缪（三八）头目如蒙。寤而不寐。胸膈隐痛。脘痹不饥。非关食滞。气火有余。拟清散理上为宜。
羚羊角（一钱） 郁金（一钱） 鲜生地（一两） 淡豆豉（一钱一分） 栝蒌皮（一钱五分） 霜桑叶（一钱）
连翘（一钱） 青菊叶（四片）
张（三六）肝阳犯胃。厥心痛。呕吐妨食。肢冷脉弦。
川楝子 制半夏 制香附 炒延胡 郁金 茯苓 生白芍 炒橘红
又 昨进苦辛方。呕吐已止。诸痛皆减。肝阳虽平。而耳鸣。咽干频渴。恶心脘痹。想六气都从火化。所以头面清
空诸窍。皆为肝火蒙闭。再拟清散。亦为内经之其上可引。勿越之。之义也。
青菊叶（三钱） 鲜生地（一两） 郁金（一钱） 栝蒌皮（一钱五分） 霜桑叶（一钱） 黑山栀（一钱五分） 羚
羊角（一钱） 连翘（一钱五分）
梅（三六）昨进凉解方。身热已止。口渴亦减。是邪解之象。但呕吐妨食。寤而少寐。余邪未清于胃腑。经云。胃
不和则卧不安。拟温胆汤。
鲜竹茹（一钱五分） 制半夏（一钱五分） 茯苓（二钱） 枳实（二钱） 橘红（一钱） 姜汁（冲入，一钱）
川石斛（三钱）
车（三一）不寐多日。气逆欲呕。此属肝阳上升。阳不下交于阴所致。进酸枣仁汤。
酸枣仁（炒黑切研，三钱） 知母（四钱） 茯苓（一钱） 生甘草（三钱） 川芎（五分）
潘（三五）脉细面白。寤不成寐。归脾汤主之。
嫩黄 （三钱） 焦于术（二钱） 远志（五分） 当归（一钱五分） 炙草（五分） 枣仁（三钱） 茯神（二
钱） 龙眼肉（三钱）
钟（四五）痢久伤阴。痢止泻减。脉象右微。泻血一次。颇多。汗泄不寐、心、脾、肝、肾皆亏。阳气不肯下交于
阴。脏病散。难奏效。深虑反复。议养荣汤去桂、芍、远志、陈皮。加枣仁。
人参（五分） 炙黄 （二钱） 炙草（五分） 炒松熟地（四钱） 五味子（三分） 当归（一钱五分） 茯神
（二钱） 枣仁（炒焦研，二钱） 甜冬术（二钱） 加桂圆肉（二钱）
又 议人参养荣汤去桂、姜、枣。
人参（五分） 绵黄 （三钱） 炙草（五分） 甜冬术（二钱） 原熟地（四钱） 当归（一钱五分） 五味子
（三分） 陈皮（一钱） 生白芍（一钱五分） 茯苓（二钱） 远志（去心研，四分） 加左牡蛎（二钱） 龙骨（
研，一钱）
又 两颧赤色。阴火上升。口干汗泄。少寐。下纯血已止。此血由经阻三月。心主血。肝藏血。脾统血。三阴大亏。
经断瘀阻。乃温补内托。而始下此病根也。与痢症下纯血例于不治之条迥异。然前方已臻小效。脉右微已振。左脉稍
濡。腹痛忽冷忽热。踞于少腹。腹为阴是也。酸水涌溢不止。木邪何疑。当此气血交亏。无清火法。必得导火归原。方
是治病法程。仍议人参养营汤去当归、姜。
人参（另煎冲，五分） 嫩黄 （三钱） 炙草（五分） 淮熟地（五钱） 五味子（三分） 炒焦白芍（一钱五
分） 甜冬术（二钱） 远志（去心研，四分） 云茯神（二钱） 陈皮（一钱） 加大枣（二枚）
缪姓患者（38岁）：头部和眼睛感觉昏沉如被蒙蔽。清醒但无法入睡。胸膈部位隐隐作痛。胃脘部痞塞不通，没有饥饿感。这不是因为食物积滞，而是气火有余所致。拟采用清散理上的治疗方法为宜。
羚羊角（一钱） 郁金（一钱） 鲜生地（一两） 淡豆豉（一钱一分） 栝蒌皮（一钱五分） 霜桑叶（一钱）
连翘（一钱） 青菊叶（四片）
张姓患者（36岁）：肝阳犯胃。厥心痛（一种以心前区疼痛为主，伴有四肢逆冷的病证）。呕吐妨碍进食。四肢发冷，脉象弦。
川楝子 制半夏 制香附 炒延胡索 郁金 茯苓 生白芍 炒橘红
复诊：昨日服用苦辛方后，呕吐已停止，各种疼痛都减轻了。肝阳虽然平息，但出现耳鸣、咽干、频繁口渴、恶心、胃脘痞塞的症状。推测六气（风、寒、暑、湿、燥、火）都已从火化。因此头面部的清空诸窍，都被肝火蒙闭。再拟用清散的方法，也符合《内经》中“其高者，因而越之”（病位在上，可用涌吐或宣散法治疗）的道理。
青菊叶（三钱） 鲜生地（一两） 郁金（一钱） 栝蒌皮（一钱五分） 霜桑叶（一钱） 黑山栀（一钱五分） 羚羊角（一钱） 连翘（一钱五分）
梅姓患者（36岁）：昨日服用凉解方后，身体发热已经停止，口渴也减轻了。这是邪气解除的迹象。但是仍然呕吐妨碍进食，清醒但睡眠少。余邪未清于胃腑。经云：“胃不和则卧不安”。拟用温胆汤。
鲜竹茹（一钱五分） 制半夏（一钱五分） 茯苓（二钱） 枳实（二钱） 橘红（一钱） 姜汁（冲入，一钱）
川石斛（三钱）
车姓患者（31岁）：不寐多日。气逆欲呕。这属于肝阳上升，阳气不能下交于阴所致。进服酸枣仁汤。
酸枣仁（炒黑切研，三钱） 知母（四钱） 茯苓（一钱） 生甘草（三钱） 川芎（五分）
潘姓患者（35岁）：脉细面白。清醒但无法入睡。用归脾汤主治。
嫩黄芪（三钱） 焦于术（二钱） 远志（五分） 当归（一钱五分） 炙甘草（五分） 枣仁（三钱） 茯神（二钱） 龙眼肉（三钱）
钟姓患者（45岁）：痢疾日久损伤阴液。痢疾停止腹泻减少。脉象右侧微弱。泻血一次，量颇多。汗出泄泻不寐，心、脾、肝、肾皆亏虚。阳气不肯下交于阴。脏病散漫，难以奏效。深虑病情反复。议用养荣汤去掉桂枝、白芍、远志、陈皮。加入枣仁。
人参（五分） 炙黄芪（二钱） 炙甘草（五分） 炒松熟地黄（四钱） 五味子（三分） 当归（一钱五分） 茯神（二钱） 枣仁（炒焦研，二钱） 甜冬术（二钱） 加桂圆肉（二钱）
复诊：议用人参养荣汤去掉桂枝、生姜、大枣。
人参（五分） 绵黄芪（三钱） 炙甘草（五分） 甜冬术（二钱） 原熟地黄（四钱） 当归（一钱五分） 五味子（三分） 陈皮（一钱） 生白芍（一钱五分） 茯苓（二钱） 远志（去心研，四分） 加左牡蛎（二钱） 龙骨（研，一钱）
又复诊：两颧赤色。阴火上升。口干汗出泄泻。睡眠少。下部纯血已止。这血由经脉阻滞三个月引起。心主血。肝藏血。脾统血。三阴大亏。经断瘀阻，乃是温补内托，才导致出现这个病根。这与痢症下纯血属于不治之条的情况截然不同。然而前方已见小效，右脉微弱已振起，左脉稍濡。腹痛忽冷忽热，位于少腹。腹部属阴。酸水涌溢不止，木邪（肝邪）何疑？当此气血交亏之时，无清火之法，必须得导火归原，这才是治病法程。仍议用人参养营汤去掉当归、生姜。
人参（另煎冲，五分） 嫩黄芪（三钱） 炙甘草（五分） 淮熟地黄（五钱） 五味子（三分） 炒焦白芍（一钱五分） 甜冬术（二钱） 远志（去心研，四分） 云茯神（二钱） 陈皮（一钱） 加大枣（二枚）
Mou (38 years old): The head and eyes feel heavy and obscured, as if covered by a veil. Awake but unable to sleep. Dull pain in the chest and diaphragm. Stomach epigastrium feels obstructed and there is no appetite. This is not due to food stagnation, but rather an excess of Qi and Fire. It is appropriate to adopt a treatment method of clearing and dispersing from the upper jiao.
Antelope Horn (Lingyangjiao) [Cornu Saigae Tataricae] (1 qian)
Curcuma Aromatica Rhizome (Yujin) [Curcumae Rhizoma] (1 qian)
Fresh Rehmannia Root (Xianshengdi) [Rehmanniae Radix Recens] (1 liang)
Prepared Soybean (Dandouchi) [Sojae Semen Praeparatum] (1.1 qian)
Trichosanthes Fruit Peel (Gualoupi) [Trichosanthis Pericarpium] (1.5 qian)
Frost Mulberry Leaf (Shuangsangye) [Mori Folium] (1 qian)
Forsythia Fruit (Lianqiao) [Forsythiae Fructus] (1 qian)
Green Chrysanthemum Leaf (Qingjuye) [Chrysanthemi Indici Folium] (4 leaves)
Zhang (36 years old): Liver Yang invading the Stomach. Jue Heartache [Jue Xin Tong, a type of heart pain accompanied by cold limbs]. Vomiting interfering with eating. Cold limbs, wiry pulse.
Toosendan Fruit (Chuannianzi) [Meliosmae Fructus]
Prepared Pinellia Tuber (Zhibanxia) [Pinelliae Rhizoma Praeparatum]
Prepared Cyperus Rhizome (Zhixiangfu) [Cyperi Rhizoma Praeparatum]
Stir-fried Corydalis Rhizome (Chao Yanhu) [Corydzalis Rhizoma]
Curcuma Aromatica Rhizome (Yujin) [Curcumae Rhizoma]
Poria (Fuling) [Poria]
Raw White Peony Root (Shengbaishao) [Paeoniae Radix Alba]
Stir-fried Tangerine Peel (Chao Juhong) [Citri Reticulatae Pericarpium Rubrum]
Follow-up: After taking the bitter-acrid formula yesterday, vomiting has stopped, and all pains have decreased. Although Liver Yang has been pacified, tinnitus, dry throat, frequent thirst, nausea, and stomach epigastric obstruction remain. It is speculated that the Six Qi [Wind, Cold, Summer-heat, Dampness, Dryness, Fire] have all transformed into Fire. Therefore, the clear orifices of the head and face are blocked by Liver Fire. Again, a clearing and dispersing method is proposed, which also conforms to the principle in the *Neijing*: "Where the disease is high, use the method of inducing vomiting or dispersing" [Qi gao zhe, yin er yue zhi].
Green Chrysanthemum Leaf (Qingjuye) [Chrysanthemi Indici Folium] (3 qian)
Fresh Rehmannia Root (Xianshengdi) [Rehmanniae Radix Recens] (1 liang)
Curcuma Aromatica Rhizome (Yujin) [Curcumae Rhizoma] (1 qian)
Trichosanthes Fruit Peel (Gualoupi) [Trichosanthis Pericarpium] (1.5 qian)
Frost Mulberry Leaf (Shuangsangye) [Mori Folium] (1 qian)
Black Gardenia Fruit (Heishanzhi) [Gardeniae Fructus] (1.5 qian)
Antelope Horn (Lingyangjiao) [Cornu Saigae Tataricae] (1 qian)
Forsythia Fruit (Lianqiao) [Forsythiae Fructus] (1.5 qian)
Mei (36 years old): After taking the cooling-resolving formula yesterday, body heat has ceased, and thirst has decreased. This is a sign of pathogenic factor resolution. However, vomiting still interferes with eating, and sleep is scant despite being awake. Residual pathogens have not cleared from the Stomach Fu organ. The Classics state: "When the Stomach is disharmonious, sleep is uneasy." Propose Wendan Tang [Warm the Gallbladder Decoction].
Fresh Bamboo Shavings (Xianzhuru) [Bambusae Caulis in Taeniam] (1.5 qian)
Prepared Pinellia Tuber (Zhibanxia) [Pinelliae Rhizoma Praeparatum] (1.5 qian)
Poria (Fuling) [Poria] (2 qian)
Immature Bitter Orange (Zhishi) [Aurantii Fructus Immaturus] (2 qian)
Tangerine Peel (Juhong) [Citri Reticulatae Pericarpium Rubrum] (1 qian)
Ginger Juice (Jiangzhi) [Zingiberis Rhizoma Recens Sucus] (1 qian, added after decoction)
Dendrobium Stem (Chuanshihu) [Dendrobii Caulis] (3 qian)
Che (31 years old): Insomnia for many days. Rebellious Qi wanting to vomit. This belongs to Rising Liver Yang, where Yang fails to descend and interact with Yin. Administer Suanzaoren Tang [Sour Jujube Seed Decoction].
Sour Jujube Seed (Suanzaoren) [Ziziphi Spinosae Semen] (3 qian, stir-fried black, cut, and ground)
Anemarrhena Rhizome (Zhimu) [Anemarrhenae Rhizoma] (4 qian)
Poria (Fuling) [Poria] (1 qian)
Raw Licorice Root (Shenggancao) [Glycyrrhizae Radix et Rhizoma] (3 qian)
Szechwan Lovage Rhizome (Chuanxiong) [Ligustici Chuanxiong Rhizoma] (0.5 qian)
Pan (35 years old): Fine pulse, pale complexion. Awake but unable to sleep. Govern with Guipi Tang [Restore the Spleen Decoction].
Tender Astragalus Root (Nenhuangqi) [Astragali Radix] (3 qian)
Charred Atractylodes Macrocephala Rhizome (Jiaoyuzhu) [Atractylodis Macrocephalae Rhizoma] (2 qian)
Polygala Root (Yuanzhi) [Polygalae Radix] (0.5 qian)
Chinese Angelica Root (Danggui) [Angelicae Sinensis Radix] (1.5 qian)
Honey-fried Licorice Root (Zhigancao) [Glycyrrhizae Radix et Rhizoma Preparata] (0.5 qian)
Sour Jujube Seed (Zaoren) [Ziziphi Spinosae Semen] (3 qian)
Poria cocos with Hostwood (Fushen) [Poria cum Mycelium] (2 qian)
Longan Aril (Longyanrou) [Euphorbiae Longan Arillus] (3 qian)
Zhong (45 years old): Chronic dysentery has damaged Yin. Dysentery has stopped, diarrhea has decreased. Pulse is faint on the right side. One episode of bloody stool, quite abundant. Sweating, diarrhea, insomnia; Heart, Spleen, Liver, and Kidney are all deficient. Yang Qi refuses to descend and interact with Yin. Zang organ disease is scattered, difficult to achieve efficacy. Deeply worry about recurrence. Propose Yangrong Tang [Nourish the Vigor Decoction], removing Cinnamon Twig (Guizhi), White Peony Root (Baishao), Polygala Root (Yuanzhi), and Tangerine Peel (Chenpi). Add Sour Jujube Seed (Zaoren).
Ginseng Root (Renshen) [Panacis Ginseng Radix] (0.5 qian)
Honey-fried Astragalus Root (Zhihuangqi) [Astragali Radix Preparata] (2 qian)
Honey-fried Licorice Root (Zhigancao) [Glycyrrhizae Radix et Rhizoma Preparata] (0.5 qian)
Stir-fried Prepared Rehmannia Root (Chaosongshudihuang) [Rehmanniae Radix Preparata] (4 qian)
Schisandra Berry (Wuweizi) [Schisandrae Chinensis Fructus] (0.3 qian)
Chinese Angelica Root (Danggui) [Angelicae Sinensis Radix] (1.5 qian)
Poria cocos with Hostwood (Fushen) [Poria cum Mycelium] (2 qian)
Sour Jujube Seed (Zaoren) [Ziziphi Spinosae Semen] (2 qian, stir-fried charred and ground)
Sweet Winter Atractylodes Rhizome (Tiandongzhu) [Atractylodis Rhizoma] (2 qian)
Add Longan Aril (Guiyuanrou) [Euphorbiae Longan Arillus] (2 qian)
Follow-up: Propose Ren Shen Yang Rong Tang [Ginseng Decoction to Nourish the Vigor], removing Cinnamon Twig (Guizhi), Ginger (Shengjiang), and Jujube (Dazao).
Ginseng Root (Renshen) [Panacis Ginseng Radix] (0.5 qian)
Silky Astragalus Root (Mianhuangqi) [Astragali Radix] (3 qian)
Honey-fried Licorice Root (Zhigancao) [Glycyrrhizae Radix et Rhizoma Preparata] (0.5 qian)
Sweet Winter Atractylodes Rhizome (Tiandongzhu) [Atractylodis Rhizoma] (2 qian)
Original Prepared Rehmannia Root (Yuanshudihuang) [Rehmanniae Radix Preparata] (4 qian)
Chinese Angelica Root (Danggui) [Angelicae Sinensis Radix] (1.5 qian)
Schisandra Berry (Wuweizi) [Schisandrae Chinensis Fructus] (0.3 qian)
Tangerine Peel (Chenpi) [Citri Reticulatae Pericarpium] (1 qian)
Raw White Peony Root (Shengbaishao) [Paeoniae Radix Alba] (1.5 qian)
Poria (Fuling) [Poria] (2 qian)
Polygala Root (Yuanzhi) [Polygalae Radix] (0.4 qian, heart removed, cut, and ground)
Add Left Oyster Shell (Zuomuli) [Ostreae Concha] (2 qian)
Dragon Bone (Longgu) [Dinosauria Ossis Femur seu Mandibula] (1 qian, ground)
Follow-up again: Redness on both malar eminences. Deficient Fire rising. Dry mouth, sweating, diarrhea. Scant sleep. Lower pure blood discharge has stopped. This blood loss was caused by meridian obstruction for three months. The Heart governs Blood. The Liver stores Blood. The Spleen controls Blood. The Three Yin [Liver, Spleen, Kidney] are greatly deficient. Menstruation stopped with blood stasis obstruction. It was warm-tonifying and internal-expelling methods that led to this pathological root. This is distinctly different from cases of pure bloody stool in dysentery which are considered untreatable. However, the previous prescription has achieved slight efficacy. The faint right pulse has revived, and the left pulse is slightly soggy. Abdominal pain alternates between cold and hot sensations, located in the lower abdomen. The abdomen belongs to Yin. Acid water surges uncontrollably, indicating Wood pathogen [Liver pathogen]. At this time of combined Qi and Blood deficiency, there is no method for clearing Fire. One must guide Fire back to its source [Dao Huo Gui Yuan]. This is the correct therapeutic course. Still propose Ren Shen Yang Ying Tang [Ginseng Decoction to Nourish the Camp], removing Chinese Angelica Root (Danggui) and Ginger (Shengjiang).
Ginseng Root (Renshen) [Panacis Ginseng Radix] (0.5 qian, separately decocted and mixed in)
Tender Astragalus Root (Nenhuangqi) [Astragali Radix] (3 qian)
Honey-fried Licorice Root (Zhigancao) [Glycyrrhizae Radix et Rhizoma Preparata] (0.5 qian)
Huai Prepared Rehmannia Root (Huai shudihuang) [Rehmanniae Radix Preparata] (5 qian)
Schisandra Berry (Wuweizi) [Schisandrae Chinensis Fructus] (0.3 qian)
Stir-fried Charred White Peony Root (Chaojiaobaishao) [Paeoniae Radix Alba] (1.5 qian)
Sweet Winter Atractylodes Rhizome (Tiandongzhu) [Atractylodis Rhizoma] (2 qian)
Polygala Root (Yuanzhi) [Polygalae Radix] (0.4 qian, heart removed, cut, and ground)
Cloud Poria cocos with Hostwood (Yunfushen) [Poria cum Mycelium] (2 qian)
Tangerine Peel (Chenpi) [Citri Reticulatae Pericarpium] (1 qian)
Add Jujube (Dazao) [Ziziphi Jujubae Fructus] (2 pieces)