徐文学三泉令郎,每下午发热直至天明,夜热更甚,右胁胀痛,咳嗽吊疼,坐卧俱疼。
医以
疟治罔效。延及二十余日,热不有退。后医谓为虚热,投以参术为主,痛益增。逆予诊之,
左弦大,右滑大搏指。予曰∶《内经》云∶左右者,阴阳之道路。据脉肝胆之火为痰所凝,
必勉强作文,过思不决,木火之性不得通达,郁而为疼。夜甚者,肝邪实也。初治只当能调
肝气,一剂可瘳。误以为疟,燥动其火,补以参术,闭塞其气。书云∶体若燔炭,汗出而散
。今汗不出,舌上之胎已沉香色,热之极矣。设不急治,立见凶危。乃以仲景小陷胸汤为主
。大栝蒌一两,黄连三钱,半夏曲二钱,前胡、青皮各一钱,水煎饮之。夜服当归龙荟丸微
下之。诸公犹争之曰∶病久而食不进,精神野狼狈若此,宁可下乎?予曰∶经云肝常有余,且
脉亦为有余,故有余者泻之。前时误认为虚,投补左矣,岂容再误哉!服后,夜半痛止热退
,两帖全安。
王祖泉乃眷,朝饭后稍寒,恶风发热,遍身疼痛,汗大出不止,口中热,腹中不知饿,
小水
短,六脉皆涩。以白芍药五钱,白术二钱,桂皮、黄芩各一钱,甘草八分。二帖而汗止,寒
热除,减去白术,加当归而遍身痛止。
费少垣乃眷,妊已九月,痰多喘嗽,胎气上逆,眼撑不起,两太阳微疼。予曰∶此子悬
症兼
痰火也。以大紫苏饮为主,才服一帖,逆即不逆,胸膈顿宽,惟喘嗽不止,与七制化痰丸而
安。
徐文学的三泉县令之子,每天下午发热直到天亮,夜间发热更加严重,右胁部胀痛,咳嗽时牵引疼痛,无论坐卧都感到疼痛。
医生按疟疾治疗无效。拖延了二十多天,热势没有减退。后来的医生认为是虚热,投用以人参、白术为主的补药,疼痛反而加剧。请我诊治,左脉弦大,右脉滑大且搏指有力。我说:《内经》说:左右是阴阳运行的道路。根据脉象,肝胆之火被痰所凝滞,必定是因为勉强写作文章,过度思虑而不能决断,导致木火之性不能通达,郁结而成为疼痛。夜间加重,说明肝邪实盛。起初治疗只应当调理肝气,一剂药即可痊愈。误诊为疟疾,燥动其火,用人参、白术进补,闭塞其气。医书说:身体像燃烧的炭火一样热,出汗后就会消散。现在汗不出,舌苔已呈沉香色,这是热到了极点。如果不紧急治疗,立刻会出现凶险危急的情况。于是以张仲景的小陷胸汤为主方。大瓜蒌一两,黄连三钱,半夏曲二钱,前胡、青皮各一钱,水煎服用。晚上服用当归龙荟丸轻微通下。各位先生还争辩说:病久且饮食不进,精神如此狼狈,怎么可以攻下呢?我说:经书说肝常有余,而且脉象也显示有余,所以对于有余的病证应当泻之。之前误认为虚证,用了补法已经错了,难道还能再错吗!服药后,半夜疼痛停止,热退,两帖药后完全康复。
王祖泉的妻子,早饭后稍微怕冷,恶风发热,全身疼痛,大汗淋漓不止,口中感觉热,腹部不知道饥饿,小便短少,六脉皆涩。用白芍药五钱,白术二钱,桂皮、黄芩各一钱,甘草八分。两帖药后汗止,寒热消除,减去白术,加入当归,全身疼痛停止。
费少垣的妻子,怀孕九个月,痰多喘咳,胎气上逆,眼睛撑不开,两侧太阳穴微痛。我说:这是子悬症兼有痰火。以大紫苏饮为主方,才服一帖,胎气上逆即止,胸膈顿时宽舒,只是喘咳不止,给予七制化痰丸而安顿下来。
The son of Xu Wenxue, who served as the magistrate of Sanquan, experienced fever every afternoon until dawn, with the fever worsening at night. He suffered from distending pain in the right hypochondrium, coughing that pulled at the pain, and pain regardless of whether he sat or lay down.
Physicians treated him for malaria (Nüe) without effect. After more than twenty days, the fever had not subsided. Subsequent physicians diagnosed it as deficiency heat (Xu Re) and administered formulas primarily consisting of Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu), which only increased the pain. I examined his pulse: the left pulse was wiry and large (Xuan Da), and the right pulse was slippery and large (Hua Da), striking the fingers forcefully. I stated: The *Neijing* says, "Left and right are the pathways of Yin and Yang." Based on the pulse, the fire of the Liver and Gallbladder is congealed by phlegm (Tan). This must be due to forcing oneself to write essays and excessive rumination without resolution, causing the nature of Wood and Fire to fail to circulate freely, becoming stagnant and resulting in pain. The worsening at night indicates excess pathogenic factors in the Liver. Initially, treatment should have focused on regulating Liver Qi, which could have been cured with one dose. Misdiagnosing it as malaria agitated the fire, and tonifying with Renshen and Baizhu blocked the Qi. Medical texts state: "When the body is hot like burning charcoal, sweating will disperse the heat." Now, there is no sweat, and the tongue coating has turned dark brown (chen xiang se), indicating extreme heat. If not treated urgently, critical danger will ensue immediately. Therefore, I used Zhongjing's Xiao Xian Xiong Tang (Minor Intra-thoracic Decoction) as the main formula: 1 liang of Trichosanthis Fructus (Gualou), 3 qian of Coptidis Rhizoma (Huanglian), 2 qian of Pinelliae Fermentata (Banxia Qu), and 1 qian each of Peucedani Radix (Qianhu) and Tangerine Peel (Qingpi), decocted in water for oral administration. At night, he took Danggui Longhui Wan (Angelica Sinensis and Picrorhiza Pill) to induce mild purgation. The other physicians still argued: "The illness has persisted for a long time, food intake is poor, and the spirit is so exhausted; how can we use purgation?" I replied: The classics state that the Liver is often in a state of excess, and the pulse also indicates excess; therefore, what is excess should be drained. Previously, misdiagnosing it as deficiency and using tonification was already an error; how could we err again? After taking the medicine, the pain stopped and the fever receded by midnight. After two doses, he was completely recovered.
Wu Zucuan's wife felt slightly cold after morning meals, with aversion to wind, fever, and pain throughout the body. She sweated profusely and continuously, felt heat in her mouth, had no appetite, short urine, and all six pulses were choppy (Se). I prescribed 5 qian of Paeoniae Radix Alba (Baishao), 2 qian of Atractylodis Macrocephalae Rhizoma (Baizhu), 1 qian each of Cinnamomi Cortex (Guipi) and Scutellariae Radix (Huangqin), and 8 fen of Glycyrrhizae Radix et Rhizoma (Gancao). After two doses, the sweating stopped, and the chills and fever resolved. Baizhu was removed, and Angelicae Sinensis Radix (Danggui) was added, which stopped the whole-body pain.
Fei Shaoyuan's wife was nine months pregnant, suffering from abundant phlegm, wheezing, and coughing, with fetal qi rebelling upward, inability to keep her eyes open, and slight pain in both temporal regions. I stated: This is the Zi Xuan syndrome (Fetal Suspension) complicated by Phlegm-Fire. I used Da Zisu Yin (Major Perilla Decoction) as the main formula. After just one dose, the rebellious fetal qi ceased, and the chest and diaphragm instantly felt relaxed. However, the wheezing and coughing persisted, so I administered Qizhi Huatan Wan (Seven-Processed Phlegm-Resolving Pill), which brought relief.