王(木渎,三十九岁)瘀血壅滞,腹大蛊鼓,有形无形之分,温通为正法,非肾气汤丸
治阴水泛滥(肾气汤丸治阴水之法,非治阳水也。)
桃仁 肉桂 制大黄 椒目 陈香橼(二两)
煎汤泛丸。
黄(江西,六十三岁) 病是劳倦内伤,客(已是伤阳本质)途舟中,往来复受时令暑湿,
病已
过月,不饥不大便,脉微小属阴,暑湿皆属阴浊,气分为浊阴蔽塞,仲景谓阴结湿结,肠胃
无阳气营运,强通大便,浊反逆致。此入夜阴用事而痛甚矣(精理名言,如印沙划泥,谁具
嗣音乎?脉法精深,人皆忽略矣。)
淡干姜 生炒黑附子 炙黑甘草 生大白芍
处方清切,通阳更以甲己法和阴止腹痛。
唐(二十三岁) 脉动,泻后利纯血,后重肛坠,乃阴虚络伤,下元不为收摄,必绝欲经
年,肾精默充可愈。
人参 熟地炭 炙甘草 五味子 禹余粮
郁(三十八岁) 秋暑暴热,烁津损液,消渴再灼,阴不承载于上,金水同乃子母生方。
人参 鲜生地 麦冬 柏子仁 知母 青甘蔗汁
处方如鲜花,抑何清灵也。
杨(三十三岁) 阳气为烦劳久伤,腹痛,漉漉水声,重按痛缓,非水积聚。盖阳乏少运
,必阴浊凝滞,理阳为宜,大忌逐水攻滞。
生白术 熟附子 泽泻 左牡蛎 水泛丸。
李(寿星桥,五十七岁) 寒湿伤阳,痞满妨食,脉沉色黄,是脾胃病。议辛温通中焦之
阳。
生益智 荜茇 檀香末 姜汁 茯苓 炒焦半夏
江(宝林寺前,二十五岁) 瘅疟邪在肺,口渴,骨节烦疼,用桂枝白虎汤。
黄(嘉兴,三十九岁) 向年戌亥时发厥,是以肝肾阴虚,阴火内风蒙神(阴火内风蒙神
,千
锤百炼而出一语,胜人千百味之无极。)治逾五载,迄今左目流泪,至暮少明,胃脘中隙痛
。经谓肝脉贯膈入胃,肝窍在目,此皆精血内亏不足之象。若云平肝是疏克,攻治乃相反矣
。
天冬 熟地 杞子 元参 浙菊花 谷精珠
邹(十岁) 稚年,泻血便溏有三四载,面黄形瘦,五疳之症,起于五味杂沓,肠胃生热
。若不慎口食,久疳延劳不治。
川连 胡连 茯苓 白芍 枳实皮 焦术 南查 臭芜荑 使君子
乌梅肉丸。
秦(二十二岁) 据述久逗客邸,情志不适,致脘中两胁按之而痛,大便久不爽利,脉形
弦坚,
面色不华,纳食已少,虚中有滞,以宣通腑络(情志不适,肝木必乘胃土,食少不化,是以
虚中有滞。)
熟桃仁 海石 土栝蒌 熟半夏 橘红 枳实皮
秦(三十九岁) 劳心力办事,气怯神耗致病,医咳嗽失血,多以清凉为药,视其形色脉
象,凡劳伤治嗽药,不惟无效,必胃口日疲。
王姓患者(木渎人,三十九岁):瘀血壅滞,腹部胀大如鼓,分为有形和无形两种情况。温通是正治法,不能用肾气汤丸治疗阴水泛滥(注:肾气汤丸是治疗阴水的方法,不是治疗阳水的方法)。
处方:桃仁、肉桂、制大黄、椒目、陈香橼(各二两),煎汤泛丸。
黄姓患者(江西人,六十三岁):病因为劳倦内伤,客邪(此时已损伤阳气本质)在舟车旅途中,反复感受时令暑湿,病程已过一个月,不思饮食且不大便,脉象微小属阴证,暑湿皆属阴浊之邪。气分被浊阴蔽塞,仲景所说的阴结、湿结,肠胃无阳气运化,若强行通便,浊邪反而逆乱上冲。此症入夜阴气主事时疼痛加剧(这是精辟的理论名言,如印沙划泥般清晰,谁能继承其音律呢?脉法精深,人们都忽略了)。
处方:淡干姜、生炒黑附子、炙黑甘草、生大白芍。
处方清切,通过“甲己合化土”之法通阳,并配合和阴法以止腹痛。
唐姓患者(二十三岁):脉动,泻后排出纯血,肛门重坠,这是阴虚络脉受损,下元不能收摄,必须禁欲经年,使肾精默默充盈方可痊愈。
处方:人参、熟地炭、炙甘草、五味子、禹余粮。
郁姓患者(三十八岁):秋暑暴热,灼伤津液,消渴症状再次加重,阴液不能承载于上,金(肺)水(肾)同补乃母子相生之法。
处方:人参、鲜生地、麦冬、柏子仁、知母、青甘蔗汁。
处方如鲜花般清新灵动。
杨姓患者(三十三岁):阳气因烦劳久伤,腹痛,肠间漉漉有水声,重按疼痛缓解,并非水饮积聚。盖因阳气匮乏少运,必然导致阴浊凝滞,理阳为宜,大忌逐水攻滞。
处方:生白术、熟附子、泽泻、左牡蛎,水泛丸。
李姓患者(寿星桥人,五十七岁):寒湿损伤阳气,痞满妨碍进食,脉沉色黄,这是脾胃病。议用辛温药通中焦之阳。
处方:生益智、荜茇、檀香末、姜汁、茯苓、炒焦半夏。
江姓患者(宝林寺前人,二十五岁):瘅疟邪气在肺,口渴,骨节烦疼,用桂枝白虎汤。
黄姓患者(嘉兴人,三十九岁):往年戌亥时发作厥逆,是因为肝肾阴虚,阴火内风蒙蔽心神(阴火内风蒙神,千锤百炼得出的一句话,胜过无数药物)。治疗逾五年,至今左目流泪,傍晚视力稍减,胃脘部间隙疼痛。经书说肝脉贯膈入胃,肝窍在目,这都是精血内亏不足之象。如果说平肝是疏泄克制,那么攻治就相反了。
处方:天冬、熟地、杞子、元参、浙菊花、谷精珠。
邹姓患者(十岁):年幼,泻血便溏已有三四载,面黄形瘦,属于五疳之症,起因于五味杂沓,肠胃生热。若不谨慎口腹之欲,久疳延转为劳损则难治。
处方:川连、胡连、茯苓、白芍、枳实皮、焦术、南查、臭芜荑、使君子,乌梅肉丸。
秦姓患者(二十二岁):据述久居客邸,情志不适,导致脘中及两胁按压而痛,大便久不爽利,脉形弦坚,面色不华,纳食已少,虚中有滞,以宣通腑络(情志不适,肝木必乘胃土,食少不化,是以虚中有滞)。
处方:熟桃仁、海石、土栝蒌、熟半夏、橘红、枳实皮。
秦姓患者(三十九岁):劳心力办事,气怯神耗致病,医生治咳嗽失血,多以清凉为药,视其形色脉象,凡劳伤治嗽药,不惟无效,必胃口日疲。
Patient Wang (Mudu, 39 years old): Blood stasis obstructs and stagnates; the abdomen is distended like a drum. It is divided into tangible and intangible types. Warming and unblocking is the correct method; Shenqi Tang Wan (Kidney Qi Pill) should not be used to treat Yin water flooding (Note: Shenqi Tang Wan treats Yin water, not Yang water).
Prescription: Tao Ren (Peach Seed), Rou Gui (Cinnamon Twig), Zhi Da Huang (Prepared Rhubarb), Jiao Mu (Sichuan Pepper Seed), Chen Xiang Yuan (Aged Citron) (2 liang each). Decoct in water to form pills.
Patient Huang (Jiangxi, 63 years old): The disease stems from fatigue-induced internal injury. Pathogenic factors (which have already damaged the Yang essence) were repeatedly exposed to seasonal summer-dampness during travel by boat. The illness has lasted over a month, with loss of appetite and constipation. The pulse is minute and small, indicating a Yin syndrome. Summer-heat and dampness both belong to Yin turbidity. Qi mechanism is blocked by turbid Yin. As Zhongjing stated regarding Yin binding and Damp binding, if intestinal and stomach Yang qi fails to circulate, forcibly promoting bowel movement will cause turbidity to reverse and ascend. Pain intensifies at night when Yin dominates (This is a profound theoretical insight, clear as ink on sand or mud; who can inherit its melody? Pulse diagnosis is profound, yet often overlooked by people).
Prescription: Dan Gan Jiang (Light Dried Ginger), Sheng Chao Hei Fu Zi (Raw Stir-fried Black Aconite Root), Zhi Hei Gan Cao (Honey-fried Black Licorice Root), Sheng Bai Shao (Raw White Peony Root).
The prescription is precise. To unblock Yang, the Jia-Ji harmonizing method is used to combine with Yin to stop abdominal pain.
Patient Tang (23 years old): Pulsation present; after diarrhea, pure blood is passed, accompanied by rectal heaviness and prolapse. This indicates Yin deficiency with collateral damage, and failure of the Lower Origin to consolidate. Abstinence for years is required to allow Kidney Essence to silently replenish for recovery.
Prescription: Ren Shen (Ginseng), Shu Di Tan (Charred Prepared Rehmannia Root), Zhi Gan Cao (Honey-fried Licorice Root), Wu Wei Zi (Schisandra Berry), Yu Yu Liang (Arca Shell).
Patient Yu (38 years old): Autumn summer-heat was violently hot, scorching fluids and damaging essences. Polydipsia recurs and burns further. Yin cannot support the Upper Jiao. Tonifying Metal (Lung) and Water (Kidney) together follows the mother-son generation principle.
Prescription: Ren Shen (Ginseng), Xian Sheng Di (Fresh Rehmannia Root), Mai Dong (Ophiopogon Tuber), Bai Zi Ren (Biota Seed), Zhi Mu (Anemarrhena Rhizome), Qing Zhe Gan Zhi Juice (Green Sugarcane Juice).
The prescription is fresh and agile like flowers.
Patient Yang (33 years old): Yang qi has been long damaged by mental agitation and fatigue. Abdominal pain is present with gurgling water sounds in the intestines; pain alleviates upon deep pressure, ruling out fluid accumulation. Since Yang is deficient and lacks movement, Yin turbidity inevitably stagnates. Regulating Yang is appropriate; purging water and attacking stagnation is strictly contraindicated.
Prescription: Sheng Bai Zhu (Raw Atractylodes Macrocephala Rhizome), Shu Fu Zi (Prepared Aconite Lateral Root), Ze Xie (Alisma Rhizome), Zuo Mu Li (Left Oyster Shell). Form pills with water.
Patient Li (Shouxing Bridge, 57 years old): Cold-dampness damages Yang, causing fullness and obstruction affecting food intake. The pulse is deep, complexion yellow; this is a Spleen-Stomach disease. Propose using acrid-warm herbs to unblock Yang in the Middle Jiao.
Prescription: Sheng Yi Zhi (Raw Alpinia Officinarum Rhizome), Bi Bo (Long Pepper Fruit), Tan Xiang Mo (Sandalwood Powder), Jiang Zhi (Ginger Juice), Fu Ling (Poria), Chao Jiao Ban Xia (Stir-fried Charred Pinellia Tuber).
Patient Jiang (Baolin Temple Front, 25 years old): Dan malaria pathogen is in the Lung. Thirst and bone/joint vexing pain are present. Use Guizhi Baitu Tang (Cinnamon Twig and Gypsum Decoction).
Patient Huang (Jiaxing, 39 years old): In previous years, syncope occurred during Xu-Hai hours (7-11 PM), due to Liver-Kidney Yin deficiency. Yin fire and internal wind confuse the Spirit (Yin fire and internal wind confusing the Spirit is a refined phrase, surpassing countless medicines). Treatment has exceeded five years; currently, the left eye tears, vision dims slightly at dusk, and there is gap-like pain in the epigastrium. Classics state the Liver meridian passes through the diaphragm into the Stomach, and the Liver opens into the eyes. These are all signs of internal deficiency of essence and blood. If one claims to calm the Liver via draining and suppressing, it contradicts the treatment strategy.
Prescription: Tian Dong (Asparagus Tuber), Shu Di (Prepared Rehmannia Root), Qi Zi (Goji Berry), Yuan Shen (Scrophularia Root), Zhe Ju Hua (Zhejiang Chrysanthemum Flower), Gu Jing Zhu (Euphrasia Seed).
Patient Zou (10 years old): Young age; bloody diarrhea and loose stools for three to four years. Yellow complexion and emaciation indicate Five Gi syndromes, originating from mixed flavors causing heat in the intestines and stomach. Without dietary caution, chronic Gi may progress to consumption (Lao disease) and become incurable.
Prescription: Chuan Lian (Coptis Rhizome), Hu Lian (Picrorhiza Rhizome), Fu Ling (Poria), Bai Shao (White Peony Root), Zhi Shi Pi (Immature Bitter Orange Peel), Jiao Zhu (Charred Atractylodes Macrocephala Rhizome), Nan Zha (Southern Quinoa/Chaff), Chou Wu Yi (Fetid Spurge Seed), Shi Jun Zi (Quisqualis Fruit). Form pills with Sour Plum Meat.
Patient Qin (22 years old): According to history, prolonged stay in a guest house led to emotional discomfort, causing pain in the epigastrium and hypochondrium upon palpation. Bowel movements are chronically unsatisfactory. The pulse is wiry and firm, complexion lusterless, and appetite reduced. Deficiency with stagnation exists. Use methods to diffuse and unblock the Fu collaterals (Emotional discomfort causes Liver Wood to invade Stomach Earth; poor digestion leads to deficiency with stagnation).
Prescription: Shu Tao Ren (Prepared Peach Seed), Hai Shi (Sea Stone/Magnesia), Tu Gua Lou (Wild Trichosanthes Fruit), Shu Ban Xia (Prepared Pinellia Tuber), Ju Hong (Tangerine Red Peel), Zhi Shi Pi (Immature Bitter Orange Peel).
Patient Qin (39 years old): Mental labor and stress caused Qi timidity and Spirit exhaustion leading to disease. Physicians treating cough and hemoptysis often use cooling herbs. Observing appearance, color, and pulse, such cooling treatments for consumption-induced cough are ineffective and gradually weaken the Stomach appetite.