余季子于丁巳正月生于燕邸，及白露时甫及半周，余见新凉日至，虞 褥之薄，恐为寒气所侵
，每切嘱眷属保护之，而眷属不以为意，及数日后，果至吐泻大作，余即用温胃和脾之药，不效。
随用理中等剂，亦不效。三日后，加人参三钱，及姜、桂、吴茱、内豆蔻之类，亦不效。至四五日
，则随乳随吐，吐其半而泻其半，腹中毫无所留矣。余不得已，乃用人参五、六钱，制附子、姜、
桂等各一、二钱，下咽即吐，一滴不存，而所下之乳则白洁无气，仍犹乳也。斯时也，其形气之危
，已万无生理矣。余含泪静坐书室，默测其故，且度其寒气犯胃而吐泻不止，若舍参、姜、桂、附
、之属，尚何术焉？伎已止此，窘莫甚矣。思之思之，忽于夜半而生意起，谓其胃虚已极，但药之
气味略有不投，则胃不能受，随拒而出，矧附子味咸，亦能致呕，必其故也。因自度气味，酌其所
宜，似必得甘辣可口之药，庶乎胃气可安，尚有生意。乃用胡椒三钱，捣碎，加煨姜一两，用水二
钟，煎至八分，另盛听用。又用人参二两，亦用水二钟，煎至一钟，另盛听用。用此二者，取其气
味之甘辛纯正也。乃用茶匙挑合二者，以配其味，凡用参汤之十，加椒姜扬之一，其味微甘而辣，
正得可口之宜。遂温置热汤中，徐徐挑而与之，陆续渐进，经一时许，皆咽而不吐，竟得获效，自
后乳药皆安，但泻仍未止也。此自四鼓服起，至午未间，已尽二两之参矣。参尽后，忽尔躁扰呻吟
，烦剧之甚，家人皆怨，谓以婴儿娇嫩，脏腑何堪此等热药。是必烧断肚肠也，相与抱泣。余虽疑
之而不为乱，仍宁神熟思之，意此药自四鼓至此，若果药有难堪，何于午前相安，而此时遽变若此
？其必数日不食，胃气新复，而仓廪空虚，饥甚则然也。傍有预备之粥，取以示之，则张皇欲得，
其状甚急，乃与一小盏，辄鲸吞虎嗜，又望其余，遂复与半碗，犹然不足，又与半惋，遂寂然安卧
矣。至次日，复加制附，始得为止全愈。呜呼！此儿之重生，固有天命，然原其所致之因，则人之
脏气皆系于背，褥薄夜寒，则寒从背俞而入，内干于脏，中必深矣，原其所治之法，则用药虽当，
而气味不投无以相入，求效难矣。及其内饥发躁，使非神悟其机，倘妄用清凉，一解则全功尽弃，
害可言哉。
故余笔此，以见病原之轻重，气味之相关，及延医之活变有如此关系者。虽然，此特以己之儿
，故可信心救疗如是，设以他人之子，有同是病者，于用参数钱之时，见其未效，不知药未及病，
必且烦言吠起，谤其误治，改用苦寒，无不即死，而仍归罪于用参者，此时黑白将焉辨之？故再赘
其详，用以广人之闻见云。
都FS 钱旭阳长郎，年及两周，季夏间以生果伤脾，因致先泻后痢。旭阳善医，知其不过伤于
生冷，乃与参、术、姜、桂、温脾等药，泻痢不愈，而渐至唇口生疮。乃谋之余，曰∶此儿明为生
冷所伤，今不利温药，将奈之何？余曰∶此因泻伤阴，兼之幸辣遽入，而虚火上炎耳，非易以附子
，不能使火归原也。因用二剂，而唇口疮痛，咽肿倍甚，外见于头面之间，而病更剧矣。又谋之余
曰∶用药不投如此，岂真因湿生热耶？余诊之曰∶上之脉息，下之所出，皆作真热，本属阳虚。今
热之不效，虽属可疑，然究其所归，寒之则死，必无疑也。意者，药犹未及耳。旭阳曰∶尚有一证
似属真寒，今其所用汤饮，必欲极滚极热者，余等不能入口，而彼则安然吞之，即其喉口肿痛如此
，所罔顾也，岂其证乎？余曰∶是矣，是矣。遂复增附子一钱五分，及姜、桂、肉果、人参、熟地
之属，其泻渐止，泻止而喉口等证，不一日而全收矣。疑似之间，难辨如此，使非有确持之见，万
无一生矣。余自经此以来，渐至不惑，后有数儿，证治大同者，俱得保全。亿，此不惑之道，其要
何居？在知本之所在耳，临证者可无慎哉！
我的第四个儿子在丁巳年正月出生于北京的宅邸，等到白露节气时刚满两周岁。我见新凉之气日益加重，担心他盖的褥子太薄，恐怕会被寒气侵袭，因此反复叮嘱家人好好保护他，但家人们并不在意。几天后，孩子果然出现了严重的呕吐和腹泻。我立即使用了温胃健脾的药物，但没有效果。随后改用理中汤的中剂量，依然无效。三天后，我在方中加入人参三钱，以及生姜、肉桂、吴茱萸、肉豆蔻等药材，仍然无效。到了第四五天，孩子吃多少吐多少，吐出一半，拉出一半，肚子里已经没有任何存留了。我不得已，将人参用量增至五到六钱，并加入制附子、生姜、肉桂各一到二钱，但药液刚咽下就吐出来，一滴也留不住，而排出的乳汁洁白无异味，看起来还是正常的乳汁。此时，孩子的形体和元气已经极度危险，完全没有生存的希望了。我含着泪静坐在书房里，默默推测病因，心想他的寒气侵犯胃部导致吐泻不止，如果舍弃人参、生姜、肉桂、附子这类药物，还有什么办法呢？医术已穷尽于此，处境窘迫到了极点。思来想去，半夜时分忽然有了生机：我认为他的胃气虚损到了极点，只要药物的气味稍微不合胃口，胃就无法受纳，随即排斥吐出，况且附子味咸，也可能引起呕吐，这大概就是原因所在。于是我自己揣摩药性气味，斟酌适宜的搭配，觉得必须找到甘辣可口的药物，才能使胃气安定，尚有一线生机。于是我取胡椒三钱，捣碎，加入煨姜一两，用水两碗，煎至八分，另盛起来备用。又取人参二两，同样用水两碗，煎至一碗，另盛起来备用。使用这两种药，是取其气味甘辛纯正。然后用茶匙挑取两者混合，调配味道，凡是十份参汤，加一份椒姜汁，味道微甘带辣，正好符合可口的需求。于是将其放在热水中保温，慢慢用勺子喂给他，陆续逐渐增加剂量，经过大约一个小时，都能咽下而不吐，竟然获得了疗效，此后喝奶吃药都安稳了，只是腹泻仍未停止。从四更天开始服药，到中午前后，已经服完了二两人参。参汤服完后，孩子突然烦躁不安、呻吟，痛苦非常剧烈，家人们都很埋怨，认为婴儿娇嫩，脏腑怎能承受如此热性的药物，一定是烧断了肚肠，大家抱头痛哭。我虽然对此有所怀疑，但没有慌乱，仍凝神深思：这些药从四更天吃到现在，如果药性真的难以忍受，为何午前还相安无事，而此时却突然变成这样？这一定是因为几天没吃东西，胃气刚刚恢复，但肠胃空虚，饥饿所致。旁边有预备好的粥，拿给他们看，他们急切地想要，神情很急迫，于是给了一小盏，他们就大口吞咽，还想要剩下的，于是又给了半碗，仍然不够，再给半碗，这才安静地躺下了。到了第二天，再加入制附子，才彻底痊愈。唉！这个孩子的重生，固然有天命因素，但追溯致病原因，人的脏气都与背部有关，褥子薄夜间寒冷，寒气从背俞穴进入体内，内伤脏腑，程度必然很深。追溯治疗方法，用药方向虽然正确，但如果气味不合，无法被身体接受，求效就很难了。当出现因饥饿引发的躁动时，如果不是我神悟其中的机理，倘若妄用清凉药物，一解表则之前的全部努力都会前功尽弃，危害岂能言说？
所以我写下这篇文字，以说明病情的轻重、药物气味的关系，以及医生临证活变的重要性。虽然如此，这只是针对我自己的儿子，所以可以有信心这样救治；如果是别人的孩子，患有同样的病，在用参数钱的时候，看到没有效果，不知道是药力尚未到达病所，一定会抱怨指责，认为是误治，改用苦寒药物，无不立即死亡，最后仍将罪责归咎于用人参的人，这时候黑白又将如何分辨呢？所以我再次详细赘述，用来开阔人们的见闻。
都指挥使钱旭阳的长子，年满两周岁，夏季末因生水果损伤脾脏，导致先腹泻后痢疾。钱旭阳擅长医术，知道这不过是生冷所伤，于是给予人参、白术、生姜、肉桂等温脾药物，但泻痢未愈，反而逐渐发展到唇口生疮。于是他向我请教，说：“这孩子明明是生冷所伤，现在不用温药，该怎么办？”我说：“这是因为腹泻伤了阴液，加上辛辣药物突然进入，导致虚火上炎罢了，如果不换用附子，不能使火回归本源。”于是用了两剂药，结果唇口疮痛、咽喉肿胀更加严重，表现在头面部，病情更重了。他又来找我商量，说：“用药如此不合，难道真的是湿邪化热吗？”我诊察脉象，说：“上面的脉象和下部的排泄物，都表现为真热，但这本质属于阳虚。现在用热药无效，虽然令人可疑，但究其根本，如果用寒药则会致死，这一点毫无疑问。我想可能是药力还未达到病所。”钱旭阳说：“还有一个症状似乎属于真寒，就是他现在喝的汤饮，一定要极滚极热的，我们喝不下去，他却安然吞下，即使喉口肿痛如此，他也顾不上了，这难道不是证据吗？”我说：“对，对。”于是再次增加附子一钱五分，以及生姜、肉桂、肉豆蔻、人参、熟地黄等药物，腹泻逐渐停止，腹泻停止后，喉口等症状也在一天之内完全消退。在疑似之间，辨别困难到这种地步，如果不是有坚定的见解，绝对没有一线生机。我自从经历此事以来，渐渐达到了“不惑”的境界，后来有几个孩子，证候治疗大同小异的，都得到了保全。思考一下，这种“不惑”的关键在哪里？在于知道疾病的根本所在罢了，临证诊治的人能不谨慎吗！
My fourth son was born in the first month of the Ding Si year at our residence in Yanjing (Beijing). By the time of the White Dew solar term, he had just turned two years old. Observing that the new coolness was increasing day by day, I feared that his thin mattress might allow cold pathogenic factors to invade his body. I repeatedly instructed my family members to protect him carefully, but they did not take it seriously. A few days later, he indeed suffered from severe vomiting and diarrhea. I immediately administered herbs for warming the stomach and harmonizing the spleen, but there was no effect. Subsequently, I used a medium dose of Lizhong Tang (Regulate the Middle Decoction), which also failed. Three days later, I added San Qian (Three Mace) of Renshen (Ginseng Radix et Rhizoma), along with Shengjiang (Zingiberis Rhizoma Recens, Fresh Ginger), Rougui (Cinnamomi Cortex, Cinnamon Bark), Wuzhuyu (Evodiae Fructus, Evodia Fruit), and Neidoukou (Myristicae Semen, Nutmeg), yet still no effect. By the fourth or fifth day, he vomited whatever he breastfed; half was vomited out and half passed as diarrhea, leaving nothing remaining in his abdomen. Desperate, I increased the dosage of Renshen (Ginseng Radix et Rhizoma, Ginseng Root) to five or six qian, and added Zhi Fuzi (Prepared Aconiti Lateralis Radix, Prepared Child Root of Monkshood), Shengjiang (Zingiberis Rhizoma Recens, Fresh Ginger), and Rougui (Cinnamomi Cortex, Cinnamon Bark), each one or two qian. However, as soon as the medicine entered his throat, he vomited it up, retaining not a single drop. The milk he expelled was white, clean, and odorless, appearing unchanged. At this moment, his physical form and vital qi were critically endangered, with absolutely no hope of survival. Holding back tears, I sat quietly in my study, silently pondering the cause. I reasoned that cold invading the stomach caused persistent vomiting and diarrhea; if I abandoned herbs like Renshen (Ginseng Radix et Rhizoma, Ginseng Root), Shengjiang (Zingiberis Rhizoma Recens, Fresh Ginger), Rougui (Cinnamomi Cortex, Cinnamon Bark), and Fuzi (Aconiti Lateralis Radix Praeparata, Prepared Child Root of Monkshood), what other methods remained? My skills seemed exhausted, and I was in an extremely difficult predicament. After much thought, a glimmer of hope arose at midnight. I surmised that his Stomach Qi (Vital Energy of the Stomach) was extremely deficient. If the flavor and aroma of the medicine were slightly incompatible, his Stomach would reject it and expel it. Moreover, Fuzi (Aconiti Lateralis Radix Praeparata, Prepared Child Root of Monkshood) has a salty taste, which can also induce vomiting; this must be the reason. Therefore, I personally evaluated the flavors and aromas, adjusting them to suit his needs. I believed that only a medicine with a sweet and spicy, palatable flavor could stabilize his Stomach Qi and preserve a chance of life. Thus, I took three qian of Hujiao (Piperis Longi Fructus, Long Pepper Fruit), crushed it, added one liang of Wei Jiang (Zingiberis Rhizoma, Roasted Ginger), and decocted it in two bowls of water until reduced to eight-tenths. This was set aside separately. Additionally, I took two liang of Renshen (Ginseng Radix et Rhizoma, Ginseng Root), decocted it in two bowls of water until reduced to one bowl, and set it aside separately. Using these two preparations aimed to utilize their pure and correct sweet and acrid aromas. I then used a tea spoon to mix them, combining ten parts of the Ginseng decoction with one part of the Pepper-Ginger mixture. The resulting flavor was mildly sweet and spicy, perfectly palatable. I kept it warm in hot water and slowly fed it to him spoonful by spoonful, gradually increasing the amount. After about an hour, he swallowed everything without vomiting, and we finally achieved efficacy. From then on, he tolerated both milk and medicine well, although the diarrhea persisted. Starting from the Fourth Watch (11 PM–1 AM), by midday, he had consumed two liang of Renshen (Ginseng Radix et Rhizoma, Ginseng Root). After finishing the Ginseng decoction, he suddenly became restless and moaned in severe pain. His family members complained, arguing that an infant’s delicate organs could not withstand such hot-natured herbs, fearing his intestines were burned. They hugged and cried. Although I suspected something else, I remained calm and thought deeply: If the medicine were truly intolerable, why was he stable during the morning hours, and why did the condition change drastically now? It must be due to several days of fasting; his Stomach Qi had just recovered, but his digestive tract was empty, causing distress from extreme hunger. There was prepared congee nearby. Showing it to them, they eagerly desired it, looking very anxious. I gave them a small cup, which they gulped down greedily, asking for more. I then gave half a bowl, which was still insufficient, so I gave another half bowl. Only then did he lie down quietly. On the next day, after adding Zhi Fuzi (Prepared Aconiti Lateralis Radix, Prepared Child Root of Monkshood), he completely recovered. Alas! The rebirth of this child was undoubtedly influenced by destiny. However, tracing the cause, the internal organs are connected to the back. Thin mattresses and night cold allowed cold to enter through the Back-Shu points (Acupoints on the back), affecting the internal organs deeply. Tracing the treatment, although the direction of medication was correct, if the flavor and aroma were incompatible and could not be absorbed, achieving efficacy would be difficult. When internal hunger triggered restlessness, if I had not intuitively grasped the mechanism, and had recklessly used cooling herbs, all previous efforts would have been wasted, leading to disastrous consequences.
Therefore, I wrote this account to illustrate the severity of the disease, the relevance of herb flavors and aromas, and the importance of flexible clinical adaptation. Nevertheless, this applies specifically to my own son, allowing me the confidence to treat him thus. If it were another person's child with the same condition, when using a few qian of Renshen (Ginseng Radix et Rhizoma, Ginseng Root) yielded no immediate effect, unaware that the medicinal force had not yet reached the disease site, people would likely complain and accuse me of misdiagnosis, switching to bitter-cold herbs, which would inevitably lead to death. They would then blame the use of Renshen (Ginseng Radix et Rhizoma, Ginseng Root). How could right and wrong be distinguished in such cases? Thus, I elaborate further to broaden people's understanding.
The eldest son of Du Zhihui Qian Xuyang was two years old. In late summer, injury from raw fruits damaged his Spleen, leading to diarrhea followed by dysentery. Mr. Qian, being skilled in medicine, knew this was merely an injury from cold and raw foods. He prescribed herbs for warming the Spleen, such as Renshen (Ginseng Radix et Rhizoma, Ginseng Root), Baizhu (Atractylodis Macrocephalae Rhizoma, Large-headed Atractylodes Rhizome), Shengjiang (Zingiberis Rhizoma Recens, Fresh Ginger), and Rougui (Cinnamomi Cortex, Cinnamon Bark). However, the diarrhea and dysentery did not improve, and ulcers gradually appeared on his lips and mouth. He consulted me, saying, "This child is clearly injured by cold and raw foods. Now that warm herbs are ineffective, what should we do?" I replied, "This is because diarrhea has injured Yin, and the sudden introduction of pungent-spicy herbs has caused deficiency fire to flare upward. Without changing to Fuzi (Aconiti Lateralis Radix Praeparata, Prepared Child Root of Monkshood), the fire cannot return to its source." Two doses were administered, but the lip and mouth ulcers and throat swelling worsened significantly, manifesting on the head and face, and the condition deteriorated. He came to me again, saying, "The medication is so incompatible. Could it truly be dampness transforming into heat?" Upon palpating the pulse, I said, "Both the upper pulse and the lower discharges indicate true heat, but the root belongs to Yang deficiency. The current ineffectiveness of heat-inducing herbs is suspicious, but ultimately, using cold herbs would be fatal without doubt. I suspect the medicinal force has not yet taken full effect." Mr. Qian said, "There is another symptom suggesting true cold: he insists that any soup or drink must be boiling hot. We cannot drink it, but he swallows it calmly despite his swollen and painful throat and mouth. Is this not evidence?" I said, "Exactly, exactly." Consequently, I increased the dosage of Fuzi (Aconiti Lateralis Radix Praeparata, Prepared Child Root of Monkshood) by one qian and five fen, and added Shengjiang (Zingiberis Rhizoma Recens, Fresh Ginger), Rougui (Cinnamomi Cortex, Cinnamon Bark), Roudoukou (Myristicae Semen, Nutmeg), Renshen (Ginseng Radix et Rhizoma, Ginseng Root), and Shudi (Rehmanniae Radix Praeparata, Prepared Rehmannia Root). The diarrhea gradually stopped, and once it ceased, the throat and mouth symptoms resolved completely within a day. Distinguishing between similar and different conditions is so difficult; without firm conviction, there would be no chance of survival. Since experiencing this, I have gradually reached a state of 'no confusion' (Bu Huo). For subsequent children with similar syndromes and treatments, all were preserved. Reflecting on this, where lies the key to this 'no confusion'? It lies in knowing the root of the disease. Clinicians must be cautious!