邓评：便血责湿，当亦恒见，诚阅历有得之言。如但在脾，立法犹易，并及于肾，则较难秉笔也。兹就足痿无力，尚未可断定及肾。立方固甚简当，拟去生姜，增炮姜、砂仁、归身；如果已及于肾，黑地黄丸亦可用也。
孙评：便血属虚者，黄土汤、归脾汤是正法也。此因滋补无功而立此方。但《金匮》有远血、近血之分，徐氏又有痔血宜清之说，不可不考。
泻痢便血，五年不愈，色黄心悸，肢体无力。此病始于脾阳不振，继而脾阴亦伤。治当阴阳两顾为佳。
邓评：用古合度，此即黄土汤加入参也。有一种虚黄病，阴阳两伤，而小便时清时黄者，极可借用此法，盖此病亦类虚黄。
外 疡 门
肝经液聚气凝，为项间痰核。病虽在外，其本在内。切不可攻，攻之则愈甚矣。
邓评：虚体患此，诚不可攻。斯法极王道精当，学者宜取法焉。
疡证以能食为要。兹先和养胃气。
诒按：案语片言居要，惟用药嫌少力量。
邓评：柳师所评极是。
诒按：此肛门漏也，名为鼠漏，未知所本。脉证已属损象，故以滋补肝肾为主。
邓评：方颇切实，专治虚在阴者宜之。
大都因俗名偷粪鼠成漏，故名鼠漏。
孙注：肛门痈俗名偷粪鼠，故云鼠漏也。
妇 人 门
诒按：认证既的，药亦丝丝入筘。
诒按：方案俱老当。
胎前喘咳肿满，是脾湿不行，上侵于肺，手足太阴病也。治在去湿下气。
邓评：方论均的当。
产后恶露不行，小腹作痛，渐见足肿面浮喘咳。此血滞于先，水渍于后。宜兼治血水，如甘遂、大黄之例。
诒按：用其例而易其药，因原方太峻也。
再诊：瘀血不下，走而上逆。急宜以法引而下之，否则冲逆成厥矣。
邓评：心灵手敏，随机应变，迭经四诊，绝不拘泥置之，活泼泼地，非庸工所能及也。
三诊：膈宽而腹满。血瘀胞中。宜以缓法下之。
又丸方：牛膝一两赤芍 延胡 蒲黄 五灵脂 川芎 桂心 桃仁各五钱 归尾 丹皮各八钱
邓评：改用丸药缓导，想其病势已减。
诒按：迭换四方，一层深一层，次序秩然，恰与病机宛转相赴。
胎前病子肿，产后四日即大泄，泄已一笑而厥，不省人事，及厥回神清，而左胁前后痛满，至今三月余矣。形瘦，脉虚，食少，少腹满，足肿，小便不利。此脾病传心，心不受邪，即传之于肝，肝受病而更传之于睥也。此为五脏相贼，与六腑食气水血成胀者不同。所以攻补递进，而绝无一效也。宜泄肝和脾法治之。
诒按：此等证情，非胸中有古书者，不能道只字。
孙评：白芍用桂木同炒何如?
评选继志堂医案两卷
右继志堂医案两卷，曹仁伯先生所著也。先生讳存心，字仁伯，别号乐山，系常熟之福山人。幼时读书颖悟，长老咸目为令器。顾以家道不丰，一衿不足裕衣食，遂谋习医。从薛性天先生游。薛故郡中名宿，得先生剧尝之，谓将来光吾道者必曹生也。先生居薛所十年，帏灯焠掌，上自灵素，下逮薛喻诸家，无不研求贯串，乃出应病者之求，辄奏奇效。先生尝言：医者存心，须视天下无不可治之病，其不治者，皆我之心未尽耳。故其临病人也，研精覃思，直以一心贯乎病者之食息起居，而曲折无不周至。每有剧病，他人所弃而不治者，先生独能运以精思，而以数剂愈之。古人谓生死肉骨，先生诚有之焉。先生又言：每遇病机丛杂，治此碍彼，他人莫能措手者，必细意研求，或于一方中变化而损益之，或合数方为一方而融贯之，思之思之，鬼神通之，苦心所到，必有一恰合之方，投之而辄效者。以是知医者之于病，稍涉危疑，即目为不治而去之者，其不尽心之过为不少也。嗟乎l先生之言如此，即先生居心之笃厚，与艺事之精能，盖皆即是而可见矣。先生所著，有琉球百问、继志堂语录、过庭录、延陵弟子纪略诸书。经先生之孙博泉玉年裒集锓行，杨太常滨石序之。先生之行谊，备详于许君廷诰所撰家传中。先生以医名著，继叶薛诸公而起，德被吴中，名驰海外，至今人能道之。特其所著医案，于过庭录延陵弟予纪略外，未有传本。今年夏，偶于友人处，得见其门弟子所录存者。借中多阙误，因假归钞录，为之次第整理，删其繁乱，撷其精粹，间或赘以评语，以发明其用意之所在，钞成上下两卷，俾后人读之，犹可想见其诊病时危坐构思，旁若无人之概云。光绪二十六年庚子八月江阴柳宝诒识。
评选继志堂医案上卷
常熟曹存心仁伯著
内伤杂病门
心营与肾水交亏，肝气挟肝阳上逆，胸中气塞，口内常干，手震舌掉，心烦不寐，即有寐时，神魂游荡，自觉身非己有，甚至便溏纳少，脾胃亦衰，脉形细小无神，而有歇止之象。逐证施治，似乎应接不暇。因思精神魂魄，必令各安其所，庶得生机勃勃；否则悠悠忽忽，恐难卜其旋元吉。拟许学士真珠母丸法。
石决明盐水煅一两 人参一钱 归身钱半 犀角五分 龙齿三钱 茯神三钱 生地四钱 麦冬二钱 枣仁二钱 炙草三分 淮药三钱 沉香磨冲三分 另珠粉四分先服
诒按：此方于肝气一层，嫌少理会。愚意去山药、甘草，加木香、陈皮，则胸中之气塞亦平矣。
邓评：心烦不寐，心火亢矣，何又脉小便溏?大都火被湿痰所遏也。于清心安神内，务参辛燥开痰，俾湿化痰豁，乃能木达风清也；若滋寒太过，恐多弊而少利耳。
孙评：所述病情，均因痰火上蒙致病，即便溏脉歇，亦为痰滞于中，脾营胃卫不调和之症，若损证而至见此，则正气垂绝，决无生理。
胸中气塞，非气之不通，是痰之上逆也。
又接服方：生地 自芍 人参 丹皮 橘红 茯神 枣仁 石决明 龙齿 秫米 佛手
邓评：选药较前方为胜，故能稍获效机。
再诊：脉之歇止向和，便之溏泄不作，气塞稍平，手震亦定。但寤多寐少，内藏之魂魄未安；胸痞脘闷，上壅之浊痰未降。容将通阳镇逆法，参入前方，冀相与有成耳。
真珠母丸真珠母、熟地，当归、人参、枣仁、柏子仁、茯神、犀角、龙齿、沉香 去柏子仁 当归 加旋覆花一钱五分 代赭石三钱 陈皮七分 冬术七钱 炙草五分 白芍二钱 麦冬三钱 甘澜水煎竹沥一两冲服
诒按：案云通阳镇逆，方中用旋赭镇逆，而术、芍、麦、草，则未可谓之通阳也。
所谓胸痞脘闷，上壅之浊痰未降，此语中的。而方内仍用地、麦，未免议论虽确而用药失当，拟更参温胆之法，如半夏、枳实、菖蒲、竹茹之属。
三诊：夜半得寐，心肾已交，肺魄肝魂，自能各安其脏。无如心易烦动，神反疲乏，气犹短促，胸还痞闷，脉仍细小，两足不安。脉虚证虚，是谓重虚，而兼有湿痰从之为患。夫痰即有形之火，火即无形之痰也。法当固本为主，消痰佐之。
人参固本丸 加龟板五钱炙茯神三饯 枣仁二饯 白芍三钱 淮麦三钱 陈皮一饯 旋覆花一钱五分 柏子仁一钱五分去油 冬术钱半 另珠粉二分 竹油二十匙 鸡子黄一枚和服
诒按：于痰病重投冬、地，得无嫌其滋腻否?
邓评：柳师破的。
诸般苦况，无非为湿痰阻塞。案云湿痰从之为患，又谓痰即有形之火，火即无形之痰，何仍重于滋补，盖终被阴虚二字横于胸中也。
孙评：痰火二旬，近人安能见得如此真切。既如是云云，当以清火化痰为法矣。
四诊：风火痰三者之有余，留滞肝经，以致卧血归肝，魂不能与之俱归，筋惕肉（目闰）而醒，前次气短等证，莫不因此。而又起于有年病后，气血两亏，何堪磨耐。所治之方，不出许学士法加减。现在脉息细小带弦，虽无止歇之形，尚有不静之意，究属难免风波，未可以能食为足恃也。
石决明盐水煅三钱麦冬二钱犀角五分柏子仁三钱 龙齿三钱枣仁盐水炒三钱 归身七分 大熟地浮石粉拌炒六钱 羚羊角一钱 冬术一钱五分 白芍三钱 陈皮一钱人参二钱 茯神三钱 银花一钱 薄荷五分 另金箔二张 竹沥一两 真珠粉三分 姜汁一匙冲服
统观四方，虽有祛邪之药，而实多滋痰之品，是以绝少奏效。
孙评：起于有年病后，必病时误补蛮涩所致，故痰热内恋而起也。
五诊。前夜熟睡，昨又变为少寐，寐之时，适在子时以后，肝胆两经尚有余邪可知。更兼痰火阻气，时逆时平，其气逆时，必面赤心悸，甚则肉（目闰）筋惕，烦热不安，脉亦随之变异，所谓心火一动，相火随之是也。调治之外，必须静养，俾心火凝然不动，方可渐入坦途。
人参丹参麦冬玄参各二钱 旋覆花冬术各一钱五分橘红一钱 小麦五饯枣仁川连煎汁拌炒
此方补而不滞，于清化痰火一面，较能着力，宜其小奏效也。
六诊：所患小恙，无一不除，盖以清之、化之、补之、养之，无微不至，而得此小效耳。所嫌者，寐非其时，寤非其时，心阳太旺，神气外驰，是卫气独行于阳，阳蹻脉满，满则不入于阴，阴分之虚明矣。将滋阴之品，参入前方，未识能弋获否?
前方加大生地五钱 陈胆星五分
诒按：此证不寐，乃肝胆有痰火所致。案中引内经阳蹻脉满之文，本属强为牵合；至以经言阴虚，指为阴血之虚，尤非经文本旨。
邓评：生地唯恐碍痰。
孙评：细阅是病，必痰火扰乱肝胆，神志因之不静。所服之药，滋则助痰，补则滞气。前后九方，惟此方最灵，用药心思亦新颖熨贴。所嫌化痰熄风之味，脏腑未得贴切，是以病不即除也。如枇杷叶、川贝，与肝胆不宜，是消肺经之痰也；丹参祛瘀，珠粉清心，麦冬养肺，均失确切之旨。易以天麻、胆汁炒半夏、黑栀、钩钩、蒺藜，则得之矣；玄参虽清火，不若生牡蛎为佳，加白芍以摄肝阴，无滋腻之弊，拟方于下：
煨天麻、盐半夏、茯苓、人参、炒白芍、姜汁炒山栀、钩钩、白蒺藜、生牡蛎、川连炒枣仁、竹茹、枳实。
南星燥烈，能祛风痰，以牛胆罩之，去燥烈，就柔和，并引入胆经，与此病最合，巧思岂可多得。
七诊：人可以参天地之干者，莫贵于眠食如常。今食能知味，眠则未安，昨夜忽寐忽醒，醒则不爽，寐则不安，以昭卫气不得入于阴，独留行于阳之意。柳按：案语牵合支离，总由误认经文阴字，故说来总不入理。是阳蹻脉满，营血不能充足，肌肉不能润泽，苟非阳生阴长，阴足恋阳，何以渐入佳境。然营中之血，既不生之于心，乌能藏之于肝，统之．于脾，而欲藉草木之无情，俾血肉之有情者，以生以长，谈何容易。况当此痰火易烦，得食暂安，以及虚风内动，筋惕肉（目闰），支体牵摇，大便难通之候，更难为力矣。急宜加意调理。
前方去玄参旋覆 珠粉 丹参 加黄芪一钱 远志三分 归身一钱 半夏一钱五分猪胆汁炒 木香三分 圆眼肉三枚
诒抟：黄芪与此证不甚合，胆汁炒半夏思路新颖。
邓评：便血归因于湿邪，这在临床上确实常见，确实是经验丰富者的真知灼见。如果病位仅在脾脏，确立治法还比较容易；如果病情已经波及肾脏，那就更难下笔了。目前患者表现为足部痿软无力，还不能断定病已及肾。所立处方虽然简洁得当，但我建议去掉生姜，增加炮姜、砂仁、当归身；如果确认病已及肾，黑地黄丸也可以使用。
孙评：属于虚证的便血，黄土汤、归脾汤是正治之法。此方是因为之前使用滋补药物无效而制定的。但是《金匮要略》中有远血和近血的区别，徐氏又有痔疮出血宜清利的说法，这些不可不考证。
泻痢便血，五年不愈，面色黄，心悸，肢体无力。此病始于脾阳不振，继而脾阴也受损。治疗应当阴阳兼顾为佳。
邓评：运用古方恰到好处，这就是黄土汤加入参。有一种虚黄病，阴阳两伤，且小便时而清亮时而发黄，极可借用此法，因为此病也类似虚黄。
鼻痒，心中火辣感，大便下血，形体消瘦，脉象小而数，病程已有数年。
邓评：此方是黄芩汤加阿胶。运用古方能灵活变化，有得心应手的乐趣。
外科门
肝经津液凝聚，气机阻滞，形成颈部的痰核。病虽表现在外部，其根本在内部。切不可攻伐，攻伐则病情会更加严重。
首乌 象贝母 白芍 牛膝 甘草 牡蛎粉 当归身 生地黄 牡丹皮
邓评：体质虚弱者患此病，确实不可攻伐。此法极为王道精当，学者应取法于此。
诒按：案语片言居要，只是用药嫌力量不足。
邓评：柳师的评价非常正确。
脉象虚细数，是阴液不足。鼠瘘（淋巴结核）未愈，热邪在大肠。
诒按：这是肛门漏管，名为鼠瘘，不知出处何在。脉证已属虚损之象，故以滋补肝肾为主。
邓评：方子颇为切实，专门治疗阴虚者适宜。
大多因为俗名“偷粪鼠”成漏，所以名叫鼠瘘。
孙注：肛门痈俗名偷粪鼠，所以说鼠瘘。
妇科门
脾虚生湿，气机为之阻滞，血液为之不能固守。这与血热导致月经量多不同。
诒按：辨证既准确，用药也丝丝入扣。
诒按：方案都很老练恰当。
孙评：既然说是胎水，川芎动血，似乎不太适宜，改用白芍更贴切。
产前喘咳肿满，是脾湿不行，上侵于肺，属于手足太阴经的病。治疗在于祛湿降气。
邓评：方论均很得当。
产后恶露不行，小腹作痛，逐渐出现足肿面浮喘咳。这是血滞在前，水渍在后。应当兼治血水，参考甘遂、大黄的例子。
诒按：用其例而换其药，因为原方太峻猛。
再诊：瘀血不下，反而上逆。急宜用法治引而下之，否则冲逆成厥脱了。
邓评：心灵手敏，随机应变，经过四次诊治，绝不拘泥固执，活泼泼地，不是庸医所能达到的。
又丸方：牛膝一两 赤芍 延胡索 蒲黄 五灵脂 川芎 桂心 桃仁各五钱 当归尾 牡丹皮各八钱
邓评：改用丸药缓导，想必病势已减。
诒按：接连更换四方，一层深一层，次序井然，恰与病机宛转相应。
产前病子肿，产后四天即大泄，泄后一笑而厥，不省人事，等到厥回神清，而左胁前后痛满，至今三月余了。形体消瘦，脉虚，食少，少腹满，足肿，小便不利。这是脾病传心，心不受邪，即传之于肝，肝受病而更传之于脾也。此为五脏相克，与六腑因食气水血成胀者不同。所以攻补递进，却绝无一效。宜用泄肝和脾法治之。
诒按：这种证情，非胸中有古书者，不能道只字。
孙评：白芍用桂木同炒如何？
评选继志堂医案两卷
右继志堂医案两卷，是曹仁伯先生所著。先生讳存心，字仁伯，别号乐山，系常熟福山人。幼时读书颖悟，长辈都把他看作良才。但因家道不丰，一介书生不足以维持衣食，于是谋求学习医学。跟随薛性天先生游学。薛原是郡中的名医宿老，得到先生的频繁请教，说将来光大吾道的必定是曹生。先生在薛处居住十年，挑灯夜读，上自《灵枢》、《素问》，下至薛己、喻嘉言诸家，无不研求贯通，于是出来应对病人的需求，辄奏奇效。先生曾说：医者存心，须视天下无不可治之病，那些不治的，都是我的心未尽罢了。所以他临症时，研精覃思，直以一心贯穿病人的饮食起居，曲折无不周至。每遇重病，他人所弃而不治的，先生独能运以精思，而以数剂治愈。古人谓生死肉骨，先生诚有之焉。先生又说：每遇病机丛杂，治此碍彼，他人莫能措手的，必细意研求，或于一方中变化损益，或合数方为一方而融贯之，思之思之，鬼神通之，苦心所到，必有一恰合之方，投之而辄效。由此可知医者对于病，稍涉危疑，即目为不治而去的，其不尽心之过为不少也。唉！先生的话如此，即先生居心之笃厚，与艺事之精能，盖皆即是而可见矣。先生所著，有《琉球百问》、《继志堂语录》、《过庭录》、《延陵弟子纪略》诸书。经先生之孙博泉玉年搜集刻印，杨太常滨石作序。先生的行谊，备详于许君廷诰所撰家传中。先生以医名著，继叶薛诸公而起，德被吴中，名驰海外，至今人能道之。特其所著医案，于《过庭录》、《延陵弟子纪略》外，未有传本。今年夏，偶于友人处，得见其门弟子所录存者。其中多阙误，因借归钞录，为之次第整理，删其繁乱，撷其精粹，间或赘以评语，以发明其用意之所在，钞成上下两卷，俾后人读之，犹可想见其诊病时危坐构思，旁若无人之概云。光绪二十六年庚子八月江阴柳宝诒识。
评选继志堂医案上卷
常熟曹存心仁伯著
内伤杂病门
心营与肾水交亏，肝气挟肝阳上逆，胸中气塞，口内常干，手震舌掉，心烦不寐，即使有睡时，神魂游荡，自觉身非己有，甚至便溏纳少，脾胃亦衰，脉形细小无神，而有歇止之象。逐证施治，似乎应接不暇。因思精神魂魄，必令各安其所，庶得生机勃勃；否则悠悠忽忽，恐难卜其旋元吉。拟许学士真珠母丸法。
石决明盐水煅一两 人参一钱 当归身钱半 犀角五分 龙齿三钱 茯神三钱 生地黄四钱 麦冬二钱 枣仁二钱 炙甘草三分 淮山药三钱 沉香磨冲三分 另珠粉四分先服
诒按：此方对于肝气一层，嫌少理会。愚意去山药、甘草，加木香、陈皮，则胸中之气塞亦平矣。
邓评：心烦不寐，心火亢盛了，为何又脉象和小便溏泄？大抵是火被湿痰所遏。于清心安神内，务参辛燥开痰，俾湿化痰豁，乃能木达风清也；若滋寒太过，恐多弊而少利耳。
孙评：所述病情，均因痰火上蒙致病，即便溏脉歇，亦为痰滞于中，脾营胃卫不调和之症，若损证而至见此，则正气垂绝，决无生理。
胸中气塞，非气之不通，是痰之上逆也。
又接服方：生地黄 白芍 人参 牡丹皮 橘红 茯神 枣仁 石决明 龙齿 秫米 佛手
邓评：选药较前方为胜，故能稍获效机。
再诊：脉之歇止向和，便之溏泄不作，气塞稍平，手震亦定。但寤多寐少，内藏之魂魄未安；胸痞脘闷，上壅之浊痰未降。容将通阳镇逆法，参入前方，冀相与有成耳。
真珠母丸真珠母、熟地黄，当归、人参、枣仁、柏子仁、茯神、犀角、龙齿、沉香 去柏子仁 当归 加旋覆花一钱五分 代赭石三钱 陈皮七分 冬术七钱 炙甘草五分 白芍二钱 麦冬三钱 甘澜水煎竹沥一两冲服
诒按：案云通阳镇逆，方中用旋覆花、代赭石镇逆，而术、芍、麦、草，则未可谓之通阳也。
所谓胸痞脘闷，上壅之浊痰未降，此语中的。而方内仍用地黄、麦冬，未免议论虽确而用药失当，拟更参温胆之法，如半夏、枳实、菖蒲、竹茹之属。
三诊：夜半得寐，心肾已交，肺魄肝魂，自能各安其脏。无如心易烦动，神反疲乏，气犹短促，胸还痞闷，脉仍细小，两足不安。脉虚证虚，是谓重虚，而兼有湿痰从之为患。夫痰即有形之火，火即无形之痰也。法当固本为主，消痰佐之。
人参固本丸 加龟板五钱 炙茯神三钱 枣仁二钱 白芍三钱 淮小麦三钱 陈皮一钱 旋覆花一钱五分 柏子仁一钱五分去油 冬术钱半 另珠粉二分 竹油二十匙 鸡子黄一枚和服
诒按：于痰病重投冬、地，得无嫌其滋腻否？
邓评：柳师破的。
诸般苦况，无非为湿痰阻塞。案云湿痰从之为患，又谓痰即有形之火，火即无形之痰，何仍重于滋补，盖终被阴虚二字横于胸中也。
孙评：痰火二旬，近人安能见得如此真切。既如是云云，当以清火化痰为法矣。
四诊：风火痰三者之有余，留滞肝经，以致卧血归肝，魂不能与之俱归，筋惕肉瞤而醒，前次气短等证，莫不因此。而又起于有年病后，气血两亏，何堪磨耐。所治之方，不出许学士法加减。现在脉息细小带弦，虽无止歇之形，尚有不静之意，究属难免风波，未可以能食为足恃也。
石决明盐水煅三钱 麦冬二钱 犀角五分 柏子仁三钱 龙齿三钱 枣仁盐水炒三钱 当归身七分 大熟地黄浮石粉拌炒六钱 羚羊角一钱 冬术一钱五分 白芍三钱 陈皮一钱 人参二钱 茯神三钱 银花一钱 薄荷五分 另金箔二张 竹沥一两 真珠粉三分 姜汁一匙冲服
统观四方，虽有祛邪之药，而实多滋痰之品，是以绝少奏效。
孙评：起于有年病后，必病时误补蛮涩所致，故痰热内恋而起也。
五诊：前夜熟睡，昨又变为少寐，寐之时，适在子时以后，肝胆两经尚有余邪可知。更兼痰火阻气，时逆时平，其气逆时，必面赤心悸，甚则肉瞤筋惕，烦热不安，脉亦随之变异，所谓心火一动，相火随之是也。调治之外，必须静养，俾心火凝然不动，方可渐入坦途。
人参 丹参 麦冬 玄参 各二钱 旋覆花 冬术 各一钱五分 橘红一钱 小麦五钱 枣仁 川连 煎汁拌炒
茯神 川贝 各三钱 炙甘草四分 枇杷叶 竹茹 各三钱 珠粉 冲三分
此方补而不滞，于清化痰火一面，较能着力，宜其小奏效也。
六诊：所患小恙，无一不除，盖以清之、化之、补之、养之，无微不至，而得此小效耳。所嫌者，寐非其时，寤非其时，心阳太旺，神气外驰，是卫气独行于阳，阳蹻脉满，满则不入于阴，阴分之虚明矣。将滋阴之品，参入前方，未识能弋获否？
前方加大生地五钱 陈胆星五分
诒按：此证不寐，乃肝胆有痰火所致。案中引内经阳蹻脉满之文，本属强为牵合；至以经言阴虚，指为阴血之虚，尤非经文本旨。
邓评：生地唯恐碍痰。
孙评：细阅是病，必痰火扰乱肝胆，神志因之不静。所服之药，滋则助痰，补则滞气。前后九方，惟此方最灵，用药心思亦新颖熨贴。所嫌化痰熄风之味，脏腑未得贴切，是以病不即除也。如枇杷叶、川贝，与肝胆不宜，是消肺经之痰也；丹参祛瘀，珠粉清心，麦冬养肺，均失确切之旨。易以天麻、胆汁炒半夏、黑栀、钩钩、蒺藜，则得之矣；玄参虽清火，不若生牡蛎为佳，加白芍以摄肝阴，无滋腻之弊，拟方于下：
煨天麻、盐半夏、茯苓、人参、炒白芍、姜汁炒山栀、钩钩、白蒺藜、生牡蛎、川连炒枣仁、竹茹、枳实。
南星燥烈，能祛风痰，以牛胆罩之，去燥烈，就柔和，并引入胆经，与此病最合，巧思岂可多得。
七诊：人可以参天地之干者，莫贵于眠食如常。今食能知味，眠则未安，昨夜忽寐忽醒，醒则不爽，寐则不安，以昭卫气不得入于阴，独留行于阳之意。柳按：案语牵合支离，总由误认经文阴字，故说来总不入理。是阳蹻脉满，营血不能充足，肌肉不能润泽，苟非阳生阴长，阴足恋阳，何以渐入佳境。然营中之血，既不生之于心，乌能藏之于肝，统之．于脾，而欲藉草木之无情，俾血肉之有情者，以生以长，谈何容易。况当此痰火易烦，得食暂安，以及虚风内动，筋惕肉瞤，支体牵摇，大便难通之候，更难为力矣。急宜加意调理。
前方去玄参 旋覆花 珠粉 丹参 加黄芪一钱 远志三分 当归身一钱 半夏一钱五分猪胆汁炒 木香三分 圆眼肉三枚
诒抟：黄芪与此证不甚合，胆汁炒半夏思路新颖。
Deng's Commentary: Hematochezia (blood in stool) is attributed to dampness, which is indeed a common clinical observation and represents the insight of an experienced practitioner. If the pathology is confined to the Spleen, establishing treatment principles is relatively straightforward; however, if the condition has extended to the Kidney, it becomes much more difficult to prescribe. Currently, with symptoms of lower limb flaccidity and weakness, one cannot definitively conclude that the Kidney is involved. Although the prescribed formula is concise and appropriate, I suggest removing Shengjiang (Fresh Ginger Rhizome), and adding Paojiang (Prepared Ginger Rhizome), Sharen (Amomum Fruit), and Dangguishen (Angelica Sinensis Root Heart); if it is confirmed that the Kidney is affected, Hei Di Huang Wan (Black Rehmannia Pill) could also be used.
Sun's Commentary: For hematochezia due to deficiency, Huangtu Tang (Yellow Earth Decoction) and Guipi Tang (Restore the Spleen Decoction) are the orthodox treatments. This formula was formulated because previous nourishing and tonifying measures were ineffective. However, *Jingui Yaolue* distinguishes between Yuanxue (distal bleeding) and Jin xue (proximal bleeding), and Xu Shi proposed that hemorrhoidal bleeding should be cleared. These points must not be overlooked.
Diarrhea, dysentery, and hematochezia have persisted for five years without cure. The complexion is yellow, there is palpitations, and limbs feel weak. This disease originated from Spleen Yang failing to thrive, subsequently damaging Spleen Yin. Treatment should ideally address both Yin and Yang.
Ren Shen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Fuzi (Aconite Lateral Root), Zhigancao (Prepared Licorice Root), Shudihuang (Prepared Rehmannia Root), Ejiao (Donkey-hide Gelatin), Fulonggan (Stove Bottom Ash), Huangqin (Scutellaria Root).
Yi's Note: This employs the method of Lizhong Tang (Regulate the Middle Decoction) combined with Huangtu Tang. The plan is practical and profound.
Deng's Commentary: The application of ancient formulas is apt; this is essentially Huangtu Tang added with Ren Shen. There is a type of deficiency jaundice where both Yin and Yang are injured, and urine alternates between clear and yellow. This method can be borrowed for such cases, as this illness resembles deficiency jaundice.
Nasal itching, burning sensation in the heart/chest, blood in stool, emaciation, pulse is small and rapid, persisting for several years.
Huangqin (Scutellaria Root), Ejiao (Donkey-hide Gelatin), Baishao (White Peony Root), Zhigancao (Prepared Licorice Root).
Yi's Note: This presents a syndrome of Yin deficiency with latent heat. The formula is particularly concise.
Deng's Commentary: This formula is Huangqin Tang (Scutellaria Decoction) added with Ejiao. It demonstrates flexibility in using ancient formulas, offering a sense of mastery.
Sun's Commentary: A burning sensation in the heart indicates heat lurking in the Ying (Nutritive) level.
Department of External Sores
Fluid accumulation and Qi stagnation in the Liver Meridian form phlegm nodules in the neck. Although the disease manifests externally, its root lies internally. Attack therapy must be avoided; attacking will only exacerbate the condition.
Shouwu (Polygonum Multiflorum Root), Xiangbei (Fritillaria Thunbergii Bulb), Baishao (White Peony Root), Niuxi (Achyranthes Root), Gancao (Licorice Root), Muli Fen (Oyster Shell Powder), Dangguishen (Angelica Sinensis Root Heart), Shengdihuang (Rehmannia Root), Mudanpi (Moutan Bark).
Yi's Note: The discussion is balanced, and the prescription is clear and steady. Muli Fen alone can resolve phlegm and dissipate hardness.
Deng's Commentary: In patients with deficient constitutions, attack therapy is indeed contraindicated. This method is extremely principled and precise; scholars should emulate it.
For sores and ulcers, the ability to eat is crucial. First, harmonize and nourish Stomach Qi.
Shihu (Dendrobium Stem), Fuling (Poria), Yizhiren (Bitter Apricot Seed), Guya (Sprouted Grain), Mugua (Chaenomeles Fruit), Guangpi (Tangerine Peel).
Yi's Note: The case notes highlight key points, but the medication lacks sufficient potency.
Deng's Commentary: Master Liu's evaluation is very correct.
Pulse is deficient, fine, and rapid, indicating insufficient Yin. Shulou (scrofula/lymphatic tuberculosis) has not healed; heat resides in the Large Intestine.
Liuwei Wan (Six-Ingredient Pill) added with Gouqi (Goji Berry), Tiandong (Asparagus Tuber), Guiban (Turtle Shell), Huangbai (Phellodendron Bark), Zhimu (Anemarrhena Rhizome), Wuweizi (Schisandra Fruit).
Yi's Note: This refers to an anal fistula named Shulou; its origin is unknown. The pulse and symptoms indicate a consumptive state, so the focus is on tonifying the Liver and Kidney.
Deng's Commentary: The formula is quite practical, suitable specifically for treating Yin deficiency.
It is mostly named Shulou because of the vulgar name "stealing feces rat" forming a fistula.
Sun's Annotation: An anal abscess is vulgarly called "stealing feces rat," hence the term Shulou.
Department of Women
Spleen deficiency generates dampness, causing Qi stagnation and Blood instability. This differs from excessive menstruation due to Blood heat.
Baizhu (Atractylodes Macrocephala Rhizome), Zexie (Alisma Rhizome), Baishao (White Peony Root), Guangpi (Tangerine Peel), Zhigancao (Prepared Licorice Root), Fuling (Poria), Niujiaosai Hui (Ash of Buffalo Horn Cavity), Chuanxiong (Ligusticum Rhizome).
Yi's Note: The diagnosis is accurate, and the medication fits perfectly.
Deng's Commentary: This appears similar in theme to Guipi Tang but is distinct in practice.
Abdominal fullness, leg swelling, diarrhea. This belongs to Taishui (fetal edema/fluid retention), caused by Spleen deficiency and dampness.
Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), Zexie (Alisma Rhizome), Guangpi (Tangerine Peel), Houpo (Magnolia Bark), Chuanxiong (Ligusticum Rhizome), Sueye (Perilla Leaf), Jiangpi (Ginger Peel), Huangqin (Scutellaria Root).
Yi's Note: The plans are all seasoned and appropriate.
Deng's Commentary: The orthodox method for treating fetal edema.
Sun's Commentary: Since it is described as fetal edema, Chuanxiong, which moves Blood, seems inappropriate; replacing it with Baishao would be more fitting.
Antenatal wheezing, coughing, swelling, and fullness result from Spleen dampness failing to circulate, invading the Lung. This is a disease of the Hand and Foot Taiyin meridians. Treatment focuses on resolving dampness and directing Qi downward.
Fuling (Poria), Chenpi (Aged Tangerine Peel), Baishao (White Peony Root), Zexie (Alisma Rhizome), Houpo (Magnolia Bark), Danggui (Angelica Sinensis Root), Sugeng (Perilla Stem), Xingren (Apricot Seed).
Yi's Note: The formula is quite agile; how about adding Ziwan (Aster Root) and Pipaye (Loquat Leaf)?
Deng's Commentary: Both the formula and theory are appropriate.
Ziwan and Pipaye can also enter the Lung's Ying collateral to disperse pathogens.
Sun's Commentary: For wheezing and coughing, removing Danggui's acrid-warm nature and replacing it with Zhishi (Immature Bitter Orange) and Chao Baizhu (Stir-fried Atractylodes) to transform dampness and direct Qi downward—what do you think?
Postpartum lochia fails to discharge, lower abdomen hurts, gradually developing leg swelling, facial edema, wheezing, and coughing. This is Blood stasis preceding, followed by Water flooding. One should treat both Blood and Water, following the example of Gansui (Kansui Root) and Dahuang (Rhubarb Root).
Ziwan (Aster Root), Fuling (Poria), Taoren (Peach Kernel), Niuxi (Achyranthes Root), Qingpi (Green Tangerine Peel), Xingren (Apricot Seed), Shan zha Rou (Hawthorn Flesh), Xiao Chunpu (Magnolia Bark), Yanhu (Corydalis Rhizome).
Yi's Note: Using the principle but changing the herbs, because the original formula is too harsh.
Sun's Commentary: Guizhi (Cinnamon Twig) seems like a necessary ingredient; one could also add Jingjiesui Tan (Charred Perilla Seed Head) and Xixiangfu (Cyperus Rhizome).
Second Visit: Stasis blood does not descend, instead rebelling upward. Urgently apply methods to guide it downward; otherwise, rebellion may lead to Jue (collapse).
Dangguishen (Angelica Sinensis Root Heart), Huashi (Talcum), Puhuang (Lygodium Spore), Tongcao (Tetrapanax Pith), Niuxi (Achyranthes Root), Qumai (Dianthus Herb), Wulingzhi (Trogopterus Dung), Chishao (Red Peony Root).
Deng's Commentary: Agile mind and skilled hands, adapting to changes. After four visits, never rigid or stuck, vibrant and lively, beyond the reach of mediocre practitioners.
Third Visit: Chest feels open but abdomen is full. Blood stasis in the Uterus. Use a mild purgative method.
Dahuang (Rhubarb Root), Qingpi (Green Tangerine Peel), Zhigancao (Prepared Licorice Root), Mudanpi (Moutan Bark), Taoren (Peach Kernel), Chishao (Red Peony Root), Dangguishen (Angelica Sinensis Root Heart).
Another Pill Formula: Niuxi (Achyranthes Root) 1 liang; Chishao (Red Peony Root), Yanhu (Corydalis Rhizome), Puhuang (Lygodium Spore), Wulingzhi (Trogopterus Dung), Chuanxiong (Ligusticum Rhizome), Guixin (Cinnamon Heart), Taoren (Peach Kernel) each 5 qian; Guiwei (Angelica Sinensis Root Tail), Mudanpi (Moutan Bark) each 8 qian.
Deng's Commentary: Switching to pills for mild guidance suggests the disease trend has subsided.
Yi's Note: Changing four formulas in succession, each deeper than the last, orderly, perfectly matching the pathogenesis.
Antenatal fetal edema, followed by severe diarrhea four days postpartum. After diarrhea, laughing led to collapse and unconsciousness. Upon recovery, pain and fullness persisted in the left hypochondrium for over three months. Emaciated, pulse deficient, poor appetite, lower abdominal fullness, leg swelling, difficulty urinating. This is Spleen disease transmitting to the Heart; since the Heart does not accept evil, it transmits to the Liver; the Liver, once diseased, transmits back to the Spleen. This is mutual conquest among the Five Zang organs, different from distension caused by food, Qi, water, and blood in the Six Fu organs. Hence, alternating attack and tonification yielded no effect. Treatment should involve draining the Liver and harmonizing the Spleen.
Baizhu (Atractylodes Macrocephala Rhizome), Mugua (Chaenomeles Fruit), Guangpi (Tangerine Peel), Jiaomu (Pepper Seeds), Fuling (Poria), Baishao (White Peony Root).
Yi's Note: For such conditions, only those with deep knowledge of ancient texts can speak a word.
Deng's Commentary: This illness critically involves the Liver and Spleen meridians, yet the treatment is flexible and thorough, truly the work of a master.
Sun's Commentary: How about stir-frying Baishao with Guimu (Cinnamon Bark)?
Selection of Ji Zhi Tang Medical Cases, Two Volumes
The above two volumes of *Ji Zhi Tang Medical Cases* were authored by Mr. Cao Renbo. His given name was Cunxin, courtesy name Renbo, pseudonym Le Shan. He was from Fushan, Changshu. Intelligent in his youth, elders regarded him as a promising talent. However, due to family poverty, a scholar's stipend was insufficient for livelihood, so he turned to medicine. He studied under Mr. Xue Xingtian. Xue was a renowned elder in the prefecture. Observing Mr. Cao's frequent inquiries, Xue said, "He who will glorify our path must be Cao Sheng." Mr. Cao lived with Xue for ten years, studying by lamplight late into the night. From *Lingshu* and *Suwen* down to works by Xue Ji and Yu Jia Yan, he researched and integrated them all. He then treated patients, achieving miraculous effects. Mr. Cao often said: "A doctor must maintain a mindset that views no disease as untreatable; those deemed untreatable are merely cases where my heart was not fully devoted." Thus, when examining patients, he pondered deeply, aligning his entire being with the patient's diet and daily life, leaving no detail unconsidered. For severe illnesses abandoned by others, Mr. Cao alone could use refined thought to cure them in a few doses. As the ancients said, bringing the dead back to life and flesh to bones, Mr. Cao truly embodied this. He also said: "Whenever pathogenesis is complex, treating one aspect hinders another, and others cannot act, I carefully research, either modifying a single formula or combining several into one. Thinking and thinking, spirits connect; where earnest effort reaches, a perfectly fitting formula is found, effective upon administration." Thus, doctors who abandon patients at the slightest sign of danger due to lack of devotion bear significant fault. Alas! Mr. Cao's words reveal his sincere heart and exquisite medical skills. His writings include *Liuyang Baiwen*, *Ji Zhi Tang Yulu*, *Guoting Lu*, and *Yanling Dizi Jilue*. Compiled and printed by his grandson Boquan Yunian, with a preface by Grand Secretary Yang Binshi. His biography is detailed in the family memoir written by Mr. Xu Tinggao. Famous for medicine, succeeding Ye and Xue, his virtue covered Wuzhong, and his fame spread overseas; people still speak of him today. Specifically, his medical cases, except for those in *Guoting Lu* and *Yanling Dizi Jilue*, had no circulating copies. This summer, I偶然ly saw records kept by his disciples at a friend's place. They contained many errors and omissions, so I borrowed them to copy, organized them sequentially, deleted redundancies, extracted essences, occasionally added comments to clarify intentions, and copied them into upper and lower volumes, so that future readers might imagine his solemn contemplation during consultations, oblivious to surroundings. Recorded by Liu Baozhi of Jiangyin in August of Gengzi, 26th Year of Guangxu.
Selection of Ji Zhi Tang Medical Cases, Upper Volume
Authored by Cao Cunxin (Renbo) of Changshu.
Internal Injury and Miscellaneous Diseases Department
Heart Ying and Kidney Water are mutually deficient. Liver Qi carries Liver Yang upward rebelliously. Chest feels blocked, mouth is constantly dry, hands tremble, tongue deviates, heart vexation, insomnia. Even when sleeping, soul and spirit wander, feeling disconnected from the body. Eventually, loose stools and poor appetite appear, Spleen and Stomach decline. Pulse is fine, small, lacking spirit, with intermittent pauses. Treating each symptom separately seems overwhelming. I consider that Spirit, Soul, and Hun must be allowed to reside in their proper places to generate vitality; otherwise, drifting aimlessly makes recovery uncertain. I propose adopting Xu Xueshi's Zhenzhumu Wan (Pearl Mother Pill) method.
Shijueming (Salt-fried Halloysitum), 1 liang; Ren Shen (Ginseng Root), 1 qian; Dangguishen (Angelica Sinensis Root Heart), 1.5 qian; Xijiao (Rhinoceros Horn), 5 fen; Longchi (Dragon Teeth), 3 qian; Fushen (Poria with Hostwood), 3 qian; Shengdihuang (Rehmannia Root), 4 qian; Maidong (Ophiopogon Tuber), 2 qian; Zaoren (Ziziphus Seed), 2 qian; Zhigancao (Prepared Licorice Root), 3 fen; Huaishanyao (Chinese Yam), 3 qian; Chenxiang (Agarwood), ground and mixed in, 3 fen; Zhufen (Pearl Powder), 4 fen taken first.
Yi's Note: This formula pays insufficient attention to Liver Qi. My opinion is to remove Huaishanyao and Zhigancao, add Muxiang (Aucklandia Root) and Chenpi (Tangerine Peel), then chest blockage will subside.
Deng's Commentary: Heart vexation and insomnia indicate hyperactive Heart Fire. Why are pulse and stool loose? Mostly, Fire is suppressed by Damp-Phlegm. Within clearing Heart and calming Spirit, one must incorporate acrid-dry herbs to open Phlegm, allowing Damp to transform and Phlegm to dissipate, thereby allowing Wood to flourish and Wind to clear; if nourishing cold is excessive, harm may outweigh benefit.
Sun's Commentary: The described symptoms are all caused by Phlegm-Fire harassing upwards. Even loose stools and intermittent pulse are due to Phlegm stagnating in the middle, disrupting harmony between Spleen Ying and Stomach Wei. If a consumptive syndrome reaches this stage, Zheng Qi is nearly exhausted, and there is absolutely no hope for life.
Chest blockage is not due to Qi obstruction, but Phlegm rebelling upward.
Continued Prescription: Shengdihuang (Rehmannia Root), Baishao (White Peony Root), Ren Shen (Ginseng Root), Mudanpi (Moutan Bark), Juhong (Citrus Peel), Fushen (Poria with Hostwood), Zaoren (Ziziphus Seed), Shijueming (Halloysitum), Longchi (Dragon Teeth), Shumi (Sorghum), Foshou (Buddha's Hand).
Deng's Commentary: Selected herbs are superior to the previous formula, thus achieving slight efficacy.
Second Visit: Intermittent pulse has smoothed, loose stools have ceased, chest blockage has slightly eased, hand tremors have stabilized. However, waking exceeds sleeping; internal Hun and Po are unsettled. Chest oppression and epigastric stuffiness indicate turbid Phlegm obstructing upwards has not descended. I will incorporate the method of Unblocking Yang and Suppressing Rebellion into the previous formula, hoping for success.
Zhenzhumu Wan (Pearl Mother Pill): Zhenzhumu (Mother-of-Pearl), Shudihuang (Prepared Rehmannia), Danggui (Angelica), Ren Shen (Ginseng), Zaoren (Ziziphus Seed), Baiziren (Biota Seed), Fushen (Poria with Hostwood), Xijiao (Rhinoceros Horn), Longchi (Dragon Teeth), Chenxiang (Agarwood). Remove Baiziren and Danggui. Add Xuanfuhua (Inula Flower) 1.5 qian, Daizheshi (Haematitum) 3 qian, Chenpi (Tangerine Peel) 0.7 qian, Dongzhu (Winter Atractylodes) 7 qian, Zhigancao (Prepared Licorice Root) 5 fen, Baishao (White Peony Root) 2 qian, Maidong (Ophiopogon Tuber) 3 qian. Decoct with Ganlan Shui (Water stirred vigorously), mix in Zhuli (Bamboo Sap) 1 liang.
Yi's Note: The case mentions "Unblocking Yang and Suppressing Rebellion." The formula uses Xuanfuhua and Daizheshi to suppress rebellion, but Dongzhu, Baishao, Maidong, and Zhigancao cannot be considered as "Unblocking Yang."
Deng's Commentary: Is the pulse intermittence also due to epidemic influence?
The phrase "chest oppression and epigastric stuffiness, turbid Phlegm obstructing upwards has not descended" hits the mark. Yet the formula still uses Dihuang and Maidong; although the theory is correct, the medication is inappropriate. I suggest incorporating the Wendan method, such as Banxia (Pinellia Rhizome), Zhishi (Immature Bitter Orange), Changpu (Acorus Rhizome), Zhuru (Bamboo Sap).
Third Visit: Sleep obtained at midnight, Heart and Kidney have interacted. Lung Po and Liver Hun can naturally reside in their respective organs. However, Heart easily becomes vexed, Spirit is fatigued, Qi is short, chest remains oppressed, pulse is still fine and small, feet are restless. Pulse deficiency and symptom deficiency constitute double deficiency, complicated by Damp-Phlegm. Phlegm is tangible Fire; Fire is intangible Phlegm. Method should prioritize securing the Root, assisting with resolving Phlegm.
Renshen Guben Wan (Ginseng Root-Securing Pill) added with Guiban (Turtle Shell) 5 qian, Zhifushen (Prepared Poria with Hostwood) 3 qian, Zaoren (Ziziphus Seed) 2 qian, Baishao (White Peony Root) 3 qian, Huaixiao Mai (Wheat) 3 qian, Chenpi (Tangerine Peel) 1 qian, Xuanfuhua (Inula Flower) 1.5 qian, Baiziren (Biota Seed, oil removed) 1.5 qian, Dongzhu (Winter Atractylodes) 0.5 qian. Separate: Zhufen (Pearl Powder) 2 fen, Zhuyou (Bamboo Oil) 20 spoons, Jizihuang (Egg Yolk) 1 piece mixed in.
Yi's Note: In treating Phlegm diseases, heavily investing in Maidong and Dihuang—is this not suspected of being cloying?
Deng's Commentary: Master Liu's critique is accurate.
All kinds of suffering are nothing but obstruction by Damp-Phlegm. The case states Damp-Phlegm causes harm, and Phlegm is tangible Fire, Fire is intangible Phlegm. Why still emphasize tonification? Ultimately, the concept of "Yin Deficiency" dominates the mind.
Sun's Commentary: Regarding Phlegm-Fire for twenty days, how can modern practitioners see so clearly? Given this, the method should be clearing Fire and transforming Phlegm.
Fourth Visit: Excess of Wind, Fire, and Phlegm lingers in the Liver Meridian, preventing Blood from returning to the Liver during sleep, so Hun cannot return with it. Muscle twitching awakens the patient; previous symptoms like shortness of Qi are all due to this. Furthermore, arising after years of illness, both Qi and Blood are deficient, unable to withstand further strain. The treated formulas do not deviate from Xu Xueshi's methods. Currently, pulse is fine and small with a stringy quality. Although there is no intermittent pause, there is still restlessness. Ultimately, storms are unavoidable; one cannot rely solely on the ability to eat.
Shijueming (Salt-fried Halloysitum) 3 qian, Maidong (Ophiopogon Tuber) 2 qian, Xijiao (Rhinoceros Horn) 5 fen, Baiziren (Biota Seed) 3 qian, Longchi (Dragon Teeth) 3 qian, Zaoren (Ziziphus Seed, salt-water fried) 3 qian, Dangguishen (Angelica Sinensis Root Heart) 0.7 qian, Dashudi (Large Prepared Rehmannia, stir-fried with Fusshi Fen) 6 qian, Lingyangjiao (Antelope Horn) 1 qian, Dongzhu (Winter Atractylodes) 1.5 qian, Baishao (White Peony Root) 3 qian, Chenpi (Tangerine Peel) 1 qian, Ren Shen (Ginseng Root) 2 qian, Fushen (Poria with Hostwood) 3 qian, Yinhua (Honeysuckle Flower) 1 qian, Bohe (Mint) 5 fen. Separate: Jinbo (Gold Foil) 2 sheets, Zhuli (Bamboo Sap) 1 liang, Zhenzhufen (Pearl Powder) 3 fen, Jiangzhi (Ginger Juice) 1 spoon mixed in.
Yi's Note: What is the intention behind using Yinhua and Bohe in the formula?
Deng's Commentary: Phlegm-Fire pathology often allows for good appetite.
Reviewing the four formulas, although they contain pathogen-dispelling herbs, they actually contain many Phlegm-nourishing items, hence rarely achieving efficacy.
Sun's Commentary: Arising after years of illness, it must be caused by mistaken tonification and astringency during the acute phase, leading to internal entanglement of Phlegm-Heat.
Fifth Visit: Slept soundly the previous night, but yesterday became less sleepy again. Sleeping occurred after Zi hour, indicating residual pathogenic factors in the Liver and Gallbladder meridians. Additionally, Phlegm-Fire obstructs Qi, alternating between rebellion and calm. When Qi rebels, face turns red, palpitations occur, even muscle twitching and tendon trembling, vexation and heat, restlessness. Pulse varies accordingly, as stated: "When Heart Fire moves, Ministerial Fire follows." Besides regulation, quiet rest is essential to keep Heart Fire still, allowing gradual entry onto a smooth path.
Ren Shen (Ginseng Root), Danshen (Salvia Root), Maidong (Ophiopogon Tuber), Xuanshen (Scrophularia Root) each 2 qian; Xuanfuhua (Inula Flower), Dongzhu (Winter Atractylodes) each 1.5 qian; Juhong (Citrus Peel) 1 qian; Xiaomai (Wheat) 5 qian; Zaoren (Ziziphus Seed), Chuanlian (Coptis Rhizome) decocted juice for stir-frying.
Fushen (Poria with Hostwood), Chuanbei (Fritillaria Cirrhosa Bulb) each 3 qian; Zhigancao (Prepared Licorice Root) 4 fen; Pipaye (Loquat Leaf), Zhuru (Bamboo Sap) each 3 qian; Zhufen (Pearl Powder) 3 fen mixed in.
Yi's Note: Ministerial Fire belongs to Shaoyang, i.e., Gallbladder Fire. Chuanlian and Zhuru in the formula fit the pathogenesis well.
Deng's Commentary: Stating that the Liver and Gallbladder have residual excess pathogens, plus Phlegm-Fire obstructing Qi, is indeed correct.
This formula is tonifying without stagnation, exerting more effort on clearing and transforming Phlegm-Fire, hence achieving slight efficacy.
Sixth Visit: All minor ailments are eliminated, achieved by clearing, transforming, tonifying, and nourishing meticulously, resulting in this slight effect. The concern is sleeping and waking at improper times. Heart Yang is too hyperactive, Spirit Qi wanders outward. Wei Qi travels alone in Yang, Yang Qiao Meridian is full. Fullness prevents entry into Yin, making Yin deficiency obvious. Incorporating Yin-nourishing items into the previous formula—will it yield results?
Previous formula added with Shengdihuang (Rehmannia Root) 5 qian, Chendanxing (Arisaema with Citrus Peel) 5 fen.
Separate: Zhenzhumu Wan (Pearl Mother Pill), Zhusha Anshen Wan (Cinnabar Calming Spirit Pill) each 50 pellets.
Yi's Note: Insomnia in this case is caused by Phlegm-Fire in the Liver and Gallbladder. The case cites *Neijing*'s text on "Yang Qiao Meridian fullness," which is forced; interpreting "Yin deficiency" in classics as Yin Blood deficiency is especially contrary to the original intent.
Deng's Commentary: Shengdihuang fears obstructing Phlegm.
Sun's Commentary: Carefully reviewing this illness, Phlegm-Fire must disturb the Liver and Gallbladder, causing mental unrest. Medications taken: nourishing aids Phlegm, tonifying stagnates Qi. Among nine formulas, this one is most effective, with novel and fitting medication thoughts. The concern is that herbs for transforming Phlegm and extinguishing Wind do not precisely target the organs, so the disease does not immediately resolve. Pipaye and Chuanbei are unsuitable for Liver/Gallbladder, targeting Lung Phlegm; Danshen removes stasis, Zhufen clears Heart, Maidong nourishes Lung—all missing the precise point. Replace with Tianma (Gastrodia Rhizome), Danzhi Banxia (Gall-blistered Pinellia), Hei Zhi (Black Gardenia), Gougou (Uncaria Hook), Jili (Tribulus Fruit), and it will be correct. Xuanshen clears Fire, but Sheng Muli (Raw Oyster Shell) is better. Add Baishao to secure Liver Yin without cloying properties. Proposed formula below:
Wei Tianma (Baked Gastrodia), Yan Banxia (Salt Pinellia), Fuling (Poria), Ren Shen (Ginseng), Chao Baishao (Stir-fried White Peony), Jiangzhi Chao Shanzhi (Ginger Juice Stir-fried Gardenia), Gougou (Uncaria Hook), Bai Jili (White Tribulus), Sheng Muli (Raw Oyster Shell), Chuanlian Chao Zaoren (Coptis Stir-fried Ziziphus Seed), Zhuru (Bamboo Sap), Zhishi (Immature Bitter Orange).
Nanxing (Arisaema) is drying and fierce, capable of dispelling Wind-Phlegm. Coated with Ox Gall to remove fierceness, adopt gentleness, and guide into the Gallbladder Meridian, fitting this disease best. Such ingenuity is rare.
Seventh Visit: Of all things participating in Heaven and Earth, none is more precious than normal sleep and eating. Now, taste is known in food, but sleep is uneasy. Last night, sleep and wakefulness alternated; waking was uncomfortable, sleeping was uneasy, demonstrating Wei Qi failing to enter Yin, lingering alone in Yang. Liu's Note: The case notes are disjointed and forced, primarily due to misinterpreting the character "Yin" in the classics, making the explanation illogical. Yang Qiao Meridian fullness means Ying Blood cannot be sufficient, muscles cannot be moistened. Unless Yang generates Yin, and Yin sufficiency retains Yang, how can one gradually enter a good state? However, Ying Blood, not generated by the Heart, how can it be stored in the Liver and unified by the Spleen? To rely on emotionless herbs to make emotional flesh and blood grow and develop—how easy is that? Moreover, in this state of Phlegm-Fire irritability, temporary relief after eating, internal moving Deficient Wind, muscle twitching, limb shaking, and difficult defecation, it is even harder to exert force. Urgent careful regulation is needed.
Previous formula removed Xuanshen, Xuanfuhua, Zhufen, Danshen. Added Huangqi (Astragalus Root) 1 qian, Yuanzhi (Polygala Root) 3 fen, Dangguishen (Angelica Sinensis Root Heart) 1 qian, Banxia (Pinellia Rhizome, pig gall-blistered) 1.5 qian, Muxiang (Aucklandia Root) 3 fen, Yuanyanrou (Longan Flesh) 3 pieces.
Separate: Zhenzhumu Wan (Pearl Mother Pill) 40 pellets, Zhusha Anshen Wan (Cinnabar Calming Spirit Pill) 30 pellets.
Yi Zhuo: Huangqi is not very suitable for this condition; Pig Gall-blistered Banxia shows novel thinking.
Deng's Commentary: Discomfort and unease are nothing but Phlegm-Fire pathology. The citation of "Yang Qiao Meridian fullness" from the classics is indeed forced.