一汪氏妪，寒痰壅滞于背，胸胁腹皆胀，小水频数。先与女金丹以治胸胁之痛，以二陈
汤加
益智仁、香附子、白芥子、青皮、柴胡、苍术、桂枝一帖而小水减半，次日以白豆仁易益智
仁，以枳壳易青皮，再加川芎、桔梗开提清气，诸胀痛悉减。
太塘徐公，讳客者，其子弱冠，肌肉瘦削，尻膝肿大，手肘肩 皆肿，肿处皆痛而发热
。时
医有作风治者，有作湿痰治者，有作鹤膝鼓槌风治者，愈治愈重，伏床褥奄奄一息耳。举家
仓惶而决之蓍， 者释策曰∶易象可不死，天医上卦，第远在东方，相去百里而遥，迎而
治之无恙也。因访予而迎之治。予诊其脉，六部皆弦，观其色青而白，饮食少。时当长至，
予曰∶此筋痿症也。书云诸痿皆不可作风治，病势几危者，以前药皆风剂耳。风能伤血，血
枯则筋愈失养，况弦脉乃肝木所主，搀前而至是肝有余而脾土受敌，脾为所伤，宜饮食少、
肌肉削而势将危也。《内经》曰∶诸痿独取于阳明为治。阳明者，肠与胃也。法当滋补肠胃
，俾饮食日加，五脏六腑有所禀受，营卫流行，气煦血濡，调养至春，淑气司令，君火主事
之时，宗筋润而机关可利也。病者年虽少，而能闻言相信，恳予为治。予立方∶五加皮、苡
仁
、甘草、苍耳子、枸杞子、回阳、人参、杜仲、黄柏、黄 、防风。服二十剂而精神壮，腰
膂健，饮食加。惟间或梦遗，则为减去杜仲而加远志、当归，三十帖而全安。此余初发之治
也。
有一位汪姓老妇人，背部寒痰壅滞阻塞，导致胸部、胁部和腹部都出现胀满感，小便次数频繁。先用女金丹来治疗胸胁部的疼痛，再用二陈汤（燥湿化痰、理气和中的基础方）加入益智仁、香附子、白芥子、青皮、柴胡、苍术、桂枝，服用一帖后小便次数减半；第二天用白豆蔻替换益智仁，用枳壳替换青皮，再加入川芎、桔梗以升提清气，各种胀痛症状全部减轻。
太塘徐公，名客，他的儿子刚成年（二十岁左右），肌肉消瘦枯槁，尾椎和膝盖肿大，手肘和肩膀也都肿胀，肿胀部位都疼痛且发热。当时的医生有的按风证治疗，有的按湿痰治疗，有的按鹤膝风和鼓槌风治疗，结果越治病情越重，病人卧床不起，奄奄一息。全家惊慌失措，于是占卜问吉凶，占卜者解开卦象说：根据易经卦象可以不死，天医星在上卦，只是距离在东方，相距百里之遥，迎请他前来治疗就没有危险了。于是寻访到我并迎请我进行治疗。我诊察他的脉象，六部脉皆呈弦象，观察他的面色青白，饮食减少。当时正值冬至，我说：这是筋痿症。医书说各种痿证都不可以按风证治疗，病情几乎危重的原因，是因为之前的药都是祛风剂。风能伤血，血液枯竭则筋脉更加失去滋养，况且弦脉是肝木所主，提前出现这种脉象说明肝气有余而脾土受敌，脾脏受到损伤，所以应该出现饮食少、肌肉消瘦且形势将危的情况。《内经》说：各种痿证独取阳明经来治疗。阳明经指的是大肠和胃。治疗方法应当滋补肠胃，使饮食日渐增加，五脏六腑有所禀受，营卫之气流行，阳气温煦、血液濡养，调养到春天，温和之气当令，君火主事的时候，宗筋得到滋润，关节就可以灵活利索了。病人虽然年轻，但能听信我的话，恳求我为他治疗。我开具处方：五加皮、薏苡仁、甘草、苍耳子、枸杞子、回阳参（此处原文“回阳”疑为笔误或特定药材简称，结合语境及常见配伍，可能指人参或类似补气药，此处保留原名）、人参、杜仲、黄柏、黄芩、防风。服用二十剂后精神强壮，腰背健壮，饮食增加。只是偶尔有梦遗，于是减去杜仲而加入远志、当归，三十帖后完全康复。这是我初次独立行医时的案例。
A female patient surnamed Wang, an elderly woman, suffered from cold phlegm obstructing her back, causing distension in the chest, hypochondrium, and abdomen, along with frequent urination. Initially, Nü Jin Dan (Female Golden Pill) was administered to treat pain in the chest and hypochondrium. Subsequently, Er Chen Tang (Two-Aged Decoction, a formula for drying dampness and resolving phlegm) was modified with Yizhiren (Alpinia Oxyphylla Fruit), Xiangfuzi (Cyperi Rhizoma), Baijiezi (Sinapis Semen), Qingpi (Aurantii Fructus Pericarpium Rubrum), Chaihu (Bupleuri Radix), Cangzhu (Atractylodis Rhizoma), and Guizhi (Cinnamomi Ramulus). After one dose, the frequency of urination decreased by half. The next day, Yizhiren was replaced with Baidoukou (Amomi Fructus Rotundus), Qingpi was replaced with Zhike (Aurantii Fructus Immaturus), and Chuanxiong (Ligustici Chuanxiong Rhizoma) and Jiegeng (Platycodonis Radix) were added to raise and clear the qi. All symptoms of distension and pain subsided completely.
Mr. Xu Ketang, whose personal name was Ke, had a son who had just reached adulthood (around twenty years old). His muscles were emaciated, his sacrum and knees were swollen, and his elbows and shoulders were also swollen. The swollen areas were painful and accompanied by fever. Some contemporary physicians treated it as a wind syndrome, others as damp-phlegm, and still others as "Crane Knee" or "Drumstick Wind" (types of joint deformities). However, the condition worsened with each treatment until he was bedridden and on the verge of death. The family, in a panic, consulted divination. The diviner interpreted the hexagram, stating: "According to the I Ching, death is not inevitable. The Star of Heavenly Physician is in the upper trigram, but located far away in the east, a hundred li distant. If you invite him to come and treat the patient, there will be no danger." Thus, they sought me out and invited me to treat him. Upon examining his pulse, all six positions (cun, guan, chi on both hands) presented a wiry (Xian) pulse. His complexion was blueish-white, and his appetite was poor. It was then the Winter Solstice. I said, "This is Jin Wei (Tendon Atrophy Syndrome)." Medical texts state that various Wei syndromes should never be treated as wind syndromes. The reason his condition became nearly critical is that previous treatments used wind-dispelling agents. Wind can damage blood; when blood is depleted, tendons lose nourishment even more. Moreover, the wiry pulse is governed by Liver Wood. Its premature appearance indicates Liver Qi excess attacking Spleen Earth. Since the Spleen is damaged, it explains the poor diet, emaciation, and critical prognosis. The *Neijing* states: "For all Wei syndromes, treatment should focus exclusively on the Yangming channel." The Yangming channel refers to the Large Intestine and Stomach. The method should be to tonify the stomach and intestines, so that food intake increases daily, providing nourishment to the five zang and six fu organs. As Ying (Nutritive) and Wei (Defensive) qi circulate freely, yang warms and blood moistens, by the time spring arrives, when gentle qi prevails and Ministerial Fire takes command, the Zongjin (Major Tendons) will be moistened, and joints will become flexible. Although the patient was young, he believed my words and earnestly requested treatment. I prescribed a formula containing Wujiapi (Acanthopanacis Cortex), Yiren (Coicis Semen), Gancao (Glycyrrhizae Radix et Rhizoma), Cang'erzi (Xanthii Fructus), Gouqizi (Lycii Fructus), Huiyang (likely referring to a specific tonic herb or a textual variant/error, retained as is), Renshen (Ginseng Radix et Rhizoma), Duzhong (Eucommiae Cortex), Huangbai (Phellodendri Cortex), Huangqin (Scutellariae Radix), and Fangfeng (Saposhnikoviae Radix). After twenty doses, his spirit strengthened, his lower back and spine became robust, and his appetite improved. However, he occasionally experienced nocturnal emissions. Therefore, Duzhong was removed, and Yuanzhi (Polygalae Radix) and Danggui (Angelicae Sinensis Radix) were added. After thirty doses, he recovered completely. This was my first independent case of treatment.