。若立斋多用加味逍遥散，鼓峰东庄辈多用滋水生肝饮，皆不及余法之善也。逍遥散亦当灸
用，缘柴胡、白术皆非阴虚火盛者所宜也。
景岳生平于薛氏诸书，似未寓目，至胁痛由于肝脉为病，至死不知，良可哀也。如案中
载治
其姻家胁肋大痛一证，全属廖论，幸得一灸而愈。此与呃逆病诸治不效，灸虚里立瘥正同也
。
凡泄泻，火证极多。
带浊之病，多由肝火炽盛，上蒸胃而乘肺。肺主气，气弱不能散布为津液，反因火性迫
速而
下输。膀胱之州都，本从气化，又肝主疏泄，反禀其令而行，遂至淫淫不绝，使但属胃家湿
热，无肝火为难，则上为痰而下为泻耳。古今医案于带浊二门，独罕存者，亦以未达其旨而
施治无验也。至单由湿热而成，一味凉燥，虽药肆工人，亦能辨此。
雄按∶此诚确凿之论。
胞痹，欲名尿梗病。香燥之药，误投杀人，世罕知也。观张石顽治闵少江证，误服丹皮
、白术，即胀痛不禁，可见。
景岳治朱翰林太夫人证，乃阴虚阳越之风秘，亦类中之轻者，一跌而病，良有已也。未
可归功姜、附。不知阴证二字，何以插入？其生平见解，大可知矣。
冯氏治崔姓风秘证，亦阴虚阳越之病，甚则为类中，其治法亦大醇而小疵耳。至云阴伏
于
内，逼阳于外，亦与景岳治朱太夫人谓为阴证，同一模糊，盖缘风秘一条，人多不讲也。
伤寒疟痢之后患闷结者，皆由攻下表散失宜所致。究其由，则皆血燥为病。至若风秘一
证，其病本由燥火生风，医者昧于风字，动用风药，死者已矣。存者幸鉴之。
雄按∶凡内风为病，不论何证，皆忌风药。医不知风有内外之殊，以致动手便错。
观医通载妇科郑青山愤喜交集，因而发狂一事，业医者亦可怜哉。有志之士，慎勿为此
。彼云不可不知医者，非圣人之言也。
凡心腹痛而唇红吐白沫者，或好啖者，多属虫证。
阴虚火盛之人，初服桂、附、姜、萸等燥热刚药，始则甚得其力，所谓劫治也。昧不知
止，久而决裂，莫可挽回，余目击其敝者，数十人矣。
二便俱从前阴出者，宜集灵膏，重用人参以补肺而润肠。盖肺与大肠相表里而主气，又
肺者
相傅之官，治节出焉。肺得养，斯大肠之燥可清，又得枸杞、二冬以滋其血槁，然后故道可
复，而清浊自分矣。
近时专科及庸手，治产后一以燥热温补为事，杀人如麻。
雄按∶非独产后也，如呕吐泄泻，疟痢哮喘，痿痹肿胀，痰饮腹痛，疝瘕诸证，粗工无
不悉指为寒，而不知其属热者多也。
冯楚瞻之媳，胎前多服八味丸，所以生子百日内即患疠证。
产后恶露不下有二，一则瘀滞宜行，一则血虚宜补。
肝火病其状如疟，盖胆为肝府，肝病则胆亦病矣。
产后病多属阴虚，治必养营。若气血兼补，杂以姜、附刚剂，非耽延时日，即贻病者后
患，临证者审之。
火极似水，乃物极必反之候。凡患此，为燥热温补所杀者多矣，哀哉！
立斋谓产后阴气大虚，正喜亡阳与阴齐等，云可勿药而愈，此正薛氏生平不能峻用养阴
之缺
处也。冯楚瞻治一产后头汗证，拘泥薛法而不与药，致病家属之庸手而败，是守而未化之过
也。
雄按∶阴虚不敢救阴，亦泥于产后宜温之俗说，乃云正喜亡阳，是何言耶？非仅缺处，
直是谬论，无怪乎徐洄溪以薛氏为庸医之首也。
患痘腰痛，曾有房事者，最称难治。余谓以大剂左归饮与之，必有可挽。
医学无真知而参末议，最能误人，智者慎之。
麻疹之发，本诸肺胃。治之但宜松透，一切风燥寒热之剂，不可入也。余常遇表散过甚
，绵
延不已者，一以生地、杞子、地骨、麦冬、娄仁、沙参等味，三四剂必嗽止热退而安。若吕
东庄之用桂、附，因其苦寒过剂，故处方如是，非可一切试之也。
病危之家，亲宾满座，议论纷纭，徒乱人意，不可不知。余尝诊一儿，见其左掌拳曲，
询其
由，乃小时患惊搐，为母抱持太急，病愈手遂不能伸舒，若初起即以大剂滋肝肾真阴与之，
必能伸舒如故。惜世无知者。
肿证多湿热为患，虽云脾虚，必审其小便长短清浊，及大便溏燥浓淡，以施治法。若概
云脾虚，参、术蛮补，必致绵延不已。
肝脉挟胃贯膈，又曰是所生病者，为胸满，故胸之痈疽，本由于肝。然此证最难别白，
即《内
经》所谓内有裹大脓血之证也。吾乡一名医自患此，同道诊之，不知为痈也。杂进参、附、
丁、桂之剂，久之吐出臭脓乃省，已无及矣。
寸强尺弱之脉，多属阴虚火炎之候，误服八味丸，每致贻患。
不拘内外病，凡阴虚者服参、 诸气分药，非惟无益而反害者。
诸病火盛而汗出者，若骤敛之，反增他证。
凡肝郁病误用热药，皆贻大患。
肝木为龙，龙之变化莫测，其于病也亦然。明者遇内伤证，但求得其本，则其标可按籍
而稽
矣。此天地古今未泄之秘。《内经》微露一言曰∶肝为万病之贼，六字而止。似圣人亦不欲
竟其端委，殆以生杀之柄不可操之人耳。余临证数十年，乃始获之，实千虑之一得也。世之
君子，其毋忽诸。
雄按∶肺主一身之表，肝主一身之里，五气之感，皆从肺入，七情之病，必由肝起，此
余夙
论如此。魏氏长于内伤，斯言先获我心。盖龙性难驯，变化莫测，独窥经旨，理自不诬。
如果薛立斋多用加味逍遥散，鼓峰、东庄等人多用滋水生肝饮，都不如我的方法好。逍遥散也应当配合艾灸使用，因为柴胡、白术都不是阴虚火旺者所适宜的。
张景岳生平似乎没有看过薛立斋的著作，直到胁痛由于肝脉病变，他到死都不知道，实在令人悲哀。如医案中记载治疗他姻亲胁肋剧烈疼痛一证，完全是荒谬的言论，幸好通过艾灸而痊愈。这与呃逆病各种治疗无效，艾灸虚里穴立刻好转的情况正相同。
凡是泄泻，火证非常多。
带下和浊病的病，多由肝火炽盛，向上熏蒸胃并乘袭肺。肺主气，气弱不能散布为津液，反而因火性迫促迅速而下输。膀胱作为州都之官，本从气化功能而来，加上肝主疏泄，反而禀受肝令而行，导致淫淫不绝（形容分泌物连绵不断）。如果仅仅属于胃家湿热，没有肝火的干扰，那么上则为痰，下则为泻罢了。古今医案对于带下和浊病这两门，唯独很少保存，也是因为未能通达其旨意而施治无效的缘故。至于单纯由湿热而成的，一味凉燥，即使是药铺工人，也能辨别此理。
赵献可按语：这确实是确凿无疑的论断。
胞痹，想要命名为尿梗病。香燥的药物，误用会杀人，世人很少知道这一点。看张石顽治疗闵少江的病证，误服丹皮、白术，立即胀痛不禁，就可以看出这一点。
张景岳治疗朱翰林太夫人的病证，乃是阴虚阳越的风秘，也是类中风中较轻的一种，一旦跌倒发病，确实有定数了。不可归功于姜、附子。不知道“阴证”二字，为何插入其中？他平生的见解，大致可以知道了。
冯氏治疗崔姓的风秘证，也是阴虚阳越的病，严重了就会成为类中风，他的治疗方法大体纯正但有小瑕疵。至于说阴伏于内，逼阳于外，也与张景岳治疗朱太夫人时称为阴证一样模糊，大概是因为风秘这一条，人们大多不研究的原因。
伤寒、疟疾、痢疾之后出现闷结症状的，都是由攻下和解表发散失宜所致。究其根源，都是血燥导致的疾病。至于风秘这一证，其病根本由燥火生风引起，医者不明白“风”字的含义，动不动就使用风药，死者已经死了。存活的人希望引以为鉴。
赵献可按语：凡是内风引起的疾病，不论什么证候，都忌用风药。医生不知道风有内外之分，以致动手就错。
看《医通》记载妇科郑青山因喜悲交集，因而发狂一事，从事医学的人也真可怜啊。有志之士，千万不要这样做。他说“不可不知医者”，这不是圣人的话。
凡是心腹痛且嘴唇红、吐白沫的，或者喜欢吃东西的，多属于虫证。
阴虚火旺的人，刚开始服用桂枝、附子、干姜、山茱萸等燥热刚猛的药物，起初很得其力，这就是所谓的“劫治”。愚昧的人不知道停止，久而久之血管决裂，无法挽回，我亲眼目睹其弊端的，有几十人了。
大小便都从前阴排出的，适宜用集灵膏，重用人参以补肺而润肠。因为肺与大肠相表里且主气，另外肺是相傅之官，治理节律由此产生。肺得到滋养，那么大肠的燥热可以清除，再加上枸杞、天冬、麦冬来滋润其枯竭的血液，然后正常的道路可以恢复，清浊自然分开。
近时的专科医生及庸手，治疗产后一概以燥热温补为事，杀人如麻。
赵献可按语：不仅仅是产后，如呕吐泄泻、疟疾痢疾、哮喘、痿痹肿胀、痰饮腹痛、疝瘕等各种证候，粗工无不全部指认为寒，而不知道其中属热的很多。
冯楚瞻的儿媳，胎前多服用八味丸，所以生子百日内即患疠证（麻风或严重传染病）。
产后恶露不下有两种情况，一种是瘀滞应当行血，一种是血虚应当补血。
产后病多属阴虚，治疗必须养营。如果气血兼补，杂用姜、附子刚猛药剂，不是拖延时日，就是给患者留下后患，临证时要审慎。
火极似水，这是物极必反的征候。凡是患此病的，被燥热温补所杀死的很多，可悲啊！
薛立斋说产后阴气大虚，正气喜欢亡阳与阴气相等，说可以不药而愈，这正是薛氏生平不能峻用养阴药的缺憾之处。冯楚瞻治疗一个产后头汗证，拘泥于薛法而不给药，致使病人家属找庸医治坏，这是守旧而未灵活变通的过错。
赵献可按语：阴虚不敢救阴，也是拘泥于产后宜温的俗说，还说“正喜亡阳”，这是什么话呢？不仅是缺憾，简直是谬论，难怪徐洄溪把薛氏列为庸医之首。
患痘疹腰痛，曾经有过房事的，最称难治。我认为用大剂量的左归饮给予治疗，必定有可挽救的。
医学没有真知而参与末流议论，最能误导人，聪明人要谨慎。
麻疹的发出，本源在于肺胃。治疗只宜松透，一切风燥寒热之剂，不可进入体内。我常遇到表散过度，缠绵不已的，一概用地黄、枸杞、地骨皮、麦冬、瓜蒌仁、沙参等药物，三四剂必然咳嗽停止、热退而安。如果吕东庄使用桂枝、附子，是因为苦寒药物过剂，所以处方如此，不可以一概尝试。
病情危重的家庭，亲友满座，议论纷纷，徒然扰乱人心，不可不知道。我曾诊治一个小孩，见其左手掌拳曲，询问其原因，原来是小时候患惊搐，被母亲抱持太急，病愈后手遂不能伸直舒展，如果初起即用大剂量滋补肝肾真阴的药物给予治疗，必定能伸直舒展如故。可惜世上无知者。
肿证多由湿热为患，虽然说是脾虚，必须审查其小便长短清浊，以及大便溏燥浓淡，以此施治。如果一概说是脾虚，蛮补人参、白术，必定导致缠绵不已。
肝脉挟胃贯膈，又说这是它所生的病，表现为胸满，所以胸部的痈疽，本来由于肝。然而这个证最难辨别清楚，就是《内经》所说的内有裹大脓血的证候。我家乡一名医生自己患此病，同道诊断，不知道是痈。杂进人参、附子、丁香、肉桂的药剂，很久以后吐出臭脓才醒悟，已经来不及了。
寸脉强尺脉弱的脉象，多属阴虚火炎的征候，误服八味丸，往往导致遗留祸患。
不拘内外病，凡是阴虚者服用人参、黄芪等气分药，不仅无益反而有害。
各种病火盛而汗出的，如果骤然收敛止汗，反而增加其他证候。
凡是肝郁病误用热药，都会遗留大祸患。
肝木为龙，龙的变幻莫测，它在疾病方面也是如此。高明的人遇到内伤证，只要求得根本，那么标症就可以按籍查询了。这是天地古今未泄露的秘密。《内经》微露一言说：肝为万病之贼，六个字而已。似乎圣人也不想探究到底，大概是怕生杀之权不可操之于人吧。我临证数十年，才获得此理，实在是千虑之一得。世上的君子，不要忽视它。
赵献可按语：肺主一身之表，肝主一身之里，五气的感受，都从肺入，七情的病，必由肝起，这是我素来的论断如此。魏氏长于内伤，这话先契合我的心意。因为龙性难驯，变幻莫测，独自窥探经旨，道理自然不会虚假。
If Xue Lizhai (Xue Ji) frequently used Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder), and Gu Feng, Dong Zhuang, and others frequently used Zi Shui Sheng Gan Yin (Nourish Water to Generate Liver Decoction), none are as effective as my method. Xiao Yao San should also be used with moxibustion, because Chai Hu (Bupleuri Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) are not suitable for those with Yin deficiency and flourishing fire.
Zhang Jingyue (Zhang Jiebin) seemed never to have read Xue Lizhai's works in his lifetime. He did not know until his death that hypochondriac pain was caused by disease of the Liver meridian; this is truly lamentable. For example, a case record mentions treating his relative's severe hypochondriac pain, which was entirely absurd reasoning. Fortunately, it was cured by moxibustion. This is exactly the same as cases where hiccups failed all treatments but improved immediately after moxibustion at Xuli (CV15).
In general, diarrhea involves many Fire syndromes.
Diseases of leukorrhea and turbid discharge often result from blazing Liver Fire steaming upward to affect the Stomach and attacking the Lungs. The Lung governs Qi; when Qi is weak, it cannot distribute fluids properly. Instead, due to the rapid nature of Fire, fluids are forced downward. The Bladder, as the reservoir, relies on Qi transformation. Additionally, the Liver governs free flow; if it dictates action, discharge becomes continuous and profuse. If it were merely Damp-Heat in the Stomach without Liver Fire, it would manifest as phlegm above and diarrhea below. Ancient and modern medical records rarely preserve cases of leukorrhea and turbid discharge, likely because practitioners failed to grasp their essence and thus treatment was ineffective. As for cases caused solely by Damp-Heat, even pharmacy workers can distinguish them using cooling and drying methods alone.
Zhao Xianke's Note: This is indeed a solid argument.
Baobi (Bladder Bi Syndrome) could be named Niao Geng Bing (Urine Obstruction Disease). Aromatic-drying herbs, if misused, can kill patients, yet few people in the world know this. Observing Zhang Shiwan's treatment of Min Shaojiang, who suffered uncontrollable distension and pain after mistakenly taking Mu Dan Pi (Moutan Cortex) and Bai Zhu, illustrates this point.
Zhang Jingyue treated the condition of Lady Zhu, mother of Hanlin Academician Zhu. It was Wind Bi caused by Yin deficiency with Yang floating outward, a mild form of stroke-like illness. Once the fall occurred, the disease was set in stone. One cannot attribute success to Ginger and Aconite. It is unclear why the term "Yin Syndrome" was inserted. His general understanding can be inferred from this.
Feng Chu-zhan treated a Wind Bi case of a surnamed Cui. This was also a disease of Yin deficiency with Yang floating outward; if severe, it becomes stroke-like. His treatment method was largely sound but had minor flaws. Saying that Yin hides inside and forces Yang outside is as vague as Zhang Jingyue calling Lady Zhu's condition a "Yin Syndrome." This is likely because few study the topic of Wind Bi.
After contracting Cold Damage, Malaria, or Dysentery, if闷结 (stifling obstruction) occurs, it is caused by improper use of purgatives or exterior-releasing methods. Investigating the root, these are diseases of Blood dryness. Regarding Wind Bi, the pathology stems from Dryness-Fire generating Wind. Physicians ignorant of the term "Wind" often indiscriminately use Wind-drugs, leading to death. Those who survive should take heed.
Zhao Xianke's Note: For any disease caused by Internal Wind, regardless of the syndrome, Wind-drugs are contraindicated. Doctors fail because they do not distinguish between External and Internal Wind, leading to errors upon intervention.
Observing the case in *Yi Tong* regarding Zheng Qingshan in gynecology, who went mad due to mixed joy and grief, medical practitioners should feel pity. Ambitious scholars must avoid such practices. His statement that "one must not ignore medicine" is not the words of a sage.
Whenever there is heart and abdominal pain with red lips and vomiting of white foam, or excessive appetite, it mostly belongs to Parasite Syndromes.
Individuals with Yin deficiency and flourishing fire, when initially taking dry-hot, rigid drugs like Gui Zhi (Cinnamomi Ramulus), Fu Zi (Aconiti Lateralis Radix Preparata), Gan Jiang (Zingiberis Rhizoma), and Yu Jin (Corni Fructus), may initially benefit greatly. This is called "plundering treatment." Ignorant people do not know when to stop. Over time, vessels rupture, and the situation cannot be reversed. I have witnessed dozens of such cases.
When both urine and feces exit through the anterior yin (genitals), Ji Ling Gao (Collection of Spirits Paste) is appropriate, using heavy doses of Ren Shen (Ginseng Radix et Rhizoma) to tonify the Lung and moisten the intestines. The Lung and Large Intestine are interior-exteriorly related and govern Qi. The Lung is the official of ministerial guidance, governing regulation. When the Lung is nourished, intestinal dryness clears. Combined with Gou Qi Zi (Lycii Fructus), Tian Dong (Asparagi Radix), and Mai Dong (Ophiopogonis Tuber) to nourish dried blood, normal function returns, and clear and turbid substances separate naturally.
Recent specialists and mediocre doctors treat postpartum conditions exclusively with dry-hot warming tonics, killing people like flies.
Zhao Xianke's Note: Not only in postpartum cases, but also in vomiting, diarrhea, malaria, dysentery, asthma, flaccidity, bi-syndrome, swelling, phlegm-fluid retention, abdominal pain, hernia, and masses, crude practitioners invariably diagnose them as Cold, failing to realize that Heat is common.
Feng Chu-zhan's daughter-in-law took Ba Wei Wan (Eight-Ingredient Replenishing Pill) excessively during pregnancy, resulting in her child contracting Leprosy (or severe infectious disease) within 100 days.
Postpartum lochia stagnation has two types: one is stasis requiring blood-invigorating, the other is Blood deficiency requiring tonification.
Liver Fire disease presents like malaria, because the Gallbladder is the palace of the Liver; Liver disease affects the Gallbladder.
Postpartum diseases mostly belong to Yin deficiency; treatment must nourish Ying (Nutritive Qi). If Qi and Blood are tonified simultaneously, mixed with rigid agents like Ginger and Aconite, it either prolongs the illness or leaves sequelae. Clinicians must be cautious.
Extreme Fire resembling Water is a sign of reversal at the extreme. Many suffering from this are killed by dry-hot warming tonics; how tragic!
Xue Lizhai stated that postpartum Yin Qi is greatly deficient, and Yang Qi tends to escape equally with Yin, suggesting recovery without medication. This highlights Xue's lifelong inability to use strong Yin-nourishing methods. Feng Chu-zhan treated a postpartum head-sweating case, adhering strictly to Xue's method and withholding medicine, causing the family to seek a mediocre doctor who ruined the patient. This was an error of rigidity without flexibility.
Zhao Xianke's Note: Fearful of Yin deficiency, they dare not rescue Yin, clinging to the vulgar saying that postpartum requires warmth. To say "Yang escaping is welcome" is nonsense. This is not just a flaw but a fallacy. No wonder Xu Huixi ranked Xue as the chief among mediocre doctors.
For acne/rubella complicated by lower back pain and recent sexual intercourse, it is most difficult to treat. I believe administering a large dose of Zuo Gui Yin (Left Restoring Decoction) can surely save the patient.
Medicine lacking true knowledge but offering superficial opinions can easily mislead people. Wise individuals should be cautious.
The eruption of Measles originates in the Lungs and Stomach. Treatment should only aim to loosen and penetrate. All Wind-dryness and Cold-Heat agents are contraindicated. I often encounter cases where exterior-releasing was excessive, leading to lingering symptoms. Using Di Huang (Rehmanniae Radix), Gou Qi Zi, Di Gu Pi (Lycii Cortex), Mai Dong, Gua Lou Ren (Trichosanthis Semen), and Sha Shen (Glehniae Radix) for three to four doses usually stops coughing, reduces fever, and ensures safety. If Lu Dongzhuang used Gui Zhi and Fu Zi, it was because bitter-cold drugs had been overdosed previously. Thus, his prescription was specific and not applicable to all cases.
In critical illnesses, with relatives and friends filling the room and discussing endlessly, it only confuses the mind. This must be known. I once diagnosed a child whose left palm was curled. Inquiry revealed that during childhood convulsions, the mother held him too tightly. After recovery, the hand could not extend. If initial treatment had used large doses of Kidney and Liver Yin-nourishing herbs, full extension would likely have returned. Alas, few possess this knowledge.
Edema is mostly caused by Damp-Heat. Although Spleen deficiency is cited, one must examine the length, clarity, and turbidity of urine, and the consistency and color of stool before treating. If one blindly attributes it to Spleen deficiency and recklessly tonifies with Ren Shen and Bai Zhu, the illness will linger.
The Liver meridian夹胃 (passes through the Stomach) and pierces the diaphragm. It is said that diseases generated by this meridian include chest fullness. Therefore, carbuncles and sores in the chest originate from the Liver. However, this syndrome is hardest to distinguish clearly. It corresponds to the *Neijing*'s description of internal abscesses containing large amounts of pus and blood. A famous doctor in my hometown suffered from this. Colleagues diagnosed him but failed to recognize it as an abscess. They administered mixed remedies of Ren Shen, Fu Zi, Ding Xiang (Caryophylli Flos), and Gui Xin (Cinnamomi Cortex). Only after vomiting foul-smelling pus long later did he realize the truth, but it was too late.
Pulse characteristics of strong Cun (inch) and weak Chi (cubit) mostly indicate Yin deficiency with flaming fire. Mistakenly taking Ba Wei Wan often leads to lingering harm.
Regardless of internal or external diseases, for those with Yin deficiency, taking Qi-moving herbs like Ren Shen and Huang Qi (Astragali Radix) is not only useless but harmful.
In various diseases with flourishing Fire and sweating, sudden astringency to stop sweat will aggravate other symptoms.
Misusing hot drugs for Liver Qi Stagnation always leads to major disasters.
Liver Wood is like the Dragon; its changes are unpredictable, and so are its pathological manifestations. The wise, encountering internal injury syndromes, seek the root. Then, the branch symptoms can be traced systematically. This is a secret unrevealed by heaven, earth, antiquity, or modernity. The *Neijing* briefly states: "The Liver is the thief of ten thousand diseases." Six characters suffice. Perhaps sages did not wish to exhaust the details, fearing that the power of life and death should not be wielded by everyone. After decades of clinical practice, I finally grasped this. It is but one insight from thousands of reflections. Gentlemen of the world, do not neglect this.
Zhao Xianke's Note: The Lung governs the exterior of the body; the Liver governs the interior. Five pathogenic influences enter via the Lung; Seven Emotions diseases arise from the Liver. This is my longstanding view. Wei Zhi excels in internal injuries, and these words resonate with me. The Dragon's nature is hard to tame and unpredictable. Only by exploring the classics can one understand the principles without falsehood.