此必有有形留着,不第无形秽浊已也。
迟(四十八岁) 背寒为饮,凡遇冷或劳烦,喘嗽气逆,聚于胸臆,越日气降痰浓,其病
自缓。
年分已多,况云中年不能安逸。议病发用《金匮》法可效,治嗽肺药不效。
朱(三十岁) 此内损也,损者益之。按脉虚芤,精夺于下,当补益肝肾精血。
李(二十七岁) 两年久病,决非风寒暑湿。据云腹鸣不和,左胁下坚硬,直至少腹,睾
丸偏大
,子和七疝主肝为多。男子纵欲,伤及冲任亦多,是病辛香流气,壮年可用(精血阳气所以
防御下焦阴寒,既因纵欲伤及奇脉,先用辛香流通气分。)
小茴香 真橘核 茯苓 泽泻 川楝子 青木香 黑栀仁 青皮子
水泛为丸。
李(四十岁) 臭秽不正之气,入自口鼻着于募原,不饥呕逆,中焦病也。宣通浊痹为正
,发散清寒为忌(达原饮。)
草果 槟榔 藿梗 浓朴 杏仁 白蔻 半夏 姜汁
臭秽虽属无形浊气,但粘着募原,必与浊滞有形凝结,不饥呕逆,恶寒发热,浊邪并结
坚聚,非达原饮不除。
顾(二十岁) 内损是脏阴中来,缘少年欲念萌动未遂,龙雷闪烁,其精离位,精血虽有
形象
,损去药不能复,必胃旺安纳,古称精生于谷,迨病日久,阴损枯涸,渐干阳位。胃口淹淹
不振,中乏砥柱,如妖庙焚燎莫制,阳主消铄,遂肌瘦喉刺。《褚氏遗书》论损怯,首云男
子神志先散,为难治之症,此下损及中至上之义。问大便三日一行而枯涩,五液干枯,皆本
乎肾。肾恶燥,味咸为补,佐苦坚阴,医以不按经义杂治,谈何容易(肾脏精神根据之如鱼得
水,谓精足则神旺也。肾精既乏,不能上供神明,则神志因精衰而先散矣。盖下损及上,浊
火乱其神明,此由下损及中至上奥也义也。)
人参 阿胶 鲜生地 茯神 龟板 柏子仁
药取清阴之品,不取浊腻滋填,早为胃中纳谷以生精作地步,应加黄柏少许。
俞(申衙前,五十岁) 男子中年,下元先亏(人到中年,生气日浅,肾肝精血因真阳衰
而不
生,不必戕贼生阳,有去无来,故下元先亏也。)肾脏阴中之阳,不司涵煦,阴不承载于上
,遂渴饮溲频溺,有硝卤之形。内经有遗热遗寒之分,上中之消主气热,下消以摄肾,蒸阳
以运津液(既指明下消之所以然,复分明三焦之治法,方成名案。)
这必定是有形的病理产物滞留体内,不仅仅是无形的秽浊之气罢了。
迟某(四十八岁):背部寒冷是由于水饮内停所致,每逢受冷或劳累烦扰,就会出现气喘咳嗽、气机上逆,病邪聚集在胸膈部位,过一天后气机下降、痰液变浓稠,病情自然缓解。病程已经多年,况且正值中年,不能安逸休养。建议发病时采用《金匮要略》中的治法可以见效,单纯用治肺止咳的药物无效。
朱某(三十岁):这是内脏亏损的病症,亏损应当补益。诊脉见虚大中空之象,说明下焦精气耗夺,应当补益肝肾的精血。
李某(二十七岁):患病两年之久,决不是风寒暑湿等外感邪气所致。据述腹部鸣响且不和顺,左侧胁下坚硬,一直延伸至少腹,睾丸偏大。根据张子和的理论,七疝多与肝脏有关。男子纵欲过度,也常损伤冲任二脉。此病宜用辛香行气的药物,壮年人可以使用(因为精血阳气是防御下焦阴寒的根本,既然因纵欲损伤了奇经八脉,先用辛香流通气分的药物)。
小茴香 真橘核 茯苓 泽泻 川楝子 青木香 黑栀子仁 青皮子
用水泛制成丸剂。
李某(四十岁):臭秽不正的气味,从口鼻侵入并停留在募原(半表半里之间),导致没有食欲、呕吐逆气,这是中焦脾胃的病变。宣通浊邪痹阻是正治,发散清寒则是禁忌(可用达原饮)。
草果 槟榔 藿梗 厚朴 杏仁 白豆蔻 半夏 姜汁
虽然臭秽属于无形的浊气,但粘着于募原,必然与浊滞等有形之物凝结,导致没有食欲、呕吐逆气、恶寒发热,浊邪并结坚聚,非用达原饮不能祛除。
顾某(二十岁):内脏亏损源于脏阴不足,因为少年时期欲望萌动而未得满足,相火妄动,导致精气离位。虽然精血虽有形象,但亏损后药物难以恢复,必须使胃气旺盛以安纳饮食,古人说“精生于谷”,等到病日久,阴精亏损枯涸,逐渐波及阳分。胃口萎靡不振,中焦缺乏支撑,如同神庙被焚烧无法控制,阳气主消烁,于是肌肉消瘦、喉咙刺痛。《褚氏遗书》论述损怯症,首先指出男子神志先散,属于难治之症,这是下损及中至上焦的道理。询问大便三日一行且干枯涩滞,五液干枯,都根本于肾。肾厌恶燥,咸味能补肾,佐以苦味以坚阴。医生如果不按照经络义理杂治,谈何容易(肾脏精神根基如鱼得水,谓精足则神旺。肾精既已匮乏,不能上供神明,则神志因精衰而先散。盖下损及上,浊火扰乱神明,这是由下损及中至上奥妙的道理。)
人参 阿胶 鲜生地 茯神 龟板 柏子仁
药物选取清阴之品,不取浊腻滋填,早早为胃中纳谷生精做准备,应加少许黄柏。
俞某(申衙前,五十岁):男子到了中年,下元先亏(人到中年,生气日渐浅薄,肾肝精血因真阳衰弱而不再生,不必戕贼生发之阳,有去无来,所以下元先亏)。肾脏阴中之阳,不能主持涵煦功能,阴不能承载于上,于是口渴饮水、小便频数,尿液有硝卤之形。《内经》有遗热、遗寒之分,上消和中消主气热,下消则以摄肾为主,蒸腾阳气以运化津液(既然指明了下消之所以然,又分明了三焦的治法,方成名案。)
This must be due to the retention of tangible pathological products, not merely the presence of intangible turbid qi.
Chi (48 years old): Back coldness is caused by fluid retention. Whenever exposed to cold or subjected to physical/mental fatigue, wheezing, coughing, and rebellious qi occur, with pathogens gathering in the chest and diaphragm. After a day, as qi descends and phlegm becomes thick, the condition naturally alleviates. The disease has persisted for many years, and being middle-aged, one cannot afford rest. It is proposed that using the method from *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) during exacerbation can be effective; treating cough solely with lung-targeted herbs is ineffective.
Zhu (30 years old): This is an internal deficiency syndrome; deficiency should be tonified. The pulse is deficient and hollow (*Kou Mai*), indicating depletion of essence in the lower jiao. Tonification of Liver and Kidney essence and blood is indicated.
Li (27 years old): A chronic illness lasting two years is certainly not due to Wind-Cold, Summer-Heat, or Dampness. According to reports, there is abdominal borborygmus and disharmony, hardness under the left hypochondrium extending to the lower abdomen, and enlargement of one testicle. According to Zhang Hezi, the Seven Types of Hernia are mostly related to the Liver. Male excessive sexual indulgence often damages the Chong and Ren vessels. For this condition, acrid-aromatic qi-moving herbs are suitable for young adults (since essence, blood, and yang qi defend against lower jiao yin-cold, and since the extraordinary vessels are damaged by indulgence, acrid-aromatic herbs to circulate qi should be used first).
Fennel Seed, Tangerine Kernel, Poria, Alisma, Toosendan Fruit, Aucklandiae Radix, Gardenia Seed, Green Tangerine Peel
Form into pills with water.
Li (40 years old): Foul and abnormal odors enter through the mouth and nose and settle at the *Mu Yuan* (separate origin/membrane source), causing loss of appetite and vomiting/rebellious qi; this is a pathology of the Middle Jiao. Promoting the unblocking of turbid obstruction is the correct treatment, while dispersing clear cold is contraindicated (use *Da Yuan Yin*).
Tsaoko Cardamom, Areca Seed, Agastache Stem, Magnolia Bark, Apricot Seed, White Cardamom, Pinellia Rhizome, Ginger Juice
Although foul odor belongs to intangible turbid qi, adhering to the *Mu Yuan*, it inevitably condenses with tangible turbid stagnation, leading to loss of appetite, vomiting, aversion to cold, fever, and firm aggregation of turbid pathogens. Only *Da Yuan Yin* can eliminate this.
Gu (20 years old): Internal damage originates from visceral yin deficiency. Due to unfulfilled desires in youth, ministerial fire flickers, causing essence to leave its proper position. Although essence and blood have form, once depleted, they cannot be fully restored by medicine. It is essential to strengthen the Stomach to ensure food intake, as ancients said "essence is generated from grain." As the disease persists, yin essence becomes depleted and dry, gradually affecting yang positions. The stomach appetite is listless, lacking central support, like an uncontrolled temple fire. Yang governs consumption, leading to emaciation and throat pricking pain. *Chu Shi Yi Shu* discusses deficiency consumptive diseases, stating first that men's spirit scatters first, making it difficult to treat. This illustrates the principle of lower damage affecting the middle and upper jiao. Bowel movements occur every three days but are dry and rough; the five fluids are dried up, all rooted in the Kidney. The Kidney dislikes dryness; salty flavor tonifies, assisted by bitter flavor to firm yin. If doctors do not follow meridian principles and treat indiscriminately, how can success be expected? (The Kidney's spirit and essence are foundational, like fish in water; sufficient essence leads to robust spirit. Since kidney essence is scarce and cannot nourish the mind upwards, the spirit scatters first due to essence decline. Lower damage affecting the upper, where turbid fire disturbs the mind, represents the profound mechanism of lower damage affecting middle and upper.)
Ginseng, Donkey-hide Gelatin, Fresh Rehmannia Root, Poria with Hostwood, Tortoise Shell, Biota Seed
Select herbs that clear yin without being greasy or cloying. Prepare early for the Stomach to absorb food and generate essence; add a small amount of Phellodendron Bark.
Yu (Shen Ya Qian, 50 years old): In men at middle age, the lower primal source is deficient first (As people reach middle age, vital qi becomes shallower; Liver and Kidney essence and blood fail to regenerate due to declining true yang. One must not injure the generating yang, which would lead to loss without return, hence the lower primal source is deficient first). The yang within the yin of the Kidney fails to provide warmth and nourishment. Yin fails to bear upwards, resulting in thirst, frequent urination, and urine resembling brine. *Nei Jing* distinguishes between residual heat and residual cold. Upper and Middle Xiao (Wasting-Thirst) are governed by qi-heat; Lower Xiao is managed by securing the Kidney, steaming yang to transport body fluids (Having clarified the cause of Lower Xiao and distinguished the treatments for the Three Jiao, this becomes a famous case record.)