脾宜升则健。胃宜降则和。盖太阴之土。得阳始运。阳明之土。得阴自安。以
脾喜刚燥。胃喜柔润。仲景急下存津。治在胃也。东垣大升阳气。治在脾也今能
食不运。医家悉指脾弱是病。但诊脉较诸冬春。盛大兼弦。据经论病。独大独小。
斯为病脉。脾脏属阴。胃肺属阳。脉见弦大。非脏阴见病之象。久病少餐。犹勉强
支撑。兼以大便窒塞。泄气不爽。坐谈片刻。嗳气频频。平素痔疮肠红。未尝安适。
此脉症全是胃气不降。肠中不通。腑失传导变化之司。古人云。九窍不和。都属
胃病六腑为病以通为补。经年调摄。不越参术桂附。而毫乏应效。不必再进汤
药。议仿丹溪小温中丸。服至七日。俾三阴三阳一周。再议治之。
小温中丸
汤食下咽。嗳噫不已。不饥不食。大便干坚若弹丸。大凡受纳饮食。全在胃
口。已经胃逆为病。加以嗔怒。其肝木之气。贯膈犯胃。斯病加剧。况平昔常似有
形骨梗脉得左部弦实。气郁血结甚肖。进商辛润方法。
桃仁 冬葵子 皂荚核 郁李仁 大黄 降香 郁金
服咸苦入阴。大便仍闭涩。针剌一次。病无增减。可谓沉锢之疾。夫病着深
远。平素饮酒浓味酿湿聚热。渍筋烁骨。既已经年不拔。区区汤液焉能通逐议
以大苦寒坚阴燥湿方法。参入酒醴引导。亦同气相求之至理。
黄柏 茅术 生大黄 干地龙 金毛狗脊 川连 萆 晚蚕砂 穿山甲 汉防已
仙灵脾 海金沙 川独活 北细辛 油松节 白茄根 黄酒烧酒各半浸七日
阳明脉大。环跳尻骨筋掣而痛。痛甚足筋皆缩。大便燥艰常秘。此老年血
枯。内燥风生。由春升上僭。下失滋养。昔喻氏上燥治肺。下燥治肝。盖肝风木横。
胃土必衰。阳明诸脉。不主束筋骨。流利机关也。用微咸微苦。以入阴方法。
鲜生地 阿胶 天冬 人中白 川斛 寒水石
肝血肾液久伤。阳不潜伏。频年不愈。伤延脾腑。由阴干及乎阳。越人且畏。
凡肝体刚。肾恶燥。问大便五六日更衣。小溲时间淋浊。尤非呆滞补涩所宜。
炒杞子 沙苑 天冬 桂拌酒白芍 茯苓 猪脊筋
少腹微胀。小便通利方安。大便三四日一通。而燥坚殊甚。下焦诸病。须推
肝肾。腑络必究幽门二肠。阅所服药。是香砂六君以治脾。不知肾恶燥耳。
当归 苁蓉 郁李仁 冬葵子 牛膝 小茴 茯苓 车前 蜜丸
脾脏的功能特点是宜升发则健运，胃腑的功能特点是宜通降则调和。太阴脾土，得到阳气的温煦才能运化；阳明胃土，得到阴液的滋润才能安宁。因为脾脏喜欢刚燥的性质，而胃腑喜欢柔润的特性。张仲景采用“急下存津”的方法，治疗重点在于胃；李东垣采用大升阳气的方法，治疗重点在于脾。如今患者能够进食但无法运化，医生们都认为是脾虚导致的疾病。但是诊察脉象，比冬季春季的脉象盛大且兼有弦象。依据经典理论判断病症，脉象独大或独小，这才是病脉。脾脏属阴，胃和肺属阳。脉象出现弦大，并不是脏阴出现病变的征象。长期患病进食少，身体还能勉强支撑，加上大便闭塞不通，排气不畅，坐谈片刻后频频嗳气。平素有痔疮和便血的症状，从未感到舒适。这些脉症完全属于胃气不下降，肠道不通畅，六腑失去了传导变化的职能。古人说：“九窍不和，都归属于胃病。”六腑生病以通畅为补益之法。多年来调理摄生，不离用人参、白术、肉桂、附子等药物，却毫无疗效。不必再服用汤药了。建议仿照朱丹溪的小温中丸方剂，服用七天，使三阴三阳之气循环一周，然后再商议治疗方案。
汤药食物咽下后，嗳气不停，没有饥饿感也不进食，大便干硬如同弹丸。大凡受纳饮食，全赖胃口的功能。既然已经发生胃气上逆的病变，再加上恼怒，肝木之气横贯膈部侵犯胃腑，使得病情加剧。况且平素常感觉喉咙里有像骨头梗塞一样的异物感，脉象左手部弦实，气郁血结的情况非常相似。采用辛润的方法进行治疗。
桃仁 冬葵子 皂荚核 郁李仁 大黄 降香 郁金
服用咸苦入阴的药物后，大便仍然闭涩不通。针刺一次，病情没有增减。这可以说是顽固难愈的疾病。病邪潜伏深远，平素饮酒及食用浓味厚腻之物酿生湿热，浸渍筋脉，灼伤骨骼，既然已经多年根深蒂固，区区汤液怎么能通达驱逐呢？建议采用大苦寒坚阴燥湿的方法，参入酒醴作为引导，这也是同气相求的最高道理。
黄柏 茅术（苍术） 生大黄 干地龙 金毛狗脊 川连（黄连） 萆薢 晚蚕砂 穿山甲 汉防己 仙灵脾（淫羊藿） 海金沙 川独活 北细辛 油松节 白茄根 黄酒烧酒各半浸七日
阳明脉大，环跳穴及尻骨部位筋脉牵拉疼痛，痛甚时足部筋脉收缩，大便干燥艰难经常秘结。这是老年人血液枯涸，内燥生风，由春季阳气升发上僭，下部失去滋养所致。过去喻嘉言提出：上燥治肺，下燥治肝。因为肝风木气横逆，胃土必然衰弱，阳明诸脉不能主司束筋骨、流利机关的作用。使用微咸微苦的药物，以入阴分的方法治疗。
鲜生地 阿胶 天冬 人中白 川斛（石斛） 寒水石
肝血肾液长期受损，阳气不能潜伏，多年不愈，病邪延及脾腑，由阴分波及阳分，即使是扁鹊这样的名医也会畏惧。凡是肝脏体性刚强，肾脏厌恶燥邪。询问得知大便五六日才排便一次，小便时常淋浊，尤其不适合使用呆滞的补涩药物。
炒枸杞子 沙苑蒺藜 天冬 桂枝拌酒白芍 茯苓 猪脊筋
少腹部轻微胀满，小便通利后才安适，大便三四日排泄一次，而且干燥坚硬特别严重。下焦的各种疾病，必须推究肝肾，经络必须追究幽门和二肠。阅读所服用的药物，是用香砂六君子汤来治疗脾脏，却不知道肾脏厌恶燥邪的道理。
当归 肉苁蓉 郁李仁 冬葵子 牛膝 小茴香 茯苓 车前子 蜜丸
The Spleen (Pi) functions healthily when its Qi ascends; the Stomach (Wei) harmonizes when its Qi descends. The Earth of Taiyin (Spleen) requires Yang to transform and transport; the Earth of Yangming (Stomach) finds peace through Yin nourishment. This is because the Spleen prefers dryness and firmness, while the Stomach prefers moistness and softness. Zhang Zhongjing's method of "drastic purgation to preserve fluids" targets the Stomach; Li Dongyuan's method of "greatly raising Yang Qi" targets the Spleen. Currently, the patient can eat but fails to digest and transport nutrients. Physicians attribute this to Spleen deficiency. However, upon palpating the pulse, it is fuller and larger than in winter and spring, with a Wiry (Xian) quality. According to classic theory, a pulse that is exclusively large or small indicates pathology. The Spleen belongs to Yin, while the Stomach and Lung belong to Yang. A Wiry and Large pulse is not an image of Zang-Yin pathology. Despite long-term illness and reduced intake, the body sustains itself barely. Accompanied by fecal impaction and difficult passage of gas, frequent belching occurs after sitting and talking for a short time. Historically, the patient has suffered from hemorrhoids and rectal bleeding, never feeling comfortable. These pulse and symptom patterns entirely indicate failure of Stomach Qi to descend and intestinal blockage, causing the Fu organs to lose their function of transmission and transformation. Ancients stated: "Disorder of the nine orifices all belong to Stomach disease." For diseases of the six Fu organs, unobstructed flow is considered tonification. Years of regulation have relied on Ginseng (Renshen), Atractylodes macrocephala (Baizhu), Cinnamon twig (Guizhi), and Aconite (Fuzi), yet yielded no effect. There is no need to continue decoctions. It is proposed to impute Danxi's Xiao Wen Zhong Wan (Small Warm Middle Pill). After seven days of administration, allowing one cycle of the Three Yin and Three Yang channels, further treatment will be discussed.
Xiao Wen Zhong Wan (Small Warm Middle Pill)
After swallowing soup and food, belching continues incessantly. There is no hunger and no desire to eat. Stool is dry and hard like pellets. Generally, receiving and accepting food depends entirely on the Stomach gate. Since Stomach Qi rebellion has occurred as a pathology, compounded by anger, Liver Wood Qi pierces the diaphragm and invades the Stomach, exacerbating the disease. Moreover, the patient often feels a sensation of a bone-like obstruction in the throat. The pulse at the left position is Wiry and Excess, resembling severe Qi stagnation and Blood congealment. Proceed with aromatic-acrid moistening methods.
Peach Kernel (Taoren), Okra Seed (Dongkuizi), Gleditsia Sinensis Pod Core (Zaojiaohe), Apricot Seed (Yuliren), Rhubarb (Dahuang), Rosewood (Jiangxiang), Curcuma aromatica (Yujin)
After administering salty-bitter herbs entering the Yin level, bowel movement remains obstructed. One acupuncture session resulted in no change in the condition. This can be described as a deeply entrenched disease. The pathogen lies deep and distant. Historically, alcohol consumption and rich flavors have brewed damp-heat, soaking sinews and scorching bones. Having been rooted for years, how can simple decoctions clear and expel it? It is proposed to use bitter-cold methods to consolidate Yin and dry Dampness, incorporating wine as a guide, which aligns with the principle of seeking resonance among similar energies.
Phellodendron bark (Huangbai), Atractylodes lancea (Maozhu/Cangzhu), Raw Rhubarb (Sheng Dahuang), Earthworm (Gandi Long), Drynaria fortunei (Jinmao Gouji), Coptis chinensis (Chuanlian), Dioscorea hypoglauca (Bixie), Silkworm frass (Wancansha), Pangolin scales (Chuanshanjia), Stephania tetrandra (Hanfangji), Epimedium (Xianlingpi), Semen Lepidii et Descurainiae (Haijinsha), Angelica dahurica (Chuan Duohuo), Asarum (Bei Xixin), Pine joint (Yousongjie), White Eggplant root (Baiqiegen), Soaked for seven days in half yellow wine and half sorghum liquor.
Yangming pulse is large. Pain and pulling sensations occur in the tendons around the Huantiao acupoint and sacrum. Severe pain causes foot tendons to contract. Stool is dry and difficult, often constipated. This is due to blood depletion in the elderly, generating internal dryness and wind. Rising Yang in spring overacts, failing to nourish the lower parts. Previously, Yu Jia Yan proposed: treat upper dryness via the Lung, lower dryness via the Liver. Because Liver Wind Wood acts horizontally, Stomach Earth must decline. The Yangming vessels fail to bind sinews and bones or facilitate joint movement. Use slightly salty and slightly bitter methods entering the Yin level.
Fresh Rehmannia root (Xian Shengdi), Donkey-hide gelatin (Ejiao), Asparagus tuber (Tiantong), Human tooth ash (Renzhongbai), Dendrobium nobile (Chuanhu), Niter (Hanshuishi)
Liver Blood and Kidney Essence have been damaged for a long time; Yang fails to reside securely. The illness persists for years, extending to the Spleen and Fu organs, affecting Yang from Yin. Even Yue Ren (Bian Que) would fear such cases. The Liver body is rigid; the Kidney detests dryness. Inquiry reveals bowel movements only once every five to six days, and urine is occasionally turbid and painful. Such conditions are unsuitable for stagnant astringent tonics.
Fried Goji berry (Qigouzi), Astragalus complanatus seed (Shayuan), Asparagus tuber (Tiantong), White Peony root soaked in wine with Cinnamon twig (Gui ban jiu Baishao), Poria (Fuling), Pig spinal cord (Zhujijin)
The lower abdomen is slightly distended; comfort is achieved only when urination is smooth. Bowel movements occur every three to four days, yet stool is extremely dry and hard. Diseases of the lower Jiao must be traced to the Liver and Kidneys; meridians must investigate the幽门 (Pylorus) and intestines. Reviewing prescribed medications, Xiang Sha Liu Jun Zi Tang (Aromatic Sand Six Gentlemen Decoction) was used to treat the Spleen, ignoring that the Kidney detests dryness.
Angelica sinensis (Danggui), Cistanche deserticola (Rongshu), Apricot Seed (Yuliren), Okra Seed (Dongkuizi), Achyranthes bidentata (Niuxi), Fennel (Xiaohui), Poria (Fuling), Plantago seed (Cheqian), Honey pills.