去予舍二里许，地名曰前坑口。一妇人清明前十日发热、头痛。医者以九味羌活汤、十
神汤
进之不效，而又加口渴，舌黑如煤。更一医以如神白虎汤、竹叶石膏汤进之亦不效，而加泄
泻不止，人事昏沉，四肢厥冷，呼吸气微，米粒不进者十四日，其家为具含殓而待毙。适予
扫祖墓而近其家。其子闻之，即告急于予，恳为一诊。其脉细如蛛丝。予曰∶此疫症也。合
理中生脉二汤饮之，连进二服，夜半神气稍苏，饮粥汤半盏。次早，六脉渐见。予喜语其子
曰∶可保无事。书云脉绝微续者生，仍以前药与之。至晚泻止，口不渴，舌心焦煤退，精神
清爽， 向安矣。再用人参、白术各五钱，炮姜、炙甘草各二钱半，麦门冬三钱，五味子
十五粒，水煎不拘时服。不数日而痊愈。
族太学从献长郎，七岁时患痢，红白稠粘，而红更多，饮食少，形气弱。于时太学应南
都试
，其兄从明雅知予，因逆予视。视毕，予曰∶此不可寻常治也。法当补。从明曰∶语云无积
不成痢，故法先推，今不下而遽用补，积何从去？予曰∶足下论者，常也。治病贵先察症，
古人有先攻后补，有先补后攻者，因症投剂，不胶于常也。今形瘦体弱，面色青，禀受大不
足者，饮良又少，予故用补。欲使宁有余，即不如意，犹可措手。若拘常法下之。倘有变将
奈之何？从明是予而索药。即以四君子汤加归芍、黄连、山楂，与服三帖，而病无进退。妇
道间有议予非幼科专门，令更请夏氏。夏至，即语予先不下而用补，以至迁延如是。夏曰∶
幸不下，若下今不可为，叩其故。曰∶丹溪云大孔如毛筒者不治。今肛门有竹筒状，岂可下
？
然也不必补，香连丸、六一散可愈耳。三服而痢愈频，其病愈甚，又加恶心，而神气惫。又
更医请汪恒春，汪至亦以香连丸、黄芩芍药汤与之，痢下日夜不可以数计，饮食不入口。妇
道信耳，谓二氏有时名，故递迎之。独从明持议复逆予。予往观其形神大非昔比，知中气虚
极，非理中汤不可。用人参、白术各二钱五分，酒炒白芍药、白茯苓各一钱，炙甘草、炮姜
各八分，肉桂三分。四帖痢即减半。前方减其半料，又六帖，而饮食进，痢也止。
稠粘虽无，而血水日夜仍三、五行，肌肉也未生。予思
其故，必疳疾从虚而动，用如圣丸以治疳病，则全瘳矣。
离我家约两里路，有个地方叫前坑口。一位妇人在清明前十天出现发热、头痛的症状。医生用九味羌活汤、十神汤治疗，没有效果，反而增加了口渴、舌头黑得像煤炭一样的症状。又换了一位医生，用如神白虎汤、竹叶石膏汤治疗，也没有效果，反而增加了腹泻不止、人事昏沉、四肢冰冷、呼吸微弱、十四天吃不下米粒的食物，她的家人为此准备了寿衣和棺材等待死亡。恰好我去扫祖墓，靠近她家。她的儿子听说后，立即向我求救，恳请我为她诊治。她的脉象细得像蛛丝一样。我说：这是疫病。应该理中汤合生脉散一起服用，连续服用了两剂，半夜时精神稍微恢复，喝了半盏粥汤。第二天早上，六部脉象逐渐显现。我高兴地对她的儿子说：可以保无事了。医书说脉象绝微但还有接续的是能活的，仍然用前面的药给她。到了晚上，腹泻停止，口不渴，舌心像焦煤的颜色退了，精神清爽，向安好了。再用人参、白术各五钱，炮姜、炙甘草各二钱半，麦门冬三钱，五味子十五粒，水煎不拘时间服用。没过几天就痊愈了。
族太学从献的长子，七岁时患痢疾，红白稠粘，而红色更多，饮食少，形体气弱。当时太学要去南京参加科举考试，他的哥哥从明雅认识我，于是邀请我去诊视。诊视完毕，我说：这个病不能按常规治疗。法当补益。从明说：俗话说没有积滞就不会成痢疾，所以法当先推荡（攻下），现在不下而遽然用补益，积滞从哪里去除？我说：足下谈论的是常法。治病贵在先察症，古人有先攻后补，有先补后攻的，因症投剂，不胶着于常法。现在形体瘦弱，面色青，禀受大不足的，饮食又少，所以我用补益。想要使正气有余，即使不如意，还可以措手。如果拘泥常法攻下。倘若有变化将怎么办？从明认可我的意见并索要药物。就以四君子汤加当归、芍药、黄连、山楂，给服用三帖，而病无进退。妇人中间有人议论我非幼科专门，令再请夏氏。夏至，就对我说先前不下而用补，以至迁延如此。夏说：幸好没下，若下今不可为，叩其故。曰：丹溪云大孔如毛筒者不治。现在肛门有竹筒状，岂可下？然而也不必补，香连丸、六一散可愈耳。三服而痢愈频，其病愈甚，又加恶心，而神气惫。又更医请汪恒春，汪至亦以香连丸、黄芩芍药汤与之，痢下日夜不可以数计，饮食不入口。妇人信耳，谓二氏有时名，故递迎之。独从明持议复逆予。我去看他的形神大非昔比，知中气虚极，非理中汤不可。用人参、白术各二钱五分，酒炒白芍药、白茯苓各一钱，炙甘草、炮姜各八分，肉桂三分。四帖痢即减半。前方减其半料，又六帖，而饮食进，痢也止。稠粘虽无，而血水日夜仍三、五行，肌肉也未生。我思考其原因，必是疳疾从虚而动，用如圣丸来治疳病，则全瘳矣。
About two *li* from my residence, there is a place named Qiankengkou. A woman developed fever and headache ten days before the Qingming Festival. The physician prescribed Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) and Shishen Tang (Ten-God Decoction), but to no avail; instead, thirst worsened, and her tongue turned black like coal. Another physician then administered Rushen Baihu Tang (Miraculous White Tiger Decoction) and Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), also without effect; diarrhea became incessant, consciousness clouded, limbs cold, respiration faint, and she had been unable to consume even a grain of rice for fourteen days. Her family prepared shrouds and coffin, awaiting death. Coincidentally, I was sweeping ancestral tombs near her home. Her son heard of this and urgently sought my help, pleading for a consultation. Her pulse was fine as a spider's thread. I said: This is an epidemic condition. It should be treated with Lizhong Tang (Regulate the Middle Decoction) combined with Shengmai San (Generate the Pulse Powder). After two doses, by midnight, her spirit slightly revived, and she drank half a cup of rice soup. By morning, the pulses in all six positions gradually appeared. Rejoicing, I told her son: Recovery is assured. As the classics state, if the pulse is faint yet continuous, life remains. I continued with the previous prescription. By evening, diarrhea ceased, thirst disappeared, the coal-like discoloration on the center of the tongue faded, and her spirit became clear and tranquil. Subsequently, I prescribed Ren Shen (Ginseng Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma), each 5 qian; Pao Jiang (Prepared Zingiberis Rhizoma) and Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma), each 2.5 qian; Mai Men Dong (Ophiopogonis Tuber) 3 qian; and Wu Wei Zi (Schisandrae Fructus) 15 grains. Decocted in water, taken at any time. Within a few days, she fully recovered.
Congxian, the eldest son of the Grand Scholar of our clan, suffered from dysentery at age seven, with red and white, thick and sticky discharge, predominantly red. His intake of food and drink was scant, and his physique and qi were weak. At that time, the Grand Scholar was preparing for the metropolitan examination in Nanjing. His brother, Congming, who knew me well, invited me to examine him. Upon examination, I stated: This case cannot be treated conventionally. The method must be tonification. Congming replied: It is said that without accumulation, there is no dysentery; thus, the method should first be purgation. To use tonification now without purging, how will the accumulation be expelled? I answered: What you discuss is the general rule. In treating disease, it is crucial to first observe the symptoms. Ancients employed either attack followed by tonification, or tonification followed by attack, prescribing according to the syndrome, not rigidly adhering to conventions. Now, the patient is emaciated and weak, with a bluish complexion, indicating significant constitutional deficiency and poor dietary intake; hence, I use tonification. It is better to have excess righteous qi; even if it does not perfectly match expectations, measures can still be taken. If one rigidly follows conventional purgation, what if complications arise? Congming agreed and requested medicine. I prescribed Sijunzi Tang (Four Gentlemen Decoction) added with Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Huang Lian (Coptidis Rhizoma), and Shan Zha (Crataegi Fructus). After three doses, the disease neither improved nor worsened. Some women in the household questioned my expertise in pediatrics and suggested consulting Dr. Xia. On the day of Summer Solstice, Dr. Xia remarked to me: Fortunately, purgation was not used initially, leading to this delay. He asked why. I explained: Danxi stated that if the anus resembles a hair tube, it is incurable. Currently, the anus has a bamboo-tube appearance; how can purgation be used? However, tonification is also unnecessary; Xianglian Wan (Amomum and Coptis Pill) and Liuyi San (Six-to-One Powder) could resolve it. After three doses, dysentery became more frequent, the condition worsened, accompanied by nausea and extreme exhaustion. Another physician, Wang Hengchun, was consulted. He also prescribed Xianglian Wan and Huangqin Shaoyao Tang (Scutellaria and Peony Decoction). Dysenteric discharges occurred day and night beyond count, and food could not enter the mouth. The women believed them because both physicians were renowned, so they sequentially invited them. Only Congming persisted in inviting me. Upon observing his form and spirit, which were vastly different from before, I knew the middle qi was extremely deficient; only Lizhong Tang would suffice. I prescribed Ren Shen (Ginseng Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma), each 2.5 qian; Jiu Chao Bai Shao Yao (Wine-processed Paeoniae Radix Alba) and Bai Fu Ling (Poria), each 1 qian; Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) and Pao Jiang (Prepared Zingiberis Rhizoma), each 0.8 qian; and Rou Gui (Cinnamomi Cortex) 0.3 qian. After four doses, dysentery halved. Reducing the dosage of the previous formula by half and administering another six doses, appetite returned, and dysentery stopped. Although thick and sticky discharge ceased, blood and water still passed three to five times daily, and muscles had not regenerated. I pondered the cause: likely, the malnutrition syndrome (Gan Disease) arose from deficiency. Using Rusheng Wan (Miraculous Sage Pill) to treat the Gan Disease would lead to complete recovery.