倪左 诊脉左尺沉濡，寸关弦滑而数，右寸郁涩，
右关软滑，舌质红，苔淡白。此乃少阴水亏，水不涵木，厥阳独亢，引动中焦素蕴之痰浊，上蒙清窍，堵塞神明
出入之路，上焦清旷之所，遂成云雾之乡，是以神机不灵，或不语而类癫，或多言而类狂，经所谓重阴则癫，
重阳则狂是也。重阳者，乃风乘火势，火藉风威，则痰悉变为火，故云重阳。重阴者，乃火渐衰而痰浊弥漫，类
乎阴象，究非真阴可比。据述大便通则神识稍清，胃络通于心包，胃浊下降，痰亦随之而下也。小溲短少而
黄，气化不及州都也。恙久根深，非易速功，拙拟滋肺肾以柔肝木，涤痰浊而清神智，冀水升火降，阴平阳秘，
则肺金有输布之权，痰浊有下降之路，伏匿虽深，可望其整肃耳。
北沙参（三钱） 全栝蒌（四钱） 朱茯神（三钱） 鲜竹茹（一钱五分） 枳壳（一钱，同炒） 川贝母（八钱）
珍珠母（八钱） 酒炒黄连（三分） 生甘草（四分） 仙半夏（三钱） 青龙齿（三钱） 酒炒木通（七分）
远志（一钱） 鲜石菖蒲（七分） 保心丹（开水吞服，三分）
二诊 心为君主之官，神明出焉；肝为将军之官，谋虑出焉；脾为谏议之官，思想出焉。曲运神机，劳伤
乎心；谋虑过度，劳伤乎肝；持筹握算，劳伤乎脾。心肝之阴已伤，暗吸肾阴，水不涵木，厥阴独亢，脾弱不能为
胃行其津液，水谷之湿生痰。阳升于上，痰浊随之，蒙蔽清窍，堵塞神机，神呆不语，类乎癫也，时或多言，类
乎狂也。前哲云，阴并于阳则狂，阳并于阴则癫，癫则如醉如痴，皆由顽痰积热，阻于上中二焦，神明无出入
之路。夫痰为火之标，火为痰之本，痰得热而色应黄，今反白而粘腻者何也？盖肺津不能输布，聚液为痰，津
液之痰，与湿浊之痰，互结为援，肺色属白，故痰色白而粘也。腑气五日不行，痰浊不得下达也；小溲短少而黄，
肺为水之上源，源不清则流不洁也。脉尺部沉濡，左寸关弦滑而数依然如昨，右部寸涩关滑，舌质红，苔薄黄，
本虚标实，显然可见，况素有肢麻腿足无力等症，非本虚之明证乎；今脉数便秘，非标实之明证乎。治本宜
补，治标宜攻，颇有顾此失彼之虑。进药后尚属平平，兹拟七分攻三分补，祛其顽痰，存其津液，俾腑气通则
顽痰可以下降，阴液存则浮火不致上扰，窃恐根株已深，难图近功耳。
北沙参（四钱） 生甘草（五分） 陈胆星（八分） 生石决（八钱） 玄参（一钱五分） 小生地（四钱）
仙半夏（三钱） 天竺黄（一钱五分） 川贝母（八钱） 炙远志（一钱） 鲜竹茹（一钱五分）
枳壳（一钱，同捣） 保心丹（三分） 礞石滚痰丸（包煎，三钱） 九节石菖蒲（八分） 淡竹油（一两）
生姜汁（一二滴，二味同冲）
三诊 昨进祛痰浊，养津液，系养正攻邪，增水行舟之意。脉寸略小，右关脉流利，余部平平。腑气得
通，痰浊虽有下行之势，惟顽痰郁闭心包，依然不化。痰而曰顽，是梗而不化也。譬如盗贼焉，伏匿深藏，扰乱
莫测，搜逐甚艰，苟欲直捣巢穴，绝其种类，当初病时，正气尚充，不妨出偏师以制胜，荡然整肃。尊恙之来，
由乎谋虑过度，深思气结，心神过用，暗吸肾阴，坎水亏于下，坤土困于中，脾不能为胃行其津液，致所入水谷，
不能化生精液，悉变为痰。涎渍于肺则咳嗽，沃于心包则神呆，蔽障神明，灵机堵塞，始而语无次序，继则默默
不言，其来也渐，其去也亦不易。夫寇不除，则党类日众；病不去，则枝节横生。张石顽先生曰∶癫症既久，面
色萎黄，时多疑惑，或吐白沫，默默不言，虫积为患。审色辨证，有类乎是。为今之计，拟十味温胆汤，扶正涤
痰为君；以妙功丸，杀其虫积为佐；以秘方甘遂丸，搜内窜之痰涎，驱痰下降为使。犹兵家深沟高垒，先立于不
败之地，而后出奇兵以制敌也。然乎否乎？请质高明！
北沙参（四钱） 姜半夏（三钱） 川贝母（八钱） 炙远志（五分） 小生地（四钱） 枳实炭（五分）
陈胆星（八分） 竹油（冲，一两） 生草（六分） 炒竹茹（五钱） 天竺黄（三钱） 生姜汁（冲，一二滴）
妙功丸方
丁香 木香 沉香（各五分） 乳香（研） 麝香（另研） 熊胆（各二分五厘） 白丁香（三十粒，即雄雀屎，
但直者为雌屎） 鹤虱（即天名精子，勿误胡萝菔子） 陈皮（去白，各一钱） 轻粉（四分五厘） 大黄（酒
浸，一钱五分） 赤小豆（三十粒，即杜赤豆，择其细者，勿误认半赤半黑者名相思子也） 巴豆（一粒，去皮，
研压去油净） 朱砂（一钱，水飞，一半为衣）
鄙意加制黄精（三钱）、明天冬（三钱），烘燥研入，以监制其香燥，而助杀虫之用。
上药为末，荞麦粉三钱作糊为丸，每丸约重一钱，朱砂为衣，阴干，间日服一粒，温水浸一宿，去水，
再用温水化开，空心服之。
治癫症秘方甘遂丸
甘遂二钱为末，以猪心管血和药入心内缚定，湿纸
裹煨熟取药，用辰砂末（一钱），分四丸，每服一丸，以猪心煎汤下，大便利下恶物为效，未下，再服一丸。如下后，
缓一二日再服。
此方治验多人，惟心虚怔忡、脾虚便溏者，不可服。
李左 肾阴不足，心肝之火有余，此离坎不交之象也。痰热蒙蔽清窍，神不守舍，舍空而痰热踞之，痰火
上炎，如彻夜不寐；痰蒙心则多疑，时闻申申之詈。脉弦滑带数。治宜益肾阴，清心火，助入安神涤痰之品。
大麦冬（二钱） 朱茯神（三钱） 石决（一两） 淡竹油（冲，一两） 川雅连（四分） 炙远志肉（一钱）
生甘草（五分） 金器（入煎，一具） 细木通（八分） 紫贝齿（三钱） 川贝母（三钱） 鲜竹茹叶（各二钱）
钱左 肝藏魂，心藏神，肾藏精，肝虚则魂不安宁，心虚则神无所根据，肾虚则封藏失职，以致惊悸惕息，恍
若有亡，遗泄频频，心肾之阴不足，君相之火有余也。盗汗甚多，汗为心液，虚阳迫津液而外泄也。脉象软弱，
右尺虚数，肝与胆为表里，肾与肝为乙癸，三阴既虚，君相内动，欲潜其阳，必滋其阴，王太仆云∶壮水之主，以
制阳光。当拟三才合六味珍珠母丸加减，滋肾阴以柔肝木，清君相而安神志，俾得阴平阳秘，水升火降，则诸恙
可愈。
北沙参（三钱） 粉丹皮（二钱） 珍珠母（八分） 生白芍（二钱） 天麦冬（各一钱五分） 抱茯神（三钱）
青龙齿（三钱） 炒枣仁（三钱） 大生熟地（各三钱） 淮山药（三钱） 左牡蛎（四钱） 炙远志肉（一钱）
封髓丹（包，三钱） 金器（入煎，一具）
朱左 心者君主之官，神明出焉。肾者作强之官，伎巧出焉。心营与肾水交亏，神机不灵，作强无权，不
能动作，不能思想，心悸跳跃，右耳响鸣，两目羞明，腰痛酸胀，健忘胆怯。舌质光，苔尖白中后黄腻，脉象弦
小而滑，痰热乘势内生，弦乃肝旺，小属肾虚，滑则有痰之明证。经云∶主不明则十二官危。心病则一身皆病
矣。脉证参合，或则成损，或则为癫，欲求速愈，静养调摄，当居其半，草木扶助，尚在其次，姑宜复方图治，养
心阴，益肾水，柔肝木，化痰热，参以调和脾胃之品。水足则木得涵养，脾健则痰热自化。
柏子仁（四钱） 朱茯神（三钱） 广橘白（一钱） 枸杞子（三钱） 酸枣仁（三钱） 水炙远志（一钱）
青龙齿（四钱） 陈胆星（八分） 滁菊花（二钱） 潼沙苑（三钱） 九节菖蒲（八分） 生
熟谷芽（各三钱） 冬青子（三钱） 合欢皮（三钱）
倪先生，诊察脉象：左尺脉沉而濡软，寸部和关部脉弦滑且数；右寸脉郁滞涩滞，右关脉软弱滑利。舌质红，苔色淡白。这是少阴肾水亏虚，水不能涵养肝木，导致厥阳之气独自亢盛，引动中焦原本蕴积的痰浊，上蒙蔽清窍，堵塞了神明出入的道路，使得上焦清旷之所，变成了云雾弥漫之乡，因此神机不灵，有时不说话类似癫证，有时多言类似狂证，正如经文所说“重阴则癫，重阳则狂”。所谓重阳，是风助火势，火借风威，使痰全部化为火，所以称为重阳。所谓重阴，是火逐渐衰微而痰浊弥漫，看似阴象，但终究不是真正的阴寒。据叙述，大便通畅后神识稍微清醒，因为胃络通于心包，胃中浊气下降，痰也随之而下。小便短少且黄，是因为气化功能不及于膀胱（州都）。病久根深，不容易迅速见效，我拟用滋肺肾以柔润肝木，涤除痰浊以清利神智的方法，希望达到水升火降、阴平阳秘的状态，这样肺金就有输布津液的权力，痰浊有下降的路径，虽然伏邪深藏，也希望能将其整肃清除。
北沙参（三钱） 全栝蒌（四钱） 朱茯神（三钱） 鲜竹茹（一钱五分） 枳壳（一钱，同炒） 川贝母（八钱）
珍珠母（八钱） 酒炒黄连（三分） 生甘草（四分） 仙半夏（三钱） 青龙齿（三钱） 酒炒木通（七分）
远志（一钱） 鲜石菖蒲（七分） 保心丹（开水吞服，三分）
二诊：心是君主之官，神明由此发出；肝是将军之官，谋虑由此产生；脾是谏议之官，思想由此产生。曲意运用神机，劳伤了心；谋虑过度，劳伤了肝；精打细算，劳伤了脾。心肝之阴已经受伤，暗中吸取肾阴，导致水不涵木，厥阴之气独自亢盛，脾弱不能为胃运行津液，水谷之湿生成痰。阳气升于上，痰浊随之，蒙蔽清窍，堵塞神机，神情呆滞不语，类似癫证，时而多言，类似狂证。前贤说，阴并入阳则狂，阳并入阴则癫，癫证时如醉如痴，都是由顽痰积热，阻滞于上中二焦，神明没有出入之路。痰是火的表象，火是痰的根本，痰得到热则颜色应呈黄色，现在反而白而粘腻，为什么呢？这是因为肺津不能输布，聚液成痰，津液之痰与湿浊之痰，互相结合作为援助，肺色属白，所以痰色白而粘。腑气五日不行，痰浊不得下达；小便短少且黄，肺为水之上源，源头不清则水流不洁。脉象尺部沉濡，左寸关弦滑而数依然如旧，右部寸涩关滑，舌质红，苔薄黄，本虚标实，显然可见，况且素来有肢体麻木、腿足无力等症状，这不是本虚的明证吗？现在脉数便秘，这不是标实的明证吗？治本宜补，治标宜攻，颇有顾此失彼的忧虑。服药后效果尚属平平，现拟定七分攻邪三分补虚，祛除顽痰，保存津液，使腑气通畅则顽痰可以下降，阴液保存则浮火不至于上扰，恐怕根株已深，难以求得近效。
北沙参（四钱） 生甘草（五分） 陈胆星（八分） 生石决明（八钱） 玄参（一钱五分） 小生地（四钱）
仙半夏（三钱） 天竺黄（一钱五分） 川贝母（八钱） 炙远志（一钱） 鲜竹茹（一钱五分）
枳壳（一钱，同捣） 保心丹（三分） 礞石滚痰丸（包煎，三钱） 九节石菖蒲（八分） 淡竹油（一两）
生姜汁（一二滴，二味同冲）
三诊：昨日服用祛痰浊、养津液的方药，属于扶正祛邪、增水行舟的意思。脉象寸部略小，右关脉流利，其余部位平平。腑气得以通畅，痰浊虽有下行之势，但顽痰郁闭心包，依然不化。痰称为顽，是指坚硬而不化解。譬如盗贼，潜伏深藏，扰乱莫测，搜逐非常艰难，如果想在初病时正气尚充的时候直捣巢穴，绝其种类，不妨派出偏师以制胜，彻底扫荡。您的病由来，是由于谋虑过度，深思导致气结，心神过用，暗中吸取肾阴，坎水亏于下，坤土困于中，脾不能为胃运行津液，导致所入的水谷，不能化生精液，全部变为痰。涎渍于肺则咳嗽，沃于心包则神呆，遮蔽神明，灵机堵塞，开始语无次序，继而默默不言，其发病缓慢，其去除也不容易。贼寇不除，则党羽日益增多；病不去除，则枝节横生。张石顽先生说：癫症日久，面色萎黄，时常多疑，或吐白沫，默默不言，是虫积为患。审察面色辨证，有点像这种情况。目前的计策，拟定十味温胆汤，扶正涤痰为主药；以妙功丸，杀灭虫积为辅药；以秘方甘遂丸，搜剔内窜的痰涎，驱痰下降为使药。犹如兵家深挖沟壕高筑壁垒，先立于不败之地，然后出奇兵制敌。是这样吗？请高明指正！
北沙参（四钱） 姜半夏（三钱） 川贝母（八钱） 炙远志（五分） 小生地（四钱） 枳实炭（五分）
陈胆星（八分） 竹油（冲服，一两） 生草（六分） 炒竹茹（五钱） 天竺黄（三钱） 生姜汁（冲服，一二滴）
妙功丸方
丁香 木香 沉香（各五分） 乳香（研碎） 麝香（另研） 熊胆（各二分五厘） 白丁香（三十粒，即雄雀屎，只有直的才是雌屎） 鹤虱（即天名精子，不要误认胡萝菔子） 陈皮（去白，各一钱） 轻粉（四分五厘） 大黄（酒浸，一钱五分） 赤小豆（三十粒，即杜赤豆，选择细小的，不要误认为半赤半黑的相思子） 巴豆（一粒，去皮，研压去油净） 朱砂（一钱，水飞，一半作衣）
我的意见加制黄精（三钱）、明天冬（三钱），烘干干燥研入，以监制其香燥之性，并辅助杀虫的作用。
以上药物研为末，荞麦粉三钱作糊制成丸，每丸约重一钱，朱砂为衣，阴干，隔日服一粒，温水浸泡一夜，去掉水，再用温水化开，空腹服用。
治癫症秘方甘遂丸
甘遂二钱研为末，用猪心管血和药放入猪心内缚定，湿纸包裹煨熟取药，用辰砂末（一钱），分成四丸，每次服一丸，用猪心煎汤送下，大便通畅排出恶物为有效，未下，再服一丸。如果服后，缓一两天再服。
此方治疗验证多人，只有心虚怔忡、脾虚便溏者，不可服用。
李先生，肾阴不足，心肝之火有余，这是离坎不交的现象。痰热蒙蔽清窍，神不守舍，舍空而痰热占据，痰火上炎，导致彻夜不寐；痰蒙心则多疑，时常听到辱骂之声。脉弦滑带数。治疗宜益肾阴，清心火，加入安神涤痰的药物。
大麦冬（二钱） 朱茯神（三钱） 石决明（一两） 淡竹油（冲服，一两） 川雅连（四分） 炙远志肉（一钱）
生甘草（五分） 金器（入煎，一件） 细木通（八分） 紫贝齿（三钱） 川贝母（三钱） 鲜竹茹叶（各二钱）
钱先生，肝藏魂，心藏神，肾藏精，肝虚则魂不安宁，心虚则神无所根据，肾虚则封藏失职，导致惊悸惕息，恍惚如有丧失，遗泄频频，心肾之阴不足，君相之火有余。盗汗甚多，汗为心液，虚阳逼迫津液外泄。脉象软弱，右尺虚数，肝与胆为表里，肾与肝为乙癸同源，三阴既虚，君相内动，想要潜藏其阳，必须滋养其阴，王太仆说：壮水之主，以制阳光。应当拟定三才合六味珍珠母丸加减，滋肾阴以柔润肝木，清君相之火而安神志，使得阴平阳秘，水升火降，则诸病可愈。
北沙参（三钱） 粉丹皮（二钱） 珍珠母（八分） 生白芍（二钱） 天麦冬（各一钱五分） 抱茯神（三钱）
青龙齿（三钱） 炒枣仁（三钱） 大生熟地（各三钱） 淮山药（三钱） 左牡蛎（四钱） 炙远志肉（一钱）
封髓丹（包煎，三钱） 金器（入煎，一件）
朱先生，心是君主之官，神明由此发出。肾是作强之官，伎巧由此产生。心营与肾水交亏，神机不灵，作强无权，不能动作，不能思想，心悸跳跃，右耳响鸣，两目羞明，腰痛酸胀，健忘胆怯。舌质光剥，苔尖白中后黄腻，脉象弦小而滑，痰热乘势内生，弦乃肝旺，小属肾虚，滑则有痰的明证。经云：主不明则十二官危。心病则一身皆病了。脉证参合，或者成为虚损，或者成为癫证，欲求速愈，静养调摄应当占一半，草木扶助尚在其次，暂宜复方图治，养心阴，益肾水，柔肝木，化痰热，参以调和脾胃的药物。水足则木得涵养，脾健则痰热自化。
柏子仁（四钱） 朱茯神（三钱） 广橘白（一钱） 枸杞子（三钱） 酸枣仁（三钱） 水炙远志（一钱）
青龙齿（四钱） 陈胆星（八分） 滁菊花（二钱） 潼沙苑（三钱） 九节菖蒲（八分） 生
熟谷芽（各三钱） 冬青子（三钱） 合欢皮（三钱）
Mr. Ni, the pulse diagnosis reveals: the left Chi (Cunian) pulse is deep and soggy; the Cun (Inch) and Guan (Bar) positions are wiry, slippery, and rapid; the right Cun position is stagnant and choppy; the right Guan position is soft and slippery. The tongue body is red with a pale white coating. This indicates a deficiency of Shaoyin Kidney Water, where Water fails to nourish Liver Wood, leading to the solitary hyperactivity of Jueyang Qi. This stirs up the phlegm-turbidity originally accumulated in the Middle Jiao, which ascends to cloud the clear orifices and blocks the pathways for the Spirit (Shen) to enter and exit. Consequently, the clear and vast space of the Upper Jiao becomes a land of clouds and mist, causing the spiritual mechanism to malfunction. Thus, there may be mutism resembling Dian syndrome (depressive psychosis), or excessive talking resembling Kuang syndrome (manic psychosis). As the classics state, "Excess Yin leads to Dian, Excess Yang leads to Kuang."
"Excess Yang" refers to wind aiding fire, and fire borrowing wind's power, transforming all phlegm into fire. "Excess Yin" refers to fire gradually declining while phlegm-turbidity spreads, resembling Yin patterns, but fundamentally distinct from true Yin cold. It is reported that mental clarity slightly improves after bowel movement, as the Stomach meridian connects to the Pericardium; when Stomach turbidity descends, phlegm follows suit. The urine is scanty and yellow, indicating that Qi transformation fails to reach the Bladder (Zhou Du). The disease has been long-standing with deep roots, making quick recovery difficult. I propose nourishing Lung and Kidney to soften Liver Wood, eliminating phlegm-turbidity to clear the Spirit, hoping to achieve the ascent of Water and descent of Fire, and balance of Yin and Yang. In this way, Metal will have the authority to distribute fluids, and phlegm-turbidity will have a path to descend. Although the latent pathogens are deep, we can hope to restore order.
*Prescription:*
Ginseng Radix Septentrionalis (Beishashen) 3 qian, Trichosanthes Fruit (Quangualou) 4 qian, Poria Cocos with Polyporus (Zhufushen) 3 qian, Fresh Bamboo Shavings (Xianzhuru) 1.5 qian, Aurantium Fructus (Zhike) 1 qian (stir-fried together), Fritillaria Bulb (Chuanbeimu) 8 qian, Mother of Pearl (Zhenzhumu) 8 qian, Coptis Rhizome stir-fried with wine (Jiuhuanglian) 0.3 qian, Raw Licorice Root (Shenggancao) 0.4 qian, Pinellia Tuber (Xianbanxia) 3 qian, Dragon Tooth (Qinglongchi) 3 qian, Akebia Caulis stir-fried with wine (Jiu mutong) 0.7 qian, Polygala Root (Yuanzhi) 1 qian, Fresh Acorus Rhizome (Xianshichangpu) 0.7 qian, Baoxin Dan (swallowed with boiled water) 0.3 qian.
Second Visit: The Heart is the Sovereign Official, from whom the Spirit emerges; the Liver is the General Official, from whom strategy arises; the Spleen is the Advisory Official, from whom thought arises. Overuse of mental effort injures the Heart; excessive planning injures the Liver; meticulous calculation injures the Spleen. The Yin of Heart and Liver is already damaged, secretly drawing upon Kidney Yin, leading to Water failing to nourish Liver Wood and solitary hyperactivity of Jueyin. The Spleen is weak and cannot transport fluids for the Stomach, generating phlegm from dampness of food and water. Yang rises upward, carrying phlegm-turbidity to cloud the clear orifices and block the spiritual mechanism, resulting in dullness and mutism resembling Dian, or occasional excessive talking resembling Kuang. Ancients said, "Yin merging with Yang causes Kuang, Yang merging with Yin causes Dian." Dian presents as drunken or foolish states, caused by stubborn phlegm and accumulated heat obstructing the Upper and Middle Jiao, blocking the Spirit's pathways. Phlegm is the manifestation of Fire; Fire is the root of Phlegm. Phlegm heated should turn yellow, yet here it is white and sticky. Why? Because Lung Jin (fluids) fail to distribute, condensing into phlegm. Fluid-phlegm and damp-turbidity-phlegm bind together. Since Lung color is white, the phlegm is white and sticky. Bowel function has not occurred for five days, preventing phlegm-turbidity from descending. Urine is scanty and yellow; as the Lung is the upper source of water, if the source is unclear, the flow is unclean. The Chi pulse is deep and soggy; the left Cun-Guan is wiry, slippery, and rapid as before; the right Cun is choppy and Guan is slippery. Tongue body red, coating thin and yellow. Root deficiency and branch excess are evident. Moreover, chronic limb numbness and leg weakness indicate root deficiency; current rapid pulse and constipation indicate branch excess. Treating the root requires tonification; treating the branch requires purging, risking neglect of one for the other. Previous medication yielded mediocre results. Now prescribing 70% purging and 30% tonifying, to remove stubborn phlegm and preserve fluids. If bowel qi flows, stubborn phlegm descends; if Yin fluids are preserved, floating fire does not harass upward. Given the deep roots, near-term success is unlikely.
*Prescription:*
Ginseng Radix Septentrionalis (Beishashen) 4 qian, Raw Licorice Root (Shenggancao) 0.5 qian, aged Arisaema with Bile (Chendanning) 0.8 fen, Raw Abalone Shell (Shengshijue) 8 qian, Scrophularia Root (Xuanshen) 1.5 qian, Small Rehmannia Root (Xiaoshengdi) 4 qian, Pinellia Tuber (Xianbanxia) 3 qian, Hyacinth Bean Meal (Tianzhuhuang) 1.5 qian, Fritillaria Bulb (Chuanbeimu) 8 qian, Processed Polygala Root (Zhiyuanzhi) 1 qian, Fresh Bamboo Shavings (Xianzhuru) 1.5 qian, Aurantium Fructus (Zhike) 1 qian (pounded together), Baoxin Dan 0.3 qian, Lapis Micae Rubra Roll Pill (Mengshi Guntan Wan) (wrapped and decocted) 3 qian, Nine-joint Acorus Rhizome (Jiujieshichangpu) 0.8 fen, Light Bamboo Oil (Danzhu you) 1 liang, Ginger Juice (Shengjiang zhi) 1-2 drops (mixed with the two oils).
Third Visit: Yesterday's prescription aimed to eliminate phlegm-turbidity and nourish fluids, embodying the principle of supporting righteousness and attacking evil, or increasing water to float the boat. The Cun pulse is slightly smaller; the right Guan pulse is smooth; others are flat. Bowel qi is unblocked, and phlegm-turbidity shows signs of descending, yet stubborn phlegm remains closed in the Pericardium, unresolving. "Stubborn phlegm" implies hardness and lack of transformation. Like bandits hiding deeply and causing unpredictable chaos, searching is difficult. If one wishes to strike the nest directly when Zhengqi was strong at onset, using auxiliary forces could succeed. Your illness stems from excessive planning, deep thinking causing Qi stagnation, and overuse of Shen secretly consuming Kidney Yin. Kan Water is deficient below, Kun Earth is trapped in the middle. The Spleen cannot transport fluids for the Stomach, so ingested food fails to transform into essence, becoming phlegm. Saliva soaking the Lung causes cough; phlegm flooding the Pericardium causes dullness, obscuring the Spirit and blocking intelligence. Initially disordered speech, then silent muteness; the onset was gradual, and removal will be difficult. If bandits are not removed, followers multiply; if disease persists, complications arise. Mr. Zhang Shiwan stated: Long-standing Dian syndrome with sallow complexion, frequent doubt, spitting white foam, and muteness suggests parasite accumulation. Examination suggests similarity. Current plan: Shiwai Wendan Tang to support righteousness and eliminate phlegm as sovereign; Miaogong Wan to kill parasites as deputy; Secret Formula Gansui Wan to search out wandering phlegm-saliva and drive phlegm downward as envoy. Like military strategy, establish an impregnable position first, then launch surprise attacks. What do you think? Please advise.
*Prescription:*
Ginseng Radix Septentrionalis (Beishashen) 4 qian, Ginger-processed Pinellia (Jiangbanxia) 3 qian, Fritillaria Bulb (Chuanbeimu) 8 qian, Processed Polygala Root (Zhiyuanzhi) 0.5 qian, Small Rehmannia Root (Xiaoshengdi) 4 qian, Charred Immature Bitter Orange (Zhishi tan) 0.5 qian, aged Arisaema with Bile (Chendanning) 0.8 fen, Bamboo Oil (Zhu you) mixed in 1 liang, Raw Licorice (Shengcao) 0.6 qian, Stir-fried Bamboo Shavings (Chaozhuru) 5 qian, Hyacinth Bean Meal (Tianzhuhuang) 3 qian, Ginger Juice (Shengjiang zhi) mixed in 1-2 drops.
*Miaogong Wan Formula:*
Sichuan Peppercorn (Dingxiang), Costus Root (Muxiang), Agarwood (Chenxiang) (each 0.5 qian); Frankincense (Ruxiang) ground; Musk (Shexiang) separately ground; Bear Bile (Xiongdan) (each 2.5 li); White Dingxiang (Baidingxiang, i.e., male sparrow droppings, only straight ones are female) 30 grains; Nematode Herb (Heshi, i.e., Herba Glehniae, do not confuse with Daucus carota seeds); Tangerine Peel (Chenpi, pith removed) (each 1 qian); Calomelas (Qingfen) 0.45 qian; Rhubarb (Dahuang) wine-soaked 1.5 qian; Adzuki Bean (Chixiaodou, i.e., Du chi dou, select small ones, do not confuse with Phaseolus angularis/lovesickness bean) 30 grains; Croton Seed (Badou) 1 grain (peeled, pounded to remove oil); Cinnabar (Zhusha) 1 qian (water-ground, half used for coating).
I suggest adding Processed Polygonatum (Zhihuangjing) 3 qian and Asparagus Fern Root (Miantian dong) 3 qian, dried and ground, to counteract their aromatic dryness and assist in killing parasites.
Grind above herbs to powder, use Buckwheat Flour (Qiaomai fen) 3 qian made into paste to form pills, each weighing approx. 1 qian, coated with Cinnabar, dried in shade. Take one pill every other day, soak in warm water overnight, drain water, dissolve in warm water, and take on an empty stomach.
*Secret Formula for Dian Syndrome: Gansui Wan*
Kansui Root (Gansui) 2 qian ground to powder. Mix with blood from pig heart tube and medicine inside the pig heart, tie securely, wrap in wet paper, roast until cooked, then retrieve the medicine. Mix with Cinnabar powder (1 qian), divide into four pills. Take one pill per dose, washed down with pig heart decoction. Effect is achieved when bowels move and expel foul matter. If not expelled, take another pill. After expulsion, wait one or two days before resuming.
This formula has verified efficacy in many cases, but is contraindicated for those with Heart deficiency palpitations or Spleen deficiency loose stools.
Mr. Li: Kidney Yin is insufficient, while Heart and Liver Fire are excessive, indicating a failure of Li (Fire) and Kan (Water) to interact. Phlegm-heat clouds the clear orifices, Spirit does not reside in its house; the empty house is occupied by phlegm-heat. Phlegm-fire flares upward, causing insomnia all night; phlegm clouding the Heart causes suspicion and hearing insults. Pulse is wiry, slippery, and rapid. Treatment should tonify Kidney Yin, clear Heart Fire, and add calming Spirit and eliminating phlegm herbs.
*Prescription:*
Ophiopogon Tuber (Damaidong) 2 qian, Poria Cocos with Polyporus (Zhufushen) 3 qian, Abalone Shell (Shijue) 1 liang, Light Bamboo Oil (Dan zhuyu) mixed in 1 liang, Coptis Rhizome (Chuan Yalian) 0.4 qian, Processed Polygala Flesh (Zhiyuanzirou) 1 qian, Raw Licorice Root (Shenggancao) 0.5 qian, Gold Artifact (Jinqi) for decoction (one piece), Fine Akebia Caulis (Xi mutong) 0.8 fen, Purple Conch Shell (Zibeichi) 3 qian, Fritillaria Bulb (Chuanbeimu) 3 qian, Fresh Bamboo Sheath and Leaves (Xian zhuru ye) (each 2 qian).
Mr. Qian: Liver stores Hun (Ethereal Soul), Heart stores Shen (Spirit), Kidney stores Jing (Essence). Liver deficiency leads to unsettled Hun; Heart deficiency leaves Shen without foundation; Kidney deficiency fails in storage, leading to fright, palpitations, startle, feeling of loss, and frequent seminal emission. Heart and Kidney Yin are insufficient, while Ministerial and Sovereign Fires are excessive. Profuse night sweats occur; sweat is the fluid of the Heart, forced out by deficient Yang. Pulse is weak and soft, right Chi is deficient and rapid. Liver and Gallbladder are interior-exterior pairs; Kidney and Liver share Yi-Gui (Wood-Water origin). With Three Yin deficient and internal movement of Sovereign/Minister fires, to subdue Yang, one must nourish Yin. Wang Taipu said: "Strengthen the master of Water to control the sunlight." Prescribe modified Sancai combined with Liuwei Zhenzhumu Wan to nourish Kidney Yin and soften Liver Wood, clear Sovereign/Minister fires and calm Spirit, achieving Yin-Yang balance, Water ascent/Fire descent, curing the diseases.
*Prescription:*
Ginseng Radix Septentrionalis (Beishashen) 3 qian, Moutan Cortex (Fendan pi) 2 qian, Mother of Pearl (Zhenzhumu) 0.8 fen, Raw White Peony Root (Shengbaishao) 2 qian, Ophiopogon and Anemarrhena (Tianmaidong) (each 1.5 qian), Poria Cocos (Baofushen) 3 qian, Dragon Tooth (Qinglongchi) 3 qian, Stir-fried Ziziphus Seed (Chaozaoren) 3 qian, Large Raw and Prepared Rehmannia (Dashengshudi) (each 3 qian), Chinese Yam (Huai shanyao) 3 qian, Left Oyster Shell (Zuomuli) 4 qian, Processed Polygala Flesh (Zhiyuanzirou) 1 qian, Fengsui Dan (wrapped) 3 qian, Gold Artifact (Jinqi) for decoction (one piece).
Mr. Zhu: Heart is the Sovereign Official, from whom Spirit emerges. Kidney is the Official of Strength, from whom dexterity arises. Heart Ying (Nutrient) and Kidney Water are mutually deficient. Spiritual mechanism is sluggish, strength is powerless, unable to move or think. Palpitations, jumping sensations, right ear tinnitus, photophobia, lower back pain and soreness, forgetfulness, and timidity. Tongue body is bare; tip coating white, middle/posterior coating yellow and greasy. Pulse is wiry, small, and slippery. Phlegm-heat arises opportunistically; wiry indicates Liver excess, small indicates Kidney deficiency, slippery confirms phlegm. Classics say: "If the Master is unclear, the Twelve Officials are in danger." Heart disease affects the whole body. Combining pulse and symptoms, it may become consumptive or Dian. To seek quick cure, quiet rest and regulation account for half; herbal assistance is secondary. Temporarily prescribe compound formula to nourish Heart Yin, benefit Kidney Water, soften Liver Wood, resolve phlegm-heat, and harmonize Spleen/Stomach. When Water is sufficient, Wood is nourished; when Spleen is healthy, phlegm-heat transforms naturally.
*Prescription:*
Biota Seed (Baiziren) 4 qian, Poria Cocos with Polyporus (Zhufushen) 3 qian, Broad-leaved Citrus Peel (Guangjubi) 1 qian, Goji Berry (Gouqizi) 3 qian, Ziziphus Seed (Suanzaoren) 3 qian, Water-processed Polygala (Shuizhiyuanzhi) 1 qian, Dragon Tooth (Qinglongchi) 4 qian, aged Arisaema with Bile (Chendanning) 0.8 fen, Chrysanthemum (Chujuhua) 2 qian, Cuscuta Seed (Tongshayuan) 3 qian, Nine-joint Acorus Rhizome (Jiujiechangpu) 0.8 fen, Raw and Prepared Rice Sprouts (Shengshu guya) (each 3 qian), Aquilaria Leaf (Dongqingzi) 3 qian, Silk Tree Bark (Hehuanpi) 3 qian.