头痛久而不愈，名曰头风。头风多害眼，方书固已言之矣。尚有一种突变，神迷肢掣，
不可
救治之证，前贤未经道及。曾见曙翁乃郎，年约十岁，头痛时发，予因他事过其家，见儿号
泣，询之，翁告之故。出方药皆辛散之属。予曰∶此由先天不足，木失水涵，风阳上冒，辛
散不宜。翁求方，疏归芍地黄汤付之。翁惑旁言，遂置不服，仍请原医看视，以为前药尚轻
，更增细辛 本，一夕痛剧而厥，手足螈 ，急来延予。予曰∶肝风动矣，不可为也。翁恳
拯援，勉用熟地、党参、麦冬、阿胶、炙甘草、麻仁、枣肉、茯神、白芍，合复脉汤，参入
牡蛎、龟板方诸水介潜之法，不验辞之。更医无功，迁延数日而殁。续见仇姓稚子及方氏女
，证同皆不治。推详病机，证属头痛巅疾，下虚上实，治当上病下取。医昧病原，恣行辛散
，以致变幻，其理显然。凡诸痛厥可治者尚多，惟此证一经神迷，即莫能救，此其故岂所谓
甚则入肾，内夺而厥，则为喑痱者与。初集载有郑氏妇一证，予虽为治愈，然亦幸也。
安波按∶肝风肝厥，发逆以后，此风盛行。大抵感乎日久人情矫柔造作的致，何则，
当发逆炽张时，人且谋食疗生之不暇，岂有怒发冲冠之患乎。
秀兄年逾五旬，向在维扬贸易，患病数月，延医多人，愈疗愈剧。因买舟载归。望其形
容枯
槁，行动艰难，诊脉弦劲欠柔。询其病原，据述旧冬少腹痈起，渐次痛连中脘，时作呕恶，
彼时纳谷虽减，尚餐烂饭一盂，交春病势日增，即啜稀糜亦吐，形羸肉脱，便秘皮枯，药饵
遍尝，毫无一效。迩来更加恶闻药气，入口即吐，君将何以教之?予曰∶医之审病，如吏之
审案，审案必得其情，审病须明其理。推详脉证，其病机已了然心目矣。按弦为肝脉，诸痛
属肝，厥阴之脉，循少腹，究缘平日情怀不适，木郁失条，少腹因而致痛。然肝为将军之官
，脏刚性急，医投辛香温燥，希图止痛，肝阴被劫，怒木益横，冲胃为呕，此肝为受病之原
，胃为传病之所。医多药杂，胃气益伤。夫胃为水谷之海，气血俱多之经，既不安谷，气血
从何生化?肤无血润则枯槁，肠无血润则干燥。阳气结于上，阴液衰于下，欲走噎途，岂区
区草木所能回枯转泽耶。经云∶诸涩枯涸，干劲皴揭，皆属于燥。燥者濡之，治法固无难也
。无如濡润之品，恒多凝滞。现今胃气空虚，呕吐恶闻药气，焉能强进?考古人治血气两伤
之候，先当益气，气为血之帅也。但益气药品殊多，首推人参者，以其能回元气于无何有之
乡
也。再考东垣云∶胃中虚热，谷气久虚，而为呕吐者，但得五谷之阴以和之，则呕吐自止，
不必用药。谨择参米饮一方，气味冲和，谅当合辙。于是每日用人参二钱，陈米水煎，果受
不吐，服至匝旬，餐加色转，再合参乳汤，守服两月，便濡肤泽而起。如此大证，只此二方
，并未别参他味，药简功专信矣。
安波按∶病久属虚，故人参能受，不然肝无补法之旨，竟置于无矣。
头痛迁延不愈，称为头风。头风多会损害眼睛，医书里已经说过了。还有一种突然发作的危重证候，表现为神志昏迷、肢体抽搐，属于无法救治的情况，前代名医未曾提及。我曾见过黄曙堂老先生的儿子，大约十岁，头痛时常发作。我因其他事情路过他家，看见孩子哭闹，询问原因，老先生告知了病情。医生开出的方药都是辛温发散类的。我说：“这是由于先天不足，肝木失去肾水的涵养，导致风阳上扰头部，不宜使用辛散药物。”老先生请求我开方，我开了归芍地黄汤给他。但老先生听信旁人的话，于是放置不用，仍然请原来的医生诊治，认为之前的药力太轻，又增加了细辛和藁本。结果一夜之间头痛加剧并出现昏厥，手足抽搐，急忙来请我救治。我说：“这是肝风内动，无法挽救了。”老先生恳求救助，我勉强使用了熟地、党参、麦冬、阿胶、炙甘草、麻仁、枣肉、茯神、白芍，配合复脉汤，加入牡蛎、龟板以及各类介壳类潜阳的药物，但无效后便辞别不再治疗。后来换其他医生治疗也无效，拖延数日后去世。随后又见到姓仇的小孩和姓方的女子，症状相同，也都无法救治。推究病机，此证属于头痛巅疾，下虚上实，治疗应当上病下取。医生不明白病因，肆意使用辛散药物，导致病情变幻莫测，道理很明显。凡是各种疼痛和昏厥可治的情况还很多，唯独这个证候一旦神志昏迷，就再也无法挽救，这难道不是《内经》所说的“甚则入肾，内夺而厥，则为喑痱”吗？初集中记载有一个郑氏妇的病例，我虽然治愈了她，但也算是侥幸。
安波按：肝风和肝厥，在太平天国战乱之后，这种风气盛行。大抵是因为长久以来人情矫揉造作导致的。为什么呢？当太平军势力猖獗时，人们连谋求生路都来不及，哪里有发怒到头发竖起冲冠的闲情逸致呢？
秀翘兄年过五十，之前在扬州经商，患病几个月，找了很多医生，越治病情越重。于是买船载他回家。看他形体枯槁，行动艰难，诊脉弦劲缺乏柔和之象。询问病因，据他说去年冬天少腹长痈，逐渐疼痛牵连到中脘部，时常呕吐恶心。那时虽然食欲减退，还能吃下一碗烂饭。到了春天，病情日益加重，即使喝稀粥也会吐出来，身体消瘦肌肉脱失，便秘皮肤干枯，各种药物都试过了，毫无效果。近来更加厌恶药味，入口即吐，您有什么教导？我说：“医生诊断疾病，就像官吏审理案件，审理案件必须弄清实情，诊断疾病必须明白原理。推究脉象和症状，病机在我心里已经很清楚了。按弦脉是肝脉，各种疼痛归属于肝，厥阴肝经循行经过少腹，追究起来是因为平时心情不畅，肝气郁结不得舒展，导致少腹疼痛。然而肝被称为将军之官，脏性刚强急躁，医生投用辛香温燥的药物，企图止痛，却劫伤了肝阴，使肝气更加横逆，冲犯胃腑导致呕吐，这是肝为受病的根源，胃为传变疾病的场所。医生用药杂乱，进一步损伤了胃气。胃是水谷之海，气血生化之源，既然不能受纳水谷，气血从哪里生化呢？皮肤没有血液滋润就会枯槁，肠道没有血液滋润就会干燥。阳气结聚于上，阴液衰败于下，想要走噎嗝（食道梗阻）的路子，哪里是区区草木药物所能挽回枯槁、转回润泽的呢？《内经》说：‘诸涩枯涸，干劲皴揭，皆属于燥’。燥证应当用濡润的方法治疗，治法本来不难。无奈濡润的药物大多性质凝滞。现在胃气空虚，呕吐且厌恶药气，怎么能强行进补呢？考察古人治疗气血两伤的证候，首先应当益气，因为气是血的统帅。但是益气的药物很多，首推人参，因为它能在元气将绝之时挽回生命。再考察李东垣的说法：‘胃中虚热，谷气久虚，而为呕吐者，但得五谷之阴以和之，则呕吐自止，不必用药’。谨慎选择参米饮一方，气味冲和，想必合乎病机。于是每天用人参二钱，陈米煎水，果然服用后不吐，服到十天，饮食增加面色好转，再合用参乳汤，坚持服用两个月，大便通畅皮肤润泽而痊愈。如此大病，只用这两个方子，并未掺杂其他药物，药简效专确实可信啊。
Headache that persists for a long time without healing is called Tou Feng (Head Wind). Tou Feng often damages the eyes, as stated in medical texts. However, there is another type of sudden, severe manifestation characterized by mental confusion and limb convulsions, which is incurable; this has not been mentioned by former sages. I once witnessed the son of Old Man Huang Shutang, who was about ten years old, suffering from recurrent headaches. Passing by his home on other business, I saw the child crying and wailing. Upon inquiry, the old man explained the situation. The prescriptions provided by the doctor consisted entirely of acrid and dispersing herbs. I said: "This is due to congenital deficiency, where Liver Wood fails to be nourished by Kidney Water, leading to the upward冒 (assault) of Wind-Yang. Acrid dispersing methods are inappropriate." The old man requested a prescription, so I prescribed Gui Shao Di Huang Tang (Cinnamon Twig, White Peony, and Rehmannia Decoction). Confused by others' advice, he discarded it and continued with the original doctor, who thought the previous medicine was too mild and added Xixin (Asarum) and Bencao (Ligusticum), resulting in severe headache and syncope overnight, along with spasms of the hands and feet. He urgently sought my help. I said: "Liver Wind has stirred; it cannot be saved." The old man pleaded for rescue, so I reluctantly used Shudi (Prepared Rehmannia), Dangshen (Codonopsis), Maidong (Ophiopogon), Ejiao (Donkey-hide Gelatin), Zhigancao (Honey-fried Licorice), Mahren (Hemp Seed), Zao Rou (Jujube Flesh), Fushen (Poria with Hostwood), and Baishao (White Peony), combined with Fu Mai Tang (Pulse-Recovering Decoction), incorporating Ouli (Oyster Shell), Guiban (Turtle Shell), and other bivalve/shellfish minerals for their subduing properties. It proved ineffective, and I declined further treatment. Subsequent doctors were also unsuccessful, and after several days of delay, he died. Subsequently, I encountered a young boy surnamed Qiu and a girl surnamed Fang, presenting identical symptoms, both of whom were incurable. Analyzing the pathogenesis, this syndrome belongs to Tou Feng (Head Wind) affecting the vertex, characterized by deficiency below and excess above. Treatment should address the upper disease by treating the lower part. The physicians misunderstood the etiology and recklessly used acrid dispersing methods, causing the condition to deteriorate; the logic is clear. While many cases of pain and syncope are treatable, once this specific syndrome involves mental confusion, it becomes untreatable. Is this not what the *Neijing* refers to when it says, "When severe, it enters the Kidney; internal depletion leads to syncope, resulting in aphasia and flaccidity"? In Volume One, there is a case of Madam Zheng, which I cured, but it was merely fortunate.
An Bo's Note: Liver Wind and Liver Syncope became prevalent after the Taiping Rebellion. This is largely due to the artificiality and affectation of human emotions over a long period. Why? When the Taiping forces were rampant, people were too busy struggling for survival to indulge in rage that makes hair stand on end.
Brother Xiuqiao was over fifty years old and had been trading in Weiyang (Yangzhou). He had been ill for months, seeing many doctors, yet the more he was treated, the worse he became. I arranged for him to be transported home by boat. His appearance was emaciated and withered, and his movements were difficult. His pulse was wiry, forceful, and lacked softness. Asking about the origin of the illness, he recounted that last winter, an abscess appeared in his lower abdomen, gradually causing pain radiating to the Zhongwan (CV12) area, accompanied by occasional nausea and vomiting. At that time, although his appetite decreased, he could still eat one bowl of soft rice. As spring arrived, the condition worsened daily; even thin gruel caused vomiting. His body wasted away, muscles depleted, constipation set in, and skin became dry. Various medicines had been tried with no effect. Recently, he developed a strong aversion to the smell of medicine, vomiting immediately upon ingestion. How do you advise me? I said: "A physician diagnosing an illness is like an official judging a case. To judge a case, one must understand the facts; to diagnose an illness, one must clarify the principles." Analyzing the pulse and symptoms, the pathogenesis was clear to me. A wiry pulse corresponds to the Liver; various pains belong to the Liver. The Jueyin Liver meridian circulates through the lower abdomen. Tracing back, it stems from habitual emotional distress, where Liver Qi stagnates and fails to flow smoothly, causing lower abdominal pain. The Liver is the "General," possessing a rigid and impatient nature. Physicians administered acrid, aromatic, warm, and drying herbs to relieve pain, which consumed Liver Yin and allowed the angry Liver Wood to become even more rampant, attacking the Stomach and causing vomiting. Thus, the Liver is the root of the disease, and the Stomach is the site of transmission. The chaotic use of multiple drugs further damaged Stomach Qi. The Stomach is the Sea of Water and Grain, the source of Qi and Blood. If it cannot accept food, how can Qi and Blood be generated? Without blood to moisten the skin, it becomes withered; without blood to moisten the intestines, they become dry. Yang Qi knots in the upper, while Yin fluids decline in the lower. Moving towards the path of Ye Ge (Dysphagia/Esophageal Obstruction), how can mere herbs reverse this withering and restore moisture? The *Classic* states: "All cases of obstruction, withering, drying, stiffness, and cracking belong to Dryness." Dryness should be treated with moistening methods; thus, the treatment principle is not difficult. However, moistening agents are often cloying and stagnant. With empty Stomach Qi, vomiting, and aversion to medicinal odors, how can they be forced down? Studying ancient treatments for simultaneous Qi and Blood deficiency, one must first tonify Qi, for Qi is the commander of Blood. Among Qi-tonifying herbs, Ginseng is paramount because it can restore Yuan Qi (Original Qi) from nothingness. Furthermore, Li Dongyuan stated: "For vomiting caused by deficient heat in the Stomach and prolonged deficiency of Grain Qi, obtaining the Yin of five grains to harmonize it will stop the vomiting without medication." Therefore, I carefully selected Shen Mi Yin (Ginseng and Rice Drink), which has a mild and harmonious flavor, likely fitting the pattern. Thus, two qian of Ginseng were decocted with aged rice water daily. Indeed, he tolerated it without vomiting. After ten days, his diet increased and complexion improved. Then, Shen Ru Tang (Ginseng and Milk Decoction) was combined and taken for two months. Bowel movements became smooth, skin became lustrous, and he recovered. For such a severe condition, only these two formulas were used, without any other ingredients. Simplicity of prescription and specificity of action are indeed trustworthy.
An Bo's Note: Since the disease has persisted for a long time, it belongs to Deficiency; hence, Ginseng can be tolerated. Otherwise, the principle that "the Liver has no tonification method" would have rendered this approach useless.