治半身不遂，手足欠利，语言费力，呵欠，喷嚏，面木，口眼歪斜宽弛，头目眩晕，痰火炽盛，筋
骨时痛，或头痛，心悸。
川芎（一钱二分） 当归 生地黄（姜汁水炒） 熟地黄 牛膝（酒洗） 橘红（盐水洗） 黄芩
（酒炒） 酸枣仁（炒，各八分） 红花（酒洗） 甘草（炙，各四分） 羌活 防风 柳桂（各六分）
南星（制） 半夏（制） 白芍药（酒炒） 白茯苓 天麻（各一钱） 白术（一钱五分） 黄柏（酒炒，三分）
上水煎，入淡竹沥、姜汁二、三茶匙，侵晨服。
四物汤加红花、牛膝，共六钱二分，补血凉血活血。
二陈汤加南星、白术、黄芩，治湿痰、风痰、火痰。再加竹沥、姜汁，以行肌表经络之痰，共五钱九
分。羌活、防风、天麻、柳桂，皆行经络肌表，辛温开发之剂，引送血药，流散邪滞。柳桂横行手臂，牛
膝、黄柏行腰腿。
白术为君，佐以茯苓、甘草、白芍药、橘红、半
夏，又以固脾胃之气血，以营运诸药输送各经。
酸枣仁佐川芎、当归、羌活，入肝治筋骨酸疼湿痹；又佐地黄、当归，入心治心虚振悸。
四物汤得羌活、防风、柳桂、南星、半夏为佐使，则经络肌表筋骨之血，皆补其虚而活其滞矣。
南星、半夏二味虽燥，共止二钱，羌活、防风、柳桂虽辛温，三味止一钱四分，通共三钱四分，温燥
之药加于血药六钱二分之内，况又有黄芩、黄柏、甘草苦寒甘寒药共一钱五分，多寡悬绝，焉得燥吾之血
耶？此正君臣佐使、分两多少之法。
痰之为物，遍身上下无处不到。故古人用二陈汤通治之，随其所在而
用药引导之。今用天麻、南星、竹沥、姜汁导之入手足经，加以白术、黄芩降其膈上之火痰。
冬寒月，减黄芩二、三分，或加炮川乌二分。若用川乌，减桂，只用一、二分。风病减去，可去川乌、
桂，减南星、羌活。若素有火，黄芩不必减。
羌活风家要药，若寒凉月，重有感冒，可加至一钱。有汗而恶风，此真感风症也，可加桂枝六、七
分，病减则减去之。川乌、桂枝、羌活、防风、南星等药，皆行经络、开发腠理之剂，故治风家必用之。风
能燥，故必用滋血润燥药。邪既客于经络肌表之中，则津液不得流通，凝滞而为痰饮，故必用治痰。风也，
血也，痰也，三者相因，但各有轻重先后之不同。或先因中风，则治风为重；或先因血虚、血热，则治血
为重；或先因痰，则治痰为重。
愚按五脏之病，相乘伏匿，隐显莫测，参以徐用诚先生五脏治要，尤善。详见一卷或问仲景处方药品
条内。
张仲景小续命汤，是论风也；刘、张、丹溪诸说，是论血与痰火也。要在随症推移消息之耳！
愚按前症多因饮食失节、起居失宜，亏损元气，腠理不致，外邪所侵，或劳伤元气，怒动肝火，皆属
内因所致也，前药亦当审而用之。
太宜人，年七十五，遍身作痛，筋骨尤甚，不能伸屈，口干，目赤，头眩，痰涌，胸膈不利，小便赤
涩而短少，夜间痰热殊甚，遍身作痒如虫行。此肝经气燥而风动也。用六味地黄丸料加山栀、柴胡治之而
愈。
一男子，时疮愈后，遍身作痛，服愈风丹，半身不遂，痰涎上涌，夜间痛甚。余作风客淫气，治以地
黄丸而愈。
一老妇，两臂不遂，语言謇涩，服祛风之药，筋挛骨痛。此因风药亏损肝血，用八珍汤补气血，用地
黄丸补肾水，乃佐以愈风丹而愈。
一妇人，因怒吐痰，胸满作痛，服二陈、四物、
芩、连、枳壳之类，不应，更加祛风之剂，半身不遂，筋挛痿软，日晡益甚，内热，口干，形气殊倦，此足
三阴亏损之症也。余用逍遥散、补中益气、六味地黄调治。喜其谨疾，年余诸症悉愈，形体康健。
倒仓后脾虚痰盛，宜先理中治痰，且将风药、血药减去，俟中气复，然后通用。
白术 白芍药（各一钱半） 陈皮（八分） 白茯苓 人参 半夏（姜制） 栝蒌仁（各一钱）
甘草（炙） 黄芩（酒炒） 枳实（麸炒，各五分） 香附米（盐水炒） 桔梗 麦门冬 麦芽（炒，
各七分） 黄连（姜炒，四分）
上水煎，入竹沥三匙、姜汁三匙服。
若寒月觉胃中冷，易泄，加炒干姜一、二分。
愚按前云倒仓后脾虚痰盛矣，然而方内芩、连、栝蒌、枳实之类，苦寒泄气克滞之剂，虽兼六君子之
调补，恐所益不偿所损，虽加干姜一、二分，亦恐未能济其寒也。盖痰之为病，有因热而生痰者，亦有因
痰而生热者，有因饮食积滞而得者，有因肾水亏损津液败浊而似痰者，有因肾水不足阴火上炎而生痰者，
有因脾肺气虚不能摄涎而似痰者，不能枚举，当各推所因而治之。然倒仓之后而痰反盛，必因中气复伤所
致，故治痰用峻厉之剂而痰愈甚者，乃脾气愈伤，津液不能运化而然耳！前症当补脾胃调中气，则津液各
归其所，而为元气矣。
倒仓后大便燥结，头晕、眼花未除，加当归身尾、桃仁（去皮尖）各一钱，川芎五分，山药一钱。
愚按前方若因酒面炙爆致痰胶固，脾气无亏者，宜用之，若因肾气亏损，津液不足者，宜用六味丸；因
脾气虚弱者，宜用六君子汤；因中气虚者，宜用补中益气汤；因肾气亏损，水泛上而为痰者，宜用六味
丸；曰脾肾虚寒，小水不调，肚腹膨胀者，宜用金匮肾气丸。
儒者王录之，素痰甚，导吐之后，大便燥结、头晕、眼花等症，尺脉浮大，按之则涩。此肾气虚而兼
血虚也。四物送六味丸，四剂，诸症悉退，仍用前丸月余而康。
佥宪高如斋，素唾痰，服下痰药痰去甚多，大便秘结，小便频数，头晕眼花，尺脉浮大，按之如无。
余谓肾家不能纳气归源，前药复耗金水而甚。用加减八味丸料煎服而愈。
儒者杨文魁，素唾痰，诸药不应，服牛黄清心丸吐痰甚多，或头晕，或热从胁起。左脉洪大有力，右
脉浮大而无力。余曰∶此足三阴亏损，虚火不能归源。用补中益气加麦门、五味及加减八味丸，补其化
源而愈。
秋官张碧崖，面赤作渴，痰盛，头晕。此肾虚水泛为痰。用地黄丸而愈。
仪制贺朝卿，吞酸，胸满，痰盛，作泻，饮食少思，用清气化痰等药，前症益甚，两膝渐肿，寒热往
来。余谓脾胃虚，湿热下注。用补中益气，倍参、术，加茯苓、半夏、炮姜而愈。
余甥范允迪，咳嗽痰盛，胸腹不利，饮食少思，肢体倦怠，脉浮大，按之微弱，服二陈、枳壳等药愈
盛。余曰∶脾、肺、肾虚也。用补中益气、六味丸而愈。
一妇人，吐痰，发热，遍身作痛，小便频数，阴中作痒，日晡热甚。余曰∶此肝脾血虚气滞而兼湿热
也。用加味逍遥散加车前子而愈。
一妇人，怀抱不舒，腹胀，少寐，饮食素少，痰涎上涌，月经频来。余曰∶脾统血而主涎，此郁闷伤
脾，不能摄血制涎归源。用补中益气、济生归脾二汤而愈。
专治痰，加味二陈汤；胃气复后，间服理痰。
橘红（八分） 半夏（姜汁炒） 白茯苓 白术（各一钱二分） 甘草（炙） 连翘 黄芩（炒）
前胡（各五分） 香附米（盐水炒，七分） 栝蒌仁（杵） 桔梗（各一钱） 大麦芽（炒，一钱）
上水煎，入生姜汁三匙，竹沥两蚬壳，半饥温服。盖治痰药亦以脾胃为主。
愚按前方若因脾土太过，营气壅滞，宜用之。若因脾土不足，营气虚痞者，宜补中气为主；若因肝木
乘脾土者，宜补脾土为主；若脾土虚寒者，宜补命门火为主。
侍御谭希曾，喘咳吐痰，或手足时冷。此中气虚寒。用补中益气、炮姜而愈。
职坊卢抑斋，饮食素少，忽痰壅气喘，头摇目札。扬手掷足，难以候脉，视其面色黄中见青。此肝木乘
脾土，如小儿慢惊之症。先用六君、柴胡、升麻而安，更以补中益气加半夏而痊。
考功杨朴庵，呕吐痰涎，胸腹膨胀，饮食少思。左关脉弦长，按之无力；右关脉弦长，按之微弱。此
木克土。用六君子加柴胡、山栀、木香而愈。
一儒者，体肥，仲夏患痰喘。用二陈、芩、连、桔梗，痰喘益甚；加桑皮、杏仁、栝蒌，盗汗，气促；
加贝母、枳壳，不时发热，饮食渐减。脉大而无力。余以为脾肺虚寒。用八味地黄丸以补土母，用补中益
气汤以接中气而愈。
一妇人，早间吐痰甚多，夜间喘急、不寐。夫早间多痰，乃脾虚饮食所化；夜间喘急，乃肺虚阴火上
冲。用补中益气加麦门、五味而愈。
加味化痰丸 治痰满胸膈，咽喉不利。
半夏（汤泡七次姜汁水拌渗透） 橘红（盐水洗，各三两） 桔梗 海蛤粉（另研） 栝蒌仁（另研，
各一两） 香附米（淡盐水炒） 枳壳（麸炒） 连翘 枯黄芩（炒，各五钱） 贝母（去心炒，各一两） 诃
子皮 枯矾（各二钱五分）
上为末，炼蜜、姜汁为丸如黍米大。淡姜汤下四、五十丸。不可过服，恐伤上焦元气。
愚按前症若因郁伤脾气，脾血虚损，用归脾汤加炒栀、柴胡治之，若因怒动肝火，脾土受克，用六君
子加炒栀、柴胡平之；若因饮食伤脾，营气虚弱，用六君子汤调之；若因劳伤元气，用补中益气汤主之。
东垣先生云∶胃为五脏之根本，胃气益虚，脾无所禀，五脏皆虚，诸症蜂起矣。
二守陈子忠，饮食少思，吐痰，口干，常服二陈、枳实、黄连之类，脾胃受伤，乃问于余。余述东垣先
生曰脾胃之症，实则枳实、黄连泻之，虚则白术、陈皮补之。彼遂以二味等分为丸常服。由是多食而不伤，
过时而不饥。
徽州汪商，常服二陈、枳实、黄连、青皮、浓朴，胸腹快利，后患腹胀请治，脉已脱。余曰∶至暮必殁。
已而果然。故《内经》千言万语，只在人有胃气则生，又曰四时皆以胃气为本。凡脉促、代、屋漏之类，或
暴脱，余急用参、附等药，多有复生者。
治疗半身不遂，手足活动不利，说话费力，打哈欠，打喷嚏，面部麻木，口眼歪斜且肌肉松弛，头晕目眩，痰火旺盛，筋骨时常疼痛，或者头痛，心悸。
川芎（一钱二分） 当归 生地黄（用姜汁水炒） 熟地黄 牛膝（酒洗） 橘红（盐水洗） 黄芩（酒炒） 酸枣仁（炒，各八分） 红花（酒洗） 甘草（炙，各四分） 羌活 防风 柳桂（各六分） 南星（制） 半夏（制） 白芍药（酒炒） 白茯苓 天麻（各一钱） 白术（一钱五分） 黄柏（酒炒，三分）
四物汤（Four-Substance Decoction）加红花、牛膝，共六钱二分，具有补血、凉血、活血的功效。
二陈汤（Two-Aged Phlegm Decoction）加南星、白术、黄芩，用于治疗湿痰、风痰、火痰。再加竹沥、姜汁，以疏导肌表经络中的痰浊，共五钱九分。羌活、防风、天麻、柳桂，都是通行经络肌表、辛温宣发的药物，用来引导和输送血药，流散邪气阻滞。柳桂横行于手臂，牛膝、黄柏下行于腰腿。
白术为君药，佐以茯苓、甘草、白芍药、橘红、半夏，以此巩固脾胃的气血，以营运诸药并输送到各条经脉。
酸枣仁佐助川芎、当归、羌活，入肝经治疗筋骨酸痛及湿痹；又佐助地黄、当归，入心经治疗心虚引起的震颤悸动。
四物汤得到羌活、防风、柳桂、南星、半夏作为佐使药，则经络肌表筋骨的血液，都能补其虚损而疏通其瘀滞。
南星、半夏两味药虽然性燥，但总量只有二钱；羌活、防风、柳桂虽然性辛温，但三味药总量只有一钱四分，总共三钱四分。温燥之药加在血药六钱二分之内，况且又有黄芩、黄柏、甘草等苦寒、甘寒的药共一钱五分，多寡悬殊，怎么能燥伤我的血液呢？这正是君臣佐使、分量多少的法度。
痰这种病邪，遍布全身无处不到。所以古人用二陈汤通治它，根据痰所在的不同部位用药来引导它。现在用天麻、南星、竹沥、姜汁引导它进入手足经脉，加上白术、黄芩降下膈上的火痰。
冬季寒冷月份，减去黄芩二、三分，或者加炮川乌二分。如果使用川乌，要减去桂枝，只用一、二分。如果是风病减轻，可以去除川乌、桂枝，减少南星、羌活的用量。如果素来有火，黄芩不必减少。
羌活是治风病的要药，如果在寒冷的月份，感冒严重，可以加到一钱。如果有汗且怕风，这是真正感受风邪的症状，可以加桂枝六、七分，病情减轻后减去它。川乌、桂枝、羌活、防风、南星等药，都是通行经络、开发腠理的药物，所以治风病的人必须使用。风能致燥，所以必须用滋血润燥的药。邪气既然客居于经络肌表之中，津液就不能流通，凝滞而成痰饮，所以必须用治痰的方法。风、血、痰三者相互关联，只是各有轻重先后的不同。或者先因中风，则治风为重；或者先因血虚、血热，则治血为重；或者先因痰，则治痰为重。
我按语：五脏的疾病，相互乘侮伏匿，隐现莫测，参考徐用诚先生的《五脏治要》，尤其好。详见一卷或问仲景处方药品条内。
张仲景的小续命汤，是论述风的；刘完素、张从正、朱丹溪等人的学说，是论述血与痰火的。关键在于随症状变化斟酌处理罢了！
我按语：前述病症多因饮食不节制、起居不合宜，亏损元气，腠理不紧密，外邪侵袭，或者劳损伤元气，怒动肝火，都属于内因所致，前面的药物也应当审慎使用。
太宜人，七十五岁，遍身疼痛，筋骨尤为严重，不能伸展屈曲，口干，眼睛红，头晕，痰涌，胸膈不畅，小便赤涩而短少，夜间痰热特别严重，遍身瘙痒如虫行。这是肝经气燥而风动。用六味地黄丸（Six-Ingredient Rehmannia Pill）的方料加山栀、柴胡治疗而痊愈。
一个男子，时疮痊愈后，遍身疼痛，服用愈风丹，导致半身不遂，痰涎上涌，夜间疼痛严重。我认为是风邪客居淫溢之气，用地黄丸治疗而痊愈。
一个老妇人，两臂不遂，说话謇涩，服用祛风药，导致筋挛骨痛。这是因为风药亏损了肝血，用八珍汤（Eight-Treasure Decoction）补气血，用地黄丸补肾水，再佐以愈风丹而痊愈。
一个妇人，因为发怒吐痰，胸满作痛，服用二陈汤、四物汤、黄芩、黄连、枳壳之类的药，没有效果，更加使用祛风的药剂，导致半身不遂，筋挛痿软，傍晚加重，内热，口干，形体气息非常疲倦，这是足三阴亏损的症状。我用逍遥散（Free and Easy Wanderer Powder）、补中益气汤（Tonify the Middle and Augment the Qi Decoction）、六味地黄丸调治。庆幸她谨慎治病，一年多后各种症状全部痊愈，形体康健。
倒仓法（倒仓指催吐排毒疗法）后脾虚痰盛，应该先调理中焦治疗痰，并且将风药、血药减去，等到中气恢复，然后通用。
白术 白芍药（各一钱半） 陈皮（八分） 白茯苓 人参 半夏（姜制） 栝蒌仁（各一钱） 甘草（炙） 黄芩（酒炒） 枳实（麸炒，各五分） 香附米（盐水炒） 桔梗 麦门冬 麦芽（炒，各七分） 黄连（姜炒，四分）
我按语：前面说倒仓后脾虚痰盛，然而方子里的黄芩、黄连、栝蒌、枳实等药，是苦寒泄气克滞的药物，虽然兼用六君子汤（Six-Gentlemen Decoction）调补，恐怕所益不足以补偿所损，虽然加干姜一、二分，也恐怕未能救济其寒。大概痰这种病，有因热而生痰的，也有因痰而生热的，有因饮食积滞而得的，有因肾水亏损津液败浊而似痰的，有因肾水不足阴火上炎而生痰的，有因脾肺气虚不能摄涎而似痰的，不能一一列举，应当各自推究病因而治疗。然而倒仓之后痰反而盛，一定是因为中气再次受伤所致，所以治痰用峻厉的药物而痰更严重的，乃是脾气更加受伤，津液不能运化而如此！前述症状应当补脾胃调中气，那么津液各自归位，成为元气。
倒仓后大便燥结，头晕、眼花未除，加当归身尾、桃仁（去皮尖）各一钱，川芎五分，山药一钱。
我按语：前面的方子如果是因为酒面炙爆导致痰胶固，脾气没有亏损的，适宜使用；如果是因为肾气亏损，津液不足的，适宜用六味地黄丸；因为脾气虚弱的，适宜用六君子汤；因为中气虚的，适宜用补中益气汤；因为肾气亏损，水泛上而为痰的，适宜用六味地黄丸；如果脾肾虚寒，小水不调，肚腹膨胀的，适宜用金匮肾气丸（Jinkui Shenqi Pill）。
儒者王录之，素来痰很多，导吐之后，大便燥结、头晕、眼花等症状，尺脉浮大，按之则涩。这是肾气虚而兼血虚。用四物汤送服六味地黄丸，四剂后，各种症状全部消退，仍用前丸月余而康复。
佥宪高如斋，素来唾痰，服用下痰药后痰去甚多，大便秘结，小便频数，头晕眼花，尺脉浮大，按之如无。
我认为肾家不能纳气归源，前面的药物又耗损金水而严重。用加减八味丸（Modified Eight-Ingredient Pill）的方料煎服而痊愈。
儒者杨文魁，素来唾痰，各种药物无效，服用牛黄清心丸后吐痰甚多，有时头晕，有时热从胁起。左脉洪大有力，右脉浮大而无力。我说：这是足三阴亏损，虚火不能归源。用补中益气汤加麦门冬、五味子及加减八味丸，补其化源而痊愈。
秋官张碧崖，面赤作渴，痰盛，头晕。这是肾虚水泛为痰。用地黄丸而痊愈。
仪制贺朝卿，吞酸，胸满，痰盛，作泻，饮食少思，用清气化痰等药，前述症状更加严重，两膝渐肿，寒热往来。我认为脾胃虚，湿热下注。用补中益气汤，倍用人参、白术，加茯苓、半夏、炮姜而痊愈。
我的外甥范允迪，咳嗽痰盛，胸腹不畅，饮食少思，肢体倦怠，脉浮大，按之微弱，服用二陈汤、枳壳等药后更加严重。我说：脾、肺、肾虚。用补中益气汤、六味地黄丸而痊愈。
一个妇人，吐痰，发热，遍身疼痛，小便频数，阴中作痒，傍晚热甚。我说：这是肝脾血虚气滞而兼湿热。用加味逍遥散加车前子而痊愈。
一个妇人，怀抱不舒，腹胀，少寐，饮食素少，痰涎上涌，月经频来。我说：脾统血而主涎，这是郁闷伤脾，不能摄血制涎归源。用补中益气汤、济生归脾汤（Jisheng Guipi Decoction）二汤而痊愈。
橘红（八分） 半夏（姜汁炒） 白茯苓 白术（各一钱二分） 甘草（炙） 连翘 黄芩（炒） 前胡（各五分） 香附米（盐水炒，七分） 栝蒌仁（杵） 桔梗（各一钱） 大麦芽（炒，一钱）
以上用水煎煮，加入生姜汁三匙，竹沥两蚬壳量，半饥时温服。大概治痰药也以脾胃为主。
我按语：前面的方子如果是因为脾土太过，营气壅滞，适宜使用。如果是因为脾土不足，营气虚痞的，适宜以补中气为主；如果是因为肝木乘脾土的，适宜以补脾土为主；如果脾土虚寒的，适宜以补命门火为主。
侍御谭希曾，喘咳吐痰，有时手足发冷。这是中气虚寒。用补中益气汤、炮姜而痊愈。
职坊卢抑斋，饮食素少，忽然痰壅气喘，头摇目眨。扬手掷足，难以候脉，看他的面色黄中见青。这是肝木乘脾土，像小儿慢惊风的症状。先用六君子汤、柴胡、升麻而安定，再用补中益气汤加半夏而痊愈。
考功杨朴庵，呕吐痰涎，胸腹膨胀，饮食少思。左关脉弦长，按之无力；右关脉弦长，按之微弱。这是木克土。用六君子汤加柴胡、山栀、木香而痊愈。
一个儒者，身体肥胖，仲夏患痰喘。用二陈汤、黄芩、黄连、桔梗，痰喘更加严重；加桑白皮、杏仁、栝蒌，盗汗，气促；加贝母、枳壳，不时发热，饮食渐减。脉大而无力。我认为脾肺虚寒。用八味地黄丸（Eight-Ingredient Rehmannia Pill）以补土母，用补中益气汤以接中气而痊愈。
一个妇人，早间吐痰甚多，夜间喘急、不寐。早间多痰，乃脾虚饮食所化；夜间喘急，乃肺虚阴火上冲。用补中益气汤加麦门冬、五味子而痊愈。
半夏（汤泡七次姜汁水拌渗透） 橘红（盐水洗，各三两） 桔梗 海蛤粉（另研） 栝蒌仁（另研，各一两） 香附米（淡盐水炒） 枳壳（麸炒） 连翘 枯黄芩（炒，各五钱） 贝母（去心炒，各一两） 诃子皮 枯矾（各二钱五分）
以上研为末，炼蜜、姜汁为丸如黍米大。淡姜汤送下四、五十丸。不可过服，恐伤上焦元气。
我按语：前述症状如果是因为郁伤脾气，脾血虚损，用归脾汤（Guipi Decoction）加炒山栀、柴胡治疗；如果是因为怒动肝火，脾土受克，用六君子汤加炒山栀、柴胡平复；如果是因为饮食伤脾，营气虚弱，用六君子汤调治；如果是因为劳伤元气，用补中益气汤主治。
东垣先生（李东垣）说：胃为五脏之根本，胃气日益虚弱，脾无所禀受，五脏皆虚，各种症状蜂拥而起。
二守陈子忠，饮食少思，吐痰，口干，常服用二陈汤、枳实、黄连之类的药，脾胃受伤，于是问我。我转述东垣先生说：脾胃的病，实证用枳实、黄连泻之，虚证用白术、陈皮补之。他于是将这两味药等分为丸常服。因此多吃而不伤，过时而不饥。
徽州汪商，常服用二陈汤、枳实、黄连、青皮、浓朴，胸腹快利，后来患腹胀请治，脉已脱。我说：到了晚上必定死亡。不久果然如此。所以《内经》千言万语，只在人有胃气则生，又说四时皆以胃气为本。凡是脉促、代、屋漏之类，或者暴脱，我急忙用人参、附子等药，多有复生的。
Treating hemiplegia, with limbs lacking dexterity, laborious speech, yawning, sneezing, facial numbness, deviation of the mouth and eyes with flaccid muscles, dizziness and vertigo, excessive phlegm-fire, occasional pain in tendons and bones, or headache, palpitations.
Chuanxiong Rhizome (Qianxiong) (1 qian 2 fen), Danggui Radix (Danggui), Shengdihuang Cortex (Shengdihuang) stir-fried with ginger juice, Shudihuang Cortex (Shudihuang), Niuxi Root (Niuxi) washed with wine, Juhong Exocarpium Citri Reticulatae (Juhong) washed with salt water, Huangqin Radix (Huangqin) stir-fried with wine, Suanzaoren Semen Ziziphi Spinosae (Suanzaoren) stir-fried, each 8 fen, Honghua Flos Carthami Tinctorii (Honghua) washed with wine, Gancao Radix et Rhizoma Preparatum (Gancao) roasted, each 4 fen, Qianghuo Rhizoma et Radix (Qianghuo), Fangfeng Radix Saposhnikoviae (Fangfeng), Liugui Cortex Cinnamomi (Liugui), each 6 fen, Nanxing Tuber Arisaematis Cum Bile (Nanxing) processed, Banxia Tuber Pinelliae Preparatum (Banxia) processed, Baishao Radix Paeoniae Alba (Baishao) stir-fried with wine, Baifuling Poria (Baifuling), Tianma Rhizoma Gastrodiae (Tianma), each 1 qian, Baizhu Rhizoma Atractylodis Macrocephalae (Baizhu) 1 qian 5 fen, Huangbai Cortex Phellodendri (Huangbai) stir-fried with wine, 3 fen.
Decoct the above ingredients in water, add 2-3 tea spoons of Danzhuli Bamboo Sap (Danzhuli) and Jiangzhi Ginger Juice (Jiangzhi), take in the early morning.
Siwu Tang (Four-Substance Decoction) added with Honghua Flos Carthami Tinctorii (Honghua) and Niuxi Radix Achyranthis Bidentatae (Niuxi), totaling 6 qian 2 fen, to nourish blood, cool blood, and invigorate blood circulation.
Erchen Tang (Two-Aged Phlegm Decoction) added with Nanxing Tuber Arisaematis Cum Bile (Nanxing), Baizhu Rhizoma Atractylodis Macrocephalae (Baizhu), and Huangqin Radix Scutellariae (Huangqin), treating damp-phlegm, wind-phlegm, and fire-phlegm. Further adding Danzhuli Bamboo Sap (Danzhuli) and Jiangzhi Ginger Juice (Jiangzhi) to guide phlegm from the muscle surface and meridians, totaling 5 qian 9 fen. Qianghuo Rhizoma et Radix (Qianghuo), Fangfeng Radix Saposhnikoviae (Fangfeng), Tianma Rhizoma Gastrodiae (Tianma), and Liugui Cortex Cinnamomi (Liugui) are all acrid-warm agents that unblock the meridians and muscle surface, guiding and transporting blood-invigorating drugs to disperse pathogenic stagnation. Liugui acts horizontally on the arms; Niuxi and Huangbai act downwards on the waist and legs.
Baizhu Rhizoma Atractylodis Macrocephalae (Baizhu) serves as the sovereign drug, assisted by Baifuling Poria (Baifuling), Gancao Radix et Rhizoma (Gancao), Baishao Radix Paeoniae Alba (Baishao), Juhong Exocarpium Citri Reticulatae (Juhong), and Banxia Tuber Pinelliae Preparatum (Banxia), thereby consolidating the qi and blood of the spleen and stomach to transport and distribute the various herbs to the respective meridians.
Suanzaoren Semen Ziziphi Spinosae (Suanzaoren) assists Chuanxiong Rhizoma (Chuanxiong), Danggui Radix (Danggui), and Qianghuo Rhizoma et Radix (Qianghuo) to enter the Liver meridian to treat soreness and pain of tendons and bones, and wind-damp bi-syndrome; it also assists Shudihuang Cortex (Shudihuang) and Danggui Radix (Danggui) to enter the Heart meridian to treat palpitations and tremors due to Heart deficiency.
When Siwu Tang (Four-Substance Decoction) is assisted by Qianghuo Rhizoma et Radix (Qianghuo), Fangfeng Radix Saposhnikoviae (Fangfeng), Liugui Cortex Cinnamomi (Liugui), Nanxing Tuber Arisaematis Cum Bile (Nanxing), and Banxia Tuber Pinelliae Preparatum (Banxia) as minister and envoy drugs, the blood in the meridians, muscle surface, and tendons/bones will be replenished for deficiency and unblocked for stagnation.
Although Nanxing Tuber Arisaematis Cum Bile (Nanxing) and Banxia Tuber Pinelliae Preparatum (Banxia) are drying, their total amount is only 2 qian; although Qianghuo Rhizoma et Radix (Qianghuo), Fangfeng Radix Saposhnikoviae (Fangfeng), and Liugui Cortex Cinnamomi (Liugui) are acrid-warm, their total amount is only 1 qian 4 fen, totaling 3 qian 4 fen. The warming and drying drugs are added within the 6 qian 2 fen of blood-nourishing drugs. Moreover, there are 1 qian 5 fen of bitter-cold and sweet-cold drugs such as Huangqin Radix Scutellariae (Huangqin), Huangbai Cortex Phellodendri (Huangbai), and Gancao Radix et Rhizoma (Gancao). The disparity in quantity is significant; how could they dry out one's blood? This precisely illustrates the principles of sovereign-minister-assistant-envoy roles and dosage proportions.
Phlegm as a pathogen can reach anywhere in the body. Therefore, ancients used Erchen Tang (Two-Aged Phlegm Decoction) to treat it generally, guiding medication according to its location. Now, Tianma Rhizoma Gastrodiae (Tianma), Nanxing Tuber Arisaematis Cum Bile (Nanxing), Danzhuli Bamboo Sap (Danzhuli), and Jiangzhi Ginger Juice (Jiangzhi) are used to guide it into the hand and foot meridians, combined with Baizhu Rhizoma Atractylodis Macrocephalae (Baizhu) and Huangqin Radix Scutellariae (Huangqin) to descend fire-phlegm above the diaphragm.
In cold winter months, reduce Huangqin Radix Scutellariae (Huangqin) by 2-3 fen, or add 2 fen of Paofuchuanwu Processed Radix Aconiti Lateralis Preparata (Paofuchuanwu). If using Paofuchuanwu, reduce Liugui Cortex Cinnamomi (Liugui) to only 1-2 fen. If wind symptoms subside, remove Paofuchuanwu and Liugui, and reduce the dosage of Nanxing and Qianghuo. If there is inherent heat, do not reduce Huangqin.
Qianghuo Rhizoma et Radix (Qianghuo) is an essential herb for treating wind diseases. In cold months with severe colds, the dosage can be increased to 1 qian. If there is sweating and aversion to wind, this indicates true wind invasion; add 6-7 fen of Guizhi Ramulus Cinnamomi (Guizhi), reducing it as the illness subsides. Drugs like Paofuchuanwu, Guizhi, Qianghuo, Fangfeng, and Nanxing are all agents that unblock meridians and open the cou-li (skin pores); thus, they are essential for treating wind diseases. Wind causes dryness, so blood-nourishing and moistening drugs must be used. Since pathogens reside in the meridians and muscle surface, body fluids cannot circulate freely, condensing into phlegm and fluid retention; therefore, phlegm-resolving methods are necessary. Wind, blood, and phlegm are interrelated but differ in severity and sequence. If wind-stroke occurs first, treating wind is prioritized; if blood deficiency or heat occurs first, treating blood is prioritized; if phlegm occurs first, treating phlegm is prioritized.
My commentary: Diseases of the five zang organs interact through overacting and hiding, appearing and disappearing unpredictably. Referencing Mr. Xu Yongcheng's *Wuzang Zhiyao* (Essentials of Five Zang Organs) is particularly beneficial. See Volume 1 under "Questions on Zhang Zhongjing's Prescription Ingredients."
Zhang Zhongjing's Xiao Xuming Tang (Minor Continuation Life Decoction) discusses wind; the theories of Liu Wansu, Zhang Congzheng, and Zhu Danxi discuss blood and phlegm-fire. The key lies in adjusting treatment according to symptom changes.
My commentary: The aforementioned conditions are mostly caused by irregular diet and lifestyle, depleting yuan qi, leading to loose cou-li and invasion of external pathogens, or by labor damaging yuan qi and anger stirring liver fire. These are internal causes. The previous prescriptions should be used cautiously.
Lady Taiyi, aged 75, suffered from generalized pain, especially in tendons and bones, inability to extend or flex, dry mouth, red eyes, dizziness, abundant phlegm, chest oppression, scanty and painful urination, severe night-time phlegm-heat, and generalized itching like insects crawling. This was liver meridian qi dryness causing wind movement. She was cured using the formula of Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) with added Zhizi Gardeniae Fructus (Zhizi) and Chaihu Radix Bupleuri (Chaihu).
A man, after recovery from intermittent sores, suffered from generalized pain. After taking Yufeng Dan (Wind-Dispelling Pill), he developed hemiplegia, upward rushing of phlegm-saliva, and severe night-time pain. I diagnosed it as wind pathogens invading and overflowing, treating him with Dihuang Wan (Rehmannia Pill) which resulted in recovery.
An elderly woman suffered from paralysis of both arms and slurred speech. After taking wind-dispelling drugs, she experienced tendon spasms and bone pain. This was due to wind drugs depleting liver blood. She was treated with Bazhen Tang (Eight-Treasure Decoction) to tonify qi and blood, Dihuang Wan (Rehmannia Pill) to tonify kidney water, assisted by Yufeng Dan (Wind-Dispelling Pill), resulting in recovery.
A woman, due to anger, vomited phlegm and had chest fullness and pain. Taking Erchen Tang (Two-Aged Phlegm Decoction), Siwu Tang (Four-Substance Decoction), Huangqin, Huanglian, Zhike, etc., yielded no results. Adding wind-dispelling agents led to hemiplegia, tendon spasms, flaccidity, worsening at dusk, internal heat, dry mouth, and extreme fatigue. This was a deficiency of the three yin meridians of the foot. I treated her with Xiaoyao San (Free and Easy Wanderer Powder), Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), and Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). Fortunately, she adhered strictly to medical advice, and after more than a year, all symptoms resolved, and her physique became healthy.
After Dao Cang (purging method), spleen deficiency leads to abundant phlegm. One should first regulate the middle jiao and resolve phlegm, reducing wind and blood-invigorating drugs until middle qi recovers, then use general formulas.
Baizhu Rhizoma Atractylodis Macrocephalae (Baizhu), Baishao Radix Paeoniae Alba (Baishao), each 1 qian 5 fen; Chenpi Pericarpium Citri Reticulatae (Chenpi) 8 fen; Baifuling Poria (Baifuling), Renshen Radix Ginseng (Renshen), Banxia Tuber Pinelliae Preparatum (Banxia) prepared with ginger juice, Gualouren Semen Benincasae (Gualouren), each 1 qian; Gancao Radix et Rhizoma (Gancao) roasted; Huangqin Radix Scutellariae (Huangqin) stir-fried with wine; Zhishi Fructus Aurantii Immaturus (Zhishi) bran-fried, each 5 fen; Xiangfumii Rhizoma Cyperi Rotundi (Xiangfu) salt-water fried; Jiegeng Radix Platycodonis (Jiegeng), Maidong Radix Ophiopogonis (Maidong), Maiya Fructus Hordei Germinatus (Maiya) stir-fried, each 7 fen; Huanglian Rhizoma Coptidis (Huanglian) ginger-fried, 4 fen.
Decoct in water, add 3 spoons of Zhuli Bamboo Sap (Zhuli) and 3 spoons of Jiangzhi Ginger Juice (Jiangzhi), take warm when half-hungry. Treating phlegm primarily focuses on the spleen and stomach.
If feeling cold in the stomach and prone to diarrhea in cold months, add 1-2 fen of Chao Ganjiang Rhizoma Zingiberis Preparatum (Chao Ganjiang).
My commentary: As stated earlier, post-Dao Cang spleen deficiency leads to abundant phlegm. However, the previous formula contains bitter-cold, qi-draining, and stagnation-clearing drugs like Huangqin, Huanglian, Gualou, and Zhishi. Although combined with Liujunzi Tang (Six-Gentlemen Decoction) for tonification, the benefit may not compensate for the damage. Even adding 1-2 fen of Ganjiang may not counteract the cold. Phlegm arises from heat, or heat arises from phlegm; it can result from food stagnation, kidney water deficiency leading to turbid fluids resembling phlegm, insufficient kidney water causing defying flaming fire to generate phlegm, or spleen-lung qi deficiency failing to control saliva resembling phlegm. Causes vary and must be treated individually. Post-Dao Cang, if phlegm increases, it is due to further injury of middle qi. Using harsh phlegm-resolving drugs worsens phlegm because spleen qi is further damaged, preventing fluid transformation. For the aforementioned symptoms, tonifying the spleen and stomach and regulating middle qi allows fluids to return to their proper places and become yuan qi.
Post-Dao Cang, with dry stool, dizziness, and blurred vision remaining, add Danggui Radix (Danggui) body and tail, Taoren Semen Persicae (Taoren) peeled and pitted, each 1 qian, Chuanxiong Rhizoma (Chuanxiong) 5 fen, Shanyao Rhizoma Dioscoreae (Shanyao) 1 qian.
My commentary: The previous formula is suitable if phlegm is sticky due to alcohol, wheat, and fried foods without spleen qi deficiency. If due to kidney qi deficiency and insufficient fluids, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). If due to spleen qi weakness, use Liujunzi Tang (Six-Gentlemen Decoction). If due to middle qi deficiency, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If due to kidney qi deficiency with water flooding upwards causing phlegm, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). If spleen-kidney deficiency-cold with abnormal urination and abdominal distension, use Jin Gui Shen Qi Wan (Jinkui Shenqi Pill).
Scholar Wang Luzhi had abundant phlegm. After purging, he suffered from dry stool, dizziness, and blurred vision. His chi pulse was floating and large, but choppy upon pressure. This indicated kidney qi deficiency combined with blood deficiency. He took Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) delivered with Siwu Tang (Four-Substance Decoction). After four doses, all symptoms subsided. Continuing the pill for over a month led to recovery.
Censor Gao Ruizhai habitually spat phlegm. After taking phlegm-draining medicines, much phlegm was expelled, leading to constipation, frequent urination, dizziness, and blurred vision. His chi pulse was floating and large, feeling empty upon pressure.
I reasoned that the kidneys failed to grasp qi and return it to its source, and previous drugs further depleted metal (lung) and water (kidney). He was cured by decocting and taking Jiawei Bawei Wan (Modified Eight-Ingredient Pill).
Scholar Yang Wenkui habitually spat phlegm. Various drugs were ineffective. After taking Niuhuang Qingxin Wan (Calculus Bovis Clearing Heart Pill), he vomited much phlegm, sometimes experiencing dizziness or heat rising from the hypochondrium. His left pulse was surging and forceful; his right pulse was floating, large, and weak. I said: This is deficiency of the three yin meridians of the foot, with deficient fire failing to return to its source. He was cured by using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Maidong Radix Ophiopogonis (Maidong) and Wuweizi Fructus Schisandrae (Wuweizi), along with Jiawei Bawei Wan (Modified Eight-Ingredient Pill) to tonify the source of transformation.
Official Zhang Biya had a red face, thirst, abundant phlegm, and dizziness. This was kidney deficiency with water flooding to form phlegm. He was cured by Dihuang Wan (Rehmannia Pill).
He Chaoping had acid regurgitation, chest fullness, abundant phlegm, diarrhea, and poor appetite. Using Qingqi Huatan Tang (Clear Qi Resolve Phlegm Decoction) worsened these symptoms, leading to swollen knees and alternating chills and fever. I diagnosed spleen-stomach deficiency with damp-heat sinking downward. He was cured by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with doubled Renshen and Baizhu, plus Baifuling, Banxia, and Paojiang Ginger Rhizome Preparatum (Paojiang).
My nephew Fan Yun迪 suffered from coughing with abundant phlegm, chest-abdominal discomfort, poor appetite, limb fatigue, floating pulse large but weak upon pressure. Taking Erchen Tang (Two-Aged Phlegm Decoction) and Zhishi worsened symptoms. I diagnosed spleen, lung, and kidney deficiency. He was cured by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill).
A woman vomited phlegm, had fever, generalized pain, frequent urination, vaginal itching, and severe evening heat. I diagnosed liver-spleen blood deficiency with qi stagnation and damp-heat. She was cured by Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) added with Cheqianzi Semen Plantaginis (Cheqianzi).
A woman felt frustrated, had abdominal distension, insomnia, poor appetite, upward rushing of phlegm-saliva, and frequent menstruation. I said: The spleen governs blood and controls saliva. Depression injured the spleen, failing to control blood and saliva to return to their source. She was cured by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Jisheng Guipi Tang (Jisheng Guipi Decoction).
To specifically treat phlegm, use Jiawei Erchen Tang (Modified Two-Aged Phlegm Decoction); after stomach qi recovers, intermittently use phlegm-regulating drugs.
Juhong Exocarpium Citri Reticulatae (Juhong) 8 fen; Banxia Tuber Pinelliae Preparatum (Banxia) stir-fried with ginger juice; Baifuling Poria (Baifuling), Baizhu Rhizoma Atractylodis Macrocephalae (Baizhu), each 1 qian 2 fen; Gancao Radix et Rhizoma (Gancao) roasted; Lianqiao Fructus Forsythiae (Lianqiao), Huangqin Radix Scutellariae (Huangqin) stir-fried, Qianhu Radix Peucedani (Qianhu), each 5 fen; Xiangfumii Rhizoma Cyperi Rotundi (Xiangfu) salt-water fried, 7 fen; Gualouren Semen Benincasae (Gualouren) pounded; Jiegeng Radix Platycodonis (Jiegeng), each 1 qian; Dayamai Fructus Hordei Germinatus (Dayamai) stir-fried, 1 qian.
Decoct in water, add 3 spoons of Shengjiangzhi Fresh Ginger Juice (Shengjiangzhi) and two clam shells of Zhuli Bamboo Sap (Zhuli), take warm when half-hungry. Treating phlegm primarily relies on the spleen and stomach.
My commentary: The previous formula is suitable if spleen earth is excessive with congested ying qi. If spleen earth is insufficient with deficient ying qi, tonifying middle qi is primary. If liver wood overacts on spleen earth, tonifying spleen earth is primary. If spleen earth is deficiency-cold, tonifying Mingmen fire is primary.
Censor Tan Xizeng suffered from wheezing, coughing, and spitting phlegm, with occasional cold hands and feet. This was middle qi deficiency-cold. He was cured by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Paojiang Ginger Rhizome Preparatum (Paojiang).
Official Lu Yizhai had poor appetite, sudden phlegm obstruction with wheezing, head shaking, and eye blinking. He waved his hands and threw his feet, making pulse diagnosis difficult. His complexion was yellow with green tinges. This was liver wood overacting on spleen earth, resembling infant slow convulsion syndrome. He was stabilized initially with Liujunzi Tang (Six-Gentlemen Decoction), Chaihu, and Shengma Rhizoma Cimicifugae (Shengma), then fully recovered with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Banxia.
Official Yang Pu'an suffered from vomiting phlegm-saliva, abdominal distension, and poor appetite. His left guan pulse was wiry and long, weak upon pressure; his right guan pulse was wiry and long, very weak upon pressure. This was wood overacting on earth. He was cured by Liujunzi Tang (Six-Gentlemen Decoction) added with Chaihu, Zhizi, and Muxiang Radix Aucklandiae (Muxiang).
A scholar, obese, suffered from phlegm-wheezing in mid-summer. Using Erchen Tang (Two-Aged Phlegm Decoction), Huangqin, Huanglian, Jiegeng worsened phlegm-wheezing; adding Sangbaipi Cortex Mori Radicis (Sangbaipi), Xingren Semen Armeniacae Amarum (Xingren), Gualou worsened night sweats and shortness of breath; adding Beimu Flos Fritillariae (Beimu), Zhishi worsened intermittent fever and reduced appetite. His pulse was large but weak. I diagnosed spleen-lung deficiency-cold. He was cured by Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) to tonify the mother of earth, and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to support middle qi.
A woman vomited much phlegm in the morning, suffered from night-time wheezing and insomnia. Morning phlegm is transformed from food due to spleen deficiency; night-time wheezing is due to lung deficiency with yin fire rushing upward. She was cured by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Maidong and Wuweizi.
Jiawei Huatan Wan (Modified Phlegm-Resolving Pill) treats phlegm filling the chest and diaphragm, with throat discomfort.
Banxia Tuber Pinelliae Preparatum (Banxia) soaked in boiling water seven times, mixed with ginger juice until permeated; Juhong Exocarpium Citri Reticulatae (Juhong) washed with salt water, each 3 liang; Jiegeng Radix Platycodonis (Jiegeng), Haige Fen Concha Meretricis et Cyclinae Pulvis (Haige Fen) ground separately; Gualouren Semen Benincasae (Gualouren) ground separately, each 1 liang; Xiangfumii Rhizoma Cyperi Rotundi (Xiangfu) light salt-water fried; Zhishi Fructus Aurantii Immaturus (Zhishi) bran-fried; Lianqiao Fructus Forsythiae (Lianqiao); Ku Huangqin Radix Scutellariae (Ku Huangqin) stir-fried, each 5 qian; Beimu Flos Fritillariae (Beimu) heart removed and stir-fried, each 1 liang; Hezi Pericarpium Terminaliae Chebulae (Hezi Pi), Kufan Alum Preparatum (Kufan), each 2 qian 5 fen.
Grind into powder, make pills with refined honey and ginger juice, size of millet seeds. Take 40-50 pills with light ginger soup. Do not overdose, lest it damage upper jiao yuan qi.
My commentary: If the aforementioned symptoms are due to depression injuring spleen qi and spleen blood deficiency, use Guipi Tang (Guipi Decoction) added with stir-fried Zhizi and Chaihu. If due to anger stirring liver fire overacting on spleen earth, use Liujunzi Tang (Six-Gentlemen Decoction) added with stir-fried Zhizi and Chaihu to calm it. If due to dietary injury to spleen with deficient ying qi, use Liujunzi Tang (Six-Gentlemen Decoction) to regulate. If due to labor damaging yuan qi, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) as the main treatment.
Mr. Dongyuan (Li Dongyuan) said: The stomach is the root of the five zang organs. As stomach qi becomes deficient, the spleen receives nothing, leading to deficiency in all five zang organs and a swarm of symptoms.
Chen Zizhong, Second Governor, had poor appetite, spitting phlegm, and dry mouth. He frequently took Erchen Tang (Two-Aged Phlegm Decoction), Zhishi, Huanglian, etc., injuring spleen and stomach. He asked me for advice. I quoted Mr. Dongyuan: For spleen-stomach excess, use Zhishi and Huanglian to drain; for deficiency, use Baizhu and Chenpi to tonify. He then took equal parts of these two herbs as pills for daily use. Consequently, he could eat more without injury and feel hungry past meal times.
Merchant Wang from Huizhou frequently took Erchen Tang (Two-Aged Phlegm Decoction), Zhishi, Huanglian, Qingpi Pericarpium Citri Reticulatae Viride (Qingpi), Houpo Cortex Magnoliae Officinalis (Houpo). His chest and abdomen felt comfortable, but later he developed abdominal distension. His pulse had vanished. I said: He will die by evening. It happened as predicted. Thus, the *Neijing* states in thousands of words: "If a person has stomach qi, they live"; and "The four seasons all rely on stomach qi as the root." For rapid, intermittent, or roof-leak pulses, or sudden collapse, I urgently use Renshen Radix Ginseng (Renshen) and Fuzi Radix Aconiti Lateralis Preparata (Fuzi), often resulting in revival.