虞恒德治一妇。年四十余。夜间发热。早晨退。五心烦热无休止时。半年后。虞诊六脉
皆数。伏而且牢。浮取全不应。与东垣升阳散火汤四服。热减大半。胸中觉清快胜前。再与
二帖。热悉退。后以四物加知母、黄柏。少佐炒干姜。服二十余帖愈。
震按夜热脉数。的系阴虚。因其脉伏且牢。浮取不应。故用升阳散火得效。仍以阴药收
功。然阴药用六味地黄及二地二冬必不效。妙在芎、归合知、柏。及从治之炒干姜也。
王仲阳治一妇。壮年。每患头痛腹痛。十指酸痛。心志纷纭。鼻息粗甚。其脉甚大。盖
欲近男子不可得也。俗谓之花风。王以凉膈散、青木香丸。互换疏导三五次。更服三黄丸。
泻三焦之火。数日而愈。曾有火旺遗精者。亦用前丸散而愈。
薛立斋治沈大尹不时发热。日饮冰水数碗。寒药二剂。热渴益甚。形体日瘦。尺脉洪而
数。时或无力。王太仆曰。热之不热。责其无火。寒之不寒。责其无水。又云。倏热往来。
是无火也。时作时止。是无水也。法当补肾。用加减八味丸。不月而愈。
汪石山治一人。年逾三十。神色怯弱。七月患热淋。诸药不效。至十一月行房方愈。正
月复作。亦行房而愈。三月伤寒。咳嗽有痰。兼事烦恼。延至十月少愈。后复作。服芦吸散
而愈。但身热不解。因服小便。腹内膨胀。小腹作痛。后又因晚卧。左胁有气触上。痛不能
睡。饮食减半。四肢无力。食则腹胀痛或泻。兼胸膈饱闷。口舌干燥。夜卧盗汗。从腰以下
常
冷。久坐腰痛脚软。手心常热。诊左手心脉浮数而滑。肾肝二脉沉弱颇缓。右手肺脉虚浮而
快。脾脉偏弦而快。命门散弱而快。次日再诊。心肝二脉细软。稍不见快矣。肾脉过于弱。
肺脉浮软。亦不见快。脾脉颇软。命门过浮。略坚。汪曰。膀胱者。津液之府。气化出焉。
淋者由气馁不能运化。故津液郁结为热而然也。房后而愈者。郁结流利而热自解矣。三月天
日和煦。何得伤寒。多由肺气不足。莫能护卫皮毛。故为风邪所袭。郁热而动其肺。以致痰
嗽也。得芦吸散而愈者。以辛温豁散痰与热也。嗽止身热不退者。由嗽久肺虚。虚则脾弱。
脾肺之气不能荣养皮毛。故热作也。经曰。形寒饮冷则伤肺。又曰。脾胃喜温而恶寒。今服
小便之寒凉。宁不愈伤其脾肺耶。是以腹胀作痛。胁气触上。或泻或汗。种种诸病。皆由损
其脾肺也。时或变易不常者。亦由气血两虚。虚而为盈。难乎有常矣。遂用参、 各二钱。
茯苓、白术一钱。归身、牛膝七分。浓朴、陈皮、木香、甘草各五分。薄桂三分。煎服二十
余帖。诸证悉退。后因梳头劳倦。诸证复作。汪诊脉与前颇同。但不数不驶耳。仍用参、
各三钱。麦冬、归身、浓朴、枳实、甘草等剂。愈。
震按王用寒泻。薛用温纳。汪用平补。乃治火热法三大纲也。故火门旧案甚多。特选此
一人七月病上辰昏晕。下午不言。昏睡一日不醒。人叫不应。身凉不食。不寒不热。皆
曰阴证。议用理中四逆。周慎斋诊其脉。沉小带伏。曰。内有火邪也。故小便一二日不解。
延至夜不醒。周曰。此真火也。其妻曰。前日房事。如何是火。周曰。夜有房事。内虚又劳
热甚。夫干热从虚入。则阴气将绝。以水救之则可。取冷水一桶。饮至五碗。病者曰渴。
饮至七碗。大汗如雨。病者曰饿。吃粥一碗。用补中益气汤加炮姜、泽泻。温中泻冷水而愈
慎斋又治一妇。五月间身凉。自言内热。水泻二月。一日数次。小水绝无。大便俱水。
自言上热极。下冻死。腰腿足俱冷。腹痛如冰。或一时发热。不欲近衣。或一时怕冷。遍身
尽热。夜至天明。面目红肿。药之不愈。六脉洪大。此伏火也。火性炎上。故上热下冷耳。
用四物汤加柴胡、葛根、升麻、甘草、栀子、黄芩、黄柏。二帖。小水行。泻止。复发牙疼
三日不愈。用黄 建中汤加附子。一服。
一妇六月卒死。遍体俱冷。无汗。六脉俱伏。三日不醒。但气未绝耳。众用四逆理中。
亦不能纳。四日后。慎斋诊之。仍无脉。念人一二日无脉立死。今三日不死。此脉伏也。热
极似寒耳。用水湿青布放身上。一时身热。遂饮冷水五六碗。反言渴。又一碗。大汗出。后
用补中益气加黄柏。十帖愈。
震按慎斋之治上热下寒。腹痛如冰。粗工必引立斋治韩州同之例矣。乃与虞公升阳散火
汤同轨合辙。此等案必须合看则有益。至如饮以冷水。覆以湿布。亦是试火之真假也。
石顽治太史张宏蘧。精气下脱。虚火上逆。怔忡失血证。诊其右关独弦。左尺微数。余
皆微细搏指。明系阴火内伏之象。诊后详述去冬劳心太过。精气滑脱。加以怵惕恐惧。怔忡
惊悸不宁。都门之医。峻用人参、桂、附。至岁底稍可。交春复剧如前。遂乞假归吴。吴门
诸医。亦用参、附导火归源。固敛精气之药。略无一验。转觉委顿。稍稍用心。则心系牵引
掣痛。痛连脊骨对心处。或时痛引膺胁。或时巅顶如掀。或时臂股手足指甲皆隐隐作痛。怔
忡状如碓杵。控引头中。如失脑髓之状。梦中尝自作文。觉时成篇可记。达旦倦怠睡去。便
欲失精。精去则神魂如飞越之状。观其气色鲜泽。言谈 。总属真元下脱。虚阳上扰之候
细推脉证。始先虽属阳气虚脱。过饵辛温峻补。致阳暴亢而反耗真阴。当此急宜转关。以
救垂绝之阴。为疏二方。煎用保丸合四君。丸用六味合生脉。服及两月后。诸证稍平。但倦
怠力微。因自检方书。得补中益气汤。为夏月当用之剂。于中加入桂、附二味。一啜即喉痛
声喑。复邀诊候。见其面颜精采。而声音忽喑。莫解其故。询之乃尊。知为升麻桂附升动虚
阳所致。即以前方倍生脉服之。半月后。声音渐复。日渐向安。但起居调摄。殊费周折。衣
被过暖。便咽喉痰结。稍凉则背微畏寒。或啜热饮。则周身大汗。怔忡走精。此皆宿昔过用
附。余热内伏而寻出路也。适有石门董载臣。谓其伏火未清。非芩、连不能解散。时值嘉
平。不敢轻用苦寒。仲春载臣复至。坐俟进药。服数剂。形神爽朗。是后坚心服之。至初夏
反觉精神散乱。气不收摄。乃复就正于予。予谓桂、附汤药。火毒之性。方能上升。得参
以濡之。故可久伏下焦。与龙潜水底不异。若究其源。惟滋肾丸一方为正治。但既经芩、连
之于上。岂堪复受知、柏侵伐于下乎。况自春徂夏不离苦寒。苦先入心。必从火化。何敢兼
用肉桂。引动虚阳。发其潜伏之性哉。端本澄源。仍不出六味合生脉。经岁常服。不特壮水
制阳。兼得金水相生之妙用。何惮桂、附之余毒不化耶。
震按此案甚平庸。然辨证明晰。用药纯正。亦可为后学之津梁矣。较之汪石山案。深浅
虞恒德治疗一位妇女，四十多岁。夜间发热，早晨退热。五心烦热没有停止的时候。半年后，虞诊察六脉都数，脉象伏而且牢，轻取完全不应指。给予东垣的升阳散火汤服用四剂，热势减轻大半，胸中觉得清爽舒适胜过以前。再服用两帖，热完全消退。后来用四物汤加入知母、黄柏，稍微佐以炒干姜，服用二十多帖痊愈。
俞震按语：夜热脉数，确实是阴虚。因为她的脉伏且牢，浮取不应，所以用升阳散火汤得以见效。仍然用滋阴药收功。然而如果用六味地黄丸及二地（生地、熟地）、二冬（天冬、麦冬）必定无效。妙在川芎、当归配合知母、黄柏，以及反治法的炒干姜。
王仲阳治疗一位妇女，壮年。每次患头痛腹痛，十指酸痛，心志纷乱，鼻息粗重。他的脉象很大，大概是想要亲近男子却不可得。俗称为花风。王用凉膈散、青木香丸，交替疏导三五次，再服用三黄丸，泻三焦之火，几天而愈。曾有因火旺遗精的人，也用前面的丸散而愈。
薛立斋治疗沈大尹不时发热。每天喝几碗冰水，服用寒凉药两剂，热渴更加严重，形体日渐消瘦。尺脉洪大而数，有时无力。王太仆说：热之不热，责其无火；寒之不寒，责其无水。又说：忽冷忽热往来，是无火；时作时止，是无水。法度应当补肾，用加减八味丸，不到一个月而愈。
汪石山治疗一个人，三十多岁，神色怯弱。七月患热淋，各种药物无效。到十一月行房事才痊愈。正月又发作，也是行房事而愈。三月患伤寒，咳嗽有痰，兼有烦恼，拖延到十月稍好。后来又发作，服用芦吸散而愈。但身体发热不退，因为服用了小便，腹内膨胀，小腹作痛。后来又因为晚上睡觉，左胁有气触上，痛不能睡，饮食减半，四肢无力，进食则腹胀痛或腹泻，兼有胸膈饱闷，口舌干燥，夜间盗汗。从腰以下常冷，久坐腰痛脚软，手心常热。诊左手心脉浮数而滑，肾肝二脉沉弱颇缓，右手肺脉虚浮而快，脾脉偏弦而快，命门散弱而快。次日再诊，心肝二脉细软，稍不见快了。肾脉过于弱，肺脉浮软，也不见快了。脾脉颇软，命门过浮，略坚。汪说：膀胱是津液之府，气化由此而出。淋证是因为气馁不能运化，所以津液郁结为热而然。房事后而愈的，是因为郁结流利而热自解了。三月天气暖和，怎么会得伤寒？多由肺气不足，不能护卫皮毛，所以被风邪所袭，郁热而动其肺，以致痰嗽。得到芦吸散而愈的，是因为辛温豁散痰与热。咳嗽止身热不退的，是因为咳嗽久了肺虚，虚则脾弱，脾肺之气不能荣养皮毛，所以热作。经书说：形寒饮冷则伤肺。又说：脾胃喜温而恶寒。现在服用小便的寒凉，难道不更加损伤脾肺吗？因此腹胀作痛，胁气触上，或泻或汗，种种诸病，都是由损伤脾肺所致。时而变易不常的，也是由于气血两虚，虚而为盈，难乎有常了。于是用人参、白术各二钱，茯苓、白术一钱（注：原文此处可能有误，前文已列人参、白术，此处疑为重复或笔误，依原文翻译），归身、牛膝七分，厚朴、陈皮、木香、甘草各五分，薄桂三分，煎服二十多帖，诸证悉退。后来因为梳头劳倦，诸证复发。汪诊脉与前大致相同，只是不数不疾罢了。仍用人参、白术各三钱，麦冬、归身、厚朴、枳实、甘草等剂，痊愈。
俞震按语：王用寒泻，薛用温纳，汪用平补，这是治火热法的三个大纲。所以火门的旧案很多，特选此一人。
七月病，上午昏晕，下午不言语，昏睡一天不醒，人叫不应，身凉不食，不寒不热，都说阴证，议论用理中四逆。周慎斋诊其脉，沉小带伏，说：内有火邪。所以小便一二日不解，延至夜不醒。周说：这是真火。他的妻子说：前几天房事，怎么是火？周说：夜里房事，内虚又劳热甚。夫干热从虚入，则阴气将绝，以水救之则可。取冷水一桶，饮至五碗，病者说渴，饮至七碗，大汗如雨，病者说饿，吃粥一碗，用补中益气汤加炮姜、泽泻，温中泻冷水而愈。
慎斋又治疗一位妇女，五月间身凉，自言内热，水泻二月，一日数次，小水绝无，大便俱水，自言上热极，下冻死，腰腿足俱冷，腹痛如冰，或一时发热，不欲近衣，或一时怕冷，遍身尽热，夜至天明，面目红肿，药之不愈，六脉洪大，这是伏火。火性炎上，所以上热下冷。用四物汤加柴胡、葛根、升麻、甘草、栀子、黄芩、黄柏，两帖，小水行，泻止。又发牙疼三日不愈，用黄芪建中汤加附子，一服。
一位妇女六月卒死，遍体俱冷，无汗，六脉俱伏，三日不醒，但气未绝。众人用四逆理中，也不能纳。四日后，慎斋诊之，仍无脉。念人一二日无脉立死，今三日不死，此脉伏也，热极似寒耳。用水湿青布放身上，一时身热，遂饮冷水五六碗，反言渴，又一碗，大汗出。后用补中益气加黄柏，十帖愈。
俞震按语：慎斋之治上热下寒，腹痛如冰，粗工必引立斋治韩州同之例矣。乃与虞公升阳散火汤同轨合辙。此等案必须合看则有益。至如饮以冷水，覆以湿布，亦是试火之真假也。
石顽治疗太史张宏蘧，精气下脱，虚火上逆，怔忡失血证。诊其右关独弦，左尺微数，余皆微细搏指，明系阴火内伏之象。诊后详述去冬劳心太过，精气滑脱，加以怵惕恐惧，怔忡惊悸不宁。都门之医，峻用人参、桂、附，至岁底稍可，交春复剧如前，遂乞假归吴。吴门诸医，亦用参、附导火归源，固敛精气之药，略无一验，转觉委顿。稍稍用心，则心系牵引掣痛，痛连脊骨对心处，或时痛引膺胁，或时巅顶如掀，或时臂股手足指甲皆隐隐作痛，怔忡状如碓杵，控引头中，如失脑髓之状。梦中尝自作文，觉时成篇可记，达旦倦怠睡去，便欲失精，精去则神魂如飞越之状。观其气色鲜泽，言谈，总属真元下脱，虚阳上扰之候。细推脉证，始先虽属阳气虚脱，过饵辛温峻补，致阳暴亢而反耗真阴。当此急宜转关，以救垂绝之阴。为疏二方，煎用保元丸合四君，丸用六味合生脉。服及两月后，诸证稍平，但倦怠力微。因自检方书，得补中益气汤，为夏月当用之剂，于中加入桂、附二味，一啜即喉痛声喑。复邀诊候，见其面颜精采，而声音忽喑，莫解其故。询之乃尊，知为升麻桂附升动虚阳所致。即以前方倍生脉服之，半月后，声音渐复，日渐向安。但起居调摄，殊费周折。衣被过暖，便咽喉痰结，稍凉则背微畏寒，或啜热饮，则周身大汗，怔忡走精。此皆宿昔过用附子，余热内伏而寻出路也。适有石门董载臣，谓其伏火未清，非芩、连不能解散。时值嘉平，不敢轻用苦寒。仲春载臣复至，坐俟进药，服数剂，形神爽朗。是后坚心服之，至初夏反觉精神散乱，气不收摄，乃复就正于予。予谓桂、附汤药，火毒之性，方能上升，得参以濡之，故可久伏下焦，与龙潜水底不异。若究其源，惟滋肾丸一方为正治。但既经芩、连之于上，岂堪复受知、柏侵伐于下乎？况自春徂夏不离苦寒，苦先入心，必从火化，何敢兼用肉桂，引动虚阳，发其潜伏之性哉？端本澄源，仍不出六味合生脉。经岁常服，不特壮水制阳，兼得金水相生之妙用，何惮桂、附之余毒不化耶？
俞震按语：此案甚平庸，然辨证明晰，用药纯正，亦可为后学之津梁矣。较之汪石山案，深浅
Yu Hengde treated a woman in her forties. She had fever at night which subsided in the morning, and constant heat in the five centers (palms, soles, and chest) without cessation. Half a year later, Yu palpated all six pulses as rapid (Shu, rapid pulse). The pulses were deep (Fu, deep pulse) and firm (Lao, firm pulse), and completely unresponsive to light pressure (Fu Qu, superficial palpation). He prescribed Dong Yuan's Sheng Yang San Huo Tang (Ascending Yang and Dispersing Fire Decoction) for four doses. The fever reduced by more than half, and she felt much clearer and more comfortable in the chest than before. After two more doses, the fever completely subsided. Later, he prescribed Si Wu Tang (Four Substances Decoction) with added Zhi Mu (Anemarrhenae Rhizoma) and Huang Bo (Phellodendri Cortex), slightly supplemented with Chao Gan Jiang (Stir-fried Gingeris Rhizoma). After taking more than twenty doses, she recovered.
Yu Zhen commented: Night fever with a rapid pulse is indeed Yin Deficiency (Yin Xu). Because her pulses were deep and firm, and unresponsive to superficial palpation, using Sheng Yang San Huo Tang was effective. He concluded treatment with Yin-nourishing herbs. However, if Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) or Er Di (Sheng Di Huang, Shu Di Huang) and Er Dong (Tian Dong, Mai Dong) were used, it would certainly be ineffective. The brilliance lies in combining Xiong (Chuan Xiong) and Gui (Dang Gui) with Zhi Mu and Huang Bo, along with the counter-treatment method of Chao Gan Jiang.
Wang Zhongyang treated a young woman who suffered from headache and abdominal pain each time, soreness and pain in the ten fingers, mental agitation, and coarse breathing. Her pulse was very large. It was likely due to an unfulfilled desire for sexual intimacy. This condition is commonly known as Hua Feng (Flower Wind). Wang alternately administered Liang Ge San (Cool the Chest Powder) and Qing Mu Xiang Wan (Green Musk Pill) three to five times for dredging and guiding, followed by San Huang Wan (Three Yellows Pill) to drain Fire from the San Jiao (Triple Burner). She recovered in a few days. A patient with seminal emission due to excessive Fire also recovered using the aforementioned pills and powders.
Xue Lizhai treated Shen Dayin, who had intermittent fever. He drank several bowls of ice water daily and took two doses of cold-natured medicines, yet the heat and thirst worsened, and his body became increasingly emaciated. The Chi (Cun Cun) pulse was surging (Hong, flooding pulse) and rapid, sometimes weak. Wang Taipu stated: "If heat cannot be warmed, blame the lack of Fire; if cold cannot be cooled, blame the lack of Water." He further said: "Sudden alternating hot and cold indicates lack of Fire; intermittent onset and cessation indicates lack of Water." The method should be to tonify the Kidney. He prescribed Jia Jian Ba Wei Wan (Modified Eight-Ingredient Pill). She recovered within a month.
Wang Shishan treated a man over thirty years old, presenting with timid spirit and weak demeanor. In July, he suffered from Hot Lin (Heat-type Strangury), to which various medicines were ineffective. He recovered after sexual intercourse in November. The condition recurred in January and resolved again after intercourse. In March, he contracted Shang Han (Cold Damage), with cough and phlegm, accompanied by vexation. It improved slightly by October but recurred later. He recovered after taking Lu Xi San (Reed Root Powder). However, body heat persisted. Due to consuming urine, his abdomen became distended, and the lower abdomen hurt. Later, while sleeping at night, Qi rose from the left hypochondrium, causing pain that prevented sleep. Food intake halved, limbs were weak, eating caused abdominal distension and pain or diarrhea, accompanied by chest fullness, dry mouth and tongue, and night sweats. From the waist down, he was often cold. Prolonged sitting caused lower back pain and soft legs. His palms were often hot. Palpation of the Left Hand showed Xin (Heart) pulse floating, rapid, and slippery; Shen (Kidney) and Gan (Liver) pulses were deep, weak, and slow. The Right Hand showed Fei (Lung) pulse deficient, floating, and fast; Pi (Spleen) pulse slightly wiry and fast; Ming Men (Gate of Life) pulse scattered, weak, and fast. On the second day, Xin and Gan pulses were fine and soft, no longer fast. Shen pulse was excessively weak. Fei pulse was floating and soft, no longer fast. Pi pulse was quite soft. Ming Men pulse was overly floating, slightly firm. Wang said: The Bladder is the mansion of fluids, where Qi transformation occurs. Lin syndrome arises because Qi deficiency fails to transport and transform, causing fluid stagnation turning into Heat. Recovery after intercourse occurred because stagnation flowed freely, resolving the Heat. In March, when weather was warm, how could one contract Cold Damage? It is mostly due to Lung Qi deficiency, unable to protect the skin and hair, thus attacked by Wind pathogen. Stagnant Heat disturbed the Lung, leading to phlegm and cough. Recovery with Lu Xi San was due to its acrid-warm nature dispersing Phlegm and Heat. Cough stopped but heat remained because prolonged coughing damaged Lung Yin, making Spleen weak. Spleen and Lung Qi failed to nourish the skin and hair, causing heat. The Classics state: "External cold and cold drinks injure the Lung." Also: "The Spleen and Stomach prefer warmth and dislike cold." Now, consuming the cold nature of urine must further injure the Spleen and Lung. Therefore, abdominal distension and pain, Qi rising in the hypochondrium, diarrhea or sweating, and various other diseases are all due to damaging the Spleen and Lung. Occasional irregular changes are due to both Qi and Blood deficiency; deficiency transforming into excess makes consistency difficult. Thus, he prescribed Ren Shen (Ginseng Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) 2 qian each, Fu Ling (Poria) and Bai Zhu 1 qian, Dang Gui (Angelicae Sinensis Radix) and Niu Xi (Achyranthis Bidentatae Radix) 7 fen, Hou Po (Magnoliae Officinalis Cortex), Chen Pi (Citri Reticulatae Pericarpium), Mu Xiang (Aucklandiae Radix), and Gan Cao (Glycyrrhizae Radix et Rhizoma) 5 fen each, Hou Po (Cinnamomi Ramulus) 3 fen. After taking more than twenty doses, all symptoms subsided. Later, due to fatigue from combing hair, symptoms recurred. Wang palpated the pulse, similar to before but not rapid or hurried. He still prescribed Ren Shen and Bai Zhu 3 qian each, Mai Dong (Ophiopogonis Tuber), Dang Gui, Hou Po, Zhi Shi (Aurantii Fructus Immaturus), and Gan Cao. She recovered.
Yu Zhen commented: Wang used cold-draining, Xue used warm-consolidating, and Wang used mild-tonifying. These are the three main principles for treating Fire disorders. Therefore, there are many old cases in the Fire section. I specifically selected this one.
In July, a patient suffered illness, fainting in the morning, not speaking in the afternoon, sleeping deeply for a day without waking, unresponsive to calling, body cool, refusing food, neither cold nor hot. Everyone diagnosed it as Yin Syndrome and discussed using Li Zhong Wan (Regulate the Middle Pill) and Si Ni Tang (Frigid Extremities Decoction). Zhou Shenzhai palpated the pulse: deep, small, and submerged. He said: "There is internal Fire pathogen." Hence, urination was absent for one or two days, extending to unconsciousness at night. Zhou said: "This is True Fire." His wife asked: "Sexual activity the previous day, how can it be Fire?" Zhou said: "Nighttime sexual activity, internal deficiency combined with labor-induced heat. Dry Heat enters through deficiency, causing Yin Qi to nearly perish. Using Water to rescue it is appropriate." They took one bucket of cold water, drinking five bowls. The patient said he was thirsty, drank seven bowls, broke into profuse sweat like rain, said he was hungry, ate one bowl of porridge, and was cured using Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Pao Jiang (Prepared Gingeris Rhizoma) and Ze Xie (Alismatis Rhizoma) to warm the middle and drain the cold water.
Shenzhai also treated a woman in May. Her body was cool, but she complained of internal heat. She had watery diarrhea for two months, several times a day, with absolutely no urination, and stools consisting entirely of water. She claimed extreme upper heat and freezing lower body, with cold waist, legs, and feet, and abdominal pain like ice. Sometimes she felt hot and did not want to wear clothes; sometimes she feared cold with whole-body heat. By night until dawn, her face and eyes were red and swollen. Medicines were ineffective. All six pulses were surging and large. This is Hidden Fire (Fu Huo). Fire nature flares upward, hence upper heat and lower cold. He prescribed Si Wu Tang with Chai Hu (Bupleuri Radix), Ge Gen (Puerariae Lobatae Radix), Sheng Ma (Cimicifugae Rhizoma), Gan Cao, Zhi Zi (Gardeniae Fructus), Huang Qin (Scutellariae Radix), and Huang Bo. After two doses, urination resumed, and diarrhea stopped. Then toothache lasted three days without relief. He prescribed Huang Qi Jian Zhong Tang (Astragalus Decoction for Building the Middle) with added Fu Zi (Aconiti Lateralis Radix Praeparata). One dose cured it.
A woman died suddenly in June. Her whole body was cold, no sweat, all six pulses submerged, unconscious for three days, but breath was not yet exhausted. Everyone used Si Ni Tang and Li Zhong Wan, but they could not be retained. Four days later, Shenzhai palpated, and still found no pulse. He reasoned that a person dies immediately if there is no pulse for one or two days. Since she survived three days, the pulse was submerged due to extreme Heat resembling Cold. He placed wet green cloth on her body. Soon her body warmed, and she drank five or six bowls of cold water, complaining of thirst. After another bowl, she broke into profuse sweat. Later, she recovered after ten doses of Bu Zhong Yi Qi Tang with Huang Bo.
Yu Zhen commented: Shenzhai's treatment of upper heat and lower cold, abdominal pain like ice, crude practitioners would inevitably cite Lizhai's case of Han Zitong. This aligns with Yu Gong's Sheng Yang San Huo Tang. Such cases must be read together to be beneficial. Drinking cold water and covering with wet cloth are also tests for the authenticity of Fire.
Shi Wen treated Grand Historian Zhang Hongqu, who suffered from downward leakage of Essence and Qi, rebellious deficient Fire, palpitations, and hemoptysis. Palpation showed the Right Guan (Bar) position only wiry, Left Chi (Cun Cun) slightly rapid, others fine and thin but beating against the finger. This clearly indicates internal Hidden Yin Fire. After diagnosis, he detailed that last winter, excessive mental labor caused Essence and Qi to slip away, compounded by fear and fright, leading to restless palpitations and panic. Physicians in the capital heavily used Ren Shen, Gui (Cinnamon Twig), and Fu Zi. By year-end, he was slightly better, but upon entering Spring, the condition worsened as before. He requested leave and returned to Wu. Physicians in Wu also used Ren Shen and Fu Zi to guide Fire back to its source and consolidate Essence and Qi, but with no effect, he felt increasingly prostrate. Slight mental effort caused the Heart system to pull and cramp, pain connecting to the spine opposite the heart, sometimes radiating to the chest and hypochondrium, sometimes to the vertex as if lifting, sometimes隐 pain in arms, thighs, hands, feet, and nails. Palpitations felt like a pestle, controlling the head, as if losing brain marrow. He dreamed of writing essays, which he could remember fully upon waking, falling asleep exhausted until dawn, then desiring seminal emission. After emission, his soul felt like flying away. Observing his fresh luster and speech, it belonged to True Yuan leaking downward and deficient Yang disturbing upward. Carefully analyzing pulse and symptoms, initially it was Yang Qi deficiency and leakage. Overuse of acrid-warm strong tonics caused Yang to surge violently and consume True Yin. At this point, it was urgent to change course to save the perishing Yin. He prescribed two formulas: decoction using Bao Yuan Wan combined with Si Jun Zi Tang (Four Gentlemen Decoction); pill using Liu Wei Di Huang Wan combined with Sheng Mai San (Generate the Pulse Powder). After two months, symptoms slightly stabilized, but he remained fatigued and weak. Checking medical books himself, he found Bu Zhong Yi Qi Tang, suitable for summer, added Gui and Fu Zi. One sip caused throat pain and hoarseness. He invited diagnosis again. Seeing his bright complexion but sudden hoarseness, he couldn't understand why. Asking his father, he learned it was due to Sheng Ma, Gui, and Fu Zi raising deficient Yang. He immediately took the previous formula with doubled Sheng Mai San. After half a month, voice gradually recovered, and health improved daily. However, lifestyle adjustment was troublesome. Too warm clothing caused phlegm obstruction in the throat; slightly cool caused slight chills in the back; drinking hot beverages caused whole-body sweating, palpitations, and seminal emission. These were all due to past overuse of Fu Zi, with residual heat hiding internally seeking an exit. Shi Men's Dong Zaichen said hidden Fire was not cleared, requiring Qin (Scutellariae Radix) and Lian (Loti Semen) to resolve. It was winter, so he dared not lightly use bitter-cold. In mid-spring, Zaichen returned, waited for medicine administration, took several doses, and became vigorous. Thereafter, he firmly continued taking it. By early summer, he felt mentally scattered and Qi uncontrolled, so he sought my advice again. I said: Gui and Fu Zi decoctions, due to their fire-toxic nature, can ascend. With Ren Shen moistening them, they can stay long in the Lower Jiao, like a dragon diving underwater. If investigating the source, only Zi Shui Wan (Nourish Water Pill) is the correct treatment. But since Qin and Lian have been used above, how can it bear Zhi Mu and Huang Bo invading below? Moreover, from spring to summer, continuous use of bitter-cold. Bitter first enters the Heart, must transform into Fire. How dare I use Rou Gui (Cinnamon Bark) to move deficient Yang and activate latent properties? To rectify the root and clear the source, it remains Liu Wei combined with Sheng Mai. Taking it yearly, not only does it strengthen Water to control Yang, but also achieves the wonderful interaction of Metal and Water generating each other. Why fear the residual toxicity of Gui and Fu Zi not dissolving?
Yu Zhen commented: This case is mediocre, but the differentiation is clear, and medication is pure. It can serve as a bridge for learners. Compared to Wang Shishan's case, depth...