孙 厥阴寒气乘胃，直犯中州，虫动不安，腹痛如刀之刺，口吐酸水清涎。法宜辛温，佐以酸苦，泄之通之。
川楝子 延胡索 川连 青皮 吴茱萸 川椒 焦楂炭 乌药 使君子 竹二青
金 少腹两旁结块，渐大渐长，静则挟脐而居，动则上攻至脘，旁及两胁，已八九年矣。据云始因积经半
载，疑其有孕，及产多是污水，后遂结块。想是水寒血气凝聚而成。
甘遂（面包煨，三钱） 香附（盐水炒，一两） 三棱（醋炒，一两） 蓬术（醋炒，
一两） 桃仁（炒，五钱） 肉桂（另研，一钱） 川楝子（五钱，巴豆七粒合炒黄，去
巴豆） 五灵脂（醋炒，五钱） 地鳖虫（酒浸，炙，二十一个）
共研为末，炼白蜜捣和为丸。每服十丸，日三服。
渊按∶水寒血气凝聚冲脉之分，果是实证，此方必效。
金 脐以上有块一条，直攻心下作痛，痛连两胁，此属伏梁，为心之积，乃气血寒痰凝聚而成。背脊热而
眩悸，营气内亏也。法当和营化积。
当归 半夏 瓦楞子 香附 丹参 茯苓 陈皮 木香 延胡索 川楝子 砂仁
渊按∶眩悸亦寒痰为患，未必即是营虚，否则背脊之热何来。
又 投化积和营，伏梁之攻痛稍缓，背脊之热亦减，仍从前制。
前方去茯苓、瓦楞子、木香，加茯神、玫瑰花。
王 腹中癖块，渐大如盘，经事不来，腰酸带下。此属营虚
气滞，瘀积内停。近日水泻，伤于暑湿。当先治其新病。
平胃散去甘草，加芍药、香附、吴茱萸、焦六曲。
又 腹块如复盘，上攻则痛，下伏则安。足跗浮肿，时时沃酸。从肝脾胃三经主治。
川楝子 延胡索 吴茱萸 川椒 木香 蓬莪术 制香附 陈皮 茯苓 川连（姜汁炒）
又 腹中结块，内热微寒，四肢无力，口沃酸水。肝脾气郁，营卫两亏，劳损之象。
党参 香附 当归 丹参 川楝子 川椒 延胡索 冬术 干姜 青蒿梗 神曲 大枣
渊按∶内热微寒，乃肝脾郁结，肺金治节不行，营卫不调也。宜参逍遥、左金法。
丁 肝之积，在左胁下，名曰肥气。日久撑痛。
川楝子 延胡索 川连 青皮 五灵脂 山楂炭 当归须 蓬莪术 荆三棱 茯苓 木香 砂仁
又 左胁之痛已缓。夜增咳嗽，寒痰走于肺络。宜肺肝同治。
旋复花 杏仁 川楝子 荆三棱 茯苓 款冬花 半夏 新会皮 蓬莪术 新绛 青葱管
蒋 少腹结块，渐大如盘。此属肠覃，气血凝滞而成。拟两疏气血。
香附 五灵脂 红花 当归 泽兰 桃仁 延胡索 丹参 陈皮 砂仁
大黄 虫丸，每服二十粒，开水送。
金 气从少腹上冲咽嗌，则心中跳，胁中痛，初起寒热而呕，此奔豚气之挟肝邪者也。半月以来，
寒热虽止，气仍上逆。脉沉弦小。宜宗《金匮》法。
二陈汤去甘草，加当归、白芍、吴茱萸、香附、川朴、槟榔、苏梗、沉香、姜汁、东行李根。
又 奔豚之气渐平，脘中之气未静。当从肝胃求治。
淡吴萸 半夏 香附 川楝子 延胡索 茯苓 焦六曲 陈皮 白芍 蔻仁
丁 久患休息痢，止数日后气攻胸脘板痛，上下不通，几至发厥，须大便通始减其痛。匝月大便仅通三
次。板痛者聚而成块，偏于右部，是脾之积也。脉沉紧而细，当与温通。
熟附子 淡干姜 川朴 陈皮 茯苓 香附 大腹皮 延胡索 沉香化气丸 东垣五积丸
米 右关尺牢弦，腰腹有块攻痛，是肝肾之积在下焦也。用缓消止痛法。
肉桂 雄黄 尖槟榔
共研细末，用独头蒜捣丸。早晚服各五丸，开水送。
渊按∶雄黄散结，槟榔破滞，肉桂温散下焦沉寒痼冷，又能温脾疏肝。丸以独蒜，以浊攻浊，深得制方之妙。
唐 经停十月，腹微满，脉沉细涩，脐上心下块长数寸，是属伏梁，因七情恚怒气郁痰凝所致。经曰∶
大积大聚，其可犯也，衰其大半而止。洁古谓∶养正积自除，不得过用克伐。今拟
开郁正元散法，理气行血，和脾化痰，寓消于补之中。
二陈汤加归身、川芎、冬术、山楂炭、延胡索、香附、麦芽、苏梗、砂仁、茺蔚子。
钱 少腹有块，痛则经来如注，气升如喘。冲脉久伤，肝木肆横。
香附（醋炒） 紫石英 当归 白芍（酒炒） 木香 三棱（醋炒） 大熟地 牛膝 小茴香（盐水炒） 青皮（醋
炒）
某 前年秋季伏暑症中，即结 瘕，居左胁下。春来下午必发微热，晨必吐痰，食面必溏泄。此当时热邪
未清，早进油腻面
食，与痰热互相结聚于肺胃之络，当以攻消为主。
柴胡（三钱，酒炒） 青皮（一两，巴豆五钱同炒；去豆） 三棱（五钱，醋炒）
蓬术（五钱，醋炒） 雄精（一两） 大黄（一两，皂荚子三粒，合炒去皂荚子）
上药为丸，每服一钱。下午服六君子丸三钱。
渊按∶柴胡、青皮疏肝胆而升清，莪、棱破滞气而消块，大黄攻热积，巴豆逐寒积，皂子去油腻之积，
雄精开结化痰也。无坚不破，无攻不利，正气不虚者可用。
陈 病起逢食则呃，食入则胀。今脐上至心下一条胀痛，坐久则知饥，行动则饱胀，此属伏梁。
胃为心之子，故胃亦病也。仿东垣五积治例。
川连 吴茱萸 干姜 陈皮 香附 半夏 茯苓 丁香 延胡索 五灵脂
渊按∶所谓食呃也，病在肠胃。
钱 脉微细，阴之象也。少腹有块，上攻及脘，自脘至嗌一条气塞，发作则大痛欲厥，头汗如雨。用方
大法，固宜以温通为主矣。惟舌有黄腻浊苔，便泄臭秽，必兼湿热，而块痛得按稍
减，中气又虚，方法极难周顾，尚祈斟酌是荷。
川楝子 乌药 肉桂 乌梅 木香 淡吴萸 泽泻 延胡索 茯苓 川连（酒炒）
又 下焦浊阴之气，上乾清阳之位。少腹胸胁有块，攻撑作痛，痛甚发厥。昨用温通，病势稍减，
脉仍微细，泄仍臭秽，恶谷厌纳，中气大亏，阴气凝结，当脐硬痛。恐属脏结，攻之不可，补之亦难，诚为棘手。
肉桂 吴茱萸 炮姜 枸杞子 乌药 木香 延胡索 金铃子 白芍 茯苓 泽泻 萱花 金橘饼
丁 小肠遗热于大肠，为伏瘕，腹中微痛。用HT 济槟榔丸。
槟榔（炒） 桃仁 当归（酒炒） 青皮（酒炒） 沉香 火麻仁 党参（元米
炒） 茯苓（烘） 木香（烘） 乌药（烘） 大熟地（砂仁拌炒） 白芍（酒炒）
上药为末，用神曲三两，煮糊为丸。每朝三钱，开水送。
伍 胸脘有块，大如碗，每午后则痛，甚于黄昏，连及背胀，时沃清水，诸药无效。
枳壳（九枚，纳入阿魏三钱，炙焦） 牡蛎（二两） 肉桂（三钱） 白蛳螺壳（二两）
共炙为末。每痛发时服一钱，开水送。
渊按∶枳壳破气。阿魏佐肉桂散寒，以浊攻浊。牡蛎软坚。白蛳螺壳始用于丹溪，云化伏痰，消宿水。
周 食填太阴，肝气欲升而不得，胃气欲降而不能，气塞于中，与食相并，脘胁疼痛，气攻有块，
汤饮辄呕，上不得纳，下不得出，法当疏运其中。
半夏 橘红 青皮 莱菔子 川朴（姜汁炒） 吴茱萸 赤苓 白蔻仁（研冲）
另∶苏梗、枳壳、槟榔，三味摩冲。
丁 脉迟细，脘中有块，纳食撑胀，腹中漉漉作声，嗳腐吞酸，大便坚结。此脾胃有寒积也。
当以温药下之，仿温脾法。
附子（制） 干姜 枳实 大黄 桂木 陈皮 半夏
洪 结癖累累，久踞腹中。年逾六旬，元气下虚，中气已弱，肝气肆横，腹渐胀满。脉沉弦细，
细而沉为虚为寒，沉而弦为气为郁。病关情志，非湿热积滞可比，攻消克伐难施。拟商通
补。补者补其虚，通者通其气。
六君子汤加、苏梗、肉桂、香附、川朴（姜汁炒）、白芍、生姜。
冯 脉右关滑动，舌苔黄白而腻，是痰积在中焦也。左关弦搏，肝木气旺，故左肋斜至脐下有梗一条，
按之觉硬，乃肝气入络所结。尺寸脉俱微缓，泄痢一载，气血两亏。补之无益，攻之
不可，而病根终莫能拔。根者何？痰积，湿热，肝气也。夫湿
热、痰积，须借元气以营运。洁古所谓养正积自除，脾胃健则湿热自化，原指久病而言。此病不谓不久，
然则攻消克伐何敢妄施。兹择性味不猛而能通能化者用之。
人参 茯苓 于术 青陈皮 炙甘草 泽泻 枳壳 神曲 茅术 当归（土炒） 黄 白芍（吴萸三分，
煎汁炒） 防风根
又 丸方∶制半夏三两，分六分。一分木香（二钱，煎汁拌炒）；一分
白芥子（二钱，煎汁拌炒）；一分乌药（三钱，煎汁拌炒）；一分金铃子（三钱，煎汁拌
炒）；一分猪苓（二钱，煎汁拌炒）；一分醋拌炒。炒毕，去诸药，仅以半夏为末，入雄精三钱，研末，射香
一分，独头蒜三个，打烂，用醋一茶杯，打和为丸。每晨服一钱五分，开水送。
渊按∶制法极佳，通化肺脾之痰，疏理肝胆之结，丸法亦有巧思。诸凡与此证相类者，皆可用之。
曹 寒饮痰涎气血凝结成癖，踞于脘肋，下及腰间，久必成囊而为窠臼。如贼伏于隐僻之处，一时难以攻
捣。昔许学士有此论，法当内和脾胃，外用攻消，今仿其意。
半夏 茯苓 乌药 白芥子 当归 青皮 泽泻 吴茱萸 延胡索 桂枝 杜仲（姜汁炒） 生木香 生熟谷芽
华 脾虚胃弱，则湿热不运而生痰。痰停中脘，则食不化而成积。胃脘结块，按之则痛，面色青黄，
木乘中土。饮食少纳，虑延胀满。
党参（姜汁炒） 半夏 陈皮 川朴 茯苓 白芥子 山楂肉 砂仁 六曲 鸡内金
丁 血虚木横，两胁气撑痛，腹中有块，心荡而寒热。病根日久，损及奇经。经云∶冲脉为病，
逆气里急，任脉为病，男疝女瘕。阳维为病苦寒热；阴维为病苦心痛。合而参之，谓非奇经之病乎？调之不易。
黄 党参 茯神 白薇 枸杞子 沙苑子 白芍 当归 陈皮 香附 紫石英。
又 和营卫而调摄奇经，病势皆减。惟腹中之块未平。仍从前法增损。
前方去枸杞子，加砂仁、冬术。
孔 病由肝气横逆，营血不调，腹中结瘕，脘胁攻痛，渐致食减内热，咳嗽痰多，当脐动跳，心悸少寐，
口干肠燥，而显虚劳血痹之象。极难医治，姑仿仲景法。
党参 茯苓 枣仁 乳香 没药 桃仁 当归 川贝 香附 白蜜 地鳖虫（酒炙）
又 前方养营化瘀，下得血块两枚。腹满稍软，内热咳嗽未减。今且和营启胃，退热止咳，再望转机。
西党参 茯苓 丹参 广皮 血余炭 川贝母 杏仁 当归 阿胶 地鳖虫
又 气滞血瘀，腹满有块攻痛，内热已减，咳嗽未平。拟两和气血方法。
党参 香附 郁金 茯苓 山楂肉 延胡索 当归 杏仁 阿胶 桃仁 沉香 血余炭
又 咳嗽不止，腹仍满痛。肝肺同病，久延不已，终成劳损。
桃杏仁 车前子 川贝 当归 丹皮 阿胶（蒲黄炒） 旋复花 苏子 茯苓 新绛
许 腹痛，大便泄出细虫，延来日久，中气渐虚，此胃中寒积也。法当温中补中。
川连（盐水炒） 炮姜 木香 白芍 白术 使君子 吴茱萸 乌药 川椒 伏龙肝（煎汤代水）
某 阅病源是属虫病无疑。虫由湿热所化，脾土不运而生。其发于月底之夜，原有脾胃虚寒。寒属阴，
故夜发也。寒久化热，土虚木强，其发移于月初，必呕吐胸热，两乳下跳，虫随酸苦痰涎而出，多寡不一，或
大便亦有，腹中微痛，虽口渴甚，不能咽水，水下复呕，呕尽乃平，至中旬则康泰无恙矣。所以然
者，月初虫头向上，且病久呕多，胃阴亏，虚火上炎，故胸中觉热。虚里跳动，中气虚也。中气者，胸中大气，
脾胃冲和之气，皆归所统。脾胃中气虚甚，故跳跃也。病延一载有余，虫属盘
踞，未易一扫而除。图治之法，和中调脾，杜生虫之源；生津平肝，治胸热口渴；化湿热，降逆气，
以治呕吐。久服勿懈，自可见功；欲求速效，恐不能耳。
川楝子 芜荑 党参（元米炒） 白术 青皮 制半夏 白芍 茯苓 焦六曲 干姜 陈皮 榧子 蔻
仁使君子肉
渊按∶病从脾胃寒湿而来，湿郁生热，热郁生虫，变成本寒
标热。本寒则藏真伤而气结生积，标热则湿热阻而虫属内踞。
吴 喜食生米，积聚生虫。腹痛面黄，口流涎沫，虫之见症无疑。先拟健脾化虫。
茅术（米泔水浸） 青皮 鹤虱 榧子（炒打） 芜荑 尖槟榔 陈米（炒黄）
共研为末，每朝调服三钱，略用砂糖少许。
马 心之积，名曰伏梁。得之忧思而气结也。居于心下胃脘之间，其形竖直而长。痛发则呕吐酸水，
兼夹肝气、痰饮为患也。开发心阳以化浊阴之凝结，兼平肝气而化胃之痰饮。
桂枝 石菖蒲 延胡索 半夏 川连 吴萸（炒） 茯苓 川楝子 陈皮 蔻仁 郁金 瓦楞子
朱 久有伏梁痞痛呕酸之患，是气血寒痰凝结也。自遭惊恐奔波，遂至脘腹气撑，旁攻胁肋，上至咽嗌，
血随气而上溢，甚至盈碗盈盆。两载以来，屡发屡止，血虽时止，而气之撑胀终未
全平。近来发作，不吐酸水而但吐血，想久伏之寒化而为热矣。立方当从气血凝积二字推求，备候商用。
孙先生：厥阴经寒气侵犯胃腑，直中中焦脾胃，导致虫体躁动不安，腹部疼痛如刀割般刺痛，口中吐出酸水及清稀涎沫。治疗法则应当使用辛温药物，辅以酸苦之品，以泄降气机、疏通郁滞。
川楝子 延胡索 黄连 青皮 吴茱萸 川椒 焦山楂炭 乌药 使君子 竹茹（取中间层）
金先生：少腹两侧有结块，逐渐增大变长，静止时位于脐旁，活动时向上攻冲至胃脘部，并向两侧胁肋蔓延，病程已有八九年了。据患者自述，起初因怀孕积滞半年，怀疑有孕，生产时多饮污水，此后便结成块状。推测是水寒之气与血气凝聚而成。
甘遂（用面包包裹煨制，三钱） 香附（盐水炒，一两） 三棱（醋炒，一两） 蓬术/莪术（醋炒，一两） 桃仁（炒，五钱） 肉桂（另研细末，一钱） 川楝子（五钱，与巴豆七粒同炒至黄，去巴豆不用） 五灵脂（醋炒，五钱） 地鳖虫（酒浸，炙干，二十一个）
以上共研为细末，用炼过的白蜜调和捣制成丸剂。每次服用十丸，每日三次。
渊按：水寒与血气凝聚于冲脉部位，如果是实证，此方必定有效。
金先生：脐以上有一条条状肿块，直攻心下引起疼痛，疼痛牵连两胁，这属于“伏梁”病，是心脏的积证，由气血寒痰凝聚而成。背部脊柱发热且伴有眩晕心悸，这是营气内部亏损的表现。治疗法则应当调和营血、化解积块。
当归 半夏 瓦楞子 香附 丹参 茯苓 陈皮 木香 延胡索 川楝子 砂仁
渊按：眩晕心悸也是寒痰所致，未必就是营血虚，否则背脊的热感从何而来。
又诊：投用化积和营的药物后，伏梁病的攻冲疼痛稍见缓解，背脊的热感也减轻，仍按原方制剂。
前方去掉茯苓、瓦楞子、木香，加入茯神、玫瑰花。
王先生：腹中有癖块，逐渐增大如盘状，月经停止，腰酸且有带下。这属于营血虚弱、气机阻滞，瘀血积滞内停。近日出现水样腹泻，是伤于暑湿之邪。应当先治疗新近发生的疾病。
平胃散去掉甘草，加入芍药、香附、吴茱萸、焦六曲。
又诊：腹中的块状物如同翻扣的盘子，向上攻冲则痛，向下潜伏则安。足背浮肿，时常泛吐酸水。从肝、脾、胃三经进行主治。
川楝子 延胡索 吴茱萸 川椒 木香 蓬莪术 制香附 陈皮 茯苓 黄连（姜汁炒）
又诊：腹中结块，自觉内热而微恶寒，四肢无力，口中泛吐酸水。这是肝脾气机郁结，营卫两虚，呈现劳损的征象。
党参 香附 当归 丹参 川楝子 川椒 延胡索 冬术/白术 干姜 青蒿梗 神曲 大枣
渊按：内热微寒，是由于肝脾郁结，肺金的治节功能不行，导致营卫不调。适宜参考逍遥散、左金丸的方法。
丁先生：肝脏的积证，位于左胁下，名叫“肥气”。日久导致撑胀疼痛。
川楝子 延胡索 黄连 青皮 五灵脂 山楂炭 当归须 蓬莪术 荆三棱 茯苓 木香 砂仁
又诊：左胁部的疼痛已经缓解。夜间咳嗽加重，寒痰流注于肺络。应当肺肝同治。
旋复花 杏仁 川楝子 荆三棱 茯苓 款冬花 半夏 新会皮/陈皮 蓬莪术 新绛 青葱管
蒋先生：少腹结块，逐渐增大如盘状。这属于“肠覃”，由气血凝滞而成。拟采用疏理气血的方法。
香附 五灵脂 红花 当归 泽兰 桃仁 延胡索 丹参 陈皮 砂仁
大黄䗪虫丸，每次服用二十粒，开水送服。
金先生：气从少腹上冲咽喉，心中跳动，胁中疼痛，初起时寒热交替并呕吐，这是奔豚气挟带肝邪的表现。半个月以来，寒热虽然停止，但气仍然上逆。脉象沉弦小。应当遵循《金匮要略》的法度。
二陈汤去掉甘草，加入当归、白芍、吴茱萸、香附、厚朴、槟榔、苏梗、沉香、姜汁、东行李根。
又诊：奔豚之气逐渐平息，胃脘部的气机仍未安静。应当从肝胃求治。
淡吴茱萸 半夏 香附 川楝子 延胡索 茯苓 焦六曲 陈皮 白芍 蔻仁
丁先生：久患休息痢，停止数日后，气攻胸脘板硬疼痛，上下不通，几乎要发生昏厥，必须大便通畅才能减轻疼痛。一个月来大便仅通三次。板硬疼痛是因为聚集成块，偏于右侧，这是脾脏的积证。脉象沉紧而细，应当给予温通之法。
熟附子 淡干姜 厚朴 陈皮 茯苓 香附 大腹皮 延胡索 沉香化气丸 东垣五积丸
米先生：右关尺脉牢弦，腰腹部有块状物攻冲疼痛，这是肝肾的积证位于下焦。采用缓消止痛的方法。
肉桂 雄黄 尖槟榔
共研为细末，用独头蒜捣烂制成丸剂。早晚各服五丸，开水送服。
渊按：雄黄散结，槟榔破滞，肉桂温散下焦沉寒痼冷，又能温脾疏肝。用独蒜制丸，是以浊攻浊，深得制方的妙处。
唐女士：月经停止十月，腹部微满，脉象沉细涩，脐上心下有长数寸的块状物，这属于伏梁，因七情恚怒气郁、痰凝所致。医经说：大积大聚，可以攻伐，但要衰其大半就停止。洁古说：养护正气，积滞自然消除，不可过度使用克伐药物。如今拟定开郁正元散的法度，理气行血，和脾化痰，在补益之中寓含消导之意。
二陈汤加归身、川芎、冬术/白术、山楂炭、延胡索、香附、麦芽、苏梗、砂仁、茺蔚子。
钱先生：少腹有块，疼痛时月经来潮如注，气机上逆如喘息。冲脉久已受伤，肝木之气肆意横逆。
香附（醋炒） 紫石英 当归 白芍（酒炒） 木香 三棱（醋炒） 大熟地 牛膝 小茴香（盐水炒） 青皮（醋炒）
某先生：前年秋季伏暑症发作时，即结成瘕块，位于左胁下。春季下午必发微热，早晨必吐痰，吃面食必溏泄。这是因为当时热邪未清，过早进食油腻面食，与痰热互相结聚于肺胃之络，当以攻消为主。
柴胡（三钱，酒炒） 青皮（一两，与巴豆五钱同炒；去豆） 三棱（五钱，醋炒） 蓬术/莪术（五钱，醋炒） 雄精（一两） 大黄（一两，与皂荚子三粒合炒去皂荚子）
以上药物为丸，每次服用一钱。下午服用六君子丸三钱。
渊按：柴胡、青皮疏利肝胆而升清阳，莪术、三棱破滞气而消块，大黄攻逐热积，巴豆驱逐寒积，皂角子去除油腻之积，雄精开结化痰。无坚不破，无攻不利，正气不虚者可用。
陈先生：发病时逢进食则呃逆，食入则胀满。如今脐上至心下一条胀痛，坐久了知道饥饿，行动则饱胀，这属于伏梁。胃为心之子，所以胃也患病了。仿照东垣五积散的治例。
黄连 吴茱萸 干姜 陈皮 香附 半夏 茯苓 丁香 延胡索 五灵脂
渊按：所谓食呃，病在肠胃。
钱先生：脉象微细，这是阴证的象。少腹有块，向上攻冲至胃脘，自胃脘至咽喉一条气塞，发作时剧烈疼痛欲昏厥，头部出汗如雨。用药大法，固宜以温通为主。只是舌上有黄腻浊苔，大便泄泻臭秽，必然兼夹湿热，而且块痛得按压稍减，中气又虚，治疗方法极难周全顾及，尚祈斟酌。
川楝子 乌药 肉桂 乌梅 木香 淡吴茱萸 泽泻 延胡索 茯苓 黄连（酒炒）
又诊：下焦浊阴之气，上犯清阳之位。少腹胸胁有块，攻撑作痛，痛甚发昏厥。昨日用温通法，病势稍减，脉仍微细，泄泻仍臭秽，厌恶谷物饮食，中气大亏，阴气凝结，当脐硬痛。恐怕属于脏结，攻之不可，补之亦难，诚为棘手。
肉桂 吴茱萸 炮姜 枸杞子 乌药 木香 延胡索 金铃子 白芍 茯苓 泽泻 萱花 金橘饼
丁先生：小肠遗热于大肠，形成伏瘕，腹中微痛。用济生槟榔丸。
槟榔（炒） 桃仁 当归（酒炒） 青皮（酒炒） 沉香 火麻仁 党参（元米炒） 茯苓（烘） 木香（烘） 乌药（烘） 大熟地（砂仁拌炒） 白芍（酒炒）
以上药物为末，用神曲三两，煮糊为丸。每晨服三钱，开水送服。
伍先生：胸脘有块，大如碗，每午后则痛，黄昏时更甚，连及背部胀满，时常泛吐清水，诸药无效。
枳壳（九枚，纳入阿魏三钱，炙焦） 牡蛎（二两） 肉桂（三钱） 白蛳螺壳（二两）
共炙为细末。每次疼痛发作时服用一钱，开水送服。
渊按：枳壳破气。阿魏佐助肉桂散寒，以浊攻浊。牡蛎软坚。白蛳螺壳始用于朱丹溪，说能化伏痰，消宿水。
周先生：食物填塞太阴脾经，肝气欲升而不能，胃气欲降而不得，气塞于中，与食相并，脘胁疼痛，气攻有块，汤饮辄呕吐，上不得纳，下不得出，法当疏运其中。
半夏 橘红 青皮 莱菔子 厚朴（姜汁炒） 吴茱萸 赤苓 白蔻仁（研碎冲服）
另：苏梗、枳壳、槟榔，三味磨汁冲服。
丁先生：脉迟细，脘中有块，进食撑胀，腹中漉漉作响，嗳腐吞酸，大便坚结。这是脾胃有寒积。应当用温药下之，仿照温脾汤法。
附子（制） 干姜 枳实 大黄 桂木/肉桂 陈皮 半夏
洪先生：结癖累累，久踞腹中。年过六十，元气下虚，中气已弱，肝气肆意横逆，腹部逐渐胀满。脉象沉弦细，细而沉为虚为寒，沉而弦为气为郁。病关情志，非湿热积滞可比，攻消克伐难以施用。拟商议通补之法。补者补其虚，通者通其气。
六君子汤加苏梗、肉桂、香附、厚朴（姜汁炒）、白芍、生姜。
冯先生：脉右关滑动，舌苔黄白而腻，是痰积在中焦。左关弦搏，肝木气旺，故左肋斜至脐下有梗一条，按之觉硬，乃肝气入络所结。尺寸脉俱微缓，泄痢一年，气血两亏。补之无益，攻之不可，而病根终莫能拔。根者何？痰积，湿热，肝气也。夫湿热、痰积，须借元气以营运。洁古所谓养正积自除，脾胃健则湿热自化，原指久病而言。此病不谓不久，然则攻消克伐何敢妄施。兹择性味不猛而能通能化者用之。
人参 茯苓 于术/白术 青陈皮 炙甘草 泽泻 枳壳 神曲 茅术/苍术 当归（土炒） 黄芪 白芍（吴茱萸三分，煎汁炒） 防风根
又诊：丸方：制半夏三两，分六份。一份木香（二钱，煎汁拌炒）；一份白芥子（二钱，煎汁拌炒）；一份乌药（三钱，煎汁拌炒）；一份金铃子（三钱，煎汁拌炒）；一份猪苓（二钱，煎汁拌炒）；一份醋拌炒。炒毕，去诸药，仅以半夏为末，入雄精三钱，研末，麝香一分，独头蒜三个，打烂，用醋一茶杯，打和为丸。每晨服一钱五分，开水送服。
渊按：制法极佳，通化肺脾之痰，疏理肝胆之结，丸法亦有巧思。诸凡与此证相类者，皆可用之。
曹先生：寒饮痰涎气血凝结成癖，踞于脘肋，下及腰间，久必成囊而为窠臼。如贼伏于隐僻之处，一时难以攻捣。昔许学士有此论，法当内和脾胃，外用攻消，今仿其意。
半夏 茯苓 乌药 白芥子 当归 青皮 泽泻 吴茱萸 延胡索 桂枝 杜仲（姜汁炒） 生木香 生熟谷芽
华先生：脾虚胃弱，则湿热不运而生痰。痰停中脘，则食不化而成积。胃脘结块，按之则痛，面色青黄，木乘中土。饮食少纳，虑延胀满。
党参（姜汁炒） 半夏 陈皮 厚朴 茯苓 白芥子 山楂肉 砂仁 六曲 鸡内金
丁先生：血虚木横，两胁气撑痛，腹中有块，心荡而寒热。病根日久，损及奇经。经云：冲脉为病，逆气里急，任脉为病，男疝女瘕。阳维为病苦寒热；阴维为病苦心痛。合而参之，谓非奇经之病乎？调之不易。
黄芪 党参 茯神 白薇 枸杞子 沙苑子 白芍 当归 陈皮 香附 紫石英。
又诊：和营卫而调摄奇经，病势皆减。惟腹中之块未平。仍从前法增损。
前方去掉枸杞子，加入砂仁、冬术/白术。
孔先生：病由肝气横逆，营血不调，腹中结瘕，脘胁攻痛，渐致食减内热，咳嗽痰多，当脐动跳，心悸少寐，口干肠燥，而显虚劳血痹之象。极难医治，姑仿仲景法。
党参 茯苓 枣仁 乳香 没药 桃仁 当归 川贝 香附 白蜜 地鳖虫（酒炙）
又诊：前方养营化瘀，下得血块两枚。腹满稍软，内热咳嗽未减。今且和营启胃，退热止咳，再望转机。
西党参 茯苓 丹参 广皮/陈皮 血余炭 川贝母 杏仁 当归 阿胶 地鳖虫
又诊：气滞血瘀，腹满有块攻痛，内热已减，咳嗽未平。拟两和气血方法。
党参 香附 郁金 茯苓 山楂肉 延胡索 当归 杏仁 阿胶 桃仁 沉香 血余炭
又诊：咳嗽不止，腹仍满痛。肝肺同病，久延不已，终成劳损。
桃杏仁 车前子 川贝 当归 丹皮 阿胶（蒲黄炒） 旋复花 苏子 茯苓 新绛
许先生：腹痛，大便泄出细虫，延来日久，中气渐虚，此胃中寒积也。法当温中补中。
黄连（盐水炒） 炮姜 木香 白芍 白术 使君子 吴茱萸 乌药 川椒 伏龙肝（煎汤代水）
某先生：阅病源是属虫病无疑。虫由湿热所化，脾土不运而生。其发于月底之夜，原有脾胃虚寒。寒属阴，故夜发也。寒久化热，土虚木强，其发移于月初，必呕吐胸热，两乳下跳，虫随酸苦痰涎而出，多寡不一，或大便亦有，腹中微痛，虽口渴甚，不能咽水，水下复呕，呕尽乃平，至中旬则康泰无恙矣。所以然者，月初虫头向上，且病久呕多，胃阴亏，虚火上炎，故胸中觉热。虚里跳动，中气虚也。中气者，胸中大气，脾胃冲和之气，皆归所统。脾胃中气虚甚，故跳跃也。病延一载有余，虫属盘踞，未易一扫而除。图治之法，和中调脾，杜生虫之源；生津平肝，治胸热口渴；化湿热，降逆气，以治呕吐。久服勿懈，自可见功；欲求速效，恐不能耳。
川楝子 芜荑 党参（元米炒） 白术 青皮 制半夏 白芍 茯苓 焦六曲 干姜 陈皮 榧子 蔻仁 使君子肉
渊按：病从脾胃寒湿而来，湿郁生热，热郁生虫，变成本寒标热。本寒则藏真伤而气结生积，标热则湿热阻而虫属内踞。
吴先生：喜食生米，积聚生虫。腹痛面黄，口流涎沫，虫之见症无疑。先拟健脾化虫。
茅术/苍术（米泔水浸） 青皮 鹤虱 榧子（炒打） 芜荑 尖槟榔 陈米（炒黄）
共研为末，每朝调服三钱，略用砂糖少许。
马先生：心脏的积证，名叫伏梁。得之忧思而气结也。居于心下胃脘之间，其形竖直而长。痛发则呕吐酸水，兼夹肝气、痰饮为患也。开发心阳以化浊阴之凝结，兼平肝气而化胃之痰饮。
桂枝 石菖蒲 延胡索 半夏 黄连 吴萸（炒） 茯苓 川楝子 陈皮 蔻仁 郁金 瓦楞子
朱先生：久有伏梁痞痛呕酸之患，是气血寒痰凝结也。自遭惊恐奔波，遂至脘腹气撑，旁攻胁肋，上至咽嗌，血随气而上溢，甚至盈碗盈盆。两载以来，屡发屡止，血虽时止，而气之撑胀终未全平。近来发作，不吐酸水而但吐血，想久伏之寒化而为热矣。立方当从气血凝积二字推求，备候商用。
Mr. Sun: Jueyin cold qi invades the Stomach, directly attacking the Middle Jiao (central digestive region), causing intestinal worms to become restless. There is abdominal pain like knife-like stabbing, and vomiting of sour fluid and clear saliva. The treatment principle should employ acrid-warm herbs, assisted by sour-bitter agents, to drain and unblock stagnation.
*Fructus Toosendan* (Chuanlianzi) *Radix Curcumae Longae* (Yanhusuo) *Rhizoma Coptidis* (Chuanlian) *Pericarpium Citri Reticulatae Viride* (Qingpi) *Fructus Evodiae* (Wuzhuyu) *Semen Zanthoxyli* (Chuanjiao) *Charred Fructus Crataegi* (Jiaozhata) *Rhizoma Linderae* (Wuyao) *Fructus Quisqualis* (Shijunzi) *Bamboo Sap* (Zhuerqing)
Mr. Jin: There are masses in both sides of the lower abdomen, gradually enlarging and lengthening. When still, they reside near the umbilicus; when moving, they attack upwards to the epigastrium and spread to both hypochondria. This has persisted for eight or nine years. According to the patient, it began with a half-year history of pregnancy retention, suspected pregnancy, and consumption of dirty water during childbirth, after which masses formed. It is speculated that this resulted from the coagulation of cold-water qi and blood qi.
*Radix Kansui* (Gansui, baked in wheat flour, 3 qian) *Rhizoma Cyperi Rotundi* (Xiangfu, stir-fried with salt water, 1 liang) *Rhizoma Sparganii* (Sanleng, vinegar-fried, 1 liang) *Rhizoma Curcumae* (Pengzhu/E Zhu, vinegar-fried, 1 liang) *Semen Persicae* (Taoren, fried, 5 qian) *Cortex Cinnamomi* (Rougui, separately ground, 1 qian) *Fructus Toosendan* (Chuanlianzi, 5 qian, stir-fried with seven seeds of *Fructus Crotonis Tiglii* until yellow, discard the Croton seeds) *Feces Trogopterori* (Wulingzhi, vinegar-fried, 5 qian) *Eupolyphaga Seu Polypagi Steleoti* (Dibiechong, soaked in wine, dried, 21 pieces)
Grind all into powder, mix with refined white honey to make pills. Take ten pills per dose, three times daily.
Note by Yuan: If water-cold and blood qi have coagulated in the region of the Chong Mai (Penetrating Vessel), and if this is indeed an excess syndrome, this formula will surely be effective.
Mr. Jin: There is a strip-shaped mass above the umbilicus, attacking directly downwards to the heart region causing pain, radiating to both hypochondria. This belongs to "Fuliang" (Hidden Beam), which is an accumulation of the Heart, formed by the coagulation of blood qi, cold, and phlegm. Heat in the dorsal spine accompanied by dizziness and palpitations indicates deficiency of Ying Qi (Nutritive Qi). The treatment principle should harmonize Ying Qi and resolve accumulations.
*Radix Angelicae Sinensis* (Danggui) *Rhizoma Pinelliae* (Banxia) *Concha Arcae* (Walengzi) *Rhizoma Cyperi Rotundi* (Xiangfu) *Radix Salviae Miltiorrhizae* (Danshen) *Poria* (Fuling) *Pericarpium Citri Reticulatae* (Chenpi) *Radix Aucklandiae* (Muxiang) *Radix Curcumae Longae* (Yanhusuo) *Fructus Toosendan* (Chuanlianzi) *Fructus Amomi* (Sharen)
Note by Yuan: Dizziness and palpitations can also be caused by cold-phlegm, not necessarily indicating Ying deficiency; otherwise, where would the heat in the dorsal spine come from?
Second visit: After administering formulas to resolve accumulations and harmonize Ying Qi, the attacking pain of Fuliang has slightly eased, and the heat in the dorsal spine has decreased. Continue with the previous prescription preparation.
Remove *Poria* (Fuling), *Concha Arcae* (Walengzi), and *Radix Aucklandiae* (Muxiang) from the previous formula; add *Poria Cum Radix Pini* (Fushen) and *Rosae Rugosa* (Meiguihua).
Mr. Wang: There is a Pi mass (firm lump) in the abdomen, gradually enlarging to the size of a plate, with amenorrhea, soreness in the lower back, and leukorrhea. This belongs to Ying deficiency and Qi stagnation, with blood stasis accumulating internally. Recently, watery diarrhea occurred due to injury from summer-heat and dampness. Treat the new illness first.
*Pingwei San* (Calm the Stomach Powder) remove *Radix Glycyrrhizae* (Gancao), add *Radix Paeoniae Alba* (Shaoyao), *Rhizoma Cyperi Rotundi* (Xiangfu), *Fructus Evodiae* (Wuzhuyu), and *Charred Massa Medicata Fermentata* (Jiaoliuqu).
Second visit: The abdominal mass is like an overturned plate; it hurts when attacking upwards and feels comfortable when settling downwards. Edema of the dorsum of the feet, frequent regurgitation of sour fluid. Treat from the perspectives of the Liver, Spleen, and Stomach meridians.
*Fructus Toosendan* (Chuanlianzi) *Radix Curcumae Longae* (Yanhusuo) *Fructus Evodiae* (Wuzhuyu) *Semen Zanthoxyli* (Chuanjiao) *Radix Aucklandiae* (Muxiang) *Rhizoma Curcumae* (Peng'e Zhu) *Prepared Rhizoma Cyperi Rotundi* (Zhi Xiangfu) *Pericarpium Citri Reticulatae* (Chenpi) *Poria* (Fuling) *Rhizoma Coptidis* (Chuanlian, stir-fried with ginger juice)
Third visit: Abdominal masses, internal heat with slight chills, weakness in the four limbs, regurgitation of sour fluid. This is Liver-Spleen Qi depression, deficiency of both Ying and Wei (Defensive) Qi, presenting as consumptive disease.
*Radix Codonopsis* (Dangshen) *Rhizoma Cyperi Rotundi* (Xiangfu) *Radix Angelicae Sinensis* (Danggui) *Radix Salviae Miltiorrhizae* (Danshen) *Fructus Toosendan* (Chuanlianzi) *Semen Zanthoxyli* (Chuanjiao) *Radix Curcumae Longae* (Yanhusuo) *Rhizoma Atractylodis Macrocephalae* (Dongzhu/Baizhu) *Radix Zingiberis Recens* (Ganjiang) *Herba Artemisiae Annuae Caulis* (Qinghao Geng) *Massa Medicata Fermentata* (Shenqu) *Fructus Jujubae* (Dazao)
Note by Yuan: Internal heat and slight chills result from Liver-Spleen depression, failure of Lung Metal's regulating function, and disharmony of Ying and Wei Qi. It is suitable to refer to the methods of *Xiaoyao San* (Free and Easy Wanderer Powder) and *Zuojin Wan* (Left Metal Pill).
Mr. Ding: Accumulation of the Liver, located under the left hypochondrium, named "Feiqi" (Fat Qi). Over time, it causes distending pain.
*Fructus Toosendan* (Chuanlianzi) *Radix Curcumae Longae* (Yanhusuo) *Rhizoma Coptidis* (Chuanlian) *Pericarpium Citri Reticulatae Viride* (Qingpi) *Feces Trogopterori* (Wulingzhi) *Charred Fructus Crataegi* (Shanzhata) *Radix Angelicae Sinensis Cauda* (Dangguixu) *Rhizoma Curcumae* (Peng'e Zhu) *Rhizoma Sparganii* (Jingsanleng) *Poria* (Fuling) *Radix Aucklandiae* (Muxiang) *Fructus Amomi* (Sharen)
Second visit: Pain in the left hypochondrium has eased. Cough worsens at night; cold-phlegm flows into the Lung collaterals. Treat both Lungs and Liver.
*Flos Inulae* (Xuanfuhua) *Semen Pruni Armeniacae* (Xingren) *Fructus Toosendan* (Chuanlianzi) *Rhizoma Sparganii* (Jingsanleng) *Poria* (Fuling) *Flos Farfarae* (Kuandonghua) *Rhizoma Pinelliae* (Banxia) *Pericarpium Citri Reticulatae* (Xinhuiqi/Chenpi) *Rhizoma Curcumae* (Peng'e Zhu) *Stamen Croci* (Xinjia) *Stem Allii Fistulosi* (Qingcongguan)
Mr. Jiang: Mass in the lower abdomen, gradually enlarging to the size of a plate. This belongs to "Xiangtan" (Intestinal Polyp/Mass), formed by Qi and Blood stagnation. Propose to diffuse both Qi and Blood.
*Rhizoma Cyperi Rotundi* (Xiangfu) *Feces Trogopterori* (Wulingzhi) *Radix Carthami Tinctorii* (Honghua) *Radix Angelicae Sinensis* (Danggui) *Radix Dichroae* (Zelan) *Semen Persicae* (Taoren) *Radix Curcumae Longae* (Yanhusuo) *Radix Salviae Miltiorrhizae* (Danshen) *Pericarpium Citri Reticulatae* (Chenpi) *Fructus Amomi* (Sharen)
*Dahuang Zhichong Wan* (Rhubarb and Beetle Pill), take twenty pills each time, washed down with boiled water.
Mr. Jin: Qi rushes from the lower abdomen up to the throat, causing palpitations in the heart and pain in the hypochondria. Initially, there were alternating chills and fever with vomiting. This is Ben Tun Qi (Running Piglet Qi) complicated by Liver pathogenic factors. For half a month, although chills and fever have stopped, the Qi still rebels upwards. The pulse is deep, wiry, and small. Follow the method of *Jin Gui Yao Lue*.
*Erchen Tang* (Two-Aged Decoction) remove *Radix Glycyrrhizae* (Gancao), add *Radix Angelicae Sinensis* (Danggui), *Radix Paeoniae Alba* (Baishao), *Fructus Evodiae* (Wuzhuyu), *Rhizoma Cyperi Rotundi* (Xiangfu), *Cortex Magnoliae Officinalis* (Chupu), *Semen Arecae* (Binglang), *Caulis Perillae* (Sugeng), *Lignum Aquilariae Resinatum* (Chenxiang), *Jucius Zingiberis Recens* (Jiangzhi), and *Radix Passiflorae Incarnatae* (Dongli Gen).
Second visit: The Qi of Running Piglet has gradually calmed, but the Qi in the epigastrium remains unsettled. Treat from the Liver and Stomach.
*Mild Fructus Evodiae* (Dan Wuyu) *Rhizoma Pinelliae* (Banxia) *Rhizoma Cyperi Rotundi* (Xiangfu) *Fructus Toosendan* (Chuanlianzi) *Radix Curcumae Longae* (Yanhusuo) *Poria* (Fuling) *Charred Massa Medicata Fermentata* (Jiaoliuqu) *Pericarpium Citri Reticulatae* (Chenpi) *Radix Paeoniae Alba* (Baishao) *Pericarpium Amomi Rotundae* (Kouren)
Mr. Ding: Suffering from intermittent dysentery for a long time. After stopping for a few days, Qi attacks the chest and epigastrium causing board-like pain, blocking upper and lower passages, nearly leading to fainting. Pain only subsides after bowel movement. In a month, bowels moved only three times. Board-like pain indicates aggregation into a mass, located on the right side; this is an accumulation of the Spleen. Pulse is deep, tight, and fine. Apply warming and unblocking methods.
*Prepared Radix Aconiti Lateralis Preparata* (Shu Fuzi) *Mild Dried Ginger* (Dan Ganjiang) *Cortex Magnoliae Officinalis* (Chupu) *Pericarpium Citri Reticulatae* (Chenpi) *Poria* (Fuling) *Rhizoma Cyperi Rotundi* (Xiangfu) *Pericarpium Arecae* (Dafupi) *Radix Curcumae Longae* (Yanhusuo) *Chenxiang Huqi Wan* (Agarwood Qi-Regulating Pill) *Dongyuan Wuji Wan* (Li Dongyuan's Five Accumulations Pill).
Mr. Mi: Right Guan and Chi pulses are firm and wiry. There are masses in the waist and abdomen causing attacking pain. This is an accumulation of the Liver and Kidney in the Lower Jiao. Use a method to slowly dissolve and relieve pain.
*Cortex Cinnamomi* (Rougui) *Realgar* (Xionghuang) *Sharp Areca Nut* (Jian Binglang)
Grind into fine powder, mix with single-head garlic to make pills. Take five pills morning and evening, washed down with boiled water.
Note by Yuan: Realgar dissipates nodules, Areca nut breaks stagnation, Cinnamon bark warms and disperses deep-seated cold in the Lower Jiao, and also warms the Spleen and soothes the Liver. Using single-head garlic for pills employs turbid substances to attack turbidity, demonstrating profound wisdom in prescription formulation.
Ms. Tang: Amenorrhea for ten months, slight abdominal fullness, pulse is deep, fine, and choppy. A mass several inches long exists above the umbilicus and below the heart. This belongs to Fuliang (Hidden Beam), caused by emotional frustration, anger, Qi depression, and Phlegm coagulation. The classics state: For large accumulations, one may attack, but stop when half is reduced. Ji Gu stated: Nourish righteousness, and the accumulation will naturally disappear; do not overuse draining and reducing methods. Now propose the method of *Kaiyu Zhengyuan San*, regulating Qi and moving Blood, harmonizing the Spleen and resolving Phlegm, embedding reduction within tonification.
*Erchen Tang* (Two-Aged Decoction) add *Radix Angelicae Sinensis Root* (Guishen), *Radix Chuanxiong* (Chuanxiong), *Rhizoma Atractylodis Macrocephalae* (Dongzhu/Baizhu), *Charred Fructus Crataegi* (Shanzhata), *Radix Curcumae Longae* (Yanhusuo), *Rhizoma Cyperi Rotundi* (Xiangfu), *Fructus Hordei Germinatus* (Maiya), *Caulis Perillae* (Sugeng), *Fructus Amomi* (Sharen), *Fructus Leonuri* (Chongweizi).
Mr. Qian: Mass in the lower abdomen. When painful, menstruation flows heavily like a gush; Qi rises like panting. The Chong Mai (Penetrating Vessel) has been injured for a long time; Liver Wood qi is rampant.
*Rhizoma Cyperi Rotundi* (Xiangfu, vinegar-fried) *Fluorite* (Zishiying) *Radix Angelicae Sinensis* (Danggui) *Radix Paeoniae Alba* (Baishao, wine-fried) *Radix Aucklandiae* (Muxiang) *Rhizoma Sparganii* (Sanleng, vinegar-fried) *Prepared Radix Rehmanniae* (Da Shudi) *Radix Achyranthis Bidentatae* (Niuxi) *Fructus Foeniculi* (Xiaohuixiang, salt-water fried) *Pericarpium Citri Reticulatae Viride* (Qingpi, vinegar-fried)
Mr. [Surname Omitted]: During the latent summer-heat syndrome last autumn, a Jia mass (soft mass) formed, residing under the left hypochondrium. Every spring afternoon, slight fever occurs; every morning, phlegm is vomited; eating noodles causes loose stools. This is because the heat pathogen was not cleared at the time, and greasy foods were consumed early, causing heat and phlegm to co-aggregate in the collaterals of the Lungs and Stomach. Treatment should focus on attacking and dissolving.
*Bupleurum Root* (Chaihu, 3 qian, wine-fried) *Pericarpium Citri Reticulatae Viride* (Qingpi, 1 liang, stir-fried with 5 qian of *Fructus Crotonis Tiglii*; discard Croton) *Rhizoma Sparganii* (Sanleng, 5 qian, vinegar-fried) *Rhizoma Curcumae* (Pengzhu, 5 qian, vinegar-fried) *Refined Realgar* (Xiongjing, 1 liang) *Radix et Rhizoma Rhei* (Dahuang, 1 liang, stir-fried with three pods of *Gleditsia Sinensis*; discard pods)
Make into pills. Take 1 qian each time. In the afternoon, take 3 qian of *Liujunzi Wan* (Six Gentlemen Pill).
Note by Yuan: Bupleurum and Qingpi soothe the Liver and Gallbladder and ascend clear Yang; E Zhu and Sanleng break Qi stagnation and dissolve masses; Dahuang attacks heat accumulations; Croton expels cold accumulations; Gleditsia pods remove greasy accumulations; Xiongjing opens nodules and resolves phlegm. Nothing is not broken, nothing is not attacked; usable only if righteous Qi is not deficient.
Mr. Chen: Illness begins with hiccups upon eating, and bloating after meals. Now, there is a distending pain from above the umbilicus to below the heart. Sitting for a long time induces hunger; moving induces fullness. This belongs to Fuliang (Hidden Beam). The Stomach is the son of the Heart, so the Stomach is also diseased. Imitate Li Dongyuan's *Wuji* (Five Accumulations) treatment example.
*Rhizoma Coptidis* (Chuanlian) *Fructus Evodiae* (Wuzhuyu) *Radix Zingiberis Recens* (Ganjiang) *Pericarpium Citri Reticulatae* (Chenpi) *Rhizoma Cyperi Rotundi* (Xiangfu) *Rhizoma Pinelliae* (Banxia) *Poria* (Fuling) *Flos Caryophylli* (Dingxiang) *Radix Curcumae Longae* (Yanhusuo) *Feces Trogopterori* (Wulingzhi)
Note by Yuan: This is called food-induced hiccups; the disease is in the intestines and stomach.
Mr. Qian: Pulse is micro and fine, a Yin image. Mass in the lower abdomen, attacking upwards to the epigastrium. From epigastrium to throat, a strip of Qi obstruction. Attacks cause severe pain almost leading to fainting, head sweating like rain. The general principle of prescription dictates warming and unblocking as primary. However, the tongue has a yellow, greasy, turbid coating, and stool is loose and foul-smelling, indicating concurrent damp-heat. Also, the mass pain is slightly relieved by pressure, and Middle Qi is deficient. The treatment method is extremely difficult to cover comprehensively; please deliberate carefully.
*Fructus Toosendan* (Chuanlianzi) *Rhizoma Linderae* (Wuyao) *Cortex Cinnamomi* (Rougui) *Fructus Myricae* (Wumei) *Radix Aucklandiae* (Muxiang) *Mild Fructus Evodiae* (Dan Wuyu) *Radix Alismatis Orientalis* (Zexie) *Radix Curcumae Longae* (Yanhusuo) *Poria* (Fuling) *Rhizoma Coptidis* (Chuanlian, wine-fried)
Second visit: Turbid Yin Qi of the Lower Jiao harasses the position of Clear Yang. Masses in the lower abdomen, chest, and hypochondria cause attacking and distending pain, severe enough to induce fainting. Yesterday, warming and unblocking reduced the disease trend slightly, but the pulse remains micro and fine, discharge remains foul-smelling, aversion to grain food indicates severe Middle Qi deficiency, Yin Qi coagulates, and there is hard pain at the umbilicus. Fear this is Zangjie (Organ Knotting); attacking is inadvisable, tonifying is also difficult. Truly a thorny case.
*Cortex Cinnamomi* (Rougui) *Fructus Evodiae* (Wuzhuyu) *Prepared Dried Ginger* (Paojiang) *Fructus Lycii* (Gouqizi) *Rhizoma Linderae* (Wuyao) *Radix Aucklandiae* (Muxiang) *Radix Curcumae Longae* (Yanhusuo) *Fructus Toosendan* (Jinlingzi) *Radix Paeoniae Alba* (Baishao) *Poria* (Fuling) *Radix Alismatis Orientalis* (Zexie) *Flos Daylilis* (Xuanhua) *Citrus reticulata 'Jinkankan'* (Jinju Bing)
Mr. Ding: Small Intestine leaves heat into the Large Intestine, forming Fu Jia (hidden mass), with slight abdominal pain. Use *Jisheng Binglang Wan* (Jisheng Areca Pill).
*Semen Arecae* (Binglang, fried) *Semen Persicae* (Taoren) *Radix Angelicae Sinensis* (Danggui, wine-fried) *Pericarpium Citri Reticulatae Viride* (Qingpi, wine-fried) *Lignum Aquilariae Resinatum* (Chenxiang) *Semen Cannabis* (Huomaren) *Radix Codonopsis* (Dangshen, stir-fried with Yuan rice) *Poria* (Fuling, dried) *Radix Aucklandiae* (Muxiang, dried) *Rhizoma Linderae* (Wuyao, dried) *Prepared Radix Rehmanniae* (Da Shudi, mixed with Fructus Amomi and stir-fried) *Radix Paeoniae Alba* (Baishao, wine-fried)
Grind into powder. Use 3 liang of *Massa Medicata Fermentata* (Shenqu), boil into paste to make pills. Take 3 qian every morning, washed down with boiled water.
Mr. Wu: Mass in the chest and epigastrium, large as a bowl. Pain occurs every afternoon, worse at dusk, extending to back distension, frequently regurgitating clear water. Various medicines ineffective.
*Fructus Aurantii* (Zhiqiao, 9 pieces, insert 3 qian of *Resina Asafoetidae* (Awei), roast until scorched) *Concha Ostreae* (Muli, 2 liang) *Cortex Cinnamomi* (Rougui, 3 qian) *Shell of Bellamya Qiniana* (Baisiluoke, 2 liang)
Roast together into powder. Take 1 qian when pain strikes, washed down with boiled water.
Note by Yuan: Zhiqiao breaks Qi. Awei assists Rougui to disperse cold, employing turbid to attack turbid. Muli softens hardness. Baisiluoke shell was first used by Danxi; it resolves hidden phlegm and eliminates old water.
Mr. Zhou: Food fills the Taiyin (Spleen); Liver Qi desires to ascend but cannot; Stomach Qi desires to descend but cannot. Qi obstructs in the middle, combining with food, causing epigastric and hypochondriac pain, Qi attacking with masses. Soup and drinks immediately provoke vomiting; nothing can enter above or exit below. The method should be to diffuse and transport the middle.
*Rhizoma Pinelliae* (Banxia) *Exocarpium Citri Reticulatae* (Juhong) *Pericarpium Citri Reticulatae Viride* (Qingpi) *Radix Raphani Sativi* (Laifuzi) *Cortex Magnoliae Officinalis* (Chupu, stir-fried with ginger juice) *Fructus Evodiae* (Wuzhuyu) *Red Poria* (Chiling) *Pericarpium Amomi Rotundae* (Baikouren, ground and taken with decoction)
Separately: *Caulis Perillae* (Sugeng), *Fructus Aurantii* (Zhiqiao), *Semen Arecae* (Binglang), grind these three and take with decoction.
Mr. Ding: Pulse is slow and fine. Mass in the epigastrium, distension upon eating, gurgling sounds in the abdomen, belching with sour regurgitation, hard constipation. This is Cold Accumulation in the Spleen and Stomach. Should use warm purgatives, imitating *Wenpi Tang* (Warm the Spleen Decoction).
*Prepared Radix Aconiti Lateralis* (Fuzi, prepared) *Radix Zingiberis Recens* (Ganjiang) *Fructus Aurantii Immaturus* (Zhishi) *Radix et Rhizoma Rhei* (Dahuang) *Cortex Cinnamomi Ramulus* (Guimu) *Pericarpium Citri Reticulatae* (Chenpi) *Rhizoma Pinelliae* (Banxia)
Mr. Hong: Numerous accumulated lumps, long residing in the abdomen. Over sixty years old, Yuan Qi is deficient below, Middle Qi is weak, Liver Qi is rampant, abdomen gradually becomes distended. Pulse is deep, wiry, and fine. Fine and deep indicates deficiency and cold; deep and wiry indicates Qi and depression. The disease relates to emotions, not comparable to damp-heat accumulation; draining and reducing methods are difficult to apply. Propose discussing Tong Bu (Unblocking and Tonifying). Tonifying means tonifying deficiency; Unblocking means unblocking Qi.
*Liujunzi Tang* (Six Gentlemen Decoction) add *Caulis Perillae* (Sugeng), *Cortex Cinnamomi* (Rougui), *Rhizoma Cyperi Rotundi* (Xiangfu), *Cortex Magnoliae Officinalis* (Chupu, stir-fried with ginger juice), *Radix Paeoniae Alba* (Baishao), *Radix Zingiberis Recens* (Shengjiang).
Mr. Feng: Right Guan pulse is slippery and rapid; tongue coating is yellow-white and greasy. This is Phlegm Accumulation in the Middle Jiao. Left Guan pulse is wiry and forceful; Liver Wood Qi is vigorous. Hence, a hard strip extends diagonally from the left hypochondrium to below the umbilicus, feeling hard upon pressure, resulting from Liver Qi entering the collaterals and knotting. Cun and Chi pulses are both micro and slow. Dysentery for one year, both Qi and Blood are deficient. Tonifying is useless, attacking is impossible, yet the root of the disease cannot be eradicated. What is the root? Phlegm accumulation, damp-heat, Liver Qi. Damp-heat and phlegm accumulation must rely on Yuan Qi for transportation. Ji Gu said: Nourish righteousness, and the accumulation will naturally disappear; when the Spleen and Stomach are healthy, damp-heat transforms itself. This originally referred to chronic diseases. This disease is not short in duration, yet how dare one recklessly use draining and reducing methods. Now select agents with mild properties that can unblock and transform.
*Radix Ginseng* (Renshen) *Poria* (Fuling) *Rhizoma Atractylodis Macrocephalae* (Yuzhu/Baizhu) *Green and Yellow Pericarpium Citri Reticulatae* (Qingchenpi) *Honey-fried Radix Glycyrrhizae* (Zhigancao) *Radix Alismatis Orientalis* (Zexie) *Fructus Aurantii* (Zhiqiao) *Massa Medicata Fermentata* (Shenqu) *Rhizoma Atractylodis Lanceae* (Maoshu/Cangzhu) *Radix Angelicae Sinensis* (Danggui, earth-fried) *Radix Astragali Membranacei* (Huangqi) *Radix Paeoniae Alba* (Baishao, stir-fried with decoction of 3 fen of Fructus Evodiae) *Radix Saposhnikoviae* (Fangfenggen)
Second visit: Pill Formula: Prepared *Rhizoma Pinelliae* (Banxia) 3 liang, divided into six parts. One part *Radix Aucklandiae* (Muxiang, 2 qian, stir-fried with decoction); one part *Semen Sinapis Albæ* (Baijiezi, 2 qian, stir-fried with decoction); one part *Rhizoma Linderae* (Wuyao, 3 qian, stir-fried with decoction); one part *Fructus Toosendan* (Jinlingzi, 3 qian, stir-fried with decoction); one part *Polyporus* (Zhuling, 2 qian, stir-fried with decoction); one part stir-fried with vinegar. After frying, remove other herbs, keep only Banxia powder, add 3 qian of Refined Realgar (Xiongjing), grind into powder, add 1 fen of *Moschus* (Shexiang), three single-head garlic cloves, mash, mix with one teacup of vinegar to make pills. Take 1.5 qian every morning, washed down with boiled water.
Note by Yuan: The preparation method is excellent, transforming Phlegm of the Lungs and Spleen, soothing knots of the Liver and Gallbladder. The pill method shows ingenuity. Any condition similar to this can use it.
Mr. Cao: Cold drink, phlegm-saliva, Qi, and Blood coagulate into Pi masses, residing in the epigastrium and hypochondria, extending down to the waist. Over time, they form sacs and nests. Like thieves hiding in obscure places, difficult to attack and destroy at once. Scholar Xu had this theory; the method should internally harmonize Spleen and Stomach, externally attack and dissolve. Now imitate his intent.
*Rhizoma Pinelliae* (Banxia) *Poria* (Fuling) *Rhizoma Linderae* (Wuyao) *Semen Sinapis Albæ* (Baijiezi) *Radix Angelicae Sinensis* (Danggui) *Pericarpium Citri Reticulatae Viride* (Qingpi) *Radix Alismatis Orientalis* (Zexie) *Fructus Evodiae* (Wuzhuyu) *Radix Curcumae Longae* (Yanhusuo) *Ramulus Cinnamomi* (Guizhi) *Radix Eucommiae Ulmoidis* (Duzhong, stir-fried with ginger juice) *Raw Radix Aucklandiae* (Sheng Muxiang) *Raw and Germinated Fructus Hordei et Fructus Setariae* (Shengshu Guya)
Mr. Hua: Spleen deficiency and Stomach weakness lead to failure of transporting damp-heat, generating phlegm. Phlegm stops in the Middle Epigastrium, causing food stagnation and accumulation. Mass in the epigastrium, painful upon pressure, complexion green-yellow, Wood overacting on Earth. Poor appetite, fear of progressing to distension.
*Radix Codonopsis* (Dangshen, stir-fried with ginger juice) *Rhizoma Pinelliae* (Banxia) *Pericarpium Citri Reticulatae* (Chenpi) *Cortex Magnoliae Officinalis* (Chupu) *Poria* (Fuling) *Semen Sinapis Albæ* (Baijiezi) *Fructus Crataegi* (Shanzhourou) *Fructus Amomi* (Sharen) *Massa Medicata Fermentata* (Liùqū) *Endothelium Corneum Gigeriae Galli* (Jineijin)
Mr. Ding: Blood deficiency with Liver Wood rampant, distending pain in both hypochondria, mass in the abdomen, palpitations with alternating chills and fever. The root disease is long-standing, damaging the Extraordinary Vessels. The classics say: Disease of the Chong Mai involves rebellious Qi and interior urgency; disease of the Ren Mai involves hernia in men and Jia masses in women. Disease of the Yang Wei Mai suffers from chills and fever; disease of the Yin Wei Mai suffers from heart pain. Considering them together, is this not a disease of the Extraordinary Vessels? Difficult to regulate.
*Radix Astragali Membranacei* (Huangqi) *Radix Codonopsis* (Dangshen) *Poria Cum Radix Pini* (Fushen) *Radix Anemarrhenae Asphodeloides* (Baiwei) *Fructus Lycii* (Gouqizi) *Semen Astragali Complanati* (Shayuanzi) *Radix Paeoniae Alba* (Baishao) *Radix Angelicae Sinensis* (Danggui) *Pericarpium Citri Reticulatae* (Chenpi) *Rhizoma Cyperi Rotundi* (Xiangfu) *Fluorite* (Zishiying).
Second visit: Harmonizing Ying and Wei, regulating the Extraordinary Vessels, the disease trend has decreased. Only the mass in the abdomen remains unresolved. Still modify the previous method.
Remove *Fructus Lycii* (Gouqizi) from the previous formula; add *Fructus Amomi* (Sharen) and *Rhizoma Atractylodis Macrocephalae* (Dongzhu/Baizhu).
Mr. Kong: Disease caused by Liver Qi rampant and rebellious, Ying Blood not harmonized, Jia mass formed in the abdomen, attacking pain in epigastrium and hypochondria, gradually leading to poor appetite, internal heat, cough with much phlegm, pulsation at the umbilicus, palpitations with insomnia, dry mouth and intestines, presenting as deficiency consumptive and blood bi syndrome. Extremely difficult to treat. Tentatively imitate Zhang Zhongjing's method.
*Radix Codonopsis* (Dangshen) *Poria* (Fuling) *Semen Ziziphi Spinosae* (Zaoren) *Resina Burseraceae* (Ruxiang) *Resina Draconis* (Moyao) *Semen Persicae* (Taoren) *Radix Angelicae Sinensis* (Danggui) *Bulbus Fritillariae Thunbergii* (Chuanbei) *Rhizoma Cyperi Rotundi* (Xiangfu) *Mel* (Baimi) *Eupolyphaga Seu Polypagi Steleoti* (Dibiechong, wine-dried)
Second visit: Previous formula nourished Ying and resolved stasis; passed two blood clots. Abdominal fullness slightly softened, internal heat and cough unchanged. Now harmonize Ying, awaken the Stomach, reduce heat, and stop cough, hoping for a turning point.
*Western Radix Codonopsis* (Xi Dangshen) *Poria* (Fuling) *Radix Salviae Miltiorrhizae* (Danshen) *Broad Peel Citrus* (Guangpi/Chenpi) *Carbonized Hair* (Xueyutan) *Bulbus Fritillariae Cirrhosae* (Chuanbeimu) *Semen Pruni Armeniacae* (Xingren) *Radix Angelicae Sinensis* (Danggui) *Colla Corii Asini* (E'jiao) *Eupolyphaga Seu Polypagi Steleoti* (Dibiechong)
Third visit: Qi stagnation and Blood stasis, abdominal fullness with mass attacking pain, internal heat reduced, cough not settled. Propose a method to harmonize both Qi and Blood.
*Radix Codonopsis* (Dangshen) *Rhizoma Cyperi Rotundi* (Xiangfu) *Radix Curcumaee Longae* (Yujin) *Poria* (Fuling) *Fructus Crataegi* (Shanzhourou) *Radix Curcumae Longae* (Yanhusuo) *Radix Angelicae Sinensis* (Danggui) *Semen Pruni Armeniacae* (Xingren) *Colla Corii Asini* (E'jiao) *Semen Persicae* (Taoren) *Lignum Aquilariae Resinatum* (Chenxiang) *Carbonized Hair* (Xueyutan)
Fourth visit: Cough continues, abdomen still full and painful. Liver and Lungs both diseased. Prolonged without resolution, eventually becoming consumptive.
*Persica and Apricot Seeds* (Tao Xingren) *Semen Plantaginis* (Cheqianzi) *Bulbus Fritillariae Thunbergii* (Chuanbei) *Radix Angelicae Sinensis* (Danggui) *Radix Moutan* (Danpi) *Colla Corii Asini* (E'jiao, stir-fried with Sanguis Fuliginis/Puhuang) *Flos Inulae* (Xuanfuhua) *Fructus Viticis* (Su Zi) *Poria* (Fuling) *Stamen Croci* (Xinjia)
Mr. Xu: Abdominal pain, passing thin worms in stool, prolonged duration, Middle Qi gradually deficient. This is Cold Accumulation in the Stomach. Method: Warm and tonify the Middle.
*Rhizoma Coptidis* (Chuanlian, salt-water fried) *Prepared Dried Ginger* (Paojiang) *Radix Aucklandiae* (Muxiang) *Radix Paeoniae Alba* (Baishao) *Rhizoma Atractylodis Macrocephalae* (Baizhu) *Fructus Quisqualis* (Shijunzi) *Fructus Evodiae* (Wuzhuyu) *Rhizoma Linderae* (Wuyao) *Semen Zanthoxyli* (Chuanjiao) *Caulis Et Radix Longanae* (Fulonggan, decoct water substitute)
Mr. [Surname Omitted]: Reviewing the pathology source, this is undoubtedly worm disease. Worms are transformed from damp-heat, generated when Spleen Earth fails to transport. Attacks occur at night towards the end of the month, originally due to Spleen-Stomach deficiency-cold. Cold belongs to Yin, hence night attacks. Cold long-standing transforms into heat; Earth deficiency and Wood strength shift attacks to the beginning of the month. Must vomit with chest heat, jumping below both breasts. Worms exit with sour-bitter phlegm-saliva, varying in quantity, sometimes in stool, slight abdominal pain. Although very thirsty, cannot swallow water; water intake provokes vomiting again; only after vomiting completely does it calm. By mid-month, health is restored. Why? At the beginning of the month, worm heads move upward. Also, long illness and frequent vomiting deplete Stomach Yin, causing deficiency fire to flare upward, hence chest heat. Jumping in the Xuli (Vital Region) indicates Middle Qi deficiency. Middle Qi refers to the Great Qi in the chest, the harmonious Qi of Spleen and Stomach, all governed by it. Severe deficiency of Spleen-Stomach Middle Qi causes jumping. Disease has lasted over a year, worms are entrenched, not easily swept away. Treatment method: Harmonize and regulate Spleen, cut off the source of worm generation; generate fluids and calm Liver, treat chest heat and thirst; transform damp-heat, direct rebellious Qi downward, treat vomiting. Take for a long time without slackening, efficacy will be seen; seeking quick results is unlikely.
*Fructus Toosendan* (Chuanlianzi) *Fructus Tsaoko* (Wuyi) *Radix Codonopsis* (Dangshen, stir-fried with Yuan rice) *Rhizoma Atractylodis Macrocephalae* (Baizhu) *Pericarpium Citri Reticulatae Viride* (Qingpi) *Prepared Rhizoma Pinelliae* (Zhi Banxia) *Radix Paeoniae Alba* (Baishao) *Poria* (Fuling) *Charred Massa Medicata Fermentata* (Jiaoliuqu) *Radix Zingiberis Recens* (Ganjiang) *Pericarpium Citri Reticulatae* (Chenpi) *Fructus Torreyae* (Feizi) *Pericarpium Amomi Rotundae* (Kouren) *Sarcotesta Semen Quisqualis* (Shijunzirou)
Note by Yuan: Disease originates from Spleen-Stomach cold-damp. Damp depression generates heat; heat depression generates worms, changing into Root Cold and Branch Heat. Root Cold injures Zang True Qi, causing Qi knotting and accumulation; Branch Heat blocks damp-heat, allowing worms to reside internally.
Mr. Wu: Likes eating raw rice, accumulation generates worms. Abdominal pain, sallow complexion, drooling. Undoubtedly signs of worms. First propose strengthening Spleen and resolving worms.
*Rhizoma Atractylodae Lanceae* (Maoshu/Cangzhu, soaked in rice wash water) *Pericarpium Citri Reticulatae Viride* (Qingpi) *Herpa Dictamni* (Heshi) *Fructus Torreyae* (Feizi, fried and crushed) *Fructus Tsaoko* (Wuyi) *Sharp Areca Nut* (Jian Binglang) *Old Rice* (Chenmi, fried yellow)
Grind into powder. Mix with water every morning, take 3 qian, add a little brown sugar.
Mr. Ma: Accumulation of the Heart, named Fuliang (Hidden Beam). Caused by worry and thought leading to Qi knotting. Resides between below the heart and epigastrium, shape vertical and long. Pain attacks with vomiting of sour fluid, complicated by Liver Qi and Phlegm-Fluid. Develop Heart Yang to transform turbid Yin coagulation, simultaneously calm Liver Qi and transform Stomach phlegm-fluid.
*Ramulus Cinnamomi* (Guizhi) *Rhizoma Polygalae Tenuifoliae* (Shichangpu) *Radix Curcumae Longae* (Yanhusuo) *Rhizoma Pinelliae* (Banxia) *Rhizoma Coptidis* (Chuanlian) *Fructus Evodiae* (Wuyu, fried) *Poria* (Fuling) *Fructus Toosendan* (Chuanlianzi) *Pericarpium Citri Reticulatae* (Chenpi) *Pericarpium Amomi Rotundae* (Kouren) *Radix Curcumaee Longae* (Yujin) *Concha Arcae* (Walengzi)
Mr. Zhu: Long suffering from Fuliang, stifling pain, vomiting acid. This is Qi-Blood-Cold-Phlegm coagulation. Since encountering fright and rushing, now epigastric-abdominal Qi distension, attacking laterally to hypochondria, upwards to throat. Blood follows Qi and overflows upwards, even filling bowls and basins. For two years, recurring and stopping repeatedly. Although bleeding stops at times, Qi distension never fully resolves. Recent attacks no longer vomit acid but only bleed blood. Presumably long-hidden cold has transformed into heat. Prescription should deduce from the two characters "Qi-Blood Coagulated Accumulation." Ready for commercial use.