68．许男。昨日呕吐如豆沙状，平素既无胃病宿疾。便是饮食之残余。今吐止而胸中闷，仲景称为心下痞。党参9克，生枳实9克，淮山药9克，川连1．5克，全瓜蒌12克，云苓12克，陈皮6克，谷芽9克，姜竹茹5克。[按]呕吐后胸中闷，一是因胃气已伤，二是因胃失和降。方中用党参、山药益胃气之虚；枳实、川连、瓜萎降胃气之逆，乃消补兼行之意。
69．蒋女。丧明①之痛，肝气犯胃，不能饮食，入则吐。淡吴萸2．4克，春砂壳5克，旋覆花9克(包)，佩兰梗9克，白蔻仁3克(后下)，苏子9克(包)，云苓12克，杏仁泥9克，佛手片6克，伏龙肝30克(煎汤代水)。二诊：呕吐甚则呕血，兼有白痰酸液。①丧明：伤子云茯苓12克，淮山药9克，阿胶珠12克，柏子仁12克，知母9克，桑白皮9克，生艾叶5克，肉桂末0．9克(分2次吞)，生侧柏叶18克，煅瓦楞子30克(先煎)。[按]此案一诊用降逆制肝、和胃止呕之品，方从旋覆代赭汤化出。二诊因呕吐过甚而呕血，转以养胃止血为主。在凉润药中用少量肉桂，一是取其辛温反佐，以行诸药之腻，一是取其通经和血以散瘀阻。
70．谢男。进食无论流固，移时胃之右侧既胀且痛，且多作于午后，此胃功能弱也。薤白头12克，生枳实、皂荚子、莱菔子、乌药各9克，海南片6克，晚蚕沙(包)、谷芽、麦芽各9克。
71．屠男。以心下痞硬为主症，饱更甚，而饥亦不稍减；干呕哕，腹中雷鸣，大便难。胃肠功能不健，而异常发酵者。薤白头12克，生枳实9克，神曲9克，制黑丑6克，海南片9克，葶苈子9克，乌药6克，谷麦芽各12克，加平散9克(分2次吞)。
72．魏男。进流质后，胃部之膨满者瘥减，胃之外形有弛缓状。此非短时期所能根治。薤白头15克，厚朴5克，生枳实9克，姜半夏15克，潞党参9克，淮山药9克，槟榔12克，上肉桂5克，来复丹12克。共研细末服，每次6克，1日2次。
73．陈女。胸中嘈而不能食，古籍大致以为肝胃病。吾人当测其在肝、在胃：在肝属神经之感觉，在胃多属胃酸过多。进甜食，其嘈益甚，病在胃。熟地12克，知母12克，云苓9克，杏仁泥18克，怀山药12克，柏子仁12克，葛根9克，米仁12克，晚蚕沙9克(包)，郁李仁12克。
74．何女。腹胀满，用酵素类、挥发油类而愈。愈后心嘈善饥，其舌并不光红。此与中消可以鉴别。生黄芪9克，桂枝9克，潞党参9克，甘草6克，杭白芍18克，当归9克，生姜2片，大枣6枚。
75．王男。验小便无蛋白质，则非肾脏病。验大便发现淀粉颗粒甚多，然则腹胀纯是异常发酵。神曲12克，晚蚕沙9克(包)，谷麦芽各9克，枳实6克，山楂肉9克，两头尖9克，莱菔子9克，五灵脂9克(包)，佛手9克。常服鸡屎醴。
76．祁男。进流质亦胀，消化不良，脾之吸收亦障碍也。腹部膨满，责之大便不利。潞党参12克，枳实9克，薤白头9克，姜半夏9克，姜川连1．5克，厚朴6克，生锦纹5克，白芍9克，杏仁泥9克，当归9克，甘草3克。
77．王男。饮与食，中脘皆胀，迟食则饥不可忍，而胀如故，按其胃部膨满，幸为时仅一来复，官能病也。台乌药9克，薤白头12克，沉香曲9克，炒苡仁12克，杏仁泥12克，生枳实9克，海南片6克，莱菔子9克，谷麦芽各9克。
78．袁男。以脘闷胀为主症，加味五磨饮主之。台乌药9克，沉香曲9克，广木香3克，海南片9克，生枳实9克，佛手9克，佩兰梗9克，谷麦芽各9克。
79．王女。拂逆则肝失调达，气机滞结中脘不散，胸闷，善太息，越鞠丸实为的当。.大川芎9克，生苍术9克，制香附9克，生枳实9克，神曲9克，山栀5克，谷麦芽各9克，台乌药6克。
80．张女。下脘作胀，得后与气，则快然自衰，盖肠胃功能病也。薤白头12克，莱菔子9克，生锦纹2．4克(判末吞服)，佛手9克，全瓜蒌12克川椒目5克，石菖蒲6克，香橼皮9克。
81．王男。寒热退后心下痞，得噫气则稍舒，此胃功能障碍也。薤白头12克，小青皮6克，川楝子9克，生苡仁12克。
82．王女。以胃脘胀为主症，其胀多作于午后，胀剧则痛，其痛得蜷曲或重按则稍缓。此消化不良之神经痛。古方五磨饮、越鞠丸、四七汤，皆其选也。生苍术3克，制香附9克，九香虫5克，延胡索12克，莱菔子9克，大川芎6克，神曲9克，生枳实12克，晚蚕沙12克，皂荚子6克(同捣)。另服五磨饮。
83．杨男。食入心下痞，以五磨饮去其大半。时作呛，而痞益足以增其呛，颇类《内经》之胃咳。白苏子12克，陈皮6克，甘草3克，川朴根1．2克(研吞)，葶苈子9克，杏仁泥15克，半夏9克，云苓12克，莱菔子9克。
[按]以上14则医案，多半均为胃功能衰减，或障碍失调者，而大便多艰而不爽。所用药物，大都均为燥湿健脾、醒胃调中、行气消胀之品；但选用皂荚子、葶苈子、薤白头等，则超乎常规用药之惯例，而为章师独特之经验。皂荚子辛温，除有和血润肠之功外，并善治膈痰吞酸。葶苈子《本经》谓其"主瘕瘕积聚结气，饮食寒热，攻坚逐邪，通利水道"，故不仅长于泻肺利水，且有消食散满，导滞宽中之功。薤白头辛苦温，乃治胸痹心痛彻背之名晶，有理气宽胸，通阳散结之功，尤能下气散血，健胃开膈，对脘胀具有著效，故凡有胃胀者，章师悉采用之。此皆章师独到之经验，值得学习和运用。
san
泄泻
1．陈女。泄泻始则爽利，继则如滞下状。临圊腹痛，病在大肠；后重乃大肠之炎症波及直肠所致。炒枳实、炒白芍、苦桔梗、海南片、熟锦纹、细青皮、薤白头各9克，山楂炭18克，炒枯赤砂糖9克。[按]泄泻临厕腹痛后重，为炎症所致，其治疗不可早止，当先荡，涤。方用大黄、槟榔清肠通腑；青皮、薤白、枳实、砂糖、白芍缓急止痛；用大量山楂为炭，于消导之中寓收敛之意，为先生治泄泻、痢疾尝用之药。
2．汤女。泄泻日四五行，泄不爽，腹隐痛，苔白。此肠部发生吸收故障，古人届诸脾有寒。炮附块4．5克，杭白芍9克，熟锦纹6克，炒防风6克，薤白头9克，生艾叶4．5克，炒枳实9克，山楂肉9克，地枯萝9克。[按]苔白，腹隐痛，为脾虚中寒，故用附子、艾叶以温之；泄不爽，为内有积滞，阻碍气机，故用大黄、枳实、薤白、山楂、地枯萝(即枯萝卜头)以消导之。大凡泄下不爽，临厕腹痛，便后则安者，都有积滞，大黄在所必用。属热则伍以芩、连；属寒则参以姜、附。
3．徐男。恶寒发热，3日后更见腹痛、泄泻。喻氏逆流挽舟之法，本为下痢夹表而设，其实治泄泻亦可用。荆芥4．5克，防风4．5克，粉葛4．5克，春柴胡4．5克，升麻2．4克，川羌活9克，白芷4．5克，桔梗3克，枳实炭9克，大腹皮9克，神曲9克，煨姜2片，山楂末9克(分2次吞)。[按]此风寒外束，寒湿内蕴之证。方中羌、防、柴、葛既可解表，又有燥湿升提，所谓"鼓舞胃气上腾，则泄泻自止"。此泄泻、痢疾初起兼表证的有效方剂。
4．沈女。黎明泄泻，多属肠痨。此病多在青年，。不易速愈。土炒党参9克，野于术9克，云茯苓12克，扁豆衣9克，五味子4．5克，芡实12克，蒸百部9克，清炙草3克。另：炮附块、炮姜、煨益智、诃子肉、肉豆蔻、罂粟壳、乌梅肉各9克，共研细末，每服3克，1日3次。[按]此即五更泄泻。煎方为四君子汤加味，补气健脾，合散剂则又有理中汤、诃子散意，具有温中止痛、涩肠止泻之功。方中百部一味，习惯都不用于治疗泄泻，但据现代药理实验，该品具有杀虫与抗结核菌的作用。先生用之，殆因有肠结核(肠痨)之可疑。
5．毛男。病泄泻4周不能愈，多则七八次，少则二三次，其便溏而臭。凡泄泻而有热者，均不宜固涩。淡子芩9克，炒白芍9克，粉甘草3克，黑防风9克，煨木香4．5克，陈皮4．5克，飞滑石9克(包)，车前子12克，白槿花12克。另：山楂炭18克，研细末，每服3克，1日3次。原注：服此方后，一剂知，二剂已。[按]病虽泄泻4周，发热便溏而臭，可知内有湿热积滞，治疗不可固涩。方用黄芩汤去大枣加白槿花直清肠热；木香、陈皮、山楂行滞；滑石、车前子分利水湿，古谓"利小便即是实大便"。
6．陈幼。长夏善病洞泄寒中，盖暑令胃酸减少，消化不良，一也；受寒之机会较多，二也；恣食生冷，三也。泄泻昼夜数十行，水分消耗太甚，厥逆之变，即在目前。炮附块6克，炮姜炭2．4克，煨益智9克，焦六曲9克，山楂炭9克，乌梅肉2．4克，干荷叶1角，伏龙肝18克(包)。[按]《内经》"长夏善病洞泄寒中"，即指此等证而言。方用姜、附振奋中阳：益智、伏龙肝温中止泻；佐以山楂、六曲行滞，乌梅敛肝，荷叶升清。勿谓盛夏炎炎，见泄泻便用苦寒清凉。先生所列3条，可为上段经文的精湛注解。此证因泄泻失水过多，利小便以实大便的治法于此决非所宜，因此先生强调指出："厥逆之变，即在目前。"所谓厥逆，即是休克。其治疗除汤剂外，尚需积极补液，增加血容量，纠正电解质的紊乱。
7．王男。两旬以来，腹痛阵作，自诉得之于感寒之后，痛时即欲大便，其便先硬而后溏；其痛得温暖则舒，得矢气亦舒。口唇干燥，不欲食，时感怯冷。当温脾肾之阳。附子6克，炮姜9克，薤白头9克，青皮9克，白术12克，桂心1．8克，益智仁12克，云苓18克。二诊：服药期间，腹痛瘥可；停药3天，其痛复作。昨日工作较忙，其痛更剧，且于清晨五时泄泻2次，坚持前法勿失。附块6克，白术9克，炮姜9克，薤白头12克，乌药9克，云苓18克，紫桂3克，木瓜12克，艾叶9克。另：附子理中丸72克，每服6克，日2次。三诊：腹泄腹痛已基本上好转，体力尚未恢复。附块6克，白术9克，紫桂3克，党参9克，艾叶9克，云苓12克，炮姜6克，薤白头9克，木瓜9克，扁豆衣12克。
[按]"必伏其所主，而先其所因"。此案腹痛阵作已经两旬，得之感寒之后，其痛喜暖，其便先硬后溏，属中寒无疑。痛即欲便，得矢气而舒者，乃阴寒凝聚，气不得畅。阴寒内阻，脾阳不振，故不欲食；气机不畅，津不上承，故口唇干燥。首方用姜、附、益智、桂心，温阳散寒；白术、茯苓，燥脾利湿；青皮、薤白，疏调气机。二诊因停药3天，工作繁忙，其病复作，坚守前法仍然收效。三诊仍用附子理中汤加味，温振脾肾之阳；木瓜酸涩收敛，兼和脾疏肝；艾叶苦温，以止虚寒腹痛。合为标本兼顾而善后调理之方。
8．马男。病历4个月，大便溏色黄，医院诊断为慢性肠炎。脉弱苔白，脾肾两补。炮附块9克，潞党参9克，焦白术9克，云苓12克，绿升麻2．4克，.益智9克，淮山药9克，谷麦芽各9克，炮姜炭3克，清炙草3克，四神丸9克(分2次吞)。二诊：药后大便次数减少，质亦稍厚。再予理中汤合四神丸复方，腹痛加木香之属。米炒党参12克，生白术9克，淡吴萸6克，广木香3克，淮山药15克，破故纸9克，清炙草3克，白茯苓12克，肉豆蔻4．5克。[按]急性肠炎，多从热治；慢性肠炎，多宜温补。此久泄、脉弱、苔白，为脾肾阳虚，治用附子理中汤、四神丸、四君子汤复方加减，以温补脾肾。
9．钱男。往日之便秘者，今反多泄，恶寒而下肢冷，真阳式微也。炮附子9克，葫芦巴9克，细辛2．4克，益智仁9克，破故纸9克，鹿角霜12克，炮姜炭3克，巴戟天9克，仙灵脾9克，肉豆蔻9克，生艾叶4．5克，肉桂末1．2克(分3次吞)。[按]真阳，指肾阳，即命门火。肾为胃之关，开窍于二阴，故二便皆肾之所主。命门火衰，脾失温煦，阴寒独盛，故为泄泻。立方峻补命门，俾阳气来复，阴霾消而泄自止。
10．韩男。便溏6个月之久，多作于朝暮。往是暴注下迫，不能自约，近则有努责意；面萎黄，1个月前曾经两足浮肿。炮附块4．5克，生白术9克，薤白头9克，海南片6克，杭白芍9克，潞党参9克，炮姜炭2．4克，清炙草3克，川楝子9克，乌梅丸12克(分2次吞)。
[按]暴泄属实，久泄多虚。本案患者便溏已达半年之久，面色萎黄，两足浮肿，为脾阳虚无疑。以往暴注下迫，是脾肾气虚不能约束；近有怒责意，为脾虚失运内有积滞。方用附子理中振奋脾肾之阳；薤白、槟榔、川楝子理气行滞；白芍缓急而和营敛阴，可缓姜、附辛燥之偏。乌梅丸寒热补泄并用，对久泄有效。
68. Male Xu. Yesterday, he vomited material resembling bean paste; he had no chronic stomach disease in the past. This was merely residual food. Now that vomiting has ceased but chest oppression remains, Zhongjing calls this "epigastric fullness" (Xin Xia Pi). Codonopsis Radix (Dangshen) 9g, Immature Bitter Orange Fructus (Zhishi) 9g, Dioscoreae Rhizoma (Shanyao) 9g, Coptidis Rhizoma (Chuanlian) 1.5g, Trichosanthis Fructus (Gualou) 12g, Poria (Fuling) 12g, Tangerine Peel (Chenpi) 6g, Rice Sprout (Guya) 9g, Ginger-processed Bamboo Shavings (Zhu Ru) 5g. [Commentary] Chest oppression after vomiting is due to two reasons: first, stomach Qi is damaged; second, the stomach fails to descend properly. In the formula, Codonopsis and Dioscorea tonify the deficiency of stomach Qi; Immature Bitter Orange and Coptis direct rebellious stomach Qi downward. This reflects the principle of combining purging and tonifying.
69. Female Jiang. The pain of losing a son caused Liver Qi to invade the Stomach, preventing eating; anything ingested is vomited. Lightly processed Evodiae Fructus (Wuzhuyu) 2.4g, Amomi Fructus Rotundus (Sharen) 5g, Inulae Flos (Xuanfuhua) 9g (wrapped), Eupatorii Herba (Peilan) 9g, Cardamomi Fructus (Bako) 3g (added later), Perillae Fructus (Suzi) 9g (wrapped), Poria (Fuling) 12g, Almond Seed (Xingren) 9g, Citri Reticulatae Pericarpium Viride (Foshou) 6g, Longan Earth (Fulonggan) 30g (decocted as water substitute). Second visit: Severe vomiting led to hematemesis, accompanied by white phlegm and sour fluid. Poria (Fuling) 12g, Dioscoreae Rhizoma (Shanyao) 9g, Processed Donkey-hide Gelatin (Ejiao) 12g, Biota Seed (Baizi) 12g, Anemarrhenae Rhizoma (Zhimu) 9g, Mulberry Cortex (Sangbupi) 9g, Raw Mugwort Leaf (Aiye) 5g, Cinnamon Bark Powder (Rougui) 0.9g (taken in 2 doses), Raw Platycladi Cacumen (Cebaiye) 18g, Calcined Arca Shell (Walengzi) 30g (decocted first). [Commentary] The first visit used herbs to subdue rebellion, control the Liver, harmonize the Stomach, and stop vomiting, derived from Xuanfu Daizhe Tang. The second visit, due to severe vomiting causing hematemesis, shifted focus to nourishing the Stomach and stopping bleeding. A small amount of Cinnamon Bark is added to cooling and moistening herbs for two reasons: first, its acrid-warm nature acts as an antithesis to prevent cloying effects of other herbs; second, it promotes circulation and harmonizes blood to dissipate stasis.
70. Male Xie. After eating, whether liquid or solid, the right side of the epigastrium becomes distended and painful after some time, mostly occurring in the afternoon. This indicates weak Stomach function. Allii Macrostemonis Bulbus (Xiebai) 12g, Immature Bitter Orange Fructus (Zhishi), Gleditsiae Spina (Zaojiazi), Raphani Semen (Laifuzi), Linderae Radix (Wuyao) each 9g, Arecae Pericarpium (Hainanpian) 6g, Bombyx Batryticatus (Can Sha) 9g (wrapped), Rice Sprout (Guya), Hordei Fructus Germinatus (Maya) each 9g.
71. Male Tu. Chief complaint is epigastric fullness and hardness, worse after meals and not relieved by hunger; dry heaving, borborygmus, and difficult defecation. Gastrointestinal function is poor with abnormal fermentation. Allii Macrostemonis Bulbus (Xiebai) 12g, Immature Bitter Orange Fructus (Zhishi) 9g, Mass Medicated Leaven (Shenqu) 9g, Prepared Black Morning Glory Seed (Heichou) 6g, Arecae Pericarpium (Hainanpian) 9g, Lepidii Semen (Tinglizi) 9g, Linderae Radix (Wuyao) 6g, Rice Sprout and Hordei Fructus Germinatus each 12g, Jia Ping San 9g (taken in 2 doses).
72. Male Wei. After consuming liquids, gastric distension improves, and the external shape of the stomach appears flaccid. This cannot be cured in a short period. Allii Macrostemonis Bulbus (Xiebai) 15g, Magnoliae Officinalis Cortex (Houpo) 5g, Immature Bitter Orange Fructus (Zhishi) 9g, Ginger-processed Pinellia Tuber (Banxia) 15g, Codonopsis Radix (Dangshen) 9g, Dioscoreae Rhizoma (Shanyao) 9g, Areca Seed (Binglang) 12g, Cinnamomi Cortex (Rougui) 5g, Laifu Dan 12g. Grind into fine powder and take, 6g per dose, twice daily.
73. Female Chen. Epigastric burning sensation preventing eating. Ancient texts generally attribute this to Liver-Stomach disease. We must determine if it is in the Liver or Stomach: if in the Liver, it belongs to neural sensation; if in the Stomach, it is mostly due to excessive gastric acid. Eating sweets worsens the burning, indicating the pathology is in the Stomach. Rehmanniae Radix Preparata (Shudi) 12g, Anemarrhenae Rhizoma (Zhimu) 12g, Poria (Fuling) 9g, Almond Seed (Xingren) 18g, Dioscoreae Rhizoma (Shanyao) 12g, Biota Seed (Baizi) 12g, Puerariae Radix (Gegen) 9g, Coicis Semen (Yiren) 12g, Bombyx Batryticatus (Can Sha) 9g (wrapped), Prunus Armeniaca Var. Ansii Semen (Yuliren) 12g.
74. Female He. Abdominal distension and fullness were cured using enzymes and volatile oils. After recovery, she experienced epigastric burning and easy hunger, but her tongue was not red and glossy. This can be differentiated from Middle Xiao (Middle Jiao Wasting-Thirst). Astragali Radix (Huangqi) 9g, Cinnamomi Ramulus (Guizhi) 9g, Codonopsis Radix (Dangshen) 9g, Glycyrrhizae Radix et Rhizoma (Gancao) 6g, Paeoniae Radix Alba (Baishao) 18g, Angelicae Sinensis Radix (Danggui) 9g, Zingiberis Rhizoma Recens (Shengjiang) 2 slices, Jujubae Fructus (Dazao) 6 pieces.
75. Male Wang. Urine test showed no protein, ruling out kidney disease. Stool test revealed many starch granules, so the abdominal distension is purely due to abnormal fermentation. Mass Medicated Leaven (Shenqu) 12g, Bombyx Batryticatus (Can Sha) 9g (wrapped), Rice Sprout and Hordei Fructus Germinatus each 9g, Immature Bitter Orange Fructus (Zhishi) 6g, Hawthorn Fruit (Shanzha) 9g, Lophatherum Herb (Liangtoujian) 9g, Raphani Semen (Laifuzi) 9g, Trogopterori Faeces (Wulingzhi) 9g (wrapped), Citri Reticulatae Pericarpium Viride (Foshou) 9g. Regularly consume Ji Shi Li (Chicken Manure Wine).
76. Male Qi. Distension occurs even with liquids; indigestion and impaired Spleen absorption. Abdominal distension is attributed to difficult defecation. Codonopsis Radix (Dangshen) 12g, Immature Bitter Orange Fructus (Zhishi) 9g, Allii Macrostemonis Bulbus (Xiebai) 9g, Ginger-processed Pinellia Tuber (Banxia) 9g, Ginger-processed Coptidis Rhizoma (Chuanlian) 1.5g, Magnoliae Officinalis Cortex (Houpo) 6g, Rheum Palmatum Root (Jinwen) 5g, Paeoniae Radix Alba (Baishao) 9g, Almond Seed (Xingren) 9g, Angelicae Sinensis Radix (Danggui) 9g, Glycyrrhizae Radix et Rhizoma (Gancao) 3g.
77. Male Wang. Both drinking and eating cause distension in the Zhongwan area. Delayed eating causes unbearable hunger, yet distension persists. Palpation reveals gastric distension. Fortunately, the duration is only one cycle, indicating a functional disorder. Linderae Radix (Wuyao) 9g, Allii Macrostemonis Bulbus (Xiebai) 12g, Agarwood Mass Medicated Leaven (Chenxiang Qu) 9g, Stir-fried Coicis Semen (Yiyi Ren) 12g, Almond Seed (Xingren) 12g, Immature Bitter Orange Fructus (Zhishi) 9g, Arecae Pericarpium (Hainanpian) 6g, Raphani Semen (Laifuzi) 9g, Rice Sprout and Hordei Fructus Germinatus each 9g.
78. Male Yuan. Chief complaint is epigastric stuffiness and distension, treated with Modified Wu Mo Yin. Linderae Radix (Wuyao) 9g, Agarwood Mass Medicated Leaven (Chenxiang Qu) 9g, Aucklandiae Radix (Muxiang) 3g, Arecae Pericarpium (Hainanpian) 9g, Immature Bitter Orange Fructus (Zhishi) 9g, Citri Reticulatae Pericarpium Viride (Foshou) 9g, Eupatorii Herba (Peilan) 9g, Rice Sprout and Hordei Fructus Germinatus each 9g.
79. Female Wang. Emotional frustration causes Liver dysfunction, leading to Qi stagnation in the Zhongwan area, chest tightness, and frequent sighing. Yueju Wan is indeed appropriate. Ligusticum Chuanxiong Rhizome (Chuanxiong) 9g, Atractylodis Rhizoma (Cangzhu) 9g, Cyperi Rhizoma (Xiangfu) 9g, Immature Bitter Orange Fructus (Zhishi) 9g, Mass Medicated Leaven (Shenqu) 9g, Gardeniae Fructus (Zhizi) 5g, Rice Sprout and Hordei Fructus Germinatus each 9g, Linderae Radix (Wuyao) 6g.
80. Female Zhang. Distension in the lower epigastrium; relief comes after defecation and passing gas, indicating a gastrointestinal functional disorder. Allii Macrostemonis Bulbus (Xiebai) 12g, Raphani Semen (Laifuzi) 9g, Rheum Palmatum Root (Jinwen) 2.4g (powder taken orally), Citri Reticulatae Pericarpium Viride (Foshou) 9g, Trichosanthis Fructus (Gualou) 12g, Zanthoxyli Semen (Chuanjiaomu) 5g, Acori Tatarinowii Rhizoma (Shichangpu) 6g, Citri Reticulatae Pericarpium (Xiangyuanpi) 9g.
81. Male Wang. Epigastric fullness after fever subsides, slightly relieved by belching, indicating Stomach dysfunction. Allii Macrostemonis Bulbus (Xiebai) 12g, Small Green Tangerine Peel (Qingpi) 6g, Toosendan Fructus (Chuanlianzi) 9g, Coicis Semen (Yiyi Ren) 12g.
82. Female Wang. Chief complaint is epigastric distension, mostly occurring in the afternoon. Severe distension causes pain, which is slightly relieved by curling up or firm pressure. This is neuralgia due to indigestion. Ancient formulas Wu Mo Yin, Yueju Wan, and Siqi Tang are all suitable choices. Atractylodis Rhizoma (Cangzhu) 3g, Cyperi Rhizoma (Xiangfu) 9g, Aspongopus (Jiu Xiang Chong) 5g, Corydalis Rhizoma (Yanhusuo) 12g, Raphani Semen (Laifuzi) 9g, Ligusticum Chuanxiong Rhizome (Chuanxiong) 6g, Mass Medicated Leaven (Shenqu) 9g, Immature Bitter Orange Fructus (Zhishi) 12g, Bombyx Batryticatus (Can Sha) 12g, Gleditsiae Spina (Zaojiazi) 6g (pounded together). Take Wu Mo Yin separately.
83. Male Yang. Epigastric fullness after eating, treated with most of Wu Mo Yin removed. Occasional choking cough, and fullness exacerbates the cough, resembling "Stomach Cough" in Neijing. Perilla Fructus (Suzi) 12g, Tangerine Peel (Chenpi) 6g, Glycyrrhizae Radix et Rhizoma (Gancao) 3g, Magnoliae Officinalis Cortex (Cunhougen) 1.2g (powder taken orally), Lepidii Semen (Tinglizi) 9g, Almond Seed (Xingren) 15g, Pinellia Tuber (Banxia) 9g, Poria (Fuling) 12g, Raphani Semen (Laifuzi) 9g.
[Commentary] Of the above 14 medical cases, most involve decline or dysfunction/disorder of Stomach function, with stools often being difficult and unsatisfactory. The herbs used are mostly for drying dampness, strengthening the Spleen, awakening the Stomach, regulating the middle, promoting Qi movement, and reducing distension. However, the selection of Gleditsiae Spina, Lepidii Semen, and Allii Macrostemonis Bulbus exceeds conventional practices and represents Master Zhang's unique experience. Gleditsiae Spina is acrid and warm; besides harmonizing blood and moistening the intestines, it effectively treats phlegm in the diaphragm and acid regurgitation. Lepidii Semen, according to the Shen Nong Ben Cao Jing, "treats masses, accumulations, stagnant Qi, dietary cold/heat, attacks hardness, expels pathogens, and unblocks water passages." Thus, it not only benefits lung diffusing and diuresis but also aids digestion, reduces fullness, guides out stagnation, and opens the middle. Allii Macrostemonis Bulbus is acrid, bitter, and warm; it is a famous herb for treating chest bi (pain extending to the back), with functions of regulating Qi, broadening the chest, unblocking Yang, and dissipating nodules. It particularly descends Qi, disperses blood, strengthens the Stomach, opens the diaphragm, and is highly effective for epigastric distension. Therefore, Master Zhang adopts it for all cases of gastric distension. These are Master Zhang's unique experiences, worthy of study and application.
Chinese Medical Treasures
Zhang Cigong's Medical Cases
Zhang Cigong
San
Diarrhea
1. Female Chen. Diarrhea started smooth but became like dysentery (tenesmus). Abdominal pain during defecation indicates pathology in the Large Intestine; tenesmus is caused by inflammation spreading from the Large Intestine to the rectum. Stir-fried Immature Bitter Orange Fructus (Zhishi), Stir-fried Paeoniae Radix Alba (Baishao), Platycodonis Radix (Jiegeng), Arecae Pericarpium (Hainanpian), Processed Rheum Palmatum Root (Jinwen), Fine Green Tangerine Peel (Qingpi), Allii Macrostemonis Bulbus (Xiebai) each 9g, Charred Hawthorn Fruit (Shanzha Tan) 18g, Stir-fried Brown Sugar (Kuchishatang) 9g. [Commentary] Diarrhea with abdominal pain and tenesmus during defecation is caused by inflammation; treatment should not stop diarrhea too early but should first purge. The formula uses Rheum and Areca Seed to clear the intestines and unblock the bowels; Green Tangerine Peel, Allii Macrostemonis Bulbus, Immature Bitter Orange Fructus, brown sugar, and White Peony Root relieve urgency and pain; large amounts of charred Hawthorn provide astringency within digestion-promoting action, a method Mr. Zhang frequently uses for diarrhea and dysentery.
2. Female Tang. Diarrhea 4-5 times a day, unsatisfactory evacuation, dull abdominal pain, white coating. This is an absorption fault in the intestines, which ancients attributed to Cold in the Spleen. Processed Aconite Lateralis Radix Preparata (Fuzi) 4.5g, Paeoniae Radix Alba (Baishao) 9g, Processed Rheum Palmatum Root (Jinwen) 6g, Stir-fried Saposhnikoviae Radix (Fangfeng) 6g, Allii Macrostemonis Bulbus (Xiebai) 9g, Raw Mugwort Leaf (Aiye) 4.5g, Stir-fried Immature Bitter Orange Fructus (Zhishi) 9g, Hawthorn Fruit (Shanzha) 9g, Radish Root (Dikuluoluo) 9g. [Commentary] White coating and dull abdominal pain indicate Spleen deficiency with Middle Cold, hence Aconite and Mugwort are used to warm; unsatisfactory evacuation indicates internal stagnation obstructing Qi mechanism, hence Rheum, Immature Bitter Orange Fructus, Allii Macrostemonis Bulbus, Hawthorn, and Dikuluoluo are used to promote digestion. Generally, unsatisfactory evacuation with abdominal pain during defecation that relieves after stool indicates stagnation, making Rheum essential. If heat, combine with Scutellaria and Coptis; if cold, add Ginger and Aconite.
3. Male Xu. Aversion to cold and fever; after 3 days, abdominal pain and diarrhea appeared. Yu's "Reverse Flow Pulling the Boat" method was originally designed for dysentery with exterior syndrome, but it can also be used for diarrhea. Schizonepetae Spica (Jingjie) 4.5g, Saposhnikoviae Radix (Fangfeng) 4.5g, Puerariae Radix (Ge Gen) 4.5g, Bupleuri Radix (Chai Hu) 4.5g, Cimicifugae Rhizoma (Shengma) 2.4g, Notopterygii Rhizoma et Radix (Qiang Huo) 9g, Angelicae Dahuricae Radix (Baizhi) 4.5g, Platycodonis Radix (Jiegeng) 3g, Charred Immature Bitter Orange Fructus (Zhishi Tan) 9g, Arecae Caulis (Fupi) 9g, Mass Medicated Leaven (Shenqu) 9g, Roasted Ginger (Weijiang) 2 slices, Hawthorn Powder (Shanzha Mo) 9g (taken in 2 doses). [Commentary] This is a case of Wind-Cold binding the exterior and Cold-Dampness accumulating internally. Qiang Huo, Fang Feng, Chai Hu, and Ge Gen in the formula can release the exterior and also dry dampness and lift Qi, as described: "Stimulating Stomach Qi to rise will stop diarrhea." This is an effective formula for early-stage diarrhea or dysentery with exterior symptoms.
4. Female Shen. Dawn diarrhea, mostly due to intestinal tuberculosis (Chang Lao). This disease mostly affects youth and is not easily cured quickly. Earth-stir-fried Codonopsis Radix (Dangshen) 9g, Wild Atractylodis Macrocephalae Rhizoma (Baizhu) 9g, Poria (Fuling) 12g, Dolichoris Semen (Bian Dou) 9g, Schisandrae Fructus (Wuweizi) 4.5g, Euryales Semen (Qianshi) 12g, Steamed Stemona Radix (Bai Bu) 9g, Honey-fried Glycyrrhizae Radix et Rhizoma (Gancao) 3g. Additionally: Processed Aconite Lateralis Radix Preparata, Processed Ginger, Roasted Alpinia Oxyphylla Fruit (Yizhi), Chebulae Fructus (He Zi), Myristicae Semen (Roudoukou), Papaveris Capsula (Yingsuke), Pruni Mume Fructus (Wumei) each 9g, grind into fine powder, take 3g per dose, 3 times daily. [Commentary] This is Cockcrow Diarrhea. The decoction is Si Jun Zi Tang modified to tonify Qi and strengthen the Spleen; combined with the powder, it implies Li Zhong Tang and He Zi San, having functions of warming the middle, relieving pain, and astringing the intestines to stop diarrhea. Bai Bu is not habitually used for diarrhea, but modern pharmacological experiments show it has insecticidal and anti-tubercular effects. Mr. Zhang likely used it due to suspected intestinal tuberculosis.
5. Male Mao. Diarrhea for 4 weeks without cure, 7-8 times at most, 2-3 times at least; loose and foul-smelling stool. For diarrhea with heat, astringents are contraindicated. Scutellariae Baicalensis Radix (Huangqin) 9g, Stir-fried Paeoniae Radix Alba (Baishao) 9g, Glycyrrhizae Radix et Rhizoma (Gancao) 3g, Blackened Saposhnikoviae Radix (Fangfeng) 9g, Roasted Aucklandiae Radix (Muxiang) 4.5g, Tangerine Peel (Chenpi) 4.5g, Calcined Gypsum (Huashi) 9g (wrapped), Plantaginis Semen (Cheqianzi) 12g, Hibiscus Mutabilis Flower (Jinhua) 12g. Additionally: Charred Hawthorn Fruit (Shanzha Tan) 18g, grind into fine powder, take 3g per dose, 3 times daily. Original note: One dose brings improvement, two doses bring cure. [Commentary] Although diarrhea lasted 4 weeks, fever, loose foul stool indicates internal Damp-Heat and stagnation; treatment should not use astringents. The formula uses Huang Qin Tang minus Da Zao plus Jinhua to directly clear intestinal heat; Muxiang, Chenpi, and Shanzha move stagnation; Huashi and Cheqianzi separate clear and turbid fluids. Ancients said "Promoting urination makes stool solid."
6. Child Chen. In late summer prone to severe diarrhea and Cold damaging the Middle. Reasons: 1. Summer heat reduces gastric acid, causing indigestion; 2. More opportunities to catch cold; 3. Excessive consumption of raw/cold foods. Diarrhea dozens of times day and night, severe water loss, shock is imminent. Processed Aconite Lateralis Radix Preparata (Fuzi) 6g, Processed Ginger Charcoal (Jiang Tan) 2.4g, Roasted Alpinia Oxyphylla Fruit (Yizhi) 9g, Scorched Mass Medicated Leaven (Liujqu) 9g, Charred Hawthorn Fruit (Shanzha Tan) 9g, Pruni Mume Fructus (Wumei) 2.4g, Dried Lotus Leaf (Heye) 1 corner, Longan Earth (Fulonggan) 18g (wrapped). [Commentary] "In late summer, prone to severe diarrhea and Cold damaging the Middle" from Neijing refers to such cases. The formula uses Ginger and Aconite to stimulate Middle Yang; Yizhi and Fulonggan warm the middle and stop diarrhea; assisted by Shanzha and Liujqu to move stagnation, Wumei to astringe the Liver, and Heye to raise clear Qi. Do not assume that because it is midsummer, diarrhea should be treated with bitter-cold cooling herbs. Mr. Zhang's three cases provide excellent commentary on this classic text. Due to excessive water loss from diarrhea, the method of promoting urination to solidify stool is absolutely inappropriate here. Hence Mr. Zhang emphasized: "Shock is imminent." Shock refers to circulatory collapse. Treatment requires active fluid replacement to increase blood volume and correct electrolyte imbalance, in addition to decoctions.
7. Male Wang. For two decades, paroxysmal abdominal pain, self-reported onset after catching cold. Pain urges defecation; stool is hard initially then loose. Pain relieved by warmth and passing gas. Dry lips, loss of appetite, occasional feeling of chill. Should warm Spleen and Kidney Yang. Aconite Lateralis Radix Preparata (Fuzi) 6g, Processed Ginger (Jiang) 9g, Allii Macrostemonis Bulbus (Xiebai) 9g, Green Tangerine Peel (Qingpi) 9g, Atractylodis Macrocephalae Rhizoma (Baizhu) 12g, Cinnamon Heart (Guixin) 1.8g, Alpinia Oxyphylla Fruit (Yizhiren) 12g, Poria (Fuling) 18g. Second visit: Abdominal pain improved during medication; stopped for 3 days, pain returned. Busy work yesterday, pain worsened, diarrhea twice at 5 AM. Persist with previous method. Aconite Lateralis Radix Preparata (Fuzi) 6g, Atractylodis Macrocephalae Rhizoma (Baizhu) 9g, Processed Ginger (Jiang) 9g, Allii Macrostemonis Bulbus (Xiebai) 12g, Linderae Radix (Wuyao) 9g, Poria (Fuling) 18g, Purple Cinnamon (Zigui) 3g, Chaenomelis Fructus (Mu Gua) 12g, Mugwort Leaf (Ai Ye) 9g. Additionally: Fuzi Lizhong Wan 72g, take 6g per dose, twice daily. Third visit: Diarrhea and abdominal pain basically improved, physical strength not yet recovered. Aconite Lateralis Radix Preparata (Fuzi) 6g, Atractylodis Macrocephalae Rhizoma (Baizhu) 9g, Purple Cinnamon (Zigui) 3g, Codonopsis Radix (Dangshen) 9g, Mugwort Leaf (Ai Ye) 9g, Poria (Fuling) 12g, Processed Ginger (Jiang) 6g, Allii Macrostemonis Bulbus (Xiebai) 9g, Chaenomelis Fructus (Mu Gua) 9g, Dolichoris Semen (Bian Dou) 12g.
[Commentary] "Must subdue what dominates, and address the cause first." Paroxysmal abdominal pain for two decades, onset after cold, pain prefers warmth, stool hard then loose, definitely Middle Cold. Urging defecation with pain, relief with passing gas indicates Yin-Cold condensation and Qi obstruction. Internal Yin-Cold blocks Spleen Yang, causing loss of appetite; Qi obstruction prevents fluids from ascending, causing dry lips. First formula uses Ginger, Aconite, Yizhi, Guixin to warm Yang and dispel cold; Baizhu and Fuling dry Spleen and drain dampness; Qingpi and Xiebai regulate Qi mechanism. Second visit, illness recurred due to 3-day break and busy work; persisting with previous method remained effective. Third visit still uses Fuzi Lizhong Tang modified to warm and boost Spleen-Kidney Yang; Mu Gua is sour and astringent, harmonizing Spleen and soothing Liver; Ai Ye is bitter and warm, stopping deficiency-cold abdominal pain. Combined as a follow-up formula addressing both root and branch.
8. Male Ma. Medical history 4 months, loose yellow stool, hospital diagnosed chronic enteritis. Weak pulse, white coating, tonify both Spleen and Kidney. Processed Aconite Lateralis Radix Preparata (Fuzi) 9g, Codonopsis Radix (Dangshen) 9g, Scorched Atractylodis Macrocephalae Rhizoma (Baizhu) 9g, Poria (Fuling) 12g, Cimicifugae Rhizoma (Shengma) 2.4g, Alpinia Oxyphylla Fruit (Yizhi) 9g, Dioscoreae Rhizoma (Shanyao) 9g, Rice Sprout and Hordei Fructus Germinatus each 9g, Processed Ginger Charcoal (Jiang Tan) 3g, Honey-fried Glycyrrhizae Radix et Rhizoma (Gancao) 3g, Sishen Wan 9g (taken in 2 doses). Second visit: Frequency of stool reduced, consistency slightly thicker. Continue Li Zhong Tang combined with Sishen Wan compound; add Muxiang for abdominal pain. Rice-stir-fried Codonopsis Radix (Dangshen) 12g, Raw Atractylodis Macrocephalae Rhizoma (Baizhu) 9g, Lightly processed Evodiae Fructus (Wuzhuyu) 6g, Aucklandiae Radix (Muxiang) 3g, Dioscoreae Rhizoma (Shanyao) 15g, Psoraleae Fructus (Poguzhi) 9g, Honey-fried Glycyrrhizae Radix et Rhizoma (Gancao) 3g, Poria (Fuling) 12g, Myristicae Semen (Roudoukou) 4.5g. [Commentary] Acute enteritis is mostly treated from Heat; chronic enteritis is mostly suitable for warming and tonifying. This long-term diarrhea, weak pulse, white coating indicates Spleen-Kidney Yang Deficiency. Treatment uses compound modification of Fuzi Lizhong Tang, Sishen Wan, and Si Jun Zi Tang to warm and tonify Spleen-Kidney.
9. Male Qian. Previously constipated, now instead has more diarrhea, aversion to cold and cold lower limbs, True Yang is declining. Processed Aconite Lateralis Radix Preparata (Fuzi) 9g, Trigonellae Semen (Huluba) 9g, Asari Radix et Rhizoma (Xixin) 2.4g, Alpinia Oxyphylla Fruit (Yizhiren) 9g, Psoraleae Fructus (Poguzhi) 9g, Cornus Officinalis Antler Frost (Lujiaoshuang) 12g, Processed Ginger Charcoal (Jiang Tan) 3g, Morinda Officinalis Radix (Bajitian) 9g, Epimedii Folium (Xinyinpi) 9g, Myristicae Semen (Roudoukou) 9g, Raw Mugwort Leaf (Ai Ye) 4.5g, Cinnamon Bark Powder (Rougui) 1.2g (taken in 3 doses). [Commentary] True Yang refers to Kidney Yang, i.e., Mingmen Fire. Kidney is the gate of the Stomach, opening to the two yin orifices, thus controlling both urination and defecation. Decline of Mingmen Fire leads to lack of warming for Spleen, excess Yin-Cold, resulting in diarrhea. The prescription severely tonifies Mingmen so Yang Qi returns, Yin-Cold dissipates, and diarrhea stops naturally.
10. Male Han. Loose stool for 6 months, mostly occurring morning and evening. Previously sudden violent diarrhea unable to control, recently has straining sensation; sallow complexion, bilateral foot edema 1 month ago. Processed Aconite Lateralis Radix Preparata (Fuzi) 4.5g, Raw Atractylodis Macrocephalae Rhizoma (Baizhu) 9g, Allii Macrostemonis Bulbus (Xiebai) 9g, Arecae Pericarpium (Hainanpian) 6g, Paeoniae Radix Alba (Baishao) 9g, Codonopsis Radix (Dangshen) 9g, Processed Ginger Charcoal (Jiang Tan) 2.4g, Honey-fried Glycyrrhizae Radix et Rhizoma (Gancao) 3g, Toosendan Fructus (Chuanlianzi) 9g, Wumei Wan 12g (taken in 2 doses).
[Commentary] Sudden diarrhea is excess, long-term diarrhea is mostly deficiency. Patient has had loose stool for half a year, sallow complexion, bilateral foot edema, undoubtedly Spleen Yang Deficiency. Previous violent diarrhea unable to control was due to Spleen-Kidney Qi deficiency failing to restrain; recent straining sensation is due to Spleen deficiency failing to transport with internal stagnation. Formula uses Fuzi Lizhong to boost Spleen-Kidney Yang; Xiebai, Binglang, Chuanlianzi regulate Qi and move stagnation; Baishao relieves urgency, harmonizes Ying, and astringes Yin, moderating the acrid-dry nature of Ginger and Aconite. Wumei Wan combines cold/heat, tonification/purging, effective for long-term diarrhea.