遗风庞 便痢未除,脉弦急,气不和,舌浓黄滑,潮热。姑宜清暑和中。(八月十四号
戊申初三日。)
焦六曲(四钱) 青蒿子(钱半) 大腹皮(三钱) 藿香梗(二钱) 六一散(三钱) 扁豆衣
(三钱) 省头草(二钱) 通草(钱半) 川朴(一钱) 炒麦芽(三钱) 仙半夏(钱半)
清煎三帖。
介按∶暑湿痢由于湿热郁滞肠胃,每至午后潮热,治以清暑渗湿,最为适当。
后马周 肠 久累,脉弦,舌滑,头晕而疼。宜黄连阿胶汤治之。(二月十二日。)
炒川连(八分) 炒白芍(钱半) 白头翁(钱半) 北秦皮(钱半) 赤茯苓(四钱) 枳壳(
钱半)
青木香(八分) 草决明(三钱,即青葙子) 炒驴胶(钱半) 荆芥炭(钱半) 通草(钱半)
(引)荷叶(一角)
一帖。
介按∶古之所谓肠 下血,即今之所谓赤痢也。兹以热入厥阴而为下痢,肝阳上越而为
头晕,治以黄连阿胶合白头翁汤,借清肝热而滋阴。
某 休息下痢,脉弦濡,跗浮脘闷,此湿热蕴蓄,宜和中清利。(三月十七日。)
秦艽(钱半) 藿梗(二钱) 炒枳壳(钱半) 猪苓(钱半) 浓朴(一钱) 原滑石(四钱)
青木香(七分) 泽泻(三钱) 大腹皮(三钱) 冬瓜皮(三钱) 新会皮(钱半)
清煎三帖。
又 休息下痢,圊而不爽,脉涩滞,胃钝,湿热犹存,舌微白。宜和中清利(三月二十
日。)
藿梗(二钱) 左金丸(八分) 川楝子(三钱) 大腹皮(三钱) 滑石(四钱) 炒枳壳(钱
半) 赤苓(三钱) 石莲子(三钱) 浓朴(一钱) 广木香(七分) 新会皮(钱半)
清煎三帖。
介按∶休息痢疾,多由病患贪食油腻,或由医者早投滋阴,以致湿热留恋,滞而不去。
兹因
湿热久蓄,伤及脾脏中气,中气一伤,则脾不能为胃行其津液,津液郁滞,则不能下润于大
肠,所以圊而不爽。初方从藿朴胃苓汤加减,次则参用平肝和胃。此后尚须参用补气之品,
庶奏桴鼓之应。
患者庞某,痢疾尚未痊愈,脉象弦而急,气机不调,舌苔浓黄且滑腻,伴有午后潮热。暂宜采用清解暑邪、调和脾胃的方法。(八月十四日,农历戊申年三月初三。)
处方:焦六曲(四钱)、青蒿子(一钱半)、大腹皮(三钱)、藿香梗(二钱)、六一散(三钱)、扁豆衣(三钱)、省头草(二钱)、通草(一钱半)、川朴(一钱)、炒麦芽(三钱)、仙半夏(一钱半)。
清水煎服,共三帖。
邵介按语:暑湿痢是由于湿热之邪郁滞于肠胃所致,常表现为午后潮热,治疗以清解暑邪、渗利湿气最为适宜。
患者马某,患有肠风久病,脉象弦,舌苔滑,头晕且疼痛。宜用黄连阿胶汤治疗。(二月十二日。)
处方:炒川连(八分)、炒白芍(一钱半)、白头翁(一钱半)、北秦皮(一钱半)、赤茯苓(四钱)、枳壳(一钱半)、青木香(八分)、草决明(三钱,即青葙子)、炒驴胶(一钱半)、荆芥炭(一钱半)、通草(一钱半,作为药引)、荷叶一角。
一帖。
邵介按语:古代所说的“肠风下血”,就是现在所说的赤痢。此处因热邪深入厥阴经导致下痢,肝阳上越导致头晕,治疗采用黄连阿胶汤合白头翁汤,借以清泻肝热并滋养阴液。
某患者,患休息痢,脉象弦而濡软,足背浮肿,胃脘部闷胀,此为湿热蕴结蓄积,宜采用调和中焦、清利湿热的治法。(三月十七日。)
处方:秦艽(一钱半)、藿梗(二钱)、炒枳壳(一钱半)、猪苓(一钱半)、浓朴(一钱)、原滑石(四钱)、青木香(七分)、泽泻(三钱)、大腹皮(三钱)、冬瓜皮(三钱)、新会皮(一钱半)。
清水煎服,共三帖。
复诊:休息痢,排便不畅,脉象涩滞,胃气呆钝,湿热依然存在,舌苔微白。宜采用调和中焦、清利湿热的方法。(三月二十日。)
处方:藿梗(二钱)、左金丸(八分)、川楝子(三钱)、大腹皮(三钱)、滑石(四钱)、炒枳壳(一钱半)、赤茯苓(三钱)、石莲子(三钱)、浓朴(一钱)、广木香(七分)、新会皮(一钱半)。
清水煎服,共三帖。
邵介按语:休息痢多由患者贪食油腻食物,或由医生过早使用滋阴药物,导致湿热留恋不去,阻滞体内所致。此次因湿热长期蓄积,损伤了脾脏的中气,中气一旦受损,脾就不能为胃传输津液,津液郁滞,就无法向下滋润大肠,所以出现排便不爽的症状。初诊方剂从藿朴胃苓汤加减而来,次诊则参用了平肝和胃的方法。此后还需参用补气类药物,才能取得如击鼓应声般迅速显著的疗效。
Patient Pang: Dysentery has not yet resolved; the pulse is wiry and rapid, qi mechanism is disharmonious, tongue coating is thick yellow and slippery, with tidal fever. Tentatively suitable to clear summerheat and harmonize the middle jiao. (August 14th, Lunar Calendar: Year of Wushen, 3rd day of the 3rd month.)
Prescription: Jiaoliuqu (Scorched Medicated Leaven) (4 qian), Qinghaozi (Artemisiae Annuae Fructus) (1.5 qian), Dafupi (Arecae Pericarpium) (3 qian), Huoxianggeng (Agastaches Rhizoma et Radix) (2 qian), Liuyisan (Six-to-One Powder) (3 qian), Biandouyi (Dolichoris Semen Testa) (3 qian), Shengtoucao (Perillae Folium) (2 qian), Tongcao (Tetrapanacis Medulla) (1.5 qian), Chuanpu (Magnoliae Officinalis Cortex) (1 qian), Chao Maiya (Fomentari Fructus Germinatus) (3 qian), Xian Banxia (Pinelliae Rhizoma Praeparatum) (1.5 qian).
Decoct in water, three doses.
Commentary by Shao Jie: Summerheat-damp dysentery arises from damp-heat stagnating in the intestines and stomach, often presenting with afternoon tidal fever. Treatment with clearing summerheat and leaching out dampness is most appropriate.
Patient Ma: Chronic intestinal wind disease, pulse is wiry, tongue coating is slippery, dizziness accompanied by pain. Suitable to treat with Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction). (February 12th.)
Prescription: Chao Chuanlian (Stir-fried Coptidis Rhizoma) (8 fen), Chao Baishao (Stir-fried Paeoniae Radix Alba) (1.5 qian), Baitouweng (Pulsatillae Radix) (1.5 qian), Bei Qinpi (Fraxini Cortex) (1.5 qian), Chi Fuling (Poria with Red Hostwood) (4 qian), Zhiqiao (Aurantii Fructus) (1.5 qian), Qingmuxiang (Illicijii Fructus Aromaticus) (8 fen), Caojueming (Semen Cassiae, i.e., Qiangxiangzi) (3 qian), Chao Lujiao (Stir-fried Asini Corii Colla) (1.5 qian), Jingjie Tan (Carbized Schizonepetae Spica) (1.5 qian), Tongcai (Tetrapanacis Medulla) (1.5 qian, as guide herb), Heluye (Nelumbinis Folium) one corner.
One dose.
Commentary by Shao Jie: What ancient texts refer to as "intestinal wind with blood discharge" corresponds to what is now called red dysentery. Here, heat enters the Jueyin meridian causing dysentery, and Liver Yang floats upward causing dizziness. Treatment employs a combination of Huanglian Ejiao Tang and Baitouweng Tang to clear Liver heat and nourish Yin.
Certain patient: Resting dysentery, pulse is wiry and soggy, dorsum of foot is swollen, epigastric stuffiness. This indicates damp-heat accumulation and storage; suitable to harmonize the middle and clear/drain damp-heat. (March 17th.)
Prescription: Qinjiao (Gentianae Radix) (1.5 qian), Huogeng (Zingiberis Rhizoma Recens) (2 qian), Chao Zhiqiao (Stir-fried Aurantii Fructus) (1.5 qian), Zhuling (Polyporus) (1.5 qian), Nongpu (Magnoliae Officinalis Cortex) (1 qian), Yuanshishi (Raw Talcum) (4 qian), Qingmuxiang (Illicijii Fructus Aromaticus) (7 fen), Zexie (Alismatis Rhizoma) (3 qian), Dafupi (Arecae Pericarpium) (3 qian), Dongguapi (Benincasae Exocarpium) (3 qian), Xinhuiqi (Citri Reticulatae Pericarpium) (1.5 qian).
Decoct in water, three doses.
Follow-up: Resting dysentery, defecation is unsatisfactory, pulse is choppy and stagnant, stomach qi is dull/stagnant, damp-heat still remains, tongue coating is slightly white. Suitable to harmonize the middle and clear/drain damp-heat. (March 20th.)
Prescription: Huogeng (Zingiberis Rhizoma Recens) (2 qian), Zuojin Wan (Left Metal Pill) (8 fen), Chuanlianzi (Toosendan Fructus) (3 qian), Dafupi (Arecae Pericarpium) (3 qian), Shishi (Talcum) (4 qian), Chao Zhiqiao (Stir-fried Aurantii Fructus) (1.5 qian), Chi Ling (Poria with Red Hostwood) (3 qian), Shilianzi (Nelumbinis Nuciferae Semen) (3 qian), Nongpu (Magnoliae Officinalis Cortex) (1 qian), Guangmuxiang (Aucklandiae Radix) (7 fen), Xinhuiqi (Citri Reticulatae Pericarpium) (1.5 qian).
Decoct in water, three doses.
Commentary by Shao Jie: Resting dysentery often results from patients overindulging in greasy foods, or from physicians administering yin-nourishing herbs too early, causing damp-heat to linger and remain stagnant. In this case, long-standing damp-heat accumulation has damaged the Middle Qi of the Spleen. Once Middle Qi is injured, the Spleen cannot transport fluids for the Stomach; fluid stagnation prevents downward moistening of the Large Intestine, hence the unsatisfactory defecation. The initial prescription was modified from Huopo Weiling Tang (Agastache and Magnolia Bark and Poria Decoction); the second visit incorporated methods to soothe the Liver and harmonize the Stomach. Subsequently, Qi-tonifying herbs should be included to achieve rapid and effective results (like a drumstick striking a drum).