日前议用辛润下气以治肺痹。谓上焦不行。则下脘不通。古称痞闷多属
气分之郁也。两番大便。胸次稍舒。而未为全爽。此岂有形之滞。乃气郁必热。陈
腐粘凝胶聚。故脘腹热气下注。隐然微痛。法当用仲景栀子豉汤。解其陈腐郁
热。暮卧另进白金丸一钱。盖热必生痰。气阻痰滞。一汤一丸。以有形无形之各异也。
黑山栀 郁金 香豉 桃仁 杏仁 栝蒌皮 降香 白金丸
面垢油亮。目 黄。头胀如束。胸脘痞闷。此暑湿热气内伏。因劳倦正气泄
越而发。既非暴受风寒。发散取汗。徒伤阳气。按胀形濡涩。岂是表症。凡伤寒必
究六经。伏气须明三焦。论症参脉。壮年已非有余之质。当以劳倦损伤伏邪例延医。
滑石 黄芩 浓朴 醋炒半夏 杏仁 蔻仁 竹叶
因惊而得。邪遂入肝。故厥后热。神色昏狂。诊得面青舌白。微呕渴饮。胸次
按之而痛。此属痞结。乃在里之症。宗仲景以泻心汤为法。
川连 半夏 干姜 黄芩 人参 枳实
疟母用针是泄。肝胆结邪。瘦人疟热伤阴。梦遗五心烦热。亦近理有诸。继
患脘膈痞闷。不饥。大便不爽。食减。乃气滞于上与前病两歧。焉得用滋阴凝滞
之药。思必病后饮食无忌。中焦清浊不和所致。
杏仁 土栝蒌 桔梗 半夏 黑山栀 枳实 香附汁
精气内损。是皆脏病。萸地甘酸。未为背谬。缘清阳先伤于上。柔阴之药。反
碍阳气之旋运。食减中痞。显然明白。病患食姜稍舒者。得辛以助阳之用也。至
于黄 麦冬枣仁。更蒙上焦。斯为背谬。姑议辛甘理阳可效。
桂枝汤去芍加茯苓
日前讨论使用辛润下气的方法以治疗肺痹。认为上焦之气不能宣通，则下脘之气也不通畅。古人称痞闷多属于气分的郁滞。经过两次大便后，胸部稍微舒畅，但并未完全清爽。这哪里是有形的积滞呢？乃是气机郁结必然生热，陈腐粘腻之物胶结凝聚，所以脘腹热气向下灌注，隐隐作痛。治法应当采用张仲景的栀子豉汤（Zhi Zi Chi Tang, Gardenia and Fermented Soybean Decoction），以解除陈腐的郁热。晚上睡觉时另外服用白金丸（Bai Jin Wan, White Gold Pill）一钱。因为热邪必然生痰，气机阻滞导致痰湿停滞，一汤一丸，是根据有形和无形病邪的不同而分别施治。
面色污垢油亮，眼睛发黄，头部胀满如被束紧，胸脘部痞闷。这是暑湿热气内伏，因劳倦导致正气耗散而引发。既然不是突然感受风寒，发散取汗只会徒然损伤阳气。诊察脉象濡涩，难道是表证吗？凡是伤寒必须究查六经，伏气温病须明辨三焦。论述症状需参考脉象，患者正值壮年，已非正气有余之体质。应当按照劳倦损伤、伏邪内发的案例来延医诊治。
面垢油亮，目黄，头胀如束，胸脘痞闷。此乃暑湿热气内伏，因劳倦正气泄越而发。既非暴受风寒，若用发散取汗之法，徒伤阳气。按脉象濡涩，岂是表症？凡伤寒必穷究六经，伏气须明辨三焦。论症参脉，壮年之人已非有余之质。当以劳倦损伤伏邪为例延医。
因惊恐而致病，邪气遂入肝经，故出现厥逆后发热，神色昏狂。诊得面色青、舌色白，轻微呕吐且口渴欲饮，胸部按压疼痛。此属痞结，是在里的病症。遵循张仲景以泻心汤为法。
疟母（Mao Mu, Malaria Mass）用针刺是泄法，针对肝胆结聚之邪。瘦人患疟疾发热伤阴，出现梦遗、五心烦热，这也合乎情理。随后患有脘膈痞闷，不思饮食，大便不爽，食量减少，这是气滞于上与前面的病情两样。怎能使用滋阴凝滞的药物？思考必定是病后饮食无忌，导致中焦清浊不和所致。
精气内损，都是脏腑的疾病。山茱萸、熟地黄味甘酸，并不违背医理。但因为清阳之气先在上部受伤，柔润滋阴的药物反而阻碍阳气的旋转运化。食欲减退、中焦痞塞，显然明白。病人吃姜稍感舒适，是因为得到了辛味以助阳的作用。至于麦冬、枣仁，更蒙蔽上焦，这就违背了医理。暂议用辛甘理阳之法可效。
It was discussed previously to use acrid-moistening and qi-descending methods to treat Fei Bi (Lung Bi, obstruction of the lung). It is believed that if the Qi of the Upper Jiao does not circulate freely, then the Qi of the Lower Stomach will also be obstructed. Ancient texts state that Pi Men (epigastric fullness and stuffiness) mostly belongs to Qi stagnation in the Qi division. After two bowel movements, the chest felt slightly relieved, but not completely refreshed. How could this be a tangible accumulation? It is Qi stagnation which inevitably generates heat; stale, sticky, and gelatinous substances coagulate and gather, causing heat Qi from the epigastrium and abdomen to flow downward, resulting in dull, slight pain. The method should employ Zhang Zhongjing's Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) to resolve the stale stagnant heat. At night before sleep, take one qian of Bai Jin Wan (White Gold Pill). Since heat inevitably generates phlegm, and Qi obstruction leads to phlegm stagnation, the decoction and the pill are used respectively according to the difference between tangible and intangible pathogens.
The face is dirty and oily, eyes are yellow, head feels distended as if bound, and there is epigastric fullness and stuffiness. This is due to latent Summerheat-Damp-Heat Qi, triggered by the leakage of Righteous Qi due to fatigue and overexertion. Since it is not an acute contraction of Wind-Cold, using diaphoresis to induce sweating would merely damage Yang Qi. Palpating the pulse reveals a soggy and choppy quality; how can this be a Exterior syndrome? In all cases of Shang Han (Cold Damage), one must investigate the Six Channels; for Fu Qi (latent pathogenic factors), one must clarify the Three Jiao. Discussing symptoms while referencing the pulse: the patient is in the prime of life and no longer possesses an abundance of Righteous Qi. One should extend medical consultation treating this as a case of injury due to fatigue with latent pathogens.
Due to fright, the pathogen entered the Liver channel, hence after Jue Ni (cold extremities/reversal) comes fever, with confused spirit and maniacal behavior. Diagnosis reveals a greenish complexion and white tongue coating, slight vomiting, thirst with desire to drink, and tenderness upon pressing the chest. This belongs to Pi Jie (stagnant knotting), a Interior syndrome. Following Zhang Zhongjing, the method uses Xie Xin Tang (Drain the Epigastrium Decoction).
Mao Mu (Malaria Mass) treated with acupuncture is a draining method, addressing the knotted pathogenic factors in the Liver and Gallbladder. A thin person suffering from malaria fever damages Yin, leading to nocturnal emission and five-palm heat, which is also reasonable. Subsequently, he suffered from epigastric and diaphragmatic fullness, lack of appetite, unsatisfactory bowel movements, and reduced food intake. This is Qi stagnation in the upper part, differing from the previous illness. How can one use Yin-nourishing and cloying/stagnating medicines? It is thought that undoubtedly, after the illness, there was no restraint in diet, causing the Clear and Turbid Qi in the Middle Jiao to fail to harmonize.
Internal damage to Essence and Qi constitutes diseases of the Zang organs. Shan Zhu Yu (Cornus Fruit) and Di Huang (Rehmannia Root) are sweet and sour, which is not contradictory. However, since the Clear Yang Qi was first injured in the upper part, soft and Yin-nourishing medicines反而 (instead) hinder the rotation and transportation of Yang Qi. Reduced appetite and middle Jiao fullness are obvious. The fact that the patient feels slightly relieved after eating ginger is due to obtaining the function of Acrid flavor to assist Yang. As for Mai Dong (Ophiopogon Root) and Suan Zao Ren (Ziziphus Seed), they further obscure the Upper Jiao, which is indeed contradictory. Tentatively proposing an Acrid-Sweet method to regulate Yang may be effective.