罗谦甫治赵运使夫人。年近六十。三月间。病脐腹冷痛。相引胁下。痛不可忍。反复闷
乱。不得安卧。乃先灸中庭穴。在膻中下寸六分陷者中。任脉气所发。灸五壮或二七三七壮
次以当归四逆汤。归尾七分。桂、附、茴香、柴胡各五分。芍药四分。茯苓、延胡、川楝
各三分。泽泻一分。数服愈。
又治火儿赤怜歹疝气。脐腹阵痛。搐撮不可忍。腰曲不能伸。热物熨之稍缓。脉得沉小
而急。难经云。任之为病。男子内结七疝。皆积寒于小肠间所致也。非大热之剂。则不能愈
遂以沉香、附子、川乌、炮姜、良姜、茴香、肉桂、吴茱萸各一两。醋丸。米饮汤下。名
沉香桂附丸。一日二服。又间以天台乌药散。每服一钱。热酒泡生姜汤下。服此二药。旬日
滑伯仁治一妇。寒疝。自脐下上至心。皆胀满攻痛。而胁疼尤甚。呕吐烦懑。不进饮食
脉两手沉结不调。此由寒在下焦。宜亟攻其下。毋攻其上。为灸章门气海中脘。服延胡、
桂、椒。佐以茴、木诸香。茯苓、青皮等。十日一服温利丸药。聚而散之也。果效。
震按首案虽云任脉为病。然脐腹痛引胁下。实兼厥阴。其灸中庭穴以治任脉。当归四逆
汤则治肝病也。次案脉证俱寒。自当纯用大热之剂。但脉沉小而急。与沉微细软不同。是寒
实。非寒虚。妙在天台乌药散以逐其寒积也。只服一钱而送药引子更佳。第三案痛且胀。
又沉结不调。亦是积寒实证。而不进饮食。元气亦虚。故灸法妙极。艾火能逐寒能壮气也。
佐以温通药。间以温利药。步伐整齐。洵为必胜之师。所谓温利丸药。想即天台乌药散。以
方中木香、茴香、乌药、良姜、青皮各五钱。槟榔两个。巴豆七十粒同川楝十个。以麸炒。
去豆用楝。取其性而弃其质。如用火攻仍不延燎也。
丹溪曰。余壮年啖柑橘过多。积成饮癖。在右肋下。因不复啖。一日。山行大劳。饥渴
遇橘芋食之。橘动旧积。芋复滞气。实时右丸肿大。寒热交作。因思脾肺皆主右。故积饮
滞气下陷。太阴阳明之经筋俱伤。其邪从而入于囊中。着在睾丸而为肿胀。戴人有言。病分
上下治。同是木郁为疝。在下则不可吐。必当从下引而竭之。然窃念病有不同。治可同乎。
今以饥劳伤脾。脾气下陷。必升举之。则胃气不复下陷。积乃可行。若用药下之。恐重陷胃
气也。先服调胃药一二帖。次早注神使气至下焦呕逆而上。觉肋下积动到中焦。则吐而出之
吐后 肿减半。次早复吐。吐后和胃气。疏经络。二三日愈。凡用此法治酒伤与饮水注右
震按此条向因名医类案脱落两行。以致文理不贯。看不明白。今从原本全录。始服其议
有妙理。其法注神使气至下焦走肋下。较之子和用药以吐者。险夷殊别矣。及读景岳全书。
记其尊人寿峰公吐法。每于五鼓睡醒时。徐徐咽气。因作嗳以提之。气有不充。则咽气为嗳
随咽随提。痰涎必随气而至。吐后或至唇肿咽痛。但以凉水一二口漱咽解之。吐毕。早膳
悉屏五味。但用淡粥一二碗。以养胃中清气。自四旬之外。绝不用酒。每月行吐法二三次。
六旬之外。则一月或半月必吐一次。用此法四十余年。愈老愈健。若遇疾病。无论表里虚实
绝不服药。但一行吐法。无不即日尽却。寿至八旬之外。犹能登山。及灯下抄录古书读之
不禁跃然。彼子和之独圣茶调。逊此和平多矣。然窃思阳明胃脉。下行为顺。若吐则上逆
频吐理当损寿。何反益寿。殊未敢信。
一人病后饮水。病左丸痛甚。灸大敦。以摩腰膏摩囊上。上抵横骨。炙温帛覆之。痛即
止。一宿肿亦消。
震按此条无甚妙义。然其法颇佳。可以备用。
汪石山治一人。年二十余。因水中久立过劳。病疝痛。痛时腹中有磊块。起落如滚浪。
其痛尤甚。诊之脉皆细弦而缓。按之似涩。曰。此血病也。考之方书。疝有七。皆不宜下。
所治多是温散之药。以气言也。兹宜变法治之。乃用小承气加桃仁下之。其痛如失。三日复
作。比前加甚。脉之轻则弦大。重则散涩。思之莫得其说。问曾食何物。曰。食鸡蛋二枚而
已。曰。得之矣。令以指探吐。出令尽。痛解矣。
一儿六岁。阴囊胀大如盏。茎皮光肿如泡。一医为之渗湿行气。不效。汪诊视。脉皆濡
缓。曰。脉缓无力者。气虚也。经云。膀胱者。津液之府。气化则能出焉。气虚不足。无能
运化而使之出矣。宜升阳补气可也。遂以补中益气汤。去当归、柴胡。加茯苓、牛膝。二帖
囊皱肿消。三帖全愈。
震按此二条乃凭脉断病之正法。前案以弦涩断为瘀血。后案以濡缓断为气虚。应手取效
皆得力于指下也。前案变温散为寒下。后案去归、柴。加苓、膝。是其学问高处。但前案
三日复作。而归咎于鸡蛋二枚。恐未确也。其痛解之功。又在吐法耳。
祠部黄新阳公夙有脾泄。便血。脚痛。六脉滑数。曾用酒煮黄连为君。佐以参、术等。
而泄血止。越年余。患狐疝。昼出囊中。夜卧入腹。不时疼痛。吴心所投以虎潜丸、还少丹
而愈。此始为热中。久为寒中。药物寒热迥别而俱效。久病从虚治也。
震按叶先生云。子和法中。原有虎潜诸论。后医弃置不用。今观此案。后医亦有用之者
矣。惟是指南疝疾门集案甚少。而方法甚多。取材既富。运用又巧。更不可及。余乡万枫江
先生。乃莲幕老名宿。年近七旬。忽患 疝。自检古方中三层茴香丸。恪遵其法服一月。而
病全愈。以是知古方每有不可思议之妙。岂独虎潜丸哉。
常州尹文辉。嗜火酒能五斤。五月间。入闽中。溪水骤涨。涉水至七里。觉腹痛甚。半
月后。右丸肿大。渐如斗形。闽中医者。与肝经之剂。乃温热之品。半载无功。归而就商于
李士材。李曰。嗜火酒则湿热满中。涉大水则湿寒外束。以胃苓汤加栀子、黄柏、枳壳、茴
香。十剂而略减。即以为丸。服至十五斤。全安而不发。
震按此案若用三层茴香丸。必不妥。观李公之讲病。益信医贵变通也。后案亦纯正可法
文学骆元宾。十年患疝。形容枯槁。士材视之。左胁有形。其大如臂。以热手握之。沥
沥有声。甚至上攻于心。闷绝者久之。热醋熏炙方苏。曰。此经所谓厥疝也。用治疝当归四
逆汤。半月积形渐小。更以八味丸间服。半载不辍。积块尽消而不复发矣。
卢不远治陈孟杼之父。六月自山东邸中受寒起。尚淹淹未王也。至次年二月。忽小腹与
腰急痛。即令人紧挽外肾。稍松便欲死。卢曰。此小肠府病也。经云。小肠病者。腰脊控睾
而痛。乃以羌活入太阳小肠。佐黄柏、茯苓、肉桂等。并刮委中穴。痛立止。但足软。卢曰
病因六月伤寒。太阳有所未尽。故入府而痛作。原以寒邪郁火。仍需夏时则火力全而血脉
通。邪始去也。果至五月天热。身发紫斑。有汗至足而始健。
震按此案引经以证病。并不牵强。其用药及刮法俱佳。至因足软而溯病情之源流。真大
喻嘉言治封翁胡养冲少腹有疝。形如鸡卵。数发以后。渐大而长。从少腹坠入睾囊甚易
返位甚难。下体稍受微寒即发。发时必俟块中冷气渐转暖热。始得软溜而缩入。否则如卧
酒瓶于胯上。半在少腹。半在睾囊。坚硬如石。其气迸入前后腰脐各道筋中。同时俱胀。上
攻入胃。大呕大吐。上攻巅顶。战栗畏寒。喻曰。是为地气上攻。元会运世。论戌亥所以混
茫者。由地气之混于天也。以大剂参、附、姜、桂。急驱阴气。呱呱有声。从大孔而出。立
时痊愈。后仍举发。更医服十全大补汤。二十余剂不效。喻曰。凡孕妇病伤寒者。不得已而
用麻、桂、硝黄等药。但加入四物。则万药即不能入胞而伤胎。岂欲除块中之邪。反可用四
物护之乎。即四君亦元老之官。不可以理繁治剧。必须姜、桂、附子之猛。始克制伏阴邪。
但悍烈之性。似非居恒所宜服。发时服之。亦有口干舌苦之患。而坚块远在少腹。又漫无平
期。于此议治。当先以姜、桂、附子为小丸。曝令干坚。然后以参、术浓为外廓。俾喉胃间
知有参、术。不知有姜、桂、附子。递送达于积块之所。猛烈始露。庶几坚者削。而窠囊可
震按西昌此说。似是而非。外廓之药。包其猛烈之药。使不犯咽膈则可。若到胃中必须
消化。方能以药性达于病所。若使不化。则入肠泻出矣。岂有到小腹胯间而后化之理哉。其
说本于吕元膺紫雪裹理中丸法也。但彼以紫雪治喉中之热。理中治中焦之寒。亦谓药入中焦
即化耳。热药冷服。同此义也。白通汤加人尿猪胆汁。以其阴盛格阳。而用阴药为向导。岂
可引作外廓之证哉。朱砂、青黛为衣。亦借其色为心肝二经之向导。岂竟护送此药到心肝哉
故节删其说而录之。
罗谦甫治疗赵运使的夫人。她年近六十岁。在三月份时，患脐腹部冷痛，疼痛牵引至胁下，痛得难以忍受，反复烦闷扰乱，无法安卧。于是先灸中庭穴，该穴位于膻中穴下一寸六分的凹陷处，是任脉经气所发之处。灸五壮或十四壮、二十一壮。随后服用当归四逆汤（温经散寒、养血通脉之剂），处方为：当归尾七分，桂枝、附子、小茴香、柴胡各五分，白芍四分，茯苓、延胡索、川楝子各三分，泽泻一分。服用数剂后痊愈。
又治疗火儿赤怜歹的疝气病。症状为脐腹部阵发性绞痛，抽搐拘急，痛不可忍，腰部弯曲不能伸直，用热物熨烫后稍感缓解。脉象沉小而急。《难经》说：“任脉为病，男子内结七疝”，都是由于寒气积聚在小肠间所致。如果不是大热的药方，就不能治愈。于是使用沉香、附子、川乌、炮姜、高良姜、小茴香、肉桂、吴茱萸各一两，醋制为丸，米汤送服。名为沉香桂附丸。每日服用两次。又间歇服用天台乌药散，每次一钱，用热酒泡生姜汤送服。服用这两种药物，十天便愈。
滑伯仁治疗一位妇女，患寒疝。疼痛从脐下上冲至心口，都感到胀满攻痛，其中胁部疼痛尤为剧烈，伴有呕吐、烦闷，不能进食。两手脉象沉结不调。这是由寒邪在下焦所致，应当紧急攻逐下焦的寒邪，不要攻逐上焦。于是灸章门、气海、中脘穴，服用延胡索、桂枝、花椒，佐以小茴香、木香等芳香药物，以及茯苓、青皮等。每十天服用一次温利丸药，以聚散积滞。果然见效。
俞震按语：第一个医案虽然说是任脉为病，但脐腹痛引胁下，实际上兼涉厥阴肝经。灸中庭穴是为了治疗任脉，当归四逆汤则是治疗肝病。第二个医案脉证皆属寒，自然应当纯用大热的药方。但是脉象沉小而急，与沉微细软不同，这是寒实证，而非寒虚证。妙在使用了天台乌药散来驱逐寒积。只服用一钱，且送药引子更佳。第三个医案既痛又胀，脉象沉结不调，也是积寒实证，但因不能进食，元气也已虚弱。所以灸法极为巧妙，艾火能驱逐寒邪并能壮阳气。佐以温通药物，间歇服用温利药物，步伐整齐，确实是必胜之师。所谓的温利丸药，我想就是天台乌药散，因为方中有木香、茴香、乌药、高良姜、青皮各五钱，槟榔两个，巴豆七十粒同川楝子十个，用麦麸炒，去掉巴豆只用川楝子，取其药性而弃其质地，就像用火攻但不蔓延燃烧一样。
朱丹溪说：“我年轻时吃柑橘过多，积成饮癖，在右肋下。后来不再吃柑橘。有一天，在山中行走极度劳累，又饥又渴，遇到橘子和芋头就吃了。橘子动摇了旧的积滞，芋头又阻滞了气机，当时右侧睾丸立即肿大，寒热交替发作。因此想到脾肺都主右侧，所以积饮和滞气下陷，损伤了太阴和阳明经筋，邪气从而进入囊中，附着在睾丸导致肿胀。戴人曾说，病分上下治疗，同样是木郁导致的疝气，在下焦则不能用吐法，必须从下引导将其排尽。然而我私下想，病情不同，治疗方法可以相同吗？现在是因为饥饿和劳累伤了脾气，脾气下陷，必须升举它，这样胃气就不会再下陷，积滞才能运行。如果用下药攻下，恐怕会使胃气进一步下陷。先服用调理胃气的药一二帖，第二天早晨通过注神导气的方法使气到达下焦，引发呕逆向上，感觉肋下的积滞动到中焦，然后将其吐出。吐后肿块减半，第二天早晨再次催吐，吐后调和胃气，疏通经络，两三天就好了。凡是使用这种方法治疗因饮酒受伤和饮水导致的右侧……”
俞震按语：这一条以前因为《名医类案》脱落了两行文字，导致文理不通，看不明白。现在从原本全文抄录，才佩服其中的议论有妙理。其方法是通过注神导气使气到达下焦并走向肋下，这与戴人用药催吐的方法相比，险峻与平安截然不同。等到读《景岳全书》，记录了他父亲寿峰公的吐法，经常在五更睡醒时，慢慢咽气，因此发出嗳气来提气，如果气不充足，就咽气作嗳声，随咽随提，痰涎必然随着气而上涌。吐后如果嘴唇肿、咽喉痛，只需喝一两口凉水漱口吞咽即可解除。吐完后，早饭完全摒弃五味调料，只吃一两碗淡粥，以养胃中的清气。从四十岁以后，绝对不喝酒，每月进行吐法两三次。到了六十岁以后，则一个月或半个月必吐一次。使用这种方法四十多年，越老越健康。如果遇到疾病，无论表里虚实，绝对不服药，只要进行一次吐法，没有不是当天就痊愈的。活到八十多岁，还能登山。等到在灯下抄录古书阅读时，不禁跃然心动。戴人的独圣茶调方，比起这个平和多了。然而我私下思考，阳明胃脉，下行才是顺，如果呕吐则是上逆，频繁呕吐理应折损寿命，为什么反而有益寿延年？实在不敢相信。
一个人病后喝水，左侧睾丸疼痛剧烈，灸大敦穴，用摩腰膏按摩阴囊上部，上抵横骨处，用温热的帛布覆盖，疼痛立即停止，一夜之间肿胀也消退了。
俞震按语：这一条没有什么深奥的道理，但这个方法很好，可以备用。
汪石山治疗一个人，二十多岁，因为在水中久立过度劳累，患疝痛，疼痛时腹中有硬块，起落如滚浪般，疼痛尤其剧烈。诊察脉象皆细弦而缓，按起来似乎涩滞。他说：“这是血病。”查阅方书，疝气有七种，都不宜用下法。所治疗的药物多是温散类的，这是从气分来说的。这里应该改变治法，于是用小承气汤加桃仁攻下。疼痛立刻消失，三天后又发作，比之前更加严重。切脉轻取则弦大，重按则散涩。思考不得其解。问曾吃过什么食物，回答说：“只吃了两个鸡蛋而已。”说：“我明白了。”用手指探喉催吐，将鸡蛋全部吐出，疼痛解除了。
一个六岁的男孩，阴囊肿胀大如杯盏，阴茎皮肤光肿如泡。一位医生为他渗湿行气，无效。汪石山诊视，脉象皆濡缓。他说：“脉缓无力，是气虚。《内经》说：膀胱是津液之府，气化后才能排出。气虚不足，无法运化使之排出。应当升阳补气。”于是使用补中益气汤，去掉当归、柴胡，加入茯苓、牛膝。服用两帖后，阴囊起皱，肿胀消退；三帖后完全痊愈。
俞震按语：这两条是凭脉断病的正法。前案以弦涩脉断为瘀血，后案以濡缓脉断为气虚，应手取效，都得力于指下诊断。前案将温散法改为寒下法，后案去掉当归、柴胡，加入茯苓、牛膝，体现了其学问的高明之处。但前案三天后复发，却归咎于吃了两个鸡蛋，恐怕不准确。其疼痛解除的功效，主要在于吐法。
祠部黄新阳公长期患有脾泄、便血、脚痛，六脉滑数。曾用酒煮黄连为君药，佐以人参、白术等，泄血止住。过了一年多，患狐疝，白天睾丸突出囊外，晚上睡觉时缩回腹中，不时疼痛。吴心所投以虎潜丸、还少丹而痊愈。这开始是热中证，久了变成寒中证，药物寒热迥然不同却都有效，这是因为久病从虚治。
俞震按语：叶先生曾说，戴人的方法中，原有虎潜丸等的论述，后世医生弃置不用。现在看这个医案，后世医生也有使用的。只是《指南疝疾门》收集的案例很少，而方法很多，取材丰富，运用又巧妙，更是不可及。我的同乡万枫江先生，是幕府中的老名宿，年近七十，突然患疝气。自己检查古方中的三层茴香丸，严格遵循其法服用一个月，病全愈。由此可知古方每每有不可思议的妙处，岂止是虎潜丸呢？
常州尹文辉，嗜好烧酒，能喝五斤。五月间，进入福建，溪水骤涨，涉水七里，觉得腹痛非常厉害。半个月后，右侧睾丸肿大，逐渐如斗形。福建的医生，给他用肝经的药物，乃是温热之品，半年无功。回来向李士材请教。李士材说：“嗜好烧酒则湿热充满体内，涉大水则湿寒外束。”用胃苓汤加栀子、黄柏、枳壳、小茴香，十剂后略微减轻，随即制成丸药，服用至十五斤，完全康复且不复发。
俞震按语：这个医案如果使用三层茴香丸，一定不妥当。看李公讲解病情，更加相信医学贵在变通。后面的医案也纯正可效法。
文学骆元宾，患疝气十年，形容枯槁。李士材诊视，左胁有形，大如手臂，用手握住时，沥沥有声，甚至上攻于心，胸闷窒息很久，用热醋熏炙才苏醒。说：“这就是经书上所说的厥疝。”使用治疝当归四逆汤，半个月后积形逐渐变小，再以八味丸间歇服用，半年不停歇，积块完全消除且不复发。
卢不远治疗陈孟杼的父亲，六月从山东邸店受寒而起，尚且缠绵未愈。到了次年二月，忽然小腹与腰部急痛，让人紧紧抱住外肾，稍微松手就要死。卢不远说：“这是小肠腑的病。《内经》说：小肠病者，腰脊控睾而痛。”于是用羌活入太阳小肠经，佐以黄柏、茯苓、肉桂等，并刮拭委中穴，疼痛立即停止。但足软。卢不远说：“病因是六月伤寒，太阳经有所未尽，所以入腑而痛作。原是以寒邪郁火，仍需夏时则火力全而血脉通，邪气才能去除。”果然到五月天热时，身上发紫斑，有汗至足后才恢复健康。
俞震按语：这个医案引用经文以证明病情，并不牵强。其用药及刮法都很好。至于因足软而追溯病情的源流，真是大大地……
喻嘉言治疗封翁胡养冲，少腹有疝，形如鸡卵，数次发作后，逐渐变大且长，从少腹坠入睾囊很容易，返回原位很难。下体稍受微寒即发作，发作时必须等待块中冷气逐渐转为暖热，才能软溜而缩入，否则像把酒瓶放在胯上，一半在少腹，一半在睾囊，坚硬如石。气迸入前后腰脐各道筋中，同时俱胀，上攻入胃，大呕大吐，上攻巅顶，战栗畏寒。喻嘉言说：“这是地气上攻。元会运世论中提到戌亥之所以混茫，是由地气混于天造成的。”用大剂量人参、附子、干姜、肉桂，急驱阴气，呱呱有声地从肛门排出，立即痊愈。后来仍举发，换医生服用十全大补汤，二十余剂无效。喻嘉言说：“凡孕妇患伤寒者，不得已而用麻黄、桂枝、硝黄等药，但加入四物汤，则万药即不能入胞伤胎。难道想要除去块中之邪，反而可用四物汤护之吗？即使四君子汤也是元老之官，不可以理繁治剧。必须用姜、桂、附子之猛药，始能克制伏阴邪。但悍烈之性，似非平时所宜服。发作时服用，也有口干舌苦之患。而坚块远在少腹，又没有平复的期限。于此议治，应当先用姜、桂、附子做成小丸，晒令干坚，然后用参、术浓煎为外廓，使得喉胃间知道有参、术，不知道有姜、桂、附子，递送达于积块之所，猛烈之性始露出来，庶几坚者削，而窠囊可破。”
俞震按语：西昌的这个说法，似是而非。外廓之药包裹其猛烈之药，使其不犯咽膈是可以的。但如果到了胃中必须消化，方能以药性达于病所。如果不消化，则入肠泻出矣。哪里有到小腹胯间后才化的道理呢？其说法本于吕元膺紫雪裹理中丸法。但彼处以紫雪治喉中之热，理中丸治中焦之寒，也说药入中焦即化。热药冷服，同此义也。白通汤加人尿猪胆汁，因其阴盛格阳，而用阴药为向导，岂可引作外廓之证哉？朱砂、青黛为衣，也是借其色为心肝二经之向导，岂竟护送此药到心肝哉？故节删其说而录之。
Luo Qianfu treated the wife of Transport Commissioner Zhao. She was nearly sixty years old. In March, she suffered from cold pain in the umbilical and abdominal regions, radiating to the hypochondrium, unbearable in intensity, with repeated restlessness and inability to lie down comfortably. First, Zhongting (CV10) acupoint was moxibusted. This point is located 1.6 cun below Danzhong (CV17) in the depression, where the Qi of the Ren Mai (Conception Vessel) emerges. Five moxa cones or fourteen to twenty-one cones were applied. Subsequently, Danggui Sini Tang (Cinnamon Twig Decoction with Angelica Root) was administered. The prescription consisted of: Danggui Wei (Tail of Angelica Sinensis Root) 7 fen, Guizhi (Cinnamon Twig), Fuzi (Prepared Aconite Root), Huixiang (Fennel Fruit), Chaihu (Bupleurum Root) each 5 fen, Shaoyao (White Peony Root) 4 fen, Fuling (Poria), Yanhusuo (Corydalis Rhizome), Chuanlianzi (Sichuan Chinaberry Seed) each 3 fen, Zexie (Alisma Rhizome) 1 fen. After several doses, she recovered.
He also treated Huo'er Chiliedai's hernia qi. Symptoms included paroxysmal colic in the umbilical and abdominal regions, spasmodic contraction unbearable to endure, lumbar curvature preventing extension, slight relief upon applying hot compresses. The pulse was deep, small, and rapid. The *Nan Jing* states: "When the Ren Mai is diseased, men develop internal seven types of hernias," all caused by cold accumulation between the small intestine. Without potent hot-natured formulas, recovery would be impossible. Thus, Chenxiang (Agarwood), Fuzi (Prepared Aconite Root), Chuanwu (Chuanwu Rhizome), Paojiang (Prepared Ginger), Liangjiang (Galangal Rhizome), Huixiang (Fennel Fruit), Rougui (Cinnamon Bark), Wuzhuyu (Evodia Fruit) each 1 liang were processed into pills with vinegar, taken with rice soup. Named Chenxiang Guifu Wan (Agarwood and Aconite Pill). Taken twice daily. Intermittently, Tiantai Wuyao San (Tiantai Cyperus Powder) was given, one qian per dose, taken with hot wine infused with ginger slices. After taking these two medicines for ten days, he recovered.
Hua Boshi treated a woman suffering from cold hernia. Pain ascended from below the navel to the heart, accompanied by distension and attacking pain, with severe hypochondriac pain, vomiting, irritability, and loss of appetite. Both hands' pulses were deep, knotted, and irregular. This was due to cold in the Lower Jiao (Lower Burner). It was necessary to urgently attack the lower pathogen, not the upper. Moxibustion was applied to Zhangmen (LR13), Qihai (CV6), and Zhongwan (CV12). Yanhusuo (Corydalis Rhizome), Guizhi (Cinnamon Twig), Huajiao (Sichuan Pepper) were administered, assisted by aromatic herbs like Huixiang (Fennel Fruit) and Muxiang (Aucklandia Root), along with Fuling (Poria) and Qingpi (Aged Tangerine Peel). Every ten days, a warming and purgative pill was taken to disperse accumulated stagnation. It proved effective.
Yu Zhen commented: Although the first case mentions Ren Mai disease, the umbilical pain radiating to the hypochondrium actually involves the Jueyin Liver Meridian. Moxibusting Zhongting treats the Ren Mai, while Danggui Sini Tang treats the Liver disease. In the second case, both pulse and symptoms indicated cold, so purely hot-natured medicine was appropriate. However, the deep, small, and rapid pulse differs from deep, micro, fine, and soft; this indicates Cold Excess, not Cold Deficiency. The brilliance lay in using Tiantai Wuyao San to expel cold accumulation. Taking only one qian, especially with a better vehicle for administration, was excellent. The third case involved pain and distension with deep, knotted, irregular pulses, also indicating accumulated cold excess. However, inability to eat indicated Yuanqi (Original Qi) deficiency. Thus, moxibustion was extremely clever, as mugwort fire expels cold and strengthens Qi. Assisted by warming and unblocking medicines, and intermittently by warming and purgative medicines, the treatment strategy was orderly, truly a victorious army. The so-called warming and purgative pill was likely Tiantai Wuyao San, as it contains Muxiang, Huixiang, Wuyao, Liangjiang, Qingpi each 5 qian, Binglang (Areca Seed) 2 pieces, Badou (Croton Seed) 70 grains stir-fried with Chuanlianzi 10 pieces using bran, discarding the beans and keeping the chinaberries to utilize their nature while discarding their substance, similar to fire therapy that does not spread.
Zhu Danxi said: "In my youth, I consumed too many citrus fruits, forming phlegm-fluid retention under the right hypochondrium. I stopped eating them. One day, after strenuous mountain walking, hungry and thirsty, I ate oranges and taro. The orange stirred up old retention, and the taro further obstructed Qi. Immediately, the right testicle swelled, alternating chills and fever. Considering that Spleen and Lung govern the right side, the retained fluids and stagnant Qi sank downward, injuring the tendons of the Taiyin and Yangming meridians. The pathogen entered the scrotum, attaching to the testis causing swelling. Dai Hansheng said diseases are treated based on upper or lower location. Similarly, Wood Stagnation causing hernia, if in the lower part, cannot be treated with emesis; it must be guided out from below. However, I ponder: since diseases differ, can treatments be the same? Now, hunger and labor injured the Spleen, causing Spleen Qi to sink; it must be lifted. Then Stomach Qi will not sink further, and retention can move. Using purgatives might cause further sinking of Stomach Qi. First, take one or two doses of stomach-regulating medicine. The next morning, use 'Shenshi' (spirit-guiding) to direct Qi to the Lower Jiao, inducing retching upwards. When the movement of retention under the ribs reaches the Middle Jiao, induce vomiting. After vomiting, the swelling halves. Repeat vomiting the next morning. Afterward, harmonize Stomach Qi and unblock collaterals. Recovery in two to three days. This method is used for alcohol injury and water retention affecting the right side..."
Yu Zhen commented: This passage previously had two lines missing from *Mingyi Leian*, making the text disjointed and incomprehensible. Recording it fully from the original edition reveals the profound logic. The method of guiding Qi to the Lower Jiao and moving towards the hypochondrium is vastly safer than Dai Hansheng's emetic drugs. Reading *Jingyue Quanshu*, I recorded his father Shoufeng Gong's emetic method: usually upon waking at dawn, slowly swallowing air to induce belching to lift Qi. If Qi feels insufficient, swallow air to belch, lifting continuously until phlegm-saliva rises. If lips swell or throat hurts after vomiting, rinse and swallow cool water. Breakfast after vomiting excludes all flavors, consuming only light porridge to nourish clear Qi in the Stomach. From age forty, no alcohol was consumed; emesis performed two to three times monthly. From age sixty, once every month or half-month. Used for over forty years, becoming healthier with age. For any illness, regardless of exterior/interior or excess/deficiency, no medicine was taken; only one emetic session cured it immediately. Living past eighty, still able to climb mountains. Copying ancient texts by lamplight, I felt exhilarated. Dai Hansheng's Dusheng Chetiao Fang is far less gentle than this. Yet I ponder: Yangming Stomach Meridian flows downward normally; vomiting reverses this. Frequent vomiting should shorten life, yet it extends it. I dare not believe this.
A person drank water after an illness, suffering severe pain in the left testicle. Dadun (LR1) was moxibusted, and Yaomo Gao (Waist-Massaging Ointment) was massaged onto the scrotum up to Henggu (GB29), covered with warm cloth. Pain ceased immediately, and swelling subsided overnight.
Yu Zhen commented: This case lacks profound meaning, but the method is good and can be kept for reference.
Wang Shishan treated a man in his twenties who stood in water for a long time, overworking himself, resulting in hernia pain. During pain, lumps formed in the abdomen, rising and falling like rolling waves, causing severe pain. Pulses were thin, wiry, and slow, feeling rough upon pressure. He said: "This is a Blood disease." Consulting medical books, there are seven types of hernia, none suitable for purgation. Treatments mostly use warming and dispersing herbs, addressing Qi. Here, the method must change. Xiaochengqi Tang (Minor Order the Yang Decoction) plus Taoren (Peach Kernel) was used to purge. Pain vanished instantly. Three days later, it recurred worse. Light pulse was wiry and large; heavy pulse was scattered and rough. Puzzled, he asked about diet. The patient replied: "Only ate two eggs." Wang said: "I understand." Induced vomiting with fingers, expelled everything. Pain resolved.
A six-year-old boy had a scrotum swollen like a cup, penile skin smooth and blister-like. A doctor tried draining dampness and moving Qi without effect. Wang diagnosed pulses as soggy and slow. He said: "Slow and forceless pulses indicate Qi Deficiency. The Classic states: The Bladder is the mansion of fluids; only through Qi transformation can they exit. Qi deficiency fails to transform and expel. Yang-raising and Qi-tonifying is needed." Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used, removing Danggui (Angelica Sinensis Root) and Chaihu (Bupleurum Root), adding Fuling (Poria) and Niuxi (Achyranthes Root). After two doses, the scrotum wrinkled and swelling reduced; after three doses, full recovery.
Yu Zhen commented: These two cases represent standard pulse-based diagnosis. The first diagnosed blood stasis via wiry-rough pulses; the second diagnosed Qi deficiency via soggy-slow pulses. Effectiveness relied on palpation. The first changed warming/dispersing to cold/purgative; the second removed Danggui/Chaihu, adding Fuling/Niuxi, showing scholarly depth. However, attributing the recurrence in the first case to two eggs is questionable. The pain relief was likely due to the emetic method.
Cibu Huang Xinyang Gong had chronic Spleen diarrhea, bloody stools, and foot pain. Six pulses were slippery and rapid. Jiuzhu Huanglian (Alcohol-boiled Coptis Rhizome) was used as the sovereign herb, assisted by Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome). Diarrhea and bleeding stopped. Over a year later, he developed Hu Hernia (Intermittent Hernia), protruding from the scrotum during the day and retracting at night, with intermittent pain. Wu Xinso prescribed Huyan Wan (Tiger-Hiding Pill) and Huanshao Dan (Return to Youth Elixir), leading to recovery. Initially Heat in the Middle, later Cold in the Middle; despite opposite drug natures, both worked because chronic illness is treated via deficiency.
Yu Zhen commented: Mr. Ye stated that Dai Hansheng's methods originally included discussions on Huyan Wan, which later doctors discarded. This case shows later doctors did use it. The *Zhinan* section on hernia has few cases but many methods, rich in material and skillful in application, surpassing others. My fellow townsman Mr. Wan Fengjiang, a veteran幕府 official near seventy, suddenly suffered hernia. Checking ancient formulas, he strictly followed Sansheng Huixiang Wan (Three-Layer Fennel Pill) for a month, achieving full cure. This proves ancient formulas often have miraculous effects, not just Huyan Wan.
Yin Wenhui of Changzhou loved strong liquor, capable of drinking five jin. In May, entering Fujian, sudden floodwaters forced him to wade seven li. Severe abdominal pain ensued. Half a month later, the right testicle swelled to the size of a dou. Fujian doctors used Liver Meridian herbs, which were warming, with no result for half a year. He consulted Li Shicai. Li said: "Liquor addiction fills the interior with Damp-Heat; wading floods binds the exterior with Damp-Cold." Weiling Tang (Stomach-Poria Decoction) plus Zhizi (Gardenia Fruit), Huangbai (Phellodendron Bark), Zhike (Aurantium Fructus), Huixiang (Fennel Fruit) was prescribed. Ten doses slightly reduced symptoms. Made into pills, taken until fifteen jin total, resulting in complete recovery without recurrence.
Yu Zhen commented: Using Sansheng Huixiang Wan here would certainly be inappropriate. Li's analysis confirms medicine values flexibility. The subsequent case is also pure and exemplary.
Luoyuanbin, a scholar, suffered hernia for ten years, looking emaciated. Li Shicai examined him: a mass in the left hypochondrium, arm-sized, making gurgling sounds when held with a hot hand, even attacking the heart causing suffocation, revived only by hot vinegar fumigation. Li said: "This is what the Classics call Jue Hernia." Zhihe Danggui Sini Tang was used. After half a month, the mass gradually shrank. Huyuan Wan (Eight-Ingredient Pill) was taken intermittently for half a year without cessation. The mass completely disappeared without recurrence.
Lu Buanyuan treated the father of Chen Mengzhu. He caught cold in June at a Shandong inn, lingering ill. By February the next year, sudden acute pain in the lower abdomen and waist occurred. Holding the external kidneys tightly was required; loosening meant death. Lu said: "This is Small Intestine Fu disease. The Classic says: Small Intestine disease causes back and thigh pain radiating to the testicles." Qianghuo (Notopterygium Rhizome) entering the Taiyang Small Intestine meridian was used, assisted by Huangbai (Phellodendron Bark), Fuling (Poria), Rougui (Cinnamon Bark), etc., and the Weizhong (BL40) acupoint was scraped. Pain stopped immediately. Feet became weak. Lu said: "The cause was summer heat-cold; Taiyang pathogens remained unresolved, entering the Fu organ. Originally, cold pathogen trapped fire; it requires summer heat to fully activate blood vessels and expel pathogens." Indeed, in May when weather warmed, purple spots appeared on the body, sweating reached the feet, and health returned.
Yu Zhen commented: This case cites classics to prove pathology without forcing connections. Medication and scraping methods were excellent. Tracing the origin of weakness to the disease source was truly insightful...
Yu Jiayan treated Governor Hu Yongchong's father. A hernia in the lower abdomen, egg-shaped. After several attacks, it grew larger and longer, easily descending into the scrotum but difficult to return. Slight cold exposure triggered it. Relief required the cold gas in the mass to turn warm before shrinking. Otherwise, it felt like a bottle lying across the hips, half in the abdomen, half in the scrotum, hard as stone. Gas rushed into tendons around the waist, navel, front, and back, causing simultaneous distension. Attacking the Stomach caused severe vomiting; attacking the vertex caused tremors and aversion to cold. Yu said: "This is Earth Qi attacking upward. In the theory of Yuan, Hui, Yun, Shi, Xu and Hai are confused because Earth Qi mixes with Heaven." Large doses of Renshen (Ginseng Root), Fuzi (Prepared Aconite Root), Jiang (Ginger), Rougui (Cinnamon Bark) were used to urgently drive out Yin Qi. Loud sounds emerged from the anus, and immediate recovery occurred. Later, it recurred. Another doctor used Shiquan Dabu Tang (Complete Great Tonifying Decoction) for over twenty doses with no effect. Yu said: "For pregnant women with Shanghan, if Mahuang, Guizhi, Xiaoshi, Dahuang are unavoidable, adding Siwu Tang prevents harm to the fetus. Why would removing pathogenic masses require protecting them with Siwu Tang? Even Sijunzi Tang is too mild for such urgent matters. Only fierce herbs like Jiang, Rougui, Fuzi can subdue hidden Yin pathogens. But their harsh nature is unsuitable for daily use. During attacks, they cause dry mouth and bitter taste. Since the hard mass is far in the lower abdomen with no clear end date, treatment should involve making small pills of Jiang, Rougui, Fuzi, dried hard, then coating them with thick decoctions of Renshen and Baizhu. This way, the throat and Stomach perceive Renshen/Baizhu first, hiding the fierce herbs until they reach the mass site, where their potency is revealed, potentially breaking the hardness and nest."
Yu Zhen commented: Xichang's theory is plausible yet flawed. Coating fierce herbs with outer layers prevents irritation to the throat and esophagus. However, in the Stomach, digestion must occur for medicinal properties to reach the disease site. Undigested pills would pass into the intestines and be excreted. How could they dissolve only in the lower abdomen and hips? This theory originates from Lu Yuanying's method of wrapping Lizhong Wan in Zixue. But Zixue treats throat heat, and Lizhong treats Middle Jiao cold, assuming digestion occurs in the Middle Jiao. Hot medicine taken cold follows similar logic. Baitong Tang plus human urine and pig bile uses Yin herbs as guides due to Yin excess repelling Yang. Can this be cited as an outer-coat argument? Cinnabar and Qingdai coatings borrow color as guides for Heart and Liver meridians; do they escort medicine to these organs? Therefore, I abridged and recorded this saying.