[按]先生对时症夹湿者，其治法常与治湿温相同，多半用三仁汤、蕾朴夏苓汤、甘露消毒丹之类。如见谵语、神昏等症，轻者用石菖蒲、郁金等，重则用至宝丹、紫雪丹之属。本例经四诊后，病势已成尾声，随后又予调理脾胃数剂而奏功。于此可见温邪夹湿，除初起用下剂外，其后清温化湿之品，也甚重要。
7.女。去夏曾病回归热，壮热一来复，脉静身凉一来复，循环不休，1个多月，此番又发作如前状。明雄黄2，4克，煨草果9克，生苍术9克，黄芩9克，绿豆衣18克。共研细末，分20次吞服，1日3次。[按]回归热系一种螺旋体侵人人体血液而致病(通过蚊虫传染)。此案用草果、苍术燥混辟秽，雄黄、黄芩、绿豆衣以清热解毒，乃苦辛并用，截夺邪热之剂，意在对病原体发挥抑制作用。雄黄一味。本经称其"主寒热，鼠瘘，恶疮，疽痔，死肌，杀百虫毒"。后世有用其合常山等药治疟疾者。唯其有毒，内服每次只宜0.5～0.，且不宜持续服用，以免蓄积中毒。
8.男。大致是发疹伤寒。此症之预后，一在脉，二在精神症状。未满一旬，尚难言之。升麻6克，青蒿子9克，连翘12克，玉枢丹1粒，鳖甲12克，广郁金9克，地T12克，银花12克，大青叶9克，碧玉散9克(包)，白茅根30克。
[按]此为温疫之邪伏于血分之症，大要以清热凉血、解毒辟秽为法。方从仲景升麻鳖甲汤化裁，取升麻之清热解毒，鳖甲之滋阴散瘀为主，再辅以玉枢丹、玉金之芳香辟秽;银花、连霰、地丁、大青叶之解毒泄热，则营热可清，疫邪可解。案中论及"此症之预后，一在脉，二在精神症状"，极为精辟。盖脉不散乱，则正气自能抗邪;无神昏痉厥之精神症状，说明邪未内陷。均为预后良好之征兆，反之则凶。
###########咳喘###########
1.男。病者是急性气管炎。素无咯痰，一也;在此时令(12月)，二也;洒然有寒意，三也;痰作白沫，喉痛，四也。牛蒡子12克，桔梗4.克，白苏子12克，桑白皮9克，射干4.克，山豆根4.克，杏仁泥12克，知贝母各9克，杭白芍6克，冬瓜子12克，柏子仁9克，甘草3克。[按]案语提示的急性气管炎的诊断要点，简明扼要，对临床辨证。很有帮助。
2.女。急性气管炎，总以祛痰为主。假使其人咳甚者，复入镇咳可矣。祛痰古称宣肺，镇咳古称肃肺。炙牛蒡9克，射干4.克，远志肉4.克，白前9克，紫菀9克，杭白芍9克，杏仁12克，桑白皮9克，知贝母各9克，甘草3克，枇杷叶3片(去毛包)。[按]先生对急性气管炎常用祛风清热、祛痰镇咳的方法。祛风用牛蒡，清热用射干、知母之类;祛痰镇咳则常用白前、紫菀、桔梗、贝母、杏仁、桑皮、旋覆花等药。用之多收良效。
3.男。咳引胸中痛，咯痰不爽，当以祛痰为先，镇咳次之。苦桔梗6克，白前6克，知贝母各9克，杭白芍9克，苏子9克，杏仁12克，桑白皮9克，柏子仁9克，炙马兜铃9克，枇杷叶5片(包)。[按]方中柏子仁一药，作为清肺滑痰之用，并非为安神而设。
4.女。当咳之初起，音即为之嗄。其咳迄今旬日，此风袭于肺。盗汗、自汗、心中悸，则关乎平日之虚。蜜炙麻黄3克，射干6克，川贝母2.克(研末分冲)，杭白芍9克，粉甘草4.克，五味子3克，浮小麦12克，桑白皮12克，麦门冬9克。[按]因风邪袭肺，咳嗽音嗄。用麻黄、射干、贝母、桑皮以祛风镇咳;因盗汗、自汗、心中悸，用白芍、甘草、五味、麦冬、浮小麦以养阴敛汗。此虚实互见之证，用药两相兼顾。
5.女。听其呛，乃急性气管炎。痰白而粘，白是寒，粘是湿。生麻黄1.克，苏芥子各9克，白前6克，炙紫菀9克，生苍术3克，橘皮6克，炙冬花9克，射干3克，粉甘草2.克，桔梗6克，山慈姑片9克(研末分2次调入)。[按]凡痰白属寒，先生常用麻黄、白芥子、白苏子等以散寒豁痰;伴有湿邪，则加苍术、半夏、茯苓等燥湿渗湿之药。关于治咳的方剂，先生常常推崇《医学心悟》的止嗽散。此方用中，上盖一厚纸板，中留一孔，药沸时即可迸行外熏。此法对久治不"愈的偏头痛亦有功效。..;:气病1.男。此与奔豚同一原理。所不同者，奔豚起自少腹上冲;病者脐上上冲，多作于午夜而已。川桂枝2.克，杭白芍9克，肉桂心1克(研末冲服)，台乌药9克，制香附9克，晚蚕沙12克(包)，五灵脂12克，清炙草2.克，沉香曲9克。另:甘松12克、延胡索18克、御米壳24克、全当归24克、大川芎9克、阿魏6克、粉丹皮30克、沉香6克、川贝母9克，共研细未，每服j2.克。以胶囊装盛，服用更便。
[按]奔豚一症，多因精神刺激，如受惊受恐所致。此病人多发。于午夜，可知并有寒邪人侵。所以一则用桂枝加桂汤，以散寒通阳，B肾止冲，一则用大队疏肝理气药，以疏肝解郁、调气降逆。续之散剂，是不可速效，而取其缓图之意。御米壳就是罂粟壳，是一味固收正气的药物，除习用于久咳、久泻等症，能敛肺涩肠外，并有"止心腹筋骨诸痛"之功，故亦选用之。
2.右。时欲哕，哕极则厥，此非寻常胃病。民间单方当其厥时有用阿魏吞服之法，此法意在排泄气体;气体之来源实在神经:系，故古籍有肝气之称。《金匮》之奔豚，其气上冲，亦此类也。炙乳没各4.克，蓬莪术9克，五灵脂12克，天台乌6克，海南片9克，阿魏9克，沉香曲12克，生枳实9克，薤白头9克，莱菔子9克，娑罗子9克，佛手9克。共研细末，每吞1克，1日3次。
二诊:药后从未发厥，排泄气体、镇静神经之效也。凡镇静剂多能引起便秘，肠蠕动受其抑制也。阿魏9克，香甘松9克，全当归15克，台乌药6克，延胡索9克，大川芎9克，海南片9克，生枳实9克，黑丑9克，五灵脂12克，广木香3克，莱菔子12克。共研细未，每吞3克许，日1一2次。
[按]先生认为此哕极昏厥之证，与"奔豚"为一类，均属神经官能症，中医辨证为肝郁不舒，气上冲逆，以致时而欲哕，哕极则厥。郁者舒之，结者散之。因此用舒肝理气，散结降逆之品，果获显著效果。先生重视民间单方，于此吸取了阿魏治厥的经验。考阿魏一药，具有消积、截疟、治痢等多种功能。《唐本草》说它能"破霰结，下恶气"，与此证用之下气降逆，颇相符合。
3.女。每遇拂逆，其病便易发作。病将发，呼吸紧张，四肢麻木;既发则齘齿，语言难出，神志不清，面色潮红，历2小时许而回苏;既而胸中窒闷异常，善太息。今持其脉大而弦，此为肝厥，亦属"脏躁"一类。明天麻4.克，杭白芍9克，料豆衣9克，广郁金4.克，炙远志4.克，潼白蒺藜各9克，旋覆花9克(包)，抱茯神9克，佩兰梗4.克。清炙草4.克，生麦芽15克，红枣10枚(去核)。
[按]《金匮.人杂病脉证并治篇》说:"妇人脏躁，喜悲伤，欲哭，像如神灵所作，数欠伸，甘麦大枣汤主之。"其证即现代医学所称之癔病。此病人虽较严重，亦癔病之表现。中医认为证属肝郁日入，化火生风。方用天麻、白芍、料豆衣、潼白蒺藜以平肝风;茯神、远志、红枣、炙草以养心安神;郁金、旋覆花、倪兰、生麦芽以理肝气。生麦芽可疏肝气，用代小麦，亦甘麦大枣汤之意。
4.女。咽中如有炙脔，经医院检查，排除实质性疾患。苔薄，脉弦滑，宗仲景法。制川朴9克，半夏9克，党参15克，山药15克，广木香9克，全当归9克，晚蚕沙12克(包)，砂仁4.克，绿萼梅4.克。此脚气之重者，有冲心之虞。炮附块6克，杭白芍6克，连皮苓15克，生苍术6克，姜皮2.克，冬瓜子皮各9克，车前子12克，生苡仁12克，椒目30粒，陈葫芦瓢30克。[按]古人认为脚气虽在足，而其病根则在腹，故有"不问足，须问腹"之说。此病人腹胀、心悸、气急，病程较长，故当考虑为脚气冲心。方用真武汤加减，以温脾肾之阳;生姜易姜皮，有利于行水之功;白术易苍术，以增强燥湿作用。
5.男。两脚麻木，不良于行，心中懊侬，舌中剥少苔，此三者皆为脚气之的候。咳呛为并发症。全当归9克，大熟地12克，杭白芍9克，大川芎2.克，宣木瓜9克，怀牛膝9克，生米仁30克，杜赤豆30克，花槟榔9克，白苏子9克，旋覆花9克(包)。[按]此患者脚不肿，即为干脚气。方用四物汤养阴和血，牛膝、苡仁、槟榔、木瓜清利湿热;苏子、旋覆花为对症的降气止咳药。
6.女。两足痿软无力，起于足肿之后，此脚气之后遗症。舌苔斑剥，唇红，表示营养缺乏。干地黄18克，杭白芍9克，制首乌12克，淮山药9克，怀牛膝9克，杜赤豆18克，麦冬9克，菟丝子9克，女贞子9克。[按]脚气病后，正气受伤，肝肾不足;肝主筋、肾主骨，故两足痿软无力。舌苔斑剥，唇红，是阴虚，故处方重在养肝肾之阴。
胃病
1.女。舌苔半光剥，溃疡病多作此状。古人谓属之阴虚，香燥药不能用。叶天士治此种胃痛嘈杂，创养胃阴之法。可见胃病不尽是吴萸姜桂证也。白芍10克，煅瓦愣18克(打，先煎)北秫米10克，知母10克，麦冬9克，黄精12克，怀山药12克，云茯苓9克，川楝子9克。[按]舌苔半光剥，是胃阴伤之证。溃疡病见此象，多为气郁化火，灼伤胃阴，故不可再用香燥理气之药。叶天士对此证主张w忌刚用柔"。处方师一贯煎意，用麦冬、山药、黄精、秫米养胃阴;知母、川楝子泄肝胃之热;瓦楞子制酸护膜;茯苓甘平淡渗健脾。知补者能知泻，方尽立方之妙。
2.陈女。胃痛多作于食后2小时许，迸硬固食物则其痛更甚，溃疡病之嫌疑最重。凡此等证过用香燥刺激之品，未有不偾事者。慎之!苦杏仁24克，全当归12克，白芍9克，玄胡索9克，桃仁泥9克，茯苓9克，米仁15克，飞滑石9克。另:鸡蛋壳置瓦上煅存性，每服2克，1日3次，饭前服。
[按]胃痛一般多用辛香理气之品，但用之过剂，是胃阴必伤。溃疡病患者易于动血，香燥刺激之品更应谨慎使用。此案用当归、桃仁、杏仁等行滞、化瘀、止痛，是先生多年经验，对渍疡病疼痛，确有良效。归、芍同用，可调营血，缓急止痛;玄胡索镇痛，亦具良效;煅鸡蛋壳能制酸，而且可促迸溃疡愈合;米仁古籍谓其具有"补脾胃，通行水"，"排脓消肿讨的作用，对溃疡病灶的消失是有帮助的;用茯苓、滑石亦是取其健脾利湿的作用。
3.男。曾经呕吐黑水，大便亦黑。今吞酸嘈杂，作于食后三四小时，脐上自觉板硬而痛。颇疑是溃疡病，切忌辛辣刺激性食物;否则呕血便血，势所难免。杏仁泥30克，当归12克；生地榆9克，血余炭9克，玄胡索9克，煅瓦楞30克。另:琥珀粉、象牙屑、滑石各9克，为极细末，和匀，每饭后吞服2克。[按]此证多系现代医学所称之十二指肠溃疡病。方用杏仁泥、当归、延胡止痛;地榆、血余止血;瓦楞子制酸。另配散剂，意在护膜生肌，亦即修补溃疡面之意。
4.男。胃痛开始多作于饥饿时，得食则减;其痛由渐加剧，、乃至食前食后皆痛，曾呕吐紫黑色物。今经常嘈杂、饱闷、腹泻。古人属诸痰火，切忌辛香燥烈药。凤凰衣9克，琥珀屑9克，炙马勃9克，柿霜18克，杏仁泥18克，象贝18克，野蔷薇花9克，花粉9克，血余炭9"克。共研细末，每服1.克，1日3次。食前服。二诊:病势已减轻。今予益气健胃剂，与前方先后进服，以培其本。党参60克，怀山药60克，鸡内金60克，煅龙骨30克。共研为散，每服3克，1日3次。
[按]此为溃疡病，中医认为饥饿则痛，得食则减，为中虚。其痛由渐加剧，乃至食前食后皆痛，并曾呕吐紫黑色物，是久痛胃络受损，瘀血内停;嘈杂、饱闷、腹泻、为脾胃虚弱，水谷失运，进而生痰，即所谓"古人属诸痰火"。方用花粉、柿霜、杏仁泥、象贝以清痰火，护胃缓痛;血余炭、马勃、琥珀等，通络、活血、止血。凤凰衣即鸡蛋内膜，既可保护溃疡面，与马勃同用，且能制酸，这是先生独到的经验。野蔷薇花又名白残花，入胃、肝两经，能清热化浊、顺气和胃，对胃热郁结而络损吐血者有效。二诊增用益气健脾之品，以治其本。
5.男。胃痛已8年，多作于食后3小时许，得食可稍缓，曾有黑粪史。其为溃疡病，殆无疑义。凤凰衣30克，玉蝴蝶30克，轻马勃20克，象贝母20克，血余炭15克，琥珀粉15克。共研细末，每服2克，1日3次，食前服。
【按语】先生对于时行疾病夹杂湿邪的情况，其治法通常与治疗湿温病相同，大多使用三仁汤、藿朴夏苓汤、甘露消毒丹这类方剂。如果见到谵语（神志不清，胡言乱语）、神昏（意识昏迷）等症状，轻症用石菖蒲、郁金等药，重症则用至宝丹、紫雪丹这类药物。本病例经过四次诊治后，病情已进入尾声，随后又给予调理脾胃的几剂药而取得疗效。由此可见，温邪夹湿之证，除了初起时使用下法（泻下法）外，其后清除温热、化除湿邪的药物，也非常重要。
7.女性。去年夏天曾患回归热（一种由螺旋体引起的传染病），高热退去后脉象平静身体凉爽，如此循环往复，持续1个多月，这次发作情况与之前相同。明雄黄2.4克，煨草果9克，生苍术9克，黄芩9克，绿豆衣18克。共同研成细末，分20次吞服，每日3次。[按语]回归热是一种螺旋体侵入人体血液而导致的疾病（通过蚊虫传染）。此案使用草果、苍术燥湿辟秽，雄黄、黄芩、绿豆衣清热解毒，这是苦味与辛味并用，截断夺取邪热的方剂，意图是对病原体发挥抑制作用。雄黄一味药，《神农本草经》称其“主治寒热，鼠瘘（淋巴结核），恶疮，疽痔，死肌，杀百虫毒”。后世有用它配合常山等药物治疗疟疾的。只是它有毒，内服每次只宜0.5～0.6克，且不宜持续服用，以免蓄积中毒。
8.男性。大致是发疹伤寒（斑疹伤寒）。此症的预后，一在于脉象，二在于精神症状。未满十天，还难以断定。升麻6克，青蒿子9克，连翘12克，玉枢丹1粒，鳖甲12克，广郁金9克，地丁12克，银花12克，大青叶9克，碧玉散9克（包煎），白茅根30克。
[按语]这是温疫之邪伏于血分的病症，大体以清热凉血、解毒辟秽为治法。方剂从张仲景的升麻鳖甲汤化裁而来，取升麻的清热解毒，鳖甲的滋阴散瘀为主，再辅以玉枢丹、郁金的芳香辟秽；银花、连翘、地丁、大青叶的解毒泄热，这样营分之热可清，疫邪可解。案中论及“此症的预后，一在于脉象，二在于精神症状”，极为精辟。因为脉象不散乱，则正气自然能抗御邪气；没有神昏、痉厥（抽搐昏迷）等精神症状，说明邪气未内陷脏腑。这都是预后良好的征兆，反之则凶险。
###########咳喘###########
1.男性。患者是急性气管炎。平时没有咯痰，这是一点；在此时令（12月），这是第二点；洒然有寒意，这是第三点；痰呈白沫状，喉痛，这是第四点。牛蒡子12克，桔梗4克，白苏子12克，桑白皮9克，射干4克，山豆根4克，杏仁泥12克，知母、贝母各9克，杭白芍6克，冬瓜子12克，柏子仁9克，甘草3克。[按语]案语中提示的急性气管炎的诊断要点，简明扼要，对临床辨证很有帮助。
2.女性。急性气管炎，总以祛痰为主。假使其人咳嗽严重的，再加入镇咳药即可。祛痰古称宣肺，镇咳古称肃肺。炙牛蒡子9克，射干4克，远志肉4克，白前9克，紫菀9克，杭白芍9克，杏仁12克，桑白皮9克，知母、贝母各9克，甘草3克，枇杷叶3片（去毛包煎）。[按语]先生对急性气管炎常用祛风清热、祛痰镇咳的方法。祛风用牛蒡子，清热用射干、知母之类；祛痰镇咳则常用白前、紫菀、桔梗、贝母、杏仁、桑白皮、旋覆花等药。使用这些药多收良效。
3.男性。咳嗽牵引胸中疼痛，咯痰不爽利，应当以祛痰为先，镇咳次之。苦桔梗6克，白前6克，知母、贝母各9克，杭白芍9克，苏子9克，杏仁12克，桑白皮9克，柏子仁9克，炙马兜铃9克，枇杷叶5片（包煎）。[按语]方中柏子仁一味药，作为清肺滑痰之用，并非为了安神而设。
4.女性。刚开始咳嗽时，声音就为之嘶哑。咳嗽至今已经十天，这是风邪袭肺所致。盗汗（夜间睡着出汗）、自汗（白天不活动也出汗）、心中悸动，则关乎平日体质虚弱。蜜炙麻黄3克，射干6克，川贝母2克（研末冲服），杭白芍9克，粉甘草4克，五味子3克，浮小麦12克，桑白皮12克，麦门冬9克。[按语]因风邪袭肺，导致咳嗽音哑。用麻黄、射干、贝母、桑白皮来祛风镇咳；因盗汗、自汗、心中悸动，用白芍、甘草、五味子、麦冬、浮小麦来养阴敛汗。这是虚实互见的证候，用药两相兼顾。
5.女性。听其呛咳声，乃是急性气管炎。痰白而粘，白色属寒，粘稠属湿。生麻黄1克，苏子、芥子各9克，白前6克，炙紫菀9克，生苍术3克，橘皮6克，炙款冬花9克，射干3克，粉甘草2克，桔梗6克，山慈姑片9克（研末分2次调入）。[按语]凡是痰白属于寒证，先生常用麻黄、白芥子、白苏子等来散寒豁痰；伴有湿邪，则加苍术、半夏、茯苓等燥湿渗湿的药物。关于治咳的方剂，先生常常推崇《医学心悟》中的止嗽散。此方用法中，上面盖一块厚纸板，中间留一个孔，药液沸腾时即可进行外熏。此法对久治不愈的偏头痛也有功效。
##### 气病 #####
1.男性。这与奔豚（一种自觉有气从少腹上冲心胸的病症）同一原理。所不同的是，奔豚之气起自少腹向上冲逆；此病人脐上向上冲逆，多在午夜发作而已。川桂枝2克，杭白芍9克，肉桂心1克（研末冲服），台乌药9克，制香附9克，晚蚕沙12克（包煎），五灵脂12克，清炙甘草2克，沉香曲9克。另：甘松12克、延胡索18克、罂粟壳24克、全当归24克、大川芎9克、阿魏6克、粉丹皮30克、沉香6克、川贝母9克，共同研成细末，每服1.5克。装入胶囊服用更方便。
[按语]奔豚一症，多因精神刺激，如受惊受恐所致。此病人多发于午夜，可知并伴有寒邪入侵。所以一则用桂枝加桂汤，以散寒通阳，平肾气之上冲；一则用大队疏肝理气药，以疏肝解郁、调气降逆。续服的散剂，不是求速效，而是取其缓图之意。罂粟壳就是御米壳，是一味固收敛正气的药物，除习惯用于久咳、久泻等症，能敛肺涩肠外，并有“止心腹筋骨诸痛”的功效，故也选用它。
2.女性。时常想要呃逆（打嗝），呃逆极甚则发生昏厥，这不是寻常胃病。民间单方在其昏厥时有用阿魏吞服的方法，此法意在排泄气体；气体的来源实在神经系统，故古籍中有肝气之称。《金匮要略》中的奔豚，其气上冲，也是此类。炙乳香、没药各4克，蓬莪术9克，五灵脂12克，天台乌药6克，海南片（槟榔）9克，阿魏9克，沉香曲12克，生枳实9克，薤白头9克，莱菔子9克，娑罗子9克，佛手9克。共同研成细末，每次吞服1克，每日3次。
二诊：服药后从未再发昏厥，这是排泄气体、镇静神经的效果。凡镇静剂多能引起便秘，因为肠蠕动受其抑制。阿魏9克，香甘松9克，全当归15克，台乌药6克，延胡索9克，大川芎9克，海南片9克，生枳实9克，黑丑（牵牛子）9克，五灵脂12克，广木香3克，莱菔子12克。共同研成细末，每次吞服约3克，每日1-2次。
[按语]先生认为此呃逆极甚致昏厥之证，与“奔豚”为一类，均属神经官能症，中医辨证为肝郁不舒，气上冲逆，以致时而欲呃逆，呃逆极甚则昏厥。郁结者舒展之，结聚者消散之。因此用舒肝理气，散结降逆之品，果然获得显著效果。先生重视民间单方，于此吸取了阿魏治厥的经验。考证阿魏一味药，具有消积、截疟、治痢等多种功能。《唐本草》说它能“破癥结，下恶气”，与此证用它之下气降逆，颇为符合。
3.女性。每当遇到拂逆之事，病情便容易发作。病将发作时，呼吸紧张，四肢麻木；既已发作则咬紧牙关，语言难出，神志不清，面色潮红，历时2小时左右而苏醒；继而胸中窒闷异常，喜欢叹气。现在切其脉大而弦，此为肝厥，也属于“脏躁”一类。明天麻4克，杭白芍9克，料豆衣9克，广郁金4克，炙远志4克，潼蒺藜、白蒺藜各9克，旋覆花9克（包煎），抱茯神9克，佩兰梗4克，清炙甘草4克，生麦芽15克，红枣10枚（去核）。
[按语]《金匮要略·妇人杂病脉证并治篇》说：“妇人脏躁，喜悲伤，欲哭，像如神灵所作，数欠伸，甘麦大枣汤主之。”其证即现代医学所称之癔病。此病人虽较严重，也是癔病的表现。中医认为证属肝郁日久，化火生风。方用天麻、白芍、料豆衣、潼白蒺藜来平肝风；茯神、远志、红枣、炙甘草来养心安神；郁金、旋覆花、佩兰、生麦芽来理肝气。生麦芽可疏肝气，用其代替小麦，也是甘麦大枣汤之意。
4.女性。咽中如有炙脔（感觉咽喉中有异物感，咳之不出，咽之不下），经医院检查，排除实质性疾患。苔薄，脉弦滑，遵循张仲景之法。制厚朴9克，半夏9克，党参15克，山药15克，广木香9克，全当归9克，晚蚕沙12克（包煎），砂仁4克，绿萼梅4克。此脚气之重者，有冲心之虞。炮附块6克，杭白芍6克，连皮茯苓15克，生苍术6克，姜皮2克，冬瓜子皮各9克，车前子12克，生薏苡仁12克，椒目30粒，陈葫芦瓢30克。[按语]古人认为脚气虽在足部，而其病根则在腹部，故有“不问足，须问腹”之说。此病人腹胀、心悸、气急，病程较长，故当考虑为脚气冲心。方用真武汤加减，以温补脾肾之阳；生姜易为姜皮，有利于行水之功；白术易为苍术，以增强燥湿作用。
5.男性。两脚麻木，行走不利，心中懊恼（烦闷不适），舌中剥落少苔，这三者皆为脚气的典型征候。咳呛为并发症。全当归9克，大熟地12克，杭白芍9克，大川芎2克，宣木瓜9克，怀牛膝9克，生薏苡仁30克，杜赤豆30克，花槟榔9克，白苏子9克，旋覆花9克（包煎）。[按语]此患者脚不肿，即为干脚气。方用四物汤养阴和血，牛膝、薏苡仁、槟榔、木瓜清利湿热；苏子、旋覆花为对症的降气止咳药。
6.女性。两足痿软无力，起于足肿之后，此为脚气之后遗症。舌苔斑剥，唇红，表示营养缺乏。干地黄18克，杭白芍9克，制首乌12克，淮山药9克，怀牛膝9克，杜赤豆18克，麦冬9克，菟丝子9克，女贞子9克。[按语]脚气病后，正气受伤，肝肾不足；肝主筋、肾主骨，故两足痿软无力。舌苔斑剥，唇红，是阴虚，故处方重在滋养肝肾之阴。
胃病
1.女性。舌苔半光剥，溃疡病多呈现此种状态。古人谓属之阴虚，香燥药不能用。叶天士治疗此种胃痛嘈杂，创立养胃阴之法。可见胃病不尽是吴茱萸、干姜、肉桂证也。白芍10克，煅瓦楞子18克（捣碎，先煎），北秫米10克，知母10克，麦冬9克，黄精12克，怀山药12克，云茯苓9克，川楝子9克。[按语]舌苔半光剥，是胃阴伤之证。溃疡病见此象，多为气郁化火，灼伤胃阴，故不可再用香燥理气之药。叶天士对此证主张“忌刚用柔”。处方师法一贯煎之意，用麦冬、山药、黄精、秫米养胃阴；知母、川楝子泄肝胃之热；瓦楞子制酸护膜；茯苓甘平淡渗健脾。知补者能知泻，方尽立方之妙。
2.陈姓女性。胃痛多在进食后2小时左右发作，吃坚硬固体食物则疼痛更甚，溃疡病的嫌疑最重。凡此类证候过用香燥刺激之品，没有不坏事者。谨慎！苦杏仁24克，全当归12克，白芍9克，玄胡索9克，桃仁泥9克，茯苓9克，薏苡仁15克，飞滑石9克。另：鸡蛋壳置瓦上煅存性，每服2克，每日3次，饭前服。
[按语]胃痛一般多用辛香理气之品，但用之过剂，必伤胃阴。溃疡病患者易于动血，香燥刺激之品更应谨慎使用。此案用当归、桃仁、杏仁等行滞、化瘀、止痛，是先生多年经验，对溃疡病疼痛，确有良效。归、芍同用，可调营血，缓急止痛；玄胡索镇痛，亦具良效；煅鸡蛋壳能制酸，而且可促进溃疡愈合；薏苡仁古籍谓其具有“补脾胃，通行水”，“排脓消肿”的作用，对溃疡病灶的消失是有帮助的；用茯苓、滑石亦是取其健脾利湿的作用。
3.男性。曾经呕吐黑水，大便亦黑。今吞酸嘈杂，发作于食后三四小时，脐上自觉板硬而痛。颇疑是溃疡病，切忌辛辣刺激性食物；否则呕血便血，势所难免。杏仁泥30克，当归12克，生地榆9克，血余炭9克，玄胡索9克，煅瓦楞子30克。另：琥珀粉、象牙屑、滑石各9克，为极细末，和匀，每饭后吞服2克。[按语]此证多系现代医学所称之十二指肠溃疡病。方用杏仁泥、当归、延胡索止痛；地榆、血余止血；瓦楞子制酸。另配散剂，意在护膜生肌，亦即修补溃疡面之意。
4.男性。胃痛开始多发作于饥饿时，得食则减轻；其痛逐渐加剧，乃至食前食后皆痛，曾呕吐紫黑色物。今经常嘈杂、饱闷、腹泻。古人属诸痰火，切忌辛香燥烈药。凤凰衣9克，琥珀屑9克，炙马勃9克，柿霜18克，杏仁泥18克，象贝母18克，野蔷薇花9克，花粉9克，血余炭9克。共同研成细末，每服1克，每日3次。食前服。二诊：病势已减轻。今予益气健胃剂，与前方先后进服，以培其本。党参60克，怀山药60克，鸡内金60克，煅龙骨30克。共同研为散，每服3克，每日3次。
[按语]此为溃疡病，中医认为饥饿则痛，得食则减，为中虚。其痛由渐加剧，乃至食前食后皆痛，并曾呕吐紫黑色物，是久痛胃络受损，瘀血内停；嘈杂、饱闷、腹泻，为脾胃虚弱，水谷失运，进而生痰，即所谓“古人属诸痰火”。方用花粉、柿霜、杏仁泥、象贝母以清痰火，护胃缓痛；血余炭、马勃、琥珀等，通络、活血、止血。凤凰衣即鸡蛋内膜，既可保护溃疡面，与马勃同用，且能制酸，这是先生独到的经验。野蔷薇花又名白残花，入胃、肝两经，能清热化浊、顺气和胃，对胃热郁结而络损吐血者有效。二诊增用益气健脾之品，以治其本。
5.男性。胃痛已8年，多在进食后3小时左右发作，得食可稍缓解，曾有黑粪史。其为溃疡病，殆无疑义。凤凰衣30克，玉蝴蝶30克，轻马勃20克，象贝母20克，血余炭15克，琥珀粉15克。共同研成细末，每服2克，每日3次，食前服。
[Commentary] For seasonal diseases complicated by dampness, Mr. Zhang's treatment method is usually the same as that for damp-warmth (Damp-Warmth). He mostly uses formulas such as San Ren Tang (Three Kernel Decoction), Huo Po Xia Ling Tang (Patchouli, Aromatics, Pinellia, and Poria Decoction), and Gan Lu Xiao Du Dan (Sweet Dew Detoxifying Pill). If symptoms such as delirium (incoherent speech due to mental confusion) and coma are observed, mild cases are treated with herbs like Shi Chang Pu (Acorus Rhizome) and Yu Jin (Curcuma Tuber), while severe cases use pills such as Zhi Bao Dan (Precious Treasure Pill) or Zi Xue Dan (Purple Snow Pill). After four consultations in this case, the disease had entered its tail end, and subsequent prescriptions regulating the spleen and stomach achieved success. This shows that for warm pathogens complicated by dampness, besides using purgatives (downward-draining methods) at the onset, clearing warmth and resolving dampness agents later on are also very important.
7. Female. Last summer, she suffered from relapsing fever (a disease caused by spirochetes invading human blood, transmitted by mosquitoes). High fever would subside, followed by a quiet pulse and cool body, cycling endlessly for over a month. This time, the recurrence was similar to before. Ming Xiong Huang (Realgar) 2.4g, Wei Cao Guo (Calcined Black Cardamom Fruit) 9g, Sheng Cang Zhu (Raw Atractylodes Rhizome) 9g, Huang Qin (Scutellaria Root) 9g, Lv Dou Yi (Mung Bean Seed Coat) 18g. All ground into fine powder, divided into 20 doses to be swallowed, three times a day. [Commentary] Relapsing fever is a disease caused by spirochetes invading human blood (transmitted by mosquitoes). In this case, Cao Guo and Cang Zhu are used to dry dampness and dispel filth; Xiong Huang, Huang Qin, and Lv Dou Yi clear heat and detoxify. This is a combination of bitter and acrid flavors, a formula to intercept and seize evil heat, intending to inhibit pathogens. Xiong Huang alone: *Shennong Bencao Jing* states it "treats chills and fever, scrofula, malignant sores, carbuncles, hemorrhoids, necrotic tissue, and kills hundred insect poisons." Later generations used it combined with Chang Shan (Dichroa Root) to treat malaria. However, it is toxic; internal dosage should only be 0.5–0.6g per time, and it should not be taken continuously to avoid accumulation poisoning.
8. Male. Approximately typhoid fever (epidemic typhus). The prognosis of this condition depends first on the pulse and second on mental symptoms. It is difficult to predict within ten days. Sheng Ma (Cimicifuga Rhizome) 6g, Qing Hao Zi (Artemisia Annua Seed) 9g, Lian Qiao (Forsythia Fruit) 12g, Yu Shu Dan (Jade Pivot Pill) 1 pill, Bie Jia (Tartar Shell) 12g, Guang Yu Jin (Curcuma Tuber) 9g, Di Ding (Viola Herba) 12g, Yin Hua (Chrysanthemum Flos) 12g, Da Qing Ye (Isatis Leaf) 9g, Bi Yu San (Jasper Powder) 9g (wrapped), Bai Mao Gen (Imperata Rhizome) 30g.
[Commentary] This is a condition where epidemic warm pathogens lie hidden in the blood level. The general principle is to clear heat, cool blood, detoxify, and dispel filth. The formula is modified from Zhang Zhongjing's Sheng Ma Bie Jia Tang (Cimicifuga and Tartar Shell Decoction), taking Sheng Ma for clearing heat and detoxifying, and Bie Jia for nourishing yin and dissipating stasis as the main components, assisted by Yu Shu Dan and Yu Jin for aromatic dispersion of filth; Yin Hua, Lian Qiao, Di Ding, and Da Qing Ye clear heat and detoxify, thus clearing Ying-level heat and resolving epidemic pathogens. The case mentions "the prognosis depends first on the pulse and second on mental symptoms," which is extremely incisive. If the pulse is not chaotic, righteous qi can naturally resist pathogens; absence of mental symptoms like coma and convulsions indicates pathogens have not sunk inward. These are signs of good prognosis; otherwise, it is ominous.
########### Cough and Asthma ###########
1. Male. The patient has acute tracheitis. First, he usually does not expectorate sputum; second, it is December (this season); third, he feels chilly; fourth, sputum is white foam, with sore throat. Niu Bang Zi (Arctii Fructus) 12g, Jie Geng (Platycodon Root) 4g, Bai Su Zi (Perillae Fructus) 12g, Sang Bai Pi (Morus Root Bark) 9g, She Gan (Belamcanda Rhizome) 4g, Shan Dou Gen (Sophorae Tonkinensis Radix et Rhizoma) 4g, Xing Ren Ni (Apricot Seed Paste) 12g, Zhi Mu (Anemarrhenae Rhizoma) and Bei Mu (Fritillariae Bulbus) 9g each, Hang Bai Shao (Paeoniae Radix Alba) 6g, Dong Gua Zi (Benincasae Semen) 12g, Bai Zi Ren (Biota Seed) 9g, Gan Cao (Licorice Root) 3g. [Commentary] The diagnostic points for acute tracheitis highlighted in the case notes are concise and helpful for clinical differentiation.
2. Female. Acute tracheitis should primarily focus on resolving phlegm. If coughing is severe, anti-tussives can be added. Resolving phlegm is anciently called "dispersing lung qi"; stopping cough is anciently called "subduing lung qi." Zhi Niu Bang Zi (Prepared Arctii Fructus) 9g, She Gan (Belamcanda Rhizome) 4g, Yuan Zhi Rou (Polygalae Radix) 4g, Bai Qian (Cynanchi Stauntonii Rhizoma et Radix) 9g, Zi Wan (Asteris Radix) 9g, Hang Bai Shao (Paeoniae Radix Alba) 9g, Xing Ren (Pruni Semen) 12g, Sang Bai Pi (Morus Root Bark) 9g, Zhi Mu and Bei Mu 9g each, Gan Cao (Licorice Root) 3g, Pi Pa Ye (Loquat Leaf) 3 slices (de-haired, wrapped). [Commentary] Mr. Zhang commonly uses methods of dispersing wind, clearing heat, resolving phlegm, and stopping cough for acute tracheitis. Wind-dispersing uses Niu Bang Zi; heat-clearing uses She Gan, Zhi Mu, etc.; phlegm-resolving and cough-stopping commonly uses Bai Qian, Zi Wan, Jie Geng, Bei Mu, Xing Ren, Sang Bai Pi, Xuan Fu Hua, etc. Using these often yields good results.
3. Male. Cough draws pain in the chest, sputum is difficult to expectorate. Priority should be given to resolving phlegm, then stopping cough. Ku Jie Geng (Bitter Platycodon Root) 6g, Bai Qian (Cynanchi Stauntonii Rhizoma et Radix) 6g, Zhi Mu and Bei Mu 9g each, Hang Bai Shao (Paeoniae Radix Alba) 9g, Su Zi (Perillae Fructus) 9g, Xing Ren (Pruni Semen) 12g, Sang Bai Pi (Morus Root Bark) 9g, Bai Zi Ren (Biota Seed) 9g, Zhi Ma Dou Ling (Gnetum Root Bark) 9g, Pi Pa Ye (Loquat Leaf) 5 slices (wrapped). [Commentary] In this formula, Bai Zi Ren is used to clear lung heat and lubricate phlegm, not for calming the mind.
4. Female. At the onset of cough, voice became hoarse. Cough has persisted for ten days; this is wind attacking the lung. Night sweats, spontaneous sweating, and palpitations relate to chronic deficiency. Mi Zha Ma Huang (Honey-fried Ephedra Herb) 3g, She Gan (Belamcanda Rhizome) 6g, Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) 2g (powder, taken separately), Hang Bai Shao (Paeoniae Radix Alba) 9g, Fen Gan Cao (Powdered Licorice Root) 4g, Wu Wei Zi (Schisandrae Fructus) 3g, Fu Xiao Mai (Light Wheat) 12g, Sang Bai Pi (Morus Root Bark) 12g, Mai Men Dong (Ophiopogonis Tuber) 9g. [Commentary] Due to wind pathogen attacking the lung causing hoarse cough, Ma Huang, She Gan, Bei Mu, and Sang Bai Pi are used to disperse wind and stop cough; due to night sweats, spontaneous sweating, and palpitations, Bai Shao, Gan Cao, Wu Wei Zi, Mai Dong, and Fu Xiao Mai are used to nourish yin and consolidate sweat. This is a syndrome of mixed deficiency and excess, so medication addresses both aspects.
5. Female. Listening to the paroxysmal cough indicates acute tracheitis. Sputum is white and sticky; white indicates cold, stickiness indicates dampness. Sheng Ma Huang (Raw Ephedra Herb) 1g, Su Zi (Perillae Fructus) and Bai Jie Zi (White Mustard Seed) 9g each, Bai Qian (Cynanchi Stauntonii Rhizoma et Radix) 6g, Zhi Zi Wan (Prepared Asteris Radix) 9g, Sheng Cang Zhu (Raw Atractylodes Rhizome) 3g, Ju Pi (Citrus Reticulatae Pericarpium) 6g, Zhi Dong Hua (Prepared Kolkwitziae Flos) 9g, She Gan (Belamcanda Rhizome) 3g, Fen Gan Cao (Powdered Licorice Root) 2g, Jie Geng (Platycodon Root) 6g, Shan Ci Gu Pian (Cremastra Pseudobulb Slices) 9g (powder, mixed in two doses). [Commentary] Whenever sputum is white, it belongs to cold; Mr. Zhang commonly uses Ma Huang, Bai Jie Zi, Bai Su Zi to disperse cold and resolve phlegm; if accompanied by dampness, Cang Zhu, Ban Xia, and Fu Ling are added to dry dampness and promote urination. Regarding cough formulas, Mr. Zhang often推崇 (recommends) Zhi Sou San (Stop Cough Powder) from *Yi Xue Xin Wu*. One usage involves covering the pot with a thick cardboard leaving a hole, allowing steam inhalation when the medicine boils. This method is also effective for chronic intractable migraine.
##### Qi Disorders #####
1. Male. This shares the same principle as Ben Tun (Rushing Pig Syndrome). The difference is that Ben Tun originates from the lower abdomen rushing upward; this patient experiences rushing above the umbilicus, mostly occurring at midnight. Chuan Gui Zhi (Cinnamon Twig) 2g, Hang Bai Shao (Paeoniae Radix Alba) 9g, Rou Gui Xin (Cinnamon Bark Heart) 1g (powder, taken separately), Tai Wu Yao (Linderae Radix) 9g, Zhi Xiang Fu (Cyperi Rhizoma) 9g, Wan Can Sha (Silkworm Excrement) 12g (wrapped), Wu Ling Zhi (Trogopterori Faeces) 12g, Qing Zhi Gan Cao (Clear-prepared Licorice Root) 2g, Chen Xiang Qu (Aquilaria Fermented Mass) 9g. Additionally: Gan Song (Nardostachys Radix et Rhizoma) 12g, Yan Hu Suo (Corydalis Rhizoma) 18g, Yu Mi Ke (Papaveris Pericarpium) 24g, Quan Dang Gui (Angelicae Sinensis Radix) 24g, Da Chuan Xiong (Ligustici Chuanxiong Rhizoma) 9g, A Wei (Ferulae Resina) 6g, Fen Dan Pi (Moutan Cortex) 30g, Chen Xiang (Aquilaria Lignum) 6g, Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) 9g. All ground into fine powder, 1.5g per dose. Encapsulated for easier administration.
[Commentary] Ben Tun syndrome is often caused by emotional stimulation, such as fright or fear. This patient's occurrence at midnight suggests invasion of cold pathogen. Therefore, Gui Zhi Jia Gui Tang (Cinnamon Twig Decoction plus Cinnamon) is used to disperse cold and unblock yang, pacifying kidney qi and stopping the rush; additionally, a large group of liver-soothing and qi-regulating herbs is used to soothe liver, resolve depression, regulate qi, and direct rebellion downward. The continued use of powder aims for gradual effect rather than quick cure. Yu Mi Ke (Papaveris Pericarpium) is astringent and consolidates righteous qi. Besides being habitually used for chronic cough and diarrhea to astringe lungs and intestines, it also stops pain in heart, abdomen, bones, and muscles, hence selected here.
2. Female. Frequently desires hiccups; extreme hiccups lead to syncope. This is not an ordinary stomach disease. Folk single remedies use swallowing A Wei during syncope to expel gas; the source of gas lies in the nervous system, hence ancient texts refer to it as liver qi. Ben Tun in *Jin Gui Yao Lue*, with qi rushing upward, is of this type. Zhi Ru Xiang (Frankincense) and Mo Yao (Myrrh) 4g each, Peng E Zhu (Curcumae Rhizoma) 9g, Wu Ling Zhi (Trogopterori Faeces) 12g, Tian Tai Wu Yao (Linderae Radix) 6g, Hai Nan Pian (Arecae Semen) 9g, A Wei (Ferulae Resina) 9g, Chen Xiang Qu (Aquilaria Fermented Mass) 12g, Sheng Zhi Shi (Immature Bitter Orange) 9g, Xie Bai (Allii Macrostemonis Bulbus) 9g, Lai Fu Zi (Radish Seed) 9g, Suo Luo Zi (Breadfruit Seed) 9g, Fo Shou (Citrus Sarcodactylis Fructus) 9g. All ground into fine powder, 1g per dose, three times daily.
Second visit: No syncope occurred after medication, indicating efficacy in expelling gas and calming nerves. Sedatives often cause constipation by inhibiting intestinal peristalsis. A Wei (Ferulae Resina) 9g, Xiang Gan Song (Nardostachyos Radix et Rhizoma) 9g, Quan Dang Gui (Angelicae Sinensis Radix) 15g, Tai Wu Yao (Linderae Radix) 6g, Yan Hu Suo (Corydalis Rhizoma) 9g, Da Chuan Xiong (Ligustici Chuanxiong Rhizoma) 9g, Hai Nan Pian (Arecae Semen) 9g, Sheng Zhi Shi (Immature Bitter Orange) 9g, Hei Chou (Pharbitidis Semen) 9g, Wu Ling Zhi (Trogopterori Faeces) 12g, Guang Mu Xiang (Agastaches Rhizoma) 3g, Lai Fu Zi (Radish Seed) 12g. All ground into fine powder, approx. 3g per dose, once or twice daily.
[Commentary] Mr. Zhang considers this syndrome of extreme hiccups leading to syncope to be of the same category as "Ben Tun," belonging to neurosis, differentiated in TCM as liver depression with qi rushing upward, causing frequent hiccups and syncope upon extremity. Depressed qi is dispersed, knotted qi is scattered. Thus, liver-soothing, qi-regulating, knot-scattering, and rebellion-directing herbs were used, achieving significant effects. Mr. values folk remedies, absorbing the experience of using A Wei for syncope here. Research shows A Wei has functions like resolving accumulation, arresting malaria, and treating dysentery. *Tang Bencao* says it "breaks masses and descends foul qi," fitting well with its use here to descend qi and reverse rebellion.
3. Female. Illness easily recurs upon encountering frustration. Before onset, breathing tightens, limbs go numb; upon onset, teeth gnashing, difficulty speaking, unclear consciousness, flushed face, lasting about 2 hours before recovery; subsequently, extreme chest oppression, frequent sighing. Pulse is large and wiry now. This is Liver Jue (Syncope), also belonging to "Zang Zao" (Organ Agitation). Tian Ma (Gastrodiae Rhizoma) 4g, Hang Bai Shao (Paeoniae Radix Alba) 9g, Liao Dou Yi (Sojae Semen Album Testa) 9g, Guang Yu Jin (Curcuma Tuber) 4g, Zhi Yuan Zhi (Polygalae Radix) 4g, Tong Ji Li (Tribuli Fructus) and Bai Ji Li (Tribuli Fructus) 9g each, Xuan Fu Hua (Inulae Flos) 9g (wrapped), Bao Fu Shen (Poria with Hostwood) 9g, Pei Lan Geng (Eupatorii Caulis) 4g, Qing Zhi Gan Cao (Clear-prepared Licorice Root) 4g, Sheng Mai Ya (Sprouted Hordei Fructus) 15g, Hong Zao (Jujubae Fructus) 10 pieces (pitted).
[Commentary] *Jin Gui Yao Lue·Fu Ren Za Bing Mai Zheng Bing Zhi Pian* states: "Women with Zang Zao often feel sad, want to cry, act as if possessed, yawn frequently; Gan Mai Da Zao Tang governs it." This corresponds to modern hysteria. Although this patient's case is severe, it manifests as hysteria. TCM views this as long-standing liver depression transforming into fire generating wind. Formula uses Tian Ma, Bai Shao, Liao Dou Yi, Tong/Bai Ji Li to calm liver wind; Fu Shen, Yuan Zhi, Hong Zao, Zhi Gan Cao to nourish heart and calm spirit; Yu Jin, Xuan Fu Hua, Pei Lan, Sheng Mai Ya to regulate liver qi. Sheng Mai Ya soothes liver qi; using it instead of wheat echoes the intent of Gan Mai Da Zao Tang.
4. Female. Sensation of a roasted meat lump in throat; hospital exams ruled out organic disease. Coating thin, pulse wiry-slippery. Following Zhang Zhongjing's method. Zhi Hou Po (Magnolia Bark) 9g, Ban Xia (Pinelliae Tuber) 9g, Dang Shen (Codonopsis Radix) 15g, Shan Yao (Dioscoreae Rhizoma) 15g, Guang Mu Xiang (Agastaches Rhizoma) 9g, Quan Dang Gui (Angelicae Sinensis Radix) 9g, Wan Can Sha (Silkworm Excrement) 12g (wrapped), Sha Ren (Amomi Fructus) 4g, Lv E Mei (Green Calyx Plum) 4g. This is severe foot qi (Beriberi), with risk of rushing to the heart. Pao Fu Ku (Prepared Aconite Lateralis Radix Preparata) 6g, Hang Bai Shao (Paeoniae Radix Alba) 6g, Lian Pi Ling (Poria with Hostwood) 15g, Sheng Cang Zhu (Raw Atractylodes Rhizome) 6g, Jiang Pi (Zingiberis Rhizoma Recens Pericarpium) 2g, Dong Gua Zi Pi and Dong Gua Pi (Winter Melon Peel) 9g each, Che Qian Zi (Plantaginis Semen) 12g, Sheng Yi Yi Ren (Coix Seed) 12g, Jiao Mu (Zanthoxyli Semen) 30 grains, Chen Hu Lu Piao (Old Gourd Scoop) 30g. [Commentary] Ancients believed foot qi, though manifesting in feet, roots in the abdomen, hence "ask not the feet, ask the abdomen." Patient has abdominal distension, palpitations, shortness of breath, long course; consider Foot Qi Rushing to Heart. Formula modifies Zhen Wu Tang to warm spleen and kidney yang; replacing Ginger with Ginger Skin aids water movement; replacing Atractylodes Macrocephala with Atractylodes Lancea enhances damp-drying.
5. Male. Numbness in both legs, difficulty walking, chest restlessness, peeled coating on tongue center. These three are typical signs of foot qi. Coughing is a complication. Quan Dang Gui (Angelicae Sinensis Radix) 9g, Da Shu Di (Rehmanniae Radix Preparata) 12g, Hang Bai Shao (Paeoniae Radix Alba) 9g, Da Chuan Xiong (Ligustici Chuanxiong Rhizoma) 2g, Xuan Mu Gua (Chaenomelis Fructus) 9g, Huai Niu Xi (Achyranthis Bidentatae Radix) 9g, Sheng Yi Yi Ren (Coix Seed) 30g, Du Chi Dou (Vigna Angularis Seed) 30g, Hua Bing Lang (Areca Seed) 9g, Bai Su Zi (Perillae Fructus) 9g, Xuan Fu Hua (Inulae Flos) 9g (wrapped). [Commentary] Since patient's feet are not swollen, this is Dry Foot Qi. Formula uses Si Wu Tang to nourish yin and harmonize blood; Niu Xi, Yi Yi Ren, Bing Lang, Mu Gua clear damp-heat; Su Zi, Xuan Fu Hua are symptomatic qi-descending and cough-stopping herbs.
6. Female. Weakness and flaccidity in both legs, starting after leg swelling; this is a sequel to foot qi. Patchy peeled tongue coating, red lips indicate nutritional deficiency. Gan Di Huang (Rehmanniae Radix) 18g, Hang Bai Shao (Paeoniae Radix Alba) 9g, Zhi Shou Wu (Polygoni Multiflori Preparata Tuber) 12g, Huai Shan Yao (Dioscoreae Rhizoma) 9g, Huai Niu Xi (Achyranthis Bidentatae Radix) 9g, Du Chi Dou (Vigna Angularis Seed) 18g, Mai Dong (Ophiopogonis Tuber) 9g, Tu Si Zi (Cuscutae Semen) 9g, Nu Zhen Zi (Ligustri Lucidi Fructus) 9g. [Commentary] After foot qi, righteous qi is injured, liver and kidney deficient; liver governs sinews, kidney governs bones, hence leg weakness. Patchy coating and red lips indicate yin deficiency; thus prescription focuses on nourishing liver and kidney yin.
Stomach Diseases
1. Female. Tongue coating half-peeled; ulcer disease often presents this way. Ancients attributed it to yin deficiency; aromatic-dry herbs cannot be used. Ye Tianshi created the method of nourishing stomach yin for this type of stomach pain and acid regurgitation. Thus, stomach diseases are not all Wuzhuyu, Ganjiang, Rougui syndromes. Bai Shao (Paeoniae Radix Alba) 10g, Duan Wa Leng Zi (Concha Arcae) 18g (crushed, decocted first), Bei Shu Mi (Milii Fructus) 10g, Zhi Mu (Anemarrhenae Rhizoma) 10g, Mai Dong (Ophiopogonis Tuber) 9g, Huang Jing (Polygonati Rhizoma) 12g, Huai Shan Yao (Dioscoreae Rhizoma) 12g, Yun Fu Ling (Poria) 9g, Chuan Liu Zi (Toosendan Fructus) 9g. [Commentary] Half-peeled tongue coating indicates stomach yin injury. Ulcer disease showing this is often due to qi stagnation transforming into fire, burning stomach yin; thus aromatic-dry qi-regulating herbs must not be used. Ye Tianshi advocated "avoid rigid, use soft" for this syndrome. Prescription follows Yi Guan Jian intent: Mai Dong, Shan Yao, Huang Jing, Shu Mi nourish stomach yin; Zhi Mu, Chuan Liu Zi drain liver-stomach heat; Wa Leng Zhi neutralizes acid and protects membrane; Fu Ling sweetly leaches dampness to strengthen spleen. Knowing tonification requires knowing draining; this embodies the subtlety of formula creation.
2. Ms. Chen. Stomach pain occurs approx. 2 hours after meals; eating hard solid food worsens pain; highest suspicion of ulcer disease. Overusing aromatic-dry stimulating herbs in such cases invariably causes harm. Caution! Ku Xing Ren (Bitter Apricot Seed) 24g, Quan Dang Gui (Angelicae Sinensis Radix) 12g, Bai Shao (Paeoniae Radix Alba) 9g, Xuan Hu Suo (Corydalis Rhizoma) 9g, Tao Ren Ni (Persicae Semen Paste) 9g, Fu Ling (Poria) 9g, Yi Yi Ren (Coix Seed) 15g, Fei Hua Shi (Prepared Talcum) 9g. Additionally: Chicken eggshell calcined on tile until charred but retaining nature, 2g per dose, three times daily, before meals.
[Commentary] Stomach pain generally uses aromatic qi-regulating herbs, but overdosing inevitably injures stomach yin. Ulcer patients are prone to bleeding; aromatic-dry stimulants must be used cautiously. This case uses Dang Gui, Tao Ren, Xing Ren to move stagnation, resolve stasis, and stop pain—Mr. Zhang's years of experience, truly effective for ulcer pain. Dang Gui and Bai Shao together regulate nutritive blood and relieve urgency/pain; Xuan Hu Suo analgesically effective; Calcined Eggshell neutralizes acid and promotes ulcer healing; Yi Yi Ren anciently described as "strengthening spleen/stomach, promoting water passage," "draining pus/reducing swelling," helping ulcer lesion resolution; Fu Ling and Hua Shi leverage spleen-strengthening and damp-draining effects.
3. Male. Previously vomited black water, stool also black. Now acid regurgitation and discomfort, occurring 3-4 hours after meals, upper abdomen feels board-like hard and painful. Highly suspicious of ulcer disease; strictly avoid spicy/stimulating foods; otherwise hematemesis or melena is inevitable. Xing Ren Ni (Apricot Seed Paste) 30g, Dang Gui (Angelicae Sinensis Radix) 12g, Sheng Di Yu (Sanguisorbae Radix) 9g, Xue Yu Tan (Pilose Barbel Blood Charcoal) 9g, Xuan Hu Suo (Corydalis Rhizoma) 9g, Duan Wa Leng Zi (Concha Arcae) 30g. Additionally: Hu Po Fen (Amber Powder), Xiang Ya Xie (Ivory Chips), Hua Shi (Talcum) 9g each, ground to ultra-fine powder, mixed evenly, 2g swallowed after each meal. [Commentary] This syndrome is likely duodenal ulcer disease in modern medicine. Formula uses Xing Ren Ni, Dang Gui, Yan Hu Suo for pain; Di Yu, Xue Yu Tan for hemostasis; Wa Leng Zi for acid neutralization. Additional powder aims to protect membrane and generate flesh, i.e., repair ulcer surface.
4. Male. Stomach pain initially occurred during hunger, relieved by eating; pain gradually intensified, now hurting before and after meals; previously vomited purple-black material. Now frequent discomfort, fullness, diarrhea. Ancients attributed this to phlegm-fire; strictly avoid pungent-aromatic-dry-hot herbs. Feng Huang Yi (Chicken Egg Inner Membrane) 9g, Hu Po Xie (Amber Chips) 9g, Zhi Ma Bo (Prepared Marshallia Herb) 9g, Shi Shuang (Persimmon Frost) 18g, Xing Ren Ni (Apricot Seed Paste) 18g, Xiang Bei (Fritillariae Thunbergii Bulbus) 18g, Ye Qiang Wei Hua (Wild Rose Flower) 9g, Hua Fen (Trichosanthis Radix) 9g, Xue Yu Tan (Pilose Barbel Blood Charcoal) 9g. All ground to fine powder, 1g per dose, three times daily, before meals. Second visit: Condition alleviated. Now providing qi-tonifying and stomach-strengthening agent, taken sequentially with previous formula to cultivate root. Dang Shen (Codonopsis Radix) 60g, Huai Shan Yao (Dioscoreae Rhizoma) 60g, Ji Nei Jin (Gallus Gizzard Lining) 60g, Duan Long Gu (Fossilia Ossis Mastodi) 30g. Ground to powder, 3g per dose, three times daily.
[Commentary] This is ulcer disease. TCM holds that pain during hunger, relief with food, indicates middle jiao deficiency. Pain intensifying to pre/post-meal pain, plus vomiting purple-black material, indicates long-term pain damaging stomach collaterals, blood stasis retention; discomfort, fullness, diarrhea indicate spleen-stomach weakness, failure to transform grain/water, generating phlegm—what ancients called "phlegm-fire." Formula uses Hua Fen, Shi Shuang, Xing Ren Ni, Xiang Bei to clear phlegm-fire, protect stomach, relieve pain; Xue Yu Tan, Ma Bo, Hu Po to unblock collaterals, invigorate blood, stop bleeding. Feng Huang Yi (egg inner membrane) protects ulcer surface; combined with Ma Bo, neutralizes acid—Mr. Zhang's unique experience. Ye Qiang Wei Hua (Wild Rose Flower), also known as Bai Can Hua, enters stomach/liver meridians, clears heat/dampness, harmonizes qi/stomach, effective for stomach heat stagnation with collateral damage and hematemesis. Second visit adds qi-tonifying spleen-strengthening herbs to treat the root.
5. Male. Stomach pain for 8 years, mostly occurring approx. 3 hours after meals, slightly relieved by eating, history of black stool. Ulcer disease is beyond doubt. Feng Huang Yi (Chicken Egg Inner Membrane) 30g, Yu Hu Die (Buddlejae Flos) 30g, Qing Ma Bo (Light Marshallia Herb) 20g, Xiang Bei Mu (Fritillariae Thunbergii Bulbus) 20g, Xue Yu Tan (Pilose Barbel Blood Charcoal) 15g, Hu Po Fen (Amber Powder) 15g. All ground to fine powder, 2g per dose, three times daily, before meals.