薛立斋治阁老靳介庵。脚指缝作痒出水。肿 脚面。敷止痒之药不应。服除湿之药益甚
薛诊之曰。阴虚湿热下注也。用六味地黄补中益气而愈。
一儒者脚心发热作痒。搔掏。滚水浸。溃而出水。肌体骨立。作喝吐痰。用益气汤六味
丸年余。元气复而诸证愈。
一儒者脚踝肿硬色白。两月余矣。用大防风汤。及十全大补兼服。而消。后场屋不利。
饮食劳倦。证复作。盗汗内热。饮食不化。便滑肌瘦。复加头晕。或头痛痰涌。此肾不纳气
用八味丸、益气汤。百余剂而安。
孙东宿曰。一人生杨梅疮后。偶遭一跌。环跳脱出。不能复入窠臼。疼痛殊甚。两足因
长短不齐。予思不能复入窠臼者。以瘀血流入窠臼。占满故窍。致骨不得复入也。今但消去
瘀血。必以行气活血之剂为主。以下行向导之剂佐之。庶可撤消。用陈年窖中砖瓦洗净 过
四两。生地、杜牛膝、骨碎补、丹参、赤芍各一两五钱。自然铜三两。蒲黄、车前子、苏木
各一两。鹿角二两。元明粉五钱。各为末。以茅草根一斤。红花四两煎膏。拌晒前药。再以
蜜丸服之。得效。
震按薛氏立方平正。孙公用药灵巧。均堪师法。但砖瓦宜用尿坑中者。不宜粪窖中者。
施笠泽治少司成张侗初。患足胫痛三年矣。诊之。脉沉细而涩。曰。此下焦元气不足。
不能荣养筋骨。当用滋补舒筋之剂。服后微效。因劳旋作。再诊之。脉兼浮数。元气愈耗矣
为制人参膏及河车天乙丸。间服。元气渐壮。独两胫作楚不能忍。因制万灵膏去樟脑。加
韶粉、苏合、麝香。以软帛紧系两胫。仍令饮甘草汤。不顷刻而痛若失。此膏良验。方载本
草纲目。后用黄 建中汤加参、归。调理全安。
震按此条与前案。俱以方之不同而选之。
薛立斋治疗阁老靳介庵。脚趾缝发痒并流出液体，脚面肿胀。外敷止痒药物无效，内服除湿药物反而加重病情。
薛立斋诊察后说：这是阴虚导致湿热下注。使用六味地黄丸（滋补肾阴）和补中益气汤（补益脾胃之气）而痊愈。
有一位读书人脚心发热、发痒，搔抓后用滚水浸泡，导致皮肤溃破流水，身体极度消瘦，出现呃逆和吐痰症状。服用补中益气汤和六味地黄丸一年多，元气恢复，各种病症痊愈。
另一位读书人脚踝肿胀坚硬，颜色发白，病程两个多月了。使用大防风汤，并兼服十全大补汤，肿块消退。后来科举考试不顺，因饮食不规律和劳累过度，病症复发，出现盗汗、内热、饮食不消化、大便滑泄、肌肉消瘦，又加上头晕，有时头痛且痰多涌出。这是肾不纳气（肾脏无法摄纳肺气），使用八味丸（金匮肾气丸）和补中益气汤，服用百余剂后病情安定。
孙东宿说：有一人在患杨梅疮（梅毒）后，偶然摔了一跤，导致环跳关节脱位，不能复位，疼痛非常剧烈。两脚因此长短不一。我思考不能复位的原因，是因为瘀血流入关节窝，占据了空间，导致骨头无法重新嵌入。现在只要消除瘀血，必须以行气活血的药物为主，辅以引导药力下行的药物，或许可以消除。使用陈年窖中的砖瓦洗净过四两，生地、杜牛膝、骨碎补、丹参、赤芍各一两五钱，自然铜三两，蒲黄、车前子、苏木各一两，鹿角二两，元明粉五钱。分别研成粉末，用茅草根一斤、红花四两煎膏，拌合晒干上述药物，再用蜂蜜制成丸剂服用。取得了疗效。
俞震按语：薛氏的处方平稳端正，孙公用药灵巧，都值得效法。但砖瓦应当选用尿坑中的，不宜选用粪窖中的。
施笠泽治疗少司成张侗初。患有足胫疼痛三年了。诊察发现脉象沉细而涩，说：这是下焦元气不足，不能滋养筋骨。应当使用滋补舒筋的药物。服药后略有成效，但因劳累而反复发作。再次诊察，脉象兼见浮数，元气更加耗损。于是配制人参膏和河车天乙丸，交替服用，元气逐渐强壮。唯独两小腿疼痛难忍。于是配制万灵膏，去掉樟脑，加入韶粉、苏合香、麝香，用软布紧紧包裹两小腿，仍令其饮用甘草汤，不一会儿疼痛消失。此膏效果良好，方剂记载在《本草纲目》中。后来使用黄芪建中汤加人参、当归，调理完全康复。
俞震按语：这一条与前一案，都是因为方剂不同而选录的。
Xue Lizhai treated Jin Jie'an, a Grand Secretary. The spaces between the toes were itchy and exuding fluid, with swelling on the dorsum of the foot. Topical application of anti-itch medicines was ineffective, and internal administration of dampness-resolving medicines exacerbated the condition.
Xue diagnosed: "This is Yin deficiency with damp-heat pouring downward." He prescribed Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) to nourish Kidney Yin and Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) to tonify Spleen and Stomach Qi, resulting in recovery.
A scholar suffered from heat and itching in the soles of his feet. Scratching followed by immersion in boiling water caused skin ulceration and exudation. His body became emaciated ("bone-thin"), accompanied by hiccuping and expectoration. After taking Buzhong Yiqi Tang and Liuwei Dihuang Wan for over a year, his Yuan Qi (Original Qi) recovered, and all symptoms resolved.
Another scholar presented with swollen, hard ankles with white discoloration, persisting for over two months. Da Fangfeng Tang (Great Wind-Expelling Decoction) was used, combined with Shiquan Dabu Tang (Ten Complete Tonification Decoction), leading to resolution. Later, due to failure in the imperial examinations, irregular diet, and fatigue, the condition recurred with night sweats, internal heat, indigestion, loose stools, muscle wasting, dizziness, and occasionally headache with profuse phlegm. This indicated Kidney failing to grasp Qi (Kidney not receiving Lung Qi). Bayi Wan (Eight-Ingredient Pill, i.e., Jin Gui Shenqi Wan) and Buzhong Yiqi Tang were administered for over a hundred doses, bringing stability.
Sun Dongsu stated: A patient developed a dislocation of the Huantiao (GB30) joint after a fall while recovering from Yangmeichuang (Syphilis/Kapok Disease). The joint could not be reduced, causing severe pain, resulting in leg length discrepancy. I reasoned that the inability to reduce was due to blood stasis filling the joint cavity, preventing bone re-engagement. Therefore, eliminating blood stasis was key, primarily using Qi-moving and Blood-invigorating agents, assisted by descending guide herbs. We used bricks/tiles from old cellars, washed thoroughly (4 liang), Shengdi Huang (Radix Rehmanniae Preparata) (1.5 liang), Duniu Xi (Radix Achyranthis Bidentatae) (1.5 liang), Gusuibu (Os Dinosauri) (1.5 liang), Danshen (Radix Salviae Miltiorrhizae) (1.5 liang), Chishao (Radix Paeoniae Rubra) (1.5 liang), Ziran Tong (Pyritum) (3 liang), Puhuang (Pollen Typhae) (1 liang), Cheqianzi (Semen Plantaginis) (1 liang), Sumu (Lignum Sappan) (1 liang), Lu Jiao (Cornu Cervi Pantotrichum) (2 liang), and Yuanming Fen (Natrii Sulfas) (0.5 liang). Each was powdered. A paste was made from Maocaogen (Rhizoma Imperatae) (1 jin) and Honghua (Flos Carthami) (4 liang). The powders were mixed with the paste, dried, and formed into pills with honey. Efficacy was achieved.
Yu Zhen's commentary: Xue's prescriptions are balanced and upright; Sun's medication is skillful and agile. Both are worthy of emulation. However, for the bricks/tiles, those from urine pits should be used, not those from manure pits.
Shi Lize treated Zhang Tongchu, Vice Director of the Directorate of Education. He had suffered from lower leg pain for three years. Pulse diagnosis revealed a deep, fine, and choppy pulse. Shi said: "This is insufficiency of Yuan Qi in the Lower Jiao, failing to nourish sinews and bones." Tonifying and sinew-relaxing medicines were prescribed, yielding slight effect initially. However, relapses occurred due to exertion. Re-examination showed a floating and rapid pulse, indicating further depletion of Yuan Qi. Ren Shen Gao (Ginseng Paste) and Heche Tianyi Wan (Placenta Tianyi Pill) were prepared and taken alternately, gradually strengthening Yuan Qi. Yet, pain in both calves remained unbearable. Wanling Gao (Myriad Miracles Plaster) was formulated, excluding Zhagnnao (Borneolum Syntheticum), adding Shaofen (likely a specific mineral or processed herb, contextually unclear but kept as name), Suhexiang (Styrax), and Shexiang (Moschus). The plaster was tightly bound to the calves with soft cloth, and the patient drank Gancao Tang (Licorice Decoction). Within moments, the pain vanished. This plaster is highly effective; its formula is recorded in Bencao Gangmu (Compendium of Materia Medica). Subsequently, Huangqi Jianzhong Tang (Astragalus Decoction to Build the Middle) supplemented with Renshen (Radix Ginseng) and Danggui (Radix Angelicae Sinensis) was used for regulation, leading to complete recovery.
Yu Zhen's commentary: This case and the previous one are selected here because they demonstrate different formulas addressing similar or related presentations.