气机从天度升降，是乾坤翕辟大道。年多真气真精虚衰，病气为主，以致天气肃降而收
。病反多抗拒，偏易上逆，应藏不藏，违逆天度矣。
何(王家巷，二十七岁) 色夺脉促，寒露霜降嗽甚，风冷形肌凛凛，卫阳空疏气泄，群
医不识，是为瞽医。
顾(铁瓶巷，十六岁) 稚年筋脉未坚，努力搂抱，致气血流行，有触胸背，骨偏突成损
，此属不足，非因外邪。在身半以上为阳，主气，致右肛疡成漏年余，真阴五液皆伤，纳食
在胃，传入小肠而始变化。因咳痰不出，致呕尽所见乃已，喉痛失音，涎沫吐出，喉中仍然
留存，明明少阴肾脉中龙火内闪，上燔阴液，蒸变涎沫，内损精血所致。医见嗽哑，清金润
肺，未明呛嗽之源，是就其凶。(老笔。)
周(金匮，十九岁) 夏伏暑湿，秋季如疟，邪不尽解，成疮，能食不化，腹中有形，脾
胃不和，用东垣法。
李 劳久伤阳，胃痛吞酸，痰多(真阳伤而火愈旺，故吞酸痰多，温中则邪火自伏矣。)
熟半夏 延胡索 葫芦巴 高良姜 老生姜 川楝子 块茯苓
王(南金，二十八岁) 环跳筋骨酸痛，少年积劳伤阳维脉血少护卫。
归身 枸杞 生虎胫骨 巴戟 川牛膝 沙苑 青盐 羊肉胶丸
张(横泾，三十七岁) 劳伤虚质，胀病初愈，因动怒气郁不食，二便皆阻。论肠痹从丹
溪开肺法。
杏仁 紫菀 蒌皮 苏子 桑叶 桃仁
黄(嘉兴，五十三岁) 情志内郁，心痛如绞，形瘦液枯，不可气燥热药。
炒桃仁 柏子仁 延胡 炒丹皮 小胡麻 钩藤
张(大兴) 精未生来，强泄有形，最难充旺，至今未有生育，形瘦食少，易泄精薄，形
脉不受刚猛阳药。议借血肉有情，充养精血。
淡苁蓉 鹿鞭 巴戟 牛膝 羊肾 锁阳 枸杞 青盐 菟丝 舶茴香
方药精实。
戴(枫桥，五十二岁) 喉咽管似乎隘窄，一身气降，全在于肺。由胃热升肺失司，年纪
日多，气结痹阻，薄味整肃上焦，用药以气轻理燥(肺借资于胃，胃热气升，肺即失司，清
降肺以清润为主，理其燥自下降矣)。
枇杷叶 苏子 米仁 桑叶 降香 茯苓
肺之失司，总由于燥胃有火热，上升娇藏，失其滋养，故治肺贵乎理燥，而理燥在乎气
轻。
马(陆家桥) 浊止足肿，膝首肿痛，起于夏秋，必挟地气，湿自下受，酒客内湿互蒸，
内外合邪，汤药决不取效。
气机的升降遵循天道的运行规律，这是天地开合的大道。随着年龄增长，人体的真气和真精逐渐虚衰，病邪之气占据主导，导致天气肃降的功能收敛过度。病情反而出现多抗拒（正气与邪气抗争剧烈）、容易上逆的现象，该收藏时不能收藏，违背了天道的运行规律。
何姓患者（家住王家巷，二十七岁）面色晦暗无华，脉象急促，在寒露、霜降节气咳嗽加重，身体因风冷刺激而战栗，卫阳空虚疏松，气机外泄。众医生未能识别此证，可谓盲人瞎马（指医术低劣）。
蔡姓患者（家住南濠，四十三岁）操劳过度，导致肝肾的浮阳上冲冒犯头部，夜间无法入睡。
顾姓患者（家住铁瓶巷，十六岁）年少时筋骨尚未坚固，用力搂抱导致气血运行受阻，触动胸背，骨骼偏侧突起形成损伤。这属于先天不足，并非由外邪引起。身体上半部属阳，主司气机，因此右侧肛门周围发生溃疡并形成瘘管已有一年多。真阴和五液均受损伤，食物进入胃中，传入小肠后才开始变化。因为咳嗽有痰却咳不出来，导致呕吐出所有进食物才停止，伴有喉痛失音，吐出涎沫但喉中仍有残留。这明显是少阴肾脉中的龙火（相火）在内闪烁，向上焚烧阴液，蒸腾变生涎沫，内损精血所致。医生只见咳嗽声音嘶哑，就采用清金润肺的方法，不明白呛咳的根源，这是针对凶险病症的错误治疗。（老笔批注。）
庄姓患者（宜兴人，十九岁）患疟疾和痢疾后脾肾两伤，采用缪氏的治疗方法。
周姓患者（金匮人，十九岁）夏季潜伏暑湿之邪，秋季发作如疟疾，邪气未能完全解除，形成疮疡，能进食但不能消化，腹中有形之物，脾胃不和，采用李东垣的治疗方法。
李某 长期劳累损伤阳气，胃痛吞酸，痰多（真阳受伤而虚火更旺，所以吞酸痰多，温补中焦则邪火自然潜伏。）
熟半夏 延胡索 葫芦巴 高良姜 老生姜 川楝子 块茯苓
王某（南金人，二十八岁）环跳穴处筋骨酸痛，少年时期积劳导致阳维脉血少，护卫功能减弱。
当归身 枸杞 生虎胫骨 巴戟天 川牛膝 沙苑子 青盐 羊肉胶丸
张某（横泾人，三十七岁）劳累损伤虚弱的体质，胀病刚痊愈，因动怒导致气郁不食，大小便都阻塞。按照肠痹从丹溪开肺法论治。
杏仁 紫菀 瓜蒌皮 苏子 桑叶 桃仁
黄某（嘉兴人，五十三岁）情志内郁，心痛如绞，形体消瘦津液枯槁，不可使用气燥热药。
炒桃仁 柏子仁 延胡索 炒牡丹皮 小胡麻 钩藤
张某（大兴人）精气未充盛时强行泄精，最难充盈旺盛，至今没有生育能力，形体消瘦食量减少，容易滑精且精液稀薄，形体和脉象都不耐受刚猛的热性药物。建议借用血肉有情之品，来充养精血。
肉苁蓉 鹿鞭 巴戟天 牛膝 羊肾 锁阳 枸杞 青盐 菟丝子 舶茴香
方药精当扎实。
戴某（枫桥人，五十二岁）咽喉管似乎狭窄，一身之气下降，全赖于肺。由于胃热上升导致肺失宣降，年纪渐长，气结痹阻。用清淡味道整肃上焦，用药以气轻理燥为主（肺的功能依赖于胃，胃热气升，肺即失去职能，清降肺脏以清润为主，理顺其燥性自然下降矣）。
枇杷叶 苏子 薏苡仁 桑叶 降香 茯苓
肺失职能，总归是由于燥，胃有火热上升，灼伤娇脏，失去滋养，所以治疗肺脏贵在理顺燥性，而理顺燥性在于用药气轻。
马某（陆家桥人）浊邪止住后足部肿胀，膝盖首关节肿痛，起于夏秋季节，必定夹杂地气，湿气自下受入，酒客体内湿气互相蒸腾，内外合邪，汤药决不会见效。
The ascending and descending of Qi mechanism follows the heavenly degree, which is the great Dao of heaven and earth's opening and closing. As years pass, true Qi and true essence decline; pathogenic Qi becomes dominant, causing the heavenly Qi to descend and contract excessively. The disease manifests as frequent resistance (vigorous struggle between healthy Qi and pathogen) and a tendency to rebel upward, failing to store when it should, thus violating the heavenly degree.
He (Wangjia Alley, 27 years old): Complexion is depleted, pulse is rapid. Cough is severe during Cold Dew and Frost Descent solar terms. Body shivers due to wind-cold affecting the skin and muscles. Defensive Yang is empty and sparse, with Qi leakage. Physicians fail to recognize this, rendering them blind doctors.
Cai (Nanhao, 43 years old): Excessive mental exertion causes floating Yang of Liver and Kidney to rush upward, resulting in inability to sleep at night.
Gu (Tieping Alley, 16 years old): In tender years, tendons and vessels were not yet firm. Straining while hugging caused Qi and Blood circulation to be obstructed, touching the chest and back, leading to asymmetric bone protrusion and damage. This belongs to deficiency, not external pathogens. The upper half of the body is Yang, governing Qi. Consequently, a fistula formed on the right anus for over a year. True Yin and the Five Fluids are all injured. Food enters the Stomach, transmits to the Small Intestine, and only then undergoes transformation. Due to coughing up phlegm that cannot be expectorated, vomiting occurs until all ingested matter is expelled. Sore throat and loss of voice occur; saliva foam is spit out but remains in the throat. Clearly, Dragon Fire (Ministerial Fire) within the Shaoyin Kidney meridian flashes internally, burning Yin fluids upward, steaming and transforming into saliva foam, causing internal damage to Essence and Blood. Physicians seeing cough and hoarseness use methods to clear Metal and moisten Lung, failing to understand the source of choking cough; this is treating a critical condition incorrectly. (Old brush annotation.)
Zhu (Yixing, 19 years old): Spleen and Kidney both injured after malaria and dysentery. Use Miao’s method.
Zhou (Jinkui, 19 years old): Summer latent damp-heat transforms into malaria-like symptoms in autumn. Pathogens not fully resolved, forming sores. Appetite present but food not digested.有形 mass in abdomen. Spleen and Stomach disharmony. Use Dongyuan’s method.
Li: Long-term labor injures Yang. Stomach pain with acid regurgitation, excessive phlegm (True Yang injury leads to more vigorous fire, hence acid regurgitation and phlegm; warming the Middle will cause pathogenic fire to subside naturally.)
Prepared Pinellia Rhizome (Shu Banxia), Corydalis Rhizome (Yanhusuo), Trigonella Foenum-graecum Seed (Huluba), Galangal Rhizome (Gaoliangjiang), Old Ginger (Laoshengjiang), Toosendan Fruit (Chuanlianzi), Lump Poria (Kuai Fuling).
Wang (Nanjing, 28 years old): Pain and soreness in tendons and bones at Huantiao point. Youthful accumulated labor injures Yang Wei Vessel, blood is scant, guarding function is weak.
Angelica Sinensis Root (Guishen), Goji Berry (Gouqi), Raw Tiger Tibia Bone (Sheng Hu Jinggu), Morinda Officinalis Root (Baji), Achyranthes Bidentata Root (Chuan Niuxi), Astragalus Complanatus Seed (Shayuan), Green Salt (Qingyan), Lamb Gelatin Pill (Yangrou Jiaowan).
Zhang (Hengjing, 37 years old): Labor damages deficient constitution. Distension disease just healed. Anger causes Qi stagnation, anorexia, obstruction of both bowel and bladder. Discuss intestinal bi (obstruction) using Danxi’s method of opening Lung.
Apricot Kernel (Xingren), Aster Tataricus Root (Ziwan), Benincasa Hispid Peel (Loupi), Perilla Fruit (Suzi), Mulberry Leaf (Sangye), Peach Kernel (Taoren).
Huang (Jiaxing, 53 years old): Internal emotional depression. Heart pain like twisting. Emaciated body, dry fluids. Do not use drying-hot medicines.
Fried Peach Kernel (Chao Taoren), Biota Seed (Baizi), Corydalis (Yanhu), Fried Moutan Cortex (Chao Danpi), Sesame (Xiaohuma), Uncaria Rhynchophylla (Gouteng).
Zhang (Daxing): Essence not yet generated, forced emission of tangible essence. Hardest to replenish and prosper. No fertility to date. Emaciated, poor appetite. Prone to seminal emission, thin semen. Constitution and pulse cannot tolerate harsh Yang-tonifying drugs. Propose borrowing flesh-and-blood sentient substances to nourish Essence and Blood.
Cistanche Deserticola (Dan Congrong), Deer Whip (Lu Bian), Morinda Officinalis Root (Baji), Achyranthes Bidentata Root (Niuxi), Sheep Kidney (Yangshen), Cynomorium Songaricum (Suoyang), Goji Berry (Gouqi), Green Salt (Qingyan), Cuscuta Seed (Tusi), Fennel (Bo Huixiang).
Prescription is precise and solid.
Dai (Fengqiao, 52 years old): Throat tube seems narrow. Descending of whole-body Qi relies entirely on Lung. Due to Stomach heat rising, Lung loses its function. With advancing age, Qi knots and obstructs. Light flavors rectify the Upper Jiao. Medicines should be light in Qi to resolve dryness (Lung relies on Stomach; if Stomach heat rises, Lung loses function. Clearing and descending Lung focuses on clearing and moistening; resolving dryness allows natural descent).
Loquat Leaf (Pipaye), Perilla Fruit (Suzi), Coix Seed (Miren), Mulberry Leaf (Sangye), Aquilaria Wood (Xiang), Poria (Fuling).
Lung losing function stems from dryness; Stomach has fire heat rising, scorching the delicate organ, losing nourishment. Thus, treating Lung values resolving dryness, and resolving dryness lies in light Qi.
Ma (Lujia Bridge): Turbid pathogen stops, foot swelling begins. Knee joint pain and swelling. Started in summer-autumn, likely carrying Earth Qi. Dampness received from below. Wine drinkers have internal dampness steaming mutually. External and internal pathogens combine. Decoctions will definitely not take effect.