吴双泉公,两尺脉洪大,两关滑,两尺沉微,此阳亢阴微之候,上盛而下虚也。上盛者
,痰
与火,下虚者,肾经真阴不足也。法当清上补下,上清则头目清利,耳鸣眩晕之症可除,下
实则腰膝不酸,筋骨强健。清上用清中丸,贝母、橘红、枳实、海石、山楂、茯苓、白芥子
、黄
连、黄芩、滑石、青黛、神曲为丸,食后茶送下二钱。补下用既济丹,辰砂,磁石各一两,
熟生地四两,黄柏、知母、菟丝子、柏子仁各二两,牛膝、枸杞子、白茯苓各一两半,炼蜜
为丸,梧桐子大,空心淡盐汤送下八九十丸。
李寅斋先生,患血淋几二年不愈。每发十余日,小水艰涩难出,窍痛不可言,将发必先
面热
牙疼,后则血淋。前数日饮汤水欲温和,再二日欲热,又二日非冷如冰者不可,燥渴之甚,
令速汲井水连饮二三碗,犹以为未足。未发时,大便燥结,四五日一行,发则泻而不实,脉
左寸短弱,关弦大,右寸下半指与关皆滑大,两尺俱洪大。据此中焦有痰,肝经有瘀血也。
向服滋阴降火及淡渗利窍之剂,皆无效,且年六十有三,病已久,血去多,何可不兼补,治
当去瘀生新,提清降浊,用四物汤加杜牛膝补新血,滑石、桃仁消其瘀血,枳实、贝母以化
痰,山栀仁以降火,柴胡升提清气,二十帖而诸症渐减。再以滑石、黄柏、知母各一两,琥
珀、小茴香、桂心各一钱半,玄明粉三钱,海金沙、没药各五钱,茅根汁熬膏为丸,每服
一钱,空心及晚,茅根汤送下而愈。
吴双泉先生,双侧尺脉洪大,双侧关脉滑利,双侧尺脉沉微,这是阳气亢盛、阴液微弱的征象,表现为上部邪气盛而下部正气虚。所谓上盛,是指痰浊与火邪壅滞;所谓下虚,是指肾经真阴不足。治疗法则应当清泄上部、补益下部。上部清则头目清爽,耳鸣眩晕的症状可以消除;下部充实则腰膝不酸软,筋骨强健。清上方面使用清中丸,由贝母、橘红、枳实、海浮石、山楂、茯苓、白芥子、黄连、黄芩、滑石、青黛、神曲组成,制成丸剂,饭后用茶水送服二钱。补下方面使用既济丹,由辰砂、磁石各一两,熟地黄四两,黄柏、知母、菟丝子、柏子仁各二两,牛膝、枸杞子、白茯苓各一两半,炼蜜为丸,如梧桐子大小,空腹时用淡盐汤送服八九十丸。
李寅斋先生,患血淋症近两年未愈。每次发作持续十余日,小便艰涩难出,尿道疼痛难以言表。即将发作前必先出现面部发热、牙痛,随后发生血淋。发病前几天饮水尚觉温和适宜,再过两日觉得水要热些,又过两日非喝冷如冰的水不可,极度燥渴,让人迅速汲取井水连续饮用二三碗,仍觉得不够。未发作时,大便干燥结硬,四五日排便一次;发作时则腹泻且粪便不成形。脉象左寸短弱,关脉弦大,右寸下半指及关脉皆滑大,双侧尺脉均洪大。据此判断中焦有痰浊,肝经有瘀血。此前服用滋阴降火及淡渗利窍的药物,均无效。况且患者年六十三岁,病程已久,失血较多,怎能不兼用补法?治疗应当祛除瘀血以生新血,提升清气以降浊阴。使用四物汤加杜牛膝以补养新血,滑石、桃仁以消散瘀血,枳实、贝母以化痰浊,山栀子仁以降火邪,柴胡以升提清气,服用二十帖后诸症逐渐减轻。再用滑石、黄柏、知母各一两,琥珀、小茴香、桂心各一钱半,玄明粉三钱,海金沙、没药各五钱,茅根汁熬膏为丸,每服一钱,空腹及晚间用茅根汤送服而痊愈。
Mr. Wu Shuangquan presented with bilaterally large and surging chi pulses (Kidney pulse), bilaterally slippery guan pulses (Liver/Spleen pulse), and bilaterally deep and faint chi pulses. This indicates a pattern of hyperactive Yang and deficient Yin, characterized by excess in the upper jiao and deficiency in the lower jiao. The "excess in the upper" refers to the accumulation of phlegm and fire; the "deficiency in the lower" refers to insufficiency of the true Yin in the Kidney meridian. The treatment principle should be to clear the upper and tonify the lower. Clearing the upper will result in clarity of the head and eyes, eliminating symptoms such as tinnitus and vertigo. Tonifying the lower will prevent soreness and weakness of the waist and knees, strengthening the sinews and bones. For clearing the upper, Qingzhong Wan (Clearing the Middle Pill) is used, composed of Fritillariae Bulbus (Beimu), Citri Reticulatae Pericarpium (Juhong), Aurantii Fructus Immaturus (Zhishi), Aragonitum (Haishi), Crataegi Fructus (Shanzha), Poria (Fuling), Sinapis Semen Album (Baijiezi), Coptidis Rhizoma (Huanglian), Scutellariae Radix (Huangqin), Talcum (Huashi), Cyanotis Arachnoidea Herba (Qingdai), and Malt (Shenqu). These are processed into pills, taken after meals with tea, two qian per dose. For tonifying the lower, Jiji Dan (Ji Ji Pill) is used, composed of Cinnabar (Chensha) and Magnetitum (Cishi), each one liang, Prepared Rehmanniae Radix (Shudihuang) four liang, Phellodendri Cortex (Huangbai) and Anemarrhenae Rhizoma (Zhimu), Dodonaeae Semen (Tusizi), and Biota Seed (Baiziren), each two liang, Achyranthis Bidentatae Radix (Niuxi), Lycii Fructus (Gouqizi), and Poria (Baifuling), each one and a half liang. These are mixed with refined honey to form pills the size of paulownia seeds, taken on an empty stomach with light salt water, 80-90 pills per dose.
Mr. Li Yinzhai suffered from hematuria (blood strangury) for nearly two years without cure. Each episode lasted over ten days, with difficult and scanty urination and unbearable pain in the urethra. Before an attack, he would first experience facial heat and toothache, followed by hematuria. In the few days preceding an attack, he desired warm water; two days later, he desired hot water; and two days after that, he could only tolerate ice-cold water. He experienced extreme dryness and thirst, requiring others to quickly draw well water and drink two or three bowls continuously, yet still feeling unsatisfied. When not attacking, his stool was dry and constipated, passing once every four or five days; during attacks, he suffered from diarrhea with incomplete evacuation. His pulse was short and weak at the left cun position, wiry and large at the left guan position, slippery and large at the right cun (lower half finger breadth) and guan positions, and large and surging at both chi positions. Based on this, it was determined that there was phlegm in the middle jiao and blood stasis in the Liver meridian. Previous treatments with herbs for nourishing Yin and descending fire, as well as diuretics for promoting urination, were ineffective. Furthermore, given his age of sixty-three, the chronic nature of the disease, and significant blood loss, tonification must be included. The treatment strategy should focus on removing stasis to generate new blood, raising clear Yang and descending turbid Yin. Siwu Tang (Four Substances Decoction) was used with added Achyranthes bidentata root (Duniuxi) to tonify new blood, Talcum (Huashi) and Persicae Semen (Taoren) to dissipate stasis, Aurantii Fructus Immaturus (Zhishi) and Fritillariae Bulbus (Beimu) to resolve phlegm, Gardeniae Fructus (Shanzhiren) to descend fire, and Bupleuri Radix (Chaihu) to raise clear Qi. After twenty doses, all symptoms gradually subsided. Subsequently, a pill formula was prepared using Talcum (Huashi), Phellodendri Cortex (Huangbai), and Anemarrhenae Rhizoma (Zhimu), each one liang; Succinum (Hupo), Foeniculi Fructus (Xiaohuixiang), and Cinnamomi Cortex (Guixin), each one and a half qian; Mirabilite (Xuanmingfen) three qian; Chrysosplenii Herba (Haijinsasha) and Myrrha (Moyao), each five qian; boiled with juice of Imperatae Rhizoma (Maogen) to form pills. One qian was taken per dose, on an empty stomach and in the evening, washed down with Imperatae Rhizoma decoction, resulting in a cure.