天津黄××，年二十岁，得神经错乱病。
病因 因心中忿郁，久之遂致神经错乱。
证候 心中满闷发热，不思饮食，有时下焦有气上冲，并觉胃脘之气亦随之上冲，遂致精神
昏瞀，言语支离，移时觉气消稍顺，或吐痰数口，精神遂复旧。其左脉弦而硬，右脉弦而
长，两尺皆重按不实，一息五至。
诊断 此乃肝火屡动，牵引冲气胃气相并上冲，更挟痰涎上冲以滞塞于喉间并冲激其脑部，是以
其神经错乱而精神言语皆失其常也。其左脉弦硬者，肝血虚而火炽盛也。右脉弦长者，冲气挟胃气上
冲之现象也。方书论脉有直上直下冲脉昭昭之语，所谓直上直下者，即脉弦且长之形状也。其两尺不实
者，下焦之气化不固也，因下焦有虚脱之象，是以冲气易挟胃气上冲也。此当治以降胃、敛冲、镇
肝之剂，更兼用凉润滋阴之品，以养肝血，清肝热，庶能治愈。
处方 生赭石（一两轧细） 灵磁石（五钱轧细） 生怀山药（八钱） 生龙骨（八钱捣碎）
生杭芍（六钱） 玄参（五钱） 柏子仁（五钱） 云苓片（三钱）
清半夏（三钱） 石菖蒲（三钱） 生远志（二钱） 镜面砂（三分研细）
药共十二味，将前十一味煎汤一大盅，送服朱砂细末。
复诊 将药连服四剂，满闷发热皆大见愈，能进饮食，有时气复上冲而不复上干神经至于
错乱，左右之脉皆较前平和，而尺部仍然欠实，拟兼用培补下元之品以除病根。
处方 生赭石（一两轧细） 熟怀地黄（八钱） 生怀山药（八钱） 大甘枸杞（六钱）
净萸肉（五钱） 生杭芍（四钱） 玄参（四钱） 云苓片（二钱）
共煎汤一大盅，温服。
效果 将药连服六剂，诸病皆愈，脉亦复常。
或问 地黄之性粘腻生痰，胃脘胀满，有痰者多不敢用，今重用之何以能诸病皆愈？答曰∶用药
如用兵，此医界之恒言也，如宋八字军最弱，刘 将之即为劲卒，遂能大败金人奏顺昌
之捷，以斯知兵无强弱，在用之者何如耳。至用药亦何独不然，忆曾治一李姓媪，胃口
满闷有痰，其脉上盛下虚，投以肾气丸作汤服，为加生赭石八钱，服后觉药有推荡之力，须
臾胸次豁然，肾气丸非重用地黄者乎？然如此用药非前无师承而能有然也。《金匮》云∶短气有微饮
当从小便去之，苓桂术甘汤主之，肾气丸亦主之。夫饮即痰也，气短亦近于满
闷，而仲师竟谓可治以肾气丸，愚为于《金匮》曾熟读深思，故临证偶有会心耳。
天津黄某某，二十岁，患神经错乱病。
证候 心中胀满闷痛且发热，不想进食，有时下焦有气向上冲逆，并感觉胃脘之气也随之上冲，于是导致精神昏沉迷糊，言语支离破碎，过一会儿觉得气消解后稍显顺畅，或者吐出几口痰，精神便恢复如常。其左脉弦而硬，右脉弦而长，两尺脉重按均不实，一息五至（脉搏频率正常）。
诊断 这是肝火屡次妄动，牵引冲气和胃气相并而上冲，更挟带痰涎上冲以滞塞于喉间并冲激脑部，因此导致神经错乱，精神和言语都失去常态。其左脉弦硬，是肝血虚而火势炽盛的表现。右脉弦长，是冲气挟带胃气上冲的现象。医书论述脉象有“直上直下，冲脉昭昭”的说法，所谓“直上直下”，即指脉象弦且长的形态。其两尺脉不实，是下焦气化功能不固的表现，因为下焦有虚脱之象，所以冲气容易挟带胃气上冲。此症应当用降胃、敛冲、镇肝的方剂治疗，同时兼用凉润滋阴的药物，以滋养肝血，清泻肝热，这样才能治愈。
处方 生赭石（一两轧细） 灵磁石（五钱轧细） 生怀山药（八钱） 生龙骨（八钱捣碎） 生杭芍（六钱） 玄参（五钱） 柏子仁（五钱） 云苓片（三钱） 清半夏（三钱） 石菖蒲（三钱） 生远志（二钱） 镜面砂（三分研细）
药共十二味，将前十一味煎汤一大盅，送服朱砂细末。
复诊 将药连续服用四剂，胀满发热症状大多痊愈，能够进食，有时气再次上冲但不再干扰神经导致错乱，左右脉象都比之前平和，但尺部仍然欠实，打算兼用培补下元的药物以除病根。
处方 生赭石（一两轧细） 熟怀地黄（八钱） 生怀山药（八钱） 大甘枸杞（六钱） 净萸肉（五钱） 生杭芍（四钱） 玄参（四钱） 云苓片（二钱）
共煎汤一大盅，温服。
效果 将药连续服用六剂，所有病症皆愈，脉象也恢复正常。
或问 地黄的性质粘腻易生痰，对于胃脘胀满、有痰者多不敢使用，如今重用它能使得诸病皆愈吗？答曰：用药如同用兵，这是医学界的常言。如宋代八字军最弱，刘锜统领后即成为精锐士兵，于是大败金人取得顺昌大捷，由此可知军队无强弱之分，关键在于使用者如何运用。至于用药又何尝不是如此？回忆曾治疗一位李姓老妇人，胃口胀满且有痰，其脉象上盛下虚，投以肾气丸改作汤剂服用，并加入生赭石八钱，服药后感觉药力有推荡之力，须臾之间胸中豁然开朗。肾气丸不是重用了吗？然而如此用药并非没有师承就能做到的。《金匮要略》说：“短气伴有轻微水饮，应当从小便排出，苓桂术甘汤主之，肾气丸亦主之。”夫水饮即痰，气短也接近于胀满，而张仲景竟说可以用肾气丸治疗，我因为对《金匮要略》曾经熟读深思，所以在临证时偶尔有所领悟罢了。
Tianjin patient Huang XX, aged twenty, suffered from mental derangement (neurosis).
Etiology: Due to prolonged resentment and depression in the heart, this eventually led to mental derangement.
Symptoms: The patient experienced fullness, oppression, and heat in the chest, loss of appetite, and sometimes Qi rushing upward from the lower Jiao. He also felt that Qi from the epigastrium rushed up along with it, leading to mental confusion and disjointed speech. After a while, when the Qi subsided slightly, he would feel more comfortable, or after expectorating a few mouthfuls of phlegm, his spirit would return to normal. His left pulse was wiry and hard; the right pulse was wiry and long; both Chi pulses were empty upon heavy pressure. The breathing rate was five beats per respiration cycle.
Diagnosis: This is caused by Liver Fire repeatedly stirring, dragging the Chong Qi and Stomach Qi to rush upward together, further carrying Phlegm-Fluids upward to obstruct the throat and irritate the brain. Consequently, the nerves are deranged, and both spirit and speech lose their normal state. The wiry and hard left pulse indicates Liver Blood deficiency with blazing Fire. The wiry and long right pulse is a manifestation of Chong Qi carrying Stomach Qi upward. Medical texts describe the pulse as "straight up and down, clearly showing the Chong Mai"; what is meant by "straight up and down" is the shape of a wiry and long pulse. The emptiness of both Chi pulses indicates instability of Qi transformation in the lower Jiao. Because there is a sign of collapse in the lower Jiao, the Chong Qi easily carries Stomach Qi upward. Treatment should employ agents to descend Stomach Qi, restrain Chong Qi, and pacify the Liver, combined with cooling, moistening, and Yin-nourishing herbs to nourish Liver Blood and clear Liver Heat, so that a cure may be achieved.
Prescription:
Sheng Zhe Shi (Raw Hematite, 1 liang, finely crushed)
Ling Ci Shi (Spiritual Magnetite, 5 qian, finely crushed)
Sheng Huai Shan Yao (Raw Chinese Yam, 8 qian)
Sheng Long Gu (Raw Dragon Bone, 8 qian, crushed)
Sheng Hang Shao (Raw White Peony Root, 6 qian)
Xuan Shen (Scrophulariae Radix, 5 qian)
Bai Zi Ren (Biota Seed, 5 qian)
Yun Ling Pian (Poria Slices, 3 qian)
Qing Ban Xia (Processed Pinellia Tuber, 3 qian)
Shi Chang Pu (Acori Tatarinowii Rhizome, 3 qian)
Sheng Yuan Zhi (Raw Polygala Root, 2 qian)
Jing Mian Sha (Refined Cinnabar, 3 fen, finely ground)
Twelve ingredients in total. Decoct the first eleven ingredients in one large bowl of water, and take with fine powder of Zhu Sha (Cinnabar).
Follow-up Visit: After taking four doses consecutively, the fullness and heat largely resolved, and the patient could eat. Although Qi occasionally rushed upward again, it no longer interfered with the nerves to cause derangement. The pulses on both sides became more peaceful compared to before, but the Chi position remained insufficient. It is proposed to additionally use herbs to tonify the Lower Origin to eliminate the root of the disease.
Prescription:
Sheng Zhe Shi (Raw Hematite, 1 liang, finely crushed)
Shu Huai Di Huang (Prepared Rehmannia Root, 8 qian)
Sheng Huai Shan Yao (Raw Chinese Yam, 8 qian)
Da Gan Gou Qi (Large Sweet Goji Berry, 6 qian)
Jing Yu Rou (Clean Cornus Fruit, 5 qian)
Sheng Hang Shao (Raw White Peony Root, 4 qian)
Xuan Shen (Scrophulariae Radix, 4 qian)
Yun Ling Pian (Poria Slices, 2 qian)
Decoct all ingredients in one large bowl of water and take warm.
Outcome: After taking six doses consecutively, all diseases were cured, and the pulse returned to normal.
Question: The nature of Di Huang (Rehmannia Root) is sticky and cloying, prone to generating Phlegm; patients with epigastric distension and Phlegm often dare not use it. How can its heavy use here lead to the cure of all diseases?
Answer: Using medicine is like using troops; this is a common saying in the medical field. For example, the Song Dynasty's Eight Character Army was the weakest, but under the command of Liu Qi, they became elite soldiers and defeated the Jin army decisively at Shunchang. From this, we know that troops have no inherent strength or weakness; it depends on how they are used. Is it not the same for medicine? I recall treating an elderly surnamed Li who had epigastric fullness and Phlegm, with a pulse indicating excess above and deficiency below. I prescribed Shen Qi Wan (Kidney Qi Pill) modified as a decoction, adding 8 qian of Sheng Zhe Shi (Raw Hematite). After ingestion, she felt the pushing and draining power of the medicine, and suddenly her chest felt open and clear. Did Shen Qi Wan not heavily use Di Huang? However, such prescription logic cannot be achieved without prior transmission of knowledge. *Jin Gui Yao Lue* states: "For shortness of breath accompanied by slight fluid retention, it should be eliminated through urination; Ling Gui Zhu Gan Tang is the primary formula, and Shen Qi Wan is also indicated." Fluid retention is Phlegm, and shortness of breath is close to fullness/oppression. Yet Master Zhang Zhongjing explicitly stated it could be treated with Shen Qi Wan. Having studied and pondered deeply over *Jin Gui Yao Lue*, I occasionally gained insight during clinical practice.