前药服后，依然夜夜发病，但发作渐轻渐稀，脉则渐现小脉，数象自除。两周后诸症消失，心胸安适。前后服药37剂，病不发作。随之则退休，退休后继续发挥余热，曹素勤勉，花甲之年，仍操劳不止，而心君竟亦泰然，未见与之抗衡也。
前方之立，是经“辨证求因，审因论治”而后所拟订，故能见速效，正是前方切中病机，药物与药物之间配合默契之结果。然若于调整心律一端而论，亦无不借重于苦参一物。近年来苦参能治心律失常之报道甚多，皆从实验而得，确有见地。余谓心律失常原因不一，虚证有气血阴阳之偏衰，实证则痰瘀火郁各不相同，原因不同，调整心律之主药亦不同，是以临证时务宜推敲斟酌，随证选药。若因心火盛者，黄连与苦参均为首选之药，而验之临证，则苦参较黄连更为应手也。关于苦参之剂量，诸书多用15～20g，甚则30g。而据余个人体会剂量以切中病机，恰到好处为宜，中病即可，不要过量。盖苦参乃苦寒之物，极易败胃．心律失常者每多气虚，此时顾护胃气甚属紧要，若胃气重伤，未有不功败垂成者。此余一得之见，亦一孔之见也，仅供读者参考。
例二房颤喘息例。某区粮食局科长杨某，年过不惑之后，即患心房纤维性颤动。经两度住院治疗，仍无明显好转，在某专家处服补养气血之中药百剂，如石投水，不见效机，出院后回郊区家中休养。忽一日下午二时许，急电促余往诊，云病人喘息数日，入夜不能平卧，坐以达旦，已三、四夜矣，故已将病人送回市区。俗语云：救病甚于救火，故余随即驰往。见患者靠坐床褥，气喘吁吁，似难接续。与之交谈，亦断续不能成句。其妻示余一纸药方，谓是患者十余岁时得气喘症，久治不愈，经乡下一老中医用方三帖即平。以后四十年中，病未复发。可谓神方矣，是故信之极深，藏之极妥。认为此方仍可救治其夫之病，欲余审阅后转抄是方。余睹方中诸品，乃三拗汤加味，药有麻黄、杏仁、甘草、苏梗、桔梗、紫菀、款冬、半夏、贝母之属，尽是开肺、降气、化痰、平喘之物。而患者之脉散乱无序，舌淡苔白，一派心肺虚耗之象。余谓杨妻曰：“乃夫幼时之喘，因于肺金痹郁，痰气交阻，以致肃降无权，肺气上逆而喘，是实证也。今日之喘，因于心力耗衰，心火不能下降于肾以温养肾水，致使肾不纳气；肾水不能上交于心以济心火，如易卦之‘火水未济’，由心肾不交而成喘促，是虚证也。一虚一实，悬若霄壤；一补一泻，生死反掌。尔夫此时病势已极，用药稍有不当，毫厘之差，必酿千里之失，抱憾终生，追悔何及!”反复与之陈明利害，劝导一小时后，方勉强允余用药，于是振笔直书：
党参15g淮小麦30g炙甘草10g大枣30g五味子10g补骨脂10g枸杞子15g
遣人配药已下午四时，是夜服一帖。次日清早，余复前往诊察，患者及其妻笑逐颜开，置谢不止。谓昨晚药后幸得一宿安卧，气不喘，心不慌，胸也不闷。服药三帖，呼吸平匀，精神渐振，仍回乡休养。返乡后房颤屡发，又数次住院，惜终未得救，然喘促一症始终未见复发。
心衰愈后呃逆
退休干部王某，祖籍山东，形躯魁梧，性格爽朗。中年得高血压病，逐渐发展为高血压性心脏病。血压常在190～210／120～130mmHg之间。严重时舒张压可高达140mmHg。二十年间屡现高血压危象，必经医院抢救始能脱险。久而久之，渐渐形成冠心病。年至五十上下，继发心力衰竭，每年须住院数次，始可苟延残喘。平素人参不离于口，一年内须服用生晒参500g以上。至三年前来余处服用中药。当时见症：自感头晕头痛，时作时止，心悸慌乱，胸闷气促，甚则略见喘息，全身乏力，精神萎顿，动辄汗出，夜梦频仍。腰脊酸软，胃纳不馨，但二便正常。脉大按之软，舌淡白无血色，略胖，苔薄净。据脉证而论，此证为气血亏损，心肾不交。头脑常痛而不甚，且时作时止者，是虚晕虚痛，气血失充，清阳不展之象也。全身乏力，动辄汗出，是气虚卫阳不固，以致津液外泄。精神萎顿，腰脊酸软，为先天受损，肾将惫矣。心悸慌乱，胸闷气促，乃血不养心，兼有心气不足之疾。心肾两脏为水火之脏，在生理情况下，心火下降于肾，肾水』二达于心，则水火既济而循环不息。今则两脏俱损，水升无力，火降不及，则火水未济，而成天地痞塞之象。恰如《周易》火下水上，卦成既济，水下火上则成未济之意相类。是以心火郁于上而胸闷心悸，肾水乏于下而腰脊酸软也。参酌脉象舌色，皆无：二致。治之之法，当两调气血，兼益心肾而交媾水火。药用：
党参、黄芪、白术、茯苓神、甘草、熟地、淮牛膝、杞子、麦门冬、五味子、当归、枣仁、姜枣之属，服数剂即见效验，诸证明显好转。续服数十剂后，症状缓解，停药不服。越年余，自觉一向安好，时已孟冬，一日夜间忽发呃逆。呃声频繁，昼夜不辍。因交通不便，至第三日下午始来余处就诊，诊得两手脉大而稍软。依然是元气不充体质，稍感寒邪则膈膜痉挛，致呃逆连声而作。拟旋覆代赭汤合丁香柿蒂汤，益气温中，降逆止呃。方为：
旋覆花9g代赭石30g党参24g甘草3g姜半夏9g柿蒂9g丁香3g生姜二片大枣七枚
上方服三帖未知，其妻来告症情依然。余推敲此症诊断无误，用药恰当，当是患者元气素弱，尚不足以运药势、制病邪，应继续服药。于是宗原方，去丁香恐其太热，柿蒂用15g，又三帖，呃逆即除，隔年相见，知未复发。
胃痛慎用辛香温燥
余昔年读清代贤宿之书，每见胃痛慎用香燥之戒，初未介意，实亦未识真蒂所在。及至临证渐多，阅历稍广，方知深契病机，必自实践经验中来。如《程杏轩医案续录》治“秀翘兄肝气犯胃作痛案”云：“肝为将军之官，脏刚性急。医投辛香温燥，希图止痛，肝阴被劫，怒木益横，冲胃为呕，此肝为受病之源，胃为传病之所，医多药杂，胃气益伤。”吴达《医学求是》亦曰：“世之称肝气胃气痛者，每用香燥破气之药，以为平肝，初服亦觉有效，久则病变莫名。”叶天士为轩岐一代天骄，倡养胃阴，与香燥治胃更不相合，其《临证指南》卷八“胃脘痛”门范氏案后邵评曰：“阳明乃十二经脉之长，其作痛之因甚多。盖胃者，汇也。乃冲繁要道，为患最易。虚邪、实邪之乘机窃发，其问消长不一，习俗辛香温燥之治，断不容一例而漫施。”程杏轩、吴达、叶天士均为清代名医，于胃痛不宜辛香温燥之论，众口一词，其间必有原因。
辛香温燥之品，其弊有三：一者香燥之品，秉质刚燥而性多温热，最易损伤肝阴胃津。二者香燥药之功用，类多行气宽胀、化滞止痛，多用久用有伐胃伤中之过。三者香燥之品多兼辛散升扬，不合胃气以下行为顺之生理特点。
因此，凡胃气虚弱，或胃阴不足，或肝肾阴亏者，皆不宜辛香温燥之品。下文再就胃腑之主要生理特征加以探讨：
其一：胃为阳土，喜润而恶燥。人身之脾脏胃腑，皆属于土，然有阴阳之别，刚柔之分，秉性有燥湿之殊，喜好有润燥之异。盖脾为阴土而性柔多湿，故喜刚燥。胃为阳土而性刚多燥，故喜柔润。《临证指南》云：“胃属戊土脾属己土。戊阳己阴，阴阳之性有别也。”又曰：“太阴湿土，得阳始运；阳明阳土，得阴自安。以脾喜刚燥，胃喜柔润也。”
胃为人体五脏六腑之海，主一身之津液。津液亦阴液也，易亏而难盈，故居常胃津不足者恒多，因而胃腑具喜润恶燥之特点。倘投以辛香温燥，是反其道而行之矣，能无伤津劫液而徒增病势乎!
此外，脾胃虽相为表里而性各不同，治法亦当有别。治脾宜温燥健运，而治胃宜甘凉濡润。《临证指南》叹惜世人以治脾温燥之药以治胃病，致使胃津更伤，而病反不治。故知辛香温燥之药可施于脾湿之证而不宜于胃燥之病，误投之有伤津劫液之弊。
其二：脾宜升则健，胃宜降则和。人身气机之升降运动，乃生命活动过程中之重要环节，故《内经》慎重而言之曰：“出入废则神机化灭，升降息则气立孤危。”于五脏六腑之气机升降运动中，脾升胃降为其他脏腑气机升降之枢纽，统领诸气之升降。而胃气主降，以下行为顺。如胃气上逆不仅变生胃腑诸病，如为胀满、为呕吐、为反胃、为疼痛等等，且能导致气机升降紊乱，如涉及他脏，则可变生诸病。故保持胃气之正常通降，为维护健康之重要一着。胃气当如何通降?《临证指南》详释曰：“所谓胃宜降则和者，非用辛开苦降，亦非苦寒下夺以损胃气。不过甘平或甘凉濡润以养胃阴，则津液来复，使之通降而已矣。”辛香温燥之品，多兼升扬上达之性，投剂不当，易致胃气逆上。故华岫云于《临证指南》“脾胃”门亦指出：“若脾阳不亏，胃有燥火，则当遵叶氏养胃阴之法。观其立论云：纳食主胃，运化主脾。脾宜升则健，胃宜降则和。”现今生活水平大有提高，饮食多膏粱厚味，加之醇酒醪醴、烟云吞吐，胃中津气更易伤残而燥火易炽，若再误投温燥，何啻火上添油!因而胃气通降不足、易致上逆者切宜慎用香燥之品。
其三：土受木制。在五脏六腑生克制化规律中，脾胃属土，肝胆属木。正常生理状态下，木能疏土，以助脾胃消导运化。如若木气亢盛，木横克土则生脾胃之病，《笔花医镜》曰：“胃属中土”，“其性与脾同，而畏木侮”。《馤塘医话》之论则更为具体：“夫脾胃为后天根本，人皆藉以生养，岂能为他经作崇，其病皆肝为之耳。肝为五脏之长而属木，一有病，则生克脾胃之土，脾胃受克无所生施，而诸经之病蜂起矣。”胃脘痛则为木克土症中之主要病证．既是肝邪犯胃而致病，则治疗之时务必虑及肝胆之特性，投剂方能不悖而收良效。如“肝为刚脏，体阴而用阳”“肝胆内寄相火”，“肝为风木之脏，风性轻扬，善行而数变。”据此则用药宜柔勿刚，宜散勿壅，宜凉勿热，而辛香温燥之品不可轻用。
然就临床实际情况而论，香燥行气之品并非全属禁忌。凡有气机郁结壅滞而致痞胀疼痛之证，又非行气开郁无以为功。关键在于用之得宜及适量与否。对此，张山雷《籀簃医话》之论则较为中肯：“心胃痛等症，无一非肝络不疏，气机横逆为患，而其源皆本于肝肾之阴亏。”“人每用香燥药，初服小效，久则致虚，以其耗竭肝阴也。”“然当病剧之时，气行紊乱，非有气分之药以疏通之、整理之，则亦无应手之效，香燥药物颇有奇功。但多用燥药则阴液愈伤，不时频发，后难为继。”
吴达于《医学求是》中述其治木邪犯土证之经验，可资借鉴：“水寒土湿，木郁不达，风木冲击而贼脾土，则痛于脐下；胃气上逆，浊阴不降，相火虚飘而贼胃土，则痛于脐上。痛于下，则温其水、补其脾、达其肝木而东升；痛于上，则清其风、和其胃、敛其胆木而西降；不用香燥而痛自愈。”
其四：西医内科之胃炎、胃窦炎、消化道溃疡病等，皆以胃脘痛胀为主要自觉症状，而局部病灶经久不愈者，每易增生、糜烂、肠化生等，甚至产生恶变。此乃西医胜于中医之处，其各种理化检查，尤为中医所望尘莫及。然胃病历久可致局部糜烂，中医亦有是说。清代喻嘉言于《寓意草》“直推岵翁公祖病后再误贻患”案中，详述“胃风”有五证，其中第五条“一日脉风成为病．言胃中之风酝酿既久，则荣气腐而不清，肌肉之间渐至溃烂，以胃主肌肉也。”虽所述疮疡皆在体表，其实胃中病灶亦必糜烂，只是当时缺乏现代西医之检查手段耳。
胃中局灶糜烂、增生，用药不当，轻则增病，重则出血如涌，而危象迭生。余曾见数例，胃脘痛糜烂增生而误用治脾经寒湿之药，如木香、砂仁、陈皮、半夏、苍术、吴茱萸、茴香、良姜、生姜等辛燥之味，以及参芪白术之类温燥健脾之品，竟至呕血不止而不得不求助于手术者。胃病而有糜烂、增生之病例，临床实不鲜见，不少患者未经检查，仅以胃脘痛而来求治者，更宜详审，务必辨明病证而后施治，而于辛香温燥之药宜加慎焉。胃痛一症病因较多，有外感寒邪、过食生冷、饮食停滞、肝气犯胃、肝胃郁热、脾胃虚寒、胃阴不足、瘀血停滞等等。上述胃阴不足及木横犯土之证，特其中之一端而已。故临证之际仍宜辨证论治，切奠囿于成见而自捆手足。然鉴于胃腑主一身津液之特殊功能，以及“为万病之贼”之肝木连同胆气，时时制约中土，则本文所述者，又为胃痛门中最为普遍而习见之证，故不揣浅陋而绕慎用辛香温燥之说，以供读者参考。
中医瑰宝苑 三十年临证经验集er
益气健脾愈胃疡
消化道溃疡(胃溃疡、十二指肠溃疡)，中医学中归属“胃脘痛”症。与慢性胃炎虽同属胃腑疾患，而病机、脉证均有差异。
本病最主要之症状为胃脘(上腹部)疼痛，古籍常云：“胃脘当心而痛”其疼痛部位多在胃脘之近中心，正在心脏偏右之内下方，故古代医家亦常误称为“心痛”。此外，本病尚有如下特点：
服用前药后，病情依然每晚发作，但发作程度逐渐减轻、频率逐渐减少，脉象逐渐呈现小脉，数象自然消除。两周后所有症状消失，心胸感到安适。前后共服药37剂，疾病不再发作。随后他退休了，退休后继续发挥余热，曹先生勤勉努力，到了花甲之年，仍然操劳不止，而心神竟然也安然无恙，没有出现与之抗衡的情况。
前方剂的制定，是经过“辨证求因，审因论治”之后所拟订的，所以能见到速效，正是前方切中病机，药物与药物之间配合默契的结果。然而若从调整心律的角度来说，也不得不倚重苦参这一味药。近年来关于苦参能治疗心律失常的报道很多，都是从实验得出的，确有见地。我认为心律失常的原因不一，虚证有气血阴阳的偏衰，实证则痰瘀火郁各不相同，原因不同，调整心律的主药也不同，因此在临证时务必推敲斟酌，随证选药。若是因心火盛者，黄连和苦参均为首选之药，而验证于临床，则苦参较黄连更为应手。关于苦参的剂量，诸书多用15～20g，甚至30g。而据我个人体会，剂量以切中病机、恰到好处为宜，中病即可，不要过量。因为苦参乃苦寒之物，极易败坏胃气。心律失常者每多气虚，此时顾护胃气甚属紧要，若胃气重伤，没有不功败垂成的。这是我的一得之见，也是一孔之见，仅供读者参考。
例二：房颤喘息病例。某区粮食局科长杨某，年过四十之后，即患心房纤维性颤动。经过两次住院治疗，仍无明显好转，在某专家处服用补养气血的中药百剂，如石投水，不见效验，出院后回郊区家中休养。忽然一日下午二时许，急电促我前往诊治，说病人喘息数日，入夜不能平卧，坐着直到天亮，已经三四天了，所以已将病人送回市区。俗语云：救病甚于救火，所以我随即驱车前往。见到患者靠坐床褥，气喘吁吁，似难接续。与之交谈，也是断续不能成句。他的妻子给我看一张药方，说是患者十几岁时得气喘症，久治不愈，经乡下一位老中医用方三帖即平。以后四十年中，病未复发。可谓神方了，因此深信不疑，藏之极妥。认为此方仍可救治其丈夫的病，欲我审阅后转抄是方。我看方中诸品，乃是三拗汤加味，药有麻黄、杏仁、甘草、苏梗、桔梗、紫菀、款冬、半夏、贝母之类，尽是开肺、降气、化痰、平喘之物。而患者的脉散乱无序，舌淡苔白，一派心肺虚耗之象。我对杨妻说：“你丈夫幼时的喘，因于肺金痹郁，痰气交阻，以致肃降无权，肺气上逆而喘，这是实证。今日的喘，因于心力耗衰，心火不能下降于肾以温养肾水，致使肾不纳气；肾水不能上交于心以济心火，如同易卦之‘火水未济’，由心肾不交而成喘促，这是虚证。一虚一实，悬若霄壤；一补一泻，生死反掌。你丈夫此时病势已极，用药稍有不当，毫厘之差，必酿千里之失，抱憾终生，追悔何及！”反复与他说明利害，劝导一小时后，才勉强允许我用药，于是挥笔写下：
党参15g 淮小麦30g 炙甘草10g 大枣30g 五味子10g 补骨脂10g 枸杞子15g
派人配药已是下午四时，当晚服一帖。次日清早，我再次前往诊察，患者及其妻子笑逐颜开，致谢不止。说昨晚药后幸得一宿安卧，气不喘，心不慌，胸也不闷。服药三帖，呼吸平匀，精神渐振，仍回乡休养。返乡后房颤屡发，又数次住院，可惜终未得救，然喘促一症始终未见复发。
心衰愈后呃逆
退休干部王某，祖籍山东，形躯魁梧，性格爽朗。中年得高血压病，逐渐发展为高血压性心脏病。血压常在190～210／120～130mmHg之间。严重时舒张压可高达140mmHg。二十年间屡现高血压危象，必经医院抢救始能脱险。久而久之，渐渐形成冠心病。年至五十上下，继发心力衰竭，每年须住院数次，始可苟延残喘。平时人参不离于口，一年内须服用生晒参500g以上。至三年前来我这里服用中药。当时见症：自感头晕头痛，时作时止，心悸慌乱，胸闷气促，甚则略见喘息，全身乏力，精神萎顿，动辄汗出，夜梦频仍。腰脊酸软，胃纳不馨，但二便正常。脉大按之软，舌淡白无血色，略胖，苔薄净。据脉证而论，此证为气血亏损，心肾不交。头脑常痛而不甚，且时作时止者，是虚晕虚痛，气血失充，清阳不展之象也。全身乏力，动辄汗出，是气虚卫阳不固，以致津液外泄。精神萎顿，腰脊酸软，为先天受损，肾将惫矣。心悸慌乱，胸闷气促，乃血不养心，兼有心气不足之疾。心肾两脏为水火之脏，在生理情况下，心火下降于肾，肾水上达于心，则水火既济而循环不息。今则两脏俱损，水升无力，火降不及，则火水未济，而成天地痞塞之象。恰如《周易》火下水上，卦成既济，水下火上则成未济之意相类。是以心火郁于上而胸闷心悸，肾水乏于下而腰脊酸软也。参酌脉象舌色，皆无二致。治之之法，当两调气血，兼益心肾而交媾水火。药用：
党参、黄芪、白术、茯苓神、甘草、熟地、淮牛膝、杞子、麦门冬、五味子、当归、枣仁、姜枣之属，服数剂即见效验，诸证明显好转。续服数十剂后，症状缓解，停药不服。越年余，自觉一向安好，时已孟冬，一日夜间忽发呃逆。呃声频繁，昼夜不辍。因交通不便，至第三日下午始来我这里就诊，诊得两手脉大而稍软。依然是元气不充体质，稍感寒邪则膈膜痉挛，致呃逆连声而作。拟旋覆代赭汤合丁香柿蒂汤，益气温中，降逆止呃。方为：
旋覆花9g 代赭石30g 党参24g 甘草3g 姜半夏9g 柿蒂9g 丁香3g 生姜二片 大枣七枚
上方服三帖未知效，其妻来告症情依然。我推敲此症诊断无误，用药恰当，当是患者元气素弱，尚不足以运药势、制病邪，应继续服药。于是宗原方，去丁香恐其太热，柿蒂用15g，又三帖，呃逆即除，隔年相见，知未复发。
胃痛慎用辛香温燥
我昔年读清代贤宿之书，每见胃痛慎用香燥之戒，初未介意，实亦未识真蒂所在。及至临证渐多，阅历稍广，方知深契病机，必自实践经验中来。如《程杏轩医案续录》治“秀翘兄肝气犯胃作痛案”云：“肝为将军之官，脏刚性急。医投辛香温燥，希图止痛，肝阴被劫，怒木益横，冲胃为呕，此肝为受病之源，胃为传病之所，医多药杂，胃气益伤。”吴达《医学求是》亦曰：“世之称肝气胃气痛者，每用香燥破气之药，以为平肝，初服亦觉有效，久则病变莫名。”叶天士为轩岐一代天骄，倡养胃阴，与香燥治胃更不相合，其《临证指南》卷八“胃脘痛”门范氏案后邵评曰：“阳明乃十二经脉之长，其作痛之因甚多。盖胃者，汇也。乃冲繁要道，为患最易。虚邪、实邪之乘机窃发，其间消长不一，习俗辛香温燥之治，断不容一例而漫施。”程杏轩、吴达、叶天士均为清代名医，于胃痛不宜辛香温燥之论，众口一词，其间必有原因。
辛香温燥之品，其弊有三：一者香燥之品，秉质刚燥而性多温热，最易损伤肝阴胃津。二者香燥药之功用，类多行气宽胀、化滞止痛，多用久用有伐胃伤中之过。三者香燥之品多兼辛散升扬，不合胃气以下行为顺之生理特点。
因此，凡胃气虚弱，或胃阴不足，或肝肾阴亏者，皆不宜辛香温燥之品。下文再就胃腑之主要生理特征加以探讨：
其一：胃为阳土，喜润而恶燥。人身之脾脏胃腑，皆属于土，然有阴阳之别，刚柔之分，秉性有燥湿之殊，喜好有润燥之异。盖脾为阴土而性柔多湿，故喜刚燥。胃为阳土而性刚多燥，故喜柔润。《临证指南》云：“胃属戊土脾属己土。戊阳己阴，阴阳之性有别也。”又曰：“太阴湿土，得阳始运；阳明阳土，得阴自安。以脾喜刚燥，胃喜柔润也。”
胃为人体五脏六腑之海，主一身之津液。津液亦阴液也，易亏而难盈，故居常胃津不足者恒多，因而胃腑具喜润恶燥之特点。倘投以辛香温燥，是反其道而行之矣，能无伤津劫液而徒增病势乎！
此外，脾胃虽相为表里而性各不同，治法亦当有别。治脾宜温燥健运，而治胃宜甘凉濡润。《临证指南》叹惜世人以治脾温燥之药以治胃病，致使胃津更伤，而病反不治。故知辛香温燥之药可施于脾湿之证而不宜于胃燥之病，误投之有伤津劫液之弊。
其二：脾宜升则健，胃宜降则和。人身气机之升降运动，乃生命活动过程中之重要环节，故《内经》慎重而言之曰：“出入废则神机化灭，升降息则气立孤危。”于五脏六腑之气机升降运动中，脾升胃降为其他脏腑气机升降之枢纽，统领诸气之升降。而胃气主降，以下行为顺。如胃气上逆不仅变生胃腑诸病，如为胀满、为呕吐、为反胃、为疼痛等等，且能导致气机升降紊乱，如涉及他脏，则可变生诸病。故保持胃气之正常通降，为维护健康之重要一着。胃气当如何通降？《临证指南》详释曰：“所谓胃宜降则和者，非用辛开苦降，亦非苦寒下夺以损胃气。不过甘平或甘凉濡润以养胃阴，则津液来复，使之通降而已矣。”辛香温燥之品，多兼升扬上达之性，投剂不当，易致胃气逆上。故华岫云于《临证指南》“脾胃”门亦指出：“若脾阳不亏，胃有燥火，则当遵叶氏养胃阴之法。观其立论云：纳食主胃，运化主脾。脾宜升则健，胃宜降则和。”现今生活水平大有提高，饮食多膏粱厚味，加之醇酒醪醴、烟云吞吐，胃中津气更易伤残而燥火易炽，若再误投温燥，何啻火上添油！因而胃气通降不足、易致上逆者切宜慎用香燥之品。
其三：土受木制。在五脏六腑生克制化规律中，脾胃属土，肝胆属木。正常生理状态下，木能疏土，以助脾胃消导运化。如若木气亢盛，木横克土则生脾胃之病，《笔花医镜》曰：“胃属中土”，“其性与脾同，而畏木侮”。《馤塘医话》之论则更为具体：“夫脾胃为后天根本，人皆藉以生养，岂能为他经作崇，其病皆肝为之耳。肝为五脏之长而属木，一有病，则生克脾胃之土，脾胃受克无所生施，而诸经之病蜂起矣。”胃脘痛则为木克土症中之主要病证．既是肝邪犯胃而致病，则治疗之时务必虑及肝胆之特性，投剂方能不悖而收良效。如“肝为刚脏，体阴而用阳”“肝胆内寄相火”，“肝为风木之脏，风性轻扬，善行而数变。”据此则用药宜柔勿刚，宜散勿壅，宜凉勿热，而辛香温燥之品不可轻用。
然就临床实际情况而论，香燥行气之品并非全属禁忌。凡有气机郁结壅滞而致痞胀疼痛之证，又非行气开郁无以为功。关键在于用之得宜及适量与否。对此，张山雷《籀簃医话》之论则较为中肯：“心胃痛等症，无一非肝络不疏，气机横逆为患，而其源皆本于肝肾之阴亏。”“人每用香燥药，初服小效，久则致虚，以其耗竭肝阴也。”“然当病剧之时，气行紊乱，非有气分之药以疏通之、整理之，则亦无应手之效，香燥药物颇有奇功。但多用燥药则阴液愈伤，不时频发，后难为继。”
吴达于《医学求是》中述其治木邪犯土证之经验，可资借鉴：“水寒土湿，木郁不达，风木冲击而贼脾土，则痛于脐下；胃气上逆，浊阴不降，相火虚飘而贼胃土，则痛于脐上。痛于下，则温其水、补其脾、达其肝木而东升；痛于上，则清其风、和其胃、敛其胆木而西降；不用香燥而痛自愈。”
其四：西医内科之胃炎、胃窦炎、消化道溃疡病等，皆以胃脘痛胀为主要自觉症状，而局部病灶经久不愈者，每易增生、糜烂、肠化生等，甚至产生恶变。此乃西医胜于中医之处，其各种理化检查，尤为中医所望尘莫及。然胃病历久可致局部糜烂，中医亦有是说。清代喻嘉言于《寓意草》“直推岵翁公祖病后再误贻患”案中，详述“胃风”有五证，其中第五条“一日脉风成为病．言胃中之风酝酿既久，则荣气腐而不清，肌肉之间渐至溃烂，以胃主肌肉也。”虽所述疮疡皆在体表，其实胃中病灶亦必糜烂，只是当时缺乏现代西医之检查手段耳。
胃中局灶糜烂、增生，用药不当，轻则增病，重则出血如涌，而危象迭生。我曾见数例，胃脘痛糜烂增生而误用治脾经寒湿之药，如木香、砂仁、陈皮、半夏、苍术、吴茱萸、茴香、良姜、生姜等辛燥之味，以及参芪白术之类温燥健脾之品，竟至呕血不止而不得不求助于手术者。胃病而有糜烂、增生之病例，临床实不鲜见，不少患者未经检查，仅以胃脘痛而来求治者，更宜详审，务必辨明病证而后施治，而于辛香温燥之药宜加慎焉。胃痛一症病因较多，有外感寒邪、过食生冷、饮食停滞、肝气犯胃、肝胃郁热、脾胃虚寒、胃阴不足、瘀血停滞等等。上述胃阴不足及木横犯土之证，特其中之一端而已。故临证之际仍宜辨证论治，切忌囿于成见而自捆手足。然鉴于胃腑主一身津液之特殊功能，以及“为万病之贼”之肝木连同胆气，时时制约中土，则本文所述者，又为胃痛门中最为普遍而习见之证，故不揣浅陋而绕慎用辛香温燥之说，以供读者参考。
中医瑰宝苑 三十年临证经验集er
益气健脾愈胃疡
消化道溃疡（胃溃疡、十二指肠溃疡），中医学中归属“胃脘痛”症。与慢性胃炎虽同属胃腑疾患，而病机、脉证均有差异。
本病最主要之症状为胃脘（上腹部）疼痛，古籍常云：“胃脘当心而痛”其疼痛部位多在胃脘之近中心，正在心脏偏右之内下方，故古代医家亦常误称为“心痛”。此外，本病尚有如下特点：
After taking the previous prescription, the condition still occurred every night, but the attacks gradually became lighter and less frequent. The pulse gradually presented as a small pulse (Xiao Mai), and the rapid quality naturally disappeared. After two weeks, all symptoms vanished, and the chest felt comfortable. A total of 37 doses were taken over time, and the disease did not recur. He then retired but continued to contribute his remaining energy. Mr. Cao was diligent; even in his sixties, he worked tirelessly, yet his Heart Spirit (Shen) remained peaceful, showing no signs of conflict or strain.
The formulation of the previous prescription was established after "seeking the cause through syndrome differentiation and treating based on the identified cause" (Bian Zheng Qiu Yin, Shen Yin Lun Zhi). Thus, it achieved rapid effects, precisely because it targeted the pathogenesis accurately, resulting in harmonious synergy among the herbs. However, regarding the regulation of heart rhythm, reliance on Ku Shen (Sophorae Flavescentis Radix) is indispensable. In recent years, there have been numerous reports on Ku Shen's efficacy in treating arrhythmia, derived from experimental studies, which are indeed insightful. I believe that the causes of arrhythmia vary: deficiency syndromes involve imbalances in Qi, Blood, Yin, and Yang, while excess syndromes differ in phlegm, blood stasis, fire, and depression. Since the causes differ, the primary herbs for regulating heart rhythm also vary. Therefore, clinical practice requires careful deliberation and selection of herbs according to the syndrome. For cases caused by excessive Heart Fire (Xin Huo), both Huang Lian (Coptidis Rhizoma) and Ku Shen are first choices, but clinical verification shows Ku Shen is more effective. Regarding the dosage of Ku Shen, most texts recommend 15–20g, up to 30g. Based on my personal experience, the dosage should be appropriate to target the pathogenesis exactly; once the illness is addressed, stop, avoiding overdose. Ku Shen is bitter and cold, easily damaging Stomach Qi (Wei Qi). Patients with arrhythmia often have Qi deficiency; thus, protecting Stomach Qi is crucial. If Stomach Qi is severely damaged, treatment will inevitably fail. This is my humble opinion, offered for readers' reference.
Case 2: Atrial Fibrillation with Asthma. Section Chief Yang from a district grain bureau developed atrial fibrillation after age forty. Despite two hospitalizations, there was no significant improvement. He took one hundred doses of Chinese herbal medicine to tonify Qi and Blood prescribed by an expert, but it was like a stone thrown into water, yielding no effect. After discharge, he rested at his suburban home. Suddenly, around 2 PM one day, an urgent call asked me to visit. His wife reported that the patient had been wheezing for several days, unable to lie flat at night, sitting until dawn for three or four nights, so he was brought back to the city. As the saying goes, "saving a life is as urgent as putting out a fire," so I rushed to see him. The patient was propped up on the bed, panting heavily, struggling to catch his breath. Conversation was fragmented. His wife showed me a prescription, claiming it cured his asthma when he was in his teens after long-term unsuccessful treatments. A local old TCM practitioner used this formula for three doses, curing him completely. The disease did not recur for forty years. It was considered a miraculous formula, deeply trusted and carefully kept. She believed it could still cure her husband and asked me to review and copy it. The formula contained San Ao Tang (Three Unblocking Decoction) modified, including Ma Huang (Ephedrae Herba), Xing Ren (Armeniacae Semen Amarum), Gan Cao (Glycyrrhizae Radix et Rhizoma), Su Geng (Perillae Caulis), Jie Geng (Platycodonis Radix), Zi Wan (Asteris Radix), Kuan Dong Hua (Farfarae Flos), Ban Xia (Pinelliae Rhizoma Preparatum), and Bei Mu (Fritillariae Cirrhosae Bulbus). These are all herbs that open the Lung, descend Qi, resolve phlegm, and calm asthma. However, the patient's pulse was chaotic and disordered, his tongue pale with a white coating, indicating severe depletion of Heart and Lung Qi and Yin. I told Mrs. Yang: "Your husband's childhood asthma was due to Lung Metal obstruction, with phlegm and Qi blocking each other, leading to loss of descending function and rebellious Lung Qi causing asthma; this was an excess syndrome. Today's asthma is due to Heart failure and exhaustion. Heart Fire cannot descend to warm Kidney Water, causing Kidney to fail to grasp Qi; Kidney Water cannot ascend to nourish Heart Fire. This is like the Hexagram 'Fire-Water Not Yet Completed' (Wei Ji) in the I Ching, where Heart-Kidney non-interaction leads to panting; this is a deficiency syndrome. One is excess, one is deficiency, separated by heaven and earth; one involves tonification, the other purgation, determining life or death. Your husband's condition is critical; any slight error in medication, a difference of a hair's breadth, will lead to a thousand-mile mistake, regretting it for life, too late to repent!" After explaining the pros and cons repeatedly and advising for an hour, she reluctantly allowed me to prescribe. I wrote immediately:
Dang Shen 15g, Huai Xiao Mai 30g, Zhi Gan Cao 10g, Da Zao 30g, Wu Wei Zi 10g, Bu Gu Zhi 10g, Gou Qi Zi 15g.
Medicine was dispensed at 4 PM, and one dose was taken that night. Early the next morning, I visited again. The patient and his wife were smiling, expressing endless gratitude. They said that after taking the medicine last night, he slept peacefully, without panting, palpitations, or chest tightness. After three doses, breathing became regular, spirit improved, and he returned to the countryside to rest. Although atrial fibrillation recurred later, requiring several hospitalizations, and unfortunately he did not survive, the symptom of panting never recurred.
Post-Heart Failure Hiccups
Retired cadre Wang, originally from Shandong, was robust and cheerful. He developed hypertension in middle age, which progressed to hypertensive heart disease. Blood pressure was often between 190–210/120–130 mmHg. Severe diastolic pressure reached 140 mmHg. Over twenty years, he experienced multiple hypertensive crises, requiring hospital rescue to survive. Gradually, coronary heart disease developed. Around age fifty, secondary heart failure occurred, requiring several hospitalizations annually just to prolong life. He constantly consumed Ginseng, taking over 500g of Sheng Shai Shen (Raw Sun-Dried Ginseng Root) per year. Three years ago, he sought TCM treatment. Symptoms included dizziness and headache, intermittent; palpitations and panic; chest tightness and shortness of breath, occasionally mild asthma; general fatigue and lethargy; sweating upon slight exertion; frequent dreams at night. Soreness and weakness in the lower back and spine; poor appetite, but normal bowel and bladder movements. Pulse was large but soft upon pressure; tongue was pale, bloodless, slightly swollen, with a thin clean coating. Based on pulse and symptoms, this syndrome was Qi and Blood deficiency with Heart-Kidney non-interaction. The occasional, mild headache was due to deficiency dizziness and pain, lack of Qi and Blood filling, and failure of Clear Yang to ascend. General fatigue and sweating indicated Qi deficiency and insecure Defensive Yang, leading to fluid leakage. Lethargy and back soreness indicated congenital damage and impending Kidney exhaustion. Palpitations and chest tightness indicated Blood failing to nourish the Heart and insufficient Heart Qi. Heart and Kidney are the organs of Water and Fire. Physiologically, Heart Fire descends to warm Kidney Water, and Kidney Water ascends to cool Heart Fire, achieving "Water-Fire Both Completed" (Ji Ji) and continuous circulation. Now, both organs are damaged; Water fails to ascend, Fire fails to descend, resulting in "Fire-Water Not Yet Completed" (Wei Ji) and cosmic stagnation. This resembles the I Ching hexagrams where Fire over Water is Ji Ji, but Water over Fire is Wei Ji. Thus, Heart Fire stagnates above causing chest tightness and palpitations, while Kidney Water lacks below causing back soreness. Pulse and tongue confirmed this. Treatment should harmonize Qi and Blood, tonify Heart and Kidney, and facilitate Water-Fire interaction. Prescription:
Dang Shen, Huang Qi, Bai Zhu, Fu Ling Shen, Gan Cao, Shu Di, Huai Niu Xi, Qi Zi, Mai Men Dong, Wu Wei Zi, Dang Gui, Zao Ren, Jiang Zao, etc. Several doses yielded obvious improvement. After dozens of doses, symptoms relieved, and he stopped medication. Over a year later, feeling well, in early winter, he suddenly developed hiccups at night. Frequent hiccups, day and night. Due to poor transport, he visited on the third afternoon. Pulses were large and slightly soft. Constitution still lacked Yuan Qi; slight cold invasion caused diaphragmatic spasm, leading to continuous hiccups. Formula: Xuan Fu Dai Zhe Tang (Inula and Hematite Decoction) combined with Ding Xiang Shi Di Tang (Clove and Persimmon Calyx Decoction) to tonify Qi, warm the Middle, descend rebellion, and stop hiccups. Prescription:
Xuan Fu Hua 9g, Dai Zhe Shi 30g, Dang Shen 24g, Gan Cao 3g, Jiang Ban Xia 9g, Shi Di 9g, Ding Xiang 3g, Sheng Jiang 2 slices, Da Zao 7 pieces.
After three doses, efficacy was unknown. His wife reported symptoms persisted. I reasoned the diagnosis was correct and medication appropriate; the patient's weak Yuan Qi was insufficient to move the medicinal force and overcome the pathogen. Continued medication was needed. Following the original formula, removing Ding Xiang fearing it too hot, increasing Shi Di to 15g, after three more doses, hiccups ceased. We met the next year, knowing no recurrence.
Caution with Pungent-Aromatic Warm-Dry Herbs for Stomach Pain
In my youth, reading Qing dynasty masters, I often saw warnings against using aromatic-dry herbs for stomach pain, initially ignoring them, not understanding the true essence. Only with more clinical experience did I realize deep alignment with pathogenesis comes from practical experience. For example, "Cheng Xingxuan Medical Cases Continuation" treats "Brother Xiuqiao's Liver Qi invading Stomach causing pain": "Liver is the general officer, rigid and impatient. Doctors use pungent-aromatic warm-dry herbs hoping to stop pain, but this robs Liver Yin, making angry Wood more rampant, attacking Stomach causing vomiting. Liver is the source of disease, Stomach is the site of transmission. Many doctors and mixed medicines further injure Stomach Qi." Wu Da in "Medical Seeking Truth" also said: "People calling it Liver Qi or Stomach Qi pain often use aromatic-dry Qi-breaking herbs to calm Liver. Initially effective, but long-term use causes inexplicable changes." Ye Tianshi, a genius of Xuanyuan-Qibo era, advocated nourishing Stomach Yin, incompatible with aromatic-dry treatment. In "Clinical Guide to Essential Medicine" Vol 8, Fan's case commentary by Shao said: "Yangming is the leader of twelve meridians, many causes of pain. Stomach is a convergence point, a busy thoroughfare, prone to harm. Deficient and excess evils strike opportunistically, waxing and waning differently. Customary pungent-aromatic warm-dry treatment must not be applied indiscriminately." Cheng Xingxuan, Wu Da, and Ye Tianshi were famous Qing doctors, unanimous in arguing against pungent-aromatic warm-dry herbs for stomach pain; there must be reasons.
Pungent-aromatic warm-dry herbs have three drawbacks: First, their nature is rigid, dry, and warm-hot, easily damaging Liver Yin and Stomach fluids. Second, their functions are mostly moving Qi, relieving distension, resolving stagnation, and stopping pain; overuse harms Stomach and Middle Jiao. Third, they tend to be pungent, dispersing, and ascending, contradicting the physiological characteristic of Stomach Qi preferring to descend.
Therefore, those with weak Stomach Qi, insufficient Stomach Yin, or Liver-Kidney Yin deficiency should avoid these herbs. Below, we discuss the main physiological characteristics of the Stomach:
First: Stomach is Yang Earth, prefers moisture, dislikes dryness. Spleen and Stomach belong to Earth, but differ in Yin-Yang, rigidity-softness, dryness-moisture, and preferences. Spleen is Yin Earth, soft and damp, preferring rigid-dry. Stomach is Yang Earth, rigid and dry, preferring soft-moist. "Clinical Guide" says: "Stomach is Wu Earth, Spleen is Ji Earth. Wu is Yang, Ji is Yin, natures differ." Also: "Taiyin Damp Earth moves only with Yang; Yangming Yang Earth settles with Yin. Because Spleen likes rigid-dry, Stomach likes soft-moist."
Stomach is the sea of five Zang and six Fu organs, governing body fluids. Fluids are Yin substances, easy to lose, hard to replenish; thus, Stomach fluid insufficiency is common, giving Stomach its preference for moisture and dislike for dryness. Using pungent-aromatic warm-dry herbs goes against this, injuring fluids and worsening disease!
Moreover, although Spleen and Stomach are exterior-interior paired, their natures and treatments differ. Treating Spleen requires warm-dry strengthening and transportation; treating Stomach requires sweet-cool moistening. "Clinical Guide" laments people using warm-dry Spleen herbs for Stomach disease, further injuring Stomach Yin, making disease incurable. Thus, pungent-aromatic warm-dry herbs suit Spleen dampness but not Stomach dryness; misuse injures fluids.
Second: Spleen thrives on ascending, Stomach harmonizes on descending. Ascending-descending movement of Qi mechanism is vital for life. "Neijing" states: "If entry-exit ceases, Spirit machinery perishes; if ascending-descending stops, Qi establishment stands alone." Among Zang-Fu Qi movements, Spleen ascending and Stomach descending are the pivot for others. Stomach Qi primarily descends; downward movement is smooth. Rebellious Stomach Qi causes Stomach diseases like distension, vomiting, regurgitation, pain, and disrupts Qi mechanism, affecting other organs. Maintaining normal Stomach Qi descent is key to health. How to descend? "Clinical Guide" explains: "Stomach harmonizing on descending does not mean using pungent-opening bitter-descending or bitter-cold purging to damage Stomach Qi. It simply means using sweet-neutral or sweet-cool moistening to nourish Stomach Yin, restoring fluids, enabling descent." Pungent-aromatic warm-dry herbs are ascending; improper use causes Stomach Qi rebellion. Hua Xiuyun in "Clinical Guide" "Spleen-Stomach" section noted: "If Spleen Yang is not deficient but Stomach has dry-fire, follow Ye's method of nourishing Stomach Yin. Theory: Stomach governs intake, Spleen governs transformation. Spleen thrives on ascending, Stomach harmonizes on descending." With improved living standards, rich diets, alcohol, and smoking, Stomach fluids and Qi are easily injured, dry-fire flares. Misusing warm-dry is adding oil to fire! Those with insufficient Stomach Qi descent prone to rebellion must cautiously use aromatic-dry herbs.
Third: Earth controlled by Wood. In Five Elements generation-restriction, Spleen-Stomach are Earth, Liver-Gallbladder are Wood. Normally, Wood疏 (shu) Earth, aiding digestion. If Wood Qi is hyperactive, Wood overacts on Earth, causing Spleen-Stomach disease. "Bi Hua Yi Jing" says: "Stomach is Central Earth," "Nature same as Spleen, fears Wood insult." "Yi Tang Yi Hua" is specific: "Spleen-Stomach are postnatal foundation, sustaining life. How can they be harmed by other meridians? All diseases are caused by Liver. Liver is head of five Zang, belongs to Wood. Once diseased, it generates/restricts Spleen-Stomach Earth. Earth restricted, cannot generate/nourish, diseases of all meridges arise." Stomach pain is a major Wood-overacting-on-Earth syndrome. Since Liver evil invades Stomach, treatment must consider Liver-Gallbladder characteristics for good effect. "Liver is rigid organ, substance Yin, function Yang," "Gallbladder houses ministerial fire," "Liver is Wind-Wood organ, wind is light, moves fast, changes often." Thus, herbs should be soft not rigid, dispersing not clogging, cool not hot; pungent-aromatic warm-dry herbs should not be used lightly.
However, clinically, aromatic-dry Qi-moving herbs are not entirely contraindicated. For Qi stagnation causing distension and pain, moving Qi is necessary. Key is proper use and dosage. Zhang Shanlei in "Zhou Yi Yi Hua" said: "Heart-Stomach pain all stem from Liver collateral not unblocking, Qi mechanism horizontal rebellion, source is Liver-Kidney Yin deficiency." "People use aromatic-dry herbs, initial small effect, long-term deficiency, because depleting Liver Yin." "But during severe illness, Qi chaos, without Qi-class herbs to unblock/organize, no effect. Aromatic-dry herbs have miracles. But overuse damages Yin fluids, frequent recurrence, hard to sustain."
Wu Da in "Medical Seeking Truth" shared experience treating Wood evil invading Earth: "Cold water, damp earth, Wood depressed not reaching, Wind-Wood attacks Spleen Earth, pain below umbilicus; Stomach Qi rebels, turbid Yin doesn't descend, ministerial fire floats attacking Stomach Earth, pain above umbilicus. Pain below: warm water, tonify Spleen, reach Liver Wood rising east; Pain above: clear wind, harmonize Stomach, gather Gallbladder Wood descending west; without aromatic-dry, pain self-heals."
Fourth: Western internal medicine gastritis, antral gastritis, digestive ulcers, etc., mainly present with epigastric pain/distension. Long-standing local lesions easily undergo hyperplasia, erosion, intestinal metaplasia, even malignancy. This is Western medicine's advantage; lab tests surpass TCM. However, TCM also notes long-term stomach disease causes local erosion. Qing doctor Yu Jiayan in "Yu Yi Cao" case "Directly pushing Hu Weng Grandfather's illness relapse due to misdiagnosis" detailed "Stomach Wind" five syndromes. Fifth: "Mai Feng becomes disease. Wind in Stomach brewing long makes Ying Qi rotten unclear, muscle layer gradually ulcerates, because Stomach governs muscles." Though ulcers described on body surface, Stomach lesions must erode, lacking modern Western checks then.
Local Stomach erosion/hyperplasia, improper meds, mild worsens disease, severe bleeding crisis. I saw cases where epigastric pain erosion/hyperplasia misused Spleen cold-damp herbs like Mu Xiang, Sha Ren, Chen Pi, Ban Xia, Cang Zhu, Wu Zhu Yu, Hui Xiang, Liang Jiang, Sheng Jiang (pungent-dry) and Shen Qi Bai Zhu (warm-dry tonifying), leading to unstoppable hematemesis, requiring surgery. Erosion/hyperplasia cases are common; many patients seek treatment for pain without exams, needing careful diagnosis before treating, especially caution with pungent-aromatic warm-dry herbs. Stomach pain causes are many: external cold, raw food, food stagnation, Liver Qi invading Stomach, Liver-Stomach stagnant heat, Spleen-Stomach deficiency cold, Stomach Yin deficiency, blood stasis. The mentioned Stomach Yin deficiency and Wood overacting on Earth are just one aspect. Clinical practice still requires syndrome differentiation, do not be bound by prejudice. Given Stomach's special role in fluids and Liver/Gallbladder ("thief of ten thousand diseases") constraining Middle Earth, what is described here is the most common/stomach pain syndrome, so I offer this caution on pungent-aromatic warm-dry herbs for reference.
TCM Treasure Garden: Thirty Years Clinical Experience Collection
Tonify Qi, Strengthen Spleen, Heal Gastric Ulcer
Digestive ulcers (gastric ulcer, duodenal ulcer) belong to "Epigastric Pain" in TCM. Although chronic gastritis is also a Stomach disease, pathogenesis and pulse/symptoms differ.
Main symptom is epigastric (upper abdomen) pain. Ancient texts say: "Epigastric pain hits the heart." Pain location is near center of epigastrium, slightly right and below heart, so ancient doctors often mistakenly called it "Heart Pain." Additionally, this disease has following characteristics: