2．康幼。其痰如脓状而臭，迄今半载有余。假使肺部化脓，决不能延长如此之久，其病多在支气管。苦桔梗15克，甜葶苈15克，浙贝母6克，冬瓜子15克，杭白芍15克，生米仁30克，海蛤壳24克，粉甘草15克。【按】支气管扩张症，可长期咳嗽，咯脓样痰；如井发感染，则痰有臭味。这在中医学亦列入肺痈范围。此病人正气未虚，治以排脓为首要措施。桔梗含有皂素，善祛疾排脓；葶苈、浙贝、米仁、冬瓜子、海蛤壳均为有效的祛痰、散结药。
3．何男。病之经过几五阅月，初起饮食作噎，最近匝月饮食有所阻隔，有时呕吐，但有时则通行无阻。暂作食道痉挛治之。全当归、香甘松、陈广皮、沉香曲、香橡皮、旋覆花（包）姜半夏、杭白芍、台乌药、香谷芽各9克。二诊：往日中午不能进食，药后中午能进糜粥。全当归15克，大贝母15克，旋覆花9克（包），杭白芍15克，香甘松3克，香谷芽12克。【按］食道痉挛应与食道癌相鉴别。本案作食道痉挛治疗，药取降逆（半夏、旋覆花）、理气（甘松、陈皮、沉香曲、香元、台乌）及归、芍和营缓痉。服后即收小效，说明不是食道器质性病变。
4．梁幼。经攻积消食药后，便之粘液者，转为泄泻，但按其盲肠部位，仍剧痛，身热如烙。金银花15克，败酱草12克，马齿苋15克，飞滑石12克，五灵脂9克，黄柏炭9克，焦枝肉9克，小蓟12克，京赤芍12克。三诊：药后热退，腹痛大减，但大便仍溏，中有粘液。银花炭9克，白槿花12克，滑石12克，晚蚕沙（包）9克，焦山楂12克，马齿苋、青皮各9克，焦谷麦芽各9克。【按］此案初诊病案散失，但既用攻积消食药，其人以腹痛（尤以盲肠部位）求诊可知。二诊方用银花、败酱草、黄柏、马齿苋、小蓟清热解毒；灵脂、山植、赤芍、滑石行瘀消滞，而获热退，腹痛大减。三诊因大便溏，含粘液，续用清热、理气行滞之品以清余邪。
5．左男。以左膺作痛为主症，自诉曾有宿伤。全当归9克，延胡索9克，旋覆花9克（包），川羌活4．5克，炙乳没各3克，五灵脂9克，婆罗子9克，六轴子1．5克。【按］本案因宿伤而致左膺作痛，故以活血、通络为治。
6．孙女。连日夜间发热，每热必发风疹，痒不可耐。凡风疹发于稚孩，多属胃肠病，以往曾7日一更衣。此其候也。海南片12克，桃仁9克，草决明12克，蒲公英18克，当归12克，丹皮9克，赤芍9克，茅根30克。【按】此为风疹，用当归、蒲公英、桃仁、丹皮、赤芍、茅根清热凉血；槟榔、草决明清肠通便。曾见一便秘患者，身发痒疹，大便得通，其痒疹亦渐次而愈。可知风疹多属胃肠病之说，不是没有临床根据的。
7．柴男。面垢，苔腻，目充血，右肋骨弓下及心窝部疼痛，按之亦然，病历旬余，二便皆少，不通便利溲，则热与呕皆不能止。春柴胡9克，黑山栀9克，绵茵陈15克，淡黄芩9克，生锦纹6克，郁李仁12克，玄明粉15克（冲），赤苓9克；制半夏9克。二诊：得大便，自觉爽适不少，肝脏部分触之亦不如昨日之痛。绵茵陈12克，梗通草6克，嫩白薇12克，玄明粉9克，车前子12克（包），郁李仁9克，冬瓜子9克，生苡仁12克。【按】本例虽未明确诊断，然当时先生认为是急性胆囊炎，方用大柴胡汤加减。二诊病情好转，则改于利二便清湿热。至三诊时，仅觉神疲，乃予异功散调理善后。
8．潘男。此古人所称之疝气痛，牵及睾丸故也。致此之由，仍在痢后。古人以痢后健脾。健脾者，恢复肠之蠕动能力，使痉挛者恢复弛缓；而有气体蓄积者，则排泄之。炮附块4．5克，补骨脂9克，制香附9克，杭白芍12克，鸡内金12克，全当归12克，生白术9克，晚蚕沙15克（包），炮姜炭6克，粉甘草6克。二诊：其便已能自行通畅，而腹之症块牵引睾丸掣痛者如故；自觉两睾皆痛而坠，则不同于偏疝。仍守和营行气，健脾升提之法。全当归12克，绿升麻4．5克，小茴香9克，淡吴萸2．5克，橘核皮各6克，潞党参9克，台乌药9克，荔枝核12克，焦白术9克，）；川楝子9克，延胡索9克。
【按】张子和有"诸疝皆归肝经"之说，因为按照经络学说，肝经络于阴器，上行少腹，所以阴寒内甚，致腹痛牵及睾丸，便责之于肝经为病。本案为寒疝，初诊用附子。炮姜、蚕沙、补骨脂温经燥湿散寒；香附辛香理气；归、芍和营止痛。得之痢后，则脾失健运可知，故复用白术、鸡内金以健脾。二诊其痛如故，考虑到久病气虚下陷，肝失疏泄，乃以参、术、升、柴以补气升陷；木香、吴萸、荔橘核等以疏肝理气止痛，是虚实兼顾之法。先生所谓："健脾者，恢复肠之蠕动能力，使痉挛者恢复弛缓，而有气体蓄积者，则排泄之"，殆即指健脾、理气、缓痛之治。
9．徐男。俗所谓偏坠者，其病有发作性，肠端弛缓不收之故也。其轻者茵香橘核丸、补中益气丸皆能上升；其重者不用刀圭，便有危殆。重症多见老年人气血衰者。此症女子亦有之。不细加考察，便致误事。生黄芪12克，升麻4．5克，苎麻根12克，脱力草15克，全当归9克，十大功劳叶9克，炙乳没各3克，乌药9克，粉甘草4．5克。【按】脱力草即仙鹤草。江浙民间常用之治脱力劳伤，言其有补益气血之功。此案用之，即取其意。
10．赵男。古人之所谓疝，一是肠脱；二是睾丸炎。今右胯青筋隆起，肠脱也。内服药无非恢复局部肌肉之紧张力，但其效甚缓。生黄芪6克，春柴胡2．2克，川楝子9克，升麻2．2克，小青皮6克，台乌药6克，全当归6克，荔枝核12克，炙乳没各2．5克，粉甘草2．5克。另：炙地鳖虫3克，蝎尾1．5克，共研末，分4次吞。【按】痢之为病，多由感寒、劳力致之，故予益气升清、散寒理气之方；然积久瘀阻，故用地鳖虫、蝎尾攻瘀镇痛。先生指出，对疝之治疗，"内服药……其效甚缓"，"其重者不用刀圭，便有危殆"，实为经验所得之谈。
11．朱男。两手指尖麻，面色不华，此属于营养方面事。左睾丸往日曾有性病。全当归9克，黑大豆12克，粉萆薢9克，粉丹皮9克，五加皮9克，秦艽9克，豨莶草15克，杜赤豆30克。二诊：据其往日之经过，颇类麻风。仲景诊王仲宣四十当眉落，亦是斯症。厥后唐初四杰之卢照邻，因此症而终生不治。故诊治之宜早！今予下方：苍耳子90克，大枫子60克，蜈蚣连头足5条，全蝎6克，雄黄15克，绿豆衣150克，蕲蛇4条海藻90克，昆布90克。共为细末，如梧子大，每次20粒。【按］先生对麻风病之早期尝用此方。
12．徐女。千金温脾饮之适应证有三：营养不良，脉沉细，一也；病后之便秘多日，二也；目的临时通便2次者，三也。炮附子90克，潞党参9克，熟锦纹9克，生锦纹锉末3克，干姜4．5克，粉甘草3克，柏子仁12克，山楂肉18克。
13．陈女。骤然耳聋，有属于实证者。不更衣5日，苔垢腻，尖红，予大柴胡汤下之。春柴胡6克，白芍9克，生枳实9克，黄芩4．5克，姜半夏9克，生锦纹2．5克（研未冲），玄明粉12克（冲），草决明12克，粉甘草4．5克，生姜2片，大枣5枚。妇科（7个门类）
l．朱女。室女之停经：①由于内分泌障碍；②营养不如所需；③神经系之变化。而第三者为最普遍，《内经》所谓"二阳之病"。当归12克，云苓9克，白术15克，薄荷6克（后下），白芍9克，柴胡9克，生姜2片，甘草3克，大黄庶虫丸12克（分2次吞服）。二诊：室女停经，萎黄病、子宫结核、内分泌障碍病，皆可从望、切两诊得之；惟神经系之变化，则少迹象可寻。生白术9克，黄芪9克，茯神9克，酸枣仁9克，广木香2．4克，潞党参9克，当归9克，远志3克，龙眼肉9克，粉甘草3克，生姜2片，大枣4枚。
【按］《内经》有"二阳之病发心脾"之说。"二阳"系指阳明（胃、肠）。意即精神抑郁，气机不舒等心脾之病，可以引起胃肠消化不良，在妇女可致月经不调。处方予逍遥散疏肝健脾、调经；大黄庶虫九祛瘀生新，以通经闭。二诊用归脾汤益心脾，充气血，乃取体健而月经自行之意。
2．吴女。经过期不潮，辄有胃症状，如消化不良，吞酸甚。今拟散剂调治。苍术12克，陈皮6克，执白芍9克，厚朴3克，当归12克，柴胡9克，云茯苓18克，薄荷6克，生白术15克，粉甘草3克，大黄庶虫丸18克。共研细末，饭后吞服4．5克。
3．陈女。室女停经，多能引起胃障碍，古人用平胃散通经，即是此理＿春柴胡6克，陈皮6克，官栓皮6克，制香附9克，小青皮6克，生艾叶4．5克，淡吴萸4．5克，薤白头9克，小茴香6克，台乌药6克。另：平胃丸60克，分则次吞服。【按】阳明为多气多血之经。月经过期不潮，则胃气壅遏，此胃证候之由来。吴案为月经过期不潮，陈案为室女停经，两方中均有平胃散，其着眼点即在此。
4．方女。脉有弦意，此种脉主拂逆恚怒。经行后期，将行乳房作胀，少腹尤甚，今经将行。
酸炒柴胡4．5克，杭白芍9克，丹皮9克，薄荷4．5克，全当归9克，生白术9克，赤苓9克，延胡9克，泽兰叶9克，生姜2片。
二诊：经已见，所苦如故，必待经净而后已。当归9克，延胡9克，小茴香9克，旋覆花9克(包)，川芎6克，泽兰叶9克，炒丹皮9克，粉甘草3克。
三诊：凡经行乳房作胀者，此与经之多少无绝对关系；其少腹之胀，如经量增多则稍舒，药后其量仍少。全当归9克，泽兰叶9克，卷柏9克，土牛膝12克，大川芎6克，粉丹皮15克，苏木6克，桃仁泥12克，香附9克。[按]脉弦，经将行乳房作胀，为肝气郁结之征；气结则经行不畅，此少腹胀之由来。用逍遥散出入化裁，疏肝解郁调经，为常用有效之法。三诊因经量少，少腹胀，乃改用活血祛瘀通经之剂。
5．李女。经闭一年有半，形质不消瘦而丰腴，当攻之。全当归12克，泽兰叶12克，益母草12克，生茜草12克，蓬莪术9克，土牛膝12克，京三棱9克，两头尖12克(包)，海南片9克，黑丑9克，大黄廑虫丸12克(分2次吞)。二诊：经闭既无虚劳嫌疑，前方重其制。全当归15克，土牛膝12克，大川芎9克，丹皮12克，蓬莪术12克，制黑丑9克，王不留行9克，紫丹参12克，抵当丸9克。[按]经闭一证，大别之，有属虚、属实之不同；论治则有或补、或攻之异。此患者经闭而形质丰腴，当用活血通经药通其闭止，殆无疑义。抵当丸由水蛭、虻虫、桃仁、大黄组成。水蛭、虻虫为攻逐瘀血的峻药，桃仁长于破血行瘀，大黄能导瘀下行。该方本为治伤寒有热，内有蓄血之证，先生借用治血瘀经闭。
6．郑女。经后期2日而来，将行，少腹沉坠，且隐隐作痛，既行，坠与痛皆消失，而小溲频。夫经与溲在生理并无绝对关系，今如此，亦虚故也。党参9克，绿升麻3克，杜仲9克，五味子4．5克，白芍6克，补骨脂9克，旋覆花9克(包)，罂粟壳9克，乌药6克，甘草3克。[按]小溲频数，一般说来，有属中虚不足者，有属肾虚者。经将行，小腹沉坠，既行，小溲频，均为虚象。案药以补气升提、益肾固摄为主。
7．马女。经将行，口腔破碎，易忿怒，此肝阴不足，而肝阳有余。生熟地各12克，冬青子9克，怀牛膝6克，柏子仁12克，麦冬6克，旱莲草9克，金石斛9克，制首乌12克，牡蛎30克(先煎)，桑麻丸12克(包)。[按]肝体不足，则肝用有余。-案中用牡蛎潜阳，桑麻丸凉肝润燥，余为大队养肝剂，以益肝体。此属肝之虚证，不宜用折肝、泻肝等法。
8．赵女。经后期，将行先下白物，既行其色淡、平居洒洒然有寒意。古人之概念，为虚寒之象。肉豆蔻9克，炮附片6克，炮姜炭4．5克，白芍9克，补骨脂9克，北细辛3克，川桂枝4．5克，黄芪9克，青防风9克，炙甘草3克。二诊：药后凛寒大定。平素经多后期，每月递减。距离经期不远，以此方催其早行。全当归9克，山萸肉9克，北细辛3克，制香附9克，丹皮9克，大川芎6克，补骨脂9克，官桂皮4．5克，炮姜炭3克，两头尖9克(包)。
[按]此案所列诸见症，责之肾阳不足。经后期而色淡，乃肾阳虚影响冲任通盛之故；将行先下白物，乃肾阳虚导致带脉失固，湿浊下流之故。因此温补肾阳为立方之主要着眼点。一诊因平居洒洒然有寒意，故方中有芪、桂、姜、附、芍、草以益气温经和营。二诊因距离经期不远，故方中有归、芎、香附、丹皮、两头尖等通经药。
9．松女。往日行经量少，今更甚，且淡，无所苦。不可攻，其人形瘦故也。全当归12克，熟地12克，怀牛膝9克，阿胶12克，炒丹皮9克，淡吴萸4．5克，麦芽9克，山萸肉9克。[按]行经量少、色淡，且无所若，均为血虚之象。不可因量少而攻之，攻之则诛伐无过，徒伤正气。
2. Kang, child patient. The sputum is purulent and foul-smelling, persisting for over half a year. If it were pulmonary abscess (pulmonary suppuration), it could not have lasted so long; the pathology likely lies in the bronchi. Prescription: Platycodonis Radix (Jiegeng) 15g, Lepidii Fructus (Tinglizi) 15g, Fritillariae Thunbergii Bulbus (Zhebeimu) 6g, Benincasae Semen (Dongguazi) 15g, Paeoniae Radix Alba (Baishao) 15g, Coicis Semen (Yiren) 30g, Clam Shell (Haigekiao) 24g, Glycyrrhizae Radix et Rhizoma Preparata with Honey (Gancao) 15g. [Commentary] Bronchiectasis can cause chronic cough and expectoration of purulent sputum; if secondary infection occurs, the sputum becomes foul-smelling. In Traditional Chinese Medicine (TCM), this falls under the scope of Lung Abscess (Fei Yong). This patient's healthy qi (Zheng Qi) is not deficient; thus, the primary treatment measure is to drain pus. Jiegeng contains saponins and is effective in resolving phlegm and draining pus; Tinglizi, Zhebeimu, Yiren, Dongguazi, and Haigekiao are all effective expectorants and scrofula-resolving agents.
3. He, male patient. The disease course has lasted nearly five months. Initially, there was dysphagia when eating; recently, for about a month, food intake has been obstructed, sometimes accompanied by vomiting, but at other times passing without obstruction. Temporarily treated as esophageal spasm. Prescription: Angelicae Sinensis Radix (Danggui), Nardostachyos Radix et Rhizoma (Gansong), Citri Reticulatae Pericarpium (Chenpi), Aromatic Mass (Chenxiangqu), Areca Seed (Xiangpizi), Inulae Flos (Xuanfuhua) wrapped, Pinelliae Rhizoma Preparatum with Ginger (Banxia), Paeoniae Radix Alba (Baishao), Lysimachiae Herba (Taiwuyao), Hordeum Germinatum (Guya) each 9g. Second visit: Previously unable to eat at noon, after medication able to consume porridge at noon. Prescription: Angelicae Sinensis Radix (Danggui) 15g, Fritillariae Cirrhosae Bulbus (Dabeimu) 15g, Inulae Flos (Xuanfuhua) 9g (wrapped), Paeoniae Radix Alba (Baishao) 15g, Nardostachyos Radix et Rhizoma (Gansong) 3g, Hordeum Germinatum (Guya) 12g. [Commentary] Esophageal spasm should be differentiated from esophageal cancer. This case was treated as esophageal spasm; medications were chosen for their ability to direct rebellious qi downward (Banxia, Xuanfuhua), regulate qi (Gansong, Chenpi, Chenxiangqu, Xiangfu, Taiwuyao), and harmonize the nutritive level while relieving spasm (Danggui, Baishao). Small efficacy was achieved immediately, indicating no organic lesion of the esophagus.
4. Liang, child patient. After using purgatives and digestive aids, mucus in the stool turned into diarrhea, but palpation of the cecal area still elicited severe pain, and body temperature was high like a brand. Prescription: Lonicerae Japonicae Flos (Jinyinhua) 15g, Patriniae Herba (Baijiangcao) 12g, Portulacae Herba (Machixian) 15g, Talcum (Huashi) 12g, Trogopterori Faeces (Wulingzhi) 9g, Phellodendri Cortex Carbonized (Huangbo Tan) 9g, Cinnamomi Cortex Carbonized (Rougui) 9g, Smilacis Glabrae Rhizoma (Xiaoji) 12g, Paeoniae Radix Rubra (Chishao) 12g. Third visit: Heat subsided after medication, abdominal pain greatly reduced, but stool remains loose with mucus. Prescription: Lonicerae Japonicae Flos Carbonized (Yinhua Tan) 9g, Hibisci Mutabilis Flos (Baijinhua) 12g, Talcum (Huashi) 12g, Bombyx Batryticatus (Wancangsha) 9g (wrapped), Crataegi Fructus Carbonized (Shanzha) 12g, Portulacae Herba (Machixian) and Aurantii Fructus Immaturus (Qingpi) each 9g, Hordei Fructus Germinatus Carbonized (Gumaiya) each 9g. [Commentary] The first-visit medical record for this case is lost, but since purgatives and digestive aids were used, it can be inferred that the patient sought treatment for abdominal pain (especially in the cecal area). The second-visit prescription used Jinyinhua, Baijiangcao, Huangbo, Machixian, and Xiaoji to clear heat and detoxify; Wulingzhi, Shanzha, Chishao, and Huashi to move blood stasis and resolve stagnation, resulting in subsided heat and greatly reduced abdominal pain. In the third visit, due to loose stool containing mucus, heat-clearing and qi-regulating agents were continued to clear residual pathogens.
5. Zuo, male patient. Main symptom is pain in the left chest; self-reported history of old injury. Prescription: Angelicae Sinensis Radix (Danggui) 9g, Corydalis Rhizoma (Yanhusuo) 9g, Inulae Flos (Xuanfuhua) 9g (wrapped), Notopterygii Rhizoma et Radix (Qianghuo) 4.5g, Frankincense and Myrrh Prepared (Rumo) each 3g, Trogopterori Faeces (Wulingzhi) 9g, Broussonetiae Fructus (Poluosi) 9g, Abutili Semen (Liuzhouzi) 1.5g. [Commentary] This case involves left chest pain caused by an old injury; therefore, the treatment focuses on invigorating blood and unblocking collaterals.
6. Granddaughter. For several days, fever occurs at night, accompanied by urticaria (wind rash) every time fever arises, causing unbearable itching. Urticaria in young children often belongs to gastrointestinal disorders; previously, bowel movements occurred only once every seven days. This is the pattern. Prescription: Areca Seed (Binglang) 12g, Pruni Semen (Taoren) 9g, Cassiae Semen (Juemingzi) 12g, Taraxaci Herba (Gongying) 18g, Angelicae Sinensis Radix (Danggui) 12g, Moutan Cortex (Danpi) 9g, Paeoniae Radix Rubra (Chishao) 9g, Imperatae Rhizoma (Magen) 30g. [Commentary] This is urticaria; Danggui, Gongying, Taoren, Danpi, Chishao, and Magen are used to clear heat and cool blood; Binglang and Juemingzi clear the intestines and promote bowel movement. I have seen a constipation patient who developed itchy rashes; upon relief of constipation, the rashes gradually healed. Thus, the notion that urticaria often belongs to gastrointestinal disorders is not without clinical basis.
7. Chai, male patient. Dull complexion, greasy tongue coating, congested eyes, pain under the right costal margin and epigastrium, tender to pressure; illness duration over ten days, scanty urine and stool. Without promoting bowel movement and urination, heat and vomiting cannot cease. Prescription: Bupleuri Radix (Chaihu) 9g, Gardeniae Fructus (Zhizi) 9g, Artemisiae Scopariae Herba (Yinchen) 15g, Scutellariae Radix (Huangqin) 9g, Rheum Palmatum Rhizoma (Dahuang) 6g, Pruni Semen (Yuliren) 12g, Natrii Sulfas (Xuanningfen) 15g (taken with decoction), Poria (Fuling) 9g; Pinelliae Rhizoma Preparatum (Banxia) 9g. Second visit: After bowel movement, felt significantly relieved; liver area tenderness decreased compared to yesterday. Prescription: Artemisiae Scopariae Herba (Yinchen) 12g, Tetsu Stem (Tongcao) 6g, Cimicifugae Rhizoma (Baicao) 12g, Natrii Sulfas (Xuanningfen) 9g, Plantaginis Semen (Cheqianzi) 12g (wrapped), Pruni Semen (Yuliren) 9g, Benincasae Semen (Dongguazi) 9g, Coicis Semen (Yiyiren) 12g. [Commentary] Although not explicitly diagnosed, the physician considered acute cholecystitis at the time, prescribing a modification of Da Chai Hu Tang. With improvement in the second visit, treatment shifted to promoting urination and bowel movement to clear damp-heat. By the third visit, only fatigue remained, so Yi Gong San was given for recovery.
8. Pan, male patient. This is the hernia pain described by ancients, radiating to the testicles. The cause lies in post-dysentery condition. Ancients advocated strengthening the spleen after dysentery. Strengthening the spleen restores intestinal peristalsis, allowing spasms to relax; accumulated gas is then expelled. Prescription: Aconiti Lateralis Radix Preparata (Fuzi) 4.5g, Psoraleae Fructus (Buguzhi) 9g, Cyperi Rhizoma (Xiangfu) 9g, Paeoniae Radix Alba (Baishao) 12g, Endothelii Corneus Gigeriae Galli (Jineijin) 12g, Angelicae Sinensis Radix (Danggui) 12g, Atractylodis Macrocephalae Rhizoma (Baizhu) 9g, Bombyx Batryticatus (Wancangsha) 15g (wrapped), Zingiberis Rhizoma Carbonized (Jiangtan) 6g, Glycyrrhizae Radix et Rhizoma Preparata with Honey (Gancao) 6g. Second visit: Bowel movement became spontaneous, but abdominal mass pulling pain to testicles persisted; both testicles felt painful and heavy, differing from unilateral hernia. Continued method of harmonizing nutritive level, moving qi, strengthening spleen, and lifting sinking qi. Prescription: Angelicae Sinensis Radix (Danggui) 12g, Aureae Ramulus (Shengma) 4.5g, Foeniculi Fructus (Xiaohui) 9g, Evodiae Fructus (Wuzhuyu) 2.5g, Citri Reticulatae Pericarpium and Fructus (Juhé) each 6g, Codonopsis Radix (Dangshen) 9g, Lysimachiae Herba (Taiwuyao) 9g, Litchi Semen (Lizhihe) 12g, Atractylodis Rhizoma Carbonized (Baizhu) 9g, Toosendan Fructus (Chuanlianzi) 9g, Corydalis Rhizoma (Yanhusuo) 9g.
[Commentary] Zhang Zihe said, "All hernias belong to the Liver Meridian." According to meridian theory, the Liver meridian connects to the genitalia and ascends to the lower abdomen; thus, severe internal cold causing abdominal pain radiating to the testicles is attributed to Liver meridian pathology. This case is Cold Hernia. First visit used Fuzi, Jiangtan, Wancangsha, and Buguzhi to warm meridians, dry dampness, and dispel cold; Xiangfu regulates qi with its aromatic nature; Danggui and Baishao harmonize the nutritive level and relieve pain. Post-dysentery implies spleen dysfunction, hence Baizhu and Jineijin were added to strengthen the spleen. In the second visit, pain persisted; considering chronic illness leading to qi deficiency and sinking, with Liver failing to soothe, Dangshen, Baizhu, Shengma, and Chaihu were used to tonify qi and lift sinking; Muxiang, Wuzhuyu, Lizhihe, and Juhé were used to soothe the Liver, regulate qi, and relieve pain, addressing both deficiency and excess. The physician's statement: "Strengthening the spleen restores intestinal peristalsis, allowing spasms to relax; accumulated gas is expelled," refers to the treatment of strengthening the spleen, regulating qi, and relieving pain.
9. Xu, male patient. Commonly known as unilateral descent, the disease is paroxysmal, due to laxity of the inguinal canal. Mild cases can be lifted by茴香橘核丸 or Bu Zhong Yi Qi Wan; severe cases require surgery (knife and scalpel), otherwise danger ensues. Severe cases are common in elderly with qi and blood deficiency. Females can also suffer from this. Lack of careful examination leads to misdiagnosis. Prescription: Astragali Radix (Huangqi) 12g, Aureae Ramulus (Shengma) 4.5g, Boehmeriae Caulis (Zhumagen) 12g, Agrimoniae Herba (Tuolicao) 15g, Angelicae Sinensis Radix (Danggui) 9g, Eleutherococci Trifoliati Folium (Dagonglaoye) 9g, Frankincense and Myrrh Prepared (Rumo) each 3g, Linderae Radix (Wuyao) 9g, Glycyrrhizae Radix et Rhizoma Preparata with Honey (Gancao) 4.5g. [Commentary] Tuolicao is Agrimoniae Herba. Commonly used in Jiangsu and Zhejiang folk medicine for fatigue and劳伤 (labor injury), believed to tonify qi and blood. Its use here follows this intent.
10. Zhao, male patient. Ancient definition of hernia includes one: intestinal prolapse; two: orchitis. Now, prominent veins in the right groin indicate intestinal prolapse. Oral medications aim to restore local muscle tension, but effect is slow. Prescription: Astragali Radix (Huangqi) 6g, Bupleuri Radix (Chaihu) 2.2g, Toosendan Fructus (Chuanlianzi) 9g, Aureae Ramulus (Shengma) 2.2g, Aurantii Fructus Immaturus (Qingpi) 6g, Lysimachiae Herba (Taiwuyao) 6g, Angelicae Sinensis Radix (Danggui) 6g, Litchi Semen (Lizhihe) 12g, Frankincense and Myrrh Prepared (Rumo) each 2.5g, Glycyrrhizae Radix et Rhizoma Preparata with Honey (Gancao) 2.5g. Additionally: Eupolyphaga Steleophaga (Dibiechong) 3g, Scorpio (Quanwei) 1.5g, ground into powder, taken in 4 doses. [Commentary] Dysentery is often caused by cold exposure or labor; thus, formula promotes qi, lifts clear yang, dispels cold, and regulates qi. However, long-standing stasis requires Dibiechong and Quanwei to break stasis and relieve pain. The physician pointed out that for hernia treatment, "oral medications... have slow effects," and "severe cases without surgery pose danger," which is based on experience.
11. Zhu, male patient. Numbness in fingertips, dull complexion, related to nutrition. History of sexually transmitted disease in left testicle. Prescription: Angelicae Sinensis Radix (Danggui) 9g, Glycine Max Seed (Heidoudou) 12g, Dioscoreae Hypoglaucae Rhizoma (Bixie) 9g, Moutan Cortex (Danpi) 9g, Acanthopanacis Cortex (Wujiapi) 9g, Gentianae Macrophyllae Radix (Qinjiao) 9g, Siegesbeckiae Herba (Xixiancao) 15g, Vigna Angularis Seed (Duchidou) 30g. Second visit: Based on past history, resembles leprosy. Zhang Zhongjing predicted Wang Zhongxuan would lose eyebrows at forty due to this disease. Later, Lu Zhaolin of the Early Tang Four Masters died from this disease. Therefore, early diagnosis and treatment are crucial! New prescription: Xanthii Fructus (Cangerzi) 90g, Semiaquilegiae Fructus (Dafengzi) 60g, Scolopendra (Wugong) 5 pieces (with head and feet), Scorpio (Quanxie) 6g, Realgar (Xionghuang) 15g, Phaseoli Semen Testa (Lvdouyi) 150g, Agkistrodon (Qishe) 4, Sargassum (Haizao) 90g, Ecklonia (Kunbu) 90g. Ground into fine powder, pill size of Sophora japonica seed, 20 pills per dose. [Commentary] The physician used this formula early in the course of leprosy.
12. Xu, female patient. Indications for Qianjin Wen Pi Yin are three: malnutrition with deep, thin pulse, one; post-illness constipation for many days, two; temporary need for bowel movement twice, three. Prescription: Aconiti Lateralis Radix Preparata (Fuzi) 90g, Codonopsis Radix (Dangshen) 9g, Rheum Palmatum Rhizoma Cooked (Shu Dahuang) 9g, Rheum Palmatum Rhizoma Raw Powder (Sheng Dahuang) 3g, Zingiberis Rhizoma (Ganjiang) 4.5g, Glycyrrhizae Radix et Rhizoma Preparata with Honey (Gancao) 3g, Platycladi Semen (Baiziren) 12g, Crataegi Fructus (Shanzha) 18g.
13. Chen, female patient. Sudden deafness, possibly excess type. No bowel movement for 5 days, greasy coating, red tip, prescribed Da Chai Hu Tang to purge. Prescription: Bupleuri Radix (Chaihu) 6g, Paeoniae Radix Alba (Baishao) 9g, Immature Bitter Orange (Zhishi) 9g, Scutellariae Radix (Huangqin) 4.5g, Pinelliae Rhizoma Preparatum with Ginger (Banxia) 9g, Rheum Palmatum Rhizoma (Dahuang) 2.5g (powder, taken with decoction), Natrii Sulfas (Xuanningfen) 12g (taken with decoction), Cassiae Semen (Juemingzi) 12g, Glycyrrhizae Radix et Rhizoma Preparata with Honey (Gancao) 4.5g, Zingiberis Rhizoma Fresh (Shengjiang) 2 slices, Jujubae Fructus (Dazao) 5 pieces. Gynecology (7 categories)
Irregular Menstruation
1. Zhu, female patient. Amenorrhea in unmarried girls: ① due to endocrine disorders; ② nutritional insufficiency; ③ nervous system changes. The third is most common, referred to in Nei Jing as "disease of Two Yangs." Prescription: Angelicae Sinensis Radix (Danggui) 12g, Poria (Fuling) 9g, Atractylodis Macrocephalae Rhizoma (Baizhu) 15g, Menthae Haplocalycis Herba (Bohe) 6g (added later), Paeoniae Radix Alba (Baishao) 9g, Bupleuri Radix (Chaihu) 9g, Zingiberis Rhizoma Fresh (Shengjiang) 2 slices, Glycyrrhizae Radix et Rhizoma Preparata with Honey (Gancao) 3g, Dahuang Zhechong Wan 12g (taken in 2 doses). Second visit: Amenorrhea in unmarried girls, chlorosis, uterine tuberculosis, endocrine disorders can be diagnosed via inspection and palpation; however, signs of nervous system changes are scarce. Prescription: Atractylodis Macrocephalae Rhizoma (Baizhu) 9g, Astragali Radix (Huangqi) 9g, Poria with Hostwood (Fushen) 9g, Ziziphi Spinosae Semen (Suanzaoren) 9g, Aucklandiae Radix (Muxiang) 2.4g, Codonopsis Radix (Dangshen) 9g, Angelicae Sinensis Radix (Danggui) 9g, Polygalae Radix (Yuanzhi) 3g, Longan Aril (Longyanrou) 9g, Glycyrrhizae Radix et Rhizoma Preparata with Honey (Gancao) 3g, Zingiberis Rhizoma Fresh (Shengjiang) 2 slices, Jujubae Fructus (Dazao) 4 pieces.
[Commentary] Nei Jing states, "Disease of Two Yangs affects Heart and Spleen." "Two Yangs" refers to Yangming (Stomach and Intestines). It means mental depression and qi stagnation affecting Heart and Spleen can cause gastrointestinal indigestion, leading to irregular menstruation in women. Prescription uses Xiaoyao San to soothe Liver, strengthen Spleen, and regulate menstruation; Dahuang Zhechong Wan removes blood stasis and generates new blood to open amenorrhea. Second visit uses Guipi Tang to benefit Heart and Spleen, replenish qi and blood, aiming for health restoration leading to spontaneous menstruation.
2. Wu, female patient. Delayed menstruation always accompanied by gastric symptoms, such as indigestion and acid regurgitation. Prescribed powder for treatment. Prescription: Atractylodis Rhizoma (Cangzhu) 12g, Citri Reticulatae Pericarpium (Chenpi) 6g, Paeoniae Radix Alba (Baishao) 9g, Magnoliae Officinalis Cortex (Houpo) 3g, Angelicae Sinensis Radix (Danggui) 12g, Bupleuri Radix (Chaihu) 9g, Poria (Fuling) 18g, Menthae Haplocalycis Herba (Bohe) 6g, Atractylodis Macrocephalae Rhizoma (Baizhu) 15g, Glycyrrhizae Radix et Rhizoma Preparata with Honey (Gancao) 3g, Dahuang Zhechong Wan 18g. Ground into fine powder, taken 4.5g after meals.
3. Chen, female patient. Amenorrhea in unmarried girls often causes gastric disorders; ancients used Pingwei San to regulate menstruation, following this principle. Prescription: Bupleuri Radix (Chaihu) 6g, Citri Reticulatae Pericarpium (Chenpi) 6g, Cinnamon Bark (Guipi) 6g, Cyperi Rhizoma (Xiangfu) 9g, Aurantii Fructus Immaturus (Qingpi) 6g, Artemisiae Folium (Aiyè) 4.5g, Evodiae Fructus (Wuzhuyu) 4.5g, Allii Macrostemonis Bulbus (Xiebai) 9g, Foeniculi Fructus (Xiaohui) 6g, Lysimachiae Herba (Taiwuyao) 6g. Additionally: Pingwei Wan 60g, taken in divided doses. [Commentary] Yangming is the meridian of abundant qi and blood. Delayed menstruation causes stomach qi stagnation, explaining the gastric symptoms. Case Wu shows delayed menstruation, Case Chen shows amenorrhea; both prescriptions contain Pingwei San, focusing on this aspect.
4. Fang, female patient. Pulse has wiry quality, indicating frustration and anger. Late menstruation, breast distension before onset, especially in hypogastrium, menstruation approaching. Prescription: Stir-fried Bupleuri Radix (Chaihu) 4.5g, Paeoniae Radix Alba (Baishao) 9g, Moutan Cortex (Danpi) 9g, Menthae Haplocalycis Herba (Bohe) 4.5g, Angelicae Sinensis Radix (Danggui) 9g, Atractylodis Macrocephalae Rhizoma (Baizhu) 9g, Poria (Fuling) 9g, Corydalis Rhizoma (Yanhu) 9g, Lycopii Herba (Zelan) 9g, Zingiberis Rhizoma Fresh (Shengjiang) 2 slices.
Second visit: Menstruation started, discomfort persists until cycle ends. Prescription: Angelicae Sinensis Radix (Danggui) 9g, Corydalis Rhizoma (Yanhu) 9g, Foeniculi Fructus (Xiaohui) 9g, Inulae Flos (Xuanfuhua) 9g (wrapped), Ligustici Chuanxiong Rhizoma (Chuanxiong) 6g, Lycopii Herba (Zelan) 9g, Stir-fried Moutan Cortex (Danpi) 9g, Glycyrrhizae Radix et Rhizoma Preparata with Honey (Gancao) 3g.
Third visit: Breast distension during menstruation has no absolute relation to flow volume; hypogastric distension relieves slightly if flow increases, but flow remains low after medication. Prescription: Angelicae Sinensis Radix (Danggui) 9g, Lycopii Herba (Zelan) 9g, Selaginellae Herba (Juanbai) 9g, Achyranthis Bidentatae Radix (Niuxi) 12g, Ligustici Chuanxiong Rhizoma (Chuanxiong) 6g, Moutan Cortex (Danpi) 15g, Sappan Wood (Sumu) 6g, Pruni Semen Paste (Taoren) 12g, Cyperi Rhizoma (Xiangfu) 9g. [Commentary] Wiry pulse and breast distension before menstruation indicate Liver qi stagnation; qi stagnation causes poor menstrual flow, leading to hypogastric distension. Modifying Xiaoyao San to soothe Liver, resolve stagnation, and regulate menstruation is a common effective method. In third visit, due to low flow and distension, changed to blood-invigorating, stasis-resolving, and menstruation-promoting formula.
5. Li, female patient. Amenorrhea for one and a half years, body not emaciated but plump, should be purged. Prescription: Angelicae Sinensis Radix (Danggui) 12g, Lycopii Herba (Zelan) 12g, Leonuri Herba (Yimucao) 12g, Rubiae Cordifoliae Radix et Rhizoma (Qiancao) 12g, Curcumae Rhizoma (Ezhu) 9g, Achyranthis Bidentatae Radix (Niuxi) 12g, Sparganii Rhizoma (Sanleng) 9g, Polygoni Multiflori Caulis (Liangtoujian) 12g (wrapped), Areca Seed (Binglang) 9g, Morning Glory Seed (Heiqiu) 9g, Dahuang Zhechong Wan 12g (taken in 2 doses). Second visit: No suspicion of consumptive disease with amenorrhea, increased dosage of previous formula. Prescription: Angelicae Sinensis Radix (Danggui) 15g, Achyranthis Bidentatae Radix (Niuxi) 12g, Ligustici Chuanxiong Rhizoma (Chuanxiong) 9g, Moutan Cortex (Danpi) 12g, Curcumae Rhizoma (Ezhu) 12g, Processed Morning Glory Seed (Heiqiu) 9g, Vaccariae Semen (Wangbuliuxing) 9g, Salviae Miltiorrhizae Radix (Danshen) 12g, Didang Wan 9g. [Commentary] Amenorrhea is broadly classified into deficiency and excess types; treatment involves tonification or purging. This patient is plump with amenorrhea, clearly requiring blood-invigorating and menstruation-promoting drugs. Didang Wan consists of Hirudo (Shuizhi), Tabanus (Mengchong), Pruni Semen (Taoren), and Rheum Palmatum Rhizoma (Dahuang). Hirudo and Tabanus are potent blood-breaking drugs; Taoren breaks blood stasis; Dahuang guides stasis downward. Originally for Shaoyang syndrome with heat and blood accumulation, the physician borrowed it for blood-stasis amenorrhea.
6. Zheng, female patient. Menstruation arrived 2 days late, impending onset with heavy sensation and dull pain in hypogastrium; after onset, heaviness and pain disappeared, but frequent urination occurred. Physiologically, menstruation and urination are unrelated; this occurrence indicates deficiency. Prescription: Codonopsis Radix (Dangshen) 9g, Aureae Ramulus (Shengma) 3g, Eucommiae Cortex (Duzhong) 9g, Schisandrae Fructus (Wuweizi) 4.5g, Paeoniae Radix Alba (Baishao) 6g, Psoraleae Fructus (Buguzhi) 9g, Inulae Flos (Xuanfuhua) 9g (wrapped), Papaveris Pericarpium (Yangsuke) 9g, Linderae Radix (Wuyao) 6g, Glycyrrhizae Radix et Rhizoma Preparata with Honey (Gancao) 3g. [Commentary] Frequent urination generally indicates Middle Jiao deficiency or Kidney deficiency. Impending menstruation with hypogastric heaviness, followed by frequent urination, are all deficiency signs. Medications focus on tonifying qi, lifting, benefiting Kidney, and securing essence.
7. Ma, female patient. Before menstruation, oral ulcers, irritability, indicating Liver yin deficiency and Liver yang hyperactivity. Prescription: Rehmanniae Radix Preparata (Shudi) and Rehmanniae Radix (Shengdi) each 12g, Ilicis Cornusi Fructus (Dongqingzi) 9g, Achyranthis Bidentatae Radix (Niuxi) 6g, Platycladi Semen (Baiziren) 12g, Ophiopogonis Radix (Maidong) 6g, Ecliptae Herba (Hanliancao) 9g, Dendrobii Caulis (Shihu) 9g, Polygoni Multiflori Radix Preparata (Heshouwu) 12g, Ostrea Concha (Muli) 30g (decocted first), Sangma Wan 12g (wrapped). [Commentary] When Liver substance is deficient, Liver function becomes hyperactive. Muli anchors yang; Sangma Wan cools Liver and moistens dryness; others are major Liver-nourishing agents to benefit Liver substance. This is a Liver deficiency pattern, unsuitable for suppressing or purging Liver methods.
8. Zhao, female patient. Late menstruation, leukorrhea before onset, pale color after onset, aversion to cold normally. Ancient concept considers this deficiency-cold pattern. Prescription: Myristicae Semen (Roudoukou) 9g, Aconiti Lateralis Radix Preparata (Fupian) 6g, Zingiberis Rhizoma Carbonized (Jiangtan) 4.5g, Paeoniae Radix Alba (Baishao) 9g, Psoraleae Fructus (Buguzhi) 9g, Asari Radix et Rhizoma (Xixin) 3g, Cinnamomi Ramulus (Guizhi) 4.5g, Astragali Radix (Huangqi) 9g, Saposhnikoviae Radix (Fangfeng) 9g, Glycyrrhizae Radix et Rhizoma Preparata with Honey (Gancao) 3g. Second visit: Chills largely resolved after medication. Normally late menstruation with decreasing flow monthly. Approaching menstruation, used this formula to induce early onset. Prescription: Angelicae Sinensis Radix (Danggui) 9g, Corni Fructus (Shanyurou) 9g, Asari Radix et Rhizoma (Xixin) 3g, Cyperi Rhizoma (Xiangfu) 9g, Moutan Cortex (Danpi) 9g, Ligustici Chuanxiong Rhizoma (Chuanxiong) 6g, Psoraleae Fructus (Buguzhi) 9g, Cinnamon Bark (Guipi) 4.5g, Zingiberis Rhizoma Carbonized (Jiangtan) 3g, Polygoni Multiflori Caulis (Liangtoujian) 9g (wrapped).
[Commentary] Symptoms are attributed to Kidney yang deficiency. Late menstruation with pale color results from Kidney yang deficiency affecting Chong and Ren meridians; leukorrhea before onset results from Kidney yang deficiency failing to secure Dai meridian, causing damp-turbidity to flow downward. Therefore, warming and tonifying Kidney yang is the main focus. First visit included Huangqi, Guizhi, Jiang, Fuzi, Baishao, Gancao to tonify qi, warm meridians, and harmonize nutritive level due to aversion to cold. Second visit, approaching menstruation, included Danggui, Chuanxiong, Xiangfu, Danpi, Liangtoujian to promote menstruation.
9. Song, female patient. Previously light flow, now even lighter and pale, no discomfort. Should not be purged due to emaciation. Prescription: Angelicae Sinensis Radix (Danggui) 12g, Rehmanniae Radix Preparata (Shudi) 12g, Achyranthis Bidentatae Radix (Niuxi) 9g, Colla Corii Asini (Ejiao) 12g, Stir-fried Moutan Cortex (Danpi) 9g, Evodiae Fructus (Wuzhuyu) 4.5g, Hordeum Germinatum (Maiya) 9g, Corni Fructus (Shanyurou) 9g. [Commentary] Light flow, pale color, and lack of discomfort are signs of blood deficiency. Do not purge due to low volume; purging harms the innocent and damages healthy qi.