吴东星上舍，辰州太守公长君也，冒暑赴南都试，落第归而怏怏，因成疟。自八月中旬
延至
十月，疟虽止，而腰痛白浊，日夜咳嗽，肌肉大消。药剂乱投。认为风者，以羌活、防风、
续断等发散；认为虚者，以六味地黄丸为补；认为火者，以芩、连、栀子、黄柏、知母、天
花粉、生地黄泻其火；认为半虚半实者，投以独活寄生汤；认为寒者，以大附子、肉桂、鹿
角胶、参、术温补之。痛剧欲死，叫撼四邻。予脉之，左弦细，右滑大，俱六至。口渴眼赤
。予知其昔患杨梅疮，余毒尚伏经络，适因疟后气血不足，旧毒感动，故痛而暴也。以当归
芍药、甘草、牛膝、钩藤、苡仁、木通、白藓皮，用土茯苓四两煎汤代水煎前药。服下而痛
止，咳嗽亦除，脉缓其半，连服数剂大效，精神渐复，乃起而督工视事。冬至日为酒兴鼓舞
，纵欲无忌，次日腰如束缚，足面亦疼，左眼赤，小水短，足底有火从两胯直冲其上，痛不
可言。予以当归、钩藤、甘草、白芍药、牛膝、苡仁、石斛、红花、生地、黄柏，调理三日
，症已守定，略无进退。适大雪，寒冻殊甚，有女医为渠宅所亲信者，因其大便燥结，一日
夜服玄明粉一两五钱，大便且不行，而腰痛愈猛，两足挛缩，气息奄奄，一语而三换气，面
青惨。渠自觉危急，乃唤内人及弟叔嘱其后事。天明予至诊之，六脉俱伏，痛使然也。扣其
由，乃知服玄明粉所致。予曰∶症虽热，便虽燥，但公病不在肠胃，而在经络筋骨间，徒泻
肠胃无益也。且冬月阳气闭藏，误泻则阳气亏乏，来春无发生根本矣。今四肢拘缩，腰胯痛
剧者，由日来天令寒极，经络凝涩也。寒主收敛，法当温散寒邪之标，使痛定，然后复治其
本，庶可保全。乃用桂心、杜仲、炙甘草、苍术、破故纸、五加皮、连与二剂，痛定而四肢
柔和，饮食始进。予知渠宅素喜速效，予适有荆溪之往，乃宣言曰∶足下之疾在经络，顾今
天令严寒，幸宁耐以俟春和为足下拔去病根。渠宅不以予言为然，乃用张云溪调理，予亦赞
张之可守，盖张氏药用养血清热，虽不去病，亦不害事。迨二月，太守公归，乃改用沈春宇
，沈揣渠必以酒色而致阴虚，乃纯用滋阴降火之剂，以为旬日可奏功也。及调治月余，略无
影响。予从荆溪归而谒渠，为三月初旬也。渠闻予至，即以沈药呈予，且语予∶公许春和拔
除病根，此其时也。予知太守公方笃信沈，随以温语慰渠曰；沈公名士也，可使彼展尽底蕴
。沈又调理半月，以无功而行。沈去，予再以煨肾散进，大泻五六度，四肢冰冷，举家大恐
，以予泻之为非也。予曰∶病患此日减矣，夫奚忧？后进理脾药，服数帖，神气始转，腰胯
柔和，可下床举数步矣。方始信而问予曰∶人皆以补为治，公何得病源之真，于三月之前，
先已预定，节节如公语也？予曰∶此杨梅疮余毒伏于经络，岂补剂所能去哉!予故先为疏通湿
热，然后以补剂收功，则无反复之患。后仍以威灵仙末子二钱，入猪腰子内，煨熟食之。又
泻一二度，病根尽拔。改用苡仁、当归、生熟地黄、白芍药、牛膝、黄柏、丹参、龟板、调
理全安。
吴东星是上舍（古代对监生的尊称），也是辰州太守公的长子。他冒着酷暑前往南京参加科举考试，落榜回家后心情抑郁不畅，因此患上了疟疾。从八月中旬一直拖到十月，虽然疟疾停止了，但出现了腰痛、白浊（尿道流出白色分泌物），日夜咳嗽，肌肉严重消瘦。期间胡乱用药：认为是风邪所致，就用羌活、防风、续断等药物发散；认为是虚证，就用六味地黄丸来补益；认为是火证，就用黄芩、黄连、栀子、黄柏、知母、天花粉、生地黄来泻火；认为是半虚半实，就投用独活寄生汤；认为是寒证，就用大附子、肉桂、鹿角胶、人参、白术来温补。疼痛剧烈让人想死，叫喊声撼动了邻居。我诊察他的脉象，左手脉弦细，右手脉滑大，都达到每息六至（脉搏极快）。口渴，眼睛发红。我知道他以前得过杨梅疮（梅毒），余毒潜伏在经络中，恰逢疟疾后气血不足，旧毒被触动，所以疼痛突然发作且剧烈。我用当归、芍药、甘草、牛膝、钩藤、薏苡仁、木通、白鲜皮，用土茯苓四两煎汤代替水来煎煮前面的药物。服用后疼痛停止，咳嗽也消除了，脉搏减缓了一半，连续服用几剂后效果显著，精神逐渐恢复，于是起身监督工程处理公务。冬至那天因为饮酒兴致高而跳舞鼓舞，纵欲没有节制，第二天腰部像被束缚一样，脚面也疼，左眼发红，小便短少，足底有热气从两胯直冲上来，疼痛难以言表。我用当归、钩藤、甘草、白芍药、牛膝、薏苡仁、石斛、红花、生地、黄柏，调理三天，症状已经稳定，没有进退变化。适逢大雪，寒冷非常厉害，有一位受他家信任的女医生，因为他大便燥结，一天一夜服用了玄明粉一两五钱，大便仍然不通，而腰痛更加猛烈，两足痉挛收缩，气息微弱，一句话要换三次气，面色青惨。他自己觉得危急，就叫来妻子和弟弟叔父交代后事。天亮时我到达诊治，六脉都伏匿不见，这是疼痛导致的。询问原因，才知道是服用玄明粉造成的。我说：病症虽然是热，大便虽然是燥，但您的病不在肠胃，而在经络筋骨之间，单纯泻肠胃是没有益处的。况且冬季阳气闭藏，误用泻法会导致阳气亏乏，来年春天就没有生长的根本了。现在四肢拘挛收缩，腰胯疼痛剧烈，是因为近日天气极寒，经络凝滞涩阻。寒性主收敛，治法应当先温散寒邪以缓解标症，使疼痛安定，然后再治疗其本，才可以保全生命。于是用桂心、杜仲、炙甘草、苍术、破故纸（补骨脂）、五加皮，连服两剂，疼痛安定而四肢柔和，饮食才开始进食。我知道他家素来喜欢速效，我又恰好要去荆溪，于是宣称说：您的病在经络，考虑到今天天气严寒，希望您忍耐等待春暖花开之时，再为您拔除病根。他家不认为我的话是对的，于是改用张云溪调理，我也赞同张氏的方案可以坚守，因为张氏用药养血清热，虽然不能去除病根，也不会害事。等到二月，太守公回来，于是改用沈春宇，沈春宇推测他一定是因为酒色导致阴虚，于是纯用滋阴降火的药剂，以为十天就可以见效。等到调理了一个多月，完全没有效果。我从荆溪回来拜见他，已经是三月初旬了。他听说我到了，就把沈医生的药拿给我看，并且对我说：您曾说春暖花开时可以拔除病根，现在正是时候了。我知道太守公正深信沈医生，便用温和的话语安慰他说：沈公是名士，可以让他把底蕴完全施展出来。沈医生又调理了半个月，因为没有功效而离开。沈医生走后，我再进献煨肾散，大泻五六次，四肢冰冷，全家非常惊恐，认为我的泻法是错误的。我说：病患这天已经减轻了，有什么可担忧的？后进食理脾药，服用几帖后，神气才恢复，腰胯柔和，可以下床走几步了。这才相信并问我道：别人都用补法治疗，您怎么能探得病源的真谛，在三月份之前就已经预定，每一步都像您说的那样呢？我说：这是杨梅疮的余毒潜伏在经络中，哪里是补剂所能去除的呢！所以我先疏通湿热，然后用补剂收功，就不会有反复的祸患。后来仍以威灵仙末子二钱，放入猪腰子内，煨熟食用。又泻了一两次，病根彻底拔除。改用薏苡仁、当归、生熟地黄、白芍药、牛膝、黄柏、丹参、龟板，调理后完全康复。
Mr. Wu Dongxing, a Shangshe (an honorific title for students in the Imperial Academy), was the eldest son of the Prefect of Chenzhou. He traveled to Nanjing during the summer heat to take the imperial examinations. After failing, he returned home feeling depressed and frustrated, which led to malaria. From mid-August until October, although the malaria subsided, he suffered from lower back pain, white turbidity (white discharge from the urethra), day-and-night coughing, and severe emaciation. Medications were administered indiscriminately: when considered as wind-pathogen, Qianghuo, Fangfeng, and Xuduan were used for dispersal; when considered as deficiency, Liuwei Dihuang Wan was used for tonification; when considered as fire, Huangqin, Huanglian, Zhizi, Huangbai, Zhimu, Tianhuafen, and Shengdihuang were used to purge fire; when considered as half-deficiency and half-excess, Duhuo Jisheng Tang was administered; and when considered as cold, Da Fuzi, Rougui, Lujiaojiao, Renshen, and Baizhu were used for warming and tonifying. The pain was so severe that he wished to die, his cries shaking the neighbors. Upon palpating his pulse, I found it wiry and fine on the left, slippery and large on the right, both reaching six beats per breath (extremely rapid). He had thirst and red eyes. I knew he had previously suffered from Yangmeichuang (syphilis), with residual toxins lying dormant in the meridians. Coinciding with the post-malaria deficiency of qi and blood, the old toxins were stirred up, causing sudden and violent pain. I prescribed Danggui, Shaoyao, Gancao, Niuxi, Gouteng, Yiyiren, Mutong, and Baixianpi, decocting four liang of Tufuling in water to replace water for decocting the aforementioned herbs. After taking this, the pain ceased, and the cough also disappeared. The pulse slowed by half. After several doses, there was significant effect, and his spirit gradually recovered. He then resumed supervising projects and handling official duties. On the Winter Solstice, emboldened by wine and dancing, he indulged in sexual activity without restraint. The next day, his waist felt bound, the dorsum of his feet hurt, his left eye was red, urination was scanty, and a sensation of fire rose from his soles straight up through his hips, causing unbearable pain. I prescribed Danggui, Gouteng, Gancao, Baishaoyao, Niuxi, Yiyiren, Shihu, Honghua, Shengdi, and Huangbai. After three days of regulation, the symptoms stabilized with no progression or regression. Suddenly, heavy snow fell, and the cold was extreme. A female physician trusted by his household, noting his dry and hard stool, administered one liang and five qian of Xuanmingfen within a day and night. His stool remained unpassed, but his lower back pain intensified, his legs became spasmodic and contracted, his breathing was faint, changing three times per sentence, and his face turned cyanotic and pale. Feeling critical, he summoned his wife and younger brothers to settle his affairs. At dawn, I arrived to diagnose him. All six pulses were deep and hidden due to the pain. Inquiring into the cause, I learned it resulted from the ingestion of Xuanmingfen. I said: "Although the syndrome is heat and the stool is dry, your disease lies not in the intestines and stomach, but in the meridians, sinews, bones, and joints. Purging the intestines and stomach alone is of no benefit. Moreover, in winter, yang qi is stored and concealed. Misusing purgatives will deplete yang qi, leaving no root for growth in the coming spring. Now, the contraction of the four limbs and severe pain in the waist and hips are due to the extreme cold weather recently, causing stagnation and obstruction in the meridians. Cold governs contraction. The treatment method should first warm and disperse the cold pathogen to alleviate the branch symptoms and stabilize the pain, before treating the root, so that life can be preserved." Thus, I used Guixin, Duzhong, Zhigancao, Cangzhu, Poguozhi (Buguzhi), and Wujia Pi. After two doses, the pain settled, the limbs became flexible, and food intake resumed. Knowing his household preferred quick results, and since I was about to travel to Jingxi, I declared: "Your illness resides in the meridians. Given the severe cold today, I advise you to endure patiently until the warmth of spring arrives to eradicate the root of the disease." His household did not accept my words and instead consulted Zhang Yunxi for regulation. I agreed that Zhang's approach could be maintained, as Zhang's medications nourished blood and cleared heat; although they would not remove the disease root, they would not cause harm. By February, the Prefect returned, and Shen Chunyu was consulted. Shen surmised that the condition must be yin deficiency caused by alcohol and sexual indulgence, so he exclusively used yin-nourishing and fire-purging formulas, expecting results within ten days. However, after more than a month of treatment, there was no improvement. I returned from Jingxi and visited him in early March. Hearing of my arrival, he presented Shen's prescriptions to me and said: "You promised that the root could be removed when spring arrives; this is the time." Knowing the Prefect deeply trusted Shen, I comforted him gently: "Dr. Shen is a renowned scholar; let him fully demonstrate his expertise." Shen treated him for another half-month but left without success. After Shen departed, I again administered Weishen San (Roasted Kidney Powder). He had severe diarrhea five or six times, his limbs became ice-cold, and the whole family was terrified, believing my purging method was wrong. I said: "The patient has improved day by day; why worry?" Subsequently, spleen-regulating medicines were given. After a few doses, his spirit recovered, his waist and hips became flexible, and he could get out of bed and walk a few steps. Only then did he believe and ask me: "Everyone uses tonification for treatment. How did you truly grasp the source of the disease? Your predictions before March have come true step by step." I replied: "This is residual toxin from Yangmeichuang lying dormant in the meridians. How could tonifying agents remove it! Therefore, I first promoted the unblocking of damp-heat, and then used tonifying agents to conclude the treatment, avoiding recurrence." Later, I prescribed two qian of Weilingshan powder inserted into a pig kidney, roasted and eaten. He had one or two more bowel movements, and the disease root was completely eradicated. Finally, Yiyiren, Danggui, Shengdihuang, Shoudihuang, Baishaoyao, Niuxi, Huangbai, Danshen, and Gui Ban were used for regulation, leading to full recovery.