[按]此患者曾经钡餐造影确诊为复合溃疡，共服上方两料，复查龛影消失，而告痊愈。此特效之案，余至今记忆犹新。究其处方是一张治疗渍疡很别致的经验方，效果好，价廉，值得迸一步研究和推广。凤凰衣有养阴清肺之功，除善治久咳、咽痛失音外，还可用于颈淋巴结结核、溃疡不敛。它是先生治疗渍疡病的常用之药。玉蝴蝶功擅润肺、舒肝、和胃、生肌，除治咳嗽、音嗄外，又善治肝胃气痛，疮口不敛，还有补虚、宽中、促进食欲之功。其与凤凰衣同用，起协同作用。马勃长于清肺利咽、解毒止血，既能止血，又可疔疮。象贝母具有清热泄降、医疮散结之功，对于渍疡病之胃痛吞酸，尤为适宜。琥珀不仅为镇惊安神药，而且有化瘀止血、疗疮散痈作用。血余主要有消瘀止血作用，与琥珀同用，治渍疡病出血极佳。本方虽药仅六味，但从辨证与辨病相结合的角度出发，可谓老药新用，而又丝丝入扣，颇能启发后人。
6.男。西医诊断为消化道溃疡，久治无效。今心下空空然，欲得重压，时有隐痛，睡不好，舌淡，苔微腻。予小建中汤加味。当归9克，桂枝3克(后下)白芍10克，甘草5克，柏子仁9克，半夏9克，秫米9克，生姜1片，大枣7枚，饴糖12克。[按]此案为脾胃虚寒证型，故选用小建中汤温中补虚、绶急止痛。归、芍同用，能和营敛肝;半夏、秫米合柏子仁;能和胃安神。
7.男。往日胃脘痛，有发作性，数月来连续不休;近则呕吐黑水。此胃之粘膜有溃疡。杏仁泥24克，云苓9克，旋覆花12克(包)，生地榆12克，全当归9克，怀山药12克，伏龙肝30克。另:鸡蛋壳煅研细末，每次服1.克，1日3次。二诊:进保护粘膜之药，呕吐黑水，其势大减，痛亦略定。杏仁泥24克，桑椹子12克，云茯苓9克，玄明粉9克，杭白芍12克，瓜蒌12克，延胡12克。
三诊:服药不得法，痛又作，盖经过溃疡面刺激故也。杏仁30克，当归9克，飞滑石12克，云苓12克，延胡12克，淮山药15克，杭白芍18克。四诊:溃疡性之胃痛，缓和包摄之药，只能暂缓所苦，根治纯在食养疗法。淮山药15克，杏仁泥45克，伏龙肝30克，云茯苓12克，当归9克，玄明粉12克，黑芝麻12克。
五诊:胃溃疡虽见平定，还须注意饮食，佐以散剂以巩固之。象牙屑6克，五灵脂18克，全当归18克，云茯苓18克，煅瓦楞18克。共研细末，1日3次，每次吞服2.克一3.克。[按]该患者初病时，异常好食，食后胃内觉舒适，否则即痛。先生最后诊断为胃溃疡，除用药外，并嘱注意饮食。患者遵守所嘱，后遂未再发作。
8.男。溃疡性之胃酸过多，徒用和中之品无益，消炎收敛类而有刺激者，亦无益。黄柏炭9克，五灵脂9克，杏仁泥30克，云茯苓9克，瓦楞子30克(煅)，当归12克，柿饼霜12克(包)延胡索9克。[按]此方具有止痛、制酸、消炎、收敛的作用，而无刺激性，适用于溃疡病之胃酸过多。但煅瓦楞子最好研细末吞服，则制酸力量更为显著。
9.男。下血后，胃之左侧痛并未消失，可以测知溃疡并末收敛。仙鹤草30克，全当归9克，威喜丸9克(包)，柿饼霜12克，阿胶珠24克。[按]此胃痛下血，以十二指肠球部溃疡为最可能。上方具有养血、止血，兼有保护粘膜的作用。先生遇胃痛下血者，常用此法治疗。若制成散剂，则效果更好。
10.男。舌中剥，其剥在舌根，大多胃粘膜有炎症或溃疡。平素嗜酒，病之主因也。此番因拂逆，上膈隐痛，似痉挛状，其痛彻背。加味金铃子散予之。金铃子9克，延胡索12克，台乌药6克，杏仁泥24克，旋覆花9克(包)云茯苓12克，全瓜蒌12克，五灵脂9克，谷麦芽各9克，佛手9克。
二诊:虽然食后定时作痛，有溃疡嫌疑，但往日从未有之，非深痼难治。金铃子9克，旋覆花12克(包)，赤石脂15克，云茯苓9克，延胡索12克，象贝母9克，杏仁泥24克，杭白芍15克，五灵脂9克(包)佛手片9克。[按]本病例所用药物具止痛、制酸、解痉、保护胃枯膜的作用。因方药对症，随后复诊，稍予加减，果然服药20天左右而获痊愈。
11.男。胃脘痛，痛有定时:一为午后3时许，一为午夜2时许。十二指肠溃疡多有之。琥珀3克，瓦楞子9克，百草霜9克，杏仁泥12克，六轴子1，2克，云茯苓9克。共研细末，每次饭后1小时半服1.克。[按]此系护胃镇痛、化瘀生新之剂。百草霜一味主要取其收涩之性，对溃疡面之修复有所助益。六轴子为杜鹘花科植物羊踯躅的果实，性味苦、温，有毒。功能祛风、止痛、散瘀消肿。治风寒湿痹、历节疼痛、跌打损伤、痈疽疔毒。用量:内服研末入丸散0.～0.克。
12.阳男。凡胃脘痛，得食能舒者多属胃酸过多，其痛多剧于黄昏时;由胃酸过多酿成十二指肠溃疡，亦属可能之事。煅瓦楞子30克，麦冬9克，赤石脂12克，全当归15克，云苓15克，龟板24克，五灵脂24克，生阿胶18克，鳖甲24克，淮山药15克，延胡索12克，杏仁30克，焦六曲12克，炒枳实9克，百草霜12克。共研细末，蜜丸如梧子大，每服二三十粒，日2次。
[按]因胃脘疼痛，故用延胡、杏仁以镇痛;因胃酸过多，故用瓦楞子以制酸;久痛多瘀，故用当归、灵脂以和营散瘀;痛易耗气，故用山药、茯苓、麦冬以养胃。一般胃痛忌用滋腻，可是先生于本方中用阿胶、龟板、鳖甲，颇有独到之处。盖此三味，含有胶质，具粘腻之性，既能滋阴养血，又能养胃护膜，促迸溃疡面之修复。赤石脂一味，据现代药理研究，有吸附作用，能吸附消化道内有毒物质，保护消化道粘膜，止胃肠道出血，先生尝用之。
13．张男。无论进食多少，皆胀满难忍。腹中雷鸣，大便难。此肠胃功能不健全，以此方缓图功效。升麻9克，制番木鳖3克，莪术3克，黄芪15克，广木香6克，明雄黄3克，怀山药12克，党参12克，生白术12克，鸡内金9克。共研细末，每服1．5克，1日2次。
[按]此方一面用升麻协助参、芪补气升提；鸡内金协助山药、白术健脾益气。盖脾得健运，则胀满自消，是治其本。一面用莪术、木香行气；明雄整肠；番木鳖即马钱子，除兴奋延髓中枢外，并为良好的苦味健胃药。是治其标。全方补泻同用，补而不滞，消而不损，将中西医理融汇于临床实际，确是先生医案的一个特色。
14．吴女。午后胃部隐痛，大便如栗状。其人体弱，神疲，当消补兼施。党参9克，鸡内金9克，白术9克，枳壳12克，青皮6克，绿萼梅3克，谷麦芽各9克，怀山药9克。二诊：近来以吞酸为苦，必欲探吐乃舒，其酸多作于食后2小时许，略进饮食可以缓解，当兼用制酸剂。党参12克，枳壳9克，厚朴9克，绿萼梅5克，鸡内金9克，白术12克，乌药9克，谷麦芽各9克。另：凤凰衣9克、炙马勃9克，二味研极细末，分作21包，每服1包，1日3次，食前服。
三诊：吞酸已止，胃痛亦瘥可。川朴6克，鸡内金12克，枳壳6克，山药12克，白术12克，绿萼梅5克，青皮6克，乌药9克，黄芪12克。另：凤凰衣9克，上紫桂9克，共研细末，分作21包，每服1包，1日3次。[按]初诊为脾失健运，故用枳术丸加味，消补兼施。二诊仍步原法，加凤凰衣、炙马勃以制酸。三诊吐酸止，痛亦瘥可，乃用黄芪补益中气；肉桂温中散寒；山药、白术健脾；青皮、枳、朴、台乌等辛通理气，以善其后。
15．解男。吐酸每发于冬令，进硬固食品时，其酸益甚，得吐乃舒。痛在少腹右下角，此不能肯定其为溃疡病。多酸之由来，疑是神经性而引起消化不良者。生黄芪9克，川桂枝5克，杭白芍9克，当归9克，吴萸2．4克，炮姜炭5克，生甘草3克，生姜2片，饴糖9克(冲服)。二诊：非溃疡性疾患以吐酸为主症者，附子粳米汤，吴茱萸汤皆其选也。炮附块9克，吴萸2．4克，半夏12克，党参9克，炙草2．4克，粳米1杯，生姜2片，大枣7枚。
[按]吐酸一症，有寒有热。属热者，当清泄肝火、降逆和胃。本案为脾胃虚寒，故初诊用黄芪建中合吴茱萸汤。二诊去黄芪、饴糖之甘，用附子温振中阳，吴萸温散肝郁，半夏、生姜降逆止呕，党参、甘草、粳米和胃。选药精当，步法井然。
16．王女。胃脘阵阵作痛，痛剧则呕，其苔白滑，寒象也。姜半夏9克，淡吴萸5克，官桂皮5克，台乌药9克，公丁香3克，荜茇6克，延胡索9克，生艾叶9克。[按]经云："寒淫于内，治以甘热，佐以苦辛。"方用夏、桂、丁、荜温胃降逆；寒凝则气滞，复用台乌、延胡索行气止痛。此种胃寒痛，相似于慢性肥厚性胃炎，服本方多收佳效。如舌质红绛者，不宜应用。
17．马女。饮食人口则吐，其病因恼怒而起。所苦欠伸不休，精神不振，当属神经性疾患，古人谓之木克土。宜芳香兴奋药。佩兰梗9克，苏子9克，杭白芍9克，煅瓦楞子24克，娑罗子9克，香橼皮9克，旋覆花9克(包)，杏仁泥12克，玉枢丹1．5克(分2次吞)。
[按]脑怒伤肝，肝失疏泄，横逆犯胃，致胃失和降，故食入则吐。疏肝即所以安胃，降肝亦即是降胃。肝气条达，胃自安和。玉枢丹又名紫金锭，原为开窍化浊、消肿散结之剂，但移治多种呕吐，有止呕安中之功。先生屡用得效。
18．张女。上至中脘，下及少腹，痛有发作性，发则手不可近，此气聚也。肉桂2克，延胡9克，槟榔9克，神曲9克，蚕沙9克，炮姜1．5克，青皮6克，莪术6克，山楂9克，皂荚子6克。
19．陈女。离药则胃部依然攻筑上下作痛，此气体也。阿魏9克，附块9克，荜茇9克，川芎9克，当归9克，黑白丑各9克，五灵脂15克，沉香曲12克，延胡索12克，甘松6克，川朴3克，莱菔子9克。共研极细末，每饭后吞服2．0-3．0克，1日3次。[按]张案治用温散。其机制在于寒凝则气聚，气聚则痛，故得温则疏通，得散则寒去，气通寒去而痛已。方中皂荚子，富含油脂，善于走滑，导气下行。陈案亦用温中行气，作用较上方为强。以散剂小量服之，则邪去而不伤正。阿魏对于驱除胃肠积气有特效，并治疟、痢及顽固泄泻，惟气臭难服，散剂可以胶囊盛贮吞服。
20．郭男。高热3日，胃脘痛剧，拒按，3日不更衣，可知是有形之积，理应通降。制大黄6克，玄明粉9克(分2次冲)，白芍12克，枳实9克，连翘9克，黄芩9克，苦杏仁18克，全瓜蒌12克。二诊：药后，胃脘部剧痛大定，但未得畅便，阳明燥气尚炽，仍当清之、攻之。生大黄6克，玄明粉9克(分2次冲)，白芍12克，枳实9克，连翘12克，地龙9克，知母9克，全瓜蒌12克，郁李仁9克。[按]此病人高热3日而出现胃脘剧痛、不大便，可能与感染有关，常见病如急性胆囊炎、胰腺炎等，其疼痛部位均与胃相近。此病虽不能确定是何炎症，但既见高热、便秘，则自当与一般胃痛迥异，"六腑以通为用"，故用清热泻下，其痛大定。
21．王女。以胃脘痛为主症，其痛竞日持续，食后暂稍缓，移时则又作。其脉细。炮附块9克，延胡索12克，薤白头12克，生枳实12克，荜茇9克，椒目5克，鸡内金12克，谷麦芽各9克。二诊：脘痛大定。服温药而能效，则胃寒也。胃寒有二：一为慢性胃炎；二为官能障碍。病者属下者。附块6克，党参9克，橘红6克，苏子12克(包)，荜澄茄9克，破故纸9克，白术9克，远志5克，粉甘草3克，半夏9克。[按]此属胃寒，治以温通健运，破故纸一味，清代黄元御说它有"温暖水土，消化饮食"的作用，先生在此用它殆即此意。再加党参、白术，作为胃痛定后的善后补益剂。
22．钱男。胃痛有定时，多作于三餐以后，早则二三时，迟则四五时。以现代医学区别之，神经痛、慢性胃炎、溃疡病者。考其从未呕吐，亦无酸水，溃疡之关系较少。先予镇痛剂以消息之。杏仁泥24克，延胡索15克，罂粟壳12克，旋覆花12克(包)，当归9克，川楝子9克。另：鸡蛋壳煅研末，饭后吞服，每次1．5克。二诊：痛已定。再予前方去罂粟壳及鸡蛋壳粉。[按]本案初诊因溃疡病不能排除，故在镇痛剂中，另用鸡蛋壳粉。二诊胃痛已定，即减去鸡蛋壳粉。先生谓胃痛有定时，有神经痛、慢性胃炎、溃疡病的区别。按之临床发作多不规则，而极少作于三餐之后，必须与溃疡病加以鉴别。罂粟壳久用易成瘾，故痛定后即停用。
23．刁男。疲劳能使胃脘痛复发，多半属于神经性。自觉胃部灼热如焚，香燥性之镇痛剂不相宜。杏仁18克，延胡索12克，刺猬皮15克，知母9克，旋覆花12克(包)，全当归、娑罗子、姜竹茹各9克。[按]自觉胃部灼热如焚，是有内火之证，香燥理气之品皆能助火，故不相宜。而用旋覆理气降逆，杏仁、延胡、娑罗子疏利条达，加刺猬皮活血止痛，知母、竹茹清胃降火。
[Commentary] This patient was previously diagnosed with compound ulcer (compound peptic ulcer) via barium meal radiography. After taking the aforementioned prescription for two doses, a follow-up examination showed the disappearance of the niche shadow (radiographic sign of ulcer), indicating recovery. This is a case of remarkable efficacy, which remains vividly in my memory to this day. Upon investigation, the prescription is a unique empirical formula for treating ulcer disease, characterized by good efficacy and low cost, worthy of further research and promotion. Fenghuangyi (Eggshell Membrane, *Testudinis Corii* or similar avian membrane) has the function of nourishing Yin and clearing Lung heat. Besides being adept at treating chronic cough, sore throat, and aphonia, it can also be used for cervical lymph node tuberculosis and non-healing ulcers. It is a commonly used herb by Mr. Zhang for treating ulcer diseases. Yuhudie (Butterfly Seed, *Oroxylum indicum* seed) excels in moistening the Lung, soothing the Liver, harmonizing the Stomach, and generating flesh. Besides treating cough and hoarseness, it is also effective for Liver-Stomach Qi pain and non-healing sores, possessing functions of tonifying deficiency, expanding the middle jiao, and promoting appetite. When used together with Fenghuangyi, they exert a synergistic effect. Mabao (Puffball Fungus, *Lycoperdon* species) is good at clearing the Lung, benefiting the throat, detoxifying, and stopping bleeding; it can stop bleeding and treat carbuncles. Xiangbeimu (Zhe Bei Mu, *Fritillaria thunbergii* bulb) clears heat, drains fire, treats sores, and dissipates nodules, making it particularly suitable for stomach pain and acid regurgitation caused by ulcer disease. Hupo (Amber, *Succinum*) serves not only as a sedative for calming fright but also for resolving blood stasis, stopping bleeding, and treating sores. Xueyutao (Hair Charcoal, *Capillis Carbonis*) mainly resolves stasis and stops bleeding; when used with Hupo, it is excellent for treating bleeding from ulcer disease. Although this prescription contains only six herbs, from the perspective of combining syndrome differentiation with disease differentiation, it represents an innovative use of traditional herbs, meticulously coordinated, and highly inspiring to future generations.
6. Male. Western medicine diagnosis: digestive tract ulcer, refractory to long-term treatment. Currently experiencing a hollow sensation in the epigastrium, desire for heavy pressure, occasional dull pain, poor sleep, pale tongue, and slightly greasy coating. Prescribed Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) with modifications. Danggui (Angelica sinensis root) 9g, Guizhi (Cinnamon twig) 3g (added later), Baishao (White peony root) 10g, Gancao (Licorice root) 5g, Baiziren (Biota seed) 9g, Banxia (Pinellia rhizome) 9g, Shumi (Millet) 9g, Shengjiang (Fresh ginger) 1 slice, Dazao (Jujube) 7 pieces, Yitang (Maltose) 12g. [Commentary] This case belongs to the Spleen-Stomach Deficiency-Cold pattern; thus, Xiao Jian Zhong Tang was selected to warm the middle, tonify deficiency, and relieve urgency/pain. Danggui and Baishao together harmonize the Ying (Nutrient) level and astringe the Liver; Banxia and Shumi combined with Baiziren harmonize the Stomach and calm the Spirit.
7. Male. History of episodic epigastric pain, continuous for several months; recently vomiting black fluid. This indicates gastric mucosal ulceration. Xingren Ni (Almond paste) 24g, Yunling (Poria) 9g, Xuanfuhua (Inula flower) 12g (wrapped), Shengdiyü (Rehmannia root) 12g, Quandonggui (Whole Angelica sinensis) 9g, Huaishanyao (Chinese yam) 12g, Fulonggan (Stove mud) 30g. Additionally: Calcined eggshell powder, 1g per dose, 3 times daily. Second visit: After taking mucosal protective medications, the vomiting of black fluid significantly decreased, and pain subsided slightly. Xingren Ni 24g, Sangshenzi (Mulberry fruit) 12g, Yunfuling (Poria) 9g, Xuanmingfen (Mirabilite) 9g, Hangbaishao (Hangzhou White Peony) 12g, Gualou (Trichosanthes fruit) 12g, Yanhusuo (Corydalis rhizome) 12g.
Third visit: Improper medication administration led to recurrence of pain, likely due to irritation of the ulcer surface. Xingren (Apricot seed) 30g, Danggui 9g, Feihuashi (Calcined Talcum) 12g, Yunling 12g, Yanhusuo 12g, Huaishanyao 15g, Hangbaishao 18g. Fourth visit: For ulcerative stomach pain, mild astringent/protective agents can only temporarily alleviate suffering; radical cure relies entirely on dietary therapy. Huaishanyao 15g, Xingren Ni 45g, Fulonggan 30g, Yunling 12g, Danggui 9g, Xuanmingfen 12g, Hei Zhima (Black sesame) 12g.
Fifth visit: Although the gastric ulcer appears stabilized, dietary attention is still required, supplemented by a powder to consolidate the effect. Xiangya Xie (Ivory shaving) 6g, Wulingzhi (Trogopterus feces) 18g, Quandonggui 18g, Yunling 18g, Duwanlengzi (Calcined Arca shell) 18g. Ground into fine powder, taken 3 times daily, 2-3g per dose orally. [Commentary] At the onset of the illness, the patient had an unusual craving for food, feeling comfortable after eating, otherwise experiencing pain. Mr. Zhang finally diagnosed gastric ulcer. In addition to medication, he advised dietary precautions. The patient followed these instructions and subsequently did not relapse.
8. Male. Ulcer-associated hyperacidity. Merely using harmonizing agents is ineffective; anti-inflammatory/astringent agents that are irritating are also ineffective. Huangbo Tan (Charred Phellodendron bark) 9g, Wulingzhi 9g, Xingren Ni 30g, Yunling 9g, Walengzi 30g (calcined), Danggui 12g, Shibingshuang (Persimmon frost) 12g (wrapped), Yanhusuo 9g. [Commentary] This prescription has analgesic, antacid, anti-inflammatory, and astringent effects without irritation, suitable for hyperacidity in ulcer disease. However, calcined Walengzi is best ground into fine powder and swallowed, which significantly enhances its antacid power.
9. Male. After hematochezia (blood in stool), left-sided stomach pain persisted, indicating the ulcer has not yet healed. Xianhecao (Agrimony herb) 30g, Quandonggui 9g, Weixi Wan (Weishi Pill) 9g (wrapped), Shibingshuang 12g, Ejiao Zhu (Gelatin pearl) 24g. [Commentary] Stomach pain with lower bleeding is most likely duodenal bulb ulceration. The above prescription nourishes blood, stops bleeding, and protects the mucosa. Mr. Zhang often uses this method for stomach pain with bleeding. If prepared as a powder, the effect would be better.
10. Male. Peeling of the central tongue, specifically at the root, usually indicates gastric mucosal inflammation or ulcer. Long-term alcohol consumption is the primary cause. Recently, due to emotional frustration, there is dull pain in the upper diaphragm, resembling spasms, radiating to the back. Prescribed Jia Wei Jin Ling Zi San (Modified Golden Bell Powder). Jinlingzi (Szechwan Chinaberry fruit) 9g, Yanhusuo 12g, Tai Wuyao (Lindera root) 6g, Xingren Ni 24g, Xuanfuhua 9g (wrapped), Yunling 12g, Quangualou (Whole Trichosanthes) 12g, Wulingzhi 9g, Guya Maiya (Valerian and Malt) 9g each, Foshou (Finger citron) 9g.
Second visit: Although pain occurs regularly after meals, suggesting possible ulceration, it has never happened before, so it is not a deep-seated difficult-to-treat condition. Jinlingzi 9g, Xuanfuhua 12g (wrapped), Chishizhi (Red kaolin) 15g, Yunling 9g, Yanhusuo 12g, Xiangbeimu 9g, Xingren Ni 24g, Hangbaishao 15g, Wulingzhi 9g (wrapped), Foshoupian (Finger citron slice) 9g. [Commentary] The drugs used in this case have analgesic, antacid, antispasmodic, and gastric mucosal protective effects. Since the prescription matched the syndrome, subsequent visits involved slight modifications. Indeed, recovery was achieved after about 20 days of medication.
11. Male. Epigastric pain with fixed timing: one around 3 PM, another around 2 AM. This is common in duodenal ulcers. Hupo 3g, Walengzi 9g, Baicaoshuang (Soot from burning straw) 9g, Xingren Ni 12g, Liuzhouzi (Daphne odora fruit) 1.2g, Yunling 9g. Ground into fine powder, take 1g 1.5 hours after each meal. [Commentary] This is a formula for protecting the stomach, relieving pain, resolving stasis, and generating new tissue. Baicaoshuang is primarily used for its astringent properties, aiding the repair of the ulcer surface. Liuzhouzi is the fruit of *Daphne odora* (Thornbush Daphne), family Thymelaeaceae, with bitter and warm nature, and toxicity. Functions: dispelling wind, relieving pain, resolving stasis, reducing swelling. Used for wind-cold-damp bi syndrome, joint pain, traumatic injury, and carbuncles. Dosage: Internal use, ground into powder for pills/powders, 0.3-0.6g.
12. Yang Male. Generally, epigastric pain relieved by eating suggests hyperacidity, often severe in the evening; duodenal ulcer caused by hyperacidity is also possible. Duwanlengzi 30g, Maidong (Ophiopogon tuber) 9g, Chishizhi 12g, Quandonggui 15g, Yunling 15g, Guiban (Turtle shell) 24g, Wulingzhi 24g, Sheng Ejiao (Raw Gelatin) 18g, Biejia (Softshell turtle shell) 24g, Huaishanyao 15g, Yanhusuo 12g, Xingren 30g, Jiao Liuqu (Charred Medicated Leaven) 12g, Chao Zhishi (Fried Aurantium fruit) 9g, Baicaoshuang 12g. Ground into fine powder, honey-pilled like wu zi (wugua seeds), take 20-30 pills twice daily.
[Commentary] Due to epigastric pain, Yanhusuo and Xingren were used for analgesia; due to hyperacidity, Walengzi was used for antacid effect; chronic pain often involves stasis, so Danggui and Wulingzhi were used to harmonize Ying and resolve stasis; pain easily consumes Qi, so Shanyao, Fuling, and Maidong were used to nourish the Stomach. Generally, sticky/cloying herbs are avoided in stomach pain, but Mr. Zhang's use of Ejiao, Guiban, and Biejia in this prescription is unique. These three contain gelatin, possess sticky properties, can nourish Yin and blood, and protect the stomach mucosa, promoting ulcer repair. Chishizhi, according to modern pharmacological research, has adsorption properties, adsorbing toxic substances in the digestive tract, protecting the mucosa, and stopping gastrointestinal bleeding, which Mr. Zhang has frequently used.
13. Zhang Male. Regardless of how much is eaten, unbearable fullness ensues. Borborygmus in the abdomen, difficulty defecating. This indicates imperfect gastrointestinal function; this prescription aims for gradual improvement. Shengma (Cimicifuga rhizome) 9g, Zhi Fanmubie (Processed Strychnos nux-vomica) 3g, Ezhu (Curcuma zedoaria rhizome) 3g, Huangqi (Astragalus root) 15g, Guangmuxiang (Costus root) 6g, Ming Xionghuang (Realgar) 3g, Huaishanyao 12g, Dangshen (Codonopsis root) 12g, Sheng Baizhu (Raw Atractylodes macrocephala rhizome) 12g, Jineijin (Chicken gizzard lining) 9g. Ground into fine powder, take 1.5g twice daily.
[Commentary] This prescription uses Shengma to assist Renshen and Huangqi in tonifying Qi and raising Yang; Jineijin assists Shanyao and Baizhu in strengthening the Spleen and boosting Qi. Since the Spleen governs transportation, once it functions well, fullness disappears naturally—this treats the root. Simultaneously, Ezhu and Muxiang move Qi; Realgar regulates the intestines; Fanmubie (Strychnos nux-vomica) excites the medullary center and acts as a bitter stomachic. This treats the branch. The entire prescription combines tonification and purging, tonifying without stagnation, draining without damaging正气 (healthy Qi), integrating Chinese and Western medical theories into clinical practice, which is indeed a characteristic feature of Mr. Zhang's medical cases.
14. Wu Female. Dull stomach pain in the afternoon, stools like pellets. The patient is weak and fatigued; treatment should combine draining and tonifying. Dangshen 9g, Jineijin 9g, Baizhu 9g, Zhiqiao (Bitter orange peel) 12g, Qingpi (Green tangerine peel) 6g, Lvemei (Green plum) 3g, Guya Maiya 9g each, Huaishanyao 9g. Second visit: Recently suffering from acid regurgitation, relief only after induced vomiting; acid mostly occurs around 2 hours after meals, slightly relieved by eating; antacid agents should be added. Dangshen 12g, Zhiqiao 9g, Houpo (Magnolia bark) 9g, Lvemei 5g, Jineijin 9g, Baizhu 12g, Wuyao (Lindera fruit) 9g, Guya Maiya 9g each. Additionally: Fenghuangyi 9g, Zhi Mabao (Roasted Puffball) 9g, ground into extremely fine powder, divided into 21 packets, take 1 packet 3 times daily before meals.
Third visit: Acid regurgitation stopped, stomach pain also improved. Chunghoupo 6g, Jineijin 12g, Zhiqiao 6g, Shanyao 12g, Baizhu 12g, Lvemei 5g, Qingpi 6g, Wuyao 9g, Huangqi 12g. Additionally: Fenghuangyi 9g, Shang Zigui (Purple Cinnamon) 9g, ground into fine powder, divided into 21 packets, take 1 packet 3 times daily. [Commentary] First visit: Spleen failing to transport, so Zhi Zhu Wan (Atractylodes and Citrus Pill) was modified, combining draining and tonifying. Second visit: Continued original method, adding Fenghuangyi and Zhi Mabao to control acid. Third visit: Acid regurgitation stopped, pain improved, so Huangqi was used to tonify Middle Qi; Rougui (Cinnamon bark) warms the middle and disperses cold; Shanyao and Baizhu strengthen the Spleen; Qingpi, Zhiqiao, Houpo, Tai Wuyao, etc., acridly unblock and regulate Qi to conclude the treatment.
15. Xie Male. Acid regurgitation occurs every winter, worsening with hard foods, relieved by vomiting. Pain in the right lower quadrant of the hypogastrium; cannot confirm if it is ulcer disease. The source of excess acid is suspected to be neurogenic causing indigestion. Sheng Huangqi 9g, Chuan Guizhi (Cinnamon twig) 5g, Hangbaishao 9g, Danggui 9g, Wuyu (Evodia fruit) 2.4g, Pao Jiangtan (Charred Ginger) 5g, Sheng Gancao 3g, Shengjiang 2 slices, Yitang 9g (dissolved). Second visit: For non-ulcer diseases with acid regurgitation as the main symptom, Fuzi Jingmi Tang (Aconite and Rice Decoction) and Wuzhuyu Tang (Evodia Decoction) are choices. Pao Fu Kuai (Prepared Aconite chunk) 9g, Wuyu 2.4g, Banxia 12g, Dangshen 9g, Zhi Cao 2.4g, Jingmi (Rice) 1 cup, Shengjiang 2 slices, Dazao 7 pieces.
[Commentary] Acid regurgitation can be Cold or Heat. If Heat, clear Liver Fire and descend rebellious Qi to harmonize the Stomach. This case is Spleen-Stomach Deficiency-Cold, so the first visit used Huangqi Jian Zhong Tang combined with Wuzhuyu Tang. Second visit removed the sweetness of Huangqi and Yitang, used Fuzi to warm and振奋 (invigorate) Middle Yang, Wuyu to warm and disperse Liver depression, Banxia and Shengjiang to descend rebellious Qi and stop vomiting, Dangshen, Gancao, and Jingmi to harmonize the Stomach. Selection of herbs was precise, steps orderly.
16. Wang Female. Paroxysmal epigastric pain, severe pain causes vomiting, white slippery coating indicates Cold. Jiang Banxia (Ginger-processed Pinellia) 9g, Dan Wuyu (Light Evodia) 5g, Guan Guipi (Cinnamon bark) 5g, Tai Wuyao 9g, Gong Dingxiang (Clove) 3g, Bibai (Long pepper fruit) 6g, Yanhusuo 9g, Sheng Aiye (Fresh Mugwort leaf) 9g. [Commentary] The Classic says: "When Cold invades internally, treat with sweet-hot, assist with bitter-acrid." The formula uses Banxia, Guizhi, Dingxiang, and Bibai to warm the Stomach and descend rebellious Qi; Cold coagulation leads to Qi stagnation, so Tai Wuyao and Yanhusuo are reused to move Qi and relieve pain. This type of Cold-Stomach pain resembles chronic hypertrophic gastritis; this prescription often yields good results. Not suitable if the tongue body is red and crimson.
17. Ma Female. Vomiting immediately after eating, caused by anger. Suffering from frequent yawning/stretching, lack of spirit, likely a neurotic disorder, referred to by ancients as Wood overacting on Earth. Suitable for aromatic stimulant herbs. Peilan Geng (Eupatorium stem) 9g, Suzi (Perilla fruit) 9g, Hangbaishao 9g, Duwanlengzi 24g, Suoluozi (Breadfruit seed) 9g, Xiangyuanpi (Citron peel) 9g, Xuanfuhua 9g (wrapped), Xingren Ni 12g, Yushudan (Jade Pivot Pill) 1.5g (swallowed in 2 doses).
[Commentary] Anger injures the Liver, Liver fails to soothe and drain, rebels against the Stomach, causing Stomach failure to descend, hence vomiting upon eating. Soothing the Liver calms the Stomach; descending Liver Qi descends Stomach Qi. When Liver Qi flows freely, the Stomach becomes harmonious. Yushudan, also known as Zijin Ding, originally opens orifices, transforms turbidity, reduces swelling, and dissipates nodules, but when applied to various vomitings, it has anti-emetic and mid-jiao calming effects. Mr. Zhang has frequently used it with success.
18. Zhang Female. Pain extending from Zhongwan to the hypogastrium, paroxysmal, so severe that touch is intolerable, this is Qi accumulation. Rougui (Cinnamon bark) 2g, Yanhu 9g, Binglang (Areca nut) 9g, Shenqu (Medicated leaven) 9g, Can Sha (Silkworm excrement) 9g, Pao Jiang 1.5g, Qingpi 6g, Ezhu 6g, Shanzha (Hawthorn fruit) 9g, Zhaojiazi (Gleditsia spine) 6g.
19. Chen Female. Without medication, the stomach continues to attack up and down with pain, this is Gas Qi.awei (Ferula resin) 9g, Fu Kuai (Aconite chunk) 9g, Bibai 9g, Chuanxiong (Ligusticum rhizome) 9g, Danggui 9g, Hei Bai Chou (Canarium album and Ipomoea batatas seeds) 9g each, Wulingzhi 15g, Chenxiang Qu (Agarwood leaven) 12g, Yanhusuo 12g, Gansong (Nardostachys root) 6g, Chunghoupo 3g, Laifuzi (Radish seed) 9g. Ground into extremely fine powder, swallow 2.0-3.0g after each meal, 3 times daily. [Commentary] Case Zhang treated with warming and dispersing. The mechanism is that Cold coagulation leads to Qi accumulation, Qi accumulation leads to pain, so warmth promotes flow, dispersal removes Cold, Qi flows, Cold leaves, and pain ceases. Zhaojiazi in the formula is rich in oil, good at moving smoothly, guiding Qi downward. Case Chen also used warming middle and moving Qi, with stronger effect than the previous formula. Taking small amounts of powder expels pathogen without damaging healthy Qi.awei is特效 (special effect) for expelling gastrointestinal gas accumulation, and also treats malaria, dysentery, and stubborn diarrhea, but smells bad and is hard to take; powder can be stored in capsules for swallowing.
20. Guo Male. High fever for 3 days, severe epigastric pain, refusal to press, no bowel movement for 3 days, indicating tangible accumulation, should be unblocking and descending. Zhi Dahuang (Prepared Rhubarb) 6g, Xuanmingfen 9g (divided into 2 doses, dissolved), Baishao 12g, Zhishi 9g, Lianqiao (Forsythia fruit) 9g, Huangqin (Scutellaria root) 9g, Kuxingren (Bitter Apricot seed) 18g, Quangualou 12g. Second visit: After medication, severe epigastric pain largely settled, but no smooth bowel movement, Yangming dryness Qi is still vigorous, still need to clear and purge. Sheng Dahuang 6g, Xuanmingfen 9g (divided into 2 doses, dissolved), Baishao 12g, Zhishi 9g, Lianqiao 12g, Dilong (Earthworm) 9g, Zhimu (Anemarrhena rhizome) 9g, Quangualou 12g, Yuliren (Bush Cherry seed) 9g. [Commentary] This patient's high fever for 3 days accompanied by severe epigastric pain and constipation may be related to infection; common diseases like acute cholecystitis, pancreatitis, etc., have pain locations near the stomach. Although the specific inflammation cannot be determined here, given high fever and constipation, it differs from general stomach pain. "The Six Fu organs function by patency," so clearing heat and purging was used, resulting in significant pain relief.
21. Wang Female. Main symptom is epigastric pain, pain lasts all day, slightly relieved after eating, recurs after a while. Pulse is thin. Pao Fu Kuai 9g, Yanhusuo 12g, Xie Baitou (Allium macrostemon bulb) 12g, Sheng Zhishi 12g, Bibai 9g, Jiaomu (Pepper pit) 5g, Jineijin 12g, Guya Maiya 9g each. Second visit: Epigastric pain largely settled. Efficacy of warm medicines indicates Cold-Stomach. There are two types of Cold-Stomach: one is chronic gastritis; the other is functional disorder. The patient falls into the latter category. Fu Kuai 6g, Dangshen 9g, Juhong (Pomelo peel) 6g, Suzi 12g (wrapped), Bidengqie (Long pepper fruit) 9g, Pogostemon (Guizhi? No, Pogostemon cablin is Huoxiang, but text says Pogostemon/Broken Paper? Text says Po Gu Zhi - Semen Costi) 9g, Baizhu 9g, Yuanzhi (Polygala root) 5g, Fen Gancao (Powdered Licorice) 3g, Banxia 9g. [Commentary] This belongs to Cold-Stomach, treated with warming, unblocking, and strengthening transport. Po Gu Zhi (Semen Costi), Qing Dynasty Huang Yuanyu said it has the function of "warming Water and Earth, digesting food"; Mr. Zhang likely used it for this meaning. Added Dangshen and Baizhu as post-pain supplementary tonic.
22. Qian Male. Stomach pain with fixed timing, mostly occurring after three meals, early 2-3 hours, late 4-5 hours. Differentiated by modern medicine: neuralgia, chronic gastritis, ulcer disease. Considering no history of vomiting or acid water, relationship with ulcer is less. First give analgesics to observe. Xingren Ni 24g, Yanhusuo 15g, Yangsuke (Poppy capsule) 12g, Xuanfuhua 12g (wrapped), Danggui 9g, Chuanlianzi (Szechwan Chinaberry) 9g. Additionally: Calcined eggshell powder, swallow after meals, 1.5g per dose. Second visit: Pain settled. Continue previous formula, removing Yangsuke and eggshell powder. [Commentary] In the first visit, since ulcer disease could not be excluded, eggshell powder was added to the analgesics. In the second visit, pain settled, so eggshell powder was removed. Mr. Zhang stated that fixed-time stomach pain distinguishes between neuralgia, chronic gastritis, and ulcer disease. Clinically, attacks are mostly irregular and rarely occur after three meals; must differentiate from ulcer disease. Yangsuke is addictive with long-term use, so stopped after pain settles.
23. Diao Male. Fatigue can trigger recurrence of epigastric pain, mostly belonging to neurotic origin. Subjective burning heat in the stomach, aromatic-dry analgesics are unsuitable. Xingren 18g, Yanhusuo 12g, Ciwei Pi (Hedgehog skin) 15g, Zhimu 9g, Xuanfuhua 12g (wrapped), Quandonggui, Suoluozi, Jiang Zhuru (Ginger-processed Bamboo shavings) 9g each. [Commentary] Subjective burning heat in the stomach indicates internal Fire; aromatic-dry Qi-regulating agents can aid Fire, hence unsuitable. Instead, Xuanfuhua regulates Qi and descends rebellion, Xingren, Yanhu, Suoluozi promote free flow, Ciwei Pi activates blood and relieves pain, Zhimu and Zhuru clear Stomach and descend Fire.