蔚兄来诊云∶病初右胁刺痛，皮肤如烙，渐致大便闭结，坐卧不安，每便努挣，痛剧难
耐，
理气清火，养血润肠，药皆不应。切脉弦急欠柔，谓曰易治耳，一剂可愈。蔚兄云∶吾病日
久，诸药无灵，何言易治?予曰∶此乃燥证。肺苦燥，其脉行于右，与大肠相表里，方书论
胁痛以左属肝，右属肺，今痛在右胁而便闭结，肺病显然。但肝虽位于左，而其脉萦于两胁
，内经言邪在肝，则两胁中痛。今痛虽在右胁，不得谓其专属肺病已也。夫金制木，忧伤肺
，金失其刚，转而为柔，致令木失其柔，转而为刚，辛香益助其刚，苦寒愈资其燥，润肠养
血，缓不济急。订方用栝蒌一枚，甘草二钱，红花五分。蔚兄见方称奇，乃询所以。予曰∶
方出《赤水元珠》。夫栝蒌柔而润下，能治插胁之痛，合之甘草缓中濡燥，稍入红花，流通
血脉，肝柔肺润，效可必矣。服药便通痛减，能以定卧，随服复渣，微溏两次，其痛如失。
安波按∶怀抱奇，肋痛法，亦可参用。
静翁孙女，年甫三龄，夏月发热，医作暑风治，投清散药两剂，忽颏脱音哑，食莫能嚼
，饮
莫能啜。又以为风中会厌，仍用散药，静翁迟疑，邀予商酌。谓曰∶颏属肾，颏脱肾虚之征
。肾脉循喉咙，挟舌本，为声音之根。经云∶内夺而厥，则为喑痱。儿质本薄，暑复伤气，
更服辛散，元气益漓，致变若此。倘再行疏泄，肝风一动，慢惊旋至，不可救矣。仿左归饮
合生脉散，服之而瘥。
安波按∶勘此等证，腹中无《内经》，犹瞎子行路。
[Background Information]
Book: *Cheng Xingxuan's Medical Cases* Author: Cheng Xingxuan Dynasty: Qing Chapter: Case of Brother Ye Weiru with Hypochondriac Pain and Constipation Cured in One Dose / Case of Granddaughter of Old Man Cao Jingchuan with Chin Dislocation and Aphonia Category: Medical Discourse
[Original Text to Process]
Brother Ye Weiru came for consultation and said: "My illness began with stabbing pain in the right hypochondrium, with the skin feeling as if scalded by fire. It gradually led to constipation, causing restlessness whether sitting or lying down. Every time I strained during defecation, the pain was severe and unbearable. Treatments aimed at regulating Qi and clearing fire, as well as nourishing blood and moistening the intestines, were all ineffective." Upon taking his pulse, I found it wiry (Xian) and rapid but lacking softness. I told him, "This is easy to treat; one dose will suffice." Ye Weiru said, "My illness has persisted for a long time, and various medicines have failed. How can you say it is easy to treat?" I replied, "This is a Dryness syndrome (Zao Zheng). The Lung dislikes dryness, its meridian runs on the right side, and it stands in exterior-interior relationship with the Large Intestine. Medical texts discuss hypochondriac pain, stating that the left belongs to the Liver and the right belongs to the Lung. Now that the pain is in the right hypochondrium accompanied by constipation, the pathology of the Lung is evident. However, although the Liver is located on the left, its meridian winds around both hypochondria. The *Neijing* states: 'When pathogenic factors are in the Liver, there is pain in the middle of both hypochondria.' Although the pain is currently in the right hypochondrium, we cannot assert that it exclusively belongs to Lung pathology. Metal (Lung) controls Wood (Liver). Sorrow injures the Lung, causing Metal to lose its rigidity and become soft. This leads to Wood losing its softness and becoming rigid. Pungent and aromatic herbs further assist this rigidity, while bitter-cold herbs further fuel the dryness. Moistening the intestines and nourishing blood acts too slowly to address the emergency." I prescribed one Trichosanthis Fructus (Gualou), two qian of Glycyrrhizae Radix et Rhizoma (Gancao), and five fen of Carthami Flos (Honghua). Seeing the prescription, Ye Weiru expressed surprise and asked for the rationale. I said, "This formula comes from *Chishui Yuanzhu*. Trichosanthis Fructus is soft and moistening, directing downwards, capable of treating stabbing pain in the hypochondrium. Combined with Glycyrrhizae Radix et Rhizoma to moderate the middle and moisten dryness, along with a small amount of Carthami Flos to promote blood circulation, the Liver will become soft and the Lung moistened, ensuring efficacy." After taking the medicine, bowel movement became smooth, pain decreased, and he could lie quietly. He then took the remaining dregs, had mild diarrhea twice, and the pain disappeared completely. An Bo's commentary: The method for treating hypochondriac pain from Huai Baoqi can also be referenced.
The granddaughter of Old Man Cao Jingchuan was only three years old. In summer, she had a fever. The physician treated it as Summerheat-Wind (Shu Feng) and administered two doses of cooling and dispersing herbs. Suddenly, her chin dislocated (or mandibular dysfunction occurred), her voice became hoarse, she could not chew food, nor could she sip drinks. Others assumed it was wind invading the epiglottis and continued using dispersing herbs. Cao Jingchuan hesitated and invited me to consult. I said, "The chin is governed by the Kidney. Chin dislocation is a sign of Kidney deficiency. The Kidney meridian follows the throat and flanks the root of the tongue, serving as the root of voice. The *Neijing* states: 'If essence is depleted internally leading to厥 (Jue/fainting or reversal), it results in aphonia and leg paralysis (Yin Fei).' The child's constitution was inherently thin. Summerheat further damaged Qi, and administering pungent-dispersing herbs caused Yuan Qi (Primary Qi) to deteriorate further, resulting in such changes. If we continue with dispersing and draining methods, when Liver Wind stirs, Slow Convulsion (Man Jing Feng) will follow immediately, and it will be incurable." I imitated Zuogui Yin combined with Shengmai San. After taking it, she recovered.
An Bo's commentary: To diagnose such syndromes, if one lacks the theoretical foundation of the *Neijing* in mind, it is like walking blindfolded.