鲍（十七） 两三年鼻塞不闻。清涕由口呛出。而气窒仍然。大凡头面诸窍。皆清阳交会通行之所。就
外邪来乘。亦必雾露无质清邪。邪郁既久。气血失其流畅。进药攻治。必不效验。欲治其 。须
查手太阴自少商穴起。施针刺以泄邪流气。乃一法也。（清邪郁久肺气窒塞无方）
徐（四十） 头面诸窍。皆清阳游行之所。邪处于中。则为堵塞。阳气不司流行。必畏寒形颓。内痹必郁
而成热有鼻柱鼽衄。矣论理当用通圣散。远处江外仓猝就诊。不可轻投。用轻可去实。
苦丁茶 干荷叶边 蔓荆子 连翘心 飞滑石 白芷
毛（十四） 热壅。肺气失降。鼻柱窒痹。（热壅肺气）
知母 水梨肉 川贝母 水熬膏
杨 咸降滋填。鼻渊止。得寐。用虎潜法。减当归陈皮。加天冬淡菜胶脊筋丸。（脑热鼻渊）
沈（氏） 素有痰火气逆。春令地中阳升。木火化风上引巅顶。脑热由清窍以泄越。耳鸣鼻渊。甚于
左者。春应肝胆。气火自左而升也。宜清热散郁。辛凉达于头而主治。
羚羊角 黑山栀 苦丁茶 青菊叶 飞滑石 夏枯草花
又 照方去滑石加干荷叶生石膏。
又 性情躁急。阳动太过。气火上升。郁于隧窍。由春深病加。失其条达之性。经言春气病在头
也。考五行六气。迅速变化。莫若火风。脑热暗泄而为鼻渊。隧道失和。结成瘿核。夫东垣升阳
散火。丹溪总治诸郁。咸取苦辛为法。然药乃片时之效。欲得久安。以怡悦心志为要旨耳。
连翘心 土贝母 海藻 昆布 黑山栀 川芎 小生香附 郁金 羚羊角 夏枯草 干荷叶边
生研末青菊叶汁法丸苦丁茶煎汤送二钱五分。
汪 形瘦尖长。禀乎木火。阴精不足。脑髓不固。鼻渊淋下。并不腥秽。暖天稍止。遇冷更甚。其为
虚证显然明白。医者愈以风寒中脑主治。发散渗泄。愈耗正气。岂但欲愈。劳怯是忧。用天真丸。
（精虚鼻渊）
人参 黄 白术 山药 苁蓉 当归 天冬 羊肉
经云。肺和则鼻能知香臭矣。又云。胆移热于脑。令人辛 鼻渊。传为衄 瞑目。是知初感
风寒之邪。久则化热。热郁则气痹而塞矣。治法利于开上宣郁。如苍耳散。防风通圣散。川
芎茶调散。菊花茶调散等类。先生则佐以荷叶边苦丁茶蔓荆连翘之属以治之。此外感
宜辛散也。内热宜清凉者。如脑热鼻渊。用羚羊山栀石膏滑石夏枯草青菊叶苦丁茶等
类。苦辛凉散郁之法也。久则当用咸降滋填。如虎潜减辛。再加镇摄之品。其有精气不足。
脑髓不固。淋下无腥秽之气者。此劳怯根萌。以天真丸主之。此就案中大概而言之也。然症候
错杂。再当考前贤之法而治之。（华玉堂）
徐评 此等病皆有专治之方。大概以清火驱风保肺为治。于理无害。而药不中 。往往无效。
所以医贵博极群书也。
鲍（十七岁）：鼻塞两三年，闻不到气味。清稀鼻涕从口中呛出。但气机窒塞依然严重。大凡头面部的各个孔窍，都是清阳之气交会通行的地方。如果是外邪侵袭，也必定是雾露般无形质的清冷邪气。邪气郁结日久，气血失去流畅运行。此时进药攻治，必然没有疗效。想要治疗这种病症，必须检查手太阴肺经，从少商穴开始，施以针刺来泄除邪气和阻滞的气机，这是一种治疗方法。（这是清冷邪气郁结日久导致肺气窒塞，缺乏有效方药的情况）
徐（四十岁）：头面部的各个孔窍，都是清阳之气游行的场所。邪气停留在其中，就会造成堵塞。阳气不能主持流行，必然会出现畏寒、形体颓废的症状。内部的痹阻必然郁结而化热，出现鼻梁部流涕或鼻出血。按理应当使用防风通圣散。但因居住在江外，仓促就诊，不可轻易投用此方。采用“轻可去实”的方法。
药材：苦丁茶、干荷叶边、蔓荆子、连翘心、飞滑石、白芷。
毛（十四岁）：热邪壅盛，肺气失于肃降，鼻梁部窒塞痹阻。（这是热邪壅滞肺气所致）
药材：知母、水梨肉、川贝母，用水熬制成膏。
杨：咸味药物沉降并滋阴填精后，鼻渊停止，能够入睡。采用虎潜丸法，减去当归和陈皮，加入天冬、淡菜胶、脊筋丸。（这是脑热导致的鼻渊）
沈（氏）：素来有痰火气逆的毛病。春季时令地中阳气上升，肝木与心火化为风邪上引至头顶。脑部热邪通过清窍向外宣泄，导致耳鸣、鼻渊，左侧症状比右侧更重。因为春季对应肝胆，气火自然从左方上升。适宜清热散郁，用辛凉之品达于头部为主治。
药材：羚羊角、黑山栀、苦丁茶、青菊叶、飞滑石、夏枯草花。
又诊：照原方去掉滑石，加入干荷叶和生石膏。
又诊：性情急躁易怒，阳气动扰太过，气火上冲，郁结在隧道孔窍中，因春深时节病情加重，失去了条达舒展的特性。经文说“春气病在头”。考察五行六气，变化迅速，莫过于火和风。脑部热邪暗中宣泄而成为鼻渊，隧道失和，结成瘿核（甲状腺肿或颈部肿块）。李东垣主张升阳散火，朱丹溪主张总治诸郁，都取用苦辛为法。然而药物只是片刻的疗效，想要长久安宁，以愉悦心志为关键要点。
药材：连翘心、土贝母、海藻、昆布、黑山栀、川芎、小生香附、郁金、羚羊角、夏枯草、干荷叶边。研成细末，用青菊叶汁泛丸，用苦丁茶煎汤送服二钱五分。
汪：形体消瘦，面部尖长，禀受木火之性，阴精不足，脑髓不固，鼻渊液体淋下，并不腥臭。温暖天气稍好，遇冷更严重。这显然是虚证。医生却用风寒中脑来主治，采用发散渗泄的方法，更加耗伤正气，岂能痊愈？反而担心劳损虚弱。使用天真丸。
（这是精气虚损导致的鼻渊）
药材：人参、黄芪、白术、山药、肉苁蓉、当归、天冬、羊肉。
经文说：“肺气和调，则鼻子能辨别香臭。”又说：“胆移热于脑，令人辛酸、鼻渊，进而发展为鼻衄、目盲。”由此可知，初感风寒邪气，久则化热，热邪郁结则气机痹阻而闭塞。治法利于开通上部、宣发郁结，如苍耳散、防风通圣散、川芎茶调散、菊花茶调散等类。先生则佐以荷叶边、苦丁茶、蔓荆子、连翘等物来治疗。此外感邪气宜用辛散方法。内热宜用清凉方法，如脑热鼻渊，用羚羊角、山栀、石膏、滑石、夏枯草、青菊叶、苦丁茶等类，这是苦辛凉散郁的方法。日久则当用咸味沉降、滋阴填精的方法，如虎潜丸减去辛散药，再加镇摄之品。那些精气不足、脑髓不固、流下液体无腥臭之气的，这是劳损虚弱的根由，以天真丸主治。这是就案中大概情况而言。然而症候错杂，再应当考前代贤人的方法而治疗。（华玉堂评注）
徐评：这类疾病都有专门治疗的方剂，大体以清火、驱风、保肺为治疗原则，在理法上没有害处。但药物不对症，往往无效。所以医学贵在博览群书。
Bao (17 years old): Nasal congestion for two or three years, unable to smell. Clear thin mucus spurts out from the mouth. However, the qi obstruction remains severe. Generally, all orifices of the head and face are places where clear yang qi converges and circulates. If attacked by external pathogens, it must be clear pathogens without substantial form, like fog or dew. After the pathogen has been depressed for a long time, qi and blood lose their smooth flow. Administering drugs to attack and treat at this stage will inevitably yield no effect. To treat this condition, one must examine the Hand-Taiyin Lung Meridian, starting from the Shaoshang acupoint, and apply acupuncture to drain the pathogenic qi and stagnant flow; this is one method. (This refers to clear pathogen depression over a long period causing lung qi obstruction, lacking an effective prescription.)
Xu (40 years old): All orifices of the head and face are places where clear yang qi travels. When pathogens reside in the middle, they cause blockage. Yang qi fails to govern circulation, inevitably leading to aversion to cold and a decadent physical appearance. Internal bi-syndrome must depress and transform into heat, resulting in rhinorrhea or epistaxis from the nasal bridge. Theoretically, Fangfeng Tongsheng San should be used. However, due to residing outside the river region and seeking medical attention hastily, it cannot be lightly administered. Use the method of "lightness can remove excess."
Herbs: Kudinchá (Ilex kudingcha), Dry Lotus Leaf Edge, Manjingzi (Vitex fruit), Lianqiao Xin (Forsythia heart), Fei Huashi (Prepared Talcum Powder), Baizhi (Angelica dahurica).
Mao (14 years old): Heat accumulation, lung qi fails to descend, nasal bridge obstruction and bi-syndrome. (Caused by heat accumulation in lung qi)
Herbs: Zhimu (Anemarrhena Rhizome), Water Pear Flesh, Chuanbeimu (Fritillaria cirrhosa), boiled with water to make an ointment.
Yang: After using salty substances to sink and nourish/fill, the nose discharge (Bi Yuan) stopped, and sleep was achieved. Use the Hujian Wan method, reduce Danggui and Chenpi, add Tiandong, Dancai Jiao, and Jijin Wan. (Brain heat causing Bi Yuan)
Shen (Lady): Suffering from phlegm-fire and rebellious qi since early on. In spring, yang qi rises from the earth, liver wood and heart fire transform into wind, drawing upwards to the vertex. Brain heat vents through the clear orifices, causing tinnitus and Bi Yuan, worse on the left side. Since spring corresponds to Liver and Gallbladder, qi and fire naturally rise from the left. It is suitable to clear heat and scatter depression, using acrid-cool substances reaching the head as the main treatment.
Herbs: Lingyangjiao (Antelope Horn), Heishanzhi (Gardenia Fruit), Kudinchá, Qingjuye (Chrysanthemum Leaf), Fei Huashi, Xiakucao Hua (Prunella Flower).
Second visit: Follow the original formula, remove Huashi, add Gan He Ye and Sheng Shigao.
Third visit: The temperament is irritable and impatient, yang movement is excessive, qi and fire ascend, depressing in the tunnels and orifices. The condition worsens in late spring, losing its free-flowing nature. The classics state, "Spring diseases affect the head." Examining the Five Elements and Six Qi, changes are rapid, none more so than fire and wind. Brain heat secretly vents becoming Bi Yuan, the tunnels lose harmony, forming goiters/nodules. Li Dongyuan advocated raising yang and scattering fire; Zhu Danxi advocated treating all depressions generally, both taking bitter and acrid methods. However, medicines only provide temporary effects. To achieve long-term peace, pleasing the mind and spirit is the key principle.
Herbs: Lianqiao Xin, Tubei Mu, Haizao, Kunbu, Heishanzhi, Chuanxiong, Xiaosheng Xiangfu, Yujin, Lingyangjiao, Xiakucao, Gan He Ye Bian. Ground into fine powder, pilled with juice of fresh Qingjuye, taken with Kudinchá decoction, 2.5 qian per dose.
Wang: Thin body, pointed and long face, inheriting Wood-Fire constitution, insufficient yin essence, unstable brain marrow, Bi Yuan dripping down, not foul-smelling. Slightly stops in warm weather, worsens when cold. This is clearly a deficiency syndrome. Physicians treated it as Wind-Cold attacking the brain, using dispersing and draining methods, further consuming healthy qi. How could it heal? Instead, worry about consumptive weakness. Use Tianzhen Wan.
(Deficiency of essence causing Bi Yuan)
Herbs: Renshen, Huangqi, Baizhu, Shanyao, Congrong, Danggui, Tiandong, Lamb meat.
The classics say: "When Lung qi is harmonious, the nose can distinguish odors." It also says: "Gallbladder transferring heat to the brain causes sour pain, Bi Yuan, transmitting to epistaxis and blindness." Thus, we know that initially contracting Wind-Cold pathogens, after a long time, transforms into heat. Heat depression causes qi obstruction and blockage. Treatment methods favor opening the upper jiao and venting depression, such as Cang'er San, Fangfeng Tongsheng San, Chuanxiong Chatiao San, Juhua Chatiao San, etc. Mr. Ye supplemented these with He Ye Bian, Kudinchá, Manjingzi, Lianqiao, etc., to treat them. For external pathogens, acrid dispersal is appropriate. For internal heat, cooling is appropriate. For example, for Brain Heat Bi Yuan, use Lingyangjiao, Shanzhi, Shigao, Huashi, Xiakucao, Qingjuye, Kudinchá, etc., which is the method of bitter-acrid-cool dispersion of depression. Over time, salty sinking and nourishing/filling methods should be used, such as Hujian Jianxin (Hujian Wan modified), removing acrid herbs, adding settling/subduing products. Those with insufficient essence and qi, unstable brain marrow, dripping without foul odor, have the root of consumptive weakness, treated with Tianzhen Wan. This summarizes the general cases. However, symptoms are complex; one must consult the methods of former sages for treatment. (Commentary by Hua Yutang)
Xu's Commentary: These diseases have specific prescriptions for treatment. Generally, clearing fire, driving away wind, and protecting the lung are the principles, which do no harm to theory. But if the medicine does not hit the target, it is often ineffective. Therefore, medicine values extensive study of books.