四物汤。(九) 逍遥散。(四十八) 左金丸。(八十八) 归脾汤。(二十一) 六君
子汤。
(二)六味丸。(十四) 八味丸。(十五) 三一承气汤。(五十四) 附子理中汤。(一百
零
七) 香砂六君子汤。
牛犬二灰散。
不拘黄牛水牛。但遇有狗放屎于牛屎上。连二屎共取和匀。候干封固。每用 灰存性三
钱。以好苦酒调服后。用真云南棋子一枚。男以白的。女以黑的。捣研极细。仍用苦酒炖浓
服之。
甘蔗饮。
取甘蔗。去皮切钱。瓷碗乘白米些少。以水润透米。将蔗钱放米内。仍用瓷碗盖定。慢
火蒸熟成饭。先取蔗钱。与本人徐徐嘴咽蔗汁。漫开喉咙。即食此饭。为开膈之第一方。即
审症议药。○二灰散不易得。先用此法。即以黑白棋子继之。再审症用药。以收全功。一膈
症。汤饮不入口。针合谷穴。亦可开通。
斗门方。
用附子一个最大者。(按近日附子宜以开水俟温和入附子泡去盐。一日二换汤。泡三日
取晒。)坐于砖上。四面着火。渐逼碎。入生姜自然汁中。又根据前火逼干。复淬之。约生姜
汁尽半碗许。捣罗为末。用粟米饮下一钱。不过三服瘥。
膈噎症。古今方法最紧。遵之亦不甚验。以上论治。未免太简。恐初学人领悟不来。正
欲续论以畅其旨。适友人自安徽来。遗予以张心在附经一书。检阅之下。深喜其读书有得。
可与共学适道也。虽识荆俟诸异日。而数千里神交。不啻同堂时晤对。请即以附经之原文。
演为问答。未知心在以为然否。
问曰。噎膈初起。有食入打呛而因不能下咽者。肺气上逆会厌不及蔽。而气喉为之病。
当用何药。余曰。治以枇杷叶百合天门冬半夏阿胶甘草。令治节行。则逆者顺矣。然必佐以
干姜之开。五味子之阖。细辛之拨动神机令咽喉二窍。得顺其出入之常。遂无呛逆之患。非
熟于仲景书者。不悟也。问曰。有食下如刀KT 草勒。胸痛畏食者。胃之上口内肿。而食
管为之不利。当用何药。余曰。金银花煮膏。以米饮调下常服。或白水牛喉焙干研末。佐之
以金银花。能止痛消肿。且味甘而质润。可滋胃脘之阴。性寒而气香。又除郁热之闭也。问
曰。每食必以饮送下者。胃中之气不上吸。故食不能自下。若非饮送。即见阻滞。应用何药。
余曰。
胃气不能上吸。非人参之助。胃不可得食。阻滞非甘澜水和白蜜之润下不可。且其阻滞
者。冲脉之为病。非半夏不能降冲脉之逆。仲景大半夏汤甚妙。问曰。有将食时必饮酒而后
能食者。胃气郁塞不开。得酒之剽悍而始通。应用何药。余曰。宜平胃散料加香附麦芽半夏
干姜白豆蔻沙参川芎。入羊肚内。蒸熟晒干。又易羊肚。如前法三次。去羊肚为末。以陈米
汤送下三钱。日二服以辛药开结。以香药醒脾。而制法之妙。化其霸气。方不伤其阴气。经
云。
阴者中之守也。此方颇为合度。问曰。有肝逆胆横小络相厄。两胁时痛。食入不犯肝胆
之络。则下。犯其小络。则土受木制。不能纳谷而因吐者。病由木郁。而土因之亦郁。应用
何药。余曰宜用小柴胡汤。遵原定分数。折为小剂。(柴胡四钱。半夏汤洗七次不可用矾煮。
黄芩人参炙甘草生姜各一钱五分。大枣一个。水煎。)加紫苏旁小梗整用。生竹茹各二钱。
橘皮内筋膜当归须各一钱。补虚清火。解郁通络。配合得法。则各药相得而益彰。自不同他
方之泛泛也。问曰。有胃火自盛。食入则吐逆不已者。应用何药。余曰。食物不得入咽。是
火阻于上。宜用黄连黄芩之大寒以泻之。大苦以降之。更用人参以助胃。俾胃喜于纳食。而
急迎之入内。然必用干姜。大辛大热。冲开其关。方无拒格之患。四味等分煎服。仲景得意
之方也。如食既入咽。随即吐出。是胃素有热。一得食物。为两热相冲。不能停留而即出。
宜大黄四钱。甘草二钱。为釜下抽薪之法。此与黄连黄芩干姜人参汤。均是苦寒之剂。而毫
厘有千里之差。况寒热之相反乎。问曰。有朝食暮吐。完谷不化。必倾囊倒箧尽净无存而后
快者。
则食久反出无火之谓也。应用何药。余曰。此症用温补法。人人共知。每服之而不效者
有故。
当辨其为中焦无火。与下焦无火。中焦无火有二。在阳明则胸满。宜吴茱萸汤。在太阴
则腹满。宜理中丸。又恐此丸之过甘。则甘草不妨减半。恐其功之过缓。不妨加入荜茇附子
吴茱萸半夏茯苓之类。勿泥定成法也。下焦无火亦有二。在厥阴则吐食而兼酸腐。亦宜吴萸
汤。又以川椒干姜肉桂吴茱萸附子当归川楝子人参沙参研末。枣汤泛丸。米饮送下三钱。一
日二服。在少阴则吐食而兼水液。宜真武汤。倍生姜。或以斗门方峻补之。愈后宜肾气丸。
倍桂附以收功。又问。以上诸症。未至于槁。皆足以至槁。至口吐白沫。便如羊矢。津液枯
竭。营卫不行。五脏不通。则食全不入。而病不可为矣。未知先生尚有法可以救之否。余曰。
津液即是真水。水由气化。亦由火致。推其所以枯竭之故。非气虚不能化之。即火虚不能致
之也。今人不明其理。以滋润甘凉。为生津养液。实所以涸津液之源而速其死。仲景云。干
呕吐涎沫。吴茱萸汤主之。虽非为噎膈症立论。而圣言无所不包少阳症火逆于上其呕有声而
不吐谷名为干呕。若不吐谷而但吐涎沫名为干呕吐涎沫。此症食全不入。无谷可吐。亦是干
呕例。津液生于谷气。绝食则津液已枯。又吐出涎沫。则津液遂竭尽无余。所以不能下滋肠
胃。粪如羊矢。唯吴茱萸一汤。大辛以开其格。大苦以镇其逆。大甘以培其中。且辛从甘以
化阳。苦从甘以化阴。阴阳合而时雨降。顷刻间。有万里沃泽之景象矣。况又佐以人参之大
生津液。并以驯诸药之性。宜其为起死之灵丹也。至于停痰瘀血。阻塞胃口。致食入之路滞
碍者。为有余之症。诸家之说。不无可采。毋庸修园之再赘也。经又有上气下虫之症。治以
骡马尿而未愈者。似可以乌梅丸继之。言不尽意。亦视乎人之善悟而已。
四物汤。(第九节) 逍遥散。(第四十八节) 左金丸。(第八十八节) 归脾汤。(第二十一节) 六君子汤。
(第二节)六味地黄丸。(第十四节) 八味肾气丸。(第十五节) 三一承气汤。(第五十四节) 附子理中汤。(第一百零七节) 香砂六君子汤。
牛犬二灰散。
不拘黄牛或水牛。只要遇到狗在牛屎上排便,将两种粪便一起收集并混合均匀。待其干燥后封存保存。每次取存性炭化后的灰烬三钱,用优质的醋调服。随后,取一枚真正的云南棋子,男性用白色的,女性用黑色的,捣碎研成极细的粉末,再用醋炖浓后服用。
甘蔗饮。
取甘蔗,去皮切成薄片。在瓷碗中放入少许白米,用水润透米粒,将蔗片放入米中,仍用瓷碗盖好,用慢火蒸熟成饭。先取出蔗片,让患者慢慢咀嚼吞咽蔗汁,以润开喉咙,然后吃这顿饭。这是治疗膈噎症(食管阻塞类疾病)的第一方。即根据症状辨证用药。○二灰散不易获得,先用此法,随即用黑白棋子继之,再根据症状用药,以收全功。有一种膈噎症,汤药和饮水都无法入口,针刺合谷穴,也可以起到开通作用。
斗门方。
选用一个最大的附子。(按:近日使用的附子宜先用开水烫至温和,去除盐分,浸泡一天换两次水,泡三天取出晒干。)坐在砖上,四面生火烘烤,逐渐将其烤碎,放入生姜自然汁中,再次按照前面的方法用火逼干,反复淬炼。大约生姜汁剩下半碗左右时,捣碎过筛成粉末。用粟米饮送服一钱,不超过三服即可痊愈。
膈噎症的治疗,古今方法最为紧迫,遵循这些方法也不甚灵验。以上论述治疗方法,未免过于简略,恐怕初学者难以领悟,正想续论来阐发其旨意。恰逢友人从安徽来信,寄给我张心在所著的《附经》一书,检阅之下,深喜其读书有所心得,可以与之共同学习探讨大道。虽然相识要等到将来,但数千里之外的神交,不亚于同堂时常面对面的会晤。请允许我将《附经》的原文,演绎为问答形式,不知心在是否认为妥当。
问曰:噎膈初起,有食物进入后呛咳而无法咽下的情况,这是肺气上逆,会厌来不及遮蔽,导致气喉生病。应当用什么药?
我回答说:治疗用枇杷叶、百合、天门冬、半夏、阿胶、甘草,使肺的治节功能运行正常,那么上逆之气就会顺降。然而必须佐以干姜的开散,五味子的收敛,细辛的拨动神机,使咽喉两窍得以顺应其出入的常态,从而没有呛逆的祸患。不熟悉仲景书籍的人,是不会明白这一点的。
问曰:有食物下咽如刀割草勒,胸痛畏食的情况,是胃的上口内部肿胀,导致食管不利。应当用什么药?
我回答说:用金银花煮膏,用米饮调下常服。或者用白水牛的喉部焙干研末,佐以金银花,能止痛消肿,且味甘而质地滋润,可滋养胃脘的阴液;性寒而气味芳香,又能清除郁热造成的闭塞。
问曰:每进食必须用饮水送服才能下咽的情况,是胃中的气不能向上吸引,所以食物不能自行下行。如果不是饮水送服,就会出现阻滞。应用什么药?
我回答说:胃气不能上吸,非人参的帮助不可,胃才能得到食物。阻滞非甘澜水和白蜜的润下不可。而且这种阻滞,是冲脉的疾病,非半夏不能降泄冲脉的逆气。仲景的大半夏汤非常妙。
问曰:有将要进食时必须饮酒后才能进食的情况,是胃气郁塞不开,得到酒的剽悍之气才开始通畅。应用什么药?
我回答说:适宜用平胃散的料加上香附、麦芽、半夏、干姜、白豆蔻、沙参、川芎,放入羊肚内,蒸熟晒干。再换一个新的羊肚,像前面方法重复三次,去掉羊肚,研成粉末,用陈米汤送服三钱,每天两次服用。用辛味药开结,用香药醒脾,而制法的巧妙之处在于化解了酒的霸气,方剂才不会损伤阴气。《内经》说:阴是体内的守持者。这个方子颇为合乎法度。
问曰:有肝气上逆、胆气横逆,小络相互制约,两胁时常疼痛的情况。食物进入如果不侵犯肝胆的小络,就能下行;如果侵犯了这些小络,则脾胃受肝木克制,不能纳谷而呕吐。病由木郁引起,而土也因此郁滞。应用什么药?
我回答说:适宜用小柴胡汤,遵照原定的剂量,折分为小剂。(柴胡四钱,半夏用水洗七次,不可用矾煮,黄芩、人参、炙甘草、生姜各一钱五分,大枣一个,水煎。)加上紫苏旁的小梗整用,生竹茹各二钱,橘皮内筋膜、当归须各一钱。补虚清火,解郁通络,配合得当,则各药相得益彰,自然不同于其他方剂的泛泛之谈。
问曰:有胃火自盛,食物进入则呕吐不止的情况,应用什么药?
我回答说:食物不得入咽,是火阻于上,适宜用黄连、黄芩的大寒之性来泻火,大苦之性以降逆。更用人参来助胃,使胃喜欢接纳食物,从而急切地迎入体内。然而必须用干姜,大辛大热,冲开其关隘,才没有拒格(排斥)的祸患。这四味药等分煎服,是仲景得意的方剂。如果食物既已入咽,随即吐出,这是胃素有热,一遇到食物,因两热相冲,不能停留而立即吐出。适宜用大黄四钱,甘草二钱,这是釜底抽薪的方法。这与黄连黄芩干姜人参汤,都是苦寒的药剂,但毫厘之间就有千里的差别,何况寒热性质相反呢?
问曰:有早晨吃晚上吐,完谷不化,必须倾囊倒箧吐尽无存而后快的情况,则是食物久留反出,属于无火的情况。应用什么药?
我回答说:这种病症用温补法,人人皆知。但每服之而不效的,是有原因的。应当辨别是中焦无火还是下焦无火。中焦无火有两种情况:在阳明经则胸满,适宜吴茱萸汤;在太阴经则腹满,适宜理中丸。又担心这个丸药的过甘,那么甘草不妨减半;担心其功效过缓,不妨加入荜茇、附子、吴茱萸、半夏、茯苓之类,不要拘泥于固定的成法。下焦无火也有两种情况:在厥阴经则吐食兼酸腐,也适宜吴茱萸汤;另外用川椒、干姜、肉桂、吴茱萸、附子、当归、川楝子、人参、沙参研末,枣汤泛丸,米饮送服三钱,一天两次服用。在少阴经则吐食兼水液,适宜真武汤,倍加生姜,或者用斗门方峻补。痊愈后适宜用肾气丸,倍加桂枝、附子以收功。
又问:以上诸症,尚未至于干枯,都足以导致干枯。到了口吐白沫,大便如羊矢,津液枯竭,营卫不行,五脏不通,则食物完全无法进入,病情就不可救治了。不知先生还有办法可以救它吗?
我回答说:津液即是真水,水由气化,也由火致。推究其枯竭的原因,不是气虚不能化生,就是火虚不能蒸腾。现在的人不明白这个道理,以为滋润甘凉的药物可以生津养液,实际上这是在涸竭津液的源头而加速死亡。仲景说:干呕吐涎沫,吴茱萸汤主之。虽然这不是专门为噎膈症立的论点,但圣人的言语无所不包。少阳症火逆于上,其呕有声而不吐谷物名为干呕;若不吐谷物而只吐涎沫名为干呕吐涎沫。这种病症食物完全无法进入,没有谷物可吐,也是干呕的例子。津液生于谷气,绝食则津液已枯,又吐出涎沫,则津液遂竭尽无余,所以不能下滋肠胃,粪如羊矢。唯有吴茱萸汤,大辛以开其格拒,大苦以镇其上逆,大甘以培补其中气。且辛从甘以化阳,苦从甘以化阴,阴阳调和而如时雨降临,顷刻间,有万里沃泽的景象。况且又佐以人参的大生津液,并驯服诸药的药性,适宜其为起死回生的灵丹。至于停痰瘀血,阻塞胃口,导致食物进入之路滞碍的,属于有余的病症,诸家的说法,不无可取之处,不需要修园再赘述了。《内经》又有上气下虫的病症,治疗用骡马尿而未愈的,似乎可以用乌梅丸接续治疗。言语不能完全表达意思,也要看人是否善于领悟罢了。
Siwu Tang (Four Substance Decoction). (Section 9) Xiaoyao San (Free and Easy Wanderer Powder). (Section 48) Zuojin Wan (Left Metal Pill). (Section 88) Guipi Tang (Restore the Spleen Decoction). (Section 21) Liujunzi Tang (Six Gentlemen Decoction).
(Section 2) Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). (Section 14) Bawei Shenqi Wan (Eight-Ingredient Kidney Qi Pill). (Section 15) Sanyi Chengqi Tang (Three-One Purging Decoction). (Section 54) Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction). (Section 107) Xiangsha Liujunzi Tang (Aucklandia and Amomum Six Gentlemen Decoction).
Niuquan Erhui San (Two Ashes of Ox and Dog Powder).
Regardless of whether it is a yellow ox or a water buffalo. Whenever a dog defecates on top of the ox dung, collect both feces together and mix them evenly. Wait for them to dry and seal them for storage. Each time, take three qian of the carbonized ash (preserving its nature), and take it with good vinegar. Subsequently, take one genuine Yunnan chess piece: white for males, black for females, crush and grind it into an extremely fine powder, then stew it thickly with vinegar and take it orally.
Ganzhe Yin (Sugarcane Drink).
Take sugarcane, peel it, and cut it into thin slices. Place a small amount of white rice in a porcelain bowl, moisten the rice thoroughly with water, put the sugarcane slices into the rice, cover the bowl again with porcelain, and steam slowly over low heat until it becomes cooked rice. First, take out the sugarcane slices, let the patient chew and swallow the juice slowly to moisten and open the throat, then eat this rice. This is the first prescription for treating Ge Ye Syndrome (dysphagia/esophageal obstruction). That is, prescribe medicine based on syndrome differentiation. ○ Erhui San is difficult to obtain; use this method first, followed by the black and white chess pieces, and then prescribe medicine according to symptoms to achieve complete efficacy. In some cases of Ge Ye Syndrome, where neither decoctions nor drinks can be taken, needling the Hegu acupoint (LI4) can also help to open the blockage.
Doumen Fang (Doumen Prescription).
Select one of the largest Fuzi (Prepared Aconite Root). (Note: Recently used Fuzi should be soaked in boiling water until warm to remove salt, changing the water twice a day, soaking for three days, then taking it out to dry.) Sit on a brick, generate fire around all four sides, gradually baking it until it breaks apart. Put it into fresh ginger juice, and again bake it dry using the previous method, repeating the quenching process. When approximately half a bowl of ginger juice remains, crush and sieve it into powder. Take one qian sent down with millet drink. It will heal within no more than three doses.
Ge Ye Syndrome (Dysphagia/Regurgitation): The treatment methods of ancient and modern times are most urgent, yet following them is not very effective. The above discussion on treatment methods is somewhat too brief, fearing that beginners may not comprehend it. I intended to continue the discussion to elaborate on its principles. Fortunately, a friend came from Anhui and left me with Zhang Xin'ai's book "Fu Jing" (Attached Classics). Upon reviewing it, I deeply appreciated that he had gained insights from his reading and could learn the Dao together. Although meeting in person must wait for another day, our spiritual connection across thousands of miles is no different from face-to-face meetings in the same hall. Please allow me to interpret the original text of "Fu Jing" into a question-and-answer format. I wonder if Xin'ai agrees.
Question: At the initial stage of Ye Ge (dysphagia/choking), there are cases where food enters but causes choking and cannot be swallowed. This is due to Lung Qi rebelling upward, and the epiglottis failing to cover in time, causing pathology in the Qi throat. What medicine should be used?
I replied: Treat with Pipa Ye (Loquat Leaf), Baihe (Lily Bulb), Tianmendong (Asparagus Root), Banxia (Pinellia Rhizome), Ejiao (Donkey-hide Gelatin), and Gancao (Licorice Root). Let the governing regulation function operate normally, and the rebellious Qi will become smooth. However, it is necessary to assist with Ganjiang (Dried Ginger) for opening, Wuweizi (Schisandra Berry) for closing, and Xixin (Asarum) for stimulating the divine mechanism, so that the two apertures of the throat can follow their normal entry and exit routines, thereby avoiding the trouble of choking and rebellion. Those unfamiliar with Zhongjing's books will not realize this.
Question: There are cases where swallowing food feels like being cut by a knife or strangled by grass, with chest pain and fear of eating. This is internal swelling at the upper opening of the Stomach, making the esophagus unfavorable. What medicine should be used?
I replied: Use Jinyinhua (Honeysuckle Flower) boiled into a paste, taken regularly with rice drink. Or, roast Shuiniu Hou (Water Buffalo Throat) until dry, grind it into powder, and assist with Jinyinhua. It can relieve pain and reduce swelling. Its taste is sweet and texture moist, nourishing the Yin of the Stomach cavity; its nature is cold and aroma fragrant, clearing the closure caused by stagnant heat.
Question: In cases where every meal must be washed down with water to go down, the Qi in the Stomach fails to absorb upward, so food cannot descend on its own. Without water, obstruction occurs. What medicine should be used?
I replied: If Stomach Qi cannot absorb upward, without the assistance of Renshen (Ginseng Root), the Stomach cannot receive food. Obstruction cannot be resolved without the descending moistening action of Ganlan Shui (Agitated Water) and Baimi (White Honey). Moreover, this obstruction is a disease of the Chong Mai (Penetrating Vessel); only Banxia (Pinellia Rhizome) can descend the rebellion of the Chong Mai. Zhongjing's Dabanxia Tang (Major Pinellia Decoction) is excellent.
Question: There are cases where alcohol must be consumed before eating to enable ingestion. This is because Stomach Qi is stagnant and blocked, only becoming unblocked by the fierce nature of wine. What medicine should be used?
I replied: It is suitable to use Pingwei San (Calm the Stomach Powder) ingredients plus Xiangfu (Cyperus Rhizome), Maiya (Barley Sprout), Banxia (Pinellia Rhizome), Ganjiang (Dried Ginger), Baiddoukou (Cardamom), Shashen (Glehnia Root), and Chuanxiong (Ligusticum Rhizome). Place them inside a sheep stomach, steam until cooked, and dry. Replace with a new sheep stomach and repeat the process three times as before. Remove the sheep stomach, grind into powder, and take three qian sent down with aged rice soup, twice daily. Use pungent medicines to resolve knots, and aromatic medicines to awaken the Spleen. The ingenuity of the preparation lies in transforming the fierce energy of wine, so the formula does not damage Yin Qi. The Classic says: "Yin is the guardian within." This formula is quite appropriate.
Question: There are cases of Liver Qi rebelling and Gallbladder Qi transgressing, with collateral vessels constraining each other, causing intermittent pain in both hypochondriac regions. If food entering does not invade the collaterals of the Liver and Gallbladder, it descends; if it invades these small collaterals, the Earth (Spleen/Stomach) is controlled by Wood (Liver/Gallbladder), unable to accept grain, resulting in vomiting. The disease originates from Wood stagnation, causing Earth to stagnate as well. What medicine should be used?
I replied: It is suitable to use Xiao Chaihu Tang (Minor Bupleurum Decoction), adhering to the original proportions but divided into smaller doses. (Chaihu 4 qian, Banxia washed seven times with water, do not boil with Fan (alum), Huangqin (Scutellaria Root), Renshen (Ginseng Root), Zhi Gancao (Honey-fried Licorice Root), and Shengjiang (Fresh Ginger) each 1.5 qian, one Dazao (Jujube), decocted in water.) Add whole Zijie (Purple Perilla Stemlets), Sheng Zhuru (Raw Bamboo Shavings) each 2 qian, Ju Nei Jin Mo (Inner Membrane of Tangerine Peel) and Danggui Xu (Angelica Sinensis Root Tips) each 1 qian. Tonify deficiency, clear fire, resolve stagnation, and unblock collaterals. When combined properly, each herb enhances the others, naturally differing from the generic nature of other formulas.
Question: There are cases of excessive Stomach Fire, where food enters and causes incessant vomiting and regurgitation. What medicine should be used?
I replied: Food cannot enter the throat because Fire blocks the upper part. It is suitable to use the great cold nature of Huanglian (Coptis Rhizome) and Huangqin (Scutellaria Root) to purge it, and their great bitter nature to direct it downward. Furthermore, use Renshen (Ginseng Root) to assist the Stomach, so that the Stomach delights in accepting food and eagerly welcomes it inward. However, Ganjiang (Dried Ginger) must be used—greatly pungent and hot—to break through the barrier, thus avoiding the trouble of rejection. These four herbs in equal parts, decocted and taken, is a favored formula of Zhongjing. If food enters the throat but is immediately vomited out, this indicates pre-existing Heat in the Stomach. Upon encountering food, the two heats clash, preventing retention and causing immediate expulsion. It is suitable to use 4 qian of Dahuang (Rhubarb Root) and 2 qian of Gancao (Licorice Root), which is the method of drawing fire from under the cauldron. This, along with the Huanglian-Huangqin-Ganjiang-Renshen Decoction, are both bitter-cold agents, yet there is a difference of a thousand li between them, let alone the opposition of cold and hot.
Question: There are cases of morning consumption and evening regurgitation, undigested food, where one must empty everything completely before feeling relief. This refers to food remaining for a long time and coming back up due to lack of Fire. What medicine should be used?
I replied: Using warming and tonifying methods for this syndrome is known to everyone. However, when it fails, there are reasons. One must distinguish between lack of Fire in the Middle Jiao and lack of Fire in the Lower Jiao. Lack of Fire in the Middle Jiao has two types: in the Yangming channel, there is chest fullness, suitable for Wuzhuyu Tang (Evodia Decoction); in the Taiyin channel, there is abdominal fullness, suitable for Lizhong Wan (Regulate the Middle Pill). One might worry that this pill is overly sweet, in which case Gancao (Licorice Root) can be halved. One might worry that its effect is too slow, in which case Bijia (Long Pepper Fruit), Fuzi (Prepared Aconite Root), Wuzhuyu (Evodia Fruit), Banxia (Pinellia Rhizome), and Fuling (Poria) can be added. Do not stick rigidly to established methods. Lack of Fire in the Lower Jiao also has two types: in the Jueyin channel, vomiting food accompanied by sourness and rotteness, also suitable for Wuzhuyu Tang (Evodia Decoction); additionally, use Chuanjiao (Sichuan Pepper), Ganjiang (Dried Ginger), Rougui (Cinnamon Bark), Wuzhuyu (Evodia Fruit), Fuzi (Prepared Aconite Root), Danggui (Angelica Sinensis Root), Chuanlianzi (Szechwan Lovage Fruit), Renshen (Ginseng Root), and Shashen (Glehnia Root), grind into powder, form pills with Jujube Soup, and take three qian sent down with millet drink, twice daily. In the Shaoyin channel, vomiting food accompanied by fluids, suitable for Zhenwu Tang (True Warrior Decoction), doubling Shengjiang (Fresh Ginger), or using Doumen Fang (Doumen Prescription) for vigorous tonification. After recovery, Shenqi Wan (Kidney Qi Pill) is suitable, doubling Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root) to conclude treatment.
Another question: None of the above syndromes have reached the state of emaciation/dryness, but all can lead to it. When reaching the point of spitting white foam, stool like sheep droppings, exhaustion of body fluids, non-circulation of Ying and Wei, and blockage of the Five Zang organs, food cannot enter at all, and the disease is incurable. Does Mr. still have a method to save it?
I replied: Body fluids are essentially True Water. Water is transformed by Qi and generated by Fire. Investigating the cause of exhaustion, it is either that Qi deficiency fails to transform it, or Fire deficiency fails to generate it. People nowadays do not understand this principle, believing that moistening, sweet, and cool drugs can generate fluids and nourish essence, but this actually dries up the source of fluids and accelerates death. Zhongjing said: "Dry vomiting with saliva froth, Evodia Decoction governs it." Although this was not specifically formulated for Ge Ye Syndrome, sage words encompass everything. In Shaoyang syndrome, Fire rebels upward; vomiting with sound but no grain expelled is called dry vomiting; if no grain is expelled but only saliva froth is vomited, it is called dry vomiting with saliva froth. This syndrome involves total inability to ingest food, no grain to vomit, so it falls under the category of dry vomiting. Fluids are born from Grain Qi; cutting off food exhausts fluids, and vomiting saliva froth exhausts them completely, so they cannot nourish the intestines and stomach downwards, resulting in stool like sheep droppings. Only Wuzhuyu Tang (Evodia Decoction) uses great pungency to open the rejection, great bitterness to suppress rebellion, and great sweetness to cultivate the center. Pungency transforms into Yang through sweetness, bitterness transforms into Yin through sweetness. When Yin and Yang harmonize, rain descends like timely showers, instantly creating a scene of vast irrigation. Moreover, assisted by Renshen (Ginseng Root) which greatly generates fluids, and taming the nature of other herbs, it is fittingly a miraculous elixir for bringing the dead back to life. As for retained phlegm and stasis blocking the stomach aperture, causing obstruction in the path of food entry, this belongs to excess syndromes. The theories of various schools are not without merit, and there is no need for Xiuyuan to add further comments. The Classic also mentions the syndrome of Upper Qi and Lower Parasites; if treated with mule or horse urine without success, it seems Umei Wan (Mume Pill) could follow. Words cannot fully express the meaning; it depends on the person's ability to comprehend.