通府黄廷用，饮食起居失宜，两足发热，口干吐痰，自用二陈、四物益甚，两尺数而无力。余
曰∶此肾虚之症也。不信，仍服前药，足跟热痒，以为疮毒，又服导湿之剂，赤肿大热，外
用敷药，破而出水，久而不愈，及用追毒丹，疮突如桃，始信余言，滋其化源，半载得瘥。
儒者章立之，左股作痛，用清热渗湿之药，色赤肿胀，痛连腰胁，腿足无力。余以为足三阴虚，
用补中益气、六味地黄，两月余元气渐复，诸症渐退，喜其慎疾，年许而痊。
府痒钟之英，两腿生疮，色黯如钱，似癣者三四，痒痛相循，脓水淋漓，晡热内热，口干，面黧
，此肾虚之症，用加味六味丸，数日而愈。此等症候，用祛风败毒之剂，以致误人多矣。
一男子，素遗精，足跟作痛，口干作渴，大便干燥，午后热甚，用补中益气加芍药、玄参及六
味丸而愈。
余症见《外科枢要》。
一儒者，大便素结，服搜风顺气丸后，胸膈不利，饮食善消，面带阳色，左关尺脉洪而虚。余
曰∶此足三阴虚也。彼恃知医，不信，乃服润肠丸，大便不实，肢体倦怠，余与补中益气、
六味地黄汤，月余而验，年许而安。若脾肺气虚者，用补中益气汤。若脾经郁结者，用加味归
脾汤。若气血虚者，用八珍汤加肉苁蓉。若脾经津液涸者，用六味丸。若发热作渴饮冷者，
用竹叶黄 汤。若燥在直肠，用猪胆汁导之。若肝胆邪侮脾者，用小柴胡加山栀、郁李、枳
壳。若膏粱浓味积热者，用加味清胃散。亦有热燥、风燥、阳结、阴结者，当审其因而治之。若
复伤胃气，多成败症。
一老儒，素有风热，饮食如常，大便十七日不通，肚腹不胀，脉洪大而虚，此阴火烁津
液，用六味丸二十余剂，至三十二日始欲去，用猪胆润而通利如常。
一妇人，年七十有三，痰喘内热，大便不通，两月不寐，脉洪大重按微细，此属肝肺肾亏损，
朝用六味丸，夕用逍遥散，各三十余剂，计所进饮食百余碗，腹始痞闷，乃以猪胆汁导而通
之，用十全大补调理而安。若间前药，饮食不进，诸症复作。
一男子，年五十余，因怒少食，大便不利，服润肠丸，大便秘结，胸胁作痛，兼服脾约丸，
肝脾肾脉浮而涩。余曰∶此足三阴精血亏损之症也。东垣先生云∶若人胃强脾弱，约束津液
不得四布，但输膀胱，小便数而大便难者，用脾约丸。若人阴血枯槁，内火燔灼，肺金受邪
，土受木伤，脾肺失传，大便秘而小便数者，用润肠。今滋其化源，则大便自调矣。如法
果验。
一儒者，怀抱郁结，复因场屋不遂，发热作渴，胸膈不利，饮食少思，服清热、化痰、行气等剂，
前症益甚，肢体倦怠，心脾二脉涩滞，此郁结伤脾之变症也，遂用加味归脾汤治之，饮食渐
进，诸症渐退，但大便尚涩，两颧赤色，此肝肾虚火，内伤阴血，用八珍汤加苁蓉、麦门、
五味，至三十余剂，大便自润。
一男子，所患同前，不信余言，服大黄等药，泄泻便血，遍身黑黯，复求治。余视之曰∶此阴阳
二络俱伤也。经曰∶阳络伤则血外溢，阴络伤则血内溢。辞不治，后果然。
职坊陈莪斋，年逾六旬，先因大便不通，服内疏等剂，后饮食少思，胸腹作胀，两胁作痛，形
体倦怠，两尺浮大，左关短涩，右关弦涩，时五月请治，余意乃命火衰，不能生脾土，而
肺金又克肝木，忧其金旺之际不起。后果然。
通政司黄廷用，因饮食起居不规律，出现双足发热、口干、吐痰的症状。他自行服用二陈汤和四物汤后，症状反而加重，诊得两尺脉数而无力。我说：“这是肾虚的病症。”他不相信，继续服用之前的药物，导致足跟热痒，误以为是疮毒，又服用了祛湿的药物，致使患处红肿大热。外用敷药后，皮肤破溃流水，久治不愈。后来使用了追毒丹，疮口突起如桃子状，他才相信我的话。我采用滋补肾阴化源的方法治疗，半年后痊愈。
儒生章立之，左大腿疼痛，使用清热渗湿的药物后，面色赤红肿胀，疼痛牵连腰胁，腿足无力。我认为这是足三阴虚损，使用补中益气汤和六味地黄丸治疗，两个多月后元气逐渐恢复，各种症状逐渐消退。庆幸他谨慎对待疾病，一年左右痊愈。
府同知钟之英，双腿生疮，颜色暗如铜钱，类似癣症有三四处，瘙痒与疼痛交替出现，脓水淋漓，午后潮热及内热，口干，面色黧黑。这是肾虚的病症，使用加味六味丸治疗，几天后痊愈。这类证候，若使用祛风败毒的药物，导致误治的人太多了。
有一名男子，平时有遗精病史，足跟疼痛，口干作渴，大便干燥，午后发热严重。使用补中益气汤加芍药、玄参以及六味地黄丸治疗后痊愈。
其余症状参见《外科枢要》。
一名儒生，大便向来干结，服用搜风顺气丸后，胸膈部不适，饮食容易消化，面带阳热之色，左关脉和左尺脉洪大而虚。我说：“这是足三阴虚损。”他自恃懂医，不相信，于是服用润肠丸，导致大便不成形，肢体倦怠。我给予补中益气汤和六味地黄汤治疗，一个多月后见效，一年左右安稳。如果是脾肺气虚者，使用补中益气汤。如果是脾经郁结者，使用加味归脾汤。如果是气血虚者，使用八珍汤加肉苁蓉。如果是脾经津液枯竭者，使用六味地黄丸。如果是发热作渴且喜饮冷水者，使用竹叶石膏汤。如果是燥邪在直肠，用猪胆汁导引通便。如果是肝胆邪气侵犯脾胃者，使用小柴胡汤加山栀、郁李仁、枳壳。如果是膏粱厚味积热者，使用加味清胃散。也有热燥、风燥、阳结、阴结的情况，应当审察病因进行治疗。如果再次损伤胃气，多会发展为败症（难治之症）。
一名老儒生，素有风热，饮食正常，大便十七天不通，肚腹不胀，脉象洪大而虚。这是阴火灼烧津液，使用六味地黄丸二十多剂，到第三十二天时才有便意，用猪胆汁润滑后，大便通畅如常。
一名妇人，七十三岁，痰喘伴内热，大便不通，两个月无法入睡，脉象洪大但重按微细。这属于肝肺肾亏损，早晨服用六味地黄丸，晚上服用逍遥散，各服用三十多剂，累计进食百余碗饭，腹部才开始痞闷，于是用猪胆汁导引通便，再用十全大补汤调理而安。如果间断服用前面的药物，饮食不进，各种症状会复发。
一名男子，五十多岁，因发怒而少食，大便不利，服用润肠丸后，大便秘结，胸胁作痛。兼服脾约丸，诊得肝脾肾脉浮而涩。我说：“这是足三阴精血亏损的病症。”东垣先生曾说：如果人胃强脾弱，约束津液不得四布，只输注膀胱，导致小便频数而大便困难者，使用脾约丸。如果人阴血枯槁，内火燔灼，肺金受邪，脾土受肝木伤害，脾肺传变失常，大便秘而小便数者，使用润肠丸。如今滋养其化源，则大便自然调和。依照此法果然有效。
一名儒生，怀抱郁结，又因科举考试不顺，出现发热作渴、胸膈不适、饮食减少等症状。服用清热、化痰、行气等药剂后，前症更加严重，肢体倦怠，心脾二脉涩滞。这是郁结伤脾的变症，于是使用加味归脾汤治疗，饮食逐渐增加，各种症状逐渐消退。但大便仍然干涩，两颧赤色，这是肝肾虚火，内伤阴血，使用八珍汤加肉苁蓉、麦门冬、五味子，服用三十多剂后，大便自然润泽。
一名男子，患同样的病，不相信我的话，服用大黄等药物，导致泄泻便血，遍身黑黯，再次求治。我查看后说：“这是阴阳二络都受伤了。”《内经》说：阳络伤则血外溢，阴络伤则血内溢。我辞谢不治，后果然如此。
职坊陈莪斋，六十多岁，起初因大便不通，服用内疏等药剂，后来饮食减少，胸腹胀满，两胁作痛，形体倦怠，两尺脉浮大，左关脉短涩，右关脉弦涩。当时是五月，我心想这是命门火衰，不能生助脾土，而且肺金又克制肝木，担忧他在金旺的季节无法挺过。后果然去世。
Huang Tingyong, a civil official of the Ministry of Revenue, suffered from fever in both feet, dry mouth, and expectoration due to irregular diet and lifestyle. After self-administering Erchen Tang (Two-Chen Decoction) and Siwu Tang (Four-Substance Decoction), his symptoms worsened; his radial pulses at both chi positions were rapid but forceless. I stated, "This is a syndrome of Kidney deficiency." He did not believe me and continued taking the previous medicines. Consequently, he developed heat and itching in the heels, mistaking it for toxic sores, and further ingested damp-draining agents. This resulted in severe redness, swelling, and heat in the affected area. Topical applications caused the skin to ulcerate and weep fluid, failing to heal over time. Later, after using Zhuidu Dan (Toxin-Pursuing Pill), the sore protruded like a peach, at which point he finally accepted my diagnosis. I treated him by nourishing the source of transformation (nourishing Kidney Yin), and he recovered after half a year.
Zhang Lizhi, a scholar, experienced pain in his left thigh. After using heat-clearing and damp-draining herbs, his complexion became red and swollen, with pain radiating to the waist and hypochondrium, accompanied by weakness in the legs and feet. I diagnosed this as deficiency of the three Yin meridians of the foot and prescribed Buzhong Yiqi Tang (Decoction to Boost the Middle and Augment Qi) and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). After more than two months, his vital energy gradually recovered, and various symptoms subsided. Fortunately, he was cautious about his illness, and he fully recovered within a year.
Zhong Zhiying, an assistant prefect, developed sores on both legs. The lesions were dark, coin-sized, resembling tinea, with alternating itching and pain, and profuse purulent discharge. He also exhibited afternoon tidal fever, internal heat, dry mouth, and a sallow complexion. This was diagnosed as Kidney deficiency. Treatment with Jiawei Liuwei Wan (Modified Six-Ingredient Pill with Rehmannia) led to recovery within a few days. Many such cases have been mismanaged due to the inappropriate use of wind-dispelling and detoxifying agents.
A male patient with a history of seminal emissions suffered from heel pain, dry mouth with thirst, dry stool, and severe afternoon fever. He was cured using Buzhong Yiqi Tang modified with Shaoyao (Paeoniae Radix Alba) and Xuanshen (Scrophulariae Radix), along with Liuwei Dihuang Wan.
For other symptoms, please refer to *Waike Shuyao* (Essentials of External Medicine).
A scholar had a chronic tendency toward constipation. After taking Sunfeng Shunqi Wan (Pill to Smooth Wind and Regulate Qi), he experienced chest and diaphragm discomfort, though his appetite remained good and digestion efficient. His face showed signs of Yang heat, and his left Guan and Chi pulses were surging yet empty. I diagnosed this as deficiency of the three Yin meridians of the foot. Relying on his own medical knowledge, he disbelieved me and took Runchang Wan (Intestine-Moistening Pill), which resulted in loose stools and limb fatigue. I then administered Buzhong Yiqi Tang and Liuwei Dihuang Tang. After more than a month, there was a visible effect, and he stabilized within a year. For cases of Spleen and Lung Qi deficiency, Buzhong Yiqi Tang is used. For Spleen meridian stagnation, Jiawei Guipi Tang (Modified Restore the Spleen Decoction) is indicated. For Qi and Blood deficiency, Bazhen Tang (Eight-Treasure Decoction) plus Roushouyu (Cistanche Stem) is prescribed. For depletion of fluids in the Spleen meridian, Liuwei Dihuang Wan is used. For fever with thirst and preference for cold drinks, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) is applied. For dryness in the large intestine, pig bile can be used as a suppository. If Liver and Gallbladder pathogenic factors invade the Spleen, Xiaochaihu Tang (Minor Bupleurum Decoction) added with Zhizi (Gardenia Fruit), Yuliren (Prunus Seed), and Zhike (Aurantii Fructus Immaturus) is used. For accumulated heat from rich foods, Jiawei Qingwei San (Modified Stomach-Clearing Powder) is indicated. There are also cases of heat-dryness, wind-dryness, Yang binding, and Yin binding, which require treatment based on etiological differentiation. Further damage to Stomach Qi often leads to intractable conditions.
An elderly scholar, who had long suffered from wind-heat, maintained normal appetite but experienced constipation for seventeen days without abdominal distension. His pulse was surging and large yet empty upon pressure. This indicated that Yin fire was scorching body fluids. He was treated with twenty-plus doses of Liuwei Dihuang Wan. By the thirty-second day, he felt the urge to defecate, and after using pig bile for lubrication, his bowel movements returned to normal.
A seventy-three-year-old woman presented with phlegm-wheezing, internal heat, constipation, and insomnia for two months. Her pulse was surging and large but fine and weak upon deep pressure. This belonged to Liver, Lung, and Kidney deficiency. She took Liuwei Dihuang Wan in the morning and Xiaoyao San (Free and Easy Wanderer Powder) in the evening, each for over thirty doses. After consuming more than one hundred bowls of food, her abdomen became distended. Pig bile was then used to induce defecation, followed by Shiquan Dabu Tang (Complete Great Tonifying Decoction) for regulation, leading to stability. If the previous medications were interrupted, food intake would decrease, and symptoms would recur.
A man in his fifties suffered from difficulty in defecation due to anger and reduced food intake. After taking Runchang Wan, he developed severe constipation and chest-hypochondriac pain. He also took Piyue Wan (Spleen-Restriction Pill). His Liver, Spleen, and Kidney pulses were floating and choppy. I stated, "This is a syndrome of Essence and Blood deficiency in the three Yin meridians of the foot." Mr. Dongyuan said: If a person has strong Stomach Qi but weak Spleen Qi, constraining fluids so they do not distribute widely but instead flow only to the Bladder, resulting in frequent urination and difficult defecation, Piyue Wan should be used. If a person suffers from withered Yin Blood, blazing internal fire, pathogenic invasion of Lung Metal, and injury to Spleen Earth by Liver Wood, causing dysfunction between Spleen and Lung, leading to constipation with frequent urination, Runchang Wan should be used. Now, by nourishing the source of transformation, bowel movements will naturally regulate. Following this method proved effective.
A scholar suffering from emotional stagnation, compounded by failure in imperial examinations, developed fever, thirst, chest discomfort, and poor appetite. After taking heat-clearing, phlegm-resolving, and Qi-moving agents, his symptoms worsened, accompanied by limb fatigue. His Heart and Spleen pulses were choppy. This was a complication of Spleen injury due to stagnation. I treated him with Jiawei Guipi Tang. His diet gradually improved, and symptoms subsided. However, his stool remained dry, and his malar regions were red, indicating deficient fire of the Liver and Kidney damaging Yin Blood internally. He was given Bazhen Tang plus Roushouyu, Maidong (Ophiopogon Tuber), and Wuweizi (Schisandra Fruit). After over thirty doses, his stool naturally moistened.
A male patient with identical symptoms disbelieved my advice and took Dahuang (Rhubarb Root and Rhizome) and other drugs, resulting in diarrhea, bloody stools, and generalized dark discoloration. He sought treatment again. Upon examination, I said, "Both the Yang and Yin collaterals are injured." The Classics state: Injury to Yang collaterals causes external bleeding; injury to Yin collaterals causes internal bleeding. I declined to treat him, and the outcome proved correct.
Chen Ezhai, a resident of Zhifang, was over sixty years old. Initially, due to constipation, he took internal-purgative agents. Subsequently, his appetite decreased, and he experienced chest-abdominal distension, hypochondriac pain, and physical fatigue. His Chi pulses were floating and large, his left Guan pulse was short and choppy, and his right Guan pulse was wiry and choppy. Seeking treatment in May, I suspected that Mingmen Fire (Gate of Life Fire) was declining, failing to generate Spleen Earth, while Lung Metal was suppressing Liver Wood. I feared he would not survive the peak of Metal season. Indeed, he passed away.