疡科君略曹先生长君大美内正，日哺潮热，经候不至。治者皆云血枯经闭，用通经之品，寒热愈甚，呕吐恶心。予诊两手滑利为结眙之兆，非经闭也，寒热者乃气血护养胎元，不能滋荣肌肤耳，至五六月后胎元已充，气血自盛则寒热自止。时以予言为谬，延原医调理，仍加破血之剂。忽夜半崩如泉，痛势频逼，下一肉块而形已成矣。此时尚未得于，悔恨不逮，染成产蓐，逾年而卒。
茂才虞葛来，少年多欲，醉饱无惮。初患胁痛，继而嘈杂，渐成反胃，医久无效，邀家君往视。见面色如土，面上两颧稍带赤色，六脉细数，食饮即吐。历览前方颇不相胶，但四君理中频服不瘳，知病不独在中州也，信为无阴则吐耳。况渚呕吐皆属于火，而季胁又属肝肾之乡，即以地黄汤加石斛沉香。愈后一载，秋前旧症复发，适家君有携李之行，干予诊治。左关弦长知怒气伤肝，故现独大之象，用加味逍遥散而安。又两月因劳忍肌，恣酒感怒，前症蜂起，较前尤甚。六脉虚软，胁痛胀闷，卧则气塞欲绝，此大虚而得盛候，为脉证相反，法在不治。伊父强请立方，仍用逍遥散。更医用小建中汤二十余剂，胁胀稍宽，痛则仍在，咯血稠痰，腥秽难近，复干余治。往者虚软之脉变成蛛丝之细，两眸露白，气促声嘶，脾元大坏，肺气孤危，此肺痿之恶候也。时冬水将弱，春木方强，延于冬者得肾水之相助也，记初十立春，木气临官，肺受其侮，脾受其乘，岂能再延耶，果殁于初十之寅时。
素君，素多劳动，因乘暑远行，遂胸臆不宽，呃忒连发，八日以来声彻邻里，自汗津津，语言断落，汤药遍尝毫无效果，举家惶恐，特干余治。现症虽脉尚有根，况准头年寿温润，不晦法令，人中光泽不枯，若论色脉生机犹存，但徒藉汤丸恐泄越之阳不返，潜伏之阴难消。当先用艾火灸期门三壮并关元气海诸穴，再煎大剂四君子汤，加炮姜肉桂为佐，丁香柿蒂为使，内外夹攻。譬之釜底加薪，则蒸气上腾，而中焦自暖，四大皆春，何虑阴翳之不散，真阳之不复耶。果一艾而呃止，再进而全愈。共骇为神奇。
云间司李王公，伤风鼻塞，周身刺痛，欲用表剂，邀余商治。六脉浮虚，予曰：风为阳邪，卫为阳气，阳与阳合则伤表分，病虽属标而治则求其本。盖肺主皮毛司开阖充元气主清肃者也。清阳不发，腠理空疏，外来风邪，内舍肺分，经曰：邪之所凑，其气必虚，正谓此也。法宜东垣先生补中益汤，补中兼发，乃谓至当。王公曰可服一剂，而诸病捐除。
徽商朱圣修内人，呕逆吐食，出多入少，皆利痰白沫，眩晕气急，半月有余，大肉尽消。治者咸谓反胃，谓吐沫脾败，已无救矣。干余调治。手少阴脉动甚，两尺滑利，为结胎之兆，而恶阻之候非翻胃也。用人参橘红白术半夏苏梗桔梗赤苓砂仁枇杷叶伏龙肝水，煎服，三剂而吐减，数剂而全瘥，后产一女。
义与荩臣鲁学师夫人，胎前滞下，胸腹胀痛，饮食艰难，大便赤浓，小便短少。荩翁曰：内子素患胸痛已历多年，在敝地举发或用枳朴槟黄方能奏效，若投轻剂徒增困苦耳。余聆其言而妄为之辨曰：胸为肺室，赖母气以升腾，始能清肃运行灌溉四脏。一有失调则天气闭塞，地气冒明，冲和之气郁而成否，水谷之滞搏而成痛，皆缘胃脘弱不能行气于三阴三阳也。若不培其元以固仓廪之虚，泛用苦寒降沉之晶，转伤上焦虚无之气，虽暂时爽快，殊不知潜损胃阳暗增其病，所以多年不瘥，而日就痿黄也。况带下尤为所禁，即宜安胎之中杂以顺气和血之品，庶便脓愈而后重除，正气复而邪自解。用当归白芍各二钱，白术茯苓各钱半，陈皮神曲各一钱，升麻葛根各七分，煨木
香炙草各五分，姜枣煎服，数贴而愈。后产一子，复用建中理中二汤出入加减，胸痛亦痊。
娄江祭酒吴梅村夫人，产后患痢，昼夜百余次，不能安枕，用滞下通导而后重转增。延家君治之，断为阴虚阳陷。用六味汤加肉桂以保衰败之阴，以补中汤加木香以提下陷之气。盖新产之后营卫空虚，阴阳残弱，咸赖孤脏之力生血生气，庶可复后天资生之本。既患下痢则知元阳已虚，又投峻剂必使真阴愈竭，惟舍通法而用塞法，易寒剂而用温剂，俾胃关泽而魄门通畅，仓廪实而传道运化自然，精微变化清浊调和矣。可见胎前产后所恃者脾元也，所赖者阳气也，坤厚既旺，乾健自复。丹溪云：产后以大补气血为主，虽有杂症以末治之。诚者是言也。
龚姓妇，产后发痉，口歪不语，角弓反张，时或稍愈，顷之复作，诸医皆用风治。予曰：肝为藏血之乡，风水之司也。肝气为风，肝血为水，流则风息而筋脉自舒。古人云治风先治血，信有言矣。况产后气衰于表，血衰于里，气衰则腠理疏而外风易袭，血耗则肝木枯而内风煽动。故血不养筋则角弓反张，风淫胃脉则唇口引动，当用滋润之品内养肝血直补其虚，少佐驱风之剂使同气相求得以易入。用四物去芍药加羌活防风独活钩勾酒炒荆芥，两剂而愈。若用辛散则风能燥血，辛走阳气，适滋其困矣。
遂安令曹绿岩长君安初，少年嗜欲，真元素虚。己亥秋，丁内艰，悲恸太过，内火燔灼，肾水干涸，肌肉顿消，咳咯脓血，腥秽异常。延予商治。六脉洪大，重按虚豁，右寸独数，此上盛下虚之候。夫上盛者赫曦过极，肺中之假阳旺也；下虚者涸流衰竭，肾家真阴虚也。阴虚则火独发坎宫，津液上腾救母，浸浸炽灼反成稠痰。浊阴胶结于清虚之脏，久而肺热叶焦，腐化为痈。若不求本而治，则肾阴愈虚，邪火更旺，痈将溃也。法当先清上焦痰火，保定肺气。以麦冬沙参紫菀贝母橘红茯苓甘草桔梗瓜蒌霜等五更时服，复用六味汤加麦冬五味大剂临卧服以滋化源。数帖而痰清嗽减，一月而精充神复。越三载因感于邪术，广图婢妾以自娱，前症复发，卒至不救。
晋中商人高呜轩，年六旬外，久历鞍马，餐风冒雾，六淫之邪袭其经络，染成痿废已三年矣。遍访名医咸以解表为治，两足愈觉无力，顽麻不仁，辛丑夏初，适回海邑告余，服药累百不获少瘥，自信此身永废矣。予曰：风寒湿气乘虚而入，不思养正以补其本，一误也；屡解表而风邪已去，犹然发散，愈损真元，二误也。且气虚则麻，血虚则木，人有恒言，是症必为中风先兆。乃以神效黄耆汤加肉桂服之，才四帖麻顿去，便能却杖而行，后以还少丹调理月余，倍常矍烁。
德州都谏王介清，丁内艰，患左胁顽痹，足腿麻木，按摩片时，少堪步履，服清火消痰补气活血病势不减，后服阕入京，邀家君诊视。见伊肾肝脉虚，断为肾虚不能生肝，肝虚不能荣血，水亏血耗经隧枯涩之症。先以四物汤加秦艽石斛牛膝葳蕤。不数剂而胁痹顿除，后服肾气丸一杯，永不复发。
秦商张玉环，感寒咳嗽，变成哮喘，口张不闭，语言不续，呀呷有声，外闻邻里，投以二陈枳桔毫不见减，延予救之。诊六脉右手寸关俱见浮紧，重取带滑，断为新寒外束，旧痰内搏，闭结清道，鼓动肺金。当以三拗汤宣发外邪涌吐痰涎为要，若畏首畏尾漫投肤浅之剂，则风寒闭固顽痰何由解释。况经曰：辛甘发散为阳，麻黄者辛甘之物也，禀天地轻清之气，轻可去实，清可利肺，肺道通而痰行，痰气行而哮愈矣。乃以前药服之，果一剂而汗出津津，一日夜约吐痰斗许，哮喘遂平。越二年因不忌口，复起前证而殁。
茸城朱公亮令嫒，血枯经闭已年余矣。大肉去半，饮食减少，日哺寒热，至夜半微汗而解。予诊其脉，两手细数，证属难疗。《素问》曰：二阳之病发心脾，有不得隐曲，女子不月。夫心统各经之血，脾为诸阴之首。二经乃子母之脏，其气恒相通也。病则二脏之气乘涩荣血，无以资生。故地道之不行，由心脾之气不充也。张洁古师弟首重{内经》，一以调荣培土为主，而薛新甫将逍遥归脾二方为用，使气血旺而经自通。若不培补其源，反以消坚破硬苦寒伤胃通道癸水为捷径，殊不知愈攻则虚而愈闭，其生生之源从此剥削殆尽，直至风消贲闭，虽有神丹难为治矣。不信予言，专行通道，至不起。
嘉定庠生沈来壅，食后感寒，头疼发热，胸膈胀满，医用表散消导，虽胸次稍舒，寒热愈剧，反增神昏不寐，已三传经矣。一医因病久症虚议用温补，一医颇明医理复尔消导，议论多端，邀予决之。六脉弦数不和，与寒热往来，大便溏而小便赤，此少阳经症。不可汗下与渗利，转犯他经，只宜和解，其邪易散，纵有食停，俾邪气解而食自消，此仲景先生之秘旨也。竟以小柴胡汤去人参加丹皮炒山栀花粉麦冬，一剂而神清气爽，寒热亦定。
上洋王邑尊幕宾张姓，盛暑发热，至六七日昏沉不语，面赤苔焦，与水则咽，大便不通，身艰转侧，医者束手，投柬招治。予诊毕谓王公曰：病虽危候，脉象和顺，况身体软缓，唇吻红润，气息调匀，俱为吉兆。只因邪热传人手少阴经，郁而不舒，所以面赤昏呆，口噤不语。乃以导赤散加黄连麦冬，佐犀角少许，加灯心竹叶。煎成，用刷脚抉开口，徐徐灌下，片时觉面色稍退，再剂而目开能视，三剂而语言如旧，后调理乃安。
李元吉妻，半产后血崩如注，头晕眼暗，饮食少进，面色青黄，六脉虚大无力，甚至昏晕不苏，一日数次延予治之。予曰：血脱益气，阳生阴长，《灵枢》之旨也。况阳为阴之使，阴为阳之守，今久患崩中，宜乎几微之时而欲绝，奚能固其内守之阴。所以经流不竭，皆阳气不能卫外故也。若徒事养阴止涩，是人已入井而又投之以石耳。用补中益气汤加五味艾叶服之，势不稍衰。予思古语云大虚必挟寒。再以人参一两熟附一钱煎成，呷下乃熟睡片时，醒来晕减神清，后以养荣汤去肉桂加附子，调理而安。
雷廉道潘畏庵乃郎，自幼腹痛，向以内伤调治，时或见愈，不能杜根。庚子春过龙华扫墓归，由巨浦而前适，风雨骤至，银浪排山，泊舟小港，因而受饥忍寒，痛遂大作，邀予往治。左手脉皆弦迟，右寸关虚大无力。盖此症因饮食过饱，伤其中州，嗣后食虽消而太阴分野犹然损伤，故一有不调，痛即随至。况历有岁时。中脘之阳不布，畜积痰涎，结成窠臼，即《内经》云：末传寒中之谓也。若不用温补辛散之品，其沉郁久凝之疾，焉能转否为泰乎。用异功散加桂枝半夏炮姜木香为粗末，姜煎服，痛即止，后照前方加益智仁白芍神曲，姜汤和丸，后不复发。
大学士徐元扈夫人，胃脘痛，初以气治，次以食治，继以火治，总不见效，痛至昏赜，良久复苏。延家君治之曰：夫人尊恙非气非食亦非火也。由劳碌太甚，中气受伤，脾阴弱而不化，胃阳衰而不布。阴阳并虚，仓禀壅滞，转输既弱，隧道失运，所以浊清相干，气血相搏而作痛者。若用消导则至高之气愈耗，误投寒剂则胃脘之阳益伤，为今之计非补不可。虽云痛无补法，此指邪气方锐者言也。今病势虽甚而手按略止，脉气虽大而重按稍松，则脉症俱虚不补而何。用六君子汤加香附砂仁，一剂而眩定痛止。
昭城王五松子舍，大肉削去，虚气攻冲，症情恍惚，手足麻木，不能自主，夜寤不宁。咸谓心脾之气涣散，所以脉络胀张如不束之状，所谓解（他-也+亦）者也。盖阳明为气血俱多之乡，主束骨而利机关者也。阳明戊土一虚必盗母气自养，而心亦虚，以《灵枢》云:心怵惕思虑则伤神，神伤则恐惧自失，破胭肉脱矣。治宜补心脾之气，以充元神之用，可指日而奏功。乃与归脾汤服数帖而始止。
分镇符公祖令媛，久泻肉脱，肢体浮肿，大腹胀痛，便内赤虫，形如柳叶，有口无目，更兼咳嗽烦躁，夜卧不寐，召予调治。公曰：小女之疾起于夏间，因饮食不节，淹缠半载。服利水药身肿不减，用参耆等剂胀闷益增。子细为审察，盖中央脾土喜燥而恶湿，脏腑为根本生化源头，虽云至阴之地，实操升阳之权。盛暑之际六阳外发，阴寒潜伏，加以浮瓜沉李饮冷吞寒，使乾阳之气郁坤土之中。所以气滞而湿化，湿化而热生，湿热壅滞转输不行，仓廪之精华下陷而为泄泻。久则清阳愈虚，浊阴愈盛，留于中州则为腹胀，散于肌肉则为浮肿，上乘肺分则为咳嗽。况脾为诸阴之首，肝为风木之司，湿热盛则阴虚而烦躁夜争，肝风旺则遇湿而虫形生化，头绪虽多不越木旺土衰之征。治当调脾抑肝，佐以升清降浊，使湿去土燥，病当渐去。用白术茯苓半夏芍药黄连肉桂干葛柴胡厚朴乌梅花椒等剂调理而安。
???????燕山中丞刘汉儒，泄泻数日，医见肝脉弦急，认为火热，用苦寒平肝反洞泄不已，筋挛少气，招家君往治。曰：此因寒气入腹，清阳不能上腾，即《素问》清气在下，则生飧泄之意也。前医以肝脉高为火，予以肝脉盛为寒，盖寒束之脉每多见弦，先哲明训班班可考，何得以寒为热耶。方以苍术白术各二钱，羌活防风各一钱，干葛炮姜各八分，升麻柴胡各五分，一剂而减。
【旧德堂医案】正文（3/4） 类别：医论
曹先生的长子曹大美，体内怀有身孕。每日傍晚出现定时发热（潮热），月经停止来潮。主治医生都说是血枯经闭，使用通经的药物，导致寒热症状更加严重，并出现呕吐恶心。我诊察两手脉象滑利，这是怀孕的征兆，并非经闭。所谓的寒热，是因为气血在护养胎元，不能滋养肌肤所致。到了五六月之后，胎元已经充实，气血自然旺盛，寒热就会自行停止。当时人们认为我的话荒谬，仍请原来的医生调理，并且又加入了破血的药剂。忽然半夜大出血如泉涌，疼痛剧烈频繁逼近，排出一块肉样组织，胎儿形态已完全形成。此时尚未出生，后悔莫及，最终因产褥感染，过了一年去世。
秀才虞葛来，年轻时纵欲过度，饮食不节制。起初患胁痛，继而胃中嘈杂不适，逐渐发展成反胃，求医很久无效，邀请我的父亲前往诊治。见面色像泥土一样枯黄，两颧稍带红色，六脉细数，进食饮水即吐。翻阅之前的处方，虽然药方之间互不兼容，但频繁服用四君子汤、理中汤等药物并未见效，我知道病不仅仅在中焦脾胃，确认为是无阴则吐。况且各种呕吐多属于火证，而季胁部位又属于肝肾所主之地，于是用六味地黄汤加石斛、沉香治疗。痊愈一年后，秋天前旧病复发，恰逢我父亲要去携李出行，便委托我诊治。左关脉弦长，知道是怒气伤肝，所以呈现独大的脉象，用加味逍遥散治疗而安定。又过了两个月，因为劳累、忍饥挨饿，加上饮酒和动怒，前面的症状蜂拥而起，比之前更严重。六脉虚软，胁痛胀闷，躺下时气塞感觉要断绝，这是大虚之证却呈现出盛实的假象，属于脉证相反，按照医理属于不治之症。他的父亲强行请求开方，仍然使用逍遥散。换用的医生用小建中汤二十多剂，胁胀稍微缓解，但疼痛仍在，咳出稠痰带血，气味腥臭难闻，再次找我治疗。以前的虚软脉象变成了蛛丝般细微，两眼露白，气促声嘶，脾元大坏，肺气孤危，这是肺痿的恶候。当时冬季水气将弱，春季木气正强，拖延到冬天还能得到肾水的相助，记得初十立春，木气临官，肺受其侮，脾受其乘，怎么能再延续呢？果然在初十寅时去世。
素君，平时多劳动，因为趁着暑天远行，于是胸膈不宽畅，呃逆连续发作，八天以来声音传到邻里，自汗淋漓，说话断断续续，汤药遍尝毫无效果，全家惶恐，特别找我诊治。现在症状虽然脉尚有根，而且鼻准头、年寿穴温润，法令纹不晦暗，人中光泽不枯，如果论色脉生机犹存，但只依靠汤丸恐怕泄越的阳气不能返回，潜伏的阴邪难以消除。应当先用艾火灸期门穴三壮，以及关元、气海等穴位，再煎煮大剂量的四君子汤，加炮姜、肉桂作为佐药，丁香、柿蒂作为使药，内外夹攻。这就好比在锅底添加柴火，蒸汽就会上腾，中焦自然温暖，全身如春天般生机勃勃，何必担心阴翳不散、真阳不复呢？果然一灸呃逆就停止，再服药而全愈。大家都惊叹为神奇。
云间司李王公，伤风鼻塞，周身刺痛，想用解表药，邀请我商量治疗。六脉浮虚，我说：风为阳邪，卫气为阳气，阳与阳相合则损伤体表分，病虽然属于标，但治疗要寻求根本。肺主皮毛，司开阖，充元气，主清肃。清阳不升发，腠理空疏，外来风邪内舍于肺分。《内经》说：邪气聚集的地方，正气必然虚弱，正是说的这个意思。法度适宜采用东垣先生的补中益气汤，补益中气的同时兼以发散，这才是最恰当的。王公说可以服一剂，结果各种疾病都消除了。
徽商朱圣修的妻子，呕逆吐食，出多入少，吐出物多为白色泡沫状痰液，眩晕气急，半个多月了，大肌肉消瘦殆尽。治者都说这是反胃，认为吐沫是脾败的表现，已经无法挽救了。委托我调治。手少阴心脉跳动甚有力，两尺脉滑利，这是怀孕的征兆，而恶阻的症状并非翻胃。用人参、橘红、白术、半夏、苏梗、桔梗、赤茯苓、砂仁、枇杷叶、伏龙肝水煎服，三剂后呕吐减少，几剂后全愈，后来生了一个女儿。
义兄荩臣鲁学师的夫人，怀孕期间患痢疾，胸腹胀痛，饮食困难，大便脓血浓稠，小便短少。荩翁说：内人平时患有胸痛多年，在当地发病时用枳实、厚朴、槟榔、大黄等药才能见效，如果投以轻剂只会徒增困苦罢了。我听了他说的话而妄加辩解道：胸廓是肺的居所，依赖母气（脾气）的升腾，才能清肃运行灌溉四脏。一旦失调，则天气闭塞，地气冒明，冲和之气郁结而成痞塞，水谷之滞搏结而成痛，都是因为胃脘虚弱不能行气于三阴三阳的缘故。如果不培补元气以固守仓廪之虚，泛用苦寒沉降的药物，反而损伤上焦虚无之气，虽然暂时爽快，殊不知暗中损耗胃阳增加病情，所以多年不愈，日渐萎黄。况且带下更是禁忌，应当在安胎之中夹杂顺气和血的药物，这样才便于脓血愈而后重除，正气复而邪自解。用当归、白芍各二钱，白术、茯苓各钱半，陈皮、神曲各一钱，升麻、葛根各七分，煨木香、炙甘草各五分，姜枣煎服，几贴后痊愈。后来生了一个儿子，又用建中汤、理中汤加减，胸痛也痊愈了。
娄江祭酒吴梅村夫人，产后患痢疾，昼夜一百多次，不能安枕，用了通导痢疾的药后，里急后重反而加重。请我的父亲诊治，判断为阴虚阳陷。用六味地黄汤加肉桂以保护衰败的阴液，用补中益气汤加木香以提举下陷之气。大概新产之后营卫空虚，阴阳残弱，全靠孤脏之力生血生气，才可以恢复后天资生之本。既然患了痢疾，就知道元阳已虚，如果再投峻猛之剂，必定使真阴更加枯竭，只有舍弃通利之法而用固涩之法，更换寒凉药剂而用温补药剂，使得胃门关隘滋润而魄门通畅，仓廪充实而传导运化自然，精微变化、清浊调和了。可见胎前产后所依靠的是脾元，所依赖的是阳气，坤土厚实既旺，乾健自然恢复。丹溪说：产后以大补气血为主，虽有杂症以末治之。这确实是至理名言。
龚姓妇人，产后发痉，口眼歪斜不能言语，角弓反张，有时稍微好转，一会儿又发作，众医都用治风的方法治疗。我说：肝是藏血之所，也是风水的主宰。肝气为风，肝血为水，水流则风息而筋脉自然舒展。古人说治风先治血，确实是有道理的。况且产后气衰于表，血衰于里，气衰则腠理疏松而外风容易侵袭，血耗则肝木枯槁而内风煽动。所以血不养筋则角弓反张，风淫经络则唇口牵引抽动，应当用滋润的药物内养肝血直补其虚，少佐驱风之剂使同气相求得以易入。用四物汤去掉芍药，加羌活、防风、独活、钩藤、酒炒荆芥，两剂而愈。如果用辛散药物，风能燥血，辛走阳气，反而增添其困厄了。
遂安令曹绿岩的长子曹安初，少年时期嗜欲过度，真元素虚。己亥年秋天，遭遇母亲去世（丁内艰），悲痛太过，内火燔灼，肾水干涸，肌肉顿时消瘦，咳嗽咯出脓血，气味异常腥秽。延请我商量治疗。六脉洪大，重按虚豁，右寸脉独数，这是上盛下虚的征候。所谓上盛，是赫曦过极，肺中的假阳旺盛；下虚，是涸流衰竭，肾家的真阴虚损。阴虚则火独发于坎宫，津液上腾救母，渐渐炽灼反而成为稠痰。浊阴胶结于清虚之脏，久而久之肺热叶焦，腐化为痈。如果不求根本而治，则肾阴愈虚，邪火更旺，痈将溃烂。法度应当先清上焦痰火，保定肺气。用麦冬、沙参、紫菀、贝母、橘红、茯苓、甘草、桔梗、瓜蒌霜等药，在五更时服用，再用六味地黄汤加麦冬、五味子大剂量临卧服用以滋生化之源。几帖后痰清嗽减，一个月后精气充盈精神恢复。过了三年，因为受到邪术迷惑，广纳婢妾以自娱，前症复发，最终无法挽救。
晋中商人高呜轩，六十多岁，长期经历鞍马劳顿，餐风宿雾，六淫邪气侵袭经络，染成痿废之症已有三年。遍访名医都以解表为治疗方法，两脚越发无力，顽麻不仁。辛丑年初夏，正好回到海邑告诉我，服药上百种未获少许好转，自信此身永远废掉了。我说：风寒湿气乘虚而入，不思养正以补其本，这是一误；屡次解表而风邪已去，仍然发散，愈损真元，这是二误。况且气虚则麻，血虚则木，人有恒言，此症必为中风先兆。于是用神效黄芪汤加肉桂服用，才四帖麻木顿时去除，便能拄杖而行，后来用还少丹调理月余，倍往常人矍铄。
德州都谏王介清，遭遇母亲去世，患左胁顽痹，足腿麻木，按摩片刻，勉强能步履，服用清火消痰补气活血药病势不减，后服丧期满入京，邀请我的父亲诊治。见他肾肝脉虚，判断为肾虚不能生肝，肝虚不能荣血，水亏血耗经隧枯涩之症。先用四物汤加秦艽、石斛、牛膝、葳蕤。不到几剂而胁痹顿时消除，后来服用肾气丸一杯，永不复发。
秦商张玉环，感寒咳嗽，变成哮喘，口张不闭，语言不续，呀呷有声，外闻邻里，投以二陈汤、枳壳、桔梗毫不见减，延请我救治。诊六脉右手寸关俱见浮紧，重取带滑，判断为新寒外束，旧痰内搏，闭结清道，鼓动肺金。应当以三拗汤宣发外邪，涌吐痰涎为要，如果畏首畏尾漫投肤浅之剂，则风寒闭固顽痰何由解释。况且《内经》说：辛甘发散为阳，麻黄是辛甘之物，禀天地轻清之气，轻可去实，清可利肺，肺道通而痰行，痰气行而哮愈矣。于是以前药服用，果然一剂后汗出津津，一日一夜约吐痰一斗许，哮喘遂平。过了两年因为不忌口，前症复发而死亡。
茸城朱公亮的千金小姐，血枯经闭已一年多。大肌肉减去一半，饮食减少，傍晚寒热，到半夜微汗而解。我诊其脉，两手细数，证属难疗。《素问》说：二阳之病发心脾，有不得隐曲，女子不月。心统摄各经之血，脾为诸阴之首。二经乃子母之脏，其气恒相通也。病则二脏之气乘涩荣血，无以资生。故地道之不行，由心脾之气不充也。张洁古师弟首重《内经》，一以调荣培土为主，而薛新甫将逍遥归脾二方为用，使气血旺而经自通。若不培补其源，反以消坚破硬苦寒伤胃通道癸水为捷径，殊不知愈攻则虚而愈闭，其生生之源从此剥削殆尽，直至风消贲闭，虽有神丹难为治矣。不信予言，专行通道，至不起。
嘉定庠生沈来壅，食后感寒，头疼发热，胸膈胀满，医用表散消导，虽胸次稍舒，寒热愈剧，反增神昏不寐，已三传经矣。一医因病久症虚议用温补，一医颇明医理复尔消导，议论多端，邀予决之。六脉弦数不和，与寒热往来，大便溏而小便赤，此少阳经症。不可汗下与渗利，转犯他经，只宜和解，其邪易散，纵有食停，俾邪气解而食自消，此仲景先生之秘旨也。竟以小柴胡汤去人参加丹皮炒山栀花粉麦冬，一剂而神清气爽，寒热亦定。
上洋王邑尊幕宾张姓，盛暑发热，至六七日昏沉不语，面赤苔焦，与水则咽，大便不通，身艰转侧，医者束手，投柬招治。予诊毕谓王公曰：病虽危候，脉象和顺，况身体软缓，唇吻红润，气息调匀，俱为吉兆。只因邪热传人手少阴经，郁而不舒，所以面赤昏呆，口噤不语。乃以导赤散加黄连麦冬，佐犀角少许，加灯心竹叶。煎成，用刷脚抉开口，徐徐灌下，片时觉面色稍退，再剂而目开能视，三剂而语言如旧，后调理乃安。
李元吉妻，半产后血崩如注，头晕眼暗，饮食少进，面色青黄，六脉虚大无力，甚至昏晕不苏，一日数次延予治之。予曰：血脱益气，阳生阴长，《灵枢》之旨也。况阳为阴之使，阴为阳之守，今久患崩中，宜乎几微之时而欲绝，奚能固其内守之阴。所以经流不竭，皆阳气不能卫外故也。若徒事养阴止涩，是人已入井而又投之以石耳。用补中益气汤加五味艾叶服之，势不稍衰。予思古语云大虚必挟寒。再以人参一两熟附一钱煎成，呷下乃熟睡片时，醒来晕减神清，后以养荣汤去肉桂加附子，调理而安。
雷廉道潘畏庵乃郎，自幼腹痛，向以内伤调治，时或见愈，不能杜根。庚子春过龙华扫墓归，由巨浦而前适，风雨骤至，银浪排山，泊舟小港，因而受饥忍寒，痛遂大作，邀予往治。左手脉皆弦迟，右寸关虚大无力。盖此症因饮食过饱，伤其中州，嗣后食虽消而太阴分野犹然损伤，故一有不调，痛即随至。况历有岁时。中脘之阳不布，畜积痰涎，结成窠臼，即《内经》云：末传寒中之谓也。若不用温补辛散之品，其沉郁久凝之疾，焉能转否为泰乎。用异功散加桂枝半夏炮姜木香为粗末，姜煎服，痛即止，后照前方加益智仁白芍神曲，姜汤和丸，后不复发。
大学士徐元扈夫人，胃脘痛，初以气治，次以食治，继以火治，总不见效，痛至昏赜，良久复苏。延家君治之曰：夫人尊恙非气非食亦非火也。由劳碌太甚，中气受伤，脾阴弱而不化，胃阳衰而不布。阴阳并虚，仓禀壅滞，转输既弱，隧道失运，所以浊清相干，气血相搏而作痛者。若用消导则至高之气愈耗，误投寒剂则胃脘之阳益伤，为今之计非补不可。虽云痛无补法，此指邪气方锐者言也。今病势虽甚而手按略止，脉气虽大而重按稍松，则脉症俱虚不补而何。用六君子汤加香附砂仁，一剂而眩定痛止。
昭城王五松子舍，大肉削去，虚气攻冲，症情恍惚，手足麻木，不能自主，夜寤不宁。咸谓心脾之气涣散，所以脉络胀张如不束之状，所谓解（他-也+亦）者也。盖阳明为气血俱多之乡，主束骨而利机关者也。阳明戊土一虚必盗母气自养，而心亦虚，以《灵枢》云:心怵惕思虑则伤神，神伤则恐惧自失，破胭肉脱矣。治宜补心脾之气，以充元神之用，可指日而奏功。乃与归脾汤服数帖而始止。
分镇符公祖令媛，久泻肉脱，肢体浮肿，大腹胀痛，便内赤虫，形如柳叶，有口无目，更兼咳嗽烦躁，夜卧不寐，召予调治。公曰：小女之疾起于夏间，因饮食不节，淹缠半载。服利水药身肿不减，用参耆等剂胀闷益增。子细为审察，盖中央脾土喜燥而恶湿，脏腑为根本生化源头，虽云至阴之地，实操升阳之权。盛暑之际六阳外发，阴寒潜伏，加以浮瓜沉李饮冷吞寒，使乾阳之气郁坤土之中。所以气滞而湿化，湿化而热生，湿热壅滞转输不行，仓廪之精华下陷而为泄泻。久则清阳愈虚，浊阴愈盛，留于中州则为腹胀，散于肌肉则为浮肿，上乘肺分则为咳嗽。况脾为诸阴之首，肝为风木之司，湿热盛则阴虚而烦躁夜争，肝风旺则遇湿而虫形生化，头绪虽多不越木旺土衰之征。治当调脾抑肝，佐以升清降浊，使湿去土燥，病当渐去。用白术茯苓半夏芍药黄连肉桂干葛柴胡厚朴乌梅花椒等剂调理而安。
燕山中丞刘汉儒，泄泻数日，医见肝脉弦急，认为火热，用苦寒平肝反洞泄不已，筋挛少气，招家君往治。曰：此因寒气入腹，清阳不能上腾，即《素问》清气在下，则生飧泄之意也。前医以肝脉高为火，予以肝脉盛为寒，盖寒束之脉每多见弦，先哲明训班班可考，何得以寒为热耶。方以苍术白术各二钱，羌活防风各一钱，干葛炮姜各八分，升麻柴胡各五分，一剂而减。
[Old Virtue Hall Medical Cases] Main Text (3/4) Category: Medical Discourse
Mr. Cao, the eldest son of the gentleman, had conceived a fetus internally. He experienced tidal fever (periodic fever) every day at dusk, and his menstruation ceased. The attending physicians all diagnosed it as blood deficiency amenorrhea and used medications to promote menstruation, which exacerbated the chills and fever, leading to vomiting and nausea. I palpated both wrists and found the pulses slippery and agile, indicating a sign of pregnancy, not amenorrhea. The so-called chills and fever were due to qi and blood nurturing the fetal origin, unable to nourish the skin and muscles. By the fifth or sixth month, when the fetal origin was fully developed, qi and blood would naturally flourish, and the chills and fever would cease on their own. At that time, people considered my words absurd and continued to seek treatment from the original physician, who added blood-breaking agents. Suddenly, in the middle of the night, he suffered a massive hemorrhage like a spring, with frequent and severe pain, expelling a fleshy mass where the fetus had already taken shape. Before birth could occur, regret came too late; he eventually died from puerperal infection after more than a year.
Yu Gelai, a scholar, indulged in desires in his youth and lacked restraint in eating and drinking. Initially, he suffered from hypochondriac pain, followed by gastric discomfort, which gradually developed into regurgitation. Despite long-term medical treatment without effect, he invited my father to examine him. His complexion was sallow like earth, with slight redness on both malar eminences. The six pulses were fine and rapid, and he vomited immediately upon eating or drinking. Reviewing previous prescriptions, although the formulas were inconsistent, frequent use of Si Jun Zi Tang (Four Gentlemen Decoction) and Li Zhong Tang (Regulate the Middle Decoction) failed to cure him. I knew the disease was not solely in the middle jiao but was indeed "vomiting due to yin deficiency." Moreover, various types of vomiting are often related to fire, and the hypochondrium belongs to the liver and kidney regions. Therefore, I treated him with Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) plus Shi Hu (Dendrobium) and Chen Xiang (Aquilaria). After recovery, one year later, the old symptoms recurred before autumn. Since my father was traveling to Xie Li, he entrusted me with the treatment. The left guan pulse was wiry and long, indicating liver injury from anger, presenting as an isolated large pulse. I used Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder), which stabilized the condition. Two months later, due to fatigue, hunger, alcohol consumption, and anger, the previous symptoms surged again, worse than before. The six pulses were weak and soft, with hypochondriac pain and distension. Lying down caused suffocation and a feeling of impending death. This was a case of extreme deficiency presenting with excess signs, a contradiction between pulse and symptoms, which is medically untreatable. His father insisted on a prescription, still using Xiao Yao San. A subsequent doctor used Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) for over twenty doses. The hypochondriac distension slightly eased, but pain persisted. He coughed up thick, bloody sputum with a foul odor. Seeking my treatment again, his previously weak pulse had become as thin as spider silk. His eyes showed white sclera, he had shortness of breath and hoarseness. His spleen yuan was severely damaged, and lung qi was precarious. This was a malignant sign of Fei Wei (Lung Withering). At this time, winter water qi was weakening, while spring wood qi was strong. Delaying until winter allowed assistance from kidney water. Remembering the 10th day was Li Chun (Start of Spring), when wood qi arrived at its official stage, the lung was insulted by wood, and the spleen was controlled by wood. How could he survive? Indeed, he died at Yin hour on the 10th.
Su Jun, accustomed to hard labor, traveled far during the summer heat. Consequently, he felt chest oppression and continuous hiccups. For eight days, his voice reached neighbors, accompanied by profuse sweating and interrupted speech. Having tried countless remedies without effect, his family was terrified and sought my help. Although his pulse still had root, and the nose tip, Nian Shou area, and facial lines were moist and lustrous, indicating preserved vitality, relying solely on decoctions might fail to restore scattered yang and eliminate latent yin. I advised moxibustion on Qi Men (LR14) for three cones, along with Guan Yuan (CV4) and Qi Hai (CV6). Then, I prescribed a large dose of Si Jun Zi Tang (Four Gentlemen Decoction) with Pao Jiang (Baked Ginger) and Rou Gui (Cinnamon Bark) as assistants, and Ding Xiang (Clove) and Shi Di (Persimmon Calyx) as guides, attacking from both inside and outside. It is like adding fuel to the bottom of a pot; steam rises, and the middle jiao warms up. With four elements returning to spring, why worry about lingering yin shadows or unrecovered true yang? Indeed, the hiccups stopped after one moxibustion session, and full recovery followed after further medication. Everyone marveled at the miracle.
Magistrate Wang of Yunjian suffered from wind-cold with nasal congestion and stabbing pain throughout the body. Wanting to use exterior-releasing agents, he invited me to discuss treatment. The six pulses were floating and deficient. I said: Wind is a yang pathogen, and Wei Qi (Defensive Qi) is yang energy. When yang combines with yang, the exterior is injured. Although the disease manifests as superficial, treatment must address the root. The Lung governs skin and hair, controls opening and closing, fills yuan qi, and maintains clarity and descending function. If clear yang does not ascend, pores become loose, allowing external wind pathogens to enter the Lung. As the Classic states: "Where evil gathers, qi must be deficient." The appropriate method is Dong Yuan's Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), which tonifies while releasing the exterior. This is most appropriate. Mr. Wang agreed to take one dose, and all diseases were eliminated.
The wife of Merchant Zhu Xiuxiu from Hui suffered from retching and vomiting food, with more output than intake. She vomited white frothy phlegm, experienced dizziness and shortness of breath, and had lost significant muscle mass for over half a month. Physicians diagnosed it as regurgitation, claiming that vomiting phlegm indicated spleen failure and incurability. She entrusted me with treatment. Her Hand-Shaoyin (Heart) pulse beat strongly, and both Chi (Kidney) pulses were slippery and agile, indicating pregnancy. The symptoms of morning sickness were not regurgitation. I prescribed Ren Shen (Ginseng), Ju Hong (Tangerine Peel), Bai Zhu (Atractylodes Macrocephala), Ban Xia (Pinellia), Su Geng (Perilla Stem), Jie Geng (Platycodon), Chi Fu Ling (Red Poria), Sha Ren (Amomum), Pi Pa Ye (Loquat Leaf), and Fu Long Gan (Stove Soil) decocted in water. After three doses, vomiting decreased; after several doses, she fully recovered and later gave birth to a daughter.
The wife of Scholar Lu Jinchen, my sworn brother, suffered from dysentery during pregnancy, with chest and abdominal pain, difficulty eating, thick bloody stools, and scanty urine. Mr. Lu said: "My wife has suffered from chest pain for years. In our region, only heavy drugs like Zhi Shi (Immature Bitter Orange), Hou Po (Magnolia Bark), Bing Lang (Areca Seed), and Da Huang (Rhubarb) work. Light drugs will only increase her suffering." Listening to him, I reasoned: The chest is the residence of the Lung, relying on maternal qi (Spleen qi) to ascend and circulate clearly to irrigate the four zang organs. Once disordered, heavenly qi closes, earthly qi obscures, harmonious qi stagnates causing obstruction, and food stagnation causes pain. This is because the stomach is weak and cannot move qi through the three yin and three yang channels. If we do not tonify yuan qi to secure the granary, and instead indiscriminately use bitter-cold descending drugs, we damage the empty qi of the upper jiao. Though temporarily relieved, we secretly harm stomach yang and worsen the disease. Hence, it persists for years, leading to emaciation. Also, leukorrhea is strictly contraindicated. We should calm the fetus while regulating qi and blood, so that pus clears and tenesmus resolves, righteous qi recovers, and evil dissipates. I prescribed Dang Gui (Angelica Sinensis) and Bai Shao (White Peony Root) each 2 qian, Bai Zhu and Fu Ling (Poria) each 1.5 qian, Chen Pi (Tangerine Peel) and Shen Qu (Medicated Leaven) each 1 qian, Sheng Ma (Cimicifuga) and Ge Gen (Kudzu Root) each 7 fen, Wei Mu Xiang (Baked Costus Root) and Zhi Gan Cao (Prepared Licorice) each 5 fen, decocted with ginger and jujube. After several applications, she recovered. Later, she gave birth to a son. Using modified Jian Zhong Tang and Li Zhong Tang, her chest pain also healed.
Madam Wu Meicun, Prefect Instructor of Loujiang, suffered from dysentery postpartum, visiting the toilet over a hundred times day and night, unable to sleep. Using purgatives for dysentery worsened the tenesmus. My father examined her and diagnosed yin deficiency with yang sinking. He used Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) plus Rou Gui (Cinnamon Bark) to preserve declining yin, and Bu Zhong Yi Qi Tang plus Mu Xiang (Aucklandia) to lift sinking qi. Generally, after childbirth, Ying and Wei are empty, and yin and yang are weak. Only the solitary organ's power can generate blood and qi to restore the postnatal foundation. Since she had dysentery, we know yuan yang is deficient. Using harsh drugs would deplete true yin further. We must abandon purgation for consolidation, and cold drugs for warm ones. This moistens the stomach gate and allows the魄门 (anus) to flow freely. When the granary is full, transmission and transformation occur naturally, refining essence and harmonizing clear and turbid. Thus, for prenatal and postnatal conditions, we rely on spleen yuan and yang qi. When Kun (Earth) is thick and prosperous, Qian (Heaven) restores itself naturally. Danxi said: "Postpartum treatment focuses mainly on tonifying qi and blood; other symptoms are secondary." This is truly correct.
Mrs. Gong, postpartum convulsions, facial deviation, inability to speak, opisthotonos. Sometimes improved slightly, then relapsed. All doctors treated it as wind. I said: The Liver stores blood and governs wind and water. Liver qi is wind; liver blood is water. Flowing water extinguishes wind, and tendons relax. The ancients said: "To treat wind, first treat blood." This is true. Postpartum, qi declines at the exterior, blood declines internally. Qi decline makes pores loose, inviting external wind. Blood depletion causes liver wood to wither, stirring internal wind. Blood failing to nourish tendons causes opisthotonos; wind invading meridians causes lip and mouth twitching. We should use moisturizing herbs to nourish liver blood and fill deficiency, with a little wind-dispelling agent to facilitate entry via similar qi affinity. I used Si Wu Tang (Four Substances Decoction) removing Shao Yao (Peony), adding Qiang Huo (Notopterygium), Fang Feng (Saposhnikovia), Du Huo (Angelica Pubescens), Gou Teng (Uncaria), and Jing Jie (Schizonepeta) fried with wine. After two doses, she recovered. Using acrid-dispersing drugs would allow wind to dry blood and acridity to scatter yang, worsening her condition.
Cao Anchu, eldest son of Magistrate Cao Luyan of Sui'an, indulged in desires in his youth, leaving his true yuan deficient. In the autumn of Ji Hai, he mourned his mother's death excessively. Internal fire blazed, kidney water dried up, muscles instantly wasted, and he coughed up purulent blood with abnormal fetor. I consulted on treatment. The six pulses were surging and large, but hollow upon deep pressure. The right cun pulse was exclusively rapid. This is upper excess and lower deficiency. Upper excess is extreme brightness, false yang flourishing in the lung. Lower deficiency is dried-up flow, true yin deficiency in the kidney. Yin deficiency causes fire to erupt in the Kan palace. Fluids rise to save the mother (metal), becoming scalding and turning into thick phlegm. Turbid yin knots in the clear organ. Over time, lung heat scorches leaves, rotting into an abscess. If we don't treat the root, kidney yin becomes more deficient, evil fire stronger, and the abscess will ulcerate. The method should first clear upper jiao phlegm-fire and stabilize lung qi. Take Mai Dong (Ophiopogon), Sha Shen (Glehnia), Zi Wan (Aster), Bei Mu (Fritillaria), Ju Hong, Fu Ling, Gan Cao (Licorice), Jie Geng, Gua Lou Shuang (Trichosanthes Frost) at dawn. Then take Liu Wei Di Huang Wan plus Mai Dong and Wu Wei Zi (Schisandra) in large doses before bed to nourish the source of transformation. After several doses, phlegm cleared and cough reduced. Within a month, essence filled and spirit recovered. Three years later, seduced by evil arts, he took many concubines for pleasure. The previous symptoms recurred, and he died irretrievably.
Merchant Gao Wuxuan from Jinzhong, over sixty years old, endured long journeys on horseback, exposed to wind and fog. Six evens invaded his meridians, causing flaccidity paralysis for three years. Visiting famous doctors, all treated with exterior release. His legs became weaker, numb and insensible. In early summer of Xin Chou, he returned to Haiyi and told me. Taking hundreds of medicines yielded no improvement. He believed he was permanently disabled. I said: Wind, cold, and dampness entered due to deficiency. Not nourishing righteousness to tonify the root is the first error. Repeatedly releasing the exterior after wind-cold is gone, yet continuing dispersion, damages true yuan further—this is the second error. Qi deficiency causes numbness; blood deficiency causes insensibility. People say this is a precursor to stroke. I prescribed Shen Xiao Huang Qi Tang (Miraculous Effect Astragalus Decoction) plus Rou Gui (Cinnamon Bark). After only four doses, numbness vanished, and he could walk with a cane. Later, treating with Hai Shao Dan (Restore Youth Pill) for a month made him twice as vigorous as usual.
Wang Jieqing, Censor of Dezhou, mourned his mother. He suffered from stubborn bi-syndrome in the left hypochondrium, numbness in legs and feet. Massage allowed brief walking. Clearing fire, resolving phlegm, tonifying qi, and invigorating blood did not reduce the disease. After mourning ended, he went to Beijing and invited my father to diagnose. Kidney and liver pulses were deficient. Diagnosed as kidney deficiency failing to generate liver, liver deficiency failing to nourish blood, water depletion and blood loss causing dry meridians. First, Si Wu Tang plus Qin Jiao (Gentiana), Shi Hu (Dendrobium), Niu Xi (Achyranthes), and Wei Rui (Polygonatum). In a few doses, hypochondriac bi-syndrome disappeared. Later, taking Shen Qi Wan (Kidney Qi Pill) once prevented recurrence forever.
Zhang Yuhuan, merchant from Qin, caught cold and cough, developing asthma. Mouth open and unable to close, speech interrupted, wheezing sounds audible to neighbors. Er Chen Tang, Zhi Ke (Aurantium), and Jie Geng had no effect. I was summoned to save him. Right hand cun and guan pulses were floating and tight, slippery upon deep pressure. Diagnosed as new cold binding externally, old phlegm clashing internally, blocking clear pathways, agitating lung metal. San Ao Tang (Three Unbinding Decoction) should be used to release external evil and induce vomiting of phlegm. Hesitation and superficial drugs cannot resolve closed wind-cold and stubborn phlegm. As the Classic says: "Acrid and sweet disperse yang." Ma Huang (Ephedra) is acrid and sweet, inheriting light and clear qi. Light can remove excess; clear can benefit the lung. When lung pathways open, phlegm moves; when phlegm-qi moves, asthma heals. Taking these herbs, indeed, after one dose, he sweated profusely. In one day and night, he vomited about a dou of phlegm, and asthma subsided. Two years later, due to dietary indiscretion, the previous symptoms recurred, and he died.
Miss Zhu, daughter of Lord Zhu Liang from Rongcheng, had blood-deficiency amenorrhea for over a year. Muscle mass halved, appetite decreased, evening chills and fever, resolving with slight sweat at midnight. I palpated her pulse: both hands fine and rapid. The syndrome was difficult to treat. The Su Wen states: "Diseases of the Two Yang originate in Heart and Spleen. Those with hidden grievances do not menstruate." The Heart governs blood of all meridians; the Spleen is head of all yin. These two are mother and child organs, their qi always connected. Disease causes qi stagnation, obstructing nutritive blood, lacking resources. Thus, menstrual flow fails because heart and spleen qi are insufficient. Zhang Jiegu valued the Nei Jing, focusing on regulating nutritive qi and cultivating earth. Xue Xinpu used Xiao Yao San and Gui Pi Tang, making qi and blood flourish so menstruation flows naturally. If we don't tonify the source, but use bitter-cold drugs to break hardness and force guiyin water, we don't realize that attacking more leads to greater deficiency and closure. The source of life is exhausted. Until wind consumes and贲闭 (cardiac constriction) occurs, even divine pills cannot cure. Disbelieving my words, she insisted on forcing menstruation and died.
Shen Laiyong, student of Jiading, caught cold after eating. Headache, fever, chest and diaphragm fullness. Doctors used exterior release and digestion-promoting drugs. Chest comfort slightly improved, but chills and fever worsened, increasing confusion and insomnia. The pathogen had passed through three meridians. One doctor proposed warming and tonifying due to chronic deficiency. Another, understanding medicine, suggested digestion promotion. Many opinions arose, inviting me to decide. Six pulses were wiry, rapid, and discordant. Alternating chills and fever, loose stool, red urine. This is Shaoyang meridian syndrome. Do not use sweating, purging, or diuresis, lest it invade other meridians. Only harmonization disperses the evil easily. Even with food stagnation, resolving evil eliminates food. This is Zhongjing's secret principle. I used Xiao Chai Hu Tang (Minor Bupleurum Decoction) removing Ren Shen, adding Dan Pi (Moutan), Chao Shan Zhi (Fried Gardenia), Hua Fen (Trichosanthes Root), and Mai Dong. After one dose, spirit cleared, mind refreshed, and chills/fever settled.
Zhang, secretary of Prefect Wang of Shangyang, suffered fever in midsummer. By day six or seven, he was comatose and mute, face red, coating scorched, swallowing water, constipation, difficulty turning body. Doctors were helpless. Invited me. After diagnosis, I told Mr. Wang: "Though critical, pulse is harmonious. Body is soft, lips red, breath regular—all auspicious signs. Only evil heat transmitted to Hand-Shaoyin meridian, stagnant and unsmooth, causing red face, coma, and locked jaw." I used Dao Chi San (Guide Out Redness Decoction) plus Huang Lian (Coptis), Mai Dong, a little Xi Jiao (Rhinoceros Horn - substitute usually used now), Deng Xin Cao (Juncus), and Zhu Ye (Bamboo Leaf). Decocted, opened mouth with brush, slowly administered. Soon, face color faded. After two doses, eyes opened and vision returned. After three doses, speech resumed. Later conditioning led to peace.
Li Yuanji's wife, post-miscarriage massive hemorrhage, dizziness, blurred vision, poor appetite, green-yellow complexion, six pulses large, deficient, and weak. Even fainting repeatedly, several times a day. I said: "Blood loss requires tonifying qi. Yang generates yin," the principle of Ling Shu. Yang is the guide of yin; yin is the guardian of yang. Now, long-term bleeding means at the critical moment, yin is about to perish. How can inner-guarding yin be secured? So, menstrual flow doesn't stop because yang fails to guard the exterior. Merely nourishing yin and astringing is like throwing stones into a well where someone has fallen. I used Bu Zhong Yi Qi Tang plus Wu Wei Zi (Schisandra) and Ai Ye (Mugwort). Condition didn't subside. Recalling ancient saying: "Great deficiency must involve cold." I added Ren Shen (Ginseng) 1 liang and Shu Fu Zi (Prepared Aconite) 1 qian, decocted and sipped. She slept soundly for a while. Waking up, dizziness reduced, spirit cleared. Later, Yang Rong Tang (Nourish Prosperity Decoction) removing Rou Gui, adding Fu Zi, conditioned her to safety.
Son of Pan Wei'an, Circuit Intendant of Leilian, had abdominal pain since childhood, treated internally, sometimes improving but never cured. In spring of Geng Zi, returning from tomb-sweeping at Longhua, near Jupu, sudden storm, huge waves, boat docked in small port. Hungry and cold, pain erupted. I was called. Left hand pulses were wiry and slow. Right cun and guan were large, deficient, and weak. This disease resulted from overeating, injuring middle jiao. Later, though food digested, Taiyin region remained damaged. Any imbalance brings pain. Years passed. Yang of Zhong Wan (Conception Vessel intersection) didn't spread, accumulating phlegm-fluids forming nests. As Nei Jing says: "Late transmission to cold center." Without warm-tonifying and acrid-dispersing drugs, how can deep, stagnant, long-condensed illness turn from bad to good? I used Yi Gong San (Extraordinary Merit Powder) plus Gui Zhi (Cinnamon Twig), Ban Xia (Pinellia), Pao Jiang, Mu Xiang (Aucklandia) ground coarse, decocted with ginger. Pain stopped. Later, adding Yi Zhi Ren (Alpinia), Bai Shao, Shen Qu, pilled with ginger soup. No recurrence.
Madam Xu Yuanhu, Grand Secretary, suffered epigastric pain. Initially treated for qi, then food, then fire, all ineffective. Pain caused fainting, recovering slowly. My father treated her: "Your ladyship's ailment is neither qi, nor food, nor fire. It stems from excessive toil, injuring middle qi. Spleen yin is weak and fails to transform; stomach yang is衰 (declining) and fails to spread. Both yin and yang are deficient. Granary is blocked, transport weak, tunnels lose movement. Thus, turbid and clear interfere, qi and blood clash causing pain. Using digestion promotes consumes high qi. Misusing cold drugs harms stomach yang further. Current plan must be tonification. Though 'pain has no tonification method,' this refers to acute evil. Now, disease is severe but pressing stops it slightly. Pulse is large but loose on deep pressure. Pulse and symptoms are both deficient. Why not tonify?" Used Liu Jun Zi Tang (Six Gentlemen Decoction) plus Xiang Fu (Cyperus) and Sha Ren. After one dose, dizziness settled, pain stopped.
Wu Songzi's son from Zhaocheng, muscle mass wasted, deficient qi attacking, mental confusion, limb numbness, involuntary movements, restless at night. All said heart and spleen qi scattered, meridians distended like unbundled ropes, so-called "jie ye" (loosening). Yangming is where qi and blood abound, binding bones and facilitating joints. If Yangming Earth (Wei) is deficient, it steals mother qi to nourish itself, and Heart becomes deficient. Ling Shu says: "Fear, alarm, and thought injure spirit. Spirit injured leads to fear and self-loss, breaking flesh and wasting away." Treatment should tonify heart and spleen qi to fill yuan spirit, achieving results quickly. Prescribed Gui Pi Tang (Restore the Spleen Decoction). After several doses, it stopped.
Daughter of Commander Fu, prolonged diarrhea with muscle wasting, limb edema, abdominal distension and pain, bloody worms in stool like willow leaves, mouth but no eyes, plus cough, irritability, insomnia. Summoned me. Father said: "Daughter's illness started in summer, irregular diet, lingering half a year. Water-draining drugs didn't reduce swelling; Ginseng and Astragalus increased distension." Careful examination: Central Spleen Earth likes dryness and dislikes dampness. Zang-fu are roots of transformation. Though yin place, it controls ascending yang. Midsummer, six yang emit outward, yin cold hides. Plus eating cold fruits and drinks, trapping Qian Yang qi in Kun Earth. Thus, qi stagnates transforming to dampness; dampness transforms to heat. Damp-heat blocks transport, essence sinks causing diarrhea. Long term, clear yang more deficient, turbid yin more abundant. Staying in middle jiao causes distension; scattering in muscles causes edema; rising to lung causes cough. Spleen is head of yin; Liver governs wind-wood. Damp-heat excess causes yin deficiency and night irritability. Liver wind旺 (flourishing) meets dampness generating worms. Many threads, but all point to Wood flourishing and Earth declining. Treatment: Regulate spleen, suppress liver, assist ascending clear and descending turbid. Remove dampness, dry earth, disease fades. Used Bai Zhu, Fu Ling, Ban Xia, Bai Shao, Huang Lian, Rou Gui, Ge Gen, Chai Hu, Hou Po, Mei Hua (Plum Flower), Hua Jiao (Sichuan Pepper). Conditioned to safety.
Liu Hanru, Viceroys of Yan Shan, diarrhea for days. Doctor saw wiry-tight liver pulse, diagnosed fire, used bitter-cold to calm liver. Resulted in hole-like diarrhea, tendon cramps, shortness of breath. Invited my father. Said: "This is cold qi entering abdomen, clear yang cannot ascend. As Su Wen says: 'Clear qi below generates undigested stool diarrhea.' Previous doctor saw high liver pulse as fire; I see full liver pulse as cold. Cold-binding pulses often appear wiry. Ancient teachings are clear. How can cold be mistaken for heat?" Formula: Cang Zhu (Atractylodes Lancea) and Bai Zhu each 2 qian, Qiang Huo and Fang Feng each 1 qian, Ge Gen and Pao Jiang each 8 fen, Sheng Ma and Chai Hu each 5 fen. One dose reduced symptoms.