臧少庚年五十，每饮食，胸膈不顺利，觉喉管中梗梗，宛转难下，大便燥结，内热，肌
肉渐瘦
，医与五香连翘汤、五膈丁香散，诸治膈之剂，尝试之不效。时予方有事于先冢，久未远出
，臧则不远千里而就予治。观其色苍黑，目中神炯炯不 ，唯气促骨立，予知其有机心人也
。其脉左弦大，右滑大。予谓之曰∶据脉，乃谋而不决，气郁成火，脾志不舒，致成痰涎，
因而血少便燥，内热肌消。张鸡峰有言∶膈乃神思间病。即是推之，子当减思虑，断色欲，
薄滋味，绝妄想，俾神思清净，然后服药有功，不然，世无大丹，而草根木石何足恃哉!子
既远来，予敢不以肝膈相照，兹酌一方颇妥，归即制服，但毋轻示人，恐见未精者，妄为加
减，乃败事矣。慎之慎之!臧曰∶谨如教。其方用桂府滑石六两，炙甘草一两，真北白芥子
、萝卜子、麝干、连翘子各一两半，辰砂五钱，以竹茹四两煎汤，打馒头糊为丸，绿豆大，
每食后及夜，用灯心汤送下一钱半，一日三服，终剂而病如失。
程石洲乃眷因产难子死，忧闷，小腹有块作痛，下午发热不思饮食。次早诊之，脉右大
于左者三倍且数。与芎归汤加糖球子、泽兰叶、肉桂。次日下午腰腹胀痛。诘之，晌午食圆
眼一
斤矣，从此小腹渐胀，大便三日未行，早晨鼻衄，夜间极热口渴，脉大无绪，势甚危急，用
川芎、当归、红花、桃仁、青皮、槟榔、莪术、山楂，水煎调玄明粉二钱，服后大便稍行结
粪二枚，安而就寝，醒后进粥稍多，又复胀痛，腹大如斗，坚如石，气促不安，势危至此亦
已极矣。乃与五灵脂、糖球子各四钱，凌霄花二钱，赤芍药一钱，服后大便通，腹软气定。
始可进粥，渐有生气，但脉仍鼓指，此腹中积滞尚多，不可不因其时而驱去也。用糖球子、
大黄各三钱，桃仁二钱，桂心、红花各五分，炙甘草七分，水煎，临服调玄明粉一钱五分，
其夜下黑粪四次，热始退，上腹虽消，脐下仍大，仍以桃仁承气加山楂、滑石、红花煎饮之
。五更大便行，脐腹胀又渐减，后与积块丸调理全消。是役也，女流只知女科专门为仗，故
前发热腹痛止之时，彼专门不察虚实，即以常套十全大补汤投之，讵知圆眼肉初入腹之时
不觉，少顷渐渐胀开，故腹亦因之而胀也。且其味甘尤能作滞，复加地黄、参、术，宁不塞
其塞哉？由是而成大满大坚之症。《内经》谓∶中满者，泻之于内。良以此夫。彼亦泥乎丹
溪产后须当大补气血之误也。
臧少庚五十岁时，每次饮食，胸膈部感觉不顺畅，觉得喉管中有梗塞感，辗转难以下咽，大便干燥结硬，体内发热，肌肉逐渐消瘦。医生给予五香连翘汤、五膈丁香散等各种治疗噎膈的方剂，尝试后均无效。当时我正忙于为先人扫墓，很久没有远出，臧少庚便不远千里来找我诊治。观察他的面色苍黑，眼中神光炯炯有神，只是气息短促、骨瘦如柴，我推测他是个心思深沉的人。他的脉象左手弦大，右手滑大。我对他说：“根据脉象，这是思虑过多而犹豫不决，导致气机郁结化火，脾的志意不舒展，致使形成痰涎，进而血少、大便干燥、内热、肌肉消损。张鸡峰曾说：‘噎膈是精神思维方面的疾病。’由此推论，您应当减少思虑，断绝色欲，清淡饮食，杜绝妄想，使神思清净，然后服药才能见效，否则，世上没有灵丹妙药，草木药材又怎能依靠呢！您既然远道而来，我岂敢不以诚心相待？现在斟酌出一个方子颇为妥当，回去立即服用，但不要轻易给别人看，恐怕见识不精的人，胡乱加减，反而坏事。务必谨慎！臧少庚说：‘谨遵教诲。’该方用桂府滑石六两，炙甘草一两，真北白芥子、萝卜子、麝干、连翘子各一两半，辰砂五钱，用竹茹四两煎汤，做成馒头糊状作为丸药，绿豆大小，每次饭后及夜间，用灯心草汤送服一钱半，一天三次，服完一个疗程后，病如同消失一般。
程石洲的妻子因为难产导致孩子死亡，忧愁郁闷，小腹有肿块作痛，下午发热不想吃东西。第二天早上诊脉，右脉比左脉大三倍且数。给予芎归汤加糖球子、泽兰叶、肉桂。次日下午腰腹部胀痛。询问得知，中午吃了一斤桂圆（圆眼），从此小腹逐渐胀大，大便三天未行，早晨鼻出血，夜间极度发热口渴，脉象大而无序，形势非常危急，用川芎、当归、红花、桃仁、青皮、槟榔、莪术、山楂，水煎调玄明粉二钱，服用后大便稍通，排出两块干结粪便，安稳入睡，醒来后进食粥稍多，又再次胀痛，腹部大如斗，坚硬如石，气息短促不安，形势危急到了极点。于是给予五灵脂、糖球子各四钱，凌霄花二钱，赤芍药一钱，服用后大便通畅，腹部变软，气息平稳。这才可以进食粥类，逐渐有了生气，但脉象仍然鼓指有力，这说明腹中积滞还很多，不能不趁此时机驱除它。用糖球子、大黄各三钱，桃仁二钱，桂心、红花各五分，炙甘草七分，水煎，临服时调玄明粉一钱五分，当夜排出黑色粪便四次，热势才退，上腹部虽然消退，脐下仍然肿大，仍以桃仁承气汤加山楂、滑石、红花煎饮。五更时分大便通行，脐腹胀痛又逐渐减轻，后来给予积块丸调理，完全消除。这次诊疗中，这位女性只知妇科专门以补益为能事，所以在前次发热腹痛停止时，那位专科医生不察虚实，就用常规的十全大补汤投予，哪里知道桂圆肉刚入腹时不觉，过了一会儿渐渐胀开，所以腹部也因此胀大。而且其味甘尤其容易导致停滞，再加上地黄、人参、白术，难道不是堵塞其中的堵塞吗？由此形成了大满大坚的症状。《内经》说：‘中满者，泻之于内。’确实是因为这个原因啊。她也拘泥于朱丹溪产后必须大补气血的错误观点。
Zang Shaogeng, aged fifty, experienced discomfort in the chest and diaphragm with every meal, feeling a blockage in the throat that made swallowing difficult. His stool was dry and hard, he suffered from internal heat, and his muscles gradually wasted away. Physicians prescribed Wuxiang Lianqiao Tang (Five-Spice Forsythia Decoction), Wuge Dingxiang San (Five-Obstruction Clove Powder), and various other remedies for dysphagia (difficulty swallowing), but none were effective. At that time, I was occupied with tomb-sweeping for my ancestors and had not traveled far. Zang came to me for treatment from a thousand li away. Observing his dark complexion and bright, spirited eyes, yet noting his shortness of breath and emaciation, I deduced he was a person of deep calculation. His pulse was wiry and large on the left, and slippery and large on the right. I told him: "Based on the pulse, this is due to excessive deliberation without resolution, leading to qi stagnation transforming into fire, and the spleen's will failing to relax, resulting in phlegm-fluid retention. This subsequently causes blood deficiency, dry stool, internal heat, and muscle wasting. Zhang Jifeng stated: 'Dysphagia is a disease of the spirit and mind.' By extension, you must reduce your worries, abstain from sexual desires, eat bland food, and abandon delusions, so that your spirit and mind become clear. Only then will herbal medicine be effective; otherwise, even if there were great elixirs in the world, what reliance could there be on roots and grasses? Since you have come from afar, how dare I not treat you with sincerity? I have carefully formulated a prescription that is quite suitable. Take it immediately upon returning, but do not show it to others lightly, lest those with imprecise understanding arbitrarily modify it and ruin the case. Be very cautious!" Zang said: "I shall follow your instructions." The prescription used Liufu Huashi (Talcum) six liang, Zhi Gancao (Honey-fried Licorice Root) one liang, Zhen Bei Baijiezhi (True Northern White Mustard Seed), Luobozhi (Radish Seed), Shegan (Dried Musk), and Lianqiaozzi (Forsythia Fruit) each one-and-a-half liang, Chensha (Cinnabar) five qian. These were decocted with Zhuru (Bamboo Shavings) four liang, mixed with mantou paste to form pills the size of mung beans. After meals and at night, take 1.5 qian washed down with Dengxin Tang (Juncus Decoction), three times a day. Upon completing the course, the illness vanished as if lost.
Cheng Shizhou's wife, after a difficult labor resulting in the death of her child, suffered from sorrow and depression, with a mass in the lower abdomen causing pain, afternoon fever, and loss of appetite. On the following morning, her pulse was three times larger on the right than on the left and rapid. She was given Xionggui Tang (Ligusticum and Angelica Decoction) added with Tangqiuzi, Zelan Ye (Leaf of Salvia Miltiorrhiza), and Rougui (Cinnamon Bark). The next afternoon, she experienced waist and abdominal distension and pain. Upon inquiry, it was found that she had eaten one jin of Yuanyan (Longan Fruit) at noon. From then on, her lower abdomen gradually distended, her stool remained unpassed for three days, she had an epistaxis in the morning, extreme thirst and heat at night, and her pulse was large and disordered. The condition was critical. A formula containing Chuanxiong (Sichuan Lovage Rhizome), Danggui (Angelica Sinensis), Honghua (Carthamus Flower), Taoren (Peach Kernel), Qingpi (Green Tangerine Peel), Binglang (Areca Seed), Ezhu (Curcuma Rhizome), and Shanzha (Hawthorn Fruit) was decocted in water, with Xuanningfen (Natrii Sulfas) two qian mixed in before administration. After taking it, her bowel movement slightly improved, passing two pieces of hard stool, and she slept peacefully. Upon waking, she ate more porridge, which caused recurrent distension and pain. Her abdomen became large as a bucket and hard as stone, with shortness of breath and restlessness. The danger reached its peak. Then, Wulingzhi (Trogopterus Dung), Tangqiuzi each four qian, Lingxiaohua (Campsis Grandiflora Flower), and ChiShaoyao (Red Peony Root) one qian were administered. Afterward, her bowels moved freely, her abdomen softened, and her breathing stabilized. Only then could she consume porridge, and she gradually regained vitality. However, her pulse remained forceful against the fingers, indicating significant accumulation in the abdomen that needed to be expelled while the opportunity arose. A formula of Tangqiuzi and Dahuang (Rhubarb Root) each three qian, Taoren two qian, Guixin (Cinnamon Twig Heart) and Honghua each five fen, and Zhi Gancao seven fen was decocted in water, with Xuanningfen 1.5 qian mixed in before drinking. That night, she passed black stool four times, and the heat subsided. Although the upper abdomen reduced, the area below the navel remained swollen. Tao Ren Cheng Qi Tang (Peach Kernel and Rhubarb Decoction) added with Shanzha, Huashi, and Honghua was decocted and drunk. In the fifth watch, her bowels moved again, and the umbilical and abdominal distension gradually decreased. Later, Jikuai Wan (Mass Dissolving Pills) was used for regulation until complete resolution. In this case, the female patient only knew that gynecology specialized in tonification. Therefore, when the previous fever and abdominal pain ceased, the specialist physician, without examining deficiency or excess, administered the standard Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction). Little did they know that the Longan fruit initially went unnoticed, but soon expanded, causing abdominal distension. Moreover, its sweet nature tends to cause stagnation; adding Dihuang (Rehmannia Root), Renshen (Ginseng Root), and Baizhu (Atractylodes Macrocephala Rhizome) would certainly obstruct the obstruction further! Thus, symptoms of severe fullness and hardness arose. The *Neijing* states: "For fullness in the middle, purge from within." This is precisely the reason. She also adhered blindly to Zhu Danxi's erroneous view that postpartum cases require great tonification of qi and blood.