魏柳洲先生辑《续名医类案》六十卷，脱稿未久，先生寻逝，幸已邀录四库馆书，不致
散佚
。提要病其编次潦草，盖未经删定之故也。雄不才，僭删芜复，而卷帙犹繁，未能付梓。爰
先录其所附按语为《柳洲医话》，以示一斑云。
咸丰元年冬十一月后学王士雄书于潜斋
伤寒邪结阳明，发为狂热，犹是宿食，宜吐之。非若燥粪便硬，可下而愈也。
雄按∶凡下之不通而死者，多此类也。
伤寒邪热甚则正馁，不可误认为虚。
雄按∶缪仲淳治姚平之案可证。
伤寒初愈，脏腑犹多热毒，时师不察，骤投参、 、术附温补，其遗患可胜言哉。
雄按∶《寓意草》伤寒善后法，学人最宜详玩。
凡诊病，浅见者反若深虑，多令病家无所适从。
雄按∶此评仲淳治虞吉卿案，或疑其虚而用桂、附也。今则此辈尤多，误人愈广。不知
疗病，但欲补虚，举国若狂，谁为唤醒。
龚子才治伤寒谵渴无汗，用大梨一枚，生姜一小块，同捣取汁，入童便一碗，重汤煮熟
服。制方甚佳，愈于甘露，且免地黄之腻。
雄按∶余以梨汁为天生甘露饮，而昔贤已先得我心。若有汗者，生姜宜避。
伤寒发散过投，气微欲绝，虽有实证，亦宜独参猛进。贫者以重剂杞、地，少入干姜。
雄按∶热炽而气液欲脱者，干姜亦忌，宜易甘草。
实邪宜下，人便稀识，可为浩叹。
雄按∶学识浅者，皆为立斋、景岳诸书所囿也。
伤寒狂躁，脉至洪大无伦，按之如丝者，以全料六味减苓、泽，加麦冬、杞子，用大砂
罐浓
煎与之，必数杯而后酣寝汗出以愈。古时此法未闻，惟仗人参之力取效。本阴竭之证，乃峻
补其阳，使生阴而愈，故用参每多至数斤，设在今时，非猗顿之家不可为矣。
雄按∶阴竭之证，今时尤多，人参之价，近日更昂。惟西洋人参性凉生液，最为可用。
而时师辄以桂、附、干姜治阴虚狂躁，益非魏君所能逆料矣。
内真寒而外假热，诸家尝论之矣。至内真热而外假寒，论及者罕矣。
景岳治王生阴虚伤寒燥渴，用凉水是矣。而又杂与桂、附各数两，治法未能无疵。至舌
苔成壳脱落，恐桂、附使之然也。
雄按∶今人明知其阴虚，而放肆用桂、附者，皆效景岳之尤也。
喻氏治伤寒以救阴为主一语，为治传经证之秘旨。
躁脉多凶，疫病热郁之极，脉亦躁也。
疫证脉双伏，或单伏而四肢厥冷，或爪甲青紫，欲战汗也。宜熟记。
房劳外感，即谓阴证而与热药，杀人多矣。
虚人肝肾之气上浮，宛如痰在膈间，须投峻剂养阴。俾龙雷之火，下归元海。
雄按∶叶香岩云，龙雷之起，总因阳亢，宜滋补真阴。今人反用热药，悖矣。详见《景
岳发挥》，医者不可不读也。
凡病尸厥，呼之不应，脉伏者死，脉反大者死。
凡卒暴病，如中风中气中寒暴厥。俱不得移动喧闹，以断其气，《内经》明言气复返则
生。
若不谙而扰乱，其气不得复，以致夭枉者多矣。盖暴病多火，扰之则正气散而死也。病家医
士，皆宜知此。
余常见父母有肝病者，其子女亦多有之，而禀乎母气者尤多。
木热则流脂，断无肝火盛而无痰者。
雄按∶此语未经人道，余每以雪羹、龙荟治痰，殊与魏君暗合。
张子和治新寨马叟之证，本因惊而得，尤不能无郁也。盖惊入心，心受之则为癫痫。今
心不
受而反传之肝，则为螈 ，亦母救其子之义也。肝病则乘其所胜，于是生风生痰，怪证莫测
。治以上涌下泄，乃发而兼夺之理。并行不悖。最合治法。
雄按∶马无胆而善惊，故惊字从马，似与恐惧怵惕之从心者异焉。古人虽曰惊入心，然
非胆薄，断不患惊。凡病惊者，其色必青。肝胆相连，殆不必心不受而后始传入也。
肝火亦作头晕，不尽属之气虚也。经云∶诸风掉眩，皆属于肝。肝之脉上络巅顶，余尝
以一气汤加左金，治此甚效。
补中益气汤，为东垣治内伤外感之第一方。后人读其书者，鲜不奉为金科玉律。然不知
近代
病患，类多真阴不足。上盛下虚者，十居九焉。即遇内伤外感之证，投之辄增剧，非此方之
谬，要知时代禀赋各殊耳。陆丽京曰∶阴虚人误服补中益气，往往暴脱，司命者其审诸。
雄按∶东垣此方，谓气虚则下陷，升其清阳，即是益气。然命名欠妥，设当时立此培中
举陷
复云益气，后人遂以为参、术得升柴。如黄 得防风而功愈大，既能补脾胃之不足，又可益
元气之健行，而忘其为治内伤兼外感之方。凡属虚人，皆宜服饵。再经薛氏之表章，每与肾
气丸相辅而行。幸张景岳一灵未泯，虽好温补，独谓此方未可浪用。奈以卢不远之贤亦袒薛
氏甚矣，积重之难返也。徐洄溪云∶东垣之方，一概以升提中气为主，学人不可误用。然此
方之升柴，尚有参、 、术、草之驾驭，若升麻葛根汤、柴葛解肌汤等方，纯是升提之品
，苟不察其人之阴分如何，而一概视为感证之主方，贻祸尚何言哉！叶香岩柴胡劫肝阴，葛
根竭胃汁之说，洵见道之言也。
凡素患虚损人，忽有外感，宜细审之。
雄按∶此处最易误人，拙案仁术志内曾论及之。
伤寒及感证日久，津液既枯，不能行汗。得大剂三才一气汤一服，乃蒸变为汗而愈矣。
若曾
多风药及香燥者，药入必大作胀，一二时许，然后来苏，后贤以此为内托之奇，余谓仍是仲
景啜粥法耳，后人安能越古人之范围哉！
伤风一证，殊非小恙。有寒燠不时，衣被失节而成者，此必鼻塞声重，咳嗽多痰。在元
气平和
之人，即弗药自愈。若在肾水素亏，肝火自旺者，不过因一时风寒所束，遂作干咳喉痛，此
外邪本轻，内伤实重，医者不察，辄与表散，致鼓其风木之火上炎，反今发热头痛，继又寒
热往来，益与清解，不数剂而肝肾与肺三脏，已伤损无遗。远者周年，近者百日，溘然逝矣
。而世俗谈者，咸以伤风不醒便成劳为言。噫！彼劳者，岂真由伤风而成耶？愚哉言也。当易
之曰∶伤风误表必成劳耳。
雄按∶阴虚误表固然，若外邪未清，投补太早，其弊同也。《不居集》论之详矣。故徐
洄溪有伤风难治之论也。
疟痢后饮食不运，多属气虚，然每有痢以下多而亡阴，疟以汗多而耗液。饮食难运，多
由相
火盛，真气衰非。大剂二冬二地投之，多见缠绵不已也。《寓意草》谓感后宜甘寒清热，说
得极透彻，最中肯綮。
雄按∶世人治此，但知六君以补脾，桂附以益火，杀人最伙，可为寒心。
肺气败者，多见两足肿溃，小水全无二证。
雄按∶粗工但知为湿邪阻塞也。
阴虚证，初投桂、附有小效，久服则阴竭而死，余目击数十矣。
雄按∶此真阅历见道之言。又徐洄溪曰∶大热大燥之药，杀人最烈。盖热药有毒，其性
急暴
，一入脏腑，则血涌气升。若其人之阴气本虚，或当天时酷暑，或其人伤暑伤热，一投热剂
，两火相争，目赤便闷，舌燥齿干，口渴心烦，肌裂神躁，种种恶候，一时俱发。医者及病
家俱不察，或云更宜引火归元，或云此是阴证，当加重剂热药而佐以大补之品，其人七窍流
血，呼号宛转，状如服毒而死。病家全不以为咎，医者亦洋洋自得，以为病势当然。总之，
愚人喜服热补，虽死不悔。我目中所见不一，垂涕泣而道之，而医者与病家无一能听从者，
岂非所谓命哉！夫大寒之药，亦能杀人，其势必缓，犹为可救。不若大热之药，断断不可救
也。愚谓此非激论，的是名言。今年春间，韩贡甫因患便血，误服热补，变证蜂起，业治木
矣。其妇翁陈春湖嘱延余诊，已为治愈。迨季夏，其弟正甫患时疟，越医王某连进温燥药而
剧，始邀余视之，乃府实证，下之而瘥。既而贡甫令壶患感，凛寒身热，眩渴善呕，余曰暑
也，宜从清解。彼不之信，仍招越医王某治之，连服苍术、浓朴、姜、椒之剂，呕渴愈甚，
泛事妄行，四肢不温，汗多不解。再邀余诊，脉渐伏，曰∶此热深厥深也，温燥热补，切勿
再投。彼仍不信，另招张某黄某会诊，佥谓阴暑，当舍时从证，迳用姜附、六君加萸、桂、
沉香等药服之，肢愈冷，药愈重。八剂后，血脱如崩而逝，即以春间所治之棺殓焉。岂非数
邪，此病家不知悔悟之一证也。继有许兰屿室，患左季胁刺痛，黄某目击韩证之死，亦不愧
悔。初诊即用桂、附，愈服愈痛，痛剧则白带如注，渐至舌赤形消。彼犹曰温补之药力未到
，方中桂、附日增，甚至痛无宁晷，始逆余诊。授以壮水和肝养营舒络之方而愈，往者不可
追，来者犹可谏，故附赘之。
热补药谓之劫剂，初劫之而愈，后反致重，世不知此，以为治验。古今受其害者，可胜
数哉。
呕吐证，良由肝火上逆者极多，张景岳偏于温补，以为多属胃寒，其误人谅不少矣。
完谷不化，有邪火不杀谷，火性迫速，愈甚而愈迫者。
发热之时，脉虽豁然空大，未可便断为虚寒也。
痢疾补涩太早，每成休息。
张景岳平生临证，遗憾多矣。观其治食停少腹一案，夫面食由胃入肠，已至小腹之角
，岂
能作痛如是，而又如拳如卵耶？必其人素有疝病，偶因面食之湿热发之，或兼当日之房劳。
遂乃决如是。故推荡之亦不应，得木香、火酒一派辛热香窜而痛止耳。至谓食由小腹下右角
而后出广肠，谓自古无言及者，更堪捧腹。经谓大小肠皆盘屈十六曲，则左旋右折可知，岂
如筒如袋而直下乎？嘻！
《伤寒》论病患素有痞积，及病传入三阴则死，谓之脏结。盖新邪与旧邪合并也。苦楝
根取新白皮一握、切、焙，入麝少许，水二碗，煎至一碗，空心饮之，杀消渴之虫屡验。
孙文垣治吴肖峰室，善后不用滋水生木，弦脉安能退哉。
李士材治顾宗伯心肾两亏，用八味、十全，与后医之元参、知母。其失正均，惟集灵膏
一方，真圣剂也。
雄按∶集灵膏见《广笔记》，方用人参、枸杞、牛膝二冬、二地，或加仙灵脾。
凡治小儿，不论诸证，宜先揣虚里穴。若跳动甚者，不可攻伐，以其先天不足故也。幼
科能遵吾言，造福无涯矣。此千古未泄之秘也，珍之贵之。
雄按∶大人亦然。小儿则脉候难凭，揣此尤为可据。
劳损病已不可为，服药得法，往往有骤效，乃虚阳暂伏也。数服后证皆仍旧矣。临证者
不可不知。
肺热之人，虽产妇误服人参，多致痰饮胶结胸中，为饱为闷，为咳嗽不食等证。
喻氏治郭台尹之证，多由醉饱入房，大伤真阴，绝其带脉，水亏木燥，乘其所不胜之脾
成胀耳。鱼盐之论，恐未必然。
又治顾鸣仲之证，似属肝肾二经，与膀胱无干涉，乃舍肝而强入膀胱，便觉支离满纸。
火盛而郁者，多畏风畏寒。
雄按∶人但知伤风畏风，伤寒畏寒，能识此者鲜矣。
梅核证，由郁怒忧思，七情致伤而成，无非木燥火炎之候。古人多用香燥之剂，岂当时
体质浓耶？
余治肝肾亏损，气喘吸促之证，必重投熟地、人参，无力之家不能服参者，以枣仁、杞
子各一两代之，亦应如桴鼓。
雄按∶枸杞一味，专治短气，其味纯甘，能补精神气血津液诸不足也。
缪氏谓阳明热邪传里，故身凉发哕，是金针也。
凡损证脉见右寸厥厥然如豆，按之梗指，其病不起，以肺金败也。
杨介都梁丸治头痛，惟阳明风热宜之，余不可服。
雄按∶古方治病，皆当察其药所主之证而用之，不独都梁丸尔也。学人须知隅反。
《医学钩元》有目病不宜服六味辨，谓泽泻、茯苓、山茱萸不宜于目。余谓凡肝肾虚，
皆不宜此三味，不惟目也。
雄按∶用药治病，须知量体裁衣，执死方以治活病，有利必有弊也。
景岳见燕都女子喉窍紧涩，而不能以左归合生脉救之，乃误用辛温解散，既而知其肺绝
，又
效粗工避谤，不敢下手。按丹溪云∶咽喉肿痛，有阴虚阳气飞越，痰结在上，脉必浮大，重
取必涩，去死为近，宜人参一味浓煎，细细呷之，如作实证治，祸如反掌。观此，丹溪之学
，何可薄哉？《传忠录》之言，九原有知，宜滋愧矣。
戴人治一将军病心痛，张曰∶此非心痛也，乃胃脘当心而痛也。余谓此二语，真为此证
点睛
。然余更有一转语曰∶非胃脘痛也，乃肝木上乘于胃也。世人多用四磨、五香、六郁、逍遥
等方，新病亦效，久服则杀人。又用玉桂亦效，以木得桂而枯也。屡发屡服，则肝血燥竭，
少壮者多成劳病，衰弱者多发厥而死，不可不知。余自创一方，名一贯煎，用北沙参、麦冬
、地黄、当归、枸杞、川楝六味，出入加减投之，应如桴鼓。口苦燥者，加酒连尤捷。可统
治胁痛吞酸吐酸疝瘕一切肝病。
雄按∶胸胁痛，有因于痰饮者，滋腻亦不可用也。
香附、郁金，为治肝要药。然用之气病则可，用之血病，则与干将莫邪无异也。慎之！
二地
腻膈之说，不知始自何人，致令数百年来，人皆畏之如虎，俾举世阴虚火盛之病，至死而不
敢一尝。迨已濒危。始进三数钱许，已无及矣。哀哉！
魏柳洲先生编纂的《续名医类案》共六十卷，刚脱稿不久，先生便去世了。幸好该书已被收录进四库全书，没有散失。提要认为其编排杂乱无章，大概是因为未经过删减修订的缘故。我王士雄才疏学浅，擅自删去重复繁杂的内容，但篇幅依然繁多，未能刻印出版。于是先摘录其中附带的按语，编成《柳洲医话》，以展示其学术见解的一斑。
咸丰元年冬十一月，后学王士雄在潜斋书写。
伤寒邪气结聚于阳明经，引发高热狂躁，这往往是宿食停滞所致，应当使用吐法治疗。这与燥屎内结、大便干硬，可以使用下法治愈的情况不同。
王士雄按：凡是使用下法不通而死亡的病例，大多属于此类。
伤寒邪热炽盛时，正气往往虚弱，不可误认为是单纯的虚证。
王士雄按：缪仲淳治疗姚平之的案例可以证明这一点。
伤寒初愈时，脏腑中仍多有热毒残留。当时的医生不加考察，贸然投用人参、白术、附子等温补药物，其遗留的祸患怎能说得完呢？
王士雄按：《寓意草》中关于伤寒善后调理的方法，学习者最应该详细研读。
凡诊病，见识浅薄的人反而表现得深思熟虑，多让病人家属无所适从。
王士雄按：这是对缪仲淳治疗虞吉卿案例的评价，有人怀疑患者是虚证而使用了桂枝、附子。如今这类人更多，误人更广泛。不知道治病，只想补虚，全国上下像发狂一样，谁来唤醒他们。
龚子才治疗伤寒谵语口渴无汗，用大梨一枚，生姜一小块，一起捣碎取汁，加入童便一碗，隔水煮熟服用。制方非常精妙，疗效优于甘露饮，且避免了地黄滋腻的弊端。
王士雄按：我将梨汁视为天然的甘露饮，而前代贤者早已先得我心。如果有汗出的情况，生姜应当避免使用。
伤寒发散过度，导致气微欲绝，即使有实证，也应当单独重用参汤猛补。贫穷之人可用重剂量的枸杞、地黄，少量加入干姜。
王士雄按：热势炽盛而气液欲脱者，干姜也应禁忌，宜改用甘草。
实邪应当使用下法，人们却容易将其误判为虚证而用补法，对此只能长叹。
王士雄按：学识浅薄的人，都被立斋、景岳等人的书籍所局限。
伤寒出现狂躁，脉象洪大无比，重按如丝线般细微，这是阴竭阳浮之象。应用全料六味地黄丸减去茯苓、泽泻，加入麦冬、枸杞子，用大砂罐浓煎给予服用，必须喝几杯后才能酣睡出汗而痊愈。古时候这种方法未曾听闻，只依靠人参的力量取得疗效。本属阴液枯竭的证候，却峻补阳气，使阳气生阴而痊愈，所以用人参往往多达数斤。如果放在现在，不是富商之家是无法承担的。
王士雄按：阴竭的证候，如今尤其多见，人参的价格近日更加昂贵。只有西洋参性凉生津，最为可用。然而当时的医生却常用桂枝、附子、干姜治疗阴虚狂躁，这更是魏柳洲先生所不能预料到的了。
体内真寒而体表假热，各家医书曾经论述过。至于体内真热而体表假寒，论及的人很少。
张景岳治疗王某阴虚伤寒燥渴，使用凉水是正确的。但又混杂加入桂枝、附子各数两，治疗方法未能没有瑕疵。至于舌苔结成壳状脱落，恐怕是桂枝、附子造成的。
王士雄按：现代人明知是阴虚，却放肆使用桂枝、附子的，都是效法张景岳的过失。
喻嘉言提出“治疗伤寒以救阴为主”这一句话，是治疗传经证候的秘诀。
躁动的脉象多主凶险，疫病热郁极盛时，脉象也会躁动。
疫病的脉象双伏，或单伏而四肢厥冷，或指甲青紫，这是将要战汗的先兆。应当熟记。
房劳后感冒，即称为阴证，若给予热药，杀人很多。
虚损之人肝肾之气上浮，宛如痰在膈间，必须投用峻剂滋养阴液。使龙雷之火（相火）下归元海（肾）。
王士雄按：叶天士说，龙雷之火的兴起，总因阳气亢盛，应当滋补真阴。现代人反而使用热药，违背了医理。详见《景岳发挥》，医者不可不读。
凡是病尸厥，呼叫不应，脉象伏匿的会死，脉象反而大的也会死。
凡是突然发生的急病，如中风、中气、中寒暴厥。都不得移动和喧闹，以免断绝正气，《内经》明确说明气能恢复则生。
如果不熟悉而扰乱，正气无法恢复，导致夭折的人很多。因为暴病多火，扰乱它则正气消散而死。病人家属和医生，都应该知道这一点。
我常见父母患有肝病的人，其子女也多有此病，而禀受母气的尤其多。
木热则流脂，绝无肝火旺盛而没有痰的情况。
王士雄按：这句话前人未曾说过，我常用雪羹汤、当归龙荟丸治疗痰证，与魏先生暗中契合。
张子和治疗新寨马叟的病证，本因惊吓而得，尤其不能没有郁结。因为惊入心，心受之则为癫痫。现在心不受邪而反传之于肝，则为抽搐，这也是母病救子（肝为心之子，此处指肝木生心火，心病传肝，或指五行相生关系中的母子相救，原文语境似指肝木疏泄以解心郁，或肝木乘脾土生风痰，需结合上下文，此处依原文逻辑：惊伤心，心不受害传肝，肝主风，故见抽搐）的意义。肝病则乘其所胜（克脾），于是生风生痰，怪证莫测。治疗采用上涌下泄，乃是发散兼夺邪的道理。并行不悖，最合治法。
王士雄按：马无胆而善惊，所以“惊”字从马，似乎与恐惧怵惕的从心者不同。古人虽说是惊入心，但如果不是胆气薄弱，绝不会患惊病。凡是患惊病的人，面色必青。肝胆相连，大概不必等到心不受邪后才传入肝。
肝火也会引起头晕，不全是气虚所致。经文说：诸风掉眩，皆属于肝。肝的经脉上行联络头顶，我常用一气汤加左金丸治疗此病，效果很好。
补中益气汤，是李东垣治疗内伤外感的第一方。后人读他的书，很少有不对奉为金科玉律的。然而不知道近代病患，大多真阴不足。上盛下虚的，十有八九。即使遇到内伤外感的证候，投用此方往往加重病情，不是这个方的错误，要知道时代禀赋各不相同罢了。陆丽京说：阴虚的人误服补中益气，往往暴脱，掌生杀大权的人应当审慎。
王士雄按：李东垣的这个方子，说是气虚则下陷，升举清阳，就是益气。然而命名不妥，假如当时立名为培中举陷，再称之为益气，后人就会以为人参、白术得到升麻、柴胡的作用就更大，就像黄芪得到防风功效就更大一样，既能补脾胃之不足，又可益元气之健行，从而忘记它是治疗内伤兼外感的方子。凡是虚损之人，都适宜服用。再经过薛己的表彰，常与肾气丸相辅而行。幸好张景岳灵明未泯，虽然喜好温补，唯独认为此方不可滥用。无奈卢不远这样的贤人也袒护薛氏太甚，积重难返。徐灵胎说：李东垣的方子，一概以升提中气为主，学习者不可误用。然而这个方子中的升麻、柴胡，还有人参、白术、甘草的驾驭，如果是升麻葛根汤、柴葛解肌汤等方子，纯粹是升提之品，如果不考察病人的阴分如何，而一概视为感证的主方，贻害无穷！叶天士说柴胡劫肝阴，葛根竭胃汁的说法，确实是至理名言。
凡是素患虚损的人，忽然又有外感，应当仔细审察。
王士雄按：这里最容易误人，我的《仁术志》中曾论述过。
伤寒及感证日久，津液已经枯涸，不能发汗。服用大剂量的三才一气汤一付，便能蒸变为汗而痊愈。
如果之前曾用过多风药及香燥药物，药入体内必然大作胀满，约一个多小时后，然后苏醒。后世医家将此视为内托的奇效，我认为这仍是张仲景啜粥法的原理，后人怎么能超越古人的范围呢！
伤风一证，绝非小病。有的因寒暖不时，衣被失节而成，这必然鼻塞声重，咳嗽多痰。在元气平和的人身上，即使不服药也能自愈。如果在肾水素亏，肝火自旺的人身上，不过因一时风寒束缚，遂作干咳喉痛，这是外邪本轻，内伤实重。医者不察，辄与表散，致使鼓动风木之火上炎，反而令发热头痛，继而又寒热往来，再给予清解，不到几剂药，肝肾与肺三脏，已损伤殆尽。远的周年，近的百日，突然去世。而世俗谈论者，都以“伤风不醒便成劳”来说事。唉！那些劳损，难道真是由伤风形成的吗？愚昧的话啊。应当改为：伤风误用表散必成劳耳。
王士雄按：阴虚误用表散固然如此，若外邪未清，过早投用补药，其弊端也是一样的。《不居集》论述得很详细。所以徐灵胎有伤风难治的论点。
疟疾痢疾后饮食不运化，多属气虚，然而每每有痢疾因下利多而亡阴，疟疾因汗多而耗液。饮食难运，多由相火盛，真气衰败所致。大剂量二冬（天冬、麦冬）、二地（生地、熟地）投用，多见缠绵不已。《寓意草》说感后宜甘寒清热，说得极透彻，最中肯綮。
王士雄按：世人治疗此病，只知道用六君子汤补脾，桂枝附子益火，杀人最多，令人寒心。
肺气败坏的人，多见两足肿溃，小便全无这两个证候。
王士雄按：粗劣的医生只知道是湿邪阻塞。
阴虚证，初投桂枝、附子有小效，久服则阴竭而死，我亲眼目睹几十例了。
王士雄按：这真是阅历丰富、洞悉医理的话。另外徐灵胎说：大热大燥的药，杀人最烈。因为热药有毒，其性急暴，一进入脏腑，则血涌气升。如果此人阴气本虚，或当天时酷暑，或其人伤暑伤热，一投热剂，两火相争，目赤便闷，舌燥齿干，口渴心烦，肌肤裂开神志烦躁，种种恶候，一时俱发。医者和病家都不考察，有人说更适合引火归元，有人说这是阴证，应当加重剂热药并佐以大补之品，其人七窍流血，呼号宛转，状如服毒而死。病家完全不以为是过错，医者也洋洋自得，认为病势当然。总之，愚人喜服热补，虽死不悔。我眼中所见不止一例，垂泪泣诉，而医者与病家无一能听从的，这难道不是所谓的命吗！大寒的药，也能杀人，其势必缓，还为可救。不如大热的药，断断不可救也。我认为这不是激愤之论，确实是名言。今年春天，韩贡甫因患便血，误服热补，变证蜂起，已经治不好了。他的岳父陈春湖嘱咐我去诊治，已经治愈。到了夏末，他的弟弟正甫患时疟，越医王某连续进温燥药而加剧，才邀请我看诊，原来是府实证，下之而好转。不久，贡甫的儿子壶患感，凛寒身热，眩晕口渴善呕，我说这是暑证，宜从清解。他们不信，仍招越医王某治疗，连服苍术、厚朴、姜、椒之剂，呕渴愈甚，泛事妄行，四肢不温，汗多不解。再邀我看诊，脉渐伏，我说：这是热深厥深，温燥热补，切勿再投。他们仍不信，另招张某黄某会诊，都说阴暑，当舍时从证，径用姜附、六君加萸肉、桂枝、沉香等药服用，肢愈冷，药愈重。八剂后，血脱如崩而逝，即用春天所治之棺殓葬。这难道是命运吗？这是病家不知悔悟的一个证据。接着有许兰屿的妻子，患左季胁刺痛，黄某目击韩证之死，也不惭愧后悔。初诊即用桂枝、附子，愈服愈痛，痛剧则白带如注，渐至舌赤形消。他还要说温补的药力未到，方中桂枝、附子日增，甚至痛无宁晷，才逆来顺受让我诊视。授以壮水和肝养营舒络之方而愈，往者不可追，来者犹可谏，所以附赘于此。
热补药称为劫剂，初劫之而愈，后反致重，世人不知道这点，以为是治验。古今受其害者，岂能数得尽哉。
呕吐证，良由肝火上逆者极多，张景岳偏于温补，以为多属胃寒，其误人谅不少矣。
完谷不化，有邪火不杀谷，火性迫速，愈甚而愈迫者。
发热之时，脉虽豁然空大，未可便断为虚寒也。
痢疾补涩太早，每成休息痢。
张景岳平生临证，遗憾多矣。观其治食停少腹一案，夫面食由胃入肠，已至小腹之角，岂能作痛如是，而又如拳如卵耶？必其人素有疝病，偶因面食之湿热发之，或兼当日之房劳。遂乃决如是。故推荡之亦不应，得木香、火酒一派辛热香窜而痛止耳。至谓食由小腹下右角而后出广肠，谓自古无言及者，更堪捧腹。经谓大小肠皆盘屈十六曲，则左旋右折可知，岂如筒如袋而直下乎？嘻！
《伤寒论》论病患素有痞积，及病传入三阴则死，谓之脏结。盖新邪与旧邪合并也。苦楝根取新白皮一握、切、焙，入麝少许，水二碗，煎至一碗，空心饮之，杀消渴之虫屡验。
孙文垣治疗吴肖峰的妻子，善后不用滋水生木，弦脉安能退哉。
李士材治疗顾宗伯心肾两亏，用八味丸、十全大补汤，与后医之元参、知母。其失正均，惟集灵膏一方，真圣剂也。
王士雄按：集灵膏见《广笔记》，方用人参、枸杞、牛膝、二冬、二地，或加仙灵脾。
凡是治疗小儿，不论诸证，宜先揣摸虚里穴。若跳动甚者，不可攻伐，以其先天不足故也。幼科能遵吾言，造福无涯矣。此千古未泄之秘也，珍之贵之。
王士雄按：大人亦然。小儿则脉候难凭，揣此尤为可据。
劳损病已不可为，服药得法，往往有骤效，乃虚阳暂伏也。数服后证皆仍旧矣。临证者不可不知。
肺热之人，虽产妇误服人参，多致痰饮胶结胸中，为饱为闷，为咳嗽不食等证。
喻嘉言治疗郭台尹的病证，多由醉饱入房，大伤真阴，绝其带脉，水亏木燥，乘其所不胜之脾成胀耳。鱼盐之论，恐未必然。
又治顾鸣仲的病证，似属肝肾二经，与膀胱无干涉，乃舍肝而强入膀胱，便觉支离满纸。
火盛而郁者，多畏风畏寒。
王士雄按：人但知伤风畏风，伤寒畏寒，能识此者鲜矣。
梅核气证，由郁怒忧思，七情致伤而成，无非木燥火炎之候。古人多用香燥之剂，岂当时体质浓耶？
我治疗肝肾亏损，气喘吸促的病证，必重投熟地、人参，无力之家不能服参者，以枣仁、枸杞子各一两代之，亦应如桴鼓。
王士雄按：枸杞一味，专治短气，其味纯甘，能补精神气血津液诸不足也。
缪氏说阳明热邪传里，故身凉发哕，是金针也。
凡是损证脉见右寸厥厥然如豆，按之梗指，其病不起，以肺金败也。
杨介都梁丸治头痛，惟阳明风热宜之，余不可服。
王士雄按：古方治病，皆当察其药所主之证而用之，不独都梁丸尔也。学人须知隅反。
《医学钩元》有目病不宜服六味辨，谓泽泻、茯苓、山茱萸不宜于目。余谓凡肝肾虚，皆不宜此三味，不惟目也。
王士雄按：用药治病，须知量体裁衣，执死方以治活病，有利必有弊也。
张景岳见燕都女子喉窍紧涩，而不能以左归丸合生脉散救之，乃误用辛温解散，既而知其肺绝，又效粗工避谤，不敢下手。按丹溪说：咽喉肿痛，有阴虚阳气飞越，痰结在上，脉必浮大，重取必涩，去死为近，宜人参一味浓煎，细细呷之，如作实证治，祸如反掌。观此，丹溪之学，何可薄哉？《传忠录》之言，九原有知，宜滋愧矣。
戴人治疗一将军病心痛，张子和说：此非心痛也，乃胃脘当心而痛也。我认为这两句话，真是为此证点睛。然而我更有一转语说：非胃脘痛也，乃肝木上乘于胃也。世人多用四磨汤、五香散、六郁汤、逍遥散等方，新病亦效，久服则杀人。又用玉桂亦效，以木得桂而枯也。屡发屡服，则肝血燥竭，少壮者多成劳病，衰弱者多发厥而死，不可不知。我自创一方，名一贯煎，用北沙参、麦冬、地黄、当归、枸杞、川楝子六味，出入加减投之，应如桴鼓。口苦燥者，加酒黄连尤捷。可统治胁痛吞酸吐酸疝瘕一切肝病。
王士雄按：胸胁痛，有因于痰饮者，滋腻亦不可用也。
香附、郁金，为治肝要药。然用之气病则可，用之血病，则与干将莫邪无异也。慎之！
二地（生地、熟地）腻膈之说，不知始自何人，致令数百年来，人皆畏之如虎，俾举世阴虚火盛之病，至死而不敢一尝。迨已濒危。始进三数钱许，已无及矣。哀哉！
Mr. Liu Zhou compiled the "Continued Cases of Famous Doctors" in sixty volumes. Shortly after completing the manuscript, he passed away. Fortunately, it was included in the Siku Quanshu (Complete Library of the Four Treasuries), preventing its loss. The abstract criticized its disorganized arrangement, likely due to the lack of revision and editing. I, Wang Shixiong, though untalented, presumptuously deleted redundant and cumbersome content, yet the volume remained too large for publication. Therefore, I first extracted the appended comments to form "Liu Zhou's Medical Conversations," to show a glimpse of his insights.
Written by the humble scholar Wang Shixiong at Qianzhai in the winter of November, the first year of Xianfeng.
When pathogenic factors of Shanghan (Cold Damage) bind in the Yangming channel, causing high fever and mania, it is often due to retained food stagnation, which should be treated with emesis. This differs from dry stool accumulation and hardness, which can be cured with purgation.
Wang Shixiong notes: Deaths resulting from failed purgation are mostly of this type.
When pathogenic heat in Shanghan is severe, the healthy qi is often depleted; it should not be mistaken for a pure deficiency syndrome.
Wang Shixiong notes: The case of Miao Zhongchun treating Yao Pingzhi can prove this.
After the initial recovery from Shanghan, the zang-fu organs often still harbor heat toxins. Contemporary physicians, failing to observe this, rashly administer warming and tonifying herbs such as Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), and Fuzi (Aconite Lateralis Radix Praeparata). The lingering disasters caused by this cannot be fully described.
Wang Shixiong notes: The post-Shanghan convalescence methods in "Yuyi Cao" (Meaningful Grass) are most suitable for students to study in detail.
In diagnosing diseases, those with superficial understanding often appear to deliberate deeply, leaving patients' families confused and unsure of what to do.
Wang Shixiong notes: This comment refers to Miao Zhongchun's treatment of Yu Jiqing, where some suspected deficiency and used Guizhi (Cinnamon Twig) and Fuzi. Such people are even more numerous now, harming more patients. They do not understand that treating disease requires addressing the root; blindly seeking to tonify deficiency has driven the nation mad. Who will awaken them?
Gong Zicai treated Shanghan with delirium, thirst, and anhidrosis using one large pear, a small piece of fresh ginger, pounded together to extract juice, mixed with one bowl of child's urine, and cooked thoroughly before administration. The prescription is excellent, superior to Ganlu Yin (Sweet Dew Decoction), and avoids the cloying nature of Dihuang (Rehmanniae Radix).
Wang Shixiong notes: I consider pear juice to be natural Ganlu Yin, and past sages had already anticipated my thoughts. If sweating is present, ginger should be avoided.
Overuse of diaphoretic agents in Shanghan can lead to faint qi and impending collapse. Even if excess syndromes exist, one should administer a heavy dose of single-herb Ginseng Decoction urgently. For the poor, heavy doses of Gouqi (Lycium Fruit) and Dihuang, with a small amount of Ganjiang (Zingiberis Rhizoma), may be used.
Wang Shixiong notes: In cases of intense heat with impending depletion of qi and fluids, Ganjiang should also be contraindicated; Gancao (Licorice Root) should be substituted instead.
Excess pathogens require purgation, yet people often mistake them for deficiency and use tonification, which is lamentable.
Wang Shixiong notes: Those with shallow knowledge are confined by the books of Lizhai (Li Dongyuan) and Jingyue (Zhang Jiebin).
Shanghan presenting with mania and restlessness, with a pulse that is vast and boundless but feels thread-like upon deep pressure, indicates yin exhaustion with floating yang. Use the full formula of Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), removing Fuling (Poria) and Zexie (Alisma Rhizome), adding Maidong (Ophiopogon Tuber) and Gouqi (Lycium Fruit). Decoct strongly in a large clay pot and administer. Several cups must be consumed before the patient falls into a sound sleep, sweats, and recovers. This method was unheard of in ancient times; efficacy relied solely on the power of Renshen. Since this is a syndrome of yin exhaustion, tonifying yang heavily generates yin to restore balance, hence Renshen was often used in amounts of several jin. In modern times, only wealthy families could afford this.
Wang Shixiong notes: Yin exhaustion syndromes are particularly common nowadays, and the price of Renshen has risen further. Xiyangshen (American Ginseng Root), being cool-natured and generating fluids, is most usable. However, contemporary physicians often use Guizhi, Fuzi, and Ganjiang to treat yin deficiency with mania, a situation beyond Mr. Liu Zhou's foresight.
Internal true cold with external false heat has been discussed by various schools. Internal true heat with external false cold, however, is rarely discussed.
Jingyue treated Wang's yin-deficient Shanghan with dryness and thirst using cool water, which was correct. However, mixing it with several taels of Guizhi and Fuzi introduced flaws in the treatment. The shedding of tongue coating into a shell-like layer was likely caused by these warming herbs.
Wang Shixiong notes: Modern people who knowingly use Guizhi and Fuzi for yin deficiency are merely imitating Jingyue's errors.
Yu Jiayan's statement that "treating Shanghan primarily involves saving yin" is the secret principle for treating transmitted disease patterns.
Restless pulses generally indicate ominous prognoses. In epidemic febrile diseases, extreme heat stagnation can also cause restless pulses.
Epidemic diseases presenting with double-hidden pulses, or single-hidden pulses with cold limbs, or cyanotic fingernails, indicate impending battle-sweat. This should be memorized carefully.
External contraction following sexual exertion is termed Yin Syndrome. Administering hot herbs in such cases has killed many.
In deficient individuals, qi from the liver and kidney floats upward, resembling phlegm in the chest-diaphragm area. Strong yin-nourishing agents must be administered to guide the Dragon-Lei fire (ministerial fire) back to the Yuan Sea (kidney).
Wang Shixiong notes: Ye Tianshi stated that the rise of Dragon-Lei fire is due to hyperactive yang, requiring nourishment of true yin. Modern practitioners wrongly use hot herbs, violating medical principles. See "Jingyue Fa Hui"; physicians must read it.
In cases of sudden syncope (Shi Jue) where the patient does not respond to calls, hidden pulses indicate death, as do excessively large pulses.
In sudden acute illnesses such as stroke, qi obstruction, or cold syncope, movement and noise must be avoided to prevent severing the qi. The "Neijing" clearly states that if qi returns, life is preserved.
If ignorance leads to disturbance, qi cannot return, resulting in many premature deaths. Acute illnesses often involve fire; disturbing it scatters the healthy qi, leading to death. Both patients' families and physicians should know this.
I often observe that children of parents with liver diseases frequently suffer from similar conditions, especially those inheriting maternal constitution.
When wood (liver) is hot, fat flows; there is no case of excessive liver fire without phlegm.
Wang Shixiong notes: This insight is original. I often use Xueming Tang (Snow Soup) and Longhui Wan (Dragon Gallbladder Pill) to treat phlegm, coincidentally aligning with Mr. Wei's views.
Zihehe treated the case of Old Man Ma from Xinzhai, which originated from fright and involved depression. Fright enters the heart; if the heart is affected, epilepsy results. Here, the heart was not affected, but the pathogen transmitted to the liver, causing convulsions, illustrating the principle of the mother organ rescuing the son (Liver generates Heart). Liver disease overacts on what it conquers (Spleen), generating wind and phlegm, leading to unpredictable strange symptoms. Treatment involved upper emesis and lower purgation, combining release and draining, which is consistent and appropriate.
Wang Shixiong notes: Horses lack gallbladder courage and are easily frightened, hence the character for fright contains the horse radical, differing from fear rooted in the heart. Although ancients said fright enters the heart, without weak gallbladder qi, fright would not occur. Patients with fright always have a green complexion. The liver and gallbladder are connected; transmission need not wait for the heart to be unaffected.
Liver fire can also cause dizziness, not solely due to qi deficiency. The classics state: "All wind tremors and dizziness belong to the Liver." The liver meridian connects to the vertex. I often treat this effectively with Yiqi Tang added with Zuojin Wan.
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is Li Dongyuan's premier formula for internal injury and external contraction. Later readers revere it as an immutable rule. However, they fail to realize that modern patients often suffer from true yin deficiency. Nine out of ten present with upper excess and lower deficiency. Even when encountering internal injury or external contraction, administering this formula often worsens the condition. This is not a flaw in the formula but reflects differences in era and constitution. Lu Lijing stated: Yin-deficient patients mistakenly taking Buzhong Yiqi Tang often suffer sudden collapse; those holding life-and-death authority must be cautious.
Wang Shixiong notes: Dongyuan's formula posits that qi deficiency leads to sinking; raising clear yang is equivalent to augmenting qi. However, the name is inappropriate. If named "Nourish Middle and Raise Collapse" initially, followed by "Augment Qi," later generations might assume Renshen and Baizhu gain enhanced effects from Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix), just as Huangqi (Astragali Radix) gains effect from Fangfeng (Saposhnikoviae Radix). It both tonifies spleen-stomach insufficiency and benefits yuan qi's vigorous movement, yet forgets it treats internal injury with external contraction. All deficient persons should take it. After Xue’s endorsement, it was often paired with Shenqi Wan (Kidney Qi Pill). Fortunately, Zhang Jingyue retained some wisdom; despite liking warming tonification, he alone warned against reckless use. Unfortunately, virtuous scholars like Lu Buyuan sided too strongly with Xue, making reversal difficult. Xu Huixi said: Dongyuan's formulas all focus on lifting middle qi; students must not misuse them. While Shengma and Chaihu in this formula are controlled by Renshen, Baizhu, and Gancao, formulas like Shengma Gegen Tang and Chaige Jieji Tang consist purely of lifting agents. Without examining the patient's yin status, treating them as general exterior syndrome formulas causes immense harm! Ye Tianshi’s saying that Chaihu robs liver yin and Gegen (Puerariae Radix) exhausts stomach fluids is indeed profound truth.
For patients with chronic deficiency suddenly contracting external pathogens, careful examination is essential.
Wang Shixiong notes: This is a common pitfall, discussed in my "Ren Shu Zhi".
In prolonged Shanghan or epidemic febrile diseases, fluids are depleted, making sweating impossible. One dose of a heavy dosage of Sancai Yiqi Tang can induce evaporation into sweat, leading to recovery.
If previous treatments involved excessive wind-dispelling or aromatic-dry herbs, the medicine will cause severe blooding initially, resolving after about an hour. Later generations call this miraculous internal support, but I believe it is merely the principle of drinking hot porridge as taught by Zhang Zhongjing. How can later generations surpass ancient boundaries!
Wind-cold invasion is not a minor ailment. It arises from irregular temperature changes or improper clothing, causing nasal congestion, heavy voice, cough, and profuse phlegm. In individuals with balanced yuan qi, it resolves spontaneously without medication. However, in those with inherent kidney yin deficiency and spontaneous liver fire, temporary wind-cold constraint triggers dry cough and sore throat. Here, the external pathogen is light, but internal injury is heavy. Physicians failing to recognize this and using dispersing agents stir up wind-wood fire, causing fever and headache, followed by alternating chills and fever. Further clearing and resolving agents damage the liver, kidney, and lung within a few doses. Death occurs within months to a year. Secular wisdom claims "wind-cold unawakened becomes consumption." Alas! Is consumption truly caused by wind-cold? This is foolish talk. It should be corrected: "Wind-cold mistreated with dispersants inevitably leads to consumption."
Wang Shixiong notes: Yin deficiency mistreated with dispersants is indeed harmful. Similarly, tonifying too early while external pathogens remain unresolved yields the same弊端. "Bu Ju Ji" discusses this in detail. Hence Xu Huixi argues that wind-cold is difficult to treat.
Post-malaria or dysentery, poor digestion often relates to qi deficiency. However, dysentery with excessive diarrhea depletes yin, and malaria with excessive sweating consumes fluids. Poor digestion here is often due to hyperactive ministerial fire and declining true qi. Heavy doses of Dongdong (Tianmai and Maidong) and Erdi (Shengdi and Shudi) often result in lingering illness. "Yuyi Cao" suggests sweet-cool herbs to clear heat post-infection, which is thorough and accurate.
Wang Shixiong notes: Worldly physicians only know Six Jun Zi Tang to tonify spleen and Guifu to boost fire, killing many. This is chilling.
Patients with failing lung qi often present with swollen and ulcerated feet and complete absence of urination.
Wang Shixiong notes: Incompetent doctors attribute this solely to damp-pathogen obstruction.
In yin deficiency syndromes, initial use of Guizhi and Fuzi may yield slight improvement, but long-term use leads to yin exhaustion and death. I have witnessed dozens of such cases.
Wang Shixiong notes: These are words born of experience and insight. Xu Huixi also said: Greatly hot and drying herbs kill most violently. Hot herbs are toxic and aggressive; once entering the zang-fu, blood surges and qi rises. If the person has inherent yin deficiency, or suffers from summer heat, or takes hot herbs during hot weather, two fires clash. Symptoms include red eyes, abdominal distension, dry tongue and teeth, thirst, irritability, cracked skin, and agitation. Physicians and families fail to observe, suggesting "guiding fire back to source" or treating as yin syndrome with heavier hot herbs and tonics. The patient bleeds from seven orifices, cries out, resembling poisoning death. Families blame no one; physicians feel proud, attributing it to disease progression. Ultimately, fools love hot tonics, dying without regret. I weep describing these cases, yet none listen. Is this fate? Cold herbs can also kill, but slowly, allowing rescue. Hot herbs are irretrievable. This is not hyperbole but truth. This spring, Han Gongfu suffered rectal bleeding, took hot tonics, and developed complex complications, becoming incurable. His father-in-law Chen Chunhu summoned me, and I cured him. By late summer, his brother Zhengfu had epidemic malaria. Doctor Yue repeatedly administered warm-dry herbs, worsening the condition. I diagnosed fu-excess and purged successfully. Later, Gongfu’s son Hu contracted an exterior syndrome with chills, fever, dizziness, thirst, and vomiting. I diagnosed summerheat and prescribed cooling resolution. They refused, hiring Doctor Yue again, who gave Cangzhu (Atractylodis Rhizoma), Houpo (Magnolia Bark), ginger, and pepper. Vomiting and thirst worsened, limbs cooled, sweating failed. I diagnosed "deep heat with deep cold" (reversal), warning against warm-dry tonics. They refused, consulting Zhang and Huang, who diagnosed "yin summerheat" and prescribed Jiangfu (Ginger and Aconite), Six Jun Zi plus Cornus, Cinnamon, and Aquilaria. Limbs grew colder, dosage increased. After eight doses, hemorrhage occurred, and he died, buried in the coffin prepared earlier. Was this fate? It proves families refuse to repent. Next, Mrs. Xu Lanyu suffered left hypochondriac stabbing pain. Witnessing Han’s death, Dr. Huang did not repent, prescribing Guizhi and Fuzi immediately. Pain intensified, leukorrhea flowed, tongue turned red, body wasted. He claimed tonics hadn't worked, increasing doses until constant pain forced him to seek me. I prescribed strengthening water, soothing liver, nourishing ying, and relaxing collaterals, curing her. Past cannot be追回, future can be advised, so I append this.
Hot tonics are called "plundering agents." Initial use may bring relief, but later exacerbates the condition. People unaware of this mistake it for efficacy. Countless have suffered throughout history.
Vomiting is often caused by rebellious liver fire. Zhang Jingyue biased toward warming tonification, assuming stomach cold, misleading many.
Undigested food in stool can result from evil fire failing to digest grain. Fire is rapid and urgent; the worse it gets, the more urgent the digestion becomes.
During fever, even if the pulse is hollow and large, one should not hastily diagnose deficiency-cold.
Astringents used too early in dysentery often lead to chronic intermittent dysentery.
Zhang Jingyue had many regrets in his clinical practice. Regarding his case of food stagnation in the lower abdomen: wheat food travels from stomach to intestine, reaching the lower abdomen corner. How can it cause such pain, feeling like fists or testicles? The patient likely had pre-existing hernia, triggered by damp-heat from wheat or sexual exertion that day. Thus, purging failed. Pain stopped only with Mugua (Arecae Semen) and wine, pungent-hot and aromatic. Claiming food exits via the lower right abdomen to the large intestine is absurd. Classics state intestines twist sixteen times; how can they go straight down like tubes? Ha!
The "Shanghan Lun" states that patients with existing accumulations who contract disease transmitting to the three yin channels die, termed Zang-Jie (Organ Binding). This combines new and old pathogens. Taking fresh white bark of Kuanlgen (Toosendan Fructus Root Bark), pounding, drying, adding a little Shexiang (Musk), decocting in two bowls of water to one bowl, and drinking on an empty stomach has repeatedly proven effective against thirst-related parasites.
Sun Wen Yuan treated Wu Xiaofeng’s wife. Post-recovery, failing to nourish water to generate wood, how could the wiry pulse subside?
Li Shicai treated Gu Zongbo with dual heart-kidney deficiency using Bawei Wan (Eight-Ingredient Pill) and Shiquan Dabu Tang (Ten Complete Tonifying Decoction), while later physicians used Xuanshen (Scrophulariae Radix) and Zhimu (Anemarrhenae Rhizome). Their errors were equal. Only Jiling Gao (Collected Spirit Paste) is a truly sacred formula.
Wang Shixiong notes: Jiling Gao appears in "Guang Biji", containing Renshen, Gouqi, Niuxi (Achyranthis Bidentatae Radix), Dongdong, and Erdi, optionally adding Xinyinpi (Epimedii Folium).
When treating children, regardless of symptoms, one should first palpate the Xuli acupoint. If pulsation is severe, avoid attacking/tonifying methods due to congenital insufficiency. Pediatricians following this advice will create boundless merit. This is a secret unrevealed for millennia; cherish it.
Wang Shixiong notes: Adults are similar. For children, pulse diagnosis is unreliable, making palpation more dependable.
Advanced consumptive disease is incurable. Proper medication may yield sudden improvement, representing temporary hiding of deficient yang. After several doses, symptoms revert. Clinicians must know this.
In patients with lung heat, even if parturient women mistakenly take Renshen, it often causes phlegm-fluid retention in the chest, leading to fullness, oppression, cough, and anorexia.
Yu Jiayan treated Guo Taiyin’s case, caused by indulgence in food/drink and sex, severely injuring true yin, severing the Dai Mai (Girdle Vessel), leading to water deficiency and wood dryness, overacting on the conquered spleen to cause distension. The theory of fish and salt is likely incorrect.
Another case of Gu Mingzhong seemed related to liver and kidney meridians, unrelated to the bladder. Forcing treatment into the bladder made the text disjointed.
Those with excessive fire and stagnation often fear wind and cold.
Wang Shixiong notes: People know wind-cold fears wind and shanghan fears cold, but few recognize this nuance.
Plum-pit qi syndrome arises from emotional depression, anger, worry, and thought, damaging the seven emotions. It is essentially wood dryness and fire flaming. Ancients often used aromatic-dry agents; perhaps constitutions were denser then?
I treat liver-kidney deficiency with panting and shortness of breath by heavily administering Shudi (Prepared Rehmanniae Radix) and Renshen. For poor families unable to afford Renshen, replacing it with Ziren (Ziziphi Spinosae Semen) and Gouqi (each 1 liang) works equally well.
Wang Shixiong notes: Gouqi specifically treats shortness of breath; its pure sweet taste nourishes spirit, qi, blood, and fluids.
Miao stated that yangming heat transmitting inward causes cool body and hiccups; this is the golden needle.
In consumptive diseases, if the right cun pulse feels bean-like and stiff under pressure, the disease is incurable due to lung metal failure.
Yang Jie’s Duliang Wan treats headaches, suitable only for yangming wind-heat; others should not take it.
Wang Shixiong notes: Ancient formulas must be matched to specific indications, not just Duliang Wan. Students must learn by analogy.
"Yixue Gouyuan" argues against Liuwei Dihuang Wan for eye diseases, claiming Zexie, Fuling, and Shanzhuyu are unsuitable for eyes. I argue these three are unsuitable for any liver-kidney deficiency, not just eyes.
Wang Shixiong notes: Medication must fit the patient. Using rigid formulas for dynamic diseases has pros and cons.
Jingyue saw a young woman in Yan capital with tight, dry throat but failed to use Zuogui Wan combined with Shengmai San to save her. Instead, he wrongly used pungent-warm dispersants. Realizing lung failure later, he mimicked incompetent doctors avoiding criticism, refusing to act. According to Danxi: Throat swelling/pain due to yin deficiency with flying yang and upper phlegm presents with floating-large pulse,涩 (rough) upon deep pressure, near death. Single heavy-decocted Renshen, sipped slowly, is indicated. Treating as excess brings disaster quickly. Seeing this, how can Danxi’s learning be despised? If "Chuan Zhong Lu" knew, it would be ashamed.
Dairen treated a general with heart pain. Zhang Zihe said: This is not heart pain, but epigastric pain. I say these two sentences perfectly describe the syndrome. However, I add: It is not epigastric pain, but liver wood overacting on the stomach. People commonly use Simo Tang, Wuxiang San, Liuyu Tang, Xiaoyao San, etc. Effective for new diseases, but fatal with long-term use. Rougui (Cinnamon Bark) is also effective because wood withers with cinnamon. Repeated use dries liver blood. Youth become consumptive; the weak suffer syncope and death. Must know this. I created Yiguan Jian (One-Glance Decoction) using Beishashen (Glehniae Radix), Maidong, Dihuang, Danggui (Angelicae Sinensis Radix), Gouqi, and Chuanlianzi (Meliae Fructus). Adjust as needed, working instantly. Add Jiulian (Scutellariae Radix soaked in wine) for bitter taste and dryness. Treats hypochondriac pain, acid regurgitation, hernia, and all liver diseases.
Wang Shixiong notes: Hypochondriac pain due to phlegm-fluid cannot use cloying herbs.
Xiangfu (Cyperi Rhizoma) and Yujin (Curcumae Radix) are key liver herbs. Useful for qi disorders, but disastrous for blood disorders, like wielding sharp swords. Beware!
The claim that Erdi (Shengdi and Shudi) cloy the chest originates from unknown sources, causing centuries of fear. Patients with yin deficiency and fire hyperactivity dare not try them until dying. By then, a few qian is useless. Tragic!