麻黄石膏，恐不可以治此，症或有误
杨(五十二岁) 气从左升，自肝而出，酸水涌上，食入呕出，胃中乏阳营运，木来克土
。当
此年岁，反胃妨食，乃大症也(既系木来克土，吴萸虽能泄肝而干姜、胡芦巴、川椒俱是辛
温，恐益助肝之震烈，尚须斟酌)。
人参 茯苓 吴萸 干姜 胡芦巴 炒黑川椒
此方尚应安顿肝木药参入二三味。
沈(五十三岁) 吞酸嘈杂，不化食味(宣泄气火)。
藿香 橘白 川连 金石斛 茯苓 黑栀皮
胡(用直，四十六岁) 望色瘦少膏泽，按脉弦促而芤。问纳谷不旺，病几数年，每春夏
阳升
气泄，偶加烦冗，或情志不适，血必溢出上窍，已交中年，非少壮阴火相同(清真切当。)夫
心主血，脾统血，肝藏血，脏阴内虚，阳动乃溢，常服归脾汤减 、术、木香加芍，和肝脾
之阳，久进有益。宜静摄不宜烦劳，乃王道养正善药，不计骤功者。
徐(富郎中巷，四十三岁) 向来纳谷不旺，自失血咳嗽以来，仅能静坐。若身动必加气
喘，问仍在操持应接，脉来虚濡，此皆内损脏真。若见血投凉，因嗽理肺，即是谬药。
人参 茯苓 黄精 炙草 枸杞子 白芨 枣仁 桂元肉
黄(六十九岁) 凡食腥油浊物，胃脘必痛，老人营运之阳已衰(脾阳已衰，阳不胜阴，
不主
为胃行其津液。)浊味皆阴凝内痛，必以取气阳药。沉香，白蔻破泄真气，误用则刺其凶。
人参 小熟附子 生姜 白蜜 桂枝 茯苓
陈(十八岁) 暑伤热入于阴，瘅疟。
生淡鳖甲 肥白知母 粉牡丹皮 川贝母 大原生地 地骨皮 麦门冬肉 生粉甘草
张(二十五岁) 血色浓浓，是肝肾阴虚。凡劳心情欲，必要禁忌，医药以寒凉滋清，久
则胃伤减食变凶。
熟地 芡实 山药(炒) 湖莲肉 川石斛 茯苓
方中皆补而不滞之品。
邵(三十三岁) 五液变痰涎，皆肾液之化，阴不承载，咳痹痛甚，乃劳怯之未传，能勉
强纳谷，可望久延。
阿胶 鸡子黄 黑豆皮 川石斛 戎盐
药用咸降。
叶(十七岁) 冲气自下而起，丹溪谓上升从肝而出，木侮胃，食少呛逆，不得着枕卧眠
。
夏热时风迎胸痛，艾炙稍安，久恙阳微，须用甘温。前法皆以疏通不效，本虚无疑，《
金匮
》见肝之病，必先理脾胃，防患于克制耳(惟中上之阳气不充，是以下焦冲气得以自肝而出
，人参建中充实中上之阳，下焦浊气何能上升，此君明臣良，下民安靖矣。)
【越婢法】
杨姓患者（五十二岁）：气机从左胁上升，发自肝脏，酸水向上涌溢，食物入口即呕吐而出，胃中缺乏阳气以推动运化，肝木之气克制脾土。到了这个年纪，出现反胃妨碍进食的症状，属于重症。（既然确系肝木克脾土，吴茱萸虽能疏泄肝气，但干姜、葫芦巴、川椒均为辛温之品，恐怕会进一步助长肝气的猛烈之势，尚需仔细斟酌。）
处方：人参、茯苓、吴茱萸、干姜、葫芦巴、炒黑川椒。
此方还应加入二至三味安抚肝木的药物参入其中。
沈姓患者（五十三岁）：吞酸嘈杂，消化不良。（治宜宣泄气火。）
处方：藿香、橘白、黄连、金石斛、茯苓、黑栀皮。
胡用直（四十六岁）：面色消瘦且缺乏光泽，脉象弦促而芤。询问得知食欲不佳，患病已数年，每逢春夏季节阳气升发、气机外泄之时，偶尔感到烦躁冗杂，或因情志不畅，血液必从上窍溢出。现已进入中年，其病机不同于少年壮盛时的阴虚火旺。（清真切当的论述符合此理。）心主血，脾统血，肝藏血，脏阴内部虚弱，阳气妄动则导致出血。常服归脾汤，减去白术、木香，加入芍药，以调和肝脾之阳气，长期服用有益。宜静养摄护，不宜烦劳，这是王道般扶助正气的善药，不追求速效。
徐姓患者（富郎中巷，四十三岁）：向来食欲不佳，自从失血咳嗽以来，只能静坐。若身体活动必然加重气喘。询问得知仍在操持事务、应酬接待，脉象虚软无力，这都是内脏真气受损的表现。如果见血就投用凉药，因咳嗽就调理肺气，就是错误的用药。
处方：人参、茯苓、黄精、炙甘草、枸杞子、白及、枣仁、桂圆肉。
黄姓患者（六十九岁）：凡是食用腥油腻浊之物，胃脘部必定疼痛，老人运化的阳气已经衰退（脾阳已衰，阳气不能胜过阴寒，无法为胃输送津液）。浊味之物皆属阴凝，引起内部疼痛，必须使用具有取气作用的阳药。沉香、白蔻破泄真气，误用则会刺激凶险之症。
处方：人参、小熟附子、生姜、白蜜、桂枝、茯苓。
陈姓患者（十八岁）：暑热伤及阴分，热邪深入阴分，发为瘅疟。
处方：生淡鳖甲、肥白知母、粉牡丹皮、川贝母、大原生地、地骨皮、麦门冬肉、生粉甘草。
张姓患者（二十五岁）：血色浓稠，是肝肾阴虚所致。凡劳累心神或纵欲，都必须禁忌。医药治疗应以寒凉滋润清热为主，但久用则会损伤胃气，减少食欲，进而变生凶险。
处方：熟地黄、芡实、山药（炒）、湖莲肉、川石斛、茯苓。
方中皆为补益而不滋腻停滞的药物。
邵姓患者（三十三岁）：五脏之液变为痰涎，都是肾液转化的结果，阴液不能承载阳气，导致咳嗽、痹痛剧烈，这是劳损怯弱之证尚未传变，若能勉强进食，有望延长寿命。
处方：阿胶、鸡子黄、黑豆皮、川石斛、戎盐。
药物利用咸味以降逆。
叶姓患者（十七岁）：冲气从下焦而起，丹溪认为上升之气发自肝脏，肝木侮犯胃土，导致食少呛逆，无法枕卧安眠。夏季炎热时风邪侵袭导致胸痛，艾灸后稍感安宁。久病阳气微弱，须用甘温之法。之前的疏通方法均无效，本虚无疑。《金匮要略》云：见肝之病，必先调理脾胃，以防患于肝木克制脾土。（唯中上焦阳气不充实，所以下焦冲气得以从肝经上行，用人参建立中气以充实中上焦之阳，下焦浊气怎能上升？这如同君主英明、臣子贤良，百姓自然安定。）
[Yuebi Method]
Mahuang (Ephedrae Herba) and Shigao (Gypsum Fibrosum) are likely inappropriate for treating this condition; the diagnosis may be erroneous.
Patient Yang (52 years old): Qi ascends from the left, originating from the Liver. Sour fluid surges upward, and food is vomited immediately after ingestion. The Stomach lacks Yang Qi to facilitate transportation and transformation. Wood (Liver) overacts on Earth (Spleen/Stomach). At this age, regurgitation hindering food intake constitutes a severe disease. (Since it is indeed Wood overacting on Earth, although Wuzhuyu (Evodiae Fructus) can vent the Liver, Ganjiang (Zingiberis Rhizoma), Hulusiba (Blasiae Spora), and Chuanjiao (Zanthoxyli Pericarpium) are all acrid and warm, which might further assist the violent nature of Liver Qi. Further deliberation is required.)
Prescription: Renshen (Ginseng Radix et Rhizoma), Fuling (Poria), Wuzhuyu (Evodiae Fructus), Ganjiang (Zingiberis Rhizoma), Hulusiba (Blasiae Spora), Chaohei Chuanjiao (Stir-fried Black Zanthoxyli Pericarpium).
This prescription should incorporate two or three herbs that soothe and settle Liver Wood.
Patient Shen (53 years old): Acid regurgitation and epigastric discomfort with indigestion. (Treatment should vent Qi and Fire.)
Prescription: Huoxiang (Agastaches Herba), Ju Bai (Citri Reticulatae Pericarpium), Chuanlian (Coptidis Rhizoma), Jinshihu (Dendrobii Caulis), Fuling (Poria), Hei Zhipi (Gardeniae Cortex).
Hu Yongzhi (46 years old): Complexion is emaciated and lacks luster. Pulse is wiry, rapid, and hollow (Kou). Appetite is poor. The illness has persisted for several years. Every spring and summer, when Yang Qi ascends and dissipates, occasional irritability arises, or due to emotional distress, blood inevitably bleeds from the upper orifices. Having entered middle age, this differs from the Yin deficiency fire of youth. (The analysis in Qing Qie Zhen Dang is accurate.) The Heart governs Blood, the Spleen controls Blood, and the Liver stores Blood. Internal deficiency of Zang Yin leads to overflow due to Yang hyperactivity. Regularly consuming Guipi Tang (Restore the Spleen Decoction), reducing Baizhu (Atractylodis Macrocephalae Rhizoma) and Muxiang (Aucklandiae Radix), and adding Shaoyao (Paeoniae Radix), harmonizes the Yang of the Liver and Spleen. Long-term consumption is beneficial. One should rest quietly and avoid overexertion. This is a "King's Way" medicine that supports righteous Qi, not one that seeks immediate results.
Patient Xu (Fulangzhong Lane, 43 years old): Historically poor appetite. Since hemoptysis and cough began, he can only sit quietly. Any physical movement exacerbates asthma/wheezing. He reports continuing to manage affairs and social engagements. The pulse is deficient and soft (Ru). These indicate internal damage to the Zhen Qi (True Qi) of the Zang organs. Using cooling herbs upon seeing blood, or regulating the Lung due to cough, would be erroneous medication.
Prescription: Renshen (Ginseng Radix et Rhizoma), Fuling (Poria), Huangjing (Polygonati Rhizoma), Zhi Cao (Honey-fried Glycyrrhizae Radix et Rhizoma), Gouqizi (Lycii Fructus), Baiji (Bletillae Rhizoma), Zaoren (Ziziphi Spinosae Semen), Guiyuanrou (Longan Arillus).
Patient Huang (69 years old): Whenever greasy, fishy, or turbid foods are consumed, epigastric pain occurs. The transportive Yang Qi of the elderly has declined (Spleen Yang is deficient; Yang cannot overcome Yin, failing to distribute fluids for the Stomach). Turbid flavors are Yin congealing internally causing pain. One must use Yang herbs that extract Qi. Chenxiang (Aquilariae Lignum Resinatum) and Baokou (Amomi Fructus Rotundus) break and drain True Qi; misuse will provoke凶险 (dangerous conditions).
Prescription: Renshen (Ginseng Radix et Rhizoma), Xiao Shu Fuzi (Prepared Aconiti Lateralis Radix), Shengjiang (Zingiberis Rhizoma Recens), Baimi (Apis Mellifera), Guizhi (Cinnamomi Ramulus), Fuling (Poria).
Patient Chen (18 years old): Summerheat injures Yin; heat enters Yin, resulting in Dan Nue (Febrile Malaria).
Prescription: Sheng Dan Biejia (Raw Trionycis Carapax), Fei Baizhimu (Anemarrhenae Rhizoma), Fen Mudanpi (Paeoniae Moutan Cortex), Chuan Beimu (Fritillariae Cirrhosae Bulbus), Da Yuan Shengdi (Rehmanniae Radix Praeparata), Digupi (Lycii Cortex), Maimendong (Ophiopogonis Tuber), Sheng Fen Gancao (Raw Powdered Glycyrrhizae Radix et Rhizoma).
Patient Zhang (25 years old): Blood color is thick and dark, indicating Liver and Kidney Yin deficiency. Laboring the mind and indulging in sexual desire must be strictly contraindicated. Medical treatment should use cold and cooling nourishing and clearing methods, but long-term use damages the Stomach, reduces appetite, and leads to dangerous outcomes.
Prescription: Shudi (Rehmanniae Radix Praeparata), Qianshi (Nelumbinis Semen), Shanyao (Dioscoreae Rhizoma, stir-fried), Huliannour (Nelumbinis Plumula), Chuan Shihu (Dendrobii Caulis), Fuling (Poria).
All items in this formula are tonifying without causing stagnation.
Patient Shao (33 years old): The five fluids transform into phlegm and saliva, which is the transformation of Kidney fluids. Yin fails to contain Yang, leading to severe cough and bi-syndrome pain. This is pre-laojie (consumptive weakness) before transmission. If he can barely maintain food intake, prolongation of life is possible.
Prescription: Ejiao (Asini Corii Colla), Jizihuang (Galli Ovi Album), Heidoupi (Phaseoli Semen Cutis), Chuan Shihu (Dendrobii Caulis), Rongyan (Natrii Chloridum).
Medicines utilize salty flavor to descend.
Patient Ye (17 years old): Chong Qi (Revolt Qi) rises from below. Danxi stated that ascending Qi originates from the Liver. Wood insults the Stomach, leading to poor appetite, hiccups/retching, and inability to lie down with a pillow. In summer heat, wind invasion causes chest pain; moxibustion provides slight relief. Chronic illness indicates weak Yang, requiring sweet and warm methods. Previous dredging methods were ineffective; root deficiency is undeniable. As stated in *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet): When treating Liver disease, one must first regulate the Spleen and Stomach to prevent Wood from overacting on Earth. (Only because the Yang Qi of the Middle and Upper Jiao is insufficient does the Lower Jiao Chong Qi ascend via the Liver channel. Renshen establishes the Middle and enriches the Yang of the Middle and Upper Jiao; how can turbid Qi from the Lower Jiao rise? This is like a wise ruler and virtuous ministers, ensuring peace among the people.)