甲申首春连翔梧年逾五旬。素多姬外家。持筹鹾务。心肾两亏发热唾痰阴痿足软颊红肉脱
肠结便
清。脉左浮缓无力。右亦洪大不匀。先数医治以款冬麦冬橘红石斛贝母之属。日嗽痰十余碗
。
神倦增剧。余曰此为钟情枕席。久竭精血病以渐致。其嗽而发热者乃肾水枯火无以制因而升
克肺金若痰则肾液上涌不能四布非出于脾也颊红者火灼肺而外征也肉脱者脾气衰火不生土也
脉肝肾浮缓此为受克于金土势应不起。独是胃气未败。饮食如常。尚犹可救。但非恪服二百
余剂。不能见效。法须壮水之主。以制阳光。用六味丸。减泽泻。加人参龟胶炙草等药。服
数日痰嗽顿减。日只碗许。体不甚倦。至四十余剂。病固未减。症亦未增。余曰杯水车薪。
安能骤愈。须宁耐久服。药力既足。病魔自解耳。彼不信。别延数医。皆力任以为投十余剂
可愈。甫两服而唾痰如涌。胸膈胀闷。察之乃琼玉膏。大都皆甘寒泻火之药。始信余言。复
再延治余曰此症本入死法初尚恃天生一线胃气留连未断。为之少延残喘今败于寒剂土气将绝
无能为矣入秋当殒。辞不治。别请张明卿。张谓连参天曰。诸痰属脾。非出于肾。怪余创言
肾经有痰。连语及。传示以立斋医案。始无辩。又刺余曰若根据立斋法治虚痨当无功。余随转
一
语曰。凭丹溪尚有罪耳。张仅投以四白散之物。固知命在垂亡。药石难苏。第立斋法最善。未
可轻诋也。翔梧至八月十四日果殁。余为备悉始末。以告同患。再录立斋阴虚治验于后。立
斋曰愚按虚损之症。设若肾经阴精不足。阳无所化。虚火妄动。以致前症者。宜用六味地黄
丸
补之使阴旺则阳化若脾虚不能生肾。阴阳俱虚而致前症者。宜用补中益气汤。六味地黄丸培
补元气以滋肾水若阴阳络伤血随气泛行。而患诸血症者。宜用四君加当归纯补脾气。以摄血
归经。又曰凡男子少年色欲过度。先见潮热盗汗咳嗽倦怠等症此属足三阴亏损虚热无火之症
故昼发夜止。夜发昼止。不时而作当用六味丸为主。以补中益气汤调补脾胃。若脾胃先损者
。当以补中益气汤为主。以六味丸温存肝肾。多有得生者。若误用黄柏知母之类。则复伤脾
胃。饮食日少。诸脏愈虚。元气下陷。腹痞作泻。则不可救矣。又曰秋官张碧崖面赤作渴。
痰盛头晕此肾虚水泛而为痰用地黄丸而愈又云若肾虚阴火炎上宜用六味丸若肾气虚寒痰上涌
用八味丸若因肝肾阴虚而痰中有血者宜用六味丸若肾气亏损。津液难降。败浊为痰者。乃真
藏之症。宜用六味丸为主肾气既壮津液清化而何痰之有哉又云大凡潮热发热晡热者五脏齐损
也。宜用六味丸气血亏损者须用十全大补汤。又云大参李北泉时唾痰涎。内热作渴。肢体倦
怠。劳而足热。用清气化痰益甚。余曰此肾水泛而为痰法当补肾不信。另进滚痰丸一服。吐
泻不止。饮食不入。头晕眼闭。始信余用六君汤数剂。胃气渐复。却用六味丸月余。诸症悉
愈。又云上舍陈道复长子亏损肾经。久患咳嗽。午后益甚。余曰当补脾土滋化源使金水自能
相生时孟春不信乃服黄柏知母之类。至夏吐痰引饮小便频数。面目如绯。余以白术当归茯苓
五味陈皮麦冬丹皮泽泻四剂。乃以参 熟地山茱为丸。俾服之诸症顿退。复请视。余以为信
。遂用前药如常与之。彼仍泥不服。卒致不起。庶吉士黄伯邻发热吐痰。口干体倦。自用补
中益气汤不应。余
谓此金水俱虚之症。兼服地黄丸而愈。一男子腿内作痛。用渗湿化痰药。痛连臀肉。面赤吐
痰。脚跟发热。余曰乃肾虚阴火上炎。当滋化源。不信。服黄柏知母之类而殁。又云按内伤
发热者。因饮食过时。劳役过度。而损耗元气阴火得以乘其土位故翕翕然而发热宜用补中益
气汤以升其阳。若因劳力辛苦入房不节。亏损精血。虚火妄动而发热者。宜用六味丸以补其
阴。不可认作有余之火。而用黄柏知母之类也。又云举人陈履贞色欲过度。丁酉孟冬发热无
时。饮水不绝。遗精不止。小便淋沥。或用四物芩连之类。前症益甚。更加痰涎上涌。口舌
生疮。服二陈黄柏知母之类。胸膈不利。饮食少思。更加枳壳香附肚腹作胀。大便不实。脉
浮大。按之微细。余朝用四君为主。佐以熟地当归。夕用加减八味丸。更以附子唾津。调搽
涌泉穴。渐愈。后用十全大补汤。其大便不通。小腹作胀。此直肠干涩。令猪胆通之。形体殊
倦。痰热顿增。急用独参汤而安。再用前药而愈。但劳发热无时。其脉浮洪。余谓其当慎起
居。否则难治彼以余言为迂。至乙巳夏复作。乃服四物黄柏知母而殁。以上十五条举其大略
乃立斋先生治阴虚唾痰诸症劳损之方法也先生治必求本滋培化源。迥与今古诸氏不同高明之
士欲曾其全。须察其全案可也。
甲申年早春，连翔梧年过五十。他平时姬妾众多，在外操持盐务。导致心肾两亏，出现发热、咳唾痰涎、阳痿、足部软弱、脸颊发红、肌肉消瘦、大便干结、小便清长等症状。脉象左手浮缓无力，右手也洪大且不均匀。先前医生用款冬花、麦冬、橘红、石斛、贝母等药物治疗，每天咳出的痰多达十余碗。神疲乏力症状加重。我说这是因沉迷枕席之情，长久耗竭精血，疾病逐渐形成。他的咳嗽和发热，是因为肾水枯竭，火气无法制约而上升克制肺金；至于痰，则是肾液上涌而不能四布，并非源于脾脏。脸颊发红是火灼伤肺脏的外在表现；肌肉消瘦是脾气衰弱，火不生土所致。脉象显示肝肾浮缓，这是受到金（肺）土（脾）克制的表现，病情势难挽回。只是胃气尚未败坏，饮食如常，还可以救治。但必须严格服用二百多剂药，才能见效。治法应当壮水之主，以制阳光。使用六味丸，减去泽泻，加入人参、龟板胶、炙甘草等药物。服用几天后，痰嗽顿时减少，每天只有一碗左右，身体不太疲倦。到了四十多剂时，病情虽未减轻，但也未增加。我说这如同杯水车薪，怎能突然痊愈？必须耐心持久服药。药力充足后，病魔自然解除。他不相信，另外请了几位医生，都自信地说投药十余剂即可痊愈。刚服两剂，就唾痰如涌，胸膈胀闷。检查发现他们用的是琼玉膏，大多是甘寒泻火的药物。这时他才相信我的话，再次延请我诊治。我说此症本已陷入死法，起初还依靠天生的一线胃气勉强维持，现在被寒凉药剂败坏，土气将绝，无能为力了。入秋时会死亡。我推辞不治。别人又请张明卿。张明卿对连翔梧说：“各种痰证属于脾，不源于肾。”他对我独创的“肾经有痰”说法感到奇怪，连翔梧便将此事告知，并出示了薛立斋的医案，张明卿才不再争辩。但他又指责我说：“如果按照立斋的方法治疗虚劳，应当没有功效。”我随即转了一句话：“即使是凭据丹溪的理论，也有过错之处。”张明卿仅投以四君子散之类的药物。本来就知道病人命在垂危，药石难以苏醒。只是立斋的方法最好，不可轻易诋毁。翔梧到八月十四日果然去世。我详细记录了始末，告诉同病相怜的人，再记录立斋治疗阴虚的验案在后面。
立斋说：我考察虚损之症，如果是肾经阴精不足，阳无所化，虚火妄动，以致出现前述症状的，宜用六味地黄丸补之，使阴旺则阳化。如果是脾虚不能生肾，阴阳俱虚而导致前述症状的，宜用补中益气汤、六味地黄丸培补元气以滋肾水。如果是阴阳络脉受伤，血随气泛行，而出现各种血症的，宜用四君子汤加当归，纯补脾气，以摄血归经。又说：凡是男子少年时色欲过度，先见到潮热盗汗、咳嗽倦怠等症状，这属于足三阴亏损，虚热无火之症，所以白天发作晚上停止，晚上发作白天停止，不时发作。应当用六味丸为主，以补中益气汤调补脾胃。如果脾胃先受损的，当以补中益气汤为主，以六味丸温存肝肾。多有得救的。如果误用黄柏、知母之类，则会再次损伤脾胃，饮食日渐减少，诸脏更加虚弱，元气下陷，腹部痞满作泻，则不可救了。又说：秋官张碧崖面赤口渴，痰盛头晕，这是肾虚水泛而为痰，用地黄丸而愈。又说：如果肾虚阴火炎上，宜用六味丸；如果肾气虚寒，痰上涌，用八味丸；如果因肝肾阴虚而痰中有血者，宜用六味丸；如果肾气亏损，津液难降，败浊为痰者，乃真脏之症，宜用六味丸为主。肾气既壮，津液清化，还有什么痰呢？又说：大凡潮热、发热、晡热（下午发热）的，是五脏齐损，宜用六味丸；气血亏损的，须用十全大补汤。又说：大参李北泉时常唾吐痰涎，内热口渴，肢体倦怠，劳累后脚热，用清气化痰药反而更甚。我说这是肾水泛而为痰，治法应当补肾。他不信，另进滚痰丸一服，吐泻不止，饮食不入，头晕眼闭，这才相信我用六君子汤数剂，胃气渐复，却用六味丸月余，诸症悉愈。又说：上舍陈道复长子亏损肾经，久患咳嗽，午后更甚。我说应当补脾土滋化源，使金水自能相生。当时孟春不信，于是服黄柏、知母之类。到了夏天，吐痰引饮，小便频数，面目如绯红。我用白术、当归、茯苓、五味子、陈皮、麦冬、丹皮、泽泻四剂，然后以人参、熟地、山茱萸为丸，让他服用，诸症顿退。再次请视诊，我以为他信服了，于是照常给他用前面的药。他仍然固执不服，最终导致死亡。庶吉士黄伯邻发热吐痰，口干体倦，自用补中益气汤不应。我说这是金水俱虚之症，兼服地黄丸而愈。一个男子腿内作痛，用渗湿化痰药，痛连臀肉，面赤吐痰，脚跟发热。我说这是肾虚阴火上炎，应当滋化源。他不信，服黄柏、知母之类而死亡。又说：按内伤发热者，因饮食过时，劳役过度，而损耗元气，阴火得以乘其土位，故翕翕然而发热，宜用补中益气汤以升其阳。如果因劳力辛苦、入房不节，亏损精血，虚火妄动而发热者，宜用六味丸以补其阴，不可认作有余之火，而用黄柏、知母之类。又说：举人陈履贞色欲过度，丁酉年孟冬发热无时，饮水不绝，遗精不止，小便淋沥。或用四物汤加黄芩、黄连之类，前症更甚，更加痰涎上涌，口舌生疮。服二陈汤、黄柏、知母之类，胸膈不利，饮食少思，更加枳壳、香附，肚腹作胀，大便不实，脉浮大，按之微细。我早晨用四君子汤为主，佐以熟地、当归；晚上用加减八味丸，更以附子蘸唾液，调搽涌泉穴，渐渐痊愈。后用十全大补汤。其大便不通，小腹作胀，这是直肠干涩，令猪胆通之。形体殊倦，痰热顿增，急用独参汤而安。再用前药而愈。但劳热发热无时，其脉浮洪，我认为他应当谨慎起居，否则难治。他把我的话当作迂腐，到乙巳年夏天复发，于是服四物汤、黄柏、知母而死亡。以上十五条列举其大略，乃是立斋先生治疗阴虚唾痰诸症、劳损的方法。先生治病必求本，滋培化源，迥与今古诸氏不同。高明之士想要了解全貌，须察其全案可也。
In the early spring of the Jia Shen year, Lian Xiangwu was over fifty years old. He usually had many concubines and managed salt affairs outside, leading to a deficiency of both Heart and Kidney (Zang-Fu organs). He presented with fever, coughing up phlegm, impotence, weakness in the legs, redness of the cheeks, emaciation, constipation, and clear urination. The pulse on the left side was floating, slow, and powerless; the right side was also surging and irregular. Previous physicians treated him with herbs such as Jundonghua (Dendranthema Flos), Maidong (Ophiopogonis Radix), Juhong (Citri Reticulatae Pericarpium), Shihu (Dendrobii Caulis), and Beimu (Fritillariae Bulbus). He coughed up more than ten bowls of phlegm daily. His fatigue worsened. I said this resulted from indulgence in sexual activities, causing long-term depletion of essence and blood, leading to gradual illness. His cough and fever were due to the withering of Kidney Water (Yin fluid), failing to control Fire, which rose to attack Lung Metal. As for the phlegm, it was Kidney fluid surging upward and failing to distribute, not originating from the Spleen. Red cheeks indicated Fire scorching the Lungs manifesting externally; emaciation indicated Spleen Qi decline, where Fire fails to generate Earth. The floating and slow pulses of Liver and Kidney indicated being controlled by Metal and Earth, suggesting an unfavorable prognosis. However, since Stomach Qi was not yet exhausted and appetite remained normal, there was still hope. But strict administration of over two hundred doses was required for effect. The method required strengthening the Master of Water to control Solar Fire. We used Liuwei Wan (Six-Ingredient Pill with Rehmannia), removing Zexie (Alismatis Rhizoma) and adding Renshen (Ginseng Radix et Rhizoma), Guijiao (Colla Testudinis), and Zhigancao (Prepared Licorice Root). After a few days, cough and phlegm decreased significantly, down to about one bowl per day, and fatigue lessened. By forty-plus doses, the condition neither improved nor worsened. I said this is like pouring a cup of water on a cartload of burning firewood; how can it be cured suddenly? One must persist with long-term medication. Once the medicinal power is sufficient, the pathogen will naturally resolve. He did not believe me and consulted other physicians who confidently claimed cure within ten doses. After just two doses, he vomited phlegm profusely and experienced chest oppression. Examination revealed they used Qiongyu Gao (Jade Essence Paste), mostly sweet-cold herbs clearing Fire. Only then did he believe my words and re-hire me. I said this case had entered a fatal stage; initially sustained by a thread of innate Stomach Qi, now ruined by cold-natured agents, Earth Qi is nearly extinct, and nothing can be done. He would die in autumn. I declined treatment. Others invited Zhang Mingqing. Zhang told Lian: "All phlegm belongs to the Spleen, not the Kidney." He was puzzled by my novel theory of "phlegm in the Kidney Meridian." Lian showed him medical cases from Li Zai (Xue Ji), after which Zhang ceased arguing but criticized: "If following Li Zai's method for consumptive disease, it should be ineffective." I retorted: "Even relying on Danxi's theories has faults." Zhang only prescribed Si Jun Zi San (Four Gentlemen Powder) type formulas. Knowing the patient was near death and difficult to revive, I noted that Li Zai's methods were superior and should not be lightly disparaged. Xiangwu indeed died on August 14th. I recorded the details for those suffering similarly and appended Li Zai's verified cases for Yin deficiency below.
Li Zai stated: In analyzing consumptive diseases, if Kidney Yin essence is insufficient, Yang lacks transformation, and deficient Fire moves recklessly causing previous symptoms, use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to tonify, so that when Yin prospers, Yang transforms. If Spleen deficiency fails to generate Kidney, resulting in dual deficiency of Yin and Yang, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Liuwei Dihuang Wan to nourish Yuan Qi and moisten Kidney Water. If Yin-Yang collaterals are injured, and blood follows Qi flooding outward causing various hemorrhagic conditions, use Sijunzi Tang (Four Gentlemen Decoction) plus Danggui (Angelicae Sinensis Radix) to purely tonify Spleen Qi to guide blood back into its vessels. Furthermore, young men who excessively indulge in sexual desire often first present with tidal fever, night sweats, cough, and fatigue. This belongs to deficiency of the Foot Three Yin meridians, characterized by deficient heat without true fire, manifesting as daytime onset with nighttime cessation or vice versa, occurring intermittently. Use Liuwei Wan as the main formula, regulating and tonifying the Spleen and Stomach with Buzhong Yiqi Tang. If Spleen-Stomach damage precedes, prioritize Buzhong Yiqi Tang and use Liuwei Wan to gently preserve Liver-Kidney. Many recover. Misusing Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) damages Spleen-Stomach further, reducing intake, weakening all Zang-Fu, sinking Yuan Qi, causing abdominal distension and diarrhea, which becomes incurable. Regarding Zhang Biya, whose red face, thirst, copious phlegm, and dizziness were caused by Kidney deficiency allowing Water to flood, Liuwei Wan cured him. For deficient Fire flaring upward due to Kidney Yin deficiency, use Liuwei Wan; for Cold-phlegm surging due to Kidney Qi deficiency-cold, use Ba Wei Wan (Eight-Ingredient Pill); for hemoptysis/phlegm-blood due to Liver-Kidney Yin deficiency, use Liuwei Wan; for turbid phlegm due to Kidney Qi failure descending fluids, representing True Zang pathology, use Liuwei Wan primarily. Strengthening Kidney Qi clarifies fluids, eliminating phlegm. Generally, tidal fever, general fever, or afternoon fever indicates simultaneous damage to Five Zang organs, treat with Liuwei Wan; Qi-Blood deficiency requires Shiquan Dabu Tang (Perfect Golden Great Tonification Decoction). Regarding Li Bei quan, who spat saliva, felt internal heat/thirst, fatigue, and hot feet upon exertion, Qingqi Huatan Tang worsened his condition. I diagnosed Kidney Water flooding creating phlegm and advised tonifying Kidney. He refused, taking Tansui Wan (Phlegm-Rolling Pill), resulting in vomiting/diarrhea, inability to eat, dizziness, and closed eyes. Only then did he accept Liujunzi Tang (Six Gentlemen Decoction) to restore Stomach Qi, followed by Liuwei Wan for a month, curing all symptoms. Chen Daofu's eldest son suffered Kidney meridian deficiency with chronic worsening cough in the afternoon. I advised tonifying Spleen Earth to nourish the source, allowing Metal-Water mutual generation. Mengchun disagreed, using Huangbai and Zhimu. By summer, he vomited phlegm, craved water, had frequent urination, and flushed face. I prescribed Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui, Fuling (Poria), Wuweizi (Schisandrae Fructus), Chenpi (Citri Reticulatae Pericarpium), Maidong, Danpi (Moutan Cortex), and Zexie for four doses, then prepared pills with Renshen, Shudi (Rehmanniae Radix Preparata), and Shanzhuyu (Corni Fructus). Symptoms retreated. Upon follow-up, assuming compliance, I continued the prescription. He stubbornly refused, leading to death. Huang Bolin had fever, phlegm, dry mouth, and fatigue. Self-administered Buzhong Yiqi Tang failed. I diagnosed dual deficiency of Metal and Water, cured by combining Dihuang Wan. A man with inner thigh pain treated with damp-draining/phlegm-resolving herbs developed pain radiating to buttocks, red face, phlegm, and hot heels. I diagnosed deficient Fire flaring upward from Kidney deficiency and advised nourishing the source. He refused, took Huangbai/Zhimu, and died. Internal injury fever due to irregular diet or overwork depletes Yuan Qi, allowing Deficient Fire to invade Earth position, causing mild fever; treat with Buzhong Yiqi Tang to raise Yang. Fever from physical labor or excessive sex depleting essence/blood involves reckless Deficient Fire; treat with Liuwei Wan to tonify Yin. Do not mistake it for Excess Fire and use Huangbai/Zhimu. Chen Lvzhen, due to excessive sexual activity, had intermittent fever, constant drinking, spermatorrhea, and dribbling urine in winter. Using Siwu Tang with Huangqin (Scutellariae Radix) and Lianzi (Nelumbinis Semen) worsened symptoms, adding phlegm and mouth ulcers. Erchen Tang with Huangbai/Zhimu caused chest discomfort and poor appetite. Adding Zhike (Aurantii Fructus) and Xiangfu (Cyperi Rhizoma) caused abdominal distension and loose stools. Pulse was floating-large but fine-deep upon pressure. Morning: Sijunzi Tang with Shudi/Danggui. Evening: Jiaban Bawei Wan (Modified Eight-Ingredient Pill) applied with Fuzi (Aconiti Lateralis Radix Preparata) mixed with saliva to Yongquan (KI1). Gradually recovered. Later used Shiquan Dabu Tang. Constipation and lower abdominal distension indicated dry rectum, treated with pig gallbladder. Severe fatigue and sudden increase in phlegm-heat were stabilized with Danshen Tang (Single Ginseng Decoction), then cured with previous formulas. For exertional fever with floating-surge pulse, I advised careful lifestyle management, otherwise untreatable. He dismissed my advice. Relapse occurred in summer of Yi Si year; he took Siwu Tang with Huangbai/Zhimu and died. These fifteen cases summarize Mr. Li Zai's methods for treating Yin-deficiency phlegm and consumptive diseases. He sought the root and nourished the transformation source, differing greatly from ancient and modern practitioners. Those wishing to understand fully should examine complete case records.