潘见所老先生有一小盛价，年可十六七，发热于午后。城中周友以为阴虚，而为滋阴降
火，
服三十余剂，热益加，且腹中渐胀，面色清白。仍以六味地黄丸加黄柏、知母、麦冬、五味
子之类。又三十剂，而腹大如斗，坚如石，饮食大减，发黄成穗，额颅光亮，口渴不可言
，两腿大肉消尽，眼大，面肉皆消，肌肤枯燥如松树皮，奄奄一骷髅耳。予观其目之神，尚
五分存。欲为治剂，潘公门下诸人语予曰∶形症如是，死在目下，尚可服药乎？予曰∶症非
死候，为用药者误耳。譬之树木，若根本坏而枝叶枯焦，非力可生；今焦枯乃斧斤伤其枝
叶，而根本仍在也。设灌溉有方，犹可冀生，安可遽弃？予以神授丹，日用一丸，煮猪肉四
两
饲之。十日腹软其半，热亦消其半，神色渐好。潘见老诘余曰∶此何症？公能肉枯骨如此之
神。予曰∶此疳积症也。彼误认为肾虚，而用补阴之药，是以滞益滞，腹焉得不大不坚？公
曰∶彼纯用寒而热愈炽，君用非寒而热反退，此何说焉？予曰∶此热乃湿热，由脾虚所致，
补阴之剂皆湿类，盖脾属土，恶湿喜燥，今以大芦荟丸、肥儿丸调理一月，可全瘳矣。公曰
∶善，微先生，此仆已为泉下物矣。
少司空凌绎泉翁，年已古稀，原有痰火之疾，因正月上旬，为令孙大婚过劳，偶占风寒
，内
热咳嗽，痰中有血，血多而痰少，痰坚不易出，鼻流清水，舌生芒刺，色焦黄，语言强硬不
清，大小便不利，喘急不能睡，亦不能仰，惟坐高椅，椅前安棹，棹上安枕，日惟额伏枕上
而已。市医环治半月不瘳，敦予诊之。两手脉浮而洪，两关滑大有力。知其内有积热痰火，
为风邪所 ，且为怒气所加，故血上逆。议者以高年见红，脉大发热为惧。予曰；此有余症
，诸公认为阴虚，而为滋阴降火，故不瘳。法当先驱中焦痰火积热，然后以地黄补血等剂收
功，斯不失先后着也。翁以予言为然。用栝蒌、石膏各三钱，橘红、半夏曲、桑白皮、前胡
、杏仁、酒芩、紫苏子，水煎，临服加入萝卜汁一小酒盏，一剂而血止。次日诊之，脉仍浮
而洪大，尚恶寒。予曰∶古云伤风必恶风，伤寒必恶寒，此其常也。只因先时失于清散，表
中之热未彻，竟用滋阴之剂，又加童便收敛，降下太速，以致风寒郁而不散，故热愈甚也。
改以定喘汤，一剂而喘急减半，再剂热退而不恶寒。复为诊之，两手浮体已无，惟两关之脉
甚
鼓指，此中焦痰积胶固已久，不可不因其时而疏导之。以清中丸同当归龙荟丸共二钱进之
。其夜大便所下稠粘秽积甚多。予忆朱丹溪有云∶凡哮喘火盛者，以白虎汤加黄连、枳实有
功。此法正绎翁对腔剂也。与十剂，外以清中丸同双玉丸夜服，调理而安。
潘见所老先生有一位名叫小盛的仆人，年龄大约十六七岁，午后出现发热症状。城中的周姓朋友认为是阴虚，便采用滋阴降火的方法治疗，服用三十多剂后，发热反而加重，且腹部逐渐胀大，面色苍白清冷。于是继续服用六味地黄丸，并加入黄柏、知母、麦冬、五味子等药物。又服用了三十剂，导致腹部大如斗，坚硬如石头，饮食大幅减少，头发枯黄成穗状，额头和颅骨光亮，口渴难以言表，双腿肌肉完全消尽，眼睛突出，面部肌肉消瘦，肌肤干燥粗糙如同松树皮，奄奄一息，形同骷髅。我观察他的眼神，尚存五分神气。想要为他开方治疗，潘公门下的众人对我说：“形体和症状如此严重，死亡就在眼前，还能服药吗？”我说：“这并非死症，是用药者误治所致。这就好比树木，如果根基毁坏而枝叶枯焦，不是人力所能挽救；如今枝叶枯焦是因为斧斤砍伤了枝叶，但根基仍然完好。如果灌溉得当，还可以希望存活，怎么能轻易放弃呢？”我给他服用神授丹，每天一粒，煮四两猪肉喂他。十天后，腹部变软了一半，热势也消退了一半，神色逐渐好转。潘见老问我：“这是什么病？您能让肉枯骨立之人恢复精神。”我说：“这是疳积症（小儿营养不良及消化功能紊乱的病症）。他们误认为是肾虚，而使用补阴的药物，因此导致停滞更加严重，腹部怎么会不大且不硬呢？”潘公说：“他们纯用寒凉药而热势更炽，您用的不是寒凉药而热势反而退去，这是什么道理？”我说：“这种热是湿热，由脾虚引起，补阴的药物都属于湿类，脾属土，厌恶湿气而喜欢燥性，现在用大芦荟丸、肥儿丸调理一个月，就可以痊愈了。”潘公说：“好，如果没有先生，我已经变成地下鬼了。”
少司空凌绎泉老先生，年已七十多岁，原本就有痰火疾病。因为正月初旬，为了孙子的大婚过度劳累，偶然感受风寒，出现内热咳嗽，痰中带血，血量多而痰量少，痰液粘稠不易咳出，流清鼻涕，舌生芒刺，舌色焦黄，语言强硬不清，大小便不通畅，气喘急促不能平卧，也不能仰卧，只能坐在高椅上，椅子前放桌子，桌子上放枕头，每天只是额头伏在枕头上而已。市井医生环绕治疗半个月没有见效，敦请我诊治。两手脉象浮而洪大，两关部脉滑大有力。我知道他体内有积热痰火，被风邪侵袭，且因怒气加剧，导致血气上逆。议论的人认为高龄出现咯血，脉大发热令人恐惧。我说：“这是有余之症（实证），各位认为是阴虚，而采用滋阴降火的方法，所以不见效。治疗方法应当先清除中焦的痰火积热，然后用地黄补血等药剂收功，这样才不失先后步骤的正确性。”老先生认为我的话是对的。使用瓜蒌、石膏各三钱，橘红、半夏曲、桑白皮、前胡、杏仁、酒炒黄芩、紫苏子，水煎，临服用时加入一小酒杯萝卜汁，一剂药后血止。第二天诊察，脉象仍然浮而洪大，还怕冷。我说：“古话说伤风必定恶风，伤寒必定恶寒，这是常理。只因为先前失于清热发散，表中之热未彻底清除，竟然使用滋阴药剂，又加入童便收敛，降下太快，导致风寒郁结而不能散发，所以热势更甚。”改为使用定喘汤，一剂后气喘减半，再服一剂热退且不怕冷。再次诊察，两手浮脉已无，只有两关脉鼓指有力，这说明中焦痰积胶固已久，不可不趁此时机疏导它。用清中丸同当归龙荟丸共二钱进服。当晚大便排出大量粘稠秽浊积滞。我想起朱丹溪说过：“凡是哮喘火盛者，用白虎汤加黄连、枳实有效。”这个方法正适合凌翁的症状。给予十剂药，外用清中丸同双玉丸夜间服用，调理后安愈。
Mr. Pan Jiansuo had a servant named Xiaosheng, aged about sixteen or seventeen, who suffered from afternoon fever. A friend in the city named Zhou diagnosed it as Yin deficiency and prescribed treatments to nourish Yin and descend fire. After taking more than thirty doses, the fever worsened, and his abdomen gradually distended, with a pale and cold complexion. They continued with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) supplemented with Huangbai (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma), Maidong (Ophiopogonis Radix), and Wuweizi (Schisandrae Fructus). After another thirty doses, his abdomen became as large as a bucket and hard as stone, food intake decreased significantly, hair turned yellow and brittle like tufts, forehead and skull shone, thirst was unbearable, muscles of both legs were completely wasted, eyes protruded, facial muscles emaciated, skin dry and rough like pine bark, appearing as if a living skeleton. I observed that his eyes still retained five-tenths of spirit. I intended to prescribe medicine for him, but those in Mr. Pan's household said to me, "With such physical and symptomatic conditions, death is imminent; can he still take medicine?" I said, "This is not a terminal condition; it is due to medical error. It is like a tree: if the roots are destroyed and branches withered, no effort can revive it; now the withering is due to axes damaging the branches, while the roots remain intact. If irrigated properly, there is still hope for survival, how can one give up? I administered Shenshou Dan (Divine Grant Pill), one pill daily, fed to him with four taels of boiled pork. After ten days, his abdomen softened by half, and the fever subsided by half, with gradual improvement in spirit and color. Mr. Pan asked me, 'What disease is this? You have restored spirit to someone whose flesh has wasted away.' I said, 'This is Ganji syndrome (infantile malnutrition and digestive dysfunction). They mistakenly identified it as Kidney deficiency and used Yin-nourishing medicines, thereby exacerbating stagnation; how could the abdomen not become large and hard?' Mr. Pan said, 'They used purely cold medicines, yet the heat intensified; you used non-cold medicines, yet the heat receded. What is the explanation?' I said, 'This heat is damp-heat caused by Spleen deficiency. Yin-nourishing agents are all damp in nature. The Spleen belongs to Earth, dislikes dampness, and prefers dryness. Now, using Dalulinwan (Large Aloe Pill) and Fei'er Wan (Child-Nourishing Pill) for conditioning over one month will lead to full recovery.' Mr. Pan said, 'Good. Without you, I would already be a ghost under the springs.'
Vice Minister Ling Yi quan, an elderly gentleman past seventy, originally suffered from Phlegm-Fire disorder. In early January, due to overexertion during his grandson's wedding, he accidentally contracted Wind-Cold, resulting in internal heat, coughing, blood in sputum, with more blood than phlegm, thick phlegm difficult to expectorate, clear nasal discharge, prickles on the tongue, scorched yellow tongue coating, stiff and unclear speech, difficulty in urination and defecation, rapid panting preventing sleep, inability to lie flat or supine, only able to sit on a high chair with a table in front, pillow on the table, resting his forehead on the pillow daily. City physicians treated him for half a month without relief, so they earnestly requested my diagnosis. Both wrists' pulses were floating and surging, with the Guan positions slippery, large, and forceful. I knew he had accumulated internal heat and Phlegm-Fire, invaded by Wind pathogen, and aggravated by anger, causing blood to rebel upwards. Critics feared that an elderly person presenting with hemoptysis, large pulse, and fever was a bad sign. I said, "This is an Excess syndrome. The gentlemen identified it as Yin deficiency and applied Yin-nourishing and fire-descending methods, hence the lack of improvement. The method should first clear the middle Jiao of Phlegm-Fire and accumulated heat, then use Rehmannia blood-nourishing formulas to conclude treatment, thus maintaining the correct sequence." The old gentleman agreed. I prescribed Gualou (Trichosanthis Fructus) and Shigao (Gypsum Fibrosum), each three qian, along with Juhong (Citri Reticulatae Pericarpium Rubrum), Banxiaqu (Pinelliae Fermentatum), Sangbaipi (Mori Cortex), Qianhu (Peucedani Radix), Xingren (Armeniacae Semen Amarum), Jiuhuangqin (Scutellariae Radix prepared with wine), and Zisuzi (Perillae Fructus), decocted in water. Just before administration, add a small wine cup of Luobozhi (Raphani Juice). After one dose, bleeding stopped. On the next day, the pulse remained floating, surging, and large, with aversion to cold. I said, "Ancient texts state that Wind injury causes aversion to wind, and Cold injury causes aversion to cold; this is the norm. Because earlier treatment failed to clear and disperse, the exterior heat was not thoroughly resolved, and instead, Yin-nourishing agents were used, plus Tongbian (Boy's Urine) for astringency, descending too rapidly, causing Wind-Cold to stagnate and fail to dissipate, thus intensifying the heat." I changed the prescription to Dingchuan Tang (Panting-Calming Decoction). After one dose, panting halved; after two doses, heat receded and aversion to cold disappeared. Upon re-examination, the floating quality of the pulses in both hands was gone, only the Guan positions were drum-like and forceful against the fingers, indicating long-standing stubborn accumulation of Phlegm in the middle Jiao, which must be guided out at this time. I administered Qingzhong Wan (Middle-Clearing Pill) combined with Danggui Longhui Wan (Angelica Dahurica and Gardenia Pill), totaling two qian. That night, the stool passed contained a large amount of sticky, foul accumulation. I recalled Zhu Danxi saying, "For asthma with excessive Fire, Baihu Tang (White Tiger Decoction) added with Huanglian (Coptidis Rhizoma) and Zhishi (Aurantii Fructus Immaturus) is effective." This method precisely matched Old Man Ling's condition. Ten doses were given, followed by Qingzhong Wan combined with Shuangyu Wan (Double Jade Pill) taken at night for conditioning, leading to recovery.