本 胁左隐痛，胸间动气，头晕肢麻，寐即舌干似辣，中夜自汗，清晨咳痰，便泻觉爽。肝阳挟风火上
冒，侵犯脾土使然。秋深左关脉弦长牢实，医谓金弱木强，非时脉见，来春木必侮土，膈逆司忧，遂用滋肾镇
肝，数十剂脉症未退。更医进胃爱丸，服后痰较少而泄气多，且皆健脾药，不能制肝阳，历冬并右脉亦弦
劲，胸脘引痛。予谓前症自是肝阳肆横，但肝为刚脏，不任克制，专用滋清，恐又致痛为胀。若仿《内经》治肝
以酸泻之法，自然柔伏矣。因用白芍、木瓜、乌梅、萸肉、五味、金橘、枣仁等，加牡蛎（醋 ）、橘络、
木香、茯神、芝麻、小麦、桑枝膏为丸。服后左关渐软，不见弦长矣。且示以静摄戒怒节劳，右脉亦和，诸
症渐除。
王 高年胸胁气阻痛，脉虚弦。用苦咸酸以泄降。浓朴（姜汁制，五分）、枳壳、旋复花（各钱半）、
牡蛎粉（醋 ，二钱）、白芍（炒，三钱）、木瓜（八分）、降香末（二钱）。三服肝逆已平，尚未嗜食，用
甘凉以调胃阴。石斛（二钱）、麦冬（钱半）、甘草（五分）、茯苓、白芍、当归（各二钱）、小麦（一撮）、
红枣（五枚）。五服全安。
沈氏 寒热食减，厥气攻注，痛连胸背，脉弦，左浮大。服平肝镇逆之剂，攻注稍缓，宿有胀症，曾用
通腑法获痊。今惧其壅而成胀，兼用通镇，庶几善后之防。白云苓（二钱）、郁金、浓朴（各
六分）、砂仁、乌药（各八分）、苏梗、枳壳（汁，各钱半）、代赭石、石决明（各二钱），金器同煎，
三五服愈。
何氏 肝郁失畅，循经则头项作胀，乘脾则痰浊化酸，入络则肌肉刺痛，腋下零湿，经信愆期，左
关沉弦。治在疏肝，佐以渗湿。浓朴、香附、郁金、白芍、茯苓、金橘皮、山栀、钩藤、当归须。三四服诸症
减，自述平昔肠鸣，必倾泻乃爽。亦木气乘土之咎，且肥人虑虚其阳。前方去郁金、山栀、加制半夏、炒白
术、薏米、炙草。经亦调。
蔡 小腹气上冲膈，食下呕吐，寒热，便泻，溺痛。病久脉弦左虚，乃厥阴浊逆为吐，攻肠为泻。治在泄浊
安胃。吴萸（泡）、川楝子（酒蒸）、小茴香（酒炒）、茯苓、车前子、橘核、白芍（俱炒）、生姜、半夏曲。
数服诸症退，去吴萸、川楝子、车前子、生姜，加砂仁、炮姜、广皮。服愈。
束氏 经阻疑孕，胸痞呕酸，寒热胫冷，食减便难，两部沉弦。乃气逆浊踞，非恶阻病，宜和肝泄浊。
吴萸、香附（盐水炒）、茯苓、浓朴、半夏（俱姜汁炒）、橘白、苏梗、枳壳、煨姜。三服前症渐平。
张 当春脉弦，肝木乘土，噫气，大便艰少，常欲入厕，皆肝气忽升忽降致之。青皮、旋复花、降香、
白芍、牡蛎、炙草、当归、半夏（姜汁制）。二服噫气平，大便不结，惟睾丸注痛，加橘核（酒炒）。服全瘳。
丁 神伤思虑则肉脱，意伤忧愁则肢废。高年忧思菀结，损动肝脾，右胁气痛，攻胸引背，不能平卧，
气粗液夺，食少便难。由肝胃不和，腑不司降，耳鸣肢麻，体瘦脉弦，风动阳升，脂肉消铄，有晕仆之惧。
香岩谓肝为刚脏，忌用刚药。仲景法肝病治胃，是有取乎酸泄通降之品矣。白芍、木瓜、牡蛎、金橘皮、苏
子、蒌仁、杏仁、归须、枳壳，再服颇适。然症由情怀内起，宜娱情善调，不宜专恃药饵也。
陈 胁胀胸痛呕吐，肝气上升，阳明当其冲，必犯脘倾液而出。脉左迟虚，右弦小，阴疟宿恙未愈。
治在益胃和肝，勿使疟厥。白芍、茯苓（各二钱）、制浓朴（六分）、制半夏（钱半）、橘白、枳壳（各一钱）、
砂仁（连壳八分）、乌梅（二枚）、煨姜（二片）。数服胀痛若失，阴疟亦瘳。
于 先由吞酸，渐次胸胁满闷，食后必吐，病因肝郁失畅，延至木气犯土，水浊不降，势必溺少便结，
肝乘胃反矣。苦降逆辛泄浊主之。制浓朴、吴萸、干姜、苏子（炒研。各五分）、枳壳、降香末、半夏
曲（各钱半）、茯苓（二钱）、椒目（十粒）。数服渐安。
潘 少腹本厥阴部分， 痛不已，利下粘腻如鱼脑，又呕紫血甚多，继以鲜红，夜烦不寐，足厥冷，
左脉虚弦，右虚小。此土受木侮，必饮啖后郁勃动肝，厥阴凌犯中下焦，清浊互伤，呕利并剧，节交雨水，
风阳猝乘，药忌刚燥，但柔肝熄风缓痛为宜。阿胶（水煨）、白芍、木香、小茴香（盐水炒）、香附（醋炒）、
延胡（酒炒）、茯神。一服血止，痛利大减，足亦和。再加炮姜、黑楂肉服，症悉平。改用潞参、茯苓、
白芍、山药、炙草、砂仁、诃子肉、粳米、枣肉，调脾而食进。但呕利伤阴，精神未复，因事枨触，寒热
烦痛，按捶略爽，是营卫流行之机，未免钝窒矣。且咳喘痰灰，肾虚气少摄纳，必补中则营卫自和，摄肾则
喘嗽可定。潞参、炙 、归身、炙草、茯神、五味、山药、骨脂、核桃肉、沙苑子。渐次调理向安。
从侄 左乳下一缕气升，热痛至项，明是肝阳郁久致然。恰当暑湿炎蒸，每岁屡发，本由怫悒，肝久
失畅，经隧痰气阻塞，致肺胃不主升降。痞嗳吞酸，大便忽溏忽硬，脉来沉涩。仿丹溪越鞠丸。山栀、川芎、
神曲、香附醋炒、蒌仁、旋复花、杏仁、贝母、枳壳。煎服辄安。
严 中年气从季胁横攻中上脘，呕沫失血，年余未愈。近日食少神衰，服燕窝汤滋胀，两关虚缓，冷涎
上泛。此肝浊瘀滞，久则入络致满，宜辛温泄浊。吴萸（盐水炒）、半夏（姜制）、广皮、延胡（酒焙）、
浓朴（姜制）、茯苓、降香末、当归须。二服冷涎痛胀悉止。但阳衰胫冷，法在益阳，去吴萸加桂枝、炮姜、
草果（煨）等。三剂食进。
吴 冬初由水泻后腹胀，是脏寒生满，脉虚食少。治先温通理阳。用益智、炮姜、潞参、茯苓、制半夏、
缩砂壳、广皮、陈粳米煎汤眼。数剂颇适。晚餐少运化，加神曲、鸡内金（俱炒），胀宽。冬季因怫逆动肝，
胁腹胀痛，寒热，脉微数。转方用白芍、
当归、潞参、苏梗、鲜橘叶，缩砂壳、郁金汁，两合肝胃，痛缓药停。春正上脘痛呕沫，由肝邪乘胃，胃气
失降则胀壅，肝阳上升则呕痛，因肝为刚脏，法当柔以软之，甘以缓之。且肝阴久亏，触事生怒，脾元不复，
病先肉脱。劣手竟用赭石重镇，桂心刚制，炒术壅气，兼蒺藜、青皮疏肝伐肝，一啜烦躁大痛，再剂胁如刃
割，腹绞痛欲绝。予闻，拟甘润柔剂，用阿胶、鸡蛋黄、白芍、甘草、枣仁、当归、饴糖等。遥寄片纸，药
未及撮而殁。志此为以刚治刚，好言平肝者鉴。
【背景信息】
书名：类证治裁 作者：林佩琴 朝代：清 章节：肝气脉案 类别：综合
【待处理原文】
本胁左隐痛，胸间动气，头晕肢麻，寐即舌干似辣，中夜自汗，清晨咳痰，便泻觉爽。肝阳挟风火上冒，侵犯脾土使然。秋深左关脉弦长牢实，医谓金弱木强，非时脉见，来春木必侮土，膈逆司忧，遂用滋肾镇肝，数十剂脉症未退。更医进胃爱丸，服后痰较少而泄气多，且皆健脾药，不能制肝阳，历冬并右脉亦弦劲，胸脘引痛。予谓前症自是肝阳肆横，但肝为刚脏，不任克制，专用滋清，恐又致痛为胀。若仿《内经》治肝以酸泻之法，自然柔伏矣。因用白芍、木瓜、乌梅、萸肉、五味、金橘、枣仁等，加牡蛎（醋）、橘络、木香、茯神、芝麻、小麦、桑枝膏为丸。服后左关渐软，不见弦长矣。且示以静摄戒怒节劳，右脉亦和，诸症渐除。
王高年胸胁气阻痛，脉虚弦。用苦咸酸以泄降。浓朴（姜汁制，五分）、枳壳、旋复花（各钱半）、牡蛎粉（醋煅，二钱）、白芍（炒，三钱）、木瓜（八分）、降香末（二钱）。三服肝逆已平，尚未嗜食，用甘凉以调胃阴。石斛（二钱）、麦冬（钱半）、甘草（五分）、茯苓、白芍、当归（各二钱）、小麦（一撮）、红枣（五枚）。五服全安。
沈氏寒热食减，厥气攻注，痛连胸背，脉弦，左浮大。服平肝镇逆之剂，攻注稍缓，宿有胀症，曾用通腑法获痊。今惧其壅而成胀，兼用通镇，庶几善后之防。白云苓（二钱）、郁金、浓朴（各六分）、砂仁、乌药（各八分）、苏梗、枳壳（汁，各钱半）、代赭石、石决明（各二钱），金器同煎，三五服愈。
何氏肝郁失畅，循经则头项作胀，乘脾则痰浊化酸，入络则肌肉刺痛，腋下零湿，经信愆期，左关沉弦。治在疏肝，佐以渗湿。浓朴、香附、郁金、白芍、茯苓、金橘皮、山栀、钩藤、当归须。三四服诸症减，自述平昔肠鸣，必倾泻乃爽。亦木气乘土之咎，且肥人虑虚其阳。前方去郁金、山栀、加制半夏、炒白术、薏米、炙草。经亦调。
蔡小腹气上冲膈，食下呕吐，寒热，便泻，溺痛。病久脉弦左虚，乃厥阴浊逆为吐，攻肠为泻。治在泄浊安胃。吴萸（泡）、川楝子（酒蒸）、小茴香（酒炒）、茯苓、车前子、橘核、白芍（俱炒）、生姜、半夏曲。数服诸症退，去吴萸、川楝子、车前子、生姜，加砂仁、炮姜、广皮。服愈。
束氏经阻疑孕，胸痞呕酸，寒热胫冷，食减便难，两部沉弦。乃气逆浊踞，非恶阻病，宜和肝泄浊。吴萸、香附（盐水炒）、茯苓、浓朴、半夏（俱姜汁炒）、橘白、苏梗、枳壳、煨姜。三服前症渐平。
张当春脉弦，肝木乘土，噫气，大便艰少，常欲入厕，皆肝气忽升忽降致之。青皮、旋复花、降香、白芍、牡蛎、炙草、当归、半夏（姜汁制）。二服噫气平，大便不结，惟睾丸注痛，加橘核（酒炒）。服全瘳。
丁神伤思虑则肉脱，意伤忧愁则肢废。高年忧思菀结，损动肝脾，右胁气痛，攻胸引背，不能平卧，气粗液夺，食少便难。由肝胃不和，腑不司降，耳鸣肢麻，体瘦脉弦，风动阳升，脂肉消铄，有晕仆之惧。香岩谓肝为刚脏，忌用刚药。仲景法肝病治胃，是有取乎酸泄通降之品矣。白芍、木瓜、牡蛎、金橘皮、苏子、蒌仁、杏仁、归须、枳壳，再服颇适。然症由情怀内起，宜娱情善调，不宜专恃药饵也。
陈胁胀胸痛呕吐，肝气上升，阳明当其冲，必犯脘倾液而出。脉左迟虚，右弦小，阴疟宿恙未愈。治在益胃和肝，勿使疟厥。白芍、茯苓（各二钱）、制浓朴（六分）、制半夏（钱半）、橘白、枳壳（各一钱）、砂仁（连壳八分）、乌梅（二枚）、煨姜（二片）。数服胀痛若失，阴疟亦瘳。
于先由吞酸，渐次胸胁满闷，食后必吐，病因肝郁失畅，延至木气犯土，水浊不降，势必溺少便结，肝乘胃反矣。苦降逆辛泄浊主之。制浓朴、吴萸、干姜、苏子（炒研。各五分）、枳壳、降香末、半夏曲（各钱半）、茯苓（二钱）、椒目（十粒）。数服渐安。
潘少腹本厥阴部分，痛不已，利下粘腻如鱼脑，又呕紫血甚多，继以鲜红，夜烦不寐，足厥冷，左脉虚弦，右虚小。此土受木侮，必饮啖后郁勃动肝，厥阴凌犯中下焦，清浊互伤，呕利并剧，节交雨水，风阳猝乘，药忌刚燥，但柔肝熄风缓痛为宜。阿胶（水煨）、白芍、木香、小茴香（盐水炒）、香附（醋炒）、延胡（酒炒）、茯神。一服血止，痛利大减，足亦和。再加炮姜、黑楂肉服，症悉平。改用潞参、茯苓、白芍、山药、炙草、砂仁、诃子肉、粳米、枣肉，调脾而食进。但呕利伤阴，精神未复，因事枨触，寒热烦痛，按捶略爽，是营卫流行之机，未免钝窒矣。且咳喘痰灰，肾虚气少摄纳，必补中则营卫自和，摄肾则喘嗽可定。潞参、炙黄芪、归身、炙草、茯神、五味、山药、骨脂、核桃肉、沙苑子。渐次调理向安。
从侄左乳下一缕气升，热痛至项，明是肝阳郁久致然。恰当暑湿炎蒸，每岁屡发，本由怫悒，肝久失畅，经隧痰气阻塞，致肺胃不主升降。痞嗳吞酸，大便忽溏忽硬，脉来沉涩。仿丹溪越鞠丸。山栀、川芎、神曲、香附醋炒、蒌仁、旋复花、杏仁、贝母、枳壳。煎服辄安。
严中年气从季胁横攻中上脘，呕沫失血，年余未愈。近日食少神衰，服燕窝汤滋胀，两关虚缓，冷涎上泛。此肝浊瘀滞，久则入络致满，宜辛温泄浊。吴萸（盐水炒）、半夏（姜制）、广皮、延胡（酒焙）、浓朴（姜制）、茯苓、降香末、当归须。二服冷涎痛胀悉止。但阳衰胫冷，法在益阳，去吴萸加桂枝、炮姜、草果（煨）等。三剂食进。
吴冬初由水泻后腹胀，是脏寒生满，脉虚食少。治先温通理阳。用益智、炮姜、潞参、茯苓、制半夏、缩砂壳、广皮、陈粳米煎汤眼。数剂颇适。晚餐少运化，加神曲、鸡内金（俱炒），胀宽。冬季因怫逆动肝，胁腹胀痛，寒热，脉微数。转方用白芍、当归、潞参、苏梗、鲜橘叶，缩砂壳、郁金汁，两合肝胃，痛缓药停。春正上脘痛呕沫，由肝邪乘胃，胃气失降则胀壅，肝阳上升则呕痛，因肝为刚脏，法当柔以软之，甘以缓之。且肝阴久亏，触事生怒，脾元不复，病先肉脱。劣手竟用赭石重镇，桂心刚制，炒术壅气，兼蒺藜、青皮疏肝伐肝，一啜烦躁大痛，再剂胁如刃割，腹绞痛欲绝。予闻，拟甘润柔剂，用阿胶、鸡蛋黄、白芍、甘草、枣仁、当归、饴糖等。遥寄片纸，药未及撮而殁。志此为以刚治刚，好言平肝者鉴。
[Background Information]
Book: *Lei Zheng Zhi Cai* (Compendium of Treatment for Differentiated Syndromes)
Author: Lin Peiqin
Dynasty: Qing
Chapter: Liver Qi Case Records
Category: Comprehensive
[Original Text Translation]
**Case 1: Ben**
The patient experienced dull pain in the left hypochondrium, qi movement in the chest, dizziness, and numbness of the limbs. Upon falling asleep, the tongue felt dry and burning-like. There was spontaneous sweating in the middle of the night, coughing up phlegm in the early morning, and relief after diarrhea. This was caused by Liver Yang carrying Wind-Fire ascending to invade the Spleen Earth. In late autumn, the pulse at the left Guan position was wiry, long, firm, and solid. The physician stated that Metal was weak and Wood was strong; this pulse appeared out of season. In the coming spring, Wood would surely overact on Earth, leading to worry about diaphragmatic regurgitation. Consequently, nourishing Kidney and subduing Liver prescriptions were used for dozens of doses, but the pulse and symptoms did not recede. Another physician administered Wei Ai Wan (Stomach-Loving Pill). After taking it, phlegm decreased slightly, but there was excessive passage of flatus. Since these were all Spleen-strengthening herbs, they could not control Liver Yang. Throughout winter, even the right pulse became wiry and forceful, with radiating pain in the chest and epigastrium. I stated that the previous symptoms were indeed due to the rampant Liver Yang. However, the Liver is a rigid organ and cannot withstand harsh suppression. Using only nourishing and clearing methods might cause pain to turn into distension. If we imitate the *Nei Jing* method of treating the Liver with sour flavors to drain it, it will naturally become soft and subdued. Therefore, I used Bai Shao (White Peony Root), Mu Gua (Chaenomeles Fruit), Wu Mei (Mume Fruit), Yu Rou (Cornus Fruit), Wu Wei Zi (Schisandra Berry), Jin Ju (Golden Orange), Zao Ren (Jujube Seed), etc., adding Mu Li (Oyster Shell, vinegar-processed), Ju Luo (Tangerine Pith Network), Mu Xiang (Aucklandia Root), Fu Shen (Poria with Hostwood), Zhi Ma (Sesame), Xiao Mai (Wheat), and Sang Zhi Gao (Mulberry Twig Paste) to make pills. After taking them, the left Guan pulse gradually softened, no longer appearing wiry and long. I also advised quiet recuperation, avoiding anger, and moderating labor. The right pulse harmonized, and various symptoms gradually disappeared.
**Case 2: Wang**
An elderly patient suffered from qi obstruction and pain in the chest and hypochondrium, with a deficient and wiry pulse. Bitter, salty, and sour flavors were used to drain and descend. Hou Po (Magnolia Bark, ginger-juice processed, 5 fen), Zhi Ke (Bitter Orange Fruit), Xuan Fu Hua (Inula Flower, each 1 qian 5 fen), Mu Li Fen (Oyster Shell Powder, calcined with vinegar, 2 qian), Bai Shao (White Peony Root, stir-fried, 3 qian), Mu Gua (Chaenomeles Fruit, 8 fen), Jiang Xiang Mo (Aquilaria Sawdust, 2 qian). After three doses, Liver rebellious Qi had calmed, but appetite was still lacking. Sweet and cool flavors were used to regulate Stomach Yin. Shi Hu (Dendrobium Stem, 2 qian), Mai Dong (Ophiopogon Tuber, 1 qian 5 fen), Gan Cao (Licorice Root, 5 fen), Fu Ling (Poria, 2 qian), Bai Shao (White Peony Root, 2 qian), Dang Gui (Angelica Sinensis Root, 2 qian), Xiao Mai (Wheat, a pinch), Hong Zao (Red Jujube, 5 pieces). After five doses, full recovery was achieved.
**Case 3: Shen Family**
Alternating fever and chills, reduced food intake, Jue Qi attacking and flooding, pain connecting the chest and back, wiry pulse, left floating and large. After taking formulas to calm the Liver and suppress rebellious Qi, the attacking sensation slowed slightly. The patient had a chronic history of distension, previously cured by purgative methods. Fearing obstruction leading to distension again, both purgative and suppressing methods were combined for preventive care in the aftermath. Bai Yun Ling (Poria, 2 qian), Yu Jin (Curcuma Tuber), Hou Po (Magnolia Bark, each 6 fen), Sha Ren (Amomum Fruit), Wu Yao (Lindera Root, each 8 fen), Su Geng (Perilla Stem), Zhi Ke (Bitter Orange Fruit juice, each 1 qian 5 fen), Dai Zhe Shi (Hematite), Shi Jue Ming (Abalone Shell, each 2 qian), decocted together with gold vessels. Cured in three to five doses.
**Case 4: He Family**
Liver Qi stagnation and lack of smooth flow. Following the meridians, it causes distension in the head and neck; invading the Spleen, it transforms turbid phlegm into acid; entering the collaterals, it causes stabbing muscle pain, dampness in the armpits, irregular menstruation, and a deep, wiry pulse at the left Guan position. Treatment focuses on soothing the Liver, assisted by draining dampness. Hou Po (Magnolia Bark), Xiang Fu (Cyperus Rhizome), Yu Jin (Curcuma Tuber), Bai Shao (White Peony Root), Fu Ling (Poria), Jin Ju Pi (Golden Orange Peel), Shan Zhi (Gardenia Fruit), Gou Teng (Uncaria Ramulus cum Uncis), Dang Gui Xu (Angelica Sinensis Root tip). After three or four doses, symptoms decreased. The patient described that normally, borborygmus occurs, and relief comes only after profuse diarrhea. This is also due to Wood Qi overacting on Earth, and one must consider yang deficiency in obese individuals. From the previous formula, remove Yu Jin and Shan Zhi; add Zhi Ban Xia (Pinellia Tuber, processed), Chao Bai Zhu (Atractylodes Macrocephala Rhizome, stir-fried), Yi Mi (Coix Seed), Zhi Cao (Honey-fried Licorice Root). Menstruation also regulated.
**Case 5: Cai**
Qi rushing from the lower abdomen to the diaphragm, vomiting after eating, alternating fever and chills, diarrhea, painful urination. Long-standing illness, wiry pulse, left deficient. This is Jue Yin turbid rebellious Qi causing vomiting, attacking the intestines causing diarrhea. Treatment focuses on draining turbidity and calming the Stomach. Wu Zhu Yu (Evodia Fruit, soaked), Chuan Lian Zi (Toosendan Fruit, steamed with wine), Xiao Hui Xiang (Fennel Fruit, stir-fried with wine), Fu Ling (Poria), Che Qian Zi (Plantago Seed), Ju He (Tangerine Seed), Bai Shao (White Peony Root, all stir-fried), Sheng Jiang (Fresh Ginger), Ban Xia Qu (Pinellia Fermented Mass). After several doses, symptoms receded. Remove Wu Zhu Yu, Chuan Lian Zi, Che Qian Zi, Sheng Jiang; add Sha Ren (Amomum Fruit), Pao Jiang (Roasted Ginger), Guang Pi (Tangerine Peel). Cured.
**Case 6: Shu Family**
Menstrual obstruction suspected pregnancy, chest stuffiness, vomiting acid, alternating fever and chills, cold calves, reduced food intake, difficult defecation, deep and wiry pulses in both positions. This is rebellious Qi and turbidity occupying, not morning sickness. It is suitable to harmonize the Liver and drain turbidity. Wu Zhu Yu (Evodia Fruit), Xiang Fu (Cyperus Rhizome, stir-fried with salt water), Fu Ling (Poria), Hou Po (Magnolia Bark), Ban Xia (Pinellia Tuber, all ginger-juice processed), Ju Bai (Tangerine White), Su Geng (Perilla Stem), Zhi Ke (Bitter Orange Fruit), Wei Jiang (Roasted Ginger). After three doses, previous symptoms gradually calmed.
**Case 7: Zhang**
In spring, the pulse is wiry; Liver Wood overacts on Earth. Belching, scanty and difficult stools, frequent urge to defecate, all caused by Liver Qi rising and falling suddenly. Qing Pi (Green Tangerine Peel), Xuan Fu Hua (Inula Flower), Jiang Xiang (Aquilaria Wood), Bai Shao (White Peony Root), Mu Li (Oyster Shell), Zhi Cao (Honey-fried Licorice Root), Dang Gui (Angelica Sinensis Root), Ban Xia (Pinellia Tuber, ginger-juice processed). After two doses, belching calmed, stool unblocked. Only testicular radiating pain remained; add Ju He (Tangerine Seed, stir-fried with wine). Cured completely.
**Case 8: Ding**
Spirit injury from overthinking leads to emaciation;意念 (Yi/Mind) injury from sorrow leads to limb paralysis. An elderly person suffers from pent-up worry and thought, damaging and moving Liver and Spleen. Qi pain in the right hypochondrium attacks the chest and radiates to the back, unable to lie flat. Rough breathing and fluid depletion, reduced food intake, difficult defecation. Due to Liver-Stomach disharmony, the Fu organs fail to descend. Tinnitus and limb numbness, thin body, wiry pulse, Wind stirring and Yang ascending, fat and flesh wasting away, fear of fainting. Xiang Yan stated that the Liver is a rigid organ, contraindicating rigid medicines. Zhong Jing’s method for Liver disease treats the Stomach, utilizing sour-draining and descending agents. Bai Shao (White Peony Root), Mu Gua (Chaenomeles Fruit), Mu Li (Oyster Shell), Jin Ju Pi (Golden Orange Peel), Su Zi (Perilla Seed), Lou Ren (Trichosanthes Seed), Xing Ren (Apricot Seed), Gui Xu (Angelica Sinensis Root tip), Zhi Ke (Bitter Orange Fruit). After another dose, felt quite comfortable. However, since the syndrome arises internally from emotions, it is suitable to entertain the mind and adjust well, rather than relying solely on herbal medicine.
**Case 9: Chen**
Hypochondriac distension, chest pain, vomiting. Liver Qi ascending, Yangming bearing the impact, must invade the epigastrium, pouring out fluids. Pulse left slow and deficient, right wiry and small. Chronic Yin Malaria not yet cured. Treatment focuses on benefiting the Stomach and harmonizing the Liver, preventing malaria convulsions. Bai Shao (White Peony Root), Fu Ling (Poria, each 2 qian), Zhi Hou Po (Magnolia Bark, processed, 6 fen), Zhi Ban Xia (Pinellia Tuber, processed, 1 qian 5 fen), Ju Bai (Tangerine White), Zhi Ke (Bitter Orange Fruit, each 1 qian), Sha Ren (Amomum Fruit, with shell, 8 fen), Wu Mei (Mume Fruit, 2 pieces), Wei Jiang (Roasted Ginger, 2 slices). After several doses, distension and pain vanished, Yin Malaria also healed.
**Case 10: Yu**
Initially acid regurgitation, gradually chest and hypochondriac fullness and oppression, vomiting after eating. Etiology is Liver Qi stagnation and lack of smooth flow, extending to Wood Qi invading Earth, Water Turbidity failing to descend, inevitably leading to scanty urine and constipation, Liver overacting on Stomantic reflux. Bitter-descending and pungent-draining turbidity is the main treatment. Zhi Hou Po (Magnolia Bark, processed), Wu Zhu Yu (Evodia Fruit), Gan Jiang (Dried Ginger), Su Zi (Perilla Seed, stir-fried and ground, each 5 fen), Zhi Ke (Bitter Orange Fruit), Jiang Xiang Mo (Aquilaria Sawdust), Ban Xia Qu (Pinellia Fermented Mass, each 1 qian 5 fen), Fu Ling (Poria, 2 qian), Jiao Mu (Pepper Seed, 10 grains). After several doses, gradually stabilized.
**Case 11: Pan**
The lower abdomen belongs to the Jue Yin portion. Pain unceasing, discharge sticky like fish brain, vomiting much purple blood followed by bright red blood, nighttime restlessness and insomnia, cold feet, left pulse deficient and wiry, right pulse deficient and small. This is Earth being overacted upon by Wood. Likely after drinking and eating, depression stirs the Liver, Jue Yin invades the Middle and Lower Jiao, Clear and Turbid mutually injuring, vomiting and diarrhea severe. Season enters Rain Water, Wind-Yang suddenly attacks. Medicines should avoid rigid and drying properties; softening the Liver, extinguishing Wind, and relieving pain is appropriate. E Jiao (Donkey-Hide Gelatin, simmered in water), Bai Shao (White Peony Root), Mu Xiang (Aucklandia Root), Xiao Hui Xiang (Fennel Fruit, stir-fried with salt water), Xiang Fu (Cyperus Rhizome, vinegar-processed), Yan Hu (Corydalis Rhizome, wine-processed), Fu Shen (Poria with Hostwood). After one dose, bleeding stopped, pain and diarrhea greatly reduced, feet harmonized. Add Pao Jiang (Roasted Ginger), Hei Zha Rou (Black Hawthorn Flesh) to take, symptoms completely calmed. Switch to Lu Shen (Codonopsis Root), Fu Ling (Poria), Bai Shao (White Peony Root), Shan Yao (Dioscorea Rhizome), Zhi Cao (Honey-fried Licorice Root), Sha Ren (Amomum Fruit), He Zi Rou (Chebulic Myrobalan Flesh), Jing Mi (Rice), Zao Rou (Jujube Flesh) to regulate the Spleen and advance food intake. But vomiting and diarrhea injured Yin, spirit not recovered. Due to matters touching emotions, alternating fever and chills, vexation and pain, pressing and kneading brings slight relief. This indicates the mechanism of Ying and Wei circulation is somewhat sluggish. Also coughing, wheezing, gray phlegm, Kidney deficiency with insufficient Qi reception. Must tonify the Middle so Ying and Wei harmonize naturally; grasp the Kidney so wheezing and coughing can be settled. Lu Shen (Codonopsis Root), Zhi Huang Qi (Honey-fried Astragalus Root), Gui Shen (Angelica Sinensis Root body), Zhi Cao (Honey-fried Licorice Root), Fu Shen (Poria with Hostwood), Wu Wei Zi (Schisandra Berry), Shan Yao (Dioscorea Rhizome), Gu Zhi (Morinda Officinalis Root Bark), Tao Ren Rou (Walnut Kernel Meat), Sha Yuan Zi (Astragalus Complanatus Seed). Gradually regulating towards peace.
**Nephew**
A strand of Qi rising under the left breast, hot pain reaching the neck, clearly caused by long-term stagnation of Liver Yang. Coinciding with summer heat and dampness steaming, recurring annually, originally due to depression. Liver has long lacked smooth flow, phlegm and Qi blocking the meridians, causing Lung and Stomach to fail in governing ascending and descending. Chest stuffiness, belching, acid regurgitation, stool alternately loose and hard, pulse deep and choppy. Imitate Dan Xi Yue Ju Wan. Shan Zhi (Gardenia Fruit), Chuan Xiong (Ligusticum Rhizome), Shen Qu (Medicated Leaven), Xiang Fu (Cyperus Rhizome, vinegar-processed), Lou Ren (Trichosanthes Seed), Xuan Fu Hua (Inula Flower), Xing Ren (Apricot Seed), Bei Mu (Fritillaria Bulb), Zhi Ke (Bitter Orange Fruit). Decocting and taking brings immediate comfort.
**Yan**
Middle-aged person, Qi horizontally attacking from the costal margin to the middle and upper epigastrium, vomiting saliva and losing blood, unresolved for over a year. Recently reduced food intake and spirit decline, taking Bird's Nest Soup caused distension, both Guan pulses deficient and slow, cold saliva surging upward. This is Liver turbidity and blood stasis stagnation, long-term entering collaterals causing fullness. Pungent-warm draining turbidity is suitable. Wu Zhu Yu (Evodia Fruit, stir-fried with salt water), Ban Xia (Pinellia Tuber, ginger-processed), Guang Pi (Tangerine Peel), Yan Hu (Corydalis Rhizome, wine-baked), Hou Po (Magnolia Bark, ginger-processed), Fu Ling (Poria), Jiang Xiang Mo (Aquilaria Sawdust), Dang Gui Xu (Angelica Sinensis Root tip). After two doses, cold saliva, pain, and distension ceased. But Yang deficiency with cold calves, method lies in benefiting Yang. Remove Wu Zhu Yu, add Gui Zhi (Cinnamon Twig), Pao Jiang (Roasted Ginger), Cao Guo (Black Cardamom Fruit, roasted), etc. Three doses, food intake advanced.
**Wu**
Early winter, abdominal distension after watery diarrhea, this is Zang Cold generating fullness, pulse deficient, reduced food intake. Treatment first warms and unblocks to regulate Yang. Use Yi Zhi Ren (Alpinia Oxyphylla Fruit), Pao Jiang (Roasted Ginger), Lu Shen (Codonopsis Root), Fu Ling (Poria), Zhi Ban Xia (Pinellia Tuber, processed), Suo Sha Ke (Amomum Fruit Shell), Guang Pi (Tangerine Peel), Chen Jing Mi (Old Rice) decocted as soup. Several doses felt quite comfortable. Dinner poor digestion, add Shen Qu (Medicated Leaven), Ji Nei Jin (Chicken Gizzard Membrane, all stir-fried), distension widened. Winter due to depression stirring Liver, hypochondriac and abdominal distension and pain, alternating fever and chills, pulse slightly rapid. Change formula to use Bai Shao (White Peony Root), Dang Gui (Angelica Sinensis Root), Lu Shen (Codonopsis Root), Su Geng (Perilla Stem), Xian Ju Ye (Fresh Tangerine Leaf), Suo Sha Ke (Amomum Fruit Shell), Yu Jin Zhi (Curcuma Juice), harmonizing Liver and Stomach, pain relieved, medicine stopped. Early Spring, upper epigastric pain and vomiting saliva, due to Liver Evil attacking Stomach, Stomach Qi failing to descend causing distension and congestion, Liver Yang ascending causing vomiting and pain. Because the Liver is a rigid organ, method should soften it with gentle means, ease it with sweet flavor. Moreover, Liver Yin long deficient, touching matters generates anger, Spleen Origin not restored, disease first manifests as emaciation. Inferior practitioners actually used heavy sedation with Zhe Shi (Magnetite), rigid restriction with Gui Xin (Cinnamon Heart), stir-fried Bai Zhu causing Qi stagnation, plus Ji Li (Tribulus Fruit) and Qing Pi (Green Tangerine Peel) to soothe and attack Liver. One sip brought vexation and severe pain, two doses made hypochondrium feel like blade cutting, abdominal colic almost unbearable. Hearing this, I proposed sweet-moistening gentle agents, using E Jiao (Donkey-Hide Gelatin), Egg Yolk, Bai Shao (White Peony Root), Gan Cao (Licorice Root), Zao Ren (Jujube Seed), Dang Gui (Angelica Sinensis Root), Yi Tang (Maltose), etc. Sent a note remotely, but died before medicine could be measured. Record this as using rigidity to treat rigidity, a warning for those who speak of calming the Liver.