罗(六十三岁) 情怀内起之热,燔燎身中脂液,嘈杂如饥,厌恶食物无味,胃是阳土,
以阴
为用,津液既窍,五火皆燃,非六气外客之邪,膏连苦辛寒不可用。必神静安坐,五志自宁
,日饵汤药无用(五志无形之火,皆本于先天元阳。静则温养脏真,为生生之气。燔灼则逼
烁津液,肌肉日削。)
人参 知母 茯神 甘草 生地 天冬 鲜莲子
胃是阳土,以阴为用,故胃阴须养,真名语也。
性情随气血改移,肌皮宽浓者,往往弛缓。每见燥急人瘦如骨立,津液不充,火气飞扬
耳。
潘(二十六岁) 少年失血遗精,阴虚为多。夫精血有形,既去难复,即是内损阴虚,日
久渐干
阳位,肝肾病必延胃府。所列病原,大暑令节,乃天运地气之交替,人身气馁失司维续,必
有不适之状(精深之论。)褚澄云∶难状之疾,谓难以鸣诉病之苦况也(至明确,惟其病延胃
府,所以人身气馁,失司维续也。)
节令交替,气旺者潜移不觉,中气虚衰少力,旋转枢纽,几于或息。故维续为难耳。
顾 暑湿必伤脾胃,二邪皆阴,不必苦寒清热,调气分利水,此邪可去。中年病伤气弱
,以强中醒后天(中年人气分已不旺,再因病伤,气更弱矣。强中壮气,即是驱邪。)
人参 炒扁豆 木瓜 茯苓 炙草 广皮
暑因乎湿,挟湿已蒸化为热,必须甘凉淡渗,亦不必用苦寒。若未经化热,不致伤津劫
液,但调气分利水足矣。暑湿一门,变症最多,不可不辨。此必是未经化热者。
胡(三十四岁) 不量自己,每事争先(此人素禀必是偏于火重,)此非伤于一时。春夏天
暧,
地中阳升,失血咳嗽,声音渐哑,填实真阴以和阳(人身随天地气机升降,元气旺时不觉,
气血衰而有病,便六气为主而此身无权矣。)
熟地 萸肉 淮山药 茯苓 天冬 麦冬 龟甲心 女贞 芡实 建莲肉
钱(四十七岁) 瘦人暑热入营,疟来咳痰盈碗,平日饮酒之热,蓄于肝胃,舌黄渴饮。
议用玉女煎。
玉女煎的系肝胃之药,暑热外侵,酒热内应,内外合邪,专在营分,非石膏、生地等属
,难以清营中之热。
杨(三十八岁) 胃伤食减,形倦舌赤,此系脾病(形倦舌赤,必是脾气伤而脾营耗者。)
罗某(六十三岁):因情志内郁产生的虚热,在体内猛烈燃烧,耗损身体的脂液,出现胃中嘈杂似饥的感觉,厌恶食物且觉得无味。胃属阳土,其功能依赖阴液来滋润,如今津液枯竭,五脏之火皆燃起,这并非由六淫外邪侵袭所致,因此含有黄连、苦参等苦辛寒性质的药物不可使用。必须保持心神宁静、安坐调息,使五志之火自然平息,每日服用汤药并无用处。(注:五志所化的无形之火,根源在于先天的元阳。静养则能温补脏腑真气,这是生生不息的气机;若火热燔灼,则会逼迫烧干津液,导致肌肉日渐消瘦。)
处方:人参、知母、茯神、甘草、生地、天冬、鲜莲子。
按语:胃是阳土,以阴为用,所以养胃阴的说法,确实是至理名言。人的性情会随着气血的变化而改变,肌肉皮肤宽厚丰满的人,往往性格弛缓;常见那些急躁干燥的人瘦得像骨头立起来一样,这是因为津液不充盈,火气飞扬的缘故。
潘某(二十六岁):少年时期失血、遗精,多为阴虚体质。精血是有形之物,一旦流失难以恢复,这就是内伤导致的阴虚。日久累及阳位,肝肾之病必然延及胃腑。所列出的病因,正值大暑时节,这是天地运气交替的时候,人体之气衰弱,失去维持平衡的能力,必然会出现不适的症状。(这是精深的论述。)褚澄说:难状之疾,是指难以诉说的病痛之苦况。(非常明确,正因为病延及胃腑,所以人身之气衰弱,失去维系的作用。)
节令交替时,正气旺盛的人潜移不觉,但中气虚衰、少力之人,旋转枢纽的功能几乎停止,所以维持平衡很难。顾某:暑湿必定损伤脾胃,这两种邪气都属阴,不必用苦寒药清热,只需调理气分、利水渗湿,这些邪气就可以去除。中年人因病导致气弱,应当通过强健中焦来唤醒后天之本(中年人气分本就不旺,再因病损伤,气更弱了。强健中气壮气,就是驱除邪气的方法)。
处方:人参、炒扁豆、木瓜、茯苓、炙甘草、广陈皮。
按语:暑邪依附于湿,挟带湿气已经蒸腾化为热,必须用甘凉淡渗之法,也不必用苦寒药。如果未经化热,不至于伤津劫液,只需调理气分、利水即可。暑湿这一门类,变症最多,不可不辨别。此案例一定是未经化热的情况。
胡某(三十四岁):不自量力,每件事都争先(此人素体禀赋必偏于火重),这不是短时间内受的伤害。春夏天气温暖,地中阳气升发,导致失血咳嗽,声音逐渐嘶哑,治疗应填补真阴以调和阳气(人身随天地气机升降,元气旺盛时不觉察,气血衰败而有病时,便由六气主导,身体自身失去了控制权)。
处方:熟地黄、山茱萸、淮山药、茯苓、天冬、麦冬、龟甲心、女贞子、芡实、建莲肉。
钱某(四十七岁):瘦人感受暑热入营分,疟疾发作时咳痰满碗,平日饮酒的热气蓄积在肝胃,舌苔黄、口渴想喝水。建议用玉女煎。
按语:玉女煎确实是针对肝胃的药物,暑热从外侵袭,酒热在内相应,内外合邪,专门在营分,如果不是石膏、生地这类药物,难以清除营分中的热邪。
杨某(三十八岁):胃受伤导致食欲减退,形体疲倦、舌质红赤,这属于脾病(形体疲倦、舌质红赤,必然是脾气受伤而脾营耗损的表现)。
Luo (63 years old): Heat arising from internal emotional stagnation fiercely burns the body's fluids and fats, causing gastric discomfort resembling hunger (gastric嘈杂), aversion to food, and a tasteless sensation. The Stomach is Yang Earth, functioning through Yin; with the depletion of fluids and the ignition of the Five Fires (internal heat generated by the five zang organs), this is not an external pathogen of the Six Qi (Six Exogenous Pathogens). Therefore, bitter, acrid, and cold herbs such as Coptidis Rhizoma (Huanglian) and Sophorae Flavescentis Radix (Kushen) are contraindicated. One must maintain mental tranquility and sit in peace to calm the Fire of the Five Emotions (Wu Zhi); daily administration of decoctions is useless. (Note: The formless fire of the Five Emotions originates from congenital Primordial Yang. Tranquility nourishes the Zhen Qi of the viscera, constituting the vital energy of life. Fierce burning forces the evaporation of fluids, leading to daily wasting of muscles.)
Prescription: Ginseng Radix et Rhizoma (Renshen), Anemarrhenae Rhizoma (Zhimu), Poria (Fushen), Glycyrrhizae Radix et Rhizoma preparata (Gancao), Rehmanniae Radix (Shengdi), Asparagi Radix (Tian Dong), Fresh Lotus Seeds (Xian Lian Zi).
Commentary: The Stomach is Yang Earth, utilizing Yin for its function; thus, the statement that "Stomach Yin must be nourished" is indeed a profound truth. Temperament shifts with Qi and Blood. Those with thick and abundant muscle and skin often have a relaxed disposition. Conversely, those who are dry and irritable are often emaciated, standing like bones, due to insufficient fluids and soaring fire qi.
Pan (26 years old): Hemorrhage and seminal emission in youth indicate predominant Yin deficiency. Essence and blood are tangible substances; once lost, they are difficult to restore, constituting internal damage and Yin deficiency. Over time, it affects Yang positions, and Liver-Kidney disease inevitably extends to the Stomach Fu organ. The listed etiology coincides with the Great Heat solar term, representing the transition of Heaven and Earth's Qi. When human Qi is weak and loses its regulatory continuity, discomfort is inevitable. (This is a profound argument.) Chu Cheng stated: "Difficult-to-describe diseases" refers to suffering that is hard to articulate. (Very clear; precisely because the disease extends to the Stomach Fu, human Qi becomes weak and loses its sustaining power.)
During seasonal transitions, those with robust Qi do not notice subtle changes. However, in those with deficient Middle Qi and lack of strength, the pivot mechanism nearly ceases, making maintenance difficult. Gu: Summer-heat and Dampness inevitably injure the Spleen and Stomach. Both pathogens are Yin in nature; there is no need to use Bitter-Cold herbs to clear heat. Regulating the Qi aspect and promoting urination can eliminate these pathogens. In middle age, illness weakens Qi; one must strengthen the Middle Jiao to awaken the Post-Heaven foundation. (In middle age, Qi aspect is already not vigorous; further injury by illness makes Qi weaker. Strengthening the Middle Qi is equivalent to expelling pathogens.)
Prescription: Ginseng Radix et Rhizoma (Renshen), Stir-fried Lablab Seed (Chao Bian Dou), Chaenomelis Fructus (Mu Gua), Poria (Fuling), Prepared Licorice Root (Zhi Cao), Tangerine Peel (Guang Pi).
Commentary: Summer-heat relies on Dampness; when accompanied by dampness, it steams and transforms into heat. Sweet-Cool and Light-Diaphoretic methods are required; Bitter-Cold herbs are unnecessary. If it has not transformed into heat, it will not injure fluids or rob essence, and regulating Qi and promoting urination suffice. Summer-heat and Dampness involve numerous variations and must be distinguished. This case likely involves summer-heat that has not yet transformed into heat.
Hu (34 years old): Acting beyond one's capacity and striving to be first in everything (this person's constitution is likely prone to excessive Fire). This is not an acute injury. In spring and summer, when the weather is warm and Earthly Yang rises, hemorrhage and cough occur, and the voice gradually becomes hoarse. Treatment should fill True Yin to harmonize Yang. (The human body follows the ascending and descending of Heaven and Earth's Qi mechanisms. When Yuan Qi is vigorous, it goes unnoticed; when Qi and Blood decline and disease arises, the Six Qi dominate, and the body loses its autonomy.)
Prescription: Prepared Rehmanniae Radix (Shu Di), Cornus Officinalis Fruit (Yu Rou), Chinese Yam (Huai Shan Yao), Poria (Fuling), Asparagi Radix (Tian Dong), Ophiopogonis Radix (Mai Dong), Tortoise Plastron Heart (Gui Jia Xin), Ligustrum Lucidum Fruit (Nv Zhen), Euryale Seed (Qian Shi), Jian Lotus Seeds (Jian Lian Rou).
Qian (47 years old): A thin person suffers from Summer-heat entering the Ying (Nutritive) level. During malaria attacks, coughing produces bowlfuls of phlegm. Daily alcohol consumption accumulates heat in the Liver and Stomach, presenting with a yellow tongue coating and thirst with desire to drink. It is proposed to use Yü Nü Jian (Jade Woman Decoction).
Commentary: Yü Nü Jian specifically targets the Liver and Stomach. With Summer-heat invading externally and Wine-Heat responding internally, the pathogens combine internally and externally, focusing on the Ying level. Without herbs such as Gypsum Fibrosum (Shi Gao) and Rehmanniae Radix (Sheng Di), it is difficult to clear heat within the Ying level.
Yang (38 years old): Stomach injury leads to reduced appetite, physical fatigue, and a red tongue. This belongs to Spleen disease. (Physical fatigue and red tongue indicate Spleen Qi injury and Spleen Ying depletion.)