四诊之法。惟脉最难。然亦惟脉为最可凭也。务必究明夫人迎气口。而求四经十二从。以通贯乎十二原。以达夫
三百六十五气穴。三百六十五孙络。则凡经所谓肝脉弦。心脉钩。脾脉代。肺脉毛。肾脉石。与夫四时之春弦夏钩
秋毛冬营者。庶乎其得之矣。或曰如君言。若生若死。指下可立决也。余曰。是何难欤。沉微为里寒。浮数为表热。芤
脉为失血。真藏为不治。皆确可凭信者也。客又曰。庸手俗术。固无论矣。至有当代称为名宿而邀求者。履满户外。
往往不能决生死于数日之间。脉岂有时不足凭耶。余曰。此又不然。譬如虚劳久病。脉本弦数无神。乃一旦回光
返照。俗谓还阳。脉象反有起色、其实乃灯尽复明之征。倘前此一手延医。岂有不知之理。此古人所以必再参之
于望闻问也。至于痛极而厥。脉细且沉。伤寒战汗。肢冷脉伏。室女经闭成干血劳。类乎胎脉。怪凭邪祟。脉必屡更。
又有素常之脉。别有一体。阴脉反阳。阳脉反阴。苟非悉其素体。虽十全上工。亦不得初诊而即知也。大抵应病之
脉。按之即知。不应病之脉。又必详晰体认。不可失之毫厘也。或以余言为然耶否耶。
衲 昧斟识。于医道略涉崖本。无一长可恃。乃谬荷诸大人先生。格外垂青。殷殷咨询。衲惟殚竭底蕴。聊效土壤
细流之助去尔。盖平日既不能于黄帝岐伯诸书。窥见隐奥。使临症仍复苟且从事。是辄以人之身命为儿戏。匪
特负人。实以负己。衲自祝发后。心怀悲悯。断不敢草草塞责。每遇奇难病症。百计图维。夜以继日。必细绎其所以
受病之故。与夫脏腑之虚实。脉理之平逆。服何药而相宜。服何药而不合。一一详悉。始敢斟酌方剂。今尊壶玉体
违和。荏苒三载。痰壅于上。血蛊于下。根深蒂固。药非瞑眩。恐难奏功。今据实条辨以闻。
凡人之一身。吸食水谷之精华。脏腑受之以生气血通十二经脉。达乎毛窍。运用于四肢百骸。而各有所主心焉
皇极居中。肺如华盖。其位最高。肺之叶下有窍。以受诸脏之气。心之下。左有肝。右有肺。为一升一降之道路。而所
以司此升降者。权又操于脾肾。故人以肾为先天之根。胃纳水谷。五脏六腑。皆禀气于胃。故又以胃为后天之本。
水谷入胃。得脾阳之蒸动。清者为津液。浊者为粪溺。其气化而上升。先至于肺。下乃灌注奉心化赤而为血。复由
胃之大络通于冲任。冲任实为血海。而其脉又肝之所主。故云肝主藏血。究竟藏血并不在肝。而在冲任二脉也。
男子之血。营运于周身。女子之血。停贮于冲任。其血一月而一下。不愆其期。名为月信。至生产之后。胃中所升之
津液不复化血。而归冲任。即于胃之大络通于两乳。是以乳妇月信不来。其义甚明。现按尊夫人之病。始于风温
发疹夫风温之邪。首先犯肺。由肺而传于胃。发疹由于风邪内郁。肺胃热盛。伤其血分。血热于肌肤。则为疹。血热
内溢。则为衄。此所以先发疹而后吐血也。发疹吐血。本无二致疹发未透。邪热蕴结于中。则吐血。肝胃有热。津液
得火煎炼。则又生痰。故气升而痰亦升。气即火也。火与元气不两立。邪火进一分。正气即退一分。迨邪火充斥。正
气日就衰耗。全身经络无处非痰。直与血气混而为一。所以上则气急痰壅。下则血蛊胀满耳。或者谓邪火既极
盛如此。火能化物。理应易饥。何以不能食。经云。邪热不杀谷。病当不能食而胀满也。且此病数更寒暑。脉象甚虚。
声音已哑。而面目神气。宛如盛怒。谓非痰火充塞。痰脉类虚之明征耶。何子翁所定之方。 乎其 。原无可议。但
根本已伤。诸邪蟠据。譬诸治军者。贼踪蔓延山野。孤城失援。危如累卵。四向粮饷。无所接济。而犹日坐堂皇。与士
卒等讲求大学三章。理虽甚正。其如势所不及何。可知此症痰气塞满经络。血蛊腹胀。其由来者渐。必非一朝一
夕之故。使不有斩关夺隘之大将。多领精锐而能操必胜之权。以凯旋者。吾不信也。考之古人治痰成法。多用攻
下鄙意药中拟用巴豆未知有当万一否并请高明裁夺。
心禅与当代士大夫。往来手扎甚多。予概不采录。惟此书论病论脉。体会入细。实与内经相发明。洵足津逮后
学。谓之痰壅血蛊治案谁曰不宜。（淞樵评）
徐淞樵曰。统观诸作。大有根柢之学。故能元元本本。倾笥而出。其知病也由于博涉。其识脉也由于多诊。其达
药也由于屡用。是以论痰不拘拘于喻氏痰饮。独出机杼。自我作古。论痢主通不主涩。挽澜既倒。砥柱中流。至
论推摩、针灸。熏蒸、薄贴各法。又皆出自心得。因时制宜。不落前人窠臼。予于虎林僧庐。与之合并数月。其指下
活人多矣。且性甚谦和。虚怀若谷。日有延医。归必质正于予。赏奇析疑。相得甚欢。临行不胜怅悒。因乞诗留别。
率成长句二律。以志雪泥鸿爪之印云尔。
有僧把臂最相宜。况是清谭玉屑时。南海林泉君久住。西湖风月我深知。竺干学浅惭留发。灵素功多易察眉。
更喜能传元化术。金针要度世人述。
心灯炯炯洛伽悬。普照群迷世大千。学道只今随意试。逃禅自古藉医传。姓名不落徐王后。謦咳应通孔孟前。
老我此肱惭未折。校雠却为疲丹铅。
四诊（望、闻、问、切）之中，唯有脉诊最为困难。然而，也唯有脉诊是最为可靠的。务必探究清楚人迎穴与气口穴的脉象变化，并推求十二经脉中顺逆变化的规律，以贯通十二原穴，进而通达全身三百六十五个气穴和三百六十五条孙络。这样，对于《内经》所说的肝脉弦、心脉钩、脾脉代、肺脉毛、肾脉石，以及四季脉象春季弦、夏季钩、秋季毛、冬季营（沉），大概就能掌握了。有人问：像您说的这样，病人的生死，在手指下就可以立刻判断吗？我说：这有什么难的呢？沉脉和微脉主里寒，浮脉和数脉主表热，芤脉主失血，真脏脉出现则属不治之症，这些都是确实可以信赖的依据。客人又说：庸医俗手的情况自然不必说，即使是当代被称为名医的人，登门求诊者踏破门槛，往往也不能在几天内决断生死。难道脉诊有时不可靠吗？我说：这又不对了。比如虚劳久病之人，脉象本来弦数且无神，一旦突然回光返照，俗称“还阳”，脉象反而有了起色，这其实是油尽灯枯前的最后光亮。如果之前早就延请医生诊治，怎么会不知道病情危重呢？这就是古人一定要结合望、闻、问三诊来参合判断的原因。至于疼痛剧烈导致厥逆，脉象细而沉；伤寒战汗时，四肢冰冷，脉伏不见；少女经闭形成干血劳，脉象类似妊娠脉；怪病邪祟作怪，脉象必然多次变化。还有平时脉象就与众不同，阴脉反见阳象，阳脉反见阴象。如果不是熟悉其平素的体质，即使是医术高超的上工，也不能在初诊时就知晓真相。大抵符合病情的脉象，按之即可知晓；不符合病情的脉象，又必须详细体察辨认，不能有一丝一毫的差错。你们认为我的话对还是不对呢？
我愚昧地斟酌认识，在医学大道上只是略知皮毛，没有一项特长可以倚仗，却承蒙各位大人先生格外垂青，殷切咨询。我只能竭尽底蕴，稍微起到土壤细流那样的微小帮助罢了。因为平日里既不能在黄帝、岐伯等书中窥见深奥的道理，如果临症仍然苟且从事，那就是把人的身家性命当作儿戏，这不仅辜负了别人，实际上也是辜负了自己。我自出家后，心怀悲悯，绝不敢草率塞责。每次遇到奇难病症，千方百计谋划，夜以继日，一定要细细推究患病的原因，以及脏腑的虚实、脉理的平逆、服用什么药物适宜、服用什么药物不合，一一详尽清楚，才敢斟酌方剂。如今尊夫人玉体违和，拖延三年之久，痰壅滞于上焦，血蛊积聚于下焦，根深蒂固，若非服用引起剧烈反应的药物（瞑眩药），恐怕难以奏效。现在根据实情逐条辨析汇报。
凡是一个人的一身，吸收饮食水谷的精华，脏腑接受这些精华产生气血，通达十二经脉，到达毛孔，运用于四肢百骸，各有所主。心脏如同皇极居中，肺如华盖，位置最高。肺的叶下有窍，以接受各脏的气。心的下方，左边是肝，右边是肺，这是一升一降的道路，而主宰这种升降的权力，又操持在脾肾手中。所以人以肾为先天之本，胃受纳水谷，五脏六腑都禀受胃气，所以又以胃为后天之本。水谷进入胃中，得到脾阳的蒸动，清的部分成为津液，浊的部分成为粪溺。其气化上升，先到达肺，向下灌注奉养心脏，化为赤色的血液，再通过胃的大络通于冲脉和任脉。冲脉和任脉实为血海，而其脉由肝所主，所以说肝主藏血。究竟藏血并不在肝，而在冲任二脉。男子的血，营运于周身；女子的血，停贮于冲任。每月下行一次，不违背期约，称为月信。到生产之后，胃中所升发的津液不再化血，而是归于冲任，即通过胃的大络通于两乳。所以哺乳妇女月经不来，道理非常明白。现在考察尊夫人的病，始于风温发疹。风温之邪，首先侵犯肺，由肺传于胃。发疹是由于风邪内郁，肺胃热盛，损伤血分。血热蕴结于肌肤，就发为疹；血热内溢，就发生鼻衄。这就是先发疹而后吐血的原因。发疹和吐血，本无二致。疹子发得不透，邪热蕴结在中焦，就会吐血。肝胃有热，津液被火煎熬，又会生痰。所以气升而痰也升。气就是火。火与元气不两立，邪火进一分，正气就退一分。等到邪火充斥全身，正气日益衰耗，全身经络无处不是痰，直接与血气混为一体。所以上面则气急痰壅，下面则血蛊胀满。或许有人说邪火既然如此炽盛，火能化物，理应容易饥饿，为什么不能进食？《内经》说：邪热不杀谷。病应当是不能进食而胀满。况且此病经历了几次寒暑更替，脉象很虚，声音已经嘶哑，而面目神气却宛如盛怒的样子，这不是痰火充塞、痰脉类虚的明显征兆吗？何子翁所定的方子，虽然无可非议，但根本已伤，诸邪盘踞，就像治军一样，贼踪蔓延山野，孤城失去援助，危险得像堆起来的蛋。四面粮饷，无处接济，却还每天坐在公堂之上，与士兵们讲解《大学》第三章。道理虽然很正，无奈形势不允许啊。可知此症痰气塞满经络，血蛊腹胀，由来已久，绝非一朝一夕的缘故。如果没有斩关夺隘的大将，率领精锐部队并能掌握必胜权柄，从而凯旋归来，我不相信。考察古人治疗痰证的成法，多用攻下之法。我的意思是在药中拟用巴豆，不知是否合乎万一？并请高明人士裁夺。
心禅与当代士大夫往来书信很多，我一概不收录。只有这本书论病论脉，体会入微，实在与《内经》相互发明，确实足以引导后学，称之为痰壅血蛊治案，谁说不可呢？（淞樵评）
徐淞樵说：纵观各种作品，大有根基深厚的学问，所以能追根溯源，倾囊而出。他了解病因是因为博览群书，辨识脉象是因为多诊察，通达药理是因为屡试药物。因此论痰不拘泥于喻嘉言的痰饮理论，独出机杼，自创一格。论痢疾主张通利而不主张涩止，力挽狂澜，砥柱中流。至于论推拿、针灸、熏蒸、薄贴等各种方法，又都是出自心得，因时制宜，不落前人窠臼。我在虎林的僧庐与他合并居住数月，他指下救活的人很多。而且性情谦和，虚怀若谷，每天有医生来请教，回去一定向我质询校正，赏奇析疑，相处甚欢。临别时不胜惆怅，于是请求作诗留别。即兴写成七律两首，以记录这次如雪泥鸿爪般的印记。
有一位僧人把手交谈最相宜，何况是清谈如玉屑般珍贵的时候。南海林泉您久住此地，西湖风月我深知。竺乾（佛家）学识浅薄惭愧保留头发，灵枢素问功夫多能明察眉目。更喜能传授造化之术，金针要领要度化世人述说。心灯明亮悬挂在洛伽山，普照众生迷途世大千。学道如今随意尝试，逃避禅宗自古藉助医学传承。姓名不落在徐王之后，谈笑应通晓孔孟之前。老朽我这手臂惭愧未折，校对书籍却为了疲惫丹铅。
Among the Four Diagnostic Methods (Inspection, Auscultation and Olfaction, Inquiry, and Palpation), pulse diagnosis is the most difficult. However, it is also the most reliable. One must thoroughly investigate the pulse at the Renying (ST9) and Qikou (LU9) points, seek the principles of the twelve meridians and their twelve compliant variations, penetrate the Twelve Yuan-Source Acupoints, and reach the 365 Qi-Acups and 365 Sun-Luo vessels. In this way, one can grasp what the Classics say about the Liver pulse being wiry, the Heart pulse being hooked, the Spleen pulse being alternating, the Lung pulse being floating like hair, and the Kidney pulse being stone-like, as well as the seasonal pulses: wiry in Spring, hooked in Summer, floating like hair in Autumn, and deep/sinking in Winter. Someone might ask: As you say, can life and death be decided instantly under the fingers? I reply: What difficulty is there in that? A Deep and Micro pulse indicates Interior Cold; a Floating and Rapid pulse indicates Exterior Heat; a Scallion-Stalk pulse indicates loss of blood; the appearance of True Organ pulses indicates incurable conditions. These are all确凿ly reliable indicators. The guest then says: The situation with mediocre practitioners goes without saying. Even those contemporary figures known as famous masters, whose doors are worn out by visitors seeking consultation, often cannot decide life and death within a few days. Is pulse diagnosis ever unreliable? I say: This is incorrect. For example, in cases of deficiency consumption and chronic illness, the pulse is originally wiry, rapid, and spiritless. Suddenly, due to a return of light (terminal lucidity), colloquially called "returning to the yang," the pulse image反而 shows improvement. This is actually a sign of the lamp burning out before going dark. If doctors had been consulted earlier, how could they not have known? This is why the ancients insisted on combining Inspection, Auscultation/Olfaction, and Inquiry with Pulse Diagnosis. Regarding extreme pain leading to syncope, where the pulse is fine and deep; or Shahan (shivering sweat) in Cold Damage, where limbs are cold and the pulse is hidden; or virgins with amenorrhea developing Dry Blood Consumption, where the pulse resembles pregnancy; or strange diseases caused by evil spirits, where the pulse changes frequently. Also, some individuals have a habitual pulse that is distinct, with Yin pulses showing Yang characteristics and vice versa. Unless one knows their constitutional baseline, even the most skilled physicians cannot know the truth upon initial diagnosis. Generally, pulses corresponding to the disease are known upon palpation; those not corresponding require detailed observation and recognition, allowing no error. Do you agree with my words?
I, though ignorant, have dabbled in the basics of medicine. Lacking any specific expertise, I am honored by your patronage and inquiries. I can only offer my humble efforts, like soil or a small stream. Since I cannot fathom the profound secrets of Huangdi and Qibo's texts, practicing casually would be treating human lives as playthings, betraying both others and myself. After becoming a monk, filled with compassion, I dare not be negligent. Facing rare and difficult cases, I plan day and night, analyzing the cause of illness, the deficiency or excess of Zang-Fu organs, the smoothness or reversal of pulse patterns, and which herbs are suitable or unsuitable. Only after thorough analysis do I prescribe formulas. Your wife has been ill for three years, with Phlegm obstructing the Upper Jiao and Blood Gu (abdominal mass due to blood stasis) accumulating in the Lower Jiao. The condition is deeply rooted; without using drastic medicines that cause intense reactions (Mingxuan drugs), efficacy is unlikely. Here is my analysis based on facts.
The human body absorbs the essence of food and water. Zang-Fu organs transform this into Qi and Blood, circulating through the Twelve Meridians to the pores and limbs. The Heart is central like an emperor; the Lung is like a canopy, highest in position. Below the lung lobes are apertures receiving Qi from other organs. Below the Heart, the Liver is on the left and the Lung on the right, forming the pathway for ascending and descending. The power governing this ascent and descent lies with the Spleen and Kidney. Thus, the Kidney is the root of Pre-Heaven, and the Stomach, receiving food and water, provides Qi to all Zang-Fu, making it the root of Post-Heaven. Food entering the Stomach is steamed by Spleen Yang. Clear parts become Body Fluids; turbid parts become feces and urine. The Qi transforms and ascends to the Lung, then descends to nourish the Heart, turning red to become Blood. It then connects via the Stomach's large collaterals to the Chong and Ren Mai. The Chong and Ren Mai are the Sea of Blood, governed by the Liver, hence "Liver stores Blood." Ultimately, blood storage occurs in the Chong and Ren Mai, not the Liver itself. Men's blood circulates throughout the body; women's blood stores in the Chong and Ren Mai, flowing down monthly, termed Menstruation. After childbirth, fluids from the Stomach no longer transform into blood but go to the Chong and Ren Mai, connecting to the breasts via the Stomach's large collaterals. Hence, lactating women stop menstruating, which is clear logic.
Now, examining your wife's illness: it began with Wind-Warmth causing rashes. Wind-Warmth pathogen first attacks the Lung, then transmits to the Stomach. Rashes result from internal stagnation of Wind pathogen, with excessive heat in Lung and Stomach damaging the Blood level. Heat in the skin causes rashes; internal overflow causes epistaxis. This explains rash followed by hematemesis. Rash and bleeding stem from the same source. If the rash does not fully erupt, pathogenic heat accumulates internally, causing bleeding. Heat in Liver and Stomach fries fluids into Phlegm. Thus, as Qi rises, Phlegm rises. Qi is Fire. Fire and Original Qi cannot coexist; as pathogenic fire increases, righteous Qi decreases. When pathogenic fire fills the body, righteous Qi declines. Phlegm fills every meridian, mixing with Qi and Blood. Hence, upper symptoms include shortness of breath and phlegm obstruction; lower symptoms include Blood Gu and abdominal distension. Some argue: if pathogenic fire is so strong, it should increase appetite. Why no eating? The Classic states: "Pathogenic heat does not digest grain." Illness leads to anorexia and distension. Moreover, the pulse is very deficient, voice hoarse, yet facial expression looks like anger. This clearly indicates Phlegm-Fire obstruction and Phlegm-pulse resembling deficiency. He Ziteng's formula is theoretically sound, but the root is damaged, pathogens entrenched. Like defending a besieged city with no supplies, discussing advanced theory is futile against such desperation. This case involves Phlegm-Qi blocking meridians and Blood-Gu causing distension, developed gradually. Without a general capable of breaking through defenses with elite troops, victory is impossible. Ancient methods for Phlegm often use purgatives. I propose using Croton Seed (Badou). Please advise.
Xin Chan corresponded with many scholars, but I omit these letters. This book discusses disease and pulse with deep insight, elucidating the Neijing, worthy of guiding students. Calling it a Case Record of Phlegm Obstruction and Blood Gu is appropriate. (Songqiao's Comment)
Xu Songqiao said: His works show solid foundations, tracing origins comprehensively. His knowledge of disease comes from broad study; pulse diagnosis from frequent practice; herbology from repeated use. He innovates on Phlegm theories beyond Yu Jia Yan, creating new approaches. For dysentery, he advocates purgation over astringency, standing firm against decline. His views on Tuina, acupuncture, fumigation, and plasters are practical and adaptive, avoiding old clichés. Living together in Hangzhou, I saw him save many lives. Humble and open-minded, he sought my advice daily. We enjoyed discussing mysteries. Upon his departure, I wrote two poems to commemorate our meeting.
A monk embracing arms fits best, especially during jade-shard-like pure conversations. You reside long in Nanhai springs; I know West Lake winds and moons well. Buddhist learning is shallow, regretting keeping hair; Ling Shu and Su Wen skills allow clear observation. Glad to transmit creation arts, golden needles must guide the world. The heart lamp hangs bright on Luojia, illuminating the great thousand worlds. Dao practice tries freely now; escaping Zen relies on medicine since ancient times. Names do not fall behind Xu and Wang; laughter connects to Confucius and Mencius. Old me regrets unbroken arm; proofreading exhausts cinnabar and lead.