滑伯仁治一人。苦胸中痞满。愦愦若怔忡状。头目昏痛。欲吐不吐。忽忽善忘。时一臂
偏痹。脉之。关以上溜而滑。按之沉而有力。曰。积饮滞痰。横于胸膈。盖得之浓味醇酒。
肥腻炙爆。蓄热而生湿。湿聚而痰涎宿饮皆上甚也。王冰云。上甚不已。吐而夺之。但冬月
降沉之令。未可行此法。乃候至春日晴朗。以药探吐之。大吐异色痰如胶饴者三四升。一二
日更吐之。三四次则胸中洞爽矣。
震按此病认为痰饮。皆人所能。惟冬月降沉之令。未可涌吐。乃先圣成法。守得极是。
孙东宿治陈光禄松奕翁。常五更胸膈胀疼。寒热温凉。遍尝不效。诊之右寸软弱。左平
两尺亦弱。孙曰。此肺肾二经之不足也。补而敛之。可无恙矣。以人参、补骨脂、山茱萸
各三两。鹿角胶、鹿角霜五两。杜仲、巴戟、茯苓、车前各一两五钱。山药二两。鹿角胶酒
化为丸。空心淡盐汤送下。又以御米壳三两。去筋膜。蜜水炒。诃子面煨去核一两。陈皮一
两五钱。蜜丸。五更枕上白汤送下一钱。服一月。病不再发。
震按人参鹿胶之丸。人犹能用。粟壳诃子之方。梦想不到矣。与陈武塘噙化丸。可比熊
掌猩唇。各一异味。
李古愚每食后即大便。腹皮稍胀急。胸膈饱闷。医与参、术。则痞闷愈甚。小水清而长
孙脉之。左寸涩。右寸滑。按之如黄豆大。且鼓指。关尺之脉皆弦小。左尺脉迢迢有神气
据脉。乃积痰郁滞于肺莫能出。以致大肠之气不固也。法当效丹溪治乃叔用吐。吐去上焦
痰积。而大便自实矣。先用苦梗、莱菔子各三钱。白蔻仁、橘红、山栀仁各一钱。川芎五分
生姜三片。葱三根。煎服探吐。不能尽出。又以莱菔子一合擂浆水。加蜂蜜。与半碗饮之
始吐胶痰二碗。平日每小水则大便并行。吐后小水始能独利。连行三四次而胸腹宽舒。初
亦以吐为惧。至是豁然称快。大便亦不频下矣。再以二陈汤加白术、旋复花、麦芽。调理而
全安。
震按右寸滑而有力。故知肺有积痰。左尺迢迢有神。故可吐而不伤。
景岳治一少年素日饮酒。亦多失饥伤饱。一日偶因饭后胁肋大痛。自服行气化滞等药。
复用吐法。尽出饮食。吐后逆气上升。胁痛虽止。而上壅胸膈。胀痛更甚。且加呕吐。再用
行滞破气等药。呕痛渐止。而左乳胸肋之下结聚一块。胀实拒按。脐腹膈闭。不能下达。每
于戌亥子丑之时。则胀不可当。因其呕吐既止。已可用下。凡大黄、芒硝、棱、莪、巴豆等
药。及菔子、朴硝、大蒜、橘叶捣罨等法。毫不能效。而愈攻愈胀。因疑为脾气受伤。用补
尤觉不便。汤水不入者。凡二十余日。无计可施。窘剧待毙。只得用手揉按其处。彼云肋
下一点。按着则痛连胸腹。及细为揣摸。则正在章门穴也。章门为脾之募。为脏之会。且乳
下肋间。正属虚里大络。乃胃气所出之道路。而气实通于章门。因悟其日轻夜重。本非有形
之积。而按此连彼。则病在气分无疑也。必须经火则气散。乃以艾灸章门十四壮。兼制神香
散。使日服三四次。胀果渐平。食亦渐进。始得保全。
震按灸法可佐吐下补三法所不及。然亦有效有不效。此能效者。想其尚属少年耳。
陈武塘曰。余长子揆。向患遗精。于天启丁卯冬。遗证大作。肾窍漏气。出如烟雾。时
作时止。眠食渐减。形瘁骨痿。大便艰涩。其色颇黑。用猪胆汁入大黄、皂角末导之。初用
甚快利。并上部诸火亦觉清息。延至戊辰六月。则愈导愈秘。因思胆汁、大黄苦寒。皂角刮
削脂膏。故求润而弥燥。乃以猪胆去汁。入蜜同温水满之以为导。导久而便始不艰。然至戊
辰八月后。不能起床。又至己巳五月。肌肉愈瘦。眠食愈减。胸膈如有物踞之。腹则空虚。
上则痞闷。每食少许。辄停留不下。隔六七时犹嗳。呼吸之气。亦碍而不畅。以为因虚致滞
则服人参必增懑。以为稠痰蓄血。用疏快之剂又全无功。身常畏寒。夏令犹掩重帏。惟身
不热。口不渴。声音虽轻而不变。面色白而不赤不黑。每日仅用粥饵二盏。或终日不食。旁
人疑在旦暮。却又绵延两载。时名医高果哉、孙见心辰夕延医无功。又延姑苏柯生。柯、大
言人也。乍闻其论。不胜喜。及治罕效。乃追忆从前。大肠气数不禁。遂觉胸膈痞闷。继因
过防衄证。日饮童便及滋清药太多。大便渐顺。然大便后即觉腹中虚怯。而胸膈分毫不宽。
若大便所下甚多。则胸膈痞闷愈甚。于是疏上补下。茫无措手。远延镇江张承溪至。张诊二
次。而曰男子久病。以太溪冲阳脉决其死生。今六部无险。太溪冲阳有根。必不死之脉也。
其证名为下脱。凡阳气上绝。阴气不得上交于阳。则为下脱。阴窍漏气是也。阴气下绝。阳
气不得下交于阴。则为上脱。耳中出气是也。方家以失血之证。为错经妄行。而不知气证亦
有错经妄行者。盖肾纳气。过泻成虚。则肾气不能自纳。遂错行而妄漏。经云。醉饱入房。
五脏反复。五脏部位。宁有反复之理。正谓其气错乱也。今未能提其气。复使归经。所以时
漏不止。漏则气虚。气虚于下。则痰结于上。故饮食难化。而成郁结痞闷之证。今用药宜疏
导郁滞。不宜误用滋阴。宜有提有降合成疏通。不宜专用顺气。若认此为阴亏之证。遂谓虚
劳不受补者不治。则大误也。阴虚生内热。岂有阴分大虚。卧床一年有半。而不发骨蒸潮热
者乎。滋阴之药。不惟无功。且于开胸膈。进饮食。有大碍。今但使膈间日宽一日。谷气日
增一日。则阴不补而自补矣。气色可指日而待。煎方用苏子、山楂各二钱。橘红、半夏曲各
一钱五分。茯苓、乌药、香附、五谷虫各一钱。升麻八分。柴胡四分。临服入韭汁二匙。此
方疏郁为主。而升降互用。其旨颇精。服二十剂。虽不大效。然视向之服一药。增一病。则
霄壤矣。秋初张别去。余因其疏郁大旨。为之推展通变。自定噙化丸。用人参六钱。醋制香
附、橘红各四钱。贝母、桔梗各三钱。松罗茶二钱。白硼砂、西牛黄、干蟾炙存性各一钱。
薄荷叶三分。以乌梅肉二钱蒸烂。同竹沥、梨膏为丸。每丸一钱。余因胸中结块。原起于午
食后即卧。用噙化丸。使睡中常有药气疏通肺胃之间。彼将欲结。药往疏之。新结不增。旧
结渐解。卧时成病。亦治以卧时。且病在膈上。不用汤之荡涤。丸之沉下。而用噙化。徐徐
沁入。日计不足。月计有余也。服六七十丸后。膈间渐宽。尔时医家疑气坠之证。恐深秋逾
剧。以秋金主降也。余谓肺主气。气得其令。则降者自降。升者自升。各得本职。非谓有降
而无升也。能使清升浊降。则气坠之病。正宜愈于深秋。至八月。病患偶伤麦粉。下以沉香
丸。忽去胶痰数升。胸膈顿爽。殆药力渐到。元气渐回。邪无所容。而乘势自下也。然气弱
形羸。长卧不起如故。冬底。医家又防春来木旺。脾病转剧。余曰无忧。凡脾受肝克。则畏
木气来侵。今乃脾困。而非脾弱。冬气闭塞。脾困所畏。幸喜及春。方藉木气以疏通之。已
而食果稍增。肌亦渐泽。五脏之情。变化如此。第执生克之常。几何而不误人。庚午夏四月
张公复至。曰。胶痰去。病本拔矣。骨痿不能自行立者。湿气留伏脾经故也。投以白术煎
用白术一斤。苍术四两。作膏服之。未终剂立起。此病奇而久。约费千日之医治。竟得全
生。故备志之。
震按陈公以缙绅先生而讲医理。却极精深。所论噙化丸。治法微妙。切合病机。虽老医
见不到此。至于张承溪之用术煎。不认骨痿为肾虚而为脾湿。见亦高人数倍矣。
滑伯仁治疗一个人。他痛苦于胸中痞塞胀满，心中烦乱不安，症状类似怔忡（心悸），头部和眼睛昏沉疼痛，想吐却吐不出来，精神恍惚且容易遗忘，偶尔一只手臂偏侧麻木不遂。诊脉时，关脉以上流利而滑，重按则沉而有力。滑伯仁说：“这是饮邪停滞、痰浊阻滞，横亘在胸膈之间。这病是因为饮食了浓烈厚味、醇酒以及肥腻、炙烤爆裂的食物，导致积热而生湿，湿气聚集进而使痰涎和宿饮都上逆壅盛。”王冰曾说：“上部邪气亢盛不止，应当用涌吐法来夺其实邪。”但是正值冬季，气候主降、主沉，此时不可行此法。于是等到春日晴朗之时，用药催吐。患者大吐出异色的胶饴状痰液三四升，过一两天再吐一次，经过三四次后，胸中顿时感到通畅清爽。
俞震按语：将此病辨认为痰饮，是常人所能做到的。但指出冬季主降沉之气，不可使用涌吐法，这是遵循先圣的成法，守得极为正确。
孙东宿治疗陈光禄松奕翁。他经常在五更时分胸膈胀痛，寒热温凉各种感觉遍尝无效。诊脉发现右寸脉软弱，左脉平和，两尺脉也弱。孙东宿说：“这是肺肾二经不足所致。补益并收敛它们，就可以安然无恙。”用人参、补骨脂、山茱萸各三两，鹿角胶、鹿角霜五两，杜仲、巴戟天、茯苓、车前子各一两五钱，山药二两。将鹿角胶用酒烊化，制成丸药。空腹时用淡盐汤送服。另外用御米壳（罂粟壳）三两，去除筋膜，用蜜水炒制；诃子面煨去核一两；陈皮一两五钱。制成蜜丸。五更时分枕头上用白开水送服一钱。服用一个月，疾病不再发作。
俞震按语：人参鹿角胶制成的丸药，人们尚且能够使用；罂粟壳、诃子组成的方剂，则是做梦也想不到的。这与陈武塘的噙化丸相比，就像熊掌和猩唇一样，各有其独特的风味。
李古愚每次进食后随即大便，腹部皮肤稍显胀急，胸膈饱闷。医生给予人参、白术等药，则痞闷更加严重，小便清长。李古愚诊脉，左寸脉涩，右寸脉滑，重按如黄豆大小，且鼓指明显，关脉和尺脉皆弦小，左尺脉悠长有神气。根据脉象，这是积痰郁滞于肺部无法排出，导致大肠之气不固。治法应当效法丹溪治疗其叔父的方法，采用吐法。吐出上焦的痰积，大便自然就会结实。先用桔梗、莱菔子各三钱，白蔻仁、橘红、山栀仁各一钱，川芎五分，生姜三片，葱三根，煎服以探吐。未能完全吐出，又用莱菔子一合研磨成浆加入浆水，再加蜂蜜，喝下半碗，这才吐出胶状痰液两碗。平时每次小便时大便也同时排出，吐后小便才能单独通利。连续进行三四次后，胸腹宽舒。起初也害怕吐法，到这时豁然开朗，称心畅快，大便也不再频繁排下了。再用二陈汤加白术、旋复花、麦芽，调理后完全康复。
俞震按语：右寸滑而有力，所以知道肺有积痰；左尺脉悠长有神，所以可以吐而不伤正气。
张景岳治疗一个少年，平日饮酒，也常饥饱无常。有一天偶然因为饭后胁肋部剧烈疼痛，自行服用行气化滞等药，又用了吐法，将饮食全部吐出。吐后逆气上升，胁痛虽然停止，但气机上壅胸膈，胀痛更加严重，并且加上呕吐。再用行滞破气等药，呕痛逐渐停止，但在左乳胸肋之下结聚一块，胀实拒按，脐腹膈闭，不能下达。每当戌、亥、子、丑四个时辰，就胀得难以忍受。因为呕吐已经停止，已经可以用下法。凡是使用大黄、芒硝、三棱、莪术、巴豆等药物，以及萝卜子、朴硝、大蒜、橘叶捣碎外敷等方法，丝毫不能见效，反而越攻伐越胀。因此怀疑是脾气受伤，用补法又觉得不便。汤水进不去，二十多天无计可施，窘迫危急等待死亡。只得用手揉按其患处，病人说肋下一点，按着则痛连胸腹。仔细揣摸，发现正在章门穴处。章门是脾之募穴，也是脏之会穴，而且乳下肋间，正是虚里大络所在，是胃气所出的道路，而气实则通达于章门。由此领悟到其病日轻夜重，本不是有形的积滞，而按此处牵连彼处，则病在气分无疑。必须用火灸才能使气散。于是艾灸章门穴十四壮，兼服自制的神香散，让每天服用三四次，胀气果然逐渐平复，饮食也渐渐增加，才得以保全性命。
俞震按语：灸法可以辅助吐、下、补三法所不及的地方，然而也有有效和不有效的情况。此例有效，想必是因为患者还是少年人。
陈武塘说：“我的长子陈揆，向来患遗精病，在天启丁卯年冬天，遗精证大作，肾窍漏气，出气如烟雾，时作时止，睡眠和饮食逐渐减少，形体憔悴，骨骼痿弱，大便艰涩，颜色颇黑。用猪胆汁加入大黄、皂角末作为导法灌肠。初用时非常通利，并且上部的诸火也觉得清息。延至戊辰年六月，则越用导法越秘结。于是想到胆汁、大黄苦寒，皂角刮削脂膏，所以寻求滋润反而更加干燥。于是去掉猪胆中的汁液，加入蜂蜜同温水灌满作为导法。导法久用后大便才不艰难。然而到了戊辰年八月后，不能起床。又至己巳年五月，肌肉更加消瘦，睡眠饮食更加减少，胸膈如有物占据，腹部则空虚，上部痞闷。每吃少许食物，就停留不下，隔六七小时还打嗝，呼吸的气流也受阻不畅。认为是因虚致滞，则服人参必定增加闷懑；认为是稠痰蓄血，用疏快之剂又全无功效。身体常常畏寒，夏天还要覆盖厚重的帷帐，只是身体不热，口不渴，声音虽轻但不变调，面色白而不赤不黑。每天仅用粥食两盏，或者整天不进食，旁人怀疑他在旦夕之间就要去世，却又绵延两年。当时名医高果哉、孙见心早晚延请医生都无功效，又延请苏州柯琴（字韵伯）。柯琴是大言的人，乍听他的论述，不胜欢喜，但治疗很少见效。于是追忆从前，大肠气数不禁，遂觉胸膈痞闷。继而又因为过分担心衄血证，每日饮用童便及滋阴清热药太多，大便逐渐顺畅，然大便后即觉腹中虚怯，而胸膈分毫不宽舒。如果大便所下甚多，则胸膈痞闷更加严重。于是疏上补下，茫无措手。远请镇江张承溪前来。张承溪诊察两次后说：男子久病，以太溪、冲阳脉决其死生，现在六部没有险象，太溪、冲阳有根，必是不死的脉象。其证名为‘下脱’。凡阳气上绝，阴气不得上交于阳，则为下脱，即阴窍漏气。阴气下绝，阳气不得下交于阴，则为上脱，即耳中出气。医家以失血之证为错经妄行，而不知道气证也有错经妄行的。盖肾纳气，过度泻泄造成虚损，则肾气不能自纳，遂错行而妄漏。《内经》云：醉饱入房，五脏反复。五脏部位，哪有反复的道理？正说的是其气错乱。现在未能提其气，使其归经，所以时时漏泄不止。漏泄则气虚，气虚于下，则痰结于上，故饮食难化，而成郁结痞闷之证。现在用药宜疏导郁滞，不宜误用滋阴。宜有提有降合成疏通，不宜专用顺气。若认此为阴亏之证，遂谓虚劳不受补者不治，则大误也。阴虚生内热，难道有阴分大虚，卧床一年有半，而不发骨蒸潮热的吗？滋阴之药，不惟无功，且于开胸膈、进饮食，有大碍。现在只要使膈间日宽一日，谷气日增一日，则阴不补而自补矣。气色可指日而待。煎方用苏子、山楂各二钱，橘红、半夏曲各一钱五分，茯苓、乌药、香附、五谷虫各一钱，升麻八分，柴胡四分。临服入韭汁二匙。此方以疏郁为主，而升降互用，其旨意颇为精妙。服用二十剂，虽然不大见效，然而比起之前服一药增一病，则相差如霄壤之别。秋初张承溪离去。我因其疏郁的大旨，为之推展通变，自定噙化丸。用人参六钱，醋制香附、橘红各四钱，贝母、桔梗各三钱，松罗茶二钱，白硼砂、西牛黄、干蟾炙存性各一钱，薄荷叶三分。以乌梅肉二钱蒸烂，同竹沥、梨膏为丸。每丸一钱。我因胸中结块，原起于午食后即卧，用噙化丸，使睡中常有药气疏通肺胃之间。他将欲结，药往疏之，新结不增，旧结渐解。卧时成病，亦治以卧时。且病在膈上，不用汤剂的荡涤，丸剂的沉下，而用噙化，徐徐沁入。日计不足，月计有余。服用六七十丸后，膈间渐宽。那时医家疑为气坠之证，恐深秋病情加重，以为秋金主降。我对他说：肺主气，气得其令，则降者自降，升者自升，各得本职，并非谓只有降而无升。能使清升浊降，则气坠之病，正宜愈于深秋。到了八月，病患偶然伤于麦粉，用沉香丸下之，忽然吐出胶痰数升，胸膈顿爽。大概是药力渐到，元气渐回，邪无所容，而乘势自下。然而气弱形羸，长卧不起如故。冬底，医家又防春来木旺，脾病转剧。我说无忧。凡脾受肝克，则畏木气来侵。现在是脾困，而非脾弱。冬气闭塞，脾困所畏，幸喜及春，方藉木气以疏通之。后来食果稍增，肌肤也逐渐润泽。五脏之情，变化如此。只执着于生克的常规，多少会误人。庚午年夏四月，张公再次来到，说：胶痰已去，病本已拔除。骨骼痿弱不能自行站立，是湿气留伏脾经的缘故。投以白术煎，用白术一斤，苍术四两，熬膏服用。未服完药剂即可站立起来。此病奇特而长久，约费千日医治，竟得全生，所以详细记录之。
俞震按语：陈先生身为缙绅先生却讲论医理，极其精深。所论噙化丸，治法微妙，切合病机，即使是老医生也想不到这一点。至于张承溪使用白术煎，不将骨痿认定为肾虚而是脾湿，见识也比一般人高出数倍。
Hua Borén treated a patient who suffered from chest stuffiness and fullness, feeling restless and agitated with symptoms resembling palpitations (Xin Ji), dizziness and headache in the head and eyes, an urge to vomit without success, mental confusion and forgetfulness, and occasional hemiplegia of one arm. Upon pulse diagnosis, the pulse at the Guan position and above was slippery and flowing, while deep pressure revealed a sinking and forceful quality. Hua stated: "This is caused by stagnant fluid retention and phlegm obstruction, lying horizontally across the chest and diaphragm. It resulted from consuming rich flavors, strong wine, fatty foods, and roasted or fried items, leading to heat accumulation generating dampness. Dampness gathers, causing phlegm saliva and retained fluids to ascend excessively." Wang Bing said, "When pathology is excessive in the upper part and does not subside, one should use emesis to drain the excess." However, during winter, when the qi descends and sinks, this method cannot be employed. Thus, they waited until a clear spring day to induce vomiting with medicine. The patient vomited copiously, expelling three to four sheng of strange-colored, glue-like phlegm. After one or two days, it was repeated; after three or four times, the chest felt thoroughly clear and comfortable.
Yu Zhen commented: Identifying this disease as phlegm-fluid retention is within everyone's capability. However, pointing out that due to the descending nature of winter, emesis should not be used follows the established methods of the sages, which is extremely correct.
Sun Dongsu treated Chen Guanglu, Song Yi Weng, who often experienced chest and diaphragm distension and pain at dawn (Wu Geng). He tried various remedies for cold, heat, warmth, and coolness without effect. Pulse diagnosis showed a weak and soft Right Cun, a normal Left pulse, and weak both Chi positions. Sun said: "This is deficiency of the Lung and Kidney meridians. Tonifying and astringing them will ensure safety." He prescribed Ren Shen (Ginseng Radix et Rhizoma), Bu Gu Zhi (Psoraleae Fructus), and Shan Zhu Yu (Corni Fructus) each 3 liang; Lu Jiao Jiao (Colla Cornus Cervi) and Lu Jiao Shuang (Cervi Cornus Colla Residuum) 5 liang; Du Zhong (Eucommiae Cortex), Ba Ji Tian (Morindae Officinalis Radix), Fu Ling (Poria), and Che Qian Zi (Plantaginis Semen) each 1.5 liang; and Shan Yao (Dioscoreae Rhizoma) 2 liang. Lu Jiao Jiao was melted with wine and made into pills. Taken on an empty stomach with light salt water. Additionally, Yu Mi Ke (Pericarpium Papaveris Rubri) 3 liang, cleaned of membranes and stir-fried with honey; He Zi (Terminaliae Chebulae Fructus) baked in flour, pitted, 1 liang; and Chen Pi (Citri Reticulatae Pericarpium) 1.5 liang were made into honey pills. One qian was taken with warm water at dawn on the pillow. After one month of administration, the disease did not recur.
Yu Zhen commented: Pills of Ren Shen and Lu Jiao are still usable by people, but formulas containing Yu Mi Ke and He Zi are unimaginable. Compared to Chen Wutang's Qin Hua Wan (Lozenge Pill), they are like bear's paw and orangutan lip—each having its unique flavor.
Li Guyu noted that every time he ate, he had a bowel movement immediately afterward, with slight abdominal tightness and chest/diaphragm fullness. When doctors administered Ren Shen (Ginseng Radix et Rhizoma) and Bai Zhu (Atractylodis Macrocephalae Rhizoma), the stuffiness worsened, and urination was clear and long. Li diagnosed the pulse: Left Cun was choppy (Se), Right Cun was slippery. Deep pressure felt like a soybean, distinct and drumming. Guan and Chi pulses were wiry and small. The Left Chi pulse was long and vigorous. Based on the pulse, there was accumulated phlegm stagnating in the Lung, unable to exit, causing insecurity of Large Intestine qi. The treatment should follow Danxi’s method for his uncle: use emesis to remove upper jiao phlegm accumulation, after which stool would naturally firm up. Initially, Jie Geng (Platycodonis Radix) and Lai Fu Zi (Radish Seed) 3 qian each; Bai Kou Ren (Cardamomi Rotundus Semen), Ju Hong (Citri Reticulatae Pericarpium), and Shan Zhi Ren (Gardeniae Semen) 1 qian each; Chuan Xiong (Ligustici Chuanxiong Rhizoma) 0.5 qian; Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices; and Cong Bai (Allii Fistulosi Bulbus) 3 stalks were decocted to induce vomiting. Unable to expel all, Lai Fu Zi 1 he was ground into paste with Jiang Shui (fermented rice liquid), mixed with honey, and half a bowl drunk, finally expelling two bowls of gelatinous phlegm. Previously, stool accompanied urine; after vomiting, urine could flow independently. After three or four such sessions, the chest and abdomen felt relaxed. Initially fearful of emesis, he now felt relieved and happy, and bowel movements became less frequent. Finally, Er Chen Tang (Two-Cured Decoction) was modified with Bai Zhu (Atractylodis Macrocephalae Rhizoma), Xuan Fu Hua (Inulae Flos), and Mai Ya (Hordei Fructus Germinatus) to regulate and restore health.
Yu Zhen commented: The Right Cun being slippery and forceful indicates lung phlegm accumulation; the Left Chi being long and vigorous indicates that emesis can be used without damaging healthy qi.
Zhang Jingyue treated a young man who drank alcohol regularly and often suffered from irregular meals. One day, after a meal, he experienced severe pain in the hypochondrium. Self-medicating with qi-regulating and stasis-resolving drugs failed. He then used emesis, expelling all food. Post-emesis, rebellious qi rose; although hypochondriac pain ceased, qi congested the chest and diaphragm, worsening distension and pain, accompanied by vomiting. Further use of stasis-breaking and qi-penetrating drugs stopped vomiting and pain, but a hard, tender mass formed under the left breast and rib cage. The umbilicus, abdomen, and diaphragm were blocked, preventing downward movement. At Xu, Hai, Zi, and Chou hours (9 PM–3 AM), distension became unbearable. Since vomiting had stopped, purgatives were considered. Drugs like Da Huang (Rhei Radix et Rhizoma), Mang Xiao (Natrii Sulfas), San Leng (Sparganii Rhizoma), E Zhu (Curcumae Rhizoma), and Ba Dou (Crotonis Fructus), along with methods using Radish seeds, Mang Xiao, garlic, and orange leaves applied externally, were ineffective. Aggression only increased distension. Suspecting spleen qi injury, tonification seemed inappropriate. For over twenty days, no soup or water could enter. Desperate and awaiting death, manual massage was attempted. The patient pointed to a spot under the rib where pressing caused pain radiating to the chest and abdomen. Careful palpation located the Zhangmen (LR13) acupoint. Zhangmen is the Front-Mu point of the Spleen and the Hui-Meeting point of the Zang organs. The area below the breast and between ribs corresponds to the Xu Li large collateral, the pathway of Stomach qi, where qi connects to Zhangmen. Realizing the daily fluctuation indicated non-organic qi pathology rather than有形 (tangible) accumulation, and that pressing one area affected another confirming qi-level disease, fire therapy was chosen to disperse qi. Fourteen moxa cones were applied to Zhangmen (LR13), combined with Shen Xiang San (Divine Fragrance Powder) taken three to four times daily. Distension gradually subsided, and appetite improved, saving his life.
Yu Zhen commented: Moxibustion can supplement what emesis, purgation, and tonification cannot achieve, though results vary. Its efficacy here likely stems from the patient’s youth.
Chen Wutang stated: "My eldest son, Kui, previously suffered from spermatorrhea. In the winter of Ding Mao (Tianqi era), the condition worsened severely. Qi leaked from the kidney orifice like smoke, intermittently. Sleep and appetite decreased, body wasted, bones weakened, and stools were difficult, dark in color. Pig bile mixed with Da Huang (Rhei Radix et Rhizoma) and Zao Jiao (Gleditsiae Sinensis Spina) powder was used as an enema. Initially effective, clearing upper heat. By June of Wu Chen, however, enemas caused worse constipation. Recognizing that pig bile and Da Huang are bitter-cold, and Zao Jiao strips fat, seeking moisture led to dryness. Pig bile juice was removed, replaced with honey and warm water for enemas. Long-term use eventually eased defecation. By August of Wu Chen, he could not get out of bed. By May of Ji Si, muscles wasted further, sleep/appetite dropped, chest felt occupied, abdomen empty, upper body stuffy. Small amounts of food stayed lodged, belching occurred after 6-7 hours, breathing was obstructed. Thinking deficiency caused stagnation, Ren Shen (Ginseng Radix et Rhizoma) increased oppression. Thinking thick phlegm/blood stasis, resolving agents failed. He feared cold even in summer, covering heavily, yet had no fever or thirst. Voice was soft but clear, complexion white but not red or black. Ate only two bowls of porridge daily or fasted entirely. Friends expected imminent death, yet he survived two years. Famous doctors Gao Guozai and Sun Jianxin failed. Suzhou doctor Ke Qin (Ke Yubo) was invited. Ke spoke grandly, initially pleasing, but treatments failed. Recalling past history: Large Intestine qi control was lost, causing chest stuffiness. Excessive fear of epistaxis led to heavy use of child urine and yin-nourishing/clearing herbs, improving stool but leaving abdominal emptiness and unchanged chest stuffiness. More stool meant more chest stuffiness. Strategies to open upper and tonify lower were futile. Doctor Zhang Chengxi from Zhenjiang was summoned. After two consultations, Zhang said: 'For chronic male illness, assess prognosis via Tai Xi (KI3) and Chong Yang (ST42) pulses. Here, six positions show no danger; Tai Xi and Chong Yang have root. Death is unlikely.' This syndrome is called 'Lower Collapse' (Xia Tuo). If upper yang severs and yin cannot ascend to interact with yang, it is Lower Collapse (leaking qi from yin orifices). If lower yin severs and yang cannot descend to interact with yin, it is Upper Collapse (air from ears). Physicians attribute hemorrhage to 'erroneous vessel wandering,' unaware qi disorders also exhibit this. Kidney grasps qi; excessive draining causes deficiency, so kidney qi fails to grasp, wandering erratically. The Classic says: 'Intercourse after drunkenness/full meals causes five zang reversal.' Reversal refers to qi chaos. Without lifting qi back to its meridian, leakage continues. Leakage causes qi deficiency; lower qi deficiency leads to upper phlegm knotting, hindering digestion and causing stuffiness. Treatment should resolve stagnation, not mistakenly nourish yin. It requires lifting and lowering together for unblocking, not just moving qi. Mistaking this for yin deficiency and declaring consumptive disease untreatable is a major error. Yin deficiency generates internal heat; how could severe yin deficiency with a year-and-a-half bedridden state lack bone-steaming tidal fever? Yin-nourishing drugs are useless and hinder opening the chest and eating. Only by widening the diaphragm daily and increasing grain qi daily will yin nourish itself. Complexion will return soon. Decoction: Su Zi (Perillae Fructus), Shan Zha (Crataegi Fructus) 2 qian each; Ju Hong (Citri Reticulatae Pericarpium), Ban Xia Qu (Pinelliae Fermentatum) 1.5 qian each; Fu Ling (Poria), Wu Yao (Linderae Radix), Xiang Fu (Cyperi Rhizoma), Wu Gu Chong (Phallus Infundibuliformis) 1 qian each; Sheng Ma (Cimicifugae Rhizoma) 0.8 qian; Chai Hu (Bupleuri Radix) 0.4 qian. Add Leek Juice (Jiu Zhi) 2 spoons before taking. This formula focuses on resolving stagnation, using ascending and descending actions mutually, very refined. Twenty doses yielded little immediate effect, but compared to previous treatments that added symptoms, it was heaven and earth apart. In early autumn, Zhang left. I expanded his principle of resolving stagnation, creating my own Qin Hua Wan (Lozenge Pill): Ren Shen (Ginseng Radix et Rhizoma) 6 qian; Vine-processed Xiang Fu (Cyperi Rhizoma), Ju Hong (Citri Reticulatae Pericarpium) 4 qian each; Bei Mu (Fritillariae Cirrhosae Bulbus), Jie Geng (Platycodonis Radix) 3 qian each; Song Luo Cha (Tea) 2 qian; Bai Peng Sha (Borax), Xi Niu Huang (Bovis Calculus), Gan Chan (Toad Skin) calcined 1 qian each; Bo He Ye (Menthae Haplocalycis Folium) 0.3 qian. Steamed Wumei (Mume Fructus) 2 qian mashed, mixed with Zhu Li (Bambusae Caulis in Taenia) and Li Gao (Pyrus Sinkiangensis Fruit Juice) into pills. Each pill 1 qian. My chest lump originated from lying down after noon meals. Using lozenges ensured constant medicinal qi circulating between Lung and Stomach during sleep. As knots formed, medicine dispersed them; new knots didn't form, old ones dissolved. Treating a sleeping-induced ailment while sleeping. Since disease was above diaphragm, harsh decoctions or sinking pills were unsuitable; slow absorption via lozenges works cumulatively. After 60-70 pills, diaphragm widened. Doctors suspected qi sinking, fearing autumn exacerbation due to Metal's descending nature. I replied: Lung governs qi; when qi receives its command, descending descends, ascending ascends, fulfilling duties. It's not just descending. Clear ascending and turbid descending means qi-sinking disease should heal in late autumn. In August, accidental wheat flour ingestion led to taking Chen Xiang Wan (Aloes Wood Pill), suddenly expelling several sheng of gelatinous phlegm, instantly clearing chest. Likely medicine took effect, yuan qi returned, pathogen had no place, descending naturally. Though weak and emaciated, bedridden status persisted. End of winter, doctors feared spring Wood excess worsening Spleen disease. I said: Fear not. Spleen受制 by Liver fears Wood invasion. Now it is Spleen *stagnation*, not weakness. Winter closure aggravates stagnation; Spring Wood helps unblock. Later, fruit intake increased, skin gained luster. Five zang dynamics change thus. Clinging to standard generation/restriction cycles errs. In April of Geng Wu, Zhang returned: 'Gelatinous phlegm gone, disease root pulled. Bone weakness preventing standing is dampness lingering in Spleen meridian.' Prescribed Bai Zhu Decoction: Bai Zhu (Atractylodis Macrocephalae Rhizoma) 1 jin, Cang Zhu (Atractylodis Rhizoma) 4 liang, boiled into paste. Before finishing dose, he stood up. This rare, chronic illness took nearly 1000 days of treatment to fully recover, hence recorded in detail.
Yu Zhen commented: Mr. Chen, a scholar-official, discussed medical principles with profound depth. His Qin Hua Wan treatment was subtle and matched the pathology, surpassing even old physicians. Dr. Zhang Chengxi’s use of Bai Zhu Decoction, identifying bone weakness as Spleen dampness rather than Kidney deficiency, showed insight far superior to others.