气郁单胀，中空无物，卧则气塞，浊饮上冲，渐有不得安卧之象。问其起病之由，多是
恼怒
，上咳气逆欲喘，脘中蕴热，咳出脓血。病根固在肝脾，今已传及肺部。丹溪曰∶养金制木
。脾无贼邪之害，滋水制火，肺得清化之权，目下至要务在顺气。胸中开爽，寝食不废，便
可从容论治。不然春分节近，更属难调矣。先用宣通上焦法。
紫菀 杏仁 蒌皮 郁金 浓朴 大腹皮 桑皮 茯苓皮 黑山栀
两剂后，早服肾气丸，晚服四君子汤。
阴气先伤，阳气独发，但热无寒，是为瘅疟。舌干渴饮，咳嗽，暑邪尚在肺胃。如饥不
嗜食，乃热邪不杀谷也。先用玉女煎，存阴消暑和肺胃。
玉女煎
再诊
原方去牛膝，加竹卷心。
任脉、督脉，分行乎身之前后，自觉热蒸，不梦自遗，皆奇经虚也。辛湿药颇效。六味
加五味子不应，方药仅仅达下，未能约束奇经，议用聚精固摄之法。
桑螵蛸 龟板 芡实 沙蒺藜 线鱼胶 胡连 龙骨 金樱子 覆盆子
产后阴虚阳实，热易拂郁，近日客邪，乃冬应寒而反温，凡羌活辛温，柴胡扰动肝血，
皆属禁忌。谓阳明未复，再动冲阳耳。恶露变成腥水，亦是热犯肝阴之极，液不养筋，内风必动
，致面肿身痛，消渴呕逆，自利暮热汗多，全是肝胃受病。诸厥皆隶厥阴，呕不能食，厥阴
之
治以镇逆，佐以酸苦，泄热调经。
牡蛎 乌梅 黄芩 茯芩皮 川连 郁金 秦皮 炒山楂
经以肾司二便，若肾无藏液，下窍气不运化，肠中即不能通水液之燥。水火吸消为多，
议知
桂化肝风以制木，是为稳当方法。
黄柏 知母 龟甲 肉苁蓉 人中白 肉桂
蜜丸
望色痿黄少膏泽，按脉弦促而芤，纳谷不旺，病已数年，每春夏阳升气泄，偶加烦冗，
情志不适，血必溢出上窍，中气非少壮阴火相同。夫心主血，脾统血，肝藏血。藏阴内虚，阳动
乃溢，常服归脾汤，去 、术、木香，加白芍，以和肝脾之阴，所谓王道养正善药，不计骤
人参 茯神 炙草 归身 白芍 枣仁 远志 桂圆肉
背痛得按摩愈痛，吐涎沫，短气腹满，小腹坚，小便不通，大便自利，下体麻木，不
得移动，不食不寐，烦则汗出，病机多端。无缕治成法。思冷浊窃踞。阳微不行，为痞塞之象。
二气既乖，岂可忽略。引仲景少阴例，急进通阳为要。议用白通加人尿猪胆汁汤。
去须葱白 生淡干姜 生炮附子
上药用水一盏，煎至四分，滤清，加人尿一小杯，猪胆汁一枚，频频调和，勿令其沉于药底。
再诊 浊阴蔽塞，舍通阳再无别法。服白通加人尿猪胆汁汤，脉不微续，仍三五参差。
尚非稳保，议用四逆通脉方。
人参 淡干姜 人尿 炮附子 猪胆汁
三诊 症象稍减，但少腹浊阴尚踞，胃气不苏，犹虑反复。
人参 生淡干姜 炮附子 茯苓 泽泻
四诊 误用攻表伤阳，致阴邪浊气结闭于下，少腹坚痛，二便阻涩，浊上干，逆则呕。
非温热佐以咸苦寒，何以直达下焦。
炮附子 淡干姜 人尿 猪胆汁 葱白头
凡疟久邪结，必成疟母，其邪深客于阴络，道路深远，肌肤无汗，能食不运，便溺通调
。病不在腑，从腹下升逆，贯及两胁腰中，推及八脉中，病理固有之。然立方无据捉摸，忆读仲
景转旋下焦痹阻，例以通阳。
气机郁滞导致的单纯腹部胀满，腹部中空无实物积聚，平卧时感觉气机阻塞，浊阴之饮邪上冲，逐渐出现无法安卧的症状。询问其发病原因，多是由于恼怒所致，伴有向上咳嗽、气逆欲喘，胃脘部蕴积热邪，咳出脓血。疾病的根本在于肝脾，如今已传变至肺部。朱丹溪说：“滋养肺金以制约肝木。”使脾脏不受肝木贼邪的侵害，滋补肾水以制约心火，肺脏得以行使清肃化降的职权，眼下最紧要的任务在于顺调气机。胸中气机开朗，睡眠和饮食不废，便可以从容地讨论治疗方案。否则临近春分节气，病情将更加难以调理。先用宣通上焦的方法。
紫菀、杏仁、瓜蒌皮、郁金、厚朴、大腹皮、桑白皮、茯苓皮、黑山栀。
阴气先受损，阳气独自亢盛发作，只发热没有恶寒，这称为瘅疟（一种但热不寒的疟疾）。舌干口渴想喝水，咳嗽，暑邪仍在肺胃。如果像饥饿一样却不爱吃东西，这是热邪不能腐熟水谷的表现。先用玉女煎，以保存阴液、清除暑热、调和肺胃。
玉女煎。
任脉和督脉，分别行于身体的前面和后面，自觉热气蒸腾，没有做梦却发生遗精，这都是奇经八脉虚损的表现。辛温燥湿的药物颇为有效。六味地黄丸加五味子无效，方药仅仅到达下焦，未能约束奇经八脉，建议采用聚精固摄的方法。
桑螵蛸、龟板、芡实、沙苑子、线鱼胶、胡黄连、龙骨、金樱子、覆盆子。
产后阴虚而阳相对偏实，热邪容易拂郁不畅，近日感受外邪，是因为冬天应当寒冷却反而温暖。凡是羌活这种辛温药物，以及柴胡扰动肝血的药物，都属于禁忌。说是阳明经之气未恢复，再次触动冲脉和阳维脉罢了。恶露变成腥臭的水样物，这也是热邪侵犯肝阴到了极点，津液不能濡养筋脉，内风必然动扰，导致面部浮肿、身体疼痛，消渴、呕吐逆气，自发性腹泻，傍晚发热出汗多，全是肝胃受病。各种厥证都归属于厥阴经，呕吐不能进食，治疗厥阴经的病以镇逆为主，佐用酸苦药物，泄热调经。
《内经》说肾脏主管二便，如果肾脏没有藏蓄津液，下窍的气机不能运化，肠道就不能通畅水液的燥结。水火相互吸消的情况较多，建议用知母、肉桂来化解肝风以制约肝木，这是稳妥的方法。
制成蜜丸。
观察面色萎黄且缺乏光泽，按脉弦促且芤，进食量不旺盛，患病已有数年，每逢春夏阳气升发、气机外泄之时，偶尔加上烦劳冗杂，情志不适，血液必定从上窍溢出，中气的虚弱与少壮时期的阴火不同。心主血，脾统血，肝藏血。肝脏藏阴内部空虚，阳气妄动则血液溢出，常服归脾汤，去掉人参、白术、木香，加入白芍，以调和肝脾之阴，这就是所谓王道补益正气的好药，不计较是否立即见效。
背痛得按摩后反而更痛，吐涎沫，短气腹胀，小腹坚硬，小便不通，大便自利，下半身麻木，不能移动，不吃不睡，烦躁则出汗，病机表现多样。没有固定的治疗方法。考虑是冷浊之邪窃踞体内。阳气微弱不能运行，表现为痞塞的现象。阴阳二气既然乖违，怎么可以忽略。引用张仲景少阴病的例子，急进通阳为关键。建议用白通加人尿猪胆汁汤。
以上药物用水一盏，煎至四分，滤去渣滓，加入人尿一小杯，猪胆汁一枚，频频调和，不要让它们沉在药底。
再诊：浊阴蔽塞，除了通阳没有其他办法。服用白通加人尿猪胆汁汤后，脉搏没有微续，仍然参差不齐。尚非稳妥保全，建议使用四逆通脉方。
三诊：症状稍减，但少腹浊阴仍然占据，胃气未苏醒，还担心反复。
四诊：误用攻表药物损伤阳气，导致阴邪浊气结闭于下，少腹坚硬疼痛，大小便阻涩，浊气上干，气逆则呕吐。不用温热药佐以咸苦寒药，怎么能直达下焦。
凡是疟疾日久邪气结聚，必成疟母，邪气深深客居于阴络，道路深远，肌肤无汗，能食但不能运化，大小便通调。病不在腑，从腹下升逆，贯穿两胁腰中，推及八脉之中，病理上是固有的。然而立方没有依据捉摸，回忆读张仲景转旋下焦痹阻的例子，以通阳为法。
Qi stagnation causing simple abdominal distension, with the abdomen hollow and devoid of solid accumulation, feels obstructed when lying down. Turbid fluid rises upward, gradually leading to an inability to sleep comfortably. Inquiry into the cause of onset reveals it is mostly due to anger, accompanied by upward coughing, rebellious Qi resembling asthma, heat accumulating in the epigastrium, and coughing up pus and blood. The root of the disease lies in the Liver and Spleen, but it has now transmitted to the Lung. Zhu Danxi said: "Nourish Metal (Lung) to control Wood (Liver)." This prevents the Spleen from being harmed by the hostile Wood. Nourish Water (Kidney) to control Fire (Heart), allowing the Lung to regain its authority for clear transformation. Currently, the most urgent task is to smooth the Qi. Once the chest feels open and sleep and eating are not abandoned, treatment can be discussed calmly. Otherwise, as the Spring Equinox approaches, regulation will be even more difficult. First, use a method to diffuse and unblock the Upper Jiao.
*Azalea Root (Zi Wan), Apricot Seed (Xing Ren), Trichosanthes Peel (Lou Pi), Curcuma Aromatic Tuber (Yu Jin), Magnolia Bark (Hou Po), Areca Peel (Da Fu Pi), Mulberry Bark (Sang Pi), Poria Peel (Fu Ling Pi), Gardenia (Hei Shan Zhi).*
After two doses, take *Shenqi Wan* (Kidney Qi Pill) in the morning and *Sijunzi Tang* (Four Gentlemen Decoction) in the evening.
Yin Qi is injured first, while Yang Qi alone flares up. There is only heat without chills; this is called Dan Malaria (Malaria characterized by heat without chills). The tongue is dry with thirst for drinking, there is coughing, and Summer-heat pathogen remains in the Lung and Stomach. If one feels hungry but lacks appetite, it is because Heat pathogen fails to digest food. First, use *Yunü Jian* (Jade Woman Decoction) to preserve Yin, dispel summer-heat, and harmonize the Lung and Stomach.
*Yunü Jian*.
Second consultation: Remove Achyranthes Root (Niuxi) from the original formula, add Bamboo Heart (Zhu Juan Xin).
The Ren Mai (Conception Vessel) and Du Mai (Governing Vessel) run along the front and back of the body respectively. Self-sensation of steaming heat and spontaneous seminal emission without dreams both indicate deficiency of the Extraordinary Vessels. Acrid-warm damp-resolving herbs have been quite effective. *Liujunzi Wan* (Six-Ingredient Pill with Gastrodia) plus Schisandra Berry (Wuweizi) was ineffective; the prescription only reached the Lower Jiao and failed to constrain the Extraordinary Vessels. It is proposed to use a method to gather essence and secure containment.
*Mantis Egg Case (Sangpiaoxiao), Turtle Shell (Guiban), Euryale Seed (Qianshi), Tribulus Fruit (Shajili), Fish Maw (Xianyu Jiao), Picrorhiza Rhizome (Hulian), Dragon Bone (Longgu), Rosa Laevigata Fruit (Jinyingzi), Raspberry (Fupenzi).*
Postpartum Yin deficiency with relative Yang excess makes Heat prone to frustration and stagnation. Recently, external pathogens were contracted because winter should have been cold but was instead warm. All acrid-warm herbs like Notopterygium Rhizome (Qianghuo) and herbs that disturb Liver Blood like Bupleurum Root (Chaihu) are contraindicated. It is said that the Yangming channel has not recovered, and the Chong and Yangwei vessels are agitated again. Lochia turning into foul-smelling water indicates that Heat has invaded Liver Yin to an extreme degree. Fluids fail to nourish sinews, leading to internal Wind stirring, resulting in facial swelling, body pain, excessive thirst and urination (Xiao Ke), vomiting and reflux, spontaneous diarrhea, evening fever, and profuse sweating. All these symptoms belong to pathology of the Liver and Stomach. All types of Jue (rebellious Qi/cold extremities) fall under the Jueyin channel. For vomiting and inability to eat, treating Jueyin involves suppressing rebellion, assisted by sour and bitter herbs to drain Heat and regulate menstruation.
*Oyster Shell (Muli), Plum Fruit (Wumei), Scutellaria Root (Huangqin), Poria Peel (Fuling Pi), Coptis Rhizome (Chuanlian), Curcuma Aromatic Tuber (Yu Jin), Bark of Chinese Privet Tree (Qinpi), Stir-fried Hawthorn Fruit (Chao Shanzha).*
The Classics state that the Kidney controls the two orifices (urinary and anal). If the Kidney lacks stored fluids, the Qi at the lower orifices cannot transform, and the intestines cannot pass the dryness of fluids. Water and Fire mutually absorb and consume each other frequently. It is proposed to use Anemarrhena Rhizome (Zhimu) and Cinnamon Twig (Rougui) to resolve Liver Wind and control Wood, which is a steady method.
*Phellodendron Bark (Huangbai), Anemarrhena Rhizome (Zhimu), Turtle Shell (Guijia), Cistanche Stem (Roucongrong), Human Tooth Ash (Renzhongbai), Cinnamon Twig (Rougui).*
Made into honey pills.
Observing the complexion, it is sallow and lacks luster. Palpating the pulse, it is wiry, rapid, and knotted (Kou). Food intake is poor. The illness has lasted for years. Every spring and summer, when Yang rises and Qi leaks out, occasional mental clutter and emotional discomfort cause blood to overflow from the upper orifices. The deficiency of Middle Qi is different from the Yin fire of youth. The Heart governs Blood, the Spleen controls Blood, and the Liver stores Blood. Internal deficiency of Liver Yin allows Yang to move recklessly, causing overflow. Regularly taking *Guipi Tang* (Restore the Spleen Decoction), removing Ginseng (Renshen), Atractylodes Macrocephala Rhizome (Baizhu), and Aucklandia Root (Muxiang), adding White Peony Root (Baishao) to harmonize the Yin of the Liver and Spleen. This is the so-called "King's Way" medicine for nourishing righteousness, not counting on immediate results.
*Ginseng (Renshen), Poria with Hostwood (Fushen), Honey-fried Licorice Root (Zhigancao), Angelica Sinensis Root (Guishen), White Peony Root (Baishao), Jujube Seed (Zaoren), Polygala Root (Yuanzhi), Longan Aril (Guiyuanrou).*
Back pain worsens with massage, salivation occurs, shortness of breath and abdominal fullness are present, the lower abdomen is hard, urination is blocked, defecation is free, the lower body is numb and immobile, there is no eating or sleeping, and sweating occurs when irritable. The pathogenesis is complex. There is no fixed method of treatment. Consider that Cold-Turbidity has secretly occupied the interior. Yang is weak and unable to circulate, presenting as obstruction. Since the two Qi (Yin and Yang) are discordant, how can they be ignored? Citing Zhang Zhongjing's example of Shaoyin disease, urgently advancing Yang circulation is key. It is proposed to use *Baitong Tang* with Human Urine and Pig Bile.
*Scallion White (without roots), Raw Light-Dried Ginger (Sheng Danganjiang), Raw-Pounded Aconite Root (Sheng Paofuzi).*
Take one cup of water for the above herbs, decoct until four-tenths remain, filter the clear liquid, add a small cup of human urine and one pig bile, mix frequently, ensuring they do not settle at the bottom.
Second consultation: Turbid Yin blocks the interior; apart from circulating Yang, there is no other method. After taking *Baitong Tang* with Human Urine and Pig Bile, the pulse is not subtly continuous, remaining irregular. It is still not stable enough to ensure safety. It is proposed to use *Sini Tongmai Fang* (Reverse the Yin Pulse-Unblocking Formula).
*Ginseng (Renshen), Light-Dried Ginger (Danganjiang), Human Urine, Pounded Aconite Root (Paofuzi), Pig Bile.*
Third consultation: Symptoms have slightly decreased, but Turbid Yin still occupies the lower abdomen, Stomach Qi has not revived, and recurrence is feared.
*Ginseng (Renshen), Raw Light-Dried Ginger (Sheng Danganjiang), Pounded Aconite Root (Paofuzi), Poria (Fuling), Alisma Rhizome (Zexie).*
Fourth consultation: Mistakenly using attacking exterior methods damaged Yang, causing Yin evil and turbid Qi to knot and close in the lower part. The lower abdomen is hard and painful, urination and defecation are obstructed, turbid Qi attacks upward, and rebellion causes vomiting. Without warm herbs assisted by salty-bitter-cold herbs, how can one reach the Lower Jiao directly?
*Pounded Aconite Root (Paofuzi), Light-Dried Ginger (Danganjiang), Human Urine, Pig Bile, Scallion White Head.*
Whenever malaria persists and pathogens knot, it inevitably becomes Malaria Mother (splenomegaly/nodule). The pathogen deeply resides in the Yin collaterals, the pathways are deep and distant, skin has no sweat, appetite exists but digestion fails, and urination/defecation are regulated. The disease is not in the Fu organs; it rises reversely from below the abdomen, penetrates the hypochondrium and waist, and extends to the Eight Extraordinary Vessels. This is inherent in the pathology. However, formulating prescriptions lacks specific reference. Recalling Zhang Zhongjing's examples for rotating and unblocking Bi-obstruction in the Lower Jiao, the method is to circulate Yang.