窦材治一妇人脾气虚，致积气留于胁下，两肋常如流水，多服草神丹而愈。（原批∶脾虚致积，当用
温行；水流胁下，当行温化。）
王海藏治一妇人，先病恶寒，手足冷，全不发热，脉八至，两胁微痛。治者从少阳治之。阳在内伏于骨髓，
阴在外致使发寒，治当不从内外，从乎中治也。宜以小柴胡调之，倍加姜、枣。
许学士云∶沈存中良方，顷在建阳，医者王琪言∶诸气惟膀胱胁下痛最难治，惟神 丸能治之。熙宁中，
予病项骨痛，诸医皆作风治之，数月不瘥，乃流入于背膂，又两臂牵痛甚苦。忆琪语有证，乃令服之，一服而
瘥。再发，又一服立效。方用木香、胡椒各二钱五分，巴豆十枚去皮心膜研，干蝎七枚。上四味共为末，汤浸，
蒸饼为丸如麻子大，用朱砂为衣。每服五丸，视诸经痛，用引送下。心膈痛，柿蒂灯心汤下；腹痛，柿蒂煨姜
汤下；血痛，炒姜醋汤下；肾气胁下痛，茴香酒下；大便不通，蜜汤调槟榔末一钱下；气噎，木香汤下；
宿食不消，茶酒任下。
朱丹溪治一妇人，脾疼带胁痛，口微干，问已多年。时尚秋，用二陈汤加川芎、干葛、青皮、木通，下芦
荟丸二十粒。
张宅张郎气痛，起自右胁，时作时止，脉沉而弦，小便时有赤色，吞酸，喜呕出食，此湿痰在脾肺间，而
肝气乘之。小柴胡汤去黄芩加川芎、白术、木通、白芍、滑石、生姜，煎汤下保和丸三十五粒。
一妇人气晕，两胁胸背皆痛，口干，用青皮、半夏各一钱，白术、黄芩、川芎各三钱，木通二钱五分，陈
皮、桔梗各二钱，甘草炙半钱。上分六帖，煎热服。又胁下有食积一条扛起，加吴茱萸、炒黄连。
孙文垣治徐三泉子，每午发热，直至天明，夜热更甚，右胁胀痛，咳嗽则疼痛，坐卧俱疼。医以疟治罔效，
已二十余日。后医谓虚，投以参、术，痛益增。诊之，左弦大，右滑大搏指。经云∶左右者，阴阳之道路也。
据脉肝胆之火，为痰所凝，必勉强作文，过思不决，木火之性，不得通达，郁而为痛。夜甚者，肝邪也。初治
当通调肝气，一剂可瘳。误以为疟，燥动其火，补以参、术，闭塞其气。经云∶体若燔炭，汗出而散。今汗不
出，舌苔已沉香色，热郁极矣。不急救，立见凶危。以仲景小陷胸汤为主。大栝蒌一两，黄连三钱，半夏曲二
钱，前胡、青皮各一钱，水煎服。夜服当归龙荟丸，微下之。医犹争曰∶病久食不进，精神野狼狈若此，宁可下
乎？曰∶病属有余，有余者泻之。已误于补，岂容再误哉？服后夜半痛止热退，两帖全安。
虚山内人胸胁胀痛，五更嘈杂，则痛更甚，左寸关脉洪滑。孙谓此肝胆有郁火，胃中有胶痰，乃有余之病。
经云∶木郁则达之。又云∶通则不痛。与以当归龙荟丸一钱五分，（ 按∶既云木郁达之，却不用达之之药，
而用逆折之法，火虽暂泄，而木之本性亦伤矣。此亦劫剂之类也。）大便行一次，痛随止。惟声不开，（却是何
故？）以陈皮、柴胡、贝母、茯苓、甘草、白芍、酒芩、香附、杏仁、桔梗，调之而安。
学士徐检老体丰浓，善饮，致有肠风，计下血不下数桶，因而委顿。己卯冬，右胁极疼痛，上至耳后，夜
分尤甚，左右不能转动，动则痛甚，饮食减，面色青，汗出如雨，湿透衣被，故不敢合睫而睡。族医皆投以香
附、青皮及辛散之剂，痛愈甚，汗愈多，面愈青。逆予诊之，两寸短弱，左关弦而搏指，右关沉滑，六脉皆近
七至。予曰∶据病在少阳经，必始于怒，木火之性上而不下，故上冲耳后而皆痛也。夜痛甚者，盖夜属肝气用
事。《内经》云∶司疏泄者肝也。邪在肝胆，故合目汗即大出。中焦原有湿痰，（此语凡案必阑入，而前后
并不照应。）法当调肝清热，解毒为主，（毒字鹘突之至。）兼利小便。（语亦无因。）不可遽止汗，使邪无
出路。逆其木火之性，不惟痛加，且将发肿毒，而害非浅矣。《内经》云∶膏粱之变，足生大疔。当预防之。
（亦非此症真谛。）公曰∶何为敛剂而谓不宜？予曰∶当归六黄汤内有地黄、当归、 ，皆滞痰闭气之味，
桔梗亦非所宜。经曰下虚者及怒气上升者，皆不可
用，故当慎也。（且将发肿以下，皆有心穿插。）因以柴胡、黄连为君，白芍、甘草、天花粉为臣，以前胡、
连翘为佐，龙胆草为使。服后汗虽仍旧，痛即减三之一，不妨睡矣。仍用前药，病又减半。第三日又服，左右
转动如常，饮食亦加。予未至，公已先迎姑苏盛氏。盛公幼时窗友也，家世授医。公初不急予，日引领期盛到，
可刈枯铲朽也。盛至诊毕，遂诘曾用何剂？公予剂示盛，盛大叫称谬。谓当隆冬之候，汗多如此，阳气大泄，
何以柴胡为君？喉中痰既未清，又何不用桔梗、当归六黄汤？前贤已试之药，置而不用，是舍纪律而务野战也。
即以六黄汤加桔梗以进。（据此孙君真是神仙。）公雅信盛，仍倾心以从，速煎服之，未超时而旧病随作，
色色加恶，（四字忮甚。）左右复不能转动，自戌至子丑，若不能支持者。语之曰∶服孙君药虽未全可，亦已
去泰甚。彼曾言二药不可用，何为轻犯而受此苦？宜取孙君药煎饮，饮下即伏枕，鼾睡达旦始寤。（抑或未必。）
命使速予至，而叩予曰∶人言隆冬汗出，不当用柴胡，而公用为君，何旨？予曰∶胆与肝为表里，肝胆之火郁
而不发，故痛。痛极而汗，汗出而痛减者，是火从汗出，盖汗乃邪出之门也，予故曰汗不可敛。本草云柴胡泻肝
胆火，而以黄连佐之。《内经》云木郁则达，火郁则发，言当顺其性而利导之，势则易克。古人治火之法，轻
则正治，重则从其性而升之者。以此，盖医贵变通，如阴虚火动而汗出者，内无余邪，故以六黄汤敛而降之，常
治法也。今内有余邪未出，遽敛降之，邪无从出，势必成毒，故变常而从治者，使邪有出路。木火之性不逆，则
毒不成，而痛可减也。公曰∶善哉，孙君之剂，奇正相生，不下孙武子兵法，何轻以无纪律议之？愿投而奏凯也。
予曰∶公数日后疮疡大发，两块且有兴块作痛，此毒出之征，公于时无恐。改用柴胡、白芍、甘草、丹参、苦参、
茯苓、瞿麦、车前、黄柏、连翘、金银花，三日而痛全减，汗全收，左右不难转动矣。逾日，公谓肌肤痒甚，
然似瘾疹，岂疮出欤？欲以药治之。予曰∶可。再三日，两胯果然发兴块，如棋子大者数枚，且痛。予已制
蜡矾丸以待，至是授服之，疮果遍身大发，两腿为甚，一月余而瘳，公始信予防毒之言不谬，披愫交欢，且
作序识胜，（何胜云有？）期与终身不替云。
是案孙君生平得意笔也，然治法非奇，行文颇谬，盈篇猥语，满纸忮心，本不入选，顾集中收彼案微，
悉加节略，独于此仍其原本，以见一斑。第亦偶然，非有心吹索前人之短也。
刘默生治诸葛子立，胁痛连腰脊，不能转侧，服六味加杜仲、续断不效。或者以为不能转侧，必因闪挫，
与推气散转剧。刘诊之曰∶脉得弦细乏力，虚寒可知。与生料八味丸加茴香，四剂而安。（《医通》。）
李士材治一妇人，受暑胁痛，皮黄发泡，用清肝破气之剂不效。用大栝蒌一个，捣烂，加粉草、红花少许，
药入而痛止。（《病机沙篆》。）
薛立斋治一妇人，性急，吐血发热，两胁胀痛，日晡益甚，此怒气伤肝，气血俱虚也。朝用逍遥散，倍加
炒黑山栀、黄柏、贝母、桔梗、麦冬，夕以归脾汤、地黄丸而愈。
龚子材治一妇人，口苦胁胀，此肝火也。用小柴胡加黄连、栀子少愈，以四君子汤加当归、白芍、柴胡，
调理脾胃而瘥。
吴孚先治蒋氏妇，善怒，两胁作痛，历所医用补脾伐肝不应。脉之，左关细涩，右脉无 。此肝胜则克脾，
脾败则自困，补尚嫌缓，何以伐为？乃与四物汤加阿胶、玉竹、枣仁、枸杞，令服三十剂，胀减七八，丸服全瘳。
柴屿青治侍卫范讳弘宾太夫人，吐痰胁痛，饮食无味。告以肝病一二十年矣，率服平肝之药，凡香附、郁
金等，各服过数斤，（此二味为治肝病要药，然用之气病则可矣，用之血病，则与干将莫邪无异也。慎之。）
今为我理肝气可也。柴曰∶肝脉已虚，理无再用伐肝，况肾肝同治，乙癸同源，自应以滋肾养肝为主。先服加味
逍遥散二剂，即以八仙长寿丸进。太夫人曰∶熟地腻膈，恐勿堪用。柴曰∶此方熟地直走肾家，断无腻膈，且
风以散之，必需雨以润之。服后果验，调理数月而康。
按∶二地腻膈之说，不知始自何人。二地腻膈之说，何尝无之，此与参、 助热，同一至理。乃好用参、
者，必引甘温除大热之语，以为参、 不热，及试之阴虚之人，而其弊立见。盖参、 所去之热，乃脾
肺虚乏之热，非肝肾亏损之热也。今玉横又以为二地不腻，不知二地之不腻，乃脾肺火燥之体，非脾肺虚
寒之人也。矫枉者必过其正，然哉！文田按∶王氏驳正魏说，真可谓平允通达。致令数百年人皆畏之如虎，
俾举世阴虚火盛之病，至死而不敢一尝。迨已濒危，始进三数钱许，已无及矣，哀哉！
朱丹溪治杨淳三哥，旧有肾疾，上引乳边及右胁痛，多痰，有时膈上痞塞，大便必秘，平时少汗，脉弦甚，
与保和、温中各二十丸，研桃仁、郁李仁，吞之而愈。（《纲目》。）
陈三农治一人，右胁痛引背，口干舌燥，上身发热，腰以下俱冷，右关尺不起。此血虚气无所附，宜用温
药行动其气，使气有所归，水升火自降矣。用干姜、肉桂各五分，当归一钱，吴茱萸半分，盐水煎服，上身热
退，下体温暖，阳气渐回。但食难消化，些元气未复耳。理脾为主，养血次之，胃气一转，诸病自愈。用参、
苓、归、术各一钱，姜、桂各五分，神曲六分，陈皮四分，炙甘草三分，渐愈。
一人遇劳与饥则胁痛，用八珍加牛膝、木瓜、山药、石斛、苡仁、枣仁、柏子仁、桃仁，数服顿愈。一人
同此，医投平肝药，痛甚而殒。谨录之，以为世戒。
一人痛引腰胁，脉弦数有力，知肝火郁结也，投龙荟丸五十粒，顿愈。（《大还》。）
立斋治一男子，脾胃不和。服香燥行气之剂，饮食少思，两胁胀闷；服行气破血之剂，致饮食不入，右胁
胀痛，喜手按之。（虚症可知。）曰∶乃肝木克脾土，而脾土不能生肺金也。用滋化源之药四剂，诸症顿退。又曰∶
火令在迩，当再补脾土，以养肺金。不信，后复作，吐脓而殁。
王肯堂治云中泰语山，掌教平湖，因劳患两胁满痛，清晨并饥时尤甚。书来求方，知其肝虚，当母子兼补。
令用黄芩、白术、当归、熟地、川芎、山萸、山药、柏子仁之类，佐以防风、细辛各少许，姜、枣煎服，不数
剂而愈。王客长安时，闻魏昆溟吏部之变，因投谒忍饥，归而胁痛，无他苦也。粗工以青皮、枳壳之类杂投之，
遂致纠缠不痊，可不监哉！
朱丹溪治寿四郎，右胁痛，小便赤少，脉少弦不数。此内有久积痰饮，因为外感风寒所遏，不能宣散，所
以作痛。以龙荟丸三十五粒，细嚼姜皮，以热汤下，服后胁痛已安，小便尚赤少。再与白术三钱，陈皮、白芍
各二钱，木通一钱半，条芩一钱，甘草五分，姜三片，煎热饮之。
方提领年五十六，因饮酒后受怒气，于左胁下与脐平作痛，自此以后渐成小块，或起或不起，起则痛，痛
止则伏，面黄口干无力，食少，吃物便嗳，服行气药转恶风寒。脉之，左大于右，弦涩而长，大率左手重取则全
弦。此热散太多，以致胃气大伤，阴血下衰。且与和胃汤，以补胃气，滋养阴血，并下保和丸，助其运化。俟
胃稍实，阴血稍充，却用消块和胃。人参三钱，白术钱半，陈皮一钱，白芍、归身各五分，干葛三分，红花豆
大，炙草二钱，作一帖，下保和丸二十五粒龙荟丸十五。
按∶此症全属肝伤，木反克土，其块隐现不常，乃虚气也。时师多以香燥辛热治之，促人年寿。余治
此不下数十人，悉用一气汤加川楝、米仁、蒌仁等，不过三五剂，其病如失。若立斋多用加味逍遥散，鼓
峰、云峰辈，多用滋水生肝饮，皆不及余法之善。
薛立斋治昆庠马进伯母，左胛连胁作痛。遣人索治，意此郁怒伤肝脾，用六君加桔梗、枳壳、柴胡、升麻。
彼别用苍术药，益甚，始请治。其脉右关弦长，按之软弱，左关弦洪，按之涩滞，乃脾土不及，肝木太过，因
饮食之毒，七情之火也。遂用前药数剂，脉症悉退。再加芎、归全愈。此等症，误用败毒行气破血导痰，以致
不起者多矣。
一治男子因怒，胁下作痛，以小柴胡加四物，加青皮、桔梗、枳壳，治之而愈。
内翰李蒲汀太夫人，左胁内作痛，牵引胸前。此肝气不和，尚未成疮，用小柴胡汤加青皮、枳壳、四剂少
可。再加芎、归，治之愈。
张景岳治一姻家，年力正壮，素饮酒，常失饥伤饱，偶饭后胁肋大痛，自服行气化滞等药，复用吐法，尽
出饮食，吐后逆气上升，胁痛虽止而上壅胸膈，胀痛更甚，且加呕吐。张用行气破滞等，（愚哉！）呕痛渐止，而左
窦材治疗一位妇人，因脾气虚弱，导致积气停留在胁下，两侧肋骨间常感觉像流水一样（悸动感），服用草神丹后痊愈。（原批注：脾虚导致积滞，应当使用温通行散的方法；水流停滞在胁下，应当采用温阳化饮的方法。）
王海藏治疗一位妇人，起初患病表现为恶寒，手足冰冷，完全不发热，脉搏跳动极快（每息八至），两胁轻微疼痛。医生按照少阳病治疗。他认为阳气内伏于骨髓之中，阴气在外导致发寒，治疗不应当从内部或外部着手，而应当从中焦进行治疗。适宜用小柴胡汤调理，加倍加入生姜、大枣。
许学士说：沈括的《良方》中记载，以前在建阳时，医生王琪曾说：各种气病中，只有膀胱经循行部位的胁下痛最难治疗，只有神丸能治愈它。熙宁年间，我患项骨疼痛，各位医生都按风邪治疗，几个月都不见好，后来疼痛流入背部脊柱，双臂牵引疼痛非常痛苦。想起王琪的话中有对应的证候，于是让他服用神丸，服一次就痊愈了。再次发作，再服一次立刻见效。方剂组成：木香、胡椒各二钱五分，巴豆十枚去皮去心膜研碎，全蝎七枚。以上四味药共研为末，用米汤浸湿，蒸饼制成如麻子大小的丸药，用朱砂做外衣。每次服用五丸，根据疼痛所在的经络，用相应的引经药送服。心膈部疼痛，用柿蒂灯心草汤送服；腹痛，用柿蒂煨姜汤送服；血瘀疼痛，用炒姜醋汤送服；肾气引起的胁下痛，用茴香酒送服；大便不通，用蜂蜜水调服槟榔末一钱送服；气逆噎塞，用木香汤送服；宿食不消化，茶或酒任意送服。
朱丹溪治疗一位妇人，脾脏疼痛伴有胁痛，口微干，询问病史已有多年。当时还是秋季，使用二陈汤加川芎、干葛根、青皮、木通，配合服用芦荟丸二十粒。
张宅家的张郎患有气痛，起自右胁，时作时止，脉象沉而弦，小便偶尔发红，吞酸水，喜欢呕吐出食物，这是湿痰停滞在脾肺之间，肝气乘虚侵犯所致。用小柴胡汤去掉黄芩，加川芎、白术、木通、白芍、滑石、生姜，煎汤送服保和丸三十五粒。
一位妇女因气机郁滞而头晕，两胁及胸背皆痛，口干，使用青皮、半夏各一钱，白术、黄芩、川芎各三钱，木通二钱五分，陈皮、桔梗各二钱，炙甘草半钱。以上药物分成六帖，煎热服用。如果胁下有食积形成一条状硬块隆起，加吴茱萸、炒黄连。
孙文垣治疗徐三泉的儿子，每天中午开始发热，直到天明，夜间发热更严重，右胁胀痛，咳嗽时疼痛加剧，坐卧都疼。医生按疟疾治疗无效，已经二十多天。后来的医生认为是虚证，投以人参、白术，疼痛更加增加。诊察脉象，左手弦大，右手滑大且搏指有力。《内经》说：左右是阴阳的道路。根据脉象判断，是肝胆之火被痰所凝滞，必定是因为勉强写作文章，过度思虑不决，导致木火之性不得通达，郁结而为痛。夜间加重，是肝邪的表现。初治应当通调肝气，一剂即可痊愈。误以为是疟疾，燥动其火，用人参、白术补益，闭塞其气。《内经》说：身体像炭火一样灼热，出汗后就会消散。现在不出汗，舌苔已变成沉香色，热郁结到了极点。不紧急救治，立刻会出现凶险危重的情况。以仲景的小陷胸汤为主方。大瓜蒌一两，黄连三钱，半夏曲二钱，前胡、青皮各一钱，水煎服。晚上服用当归龙荟丸，使其轻微泻下。医生还争辩说：病久饮食不进，精神疲惫狼狈到这种地步，怎么可以泻下呢？我说：病属于有余之证，有余就要泻它。已经误用了补法，岂容再误？服药后半夜疼痛停止，热退，两帖后完全康复。
虚山的妻子胸胁胀痛，五更时分胃中嘈杂，则疼痛更甚，左寸关脉洪滑。孙文垣说这是肝胆有郁火，胃中有胶固之痰，属于有余的病证。《内经》说：木郁结就要疏达它。又说：通则不痛。给予当归龙荟丸一钱五分，（按语：既然说是木郁达之，却不用疏达的药物，而用逆折压制的方法，火虽然暂时消退，但木的本性也受损了。这也属于劫剂一类。）大便排了一次，疼痛随之停止。只是声音不开，（这是什么原因？）用陈皮、柴胡、贝母、茯苓、甘草、白芍、酒黄芩、香附、杏仁、桔梗，调理后安宁。
学士徐检老身体肥胖浓密，喜欢饮酒，导致肠风病，累计便血不下几桶，因而身体委顿衰弱。己卯年冬天，右胁极度疼痛，向上延伸至耳后，夜分时尤其严重，左右不能转动，一动则疼痛剧烈，饮食减少，面色青暗，出汗如雨，湿透衣被，所以不敢闭眼睡觉。家族医生都投以香附、青皮及辛散的药物，疼痛更甚，汗更多，面色更青。请我诊治，两寸脉短弱，左关脉弦而搏指，右关脉沉滑，六脉都接近七至。我说：根据病位在少阳经，必定始于愤怒，木火之性向上而不向下，所以上冲耳后而全部疼痛。夜间疼痛严重，因为夜晚属肝气当令。《内经》说：主管疏泄的是肝脏。邪气在肝胆，所以合上眼睛汗水就大量流出。中焦原本有湿痰，（这句话在医案中常见插入，但前后并不呼应。）治疗方法应当调肝清热，以解毒为主，（“毒”字含糊不清。）兼利小便。（这话也没有依据。）不可以急于止汗，使邪气没有出路。违背木火的特性，不仅疼痛加重，而且将发生肿毒，危害不小。《内经》说：膏粱厚味的变化，足以产生大的疔疮。应当预防。（这也不是此症的真谛。）徐公说：为什么收敛止汗的药说不宜用？我说：当归六黄汤内有地黄、当归、黄芪，都是阻滞痰湿、闭塞气机的药味，桔梗也不适宜。经书说：下虚的人以及怒气上升的人，都不可用，所以要谨慎。（并且关于将发肿毒以下的论述，都是有心的穿插。）因此我用柴胡、黄连作为君药，白芍、甘草、天花粉作为臣药，以前胡、连翘作为佐药，龙胆草作为使药。服用后汗虽然依旧，疼痛即减轻三分之一，不妨碍睡觉了。仍然用前面的药，病又减半。第三天又服用，左右转动如常，饮食也增加了。我没到的时候，徐公已经先去迎接姑苏盛氏。盛公是他小时候窗下的朋友，家世传授医术。徐公起初不急着我，天天伸长脖子期待盛公到来，可以说是铲除枯朽杂草。盛公来诊脉完毕，随即质问用过什么药方？徐公把药方给盛公看，盛公大声叫喊称错误。认为正当隆冬季节，出汗这么多，阳气大泄，为什么用柴胡作为君药？喉中痰既未清，又为什么不用桔梗、当归六黄汤？前贤已经试过的药，弃置不用，这是舍弃纪律而追求野战。立即用六黄汤加桔梗进服。（据此看来孙君真是神仙。）徐公一向信任盛公，仍倾心听从，急忙煎服，不到一个时辰旧病随即发作，样样症状加重，（这四个字嫉妒心很重。）左右又不能转动，从戌时到子丑时，好像不能支持的样子。我对他说：服用孙君的药虽然没完全好，但也已经去除了大部分病痛。他曾说过两种药不可用，为什么轻率冒犯而受此苦？应该取孙君的药煎饮，喝下去就趴在枕头上，打鼾睡到天亮才醒。（或者未必如此。）派人速去请我，叩问我道：人说隆冬出汗，不应当用柴胡，而你用它作为君药，是什么意思？我说：胆与肝互为表里，肝胆之火郁结而不能发散，所以疼痛。疼痛剧烈而出汗，汗出后疼痛减轻，这是火随汗出，大概汗是邪气外出的门户，所以我说不可以收敛汗。本草说柴胡泻肝胆火，而以黄连辅助它。《内经》说木郁则达之，火郁则发之，意思是应当顺应其特性而引导它，形势就容易克服。古人治疗火的方法，轻则正治，重则顺从其特性而升发它。以此来看，医学贵在变通，如阴虚火动而出汗的，体内没有余邪，所以用六黄汤收敛而降之，这是常规治法。现在体内有余邪未出，急于收敛降之，邪气无从出路，势必成毒，所以变常规而从权治者，使邪气有出路。木火的特性不违背，则毒不成，而疼痛可减。徐公说：好啊，孙君的方剂，奇正相生，不亚于孙武子的兵法，为什么轻易以无纪律来议论它？愿意投药而奏凯歌。我说：您数日后疮疡大发，两块且有肿块作痛，这是毒气外出的征兆，您此时不要害怕。改用柴胡、白芍、甘草、丹参、苦参、茯苓、瞿麦、车前子、黄柏、连翘、金银花，三天后疼痛全减，汗全收，左右不难转动了。过了一天，徐公说肌肤很痒，然而像瘾疹，难道是疮出来了吗？想用药物治疗。我说：可以。再过三天，两胯果然发出肿块，如棋子大小数枚，且疼痛。我已经制备好蜡矾丸等待，这时授给他服用，疮果然遍身大发，两腿尤为严重，一月多而痊愈，徐公才开始相信我的防毒之言不错，倾诉真情交欢，并且作序记录胜利，（有什么胜可言？）期望终身不废弃。
这个医案是孙君生平得意的笔触，然而治法并不奇特，行文颇为荒谬，满篇琐碎言语，满纸嫉妒之心，本不入选，考虑到集中收录他的医案很少，全部加以节略，唯独对此案保留原本，以见一斑。也只是偶然，并非有心吹毛求疵指责前人短处。
刘默生治疗诸葛子立，胁痛连及腰脊，不能转侧，服用六味地黄丸加杜仲、续断无效。有人认为是不能转侧，必定因闪挫引起，给予推气散反而加重。刘默生诊察说：脉得弦细乏力，可知是虚寒。给予生料八味丸加小茴香，四剂而安。（《医宗必读》。）
李士材治疗一位妇人，受暑邪致胁痛，皮肤发黄起泡，用清肝破气的药剂无效。用大瓜蒌一个，捣烂，加粉甘草、红花少许，药入而痛止。（《病机沙篆》。）
薛立斋治疗一位妇人，性情急躁，吐血发热，两胁胀痛，日晡时更甚，这是怒气伤肝，气血俱虚。早晨服用逍遥散，加倍加入炒黑山栀、黄柏、贝母、桔梗、麦冬，晚上服用归脾汤、地黄丸而愈。
龚子材治疗一位妇人，口苦胁胀，这是肝火。用小柴胡汤加黄连、栀子稍愈，以四君子汤加当归、白芍、柴胡，调理脾胃而痊愈。
吴孚先治疗蒋氏妇，容易发怒，两胁作痛，经过多位医生用补脾伐肝的方法无效。诊脉，左关细涩，右脉无神。这是肝胜则克脾，脾败则自困，补尚且嫌慢，怎么能伐呢？于是给予四物汤加阿胶、玉竹、枣仁、枸杞，令服用三十剂，胀减七八，丸药服用全愈。
柴屿青治疗侍卫范讳弘宾太夫人，吐痰胁痛，饮食无味。告诉她肝病一二十年了，总是服用平肝的药物，凡是香附、郁金等，各服用过数斤，（这两味药是治疗肝病的要药，然而用于气病还可以，用于血病，那就与干将莫邪宝剑无异了。慎重啊。）现在为我调理肝气可以吗。柴某说：肝脉已虚，按理不能再伐肝，况且肝肾同治，乙癸同源，自然应当以滋肾养肝为主。先服用加味逍遥散二剂，接着服用八仙长寿丸。太夫人说：熟地腻膈，恐怕受不了。柴某说：此方熟地直走肾家，断无腻膈，且风以散之，必需雨以润之。服用后果然有效，调理数月而康。
按语：二地腻膈的说法，不知道始自何人。二地腻膈的说法，何尝没有，这与参、芪助热，是同一个道理。然而喜欢用参、芪的人，必定引用甘温除大热的语句，认为参、芪不热，等到试用在阴虚之人身上，其弊端立刻显现。盖参、芪所去除的热，乃是脾肺虚乏之热，非肝肾亏损之热也。如今玉横又认为二地不腻，不知二地之不腻，乃是脾肺火燥之体，非脾肺虚寒之人也。矫枉者必过其正，确实如此！文田按：王氏驳正魏说，真可谓平允通达。致使数百年人都畏惧它如虎，使得举世阴虚火盛的病人，至死不敢尝试。等到已经濒危，才开始进服三四钱，已经来不及了，悲哀啊！
朱丹溪治疗杨淳三哥，旧有肾疾，向上牵引乳边及右胁痛，多痰，有时膈上痞塞，大便必秘，平时少汗，脉弦甚，给予保和丸、温中丸各二十丸，研碎桃仁、郁李仁，吞服而愈。（《本草纲目》。）
陈三农治疗一人，右胁痛引及背部，口干舌燥，上身发热，腰以下俱冷，右关尺脉不起。这是血虚气无所依附，应当用温药行动其气，使气有所归，水升火自降矣。用干姜、肉桂各五分，当归一钱，吴茱萸半分，盐水煎服，上身热退，下体温暖，阳气渐回。但食物难消化，些许元气未复罢了。以理脾为主，养血次之，胃气一转，诸病自愈。用人参、茯苓、当归、白术各一钱，姜、桂各五分，神曲六分，陈皮四分，炙甘草三分，逐渐痊愈。
一人遇劳累与饥饿则胁痛，用八珍汤加牛膝、木瓜、山药、石斛、苡仁、枣仁、柏子仁、桃仁，数服顿愈。一人同样病症，医生投以平肝药，疼痛剧烈而死亡。谨录此案，以为世人警戒。
一人疼痛引及腰胁，脉弦数有力，知是肝火郁结，投予龙荟丸五十粒，顿愈。（《大还》。）
立斋治疗一男子，脾胃不和。服用香燥行气的药剂，饮食少思，两胁胀闷；服用行气破血的药剂，导致饮食不入，右胁胀痛，喜欢用手按压。（可知是虚症。）说：这是肝木克脾土，而脾土不能生肺金也。用滋化源的药物四剂，诸症顿退。又说：火令在即，应当再补脾土，以养肺金。不信，后来复发，吐脓而死亡。
王肯堂治疗云中泰语山，掌教平湖，因劳患两胁满痛，清晨并饥时尤甚。写信来求方，知其肝虚，应当母子兼补。令用黄芩、白术、当归、熟地、川芎、山萸肉、山药、柏子仁之类，佐以防风、细辛各少许，姜、枣煎服，不数剂而愈。王客居长安时，听说魏昆溟吏部的变故，因投递拜帖忍饥，回家而胁痛，没有其他痛苦。粗工用青皮、枳壳之类杂投，遂致纠缠不痊，可不鉴戒吗！
朱丹溪治疗寿四郎，右胁痛，小便赤少，脉少弦不数。这是内有久积痰饮，因为外感风寒所遏，不能宣散，所以作痛。以龙荟丸三十五粒，细嚼姜皮，以热汤下，服后胁痛已安，小便尚赤少。再给予白术三钱，陈皮、白芍各二钱，木通一钱半，条芩一钱，甘草五分，姜三片，煎热饮之。
方提领年五十六，因饮酒后受怒气，于左胁下与脐平作痛，自此以后渐成小块，或起或不起，起则痛，痛止则伏，面黄口干无力，食少，吃物便嗳，服行气药转恶风寒。诊脉，左大于右，弦涩而长，大率左手重取则全弦。这是热散太多，以致胃气大伤，阴血下衰。暂且给予和胃汤，以补胃气，滋养阴血，并下保和丸，助其运化。俟胃稍实，阴血稍充，却用消块和胃。人参三钱，白术钱半，陈皮一钱，白芍、归身各五分，干葛三分，红花豆大，炙草二钱，作一帖，下保和丸二十五粒、龙荟丸十五粒。
按语：此症全属肝伤，木反克土，其块隐现不常，乃虚气也。时师多以香燥辛热治之，促人年寿。我治疗此病不下数十人，悉用一气汤加川楝子、米仁、蒌仁等，不过三五剂，其病如失。若立斋多用加味逍遥散，鼓峰、云峰辈，多用滋水生肝饮，皆不及我法之善。
薛立斋治疗昆庠马进伯母，左胛连胁作痛。派人索治，意此郁怒伤肝脾，用六君子汤加桔梗、枳壳、柴胡、升麻。彼别用苍术药，益甚，始请治。其脉右关弦长，按之软弱，左关弦洪，按之涩滞，乃脾土不及，肝木太过，因饮食之毒，七情之火也。遂用前药数剂，脉症悉退。再加川芎、当归全愈。此等症，误用败毒行气破血导痰，以致不起者多矣。
一治疗男子因怒，胁下作痛，以小柴胡汤加四物汤，加青皮、桔梗、枳壳，治之而愈。
内翰李蒲汀太夫人，左胁内作痛，牵引胸前。这是肝气不和，尚未成疮，用小柴胡汤加青皮、枳壳，四剂稍可。再加川芎、当归，治之愈。
张景岳治疗一姻家，年力正壮，素饮酒，常失饥伤饱，偶饭后胁肋大痛，自服行气化滞等药，复用吐法，尽出饮食，吐后逆气上升，胁痛虽止而上壅胸膈，胀痛更甚，且加呕吐。张用行气破滞等，（愚哉！）呕痛渐止，而左...
Dou Cai treated a woman whose Spleen Qi was deficient, causing accumulated Qi to remain under the hypochondrium. She often felt a sensation of flowing water in both ribs. She recovered after taking Caoshen Dan (Grass God Pill). (Original commentary: Deficiency of Spleen leading to accumulation requires warming and moving methods; water flow stagnating under the hypochondrium requires warming and transforming methods.)
Wang Haicang treated a woman who initially suffered from aversion to cold, cold hands and feet, no fever, a pulse rate of eight beats per respiration, and slight pain in both hypochondria. The physician treated it as a Shaoyang disease. He believed that Yang Qi was concealed within the bone marrow, while Yin Qi on the exterior caused chills. Treatment should not focus on the interior or exterior but on the Middle Jiao. Xiao Chai Hu Tang (Minor Bupleurum Decoction) was suitable for regulation, with increased doses of Ginger and Jujube.
Scholar Xu stated: In Shen Kuo's *Liangfang*, it was recorded that during his time in Jianyang, Physician Wang Qi said: Among all Qi disorders, pain under the hypochondrium along the Bladder meridian is the most difficult to treat, and only Shen Wan (Divine Pill) can cure it. During the Xining era, I suffered from neck bone pain. Physicians treated it as wind-related for months without improvement, and the pain eventually radiated to the back spine, causing severe牵引 pain in both arms. Recalling Wang Qi's words regarding corresponding symptoms, I had him take Shen Wan. One dose cured it. Upon recurrence, another dose brought immediate relief. The formula consists of: Muxiang (Costus Root), Hujiao (Black Pepper) each 2.5 qian; Badou (Croton Seed), 10 seeds, peeled and pounded; Ganzhe (Full Scorpion), 7 pieces. These four ingredients are ground into powder, moistened with rice water, steamed, and formed into pills the size of hemp seeds, coated with Zhusha (Cinnabar). Take five pills per dose, guided by the affected meridian. For chest/diaphragm pain, use Persimmon Calyx and Juncus Decoction; for abdominal pain, use Persimmon Calyx and Roasted Ginger Decoction; for blood stasis pain, use Stir-fried Ginger and Vinegar Decoction; for Kidney Qi pain under the hypochondrium, use Fennel Wine; for constipation, use Honey Water with 1 qian of Areca Nut Powder; for Qi obstruction, use Costus Root Decoction; for retained food, take with tea or wine as preferred.
Zhu Danxi treated a woman with Spleen pain accompanied by hypochondriac pain, slight dry mouth, and a history spanning many years. It was autumn, so Er Chen Tang (Two-Cured Decoction) was used with added Chuanxiong (Sichuan Lovage Rhizome), Gegen (Kudzu Root), Qingpi (Green Tangerina Peel), and Mutong (Akebia Stem). This was followed by 20 pills of Luehui Wan (Aloe Pill).
Mr. Zhang's son suffered from Qi pain starting in the right hypochondrium, intermittent, with a deep and wiry pulse. Occasional reddish urine, acid regurgitation, and vomiting of food indicated damp-phlegm between the Spleen and Lung, invaded by Liver Qi. Xiao Chai Hu Tang (Minor Bupleurum Decoction) was modified by removing Huangqin (Scutellaria Root), adding Chuanxiong (Sichuan Lovage Rhizome), Baizhu (Atractylodes Macrocephala Rhizome), Mutong (Akebia Stem), Baishao (White Peony Root), Huashi (Talcum), and Shengjiang (Fresh Ginger). The decoction was taken with 35 pills of Baohe Wan (Preserve Harmony Pill).
A woman suffered from Qi-induced dizziness, pain in both hypochondria, chest, and back, and dry mouth. Qingpi (Green Tangerina Peel) and Banxia (Pinellia Tuber) were used at 1 qian each; Baizhu (Atractylodes Macrocephala Rhizome), Huangqin (Scutellaria Root), and Chuanxiong (Sichuan Lovage Rhizome) at 3 qian each; Mutong (Akebia Stem) at 2.5 qian; Chenpi (Aged Tangerina Peel) and Jiegeng (Platycodon Root) at 2 qian each; Zhi Gancao (Honey-fried Licorice Root) at half a qian. Divided into six doses, taken hot. If a hard mass of retained food appeared under the hypochondrium, add Wuzhuyu (Evodia Fruit) and Chao Huanglian (Stir-fried Coptis Rhizome).
Sun Wen Yuan treated the son of Xu Sanquan. Fever started at noon and lasted until dawn, worsening at night. Right hypochondriac distending pain worsened with coughing, making sitting or lying painful. Treated as malaria without effect for over 20 days. Later physicians considered it deficiency and administered Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala Rhizome), increasing pain. Pulse: Left wiry and large, Right slippery and large, bounding against the finger. The *Classic* states: Left and right are the pathways of Yin and Yang. Based on the pulse, Liver-Gallbladder Fire was congealed by phlegm, likely due to forced writing and excessive deliberation, preventing the free flow of Wood-Fire nature, leading to stagnation and pain. Nighttime worsening indicates Liver pathogen. Initial treatment should regulate Liver Qi, effective in one dose. Misdiagnosed as malaria, drying fire, and tonifying with Ginseng and Atractylodes closed the Qi flow. The *Classic* states: If the body burns like charcoal, sweating disperses it. Now there is no sweat, tongue coating is沉香-colored, indicating extreme heat stagnation. Without urgent rescue, danger looms. Use Zhang Zhongjing's Xiao Xian Xiong Tang (Minor Trap in the Chest Decoction) as the main formula. Large Gualou (Trichosanthes Fruit) 1 liang, Huanglian (Coptis Rhizome) 3 qian, Banxia Qu (Pinellia Fermented Paste) 2 qian, Qianhu (Peucedanum Root), Qingpi (Green Tangerina Peel) each 1 qian. Water decoction. At night, take Danggui Longhui Wan (Angelica and Gardenia Pill) to induce mild purgation. Physicians argued: After long illness with poor intake and exhaustion, how can purgation be used? I replied: The disease belongs to excess; excess must be drained. Having erred with tonification, we cannot err again. After taking the medicine, pain stopped and fever subsided by midnight. Two doses led to full recovery.
Lady of Xu Shan suffered from chest-hypochondriac distending pain, stomach rumbling at 5 AM worsening pain, Left Cun-Guan pulse洪-slipping. Sun said this is Liver-Gallbladder stagnant fire and sticky phlegm in the Stomach, an excess condition. The *Classic* says: When Wood is stagnant, reach it. Also: Unblocked means no pain. Prescribed Danggui Longhui Wan (Angelica and Gardenia Pill) 1.5 qian. (Commentary: Although stating "reach stagnant Wood," no reaching herbs were used, but rather suppressing ones. Fire temporarily subsides, but Wood's nature is damaged. This is a coercive method.) After one bowel movement, pain stopped. Voice remained hoarse. Regulated with Chenpi (Aged Tangerina Peel), Chaihu (Bupleurum Root), Beimu (Fritillaria Bulb), Fuling (Poria), Gancao (Licorice Root), Baishao (White Peony Root), Jiu Huangqin (Wine-processed Scutellaria Root), Xiangfu (Cyperus Rhizome), Xingren (Apricot Seed), Jiegeng (Platycodon Root).
Scholar Xu Jianlao was obese and fond of drinking, leading to Intestinal Wind (hematochezia), losing several buckets of blood, resulting in debility. In winter of Ji Mao year, severe right hypochondriac pain extended to behind the ear, worse at night, unable to turn left or right, aggravating pain upon movement, reduced appetite, blue complexion, profuse sweating soaking clothes, unable to sleep. Family doctors used Xiangfu (Cyperus Rhizome), Qingpi (Green Tangerina Peel), and acrid-dispersing agents, worsening pain, sweat, and complexion. My diagnosis: Both Cun pulses short and weak, Left Guan wiry and bounding, Right Guan deep and slippery, all six pulses near seven beats. Disease in Shaoyang meridian, likely starting from anger. Wood-Fire nature rises instead of descending, rushing to the ear causing pain. Night pain worsens because night belongs to Liver Qi function. The *Inner Classic* says: The Liver governs free flow. Pathogen in Liver/Gallbladder causes sweating when eyes close. Damp-phlegm originally in Middle Jiao. Method: Regulate Liver, clear heat, detoxify, and promote urination. Do not abruptly stop sweat, blocking the exit for pathogens. Violating Wood-Fire nature increases pain and risks swelling/toxins. The *Inner Classic* says: Rich foods can generate large carbuncles. Prevention needed. Mr. Xu asked why astringents are unsuitable. I said: Danggui Liuhuang Tang contains Dihuang (Rehmannia Root), Danggui (Angelica Sinensis), and Huangqi (Astragalus Root), which obstruct phlegm and Qi; Jiegeng (Platycodon Root) is also unsuitable. Classics state: Those with lower deficiency or rising anger should avoid them. Therefore, use Chaihu (Bupleurum Root) and Huanglian (Coptis Rhizome) as Sovereign, Baishao (White Peony Root), Gancao (Licorice Root), Tianhuafen (Trichosanthes Root) as Ministers, Qianhu (Peucedanum Root), Lianqiao (Forsythia Fruit) as Assistants, Longdancao (Gentian Root) as Envoy. Sweat continued, but pain reduced by one-third, allowing sleep. Continued medication halved the illness. On the third day, mobility and appetite returned. Before I arrived, Mr. Xu went to greet Sheng Shi from Suzhou, a childhood friend and hereditary physician. Mr. Xu waited eagerly for Sheng. Sheng diagnosed, questioned previous prescriptions, and loudly declared them wrong. Argued that in mid-winter with profuse sweat depleting Yang, using Chaihu as Sovereign is incorrect. With phlegm in throat, why not use Jiegeng and Danggui Liuhuang Tang? Discarding tried-and-tested herbs is abandoning discipline for wild warfare. Immediately prescribed Liuhuang Tang plus Jiegeng. Mr. Xu trusted Sheng, took the decoction. Within a short time, old symptoms returned severely, unable to move from Xu to Zi-Chou hours. I told him: Although Sun's medicine didn't fully cure you, it removed the worst. You ignored warnings about those two medicines. Take Sun's medicine immediately. He slept soundly until dawn. Sent for me, asking why Chaihu was used despite winter sweat contraindications. I explained: Liver and Gallbladder are exterior-interior. Stagnant Fire causes pain. Sweating relieves pain because Fire exits via sweat; sweat is the gate for pathogens. Thus, do not astringe sweat. Ben Cao states Chaihu drains Liver-Gallbladder Fire, assisted by Huanglian. Inner Classic: Stagnant Wood reaches, stagnant Fire emits. Follow nature to guide it. Light cases use direct treatment; heavy cases follow nature to ascend. Medicine values flexibility. For Yin deficiency with fire and sweat, no residual pathogen exists, so Liuhuang Tang astringes and descends—standard method. Here, residual pathogen exists; abrupt astringion traps it, causing toxins. Hence, variable treatment allows pathogen exit. If Wood-Fire nature is not violated, no toxin forms, pain reduces. Mr. Xu praised Sun's prescription as brilliant, comparing it to Sun Tzu's Art of War. I predicted abscesses would appear later as signs of toxin exiting. Changed prescription to Chaihu, Baishao, Gancao, Danshen (Salvia Root), Kushen (Sophora Root), Fuling (Poria), Qumai (Dianthus Herb), Cheqian (Plantago Seed), Huangbai (Phellodendron Bark), Lianqiao (Forsythia Fruit), Jinyinhua (Honeysuckle Flower). Pain ceased, sweat stopped, mobility restored in three days. Skin became itchy like hives. Three days later, lumps appeared on thighs like chess pieces, painful. Prescribed Lafan Wan (Beeswax and Alum Pill). Abscesses erupted all over, worse on legs. Recovered in over a month. Mr. Xu believed my warning against toxins, expressed gratitude, wrote a preface, and vowed lifelong adherence.
This case is Sun's masterpiece, though the treatment wasn't unique and the writing flawed, filled with trivialities and jealousy. It was included to show a glimpse. Coincidence, not malicious intent.
Liu Mosheng treated Zhuge Zili with hypochondriac pain radiating to waist/spine, inability to turn. Liuwei Dihuang Wan plus Duzhong (Eucommia Bark) and Xuduan (Drynaria Rhizome) failed. Some thought immobility was due to sprain, prescribing Tuiqi San, worsening condition. Liu diagnosed string-thin-weak pulse, indicating deficiency-cold. Shengliao Bawei Wan (Raw Eight-Ingredient Pill) plus Huixiang (Fennel) cured in four doses. (*Yitong*)
Li Shicai treated a woman with summerheat-induced hypochondriac pain, yellow skin with blisters. Clearing Liver/breaking Qi agents failed. One large Gualou (Trichosanthes Fruit), mashed, with Fencao (Licorice) and Honghua (Carthamus Flower), stopped pain instantly. (*Bingji Shazhuan*)
Xue Lizhai treated an irritable woman with hematemesis, fever, distending hypochondriac pain worsening at dusk. Anger injured Liver, Qi/Blood deficiency. Morning: Xiaoyao San (Free and Easy Wanderer Powder) with extra Chao Hei Zhizi (Stir-fried Black Gardenia Fruit), Huangbai (Phellodendron Bark), Beimu (Fritillaria Bulb), Jiegeng (Platycodon Root), Maidong (Ophiopogon Tuber). Evening: Guipi Tang (Restore the Spleen Decoction) and Dihuang Wan (Rehmannia Pill). Cured.
Gong Zicai treated a woman with bitter taste and hypochondriac distension, Liver Fire. Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Huanglian (Coptis Rhizome), Zhizi (Gardenia Fruit) improved slightly. Then Sijunzi Tang (Four Gentlemen Decoction) plus Danggui (Angelica Sinensis), Baishao (White Peony Root), Chaihu (Bupleurum Root) regulated Spleen/Stomach. Cured.
Wu Fuxian treated Mrs. Jiang, prone to anger, hypochondriac pain. Spleen-tonifying/Liver-suppressing failed. Left Guan fine-choppy, Right pulse lacking spirit. Liver overacting on Spleen, Spleen failing. Tonification is slow enough, suppression is inappropriate. Siwu Tang (Four Substances Decoction) plus Ejiao (Donkey-hide Gel), Yuzhu (Polygonatum Odoratum Rhizome), Zaoren (Ziziphus Seed), Gouqi (Goji Berry). 30 doses reduced distension by 70-80%. Pill form cured completely.
Chai Yuqing treated Lady Fan, mother of Guard Fan Hongbin. Phlegm expectoration, hypochondriac pain, loss of taste. History of Liver disease 10-20 years, always taking Liver-calming herbs like Xiangfu (Cyperus Rhizome), Yujin (Curcuma Rhizome), consuming pounds of each. (These are key for Qi disorders, but dangerous for Blood disorders.) Asked for Liver Qi regulation. Chai said: Liver pulse is deficient; do not suppress. Liver/Kidney share origin. Nourish Kidney to nourish Liver. First, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) for two doses, then Baxian Changshou Wan (Eight Immortals Longevity Pill). Lady feared Shudi (Prepared Rehmannia Root) cloyed the diaphragm. Chai said: Shudi goes directly to Kidney, does not cloy. Wind disperses, rain moistens. Effective. Recovered after months.
Commentary: The claim that Dihuang cloy the diaphragm originates from unknown sources. Like Renshen/Astragalus generating heat, it has truth. Proponents cite "Sweet-Warm removes Great Heat," claiming they aren't hot. Trial on Yin deficiency reveals flaws. Renshen/Astragalus remove Spleen/Lung deficiency heat, not Liver/Kidney depletion heat. Yuheng claims Dihuang doesn't cloy, ignoring it suits Spleen/Lung fire-dryness, not Spleen/Lung deficiency-cold. Correcting errors often overshoots. Wentian adds: Wang's refutation is fair. Centuries feared it, denying Yin-deficiency patients life-saving herbs until critical stages. Tragic!
Zhu Danxi treated Yang Chun's third brother, old Kidney disease, pain radiating to breast/right hypochondrium, much phlegm, epigastric stuffiness, constipation, little sweat, very wiry pulse. Baohe Wan (Preserve Harmony Pill) and Wenzhong Wan (Warm Middle Pill) 20 each, crushed Taoren (Peach Kernel), Yuliren (Prunus Seed), swallowed. Cured. (*Gangmu*)
Chen Sansan treated a man with right hypochondriac pain radiating to back, dry mouth/tongue, upper body heat, lower body cold, Right Guan/Chi pulses absent. Blood deficiency, Qi unattached. Warm herbs to move Qi, return Qi, raise Water, descend Fire. Ganjiang (Dried Ginger), Rougui (Cinnamon Bark) 5 fen each, Danggui (Angelica Sinensis) 1 qian, Wuzhuyu (Evodia Fruit) half a qian, salt-water decoction. Upper heat subsided, lower warmed, Yang returned. Digestion poor, Qi not fully recovered. Regulate Spleen primarily, nourish Blood secondarily. Ren Shen (Ginseng), Fuling (Poria), Danggui (Angelica Sinensis), Baizhu (Atractylodes Macrocephala Rhizome) 1 qian each, Jiang (Ginger), Gui (Cinnamon) 5 fen each, Shenqu (Medicated Leaven) 6 fen, Chenpi (Aged Tangerina Peel) 4 fen, Zhi Gancao (Honey-fried Licorice Root) 3 fen. Gradually recovered.
One man had hypochondriac pain with fatigue/hunger. Bazhen Tang (Eight Treasures Decoction) plus Niuxi (Achyranthes Root), Mugua (Chaenomeles Fruit), Shanyao (Dioscorea Rhizome), Shihu (Dendrobium Stem), Yiren (Coix Seed), Zaoren (Ziziphus Seed), Baizi Ren (Biota Seed), Taoren (Peach Kernel). Several doses cured. Another similar case died after Liver-calming herbs. Record as warning.
One man pain radiating to waist/hypochondrium, wiry-rapid-forceful pulse, Liver Fire stagnation. Longhui Wan (Gardenia Pill) 50 pills. Cured instantly. (*Dahuan*)
Lizhai treated a man with Spleen/Stomach disharmony. Acrid-dry Qi-moving herbs caused poor appetite, hypochondriac distension. Qi-breaking/Blood-breaking herbs caused inability to eat, right hypochondriac distending pain, relieved by pressure (deficiency). Liver Wood attacks Spleen Earth; Spleen Earth fails to generate Lung Metal. Nourish Source herbs for four doses, symptoms retreated. Fire season approaching, tonify Spleen to nourish Lung. Patient refused, relapsed, vomited pus, died.
Wang Kentang treated Yunzhong Tai Yushan, teaching in Pinghu. Labor-induced bilateral hypochondriac fullness/pain, worse morning/hunger. Letter requested formula. Liver deficiency, Mother-Son tonification needed. Huangqin (Scutellaria Root), Baizhu (Atractylodes Macrocephala Rhizome), Danggui (Angelica Sinensis), Shudi (Prepared Rehmannia Root), Chuanxiong (Sichuan Lovage Rhizome), Shanzhuyu (Cornus Fruit), Shanyao (Dioscorea Rhizome), Baizi Ren (Biota Seed). Assisted by Fangfeng (Saposhnikovia Root), Xixin (Asarum) small amounts, Ginger/Jujube decoction. Cured in few doses. While in Chang'an, heard of Wei Kunming's death, visited fasting. Returned with hypochondriac pain, no other issues. Crude doctors used Qingpi (Green Tangerina Peel), Zhike (Aurantii Fructus), causing lingering illness. Warning!
Zhu Danxi treated Shou Silang, right hypochondriac pain, scant red urine, slightly wiry non-rapid pulse. Old phlegm-fluid retention, constrained by external Wind-Cold, unable to disperse. Longhui Wan (Gardenia Pill) 35 pills, chewed with Ginger Peel, washed down with hot water. Pain resolved, urine still red/scant. Next: Baizhu (Atractylodes Macrocephala Rhizome) 3 qian, Chenpi (Aged Tangerina Peel), Baishao (White Peony Root) 2 qian each, Mutong (Akebia Stem) 1.5 qian, Tiao Qin (Scutellaria Root) 1 qian, Gancao (Licorice Root) 5 fen, 3 Ginger slices. Hot decoction.
Fang Tiling, 56, drank then got angry. Pain at left hypochondrium level with navel. Gradually formed lump, appearing/disappearing, painful when up, hidden when down. Yellow face, dry mouth, weakness, poor appetite, belching after eating. Qi-moving herbs worsened aversion to wind/cold. Pulse: Left larger than Right, wiry-choppy-long, Left heavy press entirely wiry. Heat dispersed too much, damaging Stomach Qi, declining Yin Blood. Initially Hewei Tang (Harmonize Stomach Decoction) to tonify Stomach Qi, nourish Yin Blood, plus Baohe Wan (Preserve Harmony Pill) to aid digestion. Once Stomach solid, Blood充盈, resolve lump. Renshen (Ginseng) 3 qian, Baizhu (Atractylodes Macrocephala Rhizome) 1.5 qian, Chenpi (Aged Tangerina Peel) 1 qian, Baishao (White Peony Root), Danggui (Angelica Sinensis) 5 fen each, Gegen (Kudzu Root) 3 fen, Honghua (Carthamus Flower) bean-sized, Zhi Gancao (Honey-fried Licorice Root) 2 qian. One dose, with 25 Baohe Wan, 15 Longhui Wan.
Commentary: This case is Liver injury, Wood attacking Earth. Lump appearance is deficient Qi. Contemporary doctors use acrid-dry-hot herbs, shortening life. I treated dozens with Yi Qi Tang (One-Energy Decoction) plus Chuanlianzi (Toosendan Fruit), Yiren (Coix Seed), Louren (Trichosanthes Seed). 3-5 doses cured. Lizhai used Jiawei Xiaoyao San; Gufeng/Yunfeng used Zishui Shengan Yin. None better than my method.
Xue Lizhai treated Ma Jinbo's mother, left scapula to hypochondrium pain. Sent for treatment. Suspected depression/anger injuring Liver/Spleen. Liujun Zi Tang (Six Gentlemen Decoction) plus Jiegeng (Platycodon Root), Zhike (Aurantii Fructus), Chaihu (Bupleurum Root), Shengma (Cimicifuga Rhizome). She used Cangzhu (Atractylodes Lancea Rhizome), worsening condition. Finally consulted. Right Guan wiry-long, soft on pressure; Left Guan wiry-large, choppy on pressure. Spleen Earth insufficient, Liver Wood excessive, due to dietary toxicity and Seven Emotions Fire. Previous herbs for several doses, pulse/symptoms retreated. Added Chuanxiong (Sichuan Lovage Rhizome), Danggui (Angelica Sinensis). Full recovery. Many such cases misused with toxic/Qi-moving/Blood-breaking/Phlegm-resolving herbs, leading to death.
One man anger-induced hypochondriac pain. Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Siwu Tang (Four Substances Decoction), Qingpi (Green Tangerina Peel), Jiegeng (Platycodon Root), Zhike (Aurantii Fructus). Cured.
Neihan Li Puting's mother, left hypochondriac internal pain radiating to chest. Liver Qi disharmony, not yet ulcerated. Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Qingpi (Green Tangerina Peel), Zhike (Aurantii Fructus). Four doses improved. Added Chuanxiong (Sichuan Lovage Rhizome), Danggui (Angelica Sinensis). Cured.
Zhang Jingyue treated a relative, strong youth, habitual drinker, irregular meals. Severe post-prandial hypochondriac pain. Self-administered Qi-moving/stasis-resolving herbs, then induced vomiting, expelling all food. Post-vomit, rebellious Qi rose, hypochondriac pain stopped but chest oppression/distension worsened, with vomiting. Zhang used Qi-moving/stasis-breaking herbs (Foolish!). Vomiting/pain gradually stopped, but left...