堂堂正治,波澜老成。
李(四十三岁) 疟寒必呕,胃滞痰浊未已,舌上微白,不嗜饮,开结理气如是。
草果 浓朴 荜茇 橘白 杏仁 熟半夏 姜汁
张(五十三岁) 三疟久延两三年,面肌黄萎,唇口枯白,食入脘腹, 胀,足痿如堕,
至晚浮肿。其所伤者脾阳肾阳,然脾以营运则健,肾宜收纳为命根,非一方兼用按古法。
早服肾气丸,晚服理中汤(早晚分头而治,切实了当。)
周(六十岁) 气血已衰,噎膈反胃,每每中年以后。盖操家劳瘁,必伤心脾之营,营液
日枯
,清气日结,而食管渐渐窄隘,郁久痰涎内聚,食入涎沫迎涌,而致反胃。此乃气分之结(
提清气分之结,便有主脑。)萸、地、枸杞,滋养肝肾,胃先觉其腻滞,焉得肝肾有益。
人参补气生精,半夏消痰开结,白蜜润燥滋液,最为切当。
吴(三十五岁) 据述咽中气冲,即起咳嗽,经年调治,渐致食减力乏。此皆不分外因,
徒受
治痰治嗽之累。凡久恙当问寝食,参视形色脉象,越人谓下损及胃是已(气冲即咳,内损显
然,尚徒治痰治嗽,何怪先生鄙夷。)
吴(通关坊,四十四岁) 劳伤治不以法,反受药伤,络血涸而为痛,食入痛来,病在胃
络,以甘缓肝,急以救胃。
桂元肉 炒桃仁
孙(北濠,二十六岁) 食后左胁气逆痛,是肝胆气热(老笔。)
丹皮 钩藤 生地 川石斛 柏子仁 茯苓
李(五十六岁) 少腹满胀,必在夜卧而甚,晨起肠泄浊气,白昼仍可办事。延及几年,
气冲
胃脘高突而冷,舌根亦胀痛,自胸及于舌。医用吴萸、川楝,苦辛温佐苦寒降泄不安,则知
有年。下元已虚,气散漫不为下归摄矣(此即西昌老人所谓地气加于天之症也。治法清切,
尚嫌迟钝,应先用炒枯肾气汤几服。)
八味丸(三钱)
金(三十五岁) 便泻下血多年,延及跗肿腹膨,食少色夺,无治痰嗽凉药之理(脾肾兼
温补。)
九蒸熟白术 淡熟附子
王(七十七岁) 高年气衰,不耐暑伏久热,迫津液被伤,阳不内归(阳不内归四字极精)
,寐
少不静。例用竹叶地黄汤,养液除热,莫与气燥味劣,反致戕胃(阴阳每相根据恋,老年少寐
,津血少而阳不内归也。)
尹(织造府前,五十八岁) 望六,营运之阳已微弱,饮酒及食物,气滞而湿聚(拿定气
字发挥,)脉络不行,不饥,气攻触痛,舌上白腻,以辛温开气痹,分湿理痰。
半夏 茯苓 荜茇 生姜 生益智 新会皮
丁(五十一岁) 面色亮,脉弦,此属痰饮。饮伏下焦肾络,中年冷暖不和,烦劳伤气,
着枕必气逆,饮泛喘促,脘闷咽阻,治之可效,而不除根。
文辞端庄严谨,笔法老练成熟。
李姓患者(四十三岁)患疟疾,寒战时必然呕吐,胃中停滞的痰浊之邪尚未清除,舌苔微白,没有饮水的欲望,治疗以开郁结、理气机为主。
草果 浓朴 荜茇 橘白 杏仁 熟半夏 姜汁
张姓患者(五十三岁)患三疟(三日一发之疟疾),病程迁延两三年,面部肌肉黄瘦萎软,嘴唇和口角干枯苍白,食物进入胃脘腹部后感到胀满,双腿痿软无力如同坠落一般,到了晚上出现浮肿。其所损伤的是脾阳和肾阳,然而脾脏通过运化转输功能才能强健,肾脏以收纳精气作为生命之根本,不能只用一方兼顾,必须按照古法分治。
早上服用肾气丸,晚上服用理中汤(早晚分别治疗,切实妥当。)
周姓患者(六十岁)气血已经衰弱,出现噎膈反胃的症状,这往往发生在中年以后。大概是因为操持家务劳累过度,必定损伤心脾的营血,营阴津液日渐枯竭,清气日渐郁结,导致食管逐渐狭窄,郁久之后痰涎在内部聚集,食物进入后痰涎涌起,从而导致反胃。这是气分的郁结(提起清气分的郁结,便有了治疗的主体思路)。山茱萸、熟地黄、枸杞子,用来滋养肝肾,但胃先感觉到腻滞,怎么能让肝肾得到益处呢?
人参补气生精,半夏消痰开结,白蜜润燥滋液,最为恰当。
吴姓患者(三十五岁)据描述咽喉中有气上冲,随即引发咳嗽,经过多年调理治疗,逐渐导致食欲减退、乏力。这都是因为没有区分外感病因,白白受到治疗痰嗽的拖累。凡是久病应当询问睡眠和饮食情况,参考观察面色形态和脉象,扁鹊曾说下焦亏损波及到胃就是这种情况(气冲即咳,内伤显然,如果还只是徒劳地治疗痰嗽,难怪先生会鄙夷这种做法。)
吴姓患者(通关坊,四十四岁)劳损受伤却治疗不得法,反而受到药物的伤害,络脉中的血液枯竭而导致疼痛,进食后疼痛发作,病位在胃络,用甘缓之法柔肝,以紧急救治胃气。
桂圆肉 炒桃仁
孙姓患者(北濠,二十六岁)进食后左胁部气逆疼痛,这是肝胆气热(老练的笔法。)
丹皮 钩藤 生地 川石斛 柏子仁 茯苓
李姓患者(五十六岁)小腹部满胀,一定在夜间卧床时加重,早晨起来肠道排泄浊气,白天仍然可以办事。拖延了好几年,气机上冲至胃脘,胃脘高突且感觉寒冷,舌根也胀痛,自胸部延伸至舌头。医生使用吴茱萸、川楝子,苦辛温药佐以苦寒降泄药,患者感到不安,由此可知患病已有年头。下元已经虚弱,气机散漫而不能向下归摄(这就是西昌老人所说的地气加于天的病症。治疗方法清晰确切,但仍嫌迟钝,应该先用炒枯的肾气汤服用几剂。)
八味丸(三钱)
金姓患者(三十五岁)大便带血多年,进而发展为足背浮肿、腹部膨隆,食量减少、神色衰败,没有使用化痰止咳凉药的道理(脾肾兼用温补。)
九蒸熟白术 淡熟附子
王姓患者(七十七岁)高龄之气衰弱,不耐受暑热伏久,逼迫津液被耗伤,阳气不能内归(“阳气不能内归”这四个字极其精辟),睡眠少且不宁静。常规使用竹叶地黄汤,滋养津液清除虚热,不要给予气味燥烈劣质的药物,否则反而伤害胃气(阴阳往往相互依恋,老年人睡眠少,是因为津血不足而阳气不能内归。)
尹姓患者(织造府前,五十八岁)接近六十岁,营运之阳已经微弱,饮酒及食物导致气滞而湿气聚集(抓住“气”字发挥),脉络运行不畅,没有饥饿感,气机攻冲触痛,舌苔白腻,用辛温之法开通气痹,分利湿气、调理痰浊。
半夏 茯苓 荜茇 生姜 生益智 新会皮
丁姓患者(五十一岁)面色光亮,脉弦,这属于痰饮。饮邪潜伏在下焦肾络,中年时期冷暖不调,烦劳伤气,一躺下枕头就气逆,饮邪泛滥导致喘促,胃脘闷塞、咽喉阻塞,治疗可以见效,但不能除根。
The literary style is dignified and rigorous, with a mature and skilled brushwork.
Patient Li (43 years old) suffers from malaria; vomiting inevitably occurs during chills. The turbid phlegm stagnating in the stomach has not yet cleared, the tongue coating is slightly white, and there is no desire to drink. The treatment focuses on resolving stagnation and regulating Qi.
Caoguo (Tsaoko Fruit), Nongpo (Magnolia Bark), Bibie (Long Pepper), Ju Bai (Citrus Peel), Xingren (Apricot Seed), Shu Banxia (Prepared Pinellia Rhizome), Jiang Zhi (Ginger Juice).
Patient Zhang (53 years old) has suffered from "San Nu" (malaria occurring every third day) for two or three years. Facial muscles are yellow and emaciated, lips and mouth are dry and pale. After food enters the epigastrium and abdomen, distension occurs. The legs are flaccid and weak as if dropping. Edema appears in the evening. The injury involves Spleen Yang and Kidney Yang. However, the Spleen becomes strong through transportation and transformation functions, while the Kidney serves as the root of life by receiving and storing essence. One formula cannot address both simultaneously; ancient methods must be followed for separate treatments.
Take Shenqi Wan (Kidney Qi Pill) in the morning and Lizhong Tang (Regulate the Middle Decoction) in the evening (treating separately at different times is practical and appropriate.)
Patient Zhou (60 years old) has depleted Qi and Blood, presenting with dysphagia and regurgitation, a condition often seen after middle age. This is likely due to excessive mental and physical labor in managing the household, which inevitably damages the Ying (Nutritive) aspect of the Heart and Spleen. Ying fluids dry up daily, and clear Qi knots daily, causing the esophagus to gradually narrow. Prolonged stagnation leads to internal accumulation of phlegm-saliva. When food enters, phlegm-saliva surges upward, causing regurgitation. This is a knotting of the Qi aspect (Resolving the knotting of Clear Qi provides the main therapeutic focus). Cornus Fructus (Shan Zhu Yu), Rehmanniae Radix Praeparata (Shu Di Huang), and Lycii Fructus (Gou Qi Zi) nourish the Liver and Kidneys. However, the Stomach first feels cloying and stagnant; how can the Liver and Kidneys benefit?
Ren Shen (Ginseng Root) tonifies Qi and generates essence; Ban Xia (Pinellia Rhizome) resolves phlegm and opens stagnation; Bai Mi (White Honey) moistens dryness and nourishes fluids. This approach is most appropriate.
Patient Wu (35 years old) reports a sensation of Qi rushing in the throat, immediately triggering coughing. After years of treatment, appetite has decreased and strength has failed. This results from failing to distinguish external causes, thereby suffering unnecessarily from treatments targeting phlegm and cough. For chronic illnesses, one must inquire about sleep and diet, and observe complexion, form, and pulse. Bian Que stated that damage to the lower jiao affecting the Stomach is such a case (Qi rushing causing cough indicates obvious internal damage; continuing to treat only phlegm and cough explains why the physician holds this in disdain.)
Patient Wu (from Tongguan Fang, 44 years old) was injured by fatigue but treated improperly, resulting in drug-induced injury. Collateral blood dried up, causing pain. Pain arises upon eating, indicating the disease is in the Stomach collaterals. Use sweet and缓和 (relaxing) methods to soothe the Liver to urgently rescue the Stomach.
Gui Yuan Rou (Longan Aril), Chao Tao Ren (Stir-fried Peach Kernel).
Patient Sun (from Beihao, 26 years old) experiences Qi rebellion and pain in the left hypochondrium after eating, indicating Heat in the Liver and Gallbladder (A masterful stroke.)
Mu Dan Pi (Moutan Cortex), Gou Teng (Uncaria Ramulus), Sheng Di Huang (Rehmanniae Radix), Chuan Shi Hu (Dendrobii Officinalis Caulis), Bai Zi Ren (Biota Seed), Fu Ling (Poria).
Patient Li (56 years old) has fullness and distension in the lower abdomen, worsening at night when lying down. In the morning, the intestines expel turbid gas, allowing him to function normally during the day. This has persisted for several years. Qi rushes to the epigastrium, which protrudes and feels cold. The base of the tongue is also painful and swollen, extending from the chest to the tongue. Physicians used Wu Zhu Yu (Evodia Fruit) and Chuan Lian Zi (Toosendan Fruit); bitter-cold descending agents combined with acrid-warm agents caused discomfort, indicating the illness has existed for many years. The Lower Origin is already deficient, and Qi is scattered without being grasped downward (This is what the elder of Xichang calls "Earth Qi adding to Heaven Qi." The treatment method is clear and precise, but still considered sluggish; one should first use Chao Ku Shenqi Tang (Fried Dry Kidney Qi Decoction) for a few doses.)
Bawei Wan (Eight-Ingredient Pill) (3 qian)
Patient Jin (35 years old) has had bloody stools for many years, progressing to edema of the dorsum of the foot and abdominal distension. Appetite is low, and complexion is depleted. There is no rationale for using phlegm-resolving, cough-stopping, or cooling herbs (Tonify both Spleen and Kidney with warmth.)
Jiu Zheng Shu Bai Zhu (Nine-steamed Prepared Atractylodes Macrocephala Rhizome), Dan Shu Fu Zi (Lightly prepared Aconite Lateral Root).
Patient Wang (77 years old) is advanced in age with declining Qi. He cannot endure prolonged summer heat, which forces the consumption of body fluids. Yang fails to return inward (The phrase "Yang fails to return inward" is extremely profound.), leading to scanty and restless sleep. The standard prescription is Zhuye Dihuang Tang (Bamboo Leaf and Rehmannia Decoction) to nourish fluids and eliminate heat. Do not administer drugs with drying or inferior flavors, which would instead damage the Stomach (Yin and Yang often cling to each other; the elderly have little sleep because Jing and Blood are insufficient, preventing Yang from returning inward.)
Patient Yin (in front of the Weaving Bureau, 58 years old) Approaching sixty, his transporting Yang is already weak. Alcohol and food cause Qi stagnation and dampness accumulation (Focusing on the character "Qi" expands the analysis.). Meridian circulation is blocked. There is no hunger sensation. Qi attacks causing pain. The tongue coating is white and greasy. Use acrid-warm methods to open Qi obstruction, separate dampness, and regulate phlegm.
Ban Xia (Pinellia Rhizome), Fu Ling (Poria), Bibie (Long Pepper), Sheng Jiang (Fresh Ginger), Sheng Yi Zhi (Fresh Alpinia Oxyphylla Fruit), Xin Hui Pi (Xinhui Citrus Peel).
Patient Ding (51 years old) has a bright complexion and a wiry pulse, indicating Phlegm-Fluid retention. Fluids hide in the lower jiao Kidney collaterals. Due to irregular temperature changes in middle age and fatigue damaging Qi, lying on the pillow triggers Qi rebellion. Fluids surge causing panting, epigastrical stuffiness, and throat obstruction. Treatment can be effective but will not eradicate the root.