曹桐江令堂，年六十外。九月间，发热，少飧。余诊之，六脉俱无神，有八至，右关浮
则满，沉则无。正经云∶脾虚浮似肺，亦火内郁之症，脾弱宜矣，用补中益气数剂。变疟，此正气
复而邪气欲出矣，用六君加五味、干姜，四帖痊复，合参苓白术丸调理，康健如故。
三月间，予六弟，年九岁。先于二月十八日病痧，疹退发热不已，不飧饮食，惟饮冷水
，啜数口，少顷即出，延之三月来报。余思之曰∶不思食，脾胃虚也；欲饮水，热也；饮少顷即
吐
热，此中气虚极，得药力则退，药衰复热，此药力少而病气重也。往诊之，脾胃脉弦无神，
五、六至不定，见迟，左三洪漫，看指上三关俱透，命关脉已黑，喘气昼夜不休，遍身发热
六日，十日余不更衣矣。遂胆导一次，出粪不黑不硬而带溏，非真元之热，乃脾胃气虚不能
升降耳。小便赤涩，欲便则叫呼痛楚之极，乃阳气馁而下陷，升降失司，气化失职所致。用
补中合六味汤三帖，加麦冬、五味子，喘气即止，热亦退，惟小便涩痛不已。仍用补中益气
加麦冬、五味子、牛膝、车前、干姜炒黑，清肺生水，升阳益胃暖中。一剂，小便出血，
并血块若干，乃邪火煎熬，阴血干枯而成也。又二剂，痛止，饮食顿增，全愈矣。予曰∶用前
剂而获如此之效，岂非补脾养肺、金盛水生、气化自出之谓乎？了吾先师云∶无非清气下陷
，不升不降。此翁谆谆言之，治百病无不验，识此以语后昆。（此肺热气陷蓄血于膀胱之分
曹悟冈令爱，年十七岁。七月间以劳倦发热，不思饮食，六脉俱洪，用逍遥散四剂遂愈
。自
十一月间，忽气喘咳嗽，此土不能生金也，且发寒热，复诊之，六脉无伦次、无至数，偶来
如游丝，亦无定迹，外症喘急吐痰，不食面红，遍身冰冷，两目有时而左红赤、有时而右红
赤，此脾胃久虚，真阴渐亡，虚阳上越之危证。以六君加姜、桂各三分、门冬、五味、黄
。二帖嗽为稍缓，四帖而寒热止，饮食增。又诊之，右三脉尚弦细，用补中加姜、桂，晚煎
八味丸一钱五分，十余剂而痊。至来年正月间，复病如前，盖因节下饮食过伤，亦缘前之元
气未复，脾胃未充故耳。其症比前更重，脉亦如前，日夜不睡，以归脾汤加大附三片，姜、
桂各二分，服一剂，即 睡一晚。又三剂，更服补中加姜、桂、山药、故纸，二十余剂。复
诊之，右三比前觉定，但弦不和，仍服前汤，用八味丸四十余粒同煎服之，又二十余剂，身
温症退而平。（与刘夫人、马见源案参看。）
钱心卓令爱，五岁，先于十二月间患肛门肿痛，且碎且疮，不思饮食，以翰示予。曰
∶此脾胃虚弱，虚阳内郁不伸，下溜侵肺，金受克之故，宜六君加升、柴、吴萸、制黄连炒黑色
三分，二剂即瘳。第未全复。延至正月尽，发热不思食，眼札泪出而红，泄泻。服他医煮肝
治疳之药不效，复语予，亦以四味肥儿之品与之。初觉有效，数日反益重，此元气已虚，攻
伐太过也。遂乘舟来就诊之，则右关弦细，左关洪漫，发热日夜更甚，晚间泻十数次，咳嗽
。予尝观脾胃不足及久病之人，未有不左脉大过于右者，正东垣左脉克右脉之说，理势使然
。况脾土一虚，肺金益衰，水涸木枯，枯木生火，焉得左脉不大于右？用前剂加姜、桂、门
冬、五叶，送下四神丸，六七帖。暂进暂退，脉细如故，此元气未充，不宜改方，彼亦深信
，又服四剂，眼札略疏矣，此真元渐有复意。适了吾师至，云所用之方，止减陈皮，泄气不
能堪也。又去陈皮十余剂，病减十八，再数剂全愈。
张敬山夫人，年四十外。病已八月多矣，遍身肉尽脱，气喘，不思食。延予视之，六脉
俱和缓有神，四至，虽名有胃气。经曰∶形肉尽脱者不治，脉不应病者死。姑用六君加门冬、五
味、干姜二剂，初觉不安，顷之遂 睡，气喘亦疏，声亦响亮。复诊之，六脉俱细，脾肺二
脉，似来似去，欲脱之象，此的为死候矣。再三谛询，彼云稍可，但不思食耳。予思此脉比
前反退，甚是不宜，又勉进前剂一帖。又泻，增胸膈饱闷，且不纳水汤，此中气已虚，不能
输运，遂查历日，乃乙巳。曰∶今晚死矣。重于甲，卒于乙，此五行之定制也。已而果然，
友人薛理还云∶久病脉有神，服药顿退，此决死之病。正如灯火之将灭，又愈明而遽绝耳。
。（此痘后热血蓄于肺络也。若外袭风寒，内伏寒湿，必兼喘急。）六君加姜、桂、门冬、五味四
剂。饮食顿进，嗽亦稍止，此真元未散，药力易得，再十余剂，去十九。然脉尚弦细，较前
不过略和，教以服前剂，不允而止。明年复患如左，脉亦仍前，以煎剂治之，全愈，第脉终
末和缓，犹带弦细也。予曰∶病虽瘳，脉气未复，（脉久不和，其本在血络，和血即脉复。）
又明年三月，重患如前，又视之如故，以十全大补汤、门冬、五味，四服而愈，予思之，犹
未脱也。当补中大补剂百余，方获五脏坚牢，而宿疾亦不再起矣。不然，年盛时色念一动，将
有不胜其喘患矣。世医以咳嗽之疾，全作痰火，尽治以清痰降火顺气克伐之剂，遂至脾土中
损，多致不救，不知咳嗽之疾，由脾胃不和，肺金失养，金不生水，心肝二火陡起于内，乘
所不胜，遂咳嗽不止，而肺病奄奄，脾胃益虚，此子病母忧，化气使然也。正宜补脾胃，生肺
金，不拘剂数，使脾肺得养，五行暗化，土盛金生，而咳嗽自休矣。
丹徒王盛之，年三十余。六脉俱九至，外症则咳嗽面赤，懒言怕闹，时病已半年，从前
苦寒
数则脾气虚。又云∶数则有热而属虚，是皆不足之症。六脉中又脾、肾二脉洪大，此肺金不
能生肾水也，理宜补肺金生肾水，水旺则制火
，金旺则生水准木，木平则脾土盛，又生金矣，此正治也。乃与云∶兹证取药十四五帖或二
十帖外，当有汗出，此阳气升而经络通矣。汗后即当倦，八九日或半月，此邪退而正虚也。
或十日、半月，元气渐复，倦态方去，自后温补脾胃之剂，又当痰动、血动，或发肿毒，或
作泻，此数者，听其自来，乃脏腑邪气欲出，发动流行之象也。倘不预言，恐变症多端，患
者惊骇耳。因与以补脾生肺滋肾水之剂，五、六帖，数脉不减，此真元虚而燥也。即以前剂
去头煎，服二煎，三煎，不十剂而数脉去，此时虚火一退，中气便寒，以六君子加姜、桂五
、六帖，脾气运动，痰饮便行，归于腰脊，肝肾部分大痛。邪之所凑，其气必虚，益见肝肾
虚矣。（是胃脘死血下溜，未得出路也。）令外以盐熨，内服二陈加桃仁，元胡索，薏苡仁二
帖，大肠见痰血而痛止，（血为热为痛，痰为冷为喘，此病久服苦寒，仍能见血而愈，是体气
壮实也。）复用补脾六君加五味、白芍而愈，倘不预明此理，则变出腰脊痛时，便没主张矣
一妇，年五十。小便时尝有雪白寒冰一块，塞其阴户，欲小便，须以手抠溺，否则难
。予曰∶此胃家寒湿，缘脾气气寒，凝结而下坠，至阴户口而不即出者，脾胃之气尚未虚脱，但
陷下耳。用六君加姜、桂，不念剂而愈。
一妇素劳症，四月间，胸中作饱，腹亦胀，不饥，日夜泻十数次。诊之，肝肾脉弦而不
和，此肝肾虚寒也。治以破故纸一钱，杜仲一钱五分，山萸三分，熟地三分，吴茱萸三分，甘草
二分，乌药三分，沉香磨三分。四帖稍有转头，八帖能进汤水，二十帖全愈。
丰义储中和，持斋十七年矣。先九月患梦泄，已而发惊。此五脏空虚，津液燥涸，肝木
生风，风火扇摇，故令精动而泄也，攻补皆不效，先润养其脾胃，脾胃润，使津夜四布，百骸通
泽。一月再诊之，肺脉大，土不能生金也；左尺细长，金不能生水也；余俱洪缓，且不甚流
利，（洪缓不流利，津虚血燥，浮无根，幸不在尺部，左尺细长，是梦泄发惊之本脉，以下
焦寒气上擎也。）以补肺之剂，四剂则和而长矣，虚则补其母之法也。先时不知饥，以异功
散加黄 、桂、芍、五味子补脾生肺，肺复生肾，三脏相生。晚卧不宁，以归脾汤间服之，
元气渐充，精神渐发，越半月余，加用太素丸全愈。
庚午正月，诊得用吾先生左三脉沉枯细小涩，此劳伤筋骨气也；右三脉浮而洪数，左右
皆八、九至，此饮食劳倦伤脾脉也；其症神思昏倦，发热，先因饮食不消，曾服消导之剂以致如
此。思之曰∶脉虽数，年虽高，症虽重，而长缓，尚可延生。遂用保元加桂、芍、五味子、
黑姜三分。服数剂，浮洪脉敛，数脉亦退，第不知饥耳，此脾胃不开也。且服此剂而无汗，
必气未全旺，遍身经络尚未通故耳，恐此后必发毒，因五脏之邪未透，毒必内攻一经而出。
况此平素郁劳甚，毒必从虚脏而出，未几，果少阳经发一毒，痛甚，其坚如铁，灸之念艾，
遂浮肿而散，傍复生一肿，再灸念艾而痛止，耳前后板甚，此血虽行而滞未尽散，经络未尽
通，再以保元辅脾活血通经之剂与之。适左半身发汗甚粘，左属阳，此阳气发动也。明日，
觉身中不安而躁，此作汗之兆，果下午遍身有汗，且作泻，此中气虚寒也。（作泻有蓄痰宿
水，因气化而下出者，不尽由虚寒，当详察所泻形色。）以中和散人参汤调服，遂稍饥，肚
痛亦退矣。明日再诊，六脉俱六至，二尺弦，此下焦虚寒，丹田气冷，命门火虚，不能生脾
土也，虚则补其母，不思食而作饱，当以六君子汤主之，加破故纸、小茴香温下焦以生火，
火以生土之义；加黑姜以温中，以稍食，加健运；加桂、芍、五味以敛肺金生水，水升火降
也，自此以后，脾气渐健，饮食渐进，而肿处滞血，方化为脓。大抵脾胃之疾，兼之高年，
又值春木正旺之时，过此一关，无肚饱之症，可保万全矣。（肚饱为太阴内陷，胸痹为阳明
下陷。任脉上虚，皆由血死下澄不复温化。凡高年及虚人久病，无端忽见肚饱、胸痹、体倦
、食减即不起。脉反缓长，如无病也。）
曹桐江令堂，年六十外。九月间，发热，少飧。余诊之，六脉俱无神，有八至，右关浮则满，沉则无。正经云∶脾虚浮似肺，亦火内郁之症，脾弱宜矣，用补中益气数剂。变疟，此正气复而邪气欲出矣，用六君加五味、干姜，四帖痊复，合参苓白术丸调理，康健如故。
曹桐江的母亲，年龄六十多岁。九月期间，出现发热，进食很少。我诊察她的脉象，六部脉都缺乏神气，脉搏频率为每息八次（快速），右关脉轻取时感觉充实，重按时却空虚。经典医籍记载：脾虚导致的脉象浮大类似肺脉，这也是火热之气内郁的病症，脾脏虚弱是必然的，于是使用补中益气汤（补气升阳，调补脾胃）服用数剂。病情转变为疟疾样症状，这是正气恢复而邪气想要排出的表现，于是使用六君子汤（燥湿化痰，理气和中）加入五味子、干姜，服用四帖后痊愈，再配合参苓白术丸（健脾益气，渗湿止泻）进行调理，身体恢复到健康状态。
三月间，予六弟，年九岁。先于二月十八日病痧，疹退发热不已，不飧饮食，惟饮冷水，啜数口，少顷即出，延之三月来报。余思之曰∶不思食，脾胃虚也；欲饮水，热也；饮少顷即吐热，此中气虚极，得药力则退，药衰复热，此药力少而病气重也。往诊之，脾胃脉弦无神，五、六至不定，见迟，左三洪漫，看指上三关俱透，命关脉已黑，喘气昼夜不休，遍身发热六日，十日余不更衣矣。遂胆导一次，出粪不黑不硬而带溏，非真元之热，乃脾胃气虚不能升降耳。小便赤涩，欲便则叫呼痛楚之极，乃阳气馁而下陷，升降失司，气化失职所致。用补中合六味汤三帖，加麦冬、五味子，喘气即止，热亦退，惟小便涩痛不已。仍用补中益气加麦冬、五味子、牛膝、车前、干姜炒黑，清肺生水，升阳益胃暖中。一剂，小便出血，并血块若干，乃邪火煎熬，阴血干枯而成也。又二剂，痛止，饮食顿增，全愈矣。予曰∶用前剂而获如此之效，岂非补脾养肺、金盛水生、气化自出之谓乎？了吾先师云∶无非清气下陷，不升不降。此翁谆谆言之，治百病无不验，识此以语后昆。（此肺热气陷蓄血于膀胱之分
三月期间，我的六弟，年龄九岁。此前在二月十八日患痘疹（天花或麻疹类疾病），疹子消退后发热不止，不想吃东西喝水，只喝冷水，喝几口，一会儿就吐出来，拖延到三个月后才来报告。我思考说：不想吃饭，是脾胃虚弱；想喝水，是有热；喝下去不久就吐出热气，这是中气极度虚弱，得到药力作用时热势减退，药效衰退后热势复发，这是因为药力微弱而病邪深重的缘故。前往诊察，脾胃脉象弦而无神，脉搏频率在五到六次之间不定，有时显得迟缓，左手三部脉象洪大而散漫，观察手指上的寸关尺三关脉象全部透出，命关脉色已经发黑，喘息昼夜不停，全身发热六天，十多天没有排便了。于是使用胆导法（一种通便方法）一次，排出的粪便不黑不硬且带有稀溏，这不是真元的热证，而是脾胃气虚导致升降功能失常。小便颜色红赤且排尿涩滞，想要排尿时呼叫疼痛至极，这是阳气衰弱而下陷，升降失去调控，气化功能失职所致。使用补中益气汤合六味地黄汤服用三帖，加入麦冬、五味子，喘息立即停止，热势也退了，只有小便涩痛不止。仍然使用补中益气汤加入麦冬、五味子、牛膝、车前子、干姜炒黑，以清肺生津，升举阳气，益胃暖中。服用一帖后，小便出血，并排出若干血块，这是邪火煎熬，导致阴血干枯形成的。又服用两帖，疼痛停止，食欲突然增加，完全痊愈了。我说：使用前方的剂型能获得如此效果，难道不是补脾养肺、金旺生水、气化自然产生的道理吗？我的先师了吾先生说：这无非是清气下陷，不升不降的问题。这位老先生反复强调这一点，治疗各种疾病没有不灵验的，记录这些知识以告诉后代。（这是肺热和气陷导致血液蓄积在膀胱部位的情况）
曹悟冈令爱，年十七岁。七月间以劳倦发热，不思饮食，六脉俱洪，用逍遥散四剂遂愈。自十一月间，忽气喘咳嗽，此土不能生金也，且发寒热，复诊之，六脉无伦次、无至数，偶来如游丝，亦无定迹，外症喘急吐痰，不食面红，遍身冰冷，两目有时而左红赤、有时而右红赤，此脾胃久虚，真阴渐亡，虚阳上越之危证。以六君加姜、桂各三分、门冬、五味、黄。二帖嗽为稍缓，四帖而寒热止，饮食增。又诊之，右三脉尚弦细，用补中加姜、桂，晚煎八味丸一钱五分，十余剂而痊。至来年正月间，复病如前，盖因节下饮食过伤，亦缘前之元气未复，脾胃未充故耳。其症比前更重，脉亦如前，日夜不睡，以归脾汤加大附三片，姜、桂各二分，服一剂，即 睡一晚。又三剂，更服补中加姜、桂、山药、故纸，二十余剂。复诊之，右三比前觉定，但弦不和，仍服前汤，用八味丸四十余粒同煎服之，又二十余剂，身温症退而平。（与刘夫人、马见源案参看。）
曹悟冈的女儿，年龄十七岁。七月期间因为劳累疲倦导致发热，不想吃东西，六部脉象都洪大，使用逍遥散（疏肝解郁，养血健脾）服用四剂后痊愈。从十一月开始，突然气喘咳嗽，这是脾土不能生肺金的表现，并且出现寒热往来，再次诊察，六部脉象杂乱无章，没有固定的频率，偶尔出现像游丝一样细微的脉象，也没有固定的规律，外在症状表现为喘息急促、吐痰，不吃东西、面色发红，全身冰冷，双眼有时左侧红赤、有时右侧红赤，这是脾胃长期虚弱，真阴逐渐耗亡，虚阳上浮的危重证候。使用六君子汤加入干姜、肉桂各三分、麦冬、五味子、黄芪（原文缺字，推测为黄芪或类似补气药）。服用两帖后咳嗽稍微缓解，四帖后寒热停止，食欲增加。再次诊察，右手三部脉象仍然弦细，使用补中益气汤加入干姜、肉桂，晚上煎服八味丸（金匮肾气丸，温补肾阳）一钱五分，服用十余帖后痊愈。到了第二年正月期间，病情再次像之前一样发作，大概是因为节日期间饮食过度损伤，也是因为之前的元气没有恢复，脾胃尚未充盈的缘故。症状比之前更重，脉象也和之前一样，日夜无法入睡，使用归脾汤（益气补血，健脾养心）加入附子三片，干姜、肉桂各二分，服用一帖后，就能睡一晚。又服用三帖，接着服用补中益气汤加入干姜、肉桂、山药、破故纸（补骨脂），二十多帖。再次诊察，右手三部脉象比以前安定，但是弦而不和，仍然服用前面的方剂，将八味丸四十多粒一起煎服，又服用二十多帖，身体温暖，症状消退而平稳。（可与刘夫人、马见源医案参考对照。）
钱心卓令爱，五岁，先于十二月间患肛门肿痛，且碎且疮，不思饮食，以翰示予。曰∶此脾胃虚弱，虚阳内郁不伸，下溜侵肺，金受克之故，宜六君加升、柴、吴萸、制黄连炒黑色三分，二剂即瘳。第未全复。延至正月尽，发热不思食，眼札泪出而红，泄泻。服他医煮肝治疳之药不效，复语予，亦以四味肥儿之品与之。初觉有效，数日反益重，此元气已虚，攻伐太过也。遂乘舟来就诊之，则右关弦细，左关洪漫，发热日夜更甚，晚间泻十数次，咳嗽。予尝观脾胃不足及久病之人，未有不左脉大过于右者，正东垣左脉克右脉之说，理势使然。况脾土一虚，肺金益衰，水涸木枯，枯木生火，焉得左脉不大于右？用前剂加姜、桂、门冬、五叶，送下四神丸，六七帖。暂进暂退，脉细如故，此元气未充，不宜改方，彼亦深信，又服四剂，眼札略疏矣，此真元渐有复意。适了吾师至，云所用之方，止减陈皮，泄气不能堪也。又去陈皮十余剂，病减十八，再数剂全愈。
钱心卓的女儿，五岁，此前在十二月期间患有肛门肿痛，且破碎成疮，不想吃东西，写信告诉我。我说：这是脾胃虚弱，虚阳在内郁结不能舒展，向下流窜侵犯肺脏，导致肺金受到克制的原因，适宜使用六君子汤加入升麻、柴胡、吴茱萸、制黄连炒黑三分，服用两帖即可好转。只是没有完全康复。拖延到正月结束，出现发热、不想吃东西，眼睛刺痛流泪且发红，腹泻。服用其他医生煮肝脏治疗疳积的药物无效，再次告诉我，我也给予四味肥儿丸（消积杀虫）之类的药物给她。起初觉得有效，几天后反而加重，这是因为元气已经虚弱，攻伐太过造成的。于是乘船来就诊，此时右关脉弦细，左关脉洪大而散漫，发热日夜加剧，晚上腹泻十几次，咳嗽。我曾经观察脾胃不足及久病的人，没有左脉大于右脉的，这正是李东垣所说的左脉克右脉的说法，道理和趋势使然。况且脾土一旦虚弱，肺金更加衰败，水源枯竭，肝木干枯，枯木生火，怎么会让左脉不大于右脉呢？使用前面的方剂加入干姜、肉桂、麦冬、五味子，送服四神丸（温肾暖脾，固肠止泻），服用六七帖。病情暂时进退，脉象依然细弱，这是因为元气未充实，不适宜更改方剂，患者家属也深信不疑，又服用四剂，眼睛刺痛稍微舒缓了，这是真元逐渐有恢复的迹象。恰好了吾老师到来，说所用的方剂中，只减去陈皮，因为陈皮泄气，身体承受不了。又去掉陈皮服用十余帖，病情减轻十分之八，再服用几帖后完全痊愈。
张敬山夫人，年四十外。病已八月多矣，遍身肉尽脱，气喘，不思食。延予视之，六脉俱和缓有神，四至，虽名有胃气。经曰∶形肉尽脱者不治，脉不应病者死。姑用六君加门冬、五味、干姜二剂，初觉不安，顷之遂 睡，气喘亦疏，声亦响亮。复诊之，六脉俱细，脾肺二脉，似来似去，欲脱之象，此的为死候矣。再三谛询，彼云稍可，但不思食耳。予思此脉比前反退，甚是不宜，又勉进前剂一帖。又泻，增胸膈饱闷，且不纳水汤，此中气已虚，不能输运，遂查历日，乃乙巳。曰∶今晚死矣。重于甲，卒于乙，此五行之定制也。已而果然，友人薛理还云∶久病脉有神，服药顿退，此决死之病。正如灯火之将灭，又愈明而遽绝耳。（此痘后热血蓄于肺络也。若外袭风寒，内伏寒湿，必兼喘急。）六君加姜、桂、门冬、五味四剂。饮食顿进，嗽亦稍止，此真元未散，药力易得，再十余剂，去十九。然脉尚弦细，较前不过略和，教以服前剂，不允而止。明年复患如左，脉亦仍前，以煎剂治之，全愈，第脉终末和缓，犹带弦细也。予曰∶病虽瘳，脉气未复，（脉久不和，其本在血络，和血即脉复。）又明年三月，重患如前，又视之如故，以十全大补汤、门冬、五味，四服而愈，予思之，犹未脱也。当补中大补剂百余，方获五脏坚牢，而宿疾亦不再起矣。不然，年盛时色念一动，将有不胜其喘患矣。世医以咳嗽之疾，全作痰火，尽治以清痰降火顺气克伐之剂，遂至脾土中损，多致不救，不知咳嗽之疾，由脾胃不和，肺金失养，金不生水，心肝二火陡起于内，乘所不胜，遂咳嗽不止，而肺病奄奄，脾胃益虚，此子病母忧，化气使然也。正宜补脾胃，生肺金，不拘剂数，使脾肺得养，五行暗化，土盛金生，而咳嗽自休矣。
张敬山的夫人，年龄四十多岁。患病已经八个多月了，全身肌肉完全消瘦，气喘，不想吃东西。请我去诊察，六部脉象都和缓而有神气，脉搏频率为每息四次，虽然名义上有胃气。医经说：形体肌肉完全消瘦的不治，脉象与病情不相符的会死亡。暂且使用六君子汤加入麦冬、五味子、干姜，服用两帖，起初觉得不舒服，一会儿后就睡着了，气喘也舒缓了，声音也变得响亮。再次诊察，六部脉象都细弱，脾肺二脉，似有似无，像是将脱散的迹象，这确实是死亡的征兆了。再三仔细询问，她说稍微好一点，只是不想吃东西罢了。我想这个脉象比起之前反而衰退了，非常不适宜，又勉强让她服用前面的一帖药。之后又腹泻，增加了胸膈部的饱闷感，并且不接受水和汤药，这是中气已经虚弱，不能输布运化的缘故，于是查看日历，是乙巳日。我说：今晚就会死了。病情在甲日加重，在乙日去世，这是五行相克的固定规律。后来果然如此，朋友薛理还说：久病脉象本来有神气，服药后脉象突然衰退，这是注定死亡的病。就像灯火将要熄灭时，反而变得更亮然后突然断绝一样。（这是痘疹后热血蓄积在肺络中。如果是外感风寒，内有寒湿潜伏，必定兼有喘息急促。）使用六君子汤加入干姜、肉桂、麦冬、五味子，服用四帖。食欲突然增加，咳嗽也稍微停止，这是因为真元没有散失，药力容易见效，再服用十余帖，病情好了十分之九。然而脉象仍然弦细，比起之前不过是略微调和，教导她继续服用前面的方剂，她没有答应而停止。第二年再次像这样患病，脉象也还是以前那样，用煎剂治疗，完全痊愈，只是脉象最终没有变得和缓，仍然带有弦细。我说：病虽然好了，脉气没有恢复，（脉象长期不和，根本在于血络，调和血液脉象就会恢复。）又过了一年三月，再次像之前一样重病，我又像以前那样诊察，使用十全大补汤、麦冬、五味子，服用四帖后痊愈，我思考这件事，还是没有摆脱（根本问题）。应当服用补中益气和大补剂一百多帖，才能获得五脏坚固，而旧疾也不再发作。否则，在年轻力壮时，只要情欲念头一动，就会有无法承受的喘息祸患了。世间医生把咳嗽的疾病，全都当作痰火，全部用清痰降火顺气攻伐的药物来治疗，导致脾土中间受损，大多导致无法救治，不知道咳嗽的疾病，是由脾胃不和，肺金失去滋养，金不能生水，心肝二火突然兴起于内，乘虚侵袭所不胜的脏腑，于是咳嗽不止，而肺病奄奄一息，脾胃更加虚弱，这是子病累及母亲（脾为肺之母），气化使然。正应该补益脾胃，滋生肺金，不拘泥于药剂数量，使脾肺得到滋养，五行暗中转化，土盛则金生，而咳嗽自然停止。
丹徒王盛之，年三十余。六脉俱九至，外症则咳嗽面赤，懒言怕闹，时病已半年，从前苦寒数则脾气虚。又云∶数则有热而属虚，是皆不足之症。六脉中又脾、肾二脉洪大，此肺金不能生肾水也，理宜补肺金生肾水，水旺则制火，金旺则生水准木，木平则脾土盛，又生金矣，此正治也。乃与云∶兹证取药十四五帖或二十帖外，当有汗出，此阳气升而经络通矣。汗后即当倦，八九日或半月，此邪退而正虚也。或十日、半月，元气渐复，倦态方去，自后温补脾胃之剂，又当痰动、血动，或发肿毒，或作泻，此数者，听其自来，乃脏腑邪气欲出，发动流行之象也。倘不预言，恐变症多端，患者惊骇耳。因与以补脾生肺滋肾水之剂，五、六帖，数脉不减，此真元虚而燥也。即以前剂去头煎，服二煎，三煎，不十剂而数脉去，此时虚火一退，中气便寒，以六君子加姜、桂五、六帖，脾气运动，痰饮便行，归于腰脊，肝肾部分大痛。邪之所凑，其气必虚，益见肝肾虚矣。（是胃脘死血下溜，未得出路也。）令外以盐熨，内服二陈加桃仁，元胡索，薏苡仁二帖，大肠见痰血而痛止，（血为热为痛，痰为冷为喘，此病久服苦寒，仍能见血而愈，是体气壮实也。）复用补脾六君加五味、白芍而愈，倘不预明此理，则变出腰脊痛时，便没主张矣
丹徒人王盛之，年龄三十多岁。六部脉象都是每息九次（极快），外在症状则是咳嗽、面色发红，懒言怕吵，时令疾病已经半年，从前多次服用苦寒药物导致脾气虚弱。又说：脉搏快则有热而属于虚证，这些都是不足的病症。六部脉中脾、肾二脉洪大，这是肺金不能生肾水的表现，按理应该补肺金以生肾水，水旺则能制约火，金旺则能生水并平抑肝木，木平则脾土旺盛，又能生金，这是正确的治疗方法。于是告诉他：这个病症服用十五六帖或二十多帖药后，应当会有出汗，这是阳气上升而经络通畅的表现。出汗后应当感到疲倦，经过八九天或半个月，这是邪气退去而正气虚弱的表现。或者十天、半个月，元气逐渐恢复，疲倦的状态才会消失，此后服用温补脾胃的药剂，又应当出现痰动、血动，或者发生肿毒，或者腹泻，这几项变化，听其自然发生，这是脏腑邪气想要排出，发动流行的现象。如果不预先告知，恐怕变化症状繁多，患者会惊恐害怕。因此给予补脾生肺滋肾水的药剂，服用五六帖，数脉（快速脉）没有减少，这是真元虚弱而干燥的缘故。就用前面的药剂，去掉第一煎，服用第二煎、第三煎，不到十帖数脉就消失了，此时虚火一退，中气就变得寒冷，使用六君子汤加入干姜、肉桂，服用五六帖，脾气开始运动，痰饮随之运行，归结到腰脊，肝肾部位剧烈疼痛。邪气聚集的地方，正气必然虚弱，更加显示出肝肾虚弱。（这是胃脘的死血向下流窜，没有找到出路。）让他外用盐熨烫，内服二陈汤加入桃仁、玄胡索、薏苡仁，服用两帖，大肠排出痰血而疼痛停止，（血瘀导致热和痛，痰饮导致冷和喘，这个病久服苦寒药物，仍然能通过见血而痊愈，说明体质壮实。）再次使用补脾的六君子汤加入五味子、白芍而痊愈，如果不预先明白这个道理，那么在出现腰脊疼痛的变化时，就没有主意了。
一妇，年五十。小便时尝有雪白寒冰一块，塞其阴户，欲小便，须以手抠溺，否则难。予曰∶此胃家寒湿，缘脾气气寒，凝结而下坠，至阴户口而不即出者，脾胃之气尚未虚脱，但陷下耳。用六君加姜、桂，不念剂而愈。
一位妇女，年龄五十岁。小便时曾经有一块雪白像寒冰一样的东西，堵塞阴道口，想要小便，必须用手抠出尿液，否则难以排出。我说：这是胃家寒湿，因为脾气寒冷，凝结而下坠，到达阴道口而不立即排出的原因，脾胃之气还没有虚脱，只是下陷而已。使用六君子汤加入干姜、肉桂，不需要很多帖就痊愈了。
一妇素劳症，四月间，胸中作饱，腹亦胀，不饥，日夜泻十数次。诊之，肝肾脉弦而不和，此肝肾虚寒也。治以破故纸一钱，杜仲一钱五分，山萸三分，熟地三分，吴茱萸三分，甘草二分，乌药三分，沉香磨三分。四帖稍有转头，八帖能进汤水，二十帖全愈。
一位妇女素有劳损病症，四月期间，胸中感觉饱胀，腹部也胀，不觉得饿，日夜腹泻十几次。诊察她的脉象，肝肾脉象弦而不和，这是肝肾虚寒的表现。治疗使用破故纸（补骨脂）一钱，杜仲一钱五分，山茱萸三分，熟地黄三分，吴茱萸三分，甘草二分，乌药三分，沉香磨汁三分。服用四帖后稍微好转，八帖后能喝汤水，二十帖后完全痊愈。
丰义储中和，持斋十七年矣。先九月患梦泄，已而发惊。此五脏空虚，津液燥涸，肝木生风，风火扇摇，故令精动而泄也，攻补皆不效，先润养其脾胃，脾胃润，使津夜四布，百骸通泽。一月再诊之，肺脉大，土不能生金也；左尺细长，金不能生水也；余俱洪缓，且不甚流利，（洪缓不流利，津虚血燥，浮无根，幸不在尺部，左尺细长，是梦泄发惊之本脉，以下焦寒气上擎也。）以补肺之剂，四剂则和而长矣，虚则补其母之法也。先时不知饥，以异功散加黄芪、桂、芍、五味子补脾生肺，肺复生肾，三脏相生。晚卧不宁，以归脾汤间服之，元气渐充，精神渐发，越半月余，加用太素丸全愈。
丰义人储中和，坚持吃素（持斋）十七年了。此前九月患梦遗，随后出现惊恐。这是五脏空虚，津液干燥枯竭，肝木生风，风火煽动，所以导致精气妄动而泄出，攻法和补法都不见效，先润养他的脾胃，脾胃滋润，使津液遍布全身，筋骨得到润泽。一个月后再次诊察，肺脉大，这是脾土不能生肺金的表现；左尺脉细长，这是肺金不能生肾水的表现；其余脉象都洪缓，而且不是很流利，（洪缓而不流利，是津液虚、血液燥，浮而没有根基，幸好不在尺部，左尺细长，是梦遗发惊的根本脉象，是由于下焦寒气上冲所致。）使用补肺的药剂，服用四帖后脉象变得调和而长，这是“虚则补其母”的方法。先前不知道饥饿，使用异功散加入黄芪、桂枝、白芍、五味子来补脾生肺，肺金恢复后再生肾水，三脏相生。晚上睡觉不安稳，间歇性服用归脾汤，元气逐渐充实，精神逐渐焕发，过了半个月左右，加上使用太素丸后完全痊愈。
庚午正月，诊得用吾先生左三脉沉枯细小涩，此劳伤筋骨气也；右三脉浮而洪数，左右皆八、九至，此饮食劳倦伤脾脉也；其症神思昏倦，发热，先因饮食不消，曾服消导之剂以致如此。思之曰∶脉虽数，年虽高，症虽重，而长缓，尚可延生。遂用保元加桂、芍、五味子、黑姜三分。服数剂，浮洪脉敛，数脉亦退，第不知饥耳，此脾胃不开也。且服此剂而无汗，必气未全旺，遍身经络尚未通故耳，恐此后必发毒，因五脏之邪未透，毒必内攻一经而出。况此平素郁劳甚，毒必从虚脏而出，未几，果少阳经发一毒，痛甚，其坚如铁，灸之念艾，遂浮肿而散，傍复生一肿，再灸念艾而痛止，耳前后板甚，此血虽行而滞未尽散，经络未尽通，再以保元辅脾活血通经之剂与之。适左半身发汗甚粘，左属阳，此阳气发动也。明日，觉身中不安而躁，此作汗之兆，果下午遍身有汗，且作泻，此中气虚寒也。（作泻有蓄痰宿水，因气化而下出者，不尽由虚寒，当详察所泻形色。）以中和散人参汤调服，遂稍饥，肚痛亦退矣。明日再诊，六脉俱六至，二尺弦，此下焦虚寒，丹田气冷，命门火虚，不能生脾土也，虚则补其母，不思食而作饱，当以六君子汤主之，加破故纸、小茴香温下焦以生火，火以生土之义；加黑姜以温中，以稍食，加健运；加桂、芍、五味以敛肺金生水，水升火降也，自此以后，脾气渐健，饮食渐进，而肿处滞血，方化为脓。大抵脾胃之疾，兼之高年，又值春木正旺之时，过此一关，无肚饱之症，可保万全矣。（肚饱为太阴内陷，胸痹为阳明下陷。任脉上虚，皆由血死下澄不复温化。凡高年及虚人久病，无端忽见肚饱、胸痹、体倦、食减即不起。脉反缓长，如无病也。）
庚午年正月，诊察用吾先生的脉象，左手三部脉沉枯细小涩，这是劳损伤及筋骨气的表现；右手三部脉浮而洪数，左右脉都是八、九次搏动，这是饮食劳倦损伤脾脏的脉象；他的症状是神志昏沉疲倦，发热，先前因为饮食不消化，曾经服用消导药剂导致这样。思考说：脉象虽然快，年龄虽然高，症状虽然重，但是脉象长而缓，还可以延续生命。于是使用保元汤加入桂枝、白芍、五味子、黑姜三分。服用几帖后，浮洪的脉象收敛，数脉也退去，只是不知道饥饿罢了，这是脾胃没有开畅的缘故。而且服用这个药剂没有出汗，一定是气没有完全旺盛，全身经络还没有通畅的缘故，恐怕此后一定会发毒，因为五脏的邪气没有透发，毒邪必定向内攻入一条经络而排出。况且这个人平时郁结劳损很重，毒邪必定从虚弱的脏器发出，不久，果然在少阳经发出一处毒疮，疼痛剧烈，坚硬如铁，艾灸了很多艾柱，于是浮肿消散，旁边又生出一个肿块，再次艾灸很多艾柱后疼痛停止，耳朵前后僵硬严重，这是血液虽然运行但瘀滞没有完全消散，经络没有完全通畅，再用保元汤辅助脾胃、活血通经的药剂给他。恰好左半身出汗很粘，左边属阳，这是阳气发动的表现。第二天，感觉身体内部不安躁动，这是将要出汗的征兆，果然下午全身出汗，并且腹泻，这是中气虚寒的表现。（腹泻有蓄积的痰饮宿水，因为气化而从下面排出的，不完全是由于虚寒，应当详细观察排泄物的形状和颜色。）使用中和散用人参汤调服，于是稍微感到饥饿，腹痛也退去了。第二天再次诊察，六部脉象都是六次搏动，两尺脉弦，这是下焦虚寒，丹田气冷，命门火虚，不能生脾土的表现，虚则补其母，不想吃东西而感觉饱胀，应当以六君子汤为主方，加入破故纸、小茴香温补下焦以生火，这是火生土的道理；加入黑姜以温中，以便稍微进食，加入健运药物；加入桂枝、白芍、五味子以收敛肺金生水，使水升火降，从此以后，脾气逐渐强健，饮食逐渐增加，而肿胀处的瘀血，才化为脓液。大抵脾胃的疾病，加上高龄，又正值春季木气正旺的时候，度过这一关，如果没有肚饱的症状，就可以保证万无一失了。（肚饱是太阴经气内陷，胸痹是阳明经气下陷。任脉上部虚弱，都是由死血下沉不再温化引起的。凡是高龄及虚人久病，无缘无故突然见到肚饱、胸痹、身体疲倦、食欲减少就不能起病了。脉象反而缓和悠长，好像没有生病一样。）
Cao Tongjiang's mother, aged over sixty. In September, she experienced fever and poor appetite. Upon my examination, all six pulses lacked spirit (Shen), with a rate of eight beats per breath. The right Guan pulse was full on superficial palpation but empty on deep palpation. The classic texts state: "Spleen deficiency floating resembles the Lung pulse; it is also a syndrome of internal depression of fire." Spleen weakness was indeed indicated, so I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) for several doses. The condition changed to malaria-like symptoms, which indicated that righteous Qi was recovering and pathogenic factors were attempting to exit. I then prescribed Liu Jun Zi Tang (Six Gentlemen Decoction) added with Wu Wei Zi (Schisandra Fruit) and Gan Jiang (Dried Ginger). After four doses, she recovered. She was further regulated with Shen Ling Bai Zhu Wan (Ginseng, Poria, and Atractylodes Macrocephala Pill), returning to her previous health.
In March, my sixth younger brother, aged nine, had contracted pox (smallpox or measles) on February 18th. After the rash subsided, fever persisted. He refused food and drink, only sipping cold water, which he vomited shortly after. It took three months before he reported this. I reasoned: Lack of appetite indicates Spleen-Stomach deficiency; desire for water indicates heat; vomiting shortly after drinking indicates extreme deficiency of Middle Qi. When medicinal power acts, heat recedes; when the drug effect wanes, heat returns. This signifies weak medicinal power versus strong pathogenic qi. Upon examination, the Spleen-Stomach pulses were wiry and lacked spirit, varying between five and six beats per breath, sometimes appearing slow. The left three positions were flooding and diffuse. Observing the three passes on the finger, all were penetrating, and the Ming Guan pulse was already black. He wheezed day and night without rest, had generalized fever for six days, and had not defecated for over ten days. I performed a gallbladder enema once. The stool was neither black nor hard but loose. This was not true Yuan Qi heat, but rather Spleen-Stomach Qi deficiency failing to regulate ascending and descending functions. Urine was red and scanty; upon attempting to urinate, he cried out in extreme pain. This was caused by deficient Yang sinking downward, loss of regulation in ascending/descending, and failure of Qi transformation. I prescribed Buzhong Yiqi Tang combined with Liu Wei Di Huang Tang (Six-Ingredient Pill with Rehmannia) for three doses, adding Mai Dong (Ophiopogon Tuber) and Wu Wei Zi. Wheezing stopped immediately, and fever receded, except for persistent painful dysuria. I continued using Buzhong Yiqi Tang added with Mai Dong, Wu Wei Zi, Niu Xi (Achyranthes Root), Che Qian Zi (Plantago Seed), and Chao Hei Gan Jiang (Charred Dried Ginger) to clear Lung heat, generate fluids, raise Yang, benefit the Stomach, and warm the Middle. After one dose, hematuria occurred with some blood clots, formed by evil fire boiling dry Yin blood. After two more doses, pain ceased, appetite increased suddenly, and he fully recovered. I said: Achieving such efficacy with the previous formula—is this not the principle of tonifying Spleen and nourishing Lung, where Metal abundance generates Water, and Qi transformation naturally occurs? My late master, Laowu, stated: "It is nothing but sinking of clear Qi, failing to ascend or descend." This old gentleman emphasized this repeatedly; treating hundred diseases with no exception. Record this to instruct future generations. (This case involves Lung heat and Qi sinking causing blood accumulation in the Bladder region.)
Cao Wugang's daughter, aged seventeen. In July, due to fatigue and overwork, she developed fever and anorexia. All six pulses were flooding. I prescribed Xiaoyao San (Free and Easy Wanderer Powder) for four doses, and she recovered. From November, she suddenly developed wheezing and coughing, indicating Earth failing to generate Metal. She also experienced alternating chills and fever. Re-examination showed chaotic pulses without fixed rhythm, occasionally thread-like and indistinct. External symptoms included urgent wheezing, expectoration, anorexia, facial redness, generalized coldness, and eyes alternately reddish on the left or right. This was a critical syndrome of long-term Spleen-Stomach deficiency, gradual depletion of True Yin, and floating of deficient Yang. I prescribed Liu Jun Zi Tang added with Gan Jiang and Rou Gui (3 fen each), Men Dong (Ophiopogon Tuber), Wu Wei Zi, and Huang Qi (implied). After two doses, cough eased slightly; after four doses, chills and fever stopped, and appetite increased. Re-examination showed the right three pulses remained wiry and fine. I used Buzhong Yiqi Tang added with Gan Jiang and Rou Gui, and at night, decocted Ba Wei Wan (Eight-Ingredient Pill) 1.5 qian. After over ten doses, she recovered. In January of the following year, the illness recurred similarly, likely due to dietary excess during festivals and incomplete recovery of Yuan Qi and Spleen-Stomach. Symptoms were heavier than before, with similar pulses, insomnia day and night. I prescribed Guipi Tang (Restore the Spleen Decoction) added with Fu Zi (3 slices), Gan Jiang and Rou Gui (2 fen each). After one dose, she slept for a night. After three more doses, I added Buzhong Yiqi Tang with Gan Jiang, Rou Gui, Shan Yao (Dioscorea Rhizome), and Po Gu Zhi (Psoralea Fructus). After twenty-plus doses, re-examination showed the right three pulses were steadier but still wiry and unharmonious. I continued the previous decoction, adding forty-plus pills of Ba Wei Wan to the decoction. After another twenty-plus doses, body temperature normalized, symptoms receded, and she stabilized. (Refer to cases of Lady Liu and Ma Jianyuan.)
Qian Xinzhuo's daughter, aged five. In December, she suffered from anal swelling and pain, breaking into ulcers, with anorexia. She wrote to me. I said: This is Spleen-Stomach deficiency, with deficient Yang internally depressed and unable to extend, flowing downward to invade the Lung, causing Metal to be controlled. Suitable prescription: Liu Jun Zi Tang added with Sheng Ma (Cimicifuga Rhizome), Chai Hu (Bupleurum Root), Wu Zhu Yu (Evodia Fruit), and Zhi Huang Lian (Processed Coptis Rhizome, charred black, 3 fen). After two doses, she improved, though not fully recovered. By end of January, she had fever, anorexia, stinging eyes with tears and redness, and diarrhea. Other doctors' liver-boiling medicines for infantile malnutrition (Gan syndrome) were ineffective. I again gave Si Wei Fei Er Wan (Four-Ingredient Child-Fattening Pill). Initially effective, but worsened after a few days, indicating depleted Yuan Qi and excessive attacking/draining. She came by boat for consultation. Right Guan was wiry and fine; Left Guan was flooding and diffuse. Fever intensified day and night; diarrhea occurred ten-plus times at night; coughing present. I have observed that in Spleen-Stomach insufficiency and chronic illness, the left pulse is rarely larger than the right. This aligns with Li Dongyuan's theory of Left pulse overcoming Right pulse, based on logical trends. If Spleen Earth is deficient, Lung Metal declines further; Water dries, Wood withers; withered Wood generates Fire—how can the left pulse not be larger than the right? I used the previous formula added with Gan Jiang, Rou Gui, Men Dong, and Wu Wei Zi, taken with Si Shen Wan (Four Gods Pill). For six-seven doses, symptoms fluctuated, pulse remained fine. This indicated Yuan Qi was not yet filled; changing the formula was inappropriate. The family trusted this deeply. After four more doses, eye stinging slightly relieved, indicating gradual recovery of True Yuan. Master Laowu arrived, stating the formula should only remove Chen Pi (Tangerine Peel) as it drains Qi, which the body could not bear. Removing Chen Pi for ten-plus doses reduced illness by 80%. After a few more doses, full recovery.
Lady Zhang Jingshan, aged over forty. Ill for over eight months, with generalized muscle wasting, wheezing, and anorexia. Upon examination, all six pulses were harmonious, gentle, and spirited, with four beats per breath, indicating presence of Stomach Qi. The Classics state: "Generalized muscle wasting is untreatable; pulse not matching disease indicates death." I tentatively prescribed Liu Jun Zi Tang added with Men Dong, Wu Wei Zi, and Gan Jiang for two doses. Initially uneasy, she soon slept, wheezing eased, and voice became loud. Re-examination showed all six pulses fine; Spleen and Lung pulses seemed to come and go, indicating impending collapse—a definite sign of death. After repeated inquiry, she said she felt slightly better, only lacking appetite. I thought the pulse regressed compared to before, which was highly unfavorable, yet I forced another dose of the previous formula. She then had diarrhea, increased chest/epigastric fullness, and refused water/soup. This indicated Middle Qi deficiency failing to transport. Checking the calendar, it was Yi Si day. I said: "She will die tonight. Aggravated on Jia, dying on Yi—this is the fixed rule of Five Elements." It proved true. Friend Xue Lihuan said: "Chronic illness with spirited pulse, sudden regression after medication, indicates certain death. Like a lamp about to extinguish, burning brighter before abruptly going out." (This involves hot blood accumulating in Lung collaterals post-pox. If external wind-cold and internal cold-damp are present, wheezing urgency must accompany.) I prescribed Liu Jun Zi Tang added with Gan Jiang, Rou Gui, Men Dong, Wu Wei Zi for four doses. Appetite increased suddenly, cough stopped slightly. This indicated True Yuan was not scattered, and medicinal power was effective. After ten-plus more doses, 90% recovery. However, pulse remained wiry and fine, only slightly harmonious compared to before. I advised continuing the previous formula, but she refused and stopped. Next year, illness recurred similarly, pulse unchanged. Treated with decoctions, she fully recovered, but pulse never became truly harmonious, remaining wiry and fine. I said: "Though illness abated, pulse Qi did not recover. (Long-term pulse disharmony originates in blood collaterals; harmonizing blood restores pulse.)" In March of the following year, severe recurrence. Examination same as before. Prescribed Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) with Men Dong and Wu Wei Zi. Four doses cured. I reflected: Still not free of root issues. Should have taken over a hundred doses of Buzhong and major tonics to secure the Five Zang organs and prevent recurrence. Otherwise, during youth, any sexual thought would trigger unbearable asthma. Worldly physicians treat all coughs as Phlegm-Fire, using phlegm-clearing, fire-reducing, Qi-smoothing, and draining agents, damaging Spleen Earth, often leading to untreatable conditions. They do not know cough arises from Spleen-Stomach disharmony, Lung Metal losing nourishment, Metal failing to generate Water, causing Heart and Liver fires to rise internally, attacking what they cannot overcome, leading to incessant cough, weakening Lung, and further Spleen deficiency. This is "Child illness worrying Mother," driven by Qi transformation. One should tonify Spleen-Stomach, generate Lung Metal, regardless of dose count, allowing Spleen-Lung nourishment, hidden Five Elements transformation, Earth abundance generating Metal, and cough ceasing naturally.
Wang Shengzhi from Dantu, aged over thirty. All six pulses were nine beats per breath. External symptoms: cough, facial redness, reluctance to speak, fear of noise. Seasonal disease lasted half a year. Previous use of bitter-cold drugs damaged Spleen Qi. Also, rapid pulse indicates heat belonging to deficiency—all signs of insufficiency. Among the six pulses, Spleen and Kidney pulses were flooding and large, indicating Lung Metal failing to generate Kidney Water. Reasonably, one should tonify Lung Metal to generate Kidney Water. Abundant Water controls Fire; abundant Metal generates Water and levels Wood. Level Wood makes Spleen Earth abundant, which generates Metal again. This is correct treatment. I told him: After taking fifteen to twenty doses, sweating should occur, indicating rising Yang and unblocked collaterals. Post-sweat, fatigue should follow. After eight-nine days or half a month, pathogen retreats and Zheng Qi is deficient. Or after ten days/half a month, Yuan Qi gradually recovers, fatigue disappears. Thereafter, warming-tonifying Spleen-Stomach agents may cause Phlegm movement, Blood movement, swelling/toxins, or diarrhea. These phenomena should be allowed to occur naturally, representing pathogenic factors in Zang-Fu attempting to exit. Without prior warning, patients might be startled by varied changes. I prescribed formulas to tonify Spleen, generate Lung, and nourish Kidney Water. After five-six doses, rapid pulse did not decrease, indicating True Yuan deficiency and dryness. I used the previous formula, skipping the first decoction, taking second and third decoctions. Within ten doses, rapid pulse disappeared. As deficient fire retreated, Middle Qi became cold. I prescribed Liu Jun Zi Tang added with Gan Jiang and Rou Gui for five-six doses. Spleen Qi moved, Phlegm-Fluids flowed, settling in waist/spine, causing severe Liver-Kidney pain. Where pathogen gathers, Qi is deficient, confirming Liver-Kidney deficiency. (This is dead blood from stomach epigastrium flowing down without outlet.) I instructed external salt-warming and internal Er Chen Tang added with Tao Ren (Peach Kernel), Yuan Hu Suo (Corydalis Rhizome), and Yi Yi Ren (Coix Seed) for two doses. Large intestine expelled phlegm-blood, pain stopped. (Blood indicates heat/pain; Phlegm indicates cold/wheezing. Long-term bitter-cold use still resulting in blood expulsion and cure indicates robust constitution.) I then used tonifying Spleen Liu Jun Zi Tang added with Wu Wei Zi and Bai Shao (White Peony Root) for cure. Without understanding this logic, one would be lost when lumbar pain appeared.
A woman, aged fifty. During urination, a snow-white ice-like block sometimes blocked the vaginal opening. To urinate, she had to manually extract urine, otherwise difficult. I said: This is Stomach Cold-Dampness, due to cold Spleen Qi condensing and sinking to the vaginal opening. Spleen-Stomach Qi has not collapsed, merely sunk. I prescribed Liu Jun Zi Tang added with Gan Jiang and Rou Gui. Not many doses were needed for cure.
A woman with chronic劳症 (consumption/fatigue syndrome). In April, epigastric fullness, abdominal distension, anorexia, diarrhea ten-plus times day and night. Pulse: Liver-Kidney wiry and unharmonious, indicating Liver-Kidney deficiency-cold. Treatment: Po Gu Zhi (1 qian), Du Zhong (1.5 qian), Shan Yu (3 fen), Shu Di (3 fen), Wu Zhu Yu (3 fen), Gan Cao (2 fen), Wu Yao (3 fen), Chen Xiang (3 fen ground). Four doses showed slight improvement; eight doses allowed soup intake; twenty doses cured.
Chu Zhonghe from Fengyi, kept vegetarian diet for seventeen years. In September, suffered nocturnal emission, followed by fright. This indicated emptiness of Five Zang, dryness/depletion of Jin-Ye, Liver Wood generating Wind, Wind-Fire fanning flames, causing Jing to move and emit. Attacking and tonifying both failed. First, moisten-nourish Spleen-Stomach. Once Spleen-Stomach moist, Jin-Ye distributes, nourishing all bones. Re-examination one month later: Lung pulse large (Earth fails to generate Metal); Left Chi slender-long (Metal fails to generate Water); others flooding-gentle but not fluent. (Flooding-gentle non-fluent indicates fluid deficiency and blood dryness, floating without root. Fortunately not in Chi position. Slender-long Left Chi is root pulse for emission/fright, due to Lower Jiao cold air rising.) Prescribed Lung-tonifying formula. Four doses made pulse harmonious and long—method of "tonifying deficiency by tonifying its mother." Previously anorexic, prescribed Yi Gong San added with Huang Qi, Gui, Shao, Wu Wei Zi to tonify Spleen/generate Lung, Lung regenerate Kidney, Three Zang generating each other. Restless sleep, prescribed Guipi Tang intermittently. Yuan Qi gradually filled, spirit emerged. Over half a month later, added Tai Su Wan for full recovery.
January of Gengwu year. Examined Mr. Yongwu. Left three pulses: sunken, withered, fine, small, choppy—indicating劳伤 (injury from overwork) affecting sinews/bones/Qi. Right three pulses: floating, flooding, rapid; both sides 8-9 beats—indicating dietary/labor fatigue injuring Spleen. Symptoms: mental confusion/fatigue, fever. Initially due to undigested food, treated with digestion-promoting agents, leading to this state. I reasoned: Though pulse rapid, age high, symptoms severe, the long-gentle quality allows survival. Prescribed Bao Yuan Tang added with Gui, Shao, Wu Wei Zi, Hei Jiang (3 fen). Several doses: floating-flooding pulse contained, rapid pulse receded. Only anorexia remained, indicating Spleen-Stomach not open. No sweat after medication indicates Qi not fully vigorous, collaterals not yet unblocked. Fear of subsequent toxin eruption, as Five Zang pathogens not fully excreted; toxin must attack one meridian to exit. Given his chronic depression/overwork, toxin must exit from deficient Zang. Soon, a toxin erupted on Shaoyang meridian, extremely painful, hard as iron. Moxibustion with many moxa cones caused swelling to dissipate. Another swelling appeared nearby; more moxa stopped pain. Ears front/back stiff. Blood moving but stagnation not fully dispersed, collaterals not fully unblocked. Prescribed Bao Yuan Tang assisting Spleen, activating blood, unblocking collaterals. Suddenly, left half-body sweated heavily/stickily. Left belongs to Yang, indicating Yang Qi activation. Next day, felt internal unrest/restlessness, sign of impending sweat. Indeed, afternoon generalized sweating and diarrhea occurred, indicating Middle Qi deficiency-cold. (Diarrhea may involve retained phlegm/fluids exiting via Qi transformation, not solely deficiency-cold; observe form/color carefully.) Administered Zhong He San with Ginseng Decoction. Slight hunger returned, abdominal pain subsided. Next day re-examination: All six pulses six beats; two Chi pulses wiry. Indicates Lower Jiao deficiency-cold, Dantian Qi cold, Mingmen Fire deficient, failing to generate Spleen Earth. "Tonify deficiency by tonifying mother." Anorexia with false fullness: Main formula Liu Jun Zi Tang. Add Po Gu Zhi, Xiao Hui Xiang to warm Lower Jiao/generate Fire (Fire generates Earth). Add Hei Jiang to warm Middle, aiding slight food intake and transportation. Add Gui, Shao, Wu Wei Zi to collect Lung Metal/generate Water, ensuring Water ascends/Fire descends. Thereafter, Spleen Qi gradually strengthened, diet increased, stagnant blood in swelling transformed to pus. Generally, Spleen-Stomach disease in elderly during peak Spring Wood time: passing this hurdle without abdominal fullness ensures safety. (Abdominal fullness is Taiyin sinking; Chest Bi is Yangming sinking. Upper Ren Mai deficiency stems from dead blood sinking failing to warm/transform. Elderly/chronic deficiency patients suddenly showing abdominal fullness, chest bi, fatigue, reduced appetite usually do not survive. Pulse paradoxically gentle/long, as if healthy.)