生生子曰∶一妇三十五岁无子,恐夫娶外家致郁,经不行者三月矣,病腹痛恶心,诸医皆云有孕
,其夫亦粗知医,举家欣喜,治以安胎行气止痛之药,服三五十帖不效,痛苦益甚。凡未申时发寒
热,腹中有块,如弹子大者二三十枚,翻腾作痛,行动则水声漉漉,痛极则吐酸水五六碗,吐尽则块
息而寒热除,痛亦不作,明日亦然。又作疟治,转剧。召予诊,左手弦尺涩,右
手濡弱,重取则滑,尺同左。时经已五月不行矣。予曰∶此郁病也,岂有涩脉成孕之理?若然,则前药当
效矣。其夫亦悟,乃为制方,以二陈加香附、山栀、抚芎、玄胡、当归、红花之类,药进而痛止,连与四
帖,皆效,但药止则痛发如故,调治一月,不能除根。予因持脉案见先师黄古潭先生,先生乃谕予曰∶
此郁火病也。其病起于肝胆,盖肝主谋虑,胆主决断,谋不决则郁生,郁生则木盛,木盛则凌脾,脾伤则
不能运化精微,而生气血,以故月水不来也。肺金失于母养,则降杀之令不行,木寡于畏,而侮所不胜,
是以直冲犯清道,以作吐也。吐后诸症皆减者,木升而火息也。为裁一方,以黄 五钱,柴胡三钱,白芍
药二钱,甘草一钱,陈皮、贝母、枳实各五分,姜三片。一剂而寒热除,再剂而痛减吐止,水声亦绝,七
日不发。其夫喜曰∶是何神速也!乃拉予复请命于先生,先生曰∶夫寒热者,少阳胆也,吐酸者,厥阴肝
也,痛而复块翻腾者,火盛激动其水,如锅中汤滚,泡浪沸腾是也。吐多则肺金愈伤。故用黄 补肺金为
君,使得以制肝木,以柴胡泻肝为臣,以升发其胆火,《经》曰∶“木郁则达之”,达是通达之义,夫木性
上升者也,既郁则不升,故用柴胡升发胆肝之清气,使冲开其郁结,以复其常。又曰∶“过者折之,以其
畏也,所谓泻之”。补肺制肝,正谓此也。又曰∶“泄其肝者,缓其中”。以甘草缓中为佐。
又曰∶“木位之主,其泻以酸”,以白芍药于脾中泻木为臣。病久生郁,郁久则生涎,以贝母、陈皮、
枳实,开郁逐涎,为裨使,然后金得其正,木得其平,土得其安,由是病去而愈速。前方用山栀、黄
连之类,皆降下之药,火势正炽,岂区区寒凉所能抑哉!故《经》曰∶轻者正治,重则从其性而升之
。但凡治病,要当识得此意。
先生,吾徽黟人也,汪石山翁弟子,少业儒,通五经,以疾就医,治病每有超见,此略述其二耳。
且此今人所患者多,而治者鲜有若是之明且尽也。故揭附于斯,以公同志者,庶先生之名不泯也。
生生子说:有一位三十五岁的女子没有生育,因为担心丈夫娶妾导致情绪抑郁,月经已经三个月没来了。她出现腹痛、恶心的症状,各位医生都说是怀孕,她的丈夫也略懂医术,全家都很高兴,便用安胎、行气、止痛的药物进行治疗,服用了三五十帖药后没有效果,痛苦反而更加严重。每天下午三点到五点(未申时)发作寒热,腹中有硬块,像弹子大小的有二三十个,翻腾作痛,走动时腹部有水声漉漉作响,疼痛剧烈时会吐出五六碗酸水,吐完后硬块平息,寒热消退,疼痛也不再发作,第二天也是如此。又按疟疾治疗,病情反而加重。请我诊治,左手脉象弦而尺部涩,右手脉象濡弱,重按时则滑,尺部与左手相同。此时月经已经五个月没来了。我说:这是郁证,哪有涩脉能怀孕的道理?如果是怀孕,之前的药应该有效了。她的丈夫也醒悟过来,于是为我制定方剂,用二陈汤加上香附、山栀、抚芎、玄胡索、当归、红花等药物,服药后疼痛停止,连续服用四帖,都有疗效,但停药后疼痛依旧发作,调理一个月,不能除根。我拿着脉案去见先师黄古潭先生,先生于是教导我说:这是郁火病。这个病起于肝胆,因为肝主谋虑,胆主决断,谋略不能决断就会产生郁结,郁结产生则肝木旺盛,肝木旺盛则克制脾土,脾受伤则不能运化精微物质,从而生成气血,因此月经不来。肺金失去母脏(脾土)的滋养,则肃降的功能不能正常行使,肝木缺少制约,就会反侮其所不胜(即肺金),所以直接冲犯清道,导致呕吐。呕吐后各种症状都减轻,是因为肝木之气上升而火势平息。为此裁制一方,用黄连五钱,柴胡三钱,白芍药二钱,甘草一钱,陈皮、贝母、枳实各五分,生姜三片。一剂药后寒热消除,两剂药后疼痛减轻、呕吐停止,水声也绝迹,七天不再发作。她的丈夫高兴地说:为什么这么神速呢!于是拉着我再次向先生请教,先生说:所谓的寒热,属于少阳胆经;呕吐酸水,属于厥阴肝经;疼痛且伴有硬块翻腾,是火盛激动了体内的水液,就像锅中的汤沸腾,泡沫浪涌一样。呕吐过多会进一步损伤肺金。所以用黄连补益肺金作为君药,使其能够制约肝木,用柴胡疏泄肝气作为臣药,以升发胆火,《内经》说:“木郁则达之”,“达”是通达的意思,肝木本性是上升的,既然郁结就不能上升,所以用柴胡升发胆肝的清气,使冲开其郁结,恢复常态。又说:“过者折之,以其畏也,所谓泻之”。补肺制肝,正是说的这个意思。又说:“泄其肝者,缓其中”。用甘草缓和中焦作为佐药。又说:“木位之主,其泻以酸”,用白芍药在脾中泻肝木作为臣药。病久生郁,郁久则生痰涎,用贝母、陈皮、枳实,开郁逐痰,作为使药辅助,然后金得其正,木得其平,土得其安,因此病去而痊愈迅速。前方使用山栀、黄连之类,都是降下的药物,火势正炽盛,岂是区区寒凉药所能抑制的呢!所以《内经》说:“轻者正治,重则从其性而升之”。凡是治病,一定要懂得这个意思。
先生,是我们徽州黟县人,是汪石山先生的弟子,年轻时从事儒业,通晓五经,因为生病而学习医学,治病每每有独到的见解,这里只简述了他的两个案例。况且这是现在人患的病很多,而治疗的人很少有像这样明察且详尽的。所以揭露并附记在这里,以公之于志同道合的朋友,希望先生的名声不致泯灭。
Shengshengzi said: A thirty-five-year-old woman, childless, feared that her husband taking another wife would cause emotional depression. Her menstruation had ceased for three months. She suffered from abdominal pain and nausea. All physicians claimed she was pregnant. Her husband, who had rudimentary medical knowledge, was delighted with the whole family. They treated her with herbs for calming the fetus, promoting qi circulation, and relieving pain. After taking thirty to fifty doses without effect, her suffering intensified. Every day between 3 PM and 5 PM (Wei-Shen hours), she experienced chills and fever. There were lumps in her abdomen, about twenty or thirty in number, each the size of a marble, churning and causing pain. When she moved, there was a gurgling sound of water in her abdomen. When the pain was extreme, she vomited five or six bowls of sour fluid. After vomiting, the lumps subsided, the chills and fever disappeared, and the pain ceased. The next day was the same. She was then treated as having malaria, but her condition worsened. I was summoned to examine her. Her left pulse was wiry at the cun position and choppy at the chi position; her right pulse was soggy and weak, but slippery upon heavy pressure, with the chi position similar to the left. Her menstruation had now been absent for five months. I said: This is a depression syndrome. How can pregnancy occur with a choppy pulse? If it were pregnancy, the previous medicines should have been effective. Her husband also realized this. He then prescribed a formula based on Er Chen Tang (Two-Cured Decoction) added with Xiangfu (Cyperus Rhizome), Shanzhi (Gardeniae Fructus), Fuxiong (Ligusticum Chuanxiong Rhizoma var. huoxiong), Yuanhu (Corydalis Rhizome), Danggui (Angelicae Sinensis Radix), Honghua (Carthami Flos), and similar herbs. After taking the medicine, the pain stopped. Four consecutive doses were effective, but the pain returned upon stopping the medication. After one month of regulation, the root cause could not be eliminated. I took the pulse record to consult my former teacher, Mr. Huang Gutan. He instructed me saying: This is a depression-fire syndrome. The disease originates in the Liver and Gallbladder. The Liver governs planning, and the Gallbladder governs decision-making. When plans are not decided, depression arises. Depression leads to exuberance of Wood. Exuberant Wood overacts on Spleen Earth. When the Spleen is injured, it cannot transform and transport essence and nutrients to generate Qi and Blood, hence menstruation does not arrive. Lung Metal, lacking nourishment from its mother (Spleen Earth), fails to perform its descending function. With Wood lacking restraint, it insults what it cannot overcome (i.e., Lung Metal), thus directly attacking the clear pathways, causing vomiting. The reduction of symptoms after vomiting occurs because the rising of Wood and the extinguishing of Fire. I formulated a prescription using Huanglian (Coptidis Rhizoma) 5 qian, Chaihu (Bupleuri Radix) 3 qian, Baishao (Paeoniae Radix Alba) 2 qian, Gancao (Glycyrrhizae Radix et Rhizoma) 1 qian, Chenpi (Citri Reticulatae Pericarpium), Beimu (Fritillariae Thunbergii Bulbus), and Zhishi (Aurantii Fructus Immaturus) each 5 fen, and three slices of Jiang (Zingiberis Rhizoma). After one dose, chills and fever ceased. After two doses, pain decreased, vomiting stopped, and the water sound disappeared. It did not recur for seven days. Her husband rejoiced, saying: "How miraculous and rapid!" He urged me to seek further instruction from Mr. Huang. Mr. Huang said: The chills and fever belong to the Shaoyang Gallbladder channel. Vomiting sour fluid belongs to the Jueyin Liver channel. Pain accompanied by churning lumps is due to excessive Fire agitating Water within the body, akin to soup boiling in a pot with surging bubbles. Excessive vomiting further injures Lung Metal. Therefore, Huanglian is used as the Sovereign herb to tonify Lung Metal, enabling it to control Liver Wood. Chaihu is used as the Minister herb to drain Liver Qi and ascend Gallbladder Fire. The Classic states: 'When Wood is depressed, it must be made free.' 'Free' means unobstructed. Since Wood's nature is to rise, when depressed, it fails to rise. Thus, Chaihu is used to ascend the clear Qi of the Gallbladder and Liver, breaking through the depression and restoring normalcy. It also states: 'For excess, reduce it, according to what it fears; this is called draining.' Tonifying Lung to control Liver precisely refers to this. It also states: 'To drain the Liver, soothe its center.' Gancao is used as an Assistant herb to soothe the center. Furthermore: 'In diseases primarily of the Wood position, drainage is achieved with sour flavors.' Baishao is used as a Minister herb to drain Wood within the Spleen. Prolonged illness generates depression; prolonged depression generates phlegm-fluids. Beimu, Chenpi, and Zhishi are used as Envoy herbs to open depression and expel phlegm-fluids. In this way, Metal regains its proper function, Wood achieves balance, and Earth finds peace, leading to rapid recovery. The previous formula used herbs like Shanzhi and Huanglian, which are descending agents. When Fire is blazing, how can mere cold-natured herbs suppress it? Hence the Classic says: 'For mild cases, treat directly; for severe cases, follow its nature and ascend it.' In treating any disease, one must understand this principle.
Mr. Huang was from Yi County, Huizhou. He was a disciple of Mr. Wang Shishan. In his youth, he studied Confucianism and mastered the Five Classics. Due to illness, he turned to medicine. His treatments often showed extraordinary insight. Here, only two cases are briefly recorded. Moreover, this is a common ailment today, yet few practitioners possess such clarity and thoroughness in treatment. Therefore, I publish this account to share with like-minded colleagues, hoping Mr. Huang's reputation will not fade.