余次子汉果，体格强壮，年二十岁。乎素便秘，有胃酸过多吞酸症，食物时又不惯细嚼，偶因旅行，饮食失宜，过于劳动，因而感患胃部奇痛，胃内似有西物相挤继而大吐，症遂减轻。余诊系胃疡将成，乃遂往西城某大医院诊察，余盖希望该院检查胃液，详细诊察，以资印证也。乃该院医生临诊，特别号略一询问，即为了事，余当询以何病？乃竟意气用事，反询余曰，汝在何校毕业？汝以为何病？余从实对，则忿然答曰，此胆石疝痛四字而已。余虽才浅学疏，然对胆石疝痛与胃痛，尚不致鉴别错误。一至于此，不得已乃又送入同仁会医院，经严泽与林荷骆两君之诊察，认为胃疡，与以缓下剂，约一星期而治愈。自此以后，时有胃酸过多，便秘、胃痛等现象，与以缓下剂，旋愈。某日夜间，忽觉胃痛加剧，吐血甚多，便血黑色便更多，余知胃疡已破，乃以西药施治，嘱令静卧，并先严禁固形食物。只与稀汤，约二星期。处方如下：第一方，人工加尔儿斯泉盐二五·○分二包，每日早起，用白开水化服一包。
第二方，重曹八·○，次硝苍六·○，菲沃斯越○·三（分六包），一日三包，食前服，白开水送下。
第三方，盐莫○·○○一，乳糖○·五左为一包，与以六包，痛时服一包，不痛则不用此药。
此症即以此三方而治愈，当其大吐血时，势颇危，晕厥然已确认为胃溃疡无疑，故必先令静卧勿动。约三星期，只以病者平素不能食牛乳，故代以米汤、稀粉、鸡蛋糕以鸡蛋打破，搅入一碗之清水，放盂内蒸之，如豆腐状。等稀薄流动之物为食品。约三星期每日早晨，服第一方，（一日之中，分三次服第二方）约一星期，即将第二方减去菲沃斯越以胃已不痛，故不用此药也。服之，第三方只于吐血之始，第一、二日各服一包，以痛较甚也嗣即不用此药矣，然第一、第二两方，每日与服，约四星期，一日未曾间断，第二星期后，已起床能食易消化之物矣。此症遂以此等西药而治愈。中药内之大黄有刺激性，万不可用。
姜君住北京西四牌楼大拐棒胡同十三号，年十九岁，以前患肠胃病年馀，据云腹痛，经过若干中西医，及针灸医生之治疗，至二十六年四月病势已危。延余诊治，见其面色苍白，身体瘦弱，病者自诉，胃部奇痛，有顽固之呕吐，大便则服泻药，亦不得下，以故只有呕吐、疼痛，饮食不下，衰弱几至不能起立。询悉以前曾有一次大泻黑色大便极多，正在扎针期内，闻此症请中医扎针，约数十日之久。延至现在，中西药均辞不治。余即断为胃溃疡无疑，当日与以人工盐一五·○不效，又与硫苦二○·○不效，又与甘汞锭六片，每片含量○·二，分三次服，仍未得泻，乃与拉克沙妥儿二片，服后竟得泻下极干燥之粪，嗣即水泻二次。当与阿片酊剂，嘱其每隔半点钟，眼五滴，凡一日夜，痛骤减，呕吐亦减止，能稍饮牛乳，伊家惊为神奇。嗣即与以重曹、硝苍，即前第二方去菲沃斯越嘱一日三次服，并与人工盐，即前第一方嘱其每日早晨服之，亦顺利得泻，约三星期，遂告大愈。然患者，有鸦片嗜好，且食物不谨，为本病治疗上一大障碍，是以治愈后，约年馀，忽又大吐血、泻血，衰弱已极，危险万分。又以前法参照前例治愈之。此君若无鸦片嗜好，决定不致有此二次之反复也。
按胃溃疡一症，较易诊断，以其疼痛发作时，特别剧烈，且有一切胃病状况，例如吞酸、嗳气、胀饱、便燥、呕吐等症，医者不难参照断定。此对中医而言，故略去检查胃液及检查粪便等说明。唯此症往往与胃痛相混，胃痛症按之多轻缓，胃溃疡则按之更痛。以此二症之病的现象多相同，例如上述一切胃病症状故医者当二症初起之时，容易相混，但二症治法不相反背，此指西药言，若中医论此症则有寒热虚实之分，惟余不取中医之说。若以本编所述之西药治法治之，亦均有效。仅有胃病不必用次硝苍但二症用中药，皆不如宗西医说，为确当速效。此因论胃溃疡连类说明之，但普通病人对医学不能具有常识，往往以心口痛、或胸口痛，自诉痛苦。医者对于此种场合，最要细心诊断，胃溃疡与胃痛二症，诊断不清，治法尚无大异，不致误人性命，唯胃病症治，最宜与心脏病精确鉴别，尤其与绞心症，中医所谓真心痛更须鉴别，否则用药一误，立出危险，而中医遇此场合，尤易误认，故余不得不详细说明之，愿医者临是症时，格外注意也。
凡胃痛，例如呕吐吞酸、食后痛、大便燥、胀饱等多有一切之胃病症状，此为首应注意之点，若无一般胃病症状，时常感觉心脏部疼痛，或忽然发作疼痛，俗名心口痛、胸口痛，多系统指胃病与心病之名称，最足误人。医者即应格外注意于二者之鉴别，兹将其此二病相异之点，说明于下：1．心脏之疾患①急性之心脏内膜炎，此症有显著之高热及脑症状，只有心悸亢进，不发剧痛，与胃痛容易分别。
②心脏瓣膜病，此症有喘息，呼吸困难，心悸亢进，肠胃障碍，虽与胃病有相似之点，然只有偻麻质斯疼痛，与胃痛亦易分别，又有心脏病剧烈时，患者立时即病倒，心乱如麻，且有咳嗽吐血及吐白沫者，俱系偶尔一次，须注意。此实例亦甚多，此盖由于心脏血行障碍，因而牵动肺循环之血行欤。然此种咳嗽吐血，只限于心病发作之一时，若心脏病不发作之时，绝不咳嗽，亦绝不吐血，自然不致与肺病、胃病相混，此余之实验谈也。
2，心囊之疾患中医书所谓心包络也①心囊炎，此症虽有心部发痛，似与胃病相混，然此种疼痛乃隐痛，并非剧烈，且此症心悸亢进，恶寒发热，亦与胃痛迥异，不致误认。
②心囊水肿，此症心脏部有显著之浆液蓄积，且乏疼痛，亦与胃痛不致误认。
3．心脏实质之疾患①脂肪心，此症无疼痛，不致与胃病混淆。②心脏肉质炎，此症虽有心脏部之疼痛，然本病必发高热，且有极重之神经症状，与胃痛不致混淆。
③冠状动脉硬化症，本病多起于40岁以上之人，且多因身体过劳，饮酒吸烟过多，或梅毒痛风而起，为一慢性之心脏疾患，其症候有心筋衰弱，绞心症，心内绞痛此点最易与胃痉相混心脏性喘息，失神发作胃痛无此失神现象，心动急速或缓慢，此症极易与胃痉相混，应注意其他胃病现象，自不致误认。
4．心脏之神经性疾患①神经性心悸亢进，此症无疼痛，不致与胃痛相混。
②绞心症，又名心脏痉挛，中医所谓真心痛者是也。此症最易误认为胃痉挛，治法一误，立致人死，医者最宜谨慎诊断。此症除缺乏胃病之吞酸、呕吐、便秘等症状外，最宜注意此点其疼痛之发作，几与胃痉相似。以故中医遇此症时，往往误认，杀人即在顷刻，以此症一遇中医之消导、顺气、清热等药，服下即可令代偿机停止活动，而归于死亡，此余所亲见，阅后王成琨一病自知非有不慊于中医也。此症与胃痉，在真正之西医，一经诊断不难鉴别，此为中医立言，故知此云云。绞心症之原因，强半由于心脏中应有之血量，急速减少或因烟酒过度，及其他心脏病。故其现象，患者夜间常常醒觉，感呼吸困难，及心脏部之奇痛，与异常之烦闷苦恼，此时之剧烈疼痛如绞缢，如压迫，如掰裂，有难以言传之痛苦。其痛往往波及肩胛颈肋，此与胃病不同之点，但又与肝胆肋等痛容易误认。手足厥冷，颜面失色，愈远愈显痛时皮肤出汗，脉或停止，病发时更有一种苦闷与灭绝之感觉。在病者比较疼痛，尤为苦恼，疼痛持续时间，由数秒至三十分钟不等。诱发本病以身体之剧动，精神感触，有一见凉风或行动用力即诱发者。及饱食、交接等为最易。夜间发作时尤多除消化有时微觉障碍外，其余一切胃之病状．丝毫不见，有时吐白沫喘息，故又易误认为肺病，然肺病绝不如是之绞痛也。是宜特别注意之点也。
附录王成琨君病历一则王成琨，年三十六岁，住珠市口南何家大院二十五号，膏药商人。据称早年一经过劳例如挑水恒觉立时心乱，必须卧下须臾即愈。在一千月前，偶因入澡堂沐浴，方入门，即觉呼吸困难，因而心乱疼痛、喘息、吐白沫甚多，自是之后，每一出门，行动稍劳，即诱发心内疼痛，如绞如掰，夜间尤甚。注意胃病症状均无，绝非胃痛。即请中医某诊治，谓系肺病，盖因其喘息，故错认也。治之不愈，又改延某中医诊治，认为脾胃病，与以白术、白芍等药，余汜其方，有此二味服下病更甚。又延某医诊治，闻系注射强心剂病稍减，仍未愈。最后其戚某亦中医来诊，乃为开一药方，记得内有黄芩、枳实、陈皮、龙胆草等味，余适至病家作友谊之看望，见其方煎此药，乃告以不可服用此等中药，然病者深信伊戚某之医术，至下午八点钟服下此药，约隔三小时，即觉病痛更剧，意欲如厕，方起床，即骤然死去，时为二十七年十二月五日，此即绞心症患者之病历，录之以为庸医杀人者戒也。此症疼痛最烈时稍与盐莫止痛亦可，然最有效之治法，应参照本编怔忡病作膏剂与服，可以治愈。
怔忡（四）怔忡此指久病无热之心脏重症而言，若热性病中，发现之心悸亢进，不在此例。
（原因）此症原因，不外心脏衰弱，所最习见者，为老年人衰弱者，及大失血之后，大热性病之后，日久大惊恐及手淫，均为本病原因之一，其次则嗜酒者，身体虽不甚衰弱，亦能渐罹此症，治不得法，多取死亡之转归。
（症候）感觉心脏部跳动不宁，在轻症之患者，偶尔心动，多不注意，若再病势加重，则每隔数分钟，或暂停止呼吸时，即觉心脏突突颤动，若连珠水泡之激发，稍停又来，忐忑不宁，渐次失眠，喘促，面目浮肿，一有思虑及谈话，即感心乱，即或一人独处，亦觉心内扰乱悲惨，有口不能言之心内悲苦，卒致骤然，感觉心动，倏忽毕命。余友郑如、穆松轩二君皆死于此症，二君皆嗜酒，余回籍时，询病殁时情状，故知之。
（治法）西药对此症之唯——治法，为强心剂，有特效，然根本治疗此症，乃中药之大补气血法。余曾与西药之实芰达利斯、樟脑酸、斯尔方那尔等，及其他铁剂、与强壮剂等，厉经比较，而知用西药结果，一时有效，药一间断，则病仍发作，且毛地黄等，又有蓄积作用，不宜常服，而中药内之治此症药品，则极简单子和数味，此数味，不知几经试验若千年，而始得之，不可忽视也。其效力之大，起死回生，参看医验真有研究之价值，但历经试验，若于此数味之中药外，加减太多，或太减轻其用量，则仍无效，此点更有研讨之趣味，故此数味中药，真可定为奉症之标准方矣，原方列后，不可加减用时不可随意更改药味。
大台参八钱炙黄芪八钱当归身—两柏子仁四钱炒枣仁四钱龙眼肉四钱炙甘草四钱煎妥冲入黄酒少许，（约三瓦）此药煎一大杯，一日三次分服。或不用黄酒亦可。
（医验）蔡夫人，住德县南关柴市街，年七十馀岁。此症系病家转挽余友徐仲甫先生及石君，延余治疗。当时诊得左手现代脉，右手脉细小，亦三五至一止，询其痛苦，病者下能言。伊子蔡君，则声称不过感冒之小恙而已，然详细诊察，毫无感冒症状，又无表热征兆，洵其不能起床，则已数旬，且衰弱现象毕具，绝非外感，参以脉象，非常危险乃断定为心脏衰弱之重症，处方如下中医诊术，望闻向切之问字，遇此种场合，最感困难，学者注意。
第一方，台党参六钱炙黄芪六钱当归身八钱柏子仁三钱炒枣仁三钱龙眼肉三钱土炒白术四钱炙甘草一钱煎妥一杯冲入黄酒少许一日三次分服。
服前方三剂大效，病者渐进饮食，又复延诊，脉象稍有起色，但仍现结代，精神略佳。古稀老人，心脏衰弱，药虽对症，不能骤见大效，然服药数剂，即能得此效验，足证此病尚可挽回，乃照前方，加减治之。
第二方，土炒白木四钱大台参八钱炙黄芪八钱当归身八钱柏子仁四钱炒枣仁四钱龙眼肉三钱炒白芍二钱炙甘草一钱煎妥一杯冲入黄酒少许照前法服。前方约服十馀剂，完全治愈，嘱其断药方法，以次递减，不可骤然停药，约月馀，渐渐止药。嘱其每觉心内忐忑，仍照原方煎服一、二剂，平时每隔一、二月，服西药威古龙丸一、二粒，此药不可滥用，往往诱起吐血惟不可按时常服。此症治愈后，蔡君在喧哗角街设宴酬医，深致感谢之意。余窃以为既系自觉感冒小恙，何必转托友延余诊治，既已治愈，若自以为感冒小声，又何必盛筵致谢，过分感激。后乃微闻此症，实已病危，前医业经辞谢不治，并告伊家病重，嘱其预备后事，余适于此时，由湘旋里，余友恐告知病重，余有难色，故将病情隐去，幸余尚能诊断确认，否则几何不致错认小恙，贻误人命耶！后见病者所服前医之方，所用药品，亦多治此病之对症良药，但药味太多，药量太轻，且有兼顾胃口等药，天王补心丹加减是以药性不纯，功效不著耳。余之此方，不可任意加减，服法亦宜注意叮咛相告，愿读者信余言也。
我的次子汉果，体格强壮，二十岁。平时有便秘、胃酸过多导致吞酸的症状，吃东西时又不习惯细嚼慢咽，偶尔因为旅行，饮食不当，加上过度劳累，因此患上了胃部剧烈疼痛，胃里感觉像是有东西在挤压，随后发生大吐，症状才减轻。我诊断认为是胃溃疡即将形成，于是前往西城某大医院检查，我希望该院能检查胃液，进行详细诊察，以资印证。然而该院医生临诊时，特别号只是略一询问，便草草了事。我询问他是什么病，他竟然意气用事，反问我：“你在哪所学校毕业？你认为是什么病？”我如实回答后，他愤怒地回答说：“不过是胆石疝痛这四个字罢了。”我虽然才疏学浅，但对于胆石疝痛与胃痛的区别，不至于鉴别错误到这种地步。不得已，我又将他送入同仁会医院，经严泽与林荷骆两位医生诊察，认定为胃溃疡，给予缓下剂治疗，约一周即治愈。此后，时常出现胃酸过多、便秘、胃痛等现象，给予缓下剂，很快痊愈。某日夜间，突然感到胃痛加剧，吐血很多，黑便更多，我知道胃溃疡已经破裂，于是采用西药治疗，嘱咐静卧，并先严禁固体食物，只给稀汤，约两周。处方如下：
第一方，人工加尔儿斯泉盐25.0分，两包，每天早起，用白开水化服一包。
第二方，重曹8.0，次硝苍6.0，菲沃斯越0.3（分六包），一天三包，饭前服用，白开水送下。
第三方，盐莫0.001，乳糖0.5左右为一包，给六包，痛时服一包，不痛则不用此药。
此症以此三方治愈。当其大吐血时，病情颇为危急，虽已晕厥，但确认为胃溃疡无疑，所以必须先令静卧不动。约三星期，只因病人平时不能喝牛奶，所以代以米汤、稀粉、鸡蛋糕（将鸡蛋打破，搅入一碗清水，放入盆中蒸熟，呈豆腐状）等稀薄流动之物为食品。约三星期，每天早晨服第一方，（一天之中分三次服第二方），约一星期，因胃已不痛，便将第二方减去菲沃斯越，故不用此药。第三方只在吐血之初的一、二日各服一包，因疼痛较甚，之后便不再使用此药。然而第一、二两方，每日服用，约四周，一日未曾间断，第二星期后，已能起床进食易消化之物。此症遂以此等西药治愈。中药内的大黄有刺激性，万不可用。
姜君住北京西四牌楼大拐棒胡同十三号，十九岁，以前患肠胃病一年多，据称腹痛，经过若干中西医及针灸医生的治疗，至民国二十六年四月病势已危。请我诊治，见其面色苍白，身体瘦弱，病者自诉胃部奇痛，有顽固性呕吐，大便即使服泻药也排不出，因此只有呕吐、疼痛，饮食不下，衰弱得几乎不能站立。询悉以前曾有一次大泻黑色大便极多，正在扎针期间，听说此症请中医扎针，约数十日之久。延至今日，中西药均辞谢不治。我当即断定为胃溃疡无疑，当日给予人工盐15.0，无效；又给予硫苦20.0，无效；又给予甘汞锭六片，每片含量0.2，分三次服，仍未得泻；乃给予拉克沙妥儿两片，服后竟排出极干燥的粪便，随后水泻两次。当时给予阿片酊剂，嘱咐每隔半小时滴五滴，凡一日一夜，疼痛骤减，呕吐亦止，能稍饮牛奶，家属惊为神奇。随后给予重曹、硝苍，即前第二方去菲沃斯越，嘱一日三次服，并与人工盐，即前第一方，嘱其每日早晨服之，亦顺利得泻，约三星期，遂告大愈。然而患者有鸦片嗜好，且饮食不谨慎，为本病治疗上的一大障碍，是以治愈后约一年多，忽又大吐血、泻血，衰弱已极，危险万分。又以前法参照前例治愈之。此君若无鸦片嗜好，决定不致有此二次反复。
按胃溃疡这一病症，较易诊断，因为其疼痛发作时特别剧烈，且具备一切胃病状况，例如吞酸、嗳气、胀饱、便燥、呕吐等症状，医者不难参照断定。这是针对中医而言，故略去检查胃液及检查粪便等的说明。唯此症往往与胃痛相混淆，胃痛症按压时轻缓，胃溃疡则按压更痛。由于这两症的病理现象多相同，例如上述一切胃病症状，故医者在两症初起之时容易相混，但两症治法并不相反背，这里指西药而言，若中医论此症则有寒热虚实之分，惟我不取中医之说。若以本编所述之西药治法治之，亦均有效。仅有胃病不必用次硝苍。但两症用中药，皆不如宗西医说，为确当速效。此因论胃溃疡连类说明之，但普通病人对医学不能具有常识，往往以心口痛、或胸口痛自诉痛苦。医者对于此种场合，最要细心诊断，胃溃疡与胃痛两症，诊断不清，治法尚无大异，不致误人性命，唯胃病治法，最宜与心脏病精确鉴别，尤其与绞心症，中医所谓真心痛更须鉴别，否则用药一误，立出危险，而中医遇此场合，尤易误认，故我不得不详细说明之，愿医者临是症时，格外注意。
凡胃痛，例如呕吐吞酸、食后痛、大便燥、胀饱等多有一切之胃病症状，此为首先应注意之点，若无一般胃病症状，时常感觉心脏部疼痛，或忽然发作疼痛，俗名心口痛、胸口痛，多是系统指胃病与心病之名称，最足误人。医者即应格外注意于二者之鉴别，兹将其此二病相异之点，说明于下：
1．心脏之疾患
①急性之心脏内膜炎，此症有显著之高热及脑症状，只有心悸亢进，不发剧痛，与胃痛容易分别。
②心脏瓣膜病，此症有喘息，呼吸困难，心悸亢进，肠胃障碍，虽与胃病有相似之点，然只有偻麻质斯疼痛，与胃痛亦易分别，又有心脏病剧烈时，患者立时即病倒，心乱如麻，且有咳嗽吐血及吐白沫者，俱系偶尔一次，须注意。此实例亦甚多，此盖由于心脏血行障碍，因而牵动肺循环之血行欤。然此种咳嗽吐血，只限于心病发作之一时，若心脏病不发作之时，绝不咳嗽，亦绝不吐血，自然不致与肺病、胃病相混，此余之实验谈也。
2，心囊之疾患（中医书所谓心包络也）
①心囊炎，此症虽有心部发痛，似与胃病相混，然此种疼痛乃隐痛，并非剧烈，且此症心悸亢进，恶寒发热，亦与胃痛迥异，不致误认。
②心囊水肿，此症心脏部有显著之浆液蓄积，且乏疼痛，亦与胃痛不致误认。
3．心脏实质之疾患
①脂肪心，此症无疼痛，不致与胃病混淆。
②心脏肉质炎，此症虽有心脏部之疼痛，然本病必发高热，且有极重之神经症状，与胃痛不致混淆。
③冠状动脉硬化症，本病多起于40岁以上之人，且多因身体过劳，饮酒吸烟过多，或梅毒痛风而起，为一慢性之心脏疾患，其症候有心筋衰弱，绞心症，心内绞痛（此点最易与胃痉相混）、心脏性喘息、失神发作（胃痛无此失神现象）、心动急速或缓慢（此症极易与胃痉相混，应注意其他胃病现象，自不致误认）。
4．心脏之神经性疾患
①神经性心悸亢进，此症无疼痛，不致与胃痛相混。
②绞心症，又名心脏痉挛，中医所谓真心痛者是也。此症最易误认为胃痉挛，治法一误，立致人死，医者最宜谨慎诊断。此症除缺乏胃病之吞酸、呕吐、便秘等症状外，最宜注意此点，其疼痛之发作，几与胃痉相似。以故中医遇此症时，往往误认，杀人即在顷刻，以此症一遇中医之消导、顺气、清热等药，服下即可令代偿机停止活动，而归于死亡，此余所亲见，阅后王成琨一病自知非有不慊于中医也。此症与胃痉，在真正之西医，一经诊断不难鉴别，此为中医立言，故知此云云。绞心症之原因，强半由于心脏中应有之血量，急速减少或因烟酒过度，及其他心脏病。故其现象，患者夜间常常醒觉，感呼吸困难，及心脏部之奇痛，与异常之烦闷苦恼，此时之剧烈疼痛如绞缢，如压迫，如掰裂，有难以言传之痛苦。其痛往往波及肩胛颈肋，此与胃病不同之点，但又与肝胆肋等痛容易误认。手足厥冷，颜面失色，愈远愈显痛时皮肤出汗，脉或停止，病发时更有一种苦闷与灭绝之感觉。在病者比较疼痛，尤为苦恼，疼痛持续时间，由数秒至三十分钟不等。诱发本病以身体之剧动，精神感触，有一见凉风或行动用力即诱发者。及饱食、交接等为最易。夜间发作时尤多除消化有时微觉障碍外，其余一切胃之病状．丝毫不见，有时吐白沫喘息，故又易误认为肺病，然肺病绝不如是之绞痛也。是宜特别注意之点也。
附录王成琨君病历一则
王成琨，年三十六岁，住珠市口南何家大院二十五号，膏药商人。据称早年一经过劳（例如挑水）恒觉立时心乱，必须卧下须臾即愈。在一千月前，偶因入澡堂沐浴，方入门，即觉呼吸困难，因而心乱疼痛、喘息、吐白沫甚多，自是之后，每一出门，行动稍劳，即诱发心内疼痛，如绞如掰，夜间尤甚。注意胃病症状均无，绝非胃痛。即请中医某诊治，谓系肺病，盖因其喘息，故错认也。治之不愈，又改延某中医诊治，认为脾胃病，与以白术、白芍等药，余汜其方，有此二味服下病更甚。又延某医诊治，闻系注射强心剂病稍减，仍未愈。最后其戚某亦中医来诊，乃为开一药方，记得内有黄芩、枳实、陈皮、龙胆草等味，余适至病家作友谊之看望，见其方煎此药，乃告以不可服用此等中药，然病者深信伊戚某之医术，至下午八点钟服下此药，约隔三小时，即觉病痛更剧，意欲如厕，方起床，即骤然死去，时为二十七年十二月五日，此即绞心症患者之病历，录之以为庸医杀人者戒也。此症疼痛最烈时稍与盐莫止痛亦可，然最有效之治法，应参照本编怔忡病作膏剂与服，可以治愈。
怔忡（四）
怔忡此指久病无热之心脏重症而言，若热性病中，发现之心悸亢进，不在此例。
（原因）此症原因，不外心脏衰弱，所最习见者，为老年人衰弱者，及大失血之后，大热性病之后，日久大惊恐及手淫，均为本病原因之一，其次则嗜酒者，身体虽不甚衰弱，亦能渐罹此症，治不得法，多取死亡之转归。
（症候）感觉心脏部跳动不宁，在轻症之患者，偶尔心动，多不注意，若再病势加重，则每隔数分钟，或暂停止呼吸时，即觉心脏突突颤动，若连珠水泡之激发，稍停又来，忐忑不宁，渐次失眠，喘促，面目浮肿，一有思虑及谈话，即感心乱，即或一人独处，亦觉心内扰乱悲惨，有口不能言之心内悲苦，卒致骤然，感觉心动，倏忽毕命。余友郑如、穆松轩二君皆死于此症，二君皆嗜酒，余回籍时，询病殁时情状，故知之。
（治法）西药对此症之唯一治法，为强心剂，有特效，然根本治疗此症，乃中药之大补气血法。余曾与西药之实芰达利斯、樟脑酸、斯尔方那尔等，及其他铁剂、与强壮剂等，厉经比较，而知用西药结果，一时有效，药一间断，则病仍发作，且毛地黄等，又有蓄积作用，不宜常服，而中药内之治此症药品，则极简单子和数味，此数味，不知几经试验若千年，而始得之，不可忽视也。其效力之大，起死回生，参看医验真有研究之价值，但历经试验，若于此数味之中药外，加减太多，或太减轻其用量，则仍无效，此点更有研讨之趣味，故此数味中药，真可定为奉症之标准方矣，原方列后，不可加减用时不可随意更改药味。
大台参八钱，炙黄芪八钱，当归身一两，柏子仁四钱，炒枣仁四钱，龙眼肉四钱，炙甘草四钱。煎妥冲入黄酒少许，（约三瓦）。此药煎一大杯，一日三次分服。或不用黄酒亦可。
（医验）蔡夫人，住德县南关柴市街，年七十馀岁。此症系病家转挽余友徐仲甫先生及石君，延余治疗。当时诊得左手现代脉，右手脉细小，亦三五至一止，询其痛苦，病者下能言。伊子蔡君，则声称不过感冒之小恙而已，然详细诊察，毫无感冒症状，又无表热征兆，洵其不能起床，则已数旬，且衰弱现象毕具，绝非外感，参以脉象，非常危险乃断定为心脏衰弱之重症，处方如下（中医诊术，望闻向切之问字，遇此种场合，最感困难，学者注意）。
第一方，台党参六钱，炙黄芪六钱，当归身八钱，柏子仁三钱，炒枣仁三钱，龙眼肉三钱，土炒白术四钱，炙甘草一钱。煎妥一杯，冲入黄酒少许，一日三次分服。
服前方三剂大效，病者渐进饮食，又复延诊，脉象稍有起色，但仍现结代，精神略佳。古稀老人，心脏衰弱，药虽对症，不能骤见大效，然服药数剂，即能得此效验，足证此病尚可挽回，乃照前方，加减治之。
第二方，土炒白木四钱，大台参八钱，炙黄芪八钱，当归身八钱，柏子仁四钱，炒枣仁四钱，龙眼肉三钱，炒白芍二钱，炙甘草一钱。煎妥一杯，冲入黄酒少许，照前法服。前方约服十馀剂，完全治愈，嘱其断药方法，以次递减，不可骤然停药，约月馀，渐渐止药。嘱其每觉心内忐忑，仍照原方煎服一、二剂，平时每隔一、二月，服西药威古龙丸一、二粒，此药不可滥用，往往诱起吐血，惟不可按时常服。此症治愈后，蔡君在喧哗角街设宴酬医，深致感谢之意。余窃以为既系自觉感冒小恙，何必转托友延余诊治，既已治愈，若自以为感冒小声，又何必盛筵致谢，过分感激。后乃微闻此症，实已病危，前医业经辞谢不治，并告伊家病重，嘱其预备后事，余适于此时，由湘旋里，余友恐告知病重，余有难色，故将病情隐去，幸余尚能诊断确认，否则几何不致错认小恙，贻误人命耶！后见病者所服前医之方，所用药品，亦多治此病之对症良药，但药味太多，药量太轻，且有兼顾胃口等药，天王补心丹加减是以药性不纯，功效不著耳。余之此方，不可任意加减，服法亦宜注意叮咛相告，愿读者信余言也。
My second son, Han Guo, was physically strong and twenty years old. He had a history of constipation and excessive gastric acid causing acid regurgitation. He did not habitually chew his food thoroughly. Occasionally, due to travel, improper diet, and overexertion, he suffered from severe stomach pain, feeling as if something were squeezing inside his stomach, followed by violent vomiting, after which the symptoms subsided. I diagnosed this as an impending gastric ulcer. I then took him to a large hospital in West City, hoping they would examine his gastric juice for detailed diagnosis to corroborate my findings. However, the doctor at that hospital merely asked a few questions during the special consultation and dismissed it hastily. When I asked what the disease was, he acted out of temper and retorted, "Where did you graduate? What do you think the disease is?" After I answered truthfully, he angrily replied, "It is simply biliary colic." Although my talent is shallow and learning sparse, I should not have made such a gross error in distinguishing between biliary colic and stomach pain. Reluctantly, I admitted him to the Union Hospital. After examination by Dr. Yan Ze and Dr. Lin Heluo, it was diagnosed as a gastric ulcer. They prescribed a mild laxative, and he was cured in about one week. Since then, he frequently experienced excessive gastric acid, constipation, and stomach pain, which resolved quickly with mild laxatives. One night, his stomach pain suddenly intensified, accompanied by significant hematemesis (vomiting blood) and even more melena (black stools). Knowing that the gastric ulcer had ruptured, I treated him with Western medicine, instructed him to rest quietly, and strictly prohibited solid food, providing only thin soup for about two weeks. The prescription was as follows:
First Prescription: Artificial Gars Salt 25.0 fen, two packets. Take one packet dissolved in boiled water every morning upon waking.
Second Prescription: Sodium Bicarbonate (Zhongcao) 8.0, Magnesium Sulfate (Cixiaocang) 6.0, Phenobarbital (Feiwosiyue) 0.3 (divided into six packets). Take three packets daily before meals, washed down with boiled water.
Third Prescription: Morphine Hydrochloride (Yanmo) 0.001, Lactose approximately 0.5 per packet. Six packets provided. Take one packet when in pain; do not use if pain-free.
This condition was cured using these three prescriptions. During the episode of massive hematemesis, the situation was critical, and although he fainted, the diagnosis of gastric ulcer was certain, so strict bed rest was essential. For about three weeks, since the patient could not tolerate milk, his diet consisted of rice soup, thin starch paste, and steamed egg custard (eggs beaten with a bowl of water and steamed until tofu-like consistency), which are thin liquid foods. For about three weeks, he took the First Prescription every morning, and divided the Second Prescription into three doses throughout the day. After about one week, since the stomach pain had ceased, Phenobarbital was removed from the Second Prescription. The Third Prescription was used only on the first two days of hematemesis because the pain was severe; it was discontinued thereafter. However, the First and Second Prescriptions were taken daily without interruption for about four weeks. After the second week, he was able to get up and eat easily digestible foods. This case was thus cured with Western medicines. Rhubarb (Dahuang) in Traditional Chinese Medicine has irritant properties and must absolutely not be used.
Mr. Jiang lived at No. 13 Daguaobang Hutong, Xisi Paifang, Beijing. He was nineteen years old and had suffered from gastrointestinal disease for over a year. He reported abdominal pain. After treatment by various TCM and Western doctors, as well as acupuncturists, his condition became critical in April of the 26th Year of the Republic of China. I examined him and found his complexion pale and his body emaciated. He complained of severe stomach pain, persistent vomiting, and inability to defecate even with laxatives. Consequently, he suffered only from vomiting and pain, could not eat, and was so weak he could hardly stand. He mentioned a previous episode of massive black stool while undergoing acupuncture. He had been receiving acupuncture for dozens of days. By now, both TCM and Western doctors had refused treatment. I immediately diagnosed a gastric ulcer without doubt. I initially prescribed Artificial Salt 15.0, but it was ineffective. Then I prescribed Epsom Salts (Liuku) 20.0, also ineffective. Then I gave Calomel tablets, six pieces, each containing 0.2, taken in three doses, still no bowel movement. Finally, I administered Cascara Sagrada (Lakaxi Tuor) two tablets. After taking them, he passed extremely dry feces, followed by two episodes of watery diarrhea. I then prescribed Opium Tincture, instructing him to take five drops every half hour for a day and night. His pain decreased sharply, vomiting stopped, and he could drink a little milk. His family was amazed. Subsequently, I prescribed Sodium Bicarbonate and Magnesium Sulfate (the previous Second Prescription minus Phenobarbital), instructing him to take it three times daily, along with Artificial Salt (the previous First Prescription) every morning. He passed stool smoothly. After about three weeks, he was largely recovered. However, the patient had an opium addiction and poor dietary habits, which were major obstacles to treatment. About a year after recovery, he suddenly suffered massive hematemesis and hematochezia (bloody stools), becoming extremely weak and critically ill. He was cured again using the previous methods. If he had not had an opium addiction, he would certainly not have had this second relapse.
Regarding gastric ulcers, diagnosis is relatively easy because the pain is particularly severe during attacks, and all typical gastric symptoms are present, such as acid regurgitation, belching, bloating, constipation, and vomiting. Physicians can easily make a judgment based on these. This explanation omits details on gastric juice and stool examinations, which are relevant to TCM. However, this condition is often confused with simple stomach pain. In stomach pain, palpation is mild; in gastric ulcers, palpation exacerbates the pain. Since the pathological phenomena of these two conditions are similar, such as the aforementioned gastric symptoms, physicians may confuse them at the onset. However, their treatments are not contradictory, referring here to Western medicine. If discussing this condition in TCM, there are distinctions of cold, heat, deficiency, and excess, but I do not adopt TCM theories. If treated with the Western medicines described in this volume, they are effective. Simple stomach pain does not require Magnesium Sulfate. However, for both conditions, using TCM is less accurate and slow-acting than adhering to Western medical advice. I mention this in relation to gastric ulcers. Ordinary patients lack medical common sense and often complain of "heart mouth pain" or "chest pain." Physicians must diagnose carefully in such cases. While confusion between gastric ulcer and stomach pain does not lead to fatal errors in treatment, it is crucial to distinguish gastric diseases from heart diseases, especially angina pectoris (Jiaoxin Zheng), known in TCM as True Heart Pain (Zhenxintong). Otherwise, a single medication error can be immediately dangerous. TCM practitioners are particularly prone to misdiagnosis in such scenarios, so I must explain this in detail. I hope physicians will pay extra attention when encountering such cases.
Stomach pain, such as vomiting, acid regurgitation, postprandial pain, constipation, and bloating, usually presents with all typical gastric symptoms. This is the primary point to note. If there are no general gastric symptoms, but one frequently feels pain in the cardiac region or sudden attacks of pain, commonly called "heart mouth pain" or "chest pain," it is often mistakenly attributed to stomach or heart diseases. Physicians must pay extra attention to differentiate between the two. The differences between these two diseases are explained below:
1. Diseases of the Heart
① Acute Endocarditis: This condition presents with significant high fever and cerebral symptoms. There is only hyperactive palpitations without severe pain, making it easy to distinguish from stomach pain.
② Valvular Heart Disease: This condition involves wheezing, dyspnea, hyperactive palpitations, and gastrointestinal disturbances. Although similar to stomach disease, it presents with Rheumatic pain, making it easy to distinguish from stomach pain. Also, when heart disease is severe, the patient collapses instantly, feeling chaotic, and may occasionally cough up blood or white foam. These instances are numerous, likely due to cardiac circulation disorders affecting pulmonary circulation. However, such coughing and hemoptysis occur only during heart disease attacks. When the heart disease is not active, there is no coughing or hemoptysis, so it naturally does not mix with lung or stomach diseases. This is my empirical observation.
2. Diseases of the Pericardium (referred to as Xinbaoluo in TCM books)
① Pericarditis: Although this causes chest pain, which might seem similar to stomach disease, the pain is dull, not severe. Additionally, this condition involves hyperactive palpitations, aversion to cold, and fever, which are distinctly different from stomach pain, preventing misdiagnosis.
② Pericardial Edema: This condition shows significant serous accumulation in the cardiac region and lacks pain, so it is not confused with stomach pain.
3. Diseases of the Cardiac Substance
① Fatty Heart: This condition has no pain and is not confused with stomach disease.
② Myocarditis: Although this causes cardiac pain, it is always accompanied by high fever and severe neurological symptoms, so it is not confused with stomach pain.
③ Coronary Ariosclerosis: This disease mostly affects people over 40 and is caused by physical overwork, excessive alcohol and smoking, syphilis, or gout. It is a chronic heart disease with symptoms including myocardial weakness, angina pectoris, and intracardiac绞痛 (this point is easily confused with gastric spasm), cardiac asthma, syncope (stomach pain does not have syncope), and rapid or slow heart rate (this condition is easily confused with gastric spasm; attention to other gastric symptoms prevents misdiagnosis).
4. Neurotic Diseases of the Heart
① Neurotic Palpitations: This condition has no pain and is not confused with stomach pain.
② Angina Pectoris (Jiaoxin Zheng), also known as Cardiac Spasm, referred to as True Heart Pain (Zhenxintong) in TCM. This condition is most easily mistaken for gastric spasm. A treatment error leads to immediate death. Physicians must diagnose cautiously. Besides lacking gastric symptoms like acid regurgitation, vomiting, and constipation, the most notable point is that its pain attacks resemble gastric spasms. Therefore, TCM practitioners often misdiagnose this, leading to death within moments. If this condition is treated with TCM digestive, qi-regulating, or heat-clearing herbs, it can stop compensatory mechanisms and lead to death. I have witnessed this personally. After reading Wang Chengkun's case, one knows that there is no dissatisfaction with TCM. In true Western medicine, distinguishing angina from gastric spasm is not difficult once diagnosed. I state this for TCM practitioners. The cause of angina is mostly a rapid decrease in blood volume in the heart, or excessive smoking/alcohol, and other heart diseases. Symptoms include frequent nighttime awakenings, dyspnea, severe cardiac pain, and abnormal distress. The intense pain feels like strangulation, compression, or tearing, indescribable. The pain often radiates to the scapula, neck, and ribs, differing from stomach pain but easily confused with liver/gallbladder/rib pain. Cold hands and feet, pallor, sweating during pain, pulse may stop. Patients feel extreme distress and a sense of extinction. Pain duration varies from seconds to thirty minutes. Triggers include vigorous physical activity, emotional stress, exposure to cold wind, exertion, full meals, and sexual intercourse. Nighttime attacks are common. Except for occasional slight digestive disturbance, there are no other gastric symptoms. Sometimes white foam is vomited and wheezing occurs, leading to misdiagnosis as lung disease, but lung disease never presents with such绞痛. This is a point requiring special attention.
Appendix: Case Record of Mr. Wang Chengkun
Wang Chengkun, 36 years old, lived at No. 25 Hejia Courtyard, South Zhushikou, a plaster merchant. He stated that since youth, any exertion (e.g., carrying water) caused immediate mental chaos, requiring him to lie down, after which he recovered quickly. A thousand months ago, after entering a bathhouse, he felt dyspnea, mental chaos, pain, wheezing, and profuse white foam. Since then, any outing or slight exertion triggered intracardiac pain, like twisting or tearing, worse at night. Notably, there were no gastric symptoms, definitely not stomach pain. He consulted a TCM doctor who diagnosed lung disease due to wheezing. Treatment failed. Another TCM doctor diagnosed spleen/stomach disease and prescribed Baizhu and Baishao. I saw the prescription; after taking these two herbs, his condition worsened. Another doctor injected cardiotonics, slightly reducing symptoms but not curing. Finally, a relative who was also a TCM doctor prescribed a formula containing Huangqin, Zhishi, Chenpi, and Longdancao. I visited him and advised against these herbs, but the patient trusted his relative. He took the medicine at 8 PM. Three hours later, pain intensified. He tried to go to the toilet, stood up, and died suddenly on December 5th, 27th Year of the Republic. This is the case record of angina pectoris, recorded as a warning against quackery killing patients. When pain is most severe, a small amount of Morphine Hydrochloride can relieve pain, but the most effective treatment is to refer to the Zhenchong disease ointment in this volume.
Zhenchong (4)
Zhenchong refers to severe heart disease without fever in chronic illness. Palpitations occurring in febrile diseases are not included here.
(Causes) The causes of this condition are essentially cardiac weakness. The most common cases are among elderly, weakened individuals, after massive hemorrhage, after severe febrile diseases, long-term severe fright, and masturbation. Alcoholism is another cause; even if the body is not severely weakened, one can gradually develop this condition. Improper treatment often leads to death.
(Symptoms) Sensation of restless beating in the cardiac region. In mild cases, occasional palpitations are ignored. As the condition worsens, every few minutes, or during temporary respiratory arrest, the heart trembles violently, like bubbling water stopping and restarting. The patient feels uneasy, gradually develops insomnia, dyspnea, and facial edema. Any thought or conversation causes mental chaos. Even when alone, the patient feels internal turmoil and misery, unable to express the inner sorrow. Eventually, sudden palpitations lead to sudden death. My friends Zheng Ru and Mu Songxuan both died of this condition. Both were alcoholics. When I returned home, I inquired about their dying states, hence I know this.
(Treatment) The only effective Western treatment for this condition is cardiotonics. However, the fundamental treatment is the TCM method of greatly tonifying Qi and Blood. I compared Western drugs like Digitalis, Camphoric Acid, Strychnine, and other iron/strength tonics, and found that Western drugs provide temporary relief, but symptoms recur upon discontinuation. Moreover, Digitalis has an accumulative effect and is unsuitable for long-term use. TCM remedies for this condition are very simple, consisting of just a few herbs. These few herbs, tested over thousands of years, cannot be ignored. Their efficacy is great, capable of reviving the dead. Refer to the medical verification for research value. However, extensive trials show that adding too many herbs or significantly reducing dosages outside these few makes them ineffective. This point is worthy of study. Thus, these few TCM herbs can be defined as the standard formula for this condition. The original formula is listed below; do not add or subtract ingredients, and do not change herbs arbitrarily.
Da Taishen (Codonopsis) 8 qian, Zhi Huangqi (Astragalus) 8 qian, Danggui Shen (Angelica Sinensis root body) 1 liang, Baizi Ren (Biota Seed) 4 qian, Chao Zaoren (Processed Jujube Seed) 4 qian, Longyan Rou (Longan Aril) 4 qian, Zhi Gancao (Licorice) 4 qian. Decoct and add a little yellow wine (about 3 wa). Decoct a large cup, take three times daily. Yellow wine is optional.
(Medical Verification) Mrs. Cai, lived at Chaishi Street, South Gate, De County, over 70 years old. Her family asked my friend Mr. Xu Zhongfu and Mr. Shi to invite me for treatment. Pulse diagnosis: Left hand modern pulse, right hand pulse fine and small, stopping every three to five beats. Asking about her suffering, she could not speak. Her son, Mr. Cai, claimed it was merely a minor cold. However, detailed examination showed no cold symptoms or exterior heat signs. She had been unable to rise for weeks, showing complete weakness, definitely not an external contraction. Combined with the pulse, it was very dangerous. I diagnosed severe cardiac weakness. Prescription as follows (TCM diagnosis, observing, listening/smelling, asking, and palpating; asking is most difficult in such cases, students should note):
First Prescription: Tai Dangshen (Codonopsis) 6 qian, Zhi Huangqi (Astragalus) 6 qian, Danggui Shen (Angelica Sinensis root body) 8 qian, Baizi Ren (Biota Seed) 3 qian, Chao Zaoren (Processed Jujube Seed) 3 qian, Longyan Rou (Longan Aril) 3 qian, Tu Chao Baizhu (Earth-fried Atractylodes) 4 qian, Zhi Gancao (Licorice) 1 qian. Decoct one cup, add a little yellow wine, take three times daily.
After three doses of the above prescription, there was a great effect. The patient gradually resumed eating. I consulted again; the pulse improved slightly but still showed knotted and intermittent characteristics. Spirit was slightly better. An octogenarian with cardiac weakness, although the medicine was correct, great effects cannot be seen immediately. However, getting such results after a few doses proves the disease is reversible. I continued treating according to the previous prescription with modifications.
Second Prescription: Tu Chao Baizhu (Earth-fried Atractylodes) 4 qian, Da Taishen (Codonopsis) 8 qian, Zhi Huangqi (Astragalus) 8 qian, Danggui Shen (Angelica Sinensis root body) 8 qian, Baizi Ren (Biota Seed) 4 qian, Chao Zaoren (Processed Jujube Seed) 4 qian, Longyan Rou (Longan Aril) 3 qian, Chao Baishao (Processed White Peony Root) 2 qian, Zhi Gancao (Licorice) 1 qian. Decoct one cup, add a little yellow wine, take as before. After about ten-plus doses of the previous prescription, she was completely cured. I instructed her to taper off the medicine gradually, not to stop abruptly. After about a month, she slowly stopped the medicine. I instructed her to take one or two doses of the original formula whenever she felt internal uneasiness. Normally, take one or two pills of Western medicine Wigulong Wan every one or two months. This drug must not be abused as it often induces hematemesis; do not take it regularly. After this condition was cured, Mr. Cai hosted a banquet at Xuanhua Jiao Street to thank the doctors, expressing deep gratitude. I secretly thought, if it was indeed a minor cold, why entrust friends to invite me? Since it was cured, if he considered it a minor cold, why hold a grand banquet and express excessive gratitude? Later, I heard that the condition was actually critical, and previous doctors had refused treatment, telling the family to prepare for the worst. I happened to return from Hunan at this time. My friends feared I would hesitate if told of the severity, so they concealed the病情. Fortunately, I was able to diagnose and confirm. Otherwise, how could we avoid mistaking a minor ailment and delaying life-saving treatment! Later, I saw the previous doctor's prescription and medications, which were also appropriate for this disease. However, there were too many herbs, dosages were too light, and there were herbs targeting the stomach appetite, resembling a modification of Tianwang Buxin Dan. Thus, the medicinal nature was impure, and efficacy was not prominent. My formula should not be arbitrarily modified. Administration instructions should be noted and communicated earnestly. I hope readers trust my words.