（附∶脑髓空治法）
脑贫血者，其脑中血液不足，与脑充血之病正相反也。其人常觉头重目眩，精神昏愦，或面黄唇白、或呼
吸短气、或心中怔忡。其头与目或间有作疼之时，然不若脑充血者之胀疼，似因有收缩之感觉而作疼。其
剧者亦可猝然昏仆，肢体颓废或偏枯。其脉象微弱，或至数兼迟。西人但谓脑中血少，不能荣养脑筋，以
致脑失其司知觉、司运动之机能。然此证但用补血之品，必不能愈。《内经》则谓“上气不足，脑为之不
满”，此二语实能发明脑贫血之原因，并已发明脑贫血之治法。盖血生于心，上输于脑（心有四血脉管通脑）。
然血不能自输于脑也。《内经》之论宗气也，谓宗气积于胸中，以贯心脉，而行呼吸，由此知胸中宗气，不
但为呼吸之中枢，而由心输脑之血脉管亦以之为中枢。今合《内经》两处之文参之，知所谓上气者，即宗
气上升之气也。所谓上气不足脑为之不满者，即宗气不能贯心脉以助之上升，则脑中气血皆不足
也。然血有形而气无形，西人论病皆从实验而得，故言血而不言
气也。因此知脑贫血治法固当滋补其血，尤当峻补其胸中宗气。以助其血上行。持此以论古方，则补血汤重
用黄 以补气、少用当归以补血者，可为治脑贫血之的方矣。今录其方于下并详论其随证宜加之药品。
生箭 一两、当归三钱。呼吸短气者，加柴胡、桔梗各二钱。不受温补者，加生地、玄参各四钱。素畏
寒凉者，加熟地六钱、干姜三钱。胸有寒饮者，加干姜三钱、广陈皮二钱。
《内经》∶“上气不足，脑为之不满”二语，非但据理想象也，更可实征诸囟门未合之小儿。《灵枢》五
味篇谓“大气抟于胸中，赖谷气以养之，谷不入半日则气衰，一日则气少”，大气即宗气也。观小儿慢惊
风证，脾胃虚寒，饮食不化，其宗气之衰可知。更兼以吐泻频频，虚极风动，其宗气不能助血上升以灌注于脑
更可知。是以小儿得此证者，其囟门无不塌陷，此非上气不足头为不满之明征乎？王勉能谓∶“小儿慢惊风
证，其脾胃虚寒，气血不能上朝脑中，既有贫血之病，又兼寒饮填胸，其阴寒之气上
冲脑部，激动其脑髓神经，故发痫痉”，实为通论。
方书谓∶真阴寒头疼证，半日即足损命。究之此证实兼因宗气虚寒，不能助血上升，以致脑中贫血乏气，
不能御寒，或更因宗气虚寒之极而下陷，呼吸可至顿停，故至危险也。审斯，知欲治此证，拙拟回阳升
陷汤可为治此证的方矣。若细审其无甚剧之实寒者，宜将干姜减半，或不用亦可。
《内经》论人身有四海，而脑为髓海。人之色欲过度者，其脑髓必空，人之脑髓空者，其人亦必头
重目眩，甚或猝然昏厥，知觉运动俱废，因脑髓之质原为神经之本源也。其证实较脑贫血尤为紧要。治之者，
宜用峻补肾经之剂，加鹿角胶以通督脉。并宜清心寡欲，按此服药不辍，还精补脑之功自能收效于数旬中也。
（附：脑髓空虚的治法）
脑贫血，是指脑中血液不足，这与脑充血病症正好相反。患者常感觉头重目眩，精神昏沉困倦，或者面色发黄、嘴唇苍白，或者呼吸短促气弱，或者心中悸动不安。其头部和眼睛有时也会疼痛，但不像脑充血那样胀痛，似乎是因为有收缩的感觉而引发疼痛。病情严重的，也可能突然昏倒仆地，肢体痿废无力或半身不遂。其脉象微弱，或者脉搏次数兼带迟缓。西医只说脑中血少，不能滋养脑筋，从而导致脑部失去主管知觉和主管运动的机能。然而此证如果只用补血药物，必定不能痊愈。《黄帝内经》则说“上气不足，脑为之不满”，这两句话实际上阐明了脑贫血的原因，并且也阐明了脑贫血的治疗方法。因为血由心生，向上输送到脑部（心脏有四条血脉管连通脑部）。但是血不能自行输送到脑部。《黄帝内经》关于宗气的论述，说宗气积聚在胸中，贯通心脉，并推动呼吸，由此可知胸中的宗气，不仅是呼吸的中枢，而且由心脏输送血液到脑部的血脉管也以它为中枢。现在结合《黄帝内经》两处文字参合来看，知道所谓“上气”，就是宗气上升之气。所谓“上气不足，脑为之不满”，就是宗气不能贯通心脉来帮助血液上升，那么脑中气血就都不足了。然而血是有形的，气是无形的，西医论病都是从实验得出的，所以只谈血而不谈气。因此知道治疗脑贫血的方法固然应当滋补血液，尤其应当峻补胸中的宗气，以助血液上行。用这个观点来讨论古方，那么补血汤重用黄芪以补气、少用当归以补血，可以说是治疗脑贫血的确切方剂了。现将此方录于下方，并详细论述根据症状适宜加入的药物。
生黄芪一两、当归三钱。呼吸短气的，加柴胡、桔梗各二钱。不耐受温补的，加生地、玄参各四钱。平素畏寒凉的，加熟地黄六钱、干姜三钱。胸中有寒饮停聚的，加干姜三钱、广陈皮二钱。
《黄帝内经》：“上气不足，脑为之不满”这两句话，不仅仅是凭理想想象，更可以在囟门未闭合的小儿身上得到实证。《灵枢·五味篇》说“大气聚集在胸中，依赖谷气来供养它，半天不吃东西气就会衰弱，一天不吃东西气就会减少”，这里的大气就是宗气。观察小儿慢惊风病症，脾胃虚寒，饮食不化，其宗气衰弱的情况就可以知道了。再加上频繁呕吐腹泻，极度虚弱导致内风妄动，其宗气不能帮助血液上升灌注到脑部，这也可以知道了。因此小儿患此证的，其囟门没有不塌陷的，这难道不是上气不足头部得不到充养的确凿证据吗？王勉能说：“小儿慢惊风证，是脾胃虚寒，气血不能上朝注于脑中，既有贫血的病状，又兼寒饮填塞胸中，阴寒之气上冲脑部，激动其脑髓神经，所以发生癫痫痉挛”，这实在是通达全面的论述。
医书说：真阴寒头痛证，半天就能足以致命。究其实，此证确实兼因宗气虚寒，不能帮助血液上升，导致脑中贫血乏气，不能抵御寒冷，或者更因宗气虚寒到了极点而下陷，呼吸甚至可以瞬间停止，所以非常危险。审视这一点，就知道想要治疗此证，我拟定的回阳升陷汤可以作为治疗此证的确切方剂了。如果仔细审查其没有特别剧烈的实寒症状，可以将干姜减半，或者不用也可以。
《黄帝内经》论述人身有四海，而脑为髓海。人的色欲过度者，其脑髓必然空虚，人的脑髓空虚者，其人必然也头重目眩，甚至突然昏厥，知觉和运动全部废止，因为脑髓的本质原本就是神经的本源。此证比脑贫血更为紧要。治疗者，应当使用峻补肾经的药剂，加入鹿角胶以疏通督脉。并且应当清心寡欲，按照此方服药不停止，还精补脑的功效自然能在数十日内收到效果。
(Attachment: Treatment Method for Empty Brain Marrow)
Brain anemia refers to a deficiency of blood in the brain, which is exactly opposite to the disease of cerebral hyperemia (brain congestion). Patients often feel heavy-headed and dizzy, with mental confusion and lethargy; or they may have a sallow complexion and pale lips; or suffer from shortness of breath; or experience palpitations. Their head and eyes may occasionally hurt, but unlike the distending pain of cerebral hyperemia, it seems to arise from a sensation of contraction. In severe cases, one may suddenly faint and fall, with limbs becoming flaccid or hemiplegic. The pulse is weak, or slow in rate. Western medicine only states that there is insufficient blood in the brain, failing to nourish the brain nerves, thereby causing the brain to lose its functions of perception and movement. However, this condition cannot be cured by using only blood-nourishing substances. The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states, "When the upper qi is insufficient, the brain feels empty." These two phrases actually elucidate the cause of brain anemia and also reveal its treatment method. Blood is generated by the Heart and transported upward to the brain (the Heart has four blood vessels connecting to the brain). However, blood cannot transport itself to the brain. Regarding Zongqi (Pectoral Qi), the *Neijing* states that Zongqi accumulates in the chest, penetrates the heart vessels, and governs respiration. From this, we know that Zongqi in the chest is not only the center of respiration but also the center for the blood vessels transporting blood from the Heart to the brain. Combining these two passages from the *Neijing*, we understand that "upper qi" refers to the ascending aspect of Zongqi. "When upper qi is insufficient, the brain feels empty" means that when Zongqi fails to penetrate the heart vessels to assist in ascending, both blood and qi in the brain become insufficient. Since blood is tangible and qi is intangible, Western pathology is derived from experiments, hence discussing blood but not qi. Therefore, the treatment for brain anemia should indeed tonify blood, but even more importantly, it must vigorously tonify the Zongqi in the chest to assist blood in ascending. Applying this principle to ancient formulas, Buxue Tang (Blood-Nourishing Decoction), which uses a heavy dose of Huangqi (Astragali Radix) to tonify qi and a small dose of Danggui (Angelicae Sinensis Radix) to tonify blood, can be considered the specific formula for treating brain anemia. The formula is recorded below, along with a detailed discussion on appropriate additions based on symptoms.
Sheng Huangqi (Raw Astragali Radix) 1 liang, Danggui (Angelicae Sinensis Radix) 3 qian. For shortness of breath, add Chaihu (Bupleuri Radix) and Jiegeng (Platycodonis Radix), each 2 qian. For those who cannot tolerate warm-tonifying herbs, add Shengdi (Rehmanniae Radix) and Xuanshen (Scrophulariae Radix), each 4 qian. For those who generally fear cold and cool properties, add Shudi (Prepared Rehmanniae Radix) 6 qian and Ganjiang (Zingiberis Rhizoma) 3 qian. For cold-fluid retention in the chest, add Ganjiang (Zingiberis Rhizoma) 3 qian and Guang Chenpi (Citri Reticulatae Pericarpium) 2 qian.
The statement in the *Neijing*: "When upper qi is insufficient, the brain feels empty," is not merely theoretical imagination but can be empirically verified in infants whose fontanelles have not yet closed. The *Lingshu · Wuwei Chapter* states, "The great qi gathers in the chest, relying on grain qi to nourish it; if no food is taken for half a day, qi becomes weak; if not taken for a day, qi becomes scarce." Here, "great qi" refers to Zongqi (Pectoral Qi). Observing the syndrome of slow convulsions in children (Xiao'er Man Jingfeng), where Spleen-Stomach deficiency-cold leads to undigested food, the weakness of Zongqi can be understood. Furthermore, with frequent vomiting and diarrhea leading to extreme deficiency and internal wind stirring, it is evident that Zongqi cannot assist blood in ascending to irrigate the brain. Therefore, in infants suffering from this condition, the fontanelle invariably collapses. Is this not clear evidence that insufficient upper qi fails to fill the head? Wang Mianeng stated: "In the syndrome of slow convulsions in children, Spleen-Stomach deficiency-cold prevents qi and blood from ascending to the brain; besides having anemia, there is also cold-fluid filling the chest. The yin-cold qi rushes upward to the brain, agitating the brain marrow nerves, thus causing epilepsy and spasms." This is indeed a comprehensive and accurate discussion.
Medical texts state that the syndrome of true yin-cold headache can be fatal within half a day. Upon investigation, this syndrome is indeed complicated by deficiency-cold of Zongqi, which fails to assist blood in ascending, resulting in brain anemia and lack of qi, making the brain unable to resist cold. Or, due to extreme deficiency-cold of Zongqi sinking downward, respiration may even cease abruptly, rendering it dangerous. Understanding this, to treat this syndrome, my proposed Huiyang Shengxian Tang (Decoction to Restore Yang and Raise Collapsed Qi) can serve as the specific formula. If carefully examined that there are no severe excess-cold symptoms, the dosage of Ganjiang (Zingiberis Rhizoma) can be halved or omitted entirely.
The *Neijing* discusses that the human body has four seas, with the brain being the Sea of Marrow. Those who indulge excessively in sexual desires will inevitably have empty brain marrow. Those with empty brain marrow will inevitably suffer from heavy-headedness and dizziness, or even sudden syncope, with loss of perception and movement, because the substance of brain marrow is originally the root of the nerves. This syndrome is more critical than brain anemia. Treatment should employ potent formulas to tonify the Kidney Meridian, added with Lujiaojiao (Deer Antler Glue) to unblock the Du Mai (Governing Vessel). One should also practice purity of mind and reduce desires. By continuously taking this medication, the merit of returning essence to nourish the brain will naturally yield results within several weeks.