罗谦甫治江淮漕运使崔君长子。年二十五。体丰肥。奉养膏粱。时有热证。因食凉物。
服寒药。至元庚辰秋。久疟不愈。医用砒霜截药。新汲水送下。禁食热物。疟不止。反加吐
利。腹痛肠鸣。时复胃脘当心而痛。屡医罔效。延至次年四月。因劳役烦恼。前证大作。罗
诊之。脉弦细而微。手足稍冷。面色青黄不泽。情思不乐。恶烦冗。食少。微饱则心下痞闷
呕吐酸水。发作疼痛。冷汗时出。气促。闷乱不安。须人额相抵而坐。内经云。上气不足
头为之苦倾。中气不足。溲便为之变。肠为之苦鸣。下气不足。则为痿厥心 。又曰。
寒气客于肠胃之间。则卒然而痛。得炅乃已。炅者。热也。非甘辛大热之剂则不能愈。为制
扶阳助胃汤。炮干姜一钱五分。人参、草豆蔻、炙草、官桂、白芍各一钱。陈皮、白术、吴
茱、益智各五分。炮熟附子二钱。姜、枣煎。服三帖。大势皆去。痛减过半。至秋先灸中脘
三七壮。以助胃气。次灸气海百余壮。生发元气。滋荣百脉。以还少丸服之。则善饮食。添
肌肉。明年春。灸三里二七壮。乃胃之合穴也。亦助胃气。又引气下行。春以芳香助脾。育
气汤加白檀香。戒以惩忿窒欲。慎言节食。一年而平复。
滑伯仁治一妇人。盛暑洞泄。厥逆恶寒。胃脘当心而痛。自腹引胁。转为滞下。呕哕不
食。医以中暑霍乱疗之。益剧。脉三部俱微短沉弱。不应呼吸。曰。此阴寒极矣。不亟温之
则无生理。内经虽曰用热远热。又曰。有假其气。则无禁也。于是以姜、附温药。服之七
日。诸证悉去。再以丸药除其滞下。而安。
丹溪治一人。以酒饮牛乳。患心疼年久。饮食无碍。虽盛暑饮食身无汗。医多以丁、附
治之。羸弱食减。每痛以物拄之。脉迟弱弦而涩。大便或秘结或泄。又苦吞酸。时七月。以
二陈汤加芩、连、白术、桃仁、郁李仁、泽泻。每旦服之。屡涌出黑水。若烂木耳者。服之
二百余帖。脉涩渐退。至数渐添。纯弦而渐充满。时冬暖。意其欲汗。而血气未充。以参、
、归、芍、陈皮、半夏、甘草。服之痛缓。每旦夕一二作。乃与麻黄、苍术、芎、归、甘
草等药。才下咽。忽晕厥。须臾而苏。大汗。痛止。
一妇春末。心脾疼。自言腹胀满。手足寒过肘膝。须绵裹火烘。胸畏热。喜掀露风凉。
脉沉细涩。稍重则绝。轻似弦而短。渴喜热饮。不食。以草豆蔻丸。三倍加黄连、滑石。神
曲为丸。白术为君。茯苓为佐。陈皮为使。作汤下百丸。服至二斤而愈。
震按二条脉象。俱似虚寒。而丹溪以湿热治者。上条屡服热药不效。且年久饮食无碍。
大
便或秘或泄。知其为停饮也。此条以胸前畏热喜凉。及脉沉细涩为据。所为稍重则绝者。
以细涩故也。与阔大而软之为虚寒不同矣。故加黄连、滑石。遍观丹溪案。凡脉弦细涩者。
俱不用温药。想其阅历多而认得真也。又一妇心与头互换作痛。用清空膏而愈。亦云瘦弱脉
涩。以四物加桃仁、酒芩、陈皮、甘草调理。
虞天民治一妇。四月间多食青梅得病。日间胸膈中大痛如刀锥。至晚胸中痛止而膝KT 大
痛。盖痰饮随气升降故也。医作胃寒治。与姜、桂、丁、沉、荜茇、乌、附之类。病反剧。
加口渴。小水淋漓。虞诊其六脉洪数而滑。知为痰病。令熬竹沥。服三日。口不渴。小水亦
不淋沥。但胸中与膝互痛如旧。用萝卜子研汁小半碗。吐痰半升。至夜痛尤甚而厥。此引动
其猖狂之势也。再用吐法不效。一日清晨。以藜芦末一钱。麝香少许。酸浆水调服。始大吐
其痛如脱。调理而安。
震按此条与丹溪治许文懿公案仿佛。许因中脘有食积痰饮。续冒寒湿。抑遏经络。气血
不行。津液不通。痰饮上升则为痹疼。下降则为胯痛。须涌泄之。乃以甘遂末一钱。入猪腰
子内煨食之。连泄七行。次日胯痛止而足能步。复又大作呕吐。不食烦躁。气弱不语。朱谓
多年郁结。一旦泄之。徒引动其猖狂之势。随连用吐剂大吐之。更以朴硝、滑石、黄芩、石
膏、连翘等一斤。浓煎冷冻饮料。四日尽四斤。后又腹微满。二便闭。脉歇至于寅卯时。朱谓卯
酉为手足阳明之应。此胃与大肠积滞未尽。二日内令服紫雪至五两。得稍安。又小溲闭痛。
饮以萝卜子汁半盂。得吐立通。又小腹满痛不可扪摸。神思不佳。以大黄、牵牛作丸。连下
之。得如烂鱼肠、 油条者。而神思渐安。脉乃不歇。自病半月。不食不语。惟脉皆平常弦
大。次年行倒仓法。全愈。朱公此案。宛似戴人。较之花溪。更加险峻。故节录附此。又一
童子久疟初愈。心脾疼。六脉伏。痛稍减时。气口紧盛。余皆弦实而细。意其宿食。以小胃
丹十余粒。服十二次。药尤狠。恐难学。
游以春治一嫠妇。年三十余。忽午后吐酸水碗许。至未时。心前作痛。至申时痛甚。晕
去不省人事。至戌方苏。每日如此。屡治不效。游至。用二陈下气之剂。亦不效。熟思之。
忽忆针经有云。未申时气行膀胱。想有瘀血滞于此经致然。遂用归尾、红花各三钱。干漆五
钱煎服。吐止痛定。晕亦不举。次日复进一帖。第三日加大黄、桃仁饮之。小便去凝血三四
碗而痊。
震按先吐酸水然后心前作痛。医者必认胃病。而以痰气兼湿热治。否则兼寒湿治耳。乃
从所发之时想到气行于小肠膀胱。果得小便去凝血而愈。内经所谓病在上求之下也。岂庸手
所能办。
孙东宿治查良川。怒后食鱼。骨哽喉中。即以馒头粽肉等压之。骨虽下。便觉胸膈不快
又服消骨药两日。胸膈胀痛殊甚。饮食悉从背后而下。恶寒发热。六脉弦数。因思骨哽之
后。用硬物压之。伤其胃脘。必有瘀血停蓄膈间。将食管逼在背后。故饮食觉从背后下也。
今但消去瘀血。庶使食管复元。以五灵脂为君。山楂、延胡、桃仁、枳壳为臣。赤芍、丹皮
香附、山栀仁、柴胡、石菖蒲为佐使。水煎。入韭菜汁一杯饮之。大便泻一次。即胸膈宽
快。痛减大半。饮食乃从右边而下。右边喉胸稍痛。吞物甚艰苦。吐出痰皆血腥气。改以山
栀、赤芍、归尾、桃仁、刘寄奴、五灵脂、丹皮、穿山甲煎。入韭菜汁服之。两帖全瘳。
震按同一瘀血致痛。上条难辨。此条易认。因硬物吞压。启其思路耳。然想到食管逼在
背后。思路巧极。
歙溪吴入峰之室。胃脘作痛。两胁胀急。痛一阵。则汗出一番。两颧红。唇口亦红。饮
食汤水。饮之立吐。不受者三日夜矣。孙东宿诊之。两寸脉洪大。两尺沉微。孙以井水半碗
百滚汤半碗。名曰阴阳汤。用此调元明粉一钱五分。服之不惟不吐。痛减半矣。少顷。大
便行三次。因食豆腐及粥太早而痛复作。唇脸皆红。此必有虫。故如是也。与桂枝、白芍、
甘草、乌梅、川椒、五灵脂、杏仁。水煎。痛乃定其大半。再与苍术、浓朴、山楂、枳实、
茯苓、延胡、香附。一帖全止。但心背皮肤外疼。不能着席而睡。以芎、归、苓、术、橘、
半、浓朴、腹皮、香附、甘草。调养全愈。
震按阴阳汤调元明粉。亦一医痛急着。续用三方。皆纯正可宗。
给谏章鲁斋。暑月心中大痛。服香薷饮。痛势转增。李士材曰。寸口弦急。痰食交结也
服香砂二陈汤两帖。痛虽略减。困苦烦闷。更以胃苓汤加半夏二钱。大黄三钱。下黑屎数
枚。痛减三四。仍以前汤用大黄四钱。下胶痰十数碗。始安。
章生公在南都应试。八月初五。心口痛甚。至不能饮食。李诊之。寸口涩而软。与大剂
归脾汤。加人参三钱。官桂一钱。生公曰。痛而骤补。实所不敢。得无与场期碍乎。李曰。
第能信而服之。可以无碍。恐反投破气之药。其碍也必矣。遂服之。不超时而痛减。更进一
剂。并饮独参汤。两日而愈。场事获竣。
王金 曰。予读中秘书时。馆师韩敬堂先生常患膈痛。诊其脉洪大而涩。予用山栀仁、
赤曲、通草、麦芽、香附、芎、归煎汤。加姜汁、韭汁、童便、竹沥饮之而止。一日。劳倦
忍饥。痛大发。亟邀予至卧房。问曰。晨起痛甚。不得待公。服家兄药。药下咽。如刀割。
痛益甚不可忍。何也。予曰。得非二陈、平胃、乌药、紫苏之属乎。曰然。曰。是则何怪乎
其增病也。夫劳饿而发。饱逸则止。知其虚也。饮以十全大补汤。一剂而痊。
震按李公二案。一用峻下。一用大补。皆以脉为凭。王公一案。先用行血通气。后用十
全大补。先凭于脉。后凭于因。乃知丹溪以脉因证治名书。扼其要而病无遁情也。
李时珍治一人。素饮酒。因寒月哭母受冷。遂病寒中。食必佐以姜、蒜。至夏酷暑。又
多饮水。兼怀怫郁。因病右腰一点胀痛。牵引右胁。上至胸口。则必欲卧。发则大便里急后
重。频欲登圊。小便长而数。或吞酸。或吐水。或作泻。或阳痿。或厥逆。或得酒少止。得
热少止。但受寒食寒。或劳役。或入房。或怒。或饥即发。止则诸证泯然。甚则日二三发。
服温脾胜湿滋补消导药。皆微止随发。时珍思之。此乃饥饱劳逸。内伤元气。清阳陷遏不能
上升所致。遂用升麻葛根汤合四君子加柴胡、苍术、黄 煎服。仍饮酒一二杯助之。其药入
腹则觉清气上行。胸膈爽快。手足和暖。头目精明。诸证如扫。每发一服。即止。若减升麻
葛根。或不饮酒。则效便迟。大抵人年五十以后。其气消者多。长者少。降者多。升者少
秋冬之令多。春夏之令少。若禀受弱而有前诸证者。并宜此药活法治之。
震按此种病近来颇多。每从右胁胀痛至中脘。或吞酸。或吐水。或作泻。肢冷不食。予
每以二陈汤加香附、白芍、苍术、良姜、草蔻、胡卢巴等。服之颇效。但易于发。发久则渐
重。欲其不发。殊苦无策。观此病饮酒少止。得热少止。似有间可寻矣。乃不用温药。而以
升、柴、葛、二术、参、 升阳益胃。实得力于东垣。惜不载脉象为恨。然云每发一服即止
则亦不能不发也。
一妇人胃脘痛。勺水不入。寒热往来。或从火治。用芩、连、栀、柏。或从寒治。用姜
桂、茱萸。展转月余。形体羸瘦。六脉弦数。几于毙矣。高鼓峰曰。此肝痛也。非胃脘也
其病起于郁结生火。阴血受伤。肝肾枯干。燥迫成痛。医复投以苦寒辛热之剂。胃脘重伤
其能瘳乎。急以滋肾生肝饮与之。一昼夜。尽三大剂。五鼓熟寐。次日痛定觉饿矣。再用
加味归脾汤加麦冬、五味。十余剂而愈。
震按江应宿治一男子。心脾痛。六脉弦数。曰。此火郁耳。投姜汁炒黄连、山栀泻火为
君。川芎、香附开郁。陈皮、枳壳顺气为臣。反佐以炮姜。从治一服而愈。再与平胃散加姜
炒黄连、山栀。神曲糊丸服。永不发。与此案脉同治异。可合参之。
尝阅临证指南治脘痛。大半是肝邪犯胃。或挟痰。或挟瘀。或兼寒。或兼热。再辨胃之
虚实。肝之寒热。而错综参伍以为治。即紫金丹、栝蒌薤半桂枝汤。泻心和枳实、姜汁。异
功加归、芍。总皆古法。不立新方。其用石决明、桑寄生、阿胶、生地、杞、苓、石斛等。
以养胃汁。即鼓峰滋肾生肝法也。其用苏木、人参、桃仁、归尾、郁金、栀仁、琥珀、茺蔚
以红枣肉丸。即孙东宿治查良川法也。惟缓逐其瘀。用蜣螂、 虫、灵脂各一两。桃仁二
两。桂枝尖生用五钱。蜀漆炒黑三钱。老韭白根捣汁丸。以虫豸入血搜逐。及诸配合之药为
最巧。又阳微浊凝。用炒川椒一钱。泡干姜钱半。炮黑乌、附各三钱。大剂辛热驱寒。不加
监制之药为最猛。惟此二方有大力量。然指南全部。亦仅数年之医案。岂足概先生之一生。
自刊行以来。沾溉后学。被其惠者良多。而枵腹之辈。又藉此书易于剿袭。每遇一证。即抄
其辞句之精华。及药方之纤巧而平稳者。录以应酬。竟可悬壶。无论大部医书。畏如望洋。
即小部医书。亦束之高阁。惟奉指南乐其简便。而不知学之日益浅陋也。嗟乎。岂指南误人
乎。抑人误指南乎。
〔附〕薛生白先生治嘉善一人胃脘痛。胸膈痞塞。向作痰治气治。均不效。有前辈与控
涎丹。服数日。大泻不止。上稍舒而体倦甚。遂进六君子汤。数帖后。精神复而痛胀如前矣
薛用千金子煎汤。磨沉香、木香、檀香、降香、丁香。服一月而全愈。服时亦作泻。薛云
无妨。故守其法而收功。
杭州议叙部郎叶体醇少年时。脘痛不能食。身极羸瘦。上海杜良一先生。用纲目浓朴煎
丸。每晨以人参二钱煎送丸药三钱。服一月而痛除根。食大进。身遂肥胖。
浓朴煎丸 浓朴去皮锉用。生姜二斤连皮切片。以水五升同煮干。去姜焙朴。以干姜四
两。甘草二两。再同浓朴。以水五升煮干。去草。焙姜朴为末。用枣肉、生姜同煮熟。去姜
捣枣和丸梧子大。每服五十丸。
罗谦甫治疗江淮漕运使崔君的长子。患者二十五岁。身体肥胖丰腴。饮食多为肥甘厚味。体内常有热象。因食用生冷食物。又服用寒凉药物。到了至元庚辰年秋天。长期疟疾不愈。医生使用含有砒霜的截疟药。用新汲水送服。并禁止食用热性食物。结果疟疾不止。反而增加了呕吐、腹泻。腹痛肠鸣的症状。时常出现胃脘部当心而痛的情况。多次就医无效。拖延到次年四月。因劳累和烦恼。之前的症状剧烈发作。罗谦甫诊察时。脉象弦细而微弱。手脚稍微发冷。面色青黄无光泽。情绪低落不快乐。厌恶繁琐事务。食欲减退。稍微吃饱就感到心下痞闷。呕吐酸水。发作时疼痛。出冷汗。气短。烦躁不安。需要让人额头相抵着坐着才能稍安。《内经》说。上气不足。头部就会感到沉重欲倒。中气不足。大小便就会发生异常。肠道会发出痛苦的鸣响。下气不足。就会导致痿证和厥逆。又说。寒气侵袭肠胃之间。就会突然疼痛。得到温热就会缓解。“炅”就是热的意思。如果不是甘辛大热的药剂就不能治愈。于是配制了扶阳助胃汤。炮干姜一钱五分。人参、草豆蔻、炙甘草、官桂、白芍各一钱。陈皮、白术、吴茱萸、益智仁各五分。炮熟附子二钱。加生姜、大枣煎服。服用三帖后。主要症状都去除了。疼痛减少了一半以上。到了秋天。先灸中脘穴三七壮。以助胃气。接着灸气海穴百余壮。生发元气。滋养百脉。服用还少丸。则胃口好。肌肉增加。第二年春天。灸足三里穴二七壮。这是胃的下合穴。也能助胃气。并且引气下行。春季用芳香药物助脾。在育气汤中加入白檀香。告诫他克制愤怒、节制欲望。谨慎言语、节制饮食。一年后完全康复。
滑伯仁治疗一位妇人。正值盛夏。出现严重腹泻。四肢厥冷。恶寒。胃脘部当心而痛。疼痛从腹部牵引至胁肋。转为痢疾（滞下）。呕吐呃逆。不能进食。医生按照中暑霍乱治疗。病情反而加重。三部脉象都微短沉弱。脉搏跳动与呼吸不相适应。滑伯仁说。这是阴寒极盛。如果不紧急温补就没有生机。《内经》虽然说要“用热远热”（夏季慎用热药）。但又说。如果有假象（如真寒假热或寒邪直中）就不必禁忌。于是使用干姜、附子等温药。服用七日后。所有症状全部消除。再用丸药清除痢疾。病情安定。
朱丹溪治疗一人。因为喝酒后饮牛乳。患心痛多年。饮食没有障碍。即使在盛夏饮食后身上也不出汗。医生多用丁香、附子治疗。导致身体羸弱。食欲减退。每次疼痛时用物体顶住胸口。脉象迟弱弦而涩。大便有时便秘有时泄泻。又苦于吞酸。当时是七月。朱丹溪用二陈汤加黄芩、黄连、白术、桃仁、郁李仁、泽泻。每天早晨服用。多次涌吐出黑色液体。像烂木耳一样。服用二百多帖后。脉涩逐渐消退。脉率逐渐增加。变为纯弦脉且逐渐充盈。当时冬天温暖。推测其想要出汗。但血气尚未充足。改用人参、茯苓、当归、白芍、陈皮、半夏、甘草。服用后疼痛缓解。每天早晚发作一两次。于是给予麻黄、苍术、川芎、当归、甘草等药。刚咽下。忽然晕厥。片刻后苏醒。大汗淋漓。疼痛停止。
一位妇女在春末。心脾疼痛。自述腹胀满。手足寒冷超过肘膝。需要用棉布包裹火烘烤。胸部怕热。喜欢掀开衣服吹风纳凉。脉象沉细涩。重按则脉搏消失。轻取似弦而短。口渴喜欢热饮。不能进食。用草豆蔻丸。三倍量加入黄连、滑石。神曲为丸。以白术为君药。茯苓为佐药。陈皮为使药。作汤剂送服一百丸。服用两斤后痊愈。
俞震按：上述两条脉象。都看似虚寒。但丹溪用湿热论治。上一条多次服用热药无效。且病程长。饮食无碍。大便或秘或泄。知道是水饮停聚所致。这一条以胸前畏热喜凉。以及脉沉细涩为依据。所谓重按则绝。是因为细涩的缘故。这与阔大而软的虚寒脉不同。所以加入黄连、滑石。遍观丹溪医案。凡是脉弦细涩的。都不用温药。想必是他阅历丰富。辨识准确。又一妇人心和头交替疼痛。用清空膏治愈。也是瘦弱脉涩。用四物汤加桃仁、酒黄芩、陈皮、甘草调理。
虞天民治疗一妇人。四月间多吃青梅得病。白天胸膈中剧烈疼痛如刀锥刺。到了晚上胸中痛止而膝盖KT（此处疑为“髀”或类似部位，指大腿或膝部）剧痛。这是因为痰饮随气升降所致。医生当作胃寒治疗。给予干姜、肉桂、丁香、沉香、荜茇、乌头、附子之类。病情反而加重。加上口渴。小便淋漓不尽。虞天民诊察六脉洪数而滑。知道是痰病。令熬竹沥。服用三天。口不渴。小便也不淋漓了。只是胸中与膝盖依然交替疼痛如旧。用萝卜子研汁小半碗。吐出痰液半升。到了夜晚疼痛更加严重甚至厥逆。这是引动了痰势猖狂的表现。再用吐法无效。一天清晨。用藜芦末一钱。麝香少许。用酸浆水调服。开始大量呕吐。疼痛如解脱一般。调理后安定。
俞震按：这一条与丹溪治疗许文懿公的医案相似。许先生因为中脘有食积痰饮。随后冒犯寒湿。压抑经络。气血不行。津液不通。痰饮上升则为痹疼。下降则为胯痛。必须用涌吐泄下的方法。于是用甘遂末一钱。放入猪腰子内煨熟吃下。连续腹泻七次。第二天胯痛停止。脚能走路。后来又大作呕吐。不食烦躁。气弱不语。朱丹溪认为多年的郁结。一旦泻之。徒然引动其猖狂之势。随即连续用吐剂大吐之。再用朴硝、滑石、黄芩、石膏、连翘等一斤。浓煎冷冻饮料。四天吃完四斤。后来腹部微满。二便闭结。脉象歇止到寅卯时。朱丹溪认为卯酉对应手足阳明经。这是胃与大肠积滞未尽。两天内令服用紫雪至五两。得以稍安。又小便闭痛。饮用萝卜子汁半盂。得吐后立刻通畅。又小腹满痛不可触摸。神志不佳。用大黄、牵牛做成丸药。连续攻下。排出像烂鱼肠、油条样的东西。神志逐渐安定。脉象不再歇止。生病半个月。不食不语。只有脉象平常弦大。第二年行倒仓法。完全痊愈。朱丹溪的这个医案。宛然是张从正（戴人）的风格。比丹溪更为险峻。所以节录附在此处。又一童子久疟初愈。心脾疼痛。六脉伏匿。疼痛稍减时。气口脉紧盛。其余皆弦实而细。推测是宿食。用小胃丹十余粒。服用十二次。药力尤其猛烈。恐怕难以模仿。
游以春治疗一位寡妇。三十多岁。忽然午后吐酸水约一碗。到未时。心前作痛。到申时疼痛加剧。晕倒失去人事。到戌时才苏醒。每天如此。多次治疗无效。游以春到来。用二陈汤下气之剂。也无效。深思之后。忽然想起《针经》说。未申时气行膀胱。想是有瘀血停滞在这条经脉导致这样。于是用归尾、红花各三钱。干漆五钱煎服。吐止痛定。晕厥也不再发生。次日再进一帖。第三天加大黄、桃仁饮用。小便排出凝血三四碗而痊愈。
俞震按：先吐酸水然后心前作痛。医生必定认为是胃病。而以痰气兼湿热治疗。否则兼寒湿治疗罢了。乃是从发病的时间想到气行于小肠膀胱。果然得小便去凝血而愈。《内经》所谓病在上求之下也。难道是庸医所能做到的吗？
孙东宿治疗查良川。发怒后吃鱼。鱼骨卡喉中。就用馒头粽肉等压下去。骨头虽下去了。便觉得胸膈不快。又服消骨药两天。胸膈胀痛非常严重。饮食全从背后而下。恶寒发热。六脉弦数。心想骨哽之后。用硬物压迫。损伤了胃脘。必有瘀血停蓄膈间。将食管逼在背后。所以饮食觉得从背后下。现在只要消除瘀血。才能使食管复原。以五灵脂为君药。山楂、延胡索、桃仁、枳壳为臣药。赤芍、丹皮、香附、山栀仁、柴胡、石菖蒲为佐使药。水煎。加入韭菜汁一杯饮用。大便泻一次。即胸膈宽快。疼痛减少大半。饮食乃从右边而下。右边喉胸稍痛。吞咽很艰苦。吐出痰都有血腥气。改用药方：山栀、赤芍、归尾、桃仁、刘寄奴、五灵脂、丹皮、穿山甲煎。加入韭菜汁服。两帖全愈。
俞震按：同样是瘀血致痛。上一条难辨。这一条易认。因为硬物吞压。启发了思路。然而想到食管被逼在背后。思路极其巧妙。
歙溪吴入峰的夫人。胃脘作痛。两胁胀急。痛一阵。则汗出一番。两颧红。唇口亦红。喝汤水。喝下去立刻呕吐。不吃东西已经三昼夜了。孙东宿诊察。两寸脉洪大。两尺沉微。孙东宿用井水半碗。百滚开水半碗。名叫阴阳汤。用此调元明粉一钱五分。服用后不但没吐。疼痛减半了。一会儿。大便行了三次。因为吃豆腐及粥太早而痛复发。嘴唇脸面都红。这一定有虫。所以是这样。给予桂枝、白芍、甘草、乌梅、川椒、五灵脂、杏仁。水煎。疼痛才稳定大半。再给予苍术、浓朴、山楂、枳实、茯苓、延胡索、香附。一帖全止。只是心背皮肤外疼。不能着席而睡。用川芎、当归、茯苓、白术、橘红、半夏、浓朴、腹皮、香附、甘草。调养全愈。
俞震按：阴阳汤调元明粉。也是一种急治疼痛的方法。后续用的三方。皆纯正可效法。
给谏章鲁斋。暑月心中大痛。服香薷饮。痛势转增。李士材说。寸口弦急。是痰食交结。服香砂二陈汤两帖。痛虽略减。困苦烦闷。更以胃苓汤加半夏二钱。大黄三钱。下黑屎数枚。痛减三四。仍以前汤用大黄四钱。下胶痰十数碗。始安。
章生公在南都应试。八月初五。心口痛甚。至不能饮食。李士材诊察。寸口涩而软。给予大剂归脾汤。加人参三钱。官桂一钱。章生公说。痛而骤补。实在不敢。会不会妨碍考试日期呢？李士材说。只要能相信并服用。可以无碍。恐怕反投破气之药。其妨碍必然矣。于是服用。不超过时辰疼痛减轻。再进一剂。并饮独参汤。两天而愈。考试完成。
王金曰。我读中秘书时。馆师韩敬堂先生常患膈痛。诊其脉洪大而涩。我用山栀仁、赤曲、通草、麦芽、香附、川芎、当归煎汤。加姜汁、韭汁、童便、竹沥饮用而止。一天。劳倦忍饥。痛大发。急忙邀请我到卧室。问我说。晨起痛甚。不能等待您来。服家兄的药。药下咽。如刀割。痛益甚不可忍。为什么呢？我说。莫非是二陈、平胃、乌药、紫苏之类的药吗？回答说。是的。我说。那为什么怪它增加病情呢。疲劳饥饿而发。饱逸则止。知道是虚证。饮用十全大补汤。一剂而痊愈。
俞震按：李公的两个医案。一个用峻下。一个用大补。都以脉象为依据。王公的一个医案。先用行血通气。后用十全大补。先凭脉象。后凭病因。才知道丹溪以脉因证治命名书籍。扼其要点而病情无处遁形。
李时珍治疗一人。平时饮酒。因寒冬哭母受冷。于是病寒中。吃饭必须佐以姜、蒜。到了夏天酷暑。又多饮水。兼怀怫郁。因病右腰一点胀痛。牵引右胁。上至胸口。则必须躺卧。发作则大便里急后重。频繁想上厕所。小便长而数。有时吞酸。有时吐水。有时作泻。有时阳痿。有时厥逆。有时得酒稍止。得热稍止。但只要受寒食寒。或劳役。或入房。或怒。或饥即发。止则诸证泯然。严重时一天发作二三回。服用温脾胜湿滋补消导药。都轻微停止随即发作。时珍思考。这是饥饱劳逸。内伤元气。清阳陷遏不能上升所致。于是用升麻葛根汤合四君子汤加柴胡、苍术、黄芩煎服。仍饮酒一二杯助药力。其药入腹则觉清气上行。胸膈爽快。手足和暖。头目精明。诸证如扫。每发一服。即止。如果减少升麻葛根。或不饮酒。则疗效便慢。大抵人年五十以后。其气消者多。长者少。降者多。升者少。秋冬之令多。春夏之令少。如果禀受弱而有前述诸证的。都宜用此药活法治之。
俞震按：这种病近来颇多。每从右胁胀痛至中脘。或吞酸。或吐水。或作泻。肢冷不食。我常用二陈汤加香附、白芍、苍术、良姜、草蔻、胡卢巴等。服用颇有效。但易于发作。发作久了则渐重。想要它不发作。确实苦无对策。看这个病饮酒少止。得热少止。似乎有间隙可寻。却不用温药。而以升麻、柴胡、葛根、二术、参、芪升阳益胃。实在是得力于李东垣。可惜不载脉象为恨。然而说每发一服即止。则也不能说不发作。
一妇人胃脘痛。勺水不入。寒热往来。或用火治。用黄芩、黄连、栀子、黄柏。或用寒治。用干姜、肉桂、吴茱萸。辗转月余。形体羸瘦。六脉弦数。几乎毙命。高鼓峰说。这是肝痛。不是胃脘痛。其病起于郁结生火。阴血受伤。肝肾枯干。燥迫成痛。医生又投以苦寒辛热之剂。胃脘重伤。怎么能痊愈呢。急以滋肾生肝饮与之。一昼夜。尽三大剂。五鼓熟寐。次日痛定觉饿矣。再用加味归脾汤加麦冬、五味子。十余剂而愈。
俞震按：江应宿治疗一男子。心脾痛。六脉弦数。说。这是火郁耳。投姜汁炒黄连、栀子泻火为君。川芎、香附开郁。陈皮、枳壳顺气为臣。反佐以炮姜。从治一服而愈。再与平胃散加姜炒黄连、栀子。神曲糊丸服。永不发。与此案脉同治异。可合参之。
曾阅读《临证指南》治疗脘痛。大半是肝邪犯胃。或挟痰。或挟瘀。或兼寒。或兼热。再辨胃之虚实。肝之寒热。而错综参伍以为治。即紫金丹、栝蒌薤白半夏汤、桂枝汤。泻心汤、枳实理中汤、姜汁。异功散加当归、白芍。总皆古法。不立新方。其用石决明、桑寄生、阿胶、生地、枸杞、茯苓、石斛等。以养胃汁。即是鼓峰滋肾生肝法。其用苏木、人参、桃仁、归尾、郁金、栀仁、琥珀、茺蔚草以红枣肉丸。即是孙东宿治查良川法。惟缓逐其瘀。用蜣螂、虻虫、五灵脂各一两。桃仁二两。桂枝尖生用五钱。蜀漆炒黑三钱。老韭白根捣汁丸。以虫豸入血搜逐。及诸配合之药为最巧。又阳微浊凝。用炒川椒一钱。泡干姜钱半。炮黑乌头、附子各三钱。大剂辛热驱寒。不加监制之药为最猛。惟此二方有大力量。然而《指南》全部。也不过数年之医案。岂足以概括先生的一生。自从刊行以来。沾溉后学。被其惠者良多。而空虚之辈。又借此书易于抄袭。每遇一证。就抄其辞句之精华。及药方之纤巧而平稳者。录以应酬。竟可悬壶。无论大部医书。畏如望洋。即小部医书。亦束之高阁。惟奉《指南》乐其简便。而不知学之日益浅陋也。唉。难道是《指南》误人乎。还是人误《指南》乎？
〔附〕薛生白先生治疗嘉善一人胃脘痛。胸膈痞塞。向来作为痰治气治。均不效。有前辈给予控涎丹。服用数日。大泻不止。上稍舒而体倦甚。于是进六君子汤。数帖后。精神复而痛胀如前矣。薛用千金子煎汤。磨沉香、木香、檀香、降香、丁香。服用一月而全愈。服用时也作泻。薛云无妨。故守其法而收功。
杭州议叙部郎叶体醇少年时。脘痛不能食。身极羸瘦。上海杜良一先生。用纲目浓朴煎丸。每晨以人参二钱煎送丸药三钱。服用一月而痛除根。食大进。身遂肥胖。
浓朴煎丸 浓朴去皮锉用。生姜二斤连皮切片。以水五升同煮干。去姜焙朴。以干姜四两。甘草二两。再同浓朴。以水五升煮干。去草。焙姜朴为末。用枣肉、生姜同煮熟。去姜捣枣和丸梧子大。每服五十丸。
Luo Qianfu treated the eldest son of Cui Jun, the Transport Commissioner of Jianghuai. The patient was twenty-five years old, obese and fleshy, accustomed to a diet rich in fats and sweets, with frequent heat syndromes internally. Due to consuming cold foods and taking cold-natured medicines, by the autumn of the Gengchen year of the Zhiyuan era, he suffered from persistent malaria that did not resolve. Physicians used malaria-intercepting medicines containing arsenic (Pishuang), administered with freshly drawn water, and prohibited hot foods. Consequently, the malaria persisted, and vomiting, diarrhea, abdominal pain, and borborygmus were added. He frequently experienced epigastric pain centered at the heart region. Multiple treatments failed. By April of the following year, due to labor and vexation, his previous symptoms worsened significantly. Luo examined him: the pulse was wiry, fine, and faint; hands and feet were slightly cold; complexion was greenish-yellow and lusterless; mood was depressed and unhappy; he disliked trivial matters; appetite was poor; slight fullness caused epigastric stuffiness, vomiting of sour fluid, and painful attacks with cold sweats; breathing was rapid; he felt restless and uneasy, requiring someone to sit with their forehead touching his for comfort. The *Neijing* states: "When upper Qi is insufficient, the head suffers from heaviness and tendency to fall. When middle Qi is insufficient, urination and defecation become abnormal, and the intestines suffer from painful borborygmus. When lower Qi is insufficient, flaccidity and cold limbs occur." It also says: "When cold pathogen invades between the stomach and intestines, sudden pain occurs, which is relieved by warmth." "Jiong" means heat. Without sweet, acrid, and strongly heating decoctions, it cannot be cured. Thus, Fuyang Zhwei Decoction (Support Yang and Assist Stomach Decoction) was prepared: Pao Ganjiang (Prepared Rhizoma Zingiberis) 1 qian 5 fen, Renshen (Ginseng Radix et Rhizoma), Caodoukou (Cardamomi Fructus Rotundus), Zhi Cao (Honey-fried Glycyrrhizae Radix et Rhizoma), Guanzi Gui (Cinnamomi Cortex), Baishao (Paeoniae Radix Alba) each 1 qian; Chenpi (Citri Reticulatae Pericarpium), Baizhu (Atractylodis Macrocephalae Rhizoma), Wuzhuyu (Evodiae Fructus), Yizhi (Alpiniae Oxyphyllae Fructus) each 5 fen; Paoshu Fuzi (Prepared Aconiti Lateralis Radix) 2 qian. Decocted with Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus). After three doses, major symptoms disappeared, and pain reduced by more than half. In autumn, Zhongwan (CV12) was moxibusted for 37 moxa cones to assist Stomach Qi, followed by Qihai (CV6) for over 100 cones to generate primal Qi and nourish all vessels. Huan Shao Wan (Restore Youth Pill) was taken to improve appetite and gain muscle. In spring of the next year, Zusanli (ST36) was moxibusted for 14 cones; as the He-Sea point of the Stomach, it assists Stomach Qi and guides Qi downward. Fragrant herbs were used to assist Spleen, specifically Yuxi Tang (Nourish Qi Decoction) with added Baitanxiang (Santalum Album Wood). He was advised to control anger, restrain desires, speak sparingly, and eat moderately. He recovered completely after one year.
Hua Bolin treated a woman suffering from severe diarrhea during midsummer, with cold limbs, aversion to cold, and epigastric pain centered at the heart region, radiating from the abdomen to the hypochondrium, progressing to dysentery (Zhixia). She vomited and hiccuped, unable to eat. Physicians treated her for summerheat and cholera, worsening her condition. All three pulses were faint, short, deep, and weak, not synchronizing with respiration. Hua said, "This is extreme Yin-cold. If not urgently warmed, there is no hope." Although the *Neijing* advises avoiding heat in summer ("Yong Re Yuan Re"), it also states that if there is a false appearance, prohibitions do not apply. Thus, warming medicines with Jiang (Zingiberis Rhizoma) and Fu (Aconiti Radix Praeparata) were used. After seven days, all symptoms resolved. Pills were then used to clear the dysentery, and she stabilized.
Zhu Danxi treated a man who developed chronic heart pain after drinking alcohol and milk. Digestion was unaffected. Even in midsummer, he did not sweat after eating. Physicians often treated him with Dingxiang (Caryophylli Flos) and Fuzi (Aconiti Radix Praeparata), leading to emaciation and loss of appetite. He pressed objects against his chest during pain. Pulse was slow, weak, wiry, and choppy. Bowel movements alternated between constipation and diarrhea. He suffered from acid regurgitation. It was July. Zhu prescribed Erchen Tang (Two-Aged Decoction) plus Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Taoren (Persicae Semen), Yuliren (Prunus Mume Seed), and Zexie (Alismatis Rhizoma), taken every morning. He repeatedly vomited black liquid resembling rotten wood ear mushrooms. After over 200 doses, the choppy pulse gradually receded, pulse rate increased, becoming purely wiry and fuller. Winter was warm; sweating was anticipated but blood and Qi were insufficient. Formula changed to Renshen (Ginseng Radix et Rhizoma), Fuling (Poria), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), and Gancao (Glycyrrhizae Radix et Rhizoma). Pain eased, occurring once or twice daily. Then Mahuang (Ephedrae Herba), Cangzhu (Atractylodis Rhizoma), Xiong (Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), and Gancao (Glycyrrhizae Radix et Rhizoma) were given. Immediately after swallowing, he fainted, revived shortly after, profusely sweated, and pain ceased.
A woman in late spring suffered heart-spleen pain, abdominal distension, and cold limbs extending beyond elbows and knees, requiring wrapped fire for warmth. She feared heat in the chest, preferring cool air. Pulse was deep, fine, and choppy; disappearing on heavy pressure, appearing wiry and short on light pressure. Thirsty for hot drinks, anorexic. Caodoukou Wan (Cardamom Pill) was modified with triple dosage of Huanglian (Coptidis Rhizoma) and Huashi (Talcum), using Shenqu (Medicated Leaven) as pill base, Baizhu (Atractylodis Macrocephalae Rhizoma) as chief herb, Fuling (Poria) as assistant, and Chenpi (Citri Reticulatae Pericarpium) as guide. Administered as decoction with 100 pills per dose. She recovered after consuming two jin.
Yu Zhen's commentary: Both cases appeared deficient-cold, yet Danxi treated damp-heat. The first case failed multiple hot treatments; long duration, normal digestion, alternating stool indicated fluid retention. The second case relied on chest heat intolerance and deep-fine-choppy pulse. The disappearance on heavy pressure was due to fineness and choppy nature, distinct from broad-soft deficiency-cold pulses. Hence Huanglian and Huashi were added. Danxi generally avoided warming herbs for wiry-fine-choppy pulses, reflecting extensive experience. Another woman with alternating heart-head pain was cured by Qingkong Gao (Clear Upper Paste), also showing thinness and choppy pulse, treated with Siwu Tang (Four Substances Decoction) plus Taoren (Persicae Semen), Jiu Huangqin (Wine-fried Scutellariae Radix), Chenpi (Citri Reticulatae Pericarpium), and Gancao (Glycyrrhizae Radix et Rhizoma).
Yu Tianmin treated a woman who fell ill in April after eating excessive green plums. Daytime chest diaphragm pain was severe like knife thrusts; night brought relief in chest but severe knee/thigh pain, attributed to phlegm-fluid moving with Qi. Treated as Stomach cold with Jiang (Zingiberis Rhizoma), Guirou (Cinnamomi Cortex), Dingxiang (Caryophylli Flos), Chenshen (Aquilariae Lignum Resinatum), Bibo (Piperis Kadsurae Fructus), Wutou (Aconiti Radix), and Fuzi (Aconiti Radix Praeparata), worsening condition with thirst and dribbling urine. Six pulses were surging, rapid, and slippery. Yu identified phlegm disease, prescribed Zhuli (Bambusa Textile Phyllostachydis Caulis Juice). After three days, thirst and urinary issues resolved, but chest-knee alternating pain persisted. Luobozhi juice (Radish Seed Juice) induced vomiting of half a sheng of phlegm. Night brought worse pain and syncope, indicating agitation of rampant pathogen. Further vomiting failed. Next morning, Libiao powder (Veratrum Root Powder) 1 qian and Shexiang (Moschus)少许 mixed in sour plum water induced massive vomiting, relieving pain. Recovery followed.
Yu Zhen's commentary: Similar to Danxi's case of Xu Wen Yi. Xu had food/phlegm stagnation in Zhongwan, compounded by cold-damp, blocking collaterals. Rising phlegm caused bi-pain; falling caused hip pain. Purging/vomiting was needed. Gansui powder (Kansui Radix) placed in pork kidney and baked caused seven purgations. Hip pain stopped, walking resumed. Later, severe vomiting, restlessness, weakness occurred. Zhu believed sudden purging agitated chronic stagnation. Continuous vomiting was performed. Then Poxiao (Natrii Sulfas), Huashi (Talcum), Huangqin (Scutellariae Radix), Shigao (Gypsum Fibrosum), Lianqiao (Forsythiae Fructus) totaling one jin were decocted and drunk cold over four days. Abdominal fullness and constipation ensued. Pulse skipped during Yin-Mao hours. Zhu noted Mao-You correspond to Hand-Foot Yangming, indicating residual Stomach/Large Intestine stagnation. Zixue (Purple Snow) five liang over two days provided relief. Urinary obstruction/pain resolved with Luobozhi juice. Lower abdominal fullness/pain with poor spirit treated with Dahuang (Rhei Radix et Rhizoma) and Qianniu (Pharbitidis Semen) pills, evacuating rotting fish-intestine-like material. Spirit improved, pulse normalized. After half month of fasting/silence, pulse remained normal wiry-large. Dao Cang Fa (Stomach Purging Method) the next year cured him. This case resembles Zhang Congzheng (Dairen), even more drastic than Danxi. Another youth with post-malaria heart-spleen pain had hidden six pulses; tight-rapid Kou section suggested retained food. Xiaowei Dan (Minor Stomach Pill) ten grains twelve times was too harsh to imitate.
You Yichun treated a widow, thirty-plus, vomiting one bowl of sour fluid in afternoon, heart pain starting Wei hour, worsening Shen hour, syncope until Xu hour, recurring daily. Erchen Tang failed. Recalling *Needle Classic*: Qi flows in Bladder during Wei-Shen hours. You suspected blood stasis in this meridian. Used Guiwei (Angelicae Sinensis Radix Tail), Honghua (Carthami Flos) each 3 qian, Ganqi (Drynariae Rhizoma? Note: Ganqi usually refers to Licorice, but here likely Drynaria or similar resinous substance given context of stasis, though text says Ganqi 5 qian which is high for Licorice, possibly a typo for another herb or specific preparation. Given "Ganqi" in ancient texts can sometimes refer to other substances, but standard is Licorice. However, 5 qian is very high for Licorice in a single dose unless specified. Let's stick to literal translation but note potential ambiguity. Actually, Ganqi 5 qian might be a typo for something else or a very large dose. I will translate as Ganqi (Licorice Radix et Rhizoma) but note the quantity.) Wait, checking standard texts, Ganqi is Licorice. 5 qian is approx 15g. Possible. Or maybe "Ganji" (Resin)? Text says Ganqi. I will translate as Ganqi.
Used Guiwei (Angelicae Sinensis Radix Tail), Honghua (Carthami Flos) each 3 qian, Ganqi (Licorizae Radix et Rhizoma) 5 qian decocted. Vomiting stopped, pain settled, syncope ceased. Next day repeated. Third day added Dahuang (Rhei Radix et Rhizoma) and Taoren (Persicae Semen). Urinated 3-4 bowls of clotted blood. Cured.
Yu Zhen's commentary: Sour vomiting preceding heart pain suggests Stomach disease, treated with phlegm-Qi/damp-heat or cold-damp. You deduced Small Intestine/Bladder involvement from timing. Evacuating clotted blood via urine confirmed "treat upper by seeking lower" principle. Unlikely for mediocre physicians.
Sun Dongsu treated Zha Liangchuan. After anger and eating fish, bone stuck in throat. Pressed down with steamed bun/zongzi. Bone passed, but chest discomfort remained. Two days of bone-dissolving meds caused severe chest/distal pain. Food went down the back. Aversion to cold/fever. Six pulses wiry-rapid. Sun reasoned hard pressing damaged Stomach, causing blood stasis in diaphragm, displacing esophagus backward. Treatment aimed at resolving stasis. Wulingzhi (Trogopterori Faeces) as chief; Shanzha (Crataegi Fructus), Yanhusuo (Corydalis Rhizoma), Taoren (Persicae Semen), Zhike (Aurantii Fructus Immaturus) as ministers; Chishao (Paeoniae Radix Rubra), Danpi (Moutan Cortex), Xiangfu (Cyperi Rhizoma), Shanzhiren (Gardeniae Semen), Chaihu (Bupleuri Radix), Shichangpu (Acori Tatarinowii Rhizoma) as assistants/guides. Decocted with Jiucaiju (Allium Tuberosum Juice). One bowel movement led to chest relief, pain halved, food moved right side. Right throat/chest pain persisted, swallowing difficult. Sputum bloody. Modified formula: Shanzhi (Gardeniae Fructus), Chishao (Paeoniae Radix Rubra), Guiwei (Angelicae Sinensis Radix Tail), Taoren (Persicae Semen), Liu Jinu (Lygodii Spora), Wulingzhi (Trogopterori Faeces), Danpi (Moutan Cortex), Chuanshanjia (Manis Squama). Decocted with Jiucaiju. Two doses cured.
Yu Zhen's commentary: Blood stasis pain is harder to identify in previous case, easier here due to history of hard object compression. Displacing esophagus backward shows clever reasoning.
Wu Rufeng's wife in Shexi had epigastric pain, hypochondriac distension, sweating with pain attacks, red malar flush, red lips/mouth. Immediate vomiting of fluids for three days/nights. Sun Dongsu: Cun pulses surging-large, Chi pulses deep-faint. Used Yangyin Tang (Yin-Yang Decoction: well water + boiling water) to mix Yuanningfen (Natrii Sulfas Crystallizatus) 1 qian 5 fen. No vomiting, pain halved. Three bowel movements followed. Pain returned due to early tofu/congee intake. Red lips/face suggested parasites. Formula: Guizhi (Cinnamomi Ramulus), Baishao (Paeoniae Radix Alba), Gancao (Glycyrrhizae Radix et Rhizoma), Wumei (Mume Fructus), Chuanjiao (Zanthoxyli Pericarpium), Wulingzhi (Trogopterori Faeces), Xingren (Armeniacae Semen Amarum). Pain stabilized. Second formula: Cangzhu (Atractylodis Rhizoma), Houpo (Magnoliae Officinalis Cortex), Shanzha (Crataegi Fructus), Zhishi (Aurantii Fructus Immaturus), Fuling (Poria), Yanhusuo (Corydalis Rhizoma), Xiangfu (Cyperi Rhizoma). One dose stopped pain. Skin pain on chest/back prevented lying down. Convalescence with Xiong (Chuanxiong Rhizoma), Gui (Angelicae Sinensis Radix), Ling (Poria), Zhu (Atractylodis Macrocephalae Rhizoma), Ju (Citri Reticulatae Pericarpium), Ban (Pinelliae Rhizoma), Houpo (Magnoliae Officinalis Cortex), Fupi (Tangerine Peel?), Xiangfu (Cyperi Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma). Fully recovered.
Yu Zhen's commentary: Yangyin Tang with Yuanningfen is an acute pain treatment. Subsequent formulas are pure and worthy of emulation.
Censor Zhang Luzhai had severe heart pain in summerheat. Xiangru Yin (Elsholtziae Decoction) increased pain. Li Shicai diagnosed wiry-tight Cun pulse as phlegm-food knotting. Xiangsha Erchen Tang two doses slightly reduced pain but distress remained. Weiling Tang (Stomach-Calm Decoction) plus Banxia (Pinelliae Rhizoma) 2 qian, Dahuang (Rhei Radix et Rhizoma) 3 qian evacuated black stools, reducing pain 30-40%. Same formula with Dahuang 4 qian evacuated gelatinous phlegm, finally settling.
Zhang Shenggong took imperial exams in Nanjing. Aug 5, severe heart pain, unable to eat. Li diagnosed soft-choppy Cun pulse. Prescribed large dose Guipi Tang (Restore the Spleen Decoction) plus Renshen (Ginseng Radix et Rhizoma) 3 qian, Guanzi Gui (Cinnamomi Cortex) 1 qian. Patient feared sudden tonification would affect exam. Li assured safety, warning against Qi-breaking herbs. Pain subsided quickly. Additional dose plus Dushen Tang (Single Ginseng Decoction) cured in two days. Exam completed.
Wang Jin recalled Master Han Jingtang's diaphragm pain with surging-choppy pulse. Treated with Zhiren (Gardeniae Semen), Qu (Medicated Leaven), Tongcao (Akebiae Caulis), Maiya (Hordei Fructus Germinatus), Xiangfu (Cyperi Rhizoma), Xiong (Chuanxiong Rhizoma), Gui (Angelicae Sinensis Radix) decoction with Jiangzhi (Zingiberis Rhizoma Recens Juice), Jiuzhi (Allii Tuberosi Juice), Tongbian (Infant Urine), Zhuli (Bambusa Textile Phyllostachydis Caulis Juice). Pain stopped. Later, fatigue/hunger triggered severe pain. Previous brother's medicine (Erchen, Pingwei, Wuyao, Zisu) caused knife-like pain upon ingestion. Wang diagnosed deficiency (pain from hunger/fatigue, relief from rest/fullness). Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction) one dose cured.
Yu Zhen's commentary: Li's cases used purging vs. tonification based on pulse. Wang's case used Qi/blood moving then tonification based on pulse then cause. Confirms Danxi's "Pulse, Cause, Symptom, Treatment" methodology captures essence.
Li Shizhen treated a drinker who caught cold mourning mother in winter, developing Cold-Zhong syndrome, requiring ginger/garlic with meals. Summer heat/drinking water plus depression caused right waist swelling/pain radiating to right hypochondrium/chest, needing lying down. Attacks involved tenesmus, frequent urination, acid regurgitation, vomiting water, diarrhea, impotence, cold limbs. Relief with wine/warmth; aggravation with cold/labor/sex/anger/hunger. Symptoms vanished when stopped. Warming/damp-draining/tonifying/digestive meds gave temporary relief. Li concluded internal injury from irregular diet/labor, sinking of Clear Yang. Used Shengma Gegen Tang (Kudzu and Ephedra Decoction) combined with Sijunzi Tang (Four Gentlemen Decoction) plus Chaihu (Bupleuri Radix), Cangzhu (Atractylodis Rhizoma), Huangqin (Scutellariae Radix). Wine aided efficacy. Clear Yang rose, chest refreshed, limbs warm, mind clear. Each attack resolved with one dose. Reducing Shengma/Gegen or omitting wine slowed effect. Post-50, Qi declines, descends more than rises, Autumn/Winter influence dominates. Weak constitutions with these signs benefit from this method.
Yu Zhen's commentary: Common recently. Right hypochondriac pain to Zhongwan, acid/vomiting/diarrhea, cold limbs/anorexia. My Erchen Tang plus Xiangfu, Baishao, Cangzhu, Liangjiang, Caodoukou, Huluba effective but prone to recurrence/severity. Prevention difficult. Li's case showed relief with wine/warmth, suggesting opportunity, yet used Shengma/Chaihu/Gegen/Cang/Bai/Zhu/Shen/Qi to raise Yang and benefit Stomach, learning from Dongyuan. Regret lack of pulse description. "One dose stops attack" implies prevention of recurrence is still challenging.
A woman with epigastric pain, unable to swallow water, alternating chills/fever. Fire-treatment (Qin, Lian, Zhi, Bo) or Cold-treatment (Jiang, Gui, Zhu) failed for a month. Emaciated, wiry-rapid six pulses, near death. Gao Gugeng diagnosed Liver pain, not Stomach. Originated from depression-fire injuring Yin blood, drying Liver/Kidney. Bitter-cold/acrid-hot meds further injured Stomach. Urgently prescribed Zishen Shenggan Yin (Nourish Kidney Generate Liver Decoction). Three large doses overnight. Slept deeply at dawn. Pain stopped, hunger returned. Jiawei Guipi Tang plus Maidong (Ophiopogonis Radix), Wuweizi (Schisandrae Fructus) ten doses cured.
Yu Zhen's commentary: Jiang Yingsu treated man with heart-spleen pain, wiry-rapid six pulses, diagnosing Fire-Stagnation. Jiang-huanglian, Zhizi for fire; Xiong, Xiangfu for stagnation; Chenpi, Zhike for Qi; Paojiang as counter-agent. One dose cured. Pingwei San plus fried Huanglian/Zhizi, Shenqu pills prevented recurrence. Same pulse, different treatment; worth comparing.
Reviewing *Lin Zheng Zhi Nan* (Guide to Clinical Practice) for epigastric pain: mostly Liver invading Stomach, with phlegm/stasis/cold/heat. Differentiate Stomach deficiency/excess, Liver cold/heat. Ancient methods used: Zijin Dan, Gualou Xiebai Banxia Tang, Guizhi Tang, Xiexin Tang, Zhishi Jiangxin Tang, Yigong San plus Gui/Shao. No new formulas. Using Shijueming, Sangjisheng, Ejiao, Shengdi, Gouqi, Fuling, Shihu to nourish Stomach juices mirrors Gufeng's Zishen Shenggan method. Using Sumu, Renshen, Taoren, Guiwei, Yujin, Zhiren, Hupo, Changwei with jujube paste mirrors Sun Dongsu's method for Zha Liangchuan. Slowly removing stasis with Bianlang, Mengchong, Wulingzhi, Taoren, Guizhi, Shuqi, Jiubai root pill uses insects to search blood, clever combination. For Yang-deficiency/turbid condensation, Chuanjiao, Ganjiang, Wutou, Fuzi strong acrid-hot without restraint is potent. These two formulas have great power. *Zhi Nan* covers only few years of cases, not a lifetime. Widely published, benefiting students, but plagiarists copy elegant phrases/formulas to practice easily, ignoring deeper classics. Learning becomes shallow. Is *Zhi Nan* misleading, or users misusing it?
[Appendix] Xue Shengbai treated Jiashan man with epigastric pain, chest stuffiness. Phlegm/Qi treatments failed. Kongyan Dan (Control Fluid Decoction) caused severe diarrhea, upper relief but exhaustion. Liujunzi Tang restored spirit but pain returned. Xue used Qianjinzi (Crotonis Fructus) decoction to grind Chenxiang, Muxiang, Tanxiang, Jiangxiang, Dingxiang. One month cure. Diarrhea continued, deemed harmless. Persistence yielded results.
Ye Tichun, Hangzhou official, young epigastric pain, anorexia, emaciation. Du Liangyi (Shanghai) used Gangmu Houpo Jian Wan. Morning Ren Shen decoction with 3 qian pills. One month: pain gone, appetite increased, weight gained.
Houpo Jian Wan: Houpo peeled/crushed. Ginger 2 jin sliced with skin, boiled with 5 sheng water until dry. Remove ginger, dry Houpo. Add Ganjiang 4 liang, Gancao 2 liang, boil Houpo again with 5 sheng water until dry. Remove Gancao, dry Ganjiang/Houpo, powder. Mix with jujube flesh and cooked ginger, remove ginger, pound jujube into pills size of wu zi. 50 pills per dose.