李曜西子疟症误药几危治效李青原之弟曜西，吾长子之襟兄也。其子于初秋患疟，医者为徐姓，延至八月中，忽请予诊。据云疟本寒少热多，多汗而热难退，徐医连投白虎汤，石膏每用一两，热较减而寒较多，现则寒后不能转热，有气自少腹上冲，疼痛异常，至不能受，约有一时然后渐渐转热痛，随热减热壮而后痛止，胸次饱闷，饮食不进，神情疲败。徐医屡用顺气止痛等法，全然不应，故请斟酌。余问何以用白虎汤?据云因病者热多渴饮，予问渴饮几何?曰热时约饮二十次，每次一茶碗盖。予笑曰：次数虽多，茶碗盖贮茶无几，虽二十次不足两碗，不算大渴，再问病人欲冷饮欲热饮，则专用热饮。予曰：据此则大错矣。书载白虎汤症，必大渴欲冷饮，而后可投，足见虽渴欲饮而不欲冷饮，尚不可投也。况并非大渴且欲热饮乎?且夫治疟之法，必寒能化热而后可愈，岂有寒本少而欲其寒多者乎!夫白虎汤在疟门未尝不用，然必热疟而后可。今症汗多热难解，明系暑疟，暑中兼湿故也。暑乃阴邪，热乃阳邪，岂可徒见其热遂以阴邪，而用阳邪之药耶?此必误用白虎致寒转增，而将暑邪逼入肝肾，以致肝气挟肾气上冲也。曜西问疟乃少阳症，何以转入肝肾?予曰：五脏皆令人疟，而不离乎少阳，少阳胆经，胆在肝叶之下，肝胆相为表里，胆经邪热，为寒所逼，不得外达，则内传于肝，乙癸同源，则又内传于肾，余向诊令郎脉象，肝肾本虚，所谓诸病从虚而入也。当其疟来寒固因寒药而加甚矣。至热邪为寒所遏，欲达不达，转将肝肾之气逼令上冲，以致疼痛异常，神昏气逆，久之而热渐透，疼亦渐止，久之又久而热大透疼乃全止，邪气透而肝肾之气乃宁也。至始尚能食，今则全不能食，皆因石膏诛伐无过，大伤胃阳之故。曜西闻予议论，以为透辟，遂请入诊，诊得脉来沉象，按之弦数，左关尺尤为不静，右关沉而不数，按之无力。予曰：症本暑疟，无服热药之理，奈过服寒凉，邪陷肝肾，非附子理阴煎不可。虽然其法过大，诸公未免疑虑，权以当归建中改生姜为煨姜，投之以观进退。一剂后痛较减而热较易，渐欲饮食，二剂后痛又减而热又易，然肾气仍冲，而疟不能止。予竟用附子理阴煎，曜西尚在游移，予告之曰：桂桂附子之先声也，煨姜炮姜之先声也，归芍熟地之先声也，建中既已有效，又何疑也。建中虽能温中，不能纳肾气补肾阴以托邪也。今用附子理阴，以熟地一两纳气归肾，兼以平肝，即以托邪；加以附子五分、炮姜五分，温中散寒，领邪外达；当归三钱，和阴化疟。斯方也疟可以已，奈何不用，而任疟之缠绵耶?再三开导而后肯用，如方一服，不独肝肾安宁，而疟竟止矣。知者无不以为神奇，适云汀宫保招赴清江，未能一手调理，半月后予自清回，复请往诊，盖其疟已反，他医不敢用原方，虽轻不愈。予仍以原方投之，一剂而愈。愈后连服七剂，疟不复发，而饮食香甜，精神如旧。古人称有是病即有是药，不我欺也。庸庸不知，差若毫厘，谬以千里，戕人性命，如同儿戏，岂不深可痛恨哉。尤可恨者，成效在前，犹执已见，不肯遵循，真所谓下愚不移，不教诲屑者矣。
吴婿疟中又中热治效吴泽之吾婿也，甲午岁馆于孩溪，夏秋之交，天时盛暑，致患暑疟，地无医者，唤舆来城，至晚到家，似无重恙，乃上灯时忽然昏厥，手足抽搐不知人事，惟时作笑，旋又身热如炭，烦躁异常，其时城门已闭，余不及知，天明得信，随即往看，举家慌乱，病者情形实已危急。诊其脉象洪数之中更兼躁急，夜间有刘医来诊，以为中暑。余曰：非也，此中热也，此热中厥阴也。热中足厥阴肝经，故抽搐；热中手厥阴心包，故善笑。中暑之脉数而兼濡，暑乃阴邪也；中热之脉数而兼洪热，乃阳邪也；此又兼躁急，乃素本阴亏；又中阳邪，有孤阳无阴之虑。虽然勿谓全未中暑也，其作疟也，其中暑也。因患疟而来城，由孩溪至城几四十里，至晚方到，则其动身必不早，连日天久不雨，亢热异常，一路烈日当空，四野又无避处，以中暑之虚体，日行于炎热如焚之中，有不中热者乎?故此乃先中暑而后又中热也。为今之计，且治中热，幸未服错药，似尚可救。以大剂犀角地黄汤加羚羊片三钱，犀角入心包以清热，羚羊入肝经以清热，生地辈则养阴清热，以化亢阳，外加竹茹、竹叶、西瓜翠衣凉心清热化痰以为佐，一服后人事渐醒，不复笑而抽搐，然尚神烦谵语，浑身不着一丝，三服后始知着裤，热退神宁。伊长兄渭筠素来友爱，见此十分欣悦，以为全愈。余曰：未也。中热虽解，中暑尚未全解，暑疟尚不得免耳。后果复行作疟，其脉弦数之中总兼躁象，汗出不易。余知阴疟之故，于小柴胡汤多加生地辈甘凉养阴之品，真阴难成而易亏，又系胎疟不能骤止，十数贴后始能霍然。至次年乙未，馆于东马头夏间又患暑疟，张医投以清脾饮，更觉烦热异常，急急回家就医，余仍投以隔岁原方，两剂而愈。
兰如弟鬼病治效兰如七弟吾胞弟也，又受业于予，入泮食饩晶学兼优，学中拱服且素不好色，专恶淫邪，惟信阴阳，未免偏执。道光十三年有友郑某妻病莫治，托求仙方，兰如诚心设坛，乩竟自动降坛，诗句甚属清通，自称清风真人，兰如以为神异。然所降之方全无效验，此不过灵鬼游魂能通文义者之所为，非真仙方也。果仙也，方岂有不验者。奈兰如十分敬信，以为神仙竟可求而至。十四年元旦乃兰如花甲寿辰，忽独自一人辟居云台山道院，托言持斋诵经报母，半月后回家开馆，而早晚独处密室，不许他人窥伺，惟闻檀降香气彻夜不绝。吾弟兄久已分居，伊继室年轻不知道理，二三小儿女更不知事，听其所为，吾家竟毫无闻见，百日后兰如怡然自得，偶与余晤，谓吾子皆能诚信，将来欲传之以道。予询何道，谓予不信，笑而不言，予亦置之。忽于秋间伊家传兰如往往彻夜不眠，似与人吵闹，不知何故?中秋日兰如进城敬香，顺至于家似有话说，予适不在，怏怏而去。据内人云：七爷神情恍惚，消瘦异常，近闻其家称有鬼缠闹，光景逼真。奈何予因终日诊病，未能得暇，因思二十二日秋分年例祭祠，伊最重祀先，是日必到，可以面察情形。于是前期约伊早会，是日与合族在祠专候，直至日午而兰如不来，特着人往请，竟辞以病。予更着仆人率舆夫四人将舆前去强接而至，至则在祖先前伏地大哭，口称我如何该如此死法；且称我如此伤痛，他竟不许我眼泪出来。众人拉劝不起，予亲自扶起，见其面果无滴泪，予曰：据弟言是有鬼矣。论治鬼予实有专长，弟无虑也。祀事毕后，唤舆同至予家，予细加盘问此鬼从何而来，伊尚含糊，予笑曰：弟虽不言，吾已知之矣。此弟炼笔录招来之鬼也。兰如惊曰：兄何以知吾炼笔录?予曰：弟之生性志诚而愚，素信鬼神，闻去冬弟为郑姓设坛扶乩，居然有甚清风真人降坛，此不过一鬼耳。夫秦皇汉武求神仙而不得，千古奉以为戒，岂有我辈凡人设此乩坛即有神仙下降者。故夫今之扶乩者有二，一则全无凭借，自画砂盘，假托神仙，以之愚人；一则或遇游魂，居然乱动，误认神仙，转以自愚。究之愚人之害尚小，而自愚之害则不可胜言也。故夫清风真人实鬼也，而弟直以为仙也，神仙既可求而至，何不竟炼笔录使仙与我合而为一也。故弟吃报母斋至百日者，实炼笔录也。他人炼笔录十无一成，而弟独能成者，有现成清风之鬼魂，鬼欲附弟，而弟又求鬼，故一炼而成也。弟与鬼初合之时必有彼此相契之意，故弟以为神奇，而且欲传诸侄也。久之而鬼附人身有何好处，自然转生恶念，欲害弟命，鬼本利人之死也，甚且鬼生痴念，冀弟死而伊即借躯壳以回生，若此则逞其魑魅魍魉之术无所不至矣。愚揣度如此，然乎否乎?兰如曰：人鬼情形，皆被兄道尽矣。弟实因扶乩有灵而炼笔录，附弟者即清风真人，伊称前生文士，位列桂宫，五六两月以来常作诗文，文笔清挺，且甚敏捷，所作古风大有古气，非弟所能，弟深佩服，以此日复一日，契合甚笃，凡所谈论，无非文章道义。不意七月间伊忽语涉淫邪，弟切责之，伊亦托戏言而止。弟家素供观音圣像，十五日弟清早敬香，伊忽于圣像头顶幻出大红鞋小脚一双，弟不觉大怒，责问何亵渎神灵，无礼至此。伊言初亦善念，今不知何故变为恶念，如肯淫欲，可以相安，否则必致弟命而后已。从此之后，日以淫词亵语聒噪不已，偶见少妇略施脂粉，伊即幻其全身一丝不着，蛊惑弟心，甚即见一油头背面，伊即幻出背面全体以相惑，致弟不敢见妇人之面。八月以来，伊见弟心不动，遂于夜间作闹，使弟不能安眠，眠则幻作淫梦，欲遗而醒，弟谕以既然不合，何不便去?伊言能来不能去，已与我合气，除非弟死，伊方能去。弟言我亦何能即死?伊言或刀或绳，皆是死法，否则耗尽精神，亦不愁弟不死。弟不听其言，伊彻夜吵闹，睡则抓心，弟已八夜不沾床不合睫矣。伊言弟命亦在早晚，今见兄面不过一别而已。予笑曰：弟何愚也，死生有命，鬼何能为?且此鬼欲弟死而不能死弟，乃欲弟自觅刀绳，其伎俩亦可鄙之至，弟何惧焉！予又若与鬼言曰：尔既通文义，当知情理，吾弟如此敬尔，乃忽诱之以淫，且惧之以死，反脸无情，天良丧尽，足见尔生前有文无行，淫恶多端，天理不容，以致绝子绝孙，死后游魂无所依归，不自修省，犹思害入耳。然吾笑尔有害人之心，无害人之力，且有我在，我将以药治尔，不去则以火在鬼哭穴灸尔，不去则以针在十三穴刺尔，看尔如何当受。据弟云：鬼在腹中不时说语，似以说话为生气，弟与他人言，伊即怪弟不听伊言，更加吵闹，其音聚于耳底，竟致不辨人言。今与兄言，伊即不吵，且若静听，不知何故。予闻之暗喜，据云鬼乃教门，不许弟吃猪肉。予是晚大烹肉食，强弟大嚼；据云鬼遇饮食之馨香者，虽相隔甚远而能嗅其气味由鼻入腹；予以大蒜汁调雄黄、朱砂末，令弟先涂鼻窍而后食，鬼竟不敢复嗅，盖鬼不能饮食，惟借馨香之气味以为养，每饭肉食既为其所恶，而雄黄、朱砂又为其所畏，间有合式之馨香又不敢嗅，则失所养而鬼气亦渐衰矣。予因谓弟曰：治鬼易，治心难，妖由人兴，鬼不自作。弟读孔圣之书，而于敬鬼神而远之一语全不领略，心多妄念，致受此累，从今以后，当正其心，不可信鬼，不必惧鬼，任彼多言，弟只将心拿定，听而不闻，鬼术自穷。而予又以药治之，不愁其不消灭也。是夜予与对床而眠，先制安神定魄，扶正辟邪汤药，临卧与服，又以云汀宫保所书"天地正气"四字，每字上有两江总督朱印，向闻字能辟火，兹又以之辟邪，悬于床后。又有家藏真藏香，嘱人于弟卧床后暗暗点起，予亲视弟卧，见其小衣不去，知其为夜间不眠地也。予责之曰：我再三教汝不要惧他，汝胆怯如此，鬼安得不放肆耶。逼令尽去小衣，且令人将衣远置他处，告之曰：有我在此，保汝安眠，不必作中夜起舞之想也。先是鬼不独不许弟安眠，且诱以彻夜舞蹈，因炼笔录时有持笔手舞一法，鬼诱以如此而来仍须如此而去，实欲耗其精神也。故我言及此，是夜弟竟熟睡至辰正方觉，予亦适寤，偶然一咳，据弟云鬼闻咳声在腹内吓得跄了三跄。予更暗喜，知予必能治之也。于是第款留在家，暇则以言语治其心，晚则以药石治其鬼，夜夜安眠，精神渐振。然鬼无我在前仍刺刺不休，服药后较为安静，而日间尚在胸次拱胀作祟，于是另制丸药，早服三钱，午服三钱，晚则进药，鬼势渐弱。一日弟述其言曰；令兄医道虽好，但我与尔合神，必欲治我，岂非两败俱伤耶!予笑曰：伊自称文士，究竟不通，夫神藏于心，神合则心合，心合则式好无尤矣。今弟现深恶而痛疾之，心之不合甚矣，尚何合神之有?彼此说话不过借气耳，弟如能听而不闻，将气亦不能借，尚望合神耶?一日弟又述其言曰：伊连日深自悔恨，先本欲致弟命借躯壳以回生，不意百般淫诱竟不动心，真是个正经人；又遇见令兄医道高明，连鬼之情形无不灼见，真乃我前生作孽，反陷于此，进退无法，望你转恳令兄设一良法，让我离去，感激不尽。予曰：借躯壳以回生，本其不通之想，世有暴死而鬼附以生者，其精血本尚存也。今伊欲弟淫欲而死，必定精枯髓竭，所谓无用之躯壳，伊些须鬼气即能回生耶?今伊既愿去，伊从何处来仍从何处去耳，何必求予。弟又述伊答言曰：伊本从口鼻而来，今屡次欲从口鼻挣出，竟不能去奈何?予曰：清窍即不能去，浊窍亦可去，伊尚嫌秽耶?数日后弟又述其言曰：伊言令兄分咐浊窍可去，实属出路，我此时亦不嫌秽，但我屡次欲由浊窍挣出亦不能去，转恳令兄用药之中加何药品使我乘势而去，感恩无尽。予笑曰：小鬼头，敢欺我耶。夫正气旺则鬼气衰，正气衰则鬼气旺，一定之理也。今见弟正气渐旺，伊之鬼气渐衰，从前恐吓之术不行，乃为哀怜之语，骗汝以骗子，以为予即可信其言，因于药巾加大黄、巴豆之类，大为攻下，冀其乘势而去，其实伊仅鬼气耳，大黄巴豆攻下有形之物，不能攻下无形之气，徒致无故攻下正气大伤，鬼气复旺，将更作祟，使予难治，伊视我为何如，乃敢如此见欺耶。
【案例一】李曜西患疟疾，因误用药物几乎丧命，经正确治疗后痊愈
李曜西是吴青原的弟弟，也是我长子的表兄。他的儿子在初秋时节患上疟疾，医生姓徐，治疗持续到八月中旬，突然请我去诊治。据徐医生说，患者原本表现为寒少热多，出汗多且发热难以退去。徐医生连续使用白虎汤（清热生津剂），每剂石膏用量达一两，虽然热度略有减退，但恶寒症状反而加重，现在出现发冷后无法转为发热的情况，有一股气从小腹向上冲逆，疼痛异常剧烈，甚至让人无法忍受，大约持续一段时间后，才逐渐转为发热并伴随疼痛，随着热度消退、体温升高，疼痛才停止。患者胸部憋闷饱胀，饮食不进，精神疲惫萎靡。徐医生多次采用顺气止痛等方法，完全无效，因此请我斟酌定夺。
我问：“为什么使用白虎汤？”他回答说：“因为病人发热多且口渴想喝水。”我又问：“口渴饮水多少？”他说：“发热时大约喝二十次，每次约一碗盖的茶量。”我笑着说：“次数虽多，但碗盖盛茶很少，即使二十次也不到两碗，算不上大渴。再问病人是想喝冷饮还是热饮？”回答说是专门喝热饮。我说：“据此判断，这就大错特错了。医书记载白虎汤证，必须是大渴且想喝冷饮，才可以投药，足见即使是口渴想喝水但不想喝冷饮，尚且不可投用，何况并非大渴且想喝热饮呢？况且治疗疟疾的方法，必须是寒能化热才可以痊愈，哪有本来寒少却希望它寒多的道理！白虎汤在疟疾门中并非不用，但必须是热疟才可以。现在的症状是汗多热难解，明显属于暑疟，是因为暑邪兼夹湿邪所致。暑乃阴邪，热乃阳邪，岂可只看到热象就把它当作阴邪，而使用针对阳邪的药物呢？这一定是误用白虎汤导致寒气转增，将暑邪逼迫进入肝肾，导致肝气挟带肾气上冲。
曜西问：‘疟疾本是少阳病，怎么会转入肝肾呢？’我回答说：‘五脏都能令人患疟，但不离乎少阳。少阳胆经，胆位于肝叶之下，肝胆互为表里。胆经的邪热被寒气逼迫，不能向外透达，就会向内传入肝脏；乙癸同源（肝肾同源），又会进一步内传于肾脏。我之前诊察令郎的脉象，发现肝肾本虚，这就是所谓的‘诸病从虚而入’。当疟疾发作时，寒症固然因为用了寒凉药而加重。至于热邪被寒气遏制，想要透达却无法透达，转而逼迫肝肾之气上冲，导致疼痛异常、神志昏蒙、气机上逆。久而久之，热气逐渐透出，疼痛也渐渐停止；更久之后，热气完全透出，疼痛才彻底停止，邪气透出，肝肾之气才能安宁。起初还能进食，现在完全不能进食，都是因为石膏过度攻伐无辜，严重损伤了胃阳的缘故。
曜西听了我的议论，认为透彻精辟，于是请我入内诊脉。诊得脉象沉取可见，按之弦数，左关尺部尤为不宁静，右关部沉而不数，按之无力。我说：‘病症本是暑疟，没有服用热药的理法，奈何过服寒凉药物，导致邪气陷入肝肾，非附子理阴煎不可。虽然此法药力较大，各位先生未免疑虑，暂且改用当归建中汤，将生姜改为煨姜，投药以观察进退。’服用一剂后，疼痛减轻，发热变得容易透发，逐渐有食欲；服用两剂后，疼痛又减，发热更易透发，但肾气仍上冲，疟疾未能停止。我最终决定使用附子理阴煎，曜西还在犹豫，我告诫他说：‘桂枝、附子是温阳药的先声，煨姜、炮姜也是温中药的先声，当归、芍药、熟地也是滋阴养血药的先声。建中汤既然已经有效，还有什么可怀疑的呢？建中汤虽然能温中，但不能纳肾气、补肾阴以托举邪气外出。现在使用附子理阴煎，用一两熟地纳气归肾，兼以平肝，以此托邪外出；加上五分附子、五分炮姜，温中散寒，引领邪气外达；三钱当归，调和阴血以治疟。这个方子疟疾可以治愈，为何不用，而任由疟疾缠绵不去呢？’经过再三开导，他才肯用药。如方服用一剂，不仅肝肾安宁，疟疾竟然停止了。知情的人无不认为是神奇疗效。恰逢云汀宫保召我去清江，未能一手调理，半个月后我从清江回来，再次前往诊治，原来他的疟疾复发，其他医生不敢用原方，虽然药量轻但无效。我仍然使用原方投药，一剂即愈。痊愈后连服七剂，疟疾未再复发，饮食香甜，精神恢复如初。古人说‘有是病即有是药’，确实没有欺骗我。庸医无知，差之毫厘谬以千里，残害人性命如同儿戏，难道不令人深深痛恨吗？更可恨的是，疗效就在眼前，却固执己见，不肯遵循，真所谓下愚不移，不屑于教诲之人。
【案例二】吴泽患疟疾，中途又感受热邪，经正确治疗后痊愈
吴泽是我的女婿。甲午年他在孩溪教书，夏秋之交，天气酷热，导致他患上暑疟。当地没有医生，叫来轿子进城，到了晚上到家，看似没有重病，但在点灯时突然昏厥，手足抽搐，不知人事，只是不时发出笑声，随即身体热得像炭火一样，烦躁异常。当时城门已关闭，我来不及得知消息，天亮后得到信，随即前往查看，全家慌乱，病人的情形确实危急。诊其脉象洪数之中更兼躁急。夜间有刘医生来诊，认为是中暑。我说：‘不对，这是中热，是热邪中于厥阴经。’热邪中于足厥阴肝经，所以抽搐；热邪中于手厥阴心包经，所以善笑。中暑的脉象数而兼濡，暑乃阴邪；中热的脉象数而兼洪热，乃阳邪；这里又兼躁急，说明素体阴亏；又中了阳邪，有孤阳无阴的忧虑。虽然不能说完全没有中暑，但他患疟疾而来城，从孩溪到城将近四十里，到晚上才到，那么动身必然不早。连日来天久不雨，亢热异常，一路烈日当空，四野无处躲避，以中暑后的虚弱体质，白天行走在炎热如焚的环境中，能不中热吗？所以这是先中暑后又中热。目前的计策，先治中热，幸好没有服错药，似乎还可以救治。用大剂犀角地黄汤加羚羊片三钱，犀角入心包以清热，羚羊入肝经以清热，生地等则养阴清热，以化解亢盛的阳气，外加竹茹、竹叶、西瓜翠衣凉心清热化痰作为佐使。服用一剂后，人事逐渐清醒，不再笑也不再抽搐，但仍然心烦谵语，浑身燥热不愿穿衣，服用三剂后才知要穿裤子，热退神宁。他的长兄渭筠向来友爱，见此十分高兴，以为全愈。我说：‘还没好。中热虽然解除，中暑尚未全解，暑疟还不能免除。’后果然再次发作疟疾，脉象弦数之中总兼躁象，汗出不易。我知道这是阴疟的缘故，在小柴胡汤中多加生地等甘凉养阴之品。真阴难成而易亏，又是胎疟不能骤然停止，十数帖后才霍然痊愈。到了次年乙未年，在东马头教书，夏天又患暑疟，张医生投以清脾饮，更加觉得烦热异常，急忙回家就医，我仍然投以隔年的原方，两剂即愈。
【案例三】兰如弟患鬼病，经正确治疗后痊愈
兰如是我的七弟，也是我的学生，考中秀才，学业兼优，在学校受人佩服，且平时不好色，专恶淫邪，唯独迷信阴阳，未免偏执。道光十三年，有位朋友郑某的妻子病重无法医治，委托求仙方。兰如诚心设坛扶乩，乩盘竟自动降坛，诗句非常清雅通顺，自称清风真人，兰如认为很神异。然而所降的方子完全无效验，这不过是灵鬼游魂中能通文义者所为，并非真正的仙方。如果是真仙，方子岂有不灵的？无奈兰如十分敬信，以为神仙真的可以求得而至。十四年元旦是兰如六十岁寿辰，忽然独自一人隐居在云台山道院，托言持斋诵经报答母亲。半个月后回家开课，但早晚独处密室，不许他人窥视，只闻到檀香香气彻夜不绝。我们兄弟早已分居，他的继室年轻不懂事，几个儿女更不知事，听任他所为，我家竟然毫无闻见。一百天后兰如怡然自得，偶然与我见面，说他的儿子们都能诚信，将来想把道传授给他们。我问是什么道，他说我不信，笑着不说话，我也置之不理。
忽然在秋天，他家传来消息，说兰如往往彻夜不眠，好像与人吵闹，不知什么原因？中秋节那天兰如进城敬香，顺便回家似有话要说，我不在，他怏怏而去。据我夫人说：七爷神情恍惚，消瘦异常，最近听说他家称有鬼缠闹，光景逼真。奈何我因终日诊病，未能得暇，想到二十二日秋分是按例祭祀祖先的日子，他最重视祀先，那天一定会到，可以当面察看情形。于是提前约他早会，那天与合族人在祠堂专候，直到中午兰如不来，特意派人去请，竟推辞有病。我更派仆人率四名轿夫抬着轿子前去强行接至家中，到了则在祖先牌位前伏地大哭，口称‘我该如何死法’；又说‘我如此伤痛，他竟不许我眼泪出来’。众人拉劝不起，我亲自扶起，见他脸上果然没有一滴泪，我说：‘据弟弟说有鬼了。论治鬼我实有专长，弟弟不用担心。’祭祀完毕后，叫轿子一同到我家里，我仔细盘问此鬼从何而来，他还含糊其辞，我笑着说：‘弟弟虽不言，我已经知道了。这是弟弟通过炼笔录招来的鬼。’兰如惊讶地问：‘哥哥怎么知道我在炼笔录？’我说：‘弟弟生性志诚而愚，素信鬼神，听说去年冬天弟弟为郑家设坛扶乩，居然有甚么清风真人降坛，这不过是一鬼罢了。秦始皇汉武帝求神仙而不得，千古奉以为戒，岂有我辈凡人设此乩坛就有神仙下降的道理？所以如今的扶乩者有两种人，一种全无凭借，自己画砂盘，假托神仙，用来愚弄愚人；一种或遇到游魂，居然乱动，误认神仙，反而自愚。究其结果，愚人之害尚小，而自愚之害则不可胜言。所以那清风真人其实是鬼，而弟弟直以为是仙。既然神仙既可求而至，何不竟炼笔录使仙与我合而为一呢？所以弟弟吃报母斋至百日者，实则是炼笔录。别人炼笔录十无一成，而弟弟独能成者，是有现成的清风之鬼魂，鬼欲附弟弟，而弟弟又求鬼，所以一炼而成。弟弟与鬼初合之时必有彼此相契之意，所以弟弟以为神奇，而且欲传给侄子们。久而久之，鬼附人身有何好处，自然转生恶念，欲害弟弟性命。鬼本利人之死，甚且鬼生痴念，希望弟弟死而它借躯壳回生，若此则逞其魑魅魍魉之术无所不至矣。我推测是这样，对吗？’兰如说：‘人鬼情形，都被哥哥道尽了。我实在因扶乩有灵而炼笔录，附在我身上的就是清风真人，它称前生是文士，位列桂宫，五六两个月来常作诗文，文笔清挺，且甚敏捷，所作古风大有古气，不是我所能，我深佩服，以此日复一日，契合甚笃，凡所谈论，无非文章道义。不料七月间它忽言语涉淫邪，我切责之，它也托戏言而止。我家素供观音圣像，十五日清晨我敬香，它忽于圣像头顶幻出大红鞋小脚一双，我不觉大怒，责问何亵渎神灵，无礼至此。它说初亦善念，今不知何故变为恶念，如肯淫欲，可以相安，否则必致我死而后已。从此之后，日以淫词亵语聒噪不已，偶见少妇略施脂粉，它即幻其全身一丝不着，蛊惑我心，甚即见一油头背面，它即幻出背面全体以相惑，致我不敢见妇人之面。八月以来，它见我心动，遂于夜间作闹，使我不能安眠，睡则幻作淫梦，欲遗而醒。我谕以既然不合，何不便去？它言能来不能去，已与我合气，除非我死，它方能去。我说我亦何能即死？它言或刀或绳，皆是死法，否则耗尽精神，亦不愁我不死。我不听其言，它彻夜吵闹，睡则抓心，我已八夜不沾床不合睫矣。它言我命亦在早晚，今见哥哥面不过一别而已。’
我笑着说：‘弟弟何愚也，死生有命，鬼何能为？且此鬼欲你死而不能使你死，乃欲你自觅刀绳，其伎俩亦可鄙之至，弟弟何惧焉！’我又装作对鬼说：‘你既通文义，当知情理，吾弟如此敬你，乃忽诱之以淫，且惧之以死，反脸无情，天良丧尽，足见你生前有文无行，淫恶多端，天理不容，以致绝子绝孙，死后游魂无所依归，不自修省，犹思害人耳。但我笑你有害人之心，无害人之力，且有我在，我将以药治你，不去则以火在鬼哭穴灸你，不去则以针在十三穴刺你，看你如何当受。’据弟弟说：‘鬼在腹中不时说话，似以说话为生气，弟弟与他人言，它即怪弟弟不听它言，更加吵闹，其音聚于耳底，竟致不辨人言。今与哥哥言，它即不吵，且若静听，不知何故。’我闻之暗喜。据弟弟说鬼乃教门，不许弟弟吃猪肉。我当晚大烹肉食，强弟弟大嚼；据弟弟说鬼遇饮食之馨香者，虽相隔甚远而能嗅其气味由鼻入腹；我以大蒜汁调雄黄、朱砂末，令弟弟先涂鼻窍而后食，鬼竟不敢复嗅，盖鬼不能饮食，惟借馨香之气味以为养，每饭肉食既为其所恶，而雄黄、朱砂又为其所畏，间有合式之馨香又不敢嗅，则失所养而鬼气亦渐衰矣。
我因而对弟弟说：‘治鬼易，治心难，妖由人兴，鬼不自作。弟弟读孔圣之书，而于“敬鬼神而远之”一语全不领略，心多妄念，致受此累，从今以后，当正其心，不可信鬼，不必惧鬼，任彼多言，弟弟只将心拿定，听而不闻，鬼术自穷。而我又以药治之，不愁其不消灭也。’是夜我与他对床而眠，先制安神定魄、扶正辟邪汤药，临卧与服，又以云汀宫保所书“天地正气”四字，每字上有两江总督朱印，向闻字能辟火，兹又以之辟邪，悬于床后。又有家藏真藏香，嘱人于弟弟卧床后暗暗点起，我亲视弟弟卧，见他小衣不去，知其为夜间不眠之地也。我责之曰：‘我再三教你不要惧他，你胆怯如此，鬼安得不放肆耶。’逼令尽去小衣，且令人将衣远置他处，告之曰：‘有我在此，保汝安眠，不必作中夜起舞之想也。’先是鬼不独不许弟弟安眠，且诱以彻夜舞蹈，因炼笔录时有持笔手舞一法，鬼诱以如此而来仍须如此而去，实欲耗其精神也。故我言及此，是夜弟弟竟熟睡至辰方才觉，我也适寤，偶然一咳，据弟弟说鬼闻咳声在腹内吓得跄了三跄。我更暗喜，知予必能治之也。于是第款留在家，暇则以言语治其心，晚则以药石治其鬼，夜夜安眠，精神渐振。然鬼无我在前仍刺刺不休，服药后较为安静，而日间尚在胸次拱胀作祟，于是另制丸药，早服三钱，午服三钱，晚则进药，鬼势渐弱。
一日弟弟述其言曰：‘令兄医道虽好，但我与尔合神，必欲治我，岂非两败俱伤耶！’我笑着说：‘伊自称文士，究竟不通。夫神藏于心，神合则心合，心合则式好无尤矣。今弟弟现深恶而痛疾之，心之不合甚矣，尚何合神之有？彼此说话不过借气耳，弟弟如能听而不闻，将气亦不能借，尚望合神耶？’
一日弟弟又述其言曰：‘伊连日深自悔恨，先本欲致弟弟命借躯壳以回生，不意百般淫诱竟不动心，真是个正经人；又遇见令兄医道高明，连鬼之情形无不灼见，真乃我前生作孽，反陷于此，进退无法，望你转恳令兄设一良法，让我离去，感激不尽。’我说：‘借躯壳以回生，本其不通之想。世有暴死而鬼附以生者，其精血本尚存也。今伊欲弟弟淫欲而死，必定精枯髓竭，所谓无用之躯壳，伊些须鬼气即能回生耶？今伊既愿去，伊从何处来仍从何处去耳，何必求予。’
弟弟又述伊答言曰：‘伊本从口鼻而来，今屡次欲从口鼻挣出，竟不能去奈何？’我说：‘清窍即不能去，浊窍亦可去，伊尚嫌秽耶？’
数日后弟弟又述其言曰：‘伊言令兄吩咐浊窍可去，实属出路，我此时亦不嫌秽，但我屡次欲由浊窍挣出亦不能去，转恳令兄用药之中加何药品使我乘势而去，感恩无尽。’我笑着说：‘小鬼头，敢欺我耶。夫正气旺则鬼气衰，正气衰则鬼气旺，一定之理也。今见弟弟正气渐旺，伊之鬼气渐衰，从前恐吓之术不行，乃为哀怜之语，骗汝以骗子，以为予即可信其言，因于药巾加大黄、巴豆之类，大为攻下，冀其乘势而去，其实伊仅鬼气耳，大黄巴豆攻下有形之物，不能攻下无形之气，徒致无故攻下正气大伤，鬼气复旺，将更作祟，使予难治，伊视我为何如，乃敢如此见欺耶。’
[Case 1] Li Yaoxi suffered from malaria, nearly died due to misprescription, and was cured after correct treatment.
Li Yaoxi was the younger brother of Wu Qingyuan and the cousin of my eldest son. His son contracted malaria in early autumn. The attending physician surnamed Xu treated him until mid-August, when he suddenly invited me for consultation. According to Dr. Xu, the patient originally presented with less chills and more fever, profuse sweating, and difficult-to-resolve fever. Dr. Xu consecutively administered Baihu Tang (White Tiger Decoction), using Shigao (Gypsum Fibrosum) at a dosage of one tael per dose. Although the fever slightly subsided, the chills increased. Currently, after chills, the body fails to transition into fever. There is a sensation of Qi rushing upward from the lower abdomen, causing excruciating pain that is unbearable. After approximately one hour, the condition gradually transitions into fever accompanied by pain. As the heat subsides and the body temperature rises, the pain ceases. The patient experiences chest fullness and oppression, loss of appetite, and mental exhaustion. Dr. Xu repeatedly employed methods to regulate Qi and relieve pain without effect, hence seeking my advice.
I asked, "Why was Baihu Tang used?" He replied, "Because the patient had frequent fever and thirst." I asked, "How much water did he drink?" He said, "During fever episodes, he drank about twenty times, each time roughly the amount held by a teacup lid." I smiled and said, "Although frequent, the volume per cup is small; twenty cups do not equal two bowls, which does not constitute extreme thirst. Did you ask if he desired cold or hot drinks?" He answered that he exclusively drank hot liquids. I said, "Based on this, the diagnosis is fundamentally flawed. Medical texts state that Baihu Tang is indicated only for cases of extreme thirst desiring cold drinks. Thus, even if there is thirst, if cold drinks are not desired, the formula should not be used. How much less so when there is no extreme thirst and hot drinks are desired? Furthermore, the treatment principle for malaria requires the resolution of chills into heat for recovery. How can one wish for increased chills when they were originally scarce? Baihu Tang is indeed used in malaria, but only for 'heat malaria.' The current symptoms of profuse sweating and unresolved fever clearly indicate 'summerheat malaria' caused by summerheat combined with dampness. Summerheat is a Yin pathogen, while heat is a Yang pathogen. One cannot simply see heat and treat it as a Yin pathogen using Yang-pathogen-targeting drugs. This error likely caused the increase in coldness, forcing the summerheat pathogen into the Liver and Kidney meridians, leading to Liver Qi carrying Kidney Qi upward.
Yaoxi asked, "Malaria is a Shaoyang disease; how did it transfer to the Liver and Kidney?" I replied, "All five Zang organs can cause malaria, but it is never separate from Shaoyang. The Shaoyang Gallbladder meridian: the Gallbladder lies beneath the liver lobes, and the Liver and Gallbladder are interior-exteriorly related. When Shaoyang pathogenic heat is constrained by cold and cannot reach the exterior, it transmits inward to the Liver. Since Liver (Wood/Yi) and Kidney (Water/Gui) share the same source, it further transmits to the Kidney. Previously, upon examining your son's pulse, I found inherent deficiency in the Liver and Kidney, illustrating the principle that 'all diseases enter through deficiency.' The chills worsened due to the use of cold medicines. The heat pathogen, constrained by cold, could not vent outward, instead forcing Liver and Kidney Qi to rush upward, causing severe pain, confusion, and rebellious Qi. Over time, heat gradually vents, and pain subsides; eventually, complete venting stops the pain entirely, calming the Liver and Kidney Qi. The initial ability to eat has been lost because Gypsum excessively attacked non-pathogenic factors, severely damaging Stomach Yang.
Hearing my analysis, Yaoxi found it penetrating and invited me to examine him. The pulse was deep, wiry, and rapid upon pressure, particularly restless in the left Guan and Chi positions. The right Guan was deep, not rapid, and weak upon pressure. I said, "The disease is summerheat malaria; there is no rationale for using hot medicines. However, excessive use of cold medicines has trapped the pathogen in the Liver and Kidney. Fuzi Liyin Jian (Aconite Decoction to Nourish Yin) is indispensable. Although this method is potent and may cause concern, let us temporarily use Danggui Jianzhong Tang (Angelica Decoction to Reconstruct the Middle), substituting fresh ginger with baked ginger, to observe the response." After one dose, pain decreased, and fever became easier to resolve, with appetite returning slightly. After two doses, pain decreased further, and fever resolved more easily, yet Kidney Qi still rushed upward, and malaria persisted. I ultimately decided to use Fuzi Liyin Jian. Yaoxi hesitated. I advised, "Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root) are precursors to warming Yang herbs; baked ginger and paogjiang (prepared ginger) are precursors to warming the middle; Danggui (Angelica Sinensis), Baishao (White Peony Root), and Shudi (Prepared Rehmannia Root) are precursors to nourishing Yin. If Jianzhong Tang showed efficacy, why doubt this? Jianzhong Tang warms the middle but cannot anchor Kidney Qi or nourish Kidney Yin to expel pathogens. Now, using Fuzi Liyin Jian, one taels of Shudi anchors Qi to the Kidney and soothes the Liver to support pathogen expulsion; added with 0.5 qian of Fuzi and 0.5 qian of Paogjiang to warm the middle and scatter cold, guiding pathogens outward; and 3 qian of Danggui to harmonize Yin and treat malaria. This formula will cure the malaria. Why refuse and allow it to linger?" After repeated persuasion, he agreed. One dose brought peace to the Liver and Kidney, and the malaria stopped immediately. Those knowledgeable considered it miraculous. Coincidentally, Governor Yun Ting summoned me to Qingjiang, preventing continuous care. Half a month later, upon my return, the malaria relapsed. Other physicians dared not use the original formula, and light dosages failed. I reused the original formula; one dose cured him. Seven additional doses prevented recurrence, restoring appetite and spirit. As the ancients said, 'For every disease, there is a corresponding medicine,' which proves true. Ignorant physicians err by miles, harming lives like children's play, which is truly hateful. Worse, despite visible efficacy, they cling to their views, refusing to follow proven methods—truly the 'lowest intelligence' unworthy of teaching.
[Case 2] Wu Ze contracted malaria, then suffered from heat stroke during travel, and was cured after correct treatment.
Wu Ze was my son-in-law. In the year Jiawu, he taught in Haixi. During the transition from summer to autumn, intense weather led to summerheat malaria. With no local doctors, he hired a sedan chair to go to the city. Arriving late at night, he seemed unwell but not critical. However, at dusk, he suddenly fainted, convulsed, lost consciousness, laughed intermittently, and his body became as hot as charcoal with extreme irritability. City gates were closed, so I was unaware until dawn. Rushing to his home, I found the family panicked and the patient critical. His pulse was surging and rapid, yet restless. Dr. Liu visited at night, diagnosing summerheat stroke. I said, "Incorrect. This is 'Zhong Re' (Heat Stroke/Heat Pathogen Invasion), specifically affecting the Jueyin meridians." Heat invading the Foot Jueyin Liver meridian causes convulsions; heat invading the Hand Juexin Pericardium meridian causes laughter. Summerheat stroke presents with a rapid, soggy pulse (summerheat is Yin); heat invasion presents with a rapid, surging, hot pulse (heat is Yang). The restlessness indicates inherent Yin deficiency compounded by Yang pathogen invasion, risking isolated Yang without Yin. Although he did suffer some summerheat, the primary issue is heat. Traveling forty li from Haixi to the city under relentless sun with a depleted constitution guaranteed heat invasion. Thus, it was first summerheat, then heat. The priority is treating the heat invasion, provided no wrong medicines were taken. I prescribed a large dose of Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) plus 3 qian of Lingyang Pian (Antelope Horn Slices). Xijiao clears heat from the Pericardium; Lingyang clears heat from the Liver; Shengdi nourishes Yin and clears heat to subdue hyperactive Yang. Added Zhuru (Bamboo Rind), Zhuye (Bamboo Leaf), and Xigua Cuiyi (Watermelon Rind) to cool the heart, clear heat, and resolve phlegm. After one dose, consciousness returned, laughter and convulsions ceased, though irritability and delirium persisted, and he refused clothing. After three doses, he accepted wearing pants, fever subsided, and spirit calmed. His elder brother Weiyun was delighted, thinking he was cured. I said, "Not yet. Heat invasion is resolved, but summerheat remains, and malaria persists." Indeed, malaria recurred with a wiry, rapid, restless pulse and difficult sweating. Recognizing Yin malaria, I modified Xiaochaihu Tang (Minor Bupleurum Decoction) with generous amounts of Shengdi and other sweet-cool Yin-nourishing herbs. True Yin is hard to build and easy to lose; chronic malaria cannot stop abruptly. After ten-plus doses, he recovered fully. In the following year Yiwu, teaching at Dongmatou, he again contracted summerheat malaria. Dr. Zhang prescribed Qingpi Yin (Clear the Spleen Drink), worsening irritability. He returned home urgently. I reused the previous year's formula; two doses cured him.
[Case 3] Brother Lanru suffered from a 'ghost illness,' cured after correct treatment.
Lanru was my seventh brother and student. He passed the county exam, excelled academically, was respected at school, avoided lust, and detested obscenity, yet was overly superstitious about Yin-Yang. In the 13th year of Daoguang, a friend Zheng sought a divine prescription for his wife's incurable illness. Lanru sincerely set up a Fuji (spirit writing) altar. The planchette moved automatically, producing clear poetry, claiming to be 'Qingfeng Zhenren' (True Person Qingfeng). Lanru deemed it miraculous. However, the prescriptions were ineffective, proving it was merely a literate wandering spirit, not a deity. If truly divine, would it fail? Lanru believed deeply, thinking deities could be summoned. On New Year's Day of the 14th year, his 60th birthday, he secluded himself in a Daoist temple, claiming to fast and chant prayers for his mother. Returning half a month later, he locked himself in a room day and night, allowing only incense smoke. My brothers lived separately; his young wife and children were ignorant, allowing his behavior unchecked. After 100 days, Lanru appeared content, telling me he intended to pass this 'Dao' to his sons. When asked what Dao, he smiled and refused to answer.
Suddenly in autumn, reports came that Lanru slept all night, appearing to argue with someone. On Mid-Autumn Festival, he visited the city for incense and stopped home briefly. My wife reported he looked haggard and spectral, with rumors of ghost haunting. Busy with patients, I waited for the Autumn Equinox ancestor worship, knowing he would attend. I arranged to meet early. At the shrine, he failed to appear. Sending servants to fetch him forcibly, he arrived collapsing before the ancestral tablets, crying, "Why must I die this way? It hurts so much, yet forbids my tears." No tears were visible. I said, "You claim ghosts exist. I specialize in treating such cases; fear not." After the ritual, we returned home. I questioned him about the ghost's origin; he was evasive. I said, "I know. You summoned this ghost via 'Lian Bilu' (Spirit Writing Practice)." Shocked, he asked how I knew. I explained, "Your sincere foolishness and belief in spirits led you to summon a spirit disguised as a deity. Qin Shi Huang and Han Wu Di failed to find immortals; why would you succeed? Modern spirit writers either fake it to fool others or mistake wandering spirits for gods, fooling themselves. Self-fooling is worse. Qingfeng is a ghost, not a god. Your fasting was actually Lian Bilu practice. Others fail; you succeeded because the ghost wanted to possess you, and you sought it. Initially, you felt harmony, wanting to teach your nephews. But possession brings harm; the ghost developed malicious intent to kill you, hoping to borrow your body for rebirth. Its demonic tactics are endless. Is my deduction correct?" Lanru admitted I described the situation perfectly. He confessed the spirit claimed to be a past-life scholar in the Moon Palace, wrote excellent poetry, and bonded over literature. In July, it turned obscene. He scolded it. It threatened death unless he engaged in lust. It manifested lewd images, disturbing his sleep with erotic dreams, claiming it could enter but not leave without his death. It urged suicide by knife or rope, or warned of draining his spirit.
I laughed, "Foolish brother! Life and death are destined. What can a ghost do? It wants you to kill yourself, revealing its cowardice. Fear not!" Pretending to address the ghost, I said, "You claim literacy but lack morality. You seduced with lust and threatened with death, showing no conscience. Your past life was immoral, leading to your current state as a homeless spirit. You have ill intent but no power. I am here. I will treat you with medicine, moxa at Guiku point, or needles at thirteen points if you persist." Lanru reported the ghost spoke inside his belly, angry when he talked to others, whispering in his ears. But with me present, it was quiet. I secretly rejoiced. The ghost forbade pork. I cooked meat heavily and forced him to eat. The ghost smelled food from afar but feared garlic, Realgar (Xionghuang), and Cinnabar (Zhusha). I mixed these powders with garlic juice and applied them to his nostrils before eating. The ghost recoiled, deprived of sustenance, weakening its energy.
I told Lanru, "Treating ghosts is easy; treating the mind is hard. Demons arise from human thoughts. You read Confucius but ignored 'Revere spirits but keep them at a distance.' Your妄念 (delusional thoughts) caused this. Rectify your mind, distrust ghosts, do not fear them, ignore their words, and their tricks will fail. I will also medicate you." That night, I slept beside him, administering Anshen Dingpo, Fuzheng Pixie Decoction (Calming Spirit and Soul, Supporting Righteousness and Expelling Evil). I hung Governor Yun Ting's calligraphy "Heaven and Earth Righteous Qi" (with official seals) behind the bed to ward off evil, lit rare incense, and watched him. Seeing him keep his undershirt on, I reprimanded his fear, forcing him to remove it and move clothes away, promising safety. The ghost had previously induced dance-like movements to drain his spirit. Hearing my words, Lanru slept soundly until morning. Upon coughing, Lanru reported the ghost stumbled in fright inside his belly. I was confident of the cure.
I kept him home, counseling his mind by day and medicating by night. He slept well, gaining strength. However, the ghost still complained when I wasn't present, though less active with medication. Daytime chest oppression persisted, so I prepared pills (3 qian morning, noon, evening), further weakening the ghost. Lanru relayed the ghost's complaint: "Your brother treats well, but destroying our union harms both." I replied, "It claims to be a scholar but lacks understanding. Spirits reside in the Heart. Union implies Heart unity. You now loathe it; how can spirits unite? Communication relies on Qi. If you ignore it, Qi cannot connect, and union is impossible."
Later, Lanru reported the ghost regretted its actions, noting Lanru's integrity thwarted its attempt to possess his body. It praised my medical skill, recognized its past karma, and begged to leave. I said, "Possession after sudden death works because essence/blood remain. You seek death by lust, ensuring marrow depletion—a useless shell. Even slight ghost Qi cannot revive it. Go back whence you came." Lanru relayed the ghost's distress: "It entered via mouth/nose but cannot exit. Please add medicine to help it leave." I laughed, "Little ghost, trying to deceive me? Strong Righteous Qi weakens Ghost Qi. Your energy fades; your threats failed, so you plead. You tricked the doctor into using harsh purgatives like Dahuang (Rhubarb) and Badou (Croton Seed) to force you out. These attack有形 (form/substance), not无形 (formless Qi). They damage Righteous Qi, strengthening you again. Do you think me a fool?"