王（二二）此少壮精气未旺。致奇脉纲维失护。经云。形不足者。温之以气。精不足者。补之以味。今纳
谷如昔。当以血肉充养。（阴虚）
牛骨髓 羊骨髓 猪骨髓 茯神 枸杞 当归 湖莲 芡实
温（三二）阴虚督损。 六味加麋角胶秋石川石斛膏。
陈（十七） 劳在出幼之年。形脉生气内夺。冬月可延。入夏难挨。由真阴日消烁。救阴无速功。故难
治。两仪煎。
陈（二一）春病至夏。日渐形色消夺。是天地大气发泄。真气先伤。不主内守。为损怯之症。不加静养。
损不肯复。故治嗽治热无用。交节病加。尤属虚象。脉左数甚。肛有漏疡。最难全好。
熟地 炒山药 建莲 茯苓 猪脊筋
徐（四一）清金润燥热缓。神象乃病衰成劳矣。男子中年。行走无力。寐中咳逆。温补刚燥难投。
天冬 生地 人参 茯苓 白蜜
黄（二六）阴伤劳损。
清阿胶 鸡子黄 生地 麦冬 麻子仁 炙甘草 南枣
某 摄阴得效。佐以益气。合补三阴之脏。
人参 熟地 炒杞子 五味 牛膝炭 建莲 炒山药 芡实
钱 阳外泄为汗。阴下注则遗。二气造偏。阴虚热胜。脑为髓海。腹是至阴。皆阳乘于阴。然阳气
有余。益见阴弱。无以交恋其阳。因病致偏。偏久致损。坐功运气。阴阳未协。损不肯复。颇为可
虑。今深秋入冬。天令收肃。身气泄越。入暮灼热。总是阴精损伤。而为消烁耳。
川石斛 炒知母 女贞子 茯神 糯稻根 小黑 豆皮
又 暮夜热炽。阴虚何疑。但从前表散。致卫阳疏泄。穿山甲钻筋流利后。致经络气血劫撒。内
损不复。卫阳藩篱交空。斯时亦可撑半壁矣。失此机宜。秋收冬藏主令。其在封固蛰藏耳。张
季明谓元无所归则热灼亦是。
（丸方） 人参 河车 熟地 五味 莲肉 山药
茯苓 食后超时服六神汤。
张（六七）有年呼气 颇和。吸气 则胁中刺痛。是肝肾至阴脏络之虚。初投辛酸而效。两和肝之
体用耳。大旨益肾当温。复入凉肝滋液。忌投刚燥。
大熟地 天冬 枸杞 柏子霜 茯苓 桂圆肉 女贞子 川斛 蜜丸
徐 今年长夏久热。伤损真阴。深秋天气收肃。奈身中泄越已甚。吸短精浊。消渴眩晕。见症却
是肝肾脉由阴渐损及阳明胃络。纳谷减。肢无力。越人所云。阴伤及阳。最难充复。 诚治病易。治损难耳。
人参 天冬 生地 茯神 女贞 远志
钟（二十）少年形色衰夺。见症已属劳怯。生旺之气已少。药难奏功。求医无益。食物自适者。即胃喜
为补。扶持后天。冀其久延而已。
鱼鳔 湖莲 秋石 芡实 金樱子
周（七十）脉神形色。是老年衰惫。无攻病成法。大意血气有情之属。栽培生气而已。每日不拘用人
乳。或牛乳。约茶盏许。炖暖入姜汁三分。
某（女）交夏潮热口渴。肌肤甲错。此属骨蒸潮热。
生鳖甲 银柴胡 青蒿 黄芩 丹皮 知母
汤（女）天癸未至。入暮寒热。此先天真阴不足。为损怯延挨之病。腹膨减食治在太阴厥阴。
熟白术（二钱） 生浓朴（一钱） 当归（二钱） 丹皮（一钱半） 淡黄芩（一钱） 生鳖甲（五钱）
此一通一补之法。白术补太阴。浓朴通阳明。当归补厥阴。丹皮泄少阳。黄芩清气分之热。
鳖甲滋血分之热也。
陈（十二）稚年阴亏阳亢。春阳化风地升。暮热晨汗。肌柔白。脉数虚。非客邪清解。仿仲景复脉法。
本方去姜桂加甘蔗汁。
王（十二）稚年纯阳。诸阳皆聚于骨。阴未充长。阳未和谐。凡过动烦怒等因。阳骤升巅为痛。熟寐痛
止。阳潜入阴也。此非外邪。常用钱氏六味丸。加龟甲知母咸秋石。以滋养壮阴。
曹（十三）肌肉苍赤。脉小数疾。童真阴未充长。囊下肛前。已有漏卮。阳独升降。巅窍如蒙。常与壮水
制火。犹虑变幻损怯。生六味去萸肉。加生白芍黄柏知母人中白。蜜丸。
施（三二）脉尺垂。少藏。唾痰灰黑。阴水内亏。阳火来乘。皆损怯之萌。可冀胃旺加餐耳。年岁已过三
旬。苟能静养百天。可以充旺。
熟地 天冬 川斛 茯神 远志 山药 建莲 芡实 秋石 猪脊髓丸
张 劳烦。夏秋气泄而病。交小雪不复元。咽中微痛。血无华色。求源内损不藏。阴中之阳不伏。
恐春深变病。
熟地炭 清阿胶 川斛 浸白天冬 秋石（二分）
许（三二）阴伤及阳。畏风外冷。午后潮热。舌绛渴饮。刚峻难进。腰脊坠。音哑。心嘈。姑与柔阳滋液。
首乌 枸杞 天冬 黑 豆皮 茯神 建莲
黄 当纯阳发泄之令。辛散乱进。火升。咽干气促。病根在下焦。阴虚成劳。最难调治。
熟地 炒山药 五味 芡实 茯神 湖莲
又 照前方加人参。
宋 劳损三年。肉消脂涸。吸气喘促。欲咳不能出声。必踞按季胁。方稍有力。寐醒喉中干涸。直
至胸脘。此五液俱竭。法在不治。援引人身脂膏。为继续之算。莫言治病。
鲜河车 人乳汁 真秋石 血余灰
吴（二八）遗浊已久。上冬喉中哽噎。医投寒解。入夏不痊。缘肾阴为遗消烁。龙雷不肯潜伏。于冬令
收藏之候。反升清空之所。内经以少阴之脉循喉咙。挟舌本。阴质既亏。五液无以上承。徒有
浮阳蒸灼。柔嫩肺日伤。为痹为宣。不外阴虚阳亢。但养育阴气。贵乎宁静。夫思烦嗔怒。诵读
吟咏。皆是动阳助热。不求诸己工夫。日啖草木药汁生气暗伤。岂曰善策。然未尝无药也。益
水源之弱。制火炎之炽。早用六味减丹泽。加阿胶秋石龟胶牡蛎湖莲肉之属以入下。介以
潜阳。滋填涩固。却是至静阴药。卧时量进补心丹。宁神解热。俾上下得交。经年可冀有成。（阴虚阳浮）
沈 脉细涩。入尺泽。下元精亏。龙旺火炽。是口齿龈肿。皆下焦之虚阳上越。引火归窟。未尝不
通。只以形瘦液少。虑其劫阴。致有疡痈起患。当预虑也。虎潜去广归锁阳。加山药苁蓉青
盐。羊肉胶丸。
安 脉坚。咽阻心热。得嗳气略爽。腰膝 弱。精滑自遗。必因惊恐。伤及肝肾。下虚则厥阳冲逆
而上。法宜镇逆和阳。继当填下。
生白芍 桂枝木 生牡蛎 龙骨 茯神 大枣 小黑 豆皮
郑 脉数。垂入尺泽穴中。此阴精未充早泄。阳失潜藏。汗出吸短。龙相内灼。升腾面目。肺受熏
蒸。嚏涕交作。兼之胃弱少谷。精浊下注。溺管疼痛。肝阳吸其肾阴。善怒多郁。显然肾虚如
绘。议有情之属以填精。仿古滑涩互施法。
牛骨髓（四两） 羊骨髓（四两） 猪脊髓（四两） 麋角胶（四两） 熟地（八两） 人参（四两） 萸肉（四
两） 五味（三两） 芡实（四两） 湖莲（四两） 山药（四两） 茯神（四两） 金樱膏（三两） 胶髓丸。
曹（二一）精气内夺。冬乏收藏。入夜气冲呛逆。不得安寝。皆劳怯之末传。难治。
人参 鲜紫河车 茯苓 茯神 五味 紫衣胡桃肉
姚（二三）脉左细右空。色夺神夭。声嘶。乃精伤于下。气不摄固。而为咳汗。劳怯重病。药难奏功。用大
造丸方。
程 脉左弦搏。着枕眠卧。冷痰上升。交子后干咳。此肾虚阳不潜伏。乃虚症也。从摄固引导。勿
骤进温热燥药。
熟地炭 生白芍 山药 茯苓 丹皮 泽泻 车前 牛膝 胡桃肉
蒋 脉细促。三五欲歇止。头垂欲俯。着枕即气冲不续。此肾脏无根。督脉不用。虚损至此。必无挽法。
熟地 五味 茯苓 青铅 猪脊髓
朱（二九）真阴久伤不复。阳气自为升降。行动即觉外感。皆体质失藏。外卫不固矣。治在少阴。用固
本丸之属。加入潜阳介类。
固本丸加淡菜秋石阿胶。
金（二二）虚症五年。真阴既损不复。长夏阴不生成。阳扰升越巅顶而为痛胀。目患不痊。病根亦在
肝肾。与潜阳以益乙癸。磁石六味加龟甲。
胡 厥阳上冲。心痛振摇。消渴齿血。都是下焦精损。质重味浓。填补空隙。可冀其效。
熟地（四两） 五味（二两） 茯神（二两） 建莲（二两） 芡实（二两） 山药（二两） 人乳粉（二两） 秋
石（二两）
生精羊肉胶丸。早服四钱。
程 今年厥阴司天。春分地气上升。人身阳气上举。风乃阳之化气。阴衰于下。无以制伏。上愈
热。斯下愈寒。总属虚象。故龟胶人乳。皆血气有情。服之小效者。非沉苦寒威也。兹定咸味入阴。介类潜阳法。
炒熟地 龟胶 阿胶 炒远志 炒山药 湖莲
六七日后。仍进琼玉膏减沉香。
蒋（三五）肝厥。用咸味入阴。水生木体。是虚症治法。夏令大气主泄。因烦劳病发。势虽减于昔日。而
脉症仍然。必静养经年。阴阳自交。病可全去。议介类潜阳。佐酸味以敛之。
熟地 柏子霜 萸肉 五味 锁阳 淡菜胶 海参胶 真阿胶 龟版胶 茯苓 湖莲 芡实 青盐
金 肝血肾精无藏。阳乏根据附。多梦纷纭。皆阳神浮越。当以介属有情。填补下焦。
熟地 淡菜 阿胶 萸肉 小麦 龙骨 牡蛎
又 肾虚气攻于背。肝虚热触于心。都是精血内夺。神魂不主根据附。此重镇以理其怯。填补以
实其下。血肉有情。皆充养身中形质。即治病法程矣。
熟地 牡蛎 淡菜 五味 萸肉 龙骨 杞子
吴（十八）诊脉细数。左垂尺泽。先天最素薄。真阴未充。当精通年岁。阴气早泄。使龙相刻燃。津液暗
消。有虚怯根萌。药宜至静纯阴。保养尤为要旨。 知柏六味去丹泽。加龟甲天冬。猪脊髓丸。
钱（五十）据说热自左升。直至耳前后胀。视面色油亮。足心灼热。每午后入暮皆然。上年用茶调散。
宣通上焦郁热不应。此肝肾阴火乘窍。却因男子精亏。阳不下交。经言以滋填阴药。必佐介
属重镇。试以安寝竟夜乃安。参阳动阴静至理。
熟地 龟版 萸肉 五味 茯苓 磁石 黄柏 知母 猪脊髓丸。
顾（二二）阴精下损。虚火上炎。脊腰髀酸痛。髓空。斯督带诸脉不用。法当填髓充液。莫以见热投凉。
熟地（水煮） 杞子 鱼胶 五味 茯神 山药 湖莲 芡实 金樱膏为丸。
陈（二十）喉痹。目珠痛。吸气短促。曾咯血遗精。皆阴不内守。孤阳上越诸窍。当填下和阳。
熟地 枸杞炭 旱莲草 菊花炭 女贞 茯苓
某（三二）心烦不宁。目彩无光。少阴肾水枯槁。厥阳上越不潜。议用填阴潜阳。
人参（一钱半） 熟地（五钱） 天冬（一钱） 麦冬（三钱） 茯神（三钱） 龟版（一两）
某（女）渴不欲饮。阴不上承。况寐醒神识不静。易惊汗出。法当敛补。
人参 熟地炭 萸肉炭 茯神 五味 炒远志
邵 精血伤。气不潜纳阳浮扰神。则魂魄不宁。脏阴不安其位。
人参 炙草 建莲 茯神 龙骨 金箔
卢 有形血液。从破伤而损。神气无以拥护。当此冬令藏阳。阳微畏寒。奇脉少津。乏气贯布。行
步欹斜。健忘若愦。何一非精气内夺之征。将交大雪。纯阴无阳。冬至一阳来复也。见此离散
之态。平素不受暖补。是气元长旺。今乃精衰气竭之象。又不拘乎此例也。（阳虚）
人参 鹿茸 归身 炒杞子 茯苓 沙苑
马 阴精走泄于下。阳气郁冒于上。太冲脉衰。厥气上冲。陡然痫厥。阴阳既失交偶。内随阳掀
旋。阳从汗泄矣。宜远房帏。独居静室。医治之法。从阴引阳。从阳引阴。大封大固。以蛰藏为要。
百日可效。经年可以复元。
淡苁蓉 五味 远志 茯神 芡实 建莲 生羊腰子
孙（四二）形躯丰溢。脉来微小。乃阳气不足体质。理烦治剧。曲运神机。都是伤阳之助。温养有情。栽
培生气。即古圣春夏养阳。不与逐邪攻病同例。用青囊斑龙丸。
某（二十）少壮形神憔悴。身体前后牵掣不舒。此奇经脉海乏气。少阴肾病何疑。
淡苁蓉 甘枸杞 当归 牛膝 沙苑 茯苓
某 阴阳二气不振。春初进八味。减桂之辛。益以味芍之酸。从阳引阴。兼以归脾守补其营。方
得效验。兹当春升夏令。里虚藏聚未固。升泄主令。必加烦倦。古人谓寒则伤形。热则伤气。是
当以益气为主。通摄下焦兼之。仿内经春夏养阳。秋冬养阴为法。非治病也。乃论体耳。
夏季早服青囊斑龙丸方法。
鹿茸 鹿角霜 鹿角胶 赤白茯苓 熟地 苁蓉 补骨脂 五味子
晚服归脾。去木香。加枸杞子。
王（氏）凡女科书。首篇必论调经。既嫁必究孕育。结 十载。未能得胎。病在至阴之脏。延及奇经
八脉。述经迟晨泄。心若摇漾。得食姑缓。肛疡久漏。都属下损。
人参 麋茸 紫石英 茯苓 当归 补骨脂
枣艾汤泛丸。
汪（氏）女科首列调经。今经不调和。耳鸣心漾。汗出。畏恐神痹。两足皆冷兼浮肿。冬至节交。病甚
于前。都因肝肾内怯。阳不交阴所至。薛氏加减八味丸。淡盐汤送三钱。
万（二七）诊脉数。左略大。右腰牵绊。足痿。五更盗汗即醒。有梦情欲则遗。自病半年。脊椎六七节骨
形凸出。自述书斋坐卧受湿。若六淫致病。新邪自解。验色脉推病。是先天禀赋原怯。未经
【背景信息】
书名：临证指南医案 作者：叶桂 朝代：清 章节：虚劳(1/3) 类别：医论
王（二十二岁）此人年少体壮，但精气尚未旺盛。导致奇经八脉的纲维失去保护。《内经》说：形体虚弱不足的，用气来温养；精气亏虚不足的，用味厚之物来滋补。现在他饮食如常，应当用血肉有情之品来充养。（阴虚证）
牛骨髓、羊骨髓、猪骨髓、茯神、枸杞子、当归、湖莲、芡实。
温（三十二岁）阴虚且督脉受损。六味地黄丸加鹿角胶、秋石、川石斛膏。
陈（十七岁）劳损发生在刚成年的年纪，形体和脉象显示生气被内夺。冬天还可以拖延，到了夏天就难以忍受。这是因为真阴日渐消烁，救阴没有速效，所以难治。两仪煎。
陈（二十一岁）春季发病延续到夏季，日渐出现形色消减亏损。这是天地阳气发泄，真气先受损伤，不能主司内守，属于损怯病症。如果不加以静养，损耗难以恢复。所以治疗咳嗽和治疗发热都没有用。每逢节气交替病情加重，尤其属于虚象。脉象左部数而有力，肛门有漏疮，最难痊愈。
熟地黄、炒山药、建莲、茯苓、猪脊筋。
徐（四十一岁）清金润燥，热势稍缓，但神气已衰，病已成劳损。男子中年，行走无力，睡梦中咳嗽气逆。温补刚燥的药物难以投用。
天冬、生地黄、人参、茯苓、白蜜。
黄（二十六岁）阴伤劳损。
清阿胶、鸡子黄、生地黄、麦冬、火麻仁、炙甘草、南枣。
某患者 摄纳阴精取得效果，佐以益气。配合补益肝、脾、肾三阴之脏。
人参、熟地黄、炒枸杞子、五味子、牛膝炭、建莲、炒山药、芡实。
钱先生 阳气外泄表现为汗出，阴液下注表现为遗精。阴阳二气造成偏颇，阴虚则热胜。脑为髓海，腹部是至阴之地，都是阳乘于阴。然而阳气有余，更加显得阴弱，无法交恋其阳。因病导致偏颇，偏颇日久导致损耗。坐功运气，阴阳未能协调，损耗不肯恢复，颇为令人担忧。如今深秋入冬，天气令行收肃，身体之气却泄越。入夜灼热，总是阴精损伤，从而被消烁。
川石斛、炒知母、女贞子、茯神、糯稻根、黑豆皮。
又诊 暮夜热势炽盛，阴虚有何可疑？只是从前使用表散法，导致卫阳疏泄。使用穿山甲钻筋流利后，导致经络气血被劫夺散失。内损无法恢复，卫阳藩篱交空，此时也只能支撑半壁江山了。错失这个时机，秋收冬藏的主令，在于封固蛰藏罢了。张季明说元气无所归依则热灼也是这个道理。
（丸方）人参、紫河车、熟地黄、五味子、莲肉、山药、茯苓。食后超时服用六神汤。
张（六十七岁）年事已高，呼气尚平和，吸气则胁中刺痛。这是肝肾至阴脏络的虚损。初投辛散酸收药物而见效，只是调和了肝的体用罢了。大旨益肾应当温补，再加入凉肝滋液之法，忌用刚燥药物。
大熟地黄、天冬、枸杞子、柏子霜、茯苓、桂圆肉、女贞子、川石斛、蜜丸。
徐先生 今年长夏久热，损伤真阴。深秋天气收肃，无奈身体中泄越已甚。呼吸短促，精浊，消渴眩晕。所见症状却是肝肾脉由阴渐损及阳明胃络。饮食减少，肢体无力。俞跗所说，阴伤及阳，最难充复。确实是治病容易，治损难啊。
人参、天冬、生地黄、茯神、女贞子、远志。
钟（二十岁）少年形色衰败亏损，所见症状已属劳怯。生旺之气已少，药物难以奏效。求医无益。食物自适者，就是胃喜为补。扶持后天脾胃，希望其长久拖延而已。
鱼鳔、湖莲、秋石、芡实、金樱子。
周（七十岁）脉象、神气、形色，是老年衰惫。没有攻病的成法。大意是用血气有情之属，栽培生气而已。每日不拘用人乳或牛乳，约茶盏许，炖暖后加入姜汁三分。
某女性 交夏后潮热口渴，肌肤甲错。这属于骨蒸潮热。
生鳖甲、银柴胡、青蒿、黄芩、牡丹皮、知母。
汤女性 天癸未至，入暮寒热。这是先天真阴不足，为损怯延挨之病。腹部膨隆，食欲减退。治疗在太阴、厥阴。
熟白术（二钱）、生浓朴（一钱）、当归（二钱）、牡丹皮（一钱半）、淡黄芩（一钱）、生鳖甲（五钱）。
此为一通一补之法。白术补太阴，浓朴通阳明，当归补厥阴，牡丹皮泄少阳，黄芩清气分之热，鳖甲滋血分之热。
陈（十二岁）稚龄阴亏阳亢，春阳化风地升。傍晚发热早晨出汗，肌肉柔嫩色白，脉数而虚。不是客邪，仿照张仲景复脉法。本方去掉生姜、肉桂，加入甘蔗汁。
王（十二岁）稚龄纯阳，诸阳皆聚于骨，阴未充长，阳未和谐。凡是过度活动、烦怒等原因，阳气骤升巅顶而为痛。熟睡后痛止，是阳潜入阴。这不是外邪，常用钱乙六味地黄丸，加龟甲、知母、咸秋石，以滋养壮阴。
曹（十三岁）肌肉苍赤，脉小数疾。童真阴未充长，囊下肛前已有漏孔。阳独升降，巅窍如蒙。常与壮水制火，犹虑变幻为损怯。生六味地黄丸去掉山茱萸，加生白芍、黄柏、知母、人中白，蜜丸。
施（三十二岁）脉尺部下垂，少藏。唾痰灰黑，阴水内亏，阳火来乘。都是损怯的萌芽，可期望胃气旺盛加餐而已。年岁已过三十，若能静养百天，可以充旺。
熟地黄、天冬、川石斛、茯神、远志、山药、建莲、芡实、秋石、猪脊髓丸。
张先生 劳烦。夏秋气泄而病，交小雪后不复元。咽中微痛，血无华色。求源内损不藏，阴中之阳不伏。恐春深变病。
熟地黄炭、清阿胶、川石斛、浸白天冬、秋石（二分）。
许（三十二岁）阴伤及阳，畏风外冷。午后潮热，舌绛渴饮，刚峻难进。腰脊坠，音哑，心嘈。姑与柔阳滋液。
首乌、枸杞子、天冬、黑豆皮、茯神、建莲。
黄先生 当纯阳发泄之时，辛散乱进，火升，咽干气促。病根在下焦，阴虚成劳，最难调治。
熟地黄、炒山药、五味子、芡实、茯神、湖莲。
又诊 照前方加人参。
宋先生 劳损三年，肉消脂涸。吸气喘促，欲咳不能出声。必踞按季胁，方稍有力。寐醒喉中干涸，直至胸脘。此五液俱竭，法在不治。援引人身脂膏，为继续之算。莫言治病。
鲜河车、人乳汁、真秋石、血余灰。
吴（二十八岁）遗浊已久，上冬喉中哽噎。医生投寒解药，入夏不痊。缘肾阴为遗精消烁，龙雷之火不肯潜伏，于冬令收藏之候，反升清空之所。《内经》说少阴之脉循喉咙，挟舌本。阴质既亏，五液无以上承，徒有浮阳蒸灼，柔嫩肺日伤，为痹为宣，不外阴虚阳亢。但养育阴气，贵乎宁静。思虑烦闷嗔怒，诵读吟咏，皆是动阳助热。不求诸己工夫，日啖草木药汁生气暗伤，岂曰善策。然未尝无药也。益水源之弱，制火炎之炽。早用六味地黄丸减去丹皮、泽泻，加阿胶、秋石、龟胶、牡蛎、湖莲肉之属以入下。介类以潜阳，滋填涩固，却是至静阴药。卧时量进补心丹，宁神解热，俾上下得交，经年可冀有成。（阴虚阳浮）
沈先生 脉细涩，入尺泽。下元精亏，龙旺火炽。是口齿龈肿，皆下焦之虚阳上越。引火归窟，未尝不通。只以形瘦液少，虑其劫阴，致有疡痈起患。当预虑也。虎潜丸去掉广藿香、锁阳，加山药、肉苁蓉、青盐。羊肉胶丸。
安先生 脉坚，咽阻心热，得嗳气略爽。腰膝弱，精滑自遗。必因惊恐，伤及肝肾。下虚则厥阳冲逆而上。法宜镇逆和阳，继当填下。
生白芍、桂枝木、生牡蛎、龙骨、茯神、大枣、黑豆皮。
郑先生 脉数，垂入尺泽穴中。此阴精未充早泄，阳失潜藏。汗出吸短，龙相内灼，升腾面目。肺受熏蒸，嚏涕交作。兼之胃弱少谷，精浊下注，溺管疼痛。肝阳吸其肾阴，善怒多郁。显然肾虚如绘。议有情之属以填精。仿古滑涩互施法。
牛骨髓（四两）、羊骨髓（四两）、猪脊髓（四两）、麋角胶（四两）、熟地黄（八两）、人参（四两）、山茱萸（四两）、五味子（三两）、芡实（四两）、湖莲（四两）、山药（四两）、茯神（四两）、金樱膏（三两）。胶髓丸。
曹（二十一岁）精气内夺，冬乏收藏。入夜气冲呛逆，不得安寝。皆劳怯之末传，难治。
人参、鲜紫河车、茯苓、茯神、五味子、紫衣胡桃肉。
姚（二十三岁）脉左细右空，色夺神夭，声嘶。乃精伤于下，气不摄固，而为咳汗。劳怯重病，药难奏功。用大造丸方。
程先生 脉左弦搏，着枕眠卧，冷痰上升，交子后干咳。此肾虚阳不潜伏，乃虚症也。从摄固引导，勿骤进温热燥药。
熟地黄炭、生白芍、山药、茯苓、牡丹皮、泽泻、车前子、牛膝、胡桃肉。
蒋先生 脉细促，三五欲歇止。头垂欲俯，着枕即气冲不续。此肾脏无根，督脉不用。虚损至此，必无挽法。
熟地黄、五味子、茯苓、青铅、猪脊髓。
朱（二十九岁）真阴久伤不复，阳气自为升降。行动即觉外感，皆体质失藏，外卫不固矣。治在少阴，用固本丸之属。加入潜阳介类。
固本丸加淡菜、秋石、阿胶。
金（二十二岁）虚症五年，真阴既损不复。长夏阴不生成，阳扰升越巅顶而为痛胀。目患不痊。病根亦在肝肾。与潜阳以益乙癸。磁石六味地黄丸加龟甲。
胡先生 厥阳上冲，心痛振摇，消渴齿血。都是下焦精损。质重味浓，填补空隙，可冀其效。
熟地黄（四两）、五味子（二两）、茯神（二两）、建莲（二两）、芡实（二两）、山药（二两）、人乳粉（二两）、秋石（二两）。生精羊肉胶丸。早服四钱。
程先生 今年厥阴司天，春分地气上升，人身阳气上举。风乃阳之化气，阴衰于下，无以制伏。上愈热，斯下愈寒。总属虚象。故龟胶人乳，皆血气有情。服之小效者，非沉苦寒威也。兹定咸味入阴，介类潜阳法。
炒熟地黄、龟胶、阿胶、炒远志、炒山药、湖莲。
六七日后，仍进琼玉膏减沉香。
蒋（三十五岁）肝厥。用咸味入阴，水生木体，是虚症治法。夏令大气主泄，因烦劳病发。势虽减于昔日，而脉症仍然。必静养经年，阴阳自交，病可全去。议介类潜阳，佐酸味以敛之。
熟地黄、柏子霜、山茱萸、五味子、锁阳、淡菜胶、海参胶、真阿胶、龟版胶、茯苓、湖莲、芡实、青盐。
金先生 肝血肾精无藏，阳乏根据附。多梦纷纭，皆阳神浮越。当以介属有情，填补下焦。
熟地黄、淡菜、阿胶、山茱萸、小麦、龙骨、牡蛎。
又诊 肾虚气攻于背，肝虚热触于心。都是精血内夺，神魂不主根据附。此重镇以理其怯，填补以实其下。血肉有情，皆充养身中形质。即治病法程矣。
熟地黄、牡蛎、淡菜、五味子、山茱萸、龙骨、枸杞子。
吴（十八岁）诊脉细数，左垂尺泽。先天最素薄，真阴未充。当精通年岁，阴气早泄，使龙相刻燃，津液暗消，有虚怯根萌。药宜至静纯阴，保养尤为要旨。知柏六味地黄丸去丹皮、泽泻，加龟甲、天冬。猪脊髓丸。
钱（五十岁）据说热自左升，直至耳前后胀。视面色油亮，足心灼热。每午后入暮皆然。上年用茶调散，宣通上焦郁热不应。此肝肾阴火乘窍，却因男子精亏，阳不下交。经言以滋填阴药，必佐介属重镇。试以安寝竟夜乃安。参阳动阴静至理。
熟地黄、龟版、山茱萸、五味子、茯苓、磁石、黄柏、知母、猪脊髓丸。
顾（二十二岁）阴精下损，虚火上炎。脊腰髀酸痛，髓空。斯督带诸脉不用。法当填髓充液，莫以见热投凉。
熟地黄（水煮）、枸杞子、鱼胶、五味子、茯神、山药、湖莲、芡实、金樱膏为丸。
陈（二十岁）喉痹，目珠痛，吸气短促。曾咯血遗精，皆阴不内守，孤阳上越诸窍。当填下和阳。
熟地黄、枸杞炭、旱莲草、菊花炭、女贞子、茯苓。
某患者 心烦不宁，目彩无光。少阴肾水枯槁，厥阳上越不潜。议用填阴潜阳。
人参（一钱半）、熟地黄（五钱）、天冬（一钱）、麦冬（三钱）、茯神（三钱）、龟版（一两）。
某女性 渴不欲饮，阴不上承。况寐醒神识不静，易惊汗出。法当敛补。
人参、熟地黄炭、山茱萸炭、茯神、五味子、炒远志。
邵先生 精血伤，气不潜纳阳浮扰神，则魂魄不宁，脏阴不安其位。
人参、炙甘草、建莲、茯神、龙骨、金箔。
卢先生 有形血液，从破伤而损。神气无以拥护。当此冬令藏阳，阳微畏寒。奇脉少津，乏气贯布。行步欹斜，健忘若愦。何一非精气内夺之征。将交大雪，纯阴无阳，冬至一阳来复也。见此离散之态，平素不受暖补，是气元长旺。今乃精衰气竭之象，又不拘乎此例也。（阳虚）
人参、鹿茸、当归身、炒枸杞子、茯苓、沙苑蒺藜。
马先生 阴精走泄于下，阳气郁冒于上。太冲脉衰，厥气上冲。陡然痫厥。阴阳既失交偶，内随阳掀旋，阳从汗泄矣。宜远房帏，独居静室。医治之法，从阴引阳，从阳引阴，大封大固，以蛰藏为要。百日可效，经年可以复元。
淡苁蓉、五味子、远志、茯神、芡实、建莲、生羊腰子。
孙（四十二岁）形躯丰溢，脉来微小。乃阳气不足体质。理烦治剧，曲运神机，都是伤阳之助。温养有情，栽培生气，即古圣春夏养阳，不与逐邪攻病同例。用青囊斑龙丸。
某患者 少壮形神憔悴，身体前后牵掣不舒。此奇经脉海乏气，少阴肾病何疑。
淡苁蓉、甘枸杞子、当归、牛膝、沙苑蒺藜、茯苓。
某患者 阴阳二气不振。春初进八味地黄丸，减桂之辛，益以味芍之酸。从阳引阴，兼以归脾守补其营。方得效验。兹当春升夏令，里虚藏聚未固，升泄主令，必加烦倦。古人谓寒则伤形，热则伤气，是当以益气为主，通摄下焦兼之。仿内经春夏养阳，秋冬养阴为法。非治病也，乃论体耳。
夏季早服青囊斑龙丸方法：鹿茸、鹿角霜、鹿角胶、赤白茯苓、熟地黄、肉苁蓉、补骨脂、五味子。晚服归脾汤，去木香，加枸杞子。
王氏 凡女科书，首篇必论调经。既嫁必究孕育。结婚十载，未能得胎。病在至阴之脏，延及奇经八脉。述经迟晨泄，心若摇漾，得食姑缓，肛疡久漏，都属下损。
人参、麋茸、紫石英、茯苓、当归、补骨脂。枣艾汤泛丸。
汪氏 女科首列调经。今经不调和，耳鸣心漾，汗出，畏恐神痹，两足皆冷兼浮肿。冬至节交，病甚于前。都因肝肾内怯，阳不交阴所至。薛氏加减八味丸，淡盐汤送三钱。
万（二十七岁）诊脉数，左略大，右腰牵绊，足痿。五更盗汗即醒，有梦情欲则遗。自病半年，脊椎六七节骨形凸出。自述书斋坐卧受湿。若六淫致病，新邪自解。验色脉推病，是先天禀赋原怯。未经
[Background Information]
Book: *Lin Zheng Zhi Nan Yi An* (Clinical Guide to Medical Cases)
Author: Ye Gui (Ye Tianshi)
Dynasty: Qing
Chapter: Deficiency Consumption (Part 1/3)
Category: Medical Discussion
Wang (22 years old) This young man’s essence and qi have not yet flourished, leading to a loss of protection in the network vessels (Qi Jing Ba Mai). The Classics state: "For those with insufficient form, warm them with qi; for those with insufficient essence, tonify them with flavor." Currently, his appetite remains unchanged. He should be nourished with substances of flesh and blood (Zhi Xue You Qing Zhi Pin - animal-derived medicinal materials considered to have vital energy). (Yin Deficiency)
Ox marrow, sheep marrow, pig marrow, Poria with hostwood (Fushen), Goji berry (Gouqi), Angelica sinensis (Danggui), Lotus seeds from Huzhou (Hulian), Euryale seed (Qianshi).
Wen (32 years old) Yin deficiency with damage to the Du vessel (Governor Vessel). Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) plus Deer Antler Glue (Lujiao Jiao), Autumn Stone (Qiushi), and Chuan Shihu Paste (Dendrobium officinale paste).
Chen (17 years old) The consumption occurred at the age of coming of age. The form and pulse indicate that the vital qi has been internally depleted. It can be prolonged through winter but is hard to endure entering summer. This is because true yin is daily consumed and melted away. Saving yin yields no quick results, hence it is difficult to treat. Liangyi Decoction (Two-Powder Decoction).
Chen (21 years old) Illness began in spring and extended into summer, with daily decline in form and spirit. This corresponds to the dispersal of heaven and earth's qi, injuring the true qi first, which fails to maintain internal retention. It is a syndrome of consumption and timidity. Without quiet rest, the damage will not recover. Therefore, treating cough and heat is useless. Worsening at solar terms indicates a deficient pattern. The left pulse is rapid and forceful; there is an anal fistula, making full recovery very difficult.
Prepared Rehmannia root (Shudi), stir-fried Chinese yam (Shanyao), Jian lotus seeds, Poria (Fuling), Pig spinal cord tendons.
Xu (41 years old) Clearing metal and moistening dryness slows the heat. However, the divine manifestation shows disease has progressed to consumption. A middle-aged man with weakness in walking and nocturnal coughing and counterflow qi. Warm, tonifying, rigid, and drying medicines are difficult to administer.
Anchthocarpus stem (Tiandong), Raw Rehmannia root (Shengdi), Ginseng (Renshen), Poria (Fuling), White honey.
Huang (26 years old) Yin injury and consumption.
Clear Donkey-hide gelatin (Ejiao), Egg yolk (Jizihuang), Raw Rehmannia root (Shengdi), Ophiopogon tuber (Maidong), Hemp seed (Maziren), Honey-fried Licorice root (Gancao), Southern dates (Nanzao).
Certain patient: Nourishing yin has been effective; assist with boosting qi. Combine with tonifying the three yin organs (Liver, Spleen, Kidney).
Ginseng (Renshen), Prepared Rehmannia root (Shudi), Stir-fried Goji berry (Qizi), Schisandra fruit (Wuweizi), Charred Achyranthes root (Niuxi Tan), Jian lotus seeds, Stir-fried Chinese yam (Shanyao), Euryale seed (Qianshi).
Mr. Qian: Yang escaping outward manifests as sweating; Yin pouring downward manifests as spermatorrhea. The two qi have become unbalanced. Yin deficiency leads to excess heat. The brain is the sea of marrow; the abdomen is the place of extreme yin. Both involve Yang invading Yin. However, with excess Yang, Yin appears even weaker, unable to entangle and hold Yang. Disease causes imbalance; long-term imbalance leads to consumption. Sitting exercises and qi circulation fail to harmonize yin and yang; consumption does not recover. This is quite worrying. Now, deep autumn enters winter, when nature commands gathering and肃ness (restraint). Yet body qi leaks and scatters. Burning heat at night is always due to yin essence injury and subsequent consumption.
Chuan Shihu (Dendrobium nobile), Stir-fried Anemarrhena rhizome (Zhimu), Privet fruit (Nvzhenzi), Poria with hostwood (Fushen), Sticky rice root (Nuodaogen), Black soybean skin (Xiaoheidoupi).
Second visit: Nighttime heat is fierce; yin deficiency is beyond doubt. However, previous use of exterior-releasing methods caused Wei-yang (Defensive Yang) to leak. After using Pangolin scales (Chuanshanjia) to dredge meridians and promote flow, meridian and blood-qiang were plundered and scattered. Internal damage cannot recover; the defensive barrier is empty. At this time, one can only hold half the ground. Missing this opportunity, during the seasons of autumn gathering and winter storing, the key lies in sealing and hibernating. Zhang Jiming said that if Yuan Qi (Original Qi) has nowhere to return, heat burning also occurs.
(Pill Formula) Ginseng (Renshen), Placenta (Heche), Prepared Rehmannia root (Shudi), Schisandra fruit (Wuweizi), Lotus seeds (Lianrou), Chinese yam (Shanyao), Poria (Fuling). Take Liushen Tang (Six-God Decoction) after meals and past the usual time.
Zhang (67 years old) In advanced age, exhalation is relatively smooth, but inhalation causes stabbing pain in the hypochondrium. This is deficiency in the collaterals of the Liver and Kidney, the organs of extreme yin. Initial treatment with acrid and sour herbs was effective, merely harmonizing the substance and function of the Liver. The general principle is that tonifying the Kidney should be warming; then add cooling the Liver and nourishing fluids. Avoid rigid and drying medicines.
Large Prepared Rehmannia root (Shudi), Anchthocarpus stem (Tiandong), Goji berry (Gouqi), Biota seed frost (Baizishuang), Poria (Fuling), Longan aril (Guiyuanrou), Privet fruit (Nvzhenzi), Chuan Shihu (Dendrobium nobile), Honey pills.
Mr. Xu: Last year's long summer heat damaged true yin. Deep autumn weather is restraining, but the body's leakage is severe. Shortness of breath, turbid essence, thirst, and dizziness. The symptoms show the Liver-Kidney pulse progressing from yin damage to the Stomach collaterals of Yangming. Reduced food intake, limb weakness. As Yu Fu said, yin damage affecting yang is hardest to replenish. Indeed, treating disease is easy; treating consumption is difficult.
Ginseng (Renshen), Anchthocarpus stem (Tiandong), Raw Rehmannia root (Shengdi), Poria with hostwood (Fushen), Privet fruit (Nvzhen), Polygala root (Yuanzhi).
Zhong (20 years old): Youthful form and spirit are depleted. Symptoms already belong to consumption and timidity. Vital qi is scarce; medicine is hard to work. Seeking medical help is futile. Food that suits the stomach is "stomach preference as tonification." Support the post-heaven (Spleen/Stomach) to hope for prolongation.
Fish swim bladder (Yubiao), Huzhou lotus seeds (Hulian), Autumn stone (Qiushi), Euryale seed (Qianshi), Rosa laevigata fruit (Jinyingzi).
Zhou (70 years old): Pulse, spirit, and form indicate elderly exhaustion. There are no standard methods for attacking disease. The general idea is to use substances of blood and qi (Zhi Xue You Qing Zhi Pin) to cultivate vital qi. Daily, regardless of using human milk or cow milk, about a teacup full, warmed and mixed with 3 fen of ginger juice.
Certain female: Entering summer brings tidal fever and thirst; skin is rough like fish scales. This belongs to bone-steaming tidal fever.
Raw Softshell turtle shell (Biejia), Silver wormwood (Yinchaehu), Artemisia annua (Qinghao), Scutellaria root (Huangqin), Moutan bark (Danpi), Anemarrhena rhizome (Zhimu).
Tang (Female): Tian Gui (menstruation) has not arrived; evening chills and fever. This is congenital true yin insufficiency, a lingering illness of consumption and timidity. Abdominal distension and reduced appetite. Treatment focuses on Taiyin and Jueyin.
Prepared Atractylodes macrocephala (Baizhu, 2 qian), Raw Magnolia bark (N Houpo, 1 qian), Angelica sinensis (Danggui, 2 qian), Moutan bark (Danpi, 1.5 qian), Light Scutellaria root (Huangqin, 1 qian), Raw Softshell turtle shell (Biejia, 5 qian).
This is a method of unblocking and tonifying. Baizhu tonifies Taiyin; Houpo unblocks Yangming; Danggui tonifies Jueyin; Danpi drains Shaoyang; Huangqing clears heat in the qi level; Biejia nourishes heat in the blood level.
Chen (12 years old): Young age, yin deficiency with yang hyperactivity. Spring yang transforms into wind, earth rises. Evening fever, morning sweat, soft white muscles, rapid and deficient pulse. Not external pathogens. Imitate Zhang Zhongjing's Fumai method (Pulse-Recovering Method). Remove Ginger and Cinnamon from the base formula, add Sugarcane juice.
Wang (12 years old): Young age is pure yang. All yang gathers in the bones. Yin is not yet filled and grown; yang is not yet harmonious. Factors like over-movement and anger cause yang to suddenly rise to the vertex, causing pain. Pain stops during deep sleep as yang sinks into yin. This is not external pathogen. Commonly use Qian Yi's Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), added with Turtle shell (Guijia), Anemarrhena rhizome (Zhimu), and Salty Autumn Stone (Xian Qiushi), to nourish and strengthen yin.
Cao (13 years old): Muscles are dark red, pulse is small, rapid, and hurried. Child's true yin is not yet filled and grown. Below the scrotum and before the anus, there is already a leak. Yang ascends and descends alone, vertex orifices feel covered. Often use "Strengthen Water to Control Fire" (Zhuang Shui Zhi Huo). Still worry about transformation into consumption. Use raw Liuwei Dihuang Wan removing Cornus fruit (Yurou), adding Raw White Peony root (Baishao), Phellodendron bark (Huangbai), Anemarrhena rhizome (Zhimu), and Dung powder (Renzhongbai), honey pills.
Shi (32 years old): Pulse at the chi position hangs low, lacking storage. Spitting gray-black phlegm indicates internal deficiency of yin water, with yang fire attacking. These are beginnings of consumption and timidity. One can hope for increased appetite if stomach qi prospers. Having passed thirty, if one can rest quietly for a hundred days, one can become robust.
Prepared Rehmannia root (Shudi), Anchthocarpus stem (Tiandong), Chuan Shihu (Dendrobium nobile), Poria with hostwood (Fushen), Polygala root (Yuanzhi), Chinese yam (Shanyao), Jian lotus seeds, Euryale seed (Qianshi), Autumn stone (Qiushi), Pig spinal cord pills.
Mr. Zhang: Labor and worry. Illness due to qi leakage in summer and autumn. Did not recover after Minor Snow. Slight throat pain, blood lacks luster. Seeking the source, internal damage fails to store; yang within yin fails to submerge. Fear of disease transformation in deep spring.
Charred Prepared Rehmannia root (Shudi Tan), Clear Donkey-hide gelatin (Ejiao), Chuan Shihu (Dendrobium nobile), Soaked Bai Tiandong (Anchthocarpus stem), Autumn stone (Qiushi, 2 fen).
Xu (32 years old): Yin damage affecting yang, fear of wind and external cold. Afternoon tidal fever, crimson tongue, thirst for drinking. Rigid and harsh medicines are hard to take. Lower back and spine heaviness, hoarseness, heart palpitations. Temporarily use gentle yang and fluid-nourishing methods.
Polygonum multiflorum (Shouwu), Goji berry (Gouqi), Anchthocarpus stem (Tiandong), Black soybean skin (Xiaoheidoupi), Poria with hostwood (Fushen), Jian lotus seeds.
Mr. Huang: During the period of pure yang emission, indiscriminate use of acrid dispersants caused fire to rise, dry throat, and shortness of breath. The disease root is in the lower jiao; yin deficiency becomes consumption, hardest to regulate.
Prepared Rehmannia root (Shudi), Stir-fried Chinese yam (Shanyao), Schisandra fruit (Wuweizi), Euryale seed (Qianshi), Poria with hostwood (Fushen), Huzhou lotus seeds (Hulian).
Second visit: Add Ginseng (Renshen) to the previous prescription.
Mr. Song: Consumption for three years, flesh wasted, fat dried up. Shortness of breath on inhalation, wanting to cough but unable to make sound. Must sit leaning on the lateral costal region to gain slight strength. Throat is dry upon waking from sleep, extending to the chest and epigastrium. This is exhaustion of the five fluids. The method dictates untreatability. Resort to human body fats and oils as a continuing strategy. Do not speak of curing disease.
Fresh Placenta (Hexie), Human breast milk (Renru Zhi), True Autumn stone (Zhen Qiushi), Charred hair residue (Xuyuhui).
Wu (28 years old): Long-standing spermatorrhea and turbid discharge. Upper winter, throat feels obstructed. Doctors used cold-clearing drugs, not cured entering summer. Due to kidney yin being consumed by emissions, Dragon-Lei fire refuses to lie dormant. During the winter storage season, it反而 rises to the clear void. The Inner Classic states the Shaoyin channel runs along the throat and clamps the tongue base. Since yin substance is deficient, the five fluids cannot ascend. Only floating yang steams and burns, daily injuring tender lungs, leading to bi syndrome and xuan syndrome. It is none other than yin deficiency with yang hyperactivity. Nourishing yin qi values tranquility. Mental worry, anger, reading, and chanting all move yang and aid heat. Not seeking effort in oneself, daily consuming herbal juices secretly damages vital qi. Is this a good strategy? However, there is medicine. Benefit the weak water source, control the blazing fire. Early use of Liuwei Dihuang Wan removing Moutan bark (Danpi) and Alisma rhizome (Zexie), adding Donkey-hide gelatin (Ejiao), Autumn stone (Qiushi), Turtle shell glue (Guijiao), Oyster shell (Muli), and Huzhou lotus meat to enter the lower. Shellfish-type minerals to submerge yang, nourish, fill, astringe, and secure. These are extremely tranquil yin medicines. At bedtime, take appropriate amount of Buxin Dan (Heart-Nourishing Pill) to calm spirit and resolve heat, allowing upper and lower to interact. Over a year, success can be hoped for. (Yin Deficiency with Floating Yang)
Mr. Shen: Pulse is fine and choppy, entering the chi position. Lower origin essence is deficient, Dragon is vigorous, fire is blazing. Mouth, teeth, and gum swelling are all deficient yang from the lower jiao rising upward. Guiding fire back to its cave is not without merit. Only because of thin form and little fluids, worry about plundering yin, leading to sores and abscesses. Precaution is needed. Huyang Wan removing Guang Guibu (likely Guangpuhuo/Guizhi context dependent, here likely referring to specific ingredients in original formula variant) and Suoyang, adding Chinese yam (Shanyao), Cistanche (Rongrong), Green salt (Qingyan). Lamb meat glue pills.
Mr. An: Pulse is firm, throat obstruction, heart heat. Slightly relieved by belching. Weak waist and knees, seminal emission. Likely due to fright, injuring Liver and Kidney. Lower deficiency causes Jueyang to rush upward. Method should suppress rebellion and harmonize yang, followed by filling the lower.
Raw White Peony root (Baishao), Cinnamon twig wood (Guizhimu), Raw Oyster shell (Muli), Dragon bone (Longgu), Poria with hostwood (Fushen), Jujube (Dazao), Black soybean skin (Xiaoheidoupi).
Mr. Zheng: Pulse is rapid, sinking to the Chi Ze point. This is incomplete yin essence with premature leakage, yang losing its submergence. Sweating and shortness of breath, Dragon and Minister fire burning internally, rising to the face. Lungs suffer steaming, sneezing and runny nose occur together. Additionally, weak stomach and little grain, turbid essence pours downward, painful urination. Liver yang absorbs Kidney yin, prone to anger and depression. Kidney deficiency is obvious. Propose using substances of affection (You Qing Zhi Pin) to fill essence. Imitate ancient method of alternating slippery and astringent.
Ox marrow (4 liang), Sheep marrow (4 liang), Pig spinal cord (4 liang), Elk antler glue (Lujiao Jiao, 4 liang), Prepared Rehmannia root (Shudi, 8 liang), Ginseng (Renshen, 4 liang), Cornus fruit (Yurou, 4 liang), Schisandra fruit (Wuweizi, 3 liang), Euryale seed (Qianshi, 4 liang), Huzhou lotus seeds (Hulian, 4 liang), Chinese yam (Shanyao, 4 liang), Poria with hostwood (Fushen, 4 liang), Rosa laevigata paste (Jinying Gao, 3 liang). Glue and marrow pills.
Cao (21 years old): Essence and qi internally depleted, lacking storage in winter. Nighttime qi rushes and coughs, unable to sleep. All are late stages of consumption and timidity, difficult to treat.
Ginseng (Renshen), Fresh Placenta (Xian Zihache), Poria (Fuling), Poria with hostwood (Fushen), Schisandra fruit (Wuweizi), Purple walnut skin (Ziyi Hutao Rou).
Yao (23 years old): Left pulse fine, right pulse empty. Form depleted, spirit faded, voice hoarse. Essence injured below, qi fails to secure, leading to cough and sweat. Serious consumption and timidity, medicine hard to work. Use Dazao Wan (Great Creation Pill) formula.
Mr. Cheng: Left pulse string-like and forceful. Lying down to sleep, cold phlegm rises. Dry cough after Zi hour. This is Kidney deficiency with yang failing to submerge, a deficiency syndrome. Follow securing and guiding methods. Do not abruptly advance warm, tonifying, dry medicines.
Charred Prepared Rehmannia root (Shudi Tan), Raw White Peony root (Baishao), Chinese yam (Shanyao), Poria (Fuling), Moutan bark (Danpi), Alisma rhizome (Zexie), Plantago seed (Cheqian), Achyranthes root (Niuxi), Walnut meat (Hutaorou).
Mr. Jiang: Pulse is fine and hurried, pausing every third or fifth beat. Head droops, wanting to bow. Upon lying down, qi rushes and does not continue. This is Kidney rootlessness, Du vessel non-function. Damage to this extent must have no rescue method.
Prepared Rehmannia root (Shudi), Schisandra fruit (Wuweizi), Poria (Fuling), Lead ore (Qinglian), Pig spinal cord (Zhujisuim).
Zhu (29 years old): True yin injured for a long time and not recovered. Yang rises and falls on its own. Movement feels like external contraction. All due to constitution failing to store, external defense not solid. Treatment in Shaoyin, use Gudun Wan (Solidify Root Pill) type. Add shellfish-type minerals to submerge yang.
Gudun Wan added with Edible mussel (Dancai), Autumn stone (Qiushi), Donkey-hide gelatin (Ejiao).
Jin (22 years old): Deficiency syndrome for five years. True yin damaged and not recovered. Long summer yin does not generate. Yang disturbs and rises to the vertex causing pain and distension. Eye ailment not cured. Disease root is also in Liver and Kidney. Submerge yang to benefit Yi and Gui (Liver and Kidney). Cishi Liuwei Dihuang Wan (Magnetite Six-Ingredient Rehmannia Pill) added with Turtle shell (Guijia).
Mr. Hu: Jueyang rushes upward, heart pain and trembling, thirst, bleeding gums. All are lower jiao essence damage. Heavy texture and rich flavor, filling the gaps, can hope for effect.
Prepared Rehmannia root (Shudi, 4 liang), Schisandra fruit (Wuweizi, 2 liang), Poria with hostwood (Fushen, 2 liang), Jian lotus seeds (2 liang), Euryale seed (Qianshi, 2 liang), Chinese yam (Shanyao, 2 liang), Human milk powder (Renrufen, 2 liang), Autumn stone (Qiushi, 2 liang). Shengjing Lamb Meat Glue Pills. Take 4 qian in the morning.
Mr. Cheng: This year Jueyin governs the sky. Spring Equinox earth qi rises, body yang lifts. Wind is the transformed qi of yang. Yin declines below, unable to restrain. Upper becomes hotter, lower becomes colder. Overall a deficiency pattern. Thus Guijiao (Turtle shell glue) and Renru (Human milk) are substances of blood and qi. Small efficacy from taking them is not due to heavy bitter cold power. Now establish salty flavor entering yin, shellfish-type submerging yang method.
Stir-fried Prepared Rehmannia root (Shudi), Turtle shell glue (Guijiao), Donkey-hide gelatin (Ejiao), Stir-fried Polygala root (Yuanzhi), Stir-fried Chinese yam (Shanyao), Huzhou lotus seeds (Hulian).
After six or seven days, still advance Qiongyu Gao (Jade Jade Paste) removing Agaric (Chenxiang).
Jiang (35 years old): Liver Jue. Use salty flavor entering yin, water generating wood body. This is the treatment method for deficiency syndromes. Summer atmospheric qi mainly dissipates. Illness triggered by mental labor. Although milder than before, pulse and symptoms remain. Must rest quietly for years, yin and yang will naturally intersect, disease can fully go. Propose shellfish-type submerging yang, assisting with sour flavor to astringe.
Prepared Rehmannia root (Shudi), Biota seed frost (Baizishuang), Cornus fruit (Yurou), Schisandra fruit (Wuweizi), Cynomorium (Suoyang), Edible mussel glue (Dancai Jiao), Sea cucumber glue (Haishen Jiao), True Donkey-hide gelatin (Zhen Ejiao), Turtle shell glue (Guiban Jiao), Poria (Fuling), Huzhou lotus seeds (Hulian), Euryale seed (Qianshi), Green salt (Qingyan).
Mr. Jin: Liver blood and Kidney essence have no storage. Yang lacks attachment. Many dreams, all due to floating divine spirit. Should use shellfish-type substances of affection to fill the lower jiao.
Prepared Rehmannia root (Shudi), Edible mussel (Dancai), Donkey-hide gelatin (Ejiao), Cornus fruit (Yurou), Wheat (Xiaomai), Dragon bone (Longgu), Oyster shell (Muli).
Second visit: Kidney deficiency qi attacks the back; Liver deficiency heat touches the heart. All are internal depletion of essence and blood, soul and spirit lack attachment. This uses heavy sedation to manage timidity, filling to solidify the lower. Flesh and blood substances of affection all nourish the body's form and substance. This is the course of treating disease.
Prepared Rehmannia root (Shudi), Oyster shell (Muli), Edible mussel (Dancai), Schisandra fruit (Wuweizi), Cornus fruit (Yurou), Dragon bone (Longgu), Goji berry (Qizi).
Wu (18 years old): Pulse is fine and rapid, left sinks to Chi Ze. Congenital constitution is very thin, true yin not filled. At the age of understanding, yin qi leaks early, causing Dragon and Minister fire to burn constantly, fluids secretly consumed. Roots of deficiency and timidity emerge. Medicine should be extremely tranquil and pure yin. Preservation is especially important. Zhibai Liuwei Dihuang Wan removing Moutan bark (Danpi) and Alisma rhizome (Zexie), adding Turtle shell (Guijia), Anchthocarpus stem (Tiandong). Pig spinal cord pills.
Qian (50 years old): Said heat rises from the left, swelling behind and around ears. Face looks oily, sole of foot burns hot. Every afternoon and evening thus. Last year used Chatiao San, venting upper jiao stagnant heat, ineffective. This is Liver-Kidney yin fire invading orifices, due to male essence deficiency, yang not descending to interact. Classics say using fluid-nourishing and filling yin medicines must assist with heavy shellfish-type sedation. Try sleeping peacefully all night to be safe. Referencing the truth of yang moving and yin still.
Prepared Rehmannia root (Shudi), Turtle shell (Guiban), Cornus fruit (Yurou), Schisandra fruit (Wuweizi), Poria (Fuling), Magnetite (Cishi), Phellodendron bark (Huangbai), Anemarrhena rhizome (Zhimu), Pig spinal cord pills.
Gu (22 years old): Yin essence damaged below, deficient fire flares upward. Back, waist, and thigh soreness and pain, marrow empty. Thus Du and Dai vessels do not function. Method should fill marrow and replenish fluids. Do not just see heat and throw cool medicines.
Prepared Rehmannia root (Shudi, water-boiled), Goji berry (Qizi), Fish glue (Yujiao), Schisandra fruit (Wuweizi), Poria with hostwood (Fushen), Chinese yam (Shanyao), Huzhou lotus seeds (Hulian), Euryale seed (Qianshi), Rosa laevigata paste (Jinying Gao) as pills.
Chen (20 years old): Throat bi, eye ball pain, shortness of breath on inhalation. Previously hemoptysis and spermatorrhea. All due to yin failing to retain internally, lone yang rising upward to all orifices. Should fill the lower and harmonize yang.
Prepared Rehmannia root (Shudi), Charred Goji berry (Gouqi Tan), Eclipta herb (Hanliancao), Charred Chrysanthemum flower (Juhua Tan), Privet fruit (Nvzhen), Poria (Fuling).
Certain patient: Restless mind, eyes lack luster. Shaoyin Kidney water is withered, Jueyang rises upward and fails to submerge. Propose filling yin and submerging yang.
Ginseng (Renshen, 1.5 qian), Prepared Rehmannia root (Shudi, 5 qian), Anchthocarpus stem (Tiandong, 1 qian), Ophiopogon tuber (Maidong, 3 qian), Poria with hostwood (Fushen, 3 qian), Turtle shell (Guiban, 1 liang).
Certain female: Thirsty but no desire to drink, yin does not ascend. Moreover, upon waking from sleep, spirit is unsettled, easily frightened and sweating. Method should astringe and tonify.
Ginseng (Renshen), Charred Prepared Rehmannia root (Shudi Tan), Charred Cornus fruit (Yurou Tan), Poria with hostwood (Fushen), Schisandra fruit (Wuweizi), Stir-fried Polygala root (Yuanzhi).
Mr. Shao: Essence and blood damaged, qi fails to submerge and contain, floating yang disturbs spirit. Soul and魂魄 (hun and po) are restless, zang yin is不安 its position.
Ginseng (Renshen), Honey-fried Licorice root (Gancao), Jian lotus seeds (Jianlian), Poria with hostwood (Fushen), Dragon bone (Longgu), Gold leaf (Jinbo).
Mr. Lu: Visible blood, damaged from broken injury. Divine qi has nothing to support. During this winter season storing yang, yang is weak and fears cold. Network vessels lack fluid, qi fails to penetrate and distribute. Walking is slanted, forgetful and confused. Which is not a sign of internal depletion of essence and qi? Approaching Major Snow, pure yin without yang, Winter Solstice one yang returns. Seeing this scattered state, usually not accepting warm tonification, is qi yuan long prosperous. Now it is a sign of essence decline and qi exhaustion, not adhering to this example. (Yang Deficiency)
Ginseng (Renshen), Deer antler (Lurong), Angelica sinensis root body (Guishen), Stir-fried Goji berry (Qizi), Poria (Fuling), Astragalus complanatus seed (Shayuan).
Mr. Ma: Yin essence leaks downward, yang qi stagnates and covers upward. Taichong pulse declines, Jue qi rushes upward. Suddenly epilepsy and syncope. Yin and yang lose interaction, internally following yang whirling, yang escapes through sweat. Should avoid bedroom, live alone in quiet room. Treatment method: draw yang from yin, draw yin from yang, large sealing and large securing, with hibernation as key. Effect in 100 days, recovery in a year.
Light Cistanche (Rongrong), Schisandra fruit (Wuweizi), Polygala root (Yuanzhi), Poria with hostwood (Fushen), Euryale seed (Qianshi), Jian lotus seeds (Jianlian), Raw lamb kidney (Sheng Yang Yaozi).
Sun (42 years old): Body is plump, pulse is minute. Constitution of insufficient yang. Managing troubles and severe tasks, bending to operate divine mechanism, all assist in damaging yang. Warmly nourish substances of affection, cultivate vital qi. This is the ancient sages' "Nourish Yang in Spring and Summer," not same as expelling evil and attacking disease. Use Qingnang Banlong Wan.
Certain patient: Youthful form and spirit emaciated, body front and back pulling and uncomfortable. This is network vessel sea lacking qi, Kidney disease of Shaoyin, beyond doubt.
Light Cistanche (Rongrong), Sweet Goji berry (Gouqi), Angelica sinensis (Danggui), Achyranthes root (Niuxi), Astragalus complanatus seed (Shayuan), Poria (Fuling).
Certain patient: Yin and yang qi not vigorous. Early spring advance Babai Wan (Eight-Ingredient Pill), reduce Cinnamon's acridity, increase White Peony's sourness. Draw yin from yang, additionally use Guipi Tang to guard and tonify Ying. Only then effective. Now facing spring rising and summer emitting, interior deficiency storage not solid, rising and emitting command, must add fatigue and weariness. Ancients said cold injures form, heat injures qi. Should primarily boost qi, additionally unblock and secure lower jiao. Imitate Inner Classic "Nourish Yang in Spring and Summer, Nourish Yin in Autumn and Winter" as method. Not treating disease, but discussing constitution.
Summer early morning take Qingnang Banlong Wan method: Deer antler (Lurong), Deer antler frost (Lujiaoshuang), Deer antler glue (Lujiaojiao), Red and White Poria (Chibai Fuling), Prepared Rehmannia root (Shudi), Cistanche (Rongrong), Psoralea fruit (Buguzhi), Schisandra fruit (Wuweizi). Evening take Guipi Tang, remove Amomum fruit (Muxiang), add Goji berry (Gouqizi).
Ms. Wang: All gynecology books first discuss regulating menstruation. Once married, investigate conception. Married ten years, unable to conceive. Disease in the organ of extreme yin, extending to the eight network vessels. Describes delayed menstruation and morning diarrhea, heart feeling shaky, slightly relieved by eating, chronic anal ulcer leaking. All belong to lower damage.
Ginseng (Renshen), Elk antler (Mirong), Purple quartz (Zishi), Poria (Fuling), Angelica sinensis (Danggui), Psoralea fruit (Buguzhi). Pills made with Date and Mugwort decoction.
Ms. Wang: Gynecology lists regulating menstruation first. Now menstruation is irregular, tinnitus, heart palpitations, sweating, fear and spiritual numbness, both feet cold and edematous. Winter Solstice arrives, illness worse than before. All due to Liver and Kidney internal timidity, yang not interacting with yin. Xue Shi's Modified Babai Wan, taken with light salt water, 3 qian.
Wan (27 years old): Pulse rapid, left slightly large, right waist binding, leg weakness. Dawn night sweats wake one up, dream eroticism causes emission. Sick for half a year, vertebrae 6-7 segments protrude. Self-reported sitting and lying in study exposed to dampness. If six excesses cause disease, new pathogen resolves itself. Examining color and pulse deduces disease, it is congenital endowment originally timid. Unfinished...