朱(三六)经闭半载。未有瘕聚。胀痛畏寒。是在小寒节。厥阴用事。肝胆木火上升。咳随气升而失血。然味辛易
于入表。恐伤阳气。姑议调畅气血。再商通络诸法。
降香末(五分) 丹皮(一钱) 钩藤(二钱) 郁金(一钱) 炒桃仁(一钱) 黑山栀(一钱五分) 南楂炭
(三钱)
殷(三四)左胁瘕聚。少腹痛。
延胡(一钱) 归须(一钱) 郁金(一钱) 川楝子(二钱) 炒桃仁(一钱) 茺蔚子(一钱五分) 粗桂枝
(一钱) 南楂炭(二钱)
王(四一)胃脘胀痛。产后气血凝聚成瘕。头晕。骨脊痛。晨咳痰粘。胃纳颇减。肝逆犯胃。莫如泄肝以救胃。
生左牡蛎(炒,三钱) 归须(一钱五分) 茯苓(三钱) 鳖甲(炙,五钱) 桃仁(炒,一钱) 白芥子(炒
一钱五分) 延胡(炒,一钱) 川楝子(一钱) 香附(研,三钱)
徐(廿七)热病初发。经水适来。知饥少纳。恶心嗳气。烦渴懊 。此属热邪乘虚内陷血室。是不易治之症。拟两
清气血方法。
鲜生地 麦冬 粳米 生石膏 牛膝 生草 知母 竹叶心
又 昨进两清气血方。热势稍减。恶心已缓。邪解其半。但懊 烦渴未衰。腹痛便溏。仍宗仲景无犯胃气及上下
二焦之戒立方。
细生地 麦冬 炙草 丹皮 知母 牛膝 生白芍 炒桃仁
王(三八)昨议升泄少阳。为恐热邪乘虚内陷而设。今诊脉左数右大。咽痛。舌苔灰色。大便不解。头痛如昔。脘
闷。欲呕。口干。鼻干。少寐。参色脉现症。已属热邪内陷血室。议景岳玉女煎加竹叶。
生石膏(四钱) 淮牛膝(四钱) 淮熟地(四钱) 知母(一钱五分) 拣麦冬(二钱) 卷心竹叶(一钱五分)
补前方
柴胡(五分) 连翘(心,二钱) 知母(一钱五分) 丹皮(一钱五分) 嫩元参(一钱五分) 丹参(一钱
五分) 川斛(三钱) 赤芍(一钱五分)
朱(三十六岁):月经闭止半年。尚未形成瘕聚(腹内结块)。出现胀痛、畏寒症状。正值小寒节气,厥阴肝经主令。肝胆的木火之气上升,咳嗽伴随气机上逆而导致失血。然而,辛味药物容易进入体表,恐怕会损伤阳气。暂且提议调畅气血,再商议通络的方法。
降香末(五分) 丹皮(一钱) 钩藤(二钱) 郁金(一钱) 炒桃仁(一钱) 黑山栀(一钱五分) 南楂炭(三钱)
殷(三十四岁):左胁部有瘕聚,少腹部疼痛。
延胡索(一钱) 归须(当归尾,一钱) 郁金(一钱) 川楝子(二钱) 炒桃仁(一钱) 茺蔚子(一钱五分) 粗桂枝(一钱) 南楂炭(二钱)
王(四十一岁):胃脘部胀痛。产后气血凝聚形成瘕。伴有头晕,骨脊疼痛,早晨咳嗽痰液粘稠,胃纳食量明显减少。肝气逆乱侵犯胃部,不如采用泄肝的方法来救胃。
生左牡蛎(炒,三钱) 归须(当归尾,一钱五分) 茯苓(三钱) 鳖甲(炙,五钱) 桃仁(炒,一钱) 白芥子(炒,一钱五分) 延胡索(炒,一钱) 川楝子(一钱) 香附(研,三钱)
徐(二十七岁):热病刚刚发作,月经适逢来潮。感到饥饿但进食很少,恶心嗳气,心烦懊恼,口渴。这属于热邪乘虚内陷血室(子宫及胞脉),是不易治疗的病症。拟用两清气血的方法。
鲜生地 麦冬 粳米 生石膏 牛膝 生甘草 知母 竹叶心
又诊:昨日服用两清气血的方剂后,热势稍减,恶心已缓解,邪气解除了一半。但心中懊恼烦渴仍未消退,腹痛,大便稀溏。仍遵循张仲景“无犯胃气及上下二焦”的戒律来处方。
细生地 麦冬 炙甘草 丹皮 知母 牛膝 生白芍 炒桃仁
王(三十八岁):昨日讨论升散宣泄少阳胆经之法,是担心热邪乘虚内陷而设立的方案。如今诊察脉象左手数疾右手洪大,咽喉疼痛,舌苔呈灰色,大便不通,头痛如前,胃脘闷胀,想呕吐,口干,鼻干,睡眠少。参合神色、脉象和现症,已经属于热邪内陷血室。议用张景岳的玉女煎加竹叶。
生石膏(四钱) 淮牛膝(四钱) 淮熟地(四钱) 知母(一钱五分) 拣麦冬(二钱) 卷心竹叶(一钱五分)
补前方(补充前面的方意):
柴胡(五分) 连翘(去心,二钱) 知母(一钱五分) 丹皮(一钱五分) 嫩元参(一钱五分) 丹参(一钱五分) 川石斛(三钱) 赤芍(一钱五分)
Zhu (36 years old): Amenorrhea for half a year. No mass formation in the abdomen yet. Symptoms include distending pain and aversion to cold. This occurs during the Minor Cold solar term, when the Jueyin Liver meridian governs. The Wood and Fire of the Liver and Gallbladder ascend; coughing accompanied by ascending Qi leads to bleeding. However, acrid-flavored herbs tend to enter the exterior, which may damage Yang Qi. For now, it is proposed to regulate and smooth Qi and Blood, and further discuss methods to unblock collaterals.
Powdered Xiangxiang (Aquilariae Lignum Resinatum) (5 fen), Mudanpi (Moutan Cortex) (1 qian), Gouteng (Uncariae Ramulus cum Uncis) (2 qian), Yujin (Curcumae Radix) (1 qian), Fried Taoren (Persicae Semen) (1 qian), Heishanzhi (Gardeniae Fructus Carbonized) (1.5 qian), Nanzha Tan (Crataegi Fructus Carbonized) (3 qian).
Yin (34 years old): Mass formation in the left hypochondrium, pain in the lower abdomen.
Yanhusuo (Corydalis Rhizoma) (1 qian), Guixu (Radix Angelicae Sinensis Cauda) (1 qian), Yujin (Curcumae Radix) (1 qian), Chuanlianzi (Toosendan Fructus) (2 qian), Fried Taoren (Persicae Semen) (1 qian), Chongweizi (Leonuri Fructus) (1.5 qian), Cu Guizhi (Cinnamomi Ramulus Crassus) (1 qian), Nanzha Tan (Crataegi Fructus Carbonized) (2 qian).
Wang (41 years old): Distending pain in the epigastrium. Postpartum Qi and Blood coagulation formed a mass. Accompanied by dizziness, bone and spine pain, morning cough with sticky sputum, and significantly reduced appetite. Liver Qi rebellion invades the Stomach; it is best to drain the Liver to save the Stomach.
Raw Zuo Muli (Ostreae Concha) (fried, 3 qian), Guixu (Radix Angelicae Sinensis Cauda) (1.5 qian), Fuling (Poria) (3 qian), Biejia (Testudinis Carapax et Plastrum) (roasted, 5 qian), Taoren (Persicae Semen) (fried, 1 qian), Baijiezi (Brassicae Semens Album) (fried, 1.5 qian), Yanhusuo (Corydalis Rhizoma) (fried, 1 qian), Chuanlianzi (Toosendan Fructus) (1 qian), Xiangfu (Cyperi Rhizoma) (ground, 3 qian).
Xu (27 years old): Heat disease just started, menstruation happened to occur. Feeling hungry but eating little, nausea, belching, restlessness and oppression, thirst. This belongs to Heat pathogen sinking inward into the Blood Chamber (Uterus and related vessels) due to deficiency. It is a difficult-to-treat condition. A method to clear both Qi and Blood heat is proposed.
Fresh Shengdi Huang (Rehmanniae Radix) , Maidong (Ophiopogonis Radix), Jingmi (Oryzae Semen), Sheng Shigao (Gypsum Fibrosum), Niuxi (Achyranthis Bidentatae Radix), Sheng Gancao (Glycyrrhizae Radix et Rhizoma), Zhimu (Anemarrhenae Rhizoma), Zhuyexin (Phyllostachidis Folium Cor).
Second visit: After taking the formula to clear both Qi and Blood heat yesterday, the heat trend has slightly decreased, nausea has eased, and half of the pathogen has been resolved. However, restlessness and thirst have not subsided, abdominal pain persists, and stool is loose. Still adhering to Zhang Zhongjing's warning "do not violate Stomach Qi or the Upper and Lower Jiao," the prescription is formulated as follows.
Xi Shengdi Huang (Rehmanniae Radix), Maidong (Ophiopogonis Radix), Zhi Gancao (Glycyrrhizae Radix et Rhizoma Honey-fried), Mudanpi (Moutan Cortex), Zhimu (Anemarrhenae Rhizoma), Niuxi (Achyranthis Bidentatae Radix), Sheng Baishao (Paeoniae Radix Alba), Fried Taoren (Persicae Semen).
Wang (38 years old): Yesterday, the discussion was about ascending and draining Shaoyang, designed to prevent Heat pathogen from sinking inward due to deficiency. Now, the pulse is rapid on the left and large on the right; throat pain, grey tongue coating, constipation, headache as before, epigastric stuffiness, desire to vomit, dry mouth, dry nose, insomnia. Considering complexion, pulse, and current symptoms, it already belongs to Heat pathogen sinking inward into the Blood Chamber. It is proposed to use Zhang Jingyue's Yü Nv Jian (Jade Woman Decoction) plus Zhu Ye (Bambusa Leaves).
Sheng Shigao (Gypsum Fibrosum) (4 qian), Huai Niuxi (Achyranthis Bidentatae Radix) (4 qian), Huai Shudi Huang (Rehmanniae Radix Preparata) (4 qian), Zhimu (Anemarrhenae Rhizoma) (1.5 qian), Jian Maidong (Ophiopogonis Radix) (2 qian), Juanxin Zhuye (Phyllostachidis Folium Cor) (1.5 qian).
Supplement to previous formula:
Chaihu (Bupleuri Radix) (5 fen), Lianqiao (Forsythiae Fructus) (decored, 2 qian), Zhimu (Anemarrhenae Rhizoma) (1.5 qian), Mudanpi (Moutan Cortex) (1.5 qian), Nen Yuan Shen (Scrophulariae Radix) (1.5 qian), Danshen (Salviae Miltiorrhizae Radix et Rhizoma) (1.5 qian), Chuan Hu (Dendrobii Caulis) (3 qian), Chi Shao (Paeoniae Radix Rubra) (1.5 qian).