张 久痛在络。营中之气。结聚成瘕。始而夜发。继而昼夜俱痛。阴阳两伤。遍阅医药。未尝说及
络病。便难液涸。香燥须忌。（营络气聚结瘕）
青葱管 新绛 当归须 桃仁 生鹿角 柏子仁
朱（二六） 辛润通络。成形瘀浊吐出。然瘀浊必下行为顺。上涌虽安。恐其复聚。仍宜缓通。以去瘀生
新为治。无取沉降急攻。谓怒劳多令人伤阳耳。
当归 桃仁 茺蔚子 制蒺藜 生鹿角 茯苓 香附汁法丸
周（三十） 瘕聚结左。肢节寒冷。病在奇脉。以辛香治络。
鹿角霜 桂枝木 当归 小茴 茯苓 香附 葱白
龚 脉症向安。辛甘化风方法非谬。据云痛时少腹满胀。其有形疝瘕。状亦略小。法宜益营之
中。再佐通泄其气。古称通则不痛耳。
人参 当归 肉桂 吴萸 小茴 茯苓 青葱管
钦 疝瘕。少腹痛。
当归 生姜 羊肉 桂枝 小茴 茯苓
又 瘕痛已止。当和营理虚。
归身 紫石英 白芍（酒炒） 小茴 淡苁蓉 肉桂
丸方用养营去 术桂。合杞圆膏。
朱（四十） 疝瘕。腹痛有形。用柔温辛补。
当归 生姜 羊肉
某 右胁攻痛作胀。应时而发。是浊阴气聚成瘕。络脉病也。议温通营络。
当归（三钱） 小茴（炒焦一钱） 上桂肉（一钱） 青葱管（十寸）
谭 瘕聚有形高突。痛在胃脘心下。或垂 腰少腹。重按既久。痛势稍定。经水后期。色多黄白。
此皆冲脉为病。络虚则胀。气阻则痛。非辛香何以入络。苦温可以通降。（气血凝络脘痛经阻）
延胡 川楝 香附 郁金 茯苓 降香汁 茺蔚子 炒山楂 乌药
又 瘕聚痼结。痛胀妨食。得食不下。痛甚。今月经阻不至。带淋甚多。病由冲任脉络。扰及肝胃
之逆乱。若不宣畅经通。日久延为蛊疾矣。
炒桃仁 当归须 延胡 川楝子 青皮 小茴 吴萸 紫降香 青葱管
柳（四二） 络血不注冲脉。则经阻。气攻入络。聚而为瘕乃痛。冲脉是阳明属隶。痛升于右。
胀及中脘。作呕清涎浊沫。操家烦怒。犯胃莫如肝。泄肝正救胃。
金铃子 炒延胡 蓬莪术 青橘叶 半夏 浓朴 姜汁 茯苓
又 葱白丸二钱。艾枣汤送。
某 脐下瘕形渐大。气塞至心胸及咽喉。饮不解渴。遂气攻至背部。经水百余日不来。小溲得
利。大便不爽。气滞血瘀。皆因情志易郁。肝胆相火内灼。冲脉之血欲涸。丹溪谓气有余便是
火。口甜。食后痞。用苦辛清降。（木火郁气滞血瘀）
胡黄连（八分） 山栀仁（一钱半） 南山楂（三钱） 芦荟（一钱） 鸡肫皮（不落水去垢炙
脆五钱）
化服回生丹半丸。
陆（十六） 经阻半年。腹形渐大。痛不拒按。溲短便通。据形色脉象。不是用通经丸者。下气
还攻于络。
有形若 瘕。炒枯肾气丸。（肾气不摄经阻腹痛胀）
缪 脉弦左搏。数年胃痛不痊。发时手不可按。胁中拘急。少腹左傍。素有瘕聚之形。气自下焦
冲起。为胀为呕。此乃惊忧嗔怒。致动肝木。乘其中土。胃伤失降。脉络逆并。痛势为甚。初起或
理气获效。久发中衰。辛香气燥。脾胃不胜克伐矣。议疏肝木。安土为法。冀其渐缓。再酌后法。
（气血凝络肝逆胃痛呕）
川楝子 川连 干姜 桂枝 当归 川椒 生白芍 乌梅
又 少腹疝瘕多年。冲起散漫。胃脘两胁痛甚欲呕。年前用安胃泄肝颇效。但下焦至阴。足跗
发瘰裂水。久留湿热瘀留。经脉络中交病。若非宣通气血壅遏。恐非至理。
桃仁 柏子仁 川芎 当归 小茴 小香附 茯苓 山栀（姜汁炒）
为末。用青葱管百茎。加水一杯。取汁法丸。
某（五十） 数年左胁聚瘕。发作必呕吐涎沫。酸苦浊水。寤不成寐。便闭忽泻。始于悒郁。病由
肝失畅达。木必传土。胃气受侮。病久入络。气血兼有。缓图为宜。急攻必变胀病。
生牡蛎 川楝子肉 延胡 桃仁 半夏 茯苓
橘红 白芥子 川连 吴萸 香附汁姜汁法丸。
赵 脉小。身不发热。非时气也。凡经水之至。必由冲脉而始下。此脉胃经所管。医药消导寒凉。
不能中病。反伤胃口。致冲脉上冲。犯胃为呕。攻胸痞塞。升巅则昏厥。经言冲脉为病。男子内
疝。女子瘕聚。今小腹有形。兼有动气。其病显然。夫曰结曰聚。皆奇经中不司宣畅流通之义。
医不知络脉治法。所谓愈究愈穷矣。（肝逆犯胃奇络虚滞）
鹿角霜 淡苁蓉 炒当归 炒小茴 生杜仲 茯苓 用紫石英一两煎汤。煎药。
蒋（四七） 天癸将止之年。小腹厥阴部位起瘕。动则满腹胀痛。形坚。或时脊巅掣痛。必有
秽痰血筋吐出。此起于郁伤。久则液枯气结。内风阳气烦蒸。则心热痞结咽阻。已属痼疾。治必无效。倘
腹大中满则剧矣。（郁伤液涸阳升痛胀）
牡蛎 生地 阿胶 小胡麻 茯苓 豆皮
沈（四十） 肢冷腹痛。有形为瘕。久泻。（厥阴寒滞呕泻）
当归（炒黑） 小茴（炒黑） 上肉桂 山楂（炒黑） 茯苓
又 冷利有瘕。遇冷则呕。
吴萸 炒小茴 延胡 茯苓 川楝子 生香附
某 脘中瘕聚。（肝郁犯胃）
川楝子（一钱） 延胡（一钱） 吴萸（五分） 青皮（七分） 良姜（一钱） 茯苓（三钱）
林 脉左弦涩。少腹攻逆。痛即大便。肝气不疏。厥阴滞积。
香附（一钱半） 鸡肫皮（炙一钱半） 茯苓（一钱半） 麦芽（一钱） 香橼皮（八分） 青皮
（五分） 炒楂肉（二钱） 砂仁壳（五分）
又 少腹瘕聚攻逆。身热。或噫。或浊气下泄。则诸恙悉舒。恼怒病发。厥阴肝木郁遏不疏。显露
一斑。
川楝子（一钱） 小茴（五分） 生牡蛎（三钱） 桂枝木（五分） 生白芍（一钱） 青
皮（一钱）
程 聚气疝瘕。大便不爽。必腹中 痛。当通腑经气分。
葱白丸二钱五分。红枣汤送。
又 仿朱南阳意。以浊攻浊。
韭白根（去须五钱） 两头尖（一百粒） 炒香橘核（一钱半） 小茴香（七分） 金铃子肉（一
钱半）
又 瘕聚已解。用八珍丸。加香附小茴白花益母膏丸。
某 瘕聚在左胁中。肝病。
桃仁 川楝子 延胡 当归 橘红 香附
王（四一） 瘕聚季胁。渐加烦倦减食。入夏土旺气泄。用泄少阳。补太阴方。（胆克脾暑伤气）
人参 茯苓 炙草 当归 丹皮 生地 鳖甲 泽兰膏
周 痛久在络。凝聚成形。仍属经病。议用河间法。（痰气凝结）
川楝子 栝蒌皮 香附汁 延胡 生牡蛎
又 理气豁痰。痛止思食。仍以前法参用。
半夏 栝蒌皮 香附汁 生牡蛎 橘红 香豉
葛（四一） 用丹溪小温中丸。胀利自减。知肠胃湿热。皆阻腑阳之流畅。水谷之气。不主游溢。瘕属气
聚。 为血结。由无形酿为有形。攻坚过急。药先入胃。徒致后天气乏。恐胀病必至矣。俗有痞
散成蛊之说。可为治此病之戒律。（湿热结 ）
老韭根（生晒一两） 桃仁（一两） 生香附（一两） 炒楂肉（一两） 当归须（一两） 山甲片（一两）
小茴香（三钱） 桂枝木（三钱）
胡（二十） 少腹聚瘕。能食便不爽。腹微胀。（湿热腹胀） 小温中丸。
王（二一） 初病寒热。半年经水不来。少腹已有瘕形。食又减半。当此年犯干血劳虑。（寒热食减干血劳）
焦术 茯苓 广皮 香附 当归 南山楂 白芍
夫 者征也。血食凝阻。有形可征。一定而不移。瘕者假也。脏气结聚。无形成假。推之而可
动。昔有七 八瘕之说。终属强分名目。不若有形无形之辨为明的也。二 病在肝脾。而
胃与八脉亦与有责。治之之法。即从诸经。再究其气血之偏胜。气虚则补中以行气。气滞
则开郁以宣通。血衰则养营以通络。血瘀则入络以攻痹。此治 瘕之大略。古方甚多。而
葱白丸。乌鸡煎丸。尤为神效。 瘕之外。更有 癖肠覃石瘕内疝等症。古人论之已详。兹
不必赘。今参先生方案。如营伤气阻者。于益营之中。佐通泄其气。如络虚则胀。气阻则痛
者。以辛香苦温入络通降。又如肝胃两病者。以泄肝救胃。肝胃脾同病者。则扶土制木。肝
脏之气独郁不宣者。辛香专治于气。血痹络迸失和者。辛香专理其血。病由冲任扰及肝
胃之逆乱者。仍从肝胃两经主治。以疏降温通。凡此悉灵机法眼。药不妄投。总之治 瘕
之要。用攻法。宜缓宜曲。用补法。忌涩忌呆。上逆则想肝脏冲病之源头。下垂则究中气阴
邪之衰旺。吞酸吐水。必兼刚药。液枯肠结。当祖滋营。再辨脉象之神力。形色之枯泽。致病
之因由。则治法自然无误矣。（龚商年）
徐评 案中方论。平正清切。又极和润。无刚燥克削等弊。但有形之疾。多有凝结而不可破者。
古人膏丸蒸熨等法。必不可少。此则全未见及。恐沉痼之疾。断不能除也。
张（患者）：长期疼痛位于络脉。营分中的气机结聚，形成瘕块。起初仅在夜间发作，后来昼夜都痛。这导致阴阳两伤。遍阅之前的医药记录，从未提及络病的治疗。若大便困难、津液枯竭，必须忌用香燥药物。（这是营络气机聚结形成的瘕块）
处方：青葱管、新绛、当归须、桃仁、生鹿角、柏子仁
朱（26岁）：采用辛润法以疏通络脉。如果瘀浊之邪通过呕吐排出体外，虽然瘀浊下行是顺证，但上涌呕吐即使暂时缓解，恐怕瘀浊会再次结聚。因此仍宜缓缓通络，以祛除瘀血、生成新血为治疗原则。不要使用沉降急攻的方法。因为愤怒和劳累多会损伤阳气。
处方：当归、桃仁、茺蔚子、制蒺藜、生鹿角、茯苓、香附汁泛丸
周（30岁）：瘕块结聚在左侧，肢体关节寒冷。病位在奇经八脉。采用辛香药物治疗络脉。
处方：鹿角霜、桂枝木、当归、小茴香、茯苓、香附、葱白
龚（患者）：脉象和症状趋向安宁，“辛甘化风”的治疗方法并非错误。据患者自述，疼痛时少腹满胀。那些有形的疝气和瘕块，形状也略微缩小。治法应当在补益营血之中，再辅以通泄气机。古人说“通则不痛”。
处方：人参、当归、肉桂、吴茱萸、小茴香、茯苓、青葱管
钦（患者）：患有疝气和瘕块，少腹疼痛。
处方：当归、生姜、羊肉、桂枝、小茴香、茯苓
又诊：瘕块疼痛已经停止，应当调和营血、调理虚损。
处方：归身、紫石英、白芍（酒炒）、小茴香、淡苁蓉、肉桂
丸方：去掉白术、肉桂，配合杞圆膏制成丸药。
朱（40岁）：患有疝气和瘕块，腹痛且有形可触。采用柔温辛补的方法。
处方：当归、生姜、羊肉
某（患者）：右胁部攻窜作痛并伴有胀感，按时辰发作。这是浊阴之气结聚成瘕，属于络脉病变。建议温通营络。
处方：当归（三钱）、小茴香（炒焦一钱）、上桂肉（一钱）、青葱管（十寸）
谭（患者）：瘕块结聚，有形且高突，疼痛位于胃脘心下部位，有时下垂至腰部或少腹部。重按很久后，痛势稍定。月经后期，经色多黄白。这都是冲脉为病。络脉空虚则胀，气机阻滞则痛。不用辛香药物怎能入络？苦温药物可以通降。（气血凝滞于络脉，脘痛经阻）
处方：延胡索、川楝子、香附、郁金、茯苓、降香汁、茺蔚子、炒山楂、乌药
又诊：瘕块痼结，疼痛胀满妨碍进食，吃了东西下不去，疼痛剧烈。如今月经阻塞不来，带下和淋证非常多。病由冲任脉络引起，扰乱了肝胃的气机逆乱。如果不宣畅经络、使经血通畅，日久拖延会成为蛊疾。
处方：炒桃仁、当归须、延胡索、川楝子、青皮、小茴香、吴茱萸、紫降香、青葱管
柳（42岁）：络血不能注入冲脉，则月经阻塞。气机攻入络脉，结聚而成瘕块从而产生疼痛。冲脉隶属于阳明胃经。疼痛升发于右侧，胀感波及中脘，引发呕吐清涎和浊沫。操劳家务、烦闷愤怒，侵犯胃腑的莫过于肝木。疏泄肝木正是为了救胃。
处方：金铃子、炒延胡索、蓬莪术、青橘叶、半夏、浓朴、姜汁、茯苓
又诊：服用葱白丸二钱，用艾枣汤送服。
某（患者）：脐下瘕块形状逐渐增大，气塞堵塞至心胸及咽喉，喝水不能解渴，随后气机攻冲至背部。月经百余日不来，小便通利，大便不爽。气滞血瘀，皆因情志容易抑郁，肝胆相火内灼，导致冲脉之血欲枯竭。丹溪曾说“气有余便是火”，出现口甜、食后痞满的症状。采用苦辛清降的方法。（木火郁结，气滞血瘀）
处方：胡黄连（八分）、山栀仁（一钱半）、南山楂（三钱）、芦荟（一钱）、鸡肫皮（不沾水去垢，炙脆五钱）
另：化服回生丹半丸。
陆（16岁）：月经阻塞半年，腹部形状逐渐增大，疼痛但不拒绝按压，小便短少，大便通畅。根据面色、形体、脉象，不是适合用通经丸的情况。下气还攻于络脉。
处方：若有形似瘕块，用炒枯肾气丸。（肾气不摄，经阻腹痛胀）
缪（患者）：脉象弦硬，左侧搏动明显。数年胃痛不愈，发作时手不可触碰，胁中拘急，少腹左侧素有瘕块聚集的形状。气自下焦冲起，表现为胀和呕。这是由于惊忧嗔怒，导致肝木妄动，乘袭中土，胃受伤失去降功能，脉络逆乱。疼痛程度严重。初起或许理气能获效，久发则中气衰败，辛香气燥的药物，脾胃已不能承受其克伐。建议疏肝木，安脾胃为法，希望病情逐渐缓解，再斟酌后续方法。（气血凝滞于络脉，肝逆胃痛呕）
处方：川楝子、川连、干姜、桂枝、当归、川椒、生白芍、乌梅
又诊：少腹疝瘕多年，气机冲起散漫，胃脘和两胁疼痛剧烈想呕吐。年前用安胃泄肝的方法颇有效。但下焦至阴之地，足背发生瘰疬裂开流水，久留湿热瘀滞，经脉络脉交杂生病。若不宣通气血壅遏，恐怕不是至理。
处方：桃仁、柏子仁、川芎、当归、小茴香、小香附、茯苓、山栀（姜汁炒）
研为末，用青葱管一百茎，加水一杯，取汁泛丸。
某（50岁）：数年左胁聚集瘕块，发作必呕吐涎沫、酸苦浊水，睡不成眠，便秘忽而腹泻。始于忧郁，病由肝失畅达，木必传土，胃气受侮。病久入络，气血兼病，缓图为宜，急攻必变成胀病。
处方：生牡蛎、川楝子肉、延胡索、桃仁、半夏、茯苓、橘红、白芥子、川连、吴茱萸、香附汁姜汁泛丸。
赵（患者）：脉小，身体不发热，不是时气病。凡是月经来潮，必由冲脉开始下行。此脉由胃经所管。之前的医药多用消导寒凉之法，不能中病，反而伤了胃口，导致冲脉上冲，犯胃为呕，攻胸痞塞，上冲巅顶则昏厥。医经说冲脉为病，男子内疝，女子瘕聚。现在小腹有形，兼有动气，病情显然。所谓“结”、“聚”，都是奇经中不司宣畅流通的含义。医生不知道络脉治法，所谓越研究越穷困了。（肝逆犯胃，奇络虚滞）
处方：鹿角霜、淡苁蓉、炒当归、炒小茴香、生杜仲、茯苓，用紫石英一两煎汤煎药。
蒋（47岁）：天癸将止之年，小腹厥阴部位起瘕块，动则满腹胀痛，质地坚硬，有时脊背和头顶掣痛，必有秽痰血筋吐出。此起于郁伤，久则液枯气结，内风阳气烦蒸，则心热痞结咽阻。已属痼疾，治疗必然无效。倘若腹大中满则病情加剧了。（郁伤液涸，阳升痛胀）
处方：牡蛎、生地、阿胶、小胡麻、茯苓、豆皮
沈（40岁）：肢冷腹痛，有形为瘕，久泻。（厥阴寒滞，呕泻）
处方：当归（炒黑）、小茴香（炒黑）、上肉桂、山楂（炒黑）、茯苓
又诊：冷利有瘕，遇冷则呕吐。
处方：吴茱萸、炒小茴香、延胡索、茯苓、川楝子、生香附
某（患者）：脘中瘕块聚集。（肝郁犯胃）
处方：川楝子（一钱）、延胡索（一钱）、吴茱萸（五分）、青皮（七分）、良姜（一钱）、茯苓（三钱）
林（患者）：脉左弦涩，少腹攻逆，痛即大便。肝气不疏，厥阴滞积。
处方：香附（一钱半）、鸡肫皮（炙一钱半）、茯苓（一钱半）、麦芽（一钱）、香橼皮（八分）、青皮（五分）、炒楂肉（二钱）、砂仁壳（五分）
又诊：少腹瘕块聚集攻逆，身热，或打嗝，或浊气下泄，则诸病悉舒。恼怒发病，厥阴肝木郁遏不疏，显露一斑。
处方：川楝子（一钱）、小茴香（五分）、生牡蛎（三钱）、桂枝木（五分）、生白芍（一钱）、青皮（一钱）
程（患者）：聚气疝瘕，大便不爽，必腹中隐痛。当通腑经气分。
处方：葱白丸二钱五分，红枣汤送服。
又诊：仿照朱南阳的意思，以浊攻浊。
处方：韭白根（去须五钱）、两头尖（一百粒）、炒香橘核（一钱半）、小茴香（七分）、金铃子肉（一钱半）
又诊：瘕块聚集已解，用八珍丸，加香附、小茴、白花益母膏泛丸。
某（患者）：瘕块聚集在左胁中，肝病。
处方：桃仁、川楝子、延胡索、当归、橘红、香附
王（41岁）：瘕块聚集在季胁，逐渐加重烦倦、减少食欲。入夏土旺气泄，用泄少阳、补太阴方。（胆克脾，暑伤气）
处方：人参、茯苓、炙甘草、当归、丹皮、生地、鳖甲、泽兰膏
周（患者）：疼痛日久在络脉，凝聚成形，仍属经病。议用河间法。（痰气凝结）
处方：川楝子、栝蒌皮、香附汁、延胡索、生牡蛎
又诊：理气豁痰，痛止思食，仍以前法参用。
处方：半夏、栝蒌皮、香附汁、生牡蛎、橘红、香豉
葛（41岁）：用丹溪小温中丸，胀利自减。知道肠胃湿热，都阻碍了腑阳的流畅。水谷之气，不主游溢。瘕属于气聚，寃（此处疑为“寃”或特定病名，原文如此，意指血结）属于血结，由无形酿为有形。攻坚过急，药先入胃，徒致后天脾气匮乏，恐怕胀病必至。俗有痞散成蛊之说，可为治此病的戒律。（湿热结寃）
处方：老韭根（生晒一两）、桃仁（一两）、生香附（一两）、炒楂肉（一两）、当归须（一两）、山甲片（一两）、小茴香（三钱）、桂枝木（三钱）
胡（20岁）：少腹聚瘕，能食便不爽，腹微胀。（湿热腹胀）用小温中丸。
王（21岁）：初病寒热，半年经水不来，少腹已有瘕形，食又减半。当此年犯干血劳虑。（寒热食减，干血劳）
处方：焦术、茯苓、广皮、香附、当归、南山楂、白芍
夫“寃”者征也。血食凝阻，有形可征，一定而不移。“瘕”者假也。脏气结聚，无形成假，推之而可动。昔有七寃八瘕之说，终属强分名目，不若有形无形之辨为明的也。二病在肝脾，而胃与八脉亦与有责。治之之法，即从诸经，再究其气血之偏胜。气虚则补中以行气，气滞则开郁以宣通，血衰则养营以通络，血瘀则入络以攻痹。此治寃瘕之大略。古方甚多，而葱白丸、乌鸡煎丸，尤为神效。寃瘕之外，更有癖、肠覃、石瘕、内疝等症，古人论之已详，兹不必赘。今参先生方案，如营伤气阻者，于益营之中，佐通泄其气；如络虚则胀，气阻则痛者，以辛香苦温入络通降；又如肝胃两病者，以泄肝救胃；肝胃脾同病者，则扶土制木；肝脏之气独郁不宣者，辛香专治于气；血痹络迸失和者，辛香专理其血；病由冲任扰及肝胃之逆乱者，仍从肝胃两经主治，以疏降温通。凡此悉灵机法眼，药不妄投。总之治寃瘕之要，用攻法，宜缓宜曲；用补法，忌涩忌呆。上逆则想肝脏冲病之源头，下垂则究中气阴邪之衰旺。吞酸吐水，必兼刚药；液枯肠结，当祖滋营。再辨脉象之神力，形色之枯泽，致病之因由，则治法自然无误矣。（龚商年评）
徐评：案中方论，平正清切，又极和润，无刚燥克削等弊。但有形之疾，多有凝结而不可破者，古人膏丸蒸熨等法，必不可少。此则全未见及，恐沉痼之疾，断不能除也。
Zhang: Long-standing pain is located in the collaterals (Luo Mai). Qi within the Ying (Nutrient) level condenses and gathers to form a Jia mass. Initially, it occurs only at night; subsequently, it hurts day and night, injuring both Yin and Yang. A review of previous medical records reveals no mention of treating Collateral diseases. If difficult defecation and fluid depletion occur, aromatic-dry drugs must be avoided. (This refers to Qi gathering in the Ying collaterals forming a Jia mass.)
Prescription: Qingcong Guan (Green Onion Tube), Xinjiang (Safflower-infused silk), Danggui Xu (Danggui Rootlet), Taoren (Peach Kernel), Sheng Lujiao (Raw Deer Horn), Baiziren (Biota Seed).
Zhu (26 years old): Use acrid-moistening methods to unblock the collaterals. If turbid stasis is expelled via vomiting, although downward movement of stasis is favorable, upward surging vomiting, even if temporarily relieving, may lead to re-aggregation of stasis. Therefore, slow unblocking is still appropriate, aiming to remove stasis and generate new blood. Do not use sinking or drastic attacking methods, as anger and labor often injure Yang Qi.
Prescription: Danggui (Angelica Sinensis), Taoren (Peach Kernel), Chongweizi (Chenopodium Seed), Zhi Jili (Processed Tribulus Fruit), Sheng Lujiao (Raw Deer Horn), Fuling (Poria), Xiangfu Zhi (Cyperi Rhizoma Juice) for pill coating.
Zhou (30 years old): The Jia mass aggregates on the left, with cold limbs and joints. The disease is in the Extraordinary Vessels. Treat the collaterals with acrid-aromatic drugs.
Prescription: Lujiao Shuang (Deer Horn Glue Powder), Guizhi Mu (Cinnamon Twig Wood), Danggui (Angelica Sinensis), Xiaohui (Fennel Fruit), Fuling (Poria), Xiangfu (Cyperi Rhizoma), Congbai (Scallion White).
Gong: Pulse and symptoms are trending towards peace. The method of "Acrid-Sweet transforming into Wind" is not erroneous. The patient reports fullness and distension in the lower abdomen during pain. The tangible Hernia and Jia masses have slightly reduced in size. The treatment should benefit the Ying (Nutrient) level while assisting in venting and draining Qi. As the ancients said, "Unblocked means no pain."
Prescription: Renshen (Ginseng Root), Danggui (Angelica Sinensis), Rougui (Cinnamon Bark), Wuyu (Evodia Fruit), Xiaohui (Fennel Fruit), Fuling (Poria), Qingcong Guan (Green Onion Tube).
Qin: Suffers from Hernia and Jia masses, with lower abdominal pain.
Prescription: Danggui (Angelica Sinensis), Shengjiang (Fresh Ginger), Yangrou (Mutton), Guizhi (Cinnamon Twig), Xiaohui (Fennel Fruit), Fuling (Poria).
Second visit: The Jia pain has stopped. One should harmonize the Ying (Nutrient) and regulate deficiency.
Prescription: Guishen (Danggui Body), Zi Shiyuan (Purple Quartz), Baishao (White Peony Root, wine-fried), Xiaohui (Fennel Fruit), Dan Congrong (Cistanche), Rougui (Cinnamon Bark).
Pill Formula: Remove Baizhu (Atractylodes Macrocephala) and Rougui (Cinnamon Bark), combine with Qiyuan Paste to make pills.
Zhu (40 years old): Suffers from Hernia and Jia masses, with painful, tangible abdominal masses. Use gentle-warm, acrid-tonifying methods.
Prescription: Danggui (Angelica Sinensis), Shengjiang (Fresh Ginger), Yangrou (Mutton).
Certain Patient: Pain and distension attack the right hypochondrium, occurring at specific times. This is turbid Yin Qi aggregating to form a Jia mass, a Collateral disease. Propose warming and unblocking the Ying collaterals.
Prescription: Danggui (3 qian), Xiaohui (Stir-fried scorched, 1 qian), Shang Guirou (Cinnamon Bark, 1 qian), Qingcong Guan (Green Onion Tube, 10 cun).
Tan: The Jia mass aggregates, is tangible and protruding, with pain in the epigastrium/xinxi region, sometimes垂 (drooping/sinking) to the waist or lower abdomen. Long firm pressure slightly relieves the pain. Menstruation is delayed, color often yellow-white. These are all diseases of the Chong (Penetrating) Vessel. Empty collaterals cause distension; obstructed Qi causes pain. How else can one enter the collaterals but with acrid-aromatics? Bitter-warm drugs can promote descending flow. (Qi and Blood stagnating in collaterals, epigastric menstrual obstruction).
Prescription: Yanhu (Corydalis Rhizome), Chuanlianzi (Sichuan Loranthus Fruit), Xiangfu (Cyperi Rhizoma), Yujin (Curcuma Longa Rhizome), Fuling (Poria), Jiangxiang Zhi (Daemonorops Sap Juice), Chongweizi (Chenopodium Seed), Chao Shanzha (Stir-fried Hawthorn Fruit), Wuyao (Lindera Root).
Second visit: The Jia mass is stubbornly knotted, causing pain and distension that hinders eating; food cannot go down, pain is severe. Currently, menstruation is blocked, leukorrhea and stranguria are profuse. The disease originates from the Chong and Ren vessels, disturbing the rebellious Qi of the Liver and Stomach. If meridians are not unblocked and menstruation not regulated, prolonged delay will lead to Gu disease.
Prescription: Chao Taoren (Stir-fried Peach Kernel), Danggui Xu (Danggui Rootlet), Yanhu (Corydalis Rhizome), Chuanlianzi (Sichuan Loranthus Fruit), Qingpi (Green Tangerina Peel), Xiaohui (Fennel Fruit), Wuyu (Evodia Fruit), Zijiangxiang (Purple Daemonorops Sap), Qingcong Guan (Green Onion Tube).
Liu (42 years old): Collateral Blood does not pour into the Chong Vessel, causing menstrual blockage. Qi attacks the collaterals, aggregating to form a Jia mass and pain. The Chong Vessel is subordinate to the Yangming Stomach Meridian. Pain rises on the right, distension spreads to Zhongwan, causing vomiting of clear saliva and turbid foam. Overwork, vexation, and anger invade the Stomach more than anything else; the Liver. Draining the Liver saves the Stomach.
Prescription: Jinlingzi (Melia Toosendan Fruit), Chao Yanhu (Stir-fried Corydalis Rhizome), Peng Ezhu (Curcuma Zedoary Rhizome), Qingjuye (Green Tangerine Leaf), Banxia (Pinellia Tuber), Nongpo (Magnolia Bark), Jiangzhi (Ginger Juice), Fuling (Poria).
Second visit: Take 2 qian of Congbai Wan (Green Onion Pill), delivered with Aizao Tang (Mugwort and Jujube Decoction).
Certain Patient: The Jia shape below the navel gradually enlarges. Qi blocks up to the chest, heart, and throat; drinking does not quench thirst. Subsequently, Qi attacks the back. Menstruation has been absent for over a hundred days. Urination is smooth, but defecation is unsatisfactory. Qi stagnation and Blood stasis are due to emotional depression, internal burning of Ministerial Fire in the Liver and Gallbladder, leading to depletion of Chong Vessel Blood. Danxi said, "Excess Qi becomes Fire." Symptoms include sweet taste in mouth and postprandial bloating. Use bitter-acrid clearing and descending methods. (Wood-Fire depression, Qi stagnation, Blood stasis).
Prescription: Huhuanglian (Phellodendron Bark, 8 fen), Shanzhiren (Gardenia Seed, 1.5 qian), Nanshan Zha (Southern Hawthorn Fruit, 3 qian), Lushui (Aloe, 1 qian), Jizhenpi (Chicken Gizzard Membrane, scraped clean without water, roasted crisp, 5 qian).
Additionally: Dissolve and take half a pill of Huisheng Dan.
Lu (16 years old): Menstrual blockage for half a year, abdominal shape gradually enlarging, pain not refusing pressure. Urine short, stool normal. Based on complexion, form, and pulse, this is not suitable for Tongjing Wan (Menstruation-Regulating Pill). Downward Qi attacks the collaterals.
Prescription: If tangible like a Jia mass, use Chao Ku Shenqi Wan (Roasted Dry Kidney Qi Pill). (Kidney Qi failing to control, menstrual blockage, abdominal pain/distension).
Miao: Pulse is wiry, pulsating strongly on the left. Chronic stomach pain for years, unhealed. During attacks, hands cannot touch the area; hypochondriac tension. Left lower abdomen has long had the shape of aggregated Jia masses. Qi surges from the lower jiao, causing distension and vomiting. This results from shock, worry, and anger moving Liver Wood, attacking the Middle Earth (Spleen/Stomach). Stomach injury leads to loss of descending function, collaterals rebel and merge. Pain is severe. Initially, regulating Qi might work; after long recurrence, Middle Qi declines. Acrid-aromatic dry drugs are too harsh for the Spleen and Stomach to bear. Propose soothing Liver Wood and calming Earth. Hope for gradual relief, then reconsider later methods. (Qi and Blood stagnating in collaterals, Liver rebellion, stomach pain/vomiting).
Prescription: Chuanlianzi (Sichuan Loranthus Fruit), Chuanlian (Coptis Rhizome), Ganjiang (Dried Ginger), Guizhi (Cinnamon Twig), Danggui (Angelica Sinensis), Chuanjiao (Sichuan Pepper), Sheng Baishao (Raw White Peony Root), Wu Mei (Mume Fruit).
Second visit: Lower abdominal Hernia/Jia for many years, Qi surging and scattering. Severe pain in epigastrium and hypochondrium with urge to vomit. Last year, Anwei Xiegan (Calming Stomach, Draining Liver) was effective. However, the lower jiao is the place of Supreme Yin. Scrofula and cracked skin with oozing water on the instep indicate long-standing damp-heat and stasis. Meridian and collateral diseases intersect. If Qi and Blood congestion are not unblocked, it is not the ultimate principle.
Prescription: Taoren (Peach Kernel), Baiziren (Biota Seed), Chuanxiong (Ligusticum Rhizome), Danggui (Angelica Sinensis), Xiaohui (Fennel Fruit), Xiao Xiangfu (Small Cyperi Rhizoma), Fuling (Poria), Shan Zhi (Gardenia Fruit, stir-fried with ginger juice).
Grind into powder. Use 100 stems of Qingcong Guan (Green Onion Tube), add one cup of water, extract juice to coat pills.
Certain Patient (50 years old): Left hypochondriac Jia mass for years. Attacks always involve vomiting of saliva, sour-bitter turbid water. Insomnia. Constipation alternating with sudden diarrhea. Originated from melancholy. Disease due to Liver failure to flow freely; Wood transmits to Earth. Stomach Qi is insulted. Disease enters collaterals over time; both Qi and Blood are involved. Slow planning is suitable; drastic attacking will turn into Distension disease.
Prescription: Sheng Muli (Raw Oyster Shell), Chuanlianzi Rou (Sichuan Loranthus Flesh), Yanhu (Corydalis Rhizome), Taoren (Peach Kernel), Banxia (Pinellia Tuber), Fuling (Poria), Juhong (Tangerina Pericarpium Rubrum), Baijiezi (White Mustard Seed), Chuanlian (Coptis Rhizome), Wuyu (Evodia Fruit), Xiangfu Zhi Jiang Zhi Fa Wan (Cyperi Rhizoma Juice and Ginger Juice coated pills).
Zhao: Pulse is small. No fever. Not a seasonal pathogen. Whenever menstruation arrives, it must start from the Chong Vessel. This vessel is managed by the Stomach Meridian. Previous medicines used digestion-promoting and cold-cooling methods, missing the target and injuring Stomach appetite. This caused the Chong Vessel to surge upward, invading the Stomach causing vomiting, attacking the chest causing oppression, rising to the vertex causing fainting. The Classics state: Chong Vessel disease causes internal Hernia in men and Jia aggregation in women. Now there is a tangible mass in the lower abdomen with moving Qi. The disease is obvious. "Jie" (Knot) and "Ju" (Gather) imply the Extraordinary Vessels' failure to circulate freely. Doctors do not know Collateral treatment methods; thus, the more they investigate, the more lost they become. (Liver rebellion invading Stomach, Extraordinary Collateral deficiency/stagnation).
Prescription: Lujiao Shuang (Deer Horn Glue Powder), Dan Congrong (Cistanche), Chao Danggui (Stir-fried Angelica Sinensis), Chao Xiaohui (Stir-fried Fennel Fruit), Sheng Duzhong (Eucommia Bark), Fuling (Poria). Decoct Zi Shiyuan (Purple Quartz, 1 liang) in water to decoct the medicine.
Jiang (47 years old): In the year Tian Gui (menstrual essence) is about to cease, a Jia mass arises in the lower abdomen at the Jueyin location. Movement causes full abdominal pain, hard texture. Sometimes pulling pain in the spine and vertex. There must be expulsion of foul phlegm, blood, and sinews. This originates from depression injury. Long-term leads to fluid depletion and Qi knotting. Internal Wind and Yang Qi steaming cause Heart heat, epigastric palpitations, and throat obstruction. It has become a chronic disease; treatment will likely be ineffective. If abdominal distension becomes massive, it will worsen. (Depression injury, fluid depletion, Yang rising, pain/distension).
Prescription: Muli (Oyster Shell), Shengdi (Rehmannia Root), Ejiao (Donkey-hide Gelatin), Xiao Huma (Sesame Seed), Fuling (Poria), Doupi (Bean Skin).
Shen (40 years old): Cold limbs, abdominal pain, tangible Jia mass, chronic diarrhea. (Jueyin Cold stagnation, vomiting/diarrhea).
Prescription: Danggui (Charred Black), Xiaohui (Charred Black), Shang Rougui (Top Cinnamon Bark), Shanzha (Charred Black Hawthorn), Fuling (Poria).
Second visit: Cold diarrhea with Jia mass. Vomiting when exposed to cold.
Prescription: Wuyu (Evodia Fruit), Chao Xiaohui (Stir-fried Fennel Fruit), Yanhu (Corydalis Rhizome), Fuling (Poria), Chuanlianzi (Sichuan Loranthus Fruit), Sheng Xiangfu (Raw Cyperi Rhizoma).
Certain Patient: Epigastric Jia aggregation. (Liver depression invading Stomach).
Prescription: Chuanlianzi (1 qian), Yanhu (1 qian), Wuyu (5 fen), Qingpi (7 fen), Liangjiang (Galangal Rhizome, 1 qian), Fuling (3 qian).
Lin: Left pulse wiry and choppy. Lower abdominal attacking/rebellious sensation. Pain triggers defecation. Liver Qi not diffusing, Jueyin stagnation/accumulation.
Prescription: Xiangfu (1.5 qian), Jizhenpi (Roasted, 1.5 qian), Fuling (1.5 qian), Maiya (Malt, 1 qian), Xiangyuan Pi (Citron Peel, 8 fen), Qingpi (5 fen), Chao Zharou (Stir-fried Hawthorn Flesh, 2 qian), Sharen Ke (Amomum Husk, 5 fen).
Second visit: Lower abdominal Jia aggregation attacking/rebellious. Fever. Belching or discharge of turbid Qi brings relief. Anger triggers disease. Jueyin Liver Wood depressed and not diffusing, revealing a glimpse.
Prescription: Chuanlianzi (1 qian), Xiaohui (5 fen), Sheng Muli (Raw Oyster Shell, 3 qian), Guizhi Mu (Cinnamon Twig Wood, 5 fen), Sheng Baishao (Raw White Peony Root, 1 qian), Qingpi (1 qian).
Cheng: Aggregated Qi Hernia/Jia. Unsatisfactory defecation. Must have abdominal [pain]. Should unblock Fu organ and Jing/Qi levels.
Prescription: Congbai Wan 2.5 qian, delivered with Red Date Decoction.
Second visit: Following Zhu Nanyang's intent, using turbid to attack turbid.
Prescription: Jiubai Gen (Garlic Chive Root, trimmed 5 qian), Liangtoujian (Eleutherococcus Trifoliatus Stem, 100 grains), Chao Xiang Juhe (Stir-fried Fragrant Orange Seed, 1.5 qian), Xiaohui Xiang (Fennel Seed, 7 fen), Jinlingzi Rou (Toosendan Flesh, 1.5 qian).
Third visit: Jia aggregation resolved. Use Bazhen Wan (Eight Treasure Pill), add Xiangfu, Xiaohui, Baihua Yimu Gao (Motherwort Paste) to coat pills.
Certain Patient: Jia aggregation in the left hypochondrium. Liver disease.
Prescription: Taoren (Peach Kernel), Chuanlianzi (Sichuan Loranthus Fruit), Yanhu (Corydalis Rhizome), Danggui (Angelica Sinensis), Juhong (Tangerina Pericarpium Rubrum), Xiangfu (Cyperi Rhizoma).
Wang (41 years old): Jia aggregation in the costal margin. Gradual increase in vexation/fatigue and decreased appetite. Entering summer, Earth is prosperous and Qi leaks. Use Shaoyang-draining, Taiyin-tonifying formula. (Gallbladder overcoming Spleen, Summerheat injuring Qi).
Prescription: Renshen (Ginseng Root), Fuling (Poria), Zhi Cao (Honey-fried Licorice Root), Danggui (Angelica Sinensis), Danpi (Moutan Bark), Shengdi (Rehmannia Root), Biejia (Turtle Shell), Zelan Gao (Leonurus Paste).
Zhou: Long-standing pain in collaterals, condensing into form. Still belongs to Meridian disease. Propose Hejian method. (Phlegm-Qi condensation).
Prescription: Chuanlianzi (Sichuan Loranthus Fruit), Gualou Pi (Trichosanthes Peel), Xiangfu Zhi (Cyperi Rhizoma Juice), Yanhu (Corydalis Rhizome), Sheng Muli (Raw Oyster Shell).
Second visit: Regulate Qi and resolve Phlegm. Pain stops, desire for food returns. Continue previous method with modifications.
Prescription: Banxia (Pinellia Tuber), Gualou Pi (Trichosanthes Peel), Xiangfu Zhi (Cyperi Rhizoma Juice), Sheng Muli (Raw Oyster Shell), Juhong (Tangerina Pericarpium Rubrum), Xiangchi (Fermented Soybean).
Ge (41 years old): Used Danxi's Xiao Wenzhong Wan. Distension and diarrhea self-reduced. Knowing that intestinal-stomach damp-heat obstructs the free flow of Fu Yang. Water and Grain Qi do not circulate freely. Jia belongs to Qi aggregation; Yuan [typo in source, likely referring to a specific blood-related term or 'Yuan' as in 'fixed'] belongs to Blood knotting. From intangible to tangible. Attacking hardness too hastily, medicine enters the Stomach first, merely exhausting Post-Heaven Qi. Fear that Distension disease will inevitably arrive. Folk saying: Pi disperses into Gu. This serves as a warning for treating this disease. (Damp-Heat knotting Yuan/Blood).
Prescription: Lao Jiugen (Old Garlic Chive Root, sun-dried, 1 liang), Taoren (Peach Kernel, 1 liang), Sheng Xiangfu (Raw Cyperi Rhizoma, 1 liang), Chao Zharou (Stir-fried Hawthorn Flesh, 1 liang), Danggui Xu (Danggui Rootlet, 1 liang), Shanjiapian (Tarsius Spinosus Plate/Skin, 1 liang), Xiaohui Xiang (Fennel Seed, 3 qian), Guizhi Mu (Cinnamon Twig Wood, 3 qian).
Hu (20 years old): Lower abdominal aggregated Jia. Good appetite, unsatisfactory defecation, slight abdominal distension. (Damp-Heat abdominal distension). Use Xiao Wenzhong Wan.
Wang (21 years old): Initially cold and fever. Half a year without menstruation. Lower abdomen already has Jia shape. Food intake halved. At this age, consider Ganxue Lao (Dry Blood Consumption). (Cold/Fever, decreased food, Dry Blood Labor).
Prescription: Jiao Zhu (Charred Atractylodes), Fuling (Poria), Guangpi (Broad-leaved Tangerina Peel), Xiangfu (Cyperi Rhizoma), Danggui (Angelica Sinensis), Nanshan Zha (Southern Hawthorn Fruit), Baishao (White Peony Root).
The character "Yuan" (寃) signifies evidence. Blood and food stagnation and obstruction, tangible evidence, fixed and immovable. "Jia" (瘕) signifies false. Zang Qi aggregation, intangible forming a false shape, movable upon pushing. Previously, there were sayings of Seven Yuans and Eight Jas, ultimately belonging to forced categorization. It is not as clear as distinguishing between tangible and intangible. Both diseases are in the Liver and Spleen, but the Stomach and Eight Extraordinary Vessels also bear responsibility. The treatment method follows the various meridians, further investigating the bias of Qi and Blood. Qi deficiency: tonify the middle to move Qi. Qi stagnation: open depression to unblock and diffuse. Blood decline: nourish Ying to unblock collaterals. Blood stasis: enter collaterals to attack bi-syndrome. This is the general principle for treating Yuan and Jia. Ancient formulas are numerous, but Congbai Wan (Green Onion Pill) and Wuji Jian Wan (Black Chicken Decoction Pill) are particularly miraculous. Besides Yuan and Jia, there are also Pi, Changtan, Shi Jia, and Internal Hernia, etc., which the ancients discussed in detail; no need to repeat here. Now referencing Mr.'s cases: For Ying injury and Qi obstruction, assist in venting Qi while benefiting Ying. For empty collaterals causing distension and obstructed Qi causing pain, use acrid-aromatic and bitter-warm drugs to enter collaterals and promote descending. For Liver-Stomach dual disease, drain Liver to save Stomach. For Liver-Stomach-Spleen simultaneous disease, support Earth to control Wood. For isolated Liver Qi depression not diffusing, use acrid-aromatics specifically for Qi. For Blood Bi and collateral rupture/disorder, use acrid-aromatics specifically for Blood. For disease originating from Chong-Ren disturbing Liver-Stomach rebellious Qi, still treat from Liver-Stomach meridians, using soothing, warming, and unblocking methods. All these show spiritual insight and legal eyes; drugs are not thrown randomly. In summary, the key to treating Yuan and Jia: Using attacking methods,宜缓宜曲 (should be slow and circuitous); using tonifying methods, 忌涩忌呆 (avoid astringent and rigid). For upward rebellion, trace the source of Liver-Chong disease; for downward sagging, investigate the decline/prosperity of Middle Qi and Yin pathogens. For acid regurgitation and vomiting water, must combine with Yang/Gang drugs. For fluid depletion and intestinal knotting, follow the principle of nourishing Ying. Further distinguish the spirit/power of the pulse, the withering/luster of form/color, and the cause of disease. Then treatment methods will naturally be error-free. (Comment by Gong Shangnian)
Xu's Commentary: The prescriptions and theories in the cases are balanced, pure, and precise, yet extremely harmonious and moist, lacking defects such as harsh dryness and excessive reduction. However, tangible diseases often have condensations that cannot be broken. Ancient methods like pastes, pills, steaming, and moxibustion/warming are indispensable. These are completely absent here. I fear that deep-rooted chronic diseases certainly cannot be eradicated.