乳胸胁之下，结聚一块，胀实拒按，脐腹膈间不能下达，每戌亥子丑之时，胀不可当。因呕吐既已，可以用下，
凡大黄、芒硝、三棱、巴豆等，及萝卜子、朴硝及大蒜罨等法，毫不应，愈攻愈胀，（势所必然。）因疑其脾气受伤，
用补尤觉不便，（庸极。）汤水不入者二十余日，无计可施。只得用手揉按其处，觉肋下一点，按着痛连胸腹。
细为揣摩，正在章门穴。章门为脾之募，为脏之会，且乳下肋间正属虚里大络，乃胃气所出大路，而气实通于章
门。因悟其日轻夜重，本非有形之积，而按此连彼，则病在气分无疑。（犹属盲猜。）乃用神术散，令日服三四次，
兼用艾火灸章门十四壮，以逐散其结滞之胃气，（到底未知为肝病。）不三日胀果渐平，食乃渐进，始得保全。
（幸矣。）此其症治俱奇，诚所难测哉。
按∶张君生平于薛氏诸书，似未曾寓目，至胁痛由于肝脉为病，至死不知，良可哀也。此症之愈，全
在一灸，与呃逆病诸治不效，灸虚里立止正同。
黄古潭治一人，六月途行受热过劳，性且躁暴，忽左胁痛，皮肤上一片红如碗大，发水泡疮三五点，脉七
至而弦，夜重于昼。医作肝经郁火治，以黄连、青皮、香附、川芎、柴胡之类，进一服，其夜痛极且增热。次
早视之，皮肤上红大如盘，水泡疮又加至三十余粒，医教以水调白矾末敷，仍以前药加青黛、龙胆草进之，夜
痛更甚，胁中如钩摘之状。次早视之，红已半身，水泡增之百数，乃载以询黄，为订一方。以大栝蒌一枚，重
一二两者，连皮捣烂，加粉甘草二钱，红花五分，（雄按∶玉横之一贯煎，当是从此案悟出，而更加周到，可
谓青出于蓝矣。）进药少顷即得睡，比觉已不痛矣。盖病势已急，而时医执寻常泻肝正治之剂，又多苦寒，益
资其燥，故病转增剧。发水泡疮于外者，肝郁既久，不得发越，仍侮所不胜，故皮肤为之溃也。栝蒌味甘寒，
经云泄其肝者缓其中，且其为物柔而滑润，于郁不逆，甘缓润下，又如油之洗物，未尝不洁，此其所以奏功之
捷也欤。（同上。）
阐发栝蒌之功，此案为最，然犹未尽其蕴。
吴桥治陈泉，中年两胁极痛楚，冷汗淋漓，伏枕 ，呕逆绝勺饮者六日矣。桥诊之曰∶无伤，此蓄血尔。
家人曰∶固也，昔者呕血数升，即有蓄且尽矣。曰∶蓄未尽尔，尽则当瘥。日暮乃投补中行血一剂，饮之仅内
其半，中夜尸寝，家人升屋而号。桥曰∶再予之半，阳当回，故寝以需来复，复则败血行矣，第具人参汤待之。
鸡鸣而苏，大汗大吐大下，下则垂垂满器，如腐肝败 ，乃进参汤，大汗渐止。又七日乃复。初或问蓄血而
腹不鼓，何也？且昔呕血数升，其后何蓄之多也？曰∶病得之怒而伤肝，或以蹶而蓄血伤肝，则血不纳，蓄血
则道不通，犹之沟浍塞流，则新故皆壅矣，故多也。（《太函集》。）
汪云程年近七旬，患胸胁痛，转侧滋甚，寒热交作，喘咳烦躁，再信不能伏枕。医下之，病益深。桥诊
之，六脉浮滑大而搏指，曰∶病得之过饮，且下，故火上炎。以清凉一服而愈。（《太函集》。）
魏玉横曰∶范康侯年弱冠，患胁痛，已六七年，更医既屡，转益羸瘠，食少而气馁，言懒而神疲，稍远行
则心下怦怦然，遇劳则膈间如裂。就予诊，告以初时但腹胁痛，医与逍遥散，暂愈再发，再复不应矣。医投四
磨饮，亦暂愈再发，再投亦不应矣。又更医用五香散、越鞠丸，则愈而即发，自是腹中忽有块。再更医以为痞
积，进青皮、浓朴、五灵脂、延胡索之类，块益多，时隐时现，上下左右，约六七枚，如拳如掌，往来牵痛。
近有老医谓为虚也，用当归、白芍、香附、郁金之类，服之了无进退。予曰∶似君之疾，遍宇内矣，误治而毙
者，可胜道哉。盖古来方书，于此症殊无肯綮，无怪乎世之梦梦也。原其误人之始，只肝无补法四字，遂使千
万生灵，衔冤泉壤。或以疏散成劳，香燥成膈，或以攻伐成鼓，或以辛热成痈，其于变症，笔难尽述。幸子青
年，禀赋浓而未婚，故仅若此，否则不可言矣。今据脉已细数弦涩，脏气已亏，幸不数，且无咳嗽夜热，犹可
为也。第服余剂，只可希远效，而不可求近功耳。与生熟地、沙参、麦冬、杞子、枣仁等剂略安。至数十剂，
块渐减。遂以方为丸，服数年益就痊可。今已娶，第能樽节，庶无后患也。盖此症惟两仪膏最妙，然有力者始能用之。
方某年三十余，因析居 墙，胁痛，左胁下有块如 ，按之坚硬，食下则胀，痛甚不能侧卧，百治莫应，
枯瘁如柴矣。偶于药肆，遇人谓之曰∶此病惟淳佑桥魏某能治。因就诊。脉之弦且急，曰∶肝举症也。肝叶左
三右四，血足则润而下垂。今怒火伤阴，其叶燥硬，故举而不下也。经曰，肝病则迫胃逆咽。故左叶张，则支
腋而不可侧卧；右叶张，则侵脘而不能容食。昧者不知，投以香散，则如火上添油耳。与生熟地、沙参、麦冬、
蒌仁、米仁、杞子、川楝，十余剂，其病如失。
詹渭丰母年六十余，九月间疟后自汗，余已愈之。至十一月，胁痛大作，医以加味黑逍遥散治之，未为误
也。服一剂，至夜分忽晕厥欲脱。盖柴胡、白术，皆非阴虚火盛之人所宜进也。黎明急余治，脉之，两关俱伏，
两尺极微，足冷过膝，面如纸灰。云初起左胁痛，服药后忽移于右，遂发厥，厥虽止而痛剧，不可转侧，痛处
不可按。察其舌，燥硬如干荔，已危矣。姑与生熟地、杞子各五钱，沙参、麦冬各三钱，服下痛略减。前方加
倍，再入米仁五钱，蒌仁二钱，其痛乃复归左胁，能转动矣。仍服前方数剂而愈。余常治数贫人，感症后不能进
饮食，宛如百合病，脉之或弦或涩，按其胁或左或右，或有块无块，皆曰痛甚。检其方，诸燥药外，有服柴胡
至二三两者。察其舌，或中干，或枯燥，或紫赤，是皆诛伐太过，伤其肝肾之害也。悉以前方，相其伤之轻重，
为剂之大小，数服而愈。又赵氏子年十六，金氏女年十七，其家皆素封，病胁痛，服逍遥散皆五十余剂，病益
困。以前方去熟地与之，皆不服，乃更从香燥而殁。盖地黄、杞子，举世咸畏之如虎，缘本草谓地黄腻而杞子
热也，其杀人亦多矣。言医药者可不慎哉。
陈理堂母六旬外，久病胁痛，每发必伏枕经旬。医所与皆香附、郁金、青皮、木香、小茴、延胡索、五灵
脂、龙胆草之类，或配六郁，或偕左金而已。近发则腰背胀痛，呕逆便秘，口燥不眠，脉则两寸搏指，两关弦
而乏韵，此将成关格之候。投以滋水养肺金之剂，或入川楝，或入川连，只一二剂即愈。诫以多服，以杜其渐。
然性甚畏药，愈即止矣，关格之患，其将来乎。
此与膈症门胡氏妇病同。
黄锦芳治刘尚卿，右胁痛，咳嗽头痛，肝脉微起，右脉沉滑，而脾部有一小珠，嗽必努力，痰则清稀，上
有白沫，挑起如藕丝不断。用附子二钱，茯苓二钱，半夏二钱，故纸三分，木香五分，牛膝一钱，嘱其勿食腻
滞等物，俾水行痰消，气平而痛自止。病者问痰病自何而来？黄曰∶痰病甚多，五脏各有见症。在脾名湿痰，
其候脉缓，面黄，肢体沉重，嗜卧不厌，腹胀食滞，其痰滑而易出，宜二陈、六君之类治之；在肺名气痰，又
名燥痰，其候脉涩面白，气上喘，洒淅恶寒，悲愁不乐，其痰涩而难出，宜利膈清肺饮加减治之；在肝名风痰，
脉弦面青，肢胁满闷，便溺闭涩，时有躁怒，其痰青而多泡，宜十味导痰汤、千缗汤加减治之；在心名热痰，
脉洪面赤，烦热心痛，口干唇燥，时多喜笑，其痰坚而成块，宜凉膈散加苓、半治之；在肾名寒痰，脉沉面黑，
小便急痛，足寒而逆，心多恐怖，其痰有黑点而多稀，宜桂苓丸、八味丸加减治之。至论其本，则痰之化在脾，
而痰之本在肾。如火不生土者，即火不制水，阳不胜阴者，必水反侮土，是阴中之火衰也。火盛金燥，则精不
守舍，津液枯槁，则金水相残，是阴中之水衰也。寒痰湿痰，本脾家病，然必由于肾水之亏。木郁风生，本肝
家病，然必由于肾水之亏。火盛克金，其痰在肺，然必由于肾火之炽。今此症痰虽在胁、在胃、在脾，实因肾
火衰微而起，故用附子迅补真火以强土，苓、半以除脾湿，木香以疏滞气，牛膝引左气下行归肾，故纸引右气
下行归肾，气归则痰清矣。果数剂而愈。
在乳房与胸胁下方，结聚成一块肿块，感觉胀满坚实且拒绝按压，气机阻滞导致脐腹膈间之气无法下行。每到戌、亥、子、丑这四个时辰（晚上7点至凌晨3点），胀痛难以忍受。因为已经呕吐过，可以使用泻下法治疗。凡是使用大黄、芒硝、三棱、巴豆等药物，以及萝卜子、朴硝和大蒜外敷等方法，都毫无效果，越是攻伐，胀满越严重。（这是必然的趋势。）于是怀疑是脾气受损，但用补益药反而觉得更加不适。（庸医之极。）汤水无法入口二十多天，束手无策。只得用手揉按患处，感觉到肋下有一点，按压时疼痛牵连到胸腹部。仔细揣摩，痛点正好在章门穴。章门穴是脾的募穴，也是脏气的会穴，而且乳下肋间正是虚里大络所在，这是胃气运行的主要通道，而气实通于章门。由此领悟到，病症白天轻晚上重，本来就不是有形的积滞，而是按压此处则彼处痛，说明病在气分无疑。（这仍属于盲目猜测。）于是使用神术散，让患者每天服用三四次，同时用艾火灸章门穴十四壮，以驱散结滞的胃气。（终究不知道这是肝病。）不到三天，胀满果然逐渐平复，饮食才慢慢进补，这才得以保全性命。（真是幸运。）这个病例的症状和治疗都非常奇特，确实难以预测啊。
按语：张君生平似乎未曾阅读过薛氏的各种医书，直到死都不知道胁痛是由于肝脉病变引起的，实在令人悲哀。这个病例的痊愈，全在于艾灸，与呃逆病各种治疗无效时，艾灸虚里穴立刻停止发作的情况完全相同。
黄古潭治疗一个人，六月里在路上行走受热且过度劳累，性格又急躁暴戾，突然左胁部疼痛，皮肤上一片红肿如碗口大小，发出三五颗水泡疮，脉搏七至且弦，夜间比白天重。医生当作肝经郁火来治，用了黄连、青皮、香附、川芎、柴胡之类的药，服下一剂后，当晚疼痛加剧且发热增加。第二天早上查看，皮肤上的红肿扩大如盘子大小，水泡疮增加到三十多粒。医生建议用水调白矾末外敷，仍然用前药加入青黛、龙胆草内服，夜晚疼痛更厉害，胁中像被钩子摘取一样的剧痛。第二天早上查看，红肿已蔓延到半身，水泡增加到上百个，于是载着病人来询问黄古潭，黄古潭为他制定了一个方子。用大栝蒌一枚，重量一二两的，连皮捣烂，加入粉甘草二钱，红花五分，（雄按：玉横的一贯煎，应当是从这个病例悟出，并且更加周全，可以说是青出于蓝了。）服药不久即能入睡，醒来已经不痛了。大概病情已经很急迫，而当时的医生执着于寻常泻肝的正治药剂，又多属苦寒，更加助长了燥邪，所以病情反而加重。发水泡疮于体外，是因为肝郁日久，不得发散，反而克制其所不胜（肺金），所以皮肤为之溃烂。栝蒌味甘寒，经云“泄其肝者缓其中”，而且它质地柔滑滋润，对于郁结不违逆，甘缓润下，就像油洗东西一样，没有不干净的，这就是它奏效迅速的原因吧。（同上。）
阐发栝蒌的功效，这个病例最为透彻，然而还没有穷尽其深意。
吴桥治疗陈泉，中年时期两胁极度疼痛，冷汗淋漓，趴在枕头上呕吐逆气，绝食六天不能喝一口水。吴桥诊察后说：“不要紧，这是蓄血。”家人说：“确实如此，以前呕血几升，蓄血应该已经排尽了。”吴桥说：“蓄血未尽，如果尽的话病就该好了。”傍晚时投予补中行血的药剂，喝了不到一半，半夜像死人一样躺着，家人登上屋顶哭号。吴桥说：“再给他剩下的一半，阳气应当回复，所以让他睡觉等待来复，来复则败血运行，只需准备人参汤等着。”鸡鸣时分苏醒，大汗、大吐、大下，大便几乎装满容器，像腐烂的肝脏和败坏的肉，然后进服人参汤，大汗逐渐停止。又过了七天才恢复。起初有人问蓄血而腹部不鼓胀，为什么呢？况且以前呕血几升，为什么后来蓄血这么多呢？吴桥说：“病得之于愤怒伤肝，或者因跌倒导致蓄血伤肝，则血不能收纳，蓄血则通道不通，就像沟渠堵塞水流，新旧血液都壅塞在一起，所以积聚得多。”（《太函集》。）
汪云程年近七十岁，患胸胁痛，转身时加重，寒热交替发作，喘咳烦躁，再次信任医生不能伏枕休息。医生用泻下法，病情更深。吴桥诊察，六脉浮滑大而搏指，说：“病得之于过量饮酒，且经过泻下，所以火上炎。”用清凉药剂一服而愈。（《太函集》。）
魏玉横说：范康侯二十岁左右，患胁痛，已有六七年的时间，更换了很多医生，身体越来越瘦弱，吃得少且气息微弱，说话懒倦且精神疲惫，稍微远行则心下怦怦跳动，遇到劳累则膈间像撕裂一样。找我诊察，告诉我起初只是腹胁痛，医生给逍遥散，暂时好转又复发，再吃就不管用了。医生投四磨饮，也是暂时好转又复发，再投也不管用了。又换医生用五香散、越鞠丸，则是好了就立即复发，从此腹中忽然出现肿块。再换医生认为是痞积，进用青皮、厚朴、五灵脂、延胡索之类的药，肿块更多，时隐时现，上下左右约六七枚，像拳头像手掌，往来牵引疼痛。最近有位老医生说是虚证，用当归、白芍、香附、郁金之类的药，服用后毫无进退效果。我说：“像您的这种病，遍天下都是，误治而死的人，能说尽吗？”原来古来的方书，对于这个病症特别没有抓住关键，难怪世人迷迷糊糊。原本误人的开始，只因为“肝无补法”这四个字，致使千万生灵，含冤九泉。有的人因为疏散而成劳损，香燥而成膈证，有的人因为攻伐而成鼓胀，有的人因为辛热而成痈疽，那些变症，笔墨难以尽述。幸好您年轻，禀赋浓厚且未婚，所以仅仅这样，否则不可言说了。现在根据脉象已经细数弦涩，脏气已经亏损，幸好不急促，且没有咳嗽夜热，还可以治疗。只是服用我的药剂，只能希望远期疗效，而不能追求近期功效。给予生熟地、沙参、麦冬、枸杞、枣仁等药剂，略微安宁。到了几十剂，肿块逐渐减少。于是将方子制成丸药，服用几年后逐渐痊愈。现在已经娶妻，只要能够节制，或许就没有后患了。大概这个病症只有两仪膏最妙，然而有力气的人才能够使用它。
方某年三十多岁，因为分家分居墙壁旁，胁痛，左胁下有块状物像...，按压坚硬，进食后则胀满，疼痛剧烈不能侧卧，百治无效，枯瘦如柴。偶然在药店，遇到人对他说：“这个病只有淳佑桥的魏某人能治。”于是就诊。诊脉弦且急，说：“这是肝举症。肝叶左边三片右边四片，血足则润滑而下垂。现在怒火伤阴，肝叶干燥坚硬，所以举起而不下降。经云，肝病则逼迫胃气上逆咽喉。所以左叶张开，则支撑腋下而不能侧卧；右叶张开，则侵犯胃部而不能容纳食物。愚昧的人不知道，投以香散，就像火上浇油。给予生熟地、沙参、麦冬、栝蒌仁、薏苡仁、枸杞、川楝子，十几剂后，病像消失了一样。
詹渭丰的母亲六十多岁，九月间疟疾后自汗，我已经治愈了。到了十一月，胁痛大作，医生用加味黑逍遥散治疗，并没有错。服一剂后，到半夜忽然晕厥欲脱。大概柴胡、白术，都不是阴虚火盛之人所适宜进服的。黎明急忙让我诊治，诊脉，两关俱伏，两尺极微，脚冷过膝，面色如纸灰。说初起左胁痛，服药后忽然移到右胁，于是发生厥逆，厥逆虽然停止但疼痛剧烈，不能转动，疼痛处不可按压。观察她的舌头，干燥坚硬像干荔枝，已经危重了。暂且给予生熟地、枸杞各五钱，沙参、麦冬各三钱，服下后疼痛略微减轻。前方加倍，再加入薏苡仁五钱，栝蒌仁二钱，疼痛才重新回到左胁，能够转动了。仍然服用前方几剂而痊愈。我经常治疗几个穷人，感症后不能进食，宛如百合病，诊脉或弦或涩，按其胁部或左或右，或有块无块，都说疼痛剧烈。检查他们的处方，除了各种燥药外，有的服用柴胡达到二三两。观察他们的舌头，有的中间干燥，有的干枯，有的紫赤，这都是诛伐太过，伤害肝肾的危害。都用前方，根据伤害的轻重，决定剂量的大小，几服而愈。还有赵家的儿子十六岁，金家的女儿十七岁，他们家里都很有钱，患胁痛，服用逍遥散都五十多剂，病情更加困顿。用前方去掉熟地给他们，都不肯服用，于是改从香燥治疗而死。大概地黄、枸杞，举世都害怕它们像老虎一样，因为本草说地黄腻而枸杞热，这也杀死了很多人。谈论医药的人能不谨慎吗？
陈理堂的母亲六十多岁，久病胁痛，每次发作必须伏枕十天。医生给的皆是香附、郁金、青皮、木香、小茴、延胡索、五灵脂、龙胆草之类的药，或者是配伍六郁，或者是配合左金丸而已。最近发作则腰背胀痛，呕吐逆气便秘，口燥不眠，脉象则两寸搏指，两关弦而缺乏韵味，这将要形成关格的候象。投予滋水养肺金的药剂，或者加入川楝子，或者加入川黄连，只一二剂即愈。告诫要多服，以杜绝其渐长之势。然而她性格非常怕药，好了就停止了，关格的祸患，将来会有吗？
这与膈症门胡氏妇的病相同。
黄锦芳治疗刘尚卿，右胁痛，咳嗽头痛，肝脉微起，右脉沉滑，而脾部有一小珠，咳嗽时必须用力，痰则清稀，上面有白沫，挑起像藕丝不断。用附子二钱，茯苓二钱，半夏二钱，故纸三分，木香五分，牛膝一钱，嘱咐他不食用腻滞等物，使水行痰消，气平而痛自止。病人问痰病从何而来？黄锦芳说：“痰病很多，五脏各有见症。在脾名为湿痰，其候脉缓，面黄，肢体沉重，嗜睡不厌，腹胀食滞，其痰滑而易出，宜用二陈汤、六君子汤之类治疗；在肺名为气痰，又名燥痰，其候脉涩面白，气上喘，洒淅恶寒，悲愁不乐，其痰涩而难出，宜用利膈清肺饮加减治疗；在肝名为风痰，脉弦面青，肢胁满闷，便溺闭涩，时有躁怒，其痰青而多泡，宜用十味导痰汤、千缗汤加减治疗；在心名为热痰，脉洪面赤，烦热心痛，口干唇燥，时多喜笑，其痰坚而成块，宜用凉膈散加茯苓、半夏治疗；在肾名为寒痰，脉沉面黑，小便急痛，足寒而逆，心多恐怖，其痰有黑点而多稀，宜用桂苓丸、八味丸加减治疗。至于论其根本，则痰的化生在脾，而痰的根本在肾。如火不生土者，即火不制水，阳不胜阴者，必水反侮土，这是阴中之火衰也。火盛金燥，则精不守舍，津液枯槁，则金水相残，这是阴中之水衰也。寒痰湿痰，本是脾家病，然而必定由于肾水之亏。木郁风生，本是肝家病，然而必定由于肾水之亏。火盛克金，其痰在肺，然而必定由于肾火之炽。现在这个病例痰虽然在胁、在胃、在脾，实际上是因为肾火衰微而起，所以用附子迅速补真火以强土，苓、半以除脾湿，木香以疏滞气，牛膝引左气下行归肾，故纸引右气下行归肾，气归则痰清矣。果然几剂而愈。”
Below the breasts and chest/hypochondrium, a mass has condensed, feeling distended, solid, and refusing pressure. Qi in the umbilical abdomen and diaphragm cannot descend. Every hour of Xu (19:00-21:00), Hai (21:00-23:00), Zi (23:00-01:00), and Chou (01:00-03:00), the distension is unbearable. Since vomiting has occurred, purgation can be used. However, methods using Rhubarb (Rhei Radix et Rhizoma), Mirabilite (Natrii Sulfas), Samolus (Sanleng), Croton Seed (Crotonis Fructus), as well as Radish Seed (Raphani Semen), Mirabilite, and garlic poultices, all failed. The more one attacks, the more distended it becomes. (This is inevitable.) Suspecting that the Spleen Qi was injured, using tonification felt even more inconvenient. (Extremely mediocre.) For over twenty days, no soup or water could enter, leaving no options. One had to rub and press the area by hand, feeling a specific point under the ribs; pressing it caused pain radiating to the chest and abdomen. Carefully pondering, the point was exactly at Zhangmen (LR13). Zhangmen is the Front-Mu point of the Spleen and the Hui-Meeting point of the Zang organs. Moreover, the intercostal space below the breast belongs to the Xuli large collateral, which is the major pathway where Stomach Qi emerges, and Qi connects to Zhangmen. Thus, realizing that the symptoms being lighter during the day and heavier at night were not due to有形 (tangible) accumulation, but rather pressing one spot causing pain elsewhere indicated the disease was definitely in the Qi level. (This still belongs to blind guessing.) Therefore, Shen Shu San was used, administered three to four times a day, combined with moxibustion on Zhangmen for fourteen moxa cones, to disperse the stagnant Stomach Qi. (Ultimately, it was unknown that this was a Liver disease.) Within three days, the distension gradually subsided, food intake slowly improved, and life was preserved. (How fortunate.) This case's symptoms and treatment were both extraordinary and truly unpredictable.
Commentary: Mr. Zhang seemed never to have read the various medical books of Dr. Xue. Until his death, he did not know that hypochondriac pain was caused by a disorder of the Liver meridian, which is truly pitiable. The cure of this case relied entirely on moxibustion, similar to cases of hiccups where other treatments fail, and moxibustion on Xuli immediately stops the symptom.
Dr. Huang Gutang treated a patient who, in June, walked in the heat and overexerted himself. His temperament was irritable and violent. Suddenly, he experienced left-sided hypochondriac pain. A patch of redness on the skin, about the size of a bowl, appeared, along with three to five blister-like sores. The pulse was rapid (seven beats per breath) and wiry, with symptoms worsening at night compared to the day. The physician treated it as Liver meridian constrained Fire, prescribing Coptis (Coptidis Rhizoma), Tangerine Peel (Citri Reticulatae Pericarpium), Cyperus (Cyperī Rhizoma), Ligusticum (Chuanxiong Rhizoma), and Bupleurum (Bupleuri Radix). After one dose, the pain intensified and fever increased that night. The next morning, the redness expanded to the size of a plate, and the blisters increased to over thirty. The doctor advised applying Alum powder mixed with water externally and continuing the previous prescription with added Indigo Naturalis (Indigotidis Folium) and Gentian (Gentianae Radix). That night, the pain became worse, feeling like hooks tearing the hypochondrium. The next morning, the redness covered half the body, and blisters numbered over a hundred. He was brought to consult Huang, who prescribed a formula: one large Trichosanthes Fruit (Trichosanthis Fructus), weighing one to two taels, smashed with the peel, added with Licorice Root (Gancao) 2 qian and Safflower (Honghua) 0.5 qian. (Note by Xiong: Yuheng's Yi Guan Jian was likely inspired by this case, becoming more comprehensive, truly surpassing the original.) Shortly after taking the medicine, he slept, and upon waking, the pain was gone. The disease progression was urgent, but contemporary physicians stuck to standard Liver-draining agents, mostly bitter-cold, which further exacerbated dryness, causing the condition to worsen. The appearance of blisters on the exterior indicated that long-standing Liver constraint could not vent out, instead insulting the element it cannot overcome (Metal/Lungs), causing skin ulceration. Trichosanthes is sweet and cold. The Classic states, "To drain the Liver, soothe the center." Its nature is soft, slippery, and moistening, not opposing constraint. Sweet-soothing and moistening-descending is like oil washing things, ensuring cleanliness. This explains its swift efficacy. (Ibid.)
This case best elucidates the efficacy of Trichosanthes, yet does not exhaust its potential.
Wu Qiao treated Chen Quan, who in middle age suffered extreme pain in both hypochondria, with cold sweat pouring down, lying on his pillow with retching, unable to drink anything for six days. Wu Qiao diagnosed: "No injury, this is Blood Stasis." The family said: "Indeed, he vomited several sheng of blood before, so the stasis should be exhausted." Wu Qiao replied: "The stasis is not exhausted. If it were exhausted, the illness would heal." In the evening, a formula to tonify the Middle and move blood was given. He drank only half. By midnight, he lay motionless like a corpse, and the family climbed onto the roof wailing. Wu Qiao said: "Give him the remaining half. Yang will return. Let him sleep to await recovery. When recovery comes, the stale blood will move. Prepare Ginseng Decoction to wait." At cockcrow, he woke up, experiencing profuse sweating, vomiting, and diarrhea. The stool nearly filled the vessel, resembling rotten liver and decaying flesh. Then, Ginseng Decoction was administered, and the sweating gradually stopped. Seven days later, he recovered. Initially, someone asked: Why is the abdomen not distended in Blood Stasis? And since he vomited several sheng of blood before, why is there so much stasis now? Wu Qiao said: "The disease resulted from anger injuring the Liver, or from falling causing stasis to injure the Liver. Then blood is not retained, and stasis blocks the pathways. It is like a ditch blocked; old and new flow are both congested, hence the abundance." (Tai Han Ji.)
Wang Yun Cheng, near seventy years old, suffered from chest and hypochondriac pain, worsening with turning, alternating chills and fever, panting, coughing, and irritability, unable to rest his head on the pillow again. Physicians purged him, deepening the illness. Wu Qiao diagnosed: Six pulses were floating, slippery, large, and beating against the finger. He said: "The disease resulted from excessive drinking and subsequent purging, causing Fire to flare upward." One dose of a cooling agent cured him. (Tai Han Ji.)
Wei Yuheng stated: Fan Kanghou, in his early twenties, suffered from hypochondriac pain for six or seven years. He saw many doctors, becoming increasingly emaciated, eating little, with weak Qi, lazy speech, and fatigue. Slight travel caused palpitations in the epigastrium, and exertion caused tearing pain in the diaphragm. Upon consulting me, he reported initial abdominal and hypochondriac pain. Doctors gave Xiao Yao San, which provided temporary relief followed by recurrence, then became ineffective. Si Mo Yin was tried, also providing temporary relief then failing. Wu Xiang San and Yue Ju Wan were tried, resulting in immediate recurrence upon healing, and suddenly masses appeared in the abdomen. Other doctors diagnosed Pi Accumulation, prescribing Tangerine Peel, Magnolia Bark, Trogopterus Dung, and Corydalis. The masses increased, appearing and disappearing, moving up, down, left, and right, about six or seven, fist- or palm-sized, causing pulling pain. Recently, an old doctor diagnosed deficiency, prescribing Angelica Sinensis, White Peony Root, Cyperus, and Curcuma. There was no improvement. I said: "Your condition is common throughout the land. How many have died due to misdiagnosis? Ancient formularies lack key insights for this condition, no wonder people are confused. The root of error lies in the phrase 'Liver has no tonification method,' causing millions to die unjustly. Some become consumptive from dispersing, develop obstruction from aromatic-drying herbs, suffer drum-distension from attacking/purging, or develop abscesses from acrid-hot herbs. The variations are too numerous to record. Fortunately, you are young, have strong constitution, and are unmarried, so it is only this severe. Otherwise, it would be unspeakable. Your pulse is currently fine, rapid, wiry, and choppy. Organ Qi is depleted. Fortunately, it is not rapid, and there is no cough or night fever, so it is treatable. My prescriptions aim for long-term effect, not quick results. Given Raw/Cooked Rehmannia, Glehnia, Ophiopogon, Goji Berry, and Jujube Seed, he stabilized. After dozens of doses, masses decreased. The formula was made into pills, taken for years until full recovery. He is now married; if he exercises moderation, there may be no future trouble. Only Liang Yi Gao is most excellent for this condition, but requires sufficient resources to use."
Mr. Fang, over thirty, lived separately near a wall, suffering hypochondriac pain. A mass like [missing character] existed under the left hypochondrium, hard to touch, causing distension after eating and severe pain preventing side-lying. Hundred treatments failed; he was withered like firewood.偶然ly at a pharmacy, someone told him: "Only Wei Mou of Chunyou Bridge can cure this." He consulted. Pulse was wiry and urgent. I said: "This is Liver Rising Syndrome. The Liver has three lobes on the left and four on the right. When blood is sufficient, it is moist and hangs down. Now, Fire anger injures Yin, making the lobes dry and hard, thus rising and not descending. The Classic says, 'Liver disease forces Stomach Qi to rebel upwards.' So, left lobe expansion supports the axilla, preventing side-lying; right lobe expansion invades the epigastrium, preventing food intake. Ignorant doctors prescribe aromatic dispersants, adding fuel to the fire. Prescribed Raw/Cooked Rehmannia, Glehnia, Ophiopogon, Trichosanthes Seed, Coix Seed, Goji Berry, and Toosendan Fruit. Over ten doses, the disease vanished."
Mrs. Zhan Weifeng, over sixty, had spontaneous sweating after malaria in September, which I cured. In November, severe hypochondriac pain erupted. Doctors used Modified Black Xiao Yao San, which was not wrong. After one dose, she fainted near death at midnight. Bupleurum and Atractylodes Macrocephala are not suitable for those with Yin deficiency and flourishing Fire. At dawn, I was urgently consulted. Pulses at both Guan positions were hidden; Chi positions were extremely faint. Feet were cold above the knees. Face was like ash paper. She said initial left hypochondriac pain shifted to the right after medication, causing syncope. Though syncope ceased, pain was severe, preventing movement, and the painful area was tender to touch. Tongue was dry, hard, like dried lychee. Critical. Temporarily prescribed Raw/Cooked Rehmannia and Goji Berry 5 qian each, Glehnia and Ophiopogon 3 qian each. Pain slightly reduced. Doubling the previous formula, adding Coix Seed 5 qian and Trichosanthes Seed 2 qian, pain returned to the left hypochondrium, allowing movement. Continued previous formula for several doses until cured. I often treat poor patients who, after febrile diseases, cannot eat, resembling Bai He Bing. Pulses are wiry or choppy. Hypochondriac tenderness varies left/right, with or without masses, all reporting severe pain. Checking their prescriptions, besides various drying herbs, some took Bupleurum up to 2-3 liang. Tongues were dry in the center, parched, or purple-red. These are harms from excessive purgation/injury to Liver and Kidney. Using the previous formula, adjusting dosage based on severity, they cured in a few doses. Also, Zhao's son (16) and Jin's daughter (17), from wealthy families, suffered hypochondriac pain. Taking Xiao Yao San for over fifty doses worsened their condition. Giving the previous formula minus Cooked Rehmannia, they refused, switched to aromatic-drying herbs, and died. Globally, people fear Rehmannia and Goji Berry like tigers because Materia Medica says Rehmannia is cloying and Goji is hot. This has killed many. Those discussing medicine must be cautious.
Mother of Chen Litang, over sixty, suffered chronic hypochondriac pain, requiring her to lie face down for weeks when flaring. Doctors prescribed Cyperus, Curcuma, Tangerine Peel, Aucklandia, Fennel, Corydalis, Trogopterus Dung, and Gentian. Sometimes combined with Liu Yu formula or Zuo Jin Wan. Recent flare-ups caused back/waist distension, retching, constipation, dry mouth, insomnia. Pulses: Cun positions beat against fingers; Guan positions were wiry lacking resonance. Approaching Guan Ge syndrome. Prescribed fluids-nourishing and Lung-metal-supporting agents, sometimes adding Toosendan Fruit or Coptis. Cured in one or two doses. Advised continued use to prevent recurrence. However, she feared medicine and stopped when cured. Will Guan Ge occur in the future?
This is identical to the case of Mrs. Hu in the Ge Syndrome section.
Huang Jinfang treated Liu Shangqing, with right hypochondriac pain, cough, headache. Liver pulse slightly raised; Right pulse sinking and slippery; a small nodule felt in the Spleen area. Cough required effort; sputum was clear/thin with white foam, stretching like lotus root threads. Prescribed Aconite 2 qian, Poria 2 qian, Pinellia 2 qian, Psoralea 0.3 fen, Aucklandia 0.5 fen, Achyranthes 1 qian. Advised avoiding cloying/greasy foods to promote water metabolism, resolve phlegm, calm Qi, and stop pain. Patient asked origin of phlegm. Huang said: "Phlegm diseases are numerous, presenting differently by organ. In Spleen: Wet Phlegm. Signs: slow pulse, yellow face, heavy limbs, lethargy, abdominal distension, food stagnation. Sputum is slippery/easy to expectorate. Treat with Er Chen Tang or Liu Jun Zi Tang. In Lung: Qi Phlegm (Dry Phlegm). Signs: choppy pulse, pale face, asthma, aversion to cold, sorrow. Sputum is sticky/hard to expectorate. Treat with Li Ge Qing Fei Yin modified. In Liver: Wind Phlegm. Signs: wiry pulse, green face, chest/flank fullness, urinary/fecal retention, irritability. Sputum is blue/bubbly. Treat with Shi Wei Dao Tan Tang or Qian Min Tang modified. In Heart: Heat Phlegm. Signs: surging pulse, red face, irritability, heart pain, dry mouth/lips, frequent laughter. Sputum is hard/clumped. Treat with Liang Ge San plus Poria/Pinellia. In Kidney: Cold Phlegm. Signs: sinking pulse, black face, painful urination, cold feet, fear. Sputum has black spots/is thin. Treat with Gui Ling Wan or Ba Wei Wan. Fundamentally, Phlegm transforms in the Spleen but originates in the Kidney. If Fire fails to generate Earth, Water is unchecked, Yin overcomes Yang—this is deficiency of Fire within Yin. If Fire flourishes and Metal dries, Essence does not reside, Fluids wither, Metal and Water harm each other—this is deficiency of Water within Yin. Cold/Wet Phlegm is a Spleen disease but stems from Kidney Water deficiency. Wood constraint generating Wind is a Liver disease but stems from Kidney Water deficiency. Fire flourishing overcoming Metal causes Lung phlegm but stems from Kidney Fire excess. In this case, although phlegm is in the hypochondrium, Stomach, and Spleen, it actually arises from Kidney Fire deficiency. Thus, Aconite rapidly tonifies True Fire to strengthen Earth; Poria/Pinellia remove Spleen dampness; Aucklandia moves stagnant Qi; Achyranthes guides Left Qi down to Kidney; Psoralea guides Right Qi down to Kidney. When Qi returns, phlegm clears. Indeed, cured in a few doses."