青洲学识才力，较之艮山友松，不无轩轾，而专以精思攻苦，踵事涉历之，故其治术多
出人
意表。盖青洲次诸彦之后，熏陶之力固多，加之治疡之声，独擅海内，此其人与时为得宜也
。
夫欲善外科，先宜精内科，何则？疮疡虽百端，不能出于阴阳虚实，苟审之而施之治法
，则
于外科无有间然矣。(青洲内外泛应，无不曲当。由其脉证分辨处，无不清晰。更由其内外
合一处，无不贯彻也。)
学医者，如宋儒穷理，不先格知人身道理，而后审疾病，则不能至极致矣。(拙轩曰∶
青洲
翁常诵医唯在活物穷理之语，以教诱后进。洋学未辟之前，早着眼于此。故其截断之术，穷
洋人所未穷之理。翁之于疡科，所谓斗南一人也。
失荣气瘿委中毒三病，先哲以为难治，予亦未得其治。尝视桥本驿工匠某，左颈下发如
瘤者
，因论价者曰∶此气瘿，恐数日后出血至死。果如其言。又视同病者，不过四五日迸血而死
。如委中毒膝胫渐肉脱，骨尖黑蚀，恶汁出而死。世医动谓治此病审之时毒，就足胫而漫肿
者耳。和州一妇人患失荣，疮未翻肉而口噤难饮食，试用五宝丹，肿稍减，口能食，而遂死
。又一人与猛升汞丹，大瞑眩而病颇瘥，后再发至不起。
凡肿块有动气应手者，所谓动脉也，不可妄刺。误之则迸血便死。
世所谓神仙劳者，与抑肝扶脾散，莪棱为主，兼服辰砂散，或左金丸则愈。
肺部有毒者，必见数脉不可忽。若微咳带咽痛，或吐白沫脉数者，为瘵状，遂至死。蓄
血
下利者，不可攻，攻之则反促死。宜谛其腹候及舌色，千金黄土汤，或黄连解毒汤主之。
伤寒汗出恶寒，近衣被则汗益多，去之则恶寒反甚，数日不瘥。与柴胡桂枝干姜汤，桂
枝加
黄汤等无效。或谵语不食，终至危笃者。盖有二道焉∶一则内热燃盛，津液溢表者，为越
婢汤；一则表虚多汗者，为温经益元汤。(此证必舌上见白点。)
一处女年七八岁，两脚痿弱不能立，右足心发水泡，其状如火伤，刺之水出，泡溃而外
生红
晕，按之微痛，经二日水泡及足跗浮肿，指头色点黑，此痿弱更不能流通血气，故为毒肿也
。先与桂枝加术附汤，时时以紫圆下之则愈。(此即东洞先生衣钵，东郭先生亦续其传灯。)
蝮蛇咬，内服乌头汤，及紫丸，外涂柿实汁则愈。
石淋非生会阴者，多生在阴茎中，割断去之，缝合贴膏，内插鹤羽茎补便道为妙。
手足创伤络喷血不止者，医或缝裁其络而血益甚，是与刺委中尺泽时缚其上际，则血愈
出，其理同。
小儿解颅初起者，急与葛根加术附汤，兼以紫圆攻之则效。其证已成者，攻之则促命也
。(紫圆能治上部毒，七宝丸能治下部毒，或以乾坤为二丸名。有理。)
创家眼中见黄色者，脱血候。
咽喉创系气道者，小则治，大则不能治，如食道创虽稍大多活也。
破伤湿治方见《证治准绳》，然不如越婢加术附，虎杖茎汤神效也。(拙轩曰∶虎杖根
解散凝结，虎杖茎治破伤湿灸火热，见《青洲医谈》)
脏毒看法，先控肛门谷道腐蚀为广阔，下如赤豆汁。其臭甚者，脏毒也。毒甚为翻肉者
，多不治。
舌疳疗之可救十之八九，先割去其腐肉，用熏药为主。然腐蚀及齿龈者不治，癫痫眼目
紧
缩者，瞳子散大者，俱不治。
乳漏久不愈者，始以祛毒膏为 ，后以长肉膏换之，内服葛根加术附汤，兼用端的丸。
又毒凝结者，大黄牡丹皮汤，伯州散选用。
腐骨疽近胸腹及五脏者，不可纳 ， 之则反见脱状。
眼胞或唇吻生疙瘩者，向里面取之为妙。
肿疡见流注状者，不论何因，与越婢加术附汤而可。(此初起者，至日久者，不割破去
脓，则无治法。)
黄瘅始萌以三候为征，曰眼中黄，曰心下痞，曰小便黄是也。虽身色如故，有此三候，
则为确矣。又瘅愈以眼黄去为征也。
喘息剧者，麻杏甘石汤，或麦门冬汤，方中加没食子效。盖没食子能祛胸中胶痰，而世
医知
者鲜矣。(拙轩曰∶治破伤湿以虎杖茎，治喘息以没食子，皆翁之发明。亦穷理中之事。)
痼疾与汞剂以小量长服为要，譬之如晴天灌一壶水于地上，漠然无痕，以小酌屡注，则
水自彻底焉。
走马疳，其毒甚猖獗，经日则烂龈腐骨遂至死。若初起口臭出血时，早施治则尚可救。
文化
十年六月，一儿年八岁，患此证，其腐已及齿龈，齿脱三四枚，服以芦荟消疳饮，兼以人中
白散，不出旬日愈，齿再生矣。
痘疹虽出于后世，其证之阴阳治法之温清，与痈疽无异。(许叔微曰∶能医伤寒，则能
医痘
疹，能医痘疹，则能医痈毒。彼自伤寒悟入，此自痈疽入，道异而理同。名工所见略相同)
。
风眼破溃出血不止者，犀角地黄汤，兼三黄汤效。血止而痛不止者，与通明汤，外施蒸
药则愈。
妇人头疮久不愈，诸药无效者，与桃核承气汤，兼用桃花散则愈，涂桃仁油亦可。
冷痢误用疏涤剂，白脓反甚者，与东井和中汤效。
产后遗尿者，与参 汤加附子效，盖方中益智倍加为妙。(又一方红花、洋参各一两，
上二味，锉用鸢一羽去肠纳之于肠中，烧存性，温酒送下。)
甘草干姜汤，能治自汗、盗汗，其理与承气汤治阳明自汗同，此汤又治胸胁偏痛，此皆
毒迫于心胸所致也。世医不知之，徒就汗与痛施药，宜矣不得其治。
产后暴泄与胃风汤速愈。若数十行后，心下痞满者，宜与生姜泻心汤。
或曰，走马疳疔之类或然，余视至其死者与疔无异。喘家以紫金丹攻之，则吐浊唾臭痰
而愈。白散亦能吐痰，然彼专吐在肺管者，此专吐在肺府者，其部位自异。
解颅初萌，与葛根加术附汤，时以紫圆攻之则愈，若渐甚如斗大者不治。又小儿四肢痿
弱者
，用前方而愈，是其证异而其毒同也。若痿弱脊骨突起者，及左右证异如偏枯者，不能急愈
。
凡欲用麻沸散，先与半夏泻心汤疏心下，而后不用之，则不能奏效。(此法自奥村叟吐
法脱化来。)
夫欲与麻沸散，宜审其证。若血色不爽，胸中有滞痰宿水，或心下痞硬者，不可与之。
先治
其证候，而后不施之，则误人不鲜。又服麻沸散不瞑眩，则不可施术，误施术则亦害人矣。
服麻沸散瞳子散大，脉弦数者，是为瞑眩之候。
发痫角弓筋惕，气急促迫，或叫呼者，与甘草干姜汤效。
委中毒初发寒热甚，委中肿痛，后黑色腐坏，针之黑血出无脓气，膝盖肉脱，宛如天刑
病，人证固属不治。
气瘤气瘿不可妄下手，反生害。
痉病初发，必两腮刚强，先与葛根汤，可针于合谷及发际则治。若见脱候者，十全大补
汤加
荆芥、附子，兼用豆淋酒加荆芥。然角弓反张甚，水药不下咽者，及口开者，不治。(传云
∶痉病握手者刺合谷穴，其深一寸五分或二寸，刺发际以浅为佳，铁针尤良。)
破伤风其初项背强，或言语謇涩寒栗者可治，宜葛根汤、续命汤类，无患子、虎杖茎二
味煎服亦效。若至角弓反张，则多难治，产后痉病亦同此法。
痉病脉浮涩为吉，若浮数者必再发。
一妇年五十余，患舌疳，其形舌傍疳蚀如翻肉，而腐烂及于齿龈，乃以腐药拔去其翻肉
，服以黄连解毒汤，而外用熏药者，凡百日，余毒尽，病痊愈。
行熏药者，后不用下剂，则无全功。舌疳者，用紫圆。若由霉毒者，龙门丸主之。
近世患真流注者，甚少，今见流注状者，身体必为疮痕，与《外科正宗》所论大异。
一人年二十余，腋下漫肿，按之少痛，其状似痞癖，而其左足有疮痕，因为外因流注，
与越婢加术附汤，时时以紫圆下之愈。
留饮兼蓄血者，非精腹候，则难得其辨。
鹤膝风或结顽毒固难拔者，宜乌头汤、桂枝加术附汤等，加角石。凡治毒难动者，为角
石专长。
霉毒上攻凝结头项者，与桂枝汤，加茯苓、苍术、乌头、细辛、防风，兼用消毒丸。
苓桂术甘汤加附子，能治黄胖病。胸中有动气者，为铁粉、蜀漆主治。
疝施针刺，清水出者，不脓溃。血水交出者，必脓溃。脓溃者，反易治。
肠痔血出者，实证也，水血交出者，虚证也。
乳岩有经水者易治，经水断者难治。又乳岩者，怀孕则其核忽成大也。
胀满一证，有因水气者，有因结气者。水气者属实，故易治。气结者多虚，故难治。
吉雄元吉曰∶患胀满而死者，荼毗之肠中一块凝然存，视之坚硬如石。西洋人曰∶腹胀
病动胀大管生如肉瘤者，四肢血脉为之妨害，渐至手足削小，或然。
狂痫血晕，其证相似而异，不可不辨。狂者妄语不止，痫者易惊，物剧至角弓反张。血
晕，精神昏冒，甚者口噤，此证汗出脉无胃气者死。
狗伤外贴中黄膏加杏仁、甘草，内服黄连解毒，加木鳖子，兼食蟾蜍脍为良。
脱疽觉痛者，未腐蚀也。不知痛者，既腐蚀也。
淋疾为小便自利者，与参 汤加附子效。
肩凝腰痛左手有创，右手有块，处处疼痛者，流注毒也。宜与越婢加术附汤，时时以紫
丸下之。若虚脱者，宜参 桂附剂。
金创在膈膜者，不论迟速必死，在脐上者为险，在腹者不用 ，近脏腑故也。
矾石、巴豆、斑猫、乌头等毒皆属热，故解其毒以冷水为佳。(按∶天地间不论草木虫
石，凡称酷毒者，皆辛热品也。故解毒药以苦寒为主，如黄连解毒汤、苦参汤是也。)
腐药最为瞑眩，不可不知。一病患臀上施腐药，其毒忽上攻冲心死。
腐药瞑眩，其证微者，恶寒发热，或渴，或饮食不进。剧者烦渴或烦闷，其毒迫于心下
，遂至促命期，急当救之。宜黄连解毒汤，甘连加石膏绿豆汤等。
产后战栗者，血气新虚，邪气袭之也。先与荆芥沉香汤，或与十全大补加荆芥、炮姜。
更虚者，又加附子。盖战栗至四五发者难治。然脉缓者可愈，紧数者为不治。
产后血虚，舌赤烂痛者，八物汤加鹿胎霜奇效。鹿胎霜亦能治产后下血不止者。
身体疼痛，概因血气凝滞，如金创天刑为痛者是也。故与行气剂则愈。
疝病根抵于少腹，故大肠下垂阴囊也。宜先辨其难易而施治法，阴囊偏坠渐肿大者易
治，
阴囊有消长而痛引少腹者难治。余尝遭阴囊消长证施针刺，则大便随下，不堪臭气，大困矣
。又有因霉毒偏坠成顽肉者，宜以剪刀割去之，若贴腐药反害。
胃脘痈疑似肺痈而不止肺部，痛亦连少腹，吐脓血也，治法宜排脓散、桔梗白散。小儿
发解
颅者，其初必发热，牙关紧急天吊，宜先其时治之。葛根加术附汤兼紫丸，为得矣。若解颅
证已具，多不治。
角弓反张无吐下者，急惊风也。搐搦上窜吐下者，慢惊风也，四逆汤、柴胡抑肝汤、惺
惺散
、清脾散。或的里亚加随证投之。后藤氏用柴胡加龙骨牡蛎汤，未知其应否也。急惊风则病
间明了，慢惊风则病间似睡，以是为别矣。慢惊风则发以上必昏冒，多属不治。
偏枯不论老壮，可用桂枝加术附汤。其急迫者，以紫丸下之。诊其腹不拘急者可治，拘
急者不治也。是气不能循环者，故虽下之，拘急不解也。
中风偏枯发作有时，多属痫家，桂枝加苓术附汤时时以紫丸下之。药不久服则难治也。
又妇
人手臂屈伸不止者，痫也，大七气汤治之有奇效。(拙轩曰∶以上数十则，尽是实际实语，
翁精神之所注，百读不厌，学人宜奉为金科玉律。)往年门人服部方行，(字子执。村上医员
。)喜先生说，就其书中抄录之，为叙其略曰∶先生医术内外理，随证应变，浑从实际来，
故方有准则，术有活用，后学不可以不研究焉。因请正于余，时方行婴脚疾遽没，后余有此
着。乃删润其稿以表遗爱，且系以小诗云∶多年曾乐与余游，岂计 遗忽一秋。残月当窗人
不见，满天风露滴空楼。
华冈青洲的学识才力，与艮山、友松相比，各有高下，但他专注于精思苦研，并在实践中不断积累，因此他的治疗技术往往出人意料。大概因为青洲排在众名医之后，受到熏陶的力量固然很多，加上他治疗疮疡的名声独步海内，这是他与时代相契合的结果。
想要擅长外科，必须先精通内科，为什么呢？疮疡虽然种类繁多，但离不开阴阳虚实的范畴，如果能仔细审察并施以相应的治法，那么对外科就没有什么疑难了。（青洲在内外各科都能灵活应对，没有不恰当的。从他分辨脉证的地方看，无不清晰透彻。再从内外合一的角度看，无不贯彻始终。）
学医的人，就像宋代的儒者探究道理一样，如果不先格物致知了解人体的生理道理，然后审慎地对待疾病，就不能达到极致的境界。（拙轩说：青洲先生常诵读“医学关键在于活物穷理”的话，用来教导诱导后辈。在西洋医学尚未开辟之前，他就已经着眼于此。所以他截断病势的技术，穷尽了洋人所未能穷尽的道理。他在疡科方面，可以说是南面称孤的第一人。）
失荣、气瘿、委中毒这三种病，先哲认为难治，我也没有找到治疗方法。曾经诊治桥本驿的一位工匠，左颈下方长了像瘤一样的东西，我论断说：“这是气瘿，恐怕几天后会出血致死。”果然像我说的那样。又诊治患同样病的人，不过四五天后就因迸血而死。至于委中毒，膝盖和小腿逐渐肌肉脱落，骨尖发黑腐蚀，流出恶臭脓汁而死。世间的医生动不动就说治疗这种病要审察是否为时毒，只是针对小腿和足部漫肿的情况罢了。和州有一位妇人患失荣，疮口还没有翻肉，但牙关紧闭难以饮食，试用五宝丹后，肿胀稍微减轻，口能进食，但最终还是死了。另一人服用猛升汞丹，出现剧烈的瞑眩反应后病情颇有好转，后来复发便无法挽救了。
凡是肿块有动气且按之应手的，称为动脉，不可随意针刺。误刺则会导致大出血而死。
世间所谓的神仙劳（一种慢性消耗性疾病），给予抑肝扶脾散，以莪术、棱子为主药，兼服辰砂散，或者左金丸，就能痊愈。
肺部有毒邪的，必然出现数脉，不可忽视。如果轻微咳嗽伴有咽痛，或者吐白沫且脉数的，是肺痨（瘵）的症状，最终会致死。蓄血导致下利的，不可攻下，攻下则会反而加速死亡。应当仔细诊察腹部情况和舌色，用千金黄土汤，或者黄连解毒汤主治。
伤寒汗出恶寒，靠近衣被则汗更多，去掉衣被则恶寒反而更严重，几天都不好转。给予柴胡桂枝干姜汤、桂枝加黄汤等无效。或者出现谵语不食，最终危重笃急的。这大概有两种情况：一是内热炽盛，津液外溢肌表，用越婢汤；一是表虚多汗，用温经益元汤。（这种证候舌上一定出现白点。）
一个七八岁的女孩，两脚痿弱不能站立，右足心发出水泡，形状像火烧伤，刺破后水流出，泡溃烂而外面生出红晕，按压微痛，经过两天水泡蔓延到足背浮肿，脚趾头颜色变黑，这是因为痿弱导致气血流通不畅，所以形成毒肿。先用桂枝加术附汤，时时用紫圆泻下，就能痊愈。（这就是东洞先生的衣钵，东郭先生也继续传承了他的学问。）
石淋如果不是生在会阴处，大多生在阴茎中间，割断去除，缝合贴上膏药，内部插入鹤羽茎补通尿道为妙。
手足创伤络脉喷血不止的，医生有时缝合裁剪络脉而血更加厉害，这与刺委中、尺泽穴时缚扎其上端，则血愈出出来的道理相同。
小儿解颅初起时，急予葛根加术附汤，兼以紫圆攻下则有效。其证候已经形成的，攻下则会加速死亡。（紫圆能治疗上部毒邪，七宝丸能治疗下部毒邪，或者将两者命名为乾坤二丸。很有道理。）
创家眼中见到黄色的，是脱血的征候。
咽喉创伤涉及气道的，小的可以治疗，大的不能治疗，如食道创伤虽然稍大也能存活。
破伤湿的治疗方剂见《证治准绳》，但不如越婢加术附汤、虎杖茎汤神效。（拙轩说：虎杖根解散凝结，虎杖茎治疗破伤湿灸火热，见《青洲医谈》）
脏毒的看法，先控肛门谷道腐蚀为广阔，下如赤豆汁。其臭甚者，脏毒也。毒甚为翻肉者，多不治。
舌疳疗之可救十之八九，先割去其腐肉，用熏药为主。然腐蚀及齿龈者不治，癫痫眼目紧缩者，瞳子散大者，俱不治。
乳漏久不愈者，始以祛毒膏为 ，后以长肉膏换之，内服葛根加术附汤，兼用端的丸。
眼胞或唇吻生疙瘩者，向里面取之为妙。
肿疡见流注状者，不论何因，与越婢加术附汤而可。(此初起者，至日久者，不割破去脓，则无治法。)
黄瘅始萌以三候为征，曰眼中黄，曰心下痞，曰小便黄是也。虽身色如故，有此三候，则为确矣。又瘅愈以眼黄去为征也。
喘息剧者，麻杏甘石汤，或麦门冬汤，方中加没食子效。盖没食子能祛胸中胶痰，而世医知者鲜矣。(拙轩曰∶治破伤湿以虎杖茎，治喘息以没食子，皆翁之发明。亦穷理中之事。)
痼疾与汞剂以小量长服为要，譬之如晴天灌一壶水于地上，漠然无痕，以小酌屡注，则水自彻底焉。
走马疳，其毒甚猖獗，经日则烂龈腐骨遂至死。若初起口臭出血时，早施治则尚可救。
文化十年六月，一儿年八岁，患此证，其腐已及齿龈，齿脱三四枚，服以芦荟消疳饮，兼以人中白散，不出旬日愈，齿再生矣。
痘疹虽出于后世，其证之阴阳治法之温清，与痈疽无异。(许叔微曰∶能医伤寒，则能医痘疹，能医痘疹，则能医痈毒。彼自伤寒悟入，此自痈疽入，道异而理同。名工所见略相同)。
风眼破溃出血不止者，犀角地黄汤，兼三黄汤效。血止而痛不止者，与通明汤，外施蒸药则愈。
妇人头疮久不愈，诸药无效者，与桃核承气汤，兼用桃花散则愈，涂桃仁油亦可。
产后遗尿者，与参 汤加附子效，盖方中益智倍加为妙。(又一方红花、洋参各一两，上二味，锉用鸢一羽去肠纳之于肠中，烧存性，温酒送下。)
甘草干姜汤，能治自汗、盗汗，其理与承气汤治阳明自汗同，此汤又治胸胁偏痛，此皆毒迫于心胸所致也。世医不知之，徒就汗与痛施药，宜矣不得其治。
产后暴泄与胃风汤速愈。若数十行后，心下痞满者，宜与生姜泻心汤。
或曰，走马疳疔之类或然，余视至其死者与疔无异。喘家以紫金丹攻之，则吐浊唾臭痰而愈。白散亦能吐痰，然彼专吐在肺管者，此专吐在肺府者，其部位自异。
解颅初萌，与葛根加术附汤，时以紫圆攻之则愈，若渐甚如斗大者不治。又小儿四肢痿弱者，用前方而愈，是其证异而其毒同也。若痿弱脊骨突起者，及左右证异如偏枯者，不能急愈。
凡欲用麻沸散，先与半夏泻心汤疏心下，而后不用之，则不能奏效。(此法自奥村叟吐法脱化来。)
夫欲与麻沸散，宜审其证。若血色不爽，胸中有滞痰宿水，或心下痞硬者，不可与之。先治其证候，而后不施之，则误人不鲜。又服麻沸散不瞑眩，则不可施术，误施术则亦害人矣。服麻沸散瞳子散大，脉弦数者，是为瞑眩之候。
委中毒初发寒热甚，委中肿痛，后黑色腐坏，针之黑血出无脓气，膝盖肉脱，宛如天刑病，人证固属不治。
气瘤气瘿不可妄下手，反生害。
痉病初发，必两腮刚强，先与葛根汤，可针于合谷及发际则治。若见脱候者，十全大补汤加荆芥、附子，兼用豆淋酒加荆芥。然角弓反张甚，水药不下咽者，及口开者，不治。(传云∶痉病握手者刺合谷穴，其深一寸五分或二寸，刺发际以浅为佳，铁针尤良。)
破伤风其初项背强，或言语謇涩寒栗者可治，宜葛根汤、续命汤类，无患子、虎杖茎二味煎服亦效。若至角弓反张，则多难治，产后痉病亦同此法。
一妇年五十余，患舌疳，其形舌傍疳蚀如翻肉，而腐烂及于齿龈，乃以腐药拔去其翻肉，服以黄连解毒汤，而外用熏药者，凡百日，余毒尽，病痊愈。
行熏药者，后不用下剂，则无全功。舌疳者，用紫圆。若由霉毒者，龙门丸主之。
近世患真流注者，甚少，今见流注状者，身体必为疮痕，与《外科正宗》所论大异。
一人年二十余，腋下漫肿，按之少痛，其状似痞癖，而其左足有疮痕，因为外因流注，与越婢加术附汤，时时以紫圆下之愈。
留饮兼蓄血者，非精腹候，则难得其辨。
鹤膝风或结顽毒固难拔者，宜乌头汤、桂枝加术附汤等，加角石。凡治毒难动者，为角石专长。
霉毒上攻凝结头项者，与桂枝汤，加茯苓、苍术、乌头、细辛、防风，兼用消毒丸。
苓桂术甘汤加附子，能治黄胖病。胸中有动气者，为铁粉、蜀漆主治。
疝施针刺，清水出者，不脓溃。血水交出者，必脓溃。脓溃者，反易治。
肠痔血出者，实证也，水血交出者，虚证也。
乳岩有经水者易治，经水断者难治。又乳岩者，怀孕则其核忽成大也。
胀满一证，有因水气者，有因结气者。水气者属实，故易治。气结者多虚，故难治。
吉雄元吉曰∶患胀满而死者，荼毗之肠中一块凝然存，视之坚硬如石。西洋人曰∶腹胀病动胀大管生如肉瘤者，四肢血脉为之妨害，渐至手足削小，或然。
狂痫血晕，其证相似而异，不可不辨。狂者妄语不止，痫者易惊，物剧至角弓反张。血晕，精神昏冒，甚者口噤，此证汗出脉无胃气者死。
狗伤外贴中黄膏加杏仁、甘草，内服黄连解毒，加木鳖子，兼食蟾蜍脍为良。
脱疽觉痛者，未腐蚀也。不知痛者，既腐蚀也。
肩凝腰痛左手有创，右手有块，处处疼痛者，流注毒也。宜与越婢加术附汤，时时以紫丸下之。若虚脱者，宜参 桂附剂。
金创在膈膜者，不论迟速必死，在脐上者为险，在腹者不用 ，近脏腑故也。
矾石、巴豆、斑猫、乌头等毒皆属热，故解其毒以冷水为佳。(按∶天地间不论草木虫石，凡称酷毒者，皆辛热品也。故解毒药以苦寒为主，如黄连解毒汤、苦参汤是也。)
腐药最为瞑眩，不可不知。一病患臀上施腐药，其毒忽上攻冲心死。
腐药瞑眩，其证微者，恶寒发热，或渴，或饮食不进。剧者烦渴或烦闷，其毒迫于心下，遂至促命期，急当救之。宜黄连解毒汤，甘连加石膏绿豆汤等。
产后战栗者，血气新虚，邪气袭之也。先与荆芥沉香汤，或与十全大补加荆芥、炮姜。更虚者，又加附子。盖战栗至四五发者难治。然脉缓者可愈，紧数者为不治。
产后血虚，舌赤烂痛者，八物汤加鹿胎霜奇效。鹿胎霜亦能治产后下血不止者。
身体疼痛，概因血气凝滞，如金创天刑为痛者是也。故与行气剂则愈。
疝病根抵于少腹，故大肠下垂阴囊也。宜先辨其难易而施治法，阴囊偏坠渐肿大者易治，阴囊有消长而痛引少腹者难治。余尝遭阴囊消长证施针刺，则大便随下，不堪臭气，大困矣。又有因霉毒偏坠成顽肉者，宜以剪刀割去之，若贴腐药反害。
胃脘痈疑似肺痈而不止肺部，痛亦连少腹，吐脓血也，治法宜排脓散、桔梗白散。小儿发解颅者，其初必发热，牙关紧急天吊，宜先其时治之。葛根加术附汤兼紫丸，为得矣。若解颅证已具，多不治。
角弓反张无吐下者，急惊风也。搐搦上窜吐下者，慢惊风也，四逆汤、柴胡抑肝汤、惺惺散、清脾散。或的里亚加随证投之。后藤氏用柴胡加龙骨牡蛎汤，未知其应否也。急惊风则病间明了，慢惊风则病间似睡，以是为别矣。慢惊风则发以上必昏冒，多属不治。
偏枯不论老壮，可用桂枝加术附汤。其急迫者，以紫丸下之。诊其腹不拘急者可治，拘急者不治也。是气不能循环者，故虽下之，拘急不解也。
中风偏枯发作有时，多属痫家，桂枝加苓术附汤时时以紫丸下之。药不久服则难治也。又妇人手臂屈伸不止者，痫也，大七气汤治之有奇效。(拙轩曰∶以上数十则，尽是实际实语，翁精神之所注，百读不厌，学人宜奉为金科玉律。)往年门人服部方行，(字子执。村上医员。)喜先生说，就其书中抄录之，为叙其略曰∶先生医术内外理，随证应变，浑从实际来，故方有准则，术有活用，后学不可以不研究焉。因请正于余，时方行婴脚疾遽没，后余有此着。乃删润其稿以表遗爱，且系以小诗云∶多年曾乐与余游，岂计 遗忽一秋。残月当窗人不见，满天风露滴空楼。
Aoshu's scholarship and talent were comparable to those of Genzan and Yushou, with neither clearly superior. However, his dedication to profound contemplation and arduous study, combined with extensive practical experience, resulted in treatment techniques that often exceeded expectations. Generally, Aoshu followed other renowned physicians, benefiting greatly from their influence. Moreover, his reputation for treating sores and ulcers was unparalleled within the country; this success was due to his alignment with the times.
To excel in surgery (Waike), one must first master internal medicine. Why? Although sores and ulcers manifest in myriad ways, they all fall within the categories of Yin-Yang and Deficiency-Excess. If these are carefully examined and treated accordingly, there will be no unresolved issues in surgery. (Aoshu could respond flexibly to both internal and external conditions without error. His differentiation of pulse and symptoms was always clear. Furthermore, his integration of internal and external treatments was thorough.)
Those who study medicine should emulate the Neo-Confucian pursuit of principles. Without first investigating the physiological principles of the human body before examining diseases, one cannot reach the pinnacle of medical skill. (Zhuoxuan said: Master Aoshu often recited the phrase "medicine lies in understanding living things and exhausting principles" to guide junior practitioners. Before Western medicine was introduced, he had already focused on this. Thus, his technique of intercepting disease processes exhausted principles that Westerners had not yet explored. In the field of ulcerology, he was indeed a unique figure.)
Shiryo (Loss of Glory), Ki-in (Qi Goiter), and Uchuu-doku (Popliteal Abscess) were considered difficult to treat by earlier masters, and I also lacked effective methods for them. I once treated a craftsman at Hashimoto Post Station who had a tumor-like growth on the left side of his neck. I predicted, "This is Ki-in; he will likely bleed to death in a few days." This came true. Another patient with the same condition died from hemorrhage within four or five days. Regarding Uchuu-doku, the knee and shin muscles gradually atrophied, bone tips became black and necrotic, foul pus discharged, and the patient died. Physicians often claimed to treat this as Shidoku (Seasonal Toxin), focusing only on diffuse swelling of the lower legs. A woman from Kazusa Prefecture suffered from Shiryo. Her sore had not everted flesh, but she had trismus and difficulty eating. After trying Hogo-san (Five Treasures Powder), her swelling subsided slightly, and she could eat, but she eventually died. Another patient took Gokuseigan (Mercury Pill), experienced severe Mingxuan reaction (herxheimer reaction), and improved temporarily, but relapsed and died later.
Any mass that exhibits pulsation upon palpation is called a Dongmai (Arterial Pulse/Mass). It must not be needled recklessly. Mistaken needling will cause fatal hemorrhage.
For what is commonly known as Shenxian Lao (Immortal Labor/Chronic Consumption), prescribe Yi Gan Fu Pi San (Liver-Calming and Spleen-Supporting Powder) with Ezhu (Curcuma zedoaria) and Lingzi (Bletilla striata) as main ingredients, combined with Chensha San (Cinnabar Powder) or Zuojin Wan (Left Metal Pill). Recovery is expected.
Toxicity in the lungs invariably presents with a Shuo Mai (Rapid Pulse) and must not be ignored. Mild cough with sore throat, or expectoration of white foam with a rapid pulse, indicates Zhai (Consumption/Tuberculosis), which leads to death. For Xi Xue Xia Li (Blood Stasis causing Diarrhea), purgatives must not be used; purging will accelerate death. One must carefully examine abdominal signs and tongue color, treating with Qianjin Huang Tu Tang (Thousand Gold Yellow Earth Decoction) or Huanglian Jiedu Tang (Coptis Detoxification Decoction).
In Shanghan (Cold Damage) with sweating and aversion to cold, covering with clothes increases sweating, while removing them worsens aversion to cold, persisting for days without improvement. Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) or Guizhi Jia Huangqi Tang (Cinnamon Twig plus Astragalus Decoction) are ineffective. If delirium and anorexia develop leading to critical condition, two pathways exist: First, intense internal heat forcing fluids to the exterior, treated with Yebipi Tang (Yi Bo Decoction); second, exterior deficiency with profuse sweating, treated with Wen Jing Yuan Tang (Warm Meridian and Replenish Origin Decoction). (This syndrome must present with white spots on the tongue.)
An eight-year-old girl suffered from Wei Ruo (Flaccidity) in both legs, unable to stand. A blister appeared on the sole of her right foot, resembling a burn. Upon pricking, fluid drained, the blister ruptured, and a red halo formed around it, tender to touch. Two days later, blisters spread to the dorsum of the foot with edema, and toe tips turned black. This flaccidity impaired Qi and Blood circulation, causing toxic swelling. Initially, Guizhi Jia Zhu Fuzi Tang (Cinnamon Twig plus Atractylodes and Prepared Aconite Decoction) was given, along with periodic administration of Zi Yuan (Purple Pill) to purge, resulting in recovery. (This follows the lineage of Mr. Todoh; Mr. Tongaku also continued this tradition.)
For pit viper bites, administer Wutou Tang (Aconite Decoction) and Zi Wan internally, and apply Persimmon Fruit Juice externally for cure.
For Shi Lin (Stone Strangury) located in the penis rather than the perineum, surgical excision is required. The wound should be sutured and plastered. Inserting a Crane Feather Stem into the urethra to maintain patency is advisable.
For traumatic hemorrhage from severed vessels in hands or feet that does not stop, some physicians suture the vessel, worsening the bleeding. This is similar to tying above the Weizhong (BL40) or Quze (PC3) points during needling, which causes blood to flow out more freely; the principle is the same.
For early-stage Jie Lu (Cracked Skull/Open Fontanelle) in children, urgently administer Gegen Jia Zhu Fuzi Tang (Kudzu plus Atractylodes and Prepared Aconite Decoction) combined with Zi Yuan to purge. If the condition is fully established, purging will hasten death. (Zi Yuan treats upper toxicity; Qibao Wan treats lower toxicity. Sometimes named Qiankun Pills. This rationale is sound.)
Yellow vision in patients with wounds indicates Bleeding Exhaustion.
Wounds in the throat involving the airway are treatable if small, but untreatable if large. Esophageal wounds, even if larger, can often survive.
The formula for Po Shang Shi (Broken Injury Dampness) is found in *Zhengzhi Zhunsheng*, but Yebiji Jia Zhu Fuzi Tang (Yi Bo plus Atractylodes and Aconite Decoction) and Huzhang Jing Tang (Japanese Knotweed Stem Decoction) are more miraculous. (Zhuoxuan noted: Huzhang root disperses凝结 (condensation/stagnation); Huzhang stem treats Broken Injury Dampness and fire-heat burns, as seen in *Qingzhou Yitan*.)
Regarding Zang Du (Visceral Toxin): Inspect the anus for widespread corrosion resembling mung bean juice. Severe odor indicates Zang Du. If toxin is severe causing flesh eversion, it is mostly untreatable.
She Gan (Tongue Ulcer) can be cured in 80-90% of cases. First, excise necrotic tissue, primarily using fumigation therapy. However, if corrosion reaches the gums, it is untreatable. Epilepsy with tightly closed eyes, or dilated pupils, are also untreatable.
For chronic Ru Lou (Breast Fistula) that does not heal, start with Qudu Gao (Detoxifying Ointment), then switch to Zhangrou Gao (Flesh-Growing Ointment). Internally, administer Gegen Jia Zhu Fuzi Tang combined with Duan De Wan.
For condensed toxins, select Dahuang Mudanpi Tang (Rhubarb and Moutan Decoction) or Bozhou San.
For Fu Gu Ju (Necrotic Bone Abscess) near the chest, abdomen, or viscera, do not insert drains or apply caustics, as this may cause collapse.
For nodules on eyelids or lips, extraction towards the interior is optimal.
For Swollen Sores presenting with Liu Zhu (Flowing Deposit) characteristics, regardless of cause, Yebiji Jia Zhu Fuzi Tang is appropriate. (For early stages, this works; for long-standing cases, incision and drainage are necessary, otherwise there is no cure.)
Early Huang Dan (Jaundice) is signaled by three indicators: yellow eyes, epigastric fullness, and yellow urine. Even if skin color is normal, these three signs confirm the diagnosis. Recovery is indicated by the disappearance of yellow eyes.
For severe asthma/wheezing, Maxing Gan Shi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) or Maidong Tang (Ophiopogon Decoction) with Myrobalan (Meishi Zi) is effective. Myrobalan resolves sticky phlegm in the chest, though few physicians know this. (Zhuoxuan noted: Using Huzhang stem for Broken Injury Dampness and Myrobalan for asthma are discoveries of Master Aoshu, reflecting the pursuit of principles.)
For chronic diseases requiring mercury preparations, small doses administered long-term are key. It is like pouring a pot of water on dry ground in sunny weather; it leaves no trace. But pouring small amounts repeatedly penetrates thoroughly.
Zou Ma Gan (Running Horse Gangrene) is highly virulent, rotting gums and bones leading to death within days. If treated early when bad breath and bleeding occur, it can be saved.
In the sixth month of the 10th year of Bunka, an eight-year-old boy suffered from this. Necrosis reached the gums, and 3-4 teeth fell out. He was given Lulu Xiao Gan Yin (Aloe Reducing Ulcer Drink) combined with Renzhong Bai San (Human Urine Deposit Powder). Within ten days, he recovered, and teeth regenerated.
Although Dou Zhen (Smallpox and Measles) emerged in later periods, the differentiation of Yin-Yang and the use of warming/clearing methods are no different from treating Carbuncles and Sores. (Xu Shumi said: "One who can treat Shanghan can treat Dou Zhen; one who can treat Dou Zhen can treat Carbuncles. They enter through different paths—Shanghan vs. Carbuncles—but the principles are the same. Expert physicians share similar insights.")
For Wind Eye (Ophthalmia) with ulceration and uncontrolled bleeding, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) combined with Sanhuang Tang (Three Yellows Decoction) is effective. If pain persists after bleeding stops, Tongming Tang is given, and external steaming therapy is applied for cure.
For persistent head sores in women unresponsive to other medicines, Taohe Chengqi Tang (Peach Pit and Magnolia Bark Decoction) combined with Taohua San (Peach Blossom Powder) cures it. Applying Peach Kernel Oil is also effective.
For Cold Dysentery where purgatives were mistakenly used, worsening white pus, Dongjing Hezhong Tang restores harmony effectively.
For postpartum urinary incontinence, Shenqi Tang (Ginseng and Musk Decoction - *Note: Text says 'Can [missing character] Tang', likely Shenqi or similar*) plus Fuzi is effective. Increasing Yizhi (Alpinia oxyphylla) in the formula is particularly good. (Another prescription: Honghua (Safflower) and Yangshen (American Ginseng), each 1 liang. Pound them, place in a bird's crop, roast until charred outside but preserved inside, and take with warm wine.)
Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) treats spontaneous and night sweats. Its mechanism is similar to Chengqi Tang treating Yangming spontaneous sweating. This decoction also treats unilateral chest/hypochondriac pain caused by toxin pressing on the heart/chest. Physicians ignore this, treating only sweat and pain, thus failing to cure.
For acute postpartum diarrhea, Weifeng Tang (Wind-Stomach Decoction) brings quick recovery. If epigastric fullness develops after dozens of bowel movements, Shengjiang Xiexin Tang (Fresh Ginger Heart-Purging Decoction) is indicated.
Some say Zou Ma Gan resembles Ding (Carbuncle). I observe that fatal cases are indistinguishable from Ding. For asthmatics, Zijin Dan (Purple Gold Pill) induces vomiting of foul, turbid saliva/phlegm, leading to cure. Baisan (White Powder) also induces vomiting, but targets the lung tubes, whereas Zijin Dan targets the lung organs/fu-zang; their sites differ.
For early Jie Lu (Open Fontanelle), Gegen Jia Zhu Fuzi Tang with periodic Zi Yuan purges cures it. If it progresses to the size of a bucket, it is untreatable. For children with limb flaccidity, the former formula works, showing different symptoms but same toxicity. However, if flaccidity involves protruding spine or hemiplegia-like asymmetry, rapid cure is impossible.
Before administering Mafei San (Hemp Boiling Powder), one must first use Banxia Xiexin Tang (Pinellia Heart-Purging Decoction) to clear the epigastrium. Otherwise, it will not be effective. (This method evolved from the emetic techniques of Old Man Okamura.)
When considering Mafei San, examine the syndrome carefully. If blood flow is irregular, there is stagnant phlegm/fluid in the chest, or epigastric hardness exists, do not administer it. Treating the syndrome first, then operating, prevents errors. If no Mingxuan reaction occurs after taking Mafei San, surgery should not be performed, as it harms the patient. Dilated pupils and wiry-rapid pulse after taking Mafei San indicate the Mingxuan state.
For epilepsy with opisthotonos, muscle twitching, rapid breathing, or screaming, Gancao Ganjiang Tang is effective.
For early Uchuu-doku (Popliteal Abscess) with severe chills/fever, swelling/pain at Weizhong, followed by black necrosis, needling releases black blood without pus. Knee muscle atrophy resembles Tianxing Bing (Heavenly Punishment Disease). This is inherently untreatable.
Qi Tumors and Qi Goiters must not be touched recklessly, as this causes harm.
For early Jing Bing (Spasm), jaw stiffness is mandatory. Give Gegen Tang (Kudzu Decoction). Needling Hegu (LI4) and hairline is curative. If collapse signs appear, Shiquan Dabu Tang (Ten Complete Tonifying Decoction) plus Jingjie (Schizonepeta) and Fuzi, combined with Doulin Jiu (Bean Wine) with Jingjie, is used. However, severe opisthotonos preventing swallowing, or open mouth, are untreatable. (Transmission states: For spasm with clenched hands, needle Hegu 1.5-2 cun deep. Superficial needling at hairline is better; iron needles are best.)
For Po Shang Feng (Broken Injury Wind/Wound Tetanus), early neck/back stiffness, dysarthria, or chills are treatable with Gegen Tang or Xuming Tang class. Fructus Sapindus and Huzhang Jing decocted and taken orally are also effective. Opisthotonos is mostly untreatable. Postpartum spasms follow the same method.
Floating-slippery pulse in Jing Bing is auspicious; floating-rapid indicates recurrence.
A woman over fifty suffered from She Gan (Tongue Ulcer). The lesion resembled everted flesh, corroding to the gums. Caustic agents removed the everted flesh. She took Huanglian Jiedu Tang and received external fumigation for 100 days. Residual toxin cleared, and she recovered.
After fumigation, purgatives must be used to complete the cure. For She Gan, use Zi Yuan. If caused by Syphilis (Meidu), Longmen Wan is primary.
True Liu Zhu (Flowing Deposits) are rare nowadays. Current cases presenting as Liu Zhu usually have body scars, differing greatly from *Waike Zhengzong*.
A man in his twenties had diffuse axillary swelling with slight tenderness, resembling Pi Pi (Mass). His left foot had a scar. Diagnosed as exogenous Liu Zhu, he was treated with Yebiji Jia Zhu Fuzi Tang and periodic Zi Yuan purges, resulting in cure.
Liu Yin (Retained Fluids) combined with Xu Xue (Blood Stasis) requires precise abdominal examination to differentiate.
For He Xi Feng (Crane Knee Wind) or stubborn toxins hard to extract, Wutou Tang, Guizhi Jia Zhu Fuzi Tang, etc., plus Jiaoshi (Shell Ash) are suitable. Jiaoshi specializes in treating difficult-to-move toxins.
For Syphilis attacking and condensing the head/neck, Guizhi Tang plus Fuling, Cangzhu, Wutou, Xixin, Fangfeng, combined with Xiaodu Wan, is prescribed.
Linggui Zhugan Tang plus Fuzi treats Huang Pan Bing (Yellow Puffy Disease/Dropsy). Moving Qi in the chest is treated with Tie Fen (Iron Powder) and Shuqi (Polygala).
For Hernia needling: Clear fluid discharge means no suppuration. Bloody-fluid discharge implies suppuration. Suppurated hernias are easier to treat.
Intestinal Hemorrhoids with blood discharge are Excess; bloody-fluid discharge is Deficiency.
Ru Yan (Breast Cancer) with menstruation is easy to treat; amenorrhea makes it difficult. Pregnancy causes breast cancer nodules to enlarge suddenly.
Zhang Man (Distension/Fullness) arises from Water Qi or Qi Condensation. Water Qi is Excess, thus easy to treat. Qi Condensation is mostly Deficient, thus difficult.
Jixiong Yuanji said: Those dying of distension have solidified intestinal masses upon cremation, hard as stone. Westerners note that abdominal distension with tubercles obstructing limb blood vessels leads to wasting of limbs. This may be true.
Kuang (Mania), Xian (Epilepsy), and Xue Yun (Blood Fainting) are similar but distinct. Mania involves incessant nonsense speech. Epilepsy involves fright and opisthotonos triggered by stimuli. Blood Fainting involves mental confusion, severe trismus. Sweating and pulse lacking Stomach Qi indicate death.
For dog bites, apply Zhonghuang Gao (Central Yellow Ointment) with Xingren and Gancao externally. Internally, Huanglian Jiedu Tang plus Muguaizi (Momordica seed), and eat Toad meat. This is excellent.
For Tuo Ju (Gangrene of Extremities), pain indicates non-necrotic tissue; absence of pain indicates necrosis.
Lin Ji (Strangury) with free urination is treated with Shenqi Tang plus Fuzi.
Shoulder stiffness, lower back pain, left hand wound, right hand mass, and generalized pain indicate Liu Zhu Du (Flowing Deposit Toxin). Treat with Yebiji Jia Zhu Fuzi Tang and periodic Zi Yuan purges. For collapse, use Shenqi Guifu agents.
Metal wounds in the diaphragm are fatal regardless of speed. Wounds above the navel are dangerous. Abdominal wounds avoid caustics because they are near viscera.
Fan Shi, Badou, Banzhao, Wutou, etc., are hot toxins. Cold water is best for detoxification. (Note: All potent toxins in nature are acrid-hot. Detoxifying herbs are therefore bitter-cold, such as Huanglian Jiedu Tang and Kushen Tang.)
Caustic drugs cause the most severe Mingxuan reactions. One patient applying caustics to the buttocks died from sudden upward attack of toxin to the heart.
Mild Mingxuan from caustics includes chills, fever, thirst, or anorexia. Severe cases involve irritability/thirst or oppression, with toxin pressing on the epigastrium, hastening death. Urgently rescue with Huanglian Jiedu Tang or Ganlian Jia Shigao Lutou Tang (Licorice-Coptis plus Gypsum and Mung Bean Decoction).
Postpartum shivering is due to fresh Qi/Blood deficiency and pathogen invasion. Give Jingjie Chenxiang Tang or Shiquan Dabu plus Jingjie and Paojiang. For greater deficiency, add Fuzi. Shivering occurring 4-5 times is difficult to treat. Slow pulse indicates recovery; tight-rapid pulse indicates untreatability.
Postpartum blood deficiency with red, ulcerated, painful tongue is treated miraculously with Bayi Tang plus Lutai Shuang (Deer Placenta Frost). Lutai Shuang also treats postpartum continuous bleeding.
General body pain is generally due to Qi/Blood stagnation, such as in trauma or Tianxing Bing. Qi-moving agents bring cure.
Hernia originates in the lower abdomen, causing rectal prolapse into the scrotum. Differentiate ease/difficulty. Gradual unilateral scrotal swelling is easy to treat. Scrotal fluctuation with pain radiating to lower abdomen is difficult. I once needled a case of scrotal fluctuation, causing foul-smelling stool passage, which was distressing. Syphilitic hernia forming hard flesh should be cut with scissors; caustics cause harm.
Wei Yuan Yong (Stomach Abscess) mimics Fei Yuan (Lung Abscess) but pain extends to lower abdomen with expectoration of pus/blood. Treat with Pai Nong San (Pus-Expelling Powder) or Jiegeng Bai San (Platycodon White Powder). Early Jie Lu in children begins with fever, trismus, and opisthotonos. Treat early with Gegen Jia Zhu Fuzi Tang plus Zi Yuan. Once established, it is mostly untreatable.
Opisthotonos without vomiting/diarrhea is Ji Jing Feng (Acute Infantile Convulsion). Tremors with upward gaze, vomiting/diarrhea are Man Jing Feng (Chronic Infantile Convulsion). Treat with Sini Tang, Chaihu Yi Gan Tang, Xingxing San, Qingpi San, or Deliya (likely a specific formula name) according to syndrome. Hou Tou used Chaihu Jia Longgu Muli Tang; efficacy unknown. Acute convulsions show lucidity between attacks; chronic shows sleepiness. Chronic convulsions with preceding coma are mostly untreatable.
For Pian Ku (Hemiplegia) regardless of age, Guizhi Jia Zhu Fuzi Tang is usable. For urgency, purge with Zi Yuan. Abdominal softness indicates treatability; rigidity indicates untreatability. This is due to lack of Qi circulation; purging does not relieve rigidity.
Stroke-related hemiplegia with periodic onset often belongs to Epilepsy families. Guizhi Jia Ling Zhu Fuzi Tang with periodic Zi Yuan purges is used. Long-term medication is necessary. Women with uncontrollable arm flexion/extension have epilepsy, treated with Daqi Qi Tang with miraculous effect. (Zhuoxuan: These dozens of cases are practical truths, reflecting the Master's spirit. Students should regard them as golden rules.) Former disciple Fukuba Kataoka (Courtesy name Shike, Village Physician) liked my words, copied them from my book, and wrote a preface: "Master's medicine integrates internal and external principles, adapting to syndromes practically. Formulas have standards, techniques have flexibility. Juniors must study this." He asked me to correct the draft. At that time, Kataoka died suddenly of foot disease. Later, I wrote this. I edited the manuscript to honor his legacy and added a poem: "Years ago we enjoyed wandering together, / Who counted the loss, suddenly one autumn passed. / The waning moon shines through the window, the person unseen, / Sky full of wind and dew drips on the empty tower."