别驾吴勉斋翁，体丰腴，嗜炮炙，任性纵欲，年六十七。极躁急。一日跌伤其齿，恬不
为意，
阅三日复跌，亦不为意，复跌之次日晚，左手足忽不能动，口眼歪斜。陆怀南先生，公通家
友也。即往诊之，语公诸郎曰∶此中风也，治不可缓，急取牛黄丸进之，诸郎皆有名博士弟
子。延予为治。诊其脉，左洪大，右缓大，观其色苍黑，神昏鼾呼，呼长而吸短，呼至口气
HTHT 出不能回，终日偃卧如醉，人不能动。陆曰∶此非半身不遂乎？予曰∶症候甚恶，不
特半身不遂也。半身不遂者，中风已过之疾，其势仍缓，亦有十余年无恙者，今才病，势便
若此，乃中风之渐，方来且不可测。陆重浓长者，所诣亦精，闻予言，当下了然，即与予商
确用药。始以六君子汤加全蝎、僵蚕、天麻，与之两日，神气仍未清，犹昏睡，睡犹呼吸，
口边HT HT 然，间作吐，粒米尚不进，前药再加竹茹。又两日，神始苏，欲言而舌难掉，嗫嗫
不能出诸口，前药又加石菖蒲、远志、红花，始能进粥数口，日计亦可茶瓯许，夜与正舌散
，同前药饮之。又三日，能坐，粥亦颇加，唯言尚謇涩，欲言以笔代口，写我左手甚痛，大
小便艰少。又用四君子汤加陈皮、竹茹、当归、芍药、红花、钩藤、天麻，服三日，神思大
好，饮食日加，以是方调理弥月，手痛减，稍能动，足稍能伸，扶起能坐，且能自按谱铺牌
，语言十厘清至八九， 有万全之望。唯大便有七八日或十余日始一行。予曰∶此血少之
故，补养久当自全，幸无他用而速害。公常自言吾疾乃痰在膈间，何能得一吐为快，此医家
有授之言也。予曰∶公脉大虚，非余痰为害，况今以补养而渐安，此其明验，何敢轻试一吐
，愿宁耐静俟，毋涉危险也。此戊戌九月念五，予以是日别往苕城，别不及旬，公复倾心而
任
张甲，张大言曰∶公病可吐，早吐早愈，诸郎君始信予言，持议不可。彼曰∶公病痰也，不
可不吐，吐而后补，可全愈而无后患，不然必成痼疾。公欲速效，决意吐之。诸郎君不能阻
，一吐而烦躁，犹曰吐不快耳，须大吐始可，再吐而神昏气促，汗出如雨，立时就殂，可叹
可叹!
别驾吴勉斋老先生，身体肥胖丰腴，嗜好食用经过油炸、烧烤等炮制加工的食物，任性放纵欲望，当时六十七岁。性情极其急躁。有一天摔伤牙齿，他满不在乎，不以为意；过了三天再次摔倒，也不在意；在第二次摔倒后的那个晚上，突然左手和左脚不能活动，口眼歪斜。陆怀南先生是我家世交好友。便前去诊治，对吴公的儿子们说：“这是中风病，治疗不可拖延，赶紧取牛黄丸给他服用。”吴公的儿子们都是有名的博士弟子（指太学生或秀才）。他们邀请我为他诊治。诊察他的脉象，左手脉洪大，右手脉缓大；观察他的面色苍黑，神志昏迷，打呼噜，呼吸时呼气长而吸气短，呼气时气出而不能收回，整天躺卧像喝醉了一样，别人无法移动他。陆先生说：“这不是半身不遂吗？”我说：“症状非常严重，不仅仅是半身不遂。半身不遂是中风的后遗症，病情发展仍然缓慢，甚至有十几年安然无恙的，现在刚发病，势头就这样猛烈，这是中风的前兆，病情将来还不可预测。”陆先生是一位厚重长者，造诣也很精深，听了我的话，当下完全明白，便与我商量用药。开始用六君子汤加全蝎、僵蚕、天麻，给他服用了两天，神气仍然没有清醒，还是昏睡，睡着时还有呼吸，嘴角流涎水，偶尔呕吐，一粒米都吃不下，前面的药方再加竹茹。又过了两天，神志才苏醒，想说话但舌头难以灵活转动，嗫嚅着说不出话来，前面的药方又加石菖蒲、远志、红花，才能进几口粥，每天大约能喝一碗茶量的饮食，晚上配合正舌散，连同前面的药一起服用。又过了三天，能够坐起来，粥量也增加不少，只是说话还结巴涩滞，想说话就用笔代替嘴巴，写下我左手很痛，大小便困难且量少。又用四君子汤加陈皮、竹茹、当归、芍药、红花、钩藤、天麻，服用三天，神思非常好，饮食日渐增加，用这个方子调理了一个月，手痛减轻，稍微能活动，脚稍微能伸直，扶起来能坐，并且能自己按谱铺牌（一种纸牌游戏），语言清晰度达到八九成，有了万全康复的希望。只是大便有七八天或十几天才排一次。我说：“这是血少的缘故，长期补养自然会恢复，幸好没有使用其他疗法而迅速造成伤害。”吴公常自己说我的病是痰在膈间，怎么能通过吐出来感到痛快呢？这是医生传授给他的说法。我说：“您的脉象大而虚，不是余痰为害，况且现在通过补养逐渐好转，这是明显的验证，怎么敢轻易尝试催吐，希望您忍耐安静等待，不要涉险。”这年戊戌九月二十五日，我当天告别前往苕城，分别不到十天，吴公又倾心信任张甲，张大言说：“您的病可以催吐，早吐早好。”吴公的儿子们起初相信我的话，持反对意见。张甲说：“您的病是痰，不可以不吐，吐完后再补，可以痊愈而没有后患，不然必然成为顽固疾病。”吴公想要快速见效，决意催吐。儿子们不能阻止，一吐之后出现烦躁，还说吐得不痛快，必须大吐才可以，再吐之后神志昏迷，气促，出汗如雨，立刻死亡，可悲可叹！
Mr. Wu Mianzhai, a Jieba (Prefectural Vice-Administrator), had a robust and plump physique, had a preference for food that was fried or roasted, indulged in his desires without restraint, and was sixty-seven years old at the time. His temperament was extremely irritable. One day, he fell and injured his teeth, but he paid it no mind. Three days later, he fell again, still disregarding it. On the evening following this second fall, his left hand and foot suddenly became immobile, and his mouth and eyes deviated to one side. Mr. Lu Huainan, a family friend of long standing, went to examine him and said to Mr. Wu's sons: "This is Wind-Stroke (Zhong Feng). Treatment cannot be delayed; quickly administer Niu Huang Wan (Calculus Bovis Pill)." The sons were all distinguished scholars (Tai Xue Sheng). They invited me to treat him. Upon examining his pulse, the left side was Hong Da (Surging and Large), and the right side was Huan Da (Moderate and Large). Observing his complexion, it was Cang Hei (Dark Blue-Black); his spirit was confused, he snored, his exhalations were long while inhalations were short, and breath would exit but not return. He lay supine all day as if intoxicated, unable to be moved by others. Mr. Lu asked: "Is this not Hemiplegia (Ban Shen Bu Sui)?" I replied: "The symptoms are severe; it is not merely hemiplegia. Hemiplegia is a sequela of wind-stroke where the condition progresses slowly, with some remaining asymptomatic for over ten years. Here, the disease has just begun, yet the momentum is already so fierce; this is the onset of wind-stroke, and its future course is unpredictable." Mr. Lu was a dignified elder with profound expertise. Hearing my words, he immediately understood and discussed medication with me. We initially prescribed Liu Jun Zi Tang (Six Gentlemen Decoction) added with Quan Xie (Whole Scorpion), Jiang Can (Bombyx Batryticatus), and Tian Ma (Gastrodia Rhizome). After two days of administration, his spirit remained unclear, still in a coma-like sleep, breathing while asleep, with saliva dripping from the corners of his mouth, occasional vomiting, and refusing even a grain of rice. Zhu Ru (Bamboo Shavings) was added to the previous prescription. Two days later, his consciousness finally returned. He wished to speak but his tongue was stiff and difficult to move, mumbling without being able to articulate. Shi Chang Pu (Acorus Rhizome), Yuan Zhi (Polygala Root), and Hong Hua (Carthamus Flower) were added to the previous prescription. Only then could he consume a few mouthfuls of congee, amounting to roughly a cup of tea per day. At night, Zheng She San (Tongue-Correcting Powder) was administered together with the previous decoction. Three days later, he could sit up, and his congee intake increased significantly. However, his speech remained slurred and hesitant; he used a pen to write when he wanted to speak, indicating that his left hand was very painful, and his urination and defecation were difficult and scanty. Si Jun Zi Tang (Four Gentlemen Decoction) was then prescribed with Chen Pi (Citrus Peel), Zhu Ru, Dang Gui (Angelica Sinensis), Shao Yao (Peony Root), Hong Hua, Gou Teng (Uncaria Rhizoma cum Uncis), and Tian Ma. After three days, his mental state improved greatly, and his diet increased daily. This formula was used for conditioning for a month. His hand pain decreased, and he could move slightly; his legs could extend slightly, and when supported, he could sit. He could even play card games by arranging cards according to a pattern. His speech clarity reached eighty or ninety percent, giving hope for complete recovery. However, his defecation occurred only once every seven to eight days or even ten-plus days. I said: "This is due to blood deficiency. Long-term nourishment will naturally restore health. Fortunately, no other treatments were used that might cause rapid harm." Mr. Wu often claimed that his illness was caused by phlegm in the diaphragm region and that he needed to vomit to feel relief. This was advice given to him by another physician. I said: "Your pulse is large and deficient; it is not residual phlegm causing harm. Moreover, your gradual improvement through nourishing treatment is clear evidence. How dare I lightly attempt emesis? I wish you to endure patiently and wait quietly, avoiding danger." On the twenty-fifth day of the ninth month of the Wuxu year, I departed for Tiao City on that day. Less than ten days after our parting, Mr. Wu placed his trust entirely in Zhang Jia. Zhang loudly declared: "Your illness can be treated with emesis; early emesis leads to early cure." Mr. Wu's sons initially believed my words and opposed this view. Zhang argued: "Your illness is phlegm; emesis is indispensable. Emesis followed by tonification can lead to full recovery without sequelae. Otherwise, it will inevitably become an entrenched disease." Desiring a quick effect, Mr. Wu resolved to undergo emesis. His sons could not stop him. After the first emesis, he became restless and agitated, yet still complained that the vomiting was not thorough enough and insisted on vigorous emesis. After the second emesis, he fell into a coma, experienced shortness of breath, sweated profusely like rain, and died immediately. It is truly lamentable!