宫詹吴少溪先生，有酒积，常患胃脘疼，近右腰眼足跟肢节皆痛。予谓此皆由湿热伤筋
，脾
肺痰火所致，法宜清肃中宫，消痰去湿，俾经络流通，筋骨自不疼矣。切不可作风痛而用风
剂。公极然之。用二陈汤加威灵仙、苍术、黄柏、五加皮、枳实、葛根、山栀子进之。肢节
痛减，改用清气化痰丸加瓦楞子、苍术、枳实、姜黄，用竹沥、神曲打糊为丸，调理而安。
宜兴令君胡镜阳公尊堂太夫人，年七十二，脾泄十五年不愈，近加吐红，咳嗽痰多，痰
亦不
易出，申酉时潮热，胸膈壅塞不能就枕，饮食大减，且恶风，终日坐幔中。诸医谓发热吐红
，法当寒凉。脾泄多年，气虚老蓐，法当温补。二病矛盾，难于投剂。又谓身热脉大，血家
所忌。益束手无能为计，皆辞去。且归咎于长桥上拆屋，致正堂不利。以是前丁宋二公接迹
忧去，邑中汹汹，因延予治。诊得两手脉皆浮而洪数，亦皆带滑。予曰∶据脉洪数为热，
滑为痰，浮为风邪在表，以伤风故恶风。仲景曰∶当汗不汗必作衄症。法当清解，可无恙也
。公以诸医二病矛盾之说为问。予曰∶此暗于先后者也。夫脾泄已久，未尝为害，新病势
炽，宜当速去，所谓急则治其标也。俟邪去之后，补脾未晚，且潮热为风邪所致之热，而非
阴虚火动之热，血乃当汗不汗之血，亦非阴虚火动之血。《内经》云∶夺血者无汗，夺汗者
无血。当汗不汗，邪鼓血动，但得表解热退，血自止耳。公怃然曰∶噫唏!畴昔老母过钱塘
，遇风涛受惊，因发热咳嗽，血出痰多，今以公言质之，诚由风邪起病也。愿以药进。予用
紫苏子、前胡、麻黄、薄荷解表为君，枳壳、桔梗、桑白皮、栝蒌、紫菀、贝母消痰治嗽为
臣，酒芩、甘草为佐，连服二帖，五更微汗而热退，胸膈不壅，嗽也稍减，血止大半，始进
粥。次日减麻黄，加白茯苓，夜服七制化痰丸，其夜痰嗽又减半，从是不恶风而去幔矣。前
方再减枳壳，加薏苡仁，调理而安。
宫詹吴少溪先生，体内有酒积（长期饮酒导致的湿热停滞），经常患胃脘疼痛，近期右侧腰眼、足跟及四肢关节都感到疼痛。我认为是由于湿热损伤筋脉，加上脾肺痰火所致，治疗法则应当清肃中焦脾胃，消除痰湿，使经络流通，筋骨自然就不痛了。切不可当作风痹而使用祛风药物。先生非常赞同。于是用二陈汤加威灵仙、苍术、黄柏、五加皮、枳实、葛根、山栀子给他服用。关节疼痛减轻后，改用清气化痰丸加瓦楞子、苍术、枳实、姜黄，用竹沥和神曲打糊制成丸药，调理后痊愈。
宜兴县令胡镜阳公的母亲太夫人，七十二岁，患有脾泄（脾虚引起的慢性腹泻）十五年未愈，近期又出现吐血、咳嗽痰多且痰不易咳出，申时和酉时（下午3-7点）出现潮热，胸膈堵塞无法安枕，饮食大幅减少，并且怕风，整天坐在帷幔之中。各位医生认为发热吐血，治疗法度应当用寒凉药；脾泄多年，属于气虚年老体弱，治疗法度应当用温补药。两种病症矛盾，难以用药。又有医生认为身热脉大，是血证患者所忌讳的。大家更是束手无策，纷纷辞去。甚至归咎于长桥上拆屋，导致正堂风水不利。因此前两位丁、宋两位医生接连因忧虑离职，县中议论纷纷，于是延请我来诊治。诊得两手脉象皆浮而洪数，也都带有滑象。我说：根据脉象洪数为热，滑为痰，浮为风邪在表，因为伤风所以恶风。张仲景说：应当发汗而不发汗，必然会导致衄血（鼻出血）。治疗法则应当清解表邪，可以痊愈。先生询问各位医生关于两病矛盾的说法。我说：这是不明先后缓急之理。脾泄已久，并未造成严重危害，新病势态炽盛，应当迅速去除，这就是所谓的“急则治其标”。等邪气去除之后，再补脾也不晚。而且潮热是由风邪引起的热，而非阴虚火动的热；吐血是因为当汗不汗导致的动血，也非阴虚火动之血。《内经》说：失血者不可发汗，发汗过度者不可再失血。应当发汗而不发汗，邪气鼓动血液，只要表邪解除、热退，血自然就会停止。先生怅然若失地说：唉！以前老母亲经过钱塘，遭遇风涛受惊，因而发热咳嗽，吐血痰多，现在用先生的话验证，确实是由风邪引起发病。愿意服药。我用紫苏子、前胡、麻黄、薄荷解表作为君药，枳壳、桔梗、桑白皮、栝蒌、紫菀、贝母消痰止咳作为臣药，酒炒黄芩、甘草作为佐药，连续服用两帖，五更时分微微出汗而热退，胸膈不再堵塞，咳嗽稍减，吐血止住大半，才开始进食粥。第二天减去麻黄，加入白茯苓，夜间服用七制化痰丸，当晚痰嗽又减半，从此不再怕风，撤去帷幔。前方再减去枳壳，加入薏苡仁，调理后痊愈。
Mr. Wu Shaoxi, a Palace Scholar (Gongjian), had alcohol accumulation (pathogenic retention due to chronic drinking) and frequently suffered from epigastric pain. Recently, he experienced pain in the right lumbar region, heel, and all joints. I stated that this was caused by damp-heat damaging the sinews, combined with phlegm-fire in the Spleen and Lungs. The treatment principle should be to clear and purify the Middle Jiao (Middle Burner), eliminate phlegm and dampness, thereby ensuring the free flow of meridians, after which the bones and sinews would naturally cease to hurt. It is crucial not to treat this as Wind-Bi (Wind obstruction syndrome) using wind-dispelling agents. The gentleman agreed entirely. He was administered Er Chen Tang (Two-Cured Decoction) supplemented with Saposhnikoviae Radix (Weilingxian), Atractylodis Rhizoma (Cangzhu), Phellodendri Cortex (Huangbai), Acanthopanacis Cortex (Wujia Pi), Zhi Shi, Puerariae Radix (Gegen), and Gardeniae Fructus (Shanzhizi). After the joint pain subsided, Qing Qi Hua Tan Wan (Clear Qi and Transform Phlegm Pill) was used, supplemented with Arcae Concha (Walengzi), Cangzhu, Zhi Shi, and Curcumae Longae Rhizoma (Jianghuang). These were processed into pills using Bamboo Juice (Zhuli) and Medicated Leaven (Shenqu) paste, leading to recovery through regulation.
The Dowager Lady, mother of Hu Jingyang, Magistrate of Yixing, was seventy-two years old. She had suffered from Spleen Diarrhea (Pi Xie, chronic diarrhea due to Spleen deficiency) for fifteen years without cure. Recently, she developed hematemesis (vomiting blood), cough with copious sputum that was difficult to expectorate, tidal fever during the Shen and You hours (3 PM–7 PM), chest and diaphragm fullness preventing her from lying down, significantly reduced appetite, aversion to wind, and she sat within a curtain all day. Various physicians argued that for fever and hematemesis, the treatment should involve cold-cooling herbs; whereas for long-standing Spleen Diarrhea in an elderly person with Qi deficiency, the treatment should involve warming and tonifying herbs. The two conditions seemed contradictory, making prescription difficult. Others noted that body heat and a large pulse are contraindicated in blood disorders. Consequently, they were at a loss and resigned, even attributing the condition to bad Fengshui caused by demolishing houses on Changqiao Bridge, which allegedly harmed the main hall's fortune. As a result, the previous doctors, Mr. Ding and Mr. Song, left due to anxiety, causing public unrest. I was then invited to treat her. Her pulses in both hands were floating, surging, rapid, and slippery. I said: "A surging and rapid pulse indicates Heat; a slippery pulse indicates Phlegm; a floating pulse indicates Wind pathogen in the exterior. Due to Wind-Cold injury, there is aversion to wind. Zhang Zhongjing stated: 'If sweating is indicated but not performed, nasal bleeding (Nu) will likely occur.' The treatment should focus on clearing and resolving the exterior, and she will recover." When asked about the contradiction cited by other physicians, I replied: "This reflects a lack of understanding regarding priority and sequence. The Spleen Diarrhea has existed for a long time without causing severe harm; the new condition is vigorous and should be addressed urgently. This is known as 'treating the branch in acute situations.' After the pathogen is eliminated, tonifying the Spleen will not be too late. Moreover, the tidal fever is caused by Wind pathogen, not Yin-deficiency Fire hyperactivity; the bleeding results from failure to sweat when indicated, agitating the blood, rather than Yin-deficiency Fire. The *Neijing* states: 'Those who have lost blood should not be sweated; those who have been excessively sweated should not lose blood.' Since sweating was indicated but withheld, the pathogen agitated the blood. Once the exterior is resolved and heat recedes, the bleeding will stop naturally." The gentleman sighed and said: "Alas! Previously, my mother traveled through Qiantang, was startled by wind and waves, and subsequently developed fever, cough, hematemesis, and copious sputum. Verifying this with your words, it indeed originated from Wind pathogen. I am willing to take the medicine." I used Perillae Fructus (Zisuzi), Peucedani Radix (Qianhu), Ephedrae Herba (Mahuang), and Menthae Haplocalycis Herba (Bohe) to release the exterior as Sovereign herbs; Zhi Ke, Platycodonis Radix (Jiegeng), Pulmonariae Radix (Sangbaipi), Trichosanthis Fructus (Gualou), Asteris Radix (Ziwan), and Fritillariae Cirrhosae Bulbus (Beimu) to transform phlegm and stop cough as Minister herbs; and Wine-fried Scutellariae Radix (Jiu Qin) and Glycyrrhizae Radix et Rhizoma (Gancao) as Assistant herbs. After two doses, slight sweating occurred at dawn, the fever subsided, chest fullness cleared, cough decreased slightly, and hematemesis stopped by more than half. She then began consuming congee. The next day, Mahuang was reduced, and Polyporus (Baifuling) was added. At night, Seven-Processed Phlegm-Transforming Pills (Qizhi Huatan Wan) were taken. That night, phlegm and cough halved again. From then on, she no longer feared wind and removed the curtain. In the subsequent formula, Zhi Ke was further reduced, and Coicis Semen (Yiyiren) was added, leading to recovery through regulation.