伊芳 劳伤急怒，吐血二者，皆治在肝络，医者不识，见血投凉，以致胃口为苦寒。
二十岁 所伤残，脾阳肾阳，亦为苦寒滑润，伐其生发健运之常，此腹痛晨泄不食，脉
沉弦
细之所由来也。按∶三焦俱损，先建中焦，补土可以生金，肾关之虚，亦可仰赖于胃关矣。
莲子（五钱，去心） 芡实（三钱） 白扁豆（钱半） 冰糖（三钱） 茯苓块（三钱） 广皮炭
（一钱） 人参（一钱）
缓缓多服为宜。
陈 二十三岁 左脉搏大，下焦肝肾吐血，上焦咳嗽，中焦不食，谓之三焦俱损，例在
不治，勉拟三焦俱损，先建中焦法。
桑叶（二钱） 白扁豆（三钱） 茯苓块（一钱） 莲子（三钱） 芡实（三钱） 冰糖（三钱）
桂枝（二钱） 焦白芍（钱半） 沙参（三钱） 胡肉桃（三钱）
服四帖后能食。
陈氏 三十二岁 甲子四月初五日 脉弦细失音，谓之金碎不鸣，暮热不食，食则呕，
亦系俱损为难治。
胡桃肉（三钱） 甜杏仁（三钱） 冰糖（三钱） 白扁豆（五钱） 茯苓块（二钱） 桑叶（二
钱） 洋参（二钱） 沙参（三钱） 柏子霜（三钱）
另含鲍鱼片，洋参片。
施 二十岁 形寒而六脉弦细，时而身热，先天不足，与诸虚不足之小建中法。
芍药（六钱） 生姜（四钱） 大枣（四枚，去核） 桂枝（四钱） 炙甘草（三钱） 胶糖（一
两，去渣化入）
前方服过六十剂，诸皆见效，阳虽转而虚未复，于前方内减姜桂之半，加柔兼药与护阴
大生地（五钱） 五味子（二钱） 麦冬（四钱，连心）
姚 三十岁 乙酉五月初五日 六脉弦细而紧，劳伤吐血，诸虚不足，小建中汤主之
小建中汤加茯神四钱。
共服二十一帖全愈。
李 二十四岁 乙酉五月初三日 每日五更，胃痛欲饮，得食少安，胃痛则背冷如冰，
弦细，阳微，是太阳之阳虚，累及阳明之阳虚，阳明之阳虚现症，则太阳之阳更觉其虚。此
等阳虚，只宜通补，不宜守补。
半夏（六钱） 广皮（四钱） 川椒炭（五钱） 干姜（四钱） 桂枝（八钱）
十四日 背寒减，腹痛下移，减桂枝，加萸、良姜。
傅 十八岁 乙酉五月十三日 六脉弦细而紧，吐血遗精，阳气不摄，胃口不开，法当与建
中复其阳∶奈系酒客，中焦湿热壅聚，不可与甘，改用辛淡微甘以和胃，胃旺得食，而后诸
症可复也。
半夏（五钱） 白芍（五钱） 姜汁（每杯点三小茶匙） 广皮炭（三钱） 桂枝木（三钱） 生
苡仁（五钱） 云苓块（五钱） 麦冬（三钱，连心） 炒神曲（五钱）
七帖。
二十二日 业已见效，胃开得食，脉尚弦紧，多服为宜。
沈 十五岁 乙酉年五月十五日 幼孩脉双弦而细紧，瘰 结核，胃阳不开，色白食少
，且呕，形体羸瘦，与通补胃阳。
半夏（四钱） 云芩块（四钱） 炒广皮（二钱） 白扁豆（四钱） 生姜（三钱）
六月十二日 前药已服十二帖，呕止胃开，腹微胀，脉有回阳之气。于前方加浓朴、杉
皮消
胀，胀消后。按服前方化核，于前方内去生姜、广皮，加香附、土贝母、忍冬藤、青橘叶、
海藻，以化瘰 痰核。
钱 二十七岁 乙酉五月二十八日 六脉弦紧，胃痛，久痛在络，当与和络。
公丁香（八分） 小茴香炭（二钱） 生姜（二钱） 归须（二钱） 桂枝尖（三钱） 降香末（
三钱） 乌药（二钱） 良姜（一钱） 半夏（三钱）
此方服七帖后痛止，以二十帖神曲为丸，服过一料。
八月十九日 六脉弦细而紧，脏气之沉寒可知，食难用饱，稍饱则 胀，食何物则嗳何
气，
间有胃痛时，皆腑阳之衰也。阳虚损症，与通补脏腑之阳法，大抵劳阳者十之八九，劳阴者
十之二三，不然经何云劳者温之。世人佥以六味八味治虚损，人命其何堪哉，暂戒猪肉介属
。
半夏（六钱） 川椒炭（三钱） 白蔻仁（二钱） 益智仁（四钱） 小枳实（二钱） 良姜（三
钱） 茯苓块（三钱） 生姜（五钱） 丁香（二钱） 广陈皮（五钱）
经谓必先岁气，毋伐天和，今年阳明燥金，太乙天符，故用药如上，他年温热宜减。
二十四日 前方已服五帖，脉之紧无胃气者和，痛楚已止，颇能加餐，神气亦旺，照前
方减川椒一钱，丁香一钱，再服七帖，可定丸方。
三十日 前因脉中之阳气已回，颇有活泼之神，恐刚燥太过，减去川椒、丁香各一钱，
今日
诊脉，虽不似初诊之脉紧，亦不是念四日之脉和肢凉，阳微不及四末之故。与前方内加桂枝
五钱，再服七帖。
丸方
诸症向安，惟六脉尚弦，与通补脾胃两阳。
茯苓块（八两） 小枳实（二两） 生苡仁（八两） 白蔻仁（一两） 半夏（八两） 于术（四
两） 广陈皮（四两） 人参（二两） 益智仁（四两）
共为细末，神曲八两，煎汤法丸，梧子大，每服三二钱，再服三服，自行斟酌。
备用方∶
阳虚之体质，如冬日畏寒，四肢冷，有阳微不及四末之象，服此方五七帖，以充阳气。
白芍（六钱） 生姜（五钱） 炙甘草（三钱） 桂枝（四钱） 大枣（三枚，去核） 胶糖（一
两，化冲）
煮两杯，分二次服。
此方亦可加绵黄 、人参、茯苓、白术、广橘皮。
谭 四十七岁 乙酉八月二十八日 病后六脉弦细而紧，绝少阳和之气，形体羸瘦，幸
喜胃旺，可以守补，与形不足者，补之以气法。
白芍（六钱） 云茯苓块（四钱） 生姜（三钱） 桂枝（四钱） 人参（三钱） 大枣（二枚，
去核） 炙甘草（三钱） 桂圆肉（三钱） 炙黄 （四钱） 胶糖（一两）
陈 十九岁 脉虚数，头目眩冒，暮有微热，饮食减少，面似桃花，身如柳叶。
炙甘草（六钱） 大麦冬（五钱，连心） 生牡蛎（五钱） 干地黄（六钱） 阿胶（三钱） 生
鳖甲（八钱） 生白芍（六钱） 麻仁（三钱）
服二十帖红退晕止，食进，后用专翕大生膏四斤收功。
李 四十岁 面赤舌绛，脉虚弦而数，闻妇声则遗，令其移居大庙深处。
三甲复脉汤
炙甘草 麻仁 生牡蛎 生白芍 阿胶 生鳖甲 干地黄 麦冬（连心） 生龟板
服四十帖，由渐而效，后以天根月窟膏一整料二十四斤收功。
宗 二十五岁 粉红色，虚数脉，头时晕，身微热，心悸气短不寐，食少，与补心肾之
阴。
洋参 丹皮 莲子（连心） 麦冬（连心朱拌） 丹参 地黄 五味子 云苓块 炒枣仁
冰糖
服五帖渐安，后以专翕大生，朱砂为衣，一料收功。
[Background Information]
Book: Wujutong's Medical Cases; Author: Wu Jutong; Dynasty: Qing; Chapter: Xu Lao (Deficiency Consumption); Category: Medical Treatise
Patient surnamed Yi. Due to fatigue injury and sudden anger, hematemesis occurred. The pathogenesis of both conditions lies in the Liver Collaterals (the collateral network system of the liver). The physician failed to recognize this pathogenesis and, upon seeing bleeding, administered cooling/cold-natured herbs, thereby injuring the Stomach Qi with bitter-cold substances.
Patient aged twenty. Their Spleen Yang and Kidney Yang were also damaged by bitter-cold and slippery/moistening herbs, destroying the normal physiological functions of generating vitality, ascending, and transporting. This is the origin of abdominal pain, morning diarrhea, anorexia, and a deep, wiry, and fine pulse. Commentary: When the Triple Burner (Upper, Middle, and Lower Burners) is damaged simultaneously, one should first establish the Middle Burner (Spleen/Stomach). Tonifying Earth (Spleen) can generate Metal (Lung); the deficiency of the Kidney Gate can also rely on the Stomach Gate (Spleen/Stomach) for recovery.
Prescription: Lotus Seed (5 qian, heart removed), Euryale Seed (3 qian), White Hyacinth Bean (1.5 qian), Rock Sugar (3 qian), Poria Block (3 qian), Charred Tangerine Peel (1 qian), Ginseng (1 qian).
It is advisable to take this slowly and in large quantities over time.
Patient surnamed Chen, aged twenty-three. The left pulse is large and forceful. Hematemesis due to lower Jiao Liver/Kidney damage, cough due to upper Jiao, and anorexia due to middle Jiao constitute "Triple Burner simultaneous damage," which is typically considered incurable. Reluctantly prescribing the method of "Triple Burner simultaneous damage, first establishing the Middle Burner."
Prescription: Mulberry Leaf (2 qian), White Hyacinth Bean (3 qian), Poria Block (1 qian), Lotus Seed (3 qian), Euryale Seed (3 qian), Rock Sugar (3 qian), Cinnamon Twig (2 qian), Scorched White Peony Root (1.5 qian), Glehnia Root (3 qian), Walnut Meat (3 qian).
After taking four doses, appetite returned.
Patient surnamed Chen, aged thirty-two. Diagnosed on the 5th day of the 4th lunar month in the Jiazi year. The pulse is wiry and fine, accompanied by aphonia. This is termed "Broken Metal Cannot Ring" (failure of Lung Metal to produce sound due to deficiency). Evening fever, anorexia, and vomiting after eating indicate simultaneous organ damage, making it difficult to treat.
Prescription: Walnut Meat (3 qian), Sweet Almond (3 qian), Rock Sugar (3 qian), White Hyacinth Bean (5 qian), Poria Block (2 qian), Mulberry Leaf (2 qian), American Ginseng (2 qian), Glehnia Root (3 qian), Biota Seed Coat (3 qian).
Additionally, suck on Abalone slices and American Ginseng slices.
Patient surnamed Shi, aged twenty. The body feels cold, and all six pulses are wiry and fine. There is occasional low-grade fever. This indicates congenital insufficiency. Treatment follows the Xiao Jian Zhong Method (Minor Construct the Middle Method) for various deficiencies.
Prescription: Peony Root (6 qian), Fresh Ginger (4 qian), Jujube (4 pieces, pits removed), Cinnamon Twig (4 qian), Honey-fried Licorice Root (3 qian), Gelatin Sugar (1 liang, melted into the decoction after removing dregs).
After taking sixty doses of the previous prescription, all symptoms showed improvement. Although Yang Qi has recovered, the deficiency remains. Reduce the dosage of Ginger and Cinnamon by half in the previous prescription, and add soft-moistening Yin-protecting herbs such as Large Rehmannia Root (5 qian), Schisandra Berry (2 qian), and Ophiopogon Tuber (4 qian, heart included).
Patient surnamed Yao, aged thirty. Diagnosed on the 5th day of the 5th lunar month in the Yiyu year. All six pulses are wiry, fine, and tight. Due to fatigue injury causing hematemesis, representing various deficiencies, Xiao Jian Zhong Decoction is the primary formula.
Xiao Jian Zhong Decoction plus Fu Shen (Poria with Hostwood) 4 qian.
Recovered completely after taking twenty-one doses.
Patient surnamed Li, aged twenty-four. Diagnosed on the 3rd day of the 5th lunar month in the Yiyu year. At dawn (Wugeng time), stomach pain occurs with thirst; eating provides slight relief. During stomach pain, the back feels cold as ice. The pulse is wiry and fine, indicating weak Yang. This is Taiyang Yang deficiency affecting Yangming Yang deficiency. When Yangming Yang deficiency manifests, Taiyang Yang appears even more deficient. For this type of Yang deficiency, only tonification through unblocking (Tong Bu) is suitable, not static tonification (Shou Bu).
Prescription: Pinellia Tuber (6 qian), Tangerine Peel (4 qian), Charred Sichuan Pepper (5 qian), Dried Ginger (4 qian), Cinnamon Twig (8 qian).
Diagnosed on the 14th: Back coldness decreased, abdominal pain moved downward. Reduced Cinnamon Twig, added Cornus Fruit and Galangal Rhizome.
Patient surnamed Fu, aged eighteen. Diagnosed on the 13th day of the 5th lunar month in the Yiyu year. All six pulses are wiry, fine, and tight. Hematemesis and spermatorrhea occur due to Yang Qi failing to secure. The stomach gate is closed. The treatment method should employ the Jian Zhong method to restore Yang. However, the patient is a chronic drinker, with damp-heat congested in the Middle Burner. Sweet substances cannot be used. Instead, use pungent, bland, and slightly sweet methods to harmonize the Stomach. Once Stomach Qi is strong and eating resumes, other symptoms can recover.
Prescription: Pinellia Tuber (5 qian), White Peony Root (5 qian), Ginger Juice (add three small teaspoons per cup), Charred Tangerine Peel (3 qian), Cinnamon Twig Wood (3 qian), Raw Coix Seed (5 qian), Poria Block (5 qian), Ophiopogon Tuber (3 qian, heart included), Fried Medicated Leaven (5 qian).
Seven doses.
Diagnosed on the 22nd: Already effective. The stomach gate is open, and appetite has returned. The pulse remains wiry and tight. It is advisable to continue taking it.
Patient surnamed Shen, aged fifteen. Diagnosed on the 15th day of the 5th lunar month in the Yiyu year. A child’s pulse is double-wiry, fine, and tight. Scrofula (lymph node tuberculosis) is present. Stomach Yang is not opening. The complexion is pale, food intake is low, vomiting occurs, and the body is emaciated. Use the method of tonifying Stomach Yang through unblocking.
Prescription: Pinellia Tuber (4 qian), Poria Block (4 qian), Stir-fried Tangerine Peel (2 qian), White Hyacinth Bean (4 qian), Fresh Ginger (3 qian).
Diagnosed on June 12th: The previous medicine was taken for twelve doses. Vomiting stopped, the stomach gate opened, and there is slight abdominal distension. The pulse shows signs of returning Yang Qi. Add Magnolia Bark and Fir Bark to the previous prescription to reduce distension. After distension subsides, continue using the previous prescription to resolve nodules. Remove Fresh Ginger and Tangerine Peel from the previous prescription, and add Cyperus Rhizome, Fritillaria Thunbergii Bulb, Honeysuckle Stem, Green Mandarin Leaf, and Sargassum to resolve scrofula and phlegm nodules.
Patient surnamed Qian, aged twenty-seven. Diagnosed on the 28th day of the 5th lunar month in the Yiyu year. All six pulses are wiry and tight. Stomach pain. Long-standing pain resides in the collaterals. Harmonizing the collaterals is indicated.
Prescription: Clove (8 fen), Charred Small Fennel Fruit (2 qian), Fresh Ginger (2 qian), Red Sage Root Tips (2 qian), Cinnamon Twig Tip (3 qian), Agarwood Powder (3 qian), Lindera Root (2 qian), Galangal Rhizome (1 qian), Pinellia Tuber (3 qian).
After taking seven doses of this prescription, pain ceased. Form pills using twenty doses of Medicated Leaven. One course was consumed.
Diagnosed on August 19th: All six pulses are wiry, fine, and tight. It can be known that the Zang Qi is deeply cold. Food cannot be eaten to fullness; slight overeating causes bloating. Belching corresponds to the food eaten. Occasional stomach pain indicates the decline of Fu Yang. For Yang deficiency deficiency-consumption, the method is to tonify the Yang of the Zang and Fu through unblocking. Generally, nine out of ten cases of consumption involve Yang, while two or three out of ten involve Yin. Otherwise, why would the Classic say "Consumption should be warmed"? People generally believe that Liu Wei Di Huang Wan and Ba Wei Di Huang Wan treat deficiency-consumption. How can human lives withstand this? Temporarily avoid pork and shellfish.
Prescription: Pinellia Tuber (6 qian), Charred Sichuan Pepper (3 qian), White Cardamom Seed (2 qian), Alpinia Oxyphylla Fruit (4 qian), Small Immature Bitter Orange (2 qian), Galangal Rhizome (3 qian), Poria Block (3 qian), Fresh Ginger (5 qian), Clove (2 qian), Broad-leaved Citrus Peel (5 qian).
The Classic states: "First consider the seasonal Qi, do not violate the Harmony of Heaven." This year, Yangming Dry Metal governs, forming the Taiyi Tianfu pattern. Therefore, the medication is as above; in other years when heat/warmth prevails, dosages should be reduced.
Diagnosed on the 24th: Five doses of the previous prescription have been taken. The pulse's tightness lacking Stomach Qi has become harmonious. Pain has ceased. Appetite has significantly increased, and Spirit/Qi is vigorous. Follow the previous prescription, reducing Charred Sichuan Pepper by 1 qian and Clove by 1 qian. Take another seven doses to finalize the pill prescription.
Diagnosed on the 30th: Previously, because Yang Qi in the pulse had returned, showing lively spirit, fear of excessive drying/hot nature led to the reduction of Charred Sichuan Pepper and Clove by 1 qian each. Today's pulse diagnosis shows that although the pulse is not as tight as at the initial visit, nor as harmonious as on the 24th, and limbs are cool due to weak Yang failing to reach the extremities, add Cinnamon Twig 5 qian to the previous prescription. Take another seven doses.
Pill Prescription:
All symptoms tend toward stability, but all six pulses remain wiry. Use the method of tonifying the Yang of both Spleen and Stomach through unblocking.
Poria Block (8 liang), Small Immature Bitter Orange (2 liang), Raw Coix Seed (8 liang), White Cardamom Seed (1 liang), Pinellia Tuber (8 liang), Atractylodes Macrocephala Rhizome (4 liang), Broad-leaved Citrus Peel (4 liang), Ginseng (2 liang), Alpinia Oxyphylla Fruit (4 liang).
Grind into fine powder. Use 8 liang of Medicated Leaven decoction to form pills, size of wu zi (loquat seeds). Take 2-3 qian per dose. Adjust self-care based on three doses.
Alternative Prescription:
For Yang deficiency constitution, such as fear of cold in winter, cold limbs, and signs of weak Yang failing to reach the extremities, take five to seven doses of this prescription to replenish Yang Qi.
White Peony Root (6 qian), Fresh Ginger (5 qian), Honey-fried Licorice Root (3 qian), Cinnamon Twig (4 qian), Jujube (3 pieces, pits removed), Gelatin Sugar (1 liang, dissolved and mixed in).
Boil into two cups, divide into two servings.
This prescription can also be supplemented with Astragalus Root, Ginseng, Poria, Atractylodes Rhizome, and Tangerine Peel.
Patient surnamed Tan, aged forty-seven. Diagnosed on the 28th day of the 8th lunar month in the Yiyu year. After illness, all six pulses are wiry, fine, and tight. There is very little Yang-harmonizing Qi. The body is emaciated. Fortunately, Stomach Qi is strong, allowing for static tonification (Shou Bu). Apply the method of tonifying Qi for those with insufficient form.
Prescription: White Peony Root (6 qian), Poria Block (4 qian), Fresh Ginger (3 qian), Cinnamon Twig (4 qian), Ginseng (3 qian), Jujube (2 pieces, pits removed), Honey-fried Licorice Root (3 qian), Longan Aril (3 qian), Honey-fried Astragalus Root (4 qian), Gelatin Sugar (1 liang).
Patient surnamed Chen, aged nineteen. Pulse is deficient and rapid. Vertigo and dizziness of the head and eyes. Slight fever in the evening. Reduced diet. Complexion resembles peach blossoms; body is slender like willow leaves.
Prescription: Honey-fried Licorice Root (6 qian), Large Ophiopogon Tuber (5 qian, heart included), Raw Oyster Shell (5 qian), Dried Rehmannia Root (6 qian), Donkey-hide Gelatin (3 qian), Raw Turtle Carapace (8 qian), Raw White Peony Root (6 qian), Hemp Seed (3 qian).
After taking twenty doses, redness receded, vertigo stopped, and appetite improved. Subsequently, completed treatment with four jin of Zhuan Xi Da Sheng Gao (Specialized Closing Major Life Generating Paste).
Patient surnamed Li, aged forty. Red face, crimson tongue. Pulse is deficient, wiry, and rapid. Emission occurs upon hearing women's voices. Advised to move to the depths of a great temple.
San Jia Fu Mai Tang (Three Shells Pulse Restoring Decoction)
Honey-fried Licorice Root, Hemp Seed, Raw Oyster Shell, Raw White Peony Root, Donkey-hide Gelatin, Raw Turtle Carapace, Dried Rehmannia Root, Ophiopogon Tuber (heart included), Raw Tortoise Plastron.
Took forty doses, gradually effective. Subsequently, completed treatment with one whole portion (24 jin) of Tian Gen Yue Ku Gao (Heaven Root Moon Cave Paste).
Patient surnamed Zong, aged twenty-five. Pink complexion. Pulse is deficient and rapid. Occasional dizziness. Slight body heat. Palpitations, shortness of breath, insomnia, poor appetite. Tonify Heart and Kidney Yin.
Prescription: American Ginseng, Moutan Cortex, Lotus Seed (heart included), Ophiopogon Tuber (heart included, mixed with cinnabar), Salvia Root, Rehmannia Root, Schisandra Berry, Poria Block, Fried Sour Jujube Seed, Rock Sugar.
Took five doses, gradually stabilized. Subsequently, completed treatment with one portion of Zhuan Xi Da Sheng Gao, coated with Cinnabar.