袁继明素有房劳内伤。偶因小感。自煎姜葱汤表汗。因而发热三日。变成疟疾。余诊其脉。豁大空虚。
且寒不成寒。热不成热。气急神扬。知为元阳衰脱之候。因谓其父曰。令郎光景。窃虑来日疟至。大汗不止。
难于救药。倘信吾言。今晚急用人参二两。煎浓汁频服防危。渠父不以为意。次日五鼓时。病者精神
便觉恍惚。扣门请救。及觅参至。疟已先发矣。余甚彷徨。恐以人参补住疟邪。虽救急无益也。只得姑俟疟
势稍退。方与服之。服时已汗出沾濡。顷之果然大汗不止。昏不知人。口流白沫。灌药难入。直至日暮。
白沫转从大孔遗出。余喜曰。沫下行可无恐矣。但内虚肠滑。独参不能胜任。急以附子理中汤。连进四小
剂。人事方苏。能言。但对面谭事不清。门外有探病客至。渠忽先知。家人惊以为祟。余曰。此正神魂之离舍
耳。吾以独参及附子理中。驷马之力追之。尚在半返未返之界。以故能知宅外之事。再与前药二剂而安。
胡卣臣先生曰。病情上看得委息周至。大开生面。
陆六息先生体伟神健。气旺血充。从来无病。莅任以后。适值奇荒巨寇。忧劳百倍。因而病疟。食饮
减少。肌肉消瘦。形体困倦。口中时时嗳气。其候一日轻。一日重。缠绵三月。大为所
苦。察脉辨证。因知先生之疟。乃饥饱劳佚所感。受伤在阳明胃之一经。夫阳经受病。邪气浅而易愈。乃
至为所苦者。缘不识病之所在。药与病邪不相值。反伤其正耳。诚知病邪专专在胃。则
胃为水谷之海。多气多血之区。一调其胃。而疟立止矣。故饮食减而大便转觉艰涩者。胃病而运化之机迟也。
肌肉消瘦者。胃主肌肉也。形体困倦者。胃病而约束之机关不利也。口中时时嗳气者。胃中不和而显晦塞之
象也。至于一日轻而一日重者。此人所不经见之证。病机之最当发明者。其候亦阳明胃经之候
也。内经阳明脉解篇有曰。阳明之病。恶人与火。闻木声则惕然而惊。及刺疟篇又曰。阳明之证。喜见火。
喜见日月光。何经文之自为悖谬耶。不知此正更实更虚之妙义。而与日轻日重之理
相通者也。夫阳明得病之始。则邪气有余。故恶人恶火恶木音者。恶其劫邪也。及其病久。则邪去而正亦虚。
故喜火喜日月光者。喜其助正也。若是则时日干支之衰旺。其与人身相关之故。可类推矣。盖甲丙戊庚壬者。
天时之阳也。乙丁己辛癸者。天时之阴也。疟久食减。胃中之正已虚。而邪去未尽。是以值阳日助
正。而邪不能胜则轻。值阴日助邪。而正不能胜则重也。夫人身之病。至于与天时相召。亦云亟矣。使当日稍
知分经用药。何至延绵若是哉。迄今吃紧之处。全以培养中气为主。盖人虽一胃。
而有三脘之分。上脘象天。清气居多。下脘象地。浊气居多。而
其能升清降浊者。全赖中脘为之运用。一如天地定位。不可无
人焉参赞之也。先生下脘之浊气。本当下传也。而传入肠中则艰。不当上升也。而升至胸中甚易者。无他。中
脘素受饮食之伤。不能阻下脘浊气上乾清道耳。试观天地间。有时地气上而
为云。必得天气下而为雨。则二气和而晴爽立至。若一味地气上升。天气不降。则太空窒塞。而成阴噎之象。
人之胃中亦犹是也。清浊偶有相干。顷当自定。设有升无降则逼矣。故中脘之气旺。则水谷之清气。上升于
肺。而灌输百脉。水谷之浊气。下达于大小肠。从便溺而消。胸中何窒塞之有哉。此所以培养中气
为亟亟也。中气旺。则浊气不久停于下脘。而脐下丹田之真气。方能上下无碍。可以呼之于根。吸之于蒂。深
深其息矣。所用六味地黄丸。凝滞不行之药。大为胃病所不宜。况于浊气上干。反
以阴浊之属。扬波助流。尤无所取。今订理中汤一方升清降浊为合法耳。
胡卣臣先生曰。说病机处花雨缤纷。令观者得未曾有。
袁继明平素因房事过度导致内伤。偶然因为轻微的外感，自己煎煮姜葱汤试图发汗解表，结果因此发热三天，进而演变成疟疾。我诊察他的脉象，发现脉形豁大且空虚无力。并且他出现的寒战不像真正的寒战，发热也不像真正的发热，呼吸急促，神志浮越，我知道这是元阳衰败欲脱的征兆。于是我对他的父亲说：“令尊的情况，我私下担心明天疟疾发作时，会出现大汗淋漓不止的症状，届时将难以用药救治。如果您相信我的话，今晚急需用人参二两，煎煮成浓汁频繁服用，以预防危象。”他的父亲没有在意。第二天五更时分，病人精神恍惚，敲门求救。等到找到人参时，疟疾已经先期发作了。我非常犹豫，担心用人参补益会留滞住疟邪，虽然能救急但可能无益。只得暂时等待疟疾势头稍退后，才给他服药。服药时他已经出汗湿透衣物，不久后果然大汗不止，昏迷不省人事，口流白沫，灌药困难。直到傍晚，白沫转而从肛门流出。我高兴地说：“白沫下行，就可以不必担忧了。但是体内虚弱、肠道滑泄，单用人参无法胜任治疗。急忙使用附子理中汤，连续进服四小剂，病人才苏醒过来，能够说话，只是与人面对面交谈时语意不清。门外有探病的客人到来，他突然事先知道。家人惊恐地认为是鬼祟作怪。我说：“这正是神魂离体之象。我用独参汤及附子理中汤，如驷马奔腾之力追回神魂，目前还在半返未返的状态，所以能预知宅外之事。再给予前药两剂，病情便安稳了。”胡卣臣先生说：“对病情的观察确实周密细致，大开生面，令人耳目一新。”
陆六息先生体格伟岸，精神健旺，气血充盛，向来没有疾病。到任之后，恰逢特大荒灾和巨寇之乱，忧劳百倍，因而患上疟疾。饮食减少，肌肉消瘦，形体困倦，口中时时嗳气。症状表现为一天轻、一天重，缠绵三月，深受其苦。通过诊察脉象和辨证分析，我知道先生的疟疾，是由于饥饱失调和劳逸不当所感受的病邪，受伤部位在阳明胃经这一条经络。既然阳经受病，邪气浅表而容易治愈，以至于让他如此痛苦的原因，是因为不认识病邪所在的部位，药物与病邪不相遭遇，反而损伤了正气。如果确实知道病邪专在于胃，那么胃为水谷之海，是多气多血的区域，只要调理好胃，疟疾立刻就能停止。所以饮食减少而大便转觉艰涩，是胃病导致运化机能迟缓；肌肉消瘦，是因为胃主肌肉；形体困倦，是因为胃病导致约束筋骨的机关不利；口中时时嗳气，是胃中不和而显现出痞塞的现象。至于一天轻、一天重的情况，这是人们不常见的证候，也是病机中最应当阐明的。这种表现也是阳明胃经的证候。《内经·阳明脉解篇》中说：“阳明病，厌恶人和火，听到木声则惊恐。”而在《刺疟篇》中又说：“阳明的证候，喜欢见火，喜欢见日月光。”为什么经文之间自相矛盾呢？不知道这正体现了虚实交替变化的精妙义理，与一天轻一天重的道理相通。阳明病刚开始时，邪气有余，所以厌恶人、厌恶火、厌恶木声，是厌恶它们劫夺邪气（指外界刺激引动病邪）；等到病久，邪气已去而正气也虚，所以喜欢火、喜欢日月光，是喜欢它们帮助正气。如果是这样，那么时日干支的衰旺，与人身相关的缘故，可以类推了。大概甲、丙、戊、庚、壬是天时的阳日；乙、丁、己、辛、癸是天时的阴日。疟疾日久饮食减少，胃中的正气已经虚弱，而邪气尚未清除干净，所以在阳日得到天时之助，正气胜邪气则病轻；在阴日邪气得助，正气不胜邪气则病重。人的身体疾病，竟然能与天时相互感应，也算紧急了。如果在当初稍微懂得按经络分经用药，何至于拖延缠绵到这种地步呢？如今紧要之处，完全以培养中气为主。虽然人都只有一个胃，但有上脘、中脘、下脘之分。上脘象天，清气居多；下脘象地，浊气居多。而能够升清降浊的功能，全赖中脘来运作，就像天地定位，不可没有人来参赞调和一样。先生下脘的浊气，本应当向下传导，但传入肠中则艰难；本不应当上升，但升至胸中却很容易，没有其他原因，只是因为中脘平素受到饮食损伤，不能阻挡下脘浊气上犯清道。试看天地间，有时地气上升而为云，必须得天气下降而为雨，则二气和合而晴朗清爽立即到来。若一味地气上升，天气不降，则太空窒塞，形成阴晦闭塞的景象。人的胃中也是如此。清浊之气偶尔有干扰，片刻后应当自行安定。如果有升无降就危险了。所以中脘之气旺盛，则水谷的清气上升于肺，从而灌输百脉；水谷的浊气下达于大小肠，从大小便排出，胸中怎么会有窒塞之感呢？这就是之所以急切培养中气的原因。中气旺盛，则浊气不会长时间停滞在下脘，脐下丹田的真气才能上下无障碍，可以呼之于根，吸之于蒂，气息深沉。所用六味地黄丸，是凝滞不行的药物，大大不适合胃病。况且在浊气上犯的情况下，再用阴浊性质的药物，如同扬波助流，更加不可取。现在拟定理中汤一方，以升清降浊为合法度。”胡卣臣先生说：“阐述病机之处如花雨缤纷，让观看者获得前所未有的体验。”
Yuan Jiming had a chronic internal injury due to excessive sexual activity. Accidentally contracting a mild exterior pathogen, he self-decocted ginger and scallion soup to induce sweating for relief. Consequently, he developed fever for three days, which transformed into malaria (Channeled Fever). Upon examining his pulse, I found it wide and empty (Huo Da Kong Xu). His chills did not resemble true chills, nor did his heat resemble true heat; he suffered from rapid breathing and floating spirit (Shen Yang). I knew this was a sign of the collapse of primordial yang (Yuan Yang Shuai Tuo). I said to his father, "I fear that when the malaria strikes tomorrow, there will be profuse sweating that cannot stop, making rescue medication difficult. If you believe my words, urgently use two taels of Ren Shen (Ginseng Radix) tonight, decoct into a thick liquid, and take frequently to prevent crisis." His father paid no attention. At the fifth watch of the next day, the patient's spirit became confused, and he knocked on the door seeking help. By the time Ginseng was found, the malaria had already started. I was very hesitant, fearing that tonifying with Ginseng might trap the malaria pathogen, rendering emergency rescue useless. I could only wait until the malaria momentum subsided slightly before administering the medicine. When taken, he was already sweating profusely. Soon after, indeed, sweating continued uncontrollably, he fell into a coma, foamed at the mouth, and swallowing medicine was difficult. Until dusk, the white foam began to discharge from the anus. I rejoiced, saying, "The foam moving downward means we need not fear. However, due to internal deficiency and intestinal slippage, single Ginseng cannot suffice. Urgently administer Fu Zi Li Zhong Tang (Aconite Decoction to Regulate the Middle), four small doses consecutively." Only then did he regain consciousness and speak, though his speech was unclear when facing others. When visitors arrived outside, he suddenly knew beforehand. His family was terrified, thinking it was a spirit possession. I said, "This is exactly the phenomenon of the soul leaving its residence. With the power of my single Ginseng decoction and Fu Zi Li Zhong Tang, like four horses galloping, I have chased the soul back, but it is still in the state of half-returning. Hence, he can know events outside the house." After two more doses of the previous medicine, he stabilized. Mr. Hu Youchen said, "The observation of the condition was thorough and meticulous, opening a new perspective."
Mr. Lu Lixi was physically robust, spiritually vigorous, with abundant qi and blood, and had never been ill. After taking office, amidst severe famine and banditry, he suffered extreme worry and labor, leading to malaria. His food intake decreased, muscles wasted away, body felt fatigued, and he belched frequently. The symptoms fluctuated, being mild one day and severe the next, lingering for three months, causing great suffering. Through pulse diagnosis and syndrome differentiation, I knew his malaria was caused by irregular diet and overwork/underwork, injuring the Yangming Stomach meridian. Since yang meridians are superficial and diseases therein are easy to cure, the reason for his prolonged suffering was that the location of the pathogen was unknown, so medications did not encounter the pathogen but instead damaged healthy qi. Had he known the pathogen resided specifically in the stomach, and knowing the stomach is the sea of water and grain, an area abundant in qi and blood, regulating the stomach would have stopped the malaria immediately. Thus, decreased appetite and constipation indicate delayed transportation and transformation due to stomach disease. Muscle wasting indicates the stomach governs muscles. Body fatigue indicates dysfunction of the constraining mechanisms due to stomach disease. Frequent belching indicates disharmony in the stomach manifesting as stagnation. As for the alternating mildness and severity, this is an uncommon syndrome where the pathogenesis must be elucidated. It is also a manifestation of the Yangming Stomach meridian. The *Neijing* chapter "Yangming Mai Jie" states: "Yangming disease dislikes people and fire, and hearing wood sounds causes alarm." Yet the "Ci Nie" chapter says: "Yangming syndromes like seeing fire, liking sunlight and moonlight." Why do the scriptures contradict? This lies in the subtle meaning of alternating excess and deficiency, consistent with the logic of daily fluctuations. Initially, when Yangming contracts disease, pathogenic qi is in excess, hence disliking people, fire, and wood sounds (disliking stimuli that agitate the pathogen). Later, when the disease lingers, pathogen recedes but healthy qi is deficient, hence liking fire and sunlight (liking them to support healthy qi). From this, the relationship between heavenly stems/branches' prosperity/decline and the human body can be inferred. Jia, Bing, Wu, Geng, Ren are yang days; Yi, Ding, Ji, Xin, Gui are yin days. Due to long-term malaria and reduced eating, stomach healthy qi is deficient while pathogen remains. On yang days, heaven supports healthy qi, so healthy qi overcomes pathogen, resulting in mildness. On yin days, pathogen is supported, so healthy qi fails to overcome pathogen, resulting in severity. Human illness interacting with heavenly timing is urgent. Had proper meridian-based medication been used earlier, it would not have lingered thus. Currently, the critical point is entirely focusing on cultivating middle qi (Zhong Qi). Although there is one stomach, it has upper, middle, and lower jiao (stomach chambers). Upper jiao resembles heaven, mostly clear qi; lower jiao resembles earth, mostly turbid qi. The ability to ascend clear and descend turbid relies entirely on the middle jiao, akin to heaven and earth requiring mediation. Mr. Lu's lower jiao turbid qi should descend but finds it hard to enter the intestines; it should not ascend but easily rises to the chest. This is because the middle jiao was previously injured by diet, failing to block lower jiao turbid qi from invading the clear pathway. Just as earthly qi rising forms clouds, heavenly qi descending forms rain, harmonizing both brings clarity. If only earthly qi rises without heavenly descent, space becomes blocked, creating gloomy obstruction. The stomach is similar. Occasional interference between clear and turbid qi should resolve itself. If ascending without descending, it is dangerous. Therefore, if middle jiao qi is prosperous, clear qi from water and grain ascends to the lungs to nourish all vessels, while turbid qi descends to large and small intestines for excretion, leaving no chest obstruction. This is why cultivating middle qi is urgent. Prosperous middle qi prevents turbid qi from stagnating in the lower jiao, allowing true qi in the dantian to move freely, deepening respiration. Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) is cloying and stagnant, unsuitable for stomach disease. Moreover, using yin-turbid substances when turbid qi invades upward is counterproductive. I now prescribe Li Zhong Tang (Regulate the Middle Decoction) to ascend clear and descend turbid, which is appropriate. Mr. Hu Youchen said, "The explanation of pathogenesis was brilliant, offering readers an unprecedented experience."