廷评张汝翰,胸膈作痞,饮食难化,服枳术丸,久而形体消瘦,发热口干,脉浮大而微,用补
中益气加姜、桂,诸症悉退。惟见脾胃虚寒,遂用八味丸补命门火,不月而饮食进,三月而
形体充。此症若不用前丸,多变腹胀喘促,腿足浮肿,小便淋沥等症,急用济生加减肾气丸
,亦有得生者。
一儒者,虽盛暑喜燃火,四肢常欲沸汤渍之,面赤吐痰,一似实火,吐甚宿食亦出,惟食椒姜
之物方快。余谓食入反出,乃脾胃虚寒,用八味丸及十全大补加炮姜渐愈,不月平复。
一妇人,饮食无过碗许,非大便不实,必吞酸嗳腐,或用二陈、黄连,更加内热作呕。余谓∶
东垣先生云,邪热不杀谷,此脾胃虚弱,末传寒中。以六君加炮姜、木香,数剂胃气渐复,
饮食渐进。又以补中益气加炮姜、木香、茯苓、半夏数剂痊愈。后怒饮食顿少,元气顿怯,
更加发热,诚似实火,脉洪大而虚,两尺如无,用益气汤八味丸两月,诸症悉愈。
佐云∶向因失足,划然有声,坐立久则左足麻木,虽夏月足寒如冰。嘉靖巳亥夏月,因醉睡
觉而饮水,复睡,遂觉右腹痞结,以手摩之,腹间沥漉有声,热摩则气泄而止,每每加剧,饮
食稍多则作痛泻,求治于医,令服枳术丸固守勿效。甲辰岁,求治于立斋先生,诊之,喟然叹曰
∶此非脾胃病,乃命门火衰不能生土,土虚寒使之然也,若专主脾胃,误矣,可服八味丸则愈。
予亦敬服,果验。盖八味丸有附子,医家罔敢轻用,夫附子斩关夺旗,回生起死,非良将莫
能用,立斋先生今之武侯也。家贫不能报德,故序此以记治验。嘉靖甲辰十二月望后二日,
杉墩介庵朱佐顿首拜书。
光禄邝子泾,面白神劳,食少难化,所服皆二陈、山栀、枳实之类,形体日瘦,饮食日减。余
谓此脾土虚寒之症,法当补土之母。彼不信,乃径补土,以致不起。
罗工部,仲夏腹恶寒而外恶热,鼻吸气而腹觉冷,体畏风而恶寒,脉大而虚微,每次进热粥瓯
许,必兼食生姜瓯许,离火食腹内即冷。余曰∶热之不热,是无火也,当用八味丸壮火之
源,以消阴翳。彼反服四物、玄参之类而殁。
工部陈禅亭,发热有痰,服二陈、黄连、枳壳之类,病益甚,甲辰季冬请治,其脉左尺微细,
右关浮大,重按微弱。余曰∶此命门火衰,不能生土而脾病,当补火以生土,或可愈也。不
悟,仍服前药,脾土愈弱,至乙巳闰正月,病已革。复邀治,右寸脉平脱,此土不能生金,生
气绝于内矣,辞不治。经云∶虚则补其母,实则泻其子。凡病在子,当补其母,况病在母而属
不足,反泻其子,不死何俟?
辛丑年,余在嘉兴屠渐山第,有林二守,不时昏愦,请余治之,谵语不绝,脉洪大,按之如无,
此阳虚之症也,当用参附汤治之。有原医者扬喜而迎曰∶先得我心之同然,遂服之,即静睡
觉而进食,午后再剂,神思如故,其脉顿敛。余返后,又诈云用附子多矣,吾以黄连解之,
阴仍用参附汤。窃观仲景先生治伤寒,云∶桂枝下咽,阳盛乃毙;硝黄入胃,阴盛乃亡。不辨
而自明矣。吾恐前言致误患者,故表而出之。
廷评张汝翰,胸膈部感觉痞塞胀满,饮食难以消化,服用枳术丸后,时间久了身体消瘦,出现发热、口干的症状,脉象浮大而微弱。使用补中益气汤加入生姜、肉桂,所有症状全部消退。只见到脾胃虚寒的表现,于是用八味丸来补益命门之火,不到一个月食欲增进,三个月后身体恢复丰满。这个病症如果不用前面的方剂治疗,很容易转变为腹胀、气喘急促、腿脚浮肿、小便淋漓不尽等症状,此时紧急使用济生加减肾气丸,也有能救活的。
一位读书人,虽然在盛夏时节也喜欢点燃火盆,四肢常常想要用沸水浸泡,面色发红并吐痰,看起来像是实火,呕吐严重时连宿食也一起吐出,只有食用花椒、生姜等辛辣食物才感到舒适。我认为这是“食入反出”,属于脾胃虚寒,使用八味丸及十全大补汤加入炮姜,逐渐痊愈,不到一个月就康复了。
一位妇人,每顿饭吃不到一碗,如果不是大便不成形,就是吞酸、嗳气带有腐臭味,或者使用二陈汤、黄连,反而加重内热并引发呕吐。我说:东垣先生曾说,“邪热不杀谷”,这是脾胃虚弱,最终传变为寒证。用六君子汤加入炮姜、木香,几剂药后胃气逐渐恢复,饮食慢慢增加。又用补中益气汤加入炮姜、木香、茯苓、半夏,几剂药后痊愈。后来因为发怒导致饮食突然减少,元气突然衰弱,更加发热,确实像实火,但脉象洪大却空虚,两尺脉如同没有一样,使用益气汤和八味丸两个月,所有症状全部痊愈。
朱佐说:以前因为失足,听到咔嚓一声响,坐立久了左足就会麻木,即使在夏天脚也像冰一样冷。嘉靖己亥年夏天,因为喝醉睡觉时喝了水,再次睡去,就觉得右腹部痞结,用手抚摸,腹间有沥漉的水声,用手热敷则气泄而停止,每每加剧,饮食稍多就会腹痛腹泻,求治于医生,让服用枳术丸固守治疗,没有效果。甲辰年,求治于立斋先生(薛己),诊脉后,叹息道:这不是脾胃病,而是命门火衰不能生土,土虚寒所致,如果专门主治脾胃,就错了,可以服用八味丸就能痊愈。我也非常佩服,果然验证有效。因为八味丸中含有附子,医生们都不敢轻易使用,其实附子具有斩关夺旗、回生起死的力量,不是良将不能用,立斋先生是当今的诸葛亮啊。家里贫穷无法报答恩德,所以写下这篇文章记录治疗验证。嘉靖甲辰十二月望后二日,杉墩介庵朱佐叩首拜书。
光禄邝子泾,面色苍白,精神疲惫,吃得少且难消化,所服用的都是二陈汤、山栀、枳实之类的药物,身体日渐消瘦,饮食日渐减少。我认为这是脾土虚寒的病症,治法应当补益脾土之母(即补肾)。他不相信,直接补土,以致病情恶化死亡。
罗工部,仲夏时节腹部怕冷而体表怕热,鼻子吸气时腹部觉得冷,身体畏风且怕冷,脉象大而虚微,每次进热粥约一碗,必须同时吃生姜约一碗,离开热源进食,腹内立刻变冷。我说:加热后仍不热,是没有火,应当用八味丸壮火之源,以消除阴寒之邪。他却反而服用四物汤、玄参之类的药物而死。
工部陈禅亭,发热且有痰,服用二陈汤、黄连、枳壳之类的药物,病情更加严重,甲辰年冬季请我治疗,其脉象左尺微细,右关浮大,重按微弱。我说:这是命门火衰,不能生土而导致脾病,应当补火以生土,或许可以痊愈。他不醒悟,仍然服用前药,脾土更加虚弱,到了乙巳年闰正月,病情已危重。再次邀请治疗,右寸脉平脱,这是土不能生金,生气在内断绝了,推辞不治。经云:虚则补其母,实则泻其子。凡是病在子脏,应当补其母脏,何况病在母脏且属于不足,反而泻其子脏,不死还等什么?
辛丑年,我在嘉兴屠渐山府第,有一位林二守,不时昏愦,请我治疗,胡言乱语不停,脉象洪大,按之如无,这是阳虚的病症,应当用参附汤治疗。原来的医生高兴地说:正合我意,于是服用此药,立即安静睡觉醒来后进食,午后再服一剂,神思如常,脉象顿时收敛。我回去后,他又谎称用了太多附子,我用黄连来解它,暗中还是用参附汤。私下观察仲景先生治疗伤寒时说:桂枝汤下咽,阳盛者乃毙;硝黄入胃,阴盛者乃亡。不辨证候而自行用药的错误是不言自明的。我恐怕前面的言论误导患者,所以公开陈述出来。
Zhang Ruhán, a Tingping (Court Reviewer), experienced epigastric and chest fullness (pi) and difficulty digesting food. After taking Zhizhu Wan (Bitter Orange and Atractylodes Macrocephala Pill) for a long time, he became emaciated, developed fever and dry mouth, with a floating, large yet slightly weak pulse. Using Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) added with Shengjiang (Fresh Ginger Rhizome) and Guizhi (Cinnamon Twig), all symptoms subsided. Only signs of Spleen-Stomach deficiency-cold remained, so Bawei Wan (Eight-Ingredient Pill) was used to tonify Mingmen Fire (Fire of the Gate of Life). Within a month, appetite improved, and within three months, his physique recovered. If this condition had not been treated with the aforementioned formula, it would likely have progressed to abdominal distension, panting and shortness of breath, edema of the legs and feet, and dribbling urination. In such emergencies, Jisheng Jiajian Shenqi Wan (Modified Kidney Qi Pill from the Jisheng Fang) could also save lives.
A scholar preferred to keep fires burning even in midsummer, often wishing to soak his limbs in boiling water. His face was red, and he expectorated phlegm, resembling excess heat. Severe vomiting expelled old food residues; only eating spicy foods like Sichuan pepper and ginger brought relief. I reasoned that "vomiting after eating" indicates Spleen-Stomach deficiency-cold. He gradually recovered using Bawei Wan (Eight-Ingredient Pill) and Shiquan Dabu Tang (Decoction for Complete Great Tonification) added with Paojiang (Prepared Ginger Rhizome), returning to health within a month.
A female patient ate less than one bowl per meal. She either suffered from loose stools or acid regurgitation and belching with a putrid odor. When treated with Erchen Tang (Two-Aged Decoction) or Huanglian (Coptis Rhizome), her internal heat worsened, leading to vomiting. I stated: As Master Dongyuan said, "pathogenic heat fails to digest grain." This is Spleen-Stomach weakness progressing to cold transformation. Several doses of Liujunzi Tang (Six-Gentlemen Decoction) added with Paojiang (Prepared Ginger Rhizome) and Muxiang (Vladimiria Root) gradually restored Stomach Qi and dietary intake. Subsequently, Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) added with Paojiang (Prepared Ginger Rhizome), Muxiang (Vladimiria Root), Fuling (Poria), and Banxia (Pinellia Tuber) cured her. Later, due to anger, her diet suddenly decreased, Yuanqi (Primal Qi) weakened, and fever intensified, resembling excess heat. However, the pulse was large and empty, with the two Chi pulses (Kidney pulses) feeling non-existent. Using Yiqi Tang (Qi-Supplementing Decoction) and Bawei Wan (Eight-Ingredient Pill) for two months, all symptoms resolved.
Zhu Zuo stated: Previously, due to a fall, I heard a cracking sound. Sitting or standing for long periods caused numbness in my left foot, which felt ice-cold even in summer. In the summer of the Ji-Hai year of Jiajing, after drinking water while drunk and asleep, I fell back asleep and felt a knot in my right abdomen. Massaging it produced gurgling sounds; applying heat relieved the gas but stopped the pain temporarily, though it aggravated repeatedly. Eating slightly more caused abdominal pain and diarrhea. Doctors prescribed Zhizhu Wan (Bitter Orange and Atractylodes Macrocephala Pill) without effect. In the Jia-Chen year, I sought treatment from Mr. Lizhai (Xue Ji). After diagnosis, he sighed and said: "This is not a Spleen-Stomach disease, but Mingmen Fire (Fire of the Gate of Life) decline failing to generate Earth (Spleen/Stomach), causing Earth deficiency and cold. Focusing solely on the Spleen-Stomach is a mistake. Taking Bawei Wan (Eight-Ingredient Pill) will cure you." I admired him greatly, and it proved effective. Since Bawei Wan (Eight-Ingredient Pill) contains Fuzi (Aconite Lateral Root), physicians dare not use it lightly. Indeed, Fuzi (Aconite Lateral Root) breaks through barriers and restores life, usable only by a capable general. Mr. Lizhai is the Zhuge Liang of our time. Being poor, I cannot repay his virtue, so I record this case. On the second day after the full moon in the twelfth month of the Jia-Chen year of Jiajing, Zhu Zuo of Shadun, style name Jian'an, bowed and wrote.
Kuang Zijing, a Guanglu (Director of Imperial Sacrifices), had a pale complexion and fatigued spirit, with poor appetite and indigestion. He took Erchen Tang (Two-Aged Decoction), Zhizi (Gardenia Fruit), Zhishi (Immature Bitter Orange), etc., becoming increasingly emaciated and eating less. I considered this Spleen-Earth deficiency-cold, indicating the need to tonify the Mother of Earth (Kidney). Disbelieving me, he directly tonified the Earth, leading to his death.
Luo Gongbu (Ministry of Works Official) felt cold in the abdomen but hot on the exterior in midsummer. Inhaling through the nose made his abdomen feel cold; fearing wind and cold, his pulse was large, deficient, and slight. Each bowl of hot porridge required a bowl of ginger slices; away from heat sources, his abdomen felt cold immediately. I said: "Heating does not produce warmth, indicating lack of Fire. Use Bawei Wan (Eight-Ingredient Pill) to strengthen the source of Fire to dissipate Yin shadows." Instead, he took Siwu Tang (Four-Substance Decoction) and Xuanshen (Scrophularia Root) and died.
Chen Chanting, an official in the Ministry of Works, had fever and phlegm. Taking Erchen Tang (Two-Aged Decoction), Huanglian (Coptis Rhizome), and Zhiqiao (Aurantium Fructus) worsened his condition. In late winter of the Jia-Chen year, I treated him. His Left Chi pulse was faint and fine, Right Guan pulse floating and large, but weak upon heavy pressure. I said: "Mingmen Fire (Fire of the Gate of Life) decline fails to generate Earth, causing Spleen disease. Tonifying Fire to generate Earth may cure it." Unaware, he continued previous medications, weakening Spleen-Earth further. By the intercalary first month of Yi-Si year, his illness became critical. Upon re-examination, the Right Cun pulse was flat and detached, indicating Earth failing to generate Metal, with vital Qi severed internally. I declined treatment. The Classic states: "Deficiency tonifies its mother, excess drains its son." When disease is in the Son organ, tonify the Mother. How much more so when the Mother organ is deficient? Draining the Son instead leads inevitably to death.
In the Xin-Chou year, at the residence of Tu Jianshan in Jiaxing, Lin Eryshou suffered intermittent confusion and incessant delirious speech. His pulse was large and floating but empty upon pressure, indicating Yang deficiency. I recommended Shenfu Tang (Ginseng and Aconite Decoction). The original physician happily agreed, saying it matched his thoughts. The patient took it, slept quietly, woke up, ate, and after a second dose at noon, his mental state returned to normal, and his pulse converged. Upon my return, the physician falsely claimed he had used too much Fuzi (Aconite Lateral Root) and used Huanglian (Coptis Rhizome) to counteract it, while secretly continuing Shenfu Tang (Ginseng and Aconite Decoction). Observing Zhang Zhongjing’s treatment of Shanghan (Cold Damage): "If Guizhi Tang (Cinnamon Twig Decoction) is taken when Yang is excessive, death ensues; if Xiaoshi and Dahuang enter the stomach when Yin is excessive, death ensues." The error of treating without differentiation is self-evident. Fearing these words might mislead patients, I publicly expose them.