庄季裕云。予自许昌遭金兵之难。忧劳艰危。冲冒寒暑。遂感 疟。八月起病。至次年
春末。尚苦跗肿腹胀。气促不能食。而大便利。身重足痿。杖而后起。得陈子翁专为灸膏肓
俞。七日内灸三百壮。即胸中气平。肿胀俱损。利止而食进。后又加百壮。诸证尽痊。以至
康宁。时亲旧见此殊功。灸者数人。宿 皆除。孙真人谓若能用心方便。求得其穴而灸之。
无疾不愈。信不虚也。
震按古人治病多用针灸。今则针灸有专家。凡诊脉处方者。反以卑术视之。不知处方易
而针灸难。盖切脉与取穴同一难。而取穴之难。尤难于切脉也。孙真人之言。诚为格言。
宋有里医。为李生治水肿。以药饮之不效。以受其延待之勤。一日忽为灸水分穴与气海
穴。翌早。观其面如削矣。因思明堂云。若是水病灸大良。以此穴能分水。不使妄行故耳。
震按水分穴。可灸不可针。考资生经曰。水肿惟得针水沟。若针余穴。水尽即死。此明
堂铜人所戒也。庸医多为人针水分。杀人多矣。又千金方曰。凡水病。忌腹上出水。出水者
一月死。而今有专门治肿胀者。用铜管子从脐下刺入。出水如射。顷刻盈缶。腹胀即消。以
此水露一夜。明晨视之。浮面者是清水。中央者是淡血。沉底者是脂膏。盖病者清浊不分。
气血皆变为水。决而出之。去水即去其气血也。虽一时暂快。或半月。或一月。肿胀仍作。
再针之亦死。不针之亦死矣。孙真人之言。预知有此诡术耳。
张子和云。余昔过夏邑西。有妇人腹胀如鼓。饮食乍进乍退。寒热更作。而时呕吐。且
三载矣。师觋符咒。无所不至。惟俟一死。会十月农隙。田夫聚猎。一犬役死。磔于大树下
遗腥在根上。病妇偶至树根。顿觉昏愦。眩瞀不知人。枕于根侧。口中虫出。其状如蛇。
口眼皆具。以舌舐其遗腥。其人惊见。以两袖裹其手。按虫头极力出之。且二尺许。重几斤
剖而示人。其妇遂愈。此正与华元化治法同。盖偶得吐法耳。
震按此妄言也。蛇长二尺。重几斤。何以不啮破肠胃耶。子和不过引为偶得吐法耳。然
荒唐无证。所谓吐下之神功。大率类此。又阅孙一奎与吴生问答一条。载生之堂嫂。病臌三
载。腹大如箕。时或胀痛。四肢瘦削。三吴名医历治不瘳。吴俗死者。多用火葬。烧至腹。
忽响声如炮。虫从腹中爆出。高二三丈。烧所之天为昏。俄而坠地。细视之。皆蛔也。不下
千万。大者长尺余。虫腹中复生小虫。甚多不可数。而一奎又于万历癸巳至淮阴。有王乡官
者。子年十六。新娶后。腹胀大。按之有块。形如削瓜。四肢瘦削。发热昼夜不退。已半年
矣。医惟以退热消胀之剂投之。其胀愈甚。其热愈炽。喉中两耳俱疮。诊之。脉滑数。其唇
则红。其腹则疼。又多嗜肥甘。因思诸凡腹痛者。唇色必淡。不嗜饮食。今其若此。得非虫
乎。遂投以阿魏积块丸。服之果下虫数十。大者二。一红一黑。长尺余。虫身经线自首贯
尾。虫腹中复有虫。大者数条。小者亦三四条。虫下则热渐减。胀渐消。三下而愈。始信吴
生之言为不虚。
震观此二则。较子和之说。稍觉近理。然蛔虫不下千万数。亦属荒唐。第其辨证则佳矣
较之客座新闻载江阴训导治生员腹胀。曰脉洪而大。湿热生虫之象。况饮食如常。非臌胀
也。以石榴椿树两项东行根皮。加槟榔各五钱煎服。泻下一长虫而愈者。相似。
儒门事亲又载蹴鞠张承应。年几五十。腹如孕妇。面黄食减。欲作水气。或令服黄 建
中汤及温补之剂。小溲涸闭。从戴人疗焉。戴人曰。建中汤攻表之药也。古方用之攻里。已
误也。今更以此取积。两重误也。先以涌剂吐之。置火于其旁。大汗之。次与猪肾散四钱。
以舟车丸引之。下六缶。殊不困。续下两次。约三十余行。腹平软。健啖如昔。常仲明曰。
向闻人言泻五六缶。人岂能任。及问张承应。渠云果然。乃知养生与攻 本自不同。今人以
补剂疗病。宜乎不效。
〔附〕周恭医说续编云。子和之书。非子和之笔也。特麻征君文之耳。丹溪曰。脾虚不
能行浊气。气聚则为水。水溃妄行。当补脾气。自能健运。得以升降运其极机。则水自行。
此千古圣人之至言也。奈何云补剂疗病。宜乎不效。夫人之所赖以生者元气为之耳。苟罔顾
元气。专行峻利之药。能免虚虚之祸耶。
震按此段。驳得极是。即就本条。谓建中为攻表之药。古人误用以攻里。已属可笑。方
义未明。浪指为攻。可见子和治病。止有攻之一字。不必以麻征君代为之讳也。
丹溪曰。杨兄年近五十。性嗜酒。病疟半年。患胀病。自察必死。来求治。诊其脉弦而
涩。重则大。疟未愈。手足瘦而腹大如蜘蛛状。予教以参、术为君。归、芍、川芎为臣。黄
连、陈皮、茯苓、浓朴为佐。生甘草些少。作浓汤饮之。一日服三次。彼亦严守禁忌。一月
后。疟因汗而愈。又半年。小便长而胀愈。中间虽稍有加减。大意只是补气行湿而已。
又治一女子。禀浓。患胸腹胀满。自用下药。利十数行。胀满如故。脉皆大。按则散而
无力。朱曰。此表证。反攻里。当死。赖质浓。时又在室。可救也。但寿损矣。以四物加参
术、陈皮、炙甘草。煎服。至半月尚未退。自用萝卜种煎浴一度。又虚其表。遂以前方去
芍药、地黄。加黄 。倍白术。大剂浓煎饮之。又以参为丸吞之。十日后。乃得如初病时。
然食难化而自利。以参、术为君。肉果、诃子为臣。稍加陈皮、山楂为佐使。粥丸吞之。四
五十帖而安。
又治陈时叔。年四十余。性嗜酒。大便时见血。于春间患胀。色黑而腹大。其形如鬼。诊其
脉数而涩。重似弱。属阴虚。朱以四物汤加芩、连、木通、白术、陈皮、浓朴、生甘草作汤
与之。近一年而安。
震按丹溪三条。一用参术加血药寒药。一用参术加血药温药。一用血药加寒药。用术去
参。切贴脉证以治。井井有条。可为后世师法。但前后两条一嗜酒病疟。一嗜酒便血。营阴
先亏。自当参用四物。若女子脉大而散。何以不用附子。而犹用四物耶。总之。丹溪善用补
药。慎用热药。其慎处亦极是。如述其友俞仁叔。年近五十。得腹胀。自制禹余粮丸服之。
丹溪诊其脉。弦涩而数。曰。此丸新制。 炼之火邪尚存。温热之药味太多。宜自加减。不
可执方。病者曰。此方不可加减。服之一月。口鼻中出黑血。骨立而死。此先几之见。亦难
及矣。即此三证。皆以持久得愈。非老手断不能。
项彦章治一女。腹痛。胀如鼓。四体骨立。其六脉弦滑而数。项曰。弦为气结。滑为血
聚。此气薄血室。实邪也。其父曰。服芎归辈血药多矣。曰。失于顺气也。夫气。道也。血
水也。气一息不运。则血一息不行。故治血必先顺气。俾经隧得通而后血可行。乃投苏合
香丸。三日而腰作痛。曰。血欲行矣。以硝黄逐之。下瘀数十块而愈。又二女病同。一脉虚
一脉纯弦。皆辞不治。果死。
震按气为血之先。血随气行。故攻瘀先以顺气。极是。然投苏合香丸。三日而腰痛。恐
未必也。其得力处。仍赖硝黄耳。
虞恒德治一族兄。素能饮酒。年五十。病通身水肿。腹胀尤甚。小便涩而不利。大便滑
泄。虞曰。或戒酒色盐酱。尚可保全。不然。去生渐远。兄曰。自今日戒起。虞以丹溪法。
用参、术为君。加利水道制肝木清肺金等药。十帖而小水长。大便实。肿退而安。又半月。
友人劝之饮。遂痛饮沉醉。次日疾复如前。虞曰。不可为矣。一月而逝。
震按此条以饮酒而病复发。又一条以开盐而病复发。皆至于死。故今专门治肿胀者。开
列戒单。不可犯丝毫盐酱。考其义以盐能助肾水之邪。豆与麦面助湿发热也。然胃气旺者固
能戒。若胃气弱者食难进而渐减。亦当顾虑。张路玉用伏龙肝泡水澄之。入青盐以代食盐。
用淮麦为面。同赤豆作面而成酱。其法甚巧。似可通融。
薛立斋治一男。素不善调摄。唾痰口干。饮食不美。服化痰行气之剂。胸满腹胀。痰涎
愈甚。服导痰理脾之剂。肚腹膨胀。二便不利。服分气利水之剂。腹大胁痛。不能睡卧。服
破血消导之剂。两足皆肿。脉浮大不及于寸口。朝用金匮肾气丸。夕用补中益气汤。煎送前
丸。月余。诸证渐退。饮食渐进。再服月余。自能转侧。又两月而能步履。却服大补汤、还
少丹。又半载而康。后稍失调理。其腹仍胀。服前药即愈。
震按立斋此法。为胀满虚证的对之方。与下条石山所用香连丸。虽出两路。各能奏功。
汪石山治一妇。年逾四十。瘦长善饮。诊之脉皆洪滑。曰可治。脉诀云。腹胀浮大。是
出厄也。此湿热太重。宜远酒色。可保终吉。遂以香连丸。令日吞三次。每服七八十丸。月
余良愈。
又治一人。年三十余。病水肿。面光如胞。腹大如箕。脚肿如槌。饮食减少。汪诊之。
脉浮缓而濡。两尺尤弱。曰。此得之酒色。宜补肾水。家人骇曰。水势如此。视者不曰通利
则曰渗泄。先生乃欲补之。水不益深耶。汪曰。经云。水极似土。正此病也。水极者。本
病也。似土者。虚象也。今用通利渗泄。则下多亡阴。肾水益耗。是愈伤其本病。而增湿土
之势矣。岂知亢则害。承乃制之旨乎。遂令空腹服地黄丸。再以四物汤加黄柏、木通、浓朴
陈皮、参、术。煎服十余帖。肿遂减半。三十帖而愈。
震按汪公论病甚佳。用药非是。就此脉证。宜六君子汤送济生肾气丸。何反用地黄丸、
四物汤阴湿柔粘之药。岂以脉之缓濡为湿热。故更佐以黄柏耶。三十帖愈。未敢深信。
一妇形弱瘦小。脉细濡近快。一妇身中材颇肥。脉缓弱无力。俱病鼓胀。大如箕。垂如
囊。立则遮拦两腿。有碍步履。石山视之。曰。腹皮宽。缒已定。非药可敛也。惟宜安心寡
欲。以保命耳。后皆因产而卒。或曰。病鼓胀有孕。何也。汪曰。气病而血未病也。产则血
亦病。阴阳两虚。安得不亡。又一妇鼓胀如前。越十余年无恙者。由寡居无所损也。
震按此案可以警世。女子如此。则男子有胀病而不绝欲者。岂不速其死耶。
赵氏或问曰。松江一男子。年三十余。胸腹胀大。发烦躁渴。面赤不得卧而足冷。余以
其人素饮酒。必酒后入内。夺于所用。精气溢下。邪气因从之上逆。逆则阴气在上而为 胀
其上焦之阳因下逆之邪所迫壅塞于上。故发烦躁。此因邪从下上而盛于上者也。于是用吴
茱萸、附子、人参辈以退阴逆。冰冷冻饮料之以解上焦之浮热。入咽觉胸中顿爽。少时腹中气转
如牛吼。泄气五七次。明日其证愈矣。
震按准绳及治法汇皆引此条。以其议论高爽。能发内经之精微也。惜不言脉。愚意其脉
必细而紧。或沉而涩也。若滑大数实。则此方不可用矣。喻嘉言治刘泰来。年三十二岁。面
白体丰。夏月常用冷水灌汗。坐卧巷曲当风。新秋病疟截早。变成胀满。二
便俱闭。气喘不食。能坐不能卧。能俯不能仰。势甚危急。医以二便不通。服下药不应。商
用大黄二两作一剂。喻曰。伤寒病因发热。致津液枯槁。肠胃干结。乃用下药以开其结。然
有不转失气者。不可攻之戒。正恐误治太阴经之腹胀也。此病因腹中之气散乱不收。故津水
随气横决四溢而作胀。全是太阴不能统摄。一散一结。相去天渊。再用大黄猛剂。大散其气
若不胀死。定须腹破矣。病者曰。大黄服过二剂。尚未见行。奈何。喻曰。腹中真气渐散
今晚子丑二时。阴阳交剥之界。必大汗晕眩。难为力矣。急投理中汤。用人参至三钱。次
日略加黄连。其胀大减。犹以不大便为忧。喻曰。腹中原是大黄推荡之泄粪。其所以不出者
以膀胱胀大。将大肠撑紧。任凭极力努挣。无隙可出耳。吾当以药通膀胱之气。不治大便
而大便自至也。用五苓散。药才入喉。小便先出。大便随之。顷刻泄下半桶。
震读此案。不禁拍案叫绝。只恨不载脉象若何。难以摩仿。且案末不载胀愈。并有慨叹
语气。想未必收功也。但议论高爽。不减赵氏。并录于此。以作胀病之大训天球。
赵氏又曰。嘉定沈氏子。年十八。患胸腹身面俱胀。医治半月不效。余诊其脉。六部皆
不出也。于是用紫苏、桔梗之类。煎服一盏。胸有微汗。再服。则身尽汗。六部和平之脉皆
出。一二日。其证悉平。
傅滋治一人。能大餐。但食肉必泄。忽头肿。目不可开。膈如筑。足麻至膝。恶风。阴
器挺长。脉左沉。重取不应。右短小。却和滑。令单煮白术汤空心服探吐之。后以白术二钱
麻黄、川芎各五分。防风三分。作汤下保和丸五十丸。吐中得汗。上截居多。肿退眼开。
气顺食进。以前方去麻黄、防风。加白术三钱。木通、甘草各五分。下保和丸五十丸。五日
而安。
江篁南次子。素食少。五月间。因多食杨梅。至六月。遍身面目浮肿。腹亦膨胀。用苍
白二术土炒为君。木通、赤苓、泽泻为臣。半夏、陈皮、大腹皮、桑白皮、桔梗为佐。苏梗
庄季裕说：我在许昌遭遇金兵战乱，忧劳困苦，冒险经受寒暑侵袭，于是感染了疟疾。从八月发病，直到次年春末，仍然苦于足背浮肿、腹部胀满、气短喘息、无法进食，同时大便泄泻不止，身体沉重、双腿痿软无力，必须拄着拐杖才能起身。后来得到陈子翁专门为他施灸膏肓俞穴，七天内累计艾灸三百壮，随即胸中气息平复，肿胀消退大半，泄泻停止且食欲增进。之后又加灸一百壮，所有症状全部痊愈，直至恢复健康安宁。当时亲友目睹这一神奇功效，跟随施灸的有几个人，多年的宿疾都除去了。孙思邈曾说，如果能用心寻找穴位并施灸，没有治不好的疾病，这话确实不假。
俞震按语：古人治病多使用针灸，如今针灸有了专门的专家，凡是诊脉开方的人，反而把针灸视为低微的技术。他们不知道开方容易而针灸难。切脉与取穴同样困难，而取穴之难，甚至比切脉更难。孙思邈的话，确实是至理名言。
宋代有一位乡间医生，为李生治疗水肿，用药物治疗无效。因为受到李生殷勤接待，有一天突然为他灸水分穴和气海穴。第二天早上，看到他面部消瘦如削。因此想到明堂书中说，如果是水病，灸此穴非常有效，因为这个穴位能分水，不让水湿妄行。
俞震按语：水分穴，可以艾灸，不可针刺。考证《资生经》说：水肿只有可以针刺水沟穴，如果针刺其他穴位，水排尽人就会死。这是《明堂铜人图》所告诫的。庸医常常为人针刺水分穴，害死了很多人。另外《千金方》说：凡是水病，忌讳腹部出水，一旦出水，一个月后死亡。而现在有专门治疗肿胀的医生，用铜管子从脐下刺入，让水像喷射一样流出，顷刻间就能装满瓦罐，腹胀随即消除。观察这些水露置一夜，清晨看时，浮在表面的是清水，中间是淡血，沉在底部的是脂膏。这是因为患者清浊不分，气血都变成了水，决堤排出，排出了水也就排出了气血。虽然暂时痛快，但半个月或一个月后，肿胀依然发作，再针刺也会死，不针刺也必死无疑。孙思邈的话，预先预知了这种诡诈的手段。
张子和说：我以前经过夏邑西边，有一个妇人腹胀如鼓，饮食有时进有时退，寒热交替发作，并且时常呕吐，已经三年了。求神拜佛、画符念咒的方法都用尽了，只等待一死。恰逢十月农闲，农夫们聚在一起打猎，一只狗累死，被肢解在大树下，血腥气遗留在树根上。患病妇人偶然走到树根旁，顿时感到昏沉迷糊，眩晕不知人事，头枕在树根旁，口中吐出虫子，形状像蛇，口眼俱全，用舌头舔食遗留的血腥气。旁人惊恐看见，用两只袖子裹住她的手，按住虫头用力将其拔出，长约二尺左右，重量几乎有几斤，剖开给人看，那个妇人就痊愈了。这正与华佗的治疗方法相同，大概是偶然得到了催吐法的效果。
俞震按语：这是荒诞之言。蛇长二尺，重几斤，为什么不会咬破肠胃呢？张子和不过引用它作为偶然得到催吐法的例子罢了。然而荒唐无据，所谓吐下法的神奇功效，大抵都是这类情况。我又阅读孙一奎与吴生的问答一条，记载吴生的堂嫂，患鼓胀病三年，腹部大如簸箕，时而胀痛，四肢瘦削，三吴地区的名医多次治疗都没有好转。吴地风俗死者多用火葬，烧到腹部时，忽然响声如炮竹，虫子从腹中爆出，高二三丈，烧到的天空为之昏暗，一会儿坠落在地，仔细观看，全是蛔虫，不下千万条，大的长一尺多，虫腹中又生出小虫，很多数不清，而孙一奎又在万历癸巳年到达淮阴，有一位王乡绅，儿子十六岁，新婚之后，腹胀大，按压有块状物，形状像削过的瓜，四肢瘦削，发热昼夜不退，已经半年了。医生只用退热消胀的药剂投喂，他的胀反而更甚，热更加炽盛，喉咙和两耳都生了疮。诊察其脉，滑数，嘴唇红，腹部疼痛，又多嗜好肥甘厚味。我想凡是腹痛的人，唇色必然淡白，不嗜饮食，现在他这样，莫非是虫病吗？于是投以阿魏积块丸，服药果然排出几十条虫子，大的两条，一红一黑，长一尺多，虫身用线从头贯到尾，虫腹中又有虫，大的几条，小的也有三四条。虫子排出后，热逐渐减退，胀逐渐消退，三次服药后痊愈，这才相信吴生的话不是虚言。
俞震观察这两则案例，比张子和的说法稍微觉得合乎情理。然而蛔虫不下千万条，也属于荒唐。只是他的辨证很好了。这与《客座新闻》记载江阴训导治疗生员腹胀相似，说脉象洪大而有力，是湿热生虫的迹象，况且饮食正常，不是鼓胀病。用石榴椿树两项向东生长的根皮，加槟榔各五钱煎服，泻下一条长虫而痊愈，与此相似。
《儒门事亲》又记载蹴鞠手张承应，年纪将近五十，腹部大如孕妇，面色黄，食欲减退，想要当作水气病治疗。有人让他服用黄芪建中汤及温补的药剂，导致小便涸竭闭塞。于是听从戴人（张子和）的治疗。戴人说：建中汤是攻表的药，古方用它来攻里，已经是错误了。现在再用它来消除积滞，是双重错误。先用涌剂催吐，在他旁边放置火盆，大汗出。接着给予猪肾散四钱，用舟车丸引导，排出六缶（容器）的大便，并不困倦。随后又排泄两次，大约三十多次，腹部平坦柔软，食欲恢复如昔。常仲明说：过去听人说泻下五六缶，人怎么能承受得住？等到询问张承应，他说确实如此。才知道养生与攻邪本来不同。现在人用补剂治疗疾病，当然无效。
〔附〕周恭医说续编说：张子和的书，不是张子和亲自执笔的，而是麻征君（麻九畴）代笔的。朱丹溪说：脾虚不能运化浊气，气聚则成水，水溃乱妄行，应当补脾气，自然能健运，得以升降运转其枢纽，那么水自行走。这是千古圣人的至理名言。为什么说用补剂治疗疾病会无效呢？人赖以生存的是元气。如果不顾惜元气，专行峻烈利窍的药物，能避免虚虚之祸吗？
俞震按语：这段驳斥得非常正确。就本条而言，说建中汤是攻表药，古人误用来攻里，已经可笑了。对方义不明白，胡乱指责为攻邪，可见张子和治病，只有“攻”这一个字，不必替麻征君代笔之事掩饰。
朱丹溪说：杨兄年纪近五十，性格嗜酒，患疟疾半年，患胀病，自己察觉必死，来求治。诊其脉弦而涩，重按则大，疟疾未愈，手足瘦削而腹部大如蜘蛛状。我教他以人参、白术为君药，当归、白芍、川芎为臣药，黄连、陈皮、茯苓、厚朴为佐药，少量生甘草，煎浓汤饮用。一天服用三次。他也严格遵守禁忌，一个月后，疟疾因出汗而愈。又过了半年，小便通畅而胀病痊愈。中间虽有稍许加减，大意只是补气行湿而已。
又治疗一个女子，体质浓厚，患胸腹胀满，自己服用下药，腹泻十几次，胀满依旧。脉象皆大，按之散漫无力。朱丹溪说：这是表证，反而攻里，应当死亡。幸好她体质浓厚，而且当时还在娘家未出嫁，可以救治。但寿命会受损。用四物汤加人参、白术、陈皮、炙甘草，煎服。到了半个月还没有退去，她自己用萝卜种煎水洗澡一次，又使表虚，于是以前方去掉芍药、地黄，加黄柏，倍量白术，大剂量浓煎饮用。又以人参制成丸药吞服。十日后，才恢复到像生病时的状态，然而食物难消化且自利。以人参、白术为君药，肉豆蔻、诃子为臣药，稍加陈皮、山楂为佐使，做成粥丸吞服。四五十帖后安定。
又治疗陈时叔，年纪四十多岁，性格嗜酒，大便时常见血，在春季患胀病，面色黑而腹部大，形体如鬼。诊其脉数而涩，重按似弱，属阴虚。朱丹溪用四物汤加黄芩、黄连、木通、白术、陈皮、厚朴、生甘草作汤剂给他服用。将近一年而安定。
俞震按语：丹溪这三条，一条用人参白术加血药寒药，一条用人参白术加血药温药，一条用血药加寒药，用白术去人参，切合脉证进行治疗，井井有条，可为后世师法。但前后两条，一条嗜酒病疟，一条嗜酒便血，营阴先亏，自然应当参用四物汤。至于那个女子脉大而散，为什么不用附子，而还用四物汤呢？总之，丹溪善用补药，慎用热药，他的谨慎之处也非常对。如叙述他的朋友俞仁叔，年纪近五十，得腹胀，自制禹余粮丸服用。丹溪诊其脉，弦涩而数，说：这个丸子是新制的，煅炼之火邪尚存，温热药物味道太多，应该自己加减，不可固执于方子。病人说：这个方子不可加减。服用一个月后，口鼻中流出黑血，骨立而死。这是先见之明，也难以企及。就这三个病例，都是以持久治疗而痊愈，不是老手断然不能做到。
项彦章治疗一个女子，腹痛，胀如鼓，四肢骨瘦如柴。她的六脉弦滑而数。项彦章说：弦为气结，滑为血聚，这是气薄血室，实邪。她的父亲说：服用芎归等血药很多了。项彦章说：失误在于不顺气。气，是道路；血，是水。气一息不运行，则血一息不行。所以治血必须先顺气，使经络通畅而后血可行。于是投以苏合香丸，三天后腰部作痛，说：血要行动了。用硝石、大黄驱逐它，排出瘀血几十块而痊愈。又有两个女子病相同，一个脉虚，一个脉纯弦，都推辞不治，果然死亡。
俞震按语：气为血之先导，血随气行，所以攻瘀先以顺气，极是。然而投苏合香丸，三天后腰痛，恐怕未必吧。其得力之处，仍依靠硝石和大黄罢了。
虞恒德治疗一个族兄，素来能饮酒，年纪五十，病通身水肿，腹部胀尤其严重。小便涩而不通利，大便滑泄。虞恒德说：或者戒酒色盐酱，还可以保全性命。不然，离死亡渐远。族兄说：从今天开始戒。虞恒德用丹溪的方法，用人参、白术为君药，加利水道、制肝木、清肺金等药。十帖后小便通畅，大便结实，肿退而安。又过了半个月，友人劝他饮酒，于是痛饮沉醉。第二天疾病复发如前。虞恒德说：不可救了。一个月后去世。
俞震按语：这条因为饮酒而病复发，另一条因为吃盐而病复发，都导致死亡。所以现在专门治疗肿胀的医生，开列戒单，不可犯丝毫盐酱。考证其道理，因为盐能助肾水之邪，豆与麦面助湿发热。然而胃气旺的人固然能戒，若胃气弱者，食难进而逐渐减少，也应当顾虑。张路玉用伏龙肝泡水澄清，加入青盐代替食盐，用淮麦做面，同赤豆做成面而成酱，这个方法很巧妙，似乎可以通融。
薛立斋治疗一个男子，素来不善调养，唾痰口干，饮食不佳，服用化痰行气的药剂，胸满腹胀，痰涎更甚。服用导痰理脾的药剂，肚腹膨胀，二便不利。服用分气利水的药剂，腹大胁痛，不能睡卧。服用破血消导的药剂，两脚皆肿，脉浮大不及于寸口。早晨服用金匮肾气丸，晚上服用补中益气汤，煎送前丸。月余，诸证渐退，饮食渐进。再服月余，自己能转侧。又两个月而能步履。却服用大补汤、还少丹。又半年而康复。后来稍失调理，其腹仍胀，服用前药即愈。
俞震按语：立斋这种方法，是胀满虚证的对症之方。与下条石山所用的香连丸，虽出自两路，各能奏功。
汪石山治疗一个妇人，年纪超过四十，瘦高善饮。诊其脉皆洪滑，说：可治。脉诀说：腹胀浮大，是走出厄运之兆。这是湿热太重，宜远离酒色，可保终吉。于是用香连丸，令每日吞服三次，每服七八十丸。月余良愈。
又治疗一人，年纪三十多岁，病水肿，面部光亮如胞，腹部大如簸箕，脚肿如槌，饮食减少。汪石山诊其脉，浮缓而濡，两尺尤弱，说：这是得之于酒色，宜补肾水。家人惊骇说：水势如此，看病的人不说通利就说渗泄，先生却要补之，水不更深了吗？汪石山说：经云：水极似土，正是这个病。水极者，是本病；似土者，是虚象。现在用通利渗泄，则下多亡阴，肾水益耗，是愈伤其本病，而增湿土之势了。岂知亢则害，承乃制的旨趣乎？于是令空腹服地黄丸，再以四物汤加黄柏、木通、厚朴、陈皮、人参、白术，煎服十余帖，肿遂减半。三十帖而愈。
俞震按语：汪公论病甚佳，用药非是。就此脉证，宜六君子汤送济生肾气丸，何反用地黄丸、四物汤阴湿柔粘之药？岂以脉之缓濡为湿热，故更佐以黄柏耶？三十帖愈，未敢深信。
一个妇人形体弱瘦小，脉细濡近快；一个妇人身材颇肥，脉缓弱无力，都病鼓胀，大如簸箕，垂如囊，站立时遮拦两腿，有碍步履。汪石山视之，说：腹皮宽，缒已定，非药可敛也。惟宜安心寡欲，以保命耳。后来都因生产而卒。有人说：病鼓胀有孕，为什么呢？汪石山说：气病而血未病也。产则血亦病，阴阳两虚，安得不亡。又一妇鼓胀如前，越十余年无恙者，由寡居无所损也。
俞震按语：此案可以警世。女子如此，则男子有胀病而不绝欲者，岂不速其死耶。
赵氏或问曰：松江一男子，年纪三十多岁，胸腹胀大，发烦躁渴，面赤不得卧而足冷。我认为他素来饮酒，必定酒后入内房，精气溢下，邪气因从之上逆。逆则阴气在上而为胀，其上焦之阳因下逆之邪所迫壅塞于上，故发烦躁。这是因邪从下上而盛于上者也。于是用吴茱萸、附子、人参辈以退阴逆，冰冷冻饮料之以解上焦之浮热。入咽觉胸中顿爽，少时腹中气转如牛吼，泄气五七次，明日其证愈矣。
俞震按语：《准绳》及《治法汇》都引用此条，以其议论高爽，能发内经之精微也。可惜不言脉，愚意其脉必细而紧，或沉而涩也。若滑大数实，则此方不可用矣。喻嘉言治刘泰来，年三十二岁，面白体丰，夏月常用冷水灌汗，坐卧巷曲当风，新秋病疟截早，变成胀满，二便俱闭，气喘不食，能坐不能卧，能俯不能仰，势甚危急。医生以二便不通，服下药不应，商量用大黄二两作一剂。喻嘉言说：伤寒病因发热，致津液枯槁，肠胃干结，乃用下药以开其结。然而有不转失气者，不可攻之戒，正恐误治太阴经之腹胀也。此病因腹中之气散乱不收，故津水随气横决四溢而作胀，全是太阴不能统摄，一散一结，相去天渊。再用大黄猛剂，大散其气，若不胀死，定须腹破矣。病者说：大黄服过二剂，尚未见行，奈何。喻嘉言说：腹中真气渐散，今晚子丑二时，阴阳交剥之界，必大汗晕眩，难为力矣。急投理中汤，用人参至三钱。次日略加黄连，其胀大减，犹以不大便为忧。喻嘉言说：腹中原是大黄推荡之泄粪，其所以不出者，以膀胱胀大，将大肠撑紧，任凭极力努挣，无隙可出耳。吾当以药通膀胱之气，不治大便而大便自至也。用五苓散，药才入喉，小便先出，大便随之，顷刻泄下半桶。
俞震读此案，不禁拍案叫绝，只恨不载脉象若何，难以模仿。且案末不载胀愈，并有慨叹语气，想未必收功也。但议论高爽，不减赵氏，并录于此，以作胀病之大训天球。
赵氏又说：嘉定沈氏子，年十八，患胸腹身面俱胀，医治半月不效。我诊其脉，六部皆不出也。于是用紫苏、桔梗之类，煎服一盏，胸有微汗，再服，则身尽汗，六部和平之脉皆出，一二日，其证悉平。
傅滋治疗一人，能大餐，但食肉必泄，忽头肿，目不可开，膈如筑，足麻至膝，恶风，阴器挺长，脉左沉，重取不应，右短小，却和滑。令单煮白术汤空心服探吐之。后以白术二钱、麻黄、川芎各五分、防风三分，作汤下保和丸五十丸。吐中得汗，上截居多，肿退眼开，气顺食进。以前方去麻黄、防风，加白术三钱、木通、甘草各五分，下保和丸五十丸。五日而安。
江篁南次子，素食少，五月间，因多食杨梅，至六月，遍身面目浮肿，腹亦膨胀。用苍白二术土炒为君，木通、赤苓、泽泻为臣，半夏、陈皮、大腹皮、桑白皮、桔梗为佐，苏梗……
Zhuang Jiyu said: I encountered the disaster of Jin soldiers in Xuchang. Suffering from worry, toil, hardship, and danger, and exposed to cold and heat, I contracted malaria (malaria). The illness began in August and persisted until late spring of the following year, during which I suffered from edema of the dorsum of the foot (swelling on the top of the feet), abdominal distension, shortness of breath, inability to eat, and continuous diarrhea. My body felt heavy, my legs were flaccid and weak, requiring a cane to stand. Later, Chen Zi Weng specifically moxibusted the Gao Huang Shu (Bladder 43) acupoint for me. Within seven days, three hundred moxa cones were burned. Immediately, the Qi in my chest calmed down, the swelling and distension significantly decreased, the diarrhea stopped, and my appetite improved. Subsequently, one hundred additional moxa cones were burned, and all symptoms completely resolved, leading to full health and peace. Relatives and friends who witnessed this miraculous effect had several people undergo moxibustion, and their chronic ailments were all cured. Sun Simiao stated that if one pays attention and seeks out the correct acupoints for moxibustion, no disease is incurable. This is indeed not false.
Yu Zhen commented: In ancient times, treating diseases often involved acupuncture and moxibustion. Today, acupuncture and moxibustion have specialized experts, while those who diagnose by pulse and prescribe herbs tend to view these techniques as inferior. They do not realize that prescribing herbs is easy, but acupuncture and moxibustion are difficult. Palpating the pulse and locating acupoints are both difficult, but locating acupoints is even more difficult than palpating the pulse. Sun Simiao’s words are truly golden maxims.
In the Song Dynasty, a country doctor treated Li Sheng for edema. Herbal medicine was ineffective. Out of gratitude for Li Sheng’s hospitality, the doctor suddenly moxibusted the Shui Fen (Water Division) and Qi Hai (Sea of Qi) acupoints. The next morning, his face appeared emaciated. This recalls the Ming Tang text stating that for water diseases, moxibustion at this acupoint is highly effective because it can divide water and prevent its erratic movement.
Yu Zhen commented: The Shui Fen acupoint can be moxibusted but should not be needled. According to the *Zisheng Jing*, for edema, only the Shui Gou acupoint may be needled; needling other acupoints will cause death when the water is exhausted. This is warned against in the *Ming Tang Bronze Man*. Quack doctors frequently needle the Shui Fen acupoint, killing many people. Furthermore, the *Qianjin Fang* states that for water diseases, one must avoid water draining from the abdomen; if it drains, death occurs within a month. However, there are now specialists in treating swelling who insert copper tubes below the umbilicus to drain water like a jet, filling jars instantly and relieving abdominal distension. Observing this water after leaving it overnight, the clear water floats on top, pale blood is in the middle, and fat/slime sinks to the bottom. This indicates that the patient’s clear and turbid substances are mixed, and Qi and Blood have transformed into water. Draining it removes both water and Qi/Blood. Although temporarily relieving, the swelling returns in half a month or a month. Needling again leads to death, and not needling also leads to death. Sun Simiao’s words anticipated such deceptive practices.
Zi Hezi said: Once, passing west of Xiayi, I saw a woman with an abdominal distension like a drum. Her food intake fluctuated, she experienced alternating chills and fever, and frequent vomiting. This had lasted for three years. She had tried everything from masters to shamans, including talismans and spells, awaiting only death. During the October farming break, farmers gathered to hunt. A dog died from exhaustion and was butchered under a large tree, leaving blood residue on the roots. The sick woman happened to pass by the tree root, suddenly felt dizzy and confused, lost consciousness, and rested her head by the root. Worms emerged from her mouth, shaped like snakes, with mouths and eyes, licking the blood residue. Startled observers wrapped her hands in their sleeves, held the worm's head, and pulled it out with great force. It was about two chi long and weighed nearly a jin. After dissecting it to show others, the woman recovered. This aligns with Hua Yuanhua’s treatment method, essentially achieving a spontaneous vomiting effect.
Yu Zhen commented: This is absurd. How could a snake two chi long and weighing nearly a jin not tear through the intestines and stomach? Zi Hezi merely cited it as an example of accidental vomiting therapy. However, it is baseless and ridiculous. The alleged miraculous effects of vomiting and purging methods are largely of this nature. I also read a Q&A between Sun Yikui and Wu Sheng, recording Wu Sheng’s cousin-in-law who suffered from鼓胀 (drum-like distension) for three years. Her abdomen was large as a winnowing basket, occasionally painful and distended, with emaciated limbs. Famous doctors in the Sanwu region failed to cure her. In Wu customs, the dead are cremated. When burning her abdomen, a loud bang occurred, and worms exploded from the abdomen, reaching two or three zhang high, darkening the sky where they burned, before falling to the ground. Upon inspection, they were all roundworms, numbering in the thousands, some over one chi long. Smaller worms were found inside the larger ones, too numerous to count. Sun Yikui also recorded a case in Huaiyin during the Guisi year of Wanli. A local official’s sixteen-year-old son developed abdominal distension after marriage, with hard masses feeling like a sliced melon, emaciated limbs, and unremitting day-and-night fever for half a year. Doctors used heat-clearing and distension-reducing agents, worsening the condition. His throat and ears developed sores. Pulse was slippery and rapid, lips red, abdomen painful, with a preference for rich foods. I reasoned that abdominal pain usually presents with pale lips and lack of appetite; this deviation suggests parasites. I prescribed Awei Jiku Wan (Asafoetida Mass-Resolving Pill). He expelled dozens of worms, two large ones (one red, one black), each over one chi long, threaded from head to tail, containing smaller worms inside. Fever subsided, distension reduced, and he recovered after three doses. Only then did I believe Wu Sheng’s account.
Yu Zhen observed these two cases seemed more reasonable than Zi Hezi’s, though thousands of roundworms remain absurd. However, the syndrome differentiation was excellent. It resembles a case in *Kezuo Xinwen* where a Jiangyin instructor treated a student with abdominal distension. The pulse was surging and large, indicating damp-heat generating parasites. Since diet was normal, it was not drum-like distension. Using bark from the eastward-growing roots of pomegranate and Chinese toon, plus betel nut (each five qian), decocted and taken, resulted in expelling a long worm and recovery.
*Rumen Shiqin* also records Zuju Zhang Chengying, nearly fifty, with an abdomen like a pregnant woman, yellow complexion, and reduced appetite, suspected of water qi. Someone suggested Huangqi Jianzhong Tang and warming tonics, causing urine retention. Following Dairen’s (Zi Hezi’s) treatment, Dairen said: Jianzhong Tang is a surface-expelling formula; using it internally is already wrong. Using it to remove accumulation is doubly wrong. First, induce vomiting with a涌剂 (emetic agent), place fire nearby to induce profuse sweating. Then give Zhushen San (Pig Kidney Powder) four qian, guided by Zhouche Wan (Boat and Cart Pill), resulting in six containers of stool without fatigue. Two more sessions followed, totaling thirty-plus movements. Abdomen became flat and soft, appetite restored. Chang Zhongming said: I heard people say expelling five or six containers is unbearable. Asking Zhang Chengying confirmed it. Thus, nourishing life and attacking pathogens differ. Now people use tonics for disease, hence ineffectiveness.
[Appendix] Zhou Gong’s *Yishuo Xu Bian* claims Zi Hezi’s book was written by Ma Zhengjun (Ma Jiuchou). Zhu Danxi said: Spleen deficiency fails to transport turbid Qi; Qi stagnates to form water, which leaks erratically. One must tonify Spleen Qi to restore transportation and transformation, allowing water to move naturally via the pivot mechanism. This is a sage’s eternal truth. Why claim tonics are ineffective? Human life relies on Yuan Qi (Primal Qi). Ignoring Yuan Qi and using harsh, draining drugs invites disaster from deficiency.
Yu Zhen commented: This refutation is correct. Claiming Jianzhong Tang is for the exterior and misused for the interior is laughable. Not understanding the formula’s meaning, labeling it as attacking shows Zi Hezi only knows “attack.” No need to excuse Ma Zhengjun.
Zhu Danxi said: Brother Yang, nearly fifty, alcoholic, suffered malaria for half a year, developing distension. Believing he would die, he sought treatment. Pulse was wiry and choppy, deep pressure large. Malaria unresolved, limbs emaciated, abdomen spider-shaped. I instructed him to use Ren Shen (Ginseng) and Bai Zhu (Atractylodes Macrocephala) as sovereign, Dang Gui (Angelica Sinensis), Bai Shao (White Peony Root), Chuan Xiong (Ligusticum) as ministers, Huang Lian (Coptis), Chen Pi (Tangerine Peel), Fu Ling (Poria), Hou Po (Magnolia Bark) as assistants, and a little raw Gan Cao (Licorice). Decoct strongly, take three times daily. He strictly observed taboos. After one month, malaria resolved via sweating. Six months later, urination normalized, distension cured. Modifications were minor; the gist was tonifying Qi and moving dampness.
He also treated a woman with thick constitution, chest/abdominal fullness. Self-medicating with purgatives caused ten+ bowel movements without relief. Pulse large, diffuse, and weak upon pressure. Zhu said: Exterior syndrome wrongly attacked internally leads to death. Fortunately, her constitution is strong and she is unmarried, so salvageable, but lifespan shortened. Use Si Wu Tang (Four Substance Decoction) plus Ren Shen, Bai Zhu, Chen Pi, Zhi Gan Cao (Honey-fried Licorice). After half a month, no improvement. She bathed with radish seed decoction, further weakening the exterior. Modify previous formula: remove Bai Shao and Di Huang, add Huang Bo (Phellodendron), double Bai Zhu. Decoct strongly. Swallow Ren Shen pills. Ten days later, returned to pre-illness state, but digestion poor with spontaneous diarrhea. Use Ren Shen, Bai Zhu as sovereign, Rou Dou Kou (Nutmeg), He Zi (Chebula) as ministers, slight Chen Pi, Shan Zha (Hawthorn) as assistants. Make congee pills. Forty to fifty doses brought stability.
He treated Chen Shishu, forty+, alcoholic, bloody stools, spring distension, black complexion, abdomen large, ghost-like appearance. Pulse rapid, choppy, deep weak. Yin deficiency. Zhu gave Si Wu Tang plus Huang Qin (Scutellaria), Huang Lian, Mu Tong (Akebia), Bai Zhu, Chen Pi, Hou Po, raw Gan Cao. Stable after nearly a year.
Yu Zhen commented: Danxi’s three cases: one uses Ginseng/Atractylodes + blood-regulating/cold herbs; one uses Ginseng/Atractylodes + blood-regulating/warm herbs; one uses blood-regulating + cold herbs, removing Ginseng. All match pulse/syndrome well, orderly, worthy of emulation. But why use Si Wu Tang for the first two (alcohol/malaria, alcohol/blood) where Ying/Yin is deficient? For the woman with large/diffuse pulse, why not Fu Zi (Aconite)? Danxi excels at tonics, cautious with heat. His caution is right. E.g., friend Yu Renshu, nearly fifty, abdominal distension, self-made Yuyuliang Wan. Danxi’s pulse: wiry, choppy, rapid. Said: New pill retains fire toxin, too many warm/hot flavors. Adjust yourself. Patient refused. Took one month, vomited/black stool, died emaciated. Prescient insight. These three cases took persistence, impossible for novices.
Xiang Yanzhang treated a woman with abdominal pain, drum-like distension, emaciated limbs. Six pulses wiry, slippery, rapid. Xiang said: Wiry indicates Qi knot, slippery indicates Blood accumulation. Qi invades Blood Chamber, excess pathogen. Father said: Used Xiong Gui (Chuan Xiong/Dang Gui) blood herbs much. Xiang said: Mistake was not smoothing Qi. Qi is the pathway; Blood is water. If Qi stops, Blood stops. Treat Blood by smoothing Qi first, opening meridians. Prescribed Suhexiang Wan (Styrax Pill). Three days later, waist pain: Blood wants to move. Use Xiao Huang (Mirabilite/Rhubarb) to purge. Expelled dozens of blood clots, cured. Two other women with same disease: one pulse deficient, one purely wiry. Refused treatment, died.
Yu Zhen commented: Qi precedes Blood; Blood follows Qi. Attacking stasis by smoothing Qi is correct. But waist pain after Suhexiang Wan seems unlikely. The efficacy likely came from Xiao Huang.
Yu Hengde treated a clan brother, alcoholic, fifty, whole-body edema, severe abdominal distension. Urine scanty/stagnant, loose stools. Yu said: Quit alcohol, sex, salt, soy sauce to survive. Brother agreed. Yu used Danxi’s method: Ren Shen, Bai Zhu as sovereign, plus herbs to benefit water passages, control Liver Wood, clear Lung Metal. Ten doses: urine flowed, stools solid, swelling receded. Half month later, friend urged drinking. He drank heavily, got drunk. Next day, relapse. Yu said: Incurable. Died in one month.
Yu Zhen commented: Relapse due to alcohol and salt led to death. Hence specialists list strict bans on salt/soy sauce. Salt aids Kidney Water evil; beans/wheat aid damp-heat. Those with strong Stomach Qi can quit; those with weak Stomach Qi struggle. Zhang Luyu used Fulonggan (Dragon’s House Earth) water, added Qing Yan (Green Salt) for table salt, Huai Mai (Buckwheat) flour with Chi Dou (Red Bean) for sauce. Clever, perhaps flexible.
Xue Lizhai treated a man, poor self-care, phlegm, dry mouth, poor appetite. Taking phlegm-resolving/Qi-moving herbs caused chest/abdominal fullness, more phlegm. Taking Phlegm-guiding/Spleen-regulating herbs caused belly distension, urinary/fecal obstruction. Taking Qi-dividing/Water-draining herbs caused large abdomen, hypochondriac pain, insomnia. Taking Blood-breaking/Digestion-promoting herbs caused leg swelling. Pulse floating/large, absent at Cun/Kou. Morning: Jin Kui Shen Qi Wan; Evening: Bu Zhong Yi Qi Tang, decocted to swallow pills. Month+: symptoms receded, appetite improved. Another month: could turn over. Two more months: could walk. Then Da Bu Tang, Hai Shao Dan. Half year: recovered. Later slight neglect, distension returned, cured by previous meds.
Yu Zhen commented: Lizhai’s method is specific for deficiency-type distension. Like Shishan’s Xianglian Wan, different paths, both effective.
Wang Shishan treated a woman, 40+, tall/thin, alcoholic. Pulses surging/slippery. Sayable. Pulse classic: Abdominal distension floating/large indicates escaping danger. Heavy damp-heat. Avoid alcohol/sex for safety. Prescribed Xianglian Wan, 70-80 pills, 3x/day. Month+: cured.
Treated another, 30+, edema, shiny face, large abdomen, clubbed feet, poor diet. Pulse floating/slow/soft, Chi particularly weak. Attributed to alcohol/sex. Tonify Kidney Water. Family shocked: Water so severe, why tonify? Won’t it deepen? Wang said: Classic says “Water extreme resembles Earth.” Water extreme is root disease; resembling Earth is deficiency image. Using draining/purging causes Yin loss via lower exit, depleting Kidney Water, harming root, increasing Damp-Earth. Do you not know “Excess harms, subjugation controls”? Prescribed Dihuang Wan fasting, then Si Wu Tang plus Huang Bo, Mu Tong, Hou Po, Chen Pi, Ren Shen, Bai Zhu. 10+ doses: swelling halved. 30 doses: cured.
Yu Zhen commented: Wang’s diagnosis good, prescription wrong. Given pulse/syndrome, Liu Jun Zi Tang sending Jisheng Shen Qi Wan fits better. Why Dihuang Wan/Si Wu Tang (Yin-damp/greasy)? Assuming slow/soft pulse means damp-heat, adding Huang Bo? Cured in 30 doses, skeptical.
One woman thin/weak, fine/soft/fast pulse; one woman fat, slow/weak pulse. Both drum-like distension, large as basket, hanging like bag, blocking legs. Wang said: Abdominal skin loose, fixed, not reducible by medicine. Rest, reduce desires to save life. Both died after childbirth. Asked: Distension with pregnancy? Wang said: Qi diseased, Blood healthy. Childbirth affects Blood, Yin/Yang dual deficiency, how not die? Another woman with similar distension lived 10+ years healthy due to celibacy.
Yu Zhen commented: Case warns world. Women thus, men with distension not abstaining from sex hasten death.
Zhao asked: Songjiang man, 30+, chest/abdominal distension, irritability/thirst, red face, insomnia, cold feet. He drank alcohol, entered bedroom after, essence overflowed downward, pathogen rose upward. Upward pathogen traps Upper Jiao Yang, causing irritability. Pathogen rises from below. Used Wu Zhu Yu, Fu Zi, Ren Shen to retreat Yin rebellion. Ice-cold drinks to clear Upper Jiao floating heat. Throat felt cool, abdomen gurgled like ox, passed gas 5-7 times. Next day: cured.
Yu Zhen commented: Cited in *Zhunsheng* and *Zhifa Hui* for insightful theory matching *Neijing*. Regret no pulse recorded. Likely fine/tight or deep/choppy. If slippery/large/rapid/excess, this formula contraindicated. Yu Jiayan treated Liu Tailai, 32, white/plump, summer cold sweat, wind exposure, autumn malaria turned to distension, closed bowels/urine, panting, unable to eat/sleep/lie flat/bend back, critical. Doctors failed laxatives. Discussed 2 liang Da Huang (Rhubarb). Yu said: Cold damage fever dries fluids, binds intestines, laxatives open binding. But “no passing gas = do not attack” warning prevents mistreating Taiyin distension. This case: scattered abdominal Qi, fluids spread wildly causing distension. Taiyin fails to control. Scattered vs. Bound, vast difference. Strong Rhubarb scatters Qi further; death by bursting abdomen. Patient: 2 doses Rhubarb, no effect. Yu said: True Qi scattering. Tonight Zi/Chou hours (Yin/Yang clash), massive sweat/dizziness, fatal. Urgently give Lizhong Tang, Ren Shen 3 qian. Next day slight Huang Lian. Distension reduced, worried about constipation. Yu said: Bowels contain Rhubarb-pushed feces. Not exiting because bladder distension presses colon. Straining useless. Medication opens Bladder Qi, not treating bowels directly but bowels will follow. Used Wuling San. Medicine swallowed, urine first, then stool. Half bucket expelled instantly.
Yu Zhen applauded, regretted missing pulse, doubted final success due to tone, but recorded for teaching.
Zhao said: Jiading Shen’s son, 18, chest/abdomen/body/face distension, 15 days treatment failed. Pulse: six positions undetectable. Used Zi Su, Jie Geng decoction, one cup. Chest slight sweat. Second dose: whole body sweat, six positions平和 (peaceful) pulse appeared. 1-2 days: symptoms resolved.
Fu Zi treated one, big eater, meat causes diarrhea, sudden head swelling, eyes closed, chest pounding, leg numbness to knee, aversion to wind, genital erection. Left pulse deep, heavy unresponsive; Right pulse short/small but harmonious/slippery. Ordered single decoction of Bai Zhu on empty stomach to induce vomiting. Then Bai Zhu 2 qian, Ma Huang, Chuan Xiong 5 fen, Fang Feng 3 fen decoction with Baohe Wan 50 pills. Vomiting induced sweat, upper body mostly. Swelling receded, eyes opened, Qi smoothed, appetite returned. Remove Ma Huang/Fang Feng, add Bai Zhu 3 qian, Mu Tong, Gan Cao 5 fen, Baohe Wan 50 pills. 5 days: stable.
Jiang Huangnan’s second son, vegetarian, ate many bayberries in May. June: whole body/face swelling, abdominal distension. Cang Zhu, Bai Zhu earth-fried as sovereign, Mu Tong, Chi Fu Ling, Ze Xie as ministers, Ban Xia, Chen Pi, Da Fu Pi, Sang Bai Pi, Jie Geng as assistants, Su Geng...