三诊 痿 在下，肝肾居多，但素饮必有湿热，热瘀湿滞，气血不行，筋缩，肌肉不仁
质重着不移，无非湿邪之深沉也。若论阳虚不该大发疮痍，但病久非可速攻，莫计效迟，
细生地 归身 黄柏 萆 苁蓉 川斛 牛膝 蒺藜
四诊 寝食如常，脉沉而缓，独两腿内外肉脱麻木，年逾五旬，阳脉渐衰，跷维不为用
事，非三气杂感也。温通以佐脉络之流畅，仿古圣四斤金刚之属。
苁蓉 牛膝 茯苓 萆 木瓜 枸杞子 蒺藜 金毛狗脊膏丸
经云∶烦劳则张，精绝，辟积于夏，令人煎厥。夫劳动阳气弛张，则精气不充，留恋其
阳，
益肾，使肝胆相火不致暴起，宣风静熄，不为晕厥。然必薄味静养为稳。
细生地 连翘 知母 元参 生白芍 竹叶
肾厥，由腰脊而升，发时手足逆冷，口吐涎沫，喉如刀刺。盖足少阴经脉，上循喉咙，
挟舌本，阴浊自下犯上，必循经而至。仿许学士 椒附汤，通阳以泄浊阴为主。
炮附子 淡干姜 葫芦巴 川椒 半夏 茯苓
脐上心下热炽，咽喉间陈腐气遂神昏扑厥。经时汗出而醒，口涌血沫，乃膻中热壅，以
致心窍受蒙。若非芳香清透，不能宣通络中瘀痹。
犀角 茯神 天竺黄 麝香 丹参 菖蒲 郁金 冰片
各生研末，赤豆皮煎汤泛丸，竹叶汤送。
暑由上受，先入肺络，日期渐多，气分热邪，逆传入营，遂逼入心胞络中，神迷欲躁，
舌音短缩，手足牵引，乃暑热流陷，势将发痉。热闭在里，肢体反不发热，热邪内闭外脱，岂非
至
犀尖 鲜生地 元参 银花 石菖蒲化至宝丹
向来久咳伤肺，更值雨潮感邪，但热不寒，是为瘅疟。仲圣云∶消烁肌肉，当以饮食消
息之。在乎救胃以涵肺，医知是理否。
竹叶 麦冬 连翘 甘草 梨皮 青蔗汁
疟得汗不解，近来竟夜汗出，且胸痞不饥，形瘦脉大便秘，显然阴虚体质。疟邪烁液，
致清阳痞结脘中。议以柔剂，存阴却邪。
竹卷心 辰砂益元散 生地 麦冬 知母
脾经疟邪，必由四末扰中，仲景论太阴经九条，深戒攻下。谓脾为孤藏，体阴而用阳，
喜暖而恶寒，不饥痞胀，嗳气，阳伤则运动无权，滞浊弥漫矣。昔贤制方，阳伤取药之气，阴伤取
药之味，奈何不究病之阴阳，不分药之气味，便窒则攻下，痞闷则开泄。药不对病，脾胃受
伤，数年沉痼，如脾胃论莫详于东垣，苟能玩读，焉有此等混治?
炒半夏 淡吴萸 生益智 荜茇 干姜 茯苓
苦辛过服，大泻心阳，心虚热收于里，三疟之来，心神迷惑，久延恐成痼症。考诸《金
匮》、仲景每以蜀漆散为牡疟治法。
云母石 蜀漆 生龙骨
为末，开水调服二钱。
下焦精亏，疟邪遂入少阴，当其发作从背起，乃太阳与少阴表里相应也。阴邪得汗不解
，托邪固是，但气易泄，姜、附纯刚，又恐劫阴矣。
人参 鹿茸 桂枝 细辛 杞子炭 归身炭 生姜
脉微而迟，色衰萎黄。凡阳气不足，久利久泻，穷必伤肾。今浮肿渐起，目下是水失火
而败。若非暖下，徒见泄泻有红，为脾胃湿热，必至中满败坏。
熟地炭 淡附子 茯苓 车前子 生茅术 干姜
脉左弦右浮涩，始由脘痛贯胁，继则腹大高凸，纳食减少，二便艰涩不爽，此乃有年操
萦虑太甚。肝木拂郁，脾土自困，清浊混淆，胀势乃成。盖藏真日漓，府阳不运。考古治胀
名家，以通阳为务，若滋阴柔药，微加桂、附，凝阴 浊，岂是良法。议用局方禹余粮丸，
暖其水藏，攻其秽浊。俟其小效，兼进通阳刚补，是为虚症内伤胀满治法。至于攻泻动夺，
都为有形而设，与气伤之病不同也。
第三次诊治：痿证病位在下，多与肝肾有关。但患者平素饮酒，必然导致湿热内生，热邪瘀滞、湿邪停滞，致使气血运行不畅，筋脉收缩，肌肉失去知觉，身体沉重且位置固定不移，这无非是湿邪深入体内的表现。如果说是阳虚，不该出现严重的疮疡溃烂，但病程长久，不能急于求成，不要计较见效慢，（处方）用细生地、归身、黄柏、萆薢、肉苁蓉、川石斛、牛膝、蒺藜。
第四次诊治：睡眠和饮食如常，脉象沉而缓，唯独双腿内外侧肌肉萎缩麻木，年过五十，阳气脉象逐渐衰退，跷脉和维脉功能失常，并非风、寒、湿三气杂感所致。采用温通的方法来辅助脉络流畅，仿照古代圣人的四斤金刚丸之类的方剂。（处方）肉苁蓉、牛膝、茯苓、萆薢、木瓜、枸杞子、蒺藜、金毛狗脊膏丸。
《内经》说：“烦劳过度则阳气张越，精气枯竭，若反复积累至夏季，令人发生煎厥。”因为劳动使阳气弛张，精气就不能充盈，留恋于阳分，（治疗上应）益肾，使肝胆的相火不至于暴起，宣散风邪、平息内风，从而避免晕厥。然而必须清淡饮食、安静调养才是稳妥之道。（处方）细生地、连翘、知母、玄参、生白芍、竹叶。
肾厥，从腰脊向上发展，发作时手足逆冷，口吐涎沫，喉咙像被刀刺一样痛。这是因为足少阴肾经，上行沿着喉咙，夹持舌根，阴浊之气自下而上侵犯，必然顺着经脉到达。（治疗）仿照许学士的椒附汤，以通阳泄除阴浊为主。（处方）炮附子、淡干姜、葫芦巴、川椒、半夏、茯苓。
脐上心窝处热势炽盛，咽喉间有陈腐气味，于是神志昏迷、突然跌倒昏厥。经过一段时间出汗后醒来，口中涌出血沫，这是膻中部位热邪壅塞，导致心窍受蒙蔽。如果不是用芳香清透的药物，就不能宣通络脉中的瘀阻痹塞。（处方）犀角、茯神、天竺黄、麝香、丹参、石菖蒲、郁金、冰片。各药研成生末，用赤豆皮煎汤泛制成丸，用竹叶汤送服。
暑邪从上焦受入，先进入肺络，日子久了，气分的热邪逆传入营分，于是逼迫进入心包络中，神志迷乱想要躁动，舌头僵硬短缩，手足牵引抽搐，这是暑热流陷，形势即将发展为痉病。热邪闭结在体内，肢体反而不发热，这是热邪内闭外脱，难道不是最危急的情况吗？（处方）犀角尖、鲜生地、玄参、银花、石菖蒲化开至宝丹服用。
向来久咳损伤肺气，又正值雨潮湿气感受邪气，只有热没有寒，这就是瘅疟。仲景说：“消瘦肌肉，应当依靠饮食来调息它。”关键在于救胃气以涵养肺金，医生知道这个道理吗？（处方）竹叶、麦冬、连翘、甘草、梨皮、青蔗汁。
疟疾得汗后未解，近来整夜出汗，而且胸脘痞闷不想进食，形体消瘦、脉大、大便干燥便秘，显然是阴虚体质。疟邪煎熬津液，导致清阳之气痞结在脘中。建议用柔润的药物，保存阴液、驱除邪气。（处方）竹卷心、辰砂益元散、生地、麦冬、知母。
脾经受疟邪侵袭，必然由四肢末端扰乱中焦，仲景论述太阴经的九条原则中，深深告诫不可攻下。认为脾是孤脏，体属阴而用属阳，喜欢温暖而厌恶寒冷，不饥、痞胀、嗳气，阳气受伤则运动无力，滞浊弥漫。以前的贤人制定方剂，阳气受伤取药物的气，阴液受伤取药物的味，为什么不研究病的阴阳属性，不区分药的气味，遇到闭塞就攻下，痞闷就开泄。药不对病，脾胃受伤，多年的重病，就像李东垣的《脾胃论》讲得非常详细，如果能仔细研读，怎么会有这种混乱的治疗呢？（处方）炒半夏、淡吴茱萸、生益智仁、荜茇、干姜、茯苓。
苦辛药物服用过量，大大损伤了心阳，心虚热收聚在里，三次疟疾发作时，心神迷惑，拖延日久恐怕成为顽固病症。考证《金匮要略》，仲景常用蜀漆散作为牡疟的治疗方法。（处方）云母石、蜀漆、生龙骨。研为末，开水调服二钱。
下焦精血亏虚，疟邪遂侵入少阴，当其发作从背部开始，这是太阳经与少阴经表里相应的表现。阴邪得汗后未解，托举邪气固然是对的，但正气容易耗泄，姜、附纯刚燥烈，又恐怕劫伤阴液。（处方）人参、鹿茸、桂枝、细辛、杞子炭、归身炭、生姜。
脉象微而迟，面色衰败萎黄。凡是阳气不足，长期腹泻或痢疾，穷尽必伤肾。现在浮肿渐渐起来，眼下部位是水失火助而败坏的表现。如果不温补下焦，只看到泄泻中有红色，认为是脾胃湿热，必定会导致中焦满闷败坏。（处方）熟地炭、淡附子、茯苓、车前子、生茅术、干姜。
脉象左弦右浮涩，起初由胃脘痛贯穿胁肋，接着腹部变大高凸，进食减少，大小便艰涩不爽，这是由于年事已高，操劳思虑太过。肝木拂郁，脾土自然困顿，清浊混淆，胀满之势乃成。盖藏真之气日渐流失，府阳不能运化。考古人治疗胀满的名家，以通阳为要务，如果用滋阴柔润的药，稍微加一点桂枝、附子，凝结阴浊，难道是良法吗？建议用局方禹余粮丸，温暖水脏，攻逐秽浊。等到有一点小效，再兼进通阳刚补的方法，这是虚症内伤胀满的治疗方法。至于攻泻夺实，都是为有形之邪而设，与气伤的疾病不同。
Third consultation: Wei syndrome (flaccidity syndrome) is located in the lower part, mostly involving the Liver and Kidney. However, since the patient habitually drinks alcohol, damp-heat must inevitably be generated internally. Heat stagnates and turbid-dampness obstructs, causing Qi and Blood to fail to circulate. The sinews contract, muscles lose sensation, the body feels heavy and fixed in position; this is none other than deep-seated Dampness pathogen. If it were Yang deficiency, severe sores and ulcers should not appear. But as the disease has lasted long, it cannot be attacked rapidly; one should not count on quick efficacy. Prescription: Xi Sheng Di (Rehmanniae Radix Preparata), Gui Shen (Angelicae Sinensis Radix), Huang Bo (Phellodendri Cortex), Bi Xie (Dioscoreae Hypoglaucae Rhizoma), Rong Rong (Cynomorii Fructus), Chuan Hu (Dendrobii Caulis), Niu Xi (Achyranthis Bidentatae Radix), Ji Li (Tribuli Fructus).
Fourth consultation: Sleep and diet are normal, pulse is deep and slow. Only the inner and outer muscles of both legs have atrophied and feel numb. Over fifty years old, Yang pulses are gradually declining, the Qiao and Wei vessels (extraordinary vessels regulating movement and sensation) are not functioning properly. This is not due to the mixed invasion of Wind, Cold, and Dampness. Use warming and unblocking methods to assist the smooth flow of collaterals, imitating the ancient sages' Si Jin Jin Gang Wan (Four-Jin Golden Pill). Prescription: Rong Rong (Cynomorii Fructus), Niu Xi (Achyranthis Bidentatae Radix), Fu Ling (Poria), Bi Xie (Dioscoreae Hypoglaucae Rhizoma), Mu Gua (Chaenomelis Fructus), Gou Qi Zi (Lycii Fructus), Ji Li (Tribuli Fructus), Jin Mao Gou Ji (Cibotii Rhizoma) made into paste pills.
The Classic says: "Excessive fatigue causes Yang to hyperactive, essence is exhausted. If accumulated repeatedly into summer, it causes Jian Jue (Frying Syncope)." Because labor causes Yang Qi to relax and expand, Essence and Qi cannot fill adequately, lingering in the Yang aspect. Treatment should tonify the Kidney, preventing the Ministerial Fire of the Liver and Gallbladder from rising violently, dispersing Wind and extinguishing internal stirring, thereby preventing syncope. However, a bland diet and quiet rest are the safest approaches. Prescription: Xi Sheng Di (Rehmanniae Radix Preparata), Lian Qiao (Forsythiae Fructus), Zhi Mu (Anemarrhenae Rhizoma), Yuan Shen (Scrophulariae Radix), Sheng Bai Shao (Paeoniae Radix Alba), Zhu Ye (Bambusae Folium).
Shen Jue (Kidney Syncope) rises from the waist and spine. During attacks, hands and feet are cold, mouth foams, and the throat feels like being pierced by a knife. This is because the Foot Shaoyin Kidney Meridian ascends along the throat and clamps the root of the tongue. Yin turbidity attacks from below upwards, necessarily following the meridian. Imitate Xu Xue Shi's Jiao Fu Tang (Pepper and Aconite Decoction), focusing on unblocking Yang to drain Yin turbidity. Prescription: Pao Fu Zi (Prepared Aconiti Lateralis Radix), Dan Gan Jiang (Dried Zingiberis Rhizoma), Hu Lu Ba (Trigonellae Semen), Chuan Jiao (Zanthoxyli Pericarpium), Ban Xia (Pinelliae Tuber), Fu Ling (Poria).
Heat blazes above the navel and below the heart. A stale odor in the throat leads to unconsciousness and sudden collapse. After sweating for a period, the patient wakes up, vomiting bloody foam. This is heat obstruction in the Dan Zhong (Conception Vessel point Ren 17), causing the Heart orifices to be obscured. Without aromatic clearing and penetrating herbs, the stasis and bi-syndrome in the collaterals cannot be unblocked. Prescription: Xi Jiao (Rhinocerotis Cornu - note: substitute with Buffalo Horn in modern practice), Fu Shen (Poria with Hostwood), Tian Zhu Huang (Bambusae Calamus), She Xiang (Moschus), Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma), Chang Pu (Acori Tatarinowii Rhizoma), Yu Jin (Curcumae Longae Radix), Bing Pian (Borneolum Syntheticum). Grind each into raw powder, make pills using decoction of Red Bean Skin, take with Zhu Ye (Bambusae Folium) decoction.
Summer-heat enters from above, first entering the Lung collaterals. As days pass, Qi-level heat pathogens reverse-transmit into the Ying (Nutrient) level, forcing their way into the Pericardium collaterals. Spirit is confused and restless, tongue is stiff and short, limbs are pulled and twitching. This is Summer-heat flowing and sinking, likely developing into Jing (Spasm) syndrome. Heat closure inside, yet limbs are not hot; heat pathogen closed internally with external collapse—is this not critical? Prescription: Xi Jian (Rhinocerotis Cornu - tip), Xian Sheng Di (Rehmanniae Radix Recens), Yuan Shen (Scrophulariae Radix), Yin Hua (Lonicerae Japonicae Flos), Shi Chang Pu (Acori Tatarinowii Rhizoma) dissolved with Zhi Bao Dan (Treasure Pill).
Chronic cough has damaged the Lung. Furthermore, rain and humidity have invited pathogens. There is heat but no chills; this is Dan Nue (Hot Malaria). Zhong Jing said: "Emaciation of muscles requires dietary regulation." The key is to save Stomach Qi to nourish Lung Metal. Do physicians understand this principle? Prescription: Zhu Ye (Bambusae Folium), Mai Dong (Ophiopogonis Tuber), Lian Qiao (Forsythiae Fructus), Gan Cao (Glycyrrhizae Radix et Rhizoma), Li Pi (Pyrri Fructus Pericarpium), Qing Zhe Zhi (Saccharum Officinarum Juice).
Malaria did not resolve with sweating. Recently, there has been night sweating all night, chest fullness, loss of appetite, emaciation, large pulse, and dry constipation. Clearly, this is a Yin deficiency constitution. Malaria pathogen consumes fluids, causing clear Yang to become obstructed in the epigastrium. Propose using soft/moistening agents to preserve Yin and expel pathogens. Prescription: Zhu Juan Xin (Bamboo Leaf Core), Chen Sha Yi Yuan San (Cinnabar and Yiyuan Powder), Sheng Di (Rehmanniae Radix Preparata), Mai Dong (Ophiopogonis Tuber), Zhi Mu (Anemarrhenae Rhizoma).
Spleen channel malaria pathogens disturb the middle jiao from the four extremities. Zhong Jing's discussion on the Nine Lines of the Taiyin Channel strictly warns against purgation. It states that the Spleen is an isolated organ, its substance is Yin but its function is Yang; it prefers warmth and dislikes cold. Lack of appetite, fullness, belching: if Yang is injured, motility loses power, and stagnant turbidity spreads. Ancient sages formulated prescriptions: for Yang injury, use the Qi (aroma/energy) of herbs; for Yin injury, use the Flavor (taste/substance) of herbs. Why ignore the Yin-Yang nature of the disease and the Qi-Flavor properties of herbs? Using purgatives for obstruction and venting for fullness without distinction injures the Spleen and Stomach. Years of chronic illness... If one had studied Dong Yuan's Pi Wei Lun (Treatise on the Spleen and Stomach) carefully, such chaotic treatment would not occur. Prescription: Chao Ban Xia (Processed Pinelliae Tuber), Dan Wu Yu (Evodiae Fructus), Sheng Yi Zhi (Alpiniae Oxyphyllae Fructus), Bi Bo (Piperis Kadsurae Fructus), Gan Jiang (Zingiberis Rhizoma), Fu Ling (Poria).
Bitter-cold and acrid-hot herbs were taken excessively, severely damaging Heart Yang. Heart deficiency allows heat to retreat inward. With the arrival of recurrent malaria, the Heart spirit is confused. Prolonged delay may lead to stubborn disease. Examining the Jin Gui Yao Lue, Zhong Jing often used Shu Qi San (Chinese Tallow Tree Powder) as the treatment for Mu Nue (Mulberry Malaria). Prescription: Yun Mu Shi (Muscovite), Shu Qi (Euphorbiae Humifusae Herba), Sheng Long Gu (Fossilia Ossis Mastodi). Grind into powder, mix with boiling water, take 2 qian.
Lower Jiao essence is deficient, malaria pathogen enters the Shaoyin. When attacks start from the back, it indicates the correspondence between the Taiyang and Shaoyin exterior-interior relationship. Yin pathogen does not resolve with sweating. Expelling pathogens is correct, but Qi is easily depleted. Ginger and Aconite are purely rigid/hot, risking the depletion of Yin. Prescription: Ren Shen (Ginseng Radix et Rhizoma), Lu Rong (Cervi Pantotrichum), Gui Zhi (Cinnamomi Ramulus), Xi Xin (Asari Radix et Rhizoma), Qi Zi Tan (Carbonized Lycii Fructus), Gui Shen Tan (Carbonized Angelicae Sinensis Radix), Sheng Jiang (Zingiberis Rhizoma Recens).
Pulse is faint and slow, complexion is sallow and withered. Whenever Yang Qi is insufficient, chronic diarrhea or dysentery eventually damages the Kidney. Now edema is gradually appearing; the area under the eyes indicates Water failing due to Fire defeat. If the Lower Jiao is not warmed, merely seeing red in stool and attributing it to Spleen-Stomach damp-heat will lead to middle jiao fullness and failure. Prescription: Shu Di Tan (Carbonized Rehmanniae Radix Preparata), Dan Fu Zi (Lightly Prepared Aconiti Lateralis Radix), Fu Ling (Poria), Che Qian Zi (Plantaginis Semen), Sheng Mao Zhu (Raw Atractylodis Rhizoma), Gan Jiang (Zingiberis Rhizoma).
Pulse is wiry on the left and floating-choppy on the right. Initially, epigastric pain radiated to the hypochondrium, then the abdomen became distended and convex, food intake decreased, urination and defecation were difficult and incomplete. This is due to excessive mental strain in an elderly person. Liver Wood stagnates, Spleen Earth becomes trapped, clear and turbid mix, leading to distension. The True Essence leaks daily, Fu Yang fails to transport. Ancient masters treating distension prioritized unblocking Yang. Using Yin-nourishing soft herbs with slight Cinnamon and Aconite would condense Yin turbidity; is this a good method? Propose Ju Fang Yu Yu Liang Wan (Bureau Formula Hematite Pill) to warm the Water Organ and attack turbidity. Once slight improvement is seen, combine with warming Yang and rigid tonification. This is the treatment method for deficiency-type internal injury distension. Purging and attacking are set for tangible pathogens, different from Qi-injury diseases.