李左 不寐已久,时轻时剧,苔薄腻,脉弦小,心体
亏,心阳亢,不能下交于肾,湿痰中阻,胃因不和,胃不和故卧不安也。拟和胃化痰,交通心肾。
生白芍(二钱) 朱茯神(三钱) 上川连(一分) 炒枣仁(三钱) 法半夏(二钱) 远志肉(一钱)
上肉桂(一分) 柏子霜(二钱) 北秫米(包,三钱) 炙甘草(八分)
程右 郁怒伤肝,肝胆之火内炽,痰湿中阻,胃失和降,懊 少寐,胸痹不舒。拟温胆汤加减。
法半夏(二钱) 朱茯神(三钱) 珍珠母(三钱) 黑山栀(一钱五分) 北秫米(包,三钱)
远志肉(一钱) 青龙齿(三钱) 川贝母(二钱) 炒枣仁(三钱) 生白芍(二钱) 鲜竹茹(一钱五分)
枳实(一钱,同捣) 广郁金(一钱五分) 合欢花(一钱五分) 夜交藤(三钱)
陈左 高年气阴两亏,肝阳挟痰浊上蒙清空,健忘少寐,神疲肢倦,脉象虚弦而滑,苔薄腻,虚中夹实,最
难着手,姑拟益气阴以柔肝木,化痰浊而通神明。
太子参(一钱) 仙半夏(二钱) 白归身(二钱) 豆衣(三钱) 抱茯神(三钱) 薄橘红(八分)
生白芍(二钱) 炒杭菊(一钱五分) 炒竹茹(一钱五分) 远志肉(一钱) 天竺黄(一钱五分) 石菖蒲(八
分) 淡竹油(一两) 生姜(同冲服,两滴)
陈左 阴虚难复,肝火易升,宗气跳跃,夜梦纷坛,脉象软小而数。拟育阴潜阳,交通心肾。
蛤粉炒阿胶(二钱) 朱茯神(三钱) 珍珠母(三钱) 生白芍(二钱) 小生地(三钱) 炙远志(一钱)
青龙齿(三钱) 粉丹皮(一钱五分) 川贝母(二钱) 潼蒺藜(三钱) 熟女贞(二钱) 炒竹茹(二钱)
鲜藕(切片入煎,一两)
倪左 不寐之恙,乍轻乍剧,胁痛略减,头眩心悸,皆由阴虚不能敛阳,阳亢不入于阴也。拟柔肝潜阳,和
胃安神。
蛤粉炒阿胶(二钱) 朱茯神(三钱) 青龙齿(三钱) 左牡蛎(四钱) 生白芍(二钱) 酸枣仁(三钱)
仙半夏(二钱) 炙远志(一钱) 川雅连(二分) 柏子仁(三钱) 北秫米(包,三钱) 琥珀多寐丸(吞服,一
钱)
李姓患者,失眠已久,病情时轻时重。舌苔薄而腻,脉象弦小。此为心之本体亏虚,心阳亢盛,不能下行交于肾;同时湿痰阻滞中焦,导致胃气不和,所谓“胃不和则卧不安”。治法拟调和胃气、化痰浊,并交通心肾。
处方:生白芍(二钱)、朱茯神(三钱)、上川连(一分)、炒枣仁(三钱)、法半夏(二钱)、远志肉(一钱)、上肉桂(一分)、柏子霜(二钱)、北秫米(包煎,三钱)、炙甘草(八分)。
程姓患者,因郁怒伤及肝脏,肝胆之火在内炽盛,痰湿阻滞中焦,致使胃失和降。症见心中烦闷懊恼、睡眠减少、胸痹闷塞不舒。治法拟温胆汤加减。
处方:法半夏(二钱)、朱茯神(三钱)、珍珠母(三钱)、黑山栀(一钱五分)、北秫米(包煎,三钱)、远志肉(一钱)、青龙齿(三钱)、川贝母(二钱)、炒枣仁(三钱)、生白芍(二钱)、鲜竹茹(一钱五分)、枳实(一钱,同捣碎)、广郁金(一钱五分)、合欢花(一钱五分)、夜交藤(三钱)。
陈姓患者,年事已高,气阴两虚。肝阳挟带痰浊上蒙清窍,症见健忘、睡眠少,精神疲倦、肢体乏力,脉象虚弦而滑,舌苔薄腻。此属虚中夹实证,最难治疗。暂拟益气养阴以柔润肝木,化痰浊以通利神明。
处方:太子参(一钱)、仙半夏(二钱)、白归身(二钱)、豆衣(三钱)、抱茯神(三钱)、薄橘红(八分)、生白芍(二钱)、炒杭菊(一钱五分)、炒竹茹(一钱五分)、远志肉(一钱)、天竺黄(一钱五分)、石菖蒲(八分)、淡竹油(一两)、生姜(同冲服,两滴)。
陈姓患者(另一案),阴虚难以恢复,肝火易升发,宗气跳跃不定,夜间多梦纷纭,脉象软小而数。治法拟育阴潜阳,交通心肾。
处方:蛤粉炒阿胶(二钱)、朱茯神(三钱)、珍珠母(三钱)、生白芍(二钱)、小生地(三钱)、炙远志(一钱)、青龙齿(三钱)、粉丹皮(一钱五分)、川贝母(二钱)、潼蒺藜(三钱)、熟女贞(二钱)、炒竹茹(二钱)、鲜藕(切片入煎,一两)。
倪姓患者,失眠之病,时轻时重,胁痛略有减轻,头眩心悸,皆因阴虚不能敛摄阳气,阳气亢盛不入于阴所致。治法拟柔肝潜阳,和胃安神。
处方:蛤粉炒阿胶(二钱)、朱茯神(三钱)、青龙齿(三钱)、左牡蛎(四钱)、生白芍(二钱)、酸枣仁(三钱)、仙半夏(二钱)、炙远志(一钱)、川雅连(二分)、柏子仁(三钱)、北秫米(包煎,三钱)、琥珀多寐丸(吞服,一钱)。
Patient Li has suffered from insomnia for a long time, with symptoms fluctuating in severity. The tongue coating is thin and greasy, and the pulse is wiry and small. This indicates a deficiency of the Heart substance (Zang organ) and hyperactivity of Heart Yang, which fails to descend to communicate with the Kidney. Meanwhile, damp-phlegm obstructs the middle jiao, causing disharmony of the Stomach; as the saying goes, "when the Stomach is not in harmony, sleep is restless." The treatment strategy is to harmonize the Stomach, resolve phlegm, and facilitate communication between the Heart and Kidney.
Prescription: Sheng Baishao (Radix Paeoniae Alba), Zhufushen (Poria with Hostwood), Shang Chuanlian (Rhizoma Coptidis), Chao Zaoren (Semen Ziziphi Spinosae Praeparated), Fa Banxia (Rhizoma Pinelliae Preparata), Yuanzhi Rou (Radix Polygalae), Shang Rougui (Cortex Cinnamomi), Baizi Shuang (Semen Platycladi), Beishumi (Frumentum Sorghi Glutinosi, wrapped and decocted), Zhi Gancao (Radix Glycyrrhizae Preparata).
Patient Cheng was injured by depression and anger affecting the Liver. Fire of the Liver and Gallbladder blazes internally, while damp-phlegm obstructs the middle jiao, leading to failure of the Stomach to descend properly. Symptoms include mental restlessness and vexation, reduced sleep, chest bi-syndrome with stifling sensation. The treatment strategy is modified Wendan Tang (Warm the Gallbladder Decoction).
Prescription: Fa Banxia (Rhizoma Pinelliae Preparata), Zhufushen (Poria with Hostwood), Zhenzhumu (Concha Margaritifera), Hei Shanzhi (Fructus Gardeniae Preparated), Beishumi (Frumentum Sorghi Glutinosi, wrapped and decocted), Yuanzhi Rou (Radix Polygalae), Qinglongchi (Dens Longicornis Ossis Frontalis Chini), Chuan Beimu (Bulbus Fritillariae Cirrhosae), Chao Zaoren (Semen Ziziphi Spinosae Praeparated), Sheng Baishao (Radix Paeoniae Alba), Xian Zhuru (Caulis Bambusae in Taeniam Fresh), Zhishi (Fructus Aurantii Immaturus, crushed together), Guang Yujin (Radix Curcumae Longae), Hehuanhua (Flos Albiziae), Yejiaoteng (Caulis Polygoni Multiflori).
Patient Chen is elderly, suffering from dual deficiency of Qi and Yin. Liver Yang, carrying turbid phlegm, ascends to cloud the clear orifices. Symptoms include amnesia, reduced sleep, mental fatigue, and limb weakness. The pulse is deficient, wiry, and slippery; the tongue coating is thin and greasy. This is a condition of deficiency mixed with excess, making it difficult to treat. Tentatively, the strategy is to tonify Qi and nourish Yin to soften the Liver Wood, and resolve turbid phlegm to clarify the Spirit.
Prescription: Taizishen (Radix Codonopsis Pilosulae), Xian Banxia (Rhizoma Pinelliae), Bai Guishen (Radix Angelicae Sinensis), Douyi (Hull Sojae Preparata), Baofushen (Poria Cum Radix Polypori), Bo Juhong (Pericarpium Citri Reticulatae), Sheng Baishao (Radix Paeoniae Alba), Chao Hangju (Flos Chrysanthemi Indici), Chao Zhuru (Caulis Bambusae in Taeniam), Yuanzhi Rou (Radix Polygalae), Tianzhuhuang (Calculus Bolus), Shichangpu (Rhizoma Acori Tatarinowii), Danzhuyou (Succus Bambusae), Shengjiang (Rhizoma Zingiberis Recens, taken with decoction, two drops).
Patient Chen (another case): Yin deficiency is hard to restore, and Liver Fire rises easily. Zong Qi (Gathering Qi) jumps erratically, accompanied by numerous dreams at night. The pulse is soft, small, and rapid. The treatment strategy is to nourish Yin and subdue Yang, facilitating communication between the Heart and Kidney.
Prescription: Ge Fen Chao Ejiao (Corpus Corii Asini Gelatinum prepared with Arsenical Calamine), Zhufushen (Poria with Hostwood), Zhenzhumu (Concha Margaritifera), Sheng Baishao (Radix Paeoniae Alba), Xiao Shengdi (Radix Rehmanniae Preparata), Zhi Yuanzhi (Radix Polygalae Preparata), Qinglongchi (Dens Longicornis Ossis Frontalis Chini), Fen Danpi (Cortex Moutan), Chuan Beimu (Bulbus Fritillariae Cirrhosae), Tong Jili (Fructus Tribuli), Shu Nvzhen (Fructus Ligustri Lucidi), Chao Zhuru (Caulis Bambusae in Taeniam), Xian Ou (Rhizoma Nelumbinis, sliced and decocted).
Patient Ni: The ailment of insomnia fluctuates in severity. Hypochondriac pain has slightly decreased, but dizziness and palpitations persist. These are caused by Yin deficiency failing to restrain Yang, resulting in Yang hyperactivity that does not enter into Yin. The treatment strategy is to soften the Liver and subdue Yang, harmonize the Stomach, and calm the Spirit.
Prescription: Ge Fen Chao Ejiao (Corpus Corii Asini Gelatinum prepared with Arsenical Calamine), Zhufushen (Poria with Hostwood), Qinglongchi (Dens Longicornis Ossis Frontalis Chini), Zuo Muli (Concha Ostreae), Sheng Baishao (Radix Paeoniae Alba), Suanzaoren (Semen Ziziphi Spinosae), Xian Banxia (Rhizoma Pinelliae), Zhi Yuanzhi (Radix Polygalae Preparata), Chuan Yalian (Rhizoma Coptidis), Baiziren (Semen Platycladi), Beishumi (Frumentum Sorghi Glutinosi, wrapped and decocted), Hupo Duomei Wan (Amber Sleep-Promoting Pill, swallowed, one qian).