涩脉少血，或中寒湿，反胃结肠，自汗厥逆。
《灵枢》决气篇曰∶中焦取汁，变化而赤，是谓血。壅遏营气，令无所避，是
谓脉。脉之与血，同质异名，是二而一。况体为阴液，多则滑利，少则枯涩，理势
之必然者。（枯涩、虚涩血少，宜四物汤之类。）寒湿袭人，肌腠痹着，气道不利，脉安得不涩。
（滞涩之涩，宜和剂渗湿汤、百一除湿汤、三因肾着汤之类。）反胃，则朝食暮吐，暮食朝吐，或随食随
吐。胃无余液，以致肠中枯燥而大便秘结，脉安得不涩。（枯涩之涩，宜六君子汤、宝鉴人参利膈
丸、统旨滋血润肠汤、滋阴清膈饮之类。）自汗者，汗时时自出也。出则液耗，是谓脱液。漏而不
止，卫气散失，四肢厥寒，是谓亡阳。阳亡液脱，脉又安得不涩。（虚涩之涩，宜十全大补汤、
济生 附汤、黄 建中汤之类。）一涩脉也，而有虚涩、滞涩、枯涩之分，是又在诊之者，自为灵通耳。
四物汤 治肝脾肾血虚发热，或寒热往来，或日晡热甚，头目不清，或烦躁不寐，
胸膈作胀，胁肋疼痛等症。凡血虚诸病，以此为主治。若脾气虚而不能生血，宜
四君子。若脾气郁而血虚，宜归脾汤。若肾水涸而不生肝血，宜六味丸。
当归（二钱） 白芍药（一钱） 熟地黄（三钱） 川芎（钱半）
上水煎服。
和剂渗湿汤（见第十七）
百一除湿汤 治寒湿所伤，身体重着，腰脚 疼，大便溏泄，小便或涩或利。
半夏曲（炒） 浓朴（姜制） 苍术（米泔制，各二两） 藿香叶 陈皮（去白） 白茯苓（去
皮，各一两） 甘草（炙七钱） 白术（生用一两）
上 咀。每服四钱。水一盏，姜七片，枣一枚，煎七分。食前温服。
三因肾着汤 治肾虚伤湿，身重腰冷，如坐水中，不渴，小便自利。
干姜（炮） 茯苓（各四两） 甘草（炙） 白术（各二两）
每服四钱，水一盏，煎七分，空心温服。
六君子汤（见第十六）
宝鉴人参利膈丸 治胸中不利，大便结燥，痰嗽喘满，脾胃壅滞，推陈致新，治膈
气之圣药也。
木香 槟榔（各七钱半） 人参 当归（酒洗） 藿香 甘草 枳实（麸炒黄，各一两） 大黄
（酒湿蒸熟） 浓朴（姜制，各二两）
上为细末，滴水为丸，如桐子大。每服三、五十丸。食后诸饮下。
统旨滋血润肠汤 治血枯及死血在膈，饮食不下，大便燥结。
当归（酒洗，三钱） 芍药（炒） 生地黄（各一钱半） 红花（酒洗） 桃仁（去皮尖炒） 大黄（酒
煨） 枳壳（麸炒各一钱）
水一钟半，煎七分，入韭菜汁半酒盏，食前服。
滋阴清膈饮（统旨） 治阴火上冲，或胃火太盛，食不入，脉洪数者。
当归 芍药（煨） 黄柏（盐水炒） 黄连（各一钱半） 黄芩 山栀 生地黄（各一钱） 甘草（三分）
水二钟，煎七分，入童便、竹沥各半酒盏，食前服。
十全大补汤（见第十六）
济生 附汤 治气虚阳弱，虚汗不止，肢体倦怠。
黄 （去芦、蜜炙） 附子（炮、去皮脐，各等分）
上 咀。每服四钱。水一盏，生姜十片，煎八分。食前温服。未应，更加之。
黄 建中汤 治血气不足，体常自汗。
黄 桂（各一钱半） 白芍药（三钱） 甘草（一钱）
每服五钱。水一钟半，姜五片，枣二枚，煎八分。去滓，入稠饧一大匙，再煎服。旧有微溏或呕者，不用饧。
涩脉主血少，或为寒湿内侵所致，可见反胃、大肠传导失司（便秘），以及自汗、四肢厥冷逆乱等症。
《灵枢·决气篇》说：中焦脾胃摄取水谷精微汁液，经过变化变成红色，这就是血。约束营气运行，使其不致妄行逸出，这就叫脉。脉与血，本质相同而名称不同，是二而一的关系。况且脉体属阴液范畴，充盈则滑利，亏少则枯涩，这是情理势态上的必然结果。（若因枯涩、虚涩导致血少，适宜使用四物汤之类的方剂。）寒湿之邪侵袭人体，致使肌肉腠理痹阻凝滞，气道运行不畅，脉象怎么能不涩呢？（若因滞涩导致脉涩，适宜使用和剂渗湿汤、百一除湿汤、三因肾着汤之类的方剂。）所谓反胃，就是早晨吃的饭傍晚吐出来，晚上吃的饭早晨吐出来，或者刚吃下去就吐出来。因为胃中没有剩余的津液，导致肠道中干燥枯竭而大便秘结，脉象怎么能不涩呢？（若因枯涩导致脉涩，适宜使用六君子汤、宝鉴人参利膈丸、统旨滋血润肠汤、滋阴清膈饮之类的方剂。）所谓自汗，是指汗液时时自行流出。汗出则津液耗损，这叫做脱液。如果漏汗不止，卫气随之散失，四肢厥冷寒凉，这叫做亡阳。阳气亡失、津液脱竭，脉象又怎么能不涩呢？（若因虚涩导致脉涩，适宜使用十全大补汤、济生附子汤、黄芪建中汤之类的方剂。）同样是涩脉，却有虚涩、滞涩、枯涩的区别，这又要靠诊察医生的灵活通达了。
四物汤 治疗肝脾肾血虚引起的发热，或寒热往来，或下午申时发热严重，头目昏沉不清，或烦躁失眠，胸膈胀闷，胁肋疼痛等症状。凡是血虚的各种病症，以此方为主治。如果是脾气虚弱而不能生血，适宜用四君子汤。如果是脾气郁结而导致血虚，适宜用归脾汤。如果是肾水枯竭而不能化生肝血，适宜用六味地黄丸。
当归（二钱） 白芍药（一钱） 熟地黄（三钱） 川芎（一钱半）
以上药材用水煎煮后服用。
和剂渗湿汤 （见第十七章）
百一除湿汤 治疗被寒湿所伤，身体沉重困着，腰脚疼痛，大便溏泄，小便或不通畅或通利正常。
半夏曲（炒制） 浓朴（姜汁制） 苍术（米泔水制，各二两） 藿香叶 陈皮（去白） 白茯苓（去皮，各一两） 甘草（炙制七钱） 白术（生用一两）
以上药材切碎。每次服用四钱。用水一盏，生姜七片，大枣一枚，煎至七分。饭前温服。
三因肾着汤 治疗肾虚受伤湿气，身体沉重腰部寒冷，如同坐在水中，口不渴，小便自利通畅。
干姜（炮制） 茯苓（各四两） 甘草（炙制） 白术（各二两）
每次服用四钱，用水一盏，煎至七分，空腹温服。
六君子汤 （见第十六章）
宝鉴人参利膈丸 治疗胸中气机不利，大便干结燥硬，痰嗽气喘胸闷，脾胃壅滞，推陈出新，是治疗膈气的圣药。
木香 槟榔（各七钱半） 人参 当归（酒洗） 藿香 甘草 枳实（麸皮炒黄，各一两） 大黄（酒湿润蒸熟） 浓朴（姜汁制，各二两）
以上药材研成细末，滴加水制成丸药，如梧桐子大小。每次服用三五十丸。饭后用各种饮品送服。
统旨滋血润肠汤 治疗血枯及瘀血停滞在膈部，饮食难以下咽，大便燥结。
当归（酒洗，三钱） 芍药（炒制） 生地黄（各一钱半） 红花（酒洗） 桃仁（去皮尖炒制） 大黄（酒煨） 枳壳（麸皮炒，各一钱）
用水一钟半，煎至七分，加入韭菜汁半酒盏，饭前服用。
滋阴清膈饮（出自《统旨》） 治疗阴火上冲，或胃火太盛，食物无法下咽，脉象洪数的情况。
当归 芍药（煨制） 黄柏（盐水炒） 黄连（各一钱半） 黄芩 山栀 生地黄（各一钱） 甘草（三分）
用水二钟，煎至七分，加入童便、竹沥各半酒盏，饭前服用。
十全大补汤 （见第十六章）
济生附子汤 治疗气虚阳弱，虚汗不止，肢体倦怠乏力。
黄芪（去芦头、蜜炙） 附子（炮制、去皮脐，各等分）
以上药材切碎。每次服用四钱。用水一盏，生姜十片，煎至八分。饭前温服。如果无效，增加剂量。
黄芪建中汤 治疗气血不足，身体经常自汗。
黄芪 桂枝（各一钱半） 白芍药（三钱） 甘草（一钱）
每次服用五钱。用水一钟半，生姜五片，大枣二枚，煎至八分。滤去药渣，加入一大匙稠饴糖，再煎煮后服用。原本就有轻微腹泻或呕吐的人，不使用饴糖。
The Choppy pulse (Se, 涩) indicates a deficiency of blood, or it may be caused by the invasion of cold-dampness. It is associated with regurgitation (fanwei, 反胃), constipation due to intestinal dryness, spontaneous sweating, and cold extremities with reversal (jue ni, 厥逆).
The *Ling Shu* (Spiritual Pivot), chapter "Jue Qi" (Determination of Qi), states: "The middle jiao extracts the essence from food and drink, transforms it, and turns it red; this is called Blood." "It confines the Ying (Nutrient) Qi, preventing it from wandering freely; this is called the Pulse." The pulse and blood share the same substance but have different names; they are two in appearance but one in essence. Furthermore, since the pulse body belongs to Yin fluids, when abundant, it flows smoothly (Hua, 滑); when deficient, it becomes withered and choppy (Se, 涩). This is an inevitable consequence of natural principles. (For choppy pulses due to withered/choppy or deficient/choppy conditions indicating blood deficiency, formulas such as Siwu Tang [Four Substances Decoction] are appropriate.) When cold-dampness invades the human body, it causes bi-obstruction in the muscle layers and interstices, leading to impaired flow of Qi channels; how can the pulse not be choppy? (For choppy pulses due to stagnation/stagnant-choppy conditions, formulas such as Heji Shen Shi Tang [Formulary Office Damp-Draining Decoction], Baiyi Chu Shi Tang [Hundred-One Damp-Expelling Decoction], and Sanyin Shen Zhuo Tang [Three Causes Kidney-Attaching Decoction] are appropriate.) Regurgitation refers to eating in the morning and vomiting in the evening, or eating in the evening and vomiting in the morning, or vomiting immediately after eating. Because there is no residual fluid in the stomach, the intestines become dry and depleted, resulting in constipation; how can the pulse not be choppy? (For choppy pulses due to withered/choppy conditions, formulas such as Liujunzi Tang [Six Gentlemen Decoction], Baojian Renshen Lige Wan [Treasure Mirror Ginseng Throat-Unblocking Pill], Tongzhi Zixue Runchang Tang [Unified Principles Nourishing-Blood Intestine-Moistening Decoction], and Ziyin Qingge Yin [Nourishing-Yin Clearing-Throat Infusion] are appropriate.) Spontaneous sweating refers to sweat flowing out continuously on its own. When sweat flows, fluids are consumed, which is termed Fluid Depletion (Tuo Ye, 脱液). If leakage does not stop, Wei (Defensive) Qi dissipates, leading to cold extremities, which is termed Yang Collapse (Wang Yang, 亡阳). When Yang collapses and fluids deplete, how can the pulse not be choppy? (For choppy pulses due to deficient/choppy conditions, formulas such as Shiquan Dabu Tang [Ten Thousand Complete Tonifying Decoction], Jisheng Fuzi Tang [Benefiting Life Aconite Decoction], and Huangqi Jianzhong Tang [Astragalus Middle-Reinforcing Decoction] are appropriate.) Although it is the same Choppy pulse, it is divided into Deficient-Choppy, Stagnant-Choppy, and Withered-Choppy types. This distinction relies on the diagnostician's flexibility and insight.
Siwu Tang [Four Substances Decoction] treats fever due to blood deficiency of the Liver, Spleen, and Kidney, alternating chills and fever, severe heat in the afternoon (Shen hour), cloudiness of the head and eyes, irritability and insomnia, distension in the chest and diaphragm, and pain in the hypochondrium. For all diseases of blood deficiency, this formula serves as the primary treatment. If Spleen Qi deficiency fails to generate blood, Sizijunzi Tang [Four Gentlemen Decoction] is appropriate. If Spleen Qi stagnation leads to blood deficiency, Guipi Tang [Restore the Spleen Decoction] is appropriate. If Kidney Water is exhausted and fails to generate Liver Blood, Liuwei Dihuang Wan [Six-Ingredient Pill with Rehmannia] is appropriate.
Danggui (Radix Angelicae Sinensis, 2 qian) Baishao (Radix Paeoniae Alba, 1 qian) Shudihuang (Prepared Rhizoma Anemarrhenae, 3 qian) Chuanxiong (Rhizoma Chuanxiong, 1.5 qian)
Decoct in water and take orally.
Heji Shen Shi Tang [Formulary Office Damp-Draining Decoction] (See Chapter 17)
Baiyi Chu Shi Tang [Hundred-One Damp-Expelling Decoction] treats injury from cold-dampness, characterized by a heavy sensation in the body, pain in the waist and legs, loose stools, and urination that is either obstructed or normal.
Banxiaqu (Fermented Radix Pinelliae, stir-fried) Houpo (Cortex Magnoliae Officinalis, processed with ginger juice) Cangzhu (Rhizoma Atractylodis Macrocephalae, processed with rice wash water, each 2 liang) Huoxiangye (Herba Agastaches) Chenpi (Pericarpium Citri Reticulatae, white pith removed) Baifuling (Poria, peeled, each 1 liang) Gancao (Licorice Root, honey-fried, 7 qian) Baizhu (Rhizoma Atractylodis Macrocephalae, raw, 1 liang)
Cut the herbs into small pieces. Take 4 qian per dose. Add 1 zhan of water, 7 slices of ginger, and 1 date. Decoct until 0.7 zhan remains. Take warm before meals.
Sanyin Shen Zhuo Tang [Three Causes Kidney-Attaching Decoction] treats kidney deficiency complicated by dampness injury, characterized by heaviness of the body, coldness in the waist (as if sitting in water), absence of thirst, and free urination.
Ganjiang (Dried Ginger, processed) Fuling (Poria, each 4 liang) Gancao (Licorice Root, honey-fried) Baizhu (Rhizoma Atractylodis Macrocephalae, each 2 liang)
Take 4 qian per dose. Add 1 zhan of water. Decoct until 0.7 zhan remains. Take warm on an empty stomach.
Liujunzi Tang [Six Gentlemen Decoction] (See Chapter 16)
Baojian Renshen Lige Wan [Treasure Mirror Ginseng Throat-Unblocking Pill] treats obstruction in the chest, dry and hard stools, cough with phlegm, asthma, and chest fullness, as well as stagnation in the Spleen and Stomach. It promotes the elimination of turbidity and generation of new qi, and is considered a miraculous medicine for treating Ge Qi [Diaphragmatic Qi Disturbance].
Muxiang (Radix Aucklandiae) Binglang (Semen Arecae, each 7.5 qian) Renshen (Radix Ginseng) Danggui (Radix Angelicae Sinensis, wine-washed) Huoxiang (Herba Agastaches) Gancao (Licorice Root) Zhishi (Fructus Aurantii Immaturus, bran-fried yellow, each 1 liang) Dahuang (Radix et Rhizoma Rhei, steamed with wine) Houpo (Cortex Magnoliae Officinalis, ginger-processed, each 2 liang)
Grind into fine powder. Mix with drops of water to form pills the size of paulownia seeds. Take 30–50 pills per dose after meals, washed down with various drinks.
Tongzhi Zixue Runchang Tang [Unified Principles Nourishing-Blood Intestine-Moistening Decoction] treats blood depletion and dead blood (stasis) lodged in the diaphragm, inability to swallow food, and dry, hard stools.
Danggui (Radix Angelicae Sinensis, wine-washed, 3 qian) Shaoyao (Radix Paeoniae, stir-fried) Shengdihuang (Raw Rhizoma Rehmanniae, each 1.5 qian) Honghua (Flos Carthami, wine-washed) Taoren (Semen Persicae, skin and tip removed, stir-fried) Dahuang (Radix et Rhizoma Rhei, wine-roasted) Zhike (Fructus Aurantii, bran-fried, each 1 qian)
Add 1.5 zhong of water. Decoct until 0.7 zhong remains. Add half a wine cup of leek juice. Take before meals.
Ziyin Qingge Yin [Nourishing-Yin Clearing-Throat Infusion] (From *Tongzhi*) treats rising of Yin-Fire or excessive Stomach Fire, inability to ingest food, and a洪数 (Surging-Rapid) pulse.
Danggui (Radix Angelicae Sinensis) Shaoyao (Radix Paeoniae, roasted) Huangbai (Cortex Phellodendri, salt-water fried) Huanglian (Rhizoma Coptidis, each 1.5 qian) Huangqin (Radix Scutellariae) Shanzhi (Fructus Gardeniae) Shengdihuang (Raw Rhizoma Rehmanniae, each 1 qian) Gancao (Licorice Root, 3 fen)
Add 2 zhong of water. Decoct until 0.7 zhong remains. Add half a wine cup of child's urine and half a wine cup of bamboo sap. Take before meals.
Shiquan Dabu Tang [Ten Thousand Complete Tonifying Decoction] (See Chapter 16)
Jisheng Fuzi Tang [Benefiting Life Aconite Decoction] treats Qi deficiency and weak Yang, incessant spontaneous sweating, and limb fatigue.
Huangqi (Radix Astragali, remove root neck, honey-fried) Fuzi (Radix Aconiti Lateralis Preparata, processed, remove skin and navel, equal parts)
Cut the herbs into small pieces. Take 4 qian per dose. Add 1 zhan of water and 10 slices of fresh ginger. Decoct until 0.8 zhan remains. Take warm before meals. If ineffective, increase the dosage.
Huangqi Jianzhong Tang [Astragalus Middle-Reinforcing Decoction] treats insufficiency of Qi and Blood, accompanied by frequent spontaneous sweating.
Huangqi (Radix Astragali) Guizhi (Ramulus Cinnamomi, each 1.5 qian) Baishao (Radix Paeoniae Alba, 3 qian) Gancao (Licorice Root, 1 qian)
Take 5 qian per dose. Add 1.5 zhong of water, 5 slices of ginger, and 2 dates. Decoct until 0.8 zhong remains. Strain the dregs. Add one large spoonful of thick malt sugar. Re-decoct and take. For those who already have mild diarrhea or vomiting, do not use malt sugar.