吾友黄云裳之女，十三岁，秋杪患疟，医以柴葛羌防治而愈之，已进饮食，后复发热渴饮，微汗津。津医误认复感，仍用表散，热愈炽，渴愈甚。邀余，诊脉得右关独数。余曰：此食滞耳，非外感也。原治疟时，辛散过用，燥伤胃滓，胃液不充，因食纳而化迟渐生积热，以至壅压营卫，而不能相和。胃为阳土，故独发热。儿辈病初愈，即频进饮食，每多此症。倘仍苦寒以伤胄，辛散以却津，斯变幻立殆矣。治法宜选甘凉以养胃生津，胃津充则谷食自化，营卫自和，而肌热自解。质人参白虎法加减丽参五分同煎，麦冬(连心)、鲜嫩竹叶剪碎各二钱，生扁豆不打三钱，知母、石膏各一钱，甘草三分，石膏研末，白糖沙拌炒，后下，煎服。一剂渴热稍退，三剂全愈。云裳曰；吾今始知伤食亦有寒热也。余曰：更不止此。云裳曰：君能为我备述乎余曰：试为君略举之风寒伤于表，营卫不能运行于外而寒热生；暑湿秽浊与燥气口鼻吸入，阻其气机，营卫不能转旋而寒热亦生；食滞阻气之升降，实火扰气之流行，营卫因失其循行之度而寒热亦生；又况阴虚生内热，阴盛生内寒，阳盛生外热，阳虚生外寒，重阴则热(阴盛隔阳)，重阳则寒(阳盛隔阴)；而阳维为病更苦寒热，有不关于营卫之和与不和，而急当讲究，夫育阴以和阳者耶。云裳曰：然则阴虚寒热与外感寒热究何以辨别而治之余曰：以有汗无汗为别。有汗属营卫不和，因营卫不充；循行失度，故或发热，或寒热叶氏论治谓若用桂枝汤当重用白芍以敛阴和营。无汗属肝肾，奇经以至阴，深远难隔越诸经以达于阳分而泄其汗也，叶氏论治谓当用芳香轻清之品以宣通八脉，滋阴益血之药，以调养奇经，倘参入当归桂枝汤法治(即桂枝汤加当归)，亦须去白芍，芍酸不走络也云。裳曰：君时云症不疑似分药味彼此妥诚然。
《评琴书屋医略》卷一终
评琴书屋医略 卷二
消 渴 症
消有三消之分，饮水多而小便少为上消；食谷多而大便坚为中消；饮一溲一小便如膏为下消(上中二消属热，下消属寒)。前贤治法，上消用人参白虎汤，中消用调胃承气汤，下消用肾气丸。其实皆津液干枯病，故赵养葵先生谓，凡大渴大燥无分冲下用大剂六味地黄汤加肉桂、五味(名加减八味丸)，连剂频进饮，渴自止。白虎承气皆非所宜，此赵论虽变古人成法，其中实有妙义。盖人之灌溉，一身全赖两肾中水火，少火能生气，则真水自升，而渴自止(加肉桂正所以温动少火，前贤治下消用肾气丸者即此意)，然临症总贵因脉变通。上消轻，多先拟清燥法。
大麦冬五钱，连心 大天冬三钱 白粳米四钱 大生地五钱 雪梨干八钱 乌梅肉四分加生蜜冲服。渴仍照方频进，蜜不拘多少，与乌梅酸甜合病者口味为妙，酸甘盖取其化阴。
服三四剂仍渴，倘脉洪大而数，喜冷饮者，加石膏、知母。仍渴再加黄连、甘草。脉沉弱而迟喜热饮者(拟方不合)，宜遵养葵法(或肾气丸)。中消用调胃承气汤合四物汤(或去芎硝，君以石膏)。下消宜肾气丸。若骨瘦腿疼宜知柏八味加杜仲、人参、天冬、五味。
呕 吐
呕吐一症，属足阳明胃经有寒、有热、有虚，患此最宜明辨。其因寒而呕吐者，脉必迟(唇舌白恶饮)。因热而呕吐者，脉必数(唇颊赤口燥渴)。因虚而呕吐者，脉必虚(唇白面黄倦怠嗜卧)。果能因脉辨症施治，必效。兹拟症近于热者立一安胃降逆轻剂以便因症加减。
金钗斛五钱，先煎 制半夏一钱半 细甘草三分 结云苓三钱 化橘红四分 鲜竹茹椂BR>
加生姜一钱同煎(或去甘草，甘能守中壅气发呕，因石斛苦，故少佐耳)。
如确审得脉数热盛，加石膏、粳米或麦冬、鲜芦根(经验方石膏、粳米、麦冬、芦根煎代茶，止热呕颇佳)。方内生姜、橘红或减少，或不用。若脉迟有寒者去石斛、竹茹加砂仁，或蔻仁，或独加方内生姜用三四钱，或五六钱。寒重者加至两零必效。若脉虚属中气虚者，去石斛、竹茹加白术、人参、大枣。虚而兼寒者，再加附子、干姜。至若呕吐而寒热往来者少阳症也，宜另用小柴胡汤主治。
呕吐症中更有病名噎隔病名反胃者，其人于饮食之际，气忽阻塞曰噎；心下隔拒，或食到膈间不得下(故古人亦有名之为膈者)曰隔。古人谓津液干枯为噎隔病源，忌投温补可知。误用参、耆、术以培补之，愈增其隔；误用姜、桂、附以温暖之，益速其亡。选药必须用清润之品，以急救阳明胃阴为主(高鼓峰谓治膈一阳明尽之)，如牛乳、人乳、沙参、天冬、麦冬、地黄、芦根、茅根、韭汁陈酒最为要药。选方当遵杨乘六用左归饮去茯苓加当归、生地主治。然吾尝用大半夏汤合麦门冬汤治之，亦间有犹效者。倘刺痛大便干结(大肠无血)，当遵鼓峰法熟地五钱，当归、白芍、桃仁、麻仁各三钱，以润之(如其人形体尚壮加大黄椂BR> 钱，以助血药更妙)。或用酒大黄、桃仁、归尾、炼蜜为小丸，茅根浓煎汤送下，以缓下之(大肠润利，胃口自开，然此症年五十下或可治，五十上难医。初病或易治，久病难医)。若饮食方下咽气即上逆或刺痛，启膈饮之，重用沙参以开肺气之郁，又不可不讲究也。若朝食而暮乃吐，暮食而朝乃吐，其大便甚利或溏者(与膈症分别处验大便为最要)，此中下二焦火衰反胃症也(王太仆云：食不得入是有火也；食入反出是无火也)。宜吴茱萸汤，附子理中汤或六君子汤加姜、附治之。高鼓峰亦主王太仆之论，用八味丸主治。然余治内人患此，用大小半夏汤吴茱萸汤三方合用而痊(除噎隔症外，凡治呕吐，药中磨沉香汁三四分，其效倍速)。
即发黄症。遍身面目溺皆黄，原有五疸之分(黄疸、谷疸、酒疸、女劳疸、黄汗)，阴阳虚实之别，而究湿热气蒸为患者居多。治法必从气分，宣通乃效。兹拟渗湿清热，佐以宣通气分方法(此症渴难治，不渴易治)。
苓皮五钱 滑石三钱 黄芩一钱 北杏…-钱 茵陈三钱 栀子一钱半 蔻仁四分
加淡豆豉三钱，同煎(或重用鲜田基黄、白连草煎汤，去渣，将汤代水煎药)。
热盛倍用栀芩。湿盛加苍术。周身尽痛痛湿阻气机也，宜倍用蔻仁以开肺气，肺主一身之气化故也。炒银花、泽兰叶、藿香、叶梗、猪苓、泽泻、木通、萆薢、海金沙、腹皮皆芳香逐秽渗淡除湿之品，可因症参入加减。
但所因不一，治法颇多，即女劳瘀血难疗，自有方书可考(沈金鳌尊生引述颇详可参考。且分别黄肿、与黄疸证治亦佳)。似不烦多赘。然窃念阳黄阴黄，清温各别，每见误治者，难免伤人，是不得不明辨。夫阳主明，故黄如橘子色，治胃(脉或数或缓必有力)即宜用上拟方并参以所列加减各法治之。阴主晦，故黄如曛，黄色治脾(脉必沉弱且身冷)，罗谦甫先生以茵陈四逆汤主之，高鼓峰用四苓散加炮姜、茵陈治之，重者加附子。又有脾液外越而发黄者(脉弱体倦无神，但面身黄目，溺不黄)，贫而劳苦者多(劳则伤脾，脾虚不能收摄真气故也)，宜香砂六君子汤加减治之。
附 案 二
酒肉连绵之会，适暑湿交蒸之时，稍不谨慎，最易犯，此湿热疸症。拟方七味连服数剂便可全愈。余尝医故交谢司马侄，年少患此，初起即进原方二剂，病已减半，间数日再进二剂，渐愈，惟目尚黄，祗多饮乌龙茶(此茶芳香能辟暑湿秽浊之气)与薄味调养而痊(此症忌酒肉厚味)。
叶案治疸症有云，不宜下，恐犯太阴，变脉不知，亦问其症之宜与不宜耳。琴师左君逄源患此症三月余，服药罔效，延余治。自述每三四日始一更衣，今已五日矣。能食脉有力，余用茵陈蒿汤加芒硝治之，方用大黄三钱，茵陈四钱，栀子、芒硝各二钱，煎好冲入酒二杯服。服后大泻，明日硝减半，服再泻，病稍退。隔四日仍苦便难，前方去硝加桃仁三钱，服二贴，仍泻二次，继以薄味调养而收全功。
头 痛
头为诸阳之会，与厥阴肝脉会于巅，故头痛一症，半由厥阴风火挟诸经火上扰所致。兹即是议订一方，其风寒虚三者，亦非尽无，然六淫五贼之分，气血虚实之别，前人成法，自有可稽，即沈芊绿《尊生》一书，引述颇详，可因其援引而博考之。至若偏正头风，当遵叶天士先生育阴和亢阳，柔润熄内风一法，参入商治。
北杏三钱 连翘二钱 蔓荆子一钱 钩藤五钱，打 白菊椙 鲜莲叶四钱，用边，切碎煎。
热盛加羚羊、苦丁茶各三钱，煎。兼感受暑气加六一散三钱引。
知确非由外感(无发热、恶寒、鼻塞、声重脉浮等)去北杏、连翘、荆子，转用生地、熟地、天冬、麦冬、玉竹、胡麻、阿胶、龟版、鳖甲等选择三五味配入本方治之，此养肝体佐以清肝，用法阴虚火浮最宜，即偏正头风亦可治。叶案所谓育阴和亢阳，柔润熄内风者此也。此等症或全用静药，羚羊、钩藤、菊花，或亦不用，或少佐之。
附论偏正头风
偏头风多属少阳，以少阳行身之侧故也。误投柴胡多致损目，以升散少阳，耗竭肝阴故也。朱丹溪以左属风属火，主血虚，右属痰属热，主气虚，遵之亦有效有不效。其初起者，不论左右，用鲜红根地胆草头五钱(如无以白茅根代之)，当归、羚羊(二味先煎)，木贼、天麻、荆子、菊花各一钱，川芎、白芷各四分，黑豆百粒，煎服多效。
另有一种正头风，数日一发，或数月一发，此乃风毒客于髓海，服药难达病所，故年深难愈，宜用菊花、沈茶蒸浓汁，仰卧冷注鼻中(或用生莱菔汁)，或甜瓜蒂五分，皂角二分，细辛一分，真麝香二厘，蜜小丸，绵裹，塞鼻中，沸湿则易之，得嚏或出浊涕窍通而痛自解。
风毒傍于脑海之旁，亦令偏头痛，倘用育阴和阳柔润熄风法不效，上从鼻治三法皆可选用。左痛从左治，右痛从右治(亦有主左痛治右右痛治左者当并试之)。又或用肉桂一分，人言一厘，麝香二厘，辛夷、细辛各五厘，胡椒十粒，为末，枣肉为丸，如豌豆大。一粒放膏药中心，贴准太阳穴，一日当见效(因风寒而起者更妙)。如壮年火盛者，愈后服黄芩大黄泻火，则目自愈。
腹 痛
(中脐及脐上下痛同考)
脐上属太阴(脾)，脐中属少阴(肾)，脐下属厥阴(肝)，当分别治之。凡一切痛症，虚者喜按，得食则止，脉无力，实者拒按，得食愈痛，脉有力。
藿香梗三钱 草决明四钱 生白芍二钱川楝子一钱半 大蒿麦三钱 细甘草七分 旧青皮八分，醋炒
加橘柚叶二钱(鲜取剪碎)同煎。脐上痛加木香五六分，炒谷芽三四钱。中脐痛加吴萸五六分，炒山甲一二片(皆去藿梗青皮)。脐下痛加海螵蛸四钱，茜根一钱，或再加制香附二钱，炒山查核三钱(去藿、决、蒿、芍、草五味，倘按之冷，仍须加吴萸或肉桂。若女子患此则当归、杞子、蒺藜、灵脂不可少，下附奇经心痛案可参)。又腹痛恒有因饮食不慎而致者，如肉食伤宜山查、蓬术、阿魏；食饭伤宜神曲、麦牙；食曲伤宜莱菔子，生冷伤宜草果、苍术、厚朴；宿食伤宜枳实、黄连、蓬术、槟榔，因其所伤之物而以主治之药为君，助以余药兼以化气痛自愈矣。然而腹痛之因更有不止此者，腹满痛而大便闭为实，有厚朴三物、厚朴七物与大黄附子汤法。腹满痛而下利为虚，有理中汤法。雷鸣切痛而呕吐为寒气，有附子粳米汤法。慎疾者，宜小心察之。
附 案
香邑黄阁乡麦树基每日交酉必腹痛(脏腑十二时流注说以酉属肾经)，将交戌痛乃渐止，病年余，无有能愈之者。一医会作热积治，用朴、枳、连、柏，渐增肠鸣(寒气)，更或时吐时泻。又更一医治以自制小丸，此后则诸恙倍增肠鸣，虽远坐亦闻，腹痛每至于闷死，必酉刻将尽始渐醒而痛缓，日日如是，无有间者。危急之际，邀余诊，脉无神，结见两关左尺，拟附子粳米汤加味治之，熟附子三钱、炒，粳米、制半夏各四钱，丽参、木瓜、炙草、南枣肉各一钱，是晚痛虽止，而肠尚鸣，亦将交戌而其鸣乃息。翌日诊，原方如土炒白术五钱枣肉改用三钱，木瓜改用一钱半，是晚诸恙俱安。隔年余，适到黄阁复邀诊，据述今年上半载无恙，后半载每月复发一二次，因痛不比去年之甚，故加味复方，仅服半剂，而自能渐安，余仍用附子粳米汤合理中汤加味，为小丸，令其常服，以防后患。防党参、白术各四两，附子、当归各一两，丽参、半夏、干姜、木瓜、甘草各五钱，用大枣糯米煎稠粥，为小丸，每服三钱，早用淡盐汤送。后闻连服五料，乃收全功。
附论藿乱症
我的友人黄云裳的女儿，十三岁，在深秋时节患了疟疾。医生用柴胡、葛根、羌活等药物防治并治好了她。此时她已经能够进食，但后来再次出现发热、口渴想喝水的症状，并伴有轻微出汗和津液流失。另一位医生误认为是再次感受外邪，仍然使用解表发散的药物，导致热势更加炽盛，口渴更加严重。于是邀请我诊治，诊脉发现右关脉单独呈现数象（脉搏跳动快）。我说：这是食积停滞罢了，不是外感病。原来治疗疟疾时，辛温发散的药物使用过度，燥烈之性损伤了胃中的津液，导致胃液不足，因此进食后消化迟缓，逐渐产生积热，进而壅塞压迫营卫之气，使它们不能和谐运行。胃属阳土，所以独自表现为发热。小孩子生病初愈，就频繁进食，常常会有这种病症。如果继续使用苦寒药物损伤胃气，用辛散药物耗伤津液，病情变化就会立刻变得危险。治疗方法应该选择甘凉的药物来滋养胃阴、生津液，胃津充足则食物自然消化，营卫自然调和，肌表的发热自然解除。处方参考人参白虎汤进行加减：丽参五分同煎，麦冬（带心）、鲜嫩竹叶剪碎各二钱，生扁豆不捣碎三钱，知母、石膏各一钱，甘草三分；将石膏研成粉末，用白糖沙拌炒后下锅，煎服。服用一剂后，口渴和发热稍微减退，服用三剂后完全痊愈。黄云裳说：“我现在才知道伤食也会有寒热症状。”我说：“还不止这些。”黄云裳说：“你能为我详细说说吗？”我说：“试着为您简要列举一下：风寒侵袭体表，营卫不能在体表正常运行而产生寒热；暑湿秽浊之气与燥气从口鼻吸入，阻碍气机运行，营卫不能转旋而产生寒热；食积阻滞气的升降，实火扰乱气的流行，营卫因此失去循行的规律而产生寒热；更何况阴虚产生内热，阴盛产生内寒，阳盛产生外热，阳虚产生外寒，重阴则热（阴盛格阳），重阳则寒（阳盛格阴）；还有阳维脉发病更痛苦于寒热，这不关乎营卫的和谐与否，应当急切讲究滋阴以调和阳气的方法。”黄云裳说：“那么阴虚引起的寒热与外感引起的寒热究竟如何辨别和治疗呢？”我说：“以有汗无汗作为区别。有汗属于营卫不和，因为营卫不充盈，循行失去规律，所以有时发热，有时寒热往来。叶天士论述治疗时说，如果使用桂枝汤，应当重用白芍来收敛阴气、调和营血。无汗属于肝肾及奇经至阴部位，位置深远难以跨越诸经到达阳分而泄出汗水，叶天士论述治疗时说应当使用芳香轻清的药物来宣通八脉，使用滋阴益血的药物来调养奇经，如果参入当归桂枝汤的治疗方法（即桂枝汤加当归），也必须去掉白芍，因为白芍味酸，不能走络脉。”黄云裳说：“您时常说病症如果不疑似分辨清楚，用药彼此稳妥确实如此。”
《评琴书屋医略》卷一结束
评琴书屋医略 卷二
消渴症
消渴分为上消、中消、下消三种：饮水多而小便少的是上消；吃得多而大便干结的是中消；喝多少尿多少，小便像膏脂一样的是下消（上消和中消属于热证，下消属于寒证）。前代贤人治疗上消用人参白虎汤，治疗中消用调胃承气汤，治疗下消用肾气丸。其实这些都是津液干枯的疾病，所以赵养葵先生说，凡是极度口渴干燥的，不分上中下，都用大剂量的六味地黄汤加上肉桂、五味子（名叫加减八味丸），连续服药频频饮用，口渴自然会停止。白虎汤和承气汤都不适宜。赵先生的理论虽然改变了古人的成法，其中实在有精妙的意义。大概人体的灌溉，全身全靠两肾中的水火，少火能生气，真水自然上升，口渴自然停止（加入肉桂正是为了温动少火，前代贤人治疗下消用肾气丸就是这个意思），然而临症总贵在根据脉象灵活变通。上消较轻，大多先拟定清燥法。
大麦冬五钱（连心），大天冬三钱，白粳米四钱，大生地五钱，雪梨干八钱，乌梅肉四分（加生蜜冲服）。如果口渴仍照原方频频进服，蜂蜜不拘多少，与乌梅酸甜合口味最好，酸甘取意在于化生阴液。
服用三四剂后仍然口渴，如果脉象洪大而数，喜欢冷饮的，加石膏、知母。仍然口渴再加黄连、甘草。如果脉象沉弱而迟，喜欢热饮的（拟定的方剂不合适用），应当遵循赵养葵的方法（或者用肾气丸）。中消用调胃承气汤合四物汤（或者去掉川芎、芒硝，以石膏为主药）。下消宜用肾气丸。如果骨瘦腿疼，宜用知柏八味丸加杜仲、人参、天冬、五味子。
呕吐这一症状，属于足阳明胃经，有寒、有热、有虚，患此病最宜明确辨别。因寒而呕吐的，脉象必定迟（嘴唇舌头白，厌恶饮水）。因热而呕吐的，脉象必定数（嘴唇脸颊红，口燥渴）。因虚而呕吐的，脉象必定虚（嘴唇白，面色黄，倦怠嗜卧）。如果能根据脉象辨别症状施治，必然有效。这里拟定一个针对接近热证的安胃降逆轻剂，以便根据症状加减。
金钗石斛五钱（先煎），制半夏一钱半，细甘草三分，茯苓三钱，化橘红四分，鲜竹茹适量。
加生姜一钱同煎（或者去掉甘草，因为甘味能守中壅滞气机引发呕吐，因为石斛苦，所以少佐一点）。
如果确切审察到脉数热盛，加石膏、粳米或者麦冬、鲜芦根（经验方：石膏、粳米、麦冬、芦根煎汤代茶，止热呕效果很好）。方内的生姜、橘红可以减少用量，或者不用。如果脉迟有寒的，去掉石斛、竹茹，加砂仁，或者蔻仁，或者只加方内的生姜用三四钱，或者五六钱。寒重的加到一两以上必然有效。如果脉虚属于中气虚的，去掉石斛、竹茹，加白术、人参、大枣。虚而兼寒的，再加附子、干姜。至于呕吐且寒热往来的，是少阳症，宜另外用小柴胡汤主治。
呕吐症中更有病名噎隔、病名反胃的，这个人在饮食之际，气忽然阻塞叫做噎；心下阻隔拒纳，或者食物到了膈间不得下行（所以古人也有称之为膈的）叫做隔。古人认为津液干枯是噎隔病的根源，可知忌讳投用温补药物。误用人参、黄芪、白术来培补，会增加其阻隔；误用生姜、肉桂、附子来温暖，会加速死亡。选药必须用清润的药物，以急救阳明胃阴为主（高鼓峰说治疗膈症一语概括为阳明尽之），如牛乳、人乳、沙参、天冬、麦冬、地黄、芦根、茅根、韭汁、陈酒是最为重要的药物。选方应当遵循杨乘六用左归饮去掉茯苓加当归、生地主治。然而我曾经用大半夏汤合麦门冬汤治疗它，也偶尔有见效的。如果有刺痛、大便干结（大肠无血），应当遵循鼓峰法：熟地五钱，当归、白芍、桃仁、麻仁各三钱，以滋润之（如果其人形体还强壮，加大黄一钱，以助血药更好）。或者用酒大黄、桃仁、归尾、炼蜜做成小丸，用茅根浓煎汤送下，以缓下之（大肠润滑，胃口自然打开，然而此症五十岁以下或许可以治，五十岁以上难医。初病或许易治，久病难医）。如果饮食刚咽下气就上逆或者刺痛，用启膈饮，重用沙参以开肺气之郁结，又不可不讲究。如果早晨吃饭晚上吐，晚上吃饭早晨吐，大便很通畅或者稀溏的（与膈症分别的地方，验大便最重要），这是中下二焦火衰的反胃症（王太仆说：食不得入是有火；食入反出是无火）。宜用吴茱萸汤，附子理中汤或者六君子汤加姜、附治疗。高鼓峰也主张王太仆的理论，用八味丸主治。然而我治疗内人患此病，用大小半夏汤、吴茱萸汤三方合用而痊愈（除了噎隔症外，凡是治疗呕吐，药中磨沉香汁三四分，效果加倍迅速）。
就是发黄症。遍身面目小便都黄，原有五疸之分（黄疸、谷疸、酒疸、女劳疸、黄汗），阴阳虚实之别，而究其原因是湿热气蒸发的患者居多。治疗方法必从气分入手，宣通才有效。这里拟定渗湿清热，佐以宣通气分的方法（此症口渴难治，不口渴易治）。
茯苓皮五钱，滑石三钱，黄芩一钱，北杏仁一钱，茵陈三钱，栀子一钱半，蔻仁四分。
加淡豆豉三钱，同煎（或者重用鲜田基黄、白连草煎汤，去渣，将汤代水煎药）。
热盛加倍使用栀子和黄芩。湿盛加苍术。周身尽痛是因为湿阻气机，宜加倍使用蔻仁以开肺气，因为肺主一身的气化。炒银花、泽兰叶、藿香、叶梗、猪苓、泽泻、木通、萆薢、海金沙、腹皮都是芳香逐秽、渗淡除湿的药物，可以根据症状参入加减。
但是病因不一，治法颇多，即使是女劳疸瘀血难疗，自有方书可考（沈金鳌《尊生集》引述颇详可参考。并且分别黄肿与黄疸证治也很好）。似乎不需要过多赘述。然而私下想，阳黄阴黄，清温各别，常见误治者，难免伤人，是不得不明辨。夫阳主明，所以黄如橘子色，治胃（脉或数或缓必有力）就宜用上拟定的方子并参以所列加减各法治之。阴主晦，所以黄如熏黑，黄色治脾（脉必沉弱且身冷），罗谦甫先生用茵陈四逆汤主治，高鼓峰用四苓散加炮姜、茵陈治疗，重者加附子。又有脾液外越而发黄的（脉弱体倦无神，只是面身黄，眼睛和小便不黄），贫穷而劳苦的人多（劳则伤脾，脾虚不能收摄真气所致），宜用香砂六君子汤加减治疗。
附案二
酒肉连绵的聚会，适逢暑湿交蒸的时候，稍不谨慎，最容易犯，这是湿热疸症。拟定方子七味，连服数剂便可全愈。我曾经医治故交谢司马的侄子，年少患此病，初起就进原方两剂，病已减半，间隔几天再进两剂，渐渐痊愈，只有眼睛还黄，只多喝乌龙茶（此茶芳香能辟暑湿秽浊之气）与薄味调养而痊愈（此症忌酒肉厚味）。
叶天士治疗疸症有说，不宜下法，恐怕犯太阴，变证不知，也是问其症之宜与不宜罢了。琴师左君逄源患此症三月多，服药无效，延请我治疗。自述每三四天才一次排便，现在已经五天了。能食，脉有力，我用茵陈蒿汤加芒硝治疗，方用大黄三钱，茵陈四钱，栀子、芒硝各二钱，煎好冲入酒二杯服。服后大泻，第二天硝减半，服后再泻，病稍退。隔四天仍然苦于便难，前方去掉硝加桃仁三钱，服两贴，仍泻两次，继以薄味调养而收全功。
头为诸阳之会，与厥阴肝脉会于巅顶，所以头痛一症，一半由厥阴风火挟诸经火上扰所致。这里据此议订一方，其风寒虚三者，也并非完全没有，然而六淫五贼之分，气血虚实之别，前人成法，自有可查考的，即沈芊绿《尊生》一书，引述颇详，可以因其援引而博考之。至于偏正头风，应当遵循叶天士先生育阴和亢阳，柔润熄内风一法，参入商量治疗。
北杏仁三钱，连翘二钱，蔓荆子一钱，钩藤五钱（打碎），白菊花适量，鲜莲叶四钱（用边，切碎煎）。
热盛加羚羊角、苦丁茶各三钱，煎。兼感受暑气加六一散三钱引经。
知道确切不是由外感引起（无发热、恶寒、鼻塞、声重脉浮等），去掉北杏仁、连翘、蔓荆子，转用生地、熟地、天冬、麦冬、玉竹、胡麻、阿胶、龟版、鳖甲等选择三五味配入本方治之，这是养肝体佐以清肝，用法阴虚火浮最宜，即偏正头风也可治。叶天士所谓育阴和亢阳，柔润熄内风者就是这个。此类症或者全用静药，羚羊、钩藤、菊花，或者也不用，或少佐之。
附论偏正头风
偏头风多属少阳，因为少阳行于身体侧面。误投柴胡多致损目，因为升散少阳，耗竭肝阴所致。朱丹溪认为左边属风属火，主血虚，右边属痰属热，主气虚，遵之也有有效有不效的。其初起的，不论左右，用鲜红根地胆草头五钱（如果没有用白茅根代替），当归、羚羊角（二味先煎），木贼、天麻、蔓荆子、菊花各一钱，川芎、白芷各四分，黑豆百粒，煎服多有效。
另有一种正头风，数日一发，或数月一发，这是风毒客于髓海，服药难达病所，所以年深难愈，宜用菊花、沈茶蒸浓汁，仰卧冷注鼻中（或者用生莱菔汁），或者甜瓜蒂五分，皂角二分，细辛一分，真麝香二厘，蜜小丸，绵裹，塞鼻中，沸湿则换，得嚏或出浊涕窍通而痛自解。
风毒傍于脑海之旁，也令偏头痛，如果用育阴和阳柔润熄风法不效，上从鼻治三法皆可选用。左痛从左治，右痛从右治（也有主张左痛治右右痛治左的，应当并试之）。又或用肉桂一分，人言一厘，麝香二厘，辛夷、细辛各五厘，胡椒十粒，为末，枣肉为丸，如豌豆大。一粒放膏药中心，贴准太阳穴，一日当见效（因风寒而起者更妙）。如壮年火盛者，愈后服黄芩大黄泻火，则目自愈。
（中脐及脐上下痛同考）
脐上属太阴（脾），脐中属少阴（肾），脐下属厥阴（肝），应当分别治之。凡一切痛症，虚者喜按，得食则止，脉无力，实者拒按，得食愈痛，脉有力。
藿香梗三钱，草决明四钱，生白芍二钱，川楝子一钱半，大蒿麦三钱，细甘草七分，旧青皮八分（醋炒）。
加橘柚叶二钱（鲜取剪碎）同煎。脐上痛加木香五六分，炒谷芽三四钱。中脐痛加吴茱萸五六分，炒山甲一二片（都去掉藿梗青皮）。脐下痛加海螵蛸四钱，茜根一钱，或者再加制香附二钱，炒山楂核三钱（去掉藿、决、蒿、芍、草五味，如果按之冷，仍须加吴茱萸或肉桂。如果是女子患此则当归、杞子、蒺藜、灵脂不可少，下附奇经心痛案可参）。又腹痛恒有因饮食不慎而致的，如肉食伤宜山楂、蓬术、阿魏；食饭伤宜神曲、麦芽；食曲伤宜莱菔子，生冷伤宜草果、苍术、厚朴；宿食伤宜枳实、黄连、蓬术、槟榔，因其所伤之物而以主治之药为君，助以余药兼以化气痛自愈矣。然而腹痛之因更有不止此者，腹满痛而大便闭为实，有厚朴三物、厚朴七物与大黄附子汤法。腹满痛而下利为虚，有理中汤法。雷鸣切痛而呕吐为寒气，有附子粳米汤法。慎疾者，宜小心察之。
附案
香邑黄阁乡麦树基每天酉时必腹痛（脏腑十二时流注说以酉属肾经），将交戌时痛乃渐止，病年余，没有能治愈的。一位医生会作热积治，用朴、枳、连、柏，渐渐增加肠鸣（寒气），更有时吐时泻。又换一位医生医治以自制小丸，此后则诸恙倍增肠鸣，虽远坐亦闻，腹痛每至于闷死，必酉刻将尽始渐醒而痛缓，日日如是，没有间断的。危急之际，邀我诊，脉无神，结见两关左尺，拟附子粳米汤加味治之，熟附子三钱（炒），粳米、制半夏各四钱，丽参、木瓜、炙草、南枣肉各一钱，是晚痛虽止，而肠尚鸣，也将交戌而其鸣乃息。翌日诊，原方如土炒白术五钱枣肉改用三钱，木瓜改用一钱半，是晚诸恙俱安。隔年余，适到黄阁复邀诊，据述今年上半载无恙，后半载每月复发一二次，因痛不比去年之甚，故加味复方，仅服半剂，而自能渐安，余仍用附子粳米汤合理中汤加味，为小丸，令其常服，以防后患。防党参、白术各四两，附子、当归各一两，丽参、半夏、干姜、木瓜、甘草各五钱，用大枣糯米煎稠粥，为小丸，每服三钱，早用淡盐汤送。后闻连服五料，乃收全功。
附论霍乱症
My friend Huang Yunshang's daughter, aged thirteen, contracted malaria (Malaria) in late autumn. The physician treated her with Chaihu Ge Gen Qiang Huo Fang (Bupleurum, Kudzu, and Notopterygium Decoction), which cured her. She had resumed eating, but later developed recurrent fever, thirst with desire to drink, slight sweating, and loss of body fluids (Jin Ye). Another physician mistakenly diagnosed it as a new external contraction and continued using exterior-releasing (Exterior-Releasing) methods, causing the heat to intensify and the thirst to worsen. I was invited to consult. Upon taking the pulse, I found that the Right Guan position alone was rapid (Shu). I said: "This is food stagnation (Food Stagnation), not an external contraction. Originally, during the treatment of malaria, acrid-dispersing (Acid-Dispersing) drugs were overused. Their dryness damaged the stomach fluids (Stomach Fluids), leaving them insufficient. Consequently, after eating, digestion became slow, gradually generating accumulated heat, which then obstructed and compressed the Ying (Nutritive) and Wei (Defensive) Qi, preventing them from harmonizing. The Stomach belongs to Yang Earth, so it manifests isolated fever. Children often present with this syndrome when they resume frequent eating immediately after recovering from illness. If one continues to use bitter-cold drugs to damage the Stomach or acrid-dispersing drugs to deplete fluids, the condition will deteriorate dangerously. The treatment method should select sweet-cool herbs to nourish the Stomach and generate fluids. Once Stomach fluids are sufficient, food will digest naturally, Ying and Wei Qi will harmonize, and the surface heat will resolve spontaneously." The prescription modified from Renshen Baihu Tang (Ginseng and White Tiger Decoction): Lishen (Lishen) 5 fen decocted together; Maidong (Ophiopogon Tuber, retaining the heart) and fresh tender Zhuyeqie (Bamboo Leaves, cut into pieces) each 2 qian; Sheng Biandou (Raw Lablab Bean, uncrushed) 3 qian; Zhi Mu (Anemarrhena Rhizome) and Shigao (Gypsum Fibrosum) each 1 qian; Gancao (Licorice Root) 3 fen; Shigao ground into powder, stir-fried with white sugar sand, added later, decocted and taken orally. After one dose, thirst and heat subsided slightly; after three doses, full recovery was achieved. Yunshang said: "I now realize that food injury can also cause cold and heat symptoms." I said: "It is not limited to this." Yunshang said: "Can you explain this to me in detail?" I said: "Let me briefly list some examples for you: When Wind-Cold invades the exterior, Ying and Wei cannot circulate externally, leading to cold and heat; when Summerheat-Dampness, turbid pathogens, and Dryness-Qi are inhaled through the mouth and nose, obstructing Qi mechanism, Ying and Wei cannot rotate, also leading to cold and heat; Food stagnation obstructs the ascending and descending of Qi, while Excess Fire disturbs the flow of Qi, causing Ying and Wei to lose their rhythmic circulation, also resulting in cold and heat; Furthermore, Yin deficiency generates internal heat, Yin excess generates internal cold, Yang excess generates external heat, and Yang deficiency generates external cold; Heavy Yin leads to heat (Yin excess repelling Yang), and Heavy Yang leads to cold (Yang excess repelling Yin); Moreover, disease of the Yangwei Vessel causes suffering from cold and heat. This does not concern whether Ying and Wei are harmonious or not, but urgently requires attention to nourishing Yin to harmonize Yang." Yunshang said: "Then how exactly can we distinguish between Yin-deficiency-induced cold/heat and external-contracted cold/heat, and treat them accordingly?" I said: "Distinguish by the presence or absence of sweating. Sweating belongs to disharmony of Ying and Wei, due to insufficiency of Ying and Wei and loss of rhythmic circulation, thus sometimes presenting with fever or alternating chills and fever. Master Ye Tianshi discussed treatment, stating that if Guizhi Tang (Cinnamon Twig Decoction) is used, Baishao (White Peony Root) should be heavily dosed to astringe Yin and harmonize Ying. No sweating belongs to the Liver, Kidney, and Extraordinary Vessels at the deepest Yin levels, where it is difficult to cross the meridians to reach the Yang aspect to induce sweat. Master Ye Tianshi stated that aromatic and light-clear herbs should be used to open the Eight Extraordinary Vessels, and Yin-nourishing and blood-tonifying herbs should be used to regulate the Extraordinary Vessels. If Danggui Guizhi Tang (Angelica Cinnamon Twig Decoction) is incorporated (i.e., Guizhi Tang plus Danggui), Baishao must still be removed because its sour taste does not enter the collaterals." Yunshang said: "You often say that if diseases are not suspected and differentiated clearly, the efficacy of medicines will be compromised."
*Pingqin Shuwu Yilue*, Volume 1 ends.
*Pingqin Shuwu Yilue* Volume 2
Xiao Ke Syndrome (Wasting-Thirst Syndrome)
Xiao Ke is divided into Upper, Middle, and Lower Xiao Ke: Drinking much but urinating little is Upper Xiao Ke; Eating much but having hard stools is Middle Xiao Ke; Drinking and urinating equal amounts, with urine resembling paste, is Lower Xiao Ke (Upper and Middle Xiao Ke belong to Heat patterns, Lower Xiao Ke belongs to Cold patterns). Former sages treated Upper Xiao Ke with Renshen Baihu Tang (Ginseng and White Tiger Decoction), Middle Xiao Ke with Tiaowei Chengqi Tang (Regulating the Stomach and Directing Downward Decoction), and Lower Xiao Ke with Shenqi Wan (Kidney Qi Pill). In reality, these are all diseases of dried-up body fluids (Jin Ye). Therefore, Mr. Zhao Yangkui stated that for any case of extreme thirst and dryness, regardless of upper, middle, or lower, large doses of Liuwei Dihuang Tang (Six-Ingredient Pill with Rehmannia) plus Rougui (Cinnamon Bark) and Wuweizi (Schisandra Fruit) (named Jiajian Bawei Wan) should be administered frequently until thirst stops. Baihu Tang and Chengqi Tang are not suitable. Although Mr. Zhao's theory alters ancient established methods, it contains profound meaning. Generally, the irrigation of the human body relies entirely on the Water and Fire within the two Kidneys. Mild Fire (Shao Huo) generates Qi, causing True Water to rise and thirst to cease (adding Rougui is precisely to warm and activate Mild Fire; the former sages' use of Shenqi Wan for Lower Xiao Ke embodies this intent). However, clinical practice always values flexibility based on the pulse. For mild Upper Xiao Ke, Qingzao Fa (Clearing Dryness Method) is mostly proposed first.
Damaidong (Ophiopogon Tuber, retaining the heart) 5 qian, Datiantong (Asparagus Tuber) 3 qian, Baijingmi (White Glutinous Rice) 4 qian, Dashengdi (Rehmannia Root) 5 qian, Xueligan (Dried Snow Pear) 8 qian, Wumeirou (Meat of Mume Fruit) 4 fen (take with raw honey). If thirst persists, continue taking the original formula frequently; the amount of honey is unrestricted, best combined with the sweet and sour taste of Wumei. Sour and Sweet aim to transform Yin.
If after three to four doses thirst persists, and the pulse is surging and rapid with a preference for cold drinks, add Shigao (Gypsum Fibrosum) and Zhimu (Anemarrhena Rhizome). If thirst remains, add Huanglian (Coptis Rhizome) and Gancao (Licorice Root). If the pulse is deep, weak, and slow with a preference for hot drinks (the proposed formula is unsuitable), follow Mr. Yangkui's method (or use Shenqi Wan). For Middle Xiao Ke, use Tiaowei Chengqi Tang combined with Siwu Tang (or remove Chuanxiong and Mangxiao, using Shigao as the sovereign herb). For Lower Xiao Ke, Shenqi Wan is appropriate. If emaciated with leg pain, use Zhibai Bawei Wan plus Duzhong (Eucommia Bark), Renshen (Ginseng Root), Tiantong (Asparagus Tuber), and Wuweizi (Schisandra Fruit).
Ou Tu (Vomiting)
(Huo Luan [Cholera-like disorder] and Ru Ou [Infant vomiting] see Abdominal Pain below; they differ and must not be confused.)
The symptom of vomiting belongs to the Foot-Yangming Stomach Meridian and can be caused by Cold, Heat, or Deficiency. It is crucial to distinguish clearly. Vomiting due to Cold presents with a slow pulse (white lips/tongue, aversion to drinking). Vomiting due to Heat presents with a rapid pulse (red lips/cheeks, dry mouth/thirst). Vomiting due to Deficiency presents with a deficient pulse (white lips, yellow complexion, fatigue, desire to lie down). If treatment is prescribed based on pulse differentiation, effectiveness is guaranteed. Here, a mild Anwei Jiangni (Calming the Stomach and Descending Rebellious Qi) formula is proposed for cases approaching Heat, allowing for modification based on symptoms.
Jinchahu (Dendrobium Stem) 5 qian (decoct first), Zhi Banxia (Pinellia Tuber processed) 1.5 qian, Xi Gancao (Licorice Root) 3 fen, Jie Yunling (Poria) 3 qian, Hua Ju Hong (Tangerine Peel) 4 fen, Xian Zhuru (Fresh Bamboo Sap) appropriate amount.
Add Shengjiang (Fresh Ginger) 1 qian to decoct together (or remove Gancao, as sweetness can retain dampness and obstruct Qi, inducing vomiting; since Shihu is bitter, a small amount is added).
If the pulse is definitively rapid indicating severe Heat, add Shigao (Gypsum Fibrosum) and Jingmi (Glutinous Rice) or Maidong (Ophiopogon Tuber) and Xian Lugeng (Fresh Reed Rhizome) (Empirical Formula: Shigao, Jingmi, Maidong, Lugeng decocted as tea effectively stops heat-induced vomiting). Reduce or omit Shengjiang and Juhong in the formula. If the pulse is slow indicating Cold, remove Shihu and Zhuru, add Sharen (Amomum Fruit) or Keren (Black Cardamom Seed), or add only Shengjiang (Fresh Ginger) 3-5 qian. For severe Cold, increase to over 1 liang for effectiveness. If the pulse is deficient indicating Middle Qi Deficiency, remove Shihu and Zhuru, add Baizhu (Atractylodes Macrocephala Rhizome), Renshen (Ginseng Root), and Dazao (Jujube Fruit). If Deficient with Cold, add Fuzi (Aconite Lateral Root) and Ganjiang (Dried Ginger). If vomiting accompanies alternating chills and fever, it is Shaoyang Syndrome, and Xiaochaihu Tang (Minor Bupleurum Decoction) should be used separately.
Supplementary Discussion on Ye Ge Fan Wei (Dysphagia, Obstruction, and Regurgitation)
Among vomiting syndromes, there are conditions named Ye Ge (Dysphagia/Obstruction) and Fan Wei (Regurgitation). When food enters, sudden Qi obstruction is called Ye; blockage below the heart or food reaching the diaphragm without descending is called Ge (ancients also called it Ge). Ancients believed dried-up body fluids were the root of Ye Ge, hence warming tonics were contraindicated. Mistakenly using Renshen (Ginseng Root), Qishi (Astragalus Root), and Baizhu (Atractylodes Macrocephala Rhizome) to tonify increases obstruction; mistakenly using Jiang (Ginger), Gui (Cinnamon), and Fu (Aconite) to warm accelerates death. Medicines selected must be clear and moistening, primarily aiming to urgently rescue Yangming Stomach Yin (Gao Gufeng stated treating Ge involves mastering Yangming). Key herbs include Niurui (Cow Milk), Renru (Human Milk), Shashen (Glehnia Root), Tiantong (Asparagus Tuber), Maidong (Ophiopogon Tuber), Dihuang (Rehmannia Root), Lugeng (Reed Rhizome), Maogen (Imperata Rhizome), Jiuzhi (Leek Juice), and Chenjiu (Aged Wine). Formulas should follow Yang Chengliu's use of Zuogui Yin (Left Restoring Decoction) minus Fuling (Poria) plus Danggui (Angelica Sinensis Root) and Shengdi (Rehmannia Root). However, I have occasionally used Banxiatang (Pinellia Decoction) combined with Maimendong Tang (Ophiopogon Decoction) with success. If there is stabbing pain and dry stool (Large Intestine lacks Blood), follow Gufeng's method: Shudi (Prepared Rehmannia Root) 5 qian, Danggui (Angelica Sinensis Root), Baishao (White Peony Root), Taoren (Peach Kernel), Hren (Hemp Seed) each 3 qian to moisten (if the patient is robust, add Dahuang (Rhubarb Root) 1 qian to assist blood-invigorating herbs). Or use Jiudahuang (Wine-processed Rhubarb Root), Taoren (Peach Kernel), Guiwei (Angelica Sinensis Root tail), and refined honey to make small pills, taken with thick Maogen (Imperata Rhizome) decoction for gentle purgation (when the Large Intestine is lubricated, the stomach opening opens naturally; however, this condition is treatable under fifty, difficult over fifty. Early stage is easier, late stage is difficult). If food regurgitates immediately upon swallowing or causes stabbing pain, use Qige Yin (Open Obstruction Decoction), heavily using Shashen (Glehnia Root) to open Lung Qi depression. If morning food is vomited in the evening, or evening food in the morning, with loose stools (key distinction from Ge is stool examination), this is Fan Wei due to Fire Decline in Middle/Lower Jiao (Wang Taipou said: Food cannot enter indicates Fire; Food enters and comes out indicates no Fire). Use Wuzhuyu Tang (Evodia Decoction), Fuzi Lizhong Tang (Aconite and Ginger Decoction for the Middle), or Liujunzi Tang (Six Gentlemen Decoction) plus Jiang (Ginger) and Fu (Aconite). Gao Gufeng also supported Wang Taipou's view, using Bawei Wan (Eight-Ingredient Pill). However, I cured my wife of this condition by combining Banxiatang (Pinellia Decoction), Xiaobanxiatang (Minor Pinellia Decoction), and Wuzhuyu Tang (Evodia Decoction) (For vomiting other than Ye Ge, adding Chenxiang juice (Aquilaria Wood) 3-4 fen to medicine doubles the effect).
Dan Zheng (Jaundice Syndrome)
Also known as Yellowing Syndrome. Whole body, eyes, and urine turn yellow. There are originally five types of Dan (Yellow Jaundice, Grain Jaundice, Wine Jaundice, Female Labor Jaundice, Yellow Sweat), distinguished by Yin/Yang and Deficiency/Excess, but most are caused by Damp-Heat steaming. Treatment must address the Qi level; releasing and unblocking is effective. Here, a method of draining Dampness and clearing Heat, assisted by promoting Qi movement, is proposed (This condition is difficult to treat if thirsty, easy if not thirsty).
Lingpi (Poria Skin) 5 qian, Huashi (Talcum) 3 qian, Huangqin (Scutellaria Root) 1 qian, Beixing (Apricot Seed) 1 qian, Yichen (Artemisia Capillaris) 3 qian, Zhizi (Gardenia Fruit) 1.5 qian, Keren (Black Cardamom Seed) 4 fen.
Add Danshidouchi (Fermented Soybean) 3 qian, decoct together (or heavily use Xian Tianjihuang (Selaginella) and Bailiancao (Saururus Herb) decocted, strain, and use the liquid to decoct herbs).
Increase Zhizi and Huangqin for severe Heat. Add Cangzhu (Atractylodes Lancea Rhizome) for severe Dampness. Generalized pain is due to Dampness obstructing Qi mechanism; increase Keren (Black Cardamom Seed) to open Lung Qi, as the Lung governs the Qi transformation of the whole body. Chao Yinhua (Flos Lonicerae), Zelan Ye (Eupatorium Leaf), Huoxiang (Patchouli), Yegeng (Agastache Stem), Zhuling (Polyporus), Zexie (Alisma Rhizome), Mutong (Akebia Stem), Bixie (Dioscorea Hypoglauca Rhizome), Haijinsha (Lygodium Spore), Fupi (Tangerine Peel) are all aromatic, turbidity-expelling, and diuretic herbs for draining Dampness; they can be added according to symptoms.
Causes vary, and treatments are numerous. Even Female Labor Jaundice with Blood stasis is difficult to treat, but recorded in medical books (Shen Jin'ao's *Zunsheng Ji* cites details well; distinguishing Yellow Swelling from Jaundice is also good). No need for excessive elaboration. However, Yang Dan and Yin Dan require different Clearing and Warming approaches. Mis-treatment harms people, so distinction is essential. Yang is bright, so the color is like an orange; treat the Stomach (pulse may be rapid or moderate but must be forceful); use the proposed formula and modifications. Yin is obscure, so the color is like smoked/dark; treat the Spleen (pulse must be deep and weak, body cold). Mr. Luo Qianfu used Yichen Sini Tang (Artemisia and Counterflow Decoction). Gao Gufeng used Siling San (Five Poria Powder) plus Paojiang (Processed Ginger) and Yichen (Artemisia Capillaris), adding Fuzi (Aconite Lateral Root) for severe cases. There is also Yellowing due to Spleen Fluid escaping outward (weak pulse, fatigue, spiritless, only face/body yellow, eyes/urine not yellow), common in poor, laboring individuals (Labor injures Spleen; Spleen Deficiency fails to secure True Qi). Use Xiangsha Liujunzi Tang (Costus and Amomum Six Gentlemen Decoction) modified.
Supplementary Case Two
At banquets with continuous wine and meat, during humid-heat steaming weather, carelessness easily leads to infection. This is Damp-Heat Jaundice. A seven-herb formula taken for several doses cures it completely. I once treated the nephew of my old friend, Sima Xie. Young, he contracted this. Initially, two doses of the original formula halved the illness. After a few days, two more doses led to gradual recovery, except for yellow eyes. He recovered by drinking plenty of Oolong Tea (aromatic, dispels summer-dampness and turbidity) and eating bland food (this condition forbids rich wine/meat).
Master Ye's notes on Jaundice state: Purging is unsuitable, fearing invasion of Taiyin, changing the pulse unpredictably. It depends on whether the syndrome suits purging. Musician Zuo Fengyuan suffered from this for over three months, ineffective medication. I consulted. He reported bowel movements every 3-4 days, now five days. Appetite good, pulse forceful. I used Yinchen Hao Tang (Artemisia and Coix Seed Decoction) plus Mangxiao (Mirabilite). Prescription: Dahuang (Rhubarb Root) 3 qian, Yichen (Artemisia Capillaris) 4 qian, Zhizi (Gardenia Fruit) and Mangxiao (Mirabilite) each 2 qian. Decoct, add 2 cups of wine, take orally. Profuse diarrhea ensued. Next day, half Mangxiao, took again, profuse diarrhea, illness receded. Four days later, difficulty defecating persisted. Remove Mangxiao, add Taoren (Peach Kernel) 3 qian. Two doses, two more diarrheas. Recovered with bland diet.
Tou Tong (Headache)
The head is the meeting place of all Yang meridians, connecting with the Jueyin Liver Meridian at the vertex. Thus, headache is largely caused by Jueyin Wind-Fire carrying Fire from other meridians upward. A formula is drafted here. Wind-Cold and Deficiency exist but are less common. Differentiations of Six Evils and Five Thieves, Qi/Blood Deficiency/Excess, have established ancient methods. Shen Qianlü's *Zunsheng* cites details extensively; refer to it. For Bianzheng Toufeng (Fixed/Moving Headwind), follow Master Ye Tianshi's method of nourishing Yin to harmonize Hyperactive Yang, soft-moistening to extinguish Internal Wind.
Beixing (Apricot Seed) 3 qian, Lianqiao (Forsythia Fruit) 2 qian, Manjingzi (Vitex Fruit) 1 qian, Gouteng (Uncaria Ramulus) 5 qian (crushed), Baiju (Chrysanthemum Flower) appropriate amount, Xian Lianye (Fresh Lotus Leaf) 4 qian (use edges, cut, decoct).
Severe Heat: add Lingyangjiao (Antelope Horn) and Kudingcha (Kuding Tea) each 3 qian. Accompanied by Summerheat: add Liuyisan (Six-One Powder) 3 qian as guide.
If definitely not external contraction (no fever, aversion to cold, nasal congestion, heavy voice, floating pulse), remove Beixing, Lianqiao, Manjingzi. Switch to Shengdi (Rehmannia Root), Shudi (Prepared Rehmannia Root), Tiantong (Asparagus Tuber), Maidong (Ophiopogon Tuber), Yuzhu (Polygonatum Rhizome), Huma (Hemp Seed), Ejiao (Donkey-Hide Gel), Guiban (Turtle Shell), Biejia (Softshell Turtle Shell). Select 3-5 herbs to combine with the base formula. This nourishes Liver Body and assists Liver Clearing, ideal for Yin Deficiency with Floating Fire, treating Fixed/Moving Headwind. This is Ye Tianshi's "nourish Yin, harmonize hyperactive Yang, soft-moisten, extinguish internal wind." Such cases may use only static herbs, or omit Lingyang/Gouteng/Juhua, or add sparingly.
Supplementary Discussion on Bianzheng Toufeng
Bian Toufeng (Lateral Headache) mostly belongs to Shaoyang, as Shaoyang runs along the side of the body. Mistaken use of Chaihu often damages the eyes, as it ascends and disperses Shaoyang, depleting Liver Yin. Zhu Danxi stated: Left belongs to Wind/Fire, governing Blood Deficiency; Right belongs to Phlegm/Heat, governing Qi Deficiency. Following this yields variable results. For early stages, regardless of side, use Xian Honggen Dichangcao Tou (Fresh Red-root Groundsel Head) 5 qian (substitute with Baimaogen if unavailable), Danggui (Angelica Sinensis Root), Lingyangjiao (Antelope Horn) (decoct first), Mozey (Equisetum), Tianma (Gastrodia Rhizome), Jingjie (Schizonepeta Spike), Juhua (Chrysanthemum Flower) each 1 qian, Chuanxiong (Ligusticum Rhizome), Baizhi (Angelica Dahurica Root) each 4 fen, Heidou (Black Soybean) 100 grains. Decoct, take orally; often effective.
Another type, Zheng Toufeng (Central Headache), occurs every few days or months. This is Wind-Toxin residing in the Marrow Sea; drugs rarely reach the site, making chronic cases difficult. Use Juhua (Chrysanthemum Flower) and Shenchá (Dark Tea) steamed into concentrated juice, instill cold into nostrils while lying supine (or use Sheng Laifu Zhi [Radish Juice]). Or Tianguadi (Melon Stalk Tip) 5 fen, Zaojiao (Tamarisk Pod) 2 fen, Xixin (Asarum Root) 1 fen, Zhen Shexiang (Real Musk) 2 li. Honey pills, wrapped in cotton, inserted into nostrils. Change when wet. Sneezing or discharge of turbid mucus opens orifices, pain resolves.
Wind-Toxin beside the Marrow Sea also causes lateral headache. If Yin-nourishing/Harmonizing/Soft-moistening/Extinguishing-Wind fails, the three nasal methods above are selectable. Treat left pain from left, right pain from right (some advocate cross-treatment; try both). Or use Rougui (Cinnamon Bark) 1 fen, Renyan (Arsenic) 1 li, Shexiang (Musk) 2 li, Xinyi (Magnolia Bud), Xixin (Asarum Root) each 5 li, Hujiao (Pepper) 10 grains. Powder, pill with Jiu Rou (Date Flesh), size of pea. Place one pill in center of plaster, apply to Taiyang Acupoint. Effective within one day (better if due to Wind-Cold). For robust youth with excess Fire, post-recovery use Huangqin (Scutellaria Root) and Dahuang (Rhubarb Root) to purge Fire, curing eye issues.
Fu Tong (Abdominal Pain)
(Pain at umbilicus and above/below considered together.)
Above umbilicus belongs to Taiyin (Spleen); at umbilicus to Shaoyin (Kidney); below to Jueyin (Liver). Treat separately. All pain: Deficiency likes pressure, stops with food, pulse powerless; Excess rejects pressure, worsens with food, pulse forceful.
Huoxiang Geng (Agastache Stem) 3 qian, Caojueming (Cassia Seed) 4 qian, Sheng Baishao (White Peony Root) 2 qian, Chuanlianzi (Toosendan Fruit) 1.5 qian, Da Haomai (Coix Seed) 3 qian, Xi Gancao (Licorice Root) 7 fen, Jiu Qingpi (Old Tangerine Peel, vinegar-fried) 8 fen.
Add Jieyouye (Citrus Leaf) 2 qian (fresh, cut, decoct). Above umbilicus pain: add Muxiang (Aucklandia Root) 5-6 fen, Chao Guya (Sprouted Millet) 3-4 qian. At umbilicus pain: add Wuzhuyu (Evodia Fruit) 5-6 fen, Chao Shanji (Pangolin Scale) 1-2 slices (remove Huoxiang/Qingpi). Below umbilicus pain: add Haipiaoxiao (Cuttlefish Bone) 4 qian, Qigen (Rubia Root) 1 qian, or add Zhi Xiangfu (Cyperi Rhizome) 2 qian, Chao Shanzhahe (Hawthorn Pit) 3 qian (remove Huoxiang, Jueming, Haomai, Baishao, Gancao; if cold on pressure, add Wuzhuyu or Rougui). For females, Danggui (Angelica Sinensis Root), Gouqi (Goji Berry), Jili (Tribulus Fruit), Lingzhi (Lepidium Seed) are essential (see Supplementary Extraordinary Vessel Heart Pain Case). Abdominal pain often due to dietary indiscretion: Meat injury uses Shanzha (Hawthorn Fruit), Pengzhu (Curcuma Rhizome), Awèi (Ferula Resin); Rice injury uses Shenqu (Medicated Leaven), Maiya (Barley Sprout); Fermented grain injury uses Laifuzi (Radish Seed); Cold/Raw injury uses Caoguo (Tsaoko Fruit), Cangzhu (Atractylodes Lancea Rhizome), Houpo (Magnolia Bark); Retained food injury uses Zhishi (Immature Bitter Orange), Huanglian (Coptis Rhizome), Pengzhu (Curcuma Rhizome), Binglang (Areca Seed). Use the herb matching the ingested item as sovereign, assisted by others to transform Qi and stop pain. Other causes: Fullness/pain with constipation is Excess (Houpo Sanwu, Houpo Qiwi, Dahuang Fuzi Tang methods). Fullness/pain with diarrhea is Deficiency (Lizhong Tang method). Borborygmus/cutting pain with vomiting is Cold (Fuzi Jingmi Tang method). Careful observation is required.
Supplementary Case
Mai Shuji of Huangge Township, Xiangyi, suffers abdominal pain daily at You hour (Kidney Meridian time per Twelve Hour Flow). Pain ceases near Xu hour. Ill for over a year, untreatable. One doctor treated as Heat Accumulation with Houpo, Zhishi, Huanglian, Huangbai, increasing borborygmus (Cold), sometimes vomiting/diarrhea. Another doctor used homemade pills, worsening all symptoms, loud borborygmus audible from afar, pain nearly causing fainting, resolving only at end of You hour. Daily recurrence. Urgent consultation: Pulse spiritless, knotted at Guan and Left Chi. Prescribed Fuzi Jingmi Tang modified: Shufu (Prepared Aconite) 3 qian (fried), Jingmi (Glutinous Rice), Zhi Banxia (Pinellia Tuber) each 4 qian, Lishen (Lishen), Mugua (Chaenomeles Fruit), Zhi Gancao (Licorice Root), Nanzaorou (Date Flesh) each 1 qian. Pain stopped that night, but borborygmus continued until Xu hour. Next day: Original formula plus Tuchao Baizhu (Earth-fried Atractylodes) 5 qian, change Date Flesh to 3 qian, Mugua to 1.5 qian. Symptoms resolved that night. Over a year later, consulted again. First half of year well, second half relapsed monthly, less severe. Modified compound formula, half dose, self-improved. Prescribed Fuzi Jingmi Tang combined with Lizhong Tang modified, made into small pills for regular use to prevent recurrence. Dangshen (Codonopsis Root), Baizhu (Atractylodes Macrocephala Rhizome) each 4 liang, Fuzi (Aconite Lateral Root), Danggui (Angelica Sinensis Root) each 1 liang, Lishen (Lishen), Banxia (Pinellia Tuber), Ganjiang (Dried Ginger), Mugua (Chaenomeles Fruit), Gancao (Licorice Root) each 5 qian. Decoct with Dazao (Jujube Fruit) and glutinous rice into thick porridge, make small pills. Take 3 qian each morning with light salt water. Heard five courses completed successfully.
Supplementary Discussion on Huoluan Syndrome