邓评：治肝实脾，原为脾土弱者而设。方于平肝一面自嫌疏漏，柳师增味颇合，如乌梅、防风、白蒺藜、金铃子、吴萸、川连等味，均可临时选用。
孙评：木横则土益衰，所以柳氏加瓜、芍平肝，于土亦有益。大有见解
有时惊悸，有时肌肉顽木，或一日溏泄数次，或数日一大便而坚干，惟小便常红。此心气郁结，脾气失运，失运则生湿，郁结则聚火，火则伤津，湿则阻气，而气机不利矣。拟荆公妙香散加味，以补益心脾。
山药 洋参 黄芪 茯神 赤苓 桔梗 炙草 远志 麝香 朱砂 木香 川连麦冬
邓评：此症心肝有亢火，脾家聚湿饮，大便之或泄或结，即湿与火之造偏也。 引用是方，不免泥古。惟心脾虚而郁结者为宜，于此病则未必中窾。拟苓桂术甘汤加川连、蒺藜、陈皮、白芍、远志、首乌。
血不养心，则心悸少寐；胃有寒饮，则呕吐清水；虚火烁金则咽痛，肝木乘中则腹胀。此时调剂，最难熨贴。盖补养心血之药，多嫌其滞；清降虚火之药，又恐其滋；欲除胃寒，虑其温燥劫液；欲平肝木，恐其克伐耗气。今仿胡洽居士法，专治其胃，以胃为气血之乡，土为万物之母，一举而三善备焉。请试服之。
诒按：于无可措手中，寻出养胃一法，自属扼要之图。拟再加木瓜、白芍以和肝，竹茹，麦冬以清肺，似更周匝。
邓评：此种医案，便觉强做无归束，参合症情，总由木火郁冲，宜增疏泄之品治之，方内山药、党参，尚嫌其滞。
骨格瘦小，先天元气不足。夏秋寒热，至今不已，脉细数弱，气血两亏。头不痛而但身痛，或口沃清水，此胃阳虚惫也。当商温补，仿东垣法。
诒按：少阳生气被郁，故寒热不已。东垣升阳益胃法，用之恰合，加于姜者，助胃阳也。
似可从原方增白术。
卫气虚则洒洒恶寒，营气虚则蒸蒸发热。营卫并出中焦，总以脾胃为主。补脾胃则金有所恃，不必治肝而肝自驯矣。
诒按；为虚损证，探原立论，方亦精到。
营阴内亏，头眩心嘈，下午微寒内热，能食无力。胃'中有热则消谷，脾虚气弱则无力也。
党参 沙苑 茯苓 川连 枣仁 知母 女贞子 白芍 冬术 麦冬 竹茹
左脉空大，肾水亏也；倦怠无力，脾气弱也；食少则阴虚，阴虚生内热，证属内伤。
另六味丸每朝服四钱
诒按：补中益气补脾气，六味补肾阴，立法颇切实。惟左脉空大，方中升柴两味，尚宜斟酌耳。
邓评，左脉空大，不但肾水亏，更知肝阳旺，若再投以升柴，深恐阳升至极，而卒致晕厥矣。
思虑伤脾之营，劳碌伤脾之气。归脾汤，补脾之营也；补中益气汤，补脾之气也，今将二方，并合服之。
党参 黄芪 冬术 茯神 归身 炙甘草砂仁 枣仁升麻 柴胡 木香 半夏 陈皮
诒按：同是脾病，而病原用药，确有气营之别。一经指点，便觉头头是道。
邓评；方用枣仁之酸敛，想由神魂不宁。然势必难任升柴，还望商诸博雅。
肾气虚逆，非滋不纳；脾弱运迟，滋则呆滞。然则如何而可?日补肾之阳，即可以转运脾气。从仲景肾气丸化裁。
熟地附子三分炒五味子 茯苓 山药 肉桂心 麦冬元米炒 牛膝盐承炒山萸肉 陈皮紫石英 补骨脂盐水炒胡桃肉
邓评：若肝肾无亢火者，惟以此法为上策。经是加减，较原方更觉切实。
孙评t须看其将两面合成一气之法。
久病之躯，去冬常患火升。交春木旺，肝胆阳升无制。倏忽寒热，头面红肿，延及四肢，掀热痒痛，殆即所谓游火游风之类欤。匝月以来，肿势已减。四五日前，偶然裸体伤风，遂增咳嗽音哑痰多，口干舌白，续发寒热，胃气从此不醒，元气愈觉难支，风火交煽，痰浊复甚，阴滓消涸，阳不潜藏。此时清火养阴，计非不善，抑恐滋则碍脾；化痰扶正，势所必需，又恐燥则伤液。立法但取其轻灵，用药先求其无过。
北沙参 知母 鲜生地 蛤壳 海浮石 蝉衣 豆卷 青果 海蜇 地栗 百合
另珠粉朝晨用燕窝汤送下三分
原注：上方《金匮》百合知母地黄汤，合本事神效雪羹，取其清火化痰，不伤脾胃} 生津养液，不碍痰湿。酌古参今，归于平正。
诒按：议病用药，均归精细，躁心人不能领取也。
邓评。风火交煽，恰合此病题旨。然不祛风，而但清火，其病根必不除，否则亦冀其敷衍而已。
中风 门
两手关脉，皆见一粒厥厥动摇之象。此土虚木胜，内风动跃之候也。左半肢体，麻木不仁，头眩面麻，病属偏枯，虑延仆中 首乌 当归 白芍 茯苓 陈皮 秦艽 菊花 天麻 石决明 钩钩 刺蒺藜 桑枝 邓评：论病有卓识，立方亦精到。 再诊{动摇之脉大减，内风有暗熄之机，左手屈伸稍安，左足麻木未和。拟补肾生肝，为治本之计。
地黄饮子（地、山萸、斛、苁、桂、附、麦冬、姜、五味、菖蒲、远志、茯、巴戟、大枣。）去桂附
诒按：未雨绸缪，故易于奏效。两方用药，亦能与病机宛转相赴。
邓评：前方既已中窾，再诊何必更张。
孙评：原方有薄荷。
体肥多湿，性躁多火。十年前小产血崩，血去则阴亏而火亢，肝风暗动，筋络失养，已非一日。去秋伏暑后变三疟，疟久营卫偏虚，遂致风痰扰络，右半肢体麻痹，而为偏废之象，调理渐愈。今但右足麻辣热痛，痛自足大指而起，显系肝经血虚失养。据云腿膝常冷，足骱常热，此非足骱有火，而腿膝有寒也。想由湿火乘虚下注，故痛处觉热，而腿膝气血不足，则觉寒耳。至于左胫外廉皮肉之内，结核如棉子，发作则痛甚，此属筋箭，是风痰瘀血交凝入络而成。与右足之热痛麻辣不同。今且先治其右足。
生地 阿胶 五加皮 归身 木瓜 天麻 冬术 独活 丝瓜络 牛膝 茯苓 萆薢 诒按：论颇明透，方亦平稳。
邓评：冷热异处，论归一贯。左右虽各异状，方药实堪并治。
年已六旬，肾肝精血衰微，内风痰涎走络，右偏手足无力，舌强言涩，类中之根萌也。温补精血，兼化痰涎，冀免偏枯之累，然非易事也。耐心调理为宜。
苁蓉 巴戟 茯神 木瓜 半夏 枸杞盐水炒 远志甘草汤制 海风藤 茱萸酒炒牛膝 杜仲盐水炒
诒按：此与下条均因有类中之萌，作未雨绸缪之计，故用药力求平稳，不敢喜事以邀功也。
方从地黄饮子加减，殊有斟酌。
肾藏精而主骨，肝藏血而主筋，肾肝精血衰微，筋骨自多空隙，湿热痰涎，乘虚入络，右偏手足无力，舌根牵强，类中之根。温补精血，宣通经络，兼化痰涎，守服不懈，加以静养，庶几却病延年。
苁蓉 党参元米拌炒 牛膝 半夏 杞子盐水炒 陈皮 续断茯苓 巴戟 桑枝
又丸方：
苁蓉二两酒煮烂捣入 党参三两元米炒 熟地四两砂仁末陈酒拌 麦冬二两去心元米炒 枣仁三两炒研 巴戟三两盐水炒- 归身二两酒炒 萆薢三两炒 首乌四两制炒 茯神三两 牛膝三两盐水炒半夏二两 天冬二两去心元米炒陈皮二两五钱 杜仲三两盐水炒 虎骨三两炙 菖蒲一两 杞子四两盐水炒
上药各选道地，如法制炒，共研细末，用竹沥四两、姜汁三两，捣入，再将白蜜为丸，如黍米大，用磁器装好，每朝服五钱，开水送下。
邓评；方论均平正通达，与上一案大略相同，盖用古期乎能化者。
丸方更为周匝。
孙评：右偏手足无力，有由脾胃气衰，夹痰入络者，用玉屏风散，温胆汤而愈者，又是一格。
痿 痹 门
先天不足，骨髓空虚，常以后天滋补栽培脾胃，脾胃得补，湿热壅滞，形体骤然充壮，而舌本牵强，两足痿软，不能行走，上盛下虚，病属痿壁。经云：湿热不攘，大筋软短，小筋弛长，软短为拘，弛长为痿是也。今拟法补先天之精气，强筋壮骨，以治其下；扶后天之脾胃，运化湿热，以治其中。然必耐心久服，确守弗懈，庶克获效。倘朝秦而暮楚，恐难许收攻也。
熟地四钱 附子三分煎汁炒 茯苓三钱 牛膝一钱五分盐水炒 桑枝一两虎胫骨炙三钱川断二钱酒炒 巴戟三钱盐水炒 黄柏一钱姜汁炒 苍术一钱五分 萆薢二钱盐水炒 竹沥二十匙 姜汁一匙 另洗方：独活三钱 当归五钱 红花一钱 陈酒糟=两 猪后脚骨二只葱白头三个煎汤日洗一次
诒按：此等证本难奏效，其立方仍从丹溪虎潜法加味，用药固未尝不切当也。
邓评：先天未足，湿热已壅，此种弊端，医家最易犯及，直可以东垣清燥汤治之。
伏热留于肺胃，胃热则消谷易饥，肺热则躄痿难行，热气熏于胸中，故内热不已。延今半载，节届春分，天气暴热，病加不寐。据述先前舌苔黄黑，今则舌心干红，其阴更伤。仿仲景意，用甘寒法。
生地三钱 知母一钱五分 茯神三钱 枣仁一钱五分 麦冬二钱 滑石三钱 夜合花五分 沙参三钱百合一两 泉水煎服
诒按：《金匮》百合病篇，有以百合配知母、地黄、滑石等法，此方即用其意。
邓评：痿躄一症，本属阴虚挟湿热居多，甚且有夹内风者。今见舌干易饥，是风火内扰，有灼阴化燥之象，无湿壅之咎，故立方专主甘寒，以养阴清燥为主务。
再诊。经云：肺热叶焦，则生痿跫。前方清心肺而退热，已能起床步履。但夜不安寐，是肾气不交于心，阴虚阳亢故也。清金丽水，取坎填离为治。
诒按：经云：肺热叶焦，则生痿躄。又云：治痿必取阳明。经训照然，守此二语，治法不外是矣。
邓评：不寐症每多挟痰，或可参入二陈，一或用半夏秫米法，而于大剂甘凉内，增此区区之辛燥，当无劫液之弊。
此丸为治痿之专方。 ．
三诊；阴虚未复，夜寐未安，热退不清，仍宜养阴。自云腹中微微撑痛，此属中虚。治当补益脾阴，兼清心肺之热。
生地沙参 洋参 山药 麦冬枣仁薏米 茯神 甘草 白芍赤苓百合
另归脾丸
冷雨淋背于先，竭力鼓棹于后，劳碌入房，挟杂于中，病起身热咳嗽，至今四十余日。痰气腥臭，饮食能进，卧床不起，形肉消脱，是肺先受邪，而复伤其阴也。经云：阴虚者阳必凑之，肺热叶焦，则生痿蹙。又云t一损损于肺，皮聚毛落，至骨痿不能起床者死。合经旨而互参之，分明棘手重证矣。
另八仙长寿丸四钱
邓评：肾虚精亏，邪乃深入，症情至此，固亦难矣。计惟四十余日，饮食能进，养阴散邪并投，犹可冀幸万一，当时立方，非不善也。窃思如葛氏保和汤，或者较能着力耳。果系入房受寒，而正气未至竭尽者，则麻、辛用于地、麦、五味内，尤属切实。
再诊：肺为水源，百脉朝宗于肺，犹众水朝宗于诲也。肺热叶焦，则津液不能灌输于经脉，而为痿蹙。、卧床不能行动，形肉消削，咳嗽痰臭，舌红无苔，脉细而数。是皆津液消耗，燥火内灼之象。考经论治痿独取阳明者，以阳明主润宗筋，胃为气血之源耳。今拟生胃津以供于肺，仿西昌喻氏意
沙参 阿胶 杏仁 甘草 玄参 火麻仁 天冬 麦冬 玉竹 茯苓 桑叶 枇杷叶
诒按：议病立方，深合《内经》痿论之旨。
邓评：据此苔脉，火灼阴损已极。然风寒究竟闭郁，倘痰粘厚而腥臭重者，如萎蕤汤法，亦可出入仿用乎。愚不揣鄙陋，粗备法则，以侯有识者采择。
三诊；投清燥救肺法，病情稍安，仍宗前制
桑叶 杏仁 麦冬 川贝 百合 玄精石 阿胶沙参 玄参 枇杷叶 野茭白根
邓评：治疗肝脏实证而兼顾健脾，原本是针对脾土虚弱者设立的。原方在平抑肝木方面自感有所疏漏，柳宝诒医师增加药味颇为恰当，如乌梅、防风、白蒺藜、金铃子（川楝子）、吴茱萸、黄连等药物，均可根据病情临时选用。
孙评：肝木横逆则脾土更加衰弱，所以柳氏加入瓜蒌、白芍以平抑肝木，对脾土也有益处。见解独到。
患者有时惊悸，有时肌肉麻木不仁，或者一天腹泻数次，或者几天一次大便且干硬，只有小便经常发红。这是心气郁结，脾气运化失职，运化失职则产生湿邪，郁结则聚积火邪，火邪会损伤津液，湿邪会阻滞气机，从而导致气机运行不畅。拟定荆公妙香散加味，用来补益心脾。
山药、西洋参、黄芪、茯神、赤茯苓、桔梗、炙甘草、远志、麝香、朱砂、木香、黄连、麦冬。
将上述药物研成细末，用藿香陈皮汤泛丸，每次服用三钱，开水送服。
邓评：此症心肝有亢盛之火，脾家积聚湿饮，大便或泄泻或便秘，就是湿与火偏胜造成的。引用这个方剂，不免拘泥于古法。只适合心脾虚而郁结的情况，对于这种病未必能切中要害。拟定苓桂术甘汤加黄连、白蒺藜、陈皮、白芍、远志、何首乌。
血不能滋养心脏，就会心悸失眠；胃中有寒饮，就会呕吐清水；虚火灼伤肺金就会咽痛，肝木乘克脾土就会腹胀。此时调理，最难贴切。因为补养心血的药物，多嫌其滋腻滞碍；清降虚火的药物，又恐其滋润碍胃；想要去除胃寒，担心其温燥劫伤津液；想要平抑肝木，恐怕其克伐耗损正气。现在仿照胡洽居士的方法，专门治疗胃，因为胃是气血之乡，土是万物之母，一举而三善具备。请尝试服用。
党参、冬术（白术）、茯苓、半夏、枣仁、扁豆、陈皮、山药、秫米。
柳诒按：在无可奈何的情况下，寻出养胃这一方法，自属抓住关键。拟定再加木瓜、白芍以调和肝木，竹茹、麦冬以清肺热，似乎更全面周到。
邓评：这类医案，让人觉得勉强凑合没有归宿，综合症状情况，总归是木火郁冲，应该增加疏泄的药物来治疗，方中的山药、党参，还嫌其滋腻滞碍。
骨骼瘦小，先天元气不足。夏秋季节的寒热病，至今未愈，脉象细数无力，气血两亏。头不痛只是身体痛，或者口中流清水，这是胃阳虚衰惫乏的表现。应当商量使用温补之法，仿照李东垣的方法。
党参、茯苓、陈皮、桂枝、柴胡、黄芪、半夏、神曲、当归、干姜、砂仁。
柳诒按：少阳生气被郁遏，所以寒热不止。李东垣的升阳益胃法，使用它恰好合适，加入干姜，是为了辅助胃阳。
邓评：脉象既然细数，似乎应该兼养营阴。不及时转换方剂是不妥当的。
孙评：认定身痛想办法，这是久病。如果是暴感外邪，应该疏散邪气而不宜进补。
似乎可以从原方增加白术。
再诊：前方补中益胃，温卫气，开腠理，各种病症都减轻了，仍然依照前法。
卫气虚弱则洒洒恶寒，营气虚弱则蒸蒸发热。营卫之气都出自中焦，总以脾胃为主。补益脾胃则肺金有所依靠，不必治肝而肝自然驯服了。
邓评：看方论，似乎夹杂肝经的气火，有刑金导致咳嗽、乘中导致腹胀的意思。
营阴内部亏损，头晕心慌，下午微寒内热，能吃但没力气。胃中有热则消谷易饥，脾虚气弱则无力。
党参、沙苑子、茯苓、黄连、枣仁、知母、女贞子、白芍、冬术、麦冬、竹茹。
邓评：此症终究属于阴虚为重，既然善于消化能食，冬术应该换成生地黄。
左脉空大，是肾水亏虚；倦怠无力，是脾气虚弱；吃得少则阴虚，阴虚生内热，证属内伤。
另六味地黄丸每天早上服用四钱。
柳诒按：补中益气汤补脾气，六味地黄丸补肾阴，立法颇为切实。只是左脉空大，方中的升麻、柴胡两味药，尚需斟酌。
邓评：左脉空大，不但肾水亏，更知道肝阳旺，如果再投以升麻、柴胡，深恐阳气升至极点，而导致突然晕厥。
思虑伤害脾的营血，劳碌伤害脾的元气。归脾汤，是补脾的营血；补中益气汤，是补脾的元气，现在将两个方剂合并服用。
党参、黄芪、冬术、茯神、当归身、炙甘草、砂仁、枣仁、升麻、柴胡、木香、半夏、陈皮。
柳诒按：同样是脾病，但病因和用药，确实有气营的区别。一经指点，便觉得条理清晰。
邓评：方中使用枣仁的酸敛，想必是因为神魂不宁。然而势必难以承受升麻、柴胡的升提，还希望商诸博学之人。
肾气虚逆，非滋阴不能纳气；脾弱运化迟缓，滋阴则会呆滞。那么该怎么办呢？说补肾的阳气，就可以转运脾气。从张仲景的肾气丸化裁而来。
熟地黄、附子（三分炒）、五味子、茯苓、山药、肉桂心、麦冬（元米炒）、牛膝（盐承炒）、山萸肉、陈皮、紫石英、补骨脂（盐水炒）、胡桃肉。
邓评：如果肝肾没有亢盛之火，只有以此法为上策。经过这样加减，比原方更觉切实。
孙评：须看其将两面合成一气的方法。
久病之躯，去年冬天常患火气上冲。进入春天木气旺盛，肝胆阳气上升无制。忽然寒热交替，头面红肿，延及四肢，掀热痒痛，大概就是所谓的游火游风之类吧。一个月以来，肿势已经减轻。四五天前，偶然裸体受风，于是增加咳嗽、声音嘶哑、痰多、口干舌苔白，随后发生寒热，胃气从此不振，元气越发难以支撑，风火交煽，痰浊复盛，阴津消涸，阳气不潜藏。此时清火养阴，计策并非不好，但恐怕滋腻则碍脾；化痰扶正，形势所必需，又恐怕燥烈则伤液。立法只取其轻灵，用药先求其无过失。
北沙参、知母、鲜生地、蛤壳、海浮石、蝉衣、豆卷、青果、海蜇、地栗、百合。
另珠粉早晨用燕窝汤送服三分。
原注：上方《金匮要略》百合知母地黄汤，合《本事方》神效雪羹，取其清火化痰，不伤脾胃；生津养液，不碍痰湿。酌古参今，归于平正。
柳诒按：议病用药，都归于精细，急躁的人不能领会。
邓评：风火交煽，恰好符合此病题旨。然而不祛风，只清火，病根必然不除，否则也只是期望敷衍了事而已。
紫菀、款冬花，应该可以加入，就舌苔白来看，蜜炙干姜、橘红，也是需要的。
中风门
两手关脉，都见一粒厥厥动摇的脉象。这是土虚木胜，内风动跃的征候。左半肢体，麻木不仁，头晕面麻，病属偏枯，担心发展为仆倒中风。
何首乌、当归、白芍、茯苓、陈皮、秦艽、菊花、天麻、石决明、钩藤、刺蒺藜、桑枝。
邓评：论病有卓识，立方也精到。
再诊：动摇的脉象大大减少，内风有暗熄的机转，左手屈伸稍安，左足麻木未缓解。拟定补肾生肝，作为治本之计。
地黄饮子（地黄、山萸肉、石斛、肉苁蓉、肉桂、附子、麦冬、生姜、五味子、石菖蒲、远志、茯苓、巴戟天、大枣。）去掉肉桂、附子。
柳诒按：未雨绸缪，所以容易奏效。两方用药，也能与病机宛转相合。
邓评：前方既然已经切中要害，再诊何必更改。
孙评：原方有薄荷。
身体肥胖多湿，性格急躁多火。十年前小产血崩，血去则阴亏而火亢，肝风暗动，筋络失养，已非一日。去年秋天伏暑后变成三疟，疟疾日久营卫偏虚，遂致风痰扰络，右半肢体麻痹，而为偏废之象，调理逐渐痊愈。现在只有右足麻辣热痛，痛从足大指而起，显系肝经血虚失养。据称腿膝常冷，足关节常热，这不是足关节有火，而是腿膝有寒。想是由湿火乘虚下注，故痛处觉热，而腿膝气血不足，则觉寒耳。至于左小腿外侧皮肉之内，结核如棉子，发作则痛甚，这属于筋疬，是风痰瘀血交凝入络而成。与右足的热痛麻辣不同。现在暂且先治疗右足。
生地黄、阿胶、五加皮、当归身、木瓜、天麻、冬术、独活、丝瓜络、牛膝、茯苓、萆薢。
柳诒按：论述颇明透，方剂也平稳。
邓评：冷热异处，论述归于一贯。左右虽各异状，方药实堪并治。
年已六十岁，肾肝精血衰微，内风痰涎走窜经络，右偏手足无力，舌强言涩，类中风的根萌。温补精血，兼化痰涎，希望避免偏枯的拖累，但这并非易事。耐心调理为宜。
肉苁蓉、巴戟天、茯神、木瓜、半夏、枸杞子（盐水炒）、远志（甘草汤制）、海风藤、吴茱萸（酒炒）、牛膝、杜仲（盐水炒）。
柳诒按：这与下条均因有类中风的萌芽，作未雨绸缪之计，故用药力求平稳，不敢喜事以邀功。
方从地黄饮子加减，颇有斟酌。
肾藏精而主骨，肝藏血而主筋，肾肝精血衰微，筋骨自然多有空隙，湿热痰涎，乘虚入络，右偏手足无力，舌根牵强，类中风的根。温补精血，宣通经络，兼化痰涎，守服不懈，加以静养，或许能却病延年。
肉苁蓉、党参（元米拌炒）、牛膝、半夏、杞子（盐水炒）、陈皮、续断、茯苓、巴戟天、桑枝。
又丸方：
肉苁蓉二两酒煮烂捣入，党参三两元米炒，熟地黄四两砂仁末陈酒拌，麦冬二两去心元米炒，枣仁三两炒研，巴戟天三两盐水炒，当归身二两酒炒，萆薢三两炒，何首乌四两制炒，茯神三两，牛膝三两盐水炒，半夏二两，天冬二两去心元米炒，陈皮二两五钱，杜仲三两盐水炒，虎骨三两炙，石菖蒲一两，杞子四两盐水炒。
上述药物各选道地，依法制炒，共研细末，用竹沥四两、姜汁三两，捣入，再将白蜜为丸，如黍米大，用磁器装好，每早服用五钱，开水送服。
邓评：方论均平正通达，与上一案大略相同，大概是用古方期望能化裁运用。
丸方更为周全。
孙评：右偏手足无力，有由脾胃气衰，夹痰入络者，用玉屏风散、温胆汤而愈的，又是另一种格局。
痿痹门
先天不足，骨髓空虚，常以后天滋补栽培脾胃，脾胃得到补益，湿热壅滞，形体骤然充壮，而舌本牵强，两足痿软，不能行走，上盛下虚，病属痿痹。经云：湿热不攘，大筋软短，小筋弛长，软短为拘，弛长为痿是也。现在拟定法补先天之精气，强筋壮骨，以治其下；扶后天之脾胃，运化湿热，以治其中。然而必须耐心久服，确守不懈，才可能获得疗效。倘若朝秦暮楚，恐怕难许收功。
熟地黄四钱，附子三分煎汁炒，茯苓三钱，牛膝一钱五分盐水炒，桑枝一两，虎胫骨炙三钱，川断二钱酒炒，巴戟天三钱盐水炒，黄柏一钱姜汁炒，苍术一钱五分，萆薢二钱盐水炒，竹沥二十匙，姜汁一匙。另洗方：独活三钱，当归五钱，红花一钱，陈酒糟二两，猪后脚骨二只，葱白头三个，煎汤日洗一次。
柳诒按：此类证候本难奏效，其立方仍从丹溪虎潜法加味，用药固未尝不切当。
邓评：先天未足，湿热已壅，此种弊端，医家最易犯及，直可以用东垣清燥汤治之。
伏热留于肺胃，胃热则消谷易饥，肺热则下肢痿软难行，热气熏于胸中，故内热不已。拖延至今半年，节届春分，天气暴热，病加重出现不寐。据述先前舌苔黄黑，现在则舌心干红，其阴更伤。仿照张仲景之意，用甘寒法。
生地黄三钱，知母一钱五分，茯神三钱，枣仁一钱五分，麦冬二钱，滑石三钱，夜合花五分，沙参三钱，百合一两，泉水煎服。
柳诒按：《金匮要略》百合病篇，有以百合配知母、地黄、滑石等法，此方即用其意。
邓评：痿躄一症，本属阴虚挟湿热居多，甚且有夹内风者。现在见舌干易饥，是风火内扰，有灼阴化燥之象，无湿壅之咎，故立方专主甘寒，以养阴清燥为主务。
再诊。经云：肺热叶焦，则生痿躄。前方清心肺而退热，已能起床步履。但夜不安寐，是肾气不交于心，阴虚阳亢故也。清金丽水，取坎填离为治。
生地黄、天冬、麦冬、枣仁、山药、玄参、沙参、西洋参、百合。另虎潜丸三钱。
柳诒按：经云：肺热叶焦，则生痿躄。又云：治痿必取阳明。经训昭然，守此二语，治法不外是矣。
邓评：不寐症每多挟痰，或可参入二陈汤，或用半夏秫米法，而在大剂甘凉内，增此区区之辛燥，当无劫液之弊。
此丸为治痿之专方。
三诊：阴虚未复，夜寐未安，热退不清，仍宜养阴。自云腹中微微撑痛，这属于中虚。治当补益脾阴，兼清心肺之热。
生地黄、沙参、西洋参、山药、麦冬、枣仁、薏米、茯神、甘草、白芍、赤茯苓、百合。
另归脾丸。
冷雨淋背在先，竭力鼓棹在后，劳碌入房，夹杂于中，病起身热咳嗽，至今四十余日。痰气腥臭，饮食能进，卧床不起，形肉消脱，是肺先受邪，而复伤其阴也。经云：阴虚者阳必凑之，肺热叶焦，则生痿蹙。又云：一损损于肺，皮聚毛落，至骨痿不能起床者死。合经旨而互参之，分明棘手重证矣。
另八仙长寿丸四钱。
邓评：肾虚精亏，邪乃深入，症情至此，固亦难矣。计惟四十余日，饮食能进，养阴散邪并投，犹可冀幸万一，当时立方，非不善也。窃思如葛氏保和汤，或者较能着力耳。果系入房受寒，而正气未至竭尽者，则麻黄、细辛用于地黄、麦冬、五味子内，尤属切实。
再诊：肺为水源，百脉朝宗于肺，犹众水朝宗于海也。肺热叶焦，则津液不能灌输于经脉，而为痿蹙。卧床不能行动，形肉消削，咳嗽痰臭，舌红无苔，脉细而数。是皆津液消耗，燥火内灼之象。考经论治痿独取阳明者，以阳明主润宗筋，胃为气血之源耳。现在拟定生胃津以供于肺，仿照西昌喻嘉言之意。
沙参、阿胶、杏仁、甘草、玄参、火麻仁、天冬、麦冬、玉竹、茯苓、桑叶、枇杷叶。
柳诒按：议病立方，深合《内经》痿论之旨。
邓评：据此苔脉，火灼阴损已极。然而风寒究竟闭郁，倘若痰粘厚而腥臭重者，如萎蕤汤法，亦可出入仿用乎。愚不揣鄙陋，粗备法则，以侯有识者采择。
三诊：投清燥救肺法，病情稍安，仍宗前制。
桑叶、杏仁、麦冬、川贝母、百合、玄精石、阿胶、沙参、玄参、枇杷叶、野茭白根。
Deng’s Commentary: Treating liver excess by strengthening the spleen was originally established for cases of weak spleen earth. The original formula felt somewhat deficient in its aspect of pacifying the liver; Dr. Liu Baozhi’s addition of herbs is quite appropriate, such as *Mume Fructus* (Wumei), *Saposhnikoviae Radix* (Fangfeng), *Tribuli Fructus* (Bajili), *Chuanlianzi*, *Evodiae Fructus* (Wuzhuyu), and *Coptidis Rhizoma* (Huanglian), which can be selected temporarily according to the condition.
Sun’s Commentary: When wood overacts, earth declines further; therefore, adding *Trichosanthis Fructus* (Gualou) and *Paeoniae Radix Alba* (Baishao) to pacify the liver benefits the earth as well. This shows profound insight.
The patient experiences palpitations at times and numbness/insensibility of muscles at other times. Sometimes there are several episodes of loose stools a day, or one hard stool every few days, while urine is frequently red. This indicates stagnation of heart qi and failure of spleen transportation. Failure of transportation generates dampness; stagnation gathers fire. Fire injures fluids; dampness obstructs qi, leading to unfavorable qi dynamics. We propose modifying Jinggong Miaoxiang San to tonify heart and spleen.
Chinese Yam (*Dioscoreae Rhizoma*), American Ginseng (*Panacis Quinquefolii Radix*), Astragalus (*Astragali Radix*), Poria (*Poria*), Red Poria (*Poria cum Rubo*), Platycodon (*Platycodi Radix*), Honey-fried Licorice (*Glycyrrhizae Radix et Rhizoma Praeparata*), Polygala (*Polygalae Radix*), Musk (*Moschus*), Cinnabar (*Cinnabaris*), Costus (*Aucklandiae Radix*), Coptis (*Coptidis Rhizoma*), Ophiopogon (*Ophiopogonis Radix*).
Grind the above herbs into powder, make pills using *Agastaches Herba* and *Citri Reticulatae Pericarpium* decoction, take 3 qian per dose, with warm water.
Liu Yi’s Note: Focusing solely on heart and spleen, the line of thought is precise.
Deng’s Commentary: In this case, there is hyperactive fire in heart and liver, and accumulation of damp-fluid in spleen. The alternation of diarrhea or constipation in stool is due to the bias between dampness and fire. Citing this formula inevitably leads to rigid adherence to ancient methods. It is suitable only for deficiency of heart and spleen with stagnation; it may not hit the mark for this disease. We propose Ling Gui Zhu Gan Tang added with Coptis, Tribulus, Citrus reticulata peel, White Peony Root, Polygala, and Polygonum multiflorum.
Blood failing to nourish the heart causes palpitations and poor sleep; cold fluid in stomach causes vomiting of clear water; deficient fire scorching metal causes sore throat; liver wood attacking middle jiao causes abdominal distension. Regulation at this time is hardest to apply accurately. Tonics for heart blood are often too cloying; drugs clearing deficient fire may be too moistening; warming stomach cold risks drying fluids; pacifying liver wood risks damaging qi. Now imitating Hu Qiaju’s method, we focus on treating the stomach, for the stomach is the home of qi and blood, and earth is the mother of all things, achieving three benefits at once. Please try taking this.
Codonopsis (*Codonopsis Radix*), Autumn Atractylodes (*Atractylodis Rhizoma*), Poria, Pinellia (*Pinelliae Tuber*), Ziziphus Seed (*Zizyphi Semen*), Lablab Bean (*Lablab Album*), Tangerine Peel (*Citri Reticulatae Pericarpium*), Chinese Yam, Sorghum Grain (*Sorghei Fructus*).
Liu Yi’s Note: Finding the method of nourishing the stomach amidst helplessness is indeed grasping the key point. We propose adding Chaenomelis Fructus and White Peony Root to harmonize liver, and Bamboo Shavings (*Bambusae Caulis in Taenia*) and Ophiopogon to clear lung heat, which seems more comprehensive.
Deng’s Commentary: Such medical cases feel forced without resolution. Synthesizing symptoms, it ultimately stems from constrained wood-fire surging. One should add dispersing and draining agents. The Chinese Yam and Codonopsis in the formula still seem too cloying.
Sun’s Commentary: Oyster Shell (*Concha Ostreae*) alone seems like a wonderful herb.
Small skeletal frame, insufficient congenital yuan qi. Summer-autumn alternating chills and fever persist until now. Pulse is fine, rapid, and weak; both qi and blood are deficient. Head does not hurt but body hurts; sometimes mouth produces clear saliva. This indicates deficiency and exhaustion of stomach yang. We should discuss warming and tonifying, imitating Li Dongyuan’s method.
Codonopsis, Poria, Tangerine Peel, Cinnamon Twig (*Cinnamomi Ramulus*), Bupleurum (*Bupleuri Radix*), Astragalus, Pinellia, Medicated Leaven (*Medicated Massae Fermentatae*), Angelica Sinensis (*Angelicae Sinensis Radix*), Dried Ginger (*Zingiberis Rhizoma*), Amomum (*Amomi Fructus*).
Liu Yi’s Note: Shaoyang vital qi is depressed, hence chills and fever persist. Li Dongyuan’s Shengyang Yiwetang fits perfectly here; adding Dried Ginger assists stomach yang.
Deng’s Commentary: Since the pulse is fine and rapid, one should also nourish ying-yin. Not changing the formula promptly would be improper.
Sun’s Commentary: Addressing body pain suggests chronic illness. If acute exterior contraction, one should disperse pathogen rather than tonify.
Perhaps add Atractylodes Macrocephala (*Atractylodis Macrocephalae Rhizoma*) to the original formula.
Second visit: The previous formula tonified middle and benefited stomach, warmed wei qi, and opened cou li. All ailments decreased. Continue with the previous method.
Remove Medicated Leaven and Dried Ginger from previous formula; add Atractylodes Macrocephala and White Peony Root.
Deficiency of wei qi causes shivering aversion to cold; deficiency of ying qi causes steaming fever. Ying and wei both emerge from middle jiao, centering on spleen and stomach. Tonifying spleen and stomach gives Metal support; no need to treat Liver, and Liver will naturally subdue.
Codonopsis, Autumn Atractylodes, Angelica Sinensis, Fritillaria Cirrhosa (*Fritillariae Thunbergii Bulbus*), Astragalus, Poria, White Peony Root, Tangerine Peel, Rose Flower (*Rosa Rugosa*).
Liu Yi’s Note: For deficiency damage syndrome, tracing the origin establishes theory; the formula is also refined.
Deng’s Commentary: Observing the formula commentary, it seems to involve qi and fire of the liver meridian, meaning punishing Metal causing cough and attacking Middle causing distension.
Internal deficit of ying-yin causes dizziness and heartburn; slight chills and internal heat in afternoon; able to eat but powerless. Heat in stomach digests grain easily; spleen deficiency and qi weakness cause powerlessness.
Codonopsis, *Astragalus complanatus* seed (*Astragali Complanati Semen*), Poria, Coptis, Ziziphus Seed, Anemarrhena (*Anemarrhenae Rhizoma*), Ligustrum (*Ligustri Lucidi Fructus*), White Peony Root, Autumn Atractylodes, Ophiopogon, Bamboo Shavings.
Liu Yi’s Note: This is the initial stage of deficiency damage. Due to spleen deficiency and qi weakness, tonification is not advisable yet.
Deng’s Commentary: This case ultimately belongs to severe yin deficiency. Since digestion is good and appetite is strong, Autumn Atractylodes should be replaced by Raw Rehmannia (*Rehmanniae Radix*).
Left pulse is empty and large, indicating kidney water deficiency; fatigue and weakness indicate spleen qi weakness; low food intake leads to yin deficiency; yin deficiency generates internal heat; the syndrome belongs to internal injury.
Buzhong Yiqi Tang added with Black Gardenia (*Gardeniae Fructus*) and White Peony Root.
Separately, Liuwei Dihuang Wan taken 4 qian every morning.
Liu Yi’s Note: Buzhong Yiqi Tang tonifies spleen qi; Liuwei Dihuang Wan tonifies kidney yin. The legislation is quite practical. However, given the empty-large left pulse, the use of Shengma and Chaihu needs consideration.
Deng’s Commentary: An empty-large left pulse indicates not only kidney water deficiency but also hyperactive liver yang. Further administration of Shengma and Chaihu fears extreme yang rising leading to sudden syncope.
Sun’s Commentary: For yin deficiency with internal heat, consider replacing Black Gardenia with Cortex Moutan (*Paeoniae Radix Rubra*). How about that?
Worry injures spleen ying; labor injures spleen qi. Guipi Tang tonifies spleen ying; Buzhong Yiqi Tang tonifies spleen qi. Now combine these two formulas for simultaneous use.
Codonopsis, Astragalus, Autumn Atractylodes, Poria, Angelica Sinensis Root Body (*Angelicae Sinensis Radix*), Honey-fried Licorice, Amomum, Ziziphus Seed, Cimicifuga (*Cimicifugae Rhizoma*), Bupleurum, Costus, Pinellia, Tangerine Peel.
Liu Yi’s Note: Although both are spleen diseases, the etiology and medication indeed differ between qi and ying. Once pointed out, everything becomes logical.
Deng’s Commentary: Using Sour Jujube Seed (*Zizyphi Semen*) for its astringency suggests unsettled soul-spirit. However, it will likely not tolerate Shengma and Chaihu; I hope to consult experts.
Sun’s Commentary: Injury to ying causes afternoon internal heat; injury to qi causes fatigue and weakness.
Kidney qi deficiency with rebellion cannot be grasped without nourishment; spleen weakness with slow transport makes nourishment stagnant. So what to do? Nourishing kidney yang can transform spleen qi. Modify Zhang Zhongjing’s Shenqi Wan.
Prepared Rehmannia (*Rehmanniae Radix Praeparata*), Aconite (*Aconiti Lateralis Radix Praeparata*, 3 qian fried), Schisandra (*Schisandrae Fructus*), Poria, Chinese Yam, Cinnamon Heart (*Cinnamomi Cortex*), Ophiopogon (fried with millet), Achyranthes (*Achyranthis Bidentatae Radix*, salt-processed), Cornus (*Corni Fructus*), Tangerine Peel, Purple Quartz (*Haematites*), Psoralea (*Psoraleae Fructus*, salt-processed), Walnut Kernel (*Juglandis Semen*).
Liu Yi’s Note: Tonifying kidney benefits spleen; benefiting fire generates earth. Using Shenqi Wan is appropriate.
Deng’s Commentary: If liver and kidney have no hyperactive fire, this method is superior. These modifications are more practical than the original formula.
Sun’s Commentary: Must see how these two aspects merge into one qi.
In a body long ill, last winter often suffered from rising fire. Entering spring, wood qi is vigorous, liver-gallbladder yang rises uncontrolled. Sudden chills and fever, swelling and redness of head and face extending to limbs, burning heat, itching and pain—this is likely what is called wandering fire and wandering wind. Within a month, swelling has reduced. Four or five days ago, accidental exposure to wind while naked, leading to increased cough, hoarseness, profuse phlegm, dry mouth, white tongue coating, followed by chills and fever. Stomach qi has since failed to awaken, yuan qi increasingly difficult to support. Wind and fire fan each other, turbid phlegm increases, yin fluids exhausted, yang fails to hide. Clearing fire and nourishing yin is not bad, but fear cloying hinders spleen; resolving phlegm and supporting upright qi is necessary, but fear drying injures fluids. Legislation should seek lightness and agility; medication should first seek non-harm.
Glehnia (*Glehniae Fructus*), Anemarrhena, Fresh Rehmannia (*Rehmanniae Radix*), Clam Shell (*Concha Arcae*), Floating Stone (*Lithostes*), Cicada Slough (*Periostracum Cicadae), Soybean Sprouts (*Sojae Germinatus*), Green Olive (*Canarii Fructus*), Sea Spunge (*Ephydatia Milii*), Water Chestnut (*Eleocharis Tuberosa*), Lily Bulb (*Lilii Bulbus*).
Separately, Pearl Powder (*Concha Margaritifera*) taken 3 fen in the morning with Bird's Nest decoction.
Original Note: The above formula combines *He Bai He Zhi Mu Di Huang Tang* from *Jinkui Yaolue* with *Shenxiao Xueming* from *Ben Shi Fang*. It aims to clear fire and resolve phlegm without injuring spleen-stomach; generate fluids and nourish yin without hindering phlegm-dampness. Judging ancient and modern, returning to balance.
Liu Yi’s Note: Discussing disease and prescribing medication are all refined; an impatient person cannot grasp them.
Deng’s Commentary: Wind and fire fanning each other fits the theme of this disease. However, without dispelling wind, merely clearing fire will not remove the root; otherwise, it is just hoping for temporary relief.
*Asterae Radix* (Ziwan) and *Adenophorae Radix* (Kudonghua) should be added. Based on the white tongue coating, honey-fried Dried Ginger and Tangerine Peel are also needed.
Sun’s Commentary: Soybean Sprouts seem less effective than Mulberry Leaf (*Folium Mori*).
Stroke Section
Both Guan pulses show a rolling, trembling sensation. This is earth deficiency with wood excess, a sign of internal wind stirring. Left half of body is numb and insensible; dizziness and facial numbness; the disease belongs to hemiplegia, fearing progression to collapse stroke.
Polygonum Multiflorum (*Polygoni Multiflori Radix*), Angelica Sinensis, White Peony Root, Poria, Tangerine Peel, Gentian (*Gentianae Radix*), Chrysanthemum (*Chrysanthemi Flos*), Gastrodia (*Gastrodiae Rhizoma*), Mother of Pearl (*Concha Margaritifera*), Uncaria (*Uncariae Ramulus cum Uncis*), Tribulus, Mulberry Branch (*Ramulus Mori*).
Deng’s Commentary: Discussion of disease shows outstanding insight; prescription is also refined.
Second visit: Trembling pulse greatly reduced; internal wind has signs of quiet extinguishing. Left hand flexion/extension slightly relieved; left foot numbness not resolved. Propose tonifying kidney to generate liver, as a fundamental treatment plan.
Di Huang Yin Zi (Di Huang, Shan Yu Rou, Shi Hu, Cong Rong, Gui Zhi, Fu Zi, Mai Dong, Sheng Jiang, Wu Wei Zi, Chang Pu, Yuan Zhi, Fu Ling, Ba Ji Tian, Da Zao.) Remove Gui Zhi and Fu Zi.
Liu Yi’s Note: Preparing before rain ensures easy efficacy. Medications in both formulas align well with the pathogenesis.
Deng’s Commentary: Since the previous formula hit the mark, why change it in the second visit?
Sun’s Commentary: The original formula contains Bohe.
Obese body prone to dampness; irritable nature prone to fire. Ten years ago, miscarriage caused blood flooding. Loss of blood led to yin deficiency and fire hyperactivity, latent liver wind stirring, loss of nourishment to sinews/collaterals, not for a single day. Last autumn, after latent summerheat, developed triple malaria. Long-standing malaria made ying and wei unevenly deficient, leading to wind-phlegm disturbing collaterals, right half-body paralysis, resulting in hemiplegia. Gradually improved with regulation. Now only right foot feels numbing, hot, and painful, starting from big toe, clearly liver channel blood deficiency failing to nourish. Claims legs/knees are often cold, foot joints often hot. This is not heat in foot joints, but cold in legs/knees. Likely damp-heat sinking downward due to deficiency, so pain site feels hot, while leg/knee qi-blood insufficiency feels cold. As for the lump under skin of left lower leg outer edge, size of cotton seed, very painful when erupting, this belongs to sinew abscess, formed by confluence of wind-phlegm, stasis, and blood entering collaterals. Different from right foot’s hot-numbing pain. Now treat right foot first.
Raw Rehmannia, Donkey-hide Gelatin (*Colla Corii Asini*), Eucommia Bark (*Eucommiae Cortex*), Angelica Sinensis Root Body, Chaenomelis Fructus, Gastrodia, Autumn Atractylodes, Notopterygium (*Notopterygii Rhizoma et Radix*), Loofah Network (*Luffae Fructus Retinervus*), Achyranthes, Poria, Dioscorea Hypoglauca (*Dioscoreae Hypoglaucae Rhizoma*).
Liu Yi’s Note: Discussion is clear and thorough; formula is stable.
Deng’s Commentary: Cold and heat in different places, discussion is consistent. Although left and right differ, the formula can treat both.
Age sixty, kidney-liver essence-blood severely depleted, internal wind and phlegm-saliva moving through collaterals. Right-sided hands/feet weak, stiff tongue/slurred speech, roots of apoplexy-like stroke. Warm-tonify essence-blood, simultaneously resolve phlegm-saliva, hoping to avoid hemiplegia burden, but not easy. Patience in regulation is best.
Cistanche (*Cistanches Herba*), Morinda (*Morindae Officinalis Radix*), Poria, Chaenomelis Fructus, Pinellia, Lycium Fruit (*Lycii Fructus*, salt-fried), Polygala (prepared with Licorice decoction), Sea Pepper Vine (*Sargentodoxae Caulis*), Evodia (wine-fried), Achyranthes, Eucommia (salt-fried).
Liu Yi’s Note: Both this and the next case address potential apoplexy-like stroke, preparing in advance. Thus medications strive for stability, daring not to seek merit through aggressive treatments.
Deng’s Commentary: Elderly patients with this must use warming-tonification combined with transformation.
Formula modified from Di Huang Yin Zi shows careful consideration.
Kidney stores essence and governs bones; liver stores blood and governs sinews. Kidney-liver essence-blood depletion leaves bones/sinews full of gaps. Damp-heat, phlegm-saliva enter collaterals due to deficiency. Right-sided hands/feet weak, tongue root stiff, roots of apoplexy-like stroke. Warm-tonify essence-blood, unblock collaterals, resolve phlegm-saliva. Continuous服用 without laxity, plus rest, may eliminate disease and prolong life.
Cistanche, Codonopsis (stir-fried with millet), Achyranthes, Pinellia, Lycium Fruit (salt-fried), Tangerine Peel, Dipsacus (*Dipsaci Radix*), Poria, Morinda, Mulberry Branch.
Another Pill Formula:
Cistanche 2 liang (boiled in wine until soft, mashed); Codonopsis 3 liang (stir-fried with millet); Prepared Rehmannia 4 liang (mixed with Sandalwood powder and aged wine); Ophiopogon 2 liang (heart removed, stir-fried with millet); Ziziphus Seed 3 liang (stir-fried, ground); Morinda 3 liang (salt-processed); Angelica Sinensis Root Body 2 liang (wine-fried); Dioscorea Hypoglauca 3 liang (stir-fried); Polygonum Multiflorum 4 liang (processed); Poria 3 liang; Achyranthes 3 liang (salt-processed); Pinellia 2 liang; Anemarrhena 2 liang (heart removed, stir-fried with millet); Tangerine Peel 2.5 liang; Eucommia 3 liang (salt-processed); Tiger Bone (*Os Tigridis*) 3 liang (roasted); Acorus (*Acori Tatarinowii Rhizoma*) 1 liang; Lycium Fruit 4 liang (salt-processed).
Select authentic herbs, process according to method, grind finely. Mix with 4 liang Bamboo Juice and 3 liang Ginger Juice, mash together. Form pills with white honey, size of millet seeds. Store in porcelain. Take 5 qian every morning with warm water.
Deng’s Commentary: Formula and commentary are balanced and accessible, similar to the previous case, applying ancient formulas with flexibility.
The pill formula is even more comprehensive.
Sun’s Commentary: Right-sided weakness can stem from spleen-stomach qi decline with phlegm entering collaterals. Cases cured with Yupingfeng San and Wendan Tang represent another pattern.
Flaccidity and Bi Section
Congenital insufficiency, empty marrow. Often nourish postnatal spleen-stomach. Spleen-stomach tonified, damp-heat congests, body suddenly plumps, but tongue base stiff, legs flaccid, unable to walk. Upper excess, lower deficiency, disease belongs to flaccidity-bi. Classic says: If damp-heat is not eliminated, large sinews soften and shorten, small sinews relax and lengthen. Shortening causes spasm; lengthening causes flaccidity. Now propose supplementing congenital essence-qi, strengthening sinews/bones to treat lower; supporting postnatal spleen-stomach, transforming damp-heat to treat middle. Must take patiently for long time, strictly adhere without laxity, to achieve effect. If inconsistent, success is unlikely.
Prepared Rehmannia 4 qian, Aconite 3 fen (decoct juice for frying), Poria 3 qian, Achyranthes 1.5 qian (salt-processed), Mulberry Branch 1 liang, Tiger Tibia Bone (*Os Tibiae Tigridis*) 3 qian (roasted), Dipsacus 2 qian (wine-fried), Morinda 3 qian (salt-processed), Phellodendron (*Phellodendri Chinensis Cortex*) 1 qian (ginger juice-fried), Atractylodes (*Atractylodis Rhizoma*) 1.5 qian, Dioscorea Hypoglauca 2 qian (salt-processed), Bamboo Juice 20 spoons, Ginger Juice 1 spoon. External wash formula: Notopterygium 3 qian, Angelica Sinensis 5 qian, Carthamus (*Carthami Flos*) 1 qian, Old Wine Lees 2 liang, Pig Hind Leg Bones 2 pieces, Scallion White 3 stalks. Decoct, wash once daily.
Liu Yi’s Note: Such syndromes are hard to cure. Formula follows Danxi’s Hujian Fa with additions; medication is indeed appropriate.
Deng’s Commentary: Congenital insufficiency with damp-heat congestion. This flaw is easily committed by physicians. Qingzao Tang from Li Dongyuan could be used directly.
Latent heat remains in lung-stomach. Stomach heat digests grain easily causing hunger; lung heat causes lower limb flaccidity difficulty walking. Heat steams in chest, causing persistent internal heat. Half a year passed. Spring Equinox arrived, weather suddenly hot, illness worsened with insomnia. Previously yellow-black tongue coating; now dry-red tongue center, yin further injured. Imitating Zhang Zhongjing, use sweet-cold method.
Raw Rehmannia 3 qian, Anemarrhena 1.5 qian, Poria 3 qian, Ziziphus Seed 1.5 qian, Ophiopogon 2 qian, Talc (*Talcum*) 3 qian, Albizia Flower (*Albiziae Flos*) 5 fen, Glehnia 3 qian, Lily Bulb 1 liang. Decoct with spring water.
Liu Yi’s Note: *Jinkui Yaolue* Baihe Bing chapter uses Baihe with Zhi Mu, Di Huang, Talc etc. This formula adopts that intent.
Deng’s Commentary: Flaccidity syndrome mostly involves yin deficiency with damp-heat, sometimes with internal wind. Dry tongue and easy hunger indicate wind-fire disturbing internally, burning yin to dryness, no dampness congestion. Thus formula focuses on sweet-cold to nourish yin and clear dryness.
Second visit. Classic says: Lung heat scorches leaves, causing flaccidity. Previous formula cleared heart-lung and reduced fever, allowing getting up and walking. But night insomnia indicates kidney qi not connecting to heart, yin deficiency with yang hyperactivity. Clear metal, nourish water, draw Kan to fill Li as treatment.
Raw Rehmannia, Anemarrhena, Ophiopogon, Ziziphus Seed, Chinese Yam, Scrophularia (*Scrophulariae Radix*), Glehnia, American Ginseng, Lily Bulb. Separately, Hujian Wan 3 qian.
Liu Yi’s Note: Classic says: Lung heat scorches leaves, causing flaccidity. Also says: Treat flaccidity by selecting Yangming. Classic teachings are clear. Adhering to these two phrases, treatment methods are encompassed.
Deng’s Commentary: Insomnia often involves phlegm. Could add Erchen Tang, or Banxia Shumi method. Adding this bit of pungent-dry to large doses of sweet-cool should not injure fluids.
This pill is specific for treating flaccidity.
Third visit: Yin deficiency not recovered, night sleep uneasy, fever not cleared. Still should nourish yin. Claims slight abdominal distending pain, belonging to middle deficiency. Treatment should tonify spleen yin, simultaneously clear heart-lung heat.
Raw Rehmannia, Glehnia, American Ginseng, Chinese Yam, Ophiopogon, Ziziphus Seed, Coix Seed (*Coicis Semen*), Poria, Licorice, White Peony Root, Red Poria, Lily Bulb.
Separately, Guipi Wan.
Deng’s Commentary: Abdominal distending pain belongs to middle deficiency with wood overacting, or is it fault of purely using sweet-cold in previous formula?
Propose removing American Ginseng and Chinese Yam, adding Tangerine Peel, Chaenomelis Fructus, Chuanlianzi.
Cold rain soaked back first, rowing hard later, labor and sexual indulgence mixed inside. Illness started with fever and cough, lasting 40+ days. Phlegm air fishy/stinky, diet accepted, bedridden, flesh wasted. Lung first affected, then yin injured. Classic says: Yin deficiency attracts yang; lung heat scorches leaves, causing flaccidity. Also says: First loss injures lung, skin gathers, hair falls; to bone flaccidity unable to rise from bed is death. Combining classic meanings, clearly a difficult severe case.
Glehnia, *Asterae Radix*, Poria, Groundsel Tree Bark (*Agnus Casti Fructus* - note: text says Digupi/Digupiqi usually refers to *Lycopersici Fructus* or *Datura*, but context implies *Lycopersici* or *Digupi* likely *Datura* or *Lycium* bark? Actually *Digupi* usually *Lycopersici Fructus* or *Datura Metel* fruit. Given context "Di Gu Pi" usually *Lycopersici Fructus* or *Datura*. Wait, standard TCM *Di Gu Pi* is *Lycii Cortex*. Let's assume Lycium Bark), Fritillaria, Solomon's Seal (*Polygonati Odorati Rhizoma*), Coix Seed.
Separately, Baxian Changshou Wan 4 qian.
Deng’s Commentary: Kidney deficiency and essence depletion allow pathogen to deepen. Condition thus is difficult. Only 40+ days, diet accepted. Simultaneous yin-nourishing and pathogen-dispelling, still hope for miracle. Original formula was not bad. Consider Ge Shi Baohe Tang might be more effective. If indeed cold contracted after sex, and upright qi not exhausted, Mahuang/Xixin within Dihuang/Maidong/Wuweizi is particularly practical.
Second visit: Lung is water source, hundred vessels pay homage to lung, like waters to sea. Lung heat scorches leaves, fluids cannot irrigate meridians, causing flaccidity. Bedridden unable to move, flesh wasted, cough stinky phlegm, red tongue no coating, fine-rapid pulse. All signs of fluid consumption, dry-fire internal scorching. Examining classics, treating flaccidity selects Yangming because Yangming moistens Zongjin, stomach is source of qi-blood. Now propose generating stomach fluids to supply lung, imitating Yu Jiazhi of Xichang.
Glehnia, Donkey-hide Gelatin, Apricot Seed (*Armeniacae Semen Amarum*), Licorice, Scrophularia, Hemp Seed (*Cannabis Semen*), Anemarrhena, Ophiopogon, Solomon's Seal, Poria, Mulberry Leaf, Loquat Leaf (*Eriobotryae Folium*).
Liu Yi’s Note: Discussing disease and forming formula deeply aligns with *Neijing* Flaccidity Chapter principles.
Deng’s Commentary: Based on tongue/pulse, fire scorching yin damage is extreme. However, wind-cold is definitely trapped. If phlegm is thick/stinky, Wuru Tang method could be adapted. Presuming ignorance, prepared rough rules for experts to select.
Third visit: Administered Qingzao Jiufei method, condition slightly stabilized. Follow previous system.
Mulberry Leaf, Apricot Seed, Ophiopogon, Fritillaria, Lily Bulb, Xuanjing Stone (*Xuanjing Shi*), Donkey-hide Gelatin, Glehnia, Scrophularia, Loquat Leaf, Wild Arrowhead Root (*Zizania Caduciflora Rhizoma*).
Deng’s Commentary: Three visits, methods stable enough, can sustain time, unlikely to remove root. Alas, perhaps limited by urgent circumstances.
Sun’s Commentary: Using Wild Arrowhead Root likely because fishy odor not cleared. Why not add *Asterae Radix* and Coix Seed?
Vegetarian for 20 years, essence-blood long dried up; heavy rain soaked body, dampness invaded bones. Legs/thighs heavy, unable to move. Method: Unblock joints, assist with nourishing blood and generating fluids.