毛 四十四岁 病起肝郁,木郁则克土,克阳土则不寐,克阴土则 胀,自郁则胁痛。
肝主疏泄,肝病则不能疏泄,故二便亦不宣通。肝主血,络亦主血,故治肝者必治络。
新绛纱(三钱) 半夏(八钱) 香附(三钱) 旋复花(三钱) 青皮(三钱) 小茴香(三钱)
归须(三钱) 降香末(三钱) 广郁金(三钱) 苏子霜(三钱)
头煎两杯,二煎一杯,分三次服。三帖。
初七日 服肝络药,胀满、胁痛、不寐少减,惟觉胸痛。按∶肝脉络胸,亦是肝郁之故
。再小便赤浊,气湿也。
桂枝嫩尖(三钱) 晚蚕砂(三钱) 归须(二钱) 川楝子(三钱) 半夏(六钱) 降香末(
三钱
)白通草(三钱) 青橘皮(三钱) 茯苓皮(三钱) 旋复花(三钱,新绛纱包) 小茴香(三钱
,炒黑) 两头尖(三钱)
服二帖。
初十日 驱浊阴而和阳明,现下得寐,小便少清,但肝郁必克土,阴土郁则胀,阳土郁
则食少而无以生阳,故清阳虚而成胸痹,暂与开痹。
薤白头(三钱) 半夏(一两) 广郁金(三钱) 栝蒌实(三钱,连皮仁研) 生苡仁(五钱)
桂枝尖(五钱) 茯苓皮(五钱) 浓朴(三钱) 小枳实(二钱)
服三帖。
十四日 脉缓,太阳已开,而小便清通,阳明已阖,而得寐能食。但 胀不除,病起肝
郁,与行湿之中,必兼开郁。
降香末(三钱) 生苡仁(五钱) 白通草(八钱) 浓朴(三钱) 煨肉果(钱半) 茯苓皮(
五钱) 半夏(五钱)
徐 三十岁 腹胀且痛,脉弦细,大便泄,小便短,身不热,此属寒湿,伤足太阴。
猪苓(三钱) 黄芩炭(一钱) 泽泻(二钱) 桂枝(三钱) 浓朴(三钱) 广皮(二钱) 干
姜(钱半) 生苡仁(五钱) 通草(二钱)
毛,四十四岁。疾病起因于肝气郁结,肝木郁滞则克制脾土;若克制阳土(胃),则导致失眠;若克制阴土(脾),则导致腹胀;肝气自身郁结则引起胁肋疼痛。
肝主疏泄功能,肝脏患病则疏泄功能失常,因此大小便也不通畅。肝主藏血,络脉也主血,所以治疗肝病必须同时治疗络脉。
新绛纱(三钱) 半夏(八钱) 香附(三钱) 旋复花(三钱) 青皮(三钱) 小茴香(三钱)
归须(三钱) 降香末(三钱) 广郁金(三钱) 苏子霜(三钱)
第一次煎煮取两杯药液,第二次煎煮取一杯药液,分三次服用。共服三剂。
初七日:服用调理肝络的药物后,腹胀、胁痛和失眠症状略有减轻,只感觉胸痛。按语:肝的经络循行经过胸部,这也是肝气郁结的缘故。另外小便颜色红赤浑浊,这是湿气的表现。
桂枝嫩尖(三钱) 晚蚕砂(三钱) 归须(二钱) 川楝子(三钱) 半夏(六钱) 降香末(三钱)
白通草(三钱) 青橘皮(三钱) 茯苓皮(三钱) 旋复花(三钱,用新绛纱包裹) 小茴香(三钱,炒黑) 两头尖(三钱)
服用两剂。
初十日:驱除浊阴之气以调和阳明经,目前患者能够入睡,小便稍微清澈,但肝气郁结必然克制脾土,阴土(脾)郁结则导致腹胀,阳土(胃)郁结则食欲减退且无法化生阳气,因此清阳虚弱而形成胸痹,暂时给予开通胸痹的治疗。
薤白头(三钱) 半夏(一两) 广郁金(三钱) 栝蒌实(三钱,连皮和仁一起研磨) 生苡仁(五钱)
桂枝尖(五钱) 茯苓皮(五钱) 浓朴(三钱) 小枳实(二钱)
服用三剂。
十四日:脉象缓和,太阳经邪气已解,且小便清澈通畅;阳明经气机已收敛,且能入睡并进食。但是腹胀仍未消除,病因起于肝气郁结,在行气化湿的同时,必须兼以开郁散结。
降香末(三钱) 生苡仁(五钱) 白通草(八钱) 浓朴(三钱) 煨肉果(一钱半) 茯苓皮(五钱) 半夏(五钱)
徐,三十岁。腹部胀满且疼痛,脉象弦细,大便泄泻,小便短少,身体不发热,这属于寒湿之邪损伤足太阴脾经。
猪苓(三钱) 黄芩炭(一钱) 泽泻(二钱) 桂枝(三钱) 浓朴(三钱) 广皮(二钱) 干姜(一钱半) 生苡仁(五钱) 通草(二钱)
Mao, aged forty-four. The onset of the disease originated from Liver Qi stagnation (Liver Qi Stagnation). When Wood stagnates, it overacts on Earth; if it overacts on Yang Earth (Stomach), it leads to insomnia; if it overacts on Yin Earth (Spleen), it leads to abdominal distension; self-stagnation of the Liver causes hypochondriac pain.
The Liver governs Shuxie (free flow and discharge). When the Liver is diseased, Shuxie function fails, thus urination and defecation are also not smooth. The Liver governs Blood, and the collaterals also govern Blood; therefore, treating Liver diseases requires treating the collaterals.
Xinjiang Sha (New Crimson Gauze) (3 qian) Banxia (Pinelliae Rhizoma Preparatum) (8 qian) Xiangfu (Cyperi Rhizoma) (3 qian) Xuanfuhua (Inulae Flos) (3 qian) Qingpi (Citri Reticulatae Pericarpium Viride) (3 qian) Xiaohuixiang (Foeniculi Fructus) (3 qian)
Guixu (Radix Angelicae Sinensis Caulis) (3 qian) Jiangxiang Mo (Lignum Dalbergiae Odoriferae Pulvis) (3 qian) Guang Yujin (Curcumae Radix) (3 qian) Suzi Shuang (Pericarpii Semen Sesami Nigris Preparatum) (3 qian)
First decoction yields two cups, second decoction yields one cup; divide into three doses. Three prescriptions in total.
7th day: After taking medicines for the Liver collaterals, abdominal distension, hypochondriac pain, and insomnia have slightly decreased, only chest pain remains. Note: The Liver meridian passes through the chest; this is also due to Liver Qi stagnation. Additionally, urine is red and turbid, indicating Dampness.
Guizhi Nenjian (Cinnamomi Ramulus Tender Tip) (3 qian) Wancansha (Bombyx Batryticatus) (3 qian) Guixu (Radix Angelicae Sinensis Caulis) (2 qian) Chuanlianzi (Fructus Toosendanthis) (3 qian) Banxia (Pinelliae Rhizoma Preparatum) (6 qian) Jiangxiang Mo (Lignum Dalbergiae Odoriferae Pulvis) (3 qian)
Baitongcao (Akebiae Caulis) (3 qian) Qingjupi (Citri Reticulatae Pericarpium Viride) (3 qian) Fulingpi (Poria Cum Ligno Coctum Cortex) (3 qian) Xuanfuhua (Inulae Flos) (3 qian, wrapped in Xinjiang Sha) Xiaohuixiang (Foeniculi Fructus) (3 qian, stir-fried until black) Liangtoujian (Rhizoma Bellerophones) (3 qian)
Take two prescriptions.
10th day: Expel turbid Yin to harmonize the Yangming channel. Currently, the patient can sleep, and urine is slightly clear. However, Liver Qi stagnation must overact on Earth; Yin Earth (Spleen) stagnation leads to distension, while Yang Earth (Stomach) stagnation leads to poor appetite and inability to generate Yang Qi. Thus, deficiency of Clear Yang results in Chest Bi (Chest Obstruction Syndrome). Temporarily administer treatment to open the Bi.
Xiebaitou (Allii Macrostemonis Bulbus) (3 qian) Banxia (Pinelliae Rhizoma Preparatum) (1 liang) Guang Yujin (Curcumae Radix) (3 qian) Gualou Shi (Trichosanthis Fructus) (3 qian, ground with peel and seed) Sheng Yiren (Coicis Semen) (5 qian)
Guizhi Jian (Cinnamomi Ramulus Tip) (5 qian) Fulingpi (Poria Cum Ligno Coctum Cortex) (5 qian) Nongpo (Magnoliae Officinalis Cortex) (3 qian) Xiao Zhishi (Fructus Aurantii Immaturus) (2 qian)
Take three prescriptions.
14th day: Pulse is slow/relaxed; Taiyang has opened, and urine is clear and unobstructed; Yangming has closed, and the patient can sleep and eat. However, distension persists. The disease originates from Liver Qi stagnation; amidst promoting Qi movement and resolving Dampness, one must simultaneously open stagnation.
Jiangxiang Mo (Lignum Dalbergiae Odoriferae Pulvis) (3 qian) Sheng Yiren (Coicis Semen) (5 qian) Baitongcao (Akebiae Caulis) (8 qian) Nongpo (Magnoliae Officinalis Cortex) (3 qian) Weirouguo (Myristicae Semen Praeparatum) (1.5 qian) Fulingpi (Poria Cum Ligno Coctum Cortex) (5 qian) Banxia (Pinelliae Rhizoma Preparatum) (5 qian)
Xu, aged thirty. Abdominal distension and pain, pulse is wiry and thin, loose stools, scanty urine, body not hot. This belongs to Cold-Damp injuring the Foot-Taiyin Spleen Meridian.
Zhuling (Polyporus) (3 qian) Huangqin Tan (Scutellariae Radix Carbonized) (1 qian) Zexie (Alismatis Rhizoma) (2 qian) Guizhi (Cinnamomi Ramulus) (3 qian) Nongpo (Magnoliae Officinalis Cortex) (3 qian) Guangpi (Citri Reticulatae Pericarpium) (2 qian) Ganjiang (Zingiberis Rhizoma) (1.5 qian) Sheng Yiren (Coicis Semen) (5 qian) Tongcao (Tetrapanacis Medulla) (2 qian)