从侄中叔太学，以暑月赴南雍，一日转班，出索茶饮，饮辄逆流，左鼻出茶，入腹者十
之三
。当迓白下名家调理者尽其人。几一月，不惟饮茶水为然，食粥与饭亦多从鼻出。太学生平
喜精洁，日与交游皆缙绅、逢掖，遂以疾自惭，因告假图治。闻京口多名医，买舟访之。如
何、如张、如团，无不谒治。然愈服药愈病，渐加恶心，头晕，肌肉削，四肢无力，心益惴
惴。亟归就予治。予诊毕，因叩所见诸名公认何症、投何剂？中叔曰∶诸君皆谓此疾板籍无
载，治法无稽，徒揣度为胃火。谓诸逆上冲，皆属于火。故投剂非黄连解毒，即三黄、石膏
、
栀子、黄柏、知母、天花粉、葛根之属。侄也以初到白下苦酒，因酒动火，理或为然，听其
治而不惶它计也。予曰∶治病贵辨明经络与经络之出纳虚实，明脏象，察经度，究竟夫病机
病能，此扁鹊所以随俗为变也。何常拘拘守方书哉？《内经》有云∶咽喉者，水谷之道路也
；喉咙者，气之所以上下者也；颃颡者，分气之所泄也。人之鼻渊涕出不收者，颃颡不开也
。子之症也颃颡不开之类尔。颃颡不开，故气上而不下。会厌弱而不能掩其气喉。夫鼻与气
喉相通，惟不掩故饮食逆从鼻窍而
出。不见常人偶气逆而饮食自喷嚏出乎!即其例也。且右脉缓弱无力，气虚明矣。《内经》
云∶形寒饮冷则伤肺。又曰∶脾胃喜温而恶寒。又云∶视听明而清凉，香臭辨而温暖。子多
服寒凉，此所以恶心、头晕、肌消也。予但为温补。盖肺属金而主气，金气旺则收敛下降，
气下降则饮食从气下矣。以六君子汤加辛夷、桑白皮、苡仁、沉香一进而势缓，三进而止大
半，七剂而全安。以此症旧无载，故笔之以俟后人采焉。
我的堂侄孙中叔是太学生，在暑天前往南京（南雍）赴任。有一天换班时，他出来索要茶水饮用，喝下去的茶水却全部逆流而上，从左侧鼻孔流出，真正进入腹中的只有十分之三。当时迎接他的南京名医都请遍了，调理了近一个月，不仅茶水如此，连喝粥和吃饭也大多从鼻孔溢出。孙中叔生平喜欢精细洁净，日常交往的都是官员和读书人，因此因病感到羞愧，于是请假寻求治疗。听说镇江（京口）有很多名医，他便乘船前去拜访。如何、如张、如团等医生，他都一一拜见求治。然而越是服药病情越重，逐渐出现恶心、头晕、肌肉消瘦、四肢无力的症状，内心更加惶恐不安。急忙回家找我治疗。我诊脉结束后，便询问各位名中医诊断为何症、使用了什么方剂？孙中叔说：“各位先生都说此病在医籍中没有记载，治疗方法没有依据，只是推测为胃火。认为各种气逆上冲的症状都属于火证。所以使用的方剂不是黄连解毒汤，就是三黄汤、石膏、栀子、黄柏、知母、天花粉、葛根之类的药物。我因为刚到南京时喝了酒，因酒动火，道理上或许是这样，就听从他们治疗而没有考虑其他办法。”我说：“治病贵在辨明经络及其虚实出纳情况，明确脏腑象数，考察经脉度数，彻底探究病机和病状，这就是扁鹊能够随俗变化的原因。怎么能拘泥于死守方书呢？《内经》说：咽喉是水谷通行的道路；喉咙是气息上下出入的通道；颃颡（鼻咽部）是分泄气息的地方。人的鼻渊流涕不止，是因为颃颡不开通。您的症状属于颃颡不通这一类。颃颡不通，所以气往上走而不能下行。会厌虚弱不能遮盖喉口。鼻子与气喉相通，正因为没有被遮盖，所以饮食逆向从鼻窍流出。没看见常人偶尔气逆时，饮食会从喷嚏中喷出吗！这就是同样的例子。而且右脉缓弱无力，气虚是很明显的。《内经》说：形体受寒、饮食生冷就会伤肺。又说：脾胃喜欢温暖而厌恶寒冷。还说：视听清明需要清凉，辨别香臭需要温暖。您服用了太多寒凉药物，这就是导致恶心、头晕、肌肉消瘦的原因。我只为您进行温补治疗。因为肺属金而主气，金气旺盛则收敛下降，气下降后饮食就能顺气而下。我用六君子汤加入辛夷、桑白皮、薏苡仁、沉香，服用一剂后病情减缓，三剂后大半停止，七剂后完全康复。因为这个病症以前没有记载，所以记录下来以等待后人参考。”
My cousin, Sun Zhongshu, a student at the Imperial Academy (Taixue), traveled to Nanjing (Nanyong) during the summer months. One day, after changing shifts, he came out to request tea. Upon drinking, the liquid flowed backward; it exited from his left nostril, with only three-tenths entering his stomach. At that time, all the renowned physicians in Baixia (Nanjing) who were attending him had been consulted. After nearly a month of conditioning, not only was this true for tea and water, but even porridge and rice were mostly expelled through the nose. Mr. Sun, by nature, valued cleanliness and refinement, associating daily with officials and scholars (Jinshen, Fengye). Consequently, he felt ashamed of his illness due to his status, took leave, and sought treatment. Hearing that Jingkou (Zhenjiang) had many famous doctors, he bought a boat to visit them. He visited doctors such as He, Zhang, and Tuan without exception. However, the more medicine he took, the worse his condition became. Nausea, dizziness, muscle wasting, and weakness in the four limbs gradually developed, and his heart grew increasingly anxious. He hurriedly returned home to seek my treatment. After completing my pulse diagnosis, I asked what symptoms the various renowned physicians had diagnosed and what prescriptions they had administered. Mr. Sun said: "All these gentlemen claimed that this disease is not recorded in medical texts and its treatment methods are unfounded, merely speculating it to be Stomach Fire (Wei Huo). They stated that all rebellious upward rushing belongs to Fire. Therefore, the prescribed formulas were either Huanglian Jiedu Tang (Coptis Decoction for Detoxification) or combinations involving Sanhuang Tang (Three Yellows Decoction), Shigao (Gypsum Fibrosum), Zhizi (Gardeniae Fructus), Huangbai (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma), Tianhuafen (Trichosanthis Radix), and Gegen (Puerariae Lobatae Radix). Since I suffered from drinking wine upon arriving in Baixia, which might have stirred up fire, their reasoning seemed plausible, so I accepted their treatment without considering other plans." I said: "Treating disease requires distinguishing the meridians and their influx/outflow regarding deficiency and excess, clarifying Zang-Fu manifestations, observing meridian degrees, and thoroughly understanding the pathogenesis and pathology. This is why Bian Que could adapt to customs. How can one rigidly adhere to prescription books? The *Neijing* states: 'The pharynx is the pathway for water and grain; the larynx is where Qi ascends and descends; the nasopharynx (Hangsang) is where Qi diffuses.' When people suffer from rhinorrhea that does not stop, it is because the nasopharynx is not open. Your condition belongs to the category of nasopharyngeal obstruction. Because the nasopharynx is obstructed, Qi rushes upward instead of descending. The epiglottis is weak and cannot cover the glottis. Since the nose communicates with the airway, and because it is not covered, food and drink reverse and exit through the nasal orifice. Have you not seen that when ordinary people experience occasional Qi rebellion, food and drink are expelled via sneezing? This is the same example. Moreover, your right pulse is slow, weak, and powerless, clearly indicating Qi Deficiency (Qi Xu). The *Neijing* says: 'Cold affecting the body and cold drinks injure the Lung.' It also says: 'The Spleen and Stomach prefer warmth and dislike cold.' Furthermore: 'Clear vision and hearing require coolness; distinguishing odors requires warmth.' You have taken too many cold and cooling herbs, which is why you suffer from nausea, dizziness, and muscle wasting. I will only provide warming and tonifying treatment. The Lung belongs to Metal and governs Qi. When Metal Qi is vigorous, it converges and descends. When Qi descends, food and drink follow the Qi downward. I used Liujunzi Tang (Six Gentlemen Decoction) added with Xinyi (Magnolia Flower), Sangbaipi (Morus Cortex), Yiren (Coicis Semen), and Chenxiang (Aquilaria Lignum). After one dose, the severity eased; after three doses, it stopped for the most part; after seven doses, full recovery was achieved. Since this case was previously unrecorded, I write it down for future generations to reference."