陀 五十九岁 病由情志而伤，中年下焦精气不固，上年露痱中之萌，近因情志重伤，
又在
相火主令，君火司天，君火客气，内与本身君火相火相应，以致肝风鸱张，初起如狂。医者
仍然攻风劫痰，大用辛温刚燥，复以苦寒直下，是助贼为虐也。现下左脉实大坚牢，大非吉
兆，勉以紫雪定螈 肢厥，而泄有余之客热，再以定风珠济不足之真阴，而息内风之震动。
如果病有回机，神色稍清，再拟后法。
紫雪丹（二两，每服二钱，二时许一服，以神清为度。牙关紧闭用乌梅蘸醋擦牙根，其
牙即开）
大生地（一两） 生白芍（一两） 生鳖甲（一两） 炙甘草（六钱） 真阿胶（四钱） 麻仁（
四钱
）麦冬（八钱连心） 左牡蛎（八钱） 蚌水（半酒杯，冷开水冲入） 鸡子黄（二枚，药煮成去
渣和入上火三沸）
煮成三碗，渣再煮两碗，共四碗，四刻服半碗。尽剂再作服。
二十日 左脉仍然牢固，较昨日诸证俱减，舌苔黄黑，尺肤热，阳明络现。昨谓不止本
身虚
热，且有客气加临，非虚语也，汤药仍照前方，再以清宫汤，化牛黄紫雪辈，二时一次。
连翘（三钱，连心） 元参心（五钱） 麦冬（五钱，连心） 莲子心（钱半） 鲜竹叶（三钱
，卷心）
服牛黄丸紫雪丹，即以此汤化服。
二十一日 螈 肢厥虽止，其狂如故，会厌不利，脉仍牢固数大。按∶阳盛并于上则狂
，的
系阳火有余，非极苦之药，直折其上盛之威，其势未必得减。况小肠火腑，非苦不降，痰亦
因之而降，其会厌庶可得利矣。
洋芦荟（三钱） 真雅连（三钱） 龙胆草（三钱） 生白芍（六钱） 知母（六钱） 细生地（
六钱） 丹皮（八钱） 麦冬（八钱） 元参（五钱） 犀角（八钱，先煎代水）
头煎三碗，今日服，二煎两碗，明早服。二帖半。
二十四日 脉气大减，但阳升阴络，机不灵，拟兼清会厌胆络之热。
羚羊角（三钱） 龙胆草（钱半） 知母（三钱） 钩藤（二钱） 连翘（钱半） 桑叶（钱半）
洋芦荟（钱半） 大生地（三钱） 麦冬（三钱，连心）
米醋三杯，每药一茶杯，冲入半酒杯，今晚一帖，明早一贴。
二十五日 于前方内加∶
石膏（二两）
二十六日 稍进糜粥，觉勇力培常，舌红黑，脉亦较昨日实大，犹为阳火有余。
芦荟（四钱） 龙胆草（三钱） 雅连（四钱） 犀角（六钱） 丹皮（五钱） 细生地（四钱）
麦冬（五钱） 知母（五钱） 米醋（每一杯药和入半杯冲）
浓煎三杯，分三次服，渣再煮二杯，明早服。
二十七日 于前方内加∶
铁落（一两代水）
初二日 诸证与脉俱减，然未以净，苦药犹不能除也，颊肿系客气，拟加辛凉。
芦荟（三钱） 龙胆草（三钱） 真犀角（五钱） 丹皮（五钱） 麦冬（六钱，连心） 雅连（
三钱） 知母（三钱） 羚羊角（三钱） 连翘（三钱） 钩藤（三钱） 银花（三钱） 铁落水煎
头煎三杯，二煎三杯，六次服，明日午令尽，间服牛黄紫雪辈，日三次。
初三日 于前方内加∶
生地（八钱）
齐 四十二岁 己巳二月初二日 脉弦数而劲，初因肝郁，久升无降，以致阳并于上则
狂。
心体之虚，以用胜而更虚，心用之强，因体虚而更强。间日举发，气伏最深，已难调治。况
现下卯中乙木盛时，今岁又系风木司天，有木火相煽之象，勉与补心体泻心用两法。
洋参（三钱） 大生地（一两） 莲子心（一钱） 黄柏（三钱） 白芍（六钱） 丹皮（四钱）
麦冬（六钱，连心） 生龟板（一两） 丹参（三钱） 真山连（三钱）
外用 紫雪丹（六钱），每次一钱，与此方间服。
初六日 操持太过，致伤心气之狂疾，前用补心体，泻心用，摄心神，已见大效，脉势
亦减，经谓脉小则病退是也。
洋参（三钱） 白芍（六钱） 丹皮（五钱） 真山连（二钱） 生龟板（一两） 黄柏炭（二钱）
麦冬（三钱） 女贞子（四钱） 莲子（五钱） 龙胆草（二钱） 米醋（一酒杯冲） 铁落水煎
某 二十七日 左脉弦劲，经谓单弦饮癖，前五日因观戏后，病恶梦，病狂肢厥，经谓
阳并
于上则狂，两阴交尽之厥。《灵枢》有淫发梦一卷，大意以五脏偏胜，非因梦而后病也。前
人诸般怪症。皆属于痰之诊。虽不尽然，但此症现下咳嗽块痰，左脉单弦，应作痰治。
半夏（五钱） 丹皮（三钱） 石菖蒲（二钱） 天竺黄（二钱） 茯苓块（五钱） 白附子（二
钱）
先服陈李济牛黄清心丸一二丸，温开水调服。
二十八日 狂而厥，左脉单弦，咳嗽痰块，昨议应作痰治。今日左脉渐有和平之象，证
于外
者亦效，但形貌怯弱，色白而嫩，脉亦不壮，此症之痰，究因惊起，凡神气壮者不惊，况惊
后恶梦发后大汗，其为阳虚神怯显然。此症将来必大补而后收功，现下不得以攻痰见效，而
忘其虚怯，与化痰之中，微加益气。
半夏（五钱） 茯苓块（五钱） 秋小麦（八钱）石菖蒲（一钱） 麦冬（五钱，连心） 大枣（
二枚）
二十九日 体虚有痰之证，不能纯治一边，今日脉微滑数，于昨日法中，少加逐痰。
半夏（五钱） 白附子（二钱） 秋小麦（一合） 陈胆星（一钱） 石菖蒲（钱半） 茯神块（
五钱） 麦冬（三钱，连心）
先服牛黄清心丸半丸。
初一日 昨日稍加逐痰，痰出如许，大势安静，但多怒耳，右脉仍滑，痰未净也。
半夏（六钱） 秋小麦（八钱） 白附子（二钱） 石菖蒲（一钱） 旋复花（三钱） 茯神块（
三钱） 代赭石（五钱， 飞） 炙甘草（一钱）
其后痰去，以大补心脾而安
鲍 三十二岁 十月初二日 大狂七年，先因功名不遂而病，本京先医市医儒医，已历
不少
，既徽州医、杭州医、苏州医、湖北医。所阅之医，不下数百矣，大概补虚者多，攻实者少
。间有已时，不旋踵而发。余初诊时，见其蓬首垢面，下体俱赤，衣不遮身，随作随毁，门
窗分碎，随钉随拆，械系手足，外有铁索数根，锢锁于大石盘上，言语之乱，形体之羸，更
不待言。细询其情，每日非见妇人不可，妇人不愿见，彼尽闹不可，叫号声嘶，衰鸣令人不
可
闻，只得令伊芳姬外家强侍之，然后少安，次日仍然，无一日之空。诊其脉六脉弦长而劲，余曰
∶此实症，非虚症也。于是用极苦以泻心胆二经之火，泻心者必泻小肠，病在脏，治其腑也
，但无出路，亦必泻小肠也。
龙胆草（三钱） 胡黄连（三钱） 天门冬（三钱） 细生地（三钱） 丹皮（三钱） 大麦冬（
三钱，连心）
服二帖而大效，妄语少而举动安静，初三日见其效也。以为久病体虚，恐过刚则折，用
病减
者减其制例，于原方减苦药，加补阴之甘润。初五日，病家来告云，昨服政方二帖，病势大
重，较前之叫哮妄语加数倍之多，无一刻静，此症想不能治，谅其必死，先生可不诊矣。余
曰∶不然，初用重剂而大效，继用轻剂加补阴而大重，吾知进退矣。复诊其脉，弦长而数，
于是重用苦药。
龙胆草（六钱） 洋芦荟（六钱） 天冬（五钱） 麦冬（五钱，连心） 胡黄连（五钱） 秋石
（二钱） 乌梅肉（五钱）
一气六帖，一日较一日大效，至十一日大为明白，于是将其得病之由，因伊芳念头之差，
其念
头之差，因未识文章至高之境，即欲至高，尚有命在，非人力所能为，何怒之有。人生以体
亲心为孝，痛乎责之，俯首无辞，以后渐去苦药加补阴，半月而后，去刑具，着衣冠，同跪
拜，神识与好人无异。服专翕大生膏一料而大壮，下科竟中矣。
章氏 四十二岁 先是二月间病，神识恍惚，误服肉桂、熟地等补药，因而大狂，余于
三月
间用极苦以折其上盛之威，间服芳香开心包，治三十日而愈。但脉仍洪数，余嘱其戒酒肉，
服专翕大生膏，补阴配阳，彼不惟不服丸药，至午节大开酒肉，于是狂不可当，足臭至邻，
不时脱净衣裤，上大街，一二男子不能搏之使回。五月十四日，又延余视，余再用前法随效
，二三日仍然如故，盖少阳相火极，挟制君主行令，药随暂开其闭，暂折其威，相火一动，
而仍然如故。延至六月十六日，午刻复自撕其裤，人不防而出大门矣。余坐视不忍，复自渐
无术以已其病，因谓其胞弟曰∶此症非打之极痛，令其自着衣裤也不可。盖羞恶之心，亦统
于仁，能仁则不忍，忍则不仁，不仁之至，羞恶全丧，打之极痛，则不能忍，不忍而仁心复
，仁心复而羞恶之心亦复矣，此古圣王扑作教刑之义也。伊芳弟见其乃姊如是景况，羞而成怒
，以保父母体面为义，于是以小竹板责其腿，令着裤，彼知痛而后自作衣着衣稍明。次月十
七日立秋，余以大剂苦药，一帖而全愈，盖打之功，与天时秋金之气，药之力，相须而成功
也，后以专翕生生膏而收全功。
陀某，五十九岁。病情由情志内伤所致，中年时下焦精气不固，去年已有中风（露痱）的萌芽迹象，近期因情志严重受创，又逢相火主令、君火司天之时，外界的君火客气与体内的君火、相火相互感应，导致肝风亢盛，起初表现为类似发狂的症状。医生仍然采用祛风化痰的方法，大量使用辛温刚燥的药物，随后又用苦寒药物直攻下行，这是助长病邪为虐。目前左脉实大坚牢，绝非吉兆，暂以紫雪丹来定惊止痉、缓解四肢厥冷，并泄去有余的客热；再用大定风珠来滋补不足的真阴，平息内风的震动。如果病情有转机，神色稍见清醒，再拟定后续治法。
紫雪丹（二两，每次服用二钱，约两个时辰服一次，以神志清醒为度。若牙关紧闭，用乌梅蘸醋擦拭牙根，牙齿即可张开）
大生地（一两） 生白芍（一两） 生鳖甲（一两） 炙甘草（六钱） 真阿胶（四钱） 麻仁（四钱） 麦冬（八钱，保留心） 左牡蛎（八钱） 蚌水（半酒杯，用冷开水冲入） 鸡子黄（二枚，药煮好后去渣，加入药液中上火煮沸三次）
煮成三碗，药渣再煮两碗，共四碗，每刻钟服用半碗。服完一剂后再行配制服用。
二十日，左脉仍然牢固，但比昨日所有症状都减轻，舌苔黄黑，尺部皮肤发热，阳明经络显现。昨天说不仅是本身体虚有热，还有客气加临，并非虚言，汤药仍照前方，再加用清宫汤，配合化开牛黄丸、紫雪丹等药，每两个时辰服用一次。
连翘（三钱，保留心） 元参心（五钱） 麦冬（五钱，保留心） 莲子心（一钱半） 鲜竹叶（三钱，保留卷心）
服用牛黄丸、紫雪丹时，以此汤药化开服下。
二十一日，抽搐和四肢厥冷虽然停止，但发狂如故，会厌部位不利，脉象仍然牢固且数大。分析：阳气盛并于上部则发狂，这确实是阳火有余，不用极苦的药物直接折减其上部旺盛的势头，病情未必能减轻。况且小肠作为火腑，非苦味不能降泄，痰浊也随之下降，这样会厌部位才能通畅。
洋芦荟（三钱） 真雅连（三钱） 龙胆草（三钱） 生白芍（六钱） 知母（六钱） 细生地（六钱） 丹皮（八钱） 麦冬（八钱） 元参（五钱） 犀角（八钱，先煎代水）
头煎三碗，今日服用；二煎两碗，明早服用。共两帖半。
二十四日，脉气大幅减弱，但阳气上升而阴络不畅，气机不灵，拟兼清会厌和胆络的热邪。
羚羊角（三钱） 龙胆草（一钱半） 知母（三钱） 钩藤（二钱） 连翘（一钱半） 桑叶（一钱半） 洋芦荟（一钱半） 大生地（三钱） 麦冬（三钱，保留心）
米醋三杯，每种药取一茶杯的量，冲入半酒杯，今晚一帖，明早一帖。
二十五日，在前方中加入：
石膏（二两）
二十六日，稍微进食糜粥，感觉体力逐渐恢复常态，舌色红黑，脉象也比昨日实大，仍然是阳火有余。
芦荟（四钱） 龙胆草（三钱） 雅连（四钱） 犀角（六钱） 丹皮（五钱） 细生地（四钱） 麦冬（五钱） 知母（五钱） 米醋（每一杯药液和入半杯冲服）
浓煎三杯，分三次服用，药渣再煮二杯，明早服用。
二十七日，在前方中加入：
铁落（一两，代水煎）
初二日，各种症状和脉象都减轻，但尚未痊愈，苦寒药还不能完全去除病邪，脸颊肿胀属于客气所致，拟加入辛凉药物。
芦荟（三钱） 龙胆草（三钱） 真犀角（五钱） 丹皮（五钱） 麦冬（六钱，保留心） 雅连（三钱） 知母（三钱） 羚羊角（三钱） 连翘（三钱） 钩藤（三钱） 银花（三钱） 铁落水煎
头煎三杯，二煎三杯，分六次服用，明日午时服完，间歇服用牛黄丸、紫雪丹等，每日三次。
初三日，在前方中加入：
生地（八钱）
齐某，四十二岁。己巳年二月初二日诊。脉弦数而劲急，起初因肝气郁结，长期只升不降，导致阳气并于上部而发狂。
心脏本体虚弱，因功能过亢而更加虚弱；心脏功能强盛，因本体虚弱而更加亢盛。每隔一日发作，气伏藏最深，已经难以调治。况且现在正值卯时乙木旺盛之时，今年又是风木司天，有木火相煽之象，勉强采用补心体、泻心用的两种方法。
洋参（三钱） 大生地（一两） 莲子心（一钱） 黄柏（三钱） 白芍（六钱） 丹皮（四钱） 麦冬（六钱，保留心） 生龟板（一两） 丹参（三钱） 真山连（三钱）
外用紫雪丹（六钱），每次一钱，与此方交替服用。
初六日，操劳过度，导致伤心气而发狂疾，前用补心体、泻心用、摄心神的方法，已见大效，脉势也减轻，经书说“脉小则病退”正是此理。
洋参（三钱） 白芍（六钱） 丹皮（五钱） 真山连（二钱） 生龟板（一两） 黄柏炭（二钱） 麦冬（三钱） 女贞子（四钱） 莲子（五钱） 龙胆草（二钱） 米醋（一酒杯冲服） 铁落水煎
某人，二十七岁。左脉弦劲，经书说“单弦脉主饮癖”，前五日因看戏后，出现噩梦、发狂、四肢厥冷的症状，经书说“阳气并于上部则发狂”，这是两阴交尽的厥证。《灵枢》中有论述淫邪发梦的篇章，大意是说五脏偏胜，并非因为做梦才生病。前人对于各种怪症，多诊断为属于痰。虽然不全是这样，但此症现下咳嗽有块状痰，左脉单弦，应当按痰证治疗。
半夏（五钱） 丹皮（三钱） 石菖蒲（二钱） 天竺黄（二钱） 茯苓块（五钱） 白附子（二钱）
先服用陈李济牛黄清心丸一二丸，用温开水调服。
二十八日，发狂伴厥逆，左脉单弦，咳嗽有块状痰，昨天讨论认为应按痰证治疗。今天左脉渐有平和之象，外在症状也有效，但形体貌相怯弱，面色白嫩，脉象也不壮实，此症的痰，终究是因为惊吓而起，凡是神气壮实的人不会受惊，何况受惊后做恶梦，发作后大汗淋漓，其为阳虚神怯是显而易见的。此症将来必须大补才能收功，现在不能因为攻痰见效，就忘记其虚怯的本质，在化痰之中，微微加入益气之法。
半夏（五钱） 茯苓块（五钱） 秋小麦（八钱） 石菖蒲（一钱） 麦冬（五钱，保留心） 大枣（二枚）
二十九日，体虚有痰的证候，不能单纯治疗一边，今天脉微滑数，在昨日治法中，稍微增加逐痰之力。
半夏（五钱） 白附子（二钱） 秋小麦（一合） 陈胆星（一钱） 石菖蒲（一钱半） 茯神块（五钱） 麦冬（三钱，保留心）
先服用牛黄清心丸半丸。
初一日，昨天稍微增加逐痰，痰排出很多，大势已安静，只是容易发怒，右脉仍滑，说明痰未净尽。
半夏（六钱） 秋小麦（八钱） 白附子（二钱） 石菖蒲（一钱） 旋复花（三钱） 茯神块（三钱） 代赭石（五钱，飞研） 炙甘草（一钱）
其后痰去，以大补心脾来安神。
鲍某，三十二岁。十月初二日诊。患大狂七年，起初因功名不成而致病，本京的先医、市医、儒医，已经看过不少，既有徽州医、杭州医、苏州医、湖北医。所就诊的医生，不下数百人，大概补虚的多，攻实的少。偶尔有暂时好转，不久又复发。我初诊时，见他蓬头垢面，下半身通红，衣服遮不住身体，所作所为随即毁坏，门窗打碎，刚钉好又拆掉，手脚被械系住，外面还有几根铁索，禁锢锁在大石盘上，言语混乱，形体羸弱，更不必说。仔细询问情况，每天不见妇人不可，妇人不愿见，他便吵闹不休，叫号声嘶力竭，哀鸣令人不忍听闻，只得让他的姬妾或外家强行侍奉，然后稍安，次日依然如此，没有一天空闲。诊其脉六脉弦长而劲急，我说：这是实证，不是虚证。于是用极苦的药物来泻心胆二经的火，泻心者必泻小肠，病在脏，治其腑，但若无出路，也必须泻小肠。
龙胆草（三钱） 胡黄连（三钱） 天门冬（三钱） 细生地（三钱） 丹皮（三钱） 大麦冬（三钱，保留心）
服用两帖后大效，妄语减少，举动安静，初三日见到疗效。以为久病体虚，恐过刚则折，用病减者减其制例，在原方中减去苦药，加入补阴的甘润药物。初五日，病家来告说，昨天服用正方的两帖，病势大重，比以前叫哮妄语加重数倍之多，无一刻安静，此症恐怕不能治，料想必死，先生可以不诊了。我说：不然，初用重剂而大效，继用轻剂加补阴而大重，我知道进退之道了。复诊其脉，弦长而数，于是重用苦药。
龙胆草（六钱） 洋芦荟（六钱） 天冬（五钱） 麦冬（五钱，保留心） 胡黄连（五钱） 秋石（二钱） 乌梅肉（五钱）
连续服用六帖，一天比一天大效，到十一日大为明白，于是将得病的缘由告诉他，因其念头偏差，其念头偏差，是因为未识文章至高之境，即使想要达到至高，尚有性命在，非人力所能为，有什么可怒的？人生以体谅父母之心为孝，痛斥责备他，他俯首无辞，以后渐渐去掉苦药加入补阴，半月后，去掉刑具，穿衣冠，一同跪拜，神识与好人无异。服用专翕大生膏一料而身体大壮，下场考试竟考中了。
章氏，四十二岁。先前二月间发病，神识恍惚，误服肉桂、熟地等补药，因而大狂，我在三月间用极苦药物折减其上盛之势，间服芳香开心包络之药，治疗三十日而愈。但脉仍洪数，嘱咐其戒酒肉，服用专翕大生膏，补阴配阳，他不但不吃丸药，至端午节大开酒肉，于是狂势不可抵挡，脚臭传到邻居处，不时脱光衣裤，上大街，一两个男子不能将其拉回。五月十四日，又请我去诊治，我再沿用前法，随即见效，但二三日后又如故，盖因少阳相火极盛，挟制君主行令，药物暂时打开闭塞，暂时折减其威势，相火一动，便又如故。延至六月十六日，午时他又自己撕毁裤子，人没防备而出大门了。我坐视不忍，又自感无术以止其病，便对其胞弟说：此症非打得极痛，让他自己穿衣服裤子不可。羞恶之心，也统归于仁，能仁则不忍，忍则不仁，不仁之至，羞恶全丧，打得极痛，则不能忍，不忍而仁心复归，仁心复归而羞恶之心也复归了，这是古圣王扑作教刑的意义。他弟弟见其姐姐如此景况，羞而成怒，以保全父母体面为义，于是用小竹板责打其腿部，令其穿裤子，他知道痛后便自己穿衣稍显明白。次月十七日立秋，我用大剂苦药，一帖而全愈，盖打之功，与天时秋金之气，药之力，相辅相成而成功，后以专翕生生膏而收全功。
Tuo, aged 59. The illness originated from emotional injury (injury due to emotional factors). In middle age, the essence and qi of the Lower Jiao (Lower Burner) were not secure. Last year, there were early signs of stroke (loose flaccidity). Recently, due to severe emotional trauma, combined with the period when Ministerial Fire (Xiang Huo) governed and Sovereign Fire (Jun Huo) presided over the Heaven (atmospheric influence), the external Sovereign Fire Qi interacted with the internal Sovereign Fire and Ministerial Fire, causing Liver Wind to surge wildly, initially presenting as mania-like symptoms. The physicians still employed methods to dispel wind and劫痰 (attack phlegm), using large doses of acrid-warm and rigid-dry herbs, followed by bitter-cold purgatives attacking directly downward. This is assisting the thief (pathogen) in its cruelty. Currently, the left pulse is solid, large, firm, and unyielding, which is far from an auspicious sign. Tentatively, Zixue Dan (Purple Snow Pill) is used to calm convulsions and treat limb coldness (Jue), while draining the excess external heat; then, Dafeng Zhu (Great Wind-Calming Pearl) is used to nourish the deficient True Yin and extinguish the trembling of internal wind. If the disease shows signs of recovery and the spirit/color becomes slightly clear, subsequent methods will be formulated.
Zixue Dan (2 liang, take 2 qian per dose, one dose every two hours, until the spirit clears. If the jaw is clenched, use a sour plum dipped in vinegar to rub the gum roots, and the jaw will open.)
Sheng Di Huang (Rehmanniae Radix Preparata) - 1 liang
Sheng Bai Shao (Paeoniae Radix Alba) - 1 liang
Sheng Bie Jia (Testudinis et Carapacis Carapax et Plastrum) - 1 liang
Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) - 6 qian
Zhen E Jiao (Asini Corii Colla) - 4 qian
Ma Ren (Semen Cannabis) - 4 qian
Mai Dong (Ophiopogonis Tuber) - 8 qian (retain Xin/heart)
Zuo Mu Li (Ostreae Concha) - 8 qian
Bang Shui (Clam Water) - half wine cup, mixed with cold boiled water
Ji Zi Huang (Ovi Galli Albumen) - 2 pieces, added after decoction is strained and boiled for three more boils on fire.
Decoct into three bowls, decoct the dregs again into two bowls, totaling four bowls. Take half a bowl every quarter hour (Ke). Finish one prescription before preparing another.
20th Day: The left pulse remains firm, but all symptoms are reduced compared to yesterday. The tongue coating is yellow-black, the skin at the Chi position (wrist) is hot, and the Yangming collaterals are visible. Yesterday I said it was not only deficiency-heat within the body but also the addition of external pathogenic Qi, which was not empty talk. Decoction follows the previous formula, plus Qinggong Tang (Palace-Clearing Decoction), mixed with Niu Huang Wan (Calculus Bovis Pill) and Zixue Dan, taken once every two hours.
Lian Qiao (Forsythiae Fructus) - 3 qian (retain Xin/heart)
Yuan Shen Xin (Scrophulariae Radix Xin) - 5 qian
Mai Dong (Ophiopogonis Tuber) - 5 qian (retain Xin/heart)
Lian Zi Xin (Nelumbinis Plumula) - 1.5 qian
Xian Zhu Ye (Bambusae Folium Frescum) - 3 qian (retain Juanxin/coiled heart)
Take Niu Huang Wan and Zixue Dan, dissolved and taken with this decoction.
21st Day: Convulsions and limb coldness have stopped, but mania persists. The epiglottis is obstructed, and the pulse remains firm, rapid, and large. Analysis: When Yang excels and merges upward, mania occurs. This is indeed excessive Yang-Fire. Without extremely bitter herbs to directly suppress its overwhelming upper-sheng (rising) momentum, the condition may not subside. Moreover, the Small Intestine, as a Fire Fu organ, requires bitter flavors to descend; phlegm will also descend with it, allowing the epiglottis to become patent.
Yang Lu Hui (Aloe) - 3 qian
Zhen Ya Lian (Coptidis Rhizoma - Ya variety) - 3 qian
Long Dan Cao (Gentianae Radix) - 3 qian
Sheng Bai Shao (Paeoniae Radix Alba) - 6 qian
Zhi Mu (Anemarrhenae Rhizoma) - 6 qian
Xi Sheng Di Huang (Rehmanniae Radix) - 6 qian
Dan Pi (Moutan Cortex) - 8 qian
Mai Dong (Ophiopogonis Tuber) - 8 qian
Yuan Shen (Scrophulariae Radix) - 5 qian
Xi Jiao (Rhinocerotis Cornu) - 8 qian (decoct first to replace water)
First decoction: 3 bowls, take today. Second decoction: 2 bowls, take tomorrow morning. Total 2.5 prescriptions.
24th Day: Pulse energy has significantly decreased, but Yang rises while Yin collaterals are stagnant, and the mechanism is not agile. Plan to simultaneously clear heat from the epiglottis and Gallbladder collaterals.
Ling Yang Jiao (Capricornis Cornu) - 3 qian
Long Dan Cao (Gentianae Radix) - 1.5 qian
Zhi Mu (Anemarrhenae Rhizoma) - 3 qian
Gou Teng (Uncariae Ramulus cum Uncis) - 2 qian
Lian Qiao (Forsythiae Fructus) - 1.5 qian
Sang Ye (Mori Folium) - 1.5 qian
Yang Lu Hui (Aloe) - 1.5 qian
Da Sheng Di Huang (Rehmanniae Radix Preparata) - 3 qian
Mai Dong (Ophiopogonis Tuber) - 3 qian (retain Xin/heart)
Three cups of rice vinegar. For each herb, take one tea cup amount, mix with half a wine cup. One prescription tonight, one tomorrow morning.
25th Day: Add to the previous formula:
Shi Gao (Gypsum Fibrosum) - 2 liang
26th Day: Slightly advanced to consuming porridge, feeling strength returning to normal. Tongue is red-black, pulse is larger and more substantial than yesterday, indicating still excessive Yang-Fire.
Lu Hui (Aloe) - 4 qian
Long Dan Cao (Gentianae Radix) - 3 qian
Ya Lian (Coptidis Rhizoma) - 4 qian
Xi Jiao (Rhinocerotis Cornu) - 6 qian
Dan Pi (Moutan Cortex) - 5 qian
Xi Sheng Di Huang (Rehmanniae Radix) - 4 qian
Mai Dong (Ophiopogonis Tuber) - 5 qian
Zhi Mu (Anemarrhenae Rhizoma) - 5 qian
Mi Cu (Vinegar) - Mix half cup into every cup of decoction.
Concentrated decoction into three cups, divide into three doses. Dregs decocted into two cups, take tomorrow morning.
27th Day: Add to the previous formula:
Tie Luo (Ferrum Limatura) - 1 liang (decoct to replace water)
2nd Day (Next Month): All symptoms and pulse have decreased, but not yet clean. Bitter herbs cannot remove it completely. Cheek swelling is due to external Qi; plan to add acrid-cool herbs.
Lu Hui (Aloe) - 3 qian
Long Dan Cao (Gentianae Radix) - 3 qian
Zhen Xi Jiao (Rhinocerotis Cornu) - 5 qian
Dan Pi (Moutan Cortex) - 5 qian
Mai Dong (Ophiopogonis Tuber) - 6 qian (retain Xin/heart)
Ya Lian (Coptidis Rhizoma) - 3 qian
Zhi Mu (Anemarrhenae Rhizoma) - 3 qian
Ling Yang Jiao (Capricornis Cornu) - 3 qian
Lian Qiao (Forsythiae Fructus) - 3 qian
Gou Teng (Uncariae Ramulus cum Uncis) - 3 qian
Yin Hua (Lonicerae Japonicae Flos) - 3 qian
Decoct Tie Luo water. First decoction 3 cups, second 3 cups. Take six times. Finish by noon tomorrow. Intermittently take Niu Huang Wan and Zixue Dan, three times daily.
3rd Day: Add to the previous formula:
Sheng Di Huang (Rehmanniae Radix Preparata) - 8 qian
Qi, aged 42. Diagnosed on the 2nd day of the 2nd lunar month in the Ji-Si year. Pulse is wiry, rapid, and forceful. Initially due to Liver Qi stagnation, rising without descending for a long time, leading to Yang merging upward causing mania.
The substance of the Heart is deficient; due to hyperactive function, it becomes even more deficient. The function of the Heart is strong; due to deficient substance, it becomes even stronger. Attacks occur every other day, with Qi buried deepest, making treatment difficult. Moreover, now is the Mao hour when Yi-Wood (Liver) is prosperous, and this year is Wood governing Heaven, showing signs of Wood and Fire fanning each other. Tentatively apply both tonifying Heart Substance and draining Heart Function methods.
Yang Shen (Panacis Quinquefolii Radix) - 3 qian
Da Sheng Di Huang (Rehmanniae Radix Preparata) - 1 liang
Lian Zi Xin (Nelumbinis Plumula) - 1 qian
Huang Bo (Phellodendri Cortex) - 3 qian
Bai Shao (Paeoniae Radix Alba) - 6 qian
Dan Pi (Moutan Cortex) - 4 qian
Mai Dong (Ophiopogonis Tuber) - 6 qian (retain Xin/heart)
Sheng Gui Ban (Testudinis Carapax et Plastrum) - 1 liang
Dan Shen (Salviae Miltiorrhizae Radix) - 3 qian
Zhen Shan Lian (Coptidis Rhizoma - Shan variety) - 3 qian
External use: Zixue Dan (6 qian), take 1 qian each time, alternate with this formula.
6th Day: Overexertion injured Heart Qi, causing mania. Previous use of tonifying Heart Substance, draining Heart Function, and securing Heart Spirit showed great effect. Pulse strength has decreased, as stated in the Classics: "Small pulse indicates disease retreat."
Yang Shen (Panacis Quinquefolii Radix) - 3 qian
Bai Shao (Paeoniae Radix Alba) - 6 qian
Dan Pi (Moutan Cortex) - 5 qian
Zhen Shan Lian (Coptidis Rhizoma) - 2 qian
Sheng Gui Ban (Testudinis Carapax et Plastrum) - 1 liang
Huang Bo Tan (Phellodendri Cortex Carbonized) - 2 qian
Mai Dong (Ophiopogonis Tuber) - 3 qian
Nv Zhen Zi (Ligustri Lucidi Fructus) - 4 qian
Lian Zi (Nelumbinis Semen) - 5 qian
Long Dan Cao (Gentianae Radix) - 2 qian
Mi Cu (Vinegar) - 1 wine cup mixed in
Decoct with Tie Luo water.
Certain Person, 27 years old. Left pulse is wiry and forceful. The Classics state: "Single wiry pulse indicates fluid retention and masses." Five days ago, after watching a play, he suffered from nightmares, mania, and limb coldness. The Classics say: "Yang merging upward causes mania," which is Jue syndrome where the two Yin meet their end. *Ling Shu* has a volume on dreams caused by excessive pathogens, mainly stating that imbalance of the five Zang organs causes illness, not that dreaming causes illness. Past physicians diagnosed various strange symptoms as belonging to Phlegm. Although not entirely true, currently this patient has coughing with chunky phlegm and a single wiry left pulse, so it should be treated as Phlegm.
Ban Xia (Pinelliae Rhizoma) - 5 qian
Dan Pi (Moutan Cortex) - 3 qian
Shi Chang Pu (Acori Tatarinowii Rhizoma) - 2 qian
Tian Zhu Huang (Bambusae Textuta) - 2 qian
Fu Ling Kuai (Poria) - 5 qian
Bai Fu Zi (Typhonii Rhizoma) - 2 qian
First take Chen Li Ji Niu Huang Qing Xin Wan (Calculus Bovis Clearing Heart Pill) 1-2 pills, mixed with warm boiled water.
28th Day: Mania with Jue, left pulse single wiry, coughing with chunky phlegm. Yesterday discussed treating as Phlegm. Today the left pulse shows a gradual peaceful appearance, and external symptoms are effective. However, the physique is timid, complexion white and tender, and pulse is not robust. The phlegm in this case ultimately arose from fright. Those with robust Spirit are not frightened. Moreover, after fright and nightmares, profuse sweating occurred, clearly indicating Yang deficiency and timid Spirit. This case must be greatly tonified later to achieve success. Currently, do not forget the deficiency due to temporary success in attacking phlegm. Add slight Qi-tonifying herbs among the phlegm-resolving ones.
Ban Xia (Pinelliae Rhizoma) - 5 qian
Fu Ling Kuai (Poria) - 5 qian
Qiu Xiao Mai (Tritici Fructus) - 8 qian
Shi Chang Pu (Acori Tatarinowii Rhizoma) - 1 qian
Mai Dong (Ophiopogonis Tuber) - 5 qian (retain Xin/heart)
Da Zao (Jujubae Fructus) - 2 pieces
29th Day: Deficient constitution with phlegm cannot be treated purely on one side. Today the pulse is slightly slippery and rapid. In yesterday's method, slightly increase phlegm-expelling power.
Ban Xia (Pinelliae Rhizoma) - 5 qian
Bai Fu Zi (Typhonii Rhizoma) - 2 qian
Qiu Xiao Mai (Tritici Fructus) - 1 he
Chen Dan Xing (Arisaromatis Cum Bile) - 1 qian
Shi Chang Pu (Acori Tatarinowii Rhizoma) - 1.5 qian
Fu Shen Kuai (Poria cum Radice) - 5 qian
Mai Dong (Ophiopogonis Tuber) - 3 qian (retain Xin/heart)
First take half a pill of Niu Huang Qing Xin Wan.
1st Day: Yesterday slightly increased phlegm-expelling; much phlegm was expectorated, major trend is quiet, but prone to anger. Right pulse is still slippery, indicating phlegm is not cleared.
Ban Xia (Pinelliae Rhizoma) - 6 qian
Qiu Xiao Mai (Tritici Fructus) - 8 qian
Bai Fu Zi (Typhonii Rhizoma) - 2 qian
Shi Chang Pu (Acori Tatarinowii Rhizoma) - 1 qian
Xuan Fu Hua (Inulae Flos) - 3 qian
Fu Shen Kuai (Poria cum Radice) - 3 qian
Dai Zhe Shi (Haematitum) - 5 qian (calcined)
Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) - 1 qian
Later, after phlegm is gone, greatly tonify Heart and Spleen to calm the Spirit.
Bao, aged 32. Diagnosed on the 2nd day of the 10th lunar month. Suffered from severe mania for seven years, initially due to failure in achieving official rank. Many doctors in the capital (former physicians, market physicians, Confucian physicians) had treated him, including those from Huizhou, Hangzhou, Suzhou, and Hubei. Hundreds of doctors had been consulted. Generally, tonifying deficiency was common, while attacking excess was rare. Occasionally there was temporary relief, but relapse followed quickly. When I first examined him, he had unkempt hair and dirty face, lower body was red, clothes could not cover his body, destroying things immediately after making them, breaking doors and windows, nailing them up only to tear them down again. Hands and feet were bound with restraints, and several iron chains locked him onto a large stone plate. His speech was chaotic, and his emaciated physique was beyond description. Upon detailed inquiry, he insisted on seeing women every day. If women refused, he would闹 (make a scene) uncontrollably, screaming until hoarse, wailing unbearably. Only by forcing his concubines or relatives to serve him would he calm down slightly, only to repeat the next day, without a single day of peace. His six pulses were wiry, long, and forceful. I said: This is an Excess syndrome, not Deficiency. Therefore, I used extremely bitter herbs to drain Fire from the Heart and Gallbladder meridians. To drain the Heart, one must drain the Small Intestine; since the disease is in the Zang, treat its Fu organ. But if there is no outlet, one must also drain the Small Intestine.
Long Dan Cao (Gentianae Radix) - 3 qian
Hu Huang Lian (Coptidis Rhizoma - Hu variety / Coptis chinensis var. chinensis) - 3 qian
Tian Men Dong (Asparagi Radix) - 3 qian
Xi Sheng Di Huang (Rehmanniae Radix) - 3 qian
Dan Pi (Moutan Cortex) - 3 qian
Da Mai Dong (Ophiopogonis Tuber) - 3 qian (retain Xin/heart)
After two doses, great effect: delirious speech decreased, movements became quiet. Effect seen on the 3rd day. Believing long-term illness implies deficiency, fearing overly rigid herbs might cause fracture, I reduced the dosage upon symptom reduction, removing bitter herbs and adding sweet-moistening Yin-tonics. On the 5th day, the family reported: After taking two doses of the correct formula, the condition worsened significantly, with screaming and delirium increasing several-fold, no moment of rest. They thought the case was incurable and death certain, suggesting I stop consulting. I said: No. Initially, heavy doses gave great effect; subsequently, light doses with Yin-tonics caused severe worsening. I know how to advance and retreat. Re-examining the pulse, it was wiry, long, and rapid. Thus, I heavily reused bitter herbs.
Long Dan Cao (Gentianae Radix) - 6 qian
Yang Lu Hui (Aloe) - 6 qian
Tian Dong (Asparagi Radix) - 5 qian
Mai Dong (Ophiopogonis Tuber) - 5 qian (retain Xin/heart)
Hu Huang Lian (Coptidis Rhizoma) - 5 qian
Qiu Shi (Urina Secalis) - 2 qian
Wu Mei Rou (Mume Fructus Carnosus) - 5 qian
Six doses continuously. Each day showed greater improvement. By the 11th day, clarity returned. I explained the cause of his illness to him: his thoughts were deviant. Why? Because he did not understand the highest realm of literature. Even if he desired to reach the highest, life itself exists; it is not achievable by human effort alone. What is there to be angry about? Filial piety lies in understanding parents' hearts. I severely reprimanded him. He bowed his head without excuse. Gradually, bitter herbs were removed and Yin-tonics added. Half a month later, restraints were removed, he wore clothes and hat, knelt and bowed together. His spirit was indistinguishable from a healthy person. After one course of Zhuanxi Dasheng Gao (Special Gathering Great Life Paste), he became robust and passed the imperial examination.
Madam Zhang, aged 42. Illness began in February. Spirit was vague. Mistakenly took tonics like Rou Gui (Cinnamomi Cortex) and Shu Di Huang (Rehmanniae Radix Preparata), leading to severe mania. In March, I used extremely bitter herbs to suppress her excessive upper-sheng momentum, intermittently taking aromatic herbs to open the Pericardium. She recovered after 30 days. However, the pulse remained洪数 (surging and rapid). I advised abstaining from alcohol and meat, and taking Zhuanxi Dasheng Gao to tonify Yin and balance Yang. She not only refused the pills but opened up to alcohol and meat during the Dragon Boat Festival. Consequently, mania became uncontrollable. Her foot odor reached neighbors. She frequently stripped naked and went to the main street, unable to be restrained by one or two men. On May 14th, she summoned me again. I repeated the previous method, which worked temporarily, but relapsed after two or three days. This is because Shaoyang Ministerial Fire was extreme, controlling the Monarch's command. Medicine temporarily opened blockage and suppressed momentum, but once Ministerial Fire moved, it returned to normal. By June 16th, at noon, she tore her pants again and escaped out the gate unguarded. I sat helplessly, feeling I had no means to stop her. I told her younger brother: This case requires extreme pain through beating to make her dress herself. The sense of shame and disgust is unified under Ren (Benevolence/Humaneness). If one is benevolent, one cannot bear to hurt; if one bears to hurt, one is not benevolent. Extreme lack of benevolence leads to total loss of shame. Extreme pain makes one unable to bear it; inability to bear restores Benevolence; restored Benevolence restores the sense of shame. This is the meaning of ancient sages using beating as disciplinary punishment. Seeing his sister's plight, his brother felt shame turning to anger, considering preserving parents' dignity as righteousness. He beat her legs with a small bamboo board, ordering her to wear pants. Knowing pain, she dressed herself somewhat clearly. On August 17th (Start of Autumn), I used a large dose of bitter herbs. One dose cured her completely. The merit of beating, combined with the autumn Metal Qi of nature and the power of medicine, achieved success synergistically. Later, Zhuanxi Shengsheng Gao completed the cure.