筿村侄治效兼及诸小溲不通治效大侄筿村，小溲不通已至三日，腹膨急胀，至不能忍。先有某医连进通利，不通愈甚，急觅予诊，予见其肺脉独大而数，知其素来嗜饮，因问连日饮何酒?筿村曰：近因酒贵，常饮烧酒，三日前有小集，饮烧酒且甚多。予曰，是矣。时端阳节后，急令买大枇杷二斤，恣意啖食，另变补中益气方法，去党参、黄芪、白术、当归，惟用陈皮一钱、甘草梢八分、醋炒柴胡五分、蜜炙升麻三分，而加天冬三钱、麦冬三钱、北沙参三钱、车前草一颗，与服一时许，小溲大行一大钵而愈。伊急遽中不暇问故，予亦未言。后至松江华亭县刑席邵瓣莲有沉疴甚奇，每发当脐腹痛非常，而先必溲闭，百医罔效，必小溲自通而腹痛乃止，其症少时即有，至四十外乃更甚。适当举发延予一诊，其脉肺部独大而数，与筿村侄同，予问素嗜烟酒否?曰：皆有之，而水烟尤朝夕不断。予曰：是矣。即以与筿村侄方去升柴，加黄芩、知母与服，服后小溲大行，腹痛亦止。伊问予病如何，何药之灵也。予曰：肺为气之主，又为水之上源，《内经》云膀胱为州都之官，津液藏焉，气化则能出矣。有属中气者，中气不足，溲便为之变。有属肾气者，肾与膀胱相表里是也。而其实气化之权，肺实主之。肺在人身主乎天气，天气清明而下降，肺气清肃而下行，上源行乎所不得不行，下流自有所不得而止，而有所不行者，虚也热也，虚则气不足以行，热则气反逆而上，肺气不行。则诸气不行，通则不痛，痛则不通，今溲不通而腹乃痛，肺脉独大而数。症经三十年，此先天肺热，后天烟酒，积热日伤肺阴，肺失清肃之令，故病易发而亦渐重也。以后将此方常服，且戒烟酒，可望不发。瓣莲钦服，请将所论书一通，并药方裱糊收藏。连服二十剂后，果不发。治筿村法，至松江始畅发其义。盖尝观诸禽鸟，有肺者有尿，无肺者无尿，知肺之关乎小溲者多矣。筿村侄用升柴，而邵兄不用升柴加黄芩、知母者，何也?筿村曾服利药而溲更不通，气乃更结，非加升、柴以提其气转不能通，如酒壶然，壶嘴不通，揭其盖自通也。邵瓣莲未服利药而热久而重，故不用升柴而加黄芩、知母也。虽然，勿谓癃闭之尽在清肺也。吾乡钱光斗之弟妇张氏，产育用力太过，正气大伤，三日小溲不通，予用补中益气汤全方，姜枣引，加冬葵子三钱，一服而通。写真华秋岩内怀孕六七月，偶因下阶一跌坐地，腹中坠胀，小溲不通半日，即延予诊。予知胎气震压膀胱，亦用大剂补中益气姜枣引，一服而通。此皆用温补升提，治在中气而不在肺气也。其冬葵子或用或不用者，一则癃闭三日，以葵子引经通之；一则仅半日许，提其气而溲自行，毋烦通利也。后又有丹徙县署吴晴椒明府所请钱席胡晴麓恙已愈后，大解数日未行，急欲其解，以便加餐，一日登厕数次，力努干结不出，是日晚登净桶约一更许，挣极力努挣，大便不来而小便反闭；次日自用车前、泽泻等药通利之，而仍不通，腹加胀；又次日延予，予曰：大肠膀胱相隔一间，分道而行本不相碍，今因直肠有燥粪阻塞，努力太过，前无出路，后有来者，广肠之粪皆集于此，直肠胀满，挤合膀胱，小溲无路可出，此非膀胱自病，虽多方通利，终不得通，徒增胀满耳。予有一法不知肯用否?众问何法?予曰止有下法耳。下其大便，小便自通。时署中官亲朋友来问病者甚多，予有房中倡议，而房外窃议者皆不以为然。以为小便不通，反通大便，殊难相信。且病者年已六十有四，又值病后连日，怕胀又不敢多进饮食，如何能受下剂?众口难调，予亦辞去。第三日又来敦请，晴麓本与予金兰契好，万不能辞，至则胀已至胸，盖又杂进单方，如促织、草帽圈之类，有入无出，直至胀不能动。予曰：在书大便不通有四五十日无妨者，而小便不通五日必死。今已三日，再延二日，神仙不治。此症下或不死，不下必死，诸君奈何，必欲置之死地耶!时晴椒先生以为不可下，众皆和之，予言至此，众不复言。而其如君独奋然曰：三日以来愈治愈坏，今日竟请立方，虽死不怨。予索纸开方：西党参五钱、炙黄芪三钱、于术三钱、当归身三钱、陈皮一钱、炙草-钱、炒柴胡一钱、炙升麻六分，煨姜二片、大枣二枚，众皆诧意曰：先生说要用下法，何开此补中益气汤?予笑曰：诸公勿急，尚有加味。爰加生大黄三钱、元明粉三钱，因告众曰：大便阻塞，小便固非用下不可。然是症有三虚，年高一虚也，久病二虚也，连日不敢纳谷三虚也。此三虚者，诸公曾言之，予岂不知之，故是症非下不可，而非用补以用下不可，古人黄龙汤用参以用下，玉烛散用四物以用下，今用大剂补中益气，然后用硝、黄以推荡之，大解行而膀胱路宽，小解亦自畅行，二便俱行而正气不陷，相辅之道也。不然予岂孟浪用下者哉!众乃爽然，制药与服，一时许大便畅行，小便随至源源不绝几半净桶，腹中畅快，病乃若失。以上五症皆小溲不通，四用东垣补中益气，而变化不同，法则仿古，用则因心。易云神而明之，存乎其人。岂不信哉。
牙痛治效甥婿刘桐村，嗜酒成牙痛症，痛则牵引至额，以至颠顶，一月数发，痛不可忍。予曰：面额属阳明，牙龈属阳明，齿属肾，厥少阴会于颠顶，此湿热太重，蕴积于胃，兼伤肝肾之阴。以景岳玉女煎加西茵陈三钱，嘱服七剂，且嘱节饮，可以不发。伊一服即愈，因思不能戒酒，不若将此方多服，竟服至二十余剂，后竟永不复发。吾友赵义之牙痛缠绵月余不已，忽诣予要方，诊其脉左关尺数，以六味地黄汤加升麻三分、柴胡五分，与之曰：此药服后未免更痛，然片刻即止矣。次日告予，昨服药而卧，忽然痛不可忍，急得骂汝，后竟安寐，天明不知牙痛之何往矣。药既对症，又多此一痛者何也?予曰：齿乃骨之余，而肾主骨，足下肾水太亏，肾火上浮，而为牙痛，故用六味全剂补之泻之。然其浮于齿牙之热，不能下降至肾也，不若用升柴以透之，升透之时未免较痛，然所用无几，痛亦无几，而补泻之力甚大，阴能潜阳，火不复上作痛，且得安寐也。义之兄本通晶，闻之拜服。后予以此方治肾虚牙痛者，无不立效，更胜于玉女煎。武生盖七下牙床作痒，至不能受，不寐者累日矣。偶值予求治，予笑曰：此大肠风也。上牙床属足阳明胃，下牙床属手阳明大肠，大肠有积热，热生风，风生痒。问大便结否?曰：结甚。以调胃承气小其制，加生地、槐花、荆芥、防风，与之一药，得大解畅行而愈。
龚玉屏治效并后不治之验龚玉屏予少时第一交好也，其食量最大，面量倍于饭量，肉量倍于面量，年未四十，忽得中痰，人事不知，声如拉锯，予急往视之，其脉洪劲滑数，予曰：此非中脏，乃中腑耳。中脏多虚，中腑多实。平日肥浓太过，痰多气壅。问大便闭否?其内曰：数日不解。予曰：无妨。以二陈加大黄、芒硝与服，大便通畅，痰下气平，人事遂清。后以清火化痰调理而愈。予告之曰：从此以后君能吃素，高寿无难，否则当戒猪肉，亦可延年，不然恐不过三四年客耳。君之病痰所致，痰之病肥浓所致，而猪肉则肥浓之尤，助火生痰者也。此病后胃气已伤，脾气亦损，清升浊降。健运为难。君若仍如往日食肉兼人，十分饱足，犹如大嚼，脾气不能运动，安得不俱化为痰?只宜八分饱，东坡之养生不使胜食气，圣人之垂训，子其戒之。玉屏曰：唯唯。半年余见玉屏面有滞色，语言不甚清楚，问之曰：连日食肉否?曰：不食。予心窃疑之，伊常住地藏庵僧学恭最善烹调，一日遇之，予问龚玉屏连日食肉否?僧笑曰：不食。因其笑也，而坚问之，僧又笑曰：不食精肉矣!因责玉屏曰：予何等相劝，子乃不信，且不食精肉，而食肥肉。奈何伊病后肝火甚旺，回予之言甚属决绝，大约万不能不食肉，再病不要予诊耳。予特开健脾清胃消食化痰丸方，劝之常服，亦置不理。年复一年，语言日加蹇滞，步履日见艰难，人事日见昏愦，予虽常见，知其病非一朝一夕之故，已入膏肓，伊不问予，予亦不敢多事。三年后忽一日痰涌气开闭，昏迷若睡一日夜，遂不复醒矣。予往唁，痛哭后，立制挽联曰；予交最久始为文字交继为道义交终为性命交彼此皆推心相与，君事犹多上有老母事中有弱弟事下有诸孤事如何竟撒手长辞。文虽鄙俚，亦可见吾两人之交情，而竟不能白首相依也，哀哉。
龚玉屏子椿官治效并后不治之验龚玉屏子椿官体本瘦弱，十六岁自在扬管店务当事亦太早，忽受暑而归，发热头眩，倦怠少气，心烦渴饮，天柱倾欹欲倒。予用人参白虎汤，其家以时症用参为疑，予曰：先天气弱，暑又伤气，脉象数而甚虚，非参不可，且必佳参，汝等不信，多请先生斟酌当可决疑。再三敦嘱而去。是时天气炎热，病症甚多，予至晚回家，则其叔守园坐等已久，予一见即问曰：尔侄服药何如。曰，尚未。问何以不服?曰：君教我多请先生斟酌，我连请七人矣。问伊等云何?曰：止钱觐扬先生欲改用党参，徐寿东先生以为君当不错，其余皆以为不可用参。内有焦医尤以为不可，曰时邪用参，如吃红矾，入腹必死，众言如此，不得不疑，而寒家素服君药，无有不效，又不敢服他人之药，特再候教。予曰：予只道此法平常，医者当无不解，今若此更何言。但令侄今日不服此药，明日即不救。子速回府，制药与服，倘有不测，予当偿命。送至门又嘱曰：予愿偿命，君或不肯，此方参一钱，银三十两，倘有不测，予当罚出。君纵不要，听凭散与穷苦，予决不食言。若不服至不救，其责在子。次日大早往视，已一药而愈矣。嗟乎!医道之不明也，竟至于是耶。经云热伤气，又云壮火食气，盛夏酷热，烁石流金，未有不伤气分者，故治之必顾气分。孙真人生脉散、东垣清暑益气汤、丹溪十味香藿饮，皆人人共见之方，未有不用参者。至人参白虎汤，乃《金匮》中暍门专主之方，《金匮》乃医圣仲景之书，是不足法，更何法也。且夫椿官之症，乃中暑，非时邪也。时邪者，春当暖反凉，夏当热反寒，秋当凉反暖，冬当寒反温，为四时不正之气，感而病者谓之时邪。至风、寒、暑、湿、燥、火，此六气者应时而至，本天地之正气，人或不慎感之，而病直谓之中寒中暑而已，不得混谓时邪也。今椿官当暑，中暑而混指为时邪，症且不知，何竟谤予之用药哉!论椿官之虚弱，清暑益气可用，因其大渴欲饮，恐黄芪、二术过于温补而燥，故用人参白虎。予本细心斟酌，尚几为若辈所误。椿官幸免矣，而当世之冤魂何可胜数哉！喻西昌曰：医至今日，生民之厄运也。诚哉是言也。椿官二十一岁自常贩布回家，自称有恙，延予诊治，时十二月初一也。其症外似洒浙怯寒，内则烦躁觉热，舌赤无苔，溲带白浊，脉来洪数无伦，按之空象。谓之曰：子始回家，一路恐微有外感，而又亏虚，攻补俱有未便，迟数日再诊可也。因密告其叔曰：令侄此症真不治矣。奈何其叔曰：伊起居如常，饮食尚好，何至不治。予曰：子原难解，俟至春来，予言自验。予昔年受滂不辞因能治也，今知不治，断不敢缠手招谤而受怨也。后屡请，予坚辞，且遇伊家亲友，遍告以椿官复病予并未一诊，恐将来受谤也。伊家只得另延他医，初云无妨，继则无效而加重，屡更皆然。至次年正年十八日溘然长逝矣。予往唁，其祖母泣谓予曰：子真神仙，何一见而知其不治也。予曰：予幸立意不诊，今乃以为神仙，否则今将为府上之仇仇矣。后有他医虚心问故，予曰：此不难知也。冬见夏脉，书称不治。伊脉洪数无伦，在夏脉尚为太过，而见于冬令闭藏之日，且又无根肾水告竭，肝火独旺，木生于水，无水之木何以应春气之发生乎?如树木然，当冬令闭藏莫能定其生死，至春则生者生，而死者死，人身一小天地，肝木应乎春气，根本既拔，故知其死于春也。然予虽以先见之，故脱然无累，而与龚玉屏实一人交也。伊乔梓二人，予皆能治其前而不能治其后，每念及此，心犹恻然。
【背景信息】
书名：仿寓意草 章节：正文(2/9) 类别：综合
侄子孙筿村治疗案例：兼论小便不通的治疗效果
我的大侄子孙筿村，小便不通已经三天，腹部膨胀急胀，痛苦到了无法忍受的地步。之前有医生连续使用通利药物（利尿药），结果小便更加不通，病情加重，急忙找我诊治。我诊察发现他的肺脉（反映肺气状态的脉象）特别大而数（快），知道他平时喜欢饮酒，于是问他这几天喝的是什么酒？筿村说：“最近因为酒贵，常喝烧酒，三天前有个集市，喝了大量的烧酒。”我说：“这就对了。”当时正值端午节后，我急忙让人买两斤大枇杷，让他尽情食用，另外采用补中益气汤（一种补益脾胃、升阳举陷的方剂）的方法进行加减，去掉党参、黄芪、白术、当归，只用陈皮一钱、甘草梢八分、醋炒柴胡五分、蜜炙升麻三分，并加入天冬三钱、麦冬三钱、北沙参三钱、车前草一棵。服用大约一个时辰后，小便大量排出，装满一大钵，病就好了。他在焦急匆忙中没来得及问原因，我也没有解释。
后来在松江华亭县，刑名师爷邵瓣莲患有非常奇特的重病，每次发作时肚脐周围剧烈疼痛，而且必定先出现小便闭塞，众多医生都无效，必须等到小便自然通畅，腹痛才会停止。这个症状他小时候就有，到了四十岁以后更加严重。恰逢这次发作，请我去诊脉。他的肺部脉象同样独大而数，与筿村侄相同。我问他平时是否嗜好烟酒？他说：“都有，尤其是水烟，早晚不断。”我说：“这就对了。”于是就用给筿村侄开的方子，去掉升麻、柴胡，加入黄芩、知母给他服用。服药后，小便大量排出，腹痛也停止了。他问我是什么病，什么药这么灵验？我说：“肺是气的主宰，又是水的上源，《内经》说膀胱是州都之官，津液藏在那里，依靠气化作用才能排出。有的属于中气不足，中气虚弱，大小便就会发生变化；有的属于肾气问题，因为肾与膀胱相表里。但实际上气化的权力，主要由肺主宰。肺在人体主管天气，天气清明则下降，肺气清肃则下行，上源的水流不得不行，下流自然有所止，如果不行，是因为虚或热。虚则气不足以推动，热则气反而逆向上行，肺气不行，其他气也不行。通则不痛，痛则不通，现在小便不通导致腹痛，且肺脉独大而数。此症经过三十年，这是先天肺热，加上后天烟酒，积热每天损伤肺阴，肺失去清肃的功能，所以病容易发作且逐渐加重。以后常服此方，并且戒烟酒，有望不再发作。”邵瓣莲钦佩信服，请求将我的论述抄录一通，连同药方裱糊收藏起来。连续服用二十剂后，果然不再发作。治疗筿村的方法，直到在松江才充分阐发其道理。我曾经观察各种禽鸟，有肺的有尿，无肺的无尿，可知肺与小溲的关系很大了。筿村侄用了升麻、柴胡，而邵兄不用升麻、柴胡，反而加黄芩、知母，为什么呢？筿村曾服用利尿药，导致小便更不通，气机更加郁结，不是用升麻、柴胡提升气机就不能通，就像酒壶一样，壶嘴不通，揭开盖子自然就通了。邵瓣莲没有服用利尿药，而是热邪久留且重，所以不用升麻、柴胡，而加黄芩、知母清热。虽然如此，不要认为癃闭（小便不通）都在清肺。我同乡钱光斗的弟媳张氏，生产用力过度，正气大伤，三天小便不通，我用补中益气汤全方，加生姜、大枣为引，再加冬葵子三钱，一服药就通了。还有写真画师华秋岩内人怀孕六七月，偶然下台阶跌倒坐地，腹中坠胀，小便不通半天，立即请我诊治。我知道是胎气震压膀胱，也用大剂量补中益气汤加生姜、大枣为引，一服药就通了。这些都是用温补升提的方法，治疗重点在中气而不在肺气。至于冬葵子有时用有时不用，一则是因为癃闭三天，用冬葵子引导经络以通利；二则是因为仅半天左右，提升气机后小便自行通畅，不需要烦劳通利药物。
后来又有丹徒县衙门吴晴椒明府请托的钱席胡晴麓，病愈后，大便几天未行，急于排便以便进食，一天上厕所几次，用力努挣但干结不出。那天晚上坐在马桶上约一个时辰，拼命努挣，大便不来，小便反而闭塞。第二天自己用车前子、泽泻等药通利，仍然不通，腹部更加胀满。又过一天请我诊治，我说：“大肠和膀胱相隔一间，分道而行本来互不相碍，现在因为直肠有燥粪阻塞，努力太过，前面没有出路，后面有粪便来，广肠的粪便都聚集在这里，直肠胀满，挤压合拢膀胱，小便无路可出，这不是膀胱本身的病，虽然多方通利，最终也不能通，只会增加胀满罢了。我有一个方法不知道你们肯不肯用？”众人问什么方法？我说：“只有下法（泻下通便）而已。通下大便，小便自然通畅。”当时衙门中官员亲友来探病的很多，我在房中提议，房外窃议的人都不以为然。认为小便不通，反而通大便，很难相信。而且病人已经六十四岁，又正值病后连日，怕胀又不敢多吃东西，怎么能承受泻下药？众口难调，我也只好告辞。第三天又来诚恳邀请，胡晴麓本与我情同手足，万不能推辞，到了那里，腹胀已经到胸部，大概又杂进单方，如蟋蟀、草帽圈之类，有入无出，直到胀得不能动。我说：“书上说大便不通有四五十天无妨的，但小便不通五天必死。现在已经三天，再拖两天，神仙也治不了。这个病用下法或许不死，不用下法必死，各位怎么办？一定要置他于死地吗！”当时晴椒先生认为不可用下法，众人都附和，我说到这里，众人不再说话。只有那位胡先生独自愤然说：“三天以来越治越坏，今天竟然请开方子，即使死了也不怨恨。”我索要纸笔开方：西党参五钱、炙黄芪三钱、于术三钱、当归身三钱、陈皮一钱、炙甘草一钱、炒柴胡一钱、炙升麻六分，煨姜两片、大枣二枚，众人都惊讶地说：“先生说要用下法，为什么开这个补中益气汤？”我笑着说：“各位别急，还有加味。”于是加入生大黄三钱、元明粉三钱，然后告诉众人说：“大便阻塞，小便固然非用下法不可。但是这个病有三虚：年高是一虚，久病是二虚，连日不敢进食是三虚。这三虚，各位刚才说了，我难道不知道吗？所以这个病非下不可，但不用补药配合下法也不行。古人黄龙汤用人参配合下法，玉烛散用四物汤配合下法，现在用大剂量补中益气汤，然后用硝石、大黄来推荡积滞，大便通行而膀胱道路变宽，小便也自然畅行，二便俱行而正气不陷入，这是相辅相成的道理。不然我难道是鲁莽用下法的人吗！”众人才恍然大悟，制药给药，大约一个时辰后大便畅行，小便随之源源不绝流出几乎半净桶，腹中畅快，病好像消失了。以上五个病例都是小便不通，四个用了东垣的补中益气汤，而变化不同，法则模仿古人，运用则根据内心判断。《易经》说神妙而显明，在于人的运用。难道不是这样吗？
甥婿刘桐村牙痛治疗案例
甥女婿刘桐村，嗜酒成牙痛症，疼痛时牵引至额头，直至头顶，一个月发作数次，痛不可忍。我说：“面额属阳明经，牙龈属阳明经，牙齿属肾，厥阴少阴经脉会于头顶，这是湿热太重，蕴积于胃，兼伤肝肾之阴。用景岳的玉女煎加西茵陈三钱，嘱咐服用七剂，并且嘱咐节制饮酒，可以不复发。”他一服药就痊愈了，因为想着不能戒酒，不如将此方多服，竟然服了二十多剂，后来竟然永不复发。我的朋友赵义之牙痛缠绵月余不止，忽然来找我讨方子，诊脉左关尺部数，用六味地黄汤加升麻三分、柴胡五分给他，说：“这药服用后未免会更痛，但片刻就会停止。”第二天告诉我，昨天服药后躺下，忽然痛不可忍，气得骂我，后来竟然安睡到天亮，醒来不知道牙痛去哪里了。药既然对症，为什么又多这一阵痛呢？我说：“齿是骨之余，肾主骨，足下肾水太亏，肾火上浮，导致牙痛，所以用六味地黄汤全剂补之泻之。然而浮于齿牙的热，不能下降至肾，不如用升麻、柴胡透发它，升透的时候未免较痛，但用量很少，痛也很少，而补泻的力量很大，阴能潜阳，火不再上行作痛，并且得以安睡。”义之的本家哥哥本通晶，听说后拜服。后来我用此方治疗肾虚牙痛者，无不立效，比玉女煎更好。武生盖七下牙床作痒，到了不能忍受的程度，好几天睡不着觉。偶然遇到我求治，我笑着说：“这是大肠风证。上牙床属足阳明胃，下牙床属手阳明大肠，大肠有积热，热生风，风生痒。问大便结否？他说结得很厉害。用调胃承气汤减小剂量，加生地、槐花、荆芥、防风，给他一服药，得到大便畅行而痊愈。
龚玉屏治疗案例及后来不治的验证
龚玉屏是我年轻时第一交好的人，他的食量最大，面食量是饭量的两倍，肉量是面食量的两倍，年纪不到四十，忽然得了中痰证，人事不知，声音像拉锯一样，我急忙前往查看，他的脉洪劲滑数，我说：“这不是中脏，是中腑。中脏多虚，中腑多实。平日肥腻太过，痰多气壅。问大便闭否？家属说几天不解。我说无妨。用二陈汤加大黄、芒硝给他服用，大便通畅，痰下气平，人事遂清醒。后来用清火化痰调理而痊愈。我告诫他说：“从此以后你能吃素，高寿不难，否则应当戒猪肉，也可以延年，不然恐怕活不过三四年了。你的病由痰引起，痰的病由肥腻引起，而猪肉则是肥腻中的尤物，助火生痰。这个病后胃气已伤，脾气亦损，清升浊降，健运为难。你如果还像往日吃肉加倍，十分饱足，犹如大嚼，脾气不能运动，怎么不会都化为痰？只宜八分饱，苏东坡的养生之道是不使胜食气，圣人的垂训，你要戒除啊。”玉屏说：“好的。”半年多后见到玉屏面色有滞色，语言不甚清楚，问他：“这几天吃肉否？”说不吃。我心里怀疑，他常住地藏庵，僧人学恭最善烹调，一天遇到他，我问龚玉屏这几天吃肉否？僧人笑说不吃。因为他的笑，我坚持追问，僧人又笑说不吃精肉了！于是我责备玉屏说：“我何等相劝，你却不信，而且不吃精肉，却吃肥肉。奈何你病后肝火甚旺，回我的话很决绝，大约万不能不吃肉，再病就不要我诊治了。”我特意开健脾清胃消食化痰丸方，劝他常服，他也置之不理。年复一年，语言日益蹇滞，步履日益艰难，人事日益昏愦，我虽常见，知道他的病不是一朝一夕的缘故，已入膏肓，他不问我，我也不敢多事。三年后忽然有一天痰涌气闭，昏迷若睡一日夜，遂不复醒矣。我去吊唁，痛哭后，立刻制作挽联说：“予交最久始为文字交继为道义交终为性命交彼此皆推心相与，君事犹多上有老母事中有弱弟事下有诸孤事如何竟撒手长辞。”文章虽然鄙俚，也可看出我们两人的交情，而竟不能白首相依也，哀哉。
龚玉屏之子椿官治疗案例及后来不治的验证
龚玉屏之子椿官体质本瘦弱，十六岁就在扬州管店务，管事也太早，忽然受暑而归，发热头眩，倦怠少气，心烦渴饮，天柱倾欹欲倒（脖子支撑不住头部）。我用人参白虎汤，他家因为时令病症用参感到怀疑，我说：“先天之气弱，暑又伤气，脉象数而甚虚，非人参不可，且必须是佳参，你们不信，多请先生斟酌当可决疑。”再三叮嘱而去。这时天气炎热，病症很多，我到晚回家，他的叔父守园坐等已久，我一见就问：“你侄子服药如何？”说：“尚未。”问为什么不服？说：“您教我多请先生斟酌，我连请七人了。”问他们怎么说？说：“只有钱觐扬先生想改用党参，徐寿东先生以为您不错，其余都认为不可用参。其中有庸医尤其认为不可，说时邪用参，如吃红矾，入腹必死，众言如此，不得不疑，而寒家素服您的药，无有不效，又不敢服他人的药，特再候教。”我说：“我只道此法平常，医者当无不解，如今如此，还有什么话可说。但令侄今日不服此药，明日即不救。儿子速回府，制药与服，倘有不测，我当偿命。”送到门口又嘱咐说：“我愿偿命，您可能不肯，此方人参一钱，银三十两，倘有不测，我当罚出。您纵然不要，听凭散与穷苦，我决不食言。若不服至不救，其责在您。”次日大早前往查看，已经一药而愈了。唉！医道的不明，竟至于此耶。经云热伤气，又云壮火食气，盛夏酷热，烁石流金，未有不伤气分者，故治之必顾气分。孙真人生脉散、东垣清暑益气汤、丹溪十味香藿饮，都是人人共见的方，未有不用参的。至于人参白虎汤，乃《金匮要略》中暍门专主的方，《金匮》乃医圣仲景之书，如果不值得效法，还效法什么呢？况且椿官的病，乃中暑，非时邪也。时邪者，春当暖反凉，夏当热反寒，秋当凉反暖，冬当寒反温，为四时不正之气，感而病者谓之时邪。至于风、寒、暑、湿、燥、火，此六气者应时而至，本天地之正气，人或不慎感之，而病直谓之中暑而已，不得混谓时邪也。如今椿官当暑，中暑而混指为时邪，症且不知，何竟谤予之用药哉！论椿官之虚弱，清暑益气可用，因其大渴欲饮，恐黄芪、二术过于温补而燥，故用人参白虎。我本细心斟酌，尚几为若辈所误。椿官幸免矣，而当世之冤魂何可胜数哉！喻西昌说：医至今日，生民之厄运也。诚哉是言也。
椿官二十一岁从常州贩布回家，自称有恙，延请我诊治，时十二月初一也。其症外似洒浙怯寒，内则烦躁觉热，舌赤无苔，溲带白浊，脉来洪数无伦，按之空象。我对他说：“你刚回家，一路恐微有外感，而又亏虚，攻补俱有未便，迟数日再诊可也。”因密告其叔曰：“令侄此症真不治矣。”奈何其叔曰：“伊起居如常，饮食尚好，何至不治。”我说：“你原难解，俟至春来，予言自验。予昔年受滂不辞因能治也，今知不治，断不敢缠手招谤而受怨也。”后屡请，予坚辞，且遇伊家亲友，遍告以椿官复病予并未一诊，恐将来受谤也。伊家只得另延他医，初云无妨，继则无效而加重，屡更皆然。至次年正月十八日溘然长逝矣。予往唁，其祖母泣谓予曰：“子真神仙，何一见而知其不治也。”予曰：“予幸立意不诊，今乃以为神仙，否则今将为府上之仇仇矣。”后有他医虚心问故，予曰：“此不难知也。冬见夏脉，书称不治。伊脉洪数无伦，在夏脉尚为太过，而见于冬令闭藏之日，且又无根肾水告竭，肝火独旺，木生于水，无水之木何以应春气之发生乎？如树木然，当冬令闭藏莫能定其生死，至春则生者生，而死者死，人身一小天地，肝木应乎春气，根本既拔，故知其死于春也。然予虽以先见之，故脱然无累，而与龚玉屏实一人交也。伊乔梓二人，予皆能治其前而不能治其后，每念及此，心犹恻然。”
[Background Information]
Book: Fang Yu Yi Cao (Imitating the Grass of Meaningful Allegories) Chapter: Main Text (2/9) Category: Comprehensive
Case Study of Nephew Sun Xiaocun: Treatment of Urinary Retention with Commentary on Therapeutic Efficacy
My eldest nephew, Sun Xiaocun, suffered from urinary retention for three days. His abdomen was distended and tense, causing unbearable pain. Previously, another physician had consecutively administered diuretic herbs (promoting urination), yet the condition worsened, and he urgently sought my consultation. Upon examination, I found his Lung pulse (the pulse reflecting the state of Lung Qi) to be particularly large and rapid (fast). Knowing his habit of drinking alcohol, I asked him what kind of wine he had been consuming recently. Xiaocun replied, "Due to the high price of wine lately, I have been drinking distilled liquor (Baijiu). Three days ago at a market fair, I consumed a large amount." I said, "That explains it." It was shortly after the Dragon Boat Festival. I hurriedly instructed someone to buy two jin (approx. 1 kg) of large loquats and told him to eat them freely. Additionally, I modified the Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction, a formula for tonifying Spleen/Stomach and raising Yang) by removing Dang Shen (Codonopsis Root), Huang Qi (Astragalus Root), Bai Zhu (Atractylodes Rhizome), and Dang Gui (Angelica Sinensis Root). I retained only Chen Pi (Tangerine Peel, 1 qian), Gan Cao Shao (Licorice Tip, 0.8 fen), Chai Hu stir-fried with vinegar (Bupleurum Root, 0.5 fen), and Sheng Ma honey-roasted (Cimicifuga Rhizome, 0.3 fen), adding Tian Dong (Asparagus Tuber, 3 qian), Mai Dong (Ophiopogon Tuber, 3 qian), Bei Sha Shen (Glehnia Root, 3 qian), and Che Qian Cao (Plantago Herb, one piece). After approximately one shi chen (two hours), he passed a large volume of urine, filling a large basin, and recovered. In his anxiety, he did not ask for the reason, nor did I explain immediately.
Later, in Huating County, Songjiang, Shao Banlian, a judicial clerk, suffered from a peculiar severe illness. Each episode involved intense abdominal pain around the navel, preceded invariably by urinary retention. Many physicians failed to treat it; relief came only when urination resumed spontaneously, stopping the pain. This symptom had existed since childhood but worsened after age forty. During an acute episode, he invited me to examine him. His Lung pulse was similarly isolated as large and rapid, identical to Xiaocun's. I asked if he had habits of smoking or drinking alcohol. He replied, "Both, especially water pipe tobacco, which he used morning and night without fail." I said, "That explains it." I prescribed the same formula used for Xiaocun, but removed Sheng Ma and Chai Hu, adding Huang Qin (Scutellaria Root) and Zhi Mu (Anemarrhena Rhizome). After administration, he passed a large volume of urine, and the abdominal pain ceased. He asked about the nature of the disease and the efficacy of the medicine. I explained: "The Lung is the master of Qi and the upper source of Water. The *Neijing* states that the Bladder is the official of the reservoir, storing fluids, which are excreted through Qi transformation. Some cases belong to deficiency of Middle Qi; when Middle Qi is insufficient, urination and defecation change. Others belong to Kidney Qi issues, as the Kidney and Bladder are exterior-interior related. However, the authority of Qi transformation is primarily governed by the Lung. The Lung governs Heavenly Qi in the body; clear Heaven descends, and clear Lung Qi moves downward. If the upper source flows where it must, the lower flow naturally has limits. If it does not flow, it is due to Deficiency or Heat. Deficiency means Qi lacks strength to move; Heat causes Qi to reverse upward. When Lung Qi fails to move, other Qi also fails to move. Flow implies no pain; pain implies blockage. Now, urinary blockage causes abdominal pain, and the Lung pulse is isolated as large and rapid. This disease has persisted for thirty years, stemming from congenital Lung Heat and acquired Heat from tobacco and alcohol. Accumulated heat daily damages Lung Yin, causing the Lung to lose its function of clearing and descending. Thus, the disease recurs easily and worsens gradually. By taking this formula regularly and quitting tobacco and alcohol, recurrence can be hoped to cease." Shao Banlian was convinced and requested a copy of my discussion and the prescription to be mounted and preserved. After twenty doses, he indeed did not relapse. The treatment principle for Xiaocun was fully elucidated only in Songjiang. I have observed birds: those with lungs produce urine, those without do not. This indicates the Lung's significant relationship with urination. Why did Xiaocun use Sheng Ma and Chai Hu, while Shao did not, instead adding Huang Qin and Zhi Mu? Xiaocun had taken diuretics, causing further blockage and Qi stagnation. Without lifting Qi using Sheng Ma and Chai Hu, passage could not be achieved, like uncorking a wine flask whose spout is blocked. Shao had not taken diuretics; his Heat was prolonged and severe, so Sheng Ma and Chai Hu were omitted, and Huang Qin and Zhi Mu were added to clear Heat. Nevertheless, do not assume all cases of Lin Bi (Urinary Retention) are treated by clearing the Lung. My fellow townsman Qian Guangdou's sister-in-law, Zhang Shi, exerted herself excessively during childbirth, severely damaging her Righteous Qi. She suffered from urinary retention for three days. I used the complete Bu Zhong Yi Qi Tang, with Ginger and Jujube as guides, plus Dong Kui Zi (Abutilon Seed, 3 qian). One dose restored urination. Similarly, Mrs. Hua Qiuyan, wife of portrait painter Hua Qiuyan, fell while descending stairs during pregnancy (six to seven months), causing abdominal heaviness and urinary retention for half a day. I diagnosed fetal pressure compressing the Bladder and used a large dose of Bu Zhong Yi Qi Tang with Ginger and Jujube. One dose restored urination. These cases utilized warming, tonifying, and lifting methods, targeting Middle Qi rather than Lung Qi. Regarding Dong Kui Zi, it was used in the first case because retention lasted three days, requiring the herb to guide and unblock meridians. In the second case, retention lasted only half a day; lifting Qi allowed spontaneous urination, avoiding unnecessary purgatives.
Later, Wu Qingjiao, magistrate of Dantu County, requested treatment for Hu Qinglu, a scholar in his service. After recovering from an illness, Hu had not defecated for several days and urgently needed to pass stool to eat. He attempted multiple times daily, straining vigorously but failing due to dryness. That evening, sitting on the toilet for about one shi chen, he strained intensely, but neither stool nor urine passed. The next day, he self-administered Che Qian Zi (Plantago Seed) and Ze Xie (Alisma Rhizome) to promote urination, with no effect and increased abdominal distension. On the third day, he summoned me. I said, "The Large Intestine and Bladder are separated by a partition and follow different paths, normally not interfering. However, dry feces blocking the rectum cause excessive straining. With no outlet ahead and new feces arriving behind, feces accumulate in the sigmoid colon, causing rectal distension that compresses the Bladder, leaving no path for urine. This is not a primary Bladder disease. Despite various attempts to promote urination, it will not work, only increasing distension. I have a method; would you accept it?" Everyone asked what method. I said, "Only the Purging Method (downward purgation). Clear the stool, and urine will follow." At that time, many officials and friends visited. My proposal in the inner room was met with skepticism outside. They doubted treating urinary retention by purging stool. Moreover, the patient was sixty-four, recently ill, afraid of distension, and eating little, making him unfit for strong purgatives. Facing diverse opinions, I withdrew. On the third day, he was earnestly re-invited. As Hu and I were sworn brothers, I could not refuse. Arriving, I found his distension reached his chest, likely exacerbated by folk remedies like crickets and straw hat rings, which entered but did not exit, causing immobility due to bloating. I stated, "Texts say constipation for 40-50 days may be tolerable, but urinary retention for five days is fatal. It has been three days; two more, and even gods cannot save him. Purging might save him; not purging will kill him. What shall we do? Do you wish to put him to death?" Mr. Qingjiao opposed purging, and others agreed. I stopped speaking. Only Mr. Hu stood up indignantly, saying, "Over three days, treatment made him worse. Please prescribe now; I accept death without resentment." I wrote: Xi Dang Shen (Codonopsis Root, 5 qian), Zhi Huang Qi (Honey-fried Astragalus Root, 3 qian), Yu Zhu (Atractylodes Macrocephala Rhizome, 3 qian), Dang Gui Shen (Angelica Sinensis Root Body, 3 qian), Chen Pi (Tangerine Peel, 1 qian), Zhi Gan Cao (Honey-fried Licorice Root, 1 qian), Chao Chai Hu (Stir-fried Bupleurum Root, 1 qian), Zhi Sheng Ma (Honey-fried Cimicifuga Rhizome, 0.6 fen), Wei Jiang (Baked Ginger, 2 slices), Da Zao (Jujube, 2 pieces). Everyone exclaimed, "You said purging, why prescribe Bu Zhong Yi Qi Tang?" I smiled, "Do not rush; there are additions." I added Sheng Da Huang (Raw Rhubarb Rhizome, 3 qian) and Yuan Ming Fen (Mirabilite, 3 qian). I explained, "Stool blockage necessitates purging for urinary relief. However, this case has three deficiencies: old age (one), chronic illness (two), and inability to eat for days (three). You mentioned these; do I not know them? Therefore, purging is necessary, but must be combined with tonification. Ancient formulas like Huang Long Tang used Ginseng with purgatives; Yu Zhu San used Si Wu Tang with purgatives. Now, using a large dose of Bu Zhong Yi Qi Tang, followed by Mirabilite and Rhubarb to push out stagnation, allows stool to pass, widening the Bladder's path, so urine flows freely. Both excretions proceed without sinking Righteous Qi; this is mutual support. Otherwise, am I reckless?" Everyone understood, prepared the medicine, and administered it. Within an hour, stool passed freely, followed continuously by urine filling nearly half a toilet bowl. Abdominal comfort returned, and the illness vanished.
In the above five cases of urinary retention, four used Dong Yuan's Bu Zhong Yi Qi Tang, varying in application but following ancient principles, adapted by personal insight. As the *I Ching* says, divine illumination depends on the individual. Is this not true?
Case Study of Nephew-in-Law Liu Tongcun: Toothache
Nephew-in-law Liu Tongcun developed toothache due to alcoholism. Pain radiated to the forehead and vertex, occurring several times a month, unbearable. I said, "The face and forehead belong to the Yangming channel; gums belong to Yangming; teeth belong to the Kidney; Jueyin and Shaoyin channels meet at the vertex. This is severe Damp-Heat accumulating in the Stomach, injuring Liver and Kidney Yin. Use Jing Yue's Yu Nu Jian (Jade Woman Decoction) plus Xi Yin Chen (Artemisia Capillaris Herb, 3 qian). Take seven doses and restrict alcohol to prevent recurrence." He recovered after one dose. Thinking he couldn't quit alcohol, he took the formula for over twenty doses and never relapsed.
My friend Zhao Yizhi suffered persistent toothache for over a month. He sought my prescription. His Left Guan and Chi pulses were rapid. I prescribed Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) plus Sheng Ma (0.3 fen) and Chai Hu (0.5 fen), warning, "This may cause temporary increased pain, but it will subside quickly." The next day, he reported, "After taking the medicine, I lay down, pain became unbearable, I cursed you, then slept peacefully. Woke up pain-free." I asked why the extra pain. I explained, "Teeth are surplus bone; Kidney governs bone. Your Kidney Water is deficient, allowing Kidney Fire to float up, causing toothache. Liu Wei Di Huang Wan tonifies and drains. However, heat floating in teeth doesn't descend to Kidney easily. Using Sheng Ma and Chai Hu helps vent it. Venting causes temporary pain, but dosage is small, pain is minimal, while tonification/drainage power is great. Yin anchors Yang, fire stops rising, allowing sleep." Zhao's brother, Ben Tongjing, was convinced. Later, I used this formula for Kidney-deficiency toothache with immediate effect, superior to Yu Nu Jian.
Wusheng (Martial Student) Gai Qi had itching lower gums, unbearable, causing insomnia for days. Seeking treatment, I laughed, "This is Large Intestine Wind. Upper gums belong to Foot Yangming Stomach; lower gums belong to Hand Yangming Large Intestine. Large Intestine has accumulated Heat, generating Wind, causing itching. Are stools constipated?" He said, "Very." I prescribed Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the Qi Decoction) in reduced dosage, adding Sheng Di Huang (Rehmannia Root), Huai Hua (Sophora Flower), Jing Jie (Schizonepeta Spike), and Fang Feng (Saposhnikovia Root). One dose led to free stool passage and recovery.
Case Study of Gong Yuping: Treatment and Subsequent Untreatability
Gong Yuping was my closest friend in youth. He had a huge appetite: noodles twice rice, meat twice noodles. Before forty, he suddenly suffered Zhong Tan (Phlegm Stroke), losing consciousness, snoring like a saw. I rushed to see him. Pulse was Hong (Surging), Jin (Stiff), Hua (Slippery), Shu (Rapid). I said, "This is not Zhong Zang (Stroke affecting internal organs), but Zhong Fu (Stroke affecting external channels). Zhong Zang is mostly deficiency; Zhong Fu is mostly excess. He consumes too much rich food, leading to Phlegm and Qi congestion. Ask about constipation?" Family said, "Several days." I said, "No worry." Prescribed Er Chen Tang (Two-Cured Decoction) plus Da Huang (Rhubarb Rhizome) and Mang Xiao (Mirabilite). Stool cleared, Phlegm descended, Qi calmed, consciousness returned. Later, cleared Heat and resolved Phlegm to recover. I warned, "Eat vegetarian for longevity; otherwise, quit pork to extend life. Otherwise, you may not survive three to four years. Your illness is caused by Phlegm, Phlegm by rich food, pork being the richest, promoting Fire and Phlegm. Post-illness, Stomach Qi is injured, Spleen Qi damaged. Clear ascending and turbid descending, strengthening transport is difficult. If you continue eating meat heavily and full meals, Spleen cannot transform, turning everything to Phlegm. Eat only 80% full. Su Dongpo's health advice: do not exceed food energy. Sage's teachings: heed them." Yuping agreed.
Half a year later, Yuping looked dull, speech unclear. I asked, "Eating meat?" He said no. I suspected him. He stayed at Dizang Monastery; Monk Xue Gong cooked well. I asked the monk. He smiled, "No." Pressing, he smiled again, "No lean meat!" I rebuked Yuping, "I advised you strongly; you didn't listen. Not eating lean meat but fat meat? Your Liver Fire is fierce post-illness. You refused firmly. You won't stop eating meat. Don't call me for future illnesses." I prescribed Jian Pi Qing Wei Xiao Shi Hua Tan Wan (Pills to Strengthen Spleen, Clear Stomach, Digest Food, Resolve Phlegm), advising regular use. He ignored it. Year after year, speech became slurred, walking difficult, mind confused. I knew the disease was deep-rooted, entering the Marrow and Bone (critical stage). He didn't ask, I didn't interfere. Three years later, sudden Phlegm surge and Qi closure, coma for a day and night, never woke. I mourned, writing an elegy: "Our friendship began with literature, deepened with righteousness, culminated in life and death, trusting each other completely. You still have duties: elderly mother, weak younger brother, orphaned children. How could you leave so suddenly?" Though humble, it showed our bond and the tragedy of not growing old together.
Case Study of Gong Yuping's Son Chun Guan: Treatment and Subsequent Untreatability
Chun Guan, Yuping's son, was frail. Managing a shop in Yangzhou at sixteen was too early. He contracted Summerheat upon return: fever, dizziness, fatigue, shortness of breath, irritability, thirst. Tian Zhu (neck) collapsed. I prescribed Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction). Family doubted using Ginseng for seasonal illness. I said, "Congenital Qi is weak; Summerheat injures Qi. Pulse is rapid and very deficient. Ginseng is essential, preferably high quality. If you doubt, consult others." I left. Hot weather, many cases. Returning late, his uncle waited. I asked, "How is the medicine?" "Not taken." "Why?" "You said consult others. I asked seven doctors." "What did they say?" "Only Qian Jinyang wanted to use Dang Shen. Xu Shoudong agreed with you. Others opposed. A quack said using Ginseng for seasonal evil is like eating red alum; fatal. We doubted, but your medicines usually work. We hesitated to take others' prescriptions, waiting for your instruction." I said, "I thought this was common knowledge among physicians. If so, what more can I say? If your nephew doesn't take this today, he won't survive tomorrow. Go home, prepare and administer. If anything happens, I pay with my life." I offered 30 taels of silver for the Ginseng as guarantee. Next morning, he recovered after one dose. Alas! Medicine is obscure to this extent. Classics say Heat injures Qi; vigorous Fire consumes Qi. Summer heat scorches stone and melts metal, inevitably injuring Qi. Treatment must protect Qi. Sun Simiao's Sheng Mai San, Dong Yuan's Qing Shu Yi Qi Tang, Dan Xi's Shi Wei Xiang Ru Yin all use Ginseng. Ren Shen Bai Hu Tang is the specific formula for Heatstroke in *Jingui Yaolue* by Sage Zhang Zhongjing. Should we not follow this? Chun Guan had Summerheat, not Seasonal Evil (Shi Xie). Seasonal Evil refers to abnormal climate (e.g., warm spring turning cold). Wind, Cold, Summerheat, Dampness, Dryness, Fire are normal Six Qi. Contracting them is simply Cold or Summerheat, not Seasonal Evil. Confusing Summerheat with Seasonal Evil shows ignorance of symptoms and slander of my prescription. For Chun Guan's weakness, Qing Shu Yi Qi Tang was suitable, but due to extreme thirst, Huang Qi and Bai Zhu might be too warming and drying, so I chose Ren Shen Bai Hu Tang. I deliberated carefully, almost misled by others. Chun Guan was saved, but how many wronged souls exist today? Yu Xichang said, "Medicine today is a disaster for people." True.
At twenty-one, Chun Guan returned from Changzhou trading cloth, claiming illness. Date: Dec 1st. Symptoms: Exterior chills, interior irritability/heat, red tongue without coating, cloudy urine, Surging/Rapid pulse without limit, empty on pressure. I told him, "Just returned, possibly slight exterior contraction, plus deficiency. Attack and tonification both inconvenient. Wait a few days." Secretly told his uncle, "This case is untreatable." Uncle said, "He lives normally, eats well. Why untreatable?" I said, "Hard to explain. Verify in Spring. I avoided blame by not treating." Repeated invitations refused. Warned relatives I hadn't examined him to avoid blame. Family hired other doctors. Initially said fine, then ineffective, worsening. Changed doctors repeatedly. Died Jan 18th next year. I mourned. Grandmother cried, "You are a god, knowing it was untreatable at first sight." I said, "Lucky I decided not to treat, or I'd be your enemy now." Another doctor asked why. I said, "Winter showing Summer pulse is called untreatable. His pulse was Surging/Rapid, excessive even for Summer, appearing in Winter storage time, rootless. Kidney Water exhausted, Liver Fire alone rampant. Wood grows from Water; wood without water cannot respond to Spring generation. Like trees, winter hides life/death; spring reveals it. Body is microcosm; Liver Wood corresponds to Spring. Roots pulled, thus death in Spring. Though I foresaw this, I remained unburdened. Yet I was close to Yuping. I could treat father and son initially, but not their decline. Thinking of this, my heart aches."