先天元阳,全赖后天水谷之气荫庇,胃旺纳谷,中气既能充护脏腑,且精生于谷,阴分
亦借以充裕,纳食既减平日之七,安得不急扶脾胃耶。
高(陆墓,二十岁) 少壮脉小涩属阴,脐左起瘕,年来渐大而长,此系小肠部位。小肠
失司,变化传导,大便旬日始通,但脾胃约束津液不行,古人必用温通缓攻,但通肠壅,莫
令碍脾(因大便旬日始通,故脐左起瘕,确指其为小肠部位,聪明过人)。
麻仁 桂心 桃仁 大黄
蜜丸,服二钱。
从来通肠壅之药,必碍脾胃,以汤能荡涤耳。今改作丸药,只用二钱,令每日渐积流入
肠中,而通泄法自脾约丸来(桃仁承气加入润肠之药)。
冯(宁波,二十五岁) 面起疡疮,疮愈头痛,牙关不开。凡头面乃阳气游行之所,不容
浊气留着,外疡既合邪痹入骨骱,散风药仅走肤膜,上焦气多,血药无能为干上部之隧(说穿
似觉寻常,而他人已不能道及,言言至理。)
角针 蜂房 淡豆豉 牙皂 甜瓜蒂 大豆卷
读天翁方案,虽为病患设法,其实处推开精论,治病道理,警醒当世聋 语,教人看病
下手处,后学得此,便有主张,不致一病到手,即慌忙心无措也,有功千古。
韩(海州,四十五岁) 单单腹大,脉得右弦空,左渐弱,乃积劳阳伤之胀,久病之变,
难望其愈(断语清真,切当,治病便不蒙糊)。
大针砂丸三钱。
华(南京,二十二岁) 胃痛已久,呕水,大便结燥,药已不可用。
桃仁 姜汁 茯苓 延胡 半夏 广皮白
陆(太仓,三十二岁) 阴损瘕泄,以酸收甘补。
人参 茯神 炒白芍 熟地炭 炙甘草 五味子
山药浆丸。
朱(靖江,二十五岁) 自春季失血,血止痰嗽,左脉细数,是阴虚劳嗽。幸胃纳不减,
可
熟地 萸肉 云茯苓 山药 天冬 五味 麦冬 阿胶 龟板 黄柏
袁(黎里,二十九岁) 肛疡脓漏将一年,气下垂,精血伤,补下流,佐坚阴除热。
人参 熟地 湖莲肉 海参 茯苓 黄柏
沈(东山,二十九岁) 食入吐,久不化,胃中无阳,浊气逆攻,不贯注入肠,大便坚痹
用半硫丸钱半。
热生清,寒生浊,中阳衰微,阴浊反从下而上干,大便坚痹,半硫丸温剂中之最滑润者
,不但泄浊通阳,抑且下行降逆。
钱(嘉善,三十六岁) 情志不和,病起于内,由痛吞酸呕吐,卧着气冲,必是下起,议泄木安土。
吴萸(泡) 人参 茯苓 川楝肉 干姜 半夏(炒)
顾(来安县,四十六岁) 此病起痰饮咳嗽或外寒,劳倦即发(阳气已薄极。)发必胸脘气
胀,吐出稀涎浊沫,病退痰浓气降乃已,此饮邪皆浊饮久聚。两年渐渐腹中痞闷妨食,肛门
尻骨,坐则无恙,行动站立,刻刻气坠。若大便欲下之象,肾虚不收摄显然。或于在前见痰
嗽以肺治,苟非辛解,即以寒降,以致酿成痼疾。
肾气丸加胡桃肉、角沉香。
肾虚气不归元,既不能温养脾阳以化食,以致饮邪浊阴久聚,此肾虚而脾益虚也。再经
肾气不摄,逆上饮泛,病苦胸脘胀闷,必得肾气收摄,则诸症皆安。
何(三十二岁) 酒客大便不旺,奔走劳动失血,乃酒色之伤。止血理嗽,药味无非清降
滋润,声音日哑,肺痿气馁,为难治之症。
人参 茯苓 米仁 炙草 白芨 黄精
此方脾肺并补,以肺痿气馁,顺崇土生金,母子兼顾。
四君中以米仁换白术,加白芨、黄精,以培补中宫,此旺中央以益四维之法。
姜(盐城,五十七岁) 胁膈左右懊 不舒(此中上二焦之病),有呕逆带血,凡人脏腑之
外,必有脉络拘绊络中聚血(络中留瘀,渐成血隔,)中年操持,皆令耗血。气攻入络,必有
难以自明其病状之苦。况宜宣通血分以和络,俾不致瘀着,可免噎膈反胃(此之积血若薛立
斋治吴司马积血在肺胃之间)。
新绛 青葱 橘叶 桃仁 钩藤 土蒌皮
肝气本居下焦,宁静即是生阳。动则逆攻入络,以致血液瘀聚,久生变幻。
通络宣瘀,熄风,理厥阴之血气,有如此清灵松锐。
吴(荡口,四十六岁) 面黄白,消瘦无神,腹大脐突,足冷肿重,自言如着囊沙,曾经
因胀攻下,下必伤阳(插入断语一句)而满胀如故,乃浊阴锢闭,真阳大伤,见症是不治之条
。用药究理,暖以通阳泄浊。
生炒附子 椒目 炒黄干姜 炒小茴 车前子
伤阳,伤足太阴脾、足少阴肾也。故用生附、椒目、炒姜,以温通脾肾之阳,小茴以温
太阳之腑,再加车前以利水也。
沈(长善, 二十岁) 殴詈大声用力,气逆失音,虽阴虚脑泄,亦宜以轻扬肃上。
桑叶 枇杷叶 生甘草 象贝 米仁 大北沙参
蒋(枫桥,十九岁) 冲年阴火末宁,情志易动,加怒气火迸逆络,血上溢,问纳食不旺
,气冲血上,必抚摩气降,血不退场门,但络中离位之血,恐致凝遏,越日必气升涌逆矣(此
症血气平静之后,补阴自不可少,以通瘀为主,识力俱老。)
杜苏子 降香末 炒桃仁 粉丹皮(炒) 炒南楂 薏苡仁
加老韭白汁。
用药到此地位,可谓择焉而精。
程(徽州,四十六岁) 此痰饮宿病,劳怒遇冷即发(总由肺肾不固,)已十年之久,不
能除根。
先天之元阳,完全依赖后天水谷之气来荫庇。胃气旺盛则能纳食,中气既能充盛护卫脏腑,且精髓由水谷化生,阴分也借此得以充裕。既然进食量减少到平日的十分之七,怎能不急于扶持脾胃呢?
高某(陆墓,二十岁):少年壮年时脉象小且涩,属阴证。脐左侧出现瘕块,近年来逐渐增大且变长,这属于小肠的部位。小肠功能失常,导致变化传导障碍,大便十天才能通畅一次。但脾胃约束津液使其不能正常运行,古人必定采用温通缓攻的方法,只要疏通肠道壅滞,不要妨碍脾脏(因为大便十天才能通畅一次,所以脐左侧起瘕块,确实指明是小肠部位,患者聪明过人)。
向来使用通利肠道壅滞的药物,必然会妨碍脾胃,因为汤剂药力峻猛能荡涤肠胃。现在改为丸药,只服用二钱,让药物每日逐渐积累流入肠中,而通泄的方法自然源自脾约丸(即在桃仁承气汤中加入润肠的药物)。
冯某(宁波,二十五岁):面部发生疮疡,疮愈后头痛,牙关紧闭不开。凡是头面部位,是阳气游行的场所,不容许浊气停留。外部的疮疡愈合后,邪气痹阻深入骨节关节,疏散风邪的药物只能到达肤膜,上焦气多,血分药物无法干预上部的经络通道(说穿了似乎平常,但他人已不能道及,句句都是至理名言)。
读天翁的方案,虽然是为病患设法,其实处方推敲精当,论述透彻,治病道理警醒当今耳聋目盲之人,教导人看病下手之处,后学者得到这些,便有主张,不至于病到手就慌忙无措,这是造福千古的功绩。
韩某(海州,四十五岁):唯独腹部胀大,脉象右部弦而空,左部逐渐虚弱,这是积劳导致阳气损伤引起的胀满,久病的变证,难以指望痊愈(断语真切恰当,切中要害,治病便不模糊)。
大针砂丸三钱。
华某(南京,二十二岁):胃痛已久,呕吐清水,大便干结燥硬,药物已经不可用了。
朱某(靖江,二十五岁):自春季失血,血止后痰嗽,左脉细数,这是阴虚劳嗽。幸好胃纳没有减少,可以……
熟地、山茱萸肉、云茯苓、山药、天冬、五味子、麦冬、阿胶、龟板、黄柏。
袁某(黎里,二十九岁):肛周溃疡脓液漏出将近一年,气机下坠,精血受损,补益下焦,佐以坚阴除热。
沈某(东山,二十九岁):食物入口即吐,久久不消化,胃中无阳,浊气逆攻,不能灌注注入肠道,大便坚硬闭塞。
服用半硫丸一钱半。
热生清,寒生浊,中阳衰微,阴浊反而从下向上干犯,大便坚硬闭塞,半硫丸是温剂中最滑润的,不但能泄浊通阳,而且能下行降逆。
钱某(嘉善,三十六岁):情志不和,病起于内,因疼痛吞酸呕吐,卧下时气冲,必定是从下部发起,建议疏泄肝木以安脾土。
顾某(来安县,四十六岁):此病起因于痰饮咳嗽或外感寒邪,劳累疲倦即发作(阳气已经极度薄弱)。发作时必然胸脘气胀,吐出稀涎浊沫,病退痰浓气降才停止,这些都是饮邪浊饮长久聚集所致。两年渐渐腹中痞闷妨碍饮食,肛门尻骨处,坐着则无恙,行动站立,时刻感觉气坠。若有大便欲下的现象,肾虚不能收摄显然。或者在之前见到痰嗽以肺治,如果不是辛散解表,就是以寒凉降逆,以致酿成痼疾。
肾虚气不归元,既不能温养脾阳以化食,以致饮邪浊阴长久聚集,这是肾虚而脾更虚。再经过肾气不摄,逆上饮泛,病苦胸脘胀闷,必须得到肾气的收摄,则诸症皆安。
何某(三十二岁):酒客大便不畅,奔走劳动失血,这是酒色之伤。止血理嗽,药味无非清降滋润,声音日渐嘶哑,肺痿气馁,为难治之症。
四君子汤中以薏苡仁换掉白术,加白芨、黄精,以培补中宫,这是旺中央以益四维的方法。
姜某(盐城,五十七岁):胁膈左右懊恼不舒(这是中上二焦的病),有呕逆带血,凡人的脏腑之外,必有脉络拘绊,络中聚血(络中留瘀,渐成血隔),中年操持劳作,都令耗血。气攻入络,必有难以自明其病状之苦。况且宜宣通血分以和络,使不致瘀着,可免噎膈反胃(这种积血就像薛立斋治疗吴司马积血在肺胃之间)。
肝气本居下焦,宁静即是生阳。动则逆攻入络,以致血液瘀聚,久生变幻。
通络宣瘀,熄风,调理厥阴之血气,有如此清灵松锐。
吴某(荡口,四十六岁):面色黄白,消瘦无神,腹部胀大脐突,足冷肿重,自言如穿着囊沙,曾经因胀满攻下,下必伤阳(插入断语一句)而满胀如故,这是浊阴锢闭,真阳大伤,见症是不治之条。用药究理,暖以通阳泄浊。
伤阳,伤足太阴脾、足少阴肾也。故用生附子、椒目、炒姜,以温通脾肾之阳,小茴香以温太阳之腑,再加车前子以利水。
沈某(长善,二十岁):殴骂大声用力,气逆失音,虽阴虚脑泄,也宜以轻扬肃上。
蒋某(枫桥,十九岁):冲年阴火未宁,情志易动,加之怒气火迸逆入络,血上溢,问纳食不旺,气冲血上,必抚摩气降,血不退场门,但络中离位之血,恐致凝遏,越日必气升涌逆矣(此症血气平静之后,补阴自不可少,以通瘀为主,识力俱老)。
杜苏子、降香末、炒桃仁、粉丹皮(炒)、炒南楂、薏苡仁。
加老韭白汁。
用药到此地位,可谓择焉而精。
Congenital Yuan Yang (Primordial Yang) relies entirely on the nourishment of postnatal Qi derived from water and grain. When Stomach Qi is vigorous, it accepts food; Middle Qi can then fill and protect the Zang-Fu organs. Furthermore, Essence is born from grain, and the Yin aspect also borrows this to become abundant. Since food intake has decreased to seven-tenths of the usual amount, how can one not urgently support the Spleen and Stomach?
Patient Gao (Lumu, 20 years old): In youth, the pulse was small and choppy, indicating a Yin syndrome. A mass (Jia) appeared on the left side of the umbilicus, which has gradually enlarged and lengthened over the years; this belongs to the location of the Small Intestine. The Small Intestine has lost its function of transformation and transmission, resulting in bowel movements only once every ten days. However, the Spleen and Stomach constrain the body fluids, preventing them from circulating. Ancient practitioners would certainly use warm unblocking and slow purging methods. As long as the intestinal congestion is cleared without hindering the Spleen (because bowel movements occur only once every ten days, the mass on the left of the umbilicus indeed points to the Small Intestine location; the patient is clever).
Hemp Seed (Cannabis Fructus), Cinnamon Heart (Cinnamomi Cortex), Peach Kernel (Persicae Semen), Rhubarb (Rhei Radix et Rhizoma).
Made into honey pills, take two qian per dose.
Medicines that generally clear intestinal congestion inevitably hinder the Spleen and Stomach because decoctions have a sweeping effect. Now changed into pills, taking only two qian, allowing the medicine to gradually accumulate and flow into the intestines daily. This method of unblocking and draining originates from Pi Yue Wan (Spleen Restriction Pill) (which is Tao Ren Cheng Qi Tang added with moistening intestinal herbs).
Patient Feng (Ningbo, 25 years old): Ulcers appeared on the face; after healing, headache occurred, and the jaw was locked open. The head and face are areas where Yang Qi circulates freely, and turbid Qi is not allowed to remain. After external ulcers heal, pathogenic factors obstruct deeply into the bones and joints. Wind-dispersing medicines only reach the skin and fascia. The Upper Jiao has abundant Qi, but blood-invigorating medicines cannot intervene in the upper meridians (This seems ordinary when explained, yet others cannot articulate it; every word is profound truth).
Horn Needle (Jiao Zhen), Beecomb (Feng Fang), Light Fermented Soybean (Dan Dou Chi), Toothed Soap Fruit (Ya Zao), Sweet Melon Seed (Tian Gua Di), Soybean Sprout (Da Dou Juan).
Reading Tianweng's prescriptions, although intended for patients, the formulation is refined and the discussion thorough. The principles of treatment awaken the deaf and blind of the current era, teaching practitioners where to begin treatment. Those who learn this will have direction and will not panic when a disease presents itself. This is a merit benefiting thousands of generations.
Patient Han (Haizhou, 45 years old): Only the abdomen is distended. The pulse is wiry and empty on the right, and gradually weak on the left. This is distension caused by Yang injury due to chronic fatigue, a complication of long-term illness, unlikely to be cured (The diagnosis is clear and appropriate; treating diseases becomes less ambiguous).
Da Zhen Sha Wan (Great Needle Sand Pill), three qian.
Patient Hua (Nanjing, 22 years old): Long-standing stomach pain, vomiting clear fluid, dry and hard stools. Medication is no longer usable.
Peach Kernel (Persicae Semen), Ginger Juice (Jiang Zhi), Poria (Fu Ling), Corydalis Rhizome (Yan Hu Suo), Pinellia Tuber (Ban Xia), Tangerine Peel White (Guang Pi Bai).
Patient Lu (Taicang, 32 years old): Yin damage leading to Jia and diarrhea, treated with sour astringents and sweet tonics.
Ginseng Root (Ren Shen), Spirit of Poria (Fu Shen), Stir-fried White Peony Root (Chao Bai Shao), Charred Prepared Rehmannia Root (Shu Di Tan), Roasted Licorice Root (Zhi Gan Cao), Schisandra Berry (Wu Wei Zi).
Made into pills with Yam Paste (Shan Yao Jiang).
Patient Zhu (Jingjiang, 25 years old): Hemorrhage since spring; after bleeding stopped, phlegm-cough persisted. The left pulse is fine and rapid, indicating Yin deficiency labor cough. Fortunately, appetite remains unchanged, so...
Prepared Rehmannia Root (Shu Di), Cornus Fruit (Yu Rou), Cloud Poria (Yun Fu Ling), Chinese Yam (Shan Yao), Asparagus Tuber (Tian Dong), Schisandra Berry (Wu Wei), Ophiopogon Tuber (Mai Dong), Donkey-hide Gelatin (E Jiao), Turtle Shell (Gui Ban), Phellodendron Bark (Huang Bo).
Patient Yuan (Lili, 29 years old): Anal ulcer with pus discharge for nearly a year. Qi sinks downward, Jing and Blood are damaged. Tonify the Lower Jiao, assist in firming Yin and clearing heat.
Ginseng Root (Ren Shen), Prepared Rehmannia Root (Shu Di), Lotus Seed Meat (Hu Lian Rou), Sea Cucumber (Hai Shen), Poria (Fu Ling), Phellodendron Bark (Huang Bo).
Patient Shen (Dongshan, 29 years old): Vomiting immediately after eating, prolonged indigestion. Stomach lacks Yang. Turbid Qi rebels upward, failing to descend into the intestines. Stools are hard and obstructed.
Take Ban Liu Wan (Half-Sulfur Pill), one and a half qian.
Heat generates clarity, Cold generates turbidity. Middle Yang is declining, so Yin turbidity rebels from below upwards, causing hard and obstructed stools. Ban Liu Wan is the most slippery and moistening among warming agents. It not only drains turbidity and unblocks Yang but also directs Qi downward and subdues rebellion.
Patient Qian ( Jiashan, 36 years old): Emotional disharmony, disease originating internally. Due to pain, acid regurgitation, and vomiting, Qi rushes when lying down, likely originating from below. Propose to drain Liver Wood to calm Earth.
Evodia Fruit (Wu Yu - soaked), Ginseng Root (Ren Shen), Poria (Fu Ling), Toosendan Fruit Flesh (Chuan Lian Rou), Dried Ginger (Gan Jiang), Pinellia Tuber (Ban Xia - stir-fried).
Patient Gu (Lai'an County, 46 years old): This disease originates from phlegm-fluid retention cough or external cold, triggered by fatigue (Yang Qi is extremely thin). Attacks cause chest and epigastric Qi distension, vomiting of thin saliva and turbid foam. The condition subsides when phlegm thickens and Qi descends. These are turbid fluids accumulating over time. For two years, there has been gradual epigastric stuffiness interfering with eating. At the anus and sacrum, sitting is fine, but standing or walking causes constant sensation of Qi sinking. If there is a sensation of needing to defecate, Kidney deficiency failing to secure is evident. Previously, phlegm-cough was treated via the Lung. If not using acrid release, then cold descending was used, leading to stubborn disease.
Shen Qi Wan (Kidney Qi Pill) added with Walnut Meat (Hu Tao Rou) and Agarwood (Jiao Chen Xiang).
Kidney deficiency causes Qi to fail to return to its origin. It cannot warm and nourish Spleen Yang to transform food, leading to long-term accumulation of fluid pathogens and Yin turbidity. This is Kidney deficiency causing further Spleen deficiency. With Kidney Qi failing to secure, rebellious Qi and fluid overflow cause chest and epigastric distension. Only by securing with Kidney Qi can all symptoms be resolved.
Patient He (32 years old): Wine drinkers often have poor bowel movements. Hemorrhage from running and labor is due to wine and sexual excess. Stopping bleeding and managing cough involves only clearing, descending, and moistening herbs. Voice becomes hoarse daily. Lung萎 (Fei Wei - Lung Flaccidity) and Qi exhaustion make this a difficult-to-treat condition.
Ginseng Root (Ren Shen), Poria (Fu Ling), Coix Seed (Mi Yi Ren), Roasted Licorice Root (Zhi Cao), Bletilla Tuber (Bai Ji), Polygonatum Rhizome (Huang Jing).
This formula tonifies both Spleen and Lung. Due to Lung Flaccidity and Qi exhaustion, it follows the principle of strengthening Earth to generate Metal, attending to both mother and child.
In Si Jun Zi Tang (Four Gentlemen Decoction), Coix Seed replaces Atractylodes Macrocephala Rhizome (Bai Zhu), adding Bletilla Tuber and Polygonatum Rhizome to cultivate the Central Palace. This is the method of strengthening the center to benefit the four extremes.
Patient Jiang (Yancheng, 57 years old): Oppression and discomfort on both sides of the hypochondrium and diaphragm (Disease of the Middle and Upper Jiao). Vomiting with blood. Outside the Zang-Fu organs, there must be collaterals binding together, with blood gathering in the collaterals (Stasis in collaterals gradually forms Blood Ge). Middle-aged exertion consumes Blood. Qi attacking the collaterals brings suffering that is hard to describe. One should promote circulation in the Blood aspect to harmonize collaterals, preventing stasis, thereby avoiding dysphagia and regurgitation (Such accumulated blood is like Xue Lizhai treating Wu Sima's blood stasis between Lung and Stomach).
New Crimson Silk (Xin Jiang), Green Onion Stem (Qing Cong), Tangerine Leaf (Ju Ye), Peach Kernel (Tao Ren), Uncaria Ramulus cum Uncis (Gou Teng), Trichosanthes Peel (Tu Lou Pi).
Liver Qi originally resides in the Lower Jiao; tranquility generates Yang. Movement causes rebellion into the collaterals, leading to blood stasis and long-term changes.
Unblocking collaterals and dispersing stasis, extinguishing wind, regulating Jueyin Blood and Qi, achieves such clarity, agility, and sharpness.
Patient Wu (Dangkou, 46 years old): Yellowish-white complexion, emaciated and spiritless. Abdominal distension with protruding umbilicus, cold and swollen heavy feet. Self-describes feeling like wearing a bag of sand. Previously treated distension with purgatives, which injured Yang (Inserted diagnostic comment), yet distension remained. This is turbid Yin locking closed, severe injury to True Yang. The presentation indicates an untreatable condition. Medication seeks principle: warmth to unblock Yang and drain turbidity.
Raw and Stir-fried Aconite Root (Sheng Chao Fu Zi), Pepper Seeds (Jiao Mu), Stir-fried Dry Ginger (Chao Huang Gan Jiang), Stir-fried Fennel Fruit (Chao Xiao Hui), Plantago Seed (Che Qian Zi).
Injuring Yang injures Foot-Taiyin Spleen and Foot-Shaoyin Kidney. Thus, Raw Aconite, Pepper Seeds, and Stir-fried Ginger are used to warm and unblock Spleen and Kidney Yang. Fennel warms the Bladder (Taiyang organ). Plantago Seed is added to promote urination.
Patient Shen (Changshan, 20 years old): Beating, cursing, loud shouting, and exertion caused Qi rebellion and loss of voice. Although Yin deficiency with brain leakage is present, light and ascending methods should be used to clear the Upper Jiao.
Mulberry Leaf (Sang Ye), Loquat Leaf (Pi Pa Ye), Raw Licorice Root (Sheng Gan Cao), Fritillaria Bulb (Xiang Bei), Coix Seed (Mi Yi Ren), Large North Glehnia Root (Da Bei Sha Shen).
Patient Jiang (Fengqiao, 19 years old): In youth, Yin Fire was unsettled. Emotions easily stirred. Anger and Fire rebelled into collaterals, causing blood to overflow upwards. Appetite is poor. Qi rushing and blood rising require massage to descend Qi. If blood does not retreat from the anal gate, blood displaced in collaterals may coagulate and obstruct. The next day, Qi will surely surge upwards (After blood and Qi stabilize, tonifying Yin is indispensable, focusing on unblocking stasis; insight is mature).
Perilla Seed (Du Su Zi), Agarwood Powder (Xiang Mo), Stir-fried Peach Kernel (Chao Tao Ren), Moutan Bark (Fen Dan Pi - stir-fried), Stir-fried Hawthorn (Chao Nan Zha), Coix Seed (Yi Yi Ren).
Add juice of old leek white parts.
Using medication at this level can be called precise selection.
Patient Cheng (Huizhou, 46 years old): This is a chronic phlegm-fluid disease, triggered by fatigue, anger, and cold (Rooted in Lung and Kidney insecurity). It has lasted ten years and cannot be eradicated.