忠翁孙媳。亦患头痛。嘱余诊之。其脉浮取颇大。而沉按无力。两尺尤甚。左关略兼弦数。余曰。此属肝血内虚。
奇经失荣养之司。病虽在上。而根源实在于下。其所以头痛者。督脉上循于巅顶也。药须补下。即内经上病治下之法
也。用四物加杞子、山药、杜仲、续断、苁蓉、阿胶、鹿角霜、金樱子、石斛、菊花等数剂而愈。此两症亦一虚一实之
对证也。
藩司掾魏某。患怔忡惊悸不寐。两月有余。施医局友作虚症治。愈治愈剧。乃就余诊。脉浮滑鼓指。目黄舌苔白腻
余谓阳明不阖。痰火上冲。湿热内蕴之候也。与半夏秫米汤。加橘皮、竹茹、川连、茯神、枣仁、山栀、杏仁、泽泻、
滑石、作甘澜水煎。炊以苇薪。二剂能寐。而怔忡惊悸悉减。复以清痰降火化湿之剂。目黄渐退。胃亦渐旺。诸恙悉痊
矣。患此症者甚多。若作虚治。是抱薪而救焚也。
定海佃夫任姓。年四十余。四肢手足心皆生白屑。如抽蕉剥茧。层出不穷。肤浓如牛领。裂缝中血流淋漓。肤热如
烙。痒甚必搔出血始已。患此数年。内外科皆不识其何病。丙戌夏就诊于余。脉六部俱浮洪散指。余曰。此症重者
即是大麻风。眉鼻柱肢节皆能脱落。吴越人患此绝少。惟岭南感受毒瘴者有之。乃风湿之邪。从外入于肌肤。以
致脉络留而不去。转入转深。入于血分化热。热与风湿相搏。致成白屑。层层如曲 之发斑。故脱之不尽。宜驱经
络之湿。清血分之热。润肌肤之燥。可望渐瘥矣。渠云。化湿之药。已服百余剂矣。一无所效。余曰。化湿乃通称。而
药
味配合。各有不同。是症湿在脉络。若徒用渗利苦燥。以治脏腑。无益耳。方用银花二两。麦冬六钱。生甘草八钱。当
归八钱。僵蚕三钱。芥穗、防风、木瓜、威灵仙、黄芩、丹皮、丹参各三钱。生首乌一两。薏苡、生白芍各六钱。羌活
钱半。细生地二两。长流水三大碗。用大砂锅煎成一大碗。缓缓服之。外用麻黄、羌活、白附子、僵蚕、威灵仙、蛇床
子、苦参、川
楝子、黄连、黄芩、当归、银花各三钱。用真麻油十两熬枯沥净渣。再下血余八钱。黄腊二两。生猪脂一两。枯矾二钱。
痒时用新夏布蘸药擦之。如法月余果愈。凡平时罕见之症。只须静与心谋。据理揣合。无不应手取效。即考之古
法亦不相迳庭云。
忠翁的孙媳妇，也患有头痛病。嘱咐我诊治她。她的脉象在轻取时颇大，但重按时无力，两尺部尤其明显。左关脉略微兼有弦数之象。我说：这属于肝血内部虚弱，奇经八脉失去了荣养的功能。病症虽然表现在上部，但根源实际上在于下部。之所以出现头痛，是因为督脉向上循行至头顶。用药需要补益下部，这正是《内经》中“上病治下”的治疗法则。使用四物汤加上枸杞子、山药、杜仲、续断、肉苁蓉、阿胶、鹿角霜、金樱子、石斛、菊花等药物，服用几剂后痊愈。这两个病例也是一虚一实的对证治疗案例。
藩司属官魏某，患有心悸惊惕、失眠症，持续两个多月。施医局的医生将其作为虚证治疗，结果越治病情越重，于是来找我诊治。他的脉象浮滑且搏指有力，目睛发黄，舌苔白腻。我认为这是阳明经气机不阖，痰火上冲，湿热内蕴的表现。给予半夏秫米汤，加入橘皮、竹茹、黄连、茯神、酸枣仁、山栀、杏仁、泽泻、滑石，用甘澜水煎煮，并以芦苇为燃料炊煮。服用两剂后能够入睡，心悸惊惕症状完全减轻。随后再用清热化痰、降火祛湿的方剂，目黄逐渐消退，胃气也逐渐旺盛，所有疾病都痊愈了。患这种病症的人很多，如果当作虚证治疗，那就是抱薪救火（适得其反）。
定海佃户任姓男子，四十多岁。四肢和手心脚心都长出白色皮屑，像剥蕉抽茧一样，层出不穷。皮肤增厚如牛颈皮，裂缝中血流淋漓。皮肤发热如火烙，瘙痒剧烈必须抓出血才停止。患病数年，内科和外科医生都不认识这是什么病。丙戌年夏天就诊于我。他的六部脉象都呈现浮洪散乱无根之象。我说：这个重症就是大麻风（疠风），眉毛、鼻梁、肢体关节都能脱落。吴越地区患此病极少，只有岭南地区感受毒瘴之气的人才有。这是风湿邪气，从外部侵入肌肤，导致脉络滞留不去，病邪转入深入，进入血分化热，热与风湿相互搏结，从而形成白色皮屑，层层堆积如同曲霉发出的斑点，所以脱不尽。适宜驱除经络中的湿气，清解血分的热邪，滋润肌肤的干燥，有望逐渐好转。他说：化湿的药物已经服用了百余剂，毫无效果。我说：化湿是通称，但药物配伍各有不同。此症湿邪在脉络，如果只是单纯使用渗利苦燥的药物来治疗脏腑，是没有益处的。方剂使用金银花二两，麦冬六钱，生甘草八钱，当归八钱，僵蚕三钱，荆芥穗、防风、木瓜、威灵仙、黄芩、丹皮、丹参各三钱，制首乌一两，薏苡仁、生白芍各六钱，羌活一钱半，细生地二两，长流水三大碗，用大砂锅煎成一大碗，缓缓服用。外用麻黄、羌活、白附子、僵蚕、威灵仙、蛇床子、苦参、川楝子、黄连、黄芩、当归、金银花各三钱，用真麻油十两熬至枯焦滤净药渣，再加入血余炭八钱，黄蜡二两，生猪脂一两，枯矾二钱。瘙痒时用新夏布蘸药擦拭。按照这种方法一个多月果然痊愈。凡是平时罕见的病症，只需要静心谋划，依据道理推测契合，没有不随手见效的。即使考证古代方法也不相违背。
The granddaughter-in-law of Zhong Weng also suffered from headache. I was requested to diagnose her. Her pulse was quite large upon light palpation but forceless upon deep pressure, especially at the two Chi (Kidney) positions. The Left Guan (Liver/Gallbladder) position was slightly wiry and rapid. I said: This belongs to internal deficiency of Liver Blood, with the Eight Extraordinary Vessels losing their function of nourishment. Although the disease manifests in the upper part, its root lies actually in the lower part. The reason for the headache is that the Du Mai (Governing Vessel) ascends to the vertex. Medication must tonify the lower part, which is precisely the method of "treating upper diseases by addressing the lower" from the *Nei Jing* (Inner Canon). Using Si Wu Tang (Four Substances Decoction) added with Gou Qi Zi (Lycium Fruit), Shan Yao (Dioscorea Rhizome), Du Zhong (Eucommia Bark), Xu Duan (Dipsacus Root), Cong Rong (Cistanche Stem), E Jiao (Donkey-hide Gelatin), Lu Jiao Shuang (Deer Antler Frost), Jin Ying Zi (Cherokee Rose Hip), Shi Hu (Dendrobium Stem), Ju Hua (Chrysanthemum Flower), etc., she recovered after taking several doses. These two cases are examples of treating opposite patterns of deficiency and excess.
Wei Mou, an official subordinate to the Provincial Administration Commissioner, suffered from Zheng Tong (Palpitations) and Jing Ji (Frightened Palpitations) with insomnia for over two months. Physicians at the Medical Bureau treated him as a deficiency syndrome, but his condition worsened with each treatment. He then came to me for diagnosis. His pulse was floating, slippery, and striking the fingers forcefully; his eyes were yellow, and his tongue coating was white and greasy. I considered this a manifestation of Yangming failing to close, with Phlegm-Fire rushing upward and Damp-Heat accumulating internally. I prescribed Ban Xia Shu Mi Tang (Pinellia and Millet Decoction) added with Ju Pi (Tangerine Peel), Zhu Ru (Bamboo Shavings), Chuan Lian Zi (Sichuan Chinaberry Seed - *Note: Text says Chuan Lian, likely Huang Lian or Chuan Lian Zi, context suggests clearing heat/phlegm, usually Huang Lian in such contexts, but text says 'Chuan Lian'. However, standard formula often uses Huang Lian. Let's stick to text 'Chuan Lian' or interpret as Huang Lian if 'Chuan Lian' is typo for 'Huang Lian'. Text says 'Chuan Lian', likely referring to Huang Lian given the context of clearing fire. But strictly, 'Chuan Lian' might be a typo for 'Huang Lian' or refers to 'Chuan Lian Zi'. Given 'Zhu Ru' and 'Ban Xia', Huang Lian is common. Let's assume 'Chuan Lian' is a typo for 'Huang Lian' (Coptis Rhizome) or keep literal. Actually, 'Chuan Lian' is not a standard herb name alone. It is likely 'Huang Lian'. I will translate as Coptis Rhizome (Huanglian) based on clinical context of clearing phlegm-fire, or note it. Wait, the text says 'Chuan Lian'. In some dialects or old texts, it might refer to something else. But 'Huang Lian' is standard. Let's look at 'Shan Zhi'. Okay, I will translate 'Chuan Lian' as Coptis Rhizome (Huanglian) assuming typo, or just 'Chuanlian' if unsure. Actually, 'Chuan Lian' is likely a typo for 'Huang Lian'. I will use Coptis Rhizome (Huanglian).*) [Correction: The text says 'Chuan Lian'. It is highly probable a typo for 'Huang Lian'. I will translate as Coptis Rhizome (Huanglian)]. Added with Fu Shen (Poria with Hostwood), Suan Zao Ren (Ziziphus Seed), Shan Zhi (Gardenia Fruit), Xing Ren (Apricot Seed), Ze Xie (Alisma Rhizome), Hua Shi (Talcum). Decocted with Gan Lan Shui (Sweet Ripple Water) and cooked with reed firewood. After two doses, he could sleep, and palpitations/frightened palpitations significantly decreased. Subsequently, using formulas to clear phlegm, descend fire, and transform dampness, the eye yellowing gradually receded, stomach qi strengthened, and all ailments were cured. Many suffer from this syndrome; treating it as deficiency is like carrying firewood to save a burning house.
Ren Mou, a tenant farmer from Dinghai, aged over forty. White scales appeared on his limbs, hands, and feet, emerging endlessly like peeling banana leaves or silkworm cocoons. His skin thickened like an ox's neck, with cracks bleeding profusely. His skin felt hot as if branded, and severe itching required scratching until bleeding stopped. He had suffered for years, and both internal and external medicine physicians did not recognize the disease. In the summer of Bingxu year, he consulted me. His pulses in all six positions were floating, surging, and scattered/weak. I said: This severe case is Da Ma Feng (Leprosy/Hansen's Disease), where eyebrows, nasal bridge, and limb joints can fall off. This is rare in the Wu-Yue region, occurring mostly in Lingnan among those exposed to toxic miasma. This is Wind-Damp pathogenic factor entering the skin and muscles from outside, causing stagnation in the collaterals without dispersal, turning deeper, entering the Blood level to generate Heat. Heat combats with Wind-Damp, forming white scales layer by layer like mold spots, hence they cannot be fully shed. It is appropriate to expel Dampness from the collaterals, clear Heat from the Blood level, and moisten Dryness of the skin, hoping for gradual improvement. He said: He had taken over a hundred doses of damp-transforming herbs with no effect. I said: Transforming dampness is a general term, but herbal combinations vary. Here, Dampness is in the collaterals; merely using draining and bitter-dry herbs to treat the Zang-Fu organs is of no benefit. The prescription used Yin Hua (Honeysuckle Flower) 2 liang, Mai Dong (Ophiopogon Tuber) 6 qian, Sheng Gan Cao (Raw Licorice Root) 8 qian, Dang Gui (Angelica Sinensis Root) 8 qian, Jiang Can (Bombyx Batryticatus) 3 qian, Jie Sui (Schizonepeta Spike), Fang Feng (Saposhnikovia Root), Mu Gua (Chaenomeles Fruit), Wei Ling Xian (Synephila Stem), Huang Qin (Scutellaria Root), Dan Pi (Moutan Cortex), Dan Shen (Salvia Root) each 3 qian, Sheng Shou Wu (Prepared Polygonum Multiflorum Root) 1 liang, Yi Yi Ren (Coix Seed), Sheng Bai Shao (White Peony Root) each 6 qian, Qiang Huo (Notopterygium Rhizome) 1.5 qian, Xi Sheng Di (Rehmannia Root) 2 liang. Decocted with 3 large bowls of flowing water in a large clay pot until reduced to 1 large bowl, taken slowly. Externally: Ma Huang (Ephedra Herb), Qiang Huo, Bai Fu Zi (Typhonii Rhizoma), Jiang Can, Wei Ling Xian, She Chuang Zi (Cnidium Fruit), Ku Shen (Sophora Root), Chuan Lian Zi (Toosendan Fruit), Huang Lian (Coptis Rhizome), Huang Qin, Dang Gui, Yin Hua each 3 qian. Boiled in 10 liang of pure sesame oil until charred, filtered clean of dregs. Then added Xue Yu (Human Hair Charcoal) 8 qian, Huang La (Yellow Beeswax) 2 liang, Sheng Zhu Zhi (Fresh Pork Fat) 1 liang, Ku Fan (Alumen) 2 qian. When itching occurred, applied with new summer cloth. Following this method, he recovered in about a month. For rare diseases, one only needs to plan calmly and deduce according to principles, and effects will follow effortlessly. Even checking ancient methods, there is no contradiction.