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第二十八章.治气血郁滞肢体疼痛方

Chapter 28. herbs for various pain

 

1.升降汤

1. Shenjiang Tang

治肝郁脾弱,胸胁胀满,不能饮食。宜与论肝病治法参看。
 This formula is used for Liver stagnation and Spleen weakness. The person feels fullness and bloating in stomach and has no appetite. The application of this formula should be checked with other formulas used for th Liver disease.

野台参(二钱) 生黄芪 (二钱) 白术(二钱) 广陈皮(二钱) 川浓朴(二钱) 鸡内金(二钱,捣细)知母(三钱) 生杭芍(三钱) 桂枝尖(一钱) 川芎(一钱) 生姜(二钱)
Wild Taishen 6 gram, Huangqi 6 gram, Baizhu 6 gram, Chenpi 6 gram, Houpo 6 gram, Jineijin 6 gram (grind), Zhimu 9 gram, Baishao 9 gram, Guizhi tip 3 gram, Chuanxiong 3 gram, fresh ginger 6 gram.

世俗医者,动曰平肝,故遇肝郁之证,多用开破肝气之药。至遇木盛侮土,以致不能饮食者,更谓伐肝即可扶脾。不知人之元气,根基于肾,而萌芽于肝。凡物之萌芽,皆嫩脆易于伤损,肝既为元气萌芽之脏,而开破之若是,独不虑损伤元气之萌芽乎?《内经》曰厥阴(肝经)不治,求之阳明(胃经),《金匮》曰见肝之病,当先实脾。故此方,惟少用桂枝川芎以舒肝气,其余诸药,无非升脾降胃,培养中土,俾中宫气化敦浓,以听肝气之自理。实窃师《内经》求之阳明,与《金匮》当先实脾之奥旨耳。
Ordinary doctors are ready to talk about to suppress the liver (Ping Gan, in Chinese). When they meet the Liver stagnation condition, they usually use Liver Qi-breaking herbs. When they meet the condition, in which the Wood (Liver) insults the Soil (Spleen), so that the person cannot eat, they would say that, to combat the Liver can support the Spleen. They do not know that, the human Yuan Qi, is rooted in the Kidney, but springs and starts in the Liver. Whatever a plant is in its spring stage, its young branch is easy to broken and damage. The Liver is the spring organ of the body. To sue breaking herbs as such, why not consider the possibility that the herbs may damage the spring brach of the Yuan Qi? In the book
Nei Jing, it is said: “If the Yueyin (Liver meridian) is hard to treat, treat the Yangming (Stomach meridian)”. Also, in the bookJing Kui, it is said: “To treat the liver disease, first to support the Spleen”. Therefore, in the formula here, the herb Guizhi and Chuanxiong are used to smooth the Liver Qi. Other herbs are either to raise the Spleen Qi, and to reduce the Stomach Qi, so as to nourish the Middle Soil. When the middle Soil is thick and strong, and sufficient, it would response to the adjustment by the Liver. This is to follow the idea from theNei Jinto supply the Yangming; and theJing Kuito support the Spleen.

 

按:见肝之病,当先实脾二句,从来解者,谓肝病当传脾,实之所以防其相传,如此解法固是,而实不知实脾,即所以理肝也。兼此二义,始能尽此二句之妙。
Comments: That “To treat the liver disease, first to support the Spleen” is usually explained as: the Liver disease is to pass to the Spleen. So, it is better to support the Spleen so to prevent its pass to the Spleen. They do not know that, to support and to nourish the Spleen is to adjust the function of the Liver”. To understand this sentence by these two ways, it can then really understand it.

一媪,年近六旬。资禀素弱,又兼家务劳心,遂致心中怔忡,肝气郁结,胸腹胀满,不能饮食,舌有黑苔,大便燥结,十数日一行。广延医者为治,半载无效,而羸弱支离,病势转增。后愚诊视,脉细如丝,微有弦意,幸至数如常,知犹可治。遂投以升降汤,为舌黑便结,加鲜地骨皮一两,数剂后,舌黑与便结渐愈,而地骨皮亦渐减。至十剂病愈强半,共服百剂,病愈而体转健康。

A lady, 60 years of old, was thin and slim for her life. She, due to labor and mind work in the family, suffered from palpitation in heart; had Liver Qi stagnation; felt bloating and fullness in the abdomen; had hard to eat; and her tongue was with black covering; and had constipation, which was once every ten days. She had visited many doctors without any major improvement. She was more slim and her condition turned worse. When I saw her, her pulse was as thin as silk, with slight string, but it was lucky that its frequency was normal, so it was considered that it was chance to save her. She was given Shenjiang Tang. For her black tongue covering and constipation, fresh Digupi was added. After several doses, the black tongue covering and constipation were improved gradually. After ten doses, the condition was much improved. After about hundred of doses, the body turned completely health.

 

2.培脾舒肝汤

2. Peipi Shugan Tang (Peipi means to nourish the Spleen here in Chinese; Shugan means to to relax the Liver).

治因肝气不舒、木郁克土,致脾胃之气不能升降,胸中满闷,常常短气。
This formula is used for Liver Qi stagnation; the Wood insults the Soil, so that the Spleen and Stomach Qi could not raise or fall normally. The person feels fullness and bloating in the chest, and has short of breath often.

于术(三钱) 生黄芪(三钱) 陈皮(二钱) 川浓朴(二钱) 桂枝尖(钱半) 柴胡(钱半)生麦冬(二钱) 生杭芍(四钱) 生姜(二钱)
Baishu 9 gram, Huangqi 9 gram, Houpo 6 gram, Guizhi tip 4.5 gram, Chaihu 4.5 gram, Maimendong 6 gram, Baishao 12 gram, fresh ginger 6 gram.

脾主升清,所以运津液上达。胃主降浊,所以运糟粕下行。白术、黄芪,为补脾胃之正药,同桂枝柴胡,能助脾气之升,同陈皮、浓朴,能助胃气之降。清升浊降满闷自去,无事专理肝气,而肝气自理,况桂枝柴胡麦芽,又皆为舒肝之妙品乎。用芍药者,恐肝气上升,胆火亦随之上升,且以解黄芪 桂枝之热也。用生姜者,取其辛散温通,能浑融肝脾之气化于无间也。
The Spleen dominates the raising up, so it transport liquid-fluid, the nutritional material, up to the lung; the Stomach dominates the moving down, so it transport debris down to the intestine. The herb Baizhu and Huangqi are the main herbs to nourish the Spleen and Stomach. When the two work with the Guizhi and Chaihu, they all can raise the Spleen Qi; when they work with the Chenpi and Houpo, they all can help the Stomach to transport things down. When the pure nutritional material raises and the reside falls down, the fullness will disappear naturally. In this way, even if the Liver Qi was not adjusted deliberately, the Liver Qi will be harmonized the same time. In addition, the Guizhi, Chaihu and Maiya, all are the valuable Liver-smoothing herbs. The Shaoyao used is to prevent the Hotness due to the Huangqi and Guizhi, since the raising of the Liver Qi may bring the Gall bladder Fire up the same time. The reason to use the fresh ginger, is that, for its spicy-opening property, it can harmonize the Liver Qi and Spleen Qi.

从来方书中,麦芽皆是炒熟用之,惟陈修园谓麦芽生用,能升发肝气,可谓特识。盖人之元气,根基于肾,萌芽于肝,培养于脾,积贮于胸中为大气以斡旋全身。麦芽为谷之萌芽,与肝同气相求,故能入肝经,以条达肝气,此自然之理,无庸试验而可信其必然者也。然必生煮汁饮之,则气善升发,而后能遂其条达之用也。
In the history, and in the medical books, the Maiya (malt) is fried to use in the formula. Only Dr. Chen Xiuyuan used it without any process (e.g. fry). He said that, the Maiya without fry can raise the Liver Qi. It is great recognition of the function of Maiya. For human Yuan Qi, it is rooted in the Kidney, but sprouted in the Liver, and nourished in the Spleen, and accumulated in the Chest as Big Qi to govern the Qi in the whole body. The Maiya is the germ of the wheat. Its nature is the same as the Liver, so it can go in the Liver to harmonize the Liver Qi. This is the nature rule. It is trustable without test. However, it has to be cooked into soup to drink. In this way, its Qi is good at to raise, and to function to harmony.

 

附录:
Appendix:

直隶青县张××来函:
Letter from Mr. Zhang, Qingxian, Zhili province:

族侄妇,年二十余,素性谨言,情志抑郁。因气分不舒,致四肢痉挛颤动,呼吸短促,胸中胀闷,约一昼夜。先延针科医治,云是鸡爪风,为刺囟门及十指尖,稍愈,旋即复作如故。其脉左部弦细,右部似有似无,一分钟数至百至。其两肩抬动,气逆作喘。询知其素不健壮,廉于饮食。盖肝属木而主筋,肝郁不舒则筋挛,肝郁恒侮其所胜,故脾土受伤而食少。遂为开培脾舒肝汤。为有逆气上干,又加生赭石细末五钱。嘱服二剂。痉挛即愈,气息亦平。遂去赭石,照原方又服数剂,以善其后。

A lady, who was my relatives, 20 years of old, felt depression. She usually talked very little for her inwards personality. Due to the Qi stagnation, she felt shacking and spasm in the arms and legs, short of breath, fullness in the chest. All last for one night. She visited acupuncturist for a treatment first. The doctor said that she had “bird-claw” condition. …The acupuncture worked soon, but the condition recurred soon. Her pulse on the life side was string and thin but hard to feel on the right side. The pulse was very frequent as up to hundred times per minutes. Her shoulders raised with breath, had reversed Qi up so felt as asthma. Upon asked, it was known that she was not strong usually in the body condition. She ate little usually. The Liver belongs to the Wood and dominates the tendons in the body. The Liver, when stagnated, would insult the Spleen, so the Spleen, when insulted, would cause less in eat. She was given this Peipi Shugan Tang. For her reversed Qi in the body, the herb Daizheshi (powder) 15 gram was added. The herbal tea was drunk for two doses. The spasm stopped, and the breath became calmed down. The Daizheshi was removed. The original herbal formula tea was drunk for several doses for a maintenance.

 

3.金铃泻肝汤

3. Jinling Xiegan Tang.

治胁下掀疼。
This formula is used to solve the burning pain in the side of abdomen.

川楝子(五钱,捣) 生明乳香(四钱) 生明没药(四钱) 三棱(三钱) 莪术(三钱) 甘草(一钱)
Chuanlianzi 15 gram (grind), Ruxiang 12 gram, Moyao 12 gram, Sanleng 9 gram, Ezhu 9 gram, and Gancao 3 gram.

刘河间有金铃子散(即楝子之核)与玄胡索等分,为末服之,以治心腹胁下作疼。其病因,由于热者甚效。
Dr. Liu Hejian had Jinlingzi San (e.g. the kernel of the Chuanlianzi), with equal amount of Yuanhu. The herbal powder was drunk to solve the pain in the upper and side of abdomen, if its reason is the Hotness.

诚以金铃子能引心包之火及肝胆所寄之相火下行,又佐以玄胡索以开通气血,故其疼自止也。而愚用其方,效者固多,而间有不效者。后拟得此方,莫不随手奏效。盖金铃子佐以玄胡索,虽能开气分之郁,而实不能化气。
This is because the Jinlingzi can bring the Fire in the Heart Shell and the Xiang Fire in the Liver and Gall bladder down. It can also help the Yuanhu to open the channel for the Qi and blood to circulate, so as to solve the pain. When I used this formula, it worked in many cases, but there were also cases, in which it did not work. Later, when I used the formula here, no any failure cases any more.

所谓化气者,无事开破,能使气之郁者,融化于无形,方中之乳香没药是也。去玄胡索,加三棱莪术者,因玄胡索性过猛烈,且其开破之力,多趋下焦,不如三棱莪术性较和平,且善于理肝也。用甘草者,所以防金铃子有小毒也。此方不但治胁疼甚效,凡心腹作疼,而非寒凉者,用之皆甚效验。
The so called Hua Qi, e.g. the Qi disperse, means that the herb can break the mass or stagnated block, melt it and dissolve it into no-form thing, such as the herb Ruxiang and Moyao in the formula. The reason for removal of Yuanhu, but with addition of Sanleng and Ezhu, is that, the Yuanhu is very strong and sharp in herbal nature. In addition, its breaking power tends to downwards, not as the Sanleng and Ezhu, which are more calm and good at harmonizing the Liver. The Gancao is used to prevent the side effect of Jinlingzi, since the Jinlingzi is with little toxic effect. This formula not only works to stop the pain in the side of the abdomen, but also for any pain in the chest and the abdomen, if it dose not due to Cold.

 

附录:
Appendix:

直隶盐山李××来函:
Letter from Mr. Li, Yanshan city, Zhili province:

仲冬,刘××兄,病左胁掀疼,诸治无效,询方于弟。授以活络效灵丹方,服之不应,因延为诊视。脉象他部皆微弱,惟左关沉而有力。治以金铃泻肝汤,加当归数钱。服一剂,翌日降下若干绿色粘滞之物,遂豁然而愈。盖此汤原注明治胁下掀疼,由此知兄所拟方各有主治,方病相投,莫不神效也。

In one winter, my friend, Mr. Liu, had pain in the left upper side of the abdomen. He tried various herbal therapy, but all failed. So, he came to ask me. I give him the Huoluo Xiaoling Dan, which did not work either. His pulse was slightly weak, with that on the left Chun position as deep and stronger. He was given the Jinlingzi San to try, with addition of Danggui several grams. The next day, he had bowel movement, with green and sticky stool, and the condition was solved right away after the bowel movement. Since it has been indicated clearly that, this formula works for burning pain on the side of abdomen, it is known that your formula, each has specific application. If the herbal formula matches the disease, it works very well.

 

4.活络效灵丹

4. Huoluo Xiaoling Dan.

治气血凝滞, 瘕,心腹疼痛,腿疼臂疼,内外疮疡,一切脏腑积聚,经络湮淤。
This formula is used to solve the Qi-blood stagnation, mass or clot formation, pain on the arms or legs, ulcer inside or outside of the body,

当归(五钱) 丹参(五钱) 生明乳香(五钱) 生明没药(五钱)
Danggui 15 gram, Danshen 15 gram, Ruxiang 15 gram, Moyao 15 gram.

上药四味作汤服。若为散,一剂分作四次服,温酒送下。
Cook the ingredients as herbal tea. If prepare them into powder, separate the mixture into four parts. Drink the powder with warm wine.

腿疼加牛膝。臂疼加连翘。妇女瘀血腹疼,加生桃仁(带皮尖作散服炒用)、生五灵脂。疮红肿属阳者,加金银花知母连翘。白硬属阴者,加肉桂、鹿角胶(若恐其伪可代以鹿角霜)。疮破后生肌不速者,加生黄芪 知母(但加黄芪恐失于热)、甘草。脏腑内痈,加三七(研细冲服)、牛蒡子
If there is pain in the leg, add her Niuxi; pain in the arm, add herb Lianqiao. If woman has blood stagnation that causes pain in stomach, add herb Taoren (remain the peel and tip, fry and grind. Drink with the herbal tea from other ingredients), and Wulingzhi in the formula. If the skin ulcer belongs to Yang condition, add Jinyinhua, Zhimu and Lianqiao. If the skin ulcer belongs to Yin condition, add herb Rougui, Lujiaojiao (if worry that it might be a false one, use Lujiaoshuan to replace). If the ulcer is healing slow, in which the muscle grows slow, add Huangqi and Zhimu ( The addition of Zhimu is to prevent the hot side effect from the Huangqi) and Gancao. If there is pus inside the organs, add Sanqi (grind and drink it with the herbal tea from other ingredients), and Niubangzi.

一人,年三十许。当脐忽结 瘕,自下渐长而上,其初长时稍软,数日后即硬如石,旬日长至心口。向愚询方,自言凌晨冒寒,得于途间,时心中有惊恐忧虑,遂觉其气结而不散。按:此病因甚奇,然不外气血凝滞。为制此方,于流通气血之中,大具融化气血之力,连服十剂全消。以后用此方治内外疮疡,心腹四肢疼痛,凡病之由于气血凝滞者,恒多奇效。
A man about 30 years of old suddenly had a mass in the naval, which grew from the lower to the upper, and which was soft in the beginning but after several days, became hard as a stone; and which grew to the upper part of the stomach. He came to ask formula from me. He said that, one day in the early morning and in a cold weather, he went on the road and felt some fear and worry. Later he felt kind of stagnation in the body, which remained not to disperse. (Comment: this case is strange, but belongs to stagnation of the Qi and blood). I gave him this formula, to smooth the movement of the Qi and the blood in the body, and to disperse the block and the clot. After continuous ten doses, the mass disappeared. Later, I used this formula to treat various ulcer, inside or outside of the body; the pain in the heart, abdomen, arms and legs. Whenever the pain is due to the stagnation of the Qi and the blood, it usually worked.

××年近五旬。资禀素羸弱。一日访友邻村,饮酒谈宴,彻夜不眠,时当季冬,复清晨冒寒,步行旋里。行至中途,觉两腿酸麻,且出汗,不能行步,因坐凉地歇息,至家,遂觉腿痛,用热砖熨之疼益甚。其人素知医,遂自服发汗之药数剂,病又增剧,因服药过热,吐血数口,大便燥结,延愚诊视。见其仰卧屈膝,令两人各以手托其两腿,忽歌忽哭,疼楚之态万状,脉弦细,至数微数。因思此证,热砖熨而益疼者,逼寒内陷也;服发汗药而益疼者,因所服之药,散肌肉之寒,不能散筋骨之寒,且过汗必伤气血,血气伤,愈不能胜病也。遂用活络效灵丹,加京鹿角胶四钱(另炖兑服)、明天麻二钱,煎汤饮下,左腿遂愈。而右腿疼如故,遂复用原方,以虎骨胶易鹿角胶,右腿亦出凉气如左而愈。
Mr. Gao was near 50 years of old. He was usually slim and thin in the body condition. One day, he visited a friend in a neighbor villiage. They drunk wine/liquor, and did not have sleep. It was in winter. He walked several miles home in the early morning in cold weather. On the way, he felt sour and numb on the leg with sweat and hard to walk again. He sat down on the ground for break. When he came home, felt pain on the legs. The pain became worse when he used hot brick to apply on it. He knew medicine somehow, so he drunk some sweat-creating herbs several doses and the condition became worse. Due to the hot of the herbs, he vomited blood several mouths. He also had constipation. I was invited to have a look. When I saw him, he lied down face up with legs bend and had two persons hold his legs. He cried sometimes and then laughed sometimes, appearing very painful. His pulse was string and thin, which was slightly frequent. I thought that, that the pain became worse with the hot brick application suggests that the hot forced the Cold further deeper inside; that the drink of sweat-creating herbs caused the pain worse suggests that the herbs dispersed the body surface Cold, but not the Cold in the tendons and in the bones. The over sweat would also damage the Qi and blood, which again reduce the body ability to heal. Considering this, I used this Huoluo Xiaoling Dan to him, with addition of Lujiaojiao 12 gram (drink it with herbal tea from other ingredient), and Tianma 6 gram. The pain on the left leg stopped, but the same on the right side. So, the Lujiao was replaced by Hugujiao. The pain on the right leg also stopped.

一少妇,左胁起一疮,其形长约五寸,上半在乳,下半在肋,皮色不变,按之甚硬,而微热于他处。延医询方,调治两月不效,且渐大于从前。后愚诊视,阅其所服诸方,有遵林屋山人治白疽方治者,有按乳痈治者。愚晓病家曰:此证硬而色白者,阴也。按之微热者,阴中有阳也。统观所服诸方,有治纯阴阳之方,无治半阴半阳之方,勿怪其历试皆不效也。用活络效灵丹,俾作汤服之,数剂见轻,三十剂后,消无芥蒂。
A lady had an ulcer on the left side of the body, which was about five inches long, upper half in the breast and lower half in the ribs. The skin color above it was not changed. It was very hard on feel, and slightly warm than other place. He had visited other doctors and tried various ways but not effect. The ulcer was larger than before. When I saw him, I check the herbal formula he used before. Some herbal formula was the one for the treatment of white deep-rooted ulcer, with the herbal formula of Mr. Lingwu Sanren; some herbal formulas were for the treatment of breast carbuncle. I explained to the family: the mass was hard and white in color. It belonged to the Yin condition. It was also slight warm when feeling it, suggesting that there was Yang in the Yin. For the herbal formula used before, some was for pure Yin condition and some was for pure Yang condition. There was not formula that worked for both Yin and Yang condition the same time, no strange that they did not work. I used this Huoluo Xiaoling Dan to him. After several doses, the condition was improved clearly. After 30 doses, the condition was completely cured.

一妇人年五十许。脑后发一对口疮。询方于愚,时初拟出活络效灵丹方,即书而予之,连服十剂全愈。
A lady was 50 years of old. She had an ulcer on the back of the head with two ulcer opens on opposite direction. She asked formula from me. That was the time, at which I just builded up the Huoluo Xiaoling Dan, so I wrote down to her. After ten doses, her condition was cured.

一妇人,年五十余。项后筋缩作疼,头向后仰,不能平视,腰背强直,下连膝后及足跟大筋皆疼,并牵周身皆有疼意。广延医者延医,所用之药,不外散风、和血、润筋、通络之品。两载无效,病转增剧,卧不能起,起不能坐,饮食懒进。后愚诊视,其脉数而有力,微有弦意,知其为宗筋受病。治以活络效灵丹,加生薏米八钱,知母玄参白芍各三钱,连服三十剂而愈。
A woman, 50 years of old, had pain on the neck, which felt as a tendon contracting. The head bended backwards and could be see in horizontal. Her back was straight and felt pain which down to the back of the knee and feet and the calcaneal tendon. Also, the whole body felt kind of pain. He had visited various doctors. The herbs uses were either Wind-dispersing, blood-calming, tendon-wetting, or meridian-conducting herbs. After two years, the condition was not improved but worse. She could not get up the bed, or after got up, she could not sit up. She could not eat either. When I saw her, her pulse was frequent and strong, with slight string. It was considered that the tendons were affected. She was given the Huoluo Xiaoling Dan, with addition of Yiyiren 24 gram, Zhimu 9 gram, Xunshen 9 gram, and Baoshao 9 gram. After 30 doses, the condition was solved.

盖筋属于肝,独宗筋属胃,此证因胃腑素有燥热,致津液短少,不能荣养宗筋。夫宗筋为筋之主,故宗筋拘挛,而周身牵引作疼也。薏米性味冲和,善能清补脾胃,即能荣养宗筋。又加知母玄参,以生津滋液,活络效灵丹,以活血舒筋,因其脉微弦,恐其木盛侮土,故又加芍药以和肝,即以扶脾胃也。
Tendons generally speaking belongs to the Liver, but the calcanearl tendon belongs to the Stomach. For this case, the lady usually had dry-hot in the stomach, which made the body liquid-fluid is in short, so that it could not nourish the tendons. The calcarneal tendon is the king of the various tendons in the body, so if the calcaneal tendon is in spasm, the whole body felt pain too. The herb Yiyiren is calm in herbal nature. It is good at nourishing the Spleen and Stomach, e.g. it can nourish the calcaneal tedon. The Zhimu and Xunshen can develop liquid-fluid, so to activate and to harmonize the meridians and to improve the blood circulation. For the pulse was slight string, worrying that the Wood insults the Soil, the Shaoyao is used to harmonize the Liver, which also means to help the Spleen-Stomach.

薏米主筋急拘挛《神农本草经》原有明文。活络效灵丹中加薏米,即能随手奏效。益叹《神农本草经》之精当,为不可及。
Yiyiren dominates the treatment of tendon spasm, which has been clearly indicated in the book
Shennong Bencao Jing. In the Huoluo Xiaoling Dan, the addition of Yiyiren can make the formula work very fast. It really indicates the truth and the correct of the writing in the this book.

活络效灵丹,治心腹疼痛,无论因凉、因热、气郁、血郁皆效。同里有一少年,脐下疼甚剧。医者投以温药益甚,昼夜号呼不止。又延他医,以药下之稍轻,然仍昼夜呻吟,继又服药数剂,亦不见效。适愚自津门旋里,诊其脉,两尺洪实。询其得病之由,言夜晚将寝觉饥,因食冷饼一块,眠起遂疼。晓之曰,此虽由于食凉物,然其疼非凉疼,乃下焦先有蕴热,又为凉物所迫,其热愈结而不散也。投以活络效灵丹,加龙胆草、川楝子各四钱,一剂而愈。
The Huoluo Xiaoling Dan works for pain in the heart, chest, and abdomen, no matter the reason for the pain is Cold, Hotness, Qi stagnation, or blood stagnation. There was a youth who lived in the same village as mine. He felt very painful on the the naval. Doctor had used warm herbs to him, but the the pain became so worse that he cried without stop. The second doctor used different herbs, the condition was slightly reduced, but still groaned day and night. The formula were continued several times without further more improvement. At that time, at which I came back from Tianjing city by chance. I felt his pulse. His pulse was waving and sthenic on the Chi position on both sides. I asked the reason for his pain. He said at that night, he felt hungry, so ate a cold cake. The next morning after wake up, he felt the pain. I explained to him, though the pain started from eating cold food, the pain now was not cold pain. It was due to previous hidden Fire in the Lower Jiao of the body, which was suppressed by the cold stuff, and the Fire block was more hard. He was given the Huoluo Xiaoling Dan, with addition of Longdancao 12 gram, and Chuanlianzi 12 gram. One dose solved the pain.  

或问:此证医者曾用药下之,何以其下焦之郁热,不随之俱下?答曰:热在大肠者,其热可随降药俱下,然又必所用之下药为咸寒之品,若承气汤是也。今其热,原郁于奇经冲任之中,与大肠无关,冲任主血,而活络效灵丹诸药品,皆善入血分,通经络,故能引龙胆、楝子直入冲任,而消解其郁热。况其从前所服之下药,原非咸寒之品,是以从前不效,而投以此药,则随手奏效也。
It might be asked: for this case, doctor had used bowel-cleansing therapy, why the hidden Fire did not expelled with the stool? Answer: if the Fire is in the large intestine, the Fire can be removed with the stool by the bowel-cleansing herbs. But the herbs used for the bowel-cleansing therapy must be the Cold-salty herbs, such as the Da Chenqi Tang. For this case, the Fire is stagnated in the Chong meridian and the Ren meridian, has nothing to do with the large intestine. The Chong meridian and the Ren meridian belong dominate the blood part of the body. The herbs in the Huoluo Xiaoling Dan, all are good to come into the blood part of the body, and to conduct the meridian, so the can bring the herb Longdancao and Chuanlianzi into the Chong meridian and the Ren meridian, to disperse the stagnated Fire there. In addition, the herbs the patient drunk from previous formula was not the salty-Cold herbs, so it does not work. 

 

附录:
Appendix:

直隶青县张××来函:
Letter from Mr. Zhang, Qing city in Zhili province.

族兄×,年三十余,素强壮无病。壬戌中秋,因在田间掘壑,劳苦过甚,自觉气力不支,即在壑中吃烟休息,少缓须臾又复力作。至晚归家时,途中步行,觉两腿酸木不仁。及至夜间,两腿抽疼甚剧。适生在里,其弟扣门求为往治。诊其脉,迟滞而细,号呼不已,气逆不顺,身冷,小溲不利。遂用活络效灵丹方,加白芍三钱、桂枝尖二钱、生姜三片。一剂腿疼大减,小便即利,身冷亦退。再剂,霍然全愈。

One of my relatives, who was 30 years of old. He was strong usually and no any illness. In an autumn, he worked in the field and worked very hard and felt very tired. He had a break in the ditch to have a cigarette smoking. Soon he continued the hard labor work. Upon evening he needed to go home, he felt sour and numb in both legs. Upon the night, the pain was very severe with spasm. At that time, I just by chance was at the village. His brother came, knocked the door and ask my help. His pulse was late, stagnated and thin in feeling. He groaned without end. He felt stagnation in the body, cold in the body and hard in the urination. He was given the Huoluo Xiaoling Dan, with addition of Baishao 9 gram, Guizhi tip 6 gram, fresh ginger 3 pieces. After one dose, the leg pain was reduced; the urine became smooth; and the cold in the body also disappeared. After second dose, the condition was completely solved.

又:天津王媪,年五十七岁,右膝盖部发炎,红热肿疼,食减不眠。其嗣××延为诊视。至其家,闻病者呼号不止,口称救命。其右脉洪数有力,心悸头眩,舌苔白而腻,大便三日未行,小便赤热。此足征湿热下注。予以活络效灵丹,加生石膏六钱,知母、怀牛膝、生薏米冬四钱,甘草梢一钱,嘱服一剂。次日自能来寓,其疼减肿消,夜已成寐,尚云右臂酸疼。又即原方加青连翘金银花、油松节各二钱,服之全愈。

Another case, Mrs. Wang, who lived in Tianjing city, was 57 years of old. His right know hot inflammation, which was red in color, hot, swelling and pain. She had reduced appetite and poor sleep. Her son went to see her. When he came home, he heard that the lady groaned endlessly, and cried for help. Her right pulse was waving, frequent and strong. She felt palpitation and dizziness. Her tongue covering was white and oily. She did not have bowel movement for three days and her urine was red and hot. All suggested a Wetness-Hotness condition. She was given the Huoluo Xiaoling Dan, with addition of Shigao 18 gram, Zhimu 12 gram, Niuxi 12 gram, and Yiyiren 12 gram, and Gancao 3 gram. She was asked to drink one dose only. Next day, she could come to by herself, and the pain was reduced and the swelling disappeared. She complained to have sour and pain on the right arm. Then, to the previous formula, the herb green Liangqiao 6 gram, Jinyinjhua 6 gram, and Yousongjie 6 gram were added. After drinking of the herbal tea, the condition was solved.

 

5.活络祛寒汤

5. Huoluo Quhan Tang (Huoluo means to activate; Quhan means to remove the Cold)

治经络受寒,四肢发搐,妇女多有此证。
This formula is used for Cold-invasion in the meridians, in which the arms or legs feel spasm. It is common in women.

生黄芪(五钱) 当归(四钱) 丹参(四钱) 桂枝尖(二钱) 生杭芍(三钱) 生明乳香(四钱) 生明没药(四钱) 生姜(三钱)

Huangqi 15 gram, Danggui 12 gram, Danshen 12 gram, Guizhi tip 6 gram, Baishao 9gram, Ruxiang 12 gram, Moyao 12 gram, fresh ginger 9 gram.

寒甚者,加干姜三钱。
If the cold is very severe, add Ganjiang 9 gram.

证寒在经络,不在脏腑。经络多行于肌肉之间,故用黄芪之温补肌肉者为君,俾其形体壮旺,自能胜邪。又佐以温经络、通经络诸药品,不但能祛寒,且能散风,此所谓血活风自去也。风寒既去,血脉活泼,其搐焉有不止者乎?

The Cold is in the meridian, not in the organs. The meridians distribute more in between the muscle, so the herb Huangqi is used as the king herb to warm the muscle. If the body is strong, it can combat against the Xie Qi by itself. With addition of other herbs to warm the meridian, and to conduct the energy flow among the meridian, these herbs can not only dissolve the Cold, but also expel the Wind. This is what it is said that, when the blood is activated to circulation, the Wind would be expelled off. If the Wind-Cold is removed, and the blood is in active circulation, how the spasm not stop?

 

6.健运汤

6. Jianyun Tang (Jianyun means to improve Qi movement)

治腿疼、臂疼因气虚者。亦治腰疼。
This herbal formula is used for the pain in the leg and arm, due to Qi deficiency. It also work for pain in the lower back.

生黄芪 (六钱) 野台参(三钱) 当归(三钱) 麦冬(三钱,带心) 知母(三钱) 生明乳香(三钱)生明没药(三钱) 莪术(一钱) 三棱(一钱)
Huangqi 18 gram, wild Taishen 9 gram, Danggui 9 gram, Maimendong 9 gram (with kernel), Zhimu 9 gram, Ruxiang 9 gram, Moyao 9 gram, Sanleng 3 gram and Ezhu 3 gram.

此方减麦冬知母三分之一,合数剂为一剂,轧细炼蜜为丸,名健运丸,治同前证。If from the formula, the Maimendong and the Zhimu are reduced one third, and several doses were mixed to prepare pills, the pills were called Jianyun Wan, which is used for the same condition as the Jianyun Tang.

从来治腿疼臂疼者,多责之风寒湿痹,或血瘀、气滞、痰涎凝滞。不知人身之气化壮旺流行,而周身痹者、瘀者、滞者,不治自愈,即偶有不愈,治之亦易为功也。愚临证体验以来,知元气素盛之人,得此病者极少。故凡遇腿疼、臂疼,历久调治不愈者,补其元气以流通之,数载沉 ,亦可随手奏效也。

Usually, the pain in the arms and in the legs were treated as Wind, Cold, Wetness Bi syndrome, or blood stagnation, Qi stagnation, phlegm-fluid block, and so on. People do not know that, if the Qi-blood movement and metabolism in the body is in proper and sufficient activated status, the body Bi syndrome, not matter what would be its reason, would be solved naturally by the body self. Even if it is accasionally not cured, the treatment followed would be also easier. After I came in the clinic work, I found that, the people with sufficient Qi and blood in the body, rarely suffer from the leg pain or arm pain. For this reason, if the pain has been treated with various way for a long time without improvement, the Qi-nourishing and Qi-promoting therapy can solve the long term problem very soon.

 

7.振中汤

7. Zhenzhong Tang

治腿疼、腰疼,饮食减少者。
This formula is used for people with pain the arm or leg, and has reduced and poor appetite.

白术(六钱,炒) 当归身(二钱) 陈皮(二钱) 浓朴(钱半) 生明乳香(钱半) 生明没药(钱半)
Baizhu 18 gram (fry), Danggui 6 gram, Chenpi 6 gram, Houpo 4.5 gram, Ruxiang 4.5 gram, Moyao 4.5 gram.

此方重用白术以健补脾胃,脾胃健则气化自能旁达。且白术主风寒湿痹,《神农本草经》原有明文,又辅以通活气血之药,不惟风寒湿痹开,而气血之痹而作疼者,亦自开也。
In this formula, large amount of Baizhu is used to nourish the Spleen. If the Spleen is strong, the Qi would be activated and distributed all over the body. The Baizhu also dominates the Wind Bi, Cold Bi and Wetness Bi syndrome. This has been well indicated in the book
Shennong Bencao Jing. With help from other herbs to activate the Qi and the blood, not only the Wind Bi, Cold Bi, and Wetness Bi syndrome would be solved, but the pain due to the Qi-blood stagnation, would also be solved.

一室女腿疼,几不能步,治以拙拟健运汤而愈。次年旧病复发,又兼腰疼,再服前方不效。诊其脉,右关甚濡弱,询其饮食减少,为制此汤,数剂,饮食加多,二十剂后,腰疼腿疼皆愈。
A girl felt pain on her leg. She almost could not walk. I gave her the Jianyun Tang and it solved her pain. Next year, that leg pain occurred again, together with pain in the lower back. The use of previous formula did not work. Her pulse then was ru and weak on the Guan position of the right side. When asked, she said she eat less. So, this Zhenzhong Tang was given. After several doses, her appetite was improved. After 20 days of treatment, the pain on the leg and the lower back both were cured.

一媪,年近七旬。陡然腿疼,不能行动,夜间疼不能寐。其家人迎愚调治,谓脉象有力,当是火郁作疼。及诊其脉,大而且弦,问其心中亦无热意。愚曰:此脉非有火之象,其大也,乃脾胃过虚,真气外泄也。其弦也,乃肝胆失和,木盛侮土也。治以振中汤,加人参白芍、山萸肉(去净核)各数钱,补脾胃之虚,即以抑肝胆之盛,数剂而愈。

A old lady was 70 years of old. She suddenly felt pain on the leg and she could not walk. The pain was very severe at night so much so that she could not have a sleep. Her family member came to ask for help. They said her pulse was strong, supposing that she had Fire-stagnation pain. When I felt her pulse, her pulse was big and string. When asked, She said that she did not feel any hot in the heart. I said, this pulse does not suggest the Fire. The big pulse suggests that the Spleen and Stomach were very weak, so the True Qi escapes. Its string suggests the disorder of the Liver and Gall bladder. The Wood insults the Soil. She was given this Zhenzhong Tang, with addition of Renshen, Baishao and Shanyurou (removal of kernel), several grams for each, to nourish the Spleen-Stomach deficiency, e.g. to suppress the Liver and Gall bladder. After several doses, the condition was solved.

 

8.曲直汤

8. Quzhi Tang (Qu here means circle, in Chinese; the Zhi means straight).

治肝虚腿疼,左部脉微弱者。
This formula is used for pain in the leg due to Liver deficiency, with weak pules on the left side.

萸肉(一两,去净核) 知母(六钱) 生明乳香(三钱) 生明没药(三钱) 当归(三钱) 丹参(三钱)
Shanyurou 30 gram (removal kernel), Zhimu 18 gram, Ruxiang 9 gram, Moyao 9 gram, Danggui 9 gram, Danshen 9 gram.

服药数剂后,左脉仍不起者,可加续断三钱,或更加生黄芪三钱,以助气分亦可。觉凉者,可减知母
If after several doses, the left pulse remains deep and week, add herb Xudian 9 gram, or add Huangqi 9 gram to nourish the Qi portion of the body. If the body felt cold, reduce the amount of Zhimu.

脾虚可令人腿疼,前方已详其理,深于医学人大抵皆能知之。至肝虚可令人腿疼,方书罕言,即深于医学者,亦恒不知。曾治一人,年三十许,当大怒之后,渐觉腿疼,日甚一日,两月后,卧床不能转侧。医者因其得之恼怒之余,皆用舒肝理气之药,病转加剧。后愚诊视,其左脉甚微弱,自言凡疼甚之处皆热。因恍悟《内经》谓过怒则伤肝,所谓伤肝者,乃伤肝经之气血,非必郁肝经之气血也,气血伤,则虚弱随之,故其脉象如斯也。其所以腿疼且觉热者,因肝主疏泄,中藏相火(相火生于命门寄于肝胆),肝虚不能疏泄,相火即不能逍遥流行于周身,以致郁于经络之间,与气血凝滞,而作热作疼,所以热剧之处,疼亦剧也。为制此汤,以萸肉补肝,以知母泻热,更以当归乳香诸流通血气之药佐之,连服十剂,热愈疼止,步履如常。
Spleen deficiency can cause leg pain. The reason has been discussed before. It is known by most people who understand medicine deeper. That Liver deficiency can also cause leg pain is rarely mentioned in medical books. It is even not well known among people who understand medicine. I met one patient, who was 30 years of old. After a heavy angry, he felt leg pain, which was worse day by day. After two months, he could even be unable to get up or turn the body. Doctors gave him Liver-harmonizing, and Qi-calming hers, the condition turned worse, for his condition developed after angry. When I saw him, his left pulse was very weak. He complained that the painful spot also felt hot. I suddenly recited that it was indicated in the book
Nei Jingthat “Angry damages the Liver”. The so called “damage the Liver” means to damage the Qi-blood in the Liver, not necessary to stagnate the Qi-blood in the Liver. When the Qi-blood is damaged, the weakness follows, so the pulse shows as weakness. The reason for the leg pain and hot feeling is that, the Liver dominate the opening-conducting function in the body and the Xiang Fire is hidden and stored and located in the Liver (the Xiang Fire is born in the Kidney-Life but lives in the Liver-Gall bladder). When the Liver fails to opening-conducting, the Xiang Fire is hard to circle in the body, so it is stagnated in between the meridian, together with the stagnated Qi and blood, to cause the Hotness and pain. For this reason, wherever the hot feeling is strong, where the pain is also strong. He was given this formula, in which, the Shanyurou is to nourish the Liver; Zhimu is to clear the Fire; the Danggui and other herbs work to promote the circulation of the Qi and the blood in the body. After ten days continuous treatment, the condition was cured.  

安东友人刘××,年五十许。其左臂常觉发热,且有酸软之意。医者屡次投以凉剂,发热如故,转觉脾胃消化力减少。后愚诊之,右脉和平如常,左脉微弱,较差于右脉一倍。询其心中,不觉凉热。知其肝木之气虚弱,不能条畅敷荣,其中所寄之相火,郁于左臂之经络,而作热也。遂治以曲直汤,加生黄 八钱,佐萸肉以壮旺肝气,赤芍药三钱,佐当归丹参诸药以流通经络,服两剂,左脉即见起,又服十剂全愈。
My friend, Mr. Liu in Andong city, and was 50 years of old. He usually felt hot on the left arm with kind of sour and weak feeling. Doctors gave him several times Cold herbs, but the hot feeling remained. Later, he felt reduced digest function. When I saw him, his right pulse was calm, but the left one was weak, and it was half in intensity of the right one. When asked, he said no hot or cold feeling in the heart. It was known that his Liver Wood Qi is week, which could not smooth the circulation of the Qi and the blood. The Xiang Fire that lived in it was stagnated in the meridian in the left arm to cause the hot feeling. He was therefore given the Quzhi Tang, with addition of herb Huangqi 24 gram, to help the Shanyurou to make the Liver Qi stronger, herb Chishao 9 gram, to help the Danggui and Danshen to open and to conduct the Qi circulation in the meridian. After two doses, the left pulse was stronger. After ten doses, the condition was totally cured. 

奉天王××,年四十余,两胁下连腿作疼,其疼剧之时,有如锥刺,且尿道艰涩,滴沥不能成溜,每小便一次,须多半点钟,其脉亦右部如常,左部微弱。亦投以曲直汤,加生黄芪八钱,续断三钱,一剂其疼减半,小便亦觉顺利。再诊之,左脉较前有力。又按原方略为加减,连服二十余剂,胁与腿之疼皆愈,小便亦通利如常。盖两胁为肝之部位,肝气壮旺上达,自不下郁而作疼。至其小便亦通利者,因肾为二便之关,肝气既旺,自能为肾行气也(古方书有肝行肾之气之语)。

Mr. Wang in Fengtian city was 40 years of old. He felt pain in both side of the abdomen, which past to the leg too. When it was very severe, it felt as punch by a sharp stuff. He also felt rough in urine tract. The urine dropped but not past as a line. It took half hour for each urination. His pulse was also normal in the right side but slightly weak in the left side. He was given the Quzhi Tang, with addition of Huangqi 24 gram and Xuduan 9 gram. One dose solved his pain half, the urine also felt smooth. The next time, the left pulse felt stronger than before. The original formula was modified slightly and it was continued for 20 days, one dose for one day. The pain on the abdomen side and legs all were cured, and the urination was normal. The side of the abdomen belongs to the Liver. If the Liver Qi is sufficient to go up and down, there would no stagnation there to cause pain. The reason that the urination was improved, is that the Kidney is the switch of the urine and the stool movement. If the Liver Qi is sufficient, it can direct and govern the Kidney Qi to switch the urination and bowel movement.