唐（左） 气血两亏，肝火挟痰，窜入少阳阳明之络。颈项结核坚硬，按之不移。脉虚弦滑。恐虚痰不化，而
延入损途。
桑叶 海藻 制半夏 川贝母 郁金 茯苓 丹皮 桔梗 生香附 炒枳壳 雪羹汤煎
二诊 痰核软加生于术。
某 颈有 痰，眩晕心悸，身体似觉震动，此浊痰内蕴，痰热化风上旋也。
甘菊花 云茯苓 海蛤粉 白僵蚕 石决明 净双钩
制半夏 煨天麻 白蒺藜 橘红 燥渴者雪羹汤。
张（左） 盘颈 痰已久，兹则内热连绵，时见咯血，胸膺酸痛，日来腹痛便泄。脉细弦而数。阴虚木旺，虚
火上炎，木乘土位。虚损情形，何易言治。
金石斛（四钱） 黑豆衣（三钱） 淡秋石（一钱） 炒木瓜皮（一钱五分） 女贞子（三钱） 炙黑草（五分）
侧柏炭（二钱） 炒白芍（一钱五分） 大天冬（二钱） 海蛤粉（三钱）
二诊 酸甘制木，以养脾阴，腹痛便泄已止。然虚火上炎，血虽未来，而咽痛音闪。脉数细弦。脏阴皆损，何易
言治。
大生地（三钱） 大天冬（二钱） 生熟草（各二分） 杭白芍（一钱五分酒炒） 大熟地（二钱） 大麦冬（
一钱） 女贞子（三钱酒炒） 海蛤粉（三钱包） 川贝母（二钱） 毛燕汤代水煎。
三诊 音声已开，咽痛亦止，而中脘犹复作痛。脉象细弦，舌质纹裂。 痰既久，气血并亏，不能制伏肝
木，致强肝克土乘脾则腹痛便泄，犯胃则脘痛呕吐。急者先治之。
香附（二钱） 金铃子（一钱五分） 半夏曲（一钱五分盐水炒） 茯苓（三钱） 白芍（二钱土炒） 白蒺藜（
三钱） 橘白（盐水炒一钱） 盐水炒竹茹（一钱） 左金丸（五分先服）
四诊 痛泄已止，脘痛亦减，而右胁犹复作痛。肝木克土之余，肝风入络。再标本兼顾。
阿胶珠（二钱） 醋炒香附（二钱） 柏子霜（三钱） 炒木瓜皮（一钱） 生草（三分） 白茯苓（三钱）
橘叶（一钱五分） 金铃子（一钱五分） 酒炒白芍（一钱五分）
五诊 便泄既止，脘痛亦定，而右胸膺常觉作痛，舌苔纹裂。痰 既久，阴伤则肝风入络。还恐损而难复。
阿胶珠（二钱） 白茯苓（三钱） 川贝母（二钱） 真猩绛（五分） 海蛤粉（三钱） 柏子霜（三钱）
旋复花（三钱） 酒炒白芍（一钱五分） 青葱管（三茎）
六诊 脘痛便泄，原属肝阳克犯脾胃。红炉泼水，则烈焰飞腾，所以两进柔药，火冲咽痛，随药而来。然
火之有余。阴之不足也。再参辛燥之品，以反佐之。
阿胶珠（二钱） 粉丹皮（二钱） 海蛤粉（三钱） 柏子霜（三钱） 白茯苓（三钱） 女贞子（三钱酒炒）
白芍（一钱五分酒炒） 制半夏（一钱五分） 大天冬（一钱五分）
七诊 胸膺作痛稍轻，不自觉热，而脉形带数，阴伤火炽。然痰核随处结聚，恐其流窜。再熄少阳木火，
参以化痰而和藏络。
炙生地（四钱） 海蛤粉（三钱） 桑叶（一钱） 炒白薇（一钱五分） 白茯苓（三钱） 柏子霜（三钱）
丹皮（二钱） 女贞子（三钱） 川贝母（三钱）
八诊 脉象稍缓，舌红苔腻。左胸膺作痛，牵引背肋，络隧不和。再宣通化痰和中。
川贝母（二钱） 当归（一钱五分酒炒） 白茯苓（三钱） 粉丹皮（二钱） 桑叶（一钱） 海蛤粉（三钱）
制香附（一钱五分） 川断肉（三钱） 盐水炙橘红（一钱） 生熟谷芽（各一钱）
某 少阳木火，挟痰流窜经络，肝木从而不和，少腹时有气聚。前法参以调气平木。
香附（一钱五分） 川贝（二钱） 海蛤粉（三钱） 粉丹皮（一钱五分） 郁金（一钱五分） 橘叶
（一钱五分） 桑叶（一钱） 川石斛（三钱） 金铃子（一钱五分） 白芍（一钱五分酒炒）
二诊 脉数转缓，内热已退，而滑泄频来，环口常发疹 。阴虚挟湿，混淆精窍。前法参以厘清。
桑叶（一钱） 川贝母（二钱） 干橘叶（一钱五分） 生薏仁（三钱） 川萆 （二钱） 香附（
二钱） 丹皮（一钱五分） 猪茯苓（各二钱） 大淡菜（二只）
三诊 厘清精水，滑泄未来，而右半体仍觉牵掣。良由痰阻络中，脉络从而不和。拟化痰宣络。
川贝母（二钱） 制香附（一钱五分） 生薏仁（四钱） 真猩绛（五分） 丹皮（二钱） 云茯苓（三钱）
橘红络（各一钱） 炒玉竹（三钱） 旋复花（一钱五分绢包） 桑叶（一钱）
四诊 神情稍振，遗泄未来。再拟化痰以宣络隧。
川贝（一钱） 香附（一钱五分） 黑豆衣（三钱） 郁金（一钱五分） 橘红络（各一钱） 枳壳（八分）
海藻（一钱五分） 白蒺藜（二钱） 白茯苓（三钱） 浮小麦（一两） 红枣（二枚）
五诊 舌纹裂渐满，红色较淡，而腿股作酸，即发遗精，腹中漉漉。湿热下行，精窍遂为混淆。再化痰而
厘清精水。
制半夏（一钱五分） 茯苓（三钱） 橘红（一钱） 海藻（一钱五分） 浮小麦（一两） 川贝母（
一钱五分） 萆 （一钱） 薏仁（三钱） 猪苓（二钱） 大淡菜（二只）
First Visit: The patient (left side) suffers from deficiency of both Qi and Blood. Liver Fire, carrying Phlegm, invades the collaterals of the Shaoyang and Yangming meridians. Tubercles appear in the neck and jaw area, hard in texture, and immovable upon pressure. The pulse is deficient, wiry, and slippery. There is concern that due to deficiency, the Phlegm will not resolve, leading to a consumptive disease.
Prescription: Sangye (Folium Mori), Haizao (Sargassum), Zhi Banxia (Rhizoma Pinelliae Preparata), Chuan Beimu (Bulbus Fritillariae Cirrhosae), Yujin (Radix Curcumae Longae), Fuling (Poria), Danpi (Cortex Moutan), Jiegeng (Radix Platycodonis), Sheng Xiangfu (Rhizoma Cyperi), Chao Zhike (Fructus Aurantii Preparatus). Decocted with Xue Geng Tang (Snow Soup Decoction).
Second Visit: The tubercles have softened. Add Sheng Baizhu (Rhizoma Atractylodis Macrocephalae).
Another Patient: Tubercles in the neck, accompanied by vertigo, palpitations, and a sensation of bodily tremors. This is caused by turbid Phlegm accumulating internally, transforming into Heat and generating Wind that swirls upward.
Prescription: Gan Juhua (Flos Chrysanthemi), Yun Fuling (Poria), Hai Ge Fen (Concha Meretricis et Cyclinae), Bai Jiangcan (Bombyx Batryticatus), Shi Jue Ming (Concha Haliotidis), Jing Shuanggou (Ramulus Uncariae cum Uncis), Zhi Banxia (Rhizoma Pinelliae Preparata), Wei Tianma (Rhizoma Gastrodiae), Bai Jili (Semen Tribuli), Ju Hong (Pericarpium Citri Reticulatae). For those feeling dry thirst, take with Xue Geng Tang (Snow Soup Decoction).
Patient Zhang (left side): Neck tubercles have persisted for a long time. Recently, continuous internal heat has appeared, with occasional hemoptysis, soreness and pain in the chest and hypochondrium, abdominal pain, and diarrhea. The pulse is fine, wiry, and rapid. This indicates Yin deficiency with hyperactive Liver Wood, defaming Fire flaming upward, and Liver Wood overacting on Spleen Earth. The condition presents as consumption, making treatment difficult.
Prescription: Jin Shihu (Stem Nodular Dendrobii, 4 qian), Heidouyi (Integument Vigna Sinensis, 3 qian), Dan Qiushi (Lapis Urinae, 1 qian), Chao Muguo Pi (Exocarpic Pericarpium Papayae Preparated, 1.5 qian), Nvzhenzi (Fructus Ligustri Lucidi, 3 qian), Zhi Hei Cao (Radix Glycyrrhizae Preparata, 0.5 qian), Cebai Tan (Cacumen Platycladi, 2 qian), Chao Baishao (Radix Paeoniae Alba Preparata, 1.5 qian), Da Tiandong (Herba Asparagi, 2 qian), Hai Ge Fen (Concha Meretricis et Cyclinae, 3 qian).
Second Visit: Using sour and sweet flavors to control Liver Wood and nourish Spleen Yin, abdominal pain and diarrhea have ceased. However, defaming Fire still flares upward; although menstruation has not yet occurred, there is throat pain and hoarseness. The pulse is rapid, fine, and wiry. Visceral Yin is damaged, making treatment difficult.
Prescription: Da Shengdi (Radix Rehmanniae Preparata, 3 qian), Da Tiandong (Herba Asparagi, 2 qian), Sheng Caogen (Radix Glycyrrhizae) and Shu Caogen (Radix Glycyrrhizae Preparata) (each 0.2 fen), Hang Baishao (Radix Paeoniae Alba, 1.5 qian, wine-fried), Da Shudi (Radix Rehmanniae Preparata, 2 qian), Da Maidong (Rhizoma Ophiopogonis, 1 qian), Nvzhenzi (Fructus Ligustri Lucidi, 3 qian, wine-fried), Hai Ge Fen (Concha Meretricis et Cyclinae, 3 qian, wrapped), Chuan Beimu (Bulbus Fritillariae Cirrhosae, 2 qian). Decocted using water prepared with Da Tiandong (Herba Asparagi) and Maoyan Tang (Mao Yan Soup).
Third Visit: Voice has opened, throat pain has stopped, but epigastric pain persists. Pulse is fine and wiry; tongue body shows cracks. Due to long-standing tubercles, both Qi and Blood are deficient, unable to control Liver Wood. Consequently, strong Liver Qi attacks Spleen Earth causing abdominal pain and diarrhea; invading the Stomach causes epigastric pain and vomiting. Treat the acute symptoms first.
Prescription: Xiangfu (Rhizoma Cyperi, 2 qian), Jinlingzi (Fructus Meliae Toosendan, 1.5 qian), Banxia Qu (Massa Medicata Fermentata Blandae, 1.5 qian, salt-water fried), Fuling (Poria, 3 qian), Baishao (Radix Paeoniae Alba, 2 qian, earth-fried), Bai Jili (Semen Tribuli, 3 qian), Ju Bai (Albedo Citri Reticulatae, 1 qian, salt-water fried), Shuiyan Chao Zhuru (Spiramen Bambusae Preparatum, 1 qian), Zuojin Wan (Left Metal Pill, 0.5 fen, taken first).
Fourth Visit: Painful diarrhea has stopped, epigastric pain has decreased, but right hypochondriac pain persists. This is residual Liver Wood attacking Spleen Earth, with Liver Wind entering the collaterals. Address both root and branch.
Prescription: Ejiao Zhu (Globulus Corii Asini Preparatus, 2 qian), Cu Chao Xiangfu (Rhizoma Cyperi, 2 qian, vinegar-fried), Baizi Shuang (Endocarp Semen Platycladi, 3 qian), Chao Muguo Pi (Exocarpic Pericarpium Papayae Preparated, 1 qian), Sheng Cao (Radix Glycyrrhizae, 0.3 fen), Bai Fuling (Poria, 3 qian), Ju Ye (Folium Citri Reticulatae, 1.5 qian), Jinlingzi (Fructus Meliae Toosendan, 1.5 qian), Jiuchao Baishao (Radix Paeoniae Alba, 1.5 qian, wine-fried).
Fifth Visit: Diarrhea has stopped, epigastric pain has settled, but right chest and hypochondrium often feel painful; tongue coating shows cracks. Long-standing tubercles have injured Yin, causing Liver Wind to enter collaterals. Fear it may become a consumptive disease difficult to recover from.
Prescription: Ejiao Zhu (Globulus Corii Asini Preparatus, 2 qian), Bai Fuling (Poria, 3 qian), Chuan Beimu (Bulbus Fritillariae Cirrhosae, 2 qian), Zhen Xingjiang (Cornu Bubali, 0.5 fen), Hai Ge Fen (Concha Meretricis et Cyclinae, 3 qian), Baizi Shuang (Endocarp Semen Platycladi, 3 qian), Xuanfuhua (Flos Inulae, 3 qian), Jiuchao Baishao (Radix Paeoniae Alba, 1.5 qian, wine-fried), Qingcong Guan (Caulis Allii Fistulosi, 3 stems).
Sixth Visit: Epigastric pain and diarrhea originally belonged to Liver Yang attacking Spleen and Stomach. Sprinkling water on a red-hot furnace causes flames to surge; thus, continuously using soft/moistening medicines caused Fire to rush to the throat causing pain, appearing with medication. This indicates excess Fire and insufficient Yin. Introduce acrid-drying herbs as counter-assistance.
Prescription: Ejiao Zhu (Globulus Corii Asini Preparatus, 2 qian), Fen Danpi (Cortex Moutan, 2 qian), Hai Ge Fen (Concha Meretricis et Cyclinae, 3 qian), Baizi Shuang (Endocarp Semen Platycladi, 3 qian), Bai Fuling (Poria, 3 qian), Nvzhenzi (Fructus Ligustri Lucidi, 3 qian, wine-fried), Baishao (Radix Paeoniae Alba, 1.5 qian, wine-fried), Zhi Banxia (Rhizoma Pinelliae Preparata, 1.5 qian), Da Tiandong (Herba Asparagi, 1.5 qian).
Seventh Visit: Chest and hypochondriac pain slightly relieved, spontaneous heat sensation gone, but pulse remains rapid, indicating Yin injury and blazing Fire. However, tubercles cluster everywhere, fearing spread. Extinguish Shaoyang Wood-Fire again, combine with Phlegm-resolving herbs to harmonize viscera and collaterals.
Prescription: Zhi Shengdi (Radix Rehmanniae Preparata, 4 qian), Hai Ge Fen (Concha Meretricis et Cyclinae, 3 qian), Sangye (Folium Mori, 1 qian), Chao Baiwei (Cortex Dictamni, 1.5 qian), Bai Fuling (Poria, 3 qian), Baizi Shuang (Endocarp Semen Platycladi, 3 qian), Danpi (Cortex Moutan, 2 qian), Nvzhenzi (Fructus Ligustri Lucidi, 3 qian), Chuan Beimu (Bulbus Fritillariae Cirrhosae, 3 qian).
Eighth Visit: Pulse slightly slower, tongue red with greasy coating. Left chest and hypochondriac pain radiating to back and ribs, collaterals disharmonious. Again, diffuse and resolve Phlegm, harmonize middle jiao.
Prescription: Chuan Beimu (Bulbus Fritillariae Cirrhosae, 2 qian), Danggui (Radix Angelicae Sinensis, 1.5 qian, wine-fried), Bai Fuling (Poria, 3 qian), Fen Danpi (Cortex Moutan, 2 qian), Sangye (Folium Mori, 1 qian), Hai Ge Fen (Concha Meretricis et Cyclinae, 3 qian), Zhi Xiangfu (Rhizoma Cyperi, 1.5 qian), Chuanduan Rou (Radix Dipsaci, 3 qian), Shuiyan Zhi Ju Hong (Pericarpium Citri Reticulatae, 1 qian, salt-water roasted), Sheng Shu Guya (Semen Hordei Germinatum, each 1 qian).
Another Patient: Shaoyang Wood-Fire carries Phlegm flowing through collaterals, causing Liver Wood to lose harmony, with gas accumulation in the lower abdomen. Previous method combined with Qi-regulating and Liver-calming herbs.
Prescription: Xiangfu (Rhizoma Cyperi, 1.5 qian), Chuan Bei (Bulbus Fritillariae Cirrhosae, 2 qian), Hai Ge Fen (Concha Meretricis et Cyclinae, 3 qian), Fen Danpi (Cortex Moutan, 1.5 qian), Yujin (Radix Curcumae Longae, 1.5 qian), Ju Ye (Folium Citri Reticulatae, 1.5 qian), Sangye (Folium Mori, 1 qian), Chuan Shihu (Stem Nodular Dendrobii, 3 qian), Jinlingzi (Fructus Meliae Toosendan, 1.5 qian), Baishao (Radix Paeoniae Alba, 1.5 qian, wine-fried).
Second Visit: Rapid pulse turned slow, internal heat retreated, but frequent loose stools and perioral rashes appeared. Yin deficiency with dampness confusing the essence orifices. Previous method combined with clearing/differentiating herbs.
Prescription: Sangye (Folium Mori, 1 qian), Chuan Beimu (Bulbus Fritillariae Cirrhosae, 2 qian), Gan Ju Ye (Folium Citri Reticulatae, 1.5 qian), Sheng Yiren (Semen Coicis, 3 qian), Chuan Bi (Rhizoma Dioscoreae Hypoglaucae, 2 qian), Xiangfu (Rhizoma Cyperi, 2 qian), Danpi (Cortex Moutan, 1.5 qian), Zhuling (Polyporus) and Fuling (Poria) (each 2 qian), Da Dancai (Mytilus edulis, 2 pieces).
Third Visit: Essence fluids clarified, loose stools did not occur, but right half-body feels pulling/tugging. Likely due to Phlegm blocking collaterals, causing disharmony. Plan to resolve Phlegm and diffuse collaterals.
Prescription: Chuan Beimu (Bulbus Fritillariae Cirrhosae, 2 qian), Zhi Xiangfu (Rhizoma Cyperi, 1.5 qian), Sheng Yiren (Semen Coicis, 4 qian), Zhen Xingjiang (Cornu Bubali, 0.5 fen), Danpi (Cortex Moutan, 2 qian), Yun Fuling (Poria, 3 qian), Ju Hong Luo (Pericarpium Citri Reticulatae and Retinervium Citri Reticulatae, each 1 qian), Chao Yuzhu (Rhizoma Polygonati Odorati, 3 qian), Xuanfuhua (Flos Inulae, 1.5 qian, silk-wrapped), Sangye (Folium Mori, 1 qian).
Fourth Visit: Spirit slightly revived, seminal emission did not occur. Plan again to resolve Phlegm to diffuse collaterals.
Prescription: Chuan Bei (Bulbus Fritillariae Cirrhosae, 1 qian), Xiangfu (Rhizoma Cyperi, 1.5 qian), Heidouyi (Integument Vigna Sinensis, 3 qian), Yujin (Radix Curcumae Longae, 1.5 qian), Ju Hong Luo (Pericarpium Citri Reticulatae and Retinervium Citri Reticulatae, each 1 qian), Zhike (Fructus Aurantii, 0.8 fen), Haizao (Sargassum, 1.5 qian), Bai Jili (Semen Tribuli, 2 qian), Bai Fuling (Poria, 3 qian), Fu Xiaomai (Semen Triticum Levis, 1 liang), Hongzao (Fructus Jujubae, 2 pieces).
Fifth Visit: Tongue cracks gradually filled, redness lighter, but legs and thighs feel sore, followed by nocturnal emission, and gurgling in abdomen. Damp-Heat descends, confusing the essence orifices. Resolve Phlegm again to clarify essence fluids.
Prescription: Zhi Banxia (Rhizoma Pinelliae Preparata, 1.5 qian), Fuling (Poria, 3 qian), Ju Hong (Pericarpium Citri Reticulatae, 1 qian), Haizao (Sargassum, 1.5 qian), Fu Xiaomai (Semen Triticum Levis, 1 liang), Chuan Beimu (Bulbus Fritillariae Cirrhosae, 1.5 qian), Bi (Rhizoma Dioscoreae Hypoglaucae, 1 qian), Yiren (Semen Coicis, 3 qian), Zhuling (Polyporus, 2 qian), Da Dancai (Mytilus edulis, 2 pieces).