孙(横山头,二十岁) 男子及长,欲萌未遂,肾中龙火暗动,精血由此暗伤,阴虚自内
脏而来,凉肝嗽药,必致败坏。盖胃口一疲,精血枯槁矣(三才合生脉加茯神。)
人参 熟地 茯神 五味 天冬 麦冬
孙(五十八岁) 爱饮火酒,酒毒湿热,自肠胃经络蒸搏肌腠,疮痍遍及肢体,经年久蕴
不解。法当用局方凉膈散,攻其无形之热(攻热分有形无形,细密极矣。)
胡(十四岁) 性情执拗,郁勃气逆,粒米入脘即痛。父训即若痴呆,由胆肝木横来劫胃
土。上年入冬自愈,秋金肃降,木火不主威,非狗肉温浊之功能,乃适逢其时耳。
夏枯草 生香附 川贝 土栝蒌 黑栀皮 化州橘红
开结化痰,利气清火,色色周到。
顾(五十岁) 五六月间,天热潮雨,湿气着人,渐次浮肿,能食不化,腰胀,脾真已伤
,湿结阻气,大便秘塞,脾病传肾为逆,阴囊肿大矣。
甘露饮去石膏。
李(四十三岁) 令寒暑疟初减,而脘腹痞闷,是宿病。宜清虚旬日。
浓朴 草果 半夏 生姜 广皮 茯苓皮
送保和丸二钱五分。
殷(十九岁) 先天禀薄,及长真阴不充,完姻精气下泄,春深入夏,阳气陡升,阴弱少
恋,
血痰上溢,着枕嗽甚,乃阴中龙相,有如电光闪烁,倾盆大雨,其光芒仍炽,是身中阴枯阳
亢。日进凉药无用,明明肝肾为病,医投肺药,希图缓嗽,嗽必不效,胃口必减食,形瘦。
莫如绝欲,静处林壑,养精血,增谷食,既损难逭,静养渐复(从来劳损已成,脏真已失,
惟有相火煎熬津液,成粘痰,即投大剂补药,已为阴火拒格,不入经络,化液,以复精血,
停滞脾胃,寒中,泄泻而已。真火燎原,无法可治。)
水煮熟地 茯神 山药 女贞 萸肉 芡实 湖莲 川斛
韩(十七岁) 病患说两年前初春,高处跳跃至地,入夜即有寒热,继而少腹形高(瘀留
脉络)
两足屈曲。医谓腹痈肠痈,从无脓血便出,自病至今,筋纵着骨而胀,即起寒热,瘀留深入
厥
阴,在躯壳间,久则成疡(跳跃跌蹼损伤,必有寒热,以动跃伤筋骨统引于厥阴肝,而肝为
相火,所寄是动,则火必发而为热也。)
穿山甲 自然铜 川乌头 全蝎 半两钱 地鳖虫 生青鳖甲 粉丹皮 麝香
黑豆皮煎汤泛丸。
朱(五十二岁) 此操持太过,肝血胆汁内耗,致阳气上冒入巅,外泄汗淋,阳不入阴,
阳跷穴空不寐,茎痿不举,非寒皆肝液无有,有暴仆暴厥之危(即是阳气烦劳则张,精绝使
人煎
厥之病。形容得出妙笔。)
小麦 萸肉 南枣 白芍 炙草 白石英
浦(二十二岁) 阴虚受暑,如饮腹满。
小温中丸(二钱五分)
朱(二十八岁) 归脾汤以治嗽治血,谓操持劳心,先损乎上。秦越人云∶上损过脾不治
。不曰
补脾曰归,以四脏皆归中宫,斯上下皆得宁静,无如劳以性成,心阳下坠为疡,疡以挂线(
俗云偷粪老鼠,总因肾精亏竭,心阳下坠,为疡,总不脱少阴一经。)脂液金耗,而形寒怯
风,不但肾液损伤,阴中之阳已被剥斫,劳怯多由精气之夺。
鲜河车胶 人参 炒枸杞 云茯苓 紫衣胡桃肉 沙苑
金(十六岁) 着枕气冲,显是阴中之热,验寸搏舌白,浊饮拟议暑热上吸心营,肺卫客
气未平,先用玉女煎。
下焦不纳气冲,不论行止坐卧,总易上升。此必着枕气冲,是有客气未平,不与下虚同
例,须知而细分之(必着枕,气始冲,坐立时尚未冲也。)
陆(西津桥,二十二岁) 节令嗽血复发,明是虚损,数发必重,全在知命调养。近日胸
脘
不爽,身痛气弱,腻滞阴药姑缓。议养胃阴(养胃阴所以降逆气也。以复从头走足之常。)
生扁豆 北沙参 生甘草 米拌炒麦冬 白糯米
范(三十七岁) 穷乏之客,身心劳瘁,少壮失血,尚能支持,中年未老先衰,久嗽失音
,非是肺热,乃脏阴内损,不能充复。得纳谷安逸,可望延久(就人情中体贴出来。)
早服六味加阿胶、秋石,晚用黄精米仁膏。
张(四十三岁) 思虑悲忧,由心肺二脏,不宜攻劫峻利。盖手经例以轻药,谓二脏处位
最高
,问饮酒过量,次日必然便溏。盖湿聚变痰,必伤阳阻气,痰饮由阳微气弱而来,悲忧又系
内起情怀之恙。务以解郁理气,气顺即治痰矣(解郁理气不用辛燥,转多辛润之品,以郁气
之人必有郁火,阳气虽薄,不可辛燥,以助火耳。心极细矣。)
枇杷叶 薏苡仁 白蔻仁 茯苓 杜苏子 新会橘红 鲜石菖蒲根汁 降香汁
屈(二十二岁) 长夏患痧胀,两三月渐渐腹大,入夜腹痛,凡痧是臭污秽气,留聚入络
,变出肿胀。议以秽药宣通(以臭治臭,精妙绝伦。)
孙某(横山头,二十岁)男子成年后,性欲萌动但未得疏泄,肾中相火(龙火)暗中躁动,导致精血由此暗耗。此阴虚源于内脏,若使用清肝凉血的咳嗽药,必然导致病情败坏。因为一旦胃气疲弱,精血就会枯竭。(处方:三才合生脉散加茯神。)
人参 熟地黄 茯神 五味子 天冬 麦冬
孙某(五十八岁)喜爱饮用烈性白酒,酒毒湿热之邪,从肠胃经络蒸腾搏结于肌肤腠理,疮疡遍布肢体,经年久蕴不解。治法应当使用局方凉膈散,攻逐其无形之热(攻逐热邪需分有形与无形,分析极为细致周密。)
胡某(十四岁)性情固执倔强,气机郁勃上逆,米粒入口即痛。父亲训斥时显得痴呆,这是由于胆肝木气横逆来劫犯胃土所致。去年入冬自愈,是因为秋季金气肃降,木火之气不主威势,并非狗肉温浊之功,而是恰逢时令适宜罢了。
夏枯草 生香附 川贝母 土瓜蒌 黑栀子皮 化州橘红
开结化痰,利气清火,面面俱到。
顾某(五十岁)五六月间,天气炎热且多雨,湿气着人,逐渐出现浮肿,能进食但不能消化,腰部胀满,脾脏真气已伤,湿邪凝结阻碍气机,大便秘塞。脾病传肾为逆证,阴囊肿大了。
甘露饮去石膏。
李某(四十三岁)患寒暑疟疾初愈,但脘腹痞闷,这是宿疾。宜用清虚之法调理旬日。
厚朴 草果 半夏 生姜 广陈皮 茯苓皮
送服保和丸二钱五分。
殷某(十九岁)先天禀赋薄弱,成年后真阴不充,婚后精气下泄,春末深入夏季,阳气陡升,阴液虚弱难以留恋,导致血痰上溢,躺下时咳嗽加重。这是阴中相火(龙相),如同电光闪烁,倾盆大雨,其光芒依然炽盛,这是体内阴枯阳亢。每日进服凉药无用,明明是肝肾为病,医生却投以肺药,希图缓解咳嗽,咳嗽必不效,胃口必减食,形体消瘦。不如戒绝房事,静处山林幽谷,养精血,增加谷物饮食,既然亏损已成难以逃避,唯有静养渐复(历来劳损已成,脏腑真气已失,只有相火煎熬津液,形成粘痰,即使投以大剂补药,也会被阴火拒格,不入经络,化为津液以恢复精血,反而停滞脾胃,导致寒中、泄泻而已。真火燎原,无法可治。)
水煮熟地黄 茯神 山药 女贞子 山茱萸 芡实 湖莲子 川石斛
韩某(十七岁)患者说两年前初春,从高处跳跃落地,入夜即有寒热,继而少腹部形状高起(瘀血留滞脉络)。两足屈曲。医生认为是腹痈或肠痈,但从无脓血便出,自患病至今,筋脉松弛贴骨而胀,稍起即发寒热。瘀血留滞深入厥阴经,在躯壳之间,日久则成溃疡(跳跃跌扑损伤,必有寒热,因为运动跳跃损伤筋骨,统归于厥阴肝经,而肝寄居相火,所动之处,则火必发而为热也。)
穿山甲 自然铜 川乌头 全蝎 半两钱 地鳖虫 生青鳖甲 粉牡丹皮 麝香
黑豆皮煎汤泛丸。
朱某(五十二岁)此乃操持太过,肝血胆汁内耗,导致阳气上冒入巅顶,外泄汗出如淋,阳不入阴,阳跷穴空虚而不寐,阴茎痿软不举,并非寒证,皆因肝液枯竭,有暴仆暴厥的危险(即是阳气烦劳则张,精绝使人煎厥之病。形容得出妙笔。)
小麦 山茱萸 南枣 白芍 炙甘草 白石英
浦某(二十二岁)阴虚受暑,如饮水后腹胀。
小温中丸(二钱五分)
朱某(二十八岁)归脾汤用于治疗咳嗽和治疗出血,说是操持劳心,先损伤上部。秦越人说:上损过脾不治。不说补脾曰归,是因为四脏皆归属于中宫,这样上下都能得到宁静,无奈劳累已成习性,心阳下坠形成溃疡,溃疡以挂线治疗(俗云偷粪老鼠,总因肾精亏竭,心阳下坠,形成溃疡,总离不开少阴一经。)脂液金耗,而形寒怯风,不但肾液损伤,阴中之阳已被剥蚀,劳怯多由精气之夺。
鲜河车胶 人参 炒枸杞 云茯苓 紫衣胡桃肉 沙苑蒺藜
金某(十六岁)着枕时气冲,显是阴中之热,验寸口脉搏舌苔白,浊饮拟议为暑热上吸心营,肺卫客气未平,先用玉女煎。
下焦不纳气冲,不论行止坐卧,总易上升。这必定是着枕时气冲,是有客气未平,不与下虚同例,须知而细分之(必定着枕,气始冲,坐立时尚未冲也。)
陆某(西津桥,二十二岁)节令咳嗽带血复发,明是虚损,数次发作必重,全在于知命调养。近日胸脘不爽,身痛气弱,腻滞的阴药姑且缓用。议养胃阴(养胃阴所以降逆气也。以恢复从头走足的常道。)
生扁豆 北沙参 生甘草 米拌炒麦冬 白糯米
范某(三十七岁)穷困之客,身心劳瘁,少壮时失血,尚能支持,中年未老先衰,久咳失音,不是肺热,乃是脏阴内损,不能充复。若能纳谷安逸,可望延久(就人情中体贴出来。)
早服六味地黄丸加阿胶、秋石,晚用黄精米仁膏。
张某(四十三岁)思虑悲忧,由心肺二脏引起,不宜攻劫峻利。因为手经病例多用轻药,谓二脏处位最高,问饮酒过量,次日必然便溏。盖湿聚变痰,必伤阳阻气,痰饮由阳微气弱而来,悲忧又系内起情怀之恙。务以解郁理气,气顺即治痰矣(解郁理气不用辛燥,转多辛润之品,以郁气之人必有郁火,阳气虽薄,不可辛燥,以助火耳。心极细矣。)
枇杷叶 薏苡仁 白蔻仁 茯苓 杜苏子 新会橘红 鲜石菖蒲根汁 降香汁
屈某(二十二岁)长夏患痧胀,两三月渐渐腹大,入夜腹痛,凡痧是臭污秽气,留聚入络,变出肿胀。议以秽药宣通(以臭治臭,精妙绝伦。)
Sun (Hengshantou, 20 years old) For men after adulthood, when sexual desire stirs but is not yet satisfied, the ministerial fire (Longhuo) in the Kidney moves secretly, causing a hidden damage to essence and blood. This Yin deficiency originates from the Zang organs; using cooling liver and cough medicines will inevitably lead to deterioration. Once the Stomach Qi becomes fatigued, essence and blood wither away. (Formula: Sancai He Shengmai San plus Fushen.)
Ren Shen (Ginseng Radix), Shu Di Huang (Prepared Rehmanniae Radix), Fu Shen (Poria with Hostwood), Wu Wei Zi (Schisandrae Fructus), Tian Dong (Asparagi Radix), Mai Dong (Ophiopogonis Radix).
Sun (58 years old) Fond of drinking strong liquor, the damp-heat toxicity of alcohol steams and struggles from the intestines and stomach meridians into the muscle and clefts, causing sores covering the limbs. Accumulated for years without resolution. The method should use Ju Fang Liang Ge San to attack its formless heat (Attacking heat requires distinguishing between formless and formed aspects, which is extremely detailed and thorough.)
Hu (14 years old) Stubborn and obstinate in temperament, with stagnant and rebellious Qi, experiencing pain immediately upon swallowing rice. When scolded by his father, he appears dazed; this is due to the Liver and Gallbladder Wood Qi invading horizontally to rob the Stomach Earth. It healed itself last winter because the Autumn Metal Qi descended solemnly, and Wood-Fire did not dominate authority; it was not the function of dog meat's warmth and turbidity, but rather coinciding with the appropriate season.
Xia Ku Cao (Prunellae Spica), Sheng Xiang Fu (Cyperi Rhizoma), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Tu Gua Lou (Trichosanthis Radix), Hei Zhi Zi Pi (Gardeniae Cortex), Hua Zhou Ju Hong (Citri Reticulatae Pericarpium Rubrum).
Opening knots and resolving phlegm, promoting Qi flow and clearing fire, comprehensive and thorough.
Gu (50 years old) In May and June, during hot weather and rain, dampness adheres to the person, gradually causing edema. Able to eat but unable to digest, waist distension, the true Qi of the Spleen is already injured. Dampness condenses and obstructs Qi, causing severe constipation. Spleen disease transmitting to the Kidney is adverse, leading to scrotal swelling.
Gan Lu Yin minus Shi Gao (Gypsum Fibrosum).
Li (43 years old) After the initial reduction of cold-summer malaria, epigastric and abdominal fullness persists, indicating an old disease. Suitable for clearing and nourishing deficiency for ten days.
Hou Po (Magnoliae Officinalis Cortex), Cao Guo (Tsaoko Fructus), Ban Xia (Pinelliae Rhizoma), Sheng Jiang (Zingiberis Rhizoma Recens), Guang Pi (Citri Reticulatae Pericarpium), Fu Ling Pi (Poriae Cortex).
Administer Bao He Wan (Preserve Harmony Pill) 2.5 qian.
Yin (19 years old) Innate constitution is thin; after adulthood, True Yin is insufficient. After marriage, essence and spirit leak downward. As spring deepens into summer, Yang Qi rises suddenly. Yin is weak and cannot retain, causing bloody phlegm to overflow upward. Cough worsens when lying on the pillow. This is the ministerial fire within Yin, like lightning flashing, heavy rain pouring, yet its brilliance remains intense. This indicates internal Yin exhaustion and Yang hyperactivity. Daily intake of cooling medicines is useless. Clearly, the pathology lies in the Liver and Kidney, but physicians administer Lung medicines, hoping to relieve cough. The cough will certainly be ineffective, appetite will decrease, and emaciation will occur. Better to abstain from desires, dwell quietly in forests and valleys, nourish essence and blood, increase grain intake. Since the damage is done and hard to escape, only quiet recuperation can gradually restore health. (Generally, once consumptive damage is established and Zhen Qi is lost, only ministerial fire fries body fluids into sticky phlegm. Even administering large doses of tonics will be rejected by Yin fire, failing to enter meridians, transform into fluids, and restore essence and blood. Instead, it stagnates in the Spleen and Stomach, causing cold center and diarrhea. True fire raging across the plains, no cure available.)
Shu Di Huang (Prepared Rehmanniae Radix) boiled in water, Fu Shen (Poria with Hostwood), Shan Yao (Dioscoreae Rhizoma), Nv Zhen Zi (Ligustri Lucidi Fructus), Yu Rou (Corni Fructus), Qian Shi (Euryales Semen), Hu Lian (Nelumbinis Semen), Chuan Hu (Dendrobii Caulis).
Han (17 years old) Patient stated that two years ago in early spring, jumping down from a height caused chills and fever at night, followed by elevation in the lower abdomen (blood stasis remaining in collaterals). Legs flexed. Physicians suspected abdominal or intestinal abscess, but no pus or blood was discharged. From illness onset until now, tendons hang loose against bones and swell. Rising causes chills and fever. Blood stasis has penetrated deeply into the Jueyin channel, residing in the body shell, eventually forming ulcers over time. (Jumping and falling injuries must cause chills and fever, as movement and jumping damage sinews and bones, all attributed to the Jueyin Liver channel. Since the Liver houses ministerial fire, movement there causes fire to erupt as heat.)
Chuan Shan Jia (Manis Squama), Zi Ran Tong (Pyritum), Chuan Wu Tou (Aconiti Radix Preparata), Quan Xie (Scorpio), Ban Liang Qian (unknown specific herb, likely local name), Di Bie Chong (Eupolyphaga seu Steleophaga), Sheng Qing Bie Jia (Testudinis Carapax et Plastrum), Fen Dan Pi (Moutan Cortex), She Xiang (Moschus).
Pills made by coating with decoction of Hei Dou Pi (Phaseoli Vulgaris Pericarpium).
Zhu (52 years old) This results from excessive mental exertion, consuming Liver blood and Gallbladder bile internally, causing Yang Qi to rush upward to the vertex, leaking sweat profusely externally. Yang fails to enter Yin, Yang Qiao acupoint emptiness leads to insomnia, penile flaccidity and inability to erect. Not a cold syndrome, but entirely due to depletion of Liver fluids, carrying the danger of sudden collapse or syncope. (This is precisely the disease where Yang Qi expands due to fatigue, and essence depletion causes burning syncope. Described brilliantly.)
Xiao Mai (Tritici Fructus), Yu Rou (Corni Fructus), Nan Zao (Jujubae Fructus), Bai Shao (Paeoniae Radix Alba), Zhi Cao (Glycyrrhizae Radix et Rhizoma Preparatum), Bai Shi Ying (Quartzum).
Pu (22 years old) Yin deficiency with summerheat invasion, feeling like abdominal fullness after drinking water.
Xiao Wen Zhong Wan (Minor Warming Center Pill) 2.5 qian.
Zhu (28 years old) Gui Pi Tang is used to treat cough and bleeding, stating that mental labor first damages the upper part. Qin Yueren said: Upper damage extending beyond the Spleen is incurable. It does not say "tonify Spleen" but "Return," because the four Zang organs all return to the Central Palace, thus achieving tranquility above and below. However, weariness has become habitual, Heart Yang sinks downward forming ulcers, treated with thread suspension (commonly known as fistula, generally due to Kidney essence depletion and sinking Heart Yang, always involving the Shaoyin channel). Fat and fluids are consumed, metal is exhausted, leading to aversion to wind and cold. Not only is Kidney fluid damaged, but Yang within Yin is also stripped. Consumptive diseases often arise from the loss of essence and spirit.
Xian He Che Jiao (Placentae Hominis Fresca), Ren Shen (Ginseng Radix), Chao Gou Qi (Lycii Fructus), Yun Fu Ling (Poria Cum Risus), Zi Yi Hu Tao Rou (Juglandis Semen Integrum cum Tecto Purpureo), Sha Yuan (Astragali Complanati Semen).
Jin (16 years old) Qi rushing upon lying on the pillow clearly indicates heat within Yin. Pulse at Cun position and white tongue coating verify turbid fluid retention, hypothesized as summerheat absorbing upward into the Ying level of the Heart. Guest Qi in Lung and Wei levels is not yet calm; first use Yu Nu Jian.
Failure of the Lower Jiao to grasp Qi causes rushing regardless of standing, walking, sitting, or lying. This must be due to guest Qi not being calm upon lying down, differing from lower deficiency. One must know this and distinguish it carefully. (Qi only rushes when lying on the pillow; it does not rush when sitting or standing.)
Lu (Xijin Bridge, 22 years old) Seasonal cough with hemoptysis recurs, clearly indicating deficiency consumption. Frequent episodes will be severe; recovery depends entirely on knowing destiny and nurturing oneself. Recently, chest and epigastrium feel uncomfortable, body pain, Qi weakness. Greasy and cloying Yin-nourishing medicines should be delayed temporarily. Propose nourishing Stomach Yin. (Nourishing Stomach Yin descends rebellious Qi, restoring the normal course from head to foot.)
Sheng Bian Dou (Phaseoli Radiati Semen), Bei Sha Shen (Glehniae Radix), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma), Mai Dong stir-fried with rice, Bai Nuo Mi (Glutinis Oryzae Sativi Fructus).
Fan (37 years old) A poor traveler, physically and mentally exhausted. Having lost blood in youth, he could still support himself, but middle age brings premature aging. Chronic cough and loss of voice are not due to Lung heat, but internal damage to Zang Yin, unable to replenish. If he can eat peacefully and rest, prolongation is possible. (Derived from understanding human circumstances.)
Morning: Liu Wei Di Huang Wan plus E Jiao (Colla Corii Asini) and Qiu Shi (Nitrum); Evening: Huang Jing Mi Ren Gao (Polygonati Rhizoma and Coix Seed Paste).
Zhang (43 years old) Overthinking and sorrow originate from the Heart and Lung organs; harsh purgatives should not be used. Hand meridians typically use light medicines because these two organs are located highest. Excessive alcohol consumption leads to loose stools the next day. Dampness gathers to form phlegm, damaging Yang and obstructing Qi. Phlegm-fluids arise from weak Yang and Qi. Sorrow and grief are internal emotional ailments. Must resolve depression and regulate Qi; once Qi flows smoothly, phlegm is treated. (Resolving depression and regulating Qi does not use pungent-drying herbs, but rather pungent-moistening ones, because those with stagnant Qi necessarily have stagnant fire. Although Yang Qi is thin, one must not use pungent-drying herbs to assist fire. Extremely meticulous.)
Pi Pa Ye (Loquat Leaf), Yi Yi Ren (Coicis Semen), Bai Kou Ren (Amomi Fructus Rotundus), Fu Ling (Poria), Du Su Zi (Perillae Fructus), Xin Hui Ju Hong (Citri Reticulatae Pericarpium), Xian Shi Chang Pu Gen Zhi (Acori Tatarinowii Rhizomatis Juice), Jiang Xiang汁 (Dalbergiae Odoriferae Lignum Juice).
Qu (22 years old) Contracted sha-zhang (sand swelling) in late summer. Gradually became abdominally distended over two to three months, with abdominal pain at night. Sha refers to foul and filthy qi, accumulating in collaterals, transforming into swelling. Propose using foul-smelling medicines to promote circulation. (Treating foulness with foulness, exquisitely brilliant.)