2 qian), Gui Zhi Mu (Cinnamomi Ramulus, 3 qian), Guang Pi Tan (Charred Citri Reticulatae Pericarpium, 3 qian), Jiao Bai Shao (Charred Paeoniae Radix Alba, 3 qian).
May 6: According to the patient, food intake has increased, but five-center heat (heat in palms, soles, and chest) remains as before. The pulse is harmonious and slow. For all diseases, sleep and diet are crucial; those who can eat thrive, leaving no room for modification of the formula. As for the afternoon fever, this is precisely the method of "Sweet-Warmness Removing Great Heat." Because the pulse is slightly harmonious, remove Gan Jiang Tan.
May 13: A total of ten doses have been taken previously. Sweating has stopped, appetite has increased, and hematemesis has ceased. The head feels empty; cough decreases after eating sweet foods, indicating deficiency of Middle Qi. Add Gan Cao (Glycyrrhizae Radix et Rhizoma, 3 qian) to tonify Middle Qi, and take four more doses because the pulse remains tight. In total, fourteen doses were taken, and various symptoms tend toward stability. However, the pulse remains wiry and tight. When coughing severely, there is an urge to vomit. Remove Wu Wei Zi from the original formula, reduce Gan Cao, and take four more doses.
May 21: All symptoms are gradually decreasing, and sputum is becoming thicker. Palpitations are severe. Add:
Zhi Shi (Immature Bitter Orange, 1 qian).
Four doses.
May 25: The pulse remains wiry and thin. Cough decreases daily. At night, Yang is weak, indicating Yin excess. Afternoon body heat has decreased, but after meals, there is a sensation of discomfort and fullness, with a feeling of water in the chest, which subsides shortly. Add to the original formula:
Gan Jiang (Dried Ginger, 1 qian), Zhi Shi (Immature Bitter Orange, 2 qian).
May 30: Sweating has stopped, cough has decreased, and five-center heat has also decreased. The pulse is wiry and rapid. Cough is severe at night. Taking hot herbs does not cause thirst, but drinking water still feels heavy. Patients with Phlegm-Fluid (Tan Yin) are difficult to treat in winter and summer.
Gui Zhi (Cinnamomi Ramulus, 3 qian), Ban Xia (Pinelliae Rhizoma, 6 qian), Zhi Shi (Immature Bitter Orange, 5 qian), Bai Shao (Paeoniae Radix Alba, 3 qian), Yun Ling Kuai (Poria, 5 qian), Yi Ren (Coicis Semen, 5 qian), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma, 1 qian), Gan Jiang (Dried Ginger, 1 qian), Wu Wei Zi (Schisandrae Fructus, 1.5 qian), Guang Pi Tan (Charred Citri Reticulatae Pericarpium, 3 qian).
June 4: Four doses of the previous formula have been taken. The pulse is wiry and tight but not rapid, and there is still no thirst. Add to the previous formula:
Gan Cao (Glycyrrhizae Radix et Rhizoma, 1.5 qian), Gan Jiang (Dried Ginger, 2 qian).
Take three more doses.
June 8: The pulse remains wiry and tight. Choking cough persists. The tongue coating is white and slippery. Add Gui Zhi (Cinnamomi Ramulus, 2 qian) and Gan Jiang (Dried Ginger, 2 qian).
June 12: The short and choppy quality of the pulse has receded, remaining wiry and thin. Phlegm-fluid is still heavy. Add Gui Zhi (Cinnamomi Ramulus, 2 qian), Gan Jiang (Dried Ginger, 2 qian), and Fu Ling (Poria, 3 qian) to resolve fluid retention.
June 17: Nighttime cough has stopped, which is a good sign. Daytime cough is decreasing, which is excellent. The left pulse is deep and thin; the right pulse is wiry and tight. Fluid retention is not yet fully eliminated, leading to generalized bone pain, a consequence of chronic illness. The ancients said, "For exhaustion, use warmth." Use Sweet-Warmness to harmonize Ying and Wei and restore Stomach Qi. When Qi is strong, appetite improves, and self-healing occurs over time. As symptoms decrease, reduce the intensity of treatment.
Gui Zhi (Cinnamomi Ramulus, 3 qian), Ban Xia (Pinelliae Rhizoma, 5 qian), Zhi Shi (Immature Bitter Orange, 5 qian), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma, 2 qian), Gan Jiang (Dried Ginger, 3 qian), Guang Pi (Citri Reticulatae Pericarpium, 3 qian), Wu Wei Zi (Schisandrae Fructus, 1.5 qian).
Prepare Juan Yin Wan (Phlegm-Fluid Resolving Pill). Since phlegm-fluid has accumulated for a long time, it cannot be removed suddenly. Since efficacy has been achieved, use pills for slow resolution. Avoid raw/cold foods and anger.
Gui Zhi (Cinnamomi Ramulus, half jin), Guang Pi (Citri Reticulatae Pericarpium, 12 liang), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus, 4 liang), Gan Jiang (Dried Ginger, 6 liang), Xiao Zhi Shi (Immature Bitter Orange, 4 liang), Cang Zhu Tan (Charred Atractylodis Rhizoma, 6 liang), Ban Xia (Pinelliae Rhizoma, 1 jin), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma, 6 liang), Yun Ling (Poria, 24 liang).
Make pills using Shen Qu paste, size of wutong seeds. Take three times daily, 3 qian per dose. If fluid retention is severe, take Xiao Qing Long Tang.
Chen, 51 years old. May 10: Not yet old, but has had impotence for many years. Experiences dizziness, vertigo, and confusion. Feels like oily food is stuck in the chest; drinking too much water causes stomach discomfort. This is a presentation of hidden phlegm-fluid causing vertigo. First, use Bai Zhu Ze Xie Tang (Atractylodis Macrocephalae and Alismatis Decoction) to drive out the fluid, then treat the damp-heat causing impotence with a slow approach. How can one use Shu Di Huang (Rehmanniae Radix Praeparata) and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) indiscriminately when all six pulses are wiry and thin?
Yu Zhu (Atractylodis Macrocephalae Rhizoma, 2 liang), Ze Xie (Alismatis Rhizoma, 2 liang).
Boil into three cups, divide into three doses.
May 13: Effective but not fully resolved. Continue the original formula for more than ten doses until cured.
Li, 48 years old. May 1: The person has always had phlegm-fluid, which flares up during winter when Water energy is strong. Later, due to latent summer-heat, dysentery developed. After dysentery, stools became loose. For many days, there was insomnia throughout the night. Sensations of cold, heat, hunger, and fullness were unknown. Bowel movements were blocked. Summer-heat must carry dampness, especially since phlegm-fluid was pre-existing. Fluid is transformed from damp-water. Physicians failed to recognize the disease, leading to this state of being bedridden for a long time. Discussing anorexia, lack of hunger, constipation, and insomnia, these nine orifices disharmonies belong to Stomach disease. Refer to the Ban Xia Tang in *Ling Shu* to induce sleep, then discuss further.
Jiang Ban Xia (Ginger-processed Pinelliae Rhizoma, 2 liang), Shu Mi (Sorghum Grain, 2 he).
Boil in fast-flowing water (8 cups) into three cups, divide into three doses. Stop when sleep is achieved.
May 11: Disharmony of all orifices. All six pulses are purely Yin. This is due to Phlegm-Yin being blocked by cloying tonifying herbs. Yesterday, Ban Xia Tang was used, resulting in sleep but not deep sleep. Take the previous formula for three more doses. Then use Xiao Qing Long Tang removing exterior-releasing herbs, adding Guang Pi and Zhi Shi to harmonize fluid. The current bright facial luster indicates Water (which governs brightness). The six pulses show Yin without Yang because fluid is a Yin pathogen. The left pulse is extremely wiry; the classics say a single wiry pulse indicates fluid. Each symptom has corresponding color and pulse characteristics. Why are physicians blind? What did they learn in their lives? Should they not die of shame?
Gui Zhi (Cinnamomi Ramulus, 5 qian), Jiang Ban Xia (Ginger-processed Pinelliae Rhizoma, 6 qian), Bai Shao (Paeoniae Radix Alba, 3 qian, stir-fried), Wu Wei Zi (Schisandrae Fructus, 2 qian), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma, 3 qian), Xiao Zhi Shi (Immature Bitter Orange, 5 qian), Gan Jiang (Dried Ginger, 2 qian), Guang Pi (Citri Reticulatae Pericarpium, 3 qian).
Boil Gan Lan Shui (Gently Stirred Water, 8 bowls) into three cups, divide into three doses.
May 18: The reason for Stomach disharmony is that Earth dislikes dampness and Yang is trapped. Yesterday, pure Yang and drying herbs were used to restore Stomach Yang. Today, the pulse is more vivid than before, indicating Stomach Yang is reviving. However, urine is white and turbid, meaning dampness has not yet circulated freely, so the Stomach is not yet harmonized. Apply the method of Opening Taiyang and Closing Yangming.
Ban Xia (Pinelliae Rhizoma, 2 liang), Zhu Ling (Polyporus, 6 qian), Hua Shi (Talcum, 3 qian), Shu Mi (Sorghum Grain, 1 he), Ze Xie (Alismatis Rhizoma, 6 qian), Bai Tong Cao (Akebiae Caulis, 1 qian), Guang Pi (Citri Reticulatae Pericarpium, 3 qian), Gui Zhi (Cinnamomi Ramulus, 4 qian), Yun Ling Pi (Poria Peel, 6 qian).
Boil in fast-flowing water (11 bowls), divided into two boils to make four bowls, divide into four doses.
June 3: Remove Hua Shi and Tong Cao. Add:
Chuan Jiao (Sichuan Pepper, 3 qian, stir-fried to remove sweat/oil).
Gao, 52 years old. Yiyi Year, May 16: Wiry pulse with phlegm-fluid, wheezing, and cough. Use Xiao Qing Long Tang removing Ma Huang and Xi Xin, add Guang Pi and Zhi Shi.
Gui Zhi (Cinnamomi Ramulus, 5 qian), Jiang Ban Xia (Ginger-processed Pinelliae Rhizoma, 6 qian), Bai Shao (Paeoniae Radix Alba, 3 qian), Guang Pi (Citri Reticulatae Pericarpium, 3 qian), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma, 3 qian), Xiao Zhi Shi (Immature Bitter Orange, 5 qian), Gan Jiang (Dried Ginger, 2 qian), Wu Wei Zi (Schisandrae Fructus, 2 qian).
Boil into three cups, divide into three doses. Two doses.
May 18: Small efficacy seen. Excessive sweating. Add:
Jing Ma Huang Gen (Ephedrae Herba Radix, 3 qian).
Three more doses.
As symptoms decrease, reduce the dosage. Remove:
Gui Zhi (Cinnamomi Ramulus) and Zhi Shi (Immature Bitter Orange) (2 qian each).
May 24: After taking the previous medicine, sweating is less. Only likes to sneeze. Generalized body ache. Reduce Gan Jiang by 1 qian in the original formula. Add:
Xing Ren (Armeniacae Semen) and Fang Ji (Stephaniae Tetrandrae Radix) (3 qian each).
Dong, 54 years old. May 27: Pulse is deep, thin, wiry, and weak. Cough worsens at night, persisting for a long time. This is fluid retention. Tonifying Yin is strictly contraindicated; doing so will lead to death. Fluid is a Yin pathogen, and the pulse is a Yin pulse. The classics say: "Do not tonify excess."
Gui Zhi (Cinnamomi Ramulus, 6 qian), Guang Pi (Citri Reticulatae Pericarpium, 3 qian, stir-fried), Bai Shao (Paeoniae Radix Alba, 4 qian), Ban Xia (Pinelliae Rhizoma, 5 qian), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma, 1 qian), Wu Wei Zi (Schisandrae Fructus, 1 qian), Gan Jiang (Dried Ginger, 3 qian), Xiao Zhi Shi (Immature Bitter Orange, 2 qian).
Four doses.
June 1: Add Yun Ling (Poria, 3 qian) and Xiao Zhi Shi (Immature Bitter Orange, 2 qian).
June 17: The person originally had phlegm-fluid wheezing and cough. After taking Xiao Qing Long Tang, appetite has opened. For several days, there has been alternating chills and fever in the afternoon. During the peak season of damp-heat, malaria is feared. Temporarily use herbs to circulate and unblock the San Jiao.
Xing Ren (Armeniacae Semen, 3 qian), Ban Xia (Pinelliae Rhizoma, 4 qian), Yun Ling Pi (Poria Peel, 5 qian), Bai Kou Ren (Amomi Fructus Rotundus, 1.5 qian), Zhi Shi (Immature Bitter Orange, 3 qian), Yi Ren (Coicis Semen, 5 qian), Guang Pi (Citri Reticulatae Pericarpium, 3 qian), Huo Geng (Agastaches Caulis, 3 qian), Qing Hao (Artemisiae Annuae Herba, 2 qian).
Two doses.
June 19: Chills and fever have stopped. Pulse is weak and minute. Remove Bai Kou Ren and Qing Hao. Add Gui Zhi and Gan Jiang to treat the cough.
June 22: Cough decreased, chills and fever stopped, appetite opened. Cough not fully resolved. Pulse is still fine and small. Efficacy observed, do not change the formula. Continue until cough ceases.
Zhou, 22 years old. Jan 7: Six pulses are wiry and tight. Right pulse is deep and洪大 (large and forceful). Treat according to the pattern of swelling above the waist. Tongue is white and slippery. Wheezing, cough, no sweat. Treat according to Yi Yin (Overflowing Fluid) pattern using Da Qing Long Tang, removing Gan Cao because the patient is heavy and stagnant.
Ma Huang (Ephedrae Herba, 6 qian, remove joints), Xi Xin (Asari Radix et Rhizoma, 2 qian), Sheng Jiang (Zingiberis Rhizoma Recens, 3 qian), Xing Ren (Armeniacae Semen, 5 qian, remove skin leave tip), Sheng Shi Gao Mo (Raw Gypsum Fibrosum Powder, 1 qian), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma, 2 qian), Gui Zhi (Cinnamomi Ramulus, 5 qian), Da Zao (Jujubae Fructus, 2 pieces, remove pits).
Boil into three cups. Take one cup first, cover with blanket for slight sweating. If sweating occurs, stop subsequent doses. If no sweating, take the second cup, following the same method.
Jan 11: Yi Yin, tight pulse, no sweat, wheezing, cough, edema. Yesterday, Da Qing Long Tang induced sweating, edema subsided, wheezing and cough decreased. Apply the method of Opening Taiyang and Closing Yangming.
Ban Xia (Pinelliae Rhizoma, 5 qian), Cang Zhu Tan (Charred Atractylodis Rhizoma, 2 qian), Gui Zhi (Cinnamomi Ramulus, 1.5 qian), Guang Pi (Citri Reticulatae Pericarpium, 3 qian), Zhu Ling (Polyporus, 3 qian), Fu Ling Kuai (Poria, 5 qian), Yi Ren (Coicis Semen, 5 qian), Ze Xie (Alismatis Rhizoma, 3 qian), Fei Hua Shi (Precipitated Talcum, 5 qian).
Boil into three cups, divide into three doses. After taking more than ten doses, add:
Yi Zhi Ren (Alpiniae Oxyphyllae Fructus, 2 qian), Lian Zi (Nelumbinis Semen, 5 qian).
Chen, 76 years old. Jan 10: Xuan Yin (Hanging Fluid) presents with wiry pulse. Discomfort in the left hypochondrium. This is water in the Liver pattern. Ten Zao Tang should be used. However, an elderly person near eighty may not tolerate the drug strength. Use a method to harmonize Liver and Stomach instead.
Ban Xia (Pinelliae Rhizoma, 5 qian), Qing Pi (Citri Reticulatae Pericarpium Viride, 3 qian), Xuan Fu Hua (Inulae Flos, 3 qian, wrap-boil), Guang Pi (Citri Reticulatae Pericarpium, 3 qian), Xiang Fu (Cyperi Rhizoma, 5 qian), Xiao Zhi Shi (Immature Bitter Orange, 3 qian), Dan Wu Yu (Evodiae Fructus, 3 qian).
Boil into three cups, divide into three doses. Taken for more than ten doses.
June 23: Knotted pulse. Add: Xing Ni (Apricot Kernel Paste, 6 qian).
Three doses.
Jueluo, 62 years old. Renxu Year, Jan 13: Wine drinker with phlegm-fluid asthma. Pulse is wiry, tight, and rapid. Urgently use Xiao Qing Long Tang removing Ma Huang and Xi Xin, adding Zhi Shi and Ju Pi. Did not respond. Severe pain in the right hypochondrium. This is Xuan Yin. Therefore, Xiao Qing Long Tang for Zhi Yin (Branch Fluid) did not work. Ten Zao Tang should be used. Since Ten Zao Tang is too harsh, downgrade to Kong Xian Dan.
Gan Sui (Kansui Radix, 5 qian), Da Ji (Euphorbiae Pekinensis Radix, 5 qian), Bai Jie Zi (Sinapis Semen, 5 qian).
Make pills using Shen Qu paste, size of wutong seeds. Start with 13 pills. If ineffective, gradually increase to 21 pills. Stop when rapid bowel movement with black-green water occurs. After three doses, water descends, wheezing stops. Follow with herbs to harmonize the Stomach to conclude treatment.
Ms. Wang: Latent summer-heat combined with phlegm-fluid. Used San Ren Tang heavily modified with Ban Xia and Guang Pi. Repeatedly effective but fever did not subside. Phlegm was not removed. Right pulse was slightly knotted. There was a mass of phlegm blocking the tunnels. Therefore, invited Brother Jia Zhigu to needle Zhong Quan acupoint. After purple blood emerged, two mouthfuls of old phlegm were coughed up. Subsequent medication was effective. After half a month, latent summer-heat and phlegm-fluid were both cured.
Qian, 32 years old. Jiazi Year, Aug 10: Cough with retained water in the Stomach. Used Xiao Qing Long Tang removing Ma Huang and Xi Xin, heavily adding Zhi Shi and Guang Pi for five doses. Cured by 80-90%. Returned to mother's home to celebrate father's birthday. Openly consumed alcohol and meat. Her father is also a contemporary physician, fond of using Ren Shen (Ginseng Radix). Loving his daughter, he prescribed Liu Jun Zi Tang (Six-Gentlemen Decoction) with Guan Dong Shen (Codonopsis Radix) for dozens of doses. Nearly a year later, water accumulated in the Stomach causing distension and pain. Hired her father again. Medications mostly focused on tonifying the Middle Jiao. Cured the distension but worsened the pain. Chest became elevated, unable to bend forward. Could not lie down at night, sat upright. Had not eaten for several days. Father-in-law saw the urgency, dismissed the father-doctor, and hired me. I observed eyes bulging, complexion greenish-yellow, unbearable chest distension and pain. Six pulses were wiry and rapid, 7-8 beats per breath. I said: The situation is urgent. Slow-acting drugs cannot save this. Administered Ba Shuang (Crotonis Fructus Extract) 3 fen. Passed nearly a bucket of black water. Situation stabilized. Harmonized Stomach and Spleen with appropriate herbs. Gradually stabilized after 3-4 days. Appetite opened. Ate 32 mutton dumplings. Severe stomach pain lasted a day and night. Administered Ba Shuang 1.5 fen. Pain stopped after passing stool. Strictly prohibited meat and fish. Recovered in one month.
Zhao, 46 years old. Jan 30: Taiyang Bi syndrome causes lower back and spine pain, left or right. Wind dominance causes牵引 (pulling/牵引). Wheezing or non-wheezing depends on fluid in the Middle Jiao. If fluid floats upward, there is wheezing; if not, no wheezing. Strictly avoid pork, raw/cold foods, and all tonifying herbs. Recovery expected in one year. Six pulses are extremely洪大 (large and forceful). If Shi Gao (Gypsum) is used in small amounts, it will definitely be ineffective, and life may be endangered.
Sheng Shi Gao (Raw Gypsum Fibrosum, 6 liang), Yun Ling Pi (Poria Peel, 5 qian), Bai Tong Cao (Akebiae Caulis, 1 qian), Gui Zhi (Cinnamomi Ramulus, 5 qian), Ban Xia (Pinelliae Rhizoma, 5 qian), Huang Bo Tan (Charred Phellodendri Cortex, 2 qian), Xing Ren (Armeniacae Semen, 5 qian), Xiao Zhi Shi (Immature Bitter Orange, 5 qian), Sheng Yi Ren (Raw Coicis Semen, 5 qian), Fang Ji (Stephaniae Tetrandrae Radix, 4 qian).
Boil into three cups, divide into three doses. Four doses.
Feb 2: Add to previous formula:
Zhu Ling (Polyporus, 3 qian), Hua Shi (Talcum, 1 liang), Xiao Zhi Shi (Immature Bitter Orange, 3 qian).
Four doses.
Feb 7: Remove Huang Bo Tan from previous formula. Add:
Ban Xia (Pinelliae Rhizoma, 5 qian), Sang Pi (Mori Cortex, 3 qian), Shi Gao (Gypsum Fibrosum, 4 liang).
Feb 27: Reduce Shi Gao to only 1 liang.
Feb 28: Shi Gao remains at 4 liang. Stopped medication for 6 days due to tomb-sweeping.
Feb 29: Right pulse洪大 (large and forceful) has decreased. Shi Gao used only 1 liang.
Mar 1: Shi Gao used 2 liang daily.
Mar 11: Shi Gao used 1 liang daily. Stopped medication for 5 days due to dryness qi invasion.
Dec 13: Shi Gao used 2 liang daily. Total 9 doses taken. (Note: Date likely refers to next year or subsequent period).
Dec 14: Shi Gao used 3 liang daily. Stopped medication for 10 days.
From Apr 22 to 30, and Apr 1 to 5: Traveled from Huai'an to Shaoxing. Diagnosed洪大 (large and forceful) pulse again, reduced by 70-80% compared to before, but still larger and stronger than normal pulse. Urine is red and turbid. Impotence. Bad breath from teeth gaps reappeared. Bi pain has stopped, but damp-heat in Yangming and Taiyang meridians is not cleared. Ta Yin transformation Qi has not recovered.
Apr 15: Sheng Shi Gao (Raw Gypsum Fibrosum, 4 liang), Xing Ren (Armeniacae Semen, 4 qian), Yun Ling Pi (Poria Peel, 5 qian), Yi Ren (Coicis Semen, 5 qian), Wan Can Sha (Bombyx Batryticatus, 3 qian), Hai Jin Sha (Lygodii Spora, 5 qian), Hua Shi (Talcum, 6 qian), Mu Tong (Akebiae Caulis, 3 qian).
Four doses.
Apr 19: Pulse gradually receding. Reduce Shi Gao to 2 liang. Add:
Jiang Xia (Ginger-processed Pinelliae Rhizoma, 5 qian), Guang Pi (Citri Reticulatae Pericarpium, 3 qian).
Apr 20-22: Shi Gao used 1 liang daily.
Apr 23-26: Shi Gao used 2 liang daily.
Apr 27: Difficult urination.
Xing Ren (Armeniacae Semen, 4 qian), Yun Ling Pi (Poria Peel, 5 qian), Sheng Yi Ren (Raw Coicis Semen, 5 qian), Hai Jin Sha (Lygodii Spora, 5 qian), Mu Tong (Akebiae Caulis, 3 qian), Fei Hua Shi (Precipitated Talcum, 6 qian), Jiang Ban Xia (Ginger-processed Pinelliae Rhizoma, 5 qian), Chen Pi (Citri Reticulatae Pericarpium, 3 qian), Sheng Shi Gao (Raw Gypsum Fibrosum, 4 liang).
Four doses.
May 1: Contracted wind-cold. Took Gui Zhi Tang.
May 4: Continued the formula from April 27. Three doses.
Internal fluid retention attracting external wind pathogen.
Gui Zhi (Cinnamomi Ramulus, 4 qian), Guang Pi (Citri Reticulatae Pericarpium, 3 qian), Xing Ren (Armeniacae Semen, 3 qian), Bai Shao (Paeoniae Radix Alba, 2 qian), Zhi Shi (Immature Bitter Orange, 5 qian), Ban Xia (Pinelliae Rhizoma, 5 qian), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma, 1.5 qian), Gan Jiang (Dried Ginger, 1 qian), Fang Ji (Stephaniae Tetrandrae Radix, 3 qian).
Boil into three cups. Take one cup first, then drink a bowl of hot thin porridge, cover with blanket for slight sweating to resolve. After sweating, do not drink porridge with remaining medicine. Four doses.
May 11: Previously due to wind-cold combining with fluid, used Xiao Qing Long method. Now wind-cold is resolved but fluid remains. Pulse is洪大 (large and forceful) again. Combine Da Qing Long Tang with Mu Fang Ji Tang to treat both fluid and Bi simultaneously.
Gui Zhi (Cinnamomi Ramulus, 6 qian), Xing Ren (Armeniacae Semen, 4 qian), Fang Ji (Stephaniae Tetrandrae Radix, 4 qian), Ban Xia (Pinelliae Rhizoma, 6 qian), Guang Pi (Citri Reticulatae Pericarpium, 3 qian), Fei Hua Shi (Precipitated Talcum, 6 qian), Yun Ling Pi (Poria Peel, 6 qian), Mu Tong (Akebiae Caulis, 3 qian), Xiao Zhi Shi (Immature Bitter Orange, 3 qian), Sheng Shi Gao (Raw Gypsum Fibrosum, 6 qian).
Eight doses.
May 14: Originally had Bi syndrome and phlegm-fluid. Now in midsummer, heat dissipates. Summer-dampness injures Qi, causing soreness and weakness in limbs, fatigue, sticky taste in mouth, and nausea. Follow the intent of Ju Fang Xiao Shu Wan.
Yun Ling Kuai (Poria, 1 liang, with peel), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma, 3 qian), Jiang Xia (Ginger-processed Pinelliae Rhizoma, 6 qian), Xian He Ye (Fresh Nelumbinis Folium, 1 piece, remove stem), Jiang Zhi (Ginger Juice, 3 spoons per cup).
Boil into three cups, divide into three doses. Three doses. (Stop medication from 19th to 23rd).
May 24: Continue the formula from May 11 until June 7. Total 11 doses.
June 8: Stop medication.
June 18: Shortness of breath, impending asthma. Due to new contraction of summer-dampness. Add to original formula:
Guang Pi (Citri Reticulatae Pericarpium, 2 qian), Xiao Zhi Shi (Immature Bitter Orange, 2 qian).
Five doses.
June 22: Gui Zhi (Cinnamomi Ramulus, 4 qian), Xing Ren (Armeniacae Semen, 4 qian), Fang Ji (Stephaniae Tetrandrae Radix, 4 qian), Ban Xia (Pinelliae Rhizoma, 6 qian), Guang Pi (Citri Reticulatae Pericarpium, 3 qian), Zhi Shi (Immature Bitter Orange, 3 qian), Hua Shi (Talcum, 6 qian), Yun Ling Pi (Poria Peel, 6 qian), Mu Tong (Akebiae Caulis, 3 qian), Sheng Shi Gao (Raw Gypsum Fibrosum, 6 liang).
Four doses.
June 27: Reduce Shi Gao by 3 liang from original formula. Add Hua Shi 6 qian, totaling 1.2 liang. Mu Tong 2 qian, totaling 5 qian. Can Sha (Bombyx Batryticatus) 3 qian.
Four doses.