先天禀薄，情志欠舒，心脾抑郁?诊脉细涩，细为气少，涩主血虚。问寝食如常，惟月
事失
调，每值经期，洒淅寒热，腰膂酸疼。按冲为血海，任主胞胎，二脉交通，乃能有子。脉证
若此，即无他患，恐难孕育。间进加味归脾汤，调养心脾血气之源，常服毓麟珠，补益冲任
，阴阳和协，冲任调匀，则合浦珠还，蓝田玉茁，可预必也。
安波按∶冲脉为经水之本，故内经言太冲脉盛则月事以时下。兹以毓麟珠等药以补益
冲任，正合其旨。
轩歧论五郁，首究乎肝。肝主春生之气，春气不生则长养收藏之令息矣，而欲其无灾害
者几
希。夫病端虽始于肝，久则滋蔓他脏。肤浅见血投凉，因咳治肺者，固无足论。即知求本而
不审诸阴阳消长之理，依然隔膜。所谓补阴补阳，义各有二。芩连知柏，有形之水也。麦味
地黄，无形之水也。以无形之水，制无形之火，如盏中加油，其灯自明。干姜桂附，温烈之
温也。参 甘草，温存之温也。以温存之温，煦虚无之气，如炉中复灰，其火不熄。日内咳
频，痰犹带血，似须先投甘寒以降火，未可骤用参 以补阳耳。医贯云∶凡人肺金之气，夜
卧则归藏于肾水之中，肾水干枯，无可容之地，故复上逆而为患矣。病始不得隐曲，渐至不
月，风消喘咳息贲，莫能正偃。所以然者，虽云火炽之相煎，实由水亏之莫济。夫火空则发
，使非填实其空，炎焰何能敛纳。王太仆云∶益心之阳，寒亦通行，强肾之阴，热之犹可，
诚见道之论。昨论便溏，多恐脾元下陷，夜来便圊数次，烦热少寐。夫土为物母，心肝肺肾
，若四子焉，子虚尚可仰给母气，苟土母倾颓，中无砥柱矣。古人论脾肺两亏之证，最难措
置，方欲培土强脾，恐燥剂有妨于阴液，方欲濡燥生津，恐润剂有碍于中州，惟上嗽热而下
不便溏，下便溏而上不嗽热者，方好施治耳。今日用药，当以扶脾为急。昔士材先生治虚劳
，尝云今日肺病，多保肺药中兼佐扶脾。明日脾病，多扶脾药中兼保肺。亦因时制宜法也。
但脏真损伤已极，药饵恐难图成。
先天禀赋薄弱，情志不畅，导致心脾之气郁结。诊察脉象细涩，细脉主气虚，涩脉主血虚。询问饮食睡眠如常，只是月经失调，每逢经期，便出现忽冷忽热的症状，腰部及脊背酸痛。按中医理论，冲脉为血海，任脉主司胞胎，二脉气血交通通畅，方能受孕。脉证如此，即使没有其他疾病，恐怕也难以孕育。间歇性服用加味归脾汤，以调养心脾气血之源；长期服用毓麟珠，以补益冲任二脉，使阴阳和谐，冲任调匀，那么就能像合浦珍珠回归、蓝田美玉茁壮一样，怀孕生子是可以预见的。
安波按语：冲脉是经血的根源，所以《内经》说太冲脉旺盛则月经按时来潮。现在用毓麟珠等药物来补益冲任，正符合这一宗旨。
岐伯（代指古代医家）论述五郁，首先探究肝脏。肝主春生之气，春气不生发，则长养收藏的机能就会停止，想要没有灾害是很少见的。虽然病端始于肝，但日久会蔓延至其他脏腑。肤浅的医生见出血就用寒凉药，因咳嗽就治肺，这本来就不足论道。即使知道求本，但不审察阴阳消长的道理，依然隔靴搔痒。所谓补阴补阳，含义各有两种。黄芩、黄连、知母、黄柏，属于有形之水（滋阴降火）。麦冬、五味子、地黄，属于无形之水（滋养真阴）。用无形之水来制约无形之火，就像灯盏中加油，灯火自然明亮。干姜、肉桂、附子，属于温烈之温（大热之品）。人参、甘草，属于温存之温（温和之品）。用温存之温来煦育虚无之气，就像炉灰复燃，火势不会熄灭。近日咳嗽频繁，痰中带血，似乎应当先投甘寒之剂以降火，不可骤然用人参、甘草来补阳。《医贯》说：凡人的肺金之气，夜间卧睡时则归藏于肾水之中，如果肾水干枯，无处容纳，肺气便会重新上逆而为患。病情开始于心情抑郁不得舒展，逐渐发展到闭经，进而出现消瘦、气喘咳嗽、呼吸急促，不能平卧。之所以这样，虽然说是火热炽盛相互煎熬，实际上是由于肾水亏损无法救济。火在空处则发散，如果不是填实其空，炎焰怎么能收敛纳入。王冰（王太仆）说：增强心之阳气，即使是寒证也能通行；强壮肾之阴精，即使是热证也可以治疗，这确实是见识大道的言论。昨天讨论大便稀溏，大多担心是脾元下陷，昨夜排便数次，伴有烦热和睡眠减少。土为万物之母，心、肝、肺、肾如同四个子女，子女虚弱还可以仰仗母亲的气血供养，如果土母倾颓，中间就没有了支柱。古人论述脾肺两亏的病症，最难处理，刚想培土强脾，又担心燥湿药会妨碍阴液；刚想润燥生津，又担心滋润药会阻碍中焦脾胃。只有上面咳嗽发热而下面不拉稀，或者下面拉稀而上面不咳嗽发热的情况，才好施治。今天的用药，应当以扶持脾胃为急务。昔日士材先生治疗虚劳，曾说现在的肺病，多在保肺药中兼佐扶脾药。明天的脾病，多在扶脾药中兼保肺药。这也是因时制宜的方法。但是脏真损伤已经极其严重，药物恐怕难以奏效。
Congenital constitution is weak, emotional state is unsmooth, leading to depression of Heart and Spleen Qi. The pulse is fine and choppy; a fine pulse indicates Qi deficiency, and a choppy pulse indicates Blood deficiency. Upon inquiry, appetite and sleep are normal, but menstruation is irregular. Every time during the menstrual period, there are alternating chills and fever, along with soreness and pain in the lower back and spine. According to TCM theory, the Chong Mai (Penetrating Vessel) is the Sea of Blood, and the Ren Mai (Conception Vessel) governs the uterus. When these two vessels communicate smoothly, conception can occur. Given this pulse and symptom presentation, even without other diseases, it is feared that conception will be difficult. Intermittently administer Jiawei Guipi Tang (Modified Spleen-Restoring Decoction) to nourish the source of Heart and Spleen Qi and Blood; long-term administration of Yulin Zhu (Fertility Pearl Pill) to tonify the Chong and Ren vessels. Once Yin and Yang are harmonious and the Chong and Ren vessels are regulated, pregnancy can be expected, akin to pearls returning to Hepu or jade flourishing in Lantian.
An Bo's commentary: The Chong Mai is the root of menses; thus, the *Neijing* states that when the Taichong Mai is vigorous, menses arrive on time. Using Yulin Zhu and similar herbs to tonify the Chong and Ren vessels aligns perfectly with this principle.
Qibo (representing ancient physicians) discusses the Five Stagnations, first investigating the Liver. The Liver governs the Spring-generating Qi. If Spring Qi does not generate, the functions of growth, nourishment, storage, and consolidation cease, making it rare to avoid disaster. Although the disease originates in the Liver, over time it spreads to other Zang-Fu organs. Superficial doctors who administer cooling herbs upon seeing bleeding or treat the Lung for coughing are hardly worth discussing. Even those who seek the root cause but fail to examine the principles of Yin-Yang waxing and waning remain superficial. The concepts of "Tonifying Yin" and "Tonifying Yang" each have two meanings. Huangqin (Scutellariae Radix), Lianhua (Coptidis Rhizoma), Zhimu (Anemarrhenae Rhizoma), and Huangbai (Phellodendri Cortex) represent "Formative Water" (Yin-nourishing and fire-clearing). Maidong (Ophiopogonis Radix), Wuweizi (Schisandrae Fructus), and Dihuang (Rehmanniae Radix) represent "Formless Water" (Nourishing True Yin). Using formless water to control formless fire is like adding oil to a lamp; the flame naturally brightens. Ganjiang (Zingiberis Rhizoma), Rougui (Cinnamomi Cortex), and Fuzi (Aconiti Lateralis Radix Praeparata) represent "Intense Warmth" (Great Heat). Renshen (Ginseng Radix) and Gancao (Glycyrrhizae Radix et Rhizoma) represent "Mild Warmth" (Gentle Heat). Using mild warmth to warm the Qi of emptiness is like reviving ashes in a furnace; the fire does not extinguish. Recently, frequent coughing with blood-streaked sputum suggests one should first administer sweet-cold herbs to descend fire, rather than abruptly using Renshen and Gancao to tonify Yang. *Yi Guan* states: The Qi of Lung Metal normally returns to Kidney Water during sleep at night. If Kidney Water is dry, there is no place for it to reside, causing Lung Qi to rebel upward. The illness began with emotional constraint, gradually progressing to amenorrhea, then to wasting, panting, coughing, and dyspnea, making it impossible to lie flat. This occurs because, although it appears as fierce heat scorching each other, it is actually due to Kidney Water deficiency failing to support. Fire flares up in emptiness; unless the emptiness is filled, how can the flames be contained? Wang Bing (Wang Taipu) said: Strengthening the Yang of the Heart allows cold to circulate; strengthening the Yin of the Kidneys allows heat to be treated. This is indeed a profound insight. Yesterday, regarding loose stools, concern was raised about Spleen Yuan sinking. Last night, there were several bowel movements accompanied by irritability, heat sensation, and insomnia. Earth is the mother of all things; the Heart, Liver, Lung, and Kidneys are like four children. If the children are deficient, they can still rely on the mother's Qi. However, if the Earth Mother collapses, there is no pillar in the center. Ancient texts discuss Spleen-Lung Dual Deficiency as extremely difficult to manage. One wishes to strengthen the Spleen via Earth-tonifying methods but fears drying agents may damage Yin fluids; one wishes to moisten dryness and generate fluids but fears lubricating agents may obstruct the Middle Jiao. Treatment is feasible only when upper symptoms (cough/heat) do not coincide with lower symptoms (loose stools), or vice versa. Today's medication must prioritize supporting the Spleen. Mr. Shicai once said when treating Consumption (Xu Lao): For current Lung diseases, add Spleen-supporting herbs to Lung-protecting formulas; for current Spleen diseases, add Lung-protecting herbs to Spleen-supporting formulas. This is the method of adapting to time and condition. However, since the Zhen Qi (True Qi) of the viscera is extremely damaged, medicinal treatment may hardly succeed.