疏杀虫方分量颇轻。并令服榧果。旬日全愈。失音嗄证。不出金实无声。金破无声之两途。此为医林中别开一法门也。
〔二十二〕古人煎药。各有法度。表药以气胜。武火骤煎。补药以味胜。文火慢煎。有只用头煎。不用第二煎者。
取其轻扬走上也。有不用头煎。只用第二煎第三煎者。以煮去头煎。则燥气尽。遂成甘淡之味。淡养胃气。微甘养脾阴。
为治虚损之秘诀。（出慎柔五书。）又煎药宜各药各铫。恐彼煎攻伐。此煎补益。此煎温热。彼煎清凉。有大相反者。譬
如酒壶冲茶。虽不醉人。难免酒气也。
〔二十三〕周慎斋（名子 。宛平太邑人。生正德年间。）中年患中满疾。痛楚不堪。遍访名医无效。复广搜医方。
又不敢妄试。一夕。强坐玩月。倏为云蔽。闷甚。少顷。清风徐来。云开月朗。大悟曰。夫云。阴物也。风。阳物也。
阳气通畅。则阴翳顿消。吾病其犹是乎。遂制和中方丸。服不一月而安。后成名医。尝阅本草钩元卷首武进阳湖合志杨
时泰传曰。“自明以来。江南言医者。类宗周慎斋。慎斋善以五行制化。阴阳升降。推人脏气。而为剂量准。雍正以后。
变而宗张路玉。则主于随病立方。遇病辄历试以方。迨试遍则束手。”于是购求慎斋先生书。见医学粹精五种。周慎斋三
书。查了吾正阳篇。胡慎柔五书。陈友松脉法解。附陈友松笔谈。其慎柔五书。已见于六醴斋丛书。脉法亦是慎斋先生
着。陈友松加解而已。查了吾胡慎柔俱为慎斋先生弟子。三书者。皆先生弟子口授耳传。记录成编者也。其自制丸
方录后。（周慎斋学问。究不及张路玉。第宗张路玉不善。则有遇病试方之弊耳。）和中丸治鼓胀神效。用干姜四两。（冬
炒焦夏炒黑）一两用人参一两煎汤拌炒。一两用青皮三钱煎汤拌炒。一两用紫苏五钱煎汤拌炒。一两用陈皮五钱煎汤拌
炒。肉桂二两。一分用益智仁五钱煎汤拌炒。一分用泽泻五钱同煮。一分用小茴香三钱同煮。一分用破故纸五钱同煮。
吴茱萸一两。一分用苡仁一两煎汤拌炒。一分用盐五钱同浸炒。上为末。紫苏煎汤打神曲糊为丸。如桐子大。每服因证
轻重。随证作汤送。红曲丸治泻痢日久。用此补脾健胃。红曲（三钱炒）锅巴（一两烧存性）松花（三钱炒褐色）上为
末。入白糖霜。和匀服。红痢加曲。白痢加松花。蔻附丸治元气虚寒。及脏寒泄泻。肉豆蔻（面裹煨）白茯苓（各二两）
木香（一两五钱）干姜（泡）附子（煨各五钱）上为末。姜汁糊为丸。莲子汤下。通神散治 杂。胸中割痛。三服即愈。
白术（四两）黄连（四钱）陈皮（五钱）上为末。神曲糊为丸。临卧津咽三四十丸。
〔二十四〕诊脉以辨病证之顺逆。脉书言之详矣。大抵是病应得是脉者为顺。不应得是脉者为逆。此余三十余
年阅历。为诊脉辨证之要诀。后阅查了吾先生述慎柔和尚师训曰。“凡久病患脉大小洪细沉浮弦滑。或寸浮
尺沉。或尺浮寸沉。但有病脉。反属可治。如久病浮中沉俱和缓体倦者决死。且看其面色光润。此精神皆发于面。
决难疗矣”一节。实获我心。不禁抚案称快。盖平人得和缓。为无病之脉。乃病久体倦。不应得此脉而竟得之。是
为正元大漓之象。故决其死也。至若满面精神。岂久病患所宜有。世俗谓病患无病容者大忌。亦是此意。
〔二十五〕尤在泾补中益气汤六味地黄汤合论曰。（见医学读书记）“阳虚者气多陷而不举。故补中益气多用参 术
草。甘温益气。而以升柴辛平。助以上升。阴虚者气每上而不下。故六味地黄多用熟地萸肉山药。味浓体重者。补
阴益精。而以茯苓泽泻之甘淡。资之下降。气陷者多滞。陈皮之辛。所以和滞气。气浮者多热。丹皮之寒。所以清浮
热。六味之有苓泻。犹补中之有升柴也。补中之有陈皮。犹六味之有丹皮也。其参 归术甘草。犹地黄萸肉山药
也。法虽不同。而理可通也。”此论方义上下升降颇精。而薛立斋赵养葵数先生。专以六味八味补中益气等数
方。统治诸病。则失之执滞呆板。无怪为徐灵胎陈修园诸先哲所诋论。周慎斋先生书中亦每以六味八味补中
益气数方治病。盖先生尝就正于立斋先生之门。（慎斋先生传曰。问难数日。证其初悟。豁然贯通。出谓人曰。
立斋真名师也。理道甚明。惜其稍泥。）犹不能脱薛氏窠臼。然三书言“补中益气汤若欲下达。去升柴。加杜仲牛膝。”
又言“六味丸肾虚火动之药。丹皮凉心火。萸肉敛肝火。泽泻利肾经之火。从前阴而出。若火不甚炽者。只用山药。
茯苓。熟地。单滋肾水而补脾阴。”乃知慎斋先生能变通用药。不执死方以治活病。
〔二十六〕脉见歇止。为病患所大忌。人尽知之。然余见痰食阻中。及妇人怀孕。间见歇止脉。俱无大碍。盖以有
形之物。阻滞脉道。故有时歇止也。周慎斋先生脉法云。“凡杂病。伤寒。老人见歇止脉者。俱将愈之兆。惟吐而见歇
止脉者死。”陈友松解曰。“歇止有结促两种。结者。迟而止也。病后阴血方生。阳气尚未充足。不能协济其阴。故
有迟滞之象。缓行略止。俟阳气一充。全体皆春矣。促者。数而止也。以阳气犹旺。阴分少亏。不能调燮其阳。故有奔
迫之势。急行一止。俟阴血渐生。则五脏自然畅达矣。此皆将愈未愈之时。故见此疲困之象。待愈后即无是脉。所
以杂病伤寒。庸医误治。或损其阳。或亏其阴。往往轻病变重。然而未至过伤。久之元气藉谷气以生。辄见此等之
脉。乃阴阳渐长之机。非气血全亏之候。至老人年力就衰。或病后见歇止之脉。不过阴阳两亏。非凶脉也。可见诸
脉俱不妨于歇止。惟呕吐一证。胃气逆而上行。将胃中有形之物。尽情吐出。此时脉若平和。犹可保元降气。倘见
歇止。是肾气已绝于下。不能上供其匮乏。虽用药胃必不纳。故知其必死。”按陈友松所解非是。凡脉见结促。皆
属凶候。岂可目为将愈之兆。慎斋先生所言。乃是和平脉中见歇止。方为近理。
〔二十七〕病患大肉已落。为不可救药。盖以周身肌肉瘦削殆尽也。余每以两手大指次指后。验大肉之落与不
落。以断病之生死。百不失一。病患虽骨瘦如柴。验其大指次指之后。有肉隆起者。病纵重可医。若他处肌肉尚丰。
验其大指次指之后。无肉隆起。而见平陷者。病不可治。周慎斋先生三书云。“久病形瘦。若长肌肉。须从内 眼
下胞长起。以此处属阳明胃。胃主肌肉故也。”此言久瘦渐复之机。又不可不知。
〔二十八〕族孙诗卿妇患肝风证。周身筋脉拘挛。其脉因手腕弯曲作劲。不可得而诊。神志不昏。此肝风不直上
巅脑。而横窜筋脉者。余用阿胶鸡子黄生地制首乌麦冬甘草女贞子茯神牡蛎白芍木瓜钩藤络石天仙藤丝
瓜络等出入为治。八剂愈。病患自述病发时。身体如入罗网。内外筋脉牵绊拘紧。痛苦异常。服药后。辄觉渐渐宽
松。迨后不时举发。觉面上肌肉蠕动。即手足筋脉抽紧。疼痛难伸。只用鸡子黄两枚。煎汤代水。溶入阿胶二钱。服
下当即痛缓。筋脉放宽。不服他药。旋发旋轻。两月后竟不复发。按阿胶鸡子黄法。本仲圣黄连阿胶汤。伤寒论曰。
“少阴病。得之二三日以上。心中烦。不得卧。黄连阿胶汤主之。”以热入至阴。用咸苦直走阴分。一面泄热。一面
护阴。阴充热去。阳不亢而心烦除。阳交阴而卧可得也。第彼以热邪。故兼苦寒清之。此则液涸筋燥。单取阿胶鸡
子黄二味。血肉有情。质重味浓。以育阴熄风。增液润筋。不图效验若斯。古云。‘药用当而通神。’信哉。吴鞠通先
生目鸡子黄为定风珠。立有大定风珠小定风珠二方。允推卓识。（古方用鸡子黄。俱入药搅匀。亦有囫囵同煎者。
余用是物。每令先煎代水。取其不腥浊。鸡子黄一经煎过。色淡质枯而无味。盖其汁与味。尽行煎出故也。）
〔二十九〕治痢证用木香以开郁滞。升降诸气。诚为佳品。然其气香而窜。其味苦而辣。宜于实证。而不宜于虚证。
宜于寒湿。而不宜于暑热。其有湿热粘滞。稍加木香作佐。使宣通气液。未始不可。独怪近世治痢。不辨证脉。视木
香为家常便饭。几至无方不用。甚且形消骨立。舌绛而光。阴涸显然。犹复恣用不已。浸至不救。目击心伤。特为拈
出。医家病家。切须留意。吴鞠通先生言。“近世以羌活代麻黄发汗。不知羌活之更烈于麻黄。试以羌活一两。煮
于一室。两三人坐于其侧。其气味之发泄。弱者辄不能受。”余谓煎剂中有木香在药铫内。则满室皆闻木香气。
如此雄烈之品。虚弱人燥热证曷克当之。（一人患痢月余。更加食入作呕。阅前方统计服过木香六七钱。余用甘寒养胃
加旋复代赭石人参石莲肉等。先止其呕。继仿驻车丸法以除痢。本草言阴火冲上者忌木香。此证以多用木香致胃火上冲。）
〔三十〕内经曰。“心者。君主之宫。神明出焉。”又曰。“心者。生之本。神之变也。”是故心不受邪。受邪即死。
凡外感证之病涉心者。皆在心包络与血脉也。盖包络为心主之宫城。血脉为心主之支脉。邪入包络则神昏。邪入血
脉亦神昏。但所入之邪有浅深。所现之证有轻重。如邪入包络。包络离心较近。故神昏全然不知人事。如入血脉。
血脉离心较远。故呼之能觉。与之言。亦知人事。若任其自睡。而心放即昏沉矣。有邪在血脉。因失治而渐入包络
者。此由浅而入深也。有邪在包络。因治得其法。而渐归血脉者。此由深而出浅也。又有邪盛势锐。不从气分转入。
不由血脉渐入。而直入心包络者。陡然昏厥。其证最凶。缓则不过一日。速则不及一时。当即告毙。以其直入包络
而内犯心。犯心即死耳。章虚谷伤寒本旨有神昏 语辨。谓得之于经历。古人所未道及。厥功甚大。盖邪闭血脉。
外感病每多是证。医者未识其故。因而误治者多也。其论治法。邪闭血脉者。必须温通。重用桂枝。则太执着矣。温
热暑湿证现邪闭血脉。设遇热盛之证。其可重用桂枝乎。即使佐以凉药。亦难用也。虚谷未始不见及于此。只以
“必须温通。重用桂枝”两语。横踞胸中。是以上文云。“如风寒等邪而不提出。”温热暑湿者。亦以重用桂枝。
有所窒碍。未免自相矛盾。而姑以风寒等邪混言之耳。下一“等”字以包括温热暑湿耳。不然。上文仲圣伤寒
论中之神昏 语。已辨之矣。此处何必再言风寒耶。总之闭者通之。此对待法也。桂枝可以通血脉之闭。桂枝究
非热证所宜。但取能入血脉而具流利之品。或佐以辛温。加意防其闭遏血脉。则得之矣。倘医者遵信虚谷。执着
必须温通。重用桂枝之说。以治热证。何异抱薪救火。为明辨之。不敢为先辈讳也。
〔三十一〕谈往载崇祯十六年。有疙瘩温羊毛温等名。呼病即亡。不留片刻。八九两月。疫死数百万。十月间有闽
人晓解病由。看膝湾后有筋突起紫者无救。红则速刺出血可活。至霜雪渐繁。势亦渐杀。余谓此疫即前条所云
邪盛势锐。直入心包络。内犯心主之证。所以呼病即亡。危期极速也。考嘉兴王肱枕蚓庵琐语及桐乡陈松涛灾
荒纪事皆云。崇祯十四年大旱。十五十六经年亢旱。通国奇荒。疫疠大作。据此。则其病由暑燥热毒。深入血分可
知。所以霜雪繁而病势杀。刺筋出血。而其人可活也。刺筋出血者。经云。“血实宜决之”之旨也。邪入较浅。筋色
尚红。速刺出血。则血脉松动。便有活路。筋紫则为血脉凝瘀已极。纵刺之。血亦不出。为无救耳。此证神识必然昏
沉。其脉亦必涩滞模糊。或促或伏。若用药亦当遵“血实宜决之”之经旨。通利血脉主治。必使血脉渐渐松动。
不致内犯心主。走死路。方为得法。（病由暑燥热毒。若重用桂枝温通。万万不可。）近时痧证。亦有顷刻告殂者。亦有
刺舌底黑筋。刺两臂弯。两膝弯等处。出血而愈者。但不若谈往所载既甚且多。为非常之疫疠耳。
〔三十二〕潜村医案（乾隆时。西吴杨云峰乘六着。）姚绳其病痢。腹痛后重。脓血立见。继而便孔中解出断肠一段。
长半尺许。延杨诊。杨曰。此非断肠也。若断肠则上下断头。必垂而不举。上下断口。必闭而不张。所断之半尺许者。
何能进直肠而出肛门耶。且肠既断矣。何其人犹活。而便中之脓血。仍相续而不绝耶。不知此乃肠内滑腻稠粘。如脂如
膏。粘贴肠上之一层也。是即所谓阴也。腑气大伤。阴难维系。又为邪毒所压而下。其形外圆中空。有似乎肠而实非
肠也。试以棒拨之必腐。若真肠虽烂而断。拨之不腐。家人拨之果腐。进诊。面无神气。脉甚细数弦劲。舌如镜面。胃
气将绝。无救矣。逾数日。果殁。此与卷一第二十七条同一痢下脂膜。第整段而下。为罕有之证。
〔三十三〕药气入胃。不过借此调和气血。非入口即变为血气。所以不在多也。有病患粒米不入。反用腻膈酸苦
腥臭之药。浓煎大碗灌之。即使中病。尚难运化。况与病相反。填塞胃中。即不药死。亦必塞死。小儿尤甚。此洄溪徐
疏杀虫方的药量很轻。并让患者服用榧子。十天左右完全痊愈。失音嘶哑的证候，不外乎“金实无声”和“金破无声”这两类途径。这是医学界别开生面的一种法门。
〔二十二〕古人煎药，各有法度。解表药以气味取胜，用武火急煎；补益药以滋味取胜，用文火慢煎。有的只用头煎，不用第二煎。这是取其药性轻扬上行。有的不用头煎，只用第二煎、第三煎。因为煮去头煎后，燥气尽除，便成了甘淡的味道。淡味能养胃气，微甘能养脾阴。这是治疗虚损病的秘诀。（出自《慎柔五书》。）另外，煎药宜各药分别用不同的壶煎煮。恐怕有的药是攻伐之品，有的是补益之品；有的药性温热，有的药性清凉。有大相相反的。譬如用酒壶冲茶，虽然不会醉人，却难免有酒气。
〔二十三〕周慎斋（名周澍，宛平太邑人，生于正德年间。）中年患中满病，痛苦不堪。遍访名医无效，又广泛搜集医方。但又不敢妄自尝试。一天晚上，勉强坐着赏月，忽然被云遮住，心中非常郁闷。过了一会儿，清风徐来，云开月朗，突然领悟道：云，是阴物；风，是阳物。阳气通畅，则阴翳顿时消散。我的病大概也是这样吧。于是制成和中方丸。服用不到一个月就安好了。后来成为名医。曾经阅读《本草钩元》卷首武进阳湖合志中杨时泰的传记说：“自明代以来，江南谈论医术的人，大多尊崇周慎斋。慎斋善于运用五行制化、阴阳升降的道理，推演人的脏气，作为剂量的标准。雍正以后，风气转变，尊崇张路玉，主张随病立方，遇到病就屡次试用方剂。等到试遍了，就束手无策。”于是购买寻求慎斋先生的书籍，见到《医学粹精》五种，《周慎斋三书》，查了吾的《正阳篇》，胡慎柔的《五书》，陈友松的《脉法解》，附陈友松的《笔谈》。其中《慎柔五书》，已经见于《六醴斋丛书》。《脉法》也是慎斋先生所著，由陈友松加以解释而已。查了吾、胡慎柔都是慎斋先生的弟子。这三本书，都是先生弟子口授耳传，记录成编的。他自制的丸方录在后面。（周慎斋的学问，探究起来不及张路玉。只是宗奉张路玉而不善，则有遇到病就试用方剂的弊端罢了。）和中丸治疗鼓胀症神效。用干姜四两。（冬天炒焦，夏天炒黑）一两用人参一两煎汤拌炒，一两用青皮三钱煎汤拌炒，一两用紫苏五钱煎汤拌炒，一两用陈皮五钱煎汤拌炒。肉桂二两，一分用益智仁五钱煎汤拌炒，一分用泽泻五钱同煮，一分用小茴香三钱同煮，一分用破故纸五钱同煮。吴茱萸一两，一分用苡仁一两煎汤拌炒，一分用盐五钱同浸炒。以上研为末，用紫苏煎汤打神曲糊为丸，如梧桐子大。每次服用根据病情轻重，随证作汤送服。红曲丸治疗腹泻痢疾日久，用此方补脾健胃。红曲（三钱炒），锅巴（一两烧存性），松花（三钱炒至褐色）。以上研为末，加入白糖霜，和匀服用。红痢加曲，白痢加松花。蔻附丸治疗元气虚寒，及脏寒泄泻。肉豆蔻（面裹煨），白茯苓（各二两），木香（一两五钱），干姜（泡），附子（煨，各五钱）。以上研为末，用姜汁糊为丸，莲子汤送下。通神散治疗杂病，胸中割痛，服三剂即愈。白术（四两），黄连（四钱），陈皮（五钱）。以上研为末，神曲糊为丸，临睡前津液吞咽三四十丸。
〔二十四〕诊脉用来辨别病证的顺逆。脉书说得详细了。大体上是这病应当得到这脉象为顺，不应当得到这脉象为逆。这是我三十多年阅历，作为诊脉辨证的要诀。后来阅读查了吾先生记述慎柔和尚师训说：“凡是久病患者，脉象大小洪细沉浮弦滑，或寸浮尺沉，或尺浮寸沉，只要有病脉，反而属于可治。如果久病体倦，脉象浮中沉俱和缓，决断为死证。且看其面色光润，精神都发于面部，决难治疗了。”这一节，实在符合我的心意，不禁拍案称快。因为常人得和缓脉，是无病的脉象。乃至于病久体倦，不应当得此脉象而竟然得了，这是正气大衰的现象，所以决断为死证。至于满面精神，难道是久病患者所应有的吗？世俗认为病患没有病容是大忌，也是这个意思。
〔二十五〕尤在泾对补中益气汤和六味地黄汤的合论说：（见《医学读书记》）“阳虚者气多陷而不举，所以补中益气汤多用参、术、草，甘温益气，而以升麻、柴胡辛平，帮助上升。阴虚者气每上而不下，所以六味地黄汤多用熟地、萸肉、山药，味道浓重者，补阴益精，而以茯苓、泽泻的甘淡，资助下降。气陷者多有滞涩，陈皮之辛，所以调和滞气；气浮者多有热，丹皮之寒，所以清浮热。六味中有苓、泻，就像补中益气中有升、柴一样。补中益气中有陈皮，就像六味中有丹皮一样。其中的参、归、术、甘草，就像地黄、萸肉、山药一样。方法虽然不同，但道理是相通的。”这个论述方义上下升降颇为精妙。而薛立斋、赵养葵等几位先生，专门用六味、八味、补中益气等几个方子，统管各种疾病，这就失之于固执呆板。难怪被徐灵胎、陈修园等先哲所诋毁批评。周慎斋先生的书中也常用六味、八味、补中益气等几个方子治病。大概先生曾经向薛立斋先生请教过。（慎斋先生传记说：问难数日，证实初悟，豁然贯通。出来对人说道：立斋真是名师啊，理道很明白，可惜稍微拘泥。）仍然不能摆脱薛氏的窠臼。然而三书中说“补中益气汤如果想要下达，去掉升麻、柴胡，加杜仲、牛膝。”又说“六味丸是治疗肾虚火动的药，丹皮凉心火，萸肉敛肝火，泽泻利肾经之火，从前阴而出。如果火不是很炽盛的，只用山药、茯苓、熟地，单滋肾水而补脾阴。”才知道慎斋先生能够变通用药，不执守死方来治活病。
〔二十六〕脉象出现歇止，是病患的大忌，人们都知道。然而我见到痰食阻滞中焦，以及妇女怀孕，间或出现歇止脉，都没有大碍。大概是因为有形之物，阻滞脉道，所以有时歇止。周慎斋先生脉法说：“凡是杂病、伤寒、老人出现歇止脉的，都是将要痊愈的征兆。只有呕吐而出现歇止脉的，主死。”陈友松解释说：“歇止有结、促两种。结脉，是迟而止。病后阴血刚生，阳气尚未充足，不能协济其阴，所以有迟滞的现象，缓行略止，等到阳气一充，全身皆春了。促脉，是数而止。因为阳气还旺，阴分少亏，不能调燮其阳，所以有奔迫之势，急行一止，等到阴血渐生，则五脏自然畅达了。这都是将愈未愈的时候，所以见此疲困之象，待痊愈后即无此脉。所以杂病伤寒，庸医误治，或损伤其阳，或亏损其阴，往往轻病变重。然而未至过伤，久而久之元气藉谷气以生，辄见此等之脉，乃是阴阳渐长之机，非气血全亏之候。至于老人年力就衰，或病后出现歇止之脉，不过是阴阳两亏，不是凶脉。可见诸脉都不妨碍于歇止，只有呕吐一证，胃气逆而上行，将胃中有形之物，尽情吐出，此时脉若平和，还可以保元降气。倘若出现歇止，是肾气已绝于下，不能上供其匮乏，虽用药胃必不纳，所以知道必死。”按陈友松的解释不对。凡是脉见结促，都属于凶候，岂能看作是痊愈的征兆。慎斋先生所言，乃是和平脉中见歇止，才接近事理。
〔二十七〕病患大肌肉已经消瘦脱落，是不可救药的。因为周身肌肉瘦削殆尽了。我常用两手大拇指、食指后面，来检验大肌肉是否脱落，以此判断病情的生死，百不失一。病患虽然骨瘦如柴，检验其拇指、食指之后，有肉隆起的，病纵然重也可医。如果其他地方肌肉还丰满，检验其拇指、食指之后，无肉隆起，而见平陷的，病不可治。周慎斋先生三书说：“久病形体消瘦，如果要长肌肉，须从内眼角眼下胞长起，因为这个部位属阳明胃，胃主肌肉的缘故。”这是说久瘦逐渐恢复的机理，又不可不知道。
〔二十八〕族孙诗卿的妻子患肝风证，周身筋脉拘挛。其脉因为手腕弯曲用力，无法诊察。神志不清醒。这是肝风不直接上巅顶脑窍，而是横窜筋脉。我用阿胶、鸡子黄、生地、制首乌、麦冬、甘草、女贞子、茯神、牡蛎、白芍、木瓜、钩藤、络石、天仙藤、丝瓜络等出入加减治疗。八剂痊愈。病患自述发病时，身体如同陷入罗网，内外筋脉牵绊拘紧，痛苦异常。服药后，就觉得渐渐宽松。后来不时发作，觉得面上肌肉蠕动，就手足筋脉抽紧，疼痛难伸。只用鸡子黄两枚，煎汤代水，溶入阿胶二钱，服下当即痛缓，筋脉放宽。不服其他药，发作随即减轻。两个月后竟不复发。按阿胶鸡子黄法，本源于仲景的黄连阿胶汤。《伤寒论》说：“少阴病，得之二三日以上，心中烦，不得卧，黄连阿胶汤主之。”因为热邪进入至阴，用咸苦直走阴分，一面泄热，一面护阴。阴充热去，阳不亢而心烦除，阳交阴而卧可得。只是彼方因为有热邪，所以兼用苦寒清之。此证则是津液枯竭筋脉干燥，单取阿胶、鸡子黄两味，血肉有情，质重味浓，以育阴熄风，增液润筋。没想到效验如此神奇。古话说：‘药用当而通神。’确实如此。吴鞠通先生把鸡子黄称为定风珠，创立有大定风珠、小定风珠两个方子，确是卓识。（古方用鸡子黄，都是入药搅匀，也有囫囵同煎的。我使用此物，常令先煎代水，取其不腥浊。鸡子黄一经煎过，色淡质枯而无味，因为其汁与味，尽行煎出缘故。）
〔二十九〕治疗痢疾证用木香来开郁滞，升降诸气，诚然是佳品。然而其气香而窜，其味苦而辣，适宜于实证，而不适宜于虚证。适宜于寒湿，而不适宜于暑热。其中有湿热粘滞的，稍加木香作为佐使，使宣通气液，未始不可以。唯独奇怪近世治痢，不辨证脉，视木香为家常便饭，几乎无方不用。甚至形体消瘦骨立，舌绛而光，阴液枯竭显然，还放纵使用不停止。浸渍到不可救治，目击心伤，特地拈出指出。医家病家，切须留意。吴鞠通先生说：“近世用羌活代替麻黄发汗，不知道羌活比麻黄更猛烈。试着用羌活一两，煮在一间屋子里，两三人坐在旁边，那气味的发泄，弱者就不能承受。”我认为煎剂中有木香在药壶里，则满室都能闻到木香气。如此雄烈之品，虚弱人燥热证怎么能承受得住。（一人患痢疾一个多月，更加进食作呕。阅前方统计服过木香六七钱。我用甘寒养胃加旋复花、代赭石、人参、石莲肉等，先止其呕，继仿驻车丸法以除痢。本草说阴火冲上者忌木香，此证因为多用木香导致胃火上冲。）
〔三十〕《内经》说：“心者，君主之官，神明出焉。”又说：“心者，生之本，神之变也。”所以心不受邪，受邪即死。凡外感证涉及心的，都在心包络与血脉。因为包络是心主的宫城，血脉是心主的支脉。邪入包络则神昏，邪入血脉亦神昏。只是所入之邪有浅深，所现之证有轻重。如邪入包络，包络离心较近，所以神昏全然不知人事。如入血脉，血脉离心较远，所以呼之能觉，与之言，亦知人事。如果任其自睡，而心放即昏沉矣。有邪在血脉，因失治而渐入包络的，这是由浅而入深。有邪在包络，因治得其法，而渐归血脉的，这是由深而出浅。又有邪盛势锐，不从气分转入，不由血脉渐入，而直入心包络的，陡然昏厥，其证最凶，缓则不过一日，速则不及一时，当即告毙。因为它直入包络而内犯心，犯心即死耳。章虚谷《伤寒本旨》有神昏谵语辨，谓得之于经历，古人所未道及，厥功甚大。盖邪闭血脉，外感病每多是证。医者未识其故，因而误治者多也。其论治法，邪闭血脉者，必须温通，重用桂枝，则太执着了。温热暑湿证现邪闭血脉，设遇热盛之证，其可重用桂枝乎？即使佐以凉药，亦难用也。虚谷未始不见及于此，只以“必须温通，重用桂枝”两语，横踞胸中，是以上文云：“如风寒等邪而不提出。”温热暑湿者，亦以重用桂枝，有所窒碍，未免自相矛盾，而姑以风寒等邪混言之耳。下一“等”字以包括温热暑湿耳。不然，上文仲圣《伤寒论》中之神昏谵语，已辨之矣，此处何必再言风寒耶？总之闭者通之，此对待法也。桂枝可以通血脉之闭，桂枝究非热证所宜。但取能入血脉而具流利之品，或佐以辛温，加意防其闭遏血脉，则得之矣。倘医者遵信虚谷，执着必须温通，重用桂枝之说，以治热证，何异抱薪救火。为明辨之，不敢为先辈讳也。
〔三十一〕谈往载崇祯十六年，有疙瘩瘟、羊毛瘟等名，呼病即亡，不留片刻。八九两月，疫死数百万。十月间有闽人晓解病由，看膝湾后有筋突起紫者无救，红则速刺出血可活。至霜雪渐繁，势亦渐杀。余谓此疫即前条所云邪盛势锐，直入心包络，内犯心主之证。所以呼病即亡，危期极速也。考嘉兴王肱《枕蚓庵琐语》及桐乡陈松涛《灾荒纪事》皆云：崇祯十四年大旱，十五十六经年亢旱，通国奇荒，疫疠大作。据此，则其病由暑燥热毒，深入血分可知。所以霜雪繁而病势杀，刺筋出血，而其人可活也。刺筋出血者，经云：“血实宜决之”之旨也。邪入较浅，筋色尚红，速刺出血，则血脉松动，便有活路。筋紫则为血脉凝瘀已极，纵刺之，血亦不出，为无救耳。此证神识必然昏沉，其脉亦必涩滞模糊，或促或伏。若用药亦当遵“血实宜决之”之经旨，通利血脉主治，必使血脉渐渐松动，不致内犯心主，走死路，方为得法。（病由暑燥热毒，若重用桂枝温通，万万不可。）近时痧证，亦有顷刻告殂者。亦有刺舌底黑筋，刺两臂弯，两膝弯等处，出血而愈者。但不若谈往所载既甚且多，为非常之疫疠耳。
〔三十二〕潜村医案（乾隆时，西吴杨云峰乘六着。）姚绳其病痢，腹痛后重，脓血立见。继而便孔中解出断肠一段，长半尺许。延杨诊。杨曰：此非断肠也。若断肠则上下断头，必垂而不举。上下断口，必闭而不张。所断之半尺许者，何能进直肠而出肛门耶？且肠既断矣，何其人犹活，而便中之脓血，仍相续而不绝耶？不知此乃肠内滑腻稠粘，如脂如膏，粘贴肠上之一层也。是即所谓阴也。腑气大伤，阴难维系，又为邪毒所压而下。其形外圆中空，有似乎肠而实非肠也。试以棒拨之必腐。若真肠虽烂而断，拨之不腐。家人拨之果腐。进诊，面无神气，脉甚细数弦劲，舌如镜面，胃气将绝，无救矣。逾数日，果殁。此与卷一第二十七条同一痢下脂膜，第整段而下，为罕有之证。
〔三十三〕药气入胃，不过借此调和气血，非入口即变为血气。所以不在多也。有病患粒米不入，反用腻膈酸苦腥臭之药，浓煎大碗灌之。即使中病，尚难运化。况与病相反，填塞胃中，即不药死，亦必塞死。小儿尤甚。此洄溪徐
The dosage in the formula for expelling parasites is quite light. Patients were also instructed to consume Torreya seeds (Torreya nucifera). They recovered completely within ten days. Hoarseness and aphonia fall into two categories: "metal being solid and thus silent" and "metal being broken and thus silent." This represents a unique approach in the medical field.
[22] Ancients had specific methods for decocting herbs. For exterior-releasing formulas, which rely on their aromatic qi, vigorous fire was used for rapid decoction. For tonifying formulas, which rely on their flavor, gentle fire was used for slow decoction. Some used only the first decoction, discarding the second. This was done to utilize the light, ascending nature of the herbs. Others discarded the first decoction, using only the second or third. By boiling away the first decoction, the drying properties are eliminated, resulting in a sweet and bland flavor. Bland flavors nourish stomach qi, while slightly sweet flavors nourish spleen yin. This is a secret method for treating deficiency consumptive diseases. (From *Shen Rou Wu Shu*.) Furthermore, it is advisable to decoct different herbs in separate vessels. Otherwise, one might mix attacking herbs with tonifying ones, or hot-natured herbs with cooling ones, which can have opposing effects. It is like brewing tea in a wine pot; although one may not get drunk, the tea will inevitably carry the scent of wine.
[23] Zhou Shenzhai (courtesy name Zhi, from Wanping Taiyi, born during the Zhengde reign) suffered from abdominal fullness in middle age, enduring unbearable pain. He visited many famous doctors without success and collected numerous prescriptions but dared not try them recklessly. One night, he sat up to admire the moon, which was suddenly obscured by clouds, causing great frustration. Soon, a gentle breeze arose, clearing the clouds and revealing the bright moon. He suddenly realized: Clouds are yin substances; wind is yang substance. When yang qi flows freely, yin obstructions dissipate instantly. Is my illness similar? He then formulated the *Hezhong Fang* (Harmonizing Middle Pill). After taking it for less than a month, he recovered. He later became a renowned physician. In reading the biography of Yang Shitai in the *Wujin Yanghu Combined Gazetteer* at the beginning of *Bencao Gouyuan*, it stated: "Since the Ming Dynasty, physicians in Jiangnan generally revered Zhou Shenzhai. Shenzhai excelled in applying the mutual restriction and transformation of the Five Phases, and the ascent and descent of Yin and Yang, to deduce organ qi as a standard for dosage. After the Yongzheng era, practices shifted to revering Zhang Luoyu, who advocated prescribing according to the disease, trying formulas repeatedly upon encountering cases. Once all possibilities were tried, they would be left helpless." Thus, I sought out Mr. Shenzhai's works, finding five volumes of *Yixue Cuijing*, three books by Zhou Shenzhai, *Zhengyang Pian* by Cha Liaowu, *Wu Shu* by Hu Shenrou, *Maifa Jie* by Chen Yousong, and *Bitan* by Chen Yousong. *Shenrou Wu Shu* was already included in the *Liuli Zhai Congshu*. The *Maifa* was also authored by Mr. Shenzhai, with explanations added by Chen Yousong. Both Cha Liaowu and Hu Shenrou were disciples of Mr. Shenzhai. These three books were compiled from oral teachings and listening to his lectures. His self-made pill formulas are recorded below. (Mr. Zhou Shenzhai's scholarship did not reach that of Zhang Luoyu. However, blindly following Zhang Luoyu leads to the drawback of trial-and-error prescribing.) *Hezhong Wan* is highly effective for treating drum distension. It uses four taels of dried ginger (stir-fried until charred in winter, blackened in summer). One tael is stir-fried with decoction of one tael of Ginseng Radix et Rhizoma; one tael with decoction of three qian of Pericarpium Citri Reticulatae Viride; one tael with decoction of five qian of Perilla Fructus; one tael with decoction of five qian of Exocarpium Citri Grandis. Two taels of Cinnamon Twig are processed: one part stir-fried with decoction of five qian of Alpinia Oxyphylla; one part boiled with five qian of Alisma Rhizoma; one part boiled with three qian of Foeniculum Vulgare; one part boiled with five qian of Psoralea Fructus. One tael of Evodia Fruit is processed: one part stir-fried with decoction of one tael of Coix Seed; one part soaked and stir-fried with five qian of salt. All ingredients are ground into powder. A paste made from Saccharomyces Granulum and decoction of Perilla Fructus is used to form pills the size of tung tree seeds. Dosage varies according to severity, taken with appropriate decoctions. *Hongqu Wan* treats chronic diarrhea and dysentery by tonifying the spleen and strengthening the stomach. It consists of Red Yeast Rice (three qian, stir-fried), scorched rice crust (one tael, burned to retain character), and pine pollen (three qian, stir-fried until brown). Ground into powder, mixed with white sugar frost, and taken orally. Add more yeast for red dysentery; add pine pollen for white dysentery. *Koufu Wan* treats primordial qi deficiency-cold and cold-viscera diarrhea. It contains Nutmeg (roasted in flour coating), Poria (two taels each), Aucklandia Root (one tael five qian), dried ginger (prepared), and Aconite Lateralis Radix Praeparata (roasted, five qian each). Ground into powder, formed into pills with ginger juice paste, taken with lotus seed decoction. *Tongshen San* treats miscellaneous conditions involving stabbing chest pain, curing after three doses. It comprises Atractylodes Macrocephala Rhizome (four taels), Coptis Rhizome (four qian), and Tangerine Peel (five qian). Ground into powder, formed into pills with Saccharomyces Granulum paste, swallowed with saliva before bed, 30-40 pills per dose.
[24] Pulse diagnosis is used to distinguish favorable and unfavorable prognoses in diseases. Pulse texts explain this in detail. Generally, if a disease presents with its corresponding pulse, it is favorable; if not, it is unfavorable. This is the key to pulse diagnosis and syndrome differentiation based on my thirty years of experience. Later, I read Master Cha Liaowu recording the teachings of Monk Shen Rou: "For chronic patients, whether the pulse is large, small, surging, fine, floating, deep, wiry, or slippery, or if the cun is floating and chi is deep, or vice versa, as long as there is a pathological pulse, it indicates treatability. However, if a chronic patient with body fatigue presents with a harmonious and moderate pulse in all positions, death is certain. Observe if the facial complexion is lustrous; since spirit manifests in the face, treatment will be difficult." This truly resonates with me, prompting me to clap the table in approval. A harmonious pulse in a healthy person indicates no disease. But in a chronic, fatigued patient, such a pulse is inappropriate and indicates severe depletion of true yuan qi, hence the prognosis of death. Conversely, a radiant spirit on the face is not expected in chronic patients. The common belief that a patient lacking typical sick appearance is a major taboo aligns with this meaning.
[25] You Zaijing discussed the combination of *Buzhong Yiqi Tang* and *Liuwei Dihuang Wan*: (See *Yixue Dujilu*) "In yang deficiency, qi tends to sink and fail to rise, so *Buzhong Yiqi Tang* uses Ginseng, Atractylodes, and Licorice for sweet-warm qi tonification, assisted by Schisandra and Bupleurum (actually Shengma and Chaihu) for ascending action. In yin deficiency, qi tends to ascend rather than descend, so *Liuwei Dihuang Wan* uses Prepared Rehmannia Root, Cornus Fruit, and Dioscorea Rhizome, heavy and rich in flavor, to tonify yin and benefit essence, assisted by Poria and Alisma for descending action via their sweet-bland nature. Sinking qi often causes stagnation; the pungency of Tangerine Peel harmonizes stagnant qi. Floating qi often generates heat; the cold nature of Moutan Bark clears floating heat. The presence of Poria and Alisma in *Liuwei Dihuang Wan* is analogous to Shengma and Chaihu in *Buzhong Yiqi Tang*. The presence of Tangerine Peel in *Buzhong Yiqi Tang* is analogous to Moutan Bark in *Liuwei Dihuang Wan*. The Ginseng, Angelica, Atractylodes, and Licorice correspond to Rehmannia, Cornus, and Dioscorea. Although the methods differ, the principles are interconnected." This discussion on the ascending and descending mechanisms of formulas is exquisite. However, masters like Xue Lizhai and Zhao Yangkui exclusively used *Liuwei Dihuang Wan*, *Bawei Dihuang Wan*, and *Buzhong Yiqi Tang* to treat various diseases, which is rigid and inflexible. No wonder they were criticized by sages like Xu Lingtai and Chen Xiuyuan. Mr. Zhou Shenzhai also frequently used these formulas in his writings, likely because he studied under Xue Lizhai. (Biography states: After days of questioning, he experienced sudden enlightenment. He told others: 'Lizhai is truly a master teacher, his principles are clear, but unfortunately somewhat dogmatic.') He still could not escape Xue's framework. Yet, in his books, he noted: "If *Buzhong Yiqi Tang* is intended to descend, remove Shengma and Chaihu, and add Eucommia Bark and Achyranthes Root." He also stated: "*Liuwei Dihuang Wan* treats kidney deficiency with hyperactive fire. Moutan Bark cools heart fire, Cornus Fruit astringes liver fire, Alisma drains fire from the kidney meridian, exiting through the anterior yin. If fire is not intense, use only Dioscorea, Poria, and Prepared Rehmannia to solely nourish kidney water and tonify spleen yin." This shows Mr. Shenzhai could adapt medications flexibly, not adhering to fixed formulas for dynamic diseases.
[26] Intermittent pulses (skipped beats) are considered a major taboo for patients, as everyone knows. However, I have observed intermittent pulses in cases of phlegm-food obstruction in the middle jiao and in pregnant women, without serious consequences. This is because tangible matter obstructs the pulse channel, causing occasional skips. Mr. Zhou Shenzhai's pulse method states: "Intermittent pulses in miscellaneous diseases, cold damage, or the elderly indicate impending recovery. Only intermittent pulses accompanied by vomiting indicate death." Chen Yousong explained: "Intermittence includes *Jie* (knotted) and *Cu* (hasty) types. *Jie* is slow with stops. After illness, when yin blood is newly generated but yang qi is insufficient, it cannot assist yin, leading to sluggishness and slight stops. Once yang qi fills, vitality returns. *Cu* is rapid with stops. Because yang qi is still strong but yin is slightly deficient, it cannot regulate yang, leading to urgency and brief stops. Once yin blood regenerates, the five zang become smooth. These occur during the transition from illness to health, showing signs of exhaustion. After recovery, the pulse normalizes. Therefore, in miscellaneous diseases and cold damage, quack misdiagnosis damaging yin or yang can turn mild illness severe. However, if not excessively damaged, yuan qi gradually regenerates via grain qi, producing these pulses. This indicates the gradual growth of yin and yang, not total depletion of qi and blood. In the elderly or post-illness, intermittent pulses merely indicate yin-yang dual deficiency, not an ominous sign. Thus, most pulses allow for intermittence, except in vomiting, where rebellious stomach qi expels tangible matter. If the pulse is peaceful, yuan qi can be preserved and qi descended. If intermittent, it indicates kidney qi exhausted below, unable to supply upper deficiencies. Even with medication, the stomach will not accept it, indicating inevitable death." According to Chen Yousong's explanation, this is incorrect. Knotted and hasty pulses are always ominous, never signs of recovery. Mr. Shenzhai's statement refers specifically to intermittent pulses appearing within a harmonious pulse pattern, which is reasonable.
[27] When a patient's large muscles have wasted away, the condition is incurable, as muscle mass throughout the body is nearly depleted. I often check the area behind the thumbs and index fingers to assess muscle wasting and determine prognosis, with high accuracy. Even if a patient is emaciated, if there is flesh prominence behind the thumb and index finger, the disease, however severe, is treatable. Conversely, if other muscles are plump but the area behind the thumb and index finger is flat or sunken, the disease is untreatable. Mr. Zhou Shenzhai's books state: "In chronic wasting, muscle regrowth must begin from the inner canthus/eyelid area, as this region belongs to the Stomach Meridian of Foot-Yangming, and the Stomach governs muscles." This explains the mechanism of gradual recovery from chronic emaciation, which should not be overlooked.
[28] My clan grandson Shiqing's wife suffered from Liver Wind syndrome, with spasms and contractures of tendons and vessels throughout her body. Her pulse was undetectable due to wrist curvature and tension. Her consciousness was not clouded. This indicated Liver Wind not ascending directly to the brain but traversing horizontally through the tendons. I treated her with variations of Donkey-hide Gelatin (*Ejiao*), Egg Yolk, Rehmannia Root, Prepared Polygonum Multiflorum Root, Ophiopogon Tuber, Licorice Root, Ligustrum Fruit, Polyporus, Oyster Shell, White Peony Root, Quince, Uncaria Ramulus, Trachelospermum Caulis, Aristolochia Vine, and Luffa Sponge. After eight doses, she recovered. She described the onset as feeling trapped in a net, with internal and external tendon constraints causing extreme pain. After medication, she felt gradual relaxation. Later, episodes occurred where facial muscle twitching preceded hand and foot spasms and painful extension. Using only two egg yolks boiled in water, dissolving two qian of Donkey-hide Gelatin, provided immediate pain relief and tendon relaxation without other medicines. Episodes subsided quickly. After two months, no recurrence occurred. The method of Donkey-hide Gelatin and Egg Yolk originates from Zhongjing's *Huanglian Ejiao Tang*. *Shanghan Lun* states: "Shaoyin disease, after two or three days, with vexation in the heart and inability to sleep, is treated with *Huanglian Ejiao Tang*." Since heat enters the deepest yin, salty and bitter flavors target the yin aspect, clearing heat while protecting yin. When yin is充盈 and heat removed, yang does not hyperactivity, vexation resolves, and sleep becomes possible. That formula used bitter-cold herbs to clear heat pathogens. Here, fluid depletion and dry tendons required only Donkey-hide Gelatin and Egg Yolk—substances of animal origin, heavy and rich—to nourish yin, extinguish wind, increase fluids, and moisten tendons. The efficacy was remarkable. As the ancients said, 'When medicine is appropriate, it connects with the divine.' Indeed. Mr. Wu Jutong called Egg Yolk the 'Wind-Calculating Pearl,' establishing the *Da Dingfeng Zhu* and *Xiao Dingfeng Zhu* formulas, demonstrating profound insight. (Ancient formulas mixed egg yolk into decoctions or boiled them whole. I prefer boiling them separately as water substitute to avoid fishiness. Boiled egg yolk loses color, texture, and flavor as its essence is extracted.)
[29] Using *Aucklandia* (*Muxiang*) to open depression and regulate qi in dysentery treatment is indeed excellent. However, its aroma is penetrating, and its taste bitter and acrid, making it suitable for excess patterns but not deficiency patterns; suitable for cold-dampness but not summerheat-heat. In cases of sticky damp-heat, adding a small amount as an assistant to promote qi and fluid circulation is acceptable. What surprises me is that modern practitioners treat dysentery without distinguishing syndromes or pulses, treating *Muxiang* as a staple ingredient, almost universally including it. Even in patients with severe emaciation, crimson and glossy tongues indicating obvious yin exhaustion, they continue to use it excessively until death. Witnessing this is heartbreaking. I highlight this for physicians and patients to note. Mr. Wu Jutong stated: "Modern practitioners use *Notopterygium* (*Qianghuo*) instead of *Ephedra* (*Mahuang*) for sweating, unaware that *Qianghuo* is more potent. Boiling one tael of *Qianghuo* in a room causes those nearby, especially the weak, to suffer from its strong aroma." Similarly, if *Muxiang* is decocted in the vessel, the entire room smells of it. Such a potent herb is intolerable for weak patients with dry-heat patterns. (One patient had dysentery for over a month, worsening to vomiting after eating. Previous prescriptions totaled six to seven qian of *Muxiang*. I used sweet-cold stomach-nourishing herbs plus *Inula Flower*, *Hematite*, *Ginseng*, and *Pomegranate Rind* to stop vomiting first, then applied *Zhuche Wan* method to treat dysentery. Materia Medica warns against *Muxiang* for upward rushing yin-fire; this case resulted from excessive *Muxiang* causing stomach fire to rush upward.)
[30] *Neijing* states: "The Heart is the sovereign palace, from which spirit emerges." And: "The Heart is the root of life, the residence of spirit." Therefore, the Heart does not receive pathogenic factors; if it does, death ensues. In exterior contraction diseases affecting the Heart, the pathology involves the Pericardium and Blood Vessels. The Pericardium is the palace wall of the Heart; blood vessels are its branches. Pathogens entering the Pericardium cause coma; those entering blood vessels also cause coma. The depth of invasion and severity of symptoms vary. Pericardial invasion, being closer to the Heart, causes complete unconsciousness. Blood vessel invasion, being further, allows response to calls and conversation, though spontaneous sleeping leads to drowsiness. Pathogens may move from shallow (blood vessels) to deep (Pericardium) due to mistreatment, or from deep to shallow due to correct treatment. Rapid, fierce pathogens may bypass qi and blood levels, striking the Pericardium directly, causing sudden collapse and coma, the most critical condition, leading to death within hours. Mr. Zhang Xugu's *Shanghan Benzhi* discusses coma and delirium based on experience, contributing significantly. Pathogen closure of blood vessels is common in exterior diseases, often misdiagnosed and mistreated. Zhang argued that vessel closure requires warming and unblocking, heavily using *Cinnamon Twig* (*Guizhi*). This is too rigid. In warm-heat, summerheat, or dampness patterns with vessel closure, heavy *Guizhi* use in heat-excess cases is dangerous, even with cooling assistants. Zhang likely recognized this but was constrained by his emphasis on warming/unblocking. He vaguely mentioned "wind-cold etc." to include warm-heat/dampness, creating contradiction. If physicians follow Zhang's insistence on warming/unblocking with *Guizhi* for heat patterns, it is like throwing wood on fire. I clarify this, not daring to conceal errors of seniors.
[31] Records mention the Chongzhen 16th year epidemics: "Geda Wen" and "Yangmao Wen," causing instant death. In August and September, millions died. In October, a Fujian expert identified that purple protruding veins behind the knee indicated incurability, while red veins could be cured by rapid bleeding. As snow fell, the epidemic waned. I believe this epidemic corresponds to the previously described fierce pathogens striking the Pericardium and Heart directly, causing rapid death. Research by Wang Gong (*Zhenyin'an Suoyu*) and Chen Songtao (*Zaih uang Jishi*) confirms droughts in Chongzhen 14-16 led to famine and massive epidemics. This indicates the disease stemmed from summer-dryness heat toxins penetrating the blood level. Snow cooled the environment, reducing severity. Bleeding veins followed the classic principle: "Excess blood should be drained." Superficial pathogens with red veins allowed blood release, loosening vessels and saving lives. Purple veins indicated extreme blood stasis; bleeding failed, indicating death. Coma and choppy/faint pulses were typical. Treatment should follow "drain excess blood" to loosen vessels and prevent Heart invasion. (Using warming *Guizhi* for heat-toxin blood diseases is absolutely contraindicated.) Modern "Sha" diseases also cause sudden death or cure via bleeding tongue sublingual veins or arm/knee creases, but none match the severity of historical records.
[32] Qiancun Medical Cases (by Yang Yunfeng Chengliu, West Wu, Qianlong era): Yao Shengqi suffered dysentery with abdominal pain, tenesmus, and immediate pus/blood. Then, a half-foot segment of "intestine" passed from the anus. Dr. Yang examined it, stating: "This is not intestine. A severed intestine would hang limp and close tightly. How could a severed piece enter the rectum and exit? Moreover, if the intestine were severed, how could the patient survive with continuous pus/blood? This is actually a layer of slippery, viscous mucus, like fat, adhering to the intestinal wall, known as 'Yin' (mucus). Severe fu-organ qi damage makes mucus hard to retain, pressed down by toxins. It appears tubular but is not intestine. Probing it reveals rotting tissue. True intestine, even if rotted/severed, does not rot upon probing. Family confirmed it rotted. Examination showed dull complexion, fine-rapid-wiry-tense pulse, mirror-like tongue, indicating dying stomach qi. Death ensued days later. This matches Volume 1, Case 27 (dysenteric mucus), but passing a whole segment is rare."
[33] Medicinal qi entering the stomach serves only to harmonize qi and blood; it does not immediately transform into blood and qi upon ingestion. Therefore, quantity is not the primary factor. Some patients unable to eat any rice are force-fed large bowls of thickly decocted, cloying, sour, bitter, fishy, or foul-smelling medicines. Even if the medicine addresses the disease, digestion remains difficult. If the medicine contradicts the disease, filling the stomach, death results from obstruction, not just toxicity. This is especially true for children. This is [from] Xu...