王 血虚肝风上逆，痰涎走络。头眩心跳，干咳痰少，右肩臂不能举，足热无力。养阴以熄风阳，化痰以调脾胃。
党参（元米炒） 生地（海浮石同拌） 半夏 决明 沙苑（盐水炒） 茯神
枣仁 蛤壳 茯苓 陈皮 嫩钩 竹二青
又 治风先治血，血行风自灭。治痰先化气，气化痰自失。
生地 茯神 嫩钩 陈皮 沙苑 决明 蛤壳 枣仁 竹茹
张 头痛巅疾，下虚上实，过在足少阳、厥阴，甚则入肾，
蒙昭尤。此段经衣冠文物指肝胆风阳上盛，久痛不已，必伤少阴肾
阴。肾阴一衰，故目KT KT 无所见，而腰痛复起也。前方清镇无效，今以育阴、潜阳、镇逆法。
生地 龟板 杜仲（盐水炒） 牡蛎 茯神 枣仁 磁石 阿胶（米
粉炒） 女贞（盐水炒） 沙苑（盐水炒） 石决明
渊按∶此厥阴头痛也。三阴经皆至颈而还，惟厥阴上额交
巅。甚则入肾者，木燥水必亏，乙癸同源也。
杨 郁火内燔，气血消灼，湿热不化，酿成疡毒；四肢麻
痛，眼鼻牵引，肝风内动，脾胃受戕，虑延败症。姑先清气血之燔，佐以熄风通络。
羚羊角 连翘 木防己 苡仁 滑石 黑山栀 赤苓 丝瓜络 丹皮 钩钩 通草 藿香叶
渊按∶湿热风火内盛，故以清火化湿，通络熄风，不涉虚，故不用补。
荣 病起肝风，继增痰饮吐酸，所以口目筋掣，而胸膈不利
也。近因暑热上蒸，咽喉碎痒，暂投凉剂，喉患即解，而胸脘愈
觉撑胀。夫肝风之动，由于阴血之亏；而痰饮之乘，又系胃阳之
弱。病涉两歧，法难兼用。今且宣化胃湿以祛痰，稍佐平肝降热。
法半夏 茯苓 陈皮 麦冬 杏仁 旋复花 川贝 山栀（姜汁炒） 郁金 丹皮 白蔻仁 竹茹
渊按∶此等病最难看，其实在中焦脾胃也。盖饮生于脾，聚
于胃，苟能治得痰饮，肝风无有不愈。脾气既升，肝自不郁；胃气既降，肝自清宁。何风之有！
朱 五脏六腑之精气皆上注于目，目之系上属于脑，后出于
项，故凡风邪中于项、入于脑者，多令目系急而斜视，或颈项强
急也。此症始由口目牵引，乃外风引动内风。内风多从火出，其
源实由于水亏，水亏则木旺，木旺则风至。至于口唇干燥赤碎，
名唇风，亦由肝风胃火之所成也。治当清火、熄风、养阴为法。
大生地 丹皮 沙参 钩钩 桑叶 羚羊角 石决明 白芍 川斛 芝麻 元参心 蔗皮 藜皮
顾 血不养筋，筋脉牵掣，昼日则安，暮夜则发，不能安卧，病在阴经。宜养血以和经脉。
大生地 党参 黄 川芎 茯苓 柏子仁 当归 白芍 枣仁 桑枝
何 肝风阳气上冒，头左偏痛，连及左目难开。胸脘气胀，肝木乘胃。法以泄降和阳。
羚羊角 蔓荆子 川连 刺藜 池菊 钩钩 石决明 神曲 茯苓 半夏 桑叶
施 久遗下虚，肾水不足，肝风暗动，上升则头痛眩晕，乘
中则或吐或泻。近来夜寐出汗，左目锐 赤肿，少阳木火上盛
也。法以上熄风阳，下滋肾水，中和脾胃，外实腠理，用汤丸并进。磁朱六味丸淡盐汤送下。
石决明 怀药 白芍 元参 牡蛎 沙苑子 茯神 党参 芡实 红枣 浮麦
潘 情怀郁勃，肝胆风阳上升，右目昏蒙，左半头痛，心嘈
不寐，饥而善食，内风掀旋不熄，痛势倏忽无定，营液消耗，虑
其痉厥。法以滋营养液，清熄风阳。务宜畅抱，庶克臻效。
大生地 元精石 阿胶 天冬 池菊 羚羊角 石决明 女贞子 白芍 钩钩
复 服滋阴和阳法，风阳稍熄。第舌心无苔，心嘈善饥，究属营阴消烁，胃虚求助于食。议滋柔甘缓。
大生地 石决明 麦冬 阿胶 白芍 大麻仁 女贞子 橘饼 洋参 茯神
渊按∶舌心无苔，胃阴虚也。加炙草守中壮水更妙。
李 肝风阳气弛张，兼挟湿热，上混清窍，左耳常流清水，时或作痒，右鼻燥而窒塞，头晕沉沉。法以熄风和阳。
羚羊角 石决明 池菊 钩钩 粉丹皮 黑山栀 磁石 蒺藜 赤苓 通草 豆衣 左慈丸（三钱）
吴 上年夏季痰火迷心，神呆语乱。愈后至今复发。现诊脉
浮小弱，舌心红而苔白。语言错乱，哭笑不常。凭脉而论，似属
心风。盖由风入心经，蕴热蒸痰所致。用《本事方》独活汤。
独活 防风 淡芩 山栀 元参 鲜地 茯苓 甘草 橘红 竹叶 石菖蒲 胆星
渊按∶心脾有伏痰积热，故见症如是。
宋 营血内亏，不能涵木，加以恼怒，肝风暗动，不时头昏脚软，防其跌仆。今宜养血熄风。
党参 当归 白芍 川贝 陈皮 茯神 枣仁 香附 橘叶 砂仁 石决明 刺蒺藜
渊按∶营虚由脾不化，心不生。党参、当归补脾以生营，砂
仁、橘叶快脾以疏肝，余亦清金制木，利气养营者也。
徐 少腹之块已平，小便已利而反不禁。素有肝风脾泄宿
恙，近增右手麻木。脉象弦大而滑，时觉痰多气升。此中气已虚，精血不足，内风走络，脾湿生痰。法当兼顾。
制首乌 怀山药 冬术 归身 白芍 菟丝子 沙苑子 茯苓 党参 半夏 陈皮 桑枝
朱 血与津液，其原皆禀于胃。胃气虚则血少而风动，风煽
胃中，则精液亏而火炎。夫胃与大肠同属阳明，故上为牙痛，左
肩亦痛，下则便艰而痔痛也。头眩心跳，血虚故也。拟养阳明气血，以滋津液为法。
制洋参 柏子仁 归身 麦冬 升麻 新会皮 元精石 黄 于术 茯神 荷蒂
渊按∶胃气虚未必风动。惟胃虚不能布化精微，营阴失其资
生灌溉，始木燥风生。上有牙痛，下有痔痛，津枯金燥，风火交煽矣。
又 补气血以止痛，生津液以润肠。
制洋参 熟地 黄 于术 当归 柏子仁 陈皮 麦冬 麻仁 生谷芽
钱 外风引动内风，头偏右痛，不能着枕。用青空膏。
羌活 柴胡 防风 川连（酒炒） 甘菊 焦栀 黄芩 桑叶 丝瓜络 钩钩
薛 头风痛偏于右，发则连及牙龈，甚则呕吐痰涎。肝风袭于脾胃，寒痰流入经络。温补泄化为法。
竹节 白附子 黄 羌活 刺蒺藜 半夏 吴萸 制僵蚕 钩钩
渊按∶头痛牙痛，属热者多，而亦有寒痰流络用温散者。
胡 少腹胁肋，肝之部也。腰，肾之府也。年老则精血枯而
络脉空，肝气乘虚入络，湿热又从之为患。补养精血，疏肝通络，兼化湿热以治之。
川楝子 香附 乌药 当归 茯苓 旋复花 延胡 新绛 陈皮 苁蓉干 青葱管
又 补养精血，疏通脉络，胁肋之痛稍减。惟小溲短少，夜
半以后脘腹觉胀，是浊气不化也。前方加通阳泄浊之品。
川楝子 吴萸 乌药 杞子 当归 延胡索 茯苓 车前 橘叶 苁蓉干 九香虫 两头尖 小麦芽
苏 肝阴久亏，风阳上扰不熄，头顶目珠皆痛，痛则心嘈难
过，漾漾如呕，多烦少寐，大便燥结。高年当春分节阳升勃勃之际，自宜育阴熄风，镇逆宁神。
生地 茯神 阿胶 沙参 鲜首乌 麻仁 沙苑子 枣仁 甘菊 石决明 炙甘草 麦冬 金器（先煎）
又 耳目昏花，初起多由风热，次则因于肝火，久则必致阴
虚。此证已及半年，其为阴虚阳亢无疑。毓阴以和阳，壮水以制火，是定法也。
大生地 麦冬 丹皮 磁石 茯神 石决明 焦栀 元参 枣仁 沙苑子 北沙参
另磁朱丸二钱，每朝盐花汤送下。
华 病久正虚，阴阳两弱，坎离不交，夜不成寐，久卧于
床，不耐烦劳。兹因舟行跋涉，远道就诊，忽然神糊不语，两手
不定，遮睛 发，烦躁不安。诊脉促乱，饮食不进。想由舟中热
闷，鼓动风阳，扰乱神明，卒然生变。姑拟熄风和阳，安神定志。冀得神清谷进，或可再商。
生洋参 茯苓 丹皮 沙苑 石决明 天竺黄 竹茹 枣仁 嫩钩 远志肉 金箔
渊按∶痰浊为风阳煽动，堵塞神明，猝然不语，须豁痰开
窍。豁痰如羚羊、胆星、竹沥之类，开窍如牛黄、至宝、苏合之类，随证用之，或者有济。
苏 肝风上升于巅顶，原属阴亏；痰浊弥满于中宫，多因脾
弱。目痛头疼，心嘈便结，阴亏阳亢之征；舌苔浊浓，纳少恶
心，胃虚浊泛之象。高年久病，图治实难，勉拟一方备参。
人参 半夏 天麻 橘皮 元明粉 茯神 沙苑（盐水炒） 磁石 黄柏 元精石 干姜
又 头痛减而得寐，苔薄白而带灰。火降则神安，湿化则燥显。前方加减，再望转机。
前方去干姜、黄柏，加知母、北沙参、姜竹茹。
又 头痛虽减，风阳犹未全平。舌苔灰白，痰浊仍未全化。
心跳若饥，营阴亏而有火。闻喧欲晕，阳上亢而下虚。拟养营阴
以降火，和胃气而化痰，参以镇逆，佐以宁神。
制洋参 牡蛎 茯神 沙苑 石决明 大生地 半夏 陈皮 杏仁 元精石 竹茹
钦差 军事倥偬，劳心劳力，眠食无暇，感冒风邪，引动内
风，犯胃凌上，半边头痛，呕吐黄水。拟去外风以熄内风，兼和胃气而化痰湿。录方呈电。
荆芥 秦艽 防风 天麻 石决明 陈皮 茯苓 白芷 甘菊 钩钩 半夏 竹茹 白蔻仁
某 情怀郁抑，元气内亏，心中难过，虚火肝风上逆，唇口
肿痛，头眩耳鸣，食少无力，时常太息。防其痰火神蒙之变，非轻证也。
羚羊角 沙苑子 川石斛 天竺黄 石决明 嫩钩藤 枣仁 甘菊花 元参 丹皮 灯心
又 痰火神烦不寐，防患疯癫。
枳实 天竺黄 石决明 茯神 羚羊角 胆星 川连 竹沥 姜汁 枣仁
竹沥达痰丸三钱，开水送。
朱 水亏不能涵木，阳升阴不上承。时际春深木旺阳升之
候，是以寒热，头痛，胸痞，少寐，便结等症见也。仿赵养葵法。
大生地（砂仁拌） 茯神 丹皮 柴胡（盐水炒） 枣仁 女贞子 麦
冬（朱砂拌） 归身 陈皮 生姜 石决明 红枣
渊按∶从逍遥散参入滋水养肝，颇有巧思。
陈 脉诊左关独弦滑，风阳挟痰上扰阳明，头额偏左连及腮齿皆痛。拟熄风阳，兼清痰火。
羚羊角 制僵蚕 桑叶 丹皮 嫩钩钩 甘菊花 石决明 鲜银花藤 刺蒺藜
另∶细辛三分，荆芥钱半，生石膏五钱，共研粗末，泡汤漱
口。 另∶乳香一钱，没药一钱，生南星一钱，生半夏一钱，僵蚕一钱，冰片三分，共研细末，和入陈酒干面调敷。
徐 丧弟悲哀太过，肝阳升动无制。初起病发如狂，今则心
跳少寐，头晕口干，略见咳嗽。拟安神养阴、清火降气为法。
石决明 丹皮 枣仁 茯神 川贝 北沙参 广橘红 麦冬 元参 竹茹 枇杷叶
章 经曰∶上虚则眩。丹溪云∶无痰不作眩。病机论曰∶诸
风掉眩，皆属于肝。是眩晕不出虚、风与痰三者为患。健忘筋
惕，虚与肝之病也。吐痰干腻，津液所化也。从三者治之，虽不中，不远矣。
生洋参 天麻 天竺黄 川贝 茯神 制南星 石决明 牡蛎 甘菊花 牛膝 女贞子 嫩钩钩
又 眩晕虚风兼夹痰，前方布置已成斑。病来心悸宗筋缩，养血清肝理必参。
生洋参 天竺黄 天麻 川贝 嫩钩钩 羚羊角 石决明 菖蒲 茯神 大补阴丸
诸 外风引动内风，头两边及巅顶俱痛。咳嗽，舌苔白，身
热，能食知味，病在上焦。古方治头痛都用风药，以高巅之上惟风可到也。
荆芥（一钱） 川芎（八分，酒炒） 杏仁（三钱） 防风（钱半） 甘菊花（一钱）
淡芩（钱半，酒炒） 枳壳（一钱） 羌活（钱半） 本（一钱）
上药研粗末，外加松萝茶叶三钱，分三服，开水泡服。另细辛三分，雄黄一分，研末，搐鼻取嚏。
渊按∶古方清空膏，一派升散，全无意义，可用之证甚少。
唐 肝风太旺，肝阴又虚。气旺则火动而风生，阴虚则液亏
而血弱。血弱则心跳，液亏则口干。火动故发热，风生则头痛。拟佐金以平木，培土以熄风，养血以柔肝，益阴以退热。
归身 丹皮（盐水炒） 北沙参（吴萸三分，拌炒） 枣仁 陈皮 冬术（
土炒） 刺蒺藜 豆皮 茯神 白芍 橘叶
陆 阳升头痛，心虚善忘，痰火迷心，若昧若狂。安神定
志，人参可用，而腻补且缓，以其纳少痰多也。舒郁化痰，川贝
最妙，而燥劫须忌，以其舌苔干白也。潜阳熄风，须参重镇，而收涩当戒，恐反敛其痰也。
人参 茯神 川贝 石决明 蛤壳 枣仁（川连三分，拌炒，研）
又 脉细数，懒言倦卧，其为精气神三者皆虚。然舌苔白
腻，有痰且有饮。再察神情，静则气怠而若虚，动则气上而自
乱，是虚而有痰兼有火也。火伏则痰不上升则静，静则虚象现；火
动而痰升则躁，躁则虚象隐。非不虚也，痰火为之起伏也。治不
越十味温胆加减。临症各有心思，悉关根柢。
参须 川贝 茯神 枣仁 石决明 橘红
又 阴遏于外，阳伏于内。阴如迷雾，阳若日光。今阳为阴
遏，故沉沉默默而蒙昧，脉亦为之不显。有时阳光见 ，则起坐
而神清，脉亦为之稍起。顷之阴霾四合，阳气复翳，则仍昏昏如
寐。前案谓有痰饮郁于其中，十味温胆屡投不应。再思病源起于
【背景信息】
书名：王旭高临证医案 作者：王旭高 朝代：清 章节：肝风痰火门(1/2) 类别：医论
患者王，血虚导致肝风上逆，痰涎流窜经络。症状表现为头晕、心悸、干咳且痰少，右肩臂无法抬起，足部发热且无力。治疗宜滋养阴液以平息肝阳之风，化痰以调理脾胃。
处方：党参（用元米炒制）、生地（与海浮石同拌）、半夏、决明子、沙苑子（用盐水炒制）、茯神、枣仁、蛤壳、茯苓、陈皮、嫩钩藤、竹二青。
又诊：治疗风证先治血，血行则风自灭。治疗痰证先化气，气顺则痰自消。
处方：生地、茯神、嫩钩藤、陈皮、沙苑子、决明子、蛤壳、枣仁、竹茹。
患者张，头痛属巅顶之疾，属下面虚上面实，病位在足少阳胆经和足厥阴肝经，严重时波及肾脏，蒙蔽清窍。这段经文意指肝胆风阳上盛，久痛不已，必伤及少阴肾阴。肾阴一旦衰退，故眼睛视物模糊不清，腰痛再次发作。前方清热镇潜无效，现改用育阴、潜阳、镇逆法。
处方：生地、龟板、杜仲（用盐水炒制）、牡蛎、茯神、枣仁、磁石、阿胶（用米粉炒制）、女贞子（用盐水炒制）、沙苑子、石决明。
渊按：此为厥阴头痛。三阴经都至颈部而回，只有厥阴经上行至额部交会于巅顶。所谓“甚则入肾”，是因为木燥则水必亏，乙癸同源（肝肾同源）的缘故。
患者杨，郁火在内焚烧，气血被消灼，湿热不化，酿成疡毒；四肢麻木疼痛，眼鼻牵引不适，肝风内动，脾胃受损，担心延变为败症。暂先清气分之热和血分之燔，佐以熄风通络。
处方：羚羊角、连翘、木防己、薏苡仁、滑石、黑山栀、赤茯苓、丝瓜络、丹皮、钩藤、通草、藿香叶。
渊按：湿热风火内盛，所以用清火化湿、通络熄风之法，不涉及虚证，故不用补益药。
患者荣，病起于肝风，随后增加痰饮吐酸，所以口目筋脉抽搐，胸膈不利。近期因暑热上蒸，咽喉碎痒，暂投凉剂，喉患即解，但胸脘更觉撑胀。肝风的发动，是由于阴血亏损；而痰饮的乘袭，又是由于胃阳虚弱。病涉两方面，治法难以兼顾。现暂且宣化胃湿以祛痰，稍加平肝降热。
处方：法半夏、茯苓、陈皮、麦冬、杏仁、旋复花、川贝母、山栀（姜汁炒制）、郁金、丹皮、白蔻仁、竹茹。
渊按：这类病最难诊治，其实关键在于中焦脾胃。因为饮生于脾，聚于胃，如果能治好痰饮，肝风没有不愈的。脾气既升，肝自然不郁；胃气既降，肝自然清宁。还有什么风呢！
患者朱，五脏六腑的精气都上注于目，眼的系带向上属于脑，向后出于项部，所以凡是风邪中于项部、入于脑部的，多导致目系紧急而斜视，或颈项强急。此症起初由口目牵引，乃外风引动内风。内风多从火出，其根源实在于水亏，水亏则木旺，木旺则风至。至于口唇干燥赤裂，名为唇风，也是由肝风胃火所造成。治疗当以清火、熄风、养阴为法。
处方：大生地、丹皮、沙参、钩藤、桑叶、羚羊角、石决明、白芍、川石斛、芝麻、玄参心、蔗皮、藜皮。
患者顾，血不养筋，筋脉牵掣，白天则安，夜晚则发作，不能安卧，病在阴经。宜养血以调和经脉。
处方：大生地、党参、黄芪、川芎、茯苓、柏子仁、当归、白芍、枣仁、桑枝。
患者何，肝风阳气上冒，头左侧偏痛，牵连左目难开。胸脘气胀，肝木乘犯胃土。治法以泄降和阳。
处方：羚羊角、蔓荆子、川黄连、刺蒺藜、池菊、钩藤、石决明、神曲、茯苓、半夏、桑叶。
患者施，久遗下虚，肾水不足，肝风暗动，上升则头痛眩晕，乘犯中焦则或吐或泻。近来夜寐出汗，左目锐眦赤肿，是少阳木火上盛。治法以上熄风阳，下滋肾水，中和脾胃，外实腠理，用汤丸并进。磁朱六味丸淡盐汤送下。
处方：石决明、怀山药、白芍、玄参、牡蛎、沙苑子、茯神、党参、芡实、红枣、浮小麦。
患者潘，情怀郁勃，肝胆风阳上升，右目昏蒙，左半头痛，心中嘈杂不寐，饥而善食，内风掀旋不熄，痛势忽定无定，营液消耗，担心发生痉厥。治法以滋营养液，清熄风阳。务必保持胸怀舒畅，庶几能获效。
处方：大生地、元精石、阿胶、天冬、池菊、羚羊角、石决明、女贞子、白芍、钩藤。
患者复，服用滋阴和阳法后，风阳稍熄。但舌心无苔，心中嘈杂善饥，究属营阴消烁，胃虚求助于食。议用滋柔甘缓之法。
处方：大生地、石决明、麦冬、阿胶、白芍、大麻仁、女贞子、橘饼、西洋参、茯神。
患者李，肝风阳气弛张，兼挟湿热，上混清窍，左耳常流清水，时或作痒，右鼻燥而窒塞，头晕沉沉。治法以熄风和阳。
处方：羚羊角、石决明、池菊、钩藤、粉丹皮、黑山栀、磁石、蒺藜、赤茯苓、通草、豆衣、左慈丸（三钱）。
患者吴，上年夏季痰火迷心，神呆语乱。愈后至今复发。现诊脉浮小弱，舌心红而苔白。语言错乱，哭笑无常。凭脉而论，似属心风。盖由风入心经，蕴热蒸痰所致。用《本事方》独活汤。
处方：独活、防风、淡黄芩、山栀、玄参、鲜地黄、茯苓、甘草、橘红、竹叶、石菖蒲、胆南星。
患者宋，营血内亏，不能涵木，加以恼怒，肝风暗动，不时头昏脚软，防其跌仆。今宜养血熄风。
处方：党参、当归、白芍、川贝母、陈皮、茯神、枣仁、香附、橘叶、砂仁、石决明、刺蒺藜。
渊按：营虚由脾不化生，心不生血。党参、当归补脾以生营，砂仁、橘叶快脾以疏肝，其余也是清金制木，利气养营的药。
患者徐，少腹之块已平，小便已利而反不禁。素有肝风脾泄宿恙，近增右手麻木。脉象弦大而滑，时觉痰多气升。此中气已虚，精血不足，内风走络，脾湿生痰。治法当兼顾。
处方：制首乌、怀山药、冬术、归身、白芍、菟丝子、沙苑子、茯苓、党参、半夏、陈皮、桑枝。
患者朱，血与津液，其源皆禀于胃。胃气虚则血少而风动，风煽胃中，则精液亏而火炎。胃与大肠同属阳明，故上为牙痛，左肩亦痛，下则便艰而痔痛也。头眩心跳，血虚故也。拟养阳明气血，以滋津液为法。
处方：制洋参、柏子仁、归身、麦冬、升麻、新会皮、元精石、黄芪、于术、茯神、荷蒂。
渊按：胃气虚未必风动。惟胃虚不能布化精微，营阴失其资生灌溉，始木燥风生。上有牙痛，下有痔痛，津枯金燥，风火交煽矣。
又诊：补气血以止痛，生津液以润肠。
处方：制洋参、熟地、黄芪、于术、当归、柏子仁、陈皮、麦冬、麻仁、生谷芽。
患者钱，外风引动内风，头偏右痛，不能着枕。用青空膏。
处方：羌活、柴胡、防风、川黄连（酒炒）、甘菊、焦栀、黄芩、桑叶、丝瓜络、钩藤。
患者薛，头风痛偏于右，发则连及牙龈，甚则呕吐痰涎。肝风袭于脾胃，寒痰流入经络。温补泄化为法。
处方：竹节、白附子、黄芪、羌活、刺蒺藜、半夏、吴茱萸、制僵蚕、钩藤。
患者胡，少腹胁肋，是肝之部。腰，是肾之府。年老则精血枯而络脉空，肝气乘虚入络，湿热又从之为患。补养精血，疏肝通络，兼化湿热以治之。
处方：川楝子、香附、乌药、当归、茯苓、旋复花、延胡索、新绛、陈皮、肉苁蓉干、青葱管。
又诊：补养精血，疏通脉络，胁肋之痛稍减。惟小溲短少，半夜以后脘腹觉胀，是浊气不化也。前方加通阳泄浊之品。
处方：川楝子、吴茱萸、乌药、杞子、当归、延胡索、茯苓、车前子、橘叶、肉苁蓉干、九香虫、两头尖、小麦芽。
患者苏，肝阴久亏，风阳上扰不熄，头顶目珠皆痛，痛则心嘈难过，漾漾如呕，多烦少寐，大便燥结。高年当春分节阳升勃勃之际，自宜育阴熄风，镇逆宁神。
处方：生地、茯神、阿胶、沙参、鲜首乌、麻仁、沙苑子、枣仁、甘菊、石决明、炙甘草、麦冬、金器（先煎）。
又诊：耳目昏花，初起多由风热，次则因于肝火，久则必致阴虚。此证已及半年，其为阴虚阳亢无疑。毓阴以和阳，壮水以制火，是定法也。
处方：大生地、麦冬、丹皮、磁石、茯神、石决明、焦栀、玄参、枣仁、沙苑子、北沙参。
另：磁朱丸二钱，每朝盐花汤送下。
患者华，病久正虚，阴阳两弱，坎离不交，夜不成寐，久卧于床，不耐烦劳。兹因舟行跋涉，远道就诊，忽然神糊不语，两手不定，遮睛发，烦躁不安。诊脉促乱，饮食不进。想由舟中热闷，鼓动风阳，扰乱神明，卒然生变。姑拟熄风和阳，安神定志。冀得神清谷进，或可再商。
处方：生洋参、茯苓、丹皮、沙苑、石决明、天竺黄、竹茹、枣仁、嫩钩藤、远志肉、金箔。
渊按：痰浊为风阳煽动，堵塞神明，猝然不语，须豁痰开窍。豁痰如羚羊角、胆南星、竹沥之类，开窍如牛黄、至宝丹、苏合香丸之类，随证用之，或者有济。
患者苏，肝风上升于巅顶，原属阴亏；痰浊弥满于中宫，多因脾弱。目痛头疼，心嘈便结，是阴亏阳亢之征；舌苔浊浓，纳少恶心，是胃虚浊泛之象。高年久病，图治实难，勉拟一方备参。
处方：人参、半夏、天麻、橘皮、元明粉、茯神、沙苑子（盐水炒）、磁石、黄柏、元精石、干姜。
又诊：头痛减而得寐，苔薄白而带灰。火降则神安，湿化则燥显。前方加减，再望转机。
前方去干姜、黄柏，加知母、北沙参、姜竹茹。
又诊：头痛虽减，风阳犹未全平。舌苔灰白，痰浊仍未全化。心跳若饥，营阴亏而有火。闻喧欲晕，阳上亢而下虚。拟养营阴以降火，和胃气而化痰，参以镇逆，佐以宁神。
处方：制洋参、牡蛎、茯神、沙苑、石决明、大生地、半夏、陈皮、杏仁、元精石、竹茹。
钦差，军事倥偬，劳心劳力，眠食无暇，感冒风邪，引动内风，犯胃凌上，半边头痛，呕吐黄水。拟去外风以熄内风，兼和胃气而化痰湿。录方呈电。
处方：荆芥、秦艽、防风、天麻、石决明、陈皮、茯苓、白芷、甘菊、钩藤、半夏、竹茹、白蔻仁。
某患者，情怀郁抑，元气内亏，心中难过，虚火肝风上逆，唇口肿痛，头眩耳鸣，食少无力，时常太息。防其痰火神蒙之变，非轻证也。
处方：羚羊角、沙苑子、川石斛、天竺黄、石决明、嫩钩藤、枣仁、甘菊花、玄参、丹皮、灯心。
又诊：痰火神烦不寐，防患疯癫。
处方：枳实、天竺黄、石决明、茯神、羚羊角、胆南星、川黄连、竹沥、姜汁、枣仁。
竹沥达痰丸三钱，开水送服。
患者朱，水亏不能涵木，阳升阴不上承。时际春深木旺阳升之候，是以寒热，头痛，胸痞，少寐，便结等症见也。仿赵养葵法。
处方：大生地（砂仁拌）、茯神、丹皮、柴胡（盐水炒）、枣仁、女贞子、麦冬（朱砂拌）、归身、陈皮、生姜、石决明、红枣。
患者陈，脉诊左关独弦滑，风阳挟痰上扰阳明，头额偏左连及腮齿皆痛。拟熄风阳，兼清痰火。
处方：羚羊角、制僵蚕、桑叶、丹皮、嫩钩钩、甘菊花、石决明、鲜银花藤、刺蒺藜。
另：细辛三分，荆芥钱半，生石膏五钱，共研粗末，泡汤漱口。
另：乳香一钱，没药一钱，生南星一钱，生半夏一钱，僵蚕一钱，冰片三分，共研细末，和入陈酒干面调敷。
患者徐，丧弟悲哀太过，肝阳升动无制。初起病发如狂，今则心跳少寐，头晕口干，略见咳嗽。拟安神养阴、清火降气为法。
处方：石决明、丹皮、枣仁、茯神、川贝母、北沙参、广橘红、麦冬、玄参、竹茹、枇杷叶。
患者章，经曰：上虚则眩。丹溪云：无痰不作眩。病机论曰：诸风掉眩，皆属于肝。是眩晕不出虚、风与痰三者为患。健忘筋惕，虚与肝之病也。吐痰干腻，津液所化也。从三者治之，虽不中，不远矣。
处方：生洋参、天麻、天竺黄、川贝母、茯神、制南星、石决明、牡蛎、甘菊花、牛膝、女贞子、嫩钩钩。
又诊：眩晕虚风兼夹痰，前方布置已成斑。病来心悸宗筋缩，养血清肝理必参。
处方：生洋参、天竺黄、天麻、川贝母、嫩钩钩、羚羊角、石决明、菖蒲、茯神、大补阴丸。
患者诸，外风引动内风，头两边及巅顶俱痛。咳嗽，舌苔白，身热，能食知味，病在上焦。古方治头痛都用风药，以高巅之上惟风可到也。
处方：荆芥（一钱）、川芎（八分，酒炒）、杏仁（三钱）、防风（钱半）、甘菊花（一钱）、淡黄芩（钱半，酒炒）、枳壳（一钱）、羌活（钱半）、本（一钱）。
上药研粗末，外加松萝茶叶三钱，分三服，开水泡服。另细辛三分，雄黄一分，研末，搐鼻取嚏。
患者唐，肝风太旺，肝阴又虚。气旺则火动而风生，阴虚则液亏而血弱。血弱则心跳，液亏则口干。火动故发热，风生则头痛。拟佐金以平木，培土以熄风，养血以柔肝，益阴以退热。
处方：归身、丹皮（盐水炒）、北沙参（吴茱萸三分，拌炒）、枣仁、陈皮、冬术（土炒）、刺蒺藜、豆皮、茯神、白芍、橘叶。
患者陆，阳升头痛，心虚善忘，痰火迷心，若昧若狂。安神定志，人参可用，而腻补且缓，以其纳少痰多也。舒郁化痰，川贝最妙，而燥劫须忌，以其舌苔干白也。潜阳熄风，须参重镇，而收涩当戒，恐反敛其痰也。
处方：人参、茯神、川贝母、石决明、蛤壳、枣仁（川黄连三分，拌炒，研）。
又诊：脉细数，懒言倦卧，其为精气神三者皆虚。然舌苔白腻，有痰且有饮。再察神情，静则气怠而若虚，动则气上而自乱，是虚而有痰兼有火也。火伏则痰不上升则静，静则虚象现；火动而痰升则躁，躁则虚象隐。非不虚也，痰火为之起伏也。治不越十味温胆加减。临症各有心思，悉关根柢。
处方：参须、川贝母、茯神、枣仁、石决明、橘红。
又诊：阴遏于外，阳伏于内。阴如迷雾，阳若日光。今阳为阴遏，故沉沉默默而蒙昧，脉亦为之不显。有时阳光见，则起坐而神清，脉亦为之稍起。顷之阴霾四合，阳气复翳，则仍昏昏如寐。前案谓有痰饮郁于其中，十味温胆屡投不应。再思病源起于
[Background Information]
Book: Wang Xugao's Clinical Medical Cases Author: Wang Xugao Dynasty: Qing Chapter: Liver Wind, Phlegm and Fire Section (1/2) Category: Medical Theory
Patient Wang: Blood deficiency leads to upward reversal of Liver Wind, with phlegm-saliva flowing through the collaterals. Symptoms include dizziness, palpitations, dry cough with scanty sputum, inability to raise the right shoulder and arm, heat in the feet, and weakness. Treatment should nourish Yin to extinguish Liver Yang wind, and resolve phlegm to regulate Spleen and Stomach.
Prescription: Codonopsis Radix (Dangshen, stir-fried with Yuanmi rice), Rehmanniae Radix Preparata (Shengdi, mixed with Haifushi), Pinelliae Rhizoma Preparatum (Banxia), Cassiae Semen (Jueming), Astragali Complanati Semen (Shayuanzi, stir-fried with salt water), Poria (Fushen), Ziziphi Spinosae Semen (Zaoren), Tridacnae Concha (Geqiao), Poria (Fuling), Citri Reticulatae Pericarpium (Chenpi), Uncariae Ramulus cum Uncis (Gouteng), Bamboo Sap (Zhuerqing).
Second visit: To treat wind, first treat blood; when blood moves, wind self-extinguishes. To treat phlegm, first transform Qi; when Qi transforms, phlegm self-disappears.
Prescription: Rehmanniae Radix Preparata (Shengdi), Poria (Fushen), Uncariae Ramulus cum Uncis (Gouteng), Citri Reticulatae Pericarpium (Chenpi), Astragali Complanati Semen (Shayuanzi), Cassiae Semen (Jueming), Tridacnae Concha (Geqiao), Ziziphi Spinosae Semen (Zaoren), Bamboo Shavings (Zhuru).
Patient Zhang: Headache at the vertex is a disease of deficiency below and excess above, involving the Foot Shaoyang Gallbladder Meridian and Foot Jueyin Liver Meridian. Severe cases affect the Kidney, clouding the clear orifices. This passage refers to the hyperactivity of Liver-Gallbladder Wind-Yang. Long-standing pain inevitably injures the Yin of the Shaoyin Kidney. Once Kidney Yin declines, vision becomes blurred, and lower back pain recurs. Previous prescriptions for clearing heat and anchoring were ineffective. Now use methods to nourish Yin, subdue Yang, and direct rebellious Qi downward.
Prescription: Rehmanniae Radix Preparata (Shengdi), Testudinis Carapax et Plastrum (Guiban), Eucommiae Cortex (Duzhong, stir-fried with salt water), Ostreae Concha (Muli), Poria (Fushen), Ziziphi Spinosae Semen (Zaoren), Magnetitum (Cishi), Ecliptae Herba (E'jiao, stir-fried with rice flour), Ligustri Lucidi Fructus (Nvzhenzi, stir-fried with salt water), Astragali Complanati Semen (Shayuanzi), Halitum (Shijueming).
Annotation by Yuan: This is Jueyin headache. The Three Yin meridians all return at the neck, only the Jueyin meridian ascends to the forehead and intersects at the vertex. "Severe cases affect the Kidney" means that when Wood is dry, Water must be deficient, as Yi (Liver) and Gui (Kidney) share the same source.
Patient Yang: Depressed fire burns internally, consuming Qi and Blood. Damp-heat fails to transform, brewing into ulcerative toxins. Limbs are numb and painful, eyes and nose are pulled/tractioned, internal Liver Wind moves, Spleen and Stomach are damaged. Fear it will progress to a critical condition. Temporarily clear heat from Qi and Blood, assist with extinguishing wind and unblocking collaterals.
Prescription: Antelopic Cornu (Lingyangjiao), Forsythiae Fructus (Lianqiao), Stephaniae Tetrandrae Radix (Mufangji), Coicis Semen (Yiren), Talcum (Huashi), Gardeniae Fructus Carbonisatus (Heishanzhi), Poria Cocos with Pink Host (Chiling), Luffae Fructus Reti (Sigualuo), Moutan Cortex (Danpi), Uncariae Ramulus cum Uncis (Gou gou), Tectonae Cordis Stem (Tongcao), Houttuyniae Herba (Huoxiangye).
Annotation by Yuan: Internal damp-heat, wind, and fire are abundant, so use methods to clear fire, transform dampness, unblock collaterals, and extinguish wind. It does not involve deficiency, so tonics are not used.
Patient Rong: The illness began with Liver Wind, subsequently increasing with phlegm-fluids, acid regurgitation, causing twitching of mouth and eye muscles, and discomfort in chest and diaphragm. Recently, due to summer-heat steaming upward, throat was itchy and fragmented. A temporary cooling agent resolved the throat issue, but chest and epigastrium felt more distended. The movement of Liver Wind is due to Yin-Blood deficiency; the invasion of phlegm-fluids is due to weak Stomach Yang. The pathology involves two divergent aspects, making combined treatment difficult. Now, ventilate and transform Stomach dampness to remove phlegm, slightly assisting with calming Liver and descending heat.
Prescription: Pinelliae Rhizoma Preparatum (Fabanxia), Poria (Fuling), Citri Reticulatae Pericarpium (Chenpi), Ophiopogonis Radix (Maidong), Armeniacae Semen Amarum (Xingren), Inulae Flos (Xuanfuhua), Fritillariae Thunbergii Bulbus (Chuanbei), Gardeniae Fructus (Shanzhi, stir-fried with ginger juice), Curcumae Radix (Yujin), Moutan Cortex (Danpi), Amomi Fructus Rotundus (Baokourén), Bamboo Shavings (Zhuru).
Annotation by Yuan: Such diseases are hardest to diagnose; the key lies in the Middle Jiao Spleen and Stomach. Fluids originate in the Spleen and gather in the Stomach. If phlegm-fluids can be treated, Liver Wind will surely heal. When Spleen Qi ascends, Liver naturally does not stagnate; when Stomach Qi descends, Liver naturally becomes clear and peaceful. What wind would there be!
Patient Zhu: The essence and Qi of the Five Zang and Six Fu organs all ascend to the eyes. The optic nerve connects upward to the brain and exits posteriorly at the nape. Therefore, wind-cold invading the nape and entering the brain often causes tension in the optic nerve leading to strabismus, or stiffness of the neck. This case started with traction of mouth and eyes, indicating external wind triggering internal wind. Internal wind mostly arises from fire, its root actually being Water deficiency. Water deficiency leads to Wood hyperactivity, Wood hyperactivity leads to wind arrival. Dry, red, cracked lips is named Lip Wind, also caused by Liver Wind and Stomach fire. Treatment should clear fire, extinguish wind, and nourish Yin.
Prescription: Rehmanniae Radix Preparata (Da Shengdi), Moutan Cortex (Danpi), Glehniae Radix (Shashen), Uncariae Ramulus cum Uncis (Gou gou), Mori Folium (Sangye), Antelopic Cornu (Lingyangjiao), Halitum (Shijueming), Paeoniae Radix Alba (Baishao), Dendrobii Caulis (Chuanhu), Sesamum Indicum Seed (Zhima), Scrophulariae Radix (Yuanshenxin), Sugarcane Peel (Zhepi), Tribuli Fructus (Lipi).
Patient Gu: Blood fails to nourish sinews, causing tendon pulling. Peaceful during the day, manifesting at night, unable to lie down peacefully. Disease is in the Yin meridians. Should nourish blood to harmonize meridians.
Prescription: Rehmanniae Radix Preparata (Da Shengdi), Codonopsis Radix (Dangshen), Astragali Radix (Huangqi), Chuanxiong Rhizome (Chuanxiong), Poria (Fuling), Biota Seed (Baiziren), Angelicae Sinensis Radix (Danggui), Paeoniae Radix Alba (Baishao), Ziziphi Spinosae Semen (Zaoren), Mulberry Twig (Sangzhi).
Patient He: Liver Wind and Yang Qi rebel upward, causing left-sided headache extending to the left eye which is hard to open. Chest and epigastrium feel distended with Qi. Liver Wood invades Stomach Earth. Method: Drain and descend to harmonize Yang.
Prescription: Antelopic Cornu (Lingyangjiao), Vitex Fruit (Manjingzi), Coptidis Rhizome (Chuanlian), Tribuli Fructus (Cili), Chrysanthemi Flos (Chiju), Uncariae Ramulus cum Uncis (Gou gou), Halitum (Shijueming), Massae Fermentatae Medicinatae (Shenqu), Poria (Fuling), Pinelliae Rhizoma Preparatum (Banxia), Mori Folium (Sangye).
Patient Shi: Long-term deficiency below, Kidney Water insufficient, Liver Wind moves secretly. Ascending causes headache and vertigo; invading middle causes vomiting or diarrhea. Recently, sweating during sleep, redness and swelling at the outer canthus of the left eye, indicating hyperactivity of Shaoyang Wood-Fire. Method: Extinguish Wind-Yang above, nourish Kidney Water below, harmonize middle Spleen-Stomach, solidify exterior Couli. Use decoction and pills together. Ci Zhu Liu Wei Wan sent down with light salt water.
Prescription: Halitum (Shijueming), Dioscoreae Rhizoma (Huaiyao), Paeoniae Radix Alba (Baishao), Scrophulariae Radix (Yuanshen), Ostreae Concha (Muli), Astragali Complanati Semen (Shayuanzi), Poria (Fushen), Codonopsis Radix (Dangshen), Euryale Seed (Qianshi), Red Date (Hongzao), Floating Wheat (Fumai).
Patient Pan: Emotions are depressed and agitated, Liver-Gallbladder Wind-Yang rises. Right eye is dim, left half-head hurts, heart feels empty/buzzing, insomnia, hungry but eats well. Internal wind churns incessantly, pain shifts unpredictably, Ying fluid is consumed, fear of spasms and convulsions. Method: Nourish Ying and generate fluids, clear and extinguish Wind-Yang. Must maintain open mind/chest, otherwise efficacy is unlikely.
Prescription: Rehmanniae Radix Preparata (Da Shengdi), Yuanjing Stone (Yuanjingshi), Ecliptae Herba (Ejiao), Asparagi Radix (Tiantong), Chrysanthemi Flos (Chiju), Antelopic Cornu (Lingyangjiao), Halitum (Shijueming), Ligustri Lucidi Fructus (Nvzhenzi), Paeoniae Radix Alba (Baishao), Uncariae Ramulus cum Uncis (Gou gou).
Patient Fu: After taking Yin-nourishing and Yang-harmonizing method, Wind-Yang slightly extinguished. However, no coating on center of tongue, heart buzzing and hunger, ultimately due to consumption of Ying Yin, Stomach deficiency seeking help from food. Propose moistening, softening, sweet, and緩 (soothing) method.
Prescription: Rehmanniae Radix Preparata (Da Shengdi), Halitum (Shijueming), Ophiopogonis Radix (Maidong), Ecliptae Herba (Ejiao), Paeoniae Radix Alba (Baishao), Cannabis Seed (Dama ren), Ligustri Lucidi Fructus (Nvzhenzi), Tangerine Peel Cake (Jubing), American Ginseng (Yangshen), Poria (Fushen).
Annotation by Yuan: No coating on center of tongue indicates Stomach Yin deficiency. Adding Glycyrrhizae Radix et Rhizoma Praeparata (Zhigancao) to guard the middle and strengthen water is better.
Patient Li: Liver Wind and Yang Qi are lax and expansive, mixed with damp-heat, clouding clear orifices. Left ear constantly flows clear fluid, sometimes itchy. Right nose is dry and blocked, head feels heavy. Method: Extinguish wind and harmonize Yang.
Prescription: Antelopic Cornu (Lingyangjiao), Halitum (Shijueming), Chrysanthemi Flos (Chiju), Uncariae Ramulus cum Uncis (Gou gou), Moutan Cortex (Fen Danpi), Gardeniae Fructus Carbonisatus (Heishanzhi), Magnetitum (Cishi), Tribuli Fructus (Jili), Poria Cocos with Pink Host (Chiling), Tectonae Cordis Stem (Tongcao), Soybean Skin (Douyi), Zuoci Pill (San qian).
Patient Wu: Last summer, phlegm-fire confused the Heart, spirit was dull, speech chaotic. Recurred since recovery. Current pulse is floating, small, and weak. Tongue center is red with white coating. Speech is disordered, laughing and crying irregularly. Based on pulse, it seems to be Heart Wind. Caused by wind entering Heart Meridian, accumulating heat steaming phlegm. Use Du Huo Tang from *Ben Shi Fang*.
Prescription: Angelicae Pubescentis Radix (Du huo), Saposhnikoviae Radix (Fangfeng), Scutellariae Radix (Dan Qin), Gardeniae Fructus (Shanzhi), Scrophulariae Radix (Yuanshen), Fresh Rehmanniae Radix (Xian Di), Poria (Fuling), Glycyrrhizae Radix et Rhizoma (Gancao), Citri Reticulatae Pericarpium (Juhong), Bambusa Leaves (Zhuye), Acori Tatarinowii Rhizoma (Shichangpu), Arisaematis Cum Bile (Danning).
Annotation by Yuan: Hidden phlegm and accumulated heat in Heart and Spleen cause these symptoms.
Patient Song: Ying-Blood is deficient internally, failing to contain Wood. Added anger, Liver Wind moves secretly. Occasional dizziness and weak legs, prevent falling. Now should nourish blood and extinguish wind.
Prescription: Codonopsis Radix (Dangshen), Angelicae Sinensis Radix (Danggui), Paeoniae Radix Alba (Baishao), Fritillariae Thunbergii Bulbus (Chuanbei), Citri Reticulatae Pericarpium (Chenpi), Poria (Fushen), Ziziphi Spinosae Semen (Zaoren), Cyperi Rhizoma (Xiangfu), Citrus Unshiu Leaf (Juye), Amomi Fructus (Sharen), Halitum (Shijueming), Tribuli Fructus (Ciji).
Annotation by Yuan: Ying deficiency is due to Spleen failing to transform and Heart failing to generate. Codonopsis and Angelica tonify Spleen to generate Ying. Amomi and Citrus leaf accelerate Spleen to soothe Liver. Others clear Metal to control Wood, promote Qi, and nourish Ying.
Patient Xu: Mass in lower abdomen has flattened, urination is patent but involuntary. History of Liver Wind and Spleen diarrhea. Recently added numbness in right hand. Pulse is wiry, large, and slippery. Feels excessive phlegm and rising Qi. Middle Qi is deficient, Essence and Blood insufficient. Internal wind travels collaterals, Spleen dampness generates phlegm. Method should address both.
Prescription: Polygoni Multiflori Preparata (Zhi Shouwu), Dioscoreae Rhizoma (Huai Shanyao), Atractylodis Macrocephalae Rhizoma (Dongzhu), Angelicae Sinensis Radix (Guishen), Paeoniae Radix Alba (Baishao), Cuscutae Semen (Tusizi), Astragali Complanati Semen (Shayuanzi), Poria (Fuling), Codonopsis Radix (Dangshen), Pinelliae Rhizoma Preparatum (Banxia), Citri Reticulatae Pericarpium (Chenpi), Mulberry Twig (Sangzhi).
Patient Zhu: Blood and body fluids originate from Stomach. Stomach Qi deficiency leads to blood deficiency and wind movement. Wind stirs within Stomach, leading to fluid deficiency and fire flare-up. Stomach and Large Intestine belong to Yangming. Thus, upper toothache, left shoulder pain, lower constipation and hemorrhoid pain. Dizziness and palpitations are due to blood deficiency. Plan to nourish Yangming Qi and Blood, generate fluids.
Prescription: Prepared American Ginseng (Zhi Yangshen), Biota Seed (Baiziren), Angelicae Sinensis Radix (Guishen), Ophiopogonis Radix (Maidong), Cimicifugae Rhizoma (Shengma), Citri Reticulatae Pericarpium (Xinhui Pi), Yuanjing Stone, Astragali Radix (Huangqi), Atractylodis Rhizoma (Yuzhu), Poria (Fushen), Lotus Peduncle (Hedi).
Annotation by Yuan: Stomach Qi deficiency does not necessarily cause wind. Only when Stomach deficiency fails to distribute refined essence, and Ying Yin loses its nourishment, does Wood dry and wind arise. Upper toothache, lower hemorrhoid pain, fluid depletion and Metal dryness, wind and fire fan each other.
Second visit: Tonify Qi and Blood to stop pain, generate fluids to moisten intestines.
Prescription: Prepared American Ginseng (Zhi Yangshen), Rehmanniae Radix Preparata (Shudi), Astragali Radix (Huangqi), Atractylodis Rhizoma (Yuzhu), Angelicae Sinensis Radix (Danggui), Biota Seed (Baiziren), Citri Reticulatae Pericarpium (Chenpi), Ophiopogonis Radix (Maidong), Cannabis Seed (Maren), Germinated Grain Sprout (Sheng Guya).
Patient Qian: External wind triggers internal wind, right-sided headache, cannot rest pillow. Use Qing Kong Gao.
Prescription: Notopterygii Rhizoma et Radix (Qianghuo), Bupleuri Radix (Chaihu), Saposhnikoviae Radix (Fangfeng), Coptidis Rhizome (Chuanlian, wine-fried), Chrysanthemi Indici Flos (Ganju), Gardeniae Fructus Carbonisatus (Jiaozhi), Scutellariae Radix (Huangqin), Mori Folium (Sangye), Luffae Fructus Reti (Sigualuo), Uncariae Ramulus cum Uncis (Gou gou).
Patient Xue: Head wind pain偏向 right, extends to gums upon onset, severe cases vomit phlegm-saliva. Liver wind attacks Spleen-Stomach, cold phlegm flows into collaterals. Method: Warm tonification and draining transformation.
Prescription: Bamboo Node (Zhujie), Typhonii Rhizoma (Baifu zi), Astragali Radix (Huangqi), Notopterygii Rhizoma et Radix (Qianghuo), Tribuli Fructus (Cili), Pinelliae Rhizoma Preparatum (Banxia), Evodiae Fructus (Wuyu), Prepared Bombyx Batryticatus (Zhi Jiangcan), Uncariae Ramulus cum Uncis (Gou gou).
Annotation by Yuan: Headache and toothache are mostly heat-related, but cold phlegm flowing into collaterals requires warm dispersal.
Patient Hu: Lower abdomen and hypochondrium are the domain of Liver. Waist is the mansion of Kidney. In old age, Essence and Blood wither, collaterals become empty. Liver Qi invades collaterals vacuously, damp-heat follows to cause harm. Tonify Essence and Blood, soothe Liver and unblock collaterals, simultaneously transform damp-heat.
Prescription: Toosendan Fructus (Chuanlianzi), Cyperi Rhizoma (Xiangfu), Linderae Radix (Wuyao), Angelicae Sinensis Radix (Danggui), Poria (Fuling), Inulae Flos (Xuanfuhua), Corydalis Rhizome (Yanhu), Xinjiang (Xinjieg), Citri Reticulatae Pericarpium (Chenpi), Cynomorii Herba (Rongronggan), Green Onion Tube (Qingcongguan).
Second visit: Tonify Essence and Blood, unblock collaterals, hypochondriac pain slightly reduced. Urine is short, epigastric/abdominal bloating after midnight, turbid Qi fails to transform. Add to previous formula items to promote Yang and drain turbidity.
Prescription: Toosendan Fructus (Chuanlianzi), Evodiae Fructus (Wuyu), Linderae Radix (Wuyao), Lycii Fructus (Qizi), Angelicae Sinensis Radix (Danggui), Corydalis Rhizome (Yanhusuo), Poria (Fuling), Plantaginis Semen (Qianzi), Citrus Unshiu Leaf (Juye), Cynomorii Herba (Rongronggan), Mytili Corneus Shell (Jiuxiangchong), Two-headed Sharp (Liangtoujian), Wheat Sprout (Xiaomaiya).
Patient Su: Liver Yin long deficient, Wind-Yang disturbs upward incessantly. Vertex and eyeballs hurt. Pain causes heart buzzing/discomfort, nausea, irritability, insomnia, dry stool. Elderly person during Spring Equinox when Yang rises vigorously. Naturally should nourish Yin to extinguish wind, anchor rebellion and calm spirit.
Prescription: Rehmanniae Radix Preparata (Shengdi), Poria (Fushen), Ecliptae Herba (Ejiao), Glehniae Radix (Shashen), Fresh Polygoni Multiflori Caulis (Xian Shouwu), Cannabis Seed (Maren), Astragali Complanati Semen (Shayuanzi), Ziziphi Spinosae Semen (Zaoren), Chrysanthemi Flos (Ganju), Halitum (Shijueming), Glycyrrhizae Radix et Rhizoma Praeparata (Zhigancao), Ophiopogonis Radix (Maidong), Gold Artifact (Jinqi, decocted first).
Second visit: Blurred vision/hearing usually starts with wind-heat, then Liver fire, eventually leading to Yin deficiency. This case has lasted half a year, undoubtedly Yin deficiency with Yang hyperactivity. Nurture Yin to harmonize Yang, strengthen Water to control Fire, this is a fixed method.
Prescription: Rehmanniae Radix Preparata (Da Shengdi), Ophiopogonis Radix (Maidong), Moutan Cortex (Danpi), Magnetitum (Cishi), Poria (Fushen), Halitum (Shijueming), Gardeniae Fructus Carbonisatus (Jiaozhi), Scrophulariae Radix (Yuanshen), Ziziphi Spinosae Semen (Zaoren), Astragali Complanati Semen (Shayuanzi), Glehniae Radix (Beishashen).
Separately: Ci Zhu Wan 2 qian, taken every morning with salt flower water.
Patient Hua: Long illness, righteous Qi deficient, Yin and Yang both weak, Kan-Li do not intersect, insomnia at night, lying in bed long, intolerant of fatigue. Due to boat travel, distant consultation, suddenly spirit confused, speechless, hands moving不定, covering eyes/hair, irritable. Pulse is rapid and chaotic, no appetite. Likely due to heat/stuffiness in boat stirring Wind-Yang, disturbing Spirit, sudden change. Tentatively propose extinguishing wind and harmonizing Yang, calming spirit and stabilizing will. Hope for clear spirit and intake of grain, then may discuss further.
Prescription: Raw American Ginseng (Sheng Yangshen), Poria (Fuling), Moutan Cortex (Danpi), Astragali Complanati Semen (Shayuan), Halitum (Shijueming), Trichosanthes Seed (Tianzhuhuang), Bamboo Shavings (Zhuru), Ziziphi Spinosae Semen (Zaoren), Young Uncariae Ramulus cum Uncis (Nen Gouteng), Polygalae Radix (Yuanzhi Rou), Gold Foil (Jinbo).
Annotation by Yuan: Turbid phlegm stirred by Wind-Yang blocks Spirit, sudden speechlessness requires resolving phlegm and opening orifices. Resolving phlegm like Antelopic Cornu, Arisaematis Cum Bile, Bamboo Juice. Opening orifices like Realgar, Zhibao Pill, Suhexiang Pill. Use according to syndrome, perhaps effective.
Patient Su: Liver Wind ascending to vertex originally due to Yin deficiency; Turbid phlegm filling Middle Palace mostly due to Spleen weakness. Eye/head pain, heart buzzing, constipation, signs of Yin deficiency and Yang hyperactivity. Thick greasy tongue coating, poor appetite, nausea, signs of Stomach deficiency and turbid reflux. Elderly long-term illness, treatment is difficult. Tentatively prescribe one formula for reference.
Prescription: Ginseng (Ren shen), Pinelliae Rhizoma Preparatum (Banxia), Gastrodiae Rhizoma (Tianma), Citri Reticulatae Pericarpium (Jupi), Natrii Sulfas (Yuanmingfen), Poria (Fushen), Astragali Complanati Semen (Shayuanzi, salt-fried), Magnetitum (Cishi), Phellodendri Cortex (Huangbai), Yuanjing Stone (Yuanjingshi), Dried Ginger (Ganjiang).
Second visit: Headache reduced, able to sleep. Coating thin white with gray tint. Fire descends so Spirit calms, damp transforms so dryness appears. Modify previous formula, hope for turn.
Remove Ganjiang, Huangbai from previous formula, add Anemarrhenae Rhizoma (Zhimu), Glehniae Radix (Beishashen), Ginger-processed Bamboo Shavings (Jiang Zhuru).
Third visit: Headache reduced, but Wind-Yang not fully pacified. Tongue coating gray-white, turbid phlegm not fully transformed. Heart buzzes like hunger, Ying Yin deficient with fire. Dizzy from noise, Yang rebels above, deficient below. Plan to nourish Ying Yin to descend fire, harmonize Stomach Qi to transform phlegm, combine with anchoring rebellion, assist with calming spirit.
Prescription: Prepared American Ginseng (Zhi Yangshen), Ostreae Concha (Muli), Poria (Fushen), Astragali Complanati Semen (Shayuan), Halitum (Shijueming), Rehmanniae Radix Preparata (Da Shengdi), Pinelliae Rhizoma Preparatum (Banxia), Citri Reticulatae Pericarpium (Chenpi), Armeniacae Semen Amarum (Xingren), Yuanjing Stone (Yuanjingshi), Bamboo Shavings (Zhuru).
Imperial Commissioner: Military affairs urgent, mental and physical labor, no time for sleep/eat. Contracted wind pathogen, triggered internal wind, attacking Stomach and rebelling upward. Half-headache, vomiting yellow water. Plan to remove external wind to extinguish internal wind, harmonize Stomach Qi and transform damp-phlegm. Record formula for telegram.
Prescription: Schizonepetae Spica (Jingjie), Gentianae Macrophyllae Radix (Qinjiao), Saposhnikoviae Radix (Fangfeng), Gastrodiae Rhizoma (Tianma), Halitum (Shijueming), Citri Reticulatae Pericarpium (Chenpi), Poria (Fuling), Angelicae Dahuricae Radix (Baizhi), Chrysanthemi Flos (Ganju), Uncariae Ramulus cum Uncis (Gou gou), Pinelliae Rhizoma Preparatum (Banxia), Bamboo Shavings (Zhuru), Amomi Fructus Rotundus (Baokourén).
Certain Patient: Emotions suppressed, primal Qi internally deficient, heart uncomfortable, deficient fire and Liver Wind rebel upward. Lips/mouth swollen/painful, dizziness/tinnitus, poor appetite/weakness, frequent sighing. Prevent phlegm-fire confusing Spirit, not a mild case.
Prescription: Antelopic Cornu (Lingyangjiao), Astragali Complanati Semen (Shayuanzi), Dendrobii Caulis (Chuan Shihu), Trichosanthes Seed (Tianzhuhuang), Halitum (Shijueming), Young Uncariae Ramulus cum Uncis (Nen Gouteng), Ziziphi Spinosae Semen (Zaoren), Chrysanthemi Flos (Ganjuhua), Scrophulariae Radix (Yuanshen), Moutan Cortex (Danpi), Centumbria (Dengxin).
Second visit: Phlegm-fire confuses Spirit, insomnia, prevent madness.
Prescription: Aurantii Fructus Immaturus (Zhishi), Trichosanthes Seed (Tianzhuhuang), Halitum (Shijueming), Poria (Fushen), Antelopic Cornu (Lingyangjiao), Arisaematis Cum Bile (Danning), Coptidis Rhizome (Chuanlian), Bamboo Juice (Zhuli), Ginger Juice (Jiangzhi), Ziziphi Spinosae Semen (Zaoren).
Zhuli Datann Wan 3 qian, taken with boiled water.
Patient Zhu: Water deficiency fails to contain Wood, Yang rises, Yin fails to ascend. At deep spring when Wood is prosperous and Yang rises, chills/fever, headache, chest stuffiness, insomnia, constipation appear. Imitate Zhao Yangkui's method.
Prescription: Rehmanniae Radix Preparata (Da Shengdi, mixed with Amomi Fructus), Poria (Fushen), Moutan Cortex (Danpi), Bupleuri Radix (Chaihu, salt-fried), Ziziphi Spinosae Semen (Zaoren), Ligustri Lucidi Fructus (Nvzhenzi), Ophiopogonis Radix (Maidong, mixed with Cinnabar), Angelicae Sinensis Radix (Guishen), Citri Reticulatae Pericarpium (Chenpi), Zingiberis Rhizoma (Shengjiang), Halitum (Shijueming), Red Date (Hongzao).
Annotation by Yuan: Incorporating water-nourishing and Liver-nourishing into Xiaoyao San shows clever thought.
Patient Chen: Pulse diagnosis: Left Guan alone wiry and slippery. Wind-Yang carrying phlegm disturbs Yangming. Left forehead extending to cheek/teeth hurts. Plan to extinguish Wind-Yang, simultaneously clear phlegm-fire.
Prescription: Antelopic Cornu (Lingyangjiao), Prepared Bombyx Batryticatus (Zhi Jiangcan), Mori Folium (Sangye), Moutan Cortex (Danpi), Young Uncariae Ramulus cum Uncis (Nen Gou gou), Chrysanthemi Flos (Ganjuhua), Halitum (Shijueming), Fresh Lonicerae Japonicae Caulis (Xian Yinhua Teng), Tribuli Fructus (Cili).
Separately: Asari Radix (Xixin) 3 fen, Schizonepetae Spica (Jingjie) 1.5 qian, Raw Gypsum (Sheng Shigao) 5 qian. Grind coarse, brew water to gargle.
Separately: Frankincense (Ruxiang) 1 qian, Myrrh (Moyao) 1 qian, Raw Arisaema (Sheng Nanxing) 1 qian, Raw Pinelliae Rhizoma (Sheng Banxia) 1 qian, Bombyx Batryticatus (Jiangcan) 1 qian, Borneolum Syntheticum (Bingpian) 3 fen. Grind fine, mix with aged wine and dry flour to apply.
Patient Xu: Too much grief over brother's death, Liver Yang rises uncontrollably. Initially manic, now palpitations, insomnia, dizziness, dry mouth, slight cough. Plan to calm spirit, nourish Yin, clear fire, descend Qi.
Prescription: Halitum (Shijueming), Moutan Cortex (Danpi), Ziziphi Spinosae Semen (Zaoren), Poria (Fushen), Fritillariae Thunbergii Bulbus (Chuanbei), Glehniae Radix (Beishashen), Citri Reticulatae Pericarpium (Guang Juhong), Ophiopogonis Radix (Maidong), Scrophulariae Radix (Yuanshen), Bamboo Shavings (Zhuru), Loquat Leaf (Pipaye).
Patient Zhang: Classic says: Deficiency above causes vertigo. Danxi says: No phlegm no vertigo. Pathogenesis Treatise says: All wind tremors and vertigo belong to Liver. Vertigo/dizziness is caused by deficiency, wind, and phlegm. Forgetfulness and muscle twitching are diseases of deficiency and Liver. Vomiting dry/greasy phlegm is transformed body fluid. Treating from these three aspects, even if not exact, is close.
Prescription: Raw American Ginseng (Sheng Yangshen), Gastrodiae Rhizoma (Tianma), Trichosanthes Seed (Tianzhuhuang), Fritillariae Thunbergii Bulbus (Chuanbei), Poria (Fushen), Prepared Arisaema (Zhi Nanxing), Halitum (Shijueming), Ostreae Concha (Muli), Chrysanthemi Flos (Ganjuhua), Achyranthis Bidentatae Radix (Niuxi), Ligustri Lucidi Fructus (Nvzhenzi), Young Uncariae Ramulus cum Uncis (Nen Gou gou).
Second visit: Vertigo/dizziness with deficient wind and phlegm, previous formula layout is established. Illness brings palpitations and tendon contraction, nourishing blood and clearing Liver logic must participate.
Prescription: Raw American Ginseng (Sheng Yangshen), Trichosanthes Seed (Tianzhuhuang), Gastrodiae Rhizoma (Tianma), Fritillariae Thunbergii Bulbus (Chuanbei), Young Uncariae Ramulus cum Uncis (Nen Gou gou), Antelopic Cornu (Lingyangjiao), Halitum (Shijueming), Acori Tatarinowii Rhizoma (Changpu), Poria (Fushen), Da Bu Yin Wan.
Patient Zhu: External wind triggers internal wind, sides of head and vertex hurt. Cough, white tongue coating, fever, good appetite/knows taste, disease in Upper Jiao. Ancient formulas for headache all use wind drugs, because only wind can reach high peaks.
Prescription: Schizonepetae Spica (1 qian), Chuanxiong Rhizome (8 fen, wine-fried), Armeniacae Semen Amarum (3 qian), Saposhnikoviae Radix (1.5 qian), Chrysanthemi Flos (1 qian), Scutellariae Radix (1.5 qian, wine-fried), Aurantii Fructus Immaturus (1 qian), Notopterygii Rhizoma et Radix (1.5 qian), Ligustici Rhizoma et Radix (1 qian).
Grind above herbs coarse, add Songluo tea leaves 3 qian externally. Divide into three doses, brew with boiling water. Separately: Asari Radix (3 fen), Realgar (1 fen), grind fine, insufflate nose to induce sneezing.
Annotation by Yuan: Ancient formula Qingkong Gao is purely ascending and dispersing, meaningless, few indications suitable.
Patient Tang: Liver Wind too vigorous, Liver Yin also deficient. Qi vigorous leads to fire movement and wind generation. Yin deficient leads to fluid deficiency and blood weakness. Blood weak causes palpitations, fluid deficient causes dry mouth. Fire moves causes fever, wind generates causes headache. Plan to assist Metal to calm Wood, cultivate Earth to extinguish wind, nourish blood to soften Liver, benefit Yin to retreat heat.
Prescription: Angelicae Sinensis Radix (Guishen), Moutan Cortex (Danpi, salt-fried), Glehniae Radix (Beishashen, mixed with 3 fen Evodiae Fructus and stir-fried), Ziziphi Spinosae Semen (Zaoren), Citri Reticulatae Pericarpium (Chenpi), Atractylodis Macrocephalae Rhizoma (Dongzhu, earth-fried), Tribuli Fructus (Cili), Bean Skin (Doupi), Poria (Fushen), Paeoniae Radix Alba (Baishao), Citrus Unshiu Leaf (Juye).
Patient Lu: Yang rises causing headache, Heart deficiency causing forgetfulness, phlegm-fire confusing Heart, appearing dull or manic. Calming spirit and stabilizing will, Ginseng can be used, but cloying tonification is slow due to poor intake and excessive phlegm. Soothing depression and transforming phlegm, Fritillaria is best, but drying/astringent must be avoided due to dry white tongue coating. Subduing Yang and extinguishing wind requires heavy anchoring, but astringents should be forbidden, fearing they retain phlegm.
Prescription: Ginseng (Renshen), Poria (Fushen), Fritillariae Thunbergii Bulbus (Chuanbei), Halitum (Shijueming), Tridacnae Concha (Geqiao), Ziziphi Spinosae Semen (Zaoren, mixed with 3 fen Coptidis Rhizome, stir-fried, ground).
Second visit: Pulse fine and rapid, lazy speech, tired lying down, indicates deficiency of Essence, Qi, and Spirit. However, white greasy tongue coating indicates phlegm and fluid retention. Observing expression: quiet then Qi slack and seeming deficient, moving then Qi rises and chaotic, indicating deficiency with phlegm and fire. Fire hidden then phlegm doesn't rise so quiet, quiet then deficiency signs appear; Fire moves then phlegm rises so irritable, irritable then deficiency signs hide. Not truly deficient, phlegm-fire causes fluctuations. Treatment does not exceed modification of Shiwei Wendan Decoction. Clinical cases have different thoughts, all related to root foundation.
Prescription: Ginseng Rootlet (Renshenxu), Fritillariae Thunbergii Bulbus (Chuanbei), Poria (Fushen), Ziziphi Spinosae Semen (Zaoren), Halitum (Shijueming), Citri Reticulatae Pericarpium (Juhong).
Third visit: Yin obstructed externally, Yang hidden internally. Yin like fog, Yang like sunlight. Now Yang obstructed by Yin, thus heavy/silent and confused, pulse also not apparent. Sometimes sunlight appears, then sit up and spirit clears, pulse slightly rises. Soon darkness gathers, Yang obscured again, then still drowsy like sleeping. Previous case said phlegm-fluid retained inside, Shiwei Wendan repeatedly administered without effect. Reconsidering disease origin starting from...