勉强攻胎。气血受伤。而为寒热。经脉乏气。而为身痛。乃奇经冲任受病。而
阳维脉不用事也。内经以阳维为病。苦寒热。维者。一身之网维也。既非外感。羌
苏柴葛三阳之药。及芩栀枳朴之属。辛酸继以苦寒。未能中病。胃口屡伤。致汤
饮皆哕出无余。大便不通。已经半月。其吐出形色青绿涎沫。显然肝风大动。将
胃口翻空。而肠中污水得风。翔如浪决。东西荡漾矣。熄风镇胃。固是定理。但危
笃若。此明理以邀天眷耳。
淮小麦 火麻仁 阿胶 生地 秋石拌人参 南枣肉
未病先有耳鸣眩晕。恰值二气之交。是冬藏根蒂未固。春升之气泄越。无
以制伏。更属产后。精气未复。又自乳耗血。血去液亏。真阴日损。阳气不交于阴。
变化内风。上巅犯窍。冲逆肆横。胃掀吐食。攻肠为泻。袭走脉络。肌肉皆肿。譬如
诸门户尽撤。遂致暴风飘漾之状。医者辛酸苦降重坠。不但病未曾理。致阳更
泄。阴愈涸。烦则震动即厥。由二气不能自主之义。阅王先生安胃一法。最为卓
识。所参拙见。按以两脉。右手涩弱。虚象昭然。左脉空大。按之不实。亦非肝气肝
火有余。皆因气味过辛散越。致二气造偏。兹以病因大旨。兼以经义酌方。
人参 茯苓 半夏 白芍 煨姜 炒粳米
灵枢经云。中气不足。溲便为变。是崩淋泄泻皆脾胃欲败之现症。今汤水
下咽。少顷倾囊涌出。岂非胃阳无有。失司纳物乎。奈何业医者。中怀疑惑。但图
疲药。待其自安。怕遭毁谤耳。此症一投柔药。浊升填塞。必致胀满。仲景于阳明
满实。致慎攻下者。恐以太阴之胀误治耳。今舌微红微渴。皆是津液不肯升扬。
脾弱不主。散精四布。世岂有面色如白纸。尚不以阳气为首重也耶。
人参 熟于术 炙甘草 炮姜 茯神 南枣
凡论病。先论体质形色脉象。以病乃外加于身也。夫肌肉微白属气虚。外
似丰溢。里真大怯。盖阳虚之体。为多湿多痰。肌疏汗淋。唇舌俱白。干呕胸痞。烦
渴引饮。由乎脾胃之阳伤残。邪得僭居于中。留蓄不解。正衰邪炽。试以脉之短
涩无神主义之。阳衰邪伏显然。况寒凉不能攻热。清邪便是伤及胃阳之药。今杳
不纳谷。大便渐涩。若不急和胃气。无成法可遵。所谓攻入之病。虑虚其阳。参拟
一方。仍候明眼采择。
人参 半夏 生于术 枳实 茯苓 生姜
脉濡弱。左胁下久有聚气。纳食酿积于胃脘之中。两三日呕逆吞酸。积物
上涌吐出。此皆怫怒动肝。肝木犯胃。胃中阳伤。不能传及小肠。遂变化失司。每
七八日。始一更衣。为胃气不主下行故也。法当温胃阳制肝逆。宿病久缠。恐多
反复。致成反胃之症。
淡附子 淡干姜 姜汁 生白芍 淡吴萸 白粳米
寒热邪气扰中。胃阳大伤。酸浊上涌吐出。脘痛如剌。无非阳衰阴浊上僭。
致胃气不得下行。高年下元衰惫。必得釜底暖蒸。中宫得以流通。拟用仲景附
子泻心汤。通阳之中。原可泄热开导。煎药按法用之。
人参 熟附子 淡干姜 川连 炒半夏 枳实 茯苓
壮年形伟。脉小濡。恶闻秽气。食入呕哕。缘阳气微弱。浊阴类聚。口鼻受污
浊异气。先入募原。募原是胃络分布。以上逆而为呕吐。此病理标者。用芳香辟
秽扶正气。治本以温上通阳。
藿香 草果 公丁香 茯苓 浓朴 砂仁壳 广皮 荜茇
少腹属肝。肝厥必犯阳明胃腑。故作痛呕。二年来病患已不知因何起病。
医徒见病图治。想肝肾必自内伤为病。久则奇经诸脉交伤。经谓冲脉动。而诸
脉交动也。议温通柔润剂。从下焦虚损主治。
淡苁蓉干 茯苓 当归 杞子 炒沙苑 肉桂心
知饥能纳。忽有气冲。涎沫上涌。脘中格拒。不堪容物。内经谓肝病吐涎沫。
丹溪云。上升之气。自肝而出。木火上凌。柔金受克。咳呛日加。治以养金制木。使
土宫无戕贼之祸。滋水制火。令金脏得清化之权。此皆老年积劳致伤。岂攻病可效。
苏子 麦冬 枇杷叶 杏仁 北沙参 桑叶 丹皮 降香 竹沥
勉强使用攻下法以消除胎结。导致气血受损，从而出现寒热交替的症状；经脉中气机匮乏，从而引起身体疼痛。这是奇经中的冲脉和任脉受到病邪侵袭，而阳维脉未能发挥其维系全身阳气的作用。《内经》指出，阳维脉发病时，患者会苦于寒热症状。“维”字意为网罗维系，指其像网一样维系一身之阳气。既然并非外感邪气所致，那么羌活、紫苏、柴胡、葛根等治疗三阳经的药物，以及黄芩、栀子、枳实、厚朴等苦寒药物，采用先辛散后苦寒的方法，都未能切中病机。这多次损伤了胃气，致使连汤水饮入都会呕吐而出，大便不通已经半个月。吐出物呈青绿色涎沫，显然是肝风大动，将胃气翻空，肠道中的浊液随风而动，如同决堤的波浪般上下激荡。熄风镇胃虽然是常理，但病情危重，只能阐明医理以求上天眷顾罢了。
患者在发病前已有耳鸣眩晕的症状，恰逢冬春二气交接之时，说明冬季封藏的根本未固，春季升发之气泄越，无法被制约伏藏。加之又是产后，精气尚未恢复，又因哺乳耗伤血液，血去则津液亏虚，真阴日益损耗，阳气不能交合于阴，从而化生内风，上冲巅顶侵犯清窍，冲逆横暴，导致胃气上逆呕吐食物，攻冲肠道导致腹泻，流窜脉络，肌肉皆肿胀。这就好比所有的门户都被撤除，遂致暴风飘摇动荡的状态。医生使用辛酸苦降及重坠的药物，不仅病未治愈，反而导致阳气更泄，阴液更枯。烦躁时震动即发生厥逆，这是由于阴阳二气不能自主的缘故。阅读王先生安胃的一法，最为卓越有见识。结合我个人的见解，诊察两脉：右手脉涩弱，虚象明显；左脉空大，按之不实，也并非肝气肝火有余。这都是因为之前用药气味过于辛散，导致阴阳二气偏颇。现在根据病因的大旨，兼以经义斟酌处方。
《灵枢经》说：“中气不足，大小便就会发生变化。”这说明崩漏、淋证、泄泻都是脾胃功能即将败坏的现症表现。如今汤水下咽，不久便倾囊涌出，难道不是胃阳缺失，失去受纳食物的职能吗？奈何行医者心中怀疑困惑，只图用疲软的药，等待其自行安定，害怕遭到毁谤罢了。此症若投用柔润药物，会导致浊气上升填塞，必然导致胀满。张仲景对于阳明腑实满证，谨慎使用攻下法，是担心把太阴病的胀满误治为实证。如今舌质微红微渴，都是津液不肯升扬，脾脏虚弱不能主持散布精微。世上哪有面色如白纸，还不把阳气作为首要重视的呢？
凡是讨论疾病，先论体质、形色、脉象，因为病邪是外加于身体的。肌肉微白属于气虚，外表看似丰满溢美，内在实则非常怯弱。这是阳虚的体质，容易多湿多痰，肌表疏松汗出淋漓，嘴唇和舌头都苍白，干呕胸中痞闷，烦渴引饮，这是由于脾胃阳气伤残，邪气得以僭越居于中焦，留滞积聚不解，正气衰败邪气炽盛。试以脉象短涩无神来确立主旨，阳衰邪伏显然可见。况且寒凉药不能攻清热邪，清解邪气的药往往就是损伤胃阳的药。如今完全不能进食，大便逐渐涩滞，若不紧急调和胃气，就没有现成的成法可以遵循。所谓攻伐入里的病，要顾虑其损伤阳气。参考拟定一方，仍等候高明者采纳选择。
脉象濡弱，左胁下长久有聚积之气，饮食酿积在胃脘之中，两三天出现呕逆吞酸，积滞之物上涌吐出。这都是因为愤怒触动肝气，肝木犯胃，胃中阳气受伤，不能传化至小肠，于是变化失司，每七八天才能排便一次，这是因为胃气不主下行所致。治法应当温补胃阳以制约肝气上逆。宿疾久缠，恐怕多有反复，最终导致反胃症。
寒热邪气扰乱中焦，胃阳大伤，酸浊之气上涌吐出，脘部疼痛如针刺。无非是阳气衰败，阴浊之气上僭，导致胃气不得下行。高龄老人下元衰惫，必须得到釜底加温蒸腾，中宫（脾胃）得以流通。拟用张仲景的附子泻心汤，在通阳的同时，原本就可以泄热开导。煎药按照方法使用。
壮年人形体魁伟，脉象小且濡弱，厌恶闻秽浊之气，食入则呕哕。缘于阳气微弱，浊阴类聚，口鼻受到污浊异气，先侵入募原。募原是胃络分布之处，以上逆而为呕吐。这是病理标症，用芳香辟秽扶正气的办法，治本则以温上通阳为主。
藿香、草果、公丁香、茯苓、浓朴、砂仁壳、广皮（陈皮）、荜茇。
少腹属肝，肝气厥逆必定侵犯阳明胃腑，所以作痛呕吐。两年来病患已不知因何起病，医生徒然见病治病，想肝肾必自内伤为病，久则奇经各脉交相受伤。经文说冲脉气动，则诸脉交动。议定使用温通柔润的药剂，从下焦虚损主治。
淡苁蓉干（肉苁蓉）、茯苓、当归、杞子（枸杞子）、炒沙苑（沙苑子）、肉桂心。
知道饥饿能进食，忽然有气上冲，涎沫上涌，脘中格拒，不堪容纳食物。《内经》说肝病吐涎沫，丹溪说上升之气自肝而出，木火上凌，柔金（肺）受克，咳呛日渐加重。治疗以养金制木，使土宫（脾胃）没有戕贼之祸；滋水制火，令金脏（肺）得清化之权。这些都是老年积劳致伤，岂是攻病可奏效的？
Forcibly using purgatives to eliminate fetal accumulation. This injures Qi and Blood, leading to alternating chills and fever; the meridians lack Qi, resulting in body pain. This is a disease of the Chong (Penetrating) and Ren (Conception) vessels among the Extraordinary Vessels (Extraordinary Meridians), while the Yang Wei Vessel (Yang Linking Vessel) fails to perform its function of linking the Yang meridians. The *Neijing* states that when the Yang Wei Vessel is diseased, the patient suffers from chills and fever. "Wei" means net or link, referring to its role as a net linking the entire body's Yang Qi. Since this is not caused by external pathogens, herbs for the Three Yang meridians such as Qianghuo (Notopterygii Rhizoma et Radix), Zisu (Perillae Folium), Chaihu (Bupleuri Radix), and Gegen (Puerariae Lobatae Radix), as well as bitter-cold herbs like Huangqin (Scutellariae Radix), Zhizi (Gardeniae Fructus), Zhishi (Aurantii Fructus Immaturus), and Houpo (Magnoliae Officinalis Cortex), applied with a sequence of acrid-warm followed by bitter-cold, fail to hit the pathology. These treatments repeatedly injure the Stomach Qi, causing even soups and drinks to be vomited out completely. Constipation has persisted for half a month. The vomitus consists of greenish-yellow phlegm-saliva, clearly indicating vigorous stirring of Liver Wind (Liver Wind Stirring Internally), overturning Stomach Qi, and causing turbid fluids in the intestines to surge like breaking waves. While extinguishing wind and stabilizing the stomach is a standard principle, the condition is critical; one can only clarify the medical reasoning to seek divine favor.
Huaimaixiao (Tritici Levigati Semen), Huomaren (Cannabis Semen), Ejiao (Colla Corii Asini), Shengdi (Rehmanniae Radix Preparata), Renshen (Ginseng Radix et Rhizoma) mixed with Qiushi (Lithii Carbonas), Nanzao Rou (Ziziphi Jujubae Mesocarp).
Before the onset of illness, there was tinnitus and vertigo. Coinciding with the transition between Winter and Spring, it indicates that the root of Winter storage was not solidified, and the ascending Qi of Spring leaked out uncontrollably. Furthermore, being postpartum, Essence and Qi had not recovered, and breastfeeding consumed Blood. Loss of Blood leads to deficiency of Body Fluids, daily depletion of True Yin, and failure of Yang to interact with Yin. This transforms into Internal Wind (Internal Pathogenic Wind), attacking the vertex and orifices, surging recklessly, causing Stomach Qi to rebel and vomit food, attacking the intestines to cause diarrhea, and wandering through collaterals, causing muscle swelling. It is like all gates being removed, leading to a state of violent storm-like tossing. Physicians used acrid-warm, bitter-cold, descending, and heavy-settling drugs. Not only did the illness remain unaddressed, but Yang leaked further and Yin dried up more. Irritation causes tremors and syncope, due to the inability of Yin and Yang Qi to maintain autonomy. Reading Mr. Wang's method for calming the Stomach shows profound insight. Combining this with my own view, examining the pulses: the Right hand pulse is choppy and weak, revealing obvious deficiency; the Left hand pulse is empty and large, feeling insubstantial upon pressure, indicating not excess Liver Qi or Liver Fire. All are due to previous medications having overly acrid and dispersing properties, causing deviation of Yin and Yang Qi. Now, considering the main principles of the etiology and consulting the classics, a prescription is drafted.
Renshen (Ginseng Radix et Rhizoma), Fuling (Poria), Banxia (Pinelliae Rhizoma Preparatum), Baishao (Paeoniae Radix Alba), Weijiang (Zingiberis Rhizoma Preparatum), Chao Jingmi (Mili Semen Preparatum).
The *Lingshu* states: "Deficiency of Middle Qi leads to changes in urination and defecation." This indicates that metrorrhagia, strangury, and diarrhea are manifestations of impending Spleen and Stomach failure. Now, after swallowing liquids, they are vomited out shortly thereafter. Is this not because Stomach Yang is absent, losing its function of receiving and storing? Why do practitioners hesitate, using only mild drugs and waiting for spontaneous recovery, fearing slander? If soft/moistening drugs are administered here, turbidity will rise and block, inevitably causing distension. Zhang Zhongjing was cautious about using purgatives for Yangming fullness and excess, fearing the mismanagement of Taiyin distension. Currently, the tongue is slightly red and dry, indicating that Body Fluids refuse to ascend, and the Spleen is too weak to distribute essence. How can one have a face white as paper and not prioritize Yang Qi?
Renshen (Ginseng Radix et Rhizoma), Shu Yuzhu (Atractylodis Macrocephalae Rhizoma Preparatum), Zhigancao (Glycyrrhizae Radix et Rhizoma Preparatum), Paojiang (Zingiberis Rhizoma Preparatum), Fushen (Poria cum Radice), Nanzao (Ziziphi Jujubae Fructus).
In discussing diseases, one must first discuss constitution, appearance, and pulse, as disease is an external addition to the body. Pale muscles indicate Qi deficiency; although the exterior appears plump, the interior is extremely timid. This is a Yang-deficient constitution, prone to dampness and phlegm, with loose skin and profuse sweating, pale lips and tongue, dry retching, chest stuffiness, irritability, thirst, and desire to drink. This stems from injury to Spleen and Stomach Yang, allowing pathogenic factors to usurp the Middle Jiao, accumulating unresolved. Zheng (Righteous Qi) is weak, and Xie (Pathogenic Qi) is fierce. Examining the short, choppy, and spiritless pulse confirms the theme: Yang decline and pathogen hiding are evident. Moreover, cold-cold drugs cannot attack heat; clearing pathogens often damages Stomach Yang. Now, no food is accepted, and defecation becomes increasingly difficult. Without urgently harmonizing Stomach Qi, there are no established formulas to follow. For diseases entering inward, one must worry about damaging Yang. A tentative formula is proposed, awaiting selection by experts.
Renshen (Ginseng Radix et Rhizoma), Banxia (Pinelliae Rhizoma Preparatum), Sheng Yuzhu (Atractylodis Macrocephalae Rhizoma), Zhishi (Aurantii Fructus Immaturus), Fuling (Poria), Shengjiang (Zingiberis Rhizoma Recens).
The pulse is soggy and weak. There has long been stagnant Qi under the left hypochondrium. Food accumulates in the epigastrium. After two or three days, vomiting, acid regurgitation occur, and accumulated matter surges up and is vomited. This is due to anger stirring Liver Qi, Liver Wood invading the Stomach, injuring Stomach Yang, preventing transmission to the Small Intestine, leading to loss of transformation and transportation. Bowel movements occur only every seven or eight days because Stomach Qi does not govern downward movement. The method should warm Stomach Yang to restrain Liver rebellion. Chronic entanglement may lead to relapses and eventually Fanwei (Regurgitation/Reverse Flow).
Dan Fuzi (Aconiti Lateralis Radix Preparata), Dan Ganjiang (Zingiberis Rhizoma), Jiangzhi (Zingiberis Juice), Sheng Baishao (Paeoniae Radix Alba), Dan Wuyu (Evodiae Fructus), Bai Jingmi (Oryzae Sativum Grain).
Cold-heat pathogens disturb the Middle Jiao, severely injuring Stomach Yang. Sour turbidity surges up and is vomited. Epigastric pain feels like stabbing. This is nothing but Yang decline and Yin turbidity usurping upward, preventing Stomach Qi from descending. In the elderly, the Lower Yuan is exhausted. One must warm the bottom of the cauldron to allow steaming, so the Central Palace (Spleen/Stomach) can circulate. It is proposed to use Zhang Zhongjing's Fuzi Xie Xin Tang (Aconite Decoction for Draining the Epigastrium). In passing Yang, one can originally drain heat and guide it open. Prepare and administer the decoction according to method.
Renshen (Ginseng Radix et Rhizoma), Shu Fuzi (Aconiti Lateralis Radix Preparata), Dan Ganjiang (Zingiberis Rhizoma), Chuanlian (Coptidis Rhizoma), Chao Banxia (Pinelliae Rhizoma Preparatum), Zhishi (Aurantii Fructus Immaturus), Fuling (Poria).
A strong young man with a robust physique has a small, soggy pulse. He dislikes foul odors. After eating, he retches. This is due to weak Yang Qi and aggregation of turbid Yin. The nose and mouth receive foul air, which first enters the Mu Yuan (Defense Origin/Membrane Source). The Mu Yuan is where Stomach collaterals distribute. Upward rebellion causes vomiting. This is a pathological branch symptom. Use aromatic herbs to dispel filth and support Righteous Qi. Treating the root involves warming the Upper Jiao and unblocking Yang.
Huoxiang (Agastaches Herba), Caoguo (Tsao-ko Fructus), Gong Dingxiang (Caryophylli Flos), Fuling (Poria), Nongpu (Magnoliae Officinalis Cortex), ShaRen Qiao (Amomi Fructus Pericarpium), Guangpi (Citri Reticulatae Pericarpium), Bibo (Piperis Longi Fructus).
The lower abdomen belongs to the Liver. Liver Jue (rebellious Qi) must invade the Yangming Stomach Fu organ, causing pain and vomiting. For two years, the patient does not know the origin of the illness. Physicians merely treat symptoms. It is thought that Liver and Kidney must be internally injured. Over time, the various Extraordinary Vessels are jointly damaged. The Classics state: when the Chong vessel moves, all vessels move. It is discussed to use warm-unblocking and moistening agents, treating from the perspective of Lower Jiao deficiency.
Dan Congronggan (Cynomorii Herba), Fuling (Poria), Danggui (Angelicae Sinensis Radix), Qizi (Lycii Fructus), Chao Shayuan (Astragali Complanati Semen), Rouguixin (Cinnamomi Ramulus Medullaris).
Feeling hungry and able to eat, suddenly Qi rushes upward, phlegm-saliva surges, the epigastrium rejects, unable to contain food. The *Neijing* says Liver disease causes vomiting of phlegm-saliva. Danxi said: Ascending Qi originates from the Liver. Wood fire harasses upwards, weakening Metal (Lung), causing worsening cough and wheezing. Treatment nourishes Metal to control Wood, ensuring the Earth Palace (Spleen/Stomach) is not harmed; nourishes Water to control Fire, allowing the Metal Zang (Lung) to obtain clear transformation authority. These are injuries caused by chronic fatigue in the elderly. Can attacking the disease be effective?
Su Zi (Perillae Fructus), Maidong (Ophiopogonis Tuber), Pipaye (Loquat Leaf), Xingren (Armeniacae Semen Amarum), Beishashen (Glehniae Radix), Sangye (Mori Folium), Danpi (Moutan Cortex), Jiangxiang (Aquilariae Lignum Resinatum), Zhuli (Bambusa Textilis Cauteris Succus).