夫医者，必取熔医书而后识见正，必参酌经方而后手段精，必广疗疾 而后运用极。故
不明
医经经方之旨者，虽业大行，侥幸不足观。明医经经方之旨者，虽一匙半剂，亦具有规则。
如庭先生以名家子弟，加之学术兼至，是以超逸前辈泰斗于一世。古人所谓读仲景书用仲
景之法，然未尝守仲景之方，乃为得仲景之心者，非耶。
文化丙子夏秋之交，江户大疫，其证初起热势猖獗，直进于少阳，不日至精神昏愦，大
概宜
大小柴胡汤，黄连解毒汤。而及于阳明胃实者至少，尔后流行往往类此，而如阴证甚鲜矣。
余尝视先教谕治伤寒多用参附，故老亦言先生多阴证躁扰者，噫风气变迁所使耶。(疫因岁
运有变替，亦见于工藤周庵救瘟袖历，及荻野台州瘟疫辨。盖辨六气之环转，拆神气之出入
，阴阳消长之妙，虚实递更之变，首尾贯通者，唯仲师书为尔，后学当细心辨之。)
辛巳岁，春来多旱，至夏秋之际，炎热特甚，疫邪流行，其证不恶寒，肌热如灼，脉洪
数或
紧细，手腕颤掉，下利日四五行，或溏泄过多，渴好冷水，舌上无胎而干燥，心下支结，腹
虚满雷鸣，谵语，或昏睡不语，吐沫头汗，甚者呕逆上窜，速羸瘦，下黑血，遂死。余以为
是暑热侵肌肉，邪气着筋脉，津液干枯，血分沸乱，故至下血而极矣，治法清润补三法中兼
利水而得效。盖比之于丙子之疫疾，其证候亦少异矣。
少阴病轻证有既济汤，与姜附益气汤之别。上焦津液干枯，其证似白虎汤而脉浮数无根
，脚
腹部软弱，且微利，虽渴无欲饮水数升之势者，为既济汤。若夫邪气缓慢，渐见谵语烦躁，
肌热不甚，舌上濡润，所谓劳役感寒者，为姜附益气汤。此证三十年前多见之，而至近时唯
见导赤各半汤、升阳散火汤等证，而此证绝少。时世之变，亦可以知已。
冬月伤寒发汗不解，下利数行，或不下利，三四日后热弥炽，谵语烦闷，口舌干燥，呼
吸促
迫，脉弦涩或滑数，无根底，舌上黄润，心下痞，小腹无力，面赤耳聋。余以为直中证，与
以附子剂无效。后谓上热下冷，与干姜芩连人参汤，其效如桴鼓。
文政己卯仲夏至仲秋，都下痢疾大行，毙者不知数。其证皆热毒痢，邪气炽盛，下利至
百余
行。治法发表攻里，或清凉奏效，而偶有挟虚者，桃花汤所宜，若误投粟壳、诃子类必害。
又虚家屡下之后，血水泄下羸脱者，又腹里拘急，至夜燥渴，用地黄得效。
痢疾久不愈，舌上如粟粒，其色黄白或纯红，甚者及牙 ，此证多属不治。又有舌上咽
喉牙
一面生浓黄白胎如鹅口者，有发吃逆者，皆为不治。(按∶诸 久不愈，口舌生鹅口疮者
，皆胃气衰败之候，固为死证。)
痢疾发渴者，多好热汤，不可概为阴，而治寒下剂间效。又痢疾手指逆冷者，属热，阳
脱
于上故也。又热痢失下虚极者，必手指冷至肩上，而足仅过踝而已，俱非温药，所宜矣。
痢疾初起，脉数无伦，下利频数，精神不安，额上汗出，面部肉脱者皆为不治。
文政庚辰春夏之交，淫雨数日，霁后暴催溽暑。时人发奇疾，其证如干霍乱，心腹卒痛
暴热
，脉洪大，心下支结，饮食不进，大便秘结。因与备急圆、大陷胸汤类，则反痛甚，热不去
，徒生烦渴。余以为雨湿内郁，毒瓦斯上攻者，试与增损理中丸料，(代白术以苍术。)痛顿减
，不日快复，遂活数人。后阅东郭导水琐言，京师亦行此证，东郭用外台桑白皮、吴茱萸二
味者得效，盖一类也。(按∶桑白皮、吴茱萸二味方，原治急喘，而东郭运用之，元和纪用
经名之降气汤。)
痘疹发热疑似者，诊虚里，其动亢盛及缺盆者，痘也。此动无者，他病也。余得此诀于
小川柽斋，而验之果然。
霉毒虽分四证，不出二端，何则？下疳在肌肉而毒浅，故发则为杨梅疮，便毒着筋脉而
毒深
，故潜则为结毒。然亦有虚实之分，下疳其人虚者，毒易侵入。故其愈迟便毒其人实者，毒
易外托。故其愈速，竟亦不出二端焉。
旧疾暴变者，多因邪气内伏。能认其候，不拘本病，直与发散剂则效，是即先治其卒病
之意。
和田东郭以地黄治心下痞，盖本诸吴氏参附养荣汤，治下后反痞之说。余以为地黄之痞
，与
泻心汤之痞相似而异。腹部宗筋急，津液干枯，其势上迫于心下，故以地黄滋润筋脉，则痞
自愈。若饮邪并结，心下支满者，非泻心汤不能解。是所以相似而大异也。
世医将证候错杂难名状者，檄曰痫证，盖本诸香川氏行余医言云。《先教论》曰∶痫本
小儿
病，在大人当称曰癫。如香川所谓痫证，则大病奇论所说气疾，戴复庵所谓心风为相近。余
尝考其病由，系心肝胆三脏，有由心神虚祛，与心气不宁者，有由肝气抑郁，与肝气过亢者
。如胆气亦由虚实，证候各异。能读古人论此三脏病证者，则于其治法思过半矣。
难以小便黄白辨寒热。戴复庵既论之，而如以渴之冷热定阴阳，亦不可拘执。热利喜热
汤，风湿欲冷冻饮料，同类相求之理，不可不知。其他以所喜冷热定病寒热，大抵为不瘥。
伤寒热剧证，用柴胡、黄芩类，非多服则不能奏效。水气洪肿者，与淡渗药非大剂则不
能达
方，屡验果然。
呕吐不止，诸治无效者，HT 惟和诊曰∶脉浮数，属表邪壅遏，与葛根黄芩黄
连汤速愈。又有同证者，片仓周诊曰∶脉沉伏属郁热，与白虎汤果止。可谓二子诊异表里而
并妙矣。
古方之妙，殆不可思议，今举其二三∶如牡蛎泽泻散料，(或加大黄)治实肿阳水；栝
蒌瞿麦丸
，治肾气丸证而嫌忌地黄者；黄连汤，治霍乱吐泻不止，心腹烦痛者；栀子甘草豉汤，治膈
噎食不下者；苓桂甘枣汤，治 囊累年不愈，心下痛者；白头翁汤，治肠风下血。余数年所
实验，桴鼓影响，妙不可言。用古方者，岂可不精熟哉!(陈修园曰∶旋复代赭石汤，今于呕
吐不止之证，及哕逆借用甚效者，取其重以降逆也。干姜黄连黄芩汤，今于食入即吐之证取
用甚效。又借用麻杏甘石汤，治中暑头痛汗出而喘口渴之外证。黄连阿胶汤，治心烦不得卧
之内证。借用麻轺豆汤，育阴利湿，俱从小便而出之类。可知经方之变化如龙也。)
囊治方虽居多，无如苓桂甘枣汤者。余又以三因方补脾散炼蜜为膏，服得奇效。若便
秘内实者，起废丸为妙。
《千金》紫苏子汤中当归，取之于降气。本草云∶主咳逆上气是也。人参败毒散中枳壳
，取之于驱风。本草云∶主风痒脉痹是也。世医日用而无审其效用者，噫。
余尝治一男子伤寒数日不瘥，谵语面赤，脉紧无力，微下利，上热下冷者，与姜芩连参
汤无
效，小河雄斋(吉益南涯门人。)与当归四逆汤速愈。曰∶予往年患此证，柴田芸庵用前方得
苏矣。
病患足趾甲温而两胫冷者多死，腿胫无水气，但足跗肿者亦危。
大病患忽两颏筋弛如落架风者，属不治。《和剂局方》乌荆圆主治云∶头颔宽 不收，
手盛颔能食。盖此类。
哕逆诸治无效者，与熊胆效，又与左金丸料屡验。
香港脚虽小便快利，脉 胸动，甚至冲心者，水毒外壅侵内也。又虽脉候胸动俱稳，小便
不利，以至冲心者，水毒内郁遏脉动也。此二证系局外之变，不可不精思。
香港脚下部无水气，胸背颈间面部或手背浮肿者，忽至冲心，不可轻视。如水肿上盛者亦
然。
香港脚呕逆喘急者，为冲心之渐，不可忽诸，然复有似而非者。一壮失脚弱胫肿，喘满短
气热
炽，诊之疫邪挟痰者，乃与柴胡陷胸汤，兼服利水剂亟愈。又一人麻痹痿软，呕逆不食，诊
之香港脚兼蛔虫者，乃作肾气丸料与之，兼以乌梅丸而全。治此等诊在脉与胸动，而非精诣者
难与言。(尝闻先生以一味连翘膏治香港脚呕逆冲心者，可谓得古人不传之妙矣。)
香港脚发热类风寒者，不冲心则为脚痿软，为可惧，救之偏制香港脚为妙。若真挟风寒者，
非此例，宜比较以辨其差。
诊视之际，有病情隐微难认者二端∶一则劳瘵肝郁之类，始萌时感招外邪，外邪虽解，
病不
可愈者，内为有奸也。若徒为外感治之，则其取败不鲜矣；一则旧疾人得疑似之新病者，假
令如痼瘕之得肠 ， 囊之得饮食伤，若拘执旧疾，不治新病，则其害在反睫。此二端最宜
精诊熟察。张景岳曰∶医有慧心，心在局外，医有慧眼，眼在兆前。其是谓乎？
病名古今异称，或一证及数名，极为繁衍。如一病蓄数义，最易致误，今举一二辨之。
肿本
痈肿，转为水肿之肿；疮本创夷，转为疮疡之疮；疳本蚀烂之义，而小儿嗜甘为病亦名；疳
痰即澹饮，古作淡，而后世概为稠涎之名；瘅，热也，省文作疸，而转为黄病之名，又移为
丹毒之名；瘤者，悬赘也，后世转为丹溜之溜；悸，心动也，而古来概为动筑之义；奔豚，
难经以为肾积，《伤寒论》以为气冲，咳逆谓咳嗽气逆，而后世谬为哕逆之名；此类宜甄别
焉。(桂山先生《瘟疫类编·序》辨病名字义亦精晰，宜与此条参看资益。)
近来舶斋医书，大率蹈袭陈言，未有所发明，而其序跋徒极称扬。顾不读古书者之所为
，要之优孟衣冠，不过追时习钓名利耳。
读医经与他书异。若读《伤寒论》，最当虚心平气，就其至平至易处，研性命之理，使
文义
与治术吻合符契，而后博征诸载籍，多验诸疾病，优柔厌饫，浸润涵泳，真积力久，始足以
应变无穷，此之谓善读者矣。世或有穿凿拘泥，固执偏见者，有肤浅浮疏，自夸心得者，有
徒骛论辨，而不察证治之要者，有专拘字训，而不究微意之所在者，此皆不善读之过也。又
有不学无术，臆测悬揣，以为得经旨，闻有不合己意者，概谓之后人掺入，妄删改之，此所
谓夏虫疑冰，越犬吠雪者耳。盖据经以洞病理，此其常。而亦有由验病而悟经义者，不可不
识焉。(医之所贵者，力学之外，又得名师益友。日举其所治之证与圣经之异同，合而讲论
，始知其妙。此亦由验病而悟经义之一端也。)
尝考诸家注释，成联摄顺文直解，稍属浅拘。然创辟之功诚伟，能为来者所矜式。方中
行亦出
新裁，非无发挥，然凭其私颠倒经文实作之俑，喻嘉言略本中行，更益端绪，后人何以崇信
之。至柯韵伯学识颇高，最有所见，而犹多臆断。程郊倩间话俚语，失解经之体，至论理精
密，殆非诸氏所及。汪苓友处心平稳，疏通前注，虽未能脱陋习，固与专己守残，相去悬隔
。张隐庵及令韶率由旧本，不敢错易，盖不蹈时趋者。钱天来辨订不遗余力，然或失太凿，
亦不无胶柱。《医宗金鉴》汇纂之治，殊为有益，其删章改句，无所不至，抑亦妄矣。(多
纪柳 曰，古人注张子《伤寒论》者，既无顺文释义之弊，克辟守陋袭胶之说，旨义明了。
别开生面者，柯韵伯《来苏集》是也。割裂旧章以为类纂，虽不免妄改古书之责，错综有条
，端绪井然，足以为临局施治之便者，钱天来《溯源集》是也。盖二家之集，精则精矣，奈
何博辩冗议，读者不能骤窥其要焉。在泾之书，其说多原于韵伯，其分治法佐天来，而变其
例，更出新意以启发之。辞约理该，直截易了，双珠一贯，斯供把玩，是亦活人之手段也。
二子说议论切当，为后学楷则，当与吕沧洲论历代诸医文并传)。读书法务遵古人，古人之
言既妥矣，固无须赘说。而徒斗博夸多，更生异见，右傅左会，喋喋费解，谓之无用之辩，
吾不取也。
凡读医经遇训义有确据，则举其一二而足矣，不必取于繁冗也。
训诂虽精，而其义不切于治术者，未为得也。训诂虽不精，而施之于疾病必有实效者，
乃为得经旨矣。
凡立说者，非通贯全经，则不可谓之尽理蕴，非该尽万理，则不可谓之得经旨，矧乃欲
以变
律常及拘于常而不通变者，皆善读之过也。讲研轩岐长沙之经，抉择历代良师之着，以切临
病处药之际，是吾家为学之方，亦即吾家为医之诀，是以先君子搜罗天下医书以贻子孙，其
意一在后之人善读而善用之焉已。(
此数条为后学开正路，一一书绅之语。余尝谓自古以来医籍充栋，贤愚不等，偏见迂论者，
不可胜数。亦毋庸详辨博考，只验圣经贤传紧要之书，揣摩精究，自然学术自进。锁末字句
，置之不论，别风淮雨，何必一一查考耶!)
夫医者，必须融会贯通医书，见解才能端正；必须参详考订经方，手段才能精湛；必须广泛治疗疾病，运用才能达到极致。所以，如果不明白医经和经方的宗旨，即使医术很高明，侥幸治愈一些病例，也不足为观。如果明白了医经和经方的宗旨，即使只用一匙药或半剂药，也符合法度规则。
如庭先生以名医子弟的身份，加上学术造诣全面，因此超脱超越了一世的泰斗前辈。古人说读仲景的书，用仲景的方法，然而不固守仲景的方子，这才是得到了仲景的心意，难道不是这样吗？
文化丙子年夏秋之交，江户发生大瘟疫，病症初起时热势猖獗，直接传入少阳（少阳经受邪所致的病证），不久导致精神昏愦，大概适宜使用大小柴胡汤、黄连解毒汤。而发展到阳明胃实（阳明腑实证）的情况很少，后来流行的病症往往类似，像阴证（表现为寒象的病证）非常少见。
我曾经观察先师教导治疗伤寒多用参附（人参、附子），老辈人也说先生治疗的病人多属阴证且躁扰不安，唉，这大概是风气变迁所致吧。（疫病因为岁运有变化，也见于工藤周庵的《救瘟袖历》及荻野台州的《瘟疫辨》。大概辨析六气环转、神气出入、阴阳消长之妙、虚实更替之变，首尾贯通的，只有仲景的书是这样，后学者应当细心辨析。）
辛巳年，春天多旱，到了夏秋之际，炎热特别严重，疫邪流行，其症状是不恶寒，肌肤发热如火烧，脉象洪数或紧细，手腕颤抖，每天腹泻四五次，或者溏泄过多，口渴喜欢喝冷水，舌苔无且干燥，心下支撑结聚，腹部虚满雷鸣，谵语（神志不清，胡言乱语），或者昏睡不语，吐沫头汗，严重的呕吐上逆，迅速消瘦，大便黑血，随即死亡。我认为这是暑热侵袭肌肉，邪气附着筋脉，津液干枯，血分沸腾混乱，所以下血到极点，治疗方法在清润补三法中兼用利水之法而见效。大概与丙子年的疫病相比，证候也有少许不同。
少阴病轻证有既济汤，与姜附益气汤的区别。上焦津液干枯，其症状像白虎汤证但脉浮数无根，脚腹部软弱，且有微利，虽然口渴但没有想喝几升水的势头，这是既济汤证。如果是邪气缓慢，逐渐出现谵语烦躁，肌热不严重，舌上濡润，所谓劳役感寒者，是姜附益气汤证。这种证候三十年前多见，而到现在只见到导赤各半汤、升阳散火汤等证候，而这种证候极少。时代的变迁，也可以由此知道了。
冬季伤寒发汗后不解，腹泻数次，或者不下利，三四天后热势更加炽盛，谵语烦闷，口舌干燥，呼吸急促，脉弦涩或滑数，无根底，舌上黄润，心下痞塞，小腹无力，面赤耳聋。我认为这是直中证（邪气直中脏腑），给予附子剂无效。后来认为是上热下冷，给予干姜芩连人参汤，效果如桴鼓相应（形容药效迅速）。
文政己卯年夏至仲秋，都城痢疾大行，死者不知其数。其症状都是热毒痢，邪气炽盛，腹泻多达百余次。治疗方法发表攻里，或者清凉奏效，而偶尔有挟虚者，适宜桃花汤，如果误投粟壳、诃子类必有害。另外虚弱之人多次腹泻后，血水泄下身体羸弱脱失，又腹部拘急，入夜燥渴，用地黄得效。
痢疾久不愈，舌上如粟粒，颜色黄白或纯红，严重的波及牙龈，这种证候多属于不治。又有舌上咽喉牙龈一面生浓黄白苔如鹅口疮者，有发呃逆者，都为不治。（按：诸痢久不愈，口舌生鹅口疮者，都是胃气衰败的征候，固然是死证。）
痢疾发渴的，多好热汤，不可一概认为是阴证，而治寒下剂间或有疗效。又痢疾手指逆冷的，属热，阳气脱于上故也。又热痢失下（未及时攻下）虚极的，必定手指冷至肩上，而脚仅过踝而已，都不适宜温药。
痢疾初起，脉数无伦次，下利频数，精神不安，额上汗出，面部肉脱者皆为不治。
文政庚辰年春夏之交，淫雨数日，放晴后突然催逼溽暑。当时人发奇疾，其症状像干霍乱，心腹卒痛暴热，脉洪大，心下支结，饮食不进，大便秘结。因而给予备急圆、大陷胸汤类，反而疼痛加重，热不退，徒生烦渴。我认为这是雨湿内郁，毒瓦斯上攻，试给予增损理中丸料（代白术以苍术），疼痛顿减，不久恢复健康，于是救活了几人。后来阅读东郭的《导水琐言》，京师也流行此证，东郭用外台的桑白皮、吴茱萸两味药得效，大概是一类。（按：桑白皮、吴茱萸两味方，原治急喘，而东郭运用它，元和纪用经名为降气汤。）
痘疹发热疑似者，诊虚里（位于左乳下心尖搏动处），其动亢盛及缺盆（锁骨上窝）者，是痘。此动没有的，是他病。我从小川柽斋得到这个秘诀，验证果然如此。
霉毒虽分四证，不出二端，为什么呢？下疳在肌肉而毒浅，所以发则为杨梅疮，便毒着筋脉而毒深，所以潜则为结毒。然而也有虚实之分，下疳其人虚者，毒易侵入，所以愈合迟；便毒其人实者，毒易外托，所以愈合快，终究也不出二端。
旧疾暴变者，多因邪气内伏。能认识其征候，不拘泥本病，直接给予发散剂则有效，这就是先治其卒病的意思。
和田东郭用地黄治疗心下痞，大概基于吴氏参附养荣汤，治疗下后反痞的说法。我认为地黄的痞，与泻心汤的痞相似而异。腹部宗筋急，津液干枯，其势上迫于心下，所以用地黄滋润筋脉，则痞自愈。若饮邪并结，心下支满者，非泻心汤不能解。这就是相似而大异的原因。
世医将证候错杂难名状者，称为痫证，大概基于香川氏行余医言云。《先教论》说：痫本是小儿病，在大人当称曰癫。如香川所谓痫证，则大病奇论所说气疾，戴复庵所谓心风为相近。我曾经考证其病因，系心肝胆三脏，有由心神虚怯，与心气不宁者，有由肝气抑郁，与肝气过亢者。如胆气也由虚实，证候各异。能读古人论此三脏病证者，则对其治法思过半矣。
难以小便黄白辨寒热。戴复庵已经论述过，而如以渴之冷热定阴阳，也不可拘执。热利喜热汤，风湿欲冷冻饮料，同类相求之理，不可不知。其他以所喜冷热定病寒热，大抵为不瘥。
伤寒热剧证，用柴胡、黄芩类，非多服则不能奏效。水气洪肿者，与淡渗药非大剂则不能达方，屡验果然。
呕吐不止，诸治无效者，HT 惟和诊曰：脉浮数，属表邪壅遏，与葛根黄芩黄连汤速愈。又有同证者，片仓周诊曰：脉沉伏属郁热，与白虎汤果止。可谓二子诊异表里而并妙矣。
古方之妙，殆不可思议，今举其二三：如牡蛎泽泻散料（或加大黄）治实肿阳水；栝蒌瞿麦丸，治肾气丸证而嫌忌地黄者；黄连汤，治霍乱吐泻不止，心腹烦痛者；栀子甘草豉汤，治膈噎食不下者；苓桂甘枣汤，治囊累年不愈，心下痛者；白头翁汤，治肠风下血。我数年所实验，桴鼓影响，妙不可言。用古方者，岂可不精熟哉！（陈修园说：旋复代赭石汤，今于呕吐不止之证，及哕逆借用甚效者，取其重以降逆也。干姜黄连黄芩汤，今于食入即吐之证取用甚效。又借用麻杏甘石汤，治中暑头痛汗出而喘口渴之外证。黄连阿胶汤，治心烦不得卧之内证。借用麻轺豆汤，育阴利湿，俱从小便而出之类。可知经方之变化如龙也。）
囊治方虽居多，无如苓桂甘枣汤者。我又以三因方补脾散炼蜜为膏，服得奇效。若便秘内实者，起废丸为妙。
《千金》紫苏子汤中当归，取之于降气。本草说：主咳逆上气是也。人参败毒散中枳壳，取之于驱风。本草说：主风痒脉痹是也。世医日用而无审其效用者，唉。
我曾经治疗一男子伤寒数日不瘥，谵语面赤，脉紧无力，微下利，上热下冷者，与姜芩连参汤无效，小河雄斋（吉益南涯门人）与当归四逆汤速愈。说：我往年患此证，柴田芸庵用前方得苏矣。
大病患忽两颏筋弛如落架风者，属不治。《和剂局方》乌荆圆主治说：头颔宽不收，手盛颔能食。盖此类。
香港脚虽小便快利，脉胸动，甚至冲心者，水毒外壅侵内也。又虽脉候胸动俱稳，小便不利，以至冲心者，水毒内郁遏脉动也。此二证系局外之变，不可不精思。
香港脚下部无水气，胸背颈间面部或手背浮肿者，忽至冲心，不可轻视。如水肿上盛者亦然。
香港脚呕逆喘急者，为冲心之渐，不可忽诸，然复有似而非者。一壮失脚弱胫肿，喘满短气热炽，诊之疫邪挟痰者，乃与柴胡陷胸汤，兼服利水剂亟愈。又一人麻痹痿软，呕逆不食，诊之香港脚兼蛔虫者，乃作肾气丸料与之，兼以乌梅丸而全。治此等诊在脉与胸动，而非精诣者难与言。（尝闻先生以一味连翘膏治香港脚呕逆冲心者，可谓得古人不传之妙矣。）
香港脚发热类风寒者，不冲心则为脚痿软，为可惧，救之偏制香港脚为妙。若真挟风寒者，非此例，宜比较以辨其差。
诊视之际，有病情隐微难认者二端：一则劳瘵肝郁之类，始萌时感招外邪，外邪虽解，病不可愈者，内为有奸也。若徒为外感治之，则其取败不鲜矣；一则旧疾人得疑似之新病者，假令如痼瘕之得肠，囊之得饮食伤，若拘执旧疾，不治新病，则其害在反睫。此二端最宜精诊熟察。张景岳说：医有慧心，心在局外，医有慧眼，眼在兆前。其是谓乎？
病名古今异称，或一证及数名，极为繁衍。如一病蓄数义，最易致误，今举一二辨之。肿本痈肿，转为水肿之肿；疮本创夷，转为疮疡之疮；疳本蚀烂之义，而小儿嗜甘为病亦名；疳痰即澹饮，古作淡，而后世概为稠涎之名；瘅，热也，省文作疸，而转为黄病之名，又移为丹毒之名；瘤者，悬赘也，后世转为丹溜之溜；悸，心动也，而古来概为动筑之义；奔豚，难经以为肾积，《伤寒论》以为气冲，咳逆谓咳嗽气逆，而后世谬为哕逆之名；此类宜甄别焉。（桂山先生《瘟疫类编·序》辨病名字义亦精晰，宜与此条参看资益。）
近来舶斋医书，大率蹈袭陈言，未有所发明，而其序跋徒极称扬。顾不读古书者之所为，要之优孟衣冠，不过追时习钓名利耳。
读医经与他书异。若读《伤寒论》，最当虚心平气，就其至平至易处，研性命之理，使文义与治术吻合符契，而后博征诸载籍，多验诸疾病，优柔厌饫，浸润涵泳，真积力久，始足以应变无穷，此之谓善读者矣。世或有穿凿拘泥，固执偏见者，有肤浅浮疏，自夸心得者，有徒骛论辨，而不察证治之要者，有专拘字训，而不究微意之所在者，此皆不善读之过也。又有不学无术，臆测悬揣，以为得经旨，闻有不合己意者，概谓之后人掺入，妄删改之，此所谓夏虫疑冰，越犬吠雪者耳。盖据经以洞病理，此其常。而亦有由验病而悟经义者，不可不识焉。（医之所贵者，力学之外，又得名师益友。日举其所治之证与圣经之异同，合而讲论，始知其妙。此亦由验病而悟经义之一端也。）
尝考诸家注释，成联摄顺文直解，稍属浅拘。然创辟之功诚伟，能为来者所矜式。方中行亦出新裁，非无发挥，然凭其私颠倒经文实作之俑，喻嘉言略本中行，更益端绪，后人何以崇信之。至柯韵伯学识颇高，最有所见，而犹多臆断。程郊倩间话俚语，失解经之体，至论理精密，殆非诸氏所及。汪苓友处心平稳，疏通前注，虽未能脱陋习，固与专己守残，相去悬隔。张隐庵及令韶率由旧本，不敢错易，盖不蹈时趋者。钱天来辨订不遗余力，然或失太凿，亦不无胶柱。《医宗金鉴》汇纂之治，殊为有益，其删章改句，无所不至，抑亦妄矣。（多纪柳曰，古人注张子《伤寒论》者，既无顺文释义之弊，克辟守陋袭胶之说，旨义明了。别开生面者，柯韵伯《来苏集》是也。割裂旧章以为类纂，虽不免妄改古书之责，错综有条，端绪井然，足以为临局施治之便者，钱天来《溯源集》是也。盖二家之集，精则精矣，奈何博辩冗议，读者不能骤窥其要焉。在泾之书，其说多原于韵伯，其分治法佐天来，而变其例，更出新意以启发之。辞约理该，直截易了，双珠一贯，斯供把玩，是亦活人之手段也。二子说议论切当，为后学楷则，当与吕沧洲论历代诸医文并传）。读书法务遵古人，古人之言既妥矣，固无须赘说。而徒斗博夸多，更生异见，右傅左会，喋喋费解，谓之无用之辩，吾不取也。
凡读医经遇训义有确据，则举其一二而足矣，不必取于繁冗也。
训诂虽精，而其义不切于治术者，未为得也。训诂虽不精，而施之于疾病必有实效者，乃为得经旨矣。
凡立说者，非通贯全经，则不可谓之尽理蕴，非该尽万理，则不可谓之得经旨，矧乃欲以变律常及拘于常而不通变者，皆善读之过也。讲研轩岐长沙之经，抉择历代良师之着，以切临病处药之际，是吾家为学之方，亦即吾家为医之诀，是以先君子搜罗天下医书以贻子孙，其意一在后之人善读而善用之焉已。（此数条为后学开正路，一一书绅之语。余尝谓自古以来医籍充栋，贤愚不等，偏见迂论者，不可胜数。亦毋庸详辨博考，只验圣经贤传紧要之书，揣摩精究，自然学术自进。锁末字句，置之不论，别风淮雨，何必一一查考耶!）
Physicians must integrate and comprehend medical texts to establish correct insights; they must study and evaluate classical prescriptions (Jingfang) to refine their clinical skills; and they must treat a wide variety of diseases to achieve mastery in application. Therefore, those who do not understand the principles of medical classics and classical prescriptions, even if highly skilled and occasionally successful, are not worthy of observation. Those who understand these principles, even when using only a spoonful or half a dose of medicine, will adhere to proper rules.
Mr. Tei, being a son of a renowned physician and possessing comprehensive academic attainment, transcended the leading figures of his generation. The ancients said, "Read Zhang Zhongjing's books, use Zhang Zhongjing's methods," yet one does not rigidly stick to his formulas but rather grasps his spirit. Is this not true?
During the transition from summer to autumn in the Bingzi year of the Bunka era, a great epidemic broke out in Edo. The initial symptoms featured rampant heat that directly entered the Shaoyang syndrome (disease pattern caused by pathogenic factors affecting the Shaoyang meridian), leading to mental confusion shortly thereafter. Generally, Xiao Chaihu Tang (Minor Bupleurum Decoction) or Da Chaihu Tang (Major Bupleurum Decoction), along with Huanglian Jiedu Tang (Coptis Decoction for Detoxification), were appropriate. Cases progressing to Yangming Fu-organ excess (Yangming bowel accumulation syndrome) were rare. Subsequent epidemics followed similar patterns, while Yin syndromes (disease patterns characterized by cold signs) were very scarce.
I once observed that my predecessor taught treating Taiyang disease (Taiyang meridian disease) with Ginseng and Aconite (Renshen, Fuzi). Elders also stated that Mr. Tei often treated patients with Yin syndromes accompanied by restlessness. Alas, this is likely due to changes in environmental and social conditions. (Epidemics vary according to annual climatic cycles, as seen in Kudo Shuan's *Juwun Shuryaku* and Ogino Taichu's *Onsen Ron*. Analyzing the rotation of the Six Qi, the entry and exit of Shen-Qi, the subtleties of Yin-Yang waxing and waning, and the variations of deficiency and excess transformation, only Zhang Zhongjing's writings achieve such coherence from start to finish. Later students should analyze this carefully.)
In the Xinsi year, spring was dry, and by late summer and autumn, the heat was extreme. Epidemic pathogens spread widely. Symptoms included aversion to cold absent, skin burning hot, pulse rapid and surging or tight and fine, trembling of the wrists, diarrhea four to five times daily or excessive loose stools, thirst preferring cold water, dry tongue without coating, epigastric fullness and binding, abdominal distension with borborygmus, delirium (mental confusion with incoherent speech), lethargy with inability to speak, foaming at the mouth and sweating on the head. Severe cases involved vomiting and upward counterflow of qi, rapid emaciation, melena (black bloody stools), and death. I believed this was caused by summer-heat invading muscles and pathogens adhering to sinews, leading to dried-up body fluids and chaotic boiling of blood. Thus, bleeding occurred as an extreme symptom. Treatment combining clearing, moistening, and tonifying, along with promoting urination, proved effective. Compared to the Bingzi epidemic, the symptomatology differed slightly.
For mild Shaoyin disease (Shaoyin meridian disease), there is a distinction between Jiji Tang (Ji Ji Decoction) and Jiangfu Yiqi Tang (Ginger and Aconite Qi-Supplementing Decoction). When upper jiao (upper burner) body fluids are dried up, symptoms resemble Baihu Tang (White Tiger Decoction) but with a floating, rapid, rootless pulse, weakness in the legs and abdomen, slight diarrhea, and thirst without the urge to drink several liters of water, Jiji Tang is indicated. If pathogens act slowly, gradually causing delirium and irritability, with mild muscle heat, a moist tongue, and a history of fatigue-induced cold contraction, Jiangfu Yiqi Tang is indicated. This pattern was common thirty years ago but is now rarely seen, replaced by patterns treated with Daochi Geban Tang (Guide Out Redness Half-Dose Decoction) and Shengyang Sanhuo Tang (Raise Yang and Disperse Fire Decoction). This reflects changes in the times.
In winter, after sweating fails to resolve Taiyang disease, frequent diarrhea occurs, or no diarrhea occurs. After three to four days, heat intensifies, accompanied by delirium, oppression, dry mouth and tongue, shortness of breath, wiry-choppy or slippery-rapid rootless pulse, yellow-moist tongue coating, epigastric stuffiness, lower abdominal weakness, red face, and deafness. I initially considered this direct invasion of the central organs and prescribed Aconite formulas without effect. Later, recognizing upper heat and lower cold, Ganjiang Qinlian Renshen Tang (Dried Ginger, Scutellaria, Coptis, and Ginseng Decoction) was used with immediate and profound effect.
From mid-summer to mid-autumn in the Jimbo year of the Bunsei era, dysentery raged in the capital, claiming countless lives. All cases were heat-toxin dysentery with fierce pathogens, involving over a hundred episodes of diarrhea. Treatment involved releasing the exterior and purging the interior, or using cooling methods. Occasionally, deficiency-cold patterns required Taohua Tang (Peach Blossom Decoction); misusing Poppy Shell (Mihu) or Chebula (Hezi) would be harmful. For weak patients suffering repeated diarrhea with bloody watery stools and severe debility, accompanied by abdominal cramping and night-time dry thirst, Rehmannia (Dihuang) proved effective.
Chronic dysentery unresponsive to treatment presents with millet-grain-like papillae on the tongue, colored yellow-white or pure red, potentially spreading to the gums; this is generally incurable. Another presentation involves thick yellow-white coating resembling thrush on the tongue, throat, and gums, accompanied by hiccups; this is also incurable. (Note: Chronic dysentery with oral thrush indicates failure of Stomach Qi and is a death sign.)
Dysentery with thirst often prefers hot drinks; it cannot be uniformly classified as Yin-cold, though cold-purgative formulas sometimes work. Dysentery with cold fingers indicates heat, with Yang Qi escaping upwards. In severe heat-dysentery where purgatives were neglected leading to extreme deficiency, cold may extend from fingers to shoulders, with feet cold only above the ankles; warming herbs are contraindicated.
Early-stage dysentery with irregular rapid pulse, frequent diarrhea, mental unrest, sweating on the forehead, and facial wasting is incurable.
During the spring-summer transition in the Genshin year of the Bunsei era, after days of rain followed by sudden muggy heat, people developed strange illnesses resembling Gan Huoluan (Dry Cholera): sudden heart and abdominal pain, violent heat, surging-large pulse, epigastric binding, inability to eat, and constipation. Prescribing Beiji Yuan (Emergency Pill) or Daxiexiong Tang (Major Chest-Sinking Decoction) worsened pain and heat, causing irritability and thirst. I attributed this to internal damp-heat stagnation attacking upwards. Using Zengsun Lizhong Wan Formula (Modified Center-Sustaining Pill, replacing Atractodis Rhizoma with Cyathulae Radix) reduced pain immediately, leading to recovery and saving several lives. Dongguo's *Daoshui Suoyan* mentions similar cases in the capital treated successfully with Mulberry Root Bark (Sangbaipi) and Evodia (Wuzhuyu), known as Jiangqi Tang (Descending Qi Decoction).
For suspected smallpox/rubella fever, palpating the Xu Li (defensive pulse area near the heart apex): vigorous movement extending to the Key Lou (supraclavicular fossa) indicates smallpox; absence indicates other diseases. I learned this secret from Ogawa Shosai and verified its accuracy.
Plague toxins, though categorized into four types, fall into two main categories: Chancre (Xigan) affects muscles with shallow toxin, manifesting as Syphilis sores (Yangmei Chuang); Bubonic plague (Biandu) affects sinews with deep toxin, manifesting as hidden toxic nodules. However, deficiency/excess distinctions apply: in deficient chancre patients, toxin penetrates easily, delaying healing; in robust bubo patients, toxin pushes outward, accelerating healing. Ultimately, it remains within these two categories.
Sudden exacerbation of chronic illness is often due to latent pathogens. Recognizing the pattern and treating with dispersing formulas, regardless of the original disease, is effective—this aligns with the principle of treating acute conditions first.
Wada Togo used Rehmannia (Dihuang) for epigastric stuffiness, based on Wu's Shenfu Yangrong Tang for post-purgation stuffiness. I believe Dihuang-related stuffiness differs from Xiexin Tang (Drain the Epigastrium Decoction) stuffiness. Abdominal tendon tension and dried fluids pressing upward cause the stuffiness; Dihuang moistens sinews to resolve it. If fluid retention binds with heat causing epigastric fullness, Xiexin Tang is required. They are similar yet distinct.
Physicians often label complex, indescribable patterns as "Xi Zheng" (Seizure Disorder), following Kagawa Gyoku. *Senkyo Ron* states Xi is a pediatric term; adults should be called Dian (Mania). Kagawa's Xi resembles Qi Ji (Qi Disorder) from *Dabing Qilun* or Xin Feng (Heart Wind) from Dai Fuan. I traced the etiology to Heart, Liver, and Gallbladder. Causes include Heart Spirit deficiency/restlessness or Liver Qi depression/excess. Gallbladder patterns vary by deficiency/excess. Studying ancient texts on these three organs clarifies more than half the treatment principles.
Differentiating cold/heat by urine color alone is difficult, as Dai Fuan noted. Determining Yin/Yang by thirst preference is also unreliable. Heat-dysentery patients may prefer hot drinks; wind-damp patients may desire cold drinks, following the principle of "like seeking like." Assuming disease nature solely based on temperature preference is generally inaccurate.
For severe Taiyang heat patterns, Chaihu (Bupleuri Radix) and Huangqin (Scutellariae Radix) require large doses to be effective. For massive edema due to water qi, heavy doses of diuretics (Dan Shen herbs) are necessary, which has been repeatedly verified.
For intractable vomiting unresponsive to various treatments, HT Wehe diagnosed a floating-rapid pulse indicating exterior pathogen obstruction and prescribed Gegen Huangqin Huanglian Tang (Kudzu, Scutellaria, and Coptis Decoction) for rapid cure. Another case with similar symptoms had a sunken-hidden pulse indicating constrained heat, treated with Baihu Tang (White Tiger Decoction) effectively. Both diagnoses, differing in exterior/interior location, were brilliant.
The efficacy of ancient formulas is miraculous. Examples include: Musse Zeixie San (Oyster and Alisma Powder, optionally with Rhubarb) for solid edema; Gualou Qumai Wan (Trichosanthes and Spermacoce Pill) for Shengqi Wan patterns where Rehmannia is contraindicated; Huanglian Tang (Coptis Decoction) for persistent cholera-vomiting/diarrhea with epigastric pain; Zhizi Gancao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction) for dysphagia; Linggui Gan Zao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) for chronic scrotal swelling with epigastric pain; Baitouweng Tang (Pulsatilla Decoction) for intestinal wind bleeding. My years of experience confirm their efficacy like drumbeats. Mastery of ancient formulas is essential. (Chen Xiuyuan notes: Xuanfu Daizhe Shi Tang (Inula, Oyster Shell, and Hematite Decoction) is effective for intractable vomiting/hiccups due to its heavy descending nature. Ganjiang Huanglian Huangqin Tang (Dried Ginger, Coptis, and Scutellaria Decoction) works for immediate vomiting after eating. Ma Xing Gan Shi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) treats summerheat headache/sweating/panting/thirst. Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) treats restlessness/insomnia. Mahuang Dou Tang (Ephedra and Bean Decoction) nourishes Yin and promotes urination. These show the dragon-like variability of Jingfang.)
While many formulas treat scrotal issues, Linggui Gan Zao Tang is unparalleled. I also achieved remarkable results using San Yin Fang Bupi San (Three Causes Spleen-Supplementing Powder) refined with honey. For constipation with internal excess, Qifei Wan (Restore Decline Pill) is excellent.
In *Qianjin* Zisuzi Tang, Angelica (Danggui) is used for descending Qi, as recorded in Materia Medica ("treats cough and rebellious Qi"). In Renshen Baidu San (Ginseng Detoxication Powder), Zhiqiao (Aurantii Fructus) is used to expel wind, as recorded ("treats wind-itch and channel bi"). Physicians use these daily without examining their specific effects—a pity.
I treated a man with unresolved Taiyang disease, delirium, red face, tight-powerless pulse, slight diarrhea, and upper heat/lower cold. Jiangqinlianshen Tang failed. Kobayashi Yusai (disciple of Yoshitsugu Minamiwa) cured him rapidly with Danggui Sini Tang (Angelica Decoction for Cold Extremities), noting his own past success with this formula under Shibata Un'an.
Patients with warm toe nails but cold calves often die. Those with leg edema but no water qi in the shins, presenting only with dorsal foot swelling, are also critical.
Sudden flaccidity of chin tendons resembling "falling frame wind" is incurable. *Heji Jufang* Wujing Yuan treats "loose jaw unable to close, hand supports jaw to eat," which belongs to this category.
Hiccups unresponsive to treatment respond to Bear Gallbladder (Xiongdan) or Zuojin Wan Formula (Left Metal Pill).
Hongxiangjiao (Beriberi/Water Swelling) with smooth urination but chest pulsation, even ascending to the heart, indicates external water toxin invading internally. Even with stable pulses and no urination, ascending to the heart indicates internal water toxin obstructing pulse movement. These two variations require careful thought.
Hongxiangjiao without lower edema but with swelling in chest, back, neck, face, or hands, suddenly ascending to the heart, is serious. Similar to severe upper edema.
Hongxiangjiao with vomiting, hiccups, and panting signals impending heart involvement. However, look-alikes exist. One strong man with weak swollen calves, panting, shortness of breath, and intense heat was diagnosed with epidemic pathogen phlegm; Chaihu Xianxiong Tang (Bupleurum and Chest-Sinking Decoction) plus diuretics cured him quickly. Another with paralysis, weakness, vomiting, and anorexia was diagnosed with Hongxiangjiao plus roundworms; Shengqi Wan Formula (Kidney Qi Pill) plus Wumei Wan (Mume Pill) cured him completely. Diagnosis relies on pulse and chest pulsation; only experts can discuss this. (I heard Mr. Tei cured Hongxiangjiao hiccups/heart-ascending with single-ingredient Forsythia Paste, achieving ancient secrets.)
Hongxiangjiao fever resembling wind-cold, if not ascending to the heart, leads to leg weakness, which is frightening. Treating specifically for Hongxiangjiao is wise. True wind-cold cases differ and require differentiation.
Two subtle diagnostic challenges: First, consumption/Liver Qi stagnation starting with external pathogens; even after external resolution, internal pathology prevents cure. Treating only as external contraction fails. Second, new ambiguous symptoms in chronic illness patients (e.g., intestinal issues in mass disorders, dietary injury in scrotal disorders). Clinging to old diagnoses while ignoring new ones is dangerous. These require precise diagnosis. Zhang Jingyue said: "A wise doctor's mind is outside the box; a wise doctor's eyes see before signs appear." This applies here.
Disease names vary across eras, causing confusion. Examples: "Zhong" originally meant abscess, now edema; "Chuang" originally meant wound, now sores; "Gan" originally meant erosion, now pediatric malnutrition; "Gantan" (Tan Yin) originally clear fluid, now thick saliva; "Dan" means heat, abbreviated to "Dan" (jaundice), then erysipelas; "Liu" means hanging growth, now erysipelas; "Ji" means heart beating, now pounding sensation; "Ben Tun" is Kidney Accumulation in *Nanjing*, Qi Rush in *Shanghan Lun*; "Ke Ni" is cough/wheeze, mistakenly called hiccup in later times. These must be distinguished. (Mr. Keiyama's preface to *Onsen Ruben* clarifies these well; consult it.)
Recent medical books by Hakusai merely repeat old words without innovation, with flattering prefaces written by those who don't read classics. This is mere imitation, chasing fame and profit.
Reading medical classics differs from other books. Reading *Shanghan Lun* requires humility and calmness, focusing on its simplicity to study life principles, ensuring text matches practice. Then, cross-reference sources and verify clinically. Only through long-term accumulation can one handle infinite variations. This is reading well. Others who force interpretations, hold prejudices, boast superficial insights, debate without clinical focus, or obsess over philology miss the point. Ignorant speculators claiming to grasp classics while dismissing contradictions as later interpolations are like "summer insects doubting ice" or "Yue dogs barking at snow." While classics explain pathology, clinical verification also reveals meaning. (Valuing learning and mentorship helps compare treatments with classics, another way to understand them.)
Commentaries by Cheng Lianshe are straightforward but shallow. Fang Zhongxing innovated but arbitrarily rearranged text. Yu Jiayan followed Fang, confusing later generations. Ke Yunbo was knowledgeable but speculative. Cheng Jiaoqian used colloquialisms but offered precise logic. Wang Lingyou smoothed previous notes but retained flaws. Zhang Yinan and Ling Shao stuck to old texts without alteration. Qian Tianlai debated tirelessly but was sometimes too rigid. *Yizong Jinjian* compiled much but altered chapters/sentences excessively. (Duji Liu noted: Ancient commentaries avoided literalism. Ke Yunbo's *Laisu Ji* opened new paths despite structural changes. Qian Tianlai's *Suyuan Ji* organized chaos for clinical use. Both are precise but verbose. Zai Jing's book derives from Ke, structures like Qian, offers fresh insights concisely. Their balanced views serve as models for students, alongside Lu Cangzhou's historical essays.)
Reading should follow ancients. Once their words are sound, no need for redundancy. Arguing for show or forcing connections is useless.
If textual evidence is solid, cite it simply; verbosity is unnecessary.
Precise philology is useless if it doesn't aid treatment. Imprecise philology yielding clinical results captures the classic's essence.
Theories must cover the whole classic to be complete. Rigidly sticking to norms without flexibility is poor reading. Studying Huangdi, Qibo, and Changsha classics, selecting good masters' works for clinical application, is our family's method. My father collected books for us to read and apply well. (These lines open the right path for students. Medical literature is vast; biased views are numerous. Focus on key classics, study deeply, and progress naturally. Ignore trivial details; why check every anomaly?)