叶天士曰："温邪上受，首先犯肺，逆传心胞。"又云"舌色纯绛鲜泽者，胞络受邪也。平素心虚有痰，外热一陷，里络即闭．非菖蒲、郁金等所能开，须用牛黄丸、至宝丹之类，以开其闭，恐其昏厥为痉也。"吴鞠通云："太阴温病，汗出过多者，必神昏谵语，清宫汤主之，牛黄丸、紫雪丹、局方至宝丹亦主之。"又云"温毒神昏谵语者，先与安宫牛黄丸、紫雪丹之属，继以清宫汤。"又云"手厥阴暑温，身热不恶寒，清神不了了，时时谵语者，安宫牛黄丸主之，紫雪丹亦主之。"又云"夜寐不安，烦渴舌赤，时有谵语，暑入手厥阴也，清官汤主之，舌白滑者不可与也。"王孟英说亦大略相同。于是后之医家，因陋就简，据此数书，遂以为道尽于斯也，一遇神昏谵语，为叶吴辈印定眼目，便以为治温热病在手经而不在足经．一若人身果分两截，漠然不相关者，于是群以为心包络病矣，讵知其不专属心包络乎。王晋三云："病起头痛，而后神昏不语者，此肝虚魂升于顶，当用龙骨、牡蛎救逆以降之，非至宝丹等所能苏也。"此则神昏属诸肝。李东垣云："热入血室，昼则明了，夜则谵语。"夫血室者，肝脏也，既曰昼则明了，夜必不明了可知，不明了即神昏之谓，此则神昏亦属诸肝。但王说魂升于顶之神昏，乃肝虚。李说热入血室之神昏，乃肝实。此则有异。《内经·热论》云："阳明者，十二经脉之海，其气血盛，故不知人。"《金匮·中风篇》云："邪入于府，即不识人。"赵以德注谓胃为六府总司，诸府经络受邪，必归于胃，胃热甚，津液壅溢，结为痰涎，闭塞隧道，堵其神气出入之窍，故不识人。徐忠可注谓将颈两人迎脉按住，其气即壅遏不识人。人迎者，胃脉也。夫所谓不知人、不识人者，非即神昏而何?此则神昏又属诸胃。裴兆期《医谈》曰："人谓神昏之病原于心，心清神乃清。"余谓神昏之病原于胃，胃清神乃清．胃气一有不清，即不能摄神归舍，是神之昏不昏，专在乎胃之清不清。不观酒醉之人乎?酒醉之人，醉胃不醉心也，何以神昏而言语无伦也，不观饱食填息之人乎?饱食之人，饱胃不饱心也，何以神昏而一时瞀乱也；不观痰涎壅塞之人乎?痰塞之人，塞胃不塞心也，何以神昏而瞑眩无知也。以上诸说，岂医者未之见耶?抑以为不足信耶?他书姑勿论，至《内经》、《金匮》而未之见，不复信，则何必为医。然近人亦非无知之者，余伯陶云："阳明之火蒸腾入脑，神即昏矣。"则神经之昏，明明是神经受热，究其神经之所以热，仍由阳明而来，即经所谓-悍气上冲"头也。余氏说与徐忠可说当互参。盖人迎胃脉，由胃过颈后入脑，悍气即循此脉上冲，然则胪考诸说，神昏属胃者多，属肝者亦有之，安得专属诸心包络哉?再论谵语，《内经·厥论》云："阳明之厥，妄见而妄言。"张仲景云："三阳合病，腹满身重，口不仁而面垢，谵语遗尿，白虎汤主之。"虽曰三阳合病，而六腑之邪，尽归于胃，此则谵语属诸胃。仲景又云："阳明病，其人多汗，以津液外出，肠中燥，大便必鞭，鞕则谵语，小承气汤主之。"又云："阳明病，谵语，有潮热反不能食，胃中必有燥矢，宜大承气汤下之。"此则谵语亦属诸胃。惟《内经》论厥而妄言，统胃经．胃腑言之。仲圣沦用白虎汤者，属胃经之热；用大小承气汤者，属胃腑之实，此则有辨，而其谵语属胃则一也。故崔尚书云："胃有燥粪，令人错语；邪热盛，亦令人错语。若[便]秘而错语者，宜承气汤；[便]通而错语者，宜黄连解毒汤。"错语，语言错乱之渭，与谵语义同．是崔说亦分胃腑、胃经以论治。然亦有不属胃者，《内经·厥论》云：、'厥阴厥逆谵语。"张隐庵注，谓肝主语。谵语者，肝气郁也。《伤寒论》中俨语，《千金方》俱作谵语，可见二字音义并同。王肯堂云："下血谵语头汗出者，热入血室也。"叶天士云："热陷血室，与阳明胃实，多有谵语如狂之象，当辨之血结者身体必重，非若阳明之轻旋便捷。"此则谵语又属诸肝。然则胪考诸说，谵语亦属胃者多，属肝者间有之，安得专属诸心包络哉?余上年治城内和尚浜马姓儿，病神昏谵语，当时以伊父亦知医理，与之辩论后，开方而未列案，即就肝胃两经用药，为羚羊角、石决明、陈胆星、枳实汁、鲜竹沥、生瓜蒌(打)、元明粉等，寥寥数味，乃诸医见之，群哗为非，因补一案曰："病交十二日矣，初起发黄咳嗽，或有外感，辛以散之，理原不谬，但辛热以治风寒，辛凉以治风热，已自有别。以辛温治风热，已致引动木火，已属医家之用药不细。三四日间，案中有左胁痛，恶吐，环唇青等候，胁属肝之部分，唇属脾胃部分，青乃肝色，全属肝邪犯胃见症，此时何犹因咳嗽未止，而纯用肺家开泄药耶，内仅一方加用钩藤，是肝药矣。然钩藤虽清肝热，而息肝风为主，肝热而不至热极生风者，与夫肺表外感风热者，早用之反足以引动内风，医家曾知之否?此时之咳嗽未止，已属木火刑金，所以愈开泄而愈剧也，洎乎木火炽盛，烁胃液而成痰，复挟痰以上蒙，遂致神昏谵语，理当援仲景胃热之例，兼凉肝降痰以清之；以其又大便久不通，满腹胀痛拒按转矢气也，当兼参仲景胃实之例以下之。何诸医于辛散泄肺而后，一变而即用清宫汤、至宝丹耶?前者失诸不及，后者失诸太过，其为诛伐无过则一也。余方不用白虎、承气，而另撰一方者，以其病不独在胃，而肝邪特甚，故用仲圣之法，而不用仲圣之药，师其意不必袭其方也。"质诸高明，以为然否?
按前期"寒包暑热"条，阮某谵语，即属胃热，如误用牛黄丸、至宝丹等，领邪入内，必然不救，并无绕脐痛，按之有物，转矢气等候，倘用承气亦不救。胃热之中，又有两法：其不兼湿者，则用白虎汤；其兼湿邪者，则用三黄石膏汤、黄连解毒汤，以苦能燥湿也。上期《医学报》袁桂生札记，与予说同。余君伯陶之论神昏属阳明，袁君桂生之论神昏谵语，不可只用清宫汤、紫雪丹，至宝丹，可见世固不乏高明之士，殆所谓铁中铮铮，庸中佼佼者欤!
用药分量
用药分量之轻重，鄙意当视其病以为准，初不能执定某药必重用，某药必轻用，即古方流传，其分量固已酌定，仍必赖用之者增损其间，乃合病机，不独药品之宜加减也。所谓君臣佐使，即别之于分量，故同一方也，有见此证则以此药为君，见他证复以他药为君者，朱应皆云："古方所谓各等分者，非同一分量之谓，谓审病以定药之轻重耳。"斯言甚确，余前治袁姓儿湿温症，案曰："满舌苔薄白而带滑，湿在肺胃之表也。边尖绛赤，心肝营分有热也，中心独灰微涩，胃聚湿而欲化火也，小便短赤，大便秘，火郁湿滞，而气化不灵也；湿为火烁则生痰，痰气上蒙，故欲昏睡也；其有时能冷饮者，则湿从火化，已热多湿少也；有时足冷，热内追也，须防其热厥；新又咳嗽，君相二火烁金也，宜清心肝之火，导以下行，渗肺胃之湿以佐之，斯热解而湿亦去矣。"药用淡竹叶、灯心草、石决明、通草，白茯苓、生苡仁、知母、茅根、芦根，碧玉散，鲜竹沥，内以别无痰药，竹沥用四两，分头二煎冲入。有訾余分量太重者，匡子不逮，幸甚，录此方案以志吾过。犹忆去年邹君鹤俦，病谵语如狂，时欲出门，其力甚大。余疑其痰火上壅，而脉象沉细若无，脉证不符，欲用羚羊角、竹沥而不敢，转延余君伯陶决之，余君亦疑不可，乃商酌一方服之，当日稍定，翌日，忽夺门而出，至其相知家酣睡，比醒，诊之脉忽变为滑数而大，乃知昨系热厥伏匿之脉，因用羚羊角，以鲜竹沥磨之，随磨随进，只此二味，计是日磨去羚羊角五钱许，竹沥十三四两，稍有狼戾，饮下亦复不少，较此症用之更多，病之轻重固异，然至今思之，治虽幸中，究嫌孟浪，悬壶应世，诚不如以平易药方，轻微分量，免为庸流所诟病耳。
胎黄
癸丑五月十二日，五孙钦尚生，生而面目身皆黄，此胎黄也。以其小便清长，疑是虚寒，然身体壮盛，啼声载路，唇色红紫，察其瞳于，黑而有神，且伊父系木火体质，伊母系湿痰体质，因决其为湿热无疑，但质小不能服药，思吴尚先云："内服之方，皆可移作外治，遂用绵茵陈、赤小豆、海螵蛸、马鞭草、紫花地丁、生草梢、仙半夏、大腹皮、小青皮、炒白术、赤白芍，赤苓、白颈蚯蚓等，共研细末，酒调敷脐上，日再易，两旬而全愈。可见小儿之不能服药者，类推可以改外治，如病在头目，则敷两太阳，病在臂腿则敷手足心，病在胸脯则敷胸间，病在肺则敷肺俞等穴，病在肝则敷期门等穴，病在脾胃则敷脐腹，视何病则用何药，温凉攻补，因病而施，想亦有效也。
鼻衄
赖佩瑜函询："敝邑有孔某者，年二十许，自十四岁以来，得一鼻衄奇症，每逢月之上旬，七句钟时，其鼻血源源而来，投之截血诸药，终不能禁止其流，迨至次日，呼吸始通：衄血亦时来时止，三日后，其衄血自然而愈。测量其血，多至五磅有奇。察其病时病后，神识俱清，兼无别病。但此症自发生以宋，月累一月，毫无过期．诚世界最新发明之一大奇症也。所延医治，已阅百人．投诸药石，俱无效验。延至今春，邀余诊视，切其脉．大而且沉，察其面色，非象失血之人，兼无寒热烦咳，惟不得安眠。检前所服之方，不外泻心、地黄、柏艾等汤，均归无效。仆采择古今医书，研究斯症．皆系真阳不足之弊，故先拟服独参汤加附子五钱．连服数剂，至后月复作如前，再拟早服加减归脾汤，晚服黄土汤，至三阅月，衄复如是。其或药不对症欤?即或四五剂不能中病欤?究意是何理由，敢以质之高明家。"余答之曰："《素问》谓邪客于足阳明之经，令人鼽衄。"《灵枢》谓胃足阳明之脉，起于鼻之交额中，下循鼻外，所生病者鼽衄。"是衄病有厉胃者，胃为多气多血之乡，故宋多而无害。
考虫证，必月初其头上向，安知此衄之来，非即胃中忧虫为患，大约病者体必壮实．嗜浓厚，多湿热，郁蒸生虫，攻动其赢余之血，激而上冲，其不得安卧，亦胃不和之故，经所谓"胃不和则卧不安"也，观其积久，而面色如常。决非虚症，拟用生牛膝、姜炒竹茹、刺猬皮、山栀子、川楝子、法半夏、芜荑、琥珀等，稍加以大黄末、干漆末，逐月于病发时服之，或能渐减而愈。古本有胃蛊一症，用使君子、五谷虫、雷丸、厚朴以杀虫，但不见其变病为衄耳。
窃谓天地之大，无奇不有，阴阳之对待，有时而胜负迭乘，故有五不女之奇形，即有五不男之异禀，安知此人非有生以来，虽具乾健之体，实赋坤顺之性者乎?月事之来，上应乎月，下应乎潮，月初月上钩而潮生，月望月正，圆而潮盛，月属阴象，潮为阴质。仲秋阴气最足，故月最明而潮最大，女亦阴类．月事应之，世既有不月之妇人，安必无有月之男子，犹世有无须之男子，间有有须之妇人，倘询其阳道不举，可证我说之不尽无稽，但血与经，二而一者也，血以下行为顺，仍当用生牛膝、大黄、槐角等以导之，使从大肠出耳，从大肠出则不必复冶之矣，奇想也，而实由理想，姑附载之，以博诸公一粲。
湿温 疝气 风疹 热入血室 阳明经白虎证 天花 时气
辛亥秋，余晋引南旋，奉杨俊卿文鼎中丞奏随赴秦，在沪未行，会武汉革命事起，道阻不得往，时事日非，遂壶隐淞滨，亲友延余诊治者，公启一函，为余揄扬，由孙燕秋文诒主稿，孙亦知医者，函中颇于医理有所阐发，故录出，且以志厚谊于勿谖焉。《函》：陆君晋笙，向与都人士游，鲜知其能医者，即或知之，亦不意其邃于医者， 自避来申，颜其居曰"景景医室"，应病家之招。诚保患湿温，嘉年之侄应欢亦患湿温，君谓：彭 [某]体肥，湿重热轻；邹[某]体瘦，热重湿轻，同一渗湿清热，而分量不同。承豫亦患湿温，君谓热为湿遏，宜先温化，然后用苦寒淡渗，其治法又不同。家怡患腹胀，疝气偏坠，痛不可忍，君谓舌苔白腻而厚，是肝气为寒湿所遏，用苍术、厚朴、柴胡、茴香等，一剂而愈，翌日已出门。
廷韶两子并患疹?君谓长者有汗，两关数甚，宜石膏、决明；幼者无汗，宜荆芥、薄荷，而方中之以辛凉解表则又同。文诒予疹兼泄泻，君谓是肺移热于大肠，邪有去路，于病为顺，断不可升提止涩，又不可因势下导，下导则表邪内陷，疹透邪尽，则泄自止，其言果验。元基于患疹内隐，反见恶寒等象，或以为寒，将用桂、术、橘，半，君谓不可，此温热内伏，改用牛蒡、豆豉、淡豆卷、银花、丹皮、石膏而安。承豫一子一女，并发热恶寒，君谓鼻塞微咳， 目含水气，将发疹矣，先以发透之， 自见疹至全愈，曾无多剂，未误治治也。
国桢女患风温发疹，经方来而忽止，君用辛凉之剂，而佐以丹皮、丹参等。又见其治周姓女，同患风温，经将尽而邪袭入，君亦用辛凉之剂，而佐以元参、生地等．同一热入血室，而君谓一血虚、一有瘀，是以佐使之药异，且病皆属热．是以一不用桃仁、菱蔚，一不用川芎、当归也。
叶天士说：“温邪从口鼻侵入，首先侵犯肺脏，若病情逆转，则传入心包络。”他又说：“舌色纯红鲜亮润泽的，是心包络受邪。平素心气虚弱且有痰湿的人，外热一旦内陷，里络就会闭塞。这种情况不是石菖蒲、郁金等药物所能开通的，必须使用牛黄丸、至宝丹之类的药物来开窍闭，以防出现昏厥和抽搐。”吴鞠通说：“太阴温病，出汗过多的人，必然会出现神志昏迷、胡言乱语的症状，用清宫汤主治，牛黄丸、紫雪丹、局方至宝丹也可以主治。”他又说：“温毒导致神志昏迷、胡言乱语的，先用安宫牛黄丸、紫雪丹这类药物，继之以清宫汤。”他又说：“手厥阴暑温，身体发热但不怕冷，神志不清，时常胡言乱语的，用安宫牛黄丸主治，紫雪丹也可以主治。”他又说：“夜间睡眠不安，烦躁口渴，舌质红，时有胡言乱语，这是暑邪侵入手厥阴心包经的表现，用清宫汤主治，如果舌苔白滑的则不可使用。”王孟英的说法也大致相同。于是后世的医家，因循守旧，依据这几本书，便认为治法尽在于此了。一遇到神志昏迷、胡言乱语的情况，就被叶天士、吴鞠通等人的观点所束缚，便认为治疗温热病只需在手经（心包）而不在足经，仿佛人身真的分为两截，互不相关一样，于是大家都认为是心包络的病，哪里知道这并不专属于心包络呢？
王晋三说：“病起头痛，随后神志昏迷不能说话的，这是肝虚导致魂气升腾于头顶，应当用龙骨、牡蛎救逆汤来降逆，不是至宝丹等药物所能唤醒的。”这说明神志昏迷属于肝脏。李东垣说：“热入血室，白天神志清醒，夜晚则胡言乱语。”所谓血室，就是肝脏。既然说白天清醒，夜晚必然不清醒，不清醒就是神志昏迷的意思，这说明神志昏迷也属于肝脏。但是王晋三所说的魂升于顶的神志昏迷，属于肝虚；李东垣所说的热入血室的神志昏迷，属于肝实。这两者是有区别的。《内经·热论》说：“阳明经是十二经脉的海，气血旺盛，所以会使人不知人（昏迷）。”《金匮要略·中风篇》说：“邪气侵入腑，就会不识人。”赵以德注解认为胃是六腑的总司，各腑经络受邪，必归于胃，胃热严重，津液壅滞溢出，凝结为痰涎，闭塞通道，堵住神气出入的窍道，所以不识人。徐忠可注解认为按住颈部两侧的人迎脉，气机就会壅遏导致不识人。人迎穴是胃脉所在。所谓不知人、不识人，不就是神志昏迷吗？这说明神志昏迷又属于胃。裴兆期在《医谈》中说：“人们认为神志昏迷的病源在心，心清则神清。”我认为神志昏迷的病源在胃，胃清则神清。胃气一旦不清，就不能摄纳神气回归本舍，所以神志是否昏迷，完全取决于胃是否清彻。没看过醉酒的人吗？醉酒之人，醉的是胃而不是心，为什么神志昏迷且言语无伦次呢？没看过饱食填膈的人吗？饱食之人，饱的是胃而不是心，为什么神志昏迷且一时迷乱呢？没看过痰涎壅塞的人吗？痰塞之人，塞的是胃而不是心，为什么神志昏迷且眩晕无知呢？以上这些说法，难道是医生们没见过吗？还是认为不足信呢？其他书暂且不提，连《内经》、《金匮》都没见过或不相信，那何必做医生呢？然而近世的人也不是无知的，余伯陶说：“阳明之火蒸腾上冲入脑，神志就会昏迷。”那么神经的昏迷，明明是神经受热，究其神经之所以热，仍然由阳明而来，即经文中所说的“悍气上冲头”。余氏的说法与徐忠可的说法应当互相参考。因为人迎胃脉，从胃经过颈部后方进入脑部，悍气就顺着这条脉上冲。既然如此，列举考察各种说法，神志昏迷属于胃的多，属于肝的也有，怎么能专属于心包络呢？
再论述胡言乱语，《内经·厥论》说：“阳明的厥逆，会出现幻觉和胡言乱语。”张仲景说：“三阳合病，腹部胀满身体沉重，口唇麻木面色垢浊，胡言乱语遗尿，用白虎汤主治。”虽然说是三阳合病，但六腑的邪气都归于胃，这说明胡言乱语属于胃。张仲景又说：“阳明病，病人多汗，因为津液外泄，肠中干燥，大便必然硬结，硬结则胡言乱语，用小承气汤主治。”又说：“阳明病，胡言乱语，有潮热反而不能进食，胃中一定有燥屎，宜用大承气汤攻下。”这说明胡言乱语也属于胃。只有《内经》论述厥逆而妄言，统括胃经和胃腑而言。张仲景使用白虎汤的，属于胃经的热证；使用大小承气汤的，属于胃腑的实证，这里有区别，但胡言乱语属于胃这一点是一致的。所以崔尚书说：“胃中有燥粪，使人错语；邪热盛，也使人错语。如果便秘而错语的，宜用承气汤；通便后仍错语的，宜用黄连解毒汤。”错语，就是语言错乱的意思，与谵语意义相同。崔氏的说法也是分胃腑和胃经来论治。但也有不属于胃的，《内经·厥论》说：“厥阴厥逆会导致谵语。”张隐庵注解，认为肝主言语。谵语，是肝气郁结所致。《伤寒论》中的谵语，《千金方》都写作谵语，可见二字音义相同。王肯堂说：“下血、谵语、头汗出的，是热入血室。”叶天士说：“热陷血室，与阳明胃实，多有谵语如狂的现象，应当辨别：血结者身体必然沉重，不像阳明病的轻旋便捷。”这说明谵语又属于肝。既然如此，列举考察各种说法，谵语属于胃的多，属于肝的间或有之，怎么能专属于心包络呢？
我去年治疗城内和尚浜马姓的儿子，病见神志昏迷、胡言乱语。当时因为他父亲也懂医理，与他辩论后，开了方子但没有记录病历，就直接按肝胃两经用药，用了羚羊角、石决明、陈胆星、枳实汁、鲜竹沥、生瓜蒌（打碎）、元明粉等，寥寥几味药。其他医生见了，纷纷哗然指责不对，因此补写一案曰：“病已十二天了，初起发黄咳嗽，可能有外感，用辛散之法疏散，道理原本不错，但用辛热治风寒，用辛凉治风热，本来就有区别。用辛温药治风热，已经导致引动肝木心火，这已经是医生用药不细致了。三四天时，案中有左胁痛、恶心呕吐、嘴唇周围发青等症状，胁部属肝的部位，嘴唇属脾胃的部位，青色乃肝之色，全属肝邪犯胃的见证，此时为何还因为咳嗽未止，而纯用肺家的开泄药呢？案中仅一方加用了钩藤，这是肝药。然而钩藤虽能清肝热，但以息肝风为主，肝热而未至热极生风者，以及肺表外感风热者，早用钩藤反而足以引动内风，医生们曾知道吗？此时的咳嗽未止，已属木火刑金，所以越开泄病情越重。等到木火炽盛，灼烧胃液而成痰，痰挟热上蒙清窍，遂致神志昏迷、胡言乱语，理应援引张仲景治胃热的例子，兼用凉肝降痰的方法来清解；因为他又大便久不通，腹胀痛拒按且转矢气，应当兼参张仲景治胃实的例子来攻下。为何各位医生在辛散泄肺之后，一变而即用清宫汤、至宝丹呢？前者失之于不及，后者失之于太过，其为诛伐无辜则是一样的。我的方子不用白虎汤、承气汤，而另撰一方，是因为病不仅在于胃，而肝邪特别严重，所以用张仲圣的方法，而不用张仲圣的药，师法其意不必袭用其方。”请问高明之士，以为如何？
按照前期“寒包暑热”条，阮某谵语，即属于胃热，如果误用牛黄丸、至宝丹等，引导邪气入内，必然无法救治，并没有绕脐痛、按之有物、转矢气等症状，倘若用承气汤也无法救治。在胃热之中，又有两种治法：不兼湿邪的，就用白虎汤；兼有湿邪的，就用三黄石膏汤、黄连解毒汤，因为苦味能燥湿。上期《医学报》袁桂生的札记，与我的说法相同。余君伯陶论述神志昏迷属于阳明，袁君桂生论述神志昏迷、胡言乱语不可只用清宫汤、紫雪丹、至宝丹，可见世上确实不乏高明之士，大概就是所谓的铁中铮铮、庸中佼佼者吧！
关于用药分量，我的意见应当视病情而定，不能固执地规定某药必重用，某药必轻用。即使是古方流传，其分量固然已确定，但仍需使用者根据情况增减，才能符合病机，不仅仅是药品种类需要加减。所谓君臣佐使，就是通过分量来区分的，所以同一个方子，有的见此证以此药为君，见他证又以他药为君。朱应皆说：“古方所谓各等分，并非指同一分量，而是指审察病情以确定药物的轻重。”这话很正确。我此前治疗袁姓儿子的湿温症，病历记载：“满舌苔薄白而带滑，说明湿在肺胃之表；舌边尖红赤，说明心肝营分有热；舌中心独呈灰微涩，说明胃聚湿而欲化火；小便短赤，大便秘结，说明火郁湿滞，气化不灵；湿被火灼则生痰，痰气上蒙，所以想昏睡；有时能喝冷饮，说明湿从火化，已热多湿少；有时脚冷，说明热在内逼迫，须防热厥；新近又咳嗽，说明君相二火灼伤肺金。宜清心肝之火，导之下行，渗利肺胃之湿以辅助它，这样热解而湿亦去矣。”药用淡竹叶、灯心草、石决明、通草、白茯苓、生苡仁、知母、茅根、芦根、碧玉散、鲜竹沥。因为体内别无化痰药，竹沥用了四两，分两次煎好冲入。有人指责我分量太重，我不才，幸甚，录此方案以记我的过失。还记得去年邹君鹤俦，病见谵语如狂，时时想出门，力气很大。我怀疑是痰火上壅，但脉象沉细若无，脉证不符，想用羚羊角、竹沥而不敢，转而请余君伯陶决断，余君也怀疑不可行，于是商量一方服用，当日稍定，第二天，忽然破门而出，到朋友家酣睡，醒来后诊脉忽变为滑数而大，才知道昨天是热厥伏匿之脉，于是用羚羊角，用鲜竹沥磨服，随磨随进，只此两味药，算下来那天磨去羚羊角五钱左右，竹沥十三四两，稍微有点猛烈，饮下也不少，比这个病症用的更多，病的轻重固然不同，但现在回想起来，治疗虽然侥幸成功，终究嫌孟浪。悬壶济世，实在不如用平易的药方，轻微的分量，以免被平庸之辈诟病。
胎黄
癸丑年五月十二日，我的小孙子钦尚出生，生下来面目身体都黄，这是胎黄。因为他的尿液清长，怀疑是虚寒，但身体壮实，啼声响亮，唇色红紫，观察他的瞳孔，黑而有神，而且他父亲是木火体质，母亲是湿痰体质，因此断定他是湿热无疑。但他体质小不能服药，想到吴尚先说：“内服的方子，都可以改为外治。”于是用绵茵陈、赤小豆、海螵蛸、马鞭草、紫花地丁、生草梢、仙半夏、大腹皮、小青皮、炒白术、赤白芍、赤茯苓、白颈蚯蚓等，共研细末，酒调敷在肚脐上，每天换两次，二十天后痊愈。可见小儿不能服药的，类推可以改为外治，如病在头目，则敷两太阳穴；病在臂腿则敷手足心；病在胸脯则敷胸间；病在肺则敷肺俞等穴；病在肝则敷期门等穴；病在脾胃则敷脐腹。看什么病就用什么药，温凉攻补，因病施治，想来也是有效的。
鼻衄
赖佩瑜来信询问：“我们县有个孔某人，二十岁左右，从十四岁以来，得了一个鼻衄的奇特病症，每逢每月上旬，七点钟时，鼻血源源而来，投用各种止血药，始终不能禁止流血，直到第二天，呼吸才通畅；衄血也时来时止，三天后，衄血自然停止。测量其血量，多达五磅以上。观察他发病时和发病后，神识都清醒，兼无其他病。但这个病自从发生以来，月月如此，从未过期，确实是世界最新发明的一大奇症。延请医治，已阅百人，投诸药石，均无效验。延至今春，邀我诊治，切其脉，大而且沉，察其面色，不像失血之人，兼无寒热烦咳，只是不得安眠。检查前所服的方子，不外乎泻心汤、地黄汤、柏艾汤等，均归无效。我采择古今医书，研究此症，都说系真阳不足的弊病，所以先拟服独参汤加附子五钱，连服数剂，到了下个月复发如前，再拟早服加减归脾汤，晚服黄土汤，过了三个月，衄血依然如故。是药不对症吗？即使四五剂不能中病吗？究竟是何理由，敢以此请教高明之家。”我回答说：“《素问》说‘邪客于足阳明之经，令人鼽衄’。《灵枢》说‘胃足阳明之脉，起于鼻之交额中，下循鼻外，所生病者鼽衄’。这说明衄病有源于胃的，胃是多气多血的脏腑，所以多血而无害。
考证虫证，必定在月初其头部向上，怎知此衄血之来，不是即胃中忧虫为患？大约病人身体必壮实，嗜好浓厚饮食，多湿热，郁蒸生虫，攻动其盈余之血，激而上冲，其不得安卧，也是胃不和的缘故，经所谓‘胃不和则卧不安’也。观其积久，而面色如常，绝非虚症。拟用生牛膝、姜炒竹茹、刺猬皮、山栀子、川楝子、法半夏、芜荑、琥珀等，稍加以大黄末、干漆末，逐月于病发时服用，或许能渐减而愈。古本有胃蛊一症，用使君子、五谷虫、雷丸、厚朴以杀虫，但未见其变病为衄耳。
我私下认为天地之大，无奇不有，阴阳的对待，有时胜负迭乘，所以有五不女的奇形，即有五不男的异禀，怎知此人非有生以来，虽具乾健之体，实赋坤顺之性者乎？月事之来，上应乎月，下应乎潮，月初月上钩而潮生，月望月正圆而潮盛，月属阴象，潮为阴质。仲秋阴气最足，故月最明而潮最大，女亦阴类，月事应之，世既有不月之妇人，安必无有月之男子，犹世有无须之男子，间有有须之妇人。倘询其阳道不举，可证我说之不尽无稽。但血与经，二而一者也，血以下行为顺，仍当用生牛膝、大黄、槐角等以导之，使从大肠出耳，从大肠出则不必复治之矣。奇想也，而实由理想，姑附载之，以博诸公一粲。
湿温 疝气 风疹 热入血室 阳明经白虎证 天花 时气
辛亥年秋天，我陪同引南先生南下，奉杨俊卿文鼎中丞之命奏随赴秦，在上海未行，恰逢武汉革命事起，道路阻隔不得前往，时事日非，遂隐居淞滨，亲友延请我诊治的，公开启一封函，为我揄扬，由孙燕秋文诒主稿，孙也是懂医的人，函中颇于医理有所阐发，故录出，且以志厚谊于勿忘焉。《函》：陆君晋笙，向来与都市人士交往，很少知道他擅长医术，即使知道，也不意其深于医术，自从避居上海，题其居所曰“景景医室”，应病家之招。诚保患湿温，嘉年的侄子应欢也患湿温，陆君说：彭[某]体肥，湿重热轻；邹[某]体瘦，热重湿轻，同样是渗湿清热，而分量不同。承豫也患湿温，陆君说热为湿遏，宜先温化，然后用苦寒淡渗，其治法又不同。家怡患腹胀，疝气偏坠，痛不可忍，陆君说舌苔白腻而厚，是肝气为寒湿所遏，用苍术、厚朴、柴胡、茴香等，一剂而愈，翌日已出门。
廷韶的两个儿子并患疹，陆君说长子有汗，两关脉数甚，宜石膏、决明；幼子无汗，宜荆芥、薄荷，而方中以辛凉解表则又同。文诒予疹兼泄泻，陆君说是肺移热于大肠，邪有去路，于病为顺，断不可升提止涩，又不可因势下导，下导则表邪内陷，疹透邪尽，则泄自止，其言果验。元基于患疹内隐，反见恶寒等象，或以为寒，将用桂、术、橘半，陆君说不可，此温热内伏，改用牛蒡、豆豉、淡豆卷、银花、丹皮、石膏而安。承豫一子一女，并发热恶寒，陆君说鼻塞微咳，目含水气，将发疹矣，先以发透之，自见疹至全愈，曾无多剂，未误治治也。
国桢女患风温发疹，经方来而忽止，陆君用辛凉之剂，而佐以丹皮、丹参等。又见其治周姓女，同患风温，经将尽而邪袭入，陆君亦用辛凉之剂，而佐以元参、生地等。同一热入血室，而陆君谓一血虚、一有瘀，是以佐使之药异，且病皆属热，是以一不用桃仁、菱蔚，一不用川芎、当归也。
Ye Tianshi said: "Warm pathogenic factors enter from above (mouth and nose), first attacking the Lung. If the condition reverses, it transmits to the Pericardium." He also stated: "When the tongue is purely crimson, fresh, and lustrous, it indicates that the Pericardium Collateral is affected. In individuals with pre-existing Heart deficiency and phlegm, once external heat sinks inward, the interior collaterals become blocked. This cannot be opened by herbs such as Shichangpu (Acori Tatarinowii Rhizoma) and Yujin (Curcumae Radix); one must use Niuhuang Wan (Calculus Bovis Pill) or Zhibao Dan (Precious Treasure Pill) to open the blockage, fearing coma and convulsions." Wu Jutong said: "In Taiyin Warm Disease, those who sweat excessively will inevitably suffer from mental confusion and delirious speech; Qinggong Tang (Clear the Palace Decoction) is the primary treatment, while Niuhuang Wan, Zixue Dan (Purple Snow Pill), and Ju Fang Zhibao Dan are also indicated." He further stated: "For warm toxicity causing mental confusion and delirious speech, first administer An Gong Niuhuang Wan (An Gong Calculus Bovis Pill) or Zixue Dan, followed by Qinggong Tang." He also said: "In Hand-Jueyin Summerheat-Warmth, characterized by fever without aversion to cold, unclear spirit, and frequent delirious speech, An Gong Niuhuang Wan is the primary treatment, and Zixue Dan is also indicated." He added: "Restless sleep at night, irritability, thirst, red tongue, and occasional delirious speech indicate that summerheat has entered the Hand-Jueyin [Pericardium]; Qinggong Tang is indicated, but it should not be used if the tongue coating is white and slippery." Wang Mengying's views were largely similar. Consequently, later physicians, adhering to conventions and simplifying matters based on these texts, came to believe that the treatment principles were exhausted here. Upon encountering mental confusion and delirious speech, their vision was fixed by Ye and Wu's theories, leading them to believe that treating Warm Diseases involves only the Hand meridians and not the Foot meridians, as if the human body were truly divided into two disconnected parts. Thus, they universally attributed these symptoms to Pericardium Collateral disease, failing to realize that it does not exclusively belong to the Pericardium.
Wang Jin San said: "If a disease begins with headache followed by mental confusion and inability to speak, this is due to Liver deficiency causing the Hun (Ethereal Soul) to ascend to the vertex. Longgu (Fossilia Ossis Mastodi) and Muli (Concha Ostreae) in Jiuniu Tang (Rescue from Collapse Decoction) should be used to descend it; Zhibao Dan and similar pills cannot revive the patient." This indicates that mental confusion belongs to the Liver. Li Dongyuan said: "When heat enters the Blood Chamber (Xueshi), the patient is lucid during the day but delirious at night." The Blood Chamber refers to the Liver. Since it is stated that the patient is lucid during the day, it can be inferred that they are not lucid at night; being not lucid means mental confusion. Thus, mental confusion also belongs to the Liver. However, Wang's description of mental confusion due to the Hun ascending to the vertex pertains to Liver deficiency, whereas Li's description of mental confusion due to heat entering the Blood Chamber pertains to Liver excess. There is a distinction between the two. *Neijing·Re Lun* states: "The Yangming meridian is the sea of the twelve meridians; its Qi and Blood are abundant, hence it causes unconsciousness." *Jingui Yaolue·Zhongfeng Pian* states: "When pathogenic factors enter the Fu organs, the person fails to recognize others." Zhao Yi De annotated that the Stomach is the general manager of the six Fu organs; when pathogenic factors affect the meridians and collaterals of various Fu organs, they must return to the Stomach. Severe Stomach heat causes fluids to stagnate and overflow, condensing into phlegm-saliva, blocking the tunnels and obstructing the orifices through which Shen (Spirit) enters and exits, thus causing unconsciousness. Xu Zhongke annotated that pressing the Renying (ST9) pulse on both sides of the neck causes Qi stagnation, leading to failure to recognize others. Renying is the Stomach pulse. Therefore, what is called "unconsciousness" or "failure to recognize others" is none other than mental confusion. This indicates that mental confusion also belongs to the Stomach. Pei Zhaoqi in *Yi Tan* said: "People say the source of mental confusion lies in the Heart; if the Heart is clear, the Shen is clear." I argue that the source of mental confusion lies in the Stomach; if the Stomach is clear, the Shen is clear. If Stomach Qi becomes turbid, it cannot retain the Shen within its residence. Therefore, whether the Shen is confused depends entirely on whether the Stomach is clear. Have you not observed drunk people? Drunk people have drunk Stomachs, not drunk Hearts, yet why do they exhibit mental confusion and incoherent speech? Have you not observed people who are overly full after eating? Their Stomachs are full, not their Hearts, yet why do they exhibit mental confusion and momentary disorientation? Have you not observed people blocked by phlegm-saliva? Their Stomachs are blocked, not their Hearts, yet why do they exhibit mental confusion and dizziness with lack of awareness? Are these observations unknown to physicians? Or are they considered unworthy of belief? Setting aside other texts, if one has not seen or does not believe in *Neijing* and *Jingui*, why practice medicine at all? However, modern physicians are not ignorant. Yu Botao said: "Yangming fire steams upward into the brain, causing mental confusion." Thus, neural confusion is clearly due to heat affecting the nerves. Investigating why the nerves are hot, it still originates from Yangming, i.e., the "vigorous Qi" rushing upward to the head mentioned in the classics. Yu's theory should be cross-referenced with Xu Zhongke's. Since the Renying Stomach pulse passes from the Stomach behind the neck into the brain, and vigorous Qi follows this pulse upward, examining these theories shows that mental confusion belongs to the Stomach in most cases, and to the Liver in some cases. How can it be exclusively attributed to the Pericardium Collateral?
Regarding delirious speech, *Neijing·Jue Lun* states: "Yangming Jue leads to hallucinations and delirious speech." Zhang Zhongjing said: "In San Yang combined disease, with abdominal fullness, heaviness of the body, numbness of the mouth, greasy face, delirious speech, and urinary incontinence, Baihu Tang (White Tiger Decoction) is indicated." Although it is called San Yang combined disease, the pathogenic factors of the six Fu organs all return to the Stomach; thus, delirious speech belongs to the Stomach. Zhang Zhongjing also said: "In Yangming disease, if the patient sweats profusely, fluids escape outward, the intestines become dry, and the stool becomes hard. Hardness leads to delirious speech; Xiao Chengqi Tang (Minor Order the Qi Decoction) is indicated." He further said: "In Yangming disease, delirious speech accompanied by tidal fever and inability to eat indicates dry feces in the Stomach; Da Chengqi Tang (Major Order the Qi Decoction) should be used to purge." This again indicates that delirious speech belongs to the Stomach. Only *Neijing* discusses Jue and delirious speech generally covering the Yangming Meridian and Stomach Fu organ. Zhang Zhongjing's use of Baihu Tang pertains to Heat in the Yangming Meridian; his use of Da/Xiao Chengqi Tang pertains to Excess in the Stomach Fu organ. There is a distinction, but the attribution of delirious speech to the Stomach remains consistent. Therefore, Cui Shangshu said: "Dry feces in the Stomach cause erroneous speech; excessive pathogenic heat also causes erroneous speech. If constipation accompanies erroneous speech, Chengqi Tang is indicated; if bowel movements are unobstructed yet erroneous speech persists, Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) is indicated." Erroneous speech refers to disordered language, synonymous with delirious speech. Cui's theory also distinguishes treatment based on Stomach Fu organ versus Stomach Meridian. However, there are cases not belonging to the Stomach. *Neijing·Jue Lun* states: "Jueyin Jue leads to delirious speech." Zhang Yin'an annotated that the Liver governs speech. Delirious speech is due to Liver Qi stagnation. In *Shanghan Lun*, "Zhenyu" is written as "Shanyu" in *Qianjin Fang*, indicating identical pronunciation and meaning. Wang Kentang said: "Bleeding, delirious speech, and sweating on the head indicate heat entering the Blood Chamber." Ye Tianshi said: "Heat sinking into the Blood Chamber and Yangming Stomach excess often present with delirious speech resembling madness. They must be differentiated: blood stasis causes body heaviness, unlike the agility of Yangming disease." This indicates that delirious speech also belongs to the Liver. Thus, examining these theories, delirious speech belongs to the Stomach in most cases and to the Liver occasionally. How can it be exclusively attributed to the Pericardium Collateral?
Last year, I treated the son of a Ma family member in Heshangbang, City, who presented with mental confusion and delirious speech. Since his father understood medical principles, I debated with him before prescribing. I did not record the case initially but prescribed based on the Liver and Stomach meridians, using Lingyangjiao (Antelope Horn), Shijueming (Concha Haliotidis), Chendanning (Aged Tangerine Peel and Phlegm-resolving mixture), Zhishi Juice (Fructus Aurantii Immaturus Juice), Xianzhuli (Fresh Bamboo Sap), Sheng Gualou (Raw Trichosanthes Fruit, crushed), and Yuanmingfen (Natrii Sulfas). Just a few herbs. Other physicians saw this and loudly criticized it as incorrect. I therefore added a case note stating: "The illness has lasted twelve days. Initially, there was jaundice and cough, possibly due to external contraction. Using acrid dispersants was theoretically sound. However, using acrid-warm herbs for Wind-Cold and acrid-cool herbs for Wind-Heat are distinct. Using acrid-warm herbs for Wind-Heat already induced Wood-Fire, reflecting imprecise prescription by the physician. Between the third and fourth days, the case noted left hypochondriac pain, nausea/vomiting, and bluish discoloration around the lips. The hypochondrium belongs to the Liver region; the lips belong to the Spleen/Stomach region; blue is the color of the Liver. These are signs of Liver pathogen invading the Stomach. Why, at this point, continue to use pure Lung-opening dispersants solely because the cough persisted? Only Gouteng (Uncaria Rhynchophylla) was added in one formula, which is a Liver herb. Although Gouteng clears Liver heat, its primary function is extinguishing Liver wind. For Liver heat not yet extreme enough to generate wind, or for exterior Wind-Heat, early use of Gouteng may inadvertently stir internal wind. Did the physicians know this? The persistent cough at this stage indicates Wood-Fire insulting Metal; thus, further dispersal worsens the condition. When Wood-Fire became blazing, scorching Stomach fluids into phlegm, which then mounted upward clouding the orifices, resulting in mental confusion and delirious speech. One should follow Zhang Zhongjing's example of clearing Stomach heat, combining cooling of the Liver and descending phlegm. Since the patient also had prolonged constipation, abdominal distension/pain, tenderness, and passing flatus, one should reference Zhang Zhongjing's example of purging Stomach excess. Why did the physicians switch to Qinggong Tang and Zhibao Dan immediately after using acrid dispersants to vent the Lungs? The former failed due to insufficiency; the latter failed due to excess. Both constitute unjustified attack on healthy tissue. My formula avoids Baihu Tang and Chengqi Tang, drafting a new one instead, because the disease is not solely in the Stomach, but Liver pathogen is particularly severe. Thus, I apply Zhang Zhongjing's method but not his herbs; I learn from his intent without copying his formulas." I ask the experts: Is this correct?
Referring to the previous section on "Cold Enveloping Summerheat," Ruan's delirious speech belonged to Stomach Heat. If Niuhuang Wan or Zhibao Dan were mistakenly used, guiding pathogens inward would lead to inevitable death. There were no symptoms of periumbilical pain, palpable masses, or passing flatus; even if Chengqi Tang were used, it would not save the patient. Among Stomach Heat conditions, there are two methods: if not complicated by Dampness, use Baihu Tang; if complicated by Dampness, use Sanhuang Shigao Tang (Three-Yellow White-Tiger Decoction) or Huanglian Jiedu Tang, as bitter flavors can dry Dampness. Yuan Guisheng's notes in the previous issue of *Medical Journal* align with my view. Yu Botao's discussion on mental confusion belonging to Yangming, and Yuan Guisheng's argument that mental confusion and delirious speech cannot be treated solely with Qinggong Tang, Zixue Dan, or Zhibao Dan, show that there are indeed capable scholars among us—those who stand out like iron in steel, or excel among mediocrities!
Regarding dosage, my opinion is that severity should dictate dosage. One cannot rigidly prescribe heavy doses for certain herbs and light doses for others. Even in ancient formulas where dosages are fixed, the practitioner must adjust them to fit the pathology, not just change ingredients. The concept of Jun-Chen-Zuo-Shi (Monarch-Minister-Assistant-Courier) is distinguished by dosage. Thus, in the same formula, one herb may be Monarch for one syndrome, while another is Monarch for a different syndrome. Zhu Yingjie said: "Ancient formulas stating 'equal parts' do not mean identical weights, but rather determining herb weight based on disease assessment." This is very accurate. Previously, I treated a Yuan child with Damp-Warmth. The case record stated: "Full tongue coating thin, white, and slippery indicates Dampness at the exterior of Lung and Stomach. Red edges and tip indicate Heat in Heart and Liver Ying levels. Grayish, slightly rough center indicates Stomach accumulating Dampness transforming into Fire. Short, dark urine and constipation indicate Fire stagnation and Damp obstruction, impairing Qi transformation. Damp scorched by Fire generates Phlegm; Phlegm-Qi mounting upward causes drowsiness. Occasional desire for cold drinks indicates Damp transforming into Fire, with more Heat than Damp. Cold feet indicate Heat forcing inward; watch for Heat Jue. New cough indicates Ministerial and Sovereign Fire insulting Metal. Treatment should clear Heart/Liver Fire, guide it downward, and drain Lung/Stomach Dampness to assist. Thus, Heat resolves and Damp dissipates." Herbs included Danzhuye (Lophatherum Herb), Dengxincao (Juncus Medulla), Shijueming, Tongcao (Tetrapanatis Medulla), Baifuling (Poria with Hostwood), Sheng Yiren (Coicis Semen), Zhimu (Anemarrhenae Rhizoma), Maogen (Imperatae Rhizoma), Lugeng (Phragmitis Rhizoma), Biyu San (Jade Green Powder), and Xianzhuli. As no other phlegm-resolving herbs were used, Xianzhuli was administered in large quantity (4 liang), divided into two decoctions and taken together. Some criticized my heavy dosage. I am inadequate, but fortunate to record this case to acknowledge my error. I recall last year, Mr. Zou Hetou suffered from delirious speech resembling madness, wanting to go out constantly with great strength. Suspecting Phlegm-Fire congestion, but finding deep, fine, almost imperceptible pulse inconsistent with symptoms, I hesitated to use Lingyangjiao and Zhuli. I consulted Mr. Yu Botao, who also doubted its suitability. We agreed on a formula. Symptoms stabilized that day. The next day, he suddenly broke out the door and slept deeply at a friend's house. Upon waking, his pulse had changed to slippery, rapid, and large. I realized the previous day's pulse was a hidden Heat Jue pulse. I used Lingyangjiao ground with fresh Zhuli, administered continuously. Only these two herbs were used. That day, approximately 5 qian of Lingyangjiao and 13-14 liang of Zhuli were consumed. It was somewhat aggressive, and the intake was significant, even more than for this current case. Although disease severity differs, looking back, although treatment succeeded by luck, it was reckless. Practicing medicine requires plain formulas and mild dosages to avoid criticism from mediocre peers.
Taihuang (Congenital Jaundice)
On the 12th day of the 5th month in the Gui Chou year, my grandson Qinshang was born. His face, eyes, and body were yellow from birth; this is Taihuang. His urine was clear and copious, suggesting Deficiency-Cold. However, his body was robust, crying loudly, lips red-purple, pupils black and spirited. His father had a Wood-Fire constitution; his mother had a Damp-Phlegm constitution. I concluded it was undoubtedly Damp-Heat. Due to his small size and inability to take oral medication, recalling Wu Shangxian's statement: "Internal formulas can be adapted for external treatment," I used Mian Yinchen (Artemisiae Scopariae Herba), Chixiaodou (Adzuki Bean), Haipiaoxiao (Sepiae Endoconcha), Mabiancao (Verbenae Herba), Zihuadiding (Violae Herba), Sheng Cao Gao (Glycyrrhizae Radix et Rhizoma tip), Xian Banxia (Pinelliae Rhizoma processed with Ginger), Dafupi (Arecae Pericarpium), Xiao Qingpi (Citri Reticulatae Pericarpium), Chao Baizhu (Atractylodis Macrocephalae Rhizoma fried), Chi/Bai Shaoyao (Paeoniae Radix Rubra/Alba), Chi Fuling (Poria with Red Hostwood), and Baijing Qiuyin (Earthworm). All were finely powdered, mixed with wine, and applied to the umbilicus, changed twice daily. He recovered completely in twenty days. This demonstrates that for children unable to take oral meds, external treatment can be substituted. For head/eye diseases, apply to Taiyang points; for arm/leg diseases, apply to palms/soles; for chest diseases, apply to chest; for Lung diseases, apply to Feishu (BL13); for Liver diseases, apply to Qimen (LR14); for Spleen/Stomach diseases, apply to umbilicus/abdomen. Select herbs based on disease, applying warming, cooling, purging, or tonifying methods accordingly. This approach is likely effective.
Bi Nu (Epistaxis)
Lai Peiyu wrote inquiring: "In our county, a Mr. Kong, aged twenty, has suffered from a strange epistaxis since age fourteen. Every month, during the first ten days, at 7 AM, blood flows continuously. Various hemostatic drugs fail to stop it. Breathing resumes only the next day; bleeding comes and goes, resolving naturally after three days. Blood loss exceeds five pounds. Consciousness remains clear during and after episodes, with no other symptoms. This monthly recurrence, never missing a cycle, is a unique global phenomenon. Over a hundred doctors have treated him with no effect. Invited me this spring. Pulse is large and deep. Complexion does not suggest blood loss. No chills, fever, irritability, or cough. Only insomnia. Previous prescriptions included Xiexin Tang, Dihuang Tang, Bo'ai Tang, all ineffective. Studying ancient texts, they attribute this to True Yang deficiency. I tried Dushen Tang plus 5 qian Fuzi for several doses. Recurred next month. Then tried Jiawei Guipi Tang in morning and Huangtu Tang in evening for three months. Bleeding persists. Is the prescription wrong? Or four-five doses insufficient? What is the rationale? Please advise experts." I replied: "*Suwen* states: 'Pathogens lodging in the Foot-Yangming meridian cause rhinorrhea and epistaxis.' *Lingshu* states: 'The Stomach Foot-Yangming meridian starts at the nose, crosses the forehead, descends along the nasal side; diseases include rhinorrhea and epistaxis.' Thus, epistaxis can originate from the Stomach. The Stomach is a region of abundant Qi and Blood, so excessive bleeding is harmless.
Investigating worm syndromes, worms typically position themselves head-upward at the start of the month. Could this epistaxis be caused by stomach worms? The patient is likely robust, enjoys rich food, has much Damp-Heat, generating worms through stagnation. Worms disturb surplus blood,激 (stimulating) it to rush upward. Insomnia is due to Stomach disharmony, as stated in the classics: 'Stomach disharmony leads to restless sleep.' Given the long duration and normal complexion, it is definitely not a Deficiency syndrome. I propose Sheng Niuxi (Achyranthis Bidentatae Radix), Jiangchao Zhuru (Bambusae Caulis in Taeniam fried), Ciwei Pi (Hystrix Spina), Shanzhizi (Gardeniae Fructus), Chuanliuzi (Meli Semen), Fa Banxia (Pinelliae Rhizoma processed), Wuyi (Meliosmae Fructus), Hupo (Fossilia Subcorium), plus minor amounts of Dahuang (Rhei Radix et Rhizoma) powder and Ganqi (Lac Dragontis) powder. Administer monthly during onset. This may gradually reduce and cure. Ancient texts mention 'Stomach Gu' syndrome, treated with Shijunzi (Quisqualis Fructus), Wugu Chong (Silkworm), Leiwuan (Wormwood Fruit), Houpo (Magnoliae Officinalis Cortex) to kill worms, though not specifically for epistaxis.
I speculate that heaven and earth contain all wonders. Yin and Yang contend, sometimes winning, sometimes losing. Hence, the five types of female infertility exist, just as there are five types of male sexual dysfunction. Who knows if this person, possessing a Qian (Male) physique, actually has a Kun (Female) nature? Menstruation corresponds to the moon and tides. At the beginning of the lunar month, the crescent moon rises and tides begin; at full moon, the tide peaks. Moon is Yin image; tide is Yin substance. Mid-autumn has strongest Yin, hence brightest moon and highest tide. Women are Yin class, responding to menstruation. If there are women without menstruation, why not men with menstruation? Just as there are beardless men and bearded women. If we inquire about erectile dysfunction, it supports my theory. Blood and menses are essentially one. Blood flowing downward is smooth. Use Sheng Niuxi, Dahuang, Huaijiao (Sophorae Tonkinensis Fructus) to guide it out via the Large Intestine. If it exits via the Large Intestine, no further treatment is needed. This is a wild idea based on theory, recorded here for amusement.
Damp-Warmth, Hernia, Wind-Rash, Heat Entering Blood Chamber, Yangming Meridian Baihu Syndrome, Smallpox, Seasonal Qi
In autumn of Xin Hai year, I accompanied Mr. Yin Nan southward, following Vice Minister Yang Junqing Wending to Shaanxi. While waiting in Shanghai, the Wuchang Revolution broke out, roads were blocked, and I could not go. Times worsened, so I secluded myself in Songbin. Friends invited me to treat patients. A public letter praised me, drafted by Sun Yanqiu Wenyi, who also knew medicine. The letter elaborated on medical principles, so I record it to remember this deep friendship. Letter: Lu Jinsheng usually associates with city elites, few knowing his medical skill. Even those who know do not expect such depth. Since moving to Shanghai, he named his clinic "Jingjing Medical Room." He treats Damp-Warmth. Jia Nian's nephew Yinghuan also had Damp-Warmth. Lu said: Peng [Certain] is fat, with Heavy Damp and Light Heat; Zou [Certain] is thin, with Heavy Heat and Light Damp. Both require draining Damp and clearing Heat, but dosages differ. Chengyu also had Damp-Warmth. Lu said Heat is suppressed by Damp; first warm-transform, then use bitter-cold and bland-leaching methods. Treatment differs. Jiayi had abdominal distension and hernia with unbearable pain. Lu said white, thick, greasy tongue coating indicates Liver Qi suppressed by Cold-Damp. Used Cangzhu (Atractylodis Rhizoma), Houpo (Magnoliae Officinalis Cortex), Chaihu (Bupleuri Radix), Huixiang (Foeniculi Fructus). One dose cured him; he went out the next day.
Tingshao's two sons both had rashes. Lu said the elder had sweat, rapid pulses at Guan positions; use Shigao (Gypsum Fibrosum), Jueming (Semini Cassiae). The younger had no sweat; use Jingjie (Schizonepetae Herba), Bohe (Menthae Haplocalycis Herba). Both used acrid-cool exterior-resolving methods. Wenyi had rash with diarrhea. Lu said Lung transferred Heat to Large Intestine; pathogen has an exit, favorable for disease. Do not use ascending/astringent herbs. Do not guide downward, as this traps exterior pathogen inward. Once rash emerges and pathogen exits, diarrhea stops spontaneously. His words proved true. Yuanji had rash hiding internally, showing aversion to cold. Others thought Cold, planned to use Guizhi (Cinnamomi Ramulus), Baizhu, Chenpi (Citri Reticulatae Pericarpium), Banxia. Lu said no; this is latent Warm-Heat. Changed to Niubangzi (Arctii Fructus), Douchi (Sojae Semen Praeparatum), Dandoujuan (Sojae Semen Album Preparatum), Yinhua (Lonicerae Japonicae Flos), Danpi (Moutan Cortex), Shigao. Patient settled. Chengyu's son and daughter both had fever and aversion to cold. Lu said nasal congestion, slight cough, watery eyes indicate impending rash. First promote emergence. Rash appeared, healed quickly with few doses, no misdiagnosis.
Guozhen's daughter had Wind-Warmth with rash. Period started then stopped. Lu used acrid-cool agents supplemented with Danpi, Danshen (Salviae Miltiorrhizae Radix et Rhizoma). Also treated Zhou's daughter with Wind-Warmth. Period ending, pathogen invaded. Lu used acrid-cool agents supplemented with Yuanshen (Scrophulariae Radix), Shengdi (Rehmanniae Radix). Both cases involved Heat Entering Blood Chamber. Lu distinguished one as Blood Deficiency, one as Blood Stasis, hence different assistant/courier herbs. Both were Heat, so one avoided Taoren (Persicae Semen), Ziming (Leonuri Fructus), while the other avoided Chuanxiong (Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix).