蔡姓时医治效镇江北门外蔡姓世出时医，今其子孙虽不及其祖父，而业此者甚多，友人戴半山，蔡氏婿也，一日诣予曰：有舍舅病重，请兄一诊。时予虽知医而并不行道，辞之曰：蔡家医生不知凡几，争代人家看病，岂自家病症不能治，而反需予不行医者乎!予断不去。半山曰：其症诸蔡皆看过，皆回不治，惟予叔岳欲以附子、肉桂扳之，不能决，请兄一决耳。予曰：设至其家而群相诧异奈何?半山曰：舍亲在我金珠店管事，现在惟我作主，不必过虑。随唤舆逼予同往，至其室审其症，乃时邪十一日矣。所服之方，大抵羌、防、柴、桂、枳实、查炭、厚朴、苍术、草果、炮姜之类，其症则燥热非常，人事昏沉，耳无闻，目无见，舌卷囊缩，死象已具。其脉弦劲疾数，不辨至数，惟按之尚未无根，病中从未大解。诊毕半山问臼：桂附可服否?予曰：桂附万无服理。然此人误已深，实属难治，姑请伊母出来商议。其母出见，予问曰：汝家看此人到底是死是活?其母曰：先生何出此言?予曰；汝家若以为未死，则予不敢多事，恐药不能救，归过于予，予何为来担此恶名哉!若汝家以为必死，则予尚觉有一线生路。其母曰；吾家诸医皆已回绝，先生若能施治，生死不忘。予乃曰：时邪热症治以辛凉，非比伤寒之症治以辛温，且伤寒下不厌迟，时邪下不厌早，三五日内热重便闭即当用下存阴，今时邪误服伤寒药，佐以温燥，意在推滞，不知愈燥愈结，火愈炽而真阴耗矣。真阴根于肝，肾开窍于耳，肝开窍于目，肾脉挟舌本，肝脉络阴器，今目瞆耳聋，舌卷囊缩，大热伤阴可知也。症本不治，而予谓有一线生路者，幸脉尚有根，非症重至此，药误实多，为今之计，仍非下之不可。然古人急下存阴，阴未伤也。今下已迟，阴已伤矣。宜用玉烛散法养其阴，以用下。于是用生地一两、当归五钱，加大黄三钱、芒硝二钱、甘草一钱，与服，夜下黑粪，次日热退，诸症皆退，仍进养阴清热。又次日往诊，半山出迎曰：舍亲又复发狂，奈何?予入诊，见其骂詈不避亲疏，果有狂象。予曰，无妨。仲景云下后发狂，再下则愈，一下未尽故也。仍以前方与服，明日往诊，据其家云，昨下更多，几半净桶，后继以血。予疑此方不应动血，及见原方，忽有人添桃仁三钱，予曰：此无怪乎有血矣。伤寒有蓄血症，其人如狂，下其血则愈。重则用抵当汤，轻则用桃仁承气汤，今下后发狂，并非如狂，何用桃仁动其血分，所幸脉静神安，症已无妨，惟养血药要多服数贴耳。后代立方，总以地黄、阿胶为主，幸无复参议者，而其疾乃瘳。
包式斋治效包式斋患尿血二年未痊，后觅予调治而愈。盖肾亏人也，偶然伤风，某医发散太过，转致喘不能卧者屡日，急乃延予，予曰：咳出于肺，喘出于肾，肺肾为子母之脏，过散伤肺，母不能荫子，则子来就母，而咳变为喘，肾虚人往往如此。今已肾气上冲，脉来上部大下部小，而犹以为风邪未尽，更加发散，无怪乎喘不能卧也。与以都气全方，加紫衣胡桃肉三钱，纳气归肾，一药而愈。越二年又因伤风，某医仍肆意发散，致喘不能卧者三日，又请予治，曰此与前症无异，彼昏不知，子何毫无记性耶!曰；因伊在舍诊病，偶贪顺便，不意至此。予曰：无他，仍服前方可也。其内因夫病着急，忽得笑症，终日哑哑不止，亦求予诊。其左关寸皆数甚，予曰：膻中为臣使之官，喜乐出焉，此肝火犯心包络也。与犀角地黄汤加羚羊角，次日复请予至，则笑病一药而痊。而式斋则夜仍喘不能卧，惟下半夜稍平耳。余曰；异哉!何药之灵于当年而不灵于此日哉?细诊脉象，上部大下部小，实属肾气不纳，毫无他疑，静思良久，因问昨何时服药，曰：晚饭后。予曰：是矣。今可于晚饭前服药，当必有效。次日问之，则喘定气下，一夜安眠矣。伊问何故，曰：药本纳气归肾，饭后服药，为饭阻不能直达于肾，故上半夜全然无效，下半夜药性渐到，故稍平也。今于饭前服药，腹中空空，药力直达肾经，然后以饭压之，肾气岂有不纳者哉。嘱其多服数贴，后加十倍为丸常服。并嘱偶有外感，不可任医发散，其症乃不复发。盖尝览《石室秘录》，陈氏假托乩方，直至岐伯、雷公、华佗、仲景，古之圣神无不毕集，可谓怪诞。至其方药议论亦甚平平，而大其制，一药必数两，一方必一二斤，万难取法。惟其主意先分治法，则群书罕见，可称独得之奇。如教包式斋饭前服药，即内饿治法下冶法也。是故医书汗牛充栋，而除《内经》《难经》、仲景《伤寒》《金匮》二书，无可疵议，其余则各有所偏，亦各有所得。惟在学者之知所取，而勿尚其偏而已。然则不读书固不可，而读书亦岂不贵善读哉!
厉登铭疯症治效厉登铭五兄，住城内演军巷，子后门外之贤邻，又予之密友也。初秋患疟少汗，予治之始以和解，继以景岳归柴饮加生地一两、姜皮三分，得透汗而解。知其好内嗜饮，阴虚居多也。疟三次即已，精神未甚减。是晚城南起火，伊命家人秉烛至大门观看，忽谓家人曰；适地坊老爷过去，汝等见否?家人曰：未见。登铭曰：如何未见，明明带高帽穿青袍，左扛雨伞右持芭蕉扇，适才过去，我等速关门进去。是夜遂疯，喊骂大闹，掷毁什物，且持厨刀欲杀其妻，其妻躲至床下。其婶母令人夺取其刀，伊更骂詈跳闹不止。次日大早，急请予，其妻托家人声言救命。予至其室，伊正持破碗欲伤人，见予至，忽然放下，称予曰：六哥。予见其有怯意，似予有以镇之者，因更自提精神，正言厉色谓之曰：坐下。伊即坐下。曰；将脉来诊。伊即伸手候诊，予诊其脉数大不定，而左关尤大而有力，予问因何胡闹，欲杀尔妻?伊则秽语谓妻王氏与狐狸在墙内如何，又白猴子持大扇扇伊脚等疯语。予不复问，惟嘱好好坐着，不许胡闹，否则予将治汝。伊亦应承，予至厅，家人出云又大闹矣。亲朋满座问予何法，予曰，诸病从虚而入，邪祟亦从虚而入。厉兄本疟症初愈，疟发于少阳胆经，疟后受伤，其胆必虚，适遇邪祟乘虚入胆，而成疯。且夫厉兄平日之胆最小，一语不敢伤人，琴瑟之好，称为最笃，今忽欲杀人，且为素所爱敬者，疯则胆大，岂非祟据其中而有以使之耶。夫疯字从风，有风象，然疯之或重或轻犹风之或大或小，疯之忽发忽止犹风之忽起忽息，邪祟之中人而成疯也，未尝不凭借人身内风之力，惟木生风，肝胆是也。肝胆相为表里，今邪入于胆，必将借胆之力而鼓动乎，肝因木生风，因风生火，因火生痰，痰火相搏，势乃大张，而人之魂魄神明皆扰乱而不能自守。虽然，今幸邪祟初入，譬如匪人初至旅邸，左邻右舍并无相识，其势尚孤，驱逐亦易；若失今不治，盘踞既久，巢穴已固，风鼓其势，火张其威，痰助其力，如恶人居久定而党已成，则驱逐良难也。于是用温胆汤，京制半夏二钱、化橘红八分、云茯神三钱、生甘草五分、麸炒枳实七分、鲜竹茹三钱，加粉丹皮二钱、龙胆草一钱同煎，外加朱砂三分、猪胆汁少许和服。此方专于泻胆，使邪祟不能宁居，又兼清火化痰使邪祟无所凭借。法虽平平，竟一药而愈。后以十味温胆，以沙参代人参，以生地代熟地，且重用之，以生地能补胆，贼去关门法也。连进四帖，神志如常。此嘉庆十六年事，时尚未识王九峰先生，后先生闻知，适见脉案，深蒙许可，遂相往来。予视先生为前事师，而先生以予为忘年友矣。
陈外甥疯症治效吾适陈四妹其长子乳名得儿，在泰兴南货店生理多年，已二十余岁，忽一日自归，神情沮丧，郁郁不乐，吾妹问之亦不言。数日后，忽成疯疾，不似厉登铭之杀人，惟欲自戕，见绳欲勒，见刀欲刎，见碗欲敲碎自划，语言并不颠倒，人事并不胡涂，惟言有女鬼在其腹中，教之寻死，不能不依。其家日使两人持其手，否则即欲觅物自戕，数日予始知，往视之，命人放其手，垂手不动，诊其脉乍疏乍数，而按之细弱，知其阳气大虚，实有鬼物凭之。乃用参附理中加黄芪、茯神、鬼箭羽朱砂、龙齿、虎骨，并加雄黄少许，麝香少许，大补阳气，兼辟其邪。用香药以透其出路，并告吾妹曰：此冤魂也，可先请高僧施食，因服此药，当可愈也。予去后，甥告吾妹曰：他人诊脉，鬼按脉不令诊，舅诊脉则鬼躲在腹底不敢上来，现嘱我曰：汝舅之药必不可服，服则必死。吾妹曰：此怕汝服也，不可听信。旋即请僧施食，亦即服药。药后甥云：他去矣。病即愈。嗣予因其阳气太虚，仍以参附理中加远志、茯神、黄芪、枸杞、枣仁，命之多服。病愈后仍不敢独宿，服药月余，始能如常。后至予家，询其鬼从何来，始推不知，再三驳问，乃云泰兴店对门有小户少妇，代人浆洗衣服，伊亦常送衣与浆洗，不意其夫忽疑其有私，始以骂，继以打，其妇忽自缢而死。伊闻一吓，遂觉神魂不定，渡江遄归，不意其相随而来也。予问与尔有染否?坚称无有。此子素纯谨胆小，当无他事。惟年长未婚，未免有情耳。甚矣!情之不可妄动也如是夫。此嘉庆二十四年事也。二十余年后，此子仍往江北生理，竟自缢而亡，奇哉。
吴预生疯症治效 吴鉴林名炯，诸生也。其长子预生，亦诸生，在邹同裕淮北信阳盐店管书启，其店有空房久无人住，伊爱其静，移居其中，一日忽大疯，用裁纸刀自划胸膛，店伙救之，已伤数处，鲜血淋漓矣。其店用十人帮送，始能到家，以其力大难制，有且路途遥远也。到家虽不自戕，而狂闹愈甚。医药罔效，阅二月，予自吴门归，其父鉴林屡来探予，欲得一诊。予尝谓眷属曰：疯子见予，即不敢疯。众人将信将疑，适其家与予相近，一日傍晚得暇，令人告之使来就诊。半晌数人将疯子挟持而来，舞蹈而入，予出至厅，疯子即寂然不动，予如诊厉登铭法，予上坐，使之下坐，正容壮色，以诊其脉，脉象或大或小，或疏或密，或结或促，知其邪祟无疑。厉声谓之曰：尔遇我即当去，不去我将在鬼哭穴灸汝针汝，虽然尔来路远，我当嘱伊父多赠汝盘缠。予说一句，伊应一声，予眷属乃皆称奇，予知其邪祟重，而且久气血暗伤，先以参地两补之，加犀角、羚羊角、琥珀、朱砂、龙齿、虎骨、龟板、鹿角诸多灵通宝贵之药，以通其灵性，以镇其神魂。譬如正人君子巍然满座，邪人自不能安，此药入腹，邪祟自逼处不安而思去。又仿喻西昌法，用羊肉汤一碗为引，使邪祟借腥膻之气味而出，惟药不与病人知，恐二竖避入膏盲也。又嘱鉴林曰：此实鬼祟信阳来路甚远，务请高僧施食，多烧冥资，以践予多赠盘缠之言，服药始灵。盖因鉴林素悭吝，故再三嘱付，时四月十九日也。二十日伊家施食服药，疯果即愈。二十一日行都天会，其次子忽至晚不归，次日遍找不见，其家因长子幸愈，次子年轻不才，亦即置之。三日后忽句容邹同裕盐店管事亲送伊回，细问情由，伊看会至晚，忽一大黑人引之前行，身不自主渐至旷野，不辨东西走了一夜，腿虽酸疼而不能不走，似将天明，忽路旁又走出二人与黑人大吵说：是我孙子，尔带他何往。且吵且走，忽已天明，而三人皆不见矣。伊远见有城，权且走进，不知何城，正在无路可走，幸盐店开门见问，始知遇鬼，始知已至句容，离家百里矣。管事者亦丹徒人，且与吴氏相好，留住二日，拨冗送回。吴预生曰：此想必附我之鬼也。前烧冥资太少，鬼尚不服，而服药又不能不去，故复祸弟，予向见人家寄库烧冥资，以为徒费无益，至治疯症屡用有效，且嫌少而争多不可解也。此道光八年事也。
蔡姓时医治效
镇江北门外有一位蔡姓家族世代行医。如今他的子孙虽然医术不如祖父，但从事这一行业的人很多。我的朋友戴半山是蔡家的女婿，有一天来拜访我说：“我舅舅病重，请哥哥去诊察一下。”当时我虽然懂医理，但并不以此谋生行医，便推辞说：“蔡家的医生不知有多少，争着替别人看病，难道自家的病症治不了，反而需要我这个不执业的医生吗？我坚决不去。”戴半山说：“他的症状各位蔡姓医生都看过了，都说无法治疗，只有我叔岳（妻子的父亲）想用附子、肉桂来挽救，拿不定主意，请哥哥去决断一下。”我说：“如果到了他家，大家感到诧异怎么办？”戴半山说：“我的亲戚在我金珠店管事，现在由我做主，不必过分担忧。”于是叫来轿子逼着我一同前往。到了他家里审视病情，发现这是外感时邪已经十一天的病。所服用的方剂，大抵是羌活、防风、柴胡、桂枝、枳实、山楂炭、厚朴、苍术、草果、炮姜之类的药物。患者的症状燥热非常严重，人事昏沉，耳朵听不见，眼睛看不见，舌头卷缩，阴囊收缩，死象已具备。脉象弦劲疾数，无法分辨至数（脉搏跳动的次数），只是按下去尚未无根，患病期间从未大便。诊察完毕后，戴半山问我说：“桂枝、附子可以服用吗？”我说：“桂枝、附子万万没有服用的道理。然而这个人误治已经很深，确实属于难治之症，暂且请他的母亲出来商议。”他的母亲出来见面，我问她：“你们家看这个人到底是死是活？”他母亲说：“先生为什么说出这种话？”我说：“如果你们家认为他没死，那么我不敢多事，恐怕药不能救，把过错归咎于我，我为什么要来担这个恶名呢！如果你们家认为必死无疑，那么我还觉得有一线生机。”他母亲说：“我们家的医生都已经回绝不治了，先生如果能施治，无论生死都不忘记恩情。”我便说：“时邪热症应当用辛凉法治疗，不像伤寒症用辛温法治疗。而且伤寒症攻下不厌迟，时邪症攻下不厌早，三五天内如果热重便秘就应当用攻下法以保存阴液。现在时邪误服了伤寒药，佐以温燥药物，本意是想推动积滞，却不知道越燥结得越厉害，火势越炽盛而真阴耗损了。真阴根源于肝肾，肾开窍于耳，肝开窍于目，肾脉挟持舌本，肝脉络阴器。现在眼睛昏暗耳聋，舌头卷缩阴囊收缩，可知是大热伤了阴液。这症本来是不治之症，而我为什么说有一线生机呢？幸好脉象还有根，并非症重到如此地步，而是药物误治实在太多。为今之计，仍然非攻下不可。但是古人所说的急下存阴，是因为阴液尚未受伤。现在攻下已经晚了，阴液已经受伤了。适宜采用玉烛散的方法滋养阴液，然后再用攻下法。”于是用了生地一两、当归五钱，加大黄三钱、芒硝二钱、甘草一钱，给患者服用。夜里排出了黑粪，第二天热退，各种症状都退了，继续进服养阴清热的药物。又过了一天去诊察，戴半山出来迎接说：“我亲戚又发狂了，怎么办？”我进去诊察，见他骂人不管亲疏远近，果然有狂象。我说：“不要紧。张仲景说过，攻下后发狂，再攻下就会痊愈，这是因为第一次攻下未尽的缘故。”仍然用前面的方剂给他服用。第二天去诊察，据他家人说，昨天排出的更多，几乎半桶净粪，随后继之以出血。我怀疑这个方子不应该动血，等到看到原方，忽然有人添了桃仁三钱，我说：“这就不奇怪会有出血了。伤寒有蓄血症，其人如狂，攻下瘀血就会痊愈。重的用抵当汤，轻的用桃仁承气汤。现在攻下后发狂，并不是‘如狂’（像发狂但不是真狂），为什么要用桃仁动其血分呢？所幸脉静神安，症状已经没有妨碍，只要多服几帖养血药就行了。”后代立方的医生，总以地黄、阿胶为主药，幸好没有再参与议论的人，他的病才痊愈。
包式斋治效
包式斋患尿血两年未痊愈，后来找我调治而好了。他是肾亏的人，偶然伤风，某位医生发散太过，导致转成气喘不能躺卧了好几天，急忙请来我。我说：“咳嗽出于肺，气喘出于肾，肺肾是子母关系，过度发散伤了肺，母脏不能荫庇子脏，那么子脏就来求助母脏，咳嗽就变成了气喘。肾虚的人往往是这样。现在已经肾气上冲，脉象上部大下部小，却还认为风邪未尽，更加发散，难怪气喘不能躺卧。”给予都气丸全方，加紫衣胡桃肉三钱，纳气归肾，一服药就好了。过了两年又因伤风，某位医生仍然肆意发散，导致气喘不能躺卧三天，又请我去治。我说：“这和前次症状无异，那人糊涂不知道，你怎么毫无记性呢！”他说：“因为他在我家看病，偶然贪图方便，没料到弄成这样。”我说：“没什么别的，仍然服用前方可也。”他的妻子因为丈夫病急，忽然得了笑症，整天哑哑笑个不停，也请求我去诊察。她的左关寸脉都数甚，我说：“膻中是臣使之官，喜乐由此发出，这是肝火侵犯心包络。”给予犀角地黄汤加羚羊角，第二天再次请我到，则笑病一服药而痊愈。而包式斋则是晚上仍然气喘不能躺卧，只有下半夜稍微平稳一些。我说：“奇怪啊！为什么药在当年灵验而在此日不灵验呢？”仔细诊察脉象，上部大下部小，确实是肾气不纳，没有任何其他怀疑，静思良久，于是问昨天什么时候服药，回答说：“晚饭后。”我说：“这就对了。现在可以在晚饭前服药，应当必定有效。”第二天询问，则气喘定气下降，一夜安眠了。他问什么原因，我说：“药本是纳气归肾，饭后服药，被饭食阻隔不能直达于肾，所以上半夜全然无效，下半夜药性渐渐到达，所以稍微平稳。现在在饭前服药，腹中空空，药力直达肾经，然后用饭食压住它，肾气岂有不收纳的呢？”嘱咐他多服几帖，后来加十倍量做成丸药常服。并嘱咐偶尔有外感，不可任由医生发散，症状才不会复发。我曾经阅览《石室秘录》，陈氏假托乩方，直到岐伯、雷公、华佗、仲景，古代的圣神无不毕集，可以说是怪诞。至于他的方药议论也很平庸，而且药制很大，一药必数两，一方必一二斤，很难取法。只有他的主意先分治法，则是群书中罕见的，可称独得之奇。比如教包式斋饭前服药，就是内伤治法下的冶法（此处指特定的治疗时机或方法）。所以医书汗牛充栋，除了《内经》《难经》、仲景《伤寒》《金匮》这两本书无可疵议，其余则各有所偏，也各有所得。只在于学者知道如何取舍，而不崇尚其偏颇罢了。然而不读书固然不行，而读书难道不贵在善于读吗！
厉登铭疯症治效
厉登铭的五兄，住在城内演军巷，子后门外之贤邻，又是我的密友。初秋患疟疾少汗，我治疗他开始时用和解法，接着用景岳归柴饮加生地一两、姜皮三分，得到透汗而解。知道他喜好房事嗜好饮酒，阴虚居多。疟疾三次即愈，精神并未减损。这天晚上城南起火，他命家人举烛到大门观看，忽然对家人说：“刚才地坊老爷过去，你们看见了吗？”家人说：“没看见。”登铭说：“怎么没看见，明明戴着高帽穿着青袍，左边扛雨伞右边持芭蕉扇，刚才过去了，我们快关门进去。”这天晚上就疯了，喊骂大闹，掷毁物品，并且拿着厨刀想杀他的妻子，妻子躲到床下。婶母叫人夺取他的刀，他更骂詈跳闹不止。第二天一大早，急忙请我，他的妻子托家人声言救命。我到他房间，他正拿着破碗想伤人，见我来，忽然放下，称呼我说：“六哥。”我看他有怯意，似乎我有能镇住他的东西，于是更加提精神，正言厉色对他说：“坐下。”他就坐下了。说：“把手伸出来诊脉。”他就伸手候诊，我诊他的脉数大不定，而左关尤其大而有力，我问为什么胡闹，想杀你妻子？他却用污秽言语说妻子王氏与狐狸在墙内如何，又说猴子持大扇扇他脚等疯语。我不再问，只嘱咐好好坐着，不许胡闹，否则我将治你。他也应承，我到厅堂，家人出来说又大闹了。亲朋满座问我什么办法，我说：“诸病从虚而入，邪祟也从虚而入。厉兄本来疟疾刚愈，疟疾发于少阳胆经，疟后受伤，他的胆必虚，恰好遇到邪祟乘虚入胆，而成疯。况且厉兄平日胆子最小，一句话不敢伤人，琴瑟之好，称为最笃厚，现在忽然想杀人，而且是素来爱敬的人，疯了则胆大，岂不是邪祟占据其中而使他这样吗？夫‘疯’字从‘风’，有风象，然而疯的或重或轻就像风的或大或小，疯的忽发忽止就像风的忽起忽息，邪祟中人而成疯，未尝不凭借人身内风之力，只有木生风，肝胆是也。肝胆相为表里，现在邪入于胆，必将借胆之力而鼓动乎肝，因为木生风，因风生火，因火生痰，痰火相搏，势乃大张，而人的魂魄神明都扰乱而不能自守。虽然如此，现在幸好邪祟初入，譬如匪人刚到旅店，左邻右舍并无相识，其势尚孤，驱逐也容易；如果失此不治，盘踞既久，巢穴已固，风鼓其势，火张其威，痰助其力，如同恶人居住久了党羽已成，则驱逐就很难了。”于是用温胆汤，京制半夏二钱、化橘红八分、云茯神三钱、生甘草五分、麸炒枳实七分、鲜竹茹三钱，加粉丹皮二钱、龙胆草一钱同煎，外加朱砂三分、猪胆汁少许和服。此方专于泻胆，使邪祟不能宁居，又兼清火化痰使邪祟无所凭借。法虽平平，竟一服药而愈。后来用十味温胆，以沙参代人参，以生地代熟地，且重用之，因为生地能补胆，这是贼去关门法。连进四帖，神志如常。这是嘉庆十六年的事，当时还未认识王九峰先生，后来先生听说此事，适见脉案，深蒙许可，遂相往来。我把先生视为前辈老师，而先生把我视为忘年交。
陈外甥疯症治效
我侄女陈四妹的长子乳名得儿，在泰兴南货店做生意多年，已经二十多岁，忽然一天自己回来，神情沮丧，郁郁不乐，我妹妹问他也不说话。几天后，忽然成了疯疾，不像厉登铭那样杀人，只想自戕，看见绳子就想勒，看见刀就想刎，看见碗就想敲碎自划，语言并不颠倒，人事并不糊涂，只说有女鬼在他腹中，教他寻死，不能不依从。他家每天派两人按住他的手，否则就想找东西自戕，几天后我才得知，去看视，命人放开他的手，垂手不动，诊他的脉乍疏乍数，而按之细弱，知道他是阳气大虚，实有鬼物凭依。于是用参附理中汤加黄芪、茯神、鬼箭羽、朱砂、龙齿、虎骨，并加雄黄少许，麝香少许，大补阳气，兼辟除邪气。用香药以透出邪气的出路，并告诉我妹妹说：“这是冤魂，可以先请高僧施食，因为服用此药，应当可以痊愈。”我走后，外甥告诉我妹妹说：“别人诊脉，鬼不让按脉，舅舅诊脉则鬼躲在腹底不敢上来，现在嘱咐我说：‘你舅舅的药必不可服，服则必死。’”我妹妹说：“这是怕你服啊，不可听信。”随即请僧施食，也就服药。药后外甥说：“他走了。”病就好了。此后因为我阳气太虚，仍以参附理中汤加远志、茯神、黄芪、枸杞、枣仁，命令他多服。病愈后仍不敢独自睡觉，服药月余，才能如常。后来到我家里，询问鬼从哪里来，起初推说不清楚，再三驳问，才说是泰兴店对门有小户少妇，代人浆洗衣服，他也常送衣服去浆洗，没料到他丈夫忽然疑心他有私情，开始骂，继而打，那妇人忽然自缢而死。他听到一吓，遂觉神魂不定，渡江匆忙回来，没料到她跟随而来。我问与她有染吗？坚称没有。这孩子素来纯谨胆小，应当没有其他事。只是年长未婚，未免有情吧。情之不可妄动竟然如此啊！这是嘉庆二十四年的事。二十多年后，这孩子仍往江北做生意，竟自缢而死，奇怪啊。
吴预生疯症治效
吴鉴林名炯，是诸生。他的长子预生，也是诸生，在邹同裕淮北信阳盐店管书启，店里有空房很久没人住，他喜欢那里安静，移居其中，一天忽然大疯，用裁纸刀自划胸膛，店员救他，已伤几处，鲜血淋漓了。店里用十人帮忙送，才能到家，因为他力气大难控制，而且路途遥远。到家后虽然不自戕，而狂闹更甚。医药无效，过了两个月，我从吴门回来，他父亲鉴林多次来探望我，想要诊一次。我曾对家属说：“疯子见我，就不敢疯。”众人将信将疑，恰好他家与我相近，一天傍晚得暇，让人告诉他让他来就诊。半晌几个人将疯子挟持而来，舞蹈而入，我出来到厅堂，疯子即寂然不动，我像诊治厉登铭那样，我上坐，让他下坐，正容壮色，来诊他的脉，脉象或大或小，或疏或密，或结或促，知道是邪祟无疑。厉声对他说：“你遇见我就应当离去，不离去我将在鬼哭穴灸你针你，虽然你来路远，我应当嘱咐你父亲多赠给你路费。”我说一句，他应一声，我的家属都称奇，我知道他邪祟重，而且久气血暗伤，先用参地两补之，加犀角、羚羊角、琥珀、朱砂、龙齿、虎骨、龟板、鹿角诸多灵通宝贵之药，以通其灵性，以镇其神魂。譬如正人君子巍然满座，邪人自然不能安，此药入腹，邪祟自然逼迫处不安而思去。又仿喻西昌法，用羊肉汤一碗为引，使邪祟借腥膻的气味而出，只是药不与病人知，恐怕二竖（病魔）避入膏肓。又嘱咐鉴林说：“这确实是鬼祟，信阳来路很远，务必请高僧施食，多烧冥资，以践行我多赠路费的话，服药才灵。”因为鉴林素来悭吝，所以再三嘱咐，时间是四月十九日。二十日他家施食服药，疯果然即愈。二十一日行都天会，他的次子忽然到晚不归，第二天遍找不见，他家因为长子幸愈，次子年轻不才，也就置之不理。三天后忽然句容邹同裕盐店管事亲自送他回来，细问情由，他看会到很晚，忽然一大黑人引着他前行，身不自主渐至旷野，不辨东西走了一夜，腿虽酸疼而不能不走，似将天明，忽然路旁又走出二人与黑人大吵说：“是我孙子，你带他去哪里。”边吵边走，忽已天明，而三人皆不见了。他远见有城，权且走进，不知何城，正在无路可走，幸盐店开门见问，始知遇鬼，始知已到句容，离家百里了。管事者也是丹徒人，且与吴氏相好，留住二日，拨冗送回。吴预生说：“这想必是附在我身上的鬼。之前烧冥资太少，鬼还不满意，而服药又不能不去，所以复祸弟弟，我向来见人家寄库烧冥资，以为徒费无益，至治疯症屡用有效，且嫌少而争多不可解也。”这是道光八年的事。
Cai Family Physician's Efficacy Record
A Cai family outside the north gate of Zhenjiang had practiced medicine for generations. Although his descendants were not as skilled as their grandfather, many engaged in this profession. My friend Dai Banshan, who was a son-in-law of the Cai family, came to visit me one day and said: "My uncle is critically ill; please examine him." At that time, although I understood medical principles, I did not practice medicine professionally, so I declined, saying: "There are countless doctors from the Cai family competing to treat others' illnesses. Can they not treat their own family member's condition, yet rely on an unlicensed practitioner like me? I will definitely not go." Dai Banshan replied: "All the Cai doctors have examined him and declared it untreatable. Only my father-in-law wishes to use Fuzi (Prepared Aconite Root) and Rougui (Cinnamon Bark) to rescue him but cannot decide. Please help make the decision." I asked: "What if everyone is surprised when I arrive at their home?" Dai Banshan said: "My relative manages my gold and pearl shop; I am currently in charge, so do not worry excessively." He then summoned a sedan chair and urged me to go with him. Upon examining the patient at his home, I found that the disease was caused by seasonal pathogens (Shixie) for eleven days. The prescribed formulas mostly contained Qianghuo (Notopterygii Rhizoma), Fangfeng (Saposhnikoviae Radix), Chaihu (Bupleuri Radix), Guizhi (Cinnamomi Ramulus), Zhishi (Aurantii Fructus), Shanzhata (Crataegi Fructus Carbonis), Houpo (Magnoliae Officinalis Cortex), Cangzhu (Atractylodis Rhizoma), Caoguo (Tsaoko Fructus), and Paojiang (Zingiberis Rhizoma Preparata). The symptoms were extremely dry and hot, with mental confusion, deafness, blindness, tongue retraction, and testicular contraction, presenting signs of impending death. The pulse was wiry, forceful, rapid, and frequent, making it impossible to count beats accurately, though it still had a root upon deep palpation. The patient had not had a bowel movement since falling ill. After the diagnosis, Banshan asked: "Can Guizhi and Fuzi be administered?" I answered: "There is absolutely no reason to administer Guizhi and Fuzi. However, this patient has been misdiagnosed and mistreated deeply, making it truly difficult to treat. For now, please bring his mother out to discuss." His mother came out, and I asked her: "Does your family believe he is dead or alive?" She replied: "Why do you say such things?" I said: "If you believe he is not dead, I dare not interfere further, fearing that if the medicine fails, blame will fall on me. Why should I take this bad reputation? If you believe he is surely going to die, then I feel there is still a sliver of hope." She said: "Our family doctors have all refused treatment. If you can treat him, we will never forget your kindness regardless of life or death." I then said: "Seasonal heat syndromes should be treated with acrid-cool methods, unlike Cold Damage (Shanghan) syndromes which are treated with acrid-warm methods. In Cold Damage, purging is not discouraged even if delayed; in seasonal diseases, purging is not discouraged if done early. If heat is severe and constipation occurs within three to five days, purging should be used to preserve Yin fluids. Now, the seasonal pathogen has been mistakenly treated with Cold Damage medicines, supplemented by warm-drying herbs. The intention was likely to move stagnation, but instead, dryness increased binding, fire flared up, and true Yin fluids were depleted. True Yin originates in the Liver and Kidney. The Kidney opens into the ears, the Liver opens into the eyes, the Kidney meridian connects to the base of the tongue, and the Liver meridian winds around the genitalia. Now, with dim vision, deafness, tongue retraction, and testicular contraction, it is evident that intense heat has damaged Yin fluids. This condition is essentially untreatable, yet I speak of a sliver of hope because the pulse still has a root. The severity lies not in the disease itself but in the extensive medicinal errors. The current plan must involve purging. However, the ancients' urgent purging to preserve Yin applies when Yin is not yet injured. Here, purging is late, and Yin is already injured. It is appropriate to use the Yuzhu San method to nourish Yin before employing purging." Thus, I prescribed Shengdi Huang (Rehmanniae Radix) 1 liang, Dang Gui (Angelicae Sinensis Radix) 5 qian, plus Dahuang (Rhei Radix et Rhizoma) 3 qian, Mangxiao (Natrii Sulfas) 2 qian, and Gancao (Glycyrrhizae Radix et Rhizoma) 1 qian. After administration, black stool was passed at night. The next day, fever subsided, and all symptoms receded. Subsequent treatment focused on nourishing Yin and clearing heat. Two days later, I visited again. Banshan greeted me saying: "My relative has gone mad again; what should we do?" I entered and examined him, observing cursing without regard for kinship, confirming manic symptoms. I said: "No harm. Zhang Zhongjing stated that mania after purging resolves with further purging, as the first purge was incomplete." I continued with the previous formula. The next day, the family reported heavier purgation, nearly half a bucket of clean stool, followed by bleeding. I suspected the formula should not cause bleeding. Examining the original prescription, I noticed someone had added Taoren (Persicae Semen) 3 qian. I said: "This explains the bleeding. In Cold Damage, blood stasis syndrome presents with mania-like behavior, resolved by purging blood. Severe cases use Didang Tang, mild cases use Tao Ren Cheng Qi Tang. Now, post-purge mania is not 'mania-like' (ru kuang); why use Taoren to disturb the blood level? Fortunately, the pulse is calm and spirit is peaceful; the condition is manageable. Just take more blood-nourishing prescriptions." Later physicians generally relied on Dihuang (Rehmanniae Radix) and Ejiao (Colla Corii Asini) as main ingredients. Fortunately, no one else interfered, and his illness eventually healed.
Bao Shizhai's Efficacy Record
Bao Shizhai suffered from hematuria for two years without recovery. He later sought my regulation and recovered. He had a Kidney deficiency. Accidentally catching a wind-cold, a certain doctor overused dispersing methods, leading to asthma and inability to lie flat for several days. He urgently summoned me. I said: "Cough originates in the Lung, asthma originates in the Kidney. Lung and Kidney are mother-son organs. Excessive dispersion damages the Lung; the mother organ cannot shelter the son, so the son seeks refuge in the mother, transforming cough into asthma. People with Kidney deficiency often experience this. Now, Kidney Qi is rushing upward; the pulse is large above and small below. Yet, believing wind pathogens remain, further dispersion was applied. No wonder he cannot lie flat due to asthma." I prescribed Duqi Wan (Eight-Ingredient Pill with Rehmannia) in full dosage, adding Ziyi Hutao Rou (Walnut Seed) 3 qian to guide Qi back to the Kidney. One dose cured him. Two years later, he caught a cold again. Another doctor recklessly dispersed, causing asthma and inability to lie flat for three days. He requested my treatment again. I said: "This is identical to the previous case. That doctor is ignorant; why do you have no memory?" He replied: "He treated us at home; I took convenience for granted, not expecting this result." I said: "Nothing else; simply take the previous formula." His wife, anxious about her husband's illness, suddenly developed a laughing disorder, laughing incessantly. She also sought my consultation. Her Left Guan and Cun pulses were very rapid. I said: "Dan Zhong (Conception Vessel area) is the official of the minister, where joy emerges. This is Liver Fire invading the Pericardium Meridian." I prescribed Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) plus Lingyang Jiao (Saiga Tataricae Cornu). The next day, upon my return, her laughing disorder was cured with one dose. However, Bao Shizhai still suffered from nighttime asthma and inability to lie flat, only stabilizing in the second half of the night. I remarked: "Strange! Why was the medicine effective then but not now?" Carefully examining the pulse, it was large above and small below, confirming Kidney Qi failing to grasp. After deep thought, I asked when he took the medicine. He said: "After dinner." I said: "Exactly. Take the medicine before dinner now; it should be effective." The next day, he reported that asthma settled, Qi descended, and he slept peacefully all night. He asked why. I explained: "The medicine guides Qi to the Kidney. Taking it after meals blocks its direct path to the Kidney due to food obstruction, hence ineffective in the first half of the night. By the second half, the medicine gradually takes effect. Taking it before meals, with an empty stomach, allows the medicine to reach the Kidney Meridian directly, then food presses it down, ensuring Kidney Qi grasps it." I advised taking several doses, later increasing the amount tenfold to make pills for long-term use. I also instructed that for any external contraction, do not allow doctors to disperse recklessly, preventing recurrence. I once read *Shishi Milu* (Secret Records of the Stone Chamber), where Chen falsely attributed spells to spirits, invoking Qibo, Leigong, Hua Tuo, and Zhongjing. It was bizarre. His herbal discussions were mediocre, with huge dosages—several taels per herb, one or two jin per formula—which are hard to emulate. However, his idea of distinguishing treatment methods first was rare and unique. Teaching Bao Shizhai to take medicine before meals exemplifies this specific timing method. Medical books are numerous. Except for *Neijing*, *Nanjing*, and Zhang Zhongjing's *Shanghan Lun* and *Jingui Yaolue*, which are flawless, others have biases and merits. Scholars must know how to select and avoid bias. Not reading is inadvisable, but reading requires skill.
Li Dengming's Mania Case Record
Brother Li Dengming, residing in Yanjun Alley, City Interior, near Xianlin Lane behind Zi Gate, was a close friend. Early autumn, he contracted malaria with little sweat. I initially treated him with harmonization, then used Jingyue's Guichai Yin plus Shengdi Huang 1 liang and Jiangpi (Ginger Peel) 3 fen. He achieved profuse sweating and recovered. Knowing he indulged in sex and alcohol, his Yin deficiency was significant. Malaria resolved after three episodes, with little loss of spirit. That night, a fire broke out in the south city. He ordered family members to hold candles and watch from the main gate. Suddenly, he told them: "Did you see Lord Difang pass by just now?" Family said: "No." Dengming said: "How could you not see? He clearly wore a tall hat and blue robe, carrying an umbrella on the left and a banana leaf fan on the right. He just passed. Let's close the door quickly." That night, he went mad, shouting, cursing, making noise, throwing objects, and wielding a kitchen knife to kill his wife, who hid under the bed. His aunt's servant took the knife away, but he cursed and jumped in agitation. Early the next morning, he urgently requested me. His wife begged for help through family members. When I entered, he held a broken bowl to hurt someone. Seeing me, he dropped it and called: "Sixth Brother." Seeing fear in him, sensing I could suppress him, I gathered my spirit, spoke sternly: "Sit down." He sat. "Extend your hand for pulse diagnosis." He complied. His pulse was rapid, large, and irregular, especially strong and large at the Left Guan. I asked why he was acting wildly and wanting to kill his wife. He used obscene language, claiming his wife Wang Shi was having an affair with a fox inside the wall, and that a monkey was fanning his feet with a large fan. I stopped questioning, instructing him to sit properly and stop acting wild, or I would treat him. He agreed. I went to the hall; family reported he was making noise again. Relatives asked for a method. I said: "Diseases enter through deficiency; evil spirits also enter through deficiency. Brother Li had just recovered from malaria, which affects the Shaoyang Gallbladder Meridian. Post-malaria injury leaves the Gallbladder deficient. An evil spirit took advantage of this deficiency to invade the Gallbladder, causing madness. Brother Li usually has the smallest courage, afraid to offend anyone, with a harmonious marriage. Now suddenly wanting to kill, especially someone he loved and respected, indicates madness increases courage, suggesting possession. 'Feng' (Madness) contains 'Feng' (Wind), implying wind characteristics. Severity varies like wind strength; onset/cessation varies like wind gusts. Evil spirits rely on internal wind power. Wood generates wind; Liver and Gallbladder are related. Evil entering Gallbladder borrows its power to agitate the Liver. Wood generates wind, wind generates fire, fire generates phlegm. Phlegm-fire struggle intensifies, disturbing soul and spirit. Fortunately, the evil spirit has just entered, like a stranger in an inn, isolated and easy to expel. If untreated, it settles, nests, wind boosts momentum, fire enhances power, phlegm adds strength, like evildoers forming factions, making expulsion difficult." I prescribed Wendan Tang (Warm the Gallbladder Decoction): Jingzhi Banxia (Prepared Pinellia Rhizoma) 2 qian, Huajuhong (Citrus Reticulatae Pericarpium) 8 fen, Yunfushen (Poria Cocos with Hostwood) 3 qian, Sheng Gancao (Raw Licorice Root) 5 fen, Fu Chao Zhishi (Bran-fried Aurantium Fructus) 7 fen, Xian Zhuru (Fresh Bamboo Shavings) 3 qian, plus Fen Danpi (Moutan Cortex) 2 qian and Longdan Cao (Gentianae Radix) 1 qian, decocted together. Added Zhusha (Cinnabar) 3 fen and Zhu Danzhi (Porcine Bile)少许 mixed for ingestion. This formula specifically drains the Gallbladder, preventing evil spirits from dwelling, while clearing fire and resolving phlegm, depriving the spirit of support. Though simple, it cured him in one dose. Later, I used Shimei Wendan Tang (Ten-Ingredient Warm the Gallbladder Decoction), replacing Renshen (Ginseng Radix) with Shashen (Glehniae Radix) and Shudi (Prepared Rehmanniae Radix) with Shengdi Huang, using heavy doses because Shengdi Huang can tonify the Gallbladder—the method of closing the door after the thief leaves. Four doses restored normal consciousness. This occurred in the 16th year of Jiaqing. I had not yet met Mr. Wang Jiufeng. Later, he heard of this, saw the case record, approved deeply, and we became friends. I regarded him as a senior teacher; he regarded me as a friend beyond age differences.
Chen's Nephew's Mania Case Record
My niece Chen Simu's eldest son, nickname De'er, worked in a Taixing grocery store for many years, over twenty years old. One day he returned suddenly, depressed and unhappy. My sister asked him, but he didn't speak. Days later, he developed madness, unlike Li Dengming's violence, but self-harming. Seeing rope, he wanted to hang himself; seeing a knife, he wanted to cut his throat; seeing a bowl, he wanted to smash it to cut himself. His speech was coherent, mind clear, but he claimed a female ghost was in his abdomen teaching him to seek death, forcing compliance. Family held his hands daily, otherwise he sought objects to harm himself. I learned of this days later and visited. I ordered them to release his hands; he stood motionless. Pulse was intermittent, rapid and slow, fine and weak upon pressure. I knew Yang Qi was severely deficient, possessed by a ghost. I prescribed Shenfu Lizhong Tang (Ginseng, Aconite, and Sijunzi Decoction) plus Huangqi (Astragali Radix), Fushen (Poria Cocos with Hostwood), Guijianyu (Cornus Swinhoei Branch), Zhusha (Cinnabar), Longchi (Fossilia Ossis Mastodi), Hugu (Panther Bone), plus Xionghuang (Realgar) and Shexiang (Moschus) in small amounts. Greatly tonifying Yang Qi and dispelling evil. Using aromatic herbs to open exit paths, I told my sister: "This is a vengeful soul. Invite a high monk to perform offerings. With this medicine, he should recover." After I left, the nephew told my sister: "Others couldn't take my pulse; the ghost prevented it. Uncle took my pulse, and the ghost hid in my belly, afraid to come up. It told me: 'Do not take Uncle's medicine; you will die.'" My sister said: "It fears you taking it. Do not listen." Monks performed offerings, and he took the medicine. Afterward, he said: "He left." The illness healed. Since his Yang Qi was too deficient, I continued prescribing Shenfu Lizhong Tang plus Yuanzhi (Polygalae Radix), Fushen, Huangqi, Gouqi (Lycii Fructus), and Zaoren (Ziziphi Spinosae Semen), advising prolonged use. Even after recovery, he feared sleeping alone. After a month of medication, he normalized. Visiting my home later, I asked about the ghost. Initially evasive, under persistent questioning, he revealed: A young woman from a poor family opposite the Taixing store washed clothes for others. He often sent clothes to her. Her husband suspected infidelity, scolded, then beat her. She hanged herself. He was startled, lost his spirit, crossed the river hastily, unaware she followed. I asked if he had an affair; he denied firmly. He was naturally pure, cautious, and timid, unlikely involved romantically. Perhaps longing due to being unmarried and older. Emotions must not be stirred rashly. This occurred in the 24th year of Jiaqing. Over twenty years later, he went to Northern Jiangsu for business and hanged himself. Strange.
Wu Yusheng's Mania Case Record
Wu Jianlin, name Jiong, was a Shengyuan (licentiate). His eldest son, Yusheng, also a Shengyuan, managed correspondence at Zou Tongyu Salt Shop in Xinyang, Huabei. The shop had vacant rooms unused for long. He liked the quiet and moved in. One day, he went severely mad, slashing his chest with a paper cutter. Shop assistants saved him, leaving several bloody wounds. Ten men helped carry him home due to his strength and distance. At home, though not self-harming, his manic behavior worsened. Medicine failed. Two months passed. Returning from Wu Men, Jianlin visited repeatedly seeking examination. I told my family: "Madmen do not act mad when they see me." They doubted. His home was nearby. One evening, free, I sent word for him to come. After a while, several men carried him in dancing wildly. I went to the hall; he became silent. Like treating Li Dengming, I sat high, ordered him low, maintained solemn demeanor, and took his pulse. Pulse varied large/small, sparse/dense, knotted/hurried. Clearly evil possession. I sternly said: "Leave when you meet me, or I will moxa and needle your Ghost Weeping Acupoint. Though you traveled far, I will tell your father to give you travel expenses." He responded to each statement. My family marveled. Knowing heavy possession and chronic Qi/Blood damage, I first tonified Qi and Yin with Shen (Ginseng) and Di (Rehmannia), plus Xijiao (Rhinoceros Horn - note: substitute with Buffalo Horn in modern context, but text says Xijiao), Lingyang Jiao (Saiga Tataricae Cornu), Hupo (Amber), Zhusha (Cinnabar), Longchi (Fossilia Ossis Mastodi), Hugu (Panther Bone), Guiban (Testudinis Carapax et Plastrum), Lujiao (Cervi Cornu Degelatinatum). Many precious, spiritual herbs to open spirituality and settle soul. Like upright sages sitting majestically, evil cannot rest. Medicine enters, evil feels compelled to leave. Mimicking Yu Xichang's method, I used mutton soup as a guide, allowing evil to exit via fishy odor. Medicine was kept secret from the patient to prevent demons hiding in Gaohuang (deep interior). I instructed Jianlin: "This is indeed a ghost from Xinyang, traveling far. Must invite high monks for offerings and burn much joss paper to fulfill my promise of travel expenses. Only then will medicine work." Jianlin was stingy, so I repeated instructions. Date: April 19th. On the 20th, offerings and medicine were administered; madness cured. On the 21st, during the Toutian Festival, his second son didn't return until late. Search failed next day. Family, pleased with eldest's recovery and dismissing younger son's youth/incompetence, ignored it. Three days later, manager from Jurong Zou Tongyu Salt Shop brought him back. Inquiry revealed: Watching festival late, a big black figure led him. Body involuntary, walking to wilderness, directionless, legs sore but forced to walk. Near dawn, two people argued with the black figure: "That's my grandson, where are you taking him?" Arguing and walking, dawn broke, three vanished. Saw a city, entered, unknown location, no way out. Salt shop opened, asked, realized encounter with ghosts, arrived in Jurong, 100 li from home. Manager, also from Dantu and friendly with Wu family, stayed two days, returned him. Wu Yusheng said: "This must be the ghost attached to me. Burned too little joss paper; ghost unsatisfied. Medicine forced it to leave, so it harmed brother. I always thought burning joss paper was waste. Treating madness proves effective. Disputing quantity is incomprehensible." This occurred in the 8th year of Daoguang.