常见有力之家,或父母年高,或己身微恙,往往十分珍重,药饵不绝于口。始以药之偏
气,
治身中气血之偏。不知久服药石,伤冲和清粹之气,尽为草木香移易。即参、苓日进,久之
脏腑相安。倘遇缓急服之,亦呼应不灵。病气深而归于无益,此惟阅历深且久者,方知有此
弊耳。
钱(四十七岁) 前方去犀角、连翘,加川贝、黑栀皮。
陈(二十六岁) 此劳病自肾损延及胃腑,脉垂色夺,肌消,日加枯槁,阴损及阳,草木
不能生出精血,服之不效为此。
偶(关上,五十九岁) 瘦人液枯,烦劳动阳,气逆冲气,渐如噎膈。衰老之象,安间可
久(液枯之人即劳动伤阳,亦须清养津液,是盏中添油法。)
枇杷叶 杜苏子 柏子仁 火麻仁 炒桃仁
张(五十五岁) 窍乏之人,身心劳动,赖以养家。此久嗽失血声嘶,是心营肺卫之损伤
,不与富户酒色精夺同推。
黄精 白芨 米仁 茯苓
戴(十六岁) 男子情窦动萌,龙雷内灼,阴不得充,遂有失血咳逆内热,皆阴虚而来。
自能
潜心笃志,养之可愈,数发必凶(龙雷之火内灼,势必暗烁精气,必思所以畅泄,安得不阴
虚乎?)
六味去丹皮、泽泻,加龟板、莲肉、芡实、人乳粉、金樱膏。
王(三十一岁) 劳力气血逆乱,内聚瘀血,壅阻气分,痛而呕紫滞形色,久病只宜缓逐
,不可急攻。
桃仁 茺蔚子 延胡 归尾 南查 漏芦 青葱
杨(花步) 背寒属卫阳微,汗泄热缓。
人参建中汤去姜。
严(仓前,三十三岁) 长夏湿邪,治不按法,变疟,不尽泄其邪,痛泻不爽,不能受食
,勉
强与食即呕吐(种种病形中有秽滞耳。)是脾胃营运之阳,久为苦寒消克所致(湿邪必带秽浊
,芳香逐秽,即是按法治病。)
苏合丸。
汪 到吴诸恙向愈,佥从两和脾胃,近日家中病患纠缠,以有拂郁肝胆,木火因之沸起
。气
从左胁上撞,即丹溪上升之气,自肝而出,木必犯土,胃气为减(病虽向愈,元气未固,肝
胆木火最易沸起,况气从左升,病机显然。)
人参 茯苓 炙草 生谷芽 木瓜 川斛
席(东山,二十岁) 问病已逾年,食饱腹膨,微痛便溏,久嗽痰多,凡越几日,必
身热,
此劳伤由脾胃失运,郁而来热,痰多,食不相和,则非地黄滋滞者(脾胃失运,郁火生热,
蒸动周身,此必有积滞留中,气机不畅达者。)
米仁 南枣 生麦芽 桔梗 胡连 茯苓 白芍 广皮
张(三十岁) 此肾虚不纳,冲气上干,喘嗽失音,夜坐不卧,医每治肺,日疲致凶。早
服薛氏八味丸三钱。
两肾中间一点,明是谓命门先天之精,元气之始,人托之以生命者。凡人呼出之气,肺
主之,吸入之气,直下达肾中,必肾气足,而吸引之机权自旺。
杨(二十二岁) 心事闷萦,胸膈痞痹,多嗳吐涎,述脐左及小腹有形而坚,按之微痛,
大便亦
不爽适,此属小肠部位,腑病宜通(心与小肠为表里,未有心事闷萦而不病及腑阳者。轻则
小便赤,重则坚成有形。明眼人见透。)
枳实 桔梗 莪术 青皮 槟榔 芦荟
葱汁泛丸。
此等病,妇女更多,不得误认为瘕病也。
盖妇女最多心事闷萦耳,须留意也。
沈(丁家巷,六十五岁) 痔血与肠风不同,心中嘈辣,营分有热,非温蒸补药矣(阅此
则凡心中疼热烦闷,虽因木火上冲,必是营分有热也。)
生地 白芍 柿饼炭 槐花 银花 地榆
的是营分有热,方药中下虚而下血,须用温蒸补药。
程(四十二岁) 夏四月阳升病发,深秋暨冬自愈。夫厥阴肝为阴之尽,阳之始,吐蛔而
起,
必从肝入胃。仲景辛酸两和,寒苦直降,辛热宣通,所赅甚广。白术甘草守中为忌(乌梅法
何等深奥,此则十二字广深该博,直截了当,读书另具慧眼。)
川椒 川连 桂枝 附子 乌梅 干姜 白芍 细辛 人参 川楝子 黄柏
韩(五十四岁) 时令之湿外袭,水谷之湿内蕴,游行躯壳,少阳阳明脉中久湿,湿中生
热。《内经》淡渗佐苦温,新受之(有分晓)邪易驱,已经两月余,病成变热矣(若非用桂枝
一味
,温通经络,势必凉药具湿热拒格而不相入矣。名手过人处在此。)
南花粉 飞滑石 石膏 桂枝(仙乎) 薏苡仁 羚羊角
周(钮家巷,六十七岁) 老年精血内枯,开阖失司,癃闭分利(该括无数病机,)仍是泻
法。成形者,散漫之气也(精深之论,散漫之气,浊阴之气也。)
鹿茸(二两) 麝香(二钱) 归身(一两)
用生姜一两,羊肉四两,煎汤泛丸。
汪(五十七岁) 胸痹是上焦清阳不为舒展,仲景以轻剂通阳。
【背景信息】
书名:徐批叶天士晚年方案真本 作者:叶天士 朝代:清 章节:大半夏汤 / 一气丹 类别:方剂
【待处理原文翻译】
常见富裕人家,或者父母年事已高,或者自己身体略有小病,往往十分珍视爱护,药物不断入口。起初是用药物的偏性,来纠正身体中气血的偏颇。却不知道长期服用金石类药物,会损伤冲和清粹之气(指人体平和清纯的生命之气),全部被草木药性的气味所改变。即使每天进服人参、茯苓等补益药,久而久之脏腑之间看似相安无事。倘若遇到急症时再服用这些药,也反应迟钝不灵敏。病邪深重而服药无益,这只有阅历深厚且长久的人,才知道有此弊端罢了。
陈某(二十六岁)此劳损病证从肾脏亏损蔓延波及胃腑,脉象微弱、面色枯槁,肌肉消瘦,日益干枯憔悴,阴精亏损累及阳气,草木药物不能生出精血,服用无效是因为这个原因。
偶某(关上,五十九岁)瘦人津液枯竭,烦劳耗伤阳气,气逆冲击冲脉,逐渐出现类似噎膈的症状。这是衰老的迹象。(津液枯竭之人即使因劳动损伤阳气,也必须清润滋养津液,这是在灯盏中添加油的方法。)
枇杷叶 杜苏子 柏子仁 火麻仁 炒桃仁
张某(五十五岁)窍道匮乏之人,身心过度劳累,依靠劳作养家糊口。此久咳失血、声音嘶哑,是心营肺卫的损伤,不能与富贵人家酒色过度精气耗夺的情况同等看待。
黄精 白芨 米仁 茯苓
戴某(十六岁)男子情欲萌动,龙雷之火(指肾中相火)在内灼烧,阴精不得充盈,于是有失血、咳逆、内热等症状,都是阴虚所致。若能潜心笃志修养,可以痊愈,若多次发作必然凶险。(龙雷之火在内灼烧,势必暗中烁耗精气,必须思考如何畅泄,怎能不导致阴虚呢?)
六味地黄丸去掉牡丹皮、泽泻,加入龟板、莲肉、芡实、人乳粉、金樱膏。
王某(三十一岁)劳力气血逆乱,内部聚集瘀血,壅阻气分,疼痛且呕吐紫黑色滞涩的血块,形色晦暗,久病只宜缓慢驱逐瘀血,不可急于攻伐。
桃仁 茺蔚子 延胡索 归尾 南查(注:疑为南楂或特定药材别名,此处保留原名) 漏芦 青葱
杨某(花步)背部寒冷属于卫阳微弱,汗出后热势暂缓。
人参建中汤去掉生姜。
严某(仓前,三十三岁)长夏季节湿邪侵袭,治疗不按常规方法,变为疟疾,未能完全宣泄其邪气,腹痛腹泻不爽,不能进食,勉强进食即呕吐(各种病形中有秽浊停滞的缘故)。这是脾胃营运之阳气,长期被苦寒药物消克所致(湿邪必定带有秽浊,芳香化浊逐秽,就是按法治病)。
苏合丸。
汪某 到吴地诸病趋向痊愈,大家都主张调和脾胃,近日家中病患纠缠,因为肝胆气机拂郁,木火因此沸腾而起。气从左胁上撞,这就是丹溪所说的上升之气,自肝而出,木必犯土,胃气因此减弱(病虽趋向痊愈,元气未固,肝胆木火最容易沸腾而起,况且气从左升,病机明显)。
人参 茯苓 炙甘草 生谷芽 木瓜 川石斛
席某(东山,二十岁)询问病情已超过一年,食饱腹部膨隆,微痛便溏,久咳痰多,凡是过几天,必然身热,此劳伤由脾胃失于运化,郁结而生热,痰多,食物不相调和,则不适合用地黄等滋腻药物(脾胃失于运化,郁火生热,蒸动周身,这中间必有积滞留于中焦,气机不畅达的原因)。
米仁 南枣 生麦芽 桔梗 胡黄连 茯苓 白芍 广陈皮
张某(三十岁)此肾虚不能纳气,冲气上干,喘嗽失音,夜间坐卧不安,医生每每治疗肺脏,日久疲惫导致凶险。早晨服用薛氏八味丸三钱。
两肾中间一点,明确称为命门先天之精,元气的起始,人依托它而维持生命。凡人呼出的气,由肺主司;吸入的气,直下达于肾中,必须肾气充足,而吸引的机能自然旺盛。
杨某(二十二岁)心事闷结萦绕,胸膈痞塞痹阻,多嗳气吐涎,诉说脐左及小腹有形而坚硬,按压微痛,大便也不爽适,此属小肠部位,腑病适宜通利(心与小肠互为表里,没有心事闷结萦绕而不波及腑阳的。轻则小便赤,重则坚硬成形。明眼人看得透彻)。
枳实 桔梗 莪术 青皮 槟榔 芦荟
用葱汁泛丸。
这类病,妇女更多见,不得误认为是瘕病(腹中结块)。
大概妇女最多心事闷结萦绕,须留意啊。
沈某(丁家巷,六十五岁)痔血与肠风不同,心中嘈杂辣感,营分有热,不是温蒸补药所能治的(阅读此条可知,凡心中疼热烦闷,虽然因木火上冲,必定是营分有热)。
生地 白芍 柿饼炭 槐花 银花 地榆
确实是营分有热,方药中下虚而下血,须用温蒸补药。
程某(四十二岁)夏四月阳气升发疾病发作,深秋暨冬季自愈。厥阴肝为阴之尽,阳之始,吐蛔虫而起病,必定从肝入胃。张仲景用辛味和酸味两相调和,寒苦味直接降逆,辛热味宣通,涵盖非常广泛。白术甘草守中为禁忌(乌梅法何等深奥,这十二字广深该博,直截了当,读书另具慧眼)。
川椒 川黄连 桂枝 附子 乌梅 干姜 白芍 细辛 人参 川楝子 黄柏
韩某(五十四岁)时令之湿外袭,水谷之湿内蕴,游行躯壳,少阳阳明脉中久湿,湿中生热。《内经》说淡渗佐以苦温,新受的邪气容易驱除,已经两个多月,病已成变热了(如果不是用桂枝一味,温通经络,势必凉药与湿热拒格而不相入矣。名医过人之处在此)。
南花粉 飞滑石 石膏 桂枝 薏苡仁 羚羊角
周某(钮家巷,六十七岁)老年精血内部枯竭,开阖功能失调,癃闭分利(概括了无数病机),仍是泻法。成形者,是散漫之气(精深之论,散漫之气,即浊阴之气)。
鹿茸(二两) 麝香(二钱) 归身(一两)
用生姜一两,羊肉四两,煎汤泛丸。
[Background Information]
Book: Xu's Commentary on Ye Tianshi's Late-Life Prescriptions Authentic Edition
Author: Ye Tianshi
Dynasty: Qing
Chapter: Banxia Tang / Yi Qi Dan
Category: Formula
[English Translation]
Commonly, wealthy families, whether their parents are advanced in age or they themselves have minor ailments, often cherish and protect themselves excessively, with medicines constantly entering the mouth. Initially, the bias of the medicine is used to correct the bias of qi and blood in the body. However, they do not realize that long-term consumption of mineral drugs damages the harmonious and pure qi (referring to the peaceful and pure vital qi of the human body), which is entirely altered by the aromas and properties of herbal medicines. Even if Ginseng and Poria are taken daily for a long time, the zang-fu organs may appear at peace. Yet, when encountering acute conditions later, these medicines will respond sluggishly and ineffectively. When pathogens are deep-seated, medication becomes useless; only those with profound and long experience know this drawback.
Patient Qian (47 years old): Remove Rhinoceros Horn (Xijiao) and Forsythia (Lianqiao) from the previous prescription; add Fritillaria (Chuanbei) and Black Gardenia Peel (Heizhipi).
Patient Chen (26 years old): This consumptive disease has spread from kidney deficiency to the stomach fu-organ. The pulse is faint, complexion is sallow, muscles are emaciated, and the condition worsens daily into dryness and decay. Yin deficiency affecting Yang, and herbal medicines cannot generate essence and blood; thus, taking them is ineffective for this reason.
Patient Ou (Guan Shang, 59 years old): Thin individuals suffer from fluid depletion. Excessive labor injures yang qi, causing qi rebellion attacking the Chong vessel, gradually resembling dysphagia (Yige). This is a sign of senility. (For those with depleted fluids, even if labor injures yang, one must clear and nourish fluids, akin to adding oil to a lamp.)
Loquat Leaf (Pipaye), Perilla Seed (Dusuzi), Biota Seed (Baiziren), Hemp Seed (Huomaren), Fried Peach Kernel (Taoren).
Patient Zhang (55 years old): Individuals with deficient orifices endure excessive physical and mental labor to support their families. Chronic cough with hemoptysis and hoarseness indicate damage to Heart Ying (Nutrient) and Lung Wei (Defensive) levels. This should not be equated with the essence and qi depletion caused by alcohol and sexual excess in wealthy households.
Polygonatum (Huangjing), Bletilla (Baiji), Coix Seed (Miren), Poria (Fuling).
Patient Dai (16 years old): In males, the onset of sexual desire triggers the internal burning of Dragon-Lei Fire (referring to ministerial fire in the Kidney). Yin essence fails to fill, leading to hemoptysis, coughing upward, and internal heat, all stemming from Yin deficiency. If one can concentrate their mind and cultivate properly, recovery is possible; however, recurrent attacks will surely be fatal. (The internal burning of Dragon-Lei Fire inevitably darkly scorches essence and qi; one must consider how to vent it freely, otherwise how can Yin not become deficient?)
Six-Ingredient Pill with Rehmannia (Liujunzi Wan) minus Moutan Bark (Danpi) and Alisma (Zexie); add Turtle Shell (Guiban), Lotus Seed (Lianrou), Euryale Seed (Qianshi), Human Milk Powder (Renrufen), and Rosa Laevigata Paste (Jinyingao).
Patient Wang (31 years old): Labor-induced qi and blood chaos leads to internal accumulation of blood stasis, obstructing the Qi level. Pain and vomiting of purple, stagnant blood occur, with dull coloration. For chronic illness, slow expulsion is suitable; urgent attack is contraindicated.
Peach Kernel (Taoren), Leonurus Fruit (Chongweizi), Corydalis (Yanhusuo), Angelica Tail (Guiwei), Nanzha (Note: likely a specific herb alias, kept as is), Lophatherum (Loulu), Green Onion (Qingcong).
Patient Yang (Huabu): Back coldness belongs to weak Wei Yang; sweating relieves the heat temporarily.
Renshen Jianzhong Decoction minus Ginger.
Patient Yan (Cangqian, 33 years old): Summer-damp pathogen invasion, treated improperly, transformed into malaria. Failure to fully expel the pathogen results in painful diarrhea and inability to tolerate food; forced eating causes vomiting (various pathological forms involve turbid stagnation). This is because the transporting and transforming Yang of the Spleen and Stomach has been long destroyed by bitter-cold drugs. (Dampness always carries turbidity; aromatic herbs eliminating turbidity constitute proper treatment.)
Suhe Wan.
Patient Wang: Upon arriving in Wu, various ailments were resolving. Everyone advocated harmonizing the Spleen and Stomach. Recently, domestic patients have entangled him due to Liver-Gallbladder Qi stagnation, causing Wood-Fire to boil up. Qi rushes up from the left hypochondrium, which is Danxi’s concept of ascending Qi originating from the Liver. Wood inevitably invades Earth, reducing Stomach Qi. (Although the illness was resolving, Yuan Qi was not solidified; Liver-Gallbladder Wood-Fire easily boils up. Moreover, Qi ascending from the left makes the pathology obvious.)
Ginseng (Renshen), Poria (Fuling), Roasted Licorice (Zhigancao), Raw Grain Sprout (Sheng Guya), Papaya (Mu Gua), Dendrobium (Chuanhu).
Patient Xi (Dongshan, 20 years old): The illness has lasted over a year. After full meals, the abdomen distends with slight pain and loose stools. Chronic cough produces much phlegm. Every few days, fever occurs. This consumptive injury stems from Spleen-Stomach failure to transport, leading to stagnation-generated heat. With much phlegm and indigestion, Rehmannia (Di Huang) and other cloying tonics are unsuitable. (Spleen-Stomach transport failure generates stagnation-fire and heat, steaming the whole body. There must be accumulation lingering in the middle Jiao, with unsmooth Qi mechanism.)
Coix Seed (Miren), Southern Jujube (Nanzao), Raw Malt (Sheng Maiya), Platycodon (Jiegeng), Coptis (Hulian), Poria (Fuling), White Peony Root (Baishao), Tangerine Peel (Guangpi).
Patient Zhang (30 years old): This is Kidney deficiency failing to grasp Qi, with Chong Qi rebelling upward, causing wheezing, coughing, loss of voice, and inability to lie down at night. Physicians often treat the Lung, leading to exhaustion and fatality over time. Take Xue’s Eight-Ingredient Pill (Xueshi Bawei Wan) three qian in the morning.
The point between the two kidneys is clearly called the Gate of Life (Mingmen), the primordial essence of Heaven and Earth, the beginning of Yuan Qi, upon which humans rely for life. The air exhaled is governed by the Lung; the air inhaled descends directly to the Kidneys. Only when Kidney Qi is sufficient does the mechanism of attraction naturally flourish.
Patient Yang (22 years old): Mental distress lingers, causing chest and diaphragm oppression and bi-syndrome, frequent belching and salivation. He describes a hard, palpable mass in the left umbilical and lower abdominal region, slightly painful on pressure, with uncomfortable bowel movements. This belongs to the Small Intestine area; Fu-organ diseases require unblocking. (Heart and Small Intestine are interior-exterior related; there is no case where mental distress does not affect Fu-Yang. Mild cases present with red urine; severe cases form hard masses. Insightful observers see through this clearly.)
Immature Bitter Orange (Zhishi), Platycodon (Jiegeng), Curcuma (Ezhu), Green Tangerine Peel (Qingpi), Areca Nut (Binglang), Aloe (Luhui).
Pill coated with Green Onion Juice.
Such diseases are more common in women; do not mistakenly diagnose them as Zhai masses (abdominal masses).
Generally, women suffer most from lingering mental distress; take note.
Patient Shen (Dingjia Alley, 65 years old): Hemorrhoids differ from Changfeng (wind-intestinal bleeding). A spicy sensation in the heart indicates Heat in the Ying (Nutrient) level, not suitable for warming and steaming tonics. (Reading this reveals that any heart pain, heat, and restlessness, even if due to Wood-Fire rushing up, must involve Heat in the Ying level.)
Rehmannia Root (Shengdi), White Peony Root (Baishao), Charred Persimmon Cake (Shibing Tan), Sophora Flower (Huaihua), Honeysuckle (Yinhua), Sanguisorba (Diyu).
Indeed, there is Heat in the Ying level. In prescriptions, for lower deficiency with lower bleeding, warming and steaming tonics are required.
Patient Cheng (42 years old): In the fourth lunar month, rising Yang triggers the disease; it heals spontaneously in late autumn and winter. Jueyin Liver is the end of Yin and the beginning of Yang. Vomiting roundworms marks the onset, necessarily moving from Liver to Stomach. Zhang Zhongjing uses Sour and Acrid to harmonize both, Bitter-Cold to descend directly, and Acrid-Warm to unblock; the scope is very broad. Atractylodes (Baizhu) and Licorice (Gancao) guarding the center are contraindicated. (The Wumei method is so profound; these twelve characters are extensive and profound, direct and straightforward. Reading requires special insight.)
Sichuan Pepper (Chuanjiao), Coptis (Chuanlian), Cinnamon Twig (Guizhi), Aconite (Fuzi), Mume Fruit (Wumei), Dried Ginger (Ganjiang), White Peony Root (Baishao), Asarum (Xixin), Ginseng (Renshen), Toosendan Fruit (Chuanlianzi), Phellodendron (Huangbai).
Patient Han (54 years old): Seasonal dampness invades externally, grain-water dampness accumulates internally, wandering through the body shell. Long-standing dampness in Shaoyang and Yangming meridians generates heat within dampness. The *Neijing* states using bland-draining aided by bitter-warm. Newly acquired pathogens are easy to驱除 (expel); having persisted for over two months, the disease has transformed into heat. (If not for using a single dose of Cinnamon Twig to warm and unblock the collaterals, cool medicines would certainly be rejected by damp-heat and fail to enter. This is the superior skill of famous physicians.)
Trichosanthes Root (Nanhua Fen), Calcined Talcum Feihuas Shi (Fei Huashi), Gypsum (Shigao), Cinnamon Twig (Guizhi), Coix Seed (Yiyiren), Antelope Horn (Lingyangjiao).
Patient Zhou (Niujia Alley, 67 years old): In old age, essence and blood are internally depleted, opening and closing mechanisms fail, leading to strangury and retention requiring separation and draining (this encompasses countless pathological mechanisms), which remains a purging method. Formed masses represent scattered Qi (profound theory: scattered Qi refers to turbid Yin Qi).
Deer Antler Lu Rong (2 liang), Musk She Xiang (2 qian), Angelica Sinensis Root Gui Shen (1 liang).
Pills made using decoction of 1 liang Fresh Ginger and 4 liang Mutton.
Patient Wang (57 years old): Chest Bi (obstruction) is due to Upper Jiao Clear Yang failing to expand. Zhang Zhongjing uses light agents to unblock Yang.