神伤于上。精败于下。心肾不交。久伤精气。不复谓之损。内经治五脏之损。
治各不同。越人有上损从阳。下损从阴之议。然必纳谷资生。俾胃后天得振。始
望精气生于谷食。自上秋至今日甚。乃里真无藏。当春令泄越。生气不至。渐欲
离散。从来精血有形。药饵焉能骤然充长。攻病方法。都主客邪。以偏治偏。阅古
东垣丹溪辈。于损不肯复者。首宜大进参术。多至数斤。谓有形精血难生。无形
元气须急固耳。况上下交损。当治其中。若得中苏加谷。继参入摄纳填精敛神
之属。方今春木大泄。万花尽放。人身应之。此一月中急挽勿懈矣。
参术膏 米饮调送
一月来。虽经反复。参脉症色形。生阳颇有根蒂。近食蚕豆滞气。腹中微膨。
食后口味酸浊。是久卧重着。脾阳运动之机尚少而火升心烦。动气汗出。遗精
虽减于昔。未得平复。总是内损已深。若调治合宜。只要精气复得一分。便减一
分病象。长夏脾胃主令。培土助纳为要。而精气散越。乃兼摄固之法。刻下味酸
微膨。补脾少佐疏胃。宜晚进。其早上另制补摄丸剂。益脏真以招纳散失之气。
人参 茯苓 白术 炙草 广皮 麦冬 五味 神曲 麦芽 炒黄柏 晚服
人参 桑螵蛸 白龙骨 淡苁蓉 五味 芡实 茯神 枣仁 金箔 金樱膏丸 早服
肌肉松柔。脉小如数。常有梦遗。阴精不固。上年冬令过温。温则腠理反疏。
阳动不藏。诸气皆升。络血随气上溢。见症如头面热。目下肉 。心悸怔忡。四肢
汗出。两足附肿。常冷不温。走动数武。即吸短欲喘。何一非少阴肾气失纳。阳浮
不肯潜伏之征。况多梦纷扰。由精伤及神气。法当味浓填精。质重镇神。佐酸以
收之。甘以缓之。勿因血以投凉。莫见下寒。辄进燥热。恪守禁忌以安之。经年冀
有成功。所虑壮年志虑未纯。贻忧反复。
水制熟地 人参秋石拌 白龙骨 炒杞子 五味 炒山药 茯神 牛膝炭
遗泄。有梦属心。无梦属肾。据述气火下溜。即如溺出之状。茎管中痛。热气
上冲。咽喉巅顶掀胀。语言皆怯。此任脉不摄。冲脉气逆。治法。引之导之。摄以固
之。现下便溏食少。勿投沉阴腻滞之药。
砂仁炒熟地 炒黑远志肉 炒莲须 元武版 白龙骨 锁阳 茯苓 杜芡实 金樱子熬膏为丸
神志在上受损,精气在下败坏。心与肾不能相交,长久耗伤精气,无法恢复称为“损”。《内经》论述治疗五脏的虚损,方法各不相同。扁鹊(越人)有上部的虚损应从阳分论治、下部的虚损应从阴分论治的议论。然而必须依靠饮食滋养,使脾胃后天之本得以振奋,才指望精气能从谷食中化生。从今年秋天到现在病情加重,这是里真元无藏守,正值春季阳气发泄之时,生气不至,逐渐想要离散。从来精血是有形之物,药物怎么能骤然充长?治疗疾病的方法,都针对客邪,以偏性治疗偏盛之病。阅读古代李东垣、朱丹溪等人,对于亏损不肯恢复的病症,首先应当大剂量进服人参、白术,多至数斤,认为有形的精血难生,无形的元气须急固罢了。况且上下交相亏损,应当治疗其中焦。如果中焦苏醒能进食,接着参入摄纳填精敛神的药物。如今春季木气大泄,万花尽放,人体与之相应,这一个月中急需挽救不可松懈。
参术膏 用米汤调送
一个月来,虽然病情反复,综合脉象、症状、面色和形体来看,生阳之气颇有根蒂。近期食用蚕豆导致气机阻滞,腹部微胀,饭后口味酸浊,这是久卧重着,脾阳运动的机能尚少而火升心烦,动气汗出。遗精虽比过去减少,但未得平复。总是内损已深,如果调治合宜,只要精气恢复一分,便减去一分病象。长夏时节脾胃主令,培土助纳是重要关键。而精气散越,乃兼用摄固的方法。眼下味酸微胀,补脾时少佐疏胃的药物,宜晚上服用。早上另外制作补摄丸剂,益脏真以招纳散失之气。
人参 茯苓 白术 炙甘草 广陈皮 麦冬 五味子 神曲 麦芽 炒黄柏 晚服
人参 桑螵蛸 白龙骨 淡苁蓉 五味子 芡实 茯神 枣仁 金箔 金樱膏丸 早服
肌肉松柔,脉小如数,常有梦遗,阴精不固。上年冬季过温,温则腠理反而疏松,阳气妄动不藏,诸气皆升,络血随气上溢。出现的症状如头面热,眼下肉跳,心悸怔忡,四肢汗出,两足浮肿,常冷不温,走动几步,即呼吸短促想喘。哪一样不是少阴肾气失于摄纳,阳气浮越不肯潜伏的征象?况且多梦纷扰,由精伤及神气,治法当用味浓之品填精,质重之品镇神,佐以酸味收敛,甘味缓急。不要因为见血就投凉药,不要因为见下寒就进燥热药。恪守禁忌以安养身体,经年冀望有成功。所忧虑的是壮年志虑未纯,贻忧病情反复。
水制熟地黄 人参秋石拌 白龙骨 炒枸杞子 五味子 炒山药 茯神 牛膝炭
遗精,有梦属心,无梦属肾。据叙述气火下溜,就像小便流出之状,茎管中痛,热气上冲,咽喉巅顶掀胀,语言皆怯。这是任脉不摄,冲脉气逆。治法,引之导之,摄以固之。现下大便溏薄食少,不要投沉阴腻滞的药物。
Spirit is damaged above, essence is corrupted below. Heart and Kidney fail to interact; prolonged injury to Qi and Essence, with no recovery, is termed "Damage" (Sun). The *Nei Jing* discusses the treatment of Damage in the Five Zang organs, with different methods for each. Yue Ren (Bian Que) proposed that upper Damage should be treated from the Yang aspect, and lower Damage from the Yin aspect. However, one must rely on food intake to nourish, so that the Post-Heaven Stomach and Spleen are revitalized, hoping that Essence and Qi can be generated from grain and food. From this past autumn until now, the condition has worsened; this indicates that the True Qi within lacks storage. During the Spring season when Yang Qi leaks out, the Generating Qi does not arrive, leading to gradual dispersion. Since Essence and Blood are tangible substances, how can medicines suddenly replenish them? Methods for treating disease generally target external pathogens, using bias to treat bias. Reviewing ancient masters like Li Dongyuan and Zhu Danxi, for cases of Damage that refuse to recover, they first advocated large doses of Ginseng (*Ren Shen*) and Atractylodes (*Bai Zhu*), up to several jin, stating that tangible Essence and Blood are hard to generate, while intangible Original Qi must be urgently secured. Moreover, when both upper and lower aspects are damaged, the Middle Jiao should be treated. If the Middle Jiao revives and appetite returns, then incorporate herbs that gather, tonify essence, and calm the spirit. Currently, in Spring, Wood Qi is greatly leaking, and all flowers bloom; the human body responds to this. In this month, urgent rescue is required without slackening.
Shen Shu Paste (Ginseng and Atractylodes Paste): Mixed with rice water for administration.
Over the past month, although there have been recurrences, considering pulse, symptoms, complexion, and physique, the Generating Yang Qi has substantial roots. Recently, eating broad beans caused Qi stagnation, slight abdominal distension, and a sour, turbid taste after meals. This is due to prolonged lying down and heavy clothing, where the mechanism of Spleen Yang movement is scarce, leading to rising Fire, irritability, moving Qi, and sweating. Although nocturnal emission has decreased compared to before, it has not returned to normal. The internal damage is profound. If treatment is appropriate, for every point of Essence recovered, one point of pathology is reduced. In late summer, the Spleen and Stomach govern; cultivating Earth and assisting ingestion is key. Since Essence and Qi are scattered, methods of gathering and securing are also needed. Currently, with sour taste and slight distension, tonifying the Spleen should be accompanied by slightly dispersing the Stomach. It is suitable to take medicine in the evening. In the morning, prepare separate tonifying and securing pills to benefit the organ's True Qi and attract scattered Qi.
Evening Prescription: *Ren Shen* (Ginseng), *Fu Ling* (Poria), *Bai Zhu* (Atractylodes Macrocephala), Zhi Gan Cao (Honey-fried Licorice), Guang Pi (Tangerine Peel), *Mai Dong* (Ophiopogon), *Wu Wei Zi* (Schisandra), Shen Qu (Medicated Leaven), Mai Ya (Barley Sprout), Chao Huang Bo (Fried Phellodendron).
Morning Prescription: *Ren Shen* (Ginseng), Sang Piao Xiao (Mantis Egg Case), Bai Long Gu (Fossilized Bone), Dan Cong Rong (Cistanche), *Wu Wei Zi* (Schisandra), Qian Shi (Euryale Seed), Fu Shen (Poria with Hostwood), Zao Ren (Jujube Seed), Jin Po (Gold Foil), Jin Ying Zi Paste Pills.
Muscles are loose and soft, pulse is small and rapid. There are frequent dream-emissions, and Yin Essence is insecure. Last winter, excessive warmth caused pores to become loose, Yang Qi moved recklessly without storing, all Qi rose, and collateral blood overflowed with Qi. Symptoms include heat in the head and face, twitching under the eyes, palpitations and fright, sweating in the four limbs, edema in both feet, coldness and lack of warmth, shortness of breath and desire to pant after walking a few steps. Are these not signs of Shaoyin Kidney Qi failing to secure, and Yang floating unwillingly to submerge? Moreover, frequent disturbing dreams result from Essence injury affecting Spirit and Qi. The method should use rich-tasting herbs to fill Essence, heavy-substance herbs to settle Spirit, assisted by sour herbs to astringe and sweet herbs to moderate. Do not administer cooling herbs just because of bleeding; do not administer drying-hot herbs just because of lower cold. Strictly observe taboos to ensure peace. Hope for success over a year. The concern is that a young man's will and thoughts are not pure, leading to worries of recurrence.
Water-processed Shu Di Huang (Rehmannia Root), *Ren Shen* (Ginseng) mixed with Autumn Stone, Bai Long Gu (Fossilized Bone), Chao Gou Qi Zi (Fried Lycium Fruit), *Wu Wei Zi* (Schisandra), Chao Shan Yao (Fried Dioscorea), Fu Shen (Poria with Hostwood), Niu Xi Tan (Charred Achyranthes Root).
Nocturnal emission: With dreams belongs to Heart; without dreams belongs to Kidney. According to the description, Qi and Fire flow downward, resembling the state of urination, with pain in the urethra, hot Qi rushing upward, swelling and distension in the throat and vertex, and timid speech. This is Ren Mai failing to secure and Chong Mai Qi reversing. The treatment method is to guide and lead, to secure and consolidate. Currently, stool is loose and appetite is poor; do not administer heavy, yin, cloying, or stagnant medicines.
Sha Ren processed Shu Di Huang (Rehmannia Root with Amomum), Chao Hei Yuan Zhi Rou (Fried Black Polygala Flesh), Chao Lian Xu (Fried Lotus Stamen), Yuan Wu Ban (Tortoise Plastron), Bai Long Gu (Fossilized Bone), Suo Yang (Cynomorium), *Fu Ling* (Poria), Du Zhong (Eucommia Bark), Qian Shi (Euryale Seed), Jin Ying Zi (Cherokee Rose Hip) paste pills.