邬(五九) 初夏入山买竹,逾月方回,历夏秋肌肉消炼,肥体忽成瘦躯,兼之两足痹痛
,行
步艰难,数延医治。或以为虚,或视为湿,服药数十,两目昏花,视小如大,势日沉重,彼
有邻人为栉工者,言予能治,即求延医。六脉洪实带弦,因其向肥忽瘦,意非消症乎?即问
能饮若几,小便几?答曰∶入山买竹,天气初热,烦渴喜饮,至今仍咽喉干燥,时时啜茶方
妙,少顷即欲小便。复问小溲着干土上有沙起否?曰∶未试,惟解坑内见泡沫高起数寸。予
曰
∶君半年来肌肉日削,从此而去,古人以饮一溲二,名为上消。由于亢阳,非大寒之剂,不
足与焉。
石膏(一两) 川连(一钱) 黄芩(一钱五分) 黄柏(一钱五分) 知母(一钱五分) 熟地
(四
钱) 生地(三钱) 天冬(二钱) 麦冬(二钱) 龟板(二钱) 白芍(一钱五分) 甘草(四分)
服四剂,燥渴小便泡沫稍减,目清大半。因问余曰∶从前服药数十,病日有加,今只服
四剂
,何效如是之速?予曰∶君阳体阳脉,入山阳时,经营劳顿。又喜火酒,五内之火俱动,燥
渴作矣。凡饮食入胃,熟腐水谷,游行精气,上输于肺,水精四布,下归膀胱,通调水道,
小便出焉。其间升降洒陈,原有一番工夫。今脏腑有火,如燥土沃水,易漏不滋,即大其制
,修丸常服,将及一年,足痹亦痊。邬之得生,皆出栉工之赐也!
邬某(五十九岁)初夏进山购买竹子,过了一个月才回来。经历夏秋两季,肌肉消瘦,原本肥胖的身体忽然变成了瘦弱的身躯,加上双腿麻木疼痛,行走困难,多次延请医生治疗。有人认为是虚证,有人视为湿邪,服用了数十剂药后,双眼昏花,视物时小的看起来像大的,病情日益沉重。当时他的邻居中有个做梳头匠的人,说他能治好这个病,于是便去求医诊治。诊得六脉洪大、充实且带弦象,因为他向来肥胖忽然变瘦,心想这难道是消渴症吗?随即询问他饮水和排尿的情况。回答说:进山买竹时,天气刚开始热,心烦口渴喜欢喝水,到现在仍然咽喉干燥,经常喝茶才觉得舒服,喝完后不久就想小便。又问小便滴在干土上是否有沙粒升起?回答说:没试过,只在排泄坑内见到泡沫高高隆起数寸。我说:您半年来肌肉日渐消瘦,如果这样下去,古人将“喝一份水排两份尿”的症状称为上消。这是由于亢盛的阳热所致,不用大寒的药剂,不足以治愈。
处方:石膏(一两)、川黄连(一钱)、黄芩(一钱五分)、黄柏(一钱五分)、知母(一钱五分)、熟地黄(四钱)、生地黄(三钱)、天冬(二钱)、麦冬(二钱)、龟板(二钱)、白芍(一钱五分)、甘草(四分)。
服用四剂后,燥热口渴和小便中的泡沫症状稍见减轻,眼睛清晰度恢复大半。患者问我:之前服用了数十剂药,病情却日益加重,现在只服了四剂,为何见效如此迅速?我说:您体质属阳,脉象也属阳,进山正值阳气旺盛之时,又因经营劳顿。再加上喜好喝烧酒,导致五脏内的火气全部发动,从而出现燥热口渴。凡是饮食进入胃中,经过腐熟消化水谷,游行精气,向上输送到肺,水液精微四处布散,向下归于膀胱,通调水道,形成小便排出。这其中升降洒陈的过程,原本需要一番功夫。如今脏腑有火,就像干燥的土地浇灌水一样,容易渗漏而不能滋润,所以即使加大剂量,做成丸药常服,将近一年,腿脚麻木疼痛也能痊愈。邬某能得以存活,都是那位梳头匠医生的恩赐啊!
Wu (aged 59) went into the mountains in early summer to buy bamboo and did not return for over a month. After enduring the summer and autumn seasons, his muscles wasted away, and his formerly obese body suddenly became emaciated. Accompanied by numbness and pain in both legs, making walking difficult, he sought medical treatment on several occasions. Some physicians considered it a deficiency syndrome, while others viewed it as dampness. After taking dozens of prescriptions, his vision became blurred, objects appearing small when they were actually large, and his condition worsened daily. A neighbor who worked as a barber claimed he could cure him, so Wu sought his help. The pulse in all six positions was surging, full, and wiry. Given that he had suddenly lost weight from a previously obese state, I suspected this might be Xiao Ke (Wasting-Thirst Syndrome). I asked about his fluid intake and urination frequency. He replied: "When I went into the mountains, the weather was initially hot, causing irritability and thirst; I liked drinking water. To this day, my throat remains dry, and I feel relief only after frequent sipping of tea. Shortly after drinking, I need to urinate." I further asked if sand-like particles appeared when his urine dripped onto dry soil. He answered: "I have not tested it, but I noticed foam rising several inches high in the excretion pit." I said: "For half a year, your muscles have been wasting away daily. If this continues, according to ancient texts, the symptom of 'drinking one part and urinating two parts' is termed Shang Xiao (Upper Wasting-Thirst). This is caused by hyperactive Yang heat; without potent cold-natured herbs, it cannot be cured."
Prescription: Shigao (Gypsum Fibrosum, 1 liang), Chuanlian (Coptidis Rhizoma, 1 qian), Huangqin (Scutellariae Radix, 1.5 qian), Huangbai (Phellodendri Cortex, 1.5 qian), Zhimu (Anemarrhenae Rhizoma, 1.5 qian), Shudihuang (Rehmanniae Radix Praeparata, 4 qian), Shengdihuang (Rehmanniae Radix, 3 qian), Tiandong (Asparagi Radix, 2 qian), Maidong (Ophiopogonis Radix, 2 qian), Guiban (Testudinis Carapax et Plastrum, 2 qian), Baishao (Paeoniae Radix Alba, 1.5 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 0.4 qian).
After taking four doses, the symptoms of dryness, thirst, and urinary foam decreased slightly, and his vision cleared significantly. He asked me: "Previously, I took dozens of prescriptions, yet my condition worsened. Now, having taken only four doses, why is the effect so rapid?" I replied: "Your constitution is Yang-type, and your pulse is also Yang-type. Entering the mountains during the time of abundant Yang, combined with physical labor, and your preference for distilled liquor, caused fire in the five zang organs to flare up, resulting in dryness and thirst. When food enters the stomach, it is digested and transformed; essence circulates upward to the lungs, where fluids are distributed throughout the body and descend to the bladder. Through the regulation of water passages, urine is excreted. This process of ascending, descending, and distributing requires proper physiological function. Currently, due to fire in the zang-fu organs, it is like pouring water onto dry soil: it leaks easily and fails to nourish. Even if the dosage were increased and made into pills for long-term use, it would take nearly a year for the leg numbness and pain to heal. Wu’s survival is entirely due to the grace of the barber-doctor!"