8．张女。久疟面色灰败，气血耗伤已极。肠无血以滋濡，故大便难而努责脱肛。春柴胡6克，升麻5克，绵黄芪12克，潞党参9克，生白术6克，陈皮9克，全当归9克，清炙草3克，半贝丸9克（吞）。另：陈红茶6克，五倍子9克，生地榆9克，煎汤乘热熏洗肛门。【按】此为久疟伤正。大便难，为肠失滋润；脱肛，为中气下陷。治用补中益气汤以扶正气；半贝丸化痰截疟。《通俗伤寒论》中的除疟胜金丹就用半贝丸。至于熏洗方乃先生常用验方，对于脱肛有效。
9．张男。服奎宁不得法，疟型遂乱。其发既不战栗，又不出汗，可知疟原虫虽无分裂能力，但尚未扑灭。面色不华，予补中益气汤加减。生黄芪9克，潞党参9克，全当归9克，绿升麻24克，软柴胡5克，生白术9克，陈皮5克，草果5克，制首乌12克，粉甘草5克。【按】此病服奎宁不得法，邪未除而正已伤，故不用柴平汤一类，而用补中益气汤加味。制首乌、党参、当归、陈皮，名何人饮（原方用人参），是张景岳治虚疟的名方，亦以补益气血为法。用于体虚久疟，确有良效。
10．卜女。疟原虫能破坏红细胞，故疟后体力多衰弱，假使疟原虫未能扑灭殆尽者，感寒、疲劳，动辄复发。生黄芪12克，党参9克，白术9克，当归6克，炙草3克，桂枝1．5克，大枣5枚，生姜2片，升麻6克，柴胡5克，酒淋黑豆15克，陈皮6克。【按】此用补中益气汤加味，扶养正气，以增强机体的抗疟能力。
11．刘男。服奎宁不得法，最能使疟原虫潜伏于内，酿成他变。今脉搏增快，默默不欲食。春柴胡3克，淡子芩9克，广陈皮9克，生苍术9克，姜半夏9克，潞党参6克，厚朴9克，炙甘草2．4克，生姜3片，大枣7枚。【按】使用抗疟药应注意其服用剂量及用药天数，否则非但达不到治疗效果，反会使疟原虫潜伏，导致慢性疟疾，反复发作，并引起贫血，脾肿大（中医称做"疟母"）。今脉搏增快，默默不欲食，为病在少阳，以柴平汤和解达邪，燥湿化痰。
12．杨女。去年9月抵沪，11月发疟，连续月余。停两星期又发，如此淹淹蹇蹇，腹之左侧有明显之肿块，此为疟母。春柴胡12克，赤芍9克，莪术9克，归尾9克，摈掷12克，桃仁15克。【按】疟母已成，便须化痰攻瘀。此方乘正气半衰之际，使用攻逐，冀其疟母消散。
13．陆女。疟连日作，已五六日，当恶寒时亦汗出津津，虚故也。凡用温补药，皆有间接扑灭疟原虫之意。当归9克，白芍9克，煨草果6克，黄芪9克，桂枝5克（后下），威灵仙9克，山萸肉9克，五味子5克，粉甘草3克，巴戟天9克，生姜3片，红枣9枚，半硫丸6克（分2次吞）【按］疟疾恶寒时往往无汗，此则恶寒时汗出津津，乃阳气虚弱之故。立方以温补为主，用功能截疟的半硫丸、草果等于温补之中；所谓温补药间接扑灭疟原虫，乃扶正达邪之意。
14．张男。加被则心烦不寐，去被则否，此大虚之候。原来恶疟最能衰人之体力，故景岳有何人饮之设。制首乌12克，全当归、生黄茂。潞党参各9克，橘皮6克，川桂枝6克，白芍9克，粉甘草3克，生姜3片，大枣5枚。
二诊：加被心已不烦，肝脾之触诊亦柔软不拒按，与初诊之严重状况，有天壤之别矣。炮附子5克，杭白芍9克，潞党参12克，川桂枝3克（后下），制首乌12克，全当归18克，粉甘草5克，陈皮6克，生姜1大块，大枣9枚。【按】此种烦乃虚烦，非躁可比。用景岳何人饮和黄芪建中汤（去饴糖）为治，切合病机，故一击而中。
1．卢女。高年便秘，津枯而肠燥也。当归12克，桑椹子15克，杏仁泥24克，黑芝麻15克，杭白芍9克，火麻仁12克，制首乌12克，糖炒山楂9克。【按】高年气血皆虚，血少津枯，大肠失润，其治当养血润燥。方用首乌、归、芍、桑椹补血养阴；杏仁、火麻仁润肠，山楂行滞。首乌生者含有大黄酸，有促进肠管蠕动的作用，熟者善能养肝肾、益精血。据现代药理研究，且能阻止血管内胆固醇沉积，为治疗老年疾患如冠心病等值得重视的药物。此方药多有油质，为滑润缓下剂，较更衣丸、脾约麻仁丸更稳妥。对体虚便秘，孕妇便秘以及大病后便秘均可应用。
2．刘女。头眩眼花，体力薄弱已甚。4日以来，大便艰难，临圊数小时亦不得下。生首乌30克，麦冬9克，桑椹子12克，柏子仁12克，油当归9克，黑芝麻15克。【按】便秘一证，虽责诸大肠传导失职，但有虚实之分，即虚亦有气虚、血虚之异，不可徒传攻下通便。此人头眩眼花，为血虚之象，故重用首乌，配以生津、补血、润肠之品。
3．朱女。平素有顽固性便秘，恒旬日更衣，而其量亦少。每日服丸剂，一周后方每日皆有，然不畅，噫气胸痞。昨日大便量稍多，而腹痛大作，饮食后胃院亦胀痛不已。广木香2．4克，杭白芍9克，晚蚕沙9克（包），薤白9克。小青皮9克，台乌9克，菜菔子12克，苏梗9克，谷麦芽各9克。【按］此为顽固性便秘，服丸药后始得大便。今大便量稍多，则腹痛大作，为气机郁滞，药用木香、青皮、苏梗、台乌、薤白等以理气止痛。
4．周男。左目赤、目胞肿，夙有便秘。今大便不爽，口有臭味。夫病在上取之下。草决明15克，茺蔚子15克，赤芍、生大黄（后下）、粉丹皮、菊花各9克，桃仁泥12克，黄连上清丸9克（分3次吞）。
【按】大黄通大便，配以桃仁则效益彰；赤芍与桃仁、丹皮相配，功能活血凉血。凡赤肿用消炎药，常配以活血凉血药，此古人成法。暴赤眼前人用青宁丸（即制大黄研粉为丸），今兼便秘，故"上病下取"用生大黄导下。
5．余男。下院胀满者，十去其七，苔仍灰腻，通其便，其苦自然消失。古人苔腻者，燥之，亦健其胃、动其肠而已。薤白头9克，槟榔6克，皂荚子4．5克，晚蚕沙9克，台乌药6克，生枳实9克，莱菔子9克，橘皮6克，谷麦芽各9克。二诊：便通而胀满除，食欲依旧迟钝，不必治肠，但当治胃。怀山药9克，款炒积实9克，谷麦芽各9克，云茯苓9克，佛手片6克，鸡内金9克，佩兰梗9克，潞党参9克，陈皮6克。
三诊：食欲依旧不振，体弱者，纯用刺激性无益也。薤白头9克，谷麦芽各9克，潞党参9克，款炒积实6克，鸡内金9克，生白术9克，云茯苓9克，橘红4．5克，粉甘草2．5克。四诊：已能稍进糜粥，食后仍感痞闷，约一时许逐渐消失，其为消化力迟钝无疑。生鸡金4．5克，谷麦芽9克，广木香6克，六神曲18克，潞党参9克，川厚朴4．5克，薤白头9克。共研细末，每服1．5克，1日3次。
【按】下院胀满，大便有待于通，而舌苔灰腻，湿邪为病显然。因湿而致之便秘，古称湿秘（如《普济方》）。《素问.真要大论》云："湿淫所胜……大便难"，已认识到此证之存在；清.鞠通《温病条辨》亦尝论及此证云："脾主地气，属太阴湿土，湿气太过，反伤本脏化气，湿久浊瘀，至于下焦，气不惟伤，而且阻矣。气为湿阻，二便不通。"便之不通，既由于湿阻气滞，故其治疗原则，亦惟除其湿之阻，行其气之滞而已。先生所谓"苔腻者燥之"，除其湿也；"健其胃、动其肠"者，行其气也。
蚕沙、皂荚子为《湿病条辨》宣清导浊汤中要药。吴氏自释其方云："蚕砂能走少腹之浊部，又能化湿浊而归清……皂荚……燥能除湿，辛能通上下关窍，子更直达下焦，通大便之虚秘………逐有形之湿"。槟榔，《普济方》用以治"湿秘，肠胃有湿，大便秘塞"。方中任此三味为除湿通便之主药。又，槟榔、枳实、乌药三者，乃五磨饮子之重要组成部分，其宽中除满、推动气分之力极强，伍以"辛通滑利，能泄下焦阳明气滞"（李东垣《用药法象》）之薤白，以畅利气机。陈皮、佛手，芳香理气、开胃进食。此例湿浊之生，殆与伤食有关，故又用莱菔子、谷麦芽以和胃消食。证方相符，故能应手。二诊以后，便通而胀满除，惟食欲迟迟不振，是湿浊虽蠲，而先时受戕之中气未复，遂与消补并用之法治之，立法层次井然，值得效法。
6．高女。平素有习惯性便秘，此番6日未大便。大凡暴秘可泻，久秘不可泻。泻药只能取快一时，停药则其秘如故。面色不华，脉软，用药以振奋肠功能。全当归12克，生白术9克，薤白9克，生麦芽12克，木香6克，生鸡金9克，杭白芍12克，炙草3克，半硫丸9克（分3次吞）。二诊：无效，肠之蠕动陷于麻痹状态，予千金温脾饮。党参9克，干姜3克，熟大黄9克，清炙草3克，炮附块6克，全当归12克，玄明粉9克（分3次冲）。
［按］初诊服药二剂不效，二诊头煎药服后3小时即得便，说明初诊药力不足。病人面色不华，脉软而便秘，为排便动力缺乏，中医称之"冷积便秘"。用温脾饮，振奋脾阳，攻逐冷积，亦属"振奋肠功能"之举。
7．王女。大便秘结，数日不下，胸脘痛，手不可近。得之拂逆之后。下之痛当已。熟大黄4．5克，台乌药9克，沉香曲9克，槟榔片9克，焦枳实9克，广木香3克，杏仁泥15克，莱菔子9克（研）。【按】肝气郁结，气机壅滞，以致大肠传导失职，积滞内停。治用五磨饮子加大黄、杏仁、莱菔子，调气破结，行滞导下。
1．陈男。两目发黄，较前大退，是病势向愈之先声。凡治黄不利大小便，非其治也。生大黄3克，茵陈9克，玄明粉9克，茺蔚子9克，草决明9克，生米仁12克，泽泻9克，车前子12克。【按】黄疸多因脾胃湿热熏蒸于肝胆，使胆汁不循常道而外溢所致。所以注重利大小便，给湿热之邪以出路，湿热得去，则黄疸自消。方用茵陈清利湿热；大黄、玄明粉清热通下；茺蔚子、草决明清肝退黄；苡仁、泽泻、车前子除湿利尿，为阳黄正治之法。
2．周幼。热虽退，肝脏部位触之仍痛。生大黄3克，玄明粉9克，绵茵陈9克，生苍术9克，草决明12克，广郁金3克（研分2次吞），赤猪苓各9克，车前子9克。【按】此例黄疸，发热虽退，肝区仍有触痛，是湿热之邪未清，故续用清利湿热之剂；因湿热蕴阻，最易阻遏气机，是以又用广玉金疏肝祛瘀而止痛，研末吞服，功较煎剂为优。
3．朱女。两目发黄，小溲短赤，热势起伏，渴欲饮水，左胁痛，证属阳黄，殆无疑义。绵茵陈30克，金银花15克，嫩白薇12克，鲜生地60克（打汁冲），马鞭草15克，全瓜萎9克，玄明粉9克，泽泻12克，车前子15克。
【按］叶桂说："阳黄之作，湿从火化。"今病黄疸而热势起伏，渴欲饮水，正是湿热化火之例。方用大剂鲜生地汁养阴凉血；合银花、白薇以清热泻火；用大量茵陈与车前子、泽泻、马鞭草相伍，以清利湿热退黄；用瓜萎、玄明粉通大便，使湿热之邪从下窍而出。其中茵陈一味，既能发汗使湿热从汗而出，又能利水使湿热从小便而去，是治疗黄疸的要药。
4．金男。病已5天，曾经战栗，而后发热。察其两目有充血状，小溲短赤。目赤者当下之，溲赤者当利之，于导赤散加味。小生地15克，细木通4．5克，生草梢4．5克，绵茵陈15克，车前子18克，草决明12克，芜蔚子12克，嫩白薇12克，望江南9克，郁李仁9克，淡竹叶30片。
二诊：药后热即退清，全身乏力，头目眩晕，两目充血，小溲短赤而痛。平素嗜酒，体质丰腴，湿热之蕴结久矣。生苍术9克，川黄柏9克，淮牛膝9克，绵茵陈15克，山桅皮9克，细生地15克，冬青子9克，旱莲草9克，生草梢4．5克。三诊：黄疸症状具备，其主症有五：①两目发黄，小溲短赤；②肝区触痛；③高热，脉数；④呕哕频仍；⑤夜寐烦躁，不可名状。绵茵陈15克，黑山栀9克，净连翘9克，鲜生地90克（捣汁冲），嫩白蔽9克，竹茹叶各9克，冬葵子9克，福泽泻9克，石韦9克，活芦根30厘米。
四诊：越宿热退神清，病势之变化，与昨判若霄壤；两目仍黄，小溲短赤。凉血淡渗之剂续进。原方加猪苓9克，冬瓜子皮各15克。五诊：心烦，呕吐，高热，脉数，俱不再见，目之黄、波之赤亦减。绵茵陈15克，草决明9克，茺蔚子9克，广郁金4．5克，冬葵子9克，泽泻9克，赤猪苓各9克，车前子18克。
8．张女。长期患疟疾，面色灰暗败坏，气血耗损已到了极点。肠道缺乏血液滋润濡养，所以大便困难且用力排便时导致直肠脱出（脱肛）。处方：春柴胡6克，升麻5克，绵黄芪12克，潞党参9克，生白术6克，陈皮9克，全当归9克，清炙甘草3克，半贝丸9克（吞服）。另法：陈红茶6克，五倍子9克，生地榆9克，煎汤趁热熏洗肛门。【按语】这是久疟损伤正气所致。大便困难，是因为肠道失去滋润；脱肛，是因为中气下陷。治疗使用补中益气汤来扶助正气；半贝丸用于化痰截断疟疾。《通俗伤寒论》中的除疟胜金丹就使用了半贝丸。至于熏洗方是先生常用的有效验方，对于脱肛有效。
9．张男。服用奎宁方法不当，疟疾病型因此混乱。其发作时既不寒战，也不出汗，可知疟原虫虽无分裂能力，但尚未被彻底消灭。面色无光泽，给予补中益气汤加减。处方：生黄芪9克，潞党参9克，全当归9克，绿升麻24克，软柴胡5克，生白术9克，陈皮5克，草果5克，制何首乌12克，粉甘草5克。【按语】此病因服用奎宁不得法，邪气未除而正气已伤，所以不用柴平汤一类，而用补中益气汤加味。制何首乌、党参、当归、陈皮，名为何人饮（原方用人参），是张景岳治疗虚性疟疾的名方，也是以补益气血为治法。用于体虚久疟，确有良效。
10．卜女。疟原虫能破坏红细胞，所以疟疾后体力多衰弱，假如疟原虫未能彻底消灭者，感受寒冷、疲劳，动辄复发。处方：生黄芪12克，党参9克，白术9克，当归6克，炙甘草3克，桂枝1.5克，大枣5枚，生姜2片，升麻6克，柴胡5克，酒淋黑豆15克，陈皮6克。【按语】此处用补中益气汤加味，扶养正气，以增强机体的抗疟能力。
11．刘男。服用奎宁方法不当，最能使疟原虫潜伏于体内，酿成其他病变。现在脉搏增快，神情沉默不想吃东西。处方：春柴胡3克，淡子芩9克，广陈皮9克，生苍术9克，姜半夏9克，潞党参6克，厚朴9克，炙甘草2.4克，生姜3片，大枣7枚。【按语】使用抗疟药应注意其服用剂量及用药天数，否则非但达不到治疗效果，反会使疟原虫潜伏，导致慢性疟疾，反复发作，并引起贫血，脾肿大（中医称做“疟母”）。现在脉搏增快，神情沉默不想吃东西，为病在少阳经，以柴平汤和解达邪，燥湿化痰。
12．杨女。去年9月抵上海，11月发疟疾，连续月余。停两星期又发，如此缠绵难愈，腹部左侧有明显之肿块，此为疟母。处方：春柴胡12克，赤芍9克，莪术9克，归尾9克，槟榔12克，桃仁15克。【按语】疟母已成，便须化痰攻瘀。此方乘正气半衰之际，使用攻逐之法，希望其疟母消散。
13．陆女。疟疾连日发作，已五六日，当恶寒时也汗出津津，这是因为虚的缘故。凡是用温补药，皆有间接扑灭疟原虫之意。处方：当归9克，白芍9克，煨草果6克，黄芪9克，桂枝5克（后下），威灵仙9克，山萸肉9克，五味子5克，粉甘草3克，巴戟天9克，生姜3片，红枣9枚，半硫丸6克（分2次吞服）。【按语】疟疾恶寒时往往无汗，此则恶寒时汗出津津，乃阳气虚弱之故。立方以温补为主，用功能截疟的半硫丸、草果等于温补之中；所谓温补药间接扑灭疟原虫，乃扶正达邪之意。
14．张男。盖上被子则心烦不寐，去掉被子则否，这是大虚之候。原来恶疟最能衰人之体力，所以景岳有何人饮之设。处方：制何首乌12克，全当归、生黄芪、潞党参各9克，橘皮6克，川桂枝6克，白芍9克，粉甘草3克，生姜3片，大枣5枚。
二诊：盖上被子心已不烦，肝脾触诊亦柔软不拒按，与初诊之严重状况，有天壤之别矣。处方：炮附子5克，杭白芍9克，潞党参12克，川桂枝3克（后下），制何首乌12克，全当归18克，粉甘草5克，陈皮6克，生姜1大块，大枣9枚。【按语】此种烦乃虚烦，非躁动可比。用景岳何人饮和黄芪建中汤（去饴糖）为治，切合病机，故一击而中。
1．卢女。高龄便秘，津液枯竭而肠道干燥。处方：当归12克，桑椹子15克，杏仁泥24克，黑芝麻15克，杭白芍9克，火麻仁12克，制何首乌12克，糖炒山楂9克。【按语】高龄气血皆虚，血少津枯，大肠失润，其治当养血润燥。方用首乌、归、芍、桑椹补血养阴；杏仁、火麻仁润肠，山楂行滞。生首乌含有大黄酸，有促进肠管蠕动的作用，熟首乌善能养肝肾、益精血。据现代药理研究，且能阻止血管内胆固醇沉积，为治疗老年疾患如冠心病等值得重视的药物。此方药多有油质，为滑润缓下剂，较更衣丸、脾约麻仁丸更稳妥。对体虚便秘，孕妇便秘以及大病后便秘均可应用。
2．刘女。头晕眼花，体力薄弱已甚。4日以来，大便艰难，临厕数小时亦不得下。处方：生首乌30克，麦冬9克，桑椹子12克，柏子仁12克，油当归9克，黑芝麻15克。【按语】便秘一证，虽责诸大肠传导失职，但有虚实之分，即虚亦有气虚、血虚之异，不可徒传攻下通便。此人头眩眼花，为血虚之象，故重用首乌，配以生津、补血、润肠之品。
3．朱女。平素有顽固性便秘，恒旬日更衣，而其量亦少。每日服丸剂，一周后方每日皆有，然不畅，噫气胸痞。昨日大便量稍多，而腹痛大作，饮食后胃脘亦胀痛不已。处方：广木香2.4克，杭白芍9克，晚蚕沙9克（包煎），薤白9克。小青皮9克，台乌9克，莱菔子12克，苏梗9克，谷麦芽各9克。【按语】此为顽固性便秘，服丸药后始得大便。今大便量稍多，则腹痛大作，为气机郁滞，药用木香、青皮、苏梗、台乌、薤白等以理气止痛。
4．周男。左目赤、目胞肿，夙有便秘。今大便不爽，口有臭味。夫病在上取之下。处方：草决明15克，茺蔚子15克，赤芍、生大黄（后下）、粉丹皮、菊花各9克，桃仁泥12克，黄连上清丸9克（分3次吞服）。
【按语】大黄通大便，配以桃仁则效益彰；赤芍与桃仁、丹皮相配，功能活血凉血。凡赤肿用消炎药，常配以活血凉血药，此古人成法。暴赤眼前人用青宁丸（即制大黄研粉为丸），今兼便秘，故“上病下取”用生大黄导下。
5．余男。下腹部胀满者，十去其七，苔仍灰腻，通其便，其苦自然消失。古人苔腻者，燥之，亦健其胃、动其肠而已。处方：薤白头9克，槟榔6克，皂荚子4.5克，晚蚕沙9克，台乌药6克，生枳实9克，莱菔子9克，橘皮6克，谷麦芽各9克。二诊：便通而胀满除，食欲依旧迟钝，不必治肠，但当治胃。处方：怀山药9克，麸炒枳实9克，谷麦芽各9克，云茯苓9克，佛手片6克，鸡内金9克，佩兰梗9克，潞党参9克，陈皮6克。
三诊：食欲依旧不振，体弱者，纯用刺激性无益也。处方：薤白头9克，谷麦芽各9克，潞党参9克，麸炒枳实6克，鸡内金9克，生白术9克，云茯苓9克，橘红4.5克，粉甘草2.5克。四诊：已能稍进糜粥，食后仍感痞闷，约一时许逐渐消失，其为消化力迟钝无疑。处方：生鸡内金4.5克，谷麦芽9克，广木香6克，六神曲18克，潞党参9克，川厚朴4.5克，薤白头9克。共研细末，每服1.5克，1日3次。
【按语】下腹部胀满，大便有待于通，而舌苔灰腻，湿邪为病显然。因湿而致之便秘，古称湿秘（如《普济方》）。《素问·真要大论》云：“湿淫所胜……大便难”，已认识到此证之存在；清·鞠通《温病条辨》亦尝论及此证云：“脾主地气，属太阴湿土，湿气太过，反伤本脏化气，湿久浊瘀，至于下焦，气不惟伤，而且阻矣。气为湿阻，二便不通。”便之不通，既由于湿阻气滞，故其治疗原则，亦惟除其湿之阻，行其气之滞而已。先生所谓“苔腻者燥之”，除其湿也；“健其胃、动其肠”者，行其气也。
蚕沙、皂荚子为《湿热病篇》宣清导浊汤中要药。吴氏自释其方云：“蚕砂能走少腹之浊部，又能化湿浊而归清……皂荚……燥能除湿，辛能通上下关窍，子更直达下焦，通大便之虚秘………逐有形之湿”。槟榔，《普济方》用以治“湿秘，肠胃有湿，大便秘塞”。方中任此三味为除湿通便之主药。又，槟榔、枳实、乌药三者，乃五磨饮子之重要组成部分，其宽中除满、推动气分之力极强，伍以“辛通滑利，能泄下焦阳明气滞”（李东垣《用药法象》）之薤白，以畅利气机。陈皮、佛手，芳香理气、开胃进食。此例湿浊之生，殆与伤食有关，故又用莱菔子、谷麦芽以和胃消食。证方相符，故能应手。二诊以后，便通而胀满除，惟食欲迟迟不振，是湿浊虽蠲，而先时受戕之中气未复，遂与消补并用之法治之，立法层次井然，值得效法。
6．高女。平素有习惯性便秘，此番6日未大便。大凡暴秘可泻，久秘不可泻。泻药只能取快一时，停药则其秘如故。面色不华，脉软，用药以振奋肠功能。处方：全当归12克，生白术9克，薤白9克，生麦芽12克，木香6克，生鸡内金9克，杭白芍12克，炙甘草3克，半硫丸9克（分3次吞服）。二诊：无效，肠之蠕动陷于麻痹状态，予千金温脾饮。处方：党参9克，干姜3克，熟大黄9克，清炙甘草3克，炮附块6克，全当归12克，玄明粉9克（分3次冲服）。
［按语］初诊服药二剂不效，二诊头煎药服后3小时即得便，说明初诊药力不足。病人面色不华，脉软而便秘，为排便动力缺乏，中医称之“冷积便秘”。用温脾饮，振奋脾阳，攻逐冷积，亦属“振奋肠功能”之举。
7．王女。大便秘结，数日不下，胸脘痛，手不可近。得之拂逆之后。下之痛当已。处方：熟大黄4.5克，台乌药9克，沉香曲9克，槟榔片9克，焦枳实9克，广木香3克，杏仁泥15克，莱菔子9克（研）。【按语】肝气郁结，气机壅滞，以致大肠传导失职，积滞内停。治用五磨饮子加大黄、杏仁、莱菔子，调气破结，行滞导下。
1．陈男。两目发黄，较前大退，是病势向愈之先声。凡治黄不利大小便，非其治也。处方：生大黄3克，茵陈9克，玄明粉9克，茺蔚子9克，草决明9克，生米仁12克，泽泻9克，车前子12克。【按语】黄疸多因脾胃湿热熏蒸于肝胆，使胆汁不循常道而外溢所致。所以注重利大小便，给湿热之邪以出路，湿热得去，则黄疸自消。方用茵陈清利湿热；大黄、玄明粉清热通下；茺蔚子、草决明清肝退黄；苡仁、泽泻、车前子除湿利尿，为阳黄正治之法。
2．周幼。热虽退，肝脏部位触之仍痛。处方：生大黄3克，玄明粉9克，绵茵陈9克，生苍术9克，草决明12克，广郁金3克（研分2次吞服），赤猪苓各9克，车前子9克。【按语】此例黄疸，发热虽退，肝区仍有触痛，是湿热之邪未清，故续用清利湿热之剂；因湿热蕴阻，最易阻遏气机，是以又用广玉金疏肝祛瘀而止痛，研末吞服，功较煎剂为优。
3．朱女。两目发黄，小溲短赤，热势起伏，渴欲饮水，左胁痛，证属阳黄，殆无疑义。处方：绵茵陈30克，金银花15克，嫩白薇12克，鲜生地60克（打汁冲服），马鞭草15克，全瓜蒌9克，玄明粉9克，泽泻12克，车前子15克。
【按语】叶桂说：“阳黄之作，湿从火化。”今病黄疸而热势起伏，渴欲饮水，正是湿热化火之例。方用大剂鲜生地汁养阴凉血；合银花、白薇以清热泻火；用大量茵陈与车前子、泽泻、马鞭草相伍，以清利湿热退黄；用瓜萎、玄明粉通大便，使湿热之邪从下窍而出。其中茵陈一味，既能发汗使湿热从汗而出，又能利水使湿热从小便而去，是治疗黄疸的要药。
4．金男。病已5天，曾经战栗，而后发热。察其两目有充血状，小溲短赤。目赤者当下之，溲赤者当利之，于导赤散加味。处方：小生地15克，细木通4.5克，生草梢4.5克，绵茵陈15克，车前子18克，草决明12克，茺蔚子12克，嫩白薇12克，望江南9克，郁李仁9克，淡竹叶30片。
二诊：药后热即退清，全身乏力，头目眩晕，两目充血，小溲短赤而痛。平素嗜酒，体质丰腴，湿热之蕴结久矣。处方：生苍术9克，川黄柏9克，淮牛膝9克，绵茵陈15克，山桅皮9克，细生地15克，冬青子9克，旱莲草9克，生草梢4.5克。三诊：黄疸症状具备，其主症有五：①两目发黄，小溲短赤；②肝区触痛；③高热，脉数；④呕哕频仍；⑤夜寐烦躁，不可名状。处方：绵茵陈15克，黑山栀9克，净连翘9克，鲜生地90克（捣汁冲服），嫩白薇9克，竹茹叶各9克，冬葵子9克，福泽泻9克，石韦9克，活芦根30厘米。
四诊：越宿热退神清，病势之变化，与昨判若霄壤；两目仍黄，小溲短赤。凉血淡渗之剂续进。原方加猪苓9克，冬瓜子皮各15克。五诊：心烦，呕吐，高热，脉数，俱不再见，目之黄、波之赤亦减。处方：绵茵陈15克，草决明9克，茺蔚子9克，广郁金4.5克，冬葵子9克，泽泻9克，赤猪苓各9克，车前子18克。
8. Female patient Zhang. Suffering from chronic malaria, her complexion is dull and ruined, indicating extreme depletion of Qi and Blood. The intestines lack blood nourishment and moistening, resulting in difficult defecation and rectal prolapse (Tuogang) during straining. Prescription: Chun Chai Hu (Spring Bupleurum) 6g, Sheng Ma (Cimicifugae Rhizoma) 5g, Mian Huang Qi (Astragali Radix) 12g, Lu Dang Shen (Codonopsis Radix) 9g, Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma) 6g, Chen Pi (Citri Reticulatae Pericarpium) 9g, Quan Dang Gui (Angelicae Sinensis Radix) 9g, Qing Zhi Cao (Prepared Licorice Root) 3g, Ban Bei Wan (Half-Bell Pill) 9g (swallowed). Additionally: Aged black tea 6g, Wu Bei Zi (Galla Chinensis) 9g, Sheng Di Yu (Sanguisorbae Radix) 9g, decocted to make a liquid for hot fumigation and washing of the anus. [Commentary] This is due to chronic malaria damaging healthy Qi. Difficulty in defecation is caused by intestinal loss of moistening; rectal prolapse is caused by sinking of Middle Qi. Treatment uses Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to support healthy Qi; Ban Bei Wan is used to resolve phlegm and intercept malaria. Chu Mie Sheng Jin Dan (Malaria-Intercepting Golden Pill) in *Tong Su Shang Han Lun* also utilizes Ban Bei Wan. The fumigation prescription is a commonly used effective formula by the master, effective for rectal prolapse.
9. Male patient Zhang. Improper administration of Quinine has confused the malaria pattern. His attacks feature neither chills nor sweating, indicating that although the malaria parasites lack division capability, they have not been eradicated. His complexion lacks luster. Modified Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is prescribed. Prescription: Sheng Huang Qi (Astragali Radix) 9g, Lu Dang Shen (Codonopsis Radix) 9g, Quan Dang Gui (Angelicae Sinensis Radix) 9g, Lv Sheng Ma (Green Cimicifugae Rhizoma) 24g, Ruan Chai Hu (Soft Bupleuri Radix) 5g, Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma) 9g, Chen Pi (Citri Reticulatae Pericarpium) 5g, Cao Guo (Tsao-ko Fruit) 5g, Zhi He Shou Wu (Prepared Polygoni Multiflori Caulis) 12g, Fen Gan Cao (Powdered Licorice Root) 5g. [Commentary] Due to improper use of Quinine, pathogenic factors remain while healthy Qi is damaged. Therefore, Chai Ping Tang (Bupleurum and Pinellia Decoction) is avoided in favor of modified Bu Zhong Yi Qi Tang. Zhi He Shou Wu, Dang Shen, Dang Gui, and Chen Pi constitute He Ren Yin (He Ren Decoction, originally using Ren Shen), a famous formula by Zhang Jingyue for treating deficiency-type malaria, employing the method of tonifying Qi and Blood. It is indeed effective for chronic malaria in patients with weak constitutions.
10. Female patient Bu. Malaria parasites destroy red blood cells, so physical strength is often weakened after malaria. If malaria parasites are not completely eradicated, exposure to cold or fatigue can easily trigger recurrence. Prescription: Sheng Huang Qi (Astragali Radix) 12g, Dang Shen (Codonopsis Radix) 9g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 9g, Dang Gui (Angelicae Sinensis Radix) 6g, Zhi Cao (Prepared Licorice Root) 3g, Gui Zhi (Cinnamomi Ramulus) 1.5g, Da Zao (Jujubae Fructus) 5 pieces, Sheng Jiang (Zingiberis Rhizoma Recens) 2 slices, Sheng Ma (Cimicifugae Rhizoma) 6g, Chai Hu (Bupleuri Radix) 5g, Jiu Lin Hei Dou (Wine-treated Black Soybeans) 15g, Chen Pi (Citri Reticulatae Pericarpium) 6g. [Commentary] Here, modified Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is used to nurture healthy Qi and enhance the body's anti-malarial capacity.
11. Male patient Liu. Improper use of Quinine can cause malaria parasites to lie latent within, leading to other complications. Currently, his pulse is rapid, and he is silent with no desire to eat. Prescription: Chun Chai Hu (Spring Bupleurum) 3g, Dan Zi Qin (Scutellariae Radix) 9g, Guang Chen Pi (Citri Reticulatae Pericarpium) 9g, Sheng Cang Zhu (Atractylodis Rhizoma) 9g, Jiang Ban Xia (Pinelliae Tuber Prepared with Ginger) 9g, Lu Dang Shen (Codonopsis Radix) 6g, Hou Po (Magnoliae Officinalis Cortex) 9g, Zhi Gan Cao (Prepared Licorice Root) 2.4g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 7 pieces. [Commentary] When using antimalarial drugs, dosage and duration must be noted. Otherwise, treatment efficacy may fail, causing malaria parasites to become latent, leading to chronic malaria with recurrent episodes, anemia, and splenomegaly (known in TCM as "Nuomu" or Malaria Mass). Rapid pulse and silence with anorexia indicate the disease is in the Shaoyang (Lesser Yang) stage. Chai Ping Tang (Bupleurum and Pinellia Decoction) is used to harmonize and expel pathogens, drying dampness and resolving phlegm.
12. Female patient Yang. Arrived in Shanghai last September, developed malaria in November, lasting over a month. After a two-week pause, it recurred, lingering persistently. There is a distinct mass on the left side of the abdomen, known as Nuomu (Malaria Mass). Prescription: Chun Chai Hu (Spring Bupleurum) 12g, Chi Shao (Paeoniae Radix Rubra) 9g, E Zhu (Curcumae Rhizoma) 9g, Gui Wei (Tail of Angelicae Sinensis Radix) 9g, Bing Lang (Arecae Semen) 12g, Tao Ren (Persicae Semen) 15g. [Commentary] With Nuomu established, phlegm resolution and blood stasis attack are required. This formula employs attacking methods when healthy Qi is at half-strength, hoping to dissipate the Nuomu.
13. Female patient Lu. Malaria attacks daily for five to six days. During chills, there is profuse sweating, indicating deficiency. All warm-tonifying medicines intend to indirectly eradicate malaria parasites. Prescription: Dang Gui (Angelicae Sinensis Radix) 9g, Bai Shao (Paeoniae Radix Alba) 9g, Wei Cao Guo (Roasted Tsao-ko Fruit) 6g, Huang Qi (Astragali Radix) 9g, Gui Zhi (Cinnamomi Ramulus) 5g (added later), Wei Ling Xian (Symplocos Caulis) 9g, Shan Yu Rou (Corni Fructus) 9g, Wu Wei Zi (Schisandrae Chinensis Fructus) 5g, Fen Gan Cao (Powdered Licorice Root) 3g, Ba Ji Tian (Morindae Officinalis Radix) 9g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Hong Zao (Red Jujube) 9 pieces, Ban Liu Wan (Ban-Liu Pill) 6g (taken in 2 doses). [Commentary] Malaria chills usually occur without sweat; here, profuse sweating during chills is due to Yang Qi deficiency. The prescription focuses on warm tonification, incorporating Ban Liu Wan and Cao Guo, which have malaria-intercepting functions, into the warm tonics. The idea that warm tonifiers indirectly eradicate malaria parasites is based on supporting healthy Qi to expel pathogens.
14. Male patient Zhang. Covering with blankets causes mental restlessness and insomnia; removing them resolves it. This is a sign of severe deficiency. Severe malaria most depletes physical strength, hence Zhang Jingyue created He Ren Yin (He Ren Decoction). Prescription: Zhi He Shou Wu (Prepared Polygoni Multiflori Caulis) 12g, Quan Dang Gui (Angelicae Sinensis Radix), Sheng Huang Qi (Astragali Radix), Lu Dang Shen (Codonopsis Radix) each 9g, Ju Pi (Citri Reticulatae Pericarpium) 6g, Chuan Gui Zhi (Cinnamomi Ramulus) 6g, Bai Shao (Paeoniae Radix Alba) 9g, Fen Gan Cao (Powdered Licorice Root) 3g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 5 pieces.
Second Visit: Mental restlessness under blankets has ceased. Palpation of the liver and spleen reveals softness without resistance, a world apart from the severe condition at the first visit. Prescription: Pao Fu Zi (Prepared Aconiti Lateralis Radix) 5g, Hang Bai Shao (Paeoniae Radix Alba) 9g, Lu Dang Shen (Codonopsis Radix) 12g, Chuan Gui Zhi (Cinnamomi Ramulus) 3g (added later), Zhi He Shou Wu (Prepared Polygoni Multiflori Caulis) 12g, Quan Dang Gui (Angelicae Sinensis Radix) 18g, Fen Gan Cao (Powdered Licorice Root) 5g, Chen Pi (Citri Reticulatae Pericarpium) 6g, Sheng Jiang (Zingiberis Rhizoma Recens) 1 large piece, Da Zao (Jujubae Fructus) 9 pieces. [Commentary] This type of restlessness is empty heat-induced irritability, not comparable to agitation. Using Zhang Jingyue’s He Ren Yin (He Ren Decoction) combined with Huang Qi Jian Zhong Tang (Astragalus Decoction to Establish the Middle, minus maltose) fits the pathology perfectly, achieving immediate success.
Constipation
1. Female patient Lu. Elderly constipation, due to fluid exhaustion and intestinal dryness. Prescription: Dang Gui (Angelicae Sinensis Radix) 12g, Sang Shen Zi (Mulberry Fruit) 15g, Xing Ren Ni (Apricot Seed Paste) 24g, Hei Zhi Ma (Black Sesame Seed) 15g, Hang Bai Shao (Paeoniae Radix Alba) 9g, Huo Ma Ren (Hemp Seed) 12g, Zhi He Shou Wu (Prepared Polygoni Multiflori Caulis) 12g, Tang Chao Shan Zha (Sugar-fried Hawthorn Fruit) 9g. [Commentary] In the elderly, both Qi and Blood are deficient; blood scarcity and fluid exhaustion lead to intestinal dryness. Treatment should nourish Blood and moisten dryness. The formula uses He Shou Wu, Dang Gui, Bai Shao, and Sang Shen to nourish Blood and Yin; Xing Ren and Huo Ma Ren moisten the intestines; Shan Zha promotes stagnation resolution. Raw He Shou Wu contains rhein, promoting intestinal peristalsis; cooked He Shou Wu nourishes Liver and Kidney, benefiting essence and Blood. Modern pharmacology shows it inhibits cholesterol deposition in blood vessels, making it valuable for treating geriatric diseases like coronary heart disease. This formula, rich in oils, is a lubricating laxative, safer than Geng Yi Wan (Change Clothes Pill) or Pi Yue Ma Ren Wan (Spley-Restricting Hemp Seed Pill). It applies to constipation due to weakness, pregnancy, or post-illness recovery.
2. Female patient Liu. Dizziness and blurred vision, extreme physical weakness. For four days, defecation has been difficult; hours spent on the toilet yield no result. Prescription: Sheng He Shou Wu (Raw Polygoni Multiflori Caulis) 30g, Mai Dong (Ophiopogonis Radix) 9g, Sang Shen Zi (Mulberry Fruit) 12g, Bai Zi Ren (Biota Seed) 12g, You Dang Gui (Oil-treated Angelicae Sinensis Radix) 9g, Hei Zhi Ma (Black Sesame Seed) 15g. [Commentary] Constipation, though attributed to large intestine transmission failure, has excess and deficiency patterns, including Qi and Blood deficiency. One cannot merely use purgatives. Dizziness and blurred vision indicate Blood deficiency; thus, He Shou Wu is heavily used, paired with fluids-generating, Blood-nourishing, and intestinal-moistening herbs.
3. Female patient Zhu. Suffers from stubborn constipation, changing bowels only once every ten days, with small volume. Daily pill intake results in daily bowel movements after a week, yet unsmooth, accompanied by belching and chest fullness. Yesterday, stool volume increased slightly, but severe abdominal pain ensued, along with stomach distension and pain after eating. Prescription: Guang Mu Xiang (Costi Radix) 2.4g, Hang Bai Shao (Paeoniae Radix Alba) 9g, Wan Can Sha (Silkworm Excrement) 9g (wrapped), Xie Bai (Allii Macrostemonis Bulbus) 9g. Xiao Qing Pi (Young Citri Reticulatae Pericarpium) 9g, Tai Wu (Tsaiko / Cyperi Rhizoma) 9g, Lai Fu Zi (Radish Seed) 12g, Su Geng (Perilla Stem) 9g, Gu Ya Mai Ya (Sprouted Rice and Barley) each 9g. [Commentary] This is stubborn constipation, relieved only by pills. Increased stool volume triggers severe pain due to Qi stagnation. Herbs like Mu Xiang, Qing Pi, Su Geng, Tai Wu, and Xie Bai regulate Qi and relieve pain.
4. Male patient Zhou. Left eye redness and eyelid swelling, chronic history of constipation. Current bowel movement is unsatisfactory, mouth has foul odor. Treating upper disorders by addressing the lower. Prescription: Cao Jue Ming (Cassiae Semen) 15g, Chong Wei Zi (Leonuri Fructus) 15g, Chi Shao (Paeoniae Radix Rubra), Sheng Da Huang (Rhei Radix et Rhizoma - added later), Fen Dan Pi (Moutan Cortex), Ju Hua (Chrysanthemi Flos) each 9g, Tao Ren Ni (Peach Seed Paste) 12g, Huang Lian Shang Qing Wan (Coptis Upper-Clearing Pill) 9g (taken in 3 doses).
[Commentary] Da Huang unblocks bowels; paired with Tao Ren, efficacy increases. Chi Shao paired with Tao Ren and Dan Pi activates Blood and cools Blood. For redness and swelling, anti-inflammatory drugs are often paired with Blood-activating and Blood-cooling herbs, an ancient rule. For acute red eyes, Qing Ning Wan (Made from powdered prepared Da Huang) was traditionally used. Given concurrent constipation, "treating upper by addressing lower" employs raw Da Huang to guide downward.
5. Male patient Yu. Lower abdominal fullness reduced by seven-tenths, tongue coating remains gray and greasy. Unblocking bowels naturally eliminates suffering. Ancients treated greasy coatings by drying, thereby strengthening the Stomach and moving the Intestines. Prescription: Xie Bai Tou (Allii Macrostemonis Bulbus) 9g, Bing Lang (Arecae Semen) 6g, Zao Jia Zi (Gleditsiae Spina) 4.5g, Wan Can Sha (Silkworm Excrement) 9g, Tai Wu Yao (Linderae Radix) 6g, Sheng Zhi Shi (Immature Bitter Orange Fruit) 9g, Lai Fu Zi (Radish Seed) 9g, Ju Pi (Citri Reticulatae Pericarpium) 6g, Gu Ya Mai Ya (Sprouted Rice and Barley) each 9g. Second Visit: Bowels unblocked, fullness gone, appetite remains sluggish. No need to treat Intestines, focus on Stomach. Prescription: Huai Shan Yao (Dioscoreae Rhizoma) 9g, Fu Chao Zhi Shi (Bran-fried Immature Bitter Orange Fruit) 9g, Gu Ya Mai Ya (Sprouted Rice and Barley) each 9g, Yun Fu Ling (Poria) 9g, Fo Shou Pian (Finger Citron Slice) 6g, Ji Nei Jin (Gizzard Lining) 9g, Pei Lan Geng (Eupatorium Stem) 9g, Lu Dang Shen (Codonopsis Radix) 9g, Chen Pi (Citri Reticulatae Pericarpium) 6g.
Third Visit: Appetite still poor. For the weak, pure stimulation is useless. Prescription: Xie Bai Tou (Allii Macrostemonis Bulbus) 9g, Gu Ya Mai Ya (Sprouted Rice and Barley) each 9g, Lu Dang Shen (Codonopsis Radix) 9g, Fu Chao Zhi Shi (Bran-fried Immature Bitter Orange Fruit) 6g, Ji Nei Jin (Gizzard Lining) 9g, Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma) 9g, Yun Fu Ling (Poria) 9g, Ju Hong (Red Tangerine Peel) 4.5g, Fen Gan Cao (Powdered Licorice Root) 2.5g. Fourth Visit: Able to consume congee, feeling stuffiness after meals, gradually disappearing after an hour. Digestive power is undoubtedly sluggish. Prescription: Sheng Ji Nei Jin (Raw Gizzard Lining) 4.5g, Gu Ya Mai Ya (Sprouted Rice and Barley) 9g, Guang Mu Xiang (Costi Radix) 6g, Liu Shen Qu (Six Gods Medicated Leaven) 18g, Lu Dang Shen (Codonopsis Radix) 9g, Chuan Hou Po (Magnoliae Officinalis Cortex) 4.5g, Xie Bai Tou (Allii Macrostemonis Bulbus) 9g. Ground into fine powder, 1.5g per dose, 3 times daily.
[Commentary] Lower abdominal fullness requires unblocking bowels; gray greasy tongue coating clearly indicates Dampness pathogen. Constipation caused by Dampness is called "Shi Mi" (Damp Constipation) in antiquity (*Pu Ji Fang*). *Su Wen: Zhen Yao Da Lun* states: "When Dampness prevails... difficulty in defecation," recognizing this syndrome. Qing dynasty Ju Tong’s *Wen Bing Tiao Bian* discusses it: "Spleen governs earth, belonging to Taiyin Damp Earth. Excessive Dampness damages the organ's transformation Qi. Long-standing Dampness leads to turbid stasis reaching the Lower Jiao, damaging and obstructing Qi. Obstructed by Dampness, urination and defecation cease." Since obstruction stems from Damp blocking Qi stagnation, treatment principles are removing Damp obstruction and moving Qi stagnation. Master’s "drying greasy coating" removes Damp; "strengthening Stomach, moving Intestines" moves Qi.
Can Sha (Silkworm Excrement) and Zao Jia Zi (Gleditsiae Spina) are key herbs in Xuan Qing Dao Zhuo Tang (Disperse Clear and Guide Turbid Decoction) from *Shi Bing Tiao Bian*. Wu described the formula: "Can Sha travels to turbid areas of the lower abdomen, transforming Damp-Turbidity back to clarity... Zao Jia... dryness removes Damp, pungency opens upper and lower orifices, seeds reach Lower Jiao directly, unblocking deficiency-type constipation... eliminating tangible Damp." Bing Lang (Arecae Semen) in *Pu Ji Fang* treats "Damp Constipation, intestinal Dampness, severe fecal impaction." These three are main herbs for removing Damp and unblocking bowels. Bing Lang, Zhi Shi, and Wu Yao are key components of Wu Mo Yin Zi (Five Knocks Decoction), strongly expanding the middle and removing fullness, pushing Qi. Paired with Xie Bai ("pungent, unblocking, slippery, draining Lower Jiao Yangming Qi stagnation" - Li Dongyuan), it smooths Qi mechanism. Chen Pi and Fo Shou, aromatic, regulate Qi, open appetite. This case’s Damp-Turbidity likely relates to food injury, hence Lai Fu Zi and Gu Ya Mai Ya harmonize Stomach and digest food. Syndrome matches formula, hence prompt response. After second visit, bowels unblocked, fullness gone, but appetite remains slow. Though Damp-Turbidity cleared, previously damaged Middle Qi has not recovered. Thus, combining elimination and tonification is used, demonstrating orderly legislative hierarchy worthy of emulation.
6. Female patient Gao. Habitual constipation, no bowel movement for 6 days. Generally, acute constipation can be purged, chronic cannot. Purgatives only provide temporary relief; upon stopping, constipation returns. Complexion lacks luster, pulse is soft. Medication aims to stimulate intestinal function. Prescription: Quan Dang Gui (Angelicae Sinensis Radix) 12g, Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma) 9g, Xie Bai (Allii Macrostemonis Bulbus) 9g, Sheng Mai Ya (Sprouted Barley) 12g, Mu Xiang (Costi Radix) 6g, Sheng Ji Nei Jin (Raw Gizzard Lining) 9g, Hang Bai Shao (Paeoniae Radix Alba) 12g, Zhi Cao (Prepared Licorice Root) 3g, Ban Liu Wan (Ban-Liu Pill) 9g (taken in 3 doses). Second Visit: Ineffective. Intestinal peristalsis has fallen into paralysis. Prescribe Qian Jin Wen Pi Yin (Thousand Gold Warming Spleen Decoction). Prescription: Dang Shen (Codonopsis Radix) 9g, Gan Jiang (Zingiberis Rhizoma) 3g, Shu Da Huang (Prepared Rhei Radix et Rhizoma) 9g, Qing Zhi Cao (Prepared Licorice Root) 3g, Pao Fu Kuai (Prepared Aconite Block) 6g, Quan Dang Gui (Angelicae Sinensis Radix) 12g, Xuan Ming Fen (Mirabilite) 9g (taken in 3 doses, dissolved).
[Commentary] Two doses at first visit were ineffective. At second visit, bowel movement occurred 3 hours after first decoction, indicating insufficient potency at first visit. Patient’s dull complexion, soft pulse, and constipation indicate lack of defecation motive force, termed "Leng Ji Bian Mi" (Cold Accumulation Constipation) in TCM. Wen Pi Yin (Warming Spleen Decoction) stimulates Spleen Yang, attacks cold accumulation, also belonging to "stimulating intestinal function."
7. Female patient Wang. Severe constipation, no bowel movement for several days, chest and epigastric pain, intolerant to touch. Resulted from emotional frustration. Purging should alleviate pain. Prescription: Shu Da Huang (Prepared Rhei Radix et Rhizoma) 4.5g, Tai Wu Yao (Linderae Radix) 9g, Chen Xiang Qu (Aquilaria Medicated Leaven) 9g, Bing Lang Pian (Areca Nut Slice) 9g, Jiao Zhi Shi (Charred Immature Bitter Orange Fruit) 9g, Guang Mu Xiang (Costi Radix) 3g, Xing Ren Ni (Apricot Seed Paste) 15g, Lai Fu Zi (Radish Seed) 9g (ground). [Commentary] Liver Qi stagnation and Qi mechanism blockage cause large intestine transmission failure and internal stagnation. Treatment uses Wu Mo Yin Zi (Five Knocks Decoction) plus Da Huang, Xing Ren, Lai Fu Zi to regulate Qi, break knots, move stagnation, and guide downward.
Jaundice
1. Male patient Chen. Yellowing of both eyes has significantly subsided compared to before, a precursor to recovery. Any treatment for jaundice that does not benefit urination and defecation is incorrect. Prescription: Sheng Da Huang (Rhei Radix et Rhizoma) 3g, Yin Chen (Artemisiae Scopariae Herba) 9g, Xuan Ming Fen (Mirabilite) 9g, Chong Wei Zi (Leonuri Fructus) 9g, Cao Jue Ming (Cassiae Semen) 9g, Sheng Yi Yi Ren (Coix Seed) 12g, Ze Xie (Alismatis Rhizoma) 9g, Che Qian Zi (Plantaginis Semen) 12g. [Commentary] Jaundice is mostly caused by Spleen-Stomach Damp-Heat steaming the Liver and Gallbladder, causing bile to overflow abnormally. Thus, benefiting urination and defecation provides an exit for Damp-Heat. Once Damp-Heat is removed, jaundice disappears. Yin Chen clears and drains Damp-Heat; Da Huang and Xuan Ming Fen clear heat and purge downward; Chong Wei Zi and Cao Jue Ming clear Liver and reduce jaundice; Yi Yi Ren, Ze Xie, and Che Qian Zi remove dampness and promote diuresis. This is the standard treatment for Yang Jaundice.
2. Young patient Zhou. Fever has subsided, but palpation of the liver area remains painful. Prescription: Sheng Da Huang (Rhei Radix et Rhizoma) 3g, Xuan Ming Fen (Mirabilite) 9g, Mian Yin Chen (Artemisiae Scopariae Herba) 9g, Sheng Cang Zhu (Atractylodis Rhizoma) 9g, Cao Jue Ming (Cassiae Semen) 12g, Guang Yu Jin (Curcumae Radix) 3g (ground, taken in 2 doses), Chi Zhu Ling (Polyporus and Atractylodes Macrocephala) each 9g, Che Qian Zi (Plantaginis Semen) 9g. [Commentary] In this jaundice case, fever has subsided but liver area tenderness persists, indicating Damp-Heat pathogens are not cleared. Thus, continuing with Damp-Heat clearing and draining agents. Damp-Heat accumulation easily obstructs Qi mechanism, so Guang Yu Jin is used to soothe Liver, remove stasis, and relieve pain. Taken as powder, its efficacy is superior to decoction.
3. Female patient Zhu. Yellowing of both eyes, short dark urine, fluctuating fever, thirst with desire to drink, left hypochondriac pain. Syndrome belongs to Yang Jaundice, beyond doubt. Prescription: Mian Yin Chen (Artemisiae Scopariae Herba) 30g, Jin Yin Hua (Lonicerae Japonicae Flos) 15g, Nen Bai Wei (Smilacis Glabrae Rhizoma) 12g, Xian Sheng Di (Rehmanniae Radix Recens) 60g (juice squeezed and mixed), Ma Bian Cao (Verbenae Herba) 15g, Quan Gua Lou (Trichosanthis Fructus) 9g, Xuan Ming Fen (Mirabilite) 9g, Ze Xie (Alismatis Rhizoma) 12g, Che Qian Zi (Plantaginis Semen) 15g.
[Commentary] Ye Gui said: "In Yang Jaundice, Damp transforms into Fire." Current jaundice with fluctuating fever and thirst exemplifies Damp-Heat transforming into Fire. Formula uses large dose of fresh Sheng Di juice to nourish Yin and cool Blood; combined with Yin Hua and Bai Wei to clear heat and drain fire; large amounts of Yin Chen paired with Che Qian Zi, Ze Xie, and Ma Bian Cao to clear and drain Damp-Heat and reduce jaundice; Gua Lou and Xuan Ming Fen unblock bowels, allowing Damp-Heat to exit via lower orifices. Yin Chen alone can induce sweating to release Damp-Heat through skin, and promote diuresis to release Damp-Heat via urine, making it a key herb for jaundice.
4. Male patient Jin. Ill for 5 days, experienced chills followed by fever. Both eyes show congestion, urine is short and dark. Red eyes require purging; dark urine requires draining. Modified Dao Chi San (Guide Out Redness Decoction). Prescription: Xiao Sheng Di (Rehmanniae Radix) 15g, Xi Mu Tong (Akebiae Caulis) 4.5g, Sheng Cao Shao (Licorice Root Tip) 4.5g, Mian Yin Chen (Artemisiae Scopariae Herba) 15g, Che Qian Zi (Plantaginis Semen) 18g, Cao Jue Ming (Cassiae Semen) 12g, Chong Wei Zi (Leonuri Fructus) 12g, Nen Bai Wei (Smilacis Glabrae Rhizoma) 12g, Wang Jiang Nan (Sophorae Tonkinensis Flos) 9g, Yu Li Ren (Pruni Semen) 9g, Dan Zhu Ye (Lophatheri Herba) 30 leaves.
Second Visit: Heat cleared after medication, whole body fatigue, dizziness, eye congestion, short dark painful urine. Habitual alcohol consumption, robust constitution, long-standing Damp-Heat accumulation. Prescription: Sheng Cang Zhu (Atractylodis Rhizoma) 9g, Chuan Huang Bo (Phellodendri Amurensis Cortex) 9g, Huai Niu Xi (Achyranthis Bidentatae Radix) 9g, Mian Yin Chen (Artemisiae Scopariae Herba) 15g, Shan Zhi Pi (Gardeniae Cortex) 9g, Xi Sheng Di (Rehmanniae Radix) 15g, Dong Qing Zi (Ilicis Cornusi Fructus) 9g, Han Lian Cao (Ecliptae Herba) 9g, Sheng Cao Shao (Licorice Root Tip) 4.5g. Third Visit: Jaundice symptoms complete, five main symptoms: ① Yellow eyes, short dark urine; ② Liver area tenderness; ③ High fever, rapid pulse; ④ Frequent vomiting; ⑤ Nighttime sleep restlessness, indescribable. Prescription: Mian Yin Chen (Artemisiae Scopariae Herba) 15g, Hei Shan Zhi (Black Gardeniae Fructus) 9g, Jing Lian Qiao (Forsythiae Fructus) 9g, Xian Sheng Di (Rehmanniae Radix Recens) 90g (juice squeezed and mixed), Nen Bai Wei (Smilacis Glabrae Rhizoma) 9g, Zhu Ru Ye (Bambusa Textilis Internodium and Leaf) each 9g, Dong Kui Zi (Abutilonis Semen) 9g, Fu Ze Xie (Alismatis Rhizoma) 9g, Shi Wei (Pyrrosiae Folium) 9g, Huo Lu Gen (Phragmitis Rhizoma) 30 cm.
Fourth Visit: Overnight, heat subsided, spirit clarified. Disease change is vastly different from yesterday. Eyes still yellow, urine short and dark. Continue cooling Blood and mild diuretic agents. Original formula plus Zhu Ling (Polyporus) 9g, Dong Gua Zi Pi (Winter Melon Seed and Peel) each 15g. Fifth Visit: Heart irritability, vomiting, high fever, rapid pulse all disappeared. Eye yellow and urine redness decreased. Prescription: Mian Yin Chen (Artemisiae Scopariae Herba) 15g, Cao Jue Ming (Cassiae Semen) 9g, Chong Wei Zi (Leonuri Fructus) 9g, Guang Yu Jin (Curcumae Radix) 4.5g, Dong Kui Zi (Abutilonis Semen) 9g, Ze Xie (Alismatis Rhizoma) 9g, Chi Zhu Ling (Polyporus and Atractylodes Macrocephala) each 9g, Che Qian Zi (Plantaginis Semen) 18g.