《素问·阴阳应象大论》云∶悲胜怒,恐胜喜,怒胜思,喜胜忧,思胜恐。此即五行生
克之
理也。古贤治病,若文挚之怒齐王,华元化之怒郡守,皆宗此旨。戴人、丹溪治案尤多,然
亦有不拘克制之说者,如《邵氏闻见录》云∶州监军病悲思,郝允告其子曰∶法当得悸即愈
。时通守李宋卿御史严甚,监军向所惮也,允与子请于宋卿,一造问,责其过失,监军惶怖
出,疾乃已,此恐胜忧。《簪云楼杂记》云∶鹿邑李大谏,世为农家,获售于乡,父以喜故
,失声大笑,及举进士,其笑弥甚,历十年,擢谏垣,遂成痼疾,宵旦不休,太医院某,令
家人给其父曰∶大谏已殁。其父恸绝几殒,如是者十日,病渐瘳,佯为邮语曰∶大谏治以赵
大夫 ,绝而复苏。其父因悲而笑症永不作,此悲胜喜也。盖医者,意也,苟得其意,不必
泥其法,所谓神而明之,存乎其人也。
韩飞霞谓黄连、肉桂能交心肾于顷刻,震泽毛慎夫茂才元勋,尝用之而奏效。某年四十
余,
因子女四人痧痘连绵,辛勤百日,交小暑后,忽然不寐,交睡则惊恐非常,如坠如脱,吁呼
不
宁,时悲时笑,毛诊之,谓由卫气行于阳,不得入于阴,乃心肾不交之症,用北沙参、生地
、麦冬、当归、远志、炙草、白芍、茯神、川连二分,肉桂一分,以甘澜水(长流水扬之万
遍为甘澜水。)先煮秫米一两,去渣,将汤煎药,服之全愈。毛居黎里镇,读书三十年,中
岁行道,名著一时。
汪春圃《拔粹医案》亦有以黄连、肉桂治不寐症者,丁俊文每日晡后发热微渴,心胸间
怔忡
如筑,至晚辄生懊 ,欲骂欲哭,昼夜不能寐,诸药不效,延至一载有余,汪诊其脉,左寸
浮洪,两尺沉细,知属阴亏阳盛,仿《灵枢》秫米半夏汤,如法煎成,外用肉桂三钱,另煎
待冷,黄连三钱,另煎,乘热同和入内,徐徐温服,自未至戌尽剂,是夜即得酣睡,次日巳牌
方醒,随用天王补心丹,加肉桂、枸杞、鹿胶、龟胶等味制丸,调理全愈。偶从杭城沈雨溥
书坊购得《医学秘旨》一册,有治不睡方案云∶余尝治一人患不睡,心肾兼补之药,遍尝不
效,诊其脉,知为阴阳违和,二气不交,以半夏三钱,夏枯草三钱,浓煎服之,即得安睡,仍
投补心等药而愈。盖半夏得阴而生,夏枯草得至阳而长,则阴阳配合之妙也。书系抄本,题
曰西溪居士着,不知何许人,识以俟考。
不寐之症,由于思虑伤脾,繁冗劳心者,非专恃医药可治。《老老恒言》谓不寐有操纵
二法
∶操者如贯想头顶,默数鼻息,返观丹田之类,使心有所着,乃不纷驰,庶可获寐。纵者任
其心游思于杳渺无朕之区,亦可渐入朦胧之境。余谓二法之中,纵法尤妙。盖操则心犹矜
持,未极恬愉之趣,不若纵之游行自在也。特恐稍涉妄想,即难奏效,尤当寓操于纵为佳。
余师归安沈鹿坪先生焯,官台州教授时,因阅文繁劳,患怔忡不寐,有人传一法云∶每夜就
枕后,即收敛此心,勿萌杂念,惟游思于平素所历山水佳处,任情一往,定而能静,久而久
之,心渐即于杳漠之中,则不期寐而自寐矣。如法行之获效,是其能得纵法之要者。
《素问·阴阳应象大论》中说:悲伤可以克制愤怒,恐惧可以克制喜悦,愤怒可以克制思虑,喜悦可以克制忧愁,思虑可以克制恐惧。这就是五行相生相克的道理。古代贤人治病,如文挚用激怒的方法使齐王病愈,华元化(即华佗)用激怒的方法使郡守吐出瘀血,都是遵循这一宗旨。戴复庵、朱丹溪的治疗案例中这类方法更多,但也有不拘泥于五行克制理论的情况。如《邵氏闻见录》记载:州监军因悲伤和思虑成疾,郝允告诉他的儿子说:按照医理,应当让他产生惊恐情绪才能痊愈。当时通守李宋卿御史执法严厉,是监军一向畏惧的人。郝允与儿子向李宋卿请求,让李宋卿去拜访问候并责备其过失,监军惶恐害怕地出来,病就好了,这是恐惧克制忧愁的案例。《簪云楼杂记》记载:鹿邑的大谏官李大谏,世代务农,在乡试中考中秀才,父亲因为高兴的缘故,失声大笑;等到他考中进士,父亲的笑得更厉害;过了十年,升任谏官,父亲的这种狂笑成了顽固疾病,日夜不停。太医院的一位医生,让家人欺骗他的父亲说:大谏已经去世。父亲悲痛欲绝,几乎昏死过去,像这样持续了十天,病情逐渐好转。随后假装传递消息说:大谏被赵大夫救治后苏醒过来。父亲因此因悲伤而使得狂笑之症永不发作,这是悲伤克制喜悦的案例。大概医者讲究心意,如果领悟了其精神实质,不必拘泥于固定的法则,所谓神妙通达,全在于人的灵活运用。
韩飞霞认为黄连和肉桂能在顷刻之间交通心肾。震泽的毛慎夫(名元勋)曾使用这个方法并取得疗效。某年,毛慎夫四十多岁时,因为子女四人接连出痧痘,辛勤照料了一百天,在小暑节气过后,突然失眠,一入睡就极度惊恐,感觉如坠落或脱离身体,喘息不宁,时而悲伤时而大笑。毛慎夫诊断后,认为这是由于卫气运行于阳分,不能进入阴分,属于心肾不交的症状。于是使用北沙参、生地、麦冬、当归、远志、炙甘草、白芍、茯神、川黄连二分、肉桂一分,用甘澜水(将长流水反复扬起上万遍制成甘澜水)先煮一两秫米,去掉药渣,再用此汤煎煮药物,服用后完全痊愈。毛慎夫居住在黎里镇,读书三十年,中年开始行医,在当时名声显赫。
汪春圃的《拔粹医案》中也有用黄连和肉桂治疗失眠症的案例。丁俊文每天傍晚后发热微渴,心胸间心悸如撞击般难受,到了晚上就产生烦闷懊恼,想骂人又想哭,昼夜不能入睡,各种药物都不见效,拖延了一年多。汪春圃诊察其脉象,左寸脉浮洪,两尺脉沉细,知道属于阴亏阳盛,模仿《灵枢》中的秫米半夏汤,依法煎好。另外用肉桂三钱单独煎煮待冷,黄连三钱单独煎煮,趁热混合在一起,慢慢温服,从下午未时到晚上戌时服完一剂,当晚就睡得香甜,第二天巳时才醒来。随后使用天王补心丹,加入肉桂、枸杞、鹿角胶、龟板胶等药味制成丸药,调理后完全痊愈。偶然从杭州城沈雨溥的书坊买到一本《医学秘旨》,其中有治疗不睡觉的方案说:我曾经治疗一个人患失眠症,各种心肾双补的药物都尝遍了却无效,诊察其脉象,知道是阴阳不和,二气不交,于是用半夏三钱、夏枯草三钱,浓煎服用,立刻就能安睡,再投以补心等药物而痊愈。大概是因为半夏得阴气而生,夏枯草得至阳之气而长,这是阴阳配合的奥妙所在。这本书是抄本,题为西溪居士所著,不知道是什么地方的人,记录下来等待考证。
失眠症,由于思虑损伤脾脏,繁杂事务劳伤心神的,不是专门依靠医药可以治愈的。《老老恒言》说失眠有操纵两种方法:操法如同贯想头顶、默数鼻息、返观丹田之类,使心神有所专注,就不会纷乱奔驰,或许可以获得睡眠。纵法是任由心神游思于深远无形无迹的境界,也可以渐渐进入朦胧的睡意状态。我认为在这两种方法中,纵法尤其奇妙。因为操法中心神仍然矜持紧张,未达到恬淡愉快的极致趣味,不如纵法那样游行自在。只是担心稍微涉及妄想,就难以奏效,尤其应当将操法寓于纵法之中为最好。我的老师归安的沈鹿坪先生(名焯),在担任台州教授时,因为阅读文书繁重劳累,患有心悸失眠症,有人传授一种方法说:每晚躺上枕头后,就收敛这颗心,不要萌生杂念,只游思于平时所经历的山水美景之处,任凭情感前往,安定而能静下来,久而久之,心神渐渐进入幽深漠然的状态,那么不期望入睡也会自然入睡了。按照这种方法施行获得了疗效,说明他是掌握了纵法的要领的人。
The *Suwen: Yin-Yang Yingxiang Dalun* (Basic Questions: Great Treatise on the Correspondence of Yin and Yang) states: Sorrow overcomes Anger, Fear overcomes Joy, Anger overcomes Pensive Worry, Joy overcomes Sorrow, and Pensive Worry overcomes Fear. This is the principle of the generation and restriction of the Five Elements (Wu Xing). Ancient sages treated diseases using this method; for example, Wen Zhi cured the King of Qi by provoking his anger, and Hua Yuanhua (i.e., Hua Tuo) cured the commandery governor by provoking his anger to induce vomiting of blood stasis. Both followed this principle. Cases recorded by Dai Renfu and Zhu Danxi are particularly numerous in this regard. However, there are also cases that do not adhere strictly to the theory of mutual restriction. For instance, *Shao Shi Wen Jian Lu* records: The military supervisor of a prefecture suffered from sorrow and pensive worry. Hao Yun told his son, "According to medical principles, he should be made to feel fear in order to recover." At that time, Li Songqing, the Censor of the Tongshou office, was known for his strictness, and the supervisor had long feared him. Hao Yun and his son requested Li Songqing to visit and reprimand the supervisor for his faults. Upon leaving in terror, the supervisor's illness subsided. This illustrates Fear overcoming Sorrow. *Zan Yun Lou Za Ji* records: Da Jian Guan (Censor) Li from Luyi came from a family of farmers but passed the local examination. His father laughed uncontrollably out of joy. When Li passed the metropolitan examination, his father's laughter intensified. Ten years later, after Li was promoted to the Censorate, his father's uncontrollable laughter became a chronic disease, day and night without rest. A physician from the Imperial Medical Bureau instructed the father's servants to deceive him, saying, "The Censor has died." The father was overcome with grief and nearly fainted. After ten days of this state, his condition gradually improved. Then, they falsely spread news that "The Censor was treated by Doctor Zhao and revived." Consequently, the father's grief caused his manic laughter to cease permanently. This illustrates Sorrow overcoming Joy. Generally, medicine relies on mental acuity; if one grasps the underlying intent, one need not rigidly adhere to fixed methods. As the saying goes, divine illumination depends on the individual practitioner.
Han Feixia stated that Huanglian (Coptidis Rhizoma) and Rougui (Cinnamon Bark) can facilitate the interaction between the Heart and Kidney within moments. Mao Shenfu (courtesy name Yuanxun) from Zhenze once used this method with successful results. In a certain year, when Mao was in his forties, due to his four children suffering successively from smallpox and chickenpox, he worked tirelessly for a hundred days. After the Xiaoshu (Minor Heat) solar term, he suddenly developed insomnia. Whenever he tried to sleep, he experienced extreme panic, feeling as if falling or detached from his body, panting restlessly, alternating between sorrow and laughter. Mao diagnosed this as a case where Wei Qi (Defensive Qi) circulates in the Yang aspect but cannot enter the Yin aspect, constituting a syndrome of Heart-Kidney Non-Interaction. He prescribed Beishashen (Glehniae Radix), Shengdi (Rehmanniae Radix), Maidong (Ophiopogonis Radix), Danggui (Angelicae Sinensis Radix), Yuanzhi (Polygalae Radix), Zhigancao (Prepared Licorice Root), Baishao (Paeoniae Radix Alba), Fushen (Poria with Hostwood), Chuanlian (Coptidis Rhizoma) 2 fen, and Rougui 1 fen. He first decocted 1 liang of Sumi (Sorghum Grain) in Ganlan Shui (Sweet Ripple Water, prepared by stirring running water thousands of times), removed the dregs, and then used this liquid to decoct the herbs. The patient recovered completely after taking it. Mao lived in Li Li Town, studied for thirty years, and began practicing medicine in middle age, gaining fame at the time.
Wang Chunpu's *Bacui Yi An* (Medical Cases Extracted from Brilliance) also contains a case of treating insomnia with Huanglian and Rougui. Ding Junwen suffered from low-grade fever and slight thirst every afternoon, palpitations in the chest and heart area as if being beaten, and severe restlessness and agitation in the evening, wanting to scold and cry, unable to sleep day or night. Various medicines were ineffective, and the condition persisted for over a year. Wang diagnosed his pulse: the left Cun position was floating and surging, while both Chi positions were deep and fine. He determined this belonged to Yin deficiency with Yang hyperactivity. Mimicking the Sumi Banxia Tang (Sorghum and Pinellia Decoction) from the *Lingshu*, he prepared it according to standard procedures. Separately, he decocted 3 qian of Rougui until cool, and 3 qian of Huanglian separately. He mixed them while hot and administered the mixture slowly in warm doses. From Wei hour (1-3 PM) to Xu hour (7-9 PM), one dose was completed. That night, he slept soundly, waking only at Si hour (9-11 AM) the next day. Subsequently, he used Tianwang Buxin Wan (Emperor of Heaven's Tonification of the Heart Pill), adding Rougui, Gouqi (Lycium Fruit), Lujiao Jiao (Deer Antler Glue), and Guijiao Jiao (Tortoise Shell Glue), processed into pills, which led to full recovery through conditioning. I accidentally purchased a copy of *Yixue Mizhi* (Secrets of Medicine) from a bookstore run by Shen Yupu in Hangzhou. It contained a protocol for treating insomnia: "I once treated a patient with insomnia who had tried all kinds of Heart-Kidney tonifying medicines without effect. Diagnosing the pulse, I realized it was due to disharmony of Yin and Yang and non-interaction of the two Qi. I prescribed 3 qian of Banxia (Pinelliae Rhizoma) and 3 qian of Xiakucao (Prunellae Spica), decocted strongly, and administered it. The patient immediately slept peacefully and was subsequently cured with Heart-tonifying medicines. This is because Banxia grows by receiving Yin Qi, while Xiakucao grows by receiving Supreme Yang Qi; thus, their combination embodies the wonder of Yin-Yang coordination." The book was a manuscript copy titled as authored by Xixi Jushi, whose identity remains unknown; I record this for future verification.
Insomnia caused by excessive thinking damaging the Spleen, or by complex affairs exhausting the Heart, cannot be cured solely by medicine. *Laolao Hengyan* states there are two methods for insomnia: Control and Release. The Control method involves focusing the mind on the crown of the head, silently counting breaths, or observing the Dantian, thereby anchoring the mind so it does not scatter chaotically, allowing sleep to be attained. The Release method involves letting the mind wander freely in the profound and formless realm, which can gradually lead to a drowsy state. I believe among these two, the Release method is superior. The Control method keeps the mind tense and restrained, failing to reach the ultimate state of tranquility and joy, unlike the freedom of the Release method. However, one must fear that straying into delusion will render it ineffective; therefore, embedding elements of Control within Release is best. My teacher, Mr. Shen Luping (name Zhuo) from Gui'an, while serving as a Professor in Taizhou, suffered from palpitations and insomnia due to heavy reading and fatigue. Someone taught him a method: "After lying down each night, gather your mind, eliminate distracting thoughts, and let your imagination roam freely through beautiful landscapes you have previously experienced. Allow yourself to go with the flow. If you remain stable and quiet, over time, your mind will gradually enter a profound and obscure state, and you will fall asleep naturally without striving for it." He practiced this method and achieved efficacy, demonstrating that he had grasped the essence of the Release method.