气药。兼补脾药服之。遂愈。盖心火能生脾土。又于命门火生脾土之外。另伸一义也。
宋徽宗食冰太过。病脾疾。国医不效。召杨介。进大理中丸。上曰。服之屡矣。介曰。
疾因食冰。臣请以冰煎此药。是治受病之源也。果愈。
震按此又于诸法之外。另伸一义。颖悟者可以触类旁通。
李士材治闽人张仲辉。素纵饮。又喜啖瓜果。忽患大泻。诸用分利燥湿者俱不效。李诊
其六脉皆浮。乃引经言春伤于风。夏生飧泄。用麻黄三钱。参、术各二钱。甘草、升麻各一
钱。取大汗而愈。
震按此即效戴人治赵明之之法。而加参、术。尤为稳当。
缪仲淳曰。金坛庄敛之。素壮实。善啖。仲夏忽患泄泻。一应药粥菜蔬入喉。觉如针刺
下咽即辣。因而满腹绞辣。随觉腹中有气。先从左升。次即右升。氤氲遍腹。即欲如厕。
弹响大泄。肛门恍如火灼。一阵甫毕。一阵继之。更番转厕。超时方得离厕。所泻俱清水盈
器。白脂上浮。药粥及菜蔬。俱不化而出。甚至梦中大遗。了不收摄。诸医或云停滞。或云
受暑。或云中寒。百药杂投。竟如沃石。约月余。大肉尽脱。束手待毙。予往诊之。脉洪大
且数。知其为火热所生病。用川黄连三钱。白芍五钱。茯苓、扁豆、石斛、车前各三钱。橘
红二钱。炙甘草一钱。煎成。将井水澄冷。加童便一杯。药甫入喉。恍如饮薄荷汁。隐隐沁
入心脾。腹中别成一清凉世界。遂卧达旦。洞泻顿止。连服三剂。大便已实。前泄时药粥等
物。凡温者下咽。腹中遂觉气升。即欲大解。一切俱以冷进方快。至是觉恶心畏冷。旋易以
温。始相安。余曰。此火退之征也。前方加人参二钱五分。黄 三钱。莲肉四十粒。红曲一
钱五分。升麻五分。黄连减半。五六剂后。去升麻。又服三十余剂。泻已久止。而脾气困顿
不知饥饱。且稍饮茶汤。觉肠满急胀。如欲寸裂。余曰。大泻之后。是下多亡阴也。法宜
用补。倘此时轻听盲师。以香燥取快临时。元气受伤。必致变成膨胀而不救矣。为定丸方。
熟地黄八两。萸肉、山药、人参、黄 各五两。牛膝、五味子、白芍各六两。炙甘草一两。
紫河车二具。蜜丸。空心饥时各一服。而日令进前煎方。敛之相信甚力。坚守二方。服几
三年。脾胃始知饥而嗜食。四体亦渐丰矣。其病初平后。予劝其绝欲年余。敛之因出外家。得
尽发家人阴谋。乃知向之暴泻。由中巴豆毒。本草中巴豆毒者。黄连冷水解之。余方恰与暗
合。向使如俗医所疑停滞受寒中暑法治之。何啻千里。即信为是火。而时师所投黄连。不过
七八分至钱许止矣。况一月之泻。未有不疑为虚寒者。敢用黄连至四钱乎。始知察脉施治。
贵在神而明之也。
〔附〕仲淳曰。余治敛之泻止后。恐其元气下陷。急宜升举。用升麻以提之。初不知其
为中毒也。乃因用升麻太早。致浊气混于上焦。胸中时觉似辣非辣。似嘈非嘈。迷闷之状。
不可名状。有时滴酒入腹。或啖一切果物稍辛温者。更冤苦不胜。庄一生曰。此病在上焦。
汤液入口即下注。恐未易奏功。宜以噙化丸治之。用贝母五钱。苦参一两。真龙脑薄荷叶二
钱。沉香四钱。人参五钱。为末。蜜丸如弹子大。午食后临卧时各噙化一丸。甫四丸。胸中
恍如有物推下。三年所苦。一朝若失。
震按此条初时用冷药冷服。人犹可及。至不知饥饱胀满欲裂。不用六君五皮。竟以熟地
萸肉、参、 、五味、河车填补。断不可及。庄一生之噙化丸。亦未易及也。
孙一奎治溧水令君吴涌澜夫人。每五更倒饱。必泻一次。腹常作胀。间亦痛。脉两手寸
关洪滑。两尺沉伏。孙曰。此肠胃中有食积痰饮也。乃与总管丸三钱。生姜汤送下。大便虽
行。不甚顺利。又以神授香连丸和之。外用滑石、甘草、木香、枳壳、山楂、陈皮、白芍、
酒连。调理而安。
吴九宜每早晨腹痛泄泻者半年。粪色青。腹膨 。人皆认为脾肾泄也。为灸关元三十壮
服补脾肾之药。皆不效。自亦知医。谓其尺寸俱无脉。惟两关沉滑。大以为忧。恐泻久而
六脉将绝也。东宿诊之。曰君无忧。此中焦食积痰泄也。积胶于中。故尺寸脉隐伏不见。法
当下去其积。诸公用补。谬矣。渠谓敢下耶。孙曰。何伤。素问云。有故无殒。亦无殒也。
若不乘时。久则元气愈弱。再下难矣。以丹溪保和丸二钱。加备急丸三粒。五更服之。巳刻
下稠积半桶。胀痛随愈。次日六脉齐见。再以东垣木香化滞丸调理而安。
震按二条亦皆通因通用之法。但总管丸合神授香连丸为一路。保和丸加备急丸为一路。
要看其对证投药处。又二证皆不以参、术调理。次案更以木香化滞丸调理。是即神明于规矩
喻嘉言治陈彦质下利证。因旧患肠风下血。近三十年。体肥身健。不以为意。一冬忽然
下血数斗。盖谋虑忧郁。过伤肝脾耳。延至春月。血尽而下尘水。水尽而去肠垢。纳食不化
直出如箭。肛脱三五寸。昼夜下利二十余行。面色浮肿。唇焦口干鼻煤。咸云不治。喻独
以为有五可治。乃曰。若果阴血脱尽。当目盲无所视。今双眸尚炯。是所脱者。下焦之阴。
而上焦之阴犹存也。一也。若果阳气脱尽。当魄汗淋漓。目前无非鬼像。今汗出不过偶有。
而见鬼亦止二次。是所脱者。脾中之阳。而他脏之阳犹存也。二也。胃中尚能容谷些少。未
显呕吐哕逆之证。则相连脏腑。未至交绝。三也。夜间虽艰于睡。然交睫时亦多。更不见有
发热之候。四也。脉已虚软无力。而激之间亦鼓指。是禀受原丰。不易摧朽。五也。但脾脏
大伤。阳陷入阴。故大股热气从肛门泄出。如火之烙。则阳气去绝不远耳。生死大关。全于
脾中之阳气复与不复定之。阳气渐复。则食可渐化。而肛亦渐收。泄亦渐止矣。用药惟参、
术之无陂。复气即寓生血。祗嫌才入胃中。即从肠出。乃先以人参汤调赤石脂末服之。稍安
次以人参、白术、赤石脂、禹余粮为丸。服之全愈。
少司马李萍槎。食饮素约。三日始更一衣。偶因大便后。寒热发作有时。颇似外感。其
实内伤。非感也。缘素艰大便。努挣伤气。故便出则阴乘于阳而寒。顷之少定。则阳复胜阴
而热也。若果外感之寒热。何必大便后始然耶。医者先治外感不应。谓为湿热。而用滑利之
药驱导之。致向来燥结者。转变肠 。便出急如箭。肛门热如烙。又用滑石、木通、苓、泻
等。冀分利小水以止泄。不知阴虚。自致泉竭。小便从何得来。于是食入不能停留。即从下
注。将肠中之垢。暗行驱下、其臭甚腥。色白如脓。虽大服人参。而下空反致上壅。胸膈不
舒。喉间顽痰窒塞。口燥咽干。彻夜不寐。一切食物。惟味薄质轻者。胃中始爱而受之。久
久阴从泻伤。阳从汗伤。两寸脉浮而空。阳气越于上也。关尺脉微而细。阴气越于下也。阴
阳不相维。附势趋不返矣。议用四君子汤为补脾胃之正药。去茯苓以其淡渗恐伤阴也。加山
茱萸以收肝气之散。五味子以收肾气之散。宣木瓜以收胃气之散。白芍药以收脾气及脏气之
散。合之参、术之补。甘草之缓。再佐升麻之升。俾元气下者上而上者下。团聚于中不散。
斯脉不至上盛。腹不至雷鸣。污不至淋漓。肛不至火热。庶饮食可加。便泄渐止。是收气之
散。为吃紧关头。故取四味重复。藉其专力。又须大剂药料煎浓膏。调余粮、赤石脂二末频
服。缓咽为佳。古云。下焦有病患难会。须用余粮赤石脂。盖肠胃之空。非二味不填。肠垢
已去。非二味不复其粘着之性。又况误以石之滑者伤之。必以石之涩者救之。尤有同气相求
震按二条以补救虚。以涩固脱。乃治久利之旧法。次案大剂酸收。则新法也。
周慎斋治一人常脐痛。痛则大便泄。此脾虚肾水上泛。以下犯上。寒在肾也。宜温肾则
水安不泛。升胃气则土旺而痛不作。泻从何来。用白芷七钱。北味、鹿茸、人参、炮姜各一
两。元米糊丸。白汤下。
震按此条立言简括。立方精卓。近惟叶案有云。久泻无不伤肾。食减不化。阳不用事。
八味肾气。乃从阴引阳。宜乎少效。用鹿茸、人参、阳起石、茯苓、炮附子、淡干姜。可与
服用理气药物，并配合补脾药一起服用，病就好了。这是因为心火能生脾土，这里又在“命门之火生脾土”的理论之外，提出了另一种见解。
宋徽宗因为吃冰过多，患上了脾胃疾病，御医治疗无效，于是召见杨介。杨介进献大理中丸。皇上说：“我已经多次服用了。”杨介说：“病因是吃了冰，臣请求用冰来煎煮这副药，这是为了治受病的根源。”果然治愈了。
俞震按语：这又在各种治疗方法之外，提出了另一种见解。聪慧的人可以由此触类旁通。
李士材治疗福建人张仲辉。他平时放纵饮酒，又喜欢吃瓜果，突然患上严重腹泻，所有使用分利、燥湿方法的药物都无效。李士材诊察他的六脉皆浮，于是引用经典理论：“春伤于风，夏生飧泄”，使用麻黄三钱，人参、白术各二钱，甘草、升麻各一钱，令患者出大汗而痊愈。
俞震按语：这就是效法戴元礼治疗赵明之的方法，而加入了人参、白术，更加稳妥得当。
缪仲淳说：金坛人庄敛之，平时身体壮实，善于饮食。仲夏时节突然患上泄泻，任何药粥菜蔬入口，感觉像针刺一样，咽下即觉辛辣，导致满腹绞痛辛辣。随即觉得腹中有气，先从左边升起，接着右边也升起，弥漫遍腹，就想上厕所。排便时发出弹响声，大量排泄，肛门感觉如火烧灼。一阵刚结束，一阵紧接着来，轮流去厕所，过了很长时间才离开厕所。所排泄的都是清水盈满容器，上面漂浮着白色脂膜。药粥及菜蔬都不消化就排出来，甚至在睡梦中也会大便失禁，完全无法控制。各位医生有的说是食积停滞，有的说是中暑，有的说是受寒，各种药物杂乱投用，竟然像往石头上浇水一样毫无作用。大约一个月后，大肉消瘦殆尽，束手待毙。我去诊治，发现脉象洪大且数，知道这是火热邪气导致的疾病。使用川黄连三钱，白芍五钱，茯苓、扁豆、石斛、车前子各三钱，橘红二钱，炙甘草一钱。煎好药液后，用井水澄清冷却，加入童便一杯。药刚入口，仿佛喝薄荷汁一样，隐隐沁入心脾，腹中顿时变成清凉世界。于是躺下直到天亮，洞泻立刻停止。连续服用三剂，大便已经成形。之前泄泻时，凡是温热的药粥等物咽下，腹中就觉得气往上冲，就想大便；一切都要冷服才舒服。到这时觉得恶心怕冷，随即改为温热药，才感到安稳。我说：“这是火退的征兆。”前方中加入人参二钱五分，黄芪三钱，莲子肉四十粒，红曲一钱五分，升麻五分，黄连减半。五六剂后，去掉升麻，又服用三十多剂，腹泻很久才停止。但脾气困顿，不知道饥饱，而且稍微喝点茶汤，就觉得肠满急胀，好像要撕裂一样。我说：“大泻之后，是下焦阴液亏损过多。治法应当用补法。如果此时轻信盲从的医生，用香燥药物求取暂时的快感，元气受伤，必定会导致变成膨胀症而无法救治。”于是制定丸方：熟地黄八两，山茱萸、山药、人参、黄芪各五两，牛膝、五味子、白芍各六两，炙甘草一两，紫河车两具。制成蜜丸，空腹和饥饿时各服一次，同时每天让他服用之前的煎剂。庄敛之非常信任我，坚守这两个方子，服用了将近三年，脾胃才知道饥饿并喜爱进食，四肢也逐渐丰满起来。他的病刚平息后，我劝他戒色一年多。庄敛之因为外出探亲，得以揭发家人的阴谋，才知道之前的暴泻，是因为中了巴豆毒。本草中说巴豆毒可以用黄连冷水解之。我的方子恰好与之暗合。假使像庸医所怀疑的那样，用治疗停滞、受寒、中暑的方法，那相差何止千里？即使相信是火证，当时的医生所用的黄连，不过七八分到一钱左右罢了。况且一个月的腹泻，没有不怀疑为虚寒的，谁敢用四钱黄连呢？这才明白诊察脉象施治，贵在神妙明达。
〔附〕缪仲淳说：我治疗庄敛之腹泻停止后，担心他元气下陷，急需升举，所以用升麻来提升它。起初并不知道他是中毒。结果因为过早使用升麻，导致浊气混于上焦，胸中时常觉得似辣非辣，似嘈杂非嘈杂，迷闷的状态，无法形容。有时滴酒入腹，或者吃一切稍带辛温的水果，更是冤苦不堪。庄一生说：此病在上焦，汤药入口就向下流注，恐怕不容易见效。应该用噙化丸治疗。用贝母五钱，苦参一两，真龙脑薄荷叶二钱，沉香四钱，人参五钱。研为细末，蜜丸如弹子大小，午饭后和临睡前各含化一丸。才服四丸，胸中恍惚觉得有东西推下去，三年的痛苦，一天早上就像失去了一样。
俞震按语：这一条初时用冷药冷服，人们还可以做到。到了不知道饥饱、胀满欲裂的时候，不用六君子汤、五皮饮，竟然用熟地、山茱萸、人参、黄芪、五味子、紫河车来填补，断然做不到。庄一生的噙化丸，也不容易达到这种效果。
孙一奎治疗溧水县令吴涌澜夫人。每当天将亮（五更）时打饱嗝，必然腹泻一次。腹部经常胀气，偶尔疼痛。两手寸关脉洪滑，两尺脉沉伏。孙一奎说：“这是肠胃中有食积痰饮。”于是给予总管丸三钱，生姜汤送下。大便虽然排出，但不甚顺利。又用神授香连丸调和。外用滑石、甘草、木香、枳壳、山楂、陈皮、白芍、酒黄连调理，病情安定。
吴九宜每天早上腹痛泄泻半年，粪便颜色青，腹部膨隆。大家都认为是脾肾泄。为他灸关元穴三十壮，并服用补脾肾的药物，都无效。他自己也懂医，认为尺寸脉都没有，只有两关脉沉滑，非常担忧，恐怕腹泻久了六脉将要绝灭。东宿（孙一奎号）诊察后说：“您不要担心，这是中焦食积痰泄。积滞胶结在中焦，所以尺寸脉隐伏不见。治法应当下去其积滞。各位医生用补法，是错误的。”那人说：“敢用攻下药吗？”孙一奎说：“有什么妨碍？《素问》说：‘有故无殒，亦无殒也。’如果不乘此时机，时间久了元气更弱，再想攻下就难了。”用丹溪保和丸二钱，加备急丸三粒，五更时分服用。巳时下出稠厚积滞半桶，胀痛随即痊愈。第二天六脉全部出现，再用东垣木香化滞丸调理而安。
俞震按语：这两条都是“通因通用”的方法。但总管丸合神授香连丸是一路，保和丸加备急丸是另一路。要看它们对证用药的地方。另外两个病例都不用参、术调理，第二个案例更用木香化滞丸调理，这就是在规矩中的神妙变化。
喻嘉言治疗陈彦质的下利证。因为他旧患肠风下血，近三十年，身体肥壮健康，不以为意。一个冬天忽然下血几斗。大概是因为谋虑忧郁，过度损伤肝脾。延至春季，血尽而下尘水，水尽而去肠垢，纳食不化，直出如箭，肛门脱出三五寸，昼夜下利二十多行，面色浮肿，唇焦口干鼻煤，大家都说不治。唯独喻嘉言认为有五可治。他说：“如果阴血真的脱尽，应当眼睛失明无所视，现在双眼还明亮，说明所脱的是下焦之阴，而上焦之阴还存在。这是一。如果阳气真的脱尽，应当魄汗淋漓，眼前无非鬼怪形象，现在出汗不过是偶尔有，见鬼也只两次，说明所脱的是脾中之阳，而其他脏的阳还存在。这是二。胃中还能容纳少量食物，没有出现呕吐哕逆的症状，那么相连的脏腑，还没有到交接断绝的地步。这是三。夜间虽然难以入睡，但闭眼睡觉的时间也多，更没有见到发热的症状。这是四。脉象已经虚软无力，但在激惹之间也能鼓指，说明禀赋原本丰厚，不易摧枯拉朽。这是五。只是脾脏大伤，阳气陷入阴分，所以大腿根部热气从肛门泄出，像火烙一样，那么阳气离绝不远了。生死大关，全在于脾中之阳气能否恢复。阳气逐渐恢复，则食物可逐渐消化，肛门也逐渐收回，泄泻也逐渐停止。用药只有人参、白术没有偏颇，补气即寓有生血之意。只嫌药刚入胃中，就从肠中出去，于是先用参汤调赤石脂末服用，稍安。其次用人参、白术、赤石脂、禹余粮做成丸药，服用后全愈。
少司马李萍槎，饮食素来节制，三天才换一次衣服。偶然因为大便后，寒热发作有时，很像外感。其实是内伤，不是外感。因为他平时大便困难，努挣伤了气，所以便出则阴气乘于阳气而寒，一会儿稍定，则阳气复胜阴气而热。如果是外感的寒热，何必在大便后才这样呢？医生先治外感不应，说是湿热，而用滑利药物驱导，导致向来燥结的，转变为肠澼。便出急如箭，肛门热如烙。又用滑石、木通、茯苓、猪苓等，希望分利小水以止泄。不知道阴虚，自然导致泉水枯竭，小便从何而来？于是食物进入不能停留，就从下面流注，将肠中的污垢暗中驱除，气味很腥，颜色白如脓。虽然大服人参，但下空反而导致上壅，胸膈不舒服，喉间顽痰窒塞，口燥咽干，彻夜不寐。一切食物，只有味道淡薄质地轻的，胃中才开始喜爱并接受。久而久之，阴从泻伤，阳从汗伤，两寸脉浮而空，阳气越于上；关尺脉微而细，阴气越于下。阴阳不相维系，顺势趋向而不返回。建议用四君子汤作为补脾胃的正药，去掉茯苓因为它的淡渗恐伤阴。加入山茱萸以收敛肝气的散逸，五味子以收敛肾气的散逸，宣木瓜以收敛胃气的散逸，白芍药以收敛脾气及脏气的散逸。合之人参、白术的补益，甘草的缓和，再佐以升麻的提升，使元气下的上升，上的下降，团聚于中不散。这样脉不至上盛，腹不至雷鸣，污秽不至淋漓，肛门不至火热，庶几饮食可增加，便泄逐渐停止。这是收敛气之散逸的关键关头，所以取这四味药重复使用，借其专力。还必须大剂量药料煎成浓膏，调余粮、赤石脂二种粉末频繁服用，缓缓咽下为佳。古话说：下焦有病病患难会，须用余粮赤石脂。因为肠胃的空虚，不用这两种药填不满。肠垢已去，不用这两种药不能恢复其粘着之性。更何况误用滑利的石头类药物伤害了它，必须用涩性的石头类药物来救它，尤其有同气相求的道理。
俞震按语：这两条是用补救虚损，用涩药固脱，是治疗久利的旧法。第二个案例大剂酸收，则是新法。
周慎斋治疗一个人经常脐部疼痛，痛则大便泄泻。这是脾虚肾水上泛，以下犯上，寒在肾。适宜温肾则水安不泛，升胃气则土旺而痛不作，泻从何来？用白芷七钱，北五味子、鹿茸、人参、炮姜各一两。元米糊丸，白开水送下。
俞震按语：这一条立言简括，立方精卓。近来只有叶天士案中说：久泻无不伤肾，食减不化，阳不用事。八味肾气丸，乃从阴引阳，应当少效。用鹿茸、人参、阳起石、茯苓、炮附子、淡干姜，可以与……
Administration of Qi-regulating herbs, taken concurrently with Spleen-tonifying herbs, led to recovery. This is because Heart Fire generates Spleen Earth; this case presents another perspective beyond the theory that "Mingmen Fire generates Spleen Earth."
Emperor Huizong of Song suffered from a Spleen disorder due to excessive consumption of ice. The imperial physicians were ineffective. Yang Jie was summoned and prescribed Dali Zhong Wan (Great Center Pill). The Emperor said, "I have taken it many times." Yang Jie replied, "The cause of the illness is eating ice. I request to decoct this medicine with ice, addressing the root cause of the disease." The patient recovered.
Yu Zhen's commentary: This offers yet another perspective beyond various treatment methods. Those who are insightful can draw inferences by analogy.
Li Shicai treated Zhang Zhonghui, a man from Fujian. He habitually indulged in alcohol and enjoyed eating melons and fruits. Suddenly, he suffered from severe diarrhea. All treatments using diuretic or damp-drying methods failed. Li palpated his six pulses as floating. Citing the classic saying, "Wind injury in Spring leads to undigested stool diarrhea in Summer," he used Ephedrae Herba (Mahuang) 3 qian, Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu) 2 qian each, Licorice Root (Gancao) and Cimicifugae Rhizoma (Shengma) 1 qian each. The patient recovered after profuse sweating.
Yu Zhen's commentary: This follows the method of Dai Renli treating Zhao Mingzhi, adding Renshen and Baizhu for greater stability.
Miao Zhongchun stated: Zhuang Lianzhi from Jintan was robust and had a good appetite. In mid-summer, he suddenly developed diarrhea. Any medicinal porridge or vegetables felt like needles upon swallowing, causing burning pain throughout the abdomen. Gas rose first from the left, then the right, filling the abdomen, triggering an urgent need to defecate. Defecation was loud and voluminous, with the anus feeling like it was burning. Episodes followed one another without pause, requiring frequent trips to the toilet over a long period. The excrement was clear water filling the vessel, with white lipid floating on top. Food and medicine passed through undigested. Even during sleep, he experienced fecal incontinence. Physicians attributed it to food stagnation, summerheat, or cold invasion. Various medicines were administered ineffectively, like pouring water on stone. After about a month, his muscles wasted away, and he despaired. Upon examination, the pulse was surging, large, and rapid, indicating a heat-fire pathology. Prescription: Coptidis Rhizoma (Huanglian) 3 qian, Paeoniae Radix Alba (Baishao) 5 qian, Poria (Fuling), Dolichos Semen (Bian Dou), Dendrobii Caulis (Shihu), Plantaginis Seed (Cheqianzi) 3 qian each, Citri Reticulatae Pericarpium (Juhong) 2 qian, Roasted Licorice Root (Zhi Gancao) 1 qian. The decoction was cooled with well water, and one cup of child's urine was added. Upon ingestion, it felt like drinking peppermint juice, cooling the Heart and Spleen. The abdominal burning ceased immediately. He slept until dawn, and the watery diarrhea stopped. After three doses, stools solidified. Previously, warm foods aggravated the condition, while cold foods provided relief. Later, nausea and aversion to cold appeared, so the prescription was changed to warm natured herbs, bringing comfort. I stated, "This indicates the retreat of fire." Added to the previous formula: Ginseng Radix et Rhizoma (Renshen) 2.5 qian, Astragali Radix (Huangqi) 3 qian, Nelumbinis Semen (Lianrou) 40 grains, Red Fermented Rice (Hongqu) 1.5 qian, Cimicifugae Rhizoma (Shengma) 0.5 qian, Huanglian halved. After five to six doses, Shengma was removed. After thirty more doses, diarrhea ceased. However, Spleen Qi remained weak, lacking appetite, and slight tea intake caused intestinal distension and tearing pain. I explained, "Severe diarrhea depletes Yin. Tonification is required. Blindly using aromatic-dry herbs for temporary relief would damage Yuan Qi, leading to fatal abdominal distension." A pill formula was prescribed: Rehmanniae Radix Preparata (Shu Dihuang) 8 liang, Corni Fructus (Yurou), Dioscoreae Rhizoma (Shanyao), Renshen, Huangqi 5 liang each, Achyranthis Bidentatae Radix (Niuxi), Schisandrae Fructus (Wuweizi), Baishao 6 liang each, Zhi Gancao 1 liang, Human Placenta (Ziheche) 2 units. Honey pills taken fasting. Concurrently, the decoction was continued. Trusting me completely, he adhered to these formulas for nearly three years. His Spleen and Stomach function recovered, appetite returned, and body mass increased. After recovery, I advised abstinence from sexual activity for over a year. While visiting his wife's family, he uncovered a conspiracy, revealing that the acute diarrhea was caused by Crotonis Fructus (Badou) toxicity. Materia Medica states Huanglian with cold water resolves Badou toxicity. My formula coincidentally matched this. Had standard treatments for stagnation, cold, or summerheat been used, the error would be immense. Even if diagnosed as heat, contemporary doctors used only 0.7-1 qian of Huanglian. Who would dare use 4 qian for a month-long diarrhea suspected to be deficiency-cold? This demonstrates the importance of divine insight in pulse diagnosis and treatment.
[Appendix] Miao Zhongchun said: After stopping the diarrhea, I feared Yuan Qi sinking and used Shengma to lift it, unaware of the toxicity. Premature use of Shengma caused turbid Qi to mix in the Upper Jiao, resulting in indescribable chest discomfort, resembling burning or palpitations. Spicy-warm foods exacerbated the suffering. Zhuang Yisheng suggested: Since the pathology is in the Upper Jiao and liquids pass through quickly, decoctions may be ineffective. Use Qinhua Wan (Holding-and-Melting Pill): Fritillariae Bulbus (Beimu) 5 qian, Sophorae Flavescentis Radix (Kushen) 1 liang, Menthae Haplocalycis Folium (Longnao Bohe) 2 qian, Aquilariae Lignum Resinatum (Chenxiang) 4 qian, Renshen 5 qian. Powdered, honey-pilled. Hold one pill after lunch and before bed. After four pills, a sensation of downward movement occurred, curing three years of suffering overnight.
Yu Zhen's commentary: Using cold medicine cold initially was achievable. However, treating extreme distension and loss of appetite with Shu Dihuang, Yurou, Renshen, Huangqi, Wuweizi, and Ziheche instead of Liujunzi Tang or Wupi Tang was exceptional. Zhuang Yisheng's Qinhua Wan was also difficult to match.
Sun Yikui treated Lady Wu Yonglan, wife of the magistrate of Lishui. Every pre-dawn hour (Wugeng), she belched and then defecated. Her abdomen was often distended and occasionally painful. Pulses at Cun and Guan on both hands were surging and slippery; Chi pulses were deep and hidden. Sun diagnosed food stagnation and phlegm-fluid retention in the intestines and stomach. He prescribed Zongguan Wan 3 qian, taken with Ginger Decoction. Bowel movements improved but were not smooth. Shenhou Xianglian Wan was added for regulation. External/adjunctive use of Talcum (Huashi), Licorice Root (Gancao), Aucklandiae Radix (Muxiang), Aurantii Fructus (Zhike), Crataegi Fructus (Shanzha), Citri Reticulatae Pericarpium (Chenpi), Baishao, and Wine-processed Coptidis Rhizoma (Jiu Lian) resolved the issue.
Wu Jiuyi suffered morning abdominal pain and diarrhea for half a year. Stools were green, abdomen distended. Diagnosed as Spleen-Kidney diarrhea. Moxibustion on Guanyuan (CV4) 30 moxibuns and Spleen-Kidney tonics failed. He knew medicine himself, noting absence of Cun/Guan pulses, only deep-slippery Guan pulses, fearing pulse extinction from chronic diarrhea. Dongsu (Sun Yikui) diagnosed Middle Jiao food-stagnation-phlegm diarrhea. The accumulation hides the pulses. Purging is needed; tonification is wrong. The patient feared purgatives. Sun cited Suwen: "If there is a pathogen, there is no harm [to the healthy Qi]." Delaying treatment weakens Yuan Qi further. He prescribed Baohe Wan 2 qian plus Beijji Wan 3 pills at Wugeng. By Si hour, half a bucket of thick accumulation was expelled, relieving pain. Pulses returned the next day. Regulation with Dongyuan Muxiang Huazhi Wan completed the cure.
Yu Zhen's commentary: Both cases employ "Treat obstruction with unblocking" (Tong Yin Tong Yong). Zongguan Wan + Shenhou Xianglian Wan is one approach; Baohe Wan + Beijji Wan is another. Careful syndrome differentiation is key. Neither used Renshen/Baizhu for regulation; the second case used Muxiang Huazhi Wan, showing mastery within principles.
Yu Jiayan treated Chen Yanzhi's dysentery. History of intestinal wind bleeding for 30 years. Obese and healthy until sudden massive hematochezia in winter due to worry and depression damaging Liver and Spleen. By spring, blood exhausted, followed by dust-like water, then intestinal mucus. Food passed straight through like an arrow. Rectal prolapse of 3-5 cun. Dysentery >20 times/day. Edematous face, dry lips/mouth/nose. Prognosis: terminal. Yu identified five signs of treatability: 1. Eyes still bright (Upper Jiao Yin intact despite Lower Jiao Yin loss). 2. Sweating rare, hallucinations rare (Spleen Yang lost, other Yangs intact). 3. Stomach accepts small amounts of food, no vomiting (Organs not severed). 4. Sleep possible, no fever (Yang not hyperactive). 5. Pulse weak but responsive to stimulation (Constitution strong). Pathology: Spleen damaged, Yang trapped in Yin, hot air escaping anus like burning. Survival depends on restoring Spleen Yang. Treatment: First, Renshen Tang with Chishizhi powder to stabilize. Then, pills of Renshen, Baizhu, Chishizhi, and Yuyuliang. Full recovery.
Vice Minister Li Pingcha had strict dietary habits. After defecation, he experienced periodic chills and fever, resembling exterior syndrome. Actually, it was interior injury from straining during constipation, causing Yin to invade Yang (chills) then Yang to overcome Yin (fever). Previous treatment for exterior syndrome failed. Misdiagnosed as damp-heat, treated with slippery/diuretic herbs, transforming constipation into intestinal discharge (Chang Pi). Urgent, burning defecation. More diuretics (Huashi, Mutong, Fuling, etc.) were used, worsening Yin deficiency and fluid depletion. Food passed through rapidly. Large doses of Renshen caused upper congestion due to lower emptiness. Chest discomfort, phlegm obstruction, dry mouth/throat, insomnia. Only light/bland foods tolerated. Chronic diarrhea injured Yin; sweating injured Yang. Cun pulses floating/empty (Yang floating up); Guan/Chi pulses fine/weak (Yin sinking down). Yin and Yang disconnected. Proposal: Sijunzi Tang (Four Gentlemen Decoction) as base for Spleen/Stomach. Remove Fuling (too draining). Add Corni Fructus (Yurou) to secure Liver Qi, Wuweizi to secure Kidney Qi, Chaenomelis Fructus (Mu Gua) to secure Stomach Qi, Baishao to secure Spleen/Zang Qi. Combined with Renshen/Baizhu tonification, Gancao moderation, and Shengma lifting. This gathers scattered Qi centrally. Prevents upper pulse excess, borborygmus, profuse discharge, and anal burning. Emphasizes securing scattered Qi. Heavy dosage decoction concentrated into paste, mixed with Yuyuliang and Chishizhi powders, taken frequently and slowly. Ancient saying: Lower Jiao diseases require Yuyuliang and Chishizhi to fill emptiness and restore adhesion. Slippery stones caused injury; astringent stones cure it via sympathetic resonance.
Yu Zhen's commentary: These cases use astringents to secure collapse, a traditional method for chronic dysentery. The second case uses heavy sour-astringents, a new method.
Zhou Shenzhai treated a man with periumbilical pain leading to diarrhea. Diagnosis: Spleen deficiency with Kidney Water flooding upward (Cold in Kidney). Treatment: Warm Kidney to stop water flooding; raise Stomach Qi to strengthen Earth and stop pain. Formula: Angelicae Dahuricae Radix (Baizhi) 7 qian, Northern Schisandra (Bei Wei), Deer Antler (Lurong), Renshen, Prepared Ginger (Pao Jiang) 1 liang each. Pill made with millet paste, taken with warm water.
Yu Zhen's commentary: Concise statement, excellent formula. Ye Tianshi noted chronic diarrhea damages Kidney, reducing appetite and Yang function. Bashen Shenqi Wan draws Yang from Yin, yielding little effect. Formulas with Lurong, Renshen, Yangqishi, Fuling, Paofuzi, and Ganjiang are superior...