缩砂、益母之类，而辛温之剂，又宜切忌矣，百病皆然，岂止胎门如是！盖极寒极
热，极补极攻之药，用之得当，俱可救矣。用之一误，俱可杀人。但假热假实之症，误
投寒凉攻削，则杀人立见，莫可挽回。假寒假虚之症，误投辛温补益，则惟增热燥烦
闷，不至于死，更以凉解，即见其效也。故古哲有不足之法治有余，则可以有余之法治
不足，断不可之谓，良有以也。
大兴县张公有令亲，久痢甚危，一日昏晕数次，来延余视，诊其六脉俱微，余立方
以参芩、归芍、白术、肉桂、五味之类，傍医以其积气未尽，恐加补益，则补住积气为
论，余曰∶吾闻壮人无积，未闻壮而反滞也。若欲迟迟而后补，今每日昏晕数次，恐
迟迟欲补，已无受补之人矣。张公笑而诺之，二三剂后，精神强而痢疾亦愈。
铨部谈老先生，候选而病于贵老师许御史寓，病热数日，神困脉微，乃劳伤发热也。
一医以为伤寒，投以发散，禁其饮食，日甚危笃，来招余视，按其脉弦窠无力，非伤寒也。
乃先以浓粥汤半碗进之，先生曰∶香美甚甘，饮后目亦顿觉清亮，然许老先生勿知也。余
急归寓，私以归脾汤进服，令薄粥以继之，三四日后，神气顿复，嗟嗟！世间头疼发热，便
为伤寒，而克削饿死者，不知其几矣。
副总韩老夫人，患疟甚重，壮热无汗，六脉洪大而空，余曰∶汗生于阴，肾主五
液，今六脉有阳无阴，岂可更杆，以促其孤阳亡越乎？余以八味加牛膝、五味子，每剂
纳熟地二两，煎碗余，浩饮之，滋水即所以发汗也。果大汗而愈，后以十全大补汤去川
芎、甘草，加枣仁、五味子，以生地换熟地，调理数剂，而精神大长。
养心育脾和肝清肺滋肾补荣益卫膏滋丸方按
凡五脏之精华，输归于肾，故《经》曰∶五脏盛，乃能泻，是以五脏各有精，随
所用而灌注于肾，肾不过为聚会关司之所，当其接内，则三焦内外上下之火，翕然下
从，百体玄府，悉开其滋生之精，尽会于阴气而跃出，岂止肾所藏而已哉！然精生于
血，血少精何以生？夫心主血，故曰∶无子责乎心，发白责乎肾，是以重嗣育者，不独
补肾，犹宜养心，不但养心，更宜调和五脏，使五脏精气常盛，而肾家之充溢裕如
也，设四脏燥槁不荣，将何物以输归于肾，故心属火而配离，离者阴也。心中之水，乃
真水也。肾属水而配坎，坎者阳也。肾中之火，乃真火也。心者互为其根，阴阳互为其
用，既济之道一得，氤氲之气方凝，胚胎之象成矣。今老先生右尺重按无力，是命门真
阳既已不足，左尺不沉不石，是天一真水复已空虚，八味之水火并补，对证必需之药，
何阴亏已极，宜另以熟地斤余熬膏八两，代蜜为丸，空心吞服。书云∶久服令人肥健多
子，信非虚语，但心阴亦甚不足，而肝荣中气，并未有余，肾将何以输纳，以充其用
哉！晚间食远，再为养荣益卫，五脏并滋，一补先天之不足，一助后天之发生，将见气
血日长，螽斯衍庆自可必也。陈方于下。
嫩黄 ，同人参补气以为君，使阴从阳长，令无形生出有形，四两，蜜水拌炒；当
归身，养血宜血，使荣分调和，从气生发以为臣，三两，酒拌炒；酸枣仁，赤色象离，
香气入脾，酸性入肝，故能宁心益肝，兼养脾土，当归共剂，则当归养三脏之血，而枣
仁益三脏之气，用以为臣，五两，炒熟，临煎捣碎；熟地黄，重浊象地，甘温养阴，既
滋天一真水，复润诸经燥槁，且同白术共剂，则白术补脾元中气，以存土德之燥性，
熟地滋脾阴，柔润以助土德之化育，一燥一润，土得为万物之母亦以为臣，六两，铜刀
切片；鸡腿白术，馨香和平，得天地之正气，甘温气雄，补脾元之中气，书赞术云∶
味重金浆，芳逾玉液，百邪外御，六腑内充，察草术之胜，速益于已者，并不及术之
多功也。更欲其润，以乳拌之，且与熟地、
白芍共剂，则熟地既专功壮水，复滋脾土矣。白术专补脾家之阳，白芍专补脾家之
阴，使土强而不燥，则湿润化育之功可得矣。用以为臣，四两，人乳拌透，晒干，炒
黄；远志肉，抱心而色黄，故能宁养心神，因生脾土，味辣而兼淡，故能祛逐浊阴，真
精乃生，辛散以涎，使心舍虚灵不昧，下济肾气，使真精藏固无遗，用以共剂心、肾、
脾三经之药，彼此互效成功，故用以为佐，二两，先用甘草煎取浓汁，去甘草入远志在
内，煮去辣水，晒干用；制麦冬，肾为先天，脾为后天，故脾肾两经并宜，相须补益
矣。然虚则补其母，母强得以生子也。虚则补其子，子虚恐窃母气也。且水亏金愈燥，
金一燥而水愈亏，子母失，相生相顾之义矣。故同熟地、白术共剂，则上可以承母气
而不窃，下可以生子气而有余，但性略寒润，不能脾肺两兼，故用老米拌炒，去其弊
而存其功，两经俱受其益矣。亦用之以为佐，三两，用炒黄老米同炒燥，去米；白芍
药，甘寒入脾，酸敛入肝，既佐当归以和肝荣，复佐白术以养脾阴，赞助之功，得力补
益之势益彰，用以为佐，二两四钱，蜜酒拌炒；杜仲，前药既已大补营卫于中矣。然气
血既充于里，可不令其营运经络，使其筋骨强健乎？且五脏既盛，可不令其输归于肾
乎？故用杜仲，且能营运补益筋骨之间，复能接引诸药，深达至阴之所，且同续断更能
调和补续于骨节之际，则身体轻强必矣。三两，酒拌炒；续断，熟地专补肾精，杜仲专
补肾气，且调补于筋骨之间，续断专调理于骨节之内，相须并用，骨节经络之间，并受
其益，用以为使，三两，酒拌炒；明牛膝，引诸药强壮下元，且使浊阴下降，则清阳自
能上升，但恐走下太速，酒蒸缓之，故用以为使，三两，酒拌蒸，晒干，焙；莲子，清
心而补心，健脾而固肾，煎汤和剂，则诸药功效更臻。
上用莲子二斤，去心、衣，清水煎汁，三十余碗，去莲肉，入前药，煎取头二汁，
滤去渣，熬浓膏，收入后三味，为细丸。
拣人参，峻补元神，功力既大，不寒不热，性味平和，故扶危救绝，诚能挽功于顷
刻，而补虚益损，更能久服于常时，可阴可阳、随用俱捷，可寒可热，凭佐异功，今用
以为君，和黄 培元于表裹，和归、术补益于阴阳，协枣仁以宁心，同熟地而滋肾，所
向皆宜，五脏并益，五两，研极细末；白茯苓、茯神，苓、神共享，取苓之淡渗，佐白
术以育脾，神能固守，佐枣仁以宁心，木一性二功用便殊，并为佐，各三两，研极细
末。三味共研极细末，和前膏为丸，临睡白汤送下四钱，或大丸细嚼津液送下，或白汤
化服均可。
左春坊胡老先生，年将六旬，抱病几月有余，药石寒热，攻补杂进，而症亦为药所
变幻，虚虚实实之间，几莫能辩。招余延医，按其脉六脉洪大有力，似非阳虚也。却
乃时当暑月，汗出恶风，凡饮食如故，精神日疲，痰多鼻塞，半年以来，糊涂过日，余
曰∶此阴亏不能敛阳，以致阳浮阴散，清浊不分，邪火消谷，生痰不生血，理宜仅为养
阴，则阳有所根据，投以六味，加盐水煮橘红、麦冬、五味子服之，不三剂而精神清
爽。适余回南，先生嘱之曰∶沉 十月，三剂回春，但余尚未有子，望定丸方可得子者
惠之，感更不朽。余曰∶纯阳之脉，投以纯阴，阴阳既和，生子可必，只须六味丸加麦
冬、五味足已。先生视为平常而置之，后半月精神复疲，乃照方煎丸并进，精神复旺，
且房事渐觉有力，乃异而珍重服之，至三月余而如夫人已受娠矣。无如其宠受娠之后，
觉得口淡异常，五味遍投，莫之能解，胸中烦乱之状，莫可言喻，适余次年之都，复招
延医。余曰∶左尺有神，但两寸右关太洪，此精华下阴，惟宜养阴济之，当无害也。无
如举医谋视者，接踵而至，有以为癖血凝滞者，俱议疏通，余力阻之，渐至五月有余，
怀虽稍长，按之甚软，且倏左倏右，腰间带动，当腹毫无影响，如夫人亦以为断非胎
气，遍请诸医，惧云痞癖之类，复欲攻下，余复力阻之，至九十月间，腹虽更长，然其
候其状仍如故也。诸医皆以为鬼胎怪胎，必欲攻削去之，余复再三力阻，延挨数日之
后，一日肚腹不疼，而忽欲产矣。先生招而怨之曰∶肚痛生产，此其常也。今不疼而
产，一怪也。且左腰一动，右腰亦然，中间毫无动静，二怪也。且至今尚能覆卧，肚大
而软，按之毫无形迹，口淡异常，三怪也。有此三怪，不听群谋而去之，致有今日之患
生，势必母命难保，皆先生之赐也。余曰∶余但知其脉不知其他，况果熟香飘，瓜熟蒂
落。熟极而下，不疼而产，此亦常也。躯脂丰溢，胞水有余，故当脐不显两腰跳动，非
胎而何？日生之精，下阴胎气，胃无真津，故觉口淡，何足怪焉！正争论间，群仆妇争
前出而告之曰∶果生一相公矣，当无怨也。先生跪而谢之曰∶起我沉 ，身受益矣。保
我后嗣，泽及先矣。
总宪蒋老先生之八令孙，当五月而出痘，痘不甚密，但禀赋先天真阴真阳两虚，
体肉 白，当此天令，阳气浮表，壮热溃汗不止，四五朝来，痘反退缩平陷，昏睡惊
惕，余曰∶壮热者，阳在外也，溃汗者阴外泄而阳愈竭也。若不敛纳真阴真阳，何以为
鼎竣成形，及将来滋润充灌之用？况孤阳而不重滋阴分，何以敛其浮越？滋阴而不兼补
阳，何以导其归源？但真阴真阳既亏，而中气之久虚，不言可知，若不托住中气，即药
力亦难营运，精神何能归复？但浮越之虚阳，必仗酸敛之功以收之，则真火如天与日
之力益壮，其为阴翳血肉之痘疮，不发而自起，不攻而自溃，或以酸敛为疑。乃陈此理
而竟服之，不超时熟睡身凉，汗收神爽，痘起思食而愈，其方熟地八钱、鸡腿白术乳拌
炒黄三钱、牛膝二钱、麦冬去心炒燥二钱、五味子四分，上肉桂去尽粗皮六分，水煎一
钟食前温服。盖内有肉桂得五味一敛，则桂走血达表之力益大，何虑阴翳之毒不起发
乎！
宝坻赵太先生，年七十二岁，抱病两月余，诸医不能疗，且不能识，乃延余视，其
病右颊肿硬，连及颐项耳后，一片坚实，不热不疼，医治七十余日。凡解毒攻托，敷贴
熏洗总无一效，渐至口内出脓，牙噤不开，饮食少进，精神日衰，脉则洪大而空，余知
为气血大衰，阴寒所聚，书即所谓石疽是也。不得阳和，何能外解？内溃日久，穿喉
破颊，莫可疗矣。况书云∶老人气血衰者不治，乃用猪脂捣烂，入肉桂细末，葱头食盐
杵匀，浓敷患处，使脂膏以治血肉，不无同气，易于相应，葱能透窍，盐能软坚，桂能
松动血分，油能浸润皮肤，内则空心生脉饮，送服八味丸，食远，以参 归芍、苓术
薄桂、金银花角刺之类，使真阳一得，阴寒自解，气血充和，自能逐毒。如是调理三五
日，冰硬者热软，漫肿者高耸，木者疼痛，紫者红活，饮食日进，气血渐长，驱毒外
出，久凝久瘀之血肉，无可容地，消者消，肿者肿，脓者脓，不再旬而痊愈。可见诸病
全以水火为根，气血为用，而脓肿之成，舍水火气血，将何以为攻托酿脓之具，成实收
功之用哉！
宝抵中堂杜老先生六公郎，年十九，夏月病笃，来请余治，按其脉有时洪弦而尺
弱，有时弦细而尺紧，乍寒乍热，两耳之下甚肿而疼，足亦微肿，语言无力，饮食入口
即吐，若静卧则吐势少减，如少运动，则呕哕便来。询其得病之由，因暑天偶雨冰雹，
骇而出视，背上受寒，随即发散不效，次用和解复不效，继用清热之剂，内有黄芩、山
栀者，服后即吐，恶心呕吐之端，从此而始，莫可御矣。余始知为药之误也。盖暑天
而能感寒，则中表之气不固可知，况中堂六十一岁所生之公郎，先天禀弱之薄可知，膏
梁娇养之子弟，腠里筋骨之柔脆可知，只宜
温中调理，纵有感寒而自散矣。况书曰∶风则散之，寒则温之，以风伤卫而在表，寒伤
荣而在里，今不用温中而用发散，则于感寒无益，从令中气益虚，寒郁火升，乘于空虚
之地，乃两耳之下渐肿及颊，误为实火，济之寒凉，釜下之火既浮，中宫之阳复损，尚
堪延纳饮食乎！书曰∶凡自阴经受寒，即真阴症，非从阳经传来，便宜温之，不可少
缓。又曰∶内伤多，外感少，只须温补，不必发散。又曰∶正气得力，自能推出寒邪。
如此等语，皆治虚症受寒之要法，奈何未之用而及此也。以今日之病而论之，即所谓新
病唤出旧邪，标病而打动本病，理当用上病疗下之法，况欲温以散寒，则无寒可散，欲
温中开胃，则耳颊之肿痛为碍，欲滋阴以培本，则中脘之道路壅塞，计惟有峻补真阳，
以达于下，重滋真阴，以继其中用八味加牛膝、麦冬、五味作大剂，冲入人参浓汁，以
助宣壅之势，连进二剂，无如服后，少顷即吐。凡即米饮均不能受，何况异味之药饵
乎！要知寒凉伤中极矣。无如病势虚极，不能久待，乃连夜以人参、炮姜、附子为末，
砂仁、益母草这类药物，以及辛温性质的药剂，都应当极力避免使用。所有疾病都是如此，岂止是妊娠期间才这样！极寒、极热、大补、峻攻的药物，如果使用得当，都可以救人；如果使用错误，都会致人死亡。但是，对于假热、假实的病症，如果误用寒凉攻下的药物，就会立刻致死，无法挽回。对于假寒、假虚的病症，如果误用辛温补益的药物，只会增加燥热烦闷的症状，如果不致死，再用清凉解表的方法，就能见效。所以古代哲人认为，用治疗不足的法治有余之症，或者用治疗有余之法治不足之症，都是不可取的，这确实是有道理的。
大兴县张公有位亲戚，患痢疾很久且病情危重，一天内昏晕多次，请我去诊治。我诊察他的六脉都微弱，于是开具包含人参、黄芩、当归、白芍、白术、肉桂、五味子等药物的方剂。旁边的医生认为他体内的积滞之气未尽，担心加入补益药会把积气“补住”，因此提出反对。我说：“我听说壮年人不易有积滞，没听说过身体强壮反而导致气机阻滞的。如果想慢慢来再进补，如今他每天昏晕多次，恐怕等到想补的时候，已经没有能够接受补益的身体条件了。”张先生笑着答应了。服用两三剂后，他的精神好转，痢疾也痊愈了。
铨部（吏部官员）谈老先生，在候补期间住在许御史寓所时生病，发热数日，神志困倦，脉搏微弱，这是劳伤引起的发热。一位医生认为是伤寒，投以发散药物，并禁止其饮食，导致病情日益危重，便来请我去诊治。我按摸他的脉象，弦而无力，这不是伤寒。我先让他喝半碗浓米汤，先生说：“味道非常香甜甘美，喝完后眼睛顿时觉得清亮，但请不要让许老先生知道。”我急忙回到住处，私下给他服用归脾汤，并嘱咐用稀粥接续调养。三四天后，他的神气完全恢复。唉！世间很多人一出现头痛发热就认为是伤寒，因为过度克伐和饥饿而死的人，不知有多少啊。
副总韩老夫人，患疟疾非常严重，高热无汗，六脉洪大但中空。我说：“汗液生于阴液，肾主五液。现在六脉只有阳象而没有阴象，怎么可以再发汗，从而加速孤阳亡脱呢？”我用八味地黄丸加牛膝、五味子，每剂加入熟地黄二两，煎取一碗多，让她大口喝下。滋润肾水即是为了发汗。果然大汗出而病愈，后来用十全大补汤去掉川芎、甘草，加入酸枣仁、五味子，用生地黄替换熟地黄，调理几剂后，精神大大恢复。
养心、育脾、和肝、清肺、滋肾、补荣、益卫膏滋丸方：
凡是五脏的精华，都输归于肾，所以《内经》说：“五脏精气充盛，才能向外疏泄。”因此五脏各有精气，随着所需灌注于肾，肾不过是聚会和管理的场所。当进行房事时，三焦内外上下的火气，会突然向下顺从，全身毛孔（玄府）全部打开，释放出滋生的精气，全部汇聚于阴气中跃出，难道仅仅是肾所藏的吗？然而精生于血，血少精怎么能产生？心主血，所以说：“求子要责之于心，头发早白要责之于肾。”因此重视生育的人，不仅补肾，还宜养心；不但养心，更宜调和五脏，使五脏精气常盛，肾家自然充盈裕如。如果其他四脏干枯不荣，拿什么物质输归于肾呢？所以心属火而配离卦，离卦中蕴含阴质；心中的水，是真水。肾属水而配坎卦，坎卦中蕴含阳质；肾中的火，是真火。心肾互为其根，阴阳互为其用，既济之道一旦掌握，氤氲之气才会凝聚，胚胎之象才能形成。现在老先生右尺脉重按无力，说明命门真阳已经不足；左尺脉不沉不实，说明天一真水也已经空虚。八味地黄丸水火并补，是对证必需的药物。但是阴亏已至极点，应该另外用熟地黄一斤多熬成膏八两，代替蜂蜜制成丸药，空腹吞服。书云：“久服使人肥健多子”，确实不是虚言。但是心阴也非常不足，肝血和中气也没有盈余，肾怎么能够输纳以充其用呢？所以在晚间饭后，再服用养荣益卫、五脏并滋的药，一补先天之不足，一助后天之生化，将会见到气血日渐增长，子孙繁衍庆贺自可必然。陈方如下。
嫩黄芪，同人参补气作为君药，使阴随阳长，令无形生出有形，用量四两，用蜜水拌炒；当归身，养血活血，使营分调和，从气生发作为臣药，用量三两，用酒拌炒；酸枣仁，赤色像离卦，香气入脾，酸性入肝，所以能宁心安神、益肝，兼养脾土，与当归共同制剂，则当归滋养三脏之血，而枣仁增益三脏之气，用作臣药，用量五两，炒熟，临煎捣碎；熟地黄，重浊像地，甘温养阴，既滋天一真水，又润诸经燥枯，且同白术共同制剂，则白术补脾元中气，以保存土德的燥性，熟地滋脾阴，柔润以助土德的化育，一燥一润，土成为万物之母，也用作臣药，用量六两，用铜刀切片；鸡腿白术，馨香和平，得天地正气，甘温气雄，补脾元中气。书赞白术说：“味重金浆，芳逾玉液，百邪外御，六腑内充”，考察草木的功效，速益于己者，都不及白术的多功。更希望它滋润，用乳汁拌透，晒干，炒黄；且与熟地、白芍共同制剂，则熟地既专功壮水，又滋脾土。白术专补脾家之阳，白芍专补脾家之阴，使土强而不燥，则湿润化育之功可得。用作臣药，用量四两，人乳拌透，晒干，炒黄；远志肉，抱心而色黄，所以能宁养心神，因生脾土，味辣而兼淡，所以能祛逐浊阴，真精乃生，辛散以涎，使心舍虚灵不昧，下济肾气，使真精藏固无遗，用来共同制剂心、肾、脾三经的药物，彼此互效成功，所以用作佐药，用量二两，先用甘草煎取浓汁，去甘草放入远志在内，煮去辣水，晒干用；制麦冬，肾为先天，脾为后天，所以脾肾两经都适宜，相互补充。然而虚则补其母，母强得以生子；虚则补其子，子虚恐窃母气。且水亏金愈燥，金一燥而水愈亏，子母失序，失去相生相顾之义。所以同熟地、白术共同制剂，则上可以承母气而不窃，下可以生子气而有余。但麦冬性略寒润，不能兼顾脾肺两经，所以用老米拌炒，去其弊而存其功，两经俱受其益。也用作佐药，用量三两，用炒黄的老米同炒燥，去米；白芍药，甘寒入脾，酸敛入肝，既佐当归以和肝营，复佐白术以养脾阴，赞助之功，得力补益之势益彰，用作佐药，用量二两四钱，蜜酒拌炒；杜仲，前面的药已经大补营卫于中。然而气血既然充于里，可不令其营运经络，使其筋骨强健吗？且五脏既盛，可不令其输归于肾吗？所以用杜仲，且能营运补益筋骨之间，复能接引诸药，深达至阴之所，且同续断更能调和补续于骨节之际，则身体轻强必矣。用量三两，酒拌炒；续断，熟地专补肾精，杜仲专补肾气，且调补于筋骨之间，续断专调理于骨节之内，相互并用，骨节经络之间，并受其益，用作使药，用量三两，酒拌炒；明牛膝，引诸药强壮下元，且使浊阴下降，则清阳自能上升，但恐走下太速，酒蒸缓之，故用作使药，用量三两，酒蒸，晒干，焙；莲子，清心而补心，健脾而固肾，煎汤和剂，则诸药功效更臻完美。
上面用莲子二斤，去心、衣，清水煎汁三十余碗，去莲肉，入前药，煎取头二汁，滤去渣，熬浓膏，收入后三味，为细丸。
拣选人参，峻补元神，功力既大，不寒不热，性味平和，所以扶危救绝，诚能挽功于顷刻，而补虚益损，更能久服于常时，可阴可阳、随用俱捷，可寒可热，凭佐异功。今用作君药，和黄耆培元于表里，和归、术补益于阴阳，协枣仁以宁心，同熟地而滋肾，所向皆宜，五脏并益。用量五两，研极细末；白茯苓、茯神，苓、神共享，取苓之淡渗，佐白术以育脾，神能固守，佐枣仁以宁心。木一性二功用便殊，并为佐药，各三两，研极细末。三味共研极细末，和前膏为丸，临睡白开水送下四钱，或大丸细嚼津液送下，或白开水化服均可。
左春坊胡老先生，年将六十，抱病几个月有余，药石寒热，攻补杂进，而症状也为药物所变幻，虚虚实实之间，几乎难以分辨。请我去诊治，按摸他的脉象六脉洪大有力，似乎不是阳虚。却正值暑月，汗出恶风，凡饮食如故，精神日疲，痰多鼻塞，半年以来，糊涂度日。我说：“这是阴亏不能敛阳，以致阳浮阴散，清浊不分，邪火消谷，生痰不生血，理应仅为养阴，则阳有所根据。”投以六味地黄丸，加盐水煮橘红、麦冬、五味子服用，不到三剂而精神清爽。适逢我回南方，先生嘱托我说：“深秋十月，三剂回春，但我尚未有子，望定丸方可得子的惠赐，感激更不朽。”我说：“纯阳之脉，投以纯阴，阴阳既和，生子可必，只须六味丸加麦冬、五味足已。”先生视为平常而置之不理，后半月精神复疲，乃照方煎丸并进，精神复旺，且房事渐觉有力，乃诧异而珍重服用，至三月余而妾室已受孕。无奈其宠妾受孕之后，觉得口淡异常，五味遍投，莫之能解，胸中烦乱之状，莫可言喻。适逢我次年去京城，复招延医。我说：“左尺有神，但两寸右关太洪，此精华下陷，惟宜养阴济之，当无害也。”无奈举医谋视者，接踵而至，有以为癖血凝滞者，俱议疏通，我极力阻止，渐至五月有余，怀虽稍长，按之甚软，且倏左倏右，腰间带动，当腹毫无影响，如夫人亦以为断非胎气，遍请诸医，惧云痞癖之类，复欲攻下，我复力阻之，至九十月间，腹虽更长，然其候其状仍如故也。诸医皆以为鬼胎怪胎，必欲攻削去之，我复再三力阻，延挨数日之后，一日肚腹不疼，而忽欲产矣。先生招而怨之曰：“肚痛生产，此其常也。今不疼而产，一怪也。且左腰一动，右腰亦然，中间毫无动静，二怪也。且至今尚能覆卧，肚大而软，按之毫无形迹，口淡异常，三怪也。有此三怪，不听群谋而去之，致有今日之患生，势必母命难保，皆先生之赐也。”我说：“我但知其脉不知其他，况果熟香飘，瓜熟蒂落。熟极而下，不疼而产，此亦常也。躯脂丰溢，胞水有余，故当脐不显两腰跳动，非胎而何？日生之精，下阴胎气，胃无真津，故觉口淡，何足怪焉！”正争论间，群仆妇争前出而告之曰：“果生一相公矣，当无怨也。”先生跪而谢之曰：“起我沉疴，身受益矣。保我后嗣，泽及先矣。”
总宪蒋老先生之第八个孙子，当五月而出痘，痘不甚密，但禀赋先天真阴真阳两虚，体肉苍白，当此天令，阳气浮表，壮热溃汗不止，四五朝来，痘反退缩平陷，昏睡惊惕。我说：“壮热者，阳在外也，溃汗者阴外泄而阳愈竭也。若不敛纳真阴真阳，何以为鼎炉成形，及将来滋润充灌之用？况孤阳而不重滋阴分，何以敛其浮越？滋阴而不兼补阳，何以导其归源？但真阴真阳既亏，而中气之久虚，不言可知，若不托住中气，即药力亦难营运，精神何能归复？但浮越之虚阳，必仗酸敛之功以收之，则真火如天与日之力益壮，其为阴翳血肉之痘疮，不发而自起，不攻而自溃，或以酸敛为疑。乃陈此理而竟服之，不超时熟睡身凉，汗收神爽，痘起思食而愈。”其方：熟地八钱、鸡腿白术乳拌炒黄三钱、牛膝二钱、麦冬去心炒燥二钱、五味子四分，上肉桂去尽粗皮六分，水煎一钟，食前温服。盖内有肉桂得五味一敛，则桂走血达表之力益大，何虑阴翳之毒不起发乎！
宝坻赵太先生，年七十二岁，抱病两月余，诸医不能疗，且不能识，乃延我诊治。其病右颊肿硬，连及颐项耳后，一片坚实，不热不疼，医治七十余日。凡解毒攻托，敷贴熏洗总无一效，渐至口内出脓，牙噤不开，饮食少进，精神日衰，脉则洪大而空。我知为气血大衰，阴寒所聚，书即所谓石疽是也。不得阳和，何能外解？内溃日久，穿喉破颊，莫可疗矣。况书云：“老人气血衰者不治”，乃用猪脂捣烂，入肉桂细末，葱头食盐杵匀，浓敷患处，使脂膏以治血肉，不无同气，易于相应，葱能透窍，盐能软坚，桂能松动血分，油能浸润皮肤。内则空心生脉饮，送服八味丸，食远，以人参、当归、白芍、茯苓、白术、薄桂、金银花、角刺之类，使真阳一得，阴寒自解，气血充和，自能逐毒。如是调理三五日，冰硬者热软，漫肿者高耸，木者疼痛，紫者红活，饮食日进，气血渐长，驱毒外出，久凝久瘀之血肉，无可容地，消者消，肿者肿，脓者脓，不再旬而痊愈。可见诸病全以水火为根，气血为用，而脓肿之成，舍水火气血，将何以为攻托酿脓之具，成实收功之用哉！
宝坻中堂杜老先生第六公子，年十九，夏月病笃，来请我诊治。按其脉有时洪弦而尺弱，有时弦细而尺紧，乍寒乍热，两耳之下甚肿而疼，足亦微肿，语言无力，饮食入口即吐，若静卧则吐势少减，如少运动，则呕哕便来。询其得病之由，因暑天偶雨冰雹，骇而出视，背上受寒，随即发散不效，次用和解复不效，继用清热之剂，内有黄芩、山栀者，服后即吐，恶心呕吐之端，从此而始，莫可御矣。我始知为药之误也。盖暑天而能感寒，则中表之气不固可知，况中堂六十一岁所生之公子，先天禀弱之薄可知，膏梁娇养之子弟，腠理筋骨之柔脆可知，只宜温中调理，纵有感寒而自散矣。况书曰：“风则散之，寒则温之”，以风伤卫而在表，寒伤营而在里，今不用温中而用发散，则于感寒无益，从令中气益虚，寒郁火升，乘于空虚之地，乃两耳之下渐肿及颊，误为实火，济之寒凉，釜下之火既浮，中宫之阳复损，尚堪延纳饮食乎！书曰：“凡自阴经受寒，即真阴症，非从阳经传来，便宜温之，不可少缓。”又曰：“内伤多，外感少，只须温补，不必发散。”又曰：“正气得力，自能推出寒邪。”如此等语，皆治虚症受寒之要法，奈何未之用而及此也。以今日之病而论之，即所谓新病唤出旧邪，标病而打动本病，理当用上病疗下之法，况欲温以散寒，则无寒可散，欲温中开胃，则耳颊之肿痛为碍，欲滋阴以培本，则中脘之道路壅塞，计惟有峻补真阳，以达于下，重滋真阴，以继其中。用八味加牛膝、麦冬、五味作大剂，冲入人参浓汁，以助宣壅之势，连进二剂，无如服后，少顷即吐。凡即米饮均不能受，何况异味之药饵乎！要知寒凉伤中极矣。无如病势虚极，不能久待，乃连夜以人参、炮姜、附子为末，
Safflower (Sha Ren) and Motherwort (Yi Mu Cao), as well as acrid-warm formulas, should be strictly contraindicated. This applies to all diseases, not just those during pregnancy! Drugs that are extremely cold, extremely hot, strongly tonifying, or aggressively purgative can save lives if used correctly, but can kill if misused. However, in cases of false heat and false excess, the mistaken use of cold and purgative drugs will lead to immediate death, which cannot be reversed. In cases of false cold and false deficiency, the mistaken use of acrid-warm and tonifying drugs will only increase dryness, heat, irritability, and oppression. If death is avoided, using cooling methods will show efficacy. Therefore, ancient sages held that treating deficiency with methods for excess, or treating excess with methods for deficiency, is inadvisable; this is indeed well-founded.
Mr. Zhang from Daxing County had a relative suffering from severe dysentery for a long time, fainting several times a day. I was summoned to examine him. His six pulses were all thready and weak. I prescribed a formula containing Ginseng Radix et Rhizoma (Renshen), Scutellariae Radix (Qin), Angelicae Sinensis Radix (Danggui), Paeoniae Radix Alba (Baishao), Atractylodis Macrocephalae Rhizoma (Baizhu), Cinnamomi Cortex (Rougui), and Schisandrae Fructus (Wuweizi). The attending physician argued against adding tonics, fearing that the residual stagnation would be "locked in" by tonification. I said, "I have heard that robust individuals rarely retain stagnation, never that robustness leads to qi stagnation. If we wait too long to tonify, given his daily fainting, there may soon be no body capable of receiving tonification." Mr. Zhang agreed. After two or three doses, his spirit recovered, and the dysentery healed.
Old Man Tan, an official in the Ministry of Personnel, fell ill while staying at the residence of Censor Xu. He had fevered for several days, appeared lethargic, and his pulse was thready and weak, indicating fever due to labor injury. One physician diagnosed it as Cold Damage (Shanghan) and administered diaphoretic herbs, forbidding food intake, which worsened his condition critically. Upon my examination, his pulse was wiry and empty, ruling out Cold Damage. I first gave him half a bowl of thick rice soup. He remarked, "It is very fragrant and sweet; after drinking, my eyes felt clear, but please do not let Old Man Xu know." I returned home and privately administered Guipi Tang (Restore the Spleen Decoction), followed by thin rice gruel. After three to four days, his spirit fully recovered. Alas! Many people mistake headache and fever for Cold Damage and die from excessive purging and starvation.
Madam Han, wife of a Vice Commander, suffered from severe malaria with high fever and no sweat. Her six pulses were surging yet empty. I stated, "Sweat originates from Yin fluids, and the Kidney governs the five fluids. With only Yang signs and no Yin signs in the pulse, how can we induce sweating again, accelerating the collapse of isolated Yang?" I prescribed Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) plus Achyranthis Bidentatae Radix (Niuxi) and Schisandrae Fructus (Wuweizi), adding two liang of Shu Dihuang (Prepared Rehmanniae Radix) per dose, decocted into over a bowl, which she drank in large gulps. Nourishing water induces sweating. She sweated profusely and recovered. Later, I used Shiquan Dabu Tang (Ten-Agent Great Tonifying Decoction), removing Chuanxiong Rhizoma (Chuanxiong) and Glycyrrhizae Radix et Rhizoma (Gancao), adding Ziziphi Spinosae Semen (Zaoren) and Wuweizi, replacing raw Sheng Dihuang with prepared Shu Dihuang. After several doses, her spirit greatly improved.
**Formula for Nourishing Heart, Educating Spleen, Harmonizing Liver, Clearing Lungs, Nourishing Kidneys, Enriching Ying, and Benefiting Wei (Paste and Pill Formula):**
The essence of the Five Zang organs flows into the Kidneys. Thus, the *Classic* states: "When the Five Zang are abundant, they can discharge." Each Zang has its essence, which pours into the Kidneys as needed. The Kidney serves merely as a gathering and management center. During intercourse, the fire of the San Jiao (Triple Burner) descends, opening the pores (Xuanfu) throughout the body, releasing essence that gathers in Yin and emerges. Is it merely stored in the Kidney? Essence is born from Blood; if Blood is scant, how can Essence be generated? The Heart governs Blood, hence: "For infertility, look to the Heart; for premature graying, look to the Kidney." Therefore, those valuing fertility must not only tonify the Kidney but also nourish the Heart, and further harmonize the Five Zang so their essence remains abundant, ensuring the Kidney is full. If the other four Zang are dry and barren, what substance returns to the Kidney?
The Heart belongs to Fire and corresponds to the Li trigram (Yang outside, Yin inside); the Water in the Heart is True Water. The Kidney belongs to Water and corresponds to the Kan trigram (Yin outside, Yang inside); the Fire in the Kidney is True Fire. Heart and Kidney are roots of each other; Yin and Yang function mutually. Once the Dao of Ji Ji (Intersection) is mastered, the misty Qi condenses, and the embryo forms.
Currently, the Right Chi pulse is weak upon heavy pressure, indicating insufficiency of Mingmen (Gate of Life) True Yang. The Left Chi pulse is neither deep nor solid, indicating emptiness of Tianyi (Heavenly One) True Water. Bawei Dihuang Wan tonifies both Water and Fire, essential for this pattern. However, since Yin deficiency is extreme, prepare a paste from over one jin of Shu Dihuang (yielding eight liang of paste), replacing honey for pills, taken on an empty stomach. It is said: "Long-term use makes one fat, strong, and fertile," which is true. But Heart Yin is also insufficient, and Liver Ying and Middle Qi are not surplus; how can the Kidney receive and utilize them? At night, after meals, take formulas that nourish Ying, benefit Wei, and tonify all Five Zang. One tonifies先天 (Xiantian/Pre-heaven) insufficiency; the other assists 后天 (Houtian/Post-heaven) generation. Qi and Blood will grow daily, ensuring abundant offspring. The formula follows:
* **Huangqi (Astragali Radix)** and **Renshen (Ginseng Radix et Rhizoma)** tonify Qi as Sovereign (Jun), allowing Yin to grow with Yang, transforming the formless into the formed. (4 liang, stir-fried with honey water).
* **Danggui (Angelicae Sinensis Radix)** nourishes and invigorates Blood as Minister (Chen), harmonizing Ying, generating from Qi. (3 liang, stir-fried with wine).
* **Suanzaoren (Ziziphi Spinosae Semen)**, red like Li, enters Spleen via aroma, Liver via sourness. It calms the Heart, benefits the Liver, and nourishes Spleen Earth. Together with Danggui, it nourishes Blood of three Zang and Qi of three Zang. (5 liang, stir-fried until ripe, crushed before decoction).
* **Shudihuang (Rehmanniae Radix Praeparata)**, heavy and turbid like Earth, sweet and warm, nourishes Yin, tonifies Tianyi True Water, and moistens dry meridians. With Baizhu, it balances Spleen Earth's dryness (Baizhu) and moisture (Shudihuang), making Earth the mother of all things. (6 liang, sliced with copper knife).
* **Jitui Baizhu (Atractylodis Macrocephalae Rhizoma)**, fragrant and mild, possesses righteous Qi. It tonifies Middle Qi. As praised: "Tastes better than gold, fragrant more than jade, repels hundred evils, fills six Fu organs." To enhance moistening, stir-fry with cow's milk until dry and yellow. Combined with Shudihuang and Baishaoyao, it strengthens Water and nourishes Spleen. Baizhu tonifies Spleen Yang; Baishaoyao tonifies Spleen Yin, preventing dryness. (4 liang, soaked in cow's milk, dried, stir-fried yellow).
* **Yuanzhi (Polygalae Radix)**, embracing the Heart, yellow in color, calms Spirit, generates Spleen Earth. Pungent and bland, expels turbid Yin, preserving True Essence. It aids Heart-Kidney-Spleen interaction. Pre-soaked in Licorice juice to remove pungency. (2 liang).
* **Zhi Maidong (Ophiopogonis Radix Praeparata)**, Kidney is Pre-heaven, Spleen is Post-heaven. Deficiency requires tonifying the Mother (Metal/Lung) or Child (Water/Kidney). Since Water deficiency dries Metal, and Metal dryness depletes Water, mutual support is lost. Maidong, combined with Shudihuang and Baizhu, supports Mother without stealing and generates Child with surplus. Stir-fried with old rice to mitigate coldness. (3 liang).
* **Baishaoyao (Paeoniae Radix Alba)**, sweet-cold enters Spleen, sour-astringent enters Liver. Harmonizes Liver Ying with Danggui, nourishes Spleen Yin with Baizhu. (2 liang 4 qian, stir-fried with honey and wine).
* **Duzhong (Eucommiae Cortex)**, promotes circulation of tonified Qi/Blood in meridians, strengthens sinews and bones, guides herbs to Deep Yin. Works with Xuduan to harmonize joints. (3 liang, stir-fried with wine).
* **Xuduan (Dipsaci Radix)**, complements Shudihuang (tonifies Jing) and Duzhong (tonifies Qi), regulating joints. (3 liang, stir-fried with wine).
* **Ming Niuxi (Achyranthis Bidentatae Radix)**, guides herbs to strengthen Lower Yuan, directs turbid Yin down so Clear Yang rises. Steamed with wine to slow descent. (3 liang, steamed, dried, baked).
* **Lianzi (Nelumbinis Semen)**, clears/nourishes Heart, strengthens Spleen/firms Kidney. Decocted to mix with other herbs.
**Preparation:**
Decoct 2 jin of Lianzi (removed heart and skin) in clear water to yield 30+ bowls. Remove lotus meat, add previous herbs, decoct twice, filter residue, boil to thick paste. Add final three ingredients (likely referring to specific processing steps or remaining powders mentioned in context, though text implies mixing powders later), form fine pills.
* **Renshen (Ginseng Radix et Rhizoma)**, Sovereign, tonifies Yuan Shen, neutral nature. Harmonizes Huangqi, Danggui, Baizhu, Suanzaoren, Shudihuang. (5 liang, powdered finely).
* **Baifuling (Poria) & Fushen (Poria with Hostwood)**, Ministers. Fuling drains dampness to aid Baizhu; Fushen secures Spirit to aid Suanzaoren. (Each 3 liang, powdered finely).
Mix powders with paste. Take 4 qian with warm water before sleep, or chew large pill with saliva, or dissolve in warm water.
**Case 1:**
Old Man Hu, near sixty, ill for months, treated with mixed cold/hot and tonifying/purgative methods, leading to confusing symptoms. Pulse was surging and forceful, suggesting not Yang deficiency. In summer, he sweated and feared wind, ate normally, but grew weary, had phlegm and nasal congestion. I diagnosed Yin deficiency failing to anchor Yang, causing Yang floating and Yin scattering, mixing Clear/Turbid, with pathogenic fire consuming Grain and generating Phlegm instead of Blood. Treatment: Nourish Yin to anchor Yang. Prescribed Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) with Salt-water processed Chenpi (Citri Reticulatae Pericarpium), Maidong, and Wuweizi. Within three doses, spirit cleared. He asked for fertility pills. I advised Liuwei Dihuang Wan plus Maidong and Wuweizi. He ignored this. Half a month later, spirit declined again. He resumed the formula, spirit revived, sexual potency returned. Three months later, his concubine became pregnant.
Later, the concubine complained of extreme bland taste in mouth and chest agitation. Other doctors suspected blood stasis or masses and suggested purging. I strongly opposed this. By 5-9 months, abdomen enlarged but soft, shifting sides, waist moving, no fetal movement at navel. Doctors called it a "Ghost Fetus" and demanded removal. I resisted. Suddenly, she went into labor without pain. The husband blamed me. I explained: "Fruit falls when ripe. No pain delivery is normal for obese women with excess amniotic fluid. The bland taste is due to Stomach lacking True Fluids." Servants announced the birth of a healthy boy. The husband knelt in gratitude.
**Case 2:**
Grandson of Chancellor Jiang, five months old, developed smallpox. Not dense, but congenital True Yin/Yang deficiency, pale flesh. Summer heat caused Yang to float to surface, high fever, profuse sweating. Smallpox receded and flattened after 4-5 days, with lethargy and fright. I diagnosed: High fever = Yang outside; Sweating = Yin leaking, Yang exhausting. Must gather True Yin/Yang. Without tonifying Yin, floating Yang cannot be anchored; without tonifying Yang, Yin cannot return to source. Middle Qi is also deficient. Floating Yang needs astringent power to gather. Prescribed: Shudihuang 8 qian, Jitui Baizhu (milk-fried) 3 qian, Niuxi 2 qian, Maidong (heart removed, fried) 2 qian, Wuweizi 4 fen, Rougui (Cinnamon Bark, bark removed) 6 fen. Decoct, drink warm before meal. Rougui + Wuweizi enhances blood circulation and surface penetration, helping the rash erupt. Patient slept, cooled, sweat stopped, spirit refreshed, rash rose, appetite returned, and he healed.
**Case 3:**
Mr. Zhao Taibao, 72 years old, ill for 2+ months, undiagnosed by others. Right cheek swollen and hard, extending to jaw/neck/behind ear, firm, non-hot, non-painful. Treated for 70+ days with detox/purging/topicals with no effect. Pus appeared in mouth, jaw locked, poor intake, declining spirit. Pulse surging and empty. Diagnosed as Shiju (Stone Abscess) due to Qi/Blood exhaustion and Yin-Cold accumulation. Without Yang warmth, it cannot resolve externally or internally. Recommended: Pig fat mashed with Rougui powder, scallion heads, salt, applied thickly. Fat treats flesh/blood (same energy), scallion opens orifices, salt softens hardness, Rougui moves blood, oil moisturizes skin. Internally: Kongxin Shengmai Yin (Heart-Empty Generating Pulse Drink) with Bawei Wan. After meals: Renshen, Danggui, Baishao, Fuling, Baizhu, Hougui (Thin Cinnamon), Jinyinhua (Lonicerae Japonicae Flos), Jiaocishi (Cirsii Japonici Herba). True Yang restored, Yin-Cold resolves, Qi/Blood harmonizes, driving out toxin. In 3-5 days, hardness softened, swelling raised, numbness turned painful, purple turned red. Appetite increased, Qi/Blood grew, toxin expelled. Necrotic tissue resolved. Healed in less than 10 days. Confirms: All diseases root in Water/Fire, function through Qi/Blood. Abscesses require Water/Fire/Qi/Blood to generate pus and heal.
**Case 4:**
Young Master Du, 19, critically ill in summer. Pulse sometimes surging/wiry with weak Chi, sometimes wiry/thin with tight Chi. Alternating chills/fever, swelling/pain below ears, slight foot swelling, weak voice, vomiting immediately after eating. Vomiting reduced when lying still, worsened with movement. History: Exposed to hail/cold in summer, dispersed unsuccessfully, harmonized unsuccessfully, then cooled with Huangqin/Gardenia, triggering vomiting. I diagnosed medication error. Summer cold indicates unstable Middle/Exterior Qi. Born late in father's life (weak constitution), pampered (fragile sinews/bones). Should have been warmed internally. Wind disperses, Cold warms. Wind injures Wei (Surface), Cold injures Ying (Interior). Using dispersants for Cold injury harms Middle Qi, causing Cold stagnation and Fire rising to empty areas (ears/cheeks). Misdiagnosed as Excess Fire, treated with Cold herbs, floating Fire and damaged Middle Yang. Cannot tolerate food. Classic says: Cold from Yin meridians is True Yin syndrome, requires warming. Internal injury > External injury, requires warming/tonifying, not dispersing. Righteous Qi expels Cold. Current case: New disease awakens old evil, branch disease triggers root disease. Must treat upper/lower. Warming to scatter Cold finds no Cold; warming Middle is blocked by ear swelling; nourishing Yin is blocked by Middle Jiao obstruction. Solution: Strongly tonify True Yang to reach lower, heavily nourish True Yin to sustain middle. Large dose of Bawei plus Niuxi, Maidong, Wuweizi, mixed with concentrated Renshen juice to open obstruction. Two doses, vomited shortly after. Even rice water rejected. Cold herbs severely injured Middle. Condition critical, could not wait. Prepared powder of Renshen, Paoshengjiang (Blast-fried Ginger), Fuzi (Aconiti Lateralis Radix Praeparata)...