眼病及牙病，均能牵及头痛（神经影响），应先治疗眼病，或摘去病齿，头痛自愈。此非西医不能胜任，服中药及西药，绝对无效。<凡有长久之头痛，屡治不愈，必请牙科或眼科专门西医，检查确实后，治其本病，原因既去，（例如牙龈有脓）头痛自然根治。）；咳嗽（十）咳嗽此征象系由于气管内发生变化（例如发炎）所致；但中医书论此症，亦有虚实之分。凡实证之咳嗽（伤寒、温病、感冒、肺热（炎）等，初得之时多咳嗽。），总不离乎肺受实邪（例如风、寒、暑、温、湿及污秽时气），肺气不宣而生咳嗽（初起多于咳，继则有痰），重则肺气壅闭愈甚，而生胸胁痛喘胀（气促、晌胀），不得卧或吐脓吐血，皆一时忽得之实证，治法必须先顾原病，例如严冬伤寒初得，兼有咳喘（必有表证，，则于发汗药中，加入理肺药一、二味，自然痊愈（例如加入杏仁、苏子等药于麻黄汤中，。温热病初得，兼有咳喘（伤寒邪自皮毛感受，温病邪自口鼻而入，皆肺先受邪，故多有咳嗽），则于清解药中，加入理肺药—-二味，自然痊愈。（例如加入杏仁、贝母于银翘散、桑菊饮诸汤剂中）若忽略原病，一见咳嗽，便治肺病，斯为下工，不足言医。治咳嗽之药甚多，中药内之有效者，不外杏仁、苏子、贝母、桑皮、枇杷叶等。嗽稍久者，紫菀、百合亦有效。若日久咳嗽不止，渐有虚象者，白芍一味实有特效，加入治嗽药中，百不失一，此药不但止嗽，而止血之力，更胜于西药中之麦角等，且又能止汗，故对于肺痨吐血而有虚汗（自汗、盗汗，者，实为无上妙晶。查本草所载，此药并非专治以上各症，惟余经过历年试验及多次之比较，始确定为止痨嗽、吐血、咯血、自汗、盗汗之特效药（用量必须五、六钱以上）。其因咳嗽有痰者，中医以橘红、半夏等为有效之品，余则本其经验所得，确定茯苓一味对于一切痰及痰饮（凡一切加答尔性之症候，例如多稀痰之肺水肿，加答尔性肋膜炎，水泻、腹水等，皆有奇效。）与普通治痰药合用（应认明寒热之分，佐以它药方可，有特效。（分量约五、六钱以上）此药本草所载，亦非如余之所云，吾人治病用药，但求实效，不必拘泥于古书也。（凡口干液短及有高热者不可用，滋阴补肾（例如蒺藜、枸杞子等）亦能止嗽，不可不知。西药中止咳之药，率多麻醉品；虽有特效，不可常用（恐成习惯）余常用小量之托氏散合以重曹，治咳嗽之稍久者，平稳有效。但此药内，亦有阿片，仍不脱麻醉范围，不过较歇鲁因、盐莫等，略觉和平耳。肆间治肺病之成药甚多，危险太大，万不可盲从试服，自贻伊戚也。（凡咳喘不能卧下者，皆属重症，肺炎初得即如此，故凡不能言语之小儿咳嗽，气促胸挺有热者，先防肺炎加重，应竖抱之不可强令卧下。）喘（十一）喘喘之一症，更有虚实之分，中医论喘最详，大凡参一脉象，以定虚实。实证之喘，不外宣通肺气，有寒则用麻黄、杏仁等，（必参照其他症象）有热则用桑叶、苇根、金银花、瓜蒌仁，皆和平有效之治法。（余不取葶苈泻肺法）虚（阴阳）证之喘，则不外于补肾及固摄各药，例如六味地黄丸、肾气丸，补骨脂等，甚或用黄芪、人参，均为治喘妙晶。叶天士先生论喘极精，其在肺为实，在肾为虚二语，真得治喘妙谛。其治法中之秘诀，在上者（实证）则以清肃上、中二焦，宣通肺气为主治，在下者（虚证）则以填补、温补、镇摄为主治。可谓得治喘要义，学者宗之，自是正轨；临症时再参合其他各症，细审脉象，然后论治，方为圆到。若第见喘治喘，斯为庸工矣。（记得数年前余友诸友鹤君，延余诊一唐姓（住北锣鼓巷）喘症极危，查阅前医务方，因病者患喘多日，中医认为肺实，均用泻肺药不效．西医注射止喘药喘止，然病者更痛苦，气将不属，痛苦难堪。余汹知病者多日未大便，只与以人工盐十五格拉模，一剂而愈，此事不足言治病，直治药耳，医者为世诊病，大率如此，何分中西，思之真可笑也。）厥逆（十二）厥逆中医讲四肢厥逆，是指手足而言，凡热病多有此现象，率在病势进行时期，热度愈高，手足渐渐转凉，脉亦不数，而变成沉细之状，再重则六脉皆闭，厥逆更深，渐渐至于通体皆凉，所谓热深厥亦深，真名言也。病势至此；，已陷于危笃，医者须参合其他症状，以定治法，例如伤寒、温热等症数日后（注意此三字），遇此现象，强半仍有头痛（此时绝不可认为表证）口干、神昏、目赤、腹痛、舌苔黄绛或黑、呕逆，大便燥结、或热结旁流、小便短赤、或混浊（有白粉沉淀）、喘促等症状并发。（不必皆具）医者不难断定其为实热，于此时必斟酌病者以前所服之药如何？认定此症之或在上中二焦，或在下焦。（皆指实证）如系屡经汗下之后，而有此病状，必其病在上中二焦，应于芳香开窍、清肺滋阴药中，加入紫雪丹、至宝丹、牛黄清心丸及犀角、郁金之类，以冀开宣上窍。若未经过攻下，必须注意是否肠胃郁热所致，认定后即用芒硝、大黄下之，必见功效。此时病已垂危，万不可因其通身皆凉，脉停气厥，误认为寒证。若于此时误投温热表散之药，杀人极速，慎之慎之。
（虚证亦有四肢发凉者，此必久病，参以其他症状（例如久泻）不难认定，勿庸赘述，法宜温补，不待言矣。）心悸（十三）心悸此症在热性病中最多（病人自诉心慌，即是此症。）西医所谓心悸亢进是也。此时心力抵抗病邪，有不足之势，医者用药，应格外注意。若系发汗药，必先用小量：以防危险。中药之发汗药，于此时防有危险，西药之退热剂更甚，能使发汗过多心脏骤然停止而致命。二十年前，余曾诊一直隶左翼统领黄华轩君之感冒症，脉现结代而心悸，因恶寒、头痛、身痛，完全表证，余用表散药，分量极轻，嘱取微汗。第二日病稍减，武人性急，嫌药量太轻，乃改延某医。竟用大剂麻黄、羌活发汗，服药后，翌晨未起，差弁呼之不应，启衾视之，已死去多时矣，特记于此，用为垂戒。西医遇心脏衰弱之热性病，往往于退热或清凉药中，佐以强心之品，<例如别拉密童加入樟脑酸，稀盐酸加入赤酒等类，用意颇为周到。）但中药发汗剂，则无此法，若于发汗药中，加入兼顾心气或兼顾呕吐等药，反致药力不专，不易发汗，更致误事，不可不知。余又亲见常服西药，金鸡纳霜丸及少量之别拉密童，安基比林等，骤然死去者。记得有一人患痨热，医者教以服小量之别拉密痛药片亦有效，乃连日服之。一日正食橘，方送入口，忽死去，记此以为垂戒。此人曾经余诊治，见其脉弱，不能服退热剂，只与滋阴中药无效，乃竟如此死去，此非西药之过也。若系久病虚证之心悸（怔忡），自以重用大补气血，及补心气药为正轨。余治此症，由经验上得来一秘诀，即药量要大，药味要简是也。（参看医验）盖怔忡病患者，至极重时，（此症轻时往往人不介意）比较上西药强心剂，不如中药效力之持久。且实芰答力斯等西药，有蓄积作用（即连服此药易于中毒之谓）之不便，故特附记于此。（急性心脏衰弱，（例如大吐血后或摔伤等）必注射西药强心剂，此时中药太缓，无用武之地，不可不知。）呃逆（十四）呃逆（俗称打嗝）此现象系胃气不降。实证（热性病居多）有此，率用泻药有效（此根据余之经验，屡试不爽。大凡治呃逆，应于治主症药中，（例如肺热、肠热等症）加入一二缓下之品，呃逆立去。此指呃逆甚者而言，若较轻之症，无其他热证者，以二陈汤等治之亦有效。但历试古方（例如旋覆花、代赭石汤等）多不效，不得不郑重声明之。）若久病虚证之呃逆上气，自宜以暖胃温中论治，亦多有效。西医治此症，率用麻醉药，以镇其痉挛，固有特效，但非根本治法耳。（西医治此症，亦注重主症，主症一去，呃逆亦愈，与中医殊途同归，不可妄有轩轾。）口干（十五）口干、口渴实证之口干、口渴，必由于肺胃热蒸，津液消耗，治宜参照主症（例如肺炎），加以清凉或泻下药品。（西药中之清凉剂甚有效）若系虚证（肺痨尤甚），则以生津养阴之法治之，但宜注重主症，（中药对虚证之口干、口渴效多缓，不如西药之稀盐酸等，肺痨尤甚，不易速效。余曾治一虚泻之久病患者，自觉咽喉内如烟火上冲，然不渴，又有干呕，舌红有泡，小便短赤，口唇皆肿。前医误认为实证，几殆，此症脉极细微，后服用桂、附、参、芪等药，竟尔收效，口有津液，逆气亦止，小便亦渐多。当此场合，始见吾辈医者关系民命也。（中医遇此疑难症候，虚实之辨，不差累黍，此中医所以能存在于今日也。）二便不禁（十六）二便不禁此亦应分虚实证治之。凡热性病，例如伤寒；多有大小便不能自主者，（大便或溏或稀水，小便点滴频数。
）率应治其主症。（主症一去；此症不治自愈。）若系虚证，（此必参照其他各症，例如暴厥，及虚劳人，惊恐疲劳，及大病之后，皆属之。）则宜分别其何处衰弱，治其主症，再加以收涩之品，（此病理是神经衰弱及麻痹（膀胱），中医统名为虚弱。）多有能治愈者。余治愈一因变乱长途逃难，劳苦惊恐太甚，因而患小便不禁之青年，以白术等治之而愈。
炎症．（十七）炎症此病理余纯采西医之说，似不宜于此书中论及之，然此病象，甚关紧要，且有助于中医之诊断，故加以详细说明于下，愿学者注意及之；不可存门户之见也。
1．炎症之定义，吾人身体上组织之一部，受炎性刺激后，其反应起充血渗出（俗云发红），营养障碍，细胞增殖（俗云肿）者，名曰炎症。即因外来刺激（例如受了大寒、大热、火烧、木刺等），组织之生活机亢进，且起变化之反应状态也，（亢进就是发旺的意思，例如喝了酒，心脏的生活机加快是也；起变化，就是受刺激之部分，变了原样，例如吃了麻醉药，脑神经就变化成迟钝的样子。反应二孛，反奴是对答，应就是应付的意思）炎字之意义，原基于临床上实验之名称，从一部发赤灼热、定出炎字之名。西医以局部发赤、肿胀、灼热、疼痛及官能障碍，（官能障碍，就是不灵的意思，例如肠胃受热，就能消化不良是也。）为炎症的五个最著征象。此五征，不是每个炎性病，均要全备，往往缺其二、三，（例如有疼痛之骨节炎，亦有不肿者，而不发赤，不肿痛者，例如神经炎等多有之）盖随其原因之强弱，（例如不甚剧烈药之刺激局部，即不能五征皆有）发生之部位，经过之急慢，病势之轻重，自有差异也。（尝见有中医随便断定病名，曰某某炎，（例如肾脏炎）殊属可笑，余以为中医不可不知西医之医理，文字上万不可冒袭西医之名称，以中西诊断术不同，何以能知其为某某炎耶？<例如肾脏炎与肾盂炎））关于炎症及病变之学说甚多，兹择其有价值，可供参考者，述之于下。
①充血说往时论炎症，率以充血为理由。洛开坦司开氏谓，发生主要机转，由于毛纲血管之扩张，血行之缓慢静止，致血液之成分渗出，血液浓厚，与各赤血球粘著而发生，至血管扩张血行缓慢之原因，归于血管运动神经之障碍，然此说已经近世医者认为不确，以血管扩张充血为炎症前驱，虽属事实，若以此即为炎症本体之主征则不可。盖血管之扩张充血时，未必尽有炎性变化（例如充血），有炎症时，亦非必皆伴血管之扩张充血（例如骨膜炎），以故单纯之充血论，不足以概括炎症之意义。
②吸引说此学说由维尔霍氏代表，主张炎症本性，为组织细胞之变化，而血管扩张（即宽缓放大之意）与渗出（即浸润之意），不过一种续发现象。其说盖以炎性刺激，能亢进细胞之荣养机（细胞之生活力之意），自周围吸引多量荣养物，发起混浊肿胀，脂肪变性（例如油类崩坏）或促进细胞之分裂增殖，发现新细胞，至炎症部群集之细胞，亦系因刺激而增殖，此亢进细胞之荣养机，使发起之混浊肿胀，脂肪变性之刺激，曰荣养刺激。若此刺激，唯惹起细胞变性，周围血管不生渗出（即不发浸润之意），此种炎症，曰实质性炎症。又亢进细胞之荣养机、繁殖机，促进其分裂增殖之刺激，曰繁殖刺激。此刺激常自周围血管渗出血液成分，因此所起之炎症，曰渗出性炎症。或名间质性炎盖氏以受刺激之组织细胞之荣养、繁殖两机能亢进，而说明炎症本性，其渗出作用，亦即主张系由组织细胞之吸引作用而成，此吸引说也。
③白血球游出说此说与吸引说正相反，系唐海遗谟氏，由动物试验，发现炎症时，有白血球通过血管壁，游走于组织间，以为解释炎症之基础。惟二氏互相辩论，各有真实之试验。近世从细胞核注意此核字之分裂，研究进步以来，细胞之新生增殖机转，渐次明了，知炎症亦有组织细胞之分裂新生。维氏之说，自系确实，然血管壁起变化，而白血球渗出，亦系事实，康氏之说，亦有见地。因此吾人可认为炎症之本性，不但因组织细胞之荣养、繁殖两机能亢盛，实亦由于血管壁变性之循环障碍，即不通之意两氏之说，可谓相得益彰也。
眼病和牙病，都能引起头痛（神经影响），应当先治疗眼病，或者拔除患齿，头痛自然痊愈。这并不是说西医不能胜任，而是服用中药及西药都绝对无效。（凡是长期的头痛，多次治疗不愈，必须请牙科或眼科的专门西医检查确诊后，治疗其原发病，病因去除后，例如牙龈有脓，头痛自然根治。）；咳嗽（十）咳嗽这一征象是由于气管内发生变化（例如发炎）所致；但中医书籍论述此症时，也有虚实之分。凡是实证之咳嗽（如伤寒、温病、感冒、肺热等，初起时多伴有咳嗽），总离不开肺受实邪（例如风、寒、暑、温、湿及污秽时气），导致肺气不宣而生咳嗽（初起多为干咳，随后则有痰），重则肺气壅闭更甚，产生胸胁痛、喘胀（气促、腹胀），不能平卧或吐脓吐血，这些都是突然发作的实证，治法必须先顾护原发病，例如严冬伤寒初起，兼有咳喘（必有表证），则在发汗药中加入理肺药一、二味，自然痊愈（例如在麻黄汤中加入杏仁、苏子等药）。温热病初起，兼有咳喘（伤寒邪气从皮毛感受，温病邪气从口鼻而入，都是肺先受邪，所以多有咳嗽），则在清解药中加入理肺药一、二味，自然痊愈（例如在银翘散、桑菊饮等汤剂中加入杏仁、贝母）。如果忽略原发病，一见咳嗽就治肺病，这是低水平的医生，不足以谈论医术。治疗咳嗽的药物很多，中药内有效的，不外乎杏仁、苏子、贝母、桑白皮、枇杷叶等。咳嗽稍久者，紫菀、百合也有效。若日久咳嗽不止，逐渐出现虚象者，单用白芍一味确有特效，加入治嗽药中，百发百中，此药不但能止咳，而且止血之力，更胜于西药中的麦角等，且又能止汗，所以对于肺痨吐血而有虚汗（自汗、盗汗）者，实在是无上妙药。查考本草记载，此药并非专治以上各症，但我经过历年试验及多次比较，才确定为止痨嗽、吐血、咯血、自汗、盗汗的特效药（用量必须在五、六钱以上）。对于因咳嗽有痰者，中医认为橘红、半夏等为有效之品，我则根据经验，确定茯苓一味对于一切痰及痰饮（凡一切卡他性之症候，例如多稀痰之肺水肿、卡他性肋膜炎、水泻、腹水等，皆有奇效。）与普通治痰药合用（应辨明寒热之分，佐以它药方可，有特效。（分量约五、六钱以上）此药本草记载，也并非如我所言，我们治病用药，只求实效，不必拘泥于古书也。（凡口干液短及有高热者不可用，滋阴补肾（例如蒺藜、枸杞子等）也能止咳，不可不知。西药中止咳的药，大多是麻醉品；虽有特效，不可常用（恐成习惯）。我常用小量托氏散合以重曹，治疗咳嗽稍久者，平稳有效。但此药内，也有阿片，仍不脱麻醉范围，不过较可卡因、吗啡等，略觉温和罢了。药店里治肺病的成药很多，危险太大，万万不可盲从试服，自找苦吃。（凡咳喘不能卧下者，皆属重症，肺炎初起即如此，所以凡不能言语的小儿咳嗽，气促胸挺有热者，先防肺炎加重，应竖抱之不可强令卧下。）喘（十一）喘这一症状，更有虚实之分，中医论述喘症最详细，大凡通过脉象，来定虚实。实证之喘，不外宣通肺气，有寒则用麻黄、杏仁等，（必参照其他症象）有热则用桑叶、芦根、金银花、瓜蒌仁，都是平和有效的治法。（我不取葶苈泻肺法）虚（阴阳）证之喘，则不外于补肾及固摄各药，例如六味地黄丸、肾气丸、补骨脂等，甚至用黄芪、人参，均为治喘妙药。叶天士先生论喘极精辟，其在肺为实，在肾为虚二语，真得治喘妙谛。其治法中之秘诀，在上者（实证）则以清肃上、中二焦，宣通肺气为主治，在下者（虚证）则以填补、温补、镇摄为主治。可谓得治喘要义，学者遵循，自是正轨；临症时再参合其他各症，细审脉象，然后论治，方为周全。如果只见喘治喘，这是庸医了。（记得数年前我的朋友诸友鹤君，延请我诊治一位唐姓（住北锣鼓巷）喘症极危的患者，查阅前医务方，因病者患喘多日，中医认为肺实，均用泻肺药不效．西医注射止喘药喘止，然而病者更痛苦，气将不属，痛苦难堪。我深知病者多日未大便，只给予人工盐十五格拉姆，一剂而愈，此事不足言治病，简直是治药而已，医者为患者诊病，大率如此，何分中西，思之真可笑也。）厥逆（十二）厥逆中医讲四肢厥逆，是指手足而言，凡热病多有此现象，率在病势进行时期，热度愈高，手足渐渐转凉，脉亦不数，而变成沉细之状，再重则六脉皆闭，厥逆更深，渐渐至于通体皆凉，所谓热深厥亦深，真是名言也。病势至此，已陷于危笃，医者须参合其他症状，以定治法，例如伤寒、温热等症数日后（注意此三字），遇此现象，强半仍有头痛（此时绝不可认为表证）、口干、神昏、目赤、腹痛、舌苔黄绛或黑、呕逆、大便燥结、或热结旁流、小便短赤、或混浊（有白粉沉淀）、喘促等症状并发。（不必皆具）医者不难断定其为实热，于此时必斟酌病者以前所服之药如何？认定此症之或在上中二焦，或在下焦。（皆指实证）如系屡经汗下之后，而有此病状，必其病在上中二焦，应于芳香开窍、清肺滋阴药中，加入紫雪丹、至宝丹、牛黄清心丸及犀角、郁金之类，以冀开宣上窍。若未经过攻下，必须注意是否肠胃郁热所致，认定后即用芒硝、大黄下之，必见功效。此时病已垂危，万不可因其通身皆凉，脉停气厥，误认为寒证。若于此时误投温热表散之药，杀人极速，慎之慎之。
（虚证亦有四肢发凉者，此必久病，参以其他症状（例如久泻）不难认定，勿庸赘述，法宜温补，不待言矣。）心悸（十三）心悸此症在热性病中最多（病人自诉心慌，即是此症。）西医所谓心悸亢进是也。此时心力抵抗病邪，有不足之势，医者用药，应格外注意。若系发汗药，必先用小量：以防危险。中药之发汗药，于此时防有危险，西药之退热剂更甚，能使发汗过多心脏骤然停止而致命。二十年前，我曾诊治一直隶左翼统领黄华轩君的感冒症，脉现结代而心悸，因恶寒、头痛、身痛，完全表证，我用表散药，分量极轻，嘱取微汗。第二日病稍减，武人性急，嫌药量太轻，乃改延某医。竟用大剂麻黄、羌活发汗，服药后，翌晨未起，差弁呼之不应，启衾视之，已死去多时矣，特记于此，用为垂戒。西医遇心脏衰弱之热性病，往往于退热或清凉药中，佐以强心之品，<例如贝拉朵纳加入樟脑酸，稀盐酸加入赤酒等类，用意颇为周到。）但中药发汗剂，则无此法，若于发汗药中，加入兼顾心气或兼顾呕吐等药，反致药力不专，不易发汗，更致误事，不可不知。我又亲见常服西药，金鸡纳霜丸及少量之贝拉朵纳、安基比林等，骤然死去者。记得有一人患痨热，医者教以服小量之贝拉朵纳药片亦有效，乃连日服之。一日正食橘，方送入口，忽死去，记此以为垂戒。此人曾经我诊治，见其脉弱，不能服退热剂，只给滋阴中药无效，乃竟如此死去，此非西药之过也。若系久病虚证之心悸（怔忡），自以重用大补气血，及补心气药为正轨。我治此症，由经验上得来一秘诀，即药量要大，药味要简是也。（参看医验）盖怔忡病患者，至极重时，（此症轻时往往人不介意）比较上西药强心剂，不如中药效力之持久。且洋地黄等西药，有蓄积作用（即连服此药易于中毒之谓）之不便，故特附记于此。（急性心脏衰弱，（例如大吐血后或摔伤等）必注射西药强心剂，此时中药太缓，无用武之地，不可不知。）呃逆（十四）呃逆（俗称打嗝）此现象系胃气不降。实证（热性病居多）有此，率用泻药有效（此根据我之经验，屡试不爽。大凡治呃逆，应于治主症药中，（例如肺热、肠热等症）加入一二缓下之品，呃逆立去。此指呃逆甚者而言，若较轻之症，无其他热证者，以二陈汤等治之亦有效。但历试古方（例如旋覆花、代赭石汤等）多不效，不得不郑重声明之。）若久病虚证之呃逆上气，自宜以暖胃温中论治，亦多有效。西医治此症，率用麻醉药，以镇其痉挛，固有特效，但非根本治法耳。（西医治此症，亦注重主症，主症一去，呃逆亦愈，与中医殊途同归，不可妄有轩轾。）口干（十五）口干、口渴实证之口干、口渴，必由于肺胃热蒸，津液消耗，治宜参照主症（例如肺炎），加以清凉或泻下药品。（西药中之清凉剂甚有效）若系虚证（肺痨尤甚），则以生津养阴之法治之，但宜注重主症，（中药对虚证之口干、口渴效多缓，不如西药之稀盐酸等，肺痨尤甚，不易速效。我曾治一虚泻之久病患者，自觉咽喉内如烟火上冲，然不渴，又有干呕，舌红有泡，小便短赤，口唇皆肿。前医误认为实证，几殆，此症脉极细微，后服用桂、附、参、芪等药，竟尔收效，口有津液，逆气亦止，小便亦渐多。当此场合，始见吾辈医者关系民命也。（中医遇此疑难症候，虚实之辨，不差累黍，此中医所以能存在于今日也。）二便不禁（十六）二便不禁此亦应分虚实证治之。凡热性病，例如伤寒；多有大小便不能自主者，（大便或溏或稀水，小便点滴频数。）率应治其主症。（主症一去；此症不治自愈。）若系虚证，（此必参照其他各症，例如暴厥，及虚劳人，惊恐疲劳，及大病之后，皆属之。）则宜分别其何处衰弱，治其主症，再加以收涩之品，（此病理是神经衰弱及麻痹（膀胱），中医统名为虚弱。）多有能治愈者。我治愈一因变乱长途逃难，劳苦惊恐太甚，因而患小便不禁之青年，以白术等治之而愈。
炎症．（十七）炎症此病理我纯采西医之说，似不宜于此书中论及之，然此病象，甚关紧要，且有助于中医之诊断，故加以详细说明于下，愿学者注意及之；不可存门户之见也。
1．炎症之定义，吾人身体上组织之一部，受炎性刺激后，其反应起充血渗出（俗云发红），营养障碍，细胞增殖（俗云肿）者，名曰炎症。即因外来刺激（例如受了大寒、大热、火烧、木刺等），组织之生活机能亢进，且起变化之反应状态也，（亢进就是发旺的意思，例如喝了酒，心脏的生活机能加快是也；起变化，就是受刺激之部分，变了原样，例如吃了麻醉药，脑神经就变化成迟钝的样子。反应二字，反是对答，应就是应付的意思）炎字之意义，原基于临床上实验之名称，从一部发赤灼热、定出炎字之名。西医以局部发赤、肿胀、灼热、疼痛及官能障碍，（官能障碍，就是不灵的意思，例如肠胃受热，就能消化不良是也。）为炎症的五个最著征象。此五征，不是每个炎性病，均要全备，往往缺其二、三，（例如有疼痛之骨节炎，亦有不肿者，而不发赤，不肿痛者，例如神经炎等多有之）盖随其原因之强弱，（例如不甚剧烈药之刺激局部，即不能五征皆有）发生之部位，经过之急慢，病势之轻重，自有差异也。（尝见有中医随便断定病名，曰某某炎，（例如肾脏炎）殊属可笑，我以为中医不可不知西医之医理，文字上万不可冒袭西医之名称，以中西诊断术不同，何以能知其为某某炎耶？<例如肾脏炎与肾盂炎））关于炎症及病变之学说甚多，兹择其有价值，可供参考者，述之于下。
①充血说往时论炎症，率以充血为理由。洛开坦司开氏谓，发生主要机转，由于毛纲血管之扩张，血行之缓慢静止，致血液之成分渗出，血液浓厚，与各赤血球粘著而发生，至血管扩张血行缓慢之原因，归于血管运动神经之障碍，然此说已经近世医者认为不确，以血管扩张充血为炎症前驱，虽属事实，若以此即为炎症本体之主征则不可。盖血管之扩张充血时，未必尽有炎性变化（例如充血），有炎症时，亦非必皆伴血管之扩张充血（例如骨膜炎），以故单纯之充血论，不足以概括炎症之意义。
②吸引说此学说由维尔霍氏代表，主张炎症本性，为组织细胞之变化，而血管扩张（即宽缓放大之意）与渗出（即浸润之意），不过一种续发现象。其说盖以炎性刺激，能亢进细胞之荣养机（细胞之生活力之意），自周围吸引多量荣养物，发起混浊肿胀，脂肪变性（例如油类崩坏）或促进细胞之分裂增殖，发现新细胞，至炎症部群集之细胞，亦系因刺激而增殖，此亢进细胞之荣养机，使发起之混浊肿胀，脂肪变性之刺激，曰荣养刺激。若此刺激，唯惹起细胞变性，周围血管不生渗出（即不发浸润之意），此种炎症，曰实质性炎症。又亢进细胞之荣养机、繁殖机，促进其分裂增殖之刺激，曰繁殖刺激。此刺激常自周围血管渗出血液成分，因此所起之炎症，曰渗出性炎症。或名间质性炎盖氏以受刺激之组织细胞之荣养、繁殖两机能亢进，而说明炎症本性，其渗出作用，亦即主张系由组织细胞之吸引作用而成，此吸引说也。
③白血球游出说此说与吸引说正相反，系唐海遗谟氏，由动物试验，发现炎症时，有白血球通过血管壁，游走于组织间，以为解释炎症之基础。惟二氏互相辩论，各有真实之试验。近世从细胞核注意此核字之分裂，研究进步以来，细胞之新生增殖机转，渐次明了，知炎症亦有组织细胞之分裂新生。维氏之说，自系确实，然血管壁起变化，而白血球渗出，亦系事实，康氏之说，亦有见地。因此吾人可认为炎症之本性，不但因组织细胞之荣养、繁殖两机能亢盛，实亦由于血管壁变性之循环障碍，即不通之意两氏之说，可谓相得益彰也。
Eye diseases and dental diseases can both induce headache (nerve influence); one should first treat the eye disease or extract the diseased tooth, after which the headache will heal spontaneously. This does not imply that Western medicine is incompetent; rather, taking Chinese herbal medicine or Western medicine is absolutely ineffective. (For chronic headaches that persist despite repeated treatments, one must consult a specialist Western doctor in dentistry or ophthalmology for accurate examination and treatment of the primary disease. Once the cause is removed—for example, if there is pus in the gums—the headache will be radically cured.); Cough (10) This symptom of cough arises from changes within the trachea (such as inflammation). However, Chinese medical texts also differentiate this condition into excess (Shi) and deficiency (Xu) patterns. In cases of excess-pattern cough (such as in Cold Damage [Shanghan], Warm Disease [Wenbing], common cold, or lung heat/inflammation), where cough often occurs at the onset, it invariably involves the Lung receiving excess pathogenic factors (such as Wind, Cold, Summerheat, Warmth, Dampness, and foul seasonal miasmas), leading to impaired diffusion of Lung Qi and generating cough (initially dry cough, followed by phlegm). In severe cases, Lung Qi obstruction worsens, causing chest and hypochondriac pain, wheezing and distension (shortness of breath, abdominal distension), inability to lie flat, or expectoration of pus and blood. These are all acute excess conditions; the treatment method must first address the primary disease. For instance, in early-stage Cold Damage during deep winter accompanied by cough and wheezing (with definite Exterior syndrome signs), adding one or two herbs to regulate the Lung to sweating-inducing formulas will naturally lead to recovery (e.g., adding Xingren [Apricot Seed] and Su Zi [Perilla Fruit] to Mahuang Tang [Ephedra Decoction]). In early-stage Warm Diseases accompanied by cough and wheezing (Cold Damage pathogens enter via the skin and hair, while Warm Disease pathogens enter via the mouth and nose; in both, the Lung is affected first, hence cough is common), adding one or two herbs to regulate the Lung to clearing and resolving formulas will naturally lead to recovery (e.g., adding Xingren [Apricot Seed] and Beimu [Fritillaria Bulb] to Yinqiao San [Honeysuckle and Forsythia Powder] or Sangju Yin [Mulberry Leaf and Chrysanthemum Drink]). If one ignores the primary disease and treats only the cough upon seeing it, this is the work of an inferior practitioner, unworthy of being called a physician. There are many drugs for treating cough; among Chinese medicines, effective ones include Xingren [Apricot Seed], Su Zi [Perilla Fruit], Beimu [Fritillaria Bulb], Sangbai Pi [Morus Root Bark], and Pipay Ye [Loquat Leaf]. For slightly prolonged cough, Ziwan [Aster Root] and Baihe [Lily Bulb] are also effective. If cough persists for a long time and gradually shows deficiency signs, using Baishao [White Peony Root] alone has a remarkable effect; when added to cough remedies, it rarely fails. This herb not only stops cough but also its hemostatic power surpasses that of Western ergot preparations, and it can also stop sweating. Therefore, for consumption with hemoptysis and deficiency sweating (spontaneous sweating and night sweats), it is truly an supreme remedy. Pharmacopoeias do not list this herb as specifically treating the aforementioned symptoms, but through years of testing and multiple comparisons, I have determined it to be a specific remedy for consumption cough, hemoptysis, spitting blood, spontaneous sweating, and night sweats (dosage must be above 5-6 qian). For cough with phlegm, Chinese medicine considers Juhong [Tangerine Red Peel] and Banxia [Pinellia Tuber] effective; however, based on my experience, I have determined that Fuling [Poria] is effective for all types of phlegm and phlegm-fluid retention (all catarrhal syndromes, such as pulmonary edema with profuse thin sputum, catarrhal pleurisy, watery diarrhea, ascites, etc., respond remarkably well). When used in combination with ordinary phlegm-resolving drugs (one must distinguish between Cold and Heat patterns and add adjuvant herbs accordingly, yielding special effects) (dosage approximately above 5-6 qian). Although pharmacopoeias do not describe it as I do, we seek practical efficacy in treating diseases and need not be bound by ancient texts. (It cannot be used for those with dry mouth, scanty fluids, or high fever. Nourishing Yin and tonifying Kidney [e.g., Jili [Tribulus Fruit], Gouqizi [Goji Berry]] can also stop cough, a fact one must know.) Western antitussives are mostly narcotics; although effective, they should not be used frequently (fear of habituation). I commonly use small doses of Todd's Powder combined with Sodium Bicarbonate to treat slightly prolonged cough; it is stable and effective. However, this powder contains Opium, still falling within the narcotic category, though milder than Cocaine or Morphine. Patent medicines for lung diseases sold in pharmacies are numerous and dangerous; one must never blindly follow them or try them, lest one bring disaster upon oneself. (Cough and wheezing with inability to lie down are all serious conditions; pneumonia presents thus even at onset. Therefore, for infants who cannot speak and present with cough, shortness of breath, chest protrusion, and fever, one must first prevent worsening of pneumonia; hold them upright and do not force them to lie down.) Wheezing (11) The symptom of wheezing further differentiates into excess and deficiency patterns. Chinese medicine discusses wheezing most extensively, generally determining excess or deficiency via pulse diagnosis. Excess-pattern wheezing involves diffusing and unblocking Lung Qi: if Cold, use Mahuang [Ephedra] and Xingren [Apricot Seed]; if Heat, use Sangye [Mulberry Leaf], Weigen [Reed Rhizome], Jinyinhua [Honeysuckle Flower], and Gualou Ren [Trichosanthes Seed]. These are all mild and effective methods. (I do not adopt the Tingli [Descurainia Seed] method for draining Lung Qi.) Deficiency (Yin-Yang) pattern wheezing involves tonifying the Kidney and using astringent/herbs to secure essence, such as Liuwei Dihuang Wan [Six-Ingredient Pill with Rehmannia], Shenqi Wan [Kidney Qi Pill], Buguzhi [Psoralea Fruit], and even Huangqi [Astragalus Root] and Renshen [Ginseng Root], all of which are excellent for treating wheezing. Master Ye Tianshi’s discussion on wheezing is extremely precise; his statement "wheezing originating in the Lung is excess, originating in the Kidney is deficiency" truly captures the essence of treating wheezing. The secret in its treatment lies in: for upper manifestations (excess), the main treatment is clearing and purifying the Upper and Middle Jiao and diffusing Lung Qi; for lower manifestations (deficiency), the main treatment is filling, warming/tonifying, and anchoring/calming. This grasps the essentials of treating wheezing. Scholars who follow this path will stay on the right track; when diagnosing, one must integrate other symptoms and carefully examine the pulse before prescribing, ensuring comprehensiveness. Treating wheezing merely by seeing wheezing is the work of a mediocre doctor. (I recall a few years ago, my friend Mr. Zhu Youhe invited me to diagnose a critically ill patient surnamed Tang (residing in North Luogu Alley) suffering from severe wheezing. Reviewing previous prescriptions, since the patient had wheezed for many days, Chinese physicians considered it Lung excess and used Lung-draining drugs without effect. Western doctors injected antispasmodics/antitussives which stopped the wheezing, yet the patient suffered more, feeling as if their Qi was departing, unbearable in pain. Knowing deeply that the patient had not had a bowel movement for days, I prescribed only 15 grams of artificial salt [saline laxative], and one dose resulted in recovery. This case is not about curing the disease per se, but correcting iatrogenic harm; physicians treating patients generally encounter such situations, regardless of Chinese or Western medicine. Thinking of it, it is truly laughable.) Cold Extremities (Jue Ni) (12) Chinese medicine refers to cold extremities (Jue Ni) as affecting the hands and feet. This phenomenon is common in febrile diseases, usually occurring during the progression of the illness. The higher the fever, the cooler the hands and feet become; the pulse becomes neither rapid nor superficial, but turns deep and fine. In heavier cases, all six pulses may close up, Jue Ni deepens, and eventually the whole body becomes cold. "The deeper the heat, the deeper the cold extremities" is indeed a profound truth. At this stage, the condition is critical. Physicians must integrate other symptoms to determine treatment. For instance, several days into Cold Damage or Warm Diseases (note these three characters), encountering this phenomenon, more than half still have headache (at this point, it must absolutely not be considered an Exterior syndrome), dry mouth, confusion, red eyes, abdominal pain, yellow/crimson/black tongue coating, vomiting/reversal, dry stool, or heat-binding with loose stools, scanty dark urine, or turbid urine (with white sediment), and panting (not all symptoms necessarily present). It is not difficult for the physician to determine this is Excess Heat. At this time, one must consider what medications the patient has taken previously and determine if the pathology is in the Upper/Middle Jiao or Lower Jiao (referring to Excess patterns here). If this condition follows repeated sweating and purging therapies, the disease is likely in the Upper/Middle Jiao; one should add Zixue Dan [Purple Snow Pill], Zhibao Dan [Precious Treasure Pill], Niuhuang Qingxin Wan [Calveskin and Musk Heart-Clearing Pill], Xijiao [Rhinoceros Horn - now substituted], and Yujin [Curcuma Tuber] to aromatic orifice-opening, Lung-clearing, and Yin-nourishing herbs, hoping to open the upper orifices. If purgatives have not been used, one must pay attention to whether it is caused by stagnant heat in the intestines and stomach; once confirmed, use Mangxiao [Mirabilite] and Dahuang [Rhubarb Root] to purge, and efficacy will be seen. At this critical juncture, one must absolutely not mistake the cold body and arrested pulse/Qi for a Cold pattern due to the general cooling. Prescribing warm exterior-releasing drugs at this time kills rapidly; be extremely cautious.
(Deficiency patterns also present with cold limbs, but this implies chronic illness. Integrating other symptoms [e.g., chronic diarrhea] makes it easy to identify; no need for further elaboration. The method should be warming and tonifying, as is obvious.) Palpitations (13) This symptom is most common in febrile diseases (patients report heart fluster/palpitations). This corresponds to Western medicine's "palpitation hyperkinesis." At this time, the Heart's resistance to pathogenic factors is insufficient. Physicians must pay extra attention to medication. If using sweating-inducing drugs, start with small doses to prevent danger. Chinese sweating-inducing drugs pose risks at this time; Western antipyretics are even more dangerous, potentially causing excessive sweating leading to sudden cardiac arrest and death. Twenty years ago, I diagnosed Mr. Huang Huaxuan, Commander of the Left Wing of Zhili, with a common cold. His pulse showed intermission (Jie Dai) and palpitations. Due to aversion to cold, headache, and body ache, presenting as a complete Exterior syndrome, I used exterior-releasing drugs in very light dosages, instructing him to achieve slight sweating. The next day, symptoms subsided slightly. Being a martial man impatient with slow progress, he disliked the light dosage and consulted another doctor. This doctor used large doses of Mahuang [Ephedra] and Qianghuo [Notopterygium Root] to induce sweating. After taking the medicine, he did not rise the next morning. A messenger called out to him with no response; lifting the quilt revealed he had been dead for some time. I record this as a warning. Western doctors, encountering febrile diseases with cardiac weakness, often add cardiotonic agents to antipyretics or cooling drugs (e.g., adding Camphoric Acid to Belladonna, or Red Wine to Dilute Hydrochloric Acid), showing thoughtful intent. However, Chinese sweating-inducing agents lack this approach; adding herbs to support Heart Qi or address vomiting to sweating-inducing formulas dilutes their efficacy, making sweating difficult and leading to errors—a fact one must know. I have also personally witnessed deaths resulting from sudden ingestion of Western medicines like Cinchona Bark Pills, small doses of Belladonna, and Antipyrine. I recall a person with consumption-fever who was advised by a doctor that small doses of Belladonna tablets were effective, so he took them continuously for days. One day, while eating an orange, he suddenly died just as he put it in his mouth. I record this as a warning. This patient had been treated by me; seeing his weak pulse, I determined he could not take antipyretics and prescribed only Yin-nourishing Chinese herbs, which were ineffective, leading to his death. This is not the fault of Western medicine. For chronic deficiency-pattern palpitations (Zheng Tong / Panic), the correct approach is heavily tonifying Qi and Blood, and tonifying Heart Qi. From experience, I have derived a secret for treating this: large dosages and simple formulas. (See Medical Cases). Patients with Zheng Tong, at extreme severity (often ignored when mild), find that compared to Western cardiotonics, Chinese medicines offer more sustained efficacy. Moreover, Western drugs like Digitalis have the inconvenience of accumulation toxicity (toxicity from continuous use). Thus, I specially note this. (Acute cardiac weakness [e.g., after massive hematemesis or trauma] requires injection of Western cardiotonics; at this time, Chinese medicines act too slowly and have no place—this must be known.) Hiccups (14) Hiccups (commonly known as hiccupping) result from Stomach Qi failing to descend. Excess patterns (mostly in febrile diseases) present this way; purgatives are generally effective (based on my experience, consistently successful). Generally, when treating hiccups, add one or two mild purgatives to the formula treating the primary symptom (e.g., Lung Heat, Intestinal Heat), and hiccups cease immediately. This refers to severe hiccups. For milder cases without other Heat signs, Erchen Tang [Two-Aged Decoction] is also effective. However, having tried ancient formulas (e.g., Xuanfuhua Daizheshi Tang [Inula and Hematite Decoction]) repeatedly with little success, I must solemnly declare this. For chronic deficiency-pattern hiccups with rebellious Qi, warming the Stomach and Middle Jiao is appropriate and often effective. Western medicine treats this primarily with anesthetics to suppress spasms, which has specific effects but is not a fundamental cure. (Western treatment also focuses on the primary symptom; once the primary symptom resolves, hiccups cease. Different paths, same destination; one should not arbitrarily judge superiority.) Dry Mouth (15) Dry mouth and thirst in excess patterns are definitely caused by steaming Heat in the Lung and Stomach consuming Body Fluids. Treatment should reference the primary symptom (e.g., Pneumonia) and add cooling or purgative drugs. (Western cooling agents are very effective). For deficiency patterns (especially Consumption), treat with methods to generate fluids and nourish Yin, but focus on the primary symptom. (Chinese medicines for deficiency dry mouth/thirst often act slowly, unlike Western dilute hydrochloric acid, especially in Consumption where quick results are hard to achieve. I once treated a chronic patient with deficiency-type diarrhea who felt smoke/fire rising in the throat, yet had no thirst, accompanied by dry retching, red tongue with blisters, scanty dark urine, and swollen lips. Previous doctors mistakenly identified this as an excess pattern, nearly causing death. The pulse was extremely fine and minute. Later, administering Gui [Cinnamon Twig], Fu [Prepared Aconite], Renshen [Ginseng], and Huangqi [Astragalus] achieved success. Saliva returned, rebellious Qi stopped, and urination increased. Only in such scenarios do we see the responsibility of physicians regarding people's lives. (When Chinese medicine encounters such difficult syndromes, distinguishing excess from deficiency with precision is why Chinese medicine survives today.) Incontinence of Urine and Feces (16) Incontinence of urine and feces should also be treated according to excess and deficiency patterns. Febrile diseases, such as Cold Damage, often involve loss of voluntary control over urination and defecation (stool may be loose or watery; urination may be frequent and scanty). Generally, treat the primary symptom. (Once the primary symptom resolves, this symptom heals spontaneously.) For deficiency patterns (referencing other symptoms such as sudden collapse, consumptive fatigue, fright/exhaustion, or post-major illness), identify where the weakness lies, treat the primary symptom, and then add astringents. (This pathology involves neural weakness and paralysis [of the bladder], collectively named Weakness in Chinese medicine). Many such cases can be cured. I cured a young man who developed urinary incontinence due to extreme labor, fright, and exhaustion while fleeing turmoil over a long distance, treating him with Baizhu [Atractylodes Macrocephala Root] and others.
Inflammation (17) I adopt Western medical theory purely for this pathology, which seems inappropriate to discuss in this book. However, this pathological manifestation is crucial and aids Chinese diagnostic judgment, so I explain it in detail below. Scholars should pay attention and avoid sectarian prejudice.
1. Definition of Inflammation: When a part of the body's tissue receives inflammatory stimulation, its reaction involves congestion and exudation (commonly called redness), nutritional disturbance, and cell proliferation (commonly called swelling). This is named Inflammation. It is a reactive state where the life function of tissues becomes hyperactive and undergoes changes due to external stimuli (such as extreme cold, extreme heat, fire burns, wood splinters, etc.). (Hyperactivity means flourishing; e.g., drinking alcohol accelerates the heart's life function. Change means the stimulated part alters its original state; e.g., taking anesthetics makes brain nerves迟钝/dull. 'Reaction' implies responding to a stimulus.) The character 'Yan' (Flame/Inflammation) originally derives from clinical experimental names, defined by local redness and burning heat. Western medicine identifies five prominent signs of inflammation: local redness, swelling, burning heat, pain, and functional impairment (functional impairment means dysfunction; e.g., stomach/intestines overheating leads to indigestion). These five signs are not always complete in every inflammatory disease; often two or three are missing (e.g., arthralgia with pain may not swell or redden; neuritis often lacks pain, swelling, or redness). Differences arise based on the strength of the cause (e.g., mild drug stimulation may not produce all five signs), location of occurrence, speed of progression, and severity of the condition. (It is ridiculous for some Chinese doctors to casually diagnose diseases as "itis," e.g., Nephritis. I believe Chinese doctors must understand Western medical principles, but textually must not usurp Western terminology. Since Chinese and Western diagnostic methods differ, how can one know it is "itis"? <e.g., distinguishing Nephritis from Pyelonephritis>). Regarding theories of inflammation and lesions, there are many; I select valuable ones for reference below.
① Congestion Theory: Previously, inflammation was largely attributed to congestion. Dr. Lokotsch stated that the main mechanism involves dilation of capillaries, slow/stagnant blood flow, leading to exudation of blood components, thickening of blood, and adherence of red blood cells, causing dilation and slowed flow due to vascular motor nerve obstruction. However, modern physicians consider this inaccurate. While vascular dilation/congestion precedes inflammation, it is not the main sign of the inflammation itself. Vascular dilation/congestion does not always imply inflammatory changes (e.g., simple congestion), and inflammation does not always accompany vascular dilation/congestion (e.g., periostitis). Thus, simple congestion theory is insufficient to summarize the meaning of inflammation.
② Attraction Theory: Represented by Virchow, this theory posits that the nature of inflammation is the change of tissue cells, while vascular dilation and exudation are secondary phenomena. It argues that inflammatory stimulation hyperactivates the nutrition mechanism of cells (cell vitality), attracting large amounts of nutrients from surroundings, initiating turbid swelling, fatty degeneration (e.g., breakdown of oils), or promoting cell division/proliferation to form new cells. Cells gathering at the inflamed site also proliferate due to stimulation. This stimulation, which hyperactivates cellular nutrition leading to turbid swelling and fatty degeneration, is called Nutritional Stimulation. If this stimulation only causes cell degeneration without surrounding vascular exudation (no infiltration), it is called Parenchymatous Inflammation. Another stimulation, Hyperactive Cellular Nutrition and Reproduction Mechanism, promotes division/proliferation, is called Reproductive Stimulation. This stimulation often causes exudation of blood components from surrounding vessels, resulting in Exudative Inflammation, or Interstitial Inflammation. Gassner explained the nature of inflammation by the hyperactivity of nutrition and reproduction functions of stimulated tissue cells, asserting that exudation results from the attraction of tissue cells. This is the Attraction Theory.
③ Leukocyte Emigration Theory: Opposite to the Attraction Theory, this theory, represented by Thoma-Ziegler, found through animal experiments that leukocytes pass through vessel walls and migrate into tissues during inflammation, forming the basis for explaining inflammation. Both sides debated, each with true experiments. With recent advances in studying nuclear division, the mechanism of new cell proliferation has become clearer, knowing inflammation also involves tissue cell division and renewal. Virchow's view is certainly accurate, but the change of vessel walls and leukocyte exudation is also a fact; Konig's view also has merit. Therefore, we can consider the nature of inflammation not only due to hyperactivity of tissue cell nutrition and reproduction, but also due to circulatory obstruction from vessel wall degeneration (blockage). The views of both parties complement each other.
④ Gierke's Theory: Synthesizing Konig and Virchow's theories, Gierke states that inflammatory stimulation first causes degeneration of vessel walls and tissues. Due to vessel wall degeneration, blood flow obstruction occurs, followed by leukocyte emigration.