治因思虑生痰，因痰生热，神志不宁。
清半夏（四钱） 生龙骨（六钱，捣细） 生牡蛎（六钱，捣细） 生赭石（三钱，轧细） 朴硝（二钱）
黑芝麻（三钱，炒捣） 柏子仁（三钱，炒捣） 生杭芍（三钱） 陈皮（二钱） 茯苓（二钱）
此方，即理痰汤，以龙骨、牡蛎代芡实，又加赭石、朴硝也。其所以如此加减者，因此方所主之痰，乃虚
而兼实之痰。实
痰宜开，礞石滚痰丸之用硝黄者是也；虚痰宜补，肾虚泛作痰，当用肾气丸以逐之者是也。至虚而兼实之痰，
则必一药之中，能开痰亦能补虚，其药乃为对证，若此方之龙骨、牡蛎是也。盖人之心肾，原相助为理。肾虚
则水精不能上输以镇心，而心易生热，是由肾而病及心也；心因思虑过度生热，必暗吸肾之真阴以自救，则肾
易亏耗，是由心而病及肾也。于是心肾交病，思虑愈多，热炽液凝，痰涎壅滞矣。惟龙骨、牡蛎能宁心固肾，
安神清热，而二药并用，陈修园又称为治痰之神品，诚为见道之言。故方中用之以代芡实，而犹恐痰涎过盛，
消之不能尽消，故又加赭石、朴硝以引之下行也。
一人，年三十余。常觉胆怯，有时心口或少腹 动后，须臾觉有气起自下焦，上冲胸臆，郁而不伸，连作
呃逆，脖项发热，即癫狂唱呼。其夹咽两旁内，突起若瘰 ，而不若瘰 之硬。且精气不固，不寐而遗，上焦
觉热，下焦觉凉。其脉左部平和，微嫌无力，右部直上直下（李士材脉诀云直上直下冲脉昭昭），仿佛有力，
而按之非真有力。从前屡次医治皆无效。此肾虚，致冲气挟痰上冲，乱其心之神明也。投以此汤，减浓朴之半，
加山萸肉（去净核）五钱，数剂诸病皆愈，惟觉短气。知系胸中大气下陷（理详升陷汤下），投以拙拟升陷汤，
去升麻、柴胡，加桂枝尖二钱，两剂而愈。盖此证，从前原有逆气上干，升麻、柴胡能升大气，恐兼升逆气。
桂枝则升大气，兼降逆气，故以之代升、柴也。
一媪，年六十二，资禀素羸弱。偶当外感之余，忽然妄言妄见，惊惧异常，手足扰动，饥渴不敢饮食，少
腹塌陷，胸膈突起。脉大于平时一倍，重按无力。知系肝肾大虚，冲气上逆，痰火上并，心神扰乱也。投以此
汤，去朴硝，倍赭石，加生山药、山萸肉（去净核）、生地黄各六钱。又磨取铁锈水煎药（理详一味铁养汤下），
一剂即愈。又服一剂，以善其后。
治疗因思虑过度而生痰，因痰郁而化热，导致神志不安的病证。
清半夏（四钱） 生龙骨（六钱，捣碎成细末） 生牡蛎（六钱，捣碎成细末） 生赭石（三钱，轧碎成细粉） 朴硝（二钱）
黑芝麻（三钱，炒熟后捣碎） 柏子仁（三钱，炒熟后捣碎） 生杭芍（三钱） 陈皮（二钱） 茯苓（二钱）
此方即为理痰汤，用龙骨、牡蛎代替芡实，另外加入了赭石、朴硝。之所以这样加减，是因为本方所主治的痰，是虚中夹实的痰。实证之痰宜用攻逐法，如礞石滚痰丸中使用芒硝、大黄即是此类；虚证之痰宜用补益法，如肾虚泛溢为痰，应当使用肾气丸来驱逐即是此类。至于虚中夹实的痰，则必须有一种药物既能开泄痰浊又能补益虚损，这种药才对证，比如本方中的龙骨、牡蛎就是如此。大概人的心与肾，原本互相资助以维持生理平衡。肾虚则水液精微不能上输以镇摄心火，因而心易生热，这是由肾病及心；心因思虑过度而生热，必然暗中吸取肾的真阴以自救，因而肾易亏耗，这是由心病及肾。于是心肾两脏同时患病，思虑越多，火热越炽盛，津液凝结，痰涎壅滞。只有龙骨、牡蛎能够宁心安神、固摄肾脏、清热安神，而且这两味药并用，清代医家陈修园又称之为治痰的神妙佳品，这确实是见识透彻的话。所以方中用它们来代替芡实，而又担心痰涎过于旺盛，单靠它们不能完全消除，因此又加入赭石、朴硝来引导痰浊下行。
有一位三十多岁的患者。常常感到胆怯，有时心口窝或少腹部有跳动感，片刻之后觉得有气从下焦升起，向上冲撞至胸膈，郁结而不能舒展，连续发生呃逆，脖颈发热，随即出现癫狂般的喊叫。其咽喉两侧内部突起，类似瘰疬（颈部淋巴结结核），但不像瘰疬那样坚硬。且精气不固，失眠且遗精，上焦感觉热，下焦感觉凉。其脉象左部平和，略微嫌无力，右部直上直下（李士材《脉诀》说：直上直下说明冲脉之气昭著），仿佛有力，但重按下去并非真正有力。从前多次医治都没有效果。这是肾虚，导致冲脉之气挟带痰浊上冲，扰乱了心的神明。投以此方，减去浓朴的一半，加入山萸肉（去净果核）五钱，服用几剂后各种病症都痊愈了，只是感觉短气。知道这是由于胸中大气下陷（原理详见升陷汤下方），投以我自己拟定的升陷汤，去掉升麻、柴胡，加入桂枝尖二钱，服用两剂后痊愈。因为这个病证，从前原有逆气上干，升麻、柴胡虽然能升举大气，但恐怕同时也升举了逆气。桂枝则既能升举大气，又能降逆气，所以用桂枝来代替升麻、柴胡。
有一位六十多岁的老妇人，体质向来羸弱。偶然在外感病余邪未清之时，突然胡言乱语、幻视，极度惊恐害怕，手足躁动不安，又饥又渴却不敢饮食，少腹部塌陷，胸膈部突起。脉象比平时大一倍，重按无力。知道这是肝肾大虚，冲脉之气上逆，痰火并盛，心神被扰乱。投以此方，去掉朴硝，加倍使用赭石，加入生山药、山萸肉（去净果核）、生地黄各六钱。又磨取铁锈水来煎药（原理详见一味铁养汤下方），服用一剂即痊愈。又服用一剂，以巩固疗效善后。
Treats conditions caused by excessive rumination leading to phlegm accumulation, which then transforms into heat, resulting in restless spirit and mind.
Qing Banxia (Pinelliae Rhizoma Praeparatum, 4 qian) Sheng Longgu (Fossilia Ossis Mastodi et Scapulae, 6 qian, crushed into fine powder) Sheng Muli (Concha Ostreae, 6 qian, crushed into fine powder) Sheng Zhe Shi (Haematitum, 3 qian, ground into fine powder) Piao Xiao (Natrii Sulfas, 2 qian)
Hei Zhima (Sesami Fructus Niger, 3 qian, stir-fried and crushed) Baizi Ren (Bi Semen, 3 qian, stir-fried and crushed) Sheng Hangshao (Paeoniae Radix Alba, 3 qian) Chenpi (Citri Reticulatae Pericarpium, 2 qian) Fuling (Poria, 2 qian)
This prescription is essentially Litang Tang (Phlegm-Regulating Decoction), where Longgu and Muli replace Qianshi (Euryales Semen), with the addition of Zhe Shi and Piao Xiao. The reason for these modifications is that the phlegm indicated by this formula is a type of deficiency-phlegm mixed with excess. Excess phlegm should be purged, as seen in Mengshi Guntan Wan (Mongolian Stone Phlegm-Rolling Pill) which uses Mangxiao (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma); deficiency phlegm should be tonified, such as when kidney deficiency causes water essence to overflow as phlegm, treated with Shenqi Wan (Kidney Qi Pill). For deficiency-phlegm mixed with excess, a single herb must be able to both resolve phlegm and tonify deficiency to be appropriate, such as Longgu and Muli in this formula. Generally, the Heart and Kidney mutually support each other. When the Kidney is deficient, water essence cannot ascend to suppress Heart fire, causing the Heart to easily generate heat; this is disease transmission from Kidney to Heart. Conversely, when the Heart generates heat due to excessive rumination, it inevitably draws upon the Kidney's True Yin for self-rescue, leading to Kidney depletion; this is disease transmission from Heart to Kidney. Thus, both Heart and Kidney become diseased; the more one ruminates, the more intense the heat becomes, condensing body fluids and causing stagnation of saliva and phlegm. Only Longgu and Muli can calm the Heart, secure the Kidney, soothe the spirit, and clear heat. Their combined use was praised by Qing dynasty physician Chen Xiuyuan as a divine remedy for treating phlegm, which is indeed insightful. Therefore, they are used in the formula to replace Qianshi. However, fearing that if phlegm is too abundant, these two herbs alone may not eliminate it completely, Zhe Shi and Piao Xiao are added to guide the downward movement of phlegm.
A patient, over thirty years old, often felt timid. Sometimes there was palpitation or movement at the epigastrium or lower abdomen, followed shortly by a sensation of qi rising from the Lower Jiao (Lower Burner) rushing up to the chest and diaphragm, becoming stagnant and unable to extend, accompanied by continuous hiccups. The neck and nape became hot, leading to manic shouting. Inside the sides of the throat, protrusions appeared resembling Luoli (scrofula/cervical lymphadenitis), but were not as hard as typical Luoli. Essence and qi were insecure, with insomnia and nocturnal emission. The Upper Jiao felt hot, while the Lower Jiao felt cold. The pulse on the left side was peaceful but slightly weak. The pulse on the right side moved straight up and down ("Straight up and down indicates prominent Chong Mai qi," according to Li Shicai's *Maijue*); it seemed forceful, but deep pressure revealed it was not truly forceful. Previous treatments were ineffective. This was Kidney deficiency causing Chong Mai (Penetrating Vessel) qi to carry phlegm upward, disturbing the Spirit (*Shen*) of the Heart. This decoction was administered, with Nongpu (Thunbergia Caulis) reduced by half, and Shanyurou (Corni Fructus, pitted) increased to 5 qian. After several doses, all symptoms resolved, except for a feeling of shortness of breath. It was determined that this was due to the sinking of the Great Qi in the Chest (explained in detail under Shengxian Tang). A modified version of my own Shengxian Tang (Great Qi-Lifting Decoction) was given, removing Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix), and adding Guizhi Jian (Cinnamomi Ramulus tip) 2 qian. After two doses, the patient recovered. In this condition, there was previously rebellious qi attacking upward. While Shengma and Chaihu can lift the Great Qi, they might also inadvertently lift the rebellious qi. Guizhi, however, lifts the Great Qi while simultaneously descending rebellious qi, hence it replaced Shengma and Chaihu.
An elderly woman, sixty-two years old, had always been constitutionally frail. Following an external contraction, she suddenly began speaking and seeing things irrationally, experiencing extreme fear and panic, with restlessness of hands and feet. She felt hungry and thirsty but dared not eat or drink. Her lower abdomen appeared sunken, while her chest and diaphragm protruded. Her pulse was double its usual size, yet weak upon deep pressure. This indicated severe deficiency of Liver and Kidney, with rebellious Chong Mai qi, simultaneous presence of phlegm-fire, and disturbance of the Heart Spirit. This decoction was administered, with Piao Xiao removed, Zhe Shi doubled, and Sheng Shanyao (Dioscoreae Rhizoma), Shanyurou (Corni Fructus, pitted), and Sheng Dihuang (Rehmanniae Radix) each added at 6 qian. Additionally, rust water was prepared by grinding iron rust to decoct the herbs (principle explained in Yiwu Tieyang Tang). One dose resulted in recovery. Another dose was taken to consolidate the effect and ensure aftercare.