吴 五十七岁 乙酉四月十九日 感受燥金之象，腹痛，泄泻，呕吐。现下泄泻虽止，
而呕不能食，腹痛仍然，舌苔白滑，肉色刮白，宜急温之，兼与行太阴之湿。
川椒炭（三钱） 茯苓（五钱） 陈皮（三钱） 高良姜（二钱） 苡仁（五钱） 公丁香（一钱）
吴萸（二钱） 益智仁（二钱） 半夏（五钱）
二帖。
二十二日 背仍痛，原方加∶
高良姜（一钱） 吴萸（一钱） 桂枝（五钱）
再服四帖。
二十七日 已效，阴气未退，再服三帖，分四日服完。
五月初三日 痛减，呕与泄泻俱止，减川椒、萸、姜之半，再服六帖。
十三日 阴未化，阳自不复，且心下坚大如盘，脉如故，前方再服。
姚 四十八岁 乙酉四月二十一日 燥金感后，所伤者阳气，何得以大剂熟地补阴。久
久补之，阳气困顿，无怪乎不能食而呕矣。六脉弦紧，岂不知脉双弦者寒乎。
川椒炭（三钱） 陈皮（三钱） 半夏（五钱） 干姜（二钱） 茯苓（五钱） 公丁香（八分）
生姜（三钱） 苡仁（五钱）
初二日 加桂枝（三钱） 干姜（一钱） 减川椒之半。
十一日 呕痛皆止，饮食已加，惟肢软无力，阳气太虚，加甘草合前辛药，为辛甘补阳
方法。
二十一日 复感燥气，呕而欲泻，于前方内去甘药加分量自愈。六脉弦细如丝，阳微之
极。
川椒炭（三钱） 陈皮（三钱） 吴萸（三钱） 干姜（三钱） 茯苓（五钱） 半夏（五钱） 桂
枝（五钱） 公丁香（钱半） 生姜（五钱）
二十七日 诸症皆效，脉稍有神，于原方内去吴萸、丁香之刚燥，加苡仁之平淡
，阳明从中治也。
李 四十六岁 乙酉四月十六日 胃痛胁痛，或呕酸水，多年不愈，现下六脉弦紧，皆
起初
感燥金之气，金来克木，木受病，未有不克土者。土受病之由来，则自金克木始也，此等由
外感而延及内伤者，自唐以后无闻焉。议变胃而受胃变法，即用火以克金也。又久病在络法
∶
公丁香（一钱） 茯苓（五钱） 枳实（四钱） 川椒炭（三钱） 苡仁（五钱） 生姜（五钱）
半夏（五钱） 陈皮（三钱）
四帖。
二十三日 复诊仍用原方四帖。
五月初二日 现下胃痛胁痛吐酸之证不发，其六脉弦紧不变，是胸中绝少太和之气，议
转方用温平，刚燥不可以久任也。
桂枝（四钱） 茯苓（五钱） 生姜（三钱） 陈皮（三钱） 大枣（二枚） 炙甘草（二钱） 半
夏（五钱） 干姜（二钱） 苡仁（五钱） 白芍（四钱）
服之如无弊，可多服。
十一日 诊脉已回阳，去干姜，减桂枝之半。
二十四日 复诊脉仍紧，原方加∶
益智仁（二钱）
服三帖愈。
余 五十二岁 五月初二日 胃痛胁痛，脉双弦，午后更甚者，阳邪自旺于阴分也。
川椒炭（三钱） 陈皮（三钱） 公丁香（钱半） 降香末（三钱） 香附（三钱） 楂炭（二钱）
吴萸（二钱） 青皮（二钱） 青橘叶（三钱） 半夏（五钱） 苡仁（五钱）
接服霹雳散。
十七日 复诊病稍减，脉仍紧，去∶
楂炭 橘叶 及川椒炭（一钱） 加
枳实（三钱）
二十四日 脉之紧者稍和，腹痛已止，惟头晕不寐，且与和胃令寐，再商后法。
半夏（一两） 苡仁（一两） 茯苓（五钱） 枳实（三钱）
煮三杯，分三次服，以得寐为度。如服二帖后仍不寐，可加半夏至二两，再服一帖。
谭 四十七岁 五月初二日 感受金凉，胸痹头痛，脉弦细而紧。
薤白（三钱） 川椒炭（三钱） 浓朴（二钱） 桂枝（三钱） 陈皮（三钱） 高良姜（二钱）
半夏（三钱） 苡仁（五钱） 生姜（五片） 大枣（二个）
二帖。
十八日 燥气虽化，六脉俱弦，舌苔白滑，用阳明从中治法，与苦辛淡法，最忌酸甘。
半夏（四钱） 苡仁（五钱） 香附（三钱） 茯苓（四钱） 干姜（钱半） 益智仁（二钱） 陈
皮（三钱） 蔻仁（钱半） 川椒炭（二钱）
二十一日 脉仍弦紧，热药难退，咳嗽减，效不更方。右胁微痛。加∶
香附（三钱）
二十三日 右胁微痛，脉弦紧如故，加∶
苏子霜（三钱） 降香末（三钱） 旋复花（三钱）
二十六日 胁痛咳嗽皆止，痰尚多，脉弦未和，于前方内去香附 苏子霜 降香 旋复
花加∶
桂枝（四钱） 干姜（二钱半） 以充其阳气，行痰饮，和弦脉。
霹雳散方
主治中燥吐泻腹痛，甚则四肢厥逆转筋， 痛肢麻，起卧不安，烦躁不宁，再甚则六脉
全无
。阴毒发斑疝症等症，并一切凝寒痼冷积聚，寒轻者不可多服，寒重者不可少服，以愈为度
。非实在纯受燥湿寒三气阴邪者不可服。
桂枝（六两） 公丁香（二两） 草果（二两） 川椒炭（五两） 水菖蒲（二两） 青木香（四
两）
吴萸（四两） 防己（三两） 槟榔（二两） 降香末（五两） 附子（三两） 小茴香（四两） 薤白
（四两） 苡仁（五两） 五灵脂（二两） 高良姜（三两） 荜澄茄（五两） 细辛（二两） 乌药（
三两） 干姜（三两） 雄黄（五钱）
上药共为细末，开水和服，大人每服三钱，病重者五钱，小儿减半，病甚重者连服数次
，以痛止厥回，或泻止筋不转为度。
方论 按《内经》有五疫之称，五行偏胜之极，皆可致疫。虽疠气之至，多见火证，而
燥金
寒湿之疫，亦复时有。着风火暑三者为阳邪，与秽浊异气相参，则为温疠；湿燥寒三者为阴
邪，与秽浊异气相参，则为寒疠。现下见证多有肢麻转筋、手足厥逆、吐泻腹痛、胁肋疼痛
，甚至反恶热而大渴思凉者。经谓雾伤于上，湿伤于下。此症乃燥金寒湿之气，直犯筋经，
由大络别络内伤三阴脏真，所以转筋入腹即死也。既吐且泻者，阴阳逆乱也；诸痛者，燥金
寒水之气所搏也；其渴思凉饮者，少阴篇谓自利而渴者属少阴，虚则饮水求救也；其头面赤
者，阴邪上逼，阳不能降，所谓戴阳也；其周身恶热喜凉者，阴邪盘踞于内，阳气无附欲散
也。阴病反见阳证，所谓水极似火，其受阴邪尤重也。诸阳证毕现，然必当脐痛甚拒按者，
方为阳中见纯阴，乃为真阴之证。此处断不可误，故立方会三阴经刚燥温热之品，急温脏真
，保住阳气，又重用芳香，急驱秽浊。一面由脏真而别络大络外出筋经经络以达皮毛，一面
由脏络腑络以通六腑，外达九窍，俾浊秽阴邪，一齐立解。大抵皆扶阳抑阴，所谓丽照当空
，群阴退避也。
赵 三十八岁 七月二十四日 感受燥金之气，腹痛甚，大呕不止，中有蓄水，误食水
果。
公丁香（三钱） 半夏（一两） 茯苓皮（五钱） 生姜（一两） 川椒炭（六钱） 乌梅肉（三
钱） 吴萸（四钱） 陈皮（五钱） 高良姜（四钱） 枳实（三钱）
水五碗，煎二碗，渣再煎一碗。另以生姜一两，煎汤一碗。候药稍凉，先服姜汤一口，
接服汤药一口，少停半刻，俟不吐再服第二口。如上法，以呕止痛定为度。
二十五日 燥气腹痛虽止，当脐仍坚，按之微痛，舌苔微黄而滑，周身筋骨痛，脉缓，
阳明之上中见太阳，当与阳明从中治例。
桂枝（六钱） 川椒炭（二钱） 生姜（三钱） 白芍（三钱，炒） 公丁香（一钱） 防己（三
钱） 苡仁（五钱） 茯苓（六钱） 半夏（五钱）
煮三杯，分三次服，服此身痛止。
二十六日 脉小于前，身痛已止，六脉未和，舌黄滑苔。
半夏（五钱） 生姜（三钱） 蔻仁（钱半） 茯苓（五钱） 陈皮（三钱） 浓朴（钱半） 苡仁
（五钱） 大腹皮（三钱） 川椒（钱半）
二十八日 腹胀如故不寐，加∶
半夏（一两）
初一日 太阳痹。
桂枝（六钱） 茯苓皮（五钱） 茅术炭（三钱） 防己（四钱） 通草（一钱） 片姜黄（三钱）
杏仁（五钱） 苡仁（五钱） 滑石（六钱） 蚕砂（三钱）
初六日 腹胀停饮，前方内去术之守，加苦辛之通，又去滑石。
大腹皮（三钱） 浓朴（三钱） 枳实（三钱） 陈皮（三钱）
初十日 六脉俱弦，胃口不开，腹胀肢倦，宜通六腑，即劳者温之之法也。
桂枝（六钱） 大腹皮（三钱） 川椒炭（三钱） 陈皮（五钱） 益智仁（三钱） 半夏（五钱）
枳实（二钱） 茯苓（五钱） 浓朴（二钱）
服五帖而愈。
张 女十五岁 燥金之气，直中入里，六脉全无，僵卧如死，四肢逆冷，已过肘膝，
痛转
筋，与通脉四逆汤加川椒、吴萸、丁香一大剂。厥回脉出，一昼夜，次日以食粥太早，复中
如前，脉复厥，体又死去矣。仍用前方，重加温药一剂，厥回其半。又二帖而无活，后以补
阳收功。
顾 五十岁 直中燥气，呕少泻多，四肢厥逆，无脉，目开，无语，睛不转，与通脉四
逆汤。加∶
人参 川椒 吴萸 丁香
一帖而效，三帖脉渐复，重与补阳而愈。
杨 室女 五十岁 胁痛，心烦懊 ，拘急肢冷，脉弦细而紧。欲坐不得坐，欲立不得
立，
欲卧不得卧，随坐即欲立，刚立又欲坐，坐又不安。一刻较一刻脉渐小，立刻要脱。与霹雳
散不住灌之，计二时，服散约计四两而稍定，后与两和脾胃而全安。
郑 二十六岁 先是三月初九日，得太阳中风，与桂枝汤已愈。十二日晚已卧，下体有
微汗
，因厨房不戒于火，只穿小汗褂一件，未着袜，出外救火，火熄复卧，觉身微热恶寒，腹中
胀痛，脉弦数，与桂枝柴胡各半汤，汗出稍轻，究不能解。以后外虽化热，面赤汗多如温病
状，以当脐之痛未休，舌白不燥，断不敢用辛凉，而辛温之药，或进或退，十日不解。至二
十四日反重用温热，佐以黄连三钱，次日表证里证，一齐俱解如失。后与调理脾胃两阳而安
。
多 十六岁 燥淫表里俱病，面赤身热，舌黄燥渴，六脉洪数而紧，大便闭，小便短，
通体
全似火证，只有当脐痛拒按。此为阳中之阴，乃为真阴，与苦热芳香，一剂而热退，减轻分
量，三帖而病全失矣。
吴姓患者，五十七岁。乙酉年四月十九日就诊。感受燥金之邪，出现腹痛、泄泻、呕吐症状。目前虽然泄泻已止，但仍有呕吐、不能进食，腹痛依旧，舌苔白滑，刮去舌苔后舌质颜色发白，应当紧急温补中焦，兼以行化太阴脾经的湿邪。
处方：川椒炭（三钱）、茯苓（五钱）、陈皮（三钱）、高良姜（二钱）、薏苡仁（五钱）、公丁香（一钱）、吴茱萸（二钱）、益智仁（二钱）、半夏（五钱）。
服用两剂。
二十二日复诊。背部仍然疼痛，在原方基础上加入：高良姜（一钱）、吴茱萸（一钱）、桂枝（五钱）。
再服用四剂。
二十七日。病情已有好转，但阴寒之气未退，继续服用三剂，分四天服完。
五月初三日。疼痛减轻，呕吐与泄泻均已停止，将川椒、吴茱萸、干姜的用量减半，再服用六剂。
十三日。阴寒仍未化解，阳气无法自行恢复，且心下部位坚硬胀大如盘状，脉象依然如故，继续使用前方。
姚姓患者，四十八岁。乙酉年四月二十一日就诊。感受燥金之邪后，损伤的是阳气，怎能用大剂量的熟地黄来滋补阴液？长期滋补阴液，会导致阳气困顿，难怪会出现不能进食而呕吐的情况。六脉弦紧，难道不知道脉象双弦主寒证吗？
处方：川椒炭（三钱）、陈皮（三钱）、半夏（五钱）、干姜（二钱）、茯苓（五钱）、公丁香（八分）、生姜（三钱）、薏苡仁（五钱）。
十一日。呕吐和疼痛都已停止，饮食增加，只是肢体软弱无力，这是阳气极度虚弱，加入甘草配合前面的辛味药，构成“辛甘化阳”的治疗方法。
二十一日。再次感受燥气，出现呕吐并想腹泻，在前方中去掉甘味药，增加剂量即可自愈。六脉弦细如丝，这是阳气微弱的极致表现。
处方：川椒炭（三钱）、陈皮（三钱）、吴茱萸（三钱）、干姜（三钱）、茯苓（五钱）、半夏（五钱）、桂枝（五钱）、公丁香（钱半）、生姜（五钱）。
二十七日。各种症状都见效，脉象稍有神气，在原方中去掉吴茱萸、丁香的刚燥之性，加入薏苡仁的平淡之性，这是从阳明胃经从中调理的方法。
李姓患者，四十六岁。乙酉年四月十六日就诊。胃痛胁痛，有时呕吐酸水，多年不愈。目前六脉弦紧，这都是起初感受燥金之气所致，金克木，导致肝木受病，没有不进而克制脾土的。脾土受病的由来，是从金克木开始的。这种由外感延及内伤的病症，自唐代以后就很少听说了。建议采用变通治胃和受纳于胃的方法，即用火来克制金。又根据久病入络的理论：
处方：公丁香（一钱）、茯苓（五钱）、枳实（四钱）、川椒炭（三钱）、薏苡仁（五钱）、生姜（五钱）、半夏（五钱）、陈皮（三钱）。
服用四剂。
二十三日复诊。仍然使用原方四剂。
五月初二日。目前胃痛、胁痛、吐酸的病症不再发作，但六脉弦紧不变，说明胸中缺乏太和之气，建议转换方药，使用温和平调的药物，刚燥之药不可以长期使用。
处方：桂枝（四钱）、茯苓（五钱）、生姜（三钱）、陈皮（三钱）、大枣（两枚）、炙甘草（二钱）、半夏（五钱）、干姜（二钱）、薏苡仁（五钱）、白芍（四钱）。
服用若无不良反应，可以多加服用。
二十四日复诊。脉象仍然紧，原方中加入：益智仁（二钱）。
服用三剂痊愈。
余姓患者，五十二岁。五月初二日就诊。胃痛胁痛，脉象双弦，午后加重，这是阳邪在阴分旺盛的表现。
处方：川椒炭（三钱）、陈皮（三钱）、公丁香（钱半）、降香末（三钱）、香附（三钱）、山楂炭（二钱）、吴茱萸（二钱）、青皮（二钱）、青橘叶（三钱）、半夏（五钱）、薏苡仁（五钱）。
接续服用霹雳散。
十七日复诊。病情稍减，脉象仍然紧，去掉：山楂炭、橘叶及川椒炭（一钱），加入：枳实（三钱）。
二十四日。脉象的紧象稍缓和，腹痛已止，只是头晕失眠，先给予调和脾胃以助睡眠的方法，再商量后续疗法。
处方：半夏（一两）、薏苡仁（一两）、茯苓（五钱）、枳实（三钱）。
煮取三杯，分三次服用，以能入睡为度。如果服用两剂后仍不入睡，可将半夏加至二两，再服用一剂。
谭姓患者，四十七岁。五月初二日就诊。感受金凉之气，出现胸痹头痛，脉象弦细而紧。
处方：薤白（三钱）、川椒炭（三钱）、厚朴（二钱）、桂枝（三钱）、陈皮（三钱）、高良姜（二钱）、半夏（三钱）、薏苡仁（五钱）、生姜（五片）、大枣（两个）。
服用两剂。
十八日。燥气虽已化解，但六脉俱弦，舌苔白滑，采用阳明从中治法，给予苦辛淡法，最忌讳酸甘之品。
处方：半夏（四钱）、薏苡仁（五钱）、香附（三钱）、茯苓（四钱）、干姜（钱半）、益智仁（二钱）、陈皮（三钱）、蔻仁（钱半）、川椒炭（二钱）。
二十一日。脉象仍然弦紧，热药难以退除，咳嗽减轻，效不更方。右胁轻微疼痛。加入：香附（三钱）。
二十三日。右胁轻微疼痛，脉象弦紧如故，加入：苏子霜（三钱）、降香末（三钱）、旋覆花（三钱）。
二十六日。胁痛咳嗽都已停止，痰尚多，脉象弦而未和缓，在前方中去掉香附、苏子霜、降香、旋覆花，加入：桂枝（四钱）、干姜（二钱半），以充盛其阳气，运行痰饮，调和弦脉。
霹雳散方
主治中燥引起的吐泻腹痛，严重时四肢厥冷转筋，肢体麻木，起卧不安，烦躁不宁，更严重时六脉全无。以及阴毒发斑、疝症等症，并一切凝寒痼冷积聚。寒轻者不可多服，寒重者不可少服，以痊愈为度。如果不是确实纯受燥、湿、寒三种阴邪之气者，不可服用。
处方：桂枝（六两）、公丁香（二两）、草果（二两）、川椒炭（五两）、水菖蒲（二两）、青木香（四两）、吴茱萸（四两）、防己（三两）、槟榔（二两）、降香末（五两）、附子（三两）、小茴香（四两）、薤白（四两）、薏苡仁（五两）、五灵脂（二两）、高良姜（三两）、荜澄茄（五两）、细辛（二两）、乌药（三两）、干姜（三两）、雄黄（五钱）。
以上药物共研为细末，开水调和服用。成人每次服用三钱，病重者五钱，小儿减半。病势极重者可连续服用数次，以疼痛停止、厥逆回复，或腹泻停止、筋脉不转为度。
方论：按照《内经》的说法，有五疫之称，五行偏胜到了极点，都可以导致疫病。虽然疠气到来时，多见火证，但燥金、寒湿的疫病，也时常有发生。风、火、暑三者属于阳邪，与秽浊异气相参，则成为温疠；湿、燥、寒三者属于阴邪，与秽浊异气相参，则成为寒疠。现在看到的症状多有肢体麻木转筋、手足厥逆、吐泻腹痛、胁肋疼痛，甚至反而恶热而大渴思凉者。经文说雾伤于上，湿伤于下。此症乃是燥金寒湿之气，直接侵犯筋经，由大络、别络内伤三阴脏真，所以转筋入腹就会死亡。既吐又泻，是阴阳逆乱；各种疼痛，是燥金寒水之气搏击所致；其口渴思凉饮者，《伤寒论·少阴篇》说自利而渴者属少阴，虚则饮水求救；其头面赤者，是阴邪上逼，阳气不能下降，所谓戴阳；其周身恶热喜凉者，是阴邪盘踞于内，阳气无所依附欲散失。阴病反而见到阳证，所谓水极似火，其受阴邪尤其严重。诸阳证毕现，然而必须当脐部疼痛剧烈且拒按的，方才为阳中见纯阴，乃为真阴之证。此处断不可误判，所以立方汇聚三阴经刚燥温热之品，紧急温补脏真，保住阳气，又重用芳香之品，紧急驱除秽浊。一方面由脏真通过别络、大络外出至筋经经络以达皮毛，一方面由脏络、腑络以通六腑，外达九窍，使浊秽阴邪，一齐立即解除。大抵都是扶阳抑阴，所谓丽照当空，群阴退避。
赵姓患者，三十八岁。七月二十四日就诊。感受燥金之气，腹痛剧烈，大呕吐不止，中有蓄水，误食水果。
处方：公丁香（三钱）、半夏（一两）、茯苓皮（五钱）、生姜（一两）、川椒炭（六钱）、乌梅肉（三钱）、吴茱萸（四钱）、陈皮（五钱）、高良姜（四钱）、枳实（三钱）。
用水五碗，煎取二碗，药渣再煎一碗。另外取生姜一两，煎汤一碗。等候药稍凉，先服姜汤一口，接着服汤药一口，稍停片刻，等到不呕吐了再服第二口。像这样操作，以呕吐停止、疼痛解除为度。
二十五日。燥气腹痛虽止，但当脐部仍然坚硬，按压微痛，舌苔微黄而滑，周身筋骨疼痛，脉缓，这是阳明之上中见太阳，应当给予阳明从中治法的例子。
处方：桂枝（六钱）、川椒炭（二钱）、生姜（三钱）、白芍（三钱，炒）、公丁香（一钱）、防己（三钱）、薏苡仁（五钱）、茯苓（六钱）、半夏（五钱）。
煮取三杯，分三次服用，服用此方后身痛停止。
二十六日。脉象比之前小，身痛已止，六脉未和缓，舌苔黄滑。
处方：半夏（五钱）、生姜（三钱）、蔻仁（钱半）、茯苓（五钱）、陈皮（三钱）、厚朴（钱半）、薏苡仁（五钱）、大腹皮（三钱）、川椒（钱半）。
二十八日。腹胀如故且不寐，加入：半夏（一两）。
初一日。诊断为太阳痹。
处方：桂枝（六钱）、茯苓皮（五钱）、茅术炭（三钱）、防己（四钱）、通草（一钱）、片姜黄（三钱）、杏仁（五钱）、薏苡仁（五钱）、滑石（六钱）、蚕砂（三钱）。
初六日。腹胀停饮，前方中去掉白术的守中之性，加入苦辛的通利之品，又去掉滑石。
处方：大腹皮（三钱）、厚朴（三钱）、枳实（三钱）、陈皮（三钱）。
初十日。六脉俱弦，胃口不开，腹胀肢倦，宜通利六腑，这就是劳者温之的方法。
处方：桂枝（六钱）、大腹皮（三钱）、川椒炭（三钱）、陈皮（五钱）、益智仁（三钱）、半夏（五钱）、枳实（二钱）、茯苓（五钱）、厚朴（二钱）。
服用五剂而痊愈。
张姓女子，十五岁。燥金之气直中入里，六脉全无，僵卧如死，四肢逆冷，已过肘膝，疼痛转筋，给予通脉四逆汤加川椒、吴茱萸、丁香一大剂。厥逆回复，脉象复出，一昼夜后，次日因吃粥太早，再次中邪如前，脉复厥，身体又死去一般。仍然用前方，重加温药一剂，厥逆回复了一半。又服两剂后无救活，后来以补阳收功。
顾姓患者，五十岁。直中燥气，呕吐少腹泻多，四肢厥逆，无脉，眼睛睁开，不说话，眼球不转动，给予通脉四逆汤。加入：人参、川椒、吴茱萸、丁香。
服用一剂见效，三剂后脉象逐渐恢复，重予补阳而痊愈。
杨姓室女，五十岁。胁痛，心烦懊恼，拘急肢冷，脉弦细而紧。想坐不能坐，想站不能站，想躺不能躺，刚想坐就要站，刚站立又想坐，坐着又不安。一刻比一刻脉象渐小，立刻就要脱绝。给予霹雳散不停地灌服，共计两个时辰，服用散剂约计四两而稍定，后来给予调和脾胃的药物而完全安康。
郑姓患者，二十六岁。先是三月初九日，得太阳中风，给予桂枝汤已愈。十二日晚已卧床，下身有微汗，因为厨房不注意用火，只穿小汗褂一件，没穿袜子，出去救火，火熄灭后复卧，觉得身体微热恶寒，腹中胀痛，脉弦数，给予桂枝柴胡各半汤，汗出稍轻，终究不能解表。以后外虽化热，面赤汗多如温病状，但因为当脐之痛未休，舌白不燥，断不敢用辛凉，而辛温之药，或进或退，十日不解。至二十四日反重用温热，佐以黄连三钱，次日表证里证，一齐俱解如失。后来给予调理脾胃两阳的药物而安。
多姓患者，十六岁。燥淫表里俱病，面赤身热，舌黄燥渴，六脉洪数而紧，大便闭，小便短，通体全似火证，只有当脐痛拒按。此为阳中之阴，乃为真阴，给予苦热芳香，一剂而热退，减轻分量，三帖而病全失矣。
Patient Wu, aged 57. On the 19th day of the 4th month in the Yiyou year, he contracted the pathogenic factor of Dryness-Metal (Zao Jin). Symptoms included abdominal pain, diarrhea, and vomiting. Although the diarrhea has ceased, he still suffers from vomiting and inability to eat, with persistent abdominal pain. The tongue coating is white and slippery; scraping off the coating reveals a pale tongue body. Urgent warming of the Middle Jiao (Middle Burner) is indicated, combined with promoting the movement of Dampness (Shi) in the Taiyin Spleen Meridian.
Prescription: Chuanjiao Tan (Charred Sichuan Pepper, 3 qian), Fuling (Poria, 5 qian), Chenpi (Aged Tangerine Peel, 3 qian), Gaoliangjiang (Galangal Rhizome, 2 qian), Yiren (Coix Seed, 5 qian), Gong Dingxiang (Clove, 1 qian), Wuyu (Evodia Fruit, 2 qian), Yizhiren (Bitter Apricot Seed, 2 qian), Banxia (Pinellia Tuber, 5 qian).
Take two doses.
On the 22nd day, re-examination. Back pain persists. Add to the original prescription: Gaoliangjiang (Galangal Rhizome, 1 qian), Wuyu (Evodia Fruit, 1 qian), Guizhi (Cinnamon Twig, 5 qian).
Take four more doses.
On the 27th day. Efficacy observed, but Yin-Cold (Yin Han) has not yet receded. Continue taking three doses, divided over four days.
On the 3rd day of the 5th month. Pain reduced, vomiting and diarrhea have stopped. Reduce the dosage of Chuanjiao, Wuyu, and Jiang by half. Take six more doses.
On the 13th day. Yin-Cold has not transformed, Yang Qi cannot recover spontaneously. The epigastrium feels hard and distended like a plate, and the pulse remains unchanged. Continue using the previous prescription.
Patient Yao, aged 48. On the 21st day of the 4th month in the Yiyou year. After contracting Dryness-Metal, what was injured was Yang Qi. How can one use large doses of Shudi (Prepared Rehmannia Root) to nourish Yin? Long-term nourishment of Yin will trap and exhaust Yang Qi, which explains why he cannot eat and vomits. The six pulses are wiry and tight. Does one not know that a double-wiry pulse indicates Cold?
Prescription: Chuanjiao Tan (Charred Sichuan Pepper, 3 qian), Chenpi (Aged Tangerine Peel, 3 qian), Banxia (Pinellia Tuber, 5 qian), Ganjiang (Dried Ginger, 2 qian), Fuling (Poria, 5 qian), Gong Dingxiang (Clove, 8 fen), Shengjiang (Fresh Ginger, 3 qian), Yiren (Coix Seed, 5 qian).
On the 2nd day (of the next month). Add Guizhi (Cinnamon Twig, 3 qian), Ganjiang (Dried Ginger, 1 qian). Reduce Chuanjiao by half.
On the 11th day. Vomiting and pain have ceased, dietary intake has increased, but limbs are soft and weak due to extreme deficiency of Yang Qi. Add Gancao (Licorice Root) to combine with the preceding acrid herbs, forming an "Acrid-Sweet to Tonify Yang" therapeutic method.
On the 21st day. Re-contracted Dryness Qi, resulting in vomiting and urge to defecate. Remove sweet herbs from the previous prescription and increase the dosage for self-healing. The six pulses are wiry, thin, and thread-like, indicating extreme deficiency of Yang Qi.
Prescription: Chuanjiao Tan (Charred Sichuan Pepper, 3 qian), Chenpi (Aged Tangerine Peel, 3 qian), Wuyu (Evodia Fruit, 3 qian), Ganjiang (Dried Ginger, 3 qian), Fuling (Poria, 5 qian), Banxia (Pinellia Tuber, 5 qian), Guizhi (Cinnamon Twig, 5 qian), Gong Dingxiang (Clove, 1.5 qian), Shengjiang (Fresh Ginger, 5 qian).
On the 27th day. All symptoms improved, pulse shows slight vitality. Remove the harsh-drying properties of Wuyu and Dingxiang from the original prescription, add the mild nature of Yiren (Coix Seed). This treats via the Yangming Stomach from the middle.
Patient Li, aged 46. On the 16th day of the 4th month in the Yiyou year. Gastric pain and hypochondriac pain, sometimes vomiting sour fluid, unhealed for many years. Currently, the six pulses are wiry and tight. This originated from initially contracting Dryness-Metal Qi. Metal overacts on Wood, causing Liver-Wood pathology, which inevitably overacts on Earth (Spleen/Stomach). The origin of Earth pathology lies in Metal overacting on Wood. Such cases where external contraction extends to internal injury have rarely been heard of since the Tang Dynasty. It is proposed to vary the treatment of the Stomach's transformation and reception, using Fire to control Metal. Also applying the principle of chronic illness entering the collaterals:
Prescription: Gong Dingxiang (Clove, 1 qian), Fuling (Poria, 5 qian), Zhishi (Immature Bitter Orange, 4 qian), Chuanjiao Tan (Charred Sichuan Pepper, 3 qian), Yiren (Coix Seed, 5 qian), Shengjiang (Fresh Ginger, 5 qian), Banxia (Pinellia Tuber, 5 qian), Chenpi (Aged Tangerine Peel, 3 qian).
Take four doses.
On the 23rd day, re-examination. Still use the original prescription for four doses.
On the 2nd day of the 5th month. Currently, gastric pain, hypochondriac pain, and acid regurgitation have not occurred, but the six pulses remain wiry and tight. This indicates a lack of Harmonious Qi (Taihe Zhi Qi) in the chest. It is proposed to change the prescription to use mild and balanced medicines, as harsh-drying medicines cannot be used long-term.
Prescription: Guizhi (Cinnamon Twig, 4 qian), Fuling (Poria, 5 qian), Shengjiang (Fresh Ginger, 3 qian), Chenpi (Aged Tangerine Peel, 3 qian), Dazao (Jujube, 2 pieces), Zhigancao (Honey-fried Licorice Root, 2 qian), Banxia (Pinellia Tuber, 5 qian), Ganjiang (Dried Ginger, 2 qian), Yiren (Coix Seed, 5 qian), Baishao (White Peony Root, 4 qian).
If taken without adverse effects, it may be taken in larger quantities.
On the 11th day. Pulse diagnosis shows Yang Qi has returned. Remove Ganjiang (Dried Ginger), reduce Guizhi (Cinnamon Twig) by half.
On the 24th day, re-examination. Pulse remains tight. Add to the original prescription: Yizhiren (Bitter Apricot Seed, 2 qian).
Take three doses to cure.
Patient Yu, aged 52. On the 2nd day of the 5th month. Gastric pain and hypochondriac pain, double-wiry pulse, worse in the afternoon. This is Yang Pathogen flourishing in the Yin aspect.
Prescription: Chuanjiao Tan (Charred Sichuan Pepper, 3 qian), Chenpi (Aged Tangerine Peel, 3 qian), Gong Dingxiang (Clove, 1.5 qian), Jiangxiang Mo (Powdered Dalbergia Odorifera, 3 qian), Xiangfu (Cyperus Rhizome, 3 qian), Zha Tan (Charred Hawthorn Fruit, 2 qian), Wuyu (Evodia Fruit, 2 qian), Qingpi (Green Tangerine Peel, 2 qian), Qingjuye (Green Orange Leaf, 3 qian), Banxia (Pinellia Tuber, 5 qian), Yiren (Coix Seed, 5 qian).
Continue taking Pili San (Thunderbolt Powder).
On the 17th day, re-examination. Condition slightly improved, pulse remains tight. Remove: Zha Tan (Charred Hawthorn Fruit), Juye (Orange Leaf), and Chuanjiao Tan (Charred Sichuan Pepper, 1 qian). Add: Zhishi (Immature Bitter Orange, 3 qian).
On the 24th day. The tightness of the pulse has slightly softened, abdominal pain has stopped, but there is dizziness and insomnia. First provide methods to harmonize the Stomach to induce sleep, then discuss subsequent treatments.
Prescription: Banxia (Pinellia Tuber, 1 liang), Yiren (Coix Seed, 1 liang), Fuling (Poria, 5 qian), Zhishi (Immature Bitter Orange, 3 qian).
Boil to obtain three cups, divide into three doses. Take until sleep is achieved. If still unable to sleep after two doses, increase Banxia to 2 liang and take one more dose.
Patient Tan, aged 47. On the 2nd day of the 5th month. Contracted Metal-Cool Qi, resulting in Chest Bi (Xiong Bi) and headache. Pulse is wiry, thin, and tight.
Prescription: Xiebai (Macrostemon Bulb, 3 qian), Chuanjiao Tan (Charred Sichuan Pepper, 3 qian), Houpo (Magnolia Bark, 2 qian), Guizhi (Cinnamon Twig, 3 qian), Chenpi (Aged Tangerine Peel, 3 qian), Gaoliangjiang (Galangal Rhizome, 2 qian), Banxia (Pinellia Tuber, 3 qian), Yiren (Coix Seed, 5 qian), Shengjiang (Fresh Ginger, 5 slices), Dazao (Jujube, 2 pieces).
Take two doses.
On the 18th day. Although Dryness Qi has transformed, all six pulses are wiry, tongue coating is white and slippery. Use the Yangming Middle Treatment method, providing Acrid-Bitter-Damp-draining formulas. Sour-Sweet combinations are strictly contraindicated.
Prescription: Banxia (Pinellia Tuber, 4 qian), Yiren (Coix Seed, 5 qian), Xiangfu (Cyperus Rhizome, 3 qian), Fuling (Poria, 4 qian), Ganjiang (Dried Ginger, 1.5 qian), Yizhiren (Bitter Apricot Seed, 2 qian), Chenpi (Aged Tangerine Peel, 3 qian), Keren (Cardamom Seed, 1.5 qian), Chuanjiao Tan (Charred Sichuan Pepper, 2 qian).
On the 21st day. Pulse remains wiry and tight, heat medicines are difficult to eliminate. Cough has decreased. Do not change the formula if effective. Slight pain in the right hypochondrium. Add: Xiangfu (Cyperus Rhizome, 3 qian).
On the 23rd day. Slight pain in the right hypochondrium, pulse wiry and tight as before. Add: Suzi Shuang (Frosted Perilla Fruit, 3 qian), Jiangxiang Mo (Powdered Dalbergia Odorifera, 3 qian), Xuanfuhua (Inula Flower, 3 qian).
On the 26th day. Hypochondriac pain and cough have ceased, but phlegm is still abundant. Pulse is wiry and not yet harmonious. Remove Xiangfu, Suzi Shuang, Jiangxiang, and Xuanfuhua from the previous prescription. Add: Guizhi (Cinnamon Twig, 4 qian), Ganjiang (Dried Ginger, 2.5 qian) to replenish Yang Qi, move Phlegm-Fluids (Tan Yin), and harmonize the wiry pulse.
Pili San Formula (Thunderbolt Powder)
Mainly treats vomiting, diarrhea, and abdominal pain caused by Middle Dryness. In severe cases, it treats cold extremities, tetany/cramping, limb numbness, restlessness, irritability, and even absence of all six pulses. It also treats Yin-Toxin macules, hernia, and all types of coagulated cold, entrenched cold, and accumulations. Those with mild cold should not take too much; those with severe cold should not take too little. Take until cured. It should not be taken unless the patient has truly contracted pure Yin pathogens of Dryness, Dampness, and Cold.
Prescription: Guizhi (Cinnamon Twig, 6 liang), Gong Dingxiang (Clove, 2 liang), Caoguo (Black Cardamom, 2 liang), Chuanjiao Tan (Charred Sichuan Pepper, 5 liang), Shuichangpu (Acorus Rhizome, 2 liang), Qingmuxiang (Vetiver Root, 4 liang), Wuyu (Evodia Fruit, 4 liang), Fangji (Stephania Root, 3 liang), Binglang (Areca Seed, 2 liang), Jiangxiang Mo (Powdered Dalbergia Odorifera, 5 liang), Fuzi (Prepared Aconite Root, 3 liang), Xiaohuixiang (Fennel, 4 liang), Xiebai (Macrostemon Bulb, 4 liang), Yiren (Coix Seed, 5 liang), Wulingzhi (Trogopterus Dung, 2 liang), Gaoliangjiang (Galangal Rhizome, 3 liang), Bidengqie (Long Pepper Fruit, 5 liang), Xixin (Asarum, 2 liang), Wuyao (Lindera Root, 3 liang), Ganjiang (Dried Ginger, 3 liang), Xionghuang (Realgar, 5 qian).
Grind all medicines into fine powder. Mix with boiling water and take. Adults take 3 qian per dose, severe cases 5 qian. Children take half. For extremely severe cases, take several times consecutively until pain stops, cold extremities return, or diarrhea stops and cramping ceases.
Formula Commentary: According to the *Neijing* (Inner Canon), there is a concept of Five Plagues. Extreme imbalance of the Five Elements can lead to plagues. Although epidemic pathogens often present with Fire syndromes, Dryness-Metal and Cold-Damp plagues also occur frequently. Wind, Fire, and Summerheat are Yang pathogens; when mixed with turbid and abnormal Qi, they become Warm Plagues. Dampness, Dryness, and Cold are Yin pathogens; when mixed with turbid and abnormal Qi, they become Cold Plagues. Current symptoms often include limb numbness and cramping, cold extremities, vomiting, diarrhea, abdominal pain, and hypochondriac pain, and even aversion to heat with intense thirst for cool drinks. The Classics state that mist injures the upper, and dampness injures the lower. This condition involves Dryness-Metal and Cold-Damp Qi directly invading the sinew channels, damaging the Zhen (True) Qi of the Three Yin organs via the Large and Collateral vessels. Hence, cramping entering the abdomen leads to death. Vomiting and diarrhea together indicate reversal and chaos of Yin and Yang. Various pains are caused by the struggle between Dryness-Metal and Cold-Water Qi. Thirst for cool drinks relates to the Shaoyin chapter stating that spontaneous diarrhea with thirst belongs to Shaoyin; deficiency leads to drinking water to seek rescue. Redness of the head and face is Yin pathogens forcing upward, preventing Yang from descending, known as Dai Yang (Floating Yang). General aversion to heat and preference for coolness indicates Yin pathogens occupying the interior, with Yang having no attachment and wanting to scatter. Yin disease presenting with Yang symptoms is known as "Water Extremity resembling Fire," indicating particularly severe Yin pathogen invasion. Although all Yang symptoms appear, only when there is severe pain at the umbilicus that refuses pressure is it considered Pure Yin appearing within Yang, i.e., True Yin syndrome. Misjudgment here must be avoided. Therefore, the formula gathers harsh, drying, warm, and hot herbs of the Three Yin meridians to urgently warm the Zang True Qi and protect Yang Qi. It heavily uses aromatic herbs to urgently drive out turbidity. One pathway goes from Zang True Qi through collateral vessels to sinew channels and skin; another goes from Zang collaterals and Fu collaterals to open the Six Fu organs and reach the nine orifices externally, allowing turbid Yin pathogens to resolve immediately. Generally, this supports Yang and suppresses Yin, like sunlight illuminating the sky, causing all Yin pathogens to retreat.
Patient Zhao, aged 38. On the 24th day of the 7th month. Contracted Dryness-Metal Qi, severe abdominal pain, continuous severe vomiting, water retention in the middle, caused by mistakenly eating fruit.
Prescription: Gong Dingxiang (Clove, 3 qian), Banxia (Pinellia Tuber, 1 liang), Fuling Pi (Poria Skin, 5 qian), Shengjiang (Fresh Ginger, 1 liang), Chuanjiao Tan (Charred Sichuan Pepper, 6 qian), Wumei Rou (Mume Fruit Flesh, 3 qian), Wuyu (Evodia Fruit, 4 qian), Chenpi (Aged Tangerine Peel, 5 qian), Gaoliangjiang (Galangal Rhizome, 4 qian), Zhishi (Immature Bitter Orange, 3 qian).
Use five bowls of water, decoct to two bowls. Decoct the dregs again to obtain one bowl. Separately, decoct one liang of fresh ginger to obtain one bowl of ginger soup. Wait for the medicine to cool slightly. First take one mouthful of ginger soup, then immediately follow with one mouthful of herbal medicine. Pause for a moment. Once vomiting stops, take the second mouthful. Repeat this method until vomiting stops and pain resolves.
On the 25th day. Although Dryness-related abdominal pain has stopped, the area at the umbilicus remains hard and slightly painful upon pressure. Tongue coating is slightly yellow and slippery. Whole-body bone and muscle pain. Pulse is slow. This presents Yangming Upper/Middle with Taiyin manifestation. Apply the Yangming Middle Treatment example.
Prescription: Guizhi (Cinnamon Twig, 6 qian), Chuanjiao Tan (Charred Sichuan Pepper, 2 qian), Shengjiang (Fresh Ginger, 3 qian), Baishao (White Peony Root, 3 qian, stir-fried), Gong Dingxiang (Clove, 1 qian), Fangji (Stephania Root, 3 qian), Yiren (Coix Seed, 5 qian), Fuling (Poria, 6 qian), Banxia (Pinellia Tuber, 5 qian).
Boil to obtain three cups, divide into three doses. Body pain stops after taking this.
On the 26th day. Pulse is smaller than before, body pain has stopped, six pulses are not yet harmonious. Tongue coating is yellow and slippery.
Prescription: Banxia (Pinellia Tuber, 5 qian), Shengjiang (Fresh Ginger, 3 qian), Keren (Cardamom Seed, 1.5 qian), Fuling (Poria, 5 qian), Chenpi (Aged Tangerine Peel, 3 qian), Houpo (Magnolia Bark, 1.5 qian), Yiren (Coix Seed, 5 qian), Dafupi (Areca Pericarp, 3 qian), Chuanjiao (Sichuan Pepper, 1.5 qian).
On the 28th day. Abdominal distension remains as before, insomnia. Add: Banxia (Pinellia Tuber, 1 liang).
On the 1st day (of next month). Diagnosed as Taiyin Bi.
Prescription: Guizhi (Cinnamon Twig, 6 qian), Fuling Pi (Poria Skin, 5 qian), Maozhu Tan (Charred Atractylodes Rhizome, 3 qian), Fangji (Stephania Root, 4 qian), Tongcao (Tetrapanax Pith, 1 qian), Pian Jianghuang (Slice of Turmeric Rhizome, 3 qian), Xingren (Apricot Seed, 5 qian), Yiren (Coix Seed, 5 qian), Huashi (Talcum, 6 qian), Can Sha (Silkworm Frass, 3 qian).
On the 6th day. Abdominal distension and fluid retention persist. Remove the stabilizing property of Zhu (Atractylodes) from the previous prescription, add bitter-acrid draining properties, and remove Huashi (Talcum).
Prescription: Dafupi (Areca Pericarp, 3 qian), Houpo (Magnolia Bark, 3 qian), Zhishi (Immature Bitter Orange, 3 qian), Chenpi (Aged Tangerine Peel, 3 qian).
On the 10th day. All six pulses are wiry, appetite is poor, abdominal distension, and limb fatigue. It is appropriate to drain the Six Fu organs, which is the method of "warming the exhausted."
Prescription: Guizhi (Cinnamon Twig, 6 qian), Dafupi (Areca Pericarp, 3 qian), Chuanjiao Tan (Charred Sichuan Pepper, 3 qian), Chenpi (Aged Tangerine Peel, 5 qian), Yizhiren (Bitter Apricot Seed, 3 qian), Banxia (Pinellia Tuber, 5 qian), Zhishi (Immature Bitter Orange, 2 qian), Fuling (Poria, 5 qian), Houpo (Magnolia Bark, 2 qian).
Take five doses to cure.
Patient Zhang, female, aged 15. Dryness-Metal Qi struck directly inward. All six pulses were absent. She lay stiffly as if dead, with cold extremities extending past elbows and knees, pain, and cramping. Administered a large dose of Tongmai Sini Tang (Pulse-Recovering Four Reversal Decoction) added with Chuanjiao, Wuyu, and Dingxiang. Cold extremities recovered, pulse returned. However, after one day and night, she ate rice gruel too early, re-contracted the pathogen as before. Pulse became absent again, body went cold as if dead. Used the previous prescription again, heavily increasing warming herbs for one dose. Cold extremities recovered halfway. After two more doses, she could not be saved. Later, tonifying Yang completed the recovery.
Patient Gu, aged 50. Direct strike of Dryness Qi. Less vomiting, more diarrhea. Cold extremities, no pulse, eyes open, speechless, eyes immobile. Administered Tongmai Sini Tang (Pulse-Recovering Four Reversal Decoction). Added: Renshen (Ginseng Root), Chuanjiao (Sichuan Pepper), Wuyu (Evodia Fruit), Dingxiang (Clove).
One dose showed efficacy. After three doses, pulse gradually returned. Heavy tonification of Yang led to cure.
Patient Yang, unmarried female, aged 50. Hypochondriac pain, mental restlessness (Ao Nu), stiffness, cold extremities. Pulse wiry, thin, and tight. Unable to sit, unable to stand, unable to lie down. Wants to sit but needs to stand; stands but wants to sit; sitting is uncomfortable. Pulse gets smaller every moment, imminent collapse. Administered Pili San (Thunderbolt Powder) continuously by force-feeding. Over two hours, consumed approximately 4 liang of powder, condition stabilized slightly. Later, harmonizing Stomach and Spleen herbs led to full recovery.
Patient Zheng, aged 26. Initially, on the 9th day of the 3rd month, contracted Taiyin Wind Strike. Treated with Guizhi Tang (Cinnamon Twig Decoction) and healed. On the evening of the 12th, while lying down, had slight sweating on the lower body. Due to kitchen fire hazard, wore only a thin sweat shirt, no socks, went out to extinguish fire. Returned to bed after fire was out. Felt slight fever and aversion to cold, abdominal distension and pain. Pulse wiry and rapid. Given Guizhi Chaihu Hegen Tang (Half-and-Half Cinnamon Twig and Bupleurum Decoction). Sweating provided slight relief, but ultimately failed to resolve. Later, exterior transformed to heat, red face, profuse sweating resembling Warm Disease. However, because umbilical pain persisted and tongue was white and not dry, dared not use Acrid-Cool herbs. Acrid-Warm herbs were adjusted up and down for ten days without resolution. On the 24th day, heavily used warm-hot herbs, assisted with 3 qian of Huanglian (Coptis Rhizome). Next day, both exterior and interior symptoms resolved completely. Later, regulating Stomach and Spleen with Two-Yang herbs ensured safety.
Patient Duo, aged 16. Dryness infestation affecting both exterior and interior. Red face, body heat, yellow dry tongue with thirst. Six pulses flooding, rapid, and tight. Constipation, scanty urination. Entire body resembles Fire syndrome, except for severe pain at the umbilicus refusing pressure. This is Yin within Yang, i.e., True Yin. Given Acrid-Hot and Aromatic herbs. Heat subsided after one dose. Dosage reduced. Condition completely disappeared after three doses.