终之以因循误之也。尝有破家废业，残损肢体，服药至累百盈千，挨延至数月之久，仍须刀决者，亦有不待决而
径死者，其故在辨之不早、辨之不精也。如胸疽脓胀为患，不决必死；脏毒不早决，必成漏管；头、面、唇、口
疔毒，不决不拔必死；喉痈既成，不决必死；疽发交骱，不决必成残废；青腿牙疳，不砭必不救；行程蹇、涌泉
疽，不决成废而死；紫云风，不砭必死。
又云∶《正宗》脱疽一证，在指则切之说，全无道理；洄溪论虫之说，亦属笑谈。虫，动物也，岂能隔皮杀
之？若使遁往他处，犹之流寇滋蔓，必致遍地荆棘矣。石榴疽即翻花疮同类，大率由于伏热外越，血不归经所致，
似与目中 肉同义。昔人治一人目垂 肉，刺委中及患处立痊。余师其法，以治此证甚效。寒族中有患此者，内
服外蚀而亡，治此者宜鉴之。瘭疽甚多，手指生满，逐枚破去其脓立愈。谁谓江浙所无，吾乡呼为“惹肥”。多
骨疽有二∶其一因脓老而干，渐坚如骨而不能出，久则成漏疮，出之即愈，亦有患处高起，脓与细骨并出不已者；
又一种患处坚硬，十年五载，不痛不溃者，古书谓受孕月内，六亲骨肉交合而成，此等不经之谈，污蔑后世，诚
可痛恨！而无识之医轻信之，妄肆讥诮，覆盆之冤，谁为雪之？余谓胎无二受，其为骈为品者，皆一受而成者也。
此证实由流痰滞血，阻于腠理，日久坚硬，其坚如骨，痛则骨欲出也。亦有几出复生，数出而后已者，尚得再谓胎里疾
乎？智者不惑，斯可以为医矣。余治四人皆愈。
又云∶红肿属血，心主血，若执诸疮痛痒皆属心火之说，而用泻心汤、内疏黄连汤诛伐无过，往往有内陷者
矣。去其脓腐，为外科要务。富贵者畏痛不欲去，贫者秽恶异常，医家托言不可去，因而蔓延不救者多矣。
吴俗好鬼，自吾乡以及嘉、湖、苏、松、常、镇等处，凡家有病患，必先卜而后医，而卜者别有传授，信口
胡言，辄云有鬼，令病家召巫祈祷，必用鸡数只，豕首数枚。祷而未愈，则频卜频祷，故有病未去而家产已倾者，
有人已死而殓葬无资者，不量贫富，举国若狂。其祷毕之际，所备牲物，必使亲朋啖尽，若在富宦之家，则使仆
婢啖之，故大嚼之徒，每有因此致病者。病必亦卜亦祷，遂至蔓延不已。习俗相沿，即号为绅士者，亦复为之，
陋俗殆不易革。惟望长民者严示卜人，凡占课但从《卜筮正宗》，不得擅用邪书，妄言鬼祟，即欲徇俗祈祷，准
以素食为供，庶可全民命而惜物力，洵贤有司之惠政也。拭目俟之。
《避暑录话》云∶士大夫于天下事，苟聪明自信，无不可为，惟医不可强。如圣散子方，初不见于世间方书，
巢谷自言得之于异人，子瞻以谷奇侠而取其方，序以传世，天下以子瞻文章而信其言。事本不相因，而趋名者又
至于忘性命而试其药，人之惑盖至是也。
又云∶蔡子因之妻服陷冰丹，而齿皆焦落。愚按友人徐君亚枝之外姑，许丈亮耕室也，误服附子药一剂而齿尽落。
禾中虞君梅亭患茎痿，医者不知其为湿热，而误认阳衰，与以雄蚕蛾而一齿陡折。
周公谨云∶《和剂局方》乃当时精集诸家名方，凡经几名医之手，至提领以从官内臣参校，可谓精矣。然差
舛之处不少，且以牛黄清心丸一方言之∶凡用药二十九味，其间药味寒热讹杂，殊不可晓。尝见一名医云∶此方
止是前八味，至蒲黄而止，自干山药以后凡二十一味，乃补虚门中山芋丸，当时不知何故误写在此方之后，因循
不曾改正。凡此之类，贻误匪细。
杨素园大令云∶余与半痴论膈证，谓噎必有物为梗，当有专治之药，能消其梗者，断非书中所云生地、当归
等滋润之品所能治也。且余于此证，历考群言，均无定论，用药亦皆庸劣，惟戴人确有所见，但用药太峻，人不
能从耳。至其病所由来，则必属于肝胆。试观患此证者，多忧思抑郁之人，或嗜酒之徒，是其故可思也。半痴颇
不以为谬，命着一论，附诸《古今医案按选》之后。第愧学识浅陋，不能思一物以治之也。近竟得一方，以初生
小鼠新瓦上焙干，研末醇酒冲服。万举万全，真是奇方。因录寄半痴，俾传于世。愚曩辑《古今医案按选》成，
而大令于乙卯初夏过杭，为余评点。别去经年，忽于军务倥偬之际，不远千里，以此方附包封遽来，其仁民之心
可谓切矣。
余近采简妙单方一帖，名《篷窗录验方》，又续采二卷，多医家宜备之药。可以应世，可以济贫。吾乡蒋生
沐广文见而善之，已梓入汇刊经验方矣。
徐洄溪云∶尝见一人头风痛甚，两目皆盲，遍求良医不效。
有友人教以用十字路口及人家屋脚旁野苋菜，煎汤注壶内，塞住壶嘴，以双目就壶熏之。日渐见光，竟得复明。
愚谓此方药易而功奇，未入《录验方》，故附于此。考本草苋通九窍，其实主青盲明目，而苋字从“见”，益叹
古圣取义之精。
吾乡许君辛木重订《外科正宗》，附自制消核膏一方，治瘰 、乳核、流注，及各种结核。施送多年，甚着
奇效，惟已溃者勿用。其方用制甘遂、红芽大戟各二两，白芥子八钱，麻黄四钱，生南星、姜制半夏、僵蚕、藤
黄、朴硝各一两六钱。凡九味，以麻油一斤，先入甘遂、南星、半夏，熬枯捞出；次下大戟，三下麻黄、僵蚕，
四下白芥子，五下藤黄，逐次熬枯，先后捞出；六下朴硝，熬至不爆，用绢将油沥净；再下锅熬滚，徐投入炒透
东丹搅匀，丹之多少，以膏之老嫩为度，夏宜稍老，冬宜稍嫩；膏成，乘热倾冷水盆内，扯拨数十次，以去火毒，
即可摊贴，宜浓勿薄。且云膏之老嫩，各有所宜。凡溃疡诸证，膏勿太嫩，总以贴之即粘，揭之易落为度。摊勿
过浓，嫩而过浓，则揭时非带脱皮肉，即粘住皮肉。凡寻常热疖，本可无疤，而或生妒肉，或如 镜者，非粘伤
其肉，即膏药之过也。独消核膏宜稍嫩，但令贴时勿烊塌而已。摊时须极浓，盖此膏本以代敷药，嫩而浓则药气
沉浸浓郁而能深入，又皮肉如常带脱，无虑粘住，可洗也。即煎膏亦有法度，药物坚脆不同，若一同投入，则脆
者先枯，其势欲燃，不得不一同捞出，然坚者实未熬透，虽铢两较重，而味终未出也。如消核膏甘遂、南星、半
夏最坚，故先下；大戟次之；麻黄、僵蚕更脆，故又次之；白芥爆油，又次之；藤黄多液少渣，又次之；朴硝无
质，故最后下。凡煎他膏，亦当如此。愚谓凡结核多挟痰，故许君以控涎丹为君，而加行气散结为佐，宜乎施之
辄效也。至所论膏之老嫩浓薄，及药物之坚脆分落锅之先后，尤为用法者之所当知。惜未有人道及，故亟录之。
萧山郁龙士《瑶史》云∶到瘴疠之乡，一不可吃冷物，凡蛊毒皆下于冷物也；二不可近女色；三不可过饱，
饥则可治，饱则不可治也。若瘴气来，鼻闻异香，宜即卧地，口含土，即不受矣。又广中溪水不可饮，因山多铁
梨，其叶落于山水中，渍之极毒，又多孔雀，其粪甚毒，惟开土掘泉为妙，左江至英德一路皆然。铁梨器用放热
物受毒，误食即生痈疽。愚谓食毋求饱，乃养生却疾第一方。应休琏诗云∶“量腹节所受”是也。“强饭”二字，
最为无理。世人因此致命者甚多，岂独瘴乡所忌哉！
《认字测》八十一篇，关中周子夫宇着，以八十一字为题。阅其认“寿”字云∶理寿莫如口，其说备于《易》
之颐。颐者，养也。颐贞得养，得养斯寿，乃其归在慎言语，节饮食。言语能慎而出，饮食能节而入，颐贞莫如
斯，理寿莫如斯矣。
芦菔可代粮救荒。《膳夫经》云∶贫窭之家，与盐、饭偕行，号为“三白”。
《瑶史》又载治梦遗方∶临睡时以朴硝些须放手心内，用唾调和，将龟头一擦，甚验。
蔬中之葱，功用甚广。跌打金疮，皆为圣药。其性与蜜相反，而外治藉其相济，更多神妙。凡痈疽初起，及
热结肿痛、痞积诸病，涂之辄效。从此引伸触类，可得用药之巧。芦菔之功，先曾祖《随笔》中已发明之矣。冬
时采其叶，悬挂树上，或摊屋瓦上，至立春前一日收入瓮中，藏固；如不干燥，收挂屋内，候极燥入瓮。凡一切
喉证，洗净浓煎，覆杯立已∶并治时行、客感、斑疹、疟痢，及饮食停滞，胀、泻、
疳、疸、痞满诸证，无不神效。价廉功敏，极宜备之。又《瀛寰志略》云；佛郎西芦菔造糖，味同蔗。惜未传其
法也。
海 ，妙药也。宣气化瘀，消痰行食，而不伤正气。以经盐、矾所制，入煎剂虽须漂净，而软坚开结之勋则
固在也。故哮喘、胸痞、腹痛、 瘕、胀满、便秘、滞下、疳、疸等病，皆可量用。虽宜下之证，而体质柔脆，
不能率投硝、黄者，余辄重用，而随机佐以枳、朴之类，无不默收敏效。晋三先生但言协地栗以清肝热，岂足以
尽其能哉！
余偶患睛赤肿疼，而素畏服药，亟以朴硝一味泡茶，乘热熏洗，日数作，不日痊。夫硝善涤垢浊，乘热则风、
火、湿、热诸邪皆可清散。凡水乡农人，多患香港脚，俗名大脚风，又名沙木腿，一肿不消，与寻常香港脚发过肿消
者迥殊，治之辄无效。此因伤络瘀凝，气亦阻痹，风、湿、热杂合之邪，袭入而不能出也。故病起必胯间结核而
痛，憎寒发热，而渐以下行至足。初起宜亟用葱白杵烂，和蜜罨胯核痛处；浓煎海 、地栗二物，俟海 化尽，
取汤吞当归龙荟丸三钱，俾即消散为妙。若已成者，以川黄柏一斤，酒炒研末，海 一斤，勿漂，煎烊，加葱须
自然汁和匀，泛丸如绿豆大，茅根汤日送三钱；外用杉木刨花煎浓汤，入朴硝一两频洗，日以蓝布浸盐卤束之，
以盐卤善清湿热、散风毒，凡洗鹅掌风、香港脚并良也。忌一切辛热发物，尤忌蚕蛹。如此治愈数人矣。
次女定宜十四岁，患左腿足赤痛微肿，初不以为病也，既而时作，余令以黄柏研末，水泛丸，淡盐汤下，日
一钱，服匝月而刈其根。舍弟季杰之外家，患带下如注，余知其肝热素炽也，亦令服此丸，日三钱，月余果愈。以
此类推，不但药贵精而不贵多，并不贵贵也。故详录之。
营虚气夺，脉微欲绝者，仲圣主炙甘草汤以复其脉，故此方又名“复脉汤”，夫人而知之者。若客邪深受，
气机痹塞，脉道不能流通，而按之不见者，名曰伏脉，此为实证，与绝脉判若天渊。苟遇伏脉而不亟从宣通开泄
之治，则脉亦伏而渐绝矣。但此为邪闭之绝，彼为元竭之绝，不可同日而语也。闻一人素患香港脚，今秋发之甚剧，
兼有寒热、气逆、面浮等证，医切其脉沉伏难寻，以为年逾五十，宿恙时发，脉已欲绝，遂进炙甘草汤，冀复其
脉，越日视之，果脉绝将死矣。或称其脉法精而善用古方，以告于余。因询其二便通乎，曰否。嘻，此邪闭而脉
伏也。大实之候，误作虚治，滋腻妄投，径尔塞杀。死于病乎？死于药乎？可哀也已。
今年夏仲，仁和胡次瑶学博过访，云其从女适朱仲和茂才六令弟者，患肝胃痛，朱以省垣罕名手，为求乩方
与服，大率多香燥伐肝之品，数服径死。何耶？余曰∶肝胃痛亦有虚、实、寒、热之分，令侄爱想是阴虚血少之
病。因检甲寅治徐君亚枝令媳案示之，胡始悟为药误。又云沈少莲孝廉七令弟，患两腿 软，频饵鸡血藤膏，忽
一日精流不止而亡。此曷故也？余谓鸡血藤性热善走，专祛风湿而行瘀滞，沉乃瘦弱阴亏之质，此腿恙必肝肾之
虚，治宜滋潜濡养，而误服燥热之品，故有此变，是阴精悉为迫逐也。又云余杭唐听江进士患疝，医投温补法，
附子服至一两二钱，驯致二便不行，饮食碍进，复重用麝香等药，以开关格，而便不能通，乃至粪从口吐，狂叫
而死。抑又何欤？余曰∶昔唐设帐于会垣陈君雪舫家，余尝切其脉，亦属阴虚之体，此疝必非实病，亦非寒证，
但宜温养少阴、清舒厥阴为治，而率投刚烈香散，已属非宜，况服之过多，则阴液尽
劫，风火上腾，肠胃受燎原之焚，而失传导之职，颠倒反复，故粪从口出，狂叫以死也。胡云∶君盍笔此于书，
以为世人惑鬼神、饵成药、喜温补之戒乎？余遂录之。
山妻将娩，已见红矣，胎忽上冲作呕。夤夜事急，余以酱油和开水一钱与服，咸能润下，果入口即安。
最终导致误治的原因在于因循守旧、延误时机。曾经有因为拖延而家破人亡、肢体残损，服药多达数百上千剂，拖延数月之久，仍然需要动刀切开排脓的；也有不需要切开就直接死亡的，其根本原因在于辨证不早、辨证不精。例如胸疽脓胀为患，不切开必然致死；脏毒如果不早切开，必然形成瘘管；头、面、唇、口部位的疔毒，不切开不拔除必然致死；喉痈既然已经形成，不切开必然致死；疽发于关节交接处，不切开必然造成残疾；青腿牙疳，不采用砭石放血必无法救治；行程蹇（一种足部疾病）、涌泉疽，不切开会导致残疾而死；紫云风，不采用砭石放血必然致死。
又有人说：《外科正宗》中关于脱疽这一病症，在手指部位主张截肢的说法，完全没有道理；徐灵胎（洄溪）论述说是虫所致，也属于笑谈。虫是动物，怎么能隔着皮肤杀死它呢？如果让它逃跑到别处，就像流寇蔓延一样，必定导致遍地荆棘（病情恶化）。石榴疽即翻花疮同类，大率由于伏热外越，血不归经所致，似乎与眼中息肉同义。古人治疗一人眼睑下垂长息肉，针刺委中穴及患处立即痊愈。我师法这种方法，治疗此证非常有效。我家中有患此病的人，内服药物外用腐蚀疗法后死亡，治疗此病者应当以此为鉴。瘭疽种类很多，手指生满，逐枚破去其脓液立即痊愈。谁说江浙地区没有这种病，我们家乡称之为“惹肥”。多骨疽有两种：其一是因为脓液陈旧变干，逐渐坚硬如骨而不能排出，时间久了成为漏疮，取出后即愈；也有患处高起，脓液与细骨不断排出的情况；另一种是患处坚硬，十年五年，不痛不溃烂，古书说是在受孕月内，六亲骨肉交合而成，这种不经之谈，污蔑后世，实在令人痛恨！而无知的医生轻信这种说法，妄加讥讽嘲笑，蒙受冤屈，谁来为之洗雪？我认为胎儿不可能两次受孕，那些连体或畸形的，都是单次受孕形成的。此证实由流痰滞血，阻滞于腠理，日久变得坚硬，其坚如骨，疼痛时骨头欲出。也有几次排出后又再生，多次排出后才停止的情况，还能再说这是胎里疾吗？智者不被迷惑，这才可以称为医生。我治疗的四个患者都痊愈了。
又有人说：红肿属于血分，心主血，如果执着于诸疮痛痒皆属心火的说法，而使用泻心汤、内疏黄连汤等寒凉药物攻伐无辜，往往导致邪气内陷。去除脓腐，是外科的重要任务。富贵之人怕痛不愿去除，贫苦之人嫌秽恶异常，医生托言不可去除，因而导致病情蔓延无法救治的情况很多。
吴地风俗迷信鬼神，从我家乡到嘉兴、湖州、苏州、松江、常州、镇江等地，凡是家里有病患，必须先占卜然后才就医，而占卜者另有传授，信口胡言，总说有鬼，让病人家属召巫祈祷，必须用鸡几只，猪头几个。祈祷后未痊愈，则频繁占卜频繁祈祷，所以有病未去而家产已耗尽的，有人已死而无力殓葬的，不分贫富，举国若狂。祈祷结束时，所准备的牲物，必须让亲朋吃尽，如果在富贵官宦之家，则让仆婢吃，所以贪吃之徒，常有因此致病的情况。生病必须既占卜又祈祷，遂至病情蔓延不止。习俗相沿，即使是号称绅士的人，也这样做，陋俗大概不容易革除。只希望地方长官严厉告示占卜者，凡占课只遵从《卜筮正宗》，不得擅用邪书，妄言鬼祟，即使想顺从习俗祈祷，允许以素食为供品，或许可以保全人命而爱惜物力，这确实是贤明官员的惠政啊。拭目以待。
《避暑录话》说：士大夫对于天下的事，如果聪明自信，没有什么不可以做的，只有医学不可以勉强。如圣散子方，起初不见于世间方书，巢谷自称从异人处得到，苏东坡因为巢谷是奇侠而取了这个方子，作序传世，天下人因为苏东坡的文章而相信他的话。事情本不相干，而趋名者甚至至于不顾性命而试用这个药，人的迷惑大概到了这种地步。
又说：蔡子因之的妻子服用陷冰丹，牙齿全部焦黑脱落。我按察友人徐亚枝先生的外姑，许亮耕先生的妻子，误服附子药一剂而牙齿全部脱落。嘉兴虞梅亭先生患阴茎痿软，医生不知道是湿热，而误认为阳衰，给予雄蚕蛾服用，一颗牙齿突然折断。
周公谨说：《和剂局方》是当时精心收集诸家名方，凡经过几名名医之手，直到提领以从官内臣参校，可以说是精密了。然而差错之处不少，且以牛黄清心丸一方来说：凡用药二十九味，其中药味寒热混杂，殊不可理解。曾见一名医说：此方只是前八味，到蒲黄为止，自干山药以后凡二十一味，乃补虚门中山芋丸，当时不知何故误写在此方之后，因循不曾改正。凡此类情况，贻误不小。
杨素园县令说：我与半痴讨论膈证，说噎必有物为梗，应当有专门治疗的药物，能消除其梗塞的，断非书中所谓生地、当归等滋润之品所能治疗的。况且我对此证，历考群言，均无定论，用药也都平庸低劣，只有戴人确有见解，但用药太峻猛，人不能听从罢了。至于病所由来，则必然属于肝胆。试看患此证者，多是忧思抑郁之人，或嗜酒之徒，其中的缘故可以思考。半痴颇不以为谬，命写一篇论文，附在《古今医案按选》之后。只是惭愧学识浅陋，不能想到一种药物来治疗它。近来竟得一方，用初生小鼠在新瓦上焙干，研末，醇酒冲服。万举万全，真是奇方。于是记录寄给半痴，让他传于世。我从前编辑《古今医案按选》完成，而县令在乙卯年初夏过访杭州，为我评点。分别经年，忽然在军务繁忙之际，不远千里，以此方附包封遽然送来，他的仁民之心可谓迫切了。
我近来采集简妙单方一帖，名为《篷窗录验方》，又续采二卷，多是医家宜备的药物。可以应世，可以济贫。我家乡蒋沐广文见到后认为好，已刻印入汇刊经验方中了。
徐灵胎说：曾见一人头风痛甚，两目皆盲，遍求良医不效。
有友人教以用十字路口及人家屋脚旁野苋菜，煎汤注壶内，塞住壶嘴，以双目就壶熏之。日渐见光，竟得复明。
我认为此方药易而功奇，未入《录验方》，故附于此。考证本草苋通九窍，其实主青盲明目，而苋字从“见”，更叹古圣取义之精。
我家乡许辛木先生重订《外科正宗》，附自制消核膏一方，治瘰疬、乳核、流注，及各种结核。施送多年，甚着奇效，惟已溃者勿用。其方用制甘遂、红芽大戟各二两，白芥子八钱，麻黄四钱，生南星、姜制半夏、僵蚕、藤黄、朴硝各一两六钱。凡九味，以麻油一斤，先入甘遂、南星、半夏，熬枯捞出；次下大戟，三下麻黄、僵蚕，四下白芥子，五下藤黄，逐次熬枯，先后捞出；六下朴硝，熬至不爆，用绢将油沥净；再下锅熬滚，徐投入炒透东丹搅匀，丹之多少，以膏之老嫩为度，夏宜稍老，冬宜稍嫩；膏成，乘热倾冷水盆内，扯拨数十次，以去火毒，即可摊贴，宜浓勿薄。且云膏之老嫩，各有所宜。凡溃疡诸证，膏勿太嫩，总以贴之即粘，揭之易落为度。摊勿过浓，嫩而过浓，则揭时非带脱皮肉，即粘住皮肉。凡寻常热疖，本可无疤，而或生妒肉，或如镜者，非粘伤其肉，即膏药之过也。独消核膏宜稍嫩，但令贴时勿烊塌而已。摊时须极浓，盖此膏本以代敷药，嫩而浓则药气沉浸浓郁而能深入，又皮肉如常带脱，无虑粘住，可洗也。即煎膏亦有法度，药物坚脆不同，若一同投入，则脆者先枯，其势欲燃，不得不一同捞出，然坚者实未熬透，虽铢两较重，而味终未出也。如消核膏甘遂、南星、半夏最坚，故先下；大戟次之；麻黄、僵蚕更脆，故又次之；白芥爆油，又次之；藤黄多液少渣，又次之；朴硝无质，故最后下。凡煎他膏，亦当如此。我认为凡结核多挟痰，所以许君以控涎丹为君，而加行气散结为佐，宜乎施之辄效也。至于所论膏之老嫩浓薄，及药物之坚脆分落锅之先后，尤为用法者之所当知。可惜未有人道及，故亟录之。
萧山郁龙士《瑶史》说：到瘴疠之乡，一不可吃冷物，凡蛊毒皆下于冷物也；二不可近女色；三不可过饱，饥则可治，饱则不可治也。若瘴气来，鼻闻异香，宜即卧地，口含土，即不受矣。又广中溪水不可饮，因山多铁梨，其叶落于山水中，渍之极毒，又多孔雀，其粪甚毒，惟开土掘泉为妙，左江至英德一路皆然。铁梨器用放热物受毒，误食即生痈疽。我认为食毋求饱，乃养生却疾第一方。应休琏诗云：“量腹节所受”是也。“强饭”二字，最为无理。世人因此致命者甚多，岂独瘴乡所忌哉！
《认字测》八十一篇，关中周子夫宇着，以八十一字为题。阅其认“寿”字云：理寿莫如口，其说备于《易》之颐。颐者，养也。颐贞得养，得养斯寿，乃其归在慎言语，节饮食。言语能慎而出，饮食能节而入，颐贞莫如斯，理寿莫如斯矣。
芦菔（萝卜）可代粮救荒。《膳夫经》说：贫窭之家，与盐、饭偕行，号为“三白”。
《瑶史》又载治梦遗方：临睡时以朴硝些须放手心内，用唾调和，将龟头一擦，甚验。
蔬中之葱，功用甚广。跌打金疮，皆为圣药。其性与蜜相反，而外治藉其相济，更多神妙。凡痈疽初起，及热结肿痛、痞积诸病，涂之辄效。从此引伸触类，可得用药之巧。芦菔之功，先曾祖《随笔》中已发明之矣。冬时采其叶，悬挂树上，或摊屋瓦上，至立春前一日收入瓮中，藏固；如不干燥，收挂屋内，候极燥入瓮。凡一切喉证，洗净浓煎，覆杯立已∶并治时行、客感、斑疹、疟痢，及饮食停滞，胀、泻、疳、疸、痞满诸证，无不神效。价廉功敏，极宜备之。又《瀛寰志略》说：佛郎西（法国）芦菔造糖，味同蔗。可惜未传其法也。
海蜇，妙药也。宣气化瘀，消痰行食，而不伤正气。以经盐、矾所制，入煎剂虽须漂净，而软坚开结之勋则固在也。故哮喘、胸痞、腹痛、瘕、胀满、便秘、滞下、疳、疸等病，皆可量用。虽宜下之证，而体质柔脆，不能率投硝、黄者，我辄重用，而随机佐以枳、朴之类，无不默收敏效。晋三先生但言协地栗以清肝热，岂足以尽其能哉！
我偶尔患睛赤肿疼，而素畏服药，急以朴硝一味泡茶，乘热熏洗，日数次，不日痊。夫硝善涤垢浊，乘热则风、火、湿、热诸邪皆可清散。凡水乡农人，多患香港脚，俗名大脚风，又名沙木腿，一肿不消，与寻常香港脚发过肿消者迥殊，治之辄无效。此因伤络瘀凝，气亦阻痹，风、湿、热杂合之邪，袭入而不能出也。故病起必胯间结核而痛，憎寒发热，而渐以下行至足。初起宜急用葱白杵烂，和蜜罨胯核痛处；浓煎海蜇、地栗二物，俟海蜇化尽，取汤吞当归龙荟丸三钱，俾即消散为妙。若已成者，以川黄柏一斤，酒炒研末，海蜇一斤，勿漂，煎烊，加葱须自然汁和匀，泛丸如绿豆大，茅根汤日送三钱；外用杉木刨花煎浓汤，入朴硝一两频洗，日以蓝布浸盐卤束之，以盐卤善清湿热、散风毒，凡洗鹅掌风、香港脚并良也。忌一切辛热发物，尤忌蚕蛹。如此治愈数人矣。
次女定宜十四岁，患左腿足赤痛微肿，初不以为病也，既而时作，我令以黄柏研末，水泛丸，淡盐汤下，日一钱，服匝月而刈其根。舍弟季杰之外家，患带下如注，我知其肝热素炽也，亦令服此丸，日三钱，月余果愈。以此类推，不但药贵精而不贵多，并不贵贵也。故详录之。
营虚气夺，脉微欲绝者，仲景主张炙甘草汤以复其脉，故此方又名“复脉汤”，是人人都知道的。若客邪深受，气机痹塞，脉道不能流通，而按之不见者，名曰伏脉，此为实证，与绝脉判若天渊。苟遇伏脉而不急从宣通开泄之治，则脉亦伏而渐绝矣。但这为邪闭之绝，彼为元竭之绝，不可同日而语也。听说一人素患香港脚，今秋发之甚剧，兼有寒热、气逆、面浮等证，医生切其脉沉伏难寻，以为年逾五十，宿恙时发，脉已欲绝，遂进炙甘草汤，冀复其脉，越日视之，果脉绝将死矣。或称其脉法精而善用古方，以告于我。于是询问其二便通乎，曰否。唉，此邪闭而脉伏也。大实之候，误作虚治，滋腻妄投，径尔塞杀。死于病乎？死于药乎？可哀也已。
今年夏仲，仁和胡次瑶学博过访，说他的从女适朱仲和茂才六令弟者，患肝胃痛，朱以省城罕有名手，为求乩方与服，大率多香燥伐肝之品，数服径死。为什么？我说：肝胃痛亦有虚、实、寒、热之分，令侄爱想是阴虚血少之病。于是检甲寅年治徐亚枝先生令媳案示之，胡始悟为药误。又说沈少莲孝廉七令弟，患两腿痿软，频饵鸡血藤膏，忽一日精流不止而亡。这是什么缘故？我说：鸡血藤性热善走，专祛风湿而行瘀滞，沉乃瘦弱阴亏之质，此腿恙必肝肾之虚，治宜滋潜濡养，而误服燥热之品，故有此变，是阴精悉为迫逐也。又说余杭唐听江进士患疝，医投温补法，附子服至一两二钱，驯致二便不行，饮食碍进，复重用麝香等药，以开关格，而便不能通，乃至粪从口吐，狂叫而死。抑又何欤？我说：昔唐设帐于会垣陈君雪舫家，我曾切其脉，亦属阴虚之体，此疝必非实病，亦非寒证，但宜温养少阴、清舒厥阴为治，而率投刚烈香散，已属非宜，况服之过多，则阴液尽劫，风火上腾，肠胃受燎原之焚，而失传导之职，颠倒反复，故粪从口出，狂叫以死也。胡说：您何不笔此于书，以为世人惑鬼神、饵成药、喜温补之戒乎？我于是录之。
The ultimate cause of mismanagement lies in adherence to routine and delayed timing. There have been cases where families were ruined, limbs were damaged, hundreds or thousands of doses of medicine were taken, delays lasted for months, yet incision was still required; there were also cases where death occurred directly without incision. The root cause is that differentiation was not early enough and not precise enough. For example, if a chest abscess (chest carbuncle with pus swelling) is not incised, death is inevitable; if internal toxicity (visceral toxin) is not incised early, it will inevitably form a fistula; if ding poison (malignant sore) on the head, face, lips, or mouth is not incised and extracted, death is inevitable; if a throat abscess has formed and is not incised, death is inevitable; if a carbuncle erupts at the joint junction and is not incised, disability is inevitable; if green leg and gum disease are not treated with bian stone (pricking bloodletting), rescue is impossible; if Xingcheng Jian (a foot condition) or Yongquan Carbuncle is not incised, disability and death will result; if Purple Cloud Wind is not treated with bian stone, death is inevitable.
It is also said: Regarding gangrene of the toes in *Zhengzong* (Orthodox Standard of External Medicine), the theory of amputation for fingers is completely unreasonable; Xu Lingtai's (Hui Xi) discussion attributing it to worms is also laughable. Worms are animals; how can they be killed through the skin? If they escape to other places, it is like bandits spreading, leading to thorns everywhere (worsening condition). Shiliu Ju (Pomegranate Carbuncle) is similar to Fanhuang Chuang (Flower-Returning Sore), generally caused by latent heat surging outward and blood failing to return to its vessels, seemingly identical to polyps in the eye. In the past, a person with ptosis and eye polyps was cured immediately after needling the Weizhong point and the affected area. I adopted this method and found it very effective for this condition. A member of my family suffered from this and died despite internal medication and external cauterization; practitioners should take this as a warning. Biao Ju (Acute Ulcerative Sore) comes in many types; when fingers are covered, breaking each one to drain pus leads to immediate recovery. Who says this does not exist in Jiangsu and Zhejiang? Our hometown calls it "Re Fei". Duogu Ju (Multi-bone Carbuncle) has two types: one occurs when old pus dries out, becoming hard like bone and unable to exit, eventually forming a chronic fistula; removing it cures it. There are also cases where the affected area protrudes, and pus mixed with fine bones continuously exits. Another type involves a hard affected area that remains painless and unulcerated for five to ten years. Ancient texts claim this results from the union of flesh and bone of relatives within the first month of conception. This nonsensical talk slanders future generations and is truly hateful! Ignorant doctors who believe this blindly mock it, leaving injustice unsolved. I believe a fetus cannot be conceived twice; all conjoined or deformed forms result from a single conception. This condition is actually caused by flowing phlegm and stagnant blood blocking the couli (interstices), becoming hard over time, resembling bone. Pain indicates the bone wants to exit. Some cases recur after expulsion until cessation. Can this still be called a congenital disease? The wise are not confused; only then can one be a doctor. I cured four patients.
It is also said: Redness and swelling belong to the blood level; the Heart governs blood. If one adheres strictly to the theory that all sores' pain and itching belong to Heart Fire, using Xie Xin Tang (Drain the Heart Decoction) or Nei Shu Huang Lian Tang (Internal Purging Coptis Decoction) to attack the innocent often leads to pathogen sinking inward. Removing pus and necrotic tissue is a crucial task in external medicine. The wealthy fear pain and refuse removal; the poor find it filthy. Doctors excuse themselves saying it cannot be removed, leading to widespread progression and untreatable conditions.
In Wu customs, people love ghosts. From my hometown to Jiaxing, Huzhou, Suzhou, Songjiang, Changzhou, Zhenjiang, etc., whenever a family member is ill, divination is performed before medical treatment. Diviners have secret transmissions, speak nonsense, always claiming ghosts are involved, urging the family to summon shamans for prayers, requiring several chickens and pig heads. If prayer fails, frequent divination and prayer continue. Thus, some lose their fortune before the illness leaves, and some die without funds for burial. Rich or poor, the whole region acts madly. After prayers, sacrificial animals must be eaten by relatives and friends; in wealthy official households, servants eat them. Gluttons often fall ill due to this. Illness requires both divination and prayer, causing endless spread. Even gentry follow this custom; such陋俗 (vulgar customs) are hard to eradicate. I hope local officials strictly instruct diviners to only follow *Bushì Zhengzong* (Orthodox Standard of Divination), forbidding evil books and ghost talk. If praying to suit customs, allow vegetarian offerings. This would preserve lives and conserve resources, truly a benevolent policy of virtuous officials. I await this with anticipation.
*Bushu Lu Hua* states: Scholars may be confident in worldly affairs, but medicine cannot be forced. For instance, Sheng San Zi Fang (Holy Dispersion Subtle Formula) was not found in existing medical books initially. Chao Gu claimed to receive it from an extraordinary person. Su Shi, valuing Chao Gu's chivalry, took the formula and wrote a preface to pass it down. People believed it because of Su Shi's literary fame. Unrelated events led fame-seekers to risk life and limb testing the medicine. Human delusion reaches such extremes.
It is also said: Cai Ziyin's wife took Xianbing Dan (Ice-Melting Pill), resulting in blackened and fallen teeth. I note that the maternal aunt of my friend Mr. Xu Yazhi, wife of Xu Lianggeng, accidentally took one dose of Fuzi (Aconite Root) medicine, causing all her teeth to fall out. Mr. Yu Meiting from Hezhong suffered from penile flaccidity. The doctor, mistaking damp-heat for Yang deficiency, gave him雄蚕蛾 (Male Silkworm Moth), causing a tooth to suddenly break.
Zhou Gongjin stated: *Heji Jufang* (Formulas of the Bureau of Taiping People's Welfare) carefully collected famous formulas from various experts, reviewed by physicians and imperial officials, considered precise. However, errors abound. Take Niuhuang Qingxin Wan (Calculus Bovis Clearing Heart Pill): containing 29 ingredients, the mix of cold and hot herbs is inexplicable. A famous physician noted: This formula should only include the first eight ingredients up to Puhuang (Typha Pollen). The subsequent 21 ingredients, starting from Gan Shanyao (Dried Dioscorea Rhizome), belong to the tonifying deficiency section's Shanyuan Wan. They were mistakenly appended here and never corrected due to inertia. Such errors cause significant harm.
Yang Suyuan, County Magistrate, stated: I discussed Ge Zheng (Diaphragmatic Obstruction Syndrome) with Ban Chi. He said dysphagia implies a physical obstruction requiring specific resolving medicines, definitely not treatable by moistening agents like Shengdi (Rehmannia Root) or Danggui (Angelica Sinensis Root) mentioned in books. I have examined various theories on this syndrome without definitive conclusions; treatments are mediocre. Only Dai Ren had insights, but his methods were too harsh for patients to accept. The origin likely relates to the Liver and Gallbladder. Patients are often melancholic or alcoholics. Ban Chi agreed, asking me to write an essay for *Gujin Yi'an Anxuan*. Though I lack the knowledge to find a cure, I recently obtained a miraculous formula: roast newborn mice on new tiles, powder them, and take with strong wine. It works perfectly every time. I recorded it for Ban Chi to publish. Previously, I edited *Gujin Yi'an Anxuan*, and the Magistrate critiqued it in Hangzhou in early Yimao. Years later, amidst military duties, he sent this formula from afar, showing great compassion.
I recently compiled a collection of simple, effective single prescriptions named *Pengchuang Luyuan Fang*, continuing with two more volumes of essential medicines for practitioners. It serves society and aids the poor. My fellow townsman Jiang Mu Guangwen approved it, and it was printed in a collected volume of experienced formulas.
Xu Huixi stated: I once saw a patient with severe headache and blindness, unresponsive to many good doctors.
A friend advised using wild amaranth from crossroads or house corners, decocting it in a pot, plugging the spout, and steaming the eyes. Gradually, light returned, and vision was restored.
I consider this formula easy to prepare and effective, though not included in *Luyuan Fang*, so I append it here. Materia Medica states Amaranthus opens nine orifices and treats amaurosis. The character 'Xian' contains 'Jian' (see), marveling at the precision of ancient sages' symbolism.
My hometown's Mr. Xu Xinmu revised *Waike Zhengzong*, adding his self-made Xiaoke Gao (Nodule-Dissolving Plaster) for scrofula, breast nodules, flowing abscesses, and various tubercles. Used for years with remarkable effect, except for open ulcers. Ingredients: Prepared Kansui, Red-root Daji each 2 liang, Baijiezi 8 qian, Mahuang 4 qian, Sheng Naxing, Ginger-processed Banxia, Jiangcan, Tenghuang, and Puxiao each 1 liang 6 qian. Total 9 ingredients. With 1 jin of sesame oil, first boil Kansui, Naxing, Banxia until burnt, remove. Then add Daji, then Mahuang and Jiangcan, then Baijiezi, then Tenghuang, boiling each until burnt and removing sequentially. Finally add Puxiao, boil until no longer popping, strain oil through silk. Boil again, slowly stir in roasted Dongdan (Red Lead Oxide). Amount depends on plaster consistency: slightly harder in summer, softer in winter. Pour hot plaster into cold water, pull dozens of times to remove fire toxicity, then apply thickly. Plaster hardness varies by indication. For ulcers, do not make too soft; it should stick easily and peel off easily. Do not spread too thick; if soft and thick, peeling removes skin/flesh. For ordinary hot boils, scars shouldn't form; if granulation tissue or mirror-like scars appear, it's due to sticking injury. Xiaoke Gao should be slightly softer but not melt upon application. Spread thickly as it replaces poultice; soft and thick allows deep penetration of medicinal qi without sticking, washable. Cooking method matters: hard and brittle herbs differ. If added together, brittle ones burn first, risking fire, forcing premature removal while hard ones aren't fully extracted. For Xiaoke Gao, Kansui, Naxing, Banxia are hardest, added first; Daji next; Mahuang, Jiangcan more brittle, added next; Baijiezi releases oil, added next; Tenghuang has more liquid, added next; Puxiao has no substance, added last. Other plasters follow this. I believe tubercles often involve phlegm, so Xu used Kongyan Dan as chief, adding Qi-moving and knot-resolving assistants, explaining its efficacy. The discussion on plaster consistency and herb order is vital for users, rarely mentioned, hence recorded.
Yu Longshi's *Yaoshi* states: In miasma regions, 1. Avoid cold food, as gu poison enters via cold items; 2. Avoid sexual activity; 3. Avoid overeating; fasting is treatable, fullness is not. If miasma arrives, smelling strange fragrance, lie on ground, hold soil in mouth to avoid absorption. Water in Guangdong is undrinkable due to Tie Li (Iron Pear) leaves falling into streams, highly toxic, plus peacock droppings. Dig wells instead. Along Zuo River to Yingde, this applies. Tie Li containers holding hot food become toxic; ingestion causes carbuncles. I believe eating until satisfied is the primary method for health and disease prevention. Ying Xiulian's poem "Measure belly, regulate intake" is correct. "Forcing meals" is irrational. Many die from this, not just in miasma regions.
*Renzi Ce* has 81 essays by Zhou Zifu of Guanzhong, titled with 81 characters. Reading the essay on "Shou" (Longevity): Managing longevity relies on the mouth, explained in *Yi Jing*'s Yi hexagram. Yi means nourishment. Proper nourishment brings longevity,归结于 (culminating in) guarding speech and regulating diet. Guarding speech and regulating diet are key to Yi's rectitude and longevity.
Radish (Lufu) can replace grain in famines. *Shanfu Jing* states: Poor families eat radish with salt and rice, called "Three Whites".
*Yaoshi* records a formula for nocturnal emission: Place a little Puxiao in palm, mix with saliva, rub on glans before sleep. Very effective.
Green onion (Cong) has broad uses. A holy medicine for trauma and wounds. Its nature opposes honey, but externally they complement each other miraculously. Effective for early-stage carbuncles, heat-induced swelling, and stagnation. Extending this logic reveals clever drug usage. The merit of radish was elucidated by my late great-grandfather in *Suibi*. Harvest leaves in winter, hang on trees or roof tiles, store in jar before Start of Spring. If not dry, hang indoors until very dry, then store. For all throat conditions, wash, decoct strongly, cover cup, steam immediately effective. Also treats epidemic fevers, exterior pathogens, macules/rashes, malaria/dysentery, food stagnation, bloating, diarrhea, malnutrition jaundice, and fullness—all miraculously effective. Cheap and potent, essential to keep. *Yinghuan Zhilüe* notes French radish sugar tastes like cane sugar. Regrettably, the method wasn't transmitted.
Sea cucumber (Haizhe) is a wonderful medicine. Promotes Qi circulation, resolves stasis, transforms phlegm, aids digestion, without damaging healthy Qi. Processed with salt and alum. Although rinsed clean for decoctions, its ability to soften hardness and resolve knots remains. Suitable for asthma, chest stuffiness, abdominal pain, masses, distension, constipation, dysentery, malnutrition jaundice, etc. Even for purgative indications, if constitution is fragile and cannot tolerate large doses of Xiaoshuang (Mirabilite/Gypsum), I heavily use Haizhe, assisting with Zhiqi and Houpo as needed, achieving rapid effects. Jin San Mr. only mentioned combining it with Didli (Water Chestnut) to clear Liver heat, insufficient to describe its full potential.
I once had red, swollen, painful eyes, fearing oral medication. I brewed Puxiao alone as tea, steamed and washed eyes while hot, several times daily, recovering quickly. Salt dissolves turbidity; heat clears wind, fire, dampness, and heat pathogens. Farmers in water regions often suffer from Hong Kong Foot (Tinea Pedis/Edema), locally called Da Jiao Feng or Sha Mu Tui, characterized by persistent swelling unlike typical cases. Treatment fails because collateral injury causes stasis, Qi blockage, and combined wind-damp-heat pathogens trapped inside. Onset starts with inguinal nodules and pain, chills, fever, descending to feet. Early stage: mash Congbai (Green Onion White) with honey, apply to groin nodules. Strongly decoct Haizhe and Didli, swallow Danggui Longhui Wan (Angelica Longhui Pill) 3 qian when Haizhe dissolves, to disperse. Established cases: Powder 1 jin Jiuhuangbai (Alcohol-fried Phellodendron Bark), mix with 1 jin Haizhe (unrinsed) decoction, add Congxu juice, make pills size of mung beans. Take 3 qian daily with Egen Tang. Externally: Boar wood shavings decoction with 1 liang Puxiao, frequent washing. Bind legs daily with indigo cloth soaked in brine. Brine clears damp-heat and wind-toxin, good for hand eczema and Hong Kong Foot. Avoid spicy/hot stimulating foods, especially silkworm pupae. I cured several this way.
My second daughter Dingyi, aged 14, had red, painful, slightly swollen left leg/foot. Initially ignored, symptoms recurred. I prescribed Huangbai powder, water-pilled, taken with light salt water, 1 qian daily. One month eliminated the root. My brother's wife's family suffered profuse leukorrhea. Knowing she had chronic Liver Heat, I prescribed the same pill, 3 qian daily. Cured in over a month. This shows drugs value precision over quantity or cost. Recorded in detail.
When Ying Qi is deficient and Qi exhausted, pulse faint and near-extinction, Zhang Zhongjing prescribes Zhigancao Tang (Honey-Fried Licorice Decoction) to restore pulse, also called "Fumai Tang". Everyone knows this. However, if external pathogens are severe, Qi mechanism blocked, pulse channel obstructed, pulse not felt on pressure, it is called Fu Mai (Hidden Pulse). This is excess syndrome, vastly different from extinction pulse. If Hidden Pulse is not treated with dispersing and draining methods, pulse becomes hidden and extinct. But this is extinction due to pathogen closure, whereas the former is exhaustion of Yuan Qi. Cannot be compared. Heard of a man with chronic Hong Kong Foot, severe flare-up this autumn with chills/fever, Qi rebellion, facial edema. Doctor felt deep hidden pulse, assumed age 50+ chronic relapse, pulse near extinction, administered Zhigancao Tang hoping to restore pulse. Next day, pulse was indeed extinct, near death. Praised for precise pulse diagnosis and ancient formula use. Asked about urination/defecation: No. Alas, this is pathogen closure causing hidden pulse. Great excess mistaken for deficiency, wrongly given cloying tonics, causing blockage and death. Died of disease or medicine? Tragic.
Mid-summer this year, Hu Ci Yao, Scholar, visited, saying his niece married to Zhu Zhonghe's sixth younger brother suffered Liver/Stomach pain. Zhu, finding few masters in provincial capital, sought oracle formula. Mostly aromatic-drying Liver-attacking herbs. Died after few doses. Why? I said: Liver/Stomach pain has deficiency/excess/cold/heat distinctions. Your niece likely has Yin deficiency and Blood insufficiency. Showed him a case treating Xu Yazhi's daughter-in-law in Jiayin year. Hu realized medication error. Also mentioned Shen Shaolian's seventh younger brother suffering leg weakness/flaccidity, frequently taking Jixueteng Gao (Spatholobus Paste). Suddenly died from continuous essence loss. Why? I said: Jixueteng is hot and moving, dispels wind-damp, moves stasis. Shen was thin, weak, Yin-deficient. Leg issue must be Liver/Kidney deficiency, requiring nourishing and anchoring. Mistakenly taking hot/drying herbs caused this change, exhausting Yin essence. Also mentioned Tang Tingjiang, Jinshi, suffering hernia. Doctor used warming/tonifying method, Fuzi dosage reached 1 liang 2 qian. Resulted in urinary/fecal retention, difficulty eating. Reused Shexiang (Musk) to open blockage, failed. Feces vomited, died screaming. Why? I said: Tang taught at Chen Xuefang's home in Huizhou. I felt his pulse, indicating Yin deficiency. Hernia was not excess or cold. Should warm Shaoyin, clear/shu Jueyin. Using harsh aromatic dispersants was inappropriate. Overdose depleted Yin fluids, wind-fire surged, intestines/stomach burned, lost transmission function, inverted flow, feces vomited, died screaming. Hu said: Why not record this as a warning against worshipping ghosts, taking proprietary medicines, and loving warming tonics? I recorded it.
My wife was about to deliver, bleeding started, fetus suddenly rushed upward causing vomiting. Late night emergency. I gave 1 qian soy sauce mixed with boiled water. Salty flavors descend and moisten. Calmed immediately upon ingestion.