无锡顾左,患中脘不舒,饮食减少。予诊其脉,左关甚弦,右部略沉细,此不过肝气太强,脾胃受制耳。乃出
其前服方,则居然承气汤,硝与黄各七八分,朴与枳各五六分,方案自载宗仲景法,重药轻投。噫,过矣!予
为制抑木和中汤,三剂而愈。今特申辩之。盖三承气汤,有轻有重原为胃实大症而设,故用斩关夺门之
法,救人于存亡危急之秋,非可混施于寻常之症也。今以脾胃不和之小恙,而用此重剂,谓为重药轻投,
殊不知重药既可轻投,何不轻药重投,岂不更为妥当乎?予故不惮烦而辩之。
抑木和中汤(自制)
蒺藜(四钱) 郁金(二钱) 青皮(一钱) 广皮(一钱) 茅术(一钱炒) 浓朴(一钱) 当归(二钱) 茯
苓(二钱) 白术(一钱) 木香(五分) 砂仁(一钱) 佛手(五分) 白檀香(五分)
巧不离乎规矩,而实不泥乎规矩。岳忠武不深究阵图,以为阵而后战,本属常法,然运用之妙,在乎一心,
尤以临机应变为要,旨哉言乎!吾于古方,亦犹是已。真珠母丸,本许学士治游魂为变,夜寐不安而设。予
尝以此方,略为加减,治三种重恙,无不应手而效。盖同病各发,见症虽异,而致病则同,化裁变通,于不执
成见中,确有定见,斯头头是道矣。予非教人蔑古荒经,欲人师古人之意,而不泥古人之方,乃为善学古
人。且执古方以治今病,往往有冰炭之不入者,尤不可以不审也。
丹徒张姓女,患五心烦扰,自头至腰,时时作颤,坐卧不安。予制驯龙汤,连服数十剂而愈。
驯龙汤(自制)
龙齿(二钱) 真珠母(八钱) 羚羊角(一钱五分) 杭菊(二钱) 生地(六钱) 当归(二钱) 白芍(一
钱) 薄荷(一钱) 沉香(五分) 续断(二钱) 独活(一钱) 红枣(十枚) 钩藤勾(四钱后入)
常州丁姓女,患惊悸气促,喉舌作痛,予制驯龙驭虎汤,连服数十剂而愈。
驯龙驭虎汤(自制)
龙齿(二钱) 琥珀(一钱) 真珠母(八钱) 生地(六钱) 玉竹(四钱) 栝蒌皮(三钱) 石斛(三钱) 柏
子霜(二钱) 白芍(一钱五分) 薄荷(一钱) 莲子(二十粒打碎勿去心) 沉香(四分人乳磨冲)
无锡孙左,身无他苦,饮食如常,惟彻夜不寐,间日轻重,如发疟然,一载未愈。予诊其脉,左关独见弦数,
余部平平。因思不寐之症,共十三条,从无间日重轻之象,惟少阳受病,方有起伏。但少阳为半表半里
之经,不进则退,安能久留!此实与厥阴同病,甲乙同源,互相胶结,故有起伏而又延久也。为制甲乙归
脏汤,连服数十剂而愈。
甲乙归脏汤(自制)
真珠母(八钱) 龙齿(二钱) 沉香(五分) 薄荷(一钱) 生地(六钱) 柴胡(一钱醋炒) 白芍(一钱
五分酒炒) 归身(二钱) 夜合花(二钱) 丹参(二钱) 柏子仁(二钱) 红枣(十枚) 夜交藤(四钱切)
无锡顾姓患者,感到中脘部不适,饮食量减少。我诊察他的脉象,左关脉非常弦硬,右部脉略现沉细,这不过是肝气过盛,导致脾胃受到制约罢了。于是取出他之前服用的方子,竟然是承气汤,芒硝与大黄各用七八分,厚朴与枳实各用五六分,处方方案自称遵循张仲景的法则,属于“重药轻投”。唉,太过分了!我为他配制了抑木和中汤,服用三剂后痊愈。现在特意申辩说明此事。大抵三承气汤,有轻有重,原本是为胃腑实证重症而设的,所以采用斩关夺门般的峻猛治法,在生死存亡危急时刻救人,不可随意混用于寻常病症。如今拿脾胃不和的小病,却使用这种重剂,声称是重药轻投,却不知道既然重药可以轻投,为何不轻药重投,岂不是更为妥当吗?所以我就不怕麻烦地加以辩驳。
抑木和中汤(自制)
蒺藜(四钱) 郁金(二钱) 青皮(一钱) 广陈皮(一钱) 茅苍术(一钱炒制) 浓朴(一钱) 当归(二钱) 茯苓(二钱) 白术(一钱) 木香(五分) 砂仁(一钱) 佛手(五分) 白檀香(五分)
技巧虽不离乎规矩,但实际上不能拘泥于规矩。岳飞(岳忠武)不深究阵图,认为列阵之后才开战,本是常规战法,然而运用之妙,在于用心灵活,尤其以临机应变为关键,这话真是深刻啊!我对古方,也是如此。真珠母丸,原本是许学士为了治疗神魂浮越、夜间睡眠不安而设立的。我曾经以此方略微加减,治疗三种重病,没有不随手见效的。大概同一种疾病在不同人身上表现各异,虽然症状不同,但致病原因相同,通过化裁变通,在不固执成见中确立确切的见解,这样就能处理得头头是道了。我并不是教人蔑视古籍荒废经典,而是希望人们学习古人的医理精神,而不拘泥于古人的具体方药,这才是善于学习古人。况且拿着古方来治疗今天的疾病,往往会有像冰和炭那样不相容的情况,尤其不可以不审慎考察。
丹徒张姓女子,患有心烦意乱,从头部到腰部,时时颤抖,坐卧不安。我配制了驯龙汤,连续服用几十剂后痊愈。
驯龙汤(自制)
龙齿(二钱) 真珠母(八钱) 羚羊角(一钱五分) 杭白菊(二钱) 生地黄(六钱) 当归(二钱) 白芍(一钱) 薄荷(一钱) 沉香(五分) 续断(二钱) 独活(一钱) 红枣(十枚) 钩藤勾(四钱后下)
常州丁姓女子,患惊悸气短,咽喉舌头疼痛,我配制了驯龙驭虎汤,连续服用几十剂后痊愈。
驯龙驭虎汤(自制)
龙齿(二钱) 琥珀(一钱) 真珠母(八钱) 生地黄(六钱) 玉竹(四钱) 栝蒌皮(三钱) 石斛(三钱) 柏子霜(二钱) 白芍(一钱五分) 薄荷(一钱) 莲子(二十粒捣碎不去心) 沉香(四分用人乳磨汁冲服)
无锡孙姓患者,身体没有其他痛苦,饮食如常,只是彻夜不眠,每隔一天病情轻重交替,如同发作疟疾一般,一年未愈。我诊察他的脉象,只有左关脉呈现弦数,其余部位平平无奇。因而思考不寐症共有十三条证型,从间日轻重交替的现象来看,只有少阳经受邪,才会有起伏变化。但少阳经属于半表半里的经络,如果不向表发展就会向里退却,怎么能长久停留呢!这实际上是厥阴经同时受病,甲乙同源(肝胆互为表里),互相胶结,所以既有起伏又拖延日久。为此配制了甲乙归脏汤,连续服用几十剂后痊愈。
甲乙归脏汤(自制)
真珠母(八钱) 龙齿(二钱) 沉香(五分) 薄荷(一钱) 生地黄(六钱) 柴胡(一钱醋炒) 白芍(一钱五分酒炒) 归身(二钱) 夜合花(二钱) 丹参(二钱) 柏子仁(二钱) 红枣(十枚) 夜交藤(四钱切段)
Wu Xi patient Gu suffered from discomfort in the epigastrium and reduced appetite. Upon examining his pulse, I found the left Guan position (liver/gallbladder) extremely wiry (Xian), while the right side was slightly deep and fine (Chen Xi). This indicated merely excessive Liver Qi constraining the Spleen and Stomach. I then reviewed his previous prescription, which turned out to be Chengqi Tang (Cathartic Decoction), with Xiaoshi (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma) each at 7-8 fen, and Houpo (Magnoliae Officinalis Cortex) and Zhishi (Aurantii Fructus Immaturus) each at 5-6 fen. The prescription claimed to follow Zhang Zhongjing’s methods, employing "heavy medicine in light doses." Alas, this was excessive! I prescribed Yimu Hezhong Tang (Wood-Suppressing and Middle-Regulating Decoction, self-made), and he recovered after three doses. I hereby offer a clarification. The Three Chengqi Decoctions vary in strength and were originally designed for severe Yangming Fu excess syndromes, utilizing drastic methods to save lives in critical moments; they should not be indiscriminately applied to ordinary conditions. To use such heavy formulas for minor Spleen-Stomach disharmony and claim it as "heavy medicine in light doses" is flawed logic. If heavy medicine can be used lightly, why not use light medicine heavily? Would that not be more appropriate? Thus, I do not shy away from elaborating on this point.
Yumu Hezhong Tang (Self-made):
Jili (Tribuli Fructus, 4 qian), Yujin (Curcumae Radix, 2 qian), Qingpi (Citri Reticulatae Pericarpium Viride, 1 qian), Guangpi (Citri Reticulatae Pericarpium, 1 qian), Maoshu (Atractylodis Rhizoma, 1 qian, stir-fried), Nongpo (Magnoliae Officinalis Cortex, 1 qian), Danggui (Angelicae Sinensis Radix, 2 qian), Fuling (Poria, 2 qian), Baizhu (Atractylodis Macrocephalae Rhizoma, 1 qian), Muxiang (Aucklandiae Radix, 5 fen), Sharen (Amomi Fructus, 1 qian), Foshou (Citri Sarcodactylis Fructus, 5 fen), Baitanxiang (Santalum Album Lignum, 5 fen).
Skill follows rules but does not rigidly adhere to them. Yue Fei (Yue Zhongwu) did not deeply study battle formations, believing that forming ranks before battle is standard practice; however, the subtlety of application lies in the mind, especially adapting to changing circumstances. This insight is profound! My approach to ancient prescriptions is similar. Zhenzhumu Wan (Pearl Mother Pill) was originally formulated by Scholar Xu to treat wandering soul manifestations and insomnia. I have occasionally modified this formula to treat three types of severe illnesses, achieving immediate efficacy in all cases. Although different patients may present differently with the same disease, the underlying pathogenesis remains consistent. Through flexible modification, maintaining firm principles without being bound by preconceptions, one can handle cases effectively. I am not advocating disregard for classics, but rather learning the spirit of ancient masters without being shackled by their specific formulas. Applying ancient formulas to modern diseases often results in incompatibility, akin to ice and charcoal, requiring utmost caution.
Patient Zhang, a woman from Dantu, suffered from five-palm heat and restlessness, trembling from head to waist, unable to sit or lie comfortably. I prescribed Xunlong Tang (Dragon-Taming Decoction, self-made), and she recovered after dozens of doses.
Xunlong Tang (Self-made):
Longchi (Dentis Mastodontis, 2 qian), Zhenzhumu (Margaritifera Concha, 8 qian), Lingyangjiao (Saiga Tatarica Cornu, 1.5 qian), Hangju (Chrysanthemi Flos, 2 qian), Shengdi (Rehmanniae Radix Recens, 6 qian), Danggui (Angelicae Sinensis Radix, 2 qian), Baishao (Paeoniae Radix Alba, 1 qian), Bohe (Menthae Haplocalycis Herba, 1 qian), Chenxiang (Aquilaria Lignum, 5 fen), Xuduan (Dipsaci Radix, 2 qian), Duohuo (Angelicae Pubescentis Radix, 1 qian), Hongzao (Jujubae Fructus, 10 pieces), Goutenggou (Uncariae Ramulus cum Uncis, 4 qian, added later).
Patient Ding, a woman from Changzhou, suffered from palpitations, shortness of breath, and pain in the throat and tongue. I prescribed Xunlong Yuhu Tang (Dragon-Taming and Tiger-Subduing Decoction, self-made), and she recovered after dozens of doses.
Xunlong Yuhu Tang (Self-made):
Longchi (Dentis Mastodontis, 2 qian), Hupo (Electrum, 1 qian), Zhenzhumu (Margaritifera Concha, 8 qian), Shengdi (Rehmanniae Radix Recens, 6 qian), Yuzhu (Polygonati Odorati Rhizoma, 4 qian), Gualoupi (Trichosanthis Pericarpium, 3 qian), Shihu (Dendrobii Caulis, 3 qian), Baizishuang (Platycladi Semen, 2 qian), Baishao (Paeoniae Radix Alba, 1.5 qian), Bohe (Menthae Haplocalycis Herba, 1 qian), Lianzi (Nelumbinis Semen, 20 grains, crushed, heart retained), Chenxiang (Aquilaria Lignum, 4 fen, ground with human milk and taken as suspension).
Patient Sun, from Wu Xi, had no other complaints and ate normally, but suffered from total insomnia, alternating severity every other day like malaria, persisting for a year. His pulse showed only the left Guan position as wiry and rapid (Xian Shu), while others were normal. Considering the thirteen types of insomnia, only Shaoyang (Lesser Yang) involvement presents with fluctuating severity. Since Shaoyang is the half-exterior, half-interior meridian, if it does not advance outward, it retreats inward; how can it remain stagnant long-term? This condition actually involves concurrent Jueyin (Greater Yin) pathology. Jia and Yi share the same source (Liver and Gallbladder are interior-exterior pairs), entangling each other, causing fluctuations and prolongation. I prescribed Jiayi Guizang Tang (Jia-Yi Organ-Returning Decoction, self-made), and he recovered after dozens of doses.
Jiayi Guizang Tang (Self-made):
Zhenzhumu (Margaritifera Concha, 8 qian), Longchi (Dentis Mastodontis, 2 qian), Chenxiang (Aquilaria Lignum, 5 fen), Bohe (Menthae Haplocalycis Herba, 1 qian), Shengdi (Rehmanniae Radix Recens, 6 qian), Chaihu (Bupleuri Radix, 1 qian, vinegar-fried), Baishao (Paeoniae Radix Alba, 1.5 qian, wine-fried), Guishen (Angelicae Sinensis Radix, 2 qian), Yehehua (Albiziae Flos, 2 qian), Danshen (Salviae Miltiorrhizae Radix et Rhizoma, 2 qian), Baiziren (Biotae Semen, 2 qian), Hongzao (Jujubae Fructus, 10 pieces), Yejiaoteng (Polygoni Multiflori Caulis, 4 qian, sliced).