六月二十九日 渴欲饮水，水入则吐者，名曰水逆，五苓散主之。
苍术（三钱，炒枯） 桂枝（三钱） 藿香（三钱） 云苓皮（六钱） 半夏（五钱） 猪苓（四
钱） 泽泻（四钱） 姜汁（每杯三匙）
三帖。
七月初二日 饮食有难化之象，于原方去苍术。加∶
广皮炭（四钱） 炒神曲（三钱） 益智仁（二钱） 小枳实（三钱）
通胃腑，醒脾阳。
二帖。
初七日 右脉洪数，六腑不和，食后恶心，二便不爽，暑湿所干之故，议通宣三焦。
生石膏（三两） 广皮（三钱） 滑石（六钱） 黄芩炭（三钱） 生姜（三钱） 益智仁（三钱）
姜半夏（五钱） 白蔻仁（钱半） 枳实（三钱） 茯苓皮（六钱） 生苡仁（五钱）
二帖。
初九日 加益智仁、枳实。
服一帖。
中焦停饮，晚食倒饱，是脾阳不伸之故，一以理脾阳立法。
姜半夏（五钱） 广皮（三钱） 川椒炭（八分） 煨草果（五分） 云苓皮（五钱） 益智仁（
钱半） 生苡仁（五钱） 白蔻仁（钱半） 小枳实（二钱）
煮三杯，三次服。二帖。
十七日 停饮兼痹，脉洪，向用石膏，无不见效。数日前因食后倒饱，脉不大，石膏已
近三
十斤之多，转用温醒脾阳方法，丝毫不应，水之蓄聚如故，跗肿不消，胃反不开，右脉复洪
大有力，小便短。思天下无肺者无溺，肺寒者溺短，热者溺亦短，仍用石膏凉肺胃。
生石膏（四两） 广皮（五钱） 杏仁（六钱） 半夏（五钱） 枳实（五钱） 云苓皮（五钱）
桂枝（三钱） 防己（四钱） 苡仁（五钱）
四帖。
二十一日 加云苓皮五钱，共成一两，杉木皮五钱，减石膏二两。
二十二日至二十四日 石膏用四两。
二十五日至二十八日 石膏用二两。
共服八帖。
二十九日 饮聚不行，小便已清，少时即便臭浊，六腑之不退可知，大药已用不少，而
犹然如是，病机之顽钝，又可知矣。议暂用重剂，余有原案。
生石膏（四两） 枳实（五钱） 杏仁（八钱） 飞滑石（一两先煎） 防己（三钱） 半夏（八
钱） 云苓皮（八钱） 广皮（四钱） 海金砂（八钱）
八月初一日
初二日 加石膏二两。
初七日 又加石膏二两。
初十日 减广皮四钱，枳实二钱。
以上共服七帖。
九月初四日 脉之洪大不减，加∶
石膏（二两）
至二十七日，共服二十帖。
服石膏至五十斤之多，而脉犹浮洪，千古未有如是之顽病。皆误下伤正于前，误补留邪
于后之累。今日去补阳明药，盖阳明之脉大也。
生石膏（八两） 杏仁（一两） 云苓皮（一两） 飞滑石（二两） 防己（五钱） 小枳实（五
钱） 木通（三钱）
煮四杯，四次服，专以苦淡行水，服一二帖再商。
初九日 生石膏四两，共成十二两。
九帖。
十三日 脉洪滑，痰饮未除，晨起微喘，足跗肿未消尽，余有原案。
生石膏（八两） 云苓皮（六钱） 杏仁（四钱） 滑石（一两） 葶苈子（三钱） 木通（四钱）
生苡仁（六钱） 半夏（六钱）
十五日 气已不急，去葶苈；右脉仍浮洪，加石膏一倍，成一斤。
三帖。
十六日 气急者得葶苈而止，右脉之洪大者，得石膏一斤大减，病减者减其制，但仍滑
数，加行痰饮。
生石膏（六两） 枳实（三钱） 杏仁（四钱） 云苓皮（五钱） 半夏（一两） 香附（五钱）
广皮（四钱） 旋复花（四钱，包）
二帖。
十八日 脉渐小，减∶
石膏（二两）
二帖。
二十日 脉洪数，加石膏八两，成十二两。
二帖。
二十二日 脉减，减石膏六两，加∶
葶苈（一钱五分）
二帖。
二十三日至二十五日 共服二帖。
脉之洪大者，得石膏一斤大减，病减者减其制，脉复洪大有力，再酌加其制。
生石膏（十二两） 枳实（五钱） 杏仁（四钱） 云苓皮（五钱） 半夏（一两） 香附（五钱）
广皮（四钱） 旋复花（四钱，包）
二十九日 小便短，加∶
滑石（一两）
十月初一日 停药三日。
初四日 气喘，于原方加石膏四两，共成一斤。杏仁四钱，共成八钱。广皮二钱，共成
六钱。加∶
桂枝（六钱） 生姜（四钱）
五帖。
初二日服妙应丸二分六厘，大枣三枚，煎汤下，清晨服后，约二刻先从左胁作响，坠痛
至少腹便下绿水胶痰碗许。
初三日服妙应丸二分六厘，大枣二枚，煎汤下，便痰水如前，汤药未服。
妙应丸方，《金匮》谓凡病至其年月日时复发者，当下之。此症痰饮兼痹，自正月服药
至十
月，石膏将近百斤之多，虽无不见效，究未拔除病根。左胁间漉漉有声，不时呕咳，此水在
肝也。《金匮》谓水在肝，十枣汤主之；又谓偏弦饮 ；又谓咳家之脉弦为有水，十枣汤主
之；又谓咳家一百日，至一岁不死者，十枣汤主之。合而观之，此症当用十枣无疑。但十枣
太峻，南人胆怯，未敢骤用，降用妙应丸续续下之，庶无差忒也。
制甘遂（五钱） 白芥子（五钱） 制大戟（五钱）
神曲为丸，小梧子大，从三十丸明起得下痰水即止。停数日水不尽再服，以尽为度，初
四至初七，共服五帖。
初八日 石膏（一斤） 飞滑石（一两） 苏子霜（二钱） 旋复花（四钱） 云苓皮（六钱）
广皮（三钱） 小枳实（五钱） 半夏（一两） 杏仁（八钱）
三帖。
十一日 服妙应丸三分。
十二日 脉仍洪大有力。
生石膏（八两） 杏仁（四钱） 半夏（六钱） 云苓皮（六钱） 广皮（三钱） 香附（三钱）
旋复花（四钱） 苡仁（六钱）
一帖。
十三日 杏仁（八钱） 半夏（一两） 广皮（四钱） 云苓皮（五钱） 小枳实（五钱） 香附
（三钱） 旋复花（四钱） 滑石（一两） 苏子霜（二钱） 桂枝（六钱） 生石膏（一斤）
二十二至二十九日 去香附，加苏子霜。
五帖。
服妙应丸三分四厘，服之即下痰水。
十一月初四日 服妙应丸三分八厘，下痰水如前。
右脉洪数，本有饮聚，小便不长。
生石膏（一斤） 苡仁（六钱） 云苓皮（六钱） 小枳实（四钱） 半夏（六钱） 杏泥（六钱）
飞滑石（一两） 白通草（二钱） 蚕砂（三钱）
煮三杯，三次服。
初六日 服妙应丸三分八厘，下痰水如前。
十二日 于前方加∶
广皮（三钱） 石膏（八两）
十三日 加枳实（二钱） 旋复花（四钱，绢包）
补十一日 于前方加∶
郁金（三钱）
十四日 加苏子霜（四钱）
共服五帖。
十五日 服妙应丸六分，自服丸药，每次皆下痰水，惟此次未下，以服药后即食粥故也
。
二十三日 服妙应丸六分，大便仍行痰水。
十一月十七日 痰饮喘咳，右脉洪，左关独浮，与建金制木法。
生石膏（八两） 青皮（三钱） 杏仁（六钱） 旋复花（四钱） 苏子霜（三钱） 香附（四钱）
半夏（六钱）
十八至二十六，共服五帖。
二十七日 洪大之脉已退，惟两关独浮，右大于左而兼实，木陷入土。与两和肝胃，兼
开膀胱，小便短而水易停故也。
半夏（六钱） 苏子霜（三钱） 香附（三钱） 白芍（四钱，酒炒） 旋复花（三钱） 滑石（
一两） 青皮（二钱） 云苓皮（六钱） 广皮（三钱）
十二月初一日 数日不服石膏，右脉复洪数，左关之独浮者，亦未十厘清净。与金木同
治法。
生石膏（六两） 半夏（六钱） 杏仁（六钱） 滑石（一两） 香附（四钱） 旋复花（四钱）
云苓皮（六钱） 枳实（六钱）
以后凡右脉大者，服此小即停止。
初三日 服妙应丸六分，下痰水如前。
仍服初一日原方。
二帖。
初五日 于初一日方内加桂枝五钱，广皮四钱，至初九日止，以畏寒故也。
初十日 服妙应丸八分，下痰水如前。
十一日 于前方去桂枝、广皮，脉不肯小故也，服至十五日止。
十六日 服妙应丸一钱。
丙戌正月十四日 《金匮》谓心下坚大如盘，水饮所作，枳术丸主之。兹虽不坚大而水
停不
去，病情相合，再脉洪大，洪大甚则喘发，最宜服石膏、杏仁。但石膏不可入丸方，议用橘
半枳术丸，脉小时用开水下，脉大时暂用石膏汤送下，喘发加杏仁，脉复小，不用石膏。
鹅眼小枳实（一斤） 茅山苍（一斤，炒半枯） 广皮炭（六两） 姜半夏（十两）
神曲汤法丸梧子大，每服三钱，日三服，夏日间服消暑丸亦可。
陈 四十六岁 病由疟邪伤胃，土虚则水泛，以致喘而肢软，正虚邪实，六脉俱结，且
有块痰，塞滞经脉隧道。病有三虚一实者，先治其实，后治其虚。
杏泥 广皮（三钱） 枳实（四钱） 云苓 姜半夏（六钱） 苏子霜（二钱）
甘澜水八碗。煮成三碗。分早中晚服。二帖。
初六日 脊病，痹也。右腿偏软，痿也。咳嗽而喘，支饮射肺也。日久不愈，皆误用熟
地等补塞隧道之故。脉洪。
生石膏末（一两） 杏泥（五钱） 桂枝（五钱） 防己（四钱） 片姜黄（三钱） 姜半夏（五
钱） 广皮炭（三钱） 茯苓皮（五钱） 苡仁（五钱）
煮四碗四次服。二帖退石膏一两，加赤苓一两，再二帖后加石膏一两，青橘叶五钱。
二月初二日 痹夹痰饮，与开痹蠲饮法，现下痹解而饮未除，脉之洪大者减，病减者减
其制。
姜半夏（五钱） 桂枝（五钱） 防己（三钱） 广皮（三钱） 茯苓块（六钱） 苡仁（五钱）
小枳实（三钱） 青橘叶（三钱）
煮三杯，三次服。
初八日 加小枳实（二钱） 广皮（二钱） 滑石（六钱）
初九日 加生石膏（一两）
十一日 肝郁夹痰饮，咳嗽痰多，吐瘀。
旋复花（三钱） 姜半夏（六钱） 青皮（二钱） 广皮炭（二钱） 栝蒌仁（二钱） 苏子霜（
三钱） 降香末（三钱） 归横须（二钱） 桃仁泥（二钱） 青橘叶（三钱）
煮三杯，三次服。
丸方 痰饮夹肝郁，吐出瘀血后，以两和肝胃为主。
带皮苓（八两） 姜半夏（十两） 香附（六两） 广郁金（二两） 广皮（五两） 益智（四两）
生苡仁（八两） 泽泻（八两）
共为极细末，神曲水为丸，梧子大，日三服，每服三钱，开水下。
二月初五日 暑湿行令，脉弦细，胃不开，渴而小便短，用渴者与猪苓汤法。
猪苓（五钱） 云苓块（四钱） 泽泻（五钱） 半夏（四钱） 滑石（六钱） 广皮（三钱） 益
智仁（钱半）
煮三杯，三次服，胃开即止。
初六日 痰饮之质，冒暑欲呕，六脉俱弦，虽渴甚，难用寒凉，与局方消暑丸法。
姜半夏（八钱） 云苓块（八钱） 藿梗（二钱） 广皮（三钱） 生甘草（二钱） 生姜汁（每
杯冲三小匙）
煮三杯，三次服。
初八日 病减者减其制，减∶
半夏（四钱） 云苓（四钱）
十二日 腰以下肿，当利小便。渴而小便短，议渴者与猪苓汤例。
猪苓（八钱） 泽泻（八钱） 飞滑石（一两二钱） 云苓皮（六钱） 姜半夏（四钱）
煮三杯，三次服，以渴减肿消为度。
十四日 脉沉细，胃不开，减，猪苓（三钱） 泽泻（三钱） 滑石（六钱） 加藿梗（三钱）
广皮（三钱） 益智仁（三钱）
十六日 暑湿病退，小便已长，阳气不振，与通补阳气。
桂枝（三钱） 姜半夏（三钱） 茅术（二钱） 白蔻仁（一钱，研） 云苓块（五钱） 生苡仁
（五钱） 广皮（二钱） 炙甘草（二钱）
煮三杯，三次服。
十七日 头胀胸闷，脉缓气歉，暑必夹湿也。
半叶藿梗（三钱） 白蔻仁（钱半） 姜半夏（三钱） 云苓皮（五钱） 广皮（三钱） 苡仁（
五钱） 杏仁（三钱）
煮三杯，三次服。
十九日 小便浊，加∶
猪苓（四钱） 泽泻（四钱）
二十四日 暑月头胀微痛，与清上焦。
藿香（三钱） 薄荷（一钱） 鲜荷叶（一张，去蒂）
煮三杯，三次服。
二十五日 六脉阳微，暑湿之余，小便白浊，与分利法。
川萆 （五钱） 泽泻（三钱） 云苓皮（五钱） 桂枝（三钱） 苍术（三钱，炒） 益智仁（
三钱） 猪苓（三钱） 生苡仁（五钱）
煮三杯，三次服，以小便清为度。
七月十九日 湿热为病，与苦辛淡法。
云苓皮（五钱） 姜半夏（五钱） 飞滑石（六钱） 猪苓（三钱） 木通（三钱） 泽泻（三钱）
苡仁（五钱） 桂枝（三钱） 杏泥（三钱）
煮三杯，三次服。
二十二日 湿热为病，与苦辛淡法，小便已长，胃不甚开，与阖阳明。
姜半夏（六钱） 益智仁（三钱） 广皮（三钱） 云苓皮（五钱） 苡仁（五钱） 生姜（三钱）
二十五日 加白蔻仁（三钱） 枳实（三钱）
九月二十一日 痰饮喘咳脉弦，与小青龙法。
June 29th Thirsty and desiring to drink water, but vomiting immediately after swallowing, this condition is named "Water Reversal" (Shui Ni), treated primarily with Wuling San (Five-Ingredient Poria Decoction).
Cangzhu (Atractylodis Rhizoma, 3 qian, stir-fried until charred) Guizhi (Cinnamomi Ramulus, 3 qian) Huoxiang (Agastachis Herba, 3 qian) Yunlingpi (Poria Cocos Sclerotium Exocarpium, 6 qian) Banxia (Pinelliae Tuber, 5 qian) Zhuling (Polypori Umbellati, 4 qian) Zexie (Alismatis Rhizoma, 4 qian) Jiangzhi (Zingiberis Recens Juice, 3 spoons per cup)
Three doses.
July 2nd Signs of difficulty in digesting food; remove Cangzhu from the original prescription. Add:
Guangpi Tan (Citri Reticulatae Pericarpium Carbonisatum, 4 qian) Chao Shenqu (Massae Fermentatae Medicinalis, 3 qian) Yizhiren (Alpiniae Oxyphyllae Semen, 2 qian) Xiao Zhishi (Aurantii Fructus Immaturus, 3 qian)
To unblock the Fu-organs of the Stomach and awaken the Spleen Yang.
Two doses.
7th The right pulse is surging and rapid; the six Fu-organs are out of harmony. Nausea after eating, and discomfort in urination and defecation, caused by the interference of Summerheat-Dampness. Proposal: Unblock and diffuse the Triple Burner.
Sheng Shigao (Gypsum Fibrosum, 3 liang) Guangpi (Citri Reticulatae Pericarpium, 3 qian) Huashi (Talcum, 6 qian) Huangqin Tan (Scutellariae Radix Carbonisatum, 3 qian) Shengjiang (Zingiberis Recens Rhizoma, 3 qian) Yizhiren (Alpiniae Oxyphyllae Semen, 3 qian)
Jiang Banxia (Pinelliae Tuber prepared with Ginger, 5 qian) Baikouren (Amomi Fructus Rotundus, 1.5 qian) Zhishi (Aurantii Fructus Immaturus, 3 qian) Fulingpi (Poria Cocos Sclerotium Exocarpium, 6 qian) Sheng Yiren (Coicis Semen, 5 qian)
Two doses.
9th Add Yizhiren, Zhishi.
Take one dose.
Fluid retention in the Middle Jiao, feeling full and bloated after evening meals, is due to the inability of Spleen Yang to extend. Treatment is based solely on regulating Spleen Yang.
Jiang Banxia (Pinelliae Tuber prepared with Ginger, 5 qian) Guangpi (Citri Reticulatae Pericarpium, 3 qian) Chuanjiao Tan (Zanthoxyli Pericarpium Carbonisatum, 8 fen) Wei Caoguo (Tsao-ko Fruit, roasted, 5 fen) Yunlingpi (Poria Cocos Sclerotium Exocarpium, 5 qian) Yizhiren (Alpiniae Oxyphyllae Semen, 1.5 qian) Sheng Yiren (Coicis Semen, 5 qian) Baikouren (Amomi Fructus Rotundus, 1.5 qian) Xiao Zhishi (Aurantii Fructus Immaturus, 2 qian)
Boil to yield three cups, take in three divided doses. Two doses.
17th Fluid retention complicated by Bi-syndrome (obstruction), pulse is surging. Previously using Shigao has always been effective. A few days ago, due to postprandial bloating, the pulse was not large; nearly thirty jin of Shigao had already been used. Switched to warming and awakening Spleen Yang methods, but with no effect at all. Water accumulation remains as before, edema of the dorsum of the foot does not subside, stomach qi reverses and fails to descend, right pulse becomes surging, large, and forceful again, urine is scant. I consider that there is no case where Lung involvement does not affect urination. Lung cold causes scant urine, Lung heat also causes scant urine. Still use Shigao to cool the Lung and Stomach.
Sheng Shigao (Gypsum Fibrosum, 4 liang) Guangpi (Citri Reticulatae Pericarpium, 5 qian) Xingren (Armeniacae Semen Amarum, 6 qian) Banxia (Pinelliae Tuber, 5 qian) Zhishi (Aurantii Fructus Immaturus, 5 qian) Yunlingpi (Poria Cocos Sclerotium Exocarpium, 5 qian)
Guizhi (Cinnamomi Ramulus, 3 qian) Fangji (Stephaniae Tetrandrae Radix, 4 qian) Yiren (Coicis Semen, 5 qian)
Four doses.
21st Add Yunlingpi 5 qian, totaling 1 liang. Shanmupi (Schisandrae Chinensis Fructus? Note: Context suggests a diuretic bark, likely Schisandra or similar, literal translation: Tree Bark) 5 qian. Reduce Shigao by 2 liang.
From 22nd to 24th, Shigao dosage is 4 liang.
From 25th to 28th, Shigao dosage is 2 liang.
Total eight doses taken.
29th Fluid accumulation persists, urine clears initially but becomes turbid and foul shortly after, indicating the pathogens in the six Fu-organs have not retreated. Heavy medicines have been used extensively, yet the condition remains thus, revealing the stubborn and sluggish nature of the disease mechanism. Proposal: Temporarily use heavy doses. See original case for details.
Sheng Shigao (Gypsum Fibrosum, 4 liang) Zhishi (Aurantii Fructus Immaturus, 5 qian) Xingren (Armeniacae Semen Amarum, 8 qian) Fei Huashi (Talcum, 1 liang, decoct first) Fangji (Stephaniae Tetrandrae Radix, 3 qian) Banxia (Pinelliae Tuber, 8 qian) Yunlingpi (Poria Cocos Sclerotium Exocarpium, 8 qian) Guangpi (Citri Reticulatae Pericarpium, 4 qian) Haijinsha (Lygodii Spora, 8 qian)
August 1st
2nd Add Shigao 2 liang.
7th Add another Shigao 2 liang.
10th Reduce Guangpi by 4 qian, Zhishi by 2 qian.
Total seven doses taken above.
September 4th Pulse remains surging and large without reduction. Add:
Shigao (Gypsum Fibrosum, 2 liang)
By the 27th, total twenty doses taken.
Consumed up to fifty jin of Shigao, yet the pulse remains floating and surging. Such a stubborn disease is unprecedented in history. This is the cumulative result of prior mistaken purgative treatments damaging healthy Qi, and subsequent mistaken tonic treatments retaining pathogens. Today, remove tonifying herbs for the Yangming channel, as the Yangming pulse is naturally large.
Sheng Shigao (Gypsum Fibrosum, 8 liang) Xingren (Armeniacae Semen Amarum, 1 liang) Yunlingpi (Poria Cocos Sclerotium Exocarpium, 1 liang) Fei Huashi (Talcum, 2 liang) Fangji (Stephaniae Tetrandrae Radix, 5 qian) Xiao Zhishi (Aurantii Fructus Immaturus, 5 qian) Mutong (Akebiae Caulis, 3 qian)
Boil to yield four cups, take in four divided doses. Specifically use bitter and bland methods to promote water metabolism. Take one or two doses, then re-evaluate.
9th Sheng Shigao 4 liang, totaling 12 liang.
Nine doses.
13th Pulse is surging and slippery. Phlegm-fluid retention not eliminated. Mild wheezing upon waking in the morning. Edema of the dorsum of the foot not fully resolved. See original case.
Sheng Shigao (Gypsum Fibrosum, 8 liang) Yunlingpi (Poria Cocos Sclerotium Exocarpium, 6 qian) Xingren (Armeniacae Semen Amarum, 4 qian) Huashi (Talcum, 1 liang) Tinglizi (Descurainiae Semen Lepidii seu Sisymbrii, 3 qian) Mutong (Akebiae Caulis, 4 qian)
Sheng Yiren (Coicis Semen, 6 qian) Banxia (Pinelliae Tuber, 6 qian)
15th Shortness of breath has eased. Remove Tinglizi. Right pulse remains floating and surging. Double the dosage of Shigao to reach 1 jin.
Three doses.
16th Shortness of breath stopped with Tinglizi. Surging and large right pulse significantly reduced with 1 jin of Shigao. As the illness lessens, reduce the dosage. However, the pulse remains slippery and rapid. Add herbs to move phlegm-fluid.
Sheng Shigao (Gypsum Fibrosum, 6 liang) Zhishi (Aurantii Fructus Immaturus, 3 qian) Xingren (Armeniacae Semen Amarum, 4 qian) Yunlingpi (Poria Cocos Sclerotium Exocarpium, 5 qian) Banxia (Pinelliae Tuber, 1 liang) Xiangfu (Cyperi Rhizoma, 5 qian)
Guangpi (Citri Reticulatae Pericarpium, 4 qian) Xuanfuhua (Inulae Flos, 4 qian, wrapped)
Two doses.
18th Pulse gradually becomes smaller. Reduce:
Shigao (Gypsum Fibrosum, 2 liang)
Two doses.
20th Pulse is surging and rapid. Add Shigao 8 liang, totaling 12 liang.
Two doses.
22nd Pulse weakens. Reduce Shigao by 6 liang. Add:
Tingli (Descurainiae Semen Lepidii seu Sisymbrii, 1.5 qian)
Two doses.
23rd to 25th Total two doses taken.
The surging and large pulse significantly reduced with 1 jin of Shigao. As the illness lessens, reduce the dosage. The pulse returns to surging, large, and forceful. Re-evaluate and increase the dosage.
Sheng Shigao (Gypsum Fibrosum, 12 liang) Zhishi (Aurantii Fructus Immaturus, 5 qian) Xingren (Armeniacae Semen Amarum, 4 qian) Yunlingpi (Poria Cocos Sclerotium Exocarpium, 5 qian) Banxia (Pinelliae Tuber, 1 liang) Xiangfu (Cyperi Rhizoma, 5 qian)
Guangpi (Citri Reticulatae Pericarpium, 4 qian) Xuanfuhua (Inulae Flos, 4 qian, wrapped)
29th Urine is scant. Add:
Huashi (Talcum, 1 liang)
October 1st Stop medication for three days.
4th Wheezing. Add Shigao 4 liang to the original formula, totaling 1 jin. Xingren 4 qian, totaling 8 qian. Guangpi 2 qian, totaling 6 qian. Add:
Guizhi (Cinnamomi Ramulus, 6 qian) Shengjiang (Zingiberis Recens Rhizoma, 4 qian)
Five doses.
2nd Take Miaoying Wan (Wonderful Response Pill) 2.6 li, with three red dates, decocted in soup for administration. After taking it early in the morning, about half an hour later, rumbling sounds arise from the left hypochondrium, pain drops to the lower abdomen, and approximately one bowl of green watery gelatinous phlegm is passed.
3rd Take Miaoying Wan 2.6 li, with two red dates, decocted in soup for administration. Passage of phlegm-water as before. Decoction medicine not taken.
Miaoying Wan formula: *Jingui Yaolue* states that for any disease recurring at specific years, months, days, or times, purgation should be used. This case involves phlegm-fluid retention complicated by Bi-syndrome. From January to October, nearly 100 jin of Shigao were used. Although effective each time, the root cause was not eradicated. Rumbling sounds in the left hypochondrium, frequent vomiting and coughing indicate water in the Liver. *Jingui Yaolue* states: Water in the Liver is treated with Shizao Tang (Ten-Date Decoction); it also states: Oblique string-like pulse indicates fluid retention; it also states: For patients with chronic cough, a string-like pulse indicates water, treated with Shizao Tang; it also states: For chronic cough lasting 100 days to a year without death, Shizao Tang is indicated. Synthesizing these, this case undoubtedly requires Shizao Tang. However, Shizao Tang is too harsh. Southerners are timid and dare not use it abruptly. Downgrade to Miaoying Wan for gradual purgation to avoid error.
Zhi Gansui (Euphorbiae Pekinensis Radix processed, 5 qian) Baijiezi (Brassicae Semenis Albi, 5 qian) Zhi Daji (Kadsurae Radix processed, 5 qian)
Make pills with Shenqu (Massa Medicata Fermentata), size of wu-tzu seeds. Start from 30 pills. Stop once phlegm-water is passed. If water is not exhausted after stopping for a few days, resume. Continue until exhausted. From 4th to 7th, total five doses taken.
8th Shigao (1 jin) Fei Huashi (Talcum, 1 liang) Suzishuang (Perillae Fructus Frost, 2 qian) Xuanfuhua (Inulae Flos, 4 qian) Yunlingpi (Poria Cocos Sclerotium Exocarpium, 6 qian)
Guangpi (Citri Reticulatae Pericarpium, 3 qian) Xiao Zhishi (Aurantii Fructus Immaturus, 5 qian) Banxia (Pinelliae Tuber, 1 liang) Xingren (Armeniacae Semen Amarum, 8 qian)
Three doses.
11th Take Miaoying Wan 3 fen.
12th Pulse remains surging, large, and forceful.
Sheng Shigao (Gypsum Fibrosum, 8 liang) Xingren (Armeniacae Semen Amarum, 4 qian) Banxia (Pinelliae Tuber, 6 qian) Yunlingpi (Poria Cocos Sclerotium Exocarpium, 6 qian) Guangpi (Citri Reticulatae Pericarpium, 3 qian) Xiangfu (Cyperi Rhizoma, 3 qian)
Xuanfuhua (Inulae Flos, 4 qian) Yiren (Coicis Semen, 6 qian)
One dose.
13th Xingren (Armeniacae Semen Amarum, 8 qian) Banxia (Pinelliae Tuber, 1 liang) Guangpi (Citri Reticulatae Pericarpium, 4 qian) Yunlingpi (Poria Cocos Sclerotium Exocarpium, 5 qian) Xiao Zhishi (Aurantii Fructus Immaturus, 5 qian) Xiangfu (Cyperi Rhizoma, 3 qian) Xuanfuhua (Inulae Flos, 4 qian) Huashi (Talcum, 1 liang) Suzishuang (Perillae Fructus Frost, 2 qian) Guizhi (Cinnamomi Ramulus, 6 qian) Sheng Shigao (Gypsum Fibrosum, 1 jin)
22nd to 29th Remove Xiangfu, add Suzishuang.
Five doses.
Take Miaoying Wan 3.4 li. Phlegm-water is passed immediately after ingestion.
November 4th Take Miaoying Wan 3.8 li. Phlegm-water passed as before.
Right pulse is surging and rapid. Originally there was fluid retention. Urine output is insufficient.
Sheng Shigao (Gypsum Fibrosum, 1 jin) Yiren (Coicis Semen, 6 qian) Yunlingpi (Poria Cocos Sclerotium Exocarpium, 6 qian) Xiao Zhishi (Aurantii Fructus Immaturus, 4 qian) Banxia (Pinelliae Tuber, 6 qian) Xingni (Armeniacae Semen Paste, 6 qian)
Fei Huashi (Talcum, 1 liang) Baitongcao (Tetrapanacis Medulla, 2 qian) Can Sha (Bombyx Batryticatus, 3 qian)
Boil to yield three cups, take in three divided doses.
6th Take Miaoying Wan 3.8 li. Phlegm-water passed as before.
12th Add to previous formula:
Guangpi (Citri Reticulatae Pericarpium, 3 qian) Shigao (Gypsum Fibrosum, 8 liang)
13th Add Zhishi (2 qian) Xuanfuhua (4 qian, wrapped in silk)
Supplement 11th Add to previous formula:
Yujin (Curcumae Longae Radix, 3 qian)
14th Add Suzishuang (4 qian)
Total five doses taken.
15th Take Miaoying Wan 6 fen. Since taking the pill medicine, phlegm-water is passed every time. This time it was not passed because porridge was eaten immediately after taking the medicine.
23rd Take Miaoying Wan 6 fen. Defecation still passes phlegm-water.
November 17th Phlegm-fluid retention with wheezing and coughing. Right pulse is surging. Left Guan pulse alone is floating. Apply method of strengthening Metal to control Wood.
Sheng Shigao (Gypsum Fibrosum, 8 liang) Qingpi (Citri Reticulatae Pericarpium Viride, 3 qian) Xingren (Armeniacae Semen Amarum, 6 qian) Xuanfuhua (Inulae Flos, 4 qian) Suzishuang (Perillae Fructus Frost, 3 qian) Xiangfu (Cyperi Rhizoma, 4 qian)
Banxia (Pinelliae Tuber, 6 qian)
18th to 26th Total five doses taken.
27th Surging and large pulse has receded. Only both Guan pulses are floating. Right pulse is larger than left and accompanied by excess. Wood has sunk into Earth. Apply method of harmonizing Liver and Stomach, and simultaneously opening the Bladder. Urine is scant, so water easily accumulates.
Banxia (Pinelliae Tuber, 6 qian) Suzishuang (Perillae Fructus Frost, 3 qian) Xiangfu (Cyperi Rhizoma, 3 qian) Baishao (Paeoniae Radix Alba, 4 qian, wine-fried) Xuanfuhua (Inulae Flos, 3 qian) Huashi (Talcum, 1 liang)
Qingpi (Citri Reticulatae Pericarpium Viride, 2 qian) Yunlingpi (Poria Cocos Sclerotium Exocarpium, 6 qian) Guangpi (Citri Reticulatae Pericarpium, 3 qian)
December 1st After several days without Shigao, right pulse returns to surging and rapid. Left Guan floating pulse is not yet completely clear. Apply method of treating Metal and Wood together.
Sheng Shigao (Gypsum Fibrosum, 6 liang) Banxia (Pinelliae Tuber, 6 qian) Xingren (Armeniacae Semen Amarum, 6 qian) Huashi (Talcum, 1 liang) Xiangfu (Cyperi Rhizoma, 4 qian) Xuanfuhua (Inulae Flos, 4 qian)
Yunlingpi (Poria Cocos Sclerotium Exocarpium, 6 qian) Zhishi (Aurantii Fructus Immaturus, 6 qian)
Thereafter, whenever the right pulse is large, stop this formula once the pulse becomes small.
3rd Take Miaoying Wan 6 fen. Phlegm-water passed as before.
Continue taking the original formula from the 1st.
Two doses.
5th Add Guizhi 5 qian, Guangpi 4 qian to the formula from the 1st. Until the 9th, due to aversion to cold.
10th Take Miaoying Wan 8 fen. Phlegm-water passed as before.
11th Remove Guizhi and Guangpi from the previous formula, because the pulse refuses to become small. Take until the 15th.
16th Take Miaoying Wan 1 qian.
Bing Xu Year, Jan 14th *Jingui Yaolue* states: Hardness and largeness below the heart like a plate, caused by water-fluid, is treated with Zhiju Wan (Immature Citrus and Atractylodes Pill). Although not hard and large here, water stagnation persists, matching the pathology. Furthermore, the pulse is surging and large. When surging and large, wheezing attacks. It is most suitable to take Shigao and Xingren. But Shigao cannot be made into pills. Proposal: Use Ju Ban Zhiju Wan (Tangerine Peel, Pinellia, Immature Citrus, and Atractylodes Pill). When the pulse is small, take with plain water. When the pulse is large, temporarily take with Shigao Decoction. Add Xingren when wheezing attacks. Do not use Shigao when the pulse returns to small.
Eyan Xiao Zhishi (Aurantii Fructus Immaturus, 1 jin) Maoshan Cangzhu (Atractylodis Rhizoma, 1 jin, stir-fried until half-charred) Guangpi Tan (Citri Reticulatae Pericarpium Carbonisatum, 6 liang) Jiang Banxia (Pinelliae Tuber prepared with Ginger, 10 liang)
Make pills with Shenqu decoction, size of wu-tzu seeds. Take 3 qian per dose, three times daily. In summer, taking Xiaoshu Wan (Summerheat Relieving Pill) is also acceptable.
Chen, 46 years old. Illness originated from Malaria pathogen damaging the Stomach. Earth deficiency leads to water flooding, resulting in wheezing and limb weakness. Healthy Qi is deficient, pathogens are excess. All six pulses are knotted. There are clumped phlegm obstructing meridians and collaterals. The pathology involves three deficiencies and one excess. Treat the excess first, then the deficiency.
Xingni (Armeniacae Semen Paste) Guangpi (Citri Reticulatae Pericarpium, 3 qian) Zhishi (Aurantii Fructus Immaturus, 4 qian) Yunling (Poria Cocos) Jiang Banxia (Pinelliae Tuber prepared with Ginger, 6 qian) Suzishuang (Perillae Fructus Frost, 2 qian)
Use Ganlan Shui (Galo Water, 8 bowls). Boil to yield three bowls. Take in morning, noon, and evening. Two doses.
6th Back pain, which is Bi-syndrome. Right leg is weak, which is Wei-syndrome (flaccidity). Coughing and wheezing, which is Branch-Fluid invading the Lung. Chronic non-resolution is due to mistaken use of Shudi (Rehmanniae Radix Preparata) and other tonics blocking the collaterals. Pulse is surging.
Sheng Shigao Mo (Gypsum Fibrosum Powder, 1 liang) Xingni (Armeniacae Semen Paste, 5 qian) Guizhi (Cinnamomi Ramulus, 5 qian) Fangji (Stephaniae Tetrandrae Radix, 4 qian) Pian Jianghuang (Curcumae Longae Radix Slice, 3 qian) Jiang Banxia (Pinelliae Tuber prepared with Ginger, 5 qian)
Guangpi Tan (Citri Reticulatae Pericarpium Carbonisatum, 3 qian) Fulingpi (Poria Cocos Sclerotium Exocarpium, 5 qian) Yiren (Coicis Semen, 5 qian)
Boil four bowls, take in four divided doses. Two doses: reduce Shigao by 1 liang, add Chiling (Red Poria) 1 liang. After another two doses, add Shigao 1 liang, Qingjuye (Green Tangerine Leaf) 5 qian.
Feb 2nd Bi-syndrome complicated by phlegm-fluid. Apply method of opening Bi and eliminating fluid. Currently Bi resolves but fluid remains. Surging and large pulse decreases. As illness lessens, reduce dosage.
Jiang Banxia (Pinelliae Tuber prepared with Ginger, 5 qian) Guizhi (Cinnamomi Ramulus, 5 qian) Fangji (Stephaniae Tetrandrae Radix, 3 qian) Guangpi (Citri Reticulatae Pericarpium, 3 qian) Fulingkuai (Poria Cocos Cube, 6 qian) Yiren (Coicis Semen, 5 qian)
Xiao Zhishi (Aurantii Fructus Immaturus, 3 qian) Qingjuye (Green Tangerine Leaf, 3 qian)
Boil three cups, take in three divided doses.
8th Add Xiao Zhishi (2 qian) Guangpi (2 qian) Huashi (6 qian)
9th Add Sheng Shigao (1 liang)
11th Liver Qi stagnation complicated by phlegm-fluid. Coughing with much phlegm, spitting blood stasis.
Xuanfuhua (Inulae Flos, 3 qian) Jiang Banxia (Pinelliae Tuber prepared with Ginger, 6 qian) Qingpi (Citri Reticulatae Pericarpium Viride, 2 qian) Guangpi Tan (Citri Reticulatae Pericarpium Carbonisatum, 2 qian) Gualouren (Trichosanthis Semen, 2 qian) Suzishuang (Perillae Fructus Frost, 3 qian)
Xiangmo (Aquilariae Lignum Resinatum Powder, 3 qian) Hengxu (Angelicae Sinensis Radix Transverse Rootlets, 2 qian) Taoren Ni (Persicae Semen Paste, 2 qian) Qingjuye (Green Tangerine Leaf, 3 qian)
Boil three cups, take in three divided doses.
Pill Formula: Phlegm-fluid complicated by Liver Qi stagnation. After spitting blood stasis, focus on harmonizing Liver and Stomach.
Dai Pi Ling (Poria Cocos with Skin, 8 liang) Jiang Banxia (Pinelliae Tuber prepared with Ginger, 10 liang) Xiangfu (Cyperi Rhizoma, 6 liang) Guang Yujin (Curcumae Longae Radix, 2 liang) Guangpi (Citri Reticulatae Pericarpium, 5 liang) Yizhi (Alpiniae Oxyphyllae Semen, 4 liang)
Sheng Yiren (Coicis Semen, 8 liang) Zexie (Alismatis Rhizoma, 8 liang)
Grind into extremely fine powder. Make pills with Shenqu water, size of wu-tzu seeds. Take three times daily, 3 qian per dose, with plain water.
Feb 5th Summerheat-Dampness is prevailing. Pulse is wiry and thin. Stomach not opening. Thirsty with scant urine. Apply method of "Thirst treated with Zhuling Tang".
Zhuling (Polypori Umbellati, 5 qian) Yunlingkuai (Poria Cocos Cube, 4 qian) Zexie (Alismatis Rhizoma, 5 qian) Banxia (Pinelliae Tuber, 4 qian) Huashi (Talcum, 6 qian) Guangpi (Citri Reticulatae Pericarpium, 3 qian) Yizhiren (Alpiniae Oxyphyllae Semen, 1.5 qian)
Boil three cups, take in three divided doses. Stop when Stomach opens.
6th Phlegm-fluid constitution, exposed to Summerheat, desire to vomit. All six pulses are wiry. Although very thirsty, difficult to use cold/cool herbs. Apply Ju Fang Xiaoshu Wan (Bureau Formula Summerheat Relieving Pill) method.
Jiang Banxia (Pinelliae Tuber prepared with Ginger, 8 qian) Yunlingkuai (Poria Cocos Cube, 8 qian) Huogeng (Agastachis Rhizome, 2 qian) Guangpi (Citri Reticulatae Pericarpium, 3 qian) Sheng Gancao (Glycyrrhizae Radix et Rhizoma, 2 qian) Shengjiangzhi (Zingiberis Recens Juice, 3 small spoons per cup)
Boil three cups, take in three divided doses.
8th As illness lessens, reduce dosage. Reduce:
Banxia (Pinelliae Tuber, 4 qian) Yunling (Poria Cocos, 4 qian)
12th Edema below the waist. Should promote urination. Thirsty with scant urine. Propose "Thirst treated with Zhuling Tang" example.
Zhuling (Polypori Umbellati, 8 qian) Zexie (Alismatis Rhizoma, 8 qian) Fei Huashi (Talcum, 1.2 liang) Yunlingpi (Poria Cocos Sclerotium Exocarpium, 6 qian) Jiang Banxia (Pinelliae Tuber prepared with Ginger, 4 qian)
Boil three cups, take in three divided doses. Continue until thirst subsides and edema resolves.
14th Pulse is deep and thin. Stomach not opening. Reduce: Zhuling (3 qian) Zexie (3 qian) Huashi (6 qian). Add Huogeng (3 qian) Guangpi (3 qian) Yizhiren (3 qian)
16th Summerheat-Dampness illness recedes. Urine output increases. Yang Qi is not vigorous. Apply method of unblocking and tonifying Yang Qi.
Guizhi (Cinnamomi Ramulus, 3 qian) Jiang Banxia (Pinelliae Tuber prepared with Ginger, 3 qian) Maozhu (Atractylodis Rhizoma, 2 qian) Baikouren (Amomi Fructus Rotundus, 1 qian, crushed) Yunlingkuai (Poria Cocos Cube, 5 qian) Sheng Yiren (Coicis Semen, 5 qian)
Guangpi (Citri Reticulatae Pericarpium, 2 qian) Zhi Gancao (Glycyrrhizae Radix et Rhizoma honey-fried, 2 qian)
Boil three cups, take in three divided doses.
17th Head distension and chest oppression. Pulse slow, Qi deficient. Summerheat must be complicated by Dampness.
Ban Ye Huogeng (Agastachis Rhizome half-leaf, 3 qian) Baikouren (Amomi Fructus Rotundus, 1.5 qian) Jiang Banxia (Pinelliae Tuber prepared with Ginger, 3 qian) Yunlingpi (Poria Cocos Sclerotium Exocarpium, 5 qian) Guangpi (Citri Reticulatae Pericarpium, 3 qian) Yiren (Coicis Semen, 5 qian) Xingren (Armeniacae Semen Amarum, 3 qian)
Boil three cups, take in three divided doses.
19th Urine is turbid. Add:
Zhuling (Polypori Umbellati, 4 qian) Zexie (Alismatis Rhizoma, 4 qian)
24th Summer month head distension and slight pain. Clear the Upper Jiao.
Huoxiang (Agastachis Herba, 3 qian) Bohe (Menthae Haplocalycis Herba, 1 qian) Xian He Ye (Nelumbinis Nelumbo Nuceus Leaf fresh, 1 sheet, remove stem)
Boil three cups, take in three divided doses.
25th All six pulses show Yang deficiency. Residue of Summerheat-Dampness. Urine is white and turbid. Apply method of separating and draining.
Chuan Bi (Dioscoreae Hypoglaucae Rhizoma, 5 qian) Zexie (Alismatis Rhizoma, 3 qian) Yunlingpi (Poria Cocos Sclerotium Exocarpium, 5 qian) Guizhi (Cinnamomi Ramulus, 3 qian) Cangzhu (Atractylodis Rhizoma, 3 qian, stir-fried) Yizhiren (Alpiniae Oxyphyllae Semen, 3 qian) Zhuling (Polypori Umbellati, 3 qian) Sheng Yiren (Coicis Semen, 5 qian)
Boil three cups, take in three divided doses. Continue until urine clears.
July 19th Pathology of Damp-Heat. Apply bitter-pungent-bland method.
Yunlingpi (Poria Cocos Sclerotium Exocarpium, 5 qian) Jiang Banxia (Pinelliae Tuber prepared with Ginger, 5 qian) Fei Huashi (Talcum, 6 qian) Zhuling (Polypori Umbellati, 3 qian) Mutong (Akebiae Caulis, 3 qian) Zexie (Alismatis Rhizoma, 3 qian)
Yiren (Coicis Semen, 5 qian) Guizhi (Cinnamomi Ramulus, 3 qian) Xingni (Armeniacae Semen Paste, 3 qian)
Boil three cups, take in three divided doses.
22nd Pathology of Damp-Heat. Apply bitter-pungent-bland method. Urine output increases. Stomach not opening well. Apply method of closing Yangming.
Jiang Banxia (Pinelliae Tuber prepared with Ginger, 6 qian) Yizhiren (Alpiniae Oxyphyllae Semen, 3 qian) Guangpi (Citri Reticulatae Pericarpium, 3 qian) Yunlingpi (Poria Cocos Sclerotium Exocarpium, 5 qian) Yiren (Coicis Semen, 5 qian) Shengjiang (Zingiberis Recens Rhizoma, 3 qian)
25th Add Baikouren (3 qian) Zhishi (3 qian)
Sept 21st Phlegm-fluid retention with wheezing, coughing, and wiry pulse. Apply Xiao Qinglong Tang method.