诊脉左数微弦，寸尺关虚数。阅五年前病原，左胁映背胀痛，不能卧席，曾吐瘀血，凝
块紫
人身之
吐出水沫，合乎经旨肝病吐涎沫矣。肝木必犯胃土，纳谷最少，而肢软少力，非嗽药可以愈
病。此皆肝阳逆乘，实系肝阴不足。仲圣云∶见肝之病，先理脾胃，俾土浓不为木克。原有
生金功能，据述凡食鸡子，病必加剧，则知呆滞凝涩之药，皆与病体未合。
北沙参 生扁豆 麦冬 玉竹 桑叶 生甘草 蔗浆
病已十余日，身尚躁热，舌苔粘腻，神呆目定，脉刚而数，烦躁呓语。此暑湿久伏，与
时气
蛔厥上冒。然内经有湿位之下，燥气乘之，是以从之湿转为燥。若无湿痰之潮气上蒸，舌苔
早已燥刺矣。今先滋液以洁烈焰之燔。
鲜生地 麦冬 乌梅 蔗浆 银花露 羚羊角 蚌水
再诊 面垢舌白，渴饮，气短如喘，自利，是秽浊气入口鼻，与水谷之气互相混扰，湿气阻窒
，氤氲内蒸，三焦皆受。胸背肢节有晦黯斑纹，秽与气血胶固，心终为邪熏灼，神昏呓语，
手
石菖蒲汁 白蔻仁 犀尖 小青皮 连翘心 金银花 六一散 金汁 至宝丹
三诊 邪陷复利，伤及厥阴。症见气上撞心，饥不能食，干呕腹痛，全是肝病见端。为至阴
之藏，相火内寄，仲圣治法，不用纯刚之剂，以肝为刚藏也。令正交土旺之时，水火为仇，
五日内未为稳当，宜慎之。
人参 淡吴萸 当归 白芍 秦皮 炒乌梅
脉沉而微，沉为里寒，微为无阳，舌白似粉，泻起口渴，身体卧着，其痛甚厉。交夏阴
气在内
，凡阴邪盘踞，必以阳药通之归、地列于四物汤。护持血液，虽佐热剂，反与阴邪树帜。当
以纯刚药，直走浊阴凝结之处调摄，非片言可尽也。
川附子 黑川乌 吴茱萸 干姜 猪胆汁
再诊 阴寒盘踞少腹，非纯阳刚剂，直入坚冰之地，阴凝不解。此如亚夫之师，从天而
降也。医易肾气汤，阴多阳少，立见病加，反至不食，药不对症。仿通脉四逆汤法。
附子、干姜、猪胆汁
五旬有四，阳气日薄，阳明脉络空乏，不能束筋骨，以流利机关，肩痛肢麻，头目如蒙
动痿弱无力。此下虚上实，络热内风沸起。当入夏，阳升为甚，渗湿利痰，必不应病。议清
犀角 鲜生地 元参 连翘 桑叶 丹皮 天麻 钩藤
下体痿 ，先有遗泄，湿疡，频进渗利，阴阳更伤，虽有参、 、术养脾肺以益气，未能救
下。即如长冷阳微，饭后吐食，乃胃阳顿衰，应乎卫外失职。但下焦之病，都属精血受伤，
两投温通柔剂，以肾恶燥，久病宜通任督。通摄兼施，亦与古贤四斤健步诸法互参。至于胃
药必须另用。夫胃府主乎气，气得下行为顺，东垣有升阳益胃之条，似乎相悖。然芩、连非
苦降之气乎。凡吐后一二日，停止下焦血分，药即用扶阳理胃。二日俾中下两固，经旨谓阳
明之脉，束筋骨以流利机关，本病即有合矣。
鹿茸 归身 柏子霜 茯苓 苁蓉 巴戟 补骨脂 川石斛 牛膝 枸杞子
吐后间服大半夏汤，加干姜、姜汁。
再诊长夏湿热，经脉流行气钝，兼以下元络脉已虚，痿弱不耐步趋，常似酸楚。大便
或溏，都属肝肾为病，然益下必佐宣通脉络，乃正治之法。恐夏季后湿热还扰，预为防理。
鹿角霜 生茅术 茯苓 苁蓉 归身 熟地 桑椹子 巴戟 远志 茴香 酒蒸金 毛
诊察脉象，左手脉数且微带弦象，寸、尺、关三部脉均呈虚数之象。查阅五年前的病历，患者左胁部牵连背部胀痛，无法平卧于席，曾呕吐出瘀血及紫黑色凝块。人身之中，呕吐出水沫，符合《内经》关于肝病吐涎沫的论述。肝木之气必然侵犯胃土，导致进食极少，肢体软弱无力，这不是服用止咳药物所能治愈的疾病。这些症状皆因肝阳上逆乘袭所致，实质上是肝阴不足。张仲景曾说：“见到肝病，应当先调理脾胃”，使脾胃厚实而不被肝木克制。原本具有生金（肺）的功能，据叙述凡是食用鸡蛋，病情必定加剧，由此可知，那些呆滞凝涩的药物，都与患者的病体不相契合。
发病已十余日，身体仍然躁热，舌苔粘腻，神情呆滞，目光固定，脉象刚劲而数，烦躁不安并说胡话。这是暑湿邪气久伏体内，与时行疫气相合，导致蛔厥之气上冒。然而《内经》提到“湿位之下，燥气乘之”，因此病势从湿转化为燥。如果没有湿痰的潮气上蒸，舌苔早已变得干燥起刺了。现在先用滋阴生津的方法来清除如烈火焚烧般的燥热。
二诊：面色垢浊，舌苔白，口渴饮水，气短如同喘息，自发性腹泻，这是秽浊之气侵入口鼻，与水谷之气互相混杂干扰，湿气阻滞窒塞，氤氲之气在内蒸腾，三焦都受到波及。胸背及四肢关节出现晦暗的斑纹，秽浊与气血胶结固着，心窍终被邪气熏灼，导致神志昏迷、说胡话，手部……（原文此处似有缺漏或断句，依文意推测为手部症状或动作描述，但根据后文未提及具体手部用药，暂略过具体手部细节，重点在神昏呓语）。
石菖蒲汁、白蔻仁、犀尖、小青皮、连翘心、金银花、六一散、金汁、至宝丹。
三诊：邪气内陷又见下利，损伤了厥阴经。症状表现为气向上冲撞心胸，饥饿却无法进食，干呕腹痛，全是肝病的征象。因为肝是至阴之脏，内寄相火，张仲景的治疗法则，不使用纯刚猛烈的药剂，是因为肝被称为“刚藏”。此时正值土旺之时，水火相仇，五日内治疗未必稳妥，应当谨慎对待。
脉象沉而微弱，沉主里寒，微主阳气衰微，舌苔白如粉状，腹泻后出现口渴，身体躺卧时疼痛剧烈。进入夏季，阴气在内……（原文此处似有断句，结合下文“凡阴邪盘踞”），凡阴邪盘踞体内，必须用阳药来通达。归、地（当归、地黄）列于四物汤中，保护血液，虽然佐以热剂，反而与阴邪树立旗帜（助长邪气）。应当使用纯刚猛烈的药物，直接作用于浊阴凝结之处进行调摄，这不是一两句话能讲清楚的。
二诊：阴寒邪气盘踞在少腹部，如果不是纯阳刚猛的药剂，直接进入坚冰般寒冷的境地，阴凝之邪就无法解散。这就像周亚夫率领的军队，从天而降一样迅猛有力。医生使用了肾气汤，其中阴药多而阳药少，立刻见到病情加重，甚至导致不能进食，这是因为药不对症。仿照通脉四逆汤的方法进行治疗。
患者五十四岁，阳气日渐薄弱，阳明经脉脉络空乏，不能约束筋骨，以使关节活动流利，出现肩痛、肢体麻木、头部眼睛感觉像被蒙蔽、运动痿弱无力等症状。这是下虚上实，络脉中有热，内风沸起。到了夏天，阳气升发更为严重，若采用渗湿利痰的方法，一定不能对症。建议清……（原文此处似有缺漏，结合下文药材推测为清热熄风）。
下肢痿软……（原文此处似有缺漏，结合下文“先有遗泄”），先前有遗精滑泄病史，患有湿疡，频繁进用渗利药物，导致阴阳更加受伤，虽然有参、术、苓等养脾肺以益气，未能挽救下焦之损。这就好比寒冷导致阳气微弱，饭后呕吐食物，是胃阳突然衰退，对应卫外功能失职。但是下焦的疾病，都属于精血受伤，两次投用温通柔润的药剂，因为肾恶燥，久病适宜疏通任督二脉。通摄兼施，也与古代贤人使用的四斤健步诸法相互参考。至于胃部的药物必须另外使用。胃腑主要主管气，气以下行为顺，李东垣有升阳益胃的条规，似乎与此相悖。然而黄芩、黄连不是苦降的气机吗？凡是呕吐后的一两天，停止针对下焦血分的用药，药物就改用扶阳理胃。两天后使中焦和下焦都稳固，《内经》说阳明之脉，约束筋骨以流利机关，本病即与此相符了。
鹿茸、归身、柏子霜、茯苓、肉苁蓉、巴戟天、补骨脂、川石斛、牛膝、枸杞子。
再诊：长夏季节湿热弥漫，经脉流行之气迟钝，兼之下元络脉已经虚弱，痿弱不耐行走，常常感到酸楚。大便有时溏薄，都属于肝肾为病，然而补益下焦必须佐以宣通脉络，这才是正治之法。恐怕夏季后湿热还会扰乱，预先进行防范治理。
Pulse diagnosis reveals the left pulse as rapid and slightly wiry, while the cun, chi, and guan positions on both hands present a deficient and rapid quality. Reviewing the medical history from five years ago, the patient suffered from distending pain in the left hypochondrium radiating to the back, unable to lie flat on a mat, and had previously vomited blood clots which were purple-black. In the human body, vomiting of watery foam conforms to the classic principle that liver disease can lead to vomiting of saliva and foam. Liver wood qi inevitably invades stomach earth, resulting in minimal food intake and weak limbs with little strength; this condition cannot be cured by cough medicines. These symptoms are all caused by rebellious liver yang attacking upwards, fundamentally due to insufficiency of liver yin. Zhang Zhongjing stated: "When seeing liver disease, first regulate the spleen and stomach," so that earth becomes thick and is not overcome by wood. There was originally a function of generating metal (lung), but according to the description, whenever eggs were consumed, the illness would necessarily worsen; thus, it is known that drugs that are stagnant and astringent do not suit the patient's condition.
North Glehnia Root (Beishashen), Raw Coix Seed (Sheng Biandou), Ophiopogon Tuber (Maidong), Fuzzy Fig Fruit (Yuzhu), Mulberry Leaf (Sangye), Raw Licorice Root (Sheng Gancao), Sugarcane Juice (Zheshuang).
The illness has persisted for more than ten days, with the body still restless and hot, tongue coating sticky and greasy, spirit dull and eyes fixed, pulse rigid and rapid, accompanied by irritability and muttering delirium. This is due to summer-heat and dampness lurking for a long time, combining with seasonal epidemic qi, causing ascendant jueyin qi. However, the *Neijing* mentions that "where dampness resides, dry qi attacks," therefore the pathology transforms from dampness to dryness. If there were no tidal steam of damp-phlegm rising, the tongue coating would have already become dry and prickly. Now, we first use fluids to nourish and cleanse the blazing fire-like heat.
Fresh Rehmannia Root (Xian Shengdi), Ophiopogon Tuber (Maidong), Chinese Plum (Wumei), Sugarcane Juice (Zheshuang), Honeysuckle Flower Dew (Yinhua Lu), Antelope Horn (Lingyangjiao), Clam Water (Bengshui).
Second consultation: The face is grimy, tongue coating white, thirst with desire to drink, shortness of breath resembling asthma, spontaneous diarrhea. This indicates foul turbid qi entering the mouth and nose, mixing and disturbing the qi of water and grain. Dampness blocks and obstructs, turbid qi steams internally, affecting all three burners. Dark, obscure macules appear on the chest, back, limbs, and joints; foul pathogens and blood qi are firmly bound together. The heart orifices are ultimately scorched by evil, leading to coma and muttering delirium...
Acorus Rhizome Juice (Shichangpu Zhi), White Cardamom Seed (Baokouren), Rhino Horn (Xijian - *Note: Use synthetic substitute in practice*), Small Green Tangerine Peel (Xiao Qingpi), Forsythia Heart (Lianqiao Xin), Honeysuckle Flower (Jinyinhua), Liu Yi San (Six-to-One Powder), Gold Juice (Jinzhi), Zhibao Dan (Treasure of Life Pill).
Third consultation: Evil has sunk inward again causing diarrhea, damaging the Jueyin channel. Symptoms include qi rushing up to strike the heart, hunger without ability to eat, dry heaving, abdominal pain—all signs of liver disease. Since the liver is the organ of extreme yin, housing ministerial fire internally, Zhang Zhongjing’s treatment method avoids purely harsh and rigid agents because the liver is called the "rigid organ." At this time, when earth qi is prosperous, water and fire are enemies; stability within five days is not guaranteed, caution is advised.
Ginseng Root (Renshen), Mild Evodia Fruit (Dan Wuyu), Angelica Sinensis Root (Danggui), White Peony Root (Baishao), Bark of Qin Pi (Qinpi), Stir-fried Chinese Plum (Chao Wumei).
Pulse is deep and faint; deep indicates interior cold, faint indicates absence of yang. Tongue coating is white like powder, diarrhea followed by thirst, severe pain when lying down. Entering summer, yin qi is inside... Whenever yin pathogens occupy, they must be unblocked by yang drugs. Danggui and Dihuang listed in Siwu Tang protect blood; although assisted by hot agents, they inadvertently support the yin pathogens. One should use purely rigid and strong drugs to directly target where turbid yin condenses for regulation; this cannot be fully explained in a few words.
Sichuan Aconite Carpal Root (Chuan Fuzi), Black Sichuan Aconite Lateral Root (Hei Chuanwu), Evodia Fruit (Wuzhuyu), Dried Ginger (Ganjiang), Pig Bile (Zhu Danzhi).
Second consultation: Yin-cold pathogens occupy the lower abdomen; unless purely yang and rigid agents enter the land of solid ice, the yin coagulation will not resolve. This is like General Zhou Yafu’s army descending from heaven. The physician used Shenqi Tang, which has more yin and less yang, immediately worsening the condition and even preventing eating, indicating the medicine did not match the syndrome. Imitate the method of Tongmai Sini Decoction.
Aconite Root (Fuzi), Dried Ginger (Ganjiang), Pig Bile (Zhu Danzhi).
At fifty-four years old, yang qi is daily declining. The Yangming meridians and collaterals are empty and deficient, unable to bind sinews and bones to facilitate joint movement, resulting in shoulder pain, limb numbness, sensation of head and eyes being covered, and flaccid weakness. This is deficiency below and excess above, with heat in collaterals and internal wind boiling up. As summer arrives, yang rises severely; using damp-draining and phlegm-resolving methods will certainly not address the disease. Recommendation: Clear...
Rhino Horn (Xi Jiao - *Note: Use synthetic substitute*), Fresh Rehmannia Root (Xian Shengdi), Scrophularia Root (Yuanshen), Forsythia Fruit (Lianqiao), Mulberry Leaf (Sangye), Moutan Cortex (Danpi), Gastrodia Tuber (Tianma), Uncaria Ramulus cum Uncis (Gouteng).
Lower body flaccidity... preceded by seminal emission, wet eczema, frequent use of draining/diuretic drugs, further injuring yin and yang. Although Renshen, Baizhu, and Fuling nourish spleen and lung to boost qi, they failed to save the lower jiao. It is like cold causing yang to weaken, vomiting food after meals, indicating sudden decline of stomach yang and failure of defensive exterior functions. However, diseases of the lower jiao all belong to injury of essence and blood. Two administrations of warming, unblocking, and softening agents: since the kidney dislikes dryness, chronic illness requires unblocking the Ren and Du vessels. Combining unblocking and securing also refers to ancient sages' methods like Si Jin Jian Bu. As for stomach medicine, it must be used separately. The stomach fu governs qi; qi moving downward is smooth. Li Dongyuan has principles of raising yang and benefiting the stomach, which seems contradictory. However, are Huangqin and Huanglian not bitter-descending qi? For one or two days after vomiting, stop treating the lower jiao blood level; instead, use drugs to support yang and regulate the stomach. After two days, secure both middle and lower jiao. The *Neijing* states the Yangming meridian binds sinews and bones to facilitate joint movement; this disease aligns with this principle.
Deer Antler Glue (Lurong), Angelica Sinensis Root Head (Guishen), Biota Seed (Baizi Shuang), Poria (Fuling), Cistanche Stem (Rongcong), Morinda Officinalis Root (Baji), Psoralea Fruit (Buguzhi), Dendrobium Stem (Chuan Shihu), Achyranthes Root (Niuxi), Goji Berry (Gouqizi).
After vomiting, intermittently take Banxia Houpo Tang (actually Banxia Tang per title) with added Dried Ginger (Ganjiang) and Ginger Juice (Jiangzhi).
Second consultation: Long summer damp-heat causes sluggish circulation of meridians and qi. Additionally, the lower origin and collaterals are already deficient, leading to flaccidity intolerant of walking, often feeling sore and painful. Stool is sometimes loose, all belonging to liver and kidney pathology. However, tonifying the lower must be assisted by promoting circulation of collaterals, which is the correct treatment method. Fearing that damp-heat may disturb again after summer, preventive management is undertaken.
Deer Antler Frost (Lujiaoshuang), Raw Atractylodes Macrocephala Rhizome (Sheng Maoyu), Poria (Fuling), Cistanche Stem (Rongcong), Angelica Sinensis Root Head (Guishen), Prepared Rehmannia Root (Shudi), Mulberry Fruit (Sangshenzi), Morinda Officinalis Root (Baji), Polygala Root (Yuanzhi), Fennel Seed (Huixiang), Wine-steamed Golden Dogtail Fern Rhizome (Jiu Zheng Jinmaojigu).