吴 饮停中脘，脘腹鸣响，攻撑作痛。大便坚结如栗，但能嗳气、不能矢气，是胃失下行，而气但上
逆也。和胃降逆、逐水蠲饮治之。
半夏 淡干姜 陈皮 茯苓 泽泻 白芍 旋复花 代赭石 甘遂（去心面包煨） 川椒（炒出汗） 焦六曲
潘 肛有漏疡，阴津先损于下。兼以嗜酒，湿热又盛于中。继因劳碌感寒，寒入肺经，与胸中素盛
之痰湿相合，咳嗽，呕吐清水，而成痰饮为患。仍饮烧酒祛寒，宜其血溢矣。况内热脉
数，阴津亦亏。欲蠲痰饮，恐温则劫其阴；欲除内热，恐清则加其咳。宜和胃降气。
生苡仁 紫菀 白扁豆 茯苓 款冬花 川贝母 郁金 杏仁 蛤壳 十大功劳
又 阴虚痰饮，逢暑既不可温，又不可清。舌苔粘腻，当和中化痰，兼以摄纳肾气。
二陈汤加杏仁。肾气丸一钱，都气丸二钱，相和，开水下。
渊按，暑天何尝不可用温？惟痰饮见吐血，以为阴虚，不敢温耳。其实血从烧酒伤胃而来，尚非真正阴虚。
又 咳呕清水，痰饮之病。脉细数，内热，阴虚之候。治痰饮宜温，治阴虚宜滋，药适相背。肝肾为
子母，不妨补母以益子；而胃土又为肺金之母，又当和胃以化痰。拟滋燥兼行，仿东垣法而不碍。
大熟地 冬术 阿胶 五味子 淡干姜 泽泻 茯苓 半夏 肾气丸
某 痰饮咳嗽，脾胃两亏。柯氏云∶脾肾为生痰之源，肺胃为贮痰之器。近增气急，不得
右卧，右卧则咳剧，肺亦伤矣。素
患肛门漏疡，迩来粪后有血，脾肾亏矣。幸胃纳尚可，议从肺脾
肾三经合治。然年近六旬，爱养为要，否则虑延损症。
熟地（砂仁末拌炒） 半夏 陈皮 五味子 川贝母 阿胶（蒲黄拌炒） 炮姜炭 冬术 归身炭 款冬花
此金水六君煎合黑地黄丸，加阿胶、款冬、川贝三味，补金水土三虚，上能化痰，下能止血。
虽有炮姜，勿嫌温燥，有五味以摄之。
周 饥饱劳碌则伤胃，寒痰凝聚，气血稽留，阻于胃络，而胃脘胀痛，呕吐粘痰，殆无虚日。倘不加
谨，恐成胀满。
异功散去甘草，加炮姜、熟附子、良姜、蔻仁。
又 温胃化痰，从理中、二陈、平胃三方化裁。
六君子合附子理中，加川朴。
又 寒积中焦，胃阳不布，痰饮窃踞。为胀为痛，为吐为哕。法当温运中阳。但病根日久，必耐服药乃效。
六君子合附子理中去草，加川椒、白蔻仁。
又 中虚非补不运，寒饮非温不化。益火生土，通阳蠲饮，苓桂术甘汤主之。附子理中汤亦主之。
苓桂术甘汤合附子理中去草，加半夏、陈皮、蔻仁。
又 病有常经，方有定法。药已见效，无事更张。袁诗云∶莫嫌海角天涯远，但肯扬鞭有到时。
附子理中合二陈汤，加老生姜，老桂木。
渊按∶倜傥风流，足征读书功夫。
徐 痰饮伏于胸中，遇寒则咳而喘，心嘈气塞，头眩腰 。年逾五旬，天癸当去而不去，是气虚不能
摄血也。夫气本属阳，阳气日衰，痰饮日盛。法当通阳气以祛水饮之寒。仲景云∶病痰饮者，当以温药和之，是也。
二陈合苓桂术甘，加款冬、杏仁、蛤壳、沉香。朝服都气丸二钱，肾气丸一钱，开水送下。
秦 痰饮咳喘，脘中胀满，时或微痛。虽肺胃肾三经同病，
而法当责重于脾。盖脾得运而气化，则痰饮有行动之机也。
半夏 陈皮 泽泻 茯苓 杏仁 川朴 补故纸 干姜（五味子同研） 胡桃肉
渊按∶痰饮病轻则治肺脾，重则治肾。数方皆治饮正轨。
又 痰饮停于心下，上则喘咳，下则脘胀。多由清阳失旷，痰浊内阻。转胸中之阳以安肺，
运脾中之阳以和胃，咳喘与胀满当松。
栝蒌皮 茯苓 陈皮 薤白头 川朴 半夏（姜汁炒） 干姜 泽泻 枳实（麸炒）
胡 痰饮久留于肺胃，或咳，或喘，或胀满，皆痰气之为病
也。化胃中之痰宜苓、半，化肺中之痰宜橘、贝，从此扩充以立方。
茯苓 橘红 桂枝 紫菀 白术 半夏 川贝 炙甘草 杏仁 蛤壳
顾 阅病原，知由痰饮久留，肺脾肾三脏交伤，下则肾虚不能纳气，中则脾虚不能运气，上则肺伤不能
降气。由是咳喘不得卧，肢肿腹膨，神气疲惫，虚亦甚矣。治上无益，当治中下。
大熟地（海浮石拌炒） 五味子（炒） 补故纸（盐水炒） 牛膝（盐水炒） 蛤壳（打） 沙苑子（盐水炒） 紫
石英（ ） 怀山药（炒） 麦冬（元米炒） 茯苓
黑锡丹，每朝服三钱，淡盐汤送下。
渊按∶治下固是，然五味无干姜、熟地，牛膝无肉桂，肺肾之气仍不能纳降。赖有黑锡丹主持，可以取效。
秦 悬饮踞于胁下，疼痛，呕吐清水。用仲景法。
芫花 甘遂 大戟 吴茱萸 白芥子（各二钱）
将河水两大碗，入上药五味，煎至浓汁一碗，去渣，然后入大枣五十枚，煮烂，俟干。每朝食大枣五枚。
渊按∶此五饮之一，乃实证也。用之得当，其效如神。
赵 寒入肺底，咳喘而呕，水饮停于心下也。腰胁痛而经停，肝肾已虚。拟开上、温中、补下。
麻黄 细辛 淡干姜 五味子 茯苓 陈皮 杏仁 炙甘草 大熟地（海浮石拌） 半夏 沉香 枇杷叶
又 痰饮咳呕清水，而致停经发热，带下淋漓，营阴虚而肝肾亏矣。脘中胀满，大便偶利则胀觉松，仍
是饮邪见症。夫痰饮宜温宜化，而阴虚宜补宜清。所虑热久停经，恐成干血劳损。
半夏 陈皮 茯苓（细辛拌炒） 生地（姜汁炒） 干姜（五味子同炒） 沙苑
子白芍 当归 川芎 款冬花
渊按∶经停发热，未必即属虚证；惟带下过多，营液虚矣。脘胀便通则松，乃肺脾气分不化也。
尤 痰饮咳嗽，朝晨必吐清水。本拟温药以化之，但时当酷暑，兼有臂痛，且以和胃化痰。
半夏 陈皮 茯苓 款冬花 苏子 杏仁 莱菔子 白芥子
指迷茯苓丸。每朝服三钱，开水送下。
许 寒咳交冬则发，兼以颈项强急不舒。
大熟地（二两，麻黄二钱煎汁浸一宿，炒松） 川贝（一两） 党参（一两，元米
炒） 陈皮（一两） 茯苓（一两，细辛二钱，煎汁浸一宿，晒烘） 款冬花（一两） 制首乌（一两） 苡
仁（一两） 五味子（五钱，干姜二钱同炒） 杏仁霜（六钱） 归身（一两，酒炒） 胡桃肉（一两）
上药共为细末，炼蜜丸，每朝三钱，开水送下。
王 脉弦迟，脐以上连胃脘胀痛，此有寒饮。《脉经》云∶迟则
为寒。仲景云∶口不渴而脉双弦者，饮也。
香砂六君汤去草，加炮姜、神曲、干姜。
又 当脐腹痛，痛则气塞胸中，气嗳不得语，脉弦大而迟。此胃中阳气不足，而有寒饮也。当以温药通之。
照前方去神曲，加香附、川熟附。
吕 阴虚挟痰饮为病。痰饮内留，故咳嗽背寒，心胸着冷则痛。阴虚，故内热也。金水六君煎加减治之。
大熟地 半夏 陈皮 沉香 蛤壳 款冬花 苏子 杏仁 沙参 茯苓
顾 头眩心悸，脉沉弦者，饮也。病发则呕吐酸水，满背气
攻作痛，得嗳则痛松，此浊阴之气上攻阳位。当以温药和之。
熟附子 桂木 半夏 陈皮 冬术 川椒 茯苓 沉香
强 中气不足，湿化为痰，气逆不降，喘息不安，夜重于
昼。脉象弦滑，滑主痰饮，痰饮属阴，故病甚于夜也。拟降气化痰，兼扶中气。
半夏 苏子 陈皮 茯苓 前胡 旋复花 神曲 竹茹 雪羹 枇杷叶
盖 夫邪之所凑，其气必虚，留而不去，其病则实。留饮久
踞不去，亦由中气之虚。欲逐其饮，先补其中。丹溪云∶补完胃气而后下之为当。兹议先补中气一法。
六君子汤去甘草，加干姜。
又 甘遂半夏汤，用甘遂五分。
又 照前方用甘遂七分。
又 照前方用甘遂一钱。
虽大便仍未泻，而腹中已觉甚安，即停。药三日。
某 春脉当弦而反微，是肝虚也。肝虚魂不藏，夜不得寐，昼日当寤而反寐，是胃虚也。胃为两阳合
明之腑，胃虚则阳气失明，故昼日反寐。补肝之虚以藏魂，益胃之虚以补气。
生熟枣仁 茯神 新会白 党参 半夏 生熟谷芽 秫米
白芍 炙甘草
渊按∶此等方案在古人亦不可多得。
某 水饮去后，中气大虚，胃液枯涸，难为力矣。夫中气大亏，非建中不可，而胃阴枯涸，非养胃
阴又不可，然则黄 建中但补中气而不能养其胃阴，仍非计之善也。今拟十全大补阴阳气
血双调，加入麦、夏、苁、附，即十四味建中法，并建其脾中肾中之阴阳，或者其有济乎！
人参须 黄 大熟地（附子三分，煎汁炒） 川芎 茯苓 半夏
白芍（肉桂一分，煎汁炒） 苁蓉 炙甘草 麦冬 冬术（土炒） 归身 金橘饼
又 肝虚无直补之法，补肾即所以补肝；中虚有兼补之方，
补火而更能生土。前投十四味建中，两建其脾中肾中之阴阳。证既大虚，药宜加峻。虚能受补，便是生机。
人参须 党参 黄 炙甘草 大熟地（附子一分拌炒） 肉桂
麦冬 归身 冬术 枸杞子 半夏 茯苓 枣仁 山萸肉（酒炒） 苁蓉
单 痰饮久留，咳喘不已。痰多粘腻，脾肾两亏。脾虚则痰不化而食减，肾虚则阳气衰而水泛，以致腹
满足肿面浮，病成溢饮。《金匮》云∶病溢饮者，当发其汗，小青龙汤主之。然脉细阳衰，
便难液涸，肾气久虚，何堪更投发泄耗阴伤阳之剂！拟进
附子都气丸，裁去熟地者，以其痰多痞塞也。
淡苁蓉 枸杞子（青盐炒） 茯苓 泽泻 半夏 五味子 制附子 牛膝炭 胡桃肉
孙 风邪久恋肺中，寒饮停留胃脘。风能化热，咳久伤阴。积饮生痰，胃阳失布。肺之子，肾也。
胃之妻，脾也。肺伤肾亦亏，胃虚脾亦弱。脾弱故便泄，肾亏故左尺脉弦而大也。咳将一
载，虽曾吐血，而时呕清水，其为寒饮无疑。今从饮门例治。
大熟地（海浮石拌） 麦冬（元米炒） 生苡仁 五味子 陈皮 焦六曲
茯苓 半夏 干姜 紫石英 细辛 沉香
吴 喘咳多年，近加咳呛，形消肉瘦，正阴大亏。虽有痰浊，法当补纳。
大熟地 党参 半夏 陈皮 牛膝 款冬花 麦冬 茯苓 紫石英 五味子 胡桃肉
许 痰饮流落心中，心痛彻背，大便干燥，饮食哽嗌。肠胃液枯，法当温润。
淡苁蓉 麦冬 茯苓 桂木 薤白头 枸杞子 半夏 陈皮 栝蒌霜 白蔻仁
渊按∶积饮久而伤胃，将成噎膈。桂、蒌、薤白治痰饮，亦可治噎膈。盖二证皆上中焦阳微不化所致。
范 寒痰留于胃，则脘痛而吐清水；入于肺，则咳嗽而多白沫。宜仿小青龙法，辛温开达上焦。
淡干姜 茯苓 白芍 细辛 橘红 桂枝 半夏 五味子 款冬花 杏仁
顾 嗜酒多湿，湿蕴生痰。体质阴虚，烦劳伤气。去冬咳嗽，须微带血，行动气升，至今不愈。
诊脉虚小，恐加喘急。兹以金水六君煎加味。
大熟地 半夏 陈皮 茯苓 款冬花 杏仁 蛤壳 五味子 麦冬 胡桃肉
另∶金水六君丸，每朝服三钱，淡盐花汤送下。
金 痰饮停胸，清阳失旷，咳嗽眩悸，与苓桂术甘汤加味。
茯苓 桂枝 白术 炙甘草 紫石英 五味子 陈皮 半夏 蛤壳 胡桃肉
方 向有心痛呕吐之病，得食则安，明系中虚而有痰饮伏留
于心下也。上年春季，头痛寒热，从此咳嗽喉有痰声。当时设遇明眼，用小青龙发汗散水，表邪与痰饮悉解，
何至淹缠不愈耶！迨至酷暑，邪郁化热，咳嗽带臭，肺气受伤。交白露节，秋金得
令，肺气清肃而后渐愈。至冬阳气少藏，其咳复作。交春入夏，
咳频不已，病延一载有余。诊脉双弦，形肉瘦削，口不干渴，身不发热，头眩心悸，肝肾之阴已虚，脾胃
之气亦弱，痰饮恋而未化，自浅及于深矣。昔贤谓外饮治脾肺，内饮治肾。今自外而至
于内，从肺脾肾三经立法，前后绾照，以冀各得其所。
款冬花 苏子 杏仁 川贝 茯苓 陈皮 半夏 干姜（五味
子五粒，同炒） 大熟地（海浮石拌炒） 炙甘草 牛膝（盐水炒） 蛤壳 马兜铃 姜汁 胡桃肉 枇杷叶
渊按∶外饮治肺脾，非杏、贝等清润之药可治，当求之于《金匮》。想病已棘手，方药错杂，有不得不然耳。
费 痰饮伏于胸中，咳嗽喘促。其标在肺，其本在肾。此症本虚未甚，标实有痰，法当两顾。
大熟地 茯苓 蛤壳 川贝 牛膝 半夏 陈皮 杏仁 桑白皮 枇杷叶
郝 仲景云∶风舍于肺，其人则咳。又云∶胸中有留饮，背寒冷如掌大。此症是也。
麻黄 桑白皮 象贝 橘红 黄芩（姜汁炒） 杏仁 半夏 生甘草 茯苓 款冬花
胡 痰饮 咳嗽，饱则安，饥则甚，乃胃虚也。
黄 炙甘草 冬术 陈皮 白芍 玉竹 茯苓 杏仁 桔梗
李 胃有寒侵，肺有寒侵，两寒相得饮邪停，咳而喘呕为痰
饮。气亦宜平，痰亦宜平，病痰饮者药宜温，仲师方法细详审。
二陈汤加老桂木、吴茱萸、川椒、苡仁、生姜。
罗 干咳阴虚痰火盛，丹溪方法主生津。此由脘痛兼痰饮，烟体须当温化遵。
苁蓉（养阴温润，咸能下降） 枸杞子（甘温益血） 制半夏（燥湿痰） 茯苓
吴姓患者：水饮停滞在中脘部位，导致胃脘和腹部鸣响，气机攻冲并伴有疼痛。大便干结坚硬如栗子状，只能打嗝而不能排气，这是胃气失去下行功能，而气机仅向上逆乱的表现。治疗应采用调和胃气、降逆止呕、逐水祛饮的方法。
处方：半夏、淡干姜、陈皮、茯苓、泽泻、白芍、旋复花、代赭石、甘遂（去除心部，用面包裹煨制）、川椒（炒至出汗）、焦六曲。
潘姓患者：肛门有漏管疮疡，说明下部的阴津已经先受损。加上嗜好饮酒，导致中焦湿热炽盛。随后因劳累受寒，寒气侵入肺经，与胸中原本旺盛的痰湿相结合，出现咳嗽、呕吐清水的症状，从而形成痰饮为患。此时如果继续饮用烧酒来驱寒，必然会导致出血。况且患者内有热象且脉数，阴津也已亏损。想要祛除痰饮，恐怕温燥药物会劫伤阴液；想要清除内热，恐怕寒凉药物会加重咳嗽。适宜采用调和胃气、降逆理气的方法。
处方：生薏苡仁、紫菀、白扁豆、茯苓、款冬花、川贝母、郁金、杏仁、蛤壳、十大功劳。
又诊：阴虚兼有痰饮，在暑天既不能使用温药，也不能使用清药。舌苔粘腻，应当和中化痰，同时兼顾摄纳肾气。
处方：二陈汤加杏仁。肾气丸一钱，都气丸二钱，混合后开水送服。
渊按：暑天何尝不能用温药？只是见到痰饮病伴随吐血，便认为是阴虚，不敢用温药罢了。其实血是从烧酒损伤胃络而来，并非真正的阴虚。
又诊：咳嗽呕吐清水，是痰饮的病证。脉细数，内有热象，这是阴虚的征候。治疗痰饮宜用温法，治疗阴虚宜用滋法，这两种治法似乎相互矛盾。肝肾互为母子关系，不妨通过补益母脏（肝）来滋养子脏（肾）；而脾胃土又是肺金之母，又应当调和胃气以化痰。拟定滋润与燥湿并行的方法，效仿李东垣的法度而不产生妨碍。
处方：大熟地黄、冬术（白术）、阿胶、五味子、淡干姜、泽泻、茯苓、半夏、肾气丸。
某患者：痰饮咳嗽，脾胃两虚。柯琴说：脾肾是生痰之源，肺胃是贮痰之器。近来增加气急症状，不能向右侧卧，向右卧则咳嗽加剧，说明肺也受伤了。素来患有肛门漏管疮疡，近来粪便后有出血，说明脾肾亏虚。幸好胃纳尚可，建议从肺、脾、肾三经合治。然而年近六十，调养身体最为重要，否则担心拖延成虚损重症。
处方：熟地黄（用砂仁末拌炒）、半夏、陈皮、五味子、川贝母、阿胶（用蒲黄拌炒）、炮姜炭、冬术、归身炭、款冬花。
此方是金水六君煎合黑地黄丸，加入阿胶、款冬花、川贝母三味药，补益金（肺）、水（肾）、土（脾）三脏之虚，上能化痰，下能止血。虽然有炮姜，但不要嫌弃其温燥，因为有五味子收敛制约它。
周姓患者：饥饱不均、劳累过度会损伤胃气，寒痰凝聚，气血滞留，阻滞于胃络，导致胃脘胀痛，呕吐粘痰，几乎天天如此。如果不加以谨慎调护，恐怕会发展成胀满病。
处方：异功散去掉甘草，加入炮姜、熟附子、良姜、蔻仁。
又诊：温胃化痰，从理中汤、二陈汤、平胃散三方化裁而来。
处方：六君子汤合附子理中汤，加厚朴。
又诊：寒邪积滞于中焦，胃阳不能布散，痰饮占据其中。表现为胀满、疼痛、呕吐、呃逆。治法应当温运中焦阳气。但病根日久，必须耐心服药才能见效。
处方：六君子汤合附子理中汤去掉甘草，加入川椒、白蔻仁。
又诊：中焦虚弱不补则无法运化，寒饮不温则无法化解。益火生土，通阳祛饮，主用苓桂术甘汤。附子理中汤也可主治。
处方：苓桂术甘汤合附子理中汤去掉甘草，加入半夏、陈皮、蔻仁。
又诊：疾病有其常规规律，方剂有固定法则。药物已经见效，无需更改方案。袁枚诗云：“莫嫌海角天涯远，但肯扬鞭有到时。”
处方：附子理中汤合二陈汤，加入老生姜、老桂木。
渊按：文笔倜傥风流，足见读书功夫深厚。
徐姓患者：痰饮潜伏在胸中，遇寒冷则咳嗽气喘，心中嘈杂气塞，头晕腰痛。年过五十，天癸（月经/生殖机能）应当停止而未停止，这是气虚不能摄血所致。气本属阳，阳气日渐衰退，痰饮日渐旺盛。治法应当通利阳气以祛除水饮之寒。张仲景说：患痰饮病的人，应当用温药调和，说的就是这个道理。
处方：二陈汤合苓桂术甘汤，加入款冬花、杏仁、蛤壳、沉香。早晨服用都气丸二钱，肾气丸一钱，开水送服。
秦姓患者：痰饮引起咳嗽气喘，胃脘中胀满，有时轻微疼痛。虽然肺、胃、肾三经同病，但治法应当着重责之于脾。因为脾得到运化则气化正常，痰饮就有移动化解的契机。
处方：半夏、陈皮、泽泻、茯苓、杏仁、厚朴、补骨脂、干姜（与五味子同研）、胡桃肉。
渊按：痰饮病轻则治肺脾，重则治肾。这几个方子都是治疗痰饮的正统方法。
又诊：痰饮停聚在心下，向上则喘咳，向下则胃脘胀满。多由清阳失于宣旷，痰浊内阻所致。转输胸中之阳以安肺，运化脾中之阳以和胃，咳喘与胀满自然缓解。
处方：瓜蒌皮、茯苓、陈皮、薤白头、厚朴、半夏（姜汁炒）、干姜、泽泻、枳实（麸炒）。
胡姓患者：痰饮长久停留于肺胃，或咳嗽，或气喘，或胀满，都是痰气作祟。化解胃中的痰宜用茯苓、半夏，化解肺中的痰宜用橘红、贝母，从此扩充思路来组方。
处方：茯苓、橘红、桂枝、紫菀、白术、半夏、川贝母、炙甘草、杏仁、蛤壳。
顾姓患者：阅读病因，知道是由于痰饮长久停留，肺、脾、肾三脏互相损伤。下部肾虚不能纳气，中部脾虚不能运气，上部肺伤不能降气。因此咳嗽气喘不能平卧，四肢浮肿腹部膨隆，精神疲惫，虚损已经很严重了。治上焦无益，应当治中下焦。
处方：大熟地黄（海浮石拌炒）、五味子（炒）、补骨脂（盐水炒）、牛膝（盐水炒）、蛤壳（捣碎）、沙苑子（盐水炒）、紫石英、怀山药（炒）、麦冬（元米炒）、茯苓。
黑锡丹，每晨服用三钱，淡盐汤送服。
渊按：治疗下焦固然是对的，但是五味子没有干姜配合，熟地黄没有牛膝配伍肉桂，肺肾之气仍然不能纳降。依赖黑锡丹主持大局，可以取得疗效。
秦姓患者：悬饮占据胁下，疼痛，呕吐清水。采用张仲景的方法。
处方：芫花、甘遂、大戟、吴茱萸、白芥子（各二钱）。
取河水两大碗，放入上述五味药，煎煮至浓汁一碗，去渣，然后放入大枣五十枚，煮烂，待水分收干。每早晨吃五枚大枣。
渊按：这是五饮之一，属于实证。用药得当，效果如神。
赵姓患者：寒气深入肺底，咳嗽气喘并呕吐，水饮停聚在心下。腰胁痛且月经停止，肝肾已经虚弱。拟定开宣上焦、温运中焦、滋补下焦的方法。
处方：麻黄、细辛、淡干姜、五味子、茯苓、陈皮、杏仁、炙甘草、大熟地黄（海浮石拌）、半夏、沉香、枇杷叶。
又诊：痰饮咳嗽呕吐清水，导致停经发热，带下淋漓不尽，营阴亏虚且肝肾亏损。胃脘胀满，大便偶尔通畅则胀感减轻，仍然是饮邪的表现。痰饮宜温宜化，而阴虚宜补宜清。所担忧的是热久停经，恐怕形成干血劳损。
处方：半夏、陈皮、茯苓（细辛拌炒）、生地黄（姜汁炒）、干姜（与五味子同炒）、沙苑子、白芍、当归、川芎、款冬花。
渊按：停经发热，未必就是虚证；只有带下过多，才是营液虚损。胃胀大便通则松，这是肺脾气分不化的表现。
尤姓患者：痰饮咳嗽，早晨必定呕吐清水。本打算用温药来化解，但时值酷暑，兼有手臂疼痛，暂且采用调和胃气、化痰的方法。
处方：半夏、陈皮、茯苓、款冬花、苏子、杏仁、莱菔子、白芥子。
指迷茯苓丸，每早晨服用三钱，开水送服。
许姓患者：寒咳入冬发作，兼有颈项强直不适。
处方：大熟地黄（二两，用麻黄二钱煎汁浸泡一夜，炒松）、川贝母（一两）、党参（一两，元米炒）、陈皮（一两）、茯苓（一两，细辛二钱煎汁浸泡一夜，晒烘）、款冬花（一两）、制首乌（一两）、薏苡仁（一两）、五味子（五钱，干姜二钱同炒）、杏仁霜（六钱）、当归身（一两，酒炒）、胡桃肉（一两）。
以上药物共研为细末，炼蜜为丸，每早晨服用三钱，开水送服。
王姓患者：脉弦迟，脐以上连及胃脘胀痛，这是有寒饮。《脉经》说：迟脉主寒。张仲景说：口不渴而脉双弦的，是饮邪。
处方：香砂六君子汤去掉甘草，加入炮姜、神曲、干姜。
又诊：肚脐周围腹痛，痛时气塞胸中，打嗝不能说话，脉弦大而迟。这是胃中阳气不足，而有寒饮。应当用温药通阳。
照前方去掉神曲，加入香附、川熟附子。
吕姓患者：阴虚夹杂痰饮致病。痰饮内留，所以咳嗽背寒，心胸受凉则痛。阴虚，所以内有热象。用金水六君煎加减治疗。
处方：大熟地黄、半夏、陈皮、沉香、蛤壳、款冬花、苏子、杏仁、沙参、茯苓。
顾姓患者：头晕心悸，脉沉弦的，是饮邪。发病时呕吐酸水，背部满闷气攻作痛，打嗝后痛感减轻，这是浊阴之气上攻阳位。应当用温药调和。
处方：熟附子、桂木、半夏、陈皮、冬术、川椒、茯苓、沉香。
强姓患者：中气不足，湿气化为痰，气逆不降，喘息不安，夜间重于白天。脉象弦滑，滑脉主痰饮，痰饮属阴，所以病势夜间加重。拟定降气化痰，兼扶中气。
处方：半夏、苏子、陈皮、茯苓、前胡、旋复花、神曲、竹茹、雪羹（荸荠和海蜇）、枇杷叶。
盖姓患者：邪气聚集的地方，正气必然虚弱，留滞不去，病势就转为实证。留饮长久占据不去，也是由于中气虚弱。朱丹溪说：补完胃气后再攻下才恰当。现在建议先补中气的方法。
处方：六君子汤去掉甘草，加入干姜。
又诊：照前方用甘遂七分。
又诊：照前方用甘遂一钱。
虽然大便仍未泻下，但腹中已觉非常舒适，即停药。休息三天。
某患者：春脉应当弦而反微，这是肝虚。肝虚则魂不藏，夜晚不能入睡，白天应当清醒反而嗜睡，这是胃虚。胃为两阳合明之腑，胃虚则阳气失明，所以白天反而嗜睡。补肝之虚以藏魂，益胃之虚以补气。
处方：生熟枣仁、茯神、新会白（陈皮）、党参、半夏、生熟谷芽、秫米、白芍、炙甘草。
渊按：这样的方案在古人那里也不可多得。
某患者：水饮去除后，中气大虚，胃液枯涸，难以着力了。中气大亏，非建中汤不可，而胃阴枯涸，非养胃阴又不可，那么黄芪建中汤只补中气而不能养其胃阴，仍不是最好的计策。现在拟定十全大补汤阴阳气血双调，加入麦冬、半夏、肉苁蓉、附子，即十四味建中法，并建立脾中肾中的阴阳，或许会有帮助！
处方：人参须、黄芪、大熟地黄（附子三分煎汁炒）、川芎、茯苓、半夏、白芍（肉桂一分煎汁炒）、肉苁蓉、炙甘草、麦冬、冬术（土炒）、当归身、金橘饼。
又诊：肝虚无直接补益的方法，补肾就是补肝；中虚有兼补的方子，补火更能生土。前面投用十四味建中汤，两建脾中肾中的阴阳。证候既然大虚，药物宜加峻猛。虚证能受补，便是生机。
处方：人参须、党参、黄芪、炙甘草、大熟地黄（附子一分拌炒）、肉桂、麦冬、当归身、冬术、枸杞子、半夏、茯苓、枣仁、山萸肉（酒炒）、肉苁蓉。
单姓患者：痰饮长久停留，咳嗽气喘不止。痰多粘腻，脾肾两亏。脾虚则痰不化而食欲减退，肾虚则阳气衰而水泛，以致腹部胀满足肿面部浮肿，病成溢饮。《金匮要略》说：患溢饮病的人，应当发汗，小青龙汤主治。然而脉细阳衰，大便难津液枯竭，肾气久虚，怎能再投用发泄耗阴伤阳的药剂！拟进附子都气丸，裁去熟地黄，因为其痰多痞塞。
处方：淡苁蓉、枸杞子（青盐炒）、茯苓、泽泻、半夏、五味子、制附子、牛膝炭、胡桃肉。
孙姓患者：风邪长久留恋肺中，寒饮停留胃脘。风能化热，咳嗽久了损伤阴液。积饮生痰，胃阳失于布散。肺之子脏是肾，胃之妻脏是脾。肺伤肾亦亏，胃虚脾亦弱。脾弱故大便泄泻，肾亏故左尺脉弦而大。咳嗽将近一年，虽然曾吐血，但时常呕吐清水，这无疑是寒饮。现在从饮门例治疗。
处方：大熟地黄（海浮石拌）、麦冬（元米炒）、生薏苡仁、五味子、陈皮、焦六曲、茯苓、半夏、干姜、紫石英、细辛、沉香。
吴姓患者：喘咳多年，近来加重呛咳，形体消瘦肌肉萎缩，真阴大亏。虽有痰浊，治法应当补益纳气。
处方：大熟地黄、党参、半夏、陈皮、牛膝、款冬花、麦冬、茯苓、紫石英、五味子、胡桃肉。
许姓患者：痰饮流落心中，心痛彻背，大便干燥，饮食吞咽梗阻。肠胃液枯，治法当温润。
处方：淡苁蓉、麦冬、茯苓、桂木、薤白头、枸杞子、半夏、陈皮、瓜蒌霜、白蔻仁。
渊按：积饮久而伤胃，将成噎膈。桂枝、瓜蒌、薤白治疗痰饮，也可以治疗噎膈。因为这两个证候都是上中焦阳微不化所致。
范姓患者：寒痰留在胃里，则胃脘痛而吐清水；进入肺里，则咳嗽而多白沫。宜仿效小青龙法，辛温开达上焦。
处方：淡干姜、茯苓、白芍、细辛、橘红、桂枝、半夏、五味子、款冬花、杏仁。
顾姓患者：嗜好饮酒多湿，湿蕴生痰。体质阴虚，烦劳伤气。去年冬天咳嗽，痰微带血，行动气升，至今不愈。
诊脉虚小，恐加重喘急。现用金水六君煎加味。
处方：大熟地黄、半夏、陈皮、茯苓、款冬花、杏仁、蛤壳、五味子、麦冬、胡桃肉。
另：金水六君丸，每早晨服用三钱，淡盐花汤送服。
金姓患者：痰饮停聚胸中，清阳失于宣旷，咳嗽眩晕心悸，与苓桂术甘汤加味。
处方：茯苓、桂枝、白术、炙甘草、紫石英、五味子、陈皮、半夏、蛤壳、胡桃肉。
方姓患者：向来有心痛呕吐的病，得食则安，明显是中虚而有痰饮伏留于心下。上年春季，头痛寒热，从此咳嗽喉有痰声。当时若遇到高明医生，用小青龙汤发汗散水，表邪与痰饮悉解，何至于缠绵不愈耶！等到酷暑时节，邪气郁而化热，咳嗽带臭味，肺气受伤。交白露节气，秋金得令，肺气清肃而后逐渐痊愈。到了冬季阳气少藏，咳嗽复发。交春入夏，咳嗽频繁不已，病程延长一年多。诊脉双弦，形体肌肉瘦削，口不干渴，身不发热，头晕心悸，肝肾之阴已虚，脾胃之气亦弱，痰饮恋滞未化，自浅入深了。昔贤说外饮治脾肺，内饮治肾。现在自外至于内，从肺脾肾三经立法，前后呼应，希望各得其所。
处方：款冬花、苏子、杏仁、川贝母、茯苓、陈皮、半夏、干姜（五味子五粒同炒）、大熟地黄（海浮石拌炒）、炙甘草、牛膝（盐水炒）、蛤壳、马兜铃、姜汁、胡桃肉、枇杷叶。
渊按：外饮治肺脾，非杏仁、贝母等清润之药可治，应当求之于《金匮要略》。想病情已棘手，方药错杂，有不得不如此的原因。
费姓患者：痰饮伏于胸中，咳嗽喘促。其标在肺，其本在肾。此症本虚未甚，标实有痰，治法应当两顾。
处方：大熟地黄、茯苓、蛤壳、川贝母、牛膝、半夏、陈皮、杏仁、桑白皮、枇杷叶。
郝姓患者：张仲景说：风舍于肺，其人则咳。又说：胸中有留饮，背寒冷如掌大。此症正是如此。
处方：麻黄、桑白皮、象贝母、橘红、黄芩（姜汁炒）、杏仁、半夏、生甘草、茯苓、款冬花。
胡姓患者：痰饮咳嗽，饱则安，饥则甚，乃胃虚也。
处方：黄芪、炙甘草、冬术、陈皮、白芍、玉竹、茯苓、杏仁、桔梗。
李姓患者：胃有寒侵，肺有寒侵，两寒相得饮邪停，咳而喘呕为痰饮。气亦宜平，痰亦宜平，病痰饮者药宜温，仲师方法细详审。
处方：二陈汤加老桂木、吴茱萸、川椒、薏苡仁、生姜。
罗姓患者：干咳阴虚痰火盛，丹溪方法主生津。此由脘痛兼痰饮，烟体须当温化遵。
处方：肉苁蓉（养阴温润，咸能下降）、枸杞子（甘温益血）、制半夏（燥湿痰）、茯苓。
Patient Wu: Water-fluid retention in the Zhongwan (CV12) region causes borborygmus in the epigastrium and abdomen, with qi attacking and causing pain. Stool is hard and compact like chestnuts; only belching is possible, not flatus. This indicates loss of downward flow of Stomach Qi, with Qi reversing upward only. Treatment should harmonize the Stomach, direct rebellious Qi downward, expel water, and eliminate fluid retention.
Prescription: Banxia (Pinelliae Rhizoma), Dan Jiangjiang (Dried Ginger), Chenpi (Citri Reticulatae Pericarpium), Fuling (Poria), Zexie (Alismatis Rhizoma), Baishao (Paeoniae Radix Alba), Xuanfuhua (Inulae Flos), Daizheshi (Ochrae), Gansui (Kansui Radix, processed with flour), Chuanjiao (Zanthoxyli Pericarpium), Jiao Liuqu (Fritillariae Bulbus).
Patient Pan: Anal fistula indicates prior damage to Yin-Jing (Yin fluids) below. Combined with a preference for alcohol, damp-heat is abundant in the middle jiao. Subsequently, due to overwork and cold invasion, cold enters the Lung meridian, combining with phlegm-dampness previously abundant in the chest, resulting in cough and vomiting clear fluid, forming pathology of phlegm-fluid retention. Drinking liquor to dispel cold at this stage would likely cause bleeding. Moreover, internal heat and rapid pulse indicate depleted Yin-Jing. To eliminate phlegm-fluid, warming herbs might injure Yin; to clear internal heat, cooling herbs might worsen cough. The approach should be to harmonize the Stomach and direct Qi downward.
Prescription: Sheng Yiren (Coicis Semen), Ziwan (Asteris Radix), Bai Biandou (Phaseoli Semen Album), Fuling (Poria), Kuandonghua (Farfarae Flos), Chuan Beimu (Fritillariae Cirrhosae Bulbus), Yujin (Curcumae Radix), Xingren (Armeniacae Semen Amarum), Geqiao (Tridacnis Testudinis Concha), Shida Gonglao (Mahoniae Caulis).
Re-examination: For Yin deficiency with phlegm-fluid, neither warming nor clearing is suitable during summer. The tongue coating is sticky; treatment should harmonize the middle and transform phlegm, while also grasping Kidney Qi.
Prescription: Erchen Tang (Two-Aged Decoction) plus Xingren (Armeniacae Semen Amarum). Shenqi Wan (Kidney Qi Pill) 1 qian, Duqi Wan (Nine-Ingredient Pill) 2 qian, mixed and taken with boiled water.
Note by Yuan: Why can't warming herbs be used in summer? It is just that seeing hematemesis with phlegm-fluid leads one to assume Yin deficiency and fear using warming herbs. Actually, the blood comes from liquor damaging the Stomach collaterals, not true Yin deficiency.
Re-examination: Cough and vomiting clear fluid are signs of phlegm-fluid disease. Fine and rapid pulse with internal heat indicates Yin deficiency. Treating phlegm-fluid requires warming; treating Yin deficiency requires nourishing. These methods seem contradictory. Since Liver and Kidney are mother and child, tonifying the mother (Liver) benefits the child (Kidney); since Spleen/Stomach Earth is the mother of Lung Metal, harmonizing the Stomach transforms phlegm. The plan is to moisten and dry simultaneously, following Li Dongyuan's method without obstruction.
Prescription: Da Shudi (Rehmanniae Radix Preparata), Dongzhu (Atractylodis Macrocephalae Rhizoma), Ejiao (Colla Corii Asini), Wuweizi (Schisandrae Fructus), Dan Jiangjiang (Dried Ginger), Zexie (Alismatis Rhizoma), Fuling (Poria), Banxia (Pinelliae Rhizoma), Shenqi Wan (Kidney Qi Pill).
Patient [Surname Unknown]: Phlegm-fluid cough with Spleen and Stomach dual deficiency. Ke Qin said: Spleen and Kidney are the source of phlegm production; Lung and Stomach are the containers of phlegm. Recently increased shortness of breath, inability to lie on the right side; lying on the right exacerbates cough, indicating Lung injury. Chronic anal fistula with recent hematochezia indicates Spleen and Kidney deficiency. Fortunately, appetite remains acceptable. Proposal: Treat Lung, Spleen, and Kidney together. However, near sixty years old, nurturing is crucial, otherwise fearing progression to consumptive disease.
Prescription: Shudi (Rehmanniae Radix Preparata, fried with Amomi Semen powder), Banxia (Pinelliae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Wuweizi (Schisandrae Fructus), Chuan Beimu (Fritillariae Cirrhosae Bulbus), Ejiao (Colla Corii Asini, fried with Polygonati Rhizoma powder), Pao Jiangtan (Charred Dried Ginger), Dongzhu (Atractylodis Macrocephalae Rhizoma), Guishen Tan (Charred Angelicae Sinensis Radix), Kuandonghua (Farfarae Flos).
This is Jinshui Liujun Jian (Six Gentlemen Decoction for Metal and Water) combined with Hei Di Huang Wan (Black Earth Pill), adding Ejiao, Kuandonghua, and Chuan Beimu to tonify Metal (Lung), Water (Kidney), and Earth (Spleen) deficiencies. Upper transformation of phlegm, lower hemostasis. Although Paoyan (Charred Ginger) is warm and drying, Wumeizi (Schisandrae Fructus) restrains it.
Patient Zhou: Irregular eating and overwork damage Stomach Qi; cold-phlegm condenses, Qi and Blood stagnate, obstructing Stomach collaterals, causing epigastric distension/pain and vomiting of sticky phlegm daily. Without caution, bloating may develop.
Prescription: Yigong San (Extraordinary Merit Powder) minus Gancao (Glycyrrhizae Radix), plus Paoyan (Charred Dried Ginger), Shu Fuzi (Prepared Aconiti Lateralis Radix), Liangjiang (Galangalis Rhizoma), Kourén (Amomi Fructus Rotundus).
Re-examination: Warm Stomach and transform phlegm, modified from Lizhong Tang, Erchen Tang, and Pingwei San.
Prescription: Liujunzi Tang (Six Gentlemen Decoction) combined with Fuzi Lizhong Tang (Aconite Lizhong Decoction), plus Houpo (Magnoliae Officinalis Cortex).
Re-examination: Cold accumulation in the middle jiao, Stomach Yang fails to distribute, phlegm-fluid occupies the space. Manifests as distension, pain, vomiting, hiccups. Method: Warm and move Middle Yang. Long-standing root requires patience with medication.
Prescription: Liujunzi Tang combined with Fuzi Lizhong Tang minus Gancao, plus Chuanjiao (Zanthoxyli Pericarpium), Baikourén (Amomi Fructus Rotundus).
Re-examination: Middle deficiency requires tonification to move; cold-fluid requires warming to resolve. Benefit Fire to generate Earth, unblock Yang to eliminate fluid. Main formula: Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, Licorice Decoction). Fuzi Lizhong Tang is also applicable.
Prescription: Linggui Zhugan Tang combined with Fuzi Lizhong Tang minus Gancao, plus Banxia, Chenpi, Kourén.
Re-examination: Diseases have regular patterns; formulas have fixed methods. Medication is effective; no need to change. Poem: "Do not mind if the destination is far, but keep whipping the horse until you arrive."
Prescription: Fuzi Lizhong Tang combined with Erchen Tang, plus Laoshengjiang (Old Fresh Ginger), Laoguimu (Old Cinnamomi Ramulus).
Note by Yuan: Elegant and romantic style proves deep reading cultivation.
Patient Xu: Phlegm-fluid latent in the chest; cold triggers cough and wheezing, heartburn, chest oppression, dizziness, and lower back pain. Over fifty, Tian Gui (menstruation/reproductive essence) should cease but hasn't, indicating Qi deficiency failing to control blood. Qi belongs to Yang; as Yang Qi declines daily, phlegm-fluid increases daily. Method: Unblock Yang Qi to dispel cold from water-fluid. Zhang Zhongjing said: "For phlegm-fluid disease, use warming herbs to harmonize."
Prescription: Erchen Tang combined with Linggui Zhugan Tang, plus Kuandonghua, Xingren, Geqiao, Chenxiang (Aquilariae Lignum Resinatum). Morning: Duqi Wan 2 qian, Shenqi Wan 1 qian, with boiled water.
Patient Qin: Phlegm-fluid cough/wheezing, epigastric fullness, occasional mild pain. Though Lung, Stomach, and Kidney meridians are involved, focus treatment on the Spleen. When Spleen moves, Qi transforms, and phlegm-fluid has a chance to move/resolve.
Prescription: Banxia, Chenpi, Zexie, Fuling, Xingren, Chuanpu (Magnoliae Officinalis Cortex), Buguzhi (Psoraleae Fructus), Ganjiang (Dried Ginger, ground with Wuweizi), Hutaorou (Juglandis Semen).
Note by Yuan: Mild phlegm-fluid treats Lung/Spleen; severe treats Kidney. These formulas are orthodox treatments for fluid retention.
Re-examination: Phlegm-fluid stops at Xin Xia (below heart), causing upper wheezing/cough and lower epigastric distension. Often due to failure of Clear Yang to spread and turbid phlegm blocking internally. Transform Chest Yang to calm Lung; move Spleen Yang to harmonize Stomach; cough/distension will relieve.
Prescription: Gualoupi (Trichosanthis Pericarpium), Fuling, Chenpi, Xiebaitou (Allii Macrostemonis Bulbus), Chuanpu, Banxia (fried with Ginger juice), Ganjiang, Zexie, Zhishi (Immature Bitter Orange Fruit, bran-fried).
Patient Hu: Phlegm-fluid lingers in Lung/Stomach long-term, causing cough, wheeze, or distension. All are pathologies of Phlegm-Qi. To transform Stomach phlegm, use Fuling/Banxia; to transform Lung phlegm, use Juhong/Beimu. Expand from this to formulate.
Prescription: Fuling, Juhong (Citri Reticulatae Pericarpium Rubrum), Guizhi (Cinnamomi Ramulus), Ziwan, Baizhu (Atractylodis Macrocephalae Rhizoma), Banxia, Chuan Beimu, Zhigancao (Honey-fried Glycyrrhizae Radix), Xingren, Geqiao.
Patient Gu: Etiology shows phlegm-fluid lingering long-term, injuring Lung, Spleen, and Kidney. Lower Kidney deficiency fails to grasp Qi; Middle Spleen deficiency fails to move Qi; Upper Lung injury fails to descend Qi. Thus cough/wheeze preventing lying down, limb edema, abdominal distension, fatigue—severe deficiency. Treating Upper is useless; treat Middle/Lower.
Prescription: Da Shudi (fried with Haifushi/Pumice), Wuweizi (fried), Buguzhi (salt-water fried), Niuxi (Achyranthis Bidentatae Radix, salt-water fried), Geqiao (crushed), Shayuanzi (Astragali Complanati Semen, salt-water fried), Zhiwushuang (Fluoritum), Huaishanyao (Dioscoreae Rhizoma, fried), Maidong (Ophiopogonis Radix, fried with Coix seed), Fuling.
Heixi Dan (Black Tin Pill), 3 qian every morning, with light salt soup.
Note by Yuan: Treating Lower is correct, but Wumeizi needs Ganjiang/Shudi, Niuxi needs Rougui to grasp Lung/Kidney Qi. Reliance on Heixi Dan ensures efficacy.
Patient Qin: Xuan Yin (Suspension Fluid) occupying hypochondrium, pain, vomiting clear fluid. Use Zhang Zhongjing's method.
Prescription: Yuanhua (Genkwa Flos), Gansui, Daji (Euphorbiae Pekinensis Radix), Wuzhuyu (Evodiae Fructus), Baijiezi (Sinapis Semen) — 2 qian each.
Boil five herbs in two bowls of river water to one bowl of thick decoction, strain, then add 50 Red Dates (Jujubae Fructus), boil until soft/dry. Eat 5 dates every morning.
Note by Yuan: One of the Five Fluids, excess syndrome. If used correctly, effect is miraculous.
Patient Zhao: Cold penetrates Lung base, cough/wheeze/vomit, water-fluid stops at Xin Xia. Waist/hypochondrium pain, amenorrhea, Liver/Kidney deficient. Plan: Open Upper, Warm Middle, Tonify Lower.
Prescription: Mahuang (Ephedrae Herba), Xixin (Asari Radix et Rhizoma), Dan Jiangjiang, Wuweizi, Fuling, Chenpi, Xingren, Zhigancao, Da Shudi (with Haifushi), Banxia, Chenxiang, Pipaye (Loquat Leaf).
Re-examination: Phlegm-fluid cough/vomit clear fluid causing amenorrhea/fever, profuse leukorrhea, Ying-Yin deficiency and Liver/Kidney depletion. Epigastric distension relieved slightly by bowel movement, still fluid pathology. Phlegm-fluid needs warming/transforming; Yin deficiency needs tonifying/clearing. Fear prolonged heat/amenorrhea leading to Dry Blood Consumptive Disease.
Prescription: Banxia, Chenpi, Fuling (fried with Xixin), Shengdi (Rehmanniae Radix, fried with Ginger juice), Ganjiang (fried with Wuweizi), Shayuanzi, Baishao, Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Kuandonghua.
Note by Yuan: Amenorrhea/fever isn't necessarily deficiency; only profuse leukorrhea indicates Ying fluid deficiency. Distension relieved by stool indicates Lung/Spleen Qi-Bu transformation failure.
Patient You: Phlegm-fluid cough, vomiting clear fluid every morning. Originally planned warming herbs, but it is peak summer with arm pain; temporarily harmonize Stomach and transform phlegm.
Prescription: Banxia, Chenpi, Fuling, Kuandonghua, Suzi (Perillae Fructus), Xingren, Laifuzi (Raphani Semen), Baijiezi.
Zhimi Fuling Wan (Pointing-to-Miracle Poria Pill), 3 qian every morning, with boiled water.
Patient Xu: Cold cough starts in winter, with neck stiffness/discomfort.
Prescription: Da Shudi (2 liang, soaked overnight in Mahuang decoction, fried loose), Chuan Bei (1 liang), Dangshen (Codonopsis Radix, 1 liang, fried with Coix seed), Chenpi (1 liang), Fuling (1 liang, soaked overnight in Xixin decoction, sun-dried), Kuandonghua (1 liang), Zhi Shouwu (Polygoni Multiflori Preparata, 1 liang), Yiren (1 liang), Wuweizi (5 qian, fried with Ganjiang), Xingren Shuang (6 qian), Guishen (1 liang, wine-fried), Hutaorou (1 liang).
Grind to fine powder, honey pills, 3 qian every morning, with boiled water.
Patient Wang: Pulse string-tight and slow, pain/distension from umbilicus to epigastrium, indicates cold-fluid. *Mai Jing* says: Slow pulse indicates cold. Zhang Zhongjing says: Thirstless with double-string pulse indicates fluid.
Prescription: Xiangsha Liujun Tang minus Gancao, plus Paoyan, Shenqu (Medicated Leaven), Ganjiang.
Re-examination: Periumbilical pain, Qi blockage in chest when painful, belching prevents speech, pulse string-tight-large-slow. Stomach Yang insufficient with cold-fluid. Use warming herbs to unblock.
Same prescription minus Shenqu, plus Xiangfu (Cyperi Rhizoma), Chuan Shufu (Prepared Aconiti Lateralis Radix).
Patient Lv: Yin deficiency complicated by phlegm-fluid. Phlegm-fluid retained causes cough/back chills, chest pain when cold. Yin deficiency causes internal heat. Treat with modified Jinshui Liujun Jian.
Prescription: Da Shudi, Banxia, Chenpi, Chenxiang, Geqiao, Kuandonghua, Suzi, Xingren, Shashen (Glehniae Radix), Fuling.
Patient Gu: Dizziness, palpitations, pulse deep-string-tight indicates fluid. Onset involves vomiting sour fluid, back fullness/Qi attack pain, relieved by belching. Turbid Yin attacks Yang position. Use warming herbs to harmonize.
Prescription: Shu Fuzi, Guimu (Cinnamomi Ramulus), Banxia, Chenpi, Dongzhu, Chuanjiao, Fuling, Chenxiang.
Patient Qiang: Middle Qi insufficient, dampness transforms to phlegm, Qi rebels not descending, panting uneasy, worse at night. Pulse string-slippery; slippery indicates phlegm-fluid. Phlegm-fluid is Yin, hence worse at night. Plan: Descend Qi, transform phlegm, support Middle Qi.
Prescription: Banxia, Suzi, Chenpi, Fuling, Qianhu (Peucedani Radix), Xuanfuhua, Shenqu, Zhuru (Bambusae Caulis in Taenia), Xue Geng (Dioscoreae Hypoglaucae Rhizoma and Metasequoia Wood), Pipaye.
Patient Gai: Where evil gathers, Qi must be deficient; lingering makes it excess. Retained fluid lingers due to Middle Qi deficiency. Zhu Danxi said: Tonify Stomach Qi fully before purging. Proposal: First tonify Middle Qi.
Prescription: Liujunzi Tang minus Gancao, plus Ganjiang.
Re-examination: Gansui Banxia Tang, use Gansui 5 fen.
Re-examination: Same prescription, use Gansui 7 fen.
Re-examination: Same prescription, use Gansui 1 qian.
Although stool not yet discharged, abdomen feels very comfortable, stop medicine. Rest three days.
Patient [Surname Unknown]: Spring pulse should be string-like but is faint, indicating Liver deficiency. Liver deficiency fails to store Hun (Ethereal Soul), insomnia at night; daytime sleepiness indicates Stomach deficiency. Stomach is the Fu organ of Two Yangs combined brightness; Stomach deficiency dims Yang Qi, hence daytime sleepiness. Tonify Liver to store Hun; benefit Stomach to tonify Qi.
Prescription: Sheng Shu Zaoren (Ziziphi Spinosae Semen), Fushen (Poria with Hostwood), Xinhui Bai (Chenpi), Dangshen, Banxia, Sheng Shu Guya (Hordei Fructus Germinatus), Shumi (Milii Germen), Baishao, Zhigancao.
Note by Yuan: Such prescriptions are rare even among ancients.
Patient [Surname Unknown]: After fluid removal, Middle Qi severely deficient, Stomach fluid dried up, difficult to act. Severe Middle Qi deficiency requires Jiānzhōng (Establish the Center); dried Stomach Yin requires nourishing Stomach Yin. Huangqi Jiānzhōng Tang only tonifies Middle Qi, failing to nourish Stomach Yin, thus not optimal. Now propose Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) to balance Yin/Yang/Qi/Blood, adding Maidong, Banxia, Rongrongsu (Cistanche), Fuzi. This is Shisiwei Jiānzhōng Fa (Fourteen-Ingredient Establish Center Method), establishing Yin/Yang in Spleen/Kidney. Perhaps beneficial!
Prescription: Renshen Xu (Ginseng Radix Filament), Huangqi (Astragali Radix), Da Shudi (fried with Fuzi decoction), Chuanxiong, Fuling, Banxia, Baishao (fried with Rougui decoction), Rongrong (Cistanches Herba), Zhigancao, Maidong, Dongzhu (earth-fried), Guishen, Jinju Bing (Citrus reticulata peel candy).
Re-examination: Liver deficiency has no direct tonification method; tonifying Kidney is tonifying Liver. Middle deficiency has combined tonification formulas; tonifying Fire generates Earth. Previous Shisiwei Jiānzhōng established Spleen/Kidney Yin/Yang. Syndrome severely deficient, drugs should be potent. Deficiency accepting tonification is vitality.
Prescription: Renshen Xu, Dangshen, Huangqi, Zhigancao, Da Shudi (fried with Fuzi), Rougui (Cinnamomi Cortex), Maidong, Guishen, Dongzhu, Gouqi (Lycii Fructus), Banxia, Fuling, Zaoren (Ziziphi Spinosae Semen), Shanzhuyu (Corni Fructus, wine-fried), Rongrong.
Patient Shan: Phlegm-fluid lingers long-term, persistent cough/wheeze. Phlegm sticky, Spleen/Kidney dual deficiency. Spleen deficiency fails to transform phlegm/reduces appetite; Kidney deficiency Yang declines/water floods, causing abdominal distension/foot swelling/facial edema, becoming Yi Yin (Overflowing Fluid). *Jinkui* says: Yi Yin requires sweating, Xiao Qinglong Tang main. But pulse fine/Yang declining, constipation/fluid dried, Kidney Qi long deficient, cannot bear dispersing/depleting Yin/Yang agents. Plan: Fuzi Duqi Wan, remove Shudi due to phlegm blockage.
Prescription: Dan Rongrong, Gouqi (green salt-fried), Fuling, Zexie, Banxia, Wuweizi, Zhi Fuzi, Niuxi Tan (Charred Achyranthes), Hutaorou.
Patient Sun: Wind evil lingers in Lung, cold-fluid stays in Stomach. Wind transforms to heat, chronic cough injures Yin. Accumulated fluid generates phlegm, Stomach Yang fails to distribute. Lung's child is Kidney; Stomach's wife is Spleen. Lung injured, Kidney deficient; Stomach weak, Spleen weak. Spleen weak causes diarrhea; Kidney deficient causes left Chi pulse string-tight-large. Cough nearly one year, though hemoptysis occurred, frequent vomiting clear fluid confirms cold-fluid. Treat according to Fluid chapter example.
Prescription: Da Shudi (with Haifushi), Maidong (fried with Coix seed), Sheng Yiren, Wuweizi, Chenpi, Jiao Liuqu, Fuling, Banxia, Ganjiang, Zhiwushuang, Xixin, Chenxiang.
Patient Wu: Years of wheezing/cough, recently added choking cough, emaciation, True Yin severely depleted. Though phlegm-turbidity exists, method should be tonify/grasp.
Prescription: Da Shudi, Dangshen, Banxia, Chenpi, Niuxi, Kuandonghua, Maidong, Fuling, Zhiwushuang, Wuweizi, Hutaorou.
Patient Xu: Phlegm-fluid flows into Heart, heartache penetrating back, dry stool, dysphagia. Intestinal/Stomach fluid dried, method should be moistening/warming.
Prescription: Dan Rongrong, Maidong, Fuling, Guimu, Xiebaitou, Gouqi, Banxia, Chenpi, Gualou Shuang (Trichosanthis Fructus Powder), Baikourén.
Note by Yuan: Long-standing fluid damages Stomach, approaching Ye Ge (Dysphagia). Guizhi, Gualou, Xiebai treat phlegm-fluid and Ye Ge. Both syndromes caused by Upper/Middle Jiao Yang micro-transformation failure.
Patient Fan: Cold-phlegm in Stomach causes epigastric pain/clear vomit; entering Lung causes cough/white foam. Imitate Xiao Qinglong method, acrid-warm open Upper Jiao.
Prescription: Dan Jiangjiang, Fuling, Baishao, Xixin, Juhong, Guizhi, Banxia, Wuweizi, Kuandonghua, Xingren.
Patient Gu: Alcohol preference creates dampness, dampness generates phlegm. Constitution Yin deficient, mental labor injures Qi. Last winter cough, sputum slightly bloody, exertion raises Qi, unresolved. Pulse void-small, fear worsening wheezing. Use Jinshui Liujun Jian plus modifications.
Prescription: Da Shudi, Banxia, Chenpi, Fuling, Kuandonghua, Xingren, Geqiao, Wuweizi, Maidong, Hutaorou.
Separately: Jinshui Liujun Wan, 3 qian every morning, with light salt flower soup.
Patient Jin: Phlegm-fluid stops in Chest, Clear Yang fails to spread, cough/dizziness/palpitations. With Linggui Zhugan Tang plus modifications.
Prescription: Fuling, Guizhi, Baizhu, Zhigancao, Zhiwushuang, Wuweizi, Chenpi, Banxia, Geqiao, Hutaorou.
Patient Fang: History of heartache/vomit, relieved by eating, clearly Middle deficiency with phlegm-fluid latent at Xin Xia. Last spring, headache/chills/fever, then cough/phlegm sound in throat. If treated then with Xiao Qinglong to sweat/disperse water, exterior evil and fluid would resolve, why linger? Summer heat, evil郁transforms to heat, cough foul-smelling, Lung Qi injured. White Dew solar term, Autumn Metal commands, Lung Qi clears gradually recovers. Winter Yang hides less, cough returns. Spring/Summer, frequent cough, duration over one year. Pulse double-string, emaciated, no thirst, no fever, dizziness/palpitations, Liver/Kidney Yin deficient, Spleen/Stomach Qi weak, phlegm-fluid lingers/unresolved, shallow to deep. Ancients said: External fluid treats Spleen/Lung; Internal fluid treats Kidney. Now from external to internal, legis from Lung/Spleen/Kidney meridians, front-back coordination, hoping each gets its place.
Prescription: Kuandonghua, Suzi, Xingren, Chuan Beimu, Fuling, Chenpi, Banxia, Ganjiang (fried with Wuweizi), Da Shudi (fried with Haifushi), Zhigancao, Niuxi (salt-water fried), Geqiao, Madoulou (Aristolochiae Radix), Jiangzhi (Ginger Juice), Hutaorou, Pipaye.
Note by Yuan: External fluid treats Lung/Spleen, not by Xingren/Beimu moistening herbs, seek *Jinkui*. Condition棘手 (thorny), formulas mixed, unavoidable.
Patient Fei: Phlegm-fluid latent in Chest, cough/wheezing. Branch in Lung, Root in Kidney. Syndrome root deficiency not severe, branch excess phlegm, method should address both.
Prescription: Da Shudi, Fuling, Geqiao, Chuan Beimu, Niuxi, Banxia, Chenpi, Xingren, Sangbaipi (Mori Cortex), Pipaye.
Patient Hao: Zhang Zhongjing said: Wind lodged in Lung, person coughs. Also: Retained fluid in Chest, back cold palm-sized. This syndrome matches.
Prescription: Mahuang, Sangbaipi, Xiangbei (Fritillariae Thunbergii Bulbus), Juhong, Huangqin (Scutellariae Radix, ginger-fried), Xingren, Banxia, Sheng Gancao, Fuling, Kuandonghua.
Patient Hu: Phlegm-fluid cough, relief after eating, worse on empty stomach, indicates Stomach deficiency.
Prescription: Huangqi, Zhigancao, Dongzhu, Chenpi, Baishao, Yuzhu (Polygonati Odorati Rhizoma), Fuling, Xingren, Jiegeng (Platycodonis Radix).
Patient Li: Stomach invaded by cold, Lung invaded by cold, two colds combine, fluid retention stops, cough/wheeze/vomit become phlegm-fluid. Qi should be level, phlegm should be level, phlegm-fluid disease drugs should be warm, Master Zhong's methods detailed.
Prescription: Erchen Tang plus Lao Guimu (Old Cinnamon Twig), Wuzhuyu, Chuanjiao, Yiren, Shengjiang (Fresh Ginger).
Patient Luo: Dry cough, Yin deficiency, phlegm-fire abundant, Danxi method focuses on generating fluids. Here epigastric pain with phlegm-fluid, smoking constitution must follow warming transformation.
Prescription: Rongrong (Cistanche, nourishes Yin/moistens/warms, salty descends), Gouqi (Lycium, sweet-warm benefits blood), Zhi Banxia (Pinellia, dries damp-phlegm), Fuling.