陈(南城下,五十岁) 海风入喉,侵肺久着,散之无用,议缓逐以通上窍(药味俱轻扬
上泛,丸则不失缓逐之义。)
马勃 射干 蝉衣 麻黄
为末,以葶苈子五钱,大枣十个,煎水泛丸。
金(关上,四十九岁) 凡痞胀治在气,燥实治在血,四者全见,攻之宜急。此症肝络少
血,木火气上膈而痛,辛润柔降,得以止痛,通大便。厥是肝阳化风,燥升受热,动怒必来
,不在医药中事(燥居六气之一,火就燥,燥气上升,致木火之热上膈而痛,不可不知治法
。)
芝麻 柏子仁 天冬 生地 苏子
姚(曹家巷,四十四岁) 心腹如焚,(阳结于内)肌腠寒冷,知饥不甘纳食,大便久溏,
此属劳怯(阳结于上则中下虚寒。)医案见嗽,清肺清热,损者愈损,未必用药能除病(病者
到此地位,医者无可奈何,只得出此方矣)
黄精 白芨 米仁 炙草
曹 疟热攻络,络血涌逆,胁痛咳嗽(此是疟止后见症。)液被疟伤,阳升入巅为头痛,
络病在表里之间,攻之不肯散,搜血分留邪伏热(疟热太峻,火炽烁津,而逼血上溢。络病
在表里之间,一句,指示迷途。)
生鳖甲 炒桃仁 知母 丹皮 鲜生地 寒水石
搜血分留邪伏热,真水清石见之用药,刀刀见血。
葛(东山,七岁) 成浆必藉热蒸湿气(此是痘后见症。)痘前发惊,是痘毒由血脉而出,
乃常有事,牛黄大苦大寒,直入心胞。若因时气未解,古人谓用之如油入面,反令内结,数
月语言不灵,热气胶痰,蒙蔽膻中清气(痘惊为痘毒由血脉而出之机,不得以幼科惊风论也
。)
远志 石菖蒲 天竺黄 金箔 胆星 川连 银箔 麝香 冰片
蜜丸,重五分。
杨 夏季暑湿,必入气分,谓二邪亦是一股气。同气相感,如泄泻溲少,皆湿郁阻气,
以六和汤、甘露饮,有凭可证之方。已后不分气血。凉热互进,气分之邪,引之入血,此亦
如五胡乱华,贤如温祖,难救神州陆沉(气分之邪仍从气分宣泄,末二句必有所指,非王即
薛也。)
杏仁 蔻仁 大麦仁 米仁 浙苓 橘红 佩兰叶
程(六十二岁) 形神衰,食物减,是积劳气伤,甘温益气,可以醒复。男子六旬,下元
固虚,若胃口日疲,地味浊阴,反伤中和。
陈姓患者(南城下,五十岁):海风之邪侵入咽喉,久留于肺脏难以消散,单纯发散已无效果,建议采用缓慢驱逐的方法以疏通上焦窍道。(所用药物性质均轻扬上浮,制成丸剂则不失缓慢驱逐之意。)
马勃、射干、蝉衣、麻黄。
研为细末,用葶苈子五钱、大枣十个煎水,以此药汁泛丸。
金姓患者(关上,四十九岁):凡是痞满胀闷的病证,治疗重点在于调气;燥结实热的病证,治疗重点在于治血。若上述四种情况同时出现,攻下治疗应当急切。此症肝络阴血不足,木火之气上逆至膈部导致疼痛,采用辛润柔降之法,可以止痛并通利大便。“厥”是肝阳化生内风所致,因燥气上升受热,动怒时必然发作,这已非单纯医药所能解决的事。(“燥”居六气之一,“火就燥”,燥气上升,导致木火之热上逆至膈部而痛,这一点不可不知其治法。)
芝麻、柏子仁、天冬、生地、苏子。
姚姓患者(曹家巷,四十四岁):心腹部感觉如火烧灼(阳气郁结于内),肌肤腠理寒冷,虽然知道饥饿但不愿进食,大便长期稀溏。此属劳损虚怯之证(阳气郁结于上,则中下焦虚寒)。此前医案见咳嗽症状,采用清肺清热之法,导致正气更加受损,未必能靠用药去除疾病(病人病情至此地步,医生也无可奈何,只得开出此方)。
黄精、白芨、米仁(薏苡仁)、炙甘草。
曹姓患者:疟疾的热邪攻冲经络,导致络脉血液涌逆,出现胁痛和咳嗽(这是在疟疾停止后出现的症状)。津液被疟疾损伤,阳气升入头部顶端引发头痛。络脉病变位于表里之间,强行攻散无效,需搜剔血分中残留的邪气和伏热(疟疾热势太盛,火热炽盛灼伤津液,逼迫血液上溢。关于“络病在表里之间”这一句,是指引迷途的关键提示)。
生鳖甲、炒桃仁、知母、丹皮、鲜生地、寒水石。
搜剔血分中残留的邪气和伏热,这是真水清石先生用药的精妙之处,刀刀见血,直击要害。
葛姓患者(东山,七岁):形成浆液必须借助热气蒸腾湿气(这是出痘后的症状表现)。出痘前发生惊悸,是因为痘毒从血脉外出,这是常见现象。牛黄大苦大寒,直入心包。如果因为时令之气未解,古人说使用牛黄如同油渗入面中,反而导致内部结滞,数月后语言不灵,热气胶结成痰,蒙蔽膻中的清气(痘惊是痘毒由血脉外出的机理,不能将其作为儿科惊风来论治)。
远志、石菖蒲、天竺黄、金箔、胆星、川连、银箔、麝香、冰片。
蜂蜜为丸,每丸重五分。
杨姓患者:夏季暑湿之邪,必定进入气分,认为这两种邪气也是一股气。同气相感,如泄泻、小便少,都是湿邪郁阻气机所致,以六和汤、甘露饮为例,是有凭据可验证的方剂。此后不分气血,凉药与热药交替进用,将气分的邪气引入血分,这也如同五胡乱华时期,即使是像温峤那样贤能的人,也难以挽救神州陆沉的局面(气分的邪气仍应从气分宣泄,最后两句必有特定所指,非王孟英即薛生白等人)。
杏仁、蔻仁、大麦仁、米仁(薏苡仁)、浙茯苓、橘红、佩兰叶。
程姓患者(六十二岁):形体和精神衰败,食物摄入减少,这是积劳导致的气伤,采用甘温益气之法,可以使身体苏醒恢复。男子六十岁,下元本就固虚,如果胃口日益疲乏,地黄的浊阴之性,反而会伤害中和之气。
Chen (South of the city, 50 years old) The invasion of sea wind into the throat has affected the lung for a long time. Dispersion methods are ineffective. It is proposed to slowly expel the pathogen to unblock the upper orifices. (The medicinal substances are all light and floating in nature, ascending to the upper part. Making them into pills aligns with the principle of slow expulsion.)
Lasiosphaera seu Calvatia (Mabo, Puffball), Belamcandae Rhizoma (Shegan, Blackberry Lily Rhizome), Cicadae Periostracum (Chanyi, Cicada Molting), Ephedrae Herba (Mahuang, Ephedra)
Grind into powder. Use 5 qian of Descurainiae Semen Lepidii Semen (Tinglizi, Pepperweed Seed) and 10 pieces of Jujubae Fructus (Dazao, Chinese Date) to decoct water for pill preparation.
Jin (Guanshang, 49 years old) Generally, fullness and distension are treated by regulating qi, while dryness and hardness are treated by managing blood. When all four conditions (qi stagnation, blood dryness, and excess pathogen) are present, the attack on the pathogen should be urgent. This condition involves deficiency of blood in the liver collaterals, with liver fire (wood-fire) qi ascending to the diaphragm causing pain. Pungent-moistening and gentle-descending methods can relieve pain and promote bowel movement. Syncope is due to liver yang transforming into wind, with dryness ascending and receiving heat. If anger is provoked, it will inevitably occur, which is not within the scope of medical treatment. (Dryness is one of the six pathogenic qi. Fire tends to combine with dryness. When dryness qi ascends, it leads to liver fire (wood-fire) heat ascending to the diaphragm causing pain. One must understand this treatment method.)
Sesami Semen (Zhima, Sesame Seed), Platycladi Semen (Baiziren, Arborvitae Seed), Asparagi Radix (Tiandong, Asparagus Root), Rehmanniae Radix (Shengdi, Rehmannia Root), Perillae Fructus (Suzi, Perilla Fruit)
Yao (Caojia Lane, 44 years old) The heart and abdomen feel as if burning (yang binds internally), yet the muscles and skin feel cold. There is hunger but poor appetite, with long-term loose stools. This belongs to consumptive deficiency. (When yang binds in the upper part, the middle and lower parts become deficient and cold.) The medical record shows cough, so clearing the lung and clearing heat were used. This further damages the already deficient, and medicine may not necessarily eliminate the disease. (The patient has reached this state, and the physician is helpless, thus prescribing this formula.)
Polygonati Rhizoma (Huangjing, Solomon's Seal Rhizome), Bletillae Rhizoma (Baiji, Bletilla Tuber), Coicis Semen (Miren, Coix Seed), Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (Zhigancao, Honey-fried Licorice Root and Rhizome)
Cao Malaria heat attacks the collaterals, causing blood in the collaterals to surge and rebel, resulting in hypochondriac pain and cough. (These are symptoms seen after malaria subsides.) Body fluids are damaged by malaria. Ascending yang enters the vertex causing headache. The collateral disease is between the exterior and interior. Attacking it fails to disperse it. It is necessary to search for and eliminate the lingering pathogen and latent heat in the blood aspect. (Malaria heat is too intense, fire blazes and scorches fluids, forcing blood to overflow upward. The phrase "collateral disease is between the exterior and interior" points out the misguided path.)
Fresh Carapax Trionycis (Sheng Biejia, Fresh Turtle Shell), fried Persicae Semen (Taoren, Peach Seed), Anemarrhenae Rhizoma (Zhimu, Anemarrhena Rhizome), Moutan Cortex (Mudanpi, Tree Peony Bark), fresh Rehmanniae Radix (Xian Shengdi, Fresh Rehmannia Root), Gypsum Fibrosum (Hanshuishi, Gypsum)
Searching for and eliminating the lingering pathogen and latent heat in the blood aspect is truly a clear and precise approach to medication, with each herb hitting the mark.
Ge (Dongshan, 7 years old) Vesiculation of pox necessarily relies on heat to steam dampness. (This is a condition seen after smallpox.) Convulsions before the eruption of pox indicate that the pox toxin is being expelled through the blood vessels, which is a common occurrence. Calculus Bovis (Niuhuang, Cow-bezoar) is extremely bitter and cold, directly entering the pericardium. If seasonal qi has not been resolved, the ancients said using it is like mixing oil into flour, instead causing internal binding. For several months, speech has been impaired. This is due to heat qi and sticky phlegm clouding the clear yang qi in the chest (Danzhong). (Pox convulsions are a mechanism for the pox toxin to be expelled through the blood vessels and should not be treated as infantile convulsive disease.)
Polygalae Radix (Yuanzhi, Polygala Root), Acori Tatarinowii Rhizoma (Shichangpu, Grassleaf Sweetflag Rhizome), Bambusae Concretio Silicea (Tianzhuhuang, Tabasheer), Aurum Foliatum (Jinbo, Gold Leaf), Arisaema cum Bile (Danxing, Bile Arisaema), Coptidis Rhizoma (Chuanlian, Coptis Rhizome), Argentum Foliatum (Yinbo, Silver Leaf), Moschus (Shexiang, Musk), Borneolum Syntheticum (Bingpian, Borneol)
Make into honey pills, each weighing 5 fen.
Yang Summer dampness-heat must enter the qi aspect. It is said these two pathogens are also a kind of qi. Like qi resonates with each other. Symptoms like diarrhea and scanty urine are all due to dampness stagnation obstructing qi. Formulas like Liuhe Tang (Six-Harmony Decoction) and Ganlu Yin (Sweet Dew Beverage) are well-documented and verifiable prescriptions. Afterwards, treatment did not differentiate between qi and blood aspects. Alternating use of cold-cool and warm-heat medicinals led the pathogen from the qi aspect into the blood aspect. This is akin to the Five Barbarians throwing China into chaos; even sages like Wen Qiao and Zu Ti could hardly save the land from submergence. (Pathogens in the qi aspect should still be dispersed from the qi aspect. The last two sentences must refer to someone, likely either Wang (Mengying) or Xue (Xue).)
Armeniacae Semen Amarum (Xingren, Bitter Apricot Seed), Amomi Fructus Rotundus (Kouren, Round Cardamom Fruit), Hordei Fructus Germinatus (Damaren, Barley Sprout), Coicis Semen (Miren, Coix Seed), Poria (Zhe Fuling, Poria from Zhejiang), Citri Reticulatae Exocarpium (Juhong, Tangerine Peel), Eupatorii Herba (Peilan, Fortune's Eupatorium Herb)
Cheng (62 years old) Physical form and spirit are declining, food intake is reduced. This is due to accumulated fatigue damaging qi. Sweet-warm medicinals to boost qi can revive it. A man at sixty naturally has a deficient lower source. However, if the appetite deteriorates daily, using heavy, turbid yin medicinals will instead damage the harmonious qi of the middle.