东垣治一妇麻木。六脉中俱得弦洪缓相合。按之无力。弦在其上。是风热下陷入阴中。
阳道不行。其证闭目则浑身麻木。昼减夜甚。觉而目开。则麻木渐退。久乃止。惧而不睡。
身体重。时有痰嗽。觉胸中常有痰而不利。时烦躁。气短促而喘。肌肤充盛。饮食二便如常
惟畏麻木不敢合眼为最苦。李曰。麻木为风。皆以为然。然如久坐而起。亦有麻木。喻如
绳缚之人。释之则麻作。良久自已。此非风邪。乃气不行也。经云。阳病 目而动轻。阴病
闭目而静重。灵枢云。开目则阳道行。阳气遍布周身。闭目则阳道闭而不行。如昼夜之分。
以此知其阳衰而阴旺也。时痰嗽者。秋凉在外而湿在上也。身重脉缓者。湿气伏匿于脾也。
时烦躁者。经脉中阴火乘其阳分也。法当升阳助气。益血。微泻阴火。去湿。通行经脉。调
其阴阳则已。非脏腑之本有邪也。黄 五分。人参三分。甘草炙四分。生一分。陈皮归身各
二分。佛耳草四分。白芍三分。草豆蔻、苍术各一分半。白术二分。黄柏酒洗。苓、泽、升
麻各一分。水煎服。八帖而愈。名曰补气升阳和中汤。
一人年七旬。病体热麻。股膝无力。饮食有汗。妄喜笑。善饥。痰涎不利。舌强难言。
声嗄不鸣。李诊脉。左手洪大而有力。是邪热客于经络之中也。二臂外有数瘢。问其故。对
以燃香所致。李曰。君病皆由此也。人身经脉。手之三阳。从手表上行于头。加以火邪。阳
并于阳。势甚炽焉。故邪热妄行。流散于周身而为热麻。热伤元气。则沉重无力。热泄卫气
则多汗。心火盛则妄喜笑。脾胃热则消谷善饥。肺金衰则声不鸣。仲景所谓因火为邪。焦骨
伤筋。血难复也。内经云。热淫所胜。治以苦寒。佐以苦甘。以甘泻之。以酸收之。用黄柏
知母之苦寒为君。以泻火邪。壮筋骨。又肾欲坚。急食苦以坚之。黄 、生甘草之甘寒。
泻热补表。五味子酸。止汗补肺气之不足以为臣。炙草、当归之甘辛。和血润燥。升、柴之
苦平。行少阳阳明二经自地升天。以苦发之者也。以为佐。命其方曰清阳补气汤。又缪刺四
肢。以泻诸阳之本。使十二经络相接而泄火邪。不旬日而愈。
震按东垣论病。悉本内经。简明确切。能发其所以然之故。用药亦本内经。以药性气味
配合脏腑经络。绝无粉饰闲词。而轩岐要旨昭然若揭。诚非挽近可及。第药止一二分至四
五
分。何太少耶。岂以气味配合得当。机灵而径捷耶。后贤常云。愿学仲景。不学东垣。然东
垣以极轻之分两。能愈疑难之久病。亦正易学。
吴茭山治一妇。夏月乘凉。夜多失盖。因得冷风入骨。两足麻木。疼痛不已。服祛风止
痛药。不效。与大防风汤数服。其疾渐轻。仍以乌头粥服三晨而愈。
震按上二案所用诸药。细腻熨贴。此案所用二方。直捷爽快。俱与病情吻合。遂各见其
妙。
李士材治文学陆文湖。两足麻木。自服活血之剂。不效。改服攻痰之剂。又不效。经半
载后。两手亦麻。左胁下有尺许不知痛痒。李曰。此经所谓着痹也。六脉大而无力。气血皆
损。用神效黄 汤。加茯苓、白术、当归、地黄。十剂后。小有效。更用十全大补五十余剂
始安。
少宰蒋恬庵手足麻痹。目中睹一成两。服补血药不应。改服脾药。精神困倦。李诊得寸
口脉大。两尺独涩。此心肾不交。水泛为痰之故也。乃取地黄丸料作煎剂。倍用泽泻、茯苓
入青盐少许。凡六剂。而岐视遂收。乃兼进参、 安神之剂。一月而康复如常。
震按上条气血兼补。原系古人成法。此条用地黄汤。因两尺脉涩。故先补肾。继以参、
。仍是治麻成法。后案张公以参汤下紫雪。则别有洞天矣。由其病根在痰火也。开眼则麻
确是东垣对面文章。讲得最好。
张路玉治洋客巴慈明妇。产后。眩晕心悸。神魂离散。若失脏腑之状。开眼则遍体麻木
如在云雾中。必紧闭其目。似觉稍可。昼日烦躁。夜则安静。专事女科者。用四物等血药
则呕逆不食。更一医用姜、附等热药。则躁扰不宁。其脉虚大而数。按之则散。举之应指
此心火浮散之象。因艰产受惊。痰饮乘虚袭入心包络中。留伏膈上。有入无出。所以绵延
不已。盖目开则诸窍皆开。痰火堵塞心窍。所以神识无主。目闭则诸窍皆闭。痰火潜伏不行
故得稍安。与东垣所言合眼则阳气不行之麻木迥殊。况昼甚夜轻。明是上焦阳位之病。与
理痰清火之剂。诸证渐宁。然或因惊恐。或因饮食。不时举发。此伏匿膈上之痰。无从搜涤
也。乘发时用独参汤下紫雪。开通膈膜。仍与前药调补。半载而康。
震按麻多在于手足者。以四末道远气馁。则卫行迟而难到也。故麻不兼木。必属气虚。
否则风痰。凡脉浮而软。或大而弱者。气虚也。脉浮而滑。按之不衰者。风痰也。若麻木兼
作。则有寒湿积痰死血之殊。其脉有沉迟滑实与沉涩而芤之分矣。宜详辨之。
李东垣治疗一位妇女麻木。六部脉象中均呈现弦、洪、缓相合，重按无力，弦脉位于表层。这是风热之邪下陷于阴分，导致阳气运行受阻。其症状表现为闭眼时全身麻木，白天减轻，夜间加重；醒来睁眼后，麻木逐渐消退，久而久之停止。患者因恐惧而不敢入睡，身体沉重，时常咳嗽有痰，感觉胸中常有痰液阻滞不畅，时而烦躁，气短促且喘息，肌肤丰满，饮食和二便正常。唯独畏惧麻木而不敢闭眼是最痛苦的。李东垣说：麻木属于风邪，大家都认为是这样。然而，就像久坐后起身，也会出现麻木，好比被绳子捆绑的人，解开绳子后麻感发作，过一会儿自然缓解。这并非风邪所致，而是气机运行不畅。《内经》说：阳病睁眼则动而轻，阴病闭目则静而重。《灵枢》说：睁眼则阳气运行，阳气遍布周身；闭目则阳气运行闭塞而不行，如同昼夜之分。由此可知是阳气衰弱而阴气旺盛。时常咳嗽有痰，是因为秋凉在表而湿气在上。身体沉重、脉象缓，是因为湿气潜伏于脾脏。时而烦躁，是因为经脉中的阴火乘袭阳分。治法应当升发阳气、辅助正气、益血、轻微泻除阴火、祛湿、通行经脉，调和阴阳即可。这并不是脏腑本身有邪气。黄芪五分，人参三分，炙甘草四分，生甘草一分，陈皮和当归身各二分，佛耳草四分，白芍三分，草豆蔻和苍术各一分半，白术二分，黄柏酒洗，茯苓、泽泻、升麻各一分，水煎服。服用八帖痊愈。名为补气升阳和中汤。
另一位七十岁的老人，患身体发热、麻木，大腿和膝盖无力，进食时有汗出，无故喜笑，容易饥饿，痰涎不利，舌强难以言语，声音嘶哑不能发声。李东垣诊脉，左手脉洪大有力，这是邪热客居于经络之中。双臂外侧有几处疤痕，询问原因，回答说是由燃香所致。李东垣说：您的病都由此引起。人体的经脉，手三阳经从手部上行至头部，加上火邪，阳气并聚于阳分，势头非常炽盛。所以邪热妄行，流散于周身而表现为热麻。热邪损伤元气，则身体沉重无力；热邪泄耗卫气则多汗；心火旺盛则无故喜笑；脾胃有热则消谷善饥；肺金虚弱则声音不鸣。正如张仲景所说：因火为邪，焦骨伤筋，血液难以恢复。《内经》说：热邪淫胜，用苦寒药治疗，佐以苦甘药，用甘味药泻之，用酸味药收之。用黄柏、知母的苦寒作为君药，以泻火邪，强壮筋骨。又肾欲坚，急食苦以坚之。用黄芪、生甘草的甘寒，泻热补表；五味子的酸味，止汗补肺气之不足，作为臣药。炙甘草、当归的甘辛，和血润燥；升麻、柴胡的苦平，行少阳、阳明二经自地升天，以苦味发散，作为佐药。命名为清阳补气汤。又采用缪刺法针刺四肢，以泻诸阳之本，使十二经络相接而泄火邪，不到十天痊愈。
俞震按语：李东垣论述疾病，完全依据《内经》，简明确切，能阐发病症之所以然的原因。用药也依据《内经》，根据药性气味配合脏腑经络，绝无粉饰闲词，而黄帝岐伯的要旨昭然若揭。确实不是近代医家所能企及的。只是药物剂量只有一二分至四五分，为何这么少呢？难道是因为气味配合得当，药效灵敏而迅速吗？后世贤者常说：愿学张仲景，不学李东垣。然而李东垣用极轻的分两，能治愈疑难的久病，这也正是容易学习的。
吴茭山治疗一位妇女，夏天乘凉，夜里多未盖被子，因此冷风入骨，双脚麻木，疼痛不止。服用祛风止痛药，无效。给予大防风汤数服，病情逐渐减轻，随后仍用乌头粥服用三个早晨而痊愈。
俞震按语：上面两个案例所用的药物，细腻熨贴；此案例所用的两个方剂，直捷爽快，都与病情吻合，各自显现其妙处。
李士材治疗文学陆文湖，双脚麻木，自行服用活血药剂，无效；改服攻痰药剂，又无效。经过半年后，双手也麻木，左胁下有一尺左右的地方不知痛痒。李士材说：这就是《内经》所说的着痹。六部脉象大而无力，气血皆受损。使用神效黄芪汤，加茯苓、白术、当归、地黄。十剂后，略有小效。改用十全大补汤五十余剂才安定。
少宰蒋恬庵手足麻痹，眼中看东西一分为二，服用补血药不应验，改服健脾药，精神困倦。李士材诊得寸口脉大，两尺脉独涩。这是心肾不交，水泛为痰的缘故。于是取地黄丸的药料作煎剂，倍用泽泻、茯苓，加入少许青盐。共六剂，复视遂收。接着兼进人参、远志等安神之剂，一个月康复如常。
俞震按语：上一条气血兼补，原是古人的成法。这一条用地黄汤，因为两尺脉涩，所以先补肾，继用人参、远志，仍是治麻木的成法。后面的案例张公用人参汤送服紫雪，则别有洞天了。因为其病根在痰火。开眼则麻木确实是与东垣的观点相对的文章，讲得最好。
张路玉治疗洋商巴慈明的妻子，产后眩晕心悸，神魂离散，好像失去脏腑的样子，睁眼则遍体麻木如在云雾中，必须紧闭双眼，似乎觉得稍好一些。白天烦躁，夜间则安静。专事妇科的医生，用四物汤等血药，则呕吐逆乱不能进食；换一位医生用姜、附等热药，则躁扰不宁。其脉虚大而数，重按则散，轻举应指，这是心火浮散的征象。因难产受惊，痰饮乘虚袭入心包络中，留伏膈上，有入无出，所以绵延不已。大概睁眼则诸窍皆开，痰火堵塞心窍，所以神识无主；闭目则诸窍皆闭，痰火潜伏不行，所以得以稍安。这与东垣所说的闭眼则阳气不行的麻木截然不同。况且白天重夜间轻，明显是上焦阳位的病。给予理痰清火的药剂，诸证渐宁。然而或因惊恐，或因饮食，不时发作，这是伏匿膈上的痰，无从搜涤清除。趁发作时用独参汤送服紫雪，开通膈膜，仍与前药调补，半年而康。
俞震按语：麻木多在于手足，因为四肢末端距离远，气馁则卫气运行迟缓而难到达。所以麻木不兼木，必属气虚，否则是风痰。凡是脉浮而软，或大而弱的，是气虚。脉浮而滑，重按不衰的，是风痰。如果麻木兼作，则有寒湿、积痰、死血的不同，其脉有沉迟滑实与沉涩而芤的区别。应当详细辨别。
Li Dongyuan treated a woman suffering from numbness. In all six pulse positions, the pulses were combined with Xian (wiry), Hong (surging), and Huan (moderate) qualities, feeling powerless upon deep pressure, with the Xian quality located superficially. This indicates that Wind-Heat pathogen has sunk into the Yin aspect, causing the Yang pathway to fail to circulate. The symptoms manifested as whole-body numbness when closing the eyes, decreasing during the day and worsening at night; upon waking and opening the eyes, the numbness gradually receded and eventually stopped. Fearing this, she dared not sleep. Her body felt heavy, she occasionally had phlegm-cough, feeling phlegm constantly obstructing in the chest without relief, occasional irritability, shortness of breath with panting, skin and flesh appeared full, diet and urination/defecation were normal. Only the fear of numbness preventing her from closing her eyes was the most distressing. Li said: Numbness is attributed to Wind, which everyone agrees with. However, just as one feels numb after sitting for a long time and then standing up, similar to a person bound by ropes where numbness arises upon release and subsides after a while, this is not due to Wind pathogen, but rather Qi failing to circulate. The Classics state: Yang diseases manifest with movement when eyes are open and feel light; Yin diseases manifest with stillness when eyes are closed and feel heavy. The *Ling Shu* states: Opening the eyes allows the Yang pathway to circulate, distributing Yang Qi throughout the body; closing the eyes blocks the Yang pathway, akin to the division between day and night. From this, it can be known that Yang is deficient and Yin is prosperous. Occasional phlegm-cough is due to autumn coolness on the exterior and dampness above. Heavy body and moderate pulse indicate dampness hiding in the Spleen. Occasional irritability indicates Yin Fire attacking the Yang aspect within the meridians. The treatment method should be to raise Yang, assist Qi, nourish Blood, slightly drain Yin Fire, remove dampness, unblock meridians, and harmonize Yin and Yang. This is not due to pathogens originally residing in the Zang-Fu organs. Huangqi (Astragali Radix) 5 fen, Renshen (Ginseng Radix) 3 fen, Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) 4 fen, Shenggancao (Raw Glycyrrhizae Radix et Rhizoma) 1 fen, Chenpi (Citri Reticulatae Pericarpium) and Dangguishen (Angelicae Sinensis Radix) each 2 fen, Erercao (Tussilaginis Flos) 4 fen, Baishao (Paeoniae Radix Alba) 3 fen, Caodoukou (Amomi Fructus Rotundus) and Cangzhu (Atractylodis Rhizoma) each 1.5 fen, Baizhu (Atractylodis Macrocephalae Rhizoma) 2 fen, Huangbai (Phellodendri Cortex) washed with wine, Fuling (Poria), Zexie (Alismatis Rhizoma), and Shengma (Cimicifugae Rhizoma) each 1 fen. Decoct in water and take orally. Cured after eight doses. Named Buqi Shengyang Hezhong Tang (Qi-Supplementing and Yang-Raising Middle-Harmonizing Decoction).
Another patient, seventy years old, suffered from body heat and numbness, weakness in thighs and knees, sweating during meals, irrational laughter, easy hunger, difficult expectoration of saliva/phlegm, stiff tongue making speech difficult, hoarse voice unable to speak. Li diagnosed the pulse: the left hand pulse was Hong (surging) and large yet forceful, indicating Evil Heat lodging within the meridians. There were several scars on the outer sides of both arms. Upon inquiry, he replied they were caused by burning incense. Li said: Your illness stems from this. The human meridians: the three Yang meridians of the hands ascend from the hands to the head. Added with Fire pathogen, Yang merges with Yang, creating an intense momentum. Thus, Evil Heat wanders, scattering throughout the body causing heat-numbness. Heat damages Yuan Qi, leading to heaviness and weakness; Heat leaks Wei Qi, causing excessive sweating; Heart Fire flourishing causes irrational laughter; Stomach/Spleen Heat causes digestion of food and easy hunger; Lung Metal deficiency causes voice loss. As Zhang Zhongjing stated: When Fire becomes pathogenic, it scorches bones and injures sinews, making blood difficult to restore. The *Nei Jing* states: When Heat is excessively prevalent, treat with Bitter-Cold herbs, assist with Bitter-Sweet herbs, use Sweet herbs to drain, and Sour herbs to astringe. Use Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) as the Sovereign herb for their Bitter-Cold nature to drain Fire pathogen and strengthen sinews/bones. Furthermore, the Kidney desires firmness; urgently eat Bitter substances to firm it. Use Huangqi (Astragali Radix) and Shenggancao (Raw Glycyrrhizae Radix et Rhizoma) for their Sweet-Cold nature to drain heat and tonify the exterior; Wuweizi (Schisandrae Fructus) for its Sour nature to stop sweating and tonify Lung Qi deficiency, serving as the Minister herb. Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) and Danggui (Angelicae Sinensis Radix) for their Sweet-Acrid nature to harmonize blood and moisten dryness; Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) for their Bitter-Ping (neutral) nature to move the Shaoyang and Yangming meridians from earth to heaven, using Bitter to disperse, serving as the Assistant herb. Named Qingyang Buqi Tang (Clear-Yang and Tonify-Qi Decoction). Additionally, employed Miao Ci (counter-pricking) acupuncture on the four limbs to drain the root of all Yang meridians, allowing the twelve meridians to connect and drain Fire pathogen. Cured in less than ten days.
Yu Zhen commented: Li Dongyuan’s discussion of diseases is entirely based on the *Nei Jing*, concise and accurate, able to elucidate the underlying causes. His medication also follows the *Nei Jing*, matching drug properties and flavors to Zang-Fu organs and meridians, devoid of embellishments, making the essential principles of Xuanyuan and Qibo clearly evident. Indeed, this is beyond the reach of recent physicians. However, the dosages were only one or two fen to four or five fen; why so small? Is it because the combination of flavors and properties is appropriate, resulting in agile and rapid efficacy? Later scholars often say: I wish to learn from Zhang Zhongjing, not Li Dongyuan. Yet, Li Dongyuan used extremely light dosages to cure difficult chronic illnesses, which is precisely what is easy to learn.
Wu Jiaoshan treated a woman who, in summer, sought coolness and often slept uncovered at night, allowing cold wind to penetrate the bones. She suffered from numbness and unceasing pain in both feet. Taking Wind-dispelling and pain-stopping medicines was ineffective. Prescribed Dafangfeng Tang (Great Wind-Dispersing Decoction) for several doses, the condition gradually lightened. Subsequently, she took Wutou Porridge (Aconite Porridge) for three mornings and was cured.
Yu Zhen commented: The medications used in the previous two cases were delicate and fitting; the two formulas used in this case were direct and straightforward. All matched the disease condition, each revealing its own brilliance.
Li Shicai treated Scholar Lu Wenhu, who suffered from numbness in both feet. Self-medicating with Blood-invigorating agents was ineffective; switching to Phlegm-attacking agents was also ineffective. After half a year, his hands also became numb, and there was a patch about one chi long under the left hypochondrium insensitive to pain and itch. Li said: This is what the Classics call Zhuo Bi (Fixed Bi Syndrome). The six pulses were large yet powerless, indicating damage to both Qi and Blood. Used Shenxiao Huangqi Tang (Miraculous Efficacy Astragalus Decoction), adding Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), and Dihuang (Rehmanniae Radix). After ten doses, slight improvement was seen. Then switched to Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) for over fifty doses before stabilizing.
Shouzai Jiang Tian’an suffered from numbness and paralysis of hands and feet, diplopia (seeing double). Taking Blood-tonifying medicines did not work; switching to Spleen-targeted medicines resulted in mental fatigue. Li diagnosed the Cun Kou pulse as large, while the two Chi pulses alone were Se (choppy). This indicated non-interaction between Heart and Kidney, with Water overflowing to form Phlegm. Thus, he took the ingredients of Dihuang Wan (Rehmannia Pill) as a decoction, doubling the dosage of Zexie (Alismatis Rhizoma) and Fuling (Poria), adding a little Qingyan (Green Salt). After six doses, diplopia resolved. Then, concurrently administered Ren Shen (Ginseng Radix) and Yuan Zhi (Polygalae Radix) etc., Spirit-calming agents. Within one month, he recovered fully.
Yu Zhen commented: The previous case supplemented both Qi and Blood, which is an established ancient method. This case used Dihuang Tang because the Chi pulses were choppy, thus first tonifying the Kidney, followed by Ren Shen and Yuan Zhi, which remains a standard method for treating numbness. In the later case, Master Zhang used Renshen Tang to administer Zixue (Purple Snow), opening a new realm. This is because the root of the disease lay in Phlegm-Fire. "Numbness upon opening eyes" is indeed the counterpart article to Dongyuan’s theory, explained best here.
Zhang Luyu treated the wife of foreign merchant Ba Cimings. Postpartum, she suffered from vertigo and palpitations, soul and spirit scattered, appearing as if losing her Zang-Fu organs. Upon opening her eyes, her whole body felt numb as if in clouds/fog; she had to keep her eyes tightly closed to feel slightly better. She was irritable during the day and quiet at night. A gynecologist used Siwu Tang (Four Substance Decoction) and other Blood medicines, causing vomiting and refusal to eat. Another doctor used Ginger and Aconite (Jiang, Fu) and other hot medicines, causing restlessness and agitation. Her pulse was Xu (empty) and large, rapid, scattering upon deep pressure, but responding to touch upon light pressure. This is a sign of floating and scattering Heart Fire. Due to difficult childbirth and fright, Phlegm-Fluids invaded the Pericardium collateral vacuously, lingering above the diaphragm, entering but not exiting, hence persisting endlessly. Generally, opening eyes opens all orifices; Phlegm-Fire blocks the Heart orifice, causing lack of mental mastery. Closing eyes closes all orifices; Phlegm-Fire lies dormant, hence slight relief. This is distinctly different from Dongyuan’s description of numbness due to Yang Qi failing to circulate when eyes are closed. Moreover, worsening during the day and improving at night clearly indicates a disease in the Upper Jiao Yang position. Prescribed Phlegm-regulating and Fire-clearing agents, symptoms gradually calmed. However, triggered intermittently by fright or diet, this is because the Phlegm lurking above the diaphragm could not be thoroughly scavenged. During attacks, used Dushen Tang (Single Ginseng Decoction) to administer Zixue (Purple Snow) to open the diaphragm membrane, then continued with the previous tonifying medicines. Recovered after half a year.
Yu Zhen commented: Numbness mostly occurs in hands and feet because the extremities are distant; when Qi is deficient, Wei Qi moves slowly and fails to reach them. Therefore, numbness without woodiness (stiffness/heaviness) must belong to Qi deficiency; otherwise, it is Wind-Phlegm. Whenever the pulse is Fu (floating) and soft, or large and weak, it is Qi deficiency. If the pulse is Fu (floating) and Hua (slippery), remaining unchanged upon deep pressure, it is Wind-Phlegm. If numbness and woodiness occur together, there are distinctions among Cold-Dampness, accumulated Phlegm, and dead Blood; their pulses differ between Chen-Chi-Hua-Shi (deep-slow-slippery-solid) and Chen-Se-Kou (deep-choppy-hollow). One should distinguish carefully.