东垣治一人。冬时忽有风气暴至。六脉弦甚。按之洪大有力。其证手挛急。大便秘涩。
面赤热。此风寒始至于身也。四肢者。脾也。以风寒之邪伤之。则搐如挛痹。乃风淫未疾而
寒在外也。内经曰。寒则筋挛。正谓此也。素饮酒。内有实热乘于肠胃之间。故大便秘涩而
面赤热。内则手足阳明受邪。外则足太阴脾经受风寒之邪。用桂枝二钱。甘草一钱。以却其
寒邪而缓其急缩。黄柏二钱苦寒。滑以泻实润燥。急救肾水。升麻、葛根各一钱。以升阳气
行手阳明之经。不令遏绝。桂枝辛热。入手阳明之经为引用润燥。复以甘草专补脾气。使不
受风寒之邪。而退贼邪。专益肺经也。佐以人参补气。当归和血润燥。作一帖。水煎服。令
暖房中摩搓其手。遂安。
震按此案寒热补散并用。恰与标本俱合。但东垣立方。分量甚轻。此却重用者。盖以风
寒大病。逐邪宜急。不比他证。调理脾胃。只取轻清以升发元气也。
丹溪治一少年。患血痢。用涩药取效。致痛风叫号。此恶血入经络也。血受湿热。久必
凝浊。所下未尽。留滞隧道。所以作痛。久则必成枯细。与四物汤加桃仁、红花、牛膝、黄
芩、陈皮、生甘草。煎入生姜汁研潜行散。入少酒饮之。数十帖。又刺委中。出黑血三合而
安。
震按此是痢后痛风。其法至今传用。但因涩药留滞湿热以成瘀血。故用此方。倘又有别
因者。不得以此概论。
一人贫劳。秋深浑身发热。手足皆疼如 。昼轻夜重。服风药愈痛。气药不效。脉涩而
数。右甚于左。饮食如常。形瘦如削。盖大痛而瘦。非病致也。用苍术、酒黄柏各一钱五分
生附一片。生甘草三分。麻黄五分。研桃仁九个。煎入姜汁令辣。热服四帖。去附。加牛
膝一钱。八帖后气喘促不得眠。痛略减。意其血虚。因多服麻黄。阳虚被发动而上奔。当补
血镇坠。以酸收之。遂以四物汤减川芎。倍芍药。加人参二钱。五味子十二粒。与二帖定。
三日后。数脉减大半。涩如旧。仍痛。以四物加牛膝、参、术、桃仁、陈皮、甘草、槟榔。
生姜三片。五十帖而安。后因负重复痛。再与前药加黄氏三分。又二十帖愈。
震按身发热。疼如 。脉涩而数。右甚于左。应属血虚有热。所谓热痹证也。宜用生地
龟板、天冬、黄柏、丹皮、黑栀、秦艽、防己、牛膝、红花、银花、木通等药可愈。或仲
景栀子柏皮汤大剂与之亦佳。若二妙之苍术。已不相宜。附子一片何用。麻黄五分太过。至
因多服麻黄。虚阳上升而喘。议与酸收是矣。遽用人参二钱。窃恐痹痛转增。然云喘定数脉
大减。异哉。或者脉数无力耶。则前之麻黄已误。后之桃仁、槟榔。义又何居。予素服膺丹
溪。此则不敢阿其所好也。再阅下案。讲究病因。传变道理。真不可及矣。
一人患背胛缝一线痛。起上胯骨至胸前侧胁而止。昼夜不住。脉弦而数。重取左豁大于
右。意其背胛。小肠经。胸胁。胆经也。必思虑伤心。心脏未病。而小肠府先病。故痛从背
胛起。及虑不能决。乃归之胆。故痛至胸胁。及小肠火乘胆木。子来乘母。是为实邪。询之
果因谋事不遂而病。用人参四分。木通二分。煎汤使吞龙胆丸。数服而愈。
一壮年浓味多怒。秋间于髀枢左右发痛一点。延及膝 。痛处恶寒。昼静夜剧。口或渴
膈或痞。医用补血及风药。至次年春痛甚。食减形瘦。膝肿如碗。脉弦大颇实。寸涩甚。
大率皆数。小便数而短。作饮食痰积在太阴阳明治之。以酒炒黄柏一两。生甘草梢、犀角屑
盐炒苍术各三钱。川芎二钱。陈皮、牛膝、木通、芍药各五钱。遇暄热。加黄芩二钱为末
每三钱。与姜汁同研细。煎令带热。食前服之。日夜四次。半月后。脉减病轻。去犀角。
加牛膝、龟板、归身尾各五钱。如前服。又半月。肿减食增。不恶寒。惟脚痿软。去苍术、
黄芩。夏。加炒柏一两五钱。余根据本方。内加牛膝。因中年。加生地黄五钱。冬。加桂枝、
茱萸。病遂愈。仍绝酒肉湿面胡椒。
震按此案现证甚杂。而作饮食痰积在太阴阳明治。诚为扼要之论。然方中无消食消痰药
想以醇酒浓味。酿成湿热耳。故湿热与风寒。乃痹证两大纲。
一人项强。动则微痛。脉弦而数实。右为甚。作痰热客太阳经治之。以二陈汤加酒洗黄
芩、羌活、红花而愈。
一村夫背伛偻。足挛。成废疾。脉沉弦而涩。以煨肾散与之。上吐下泻。过一月。又行
一次。凡三四帖而愈。
一人湿气。脚挛拳。伸不直。用当归拈痛汤加杜仲、黄柏、川芎、白术、甘草、枳壳。
愈。
震按此三条。亦皆从湿热治。但因所兼之证而变换其药。仍是殊途同归也。
薛立斋治一妇人。自汗盗汗。发热晡热。体倦少食。月经不调。吐痰甚多。已二年矣。
遍身作痛。天阴风雨益甚。用小续命汤而痛止。用补中益气、加味归脾汤。三十余剂。诸证
悉愈。此皆郁结伤脾。不能输养诸脏所致。故用前二汤专主脾胃。若用寒凉降火。理气化痰
复伤生气。多致不起。
一妇人因怒。月经去多。发热作渴。左目紧小。头项动掉。四肢抽搐。遍身疼痛。此怒
动肝火。肝血虚而内生风。用加味逍遥加钩藤。数剂。诸证渐愈。又八珍汤调理而安。
一妇人历节作痛。发热作渴。饮食少思。月经过期。诸药不应。脉洪大。按之微细。用
附子八物四剂而痛止。用加味逍遥而元气复。六味丸而月经调。
一妇体胖。素内热。月经失调。患痛风。下体微肿。痛甚。小便频数。身重脉缓。证属
风湿。而血虚有热。先用羌活胜湿汤四剂。肿渐愈。用清燥汤数剂。小便渐清。用加味逍遥
十余剂。内热渐愈。为饮食停滞。发热仍痛。面目浮肿。用六君子加柴胡、升麻而愈。又因
怒气。小腹痞闷。寒热呕吐。此木侮脾土。用前药加山栀、木香而安。惟小腹下坠。似欲去
后。此脾气下陷。用补中益气而愈。后因劳役怒气。作呕吐痰。遍身肿痛。月经忽来。寒热
用六君子加柴胡、山栀以扶元气。清肝火。肿痛呕吐悉退。用补中益气以升阳气。健营气
月经寒热渐瘥。
震按此四案。即于暗中摸索。亦知为薛派治法。然而散风寒。补元气。胜湿清燥。滋肝
益肾。平补温补诸法毕具。诚为对证发药之良工也。
汪石山治一妇。年逾五十。左脚膝挛痛。不能履地。夜甚于昼。小腹亦或作痛。诊其脉
浮细缓弱。按之无力。尺脉尤甚。病属血衰。遂以四物汤加牛膝、红花、黄柏、乌药。连进
十余帖而安。
震按石山亦长于补。如此案之脉。人尽知其宜补矣。投以此方。恐病深药浅。岂能十余
剂而安乎。
韩飞霞治一都司。因哭弟成疾。饮食全绝。筋骨百节皮肤无处不痛。而腰为甚。一云肾
虚宜补。或云风寒宜散。韩曰。此亦危证。其脉涩。正东垣所谓非十二经中正疾。乃经络奇
邪也。必多忧愁转抑而成。若痰上。殆矣。补则气滞。散则气耗。乃主以清燥汤。连进三瓯
遂因睡至五鼓。无痰。觉少解。脉之。减十之三。遂专用清燥汤加减与之。十剂而愈。
震按此证甚危。此论甚佳。乃以清燥汤一方收功者。盖五志过极。皆为火郁。此方连、
柏以清火。苍、曲以散郁。郁热能蒸湿。二苓、泽泻以渗湿。湿热甚则脾土衰。二术、人参
以助脾补元。湿热胜则肺金困。参、 、麦冬、五味助金以制木。使不生火。又火亢者水必
亏。故兼归、地养血。再合升、柴之升清。苓、泻之降浊。恰与经络奇邪吻合。所谓奇邪者
乃奇经之邪。故云非十二经中正疾也。
吴茭山治一男子。瘦弱。因卧卑湿之地。遂头目眩晕。畏见日光。寒热时作。四肢历节
疼痛。或作风治。或作虚治。将及半年。俱不效。吴诊脉曰。寸口脉沉而滑。两尺弦。此溢
饮湿痰也。当汗吐之。虽虚羸。不当用补药。乃以控涎丹一服。却用曝干棉子一斗燃之。以
被围之。勿令气泄。使患人坐。熏良久。倏然吐出黑痰升许。大汗如雨。痛止身轻。病遂愈
震按此系痹痛之由于痰饮者。叶氏医案亦曾用之。
李士材治盐贾叶作舟。遍体疼痛。尻髀皆肿。足膝挛急。曰。此寒伤荣血。筋脉为之引
急。内经所谓痛痹也。用乌药顺气散。七剂而减。更加白术、桂枝。一月而愈。
震按此案用温燥发散药。乃风寒湿三气成痹正治法。
孙东宿治行人孙质庵患痛风。手足节骱。肿痛更甚。痛处热。饮食少。诊之脉皆弦细而
数。面青肌瘦。大小腿肉皆削。曰。此病得之禀气弱。下虚多内以伤其阴也。在燕地又多寒
经云。气主煦之。血主濡之。今阴血虚。则筋失养。故营不荣于中。气为寒束。百骸拘挛
故卫不卫于外。荣卫不行。故肢节肿痛而热。病名周痹是也。治当养血舒筋。流湿润燥。
俟痛止后。继以大补阴血之剂。实其下元可也。乃以五加皮、苍术、黄柏、苍耳子、当归、
红花、苡仁、羌活、防风、秦艽、紫荆皮。二十剂而筋渐舒。肿渐消。痛减大半。更以生地
龟板、牛膝、当归、苍术、黄柏、晚蚕砂、苍耳子、秦艽、苡仁、海桐皮。三十剂而肿痛
全减。行人大喜。孙曰。公下元虚惫。非岁月不能充实。须痛戒酒色。则培补乃效。丸方以
仙茅为君。人参、鹿角胶、虎胫骨、枸杞、牛膝为臣。熟地、茯苓、黄柏、苍耳子、晚蚕砂
为佐。桂心、秦艽、泽泻为使。蜜丸。服百日。腿肉长完。精神复旧。
震按此案论治处方。俱极精当。叶案有蓝本于此者。
文学闵唇楼令室。躯肥性躁。患痛风。痛处略肿。呻吟喊叫。手足不能举动。医用归、
芍、地黄、人参、牛膝之类。其痛愈加。已逾七月。东宿曰。此乃湿痰凝滞经络作痛。须以
燥湿流动之剂疏决一番。但初服不效。须十帖见功耳。因用二陈加乌药叶、苍术、僵蚕、海
桐皮、南星。至六七帖。痛如故。乃以芫花醋炒过三分。海金砂一分。为末。白汤送下。至
晚。泻一次。下稠痰半盆。足痛减大半。稍能动止。更后。腹中大痛而厥。冷汗淋漓。面青
息断。举家以为死矣。执而诊之。手冷如冰。但六脉俱在。惟沉伏耳。知其为痛极使然。用
生姜汤灌之而苏。语侍女曰。适来腹中痛甚。耳后火光溅出。肛门如焚。大响一声。不知泻
下何物。群看之。乃血鳅一条。长六寸。阔半寸余。鳞目俱在。盆中尚能游动。众皆悚骇。
此证本由痰作。治者特为行痰。初不知其有虫如是。第药中有芫花。乃杀虫物。故偶中耳。
次日手足皆能动。仍以二陈汤加苡仁、红花、五加皮。四帖脱然。
震按此案末药方甚佳。所谓若药不暝眩。厥疾不瘳也。然其痛并不由于虫。虫下之时。
必痰血俱下。故得愈耳。且云血鳅则为湿热蒸其瘀血所成。复何疑耶。
祝茹穹治闽闱典试。半月前忽腿疼。两脚筋缩。脚跟缩粘至腿。寸步不能行。将一月。
屡药无效。咸以此为痿痹证。祝曰。非也。察其脉。左寸忽洪忽涩。迟数无定栖。因此人好
饮冷酒。酒新则性热燥。冷冻饮料又犯寒湿。寒热相搏。遂有此病。乃以川乌二钱去皮脐。麻黄
二钱。二股梢。一股根。苍术一钱。以甘草汁拌炒。白蒺藜一钱。去刺。酒蒸熟。焙干同为
末。每服一钱二分。用老酒热冲服。盖被出汗。一服即能行动。三服愈。
震按此病甚重。所用川乌。麻黄。虽属狠药。然以治痛风。亦甚平常。恐未必速效至此
〔附〕叶天士先生治嘉善周姓。体浓色苍。患痛风。膝热而足冷。痛处皆肿。夜间痛甚
发之甚时。巅顶如芒刺。根根发孔觉火炎出。遍身躁热不安。小便赤涩。口不干渴。脉沉
细带数。用生黄 五钱。生于术三钱。熟附子七分。独活五分。北细辛三分。汉防己一钱五
分。四剂而诸证皆痊。惟肿痛久不愈。阳痿不举。接用知、柏、虎膝、龟板、苁蓉、牛膝。
不应。改用乌头、全蝎各一两。穿山甲、川柏各五钱。汉防己一两五钱。麝香三钱。马料豆
生用二两。茵陈汤泛丸。每服一钱。开水下而全愈。
震按此与指南所载治鲍姓周痹。用蜣螂、全蝎、地龙、穿山甲、蜂房、川乌、麝香、乳
香。以无灰酒煮黑大豆汁法丸者。各有妙义。非浅见寡闻者所能窥测。后张路玉案用安肾丸
亦有巧思。又与叶案之蠲痛丹、木防己汤诸方。可谓同工异曲。
张路玉治包山劳俊卿。年高挛废。山中诸医。用木瓜、独活、防己、 、威灵仙之类
将半年余。乃致跬步不能动移。或令服八味丸。亦不应。诊其脉尺中微浮而细。时当九夏
自膝至足。皆寒冷如从水中出。知为肾虚。风雨所犯而成是疾。遂授安肾丸。终剂而能步
履。连服二料。绝无痿弱之状矣。
李东垣治疗一个人。冬季时突然遭遇猛烈风气侵袭。六脉弦紧严重，重按洪大有力。症状表现为手部拘挛急迫，大便干结难解。面部发红发热。这是风寒之邪刚刚侵袭身体。四肢归属于脾脏。因风寒邪气损伤了它，就会出现抽搐如同拘挛痹阻的症状，这是风邪淫溢而寒邪在表的表现。《内经》说：“寒则筋脉拘挛。”正是说的这种情况。患者平时爱喝酒，体内有实热乘积在肠胃之间，所以大便干结难解且面部发红发热。内部则是手阳明大肠经和足阳明胃经受邪，外部则是足太阴脾经受风寒邪气。处方用桂枝二钱、甘草一钱，以驱除寒邪并缓解拘挛紧缩。黄柏二钱，味苦性寒，滑利以泻实润燥，紧急救助肾水。升麻、葛根各一钱，用以升发阳气，运行于手阳明经，不让阳气被遏止断绝。桂枝辛热，入入手阳明经作为引经药以润燥，再用甘草专门补益脾气，使脾不受风寒邪气侵害，从而退去贼邪，专门补益肺经。佐以人参补气，当归调和血液并润燥。做成一帖，水煎服。嘱咐患者在温暖的房间中按摩搓揉双手，于是病情安定。
俞震按：此案寒凉与温热、补益与发散并用，恰好符合标本兼治的原则。但李东垣立方的剂量很轻，这里却重用药物。大概是因为风寒是大病，驱逐邪气应当急切，不像其他病症调理脾胃那样只取轻清之品以升发元气。
朱丹溪治疗一个少年。患血痢，使用收敛固涩的药物取得疗效，导致痛风发作叫喊痛苦。这是恶血进入经络所致。血液受湿热熏蒸，时间久了必然凝滞浑浊。痢疾未完全清除，留滞在隧道（经络）中，所以产生疼痛。时间久了必然形成枯细之症。给予四物汤加桃仁、红花、牛膝、黄芩、陈皮、生甘草。煎煮时加入生姜汁，研磨潜行散，调入少量酒饮用。服用数十帖后，又针刺委中穴，放出黑血三合，于是病情安定。
俞震按：这是痢疾之后的痛风，其治疗方法至今仍在流传使用。但因为收敛药物导致湿热留滞而成瘀血，所以用此方。倘若又有其他原因引起的，不能以此一概而论。
另有一人贫穷劳累，深秋时节浑身发热，手足都疼痛如针刺般（注：原文“ ”处似缺字，结合语境及下文“热痹”推测为刺痛或灼痛感，此处译为刺痛感）。白天轻晚上重，服用祛风药疼痛加剧，服用理气药无效。脉象涩而数，右侧比左侧更甚。饮食正常，形体消瘦如削。大概剧烈疼痛导致消瘦，并非疾病直接造成。处方用苍术、酒炒黄柏各一钱五分，生附子一片，生甘草三分，麻黄五分，研磨桃仁九个。煎煮时加入姜汁使其辛辣，热服。连服四帖后，去掉附子，加牛膝一钱。服用八帖后出现气喘急促无法入睡，疼痛略微减轻。推测是血虚，因为多服麻黄，导致阳虚被发动而上奔。应当补血镇坠，用酸味药物收敛。于是用四物汤减去川芎，加倍芍药，加人参二钱，五味子十二粒。服用两帖后病情稳定。三天后，数脉减少大半，脉象恢复涩象如旧，仍然疼痛。用四物汤加牛膝、人参、白术、桃仁、陈皮、甘草、槟榔，生姜三片。服用五十帖后病情安定。后来因负重再次疼痛，再给前药加黄芪三分。又服用二十帖痊愈。
俞震按：身体发热，疼痛如针刺，脉象涩而数，右侧比左侧更甚，应当属于血虚有热，即所谓的热痹证。宜用地黄、龟板、天冬、黄柏、丹皮、黑栀子、秦艽、防己、牛膝、红花、银花、木通等药物治疗可愈。或者用张仲景的栀子柏皮汤大剂量给予也很好。像二妙散中的苍术，已经不相适宜，附子一片有什么用？麻黄五分太过分了。至于因为多服麻黄，导致虚阳上升而气喘，建议用酸味收敛是正确的。但仓促用人参二钱，我担心痹痛会转而加重。然而文中说气喘定后数脉大减，真是奇怪。或许脉数而无力呢？那么之前的麻黄已经误用了，后面的桃仁、槟榔，道理又何在呢？我向来信奉丹溪的观点，对此案却不敢阿谀他所好。再阅读下面的医案，讲究病因和传变道理，真是不可企及啊。
一人患背部肩胛缝间一线疼痛，从上方胯骨起，至胸前侧胁部为止。昼夜不停。脉象弦而数，重取左侧豁然大于右侧。推测背部肩胛属小肠经，胸胁属胆经。必定是因思虑伤心，心脏本身未病，而小肠腑先病，所以疼痛从背胛开始。等到思虑不能决断，便归于胆，所以疼痛至胸胁。以及小肠火邪侵犯胆木，子来乘母，这是实邪。询问得知确实是因为谋事不顺而致病。用人参四分，木通二分，煎汤送服龙胆丸。服用数次后痊愈。
一壮年男子喜食肥甘厚味且易怒。秋季在髀枢左右发起一点疼痛，蔓延至膝盖。疼痛部位怕冷，白天安静晚上加剧。有时口渴有时胸膈痞闷。医生用补血及祛风药治疗，到次年春季疼痛加重，食欲减退，形体消瘦，膝盖肿胀如碗大。脉象弦大颇实，寸脉涩甚，大体都是数脉。小便频数而短少。认为是饮食痰积在太阴、阳明经治疗。用酒炒黄柏一两，生甘草梢、犀角屑、盐炒苍术各三钱，川芎二钱，陈皮、牛膝、木通、芍药各五钱。遇到晴朗炎热天气，加黄芩二钱。研成末，每三钱，与姜汁同研细，煎煮带热服用。饭前服用，日夜四次。半月后，脉象减轻，病情好转，去掉犀角，加牛膝、龟板、当归身尾各五钱。照前方服用。又半月，肿胀减轻，食欲增加，不怕冷，只有脚痿软无力。去掉苍术、黄芩。夏季，加炒黄柏一两五钱。其余根据原方。因患者中年，加生地黄五钱。冬季，加桂枝、山茱萸。病于是痊愈。仍然戒绝酒肉、湿面、胡椒。
俞震按：此案现证非常复杂，而认为作饮食痰积在太阴、阳明经治疗，确实是扼要之论。然而方中没有消食消痰的药，想必是因为醇酒浓味，酿成湿热罢了。所以湿热与风寒，是痹证的两大纲领。
一人项部僵硬，活动则微痛，脉象弦而数实，右侧更甚。认为是痰热客居太阳经治疗。用二陈汤加酒洗黄芩、羌活、红花而痊愈。
一村夫背部佝偻，足部拘挛，成为废疾。脉象沉弦而涩。给予煨肾散。上吐下泻。过一个月，又排泄一次。凡服用三四帖后痊愈。
一人湿气重，脚部拘挛弯曲，伸不直。用当归拈痛汤加杜仲、黄柏、川芎、白术、甘草、枳壳。痊愈。
俞震按：这三条，也都是从湿热治疗，但因所兼夹的证候而变换药物，仍然是殊途同归。
薛立斋治疗一位妇人。自汗盗汗，午后发热，身体疲倦，进食少，月经不调，吐痰很多，已经两年了。遍身疼痛，阴天风雨时更加严重。用小续命汤而疼痛停止。用补中益气汤、加味归脾汤。三十余剂，各种症状全部痊愈。这都是郁结伤脾，不能输养诸脏所致。所以用前两方专门主治脾胃。如果用寒凉降火，理气化痰，反而损伤生气，大多导致不治。
一妇人因愤怒，月经量多，发热口渴，左眼紧闭变小，头项抖动，四肢抽搐，遍身疼痛。这是愤怒触动肝火，肝血虚而生内风。用加味逍遥散加钩藤。数剂，各种症状逐渐痊愈。又用八珍汤调理而安定。
一妇人历节疼痛，发热口渴，饮食少思，月经过期，各种药物无效。脉象洪大，重按微细。用附子八物汤四剂而疼痛停止。用加味逍遥散而元气恢复。用六味丸而月经调顺。
一妇人体胖，素来内热，月经失调，患痛风，下体微肿，疼痛剧烈，小便频数，身体沉重脉缓。证属风湿，而血虚有热。先用羌活胜湿汤四剂，肿胀逐渐痊愈。用清燥汤数剂，小便逐渐清利。用加味逍遥散十余剂，内热逐渐痊愈。因饮食停滞，发热仍然疼痛，面目浮肿。用六君子汤加柴胡、升麻而痊愈。又因怒气，小腹痞闷，寒热呕吐，这是木侮脾土。用前药加山栀、木香而安定。只有小腹下坠，似乎想排便，这是脾气下陷。用补中益气汤而痊愈。后来因劳役怒气，出现呕吐痰涎，遍身肿痛，月经忽来，寒热。用六君子汤加柴胡、山栀以扶元气，清肝火。肿痛呕吐全部消退。用补中益气汤以升阳气，健营气。月经寒热逐渐好转。
俞震按：这四个医案，即使在暗中摸索，也知道是薛派的治疗方法。然而散风寒，补元气，胜湿清燥，滋肝益肾，平补温补各种方法具备。诚然是对证发药的良工。
汪石山治疗一位妇人，年过五十，左脚膝盖拘挛疼痛，不能踩地，夜间比白天严重，小腹也偶尔疼痛。诊其脉浮细缓弱，重按无力，尺脉尤其明显。病属血衰。于是用四物汤加牛膝、红花、黄柏、乌药。连续进服十余帖而安定。
俞震按：石山也擅长补法。像此案的脉象，人们都知道应该补益。投以此方，恐怕病深药浅，怎么能十余剂就安定呢？
韩飞霞治疗一位都司。因哭弟弟而成疾，饮食完全拒绝，筋骨百节皮肤无处不痛，腰部尤其严重。有人说肾虚宜补，有人说风寒宜散。韩飞霞说：这也是危重证候。其脉涩，正是李东垣所说的非十二经中正疾，乃是经络奇邪。必定是多忧愁压抑而成。如果痰涌上来，就危险了。补则气滞，散则气耗。于是主以清燥汤。连续进服三碗，于是睡觉直到五更，无痰，感觉稍缓解。诊脉，减少了十分之三。于是专用清燥汤加减给予。十剂而痊愈。
俞震按：此证非常危重，此论述非常好。乃是用清燥汤一方收功的。大概五志过极，皆为火郁。此方黄连、黄柏以清火，苍术、神曲以散郁。郁热能蒸湿，茯苓、泽泻以渗湿。湿热盛则脾土衰弱，白术、人参以助脾补元。湿热胜则肺金困顿，人参、麦冬、五味子助金以制木，使不生火。又火亢者水必亏，所以兼用当归、地黄养血。再合升麻、柴胡之升清，茯苓、泽泻之降浊。恰好与经络奇邪吻合。所谓奇邪乃是奇经之邪，所以说非十二经中正疾。
吴茭山治疗一男子，瘦弱。因卧于卑湿之地，于是头目眩晕，畏见日光，寒热时作，四肢历节疼痛。有的按风治，有的按虚治，将近半年，都不见效。吴诊脉说：寸口脉沉而滑，两尺脉弦。这是溢饮湿痰。应当用汗法吐法。虽然虚弱羸瘦，不应当用补药。于是用控涎丹一服，却用晒干棉籽一斗燃烧，用被子围住，不让气体泄漏，让病人坐着，熏烤很久。忽然吐出黑痰约一升，大汗如雨，疼痛停止身体轻松，病于是痊愈。
李士材治疗盐商叶作舟，遍体疼痛，尻部和髀部都肿胀，足膝拘挛急迫。说：这是寒伤荣血，筋脉为之牵引急迫。《内经》所谓痛痹。用乌药顺气散，七剂而减轻。再加白术、桂枝。一月而痊愈。
孙东宿治疗行人孙质庵患痛风。手足关节，肿痛更甚，疼痛部位发热，饮食少。诊之脉皆弦细而数。面色青，肌肉消瘦，大小腿肌肉皆消瘦。说：这病得之于禀赋气弱，下虚多内伤其阴。在燕地又多寒。经云：气主煦之，血主濡之。现在阴血虚，则筋失养，所以营气不荣于中。气为寒束，百骸拘挛，所以卫气不卫于外。营卫不行，所以肢节肿痛而热。病名周痹。治疗应当养血舒筋，流湿润燥。等疼痛停止后，继以大补阴血的药剂，充实其下元即可。于是用五加皮、苍术、黄柏、苍耳子、当归、红花、苡仁、羌活、防风、秦艽、紫荆皮。二十剂而筋渐舒展，肿胀渐消，疼痛减少大半。再用生地黄、龟板、牛膝、当归、苍术、黄柏、晚蚕砂、苍耳子、秦艽、苡仁、海桐皮。三十剂而肿痛全减。行人非常高兴。孙说：您下元虚惫，不是岁月不能充实。必须痛戒酒色，则培补才有效。丸方以仙茅为君药，人参、鹿角胶、虎胫骨、枸杞、牛膝为臣药。熟地、茯苓、黄柏、苍耳子、晚蚕砂为佐药。桂心、秦艽、泽泻为使药。蜜丸。服用百日，腿部肌肉长完，精神恢复旧观。
俞震按：此案论治处方，都非常精当。叶氏医案有蓝本于此。
文学闵唇楼令室，躯肥性躁，患痛风。疼痛部位略肿，呻吟喊叫，手足不能举动。医生用当归、芍药、地黄、人参、牛膝之类。其疼痛更加厉害。已超过七月。孙东宿说：这是湿痰凝滞经络作痛。须用燥湿流动之剂疏决一番。但初服不效，须十帖见功。于是用二陈汤加乌药叶、苍术、僵蚕、海桐皮、南星。至六七帖，疼痛如故。于是用芫花醋炒过三分，海金砂一分，研为末，白开水送下。到了晚上，泻一次，下稠痰半盆。足痛减少大半，稍微能动止。后来，腹中大痛而厥逆，冷汗淋漓，面色青，气息断绝，全家以为死了。坚持诊脉，手冷如冰，但六脉俱在，只是沉伏而已。知道这是疼痛极度导致的。用生姜汤灌之而苏醒。对侍女说：刚才腹中疼痛剧烈，耳后火光溅出，肛门如火烧，大声响一声，不知道泻下什么东西。大家看，是一条血鳅，长六寸，宽半寸有余，鳞目都在，盆中还能游动。众人都惊恐骇异。此证本来由痰引起，治疗者特意行痰，起初不知道有虫如此。只是药中有芫花，乃杀虫之物，所以偶然中效。第二天手足都能动。仍以二陈汤加苡仁、红花、五加皮。四帖脱然痊愈。
俞震按：此案末药方很好。所谓若药不暝眩，厥疾不瘳也。然而其疼痛并不由于虫，虫下之时，必痰血俱下，所以得以痊愈。且说血鳅则为湿热蒸其瘀血所成，还有什么可疑的呢？
祝茹穹治疗福建闱典试官员。半个月前突然腿疼，两脚筋缩，脚跟收缩粘至腿，寸步不能行。将近一月，屡药无效。大家都认为是痿痹证。祝说：不是。察其脉，左寸忽洪忽涩，迟数无定栖。因为此人好饮冷酒，酒新则性热燥，冷冻饮料又犯寒湿。寒热相搏，遂有此病。于是用川乌二钱去皮脐，麻黄二钱，二股梢，一股根，苍术一钱，以甘草汁拌炒，白蒺藜一钱，去刺，酒蒸熟，焙干同为末。每服一钱二分，用老酒热冲服。盖被出汗，一服即能行动，三服痊愈。
俞震按：此病很重，所用川乌、麻黄，虽属狠药，但以治痛风，也很平常。恐怕未必速效至此。
【附】叶天士先生治疗嘉善周姓。体浓色苍，患痛风。膝热而足冷，疼痛部位都肿，夜间痛甚。发作严重时，巅顶如芒刺，根根发孔觉火炎出，遍身躁热不安，小便赤涩，口不干渴。脉沉细带数。用生黄芪五钱，生于术三钱，熟附子七分，独活五分，北细辛三分，汉防己一钱五分。四剂而各种症状都痊愈。只有肿痛久不愈，阳痿不举。接用知母、黄柏、虎膝、龟板、肉苁蓉、牛膝。不应。改用乌头、全蝎各一两，穿山甲、川柏各五钱，汉防己一两五钱，麝香三钱，马料豆生用二两，茵陈汤泛丸。每服一钱，开水下而全愈。
俞震按：这与《指南》所载治疗鲍姓周痹，用蜣螂、全蝎、地龙、穿山甲、蜂房、川乌、麝香、乳香，以无灰酒煮黑大豆汁法丸者，各有妙义，不是浅见寡闻者所能窥测。后来张路玉案用安肾丸也有巧思。又与叶案之蠲痛丹、木防己汤诸方，可谓同工异曲。
张路玉治疗包山劳俊卿。年高挛废。山中各位医生，用木瓜、独活、防己、威灵仙之类将半年多。以致跬步不能移动。有人令服八味丸，也不应。诊其脉尺中微浮而细。时值九夏，自膝至足，皆寒冷如从水中出。知为肾虚，风雨所犯而成是疾。于是授安肾丸。终剂而能步履。连服二料，绝无痿弱之状矣。
Li Dongyuan treated a patient. In winter, there was a sudden and violent invasion of wind qi. The six pulses were severely wiry (Xian), and forceful and large (Hong Da) upon deep pressure. The symptoms included spasticity and urgency in the hands, and dry, difficult defecation. The face was red and hot. This indicated that pathogenic wind and cold had just invaded the body. The four limbs belong to the Spleen. When injured by pathogenic wind and cold, spasms resembling contracture and bi-syndrome occur; this is when wind pathogen is excessive and cold pathogen is on the exterior. The *Neijing* states: "Cold causes tendon contracture." This refers precisely to this situation. The patient habitually drank alcohol, so there was excess heat accumulating between the Stomach and Intestines internally, causing dry, difficult defecation and a red, hot face. Internally, the Hand-Yangming Large Intestine Meridian and Foot-Yangming Stomach Meridian were affected; externally, the Foot-Taiyin Spleen Meridian was affected by wind-cold pathogens. The prescription used Guizhi (Cinnamon Twig) 2 qian and Gancao (Licorice Root) 1 qian to dispel cold pathogen and relieve contraction. Huangbai (Phellodendron Bark) 2 qian, bitter and cold, is slippery to drain excess and moisten dryness, urgently assisting Kidney Water. Shengma (Cimicifuga Rhizome) and Gegen (Pueraria Root) each 1 qian were used to raise Yang Qi and circulate it through the Hand-Yangming Meridian, preventing obstruction. Guizhi is pungent and hot, entering the Hand-Yangming Meridian as a guiding herb to moisten dryness; Gancao was used again to specifically tonify Spleen Qi, protecting it from wind-cold pathogens, thereby expelling the thief pathogen and specifically benefiting the Lung Meridian. Zushi (Assisting herbs) included Renshen (Ginseng Root) to tonify Qi and Danggui (Angelica Sinensis Root) to harmonize Blood and moisten dryness. Prepared as one decoction, taken with water, warm. The patient was instructed to massage and rub his hands in a warm room, after which he stabilized.
Yu Zhen commented: In this case, cold and heat, tonification and dispersion are used together, appropriately addressing both root and branch. However, Li Dongyuan's prescriptions typically use light dosages; here, heavy dosages were used. This is likely because wind-cold is a major disease, requiring urgent expulsion of pathogens, unlike other conditions where regulating the Spleen and Stomach only requires light, clear herbs to raise Yuan Qi.
Zhu Danxi treated a young man suffering from bloody dysentery. Using astringent herbs brought relief but caused gout-like pain and wailing. This was due to evil blood entering the collaterals. Blood affected by damp-heat eventually becomes turbid and coagulated. Residual dysentery remained stagnant in the tunnels (collaterals), causing pain. Over time, this leads to wasting and thinning. He prescribed Siwu Tang (Four Substances Decoction) plus Taoren (Peach Kernel), Honghua (Safflower), Niuxi (Achyranthes Root), Huangqin (Scutellaria Root), Chenpi (Tangerine Peel), and Sheng Gancao (Raw Licorice Root). Decocted with fresh ginger juice and Qianxing San (Hidden Walking Powder), taken with a little wine. After dozens of doses, acupoint Weizhong (BL-40) was pricked, releasing three he of dark blood, after which he stabilized.
Yu Zhen commented: This is post-dysentery gout. The method is still transmitted and used today. It is used because astringent herbs caused damp-heat stagnation leading to blood stasis. If other causes exist, this cannot be generalized.
Another case: A poor, overworked person suffered whole-body fever in late autumn, with hand and foot pain like needle pricks. Symptoms were lighter during the day and heavier at night. Wind-dispelling herbs worsened the pain; Qi-regulating herbs were ineffective. The pulse was choppy (Se) and rapid (Shu), more pronounced on the right than the left. Diet was normal, but the body was emaciated. Severe pain leading to emaciation is not necessarily caused directly by the disease. Prescription: Cangzhu (Atractylodes Rhizome) and Jiuhuangbai (Wine-processed Phellodendron Bark) each 1.5 qian, Sheng Fuzi (Raw Aconite Lateral Root) 1 slice, Sheng Gancao (Raw Licorice Root) 3 fen, Mahuang (Ephedra Herb) 5 fen, crushed Taoren (Peach Kernel) 9 pieces. Decocted with ginger juice to make it spicy, taken hot. After four doses, remove Fuzi, add Niuxi (Achyranthes Root) 1 qian. After eight doses, asthma became急促 (rapid/shortness of breath) and insomnia occurred, with slight pain reduction. Suspected Blood deficiency exacerbated by excessive Mahuang, causing deficient Yang to rush upward. Treatment should tonify Blood, anchor descending, and use sour astringents. Thus, Siwu Tang (Four Substances Decoction) minus Chuanxiong (Ligusticum Rhizome), doubled Shaoyao (Peony Root), added Renshen (Ginseng Root) 2 qian and Wuweizi (Schisandra Fruit) 12 grains. Two doses stabilized the condition. Three days later, the rapid pulse decreased significantly, returning to a choppy state, with persistent pain. Siwu Tang (Four Substances Decoction) plus Niuxi (Achyranthes Root), Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Taoren (Peach Kernel), Chenpi (Tangerine Peel), Gancao (Licorice Root), Binglang (Areca Seed), and three slices of fresh ginger were given. After fifty doses, he stabilized. Later, pain recurred due to carrying heavy loads; the previous prescription plus Huangqi (Astragalus Root) 3 fen was given. After twenty more doses, he recovered.
Yu Zhen commented: Whole-body fever, pain like needle pricks, choppy and rapid pulse, more pronounced on the right, should belong to Blood deficiency with heat, i.e., Heat Bi syndrome. Suitable herbs include Shengdi (Rehmannia Root), Guiban (Tortoise Shell), Tiandong (Asparagus Tuber), Huangbai (Phellodendron Bark), Danpi (Moutan Cortex), Heizhi (Black Gardenia Fruit), Qinjiao (Gentiana Macrophylla Rhizome), Fangji (Stephania Root), Niuxi (Achyranthes Root), Honghua (Safflower), Yinhua (Honeysuckle Flower), Mutong (Akebia Stem). Or Zhang Zhongjing's Zhizi Bopi Tang (Gardenia and Phellodendron Decoction) in large dosage would also be good. Cangzhu (Atractylodes Rhizome) from Ermiao San (Two Marvels Powder) is inappropriate; what use is one slice of Fuzi? Five fen of Mahuang is excessive. Regarding the asthma from excessive Mahuang causing deficient Yang to rise, suggesting sour astringents was correct. But hastily using 2 qian of Renshen might increase Bi pain. Yet, the text says asthma resolved and rapid pulse decreased greatly, which is strange. Perhaps the rapid pulse was weak? Then the previous Mahuang was a mistake, and the rationale for subsequent Taoren and Binglang is unclear. I have always admired Danxi, but here I dare not flatter him. Reading the next case, analyzing etiology and transmission, is truly unsurpassable.
One person suffered a line of pain in the scapular seam, starting from the upper hip bone to the lateral chest and胁 (hypochondrium). Unceasing day and night. Pulse was wiry and rapid. Heavy pressure revealed the left pulse wider and larger than the right. Speculated that the scapula belongs to the Small Intestine Meridian, and the hypochondrium to the Gallbladder Meridian. Likely mental worry damaged the Heart; although the Heart organ itself was not diseased, the Small Intestine Fu organ was diseased first, hence pain started in the scapula. When worry could not be resolved, it attributed to the Gallbladder, hence pain extended to the hypochondrium. Small Intestine Fire attacking Gallbladder Wood, child attacking mother, constitutes an Excess pathogen. Inquiry confirmed illness due to unsuccessful planning. Ren Shen (Ginseng Root) 4 fen, Mutong (Akebia Stem) 2 fen, decocted to swallow Longdan Wan (Gentian Pill). Several doses cured it.
A robust man who enjoyed rich foods and got angry easily developed a point of pain around the hip pivot in autumn, extending to the knees. The painful area feared cold; quiet by day, worse by night. Occasional thirst or chest oppression. Doctors used Blood-tonifying and Wind-dispelling herbs. By the following spring, pain intensified, appetite decreased, body emaciated, knees swollen like bowls. Pulse was wiry, large, and quite solid; Cun (inch) position very choppy; generally rapid. Urination frequent and scanty. Diagnosed as food retention and phlegm accumulation in Taiyin and Yangming meridians. Prescription: Jiuhuangbai (Wine-processed Phellodendron Bark) 1 liang, Sheng Gancao Gao (Raw Licorice Root Tip), Xijiao Xie (Rhinoceros Horn Shavings - note: modern substitute often used), Yanbaizhu (Salt-processed Atractylodes Rhizome) each 3 qian, Chuanxiong (Ligusticum Rhizome) 2 qian, Chenpi (Tangerine Peel), Niuxi (Achyranthes Root), Mutong (Akebia Stem), Shaoyao (Peony Root) each 5 qian. On warm/hot days, add Huangqin (Scutellaria Root) 2 qian. Powdered, 3 qian per dose, mixed with ginger juice, decocted warm, taken before meals, four times daily. After half a month, pulse improved, condition lightened; remove Xijiao, add Niuxi (Achyranthes Root), Guiban (Tortoise Shell), Danggui Shenyi (Angelica Sinensis Root and Tail) each 5 qian. Continue as before. Another half month, swelling reduced, appetite increased, no longer feared cold, only leg weakness. Remove Cangzhu, Huangqin. In summer, add Jiaohuangbai (Processed Phellodendron Bark) 1.5 liang. Rest based on original formula. Since middle-aged, add Shengdi (Rehmannia Root) 5 qian. In winter, add Guizhi (Cinnamon Twig) and Zhuyu (Cornus Fruit). Disease cured. Strictly avoid alcohol, meat, damp noodles, and pepper.
Yu Zhen commented: The current symptoms are complex, but diagnosing food retention and phlegm accumulation in Taiyin/Yangming is indeed crucial. However, the formula lacks digestive and phlegm-resolving herbs; likely strong wine and rich flavors brewed damp-heat. Thus, damp-heat and wind-cold are the two main categories of Bi syndrome.
One person had neck stiffness, slight pain on movement, pulse wiry, rapid, and solid, more on the right. Diagnosed as Phlegm-Heat lodging in the Taiyang Meridian. Cured with Erchen Tang (Two Aged Herbs Decoction) plus Jiuhuangqin (Wine-washed Scutellaria Root), Qianghuo (Notopterygium Rhizome), and Honghua (Safflower).
A village laborer had a hunched back and contracted feet, becoming disabled. Pulse was deep, wiry, and choppy. Given Weishen San (Baked Kidney Powder). Vomiting and diarrhea ensued. After a month, another bowel movement occurred. Cured after three to four doses.
One person with Dampness had contracted, curled feet that could not straighten. Cured with Danggui Niantong Tang (Angelica Pain-Relieving Decoction) plus Duzhong (Eucommia Bark), Huangbai (Phellodendron Bark), Chuanxiong (Ligusticum Rhizome), Baizhu (Atractylodes Macrocephala Rhizome), Gancao (Licorice Root), and Zhike (Aurantium Fruit).
Yu Zhen commented: These three cases all treated Damp-Heat, varying herbs based on accompanying syndromes, achieving the same goal via different paths.
Xue Lizhai treated a woman with spontaneous sweating, night sweats, afternoon fever, fatigue, poor appetite, irregular menstruation, and excessive phlegm production for two years. Whole-body pain, worsening on cloudy/rainy days. Pain stopped with Xiao Xuming Tang (Minor Continuation of Life Decoction). Stabilized with Buzhong Yiqi Tang (Middle-Boosting Qi-Enhancing Decoction) and Jiawei Guipi Tang (Modified Restore the Spleen Decoction) over thirty-plus doses. All symptoms resolved. This was due to depression injuring the Spleen, failing to nourish organs. Thus, these two formulas focused on Spleen/Stomach. Using cold/cool fire-draining or Qi-regulating/phlegm-resolving herbs would damage vital Qi, often leading to death.
A woman, angered, had heavy menstruation, fever, thirst, small left eye, head/neck tremors, limb convulsions, and whole-body pain. Anger stirred Liver Fire; Liver Blood deficiency generated internal Wind. Cured gradually with Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) plus Gouteng (Uncaria Ramulus) over several doses, then regulated with Bazhen Tang (Eight Treasures Decoction).
A woman suffered joint pain, fever, thirst, poor appetite, delayed menstruation, unresponsive to various drugs. Pulse was large and洪 (surging) but fine and subtle on pressure. Pain stopped after four doses of Fuzi Bawu Tang (Aconite Eight Substances Decoction). Vitality restored with Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder); menstruation regulated with Liuwei Wan (Six Ingredients Pill).
A fat woman, prone to internal heat, with irregular menstruation, suffered gout. Lower body slightly swollen, severe pain, frequent urination, heavy body, slow pulse. Syndrome: Wind-Damp with Blood deficiency and heat. First, Qianghuo Shengshi Tang (Notopterygium Damp-Overcoming Decoction) for four doses reduced swelling. Qingzao Tang (Moisture-Clearing Decoction) for several doses cleared urine. Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) for ten-plus doses cleared internal heat. Due to food stagnation, fever and pain returned with facial swelling. Cured with Liujunzi Tang (Six Gentlemen Decoction) plus Chaihu (Bupleurum Root) and Shengma (Cimicifuga Rhizome). Anger caused lower abdominal fullness, chills/fever, vomiting. Wood insulting Earth. Previous medicine plus Zhizi (Gardenia Fruit) and Muxiang (Vladimiria Root) stabilized. Only lower abdominal bearing-down sensation suggested Spleen Qi sinking; cured with Buzhong Yiqi Tang (Middle-Boosting Qi-Enhancing Decoction). Later, labor and anger caused vomiting phlegm, whole-body swelling/pain, sudden menstruation, chills/fever. Liujunzi Tang (Six Gentlemen Decoction) plus Chaihu (Bupleurum Root) and Zhizi (Gardenia Fruit) supported Yuan Qi and cleared Liver Fire. Swelling/pain/vomiting subsided. Buzhong Yiqi Tang (Middle-Boosting Qi-Enhancing Decoction) raised Yang Qi and strengthened Ying Qi. Menstrual chills/fever gradually improved.
Yu Zhen commented: These four cases reveal Xue's school methods even if guessed blindly. Dispelling wind-cold, tonifying Yuan Qi, overcoming dampness, clearing dryness, nourishing Liver/Kidney, flat/warm tonification—all present. Truly a skilled practitioner matching treatment to syndrome.
Wang Shishan treated a woman over fifty with left knee contracture/pain, unable to walk, worse at night, occasional lower abdominal pain. Pulse floating, fine, slow, weak, powerless on pressure, especially Chi (cubit) position. Disease: Blood deficiency. Prescribed Siwu Tang (Four Substances Decoction) plus Niuxi (Achyranthes Root), Honghua (Safflower), Huangbai (Phellodendron Bark), Wuyao (Lindera Root). Ten-plus doses brought stability.
Yu Zhen commented: Shishan excels in tonification. With such a pulse, everyone knows tonification is needed. Using this formula might seem too light for deep disease, yet it worked in ten doses.
Han Feixia treated a Du Si (Military Officer) ill from crying for his brother. Refused all food. Pain everywhere in bones/joints/skin, worst in waist. Some said Kidney deficiency needs tonification; others said wind-cold needs dispersion. Han said: Critical condition. Pulse is choppy, exactly Li Dongyuan's description of non-twelve-meridian regular disease, but odd-pathogen in collaterals. Caused by excessive worry/suppression. If phlegm rises, fatal. Tonification causes Qi stagnation; dispersion causes Qi consumption. Main treatment: Qingzao Tang (Dryness-Clearing Decoction). Three bowls cured sleepiness until dawn, no phlegm, feeling relieved. Pulse decreased by 30%. Continued Qingzao Tang (Dryness-Clearing Decoction) modified for ten doses, cured.
Yu Zhen commented: Critical condition, excellent analysis. Qingzao Tang (Dryness-Clearing Decoction) succeeded. Extreme emotions become Fire Depression. Lian (Coptis) and Bai (Phellodendron) clear fire; Cang (Atractylodes) and Qu (Medicated Leaven) scatter depression. Depressed heat steams dampness; Ling (Poria) and Ze (Alisma) drain damp. Damp-heat weakens Spleen Earth; Zhu (Atractylodes) and Renshen (Ginseng) assist Spleen/Yuan Qi. Damp-heat confuses Lung Metal; Renshen (Ginseng), Maidong (Ophiopogon Tuber), Wuweiizi (Schisandra) support Metal to control Wood, preventing Fire. Fire excess implies Water deficiency; Danggui (Angelica) and Dihuang (Rehmannia) nourish Blood. Combined with Sheng (Cimicifuga) and Chai (Bupleurum) raising clear Qi, Ling (Poria) and Ze (Alisma) lowering turbid Qi. Matches odd-pathogen perfectly. Odd-pathogen refers to odd vessels, hence "not twelve-meridian regular disease."
Wu Jiaoshan treated a thin, weak man lying on damp ground. Developed dizziness, photophobia, alternating chills/fever, whole-joint pain. Treated as Wind or Deficiency for nearly half a year, ineffective. Pulse: Cun (inch) deep and slippery, Chi (cubit) wiry. Diagnosis: Overflowing Drink, Damp-Phlegm. Should use sweating/vomiting methods. Despite weakness, no tonification. One dose of Kongyan Dan (Controlling Fluids Pill). Burned one dou of dried cotton seeds, covered patient with quilt to retain gas, seated patient, fumigated for a long time. Suddenly vomited about one sheng of black phlegm, profuse sweat like rain, pain stopped, body light, cured.
Yu Zhen commented: Bi pain due to Phlegm-Drink. Ye Tianshi's cases also used this.
Li Shicai treated salt merchant Ye Zuozhou with whole-body pain, swelling of buttocks/hips, foot/knee contracture. Said: Cold injuring Ying Blood, tendons/muscles pulling tight. Neijing calls this Tong Bi (Painful Bi). Used Uyao Shunqi San (Uyao Qi-Smoothening Powder) for seven doses, reduced. Added Baizhu (Atractylodes Macrocephala Rhizome) and Guizhi (Cinnamon Twig). Cured in one month.
Yu Zhen commented: Warm/dispersive herbs are the standard treatment for Bi caused by Wind-Cold-Damp.
Sun Dongsu treated pedestrian Sun Zhi'an with gout. Hand/foot joints swollen/painful, hot painful areas, poor appetite. Pulse wiry, fine, rapid. Face green, muscles wasted, calves/thighs emaciated. Said: Congenital weakness, lower deficiency damaging Yin. In Yan region, cold is prevalent. Classic: Qi warms, Blood moistens. Yin/Blood deficiency means tendons lose nourishment, Ying fails to nourish inside. Qi constrained by cold, hundred bones contract, Wei fails to protect outside. Ying/Wei circulation blocked, causing joint swelling/pain/heat. Named Zhou Bi (General Bi). Treatment: Nourish Blood, relax tendons, flow dampness, moisten dryness. After pain stops, continue with strong Yin/Blood tonics to fill lower Yuan. Prescription: Wujia Pi (Eleutherococcus Bark), Cangzhu (Atractylodes Rhizome), Huangbai (Phellodendron Bark), Cang'erzi (Xanthium Fruit), Danggui (Angelica Sinensis Root), Honghua (Safflower), Yiren (Coix Seed), Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root), Qinjiao (Gentiana Macrophylla Rhizome), Zijing Pi (Bauhinia Bark). Twenty doses relaxed tendons, reduced swelling, halved pain. Next prescription: Shengdi (Rehmannia Root), Guiban (Tortoise Shell), Niuxi (Achyranthes Root), Danggui (Angelica Sinensis Root), Cangzhu (Atractylodes Rhizome), Huangbai (Phellodendron Bark), Wancansha (Silkworm Frass), Cang'erzi (Xanthium Fruit), Qinjiao (Gentiana Macrophylla Rhizome), Yiren (Coix Seed), Haitong Pi (Sapium Bark). Thirty doses eliminated swelling/pain. Patient delighted. Sun said: Lower Yuan deficiency takes time to fill. Strictly avoid alcohol/sex for tonification to work. Pill formula: Xianmao (Curculigo Rhizome) as Sovereign; Renshen (Ginseng Root), Lujiaojiao (Deer Antler Glue), Hu Jinggu (Tiger Tibia Bone - note: protected species, historical context), Gouqi (Goji Berry), Niuxi (Achyranthes Root) as Ministers; Shudi (Prepared Rehmannia Root), Fuling (Poria), Huangbai (Phellodendron Bark), Cang'erzi (Xanthium Fruit), Wancansha (Silkworm Frass) as Assistants; Guixin (Cinnamon Heart), Qinjiao (Gentiana Macrophylla Rhizome), Zexie (Alisma Rhizome) as Guides. Honey pills. Taken for 100 days, leg muscles regenerated, spirit restored.
Yu Zhen commented: Analysis, treatment, and prescription are extremely precise. Ye Tianshi's cases have blueprints here.
Literary Min Chunlou's wife, fat and irritable, suffered gout. Slight swelling at pain sites, groaning/crying, immobile hands/feet. Doctors used Danggui (Angelica), Shaoyao (Peony), Dihuang (Rehmannia), Renshen (Ginseng), Niuxi (Achyranthes). Pain worsened. Over seven months. Sun Dongsu said: Damp-Phlegm stagnating collaterals causing pain. Need drying/damp-resolving, moving agents to vent. Initial doses ineffective; need ten doses for effect. Used Erchen Tang (Two Aged Herbs Decoction) plus Wuyaoye (Litsea Leaf), Cangzhu (Atractylodes Rhizome), Jiangcan (Bombyx Batryticatus), Haitong Pi (Sapium Bark), Nanxing (Pinellia Tuber). At six-seven doses, pain unchanged. Then used Yuanhua (Kadsura Flower) vinegar-fried 3 fen, Haijinsha (Lygodium Spore) 1 fen, powdered, taken with warm water. Evening: one bowel movement, half basin of thick phlegm. Foot pain halved, slight movement possible. Later, severe abdominal pain, syncope, cold sweat, cyanotic face, absent breathing. Family thought dead. Pulse held: hands ice-cold, six pulses present but deep/profound. Knew it was extreme pain reaction. Gave Shengjiang Tang (Fresh Ginger Decoction), revived. Told maid: severe abdominal pain, felt fire behind ears, anus burning, loud sound, didn't know what passed. Looked: a "blood leech" (bloodworm), 6 cun long, half cun wide, scales/eyes intact, swimming in basin. Crowd horrified. Syndrome originally Phlegm; treatment moved Phlegm; unknown presence of worm. Yuanhua kills worms, so accidental efficacy. Next day, hands/feet moved. Continued Erchen Tang (Two Aged Herbs Decoction) plus Yiren (Coix Seed), Honghua (Safflower), Wujia Pi (Eleutherococcus Bark). Four doses, completely recovered.
Yu Zhen commented: Final prescription is excellent. "If medicine does not cause dizziness, chronic disease does not heal." Pain wasn't due to worm; worm passage coincided with phlegm/blood discharge, hence cure. "Blood leech" formed by damp-heat steaming stasis. No doubt.
Zhu Ruqiong treated a Fujian examination official. Sudden leg pain half a month ago, calf muscle contraction, heel stuck to leg, unable to walk. Nearly one month, ineffective medicines. All considered Wei-Bi (Atrophy-Bi). Zhu said: No. Left Cun pulse fluctuates between surging/choppy, irregular speed. Patient likes cold wine. New wine is hot/dry; cold drink adds cold-damp. Cold-heat struggle causes this. Prescription: Chuanwu (Chuanwu Aconite Root) 2 qian peeled/cored, Mahuang (Ephedra Herb) 2 qian (two tips, one root), Cangzhu (Atractylodes Rhizome) 1 qian stir-fried with Gancao juice, Bajieli (Tribulus Fruit) 1 qian de-spined, wine-steamed, dried, powdered. Take 1.2 qian, mix with hot old wine. Cover, induce sweating. One dose enabled walking; three doses cured.
Yu Zhen commented: Serious disease. Chuanwu and Mahuang are harsh but common for gout. Speed of cure surprising.
[Appendix] Ye Tianshi treated Jia Shan Zhou surname. Robust build, dark complexion, gout. Hot knees, cold feet, swollen painful areas, worse at night. Severe attacks: vertex feels like thorns, pores feel fiery, whole body restless, red/scanty urine, no mouth thirst. Pulse deep, fine, slightly rapid. Sheng Huangqi (Astragalus Root) 5 qian, Sheng Baizhu (Atractylodes Macrocephala Rhizome) 3 qian, Shu Fuzi (Prepared Aconite Lateral Root) 7 fen, Duhuo (Angelica Pubescens Root) 5 fen, Beixixin (Asarum Root) 3 fen, Han Fangji (Stephania Tetrandra Root) 1.5 qian. Four doses cured all symptoms. Swelling/pain persisted, impotence. Switched to Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), Huxi (Panax Notoginseng Root - note: context implies tiger knee substitute or similar), Guiban (Tortoise Shell), Rongrong (Cistanche Stem), Niuxi (Achyranthes Root). Ineffective. Changed to Wutou (Aconite Root), Quanxie (Scorpion) each 1 liang, Chuanshanjia (Pangolin Scale), Chuanbai (Phellodendron Bark) each 5 qian, Han Fangji (Stephania Tetrandra Root) 1.5 liang, Shexiang (Musk) 3 qian, Maliaodou (Glycine Max Seed) raw 2 liang, Yichen Tang (Artemisia Decoction) pill base. Take 1 qian, warm water. Cured.
Yu Zhen commented: Similar to *Zhinan* treating Bao surname Zhou Bi with Dung Beetle, Scorpion, Earthworm, Pangolin Scale, Beehive, Chuanwu, Musk, Frankincense, boiled black soybean juice pills. Both have profound meanings, inaccessible to shallow observers. Later Zhang Luyu's Anshen Wan also shows ingenuity. Comparable to Ye's Juantong Dan and Mugufengji Tang—same skill, different approaches.
Zhang Luyu treated Bao Shan Lao Junqing. Elderly, contracted/disabled. Mountain doctors used Mugua (Chaenomeles Fruit), Duhuo (Angelica Pubescens Root), Fangji (Stephania Root), Weilingxian (Clematis Root) for over half a year. Result: unable to move step. Bajian Wan (Eight Flavors Pill) ineffective. Pulse Chi position slightly floating/fine. Summer season, knees/feet cold as if from water. Known as Kidney deficiency attacked by wind/rain. Prescribed Anshen Wan (Kidney-Anchoring Pill). One course enabled walking. Two courses eliminated atrophy signs.