（即名高氏遗书。东庄已述之医贯批中。但此详于彼。故从谢达宸本抄附。）
归脾汤
治脾经失血。少寐。发热。盗汗。或思虑伤脾。不能摄血。以致妄行。或健忘怔忡。惊悸不
寐。或心脾伤痛。嗜卧。少食。或忧思伤脾。血虚发热。或肢体作痛。大便不调。或女子经候不
准。晡热内热。或瘰 流注。不能消散溃敛。
归身（炙） 远志（炒研） 枣仁 茯神 人参（炙） 黄 （土炒）
白术 龙眼 煨甘草（炙） 木香（呕血归脾全在此味） 姜枣引。
此方乃严用和所造。其对症则二阳之病发心脾也。盖欲补脾。则先补心。欲补心。则先补肝
。所谓隔二之治。赵氏论之详矣。然往往用之于吐血咳嗽寒热。木香多不合。以其香燥反能动肝
火而燥津液。予每去
之。而加白芍以追已散之真阴。颇称稳当。且肺受火刑。白术太燥。恐反助嗽。得芍药之阴以为
佐。亦是妙于配合。如肺肾受伤。再加麦冬五味。肝肾受伤。则芍药更为有益。如从拂郁而起。
则加柴胡丹皮山栀。如非二阳之病至怔忡。则去木香。加枸杞麦冬五味之属。如梦遗。则加五味
熟地白芍牡蛎之属。如怔忡而实挟包络一种有余之火兼痰者。则加黄连生地贝母之类以清之。梦
遗而挟相火者。加黄柏知母麦冬以清之。惟脾虚久泻而不止者。方留木香以醒脾。脾虚而挟寒者
。虽肉果桂附等类。皆可加也。阳虚盗汗。脉四至以内。奄奄不起。惺惺不寐。此方亦是对症要
药。亦可变为养荣加减。
甘露饮
治大人小儿。胸中客热。牙宣口臭。齿龈肿烂。时出脓血。目睑垂重。常欲合闭。或即饥烦
。不欲饮食。及目赤肿痛。不任凉药。口舌生疮。咽喉肿痛。疮疹已发。皆可服之。又治脾胃受
湿。瘀热在里。或醉饱房劳。湿热相搏。致生疸病。身目皆黄。肢体微肿。胸满气短。大便不调
。小便黄涩。或时身热。并皆治之。
生地 熟地 天冬 麦冬 黄芩 石斛 枳壳
茵陈 枇杷叶 甘草
小甘露饮
治脾劳实热。身体面目悉黄。舌干咽喉肿痛。
山栀 黄芩 生地 升麻 桔梗 茵陈 石斛
甘草
此方创自洁古老人。丹溪以为此心肺胃三经药也。主治胸中客热。口臭齿烂。心烦咽疮等症
。许学士又去门冬加犀角。主治与上略同。别如赤眼并一切疮疡。已散未散。皆可治之。然小甘
露去熟地二冬者。以手阳明与肾无相关之势。故加桔梗。使与里合。治胃则以肾为关。故加熟地二
冬也。按此方以固本丸为症。而加入他药。原因胃中湿热。下流归坎。则水源浊泛。故见症如此
。而当日立方之意。实从救肾起见。清胃者自清胃。而救原者仍救原。丹溪止言心肺胃。犹未是
全论。予每于肝经有郁火者。亦以此方加丹皮山栀。去石斛甘草枇杷叶。亦无不应验。则知水木
同原之义。若原有胃火。而又挟肝木之势者。竟以原方不减。而但加丹皮山栀等味。亦无不效也
。丹溪言肺最妙。然必须列症中云大便干燥。才合手足阳明两经之药耳。至一变而为小甘露。去
枇杷叶熟地二冬枳壳。而加升麻桔梗栀子。则手阳明实症通治之义全见矣。火盛渴甚者。加知母
。走马疳而急者。加石膏黄连。火蚀既久。元气虚者。加人参。真胃中燥火之神剂也 。
清脾饮
治瘅疟。脉弦数。但热不寒。或热多寒少。膈满不食。口苦。舌干。烦渴。小便黄赤。大便
不利。
青皮 浓朴 草果 柴胡 黄芩 半夏 茯苓
白术 甘草 姜引。
此严用和所造治疟方也。治疟多方。俱不得要。惟此方为中正。予每用此加减。无不愈者。
盖疟发寒热。原属少阳半表半里。故必以小柴胡为君。青皮以解脉之弦数。浓朴以宽胃中之积滞
。草果以化痰消壅。苓术以实脾土。此二味乃补正之义。缘疟固由外感。然必内伤而后外始感焉
。此东垣之微旨也。严氏立方。最为的当。但竟由饮食起者。予每以苍术易白术。加陈皮以合平
胃之意。热多寒少者。稍加黄连滑石。寒多热少者。稍加前胡以发其郁热。无不应手而验。能审
此而消息之。何至迁延久病。困苦天下人哉。若误服汤药病久者。不可执此为不易之法。是在学
者神明之耳。如服寒药而致胃伤者。须以人参养胃汤养之。服热药多者。仍以小柴胡汤。多加黄
连丹皮生地以解之。久而虚者。补中益气以救之。发于夜者。四物汤益母草饮（一名香红饮）
以济之。用法虽殊。然小柴胡之旨。不可脱也。
六味地黄丸
治肾经不足。发热作渴。小便淋闭。气壅痰嗽。头目眩晕。眼花耳聋。咽燥舌痛。齿牙不固。腰
腿痿软。自汗盗汗。便血诸血。失音水泛为痰。血虚发热等症。其功不能尽述。
熟地 山药 萸肉 丹皮 茯苓 泽泻
张仲景立八味丸。治汉元帝三阴疟。至宋时钱仲阳。始去桂附。变而为六味。以治小儿。盖
以小儿纯阳。无补阳之法。倘或先天不足。行迟脚软。阴虚发热。则用六味以补之。此仲阳变法
也。乃薛氏则因此悟到大方。亦当以此补阴。而丹溪之补阴丸始废。然其方虽列于医案中。而未
尝发明其为救阴之的剂也。至赵氏始大阐薛氏用此方之意。而以为圣方神剂。又不止治阴虚发热
之一法。触处旁通。无不立应。而学人始善于用六味矣。然浙东惟四明医家。承受赵氏之学人多。
为善于用。浙西惟张卿子。亦稍用之。沿及三吴。不能解也。即读赵氏书者。亦懵然不觉。然赵
氏加减之法甚严。又非薛氏之意矣。今录两家加减之法于后。并附愚意。惟学人择之。
薛氏治妇女郁怒伤肝脾。以致小便淋漓不利。月经不调。两胁胀闷。小腹作痛。寒热往来。
胸乳作痛。左关弦洪。右关弦数。此郁怒伤肝脾。血虚气滞为患。则变为滋肾生肝饮。
熟地 山药 萸肉 丹皮 茯苓 泽泻 五味 当归 柴胡 白术 甘草
原用六味双对减半分两。而加柴胡白术甘草当归五味。合逍遥而去白芍。加五味者。合都气
意也。以生肝。故去白芍。而留白术甘草以补脾。补脾者。生金以制木也。以制为生。天地自然
之序也。又一变而为滋阴肾气丸。治目神水宽大渐散。或如雾露中行。渐睹空中有黑花。视物二
体。久则光不收。及内障。神水淡白色。
熟地 山药 丹皮 茯苓 泽泻 生地 归尾 柴胡
上为丸。辰砂为衣。每服十丸。白滚汤下。
独去山萸肉。而加柴胡生地归尾五味。仍合逍遥都气。肝肾同治。然用归尾生地者。行瘀滞
也。柴胡者。疏木气也。去白芍者。恐妨于行之疏之也。名滋阴者。厥阴也。皆用五味者。虽合
都气。然实防木之反克。泻丁之义也。去萸肉者。不欲强木也。
又一变而为人参补肺汤。治肾水不足。虚火上炎。咳唾脓血。发热作渴。小便不调。
熟地 山药 萸肉 丹皮 茯苓 人参 麦冬
五味 当归 黄 （蜜炙） 白术 陈皮 甘草（蜜炙）姜引。
其义愈变化无穷。真游龙戏水之妙也。去泽泻而加参 归术麦冬五味陈皮甘草。夫白术之与
六味。其化相反。焉得合之。曰从合生脉来。则有自然相通之义。借茯苓以合五味异功之妙。用
归以合养血之奇。其不用泽泻者。盖为发热作渴。小便不调。则无再竭之理。理无再竭。盒饭
急生。生脉之所由来也。既当生脉。则异功可以转入矣。且水生高原。气化能出。肺气将败。故
作渴不调。此所以急去泽泻。而生金滋水。复崇土以生金也。薛氏苦心。可不知哉。
又一变而为加味地黄丸。又名抑阴地黄丸。以治肝肾阴虚诸症。或耳内痒痛出水。或眼昏痰
喘。或热渴便涩等症。
熟地 山药 萸肉 丹皮 茯苓 泽泻 柴胡 生地 五味
加生地柴胡五味。复等其分。真愈出愈奇矣。柴胡从逍遥来。生地从固本来。五味仍合都气
。其曰耳内痒痛出水。或眼昏痰喘。或热渴便涩。而总以肝肾阴虚。则知其阴虚。半由火郁而致
也。故用柴胡以疏之。郁火非生地不能凉。故用生地。用五味者。仍泻丁以补金。补金以生水
也。曰抑阴。为郁火太盛。非疏不可。疏
之所以抑之。生地凉血。便有泻义。泻之所以抑之也。
又一变而为九味地黄丸。以治肾疳。
熟地 山药 萸肉 丹皮 川芎 当归 赤茯苓
川楝子 使君子
上丸。空心温酒下。
以赤茯苓换白茯苓。而加川芎当归川楝子使君子。尽是直泻厥阴之药。仍是肝肾同治之法。
缘诸疳必有虫。皆风木之所化。是肝有可伏之理。但伐其子。必伤其母。故用六味以补其母。去
泽泻者。肾不宜再泄也。
又一变而为益阴肾气丸。以治诸脏亏损。发热晡热潮热盗汗。或寒热往来。五心烦热。或口
干作渴。月经不调。或筋骨酸倦。饮食少思。或头目不清。痰气上壅。咳嗽晡甚。胸膈痞闷。或
小便赤数。两足热痛。或脚足痿软。肢体作痛等症。此壮水之主。以制阳光之剂也。
熟地（自制杵膏） 山药 萸肉 丹皮 茯苓 泽泻 五味
当归 生地（酒拌杵膏）
上为末。入二膏加炼蜜丸桐子大。 砂为衣。每服五十丸。空心淡盐汤下。
加五味子。仍合都气。当归生地二味。则从四物汤来。何也。其列症有发热晡热潮热。肝血
亏矣。焉可再以柴胡疏之哉。最妙在胸膈痞闷一句。缘此症之闷。是肝胆燥火。闭伏胃中。非当
归生地合用。何以清胃中之火。而生胃中之阴哉。盖一用柴胡。便为逍遥。入肝胆。不能走胃阴
矣。一用柴胡。一去柴胡。流湿就燥之义。判若天渊。微乎微乎。
至赵氏则以为六味加减。须严。其善用六味。虽是薛氏启其悟端。而以上变化。概未透其根柢
。故尽废而不敢用。见其合当归柴胡而去白芍。则反用白芍。名疏肝益肾。此则其聪明也。乃谓
白术与六味。水土相反而禁用。初谓其立论高简。立法严密。后细参薛氏。毕竟薛氏博大。而赵
氏拘浅。薛氏诸变法。似乎宽活。而其实严密。学人善悟其妙。而以意通之。大概以肝肾为主。
而旁救脾肺。脾肺安顿。则君相二火。不必提起。自然帖伏矣。
（即名为高氏遗书。东庄已在《医贯》批注中提及。但此书比彼处更为详尽。因此从谢达宸本抄录附入。）
归脾汤
治疗脾经失血。失眠少睡。发热。盗汗。或因思虑损伤脾气。不能统摄血液。导致血液妄行溢出。或健忘、心悸。惊悸不安无法入睡。或心脾疼痛。嗜睡。食欲不振。或因忧思损伤脾气。血虚发热。或肢体疼痛。大便不调。或女子月经周期不准。午后潮热及内热。或瘰疬流注。不能消散、溃破或愈合收敛。
当归身（炙） 远志（炒后研碎） 酸枣仁 茯神 人参（炙） 黄芪（土炒）
白术 龙眼肉 煨甘草（炙） 木香（若呕血，使用归脾汤全赖此味） 生姜、大枣为引。
此方由严用和创制。其对应的病证是“二阳之病发心脾”。大概想要补脾，则先补心；想要补心，则先补肝。这就是所谓的“隔二之治”，赵献可对此论述得很详细了。然而往往将此方用于吐血、咳嗽、寒热往来等症时，木香多不适用。因为木香香燥，反而容易动肝火并耗伤津液。我每次去掉它，而加入白芍以追摄已散失的真阴，颇为稳妥恰当。况且肺受火邪刑克，白术过于燥烈，恐怕反而助长咳嗽。得到白芍的阴柔作为佐使，也是精妙的配伍。如果肺肾受伤，再加麦冬、五味子。肝肾受伤，则白芍更为有益。如果是因抑郁而起病，则加柴胡、牡丹皮、山栀。如果不是二阳之病导致的怔忡，则去掉木香，加入枸杞、麦冬、五味子之类。如果是梦遗，则加五味子、熟地、白芍、牡蛎之类。如果是怔忡且确实兼有包络一种有余之火兼痰者，则加黄连、生地、贝母之类以清泻之。梦遗而兼有相火者，加黄柏、知母、麦冬以清泻之。只有脾虚久泻不止的情况，才保留木香以醒脾。脾虚而兼有寒邪者，虽然肉豆蔻、桂枝、附子等类药，都可以加入。阳虚盗汗，脉象四至以内，气息微弱不起，清醒却难以入睡，此方也是对证的要药。也可以变为养荣汤加减。
甘露饮
治疗大人小儿。胸中有客热。牙龈出血口臭。齿龈肿胀腐烂。时常流出脓血。眼睑沉重下垂。常想闭合。或者即使饥饿烦躁。不想饮食。以及眼睛红肿疼痛。不耐受凉药。口舌生疮。咽喉肿痛。疮疹已经发出。都可以服用。又治疗脾胃受湿。瘀热在体内。或者醉酒饱食、房劳过度。湿热相互搏结。导致产生黄疸病。身体和眼睛都发黄。肢体轻微肿胀。胸闷气短。大便不调。小便黄涩。或者时而身体发热。都一并治疗。
生地 熟地 天冬 麦冬 黄芩 石斛 枳壳
茵陈 枇杷叶 甘草
小甘露饮
治疗脾劳实热。身体面目全部发黄。舌干咽喉肿痛。
山栀 黄芩 生地 升麻 桔梗 茵陈 石斛
甘草
此方创自洁古老人。丹溪认为这是心肺胃三经的药。主治胸中客热。口臭齿烂。心烦咽疮等症状。许学士又去掉门冬加入犀角。主治与上面大致相同。另外如赤眼以及一切疮疡。无论已散或未散。都可以治疗。然而小甘露饮去掉熟地和二冬（天冬、麦冬），是因为手阳明大肠经与肾没有相关联的趋势。所以加入桔梗，使其与里合。治疗胃病则以肾为关窍，所以加入熟地和二冬。按此方以固本丸为基础病症，而加入其他药物，原因是胃中湿热。下流归于坎宫（肾）。则水源浊泛。所以出现症状如此。而当日立方的用意，实在从救肾起见。清胃的清胃。而救本源者仍救本源。丹溪只说心肺胃。还不是完整的论述。我每次遇到肝经有郁火者。也以此方加牡丹皮、山栀。去掉石斛、甘草、枇杷叶。也没有不应验的。就知道水木同原的道理。如果原有胃火。而又挟带肝木之势者。竟然用原方不减。而只加牡丹皮、山栀等味。也没有不有效的。丹溪说肺最妙。然而必须在列出的症状中写明大便干燥。才符合手足阳明两经用药的意思。至于一变而为小甘露饮。去掉枇杷叶、熟地、二冬、枳壳。而加入升麻、桔梗、栀子。那么手阳明实症通治的意义就完全显现了。火盛口渴严重的。加知母。走马疳而且急迫的。加石膏、黄连。火蚀既久。元气虚者。加人参。真是胃中燥火的神剂。
清脾饮
治疗瘅疟。脉弦数。只热不寒。或者热多寒少。膈部胀满不想进食。口苦。舌干。烦渴。小便黄赤。大便不利。
青皮 厚朴 草果 柴胡 黄芩 半夏 茯苓
白术 甘草 生姜为引。
这是严用和创制的治疗疟疾的方子。治疗疟疾有很多方子。都不得其要领。只有此方最为中正。我每次用此方加减。没有不痊愈的。
大概疟疾发作寒热。原本属于少阳半表半里。所以必须以小柴胡汤为君药。青皮来解脉象的弦数。厚朴来宽舒胃中的积滞。草果来化痰消除壅塞。苓术（茯苓、白术）来充实脾土。这两味药乃是扶正的意义。因为疟疾固然由外感引起。然而必须内伤之后外邪才能侵袭。这是李东垣的微旨。严氏立方。最为得当。但如果完全是由饮食引起的。我每次用苍术代替白术。加陈皮以合平胃散之意。热多寒少的。稍加黄连、滑石。寒多热少的。稍加前胡以发散其郁热。没有不应手而验的。能审察这一点而斟酌处理。怎么会延误成久病。困苦天下人呢？如果误服汤药病久的。不可固执此为不变之法。这在于学者灵活变通罢了。如服寒药而致胃伤者。须用人参养胃汤调养。服热药多的。仍用小柴胡汤。多加黄连、牡丹皮、生地以解之。久而虚者。用补中益气汤补救。发于夜间的。用四物汤益母草饮（一名香红饮）来济助。用法虽然不同。然而小柴胡汤的宗旨。不可脱离。
六味地黄丸
治疗肾经不足。发热作渴。小便淋闭。气壅痰嗽。头目眩晕。眼花耳聋。咽燥舌痛。牙齿不坚固。腰腿痿软。自汗盗汗。便血及其他各种出血。失音水泛为痰。血虚发热等症状。其功效不能尽述。
熟地 山药 山茱萸 丹皮 茯苓 泽泻
张仲景创立八味丸。治疗汉元帝的三阴疟。到了宋代钱仲阳。才开始去掉桂枝、附子。变而为六味。用来治疗小儿。大概因为小儿纯阳。没有补阳的方法。倘若先天不足。行走迟缓脚软。阴虚发热。则用六味丸来补之。这是仲阳变法。薛己则因此悟到大方。也应当以此补阴。而丹溪的补阴丸开始被废弃。然而他的方子虽然列在医案中。却未曾阐明其为救阴的确切剂型。直到赵献可才大力阐发薛己使用此方的意图。而认为是圣方神剂。又不止治疗阴虚发热这一种方法。触类旁通。无不立即见效。而学人才善于使用六味丸了。然而浙东只有四明医家。承袭赵献可学问的人多。善于使用。浙西只有张卿子。也稍微使用它。沿用到三吴地区。就不能理解了。即使读赵献可书的。也懵懂不觉。然而赵献可的加减之法很严格。又不是薛己的本意了。现在记录两家加减之法在后面。并附上我的意思。希望学人选择。
薛己治疗妇女郁怒伤肝脾。以致小便淋漓不利。月经不调。两胁胀闷。小腹疼痛。寒热往来。胸乳疼痛。左关脉弦洪。右关脉弦数。这是郁怒伤肝脾。血虚气滞为患。则变为滋肾生肝饮。
熟地 山药 山茱萸 丹皮 茯苓 泽泻 五味子 当归 柴胡 白术 甘草
原用六味地黄丸剂量减半。而加柴胡、白术、甘草、当归、五味子。合逍遥散而去掉白芍。加五味子。合都气丸之意。以生肝。所以去掉白芍。而留白术、甘草以补脾。补脾者。是生金以制木。以制为生。是天地自然的秩序。又一变而为滋阴肾气丸。治疗目中神水宽大渐散。或者像雾露中行。渐渐看到空中有黑花。视物重影。久了则光不收。以及内障。神水淡白色。
熟地 山药 丹皮 茯苓 泽泻 生地 当归尾 柴胡
上药为丸。辰砂为衣。每服十丸。白开水送下。
独去山茱萸。而加柴胡、生地、当归尾、五味子。仍合逍遥散、都气丸。肝肾同治。然而用当归尾、生地的原因。是行瘀滞。柴胡的原因。是疏泄木气。去掉白芍的原因。是恐怕妨碍行的疏泄。名叫滋阴。是因为厥阴肝经。都用五味子的原因。虽然合都气丸。然而实际上是防木反克土。泻丁（心火）之义。去萸肉的原因。是不想强木。
又一变而为人参补肺汤。治疗肾水不足。虚火上炎。咳唾脓血。发热作渴。小便不调。
熟地 山药 山茱萸 丹皮 茯苓 人参 麦冬
五味子 当归 黄芪（蜜炙） 白术 陈皮 甘草（蜜炙）生姜为引。
其义愈变化无穷。真如游龙戏水般奇妙。去掉泽泻而加参、归、术、麦冬、五味、陈皮、甘草。白术与六味地黄丸。其化相反。怎么能合在一起呢？回答说：从合生脉散来。则有自然相通的意义。借茯苓以合五味异功散的妙处。用当归以合养血的神奇。其不用泽泻的原因。是因为发热作渴。小便不调。则没有再竭肾水的道理。理无再竭。盒饭（此处疑为‘必当’之误，依文意译为必须）急生脉。生脉散之所由来。既然应当生脉。则异功散可以转入矣。且水生高原（肺）。气化能出。肺气将败。所以作渴不调。此所以急去泽泻。而生金滋水。复崇土以生金。薛己的苦心。岂能不知哉。
又一变而为加味地黄丸。又名抑阴地黄丸。用来治疗肝肾阴虚诸症。或者耳内痒痛出水。或者眼昏痰喘。或者热渴便涩等症状。
熟地 山药 山茱萸 丹皮 茯苓 泽泻 柴胡 生地 五味子
加生地、柴胡、五味子。分量相等。真是愈出愈奇了。柴胡从逍遥散来。生地从固本丸来。五味子仍合都气丸。其说耳内痒痛出水。或者眼昏痰喘。或者热渴便涩。而总归结为肝肾阴虚。则知其阴虚。一半由火郁而导致。所以用柴胡来疏之。郁火非生地不能凉。所以用生地。用五味子的原因。仍是泻丁以补金。补金以生水。曰抑阴。是因为郁火太盛。非疏不可。疏之所以抑之。生地凉血。便有泻义。泻之所以抑之。
又一变而为九味地黄丸。用来治疗肾疳。
熟地 山药 山茱萸 丹皮 川芎 当归 赤茯苓
川楝子 使君子
上药为丸。空心温酒送下。
以赤茯苓换白茯苓。而加川芎、当归、川楝子、使君子。尽是直泻厥阴肝经的药。仍是肝肾同治的方法。因为诸疳必有虫。皆风木所化。是肝有可伏之理。但伐其子（脾土/虫属土？此处指虫或脾，原文意指虫属肝风所化，治虫需疏肝，但伐子必伤母，故补母即补肾），必伤其母。所以用六味丸来补其母。去泽泻的原因。是肾不宜再泄。
又一变而为益阴肾气丸。用来治疗诸脏亏损。发热晡热潮热盗汗。或者寒热往来。五心烦热。或者口干作渴。月经不调。或者筋骨酸倦。饮食少思。或者头目不清。痰气上壅。咳嗽傍晚加重。胸膈痞闷。或者小便赤数。两足热痛。或者脚足痿软。肢体疼痛等症状。这是壮水之主。以制阳光之剂。
熟地（自制杵膏） 山药 山茱萸 丹皮 茯苓 泽泻 五味子
当归 生地（酒拌杵膏）
上药为末。入二膏加炼蜜丸桐子大。砂为衣。每服五十丸。空心淡盐汤送下。
加五味子。仍合都气丸。当归、生地二味。则从四物汤来。为什么呢？其列出的症状有发热晡热潮热。肝血亏矣。怎么可以再以柴胡疏之呢？最妙在胸膈痞闷一句。因为这个症的闷。是肝胆燥火。闭伏胃中。非当归、生地合用。怎么能清胃中之火。而生胃中之阴呢？盖一用柴胡。便为逍遥散。入肝胆。不能走胃阴了。一用柴胡。一去柴胡。流湿就燥的意义。判若天渊。微妙啊微妙。
至于赵献可则认为六味丸的加减。必须严格。他善于使用六味丸。虽然是薛己启发其悟端。而以上的变化。概未透彻其根柢。所以全部废弃而不敢用。见其合当归、柴胡而去白芍。则反用白芍。名叫疏肝益肾。这则是他的聪明之处。乃谓白术与六味丸。水土相反而禁用。起初认为其立论高简。立法严密。后来细参薛己。毕竟薛己博大。而赵献可拘浅。薛己的各种变法。似乎宽活。而其实严密。学人善于领悟其妙。而以意通之。大概以肝肾为主。而旁救脾肺。脾肺安顿。则君相二火。不必提起。自然帖伏矣。
(Guishi Yishu, i.e., Gao's Posthumous Works. Dongzhuang has already mentioned it in the commentary on *Yi Guan*. However, this text is more detailed than that one. Therefore, it is copied and attached from Xie Dacheng's edition.)
**Guipi Tang (Return to the Spleen Decoction)**
Treats bleeding disorders originating from the Spleen Meridian. Insomnia with little sleep. Fever. Night sweats. Or due to overthinking injuring the Spleen Qi, failing to control blood, leading to reckless bleeding. Or forgetfulness, palpitations. Palpitations with fright and inability to sleep. Or pain in the Heart and Spleen. Lethargy. Poor appetite. Or due to worry and thought injuring the Spleen, blood deficiency causing fever. Or limb pain. Irregular bowel movements. Or irregular menstruation in women. Afternoon tidal fever and internal heat. Or scrofula and flowing abscesses that cannot dissipate, suppurate, or heal.
*Danggui Shen* (Radix Angelicae Sinensis, prepared with honey) *Yuanshi* (Radix Polygalae, stir-fried and crushed) *Suanzaoren* (Semen Ziziphi Spinosae) *Fushen* (Poria with Hostwood) *Renshen* (Radix Ginseng, prepared with honey) *Huangqi* (Radix Astragali, stir-fried with soil)
*Bai Zhu* (Rhizoma Atractylodis Macrocephalae) *Longyan Rou* (Arillus Longan) *Wei Gancao* (Radix Glycyrrhizae, baked) *Muxiang* (Radix Aucklandiae; for hematemesis, Guipi Tang relies entirely on this herb) Ginger and Jujube as guides.
This formula was created by Yan Yonghe. The corresponding syndrome is "diseases of the Yangming affecting the Heart and Spleen." Generally, to tonify the Spleen, one must first tonify the Heart; to tonify the Heart, one must first tonify the Liver. This is called the "treatment separated by two organs." Zhao Xianke discussed this in detail. However, when often used for hematemesis, cough, and alternating chills and fever, Muxiang is often unsuitable. Because its aromatic dryness can stir up Liver Fire and dry up body fluids. I usually remove it and add Baishao (Radix Paeoniae Alba) to retrieve the dispersed True Yin, which is quite stable and appropriate. Moreover, if the Lung is affected by Fire punishment, Baizhu is too drying and may aggravate the cough. Adding Baishao's yin nature as an assistant is also a brilliant combination. If the Lung and Kidney are injured, add Maidong (Herba Ophiopogonis) and Wuweizi (Fructus Schisandrae). If the Liver and Kidney are injured, Baishao is even more beneficial. If arising from depression/stagnation, add Chaihu (Radix Bupleuri), Mudanpi (Cortex Moutan), and Shanzhi (Fructus Gardeniae). If not a disease of the Yangming causing palpitations, remove Muxiang and add Gouqi (Fructus Lycii), Maidong, and Wuweizi. If nocturnal emission, add Wuweizi, Shudi (Radix Rehmanniae Preparata), Baishao, and Muli (Concha Ostreae). If palpitations accompanied by excess Fire in the Pericardium and Phlegm, add Huanglian (Rhizoma Coptidis), Shengdi (Radix Rehmanniae), and Beimu (Bulbus Fritillariae Cirrhosae) to clear it. If nocturnal emission accompanied by Ministerial Fire, add Huangbai (Cortex Phellodendri), Zhimu (Rhizoma Anemarrhenae), and Maidong to clear it. Only in cases of chronic diarrhea due to Spleen deficiency that does not stop, should Muxiang be retained to awaken the Spleen. In cases of Spleen deficiency with Cold, herbs like Roudoukou (Nucis Arecae Semina), Guizhi (Ramulus Cinnamomi), and Fuzi (Radix Aconiti Lateralis Preparata) can all be added. For Yang deficiency night sweats, pulse within four beats per respiration, faint vitality, unable to rise, awake but unable to sleep, this formula is also a key remedy for the syndrome. It can also be modified into Yangrong Tang (Tonify the Nutritive Decoction).
**Ganlu Yin (Sweet Dew Drink)**
Treats adults and children. Guest-heat in the chest. Bleeding gums and bad breath. Swollen and ulcerated gingiva. Occasional discharge of pus and blood. Heavy eyelids drooping, always wanting to close. Or hunger and irritability despite lack of desire to eat. And red, swollen, painful eyes intolerant to cooling medicines. Mouth and tongue sores. Swollen and painful throat. Eruptions and rashes that have appeared. All can take this. Also treats Dampness invading the Spleen and Stomach. Stagnant Heat inside. Or after drunken feasting and sexual exhaustion. Damp-Heat clashing. Leading to Jaundice. Yellowing of the body and eyes. Slight swelling of limbs. Chest fullness and shortness of breath. Irregular bowel movements. Yellow and scanty urine. Or occasional fever. All are treated.
*Shengdi* (Radix Rehmanniae) *Shudi* (Radix Rehmanniae Preparata) *Tiantong* (Herba Asparagi) *Maidong* (Herba Ophiopogonis) *Huangqin* (Radix Scutellariae) *Shihu* (Caulis Dendrobii) *Zhiqiao* (Fructus Aurantii)
*Yinchen* (Herba Artemisiae Scopariae) *Pipaye* (Folium Eriobotryae) *Gancao* (Radix Glycyrrhizae)
**Xiao Ganlu Yin (Small Sweet Dew Drink)**
Treats Spleen Labor with Excess Heat. Complete yellowing of the body and face. Dry tongue and swollen/painful throat.
*Shanzhi* (Fructus Gardeniae) *Huangqin* (Radix Scutellariae) *Shengdi* (Radix Rehmanniae) *Shengma* (Rhizoma Cimicifugae) *Jiegeng* (Radix Platycodonis) *Yinchen* (Herba Artemisiae Scopariae) *Shihu* (Caulis Dendrobii)
*Gancao* (Radix Glycyrrhizae)
This formula was created by Jiegu Laoren (Old Man Jiegu). Danxi considered it a medicine for the Heart, Lung, and Stomach meridians. Mainly treating guest-heat in the chest, bad breath, rotten teeth, heart vexation, and throat sores. Scholar Xu further removed Dongdong (Tiantong/Maidong) and added Xijiao (Cornu Rhinocerotis). The main treatment is similar to above. Additionally, for red eyes and all sores/ulcers, whether resolved or unresolved, it can treat them. However, Xiao Ganlu Yin removes Shudi and Er Dong (Tiantong, Maidong) because the Hand-Yangming Large Intestine Meridian has no direct connection with the Kidney. Thus, adding Jiegeng allows it to connect with the interior. Treating the Stomach uses the Kidney as a gate, thus adding Shudi and Er Dong. According to this, the formula takes Guben Wan (Solidify the Root Pill) as the base syndrome, adding other herbs. The reason is stomach Damp-Heat flowing down to Kan (Kidney). Then the water source becomes turbid and overflows, hence these symptoms. The original intent of the formula was actually to save the Kidney. Clearing the Stomach clears the Stomach, while saving the root saves the root. Danxi only mentioned Heart, Lung, and Stomach, which is not a complete theory. Whenever I encounter Liver Meridian Depressed Fire, I use this formula adding Mudanpi and Shanzhi, removing Shihu, Gancao, and Pipaye. It is invariably effective. This shows the meaning of Water and Wood sharing the same origin. If there is originally Stomach Fire combined with Liver Wood momentum, using the original formula unchanged but adding only Mudanpi and Shanzhi is also invariably effective. Danxi said the Lung is most excellent, but one must list "dry stool" among the symptoms to match the medicines of both Hand and Foot Yangming meridians. As for changing to Xiao Ganlu Yin, removing Pipaye, Shudi, Er Dong, and Zhiqiao, and adding Shengma, Jiegeng, and Zhizi, the meaning of universally treating Hand-Yangming Excess Syndromes is fully revealed. For severe Fire excess and thirst, add Zhimu. For rapid gangrene of the mouth (Zouma Gan), add Shigao (Lapis Gypsum Fibrosum) and Huanglian. For long-term Fire erosion with deficient Yuan Qi, add Renshen. It is truly a divine agent for Stomach Dry-Fire.
**Qingpi Yin (Clear the Spleen Drink)**
Treats Dan Malaria (Febrile Malaria). Pulse wiry and rapid. Only heat without chills. Or more heat than chills. Chest fullness and anorexia. Bitter taste in mouth. Dry tongue. Vexation and thirst. Yellow-red urine. Constipation.
*Qingpi* (Pericarpium Citri Reticulatae Viride) *Houpo* (Cortex Magnoliae Officinalis) *Caoguo* (Fructus Tsaoko) *Chaihu* (Radix Bupleuri) *Huangqin* (Radix Scutellariae) *Banxia* (Rhizoma Pinelliae Preparata) *Fuling* (Poria)
*Bai Zhu* (Rhizoma Atractylodis Macrocephalae) *Gancao* (Radix Glycyrrhizae) Ginger as guide.
This is a malaria formula created by Yan Yonghe. There are many formulas for treating malaria, none hitting the mark. Only this formula is most balanced. I use this formula with modifications every time, and there is no case that does not heal.
Generally, malaria chills and fever originate from Shaoyang Half-Exterior Half-Interior. Thus, Xiaochaihu Tang (Minor Bupleurum Decoction) must be the Sovereign herb. Qingpi resolves the wiry-rapid pulse. Houpo expands stagnation in the Stomach. Caoguo transforms Phlegm and eliminates obstruction. Lingzhu (Fuling, Bai Zhu) strengthens the Spleen Earth. These two herbs represent the principle of supporting Righteous Qi. Although malaria is caused by external pathogens, it requires internal injury before external invasion can occur. This is Li Dongyuan's subtle insight. Yan's formula creation is most accurate. But if it arises purely from diet, I replace Bai Zhu with Cangzhu (Rhizoma Atractylodis Lanceae) and add Chenpi (Pericarpium Citri Reticulatae) to align with Pingwei San (Peaceful Stomach Powder). For more heat than chills, slightly add Huanglian and Huashi (Lapis Kaolin). For more chills than heat, slightly add Qianhu (Radix Peucedani) to disperse stagnant heat. No case fails to respond promptly. If one examines this and adjusts accordingly, how could it become a lingering illness tormenting the world? If the disease has persisted due to mistaken herbal intake, do not rigidly adhere to this unchangeable method. It depends on the scholar's spiritual flexibility. If cold medicines damaged the Stomach, nourish it with Renshen Yangwei Tang (Ginseng Stomach-Nourishing Decoction). If too many hot medicines were taken, still use Xiaochaihu Tang, adding more Huanglian, Mudanpi, and Shengdi to resolve it. If prolonged and deficient, use Buzhong Yiqi Tang (Middle-Boosting Qi-Rescuing Decoction) to save it. If occurring at night, use Siwu Tang (Four Substances Decoction) with Yimucao (Herba Leonuri) and Yimucao Yin (Motherwort Drink, aka Xianghong Yin) to assist. Although methods differ, the principle of Xiaochaihu Tang must not be abandoned.
**Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia)**
Treats Kidney Meridian Deficiency. Fever with thirst. Dysuria and retention. Qi stagnation and Phlegm-cough. Dizziness and vertigo. Blurred vision and deafness. Dry throat and painful tongue. Loose teeth. Weak and flaccid waist and legs. Spontaneous sweating and night sweats. Blood in stool and various bleeding disorders. Aphonia. Water overflowing transforming into Phlegm. Blood deficiency fever, etc. Its merits cannot be fully described.
*Shudi* (Radix Rehmanniae Preparata) *Shanyao* (Rhizoma Dioscoreae) *Yurou* (Fructus Corni) *Danpi* (Cortex Moutan) *Fuling* (Poria) *Zexie* (Rhizoma Alismatis)
Zhang Zhongjing established Bawei Wan (Eight-Ingredient Pill) to treat Emperor Yuan of Han's Three-Yin Malaria. By Song Dynasty, Qian Zhongyang began removing Guizhi and Fuzi, changing it to Liuwei (Six Ingredients) to treat children. Generally, because children are Pure Yang, there is no method to tonify Yang. If congenital deficiency exists, with delayed walking and soft feet, Yin-deficiency fever, then use Liuwei to tonify. This is Zhongyang's modification. Xue Ji then realized that major formulas should also use this to tonify Yin, and Danxi's Buyin Wan (Tonify Yin Pill) began to be discarded. However, although his formula was listed in medical cases, he never clarified it as the specific agent for rescuing Yin. Until Zhao Xianke, who greatly expounded on Xue Ji's intent in using this formula, calling it a Sage Formula and Divine Agent, not just for Yin-deficiency fever. Touching upon everything and connecting sideways, it works immediately. Scholars then became adept at using Liuwei. However, in Eastern Zhejiang, only Siming physicians inherited Zhao's learning and were good at using it. In Western Zhejiang, only Zhang Qingzi used it slightly. Extending to the Sanwu region, no one understood it. Even those reading Zhao's books remained ignorant. However, Zhao's modification methods were very strict, differing from Xue Ji's intent. Now recording both families' modification methods below, attaching my own opinion. Let scholars choose.
Xue Ji treated women whose Liver and Spleen were injured by depressed anger, leading to dribbling dysuria, irregular menstruation, distension in both hypochondria, lower abdominal pain, alternating chills and fever, chest and breast pain. Left Guan pulse wiry and surging, Right Guan pulse wiry and rapid. This is Liver-Spleen injury from depressed anger, suffering from Blood deficiency and Qi stagnation. Then it changes to Zishen Shenggan Yin (Nourish Kidney Generate Liver Drink).
*Shudi* (Radix Rehmanniae Preparata) *Shanyao* (Rhizoma Dioscoreae) *Yurou* (Fructus Corni) *Danpi* (Cortex Moutan) *Fuling* (Poria) *Zexie* (Rhizoma Alismatis) *Wuweizi* (Fructus Schisandrae) *Danggui* (Radix Angelicae Sinensis) *Chaihu* (Radix Bupleuri) *Baizhu* (Rhizoma Atractylodis Macrocephalae) *Gancao* (Radix Glycyrrhizae)
Originally using half dosage of Liuwei, adding Chaihu, Baizhu, Gancao, Danggui, and Wuweizi. Combining Xiaoyao San (Free Wanderer Powder) but removing Baishao. Adding Wuweizi combines Douqi Wan (All-Qi Pill) intent. To generate Liver, thus removing Baishao, and retaining Baizhu and Gancao to tonify Spleen. Tonifying Spleen generates Metal to control Wood. Controlling is generating. This is the natural order of Heaven and Earth. Another change becomes Ziyin Shenqi Wan (Nourish Yin Kidney Qi Pill). Treating eye spirit water widening and dispersing, or seeing through fog/mist, gradually seeing black flowers in the air, diplopia. Long-term loss of light focus, and internal cataracts, spirit water pale white.
*Shudi* (Radix Rehmanniae Preparata) *Shanyao* (Rhizoma Dioscoreae) *Danpi* (Cortex Moutan) *Fuling* (Poria) *Zexie* (Rhizoma Alismatis) *Shengdi* (Radix Rehmanniae) *Danggui Wei* (Cauda Radicis Angelicae Sinensis) *Chaihu* (Radix Bupleuri)
Grind into pills, coat with ChenSha (Cinnabar). Take ten pills each time, swallow with plain boiled water.
Uniquely removing Yurou, adding Chaihu, Shengdi, Danggui Wei, and Wuweizi. Still combining Xiaoyao and Douqi. Treating Liver and Kidney together. Using Danggui Wei and Shengdi is to move stasis. Chaihu is to vent Wood Qi. Removing Baishao is to avoid hindering movement and venting. Named Nourish Yin because of Jueyin Liver. Using Wuweizi in all: although combining Douqi, it actually prevents Wood counter-attacking Earth. Meaning of draining Ding (Heart Fire). Removing Yurou is to avoid strengthening Wood excessively.
Another change becomes Renshen Bufei Tang (Ginseng Tonify Lung Decoction). Treating Kidney Water deficiency, Deficient Fire flaming upward. Coughing up purulent blood. Fever with thirst. Urinary irregularity.
*Shudi* (Radix Rehmanniae Preparata) *Shanyao* (Rhizoma Dioscoreae) *Yurou* (Fructus Corni) *Danpi* (Cortex Moutan) *Fuling* (Poria) *Renshen* (Radix Ginseng) *Maidong* (Herba Ophiopogonis)
*Wuweizi* (Fructus Schisandrae) *Danggui* (Radix Angelicae Sinensis) *Huangqi* (Radix Astragali, honey-fried) *Baizhu* (Rhizoma Atractylodis Macrocephalae) *Chenpi* (Pericarpium Citri Reticulatae) *Gancao* (Radix Glycyrrhizae, honey-fried) Ginger as guide.
Its meaning changes infinitely. Truly like a swimming dragon playing in water. Removing Zexie and adding Renshen, Danggui, Baizhu, Maidong, Wuweizi, Chenpi, Gancao. Baizhu and Liuwei have opposite transformations. How can they combine? Answer: Coming from He Shengmai San (Harmonize Generate Pulse Powder), there is a natural connection. Borrowing Fuling to combine with Wuwei Yigong San (Five-Ingredient Miracle Worker Powder) wonder. Using Danggui to combine with Blood-Nourishing miracle. Not using Zexie is because fever/thirst and urinary irregularity mean no reason to deplete again. Logic dictates no depletion, must urgently generate Pulse. Hence Shengmai San's origin. Since generating Pulse is needed, Yigong San can transition in. Furthermore, Water generates High Plain (Lung). Qi transformation can emerge. Lung Qi is about to fail, hence thirst and irregularity. This is why urgently removing Zexie, generating Metal to nourish Water, and reinforcing Earth to generate Metal. Xue Ji's painstaking effort, how could it not be known?
Another change becomes Jiawei Dihuang Wan (Modified Rehmannia Pill), also named Yiyin Dihuang Wan (Suppress Yin Rehmannia Pill). Treating Liver-Kidney Yin Deficiency syndromes. Or ear itching/pain with discharge. Or blurred vision, Phlegm-wheezing. Or heat-thirst and difficult urination.
*Shudi* (Radix Rehmanniae Preparata) *Shanyao* (Rhizoma Dioscoreae) *Yurou* (Fructus Corni) *Danpi* (Cortex Moutan) *Fuling* (Poria) *Zexie* (Rhizoma Alismatis) *Chaihu* (Radix Bupleuri) *Shengdi* (Radix Rehmanniae) *Wuweizi* (Fructus Schisandrae)
Adding Shengdi, Chaihu, Wuweizi in equal parts. Truly emerging more wonders. Chaihu comes from Xiaoyao San. Shengdi comes from Guben Wan. Wuweizi still combines Douqi. Saying ear itching/discharge, blurred vision/wheezing, heat-thirst/difficult urination, all summarized as Liver-Kidney Yin Deficiency, knowing Yin deficiency is half caused by Fire Stagnation. Thus using Chaihu to vent it. Depressed Fire cannot be cooled except by Shengdi, thus using Shengdi. Using Wuweizi is still draining Ding to tonify Metal, tonifying Metal to generate Water. Named Suppress Yin because Depressed Fire is too strong, must vent. Venting suppresses it. Shengdi cools Blood, having draining meaning. Draining suppresses it.
Another change becomes Jiwei Dihuang Wan (Nine-Ingredient Rehmannia Pill). Treating Kidney Gangrene (Gan).
*Shudi* (Radix Rehmanniae Preparata) *Shanyao* (Rhizoma Dioscoreae) *Yurou* (Fructus Corni) *Danpi* (Cortex Moutan) *Chuanxiong* (Rhizoma Chuanxiong) *Danggui* (Radix Angelicae Sinensis) *Chi Fuling* (Poria with Red Heart)
*Chuanlianzi* (Fructus Toosendan) *Shijunzi* (Fructus Quisqualis)
Grind into pills. Take on empty stomach with warm wine.
Replacing Bai Zhu with Chi Fuling, adding Chuanxiong, Danggui, Chuanlianzi, Shijunzi. All are direct draining Jueyin herbs. Still Liver-Kidney simultaneous treatment. Because all Gan involve parasites, transformed from Wind-Wood. Liver has a reason to be subdued. But draining the child harms the mother. Thus using Liuwei to tonify the mother. Removing Zexie because Kidney should not be drained again.
Another change becomes Yiyin Shenqi Wan (Nourish Yin Kidney Qi Pill). Treating various organ deficiencies. Fever afternoon tidal fever/night sweats. Or alternating chills/fever. Five-palm heat. Or dry mouth/thirst. Irregular menstruation. Or bone/tendon soreness/fatigue. Poor appetite. Or unclear head/eyes. Phlegm-Qi congestion. Cough worse in evening. Chest/diaphragm stuffiness. Or red/frequent urination. Hot/painful feet. Or foot/leg weakness. Limb pain. This is a formula strengthening the Master of Water to control Solar Flare.
*Shudi* (Homemade paste) *Shanyao* (Rhizoma Dioscoreae) *Yurou* (Fructus Corni) *Danpi* (Cortex Moutan) *Fuling* (Poria) *Zexie* (Rhizoma Alismatis) *Wuweizi* (Fructus Schisandrae)
*Danggui* (Radix Angelicae Sinensis) *Shengdi* (Radix Rehmanniae, wine-mixed paste)
Grind into powder. Add two pastes, refined honey, make pills size of paulownia seeds. Coat with Sha (Cinnabar?). Take fifty pills on empty stomach with light salt water.
Adding Wuweizi still combines Douqi. Danggui and Shengdi come from Siwu Tang. Why? Listed symptoms include afternoon tidal fever. Liver Blood is deficient. How can one vent with Chaihu? Most wonderful is "chest/diaphragm stuffiness." Because this stuffiness is Liver-Gallbladder Dry-Fire closed in Stomach. Without Danggui and Shengdi combined, how to clear Stomach Fire and generate Stomach Yin? Using Chaihu makes it Xiaoyao San, entering Liver/Gallbladder, cannot reach Stomach Yin. Using Chaihu vs removing Chaihu. The meaning of directing dampness to dryness is worlds apart. Subtle, oh subtle!
As for Zhao Xianke, he believed Liuwei modifications must be strict. His skillful use of Liuwei, although inspired by Xue Ji, did not penetrate the root of the above changes. Thus he discarded them all and dared not use them. Seeing him combine Danggui/Chaihu and remove Baishao, he reversed it using Baishao, naming it Shugan Yishen (Vent Liver Nourish Kidney). This is his cleverness. He claimed Baizhu and Liuwei are Earth/Water opposing and forbidden. Initially thinking his theory high/simple and legislation strict. Later carefully studying Xue Ji, ultimately Xue Ji is broad, Zhao is narrow/rigid. Xue Ji's various methods seem loose/lively, but actually strict. Scholars should grasp the wonder and understand by intent. Generally focusing on Liver/Kidney, while assisting Spleen/Lung. Once Spleen/Lung are settled, Ministerial and Sovereign Fires need not be raised, naturally settling down.