张戴人治一人病危笃。自述曰。我别无病。三年前。隆暑时出村野。有以煮酒馈予者。
冷冻饮料数升。便觉左胁下闷。渐作痛。结硬如石。至今不散。针灸摩药。殊无寸效。张诊之。
两手俱沉实而有力。先以独圣散吐之。一涌二三升。气味如酒。其痛即止。后服和脾安胃之
剂而愈。
震按胁下结硬如石。的系积块。若宗养正积自除之说。而用参、术。何异助纣为虐。幸
遇戴人。以涌法起其沉 。亦赖脉之沉实有力耳。因知善于切脉。则如礼乐与干戈。俱能戡
乱致治也。
虞天民治一人。年四十余。因骑马跌扑。次年左胁胀痛。医与小柴胡汤加青皮、龙胆草
等药。不效。诊其脉。左手寸尺皆弦数而涩。关脉芤而急数。右三部惟数而虚。虞曰。明是
死血证。用抵当丸一剂。下黑血二升许。后以四物汤加减。调理而安。
震按橘泉翁治一老八十余。左胁大痛。肿起如覆杯。手不可近。谓有瘀血在脾中。而立
斋治一人右胁胀痛。喜用手按。谓是肝木克脾土。而脾土不能生肺金。若内有瘀血。虽单衣
亦不敢着肉。此可以树辨证之洪范矣。又李士材治李明奇。素雄壮。忽左胁痛。手不可近。
用左金丸、泻肝汤。至月余。痛处渐大。右胁亦痛。不能行动。神气如痴。惚惚若有所失。
面色黄。两关脉促。谓其蓄血已深。非快剂不下。用桃仁承气汤。一服不动。再加干漆、生
大黄五钱。下血块十余枚。遂痛止神清。惟见困倦。先与独参汤。再用八珍汤调理。三月而
康。此与橘泉之用承气加归、芍、柴胡、黄柏、黄连者。微有不同。但连、柏苦寒。何以瘀
血亦下也。
薛立斋治一妇人。饮食后因怒患疟。呕吐。用藿香正气散。二剂而愈。后复怒。吐痰甚
多。狂言热炽。胸胁胀痛。手按少止。脉洪大无伦。按之微细。此属肝脾二经血虚。以加味
逍遥散加熟地、川芎。二剂脉证顿退。再用十全大补而安。此证若用疏通之剂。是犯虚虚之
戒矣。
震按薛翁自己之注释。及后金坛之垂戒。学人所当切记。
石山治一人。客维扬。病胁痛。医以为虚。用人参羊肉补之。其痛愈甚。一医投龙荟丸
痛减。汪诊脉弦濡而弱。曰。脾胃为痛所伤。尚未复。遂以橘皮枳术丸加黄连、当归。服
之而安。越五年。腹胁复痛。彼思颇类前病。欲服龙荟丸未决。汪诊之。脉皆濡弱而缓。曰
前病属实。今病属虚。非前药可治也。以人参为君。芎、归、芍药为臣。香附、陈皮为佐
甘草、山栀为使。煎服十余帖。痛止食进。
震按此人之脉。先后皆濡弱。惟弦与缓不同。而先用清。后用补者。岂以弦为肝火。缓
属脾虚耶。然弦而濡弱。亦宜补不宜清矣。观立斋治马庠生之母。左胛连胁作痛。其脉右关
弦长。按之软弱。左关弦洪。按之涩滞。薛曰。郁怒伤肝脾。六君加芎、归而愈。则弦脉又
不得尽责之肝火也。
王金坛曰。云中秦文山。掌教平湖。每患胁痛。遇劳忍饿则发。以书介家兄来求方。予
以参、 、术、地黄、芎、归、萸肉、枣仁、牛膝、木瓜、石斛、苡仁、柏子仁、桃仁之属
令常服之。后来谢云。自服药后。积久之疾。一朝而愈。不复发矣。闻魏昆溟吏部。亦以
劳饿得胁痛。无大病也。而医者投以枳壳、青皮破气之药。痛愈甚。不数日而殒。予故着之
以为世戒。
一人六月途行。受热。过劳。性又躁暴。忽左胁痛。皮肤上一片红如碗大。发水泡疮三
五点。脉七至而弦。夜重于昼。医作肝经郁火治之。以黄连、青皮、香附、川芎、柴胡之类
进一服。其夜痛极。且憎热。次早视之。皮肤上红大如盘。水泡疮又加至三十余粒。医教
以水调白矾末敷。仍于前药加青黛、龙胆草进之。夜痛益甚。胁中如钩摘之状。次早视之。红
及半身矣。水泡又增至百数。乃求王古潭。为订一方。以大栝蒌一枚。重一二两者。连皮捣
烂。加粉草二钱。红花五分。进药少顷。即得睡。比觉已不痛矣。盖痛势已急。而时医执寻
常泻肝正治之剂。又多苦寒。愈添其燥。故病转增剧。水泡疮发于外者。肝郁既久。不得发
越。乃侮所不胜。故皮腠为之溃也。栝蒌味甘寒。经云。泄其肝者缓其中。且其为物。柔而
滑润。于郁不逆。甘缓润下。又如油之洗物。未尝不洁。此其所以奏效之捷也欤。
震按金坛之妙解。从儒理中流露出来。俗人初见此方。毫不解其何意也。但此方适合此
证耳。后之学人。勿遽执为锦囊秘策。
孙东宿治李悦斋夫人。胸胁大腹作痛。谵语如狂。寅卯辰三时少轻。午后及夜。痛剧咬
人。昼夜不睡。饮食不进者十八日。究其故。原有痰火与头疼牙疼之疾。又因经行三日后。
头疼发寒热。医以疟治。因大恶热。三四人交扇之。而两手浸冷水中。口噙水而不咽。鼻有
微衄。又常自悲自哭。目以多哭而肿。小水直下不固。喉梗梗吞药不下。脉则左弦数。右关
洪滑。孙曰。此热入血室证也。误服刚燥之剂而动痰火。以致标本交作。诸人犹谓热入血室
惟夜间谵语如见鬼。何至胸胁疼剧咬人耶。孙曰。仲景云。经水适来适止得疾。皆作热入
血室治。痛极咬人者。乃胃虚虫行求食而不得。故喉中梗梗然也。即以小柴胡加桃仁、丹皮
而谵语减。次日以安蛔汤与服。而疼止食进。
震按痛极咬人。合以喉中梗梗。认为蛔饥求食。亦属偶然应验。若欲据以辨证。恐不足
凭。
张戴人治疗一位病情危重的患者。患者自述说：“我并没有其他疾病。三年前，在酷暑时节，我在村野间行走，有人送给我煮好的酒。我喝了几升冰镇饮料，随即感到左胁下胀闷，逐渐开始疼痛，结块坚硬如石头，至今没有消散。针灸、按摩和用药，都没有丝毫效果。”张戴人诊察后，发现患者两手脉象都沉实而有力。先用独圣散催吐，一次涌出二三升呕吐物，气味像酒一样，其疼痛随即停止。后来服用调和脾胃的药剂而痊愈。
俞震按语：胁下结块坚硬如石，确实是积块。如果遵循“扶助正气，积块自然消除”的说法，而使用人参、白术等补益药，这与助纣为虐有什么区别呢？幸好遇到戴人，用涌吐法治好了他的重病，这也依赖于脉象沉实有力的诊断。由此可知，善于切脉，就像礼乐与干戈一样，都能平定乱局，达到治理的效果。
虞天民治疗一位四十多岁的患者。因为骑马跌倒，次年左胁胀痛。医生给予小柴胡汤加青皮、龙胆草等药物，无效。诊察其脉象，左手寸、尺两部皆弦数而涩，关脉芤而急数；右手三部脉仅见数而虚。虞天民说：“这明显是死血（瘀血）证。”使用抵当丸一剂，排出黑血约二升。后来用四物汤加减调理，病情安定。
俞震按语：橘泉翁治疗一位八十多岁的老人，左胁剧烈疼痛，肿起如倒扣的杯子，手不能靠近，认为是有瘀血在脾中。而立斋治疗一位右胁胀痛的患者，喜欢用手按压，认为是肝木克制脾土，而脾土不能生肺金。如果有瘀血在内，即使穿单衣也不敢接触皮肤。这些案例可以作为辨证的宏大准则。另外，李士材治疗李明奇，平时身体雄壮，突然左胁痛，手不能靠近，使用左金丸、泻肝汤，过了一个多月，疼痛部位逐渐变大，右胁也痛，无法行动，神情痴呆恍惚，面色黄，两关脉促，认为蓄血已深，非猛烈药剂不能攻下。使用桃仁承气汤，服后未动，再加干漆、生大黄五钱，排出血块十余枚，于是疼痛停止，神志清醒，只见到困倦。先给予独参汤，再用八珍汤调理，三个月康复。这与橘泉翁使用承气汤加当归、芍药、柴胡、黄柏、黄连的方法略有不同。但黄连、黄柏苦寒，为什么瘀血也能下行呢？
薛立斋治疗一位妇人，饮食后因发怒患疟疾，呕吐，使用藿香正气散，两剂而愈。后来再次发怒，痰多，狂言，热势炽盛，胸胁胀痛，手按稍止，脉洪大无比，重按微细。这属于肝脾二经血虚，用加味逍遥散加熟地黄、川芎，两剂后脉证顿退。再用十全大补汤而安。此证如果使用疏通的药剂，就犯了“虚虚”（使虚者更虚）的禁忌了。
俞震按语：薛立斋自己的注释，以及后来王金坛的告诫，是学者应当牢记的。
石山治疗一位客居维扬的患者，患胁痛。医生认为是虚证，用人参羊肉补益，疼痛反而加重。另一位医生投以龙荟丸，疼痛减轻。汪诊察脉象弦濡而弱，说：“脾胃被疼痛所伤，尚未恢复。”于是用橘皮枳术丸加黄连、当归，服用后安定。过了五年，腹胁又痛，他心想大概与前病类似，想服用龙荟丸但未决定。汪诊察后，脉象皆濡弱而缓，说：“前病属实，今病属虚，不是前药可以治疗的。”以人参为君药，川芎、当归、芍药为臣药，香附、陈皮为佐药，甘草、山栀为使药，煎服十余帖，疼痛停止，食欲增进。
俞震按语：这个人的脉象，前后都是濡弱，只有弦与缓不同。而先用清法，后用补法，难道是因为弦脉主肝火，缓脉属脾虚吗？然而弦而濡弱的脉象，也宜补不宜清。看立斋治疗马庠生的母亲，左肩胛连胁作痛，其脉右关弦长，重按软弱，左关弦洪，重按涩滞。薛立斋说：“郁怒伤肝脾”，用六君子汤加川芎、当归而愈。那么弦脉又不能全归咎于肝火。
王金坛说：云中的秦文山，在平湖掌教，经常患胁痛，遇劳累或忍饿则发作。写信介绍给家兄来求方。我给他人参、茯苓、白术、地黄、川芎、当归、山茱萸、枣仁、牛膝、木瓜、石斛、薏苡仁、柏子仁、桃仁之类的药物，让他常服。后来感谢说，自从服药后，积久之疾，一天就好了，不再复发。听说魏昆溟吏部，也是因为劳累饥饿得胁痛，没有大病。但医生投以枳壳、青皮破气的药物，疼痛更加严重，不几天就死亡。我特意记载下来作为世人的警戒。
一人在六月途中行走，受热，过度劳累，性格又急躁暴烈，忽然左胁痛，皮肤上一片红如碗大，发出水泡疮三五个点，脉七至而弦，夜间重于白天。医生当作肝经郁火治疗，用黄连、青皮、香附、川芎、柴胡之类进服一剂，当晚疼痛极度加剧，且憎恶热气。次日早上看，皮肤上红色扩大如盘，水泡疮又增加到三十余粒。医生建议用水调白矾末敷，仍然在前药中加入青黛、龙胆草进服。夜间疼痛更加厉害，胁中如同钩摘之状。次日早上看，红色蔓延到半身，水泡又增加到上百个。于是求王古潭诊治，为他订一方，以大栝蒌一枚，重一二两的，连皮捣烂，加粉草二钱，红花五分，进药片刻，即能入睡，醒来已经不痛了。大概痛势已经紧急，而当时的医生执着于寻常泻肝正治的药剂，又多苦寒，更加增添燥性，所以病情转增剧烈。水泡疮发于外，是因为肝郁已久，不得发越，乃侮所不胜（反克肺金），所以皮腠为之溃烂。栝蒌味甘寒，《内经》说：“泄其肝者缓其中。”而且栝蒌这种药物，柔而滑润，对于郁结不逆，甘缓润下，又如油洗物，未尝不洁净。这就是它奏效迅速的原因吧。
俞震按语：王金坛的精妙解释，是从儒家道理中流露出来的。俗人初见此方，完全不解其含义。但这方子适合这个证候罢了。后来的学者，不要急于把它当作锦囊秘策。
孙东宿治疗李悦斋夫人，胸胁大腹作痛，谵语如狂，寅卯辰三个时辰稍轻，午后及夜间，疼痛剧烈咬人，昼夜不睡，饮食不进十八天。探究其原因，原来有痰火与头疼牙疼的疾病，又因月经行经三天后，头疼发寒热，医生当作疟疾治疗，因为非常厌恶热气，三四人轮流扇风，并将双手浸在冷水中，口中含水而不咽，鼻子有轻微出血，又常常自悲自哭，眼睛因为多哭而肿，小便直下不固，喉咙梗梗吞药不下，脉象则左弦数，右关洪滑。孙东宿说：“这是热入血室证。”误服刚燥的药物而动痰火，以致标本交作。众人还说热入血室只是夜间谵语如见鬼，何至于胸胁疼痛剧烈咬人呢？孙东宿说：“张仲景说，月经适来或适止时得病，都作热入血室治疗。疼痛剧烈咬人，是胃虚虫行求食而不得，所以喉中梗梗然。”即用小柴胡汤加桃仁、丹皮，谵语减少。次日用安蛔汤服用，疼痛停止，食欲增进。
Zhang Dairen treated a patient in critical condition. The patient described: "I have no other illness. Three years ago, during the intense heat of summer, I was walking in the countryside when someone offered me boiled wine. I drank several sheng (a unit of volume) of chilled beverage, and immediately felt stuffiness under the left hypochondrium, which gradually became painful. A mass formed, hard as stone, which has not dissipated to this day. Acupuncture, massage, and medication have yielded no effect." Zhang Dairen examined the patient and found both wrists' pulses to be deep, solid, and forceful. He first administered Dusheng San (Single Sage Powder) to induce vomiting, expelling two or three sheng of vomitus with an odor like wine; the pain ceased immediately. Subsequently, he prescribed formulas to harmonize the spleen and stomach, leading to recovery.
Yu Zhen commented: A mass under the hypochondrium hard as stone is indeed an accumulation (mass). If one were to follow the theory that "tonifying the righteous qi will cause the pathogenic accumulation to eliminate itself," and use tonics such as Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma), how would this differ from assisting a tyrant? Fortunately, Dairen encountered this case and used the emetic method to rescue him from severe illness, relying also on the diagnosis of deep, solid, and forceful pulses. This indicates that proficiency in pulse diagnosis is like having both ritual music and weapons; both can quell chaos and restore order.
Yu Tianmin treated a man over forty years old. After falling from a horse, he suffered distending pain in the left hypochondrium the following year. Physicians prescribed Xiao Chai Hu Tang (Minor Bupleurum Decoction) with added Qingpi (Citri Reticulatae Pericarpium Viride) and Longdancao (Gentianae Radix), but it was ineffective. His pulse was wiry, rapid, and choppy at the cun and chi positions of the left hand, and hollow (kou) with rapid and frequent beats at the guan position; the three positions on the right hand were merely rapid and deficient. Yu stated: "This is clearly a case of fixed blood (stasis)." He administered Didang Wan (Didang Pill) once, resulting in the passage of approximately two sheng of dark blood. Later, he regulated the condition using Siwu Tang (Four Substance Decoction) with modifications, leading to stability.
Yu Zhen commented: Juquan treated an elderly man over eighty with severe left hypochondriac pain and swelling like an inverted cup, intolerable to touch, attributing it to blood stasis in the spleen. Lizaizhi treated a patient with right hypochondriac distending pain relieved by pressure, attributing it to Liver Wood overacting on Spleen Earth, causing Spleen Earth to fail to generate Lung Metal. If there were internal blood stasis, even thin clothing touching the skin would be unbearable. These cases serve as grand principles for syndrome differentiation. Additionally, Li Shicai treated Li Mingqi, who was robust but suddenly developed left hypochondriac pain intolerable to touch. He used Zuojin Wan (Left Metal Pill) and Xie Gan Tang (Drain the Liver Decoction). After more than a month, the painful area enlarged, right hypochondriac pain appeared, mobility ceased, spirit was dull and absent-minded, complexion was yellow, and both guan pulses were hurried. Li attributed this to deep blood retention requiring potent purgatives. He used Tao Ren Cheng Qi Tang (Peach Kernel and Magnolia Bark Decoction); after one dose without effect, he added Ganqi (Drynariae Rhizoma) and raw Dahuang (Rhei Radix et Rhizoma) 5 qian. More than ten blood clumps were passed, pain ceased, and consciousness cleared, leaving only fatigue. He first gave Dushen Tang (Single Ginseng Decoction), then regulated with Bazhen Tang (Eight Treasure Decoction), recovering in three months. This differs slightly from Juquan's use of Cheng Qi Tang plus Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix), Chaihu (Bupleuri Radix), Huangbai (Phellodendri Cortex), and Huanglian (Coptidis Rhizoma). However, since Huanglian and Huangbai are bitter and cold, why did the blood stasis pass?
Xue Lizhi treated a woman who developed malaria and vomiting after anger following meals. She recovered after two doses of Huoxiang Zhengqi San (Agaricus and Patchouli Powder). Later, upon becoming angry again, she produced much phlegm, spoke madly, had intense heat, distending pain in the chest and hypochondrium relieved slightly by pressure, and a pulse that was extremely flooding but fine and subtle upon deep pressure. This belonged to blood deficiency in the Liver and Spleen meridians. He used Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) with Shudi (Rehmanniae Radix Praeparata) and Chuanxiong (Ligustici Chuanxiong Rhizoma). After two doses, the pulse and symptoms subsided significantly. He then used Shiquan Dabu Tang (Ten Significant Tonifying Decoction) to stabilize her. Using draining and unblocking agents in this case would violate the prohibition against "making deficiency more deficient."
Yu Zhen commented: Xue Lizhi's own annotations and Wang Jintan's later warnings are lessons scholars must remember.
Shishan treated a patient residing in Weiyang suffering from hypochondriac pain. Physicians considered it deficiency and tonified with Renshen (Ginseng Radix) and mutton, worsening the pain. Another physician administered Longhui Wan (Longhui Pill), reducing the pain. Wang diagnosed the pulse as wiry, soggy, and weak, stating: "The spleen and stomach are injured by the pain and have not yet recovered." He prescribed Jupi Zhizhu Wan (Tangerine Peel and Atractylodes Pill) with Huanglian (Coptidis Rhizoma) and Danggui (Angelicae Sinensis Radix), leading to stability. Five years later, abdominal and hypochondriac pain recurred. The patient thought it resembled the previous illness and hesitated to take Longhui Wan. Wang diagnosed the pulse as soggy, weak, and slow, stating: "The previous illness was excess; the current illness is deficiency. It cannot be treated with the previous medicine." He used Renshen (Ginseng Radix) as the sovereign herb, Chuanxiong (Ligustici Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), and Shaoyao (Paeoniae Radix) as minister herbs, Xiangfu (Cyperi Rhizoma) and Chenpi (Citri Reticulatae Pericarpium) as assistant herbs, and Gancao (Glycyrrhizae Radix et Rhizoma) and Shanzhi (Gardeniae Fructus) as envoy herbs. After more than ten decoctions, pain ceased and appetite improved.
Yu Zhen commented: This patient's pulse was soggy and weak before and after, differing only in wiry versus slow characteristics. Why use clearing methods first and tonifying methods later? Is it because wiry indicates Liver fire and slow indicates Spleen deficiency? However, a wiry and soggy/weak pulse also suggests tonification is preferable to clearing. Observing Lizhi treating the mother of student Ma Xiang, who had pain from the left scapula connecting to the hypochondrium, with a right guan pulse wiry and long but weak upon pressure, and a left guan pulse wiry and flooding but choppy upon pressure: Xue said, "Depressed anger injures Liver and Spleen," curing her with Liu Jun Zi Tang (Six Gentlemen Decoction) plus Chuanxiong (Ligustici Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix). Thus, a wiry pulse cannot be solely blamed on Liver fire.
Wang Jintan said: Qin Wenshan from Yunzhong, teaching in Pinghu, frequently suffered from hypochondriac pain triggered by labor or hunger. He introduced himself through my elder brother to seek a prescription. I provided him with Renshen (Ginseng Radix), Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma), Dihuang (Rehmanniae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), Yurou (Corni Fructus), Zaoren (Ziziphi Spinosae Semen), Niuxi (Achyranthis Bidentatae Radix), Mugua (Chaenomelis Fructus), Shihu (Dendrobii Caulis), Yiren (Coicis Semen), Baizi Ren (Platycladi Semen), and Taoren (Persicae Semen) for regular consumption. He later thanked me, saying his chronic ailment was cured overnight and did not recur. I heard that Wei Kunming, a ministry official, also suffered hypochondriac pain due to labor and hunger, without serious disease. However, physicians prescribed Qikiao (Magnoliae Officinalis Fructus) and Qingpi (Citri Reticulatae Pericarpium Viride) to break qi, worsening the pain, leading to death within days. I recorded this as a warning to the world.
A person traveling in June suffered heat exposure and overexertion, and being naturally irritable, suddenly developed left hypochondriac pain. A patch of redness the size of a bowl appeared on the skin, along with three or five blister-like sores. The pulse was seven beats per breath and wiry, worse at night than during the day. Physicians treated it as Liver meridian depressed fire, administering Huanglian (Coptidis Rhizoma), Qingpi (Citri Reticulatae Pericarpium Viride), Xiangfu (Cyperi Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Chaihu (Bupleuri Radix). After one dose, the pain intensified severely at night, accompanied by aversion to heat. The next morning, the redness expanded to the size of a plate, and the blisters increased to over thirty. Physicians advised applying alum powder mixed with water externally and adding Qingdai (Indigo Naturalis) and Longdancao (Gentianae Radix) to the internal formula. Nighttime pain worsened, feeling like hooks tearing inside the hypochondrium. The next morning, redness spread to half the body, and blisters numbered over a hundred. They sought Wang Gutan, who prescribed a large Trichosanthes fruit (Gualou) weighing one to two liang, mashed with peel, plus Fugancao (Licorice Root) 2 qian and Honghua (Carthami Flos) 5 fen. Shortly after taking the medicine, the patient slept and woke up pain-free. The pain was urgent, but contemporary doctors adhered to standard liver-draining formulas, mostly bitter and cold, increasing dryness and exacerbating the condition. The external blisters occurred because prolonged Liver depression failed to vent, leading to counter-attack on the conquering element (Metal/Lung), causing skin breakdown. Gualou is sweet and cold; the Classic states, "To drain the Liver, soothe the center." Moreover, Gualou is soft and slippery, non-opposing to depression, sweet-soothing and moistening downward, like oil cleaning objects. This explains its swift efficacy.
Yu Zhen commented: Wang Jintan's brilliant explanation flows from Confucian principles. Laypeople seeing this formula initially understand nothing. But this formula suits this specific syndrome. Scholars should not hastily treat it as a secret strategy.
Sun Dongsu treated Lady Li Yuezhai with pain in the chest, hypochondrium, and abdomen, delirious speech resembling madness, slightly lighter during Yin, Mao, and Chen hours, but severe pain biting people during afternoon and night, sleepless day and night, and no food intake for eighteen days. Investigating the cause, she had pre-existing phlegm-fire, headache, and toothache. After menstruation ended three days prior, she developed headache with chills and fever. Physicians treated it as malaria. Due to extreme aversion to heat, three or four fans fanned her, and she immersed her hands in cold water, holding water in her mouth without swallowing, with slight nasal bleeding. She often wept sadly, eyes swollen from crying, urine flowed uncontrollably, throat felt blocked making swallowing difficult, pulse was wiry and rapid on the left, and flooding and slippery at the right guan. Sun said: "This is Heat Entering the Blood Chamber syndrome." Misuse of drying and warm agents agitated phlegm-fire, causing root and branch manifestations. Others claimed Heat Entering the Blood Chamber only causes nighttime delirium seeing ghosts, not severe hypochondriac pain and biting. Sun said: "Zhang Zhongjing stated that diseases occurring when menstruation begins or stops are all treated as Heat Entering the Blood Chamber. Severe pain and biting indicate Stomach deficiency with worms seeking food but failing, hence the throat blockage." He used Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Taoren (Persicae Semen) and Danpi (Moutan Cortex), reducing delirium. The next day, An Hui Tang (Calming Ascaris Decoction) stopped pain and restored appetite.
Yu Zhen commented: Interpreting severe pain and biting combined with throat blockage as hungry worms seeking food is coincidental. Relying on this for syndrome differentiation is unreliable.