丹溪治一少年。暑月。因大劳而渴。恣饮梅浆。又连大惊。妄言妄见。病似邪鬼。脉虚
弦而带沉数。数为有热。虚弦是惊。又梅浆停郁中脘。宜补虚清热。导去淡滞乃可。遂与参
术、陈皮、茯苓、芩、连。并入竹沥、姜汁。旬日未效。乃虚未回。痰未导也。以前药入
荆沥。又旬日而安。
又治浦江郑姓者。年二十余。秋间大发热。口渴。妄言妄见。病似邪鬼。七八日后。请
朱治之。脉之。两手洪数而实。视其形肥。面赤带白。却喜露筋。脉本不实。凉药所致。此
因劳倦成病。与温补药自安。曰。柴胡七八帖矣。以黄 附子汤冷与之。饮三帖后。困倦鼾
睡。微汗而解。脉亦稍软。继以黄 白术汤。至十日。脉渐收敛而小。又与半月而安。
虞恒德治一妇。年近三十。有姿色。得一证。如醉如痴。颊赤面青。略有潮热。饮食不
美。其脉乍疏乍数而虚。每夜见白衣少年与睡。一医与八物汤。服数十帖不效。虞见其家有
白狗。卧枕户阈。虞曰。必此所为。命杀狗取其心血及胆汁。丸安神定志之药。以八物汤舌
下。丸药用远志、石菖蒲、川归、黄连、茯神、朱砂、侧柏叶、草龙胆等药。
震按此三条甚奇。却难效法。首条若在今日。惟有清热导痰耳。敢用人参耶。丹溪则以
脉之虚弦。因之大劳。认得清。故虽旬日未效。仍守前药。设有游移。则前功尽弃。病不痊
而谤随之矣。次条脉证。俱似实热。乃云脉本不实。凉药所致。苟非具大本领者。谁敢道此
然用 、附、术。而不用人参。想其审证处。必另有会心也。第三条诚系邪魅。然以白衣
疑及白狗。近于诡幻。倘仍不效。能无雉罹于罗之叹。汇而录之。以备考订。
张路玉治文学黄稚洁。谵妄颠仆。数月以来。或六七日一发。或二三日一发。或一日二
三发。发则大吐涎水血沫。或一日半日而苏。或二三时而苏。医祷不灵。近于邪祟。术士皆
言宿孽所致。昼夜恒见亡婢仆妇二鬼缠绵。或时昏愦不省。或时妄言妄见。精气不时下脱。
不能收摄。服二冬、二地、连、柏、金樱、石莲之属无算。反加作泻不食。后延张诊之。脉
来寸盛尺微。前大后小。按之忽无。举之忽有。知为神气浮散之候。因与六君子加龙齿、菖
蒲、远志。送养正丹。间续而进。前后共三七服。是后谵妄颠仆。绝不复发。邪祟亦不复见
惟梦泄为平时痼疾。不能霍然。更与平补镇心丹。两月而安。其尊人及昆弟亲戚。咸谓金
石之药。能镇鬼神。曷知从前谵妄。皆神气浮散之故。得养正镇摄之功。当无神魂飞越之患
矣。因识此以破杯影弓蛇之惑。
震按鬼祟岂能病患。不过病似鬼祟耳。或痰或虚。从其脉象以施治法。诸案皆先资之助
也。
朱丹溪治疗一名少年。正值暑天，因过度劳累而口渴，肆意饮用梅子浆，又接连受到惊吓，出现胡言乱语、幻视幻听的症状，病情看起来像被邪鬼附身。脉象虚弦且带有沉数之象。数脉主热，虚弦脉主惊悸。加之梅浆停滞郁结在中脘部位，应当补益虚损、清除内热，并疏导去除痰湿积滞才可以治愈。于是给予人参、白术、陈皮、茯苓、黄芩、黄连，并加入竹沥、姜汁。十天过去没有见效，这是因为正气未复，痰浊未被导出的缘故。在前方中加入荆沥，又过了十天病情才安定下来。
又治疗浦江姓郑的人。二十多岁。秋季突发高热，口渴，胡言乱语，幻视幻听，病情看似邪鬼作祟。七八天后，请朱丹溪诊治。诊其脉，两手脉洪大、数急且有力。观察其形体肥胖，面色红中带白，却喜欢露出筋脉（显示皮下脂肪薄或血管显露），脉象其实并不实，这是服用凉药导致的。此病是因为劳倦而成，给予温补药物自然能安宁。当时已经服用了七八帖柴胡剂，改用附子汤冷服给他。喝了三帖后，感到困倦并打鼾入睡，微微出汗而病解。脉象也变得稍柔和。接着给予黄芪白术汤，到第十天，脉象逐渐收敛变小。再服药半个月，病情痊愈。
虞恒德治疗一名妇女。年龄近三十岁，有姿色。患有一种病症，神情恍惚如醉如痴，脸颊红润面色青暗，略有潮热，饮食不佳。脉象时而疏缓时而急促且虚弱。每晚梦见白衣少年与之同睡。一位医生给予八物汤，服用几十帖无效。虞恒德看见她家有一只白狗，卧在门坎上。虞恒德说：“必定是这只狗所为。”命令杀掉狗，取用其心血和胆汁，制成安神定志的丸药，配合八物汤送服。丸药使用远志、石菖蒲、川当归、黄连、茯神、朱砂、侧柏叶、草龙胆等药材。
俞震按语：这三条医案非常奇特，却难以效仿。第一条若放在今日，只有清热化痰一法罢了，怎敢用人参呢？丹溪因为脉象虚弦，结合大劳的病史，认识清晰，所以即使十天未见效，仍坚守前药。如果此时犹豫动摇，则前功尽弃，病不痊愈而诽谤随之而来。第二条脉证，都像是实热，却说脉本不实，是凉药所致。如果不是具有大本领的人，谁敢这样说？虽然使用了黄芪、附子、白术，而没有用人参，想必他在审察病证之处，必有另外的领悟。第三条确实像是邪魅作祟，但因为白衣而怀疑到白狗，近乎诡幻。如果仍然无效，怎能没有“雉罹于罗”（比喻陷入困境无法解脱）的叹息呢？汇总记录这些案例，以备考证订正。
张路玉治疗文人黄稚洁。出现谵语狂妄、跌倒抽搐的症状，持续数月。有时六七天发作一次，有时两三天发作一次，有时一天发作两三次。发作时大口吐出涎水和血沫，有时半天或一天半才能苏醒，有时两三个时辰才能苏醒。求医问卜都不灵验，接近邪祟。术士都说这是宿世罪孽所致，昼夜常看到已故婢女和仆妇两个鬼魂纠缠。有时昏沉糊涂不省人事，有时胡言乱语、幻视幻听。精气不时下泄脱失，不能收摄。服用天冬、麦冬、生地、熟地、黄连、黄柏、金樱子、石莲子等药物无数，反而加重了腹泻和不思饮食。后来延请张路玉诊治。脉象寸部盛而尺部微，前部大后部小，重按时忽然感觉不到，轻取时忽然又有。知道这是神气浮散的征候。于是给予六君子汤加龙齿、石菖蒲、远志，送服养正丹。间断续服，前后共服用三七二十一帖。此后谵妄颠仆的症状，绝对不再复发，邪祟也不再出现。只有梦遗成为平时的顽固疾病，不能立刻痊愈。又给予平补镇心丹，两个月后病情安定。他的父亲及兄弟亲戚，都认为金石类药物能镇压鬼神，哪里知道从前的谵妄，都是神气浮散的缘故。得到养正镇摄的功效，就没有神魂飞越的祸患了。因此记录此案以破除杯弓蛇影的迷惑。
Zhu Danxi treated a young man. It was the summer season, and due to excessive labor, he felt thirsty and drank plum syrup indiscriminately. He then suffered repeated frights, resulting in delirious speech and visual hallucinations; his condition resembled possession by evil spirits. His pulse was deficient, wiry, and carried a deep, rapid quality. A rapid pulse indicates heat; a deficient and wiry pulse indicates fright. Additionally, the plum syrup had stagnated and obstructed the middle jiao (middle burner). The treatment should have been to tonify deficiency, clear heat, and guide out phlegm-dampness stagnation. Therefore, he was prescribed Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Citri Reticulatae Pericarpium (Chenpi), Poria (Fuling), Scutellariae Radix (Huangqin), and Coptidis Rhizoma (Huanglian), combined with Bamboo Sap (Zhuli) and Ginger Juice (Jiangzhi). After ten days, there was no improvement. This was because the deficiency had not yet recovered, and the phlegm had not yet been guided out. Jingshe (Arisaema Cum Bile) was added to the previous prescription. After another ten days, the patient stabilized.
He also treated a Mr. Zheng from Pujiang. In his early twenties, during autumn, he suffered sudden high fever, thirst, delirious speech, and visual hallucinations; his condition seemed like evil spirit affliction. Seven or eight days later, Zhu Danxi was invited to treat him. Palpating the pulse, both hands showed a surging, rapid, and full/excess quality. Observing his physique, he was fat, with a red face showing white patches, yet he liked to expose his veins (indicating thin subcutaneous tissue or prominent vessels); the pulse was actually not truly excess, but caused by the administration of cooling medicines. This illness resulted from fatigue and overwork; administering warming and tonifying medicines would naturally bring peace. At that time, he had already taken seven or eight doses of Bupleuri Radix (Chaihu) decoction. Instead, Fuzi Decoction (Fuzi Tang) was given cold. After drinking three doses, he felt drowsy, slept with snoring, and resolved with slight sweating. The pulse became slightly softer. Subsequently, Astragali Radix et Atractylodis Macrocephalae Rhizoma Decoction (Huangqi Baizhu Tang) was administered. By the tenth day, the pulse gradually converged and became smaller. After another half month of medication, he recovered.
Yu Hengde treated a woman near thirty years old, who was attractive. She suffered from a condition where she appeared intoxicated and foolish, with reddish cheeks and bluish complexion, slight tidal fever, and poor appetite. Her pulse was intermittently sparse and rapid, yet deficient. Every night, she dreamed of sleeping with a youth in white clothes. One physician prescribed Eight-Ingredient Decoction (Bawu Tang), but after dozens of doses, there was no effect. Yu Hengde noticed a white dog lying on the threshold at her home. Yu said, "This must be caused by this animal." He ordered the dog to be killed, and its heart blood and bile were collected to make pills for calming the mind and stabilizing the will, administered with Bawu Tang. The pills contained Polygalae Radix (Yuanzhi), Acori Tatarinowii Rhizoma (Shichangpu), Angelicae Sinensis Radix (Chuan Gui), Coptidis Rhizoma (Huanglian), Poria (Fushen), Cinnabaris (Zhusha), Platycladi Cacumen (Cebaiye), and Gentianae Macrophytae Radix (Caolongdan).
Commentary by Yu Zhen: These three cases are very strange and difficult to emulate. If the first case were treated today, one would only use methods to clear heat and resolve phlegm; how could one dare to use Ginseng? Danxi, recognizing the deficient and wiry pulse in the context of great labor, had a clear understanding. Thus, even though there was no effect after ten days, he stuck to the original prescription. Had he hesitated, all previous efforts would have been wasted, the disease would not have cured, and slander would have followed. The second case's pulse and symptoms both resembled excess heat, yet he stated the pulse was originally not excess, caused by cooling medicines. Only someone with great skill would dare to say this. Although Huangqi, Fuzi, and Baizhu were used, without Renshen, it is likely he had a specific insight into the syndrome differentiation. The third case indeed seems like demonic influence, but suspecting a white dog based on the "white-clad" dream is somewhat fanciful. If it still failed, one might sigh about being trapped like a pheasant in a net. These cases are compiled for reference and verification.
Zhang Luyu treated a scholar, Huang Zhijie. He suffered from delirious madness and falling/collapsing episodes for several months. Episodes occurred every six to seven days, or two to three days, or twice or three times a day. During attacks, he vomited large amounts of saliva and bloody foam, recovering consciousness after half a day, a day and a half, or two to three shichen (hours). Medical prayers were ineffective, resembling evil spirit affliction. Fortune tellers claimed it was due to past-life sins, stating he saw ghosts of deceased maidservants and female servants day and night entangling him. Sometimes he was confused and unconscious, sometimes delirious and hallucinating. Essence and qi leaked out uncontrollably. He took countless doses of Asparagi Radix (Donggu), Ophiopogonis Radix (Dongshen), Rehmanniae Radix Preparata (Dishu), Scutellariae Radix (Huangqin), Phellodendri Cortex (Huangbai), Cornus Officinalis Fructus (Jinyingzi), and Nelumbinis Semen (Shilian), which worsened diarrhea and loss of appetite. Later, Zhang Luyu was consulted. The pulse was strong at the Cun (inch) position and weak at the Chi (cubit) position, large anteriorly and small posteriorly; pressing deeply made it vanish, while light pressure made it appear. This indicated floating and scattering of Shen (Spirit). He prescribed Six-Ingredient Pill with Ginseng (Liujunzi San) plus Long Gu (Dragon Bone), Shichangpu, and Yuanzhi, delivered with Yangzheng Dan (Nourishing Righteousness Pill). Taken intermittently, totaling twenty-one doses, the delirium and collapsing stopped completely, and the ghost visions disappeared. Only nocturnal emission remained as a chronic ailment, not fully cured. Pingbu Zhenxin Dan (Calming and Tonifying Heart Pill) was then given, and he stabilized after two months. His father, brothers, and relatives believed mineral drugs could suppress ghosts, unaware that the prior delirium was due to floating Shen. With the function of nourishing righteousness and suppressing floating, there was no danger of Shen flying away. This record is written to dispel illusions like the bow reflected in a cup.
Commentary by Yu Zhen: How can ghosts cause illness? The condition merely resembles ghost affliction. It is either phlegm or deficiency; treatment is applied according to the pulse image. These cases serve as references.