就兄体素虚寒，向患腹痛，服温药相安，年来痛移上脘，气逆呕吐，饮食渐减，丁亥之
秋，
病发益剧，食全不纳，自服理中六君之属，温理脾阳未应，形羸气怯，卧床不起，遣价逆予
。诊脉胃少弦多，望色青白不泽，自以为殆，予曰无妨，治未中肯耳。尊体平素虚寒，原宜
温理，据兹脉证，由于心境欠舒，木郁不达，厥阴干犯阳明，肝气逆横，胃降失职。仲圣云
∶厥阴为病，气上冲心，心中热疼，饥不欲食。夫肝为将军之官，脏刚性急，脾胃虽俱属土
，然须分别治之，不容笼统而论。叶香岩谓胃司受纳，脾主运化，脾宜升则健，胃宜降则和
，太阴湿土，得阳始运，阳明燥土，得阴自安数语，实发前人之所未发。观其食入即呕，足
见其病在胃而不在脾。理中六君，皆是脾药，不能治胃，今胃空若谷，必须参力扶持，始克
有济，寒士购参不易，姑思其次，以高丽参代之，乃于六君子汤中，除术甘之守，加入川椒
、乌梅、干姜、木瓜、白芍，另用陈仓米水煎服。药则辛酸并投，法合制肝安胃。予辞归。
越日就兄专札来云∶妙方连服两剂，痛缓呕止，稍能安谷，颇见效灵，深为感佩。尚祈加减
，照原法略为出入，守服而痊。次春相唔郡城饶君扬翁宅中，丰采倍胜于前。
安波按∶此亦病久胃虚，故丽参能受。然必须参入梅椒瓜等，仿安胃腕，以辛散、酸
收、甘缓三法并济也。
我的黄就唐表兄体质向来虚弱且偏寒，过去患有腹痛，服用温性药物后能保持安稳。近年来疼痛转移至上脘部位，出现气逆呕吐，饮食逐渐减少。丁亥年秋天，病情发作得更加剧烈，完全无法进食。他自行服用了理中汤、六君子汤等属于温补脾阳的方剂，但未见疗效，身体消瘦，气息怯弱，卧床不起，派人急召我去诊治。
我诊察他的脉象，胃气少而弦脉多；观察他的面色，青白而无光泽。他自己认为病势危殆，我说不要紧，只是治疗没有抓住关键罢了。尊体平时虚寒，原本适宜温补调理，但根据目前的脉证，是由于心境不畅，肝木郁结不能舒展，厥阴肝经侵犯阳明胃经，导致肝气横逆，胃失和降。仲景曾说：“厥阴病，气上冲心，心中热疼，饥不欲食。”肝为将军之官，脏性刚强急躁，脾胃虽然都属土，但必须分别治疗，不能笼统而论。叶天士说：“胃司受纳，脾主运化，脾宜升则健，胃宜降则和，太阴湿土，得阳始运，阳明燥土，得阴自安。”这几句话，确实阐发了前人未曾发挥的理论。看其食入即呕，足以证明病在胃而不在脾。理中汤、六君子汤都是治脾的药，不能治胃。如今胃中空虚如谷，必须用参力扶持，才能见效。寒门之士购买人参不易，暂且考虑次选方案，用高丽参代替。于是我在六君子汤中，去掉了白术、甘草的守中之性，加入川椒、乌梅、干姜、木瓜、白芍，另用陈仓米水煎服。药味辛、酸并用，法度符合制肝安胃的原则。我告辞回家。
第二天，就唐表兄专门来信说：“妙方连服两剂，疼痛缓解，呕吐停止，稍能进食谷物，非常见效灵验，深表感激敬佩。恳请加减处方，按照原法略作变动，继续服用以求痊愈。”次年春天，我在郡城饶扬翁家中相见，他的风采比之前好得多。
安波按语：这也是因为久病导致胃虚，所以能够承受高丽参。然而必须加入乌梅、川椒、木瓜等药物，仿照安胃丸的法度，将辛散、酸收、甘缓三法并济使用。
My cousin Huang Jiutang has constitutionally been deficient and cold. He previously suffered from abdominal pain, which remained stable after taking warming medicines. In recent years, the pain shifted to the upper epigastrium (upper abdomen), accompanied by rebellious Qi and vomiting, with a gradual decrease in food intake. In the autumn of the Dinghai year, the illness worsened significantly; he could not retain any food. He self-administered formulas belonging to Lizhong Tang (Regulate the Middle Decoction) and Liu Junzi Tang (Six Gentlemen Decoction) to warm and regulate Spleen Yang, but there was no response. His body became emaciated, his Qi weak, and he was bedridden. He sent a messenger to summon me urgently.
Upon examination, his pulse showed little Stomach Qi and excessive Xian (Wiry) pulse. His complexion was cyan-white and lusterless. He considered his condition desperate. I said, "No need to worry; the treatment simply missed the key point." Although his constitution is typically deficient and cold, suitable for warming regulation, based on the current pulse and symptoms, the cause lies in an unrelaxed state of mind, leading to Liver Wood stagnation and failure to diffuse. The Jueyin (Liver) channel invades the Yangming (Stomach) channel, causing Liver Qi to rebel and spread horizontally, resulting in the Stomach's failure to descend. Zhongjing stated: "In Jueyin disease, Qi rushes upward to the heart, causing heat and pain in the chest, hunger without desire to eat." The Liver is the official of the General; its nature is rigid and impatient. Although both the Spleen and Stomach belong to Earth, they must be treated separately and cannot be discussed generally. Ye Tianshi said: "The Stomach governs reception and acceptance; the Spleen governs transportation and transformation. The Spleen thrives when ascending; the Stomach harmonizes when descending. Taiyin Damp Earth begins to function only with Yang; Yangming Dry Earth finds peace naturally with Yin." These words truly elucidated theories not previously expounded by predecessors. Observing that food is vomited immediately upon ingestion, it is evident that the pathology resides in the Stomach, not the Spleen. Lizhong Tang and Liu Junzi Tang are herbs targeting the Spleen and cannot treat the Stomach. Now that the Stomach is empty like a valley, it requires the support of Ginseng to achieve efficacy. As purchasing Ginseng is difficult for a poor scholar, I considered a secondary option and substituted it with Korean Ginseng (Ginseng Cornea). Thus, within Liu Junzi Tang, I removed the retaining properties of Atractylodis Macrocephalae Rhizoma (Baizhu) and Glycyrrhizae Radix et Rhizoma (Gancao), and added Zanthoxyli Fructus (Chuanjiao), Mume Fructus (Wumei), Zingiberis Rhizoma Recens (Ganjiang), Chaenomelis Fructus (Mugua), and Paeoniae Radix Alba (Baishao). Separately, aged rice (Chencangmi) was decocted in water for administration. The herbs combined pungent and sour flavors, adhering to the method of restraining the Liver and calming the Stomach. I then took my leave.
The following day, Cousin Jiutang sent a letter stating: "The miraculous prescription, taken for two doses, relieved the pain and stopped vomiting; he could slightly consume grain. It proved very effective and efficacious. I am deeply grateful and admiring. I implore you to modify the formula, making slight adjustments according to the original method, and continue taking it to achieve recovery." In the spring of the following year, we met at the residence of Mr. Rao Yang in the prefectural city. His demeanor was far superior to before.
Note by Anbo: This case also involves long-standing illness leading to Stomach deficiency, hence allowing the tolerance of Korean Ginseng. However, it is essential to incorporate Mume Fructus, Zanthoxyli Fructus, and Chaenomelis Fructus, imitating the method of Anwei Wan (Stomach-Calming Pill), combining the three methods of Pungent Dispersing, Sour Astringing, and Sweet Moderating.