潘(左)两足软弱,步履不便,肌肤作麻,中脘痞满,恶心欲呕。脉象糊滑,苔白微腻。湿郁胃中,胃为十二
经之总司,胃病则不能束筋骨而利机关,所以足膝软弱,痿症之情形也。当取阳明。
制半夏(一钱五分) 生熟薏仁(各二钱) 云茯苓(三钱) 川萆 (二钱) 汉防己(一钱五分) 台白术
(一钱五分) 焦苍术(一钱五分) 上广皮(一钱)
二诊 寒湿停阻胃中,呕吐恶心,频渴欲饮,咳嗽则少腹两旁牵痛,四肢脉络不舒。盖寒湿内阻,则清
津不升,故口渴。阳明病则脉络不和。再温运湿邪,而降阳明。
制半夏(二钱) 木猪苓(二钱) 台白术(一钱五分) 川桂枝(五分) 白茯苓(四钱) 建泽泻(二钱)
炒竹茹(一钱) 老生姜(一钱先切) 王枢丹(五分研末先调服)
三诊 脉络稍和,略能安卧,恶心呕吐口渴俱觉减轻,胸中如有物阻。脉象沉弦。寒湿停饮,阻于阳明,
大便不行,不得不暂为控逐也。
制半夏(二钱) 台白术(一钱五分) 上官桂(五分) 泽泻(一钱五分) 云茯苓(四钱) 大腹皮(一钱五
分) 陈皮(一钱) 老生姜(一钱) 木猪苓(二钱) 控涎丹(八分先服五分不行再服三分姜汤下)
四诊 脉沉弦稍起,呕吐大减,施化得行,口渴较定。然胃病则土难御木,风木大动,机关脉络失和,四
肢痿软。急为柔养脉络,而和营液。
土炒杭白芍(三钱) 炒宣木瓜(一钱五分) 酒炒当归身(二钱) 鲜苁蓉(酒洗淡六钱)
炙黑甘草(五分) 天冬(三钱) 肥玉竹(三钱) 阿胶珠(三钱) 火麻仁(三钱)
左 呕吐痰涎,泄泻甚多,府中郁阻之湿,得以开通,水气一层,今可幸免。而两足仍然肿胀,足膝痿软
诚恐在下之湿,延成痿症。再取阳明。
生薏仁 赤白苓 陈皮 制半夏 猪苓 炒黄柏 汉防己 泽泻 川桂枝
某 腿股烙热不能步履,手指作麻。此肝火陷下,阳乘阴位,痿症情形也。
全当归 黑豆衣 泽泻 生薏仁 虎潜丸 汉防己 女贞子 白芍 粉丹皮
邵(左) 大病之后,湿恋阳明。身热不退,腿足痿软,不能步履。有难复之虞。
汉防己 大豆卷 泽泻 米仁 独活 桂枝
川萆 赤白苓 制半夏 杏仁泥 二妙丸
二诊 身热口渴俱减,步履略能自如。再祛湿泄热。
大豆卷 生薏仁 秦艽 木瓜 川桂枝 制半夏
光杏仁 独活 汉防己 萆 建泽泻 酒炒桑枝 二妙丸
【初诊】患者(左侧)双足软弱无力,行走不便,肌肤感觉麻木,中脘部位痞塞胀满,恶心欲呕吐。脉象糊滑,舌苔白而微腻。湿邪郁结于胃中,胃为十二经脉的总司,胃病则不能约束筋骨、滑利关节,因此出现足膝软弱,这是痿证的典型表现。治疗应当选取阳明经。
处方:制半夏(一钱五分)、生薏苡仁与熟薏苡仁(各二钱)、云茯苓(三钱)、川萆薢(二钱)、汉防己(一钱五分)、台白术(一钱五分)、焦苍术(一钱五分)、上广皮(一钱)。
【二诊】寒湿停滞阻遏于胃中,导致呕吐恶心,频繁口渴想喝水,咳嗽时少腹两侧牵引疼痛,四肢脉络不畅。因为寒湿内阻,清阳之津液不能上升,所以感到口渴。阳明经病则脉络不和。再次采用温运湿邪的方法,并降逆阳明之气。
处方:制半夏(二钱)、木猪苓(二钱)、台白术(一钱五分)、川桂枝(五分)、白茯苓(四钱)、建泽泻(二钱)、炒竹茹(一钱)、老生姜(一钱,先切片)、王枢丹(五分,研成细末先调服)。
【三诊】脉络稍见调和,略能安稳躺卧,恶心呕吐和口渴都感觉减轻,但胸中好像有物阻塞。脉象沉弦。寒湿停聚成饮,阻滞于阳明经,大便不通,不得不暂时采用控逐水饮的方法。
处方:制半夏(二钱)、台白术(一钱五分)、上官桂(五分)、泽泻(一钱五分)、云茯苓(四钱)、大腹皮(一钱五分)、陈皮(一钱)、老生姜(一钱)、木猪苓(二钱)、控涎丹(八分,先服用五分,若不行再服用三分,用姜汤送下)。
【四诊】脉象沉弦稍微起浮,呕吐大幅减少,气化功能得以运行,口渴情况较前安定。然而胃病则脾土难以制约肝木,风木之气大动,机关脉络失于调和,四肢痿软无力。急需柔养脉络,调和营血津液。
处方:土炒杭白芍(三钱)、炒宣木瓜(一钱五分)、酒炒当归身(二钱)、鲜肉苁蓉(酒洗淡,六钱)、炙黑甘草(五分)、天冬(三钱)、肥玉竹(三钱)、阿胶珠(三钱)、火麻仁(三钱)。
【另一病例(左)】呕吐痰涎,泄泻严重,腑中郁积阻滞的湿邪得以开通,水气一层得以幸免。但双足仍然肿胀,足膝痿软,诚恐下部的湿邪蔓延演变成痿证。再次选取阳明经治疗。
处方:生薏苡仁、赤茯苓与白茯苓、陈皮、制半夏、猪苓、炒黄柏、汉防己、泽泻、川桂枝。
【另一病例】大腿和小腿烙热,无法行走,手指发麻。这是肝火陷入下部,阳气乘袭阴位,属于痿证的表现。
处方:全当归、黑豆衣、泽泻、生薏苡仁、虎潜丸、汉防己、女贞子、白芍、粉丹皮。
【邵某(左侧)】大病之后,湿邪留恋于阳明经。身体发热不退,腿足痿软,不能行走。有难以恢复的忧虑。
处方:汉防己、大豆卷、泽泻、米仁(即薏苡仁)、独活、桂枝、川萆薢、赤茯苓与白茯苓、制半夏、杏仁泥、二妙丸。
【邵某二诊】身体发热和口渴都减轻,步履略微能够自如。再次祛除湿邪,泄除热邪。
处方:大豆卷、生薏苡仁、秦艽、木瓜、川桂枝、制半夏、光杏仁、独活、汉防己、川萆薢、建泽泻、酒炒桑枝、二妙丸。
[First Visit] The patient (left side) presents with weakness in both lower limbs, difficulty in walking, and numbness of the skin. There is a sensation of fullness and distension in the Zhongwan area, accompanied by nausea and a desire to vomit. The pulse is muddy and slippery, and the tongue coating is white and slightly greasy. Dampness is stagnant in the Stomach. As the Stomach is the commander of the twelve meridians, stomach pathology leads to an inability to bind the sinews and bones and facilitate joint movement, resulting in weak knees and legs; this is the presentation of Wei Syndrome (Flaccidity Syndrome). Treatment should focus on the Yangming Meridian.
Prescription: Prepared Banxia (Pinelliae Rhizoma Praeparatum, 1.5 qian), Raw and Cooked Yiren (Coicis Semen, 2 qian each), Yun Fuling (Poria, 3 qian), Chuan Bixie (Dioscoreae Hypoglaucae Rhizoma, 2 qian), Han Fangji (Stephaniae Tetrandrae Radix, 1.5 qian), Tai Baizhu (Atractylodis Macrocephalae Rhizoma, 1.5 qian), Jiao Cangzhu (Atractylodis Rhizoma Ustums, 1.5 qian), Shang Guangpi (Citri Reticulatae Pericarpium, 1 qian).
[Second Visit] Cold-dampness is stagnant and obstructing the Stomach, causing vomiting, nausea, frequent thirst with desire to drink, and pulling pain on both sides of the lower abdomen when coughing. The meridians of the four limbs are not smooth. Because cold-dampness obstructs internally, clear fluids cannot ascend, hence the thirst. Pathology of the Yangming meridian leads to disharmony of the meridians. Again, employ methods to warm and transport dampness, and descend Qi of the Yangming.
Prescription: Prepared Banxia (Pinelliae Rhizoma Praeparatum, 2 qian), Mu Zhuling (Polyporus, 2 qian), Tai Baizhu (Atractylodis Macrocephalae Rhizoma, 1.5 qian), Chuan Guizhi (Cinnamomi Ramulus, 0.5 qian), Bai Fuling (Poria, 4 qian), Jian Zexie (Alismatis Rhizoma, 2 qian), Chao Zhuru (Bambusae Caulis Praeparatus, 1 qian), Lao Shengjiang (Zingiberis Rhizoma Recens, 1 qian, sliced first), Wangshu Dan (Wangshu Pill, 0.5 qian, ground into powder and taken first after mixing).
[Third Visit] The meridians are slightly harmonized, allowing for slight ability to lie down comfortably. Nausea, vomiting, and thirst have all alleviated, but there is a sensation of obstruction in the chest. The pulse is deep and wiry. Cold-dampness has stagnated into fluid retention, obstructing the Yangming meridian, leading to constipation. It is necessary to temporarily use methods to control and purge fluid retention.
Prescription: Prepared Banxia (Pinelliae Rhizoma Praeparatum, 2 qian), Tai Baizhu (Atractylodis Macrocephalae Rhizoma, 1.5 qian), Shang Angui (Cinnamomi Cortex, 0.5 qian), Zexie (Alismatis Rhizoma, 1.5 qian), Yun Fuling (Poria, 4 qian), Dafupi (Arecae Pericarpium, 1.5 qian), Chenpi (Citri Reticulatae Pericarpium, 1 qian), Lao Shengjiang (Zingiberis Rhizoma Recens, 1 qian), Mu Zhuling (Polyporus, 2 qian), Kongyan Dan (Kongyan Pill, 0.8 qian; take 0.5 qian first, if no effect, take another 0.3 qian washed down with ginger soup).
[Fourth Visit] The deep and wiry pulse has risen slightly, vomiting has greatly decreased, qi transformation is functioning, and thirst has stabilized. However, stomach disease implies that Earth (Spleen) fails to control Wood (Liver), leading to vigorous movement of Wind-Wood. The joints and meridians lose harmony, resulting in flaccidity and weakness of the four limbs. Urgently nourish the meridians with softening agents and harmonize Ying (Nutritive) fluids.
Prescription: Tu Chao Hangbaishao (Paeoniae Radix Alba Praeparata cum Terra, 3 qian), Chao Xuan Mugua (Chaenomelis Fructus, 1.5 qian), Jiu Chao Dangguishen (Angelicae Sinensis Radix, wine-fried, 2 qian), Xian Congrong (Cynomorii Herba, fresh, wine-washed and rinsed, 6 qian), Zhi Hei Gancao (Glycyrrhizae Radix et Rhizoma, roasted black, 0.5 qian), Tiandong (Asparagi Radix, 3 qian), Fei Yuzhu (Polygonati Odorati Rhizoma, 3 qian), Ejiaozhu (Asini Corii Colla Granula, 3 qian), Huomaren (Semen Cannabis, 3 qian).
[Another Case (Left)] Vomiting of phlegm-saliva and severe diarrhea indicate that the dampness stagnating and obstructing the Fu organs has been opened up, sparing the layer of water-qi. However, both feet remain swollen, and the knees and legs are flaccid. There is fear that dampness below will extend and develop into Wei Syndrome (Flaccidity Syndrome). Again, target the Yangming Meridian.
Prescription: Sheng Yiren (Coicis Semen), Chi Bai Ling (Red and White Poria), Chenpi (Citri Reticulatae Pericarpium), Zhi Banxia (Prepared Pinelliae Rhizoma), Zhuling (Polyporus), Chao Huangbai (Phellodendri Cortex, fried), Han Fangji (Stephaniae Tetrandrae Radix), Zexie (Alismatis Rhizoma), Chuan Guizhi (Cinnamomi Ramulus).
[Another Case] Burning heat in the thighs and calves prevents walking, and the fingers feel numb. This is Liver Fire sinking downward, with Yang invading Yin positions, presenting as Wei Syndrome (Flaccidity Syndrome).
Prescription: Quan Danggui (Angelicae Sinensis Radix), Doukouyi (Sojae Semen Nigrum Testa), Zexie (Alismatis Rhizoma), Sheng Yiren (Coicis Semen), Huqian Wan (Tiger-Hiding Pill), Han Fangji (Stephaniae Tetrandrae Radix), Nvzhenzi (Ligustri Lucidi Fructus), Baishao (Paeoniae Radix Alba), Fen Danpi (Moutan Cortex).
[Shao (Left)] After a major illness, dampness lingers in the Yangming Meridian. Body heat persists, legs and feet are flaccid and unable to walk. There is concern that recovery may be difficult.
Prescription: Han Fangji (Stephaniae Tetrandrae Radix), Dadoujuan (Sojae Semen Praeparatum), Zexie (Alismatis Rhizoma), Miren (Coicis Semen), Duhuo (Angelicae Pubescentis Radix), Guizhi (Cinnamomi Ramulus), Chuan Bixie (Dioscoreae Hypoglaucae Rhizoma), Chi Bai Ling (Red and White Poria), Zhi Banxia (Prepared Pinelliae Rhizoma), Xingren Ni (Armeniacae Semen Amarum Paste), Ermiao Wan (Two Wonders Pill).
[Shao Second Visit] Body heat and thirst have both reduced, and walking has become slightly more free. Again, dispel dampness and drain heat.
Prescription: Dadoujuan (Sojae Semen Praeparatum), Sheng Yiren (Coicis Semen), Qinjiao (Gentianae Macrophyllae Radix), Mugua (Chaenomelis Fructus), Chuan Guizhi (Cinnamomi Ramulus), Zhi Banxia (Prepared Pinelliae Rhizoma), Guang Xingren (Armeniacae Semen Amarum), Duhuo (Angelicae Pubescentis Radix), Han Fangji (Stephaniae Tetrandrae Radix), Bixie (Dioscoreae Hypoglaucae Rhizoma), Jian Zexie (Alismatis Rhizoma), Jiu Chao Sangzhi (Mori Ramulus, wine-fried), Ermiao Wan (Two Wonders Pill).