罗谦甫治杨郎中之内。年五十余。体肥盛。春患头目昏闷。面赤热。多服清上药。不效
罗诊其脉洪大而有力。内经云。面热者。足阳明病。脉经云。阳明经气盛有余。则身以前
皆热。况其人素膏粱。积热于胃。阳明多血多气。本实则风热上行。诸阳皆会于头。故面热
之病生矣。先以调胃承气汤七钱。黄连二钱。犀角一钱。疏利三两行。撤其本热。次以升麻
加黄连汤。去经络中风热上行。则标本之病俱退矣。方以升麻、葛根各一钱。白芷七分。甘
草、炙白芍各五分。连、芩酒制各四分。川芎、生犀末各三分。荆芥穗、薄荷叶各二分。水
半盏。先浸川芎、荆芥穗、薄荷。另以水二盏半煎至一盏半。入先浸三味同煎。至一盏。食
后温服。日三服。忌湿面五辛之物。
真定府维摩院僧。年六十余。体瘠弱。初冬。头面不耐寒。气弱不敢当风行。诸法不效
罗诊其脉。弦细而微。且年高常食素茶果。此阳明之经本虚。脉经云。气不足。则身以前
皆寒栗。又加诵经文损气。由此胃气虚。经络之气亦虚。不能上达头面。故大恶风寒。先以
附子理中丸数服。温其中气。次以升麻汤加附子行其经络。方以升麻、葛根各一钱。白芷、
黄各七分。炙甘草、草豆蔻仁、人参各五分。黑附炮七分。益智三分。连须葱白同煎。数
服良愈。或曰。升麻汤加黄连治面热。加附子治面寒。有何根据。答曰。出自仲景。盖诊杨
氏脉阳明标本俱实。宜先攻其里。后泻经络中风热。故升麻汤加黄连。以寒治热也。尼僧阳
明标本俱虚寒。宜先实其里。次行经络。故升麻汤加附子。以热治寒也。仲景群方之祖。信
哉。
震按此二条罗公自注甚明。由其熟读内经。故能切实发挥。下二条讲面黑之理。亦极有
精义。
又治一妇三十余岁。忧思不已。饮食失节。脾胃有伤。面色黧黑不泽。环唇尤甚。心悬
如饥。饥不欲食。气短而促。罗曰。人身心肺在上。行营卫而光泽于外。色宜显而不藏。肾
肝在下。养筋骨而强壮于内。色当隐而不见。又必赖脾胃在中。传化精微。以灌四旁。冲和
而不息。若其气一伤。则四脏失所。今忧思不已。脾胃气结而不行。饮食失节。脾胃气耗而
不足。故使阴气上溢于阳中。而黑色见于面。又经云。脾气通于口。其华在唇。今水反侮土
故黑色见于唇。此阴阳相反。病之逆也。上古天真论云。阳明脉衰于上。面始焦。可知阳
明之气不足。乃用冲和顺气汤。以葛根一钱五分。升麻、防风各一钱。白芷、黄 各八分。
人参七分。甘草四分。白芍、苍术各三分。以姜、枣煎。已午前服。取天气上升之时。使人
之阴气易达也。数服而愈。此阴出乘阳治法也。
有人因灸三里而满面黑气。医皆以为肾气浮面。危候也。有人云。肾经有湿气上蒸于心
心火得湿成烟气。形于面。面属心。心肾之气常相通。如坎之外体即离。离之外体即坎。
心肾未尝相离也。耳属水。其中虚。则有离之象。目属火。其中满。则有坎之象。抑可见矣
以去湿药治之。如五苓散、黄 、防己之类皆可用。
〔附〕兴国初有任氏。色甚美。聘进士王公甫。谓甫不遂寸禄。愁郁不乐。面色渐黑。
自惭而归母家求治。一道人曰。是可疗也。以女真散酒下二钱。日两服。数日间面变微白。
一月如旧。赂得其方。乃黄丹、紫菀。等分为末耳。
震按此因愁郁而致面黑。此方恐未必效。又有触受秽臭面色忽黑者。宜焚沉、檀。却能
着效。
余杭人和 。将赴官。因蒸降真木犀香。自开甑而仆甑面上。为热气所熏。面即浮肿。
口眼皆为之闭。更数医不能治。一医云。古无此证。以意疗之。乃取僧寺久用炊布烧灰存性
随敷而消。未半月愈。盖以炊布受汤上气多。反用以出汤毒。犹以盐水取盐味耳。此心法
之巧也。
震按釜盖气水以治烧酒毒。即同此义。
罗谦甫治疗杨郎中的妻子。她五十多岁，身体肥胖。春季出现头部和眼睛昏沉闷胀，面部发红发热。服用了许多清热上焦的药物，但无效。
罗医生诊察她的脉象，洪大且有力。《内经》说：面部发热，是足阳明经的病证。《脉经》说：阳明经气盛有余，则身体前部都会发热。况且此人平时饮食肥甘厚味，导致胃中积热。阳明经多血多气，原本就实证，风热之邪上行，所有阳经都汇聚于头部，所以产生了面部发热的病症。先用调胃承气汤七钱、黄连二钱、犀角一钱，疏利大便三到四次，撤除根本的热邪。接着用升麻加黄连汤，去除经络中风热上行的病邪，这样标病和本病都退去了。方剂组成：升麻、葛根各一钱，白芷七分，甘草、炙白芍各五分，黄连、黄芩酒制各四分，川芎、生犀角末各三分，荆芥穗、薄荷叶各二分。用水半盏，先浸泡川芎、荆芥穗、薄荷。另外用水二盏半煎煮至一盏半，加入先浸泡的三味药同煎，煮至一盏，饭后温服，每日三次。忌食湿面及五辛之物。
真定府维摩院的僧人，六十多岁，身体瘦弱。初冬时节，头面不耐寒冷，气力虚弱不敢迎风行走。各种治疗方法都无效。
罗医生诊察他的脉象，弦细而微弱。而且他年事已高，常素食茶果，这是阳明经本虚。《脉经》说：气不足，则身体前部都会寒冷战栗。再加上诵念经文耗损元气，由此导致胃气虚，经络之气也虚，不能上达头面，所以非常厌恶风寒。先用附子理中丸服用数次，温补其中气。接着用升麻汤加附子疏通经络。方剂组成：升麻、葛根各一钱，白芷、黄芩各七分，炙甘草、草豆蔻仁、人参各五分，黑附子炮制七分，益智仁三分，连须葱白同煎。服用数次后痊愈。有人问：升麻汤加黄连治疗面部发热，加附子治疗面部发冷，有什么根据？回答说：出自张仲景。因为诊断杨氏患者，阳明标本俱实，适宜先攻里，后泻经络中的风热，所以升麻汤加黄连，以寒治热。尼僧阳明标本俱虚寒，适宜先充实其里，次行经络，所以升麻汤加附子，以热治寒。张仲景是群方之祖，确实可信啊。
俞震按语：这两条罗公自注非常明确，因为他熟读《内经》，所以能切实发挥。下面两条讲述面色发黑的道理，也极有精义。
又治疗一位三十多岁的妇女，忧思不已，饮食失节，脾胃受损，面色黧黑无光泽，嘴唇周围尤其严重。心中空虚像饥饿感，但饿了不想吃东西，气短而急促。罗医生说：人的心肺在上，运行营卫之气而使光泽显现于外，面色应当显露而不隐藏。肝肾在下，滋养筋骨而强壮于内，面色应当隐伏而不见。又必须依赖脾胃在中焦，传化精微物质，以灌溉四旁，冲和而不息。如果脾胃之气受伤，则四脏失去所养。现在忧思不已，导致脾胃气结而不行；饮食失节，导致脾胃气耗而不足。所以使阴气上溢于阳气之中，黑色显现于面部。又《内经》说：脾气通于口，其华在唇。现在水反侮土，所以黑色显现于唇。这是阴阳相反，属于病之逆证。《上古天真论》说：阳明脉衰于上，面部开始憔悴。可知阳明之气不足。于是使用冲和顺气汤，以葛根一钱五分，升麻、防风各一钱，白芷、黄芩各八分，人参七分，甘草四分，白芍、苍术各三分，用生姜、大枣煎煮。已在午前服用，取天气上升之时，使人体的阴气容易通达。服用数次后痊愈。这是阴出乘阳的治疗方法。
有人因灸足三里穴而导致满面黑气，医生们都认为是肾气浮越于面，是危重的征候。有人说：肾经有湿气上蒸于心，心火得湿成为烟气，形状显现于面部。面部属心，心肾之气常相通，如坎卦的外体即是离卦，离卦的外体即是坎卦，心肾未曾分离。耳属水，其中空，则有离卦之象；目属火，其中满，则有坎卦之象。以此可见。用去湿药治疗，如五苓散、黄芩、防己之类都可以使用。
〔附〕兴国初年有位任氏，容貌很美，许配给进士王公甫。认为王公甫未能考取功名，愁郁不乐，面色逐渐变黑。自惭形秽回到娘家求治。一位道士说：这可以治疗。用女真散酒送服二钱，每日两次。几天间面色变得微白，一个月恢复如初。贿赂得到了这个方子，原来是黄丹、紫菀等分为末而已。
俞震按语：这是因为愁郁而导致面色发黑，此方恐怕未必有效。又有因接触秽臭之气而面色突然变黑的，焚烧沉香、檀香却能奏效。
余杭人和某，即将赴任。因蒸煮降真木犀香，自己打开蒸笼时仆倒在蒸笼面上，被热气熏蒸，面部立即浮肿，口眼都因此闭合。更换多位医生无法治愈。一位医生说：古代没有这种病症，凭心意治疗。于是取寺庙久用的炊布烧灰存性，随即敷贴而消退，不到半月痊愈。大概是因为炊布受蒸汽影响多，反过来用以排出汤毒，犹如用盐水提取盐味一样。这是心法的巧妙之处。
俞震按语：用釜盖上的气水来治疗烧酒毒，即与此义相同。
Luo Qianfu treated the wife of Physician Yang. She was over fifty years old, with a robust and obese physique. In spring, she suffered from dizziness and stuffiness in the head and eyes, along with facial redness and heat. She had taken numerous herbs to clear heat from the upper jiao, but to no avail.
Dr. Luo examined her pulse, which was surging (Hong) and forceful. The *Neijing* states: "Facial heat indicates disease of the Foot-Yangming meridian." The *Maijing* states: "When Qi of the Yangming meridian is excessive, the anterior aspect of the body will be hot." Moreover, this person habitually consumed rich and greasy foods, leading to accumulated heat in the Stomach. The Yangming meridian is abundant in blood and Qi; originally presenting as excess syndrome, wind-heat ascended. All Yang meridians converge at the head, thus giving rise to the condition of facial heat. Initially, Tiaowei Chengqi Tang (Regulate the Stomach Purge Decoction) 7 qian, Huanglian (Coptidis Rhizoma) 2 qian, and Xijiao (Rhinocerotis Cornu) 1 qian were administered to promote bowel movements three to four times, thereby withdrawing the root heat. Subsequently, Shengma Jia Huanglian Tang (Cimicifugae Decoction with Added Coptis) was used to dispel wind-heat ascending through the collaterals, resolving both the branch and root conditions. The prescription consisted of Shengma (Cimicifugae Rhizoma) and Gegen (Puerariae Lobatae Radix) each 1 qian, Baizhi (Angelicae Dahuricae Radix) 7 fen, Gancao (Glycyrrhizae Radix et Rhizoma) and Zhi Baishao (Prepared White Peony Root) each 5 fen, Huanglian and Huangqin (Scutellariae Radix) prepared with wine each 4 fen, Chuanxiong (Chuanxiong Rhizoma) and raw Xijiao powder each 3 fen, Jingjiesui (Schizonepetae Spica) and Boheye (Menthae Haplocalycis Folium) each 2 fen. Half zhan of water was used to soak Chuanxiong, Jingjiesui, and Bohe initially. Separately, two and a half zhan of water were boiled down to one and a half zhan, then the pre-soaked three ingredients were added and decocted together until one zhan remained. It was taken warm after meals, three times daily. Wet noodles and pungent spices (Wuxin) were prohibited.
A monk from Weimo Temple in Zhending Prefecture, over sixty years old, was emaciated and weak. In early winter, his head and face could not tolerate cold, and his Qi was too weak to withstand the wind. Various treatments failed.
Dr. Luo examined his pulse, which was wiry (Xian), fine (Xi), and faint (Wei). Furthermore, being elderly and subsisting on vegetarian food, tea, and fruits, indicated deficiency of the Yangming meridian. The *Maijing* states: "When Qi is insufficient, the anterior aspect of the body will feel cold and shiver." Additionally, chanting scriptures depleted his Qi, resulting in deficiency of Stomach Qi and collateral Qi, which could not ascend to the head and face, causing severe aversion to wind and cold. Initially, Fuzi Lizhong Wan (Aconite Pill to Regulate the Middle) was administered several times to warm the middle Qi. Subsequently, Shengma Tang (Cimicifuga Decoction) with added Fuzi (Prepared Aconiti Lateralis Radix) was used to circulate Qi in the collaterals. The prescription consisted of Shengma and Gegen each 1 qian, Baizhi and Huangqin each 7 fen, Zhi Gancao, Caodoukou Ren (Cardamomi Fructus), and Renshen (Ginseng Radix) each 5 fen, Pao Hei Fuzi 7 fen, Yizhi Ren (Alpiniae Oxyphyllae Fructus) 3 fen, and Lianxu Congbai (Scallion White with Roots) decocted together. After several doses, he recovered. Someone asked: "Shengma Tang with Huanglian treats facial heat, while with Fuzi it treats facial cold. What is the basis?" The answer was: "It originates from Zhang Zhongjing. In diagnosing Patient Yang, both the root and branch of Yangming were excess, so it was appropriate to first purge the interior, then drain wind-heat from the collaterals; hence Shengma Tang with Huanglian was used to treat heat with cold. For the nun, both root and branch of Yangming were deficient and cold, so it was appropriate to first tonify the interior, then move the collaterals; hence Shengma Tang with Fuzi was used to treat cold with heat. Zhang Zhongjing is the ancestor of all prescriptions; this is indeed true."
Yu Zhen commented: These two cases are clearly annotated by Dr. Luo himself. Because he was well-versed in the *Neijing*, he could expound upon them effectively. The following two cases discuss the principles of dark complexion, which are also highly profound.
He also treated a woman in her thirties who suffered from incessant worry and thought, irregular diet, and damage to the Spleen and Stomach. Her complexion was dark and lusterless, especially around the lips. She felt a hollow sensation in the heart as if hungry, but did not desire food when hungry. Her breath was short and rapid. Dr. Luo said: "The Heart and Lung are located above, circulating Ying and Wei Qi to manifest luster externally; the complexion should be apparent and not hidden. The Liver and Kidney are located below, nourishing sinews and bones to strengthen internally; the complexion should be concealed and not visible. They must rely on the Spleen and Stomach in the middle to transform and transport essence, irrigating the four peripheries, harmonious and ceaseless. If their Qi is injured, the four Zang organs lose their support. Now, incessant worry causes Spleen-Stomach Qi to knot and stagnate; irregular diet depletes Spleen-Stomach Qi, causing insufficiency. Thus, Yin Qi overflows into Yang, and black color appears on the face. Also, the classics state: 'Spleen Qi connects to the mouth, its brilliance manifests in the lips.' Now Water insults Earth, so black color appears on the lips. This is Yin opposing Yang, an adverse condition. The *Shanggu Tianzhen Lun* states: 'Yangming pulse declines upwards, and the face begins to wither.' This indicates insufficiency of Yangming Qi. Therefore, Chonghe Shunqi Tang (Harmonizing and Regulating Qi Decoction) was used: Gegen 1.5 qian, Shengma and Fangfeng (Saposhnikoviae Radix) each 1 qian, Baizhi and Huangqin each 8 fen, Renshen 7 fen, Gancao 4 fen, Baishao and Cangzhu (Atractylodis Macrocephalae Rhizoma) each 3 fen, decocted with Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus). It was taken before noon, taking advantage of the time when heavenly Qi ascends, facilitating the ascent of the patient's Yin Qi. After several doses, she recovered. This is the method of treating Yin emerging to overwhelm Yang."
Someone developed a dark aura over the entire face after moxibustion on Zusanli (ST36). Physicians considered it floating Kidney Qi on the face, a critical sign. Someone said: "Dampness in the Kidney meridian steams upward to the Heart; Heart Fire combined with dampness becomes smoke vapor, manifesting on the face. The face belongs to the Heart, and Heart and Kidney Qi are constantly connected. The outer form of Kan (Water) is Li (Fire); the outer form of Li is Kan. Heart and Kidney never separate. The ear belongs to Water, and its hollowness presents the image of Li; the eye belongs to Fire, and its fullness presents the image of Kan. This can be seen." Treatment with damp-draining herbs, such as Wuling San (Five-Ingredient Powder with Poria) or Huangqin and Fangji (Stephaniae Tetrandrae Radix), was applicable.
[Appendix] Early in the Xingguo era, there was a woman named Ren, who was very beautiful. She was betrothed to Jinshi Wang Gongfu. Believing that Wang had failed to obtain any official rank, she became depressed and unhappy, and her complexion gradually turned black. Ashamed, she returned to her natal home for treatment. A Daoist priest said: "This can be cured." He prescribed Nüzhen San (Nüzhen Powder) taken with wine, 2 qian per dose, twice daily. Within a few days, her face turned slightly white, and within a month, it returned to normal. Through bribery, the formula was obtained: it was simply Huangdan (Minii Oxidum) and Ziwan (Asturi Radix) ground into equal parts of powder.
Yu Zhen commented: This case resulted in dark complexion due to depression. This formula is unlikely to be effective. There are also cases where sudden exposure to foul odors causes immediate darkening of the face; burning Chenxiang (Aquilariae Lignum Resinatum) and Tanxiang (Santalum Album Lignum) can be effective.
Ren He from Yuhang was about to take up an official post. While steaming Jiangzhen wood and Muxi incense, he accidentally fell forward onto the steamer lid, scalded by the rising steam. His face immediately swelled, and his mouth and eyes closed. Several physicians failed to treat him. One physician said: "There is no such case in ancient texts; I will treat it based on my understanding." He took cloth used for cooking in temples for a long time, burned it to ash retaining its nature, and applied it topically, causing the swelling to subside. He healed within half a month. Presumably, because the cooking cloth absorbed much steam vapor, using it inversely helped expel the steam toxin, similar to using salt water to extract salt flavor. This demonstrates the ingenuity of clinical intuition.
Yu Zhen commented: Using the condensation water from the pot lid to treat burn alcohol toxicity follows the same principle.