王（右） 先是肝胃不和，木郁土中，中脘作痛，痛势甚剧。至仲春忽尔面目肢体发黄，小溲红赤，漩脚澄
下，则黄如柏汁。至今时痛时止，口吐涎沫。脉沉弦带涩。考中脘为胃土所居之地，阳明又为多气多血
之乡，今久病而气滞于络，气多血多之处，气亦留阻，血亦瘀凝，相因之理，有必然者。夫至血凝气滞，则
流行之道，壅而不宣，木气横行，土气郁阻，所以为痛为黄。实与黄胆有间。拟宣络化瘀法。
当归须 延胡索 乌药 单桃仁 瓦楞子 广郁金
制香附 甜广皮 川桂木 旋复花 猩绛 青葱管
二诊 中脘较舒，痛亦未甚，未始不为起色。然面目色黄不减，脉仍弦涩。无非络阻气滞，气血不行。药
既应手，宜守前意出入。
旋复花 瓦楞子 南楂炭 当归尾 建泽泻 单桃仁
广郁金 真猩绛 沉香曲 香附 青葱管
三诊 病势稍疏，遍体黄色略退。然中脘气滞，痛势虽轻，仍不能脱然无累。络气被阻，营气不行。再化
气瘀而通络隧。
延胡索 瓦楞子 单桃仁 青皮 炒杭白芍 旋复花
制香附 当归尾 猩绛 木猪苓 建泽泻 青葱管
沈（右） 产后气血亏损，不能制伏肝木，以致木乘土位，饮食稍一过节，辄作便泄，中脘作痛，噫出腐气。
脉象细弦，舌苔腻浊。肝强土弱，拟温中运中，所谓将欲升之，必先降之也。
炒木瓜皮（一钱五分） 云茯苓（二钱） 上广皮（一钱） 炒杭白芍（一钱五分） 白蒺藜（三钱） 煨益智仁
（八分） 炒薏仁（三钱） 砂仁（四钱） 川朴（一钱）
二诊 温中运中，脉症相安。肝强土弱，脾胃升降失常，所以上则噫腐气，下则便溏泄。脾宜补，胃宜通，
拟养脏疏腑。
整砂仁（盐水炒二粒） 炒于潜术（二钱） 炒东白芍（一钱五分） 炒半夏曲（二钱） 炒木瓜皮（一钱） 上
广皮（一钱） 白蒺藜（三钱） 白茯苓（三钱） 黑大枣（三枚）
金（左） 肝木素旺木来克土，胃气失于通降，不纳不饥，寐则汗出，少腹有时痛胀。宜通补阳，明参以平木。
奎党参（二钱） 白茯苓（三钱） 制半夏（一钱五分） 藿香（一钱五分） 砂仁（四分） 炒木瓜（一钱）
炒于术（一钱） 炒白芍（一钱五分） 陈皮（八分） 炙黑草（三分）
周（左） 湿寒内伏，脾胃健运迟钝，胃呆少纳，形体恶寒非。寒也卫气之阻也。
炒于术（二钱） 川桂枝（四分） 广皮（一钱） 生熟薏仁（各二钱） 猪苓（二钱） 制半夏（一钱五分）
白茯苓（三钱） 砂仁壳（五分） 炒谷芽（一钱五分） 玫瑰花（二朵）
二诊 胃纳稍起，痰多微咳。再温脾胃阳气。
制半夏（一钱五分） 煨益智（七分） 橘皮（一钱） 生熟薏仁（四钱） 藿香（二钱） 炒于术（二钱）
白茯苓（三钱） 炒竹茹（一钱） 炒谷芽（二钱） 玫瑰花（二朵） 老生姜（二片）
陈（左） 中虚夹痰，胆胃失降，甲木升浮，头胀眩晕，有时火升，身体似觉升浮，四肢作麻。脉形濡滑。虚里
跳动。宜化痰而扶持中气。
人参须（另煎冲七分） 陈胆星（五分） 煨天麻（一钱五分） 制半夏（一钱五分） 茯苓（三钱） 炙绵
（二钱） 生薏仁（四钱） 川萆 （一钱五分） 海蛤粉（三钱） 大淡菜（二只） 白金丸（四分先服）
沈（左） 中虚湿阻，不纳不饥，脾土不运，胃土不降，二土气滞木气遂郁，如种植然，其土松者其木荣，其
土坚者其木萎，土病及木，大概如此。今诊六脉细弦，均有数意，舌红苔黄，微带灰霉。谷食不进，气冲哕
恶。若以痰浊上泛，则脉象应当滑大，今细弦而数，其为土虚木乘无疑。夫土中有木，木土相仇，虽饮食
倍常者，且将由此而减，而况先从脾胃起点乎。欲求安谷，必先降胃，欲求降胃，必先平肝，金匮厥阴篇
中每以苦辛酸主治，即宗其意，以观动静如何。方草即请浓甫先生商政。
台参须（另煎冲一钱） 雅连（四分） 杭白芍（二钱） 橘白（一钱） 佩兰叶（一钱） 淡干姜（三分）
淡黄芩（一钱） 制半夏（一钱五分） 茯苓（三钱） 炒麦芽（一钱） 泽泻（一钱） 水炒竹茹（一钱）
二诊 哕恶少定，胃纳略觉增多，寐稍安稳。舌红略淡，灰霉已化，脉象细弦，仍有数意。中脘微痛，土中
有木，即此可知。中气素虚，胃浊素重，然浊虽中阻，而缠绵二月，和中化浊，屡投频进，而何以浊不得化，
胃不得和。良以木火犯中，浊被火蒸，则胶滞难化，胃中之浊气不降，则胃中之清气不升，不纳不饥，势
所必至。前投扶土熄木，尚合机宜，再拟扶持中气，化浊和中，仍参熄木，以望肝胃协和，清升浊降，胃气
从此鼓舞，然不易也。方草即请商裁。
小兼条参（一钱五分另煎冲） 制半夏（一钱五分） 炒香甜杏仁（二钱） 云茯苓（三钱）
代赭石（三钱） 佩兰叶（一钱） 盐水炒竹茹（一钱） 旋复花（包一钱五分） 焦麦芽（二钱）
广橘白（一钱） 枳实（一钱） 左金丸（七分入煎另四分开水先送下）
三诊 扶中熄木，哕恶又得稍减，舌心 白之苔，亦得全化，胃中之浊，有渐化之机，肝木亦得稍平。惟
冒纳仍未馨增，胃气虚而不复，胃中之清气，不能鼓舞。再扶持中气，养胃化浊，即请商裁。
小兼条参（另煎冲二钱） 炙甘草（四分） 水炒竹茹（一钱五分） 茯苓（三钱） 炒木瓜皮（一钱五分）
制半夏（一钱五分） 橘皮（一钱） 炒香甜杏仁（三钱） 炒谷麦芽（各一钱） 炒焦秫米（一钱五分）
佩兰叶（一钱五分） 玫瑰花（去蒂三朵）
四诊 气虚脾弱，湿热留停，不能旋运，以致湿气泛溢，入于肌肤，由足肿而致肤胀面浮。恐延蔓入腹。
大腹皮（二钱） 茯苓皮（二钱） 通草（一钱） 泽泻（一钱五分） 五加皮（二钱） 广陈皮（一钱）
猪苓（二钱） 生姜衣（二分） 生熟薏仁（各五钱） 炒冬瓜皮（一两以上二味煎汤代水）
荣（左） 气虚脾弱，旋运失常。胃纳不馨，咽中不爽。宜和中化痰，以裕其生化之源。
人参须（七分） 益智仁（一钱） 茯苓（四钱） 制半夏（一钱五分） 僵蚕（一钱五分） 野于术（一钱五分）
白蒺藜（三钱） 橘皮（一钱） 天麻（一钱五分） 泽泻（一钱五分） 玫瑰花（二朵） 生熟谷芽（各一钱五分）
子浓兄 人之一身，气血阴阳而已。血阴气阳，气中之血，阳中之阴也，血中之气，阴中之阳也。病从暑
温而起，变成外疡，其湿热之盛，不问可知。乃疡肿而溃，溃而不敛，脓水去多，气中之血既虚，血中之气
亦损，以致肌肉瘦削，便泄无度。刻下泄虽渐定，而二便不固，痰气上升，胸次窒闷，口渴而不欲饮。舌苔
糜腐，质淡白。小溲带黑，并无热痛情形。四肢虽属温和，而自觉恶寒，知味而不能食。脉左寸细数，关部
弦搏，尺部细而带涩，右部濡弱，重按微滑，尺部细沉。手太阴之津，足阳明之气，足少阴之水，一齐耗亏，
而湿痰留恋于胃之上口，致补益之品，不能飞渡胃关，气血从而日耗。勉同蓉舫先生议气血并补，汤
丸并进，勿壅滞胃口，即请商政。
南沙参（炒黄三钱） 橘红（盐水炒五分） 水炒竹茹（八分） 霍石斛（三钱） 青盐半夏（一钱五分
）生薏仁（三钱） 炒扁豆衣（三钱） 白茯苓（三钱） 生谷芽（一钱五分） 佩兰叶（一钱）
丸方
吉林参（一钱烘另研和入） 生于术（一钱） 杭白芍（一钱五分川芎一钱煎汁收入） 生熟绵 （各一
钱） 大熟地（砂仁炙四钱） 上徭桂（四分另研和入） 生熟草（各二分） 云苓（三钱） 当归（炒透一钱）
上药研为细末，浓粳米汤打糊为丸绿豆大，每服三钱，药汁送下。
二诊 昨进气阴并补，痰涌稍定，寐醒之时，汗出亦止，胸次亦觉快畅，舌苔糜腐较化，未始不为起色。
无如湿热逗留，津气遏伏，不能上布，虽不引饮，而频觉口渴。舌质干光少津。懊 里急，小溲涩少。脉弦
搏稍收。而均带细数。气血并亏，方虑草木无情，不能相济，乃湿热隐伏，致培养之剂，动多窒碍。勉与蓉
舫先生同议，肾为肺子，金为水母，益水之上源，参以和中流化之品。即请商政。
吉林参（一钱咀作小块药汁送下） 海蛤壳（八钱打） 云苓（三钱） 木猪苓（二钱） 冬瓜子（三钱）
半夏曲（一钱五分） 炒松天冬（三钱） 白扁豆花（一钱） 霍石斛（四钱） 生薏仁（三钱） 建泽泻（一钱
五分） 干白荷花瓣（六片）
华（左） 劳倦内伤，背肋作痛。不能急切图功。
白术 赤白苓 白蒺藜 川桂枝 泽泻 秦艽 丝瓜络 桑寄生 川独活 范志曲
钱（左） 食入运迟，肢困力乏。脾阳为湿所遏。宜祛湿崇土。
广皮 枳壳 赤白苓 猪苓 生薏仁 沉香曲 砂仁 泽泻 小川朴 制半夏 莱菔子（三钱） 焦麦芽
左 劳倦伤脾，湿土化风，其来也渐，其去也难。
炒白术 蒺藜 猪苓 生薏仁 半夏 焦麦芽 赤白苓 僵蚕 泽广皮 天麻 苍矾丸（百粒）
薛（左） 涌涎较定，形寒而仍恶心。还是胃中阳气有亏，不足以约束津液。踵前法以觇其后。
制半夏 广藿香 广皮 奎党参 生熟草 炒冬术 云茯苓 炮姜 益智仁
程（左） 大便或结或溏，小溲时带黄赤。此由脾虚湿胜，土困于湿，则旋运失常，祛湿所以崇土也。
白术 川朴 生薏仁 陈皮 泽泻 赤白苓 猪苓 制半夏 生熟谷芽
左 温助命阳，欲其蒸变，使其胃中之痰默化。而咽舌俱燥，未便过进辛温。据述平素嗜饮。再从中阳
损伤不能转旋例治。
奎党参 范志曲 砂仁 赤白苓 蜜干姜 白术 白蔻仁 葛花 青陈皮 泽泻
左 饮食在胃，运化在脾，然所以运化者，阳气之鼓舞也。湿温之后，多进甘寒，致湿邪日见其有余，阳
气日形其不足，所以纳食之后，动辄胀满，脘中微觉坚硬。脉细而沉。胃府失其通降之权。宜温运和中，
使脾胃之气，旋运鼓舞，则不治其满而满自退也。
上川朴 于术 连皮苓 草果仁 焦麦芽 川椒目 泽泻 公丁香 上广皮 生姜衣
陈（左） 劳倦伤脾，脾病则四肢不用矣。
焦苍术（二钱） 范志曲（二钱炒） 川朴（一钱） 晚蚕砂（三钱） 上广皮（一钱） 制半夏（一钱五分）
萆（三钱） 白蒺藜（三钱） 秦艽（一钱五分） 焦麦芽（四钱） 酒炒桑枝（五钱）
又 神情稍振，再守效方出入。
焦白术（一钱） 范志曲（二钱炒） 川朴（一钱） 秦艽（一钱五分） 上广皮（一钱） 制半夏（一钱五分）
川萆 （二钱） 泽泻（一钱五分） 生薏仁（四钱） 赤猪苓（各二钱） 焦麦芽（三钱） 桑枝（酒炒五钱）
张（左） 神情不爽，头目昏晕，起居动作，甚属畏葸。此湿困脾阳，弗作虚诊。
制半夏 猪苓 赤白苓 生熟薏仁 酒炒桑枝 台白术 泽泻 川萆 白蒺藜
Wang (Right pulse) Initially, Liver-Stomach disharmony occurred, with Liver Qi stagnation in the Spleen-Stomach region, causing severe pain in the epigastrium. In mid-spring, sudden jaundice appeared on the face and limbs, with red urine; after sedimentation, the bottom of the urine was yellow like crape myrtle juice. Since then, the pain has come and gone intermittently, accompanied by spitting of saliva. The pulse is deep, wiry, and choppy. Examining the epigastrium as the dwelling place of Stomach Earth, and the Yangming channel as a region abundant in Qi and Blood, prolonged illness leads to Qi stagnation in the collaterals. In this region of abundant Qi and Blood, both Qi and Blood become obstructed and coagulated, which is an inevitable consequence of their interdependence. When Blood coagulates and Qi stagnates, the pathways of circulation become blocked and unventilated. Liver Qi rebels horizontally, and Spleen Earth Qi becomes depressed, resulting in pain and jaundice. This differs from true Jaundice disease (Huangdan). A method to vent the collaterals and resolve stasis is proposed.
Danggui Xu (Angelica Sinensis Root Hair), Yanhusuo (Corydalis Rhizome), Wuyao (Lindera Root), Dan Taoren (Single Peach Kernel), Walengzi (Arca Shell), Guang Yujin (Curcuma Aromatica Rhizome).
Zhi Xiangfu (Cyperi Rhizoma Prepared), Tian Guangpi (Sweet Tangerine Peel), Chuan Guimu (Cinnamon Twig), Xuanfuhua (Inula Flower), Xingjiang (Safflower), Qingcongguan (Green Onion Stem).
Second visit: The epigastrium feels more comfortable, and the pain is not severe, which is undoubtedly a sign of improvement. However, the facial jaundice has not faded, and the pulse remains wiry and choppy. This indicates collateral obstruction and Qi stagnation, preventing Qi and Blood from circulating. Since the medication has been effective, the previous strategy should be maintained with modifications.
Xuanfuhua, Walengzi, Nanzha Tan (Charred Hawthorn Fruit), Danggui Wei (Angelica Sinensis Tail), Jian Zexie (Alisma Rhizome), Dan Taoren.
Guang Yujin, Zhen Xingjiang (Safflower), Chenxiang Qu (Agarwood Fermented Pill), Xiangfu, Qingcongguan.
Third visit: The disease condition has slightly eased, and the generalized yellow color has somewhat receded. However, Qi stagnation in the epigastrium persists; although the pain is lighter, it has not completely resolved. Collateral Qi is obstructed, and Ying (Nutritive) Qi cannot circulate. Again, resolve Qi-Blood stasis and unblock the collaterals.
Yanhusuo, Walengzi, Dan Taoren, Qingpi (Tangerine Peel), Chao Hang Baishao (Stir-fried Hangzhou White Peony Root), Xuanfuhua.
Zhi Xiangfu, Danggui Wei, Xingjiang, Mu Zhuling (Polyporus), Jian Zexie, Qingcongguan.
Shen (Right pulse) Postpartum deficiency of Qi and Blood fails to control Liver Wood, leading to Liver Wood overacting on Spleen Earth. Slight dietary excess triggers diarrhea, epigastric pain, and belching of putrid odor. The pulse is fine and wiry; the tongue coating is greasy and turbid. With strong Liver and weak Spleen, a method to warm the Middle and promote transportation is proposed, following the principle: "To ascend, one must first descend."
Chao Mugua Pi (Stir-fried Papaya Peel, 1.5 qian), Yun Fuling (Poria, 2 qian), Shang Guangpi (Premium Tangerine Peel, 1 qian), Chao Hang Baishao (Stir-fried Hangzhou White Peony Root, 1.5 qian), Bai Jili (Tribulus Fruit, 3 qian), Wei Yizhiren (Baked Alpinia Oxyphylla Seed, 0.8 qian).
Chao Yiren (Stir-fried Coix Seed, 3 qian), Sharen (Amomum Fruit, 4 qian), Chuan Pu (Magnolia Bark, 1 qian).
Second visit: After warming the Middle and promoting transportation, the pulse and symptoms are stable. Due to strong Liver and weak Spleen, the ascending and descending functions of Spleen and Stomach are disordered, causing upper belching of putrid odor and lower loose stools. The Spleen requires tonification, and the Stomach requires unblocking. A method to nourish the Zang organs and unblock the Fu organs is proposed.
Zheng Sharen (Whole Amomum Fruit, stir-fried in salt water, 2 grains), Chao Yuqian Zhu (Stir-fried Yuqian Atractylodes Rhizome, 2 qian), Chao Dong Baishao (Stir-fried East Baishao, 1.5 qian), Chao Banxia Qu (Stir-fried Pinellia Fermented Pill, 2 qian), Chao Mugua Pi (Stir-fried Papaya Peel, 1 qian), Shang Guangpi (1 qian), Bai Jili (3 qian), Bai Fuling (White Poria, 3 qian), Hei Dazao (Black Jujube, 3 pieces).
Jin (Left pulse) Liver Wood is inherently hyperactive, overacting on Earth. Stomach Qi loses its descending function, leading to lack of appetite and hunger, night sweats, and occasional lower abdominal pain and distension. It is appropriate to tonify Yang while referencing methods to calm Liver Wood.
Kui Dangshen (Codonopsis, 2 qian), Bai Fuling (Poria, 3 qian), Zhi Banxia (Prepared Pinellia Rhizome, 1.5 qian), Huoxiang (Patchouli Leaf, 1.5 qian), Sharen (Amomum Fruit, 0.4 qian), Chao Mugua (Stir-fried Papaya, 1 qian).
Chao Yuzhu (Stir-fried Atractylodes Macrocephala Rhizome, 1 qian), Chao Baishao (Stir-fried White Peony Root, 1.5 qian), Chenpi (Tangerine Peel, 0.8 qian), Zhihei Cao (Charred Licorice Root, 0.3 qian).
Zhou (Left pulse) Damp-Cold lurks internally, slowing down Spleen-Stomach transportation. The Stomach is dull with poor intake. The aversion to cold in the body is not due to external Cold but rather obstruction of Wei (Defensive) Qi.
Chao Yuzhu (Stir-fried Atractylodes Macrocephala Rhizome, 2 qian), Chuan Guizhi (Cinnamon Twig, 0.4 qian), Guangpi (Tangerine Peel, 1 qian), Sheng Shu Yiren (Raw and Cooked Coix Seed, 2 qian each), Zhuling (Polyporus, 2 qian), Zhi Banxia (Prepared Pinellia Rhizome, 1.5 qian).
Bai Fuling (White Poria, 3 qian), Sharen Qiao (Amomum Fruit Husk, 0.5 qian), Chao Guya (Stir-fried Rice Sprout, 1.5 qian), Meiguihua (Rose Flower, 2 buds).
Second visit: Appetite has slightly improved, with excessive phlegm and mild cough. Continue to warm Spleen and Stomach Yang.
Zhi Banxia (Prepared Pinellia Rhizome, 1.5 qian), Wei Yizhi (Baked Alpinia Oxyphylla Seed, 0.7 qian), Jupi (Tangerine Peel, 1 qian), Sheng Shu Yiren (Raw and Cooked Coix Seed, 4 qian), Huoxiang (Patchouli Leaf, 2 qian), Chao Yuzhu (Stir-fried Atractylodes Macrocephala Rhizome, 2 qian).
Bai Fuling (White Poria, 3 qian), Chao Zhuru (Stir-fried Bamboo Shavings, 1 qian), Chao Guya (Stir-fried Rice Sprout, 2 qian), Meiguihua (Rose Flower, 2 buds), Laoshengjiang (Old Ginger, 2 slices).
Chen (Left pulse) Middle Jiao deficiency with Phlegm accumulation, Gallbladder and Stomach failing to descend, Jia (Liver) Wood floating upward. Symptoms include head distension and dizziness, occasional rising of Fire sensation, feeling of bodily floating, and numbness in the four limbs. The pulse is soggy and slippery. The Xuli (Vital Gate) pulsates. The approach is to transform Phlegm and support Middle Qi.
Renshen Xu (Ginseng Thread, decocted separately, 0.7 qian), Chen Danning (Aged Calamint Star, 0.5 qian), Wei Tianma (Baked Gastrodia Rhizome, 1.5 qian), Zhi Banxia (Prepared Pinellia Rhizome, 1.5 qian), Fuling (Poria, 3 qian), Zhi Mian (Prepared Astragalus Root, 2 qian), Sheng Yiren (Raw Coix Seed, 4 qian), Chuan Bixie (Dioscorea Hypoglauca Rhizome, 1.5 qian), Haige Fen (Clam Shell Powder, 3 qian), Da Dancai (Large Mussel, 2 pieces), Baijin Wan (White Gold Pill, 0.4 qian, taken first).
Shen (Left pulse) Middle deficiency with Damp obstruction, leading to inability to eat or feel hungry. Spleen Earth fails to transport, and Stomach Earth fails to descend. Stagnation in the two Earths causes Liver Wood to depress. Like planting, if the soil is loose, the tree thrives; if hard, it withers. Earth disease affecting Wood is generally like this. Currently, all six pulses are fine and wiry with rapidity. The tongue is red with yellow coating, slightly covered with gray mold. Food intake is poor, with Qi rushing up causing hiccups and nausea. If it were Phlegm-Turbidity rising, the pulse would be slippery and large; now being fine, wiry, and rapid, it is undoubtedly Earth deficiency with Wood overacting. Within Earth lies Wood; Wood and Earth are antagonistic. Even with double the usual diet, digestion will decrease, let alone starting from the Spleen-Stomach. To ensure food assimilation, one must first descend Stomach Qi; to descend Stomach Qi, one must first calm Liver Wood. The *Jinkui Yaolue* Ju Yin chapter often uses bitter, sour, and acrid flavors for treatment. Following this intent, we observe the dynamics. The prescription draft is submitted to Mr. Nongfu for discussion.
Tai Renshen Xu (Ginseng Thread from Taihang, decocted separately, 1 qian), Yalian (Acute Coptis Rhizome, 0.4 qian), Hang Baishao (Hangzhou White Peony Root, 2 qian), Jubai (Tangerine Pith, 1 qian), Peilan Ye (Eupatorium Leaf, 1 qian), Gan Jiang (Dried Ginger, 0.3 qian).
Dan Huangqin (Scutellaria Root, 1 qian), Zhi Banxia (Prepared Pinellia Rhizome, 1.5 qian), Fuling (Poria, 3 qian), Chao Maiya (Stir-fried Barley Sprout, 1 qian), Zexie (Alisma Rhizome, 1 qian), Shui Chao Zhuru (Water-stir-fried Bamboo Shavings, 1 qian).
Second visit: Hiccups and nausea have subsided slightly, appetite has increased marginally, and sleep is somewhat stable. The tongue redness has lightened, and the gray mold has transformed. The pulse is fine, wiry, and still rapid. Mild epigastric pain indicates "Wood within Earth," which can be understood from this. Middle Qi has always been deficient, and Stomach Turbidity heavy. Although Turbidity blocks the Middle, despite two months of harmonizing the Middle and transforming Turbidity with frequent dosing, why has the Turbidity not transformed and the Stomach not harmonized? Primarily because Liver Fire invades the Middle; Turbidity steamed by Fire becomes sticky and difficult to transform. If Stomach Turbid Qi does not descend, Stomach Clear Qi cannot ascend, making inability to eat or feel hungry inevitable. The previous formula supporting Earth and extinguishing Wood was appropriate. Now, again propose supporting Middle Qi, transforming Turbidity, harmonizing the Middle, and still referencing extinguishing Wood, hoping for Liver-Stomach harmony, Clear ascending and Turbid descending, thereby stimulating Stomach Qi, though this is not easy. The prescription draft is submitted for discussion.
Xiao Jian Tiaoshen (Small Joint Strip Ginseng, 1.5 qian, decocted separately), Zhi Banxia (Prepared Pinellia Rhizome, 1.5 qian), Chao Xiangtian Xingren (Stir-fried Sweet Almond, 2 qian), Yun Fuling (Poria, 3 qian).
Daizheshi (Magnetite, 3 qian), Peilan Ye (Eupatorium Leaf, 1 qian), Yanshui Chao Zhuru (Salt-water stir-fried Bamboo Shavings, 1 qian), Xuanfuhua (Wrapped Inula Flower, 1.5 qian), Jiao Maiya (Charred Barley Sprout, 2 qian).
Guang Jubai (Broad Tangerine Pith, 1 qian), Zhishi (Immature Bitter Orange, 1 qian), Zuojin Wan (Left Metal Pill, 0.7 qian added to decoction, remaining 0.4 qian taken separately with water first).
Third visit: Supporting Middle and extinguishing Wood has further reduced hiccups and nausea. The white coating on the center of the tongue has fully transformed, and there is a gradual trend of transforming Stomach Turbidity. Liver Wood has also calmed slightly. However, appetite has not significantly increased. Stomach Qi is deficient and not restored; Clear Qi in the Stomach cannot be stimulated. Again, support Middle Qi, nourish the Stomach, and transform Turbidity. Submitted for discussion.
Xiao Jian Tiaoshen (Small Joint Strip Ginseng, 2 qian, decocted separately), Zhi Gancao (Prepared Licorice Root, 0.4 qian), Shui Chao Zhuru (Water-stir-fried Bamboo Shavings, 1.5 qian), Fuling (Poria, 3 qian), Chao Mugua Pi (Stir-fried Papaya Peel, 1.5 qian).
Zhi Banxia (Prepared Pinellia Rhizome, 1.5 qian), Jupi (Tangerine Peel, 1 qian), Chao Xiangtian Xingren (Stir-fried Sweet Almond, 3 qian), Chao Guya Maiya (Stir-fried Rice and Barley Sprouts, 1 qian each), Chao Jiao Shumi (Stir-fried Charred Millet, 1.5 qian).
Peilan Ye (Eupatorium Leaf, 1.5 qian), Meiguihua (Rose Flower, three buds without stems).
Fourth visit: Qi deficiency and Spleen weakness lead to retention of Damp-Heat, preventing rotation and transportation. Consequently, Dampness overflows into the skin, causing foot swelling leading to skin distension and facial edema. Fear it may spread to the abdomen.
Dafupi (Areca Peel, 2 qian), Fuling Pi (Poria Skin, 2 qian), Tongcao (Tetrapanax Pith, 1 qian), Zexie (Alisma Rhizome, 1.5 qian), Wujiapi (Acanthopanax Bark, 2 qian), Guang Chenpi (Broad Tangerine Peel, 1 qian).
Zhuling (Polyporus, 2 qian), Shengjiang Yi (Ginger Skin, 0.2 qian), Sheng Shu Yiren (Raw and Cooked Coix Seed, 5 qian each), Chao Dongguapi (Stir-fried Winter Melon Peel, 1 liang; decoct these two ingredients to replace water).
Rong (Left pulse) Qi deficiency and Spleen weakness disrupt rotation and transportation. Poor appetite and throat discomfort occur. Harmonize the Middle and transform Phlegm to enrich the source of production and transformation.
Renshen Xu (Ginseng Thread, 0.7 qian), Yizhiren (Alpinia Oxyphylla Seed, 1 qian), Fuling (Poria, 4 qian), Zhi Banxia (Prepared Pinellia Rhizome, 1.5 qian), Jiangcan (Bombyx Batryticatus, 1.5 qian), Ye Yuzhu (Wild Atractylodes Macrocephala Rhizome, 1.5 qian).
Bai Jili (Tribulus Fruit, 3 qian), Jupi (Tangerine Peel, 1 qian), Tianma (Gastrodia Rhizome, 1.5 qian), Zexie (Alisma Rhizome, 1.5 qian), Meiguihua (Rose Flower, 2 buds), Sheng Shu Guya (Raw and Cooked Rice Sprout, 1.5 qian each).
Brother Zinong: The human body consists only of Qi, Blood, Yin, and Yang. Blood is Yin, Qi is Yang; Blood within Qi is Yin within Yang; Qi within Blood is Yang within Yin. The disease started as Summer-Warmth, transforming into an external ulcer. The prevalence of Damp-Heat is evident. The ulcer swelled, ruptured, but did not heal. Excessive loss of pus and fluid depleted Blood within Qi and Qi within Blood, leading to emaciation and uncontrolled diarrhea. Currently, although diarrhea is gradually stabilizing, urination and defecation remain insecure. Phlegm-Qi rises, causing chest oppression, thirst without desire to drink. The tongue coating is eroded and rotting, with a pale-white substance. Urine is dark black without heat or pain. Limbs are warm, yet there is self-perceived aversion to cold. Taste is perceived, but eating is impossible. The Left Cun pulse is fine and rapid; Guan is wiry and forceful; Chi is fine and choppy. The Right pulse is soggy and weak, slightly slippery upon heavy pressure; Chi is fine and deep. Lung Yin, Stomach Qi, and Kidney Water are all depleted. Damp-Phlegm lingers at the upper opening of the Stomach, preventing tonifying substances from crossing the Stomach gate, causing daily depletion of Qi and Blood. I tentatively discuss with Mr. Rongfang simultaneous tonification of Qi and Blood, using both decoctions and pills, avoiding stagnation in the stomach. Submitted for discussion.
Nashashen (Stir-fried Golden Adenophora Root, 3 qian), Juhong (Stir-fried Tangerine Red Peel in salt water, 0.5 qian), Shui Chao Zhuru (Water-stir-fried Bamboo Shavings, 0.8 fen), Huo Shihu (Dendrobium Officinale, 3 qian), Qingyan Banxia (Blue Salt Pinellia Rhizome, 1.5 qian).
Sheng Yiren (Raw Coix Seed, 3 qian), Chao Biandou Yi (Stir-fried Broad Bean Coat, 3 qian), Bai Fuling (White Poria, 3 qian), Sheng Guya (Raw Rice Sprout, 1.5 qian), Peilan Ye (Eupatorium Leaf, 1 qian).
Pill Formula
Jilin Renshen (Jilin Ginseng, 1 qian, baked and ground separately), Sheng Yuzhu (Raw Atractylodes Macrocephala Rhizome, 1 qian), Hang Baishao (Hangzhou White Peony Root, 1.5 qian, combined with Chuanxiong 1 qian decoction), Sheng Shu Mian Huangqi (Raw and Cooked Astragalus Root, 1 qian each).
Da Shudi (Rehmannia Glutinosa Root Prepared, 4 qian, roasted with Sharen), Shang Yao Gui (Premium Cassia Bark, 0.4 qian, ground separately), Sheng Shu Gancao (Raw and Cooked Licorice Root, 0.2 qian each), Yun Ling (Cloud Poria, 3 qian), Danggui (Angelica Sinensis Root, stir-fried thoroughly, 1 qian).
Grind the above herbs into fine powder. Make pills the size of mung beans using thick rice gruel paste. Take 3 qian per dose, washed down with medicinal decoction.
Second visit: Yesterday, simultaneous tonification of Qi and Yin was administered. Phlegm surge has slightly stabilized, sweating upon waking has stopped, and the chest feels freer. The eroded tongue coating has partially transformed, which is undoubtedly a positive sign. However, Damp-Heat lingers, and Jin-Yi fluids are suppressed, unable to distribute upward. Although there is no urge to drink, frequent thirst is felt. The tongue substance is dry, smooth, and lacks fluids. Restlessness and urgency are present, with scanty, painful urination. The wiry and forceful pulse has slightly retracted but remains fine and rapid. Both Qi and Blood are deficient. We worry that herbaceous medicines, lacking emotion, cannot mutually assist. Damp-Heat lies hidden, causing obstructions in nurturing agents. Tentatively discussing with Mr. Rongfang: Kidney is the child of Lung; Metal is the mother of Water. Tonify the upper source of Water, combined with agents that harmonize the middle and transform flow. Submitted for discussion.
Jilin Renshen (Jilin Ginseng, 1 qian, cut into small pieces, taken with decoction), Haigekiao (Clam Shell, 8 qian, crushed), Yun Ling (Cloud Poria, 3 qian), Mu Zhuling (Polyporus, 2 qian), Dongguazi (Winter Melon Seed, 3 qian).
Banxia Qu (Pinellia Fermented Pill, 1.5 qian), Chao Song Tiandong (Stir-fried松 Tianshen/Songtiandong, 3 qian), Bai Biandou Hua (White Broad Bean Flower, 1 qian), Huo Shihu (Dendrobium Officinale, 4 qian), Sheng Yiren (Raw Coix Seed, 3 qian), Jian Zexie (Alisma Rhizome, 1.5 qian).
Gan Baihe Hua (Dry White Lotus Petal, 6 petals).
Hua (Left pulse) Internal injury from labor and fatigue causes back and rib pain. Success cannot be sought hastily.
Baizhu (Atractylodes Macrocephala Rhizome), Chi Bai Ling (Red and White Poria), Bai Jili (Tribulus Fruit), Chuan Guizhi (Cinnamon Twig), Zexie (Alisma Rhizome), Qinjiao (Gentiana Macrophylla Root), Sigualuo (Luffa Fiber), Sangjisheng (Taxillus Branch), Chuan Duhuo (Angelica Pubescens Root), Fanzhi Qu (Fanzhi Fermented Pill).
Qian (Left pulse) Slow digestion after eating, limb fatigue and weakness. Spleen Yang is inhibited by Dampness. Remove Dampness and strengthen Earth.
Guangpi (Tangerine Peel), Zhike (Immature Bitter Orange), Chi Bai Ling (Red and White Poria), Zhuling (Polyporus), Sheng Yiren (Raw Coix Seed), Chenxiang Qu (Agarwood Fermented Pill), Sharen (Amomum Fruit), Zexie (Alisma Rhizome), Xiao Chuanpu (Minor Magnolia Bark), Zhi Banxia (Prepared Pinellia Rhizome), Laifuzi (Radish Seed, 3 qian), Jiao Maiya (Charred Barley Sprout).
Left: Labor and fatigue injure the Spleen; Damp-Earth transforms into Wind. Its onset is gradual, and its departure is difficult.
Chao Baizhu (Stir-fried Atractylodes Macrocephala Rhizome), Jili (Tribulus Fruit), Zhuling (Polyporus), Sheng Yiren (Raw Coix Seed), Banxia (Pinellia Rhizome), Jiao Maiya (Charred Barley Sprout), Chi Bai Ling (Red and White Poria), Jiangcan (Bombyx Batryticatus), Ze Guangpi (Zexie and Tangerine Peel), Tianma (Gastrodia Rhizome), Cangfan Wan (Cangfan Pill, 100 pills).
Xue (Left pulse) Saliva secretion has stabilized, but chills and nausea persist. This is due to deficiency of Stomach Yang, insufficient to constrain fluids. Follow the previous method to observe the outcome.
Zhi Banxia (Prepared Pinellia Rhizome), Guang Huoxiang (Patchouli Leaf), Guangpi (Tangerine Peel), Kui Dangshen (Codonopsis Root), Sheng Shu Cao (Raw and Cooked Licorice Root), Chao Dongzhu (Stir-fried Winter Atractylodes Rhizome), Yun Fuling (Poria), Pao Jiang (Roasted Ginger), Yizhiren (Alpinia Oxyphylla Seed).
Cheng (Left pulse) Stool alternates between constipation and looseness; urine is occasionally yellow-red. This is due to Spleen deficiency and Dampness excess. Earth trapped by Dampness loses its rotational function. Removing Dampness strengthens Earth.
Baizhu (Atractylodes Macrocephala Rhizome), Chuanpu (Magnolia Bark), Sheng Yiren (Raw Coix Seed), Chenpi (Tangerine Peel), Zexie (Alisma Rhizome), Chi Bai Ling (Red and White Poria), Zhuling (Polyporus), Zhi Banxia (Prepared Pinellia Rhizome), Sheng Shu Guya (Raw and Cooked Rice Sprout).
Left: Warmly assist Mingmen Fire to vaporize and transform, allowing silent resolution of Phlegm in the Stomach. However, the throat and tongue are dry, so pungent-warm herbs should not be advanced excessively. According to reports, the patient habitually drinks alcohol. Treat according to the pattern of Middle Yang injury failing to rotate.
Kui Dangshen (Codonopsis Root), Fanzhiqu (Fanzhi Fermented Pill), Sharen (Amomum Fruit), Chi Bai Ling (Red and White Poria), Mi Ganjiang (Honey-processed Dried Ginger), Baizhu (Atractylodes Macrocephala Rhizome), Baokou Ren (White Cardamom Seed), Gehua (Kudzu Flower), Qing Chenpi (Green and Tangerine Peel), Zexie (Alisma Rhizome).
Left: Food enters the Stomach, but digestion occurs in the Spleen. However, what enables digestion is the stimulation of Yang Qi. After Damp-Warmth, excessive consumption of sweet-cold foods leads to increasing Dampness and decreasing Yang. Thus, after eating, blooming occurs frequently, and the epigastrium feels slightly hard. The pulse is fine and deep. The Stomach Fu organ loses its authority of unblocking and descending. Warm and move the Middle to harmonize, stimulating the rotational Qi of Spleen and Stomach, so that without treating the fullness, it will retreat naturally.
Shang Chuanpu (Superior Magnolia Bark), Yuzhu (Atractylodes Macrocephala Rhizome), Lianpi Ling (Poria with Skin), Caoguoren (Tsaoko Cardamom Seed), Jiao Maiya (Charred Barley Sprout), Chuan Jiaomu (Sichuan Pepper Seed), Zexie (Alisma Rhizome), Gong Dingxiang (Public Clove), Shang Guangpi (Superior Tangerine Peel), Shengjiang Yi (Ginger Skin).
Chen (Left pulse) Labor and fatigue injure the Spleen; when the Spleen is diseased, the four limbs lose their use.
Jiao Cangzhu (Charred Atractylodes Lancea Rhizome, 2 qian), Fanzhiqu (Fanzhi Fermented Pill, stir-fried 2 qian), Chuanpu (Magnolia Bark, 1 qian), Wancansha (Silkworm Frass, 3 qian), Shang Guangpi (Superior Tangerine Peel, 1 qian), Zhi Banxia (Prepared Pinellia Rhizome, 1.5 qian).
Bixie (Dioscorea Hypoglauca Rhizome, 3 qian), Bai Jili (Tribulus Fruit, 3 qian), Qinjiao (Gentiana Macrophylla Root, 1.5 qian), Jiao Maiya (Charred Barley Sprout, 4 qian), Jiuchao Sangzhi (Wine-stir-fried Mulberry Twig, 5 qian).
Again: Mental spirit has slightly revived. Continue to follow the effective formula with modifications.
Jiao Baizhu (Charred Atractylodes Macrocephala Rhizome, 1 qian), Fanzhiqu (Fanzhi Fermented Pill, stir-fried 2 qian), Chuanpu (Magnolia Bark, 1 qian), Qinjiao (Gentiana Macrophylla Root, 1.5 qian), Shang Guangpi (Superior Tangerine Peel, 1 qian), Zhi Banxia (Prepared Pinellia Rhizome, 1.5 qian).
Chuan Bixie (Dioscorea Hypoglauca Rhizome, 2 qian), Zexie (Alisma Rhizome, 1.5 qian), Sheng Yiren (Raw Coix Seed, 4 qian), Chi Zhuling (Red Polyporus, 2 qian each), Jiao Maiya (Charred Barley Sprout, 3 qian), Sangzhi (Mulberry Twig, wine-stir-fried 5 qian).
Zhang (Left pulse): Mental spirit is not clear, head and eyes are dizzy. Daily activities and movements are done with great caution. This is Dampness trapping Spleen Yang, not to be diagnosed as deficiency.
Zhi Banxia (Prepared Pinellia Rhizome), Zhuling (Polyporus), Chi Bai Ling (Red and White Poria), Sheng Shu Yiren (Raw and Cooked Coix Seed), Jiuchao Sangzhi (Wine-stir-fried Mulberry Twig), Tai Baizhu (Tai Atractylodes Macrocephala Rhizome), Zexie (Alisma Rhizome), Chuan Bixie (Dioscorea Hypoglauca Rhizome), Bai Jili (Tribulus Fruit).