地黄饮子地、巴、苁、萸、麦、斛、菖、芩、远、薄、味、附、桂。 去麦、味、菖合异功散 加当归 芍药 蝎尾 竹油
诒按：此病之由乎虚者，故用药专以补养收功。从前并未用疏风化痰之药，案中亦无见证；至末方诸恙就痊，而忽加蝎尾、竹油二味，想必另有风痰见证也。
怒则气上，痰即随之，陡然语言蹇涩，口角流涎，月余不愈，所谓中痰中气也。然痰气为标，阳虚为本，所以脉息迟弦，小水甚多，肢麻无力，法宜扶阳为主，运中化痰佐之。
诒按：立方虚实兼到，所谓看似寻常，最奇特也，勿以平易忽之。
邓评；病因怒起，究属肝阳内盛；其小水多者，阳火主乎疏泄也。今反以扶阳为主，恐非善法，倘将附子易沉香似较妥。
左肢痿而不用，口歪流涎，舌苔起腻，便溏溺少，脉形弦迟，以中虚湿胜之体，易于生痰动风，内风既动，未有不招外风者也。
议论病源，具见卓识。
再诊：肢体稍和，流涎略减，仍以前方增减。
诒按：方案均切实不浮。
痿 痹 门
膝骨日大，上下渐形细小，是鹤膝风证。乃风寒湿三气合而为病，痹之最重者也。三气既痹，又挟肺金之痰以痹肘，所谓肺有邪，其气留于两肘。肘之痹，偏于左，属血属阴。阴m久亏，无怪乎腰脊突出，接踵而来。至于咳嗽鼻流清涕，小水色黄，肌肉暗削，行步无力，脉形细小，左关独见弦数，是日久正虚，风寒湿三气渐见化热之象。拟用痹门羚羊角散加减。
羚羊角 归身 白芍 杏仁 羌活 知母 桂枝 薏米 秦艽 制蚕 茯苓竹沥 桑枝
诒按：由膝而肘而脊，病情渐引渐深，方中于膝肘之邪，已能兼治，于脊突一层，似未能兼顾及之。拟再加鹿角霜、川怀牛膝等味。
邓评；膝肘腰脊等患，皆风痰所注，用痹门羚羊角散加减合法。或加虎胫骨、牛膝亦可。
孙评：咳嗽鼻涕溺黄，并非正虚，因日久化热，或由新感外风所致；脊突肌削，是肝肾二阴大伤，诚如柳氏加法为要。至于新感宜另治，若非新感，则不必兼治，盖正气充足，稍有微邪，不治自去也。知、杏可不用。
素患鼻衄，入夏又发，下体痿软无力，咳嗽口干，溺黄肤热。想是鼻衄屡发，上焦阴液久耗，而胃中湿热之邪熏蒸于肺，肺热叶焦，则生痿躄也。
清燥汤参、芪、草、术、归、橘、柴、麻。羌、地、连、猪、茯、麦、味、苍、柏，泻。去术、升、柴 加白芍 茅花 枇杷叶
诒按：此证自当滋清营液为主。东垣清燥汤，立法未纯，前人颇有议之者，用者当审之。案语阐发病情，极其熨贴。
邓评：如此加减，便能中裒。
孙评：咳嗽、口干、溺黄、肤热，由于肺热叶焦，则阴液久耗，宜去麻、苍、连、猪，伤阴耗液之品，细考自知。
人年四十，阴气自半，从古至今如是。惟尊体独异者，盖以湿热素多，阳事早痿耳。近又患臂痛之证，此非医书所载之夜卧臂在被外，招风而痛。乃因久卧竹榻，寒凉之气渐入筋骨，较之被外感寒，偶伤经络者更进一层。所以阳气不宣，屈伸不利，痛无虚日，喜热恶寒。仲景云：一臂不举为痹，载在中风门中；实非真中，而为类中之机，岂容忽视。现在治法，首重补阳，兼养阴血，寓之以祛寒，加之以化痰，再通其经络，而一方中之制度，自有君臣佐使焉。
熟地八两当归四两白芍二两虎掌一对阿胶三两半夏四两橘红二两枳壳二两沉香五钱党参四两于术四两茯苓八两熟附一两炙草一两风化硝一两桂枝一两羌活一两绵芪=两姜黄一阿海桐皮一两
共为末，用竹沥、姜汁，和蜜水泛丸，
诒按：立方清切周到，可法可师。
邓评：立方从黄芪五物而扩充之。
神 志 门
神识不清，自言自语，起坐无常，寤寐失度，脉形小 滑，舌苔白腻。此痰热内郁心包，无路可出，而作心风也。久久归入癫痫，毋忽。
另白金丸
邓评：见证属痰，痰中有火，理固然也。立方宜从柳师加味，更参竹油、姜汁。所用乌梅去之为是。
孙评：导痰古方无梅、姜二味；想是后人误加。导痰之品加乌梅收摄，大相背谬，万无此理；即姜亦嫌温燥。
阳明之脉环于唇。唇起红筋，即发牵动而厥，厥醒吐沫，咳血鼻衄，二便失调，脉弦滑数。显系胃有积热，动血生痰，又被肝火所冲激，乃痫证之根，毋忽。
另虎睛丸（虎睛一对、制军一两、远志五钱、犀角一两、黑栀一两，蜜丸，每服二十一粒）
诒按：既日胃有积热，似非六味所能胜任。且方中如萸肉之酸温，亦宜避去。
又按：积热者，蓄积之热也，与积滞之积不同。虎睛丸中大黄、黑栀，即为泄热而设。
邓评：此两丸方并用甚妙，一以滋养肝肾阴气，一以清泄阳明营热。
孙评：吐沫是胃中湿热蒸痰，咳血是胃中热瘀不化，用方不合，惟虎睛丸足以当之。
痫证之因，未有不由乎龙雷之火上升；此则更有湿热之痰，从而和之为患。
诒按：连读痫证数案，皆以六味丸为主。查六味为通补三阴之方。先生习于《内经》重阴者癫一语，谓痫证必挟龙雷之火，而以滋水柔木为主，故用药如此。其实痫证有因于胎惊者，有因于先天阴虚者，亦有因于惊痰内扰者，当随所因而治之，初非可执一端以论也。
邓评：阴分虚者，六味丸固为主方，若由乎郁痰、惊痰，痰火内盛者，地、萸究非所宜。
孙评：古人云：川贝治肺经燥痰，既云湿热蒸痰，宜用半夏，燥湿二字适相反，用药何不分析如此。
惊则气乱，神出舍空，痰涎袭入，此心悸形呆，善忘不语所由来也。至月事不至，血从内并，用药亦须兼及。
另惊气丸白花蛇、蝎，蚕、脑、麝、辰砂、白附、麻黄、天麻、橘红、南星、苏子。
诒按：拟加丹参、琥珀、归须等，兼顾血分，乃与案语相合。
邓评：心火亦宜兼清，清其火调其气，即所以行其血而通其经也。柳师所加亦妥。
孙评：细察案意，由血瘀于内，夹痰热上冲致病。柳加甚合法，宜宗之。
心悸，初从惊恐得之，后来习以为常，经年不愈，手振舌糙，脉芤带滑，不耐烦劳。此系心血本虚，痰涎袭入也。
人参 玄参 丹参 枣仁 天冬 麦冬 菖蒲 茯苓 茯神 当归 远志 五味 桔梗半夏 生地 橘红 枳壳 柏仁 炙草 竹茹
原注：此天王补心丹，合十味温胆法也。心血本亏，补心丹主之；痰涎袭入，十味温胆汤主之。
湿热生痰，留于手足少阳之府，累及心包。心惊胆怯，性急善忘，多虑多思，舌苔浊腻带黄，胸脘内热。清化为宜。
原注：舌苔浊腻带黄，加入黄连一味，苦燥化湿。再加洋参补阴，枇杷叶清肺，想是火旺之体，肺液必亏，且以救二陈之过燥也。
邓评：证见苔浊脘闷，方用清化极是。若拘乎壮水养血，滋补频投，其病必难脱体。
神蒙善忘，包络之病为多。然左寸脉息上浮，关部独带弦数，右寸与关小而带弦，白苔满布，大便久溏，肢体无力，倦怠嗜卧。脾经之湿痰，被肝火所冲激，累及心包也。
藿梗党参 于术 半夏 陈皮 香附 砂仁 木香 沉香远志 枳壳 葛根 菖蒲 竹油
治按：此必兼有胀满之候，故方中多香燥和脾之品。用葛根、藿梗，乃兼清暑湿之意。
邓评：推论病情殊透彻。惟此方与病源不甚中窾，宜以导痰汤加远志、姜、连、白术。竹油宜易竹茹。
孙评：便溏体倦嗜卧，想腹中必痛，故用诸多香燥和脾之品，兼入藿梗、葛根者，清暑而并升清气之意也。
再诊：痰因湿酿，湿自脾生，脾若健运，则无湿以生痰，所患善忘等证，自可化为乌有。然则健脾一法，在所必需矣。
邓评：案语倜傥。所加沙苑不如益智子为切当。
另白金丸
诒按；此治痰蒙之正法也。在此证尚属轻剂。
诒按：阴虚挟痰之证，用药最难恰好。十味温胆汤，即温胆汤去竹茹，加参、地、枣仁、远志、五味，治寒涎沃胆，胆寒肝热，心悸不寐。
邓评：脉象既已滑数，当必痰火内盛。所用参、地、五味，恐有碍于痰火。
孙评：十味温胆之用，前人未尝如此清晰。足见柳氏读书曾皆细玩。
痰 饮 门
积饮成囊。
另丸方：茅术一斤芝麻半斤枣肉丸如便血山栀
汤下
诒按：此病不易除根。煎丸两方，极为熨贴，特未识能奏肤功否。
鼻血遗精，肺肾俱病；寒热盗汗，营卫并伤。必须大补为是。无如脉息细弦，舌苔满布，二便失调，饮食不舒，脾家又有湿痰为患，先宜化湿健脾，再商补剂。
诒按；方中乌梅一味，似不入格。查《医通》载二陈汤古方，本有乌梅，取敛护胃阴之意；先生用此，其意或在是乎。
动则气喘，言则亦然，是下虚也，宜其俯仰不适矣。至于脘中拒按，隐隐作疼，筑筑而跳，脉息中部太弦，必有湿热痰浊交阻于胃，失下行为顺之常，未便独以虚治。
另水泛资生丸
诒按；此必挟有痰饮，阻于中脘，宜从饮门用意。
邓评：病既下虚上实，用药须两不相碍。此方固称平妥，拟再加蒌、连、桑皮可也。盖脉息中部太弦，必挟木火为患耳。
再诊：俯仰自如，渐通之兆。所见言动之气喘，脘腹之拒按，已日轻一日，大妙事也。动气攻筑，独不能除，且兼气坠少腹，卧则可安，此则非胃气之能降，而实脾气之不升也。
另资生丸
诒按：立论精当明了，惟用药尚不甚得力。
咳 喘 门
原注：补命门之火以生土，清其生痰之原，则肺之咳喘自宁。煎方金水六君煎以治脾肾，生脉以养肺，桃肉以补命门。其奠安下焦之剂，另用丸药常服，斟酌可谓尽善矣。
气喘痰升，胸痞足冷，是中下阳虚，气不纳而水泛也。已进肾气汤，可以通镇之法继之。
治按：于肾气后续进此方，更加旋、赭以镇逆，薤白以通阳，用意极为周到。
薤白为胸中之痞，车、苓其小水必少。
交冬咳嗽，素惯者也。今春未罢，延及夏间。当春已见跗肿，入夏更增腹满，口燥舌剥，火升气逆，右脉濡数，左脉浮弦。风邪湿热由上而及下，由下而及中，即经所云：久咳不已，三焦受之，三焦咳状，咳而腹满是也。际此天之热气下行，小便更短，足部尚冷，其中宫本有痞象，亦从而和之为患，用药大为棘手。姑拟质重开下法，佐以和胃泄肝之品。
原注：风邪归并于肺，肺气素虚者，由肺而陷入于脾，尚是一线；加以口燥舌剥，阴虚有火之体，更属难治。用河问甘露之意，质重开下，方则极妙，未识效否?
诒按：病情纷错，实难著手，以桂苓法增减出之，已属苦心经营。特于痞满一层，尚恐与两石有碍，方中茯苓、滑石，似不可少。
邓评；交冬必咳，肾气自亏。况以跗肿起见．其脾肾之虚尤必相关。今用二石治痰火之标，恐适以妨脾肾之本，特此本为不治之症。
Third visit: The patient's feet are strong, and walking is no longer difficult; it can be known that the tonifying prescription has taken effect. Continue with the previous method.
Dihuang Yinzi (Rehmanniae Radix Preparata, Morindae Officinalis Radix, Cistanches Herba, Corni Fructus, Ophiopogonis Tuber, Dendrobii Caulis, Acori Tatarinowii Rhizoma, Scutellariae Radix, Polygalae Radix, Menthae Haplocalycis Herba, Schisandrae Fructus, Aconiti Lateralis Radix Preparata, Cinnamomi Ramulus). Remove Ophiopogonis Tuber, Schisandrae Fructus, and Acori Tatarinowii Rhizoma; combine with Yigong San (Atractylodis Macrocephalae Rhizoma, Poria, Citri Reticulatae Pericarpium, Ginseng Radix, Zingiberis Recensis Rhizoma); add Angelicae Sinensis Radix, Paeoniae Radix Alba, Scorpio, and Bamboo Sap.
Liu Yi's commentary: This disease arises from deficiency, so the medication focuses exclusively on nourishment and tonification. Previously, no wind-dispelling or phlegm-resolving medicines were used, and there were no corresponding manifestations in the case record; by the final prescription when all ailments were cured, the sudden addition of Scorpio and Bamboo Sap suggests that new wind-phlegm manifestations must have appeared.
Deng's comment: Since the tonifying prescription was already effective, the sudden insertion of Scorpio and Bamboo Sap is indeed strange.
Anger causes Qi to ascend, and Phlegm follows. Suddenly, speech becomes slurred and saliva flows from the corner of the mouth, persisting for over a month without healing; this is what is called "Zhong Tan" (Phlegm Stroke) and "Zhong Qi" (Qi Stroke). However, Phlegm and Qi are the branch manifestation, while Yang deficiency is the root. Therefore, the pulse is slow and wiry, urination is frequent, limbs are numb and weak. The treatment method should prioritize supporting Yang, assisted by regulating the middle Jiao and resolving Phlegm.
Liujunzi Tang (Six Gentlemen Decoction), added with Chuan Fuzi (Prepared Aconite Lateralis Radix), Baishao (White Peony Root), Maidong (Ophiopogon Tuber), Zhuyu (Bamboo Sap), and Xieshao (Scorpion tail).
Liu Yi's commentary: The prescription addresses both deficiency and excess, as the saying goes, "seemingly ordinary, yet most unique." Do not overlook it because it appears simple.
Deng's comment: The etiology stems from anger, ultimately belonging to internal hyperactivity of Liver Yang; frequent urination occurs because Yang Fire governs dispersion and excretion. To prioritize supporting Yang now seems inappropriate; replacing Fuzi with Chenxiang (Aquilaria Wood) would likely be more suitable.
Left limb flaccidity and dysfunction, facial deviation with salivation, greasy tongue coating, loose stools, and scanty urine, with a wiry and slow pulse. In a constitution characterized by Middle Jiao deficiency and dampness predominance, Phlegm and Wind are easily generated. Once internal Wind moves, it inevitably attracts external Wind.
Qianzheng San (Stabilize Face Powder) (Alum Root, Scorpion Tail) combined with Erchen Tang (Two Aged Things Decoction), added with Chuan Fuzi, Guizhi (Cinnamon Twig), Baishao, and Zhi Jiangcan (Processed Bombyx Batryticatus).
Deng's comment: Due to loose stools and a slow pulse, the prescription prioritizes warming and transforming damp-Phlegm, while also dispersing external Wind.
The discussion on the disease source demonstrates profound insight.
Second visit: Limbs are slightly more relaxed, salivation has decreased slightly. Continue modifying the previous prescription.
Remove Baishao from the previous prescription; add Shouwu (Polygoni Multiflori Caulis), Chuanduan (Drynariae Rhizoma), and Zhuyu (Bamboo Sap).
Liu Yi's commentary: The prescriptions are practical and grounded, lacking superficiality.
Wei Bi Men (Flaccidity and Obstruction Section)
Knee bones enlarge daily, while the areas above and below gradually appear thin; this is He Xi Feng (Crane Knee Wind). It is caused by the combination of Wind, Cold, and Dampness, representing the most severe form of Bi syndrome. Once these three pathogens cause obstruction, they are accompanied by Lung Metal Phlegm obstructing the elbows, as stated: "When the Lung has pathogenic factors, their Qi remains in the two elbows." Elbow Bi pain,偏于 left, belongs to Blood and Yin. Long-term Yin deficiency explains why lumbar and spinal protrusion follows closely. Regarding coughing, clear nasal discharge, yellow urine, emaciated muscles, weakness in walking, and a fine pulse, with the left Guan position showing only wiry and rapid qualities, this indicates long-standing righteous Qi deficiency, with Wind-Cold-Dampness gradually transforming into Heat. I propose modifying Lingyangjiao San (Antelope Horn Decoction) from the Bi section.
Lingyangjiao (Antelope Horn), Guishen (Angelica Sinensis Root Body), Baishao, Xingren (Apricot Seed), Qianghuo (Notopterygii Rhizoma et Radix), Zhimu (Anemarrhenae Rhizoma), Guizhi, Yimi (Coix Seed), Qinjiao (Gentianae Macrophyllae Radix), Zhi Jiangcan, Fuling (Poria), Zhuyu, Sangzhi (Mulberry Twig).
Liu Yi's commentary: The condition progresses from knee to elbow to spine, deepening gradually. The formula treats pathogens in the knees and elbows but seems unable to address the spinal protrusion. I suggest adding Lu Jiaoshuang (Deer Antler Glue Frost), Chuan Nixi (Cyathulae Radix), and Huai Nixi (Achyranthidis Bidentatae Radix).
Deng's comment: Afflictions of the knees, elbows, waist, and spine are all due to Wind-Phlegm deposition; modifying Lingyangjiao San from the Bi section is appropriate. Adding Hu Jinggu (Tiger Tibia Bone) or Nixi could also work.
Sun's comment: Coughing, runny nose, and yellow urine are not signs of righteous deficiency but result from long-standing heat transformation or new external Wind invasion. Spinal protrusion and muscle wasting indicate severe damage to Liver and Kidney Yin, making Liu's suggested additions essential. New invasions should be treated separately; if not new, concurrent treatment is unnecessary, as sufficient righteous Qi will expel minor pathogens spontaneously. Zhi Mu and Xingren may be omitted.
Suffering from epistaxis since youth, recurring in summer, lower body flaccid and weak, coughing, dry mouth, yellow urine, and hot skin. Likely, repeated epistaxis has long depleted Upper Jiao Yin fluids, while damp-heat in the Stomach steams upward to the Lung. Lung Heat scorches the leaves, leading to Wei Bi (flaccidity syndrome).
Qingzao Tang (Clear Dryness Decoction) (Renshen, Huangqi, Gancao, Baizhu, Danggui, Ju Pi, Chai Hu, Ma Huang. Qianghuo, Dihuang, Lian, Zhu Ling, Fuling, Maidong, Wuwei Zi, Cang Zhu, Huang Bai, purgatives). Remove Baizhu, Shengma, and Chai Hu; add Baishao, Maohua (Hemp Flower), and Pipa Ye (Loquat Leaf).
Liu Yi's commentary: This condition naturally requires nourishing and clearing Ying fluids. Dongyuan's Qingzao Tang lacks purity in its principles, and predecessors have criticized it; users must exercise caution. The case analysis elucidates the pathology extremely well.
Deng's comment: Such modifications align well with the pathology.
Sun's comment: Coughing, dry mouth, yellow urine, and skin heat stem from Lung Heat scorching leaves and depleting Yin fluids. One should remove Ma Huang, Cang Zhu, Lian, and Zhu Ling, which injure Yin and consume fluids; careful study will clarify this.
At forty years old, Yin Qi naturally halves, as has been the case since ancient times. Your constitution is uniquely different, likely due to chronic damp-heat and early sexual decline. Recently suffering from arm pain, this is not the medical text description of sleeping with arms outside the blanket, catching wind and pain. Rather, lying long on bamboo beds allows cold air to gradually enter sinews and bones, progressing further than occasional meridian injury from cold outside the blanket. Thus, Yang Qi cannot circulate, flexion and extension are difficult, pain is daily, and one prefers warmth and dislikes cold. Zhang Zhongjing said: "One arm unable to lift is Bi," recorded in the Wind Stroke section; it is not true Wind Stroke but a precursor to similar stroke, which cannot be ignored. Current treatment prioritizes supporting Yang, nourishing Yin blood, incorporating cold-dispelling methods, adding phlegm-resolving agents, and unblocking meridians, with proper Jun-Chen-Zuo-Shi hierarchy within one formula.
Shudi (Prepared Rehmannia Root) 8 liang, Danggui (Angelica Sinensis) 4 liang, Baishao 2 liang, Huzhang (Pinellia Ternata - *Note: Context implies Pinellia or similar, literally Tiger Palm*) 1 pair, Ejiao (Donkey-hide Gelatin) 3 liang, Banxia (Pinellia Tuber) 4 liang, Juhong (Citrus Reticulatae Pericarpium Rubrum) 2 liang, Zhiqiao (Aurantium Fructus Immaturus) 2 liang, Chenxiang (Aquilaria Wood) 5 qian, Dangshen (Codonopsis Radix) 4 liang, Baizhu (Atractylodis Macrocephalae Rhizoma) 4 liang, Fuling 8 liang, Shufu (Prepared Aconite) 1 liang, Zhigancao (Prepared Licorice Root) 1 liang, Fenghua Xiao (Saltpeter) 1 liang, Guizhi 1 liang, Qianghuo 1 liang, Mian Huangqi (Milky Astragalus Root) 2 liang, Jianghuang (Curcuma Longa Rhizome) 1 piece, Haitongpi (Erythrinae Cortex) 1 liang.
Grind into powder, use Bamboo Sap and Ginger Juice, mix with honey water to form pills.
Liu Yi's commentary: The prescription is clear and thorough, worthy of emulation.
Deng's comment: The formulation expands upon Huangqi Wuwu Tang (Astragalus Five Substance Decoction).
Sun's comment: Comparing the two layers stimulates thought.
Shen Zhi Men (Spirit and Mind Section)
Unclear consciousness, talking to oneself, irregular sitting and rising, loss of sleep-wake rhythm, pulse is small and slippery, tongue coating is white and greasy. This is Phlegm-Heat internally stagnating in the Pericardium, with no outlet, manifesting as Xin Feng (Heart Wind). If prolonged, it will become Dian Xian (epilepsy); do not neglect it.
Daotan Tang (Guiding Phlegm Decoction) (Fuling, Banxia, Zhishi, Xingnan, Wumei, Ju Pi, Shengjiang, Gancao). Add Shichangpu (Acorus Rhizome) and Yuanzhi (Polygalae Radix).
Separately administer Baijin Wan (White Gold Pill).
Liu Yi's commentary: The condition has reached Dian syndrome (mental confusion/mania). Adding Xijiao (Rhinoceros Horn), Longgu (Fossilized Bones), and Muli (Oyster Shell) for clearing and calming would likely be more effective.
Deng's comment: The manifestations belong to Phlegm, with Fire within Phlegm; this is logical. The prescription should follow Master Liu's modified version, referencing Bamboo Sap and Ginger Juice. The Wumei used should be removed.
Sun's comment: Ancient Daotan Tang does not contain Wumei or Shengjiang; likely later errors. Adding Wumei to Phlegm-guiding herbs for astringency contradicts the principle entirely; even Shengjiang is too warm and drying.
Yangming Meridian circles the lips. Red veins on the lips trigger twitching and convulsions; upon waking, foaming occurs, along with hemoptysis, epistaxis, bowel/bladder dysfunction, and a wiry-slippery-rapid pulse. Clearly, stomach accumulation heat agitates blood and generates Phlegm, stirred by Liver Fire; this is the root of Xian Zheng (epilepsy); do not neglect it.
Liuwei Wan (Six Ingredient Pill with Rehmannia), added with Chuan Bei (Fritillaria Cirrhosa Bulb) and Shijueming (Haliotidis Concha).
Separately administer Huqing Wan (Tiger Eye Pill) (1 Tiger Eye, 1 liang Prepared Dahuang, 5 qian Yuanzhi, 1 liang Xijiao, 1 liang Hei Zhi, honey pills, take 21 pills per dose).
Liu Yi's commentary: If there is stomach accumulation heat, Liuwei Wan is insufficient. Moreover, acidic and warm herbs like Shan Zhu Yu should be avoided.
Further note: Accumulation heat differs from stagnation accumulation. Dahuang and Hei Zhi in Huqing Wan are set to drain heat.
Deng's comment: Using these two pills together is ingenious: one nourishes Liver-Kidney Yin, the other clears Yangming Ying heat.
Sun's comment: Foaming indicates damp-heat steaming Phlegm in the Stomach; hemoptysis indicates unresolved heat-stasis in the Stomach. The prescribed formulas do not match; only Huqing Wan is adequate.
The cause of epilepsy invariably involves Dragon-Lei Fire ascending; this case additionally involves damp-heat Phlegm harmonizing to cause harm.
Liuwei Wan, added with Longchi (Dragon Bone), Shijueming, Juhong, Hei Zhi, Chuan Bei, Chuan Lian (Coptis Rhizome), and Zhuru (Bambusa Textilis Caulis).
Liu Yi's commentary: Reading several epilepsy cases, Liuwei Wan is consistently primary. Liuwei Wan tonifies the Three Yin. Master Liu adheres to the Neijing phrase "Heavy Yin leads to Dian," believing epilepsy always involves Dragon-Lei Fire, thus prioritizing nourishing Water to soften Wood. However, epilepsy can stem from fetal fright, congenital Yin deficiency, or internal disturbance by fright-Phlegm; treatment must follow the specific cause, not a single rigid approach.
Deng's comment: For Yin deficiency, Liuwei Wan is indeed primary. However, for depression-Phlegm or fright-Phlegm with internal Phlegm-Fire excess, Dihuang and Shan Zhu Yu are unsuitable.
Sun's comment: Ancients state Chuan Bei treats Lung dry-Phlegm. If damp-heat steaming Phlegm is present, Banxia should be used; "drying-dampness" contradicts the diagnosis. Why is medication analysis not clearer?
Fright causes Qi chaos, spirit leaves the empty house, Phlegm-saliva attacks; this leads to palpitations, dull expression, amnesia, and muteness. Amenorrhea, with blood merging internally, requires medication addressing blood aspects.
Fuling, Xiangfu (Cyperi Rhizoma), Chenxiang, Banxia, Juhong, Yuanzhi, Dansheng (Arisaema cum Bile), Niuxi (Achyranthes Bidentatae Radix).
Separately administer Jingqi Wan (Startle Qi Pill) (Baihua She, Xie, Can, Bingpian, Shexiang, Chensha, Baifu, Mahuang, Tianma, Juhong, Nanxing, Suzi).
Liu Yi's commentary: Suggest adding Danshen, Hupo (Amber), and Guixu (Angelica Sinensis Root Tips) to address the blood aspect, aligning with the case notes.
Deng's comment: Heart Fire should also be cleared; clearing fire and regulating Qi promotes blood circulation and meridian unblocking. Master Liu's additions are appropriate.
Sun's comment: Careful observation reveals the illness stems from internal blood stasis combined with Phlegm-Heat rushing upward. Master Liu's additions are lawful; follow them.
Palpitations, initially from fright, became habitual, persisting for years without cure. Hand tremors, rough tongue, pulse is hollow and slippery, intolerance to fatigue. This is original Heart Blood deficiency with Phlegm-saliva attack.
Renshen, Xuanshen (Scrophulariae Radix), Danshen, Zaoren (Ziziphi Spinosae Semen), Tiandong (Asparagi Tuber), Maidong, Shichangpu, Fuling, Fushen (Poria with Hostwood), Danggui, Yuanzhi, Wuwei Zi, Jiegeng (Platycodon Root), Banxia, Shengdi (Rehmanniae Radix), Juhong, Zhiqiao, Bairén (Prunus Armeniaca Seed), Zhigancao, Zhuru.
Original Note: This combines Tianwang Buxin Dan (Emperor of Heaven's Heart-Nourishing Pill) with Shiwei Wandan Fa (Ten-Ingredient Warm Gallbladder Method). Original Heart Blood deficit is treated by Buxin Dan; Phlegm-saliva attack is treated by Shiwei Wandan Tang.
Deng's comment: Hand tremors and palpitations often involve mixed Wind-Phlegm; Gouteng (Uncaria Rhynchophylla), Tianma, Fangfeng, etc., should be added.
Sun's comment: Limb tremors show Wind movement signs; add Wind-extinguishing herbs like Tianma.
Damp-heat generates Phlegm, remaining in the Fu organs of Hand-Foot Shaoyang, affecting the Pericardium. Palpitations, timidity, irritability, amnesia, overthinking, turbid-greasy-yellow tongue coating, chest-epigastric internal heat. Clearing and transforming is appropriate.
Huanglian Wendan Tang (Coptis Warm Gallbladder Decoction), added with Yangshen (American Ginseng) and Pipa Ye.
Original Note: Turbid-greasy-yellow tongue coating warrants adding Huanglian to dry dampness with bitterness. Yangshen nourishes Yin, Pipa Ye clears Lung; likely a Fire-excess constitution with deficient Lung fluids, correcting the excessive dryness of Erchen Tang.
Deng's comment: Manifestations of turbid coating and epigastric fullness make clearing-transforming very appropriate. Adhering strictly to nourishing Water and blood with frequent tonics would hinder recovery.
Mental cloudiness and amnesia mostly involve Pericardium disease. Left Cun pulse floats up, Guan is wiry-rapid; Right Cun and Guan are small and wiry, white coating covers the tongue, chronic loose stools, limb weakness, fatigue, and drowsiness. Spleen Damp-Phlegm is stirred by Liver Fire, affecting the Pericardium.
Huogen (Agastache Rhizome), Dangshen, Baizhu, Banxia, Chenpi (Citri Reticulatae Pericarpium), Xiangfu, Sharen (Amomi Fructus), Muxiang (Aucklandiae Radix), Chenxiang, Yuanzhi, Zhiqiao, Gegen (Puerariae Lobatae Radix), Shichangpu, Zhuyu.
Treatment Note: There must be accompanying distension; hence many aromatic-drying Spleen-harmonizing herbs. Gegen and Huogen intend to clear Summerheat-Dampness.
Deng's comment: Pathology deduction is thorough. However, this formula does not fully hit the disease source; Daotan Tang with Yuanzhi, Ginger, Lian, and Baizhu is better. Replace Zhuyu with Zhuru.
Sun's comment: Loose stools, fatigue, and drowsiness suggest abdominal pain, justifying aromatic-drying Spleen herbs. Huogen and Gegen clear Summerheat and raise clear Qi.
Second visit: Phlegm is brewed by Dampness, Dampness originates from Spleen. If Spleen transport functions normally, no Dampness generates Phlegm, and amnesia symptoms will vanish. Thus, strengthening Spleen is essential.
Xiangsha Liujunzi Tang (Amomum and Aucklandia Six Gentlemen Decoction), added with Shayuan (Astragali Complanati Semen), Yuanzhi, and Guya (Sprouted Grain).
Original Note: White coating, loose stools, fatigue, and drowsiness are Spleen exhaustion signs; thus, strengthen Spleen and transform Dampness.
Deng's comment: Case notes are elegant. Shayuan is less appropriate than Yizhi (Alpinia Oxyphylla Fructus).
Tan Huo Men (Phlegm-Fire Section)
Stomach is the vessel storing Phlegm; ascending to Pericardium, mild cases cause chest oppression, severe cases cause mental cloudiness.
Daotan Tang combined with Wendan Tang.
Separately administer Baijin Wan.
Liu Yi's commentary: This is the standard treatment for Phlegm obscuration. For this condition, it is still a light formula.
Deng's comment: This must be a case of heavy Phlegm and light Fire.
Sun's comment: Mental cloudiness should include aromatic orifice-opening herbs like Shichangpu and Yuanzhi.
History of blood loss, currently internal heat with expectoration, severe nightmares at night, pulse slippery-rapid. Caused by Yin deficiency with Phlegm retention.
Shiwei Wendan Tang (Ten-Ingredient Warm Gallbladder Decoction), added with Maidong and Guishen.
Liu Yi's commentary: Medication for Yin deficiency with Phlegm is hardest to balance perfectly. Shiwei Wendan Tang is Wendan Tang removing Zhuru, adding Renshen, Dihuang, Zaoren, Yuanzhi, Wuwei Zi; it treats Cold-Phlegm flooding Gallbladder, Gallbladder Cold-Liver Heat, palpitations, and insomnia.
Deng's comment: Slippery-rapid pulse indicates internal Phlegm-Fire excess. Renshen, Dihuang, and Wuwei Zi may hinder Phlegm-Fire.
Sun's comment: The application of Shiwei Wendan Tang has never been clarified by predecessors. This shows Master Liu studied texts carefully.
Tan Yin Men (Phlegm-Fluid Section)
Accumulated fluids form cysts.
Pingchen Tang (Leveling Phlegm Decoction).
Separate pill formula: Maoyu (Atractylodis Rhizoma) 1 jin, Zhima (Sesame) 0.5 jin, Jiazrou (Jujube Flesh) pills, size of Bianxue Zhizi (Gardenia for bloody stool), taken with decoction.
Liu Yi's commentary: This disease is hard to eradicate completely. Both decoction and pills are well-matched; whether they achieve surface-level cure is unknown.
Deng's comment: Using Maoyu with Zhima likely addresses intestinal dryness from bloody stool.
Epistaxis and spermatorrhea, Lung and Kidney both diseased; chills, fever, and night sweats, Ying and Wei both injured. Major tonification is necessary. However, pulse is fine-wiry, tongue coating covers the surface, bowel/bladder dysfunction, poor appetite, and Spleen suffers from Damp-Phlegm. First resolve Dampness and strengthen Spleen, then discuss tonification.
Zisha Erchen Tang (Cardamom and Tangerine Peel Two Aged Things Decoction), added with Wumei and Shengjiang.
Liu Yi's commentary: Wumei in the formula seems out of place. Checking *Yitong*, ancient Erchen Tang contains Wumei to astringe and protect Stomach Yin; Master Liu's intent may be here.
Deng's comment: Uncontrolled essence-blood and sweat are also due to internal disturbance by Phlegm-Fire and damp-heat.
Sun's comment: Wumei is likely used for night sweats; astringing Yin and harmonizing Yang is slightly inferior to Wuwei Zi.
Wheezing upon exertion, also when speaking, indicates Lower Deficiency, explaining discomfort in bending and stretching. Epigastric tenderness, dull pain, throbbing, and excessively wiry Middle Jiao pulse indicate Damp-Heat and turbid Phlegm obstructing the Stomach. Loss of downward flow violates normal physiology; treating solely as deficiency is inappropriate.
Chuan Bei, Chenpi, Fuling, Baishao, Niuxi, Haishe (Sea Snake), Biqi (Water Chestnut).
Separately administer Shui Fan Zisheng Wan (Water-Pellet Vitality Generating Pill).
Liu Yi's commentary: This likely involves Phlegm-fluids obstructing the Middle Jiao; apply insights from the Fluid section.
Deng's comment: With Lower Deficiency and Upper Excess, medication must not interfere. This formula is balanced; adding Gualou (Trichosanthes Fruit), Lian (Coptis), and Sangbai (Morus Root Bark) is suggested. Excessively wiry Middle pulse implies Wood-Fire involvement.
Second visit: Freedom in bending/stretching indicates gradual unblocking. Wheezing during speech/movement and epigastric tenderness are improving daily, a great sign. Moving Qi attacking and throbbing persists, accompanied by Qi sinking to Lower Abdomen, relieved by lying down. This is not failure of Stomach Qi to descend, but failure of Spleen Qi to ascend.
Xiangsha Liujun Wan (Amomum-Aucklandia Six Gentlemen Pill) combined with Xue Geng (Snow Broth), added with Shenqu (Medicated Leaven).
Separately administer Zisheng Wan.
Liu Yi's commentary: Argument is precise and clear, but medication is not yet potent enough.
Deng's comment: Not only Spleen Qi fails to ascend, but Wood Qi is also depressed and sunken.
Ke Chuan Men (Cough-Asthma Section)
Over seventy years old, Kidney Qi is deficient below, generating Phlegm invading Lung, cough-asthma with faint pulse; major tonification is required.
Jinshui Liujun Jian (Metal-Water Six Gentlemen Decoction) (Maidong, Dihuang, Ju Pi, Banxia, Fuling, Gancao). Combined with Shengmai San (Generate Pulse Powder), added with Hetao Rou (Walnut Kernel).
Separately administer Baxian Changshou Wan (Eight Immortals Longevity Pill) and Shenqi Wan (Kidney Qi Pill).
Original Note: Tonify Mingmen Fire to generate Earth, clear the source of Phlegm generation, so Lung cough-asthma calms naturally. Decoction Jinshui Liujun Jian treats Spleen-Kidney; Shengmai nourishes Lung; Walnut tonifies Mingmen. For stabilizing Lower Jiao, separate pills are taken regularly; deliberation is perfect.
Deng's comment: This is a method for dual Yin-Yang deficiency.
Asthma with Phlegm rising, chest oppression, cold feet, indicates Middle-Lower Yang deficiency, Qi failing to grasp, and Water flooding. Shenqi Tang has been administered; following with dredging and calming methods is appropriate.
Xuanfu Daizhe Tang (Inula and Hematite Decoction) removing Shengjiang and Dazao, combined with Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction) removing Guizhi and Qianhu.
Caoguo (Black Cardamom), Shengjiang, added with Xiebai (Allium Macrostemon Bulb), Cheqian (Plantago Seed), Fuling, Zhiqiao.
Treatment Note: Following Shenqi Tang with this formula adds Xuanfu and Daizhe to calm rebellion, and Xiebai to unblock Yang; intention is thorough.
Deng's comment: Kidney-tonifying herbs like Chenxiang and Geke (Tridacna Concha) could be added.
Xiebai treats chest oppression; Cheqian and Fuling reduce scanty urine.
Winter cough is a chronic habit. Unresolved in Spring, extending to Summer. Edema appeared in Spring; abdominal distension increased in Summer. Dry mouth, peeled tongue, Fire rising, Qi reversing, Right pulse soggy-rapid, Left pulse floating-wiry. Wind-pathogen and damp-heat move from Upper to Lower, then to Middle. As classics state: "Long-lasting cough affects the San Jiao; San Jiao cough presents with cough and abdominal distension." With heavenly heat descending, urine becomes shorter, feet remain cold. Middle Jiao originally has obstruction signs, harmonizing to cause harm; medication is tricky. Tentatively propose heavy-substance opening-lowering method, assisted by Stomach-harmonizing and Liver-draining agents.
Zhuling (Polyporus), Jijin (Chicken Gizzard Membrane), Baizhu, Shigao (Gypsum Fibrosum), Hanshuishi (Halloysitum Rubrum), Xue Geng, Rougui (Cinnamon Bark), Pipa Ye.
Original Note: Wind-pathogen consolidates in Lung; if Lung Qi is originally deficient, it sinks from Lung to Spleen, leaving a thread of hope. Added dry mouth and peeled tongue indicate Yin deficiency with Fire, making it harder to treat. Using Hejian Ganlu (River Between Sweet Dew) concept, heavy-substance opening-lowering, the formula is excellent; efficacy is unknown.
Liu Yi's commentary: Pathology is complex and hard to address; using Guiling method modifications shows painstaking effort. However, regarding obstruction-fullness, the two stones (Shigao, Hanshuishi) may interfere; Fuling and Huashi (Talcum) seem indispensable.
Deng's comment: Winter cough implies Kidney Qi deficiency. Edema indicates Spleen-Kidney deficiency connection. Using two stones to treat Phlegm-Fire branch may hinder Spleen-Kidney root; this is inherently incurable.
Sun's comment: Yin deficiency with Fire hyperactivity requires salty-cold herbs; two stones directly clear Excess Fire, injuring Yin further.
After chills-fever, thick cough-phlegm, headache, thirst, red tongue, rapid pulse, loose stools. Winter-Warmth pathogen stagnates in Lung division, transforming via Dryness; must drain and clear.
Weirui Tang (Smilax Glabra Decoction) (Weirui, Shigao, Qingmuxiang, Weimao, Mahuang, Chuanxiong, Gegen, Qianghuo, Gancao, Xingren).