陶 四十五岁 乙酉年四月十五日 久泄脉弦,自春令而来,古谓之木泄,侮其所胜也
。
柴胡(三钱) 猪苓(三钱) 生姜(五钱) 姜半夏(五钱) 炙甘草(二钱) 大枣(三枚,
去核) 泽泻(三钱) 广陈皮(三钱) 茯苓块(五钱) 桂枝(三钱)
十九日 泄泻已减前数,加∶
苍术(三钱)
前后共计服十三帖全愈。
五月初六日 前曾木泄,与小柴胡汤十三帖而愈。向有粪后便红,乃小肠寒湿之症,现
在脉虽弦而不劲,且兼缓象,大便复溏,不必用柴胡汤矣,转用黄土汤法。
灶中黄土(四两) 黄芩炭(二钱) 熟附子(三钱) 茯苓块(五钱,连皮) 炒苍术(五钱)
广皮炭(二钱)
煮三杯,分三次服。
十二日 湿温成五泄,先与行湿止泄,其粪后便红,少停再拟。
猪苓(五钱) 苍术(四钱) 泽泻(五钱) 茯苓(六钱连皮) 桂枝(五钱) 苡仁(五钱)
广皮(四钱) 广木香(二钱)
煮三杯,分三次服,以泄止为度。
八月初六日 胃不开,大便溏,小便不畅,脉弦。
猪苓(三钱) 白蔻仁(二钱) 泽泻(三钱) 生苡仁(五钱) 茯苓皮(五钱) 广皮(二钱)
姜半夏(三钱) 柴胡(一钱)
煮三杯,分三次服。
陆 二十七岁 乙酉年五月十九日 六脉弦细,面色淡黄,泄则脾虚,少食则胃虚,中
焦不能创建,安望行经,议先与强土。
藿香梗(二钱) 广皮炭(钱半) 广木香(钱半) 白蔻仁(一钱) 云苓块(三钱) 苏梗(
钱半) 苡仁(二钱) 姜半夏(三钱) 益智仁(一钱)
煮三杯,分三次服,七帖。
二十八日 右脉宽泛,缓也。胃口稍开,泄则加添,小便不通,加实脾利水。
猪苓(三钱) 泽泻(三钱) 茯苓(五钱) 苡仁(五钱)
六月十八日 前方服十四帖,泄止,胃稍醒,脘中闷,舌苔滑,周身痹痛,六脉弦细而
沉,先与和中,治痹在后。
桂枝(三钱) 防己(三钱) 益智仁(钱半) 藿香梗(三钱) 杏仁(三钱) 苡仁(五钱)
姜半夏(五钱) 白蔻仁(二钱) 广皮(三钱)
煮三杯,分三次服。
王 三十五岁 渴而小便后淋浊,此湿家渴也,况舌苔黑滑乎,议《金匮》渴者猪苓汤
法。
但前医大剂地、萸、五味、麦冬、龟胶等,纯柔粘腻补阴封固日久,恐难速愈。戒猪肉介属
滑腻。
猪苓(六钱) 萆 (六钱) 泽泻(五钱)
初五日 渴而小便短,便后淋浊,与猪苓汤法,小便长而淋浊大减,渴止舌黑苔退,惟
肩背微有麻木酸楚之象。是脏腑之湿热已行,而经络之邪未化也。与经腑同治法。
生石膏(八钱) 云苓块(五钱,连皮) 晚蚕砂(三钱) 杏仁(四钱) 广皮(钱半) 通草
(一钱) 防己(二钱) 萆 (四钱) 生苡仁(四钱) 桂枝(三钱) 黄柏炭(钱半)
陶某,四十五岁。乙酉年四月十五日就诊:长期腹泻,脉象弦,症状自春季开始,古人称之为“木泄”,即肝木乘克脾土(侮其所胜)。
处方:柴胡(三钱)、猪苓(三钱)、生姜(五钱)、姜半夏(五钱)、炙甘草(二钱)、大枣(三枚,去核)、泽泻(三钱)、广陈皮(三钱)、茯苓块(五钱)、桂枝(三钱)。
十九日:腹泻次数已减少,在前方基础上加用:苍术(三钱)。
前后共计服用十三剂后痊愈。
五月初六日:此前曾患木泄,服用小柴胡汤(Minor Bupleurum Decoction)十三剂而愈。患者既往有排便后便血的症状,这是小肠寒湿的证候。目前脉象虽弦但不强劲,且兼有缓象,大便再次变稀溏,不再需要使用柴胡汤了,转而采用黄土汤(Yellow Earth Decoction)的治法。
处方:灶心黄土(四两)、黄芩炭(二钱)、熟附子(三钱)、茯苓块(五钱,带皮)、炒苍术(五钱)、广皮炭(二钱)。
煎煮取汁三杯,分三次服用。
十二日:湿温病导致五种类型的泄泻,先给予行气化湿、止泻的治疗,对于排便后便红的症状,稍后再做处理。
处方:猪苓(五钱)、苍术(四钱)、泽泻(五钱)、茯苓(六钱,带皮)、桂枝(五钱)、薏苡仁(五钱)、广陈皮(四钱)、广木香(二钱)。
煎煮取汁三杯,分三次服用,以腹泻停止为度。
处方:猪苓(三钱)、白蔻仁(二钱)、泽泻(三钱)、生薏苡仁(五钱)、茯苓皮(五钱)、广陈皮(二钱)、姜半夏(三钱)、柴胡(一钱)。
煎煮取汁三杯,分三次服用。
陆某,二十七岁。乙酉年五月十九日就诊:六脉皆呈弦细之象,面色淡黄,腹泻说明脾气虚弱,进食少说明胃气虚弱,中焦脾胃无法运化生成气血,怎能期望月经来潮?建议先通过健脾(强土)来治疗。
处方:藿香梗(二钱)、广皮炭(钱半)、广木香(钱半)、白蔻仁(一钱)、云苓块(三钱)、苏梗(钱半)、薏苡仁(二钱)、姜半夏(三钱)、益智仁(一钱)。
煎煮取汁三杯,分三次服用,共七剂。
二十八日:右脉宽大舒缓,是缓和之象。胃口稍微好转,但腹泻加重,小便不通,加入健脾实脾、利水渗湿的药物。
处方:猪苓(三钱)、泽泻(三钱)、茯苓(五钱)、薏苡仁(五钱)。
六月十八日:前方服用十四剂后,腹泻停止,胃气稍醒,但脘腹闷胀,舌苔滑腻,周身痹痛,六脉弦细而沉。先给予调和脾胃的方法,治疗痹症放在后面。
处方:桂枝(三钱)、防己(三钱)、益智仁(钱半)、藿香梗(三钱)、杏仁(三钱)、薏苡仁(五钱)、姜半夏(五钱)、白蔻仁(二钱)、广陈皮(三钱)。
煎煮取汁三杯,分三次服用。
王某,三十五岁。口渴且小便后出现淋浊,这是湿邪致病者的口渴,况且舌苔黑而滑润,建议采用《金匮要略》中针对口渴者的猪苓汤(Polyporus Decoction)治法。
但是前医使用了大剂量的地黄、山茱萸、五味子、麦冬、龟胶等药物,纯用柔润粘腻之品补阴封固日久,恐怕难以迅速痊愈。告诫患者禁食猪肉及贝类甲壳属食物,因其滑腻碍胃。
初五日:口渴且小便短少,便后淋浊,仍用猪苓汤法治疗。小便量增加且淋浊大幅减轻,口渴停止,舌上黑苔消退,只有肩背微微有麻木酸楚的感觉。这说明脏腑内的湿热已经排出,但经络中的邪气尚未化解。采用经腑同治的方法。
处方:生石膏(八钱)、云苓块(五钱,带皮)、晚蚕砂(三钱)、杏仁(四钱)、广陈皮(钱半)、通草(一钱)、防己(二钱)、萆薢(四钱)、生薏苡仁(四钱)、桂枝(三钱)、黄柏炭(钱半)。
Patient Tao, 45 years old. On the 15th day of the 4th month in the Yiyu year: Chronic diarrhea with a wiry pulse (Xian Mai). The condition has persisted since spring; ancient texts refer to this as "Wood Diarrhea" (Mu Xie), where Liver Wood overacts on Spleen Earth (insulting what it should control).
Prescription: Chai Hu (Bupleuri Radix) 3 qian, Zhu Ling (Polypori Parietis Sclerotium) 3 qian, Sheng Jiang (Zingiberis Rhizoma Recens) 5 qian, Jiang Ban Xia (Pinelliae Rhizoma Preparatum) 5 qian, Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparatum cum Melle) 2 qian, Da Zao (Jujubae Fructus) 3 pieces, pitted, Ze Xie (Alismatis Rhizoma) 3 qian, Guang Chen Pi (Citri Reticulatae Pericarpium) 3 qian, Fu Ling Kuai (Poria) 5 qian, Gui Zhi (Cinnamomi Ramulus) 3 qian.
On the 19th: Diarrhea frequency has decreased. Add to the previous formula: Cang Zhu (Atractylodis Rhizoma) 3 qian.
After taking a total of thirteen doses, the patient recovered completely.
On the 6th day of the 5th month: Previously suffered from Wood Diarrhea, cured after taking Xiao Chai Hu Tang (Minor Bupleurum Decoction) for thirteen doses. The patient historically had hematochezia (blood in stool) after defecation, which is a syndrome of Cold-Dampness in the Small Intestine. Currently, although the pulse is wiry, it is not forceful, and is accompanied by a moderate quality. The stool has become loose again. It is no longer necessary to use Chai Hu Tang; instead, adopt the method of Huang Tu Tang (Yellow Earth Decoction).
Prescription: Zao Zhong Huang Tu (Caulis Trichosanthis Preparatus / Hearth Soil) 4 liang, Huang Qin Tan (Scutellariae Radix Carbonisata) 2 qian, Shu Fu Zi (Aconiti Lateralis Radix Preparata) 3 qian, Fu Ling Kuai (Poria) 5 qian, with skin, Chao Cang Zhu (Atractylodis Rhizoma Stir-fried) 5 qian, Guang Pi Tan (Citri Reticulatae Pericarpium Carbonisatum) 2 qian.
Decoct to yield three cups, divide into three doses.
On the 12th: Damp-Warmth disease has resulted in five types of diarrhea. First, administer treatment to promote dampness resolution and stop diarrhea. The symptom of blood in stool after defecation will be addressed later.
Prescription: Zhu Ling (Polypori Parietis Sclerotium) 5 qian, Cang Zhu (Atractylodis Rhizoma) 4 qian, Ze Xie (Alismatis Rhizoma) 5 qian, Fu Ling (Poria) 6 qian, with skin, Gui Zhi (Cinnamomi Ramulus) 5 qian, Yi Yi Ren (Coicis Semen) 5 qian, Guang Chen Pi (Citri Reticulatae Pericarpium) 4 qian, Guang Mu Xiang (Costi Radix) 2 qian.
Decoct to yield three cups, divide into three doses. Take until diarrhea stops.
On the 6th day of the 8th month: Stomach Qi is stagnant, stool is loose, urination is obstructed, pulse is wiry.
Prescription: Zhu Ling (Polypori Parietis Sclerotium) 3 qian, Bai Kou Ren (Amomi Fructus Rotundus) 2 qian, Ze Xie (Alismatis Rhizoma) 3 qian, Sheng Yi Yi Ren (Coicis Semen Crudum) 5 qian, Fu Ling Pi (Poria Cum Cortice) 5 qian, Guang Chen Pi (Citri Reticulatae Pericarpium) 2 qian, Jiang Ban Xia (Pinelliae Rhizoma Preparatum) 3 qian, Chai Hu (Bupleuri Radix) 1 qian.
Decoct to yield three cups, divide into three doses.
Patient Lu, 27 years old. On the 19th day of the 5th month in the Yiyu year: All six pulses are wiry and fine. Complexion is pale yellow. Diarrhea indicates Spleen Deficiency; poor appetite indicates Stomach Deficiency. The Middle Jiao cannot transform and transport, so how can one expect menstruation? Proposal: First strengthen the Earth (Spleen/Stomach).
Prescription: Huo Xiang Geng (Agastaches Caulis) 2 qian, Guang Pi Tan (Citri Reticulatae Pericarpium Carbonisatum) 1.5 qian, Guang Mu Xiang (Costi Radix) 1.5 qian, Bai Kou Ren (Amomi Fructus Rotundus) 1 qian, Yun Ling Kuai (Poria) 3 qian, Su Geng (Perillae Caulis) 1.5 qian, Yi Yi Ren (Coicis Semen) 2 qian, Jiang Ban Xia (Pinelliae Rhizoma Preparatum) 3 qian, Yi Zhi Ren (Alpiniae Oxyphyllae Fructus) 1 qian.
Decoct to yield three cups, divide into three doses. Seven doses total.
On the 28th: Right pulse is broad and moderate (Huan). Appetite has slightly improved, but diarrhea has worsened. Urination is obstructed. Add formulas to solidify the Spleen and promote diuresis.
Prescription: Zhu Ling (Polypori Parietis Sclerotium) 3 qian, Ze Xie (Alismatis Rhizoma) 3 qian, Fu Ling (Poria) 5 qian, Yi Yi Ren (Coicis Semen) 5 qian.
On the 18th day of the 6th month: After taking the previous prescription for fourteen doses, diarrhea stopped, Stomach Qi revived slightly, but there is fullness in the epigastrium, slippery tongue coating, and generalized bi-syndrome pain. All six pulses are wiry, fine, and deep. First, harmonize the Middle Jiao; treat the Bi-syndrome subsequently.
Prescription: Gui Zhi (Cinnamomi Ramulus) 3 qian, Fang Ji (Stephaniae Tetrandrae Radix) 3 qian, Yi Zhi Ren (Alpiniae Oxyphyllae Fructus) 1.5 qian, Huo Xiang Geng (Agastaches Caulis) 3 qian, Xing Ren (Armeniacae Semen Amarum) 3 qian, Yi Yi Ren (Coicis Semen) 5 qian, Jiang Ban Xia (Pinelliae Rhizoma Preparatum) 5 qian, Bai Kou Ren (Amomi Fructus Rotundus) 2 qian, Guang Chen Pi (Citri Reticulatae Pericarpium) 3 qian.
Decoct to yield three cups, divide into three doses.
Patient Wang, 35 years old. Thirsty with turbid discharge after urination. This is thirst caused by a dampness constitution. Moreover, the tongue coating is black and slippery. Proposal: Adopt the method of Zhu Ling Tang (Polyporus Decoction) from *Jin Gui Yao Lue* for cases of thirst.
However, the previous physician used large doses of Di Huang (Rehmanniae Radix), Yu Jin Shan (Corni Fructus), Wu Wei Zi (Schisandrae Chinensis Fructus), Mai Dong (Ophiopogonis Radix), Gui Jiao (Testudinis Carapax et Plastrum Preparatum), etc., purely using soft, sticky, and cloying yin-nourishing and consolidating herbs for a long time. It is feared that recovery will not be rapid. Advise avoiding pork and mollusks/shellfish, which are slippery and cloying.
Prescription: Zhu Ling (Polypori Parietis Sclerotium) 6 qian, Bi Xie (Dioscoreae Hypoglaucae Rhizoma) 6 qian, Ze Xie (Alismatis Rhizoma) 5 qian.
On the 5th day: Thirsty with scanty urine, turbid discharge after urination. Continue with Zhu Ling Tang method. Urine volume increased, turbid discharge significantly reduced, thirst ceased, black tongue coating receded. Only slight numbness, soreness, and discomfort remain in the shoulders and back. This indicates that Damp-Heat in the Zang-Fu organs has been expelled, but pathogenic factors in the meridians have not yet transformed. Adopt a method treating both meridians and fu-organs simultaneously.
Prescription: Sheng Shi Gao (Gypsum Fibrosum) 8 qian, Yun Ling Kuai (Poria) 5 qian, with skin, Wan Can Sha (Bombyx Batryticatus) 3 qian, Xing Ren (Armeniacae Semen Amarum) 4 qian, Guang Chen Pi (Citri Reticulatae Pericarpium) 1.5 qian, Tong Cao (Tetrapanacis Medulla) 1 qian, Fang Ji (Stephaniae Tetrandrae Radix) 2 qian, Bi Xie (Dioscoreae Hypoglaucae Rhizoma) 4 qian, Sheng Yi Yi Ren (Coicis Semen Crudum) 4 qian, Gui Zhi (Cinnamomi Ramulus) 3 qian, Huang Bo Tan (Phellodendri Cortex Carbonisata) 1.5 qian.