疼痛长期、持续，发作呈周期性；疼痛发作时常有烧灼感，或钝痛，或似饥饿；疼痛具有节律性：胃溃疡疼痛多发于餐后半小时，经1～2小时可自行缓解。十二指肠溃疡疼痛多发于餐后2～3小时，常须持续至进食而止；消化道溃疡患者多得食痛减，得按痛止。
脘痛发作有时，具周期与节律特性，此谓之“信”。“胃属土而主信”，故凡信守季节、气候、年月、日期、时刻等而发病者，每多与中土脾胃有关。脘痛本是脾胃之病，当从脾胃而治。本病痛发之时得食则痛减，得按则痛舒，为中土虚衰特征。如林佩琴《类证治裁》云：“凡痛有虚实，按之痛止者为虚，按之痛反甚者为实。”本病之脉象多见虚细或缓弱，舌质多淡或淡胖，苔多薄白。故本病之治法当遵“虚则补之”、“劳则温之”之旨，以健脾益气、温养中土为主。稍兼宽中降逆、行气止痛以治其标。本病于临证之际虽非同一类型，但以脾胃气虚为多见，故余选用六君子汤随证增损以治本病中属于上述证候者。
方中以四君子汤益气培土以治其本，夏陈降逆和中，诸药作用恰与本病见症相合，故投之多见效机。本方如痛时喜温熨及热饮者，则虚中夹有寒象，宜加姜枣同煎，以加强和中温运。关于生姜，其味辛辣，其性宣散，用治此证则散寒有余，温养不足，最适宜者莫如煨姜，惜需自制，恐非一般病者所能为。
消化道溃疡所见脘痛，既有溃疡，多带炎症。患者脉象中常兼微弦或略弦强，舌边偏红．则为肝木犯胃、肝胃郁热之象，方中宜兼清热，今时多用蒲公英、金钱草或四季青，确有良效。明代孙一奎之《生生子医案》中每加黄柏一味。余思此味确具至理，人身相火发自命门，寄于肝胆，泻其相火，则肝胆之热易清，热清则肝木舒而中土不受克制，则脾胃安和，健运自如，溃疡愈合，疼痛匿迹矣。
余以此方治消化道溃疡，似觉较小建中汤更能应手。小建中汤宜于中虚而肝木不旺，胃酸不多之人。而今之患者每多肝木偏亢，泛酸频频。不宜于白芍酸敛，桂枝温热以及饴糖之作酸也。
附治验病例一一则。
干部陶某，年过四旬。因胃小弯溃疡，于1969年手术切除，而后十二指肠及小弯部又有新生病灶，且发作渐频，痛势渐增，于1976年10月6日来诊。
自诉胃脘疼痛，发作有时，上午9～10时，下午2～4时必发。初则隐痛绵绵，逐渐加剧而为大痛，但仍能忍受。且痛时得食则减，得暖则舒。平素嗳气频作，不嗳则脘中胀闷。大便不实，日行二、三次。脉弦而缓，苔薄白微腻，舌尖带红。此系中土亏损，土虚木旺，乃肝脾不和之证。然则侧重脾弱，脾虚失运，兼有气滞痰停，湿浊内困，因当时见证嗳气为甚，先用和中降逆法，以旋覆代赭汤进服五帖，嗳气除，脘痛亦减。原方加砂仁、白芍、玉竹，又服十帖，脘痛又减。但腹中气胀不消，大便未实。脉则弦而带滑，右关较细。迳与归芍六君汤加味，培土抑木。方为：
党参9g焦白术9g茯苓9g炙甘草4．5g姜半夏4．5g陈皮4．5g砂仁2g当归6g炒白芍9g黄芪15g炒黄柏4．5g
此方间断服用106帖，依病者要求，药味药量均未变动。药后脘痛消失，大便正常，诸症俱解。以后仅过于劳累或熬夜后，脘中略有不适而已。患者性好杜康，病剧时勉力克制，戒酒不饮。今觉病愈，复饮如初，日无虚夕。十三年后随访，病未复作。
橘皮竹茹消胃炎
慢性胃炎(包括浅表性胃炎、萎缩性胃炎、肥厚性胃炎、糜烂性胃炎、胃窦炎等。)为西医学病名，中医学无有相对应之疾病名称。且本病缺乏特异性症状，甚至不少患者竟毫无症状可见。中医治病，不如西医须经理化检验，中医每以症状体征
橘皮竹茹消胃炎
慢性胃炎(包括浅表性胃炎、萎缩性胃炎、肥厚性胃炎、糜烂性胃炎、胃窦炎等。)为西医学病名，中医学无有相对应之疾病名称。且本病缺乏特异性症状，甚至不少患者竟毫无症状可见。中医治病，不如西医须经理化检验，中医每以症状体征为其主要依据，故无症状患者易被忽略。部分病人出现消化不良症状，可见中皖饱胀、嗳气等症，稍重者则有食欲减退，伴呕吐之患者，余所见不多，但泛恶者亦常有之。
余临证所见之慢性胃炎患者中，最多气阴两虚而兼肝胃郁热证候，故其舌体较薄较小，舌色淡红中略偏于红，苔则薄白稍干。脉象细小，或弦细，或细涩，偶可见细而带数者。
本病辨证略如上述，而其治法宜两调气阴，兼和肝胃。余抉择诸方，选用严用和之“橘皮竹茹汤”，随证加减，常常得心应手。
古方“橘皮竹茹汤”传有两方：一见于仲景之《金匮要略》，由橘皮、竹茹、人参、甘草、生姜、大枣六味组成，为治哕逆之剂。另有一首见于严用和之《济生方》，药味较前方多，实由前方加味而成。方由橘皮、竹茹、人参、甘草、半夏、麦冬、赤茯苓、枇杷叶、姜枣组成。以治久病虚赢，呕逆不已；或吐泻之后，胃虚呃逆。汪讱庵曰：“此是阳明胃药也。胃火上冲，肝胆之火助之，肺金之气不得下降，故呕。竹茹、枇杷叶、麦门冬，皆能清肺而和胃，肺金清则肝气亦平矣。二陈所以散逆气；赤茯苓所以降心火；生姜呕家之圣药；久病虚赢，故人参、甘草、大枣扶其胃气也。”汪氏对此方之释义，尚能符合今时胃炎中之气阴两虚兼见肺、肝、胃稍有郁热者之病机，故余见此证，每以此方加减投之，获效甚佳。且此方运用时，不必泥于呕吐一证，只须辨证明确，无呕吐者用之同样有效。惟不呕者可去姜枣，加入所需药物。方中赤茯苓余每以白茯苓易之，取其和中也。胃阴不足者，人参(或党参)改用太子参。胃津亏损者，去人参、半夏，而北沙参、川石斛、玉竹、白芍之类均可加入，或合入叶氏养胃汤，或参酌沙参麦冬汤意亦可，总在契合病机，药随证用则得矣。下附病例一则：
青年周某，1980年前后应征入伍，继因胃病退役回沪。自觉胃脘时痛，纳食不振，形瘦面黑，深以为虑。1984年11月在区中心医院摄片，确诊为“胃小弯溃疡”及“胃窦炎”。屡服西药及中成药，终未获得可靠疗效，且咽痛、感冒、牙龈炎等症常与脘痛错杂而见。至1987年1月病情加重：脘痛而外，常作头晕呕吐，所吐之物为饮食及粘痰，时带血丝。痛时胃中有似翻江倒海，自觉搅动不已。大便不实，泛恶而不泛酸。至此始来余处就诊。余诊得脉弦带滑，舌质红苔薄净。予《济生方)之橘皮竹茹汤：
党参9g炙甘草3g陈皮6g竹茹9g麦门冬9g姜半夏9g茯苓9g枇杷叶9g(包)生姜二片大枣7枚
按：此例患者，初起证情并不复杂，因循失治，渐至痰热孳生于胃脘，上逆则头晕呕吐，下行则大便不实。胃热上熏，则咽痛、龈肿，盖咽喉为肺胃之门户，而“齿为肾之余，龈为胃之络”也。故以橘皮竹茹汤清消脘中痰热，佐以益气扶中，药病相当，故诸证渐蠲。胃火亢盛时，稍参黄连之苦泄，即得其平。
至1988年3月于甲肝流行病中，复患传染性肝炎，GPT高达400U，服中药七帖后降至50u，又服七帖恢复正常。(所服方见“肝炎杂说”篇)
患者愈后胃病及肝炎均未复发，且感冒、咽痛等症亦少见。二年后摄片复查，仅有轻度胃炎，胃窦炎及胃小弯溃疡皆已消失。
饮食疗法胃疡平
某局职员曾某，于1974年底曾为余口述其所患严重胃溃疡不药而愈之经过。治法颇为巧妙，可资临证参考，爰记于此，以飨读者。曾约于七、八年前患胃小弯溃疡症，上午十时许、下午三时许必发剧痛，每痛必至浑身冷汗。中西医药迭治三年，病益笃。一日去外地出差，乘轮船中，旁坐两人，一老一少，正在谈论此病。听其言，知年少者患病而年长者为老医，彼此为戚者也。少者所述病情与曾极相似，曾遂侧耳细听。老医云：“此病吾治愈多人，不用药物，惟贵乎有恒，其效正不可思议。”于是告之以方法，曾亦默然记之，回家后即依法践行。其法为：每在规律性疼痛发作前约半小时进一餐，以平素喜食、易消化而富有营养之食物为佳。宜温食不宜冷食，宜软食不宜硬食。须基本吃饱，至正餐时仍须随量而进。每日发作几次，即须进食几次，一次都不得间断，二、三月后痛必不作，但仍须在原先每次食用之时间，继续进餐，吃至一年可断病根。曾遵行半载，已不觉疼，饮食畅进，全无妨碍。续行半年，以竟其全功。于是停止服食，越一周，脘中又见隐痛，寻思病重根深，食疗亦宜延长。嗣又如法服食半载，病根遂拔。其告余之时，已病愈十四、五年，胃脘从未再痛，仅多食纤维粗大之食物时，胃中稍有不适而已。从曾氏告余至今日，又二十余年，曾已由壮变老，而未闻其病之复萌也。后曾以此法授一店员，病不甚重，但上下午有明显之疼痛规律，服食半年即愈。
上述之法，可谓简矣，人皆能则而行之；可谓善矣，不服药即能去病如扫；亦可谓巧矣，法虽平易，而于服用时间、方法、食物均有明确要求。余所见消化道溃疡一病，类多虚证，恒以建中之法取其效，与曾氏所传，途虽殊而归则同也。而药之气味．必非胃家所喜，饮食之物，正乃谷肉果菜食以养之也。此法之着重处，必于痛发前半小时食用，痛而后食，则效差矣。其局限处，惟疼痛无规律者，为难以施行耳。
扶土抑木除脘痛
木旺犯土一症，为医家所习见，叶氏《临证指南》中收集验案甚多。华岫云于编后书曰：“肝为风木之脏，又为将军之官，其性急而动，故肝脏之病，较他脏为多。”又曰：“肝病必犯土，是侮其所胜也。”肝病犯土之证，每见呕吐不食，胁胀脘痞，因而医家常易误认脾胃之病，而忽略“实由肝邪所致。”为发聋振聩计，华氏将“木克土”证，立为一门，“以醒后人耳目。”虽屡遭徐灵胎诟病，而华氏济世之良工苦心实堪嘉许。木克土证之诊断，除症状而外，《临证指南》总结叶氏经验指出：“大凡其脉必弦。”颇符临床实际。
至其治法，《临证指南》曰：“若肝阴胃阴未亏，肝阳亢逆犯胃”者，“用药则远柔用刚。”“若肝阴胃汁已虚，木火炽盛，风阳扰胃，用药忌刚用柔。”余于临证间凡遇此症，不用大刚大柔之品，每以扶土抑木为法，欲其刚者，稍参温运。欲其柔者，略兼凉润，肝郁则佐以疏解，血滞则结合开通。苟能认证无误，投剂必有应验。某大饭店俞总经理之爱子，数年前独身赴美，攻读钢琴学位。毕业后举办演奏会，一举成名。于是邀请者踵至，演出日无虚夕。夜半返寓，必觉胃脘疼痛，渐至每夕演毕即痛，痛势甚剧，持续二、二三小时方始缓解。在彼就诊多次尚未有明确结论，予服之药，价极昂贵。然服后仅能减痛，不能全愈。巧值应邀回沪演出之机，经友人介绍，由其母陪同前来就诊。诊得两手脉弦强不和，舌质淡白，苔薄而净。据证据脉，当属木旺犯土之候。询其得病之因，彼则曰：“人而无名，自由自在；一经名噪，重负难释。”寥寥数语心声，不言病因而病因正在言中。余思此证病发于精神紧张之后，加之脉象弦甚，是肝郁不舒，致肝经气火亢盛，横越而克犯中土之象。治法惟宜疏肝泄木，扶土止痛之法。当今名医张镜人先生之安中和胃汤，虽不为此证设，而移用之恰极合拍，于是书方与之：
柴胡9g炒白术芍各9g黄芩9g丹参9g甘草3g太子参9g制香附6g生谷芽12g徐长卿15g
当日服一帖，夜间痛即不作。连服七日，疼痛沓然。为巩固疗效计，又服七日后停药，则脘痛始终未作也，且白昼精神情志亦较前大为宽松舒畅。嗣后带方返美，为事业之腾飞而继续奋斗。
饮证说约
人体水液输布失常，停积于某些局部者谓之饮证。《金匮要略》“痰饮咳嗽病脉证并治第十二”篇，将饮证分为痰饮、悬饮、溢饮、支饮四类。四者之区别在于：痰饮缘由脾胃阳衰，水饮停蓄于胃，下走肠间，故感沥沥有声。悬饮为水饮流于胁下，致使三焦之气机受阻，阴阳升降失其常度，咳则激动，停饮而发为“咳唾引痛”。溢饮为水饮浸润四肢肌表。而支饮则饮邪阻于胸膈之间，肺气升降失司，则“咳逆倚息，短气不得卧。”此外尚有留饮与伏饮。留饮乃饮邪久留不去之病证，至其症状：如饮邪留于心下则“背寒冷如掌大”；饮留胁下则胁下痛引缺盆，咳则增剧；饮留胸中则见短气、口渴；饮邪流注关节则四肢历节痛。伏饮为饮伏于内，为外邪引动而发之病证，可见发热、咳喘、腰背疼痛、目中泪出、发剧时身体振振动等证。
将仲景上述之论述加以归纳分析，痰、悬、溢、支之四饮，其区别主要在于发病部位，而留伏二饮，尚兼病久邪留不去因素。依据前人经验将饮证以三焦划分，似更简捷。如饮在上焦者，则见心肺证候：在肺则为咳为喘；在心则为悸为眩。如饮在中焦者，病见于胃、胸胁、四肢。在胃则饮食不消或发呕吐；在胸胁则胀痛或背寒冷如掌大；在四肢则历节疼痛或瘫废。饮在下焦者则见肠及脐下证候，如饮走肠间则腹中沥沥有声，或下利涎沫；饮在脐下则脐下悸。
疼痛长期且持续，发作呈现周期性；疼痛发作时常伴有烧灼感，或是钝痛，又或类似饥饿时的感觉；疼痛具有节律性：胃溃疡的疼痛多发生在餐后半小时，经过1～2小时可自行缓解。十二指肠溃疡的疼痛多发生在餐后2～3小时，通常需要进食才能停止；消化道溃疡患者大多表现为进食后疼痛减轻，按压后疼痛停止。
脘痛（上腹部疼痛）发作有定时，具备周期性和节律性的特征，这称为“信”。“胃属土而主信”，所以凡是因遵守季节、气候、年月、日期、时刻等规律而发病的，大多与中焦脾胃有关。脘痛本质上是脾胃的疾病，应当从调理脾胃入手治疗。本病在疼痛发作时，进食则疼痛减轻，按压则舒适，这是中焦土气虚衰的特征。如林佩琴在《类证治裁》中说：“凡是疼痛有虚实之分，按压后疼痛停止的是虚证，按压后疼痛反而加剧的是实证。”本病的脉象多见虚细或缓弱，舌质多淡或淡胖，苔多薄白。因此，本病的治疗法则应当遵循“虚则补之”、“劳则温之”的宗旨，以健脾益气、温养中焦为主。稍加宽中降逆、行气止痛的药物以治其标。本病在临床实践中虽非同一类型，但以脾胃气虚为多见，所以我选用六君子汤随证加减来治疗属于上述证候的本病患者。
方中以四君子汤益气培土以治其本，半夏和陈皮降逆和中，诸药的作用恰好与本病的见症相合，所以投用此方多能见效。本方如果患者在疼痛时喜欢温热敷熨及热饮，说明虚中夹有寒象，适宜加入生姜和大枣同煎，以加强和中温运的功效。关于生姜，其味辛辣，其性宣散，用于治疗此证则散寒有余，温养不足，最适宜的莫过于煨姜，可惜需要自制，恐怕不是普通患者所能做到的。
消化道溃疡所见的脘痛，既然有溃疡，多带有炎症。患者的脉象中常兼微弦或略弦强，舌边偏红，则是肝木犯胃、肝胃郁热的征象，方中应当兼清清热。当今多用蒲公英、金钱草或四季青，确有良效。明代孙一奎的《生生子医案》中每加黄柏一味。我思考这一味药确实极具道理，人身相火发自命门，寄居于肝胆，泻其相火，则肝胆之热易清，热清则肝木舒展而不克制中土，则脾胃安和，健运自如，溃疡愈合，疼痛消失。
我用此方治疗消化道溃疡，似乎觉得比小建中汤更能应手。小建中汤适宜于中焦虚损而肝木不旺、胃酸不多的人。而今的患者大多肝木偏亢，泛酸频繁。不宜使用白芍的酸敛，桂枝的温热以及饴糖的生酸作用。
附上一个治疗验案。
干部陶某，年过四十岁。因胃小弯溃疡，于1969年手术切除，之后十二指肠及小弯部又有新生病灶，且发作逐渐频繁，痛势逐渐增加，于1976年10月6日来诊。
自述胃脘疼痛，发作有定时，上午9～10时，下午2～4时必发。起初是隐隐作痛，逐渐加剧成为剧痛，但仍能忍受。且疼痛时进食则减轻，得暖则舒适。平时嗳气频繁，不嗳气则胃中胀闷。大便不成形，每天二、三次。脉弦而缓，苔薄白微腻，舌尖带红。这是中焦土气亏损，土虚木旺，乃肝脾不和的证候。然而侧重在于脾弱，脾虚失于运化，兼有气滞痰停，湿浊内困，因为当时见证嗳气尤为严重，先用和中降逆法，服用旋覆代赭汤五帖，嗳气消除，脘痛也减轻。原方加入砂仁、白芍、玉竹，又服十帖，脘痛再次减轻。但腹中气胀未消，大便仍未成形。脉则弦而带滑，右关脉较细。直接给予归芍六君汤加味，培土抑木。方剂组成如下：
党参9g 焦白术9g 茯苓9g 炙甘草4.5g 姜半夏4.5g 陈皮4.5g 砂仁2g 当归6g 炒白芍9g 黄芪15g 炒黄柏4.5g
此方间断服用106帖，依患者要求，药味药量均未变动。服药后脘痛消失，大便正常，诸症俱解。以后仅在过于劳累或熬夜后，胃中略有不适而已。患者喜好饮酒，病重时勉强克制，戒酒不饮。现在觉得病愈，恢复如初饮酒，每晚无例外。十三年后随访，病未复发。
橘皮竹茹消胃炎
慢性胃炎（包括浅表性胃炎、萎缩性胃炎、肥厚性胃炎、糜烂性胃炎、胃窦炎等。）为西医学病名，中医学没有相对应的疾病名称。且本病缺乏特异性症状，甚至不少患者竟毫无症状可见。中医治病，不像西医须经理化检验，中医多以症状体征为主要依据，故无症状患者易被忽略。部分病人出现消化不良症状，可见中脘饱胀、嗳气等症，稍重者则有食欲减退，伴有呕吐的患者，我所见到的不多，但泛恶者亦常有之。
我在临证所见到的慢性胃炎患者中，最多见的是气阴两虚而兼肝胃郁热证候，故其舌体较薄较小，舌色淡红中略偏于红，苔则薄白稍干。脉象细小，或弦细，或细涩，偶可见细而带数者。
本病辨证略如上述，而其治法宜两调气阴，兼和肝胃。我抉择诸方，选用严用和的“橘皮竹茹汤”，随证加减，常常得心应手。
古方“橘皮竹茹汤”传有两方：一见于张仲景的《金匮要略》，由橘皮、竹茹、人参、甘草、生姜、大枣六味组成，为治呃逆之剂。另有一首见于严用和的《济生方》，药味较前方多，实由前方加味而成。方由橘皮、竹茹、人参、甘草、半夏、麦冬、赤茯苓、枇杷叶、姜枣组成。用以治疗久病虚弱羸瘦，呕逆不已；或吐泻之后，胃虚呃逆。汪讱庵说：“这是阳明胃药也。胃火上冲，肝胆之火助之，肺金之气不得下降，故呕。竹茹、枇杷叶、麦门冬，皆能清肺而和胃，肺金清则肝气亦平矣。二陈汤所以散逆气；赤茯苓所以降心火；生姜是呕家之圣药；久病虚弱羸瘦，故用人参、甘草、大枣扶其胃气也。”汪氏对此方的释义，尚能符合今时胃炎中之气阴两虚兼见肺、肝、胃稍有郁热者的病机，所以我见此证，每以此方加减投用，获效甚佳。且此方运用时，不必拘泥于呕吐一证，只要辨证明确，无呕吐者用之同样有效。惟有不呕吐者可去掉姜枣，加入所需药物。方中赤茯苓我每以白茯苓替代，取其和中之意。胃阴不足者，人参（或党参）改用太子参。胃津亏损者，去人参、半夏，而北沙参、川石斛、玉竹、白芍之类均可加入，或合入叶天士养胃汤，或参酌沙参麦冬汤之意亦可，总在契合病机，药随证用即可。下附病例一则：
青年周某，1980年前后应征入伍，继因胃病退役回沪。自觉胃脘时痛，纳食不振，形体消瘦面色黑，深以为虑。1984年11月在区中心医院摄片，确诊为“胃小弯溃疡”及“胃窦炎”。屡服西药及中成药，终未获得可靠疗效，且咽痛、感冒、牙龈炎等症常与脘痛错杂而见。至1987年1月病情加重：除脘痛外，常作头晕呕吐，所吐之物为饮食及粘痰，时带血丝。疼痛时胃中有似翻江倒海，自觉搅动不已。大便不实，泛恶而不泛酸。至此始来我处就诊。我诊得脉弦带滑，舌质红苔薄净。予《济生方》之橘皮竹茹汤：
党参9g 炙甘草3g 陈皮6g 竹茹9g 麦门冬9g 姜半夏9g 茯苓9g 枇杷叶9g（包） 生姜二片 大枣7枚
按：此例患者，初起证情并不复杂，因循失治，渐至痰热孳生于胃脘，上逆则头晕呕吐，下行则大便不实。胃热上熏，则咽痛、龈肿，盖咽喉为肺胃之门户，而“齿为肾之余，龈为胃之络”也。故以橘皮竹茹汤清消脘中痰热，佐以益气扶中，药病相当，故诸证渐蠲。胃火亢盛时，稍参黄连之苦泄，即得其平。
至1988年3月在甲肝流行病中，复患传染性肝炎，GPT高达400U，服中药七帖后降至50u，又服七帖恢复正常。（所服方见“肝炎杂说”篇）
患者愈后胃病及肝炎均未复发，且感冒、咽痛等症亦少见。二年后摄片复查，仅有轻度胃炎，胃窦炎及胃小弯溃疡皆已消失。
饮食疗法胃疡平
某局职员曾某，于1974年底曾为我口述其所患严重胃溃疡不药而愈之经过。治法颇为巧妙，可资临证参考，爰记于此，以飨读者。曾约于七、八年前患胃小弯溃疡症，上午十时许、下午三时许必发剧痛，每痛必至浑身冷汗。中西医药迭治三年，病益笃。一日去外地出差，乘轮船中，旁坐两人，一老一少，正在谈论此病。听其言，知年少者患病而年长者为老医，彼此为亲戚者也。少者所述病情与曾极相似，曾遂侧耳细听。老医云：“此病吾治愈多人，不用药物，惟贵乎有恒，其效正不可思议。”于是告之以方法，曾亦默然记之，回家后即依法践行。其法为：每在规律性疼痛发作前约半小时进一餐，以平素喜食、易消化而富有营养之食物为佳。宜温食不宜冷食，宜软食不宜硬食。须基本吃饱，至正餐时仍须随量而进。每日发作几次，即须进食几次，一次都不得间断，二、三月后痛必不作，但仍须在原先每次食用之时间，继续进餐，吃至一年可断病根。曾遵行半载，已不觉疼，饮食畅进，全无妨碍。续行半年，以竟其全功。于是停止服食，越一周，脘中又见隐痛，寻思病重根深，食疗亦宜延长。嗣又如法服食半载，病根遂拔。其告余之时，已病愈十四、五年，胃脘从未再痛，仅多食纤维粗大之食物时，胃中稍有不适而已。从曾氏告余至今日，又二十余年，曾已由壮变老，而未闻其病之复萌也。后曾以此法授一店员，病不甚重，但上下午有明显之疼痛规律，服食半年即愈。
上述之法，可谓简矣，人皆能则而行之；可谓善矣，不服药即能去病如扫；亦可谓巧矣，法虽平易，而于服用时间、方法、食物均有明确要求。我所见消化道溃疡一病，类多虚证，恒以建中之法取其效，与曾氏所传，途虽殊而归则同也。而药之气味，必非胃家所喜，饮食之物，正乃谷肉果菜食以养之也。此法之着重处，必于痛发前半小时食用，痛而后食，则效差矣。其局限处，惟疼痛无规律者，为难以施行耳。
扶土抑木除脘痛
木旺犯土一症，为医家所习见，叶氏《临证指南》中收集验案甚多。华岫云于编后书曰：“肝为风木之脏，又为将军之官，其性急而动，故肝脏之病，较他脏为多。”又曰：“肝病必犯土，是侮其所胜也。”肝病犯土之证，每见呕吐不食，胁胀脘痞，因而医家常易误认脾胃之病，而忽略“实由肝邪所致。”为发聋振聩计，华氏将“木克土”证，立为一门，“以醒后人耳目。”虽屡遭徐灵胎诟病，而华氏济世之良工苦心实堪嘉许。木克土证之诊断，除症状而外，《临证指南》总结叶氏经验指出：“大凡其脉必弦。”颇符临床实际。
至其治法，《临证指南》曰：“若肝阴胃阴未亏，肝阳亢逆犯胃”者，“用药则远柔用刚。”“若肝阴胃汁已虚，木火炽盛，风阳扰胃，用药忌刚用柔。”我于临证间凡遇此症，不用大刚大柔之品，每以扶土抑木为法，欲其刚者，稍参温运。欲其柔者，略兼凉润，肝郁则佐以疏解，血滞则结合开通。苟能认证无误，投剂必有应验。某大饭店俞总经理之爱子，数年前独身赴美，攻读钢琴学位。毕业后举办演奏会，一举成名。于是邀请者踵至，演出日无虚夕。夜半返寓，必觉胃脘疼痛，渐至每夕演毕即痛，痛势甚剧，持续二、三小时方始缓解。在彼就诊多次尚未有明确结论，予服之药，价极昂贵。然服后仅能减痛，不能全愈。巧值应邀回沪演出之机，经友人介绍，由其母陪同前来就诊。诊得两手脉弦强不和，舌质淡白，苔薄而净。据证据脉，当属木旺犯土之候。询其得病之因，彼则曰：“人而无名，自由自在；一经名噪，重负难释。”寥寥数语心声，不言病因而病因正在言中。我思此证病发于精神紧张之后，加之脉象弦甚，是肝郁不舒，致肝经气火亢盛，横越而克犯中土之象。治法惟宜疏肝泄木，扶土止痛之法。当今名医张镜人先生的安中和胃汤，虽不为此证设，而移用之恰极合拍，于是书方与之：
柴胡9g 炒白术芍各9g 黄芩9g 丹参9g 甘草3g 太子参9g 制香附6g 生谷芽12g 徐长卿15g
当日服一帖，夜间痛即不作。连服七日，疼痛沓然。为巩固疗效计，又服七日后停药，则脘痛始终未作也，且白昼精神情志亦较前大为宽松舒畅。嗣后带方返美，为事业之腾飞而继续奋斗。
饮证说约
人体水液输布失常，停积于某些局部者谓之饮证。《金匮要略》“痰饮咳嗽病脉证并治第十二”篇，将饮证分为痰饮、悬饮、溢饮、支饮四类。四者之区别在于：痰饮缘由脾胃阳衰，水饮停蓄于胃，下走肠间，故感沥沥有声。悬饮为水饮流于胁下，致使三焦之气机受阻，阴阳升降失其常度，咳则激动，停饮而发为“咳唾引痛”。溢饮为水饮浸润四肢肌表。而支饮则饮邪阻于胸膈之间，肺气升降失司，则“咳逆倚息，短气不得卧。”此外尚有留饮与伏饮。留饮乃饮邪久留不去之病证，至其症状：如饮邪留于心下则“背寒冷如掌大”；饮留胁下则胁下痛引缺盆，咳则增剧；饮留胸中则见短气、口渴；饮邪流注关节则四肢历节痛。伏饮为饮伏于内，为外邪引动而发之病证，可见发热、咳喘、腰背疼痛、目中泪出、发剧时身体振振动等证。
将仲景上述之论述加以归纳分析，痰、悬、溢、支之四饮，其区别主要在于发病部位，而留伏二饮，尚兼病久邪留不去因素。依据前人经验将饮证以三焦划分，似更简捷。如饮在上焦者，则见心肺证候：在肺则为咳为喘；在心则为悸为眩。如饮在中焦者，病见于胃、胸胁、四肢。在胃则饮食不消或发呕吐；在胸胁则胀痛或背寒冷如掌大；在四肢则历节疼痛或瘫废。饮在下焦者则见肠及脐下证候，如饮走肠间则腹中沥沥有声，或下利涎沫；饮在脐下则脐下悸。
Pain is long-term and continuous, with episodes presenting a periodicity; during pain episodes, there is often a burning sensation, or dull pain, or a feeling similar to hunger; the pain has rhythm: gastric ulcer pain mostly occurs half an hour after meals and can relieve itself after 1-2 hours. Duodenal ulcer pain mostly occurs 2-3 hours after meals and usually requires eating to stop; patients with digestive tract ulcers mostly show pain relief after eating and pain cessation upon pressure.
Epigastric pain (upper abdominal pain) occurs at fixed times, possessing characteristics of periodicity and rhythm, which is called "Xin" (Faithfulness/Punctuality). "The Stomach belongs to Earth and governs Xin," so diseases that occur in accordance with seasons, climate, years, months, dates, and times are mostly related to the Middle Jiao Spleen and Stomach. Epigastric pain is essentially a disease of the Spleen and Stomach and should be treated by regulating the Spleen and Stomach. When this disease's pain occurs, eating relieves it and pressing brings comfort, which is a characteristic of Middle Jiao Earth Qi deficiency. As Lin Peiqin stated in *Lei Zheng Zhi Cai* (Classification and Treatment of Various Diseases): "For all pains, there is deficiency and excess; if pressing stops the pain, it is deficiency; if pressing aggravates the pain, it is excess." The pulse of this disease mostly appears deficient and fine or slow and weak; the tongue body is mostly pale or pale and swollen, and the coating is mostly thin and white. Therefore, the treatment principle for this disease should follow the maxim "tonify deficiency" and "warm exhaustion," focusing on invigorating the Spleen, benefiting Qi, and warming/nourishing the Middle Jiao. Slightly adding herbs to broaden the middle, direct rebellious Qi downward, move Qi, and stop pain treats the branch. Although this disease presents in various types in clinical practice, Spleen-Stomach Qi deficiency is most common, so I select Liu Jun Zi Tang (Six Gentlemen Decoction) with modifications to treat patients with the above syndrome.
In the formula, Si Jun Zi Tang (Four Gentlemen Decoction) benefits Qi and cultivates Earth to treat the root; Ban Xia (Pinelliae Rhizoma) and Chen Pi (Citri Reticulatae Pericarpium) direct rebellious Qi downward and harmonize the middle; the actions of the herbs coincide well with the symptoms of this disease, so administering it often yields results. If patients prefer warm compresses and hot drinks during pain, indicating cold夹杂 within deficiency, it is suitable to add Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus) to decoct together, to strengthen harmonizing the middle and warming movement. Regarding Sheng Jiang, its flavor is pungent and spicy, its nature is dispersing; used for this syndrome, it has sufficient ability to dispel cold but insufficient ability to warm and nourish. The most suitable is Wei Jiang (Roasted Ginger), unfortunately requiring homemade preparation, which ordinary patients may not be able to do.
Epigastric pain seen in digestive tract ulcers, since there is an ulcer, often carries inflammation. The patient's pulse often includes slight wiriness or slightly wiry-strong, and the tongue edges are reddish, which is a sign of Liver Wood invading the Stomach and Liver-Stomach stagnant heat. The formula should include clearing heat. Nowadays, Pu Gong Ying (Taraxaci Herba), Jin Qian Cao (Lysimachiae Herba), or Si Ji Qing (Ilicis Cornutae Folium) are mostly used, with definite good effects. In Sun Yikui's *Sheng Sheng Zi Yi An* (Medical Cases of Sheng Sheng Zi) from the Ming Dynasty, Huang Bo (Phellodendri Cortex) is added. I consider this herb to have profound rationale; the Ministerial Fire in the human body originates from the Gate of Life (Ming Men) and resides in the Liver and Gallbladder. Clearing the Ministerial Fire makes clearing Liver-Gallbladder heat easy; once heat is cleared, Liver Wood relaxes and does not suppress the Middle Jiao, thus the Spleen and Stomach become peaceful, transportation and transformation function freely, ulcers heal, and pain disappears.
I use this formula to treat digestive tract ulcers and feel it seems more effective than Xiao Jian Zhong Tang (Minor Construct the Middle Decoction). Xiao Jian Zhong Tang is suitable for those with Middle Jiao deficiency where Liver Wood is not hyperactive and stomach acid is not excessive. However, modern patients mostly have hyperactive Liver Wood and frequent acid regurgitation. It is unsuitable to use Bai Shao (Paeoniae Radix Alba) for its sour astringency, Gui Zhi (Cinnamomi Ramulus) for its warmth, and Yi Tang (Maltose) for its tendency to generate acid.
Attached is one treatment case.
Cadre Mr. Tao, over forty years old. Due to a lesser curvature gastric ulcer, he underwent surgical resection in 1969. Later, new lesions appeared in the duodenum and lesser curvature, with increasing frequency and severity of attacks. He came for consultation on October 6, 1976.
He reported epigastric pain occurring at fixed times, inevitably happening between 9-10 AM and 2-4 PM. Initially, it was a lingering dull pain, gradually intensifying to severe pain, but still bearable. Pain relieved with eating and comforted by warmth. Usually, he belched frequently; without belching, his epigastrium felt distended and stuffy. Stools were unformed, two to three times daily. Pulse was wiry and slow, coating thin white and slightly greasy, tongue tip red. This is Middle Jiao Earth deficiency, Earth deficiency leading to Wood hyperactivity, a syndrome of Liver-Spleen disharmony. However, the focus is on Spleen weakness; Spleen deficiency fails in transportation, accompanied by Qi stagnation and Phlegm retention, with Damp-Turbidity confining internally. Since belching was prominent at that time, I first used the method of harmonizing the middle and directing rebellious Qi downward, administering Xuan Fu Dai Zhe Tang (Inula and Hematite Decoction) for five doses. Belching ceased, and epigastric pain also decreased. To the original formula, Sha Ren (Amomi Fructus Rotundus), Bai Shao (Paeoniae Radix Alba), and Yu Zhu (Polygonati Odorati Rhizoma) were added, taken for ten doses, further reducing epigastric pain. However, abdominal Qi distension remained, and stools were still unformed. Pulse became wiry and slippery, with the Right Guan position thinner. Directly administered Gui Shao Liu Jun Zi Tang (Guizhi-Shaoyao Six Gentlemen Decoction? Note: Text says Gui Shao Liu Jun Zi Tang, likely implying Guizhi/Bai Shao modification or just a specific variation, but literally "Return and White Peony Six Gentlemen") with modifications to cultivate Earth and suppress Wood. Formula:
Dang Shen (Codonopsis Radix) 9g, Jiao Bai Zhu (Charred Atractylodis Macrocephalae Rhizoma) 9g, Fu Ling (Poria) 9g, Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) 4.5g, Jiang Ban Xia (Ginger-processed Pinelliae Rhizoma) 4.5g, Chen Pi (Citri Reticulatae Pericarpium) 4.5g, Sha Ren (Amomi Fructus Rotundus) 2g, Dang Gui (Angelicae Sinensis Radix) 6g, Chao Bai Shao (Stir-fried Paeoniae Radix Alba) 9g, Huang Qi (Astragali Radix) 15g, Chao Huang Bo (Stir-fried Phellodendri Cortex) 4.5g.
This formula was taken intermittently for 106 doses. At the patient's request, herb names and dosages remained unchanged. After medication, epigastric pain disappeared, stools normalized, and all symptoms resolved. Afterwards, only slight discomfort occurred in the epigastrium after extreme fatigue or staying up late. The patient enjoyed drinking alcohol; during severe illness, he forcibly restrained himself and abstained. Now feeling cured, he resumed drinking as before, every night without exception. Follow-up thirteen years later showed no recurrence.
Ju Pi Zhu Ru Xiao Wei Yan (Tangerine Peel and Bamboo Shave Eliminate Gastritis)
Chronic gastritis (including superficial gastritis, atrophic gastritis, hypertrophic gastritis, erosive gastritis, antral gastritis, etc.) is a Western medical term; Traditional Chinese Medicine (TCM) has no corresponding disease name. Moreover, this disease lacks specific symptoms, and even many patients show no visible symptoms. TCM treatment, unlike Western medicine which requires physical and chemical examinations, relies mainly on symptoms and signs; thus, asymptomatic patients are easily overlooked. Some patients present with dyspepsia symptoms, such as fullness in the Zhongwan area and belching. Those with slightly heavier conditions have reduced appetite. Patients with vomiting are rare in my experience, but nausea is common.
Among chronic gastritis patients I see clinically, the most common is Qi and Yin deficiency combined with Liver-Stomach stagnant heat. Thus, their tongues are relatively thin and small, the tongue color is pale red leaning slightly towards red, and the coating is thin white and slightly dry. The pulse is fine, or wiry-fine, or fine-choppy, occasionally fine and rapid.
Syndrome differentiation for this disease is roughly as described above, and the treatment method should simultaneously regulate Qi and Yin, and harmonize the Liver and Stomach. After selecting among various formulas, I chose Yan Yonghe's "Ju Pi Zhu Ru Tang" (Tangerine Peel and Bamboo Shave Decoction), modified according to the syndrome, and it often works effectively.
There are two ancient versions of "Ju Pi Zhu Ru Tang": one appears in Zhang Zhongjing's *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), composed of six herbs: Ju Pi (Citri Reticulatae Pericarpium), Zhu Ru (Bambusae Caulis in Taenia), Ren Shen (Ginseng Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Sheng Jiang (Zingiberis Rhizoma Recens), and Da Zao (Jujubae Fructus), serving as a remedy for hiccups. The other appears in Yan Yonghe's *Ji Sheng Fang* (Prescriptions for Saving Lives), with more herbs than the former, actually formed by adding to the previous formula. The formula consists of Ju Pi, Zhu Ru, Ren Shen, Gan Cao, Ban Xia (Pinelliae Rhizoma), Mai Dong (Ophiopogonis Radix), Chi Fu Ling (Red Poria), Pi Pa Ye (Loquat Leaf), Sheng Jiang, and Da Zao. It treats chronic illness with weakness and emaciation, incessant vomiting and hiccups; or after vomiting and diarrhea, Stomach deficiency causing hiccups. Wang Ren'an said: "This is a Yangming Stomach herb. Stomach Fire rushes upward, assisted by Liver-Gallbladder Fire, Lung Metal Qi cannot descend, hence vomiting. Zhu Ru, Pi Pa Ye, and Mai Men Dong can all clear the Lung and harmonize the Stomach; when Lung Metal is clear, Liver Qi is also pacified. Er Chen Tang disperses rebellious Qi; Chi Fu Ling descends Heart Fire; Sheng Jiang is the holy medicine for vomiters; due to chronic illness and weakness, Ren Shen, Gan Cao, and Da Zao support Stomach Qi." Wang's interpretation of this formula still fits the pathogenesis of modern gastritis involving Qi and Yin deficiency combined with slight stagnant heat in the Lung, Liver, and Stomach. Therefore, when I encounter this syndrome, I often use this formula with modifications, achieving excellent results. Furthermore, when using this formula, one need not stick strictly to the symptom of vomiting; as long as syndrome differentiation is clear, it is equally effective for those without vomiting. For those not vomiting, Sheng Jiang and Da Zao can be removed, and necessary herbs added. I often replace Chi Fu Ling with Bai Fu Ling (White Poria) in the formula, taking advantage of its harmonizing property. For Stomach Yin deficiency, Ren Shen (or Dang Shen) is changed to Tai Zi Shen (Pseudostellariae Radix). For Stomach Fluid loss, Ren Shen and Ban Xia are removed, and Bei Sha Shen (Glehniae Radix), Chuan Shi Hu (Dendrobii Caulis), Yu Zhu, and Bai Shao can be added, or combined with Ye Tian Shi's Yang Wei Tang (Nourish Stomach Decoction), or referring to the intent of Sha Shen Mai Dong Tang (Glehnia and Ophiopogon Decoction) is also acceptable. The key lies in matching the pathogenesis and using herbs according to the syndrome. Below is one case:
Young Mr. Zhou, enlisted around 1980, and subsequently discharged due to stomach disease, returning to Shanghai. He felt intermittent epigastric pain, poor appetite, emaciated with dark complexion, deeply worried. In November 1984, X-rays at the District Central Hospital confirmed "lesser curvature gastric ulcer" and "antral gastritis." Repeated treatments with Western medicines and Chinese patent medicines yielded no reliable effect, and symptoms like sore throat, colds, and gingivitis often mixed with epigastric pain. By January 1987, the condition worsened: besides epigastric pain, he often experienced dizziness and vomiting, vomiting food and sticky phlegm, sometimes with blood streaks. During pain, his stomach felt like churning seas, constantly agitated. Stools were unformed, nausea without acid regurgitation. Only then did he come to consult me. I diagnosed a wiry-slippery pulse, red tongue body with thin clean coating. I prescribed Ju Pi Zhu Ru Tang from *Ji Sheng Fang*:
Dang Shen (Codonopsis Radix) 9g, Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) 3g, Chen Pi (Citri Reticulatae Pericarpium) 6g, Zhu Ru (Bambusae Caulis in Taenia) 9g, Mai Men Dong (Ophiopogonis Radix) 9g, Jiang Ban Xia (Ginger-processed Pinelliae Rhizoma) 9g, Fu Ling (Poria) 9g, Pi Pa Ye (Loquat Leaf) 9g (wrapped), Sheng Jiang (Zingiberis Rhizoma Recens) 2 slices, Da Zao (Jujubae Fructus) 7 pieces.
Subsequently, Huang Lian (Coptidis Rhizoma) and Shi Hu (Dendrobii Caulis) were added according to the syndrome. After thirty doses, all symptoms gradually resolved.
Commentary: This patient's initial condition was not complex. Neglecting treatment led to Phlegm-Heat breeding in the epigastrium. Rising upward caused dizziness and vomiting; descending downward caused unformed stools. Stomach Heat steaming upward caused sore throat and gum swelling, as the throat is the gateway of the Lung and Stomach, and "teeth are the surplus of Kidney, gums are the collaterals of Stomach." Thus, Ju Pi Zhu Ru Tang clears and eliminates Phlegm-Heat in the epigastrium, assisted by tonifying Qi and supporting the Middle. The medicine matched the disease, so symptoms gradually subsided. When Stomach Fire was hyperactive, slightly adding Huang Lian's bitter drainage brought balance.
By March 1988, during the Hepatitis A epidemic, he contracted infectious hepatitis again. GPT reached 400U. After seven doses of Chinese medicine, it dropped to 50U, and after another seven doses, it returned to normal. (The prescribed formula is seen in the "Miscellaneous Sayings on Hepatitis" chapter).
After recovery, neither the stomach disease nor hepatitis recurred, and symptoms like colds and sore throats were rarely seen. Two years later, X-ray复查 showed only mild gastritis; antral gastritis and lesser curvature gastric ulcer had disappeared.
Dietary Therapy: Wei Yang Ping (Stomach Ulcer Peace)
Mr. Zeng, a staff member of a certain bureau, narrated to me in late 1974 how his severe gastric ulcer healed without medication. The treatment method was quite ingenious, worthy of clinical reference, so I record it here for readers. About seven or eight years prior, Mr. Zeng suffered from a lesser curvature gastric ulcer. Severe pain inevitably occurred around 10 AM and 3 PM, causing profuse cold sweats throughout the body. Three years of alternating Chinese and Western medical treatments made the disease worse. One day, while traveling abroad on business, he sat next to two people on a ship, an old man and a young man, discussing this disease. Listening to them, he learned the young man was sick and the old man was an elderly doctor, and they were relatives. The young man's described condition was very similar to Mr. Zeng's, so he listened carefully. The old doctor said: "I have cured many people of this disease without drugs. Persistence is key; the effect is truly incredible." He then told him the method. Mr. Zeng memorized it silently and practiced it at home. The method was: eat a meal about half an hour before the regular pain episode, preferably foods he usually liked, easy to digest, and nutritious. Warm food is better than cold; soft food is better than hard. Eat until basically full, and continue to eat according to capacity at regular meal times. Whatever number of times pain occurs daily, eat that many times, never missing a single time. After two or three months, pain will surely cease. However, one must continue eating at the original times for a year to eradicate the root cause. Mr. Zeng followed this for half a year, no longer felt pain, ate freely without hindrance. He continued for another half year to complete the cure. Then he stopped eating according to the schedule. A week later, dull pain appeared in the epigastrium again. Thinking the disease was deep-rooted, dietary therapy should be extended. He followed the method for another half year, and the root cause was eradicated. When he told me, he had been cured for fourteen or fifteen years, never having epigastric pain again, except for slight discomfort when eating coarse fibrous foods. From when Mr. Zeng told me to today, over twenty years have passed. He has aged from youth to old age, and we have not heard of the disease recurring. Later, Mr. Zeng taught this method to a shop assistant. The disease was not severe, but there was a clear pain pattern in the morning and afternoon. Eating according to the method for half a year resulted in a cure.
The aforementioned method can be called simple, as everyone can follow it; it can be called good, as it removes disease like sweeping without taking medicine; it can also be called ingenious. Although the method is plain, it has clear requirements for timing, method, and food. The digestive tract ulcers I see are mostly deficiency syndromes, and I often achieve efficacy with Jian Zhong methods. Although the paths differ from Mr. Zeng's transmission, the destination is the same. The taste and smell of medicine are certainly not what the Stomach likes, whereas food items—grains, meats, fruits, and vegetables—are indeed what nourish the body. The emphasis of this method is eating half an hour before pain onset; eating after pain starts yields poorer effects. Its limitation is that it is difficult to implement for those with irregular pain.
Foster Earth Suppress Wood to Eliminate Epigastric Pain
Wood Hyperactivity Invading Earth is a syndrome commonly seen by physicians. Ye Tianshi's *Lin Zheng Zhi Nan* (Guide to Clinical Practice) collects many verified cases. Hua Xiuyun wrote in the postscript: "The Liver is the organ of Wind-Wood and the General Officer. Its nature is urgent and active, so Liver diseases are more numerous than those of other organs." He also said: "Liver disease must invade Earth, which is insulting what it conquers." Syndromes of Liver disease invading Earth often present with vomiting, refusal to eat, hypochondriac distension, and epigastric fullness. Consequently, physicians often mistakenly recognize them as Spleen-Stomach diseases, ignoring that "they are actually caused by Liver pathogenic factors." To awaken the deaf and startle the dull, Mr. Hua established "Wood Overacting on Earth" as a separate category "to wake up future generations' eyes and ears." Although criticized repeatedly by Xu Lingtai, Mr. Hua's benevolent effort to save the world is truly commendable. For diagnosing Wood Overacting on Earth, besides symptoms, *Lin Zheng Zhi Nan* summarizes Ye Tianshi's experience pointing out: "Generally, the pulse must be wiry." This fits clinical reality well.
Regarding treatment, *Lin Zheng Zhi Nan* states: "If Liver Yin and Stomach Yin are not depleted, and Liver Yang rebels invading the Stomach," use "medicine that avoids softness and uses hardness." "If Liver Yin and Stomach Juice are already deficient, Wood-Fire is blazing, Wind-Yang disturbs the Stomach," avoid hardness and use softness. Whenever I encounter this syndrome in clinical practice, I do not use extremely hard or soft herbs. Instead, I use the method of fostering Earth and suppressing Wood. For hardness, I slightly add warming and moving herbs. For softness, I slightly add cooling and moistening herbs. For Liver depression, I assist with soothing and resolving; for Blood stasis, I combine with opening and unblocking. If syndrome differentiation is accurate, the prescription will surely work. The beloved son of General Yu of a large hotel went alone to the US several years ago to study for a piano degree. After graduation, he held a concert and became famous overnight. Invitations followed continuously, performing every night without fail. Returning home at midnight, he always felt epigastric pain, which gradually progressed to pain immediately after every evening performance, severe in intensity, lasting two to three hours before relief. Multiple consultations there yielded no clear conclusion. The medicines he took were extremely expensive. However, they only reduced pain, not curing it completely. Coincidentally, when invited back to Shanghai for performances, introduced by a friend, he came for consultation accompanied by his mother. I diagnosed both hands' pulses as wiry-strong and discordant, tongue body pale white, coating thin and clean. Based on symptoms and pulse, this belongs to the syndrome of Wood Hyperactivity Invading Earth. Asking for the cause of the disease, he said: "Without fame, one is free; once famous, the heavy burden is hard to shed." These few words revealed his heart; without explicitly stating the cause, the cause was right there. I considered this syndrome developed after mental tension, plus the wiry pulse indicated Liver depression and discomfort, causing Liver Meridian Qi and Fire to become hyperactive, crossing horizontally to attack the Middle Jiao. The treatment method should be soothing the Liver, draining Wood, fostering Earth, and stopping pain. Mr. Zhang Jingren, a famous contemporary physician, has An Zhong He Wei Tang (Harmonize the Middle and Stomach Decoction). Although not specifically designed for this syndrome, applying it fits perfectly. So I prescribed:
Chai Hu (Bupleuri Radix) 9g, Chao Bai Zhu Shao (Stir-fried Atractylodis Macrocephalae Rhizoma and Paeoniae Radix Alba) each 9g, Huang Qin (Scutellariae Radix) 9g, Dan Shen (Salviae Miltiorrhizae Radix) 9g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 3g, Tai Zi Shen (Pseudostellariae Radix) 9g, Zhi Xiang Fu (Cyperi Rhizoma) 6g, Sheng Gu Ya (Hordei Fructus Germinatus) 12g, Xu Chang Qing (Polygalae Radix) 15g.
He took one dose that day, and the nighttime pain did not occur. Taking it continuously for seven days, the pain vanished. To consolidate the curative effect, he took it for another seven days before stopping. Epigastric pain never occurred again, and his daytime spirit and mood were much more relaxed and comfortable than before. Subsequently, he took the formula back to the US to continue striving for career success.
Brief Discussion on Yin Syndrome
When the body's fluid distribution is abnormal and accumulates in certain localities, it is called Yin Syndrome. The chapter "Tan Yin Ke Sou Bing Mai Zheng Bing Zhi Di Shi Er" (Chapter 12: Tan Yin, Cough, and Asthma Disease, Pulse, Syndrome, and Treatment) in *Jin Gui Yao Lue* divides Yin Syndrome into four categories: Tan Yin (Phlegm-Fluid), Xuan Yin (Hanging Fluid), Yi Yin (Overflowing Fluid), and Zhi Yin (Supporting Fluid). The distinction among the four lies in: Tan Yin arises from Spleen-Stomach Yang decline, water-fluid stagnates in the Stomach, flows down to the intestines, causing gurgling sounds. Xuan Yin is water-fluid flowing under the hypochondrium, obstructing San Jiao Qi mechanism, causing Yin-Yang ascent-descent to lose normal degree; coughing stimulates it, stagnant fluid causes "pain induced by coughing and spitting." Yi Yin is water-fluid infiltrating the limbs and muscle surface. Zhi Yin is fluid pathogen blocking between the chest and diaphragm, Lung Qi ascent-descent losing control, causing "coughing and wheezing leaning on support, shortness of breath unable to lie flat." Additionally, there are Liu Yin (Retained Fluid) and Fu Yin (Hidden Fluid). Liu Yin is a disease where fluid pathogen remains for a long time. Its symptoms: if fluid stays below the heart, "back feels cold as large as a palm"; if fluid stays under the hypochondrium, hypochondriac pain radiates to the supraclavicular fossa, worsening with cough; if fluid stays in the chest, shortness of breath and thirst appear; if fluid flows into joints, limb joint pain occurs. Fu Yin is fluid hidden internally, triggered by external pathogens, manifesting as fever, coughing and wheezing, lower back pain, tearing from eyes, and body trembling during severe attacks.
Summarizing and analyzing Zhang Zhongjing's above discussion, the distinction among Tan, Xuan, Yi, and Zhi fluids mainly lies in the site of onset. Liu and Fu fluids additionally involve the factor of long-standing disease with pathogen remaining. Based on predecessors' experience, dividing Yin Syndrome by San Jiao seems simpler. If fluid is in the Upper Jiao, Heart-Lung syndromes appear: in the Lung, it is cough and asthma; in the Heart, palpitations and dizziness. If fluid is in the Middle Jiao, disease appears in the Stomach, chest-hypochondrium, and limbs. In the Stomach, indigestion or vomiting occurs; in the chest-hypochondrium, distending pain or back coldness like a palm size; in the limbs, joint pain or paralysis. If fluid is in the Lower Jiao, Intestine and below-umbilicus syndromes appear: if fluid flows through intestines, gurgling sounds in abdomen or diarrhea with saliva-like mucus; if fluid is below the umbilicus, palpitations below the umbilicus.