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Appreciation of Ye Tianshi's Stroke Medical Records (IV)
Jin (69), at first, was dull and drowned. (Xu Comment: Diseases of the heart and small intestine. ) The old man fainted obviously. I haven't slept at night for months. (Xu's comment: Heart disease) It is that yang fails to pay yin. Don't call it phlegm fire, only to attack and eliminate it. It's a lack of acceptance. Discussion and latent yang. (Xu commented that this disease should be treated with both heart and kidney, and the medicine for treating heart is the main one. Prescription: Pinellia ternata, Poria, Scrophularia, Alpinia oxyphylla, Tooth Kernel, Chamomile, Dragon Tooth, Gastrodia elata, and roasted grass. )

Turtle, abdomen, armour, heart, prepared rhizome of rehmannia, dried cistanche, asparagus tiger, tibia, Huai, Achyranthes bidentata, stir-fried wolfberry fruit and phellodendron amurense.

(Xu's comment: this prescription is also proper, but it must be indispensable to have a prescription for governance. )

Detailed explanation:

Numbness and enuresis, when it belongs to cerebrovascular accident, is dull rather than faint, so it is more likely to estimate ischemic encephalopathy. If severe cerebral arteriosclerosis (brain atrophy) can also have these symptoms. As for Xu's comment that the heart has diseases of the heart and the small intestine, the heart governs the spirit, but the small intestine is not. Because the heart is lost, the twelve officials are in danger, and all functions can be abnormal, which is not necessarily the problem of the small intestine itself (Chinese medicine has the view that abnormal urination is related to the small intestine). Therefore, it is said that the elderly have syncope, that is, stroke, thin syncope, fried syncope and so on. "Su Wen, Anger Up to the Sky": "Yang-qi, great anger will lead to qi extinction, while blood stasis (dredging blood) will make people faint." . "Su Wen, Angry to the Heaven": "Yang-qi, overworked, relaxed, refined, accumulated in summer, making people faint. You can't see if you are blind, and you can't listen if you are deaf. If you collapse, you will be ruined by Fukashi. "

Insomnia for several months is caused by heart fire floating above, kidney water deficiency in the lower part, and heart-kidney disharmony. Xu commented on heart disease, but in fact, it is a common disease of heart and kidney with little yin. If typhoid Huanglian Ejiao decoction is also sick, it is good to treat both the upper and lower levels, taking into account the liver. Huanglian Ejiao Decoction Huanglian Qingxin, Scutellaria baicalensis Qinggan, Paeonia lactiflora Yanggan, Ejiao and gallus gallus domesticus brisson Bushen. Ye's theory of phlegm-fire suggests that patients have symptoms such as red tongue, greasy fur, phlegm, and so on. Generally, people will punish them with Huanglian Wendan Decoction and so on. However, Ye stressed that these situations can't be understood as phlegm fire, so we can't use heat-clearing and phlegm-eliminating products, or even attack them with Hushi Guntan Pills. Instead, it is suggested that this is caused by the deficiency of the lower energizer, which can not absorb the floating yang, and the body fluid goes up with the deficiency yang and turns into phlegm and saliva. Gu advocates filling the lower jiao and absorbing floating yang as the treatment. Xu Ling's fetus advocates communicating with the heart and kidney, calming the liver and calming the wind. In the prescription, Pinellia ternata is good at inducing yang into yin to treat insomnia, but it can also eliminate phlegm and saliva, and it can soothe the heart and soothe the nerves by tucking in Poria and Tooth Kernel (or jujube kernel), while Yuanshen can clear the heart by floating rootless fire, benefiting wisdom and tonifying kidney, Dragon Tooth can subdue yang and soothe the nerves, Chrysanthemum can clear the liver and calm the wind, Gastrodia elata can calm the wind and unblock the collaterals, and Radix Glycyrrhizae can be roasted to reconcile various drugs. This prescription obviously focuses on nourishing the heart, clearing the heart and calming the nerves, slightly calming the liver and calming the wind, and giving consideration to tonifying the kidney and suppressing yang. It is different from Ye's specialization in filling essence and subduing yang.

Yip's side seems to have evolved from Zhu Danxi Huqian Pill. With tortoise plastron and prepared rehmannia root nourishing kidney yin, cistanche deserticola can nourish essence and blood, which has the function of moistening intestine and relaxing bowels (apoplexy patients tend to be constipated), Asparagus root clearing heat and nourishing yin deficiency, tiger bone (modern tigers are protected animals, which should be replaced by artificial tiger bone), Achyranthes bidentata strengthen bones and muscles and wither, Lycium barbarum enters the liver to nourish blood and produce tendons, and Phellodendron amurense clears fire to prevent it from helping the heart with the rise of liver wood.

Both of them are famous doctors of the same generation. Why do they have this difference in understanding? Gaiye really saw the patient. In addition to insomnia, this patient should have symptoms such as decreased thinking (empty marrow), weakness of limbs, weakness of waist and feet according to the previous enuresis. Therefore, Huqian Pill for tonifying kidney and strengthening bone was selected. However, Xu can only legislate according to the symptoms recorded in the medical records, so he can only take enuresis, insomnia and stupor as the main symptoms, and he is diagnosed as a stroke with phlegm and obsession, and the lower energizer is not firm in enuresis. Therefore, he has adopted the treatments of Fu Shen, Tooth Kernel (or Jujube Kernel), Dragon Tooth calming the heart and calming the nerves, Radix Scrophulariae clearing the heart, Gastrodia elata and so on. At the same time, Alpinia oxyphylla was added to treat enuresis by fixing semen and shrinking urine. Xu often criticizes Ye's thoughts on classical prescriptions, but in this case, Xu made a prescription completely according to the ideas of the time.

The key question is, why didn't Ye fill the lower energizer directly instead of phlegm-resolving and heart-calming drugs? This must also be interpreted from Zhongjing Jueyin disease. If the lower yuan is deficient and the water does not contain wood, the liver and wood will go up in fire, and the heart will go up along the pulse. That is, the Jue yin disease of rushing to the heart in the middle of the boom, which is the syndrome of Huanglian Ejiao decoction that is upset and unable to lie down. Ye's prescription uses Cortex Phellodendri to clear the fire, which is the source of Du Longlei's fire. Especially Wumei Pills use Cortex Phellodendri, Radix Rehmanniae Preparata, Tortoise Shell and Tiger Bone, Ejiao and gallus gallus domesticus brisson of Youhuanglian Ejiao Decoction, and Angelica sinensis of Youwumei Pills. Cistanche deserticola, the aconite of Youwumei Pill. Radix Asparagi, Rhizoma Coptidis of Youwumei Pill, and Radix Scutellariae of Huanglian Ejiao Decoction. Achyranthes bidentata draws blood downward, while Guizhi of Youwumei Pill flushes downward. In this case, it was Ye Tianshi who really learned from Zhongjing's method.

Another important question is, isn't Ye Tianshi afraid of helping the phlegm and turbidity in the world by using drugs such as Radix Rehmanniae Preparata? Here, there is a unique theory of Ye's, that is, reusing Rehmannia glutinosa to fill kidney essence can induce phlegm to descend and turn into body fluid, but phlegm will disappear without eliminating phlegm. Xu Ling's fetus was afraid of not knowing this, so she still used Pinellia ternata and Poria Shen to relieve phlegm.

Attached to Zhang Xichun's experience in using cultivated land:

The answer is that if we use the prepared land, I will be able to help others. When I first read the prescription, I read Zhao's books such as Yi Guan, Zhang's Eight Arrays and Feng's Tips, so I was convinced of what he said. I like to use Radix Rehmanniae Preparata most in clinical practice. I used Bawei Dihuang Pill as soup, and added Perilla and Radix Paeoniae Alba to treat asthma and asthma. Adding Pericarpium Citri Reticulatae and Radix Paeoniae Alba to treat phlegm and saliva due to deficiency and excess; Adding Perilla frutescens, being rich and simple, treating kidney without absorbing qi, resulting in fullness due to the upward movement of qi (when the patient takes it, it is more effective to treat this syndrome by making Shenzhe Zhenqi decoction, and reducing the frequency of urination by two-thirds of Poria cocos and Alisma orientalis (it is also effective to treat men's thirst and women's thirst in the Golden Chamber, for details, see Yuye decoction), and also tasting aconite. I also tried to use Liuwei Dihuang Pill as soup, and added Chuanxiong and Anemarrhena to treat a broken headache. Add gall grass and indigo naturalis to treat extreme dizziness; Add five flavors, medlar and arborvitae seeds to disperse the pupils of the big ones, and believe in the saying that they decoct several bowls of juice and drink mightily; Use four or two pieces of rehmannia root and one or two pieces of poria cocos to stop the diarrhea caused by unstable lower energizer; Use four or two of Radix Rehmanniae Preparata and one or two of Radix Paeoniae Alba to pass urine that is unfavorable for yin deficiency; I also tasted the danger of using Rehmannia glutinosa in one day, and after treating a serious illness caused by exogenous diseases, I suddenly gasped and my pulse was scattered (this card should be used later to recover the soup, but its prescription was not drawn up at that time, but I was lucky to succeed if I knew how to use Rehmannia glutinosa, because Feng Chuzhan said that Rehmannia glutinosa can greatly tonify the kidney and sincerely try it), and I didn't only treat internal injuries; I also tried Radix Rehmanniae Preparata and Colla Corii Asini to nourish the true yin, so as to treat febrile diseases, where the pulse is yang floating but the yin should not be, and I can't sweat. I took two doses a day to help the yin to cope with the yang and make it sweat (for details, see Cold Solution Decoction). And all exogenous typhoid fever, because of the exhaustion of the next yuan and the deep evil, must reuse the prepared rhizome of rehmannia, make up its next yuan, that is, go out with evil spirits.

Zhang Xichun on phlegm:

In the world, Erchen Decoction, written by Ju Fang in Song Dynasty, is used to treat phlegm, which is called the general agent for treating phlegm. I don't know that Erchen decoction can cure phlegm, but it can't cure phlegm. Who is it? The standard of phlegm lies in the stomach, and the origin of phlegm lies in the kidney. The kidney governs the storage, and the bladder is the fu-organ as well. Sometimes, the power of its hiding is not solid, so it must be injected into the bladder. Bladder expansion, can not be empty, that is, can not attract water in the stomach to drink, faster than the downward and urinate, the origin of this phlegm is also. Above the kidney, there is a sea of blood, and the pulse of the strange meridian is also strong. Its pulse is superior to Yangming and inferior to Shaoyin. Because it is connected with less yin in the lower part, it is easy to dry up if the kidney is not gasified. In order to transfer Yangming to the upper level, the qi is flushed to the upper level, and the stomach qi is also reversed. It is impossible to rest and descend to transport water and drink, which is also the origin of phlegm.