24．闵女。胃脘痛，迄今数年，时作时辍，发则手不可近，而转动其痛尤剧。痛剧时拊其背部，则痛稍减。炮附块9克，杏仁泥18克，厚朴3克，赤石脂15克，荜茇9克，谷麦芽各9克。另：灵丑散，吞服。二诊：用散药与汤剂之结果，其为神经痛更为明显。盖实质性病变，决无有所事而能遗忘其痛处者。延胡索15克，川楝子12克，旋覆花12克(包)，香甘松6克，九香虫9克，晚蚕沙9克(包)。上药入前方中再服。
[按]此病初诊，作为神经性胃病与消化不良并治。先生预告患者服药后，若有头晕如酩酊状者，为药物所致，即古籍所谓"若药不瞑眩，厥疾弗瘳"。后果如此。考杏仁用大量，有润胃肠、消食、开滞气之功，能疏利开通、破壅降逆而缓胃痛。但苦杏仁甙可分解而为苯甲醛和氢氰酸，多服易致中毒，表现为眩晕，甚则晕倒、呕吐。若用20～30克煎服，可能有轻度中毒症状，故先生预告"有头晕如酩酊状者"，一般以不超过30克为是。灵丑散即是五灵脂、黑丑等份研末，每服3～6克，有消导行滞、通便止痛之功，实证多用之。
25．李女。胃脘痛，其痛得按则舒，并不呕吐噫哕。川楝子9克，延胡索12克，杏仁18克，甘松6克，川椒目5克，台乌药9克，香橼皮9克，罂粟壳12克，旋覆花12克(包)。二诊：自觉心摇摇如悬旌然，则胃脘痛，得重按则舒，亦神经痛也。延胡索12克，全当归9克，杏仁泥15克，罂粟壳12克，小茴香3克，远志肉12克，旋覆花9克(包)，细辛2．4克，炮附块5克，香橼皮9克，良附丸9克(吞)。
三诊：胃脘痛止，进流质尚感胀，上膈隐痛，此胸痹也。薤白头12克，生枳实9克，全瓜蒌12克，香附9克，延胡索12克，娑罗子9克，佛手6克，木香5克，半夏曲9克，乌药9克，大川芎6克。[按]神经性胃痛，前人认为是肝胃气失舒所致。先生用温性理气止痛药，屡屡见效。本案三诊时，见上膈隐隐作痛，乃辨为"胸痹"证，加薤白、枳实、瓜蒌等药，以加强其宽胸下气的作用，方为瓜蒌薤白半夏汤的加味。
26．罗男。以胃脘痛为主症，初起是局限性，近则放散性，与饮食无关。考其痛有时或稀，盖气痛也。延胡索15克，旋覆花(包)、乌药各9克，杏仁12克，细辛5克，罂粟壳12克，刺猬皮15克，香橼9克，炙乳没各5克，粉甘草3克。
二诊：作气痛论治，有效，仍之。金铃子12克，延胡索15克，荜茇9克，杏仁12克，小茴香5克，罂粟壳12克，五灵脂9克(包)，娑罗子6克，佛手6克。另服五磨饮。三诊：今用镇痛而无刺激之品。全当归9克，延胡索9克，杏仁泥12克，五灵脂9克(包)，罂粟壳12克，刺猬皮15克，旋覆花12克(包)，良附丸9克。四诊：胃痛停顿，纳谷不香，精神倦怠，四肢乏力。予异功散加炒谷芽、神曲以调之。
27．王女。胃脘痛，得按则舒，属气属寒居多。便秘须通之。延胡索12克，金铃子9克，刺猬皮15克，杏仁15克，莱菔子9克，黑丑9克，海南片6克，桑椹子15克。另：沉香化滞丸9克，吞服。[按]所谓"气痛"，多属功能性的疼痛，故用辛香理气、止痛等药有效。如果属寒痛，用之也有作用，王案因便秘，故用海南片、黑丑、桑椹子等。
28．潘男。胃脘痛，得食则减，古人以为中虚。当归9克，杭白芍12克，桂枝6克，生姜2片，生甘草9克，饴糖30克，大枣7枚，旋覆花12克(包)。
29．邱男。胃脘痛，饥则更甚，其食量不为之减，反稍见增，故多进饮食反稍定，此虚痛也。予黄芪建中汤。
30．王男。每日有定时之饥饿，多在食前一二小时，进食所苦立释。否则，脐部有痉挛之不快。往者数日即愈，今则缠绵1个月有半。川桂枝5克，杭白芍9克，大红枣12枚，饴糖30克，全当归12克，生黄芪12克，生姜5片，粉甘草6克。
31．叶男。胃痛时发时止，今因受寒而发，神经痛也。高良姜6克，延胡索9克，杏仁12克，当归9克，九香虫6克，制香附9克，旋覆花9克(包)，甘松6克，川芎6克，佛手9克。另服五磨饮子。二诊：前方不能治其胃脘之痛，饥则其痛益甚，改作中虚论治。黄芪9克，全当归12克，杭白芍18克，生姜3片，饴糖30克，川桂枝9克，甘草6克，大枣9枚，谷麦芽各12克。
32．邱男。胃脘痛，饱食后反稍瘥，其痛多在午后，应是虚痛。延胡索12克，金铃子12克，川桂枝7克，白芍5克，饴糖31克，生姜3片，甘草5克，大枣9枚[按]先生对胃脘痛属虚者，常用建中汤，其应用指征是：便难而痛较剧者，用当归建中汤；气虚者，用黄芪建中汤；较轻者，用小建中汤。一般以十二指肠球部溃疡属虚寒型者，用建中汤最为适应。若；建中汤加蒲公英30克，其效果更佳。所谓溃疡病虚寒型者，其特征有三：①饥饿疼痛，得食则减；②得温则舒；③得按则舒。凡泛酸而嘈杂者忌用。
33．沈男。胃脘痛2年余，其痛隐隐然，作于食后2时许，得食则减。口干、舌红、便难，仿魏玉璜一贯煎法。麦冬9克，北沙参9克，玉竹9克，当归9克，甘杞子9克，生地12克，川楝子9克，制香附6克，杏仁24克，白芍12克。[按]患者原经他医诊治，进服温燥理气之药，虽缓解一时，终未根治，因至先生处就诊。先生予上方，并嘱饮食多餐少量。服20剂后，其痛由逐渐减轻而至消失。因其有效，原方曾连服四十余剂。舌红、便难亦愈。
34．翁女。食入则痛，两月于兹。食品稍硬，痛更甚。病由抑郁而来，神经痛有之，胃溃疡亦有之。先予镇痛而不刺激者。杏仁泥30克，旋覆花12克(包)，云苓12克，延胡索12克，桃仁泥15克，谷麦芽各9克，佛手6克，伏龙肝30克。
35．姚女。钙铋镁不能治其脘痛，此非药不中的，转可以测验胃粘膜无溃疡之可言，佳象也。考其经过，因痛而吐，吐后其痛稍减，胃粘膜有慢性炎症，自属可能。延胡索15克，金铃子9克，土炒党参12克，白蜜24克(冲)杏仁24克，橘皮6克，川椒目5克，白苏子12克(包)，半夏15克，炙甘草3克。[按]此系金铃子散、大建中汤、二陈汤的合剂。
36．陈女。以胃脘痛为主症，形容逐渐消瘦，颇疑其为癌；所幸饱食后痛能略减，以往曾吞酸，则溃疡性之痛为多。自诉操作则痛剧，休息则轻，然此诊其为神经痛亦可。今以镇痛剂观其后。延胡索15克，旋覆花12克(包)，香甘松6克，赤石脂6克(分2次和入)，杏仁泥24克，九香虫6克，六轴子1．8克，陈香橼9克。
[按]本案胃痛，先生认为饱食后痛能略减，且以往曾见吞酸，属溃疡性痛较为可能；但因操劳则痛剧，休息则减轻，则为神经痛也有可能性。因此，所用方剂，既有镇痛理气的药物；也用收敛的赤石脂。六轴子用量不宜大，否则，可引起中毒。此药对呼吸、循环有极强的抑制作用。若中毒后，可有恶心、呕吐、腹泻、心跳缓慢、血压下降、动作失调、呼吸困难等症状出现，严重时可因呼吸停止而死亡。本品作煎剂，一般每日量为1．5～2克。
37．陈女。胃脘痛其原因最多，主要当分主动、被动，主动多属胃之本身疾患，胃溃疡、胃炎、胃痉挛之类，被动多由某种原因使之作痛，如胃酸过多、冷食及刺激等。病者乃主动之痛而属于神经性者。炮附片5克，延胡索9克，制香附9克，当归9克，旋覆花9克(包)，刺猬皮5克，娑罗子9克，小茴香6克，佛手片6克。
二诊：胃痛将作，背部先有不快感，《金匮》所谓"心痛彻背，背痛彻心"之症也。非神经痛即胃痉挛也。杏仁泥24克，炮附片9克，旋覆花9克(包)，赤石脂9克，延胡索15克，香甘松6克，佛手9克，当归12克。[按]此案心痛彻背，背痛彻心，乃寒气凝结较甚之故。此方从《金匮》乌头赤石脂丸化裁，意在逐寒止痛。
38．王男。急性胃炎亦有高热，舌苔厚腻。曾以治温之法治之无效，热退而痛大作，坐卧不安，苦难尽述。昨以定痛丸救其急，利用石膏之钙披护胃膜之炎，兼能镇静，杏仁之氢氰酸以镇痛，杏仁之油以弛缓痉挛，川连为消炎药，其他皆清凉药，服后痛大停。杏仁24克，知母9克，淡竹茹5克，天花粉12克，玉竹9克，银花12克，生石膏12克(研极细分吞)。[按]此案初起高热，舌苔厚腻，乃阳明热盛之征。胃痛而高热，是有取乎石膏、杏仁之类以镇静、镇痛。
39．乐男。少腹痛，其痛时轻时剧，病历半年，暑令有数月不发者。比来气候日寒，其发甚频；其并发症口唾酸涎，进食即酸减，腹痛亦能缓解。旋覆花9克(包)，延胡索12克，炮附片5克，全当归9克，杏仁泥15克，赤石脂6克(分2次和人药中)，姜半夏12克，云苓12克，生熟米仁各15克，淮山药9克，淡吴萸5克。
二诊：酸能减，少腹痛亦因之缓解，可见痛是酸之刺激，则根治在制酸。煅瓦楞子30克，赤石脂9克(分2次冲)，旋覆花9克(包)，全当归9克，杏仁泥18克，云苓12克，姜半夏9克，肉桂末2．4克，生熟米仁各15克，沉香曲9克。[按]腹痛经久不愈，一般都属寒属虚。气候日寒，其发甚频，更是明征。案中述及"病是酸之刺激，则根治在制酸"，故方药以制酸为主；并又以桂、萸等辛热之品，通阳止痛。
40．胡男。饮食皆不能大口下咽，大口则梗梗然胸次作痛，痛则泛吐粘痰，必咯吐出而后快，病之因不在食道，而在胃。煅瓦楞15克，晚蚕沙12克，荜茇9克，生鸡金12克，刺猬皮9克，谷麦芽各12克，潞党参、怀山药、台乌药各9克，良附丸15克。共研细末，每吞1．5克，日服3次。
[按]本案先生断其病所在胃，除案语所述外，当具脘痛喜温、畏寒、苔白、脉迟等中阳式微见症。诚如《奇效良方》所述："宿滞痼癖，积聚停痰，动扰脾胃，胃弱不能消磨谷食，遂成此证。"梗痛碍咽，非通补不除；泛吐粘痰，惟温药能化。治用党参、山药、谷麦芽补中而苏胃气、良附、荜茇、乌药温通以祛沉寒，蚕沙、鸡金化浊助运、瓦楞、猬皮养胃止痛，取寻常降逆化痰之品，一味以温中养胃为法，非有卓识，不能如此。
41．刘女。心下痞，进食梗梗然不舒，得之胸襟拂逆。薤白头12克，木瓜9克，大川芎6克，谷麦芽各9克，制香附9克，广橘皮6克，生枳壳9克，神曲9克，佛手9克[按]此因肝郁不舒，气机上逆，使胃失和降，而致心下痞，进食梗梗然不舒。方药以调达肝气、和降胃气为大旨。香附、川芎并用为越鞠丸配伍方法，有解郁舒肝之效；木瓜之酸，能柔肝；薤白辛滑能通胃阳；枳、橘、曲、谷麦芽、佛手以降气和胃。胃以通为补，故不杂守中之品于方内。
42．尹女。胸次窒闷，迄今2个月之久，胸襟怡悦，则所苦瘥减，可见是肝失条达。醋柴胡9克，香甘松5克，旋覆花9克(包)，白苏子9克(包)，杭白芍9克，佩兰梗9克，广玉金5克，小青皮5克，生枳实9克，制黑丑6克，左金丸2．4克(吞)，佛手9克。二诊：先是胸襟拂逆，继之胃与肠之功能亦障碍，食物不消而泄。其胸次之窒闷，则终日如此。制川朴3克，制香附9克，生苍术9克，薤白头18克，广郁金5克，台乌药6克，大川芎9克，神曲15克，石菖蒲9克，上肉桂2克。共研细末，每次吞服1．5克。三诊：经投散剂，症状大见改善。仍用前方。
[按]初诊用疏泄、降逆之剂。二诊时，知无动静，乃改予越鞠丸加减。方中加入薤白、乌药、菖蒲、肉桂等辛香之品，以增强胃肠功能。果然，二诊以后，病势大有改善。足见因拂逆而致胃肠功能障碍，若为时较久，则非一般疏泄、降逆之剂所能奏效。证之临床，往往如此。
43．朱男。迭用消导，依旧胸中痞窒。夫痞本有虚实之分，故仲景心下痞有用参之例。今仿四磨饮。潞党参9克，尖槟榔6克，佩兰梗、谷芽、麦芽、台乌药、沉香曲(后下)、佛手、麸炒枳实各9克。另：服香砂六君子丸或香砂胃苓丸。二诊：此症初起，却是肠胃有所阻滞。迭用消导攻下，心下所以仍痞，少腹所以隐痛，痞是功能障碍，痛是气体之刺激。当宗醒胃运脾之法，不能再事摧残，致有虚虚之戒。土炒潞党参9克，生白术9克，台乌药6克，炮附块5克。另：沉香2．4克、鸡内金6克、晚蚕沙9克、蓬莪术6克，共研末，每服1．5～3．0克。
24．闵女。胃脘疼痛，至今已有数年，时好时坏，发作时手不能触碰，转动身体时疼痛更加剧烈。疼痛剧烈时抚摸其背部，则疼痛稍减。炮附块9克，杏仁泥18克，厚朴3克，赤石脂15克，荜茇9克，谷芽和麦芽各9克。另：灵丑散，吞服。二诊：使用散剂和汤剂后，结果更倾向于神经痛。因为实质性病变，绝不会在从事某项活动时就能忘记疼痛部位。延胡索15克，川楝子12克，旋覆花12克（包煎），香甘松6克，九香虫9克，晚蚕沙9克（包煎）。以上药物加入前方中继续服用。
[按]此病初诊时，作为神经性胃病与消化不良并治。先生预先告知患者服药后，若出现头晕如醉酒状的情况，这是药物所致，即古籍所谓“若药不瞑眩，厥疾弗瘳”（如果服药后没有剧烈的反应，顽固的疾病就不会痊愈）。后果确实如此。考察发现，大量使用杏仁，具有润肠通便、消食、疏通滞气的功效，能疏利开通、破壅降逆从而缓解胃痛。但苦杏仁苷可分解为苯甲醛和氢氰酸，多服容易中毒，表现为眩晕，甚至晕倒、呕吐。如果使用20～30克煎服，可能出现轻度中毒症状，所以先生预先告知“有头晕如醉酒状者”，一般以不超过30克为宜。灵丑散即是五灵脂、黑丑等份研末，每次服用3～6克，有消导行滞、通便止痛的功效，实证多用之。
25．李女。胃脘疼痛，按压则舒适，并不呕吐或打嗝。川楝子9克，延胡索12克，杏仁18克，甘松6克，川椒目5克，台乌药9克，香橼皮9克，罂粟壳12克，旋覆花12克（包煎）。二诊：自觉心中摇晃如同悬挂的旗帜般不安，此时胃脘痛，重按则舒适，这也是神经痛。延胡索12克，全当归9克，杏仁泥15克，罂粟壳12克，小茴香3克，远志肉12克，旋覆花9克（包煎），细辛2.4克，炮附块5克，香橼皮9克，良附丸9克（吞服）。
三诊：胃脘痛止，进食流质食物尚感胀满，上膈隐痛，这是胸痹证。薤白头12克，生枳实9克，全瓜蒌12克，香附9克，延胡索12克，娑罗子9克，佛手6克，木香5克，半夏曲9克，乌药9克，大川芎6克。[按]神经性胃痛，前人认为是肝胃气机失于舒展所致。先生使用温性理气止痛药，屡屡见效。本案三诊时，见上膈隐隐作痛，便辨为“胸痹”证，加用薤白、枳实、瓜蒌等药，以加强宽胸下气的作用，方剂为瓜蒌薤白半夏汤的加味。
26．罗男。以胃脘痛为主症，起初是局限性疼痛，近来变为放散性疼痛，与饮食无关。考察其疼痛有时稀疏，这属于气痛。延胡索15克，旋覆花（包煎）、乌药各9克，杏仁12克，细辛5克，罂粟壳12克，刺猬皮15克，香橼9克，炙乳香和没药各5克，粉甘草3克。
二诊：按气痛论治，有效，处方不变。金铃子12克，延胡索15克，荜茇9克，杏仁12克，小茴香5克，罂粟壳12克，五灵脂9克（包煎），娑罗子6克，佛手6克。另服五磨饮。三诊：今日使用镇痛而无刺激的药品。全当归9克，延胡索9克，杏仁泥12克，五灵脂9克（包煎），罂粟壳12克，刺猬皮15克，旋覆花12克（包煎），良附丸9克。四诊：胃痛暂停，食欲不佳，精神倦怠，四肢乏力。给予异功散加炒谷芽、神曲来调理。
27．王女。胃脘疼痛，按压则舒适，多属气滞或寒凝。便秘需要通泄。延胡索12克，金铃子9克，刺猬皮15克，杏仁15克，莱菔子9克，黑丑9克，海南片6克，桑椹子15克。另：沉香化滞丸9克，吞服。[按]所谓“气痛”，多属于功能性疼痛，因此使用辛香理气、止痛等药有效。如果属于寒痛，使用这些药也有作用，王案因便秘，故用海南片、黑丑、桑椹子等。
28．潘男。胃脘疼痛，进食后减轻，古人认为这是中焦虚损。当归9克，杭白芍12克，桂枝6克，生姜2片，生甘草9克，饴糖30克，大枣7枚，旋覆花12克（包煎）。
29．邱男。胃脘疼痛，饥饿时加重，食量并未减少，反而稍见增加，所以多吃些饮食反而稍定，这是虚痛。给予黄芪建中汤。
30．王男。每日有定时性的饥饿感，多在进食前一两个小时，进食后痛苦立即解除。否则，脐部有痉挛般的不适。以往数日即可痊愈，如今则缠绵一个半月。川桂枝5克，杭白芍9克，大红枣12枚，饴糖30克，全当归12克，生黄芪12克，生姜5片，粉甘草6克。
31．叶男。胃痛时发时止，今日因受寒而发作，属于神经痛。高良姜6克，延胡索9克，杏仁12克，当归9克，九香虫6克，制香附9克，旋覆花9克（包煎），甘松6克，川芎6克，佛手9克。另服五磨饮子。二诊：前方不能治疗其胃脘之痛，饥饿时疼痛更加严重，改为从中焦虚损论治。黄芪9克，全当归12克，杭白芍18克，生姜3片，饴糖30克，川桂枝9克，甘草6克，大枣9枚，谷芽和麦芽各12克。
32．邱男。胃脘疼痛，饱食后反而稍好，疼痛多在午后，应当是虚痛。延胡索12克，金铃子12克，川桂枝7克，白芍5克，饴糖31克，生姜3片，甘草5克，大枣9枚。[按]先生对胃脘痛属于虚证的，常用建中汤，其应用指征是：大便困难且疼痛较剧者，用当归建中汤；气虚者，用黄芪建中汤；较轻者，用小建中汤。一般以十二指肠球部溃疡属于虚寒型者，用建中汤最为适应。若在建中汤中加入蒲公英30克，效果更佳。所谓溃疡病虚寒型者，其特征有三：①饥饿疼痛，进食后减轻；②得温则舒适；③得按则舒适。凡泛酸而嘈杂者忌用。
33．沈男。胃脘疼痛2年多，疼痛隐隐然，发生在进食后2小时左右，进食后减轻。口干、舌红、大便困难，仿照魏玉璜一贯煎法。麦冬9克，北沙参9克，玉竹9克，当归9克，甘杞子9克，生地12克，川楝子9克，制香附6克，杏仁24克，白芍12克。[按]患者原经其他医生诊治，进服温燥理气之药，虽暂时缓解，终未根治，因而到先生处就诊。先生给予上方，并嘱咐饮食多餐少量。服用20剂后，疼痛由逐渐减轻而至消失。因其有效，原方曾连续服用四十余剂。舌红、大便困难也痊愈了。
34．翁女。进食则痛，至今已有两个月。食品稍硬，疼痛更甚。病由抑郁而来，既有神经痛，也有胃溃疡的可能。先给予镇痛而不刺激的药品。杏仁泥30克，旋覆花12克（包煎），云苓12克，延胡索12克，桃仁泥15克，谷芽和麦芽各9克，佛手6克，伏龙肝30克。
35．姚女。钙铋镁不能治疗其脘痛，这不是药不对症，反而可以测验胃粘膜无溃疡可言，这是佳象。考察其经过，因痛而吐，吐后疼痛稍减，胃粘膜有慢性炎症，自属可能。延胡索15克，金铃子9克，土炒党参12克，白蜜24克（冲服）杏仁24克，橘皮6克，川椒目5克，白苏子12克（包煎），半夏15克，炙甘草3克。[按]这是金铃子散、大建中汤、二陈汤的合剂。
36．陈女。以胃脘痛为主症，形容逐渐消瘦，颇怀疑其为癌症；所幸饱食后疼痛能略减，以往曾吞酸，则溃疡性疼痛为多。自诉操作劳动则疼痛剧烈，休息则减轻，然而此次诊断其为神经痛也可以。今日以镇痛剂观察其后效。延胡索15克，旋覆花12克（包煎），香甘松6克，赤石脂6克（分2次和入），杏仁泥24克，九香虫6克，六轴子1.8克，陈香橼9克。
[按]本案胃痛，先生认为饱食后疼痛能略减，且以往曾见吞酸，属于溃疡性疼痛较为可能；但因操劳则疼痛剧烈，休息则减轻，则为神经痛也有可能性。因此，所用方剂，既有镇痛理气的药物；也用收敛的赤石脂。六轴子用量不宜大，否则，可引起中毒。此药对呼吸、循环有极强的抑制作用。若中毒后，可有恶心、呕吐、腹泻、心跳缓慢、血压下降、动作失调、呼吸困难等症状出现，严重时可因呼吸停止而死亡。本品作煎剂，一般每日量为1.5～2克。
37．陈女。胃脘痛的原因最多，主要当分主动、被动，主动多属于胃本身的疾患，如胃溃疡、胃炎、胃痉挛之类，被动多由某种原因使之作痛，如胃酸过多、冷食及刺激等。病者乃主动之痛而属于神经性者。炮附片5克，延胡索9克，制香附9克，当归9克，旋覆花9克（包煎），刺猬皮5克，娑罗子9克，小茴香6克，佛手片6克。
二诊：胃痛将要发作，背部先有不快感，《金匮要略》所谓“心痛彻背，背痛彻心”的症状。不是神经痛就是胃痉挛。杏仁泥24克，炮附片9克，旋覆花9克（包煎），赤石脂9克，延胡索15克，香甘松6克，佛手9克，当归12克。[按]此案心痛彻背，背痛彻心，乃是寒气凝结较甚的缘故。此方从《金匮要略》乌头赤石脂丸化裁而来，意在逐寒止痛。
38．王男。急性胃炎亦有高热，舌苔厚腻。曾用治温病的方法治疗无效，热退而疼痛大作，坐卧不安，苦难尽述。昨日用定痛丸救其急，利用石膏中的钙保护胃膜之炎症，兼能镇静，杏仁中的氢氰酸以镇痛，杏仁的油以弛缓痉挛，川连为消炎药，其他皆清凉药，服后疼痛大停。杏仁24克，知母9克，淡竹茹5克，天花粉12克，玉竹9克，银花12克，生石膏12克（研极细分吞）。[按]此案初起高热，舌苔厚腻，乃是阳明热盛之征。胃痛而高热，是有取乎石膏、杏仁之类以镇静、镇痛。
39．乐男。少腹疼痛，疼痛时轻时剧，病历半年，暑令有数月不发者。近来气候日渐寒冷，其发作很频繁；其并发症口唾酸涎，进食即酸减，腹痛亦能缓解。旋覆花9克（包煎），延胡索12克，炮附片5克，全当归9克，杏仁泥15克，赤石脂6克（分2次和人药中），姜半夏12克，云苓12克，生熟米仁各15克，淮山药9克，淡吴萸5克。
二诊：酸能减，少腹痛亦因之缓解，可见疼痛是酸的刺激，则根治在制酸。煅瓦楞子30克，赤石脂9克（分2次冲服），旋覆花9克（包煎），全当归9克，杏仁泥18克，云苓12克，姜半夏9克，肉桂末2.4克，生熟米仁各15克，沉香曲9克。[按]腹痛经久不愈，一般都属寒属虚。气候日渐寒冷，其发作很频繁，更是明证。案中述及“病是酸之刺激，则根治在制酸”，故方药以制酸为主；并又以桂、萸等辛热之品，通阳止痛。
40．胡男。饮食皆不能大口下咽，大口则梗梗然胸次作痛，痛则泛吐粘痰，必须咯吐出而后快，病之因不在食道，而在胃。煅瓦楞15克，晚蚕沙12克，荜茇9克，生鸡内金12克，刺猬皮9克，谷芽和麦芽各12克，潞党参、怀山药、台乌药各9克，良附丸15克。共研细末，每次吞服1.5克，日服3次。
[按]本案先生断其病所在胃，除案语所述外，当具脘痛喜温、畏寒、苔白、脉迟等中阳式微见症。诚如《奇效良方》所述：“宿滞痼癖，积聚停痰，动扰脾胃，胃弱不能消磨谷食，遂成此证。”梗痛碍咽，非通补不除；泛吐粘痰，惟温药能化。治用党参、山药、谷麦芽补中而苏胃气、良附、荜茇、乌药温通以祛沉寒，蚕沙、鸡内金化浊助运、瓦楞、猬皮养胃止痛，取寻常降逆化痰之品，一味以温中养胃为法，非有卓识，不能如此。
41．刘女。心下痞塞，进食梗梗然不舒，得之胸襟拂逆。薤白头12克，木瓜9克，大川芎6克，谷芽和麦芽各9克，制香附9克，广橘皮6克，生枳壳9克，神曲9克，佛手9克。[按]此因肝郁不舒，气机上逆，使胃失和降，而致心下痞，进食梗梗然不舒。方药以调达肝气、和降胃气为大旨。香附、川芎并用为越鞠丸配伍方法，有解郁舒肝之效；木瓜之酸，能柔肝；薤白辛滑能通胃阳；枳、橘、曲、谷麦芽、佛手以降气和胃。胃以通为补，故不杂守中之品于方内。
42．尹女。胸次窒闷，迄今2个月之久，胸襟怡悦，则所苦瘥减，可见是肝失条达。醋柴胡9克，香甘松5克，旋覆花9克（包煎），白苏子9克（包煎），杭白芍9克，佩兰梗9克，广玉金5克，小青皮5克，生枳实9克，制黑丑6克，左金丸2.4克（吞服），佛手9克。二诊：先是胸襟拂逆，继之胃与肠之功能亦障碍，食物不消而泄。其胸次之窒闷，则终日如此。制川朴3克，制香附9克，生苍术9克，薤白头18克，广郁金5克，台乌药6克，大川芎9克，神曲15克，石菖蒲9克，上肉桂2克。共研细末，每次吞服1.5克。三诊：经投散剂，症状大见改善。仍用前方。
[按]初诊用疏泄、降逆之剂。二诊时，知无动静，乃改予越鞠丸加减。方中加入薤白、乌药、菖蒲、肉桂等辛香之品，以增强胃肠功能。果然，二诊以后，病势大有改善。足见因拂逆而致胃肠功能障碍，若为时较久，则非一般疏泄、降逆之剂所能奏效。证之临床，往往如此。
43．朱男。迭用消导，依旧胸中痞窒。夫痞本有虚实之分，故仲景心下痞有用参之例。今仿四磨饮。潞党参9克，尖槟榔6克，佩兰梗、谷芽、麦芽、台乌药、沉香曲（后下）、佛手、麸炒枳实各9克。另：服香砂六君子丸或香砂胃苓丸。二诊：此症初起，却是肠胃有所阻滞。迭用消导攻下，心下所以仍痞，少腹所以隐痛，痞是功能障碍，痛是气体之刺激。当宗醒胃运脾之法，不能再事摧残，致有虚虚之戒。土炒潞党参9克，生白术9克，台乌药6克，炮附块5克。另：沉香2.4克、鸡内金6克、晚蚕沙9克、蓬莪术6克，共研末，每服1.5～3.0克。
24. Female patient Min. Epigastric pain, persisting for several years, intermittent. During attacks, the area is too tender to touch, and movement exacerbates the pain. Pressing on the back during severe pain provides slight relief. Pao Fu Kuai (Prepared Aconite Lateralis Radix) 9g, Xing Ren Ni (Apricot Seed Paste) 18g, Hou Po (Magnolia Bark) 3g, Chi Shi Zhi (Red Halloysite) 15g, Bi Bo (Long Pepper) 9g, Gu Ya (Sprouted Millet) and Mai Ya (Sprouted Barley) 9g each. Additionally: Ling Chou San (Spirit and Black Morning Glory Powder), taken orally. Second visit: The results of using powder and decoction therapies indicate neuralgia more clearly. Organic lesions would not allow one to ignore the pain site during activity. Yan Hu Suo (Corydalis Rhizome) 15g, Chuan Lian Zi (Sichuan Chinaberry Fruit) 12g, Xuan Fu Hua (Inula Flower) 12g (wrapped), Xiang Gan Song (Nardostachys Root) 6g, Jiu Xiang Chong (Stink Bug) 9g, Wan Can Sha (Silkworm Excrement) 9g (wrapped). Add these herbs to the previous prescription and continue taking.
[Commentary] At the first visit, this condition was treated as both neurotic gastric disorder and indigestion. Mr. Zhang warned the patient beforehand that dizziness resembling intoxication after medication would be a drug-induced effect, consistent with the ancient saying "If the medicine does not cause dizziness, the stubborn disease will not heal." This indeed occurred. Extensive use of Apricot Seeds has effects of moistening the intestines, promoting digestion, and opening stagnant Qi, thereby relieving epigastric pain by unblocking obstruction and directing rebellious Qi downward. However, Amygdalin in bitter apricot seeds decomposes into benzaldehyde and hydrocyanic acid; excessive intake can lead to poisoning, manifesting as dizziness, fainting, or vomiting. Using 20–30g in decoction may cause mild toxicity, hence the warning about dizziness. Generally, dosage should not exceed 30g. Ling Chou San consists of equal parts Wu Ling Zhi (Trogopterus Dung) and Hei Qian (Black Morning Glory Seed) ground into powder, 3–6g per dose, effective for resolving stagnation, promoting bowel movements, and relieving pain, mainly used for excess patterns.
25. Female patient Li. Epigastric pain, relieved by pressure, without vomiting or belching. Chuan Lian Zi 9g, Yan Hu Suo 12g, Xing Ren 18g, Gan Song 6g, Chuan Jiao Mu (Sichuan Pepper Pit) 5g, Tai Wu Yao (Lindera Root) 9g, Xiang Yuan Pi (Citron Peel) 9g, Ying Su Ke (Poppy Shell) 12g, Xuan Fu Hua 12g (wrapped). Second visit: Feeling of inner restlessness like a hanging banner, accompanied by epigastric pain, relieved by firm pressure; also neuralgia. Yan Hu Suo 12g, Quan Dang Gui (Whole Angelica Sinensis) 9g, Xing Ren Ni 15g, Ying Su Ke 12g, Xiao Hui Xiang (Fennel) 3g, Yuan Zhi Rou (Polygala Root Flesh) 12g, Xuan Fu Hua 9g (wrapped), Xi Xin (Asarum) 2.4g, Pao Fu Kuai 5g, Xiang Yuan Pi 9g, Liang Fu Wan (Ginger and Bitter Orange Pill) 9g (taken orally).
Third visit: Epigastric pain ceased, but bloating persists with liquid diet, with dull pain in the upper diaphragm, indicating Chest Bi syndrome. Xie Bai Tou (Allium Macrostemon Bulb) 12g, Sheng Zhi Shi (Immature Bitter Orange) 9g, Quan Gua Lou (Trichosanthes Fruit) 12g, Xiang Fu (Cyperus Rhizome) 9g, Yan Hu Suo 12g, Suo Luo Zi (Breadfruit Seed) 9g, Fo Shou (Finger Citron) 6g, Mu Xiang (Aucklandia Root) 5g, Ban Xia Qu (Pinellia Fermented) 9g, Wu Yao 9g, Da Chuan Xiong (Ligusticum Rhizome) 6g. [Commentary] Antecedents attributed neurotic gastric pain to Liver-Stomach Qi stagnation. Mr. Zhang frequently used warm, Qi-regulating, and pain-relieving herbs with success. In the third visit, recognizing dull pain in the upper diaphragm as Chest Bi, he added Xie Bai, Zhi Shi, and Gua Lou to enhance chest-opening and Qi-descending actions, modifying Gua Lou Xie Bai Ban Xia Tang.
26. Male patient Luo. Main symptom is epigastric pain, initially localized, now radiating, unrelated to diet. The pain intervals vary, suggesting Qi-type pain. Yan Hu Suo 15g, Xuan Fu Hua (wrapped), Wu Yao 9g each, Xing Ren 12g, Xi Xin 5g, Ying Su Ke 12g, Ci Wei Pi (Hedgehog Skin) 15g, Xiang Yuan 9g, Zhi Ru Mo (Masticated Myrrh and Frankincense) 5g each, Fen Gan Cao (Licorice) 3g.
Second visit: Treated as Qi pain, effective, prescription unchanged. Jin Ling Zi 12g, Yan Hu Suo 15g, Bi Bo 9g, Xing Ren 12g, Xiao Hui Xiang 5g, Ying Su Ke 12g, Wu Ling Zhi 9g (wrapped), Suo Luo Zi 6g, Fo Shou 6g. Additionally take Wu Mo Yin. Third visit: Using analgesics without irritation. Quan Dang Gui 9g, Yan Hu Suo 9g, Xing Ren Ni 12g, Wu Ling Zhi 9g (wrapped), Ying Su Ke 12g, Ci Wei Pi 15g, Xuan Fu Hua 12g (wrapped), Liang Fu Wan 9g. Fourth visit: Gastric pain paused, poor appetite, mental fatigue, limb weakness. Yi Gong San (Extra Efficacy Powder) with fried Gu Ya and Shen Qu given to regulate.
27. Female patient Wang. Epigastric pain, relieved by pressure, mostly due to Qi stagnation or Cold. Constipation requires purging. Yan Hu Suo 12g, Jin Ling Zi 9g, Ci Wei Pi 15g, Xing Ren 15g, Lai Fu Zi (Radish Seed) 9g, Hei Qian 9g, Hai Nan Pian 6g, Sang Shen Zi (Mulberry Fruit) 15g. Additionally: Chen Xiang Hua Zhi Wan (Agarwood Resolving Stagnation Pill) 9g, taken orally. [Commentary] "Qi pain" is often functional, so acrid-aromatic Qi-regulating and pain-relieving herbs are effective. For Cold pain, they also work. In this case, due to constipation, Hai Nan Pian, Hei Qian, and Sang Shen Zi were used.
28. Male patient Pan. Epigastric pain, relieved by eating, considered Middle Jiao Deficiency by ancients. Dang Gui 9g, Hang Bai Shao (White Peony) 12g, Gui Zhi (Cinnamon Twig) 6g, Sheng Jiang (Fresh Ginger) 2 slices, Sheng Gan Cao 9g, Yi Tang (Maltose) 30g, Da Zao (Jujube) 7 pieces, Xuan Fu Hua 12g (wrapped).
29. Male patient Qiu. Epigastric pain, worse when hungry, appetite not reduced, sometimes increased, so eating brings slight relief, indicating Deficiency pain. Huang Qi Jian Zhong Tang (Astragalus Decoction for Replenishing the Middle) given.
30. Male patient Wang. Regular daily hunger, usually 1-2 hours before meals, pain relieved immediately upon eating. Otherwise, spasmodic discomfort in the umbilical region. Previously resolved in days, now lingering for 1.5 months. Chuan Gui Zhi 5g, Hang Bai Shao 9g, Da Hong Zao (Large Jujube) 12 pieces, Yi Tang 30g, Quan Dang Gui 12g, Sheng Huang Qi (Astragalus) 12g, Sheng Jiang 5 slices, Fen Gan Cao 6g.
31. Male patient Ye. Intermittent stomach pain, triggered by cold exposure, identified as neuralgia. Gao Liang Jiang (Galangal) 6g, Yan Hu Suo 9g, Xing Ren 12g, Dang Gui 9g, Jiu Xiang Chong 6g, Zhi Xiang Fu 9g, Xuan Fu Hua 9g (wrapped), Gan Song 6g, Chuan Xiong 6g, Fo Shou 9g. Additionally take Wu Mo Yin Zi. Second visit: Previous formula ineffective for epigastric pain; pain worsens with hunger, shifting diagnosis to Middle Jiao Deficiency. Huang Qi 9g, Quan Dang Gui 12g, Hang Bai Shao 18g, Sheng Jiang 3 slices, Yi Tang 30g, Chuan Gui Zhi 9g, Gan Cao 6g, Da Zao 9 pieces, Gu Ya and Mai Ya 12g each.
32. Male patient Qiu. Epigastric pain, slightly better after full meals, pain mostly in afternoon, likely Deficiency pain. Yan Hu Suo 12g, Jin Ling Zi 12g, Chuan Gui Zhi 7g, Bai Shao 5g, Yi Tang 31g, Sheng Jiang 3 slices, Gan Cao 5g, Da Zao 9 pieces. [Commentary] For Deficiency-type epigastric pain, Mr. Zhang commonly uses Jian Zhong Tang. Indications: Severe pain with difficult stool calls for Dang Gui Jian Zhong Tang; Qi deficiency calls for Huang Qi Jian Zhong Tang; milder cases call for Xiao Jian Zhong Tang. It is most suitable for duodenal bulb ulcers of the Deficiency-Cold type. Adding Pu Gong Ying (Dandelion) 30g improves efficacy. Characteristics of ulcer Deficiency-Cold type: 1) Hunger pain relieved by food; 2) Relieved by warmth; 3) Relieved by pressure. Contraindicated in cases with acid regurgitation and heartburn.
33. Male patient Shen. Epigastric pain for over 2 years, dull pain occurring ~2 hours after meals, relieved by eating. Dry mouth, red tongue, difficult stool. Following Wei Yuhuang's Yi Guan Jian method. Mai Dong (Ophiopogon) 9g, Bei Sha Shen (Glehnia) 9g, Yu Zhu (Polygonatum) 9g, Dang Gui 9g, Gan Qi Zi (Goji Berry) 9g, Sheng Di (Rehmannia) 12g, Chuan Lian Zi 9g, Zhi Xiang Fu 6g, Xing Ren 24g, Bai Shao 12g. [Commentary] Patient had been treated by other doctors with warm-drying Qi-regulating herbs, providing temporary relief but no cure. Mr. Zhang prescribed the above formula and advised small, frequent meals. After 20 doses, pain gradually disappeared. Due to efficacy, continued for over 40 doses. Red tongue and difficult stool also resolved.
34. Female patient Weng. Pain upon eating for two months. Harder food causes worse pain. Etiology involves depression; possibilities include neuralgia and gastric ulcer. Initially given non-irritating analgesics. Xing Ren Ni 30g, Xuan Fu Hua 12g (wrapped), Yun Ling (Poria) 12g, Yan Hu Suo 12g, Tao Ren Ni (Peach Kernel Paste) 15g, Gu Ya and Mai Ya 9g each, Fo Shou 6g, Fu Long Gan (Household Chimney Soil) 30g.
35. Female patient Yao. Calcium-Bismuth-Magnesium failed to relieve abdominal pain, not due to wrong indication, but confirming absence of gastric ulcer mucosal damage, which is favorable. History shows vomiting relieves pain slightly, suggesting chronic gastric mucosal inflammation. Yan Hu Suo 15g, Jin Ling Zi 9g, Tu Chao Dang Shen (Earth-fried Codonopsis) 12g, Bai Mi (White Honey) 24g (dissolved), Xing Ren 24g, Ju Pi (Tangerine Peel) 6g, Chuan Jiao Mu 5g, Bai Su Zi (Perilla Seed) 12g (wrapped), Ban Xia 15g, Zhi Gan Cao 3g. [Commentary] This is a combination of Jin Ling Zi San, Da Jian Zhong Tang, and Er Chen Tang.
36. Female patient Chen. Main symptom epigastric pain, progressive emaciation raises suspicion of cancer; fortunately, pain slightly relieved after full meals, history of acid regurgitation suggests ulcerative pain. Self-reports pain worsens with labor, lightens with rest, yet neuralgia is also possible. Observing response to analgesics. Yan Hu Suo 15g, Xuan Fu Hua 12g (wrapped), Xiang Gan Song 6g, Chi Shi Zhi 6g (divided into 2 doses mixed in), Xing Ren Ni 24g, Jiu Xiang Chong 6g, Liu Zhou Zi (Abutilon Seed) 1.8g, Chen Xiang Yuan 9g.
[Commentary] Mr. Zhang considers post-prandial pain relief and history of acid regurgitation as indicative of ulcerative pain, while labor-induced worsening suggests neuralgia. Thus, the formula includes analgesic Qi-regulating herbs and astringent Chi Shi Zhi. Liu Zhou Zi dosage must be low to avoid toxicity; it strongly inhibits respiration and circulation. Toxicity symptoms include nausea, vomiting, diarrhea, bradycardia, hypotension, ataxia, dyspnea, potentially fatal respiratory arrest. Decoction dose generally 1.5–2g/day.
37. Female patient Chen. Causes of epigastric pain are numerous, primarily divided into active and passive. Active relates to gastric diseases like ulcers, gastritis, spasms; passive results from factors like hyperacidity, cold food, irritants. This case is active pain of neuralgic nature. Pao Fu Pian 5g, Yan Hu Suo 9g, Zhi Xiang Fu 9g, Dang Gui 9g, Xuan Fu Hua 9g (wrapped), Ci Wei Pi 5g, Suo Luo Zi 9g, Xiao Hui Xiang 6g, Fo Shou Pian 6g.
Second visit: Impending gastric pain preceded by back discomfort, akin to "Heart pain penetrating to back, back pain penetrating to heart" in *Jin Gui Yao Lue*. Likely neuralgia or gastric spasm. Xing Ren Ni 24g, Pao Fu Pian 9g, Xuan Fu Hua 9g (wrapped), Chi Shi Zhi 9g, Yan Hu Suo 15g, Xiang Gan Song 6g, Fo Shou 9g, Dang Gui 12g. [Commentary] "Heart pain penetrating to back..." indicates severe Cold coagulation. This formula is modified from *Jin Gui* Wu Tou Chi Shi Zhi Wan, aiming to expel Cold and relieve pain.
38. Male patient Wang. Acute gastritis with high fever and thick greasy coating. Treatment for Warm Disease failed; fever subsided but pain intensified, causing restlessness. Yesterday, Ding Tong Wan (Stop Pain Pill) was used urgently: Gypsum calcium protects inflamed gastric mucosa and sedates; Hydrocyanic acid in Apricot Seed analgesizes; Apricot Seed oil relaxes spasms; Coptis (Chuan Lian) is anti-inflammatory; others are cooling. Pain largely stopped after ingestion. Xing Ren 24g, Zhi Mu (Anemarrhena) 9g, Dan Zhu Ru (Bamboo Shavings) 5g, Tian Hua Fen (Trichosanthes Root) 12g, Yu Zhu 9g, Yin Hua (Honeysuckle) 12g, Sheng Shi Gao (Raw Gypsum) 12g (finely ground, taken orally). [Commentary] Initial high fever and thick greasy coating indicate Yangming Heat Excess. High fever with stomach pain warrants Gypsum and Apricot Seed for sedation and analgesia.
39. Male patient Le. Hypogastric pain, fluctuating severity, lasting half a year, asymptomatic for months in summer. Recent cold weather increases frequency. Complication: sour saliva, pain reduces after eating. Xuan Fu Hua 9g (wrapped), Yan Hu Suo 12g, Pao Fu Pian 5g, Quan Dang Gui 9g, Xing Ren Ni 15g, Chi Shi Zhi 6g (divided into 2 doses mixed in), Jiang Ban Xia 12g, Yun Ling 12g, Sheng/Shu Mi Ren (Coix Seed) 15g each, Huai Shan Yao (Chinese Yam) 9g, Dan Wu Yu (Evodia) 5g.
Second visit: Acid reduction alleviates hypogastric pain, confirming pain is acid-stimulated; root treatment lies in neutralizing acid. Duan Wa Leng Zi (Calcined Arca Shell) 30g, Chi Shi Zhi 9g (divided into 2 doses taken orally), Xuan Fu Hua 9g (wrapped), Quan Dang Gui 9g, Xing Ren Ni 18g, Yun Ling 12g, Jiang Ban Xia 9g, Rou Gui (Cinnamon Bark) powder 2.4g, Sheng/Shu Mi Ren 15g each, Chen Xiang Qu (Agarwood Fermented Pill) 9g. [Commentary] Chronic abdominal pain is typically Cold/Deficiency. Increased frequency in cold weather confirms this. Since pain is acid-stimulated, treatment focuses on acid neutralization; plus acrid-hot herbs like Cinnamon and Evodia to unblock Yang and relieve pain.
40. Male patient Hu. Cannot swallow large bites; large swallows cause choking pain in chest, followed by vomiting sticky phlegm, relief only after expectoration. Pathology lies in Stomach, not esophagus. Duan Wa Leng 15g, Wan Can Sha 12g, Bi Bo 9g, Sheng Ji Jin (Chicken Gizzard Lining) 12g, Ci Wei Pi 9g, Gu Ya and Mai Ya 12g each, Lu Dang Shen, Huai Shan Yao, Tai Wu Yao 9g each, Liang Fu Wan 15g. Ground fine, 1.5g per dose, 3 times daily.
[Commentary] Mr. Zhang locates pathology in the Stomach, supported by signs of Middle Yang decline: preference for warmth, aversion to cold, white coating, slow pulse. As stated in *Qi Xiao Liang Fang*: "Old stagnation and fixed masses, accumulated phlegm disturb Spleen/Stomach; weak Stomach cannot digest grain, leading to this syndrome." Choking pain requires tonification and unblocking; sticky phlegm requires warming herbs. Formula uses Codonopsis, Yam, Sprouts to tonify Middle and revive Stomach Qi; Liang Fu, Bi Bo, Wu Yao to warm and unblock deep Cold; Can Sha, Ji Jin to transform turbidity and aid transport; Wa Leng, Ci Wei Pi to nourish Stomach and stop pain. All guided by warming Middle and nourishing Stomach, requiring profound insight.
41. Female patient Liu. Subcardiac fullness, uncomfortable swallowing, caused by emotional frustration. Xie Bai Tou 12g, Mu Gua (Papaya) 9g, Da Chuan Xiong 6g, Gu Ya and Mai Ya 9g each, Zhi Xiang Fu 9g, Guang Ju Pi 6g, Sheng Zhi Ke (Immature Bitter Orange Peel) 9g, Shen Qu 9g, Fo Shou 9g. [Commentary] Liver Qi stagnation leads to rebellious Qi, causing Stomach disharmony and subcardiac fullness/uncomfortable swallowing. Formula aims to soothe Liver and harmonize/descend Stomach Qi. Xiang Fu + Chuan Xiong mimics Yue Ju Wan for resolving depression and soothing Liver; Papaya's sourness softens Liver; Xie Bai's acrid-slippery nature unblocks Stomach Yang; Zhi, Ju, Shen Qu, Sprouts, Fo Shou descend Qi and harmonize Stomach. Stomach benefits from free flow, so astringent herbs are avoided.
42. Female patient Yin. Chest oppression for 2 months; mood improvement alleviates symptoms, indicating Liver failure to course freely. Cu Chai Hu (Vinegar-processed Bupleurum) 9g, Xiang Gan Song 5g, Xuan Fu Hua 9g (wrapped), Bai Su Zi 9g (wrapped), Hang Bai Shao 9g, Pei Lan Geng (Eupatorium Stem) 9g, Guang Yu Jin 5g, Xiao Qing Pi 5g, Sheng Zhi Shi 9g, Zhi Hei Qian 6g, Zuo Jin Wan (Left Metal Pill) 2.4g (taken orally), Fo Shou 9g. Second visit: Initially emotional frustration, then Stomach/Intestine dysfunction, undigested food leading to diarrhea. Chest oppression persists all day. Zhi Chuan Po (Processed Magnolia Bark) 3g, Zhi Xiang Fu 9g, Sheng Cang Zhu (Atractylodes) 9g, Xie Bai Tou 18g, Guang Yu Jin 5g, Tai Wu Yao 6g, Da Chuan Xiong 9g, Shen Qu 15g, Shi Chang Pu (Acorus) 9g, Shang Rou Gui (Cinnamon Bark) 2g. Ground fine, 1.5g per dose. Third visit: Powder therapy greatly improved symptoms. Continue previous formula.
[Commentary] First visit used dispersing and descending agents. Second visit, seeing no change, switched to modified Yue Ju Wan. Added Xie Bai, Wu Yao, Chang Pu, Rou Gui (acrid-aromatics) to enhance GI function. Indeed, condition improved significantly after second visit. Shows that long-standing GI dysfunction from emotional frustration requires more than simple dispersing/descending agents. Clinical evidence supports this.
43. Male patient Zhu. Repeated digestive aids failed; chest still feels blocked. Fullness has Deficiency/Excess differentiation; thus Zhang Zhongjing used Ginseng for subcardiac fullness. Now imitating Si Mo Yin. Lu Dang Shen 9g, Jian Bing Lang (Areca Nut) 6g, Pei Lan Geng, Gu Ya, Mai Ya, Tai Wu Yao, Chen Xiang Qu (added late), Fo Shou, Fu Chao Zhi Shi (Wheat-bran fried Immature Bitter Orange) 9g each. Additionally: Take Xiang Sha Liu Jun Zi Wan or Xiang Sha Wei Ling Wan. Second visit: Initial stage involved GI obstruction. Repeated purging led to persistent subcardiac fullness and hypogastric dull pain. Fullness is functional dysfunction; pain is gas stimulation. Should follow method of awakening Stomach and transporting Spleen, avoiding further depletion to prevent "deficiency of deficiency" error. Tu Chao Lu Dang Shen 9g, Sheng Bai Zhu (Atractylodes Macrocephala) 9g, Tai Wu Yao 6g, Pao Fu Kuai 5g. Additionally: Chen Xiang 2.4g, Ji Nei Jin 6g, Wan Can Sha 9g, Peng E Zhu (Curcuma Zedoaria) 6g, ground fine, 1.5–3.0g per dose.