许（左） 天气温和，头晕辄剧，曾经见红，知系火风。甘凉频进，以胃药治肝，火风虽得稍杀，而脾阳为之
暗损，旋运不及，遂致胃中之水湿停留，胃脘痞阻，甚则呕吐。脉象沉弦。停饮之兆，久恐延膈。
制南星 赤白苓 淡干姜 制半夏 煨天麻 川雅连 白蒺藜 炒枳壳 竹茹（姜汁炒） 白金丸（三分先服）
薛（左） 腹中漉漉，饮象也，口吐涎沫。良以胃气虚寒，津液不能约束，其来也渐，则其愈也难。拟以丸药缓调。
陈半六君丸，每晨服三钱，益智仁一钱，生姜三片，煎汤送下。
杨（左） 停饮内阻，火被水抑，不能蒸变，以致谷食不化，涌吐而出。土为火子，命火不治，则脾土不运，大
便频泄。脉沉细，右尺更甚。宜理中汤。
潞党参（一钱五分） 炮姜（五分） 制附片（五分） 炒于术（二钱） 炙甘草（三分） 白茯苓（三钱）
煨木香（四分）
虞（左） 水饮停留，控之不出，攻之不行，刻下食入倒饱，中脘痞胀， 作酸，欲吐不吐，小溲短少，便不
畅行。脉象濡软。良由久病脾胃气虚，不能运旋，水谷之气，不能变化，清浊不克分渗。用介宾先生五君
子煎，以补脾胃而振中阳，参分化清浊，以观动静。
吉林参（一钱） 云茯苓（四钱） 炙甘草（七分） 炒于术（二钱） 淡干姜（七分） 来复丹（一钱五分药汤
送下）
二诊 温运脾胃，而厘清浊痛胀不退，欲吐不吐，胸中有窒闷莫名之状，大便不行，小溲涩少。脉沉细
微数，舌红前半少苔。停饮日聚于上，胃液日耗于下，攻之不行，执是之故。木为水子，用刚体柔，营液既
虚，则木失涵养，横暴之气，挟痰攻冲。脾胃皆受其困。再养营液，参苦辛酸以制强肝，冀其气平而痰饮默化。
干苁蓉（三钱） 炒萸肉（二钱） 制半夏（一钱五分） 甘杞子（三钱） 茯苓（三钱） 白芍（土炒二钱）
安胃丸（三钱分二次服）
三诊 痰饮结聚于上，肝气纵横于下，以手探吐，痰出略舒，而仍腹满作胀。经谓浊气在上，则生 胀
又谓在上者因而越之。姑再遵此立方。
炒于术（二钱） 陈皮（二钱） 石菖蒲（一钱五分） 川朴（二钱） 生熟草（各三分） 广藿梗（四钱）
六味研末，每服三钱。甜瓜蒂一两，赤小豆一两，二味微炒黄色，研细，另服三钱。均开水调送下。
四诊 肝气挟饮内阻，吐出痰涎甚多。所有痰涎，当从涌出，而胸膈仍然不舒，噫出腐气。脉象濡弱。良
由屡次挖之使呕，胃中之气阴安得不亏，谷气不能变化，酿为腐气。未可漫投消导，用金匮大半夏汤，
以通补阳明，而推扬谷气，参重以镇逆，咸以软痞。
吉林参（八分） 代赭石（四钱） 蜜炙干姜（三分） 炙甘草（五分） 制半夏（二钱） 旋复花（三钱包）
炒木瓜皮（一钱五分） 橘白（一钱） 南枣（三枚） 白蜜（一钱五分入煎）
朱（左） 停饮感寒复发，由脘痛而致呕吐，间日必发，发则脘中不舒，或觉作痛，呕出涎水，方得暂舒。胃
无通降之权，饮食因而降序，股肉因而消瘦。脉象沉弦，舌苔白腻，中心浮浊。水饮不化，阳气不能旋运。
拟分化清浊，兼通胃阳。
制半夏（三钱） 茯苓（五钱） 大腹皮（二钱） 广皮（一钱） 干姜（盐水炒五分） 白蔻仁（五分）
公丁香（三分） 猪苓（二钱） 来复丹（一钱五分开水先送下）
二诊 分化清浊，药进之后，呕出涎水甚多，此病聚于中，不能不出者。既呕之后，至今三日，食未反出，
药病不可谓不投。水饮之气，非温不化，再参马元仪法。
上徭桂（五分去粗皮药汁另煎） 制半夏（二钱） 云茯苓（五钱） 公丁香（三分） 淡干姜（七分）
大腹皮（二钱） 建泽泻（一钱五分） 淡吴萸（五分） 来复丹（三钱开水先送下）
三诊 呕吐暂定，而水气不化，中阳不旋，中脘作痛。脉沉细，苔白质腻。温理中阳，固是定局，然水饮盘
踞，阳气何由得宣。再从温化之中，稍寓攻逐之意。
淡吴萸（五分） 陈皮（一钱） 茯苓（四钱） 大腹皮（二钱） 制半夏（二钱） 公丁香（三分）
淡干姜（七分） 白蔻仁（六分研后入） 制香附（二钱） 上沉香（三分） 黑丑（四分二味研细末生姜汤分二次下）
四诊 温理中阳，兼逐饮邪，阳气转旋，脘痛已止。然正气暗亏，气不得化，小溲不畅。再参扶持中气，以
期气化则水湿亦化。
吉林参（另煎冲八分） 茯苓（四钱） 川桂枝（六分） 白蔻仁（六分研后入） 淡干姜（七分） 泽泻（一
钱五分） 公丁香（五分） 高良姜（五分） 老姜（三片）
改方仍呕 良姜（七分） 广皮（一钱） 公丁香（三分） 制半夏（二钱） 制香附（三钱打） 干姜（七分）
白蔻仁（六分后入） 茯苓（四钱） 上沉香（三分） 黑丑（三分二味同研细末先服）
五诊 饮阻于中，复经吐下，脘痛已止。然小溲未畅，水难外泄。恐饮再停聚。宜分化清浊，再利膀胱以开支道。
制半夏（二钱） 茯苓（四钱） 干姜（六分） 建泽泻（一钱五分） 台白术（二钱） 陈广皮（一钱）
薄官桂（六分） 公丁香（三分） 木猪苓（二钱） 老姜（一钱） 来复丹（一钱开水先服）
六诊 呕吐未作，胃纳渐增。然中脘时仍作痛，大便六日不行。脉行沉细。脾为阴土，主健运而恶湿，今
水久停，则脾土不能运旋，腐气因而阻痹。当再通阳。
制半夏（三钱） 白蔻仁（六分） 制香附（二钱） 泽泻（一钱五分） 云茯苓（五钱） 丁香（三分）
干姜（五分） 猪苓（二钱） 老姜（一钱五分） 半硫丸（一钱五分先服）
七诊 助阳气以资鼓舞旋运，大便通行。然水饮之气，旋去旋停，皆因脾胃之阳，久为困遏，不克转旋。
温中蠲饮，参以分利。
制半夏（三钱） 丁香（三分） 白蔻仁（五分） 建泽泻（一钱五分） 云茯苓（五钱） 淡吴萸（八分）
广橘皮（一钱） 木猪苓（二钱） 老姜片（二钱） 公丁香（二钱另研饭丸姜汤送下）
八诊 水饮根蒂未除，旋去旋停，得呕始宽。燥土利湿，可以通阳，而不能撤水，乘元气未漓，而为攻逐。
叔涛先生所见相同，即行照用。
川桂枝（七分） 茯苓（六钱） 制半夏（二钱） 橘皮（二钱） 淡干姜（七分） 白术（二钱）
大腹皮（二钱） 生甘草（二分） 控涎丹（一钱姜汤下）
九诊 水饮既去，中气不足，旋运不及，去者自去，停者自停。病至则攻，病去则补。
川桂枝（七分） 制半夏（二钱） 大腹皮（二钱） 公丁香（二分） 茯苓（三钱） 川朴（一钱）
老姜（一钱五分） 控涎丹（五分姜汤先服）
又诊 水行后，另服补方。
吉林参（一钱五分） 炙上 （二钱） 桂枝（七分） 川椒目（四分） 木猪苓（二钱） 炒于术（
二钱） 干姜（七分） 茯苓（五钱） 赤石脂（一钱研末饭糊为丸先服）
毛 向有肝气旧恙，秋季肢厥，胸闷头晕，有似发痧，盖气道闭塞，阳气上升，即肝木勃动之先声也。平
复未久，忽复身热腹痛，右半胸腹尤甚，当脐坚硬跳动，缠绵已久，咳嗽痰多，经日盈碗。今痛势虽定，而
遍右尚觉不舒，所最甚者，中宫窒塞，谷食难容，大便不解。六脉濡软，沉候俱弦，右关尤甚，寸细尺沉，左
尺小涩。此肝木纵横，挟内伏之痰饮，乘于土位，肝脏居左，而土位居右，木既乘土，所以痛甚于右也。中
脘属胃，胃为戊土，脐居一身之中，亦土位也，金匮当脐动气，有水邪干土之例，正与痰饮一层吻合。夫
土中之木，木即气也，气乃无形之物，饮为有质之邪，事楚事齐，则是有形者急，无形者缓。欲治有形，可
攻可下，可燥可劫，但可施之于壮实之躯，断难施之于尺脉小涩之体。今食喜暖热，舌苔薄白，而色淡
质腻。长沙云、饮家当以温药和之差。饮为阴邪，阴霾闭塞，非阳光煦照，安能雾散云收。况胃为阳土，水
谷至此，顷刻即消，吾身之一丹灶也。今气停于是，湿停于是，痰停于是，饮停于是，然则水谷之海，岂是
停气停湿停痰停饮之所。特温以煦之，其气既虚，血亦不足，刚燥之品，未免伤阴。拟用长沙栝蒌薤白
汤出入，取辛润滑利，以开胃阳。而辛温大热之品，另制为丸，飞渡上焦，免致伤液。药能应手，尚有可为，
特气弱年高，胜负之数，不能预决耳。管窥所见，尚乞高正。
薤白头（三钱） 制半夏（二钱） 霞天曲（炒一钱五分） 栝蒌仁（五钱姜汁炒研） 广皮（一钱五分）
云茯苓（三钱） 白螺蛳壳（二钱） 生姜汁（两茶匙冲） 上徭桂（三分研细末饭包丸姜汤送下）
服药前先服白酒一小杯，药后再服一杯。
二诊 伐肝通阳，脐腹之痛大减，中脘痞胀略松，稍思纳谷，大便畅行，然每至食后，中州仍觉不舒。数
日之间，先寒后热者再，以胆主开合，为肝之外府，藏病于内，府应于外，则开合为之失度，胆病实肝病
也。高年久病，断无破泄之理。然食能知味，非无胃也，食入必胀，土中有木也，木在土中则有胃若无胃
矣。胃府以通为用。又肝无补法，前人谓泻肝即所以补肝，则是破泄一层，未便过馁。今右关弦滑，尺脉
较前稍起，左关仍弦，沉候尚觉有力。伐肝泻木，虽经病久，尚在急需。拟从辛通之中，参以化痰调气。正之。
半夏曲（二钱） 炒枳壳（一钱） 广皮（一钱） 茯苓（五钱） 白蒺藜（去刺炒三钱） 白芍（土
炒一钱五分） 囫囵砂仁（四分盐水炒后入） 野蔷薇花（七分） 苏 子（磨冲四分） 薤白头（三钱）
上徭桂（五分研末饭丸姜汤分两次送下）
翁（媪） 痰饮内阻，肺气失降，咳嗽痰多气逆，卧着尤甚，食入胀满。脉象沉弦，舌苔白腻。宜温开饮邪，用
重药轻服法。
麻黄（蜜炙后入三分） 淡干姜（三分） 北细辛（二分） 长牛膝（盐水炒三钱） 白芍（酒炒一钱） 桂枝
（三分） 五味子（同干姜打四粒） 炙草（三分） 茯苓（三钱）
二诊 辛温以开太阳，喘咳稍轻，痰略见少。再用三子养亲汤以温肺蠲饮。
白芥子（五分研） 生莱菔子（二钱） 广橘红（一钱） 炒于术（一钱五分） 淡干姜（三分五味子四粒同打）
炒苏子（三钱） 茯苓（三钱） 炒枳壳（一钱） 制半夏（一钱五分）
陈（左） 素体湿盛，日前感受风寒，致风在于上，湿袭于下，上为咳嗽，下为足肿。兹则寒湿之邪，蔓延及
上中脘痞满，胸中作痛，中州格截，上焦之气，尽壅于上，不能下降。日来咳甚气升，不能着卧，痰多成块，
肌肤带肿，面色黄浮。脉细沉弦，舌苔薄白。三焦升降之机，悉为寒痰所阻，深恐升降不通而喘甚致脱，
不得不为预告也。勉拟开降上中，作背城之一战。
甜葶苈 橘红 苏子 连皮苓 枳实 川朴 制半夏 连皮槟 砂仁 沉香（三分） 黑丑（三
分） 皂荚子（一分后三味另研末调服）
陈（左） 肺有伏寒，咳绵不止者已经两载，去秋复感凉燥，咳遂日剧，气逆不平，不能着枕。数日以来，更
带中脘作痛，小腹胀满，大便六日不行。脉形弦滑，苔白口腻。此痰气交阻，土滞木郁，肝木从而不平。深
恐元气难支。
薤白头 制半夏 新会皮 白蒺藜 缩砂仁 制香附
炒枳壳 云茯苓 栝蒌仁（姜汁炒研） 上徭桂（四分饭丸分两次服） 沉香化气丸（四钱绢包入煎）
朱（左） 停饮凝痰，聚于胃府，胃府之气，升多降少，五七日辄呕粘痰涎水，二便不利。脉象沉弦。夫痰之
与津，木属同类，清气化、则随气布而上供，清气不化、则液滞为痰而中阻，气之化与不化，悉视脾阳之
转运如何，所以金匮有饮家当以温药和之之例也。然刚燥之药，多服劫阴，攻逐之剂正虚难任，惟有
分其清浊，使清津上升，浊液下降，虽难霍愈，或可减轻耳。
制半夏（二钱） 云茯苓（八钱） 老生姜（一钱） 来复丹（一钱药汁送下）
二诊 用半夏茯苓汤以行水降胃，兼进分利清浊之品，清升浊降，所以不治呕而呕自止，不攻荡而
便自行。惟中脘时有上涌之意。痰气未能悉化，前治稍为扩充。
制半夏（三钱） 云茯苓（一两） 薤白头（三钱） 老生姜（四钱） 来复丹（一钱药汁送下）
王（左） 昔肥今瘦，病发则吐呕痰水，倾盆而出，呕至竭尽，往往微呕而带出紫血。夫饮食不为肌肤，而
凝聚痰水，及时而发，其为蓄饮略见一斑。惟是痰饮之证，都成于中气虚微，脾阳不运。夫既阳虚气弱，
何至呕辄见红。若谓阳明为多气多血之乡，呕动胃络，而血从络溢，亦顷刻间耳，何至随动随出之血，
而辄变紫瘀哉。先哲有言，人受气于水谷，水谷之气，流则为津为液，滞则为饮为痰，盖流者气化之流，
滞者气化之滞也。尊体丰伟，断非阳虚之比，参诸脉象，左部柔和，右部沉弦而滑。此由肝木之气，失于
Mr. Xu (Left pulse): When the weather is mild, dizziness often worsens. There was a history of hematemesis or epistaxis, indicating this is caused by Fire and Wind pathogens. Frequent administration of sweet-cool natured medicines to "treat the stomach to regulate the liver" has slightly subdued the Fire and Wind, but the Spleen Yang has been secretly damaged in the process. This leads to insufficient transportation and transformation, causing water-dampness to stagnate in the Stomach, resulting in epigastric fullness and obstruction, and even vomiting in severe cases. The pulse is deep and wiry. This is a sign of retained fluid; if prolonged, it may develop into a Ge syndrome (obstruction at the diaphragm).
Prescription: Zhi Nan Xing (Prepared Arisaema Rhizome), Chi Ling & Bai Ling (Red Poria & White Poria), Dan Gan Jiang (Light Dried Ginger), Zhi Ban Xia (Prepared Pinellia Rhizome), Wei Tian Ma (Baked Gastrodia Tuber), Chuan Ya Lian (Sichuan Coptis Rhizome), Bai Ji Li (Tribulus Fruit), Chao Zhi Ke (Stir-fried Bitter Orange Peel), Zhu Ru (Bamboo Shavings stir-fried with ginger juice), Bai Jin Wan (White Gold Pill - take 3 fen first).
Mr. Xue (Left pulse): Gurgling sounds in the abdomen indicate Fluid retention, accompanied by spitting of saliva. This is due to deficiency-cold of Stomach Qi, failing to constrain body fluids. The onset is gradual, so recovery will be difficult. A pill preparation is proposed for slow regulation.
Prescription: Chen Ban Liu Jun Wan (Chen Pi Ban Xia Liu Jun Zi Pill), taken 3 qian every morning, with Yi Zhi Ren (1 qian) and 3 slices of fresh ginger, decocted in water to wash down.
Mr. Yang (Left pulse): Internal obstruction by retained fluid suppresses Fire, preventing steaming and transformation, leading to undigested food being vomited up. Earth is the child of Fire; if Mingmen Fire is not regulated, Spleen Earth cannot transport, resulting in frequent loose stools. The pulse is deep and fine, more pronounced at the Right Chi position. Li Zhong Tang should be used.
Prescription: Lu Dang Shen (Codonopsis Root, 1.5 qian), Pao Jiang (Roasted Ginger, 0.5 qian), Zhi Fu Pian (Prepared Aconite Slice, 0.5 qian), Chao Yu Zhu (Stir-fried Atractylodes Macrocephala Rhizome, 2 qian), Zhi Gan Cao (Honey-fried Licorice Root, 0.3 qian), Bai Fu Ling (White Poria, 3 qian), Wei Mu Xiang (Baked Costus Root, 0.4 qian).
Mr. Yu (Left pulse): Water-fluids are retained internally; they cannot be controlled to exit nor attacked to move. Currently, food feels heavy after eating, epigastric fullness and distension occur, acid regurgitation is present, there is an urge to vomit but nothing comes out, urine is scant, and bowel movements are difficult. The pulse is soggy and soft. This is due to chronic deficiency of Spleen and Stomach Qi, failing to rotate and transform, leading to failure in separating clear from turbid. Mr. Jiebin's Wu Jun Zi Jian (Five Gentlemen Decoction) is used to tonify Spleen and Stomach and invigorate Middle Yang, combined with methods to separate clear from turbid, observing the dynamics.
Prescription: Ji Lin Shen (Jilin Ginseng Radix, 1 qian), Yun Fu Ling (Yunnan Poria, 4 qian), Zhi Gan Cao (Honey-fried Licorice Root, 0.7 qian), Chao Yu Zhu (Stir-fried Atractylodes Macrocephala Rhizome, 2 qian), Dan Gan Jiang (Light Dried Ginger, 0.7 qian), Lai Fu Dan (Reviving Pill, 1.5 qian, taken with medicinal decoction).
Second Visit: After warming and transporting Spleen and Stomach, and clarifying clear/turbid, pain and distension persist. There is an urge to vomit without success, and indescribable stifling sensation in the chest. Bowel movement is absent, and urination is scanty and painful. The pulse is deep, fine, and slightly rapid; the tongue is red with little coating on the anterior half. Retained fluid accumulates daily in the upper jiao, while Stomach Yin is consumed daily in the lower jiao. Attack is ineffective. Wood is the child of Water; using a method that combines rigidity with flexibility, since Ying (Nutritive) fluid is deficient, Wood loses nourishment, and its rampant Qi attacks with Phlegm. Both Spleen and Stomach are constrained. Nourish Ying fluid again, incorporate bitter, acrid, and sour flavors to restrain the hyperactive Liver, hoping for Qi calmness and silent resolution of Phlegm-Fluid.
Prescription: Dry Cong Rong (Dry Cistanche Stem, 3 qian), Chao Yu Rou (Stir-fried Cornus Fruit, 2 qian), Zhi Ban Xia (Prepared Pinellia Rhizome, 1.5 qian), Gan Qi Zi (Sweet Goji Berry, 3 qian), Fu Ling (Poria, 3 qian), Bai Shao (White Peony Root stir-fried with soil, 2 qian), An Wei Wan (Stomach-Calming Pill, 3 qian taken in two doses).
Third Visit: Phlegm-Fluid aggregates in the upper, while Liver Qi spreads wildly in the lower. Probing the throat induces vomiting, providing slight relief upon expectoration, but abdominal fullness and distension remain. The Classics state: "Turbid Qi in the upper causes distension," and "For those in the upper, induce emesis." Temporarily follow this prescription.
Prescription: Chao Yu Zhu (Stir-fried Atractylodes Macrocephala Rhizome, 2 qian), Chen Pi (Tangerine Peel, 2 qian), Shi Chang Pu (Acorus Rhizome, 1.5 qian), Chuan Po (Magnolia Bark, 2 qian), Sheng Cao & Shu Cao (Raw and Prepared Licorice Root, 0.3 qian each), Guang Huo Geng (Patchouli Stem, 4 qian). Grind the above six herbs into powder, take 3 qian per dose. Tian Gua Di (Melon Peduncle, 1 liang) and Chi Xiao Dou (Red Adzuki Bean, 1 liang) are lightly stir-fried until yellow, ground finely, and taken separately as 3 qian. All mixed with warm water.
Fourth Visit: Liver Qi obstructs internally with Fluid, expelling much phlegm-saliva. Although expectoration should relieve the chest and diaphragm, discomfort persists, belching emits foul odor. The pulse is soggy and weak. Repeated induction of vomiting has depleted Stomach Qi and Yin. Grain Qi fails to transform, generating foul gas. Do not casually use digestive aids. Use Da Ban Xia Tang from *Jin Gui Yao Lue* to unblock and tonify Yangming, promoting Grain Qi. Incorporate heavy sedatives to counteract rebellion and salty substances to soften hardness.
Prescription: Ji Lin Shen (Jilin Ginseng Radix, 8 fen), Dai Zhe Shi (Magnetite, 4 qian), Mi Zhi Gan Jiang (Honey-fried Dried Ginger, 0.3 qian), Zhi Gan Cao (Honey-fried Licorice Root, 0.5 qian), Zhi Ban Xia (Prepared Pinellia Rhizome, 2 qian), Xuan Fu Hua (Inula Flower, 3 qian wrapped), Chao Mu Gua Pi (Stir-fried Papaya Peel, 1.5 qian), Ju Bai (Orange Albedo, 1 qian), Nan Zao (Chinese Jujube, 3 pieces), Bai Mi (White Honey, 1.5 qian added during decoction).
Mr. Zhu (Left pulse): Retained fluid recurs upon cold invasion, starting with epigastric pain leading to vomiting. It occurs every other day; during attacks, epigastric discomfort or pain occurs, and vomiting saliva brings temporary relief. The Stomach lacks descending authority, disrupting the order of food intake, leading to muscle wasting. The pulse is deep and wiry; the tongue coating is white and greasy, turbid in the center. Water-fluids fail to transform, and Yang Qi fails to rotate.
Plan to separate clear from turbid and simultaneously unblock Stomach Yang.
Prescription: Zhi Ban Xia (Prepared Pinellia Rhizome, 3 qian), Fu Ling (Poria, 5 qian), Da Fu Pi (Areca Peel, 2 qian), Guang Pi (Tangerine Peel, 1 qian), Gan Jiang (Dried Ginger stir-fried with salt water, 0.5 qian), Bai Kou Ren (Cardamom Seed, 0.5 qian), Gong Ding Xiang (Clove, 0.3 qian), Zhu Ling (Polyporus, 2 qian), Lai Fu Dan (Reviving Pill, 1.5 qian, taken first with boiling water).
Second Visit: Separating clear from turbid resulted in vomiting much saliva after medication. This indicates pathogenic factors gathering in the middle jiao must be expelled. Since vomiting occurred three days ago and no food has been regurgitated since, the medicine matches the disease. Water-fluids require warmth to transform. Refer to Ma Yuanyi's method.
Prescription: Shang Yao Gui (Superior Cassia Twig, 0.5 qian, bark removed, decocted separately), Zhi Ban Xia (Prepared Pinellia Rhizome, 2 qian), Yun Fu Ling (Yunnan Poria, 5 qian), Gong Ding Xiang (Clove, 0.3 qian), Dan Gan Jiang (Light Dried Ginger, 0.7 qian), Da Fu Pi (Areca Peel, 2 qian), Jian Ze Xie (Jian泽泻/Alisma Rhizome, 1.5 qian), Dan Wu Zhu Yu (Light Evodia Fruit, 0.5 qian), Lai Fu Dan (Reviving Pill, 3 qian, taken first with boiling water).
Third Visit: Vomiting has temporarily stopped, but water-Qi remains untransformed, Middle Yang does not rotate, and epigastric pain persists. The pulse is deep and fine; the tongue coating is white and greasy. Warming and regulating Middle Yang is appropriate, yet with water-fluids entrenched, how can Yang Qi be disseminated? Add a hint of purgation within the warming and transforming approach.
Prescription: Dan Wu Zhu Yu (Light Evodia Fruit, 0.5 qian), Chen Pi (Tangerine Peel, 1 qian), Fu Ling (Poria, 4 qian), Da Fu Pi (Areca Peel, 2 qian), Zhi Ban Xia (Prepared Pinellia Rhizome, 2 qian), Gong Ding Xiang (Clove, 0.3 qian), Dan Gan Jiang (Light Dried Ginger, 0.7 qian), Bai Kou Ren (Cardamom Seed, 0.6 qian, added after grinding), Zhi Xiang Fu (Prepared Cyperus Rhizome, 2 qian), Shang Chen Xiang (Premium Agarwood, 0.3 qian), Hei Chou (Black Morning Glory Seed, 0.4 qian, both ground into powder, taken in two doses with ginger soup).
Fourth Visit: Warming and regulating Middle Yang while expelling fluid pathogens allows Yang Qi to rotate, and epigastric pain ceases. However, Zheng Qi is secretly depleted, Qi fails to transform, and urination is obstructed. Further support Middle Qi, hoping that Qi transformation will resolve water-dampness.
Prescription: Ji Lin Shen (Jilin Ginseng Radix, 0.8 qian, decocted separately and taken with liquid), Fu Ling (Poria, 4 qian), Chuan Gui Zhi (Sichuan Cassia Twig, 0.6 qian), Bai Kou Ren (Cardamom Seed, 0.6 qian, added after grinding), Dan Gan Jiang (Light Dried Ginger, 0.7 qian), Ze Xie (Alisma Rhizome, 1.5 qian), Gong Ding Xiang (Clove, 0.5 qian), Gao Liang Jiang (Galangal Rhizome, 0.5 qian), Lao Jiang (Old Ginger, 3 slices).
Modified Prescription for Persistent Vomiting: Gao Liang Jiang (Galangal Rhizome, 0.7 qian), Guang Pi (Tangerine Peel, 1 qian), Gong Ding Xiang (Clove, 0.3 qian), Zhi Ban Xia (Prepared Pinellia Rhizome, 2 qian), Zhi Xiang Fu (Prepared Cyperus Rhizome, 3 qian crushed), Gan Jiang (Dried Ginger, 0.7 qian), Bai Kou Ren (Cardamom Seed, 0.6 qian added later), Fu Ling (Poria, 4 qian), Shang Chen Xiang (Premium Agarwood, 0.3 qian), Hei Chou (Black Morning Glory Seed, 0.3 qian, both ground finely, taken first).
Fifth Visit: Fluid obstruction in the middle, following vomiting and purging, epigastric pain has ceased. However, urination is not smooth, making it hard for water to exit externally. Fear of further fluid accumulation. Plan to separate clear from turbid and benefit the Bladder to open pathways.
Prescription: Zhi Ban Xia (Prepared Pinellia Rhizome, 2 qian), Fu Ling (Poria, 4 qian), Gan Jiang (Dried Ginger, 0.6 qian), Jian Ze Xie (Alisma Rhizome, 1.5 qian), Tai Bai Zhu (Tai Bai Atractylodes Rhizome, 2 qian), Chen Guang Pi (Aged Tangerine Peel, 1 qian), Bo Guan Gui (Thin Official Cassia Twig, 0.6 qian), Gong Ding Xiang (Clove, 0.3 qian), Mu Zhu Ling (Wood Polyporus, 2 qian), Lao Jiang (Old Ginger, 1 qian), Lai Fu Dan (Reviving Pill, 1 qian, taken first with boiling water).
Sixth Visit: Vomiting has not recurred, and appetite gradually increases. However, epigastric pain occasionally persists, and bowel movement has been absent for six days. The pulse is deep and fine. Spleen is Yin Earth, governing healthy transportation and disliking dampness. Long-term water retention prevents Spleen Earth from rotating, causing foul gas to block. Must unblock Yang again.
Prescription: Zhi Ban Xia (Prepared Pinellia Rhizome, 3 qian), Bai Kou Ren (Cardamom Seed, 0.6 qian), Zhi Xiang Fu (Prepared Cyperus Rhizome, 2 qian), Ze Xie (Alisma Rhizome, 1.5 qian), Yun Fu Ling (Yunnan Poria, 5 qian), Ding Xiang (Clove, 0.3 qian), Gan Jiang (Dried Ginger, 0.5 qian), Zhu Ling (Polyporus, 2 qian), Lao Jiang (Old Ginger, 1.5 qian), Ban Liu Wan (Half-Sulfur Pill, 1.5 qian taken first).
Seventh Visit: Assisting Yang Qi to encourage rotation results in bowel movement. However, water-Qi leaves only to return; this is because Spleen-Stomach Yang has long been suppressed and unable to rotate. Warm the middle to eliminate fluid, combined with separation and draining.
Prescription: Zhi Ban Xia (Prepared Pinellia Rhizome, 3 qian), Ding Xiang (Clove, 0.3 qian), Bai Kou Ren (Cardamom Seed, 0.5 qian), Jian Ze Xie (Alisma Rhizome, 1.5 qian), Yun Fu Ling (Yunnan Poria, 5 qian), Dan Wu Zhu Yu (Light Evodia Fruit, 0.8 qian), Guang Ju Pi (Broad Mandarin Peel, 1 qian), Mu Zhu Ling (Wood Polyporus, 2 qian), Lao Jiang Pian (Old Ginger Slices, 2 qian), Gong Ding Xiang (Clove, 2 qian, ground separately into rice pills, taken with ginger soup).
Eighth Visit: The root of water-fluids is not removed; they leave only to return, relieved only by vomiting. Drying Earth and benefiting dampness can unblock Yang but cannot remove water. While Yuan Qi is not yet exhausted, employ purgation.
Mr. Shutao agrees with this view; proceed accordingly.
Prescription: Chuan Gui Zhi (Sichuan Cassia Twig, 0.7 qian), Fu Ling (Poria, 6 qian), Zhi Ban Xia (Prepared Pinellia Rhizome, 2 qian), Ju Pi (Tangerine Peel, 2 qian), Dan Gan Jiang (Light Dried Ginger, 0.7 qian), Bai Zhu (Atractylodes Rhizome, 2 qian), Da Fu Pi (Areca Peel, 2 qian), Sheng Gan Cao (Raw Licorice Root, 0.2 qian), Kong Yan Dan (Controlling Phlegm Pill, 1 qian taken with ginger soup).
Ninth Visit: Water-fluids have gone, but Middle Qi is insufficient, and rotation is inadequate. What left stays left; what remains stays remaining. Attack when the disease is present; tonify when it recedes.
Prescription: Chuan Gui Zhi (Sichuan Cassia Twig, 0.7 qian), Zhi Ban Xia (Prepared Pinellia Rhizome, 2 qian), Da Fu Pi (Areca Peel, 2 qian), Gong Ding Xiang (Clove, 0.2 qian), Fu Ling (Poria, 3 qian), Chuan Po (Magnolia Bark, 1 qian), Lao Jiang (Old Ginger, 1.5 qian), Kong Yan Dan (Controlling Phlegm Pill, 0.5 qian taken first with ginger soup).
Another Visit: After water flows, take a separate tonic prescription.
Prescription: Ji Lin Shen (Jilin Ginseng Radix, 1.5 qian), Zhi Huang Qi (Honey-fried Astragalus Root, 2 qian), Gui Zhi (Cassia Twig, 0.7 qian), Chuan Jiao Mu (Sichuan Pepper Seed, 0.4 qian), Mu Zhu Ling (Wood Polyporus, 2 qian), Chao Yu Zhu (Stir-fried Atractylodes Macrocephala Rhizome, 2 qian), Gan Jiang (Dried Ginger, 0.7 qian), Fu Ling (Poria, 5 qian), Chi Shi Zhi (Red Halloysite, 1 qian ground into powder, made into pills with rice paste, taken first).
Mr. Mao: Historically suffering from Liver Qi disorders, in autumn he experienced limb coldness, chest tightness, and dizziness, resembling Sha sickness. This is due to blocked airways and rising Yang Qi, a precursor to Liver Wood stirring. Shortly after recovery, sudden fever and abdominal pain occurred, worse on the right side of the chest and abdomen. The area around the umbilicus is hard and pulsating. This has persisted for a long time, accompanied by cough with copious sputum filling bowls daily. Although pain has settled, discomfort remains throughout the right side. Most severely, the central palace is blocked, food is hard to retain, and bowels do not move. Six pulses are soggy and soft; deep palpation reveals wiry qualities everywhere, especially at the Right Guan. Cun is fine, Chi is deep, Left Chi is small and choppy. This is Liver Wood spreading wildly, carrying internal latent Phlegm-Fluid, attacking the Earth position. The Liver resides on the left, while Earth occupies the right; since Wood attacks Earth, pain is worse on the right. Zhong Wan belongs to the Stomach, which is Wu Earth. The umbilicus is in the center of the body, also an Earth position. *Jin Gui* mentions moving Qi at the umbilicus as an example of Water Evil attacking Earth, matching this case of Phlegm-Fluid. Wood within Earth is Qi, which is formless; Fluid is a tangible pathogen. Dealing with tangible matters is urgent, while formless matters are slower. To treat the tangible, one can attack, purge, dry, or劫 (rob), but this applies only to robust constitutions, never to a body with a small and choppy Chi pulse. Currently, food prefers warmth; the tongue coating is thin and white, pale in color and greasy in texture. Changsha says: "For drinkers, harmonize with warm medicines." This is incorrect. Fluid is a Yin pathogen; if Yin mist blocks, how can fog dissipate without sunlight warming? Moreover, the Stomach is Yang Earth; water and grain digest instantly here, like a cinnabar furnace in our body. Now Qi stops here, dampness stops here, Phlegm stops here, Fluid stops here. How can the Sea of Water and Grain be a place for stopping Qi, dampness, Phlegm, and Fluid? Specifically warm to nourish it. Since Qi is deficient and Blood is also insufficient, harsh drying agents will inevitably injure Yin. Propose modifying Gua Lou Xie Bai Tang from Changsha, using acrid, slippery, and lubricating herbs to open Stomach Yang. Acrid-warm and hot substances will be prepared separately into pills to fly over the Upper Jiao, avoiding fluid injury. If the medicine responds, there is hope. However, due to weak Qi and advanced age, the outcome cannot be predetermined. My humble opinion requests correction from experts.
Prescription: Xie Bai Tou (Allium Macrostemon Bulb, 3 qian), Zhi Ban Xia (Prepared Pinellia Rhizome, 2 qian), Xia Tian Qu (Cloud Sky Qu stir-fried, 1.5 qian), Gua Lou Ren (Trichosanthes Seed, 5 qian stir-fried with ginger juice and ground), Guang Pi (Tangerine Peel, 1.5 qian), Yun Fu Ling (Yunnan Poria, 3 qian), Bai Luo Si Ke (White Snail Shell, 2 qian), Sheng Jiang Zhi (Fresh Ginger Juice, 2 teaspoons mixed in), Shang Yao Gui (Superior Cassia Twig, 0.3 qian ground finely, made into rice pills taken with ginger soup).
Take a small cup of white wine before taking the medicine, and another cup after.
Second Visit: Suppressing Liver and unblocking Yang significantly reduces umbilical and abdominal pain. Epigastric fullness loosens slightly, appetite returns somewhat, and bowel movements are smooth. However, discomfort persists in the Middle Jiao after meals. In a few days, chills followed by fever occurred twice. The Gallbladder governs opening and closing and is the outer mansion of the Liver. Disease in the zang affects the fu, causing dysfunction in opening and closing. Gallbladder disease is essentially Liver disease. For an elderly person with chronic illness, destructive methods are inappropriate. However, ability to taste food indicates the Stomach exists. Food entering causes bloating because Wood is within Earth; Wood within Earth makes the Stomach seem non-existent. The Stomach Mansion functions through unblocking. Also, the Liver has no tonification method; predecessors said suppressing the Liver is tonifying the Liver. Thus, destruction is unavoidable but should not be excessive. Currently, Right Guan is wiry and slippery, Chi pulse has risen slightly compared to before, Left Guan remains wiry, and deep palpation feels forceful. Suppressing Liver and draining Wood is still urgently needed despite chronic illness. Plan to combine acrid unblocking with resolving Phlegm and regulating Qi. Corrected.
Prescription: Ban Xia Qu (Pinellia Fermented Curd, 2 qian), Chao Zhi Ke (Stir-fried Bitter Orange Peel, 1 qian), Guang Pi (Tangerine Peel, 1 qian), Fu Ling (Poria, 5 qian), Bai Ji Li (Tribulus Fruit de-spined and stir-fried, 3 qian), Bai Shao (White Peony Root stir-fried with soil, 1.5 qian), Hu Lun Sha Ren (Whole Cardamom Seed, 0.4 qian stir-fried with salt water, added later), Ye Qiang Wei Hua (Wild Rose Flower, 0.7 qian), Su Zi (Perilla Seed, 0.4 qian ground and mixed in), Xie Bai Tou (Allium Macrostemon Bulb, 3 qian), Shang Yao Gui (Superior Cassia Twig, 0.5 qian ground into powder, made into rice pills taken in two doses with ginger soup).
Elderly Woman Weng: Internal obstruction by Phlegm-Fluid causes Lung Qi to fail to descend, resulting in cough, copious sputum, and rebellious Qi, worsening when lying down, and fullness after eating. The pulse is deep and wiry; the tongue coating is white and greasy. Warm and open the fluid pathogen using the method of heavy medicine taken in light doses.
Prescription: Ma Huang (Ephedra Herb honey-fried, added last, 0.3 qian), Dan Gan Jiang (Light Dried Ginger, 0.3 qian), Bei Xi Xin (Asarum Root, 0.2 qian), Chang Niu Xi (Long Achyranthes Root stir-fried with salt water, 3 qian), Bai Shao (White Peony Root wine-fried, 1 qian), Gui Zhi (Cassia Twig, 0.3 qian), Wu Wei Zi (Schisandra Berry, pounded together with 4 grains of dried ginger), Zhi Cao (Licorice Root honey-fried, 0.3 qian), Fu Ling (Poria, 3 qian).
Second Visit: Acrid-warm herbs opened Taiyang; wheezing and coughing are slightly lighter, and sputum is slightly reduced. Use San Zi Yang Qin Tang to warm the Lung and eliminate fluid.
Prescription: Bai Jie Zi (White Mustard Seed ground, 0.5 qian), Sheng Lai Fu Zi (Raw Radish Seed, 2 qian), Guang Ju Hong (Broad Mandarin Red Peel, 1 qian), Chao Yu Zhu (Stir-fried Atractylodes Macrocephala Rhizome, 1.5 qian), Dan Gan Jiang (Light Dried Ginger, 0.3 qian pounded with four Schisandra berries), Chao Su Zi (Stir-fried Perilla Seed, 3 qian), Fu Ling (Poria, 3 qian), Chao Zhi Ke (Stir-fried Bitter Orange Peel, 1 qian), Zhi Ban Xia (Prepared Pinellia Rhizome, 1.5 qian).
Mr. Chen (Left pulse): Constitution prone to dampness. Recently invaded by wind-cold, causing wind in the upper and dampness in the lower. Upper manifests as cough, lower as foot swelling. Now cold-damp evil spreads to the upper and middle, causing epigastric fullness, chest pain, blocking the Middle Jiao. Upper Jiao Qi is entirely congested upwards and cannot descend. Recent days show severe cough with rising Qi, inability to lie flat, copious clumped sputum, skin edema, and sallow floating complexion. The pulse is fine, deep, and wiry; the tongue coating is thin and white. The mechanism of ascending and descending in the Three Burners is completely blocked by cold-phlegm. Deeply fear that blocked ascent/descent will lead to severe wheezing and collapse. Must give advance warning. Tentatively prescribe to open and descend upper and middle, fighting a desperate battle.
Prescription: Ting Li (Lepidium Seed), Ju Hong (Mandarin Red Peel), Su Zi (Perilla Seed), Lian Pi Ling (Poria with skin), Zhi Shi (Immature Bitter Orange), Chuan Po (Magnolia Bark), Zhi Ban Xia (Prepared Pinellia Rhizome), Lian Pi Bin (Betel Nut with skin), Sha Ren (Cardamom Seed), Chen Xiang (Agarwood, 0.3 qian), Hei Chou (Black Morning Glory Seed, 0.3 qian), Zao Jia Zi (Soapberry Seed, 0.1 qian, last three herbs ground separately and mixed).
Mr. Chen (Left pulse): Latent cold in the Lung has caused continuous cough for two years. Last autumn, cool-dryness was re-invaded, worsening cough daily, rebellious Qi preventing sleep. Recent days include epigastric pain, lower abdominal fullness, and no bowel movement for six days. The pulse is wiry and slippery; the tongue coating is white and mouth feels greasy. This is Phlegm and Qi interlocking, Earth stagnation causing Liver Wood depression, making Liver Qi uneven. Deeply fear Yuan Qi cannot sustain.
Prescription: Xie Bai Tou (Allium Macrostemon Bulb), Zhi Ban Xia (Prepared Pinellia Rhizome), Xin Hui Pi (Xinhui Tangerine Peel), Bai Ji Li (Tribulus Fruit), Suo Sha Ren (Amomum Fruit), Zhi Xiang Fu (Prepared Cyperus Rhizome), Chao Zhi Ke (Stir-fried Bitter Orange Peel), Yun Fu Ling (Yunnan Poria), Gua Lou Ren (Trichosanthes Seed stir-fried with ginger juice and ground), Shang Yao Gui (Superior Cassia Twig, 0.4 qian made into rice pills taken in two doses), Chen Xiang Hua Qi Wan (Agarwood Qi-Moving Pill, 4 qian wrapped in silk and decocted).
Mr. Zhu (Left pulse): Retained fluid condenses into Phlegm, gathering in the Stomach Mansion. Stomach Qi ascends more than it descends. Every five to seven days, sticky phlegm-saliva is vomited, and urination/defecation are obstructed. The pulse is deep and wiry. Phlegm and Jin (Body Fluids) belong to the same category. If Clear Qi transforms, it distributes upward; if Clear Qi fails to transform, fluids stagnate into Phlegm obstructing the middle. Transformation depends on Spleen Yang rotation. Hence *Jin Gui* states: "For drinkers, harmonize with warm medicines." However, harsh drying drugs injure Yin with prolonged use, and purgative agents are hard to bear with deficiency. Only by separating clear from turbid, allowing Clear Jin to rise and Turbid Fluid to descend, can symptoms be alleviated, though quick cure is unlikely.
Prescription: Zhi Ban Xia (Prepared Pinellia Rhizome, 2 qian), Yun Fu Ling (Yunnan Poria, 8 qian), Lao Sheng Jiang (Old Fresh Ginger, 1 qian), Lai Fu Dan (Reviving Pill, 1 qian taken with medicinal decoction).
Second Visit: Using Ban Xia Fu Ling Tang to move water and descend Stomach Qi, combined with separating clear from turbid. Clear rises and turbid falls, so vomiting stops without direct treatment, and bowels move without purging. Only occasional upward surging in the epigastrem remains. Phlegm-Qi is not fully resolved; previous treatment is slightly expanded.
Prescription: Zhi Ban Xia (Prepared Pinellia Rhizome, 3 qian), Yun Fu Ling (Yunnan Poria, 1 liang), Xie Bai Tou (Allium Macrostemon Bulb, 3 qian), Lao Sheng Jiang (Old Fresh Ginger, 4 qian), Lai Fu Dan (Reviving Pill, 1 qian taken with medicinal decoction).
Mr. Wang (Left pulse): Formerly fat, now thin. Attacks involve vomiting copious phlegm-water, pouring out like a basin. Vomiting to exhaustion often brings out purple blood. Diet fails to nourish flesh, instead condensing into phlegm-water, erupting timely. This hints at retained fluid. Phlegm-Fluid syndromes arise from deficiency of Middle Qi and failure of Spleen Yang to transport. If Yang is deficient and Qi weak, why does vomiting bring blood? If we say Yangming is a land of abundant Qi and Blood, and vomiting damages Stomach collaterals causing bleeding, it happens instantly. Why would blood turning purple and stasis occur immediately upon movement? Ancients said: Humans receive Qi from water and grain. Flowing becomes Jin and Ye; stagnant becomes Yin and Tan. Flowing is the flow of Qi transformation; stagnant is the stagnation of Qi transformation. Your physique is robust, definitely not Yang deficiency. Considering the pulse: Left is soft and harmonious; Right is deep, wiry, and slippery. This is due to Liver Wood Qi losing...