按∶当时传艮山先生术者，京师有香川修德、山胁尚德，浪华有市濑穆，伊芳势有山村重
高，
备前有赤泽贞干，家着户述，不乏其人。而后来私淑先生者，以筑前龟井鲁为最。曾着《病
因备考》，补翼其说。又赋诗云∶长沙太守元儒绅，述古兼医百世人。直指经方归易易，谁
家私说言断断。枢机何用烦汗简，糟粕须知耻刘轮。卓乎艮山藤老子，才良仁术足相亲。
友松胸宇洒落，以旷世之才，授闽医之传，善得法外之法。故治术别开生面，自有神识
迢迈，触手生春之妙矣。
友松尝善象胥学，又从禅僧化林学仲景奥旨，就戴曼公得《内经》、本草精蕴，既而谓
皇朝医风亦不可不研，乃师小仓医员原长庵(冈本玄治高弟)，遂大成其业。
虚劳有直肠疼痛大便难，或发痔漏者，此皆系肺大肠损伤，为难治。(常屡诊虚劳者，
发此
证颇多，而百无一治。古云肺与大肠为表里，理或然。)敛血品以牡丹皮、荆芥、蒲黄各炒
黑为奇。(本邦妇人套药皆炒黑为用，即此意。)
阪本人年五十所，郁郁不对人，饮食减少，颇如劳瘵。先与补中益气汤，后以九味清脾
加葳蕤得愈。凡开达肝脾之郁塞，无若清脾汤。若逢肝脾郁
塞，以认此汤主治为要。
一妇人三年不语，一月内或一二言耳。乃以为脱营类，与人参养荣汤，易裘葛而愈。
盗汗不止者，九味清脾汤加地骨、鳖甲、椒目奇效，当归六黄，加地骨、防风、桂枝、
黑姜
、椒目亦效。椒目能敛汗，古人尝论之，今忘其出典。(香川修德药选论椒目效最详，悉宜
参考。)
一男子得病，其证类膈噎。友松诊之，以为心脾肾气不足，胸膈无润泽，故食饮不能下
。与
八味丸料，加蒌仁、贝母、陈皮、缩砂，兼用金匮大半夏汤。(参五分至一钱，时用参附汤
。)
霉毒头痛久不愈者，柘榴皮酒煎服忽差。盖此证医误以风药发之，故柘榴皮涩之则愈也
。先
醒斋头风神方亦效。(土茯苓四两，金银花三钱，蔓荆子一钱，玄参八分，防风一钱，天麻
一钱，辛荑花五分，黑豆四十九粒，灯心草二十根，芽茶五钱，河水井水各一钟半，煎一钟
服。)
某生胸下上脘边突出，气急烦闷，与异效散加椒目愈。又目疮，(俗称女波津古一名女
保者。)用升麻葛根汤加椒目效。
友松以养荣汤或左归丸料，治虚羸，专视十指爪甲血潮之多少为消息。盖辨血色之好恶
在爪
甲，不可不知。(老医传云∶诊脉毕，宜以指按病者爪。按之白放之红者吉，虽久病可治。
放之红不复者，虽顿病甚凶。香川修德行医言，亦载辨爪法宜考。)
呕吐膈噎食不下者，半夏、浓朴汤，加海浮石、枯矾效。
乳肿属气滞。乳汁不通者，四物，加王不留行、穿山甲效。
霉毒为残害者，主小柴胡汤，随证加减多验。(按医纲小柴胡汤加草龙胆、黄连、胡黄
连，
治旧下疳疮。忽头痛发热自汗，撮要小柴胡去大枣、生姜，加山栀、龙胆草、当归、芍药。
治肝经热毒下注，便毒肿痛，一切疮疡，或风毒恶核瘰 ，此类颇多，宜考。和田东郭曰∶
凡霉毒有热者，先不解其热则不愈，此即用小柴胡汤之旨。)
土佐翁(谓长泽道寿。)隐栖西山，一日诊京师商人痈疽曰∶宜日服人参五钱。后五日诊
曰∶
未见参效，恐不治。病家告实曰∶服参一日不过二钱五分。翁曰∶贱命重财，无益矣。苟欲
生则服参，宜今日五钱，明日六钱，又明日七钱，渐次相进。商如其言，七日病果愈。友松
曰∶用参将息适宜，可谓得补托之真诀矣。
土佐翁着《医方口诀集》，三日而成。有马氏凉及手写《证治准绳》全帙，以谙记其卓
识，笃志可并称。
治头痛，薄荷、石菖、葛粉、川芎、白芷，五味细研，蜜炼服效。平常患头风者尤妙。
杂着化痰丸如白刀豆，以治痰妙。风痰结心包健忘者，无不效。一僧疫后患此证，服之
速愈。
过服石膏下血者，补中益气汤加肉桂、干姜效。
妇人下部水肿，或小便不利者，枯矾细研，以涂涌泉穴及指头，则尿利肿消。
痘疮以日数证候变者，其理与伤寒传经同属疫气故也。宜知元气旺衰，邪势剧易为要
。若徒
执黄 、当归、人参终始疗之者，不足与论也。(按隋唐医书皆以痘属疫，迨宋元胎毒说起
，其理遂晦，先生特阐之，可谓卓见矣)。
疫证舌上白胎者，热入腑也。赤烂干燥者，热入脏也。张氏舌鉴论之为确。
张景岳制人参胡椒汤，为有深旨。凡极虚者，附子反走散元气。故与附子则脉却伏结，
不可无此汤之设也。
一妇人喜唾，数日不止。医以为虫积或虚冷，治之无效。余以为郁，与正气天香汤，速
愈。(疫后喜唾不了了者，一老医与大柴胡汤速效，是亦属郁者。)
《准绳》伤寒门伤寒类伤寒辨，学人宜熟读谙记，使门人各书写一通。
妇化医某始疗病，每服药重七八钱，甘草分两尤多而无效，人皆以为庸工。某曰∶吾过
矣
，国人比之于唐山腹力颇弱，故不能中肯綮。便减其分量，杀甘味以为之，无不百中也。
治病必求其本，乃往圣之模范。随证而施药，是后学之应用。及治四时伤寒，各随其类
，岂可局于区区论说哉!(医家宜当之羹墙。)
明太祖论徐达曰∶更涉世故则智明，久历患难则虑周，吾业最为然。(以救己之心，推
以救人，所谓现身说法。诚千古不磨之论。)
夏布政字正夫，未尝以淹屈降志，尝曰∶君子有三惜，此生不学一可惜，此日虚过二可
惜，此身一败三可惜。余续之曰∶有善不作四可惜，有过不改五可惜，老来怨天更可惜。
《骨空论》曰∶厉风者，素刺其肿上已，刺以锐针，针共按处出其恶气，肿然乃止。常
食方
食，无食他食，按常食以下八字，为治难病之妙诀，不止厉风。故余一生以为治病药食之准
则矣。又按张氏注云∶食得其法，谓之方食；无食他食，忌动风发毒等物也。此说未是，方
食即谓方宜惯食之物，他食即谓所不常食之物。言食膏粱之人，试以淡泊则恶；茹藜藿之人
，试以美食则伤食，不唯却其病，反生他病。
东垣《辨惑论》当为一卷，今别有二卷者，恐系后人之手，何则？举补中益气以至暑伤
胃气
，即说正月以下三四月治法。肺以下至脾胃虚，即说五六月治法，下之至内伤辨，皆属九月
以至十二月之治法。一意到底，不可为二卷者昭然。
李氏辨内外疑似证最精矣。且如气少气盛辨，益于后学不为鲜。然至内外相兼者，李氏
说未为尽，宜涉猎古人书以补其阙。
下元虚损，精气枯槁，人外感风寒，颇似温疫者，或宜先补虚，或宜先发邪，或宜补泻
相兼。此际医最可苦心处，固非笔墨之所尽焉。
《医药纲目》别为一家，与他书体裁自异。钱氏论小儿亦自一派，据之不为可，不据亦
不为
可。(拙轩曰∶有明一代医书之多，汗牛不啻。所谓类比 者居多，戴复庵、吴有性、陈
实功之外，仅仅数家耳。《医学纲目》亦庸中之佼佼者，此言有味。钱仲阳之于哑科，颇为
大家，然见为一派，真是有识之言。)
疗伤寒知去路来路为要，或表入里，或阳转阴，或前在某位，后进某位，或始终一位。
审之以处方，思过半矣。喻昌曾辨之，可就见焉。
余常主实学示子弟曰∶经络脉说不可不知，而深拘之则反失于实用，学人固不可无取舍
之见。
余不喜讲说，唯正月初八祭神农氏，使门人讲《上古天真论》耳。(其说曰∶听讲义鲜
益其效，不若熟讲百遍，盖在心悟。此可以为世医信耳不信目之戒。)
余晚年读本草日夜不释手，故其用药虽一味无赘品。
余疗南源悦山高泉诸僧，皆用大剂何者？西土人比之本邦颇浓肠强胃，非轻品所敌。风
土人
物之异，不可不知。(西土医诊病直记其药按以与病者，病者购之于药铺以服之，故其品剂
量适，正与邦医轻剂射利者迥异。)
甘麦大枣汤，治产后似邪祟者奇效。(按∶所谓如有神灵者也。)
伤寒壮热烦渴，小便赤，不大便七八日，舌燥目赤，时闭乍开，仅啜粥汁耳。一医与清
心温
胆汤去香附，加辰砂、淡竹叶、而谵语益剧，脉伏不应。因与白虎汤合黄连解毒汤，诸证自
若。乃煎人参三钱，黑姜一钱，兼服之脱然愈。(按∶此与吴有性承气加人参合辙。)
建中汤入口则痛乍止者，甘以缓急也。甘草粉蜜汤治心痛，其旨颇同。膈噎服蜂蜜，一
旦纳食亦同意。大半夏汤之于蜜，不过此意矣。
张仲景一书，炳如日星，亘千古不可磨灭，熟读者知其意。(当时医多读《素》、《难
》不读《伤寒论》，故发此言，以示为万世理道之神书，救人之秘典也。)
《内经》终始一言以蔽之曰∶亢则害，承乃制。(经云∶知其要者，一言而终。不知其
要者，流散无穷。可谓真知其要者。)
东垣本于《内经》阳气清净则四维收之意，制补中益气汤，深得经旨矣。在本邦土佐道
寿善研究其意，故治脾胃手段最长矣。
罗氏曰∶七分内伤，三分外伤者不治，是善得李氏之意者。
治疗之法，先泻后补为易，先补后泻为难。
丹溪斥《局方》者系救时弊，门人戴氏专用《局方》，其意可知矣。
古林见宜疗纪州熊野山中农夫水肿，服药良久无效。因加青芋于方中，又以之为朝夕餐
而病
愈。盖其人生于山中，以此物为常食。而偶出于浪华请药于众医，禁忌亦随严。故脾胃失常
度，药力不能达，是以施方宜之术也。
咽喉痛颊肿及呕哕者，小柴胡汤连翘各等分服之效。
水气不论新久，欲持脉不能遽举手，或欲按足跗不能伸脚而微喘者，死证也。肿气一旦
减乍复者，亦不治。
淋疾与五苓、平胃、泻肝诸汤。茎中涩痛甚者，补中益气汤加蒲黄(大)、五灵脂、金银
花效。(按∶内注下疳远年不愈者，与此汤亦效。)
常诲初学用零纸书古人医案，各处其方，以得其当为上等。
凡方证虽相对，分量有不过及，则不能奏效。故葛可久损伤病论大黄多少至密矣。况如
中气卒厥之于人参，阴虚之于龟板，其多少不可不最密矣。
友松治肿胀用补气养血汤，十愈七八，盖此方不用利水品，而肿胀难治者，间奏大效。
其意在专治胀也。
一医生读喻氏《寓意草》，友松闻之曰∶喻氏之书不无益，然以之为治疗之模范，恐为
下工。
呕逆诸治无效者，及诸呕吐不能服药者，与旋复代赭石汤效。盖此方人参、代赭相伍为
妙用也。如白通加猪胆汁汤，其妙亦在附子、猪胆相伍也。
闽人化林老汉传治眼暗失明，用鸢首霜，此理高上可玩味。
摄津池田有一奇病，其证两脚酸疼，渐肌肉削小难屈伸，遂成痿，俗名曰池田病。此病
他人间患之，而皆受之于池田云，友松与独参汤愈。
八味丸为转胞之套剂，而服法非逐次增分量则无效。此即益水源之意，宜三钱至八钱为
妙。
小剂药量时不无效，《医学正传》有其说，汪认庵亦论之。
积气气郁，或夜中发热等病。有发止者，详其由有患疟者，虽数年后兼用阴疟丸。则奇
中焉。
闽人传治贫窭消渴，水中腐木一味为散服。又治头风，鸢头霜烧酒服。友松治一武弁两
眼旋动，与鸢头灰。盖扩充此意云。
凡用滋补滋阴药，方中无陈皮、半夏、木香、砂仁等，则不能达药气，此理尤不可阙。
(按古人黄 建中汤加半夏者，即此意。)
方者法也，如毁旧屋而建新屋，故使方而不使于方为要。假令如以中风方治咳嗽是使方
也，
若以风药治风，以咳药治咳，是不使于方也，况索病根而治之，诸证不治而自治，乃上乘法
。
下部肿与防己茯苓汤，上部肿与茯苓补心汤，并奏效。妇人肿气多属血分，防己能入血
分，
故多效。若属气分者，茯苓、泽泻为主。若男妇阴虚为肿者，六味地黄丸加附子、防己、苍
术效。又肿病元气实者，大承气汤为丸用之效。
《证治要诀》为必读之书也，如藿香正气散加木香以为一方之类，其意尤可称。江州坚
田村
北村道卜者，年可六十，患中风，京医几岛氏疗之无效，因延余。余诊曰∶欲速愈，则后三
年必再发，以至不治，若不欲速愈，则十五六年当延其寿，二者请选之。病者曰∶荏苒弥年
，何堪其久，愿速愈以谢朋友。乃作异功散，加乌药、白芷、青皮与之，服五十贴全愈。后
三年果如其言。门人矢岛安节问缓治之方。曰∶十全大补汤为得焉。
友松在北村氏家隐几而坐，一女子将请诊。请诊，望见叱之曰∶汝妒心溢面，可深恶。
女子
赧然谢服。因语曰∶汝神彩甚病矣，苟有悔心，余善疗之，即与药而愈。盖此女嫉妒多年，
夜则穿户窥隙，颇如狂人。而友松一见洞视，人服其技云。
阪阳老医问起死回生之方。答曰∶方无灵，唯求其本耳不言其他。
凡病虚实难辨，补泻难决者，能察其脉证，审脉可据，与证可执。而从其确者，则治法
庶无愆矣。
按语：当时流传艮山先生医术的人，京城有香川修德、山胁尚德，浪华（大阪）有市濑穆，伊势有山村重高，备前有赤泽贞干，家传户述，不乏其人。而后来私下仰慕并师法先生的，以筑前龟井鲁为最。他曾撰写《病因备考》，补充和辅助艮山的学说。又赋诗说：“长沙太守本是儒生，阐述古法兼通医理惠及百代世人。直指经方回归简易，谁家的私说如此固执己见？枢机何用烦劳汗牛充栋的书籍，糟粕须知以刘轮（比喻技艺精妙或浅显之理）为耻。卓然独立的艮山藤老先生，才德仁术足以让人亲近。”
友松胸怀开阔洒脱，凭借旷世之才，传授闽地医生的传承，善于掌握法度之外的法度。所以他的治疗技术别开生面，自有深远的神识，触手生春般的奇妙疗效。
友松曾经擅长翻译（象胥学），又从禅僧化林那里学习张仲景的深奥旨意，从戴曼公那里得到《黄帝内经》和本草学的精微蕴藏，不久后认为本国的医风也不可不去研究，于是拜小仓医生原长庵（冈本玄治的高徒）为师，最终成就了他的学业。
虚劳病出现直肠疼痛、大便困难，或者发生痔疮漏管的情况，这都是因为肺和大肠受损，属于难治之症。（我常多次诊治虚劳患者，发这种证候很多，但百无一治。古人说肺与大肠相表里，道理或许是这样。）收敛血的药物以牡丹皮、荆芥、蒲黄各炒黑使用为奇特。（我国妇人常用药都是炒黑使用，就是这个意思。）
大阪有一人五十岁左右，情绪抑郁不与人交流，饮食减少，很像劳瘵（肺结核）。先给予补中益气汤，后用九味清脾汤加葳蕤（玉竹）得以痊愈。凡是开通肝脾郁塞的，没有比清脾汤更好的了。如果遇到肝脾郁塞，认定此汤为主治关键。
有一位妇女三年不说话，一个月内只说一两句。认为是脱营类疾病，给予人参养荣汤，更换衣物（调理生活起居）后痊愈。
盗汗不止的，九味清脾汤加地骨皮、鳖甲、椒目有奇效；当归六黄汤加地骨皮、防风、桂枝、黑姜、椒目也有效。椒目能收敛止汗，古人曾论述过，现在忘记了出处。（香川修德的《药选》中论述椒目的功效最详细，都适宜参考。）
一名男子患病，症状类似膈噎（吞咽困难）。友松诊察后，认为是心脾肾气不足，胸膈缺乏润泽，所以饮食不能下咽。给予八味丸料，加瓜蒌仁、贝母、陈皮、缩砂仁，同时服用金匮大半夏汤。（人参用量五分至一钱，时常配合参附汤使用。）
梅毒引起的头痛久治不愈的，用柘榴皮酒煎服忽然好转。因为这个证候医生误用风药发散，所以用柘榴皮涩敛则痊愈。先醒斋的头风神方也有效。（土茯苓四两，金银花三钱，蔓荆子一钱，玄参八分，防风一钱，天麻一钱，辛荑花五分，黑豆四十九粒，灯心草二十根，芽茶五钱，河水和井水各一钟半，煎至一钟服用。）
某学生胸下上脘穴附近突出，气急烦闷，给予异效散加椒目痊愈。又有眼疮（俗称女波津古，又名女保），用升麻葛根汤加椒目有效。
友松用养荣汤或左归丸料治疗虚羸（极度消瘦虚弱），专门观察十指爪甲血色的多少来调节用药。辨别血色好坏关键在于爪甲，不可不知道。（老医生传说：诊脉结束后，应用手指按压病人的指甲。按压后变白松开后变红的为吉兆，即使是久病也可治。松开后变红不再恢复的，即使是突发重病也很凶险。香川修德行医言论中，也记载了辨别指甲的方法宜考察。）
乳房肿胀属于气滞。乳汁不通者，四物汤加王不留行、穿山甲有效。
梅毒造成的残害性疾病，主用小柴胡汤，随证加减多有效验。（按：《医纲》中小柴胡汤加草龙胆、黄连、胡黄连，治疗陈旧性下疳疮。忽然头痛发热自汗，撮要篇中去掉大枣、生姜，加山栀、龙胆草、当归、芍药。治疗肝经热毒下注，便毒肿痛，一切疮疡，或风毒恶核瘰疬，此类情况很多，宜考察。和田东郭说：凡是梅毒有热的，先不解其热则不会痊愈，这就是用小柴胡汤的宗旨。）
土佐翁（指长泽道寿）隐居西山，有一天诊断京都商人的痈疽说：“应当每天服用人参五钱。”五天后复诊说：“没见到人参的效果，恐怕治不好了。”病人家属如实告知说：“服用人参一天不过二钱五分。”翁说：“轻视生命重视钱财，没有益处啊。如果想要活命就服用人参，应当今天五钱，明天六钱，后天七钱，逐渐增加。商人照他的话做，七天病情果然痊愈。友松说：用人参调养适宜，可以说是得到了补托法的真诀了。”
土佐翁撰写《医方口诀集》，三天完成。有马氏凉及手写《证治准绳》全书，凭借熟记其中的卓越见识，笃志精神可并称。
治疗头痛，薄荷、石菖蒲、葛粉、川芎、白芷，五味细研，炼蜜服用有效。平常患头风的人尤其妙。
杂着化痰丸像白刀豆一样，用来治痰很妙。风痰结在心包导致健忘的，没有无效的。一位僧人疫病后患此证，服用后迅速痊愈。
妇人下部水肿，或者小便不利的，枯矾细研，涂抹涌泉穴及手指头，则小便通利水肿消退。
痘疮随着天数和证候变化，其原理与伤寒传经相同，都属于疫气所致。应当知道元气旺衰，邪势剧易是关键。如果执着于黄芪、当归、人参始终治疗，不足以与之谈论。（按：隋唐医书都以痘疹属于疫病，到了宋元时期胎毒说起，其理就晦暗了，先生特别阐发它，可以说是卓越的见解。）
疫病舌上有白苔的，是热入腑。舌赤烂干燥的，是热入脏。张氏《舌鉴》论述得很确切。
张景岳配制人参胡椒汤，有着深远的旨意。凡是极虚的病人，附子反而会导致元气走散。所以配合附子使用时脉搏会伏结，不可没有这个汤的设置。
一名妇女喜欢吐唾沫，几天不停。医生认为是虫积或虚冷，治疗无效。我认为属于郁证，给予正气天香汤，迅速痊愈。（疫病后喜欢吐唾沫淋漓不尽的，一位老医生给予大柴胡汤迅速见效，这也属于郁证。）
《证治准绳》伤寒门中伤寒与类伤寒的辨析，学习者应当熟读牢记，让门人各自抄写一通。
妇化医某人刚开始治病时，每服药重量七八钱，甘草分量尤其多却无效，人们都认为他是庸医。某人说：“是我的过错，国人相比唐山（中国）体质较弱，所以不能击中要害。于是减少药量，减轻甘味，没有不百发百中的。”
治病必须探求根本，这是往圣的模范。随证施药，是后学的应用。等到治疗四时伤寒，各随其类别，岂可局限于区区论说呢！（医家应当将其视为榜样。）
明太祖评论徐达说：“更涉世事则智慧明朗，久历患难则思虑周全，我的事业最为如此。（用自己的心去救人，所谓现身说法。这确实是千古不朽的言论。）”
夏布政字正夫，未曾因困顿降低志向，曾说：“君子有三惜，此生不学一可惜，今日虚过二可惜，此身一败三可惜。”我接着说：“有善不作四可惜，有过不改五可惜，老来怨天更可惜。”
《骨空论》说：“厉风病，素刺其肿处已，用锐针刺，针刺同时按压患处排出恶气，肿消才停止。常食方食，不吃其他食物，按照常食以下八个字，是治疗难病的妙诀，不只是厉风。所以我一生把它作为治病药食的准则。”又按张氏注释说：“吃得合乎法度，叫做方食；不吃其他食物，忌动风发毒等物。这种说法不对，方食即谓平时习惯吃的东西，他食即谓不常吃的东西。说吃膏粱厚味的人，尝试清淡饮食则厌恶；吃粗茶淡饭的人，尝试美食则伤食，不仅不能驱除疾病，反而产生其他疾病。”
东垣《辨惑论》应当是一卷，现在另外有两卷的，恐怕是后人所为，为什么呢？列举补中益气到暑伤胃气，就说正月到三四月的治法。肺以下到脾胃虚，就说五六月的治法，下面的直到内伤辨，都属于九月到十二月的治法。一意到底，不能分为两卷是很明显的。
李氏辨别内外疑似证非常精当。而且如气少气盛的辨别，对后学大有裨益。然而到了内外相兼的情况，李氏的说法未尽完善，应当涉猎古人书籍来弥补其缺失。
下元虚损，精气枯槁，人外感风寒，颇似温疫的，或者宜先补虚，或者宜先发邪，或者宜补泻相兼。此时医生最可苦心之处，固非笔墨所能尽述。
《医药纲目》自成一家，与其他书体裁自然不同。钱氏论小儿也是自成一派，依据它不为错，不依据它也不为错。（拙轩说：明代医书之多，汗牛充栋。所谓类比的大居多，戴复庵、吴有性、陈实功之外，仅仅几家而已。《医学纲目》也是平庸中的佼佼者，这话有味道。钱仲阳对于哑科，颇为大家，然而见解为一派，真是有识之言。）
治疗伤寒知道去路和来路是关键，或表入里，或阳转阴，或前在某位，后进某位，或始终一位。审察清楚以此处方，思过半矣。喻昌曾辨析过，可以查看。
我常主张实学教导子弟说：经络脉说不可不知，但过分拘泥反而失去实用价值，学习者固然不可没有取舍之见。
我不喜欢讲说，只有正月初八祭神农氏，让门人讲《上古天真论》罢了。（它的说法是：听讲义很少有益处，不如熟讲百遍，大概在于心悟。这可以作为世医信耳不信目的警戒。）
我晚年读本草日夜不释手，所以他的用药即使一味也没有多余的药物。
我治疗南源悦山高泉等僧人，都用大剂量的药为什么？西方土地的人相比本国肠胃强壮，不是轻品所能抵挡的。风土人物之异，不可不知道。（西方医生诊病直接记录药物交给病人，病人去药店购买服用，所以品种剂量适中，正与我们国家医生轻剂射利者截然不同。）
甘麦大枣汤，治疗产后似邪祟者有奇效。（按：所谓如有神灵附体一般。）
伤寒壮热烦渴，小便赤，不大便七八日，舌燥目赤，时而闭目时而睁眼，仅喝粥汁。一位医生给予清心温胆汤去掉香附，加辰砂、淡竹叶，而谵语更加剧烈，脉伏不应。于是给予白虎汤合黄连解毒汤，诸证自然平复。然后煎人参三钱，黑姜一钱，兼服之后豁然痊愈。（按：这与吴有性的承气加人参法一致。）
建中汤入口则痛暂时停止的，是甘以缓急的意思。甘草粉蜜汤治心痛，其旨意颇同。膈噎服蜂蜜，一旦进食也同意。大半夏汤之于蜜，不过是这个意思罢了。
张仲景一书，炳如日星，亘古不可磨灭，熟读者知其意。（当时医生多读《素问》、《难经》而不读《伤寒论》，所以发出这番话，以示其为万世理道的神书，救人的秘典。）
《内经》终始一言以蔽之曰：亢则害，承乃制。（经文说：知其要者，一言而终。不知其要者，流散无穷。可以说是真正知道要领的人。）
东垣本于《内经》阳气清净则四维收的意思，配制补中益气汤，深得经旨。在本国土佐道寿善于研究其意，所以治疗脾胃手段最长。
治疗之法，先泻后补为易，先补后泻为难。
丹溪斥责《局方》是为了救治时弊，门人戴氏专用《局方》，其意可知。
古林见宜治疗纪州熊野山中农夫的水肿，服药很久无效。于是加青芋在方中，又以之为朝夕餐而病愈。盖因为他生于山中，以此物为常食。而偶然来到浪华请药于众医，禁忌也随之严格。所以脾胃失常度，药力不能到达，因此施用方宜之术。
水气不论新久，想要切脉不能遽举手，或者想要按足跗不能伸脚而微喘的，是死证。肿气一旦减少突然复发的，也不治。
淋疾与五苓散、平胃散、泻肝诸汤。茎中涩痛甚重的，补中益气汤加大蒲黄、五灵脂、金银花有效。（按：内注下疳远年不愈的，与此汤也有效。）
常教诲初学者用零纸书写古人医案，各处其方，以得其当为上等。
凡方证虽相对，分量有不过及，则不能奏效。所以葛可久损伤病论大黄多少至密。何况如中气卒厥之于人参，阴虚之于龟板，其多少不可不最密。
友松治疗肿胀用补气养血汤，十愈七八，盖此方不用利水品，而肿胀难治者，间奏大效。其意在专治胀也。
一位医生读喻氏《寓意草》，友松听说后说：喻氏的书不无益处，然而以其为治疗的模范，恐为下工。
呕逆诸治无效者，及诸呕吐不能服药者，给予旋复代赭石汤有效。盖此方人参、代赭相伍为妙用。如白通加猪胆汁汤，其妙也在附子、猪胆相伍。
摄津池田有一种奇病，其证两脚酸疼，渐肌肉削小难屈伸，遂成痿，俗名曰池田病。此病他人间患之，而皆受之于池田云，友松给予独参汤痊愈。
八味丸为转胞的套剂，而服法非逐次增分量则无效。此即益水源之意，宜三钱至八钱为妙。
小剂药量时不无效，《医学正传》有其说，汪认庵亦论之。
积气气郁，或夜中发热等病。有发止者，详其由有患疟者，虽数年后兼用阴疟丸。则奇中焉。
闽人传授治疗贫窭消渴，水中腐木一味为散服。又治头风，鸢头霜烧酒服。友松治疗一武弁两眼旋动，给予鸢头灰。盖扩充此意云。
凡用滋补滋阴药，方中无陈皮、半夏、木香、砂仁等，则不能达药气，此理尤不可阙。（按：古人黄芪建中汤加半夏者，即此意。）
方者法也，如毁旧屋而建新屋，故使方而不使于方为要。假令如以中风方治咳嗽是使方也，若以风药治风，以咳药治咳，是不使于方也，况索病根而治之，诸证不治而自治，乃上乘法。
下部肿与防己茯苓汤，上部肿与茯苓补心汤，并奏效。妇人肿气多属血分，防己能入血分，故多效。若属气分者，茯苓、泽泻为主。若男妇阴虚为肿者，六味地黄丸加附子、防己、苍术有效。又肿病元气实者，大承气汤为丸用之有效。
《证治要诀》为必读之书也，如藿香正气散加木香以为一方之类，其意尤可称。江州坚田村北村道卜者，年可六十，患中风，京医几岛氏疗之无效，因延余。余诊曰：欲速愈，则后三年必再发，以至不治，若不欲速愈，则十五六年当延其寿，二者请选之。病者曰：荏苒弥年，何堪其久，愿速愈以谢朋友。乃作异功散，加乌药、白芷、青皮与之，服五十贴全愈。后三年果如其言。门人矢岛安节问缓治之方。曰：十全大补汤为得焉。
友松在北村氏家隐几而坐，一女子将请诊。请诊，望见叱之曰：汝妒心溢面，可深恶。女子赧然谢服。因语曰：汝神彩甚病矣，苟有悔心，余善疗之，即与药而愈。盖此女嫉妒多年，夜则穿户窥隙，颇如狂人。而友松一见洞视，人服其技云。
阪阳老医问起死回生之方。答曰：方无灵，唯求其本耳不言其他。
Note: Those who transmitted Mr. Gensan's medical skills at that time included Shukoku Kagawa and Shoutoku Yamawaki in the capital (Kyoto), Matase Mutsu in Naniwa (Osaka), Shigetaka Yamasaka in Ise, and Teisen Akazawa in Bizen. Family transmissions were numerous. Among those who later privately revered him as their teacher, Kamei Ro of Chikzen was the most prominent. He wrote *Byoin Bikou* (Supplementary Examination of Disease Causes) to supplement and support his theories. He also composed a poem: "The Grand Administrator of Changsha was originally a Confucian scholar, expounding ancient methods and medicine to benefit generations for a hundred years. Pointing directly to the classic prescriptions returns to simplicity; whose private theories are so dogmatic? Why trouble with voluminous books on the pivot mechanisms? One should be ashamed of understanding only the dregs, like Liu Lun [a metaphor for superficial understanding]. Lofty is Old Man Gensan Fuji, whose talent, virtue, and benevolent art are worthy of closeness."
Yumatsu had an open and free spirit. With extraordinary talent, he inherited the transmission of Fujian doctors and excelled in mastering methods beyond the conventional rules. Thus, his therapeutic techniques opened new paths, possessing profound spiritual insight and the miraculous ability to bring spring to his touch.
Yumatsu was skilled in translation (Xiangshu studies) and studied the profound principles of Zhang Zhongjing from the Zen monk Karyin. From Dai Manso, he obtained the essence of *Huangdi Neijing* (Yellow Emperor's Inner Canon) and Materia Medica. Later, believing that the medical customs of his own country (Japan) should also be studied, he took the small-courier doctor Harasan (a senior disciple of Okamoto Genchi Takatomo) as his teacher, ultimately achieving great success in his field.
In cases of deficiency consumption (Xu Lao) presenting with rectal pain, difficulty in defecation, or hemorrhoidal fistulas, these are all due to damage to the lungs and large intestine, making them difficult to treat. (I have frequently diagnosed deficiency consumption patients, finding this syndrome common, yet rarely curable. The ancients said the lungs and large intestine are exteriorly-interiorly related; this reasoning may be correct.) For blood-astringing herbs, using Cinnamon Twig Decoction (Guizhi Tang - *Note: Text says Mudanpi, Jingjie, Puhuang fried black*, correcting to specific herbs mentioned: Radix Paeoniae Rubra (Mudanpi), Schizonepeta Herb (Jingjie), and Sparganium Rhizome (Puhuang) fried until charred is considered unique. (This aligns with the practice in our country where women's medicines are often fried black for use, deriving from this idea.)
A man in Osaka around fifty years old was depressed, avoided people, had reduced appetite, and resembled tuberculosis (Lao Zhai). Initially treated with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), then cured by Jiu Wei Qing Pi Tang (Nine-Ingredient Spleen-Clearing Decoction) added with Yu Zhu (Polygonatum Odoratum Rhizome). For opening liver and spleen stagnation, nothing surpasses Qing Pi Tang. When encountering liver-spleen stagnation, recognizing this decoction as the primary treatment is crucial.
A woman who had not spoken for three years, speaking only one or two words within a month, was considered a case of Tuo Ying (Depletion of Camp Qi). She was given Ren Shen Yang Rong Tang (Ginseng and Nutritive-Qi Tonifying Decoction) and recovered along with lifestyle adjustments (changing clothes/seasonal care).
For persistent night sweats, Jiu Wei Qing Pi Tang added with Gu Pi (Cortex Lycii) and Bie Jia (Carapax et Plastrum Testudinis) yields miraculous effects. Dang Gui Liu Huang Tang (Danggui Six-Yellow Decoction) added with Gu Pi, Fang Feng (Saposhnikovia Root), Gui Zhi (Ramulus Cinnamomi), Hei Jiang (Charred Ginger), and Jiao Mu (Fructus Piperis Kadsurae) is also effective. Jiao Mu can astringe sweat; the ancients discussed this, though I have forgotten the source. (Kagawa Shukoku's *Yakusen* discusses the efficacy of Jiao Mu in detail; reference is advisable.)
A man suffered from a disease resembling Ge Ye (Diaphragmatic Dysphagia). Yumatsu diagnosed it as insufficiency of heart, spleen, and kidney qi, causing a lack of moisture in the chest and diaphragm, preventing food and drink from going down. He prescribed Ba Wei Wan (Eight-Ingredient Pill) formula added with Gua Lou Ren (Semen Trichosanthis), Bei Mu (Fritillariae Bulbus), Chen Pi (Pericarpium Citri Reticulatae), and Suo Sha (Fructus Amomi Rotundus), concurrently using Jin Gui Da Ban Xia Tang (Major Pinellia Decoction from the Golden Cabinet). (Ren Shen dosage 0.5 to 1 qian; often combined with Shen Fu Tang.)
For chronic headache caused by syphilis that does not heal, drinking decoction made from Pomegranate Peel (Zhe Liu Pi) wine suddenly improves it. This is because previous doctors mistakenly used wind-dispersing herbs to induce sweating; thus, the astringent nature of Pomegranate Peel heals it. Xian Xing Zhai's Divine Formula for Head Wind is also effective. (Tu Fu Ling 4 liang, Jin Yin Hua 3 qian, Man Jing Zi 1 qian, Xuan Shen 8 fen, Fang Feng 1 qian, Tian Ma 1 qian, Xin Yi Hua 5 fen, Hei Dou 49 grains, Deng Xin Cao 20 roots, Ya Cha 5 qian. Decoct with half a bell each of river water and well water, take one bell.)
A student had a protrusion near the Shangwan point below the chest, accompanied by shortness of breath and irritability. Yi Xiao San (Miraculous Effect Powder) added with Jiao Mu cured him. For eye sores (commonly known as Nu Bo Jin Gu or Nu Bao), Sheng Ma Ge Gen Tang (Bupleurum and Kudzu Root Decoction) added with Jiao Mu is effective.
Yumatsu treated extreme emaciation (Xu Lei) using Yang Rong Tang or Zuo Gui Wan (Left Restoring Pill) formula, specifically adjusting based on the amount of blood color in the ten fingernails. Distinguishing good or bad blood color lies in the nails, which must not be ignored. (Old doctors' tradition says: After checking the pulse, press the patient's nails. If they turn white upon pressing and red upon release, it is auspicious; even long-term illness is treatable. If they turn red but do not recover color, even acute severe illness is ominous. Kagawa Shukoku's medical remarks also record nail-differentiation methods for examination.)
For vomiting, dysphagia, and inability to eat, Ban Xia Hou Po Tang (Pinellia and Magnolia Bark Decoction) added with Hai Fu Shi (Lapis Aquamarina) and Ku Fan (Alumen Calcination) is effective.
Breast swelling belonging to qi stagnation and blocked lactation are effectively treated with Si Wu Tang (Four-Substance Decoction) added with Wang Bu Liu Xing (Vaccariae Semen) and Chuan Shan Jia (Scaly Pangolin Scale).
For debilitating syphilis, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the main prescription, with modifications based on symptoms showing many verifications. (Note: In *Yi Gang*, Xiao Chai Hu Tang added with Cao Long Dan, Huang Lian, and Hu Huang Lian treats chronic chancres. For sudden headache, fever, and spontaneous sweating, the summary version removes Da Zao and Sheng Jiang, adding Zhi Zi, Long Dan Cao, Dang Gui, and Shao Yao. It treats heat-toxin descending in the liver meridian, buboes, swelling and pain, all sores and ulcers, or wind-toxin nodules and scrofula; many such cases exist,宜考. Wada Toaku said: For syphilis with heat, if the heat is not resolved first, it will not heal; this is the purport of using Xiao Chai Hu Tang.)
Master Tosa (Chosawa Michitoshi) lived in seclusion in the Western Mountains. One day, diagnosing a Kyoto merchant's carbuncle and abscess, he said: "You should take 5 qian of Ren Shen daily." Five days later, he said: "I see no effect from the Ginseng; I fear it is incurable." The family admitted: "He takes only 2.5 qian per day." The Master said: "Disregarding life for wealth is useless. If you wish to live, take Ginseng: 5 qian today, 6 qian tomorrow, 7 qian the next day, gradually increasing. The merchant followed this advice, and the disease healed in seven days. Yumatsu said: Using Ginseng with proper regulation truly grasps the secret of tonification and expulsion."
Master Tosa wrote *Yifang Koujue Ji* (Collection of Key Formulas) in three days. Arima Ryori possessed a handwritten complete copy of *Zhengzhi Zhunsheng* (Standardized Diagnosis and Treatment), memorizing its insights; his dedication is equally commendable.
For treating headaches, Bo He (Menthae Haplocalycis Herba), Shi Chang Pu (Rhizoma Acori Tatarinowii), Ge Fen (Radix Puerariae), Chuan Xiong (Ligustici Chuanxiong Rhizoma), and Bai Zhi (Angelicae Dahuricae Radix), ground finely and taken with refined honey, is effective. It is especially wonderful for chronic head wind.
Za Zhuo Hua Tan Wan (Miscellaneous Writing Phlegm-Resolving Pill), shaped like a white broad bean, is excellent for resolving phlegm. For forgetfulness caused by wind-phlegm knotting in the pericardium, it is invariably effective. A monk suffering from this after an epidemic recovered quickly after taking it.
For bleeding due to excessive use of Shi Gao (Gypsum Fibrosum), Bu Zhong Yi Qi Tang added with Rou Gui (Cinnamomi Cortex) and Gan Jiang (Zingiberis Rhizoma) is effective.
For lower body edema in women or difficulty urinating, grinding Ku Fan (Alumen Calcination) finely and applying it to Yongquan (KI 1) acupoint and fingertips promotes urination and reduces swelling.
Changes in chickenpox/variolola symptoms according to days follow the same principle as the transmission of meridians in Cold Damage; both belong to epidemic qi. Knowing the rise and fall of Yuan Qi (Primal Qi) and the intensity of pathogenic factors is key. Merely adhering to Huang Qi (Astragali Radix), Dang Gui (Angelicae Sinensis Radix), and Ren Shen throughout treatment is insufficient for discussion. (Note: Sui-Tang medical texts classified variola as epidemic; during Song-Yuan, the theory of fetal toxin arose, obscuring this logic. The master specifically elucidated it, showing outstanding insight.)
White coating on the tongue in epidemic diseases indicates heat entering the fu organs. Red, ulcerated, and dry tongue indicates heat entering the zang organs. Zhang's *She Jian* (Tongue Diagnosis) discusses this accurately.
Zhang Jingyue's formulation of Ren Shen Hu Jiao Tang (Ginseng and Pepper Decoction) has profound significance. For extremely deficient patients, Fu Zi (Aconiti Lateralis Radix Praeparata) can cause primal qi to scatter. Therefore, when using Fu Zi, the pulse may become hidden and knotted; the existence of this decoction is necessary.
A woman suffered from excessive salivation for several days. Doctors attributed it to intestinal parasites or deficiency-cold, but treatment failed. I attributed it to depression/stagnation (Yu) and gave Zheng Qi Tian Xiang Tang (Upright Qi Heavenly Fragrance Decoction), resulting in rapid recovery. (Excessive salivation lingering after an epidemic, treated rapidly by an old doctor with Da Chai Hu Tang, also belongs to stagnation.)
The differentiation between Shang Han (Cold Damage) and Lei Shang Han (Similar-to-Cold-Damage) in the *Shang Han* section of *Zhengzhi Zhunsheng* should be read and memorized thoroughly by students; let disciples copy it out.
A female physician initially treated patients with heavy doses of 7-8 qian per prescription, especially high amounts of Gan Cao (Glycyrrhizae Radix), without effect, and was considered mediocre. She said: "My fault. Our people are physically weaker than those from Tangshan (China), so standard doses do not hit the mark. I reduced the dosage and lessened the sweet taste, achieving nearly 100% success."
Seeking the root in treating disease is the model of past sages. Prescribing according to symptoms is the application for later learners. When treating four-season cold damage, following their categories, how can one be confined to limited theories! (Physicians should regard this as a guiding ideal.)
Emperor Taizu of Ming commented on Xu Da: "Engaging more with worldly affairs clarifies wisdom; enduring hardships for long makes thoughts comprehensive. My career exemplifies this." (Extending one's own desire for salvation to save others is called 'manifesting the teaching.' Indeed, an immortal argument through the ages.)
Bu Zheng Xia, courtesy name Zhengfu, never lowered his aspirations despite adversity. He once said: "A gentleman has three regrets: not learning in this life is the first regret; wasting this day is the second regret; failing this body is the third regret." I added: "Not doing good is the fourth regret; not correcting faults is the fifth regret; blaming heaven in old age is the most regrettable."
*Guykong Lun* states: "For Li Feng (Leprosy/Malignant Wind), prick the swelling with素的 (plain/unadorned) needles. Stop after pricking. Use sharp needles, pressing the area while needling to expel evil qi. Stop when swelling subsides. Eat only 'Fang Shi' (standard/appropriate food), do not eat other foods." Following these eight characters regarding 'standard food' is a wondrous secret for treating difficult diseases, not just Leprosy. Thus, I have regarded it as the standard for medicine and diet throughout my life. Note Zhang's commentary: "Eating according to method is called Fang Shi; not eating other foods means avoiding wind-moving and toxin-releasing items." This view is incorrect. 'Fang Shi' refers to habitual foods; 'other foods' refer to uncommon ones. People accustomed to rich foods find bland food repulsive; those used to coarse food find fine food damaging. Not only does this not cure the disease, it generates new ones.
Dong Yuan's *Bian Huo Lun* (Discussion on Dissolving Doubts) should be one volume. The current two volumes are likely later additions. Why? From Bu Zhong Yi Qi Tang to Summer Heat Damaging Stomach Qi, it discusses treatments for Jan-April. From Lung to Spleen-Stomach Deficiency, it discusses May-June. Down to Internal Injury differentiation, it covers Sept-Dec. It follows one theme consistently; dividing it into two volumes is obvious.
Li Dongyuan's differentiation of internal vs. external suspected syndromes is very precise. Especially the distinction between Qi Deficiency and Qi Excess benefits later learners greatly. However, for combined internal-external cases, Li's explanation is incomplete; one should study ancient texts to fill gaps.
Deficiency and damage of the lower origin, with withered essence and qi, when complicated by external wind-cold resembling warm epidemics, requires deciding whether to tonify deficiency first, expel pathogen first, or combine tonification and purgation. This is the most arduous part for physicians, beyond what ink and brush can fully describe.
*Yi Gang Mu Lu* stands alone, differing in style from other books. Qian's discussions on pediatrics form a distinct school. Relying on it is not wrong, nor is ignoring it. (Zhuoxuan said: Medical books in the Ming Dynasty were countless. Most were comparative; apart from Dai Fuan, Wu Youxing, and Chen Shigong, there are few. *Yixue Gangmu* is among the outstanding mediocrities; this remark is meaningful. Qian Zhongyang was a major figure in 'Silent Diseases' (pediatrics), but viewing his work as a single school shows true insight.)
Treating Cold Damage, knowing the 'path of departure' and 'path of arrival' is key. Whether surface to interior, Yang turning to Yin, moving positions, or staying constant. Examining this allows for over half the prescription strategy. Yu Chang discussed this; consult his works.
I often advocate practical learning to disciples: Meridian and pulse theories must be known, but rigid adherence loses practical utility. Learners must have discernment in selection.
I dislike lecturing, except on the 8th of the first lunar month honoring Shennong, where disciples lecture on *Shanggu Tianzhen Lun*. (Its saying: Listening to lectures yields little benefit compared to reciting a hundred times; understanding comes from the heart. This serves as a warning for physicians to trust ear [oral tradition] over eye [text].)
In my late years, I read Materia Medica day and night without putting it down, so my prescriptions contain no redundant herbs.
When treating monks like Nan Yuan Yue, Gao Quan, etc., I used large doses. Why? People from the Western lands have stronger guts and stomachs than our locals; light doses cannot match them. Differences in climate and constitution must be known. (Western doctors prescribe directly for patients to buy and take, ensuring appropriate dosages, unlike our local doctors who use light doses for profit.)
Gan Mai Da Zao Tang (Licorice, Wheat, and Jujube Decoction) has miraculous effects for postpartum conditions resembling possession. (Note: So-called 'as if possessed by spirits'.)
For Cold Damage with high fever, irritability, thirst, red urine, constipation for 7-8 days, dry tongue, red eyes, intermittent consciousness, and only sipping rice gruel: One doctor gave Qing Xin Wen Dan Tang removing Xiang Fu, adding Chen Sha and Dan Zhu Ye, worsening delirium and making the pulse hidden. Then, Bai Hu Tang (White Tiger Decoction) combined with Huang Lian Jie Du Tang (Coptis Detoxification Decoction) stabilized symptoms. Finally, decocting 3 qian Ren Shen and 1 qian Hei Jiang, taken together, led to complete recovery. (Note: This aligns with Wu Youxing's Chengqi Tang plus Ren Shen.)
Jian Zhong Tang stopping pain upon entry demonstrates 'sweetness relieves urgency'. Gan Cao Fen Mi Tang treating heart pain shares similar intent. Taking honey for dysphagia allowing immediate eating reflects the same principle. Da Ban Xia Tang's use of honey is merely this intent.
Zhang Zhongjing's book shines like the sun and stars, imperishable through ages; those who read it thoroughly understand its meaning. (At that time, doctors mostly read *Suwen* and *Nanjing* but not *Shanghan Lun*; thus he spoke to show it as a divine book for eternal principles and a secret manual for saving lives.)
*Neijing*'s concept of Zhong Shi can be summarized as: Hyperactivity causes harm, succession brings control. (Scripture says: Knowing the key ends in one word; not knowing it leads to infinite scattering. Truly knowing the key.)
Dong Yuan based Bu Zhong Yi Qi Tang on the *Neijing* principle that clear and pure Yang qi gathers the four extremes, deeply grasping the scriptural intent. In our country, Tosa Michitoshi studied this intent well, making him longest in treating spleen and stomach disorders.
Luo said: Cases with 70% internal injury and 30% external injury are incurable; this shows good understanding of Li's intent.
Therapeutic methods: Purging then tonifying is easy; tonifying then purging is difficult.
Danxi criticized *Ju Fang* to remedy contemporary abuses; his disciple Dai exclusively using *Ju Fang* reveals the intent.
Gurin Jianyi treated edema in a farmer from Kumano Mountain, Japan. Medicine failed for a long time. He added Qing Yu (Green Taro) to the formula and made it a daily meal, curing the disease. Because the farmer grew up in the mountains and ate this regularly. But when he went to Naniwa to seek medicine from various doctors, taboos became strict. Thus, spleen-stomach function was disrupted, and drug power could not reach. This applied the method of 'appropriate dietary therapy'.
For sore throat, cheek swelling, and vomiting/hiccups, Xiao Chai Hu Tang and Lian Qiao (Forsythiae Fructus) in equal parts are effective.
For Water Qi (Edema/Water Retention) regardless of new or old, if pulse-taking prevents raising the hand, or pressing the foot prevents extending the leg with slight panting, it is a death sign. Edema that suddenly decreases and recurs is also incurable.
For Lin Disease (Strangury), use Wu Ling San, Ping Wei San, or Liver-Purging decoctions. For severe涩痛 (astringent pain) in the urethra, Bu Zhong Yi Qi Tang added with large dose Pu Huang, Wu Ling Zhi, and Jin Yin Hua is effective. (Note: Also effective for chronic chancres noted internally.)
I often teach beginners to write ancient medical cases on scrap paper, placing formulas separately, aiming for appropriateness as the highest level.
Even if formula and syndrome correspond, if dosages are insufficient, efficacy fails. Ge Kejiu's discussion on Rhubarb dosage in trauma is very detailed. Especially for Ren Shen in sudden collapse of middle qi, or Gui Ban (Plastrum Testudinis) in yin deficiency, precise dosage is crucial.
Yumatsu treated swelling with Bu Qi Yang Xue Tang, curing 70-80%. This formula uses no diuretics, yet achieves great results in difficult swelling cases. Its intent is specifically treating distension.
A doctor read Yu Chang's *Yuyi Cao*. Yumatsu heard and said: Yu's book has benefits, but using it as a treatment model might be for inferior practitioners.
For refractory hiccups and vomiting unable to take medicine, Xuan Fu Dai Zhe Shi Tang (Inula and Hematite Decoction) is effective. The妙用 (wonderful use) lies in the combination of Ren Shen and Dai Zhe Shi. Similarly, Bai Tong Jia Zhu Dan Jiang Tang's wonder lies in Fu Zi and Pig Gallbladder bile.
An old man from Min transmitted treating dim/blind vision using Yuan Shuang (Iris Frost/Poison). This principle is lofty and worth pondering.
In Ikeda, Settsu, there was a strange disease: sore legs, muscle wasting, difficulty bending/extending, becoming paralysis, commonly called Ikeda Disease. Others contracted it from Ikeda. Yumatsu cured it with Du Shen Tang (Single Ginseng Decoction).
Ba Wei Wan is a standard formula for Zhuan Pao (Bladder Displacement), but dosage must be increased stepwise to be effective. This implies benefiting the water source; 3 to 8 qian is optimal.
Small dosage prescriptions are not always ineffective; *Yixue Zhengchuan* discusses this, and Wang Ren'an also commented.
For accumulated qi, qi stagnation, or night fevers: Some have onset and cessation. Detailing the cause, some had malaria; even years later, combining Yin Malaria Pills yields miraculous results.
Min people transmitted treating poverty-induced Xiao Ke (Wasting-Thirst) using rotten wood from water, powdered. Also treating head wind with Yuan Tou Shuang (Iris Frost) in sake. Yumatsu treated a military officer with spinning eyes using Yuan Tou Hui (Iris Ash), expanding this intent.
Whenever using tonifying and yin-nourishing herbs, if Chen Pi, Ban Xia, Mu Xiang, or Sha Ren are not included, the medicinal qi cannot penetrate. This principle must not be omitted. (Note: Ancient Huang Qi Jian Zhong Tang added Ban Xia derives from this intent.)
Formulas are methods. Like destroying an old house to build a new one, it is key to use the formula without being enslaved by it. Using a stroke formula for cough is 'using the formula'; using wind-dispersing herbs for wind and cough-suppressing herbs for cough is 'not using the formula'. Seeking the root cause and letting symptoms resolve themselves is the supreme method.
Lower body edema with Fang Ji Fu Ling Tang, upper body edema with Fu Ling Bu Xin Tang, both effective. Women's edema often belongs to blood aspect; Fang Ji enters blood aspect, hence effective. If qi aspect, Fu Ling and Ze Xie are primary. For male/female yin-deficiency edema, Liu Wei Di Huang Wan added with Fu Zi, Fang Ji, and Cang Zhu is effective. For edema with strong yuan qi, Da Cheng Qi Wan (pill form) is effective.
*Zhengzhi Yaojue* is a must-read. Adding Mu Xiang to Huo Xiang Zheng Qi San as a variation is particularly commendable. Bei Cun Daobu from Kitamura Village, Kyushu, aged sixty, suffered stroke. Kyoto doctor Jishima failed. I was invited. I diagnosed: "To heal quickly, it will recur in three years, becoming incurable. If not seeking quick healing, lifespan extends 15-16 years. Choose." Patient chose quick healing. I prescribed Yi Gong San added with Wu Yao, Bai Zhi, and Qing Pi. Fifty doses cured him. Three years later, it recurred as predicted. Disciple Yajima Ansetsu asked for slow-treatment formula. I said: Shi Quan Da Bu Tang is appropriate.
Yumatsu sat leaning on a table at Bei Cun's house. A woman came for consultation. Seeing her, he rebuked: "Your jealousy overflows your face; detest it deeply." The woman blushed and accepted. He said: "Your spirit is very diseased. If you repent, I will treat you kindly." He gave medicine, and she recovered. This woman had been jealous for years, peeping through doors at night, acting mad. Yumatsu saw through it instantly; people admired his skill.
An old doctor from Sakai asked for a resurrection formula. Answer: "No formula is magical; only seek the root. Nothing else."
For diseases hard to distinguish as deficiency/excess, or hard to decide tonify/purge: Observing pulse and syndrome, trusting the reliable pulse and syndrome, and following the certain signs ensures no error in treatment.