未深入耳。又问咳嗽与带下。既皆中虚所致。宜其病则俱病。治则俱治。何为咳嗽既见。而带下
未见耶。且咳嗽既愈。而带下反甚耶。岂其既能生我所生。而犹未能制我所制耶。曰。此则病之
见也。有先有后。医之治也。有次有序。缘土困则金即衰。故咳嗽先见。其不仅用补中而加白芍
五味者。以非补土无以生金。而补土又不可以不生金也。清升而浊始降。故带下后见。其不仅用
调中而加阿胶故纸者。以非崇土无以摄水。而崇土又不可以不摄水也。尤妙在重用人参与兼服六
味。盖非重用人参。则不能峻补其下。非兼服六味。则不能使水归其壑。所谓因其势而利导之。
使利机关而脾土健实也。揣东庄之意。大率如此。子以为何如。吴尹明子。十岁。患夜热二年余
。颌下忽肿硬如石。面黄。时时鼻衄如注。孟举致予看之。疑久病必虚。预拟
予用参术等方。予脉之。沉郁之气。独见阳关。曰。病敦阜也。用石膏藿香叶栀子仁防风黄连甘
草等。颌肿渐软。面黄复正。继用黄芩枇杷叶玄参枳壳山栀茵陈石斛天麦门冬生熟地黄等。重加
黄连。而衄血夜热悉除。孟举笑出所拟方。以为非所料云。
如遇此等脉症。即东庄亦未始不用寒凉。看黄叶村庄与东庄最契。其所用方。尚难预料。可
知寒热攻补。须凭所遇脉症。随宜而用。原未始先存成见也。乃有谓东庄派只一味好用温补者。
此不知东庄之言耳。知东庄者。其敢为此言乎。
从子在公妇。半产。恶露稀少。胸腹胀甚。脉之濡数。当重用参 。不然必崩。因力艰未服。
已而果崩溃不止。下血 如拳如碗大者无数。神气昏愦。两足厥冷至少腹。两手厥冷至肩。额鼻
俱如冰。头上汗如油。旋拭旋出。按其脉。至骨不得见。予投大剂补中益气汤加人参一两。未效
。急用人参一两。附子一两。炮姜二钱。浓煎灌之。至暮渐减。予戒曰。俟其手足温即停药。至
三鼓。手足尽温。崩亦止。家人忘予言。又煎前方进之。比晓。予往视。脉已出而无伦。痰忽上
涌。点水不能饮。入口即呕吐。并独参汤不能下。予曰。此过剂所致也。即投生地黄五钱。熟地
黄一两。当归芍药枸杞子各三钱。甘草一钱。浓煎与饮。病者意参饮尚吐。况药乎。不肯服。予
强之曰。试少饮。必不吐。进半瓯殊安。遂全与之。尽药而痰无半点。神气顿清矣。午后体发热
。予
曰。此血虚热恒理也。复用十全大补调而痊。
既因力艰。不能救虚于未崩之前。崩后见症。俱属虚上加寒。则非姜附不能挽矣。犹用前方
。止以救虚。此均是失之不及处。迨至三鼓手足尽温。则一阳之复于半子者。已遍达于四表矣。
乃又误进前剂。以致脉出无伦。痰涌呕吐。点水不入。不又失之过剂乎。举此可见临症制方。凡
前后次第。及轻重缓急。皆当合宜而用。若过与不及。无论方不对症也。即使对症。亦堪杀人。
其可畏如此。
吴维师内。患胃脘痛。叫号几绝。体中忽热忽止。觉有气逆左胁上。呕吐酸水。饮
食俱出。或疑停滞。或疑感邪。或疑寒凝。或疑痰积。予脉之弦数。重按则濡。盖火郁肝血燥耳
。与以当归芍药地黄柴胡枣仁山药山萸肉丹皮山栀茯苓泽泻顿安。唯胃口犹觉劣劣。用加味归脾
汤及滋肝补肾丸而愈。
列症中既云觉有气逆左胁上。呕吐酸水。则即不知脉。而第以症验之。已
明明是肝血燥痛矣。何诸医议论纷纭。茫无确见乎。想缘此症在四明东庄以前。无人阐明其义耳。
然试问四明东庄两家。从谁氏医案中参究得来耶。
家仲兄次女。年十四。新夏患感症。项强头痛身热。仲兄治之旋愈。惟热尚未解。至第七日
。予适候兄。命诊之。予曰。汗至解矣。不必药也。惟身凉当服补中益气汤加黄芩数帖。不则虑
其复耳。果得汗愈。遂不肯服
药。越数日果复。又二日。兄召予视。则体燥热甚。舌胎干黄口渴。遍身疼痛。举手足俱呼痛不
可忍。胸腹尤甚。脐上有块高起。如鹅子大。按之坚如石。痛欲死。兄曰。补之乎。下之乎。予
对曰。下之则死。补之则甚。第可润之耳。兄曰。得之矣。用人参地黄当归芍药甘草麦门冬枸杞
子丹皮煨姜饮之。即熟睡。醒觉寒 发战。汗沾被席。遂失脐腹硬块所在。痛止热解。翌日下黑
矢而愈。会得阴气外溢则得汗。阴血下润则便通之义。方知东庄此案中。第可润之一语之妙。
其下之则死。补之则甚二语。虽是端就此症而论。然足与景岳实而误补。不过增病。病增者可解
。虚而误攻。必先脱元。元脱者无救矣数语合璧也。一长姓者。好学深思士也。年十八。岁杪得
齿衄及手足心热。恍惚不宁。合目愈甚。盗汗胸前出如油。间或梦遗。或不梦而遗。伊芳叔录脉症
求方。予曰。脉不敢凭。据所示症。乃三焦包络火游行也。试用后方治之。方用连翘黄芩麦冬生
地丹皮丹参茯苓石斛滑石粉辰砂甘草白豆蔻仁等。服七剂而愈。及明年用功急迫。至夏其症复发
。就便医治。皆云不足症。用温补肾经及涩精等剂。服之日剧。又进温补肾经丸料斤许。愈剧。
至不能立。立则足腕下刺痛。见者汹汹。谓为弱症矣。始疑俗医之谬。乃驾舟就诊。予曰。尊体
虽羸而面色憔悴之中，精神犹在，已诊问曰。迫服何等汤剂，出示方予曰。生药补矣。何得不凶。且少年朴实人。
何必用温补。曰。手足心热奈何。曰。劳心人大抵如是。曰。梦泄则奈何。曰。梦泄人人各殊。
子乃心肾下交所致。与夫盗汗恍惚等。皆三焦包络之火游行而然。药宜清凉。遂用连翘生地黄芩
丹皮茯苓丹参甘草升麻石斛麦冬北五味灯草。服十余剂。又用麦冬熟地生地滑石石斛茯苓芍药丹
参神曲辰砂作丸。守服而愈。
血从齿缝中或牙龈中出。名曰齿衄。系阳明少阴之症。盖肾主骨。齿者骨之标。其龈则属胃
土。又上齿止而不动属土。下齿动而不止属水。凡阳明病者。口臭不可近。根肉腐烂。痛不可忍
。血出或如涌。而齿不动摇。其人必好饮。或多啖炙爆。肥甘豢养所致。内服清胃汤。外敷石膏
散。甚者服调胃承气汤。下黑粪而愈。或有胸虚热者。以补中益气加丹皮黄连亦得。少阴病者。口
不臭。但浮动或脱落出血。或缝中痛而出血。或不痛。此火乘水虚而出。服安肾丸而愈。余尝以
水虚有火者。用六味加骨碎补。无火者。八味丸加骨碎补。随手而应。外以雄鼠骨散敷之。齿动
复固。又小儿疳症。出血口臭肉烂者。芦荟丸主之。东庄此案。可为凡症属三焦包络之火游行者
。立一准绳。并可使惯用温补者。推而广之。不致误以此火认为无根之火。故从西塘治法备忘稿
中录存之。古人立一方。必有一旨。若近来医方。见某病即用某药。一方中必下数十味。直是一
纸药帐矣。案中生药补一语。快极。
新安许开雍。病齿上龈从耳根痛起。便苦楚不可耐。医用平胃降火药。日增剧。予诊之。关滞而
尺衰。授方以熟地黄为君。杜仲枸杞子女贞子甘草黄柏山药山茱萸为臣佐。其尊人青臣举以问医
曰。此方何如。医云。大谬不可服。问其谬状。曰。齿病为阳明之火。与肾何干。而俱用补肾药
耶。青臣曰。果尔。则吾知此方之妙矣。乃更邀予往视之。余曰。病见于上。而治当从下起。此
有步骤。不可责速效也。青臣曰。唯命。乃仍用前药数剂。继用人参白术茯神甘草白芍药枣仁远
志肉当归黄 牡丹皮。数剂。痛已减而未去也。予诊其两尺已应。右关以上皆平和。惟左关尚郁
塞。曰。今当为君立除之。遂用补中益气汤加龙胆草。即愈。后小发。复加减前方愈之。因嘱之
曰。此虽小疾。而其根在下。当谨调摄。无使频复也。青臣以为奇。亦令予诊。脉得风木之气太
过。法当即见痰症矣。微言之。未数日。夜间痰忽上涌。如中风状。遂复召予诊。脉洪弦而坚。
予曰。此类中风根也。今发幸轻。且精力尚强实。培脾土则风木自能退听。可无害也。但杜征南
所谓平吴之后。正烦圣虑耳。乃用六君子汤。合玉屏风散与之。数帖而愈。予谓宜连服百余帖。
及都气丸二三料。以绝其株 。俗儒阻之曰。服参过多。补住痰涎。祸不旋踵。不可从也。因犹
豫停止。然颇慎调摄。今幸无恙。症见齿上龈从耳根痛起。诊得关滞尺衰。在吾辈处此。必当投
以大甘露饮。去茵陈枳壳而加柴栀丹皮矣。乃始则不用甘露而用左归。继又不用逍遥而用归脾。
后复不用归脾而用补中。何令人莫测也。
然细按之。则见其主方之当。加味之精矣。
孟举仆钱姓者。患梦泄不止。夜热羸弱。予用甘温治之。梦泄顿愈。惟夜热未除。他医进清
凉之药。身大热。下利脓。腹痛不可忍。更医治痢。杂姜桂芩连。益野狼狈。下鲜血。或如屋漏。
或如猪肝。或如鱼脑汁。复迎予视。脉数大而坚。此挟虚感热。医不得次第。致血虚而毒盛也。
与当归丹皮芍药泽泻茯苓地黄。加黄连。数剂而痢止。时适与友人集公所。其家人驰至曰。顷忽
增一病患。小便内痛。点滴不能便。便后痛愈甚。正号呼床席。求急解之。予思良久。问痛连少
腹乎。曰否。予曰。吾知之矣。急归。取丸子两许。令急吞之。下咽少许时痛若失而便通矣。孟
举惊问何药。其神如是。则金匮肾气丸也。孟举曰。芩连桂附。两者冰炭。他人用之两败。而今
则两以奏功。何也。予曰。此所谓次第也。毒传脾肾。不先解之。而骤用姜桂。则其焰益张。不
得已用寒凉救之。热毒既去。虚症乃见。命门无气。肾将败矣。故急以桂附用之也。孟举曰。焉
知便痛非毒甚乎。予曰。毒甚则必下利仍频。体反加热矣。未有痢止身凉食进而毒甚者。故知其
非也。且毒甚而痛。乃火逼膀胱而致。则必痛连少腹。今少腹反不痛。故知其为肾气寒也。孟举
惊案称善。越数日。其人正饭。与人争谇。复大发热。此木抑土虚而食复也。与补中益气汤。热
渐退。但不寐。左横骨下坚硬。饭食过之俱有碍。适有医者过其门。令诊之。曰。伤寒心下痞。
不当用参术。孟举问予。予笑曰。渠辈惯误下人。故熟此症。予未尝妄
下。故不识也。孟举曰。吾固知其非。姑举为一噱耳。请问此何病也。曰。是为肝胀。曰。得毋
抑积停滞乎。曰。如所言。当连右骨下。曰。饮食不经于肝。过之而碍。何也。曰。肝怒则叶张
。右侵于胃。胃虚受侵。贲门侧寒。故碍也。经不云乎。肝大则逼胃迫咽。迫咽则苦膈中且胁下
痛。肝高则支贲切胁。 为息贲。此之谓也。乃以加味归脾汤吞八味丸。加补骨脂吴茱萸杜仲等
饮之而平。其反复辨症处。溯流穷源。既极精透。其次第用药处。得心应手。又甚神奇。此等案
一出。真可拓后学之心胸。扩群医之见解。识者谅不以予言为阿其所好也。 每验怒气易动者。
最多肝胀一症。其左胁骨下痛而有块。扁大如痞。实非痞也。乃肝叶血燥。不肯下垂故也。吾友
董两舟。夏月捣膏。劳力致感。头痛发热。服解表之药不效。其长君方白来问予。予曰。子不观
东垣脾胃论乎。服补中益气。加北五味麦冬自愈矣。如予言服之顿安。复起作劳。仍发热头痛。
别用清解药。增甚。予同叶御生往候之。四肢微冷。胸腹热甚。烦闷。腰坠下。少腹胀痛不能
小便。时旁观者谓重感风邪所致。力主发散。予曰。虚邪内郁。正以劳倦伤中。真气不足。不能
托之使尽出。又遇清凉。其火下逼膀胱。责及本藏。故然。安可攻也。请以滋肾饮子合生脉散与
之何如。御生论与予合。竟投之。得睡。醒热解小便通矣。留方补之而别。翌日方白至云。内热
时作。烦闷头痛。亦间发不尽去。予曰。余火未散。移热于上也。用软柴胡
人参白术黄连丹皮甘草茯神等而愈。
不能小便一症。除合补中合生脉症外。其余非寒结膀胱。即热逼膀胱所致。其辨验全在少腹
。如不能便而痛连少腹者为热。少腹不痛则为寒。故同见是症。而前案以益火取效。此案以滋水
得功。炎上润下。判若天渊。互相研究。愈见前辈因症制方一线不走之妙。
未几其内人亦病感症。久不瘳。予用清肝醒脾之药。病解复患疟。用六君子治之。不应。用
补中益气加半夏治之。又不止。予请再诊之。曰。得矣。此郁火为疟也。用龙脑叶贝母黄连丹皮
生白术茯神生芍药当归甘草陈皮柴胡即安。复用补中益气汤加黄连。数帖。遂健如常。经云。木
郁则达之。火郁则发之。加味逍遥散正所以透发郁火之的剂也。然此案不用山栀而用黄连者。以
山栀屈曲下行。不若黄连运用在上。尤能达心胃之郁也。其复用补中者。升木以培土也。其又加
黄连者。左金以平木也。前辈临一症必寻其源。处一方必求其当类如此。学人须逐案细心参究之。吾
友徐方虎。以妹病召予。病已浃旬矣。切其脉。弦而数。唇焦黑生皮如蝙蝠翅。剪去复生。齿枯
。舌黑如炭。中起刺。状如焦荔枝壳。体热痰急。予曰。此小柴胡症也。何遽至此。岂服苦寒攻
还没有深入理解罢了。又问到咳嗽和带下病。既然都是中气虚弱所致，那么发病时应该同时发病，治疗时应该同时治疗，为什么咳嗽出现了，而带下病却没有出现呢？况且咳嗽好了，带下病反而加重了呢？难道它能生成我所生成的（土生金），却还不能制约我所制约的（土克水）吗？回答说：这是病症的表现，有先有后；医生的治疗，有次序有步骤。因为脾土困顿，肺金就会衰弱，所以咳嗽先出现。治疗不仅用补中益气的方法，还加入白芍、五味子，是因为不补脾土就无法生养肺金，而补脾土的目的又在于生养肺金。清气上升，浊气才能下降，所以带下病后出现。治疗不仅用调理中焦的方法，还加入阿胶、故纸（补骨脂），是因为不崇厚脾土就无法摄纳水液，而崇厚脾土的目的又在于摄纳水液。尤其妙在重用人参并兼服六味地黄丸。如果不重用人参，就不能峻补下元；如果不兼服六味地黄丸，就不能使水液回归其正道。这就是所说的顺着病势而加以引导，使气机通畅而脾土健实。推测东庄先生的意思，大体就是这样。您认为如何？
吴尹明，十岁。患夜间发热两年多。颌下突然肿胀坚硬如石头，面色发黄，时常鼻出血像注水一样。孟举请我去看。我怀疑久病必然体虚，预先打算用党参、白术等方剂。我诊脉，沉郁之气独见于阳关穴部位（此处指尺脉或特定脉位，意指病邪深伏）。我说：这是病邪敦盛（邪气壅盛）。用石膏、藿香叶、栀子仁、防风、黄连、甘草等药。颌下的肿硬逐渐变软，面色恢复正常。接着用黄芩、枇杷叶、玄参、枳壳、山栀、茵陈、石斛、天冬、麦冬、生地黄、熟地黄等药，重用黄连，于是鼻血和夜间发热都消除了。孟举拿出他原先拟定的方子给我看，说没想到我会这样用药。
如果遇到这样的脉症，即使是东庄先生也未必不用寒凉药。看黄叶村庄与东庄先生最为投契，他所用的方子，也难以预料。可知寒热攻补，必须根据所遇到的脉症，随意而用，原本就不应该先存有成见。然而有人却说东庄派只用一味药喜欢温补，这是不了解东庄先生的言论啊。了解东庄先生的人，谁敢这样说呢？
从子在公的妻子，小产，恶露稀少，胸腹胀痛严重。诊脉濡数。应当重用人参，否则必定发生崩漏。因为家境艰难未能服药。不久果然崩溃不止，下血量无数，有的像拳头大，有的像碗大。神志昏沉迷糊，双脚冰冷直到小腹，双手冰冷直到肩膀，额头鼻子都像冰一样，头上出汗像油一样，刚擦掉又出来。按脉，重按至骨都摸不到脉搏。我投以大剂量补中益气汤加人参一两。没有见效。急忙用人参一两，附子一两，炮姜二钱，浓煎灌服。到傍晚症状逐渐减轻。我告诫家属说：等到手脚温暖就停药。到了三更天，手脚完全温暖，崩漏也停止了。家人忘记了我的话，又煎前面的药给病人喝。到了天亮，我去探望，脉象已经浮出但杂乱无章，痰突然上涌，连一点水都喝不下，入口即呕吐，连独参汤都喝不下去。我说：这是用药过量的后果。立即投生地黄五钱，熟地黄一两，当归、芍药、枸杞子各三钱，甘草一钱，浓煎给病人喝。病人心想喝参汤还要吐，何况是其他药呢？不肯服用。我强迫她说：试着少喝点，一定不会吐。喝了半碗后特别安稳，于是全部给她喝完。药吃完后痰没有半点，神志顿时清醒了。午后身体发热。我说：这是血虚发热的常理。再用十全大补汤调理而痊愈。
既然因为家境艰难，不能在崩漏之前救治虚损，崩漏后出现的症状，都属于虚证加上寒证，那么非用干姜、附子不能挽救。仍然用前面的方子，只是为了救虚，这都是失之于不及的地方。等到三更天手脚完全温暖，那么一阳之气复生于半夜，已经遍达于四肢体表。却又误进前面的药剂，导致脉象浮出无伦次，痰涌呕吐，滴水不进，这不又是失之于过量了吗？由此可以看出临症制方，凡前后的次第，以及轻重缓急，都应当合宜而用。如果过量或不足，无论方子是否对症，即使对症，也足以杀人。这真是令人敬畏啊。
吴维师的妻子，患胃脘痛，叫喊声几乎断绝，身体忽冷忽热，觉得有气逆冲向左胁，呕吐酸水，饮食都吐出来。有人怀疑是食积停滞，有人怀疑是感受外邪，有人怀疑是寒凝，有人怀疑是痰积。我诊脉弦数，重按则濡。这是火郁结、肝血燥所致。给予当归、芍药、地黄、柴胡、枣仁、山药、山萸肉、丹皮、山栀、茯苓、泽泻，顿时安宁。只是胃口还觉得不太好。用加味归脾汤及滋肝补肾丸而痊愈。
列出的症状中说觉得有气逆冲向左胁，呕吐酸水，那么即使不知道脉象，仅以症状验证，已经是明显的肝血燥痛了。为什么各位医生议论纷纷，茫然没有确切的见解呢？想是因为这个病症在四明东庄先生以前，没有人阐明其中的道理罢了。然而试问四明和东庄两家，是从谁的医案中参悟研究得来的呢？
家仲兄的次女，十四岁。初夏患感症，项强头痛身热。仲兄治疗她很快痊愈，只有热尚未解除。到了第七天，我正好去拜访兄长，让他叫我诊治。我说：汗出到解除了，不需要吃药了。只是身体凉下来后应当服用补中益气汤加黄芩几帖，不然担心复发。果然得汗而愈，于是不肯服药。过了几天果然复发。又过了两天，兄长召我去看，则身体燥热严重，舌苔干黄口渴，遍身疼痛，举手抬足都呼痛难忍，胸腹尤其严重，脐上有块高起，像鹅蛋大，按之坚硬如石头，痛得要死。兄长说：补它呢？还是攻下它呢？我对答说：攻下则死，补益则更严重。只可以润燥而已。兄长说：我明白了。用人参、地黄、当归、芍药、甘草、麦门冬、枸杞子、丹皮、煨姜煎服。立刻熟睡，醒来感觉寒冷战栗，汗湿被席，于是脐腹硬块消失，疼痛停止热退。第二天排黑便而痊愈。领会到阴气外溢则得汗，阴血下润则便通的意义，才知道东庄此案中“只可润之”这一句话的妙处。“下之则死，补之则甚”这两句话，虽然是针对这个病症而言，但也足以与景岳说的“实证误补，不过增加病情，病情增加的还可以解救；虚证误攻，必先脱失元气，元气脱失的无法挽救”这几句话相媲美。
一个姓一的长者，是好学深思的士人。十八岁，年底得了齿衄（牙龈出血）和手足心热，恍惚不安，闭眼更严重，盗汗胸前流出像油一样，偶尔梦遗，或者不梦而遗。他的叔叔记录脉症求方。我说：脉不敢凭信，根据所示的症状，是三焦包络之火游行所致。试用后方治疗。方用连翘、黄芩、麦冬、生地、丹皮、丹参、茯苓、石斛、滑石粉、辰砂、甘草、白豆蔻仁等。服七剂而愈。到了第二年用功急迫，到夏天病症复发。就近医治，都说是不足症，用温补肾经及涩精等药剂，服用后一天比一天严重。又进温补肾经丸料一斤左右，更加严重。到了不能站立，站立则足腕下刺痛，看见的人都惊慌，说是弱症。这才怀疑庸医的错误，于是驾船来就诊。我说：尊体虽然瘦弱，但在面色憔悴之中，精神还在。已诊问说：最近服了什么汤剂，出示方子给我看。我说：生药补益太过，怎么能不凶险。况且少年朴实之人，何必用温补。他说：手足心热怎么办。我说：劳心人大抵如此。他说：梦遗怎么办。我说：梦遗人人各不相同。你这是由于心肾不交所致。以及盗汗恍惚等，都是三焦包络之火游行所致。药物宜清凉。于是用连翘、生地黄、黄芩、丹皮、茯苓、丹参、甘草、升麻、石斛、麦冬、北五味子、灯草。服十余剂，又用麦冬、熟地、生地、滑石、石斛、茯苓、芍药、丹参、神曲、辰砂做成丸药，坚持服用而痊愈。
血从齿缝中或牙龈中出，名叫齿衄。属于阳明少阴的病症。大概肾主骨，牙齿是骨的标志，牙龈则属胃土。又上齿静止不动属土，下齿动而不止属水。凡是阳明病的，口臭不可靠近，牙根肉腐烂，痛不可忍，血出像涌出一样，而牙齿不动摇。其人一定喜好饮酒，或多吃烤炸、肥甘厚味滋养所致。内服清胃汤，外敷石膏散。严重的服调胃承气汤，排黑粪而愈。或者有胸中虚热的，用补中益气汤加丹皮、黄连也可以。少阴病的，口不臭，但牙齿浮动或脱落出血，或缝中痛而出血，或不痛。这是火乘水虚而出，服安肾丸而愈。我曾经对水虚有火的，用六味地黄丸加骨碎补；无火的，用八味丸加骨碎补，随手应验。外用雄鼠骨散敷之，牙齿松动重新坚固。又有小儿疳症，出血口臭肉烂的，芦荟丸主治。东庄此案，可以为凡是属于三焦包络之火游行的病症，立下一个标准，并可使习惯用温补的人，推而广之，不致错误地把这种火认为是无根之火。所以从西塘治法备忘稿中记录下来。古人立一方，必有一宗旨。若近来的医方，见某病就用某药，一方中必下数十味药，简直是一纸药账罢了。案中生药补这一句话，痛快极了。
新安许开雍，病齿上龈从耳根痛起，大便痛苦不堪忍受。医生用平胃降火药，日益加剧。我诊脉，关脉滞涩而尺脉衰弱。授方以熟地黄为君药，杜仲、枸杞子、女贞子、甘草、黄柏、山药、山茱萸为臣佐药。他的父亲青臣拿给医生看问：这个方子怎么样？医生说：大错不可服用。问其错误之处，说：齿病是阳明之火，与肾有什么关系，却都用补肾药呢？青臣说：果真如此，那我就知道这个方子的妙处了。于是再邀请我去看。我说：病表现在上面，而治疗应当从下面入手，这有步骤，不可以责求速效。青臣说：听您的命令。于是仍用前药几剂。接着用人参、白术、茯神、甘草、白芍药、枣仁、远志肉、当归、黄芪、牡丹皮。几剂后，疼痛已减轻但未去除。我诊两尺脉已应指，右关以上皆平和，只有左关尚郁塞。我说：现在应当为您除去这个隐患。于是用补中益气汤加龙胆草，立刻痊愈。后来小发作，又加减前方治愈。于是嘱咐他说：这是小病，但其根在下，应当谨慎调养，不要使它频繁复发。青臣觉得很奇怪，也让我诊脉。脉得风木之气太过，法度上应当立即出现痰症了。我委婉地说，没过几天，夜间痰突然上涌，像中风的样子，于是又召我去诊。脉洪弦而坚。我说：这类是中风之根。现在发作幸好轻，而且精力尚强实，培补脾土则风木自然能退让听从，可以无害。但这正如杜征南所说，平定吴国之后，正烦圣虑罢了。于是用六君子汤，合玉屏风散给他。几帖而愈。我建议连续服用百余帖，以及都气丸二三料，以绝其病根。俗儒阻止说：服参过多，会补住痰涎，祸患马上就到，不可听从。因此犹豫停止。然而颇谨慎调养，如今幸好无恙。症见齿上龈从耳根痛起，诊得关滞尺衰，在我们这一辈处理这种情况，必定会投以大甘露饮，去掉茵陈、枳壳而加柴胡、山栀、丹皮。然而开始不用甘露而用左归丸，接着又不用逍遥散而用归脾汤，后来又不用归脾汤而用补中益气汤。多么让人莫测啊。
然而仔细分析，则看到其主方的恰当，加味的精细了。
孟举的仆人钱姓者，患梦泄不止，夜间发热羸弱。我用甘温法治疗，梦泄顿时痊愈。只有夜间发热未除。其他医生进清凉药，身体大热，下利脓血，腹痛不可忍。换医生治痢疾，杂用姜、桂、芩、连，更加狼狈。下鲜血，有的像屋漏，有的像猪肝，有的像鱼脑汁。又迎我去看。脉数大而坚。这是挟虚感热，医生不得次第，导致血虚而毒盛。给予当归、丹皮、芍药、泽泻、茯苓、地黄，加黄连。几剂而痢止。当时正好与友人在公所集会，他的家人跑来说：刚才忽然增加一个病患，小便内痛，点滴不能便，便后痛更严重，正在床席上号呼，请求紧急解决。我想了好久，问痛连少腹吗？回答说：否。我说：我知道了。急忙回去，取丸子两许，令其急吞。下咽少许时候，痛若消失而便通了。孟举惊讶地问是什么药，竟然神效如此。原来是金匮肾气丸。孟举说：芩连桂附，两者如冰炭。别人用之两败，而现在则两次奏功，为什么呢？我说：这就是所谓的次第。毒传脾肾，不先解之，而骤用姜桂，则其焰更张。不得已用寒凉救之，热毒既去，虚症乃见，命门无气，肾将败矣。所以急以桂附用之。孟举说：怎么知道便痛不是毒甚呢？我说：毒甚则必下利仍频，体反加热。未有痢止身凉食进而毒甚的。所以知道不是。且毒甚而痛，乃是火逼膀胱所致，则必痛连少腹。今少腹反不痛，所以知道其为肾气寒。孟举惊案称善。过了几天，那人正在吃饭，与人争吵，又大发高热。这是木抑土虚而食复。给予补中益气汤，热渐退。但不寐，左横骨下坚硬，饭食经过都有阻碍。适有医者路过其门，让我诊脉。说：伤寒心下痞，不当用参术。孟举问我，我笑着说：他们惯于误下人，所以熟悉此症。我未曾妄下，所以不认识。孟举说：我本来就知道不是，姑且举为一笑罢了。请问这是什么病？我说：这是肝胀。难道不是郁积停滞吗？我说：如所言，应当连右骨下。他说：饮食不经于肝，经过而有阻碍，为什么呢？我说：肝怒则叶张，右侵于胃，胃虚受侵，贲门侧寒，所以阻碍。经不云乎：肝大则逼胃迫咽，迫咽则苦膈中且胁下痛。肝高则支贲切胁，为息贲。此之谓也。于是以加味归脾汤吞八味丸，加补骨脂、吴茱萸、杜仲等煎服而平。其反复辨症处，溯流穷源，既极精透。其次第用药处，得心应手，又甚神奇。此类案一出，真可拓后学之心胸，扩群医之见解。识者谅不以予言为阿其所好也。每验怒气易动者，最多肝胀一症。其左胁骨下痛而有块，扁大如痞，实非痞也。乃肝叶血燥，不肯下垂故也。吾友董两舟，夏月捣膏，劳力致感，头痛发热。服解表之药不效。其长君方白来问我。我说：你不看东垣脾胃论吗？服补中益气，加北五味、麦冬自愈。如予言服之顿安。复起作劳，仍发热头痛。别用清解药，增甚。我与叶御生前往问候。四肢微冷，胸腹热甚，烦闷，腰坠下，少腹胀痛不能小便。时常旁观者谓重感风邪所致，力主发散。我说：虚邪内郁，正以劳倦伤中，真气不足，不能托之使尽出。又遇清凉，其火下逼膀胱，责及本藏，故然。安可攻也。请以滋肾饮子合生脉散与之何如？御生论与予合，竟投之。得睡，醒热解小便通矣。留方补之而别。翌日方白至云：内热时作，烦闷头痛，亦间发不尽去。我说：余火未散，移热于上也。用软柴胡、人参、白术、黄连、丹皮、甘草、茯神等而愈。
不能小便一症，除合补中合生脉症外，其余非寒结膀胱，即热逼膀胱所致。其辨验全在少腹。如不能便而痛连少腹者为热，少腹不痛则为寒。故同见是症，而前案以益火取效，此案以滋水得功。炎上润下，判若天渊。互相研究，愈见前辈因症制方一线不走之妙。
不久其妻子也病感症，久不愈。我用清肝醒脾之药，病解复患疟。用六君子治之，不应。用补中益气加半夏治之，又不止。我请再诊之。说：得矣。此郁火为疟也。用龙脑叶、贝母、黄连、丹皮、生白术、茯神、生芍药、当归、甘草、陈皮、柴胡即安。复用补中益气汤加黄连。数帖，遂健如常。经云：木郁则达之，火郁则发之。加味逍遥散正所以透发郁火之的剂也。然此案不用山栀而用黄连者，以山栀屈曲下行，不若黄连运用在上，尤能达心胃之郁也。其复用补中者，升木以培土也。其又加黄连者，左金以平木也。前辈临一症必寻其源，处一方必求其当类如此。学人须逐案细心参究之。吾友徐方虎，以妹病召予。病已浃旬矣。切其脉，弦而数。唇焦黑生皮如蝙蝠翅，剪去复生。齿枯。舌黑如炭，中起刺，状如焦荔枝壳。体热痰急。我说：此小柴胡症也。何遽至此。岂服苦寒攻
It has not been understood deeply enough. [The patient] asked again about cough and leukorrhea. Since both are caused by deficiency of the Middle Jiao (Middle Burner/Spleen-Stomach), it should be that when the disease occurs, both occur, and when treated, both are treated. Why does the cough appear while the leukorrhea does not? Moreover, why does the leukorrhea worsen after the cough heals? Could it be that [the Spleen] can generate what I generate (Earth generates Metal), yet still cannot control what I control (Earth controls Water)? The reply was: This is a manifestation of the disease; there is an order of precedence in appearance. Medical treatment also has a sequence and steps. Because when Earth is constrained, Metal inevitably declines, so the cough appears first. The reason for not only using Middle-Jiao tonification but also adding White Peony Root (Bai Shao) and Schisandra Berry (Wu Wei Zi) is that without tonifying Earth, one cannot generate Metal, and tonifying Earth must aim at generating Metal. When Clear Qi ascends, Turbid Qi can descend, so the leukorrhea appears later. The reason for not only regulating the Middle but also adding Donkey-Hide Gelatin (E Jiao) and Psoralea Fruit (Gu Zhi/Bu Gu Zhi) is that without strengthening Earth, one cannot grasp Water, and strengthening Earth must aim at grasping Water. What is particularly ingenious is the heavy use of Ginseng Root (Ren Shen) combined with taking Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). Without heavy use of Ginseng Root, one cannot vigorously tonify the Lower Jiao (Lower Burner/Kidneys); without taking Liuwei Dihuang Wan, one cannot cause Water to return to its proper channel. This is what is meant by "following the momentum and guiding it advantageously," making the mechanism smooth and the Spleen-Earth solid. I speculate Dongzhuang's intention was roughly like this. What do you think?
Wu Yinming, aged ten, suffered from night fever for over two years. Suddenly, the submandibular area became swollen and hard as stone, the face was yellow, and epistaxis (nosebleed) occurred frequently like pouring water. Mengju invited me to examine him. Suspecting that chronic illness must involve deficiency, I initially planned to use formulas containing Codonopsis Root (Dang Shen) and Atractylodes Rhizome (Bai Zhu). Upon palpating the pulse, I found stagnant Qi uniquely visible at the Yangguan position (referring to the Chi pulse or deep pulse position indicating deep-seated pathology). I said: This is an excess condition (pathogenic factors are robust). I used Gypsum (Shi Gao), Agastache Leaf (Huo Xiang Ye), Gardenia Seed (Zhi Zi Ren), Saposhnikovia Root (Fang Feng), Coptis Rhizome (Huang Lian), and Licorice Root (Gan Cao). The submandibular swelling gradually softened, and the facial color returned to normal. Subsequently, I used Scutellaria Root (Huang Qin), Loquat Leaf (Pi Pa Ye), Scrophularia Root (Xuan Shen), Aurantium Fruit (Zhi Ke), Gardenia Fruit (Shan Zhi), Imperata Rhizome (Yin Chen), Dendrobium Stem (Shi Hu), Ophiopogon Tuber (Tian Men Dong), Ophiopogon Tuber (Mai Men Dong), Rehmannia Root (Sheng Di Huang), and Prepared Rehmannia Root (Shu Di Huang), heavily adding Coptis Rhizome (Huang Lian). Consequently, the epistaxis and night fever were completely eliminated. Mengju showed me the formula he had originally prescribed, saying he did not expect such treatment.
When encountering such pulse and symptom patterns, even Dongzhuang would not necessarily avoid using cold/cooling herbs. Observing that Huangye Village and Dongzhuang were most compatible, their prescriptions are difficult to predict. Thus, it can be known that cold/hot, attacking/tonifying methods must be applied according to the encountered pulse and symptoms, without preconceived notions. However, some claim that the Dongzhuang school only likes to use warm-tonifying herbs. This is ignorance of Dongzhuang's words. Those who know Dongzhuang, how dare they say this?
Congzi's wife experienced a miscarriage, with scant lochia, and severe chest and abdominal distension/pain. Palpation revealed a soggy (Ru) and rapid (Shu) pulse. Heavy use of Ginseng Root (Ren Shen) was indicated; otherwise, metrorrhagia (Beng Lou) would certainly ensue. Due to financial hardship, she did not take the medicine. Soon, indeed, bleeding collapsed uncontrollably, with blood loss countless, some clots the size of a fist, others the size of a bowl. Spirit and Qi were confused and dull; both feet were cold up to the lower abdomen, both hands cold up to the shoulders; forehead and nose were ice-cold; sweat on the head was oily, appearing immediately after wiping. Palpation of the pulse revealed it could not be felt even pressing to the bone. I administered a large dose of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with one tael of Ginseng Root (Ren Shen). There was no effect. Urgently, I used one tael of Ginseng Root (Ren Shen), one tael of Aconite Root (Fu Zi), and two qian of Processed Ginger (Pao Jiang), decocted strongly and灌 (forced fed). By evening, symptoms gradually decreased. I warned: Stop the medication once the hands and feet become warm. By the third watch (midnight), hands and feet were fully warm, and bleeding stopped. The family forgot my warning and decocted the previous prescription again. By dawn, I went to visit. The pulse had emerged but was chaotic/disordered; phlegm suddenly surged upward; not even a drop of water could be swallowed, vomiting immediately upon entry; even Dushen Tang (Single Ginseng Decoction) could not go down. I said: This is caused by overdosing. Immediately, I administered five qian of Raw Rehmannia Root (Sheng Di Huang), one tael of Prepared Rehmannia Root (Shu Di Huang), three qian each of Angelica Sinensis Root (Dang Gui), White Peony Root (Shao Yao), and Goji Berry (Gou Qi Zi), and one qian of Licorice Root (Gan Cao), decocted strongly and given to drink. The patient thought, "I vomit even when drinking Ginseng, how can I tolerate other medicines?" and refused to take it. I insisted: Try drinking a little, it definitely will not cause vomiting. After drinking half a bowl, she felt very comfortable, so I gave her the rest. After finishing the medicine, there was not a bit of phlegm, and her spirit and clarity instantly recovered. In the afternoon, her body became hot. I said: This is the normal principle of heat due to Blood deficiency. I used Shiquan Dabu Tang (Ten Significant Tonifying Decoction) to regulate and cure her.
Since, due to financial hardship, the deficiency could not be rescued before the collapse, the symptoms seen after the collapse all belonged to deficiency compounded with cold. Therefore, only Ginger and Aconite could save her. Using the previous formula only aimed at saving deficiency; this was a failure of insufficient treatment. By the third watch, when hands and feet were fully warm, the recovery of One Yang (vital Qi) at midnight had already reached the four extremities. Yet, mistakenly advancing the previous agent led to a chaotic pulse, surging phlegm, vomiting, and inability to ingest water. Was this not a failure of excessive treatment? From this, it can be seen that in clinical prescription, the sequence of prior and subsequent steps, as well as severity and urgency, must be appropriate. Whether excessive or insufficient, regardless of whether the formula matches the syndrome, even if it matches, it can kill people. How terrifying this is!
Wu Weishi's wife suffered from stomach pain, crying out until nearly breathless. Her body fluctuated between hot and cold sensations. She felt Qi counterflowing up the left hypochondrium, vomiting sour water, with food and drink being expelled. Some suspected food stagnation, some suspected pathogenic invasion, some suspected cold coagulation, some suspected phlegm accumulation. Palpation revealed a wiry (Xuan) and rapid (Shu) pulse, which became soggy (Ru) upon heavy pressure. This indicated Fire stagnation and Liver Blood dryness. I prescribed Angelica Sinensis Root (Dang Gui), White Peony Root (Shao Yao), Rehmannia Root (Di Huang), Bupleurum Root (Chai Hu), Ziziphus Seed (Zao Ren), Chinese Yam (Shan Yao), Cornus Fruit (Shan Yu Rou), Moutan Bark (Dan Pi), Gardenia Fruit (Shan Zhi), Poria (Fu Ling), and Alisma Rhizome (Ze Xie). She was instantly relieved. Only the appetite remained poor. I used Jiawei Guipi Tang (Modified Restore the Spleen Decoction) and Zigan Bushen Wan (Nourish Liver and Tonify Kidney Pills) to cure her.
The listed symptoms mentioned feeling Qi counterflowing up the left hypochondrium and vomiting sour water. Even without knowing the pulse, verifying solely by symptoms clearly indicates Liver Blood dryness pain. Why did the various doctors debate endlessly without a definite view? I suppose because before Siming Dongzhuang, no one had elucidated this meaning. However, asking whom the Siming and Dongzhuang schools learned from in medical cases?
My elder brother's second daughter, aged fourteen, contracted a febrile disease in early summer with neck stiffness, headache, and body heat. My brother treated her, and she quickly recovered, except the heat had not resolved. On the seventh day, I happened to visit my brother and was asked to diagnose. I said: Sweating leads to resolution; no medicine is needed. However, once the body cools, she should take Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Scutellaria Root (Huang Qin) for several doses, otherwise, recurrence is feared. Indeed, she recovered through sweating and refused to take medicine. Several days later, she indeed recurred. Two days later, my brother summoned me. Her body was extremely dry and hot, tongue coating dry and yellow, thirsty, whole-body pain, unbearable when moving limbs, especially in chest and abdomen. Above the navel, a mass protruded, goose-egg sized, hard as stone upon pressure, causing excruciating pain. My brother asked: Tonify or purge? I replied: Purging leads to death; tonifying worsens it. Only moistening is possible. My brother said: I understand. I prescribed Ginseng Root (Ren Shen), Rehmannia Root (Di Huang), Angelica Sinensis Root (Dang Gui), White Peony Root (Shao Yao), Licorice Root (Gan Cao), Ophiopogon Tuber (Mai Men Dong), Goji Berry (Gou Qi Zi), Moutan Bark (Dan Pi), and baked Ginger (Wei Jiang) decocted. She fell into a deep sleep. Waking, she felt cold and shivered, sweat soaking the bedding. The umbilical/abdominal hard mass disappeared, pain stopped, and heat resolved. The next day, she passed black stool and recovered. I realized the meaning: when Yin Qi overflows outward, sweating occurs; when Yin Blood moistens downward, bowel movements clear. Only then did I appreciate the brilliance of Dongzhuang's phrase "only moistening is possible" in this case. "Purging leads to death, tonifying worsens it" applies to this specific case but also aligns with Jingyue's statement: "Excess mistaken tonification merely increases disease, which can be resolved; deficiency mistaken purging first depletes Yuan Qi, which cannot be saved." These statements complement each other.
A surnamed Yi, a scholar fond of deep study, aged eighteen, developed gingival bleeding (Chi Nu) and heat in palms/soles at year-end. He was agitated and restless, worse with eyes closed. Night sweats on the chest flowed like oil. Occasional nocturnal emission, or emission without dreams. His uncle recorded pulse/symptoms seeking a prescription. I said: I dare not rely on the pulse. Based on the symptoms, this is Fire wandering in the Sanjiao and Pericardium. Try the following formula: Forsythia Fruit (Lian Qiao), Scutellaria Root (Huang Qin), Ophiopogon Tuber (Mai Dong), Raw Rehmannia Root (Sheng Di), Moutan Bark (Dan Pi), Salvia Root (Dan Shen), Poria (Fu Ling), Dendrobium Stem (Shi Hu), Talc (Hua Shi), Cinnabar (Chen Sha), Licorice Root (Gan Cao), Cardamom Seed (Bai Dou Kou Ren). Seven doses cured him. Next year, under intense study pressure, symptoms recurred in summer. Local doctors called it deficiency, using warm-kidney-tonifying and essence-astringing agents. Condition worsened daily. Another jin of warm-kidney pills made it worse. He could not stand; standing caused stabbing pain below ankles. Onlookers panicked, calling it a weak condition. Doubting quacks' errors, he took a boat to see me. I said: Though emaciated, your complexion shows spirit remains. I asked: What decoctions have you taken? Show me the formula. I said: You used raw tonifying herbs excessively, hence the danger. Moreover, a young, honest person need not use warm tonics. He asked: What about palm/sole heat? I said: Mental laborers generally have this. He asked: What about nocturnal emission? I said: Emission varies per person. Yours is due to Heart-Kidney non-interaction. Night sweats and agitation are all due to Fire wandering in Sanjiao/Pericardium. Medication should be cooling. I prescribed Forsythia Fruit (Lian Qiao), Raw Rehmannia Root (Sheng Di Huang), Scutellaria Root (Huang Qin), Moutan Bark (Dan Pi), Poria (Fu Ling), Salvia Root (Dan Shen), Licorice Root (Gan Cao), Cimicifuga Rhizome (Sheng Ma), Dendrobium Stem (Shi Hu), Ophiopogon Tuber (Mai Dong), Schisandra Berry (Bei Wu Wei Zi), and Juncus Effusus (Deng Cao). Ten doses. Then Mai Dong, Shu Di, Sheng Di, Hua Shi, Shi Hu, Fu Ling, Shao Yao, Dan Shen, Shen Qu, Chen Sha made into pills. Continued use cured him.
Bleeding from tooth gaps or gums is called Gingival Bleeding (Chi Nu). It belongs to Yangming and Shaoyin syndromes. Kidney governs bones; teeth are the exterior of bones. Gums belong to Stomach Earth. Upper teeth are static (Earth); lower teeth move (Water). Yangming disease features foul breath, rotting gum tissue, unbearable pain, gushing blood, but stable teeth. Patients usually love alcohol or eat fried/fatty foods. Internal: Qingwei Tang. External: Shigao San. Severe cases: Tiaowei Chengqi Tang, passing black stool cures. Chest deficiency heat: Buzhong Yiqi Tang plus Dan Pi, Huang Lian works. Shaoyin disease features no foul breath, floating/loose teeth, bleeding from gaps or painless bleeding. Fire exploits Water deficiency. Anshen Wan cures. I used Liuwei Dihuang Wan plus Gusuibu (Drynaria Rhizome) for Water deficiency with Fire; Bawei Wan plus Gusuibu for no Fire. Externally, Xiongshugu San applied stabilizes loose teeth. Pediatric malnutrition with bleeding/foul breath/rotting flesh: Lu Hui Wan cures. Dongzhuang's case sets a standard for Fire wandering in Sanjiao/Pericardium, warning against mistaking this fire for rootless fire. Recorded from Xitang's notes. Ancient formulas have intent; modern ones list dozens of herbs like a pharmacy bill. The phrase "raw herbs tonify too much" is refreshing.
Xu Kaiyong of Xin'an suffered from upper gum pain starting from the ear root, unbearable defecation pain. Doctors used Pingwei and Fire-clearing herbs, worsening daily. Pulse: Guan stagnant, Chi deficient. Formula: Prepared Rehmannia Root (Shu Di Huang) as Sovereign; Eucommia Bark (Du Zhong), Goji Berry (Gou Qi Zi), Privet Fruit (Nv Zhen Zi), Licorice Root (Gan Cao), Phellodendron Bark (Huang Bai), Chinese Yam (Shan Yao), Cornus Fruit (Shan Zhu Yu) as Ministers/Assistants. His father Qingchen asked a doctor: "How is this?" Doctor: "Great error, do not take. Tooth disease is Yangming Fire, what does it have to do with Kidney? Why use Kidney tonics?" Qingchen: "If so, I know its brilliance." Invited me back. I said: Disease manifests above, treat from below. Steps matter, do not demand quick results. Qingchen agreed. Previous herbs for several doses. Then Ren Shen, Bai Zhu, Fu Shen, Gan Cao, Bai Shao, Zao Ren, Yuan Zhi, Dang Gui, Huang Qi, Mu Dan Pi. Pain reduced but persisted. Pulse: Chi responsive, Guan peaceful, Left Guan still stagnant. I said: Now remove the sovereign issue. Prescribed Buzhong Yiqi Tang plus Longdan Cao. Cured. Minor relapse, adjusted formula cured. Advised: Small disease, root is below, careful regulation prevents recurrence. Qingchen amazed, asked for pulse. Wind-Wood Qi excessive, phlegm syndrome expected. I hinted. Days later, night phlegm surge like stroke. Pulse: Hong, Xuan, Jian. I said: Stroke root. Mild now, strong vitality. Tonify Spleen Earth, Wind-Wood yields. Like Du Zhengnan's "after pacifying Wu, worry remains." Used Liujunzi Tang + Yupingfeng San. Cured. Recommended 100+ doses, Duqi Wan. Confucians blocked: "Too much Ginseng traps phlegm, disaster follows." Hesitated. Careful regulation kept him safe. Case: Gum pain from ear root, Guan stagnant/Chi deficient. We would use Daganyin Tang minus Yin Chen/Zhi Ke, plus Chai Hu/Shan Zhi/Dan Pi. But started with Zuogui Wan, then Guipi Tang, then Buzhong Yiqi Tang. Unpredictable! Yet, analyzing closely, the main formula was apt, additions precise.
Mengju's servant, surnamed Qian, suffered continuous nocturnal emission, night fever, emaciation. I used sweet-warm method; emission stopped. Night fever persisted. Other doctors used cooling herbs; high fever, dysentery with pus, unbearable abdominal pain. Another doctor treated dysentery with mixed Ginger/Cinnamon/Huang Qin/Huang Lian; worse. Fresh blood, like roof leaks, pig liver, fish brain juice. Summoned me. Pulse: Shu, Da, Jian. Deficiency with Heat-Toxin. Doctors lacked sequence, causing Blood deficiency and toxin excess. Dang Gui, Dan Pi, Shao Yao, Ze Xie, Fu Ling, Di Huang, plus Huang Lian. Dysentery stopped. At that time, family rushed: New patient, painful urination, dropsy, worse after voiding, screaming. I asked: Pain radiates to lower abdomen? No. I said: I know. Went home, took two xu of pills, forced swallowing. Pain ceased, urination resumed. Mengju shocked: What medicine? Golden Standard Kidney Qi Pill (Jinkui Shenqi Wan). Mengju: Huang Qin/Lian vs Gui/Fu are ice/fire. Others fail, you succeed twice. Why? I: Sequence. Toxin spreads to Spleen/Kidney. Not resolving first, sudden Ginger/Cinnamon fuels fire. Forced to use cold to save. Heat-toxin gone, deficiency appears, Mingmen Qi lost, Kidney failing. Hence urgent Gui/Fu. Mengju: How know pain isn't toxin excess? I: Toxin excess causes frequent dysentery, body heats. Rarely dysentery stops, body cools, appetite returns, yet toxin excess. Also, toxin pain implies Fire forcing Bladder, radiating to lower abdomen. Here, lower abdomen painless, so Kidney Qi Cold. Mengju praised. Days later, eating, arguing, high fever. Wood suppressing Earth deficiency, food recurrence. Buzhong Yiqi Tang. Fever subsided, insomnia, hardness below left inguinal region, obstruction during digestion. Passing doctor diagnosed: Taiyang Shaoyang complex, "Stomach fullness, do not use Ren/Bai." Mengju asked me. I laughed: They habitually misuse purgatives, so they know this. I never misuse, so I don't recognize it. Mengju: I knew it wasn't, just joking. What is it? I: Gan Zhang (Liver Distension). Is it stagnation? I: As you say, right bone area. Food doesn't pass through Liver, why obstruction? I: Liver anger expands leaves, invades Stomach right. Stomach deficiency accepts invasion, cardia side cold, hence obstruction. Classic: Liver large presses Stomach/throat, causing chest/hypochondriac pain. Liver high presses cardia/ribs, causing Xi Ben. Used Jiawei Guipi Tang swallowing Bawei Wan, plus Buguzhi, Wuzhuyu, Duzhong. Calmed. Analysis traced source precisely. Medication sequence magical. Expands learners' minds. Anger-prone often have Gan Zhang. Left hypochondriac pain/mass, flat like fullness, actually Liver leaf Blood dryness, refusing to descend.
Friend Dong Liangzhou, summer, grinding paste, labor-induced contraction, headache/fever. Exterior-releasing herbs failed. Son Fangbai asked. I said: Read Dongyuan's Pi Wei Lun? Buzhong Yiqi Tang plus Bei Wu Wei Zi, Mai Dong cures. Took as advised, instantly calm. Returned to labor, fever/headache returned. Cooling/clearing herbs worsened. With Ye Yusheng visited. Limbs slightly cold, chest/abdomen very hot, irritability, lumbar heaviness, lower abdominal distension/pain, unable to urinate. Bystanders blamed wind-pathogen, advocated dispersal. I said: Deficient pathogen internal stagnation, labor injures Middle, True Qi insufficient to expel. Cooling drives Fire down to Bladder, affecting Root Organ. How can we attack? Use Zishen Yinzi + Shengmai San? Yusheng agreed. Administered. Slept, woke, heat resolved, urination resumed. Left formula, parted. Next day Fangbai: Intermittent internal heat, irritability/headache persist. I said: Residual fire unscattered, shifting heat upward. Ruan Chai Hu, Ren Shen, Bai Zhu, Huang Lian, Dan Pi, Gan Cao, Fu Shen. Cured.
Inability to urinate: Except matching Buzhong/Shengmai patterns, it's either Cold binding Bladder or Heat forcing Bladder. Differentiation lies in lower abdomen. Pain radiating to lower abdomen = Heat; no pain = Cold. Same symptom, previous case used Fire-benefiting (Yi Huo), this case used Water-nourishing (Zi Shui). Fire rises, Water moistens down, vast difference. Studying together reveals predecessors' precision in prescribing based on symptoms.
Soon his wife contracted febrile disease, lingering. I used Liver-clearing/Spleen-awakening herbs. Disease resolved, then malaria. Liujunzi failed. Buzhong Yiqi + Banxia failed. Re-diagnosed: Depressed Fire causing malaria. Longnao Ye, Bei Mu, Huang Lian, Dan Pi, Sheng Bai Zhu, Fu Ling, Sheng Shao Yao, Dang Gui, Gan Cao, Chen Pi, Chai Hu. Calmed. Buzhong Yiqi + Huang Lian. Healthy. Classic: "Wood depression, reach it; Fire depression, emit it." Jiawei Xiaoyao San emits depressed Fire. Used Huang Lian instead of Shan Zhi because Shan Zhi descends曲折, Huang Lian operates upper, reaching Heart/Stomach depression better. Reusing Buzhong raises Wood to tonify Earth. Adding Huang Lian uses Left Metal to calm Wood. Predecessors seek source for every symptom, match formula appropriately. Learners must study carefully.
Friend Xu Fanghu summoned for sister's illness, duration ten days. Pulse: Xuan, Shu. Lips scorched black, peeling like bat wings, regrowing. Teeth dry. Tongue black as charcoal, prickly like scorched lychee shell. Body heat, urgent phlegm. I said: Xiao Chai Hu Tang syndrome. How did it reach this? Did you take bitter-cold attacking...