典藏书目

Wenli (Clam Shell) 5 liang, Mahuang (Ephedrae Herba), Gancao (Glycyrrhizae Radix et Rhizoma), Shengjiang (Zingiberis Rhizoma Recens) each 3 liang, Shigao (Gypsum Fibrosum) 5 liang, Xingren (Armeniacae Semen Amarum) 50 pieces, Dazao (Jujubae Fructus) 12 pieces.
The above seven ingredients are boiled in six sheng of water until two sheng remain. Take one sheng warm; when sweating occurs, the disease is cured.

[Ji Jie]
Li [Name Redacted] said: Wenli Tang (Clam Shell Decoction) is Da Qinglong Tang (Major Blue Dragon Decoction) with Guizhi (Cinnamon Twig) removed. It is a diaphoretic formula that causes fluid retention to be excreted through the hair pores, thereby dissipating external fluid retention. The Classic states: "Open the ghost gate (induce sweating) and cleanse the clean mansion (promote urination)." This single formula achieves both effects. Because it contains exterior-releasing herbs such as Mahuang (Ephedrae Herba) and Shengjiang (Zingiberis Rhizoma Recens), it also treats symptoms caused by slight wind invasion, including tight pulse, headache.

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Question: A patient has a rapid pulse. Rapid pulse indicates heat, which should lead to efficient digestion and increased appetite, yet the patient vomits instead. Why? The Master said: This is due to improper use of diaphoresis, causing yang qi to become weak and qi in the diaphragm to be deficient, resulting in a rapid pulse. This rapidness represents guest heat (false heat), which cannot digest food, because there is deficiency-cold in the stomach. A wiry pulse also indicates deficiency. When stomach qi is exhausted, morning food is vomited in the evening, evolving into Wei Fan (Stomantic Reflux). Cold is located in the upper jiao, but the physician incorrectly used purgatives. Now the pulse has become wiry, hence it is named deficiency.

[An]
The passage from "Patient's pulse is rapid" to "because of deficiency-cold in the stomach" is already detailed in the Yangming Chapter of Shanghan Lun (Treatise on Cold Damage). Its presence here is due to bamboo slip dislocation (textual error), and its meaning does not connect with "A wiry pulse indicates deficiency."

[Zhu]
Wiry pulse is a sign of fluid retention, not deficiency. If a vomiting patient presents a wiry pulse, it indicates that stomach qi is exhausted. With exhausted stomach qi, liver pathogenic qi invades, producing a wiry pulse, hence it is termed deficiency. Inquiring into the cause of the wiry pulse: it arises because cold was in the upper jiao, and the physician incorrectly used purgatives, exhausting stomach qi completely. Consequently, water and grain cannot be digested, leading to morning food vomited in the evening and evening food vomited in the morning, evolving into Zhong Han Wei Fan (Middle Cold Stomantic Reflux).

[Ji Zhu]
Li [Name Redacted] said: Food unable to enter indicates fire; food entering and then being vomited indicates lack of fire. In cases of cold in the upper jiao, the method should be to warm the middle to achieve recovery. Incorrectly using purgatives will exacerbate deficiency-cold and increase vomiting.

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The Cun Kou (Inch Position) pulse is faint and rapid. Faint indicates lack of qi. Lack of qi leads to Ying Xu (Deficiency of Nutritive Qi). Ying Xu leads to insufficient blood. Insufficient blood results in cold in the chest.

[An]
The meaning of this text segment is disjointed; it must be a result of bamboo slip dislocation.

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The Fu Yang (Foot-Yangming) pulse is floating and choppy. Floating indicates deficiency. Deficiency injures the Spleen. Spleen injury impairs grinding/digestion. Morning food is vomited in the evening, evening food is vomited in the morning, undigested old food remains, named Wei Fan (Stomantic Reflux). If the pulse is tight and choppy, the disease is difficult to treat.

[An]
The character "Xu" (Deficiency) in "Deficiency injures the Spleen" should likely be "Se" (Choppy); this is a transcription error.

[Zhu]
In the previous case, Wei Fan resulted from incorrect purgation, presenting a wiry pulse. In this case, Wei Fan did not result from incorrect purgation, presenting a floating and choppy pulse. At the Fu Yang position, floating and choppy pulses are observed: floating examines the Stomach, choppy examines the Spleen. Floating without strength indicates Stomach deficiency; choppy without strength indicates Spleen injury. With Stomach deficiency and Spleen injury, water and grain cannot be processed, so morning food is vomited in the evening and evening food in the morning. The vomitus consists of undigested old food, hence it is called Wei Fan. If the pulse is tight and choppy, it indicates excess pathogen and deficient righteous qi, thus the disease is difficult to treat.

[Ji Zhu]
Xu Bin said: Tight indicates severe cold; choppy indicates exhaustion of body fluids. Righteous qi cannot overcome the pathogen, hence it is said: difficult to treat.

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For patients with Wei Fan (Stomantic Reflux) and vomiting, Banxia Houpo Tang (Pinellia and Magnolia Bark Decoction - *Note: Text says Ban Xia Tang, usually interpreted as Da Ban Xia Tang*) is the primary treatment.

[Zhu]
This follows the previous section to clarify the treatment. Wei Fan and vomiting refer to the condition where morning food is vomited in the evening and evening food in the morning. Da Ban Xia Tang (Major Pinellia Decoction) is prescribed to tonify the Spleen and Stomach and stop vomiting.