吾友黄云裳之女，十三岁，秋杪患疟，医以柴葛羌防治而愈之，已进饮食，后复发热渴饮，微汗津。津医误认复感，仍用表散，热愈炽，渴愈甚。邀余，诊脉得右关独数。余曰：此食滞耳，非外感也。原治疟时，辛散过用，燥伤胃滓，胃液不充，因食纳而化迟渐生积热，以至壅压营卫，而不能相和。胃为阳土，故独发热。儿辈病初愈，即频进饮食，每多此症。倘仍苦寒以伤胄，辛散以却津，斯变幻立殆矣。治法宜选甘凉以养胃生津，胃津充则谷食自化，营卫自和，而肌热自解。质人参白虎法加减丽参五分同煎，麦冬(连心)、鲜嫩竹叶剪碎各二钱，生扁豆不打三钱，知母、石膏各一钱，甘草三分，石膏研末，白糖沙拌炒，后下，煎服。一剂渴热稍退，三剂全愈。云裳曰；吾今始知伤食亦有寒热也。余曰：更不止此。云裳曰：君能为我备述乎余曰：试为君略举之风寒伤于表，营卫不能运行于外而寒热生；暑湿秽浊与燥气口鼻吸入，阻其气机，营卫不能转旋而寒热亦生；食滞阻气之升降，实火扰气之流行，营卫因失其循行之度而寒热亦生；又况阴虚生内热，阴盛生内寒，阳盛生外热，阳虚生外寒，重阴则热(阴盛隔阳)，重阳则寒(阳盛隔阴)；而阳维为病更苦寒热，有不关于营卫之和与不和，而急当讲究，夫育阴以和阳者耶。云裳曰：然则阴虚寒热与外感寒热究何以辨别而治之余曰：以有汗无汗为别。有汗属营卫不和，因营卫不充；循行失度，故或发热，或寒热叶氏论治谓若用桂枝汤当重用白芍以敛阴和营。无汗属肝肾，奇经以至阴，深远难隔越诸经以达于阳分而泄其汗也，叶氏论治谓当用芳香轻清之品以宣通八脉，滋阴益血之药，以调养奇经，倘参入当归桂枝汤法治(即桂枝汤加当归)，亦须去白芍，芍酸不走络也云。裳曰：君时云症不疑似分药味彼此妥诚然。
《评琴书屋医略》卷一终
评琴书屋医略 卷二
消 渴 症
消有三消之分，饮水多而小便少为上消；食谷多而大便坚为中消；饮一溲一小便如膏为下消(上中二消属热，下消属寒)。前贤治法，上消用人参白虎汤，中消用调胃承气汤，下消用肾气丸。其实皆津液干枯病，故赵养葵先生谓，凡大渴大燥无分冲下用大剂六味地黄汤加肉桂、五味(名加减八味丸)，连剂频进饮，渴自止。白虎承气皆非所宜，此赵论虽变古人成法，其中实有妙义。盖人之灌溉，一身全赖两肾中水火，少火能生气，则真水自升，而渴自止(加肉桂正所以温动少火，前贤治下消用肾气丸者即此意)，然临症总贵因脉变通。上消轻，多先拟清燥法。
大麦冬五钱，连心 大天冬三钱 白粳米四钱 大生地五钱 雪梨干八钱 乌梅肉四分加生蜜冲服。渴仍照方频进，蜜不拘多少，与乌梅酸甜合病者口味为妙，酸甘盖取其化阴。
服三四剂仍渴，倘脉洪大而数，喜冷饮者，加石膏、知母。仍渴再加黄连、甘草。脉沉弱而迟喜热饮者(拟方不合)，宜遵养葵法(或肾气丸)。中消用调胃承气汤合四物汤(或去芎硝，君以石膏)。下消宜肾气丸。若骨瘦腿疼宜知柏八味加杜仲、人参、天冬、五味。
呕 吐
呕吐一症，属足阳明胃经有寒、有热、有虚，患此最宜明辨。其因寒而呕吐者，脉必迟(唇舌白恶饮)。因热而呕吐者，脉必数(唇颊赤口燥渴)。因虚而呕吐者，脉必虚(唇白面黄倦怠嗜卧)。果能因脉辨症施治，必效。兹拟症近于热者立一安胃降逆轻剂以便因症加减。
金钗斛五钱，先煎 制半夏一钱半 细甘草三分 结云苓三钱 化橘红四分 鲜竹茹椂BR>
加生姜一钱同煎(或去甘草，甘能守中壅气发呕，因石斛苦，故少佐耳)。
如确审得脉数热盛，加石膏、粳米或麦冬、鲜芦根(经验方石膏、粳米、麦冬、芦根煎代茶，止热呕颇佳)。方内生姜、橘红或减少，或不用。若脉迟有寒者去石斛、竹茹加砂仁，或蔻仁，或独加方内生姜用三四钱，或五六钱。寒重者加至两零必效。若脉虚属中气虚者，去石斛、竹茹加白术、人参、大枣。虚而兼寒者，再加附子、干姜。至若呕吐而寒热往来者少阳症也，宜另用小柴胡汤主治。
呕吐症中更有病名噎隔病名反胃者，其人于饮食之际，气忽阻塞曰噎；心下隔拒，或食到膈间不得下(故古人亦有名之为膈者)曰隔。古人谓津液干枯为噎隔病源，忌投温补可知。误用参、耆、术以培补之，愈增其隔；误用姜、桂、附以温暖之，益速其亡。选药必须用清润之品，以急救阳明胃阴为主(高鼓峰谓治膈一阳明尽之)，如牛乳、人乳、沙参、天冬、麦冬、地黄、芦根、茅根、韭汁陈酒最为要药。选方当遵杨乘六用左归饮去茯苓加当归、生地主治。然吾尝用大半夏汤合麦门冬汤治之，亦间有犹效者。倘刺痛大便干结(大肠无血)，当遵鼓峰法熟地五钱，当归、白芍、桃仁、麻仁各三钱，以润之(如其人形体尚壮加大黄椂BR> 钱，以助血药更妙)。或用酒大黄、桃仁、归尾、炼蜜为小丸，茅根浓煎汤送下，以缓下之(大肠润利，胃口自开，然此症年五十下或可治，五十上难医。初病或易治，久病难医)。若饮食方下咽气即上逆或刺痛，启膈饮之，重用沙参以开肺气之郁，又不可不讲究也。若朝食而暮乃吐，暮食而朝乃吐，其大便甚利或溏者(与膈症分别处验大便为最要)，此中下二焦火衰反胃症也(王太仆云：食不得入是有火也；食入反出是无火也)。宜吴茱萸汤，附子理中汤或六君子汤加姜、附治之。高鼓峰亦主王太仆之论，用八味丸主治。然余治内人患此，用大小半夏汤吴茱萸汤三方合用而痊(除噎隔症外，凡治呕吐，药中磨沉香汁三四分，其效倍速)。
即发黄症。遍身面目溺皆黄，原有五疸之分(黄疸、谷疸、酒疸、女劳疸、黄汗)，阴阳虚实之别，而究湿热气蒸为患者居多。治法必从气分，宣通乃效。兹拟渗湿清热，佐以宣通气分方法(此症渴难治，不渴易治)。
苓皮五钱 滑石三钱 黄芩一钱 北杏…-钱 茵陈三钱 栀子一钱半 蔻仁四分
加淡豆豉三钱，同煎(或重用鲜田基黄、白连草煎汤，去渣，将汤代水煎药)。
热盛倍用栀芩。湿盛加苍术。周身尽痛痛湿阻气机也，宜倍用蔻仁以开肺气，肺主一身之气化故也。炒银花、泽兰叶、藿香、叶梗、猪苓、泽泻、木通、萆薢、海金沙、腹皮皆芳香逐秽渗淡除湿之品，可因症参入加减。
但所因不一，治法颇多，即女劳瘀血难疗，自有方书可考(沈金鳌尊生引述颇详可参考。且分别黄肿、与黄疸证治亦佳)。似不烦多赘。然窃念阳黄阴黄，清温各别，每见误治者，难免伤人，是不得不明辨。夫阳主明，故黄如橘子色，治胃(脉或数或缓必有力)即宜用上拟方并参以所列加减各法治之。阴主晦，故黄如曛，黄色治脾(脉必沉弱且身冷)，罗谦甫先生以茵陈四逆汤主之，高鼓峰用四苓散加炮姜、茵陈治之，重者加附子。又有脾液外越而发黄者(脉弱体倦无神，但面身黄目，溺不黄)，贫而劳苦者多(劳则伤脾，脾虚不能收摄真气故也)，宜香砂六君子汤加减治之。
附 案 二
酒肉连绵之会，适暑湿交蒸之时，稍不谨慎，最易犯，此湿热疸症。拟方七味连服数剂便可全愈。余尝医故交谢司马侄，年少患此，初起即进原方二剂，病已减半，间数日再进二剂，渐愈，惟目尚黄，祗多饮乌龙茶(此茶芳香能辟暑湿秽浊之气)与薄味调养而痊(此症忌酒肉厚味)。
叶案治疸症有云，不宜下，恐犯太阴，变脉不知，亦问其症之宜与不宜耳。琴师左君逄源患此症三月余，服药罔效，延余治。自述每三四日始一更衣，今已五日矣。能食脉有力，余用茵陈蒿汤加芒硝治之，方用大黄三钱，茵陈四钱，栀子、芒硝各二钱，煎好冲入酒二杯服。服后大泻，明日硝减半，服再泻，病稍退。隔四日仍苦便难，前方去硝加桃仁三钱，服二贴，仍泻二次，继以薄味调养而收全功。
头 痛
头为诸阳之会，与厥阴肝脉会于巅，故头痛一症，半由厥阴风火挟诸经火上扰所致。兹即是议订一方，其风寒虚三者，亦非尽无，然六淫五贼之分，气血虚实之别，前人成法，自有可稽，即沈芊绿《尊生》一书，引述颇详，可因其援引而博考之。至若偏正头风，当遵叶天士先生育阴和亢阳，柔润熄内风一法，参入商治。
北杏三钱 连翘二钱 蔓荆子一钱 钩藤五钱，打 白菊椙 鲜莲叶四钱，用边，切碎煎。
热盛加羚羊、苦丁茶各三钱，煎。兼感受暑气加六一散三钱引。
知确非由外感(无发热、恶寒、鼻塞、声重脉浮等)去北杏、连翘、荆子，转用生地、熟地、天冬、麦冬、玉竹、胡麻、阿胶、龟版、鳖甲等选择三五味配入本方治之，此养肝体佐以清肝，用法阴虚火浮最宜，即偏正头风亦可治。叶案所谓育阴和亢阳，柔润熄内风者此也。此等症或全用静药，羚羊、钩藤、菊花，或亦不用，或少佐之。
附论偏正头风
偏头风多属少阳，以少阳行身之侧故也。误投柴胡多致损目，以升散少阳，耗竭肝阴故也。朱丹溪以左属风属火，主血虚，右属痰属热，主气虚，遵之亦有效有不效。其初起者，不论左右，用鲜红根地胆草头五钱(如无以白茅根代之)，当归、羚羊(二味先煎)，木贼、天麻、荆子、菊花各一钱，川芎、白芷各四分，黑豆百粒，煎服多效。
另有一种正头风，数日一发，或数月一发，此乃风毒客于髓海，服药难达病所，故年深难愈，宜用菊花、沈茶蒸浓汁，仰卧冷注鼻中(或用生莱菔汁)，或甜瓜蒂五分，皂角二分，细辛一分，真麝香二厘，蜜小丸，绵裹，塞鼻中，沸湿则易之，得嚏或出浊涕窍通而痛自解。
风毒傍于脑海之旁，亦令偏头痛，倘用育阴和阳柔润熄风法不效，上从鼻治三法皆可选用。左痛从左治，右痛从右治(亦有主左痛治右右痛治左者当并试之)。又或用肉桂一分，人言一厘，麝香二厘，辛夷、细辛各五厘，胡椒十粒，为末，枣肉为丸，如豌豆大。一粒放膏药中心，贴准太阳穴，一日当见效(因风寒而起者更妙)。如壮年火盛者，愈后服黄芩大黄泻火，则目自愈。
腹 痛
(中脐及脐上下痛同考)
脐上属太阴(脾)，脐中属少阴(肾)，脐下属厥阴(肝)，当分别治之。凡一切痛症，虚者喜按，得食则止，脉无力，实者拒按，得食愈痛，脉有力。
藿香梗三钱 草决明四钱 生白芍二钱川楝子一钱半 大蒿麦三钱 细甘草七分 旧青皮八分，醋炒
加橘柚叶二钱(鲜取剪碎)同煎。脐上痛加木香五六分，炒谷芽三四钱。中脐痛加吴萸五六分，炒山甲一二片(皆去藿梗青皮)。脐下痛加海螵蛸四钱，茜根一钱，或再加制香附二钱，炒山查核三钱(去藿、决、蒿、芍、草五味，倘按之冷，仍须加吴萸或肉桂。若女子患此则当归、杞子、蒺藜、灵脂不可少，下附奇经心痛案可参)。又腹痛恒有因饮食不慎而致者，如肉食伤宜山查、蓬术、阿魏；食饭伤宜神曲、麦牙；食曲伤宜莱菔子，生冷伤宜草果、苍术、厚朴；宿食伤宜枳实、黄连、蓬术、槟榔，因其所伤之物而以主治之药为君，助以余药兼以化气痛自愈矣。然而腹痛之因更有不止此者，腹满痛而大便闭为实，有厚朴三物、厚朴七物与大黄附子汤法。腹满痛而下利为虚，有理中汤法。雷鸣切痛而呕吐为寒气，有附子粳米汤法。慎疾者，宜小心察之。
附 案
香邑黄阁乡麦树基每日交酉必腹痛(脏腑十二时流注说以酉属肾经)，将交戌痛乃渐止，病年余，无有能愈之者。一医会作热积治，用朴、枳、连、柏，渐增肠鸣(寒气)，更或时吐时泻。又更一医治以自制小丸，此后则诸恙倍增肠鸣，虽远坐亦闻，腹痛每至于闷死，必酉刻将尽始渐醒而痛缓，日日如是，无有间者。危急之际，邀余诊，脉无神，结见两关左尺，拟附子粳米汤加味治之，熟附子三钱、炒，粳米、制半夏各四钱，丽参、木瓜、炙草、南枣肉各一钱，是晚痛虽止，而肠尚鸣，亦将交戌而其鸣乃息。翌日诊，原方如土炒白术五钱枣肉改用三钱，木瓜改用一钱半，是晚诸恙俱安。隔年余，适到黄阁复邀诊，据述今年上半载无恙，后半载每月复发一二次，因痛不比去年之甚，故加味复方，仅服半剂，而自能渐安，余仍用附子粳米汤合理中汤加味，为小丸，令其常服，以防后患。防党参、白术各四两，附子、当归各一两，丽参、半夏、干姜、木瓜、甘草各五钱，用大枣糯米煎稠粥，为小丸，每服三钱，早用淡盐汤送。后闻连服五料，乃收全功。
附论藿乱症
My friend Huang Yunshang's daughter, aged thirteen, contracted malaria (Malaria) in late autumn. The physician treated her with Chaihu Ge Gen Qiang Huo Fang (Bupleurum, Kudzu, and Notopterygium Decoction), which cured her. She had resumed eating, but later developed recurrent fever, thirst with desire to drink, slight sweating, and loss of body fluids (Jin Ye). Another physician mistakenly diagnosed it as a new external contraction and continued using exterior-releasing (Exterior-Releasing) methods, causing the heat to intensify and the thirst to worsen. I was invited to consult. Upon taking the pulse, I found that the Right Guan position alone was rapid (Shu). I said: "This is food stagnation (Food Stagnation), not an external contraction. Originally, during the treatment of malaria, acrid-dispersing (Acid-Dispersing) drugs were overused. Their dryness damaged the stomach fluids (Stomach Fluids), leaving them insufficient. Consequently, after eating, digestion became slow, gradually generating accumulated heat, which then obstructed and compressed the Ying (Nutritive) and Wei (Defensive) Qi, preventing them from harmonizing. The Stomach belongs to Yang Earth, so it manifests isolated fever. Children often present with this syndrome when they resume frequent eating immediately after recovering from illness. If one continues to use bitter-cold drugs to damage the Stomach or acrid-dispersing drugs to deplete fluids, the condition will deteriorate dangerously. The treatment method should select sweet-cool herbs to nourish the Stomach and generate fluids. Once Stomach fluids are sufficient, food will digest naturally, Ying and Wei Qi will harmonize, and the surface heat will resolve spontaneously." The prescription modified from Renshen Baihu Tang (Ginseng and White Tiger Decoction): Lishen (Lishen) 5 fen decocted together; Maidong (Ophiopogon Tuber, retaining the heart) and fresh tender Zhuyeqie (Bamboo Leaves, cut into pieces) each 2 qian; Sheng Biandou (Raw Lablab Bean, uncrushed) 3 qian; Zhi Mu (Anemarrhena Rhizome) and Shigao (Gypsum Fibrosum) each 1 qian; Gancao (Licorice Root) 3 fen; Shigao ground into powder, stir-fried with white sugar sand, added later, decocted and taken orally. After one dose, thirst and heat subsided slightly; after three doses, full recovery was achieved. Yunshang said: "I now realize that food injury can also cause cold and heat symptoms." I said: "It is not limited to this." Yunshang said: "Can you explain this to me in detail?" I said: "Let me briefly list some examples for you: When Wind-Cold invades the exterior, Ying and Wei cannot circulate externally, leading to cold and heat; when Summerheat-Dampness, turbid pathogens, and Dryness-Qi are inhaled through the mouth and nose, obstructing Qi mechanism, Ying and Wei cannot rotate, also leading to cold and heat; Food stagnation obstructs the ascending and descending of Qi, while Excess Fire disturbs the flow of Qi, causing Ying and Wei to lose their rhythmic circulation, also resulting in cold and heat; Furthermore, Yin deficiency generates internal heat, Yin excess generates internal cold, Yang excess generates external heat, and Yang deficiency generates external cold; Heavy Yin leads to heat (Yin excess repelling Yang), and Heavy Yang leads to cold (Yang excess repelling Yin); Moreover, disease of the Yangwei Vessel causes suffering from cold and heat. This does not concern whether Ying and Wei are harmonious or not, but urgently requires attention to nourishing Yin to harmonize Yang." Yunshang said: "Then how exactly can we distinguish between Yin-deficiency-induced cold/heat and external-contracted cold/heat, and treat them accordingly?" I said: "Distinguish by the presence or absence of sweating. Sweating belongs to disharmony of Ying and Wei, due to insufficiency of Ying and Wei and loss of rhythmic circulation, thus sometimes presenting with fever or alternating chills and fever. Master Ye Tianshi discussed treatment, stating that if Guizhi Tang (Cinnamon Twig Decoction) is used, Baishao (White Peony Root) should be heavily dosed to astringe Yin and harmonize Ying. No sweating belongs to the Liver, Kidney, and Extraordinary Vessels at the deepest Yin levels, where it is difficult to cross the meridians to reach the Yang aspect to induce sweat. Master Ye Tianshi stated that aromatic and light-clear herbs should be used to open the Eight Extraordinary Vessels, and Yin-nourishing and blood-tonifying herbs should be used to regulate the Extraordinary Vessels. If Danggui Guizhi Tang (Angelica Cinnamon Twig Decoction) is incorporated (i.e., Guizhi Tang plus Danggui), Baishao must still be removed because its sour taste does not enter the collaterals." Yunshang said: "You often say that if diseases are not suspected and differentiated clearly, the efficacy of medicines will be compromised."
*Pingqin Shuwu Yilue*, Volume 1 ends.
*Pingqin Shuwu Yilue* Volume 2
Xiao Ke Syndrome (Wasting-Thirst Syndrome)
Xiao Ke is divided into Upper, Middle, and Lower Xiao Ke: Drinking much but urinating little is Upper Xiao Ke; Eating much but having hard stools is Middle Xiao Ke; Drinking and urinating equal amounts, with urine resembling paste, is Lower Xiao Ke (Upper and Middle Xiao Ke belong to Heat patterns, Lower Xiao Ke belongs to Cold patterns). Former sages treated Upper Xiao Ke with Renshen Baihu Tang (Ginseng and White Tiger Decoction), Middle Xiao Ke with Tiaowei Chengqi Tang (Regulating the Stomach and Directing Downward Decoction), and Lower Xiao Ke with Shenqi Wan (Kidney Qi Pill). In reality, these are all diseases of dried-up body fluids (Jin Ye). Therefore, Mr. Zhao Yangkui stated that for any case of extreme thirst and dryness, regardless of upper, middle, or lower, large doses of Liuwei Dihuang Tang (Six-Ingredient Pill with Rehmannia) plus Rougui (Cinnamon Bark) and Wuweizi (Schisandra Fruit) (named Jiajian Bawei Wan) should be administered frequently until thirst stops. Baihu Tang and Chengqi Tang are not suitable. Although Mr. Zhao's theory alters ancient established methods, it contains profound meaning. Generally, the irrigation of the human body relies entirely on the Water and Fire within the two Kidneys. Mild Fire (Shao Huo) generates Qi, causing True Water to rise and thirst to cease (adding Rougui is precisely to warm and activate Mild Fire; the former sages' use of Shenqi Wan for Lower Xiao Ke embodies this intent). However, clinical practice always values flexibility based on the pulse. For mild Upper Xiao Ke, Qingzao Fa (Clearing Dryness Method) is mostly proposed first.
Damaidong (Ophiopogon Tuber, retaining the heart) 5 qian, Datiantong (Asparagus Tuber) 3 qian, Baijingmi (White Glutinous Rice) 4 qian, Dashengdi (Rehmannia Root) 5 qian, Xueligan (Dried Snow Pear) 8 qian, Wumeirou (Meat of Mume Fruit) 4 fen (take with raw honey). If thirst persists, continue taking the original formula frequently; the amount of honey is unrestricted, best combined with the sweet and sour taste of Wumei. Sour and Sweet aim to transform Yin.
If after three to four doses thirst persists, and the pulse is surging and rapid with a preference for cold drinks, add Shigao (Gypsum Fibrosum) and Zhimu (Anemarrhena Rhizome). If thirst remains, add Huanglian (Coptis Rhizome) and Gancao (Licorice Root). If the pulse is deep, weak, and slow with a preference for hot drinks (the proposed formula is unsuitable), follow Mr. Yangkui's method (or use Shenqi Wan). For Middle Xiao Ke, use Tiaowei Chengqi Tang combined with Siwu Tang (or remove Chuanxiong and Mangxiao, using Shigao as the sovereign herb). For Lower Xiao Ke, Shenqi Wan is appropriate. If emaciated with leg pain, use Zhibai Bawei Wan plus Duzhong (Eucommia Bark), Renshen (Ginseng Root), Tiantong (Asparagus Tuber), and Wuweizi (Schisandra Fruit).
Ou Tu (Vomiting)
(Huo Luan [Cholera-like disorder] and Ru Ou [Infant vomiting] see Abdominal Pain below; they differ and must not be confused.)
The symptom of vomiting belongs to the Foot-Yangming Stomach Meridian and can be caused by Cold, Heat, or Deficiency. It is crucial to distinguish clearly. Vomiting due to Cold presents with a slow pulse (white lips/tongue, aversion to drinking). Vomiting due to Heat presents with a rapid pulse (red lips/cheeks, dry mouth/thirst). Vomiting due to Deficiency presents with a deficient pulse (white lips, yellow complexion, fatigue, desire to lie down). If treatment is prescribed based on pulse differentiation, effectiveness is guaranteed. Here, a mild Anwei Jiangni (Calming the Stomach and Descending Rebellious Qi) formula is proposed for cases approaching Heat, allowing for modification based on symptoms.
Jinchahu (Dendrobium Stem) 5 qian (decoct first), Zhi Banxia (Pinellia Tuber processed) 1.5 qian, Xi Gancao (Licorice Root) 3 fen, Jie Yunling (Poria) 3 qian, Hua Ju Hong (Tangerine Peel) 4 fen, Xian Zhuru (Fresh Bamboo Sap) appropriate amount.
Add Shengjiang (Fresh Ginger) 1 qian to decoct together (or remove Gancao, as sweetness can retain dampness and obstruct Qi, inducing vomiting; since Shihu is bitter, a small amount is added).
If the pulse is definitively rapid indicating severe Heat, add Shigao (Gypsum Fibrosum) and Jingmi (Glutinous Rice) or Maidong (Ophiopogon Tuber) and Xian Lugeng (Fresh Reed Rhizome) (Empirical Formula: Shigao, Jingmi, Maidong, Lugeng decocted as tea effectively stops heat-induced vomiting). Reduce or omit Shengjiang and Juhong in the formula. If the pulse is slow indicating Cold, remove Shihu and Zhuru, add Sharen (Amomum Fruit) or Keren (Black Cardamom Seed), or add only Shengjiang (Fresh Ginger) 3-5 qian. For severe Cold, increase to over 1 liang for effectiveness. If the pulse is deficient indicating Middle Qi Deficiency, remove Shihu and Zhuru, add Baizhu (Atractylodes Macrocephala Rhizome), Renshen (Ginseng Root), and Dazao (Jujube Fruit). If Deficient with Cold, add Fuzi (Aconite Lateral Root) and Ganjiang (Dried Ginger). If vomiting accompanies alternating chills and fever, it is Shaoyang Syndrome, and Xiaochaihu Tang (Minor Bupleurum Decoction) should be used separately.
Supplementary Discussion on Ye Ge Fan Wei (Dysphagia, Obstruction, and Regurgitation)
Among vomiting syndromes, there are conditions named Ye Ge (Dysphagia/Obstruction) and Fan Wei (Regurgitation). When food enters, sudden Qi obstruction is called Ye; blockage below the heart or food reaching the diaphragm without descending is called Ge (ancients also called it Ge). Ancients believed dried-up body fluids were the root of Ye Ge, hence warming tonics were contraindicated. Mistakenly using Renshen (Ginseng Root), Qishi (Astragalus Root), and Baizhu (Atractylodes Macrocephala Rhizome) to tonify increases obstruction; mistakenly using Jiang (Ginger), Gui (Cinnamon), and Fu (Aconite) to warm accelerates death. Medicines selected must be clear and moistening, primarily aiming to urgently rescue Yangming Stomach Yin (Gao Gufeng stated treating Ge involves mastering Yangming). Key herbs include Niurui (Cow Milk), Renru (Human Milk), Shashen (Glehnia Root), Tiantong (Asparagus Tuber), Maidong (Ophiopogon Tuber), Dihuang (Rehmannia Root), Lugeng (Reed Rhizome), Maogen (Imperata Rhizome), Jiuzhi (Leek Juice), and Chenjiu (Aged Wine). Formulas should follow Yang Chengliu's use of Zuogui Yin (Left Restoring Decoction) minus Fuling (Poria) plus Danggui (Angelica Sinensis Root) and Shengdi (Rehmannia Root). However, I have occasionally used Banxiatang (Pinellia Decoction) combined with Maimendong Tang (Ophiopogon Decoction) with success. If there is stabbing pain and dry stool (Large Intestine lacks Blood), follow Gufeng's method: Shudi (Prepared Rehmannia Root) 5 qian, Danggui (Angelica Sinensis Root), Baishao (White Peony Root), Taoren (Peach Kernel), Hren (Hemp Seed) each 3 qian to moisten (if the patient is robust, add Dahuang (Rhubarb Root) 1 qian to assist blood-invigorating herbs). Or use Jiudahuang (Wine-processed Rhubarb Root), Taoren (Peach Kernel), Guiwei (Angelica Sinensis Root tail), and refined honey to make small pills, taken with thick Maogen (Imperata Rhizome) decoction for gentle purgation (when the Large Intestine is lubricated, the stomach opening opens naturally; however, this condition is treatable under fifty, difficult over fifty. Early stage is easier, late stage is difficult). If food regurgitates immediately upon swallowing or causes stabbing pain, use Qige Yin (Open Obstruction Decoction), heavily using Shashen (Glehnia Root) to open Lung Qi depression. If morning food is vomited in the evening, or evening food in the morning, with loose stools (key distinction from Ge is stool examination), this is Fan Wei due to Fire Decline in Middle/Lower Jiao (Wang Taipou said: Food cannot enter indicates Fire; Food enters and comes out indicates no Fire). Use Wuzhuyu Tang (Evodia Decoction), Fuzi Lizhong Tang (Aconite and Ginger Decoction for the Middle), or Liujunzi Tang (Six Gentlemen Decoction) plus Jiang (Ginger) and Fu (Aconite). Gao Gufeng also supported Wang Taipou's view, using Bawei Wan (Eight-Ingredient Pill). However, I cured my wife of this condition by combining Banxiatang (Pinellia Decoction), Xiaobanxiatang (Minor Pinellia Decoction), and Wuzhuyu Tang (Evodia Decoction) (For vomiting other than Ye Ge, adding Chenxiang juice (Aquilaria Wood) 3-4 fen to medicine doubles the effect).
Dan Zheng (Jaundice Syndrome)
Also known as Yellowing Syndrome. Whole body, eyes, and urine turn yellow. There are originally five types of Dan (Yellow Jaundice, Grain Jaundice, Wine Jaundice, Female Labor Jaundice, Yellow Sweat), distinguished by Yin/Yang and Deficiency/Excess, but most are caused by Damp-Heat steaming. Treatment must address the Qi level; releasing and unblocking is effective. Here, a method of draining Dampness and clearing Heat, assisted by promoting Qi movement, is proposed (This condition is difficult to treat if thirsty, easy if not thirsty).
Lingpi (Poria Skin) 5 qian, Huashi (Talcum) 3 qian, Huangqin (Scutellaria Root) 1 qian, Beixing (Apricot Seed) 1 qian, Yichen (Artemisia Capillaris) 3 qian, Zhizi (Gardenia Fruit) 1.5 qian, Keren (Black Cardamom Seed) 4 fen.
Add Danshidouchi (Fermented Soybean) 3 qian, decoct together (or heavily use Xian Tianjihuang (Selaginella) and Bailiancao (Saururus Herb) decocted, strain, and use the liquid to decoct herbs).
Increase Zhizi and Huangqin for severe Heat. Add Cangzhu (Atractylodes Lancea Rhizome) for severe Dampness. Generalized pain is due to Dampness obstructing Qi mechanism; increase Keren (Black Cardamom Seed) to open Lung Qi, as the Lung governs the Qi transformation of the whole body. Chao Yinhua (Flos Lonicerae), Zelan Ye (Eupatorium Leaf), Huoxiang (Patchouli), Yegeng (Agastache Stem), Zhuling (Polyporus), Zexie (Alisma Rhizome), Mutong (Akebia Stem), Bixie (Dioscorea Hypoglauca Rhizome), Haijinsha (Lygodium Spore), Fupi (Tangerine Peel) are all aromatic, turbidity-expelling, and diuretic herbs for draining Dampness; they can be added according to symptoms.
Causes vary, and treatments are numerous. Even Female Labor Jaundice with Blood stasis is difficult to treat, but recorded in medical books (Shen Jin'ao's *Zunsheng Ji* cites details well; distinguishing Yellow Swelling from Jaundice is also good). No need for excessive elaboration. However, Yang Dan and Yin Dan require different Clearing and Warming approaches. Mis-treatment harms people, so distinction is essential. Yang is bright, so the color is like an orange; treat the Stomach (pulse may be rapid or moderate but must be forceful); use the proposed formula and modifications. Yin is obscure, so the color is like smoked/dark; treat the Spleen (pulse must be deep and weak, body cold). Mr. Luo Qianfu used Yichen Sini Tang (Artemisia and Counterflow Decoction). Gao Gufeng used Siling San (Five Poria Powder) plus Paojiang (Processed Ginger) and Yichen (Artemisia Capillaris), adding Fuzi (Aconite Lateral Root) for severe cases. There is also Yellowing due to Spleen Fluid escaping outward (weak pulse, fatigue, spiritless, only face/body yellow, eyes/urine not yellow), common in poor, laboring individuals (Labor injures Spleen; Spleen Deficiency fails to secure True Qi). Use Xiangsha Liujunzi Tang (Costus and Amomum Six Gentlemen Decoction) modified.
Supplementary Case Two
At banquets with continuous wine and meat, during humid-heat steaming weather, carelessness easily leads to infection. This is Damp-Heat Jaundice. A seven-herb formula taken for several doses cures it completely. I once treated the nephew of my old friend, Sima Xie. Young, he contracted this. Initially, two doses of the original formula halved the illness. After a few days, two more doses led to gradual recovery, except for yellow eyes. He recovered by drinking plenty of Oolong Tea (aromatic, dispels summer-dampness and turbidity) and eating bland food (this condition forbids rich wine/meat).
Master Ye's notes on Jaundice state: Purging is unsuitable, fearing invasion of Taiyin, changing the pulse unpredictably. It depends on whether the syndrome suits purging. Musician Zuo Fengyuan suffered from this for over three months, ineffective medication. I consulted. He reported bowel movements every 3-4 days, now five days. Appetite good, pulse forceful. I used Yinchen Hao Tang (Artemisia and Coix Seed Decoction) plus Mangxiao (Mirabilite). Prescription: Dahuang (Rhubarb Root) 3 qian, Yichen (Artemisia Capillaris) 4 qian, Zhizi (Gardenia Fruit) and Mangxiao (Mirabilite) each 2 qian. Decoct, add 2 cups of wine, take orally. Profuse diarrhea ensued. Next day, half Mangxiao, took again, profuse diarrhea, illness receded. Four days later, difficulty defecating persisted. Remove Mangxiao, add Taoren (Peach Kernel) 3 qian. Two doses, two more diarrheas. Recovered with bland diet.
Tou Tong (Headache)
The head is the meeting place of all Yang meridians, connecting with the Jueyin Liver Meridian at the vertex. Thus, headache is largely caused by Jueyin Wind-Fire carrying Fire from other meridians upward. A formula is drafted here. Wind-Cold and Deficiency exist but are less common. Differentiations of Six Evils and Five Thieves, Qi/Blood Deficiency/Excess, have established ancient methods. Shen Qianlü's *Zunsheng* cites details extensively; refer to it. For Bianzheng Toufeng (Fixed/Moving Headwind), follow Master Ye Tianshi's method of nourishing Yin to harmonize Hyperactive Yang, soft-moistening to extinguish Internal Wind.
Beixing (Apricot Seed) 3 qian, Lianqiao (Forsythia Fruit) 2 qian, Manjingzi (Vitex Fruit) 1 qian, Gouteng (Uncaria Ramulus) 5 qian (crushed), Baiju (Chrysanthemum Flower) appropriate amount, Xian Lianye (Fresh Lotus Leaf) 4 qian (use edges, cut, decoct).
Severe Heat: add Lingyangjiao (Antelope Horn) and Kudingcha (Kuding Tea) each 3 qian. Accompanied by Summerheat: add Liuyisan (Six-One Powder) 3 qian as guide.
If definitely not external contraction (no fever, aversion to cold, nasal congestion, heavy voice, floating pulse), remove Beixing, Lianqiao, Manjingzi. Switch to Shengdi (Rehmannia Root), Shudi (Prepared Rehmannia Root), Tiantong (Asparagus Tuber), Maidong (Ophiopogon Tuber), Yuzhu (Polygonatum Rhizome), Huma (Hemp Seed), Ejiao (Donkey-Hide Gel), Guiban (Turtle Shell), Biejia (Softshell Turtle Shell). Select 3-5 herbs to combine with the base formula. This nourishes Liver Body and assists Liver Clearing, ideal for Yin Deficiency with Floating Fire, treating Fixed/Moving Headwind. This is Ye Tianshi's "nourish Yin, harmonize hyperactive Yang, soft-moisten, extinguish internal wind." Such cases may use only static herbs, or omit Lingyang/Gouteng/Juhua, or add sparingly.
Supplementary Discussion on Bianzheng Toufeng
Bian Toufeng (Lateral Headache) mostly belongs to Shaoyang, as Shaoyang runs along the side of the body. Mistaken use of Chaihu often damages the eyes, as it ascends and disperses Shaoyang, depleting Liver Yin. Zhu Danxi stated: Left belongs to Wind/Fire, governing Blood Deficiency; Right belongs to Phlegm/Heat, governing Qi Deficiency. Following this yields variable results. For early stages, regardless of side, use Xian Honggen Dichangcao Tou (Fresh Red-root Groundsel Head) 5 qian (substitute with Baimaogen if unavailable), Danggui (Angelica Sinensis Root), Lingyangjiao (Antelope Horn) (decoct first), Mozey (Equisetum), Tianma (Gastrodia Rhizome), Jingjie (Schizonepeta Spike), Juhua (Chrysanthemum Flower) each 1 qian, Chuanxiong (Ligusticum Rhizome), Baizhi (Angelica Dahurica Root) each 4 fen, Heidou (Black Soybean) 100 grains. Decoct, take orally; often effective.
Another type, Zheng Toufeng (Central Headache), occurs every few days or months. This is Wind-Toxin residing in the Marrow Sea; drugs rarely reach the site, making chronic cases difficult. Use Juhua (Chrysanthemum Flower) and Shenchá (Dark Tea) steamed into concentrated juice, instill cold into nostrils while lying supine (or use Sheng Laifu Zhi [Radish Juice]). Or Tianguadi (Melon Stalk Tip) 5 fen, Zaojiao (Tamarisk Pod) 2 fen, Xixin (Asarum Root) 1 fen, Zhen Shexiang (Real Musk) 2 li. Honey pills, wrapped in cotton, inserted into nostrils. Change when wet. Sneezing or discharge of turbid mucus opens orifices, pain resolves.
Wind-Toxin beside the Marrow Sea also causes lateral headache. If Yin-nourishing/Harmonizing/Soft-moistening/Extinguishing-Wind fails, the three nasal methods above are selectable. Treat left pain from left, right pain from right (some advocate cross-treatment; try both). Or use Rougui (Cinnamon Bark) 1 fen, Renyan (Arsenic) 1 li, Shexiang (Musk) 2 li, Xinyi (Magnolia Bud), Xixin (Asarum Root) each 5 li, Hujiao (Pepper) 10 grains. Powder, pill with Jiu Rou (Date Flesh), size of pea. Place one pill in center of plaster, apply to Taiyang Acupoint. Effective within one day (better if due to Wind-Cold). For robust youth with excess Fire, post-recovery use Huangqin (Scutellaria Root) and Dahuang (Rhubarb Root) to purge Fire, curing eye issues.
Fu Tong (Abdominal Pain)
(Pain at umbilicus and above/below considered together.)
Above umbilicus belongs to Taiyin (Spleen); at umbilicus to Shaoyin (Kidney); below to Jueyin (Liver). Treat separately. All pain: Deficiency likes pressure, stops with food, pulse powerless; Excess rejects pressure, worsens with food, pulse forceful.
Huoxiang Geng (Agastache Stem) 3 qian, Caojueming (Cassia Seed) 4 qian, Sheng Baishao (White Peony Root) 2 qian, Chuanlianzi (Toosendan Fruit) 1.5 qian, Da Haomai (Coix Seed) 3 qian, Xi Gancao (Licorice Root) 7 fen, Jiu Qingpi (Old Tangerine Peel, vinegar-fried) 8 fen.
Add Jieyouye (Citrus Leaf) 2 qian (fresh, cut, decoct). Above umbilicus pain: add Muxiang (Aucklandia Root) 5-6 fen, Chao Guya (Sprouted Millet) 3-4 qian. At umbilicus pain: add Wuzhuyu (Evodia Fruit) 5-6 fen, Chao Shanji (Pangolin Scale) 1-2 slices (remove Huoxiang/Qingpi). Below umbilicus pain: add Haipiaoxiao (Cuttlefish Bone) 4 qian, Qigen (Rubia Root) 1 qian, or add Zhi Xiangfu (Cyperi Rhizome) 2 qian, Chao Shanzhahe (Hawthorn Pit) 3 qian (remove Huoxiang, Jueming, Haomai, Baishao, Gancao; if cold on pressure, add Wuzhuyu or Rougui). For females, Danggui (Angelica Sinensis Root), Gouqi (Goji Berry), Jili (Tribulus Fruit), Lingzhi (Lepidium Seed) are essential (see Supplementary Extraordinary Vessel Heart Pain Case). Abdominal pain often due to dietary indiscretion: Meat injury uses Shanzha (Hawthorn Fruit), Pengzhu (Curcuma Rhizome), Awèi (Ferula Resin); Rice injury uses Shenqu (Medicated Leaven), Maiya (Barley Sprout); Fermented grain injury uses Laifuzi (Radish Seed); Cold/Raw injury uses Caoguo (Tsaoko Fruit), Cangzhu (Atractylodes Lancea Rhizome), Houpo (Magnolia Bark); Retained food injury uses Zhishi (Immature Bitter Orange), Huanglian (Coptis Rhizome), Pengzhu (Curcuma Rhizome), Binglang (Areca Seed). Use the herb matching the ingested item as sovereign, assisted by others to transform Qi and stop pain. Other causes: Fullness/pain with constipation is Excess (Houpo Sanwu, Houpo Qiwi, Dahuang Fuzi Tang methods). Fullness/pain with diarrhea is Deficiency (Lizhong Tang method). Borborygmus/cutting pain with vomiting is Cold (Fuzi Jingmi Tang method). Careful observation is required.
Supplementary Case
Mai Shuji of Huangge Township, Xiangyi, suffers abdominal pain daily at You hour (Kidney Meridian time per Twelve Hour Flow). Pain ceases near Xu hour. Ill for over a year, untreatable. One doctor treated as Heat Accumulation with Houpo, Zhishi, Huanglian, Huangbai, increasing borborygmus (Cold), sometimes vomiting/diarrhea. Another doctor used homemade pills, worsening all symptoms, loud borborygmus audible from afar, pain nearly causing fainting, resolving only at end of You hour. Daily recurrence. Urgent consultation: Pulse spiritless, knotted at Guan and Left Chi. Prescribed Fuzi Jingmi Tang modified: Shufu (Prepared Aconite) 3 qian (fried), Jingmi (Glutinous Rice), Zhi Banxia (Pinellia Tuber) each 4 qian, Lishen (Lishen), Mugua (Chaenomeles Fruit), Zhi Gancao (Licorice Root), Nanzaorou (Date Flesh) each 1 qian. Pain stopped that night, but borborygmus continued until Xu hour. Next day: Original formula plus Tuchao Baizhu (Earth-fried Atractylodes) 5 qian, change Date Flesh to 3 qian, Mugua to 1.5 qian. Symptoms resolved that night. Over a year later, consulted again. First half of year well, second half relapsed monthly, less severe. Modified compound formula, half dose, self-improved. Prescribed Fuzi Jingmi Tang combined with Lizhong Tang modified, made into small pills for regular use to prevent recurrence. Dangshen (Codonopsis Root), Baizhu (Atractylodes Macrocephala Rhizome) each 4 liang, Fuzi (Aconite Lateral Root), Danggui (Angelica Sinensis Root) each 1 liang, Lishen (Lishen), Banxia (Pinellia Tuber), Ganjiang (Dried Ginger), Mugua (Chaenomeles Fruit), Gancao (Licorice Root) each 5 qian. Decoct with Dazao (Jujube Fruit) and glutinous rice into thick porridge, make small pills. Take 3 qian each morning with light salt water. Heard five courses completed successfully.
Supplementary Discussion on Huoluan Syndrome