左 肝肾两亏,风与湿袭入经络,肩背腰膂俱痛。再宣络而理湿祛风。
桂枝 秦艽 独活 橘皮络 威灵仙 萆 薏仁 防风 桑寄生 二妙丸
沈(左) 由胁痛而致吐下皆血,血去之后,络隧空虚,风阳入络,胸膺腰膂两胁皆痛,时或眩晕。脉象虚
弦。宜育阴以熄肝,养营以和络。
阿胶珠(二钱) 柏子霜(三钱) 龙齿(三钱) 甘杞子(三钱) 细生地(四钱) 杭白芍(一钱五分)
白归身(二钱) 炒萸肉(一钱五分) 云茯苓(三钱) 浓杜仲(三钱)
左 疏补兼施,气分尚属和平,而腰膂酸楚,颇觉板胀。肝肾虚而湿走入络。再益肝肾,参以制肝。
上徭桂(四分) 浓杜仲(三钱) 盐水炒菟丝子(三钱) 甘杞子(三钱) 血鹿片(三分)
淮牛膝(三钱) 盐水炒潼沙苑(三钱) 云茯苓(三钱) 土炒东白芍(一钱五分)
小茴香(五分) 别直参(另煎冲一钱)
二诊 体重腰脊作痛。肝肾空虚,所有湿邪复趋其地。用肾着汤出入。
淡干姜(四分炒) 广橘红(一钱) 生熟甘草(各二分) 独活(一钱) 焦白术(二钱) 云茯苓(一两)
制半夏(一钱五分)
右 腰府作痛。脉形沉细。肝肾虚而湿寒乘袭也。
川萆 黄柏 当归须 赤猪苓 泽泻 川桂枝 独活 延胡索 生米仁
邹(左) 肝肾不足,闪挫气注,腰府不舒。当益肝肾而和络气。
川桂枝(五分) 杜仲(三钱) 炒牛膝(三钱) 炒丝瓜络(一钱五分) 川独活(一钱) 猩绛
(五分) 旋复花(二钱包) 生熟薏仁(各二钱) 橘红(一钱五分) 青葱管(三茎)
某 腰背作痛,右腿股不时麻木。气虚而湿热袭流经络。恐成痿痹。
炙绵 木防己 制半夏 广橘红 焦冬术 赤白苓 白僵蚕 桑枝 左秦艽 川萆 川独活
席(左) 痛胀退而复甚,腰膂作酸,大便不调。痰湿之闭阻虽开,而肝肾之络暗损。宜舍标治本,
而通和奇脉。
干苁蓉(二钱) 杜仲(三钱) 盐水炒菟丝子(三钱) 炒萸肉(一钱五分) 甘杞子(三钱)
酒炒白芍(一钱五分) 川桂枝(三分) 酒炒当归(二钱) 柏子霜(三钱) 橘络叶(一钱五分)
二诊 通和奇脉,脉症相安,惟腰府仍然作酸,大便涩滞营络不和。前法进退。
干苁蓉(三钱) 川桂枝(四分) 柏子霜(三钱) 盐水炒浓杜仲(三钱) 酒炒白芍(二钱)
粉归身(二钱) 酒炒淮牛膝(三钱) 川断肉(三钱) 火麻仁(三钱) 甘杞子(三钱)
三诊 脉症相安,腰府作酸。还是络虚气滞。效方扩充。
川桂枝(四分) 甘杞子(三钱) 干苁蓉(二钱) 柏子霜(三钱) 火麻仁(三钱) 酒炒当
归身(二钱) 酒炒杭白芍(一钱五分) 盐水炒菟丝子(三钱) 炒萸肉(一钱五分) 盐水炒补骨脂(三钱)
四诊 腰痛作酸降序,痰带灰黑。肾寒肺热。前法参以化痰。
竹沥半夏(一钱五分) 酒炒怀牛膝(三钱) 浓杜仲(三钱) 菟丝子(三钱) 广橘红(一钱)
海蛤粉(三钱) 川桂枝(四分) 火麻仁(三钱) 甘杞子(三钱) 干苁蓉(二钱) 炒竹茹(一钱)
五诊 肝肾空虚,络气不宣。腰酸气阻,痰带灰黑。再益肝肾而宣络气。
浓杜仲(三钱) 甘杞子(三钱) 柏子霜(三钱) 白茯苓(三钱) 干苁蓉(三钱) 制香附(二钱打)
橘红络(各一钱) 旋复花(二钱包) 海蛤粉(三钱) 冬瓜子(三钱)
六诊 肝肾不足,湿痰有余,时分时开时阻,络隧因而不宣。再调气化痰,以宣络隧。
制香附(二钱) 炒枳壳(一钱) 半夏(一钱五分) 旋复花(一钱五分) 橘红络(各一
钱) 海蛤粉(三钱) 杜仲(三钱) 越鞠丸(三钱先服)
左脉证:肝肾两脏亏虚,风邪与湿邪侵袭经络,导致肩背及腰部脊柱疼痛。治疗宜疏通络脉,调理湿气,祛除风邪。
桂枝、秦艽、独活、橘皮络、威灵仙、萆薢、薏苡仁、防风、桑寄生,配合二妙丸服用。
沈姓患者(左侧):因胁痛引发呕吐和腹泻,且吐下物中均带血。失血之后,络脉通道空虚,风阳之邪侵入络脉,导致胸膺部、腰脊及两侧胁肋均感疼痛,时而出现眩晕。脉象表现为虚弦。适宜滋养阴液以平息肝风,调养营血以调和络脉。
阿胶珠(二钱)、柏子霜(三钱)、龙齿(三钱)、甘枸杞子(三钱)、细生地(四钱)、杭白芍(一钱五分)、白归身(二钱)、炒山茱萸肉(一钱五分)、云茯苓(三钱)、浓杜仲(三钱)。
左脉证:疏泄与补益兼施,气分状况尚属平和,但腰部脊柱酸楚,感觉颇为板滞胀满。此为肝肾虚弱,湿邪流入络脉。治疗宜补益肝肾,参酌平抑肝木之法。
上徭桂(四分)、浓杜仲(三钱)、盐水炒菟丝子(三钱)、甘枸杞子(三钱)、血鹿片(三分)、淮牛膝(三钱)、盐水炒潼蒺藜/沙苑子(三钱)、云茯苓(三钱)、土炒东白芍(一钱五分)、小茴香(五分)、别直参(另煎冲服一钱)。
二诊:身体沉重,腰脊作痛。肝肾空虚,原有的湿邪再次趋向于该部位。使用肾着汤加减治疗。
淡干姜(四分,炒)、广橘红(一钱)、生甘草与熟甘草(各二分)、独活(一钱)、焦白术(二钱)、云茯苓(一两)、制半夏(一钱五分)。
右侧:腰府作痛。脉形沉细。此为肝肾虚弱,寒湿乘虚侵袭所致。
川萆薢、黄柏、当归须、赤猪苓、泽泻、川桂枝、独活、延胡索、生米仁(薏苡仁)。
邹姓患者(左侧):肝肾不足,因闪挫导致气机阻滞,腰府不适。应当补益肝肾,调和络脉之气。
川桂枝(五分)、杜仲(三钱)、炒牛膝(三钱)、炒丝瓜络(一钱五分)、川独活(一钱)、猩绛(五分)、旋复花(二钱,包煎)、生薏苡仁与熟薏苡仁(各二钱)、橘红(一钱五分)、青葱管(三茎)。
某患者:腰背部作痛,右腿大腿不时麻木。气虚而湿热之邪流注经络。恐怕会发展成痿痹证。
炙绵黄芪、木防己、制半夏、广橘红、焦冬术、赤茯苓与白茯苓、白僵蚕、桑枝、左秦艽、川萆薢、川独活。
席姓患者(左侧):疼痛肿胀消退后复发加重,腰脊作酸,大便不调。虽然痰湿闭阻的情况已开,但肝肾的络脉暗中受损。宜舍弃治标,转而治本,通调奇经八脉。
干苁蓉(二钱)、杜仲(三钱)、盐水炒菟丝子(三钱)、炒山茱萸肉(一钱五分)、甘枸杞子(三钱)、酒炒白芍(一钱五分)、川桂枝(三分)、酒炒当归(二钱)、柏子霜(三钱)、橘络叶(一钱五分)。
二诊:通调奇经八脉后,脉症相安,仅腰府仍然作酸,大便涩滞,营络不和。以前法进退调整。
干苁蓉(三钱)、川桂枝(四分)、柏子霜(三钱)、盐水炒浓杜仲(三钱)、酒炒白芍(二钱)、粉归身(二钱)、酒炒淮牛膝(三钱)、川断肉(三钱)、火麻仁(三钱)、甘枸杞子(三钱)。
三诊:脉症相安,腰府作酸。仍是络脉虚弱,气机阻滞。效方扩充继续治疗。
川桂枝(四分)、甘枸杞子(三钱)、干苁蓉(二钱)、柏子霜(三钱)、火麻仁(三钱)、酒炒当归身(二钱)、酒炒杭白芍(一钱五分)、盐水炒菟丝子(三钱)、炒山茱萸肉(一钱五分)、盐水炒补骨脂(三钱)。
四诊:腰痛作酸程度逐渐减轻,痰中带灰黑色。此为肾寒肺热。在前法基础上参酌化痰之法。
竹沥半夏(一钱五分)、酒炒怀牛膝(三钱)、浓杜仲(三钱)、菟丝子(三钱)、广橘红(一钱)、海蛤粉(三钱)、川桂枝(四分)、火麻仁(三钱)、甘枸杞子(三钱)、干苁蓉(二钱)、炒竹茹(一钱)。
五诊:肝肾空虚,络气不宣。腰酸气阻,痰中带灰黑色。再补益肝肾,宣通络气。
浓杜仲(三钱)、甘枸杞子(三钱)、柏子霜(三钱)、白茯苓(三钱)、干苁蓉(三钱)、制香附(二钱,捣碎)、橘红络(各一钱)、旋复花(二钱,包煎)、海蛤粉(三钱)、冬瓜子(三钱)。
六诊:肝肾不足,湿痰有余,症状时分时开时阻,络脉通道因此不通畅。再调理气机,化痰,以宣通络脉通道。
制香附(二钱)、炒枳壳(一钱)、半夏(一钱五分)、旋复花(一钱五分)、橘红络(各一钱)、海蛤粉(三钱)、杜仲(三钱)、越鞠丸(三钱,先服)。
Left pulse/syndrome: Deficiency of both the Liver and Kidney, with Wind and Dampness invading the collaterals, causing pain in the shoulders, back, and lumbar spine. Treatment should focus on unblocking the collaterals, regulating Dampness, and expelling Wind.
Guizhi (Cinnamon Twig), Qinjiao (Gentiana Macrophylla Root), Du Huo (Angelica Pubescens Root), Jupi Luo (Tangerine Peel Mesh), Weilingxian (Syneilesis Aconitifolia Rhizome), Bibai (Dioscorea Hypoglauca Rhizome), Yiren (Coix Seed), Fangfeng (Saposhnikovia Root), Sangjisheng (Taxillus Chinensis), administered with Ermiao Wan (Two Marvels Pill).
Patient Shen (Left): Vomiting and diarrhea accompanied by blood, originating from hypochondriac pain. After blood loss, the collateral channels become empty, allowing Wind-Yang to invade the collaterals. This results in pain in the chest, lumbar spine, and bilateral hypochondrium, accompanied by occasional vertigo. The pulse is deficient and wiry. Treatment should nourish Yin to extinguish Liver wind, and nourish Ying (Nutritive) blood to harmonize the collaterals.
Ejiao Zhu (Donkey-hide Gelatin Bead, 2 qian), Baizi Shuang (Platycladi Semen Frost, 3 qian), Longchi (Dragon Bone, 3 qian), Gan Qizi (Goji Berry, 3 qian), Xi Shengdi (Rehmannia Root, 4 qian), Hang Baishao (White Peony Root, 1.5 qian), Bai Guishen (Angelica Sinensis Root, 2 qian), Chao Yurou (Stir-fried Cornus Fruit, 1.5 qian), Yun Fuling (Poria, 3 qian), Nong Duzhong (Eucommia Bark, 3 qian).
Left pulse/syndrome: Combining dispersing and tonifying methods; the Qi aspect remains relatively peaceful, yet there is soreness and a sensation of stiffness and distension in the lumbar spine. This indicates Liver-Kidney deficiency with Dampness entering the collaterals. Treatment should benefit the Liver and Kidney, incorporating methods to subdue the Liver.
Shang Yao Gui (Cassia Twig, 0.4 fen), Nong Duzhong (Eucommia Bark, 3 qian), Salt-stir-fried Tusizi (Cuscuta Seed, 3 qian), Gan Qizi (Goji Berry, 3 qian), Xuelu Pian (Blood Deer Slice, 0.3 fen), Huai Niuxi (Achyranthes Root, 3 qian), Salt-stir-fried Tongshayuan (Astragalus Complanatus Seed, 3 qian), Yun Fuling (Poria, 3 qian), Earth-stir-fried Dong Baishao (White Peony Root, 1.5 qian), Xiaohuixiang (Fennel Fruit, 0.5 fen), Biezhi Shen (American Ginseng, decocted separately, 1 qian taken as infusion).
Second visit: Heavy body, pain in the waist and spine. Deficiency of Liver and Kidney allows residual Damp pathogen to return to this area. Use Shen Zhuo Tang (Kidney Fixation Decoction) with modifications.
Dan Jiang (Light Dried Ginger, 0.4 fen, stir-fried), Guang Juhong (Broad Tangerine Red Peel, 1 qian), Sheng Gancao (Raw Licorice Root) and Shu Gancao (Prepared Licorice Root) (0.2 qian each), Du Huo (Angelica Pubescens Root, 1 qian), Jiao Baizhu (Charred Atractylodes Macrocephala Rhizome, 2 qian), Yun Fuling (Poria, 1 liang), Zhi Banxia (Prepared Pinellia Tuber, 1.5 qian).
Right side: Pain in the lumbar region. Pulse is deep and thin. This is due to Liver-Kidney deficiency with Cold-Damp attacking.
Chuan Bibai (Dioscorea Hypoglauca Rhizome), Huangbai (Phellodendron Bark), Danggui Xu (Angelica Sinensis Root Tip), Chi Zhuling (Polyporus with Cinnabar or Red Poria), Zexie (Alisma Rhizome), Chuan Guizhi (Cinnamon Twig), Du Huo (Angelica Pubescens Root), Yanhusuo (Corydalis Rhizome), Sheng Miren (Coix Seed).
Patient Zou (Left): Insufficiency of Liver and Kidney, qi stagnation due to sprain/trauma, causing discomfort in the lumbar region. Treatment should tonify Liver and Kidney and harmonize collateral qi.
Chuan Guizhi (Cinnamon Twig, 0.5 fen), Duzhong (Eucommia Bark, 3 qian), Chao Niuxi (Stir-fried Achyranthes Root, 3 qian), Chao Sigualuo (Stir-fried Luffa Reticulate Fiber, 1.5 qian), Chuan Du Huo (Angelica Pubescens Root, 1 qian), Xingjiang (Safflower/Carmine, 0.5 fen), Xuanfu Hua (Inula Flower, 2 qian, wrapped), Sheng Shu Yiren (Raw and Prepared Coix Seed, 2 qian each), Juhong (Tangerine Red Peel, 1.5 qian), Qingcong Guan (Green Onion Tube, 3 stems).
Certain patient: Pain in the lower back and back, with intermittent numbness in the right thigh. Qi deficiency with Damp-Heat flowing into the collaterals. Fear of developing into Wei Bi (Flaccidity and Obstruction syndrome).
Zhi Mian (Honey-fried Astragalus Root), Mu Fangji (Stephania Tetrandra Root), Zhi Banxia (Prepared Pinellia Tuber), Guang Juhong (Broad Tangerine Red Peel), Jiao Dongzhu (Charred Winter Atractylodes Rhizome), Chi Bai Ling (Red and White Polyporus), Bai Jiangcan (Bombyx Batryticatus), Sangzhi (Mulberry Twig), Zuo Qinjiao (Gentiana Macrophylla Root), Chuan Bibai (Dioscorea Hypoglauca Rhizome), Chuan Du Huo (Angelica Pubescens Root).
Patient Xi (Left): Pain and distension subsided then worsened again, soreness in the lumbar spine, irregular bowel movements. Although the obstruction by Phlegm-Damp has opened, the collaterals of the Liver and Kidney are secretly damaged. Abandon treating the branch (symptoms) to treat the root (cause), and unblock and harmonize the Extraordinary Vessels.
Gan Congrong (Cistanche Stem, 2 qian), Duzhong (Eucommia Bark, 3 qian), Salt-stir-fried Tusizi (Cuscuta Seed, 3 qian), Chao Yurou (Stir-fried Cornus Fruit, 1.5 qian), Gan Qizi (Goji Berry, 3 qian), Wine-stir-fried Baishao (White Peony Root, 1.5 qian), Chuan Guizhi (Cinnamon Twig, 0.3 fen), Wine-stir-fried Danggui (Angelica Sinensis Root, 2 qian), Baizi Shuang (Platycladi Semen Frost, 3 qian), Jueluo Ye (Tangerine Peel Mesh and Leaf, 1.5 qian).
Second visit: After unblocking the Extraordinary Vessels, pulse and symptoms are stable. Only the lumbar region remains sore, with constipation and disharmony of Ying collaterals. Adjust the previous method.
Gan Congrong (Cistanche Stem, 3 qian), Chuan Guizhi (Cinnamon Twig, 0.4 fen), Baizi Shuang (Platycladi Semen Frost, 3 qian), Salt-stir-fried Nong Duzhong (Eucommia Bark, 3 qian), Wine-stir-fried Baishao (White Peony Root, 2 qian), Fen Guishen (Angelica Sinensis Root, 2 qian), Wine-stir-fried Huai Niuxi (Achyranthes Root, 3 qian), Chuan Duanrou (Dipsacus Root, 3 qian), Huomaren (Hemp Seed, 3 qian), Gan Qizi (Goji Berry, 3 qian).
Third visit: Pulse and symptoms are stable, but the lumbar region is sore. Still due to collateral deficiency and qi stagnation. Expand the effective formula.
Chuan Guizhi (Cinnamon Twig, 0.4 fen), Gan Qizi (Goji Berry, 3 qian), Gan Congrong (Cistanche Stem, 2 qian), Baizi Shuang (Platycladi Semen Frost, 3 qian), Huomaren (Hemp Seed, 3 qian), Wine-stir-fried Dangguishen (Angelica Sinensis Root, 2 qian), Wine-stir-fried Hang Baishao (White Peony Root, 1.5 qian), Salt-stir-fried Tusizi (Cuscuta Seed, 3 qian), Chao Yurou (Stir-fried Cornus Fruit, 1.5 qian), Salt-stir-fried Buguzhi (Psoralea Fruit, 3 qian).
Fourth visit: Lower back pain and soreness decrease progressively; sputum contains grey-black particles. Kidney Cold and Lung Heat. Modify the previous method to include resolving phlegm.
Zhuli Banxia (Pinellia Tuber processed with Bamboo Sap, 1.5 qian), Wine-stir-fried Huai Niuxi (Achyranthes Root, 3 qian), Nong Duzhong (Eucommia Bark, 3 qian), Tusizi (Cuscuta Seed, 3 qian), Guang Juhong (Broad Tangerine Red Peel, 1 qian), Haigefen (Clam Shell Powder, 3 qian), Chuan Guizhi (Cinnamon Twig, 0.4 fen), Huomaren (Hemp Seed, 3 qian), Gan Qizi (Goji Berry, 3 qian), Gan Congrong (Cistanche Stem, 2 qian), Chao Zhuru (Stir-fried Bamboo Shavings, 1 qian).
Fifth visit: Liver and Kidney emptiness, collateral qi not disseminating. Soreness in waist, qi obstruction, sputum with grey-black particles. Again benefit Liver and Kidney and disseminate collateral qi.
Nong Duzhong (Eucommia Bark, 3 qian), Gan Qizi (Goji Berry, 3 qian), Baizi Shuang (Platycladi Semen Frost, 3 qian), Bai Fuling (Poria, 3 qian), Gan Congrong (Cistanche Stem, 3 qian), Zhi Xiangfu (Cyperi Rhizoma, 2 qian, crushed), Juhongluo (Tangerine Peel Mesh, 1 qian each), Xuanfu Hua (Inula Flower, 2 qian, wrapped), Haigefen (Clam Shell Powder, 3 qian), Dongguazi (Winter Melon Seed, 3 qian).
Sixth visit: Liver and Kidney insufficiency, excess Damp-Phlegm. Symptoms fluctuate between opening and obstruction, causing blockage in the collateral channels. Regulate qi and resolve phlegm to disseminate the collateral channels.
Zhi Xiangfu (Cyperi Rhizoma, 2 qian), Chao Zhiqiao (Stir-fried Aurantium Fructus, 1 qian), Banxia (Pinellia Tuber, 1.5 qian), Xuanfu Hua (Inula Flower, 1.5 qian), Juhongluo (Tangerine Peel Mesh, 1 qian each), Haigefen (Clam Shell Powder, 3 qian), Duzhong (Eucommia Bark, 3 qian), Yueju Wan (Yueju Pill, 3 qian, taken first).