汪良翁。年七十七。患下体沉重。酸痛不能行。己丑十月。召余诊之。其脉六部皆大而空。余谓此乃阳寒湿相乘之
症。治当固本理虚。不得过于渗利其湿。乃用参、苓、术、草、归、芍、牛膝、木瓜、薏苡、防己等。服数剂。病无进
退。一医谓当发汗。投以麻黄、羌活、川芎等。汗大出如雨。其夜合眼即惊。觉心中空空。如无物然。次日又觉身轻。
如两腋生翼。欲飞翔状。且常欲跳跃高处。其家惊惶不知所为。医亦如之复召余诊手足乱舞。力大甚有逾垣上屋之势须。
两三人掖之始可。诊脉寸关二部俱浮数侵上两尺尤躁动。余曰。此误汗阳并于上不急固补必发癫狂。元气亦因之
而即脱。方用人参、附子、炙甘草各三钱、五味子一钱、生白芍、麦冬各八钱、熟地四两、生铁落二两。煎汤代水煎药。
服后睡三四时之久。及醒脉敛神清而下体仍重痛。余曰。此病难以痊好。但可望迁延岁月耳。昔徐洄溪以病不
愈不死。愈则必死。即此类也。乃检其医论示之。彼方信从。后与调养气血。胃气渐旺。脉亦安和。而下体之病。终不
能瘥。
赵忠翁老太太。今年八十有二。长忠翁二岁。玉体稍有违和。即召余延医。每一二剂而辄愈。忽一夕身大热而喘。
又召余诊。脉两寸关俱浮大而数。两尺极虚。余谓阳气浮越。真元将离。若加大汗一出。顷刻即有暴脱之虑。乃用
大剂生脉饮加朱拌茯神、当归各四钱。石斛、龙齿各三钱。牡蛎一两服之即热退而安。次日复诊。脉气顿敛。两尺
亦有根。惟两胁牵引而痛。乃改用养血疏肝和络之轻剂。方用苏梗、橘络各八分。香附、柴胡各五分。桂枝三分。归
须、丹参、丝瓜络各二钱、石斛、蒺藜各三钱。服二剂而愈。忠翁每谓余方太重。似吴越非所宜者。余曰。方剂之大小
轻重。当度其病势。审其体质。不可一例而论也。即如是症。昨日真元将离。脉已无根。制剂若小。何能热退而安。今
日肝络不和。法宜轻宣。如重用柴胡、桂枝等。则真阳复升。而气又将上越矣。是昨不得不重。今不得不轻也。且余
在杭。医治之症。往往遇有危险者。而方亦不得不然。总之实事求是。能中病即为合法。如惯用轻方。或遇重病。将
苟且姑息。知之而不用耶。抑任人讪谤以尽吾之心耶。昔苏长公文章经济。出人头地。一肚皮不合时宜。无如何
也。余于医理粗涉藩篱。本无华扁之术。其克于讪谤者几希。古人云。岂能如人意。但求不愧我心。
汪良老先生，七十七岁。患有下体沉重、酸痛且无法行走的症状。己丑年十月，他请我去诊治。他的六部脉象都大而中空。我判断这是阳气虚弱、寒湿邪气乘虚而入的病症，治疗应当固护根本、调理虚损，不能过度使用渗湿利水的药物。于是使用了人参、茯苓、白术、甘草、当归、白芍、牛膝、木瓜、薏苡仁、防己等药材。服用几剂后，病情没有进展也没有退步。另一位医生认为应当发汗，便投用麻黄、羌活、川芎等药物。结果患者大汗淋漓如雨。当晚一闭眼就受惊，感觉心中空虚，好像里面什么都没有一样。第二天又觉得身体轻盈，如同腋下长出翅膀，想要飞翔的样子，并且经常想跳到高处。他的家人惊慌失措，不知如何是好，医生也感到困惑。再次请我去诊视时，患者手足乱舞，力气极大，甚至有翻墙爬屋的气势，需要两三个人搀扶才能控制住。诊察脉搏，寸部和关部都浮数且向上冲，两尺部尤其躁动不安。我说：“这是误用发汗法导致阳气并聚于上部，如果不紧急固本补益，必然会导致癫狂，元气也会因此立即脱失。”方剂用人参、附子、炙甘草各三钱，五味子一钱，生白芍、麦冬各八钱，熟地黄四两，生铁落二两。煎汤代替水来煎煮药物。服药后睡了三四个小时之久，醒来后脉象收敛，神志清醒，但下体仍然沉重疼痛。我说：“这个病难以痊愈，只能希望延长寿命罢了。以前徐洄溪说过‘病不愈则不死，若痊愈则必死’，就是指的这类情况。”于是拿出那位医生的医论给他看，他才信服。后来通过调养气血，胃气逐渐旺盛，脉象也变得安和，但下体的疾病最终未能治愈。
赵忠老先生的老太太，今年八十二岁，比赵忠老先生大两岁。身体稍有不适，就会请我去延医诊治。通常一两剂药就能痊愈。忽然有一天晚上身体高热且气喘，又请我去诊治。脉象两寸、关部都浮大且数，两尺部极虚。我判断这是阳气浮越，真元即将离散。如果再用大汗法，顷刻间就有暴脱的危险。于是用了大剂量的生脉饮（Shengmai Yin, Ouyang's Pulse-Generating Powder），加入朱砂拌过的茯神、当归各四钱，石斛、龙齿各三钱，牡蛎一两。服用后热退身安。第二天复诊，脉气顿时收敛，两尺部也有根了，只是两胁牵引疼痛。于是改用养血疏肝、调和经络的轻剂。方剂用苏梗、橘络各八分，香附、柴胡各五分，桂枝三分，归须、丹参、丝瓜络各二钱，石斛、蒺藜各三钱。服用两剂后痊愈。赵忠先生常对我说我的方子太重，似乎不适合吴越地区的人。我说：“方剂的大小轻重，应当根据病势和体质来判断，不能一概而论。就像这个病症，昨天真元将离，脉已无根，如果制剂太轻，怎么能退热安神呢？今天肝络不和，治法适宜轻宣。如果重用柴胡、桂枝等药，那么真阳又会上升，气机又将上越。所以昨天不得不重，今天不得不轻。况且我在杭州治病，往往遇到危险病例，方剂也不得不如此。总之要实事求是，能击中病症就是合法度。如果习惯用轻方，或者遇到重病，是苟且姑息呢，还是明知故犯任由别人讥讽以尽我的心意呢？从前苏东坡文章经世济民，出类拔萃，满肚子不合时宜，无可奈何啊。我对医理只是粗涉门径，本来没有华佗、扁鹊那样的医术，能被讥讽的情况很少。古人说：‘怎能如人意，但求不愧我心。’”
Mr. Wang Liang, aged seventy-seven, suffered from heaviness and soreness in the lower body, rendering him unable to walk. In the tenth month of the Jichou year, he summoned me for consultation. His pulse at all six positions was large and empty. I diagnosed this as a condition where Yang deficiency allowed Cold-Dampness to invade. The treatment should focus on consolidating the root and addressing deficiency, avoiding excessive diuresis to drain dampness. Therefore, I prescribed Ren Shen (Ginseng Radix), Fu Ling (Poria), Bai Zhu (Atractylodis Rhizoma), Gan Cao (Licorice Radix et Rhizoma), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Niu Xi (Achyranthis Bidentatae Radix), Mu Gua (Chaenomelis Fructus), Yi Yi Ren (Coicis Semen), and Fang Ji (Stephaniae Tetrandrae Radix). After several doses, there was no improvement or regression. Another physician suggested inducing sweating and administered Ma Huang (Ephedrae Herba), Qiang Huo (Notopterygii Rhizoma et Radix), and Chuan Xiong (Ligustici Chuanxiong Rhizoma). The patient sweated profusely like rain. That night, he startedle easily upon closing his eyes and felt an emptiness in the heart, as if nothing were inside. The next day, he felt his body was light, as if wings had grown under his armpits, desiring to fly, and frequently wanted to jump onto high places. His family was panicked and did not know what to do; the physician was also perplexed. Upon my second consultation, the patient was waving his hands and feet wildly, with great strength, showing signs of wanting to climb walls and roofs, requiring two or three people to restrain him. His pulse at the Cun (Inch) and Guan (Bar) positions was floating, rapid, and surging upward, while the Chi (Cubit) positions were particularly restless. I said, "This is due to erroneous sweating causing Yang Qi to congregate in the upper body. If immediate tonification and consolidation are not performed, mania will ensue, and Yuan Qi (Original Qi) will collapse immediately." The prescription consisted of Ren Shen (Ginseng Radix), Fu Zi (Aconiti Lateralis Radix Praeparata), and Zhi Gan Cao (Prepared Licorice Radix et Rhizoma) each at 3 qian, Wu Wei Zi (Schisandrae Chinensis Fructus) at 1 qian, Sheng Bai Shao (Raw Paeoniae Radix Alba) and Mai Dong (Ophiopogonis Radix) each at 8 qian, Shu Di Huang (Rehmanniae Radix Preparata) at 4 liang, and Sheng Tie Luo (Ferrum Depressum) at 2 liang. Decoct these ingredients using water prepared by decocting the Tie Luo. After taking the medicine, he slept for three to four hours. Upon waking, his pulse had settled, his spirit was clear, but the lower body remained heavy and painful. I said, "This disease is difficult to cure completely; one can only hope to prolong life. As Xu Huixi once said, 'If the disease does not resolve, death does not occur; if it resolves, death is certain,' this refers to such cases." I then showed him the other physician's medical notes, after which he accepted the diagnosis. Subsequently, through regulating Qi and Blood, his Stomach Qi gradually strengthened, and his pulse became harmonious, though the lower body ailment never fully resolved.
Madam Zhao, wife of Mr. Zhao Zhong, was eighty-two years old, two years senior to her husband. Whenever her health slightly faltered, she would summon me for treatment, usually recovering within one or two doses. Suddenly, one night, she experienced high fever and panting. Upon consultation, her pulse at both Cun and Guan positions was floating, large, and rapid, while both Chi positions were extremely deficient. I diagnosed this as Floating Yang and impending separation of True Yuan (True Original Qi). If heavy sweating were induced, sudden collapse could occur instantly. Therefore, I prescribed a large dose of Sheng Mai Yin (Ouyang's Pulse-Generating Powder) added with Zhu Sha Ban Fu Shen (Poria with Cinnabar coating) and Dang Gui (Angelicae Sinensis Radix) each at 4 qian, Shi Hu (Dendrobii Caulis) and Long Gu (Fossilia Ossis Mastodi) each at 3 qian, and Mu Li (Ostreae Concha) at 1 liang. After administration, the fever subsided, and she stabilized. On the following day, her pulse qi had settled, and the Chi positions showed root, except for pulling pain in both hypochondriac regions. I then switched to a mild formula for nourishing Blood, soothing the Liver, and harmonizing collaterals. The prescription included Su Geng (Perillae Caulis), Ju Luo (Citri Reticulatae Pericarpium Retinervum) each at 8 fen, Xiang Fu (Cyperi Rhizoma) and Chai Hu (Bupleuri Radix) each at 5 fen, Gui Zhi (Cinnamomi Ramulus) at 3 fen, Gui Xu (Angelicae Sinensis Radix Fiber), Dan Shen (Salviae Miltiorrhizae Radix), and Si Gua Luo (Luffae Fructus Rete) each at 2 qian, and Shi Hu (Dendrobii Caulis) and Ji Li (Tribuli Fructus) each at 3 qian. After two doses, she recovered. Mr. Zhao often remarked that my prescriptions were too heavy and seemingly unsuitable for people in the Wu-Yue region. I replied, "The size and weight of a prescription must be measured against the pathogenic trend and the patient's constitution; they cannot be judged by a single standard. In this case, yesterday, with True Yuan about to depart and the pulse lacking root, a mild preparation could not have reduced the fever and calmed the spirit. Today, with disharmony of the Liver collaterals, the method requires mild dispersion. If Chai Hu (Bupleuri Radix) and Gui Zhi (Cinnamomi Ramulus) were used heavily, True Yang would rise again, and Qi would surge upward. Thus, yesterday required heaviness, and today requires lightness. Moreover, when practicing in Hangzhou, I often encounter critical cases where heavy prescriptions are necessary. One must seek truth from facts; hitting the disease accurately constitutes proper practice. Would one habitually use light formulas or, facing serious illness, act negligently and tolerate criticism? Formerly, Su Dongpo excelled in literature and statecraft but found himself out of step with the times, helpless in the matter. I have only superficial knowledge of medical principles and lack the skills of Hua Tuo or Bian Que; thus, criticism is rare. As the ancients said, 'How can one please everyone? One only seeks to have a clear conscience.'"