精未充而先泄，异日必有难状之疾，此南齐褚尚书之言。夫精气所以护神，既受损伤，
神形衰怯，数年不得充旺，议双补脾肾，略用通络，舍此竟无别法。
黑地黄丸。痛发时用阿魏丸。
宿症脘胀，似乎气滞，从
小产后失调，病起三年不愈。病伤日虚，不思纳谷，经候如常，及立夏小满，经候不来，食
下即吐，汤饮下咽，脘中胀痹，腹满脐突，大便旬余始解。始而畏寒，今渐怕热，呕吐，先
出有形之物，继以痰涎白沫，味必酸浊。参诸经旨，全是足厥阴肝经受病，阳化内风，乘犯
阳明胃土，胃不主乎顺趋达肠，遂成反胃之症。治宜理肝木以安土。但气逆沸腾，阳药不能
下膈，势必随涌，议分治方法于下。
左金丸盐水煮，蒸饼和丸。
左金平肝，苦辛气味，尤虑下行未速，加盐味令其下行，宗《内经》本草咸苦之味入阴
厥，阳浊气退避，胃乏中流砥柱，热势风阳再逆。议坐镇中宫木火，庶不乘土。服左金丸逾二时
，继用针头、代赭石、化州橘红，饭和丸，煎大半夏汤，加姜汁送下。
再诊 昔人云∶吐中有散，谓多呕多吐，诸气升腾而散。《内经》以阳明经脉主束筋骨
，以利机关。今为厥阴风木久侵，中虚困穷，清空溃散，致浊蒙蟠聚，不徒胸腹胀满，腰痹肌膜
，亦令浮肿。左金泻肝止呕吐，谓肝家郁勃上冲，大苦寒降其逆，大辛热泄其气。丹溪制方
之义，以相火内寄于肝胆，上升之气，皆从肝出。气有余便是火。此非有余，因数日不食，
阳明胃土伤疲已极，中无砥柱，木横浊攻。历考治胀诸贤，河间分消三焦，戴人必攻六腑，
此皆有余治法。今乃虚症，若呆钝补阳，适助其胀。议通阳明兼泄厥阴法。
人参 川楝子 延胡索 麻仁 茯苓 茺蔚子
时刻精遗，少腹胀满，皆肾不收纳。咽喉微干，火升及面，由阴不上承，虚阳浮越。上
年用纯阴静药即泻，下损及中，今当固下。
熟地 山药 茯苓 北五味 人参 芡实 湘莲
人乳粉同河车、金樱二膏为丸。
眼胞上下脾肾之脉，循行倦于开阁太阴脾脉已钝，甘补多用为宜。
蒸于术 枸杞子 桂圆肉 归身 黄 炙草
脉弦右大，弦则为饮，大则胃阳已虚。缘操持萦思，积劳阳伤，致不饥不食，勉纳食物
，嗔怒，兼以夜卧不安，多寤少寐，恍惚中心懊 ，忽尔腹鸣气震，四肢筋骱，痿弱无力，起
病时晨必寒痉，足跗微冷。按是脉症有年，阳虚为本，而痰饮气逆，因虚而聚。夫虚则生
寒，实则生热。寝食不安，将及半载，已交四之气中，长夏湿土乘侮脾胃，虑及肌肿腹胀，
故周身束筋利机，阳明胃脉是积。阅医药气血淆混，寒热互投，不以阴阳偏着调理，宜乎不
应。议通补理胃阳为主，疏肝为辅，气宣阳苏，何虑痰浊之蒙昧。以茯苓饮法减术，合薛氏星附六君子意。
人参 茯苓 香附 苏梗 白附 半夏 姜汁 陈皮
舌白不大渴，寒战复热，神躁欲昏，心胸饱闷更甚。疟系客邪，先由四末以及中宫，咳痰呕
逆，是邪干肺胃，体虚邪聚，闭塞不通。故神昏烦闷，郁蒸汗泄，得以渐解，营卫之邪未清
，寒热蔓延无已。此和补未必中款，按经设法为宜。
白蔻仁 黄芩 半夏 竹叶 薏苡仁 姜汁
治目疾无非辛散寒苦，遂致精滑淋浊。夫阳虚则生外寒，阴虚则生内热。精气皆亏，神志孤
独，梦魂纷扰，惊惕恐惧，而无以自主。法当固摄肾关，养心宁神，镇怯理虚，渐次夜视反听，十分调护，方可治疗。
精液未充盈时便过早泄出，日后必定会有难以名状的疾病，这是南齐褚尚书的言论。精气是用来护卫神志的，既然已经受到损伤，就会导致神气与形体衰弱怯懦，数年之内无法恢复充盛旺盛，建议采用脾肾双补的方法，略微配合疏通经络的药物，除此之外竟没有别的办法。
宿疾导致脘腹胀满，看似是气机阻滞，实际上是因为小产后调理不当，患病三年未能痊愈。病情日渐虚弱，不思饮食，月经周期原本正常，但到了立夏、小满时节，月经却停止不来，进食后立即呕吐，汤水喝下去后，脘部胀闷痹阻，腹部胀满且肚脐突出，大便十几天才解一次。起初怕冷，现在逐渐转为怕热，伴有呕吐，先吐出有形的食物残渣，随后吐出痰涎白沫，味道必定酸浊。综合参考各经经典旨意，这完全是足厥阴肝经受病，阳气化生内风，乘袭侵犯阳明胃土，胃不能主导顺降通达至肠道，于是形成了反胃的症状。治疗应当调理肝木以安顿脾胃。但是气逆如沸腾般上冲，温阳药物不能通过膈肌，势必会随着呕吐涌出，建议在下方采用分治的方法。
左金丸用盐水煮过，蒸饼和药制成丸剂。
左金丸平抑肝火，其苦辛的气味，尤其担心下行速度不够快，加入盐味使其下行更快，遵循《内经》本草中咸苦之味入阴经的理论，使阳浊之气退避，因为胃缺乏中流砥柱般的支撑，热势与风阳再次上逆。建议坐镇中宫（脾胃）以制约木火，这样就不会再乘袭脾土。服用左金丸两个时辰后，继用针头（指代某种特定炮制或形态的药材，此处依原文保留）、代赭石、化州橘红，用米饭和药制成丸剂，煎煮大半夏汤，加姜汁送服。
复诊 古人说：“吐中有散”，意思是多次呕吐，各种气机升腾而散乱。《内经》认为阳明经脉主要约束筋骨，以利于关节运动。如今被厥阴风木长久侵扰，中焦虚损困穷，清空之气溃散，导致浊邪蒙蔽盘踞，不仅胸腹胀满，连腰部痹痛、肌肉腠理也出现浮肿。左金丸泻肝止呕吐，是说肝家郁勃之气上冲，用大苦寒之品降其逆气，用大辛热之品泄其气。丹溪制方的意义在于，相火内寄于肝胆，上升的气机皆从肝出。气有余便是火。这里并非气有余，而是因为数日不进食，阳明胃土损伤疲惫已极，中间没有砥柱支撑，肝木横逆，浊邪攻冲。历代考察治疗胀满的各位贤者，河间先生分消三焦，戴人必攻六腑，这些都是针对有余实证的治疗方法。如今却是虚证，如果呆板地单纯补阳，恰好会助长胀满。建议采用通补阳明兼泄厥阴的方法。
时刻发生精液遗泄，少腹胀满，都是肾气不能收纳的表现。咽喉微干，火气上升至面部，是由于阴液不能上承，虚阳浮越。去年使用纯阴静药就会腹泻，下元亏损波及中焦，如今应当固摄下元。
眼睑上下为脾肾之脉循行之处，太阴脾脉运行倦怠且脉象迟钝，适宜多用甘温补益的药物。
脉象弦而右脉大，弦主饮邪，大则说明胃阳已虚。因为操持劳碌、思虑过度，积劳导致阳气损伤，致使不饥饿不想吃东西，勉强进食后容易发怒，加上夜间睡眠不安，多醒少睡，心中恍惚懊恼，忽然腹鸣气震，四肢筋骨痿弱无力，起病时早晨必定出现寒战痉挛，足背微冷。按此脉症已有多年，阳虚为本，而痰饮气逆，是因虚而聚结。虚则生寒，实则生热。寝食不安将近半年，正值四之气（长夏湿土当令），湿土乘侮脾胃，担心出现肌肤肿胀、腹部胀满，所以周身束筋利机的功能受影响，阳明胃脉是积聚所在。阅读之前的医药记录，气血混淆，寒热互投，不以阴阳偏颇进行调理，自然没有效果。建议以通补理胃阳为主，疏肝为辅，气机宣通，阳气复苏，何必担忧痰浊的蒙蔽。采用茯苓饮法减去白术，结合薛氏星附六君子汤的意思。
舌苔白且不甚口渴，寒战后发热，神志烦躁欲昏沉，心胸饱闷更加严重。疟疾属于客邪致病，先从四肢末端发展到中焦，咳嗽痰多、呕吐逆气，是邪气干扰肺胃，体质虚弱导致邪气聚集，闭塞不通。所以神志昏沉烦闷，郁蒸汗出，得以逐渐缓解，但营卫之邪尚未清除，寒热蔓延不止。这种温和补益的方法未必对症，按照经络设法为宜。
治疗眼疾无非是用辛散、寒凉、苦燥的药物，结果导致精滑、淋浊。阳虚则产生外寒，阴虚则产生内热。精气都亏损，神志孤独，梦魂纷扰，惊惕恐惧，无法自主。治疗方法应当固摄肾关，养心宁神，镇怯理虚，逐渐做到夜视反听（指内守精神），十分小心调护，才可以进行治疗。
If essence is discharged before it is fully accumulated, there will inevitably be difficult-to-describe illnesses in the future; this was stated by Minister Chu of Southern Qi. Essence and Qi protect the Shen (Spirit). Once damaged, both the Spirit and the physical form become weak and timid, failing to regain fullness and vigor for several years. It is proposed to tonify both the Spleen and Kidney simultaneously, with a slight addition of herbs to unblock collaterals; apart from this method, there is no other alternative.
Hei Di Huang Wan (Black Earth Pill). When pain occurs, use A Wei Wan (Asafoetida Pill).
Chronic pathogenic factors cause distension in the epigastrium, which appears to be Qi stagnation, but actually stems from improper regulation after a miscarriage, with the illness persisting for three years without resolution. The condition worsens day by day into deficiency; there is no desire to eat, and menstruation was previously regular. However, during Lixia (Start of Summer) and Xiaoman (Grain Buds), menstruation ceases. Food is vomited immediately after ingestion; after swallowing liquids, the epigastrium becomes distended and bi-obstructed, the abdomen is full with protrusion of the umbilicus, and bowel movements occur only once every ten-plus days. Initially, there was aversion to cold, but now there is gradually increasing aversion to heat, accompanied by vomiting. First, solid matter is expelled, followed by phlegm-saliva and white foam, which must taste sour and turbid. Consulting various classic texts, this is entirely a disease of the Foot Jueyin Liver Meridian. Yang transforms into internal Wind, which attacks the Yangming Stomach Earth. The Stomach fails to govern smooth descent and transmission to the intestines, resulting in regurgitation (Fan Wei). Treatment should regulate Liver Wood to pacify Earth. However, since Qi rebellion is boiling upward, Yang-tonifying medicines cannot pass through the diaphragm and will inevitably surge out with vomiting. It is proposed to adopt separate treatment methods as follows:
Zuo Jin Wan (Left Metal Pill) is boiled in salt water and formed into pills with steamed wheat cake.
Zuo Jin Wan pacifies the Liver. Its bitter and pungent aroma may worry that its downward action is not fast enough; adding salt flavor accelerates its descent, following the *Neijing* principle that salty and bitter flavors enter Yin meridians. This causes Yang turbidity to retreat. Because the Stomach lacks a central pillar (support), heat and Wind-Yang rebel again. It is proposed to stabilize the Central Palace (Spleen/Stomach) to control Wood and Fire, so they do not attack Earth. After taking Zuo Jin Wan for two shichen (4 hours), follow up with Zhen Tou (Needle Head - likely a specific preparation or typo for another herb, kept as per text), Dai Zhe Shi (Hematite), and Hua Zhou Ju Hong (Exocarpium Citri Reticulatae from Huazhou), formed into pills with rice. Decoct Da Ban Xia Tang (Large Pinellia Decoction) and administer with Ginger Juice.
Second consultation: Ancients said, "In vomiting, there is dispersion," meaning frequent vomiting causes all Qi to ascend and scatter. The *Neijing* states that the Yangming Meridian binds sinews and bones to facilitate joint movement. Now, long-term invasion by Jueyin Wind-Wood has caused middle-jiao deficiency and exhaustion, leading to the collapse of clear Qi and accumulation of turbid pathogens. This results not only in chest and abdominal distension but also lumbar bi-pain and edema of muscles and fascia. Zuo Jin Wan purges the Liver to stop vomiting, addressing the Liver's郁 (depression) and surging Qi. Greatly bitter-cold herbs descend the rebellious Qi, while greatly bitter-hot herbs vent the Qi. Danxi's prescription logic posits that Ministerial Fire resides internally in the Liver and Gallbladder, and ascending Qi all originates from the Liver. Excess Qi becomes Fire. Here, it is not excess, but rather due to days of fasting, the Yangming Stomach Earth is extremely injured and fatigued, lacking a central pillar, allowing Liver Wood to transverse and turbid pathogens to attack. Reviewing sages who treated distension, Hejian separated and eliminated the Sanjiao, and Dairen attacked the Six Fu organs; these are methods for excess conditions. Now it is a deficiency syndrome. If one rigidly tonifies Yang, it will only aid distension. It is proposed to use a method of unblocking and tonifying Yangming while draining Jueyin.
Ren Shen (Ginseng Radix), Chuan Lian Zi (Toosendan Fruit), Yan Hu Suo (Corydalis Rhizome), Ma Ren (Semen Cannabis), Fu Ling (Poria), Chong Wei Zi (Seed of Leonurus japonicus).
Constant seminal emission and lower abdominal distension indicate the Kidney's failure to receive and store. Slight dryness in the throat and rising fire to the face result from Yin failing to ascend and floating Deficient Yang. Last year, pure Yin quieting herbs caused diarrhea; lower damage affected the middle. Now, securing the lower jiao is required.
Shu Di Huang (Prepared Rehmannia Root), Shan Yao (Dioscorea Rhizome), Fu Ling (Poria), Bei Wu Wei Zi (Schisandra Berry), Ren Shen (Ginseng Radix), Qian Shi (Euryale Seed), Xiang Lian (Nelumbo Nucifera Seed).
Form pills using Ren Ru Fen (Human Milk Powder) mixed with He Che (Placenta Hominis) and Jin Ying Zi (Rosa Laevigata Fruit) pastes.
The eyelids are where the Spleen and Kidney meridians circulate. The Taiyin Spleen Meridian runs sluggishly and is dull; sweet and tonifying herbs should be used predominantly.
Zheng Bai Zhu (Steamed Atractylodes Macrocephala Rhizome), Gou Qi Zi (Lycium Fruit), Gui Yuan Rou (Longan Aril), Gui Shen (Angelica Sinensis Root Body), Huang Qi (Astragalus Root), Zhi Cao Cao (Honey-fried Licorice Root).
The pulse is wiry and large on the right. Wiry indicates fluid retention; large indicates Deficient Stomach Yang. Due to overwork and excessive thinking, accumulated labor injured Yang, causing lack of hunger and anorexia. Reluctantly ingesting food leads to irritability. Night sleep is restless, with much waking and little sleeping. There is mental vagueness and inner vexation, sudden abdominal borborygmus and Qi vibration, and flaccid weakness in the limbs and joints. At onset, morning chills and spasms occurred, with slightly cold dorsum pedis. Analyzing these pulses and symptoms over years, Yang deficiency is the root, while Phlegm-Fluid and Qi rebellion accumulate due to deficiency. Deficiency generates Cold, Excess generates Heat. Restless sleep and eating for nearly half a year coincide with the Fourth Qi period (Late Summer damp-earth attacking Spleen/Stomach). Concern arises regarding muscle swelling and abdominal distension, affecting the body's binding of sinews and joint function; the Yangming Stomach Meridian is the site of accumulation. Previous medications confused Qi and Blood, mixing Cold and Heat, without regulating based on Yin-Yang bias, hence no response. It is proposed to primarily unblock and tonify Stomach Yang, with secondary liver-soothing. As Qi spreads and Yang revives, why worry about turbid Phlegm obscuring? Use the method of Fu Ling Yin (Poria Drink) reducing Bai Zhu, combined with Xue's Xing Fu Liu Jun Zi Tang (Star and Aconite Six Gentlemen Decoction).
Ren Shen (Ginseng Radix), Fu Ling (Poria), Xiang Fu (Cyperus Rhizome), Su Geng (Perilla Stem), Bai Fu Zi (Typhonii Rhizoma), Ban Xia (Pinellia Tuber), Jiang Zhi (Ginger Juice), Chen Pi (Citrus Reticulata Peel).
White tongue coating, not very thirsty, alternating chills and fever, restlessness and impending coma, worsening chest/epigastric fullness. Malaria is a guest pathogen, starting from the four extremities reaching the central palace. Cough with phlegm and vomiting/reversal indicate pathogens interfering with Lung and Stomach. Weak constitution allows pathogen aggregation, causing blockage. Thus, coma and vexation occur.郁蒸 (stagnant heat) sweating allows gradual relief, but Ying-Wei pathogens remain uncleared, with chills and fever spreading endlessly. Mild tonification may not hit the mark; treating according to the meridian is appropriate.
Bai Kou Ren (Amomi Fructus Rotundus), Huang Qin (Scutellaria Root), Ban Xia (Pinellia Tuber), Zhu Ye (Bambusa Leaf), Yi Yi Ren (Coix Seed), Jiang Zhi (Ginger Juice).
Treating eye diseases involves only acrid dispersing, cold, and bitter herbs, leading to seminal slip and cloudy urine. Yang deficiency generates external cold; Yin deficiency generates internal heat. Both Essence and Qi are depleted; Shen is isolated, dreams are chaotic, with fright and fear, lacking self-control. The method should secure the Kidney gate, nourish the Heart and calm the Shen, settle fright and treat deficiency. Gradually achieving "night vision and reverse hearing" (internal spiritual focus) with meticulous care is necessary before treatment can proceed.