咫旭乃室病膈气。二十余日。饮粒全不入口。延余诊时。尺脉已绝而不至矣。询其二便。自病起至今。
从未一通。止是一味痰沫上涌。厌厌待尽。无法以处。邑庠有施姓者。善决生死。谓其脉已离根。顷刻当坏。
余曰。不然。脉经明有开活一款云。上部有脉。下部无脉。其人当吐。不吐者死。是吐则未必死也。但得
天气下降。则地道自通。故此症倍宜治中。以气高不返。中无开阖。因成危候。待吾以法缓缓治之。自然逐
日见效。于是始独任以观验否。乃遂变旋复代赭成法。而用其意。不泥其方。缘女病至尺脉全无。则莫可验
其受孕。万一有而不求。以赭石干姜辈伤之。呼吸立断矣。姑阙疑。以赤石脂易赭石。煨姜易干姜。用
六君子汤加旋复花煎调。服下呕即稍定。其岳父见用人参。以为劫病而致憾。余曰。无恐也。治此不愈。愿
以三十金为罚。如愈一文不取。乃全神照应。药必亲调。始与服之。三日后。渐渐不呕。又三日后。粥饮
渐加。举家称快。但病者全不大便。至是已月余矣。一则忧病之未除。再则忧食之不运。刻刻以通利为
嘱。余曰。脏气久结。食饮入胃。每日止能透下肠中一二节。食饮积之既久。脏气自然通透。原议缓治。
何得急图耶。举家佥以余为不情。每进诊脉。辄闻病者鼻息之扬。但未至发声相詈耳。盖余以归地润肠之药。
恐滞膈而作呕。硝石大黄通肠之药。恐伤胎而殒命。姑拂其请。坚持三五日。果气下肠通而病全瘳矣。
病瘳而其家窃议曰。一便且不能通。曷贵于医耶。月余。腹中之
孕。果渐形着。又议曰。一孕且不能知。安所称高耶。吁嗟。余之设诚而行。以全人夫妻子母。而反以得谤也。
岂有他哉。惟余得谤。当世之所谓医者。然后乃得名耳。
胡卣臣先生曰。议病入理之深。自然入俗之浅。如中无开阖之语。及脏气逐日渐通之语。岂堪向寻常索解耶。
胡咫旭的夫人患有膈气病。二十多天了，连一粒米、一口水都进不去。请我诊治时，尺脉已经断绝，摸不到了。询问她的大小便情况，从发病到现在，从来没有通畅过一次，只是一味地痰沫上涌，精神萎靡，奄奄一息，似乎没有法子了。当地有一位姓施的生员，擅长判断生死，说她的脉象已经脱离根本，顷刻间就会死亡。我说：不对，《脉经》中明确有一条活法说：“上部有脉，下部无脉，病人应当呕吐，如果不吐就会死。”这说明呕吐未必是死症。只要天气（肺气）下降，地道（肠道）自然通畅。所以这个病症特别适合从中焦治疗，因为气逆在上不降，中焦失去了开阖的功能，因而形成危重证候。等我用法子缓缓治疗，自然会逐日见效。于是我开始独自承担诊断责任以观察疗效。
于是我改变了旋覆代赭汤的固定成法，而取其意，不拘泥于原方。因为女病人的尺脉全无，无法验证是否怀孕。万一有孕而不加注意，用赭石、干姜这类药物去损伤它，呼吸立刻就会断绝。姑且存疑，用赤石脂代替赭石，用煨姜代替干姜，使用六君子汤加入旋覆花煎服调治。服药后呕吐稍微安定。她的岳父见我用到了人参，认为这是劫夺正气导致病情加重，因此对我产生怨恨。我说：不要担心。如果治不好，我愿罚三十金；如果治好了，一文不收。于是全神贯注地照顾，药必亲自调配，这才让她服用。三天后，渐渐不再呕吐。又过了三天，粥饮逐渐增加，全家称快。但是病人仍然完全不大便，到现在已经一个多月了。一方面担忧病未除，另一方面担忧食物不运化，时刻嘱咐我要通利大便。我说：脏腑之气久已郁结，饮食进入胃中，每天只能向下透入肠中的一两节。饮食积滞久了，脏腑之气自然会通透。原本计划的是缓治，怎么能急于求成呢？全家人都认为我不近人情。每次我去诊脉，总能听到病人鼻息粗重，只是还没有到出声骂人的地步罢了。大概是因为我用熟地黄、当归等润肠的药物，担心会阻滞膈气而引起呕吐；用芒硝、大黄等通肠的药物，又担心会伤胎而丧命。姑且违背他们的请求，坚持了三五天，果然气下行、肠道通畅，病完全痊愈了。
病好后，那家人私下议论说：“连一次大便都不能通，医生有什么可贵的呢？”一个月后，腹中的胎儿果然逐渐显现出来。又议论说：“连一次怀孕都不知道，怎么称得上高明呢？”唉！我诚心诚意行事，保全了夫妻母子，反而遭到诽谤。难道有别的原因吗？只有我受到诽谤，当世所谓的医生，然后才能得名声啊。
胡卣臣先生说：分析病情道理深刻，自然就能避开世俗的浅见。像“中焦无开阖”这样的话，以及“脏腑之气逐日逐渐通畅”的话，哪里是向普通人寻求解释所能理解的呢？
Hu Zhixu's wife suffered from *geqi* (obstruction in the diaphragm/chest). For more than twenty days, she could not take even a single grain of food or sip of liquid. When I was consulted for diagnosis, her *chimai* (cunameter pulse, located at the distal end of the radial artery) had already vanished and was imperceptible. Upon inquiring about her urination and defecation, it was found that since the onset of the illness, there had been no passage at all; instead, there was only a continuous surging up of phlegm foam. She appeared listless and on the verge of death, with no apparent remedy. A local scholar named Shi, who was skilled at predicting life and death, stated that her pulse had detached from its root and that she would perish within moments. I replied, "Not so. The *Maijing* (Classic of Pulse Diagnosis) explicitly contains a section on vital signs: 'If there is pulse in the upper part but none in the lower part, the patient should vomit; if they do not vomit, they will die.' This indicates that vomiting does not necessarily signify death. If the Qi of Heaven (Lung Qi) descends, then the pathways of Earth (Intestinal channels) will naturally open. Therefore, this condition is particularly suitable for treatment focusing on the Middle Jiao (Middle Burner), because the Qi is high and failing to return, and the Middle Jiao has lost its opening and closing functions, leading to a critical state. Let me treat it slowly with specific methods, and it will naturally show improvement day by day." Thus, I took sole responsibility to observe whether the treatment would be effective.
I then altered the established formula of *Xuanfu Daizhe Tang* (Inula and Hematite Decoction), adopting its principle without being bound by its composition. Since the female patient's *chimai* was completely absent, it was impossible to verify pregnancy. If there were a pregnancy and we failed to recognize it, using substances like *Daizhishi* (Hematite) and *Ganjiang* (Dried Ginger) could cause immediate cessation of respiration. Therefore, I suspended judgment regarding pregnancy and substituted *Daizhishi* with *Chishizhi* (Red Halloysite) and *Ganjiang* with *Weijiang* (Baked Ginger). I prescribed *Liujunzi Tang* (Six Gentlemen Decoction) added with *Xuanfuhua* (Inula Flower) and administered it as a decoction. After taking the medicine, the vomiting subsided slightly. Her father-in-law, seeing the use of *Renshen* (Ginseng Root), believed it was depleting the disease-causing pathogen and causing resentment towards me. I said, "Do not fear. If this is not cured, I am willing to pay a penalty of thirty taels of gold; if cured, I will accept not a single coin." I then attended to her with full concentration and personally prepared the medicines before allowing her to take them. After three days, the vomiting gradually ceased. Three days later, her intake of porridge and drinks gradually increased, bringing joy to the whole family. However, the patient still had no bowel movement, which had persisted for over a month. On one hand, they worried that the illness was not removed; on the other, they worried that food was not being transported. They constantly urged me to promote unblocking and purgation. I said, "The Zang-organ Qi has been knotted for a long time. Food and drink entering the Stomach can only penetrate down one or two sections of the intestines each day. Once food and drink have accumulated for a long time, the Zang-organ Qi will naturally become clear and unobstructed. The original plan was slow treatment; how can one seek urgent results?" The entire family thought I was unreasonable. Every time I went to diagnose her pulse, I could hear her nasal breathing becoming loud, though she had not yet reached the point of cursing aloud. This was likely because I used moistening intestinal herbs such as *Shudihuang* (Prepared Rehmannia Root) and *Danggui* (Angelica Sinensis Root), fearing they might stagnate the Diaphragm and induce vomiting; and I avoided purgative herbs like *Xiaoshi* (Niter) and *Dahuang* (Rhubarb Root), fearing they might damage the fetus and cause death. I temporarily disregarded their requests and persisted for three or five days. Indeed, the Qi descended, the intestines became unobstructed, and the illness was completely cured.
After the cure, the family discussed privately among themselves: "She could not pass stool even once; what value is there in the doctor?" More than a month later, the pregnancy in her abdomen indeed gradually became apparent. They then discussed again: "You did not even know about the pregnancy; how can you be called eminent?" Alas! I acted with sincerity to preserve the lives of the husband, wife, mother, and child, yet I was slandered. Is there any other reason? Only when I am slandered can the so-called doctors of the world gain fame.
Mr. Hu Youchen said: "Analyzing the disease with profound understanding naturally leads to avoiding superficial worldly views. Phrases such as 'the Middle Jiao lacks opening and closing' and 'Zang-organ Qi becomes clear and unobstructed day by day' are certainly beyond the comprehension of ordinary people seeking simple explanations."