情志郁勃,气逆多升,络血上冒,连次小产,冲任已怯,心嘈震悸,目珠痛,头胀,肝
胆厥
天冬、石决明。经来后期两旬,牙宣吐血,防其倒经,议养肝阴,兼通冲脉。
生地 天冬 枸杞子 牛膝 茯苓 白芍 阿胶 桂圆肉 丹参 茯神
乌骨鸡煮烂为丸。
烦劳气泄,阳升巅顶,瞳神必胀,容色夺,目眶变,呼吸似乎下陷,若热气升,舌本必
麻,即痰气阻咽。天暖风和必逸,乃血气因劳致虚。有藉乎天气之煦涵,《内经》云∶劳者温之
。取味甘气平,以补其阴阳血气。然痰气宿恙,勿以腻浊为准。
人参 白术 当归 枸杞子 茯苓 甘草 白芍 天麻 嫩钩藤 菊花炭
桂圆汁丸,午后服三钱。另早服虎潜丸四钱。
质瘦脉弱,交夏天暖真气发泄,心热口渴,头痛胁疼,食下如噎,右耳气闭,少聪,语
言
北沙参 天冬 麦冬 麻仁 杏仁 桑叶 蜜水炒橘红
川石斛煮汁泛丸。
筋胀肤疼,发作有年,左胁有形,不痛为瘕,肝气久郁血虚,生热生风,不受辛热之药
,以肝木内寄相火,只宜和血熄风,柔筋缓痛。
生首乌 归须 胡麻 丹皮 黑山栀 桑叶 嫩钩藤
丸方
桑寄生 阿胶 钩藤 丹皮 大生地 当归 天冬 白芍 黑芝麻 柏子仁
炼蜜丸。
情怀挹郁,肝气不舒,患乳生痈脓溃,血液大耗,气蒸上逆咳嗽,左胁内痛,不能转侧
。盖肝络少血内养,左右升降不利,清润治嗽无益。
炒桃仁 当归 茯神 丹皮 阿胶 柏子仁
时令温邪内迫,经水不应期至,淋淋不断,二便不通,唇舌俱白,不喜冷冻饮料,神呆恍惚
,言
属危脱之象。拟用仲景救逆法,以扼其危。
人参 龙骨 制附子 炙草 桂枝 牡蛎 蜀漆 南枣肉
经停两月,恰值嗔怒,阳气升降失和,血随气行冲任,脉络不固,遂为崩漏。且血凝成
,非血热宜凉,从来血脱,必须益气,但冲任奇经在下焦,又非东垣归、 、升、柴升举诸
法所宜。须固摄奇脉之药,乃能按经循络耳。
人参 茯苓 乌 骨 鲍鱼 茜草
震灵丹冲服。
再诊 昨拟震灵丹通摄,咸苦入阴,加人参见效。但头痛身热,是血大去,阴气不主内守,
阳孤失偶泛越。景岳云∶阳因阴而离散,宜从阴以收散亡之阳。两仪煎加龟甲、秋石主之,
人参 熟地 茯神 龟板 紫石英 桑螵蛸 当归
酒客中虚聚湿,口鼻吸受秽浊不正之气,初病头胀胸痞,身痛微汗,不解秽湿,在募原
内蒸
奈不分气血,从热消导,清热攻下,邪混血分成斑,冒入膻中,神昏谵妄,内闭脏腑,外象
肢冷大汗,势已危笃,仍以病根源秽邪,逼迫心胞络,论神气少清,翼其回生。
至宝丹四分,金汁一杯,石菖蒲汁一匙,研细和匀,炖温服。
情志抑郁勃发,气机逆乱而上升,络脉之血上冲,导致多次小产,冲任二脉已显虚弱,心中嘈杂、惊恐悸动,眼球疼痛,头部胀满,肝胆之气厥逆上亢。
(治法:)天冬、石决明。
月经推迟二十天未来,牙龈出血吐血,防止发生倒经(经血随胃气上逆从口鼻而出),议定滋养肝阴,兼以疏通冲脉。
(方药:)生地、天冬、枸杞子、牛膝、茯苓、白芍、阿胶、桂圆肉、丹参。
用乌骨鸡煮烂后作为丸剂基质。
因烦劳导致气机泄越,阳气升腾至头顶,瞳孔神光必然胀痛,面色憔悴,眼眶变色,呼吸似乎有下陷之感,若热气上升,舌根必然麻木,随即痰气阻滞咽喉。天气温暖和风时必然安逸,这是因为气血因劳累而致虚。需要借助天气的温煦涵养,《内经》说:“劳者温之”。选取味甘气平的药物,来补益阴阳血气。然而痰气是宿疾,不要以滋腻浑浊的药物为准。
(方药:)人参、白术、当归、枸杞子、茯苓、甘草、白芍、天麻、嫩钩藤、菊花炭。
用桂圆汁泛丸,午后服用三钱。另外早上服用虎潜丸四钱。
体质瘦弱,脉象微弱,进入夏天天气变暖,真气发泄,心热口渴,头痛胁痛,进食感觉像噎住一样,右耳气闭,听力减退,言语不利。
(方药:)北沙参、天冬、麦冬、火麻仁、杏仁、桑叶、蜜水炒橘红。
用川石斛煮汁泛丸。
筋脉胀满,皮肤疼痛,发作已有多年,左胁下有形之物,不痛者为瘕聚,肝气长期郁结且血虚,产生内热生风,不能耐受辛热药物,因为肝木内部寄居相火,只宜和血熄风,柔润筋脉以缓解疼痛。
(方药:)生首乌、归须、胡麻、丹皮、黑山栀、桑叶。
(制成)丸方。
(另一组方药:)桑寄生、阿胶、钩藤、丹皮、大生地、当归、天冬、白芍、黑芝麻、柏子仁。
用炼蜜制成丸剂。
情怀抑郁,肝气不舒,乳房患痈脓溃破,血液大量耗损,气蒸上逆引起咳嗽,左胁内部疼痛,身体不能转动。大概是因为肝络少血内养,左右升降不利,单纯使用清润药物治疗咳嗽没有益处。
(方药:)炒桃仁、当归、茯神、丹皮、阿胶、柏子仁。
时令温邪内迫,月经未按期而至,淋漓不断,大小便不通,嘴唇和舌头都发白,不喜欢冷冻饮料,神情呆滞恍惚,言语……(原文此处似有缺漏,结合上下文推测为言语错乱或失语)。
属于危重脱证的征象。拟用张仲景的救逆法,来遏制其危局。
(方药:)人参、龙骨、制附子、炙甘草、桂枝、牡蛎、蜀漆、南枣肉。
月经停止两个月,恰逢愤怒,阳气升降失和,血随气行冲击冲任,脉络不固,于是发生崩漏。而且血凝成瘀块,并非血热适宜用凉药,历来血脱证,必须益气,但冲任奇经位于下焦,又不适合李东垣的归、芪、升、柴等升举诸法。必须使用固摄奇经的药物,才能按照经络循行发挥作用。
(方药:)人参、茯苓、乌贼骨、鲍鱼、茜草。
震灵丹冲服。
再诊:昨天拟定震灵丹通摄,咸苦入阴,加入人参见效。但是头痛身热,这是血液大量流失,阴气不能主守于内,阳气孤阳失偶而泛越。张景岳说:“阳因阴而离散”,应当从阴分入手以收敛散亡之阳。两仪煎加龟甲、秋石为主治之方。
(方药:)人参、熟地、茯神、龟板、紫石英、桑螵蛸、当归。
酒客中焦虚弱聚湿,口鼻吸入秽浊不正之气,初病时头胀胸痞,身体疼痛微汗,未能解除秽湿,邪气在募原内蒸腾。
奈何不分气血,从热消导,清热攻下,邪气混入血分成斑,冒犯膻中,神昏谵妄,内闭脏腑,外现肢冷大汗,形势已经危笃,仍然以病根源于秽邪,逼迫心包络,论述神气稍清,希望其回生。
(方药:)至宝丹四分,金汁一杯,石菖蒲汁一匙,研细和匀,炖温服。
Emotional depression and stagnation cause qi rebellion and upward rising, leading to blood surging in the collaterals upwards. This results in multiple spontaneous abortions, weakening the Chong and Ren vessels (Penetrating and Conception Vessels). Symptoms include heart palpitations with a sensation of emptiness, eye pain, head distension, and rebellious Qi of the Liver and Gallbladder ascending.
(Treatment:) Tian Dong (Asparagi Radix), Shi Jue Ming (Haliotidis Concha).
Menstruation is delayed by twenty days, accompanied by gingival bleeding and hematemesis. To prevent inverted menstruation (menstrual flow through the nose or mouth), the strategy is to nourish Liver Yin and unblock the Chong vessel.
(Formula:) Sheng Di Huang (Rehmanniae Radix), Tian Dong (Asparagi Radix), Gou Qi Zi (Lycii Fructus), Niu Xi (Achyranthis Bidentatae Radix), Fu Ling (Poria), Bai Shao (Paeoniae Radix Alba), E Jiao (Colla Corii Asini), Gui Yuan Rou (Longan Arillus), Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma).
Processed into pills using stewed black-bone chicken meat as the binder.
Fatigue causes Qi leakage, with Yang Qi ascending to the vertex, causing distension of the pupil and visual spirit. The complexion becomes sallow, eye sockets change color, breathing seems to sink. If hot Qi rises, the tongue base becomes numb, followed by phlegm-Qi obstructing the throat. Warm and gentle weather brings relief, indicating that Qi and Blood are deficient due to labor. One must rely on the warming and nurturing influence of heaven's Qi. As stated in the *Nei Jing*: "For exhaustion, use warmth." Select sweet-flavored and neutral-qi herbs to tonify Yin-Yang, Qi, and Blood. However, since phlegm-Qi is a chronic condition, avoid overly cloying and turbid substances.
(Formula:) Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Dang Gui (Angelicae Sinensis Radix), Gou Qi Zi (Lycii Fructus), Fu Ling (Poria), Gan Cao (Glycyrrhizae Radix et Rhizoma), Bai Shao (Paeoniae Radix Alba), Tian Ma (Gastrodiae Rhizoma), Nen Gou Teng (Uncariae Ramulus cum Uncis), Ju Hua Tan (Chrysanthemi Flos carbonized).
Pills made with Longan juice, taken in the afternoon, 3 qian. Additionally, take Hu Qian Wan (Tiger Crouch Pill) in the morning, 4 qian.
The constitution is thin with a weak pulse. In summer, when the weather warms, true Qi dissipates. Symptoms include heart heat, thirst, headache, hypochondriac pain, dysphagia (feeling of obstruction when eating), right ear deafness, and impaired speech.
(Formula:) Bei Sha Shen (Glehniae Radix), Tian Dong (Asparagi Radix), Mai Dong (Ophiopogonis Tuber), Ma Ren (Cannabis Semen), Xing Ren (Armeniacae Semen Amarum), Sang Ye (Mori Folium), Ju Hong (Citri Reticulatae Pericarpium stir-fried with honey).
Pills processed with decoction of Chuan Shi Hu (Dendrobii Officinalis Caulis).
Distension of sinews and skin pain have persisted for years. There is a palpable mass in the left hypochondrium; if painless, it is classified as a Jia accumulation (mass). Chronic Liver Qi stagnation and Blood deficiency generate internal heat and wind. Acrid-warm herbs are contraindicated because the Liver Wood houses Ministerial Fire internally. The treatment should harmonize Blood, extinguish wind, and soften sinews to relieve pain.
(Formula:) Sheng Shou Wu (Polygoni Multiflori Preparata Radix - raw form implied for specific action), Gui Xu (Angelicae Sinensis Radix tip), Hu Ma (Sesami Fructus Niger), Dan Pi (Moutan Cortex), Hei Shan Zhi (Gardeniae Fructus charred), Sang Ye (Mori Folium).
Made into pills.
(Another formula:) Sang Ji Sheng (Taxilli Caulis), E Jiao (Colla Corii Asini), Gou Teng (Uncariae Ramulus cum Uncis), Dan Pi (Moutan Cortex), Da Sheng Di Huang (Rehmanniae Radix Recens), Dang Gui (Angelicae Sinensis Radix), Tian Dong (Asparagi Radix), Bai Shao (Paeoniae Radix Alba), Hei Ba Zi (Sesamum Fructus Niger), Bai Zi Ren (Biota Semen).
Pills made with refined honey.
Emotional suppression leads to stagnant Liver Qi. A breast abscess formed, suppurated, and ruptured, causing massive blood loss. Steaming Qi rebels upward causing cough, with internal pain in the left hypochondrium and inability to turn the body. This is due to insufficient Blood nourishing the Liver collaterals, impairing left-right Qi movement. Purely clearing and moistening treatments for cough are ineffective.
(Formula:) Chao Tao Ren (Persicae Semen stir-fried), Dang Gui (Angelicae Sinensis Radix), Fu Ling (Poria), Dan Pi (Moutan Cortex), E Jiao (Colla Corii Asini), Bai Zi Ren (Biota Semen).
Seasonal warm pathogens press inward, causing menstrual irregularity with continuous spotting. Urination and defecation are obstructed. Lips and tongue are pale. The patient dislikes cold drinks. Spirit is dull and恍惚 (trance-like), speech... [text incomplete].
This presents as a critical collapse syndrome. The method of Zhang Zhongjing for saving from reversal is proposed to arrest the crisis.
(Formula:) Ren Shen (Ginseng Radix et Rhizoma), Long Gu (Fossilia Ossis Mastodi), Zhi Fu Zi (Aconiti Lateralis Radix Praeparata), Zhi Cao (Glycyrrhizae Radix et Rhizoma cum melle), Gui Zhi (Cinnamomi Ramulus), Mu Li (Ostreae Concha), Shu Qi (Periplocae Radix), Nan Zao Rou (Zizyphi Fructus pulp).
Menstruation has stopped for two months, coinciding with anger. The ascent and descent of Yang Qi are disharmonious. Blood follows Qi and assaults the Chong and Ren vessels. Collateral integrity fails, resulting in metrorrhagia and metrostaxis (bing lou). Blood coagulates into stasis. It is not a case of Blood Heat requiring cooling. Historically, in cases of Blood depletion, Qi must be tonified. However, the Chong and Ren extraordinary vessels are located in the lower jiao, so methods of lifting and raising like those of Li Dongyuan (using Gui, Qi, Sheng, Chai) are unsuitable. Herbs that secure and grasp the extraordinary vessels are required to follow the meridians.
(Formula:) Ren Shen (Ginseng Radix et Rhizoma), Fu Ling (Poria), W Yu Gu (Sepiae Endoconcha), Bao Yu (Haliotis Carnis), Qian Cao (Rubiae Cordifoliae Radix et Rhizoma).
Zhen Ling Dan (Vibrant Spirit Pill) taken with water.
Second consultation: Yesterday, Zhen Ling Dan was used to secure and grasp. Salty and bitter herbs enter the Yin, and adding Ren Shen showed efficacy. However, headache and body heat indicate massive blood loss, with Yin failing to hold within, leaving isolated Yang floating without its companion. Zhang Jingyue stated: "Yang disperses due to Yin deficiency"; one should act from the Yin to gather the scattered Yang. Liang Yi Jian (Two Extremities Decoction) plus Gui Jia (Testudo Carapax and Plastrum) and Qiu Shi (Urinalis Calculus) is prescribed.
(Formula:) Ren Shen (Ginseng Radix et Rhizoma), Shu Di Huang (Rehmanniae Radix Praeparata), Fu Ling (Poria), Gui Ban (Testudinis Carapax et Plastrum), Zi Shi Ying (Fluorite), Sang Piao Xiao (Mantidis Ootheca), Dang Gui (Angelicae Sinensis Radix).
Wine drinkers suffer from middle jiao deficiency and dampness accumulation. Inhaling foul and turbid air initially causes head distension, chest oppression, body pain, and slight sweating. The foul-dampness is not resolved. The pathogen steams within the Mu Yuan (semi-exterior/semi-interior region).
Unfortunately, treating without distinguishing between Qi and Blood, using heat-clearing and draining methods, causes the pathogen to mix with blood, forming macules. The pathogen invades the Dan Zhong (Chest center), causing coma and delirium. Internal closure of zang-fu organs manifests externally as cold limbs and profuse sweating. The situation is critical. The root cause remains the foul pathogen forcing the Pericardium collaterals. Discussing the slight clarity of spiritual Qi, hoping for recovery.
(Formula:) Zhi Bao Dan (Treasure of Life Pill), 4 fen. Jin Zhi (Human Excrement Juice), 1 cup. Shi Chang Pu Juice (Acori Tatarinowii Rhizoma), 1 spoon. Ground finely and mixed evenly, warmed in a steamer, and taken orally.