龚童 腹痛有年，陡然而来，截然而止，面黄肌瘦，舌光无苔，脉象虚弦。此脾虚生湿，湿郁生虫，虫日积
而脾愈伤，脾愈伤而虫愈横也。当崇土化湿，酸苦杀虫，以虫得酸则伏，得苦则安之故。
生白术（一钱五分） 云茯苓（三钱） 大白芍（二钱） 乌梅肉（五分） 金铃子（二钱） 陈广皮（一钱）
使君肉（三钱） 陈鹤虱（二钱） 白雷丸（一钱五分） 开口花椒（十粒）
原按∶虫痛一症，孩童最多，其别即在面黄与阵作之间，此方屡试屡效。惟随症之新久，病之虚实，而加
减施用。使初起者，可去白术、白芍，加芜荑（一钱五分），延胡索（一钱），重在杀虫，以其脾胃尚未伤也。
尹左 诊脉左三部弦数，右三部滑数，太溪细弱，趺阳濡数。见症饮食不充肌肤，神疲乏力，虚里穴动。
自汗盗汗，头眩眼花。皆由阴液亏耗，不能涵木，肝阳上僭，心神不得安宁，虚阳逼津液而外泄则多汗，消灼
胃阴则消谷。头面烘热，汗后畏冷，营虚失于内守，卫虚失于外护故也。脉数不减，颇虑延成消症。姑拟养
肺阴以柔肝木，清胃阴而宁心神，俾得阴平阳秘，水升火降，方能渐入佳境。
大生地（四钱） 抱茯神（三钱） 潼蒺藜（三钱） 川贝母（二钱） 浮小麦（四钱） 生白芍（一钱五分）
左牡蛎（四钱） 熟女贞（三钱） 天花粉（三钱） 肥玉竹（三钱） 花龙骨（三钱） 冬虫夏草（二钱）
五味子（三分）
二诊 心为君主之官，肝为将军之官，曲运劳乎
心，谋虑劳乎肝，心肝之阴既伤，心肝之阳上亢，消灼胃阴，胃热炽盛，饮食入胃，不生津液，既不能灌溉于五
脏，又不能输运于筋骨，是以饮食如常，足膝软弱。汗为心之液，心阳逼津液而外泄则多汗；阴不敛阳，阳升于
上则头部眩晕，面部烘热，且又心悸。胃之大络名虚里，虚里穴动，胃虚故也。脉象左三部弦数，右三部滑数，
太溪细弱，趺阳濡数，唇红舌光，微有苔意，一派阴液亏耗，虚火上炎之象，此所谓独阳不生，独阴不长也。
必须地气上升，天气始得下降。今拟滋养肺阴，以柔肝木，蒸腾肾气，而安心神。务使阴阳协和，庶成既济之象。
北沙参（三钱） 抱茯神（三钱） 五味子（三分） 肥玉竹（三钱） 天麦冬（各二钱） 左牡蛎（四钱）
生白芍（二钱） 川贝母（二钱） 大生地（四钱） 花龙骨（三钱） 潼蒺藜（三钱） 制黄精（三钱）
浮小麦（四钱） 金匮肾气丸（包，四钱）
三诊 饮食入胃，不生津液，始不为肌肤，继不为筋骨，书谓食亦见症，已着前章矣。阴液亏耗，肝阳上
僭，水不制火，火不归宅。两进养肺阴以柔肝木，益肾阴而安心神之剂，尚觉合度。诊脉弦数较和，细数根据
然，仍守原意出入，俾得阴阳和协，水火既济，则入胃之饮食，自能生化精微，灌溉于五脏，洒陈于六腑。第是
恙延已久，断非能克日奏功也。
照前方去金匮肾气丸、五味子、制黄精，加淮山药（三钱）、盐水炒杜仲（三钱）、上桂心（四分）。
何左 多饮为上消，多食为中消，多溲为下消。经云∶二阳结谓之消。金匮云∶厥阴之为病为消。皆由阴分
不足，厥阴之火消灼胃阴，津少上承。拟育阴生津法。
大麦冬（三钱） 川石斛（三钱） 栝蒌皮（二钱） 北秫米（包，三钱） 大生地（四钱） 天花粉（三钱）
淮山药（三钱） 川贝母（二钱） 金匮肾气丸（包，三钱） 南北沙参（各三钱） 生甘草（六分）
邱左 上消多渴，下消多溲，上消属肺，下消属肾。肺肾阴伤，胃火内炽，治火无益。宜壮水之主，以制阳光。
大生地（四钱） 生甘草（八分） 川贝母（二钱） 粉丹皮（一钱五分） 川石斛（三钱） 天花粉（三钱）
肥知母（一钱五分） 生白芍（二钱） 大麦冬（三钱） 炙乌梅（四分） 活芦根（去节，一尺） 青皮甘蔗
（劈开入煎，三两）
龚姓患儿，腹痛多年，突然发作，突然停止，面色萎黄，肌肉消瘦，舌面光滑无苔，脉象虚而带弦。这是脾虚生湿，湿气郁结滋生虫体，虫体日益积聚从而更加损伤脾胃，脾胃越受损则虫体越发猖獗。治疗应当培补脾土、化除湿气，并用酸味和苦味的药物杀虫，因为虫体遇到酸味就会伏藏，遇到苦味就会安宁。
生白术（一钱五分） 云茯苓（三钱） 大白芍（二钱） 乌梅肉（五分） 金铃子（二钱） 陈广皮（一钱）
使君子肉（三钱） 陈鹤虱（二钱） 白雷丸（一钱五分） 开口花椒（十粒）
原案按语：虫痛这一病症，在孩童中最常见，其鉴别要点在于面色萎黄与疼痛阵发性发作之间。此方屡试屡效。只是要根据病情的新久、虚实进行加减施用。如果是初起阶段，可以去掉白术、白芍，加入芜荑（一钱五分）、延胡索（一钱），重在杀虫，因为其脾胃尚未受到严重损伤。
尹姓患者，诊察左三部脉弦数，右三部脉滑数，太溪穴处脉细弱，趺阳穴处脉濡数。临床表现饮食不能滋养肌肤，精神疲倦乏力，虚里穴跳动明显。自汗、盗汗，头晕眼花。这都是由于阴液亏耗，不能涵养肝木，导致肝阳上僭，心神不得安宁，虚阳逼迫津液外泄所以多汗，消灼胃阴所以消谷善饥。头面部烘热，出汗后怕冷，这是因为营血虚弱失去内守，卫气虚弱失去外护的缘故。脉数不减，很担心发展成消渴症。暂拟滋养肺阴以柔润肝木，清养胃阴以宁心安神，使得阴平阳秘，水升火降，才能逐渐好转。
大生地（四钱） 抱茯神（三钱） 潼蒺藜（三钱） 川贝母（二钱） 浮小麦（四钱） 生白芍（一钱五分）
左牡蛎（四钱） 熟女贞（三钱） 天花粉（三钱） 肥玉竹（三钱） 花龙骨（三钱） 冬虫夏草（二钱）
五味子（三分）
二诊：心为君主之官，肝为将军之官，思虑劳损于心，谋虑劳损于肝，心肝之阴既已受伤，心肝之阳上亢，消灼胃阴，胃热炽盛，饮食进入胃中，不能生津液，既不能灌溉五脏，又不能输运筋骨，所以饮食如常，但足膝软弱无力。汗为心之液，心阳逼迫津液外泄所以多汗；阴不敛阳，阳气升于上所以头部眩晕，面部烘热，并且伴有心悸。胃的大络名为虚里，虚里穴跳动，是因为胃虚的缘故。脉象左三部弦数，右三部滑数，太溪细弱，趺阳濡数，唇红舌光，微有苔意，一派阴液亏耗、虚火上炎之象，这就是所谓的“独阳不生，独阴不长”。必须地气上升，天气才能下降。现在拟滋养肺阴，以柔润肝木，蒸腾肾气，以安心神。务必使阴阳协和，形成水火既济的局面。
北沙参（三钱） 抱茯神（三钱） 五味子（三分） 肥玉竹（三钱） 天麦冬（各二钱） 左牡蛎（四钱）
生白芍（二钱） 川贝母（二钱） 大生地（四钱） 花龙骨（三钱） 潼蒺藜（三钱） 制黄精（三钱）
浮小麦（四钱） 金匮肾气丸（包煎，四钱）
三诊：饮食进入胃中，不能生津液，开始不能滋养肌肤，后来不能滋养筋骨，医书称为“食亦”症状，已经见于前文章节了。阴液亏耗，肝阳上僭，水不制火，火不归宅。两次进服滋养肺阴以柔润肝木、益肾阴以安心神的方剂，尚觉合适。诊脉弦数较之前缓和，细数依然存在，仍守原意稍作出入，使得阴阳和谐，水火既济，那么进入胃中的饮食，自然能生化精微，灌溉五脏，布散六腑。但这病拖延已久，绝非能短期内见效的。
照前方去掉金匮肾气丸、五味子、制黄精，加入淮山药（三钱）、盐水炒杜仲（三钱）、上桂心（四分）。
何姓患者：多饮为上消，多食为中消，多尿为下消。《内经》说：二阳结谓之消。《金匮要略》说：厥阴之为病为消。都是由阴分不足，厥阴之火消灼胃阴，津液少不能上承所致。拟用育阴生津法。
大麦冬（三钱） 川石斛（三钱） 栝蒌皮（二钱） 北秫米（包煎，三钱） 大生地（四钱） 天花粉（三钱）
淮山药（三钱） 川贝母（二钱） 金匮肾气丸（包煎，三钱） 南北沙参（各三钱） 生甘草（六分）
邱姓患者：上消多渴，下消多尿，上消属肺，下消属肾。肺肾阴伤，胃火内炽，治火无效。宜壮水之主，以制阳光。
大生地（四钱） 生甘草（八分） 川贝母（二钱） 粉丹皮（一钱五分） 川石斛（三钱） 天花粉（三钱）
肥知母（一钱五分） 生白芍（二钱） 大麦冬（三钱） 炙乌梅（四分） 活芦根（去节，一尺） 青皮甘蔗（劈开入煎，三两）
Gong, a child patient: Abdominal pain has persisted for years, appearing suddenly and ceasing abruptly. The complexion is sallow, muscles are emaciated, the tongue surface is smooth without coating, and the pulse is deficient and wiry. This indicates Spleen deficiency generating dampness; dampness stagnation breeds parasites. As parasites accumulate day by day, the Spleen is further injured; as the Spleen is further injured, the parasites become more rampant. Treatment should focus on fortifying Earth (Spleen) and transforming dampness, using sour and bitter substances to kill parasites, because parasites subside when encountering sour flavors and settle when encountering bitter flavors.
Raw Atractylodis Macrocephalae Rhizoma (1.5 qian) Cloud Poria (3 qian) Large White Peony Root (2 qian) Dark Plum Flesh (0.5 qian) Belladonna Fruit (2 qian) Aged Tangerine Peel (1 qian)
Quince Seed Kernel (3 qian) Old Chrysanthemum Parasol Flower (2 qian) White Omphalia (1.5 qian) Opened Sichuan Pepper (10 grains)
Original annotation: Parasitic colic is most common in children. Its differentiation lies in the sallow complexion and paroxysmal nature of pain. This formula has proven effective repeatedly. However, modifications must be made according to the duration of the disease and its excess or deficiency patterns. In early stages, Raw Atractylodis Macrocephalae Rhizoma and White Peony Root can be removed, adding Melia Toosendan Seed (1.5 qian) and Corydalis Rhizoma (1 qian), focusing on killing parasites, as the Spleen and Stomach have not yet been severely damaged.
Yin, left side: Palpation reveals wiry and rapid pulses in the three positions on the left, and slippery and rapid pulses in the three positions on the right. The Taixi (KI3) pulse is fine and weak, while the Duyang (ST41) pulse is soggy and rapid. Symptoms include poor nourishment of the flesh from diet, mental fatigue, weakness, and hyperactivity at the Xuli point (CV15). Spontaneous sweating and night sweats occur, accompanied by dizziness and blurred vision. All these result from Yin fluid depletion failing to nourish Liver Wood, leading to Liver Yang usurping upward, causing the Heart Spirit to lose tranquility. Deficient Yang forces fluids outward, causing excessive sweating; consumption of Stomach Yin leads to polyphagia. Heat flushing in the head and face, followed by aversion to cold after sweating, occurs because Ying (Nutritive) deficiency fails to maintain interior stability, and Wei (Defensive) deficiency fails to protect the exterior. With the rapid pulse persisting, there is concern it may develop into Xiao Ke (Wasting-Thirst). Tentatively prescribe nourishing Lung Yin to soften Liver Wood, clearing Stomach Yin to calm the Heart Spirit, so that Yin and Yang remain balanced, Water ascends and Fire descends, allowing gradual improvement.
Large Rehmanniae Radix Preparata (4 qian) Fufu with Heartwood (3 qian) Tongsili (Tribulus Terrestris) (3 qian) Fritillariae Cirrhosae Bulb (2 qian) Floating Wheat (4 qian) Raw White Peony Root (1.5 qian)
Left Oyster Shell (4 qian) Prepared Ligustrum Lucidum Fruit (3 qian) Trichosanthis Radix (3 qian) Platyphyllus Stemona (3 qian) Flower Dragon Bone (3 qian) Cordyceps (2 qian)
Schisandrae Fructus (0.3 qian)
Second visit: The Heart is the Monarch Official; the Liver is the General Official. Mental labor exhausts the Heart; deliberation exhausts the Liver. Since Heart and Liver Yin are injured, Heart and Liver Yang ascend hyperactively, consuming Stomach Yin. Stomach heat becomes blazing. Food entering the Stomach fails to generate Jin-Ye (Body Fluids); thus, it cannot irrigate the Five Zang organs nor transport to sinews and bones. Hence, appetite remains normal, but knees and feet are weak. Sweat is the fluid of the Heart; Heart Yang forcing fluids outward causes excessive sweating. Yin failing to contain Yang allows Yang to rise upward, causing head dizziness, facial heat flushing, and palpitations. The great collateral of the Stomach is named Xuli; hyperactivity at the Xuli point indicates Stomach deficiency. Pulse presentation: wiry and rapid on the left, slippery and rapid on the right, fine and weak at Taixi, soggy and rapid at Duyang. Lips are red, tongue is smooth with slight signs of coating—a picture of Yin fluid depletion and defunct fire flaming upward. This is what is meant by "Solitary Yang does not grow, solitary Yin does not thrive." Earth Qi must ascend for Heaven Qi to descend. Now prescribing nourishing Lung Yin to soften Liver Wood, steaming Kidney Qi to calm the Heart Spirit. Ensure Yin and Yang harmonize, achieving the state of Ji Ji (Water and Fire interacting).
Northern Glehniae Radix (3 qian) Fufu with Heartwood (3 qian) Schisandrae Fructus (0.3 qian) Platyphyllus Stemona (3 qian) Tian Dong (Ophiopogonis Radix) and Mai Dong (Liriope Radix) (2 qian each) Left Oyster Shell (4 qian)
Raw White Peony Root (2 qian) Fritillariae Cirrhosae Bulb (2 qian) Large Rehmanniae Radix Preparata (4 qian) Flower Dragon Bone (3 qian) Tongsili (Tribulus Terrestris) (3 qian) Processed Polygonati Rhizoma (3 qian)
Floating Wheat (4 qian) Jingui Shenqi Pill (wrapped, 4 qian)
Third visit: Food entering the Stomach fails to generate fluids, initially failing to nourish flesh, subsequently failing to nourish sinews and bones. Medical texts refer to this symptom as "Shi Yi" (Eating Without Gaining Weight), already discussed in previous chapters. Yin fluid depletion, Liver Yang usurping upward, Water failing to control Fire, Fire failing to return to its residence. Two courses of treatment nourishing Lung Yin to soften Liver Wood and benefiting Kidney Yin to calm the Heart Spirit were deemed appropriate. The wiry and rapid pulse has moderated, but the fine and rapid pulse persists. Adhering to the original intent with minor adjustments to achieve Yin-Yang harmony and Water-Fire interaction, food entering the Stomach will naturally transform into essence, irrigating the Five Zang and distributing through the Six Fu organs. However, this illness has dragged on for a long time and cannot be cured overnight.
Following the previous formula, remove Jingui Shenqi Pill, Schisandrae Fructus, and Processed Polygonati Rhizoma. Add Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma) (3 qian), Salt-fried Eucommiae Cortex (3 qian), and Shang Gui Xin (Cinnamomi Cortex) (0.4 qian).
He, left side: Excessive drinking characterizes Upper Xiao; excessive eating characterizes Middle Xiao; excessive urination characterizes Lower Xiao. The Classics state: "Binding of the Two Yangs constitutes Xiao." The Golden Cabinet states: "The Jueyin disease manifests as Xiao." All result from insufficiency of the Yin aspect, where Jueyin Fire consumes Stomach Yin, and insufficient fluids fail to ascend. Prescribe method to nurture Yin and generate fluids.
Large Ophiopogonis Radix (3 qian) Chuan Shi Hu (Dendrobii Nobile Caulis) (3 qian) Trichosanthis Pericarpium (2 qian) Northern Sorghum (wrapped, 3 qian) Large Rehmanniae Radix Preparata (4 qian) Trichosanthis Radix (3 qian)
Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma) (3 qian) Fritillariae Cirrhosae Bulb (2 qian) Jingui Shenqi Pill (wrapped, 3 qian) Northern and Southern Glehniae Radix (3 qian each) Raw Licorice Root (0.6 qian)
Qiu, left side: Upper Xiao involves excessive thirst; Lower Xiao involves excessive urination. Upper Xiao belongs to the Lung; Lower Xiao belongs to the Kidney. Lung and Kidney Yin are injured, while Stomach Fire blazes internally. Treating Fire directly is ineffective. One should strengthen the Master of Water to control the Sunlight (Hyperactive Yang).
Large Rehmanniae Radix Preparata (4 qian) Raw Licorice Root (0.8 qian) Fritillariae Cirrhosae Bulb (2 qian) Moutan Cortex (1.5 qian) Chuan Shi Hu (Dendrobii Nobile Caulis) (3 qian) Trichosanthis Radix (3 qian)
Fei Zhi Mu (Anemarrhenae Rhizoma) (1.5 qian) Raw White Peony Root (2 qian) Large Ophiopogonis Radix (3 qian) Roasted Dark Plum (0.4 qian) Fresh Reed Rhizome (nodes removed, 1 chi) Green Sugarcane (split for decoction, 3 liang)