宋 前议辛润下气以治肺痹。谓上焦不行。则下脘不通。古称痞闷都属气分之郁也。两番大
便。胸次稍舒。而未为全爽。此岂有形之滞。乃气郁必热。陈腐粘凝胶聚。故脘腹热气下注。隐
然微痛。法当用仲景栀子豉汤。解其陈腐郁热。暮卧另进白金丸一钱。盖热必生痰。气阻
痰滞。一汤一丸。以有形无形之各异也。（痰热内闭）
黑山栀 香豉 郁金 杏仁 桃仁 栝蒌皮 降香 另付白金丸（五钱）
孙 寒热由四末以扰胃。非药从口入以扰胃。邪热。津液。互胶成痰。气不展舒。阻痹脘中。治法
不但攻病。前议停药。欲谬药气尽。病自退避三舍耳。
人参 川连（盐水炒） 枳实 半夏 郁金 石菖蒲
某 脉不清。神烦倦。中痞恶心。乃热邪里结。进泻心法。（热邪里结）
炒半夏 黄芩 黄连 干姜 枳实 杏仁
刘 热气痞结。非因食滞。胃汁消烁。舌干便难。苦辛开气。酸苦泄热。是治法矣。
川连 生姜 人参 枳实 橘红 乌梅 生白芍
顾 气闭久则气结。不饥不食不大便。（气闭化热）
川贝母 白蔻仁 郁金 杏仁 金银花 绿豆壳
又 气结必化热。乃无形之病。故徒补无益。
鲜省头草 川斛 甜杏仁 川贝母 麻仁
何（三七） 烦劳之人。卫气少固。雾露雨湿。伤其流行清肃。疮痍外涸。脘胁反痹。乃经脉为病。无关腑
脏。
钩藤 生白蒺 郁金 白蔻仁 桑叶 橘红
又 气窒热郁。仍治上可以通痹。
杏仁 郁金 香附 栝蒌皮 黑山栀 苏梗
周 寒热。呕吐蛔虫自利。是暑湿热外因。因嗔怒动肝。邪气入于厥阴。胸满腹胀消渴。议以开
痞方法。（热邪入厥阴）
泻心汤去参甘加枳实白芍。
伊芳 因惊而得。邪遂入肝。故厥后热。神识昏狂。视得面青舌白。微呕渴饮。胸次按之而痛。此属
痞结。乃在里之症。宗仲景以泻心汤为法。
川连 半夏 干姜 黄芩 人参 枳实
尤 面垢油亮。目 黄。头胀如束。胸脘痞闷。此暑湿热气内伏。因劳倦。正气泄越而发。既非暴
受风寒。发散取汗。徒伤阳气。按脉形濡涩。岂是表症。凡伤寒必究六经。伏气须明三焦。论症
参脉。壮年已非有余之质。当以劳倦伤。伏邪例延医。（暑湿伏邪夹食）
滑石 黄芩 浓朴 醋炒半夏 杏仁 蔻仁 竹叶
又 胸痞自利。状如结胸。夫食滞在胃。而胸中清气。悉为湿浊阻遏。与食滞两途。此清解三焦
却邪汤药。兼进保和丸消导。
淡黄芩 川连 淡干姜 浓朴 醋炒半夏 郁金 白蔻仁 滑石 送保和丸三钱。
谈（氏） 胸痞不饥。热不止。舌白而渴。此暑邪未尽。仍清气分。（暑邪阻气）
鲜竹茹 淡黄芩 知母 橘红（盐水炒） 滑石 桔梗 枳壳汁 郁金汁
某（四一） 恶寒泄泻悉减。胸脘仍闷。余暑未尽。胃气未苏故耳。
大麦仁（四钱） 佩兰叶（三钱） 新会皮（一钱） 半夏曲（炒一钱半） 金斛（一钱半） 茯苓（三钱）
刘 湿热。非苦辛寒不解。体丰。阳气不足。论体攻病为是。胸中痞闷不食。议治在胃。（湿热伤胃）
川连 炒半夏 人参 枳实 姜汁 茯苓 橘红
邱 脉濡而缓。不饥不食。时令之湿。与水谷相并。气阻不行。欲作痞结。但体质阳微。开泄宜
轻。（湿阻气分）
炒半夏 茯苓 杏仁 郁金 橘红 白蔻仁
某（三六） 舌白脘痛。呕恶腹鸣。此湿阻气分。胃痹成痛。是不通之象。
炒半夏（三钱） 高良姜（一钱） 广藿香（一钱） 橘红（一钱） 乌药（一钱） 香附（一钱半）
沈（二四） 精气内损。是皆脏病。萸地甘酸。未为背谬。缘清阳先伤于上。柔阴之药。反碍阳气之旋运。
食减中痞。显然明白。病患食姜稍舒者。得辛以助阳之用也。至于黄 麦冬枣仁。更蒙上焦。
斯为背谬极。议辛甘理阳可效。（中阳不运）
桂枝汤去芍加茯苓。
汪 脉沉。中脘不爽。肢冷。
人参（七分） 淡干姜（一钱） 炒半夏（一钱半） 川熟附（七分） 茯苓（三钱） 草果仁（八分）
朱（妪） 目垂气短。脘痞不食。太阴脾阳不运。气滞痰阻。拟用大半夏汤。
人参 炒半夏 茯苓 伽楠香汁
又 脉微有歇。无神倦欲寐。服大半夏汤。脘痛不安。不耐辛通。营液大虚。春节在迩。恐防
衰脱。
人参 炒麦冬 北五味
某 舌白脘闷。中焦阳气不宣。
半夏 草果 浓朴 广皮 茯苓 藿香梗
张（五二） 胃寒涌涎。中痞。（胃寒）
泡淡吴萸 干姜 茯苓 半夏 橘红 川楝子
平 酒客脾胃阳微。下午阴气渐漫。脘中微痛。不饥。服苦降重坠辛燥。愈加不适者。清阳再受
伤触也。宗仲景圣训。以转旋胸次之阳为法。（胸次清阳不运） 苓桂术甘汤。
某 气阻脘痹。饮下作痛。当开上焦。（肺气不降胸脘痹阻）
枇杷叶 大杏仁 苏子 降香汁 白蔻仁 橘红
张 脉涩。脘痞不饥。口干有痰。当清理上焦。
枇杷叶 杏仁 山栀 香豆豉 郁金 栝蒌皮
加姜汁炒竹茹。
陈（三四） 食进颇逸。而胸中未觉清旷。宜辛润以理气分。勿以燥药伤阴。
枇杷叶 大杏仁 橘红 黑山栀 香豉 郁金 栝蒌皮 晨服。五剂后。接服桑麻丸。
杨 疟母用针。是泄肝胆结邪。瘦人疟热伤阴。梦遗。五心烦热。亦近理有诸。继患脘膈痞闷。不
饥食减。大便不爽。乃气滞于上。与前病两歧。焉得用滋阴凝滞之药。思必病后饮食无忌。中
焦清浊不和所致。
杏仁 土栝蒌 桔梗 半夏 黑山栀 枳实 香附汁
俞（女） 脘痹身热当开气分。
杏仁 栝蒌皮 枇杷叶 广皮 枳壳汁 桔梗
王（四三） 劳伤胃痛。明是阳伤。错认箭风。钓药敷贴。更服丸药。心下坚实按之痛。舌白烦渴。二便涩
少。喘急不得进食。从痞结论治。（寒热客邪互结）
生姜汁 生淡干姜 泡淡黄芩 枳实 姜汁炒川连 半夏
案中六淫外侵。用仲景泻心汤。脾胃内伤。用仲景苓姜桂甘法。即遵古贤治痞之以苦为
泄。辛甘为散二法。其于邪伤津液者。用辛苦开泄。而必资酸味以助之。于上焦不舒者。既
有枳桔杏蒌开降。而又用栀豉除热化腐。疏畅清阳之气。是又从古人有形至无形论内。
化出妙用。若所用保和化食。白金驱痰。附姜暖中。参苓养胃。生脉敛液。总在临症视其阴
阳虚实。灵机应变耳。（姚亦陶）
徐评 痞有二义。痞结成形之痞。是病胸膈痞满。是症痞结之痞。即积聚之类。另立一门亦可。
但痞满之痞。不拘何病皆有。此症如何另立一门。此非此老之故。乃编书之不明也。
宋姓患者。此前讨论采用辛润之法以降气，治疗肺痹（肺气闭阻的病证）。认为上焦气机不通畅，则下脘也会堵塞不通。古人称痞闷都属于气分的郁滞。经过两次大便后，胸部稍微舒展，但尚未完全清爽。这哪里是有形的积滞呢？乃是气机郁滞必然化热，陈旧的腐浊粘凝胶聚在一起，所以胃脘腹部热气向下灌注，隐隐感到轻微疼痛。治法应当使用张仲景的栀子豉汤，来解除陈旧的腐浊郁热。晚上睡觉时另外服用一钱白金丸。因为热邪必然生痰，气机阻滞导致痰湿停滞。一汤一丸，是根据有形和无形的病邪不同而分别施治。（痰热内闭）
黑山栀、香豉、郁金、杏仁、桃仁、栝蒌皮、降香。另付白金丸（五钱）。
孙姓患者。寒热从四肢末端扰动胃部，并非药物入口直接扰动胃部。邪热与津液互相胶结形成痰浊，气机不能舒展，阻滞闭塞在胃脘中。治法不仅在于攻逐病邪，之前建议停药，想要让谬误的药气耗尽，病邪自然会退避三舍（指病邪衰退）。
人参、川连（用盐水炒）、枳实、半夏、郁金、石菖蒲。
某患者。脉象不清爽，神志烦躁疲倦，中焦痞塞恶心，这是热邪在里结聚。采用泻心法治疗。（热邪里结）
炒半夏、黄芩、黄连、干姜、枳实、杏仁。
刘姓患者。热气痞结，不是因为食物停滞，而是胃中津液被消灼，舌干大便困难。用苦辛之品开通气机，用酸苦之品泄除热邪，这就是治法了。
川连、生姜、人参、枳实、橘红、乌梅、生白芍。
顾姓患者。气机闭塞久了就会气结，表现为不想吃东西、不进食、不大便。（气闭化热）
川贝母、白蔻仁、郁金、杏仁、金银花、绿豆壳。
又诊。气结必然会化热，这是无形的病邪，所以单纯补益没有益处。
鲜省头草、川斛、甜杏仁、川贝母、麻仁。
何姓（三七）。烦劳的人，卫气虚弱不固，雾露雨湿之气，损伤了其流行清肃的功能。疮痍外部干枯，胃脘胁肋反而痹阻，这是经脉发生的病变，与脏腑无关。
钩藤、生白蒺藜、郁金、白蔻仁、桑叶、橘红。
又诊。气窒热郁，仍然治疗上焦可以通利痹阻。
杏仁、郁金、香附、栝蒌皮、黑山栀、苏梗。
周姓患者。寒热，呕吐蛔虫，自发性腹泻，这是暑湿热的外因。因为嗔怒触动肝气，邪气进入厥阴经。胸满腹胀消渴，建议采用开痞的方法。（热邪入厥阴）
泻心汤去掉人参、甘草，加入枳实、白芍。
伊姓患者。因为受惊而得病，邪气于是进入肝脏，所以出现厥逆后发热，神识昏乱狂躁。看面色青、舌色白，轻微呕吐口渴想喝水，胸部按压会痛。这属于痞结，是病位在里的症状。遵循张仲景以泻心汤为法。
川连、半夏、干姜、黄芩、人参、枳实。
尤姓患者。面部污垢油亮，眼睛发黄，头部胀得像被束住一样，胸脘痞闷。这是暑湿热气内伏，因为劳累倦怠，正气外泄而发病。既然不是突然遭受风寒，发散取汗只会徒然损伤阳气。按脉象形濡涩，难道是表症吗？凡是伤寒必须究查六经，伏气温病必须明辨三焦。论症状参考脉象，壮年人已经不是有余的体质，应当作为劳倦伤、伏邪例延请医生诊治。（暑湿伏邪夹食）
滑石、黄芩、浓朴、醋炒半夏、杏仁、蔻仁、竹叶。
又诊。胸痞自发性腹泻，症状像结胸。那是食物停滞在胃，而胸中的清气，全被湿浊阻遏。这与单纯的食滞是两回事。此方清解三焦驱除邪气的汤药，兼进保和丸以消食导滞。
淡黄芩、川连、淡干姜、浓朴、醋炒半夏、郁金、白蔻仁、滑石。送服保和丸三钱。
谈姓（氏）。胸痞不想吃东西，热不退，舌苔白且口渴，这是暑邪未尽，仍然清气分的热。（暑邪阻气）
鲜竹茹、淡黄芩、知母、橘红（用盐水炒）、滑石、桔梗、枳壳汁、郁金汁。
某患者（四十一岁）。恶寒泄泻都减轻了，胸脘仍然闷，余暑未尽，胃气没有苏醒的缘故。
大麦仁（四钱）、佩兰叶（三钱）、新会皮（一钱）、半夏曲（炒一钱半）、金斛（一钱半）、茯苓（三钱）。
刘姓患者。湿热，不用苦辛寒凉之品不能解开。身体肥胖，阳气不足。根据体质攻逐病邪是正确的。胸中痞闷不想吃东西，建议治疗在胃。（湿热伤胃）
川连、炒半夏、人参、枳实、姜汁、茯苓、橘红。
邱姓患者。脉濡缓，不想吃东西，不想进食。时令的湿气，与水谷相并，气机阻滞不行，想要形成痞结。但是体质阳微，开泄宜轻。（湿阻气分）
炒半夏、茯苓、杏仁、郁金、橘红、白蔻仁。
某患者（三十六岁）。舌苔白，胃脘痛，呕吐恶心，腹鸣。这是湿阻气分，胃痹形成疼痛，是不通的征象。
炒半夏（三钱）、高良姜（一钱）、广藿香（一钱）、橘红（一钱）、乌药（一钱）、香附（一钱半）。
沈姓（二十四岁）。精气内部亏损，这都是脏病。萸肉、地黄甘酸，并不违背医理。因为清阳先在上部受伤，柔阴的药物，反而阻碍阳气的旋运。食欲减退，中焦痞塞，显然明白。病人吃姜稍微舒服的，是得到辛味以助阳的作用。至于黄精、麦冬、枣仁，更蒙蔽上焦。这是极其错误的。建议用辛甘理阳的方法可以见效。（中阳不运）
桂枝汤去掉芍药，加入茯苓。
汪姓患者。脉沉，中脘不舒服，四肢冷。
人参（七分）、淡干姜（一钱）、炒半夏（一钱半）、川熟附子（七分）、茯苓（三钱）、草果仁（八分）。
朱姓（老妇人）。眼皮下垂，气短，胃脘痞塞不想吃东西，太阴脾阳不运，气滞痰阻。拟用大半夏汤。
人参、炒半夏、茯苓、伽楠香汁。
又诊。脉微有间歇，无神志疲倦想睡。服用大半夏汤后，胃脘痛不安，不耐受辛通之药，营液大虚。春节临近，恐怕防止虚脱。
人参、炒麦冬、北五味子。
某患者。舌苔白，胃脘闷，中焦阳气不宣通。
半夏、草果、浓朴、广皮、茯苓、藿香梗。
张姓（五十二岁）。胃寒涌出涎水，中焦痞塞。（胃寒）
泡淡吴茱萸、干姜、茯苓、半夏、橘红、川楝子。
平姓。酒客脾胃阳气微弱，下午阴气逐渐弥漫，胃脘中轻微疼痛，不想吃东西。服用苦降重坠辛燥的药物，更加不适，是因为清阳再次受到损伤触碰。遵循张仲景的圣训，以转旋胸次之阳为法。（胸次清阳不运）苓桂术甘汤。
某患者。气阻胃脘痹阻，饮水下去作痛，应当开通上焦。（肺气不降胸脘痹阻）
枇杷叶、大杏仁、苏子、降香汁、白蔻仁、橘红。
张姓。脉涩，胃脘痞塞不想吃东西，口干有痰，应当清理上焦。
枇杷叶、杏仁、山栀、香豆豉、郁金、栝蒌皮。
加姜汁炒竹茹。
陈姓（三十四岁）。进食颇安逸，但胸中未觉得清旷。宜用辛润来调理气分。不要用燥药伤阴。
枇杷叶、大杏仁、橘红、黑山栀、香豉、郁金、栝蒌皮。早晨服用。五剂后，接服桑麻丸。
杨姓。疟母用针，是泄肝胆结聚的邪气。瘦人疟热伤阴，梦遗，五心烦热，也接近情理有依据。继患胃脘膈膜痞闷，不想吃东西，食欲减退，大便不爽，这是气滞于上，与前病两样。怎么能用滋阴凝滞的药物？思考必定是病后饮食无忌，中焦清浊不和所致。
杏仁、土栝蒌、桔梗、半夏、黑山栀、枳实、香附汁。
俞姓（女）。胃脘痹阻身热，应当开通气分。
杏仁、栝蒌皮、枇杷叶、广皮、枳壳汁、桔梗。
王姓（四十三岁）。劳伤胃痛，明明是阳气受伤。错认箭风，用药敷贴，更服丸药，心下坚实按压痛，舌苔白烦躁口渴，二便涩少，喘急不能进食。从痞结论治。（寒热客邪互结）
生姜汁、生淡干姜、泡淡黄芩、枳实、姜汁炒川连、半夏。
案中六淫外侵，用张仲景泻心汤。脾胃内伤，用张仲景苓姜桂甘法。即遵循古贤治疗痞疾的苦为泄、辛甘为散二法。对于邪气损伤津液的，用辛苦开泄，而必须借助酸味来辅助它。对于上焦不舒的，既有枳桔杏蒌开降，而又用栀豉除热化腐，疏畅清阳之气。这是又从古人有形至无形论内部，化出妙用。如果所用保和化食，白金驱痰，附姜暖中，参苓养胃，生脉敛液，总在临症视其阴阳虚实，灵机应变罢了。（姚亦陶）
徐评。痞有二义。痞结成形之痞，是病胸膈痞满；是症痞结之痞，即积聚之类，另立一门也可以。但痞满之痞，不拘何病皆有，此症如何另立一门？这不是这位老先生的本意，是编书的不明确啊。
Patient Song. Previous discussion proposed using acrid-moistening methods to descend qi and treat Lung Bi (a syndrome caused by obstruction of lung qi). It was stated that if the Upper Jiao does not circulate, the Lower Wan (stomach outlet) will be blocked. Ancient texts state that stuffiness and oppression belong to Qi stagnation in the Qi division. After two bowel movements, the chest felt slightly relieved, but not completely refreshed. How could this be a tangible accumulation? It is Qi stagnation transforming into heat; old, foul, sticky substances have coagulated. Thus, hot qi pours downward into the epigastrium and abdomen, causing隐然微痛 (hidden, slight pain). The method should employ Zhang Zhongjing's Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) to resolve the old, foul, stagnant heat. At night before sleep, take one qian of Baijin Wan (White Gold Pill) separately. Since heat generates phlegm, and Qi obstruction causes phlegm stagnation, the decoction and the pill address tangible and intangible pathogens respectively. (Phlegm-heat internal closure)
Heishanzhi (Gardeniae Fructus), Xiangshi (Fermented Sojae Semen Preparatum), Yujin (Curcumae Radix), Xingren (Armeniacae Semen Amarum), Taoren (Persicae Semen), Gualoupi (Benincasae Exocarpium), Jiangxiang (Dalbergiae Odoriferae Lignum). Separate prescription: Baijin Wan (5 qian).
Patient Sun. Chills and fever disturb the Stomach starting from the four extremities, not because medicine enters the mouth to disturb the Stomach. Pathogenic heat and body fluids interlock to form phlegm; Qi cannot expand and relax, obstructing and blocking the epigastrium. The treatment method is not only to attack the disease. Previously, it was advised to stop medication, hoping that after the erroneous medicinal qi dissipates, the pathogen will retreat three camps (recede).
Renshen (Ginseng Radix et Rhizoma), Chuanlian (Coptidis Rhizoma, stir-fried with salt water), Zhishi (Aurantii Fructus Immaturus), Banxia (Pinelliae Rhizoma), Yujin (Curcumae Radix), Shichangpu (Acori Tatarinowii Rhizoma).
Certain Patient. Pulse is unclear, spirit is irritable and fatigued, middle jiao stuffiness with nausea. This is pathogenic heat binding internally. Advance the Xiexin method. (Pathogenic heat binding internally)
Chao Banxia (Stir-fried Pinelliae Rhizoma), Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Ganjiang (Zingiberis Rhizoma), Zhishi (Aurantii Fructus Immaturus), Xingren (Armeniacae Semen Amarum).
Patient Liu. Hot qi stuffiness and knotting, not due to food stagnation. Stomach juices are consumed/scorched, tongue is dry, difficult defecation. Bitter-acrid to open Qi, sour-bitter to drain heat. This is the treatment method.
Chuanlian (Coptidis Rhizoma), Shengjiang (Zingiberis Rhizoma Recens), Renshen (Ginseng Radix et Rhizoma), Zhishi (Aurantii Fructus Immaturus), Juhong (Citri Reticulatae Pericarpium), Wumei (Mume Fructus), Sheng Baishao (Paeoniae Radix Alba).
Patient Gu. Qi closure for a long time leads to Qi knotting. No appetite, no eating, no bowel movement. (Qi closure transforming into heat)
Chuanbeimu (Fritillariae Cirrhosae Bulbus), Baokouren (Amomi Fructus Rotundus), Yujin (Curcumae Radix), Xingren (Armeniacae Semen Amarum), Jinyinhua (Lonicerae Japonicae Flos), Lüdouke (Phaseoli Radiati Testa).
Second consultation. Qi knotting must transform into heat; this is an intangible pathology. Therefore, mere tonification is of no benefit.
Xian Shentoucao (Fresh Houttuyniae Herba), Chuanhu (Dendrobii Caulis), Tian Xingren (Sweet Armeniacae Semen Amarum), Chuanbeimu (Fritillariae Cirrhosae Bulbus), Maren (Cannabis Semen).
Patient He (37 years old). People who labor excessively have deficient and insecure Wei Qi (Defensive Qi). Mist, dew, rain, and dampness injure its circulating and clear-purifying function. External sores dry up; the epigastrium and hypochondrium become bi-obstructed. This is a disease of the meridians and collaterals, unrelated to Zang-Fu organs.
Gouteng (Uncariae Ramulus cum Uncis), Sheng Baiji (Tribuli Fructus), Yujin (Curcumae Radix), Baokouren (Amomi Fructus Rotundus), Sangye (Mori Folium), Juhong (Citri Reticulatae Pericarpium).
Second consultation. Qi suffocation and heat stagnation. Treating the Upper Jiao can still unblock the bi-obstruction.
Xingren (Armeniacae Semen Amarum), Yujin (Curcumae Radix), Xiangfu (Cyperi Rhizoma), Gualoupi (Benincasae Exocarpium), Heishanzhi (Gardeniae Fructus), Sugeng (Perillae Caulis).
Patient Zhou. Chills and fever, vomiting roundworms, spontaneous diarrhea. These are external factors of Summer-heat, Dampness, and Heat. Anger stirs the Liver; pathogenic qi enters the Jueyin channel. Chest fullness, abdominal distension, excessive thirst. Propose opening stuffiness methods. (Pathogenic heat entering Jueyin)
Xiexin Tang (Gallbladder and Heart-Draining Decoction) minus Renshen and Gancao, plus Zhishi and Baishao.
Patient Yi. Acquired due to fright; pathogenic qi entered the Liver. Hence, Jue (cold limbs) followed by fever, confused spirit and mania. Observation shows blue face and white tongue, slight vomiting, thirst with desire to drink, pain upon pressing the chest. This belongs to Pi-jie (stuffiness-knotting), a symptom located internally. Follow Zhang Zhongjing’s method using Xiexin Tang.
Chuanlian (Coptidis Rhizoma), Banxia (Pinelliae Rhizoma), Ganjiang (Zingiberis Rhizoma), Huangqin (Scutellariae Radix), Renshen (Ginseng Radix et Rhizoma), Zhishi (Aurantii Fructus Immaturus).
Patient You. Face is dirty and oily, eyes yellow, head feels distended as if bound, chest and epigastrium stuffy. This is Summer-heat and Dampness-Qi lying latent internally. Due to fatigue and overwork, Zheng Qi (Upright Qi) leaks outward, triggering onset. Since it is not sudden exposure to Wind-Cold, dispersing to induce sweating would vainly injure Yang Qi. Palpating the pulse, it is soggy and choppy; how can this be a Exterior syndrome? All Shanghan (Cold Damage) must investigate the Six Channels; latent Qi diseases must clarify the Three Jiaos. Discuss symptoms referencing pulses. A young adult is no longer in a state of excess. This should be treated as injury from overwork and latent pathogen. (Summer-dampness latent pathogen combined with food)
Huashi (Talcum), Huangqin (Scutellariae Radix), Nongpo (Magnoliae Officinalis Cortex), Cu Chao Banxia (Vinegar-stir-fried Pinelliae Rhizoma), Xingren (Armeniacae Semen Amarum), Kourén (Amomi Fructus Rotundus), Zhuye (Bambusae Folium).
Second consultation. Chest stuffiness with spontaneous diarrhea, resembling Jie Xiong (chest binding). Food stagnation in the Stomach, while clear Qi in the chest is entirely obstructed by damp-turbidity. This differs from simple food stagnation. This decoction clears and resolves the Three Jiaos to expel pathogens, taken concurrently with Baohe Wan to digest and guide out food.
Dan Huangqin (Light Scutellariae Radix), Chuanlian (Coptidis Rhizoma), Dan Ganjiang (Light Zingiberis Rhizoma), Nongpo (Magnoliae Officinalis Cortex), Cu Chao Banxia (Vinegar-stir-fried Pinelliae Rhizoma), Yujin (Curcumae Radix), Baokouren (Amomi Fructus Rotundus), Huashi (Talcum). Take with 3 qian of Baohe Wan (Harmonize the Stomach Pill).
Patient Tan (Family name). Chest stuffiness, no appetite, heat does not cease, white tongue coating with thirst. This is incomplete resolution of Summer-heat pathogen; still clear Qi division heat. (Summer-heat pathogen obstructing Qi)
Xian Zhuru (Fresh Bambusae Cocos Descidua), Dan Huangqin (Light Scutellariae Radix), Zhimu (Anemarrhenae Rhizoma), Juhong (Citri Reticulatae Pericarpium, stir-fried with salt water), Huashi (Talcum), Jiegeng (Platycodonis Radix), Zhikezhi (Schizonepetae Fructus Juice), Yujinzhi (Curcumae Radix Juice).
Certain Patient (41 years old). Chills and diarrhea have largely decreased, but chest and epigastrium remain stuffy. Residual summer-heat has not cleared, and Stomach Qi has not revived.
Damai ren (Hordei Fructus Germinatus, 4 qian), Peilan ye (Eupatorii Folium, 3 qian), Xinhui pi (Citri Reticulatae Pericarpium, 1 qian), Banxia qu (Pinelliae Rhizoma Prepared with Bran, stir-fried 1.5 qian), Jinhu (Dendrobii Caulis, 1.5 qian), Fuling (Poria, 3 qian).
Patient Liu. Damp-heat requires bitter-acrid-cold to resolve. The patient is corpulent, Yang Qi is insufficient. Treating the disease based on constitution is correct. Chest stuffiness, no appetite. Propose treating the Stomach. (Damp-heat injuring Stomach)
Chuanlian (Coptidis Rhizoma), Chao Banxia (Stir-fried Pinelliae Rhizoma), Renshen (Ginseng Radix et Rhizoma), Zhishi (Aurantii Fructus Immaturus), Jiangzhi (Zingiberis Rhizoma Recens Juice), Fuling (Poria), Juhong (Citri Reticulatae Pericarpium).
Patient Qiu. Pulse is soggy and slow, no appetite, no eating. Seasonal dampness combines with food and water; Qi is obstructed and fails to move, intending to form Pi-jie (stuffiness-knotting). However, the constitution is Yang-deficient; opening and draining should be mild. (Dampness obstructing Qi division)
Chao Banxia (Stir-fried Pinelliae Rhizoma), Fuling (Poria), Xingren (Armeniacae Semen Amarum), Yujin (Curcumae Radix), Juhong (Citri Reticulatae Pericarpium), Baokouren (Amomi Fructus Rotundus).
Certain Patient (36 years old). White tongue coating, epigastric pain, vomiting/nausea, borborygmus. This is dampness obstructing Qi division, Stomach Bi forming pain, indicating blockage.
Chao Banxia (Stir-fried Pinelliae Rhizoma, 3 qian), Gaoliangjiang (Alpiniae Officinarum Rhizoma, 1 qian), Guanghuoxiang (Agastaches Herba, 1 qian), Juhong (Citri Reticulatae Pericarpium, 1 qian), Wuyao (Linderae Radix, 1 qian), Xiangfu (Cyperi Rhizoma, 1.5 qian).
Patient Shen (24 years old). Essence and Qi are internally damaged; these are all Zang organ diseases. Shan Zhu Yu (Corni Fructus) and Di Huang (Rehmanniae Radix) being sweet and sour are not contradictory. Because Clear Yang is injured first in the Upper Jiao, soft-Yin medicines hinder the rotation and transport of Yang Qi. Reduced food intake and middle jiao stuffiness are obvious. The patient feels slightly better after eating ginger, obtaining the use of acridity to assist Yang. As for Huang Jing (Polygonati Rhizoma), Maidong (Ophiopogonis Radix), and Zaoren (Ziziphi Spinosae Semen), they further obscure the Upper Jiao. This is extremely contradictory. Propose acrid-sweet regulating Yang method for efficacy. (Middle Yang failing to transport)
Guizhi Tang (Cinnamon Twig Decoction) minus Shaoyao, plus Fuling.
Patient Wang. Pulse is deep, Middle Wan (epigastrium) is uncomfortable, cold limbs.
Renshen (Ginseng Radix et Rhizoma, 0.7 qian), Dan Ganjiang (Light Zingiberis Rhizoma, 1 qian), Chao Banxia (Stir-fried Pinelliae Rhizoma, 1.5 qian), Chuan Shu Fu (Prepared Aconiti Lateralis Radix, 0.7 qian), Fuling (Poria, 3 qian), Caoguoren (Myristicae Arillus, 0.8 qian).
Patient Zhu (Elderly woman). Drooping eyelids, shortness of breath, epigastric stuffiness, no appetite. Taiyin Spleen Yang fails to transport; Qi stagnation and phlegm obstruction. Prescribe Da Banxia Tang (Major Pinellia Decoction).
Renshen (Ginseng Radix et Rhizoma), Chao Banxia (Stir-fried Pinelliae Rhizoma), Fuling (Poria), Jiananxiangzhi (Aquilariae Resina Juice).
Second consultation. Pulse is faint with intermittent pauses, listlessness and desire to sleep. After taking Da Banxia Tang, epigastric pain and discomfort persist; intolerant of acrid-unblocking agents. Ying and Ye (Nutritive Fluids) are greatly deficient. Spring Festival is approaching; fear collapse/depletion.
Renshen (Ginseng Radix et Rhizoma), Chao Maidong (Stir-fried Ophiopogonis Radix), Bei Wuwei (Schisandrae Fructus).
Certain Patient. White tongue coating, epigastric stuffiness, Middle Jiao Yang Qi not disseminated.
Banxia (Pinelliae Rhizoma), Caoguo (Tsaoko Fructus), Nongpo (Magnoliae Officinalis Cortex), Guangpi (Citri Reticulatae Pericarpium), Fuling (Poria), Huoxiang geng (Agastaches Caulis).
Patient Zhang (52 years old). Cold Stomach surging saliva, middle jiao stuffiness. (Stomach Cold)
Pao Dan Wuyu (Soaked and Lightened Evodiae Fructus), Ganjiang (Zingiberis Rhizoma), Fuling (Poria), Banxia (Pinelliae Rhizoma), Juhong (Citri Reticulatae Pericarpium), Chuanlianzi (Toosendan Fructus).
Patient Ping. Wine drinkers have weak Spleen and Stomach Yang. In the afternoon, Yin Qi gradually spreads. Slight pain in the epigastrium, no appetite. Taking bitter-draining, heavy-settling, acrid-drying medicines makes them more uncomfortable because Clear Yang is injured again. Following Zhang Zhongjing’s sage instruction, the method is to rotate the Yang of the chest. (Clear Yang of the chest failing to transport) Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction).
Certain Patient. Qi obstruction causing epigastric Bi, pain when drinking. Should open the Upper Jiao. (Lung Qi failing to descend, chest-epigastrium Bi obstruction)
Pipaye (Eriobotryae Folium), Da Xingren (Large Armeniacae Semen Amarum), Suzi (Perillae Fructus), Jiangxiangzhi (Dalbergiae Odoriferae Lignum Juice), Baokouren (Amomi Fructus Rotundus), Juhong (Citri Reticulatae Pericarpium).
Patient Zhang. Pulse is choppy, epigastric stuffiness, no appetite, dry mouth with phlegm. Should clear and regulate the Upper Jiao.
Pipaye (Eriobotryae Folium), Xingren (Armeniacae Semen Amarum), Shanzhi (Gardeniae Fructus), Xiangdouchi (Perillae Fructus and Sojae Semen Preparatum), Yujin (Curcumae Radix), Gualoupi (Benincasae Exocarpium).
Add Jiangzhi Chao Zhuru (Zingiberis Rhizoma Recens Juice stir-fried Bambusae Cocos Descidua).
Patient Chen (34 years old). Eating is quite leisurely, but the chest does not feel clear and spacious. Should use acrid-moistening to regulate Qi division. Do not use drying medicines to injure Yin.
Pipaye (Eriobotryae Folium), Da Xingren (Large Armeniacae Semen Amarum), Juhong (Citri Reticulatae Pericarpium), Heishanzhi (Gardeniae Fructus), Xiangshi (Fermented Sojae Semen Preparatum), Yujin (Curcumae Radix), Gualoupi (Benincasae Exocarpium). Take in the morning. After five doses, follow with Sangma Wan (Mulberry and Hemp Seed Pill).
Patient Yang. Needle treatment for Nu Mu (malaria mass) drains Liver and Gallbladder knotted pathogens. Thin people with malaria heat injuring Yin experience nocturnal emission and five-palm heat, which is also reasonable. Subsequently suffered epigastric/diaphragm stuffiness, no appetite, reduced food intake, unsatisfactory defecation. This is Qi stagnating in the Upper Jiao, differing from the previous illness. How can one use Yin-nourishing, cloying medicines? It is thought that post-illness dietary indiscretion caused disharmony of Clear and Turbid in the Middle Jiao.
Xingren (Armeniacae Semen Amarum), Tu Gualou (Wild Benincasae Fructus), Jiegeng (Platycodonis Radix), Banxia (Pinelliae Rhizoma), Heishanzhi (Gardeniae Fructus), Zhishi (Aurantii Fructus Immaturus), Xiangfuzhi (Cyperi Rhizoma Juice).
Patient Yu (Female). Epigastric Bi with body heat should open the Qi division.
Xingren (Armeniacae Semen Amarum), Gualoupi (Benincasae Exocarpium), Pipaye (Eriobotryae Folium), Guangpi (Citri Reticulatae Pericarpium), Zhikezhi (Schizonepetae Fructus Juice), Jiegeng (Platycodonis Radix).
Patient Wang (43 years old). Labor-injury stomach pain, clearly Yang injury. Misdiagnosed as arrow-wind, applied herbal patches, took pills. Epigastrium is firm and painful on pressure, white tongue coating, irritability and thirst, scanty urination and defecation, panting urgency, unable to eat. Treat according to Pi conclusion. (Cold-heat exogenous pathogens mutually binding)
Shengjiangzhi (Zingiberis Rhizoma Recens Juice), Sheng Dan Ganjiang (Raw Light Zingiberis Rhizoma), Pao Dan Huangqin (Soaked Light Scutellariae Radix), Zhishi (Aurantii Fructus Immaturus), Jiangzhi Chao Chuanlian (Jiangzhi stir-fried Coptidis Rhizoma), Banxia (Pinelliae Rhizoma).
In the cases, for invasion of the six excesses externally, Zhang Zhongjing’s Xiexin Tang is used. For internal injury of Spleen and Stomach, Zhang Zhongjing’s Ling-Jiang-Gui-Gan method is used. This follows the ancient sages’ methods for treating Pi: bitter for draining, acrid-sweet for dispersing. For those where pathogens injure body fluids, bitter-acrid opening-draining is used, assisted by sour flavors. For Upper Jiao discomfort, besides Zhi-Jie-Xing-Gualou descending and opening, Zhizi-Chi is used to remove heat and transform rot, smoothing Clear Yang Qi. This derives wonderful applications from the ancient theory of moving from tangible to intangible. If using Baohe to digest food, Baijin to drive phlegm, Fuzi/Ganjiang to warm the middle, Renshen/Fuling to nourish the Stomach, Shengmai to collect fluids, it all depends on clinical observation of Yin-Yang deficiency/excess, adapting flexibly. (Yao Yitao)
Commentary by Xu. Pi has two meanings. Pi-jie forming shape refers to chest-diaphragm stuffiness/fullness. Symptomatic Pi-jie refers to accumulations/masses, which could establish a separate category. But Pi-man (stuffiness-fullness) occurs in any disease regardless of type. How can this specific symptom establish a separate category? This is not the fault of this old master, but of the unclear compilation of the book.