诒按：案语分析病机，极其圆到。惟立方似末恰合，阳明药少，宜加知母、枳实。
邓评：能指出病之关键处，便为好手。
风热上甚，头痛不已。如鸟巢高巅，宜射而去之。
诒按：此虽前人成法，而选药颇精筒。据此则大黄当用酒炒，以使之上行。
邓评：此等方具见学博才高。宜射而去之者，因有川芎引而上之也。拟再加天麻、防风佐之为引。
孙评；宜参酒洗蝎尾之类。据此则头上必有高凸之形。
肢体诸痛门
风邪中入经络，从肩膊至项强痛，舌干唇紫而肿，痛处如针刺之状。此是内挟肝火，不宜过用温散，惟宜养阴熄肝火而已。
邓评：痛如针刺之状，知是内挟肝火。审病之诀，可谓熟极。所用细生地、钩钩，皆能清络中之热。
孙评：肩项强痛，本是寒入经络之象，宜从温散多惟内挟肝火，舌干唇紫者，里热为重，宜从里治。
柳师加减，更为贴切。
身半以上，痛引肩臂，风湿在于太阴之分，行动则气促不舒，胸肤高起，治在经络。
诒按：拟用旋覆新绛汤送下。
睥肾寒湿下注，右膝肿痛，而色不赤，其脉当迟缓而小促，食少辄口区，中气之衰，亦已甚矣。此当以和养中气为要，肿痛姑置勿论。盖未有中气不复，而膝得愈者也。
诒按：议论明通。
邓评：此乃水鹤膝风之证状。所谓和养中气，实即所以治肿痛也；但不拘拘乎肿痛常例，吴萸似可加入。
背脊为督脉所过之处，风冷乘之，脉不得通，则恶寒而痛。法宜通阳。
邓评：分经辨络既明，自能头头是道。
身痛偏左。血不足，风乘之也。
诒按：案只一二句，却有筒逸之致。
邓评：观方药不特有风，且多抉痰饮。盖案取筒净，言风而痰亦该之矣。
久咳胁痛，不能左侧。病在肝，逆在肺，得之情志，难以骤驱。治法不当求肺，而当求肝。
诒按：审证用药，巧力兼到。拟再加青皮、桑皮、紫苏、山栀、瓦楞子壳。
柳师所加，亦宜于肝体未伤之时。
孙评：柳氏所加，似太烦复。
胁疼遇春即发，过之即止，此肝病也。春三月肝木司令，肝阳方张，而阴不能从，则其气有不达之处，故痛；夏秋冬肝气就衰，与阴适协，故不痛也。
诒按：朴实说理，绝无躲闪。方用胶、芍，鲍鱼，滋肝配阳，亦觉妥贴易施。
孙评：细阅方意，有痛则咯血之症。
诒按：立方妥贴，层折俱到。
脉数、耳鸣、吐痰，天柱与腰膝酸痛，两足常冷。病属阴亏阳升。法当填补实下。
邓评：此病属阴虚阳升，盖有不易之理，如杜仲、牛膝、牡蛎之类，均在可用之例。
诸 窍 门
风热蓄于脑髓，发为鼻渊，五年不愈，此壅疾也。壅则宜通，不通则不治。
肺之络会于耳中，肺受风火，久而不清，窍与络俱为之闭，所以鼻塞不闻香臭，耳聋耳鸣不闻音声也。兹当清通肺气。
苍耳子 薄荷 桔梗 连翘 辛夷 黄芩 山栀 杏仁 甘草 木通
诒按：语云耳聋治肺，观此信然。
少阳之脉，循耳外，走耳中。是经有风火，则耳脓而鸣。治宜清散。
诒按：案既老当，方亦清灵。
邓评：看病如此熟悉，有意到笔随之势。
孙评：风火为患，必有肿痛；如不肿痛，已有虚象。 日久则肝肾阴虚，宜用六味、磁朱之类以滋养之。
加减八味丸 每服三钱盐花汤下
诒按：立方精到。
邓评，识见高超，直如老吏断狱。
孙评：齿痛属肾虚者，每挟肝阳上升，宜参入清肝之品，如天冬、石斛之类。
脚 气 门
厥阴之邪，逆攻阳明，始为肿痛，继而腹疼，胸满呕吐。此属脚气冲心，非小恙也。拟外台法冶之。
邓评：能用古而不疑者，诚火候工深，胸有成竹。
邓评：转方轻松，与前方意同而药异。
诒按：脚气一证，前人归入类伤寒中：必憎寒壮热，病与伤寒相似，甚则有冲心之患，敢谓之重证。外台有大犀角汤及风引汤，后人有鸡呜散等方，均为专治脚气之重剂。乃今时所谓脚气者，则以脚膝酸软而肿者，谓之湿脚气，不肿者，谓之干脚气，专用防己、木瓜、牛膝、薏米等风湿之药治之。与前人所称者，大相径庭。学者不可不辨。
孙讦：前人之法，及今时所治，如有精义，兼参可也，学者不可偏废。
遗 精 门
遗精无梦，小劳即发，饥不能食，食多即胀，面白唇热，小便黄赤。此睥家湿热，流入肾中为遗滑，不当徒用补涩之药；恐积热日增，致滋他族。
诒按：此等证，早服补涩，每多愈服愈甚者。先生此案，可谓大声疾呼。
邓评：认题清楚，立方熨贴。非若近世之医，或因遗精无梦而峻用补涩，或以湿热内留而专事通利，凡其弊与此病适相同也。
孙评：此人必身强色苍，今因病而面白耳。
邓评：循理用药，自能应手，加减亦中肯綮。
少阴为三阴之枢，内司启闭，虚则失其常矣。法宜填补少阴；或通或塞，皆非其治。
诒按：此补肾之乎剂，可以常服无弊。
邓评：重在补而不重在塞，可谓至理至情。
孙评：填补之法，似宜从叶氏有情之品。
遗精伤肾，气不收摄，入夜卧著，气冲上膈，腹胀呼吸不通，竟夕危坐，足跗浮肿清冷，小便渐少。此本实先拨，枝将败矣，难治之证也。
诒按：此阴阳两损，气不摄纳之重证，舍此竟无良法，然亦未能必效也。
邓评：本虚而病重，至此难为力矣。区区丸药，乌能有济，且恐不得下咽耳。
阴亏阳动，内热梦泄。
诒按：六味合封髓法也，亦妥贴易施。
小 便 门
两尺软弱，根本不固；小便浑浊，病在肾脏；久久不愈，则成下消。
诒按：方法稳切。
孙评：此症必小便频而且数。
形伟体丰，脉得小缓。凡阳气发泄之人，外似有余，内实不足，水谷之气，不得阳运，酿湿下注，而为浊病，已三四年矣。气坠宜升阳为法，非比少壮阴火自灼之病。
菟丝子 茴香 车前子 韭子 蒺藜 茯苓 覆盆子 蛇床子 黄鱼骨捣丸每服五钱
诒按：此证当以脾土为主。 但与温养下元，尚非洁源清流之道。
又按，此与相火下注者不同，故用药如是。
邓评：老年体丰，温药以通补，尚合题旨。
菟丝子、韭子、茴香，为升阳之味。骨字或是胶字之误。蒺藜即是沙苑子。
孙评：因水谷酿湿，故柳云宜以脾土为主。然形丰者必肥白而非花黑也。
烦劳四十余天，心阳自亢，肾水暗伤，阳坠入阴，故溲数便血，不觉管窒痛痹，实与淋证不同。其中虽不无湿热，而寝食安然。不必渗泄利湿，宜宁心阳`益肾阴，宣通肾气以和之。
熟地炭 人参 霍石斛 丹皮 泽泻 茯苓 远志 柏子仁 湖莲肉
诒按：此治本之方，由其论病亲切，故立方自稳。
邓评：随其因，就其证，合推其源，自无遁情。方内如细生地、元武板，尚可参入。
泄 泻 门
恼怒伤中，湿热乘之，脾气不运，水谷并趋大肠，而为泄；腹中微疼，脉窒不和，治在中焦。
诒按：此方妙在木瓜一味，兼能疏肝。须知此意，乃识立方选药之妙。
又按：案中脉窒句，不甚明了。
邓评：方实轻灵可喜。
脉窒即是涩滞之意。但何不竟云脉涩为直捷了当！
痢 疾 门
暑湿外侵经络则为疟，内动肠藏则为痢，而所恃以攘外安内者，则在胃气。故宜和补之法，勿用攻削之剂，恐邪气乘虚，尽入于里也。
诒按：案语殊妙，惜此方之佚也。
邓评：疟痢并作，宜和养胃气，为至要之言。拟升阳益胃汤以补其缺。
孙评：根本深谭，入理妙论。
大 便 门
气郁不行，津枯不泽，饮食少，大便难，形瘦脉涩。未可概与通下。宜以养液顺气之剂治之。
诒按：此气阻液枯之证，拟加鲜首乌。
邓评：仲景虽有脉涩可下之例，究属涩不宜下者罕见也。此方宗通凿汤而交通之，却胜于原方，以其流利不滞也。
孙评：此证必大腹硬满，按之或痛；若不硬满者，即无燥矢闭结，不可用承气。
邓评：想其营分亦伤，故加归、芍以养之。
三诊：改用制军加浔桂厚朴
邓评：三诊想因旁流挟湿，非温不化。
下血后，大便燥闭不爽，继而自利，白滑胶粘，日数十行，形衰脉沉。必因久伏水谷之湿。府病宜通，以温下法。
诒按：自利胶滑，有因燥矢不行，气迫于肠，而脂膏自下者。当专行燥矢，兼养肠液，未可概以湿论也。
邓评：苟系燥矢而利胶粘，其粪仍燥结。据继而自利白滑胶粘，当有湿积。方极周到。
孙评：此又是一格，学者务宜细考虚实，病而腹满痛者，亦可参用此法，以下寒湿之积，利出白滑胶粘为验。
脾约者，津液约束不行，不饥不大便。备尝诸药，中气大困。仿古人以食治之法。
黑芝麻杜苏子 二味煎浓汁如饴，服三五日，即服人乳一杯，炖温入姜汁二匙。
诒按：此无法之法也。良工心苦矣。
邓评：中气既已大困，似宜醒运中枢以致开阔，如归芍六君与枳术丸之类，二法均可取用。
孙注：华用康先生遇一伏暑后不饥不食，大便燥闭，如是者半年余矣。用鲜苁蓉二两，漂淡，合五仁汤、梨汁等而愈者，想系初起过投苦燥，脾阳愈旺而胃阴益伤，故用叶氏养胃阴之法，与此正同。
便血，不独责虚，亦当责湿，所以滋补无功，而疏利获益也。兹足痿无力，其湿不但在脾，又及肾矣。当作脾肾湿热成痹治之。
诒按：案语明确，方亦简当。
【柳选按语】：对医案中的病机分析极为周全圆融。但所立处方似乎不够恰当，阳明经的药物偏少，建议加入知母、枳实。
邓评：能够指出疾病的关键所在，就算是好医生了。
孙评：痰火相互郁结，因此应当采用清降的方法，而不宜使用补益收敛之法，这是确定的治疗层次。
头痛偏向左侧，耳朵听力沉重，眼睛视物不明，脉象寸部大尺部小。这是风火在上焦，暂且采用清热解表的方法。
风热上扰严重，头痛不止。就像鸟巢在高处，应当用箭射下来。
【柳选按语】：这虽然是前人的成法，但选药颇为精简。据此推断，大黄应当用酒炒，以便使其药性上行。
邓评：这样的方子体现了医者学识渊博、才华高超。“宜射而去之”的意思，是因为有川芎引药上行。拟再加天麻、防风作为引经药。
孙评：适宜参入酒洗的全蝎尾之类。据此推断，头上必定有高凸的形状。
肢体疼痛门
风邪侵入经络，从肩膊到项部僵硬疼痛，舌头干燥嘴唇紫绀且肿胀，疼痛部位像针刺一样。这是内部挟带肝火，不宜过度使用温散药物，只适宜养阴以熄灭肝火。
【柳选按语】：因为嘴唇紫绀、舌头干燥，所以知道内部挟带肝火。方中的黄芩，不如山栀恰当。
邓评：疼痛如针刺状，可知是内部挟带肝火。审察疾病的诀窍，可以说是熟练至极。所用的细生地、钩藤，都能清除络脉中的热邪。
孙评：肩项强痛，本是寒邪侵入经络的现象，本应从温散入手；但内部挟带肝火，舌干唇紫者，里热为重，应当从调理内部着手。
项背部疼痛如刀割。治疗应当养血通络。
柳师加减后，更为贴切。
身体半以上，疼痛牵引肩臂，风湿邪气在太阴经分，行动时气促不适，胸部皮肤高起，治疗重点在经络。
脾肾寒湿下注，右膝肿痛，但颜色不红，脉象应当迟缓而小促，吃得少就恶心呕吐，中气衰弱，也已经很严重了。这应当以调和养护中气为关键，肿痛暂时搁置不论。从来没有中气不恢复，而膝盖能痊愈的道理。
【柳选按语】：议论明白通达。
邓评：这是鹤膝风的证状。所谓调和养护中气，实际上就是治疗肿痛的方法；但不拘泥于治疗肿痛的常规，吴茱萸似乎可以加入。
背脊是督脉经过的地方，风冷侵袭它，脉道不通畅，就会恶寒且疼痛。治法应当通阳。
邓评：分经辨络既然明确，自然能头头是道。
方中使用半夏、生姜，怀疑是有痰饮进入的缘故吧。柳师的加味极其巧妙。
身体疼痛偏向左侧。血不足，风邪乘虚而入。
【柳选按语】：医案只有寥寥一二句，却有简练飘逸的风致。
邓评：看方药不仅治风，而且多涉及祛除痰饮。大概医案追求简洁干净，言风而痰也在其中了。
久咳伴胁痛，不能向左侧卧。病在肝，气逆在肺，得自情志因素，难以迅速驱除。治法不应当求之于肺，而应当求之于肝。
【柳选按语】：审察证候用药，巧劲与力度兼备。拟再加青皮、桑皮、紫苏、山栀、瓦楞子壳。
邓评：咳嗽难以向左睡，本来属于难治的例子，现见此方药，想是病机尚未至深重枯竭罢了。
柳师所加的药材，也适宜在肝体未受损时使用。
孙评：柳氏所加的药材，似乎太繁杂。
胁痛遇春季即发作，过后即停止，这是肝病。春季三个月肝木当令，肝阳正盛，而阴液不能随之，导致气机不达之处，所以疼痛；夏秋冬三季肝气衰退，与阴液协调，所以不痛。
【柳选按语】：朴实说理，绝无躲闪。方中用胶、芍、鲍鱼，滋养肝体配合潜阳，也觉得妥帖易行。
孙评：细阅方意，有痛则咯血的症候。
风气乘虚侵入肾络，腰部疼痛牵引背胁。适宜用寄生汤补虚通络祛风。
【柳选按语】：立方妥帖，层层转折都到位。
邓评：其疼痛牵引胁部，或许兼挟肝气，可参合旋覆花汤以疏通肝络。
脉数、耳鸣、吐痰，天柱骨及腰膝酸痛，两脚常冷。病属阴亏阳升。治法应当填补下部。
邓评：此病属阴虚阳升，确有不易之理，如杜仲、牛膝、牡蛎之类，都在可用之列。
诸窍门
风热蓄积于脑髓，发为鼻渊，五年不愈，这是壅滞之疾。壅滞则宜通利，不通则无法治愈。
邓评：此病不离清散之法，绝不拘守咸味软坚之法，这也是脱化功夫。
肺的络脉会合于耳中，肺受风火侵袭，久而不清，窍与络都被闭塞，所以鼻塞闻不到香臭，耳聋耳鸣听不到声音。此时应当清通肺气。
苍耳子 薄荷 桔梗 连翘 辛夷 黄芩 山栀 杏仁 甘草 木通
少阳经脉，循行于耳外，走向耳中。这条经脉有风火，就会耳流脓且鸣响。治法宜清散。
【柳选按语】：医案既老练，方剂也清灵。
邓评：看病如此熟悉，有意到笔随的气势。
孙评：风火为患，必有肿痛；如果不肿痛，已有虚象。日久则肝肾阴虚，宜用六味地黄丸、磁朱丸之类来滋养。
加减八味丸 每服三钱盐花汤送下
【柳选按语】：立方精到。
邓评：识见高超，直如老吏断狱。
孙评：齿痛属肾虚者，每挟肝阳上升，宜参入清肝之品，如天冬、石斛之类。
脚气门
厥阴之邪，逆攻阳明，开始肿痛，继而腹痛，胸满呕吐。这属于脚气冲心，不是小病。拟用《外台秘要》的方法治疗。
邓评：能用古方而不怀疑的人，确实火候工深，胸有成竹。
邓评：转方轻松，与前方的意图相同但药物不同。
【柳选按语】：脚气一证，前人归入类伤寒中：必定憎寒壮热，病与伤寒相似，甚至有冲心的祸患，敢称之为重证。《外台秘要》有大犀角汤及风引汤，后人有鸡鸣散等方，均为专治脚气的重剂。然而今时所谓的脚气，则是以脚膝酸软而肿者，称为湿脚气，不肿者，称为干脚气，专用防己、木瓜、牛膝、薏米等风湿药物治疗。与前人所称的，大相径庭。学者不可不辨别。
孙评：前人的方法，以及今时所治的，如有精义，兼参即可，学者不可偏废。
遗精门
无梦遗精，轻微劳累即发作，饥饿不能进食，吃多即腹胀，面白唇热，小便黄赤。这是脾家湿热，流入肾中导致遗滑，不应当单纯使用补涩药物；恐怕积热日益增加，导致滋生病变。
【柳选按语】：此类证候，早服补涩药，往往越服越严重。先生此案，可谓大声疾呼。
邓评：认题清楚，立方熨帖。不像近世的医生，或因遗精无梦而峻用补涩，或以湿热内留而专事通利，凡其弊病与此病恰相同也。
孙评：此人必定身体强壮面色黧黑，现在因病而面白罢了。
邓评：循理用药，自然能应手而效，加减也中肯綮。
少阴是三阴的枢纽，内部主管启闭，虚则失去常态。治法宜填补少阴；或通或塞，都不是正确的治法。
邓评：重在补而不重在塞，可谓至理至情。
遗精伤肾，气不收摄，入夜卧床，气冲上膈，腹胀呼吸不通，整夜危坐，足背浮肿清冷，小便渐少。这是根本先拔，枝叶将败，难治之证。
【柳选按语】：这是阴阳两损，气不摄纳的重证，舍此竟无良法，但也未必能必效。
邓评：本虚而病重，到了这一步难以施力了。区区丸药，怎么能有济于事，且恐怕不得下咽罢了。
阴亏阳动，内热梦泄。
小便门
两尺脉软弱，根本不固；小便浑浊，病在肾脏；久久不愈，则成下消。
【柳选按语】：方法稳切。
孙评：此症必定小便频而且数。
形体伟岸丰满，脉象小缓。凡是阳气发泄之人，外表似有余，内里实不足，水谷之气，不得阳气运化，酿湿下注，而为浊病，已经三四年了。气坠宜用升阳为法，不像少壮之年阴火自灼的病。
菟丝子 茴香 车前子 韭子 蒺藜 茯苓 覆盆子 蛇床子 黄鱼骨捣丸每服五钱
【柳选按语】：此证应当以脾土为主。但与温养下元相比，尚非洁源清流之道。
又按，这与相火下注者不同，所以用药如此。
邓评：老年体丰，温药以通补，尚合题意。
菟丝子、韭子、茴香，为升阳之味。骨字或是胶字之误。蒺藜即是沙苑子。
孙评：因水谷酿湿，所以柳云宜以脾土为主。然而形丰者必定肥白而非花黑也。
烦劳四十余天，心阳自亢，肾水暗伤，阳坠入阴，所以溲数便血，不觉尿道窒痛痹阻，实在与淋证不同。其中虽不无湿热，但寝食安然。不必渗泄利湿，宜宁心阳、益肾阴，宣通肾气以调和之。
熟地炭 人参 霍石斛 丹皮 泽泻 茯苓 远志 柏子仁 湖莲肉
【柳选按语】：这是治本之方，由其论病亲切，故立方自稳。
邓评：随其因，就其证，合推其源，自无遁情。方内如细生地、元武板（龟板），尚可参入。
泄泻门
恼怒伤中，湿热乘之，脾气不运，水谷并趋大肠，而为泄；腹中微疼，脉窒不和，治在中焦。
【柳选按语】：此方妙在木瓜一味，兼能疏肝。须知此意，乃识立方选药之妙。
又按：案中脉窒句，不甚明了。
邓评：方实轻灵可喜。
脉窒即是涩滞之意。但何不竟云脉涩为直捷了当！
痢疾门
暑湿外侵经络则为疟，内动肠藏则为痢，而所恃以攘外安内者，则在胃气。故宜和补之法，勿用攻削之剂，恐邪气乘虚，尽入于里也。
【柳选按语】：案语殊妙，惜此方之佚也。
邓评：疟痢并作，宜和养胃气，为至要之言。拟升阳益胃汤以补其缺。
孙评：根本深谭，入理妙论。
大便门
气郁不行，津枯不泽，饮食少，大便难，形瘦脉涩。未可概与通下。宜以养液顺气之剂治之。
邓评：仲景虽有脉涩可下之例，究属涩不宜下者罕见也。此方宗通凿汤而交通之，却胜于原方，以其流利不滞也。
孙评：此证必大腹硬满，按之或痛；若不硬满者，即无燥矢闭结，不可用承气。
邓评：想其营分亦伤，故加归、芍以养之。
三诊：改用制军加浔桂厚朴
邓评：三诊想因旁流挟湿，非温不化。
下血后，大便燥闭不爽，继而自利，白滑胶粘，日数十行，形衰脉沉。必因久伏水谷之湿。府病宜通，以温下法。
【柳选按语】：自利胶滑，有因燥矢不行，气迫于肠，而脂膏自下者。当专行燥矢，兼养肠液，未可概以湿论也。
邓评：苟系燥矢而利胶粘，其粪仍燥结。据继而自利白滑胶粘，当有湿积。方极周到。
孙评：此又是一格，学者务宜细考虚实，病而腹满痛者，亦可参用此法，以下寒湿之积，利出白滑胶粘为验。
脾约者，津液约束不行，不饥不大便。备尝诸药，中气大困。仿古人以食治之法。
黑芝麻杜苏子 二味煎浓汁如饴，服三五日，即服人乳一杯，炖温入姜汁二匙。
邓评：中气既已大困，似宜醒运中枢以致开阔，如归芍六君与枳术丸之类，二法均可取用。
孙注：华用康先生遇一伏暑后不饥不食，大便燥闭，如是者半年余矣。用鲜苁蓉二两，漂淡，合五仁汤、梨汁等而愈者，想系初起过投苦燥，脾阳愈旺而胃阴益伤，故用叶氏养胃阴之法，与此正同。
便血，不独责虚，亦当责湿，所以滋补无功，而疏利获益也。兹足痿无力，其湿不但在脾，又及肾矣。当作脾肾湿热成痹治之。
【柳选按语】：案语明确，方亦简当。
[Liu's Commentary]: The analysis of the pathogenesis in the case is extremely comprehensive and well-rounded. However, the prescribed formula seems somewhat inappropriate; there are few herbs targeting the Yangming channel. It is advisable to add *Anemarrhenae Rhizoma* (Zhimu) and *Immature Bitter Orange* (Zhishi).
[Deng's Comment]: Being able to point out the key aspect of the disease marks a skilled practitioner.
If this disease presents with chest fullness and stagnation accompanied by Yin deficiency, it is indeed a difficult and tricky condition to treat.
[Sun's Comment]: When Phlegm-Fire intertwine and stagnate, clearing and descending methods should be used rather than tonifying and astringing methods. This is a fixed principle.
Headache偏向 left side, heavy hearing in ears, blurred vision, pulse large at Cun (inch) position and small at Chi (cubit) position. Wind-Fire is ascending in the Upper Jiao. For now, use clearing and resolving methods.
*Antelope Horn* (Lingyangjiao), *Rehmanniae Radix Preparata* (Shengdi), *Glycyrrhizae Radix et Rhizoma* (Gancao), *Chrysanthemi Flos* (Juhua), *Moutan Cortex* (Danpi), *Haliotidis Concha* (Shijueming), *Forsythiae Fructus* (Lianqiao), *Menthae Haplocalycis Herba* (Bohe)
[Liu's Commentary]: This is Internal Wind combined with External Pathogen. Dispersing and clearing should be applied together.
[Deng's Comment]: Indeed, Wind-Fire is excessively ascending, hence the medication is so precise and effective.
[Sun's Comment]: It is suitable to include *Broussonetiae Folium* (Sangye), *Vitex Fructus* (Manjingzi), and *Uncariae Ramulus cum Uncis* (Gouteng).
Wind-Heat is severe in the upper part, headache persists. Like a bird's nest on a high peak, it should be shot down.
*Radix Rhei Preparata* (Zhi Jun/Dahuang), *Rhinocerotis Cornu* (Xijiao), *Ligustici Chuanxiong Rhizoma* (Chuanxiong), Fine Tea (Xicha)
[Liu's Commentary]: Although this is an established method from predecessors, the selection of herbs is quite concise. Based on this, Dahuang should be stir-fried with wine to facilitate its upward movement.
[Deng's Comment]: Such formulas demonstrate profound learning and high talent. "Should be shot down" implies that because *Chuanxiong* guides the medicine upward, we should consider adding *Gastrodiae Rhizoma* (Tianma) and *Saposhnikoviae Radix* (Fangfeng) as guiding agents.
[Sun's Comment]: It is suitable to include scorpion tails washed with wine. Based on this, there must be a convex shape on the head.
Chapter: Limb Pain
Wind-Evil enters the meridians, causing stiffness and pain from shoulders to neck. Tongue is dry, lips are purple and swollen, pain feels like needle pricks. This indicates internal Liver Fire. Overuse of warm dispersing drugs is not suitable; only nourishing Yin and extinguishing Liver Fire is appropriate.
*Antelope Horn*, *Rehmanniae Radix* (Xi Shengdi), *Chrysanthemi Indici Flos* (Ganju), *Scutellariae Radix* (Huangqin), *Uncariae Ramulus cum Uncis* (Gou Gou), *Gnaphalii Herba* (Qinjiao), *Moutan Cortex*
[Liu's Commentary]: Because lips are purple and tongue is dry, we know there is internal Liver Fire. In the formula, *Huangqin* is less appropriate than *Gardeniae Fructus* (Shanzhi).
[Deng's Comment]: Pain like needle pricks indicates internal Liver Fire. The key to diagnosing the disease shows great proficiency. The *Xi Shengdi* and *Gou Gou* used can both clear heat from the collaterals.
[Sun's Comment]: Stiffness and pain in shoulder and neck are originally signs of Cold entering the meridians, which should be treated with warm dispersing. However, since there is internal Liver Fire, with dry tongue and purple lips, the interior heat is heavy, so treatment should focus on the interior.
Pain in neck and back like knife cutting. Treatment should nourish Blood and unblock collaterals.
*Cinnamomi Ramulus* (Guizhi), *Uncariae Ramulus* (Gouteng), *Paeoniae Radix Alba* (Baishao), *Anemarrhenae Rhizoma* (Zhimu), *Antelope Horn*, *Asini Corii Colla* (Ejiao), *Glycyrrhizae Radix et Rhizoma* (Zhi Cao), *Rehmanniae Radix Preparata* (Shengdi)
[Liu's Commentary]: Propose removing *Zhimu*, adding *Angelicae Sinensis Radix* (Guixu), *Tribuli Fructus* (Ciji), and *Luffae Fructus Retinervus* (Sigualuo).
[Deng's Comment]: This belongs to Blood deficiency with Wind-Evil. The prescription fits the theme perfectly.
Master Liu's modifications are even more appropriate.
Pain above the half-body radiating to shoulders and arms. Wind-Dampness is in the Taiyin division. Movement causes shortness of breath and discomfort. Chest skin is raised. Treatment focuses on the meridians.
*Da Huoluo Dan* (Great Living Meridian Pill)
[Liu's Commentary]: Propose administering with *Xuanfu Xingjiang Tang*.
[Deng's Comment]: *Zhimi Fu Ling Wan* also seems compatible with this syndrome.
[Sun's Comment]: For shoulder and arm pain, *Curcumae Radix* (Pian Jianghuang) and *Mori Ramulus* (Yezhizhi) should be added to guide the medicine.
Spleen and Kidney Cold-Dampness sinking downward. Right knee is swollen and painful but color is not red. Pulse should be slow and small with occasional rapid beats. Poor appetite leads to nausea. Middle Qi decline is severe. The priority is to harmonize and nourish Middle Qi. Swelling and pain can be temporarily ignored. There is no case where Middle Qi does not recover yet the knee heals.
*Ginseng Radix* (Ren Shen), *Pinelliae Rhizoma Preparatum* (Banxia), *Chaenomelis Fructus* (Mugua), Stir-fried *Oryza Sativa* (Chao Jingmi), *Poria* (Fuling), *Citri Reticulatae Pericarpium* (Guangpi), *Alpiniae Oxyphyllae Fructus* (Yizhiren)
[Liu's Commentary]: The discussion is clear and logical.
[Deng's Comment]: This is a symptom of Crane Knee Wind (Knee Bi). Harmonizing and nourishing Middle Qi is essentially treating the swelling and pain; however, not sticking rigidly to standard treatments for swelling, *Evodiae Fructus* (Wuyu) could be added.
[Sun's Comment]: Ultimately, herbs that guide downward should be added, such as *Achyranthis Bidentatae Radix* (Niuxi) and *Gnaphalii Herba* (Qinjiao).
The spine is where the Du Mai passes. Wind-Cold attacks it, blocking the pulse, causing aversion to cold and pain. The method should be to unblock Yang.
*Cornus Cervi Os Degelatinatum* (Lujiaoshuang), *Paeoniae Radix Alba* (Baishao), *Glycyrrhizae Radix et Rhizoma* (Zhi Cao), *Cinnamomi Ramulus* (Guizhi), *Angelicae Sinensis Radix* (Guishen), *Pinelliae Rhizoma* (Banxia), *Zingiberis Rhizoma Recens* (Shengjiang), *Jujubae Fructus* (Nanzao)
[Liu's Commentary]: *Banxia* in the formula has no specific meaning. Propose adding *Eucommiae Cortex* (Duzhong) and *Achyrantis Radix* (Gouji) to unblock Yang.
[Deng's Comment]: Since meridian and collateral differentiation is clear, the reasoning is sound.
Using *Banxia* and *Shengjiang* in the formula suggests suspicion of Phlegm-Fluid retention. Master Liu's additions are excellent.
[Sun's Comment]: *Notopterygii Rhizoma* (Qianghuo) and *Angelicae Pubescentis Radix* (Duohuo) can be added to warm and disperse Wind.
Body pain偏向 left. Blood is insufficient, Wind takes advantage.
*Pinelliae Rhizoma* (Banxia), *Gnaphalii Herba* (Qinjiao), *Angelicae Sinensis Radix* (Guishen), *Citri Reticulatae Pericarpium* (Guangpi), *Poria* (Fuling), *Salviae Miltiorrhizae Radix* (Danshen), *Dipsaci Radix* (Chuanduan), *Glycyrrhizae Radix et Rhizoma* (Zhi Cao)
[Liu's Commentary]: The case has only one or two sentences, yet possesses a concise and elegant style.
[Deng's Comment]: Looking at the prescription, it treats not only Wind but also removes Phlegm-Fluid. The case aims for simplicity; mentioning Wind implies Phlegm is also addressed.
[Sun's Comment]: The wind-dispelling agents seem insufficient.
Chronic cough with hypochondriac pain, unable to lie on left side. Disease is in Liver, rebellion is in Lung, caused by emotional factors, difficult to drive out quickly. Treatment should not seek the Lung, but the Liver.
*Inulae Flos* (Xuanfuhua), *Moutan Cortex* (Danpi), *Persicae Semen* (Taoren), *Curcumae Aromatica Rhizoma* (Yujin), *Rubia Cordifolia Radix et Rhizoma* (Xingjiang), *Glycyrrhizae Radix et Rhizoma* (Gancao), *Achyranthis Bidentatae Radix* (Niuxi), *Paeoniae Radix Alba* (Baishao)
[Liu's Commentary]: Examining symptoms and prescribing medication combines skill and strength. Propose adding *Citri Reticulatae Pericarpium Viride* (Qingpi), *Mori Folium* (Sangpi), *Perillae Folium* (Zisu), *Gardeniae Fructus* (Shanzhi), and *Arcaea Concha* (Walengzi Qiao).
[Deng's Comment]: Cough preventing sleep on the left is traditionally considered difficult to treat. Seeing this prescription, the pathogenesis likely has not reached deep exhaustion.
The additions by Master Liu are suitable when the Liver substance is not yet damaged.
[Sun's Comment]: The additions by Mr. Liu seem too complex.
Hypochondriac pain starts in spring and stops afterwards. This is Liver disease. In the three months of Spring, Liver Wood commands. Liver Yang is rising, but Yin cannot follow, causing Qi stagnation and pain. In Summer, Autumn, and Winter, Liver Qi declines and harmonizes with Yin, so there is no pain.
*Asini Corii Colla* (Ejiao), *Paeoniae Radix Alba* (Baishao), *Poria* (Fuling), *Moutan Cortex* (Danpi), *Rubia Cordifolia Radix et Rhizoma* (Qiancao), *Glycyrrhizae Radix et Rhizoma* (Zhi Cao), Abalone Soup instead of water
[Liu's Commentary]: Plain reasoning, no evasion. Using Ejiao, Baishao, and Abalone nourishes Liver and anchors Yang, feeling appropriate and easy to apply.
[Deng's Comment]: Complex thinking, penetrating understanding of disease origin. The plans have irrefutable logic.
[Sun's Comment]: Carefully reading the prescription intent, there is a symptom of hemoptysis upon pain.
Wind-Evil enters Kidney collaterals due to deficiency. Waist pain radiates to back and sides. *Sangjisheng Tang* (Mulberry Mistletoe Decoction) should be used to tonify deficiency, unblock collaterals, and dispel Wind.
*Rehmanniae Radix Preparata* (Shengdi), *Angelicae Sinensis Radix* (Guishen), *Sojae Semen Nigrum* (Heidouda), *Angelicae Pubescentis Radix* (Duohuo), *Dioscoreae Rhizoma* (Shanyao), *Tribuli Fructus* (Baijili), *Eucommiae Cortex* (Duzhong), *Glycyrrhizae Radix et Rhizoma* (Zhi Cao), *Taxilli Herba* (Sangjisheng)
[Liu's Commentary]: The prescription is appropriate, with layered considerations fully addressed.
[Deng's Comment]: Since pain radiates to sides, it might involve Liver Qi. Consider combining with *Xuanfuhua Tang* to unblock Liver collaterals.
Pulse is rapid, tinnitus, expectoration, Tianzhu bone and waist/knee soreness, feet always cold. Disease belongs to Yin deficiency with Yang rising. Method should be to fill and solidify the Lower Jiao.
*Rehmanniae Radix Preparata* (Shudi), *Cornus Cervi Os Degelatinatum* (Lujiaoshuang), *Cuscutae Semen* (Tusizi), *Dioscoreae Rhizoma* (Shanyao), *Corni Fructus* (Yurou), *Semen Lycii* (Qizi), *Testudinis Carapax et Plastrum Preparatum* (Guiban Jiao)
[Deng's Comment]: This disease belongs to Yin deficiency and Yang rising, which is an immutable principle. Herbs like *Duzhong*, *Niuxi*, and *Ostrea Concha* (Muli) are all usable.
Chapter: Orifices
Wind-Heat accumulates in brain marrow, causing Nasal Sinusitis (Bi Yuan), lasting five years without healing. This is a stagnant disease. Stagnation requires unblocking; if not unblocked, it cannot be cured.
*Rhinocerotis Cornu* (Xijiao), *Xanthii Fructus* (Cangerzi), *Scutellariae Radix* (Huangqin), *Curcumae Aromatica Rhizoma* (Yujin), *Prunus Armeniaca Semen* (Xingren), *Phragmitis Rhizoma* (Lugen)
[Liu's Commentary]: If we want unblocking, *Tubulostemonis Flos* (Xinyi) and *Angelicae Dahuricae Radix* (Baizhi) seem indispensable.
[Deng's Comment]: This disease does not exceed clearing and dispersing methods, absolutely not sticking to salty softening methods. This is also a skill of transformation.
[Sun's Comment]: To achieve unblocking, *Asari Radix et Rhizoma* (Xixin) can also be used.
Lung collaterals meet in the ear. Lung affected by Wind-Fire, long-term uncleared, orifices and collaterals are closed. Hence nasal congestion, loss of smell/hearing, tinnitus, deafness. Now should clear and unblock Lung Qi.
*Xanthii Fructus* (Cangerzi), *Menthae Haplocalycis Herba* (Bohe), *Platycodonis Radix* (Jiegeng), *Forsythiae Fructus* (Lianqiao), *Tubulostemonis Flos* (Xinyi), *Scutellariae Radix* (Huangqin), *Gardeniae Fructus* (Shanzhi), *Prunus Armeniaca Semen* (Xingren), *Glycyrrhizae Radix et Rhizoma* (Gancao), *Akebiae Caulis* (Mutong)
[Liu's Commentary]: Saying "Deafness is treated via Lung," observing this case confirms it.
[Deng's Comment]: Should know that deafness and tinnitus not related to Kidney/Liver deficiency are extremely rare.
Shaoyang meridian runs outside the ear and into the middle of the ear. If this meridian has Wind-Fire, ear pus and tinnitus occur. Treatment should be clearing and dispersing.
*Menthae Haplocalycis Herba* (Bohe), *Forsythiae Fructus* (Lianqiao), *Chrysanthemi Indici Flos* (Ganju), *Paeoniae Radix* (Shaoyao), *Scutellariae Radix* (Huangqin), *Tribuli Fructus* (Ciji), *Glycyrrhizae Radix et Rhizoma* (Gancao), *Akebiae Caulis* (Mutong)
[Liu's Commentary]: The case is experienced, the prescription is clear and spiritual.
[Deng's Comment]: Familiarity with diagnosis is such that brush follows intention.
[Sun's Comment]: Wind-Fire pathology must have swelling and pain; if no swelling/pain, there is deficiency. Long-term leads to Liver/Kidney Yin deficiency. Use *Liuwei Dihuang Wan* and *Cizhu Wan* to nourish.
Kidney deficiency toothache, occurs at night. Not Wind, not Fire. Clearing/dispersing is useless.
*Jiawei Bawei Wan* (Modified Eight Flavor Pill). Take 3 qian per dose with salt flower soup.
[Liu's Commentary]: Prescription is precise.
[Deng's Comment]: Insight is superb, like an old judge deciding cases.
[Sun's Comment]: Toothache due to Kidney deficiency often involves Liver Yang rising. Include Liver-clearing herbs like *Asparagi Radix* (Tian Dong) and *Dendrobii Caulis* (Shihu).
Chapter: Leg Qi (Beriberi)
Jueyin evil rebels against Yangming, starting with swelling/pain, then abdominal pain, chest fullness, vomiting. This is Leg Qi rushing to Heart, not a minor illness. Propose using *Waitai* method.
*Rhinocerotis Cornu* (Xijiao), *Arecae Semen* (Binglang), *Poria* (Fuling), *Immature Bitter Orange* (Zhishi), *Prunus Armeniaca Semen* (Xingren), *Citri Reticulatae Pericarpium* (Juhong), *Pinelliae Rhizoma* (Banxia), *Akebiae Caulis* (Mutong), *Chaenomelis Fructus* (Mugua)
[Deng's Comment]: One who uses ancient formulas without doubt truly has deep experience and confidence.
[Sun's Comment]: *Binglang* guides stagnation downward, very clever; red-colored ones can be combined with *Huanglian* and *Huangbai*.
Second Visit: *Pinelliae Rhizoma* (Banxia), *Chaenomelis Fructus* (Mugua), *Citri Reticulatae Pericarpium* (Guangpi), *Phragmitis Rhizoma* (Lugen), *Immature Bitter Orange* (Zhishi), *Poria* (Fuling), *Bambusae Tabulae Preparata* (Zhuru), *Loquat Folium* (Pipaye)
[Deng's Comment]: Formula change is light. Same intent as previous, different herbs.
[Liu's Commentary]: Leg Qi was classified by predecessors under Similar-to-Taiyang diseases: must have aversion to cold and high fever, similar to Taiyang disease, even risk of rushing to Heart. Called a severe syndrome. *Waitai* has *Da Xijiao Tang* and *Fengyin Tang*; later generations had *Jiming San*. These are heavy doses specifically for Leg Qi. However, modern "Leg Qi" refers to soft/swollen legs (Wet Leg Qi) or non-swollen (Dry Leg Qi), treated with *Stephaniae Tetrandrae Radix*, *Mugua*, *Niuxi*, *Coicis Semen* etc. This differs greatly from predecessors. Scholars must distinguish.
[Sun's Comment]: Both ancient methods and modern treatments have essence. Reference both. Do not neglect either.
Chapter: Spermatorrhea
Spermatorrhea without dreams, triggered by slight labor. Hungry but cannot eat, bloated after eating. Pale face, hot lips, yellow/red urine. This is Spleen Damp-Heat flowing into Kidney causing leakage. Do not solely use tonifying/astringing drugs; fear accumulated heat will increase and cause other issues.
*Dioscoreae Hypoglaucae Rhizoma* (Bixie), *Amomi Fructus* (Sharen), *Poria* (Fuling), *Ostrea Concha* (Muli), *Atractylodis Macrocephalae Rhizoma* (Baizhu), *Phellodendri Cortex* (Huangbai), *Glycyrrhizae Radix et Rhizoma* (Zhi Cao), *Dioscoreae Rhizoma* (Shanyao), *Rehmanniae Radix Preparata* (Shengdi), *Polyporus* (Zhuling)
[Liu's Commentary]: For such syndromes, early use of tonifying/astringents often makes them worse. This case is a loud warning.
[Deng's Comment]: Clear topic identification, appropriate prescription. Unlike modern doctors who heavily use tonifying/astringents for dreamless spermatorrhea, or solely use draining for internal Damp-Heat. Their flaws match this disease.
[Sun's Comment]: This person must be strong and dark-complexioned, now pale due to illness.
Second Visit: After taking previous medicine, spermatorrhea stopped, lip heat remains. Spleen still has residual heat.
Previous formula remove *Sharen*, *Huangbai*. Add *Coptidis Rhizoma* (Chuanlian), *Sophorae Flavescentis Radix* (Kushen).
[Liu's Commentary]: Lip heat belongs to Spleen.
[Deng's Comment]: Following principles in medication ensures effectiveness. Modifications hit the mark.
Shaoyin is the pivot of Three Yin, managing opening/closing internally. Deficiency loses normal function. Method should tonify Shaoyin. Neither unblocking nor closing is correct.
*Liuwei Wan* (Six Flavor Pill) remove draining herbs. Add *Cuscutae Semen* (Tusizi), *Astragali Complanati Semen* (Shayuan), *Semen Lycii* (Qizi).
[Liu's Commentary]: This is a balanced Kidney-tonifying pill, safe for long-term use.
[Deng's Comment]: Focuses on tonifying, not closing. Truly profound truth.
[Sun's Comment]: Tonification method should perhaps use Ye Tianshi's "sentient substances" (animal/mineral derived).
Spermatorrhea damages Kidney, Qi fails to secure. At night lying down, Qi rushes to diaphragm, abdominal distension, breathing blocked, sitting upright all night. Foot dorsum swollen/cold, urine gradually decreases. Root is uprooted, branches will fail. Difficult to treat.
*Douqi Wan* + *Achyranthis Bidentatae Radix* (Niuxi), *Cinnamomi Cortex* (Rougui)
[Liu's Commentary]: This is severe syndrome of dual Yin/Yang damage and Qi failure to grasp. No better method exists, yet efficacy is not guaranteed.
[Deng's Comment]: Root deficiency and severe disease, hard to help at this stage. Mere pills, how can they help? Might not even be swallowed.
Yin deficiency, Yang movement, internal heat, nocturnal emission.
*Liuwei Wan* + *Phellodendri Cortex* (Huangbai), *Amomi Fructus* (Sharen)
[Liu's Commentary]: Combination of *Liuwei* and *Fengsui* method. Appropriate and easy to apply.
[Deng's Comment]: For Kidney deficiency with Damp-Heat, this method is standard.
Chapter: Urination
Both Chi pulses weak, root not firm. Turbid urine, disease in Kidney. Long-term unresolved becomes Lower Xiao (Lower Wasting-Thirst).
*Liuwei Wan* + *Asparagi Radix* (Tiandong), *Ophiopogonis Radix* ( Maidong), *Semen Lycii* (Qizi), *Schisandrae Fructus* (Wuweizi)
[Liu's Commentary]: Method is stable and accurate.
[Deng's Comment]: Turbid urine never violates draining methods, relying solely on pulse.
[Sun's Comment]: This syndrome must have frequent and numerous urination.
Large and robust body, pulse small and slow. People who emit Yang outward appear sufficient but are internally deficient. Food/Qi cannot be transported by Yang, brewing Dampness sinking downward, causing turbid disease for 3-4 years. Qi sinking requires raising Yang method, unlike young people with self-burning Yin Fire.
*Cuscutae Semen* (Tusizi), *Foeniculi Fructus* (Huixiang), *Plantaginis Semen* (Cheqianzi), *Allii Tuberosi Semen* (Jiu Zi), *Tribuli Fructus* (Jili), *Poria* (Fuling), *Rubiae Fructus* (Fupenzi), *Cnidii Fructus* (Shechuangzi). Yellow Fish Bone pounded into pills, take 5 qian per dose.
[Liu's Commentary]: This syndrome should focus on Spleen Earth. But merely warming/nourishing Lower Origin is not purifying source and clearing stream.
Another note: Different from Minister Fire sinking downward, hence medication is like this.
[Deng's Comment]: Elderly robust body, warm herbs for tonifying/unblocking fit the theme.
*Tusizi*, *Jiu Zi*, *Huixiang* are raising Yang herbs. "Bone" might be a typo for "Colla". *Jili* is *Shayuanzi*.
[Sun's Comment]: Because food/water brews Dampness, Liu says focus on Spleen Earth. However, robust people are usually fat/white, not dark/black.
Minister Fire sinking downward uses *Fengsui* method.
Fatigue for 40+ days. Heart Yang hyperactive, Kidney Water secretly damaged. Yang sinks into Yin. Hence frequent urination and blood in urine, urethral obstruction/pain. Actually different from Lin Syndrome. Though some Damp-Heat exists, sleep/appetite are fine. No need for draining/dampness removal. Should calm Heart Yang, benefit Kidney Yin, promote Kidney Qi to harmonize.
*Rehmanniae Radix Preparata Charred* (Shudi Tan), *Ginseng Radix* (Renshen), *Dendrobii Caulis* (Huoshihu), *Moutan Cortex* (Danpi), *Alismatis Rhizoma* (Zexie), *Poria* (Fuling), *Polygalae Radix* (Yuanzhi), *Platycladi Semen* (Baiziren), *Nelumbinis Semen* (Hulianrou)
[Liu's Commentary]: This is a root-treatment formula. Due to close analysis of disease, prescription is stable.
[Deng's Comment]: Follow cause, address syndrome, deduce origin. No hiding. *Xi Shengdi* and *Gui Ban* (Turtle Shell) could be added.
[Sun's Comment]: Calming Heart Yang, replace *Shudi* with *Shengdi*.
Chapter: Diarrhea
Anger injures Middle, Damp-Heat takes advantage. Spleen Qi fails to transport. Food/Water rush to Large Intestine causing diarrhea. Mild abdominal pain, pulse obstructed/disordered. Treat Middle Jiao.
*Agastachis Herba* (Huogeng), *Magnoliae Officinalis Cortex* (Chuanpu), *Medicated Leaven* (Shenqu), *Alismatis Rhizoma* (Zexie), *Poria* (Fuling), *Citri Reticulatae Pericarpium* (Chenpi), *Dolichoris Semen* (Biandou), *Chaenomelis Fructus* (Mugua)
[Liu's Commentary]: The brilliance lies in *Mugua*, which also soothes Liver. Knowing this reveals the art of prescription.
Another note: "Pulse obstructed" phrase is unclear.
[Deng's Comment]: Prescription is light and delightful.
"Pulse obstructed" means choppy/stagnant. Why not just say "choppy pulse"?
Chapter: Dysentery
Summer-Wheat invading meridians causes Malaria; moving internally in intestines causes Dysentery. Reliance on expelling external and calming internal lies in Stomach Qi. Therefore, harmonizing/tonifying method is suitable. Do not use attacking/scouring agents, fearing evil enters deeply due to deficiency.
[Liu's Commentary]: Case commentary is wonderful, pity the formula is lost.
[Deng's Comment]: Malaria and Dysentery occurring together, harmonizing/nourishing Stomach Qi is crucial. Propose *Shengyang Yiwetang* to fill the gap.
[Sun's Comment]: Deep fundamental discussion, profound theory.
Yu Xichang using *Renshen Baidu San* is exactly for this reason.
Chapter: Defecation
Qi stagnation not moving, fluids dry not moistening. Poor appetite, difficult defecation, thin body, choppy pulse. Cannot generally use purging. Should use fluid-nourishing and Qi-smoothing agents.
*Rehmanniae Radix Preparata* (Shengdi), *Angelicae Sinensis Radix* (Danggui), *Persicae Semen* (Taoren), *Carthami Flos* (Honghua), *Aurantii Fructus* (Zhike), *Semen Cannabis* (Maren), *Glycyrrhizae Radix et Rhizoma* (Gancao), *Prunus Armeniaca Semen* (Xingren)
[Liu's Commentary]: This is Qi blockage and fluid depletion. Propose adding fresh *Polygoni Multiflori Caulis* (Xian Shouwu).
[Deng's Comment]: Zhang Zhongjing has examples of purging with choppy pulse, but rarely suitable. This formula follows *Tongzao Tang* to connect, superior to original due to smooth flow.
[Sun's Comment]: Fresh *Shouwu* or fresh *Cistanche* are excellent for nourishing fluids and lubricating bowels.
Defecation obstruction, fluid flows sideways. Once defecation opens, fluid stops.
*Da Chengqi Tang* + *Glycyrrhizae Radix et Rhizoma* (Gancao)
[Liu's Commentary]: According to Wu Jutong, *Tiaowei Chengqi Fa* is safer.
[Deng's Comment]: Adding Gancao to moderate is excellent.
[Sun's Comment]: This syndrome must have large abdomen hardness/fullness, painful on pressure. If not hard/full, no dry stool obstruction, do not use *Chengqi*.
Second Visit: Previous formula add *Angelicae Sinensis Radix* (Danggui), *Paeoniae Radix Alba* (Baishao).
[Deng's Comment]: Likely Ying level also damaged, so adding Danggui/Baishao to nourish.
Third Visit: Change to *Zhi Jun* (Prepared Rhubarb) + *Xungui* (Cinnamon Bark), *Houpo*.
[Deng's Comment]: Third visit likely due to sideways flow with Dampness, requires warmth to transform.
After bleeding, stool dry/obstructed, then spontaneous loose stools, white/slime/sticky, dozens times daily. Thin body, deep pulse. Must be long-standing Food/Water Dampness. Bowel disease requires unblocking, use Warm-Purgative method.
*Smilacis Glabrae Rhizoma* (Sheng Maoyu), *Radix Rhei Preparata* (Zhi Jun), *Aconiti Lateralis Radix Preparata* (Shu Fuzi), *Magnoliae Officinalis Cortex* (Houpo)
[Liu's Commentary]: Spontaneous sticky stools can be due to dry stool blocking, Qi forcing intestinal mucus down. Should focus on moving dry stool and nourishing intestinal fluid, not simply treating as Dampness.
[Deng's Comment]: If dry stool causes sticky discharge, stool remains dry. Given subsequent white/sticky discharge, there must be Damp accumulation. Prescription is thorough.
[Sun's Comment]: Another pattern. Scholars must examine deficiency/excess carefully. If abdomen full/painful, this method can be referenced to purge Cold-Damp accumulation. White/sticky discharge is the sign.
Pi Yue (Spleen Restriction): Fluids restricted not moving. No hunger, no defecation. Tried many medicines, Middle Qi severely troubled. Imitate ancients' food therapy.
*Sesami Fructus* (Heizhima), *Perillae Fructus* (Dusu Zi). Boil two herbs thick like syrup. Take 3-5 days, then drink one cup human milk, warmed with 2 spoons Ginger Juice.
[Liu's Commentary]: This is a method beyond methods. Good doctor's heart is bitter.
[Deng's Comment]: With severely troubled Middle Qi, should awaken/move center to open, e.g., *Guibao Liujun* and *Zhizhu Wan*. Both methods applicable.
[Sun's Note]: Mr. Hua Yongkang met a patient with latent summer-heat, no hunger/eating, dry constipation for half year. Used 2 liang fresh *Cistanche*, rinsed, combined with *Wuren Tang* and Pear Juice to cure. Likely initial overuse of bitter/dry herbs damaged Spleen Yang and Stomach Yin. Thus using Ye Tianshi's Stomach-Yin nourishing method, same as this.
Blood in stool, not only blame deficiency, also blame Dampness. Hence tonification fails, draining benefits. Now foot weakness, Dampness not only in Spleen but also Kidney. Treat as Spleen/Kidney Damp-Heat forming Bi.
*Dioscoreae Hypoglaucae Rhizoma* (Bixie), *Coicis Semen* (Yiren), *Atractylodis Macrocephalae Rhizoma* (Baizhu), *Dendrobii Caulis* (Shihu), *Achyranthis Bidentatae Radix* (Niuxi), *Zingiberis Rhizoma Recens* (Shengjiang)
[Liu's Commentary]: Case commentary clear, prescription simple.