独啸庵能脱洒风尘，义气慷慨，似不屑医。而至其失鉴误治，详录以为后图。是以年虽
未满强壮，治术多可见者，今就其遗着钞一二云。
痢疾初起，尤可重发汗，而俟邪气聚于胃，与大小承气汤为得也。(按∶疫痢汗下之机
，最
为紧关。其初发汗彻透，则十可治七八。若里证不失下剂之机，则痢后诸患无起，误其机则
多至脱候。)
伤寒二三日，脉沉数，虚里如奔马，或心下痞硬者，后皆为大患。
病势缓者，死生易审定，如劳瘵、膈噎、鼓胀之类是也。病势急者，死生难预决，如伤
寒、麻疹、痘疮之类是也。医须精苦，勿误此机。
癫痫固为难证，而男子精欲未发者，妇子天癸未至者，灸药得当，则十可治四五。但禀
之于先天地得，决为不治。
家猪胆通壅滞，下逆气，功不让熊胆。熊胆多赝，非精鉴者不能辨也。(拙轩曰∶按诸
胆功用相均，牛胆猿胆亦可代用，胜赝熊胆远甚。)
韩参润渴下气，其功过诸药。而世或谓韩参制焙失其性，不如芳野之产，可谓冤矣(余
闻之对
马人韩参肥大长四五寸者，人含之则走不必喘，虽冒烟火亦不为熏杀。又闻插花者，言采牵
牛花， 咀韩参传其茎中，则不急萎。盖韩参当暑月浸诸瓯水，俄而喷出泡沫如浊酷 沸之
状，故用之足以见此说之确矣。)
今世患霉毒者，多兼气疾。故处方不兼理气之药，则毒瓦斯凝而不散。
淋疾痔漏亦因气发者不为少，攻之兼理气之药可也。
痿 初发，其人无湿毒及瘀血之诸症。而心下痞硬弦急者，是为气疾，宜吐之，而后服
泻心汤为佳。
劳瘵不可治，似劳瘵者可治。膈噎者，不可治，似膈噎者可治。世医动谓能治之，盖其
似者耳。
吐血因酒者易治，因气者难治。一发尚可，再发多死。吐血后见肿者，危矣。
人多思虑，火易动，火动则津液涸，加之恣欲，则为肾劳，肾劳亦多气疾。气疾为痿
者，其阴多先缩小，及其将愈，其阴先舒畅。
霉毒禀于胚胎者，决不治。假令一旦得痊，后必发。为人父母者，可不慎之于其初乎。
痉病有表证，而手足拘挛瘫痪者，以葛根汤发之。表证既去，拘挛瘫痪不休者，与大柴
胡汤而愈。
中 吐泻，手足厥冷者，有二途、一宜四逆汤，一宜白虎汤，医应湛思诊之。(霍乱热
厥冷厥之辨，亦宜审之)。
《金匮》胸痹心痛之治方，多用桂枝、附子。而浇薄之世，民众黠而多欲，以郁蒸气火
。故
可芩、连者多，可桂、附者少，宜详其证候而勿误之。(仲景门墙之外，别辟畦径。非精思
治术者，孰能为之。)
产后血气易涸，寻劳伤精神，则舌干、泄利发咳为劳。又新产时恶露不全尽，则凝结上
冲舌烂，泄利发咳为劳。( 劳说二途，诚不磨之论。专门产科恐未能明悉此义。)
伤寒二三日，心下痞硬，脉沉数者，后为大患，可微吐之。(伤寒行吐，不可过二三回
。得一快吐则止，用瓜蒂三分若五分。其治一逆，则急者促命期，缓者为坏证。)
伤寒与承气汤不得下者，当行吐方，而后再下矣。(此谚所谓欲得南风，先开北牖之意
。尿
闭亦有此法。陈修园曰∶譬之滴水之器，闭其上窍，则下窍不通，去其上窍之闭，则水自通
矣。用补中益气汤或吐法甚妙是也。)
伤寒外证已解，胸中有停痰宿水者，微吐之。
月事积年不来，心下痞硬者，及淋疾浊证心下痞硬诸药无验者，当先与吐方，而后服对
证药。
痿 初起，暨病将发者，其心下有痞，则先吐之为佳。(荻元凯曰∶暴得痿病，腰股两
足皆不遂，脉滑而有力者，宜先与吐方，而后用乌附剂。)
欲决病之治不治，定死生之期者，当审腹中虚实。凡候腹之法，如易而实甚难，何则。
有如
虚而实者，有如实而虚者，有因邪而虚邪祛而实者，有因邪而实邪祛而虚者，其决得于手而
应于心，父不可以喻子焉。
水陆草木之花实不一，有乍开乍落者，有倏花倏萎者，有花盛而无实者，有无花而结实
者，
有花小而长存者，有花大而乍落者。疾病之染人亦如此，医当察其开落之机，慎芟刈之期。
医为病制，则虽药峻剂大，其病不易治也。医制病，则虽药慢剂下，其病可治也。医宜
谋诸
未病之日，征诸既病之日矣。(拙轩曰∶医为病制，医制病，语极妙。医书中无此文本，学
者免为病制之医则难矣。)
阅诸病者，不治而自愈者，百人之内不过六十。其余四十，十人者必死证，十人者难治
，十
人者险证，非良医不能救，特下工所疗者，十
人耳。世医不知此区别，漫忽施治，取狂妄之名，遂归罪于古方，何不省之甚哉？余奉古方
以汗吐下之方疗癫痫、劳瘵、喘息、鼓胀、膈噎之类数年，始知此区别，诊视不迷，左右逢
源。而后信古人之技，不在既病，而在未病也。
独啸庵能够超脱世俗尘嚣，义气慷慨，似乎不屑于从事医术。然而当他遇到诊断失误或治疗错误时，会详细记录下来，作为后人的借鉴。因此他虽然年纪未满壮年，但治疗方法多有可取之处，现在摘录他遗留著作中的一二内容如下。
痢疾初起时，尤其应当重用发汗法，等待邪气聚集在胃腑时，再使用大承气汤或小承气汤，这样才得当。（按语：疫痢中发汗与攻下的时机，最为关键。初期若能彻底发汗透邪，十人可治七八人。如果里证没有错过攻下的时机，那么痢疾后的各种变证就不会发生；若误了时机，则多会导致脱证危候。）
伤寒发病二三日，脉象沉而数，虚里穴跳动如奔马般剧烈，或者心下部位痞塞硬满的，后来都会演变成严重的病患。
病情发展缓慢的疾病，生死容易判定，如劳瘵（肺结核）、膈噎（食管梗阻）、鼓胀（腹水）等就是这类。病情急骤的疾病，生死难以预先断定，如伤寒、麻疹、痘疮等就是这类。医生必须精心刻苦钻研，不要错失诊治良机。
癫痫固然属于难治之证，但对于男子精气未发泄、女子天癸（月经）未至者，只要灸法和用药得当，十人可以治愈四五人。但如果这种病是禀受于先天胎元缺陷所致，则决断为不治之症。
家猪胆能疏通壅滞，降逆气，功效不亚于熊胆。市面上熊胆多为假货，不是精于鉴别的人不能辨别。（拙轩说：按各种胆汁功效相近，牛胆、猿胆也可以替代使用，远胜于假冒的熊胆。）
韩参（即党参的一种古称或特定品种）能润燥止渴、降气，其功效超过其他药物。世人有的说韩参经过炮制焙干后失去了药性，不如野生产地的好，这真是冤枉啊（我听说对马岛产的韩参肥大长达四五寸，含在口中能缓解气喘，即使冒着烟火也不会被熏坏。又听插花的人说，采摘牵牛花时，咀嚼韩参并将其茎插入牵牛花茎中，牵牛花就不会迅速枯萎。大概韩参在暑月浸泡在器皿水中，不久就会喷出泡沫，像浑浊醋沸腾的样子，所以用这些事实足以证明上述说法的确凿。）
当今患梅毒的人，多兼有气机郁滞的病证。所以处方如果不兼顾理气的药物，毒瓦斯就会凝结而不消散。
淋疾和痔漏也有因气机郁滞引发的不少，治疗时攻邪兼用理气药物是可以的。
痿证初发时，患者如果没有湿毒及瘀血的各种症状，而心下部位痞塞硬满且弦紧急迫的，这是气机郁滞所致，适宜用吐法，之后再服用泻心汤为佳。
劳瘵确实不可治，但“类似劳瘵”的症状是可以治疗的。膈噎确实不可治，但“类似膈噎”的症状是可以治疗的。世间的医生动不动就说能治好，其实他们治的大多是那些“类似”的情况罢了。
因饮酒引起的吐血容易治疗，因气机逆乱引起的吐血难治。第一次发作尚可救治，再次发作大多死亡。吐血后出现浮肿的，情况危急。
人多思虑，火气容易妄动，火动则津液枯竭，再加上纵欲，就会造成肾劳，肾劳也多伴有气机郁滞。因气机郁滞导致痿证的，其生殖器多先缩小，等到将要痊愈时，生殖器先恢复舒畅。
禀受于胚胎期的梅毒，决断为不治。假如有一天侥幸痊愈，日后必定复发。为人父母者，能不在这初始阶段谨慎吗？
痉病如果有表证，且手足拘挛瘫痪的，用葛根汤发汗解表。表证去除后，拘挛瘫痪仍不止息的，给予大柴胡汤即可痊愈。
霍乱引起的呕吐腹泻，手足厥冷的，有两种情况：一种适宜用四逆汤，一种适宜用白虎汤，医生应深思熟虑地诊察。（霍乱热厥与冷厥的辨别，也应当审慎。）
《金匮要略》中治疗胸痹心痛的方剂，多用桂枝、附子。但浇薄浅陋的世道，民众狡黠而欲望多，体内多因郁蒸产生气火。所以适用黄芩、黄连清热者多，适用桂枝、附子温补者少，应当详细审查证候以免误治。（在仲景学术体系之外，另辟蹊径。不是精于思考医术的人，谁能做到呢？）
产后气血容易枯竭，寻究劳伤精神，就会出现舌干、泄利、咳嗽等症状，这称为劳损。另外新产时恶露不尽，凝结上冲导致舌烂、泄利、咳嗽，也称为劳损。（关于劳损的说法分两类，确实是不可磨灭的真理。专门从事产科的医生恐怕未必能透彻明白此义。）
伤寒发病二三日，心下痞塞硬满，脉象沉数的，后来会成为严重病患，可以轻微使用吐法。（伤寒使用吐法，不可超过两三次。得到一次畅快呕吐就停止，使用瓜蒂三分或五分。如果治疗出现一逆，急症会加速死亡，缓症会变成坏证。）
伤寒服用承气汤却不得大便的，应当先施行吐法，然后再攻下。（这就是谚语所说的“想要吹来南风，先打开北窗”的意思。尿闭也有这种方法。陈修园说：好比滴水器，堵住上面的窍孔，下面的窍孔就不通；去掉上面窍孔的堵塞，水自然流通。使用补中益气汤或吐法非常巧妙。）
月经积年不来，心下痞塞硬满的，以及淋疾浊证心下痞塞硬满、各种药物无效的，应当先给予吐法，然后再服用对症的药物。
痿证初起，以及疾病即将发作时，如果心下有痞塞感，则先使用吐法为佳。（荻元凯说：突然患上痿病，腰股双腿都不能随意活动，脉象滑而有力的，宜先给予吐法，然后再用乌头、附子类药剂。）
要想决定疾病能否治愈，确定生死期限，应当审察腹部虚实。凡是诊察腹部的方法，看似容易实则很难，为什么呢？因为有看起来虚而实际实的，有看起来实而实际虚的，有因为邪气存在而显得虚、邪气祛除后显得实的，有因为邪气存在而显得实、邪气祛除后显得虚的。这种判断依靠手感而应于心中，父亲无法向儿子言传身教。
水陆草木的花果各不相同，有乍开乍落的，有瞬间开花瞬间枯萎的，有花开茂盛而无果实的，有无花而结出果实的，有花朵小而长久存在的，有花朵大而瞬间凋落的。疾病传染给人也是如此，医生应当观察其开落之机，谨慎选择剪除（治疗）的时机。
如果是医生被疾病所制约，那么即使药性峻猛、剂量大，疾病也不容易治好。如果是医生制约了疾病，那么即使药性缓慢、剂量小，疾病也可以治好。医生应当在未病之时谋划，在既病之时验证。（拙轩说：“医为病制，医制病”，这句话极其精妙。医书中没有这样的文本，学者如果不成为不被疾病制约的医生，那就很难了。）
阅读各种病例，不治而自愈的，一百人中不过六十人。其余四十人中，十人是必死之证，十人是难治之证，十人是险证，非良医不能挽救，特别是一般的庸医只能处理那十人（指易治或必死之外的中间状态，此处原文意指庸医仅能处理极少部分或误治）。世间的医生不知道这种区别，轻率地施治，妄图获取狂妄的名声，却归罪于古方，为什么不深刻反省呢？我奉行古方中的汗、吐、下法治疗癫痫、劳瘵、喘息、鼓胀、膈噎等疾病数年，才开始明白这种区别，诊视不再迷惑，左右逢源。此后才相信古人的技艺，不在于既病之后，而在于未病之前。
Duxiao An was able to transcend worldly dust, possessing a generous sense of righteousness, appearing disdainful of medicine. However, when he encountered diagnostic errors or treatment mistakes, he would record them in detail for future reference. Thus, although he had not yet reached his prime, his therapeutic methods were largely commendable. Herein, I excerpt one or two points from his remaining writings.
In the initial stage of dysentery, heavy sweating should be particularly employed; once the pathogenic factor gathers in the Stomach, administering Da Cheng Qi Tang (Great Order the Yang Decoction) or Xiao Cheng Qi Tang (Minor Order the Yang Decoction) is appropriate. (Note: The timing of sweating and purging in epidemic dysentery is most critical. If sweating thoroughly penetrates at the onset, seven or eight out of ten cases can be cured. If the interior syndrome does not miss the opportunity for purging, various complications following dysentery will not arise; missing this opportunity often leads to collapse syndromes.)
In Shanghan (Cold Damage), on the second or third day, if the pulse is deep and rapid, the Xu Li point (located above the heart apex) beats violently like a galloping horse, or there is fullness and hardness below the heart, these conditions will later develop into major ailments.
For diseases with a slow progression, life and death are easy to determine, such as Lao Zhai (Consumption/Tuberculosis), Ge Ye (Regurgitation/Dysphagia), and Gu Zhang (Drum Distension/Ascites). For diseases with acute progression, life and death are difficult to predict in advance, such as Shanghan (Cold Damage), Ma Zhen (Chickenpox/Measles), and Dou Chuang (Smallpox). Physicians must study diligently and carefully, lest they miss this crucial opportunity.
Epilepsy is indeed a difficult condition to treat. However, for men whose essence has not yet been released, or women whose Tian Gui (Menstruation) has not yet arrived, if moxibustion and medication are properly applied, four or five out of ten cases can be cured. But if the condition is congenital due to prenatal endowment, it is determined to be incurable.
Domestic pig gallbladder can unblock stagnation and direct rebellious Qi downward; its efficacy is not inferior to that of bear gallbladder. Bear gallbladder is often counterfeit, and only those skilled in identification can distinguish it. (Zhuo Xuan said: According to records, the functions of various gallbladders are similar; ox gallbladder and ape gallbladder can also be used as substitutes, far superior to fake bear gallbladder.)
Han Shen (a type of Codonopsis/Panax) moistens dryness, relieves thirst, and directs Qi downward, surpassing other herbs in efficacy. Some people claim that Han Shen loses its nature after processing and roasting, unlike wild-grown varieties, which is truly unjustified. (I heard that Han Shen from Tsushima Island grows fat and long, four or five cun, and when held in the mouth, it alleviates wheezing; even amidst smoke and fire, it is not scorched. I also heard from flower arrangers that chewing Han Shen and inserting its stem into a morning glory stem prevents the latter from wilting quickly. Probably, during summer months, Han Shen soaked in water vessels soon sprays foam resembling boiling turbid vinegar. Thus, using these facts proves the accuracy of this statement.)
Currently, patients suffering from Mei Du (Syphilis) often have concurrent Qi disorders. Therefore, if prescriptions do not include Qi-regulating herbs, the toxic vapors will condense and fail to disperse.
Lin Ji (Strangury) and Zhi Lou (Hemorrhoids/Fistulas) are also caused by Qi disturbances in many cases; attacking the pathogen while regulating Qi is acceptable.
In Wei Bing (Flaccidity Syndrome), at the initial onset, if the patient lacks symptoms of damp-toxin and blood stasis, but presents with fullness, hardness, string-tightness, and urgency below the heart, this is a Qi disorder. It is suitable to induce vomiting first, followed by taking Xie Xin Tang (Drain the Epigastrium Decoction).
Lao Zhai (Consumption) is indeed incurable, but conditions resembling Lao Zhai are treatable. Ge Ye (Regurgitation) is indeed incurable, but conditions resembling Ge Ye are treatable. Physicians of the world often claim they can cure these, but they are actually treating the "resembling" conditions.
Hematemesis (vomiting blood) caused by alcohol is easy to treat; that caused by Qi rebellion is difficult. The first episode may be manageable, but recurrent episodes often lead to death. Hematemesis followed by edema indicates a critical condition.
People who overthink easily stir up Fire; when Fire moves, body fluids dry up. Coupled with excessive desire, this leads to Kidney Lao (Kidney Exhaustion), which is often accompanied by Qi disorders. In cases where Qi disorders cause Wei Bing (Flaccidity), the genitals usually shrink first; as recovery approaches, the genitals become relaxed and comfortable first.
Mei Du (Syphilis) acquired from the embryo is determined to be incurable. Even if one miraculously recovers once, it will inevitably recur later. Parents, can they not be cautious at the beginning?
Jing Bing (Spasm Syndrome) presenting with exterior signs and spasms/paralysis of the hands and feet should be treated with Ge Gen Tang (Kudzu Decoction) to release the exterior. Once the exterior signs are resolved, if spasms and paralysis persist, Da Chai Hu Tang (Major Bupleurum Decoction) will bring about a cure.
Zhong Yu (Food Poisoning/Acute Gastroenteritis) presenting with vomiting, diarrhea, and cold extremities has two pathways: one is suitable for Si Ni Tang (Frigid Extremities Decoction), and the other for Bai Hu Tang (White Tiger Decoction). Physicians should ponder deeply and diagnose carefully. (The distinction between heat-jue and cold-jue in Huo Luan (Cholera-like disease) should also be examined carefully.)
Formulas in *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) for treating Xiong Bi (Chest Bi) and Heart Pain mostly use Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite Root). However, in this shallow and decadent era, the populace is cunning and desirous, leading to internal stagnation transforming into Qi-Fire. Thus, cases suitable for Huang Qin (Scutellaria Root) and Lian Zi (Lotus Plumule) are common, while those suitable for Gui Zhi and Fu Zi are rare. One must examine the syndrome details carefully to avoid error. (Outside the gates of Zhong Jing's school, opening new paths. Who but those who think profoundly about medical arts can achieve this?)
Postpartum Qi and Blood are prone to depletion. Seeking out labor and mental injury leads to dry tongue, diarrhea, and coughing, termed Lao (Exhaustion). Additionally, if lochia is incomplete after childbirth, coagulation rushes upward causing tongue ulcers, diarrhea, and coughing, also termed Lao. (The theory of Lao having two categories is indeed an unshakeable truth. Specialists in obstetrics may not fully comprehend this meaning.)
In Shanghan (Cold Damage), on the second or third day, if there is fullness and hardness below the heart and a deep, rapid pulse, it will later become a major ailment; mild induction of vomiting is permissible. (Inducing vomiting in Shanghan should not exceed two or three times. Stop once a satisfying vomit occurs, using 3-5 fen of Gua Di (Melon Seed). If treatment goes awry, acute cases accelerate death, while chronic cases become complicated syndromes.)
If Shanghan patients take Cheng Qi Tang (Order the Yang Decoction) but cannot pass stool, one should perform vomiting first, then proceed to purging. (This is the meaning of the proverb: "To get the south wind, open the north window." Urinary retention also uses this method. Chen Xiuyuan said: It is like a dripping vessel; blocking the upper orifice blocks the lower orifice. Removing the blockage from the upper orifice allows water to flow freely. Using Bu Zhong Yi Qi Tang or vomiting methods is very clever.)
If Shanghan exterior signs are resolved but there is retained phlegm and old water in the chest, mild induction of vomiting is indicated.
If menstruation has been absent for years and there is fullness/hardness below the heart, or if Lin Ji (Strangury) with turbid urine and fullness/hardness below the heart fails to respond to various medicines, one should first administer a vomiting formula, then take symptom-specific medicine.
At the onset of Wei Bing (Flaccidity Syndrome), or when the disease is about to manifest, if there is fullness in the epigastrium, inducing vomiting first is best. (Di Yuan Kai said: For sudden onset of Wei Bing with inability to move waist, thighs, and legs, and a slippery, forceful pulse, one should first give a vomiting formula, then use Wu Tou (Aconite) and Fu Zi preparations.)
To decide whether a disease is treatable and to determine the time of death, one must examine the emptiness or fullness in the abdomen. All methods of examining the abdomen seem easy but are actually very difficult. Why? Because there are cases that appear empty but are full, appear full but are empty, appear empty due to pathogen but become full after pathogen removal, and appear full due to pathogen but become empty after pathogen removal. This judgment relies on tactile sensation and resonates in the mind; a father cannot teach it to his son.
The flowers and fruits of land, water, trees, and grass vary; some open and fall suddenly, some bloom and wither instantly, some bloom abundantly but bear no fruit, some bear fruit without flowers, some have small flowers that last long, and some have large flowers that fall quickly. Disease transmission to humans is also like this. Physicians must observe the mechanism of opening and falling, and carefully choose the time for pruning (treatment).
If the physician is controlled by the disease, even with harsh drugs and large doses, the disease will not be easily cured. If the physician controls the disease, even with mild drugs and small doses, the disease can be cured. Physicians should plan before illness strikes and verify after illness occurs. (Zhuo Xuan said: "Physician controlled by disease, physician controlling disease" is extremely profound. Such texts are rare in medical books; scholars who do not become physicians who control diseases will find it difficult.)
Reading through various cases, those that heal spontaneously without treatment account for no more than sixty out of a hundred. Of the remaining forty, ten are fatal cases, ten are difficult-to-treat cases, ten are dangerous cases requiring a good physician to save them, and only ten are within the scope of ordinary practitioners. Physicians of the world do not know this distinction, treating casually to gain a reputation for arrogance, and then blaming ancient formulas. How unreasonable! I practiced using ancient sweating, vomiting, and purging formulas to treat epilepsy, consumption, asthma, drum distension, and regurgitation for several years, and only then understood this distinction. My diagnosis became clear, and I found resources everywhere. Only then did I believe that the skill of the ancients lies not in treating after illness, but in preventing before illness.