吾里张云寰先生，（季瀛，桐乡县人），医学深邃，求治者门常如市。余表兄周士勋，夏
日身
证也，再服清暑药脱矣。投以八珍大补之剂获愈。其子铁葫上舍（禾），亦精医理，诊病胆识
绝人，有乡农病喘十余日，服药不效，登门求治，令服小青龙汤。乡农有难色，张曰∶服此
药二剂，仍不得卧者，余甘任其咎。乡农去，家人讶其失言，张曰∶彼喘而延至十余日不死
，非实证不能，又何疑焉？阅数日，乡农复来，则病果瘳矣。
临海洪录园孝廉裕封，精医理，常言古方书如《伤寒》、《金匮》，今方书如《临证指
南》
，诚能专心玩索，诊疾自能奏功。台郡少良医，由于昧所适从，仅读《药性赋》、《汤头歌
括》及《医宗必读》等书耳，其治病每以古方获效。文参军之子患暑症，初微恶寒，后壮热
汗出，嗳气腹痞，口干渴，面肿头痛，大小便少，医用葛根、桔梗、制半夏、薄荷、佩兰、
赤苓、通草、杏仁、芦根等药，渐觉气急神昏，录园诊之，谓脉大舌黄，是白虎汤症也，投
一剂，诸症皆减，改用鲜石斛、黄连、生甘草、金银花、栝蒌实等味而痊。张明径患春温，
恶寒发热，喉烂，医用甘、桔、荆、防、牛蒡等味，病不减，录园投以黄芩汤加连翘壳、杏
仁，一剂获愈，此真善用古方者！
嫡兄星槎先生瀚，少好学，以多病兼玩医书，久而精能，宰化县，年老罢官，贫不能归
，乃
悬壶于会城顺德县。县令徐某之子夏月泄泻，服清暑利湿药不效，渐至发热不食，神疲息微
，
徐年已暮，只此一子，计无所出，延兄求治，兄曰∶此由寒药伤脾，阳虚欲脱，宜进温药以
救之。因用附子理中汤，徐疑不敢服，兄曰∶此生死关头，前药已误，岂可再误？设此药有
疏虞，我当任其咎。服药诸症俱轻，连进数剂全愈。徐大喜，倾囊浓赠，复为乞援同寮，因
得全家归里。兄着有《制方赘说》行世。
钱塘吕 村司马震名，官湖北，有政声，忽动归思，侨居吴门，为人治疾多获效。潘太
史遵
祁病瘅，服茵陈汤不效，服平胃散又不效，脘中若藏井底泥，米饮至前辄哕，吕诊之曰；
湿固
是已，此寒湿，宜温之。与五苓散加附子，药下咽，胸次爽然。方氏子伤寒疾革，议用牛黄
清心丸，吕曰∶邪在腑上蒙心包，开之是揖盗也，宜急下存阴。投以犀连承气汤，一服病愈
。叶氏女周岁，遘疾将殆，仰卧，胸膈如阜，呻吟拒按，吕曰∶此结胸也。服小陷胸汤立效
。吕酷好医书，遍览百家，而一以仲景为宗，尝言仲景伤寒立法，能从六经辨证，则虽繁剧
如伤寒，不为多岐所误，而杂症即一以贯之。其为医也，问切精审，不杂一他语，立方必起草
，阅数刻始安。一家有病者数人，一一处之无倦容，暇辄手自撰论，阐发仲景之学，着有《
伤寒寻源》行于世。
青浦何书田其伟，家世能医，初为诸生专于学，工古今体诗，未尝为医。自其父元长先
生卒
，念世业不可无继，稍稍为之，名大噪。有徐姓者，昏热发狂，力能逾墙屋，何曰∶是邪食
交结也。则其人果以酷暑食水浇饭，旋就柳阴下卧也。以大黄、枳实下之而愈。金泽镇某生
逾冠未婚，得狂疾，用牛黄清心加味法，而嘱其家人于煮药时覆女子亵衣于其上，两剂而愈
。门人疑之，何曰∶是阴阳易法，吾用之偶验耳。尝作医论诗云∶治病与作文，其道本一贯
。病者文之题，切脉腠理现。见到无游移，方成贵果断。某径用某药，一味不可乱。心灵则
手敏，法熟用益便。随症有新获，岂为症所难？不见古文家，万篇局万变。此可见其生平所
得力矣。
表兄周乙藜学博士照，潜研医理，尝治分水典史王某之妻，两臂挛不能举，面色黯淡，
脉沉
缓，诸药不效，令服活络丹数服即愈。后以治手臂足腿挛肿之属寒湿者皆效。乙藜之戚张氏
妇，体弱恶食，月信已停八月，就诊于苏州名医何氏诊之，云是经阻，令服通药，乙藜诊之
曰∶六脉滑疾，右寸尤甚，是孕也，且必得男。以安胎药与之，阅四月果生男。
乌程钮松泉殿撰，福保之父，晴岚封翁芳鼎，精外科术，贫者求治不取钱，且赠以药，
制药
不惜重值，拯治危症甚多。殿撰尤好岐黄书，在京师每为人治愈危疾。尝治其同年之母，高
年患痢，医用芍药汤不效，转益困笃，身热不食，殿撰询知病前曾多食蟹，诊脉左弦数，右
数而弱，舌苔中黑，腹痛喜按，力排众议，专主热药，用熟附子八分，炮姜一钱，白芍一钱
，吴茱萸五分，焦白术三钱，茯苓三钱，肉桂八分，炙甘草一钱，砂仁五分，陈皮五分，生
姜二片，一剂痢稀热减，去茱萸、陈皮、加丁香、木香，二剂痢止，改用补中益气汤，加附
、桂、炮姜全愈。殿撰有延医医案一册，名曰《春冰集》，盖言慎也。
吴江陈梦琴茂才希恕，家居芦墟，其曾祖为诸生者名策，得外科秘方于外家潘氏，始为
医。
茂才幼好学，有声庠序间，壮岁家中落，母令习家学，可养生兼可治生，乃从其兄省吾上舍
希曾学，期年而业成，生平所治疾，悉录成为书，积三百二十二卷，手撮其要为十册，以训
子侄。其婿沈沃之学博曰富，择取之，为《妇翁陈先生治疾记》，篇长不备录，录其尤者。
一人无故舌出于口寸余，他医遵古方熏以巴豆烟，饮以清心脾药不效，先生命取鸡冠血涂之
，使人持铜钲立其后，掷于地，声大而腾，病者愕顾而舌收矣。或问其故，先生曰∶舌为心
苗，心主血，用从其类，必鸡冠者，清高之分，精华所聚也，掷钲于地者，惊气先入心，治
其原也。（以HT 按∶周真治妇因产子舌上不收，以朱砂敷之，令以壁外堕瓦盆作声而舌收，
此盖从其法化出。）
先生治疾，以至之先后为序。一日忽于众中呼一人前问所患，曰∶臂有微肿。视之仅一
小
，先生潜谓同来者曰∶此白刃疔，试视其额端已起白色，速归矣，危在须臾。其人方出门，
面部白色渐趋口角，未至家死。徐氏子年二十余，四肢不举，昏昏欲寐，食后益甚，莫识其
症，先生
曰∶是见《肘后方》，名曰谷劳，由饱食即卧而得，以川椒、干姜、焙麦芽为丸服之，遂瘳
。
有食鸦片烟者，遍体发 ，痛痒交作，抑搔肤脱，终日昏愦，语言诞妄，先生曰∶此中
毒之
最甚者，寻常解法，恐不及济。用朱砂一两，与琥珀同研末，犀角磨汁，和三豆汤进之，神
志顿清，遍体无皮，痛不可忍，复磨菖蒲、绿豆为粉尘粘席，乃得安卧，不半月愈。
胡氏子咽痛气急，勺水不能下，或曰风温，或曰风痰，先生切其脉细微，手足清而脾滑
，曰
∶虚寒喉痹也，用理中汤。观者皆骇相顾，先生曰∶急服之，迟将不及，苟无效，余任咎耳
。覆杯而平。
吾邑张梦庐学博千里，少工诗文，长精医术，家居后珠村，就诊之舟，日以百计，医金
所入
，半周亲友，不置生产，惟聚书数万卷而已。时长兴臧孝廉寿恭有文名，张延课诸子，臧亦
通
医理，尝问张曰∶长洲叶氏忌用柴胡，吴江徐氏讥之，先生亦不轻用此味，得毋为叶说所惑
？曰∶非也。江浙人病多挟湿，轻投提剂，瞑眩可必，获效犹赊。叶氏实阅历之言，徐氏乃
拘泥之说，此河间所以有古法不可从之激论也。臧曰∶闻先生治疮疡，不用升药，何也？曰
∶
升药即汉之五毒药，其方法见疡医后郑注，自来疡医皆用之，然诸疮皆属于心，心为火脏，
又南人疮疡皆由湿热，若更剂以刚烈 炼之药，弱者必痛伤其心气，强者必反增其热毒，此
所谓不可轻用也。张生平拯危疾甚多。尤着者，湖州归某，寒疝宿饮，沉绵四年，诸药不应
，投一方立效，三易方全愈，兹录于后。初诊之∶肝阳郁勃，动心犯胃，久则胃气大伤，全
失中和之用，以致肝之郁勃者，聚而为疝，胃之停蓄者，聚而为饮，疝动于下，则饮溢于中
，
通，便溺渐行，此所谓寒疝宿饮互为病也。病经数年，宜缓以图之。若得怡情舒郁，当可全
愈。〔茯苓三钱，桂枝三分，生冬术一钱半，炙甘草四分，小川连三分，吴茱萸（泡淡）三分
，干姜三分，制半夏一钱，枳实（炒）五分，白芍（酒炒）一钱半，生姜三分，竹茹七分。〕次
诊云∶寒疝宿饮，盘踞于中，久而不和，阳明大失中和之用，今肠渐通降，屡次所下黑黄干
坚之矢，既多且畅，则肠腑之蓄积者得以渐去，肠通然后胃和，此数年来病之大转机也。盖饮
疝互扰，皆在阳明，下流壅塞，则上流何能受盛传导？盆满？必上溢，此理之易明者也。今宜
专与养胃，以渐渐充复其受盛传导之职。机不可失，正在此时。至于痔 溺少，皆属阳明，可
一贯也。〔党参三钱，橘皮钱半，茯苓二钱，制半夏一钱，麦冬（去心）钱半，火麻仁二钱，
叭杏仁（去皮尖）二钱，白蒺藜（炒去刺）二钱，刀豆子（炒研）三钱，黑芝麻三钱，柿饼（煨）半
枚，白粳米一撮。〕三诊云∶病缠三四年，至今秋才得肠腑通润，燥矢渐来，继以溏润，然
后胃脉不致上逆，呕吐止而饮食进。可见阳明之病，以通为补也。今深秋燥令，痔必稍愈，
仍宜柔养阳明，以期渐渐充复。〔党参三钱，橘皮钱半，茯苓二钱，制半夏一钱，麦冬（去心
）钱半，秫米二钱，金石斛三钱，枣仁（炒研）二钱，生甘草四分，驴皮胶二钱，柿饼半枚，
荷叶一角。〕
历代宰相通医理者，伊芳尹而后，狄梁公、陆忠宣公、范文正公是已，我朝山阳汪文端公
亦谙
医理，其评吴鞠通《温病条辨》有云∶温热、湿温为本书两大纲。温热从口鼻吸受，并无寒
症，最忌辛温表散，但当认定门径，勿与伤寒混杂，再能三焦投药，辨清气血营卫，不失先
后
缓急之序，便不致误 。湿温为三气杂感，浊阴弥漫，有寒有热，传变不一，全要细察兼证
，
辨明经络脏腑、气血阴阳，湿热二气，偏多偏少，方可论治。又云∶热证清之则愈，湿证宣
之则愈，重者往往宣之未愈，待其化热而后清，清而后愈。一为阳病，一兼阴病，难易较然
。观此知公学识之精矣。
吾里孔行舟上舍广福善医，治外感尤精，尝云∶噤口痢半因误药而成，医者治痢，辄用
葛根
，湿热提入阳明，遂至哕逆不食，变成险症，急投以黄连、干姜，庶克有济。余见近世治外
感，不辨手足六经，辄用葛根、柴胡，温病遇之，鲜不轻者至重，重者至死，病家不识药性
，以为疾不可治，而不知医实杀之也，可慨也夫！
《续名医类案》云∶鲍录饮年二十余，夏月至歙受热，鼻衄愈后，偶啖梨，遂得吐症，
盖肝
火而胃寒也。百治无效，闻说吐字则应声而呕，后至吴门就叶氏诊，以其脉沉细，令服附子
理中汤，参、姜、附俱用三钱，服后出门，行及半里，觉头重目眩，急归寓，及门而仆，其
尊人谙药性，谓必中附毒，亟煎甘草灌之，良久乃苏，后去附子，仍服三剂，吐转甚，再往
诊，仍令服前方，遂改就薛氏，告以故，薛用六君子汤，服四剂无验，冬月感寒增咳，缠绵
至夏，余偶访知则病剧，询知为向患吐，近复二便秘，已七八日不食，惟渴饮茶水，更医数
人，或言令以艾灸脐，俱不应，请诊之，见其面色青悴，脉弦伏而寸上溢，谓此缘脾阴大亏
，
水火炽盛，又因久咳肺虚，肝无所畏，遂下乘脾而上侮胃，致成关格，幸脉不数，易治也，
宜先平其肝，俾不上冲而吐止，斯肺得下降而便行，令以黄连、肉桂各五分，隔汤蒸服饮下
，觉吐稍止，即能食糕数块，然二便胀不可支，令以大田螺一枚，捣烂，掩于丹田，以物系
定，不超时，二便俱行，所下皆青色，遂霍然而愈，时甲戌五月二十七日也。（按∶甲戌为
乾隆十九年，叶天士卒于乾隆十年，诊疾者当是其后人，若出天士手，必不若是。）后以六
味加减，入沙参、麦冬等，咳嗽亦止，向后常服养荣之剂，吐不复作。余按∶鲍刊《名医类
案》，魏为校正，鲍赋夕阳诗，魏亦和作，二人之交情，非比寻常，盖有由然矣。上元葛芝
山布衣镛，少孤极贫，读书僧寺，遇异人援书一卷，乃岐黄家言，其方甚秘，习之以治者效
如神。群小儿戏，一人张口而跳，蹶伏门限，舌断堕地，一人骑门限坐力猛，肾囊破，睾丸
坠，葛悉为安之。自朝至日中，门庭如市，口讲手画无倦色，午后携百钱独游，或采药，或
看花，或冒雨雪提酒 访知己。当道闻名，迎者沓至，则诡曰∶葛某穷士，藉医苟话，实无
伎俩，昨误杀人，群聚殴之，已遁
矣。其志趣如此，尤精砭法，凡病赤游风，汗不得发，死者十八九，宜以血代汗，葛削竹夹
瓷
锋砭之，出血如珠，密排而不流立愈。盖轻则皮不破，重则肉伤，无第二手也。咸丰癸丑三
月，贼陷金陵，胁为内医官，不从。十四日既夕，舁旧制两棺于厅事，出白金九锭，分赠邻
里，且托身后事，遂与妻周氏纵饮沉醉，整衣冠，各入棺，呼其兄子盖而钉之，时夜将半，
我的同乡张云寰先生（名季瀛，桐乡县人），医学造诣深厚，求医的人家门口常常像集市一样热闹。我的表兄周士勋，夏天患了暑病，服用两次清暑药后病情反而加重（脱证）。后来投用八珍汤这种大补气血的方剂才痊愈。他的儿子铁葫上舍（名禾），也精通医理，诊断疾病时胆识过人。有一个乡下农民患气喘病十多天，服药无效，登门求治，张先生让他服用小青龙汤。乡下农民面露难色，张先生说：“服用此药两剂，如果仍然不能安卧，我甘愿承担后果。”乡下农民走后，家人惊讶于他说了这样的话，张先生说：“他气喘拖延到十多天还没死，说明不是实证（邪气盛实的病证），还有什么可怀疑的呢？”过了几天，乡下农民又来了，果然病好了。
临海的洪录园孝廉（举人）裕封，精研医理，常言古代方书如《伤寒论》、《金匮要略》，现代方书如《临证指南》，如果能专心研读探索，诊治疾病自然能奏效。台州郡缺乏良医，是因为不知道遵循什么标准，只读《药性赋》、《汤头歌括》及《医宗必读》等书罢了，他们治病往往以古方获得疗效。文参军之子患暑症，起初轻微恶寒，后来高热汗出，嗳气腹部痞满，口干口渴，面部肿胀头痛，大小便量少，医生使用葛根、桔梗、制半夏、薄荷、佩兰、赤茯苓、通草、杏仁、芦根等药，患者逐渐感到气急神志昏沉，洪录园诊察后，说脉象大舌苔黄，这是白虎汤证，投用一剂，所有症状都减轻，改用鲜石斛、黄连、生甘草、金银花、栝蒌实等药而痊愈。张明径患春温病，恶寒发热，咽喉溃烂，医生使用甘草、桔梗、荆芥、防风、牛蒡子等药，病不减，洪录园投用黄芩汤加连翘壳、杏仁，一剂获愈，这真是善于运用古方的人啊！
嫡兄星槎先生瀚，年少好学，因为多病兼读医书，久而久之精通医术，曾任化县县令，年老罢官，贫穷无法回家，便在省会顺德县行医。县令徐某的儿子夏天腹泻，服用清暑利湿药无效，逐渐发展到发热不进食，精神疲乏气息微弱，徐某年纪已老，只有这一个儿子，无计可施，请我兄长求治，兄长说：“这是由于寒凉药物损伤脾阳，阳气虚衰即将脱失，应当进服温性药物来救治。”于是使用附子理中汤，徐某怀疑不敢服用，兄长说：“这是生死关头，前面的药已经误了，岂能再误？假如这个药有疏忽，我当承担后果。”服药后各种症状都减轻，连续进服几剂完全痊愈。徐某大喜，倾尽钱财重重赠送，又向同僚求助，因此得以全家回乡。兄长著有《制方赘说》流传于世。
钱塘吕村司马震名，在湖北做官，有政治声誉，忽然产生归隐之念，侨居苏州，为人治病多获效。潘太史遵祁患黄疸病，服用茵陈汤无效，服用平胃散也不见效，胃脘中好像藏着井底的泥，米汤喝到嘴边就呕吐，吕诊察后说：“湿气固然存在，但这是寒湿，应当温化。”给予五苓散加附子，药一下咽，胸膈间清爽舒畅。方氏之子患伤寒病势危急，商议使用牛黄清心丸，吕说：“邪气在腑，上蒙心包，开窍是引盗入室，应当急下存阴。”投用犀角地黄承气汤，一服病愈。叶氏女儿周岁，患病几乎死亡，仰卧，胸膈部隆起如小山，呻吟拒按，吕说：“这是结胸证。”服用小陷胸汤立刻见效。吕酷爱医书，遍览各家，但以张仲景为宗师，曾言张仲景治疗伤寒的立法，能从六经辨证，那么即使是繁杂严重的如伤寒病，也不会被多种歧途所误导，而杂病也能一以贯之。他行医时，问诊切脉精细审慎，不说其他闲话，开方必定打草稿，看几刻钟后才安心。一家有好几人患病，一一处置没有疲倦的神色，闲暇时就亲手撰写论述，阐发张仲景的学问，著有《伤寒寻源》流传于世。
青浦何书田其伟，家世擅长医术，起初作为诸生专注于学业，擅长古今体诗，未曾行医。自从他的父亲元长先生去世后，想到家传医术不可无人继承，稍微开始行医，名声大噪。有个姓徐的人，昏热发狂，力气大得能翻墙越屋，何先生说：“这是邪气与食积交结。”这人果然因为在酷暑天吃冷水浇的饭，随即就在柳荫下睡觉。用大黄、枳实攻下而痊愈。金泽镇某个秀才超过二十岁未婚，得了狂疾，用牛黄清心丸加味法，并嘱咐家人在煮药时把女子的贴身衣物覆盖在药锅上，两剂而愈。门人对此感到疑惑，何先生说：“这是阴阳易疗法，我偶然使用验证有效罢了。”曾作医论诗说：“治病与作文，道理本一贯。病人是文章题目，切脉观察腠理显现。见解坚定不犹豫，才能成就果断。某径用某药，一味不可乱。心灵则手敏捷，法熟练用更便利。随病症有新收获，难道会被病症难倒？不见古文家，万篇局万变。这可见他生平得力之处。”
表兄周乙藜学博士照，潜心研究医理，曾治疗分水典史王某的妻子，双臂拘挛不能举起，面色黯淡，脉象沉缓，各种药无效，让她服用活络丹几次即愈。后来治疗手臂足腿拘挛肿胀属于寒湿的都有效。乙藜的亲戚张氏妇人，身体虚弱厌恶饮食，月经停止八月，就诊于苏州名医何氏，诊断为经血阻滞，让服用通经药，乙藜诊察后说：“六脉滑数，右寸尤其明显，这是怀孕，而且必得男孩。”给予安胎药给她，过了四个月果然生下男孩。
乌程钮松泉殿撰，是福保的父亲，晴岚封翁芳鼎，精通外科技术，贫穷的人求治不收钱，还赠送药物，制药不惜重金，拯救治疗危重病症很多。殿撰尤其喜好岐黄之书，在京师经常为人治愈危重疾病。曾治疗同年进士的母亲，高龄患痢疾，医生用芍药汤无效，病情更加困顿严重，身热不进食，殿询问得知发病前曾多吃螃蟹，诊脉左弦数，右数而弱，舌苔中间黑，腹痛喜欢按压，力排众议，专门主张用热药，用熟附子八分，炮姜一钱，白芍一钱，吴茱萸五分，焦白术三钱，茯苓三钱，肉桂八分，炙甘草一钱，砂仁五分，陈皮五分，生姜二片，一剂后痢疾稀薄热减，去掉茱萸、陈皮，加丁香、木香，二剂后痢止，改用补中益气汤，加附子、肉桂、炮姜全愈。殿撰有延医医案一册，名叫《春冰集》，大概是说要谨慎的意思。
吴江陈梦琴茂才希恕，家居芦墟，他的曾祖作为诸生名叫策，从外家潘氏得到外科秘方，才开始行医。茂才年幼好学，在庠序间有声望，壮年家中衰落，母亲让他学习家传医术，可以养生兼可以谋生，于是跟随他的哥哥省吾上舍希曾学习，一年学业完成，生平所治疗的疾病，全部记录成为书，积累三百二十二卷，亲手摘录要点为十册，用来训诫子侄。他的女婿沈沃之学博曰富，选取这些内容，编为《妇翁陈先生治疾记》，篇幅太长不全录，只录其中特别好的。一个人无故舌头伸出嘴外一寸多，其他医生遵照古方用巴豆烟熏，饮用清心脾药无效，先生命取鸡冠血涂在上面，让人拿着铜锣站在其后，扔在地上，声音大而腾空，病人惊吓回头看，舌头收回了。有人问原因，先生说：“舌为心之苗，心主血，用与其同类之物，必须是鸡冠，因为它是清高之分，精华聚集的地方，扔锣在地上，惊气先入心，治疗其本源。（以HT按：周真治疗妇女因生产后舌上不收，用朱砂敷之，让人敲击壁外堕落的瓦盆发出声音而舌收，这大概是沿袭这种方法变化出来的。）”
先生治病，以先后顺序为准则。有一天忽然在众人中叫一人上前问患病情况，说：“手臂有微肿。”看去只是一个小疔疮，先生悄悄对同行者说：“这是白刃疔，试看他额头端已起白色，快回去吧，危险就在顷刻之间。”那人刚出门，面部白色逐渐趋向口角，没到家就死了。徐氏儿子二十多岁，四肢不能举动，昏昏欲睡，进食后更严重，不认识这是什么症，先生说：“这在《肘后方》见过，名叫谷劳，由吃饱了就躺下而得，用川椒、干姜、焙麦芽做成丸服用，于是痊愈。”
有吸食鸦片烟的人，遍体发斑，痛痒交作，抓挠皮肤脱落，整天昏愦，语言荒诞妄语，先生说：“这是中毒最严重的，寻常解毒方法，恐怕来不及救助。”用朱砂一两，与琥珀同研末，犀角磨汁，和三豆汤进服，神志顿时清醒，遍体无皮，痛不可忍，又磨菖蒲、绿豆为粉尘粘在席子上，才得以安卧，不到半月痊愈。
胡氏儿子咽痛气急，一勺水都不能下咽，有人说风温，有人说风痰，先生切其脉细微，手足清冷而脾脉滑，说：“这是虚寒喉痹。”用理中汤。旁观者都惊讶互相看，先生说：“赶快服用，迟了就来不及了，假如无效，我承担后果。”喝完杯中药即平复。
我县张梦庐学博千里，年少擅长诗文，长大精通医术，家居后珠村，就诊的船只，每天以百计，医金所得，一半接济亲友，不置办产业，只聚书数万卷而已。当时长兴臧孝廉寿恭有文名，张邀请他教课诸子，臧也通晓医理，曾问张说：“长洲叶氏忌用柴胡，吴江徐氏讥笑他，先生也不轻易用此味，莫非被叶氏之说迷惑了吗？”说：“不是这样。江浙人病多挟湿，轻率投用提透之剂，出现瞑眩反应是必然的，获得疗效还远。叶氏确实是阅历之言，徐氏乃是拘泥之说，这就是河间所以有古法不可从的激论的原因。”臧说：“听说先生治疮疡，不用升药，为什么？”说：“升药即汉代的五毒药，其方法见疡医后郑注，自来疡医都用它，然而诸疮皆属于心，心为火脏，又南方人疮疡皆由湿热，如果再制剂以刚烈煅炼之药，弱者必痛伤其心气，强者必反增其热毒，这就是所谓不可轻用的原因。”张生平拯救危重疾病很多。特别著名的，湖州归某人，寒疝宿饮，缠绵四年，各种药不应，投一方立效，三次换方全愈，兹录于后。初诊说：肝阳郁勃，动心犯胃，久则胃气大伤，全失中和之用，以致肝之郁勃者，聚而为疝，胃之停蓄者，聚而为饮，疝动于下，则饮溢于中，通，便溺渐行，此所谓寒疝宿饮互为病也。病经数年，宜缓以图之。若得怡情舒郁，当可全愈。〔茯苓三钱，桂枝三分，生冬术一钱半，炙甘草四分，小川连三分，吴茱萸（泡淡）三分，干姜三分，制半夏一钱，枳实（炒）五分，白芍（酒炒）一钱半，生姜三分，竹茹七分。〕次诊说：寒疝宿饮，盘踞于中，久而不和，阳明大失中和之用，今肠渐通降，屡次所下黑黄干坚之矢，既多且畅，则肠腑之蓄积者得以渐去，肠通然后胃和，此数年来病之大转机也。盖饮疝互扰，皆在阳明，下流壅塞，则上流何能受盛传导？盆满？必上溢，此理之易明者也。今宜专与养胃，以渐渐充复其受盛传导之职。机不可失，正在此时。至于痔 溺少，皆属阳明，可一贯也。〔党参三钱，橘皮钱半，茯苓二钱，制半夏一钱，麦冬（去心）钱半，火麻仁二钱，叭杏仁（去皮尖）二钱，白蒺藜（炒去刺）二钱，刀豆子（炒研）三钱，黑芝麻三钱，柿饼（煨）半枚，白粳米一撮。〕三诊说：病缠三四年，至今秋才得肠腑通润，燥矢渐来，继以溏润，然后胃脉不致上逆，呕吐止而饮食进。可见阳明之病，以通为补也。今深秋燥令，痔必稍愈，仍宜柔养阳明，以期渐渐充复。〔党参三钱，橘皮钱半，茯苓二钱，制半夏一钱，麦冬（去心）钱半，秫米二钱，金石斛三钱，枣仁（炒研）二钱，生甘草四分，驴皮胶二钱，柿饼半枚，荷叶一角。〕
历代宰相通晓医理的，伊尹之后，狄梁公、陆忠宣公、范文正公就是，我朝山阳汪文端公也精通医理，他评吴鞠通《温病条辨》说：温热、湿温为本书两大纲。温热从口鼻吸受，并无寒症，最忌辛温表散，但当认定门径，勿与伤寒混杂，再能三焦投药，辨清气血营卫，不失先后缓急之序，便不致误 。湿温为三气杂感，浊阴弥漫，有寒有热，传变不一，全要细察兼证，辨明经络脏腑、气血阴阳，湿热二气，偏多偏少，方可论治。又说：热证清之则愈，湿证宣之则愈，重者往往宣之未愈，待其化热而后清，清而后愈。一为阳病，一兼阴病，难易较然。观此知公学识之精矣。
我的同乡孔行舟上舍广福善医，治外感尤精，曾说：噤口痢半因误药而成，医者治痢，辄用葛根，湿热提入阳明，遂至哕逆不食，变成险症，急投以黄连、干姜，庶克有济。我见近世治外感，不辨手足六经，辄用葛根、柴胡，温病遇之，鲜不轻者至重，重者至死，病家不识药性，以为疾不可治，而不知医实杀之也，可慨也夫！
《续名医类案》记载：鲍录饮年二十余，夏月至歙受热，鼻衄愈后，偶啖梨，遂得吐症，盖肝火而胃寒也。百治无效，闻说吐字则应声而呕，后至吴门就叶氏诊，以其脉沉细，令服附子理中汤，参、姜、附俱用三钱，服后出门，行及半里，觉头重目眩，急归寓，及门而仆，其尊人谙药性，谓必中附毒，亟煎甘草灌之，良久乃苏，后去附子，仍服三剂，吐转甚，再往诊，仍令服前方，遂改就薛氏，告以故，薛用六君子汤，服四剂无验，冬月感寒增咳，缠绵至夏，余偶访知则病剧，询知为向患吐，近复二便秘，已七八日不食，惟渴饮茶水，更医数人，或言令以艾灸脐，俱不应，请诊之，见其面色青悴，脉弦伏而寸上溢，谓此缘脾阴大亏，水火炽盛，又因久咳肺虚，肝无所畏，遂下乘脾而上侮胃，致成关格，幸脉不数，易治也，宜先平其肝，俾不上冲而吐止，斯肺得下降而便行，令以黄连、肉桂各五分，隔汤蒸服饮下，觉吐稍止，即能食糕数块，然二便胀不可支，令以大田螺一枚，捣烂，掩于丹田，以物系定，不超时，二便俱行，所下皆青色，遂霍然而愈，时甲戌五月二十七日也。（按：甲戌为乾隆十九年，叶天士卒于乾隆十年，诊疾者当是其后人，若出天士手，必不若是。）后以六味加减，入沙参、麦冬等，咳嗽亦止，向后常服养荣之剂，吐不复作。我按：鲍刊《名医类案》，魏为校正，鲍赋夕阳诗，魏亦和作，二人之交情，非比寻常，盖有由然矣。上元葛芝山布衣镛，少孤极贫，读书僧寺，遇异人援书一卷，乃岐黄家言，其方甚秘，习之以治者效如神。群小儿戏，一人张口而跳，蹶伏门限，舌断堕地，一人骑门限坐力猛，肾囊破，睾丸坠，葛悉为安之。自朝至日中，门庭如市，口讲手画无倦色，午后携百钱独游，或采药，或看花，或冒雨雪提酒 访知己。当道闻名，迎者沓至，则诡曰：葛某穷士，藉医苟话，实无伎俩，昨误杀人，群聚殴之，已遁矣。其志趣如此，尤精砭法，凡病赤游风，汗不得发，死者十八九，宜以血代汗，葛削竹夹瓷锋砭之，出血如珠，密排而不流立愈。盖轻则皮不破，重则肉伤，无第二手也。咸丰癸丑三月，贼陷金陵，胁为内医官，不从。十四日既夕，舁旧制两棺于厅事，出白金九锭，分赠邻里，且托身后事，遂与妻周氏纵饮沉醉，整衣冠，各入棺，呼其兄子盖而钉之，时夜将半，
My fellow townsman, Mr. Zhang Yunhuan (courtesy name Jiying, from Tongxiang County), possessed profound medical knowledge, and the door of his residence was often as crowded as a market with those seeking treatment. My cousin, Zhou Shixun, suffered from Summerheat disease in summer; after taking cooling Summerheat medicines twice, his condition deteriorated into a collapse syndrome. He was eventually cured by administering Bazhen Tang (Eight Treasure Decoction), a major tonic for replenishing Qi and Blood. His son, Tiehu Shangshe (name He), also had a mastery of medical principles and displayed exceptional courage and insight in diagnosis. A rural farmer suffering from asthma for over ten days without effect from medication sought treatment at their home. Mr. Zhang prescribed Xiao Qing Long Tang (Minor Green Dragon Decoction). The farmer hesitated, but Mr. Zhang said, "Take two doses of this medicine; if you still cannot lie down afterwards, I will gladly bear the responsibility." After the farmer left, his family was surprised by his bold statement. Mr. Zhang explained, "He has survived asthma for over ten days, which indicates it is not an Excess syndrome (a disease pattern characterized by strong pathogenic factors); what else could there be to doubt?" A few days later, the farmer returned, and indeed, his illness had subsided.
Hong Luyuan, a Xiaolian (Juren degree holder) from Linhai, mastered medical principles. He often stated that ancient formularies such as *Shanghan Lun* (Treatise on Cold Damage) and *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), along with modern clinical guides like *Linzheng Zhinan*, should be studied with concentration and deep exploration; only then can one achieve success in diagnosing and treating diseases. There were few good physicians in Taizhou Prefecture because they lacked direction, reading only basic primers like *Yaoxing Fu* (Ode to Drug Properties), *Tangtou Gekuo* (Song Formulas), and *Yizong Bixu*. Consequently, they often relied on ancient formulas to achieve efficacy. The son of Military Officer Wen suffered from Summerheat syndrome. Initially, he had slight aversion to cold, followed by high fever, sweating, belching, abdominal fullness, dry mouth, thirst, facial swelling, headache, and scanty urination and defecation. The physician used herbs such as Gegen (Kudzu Root), Jiegeng (Platycodon Root), Zhi Banxia (Prepared Pinellia), Bohe (Mint), Peilan (Eupatorium), Chi Ling (Red Poria), Tongcao (Tetrapanax Pith), Xingren (Apricot Seed), and Lugen (Reed Rhizome). The patient gradually developed shortness of breath and mental confusion. Hong Luyuan diagnosed the pulse as large and the tongue coating as yellow, identifying it as a Baihu Tang (White Tiger Decoction) syndrome. One dose reduced all symptoms significantly. He then switched to fresh Shihu (Dendrobium Stem), Huanglian (Coptis Rhizome), Sheng Gancao (Raw Licorice Root), Jinyinhua (Honeysuckle Flower), and Gualou Shi (Trichosanthes Fruit), leading to recovery. Zhang Mingjing suffered from Spring Warmth disease, with aversion to cold, fever, and throat ulceration. The doctor used Gancao (Licorice Root), Jiegeng (Platycodon Root), Jingjie (Schizonepeta), Fangfeng (Saposhnikovia Root), and Niubangzi (Arctium Fruit) without improvement. Hong Luyuan prescribed Huangqin Tang (Scutellaria Decoction) plus Lianqiao Qiao (Forsythia Husk) and Xingren (Apricot Seed), resulting in cure after one dose. This truly demonstrates the skillful use of ancient formulas!
My elder brother, Mr. Xingcha (name Han), loved learning in his youth. Due to frequent illnesses, he read medical books extensively and became proficient over time. He served as the magistrate of Hua County but retired due to old age. Poor and unable to return home, he practiced medicine in Shunde County, the provincial capital. The son of Magistrate Xu suffered from summer diarrhea. Treatment with cooling Summerheat and damp-draining medicines failed, progressing to fever, anorexia, fatigue, and weak respiration. Mr. Xu was elderly and had only this son, leaving him desperate. He invited my brother for treatment. My brother said, "This is caused by cold medicines damaging Spleen Yang, leading to Yang deficiency and impending collapse. You must administer warming medicines to save him." He prescribed Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction). Mr. Xu doubted and dared not take it. My brother said, "This is a critical juncture of life and death. The previous treatment was already a mistake; how can we make another? If this prescription fails, I will accept the blame." After taking the medicine, symptoms alleviated. Several doses led to complete recovery. Mr. Xu was overjoyed, gave generously from his purse, and sought help from colleagues, enabling his family to return home. My brother authored *Zhifang Zhuishuo* (Additional Remarks on Formula Preparation), which is circulated today.
Lü Cun Sima Zhenming from Qiantang served in Hubei with a reputation for good governance. Suddenly desiring to retire, he lived in Wumen (Suzhou) and treated many patients successfully. Tai Shi Pan Zunqi suffered from Jaundice (Dan Syndrome). Yinchen Tang (Artemisia Capillaris Decoction) was ineffective, and Pingwei San (Stomach-Calming Powder) also failed. He felt mud from the bottom of a well in his epigastrium and vomited even when rice water approached his lips. Lü diagnosed: "Dampness is present, but this is Cold-Dampness; it requires warming." He administered Wuling San (Five-Ingredient Powder with Poria) plus Fuzi (Aconite Root). Upon swallowing, the chest felt refreshed. The son of the Fang family suffered from severe Shanghan (Cold Damage). It was proposed to use Niuhuang Qingxin Wan (Calves' Calculus Clearing Heart Pill). Lü said, "The pathogen is in the Fu organs and clouding the Pericardium. Opening orifices here would be inviting thieves. We must urgently purge to preserve Yin." He prescribed Xilian Chengqi Tang (Rhino Horn and Coptis Purging Decoction), curing the patient after one dose. The daughter of the Ye family, aged one year, was critically ill. She lay supine with a chest prominence like a mound, moaning and rejecting pressure. Lü diagnosed this as Jie Xiong (Chest Binding) and prescribed Xiaoxianxiong Tang (Minor Intra-thoracic Unbinding Decoction), which worked immediately. Lü passionately loved medical texts, studying various schools but regarding Zhang Zhongjing as his master. He once said that Zhang's legislation for Shanghan allows differentiation via the Six Channels; thus, even complex cases are not misled by divergent paths, and miscellaneous diseases can be understood consistently. In practice, his inquiry and pulse-taking were precise and silent. He always drafted prescriptions, reviewing them for several moments before finalizing. When multiple family members were ill, he treated them tirelessly. In his leisure, he wrote treatises expounding Zhang's theories, authoring *Shanghan Xunyuan* (Tracing the Source of Cold Damage), which is published.
He Shutian Qiwei from Qingpu came from a family of physicians. Initially a student focusing on scholarship and poetry, he did not practice medicine. After his father, Mr. Yuanzhang, passed away, feeling the family profession needed succession, he began practicing and gained great fame. A surnamed Xu patient suffered from delirious heat and mania, possessing strength to jump over walls. He said, "This is a binding of pathogen and food retention." Indeed, the patient had eaten cold-water-soaked rice in intense heat and slept under a willow tree. He was cured by purging with Dahuang (Rhubarb Root) and Zhishi (Bitter Orange Fruit). A scholar from Jinze Town, unmarried past twenty, suffered from mania. Using modified Niuhuang Qingxin Wan, He instructed the family to cover the decoction pot with a woman's underwear while boiling. Two doses cured him. Disciples were puzzled. He said, "This is the method of Yin-Yang Exchange; I used it accidentally with success." He composed a poem on medical theory: "Treating disease and writing essays share the same principle. The patient is the topic, pulse-taking reveals the texture. Firm insight avoids hesitation, forming decisive action. Specific drugs for specific paths, no herb should be mixed up. A clear mind makes hands agile, familiar methods become convenient. New gains follow symptoms, why be hindered by them? Do you not see classical writers, constrained by myriad changes? This shows where his lifelong strength lies."
My cousin, Dr. Zhou Yili, studied medical principles deeply. He once treated the wife of Wang, a district official in Fenshui, who had spasmodic arms unable to lift, dark complexion, and a slow, deep pulse. Various medicines failed. He prescribed Huoluo Dan (Meridian-Unblocking Pill), which cured her after several doses. Later, he effectively treated similar cold-dampness cases involving arm and leg spasms/swelling. Zhang, a relative of Yili, suffered from weakness, anorexia, and amenorrhea for eight months. A famous Suzhou doctor named He diagnosed menstrual obstruction and prescribed blood-invigorating medicines. Yili diagnosed: "Six pulses are slippery and rapid, especially the Right Cun position. This is pregnancy, and likely a male child." He gave fetal-calming medicines. Four months later, she gave birth to a boy.
Niu Songquan, Dianzhuan (Top Scholar), son of Fu Bao, and Fengweng Fangding (Qinglan), excelled in surgery. They treated the poor for free, giving medicines and spending heavily on preparation, saving many critical cases. Dianzhuan loved Huangdi Neijing (Yellow Emperor's Inner Canon) texts. In Beijing, he frequently cured critical illnesses. He treated the mother of a fellow Jinshi graduate, an elderly woman with dysentery. Shaoyao Tang (Peony Decoction) failed, worsening her condition with fever and anorexia. He learned she had eaten much crab before onset. Pulse: Left wiry-rapid, Right rapid-weak. Tongue coating black in center. Abdominal pain relieved by pressure. Defying consensus, he insisted on hot medicines: Shu Fuzi (Prepared Aconite Root) 8 fen, Pao Jiang (Roasted Ginger) 1 qian, Baishao (White Peony Root) 1 qian, Wuzhuyu (Evodia Fruit) 5 fen, Jiao Baizhu (Charred Atractylodes Macrocephala Rhizome) 3 qian, Fuling (Poria) 3 qian, Rougui (Cinnamon Bark) 8 fen, Zhi Gancao (Honey-fried Licorice Root) 1 qian, Sharen (Amomum Fruit) 5 fen, Chenpi (Tangerine Peel) 5 fen, Shengjiang (Fresh Ginger) 2 slices. One dose reduced dysentery frequency and heat. Remove Wuzhuyu and Chenpi, add Dingxiang (Clove) and Muxiang (Costus Root). Two doses stopped dysentery. Switch to Buzhong Yiqi Tang (Middle-Warming and Qi-Boosting Decoction) plus Fuzi, Rougui, and Pao Jiang for complete recovery. Dianzhuan kept a case record book titled *Chunbing Ji* (Spring Ice Collection), implying caution.
Chen Mengqin Maocai Xishu from Wujiang lived in Luxu. His great-grandfather, a student named Ce, obtained a secret surgical formula from the Pan family and began practicing. Maocai was scholarly and respected in his youth. When his family declined, his mother urged him to learn the family trade for livelihood. He studied under his brother, Shangshe Xi Zeng, completing his training in a year. He recorded all his cases into 322 volumes, extracting key points into ten volumes to teach his nephews. His son-in-law, Scholar Shen Wozhi Dafu, selected these to compile *Records of Father-in-Law Mr. Chen's Disease Treatments*. Only the best cases are recorded here. One patient had his tongue protruding out of his mouth by more than an inch. Other doctors tried ancient methods using Dadou (Velvet Bean) smoke and Heart-Spleen clearing medicines without success. Mr. Chen ordered chicken comb blood applied to the tongue and had someone strike a bronze gong loudly behind the patient. Startled, the patient looked back, and the tongue retracted. Asked why, Mr. Chen said, "The tongue is the sprout of the Heart; the Heart governs blood. Use something of its kind. Chicken combs represent purity and gather essence. Striking the gong startles the Qi into the Heart, treating the root." (Note: Zhou Zhen treated a woman whose tongue remained out after childbirth by applying Cinnabar and having someone knock a broken pot against the wall to retract the tongue. This seems derived from that method.)
Mr. Chen prioritized the sequence of treatment. Once, amidst a crowd, he called a man forward and asked about his ailment, noting slight arm swelling. Looking closely at a small carbuncle, he whispered to companions, "This is a White Blade Carbuncle. Look at the white spot rising on his forehead. Go home quickly; danger is imminent." As the man left, the white spread to his mouth corner, and he died before reaching home. The Xu son, over twenty, could not move limbs, was drowsy, and worse after eating. Unknown diagnosis, Mr. Chen said, "I saw this in *Zhouhou Beiji Fang* (Emergency Prescriptions Kept in the Sleeve), called 'Grain Labor,' caused by lying down immediately after a full meal." He prescribed pills made of Chuanjiao (Sichuan Pepper), Ganjiang (Dried Ginger), and Bei Maiya (Roasted Barley Sprout), curing him.
An opium smoker had widespread eruptions, itching, skin peeling, daily confusion, and delirious speech. Mr. Chen said, "This is severe poisoning. Ordinary detoxification may fail." He used 1 liang of Zhusha (Cinnabar) ground with Hupo (Fossilized Wood/Amber), mixed with Xijiao (Rhino Horn) juice, and administered with Sandou Tang (Three Beans Decoction). Mental clarity returned instantly. Skin peeled off, causing unbearable pain. He then ground Changpu (Acorus Rhizome) and Ludou (Mung Bean) into powder, sprinkled it on mats, allowing the patient to sleep peacefully. Recovery occurred within half a month.
The Hu son suffered sore throat and shortness of breath, unable to swallow water. Some diagnosed Wind-Warmth, others Wind-Phlegm. Mr. Chen found fine, weak pulses, cold extremities, and a slippery Spleen pulse. He diagnosed Deficient-Cold Throat Bi and prescribed Lizhong Tang (Regulate the Middle Decoction). Observers were shocked. Mr. Chen said, "Administer urgently, or it will be too late. If ineffective, I bear the blame." The cup was finished, and the patient stabilized.
Zhang Menglu Xuebo Qianli from my county excelled in poetry and medicine. Living in Houzhu Village, hundreds of boats visited him daily. Half his income supported relatives and friends; he owned no property, only tens of thousands of books. Zang Shougong, a Xiaolian from Changxing with literary fame, tutored Zhang's sons and knew medicine. He asked Zhang, "Ye of Changzhou forbids Chaihu (Bupleurum Root); Xu of Wujiang mocks this. You rarely use it. Are you confused by Ye's view?" Zhang replied, "No. People in Jiangsu/Zhejiang often have dampness. Lightly using lifting agents inevitably causes Mingxuan (medication reaction/dizziness), delaying efficacy. Ye's words come from experience; Xu's are rigid. This explains Hejian's radical view that ancient methods shouldn't be blindly followed." Zang asked, "Why do you not use Sheng Yao (Ascending Medicines) for sores?" Zhang said, "Sheng Yao is the Five Poison Drugs of Han times. All sores relate to the Heart (Fire organ). Southern sores stem from Damp-Heat. Using harsh, refined hot medicines damages the Qi of the weak or increases heat/toxicity in the strong. Hence, they should not be used lightly." Zhang saved many lives. Notably, Gui from Huzhou suffered from Cold Hernia and retained fluid for four years. One formula worked immediately; three changes cured him completely. First visit: Liver Yang stagnation attacking Stomach, damaging Stomach Qi, losing harmonizing function. Liver stagnation gathers as Hernia; Stomach retention gathers as Fluid. Hernia moves below, Fluid overflows above. Bowels/bladder slowly open. Cold Hernia and Retained Fluid attack each other. Chronic case requires slow treatment. Emotional relief helps. [Fuling 3 qian, Guizhi 3 fen, Sheng Dongzhu 1.5 qian, Zhi Gancao 4 fen, Xiao Chuanlian 3 fen, Wuzhuyu (soaked) 3 fen, Ganjiang 3 fen, Zhi Banxia 1 qian, Zhishi (stir-fried) 5 fen, Baishao (wine-fried) 1.5 qian, Shengjiang 3 fen, Zhuru 7 fen.] Second visit: Cold Hernia/Fluid stuck in middle, disrupting Yangming. Intestines begin descending; dark/yellow hard stools pass freely. Accumulation clears. Intestines open, then Stomach harmonizes. Major turning point. Fluid/Hernia disturb Yangming. Lower blockage prevents upper reception/conduction. Basin full, spills over. Now focus on nourishing Stomach to restore function. Opportunity now. Hematuria/scanty urine also relate to Yangming. [Dangshen 3 qian, Ju Pi 1.5 qian, Fuling 2 qian, Zhi Banxia 1 qian, Maidong (cored) 1.5 qian, Huomaren 2 qian, Pa Xingren (peeled) 2 qian, Baijili (fried, thorns removed) 2 qian, Douwandou (fried, ground) 3 qian, Heima 3 qian, Shibing (roasted) half piece, Jingmi 1 pinch.] Third visit: Illness for 3-4 years, autumn finally moistened intestines. Dry stool comes, then loose. Stomach pulse stops reversing upward. Vomiting stops, appetite returns. Yangming disease benefits from unblocking as tonifying. Late autumn dryness, hemorrhoids improve. Continue nourishing Yangming gently. [Dangshen 3 qian, Ju Pi 1.5 qian, Fuling 2 qian, Zhi Banxia 1 qian, Maidong (cored) 1.5 qian, Shumi 2 qian, Jin Shihu 3 qian, Zaoren (fried, ground) 2 qian, Sheng Gancao 4 fen, Lupi Jiao 2 qian, Shibing half piece, Heye one corner.]
Historically, chancellors knowledgeable in medicine include Yi Yin, Di Lianggong, Lu Zhongxuan Gong, Fan Wenzheng Gong. In our dynasty, Wang Wendu Gong from Shanyang also mastered medicine. He commented on Wu Jutong's *Wenbing Tiaobian*: Warmth and Damp-Warmth are the two main outlines. Warmth enters via nose/mouth, has no cold signs, strictly avoids acrid-warm exterior-releasing, must distinguish from Cold Damage, use Three-Jiao medication, differentiate Qi/Blood/Ying/Wei, and maintain order of priority/emergency to avoid error. Damp-Warmth involves mixed pathogens, turbid Yin pervades, has cold/heat, variable transmission. Carefully observe accompanying signs, differentiate meridians/organs/Qi/Blood/Yin/Yang, and balance Damp/Heat ratios before treating. Heat cures with clearing; Damp cures with venting. Severe Damp may not cure with venting alone; wait for transformation to Heat, then clear. One is Yang disease, one involves Yin; difficulty differs clearly. This shows his precision.
Kong Xingzhou Shangshe Guangfu from my hometown excelled in external pathogens. He said: Jin Kou Li (Lockmouth Dysentery) often results from wrong medication. Doctors treating dysentery often use Gegen, lifting Damp-Heat into Yangming, causing hiccups/anorexia and dangerous conditions. Urgently administer Huanglian and Ganjiang to succeed. I see modern doctors treating external pathogens without differentiating Hand/Foot Six Channels, blindly using Gegen and Chaihu. For Warm Diseases, this turns mild to severe, severe to fatal. Families don't understand drug properties, thinking the disease is incurable, not knowing the doctor kills them. Tragic!
*Continued Cases of Famous Doctors* records: Bao Luyin, over twenty, caught heat in She in summer. After nasal bleeding healed, he ate a pear and developed vomiting. Liver Fire with Stomach Cold. Hundred treatments failed. Hearing the word 'vomit' triggered immediate emesis. Went to Ye in Wumen. Pulse deep/fine. Prescribed Fuzi Lizhong Tang with Renshen, Ganjiang, Fuzi at 3 qian each. After taking, walked half a li, felt heavy head/dizzy, rushed home, collapsed at the door. His father knew drugs, suspected Aconite toxicity, urgently boiled Gancao to灌 (force-feed). Revived after a long time. Removed Fuzi, took three more doses, vomiting worsened. Re-diagnosed, told to take original formula. Changed to Xue Meishi. Explained history. Xue used Liujunzi Tang. Four doses failed. Winter cold increased cough, lingering to summer. I visited, found severe illness. Previously vomiting, now constipation for 7-8 days, only drinking tea. Several doctors suggested moxa on navel, no effect. Diagnosed: Blue/pale face, wiry/deep pulse overflowing at Cun. Spleen Yin severely deficient, Water/Fire blazing. Chronic cough lung deficiency, Liver unrestrained, attacks Spleen/Stomach, causing Guan Ge (Obstruction/Regurgitation). Pulse not rapid, easy to treat. Calm Liver first to stop upward rush/vomiting, allowing Lung to descend/bowels to move. Prescribed Huanglian and Rougui 5 fen each, steamed in soup. Vomiting stopped slightly, ate cakes. But bowel/bladder distension unbearable. Ordered one large river snail, mashed, applied to Dantian, tied firmly. Within hour, bowels/bladder moved, excreting green matter. Recovered suddenly. Date: May 27, Ji Xu year (Qianlong 19). Ye Tian shi died in Qianlong 10, so this must be his descendant. If by Tian shi, he wouldn't act this way. Later, Liuwei Dihuang Wan modified with Shashen/Maidong stopped cough. Long-term Yangrong tonics prevented recurrence. Note: Bao published *Mingyi Leian*, Wei corrected it. They were close friends. Ge Zhishan Buyi Yong from Shangyuan was orphaned/poor, studied in a temple. Met a strange man who gave him a secret Huangdi Neijing text. Treatments were miraculous. Children playing: one jumped with open mouth, fell on threshold, tongue severed. Another sat on threshold, scrotum broke, testicle dropped. Ge treated all. Morning to noon, busy as market, teaching/drawing tirelessly. Afternoon, wandered with 100 coins, gathering herbs/flowers/visiting friends. Officials heard of him, welcomed him. He lied: "Ge is a poor scholar, faking skills, killed someone yesterday, fled." He valued freedom. Expert in Bian (stone needle) therapy. For Chiyou Feng (Cellulitis/Erysipelas) where sweat couldn't emerge (high mortality), he used bloodletting to replace sweat. Cut bamboo clamped with porcelain edge to prick, beads of blood flowed, cured immediately. Light cases didn't break skin; severe cases injured flesh, no second hand needed. In Xianfeng Gui Chou March, rebels took Jinling, forced him to be internal physician. Refused. 14th day evening, carried two old coffins to hall, gave 9 silver ingots to neighbors, settled affairs. Drank with wife Zhou until drunk, dressed properly, entered coffins, called nephew to nail shut. Time near midnight.