西医论炎症有五征，即1．局部发赤，2．肿胀（此肿胀指实症言），3，灼热，4.疼痛，5．官能障碍。由以上二说观之，即可了解有病时疼痛之病理。盖吾人身体，无论何处疼痛，必该处之血行有障碍，血管运动神经受刺激，此为一定不易之理。（此病理非此数字所能说明）故病痛名目虽多，总以此说为最可信，且中西医两说，亦相吻合，故余采此理论。惟中医治疼痛，大纲细分为寒、热、虚、实，又细别为气、血、风、湿、积聚、内痈、（外科从略）症瘕、蛔蛲、疝痹、痧胀，中恶等类。其治法串分温补、泻下、宣通、顺气、消导、祛风、祛湿、杀虫、破瘀诸法。与西药之消炎（泻药）、麻醉等法（除外科手术，相比较，似觉灵活。兹将疼痛证治，举其概要如下：1．实痛此种疼痛，新得之病居多。例如伤寒初起之头痛、腰痛、骨节痛。（此必恶寒，宜用发汗药，散其表邪）温病初起之头痛、骨节痛。（宜于清解药中兼轻散药）热性病之肠炎、大便不通（或泻极臭稀粪之类）。或虫积、食积，血瘀气滞之胃痛，腹痛、胁痛、（宜泻下或杀虫，或舒气，或破瘀消导等药）腰、腿、肩、臂诸痛（此指痛痹而言，宜驱除风湿、活血。），皆属实证。（实痛之中．又分寒热，不可不知。）2．虚痛此种疼痛久病居多（例如心痛痉挛）。且其痛多不甚剧烈；而隐隐常痛（亦有剧烈者，例如心痛），用手按之则减，或痛或止（西医所谓神经性疼痛），且痛多无一定之点（除偏头痛、心痛、皆属虚证。此种疼痛，以西药之麻醉剂为有速效，然中药之效力，则以持续常久胜也。（虚寒虚热，均有疼痛，是宜详审。）血（三）血此血字，在中医多连气血言之，以气血二字，原不能分立也。此血字似不宜列于病理，余欲学者特别注意，且余对血证实验亦特别有心得，故录于此。西医言病理，对于血之变态，则专注重于有形，其说之大概约分四种：①动脉性充血，即由于身体内一部分血管运动神经作用障碍，或由于血管壁之弛缓，而起之充血，此种充血，多为一时性，与原因共消长。例如因长途步行，致令腿肿；因忿怒忧愁，致诱起脑充血是也。
②静脉性充血（即瘀血），一由于心脏衰弱，二由于静脉管闭塞狭窄或压迫。例如经闭肝郁等症，均属之。
⑧贫血，即中医所称之血虚血亏之类是也。
④出血，此则大分之为二种，一外出血，一内出血。例如咯血、吐血、衄血、尿血、便血（外出血）及脑膜睦等出血（内出血）均属之。
吾人治疗血病，非常困难，中医方法，治血药中，必兼顺气（或补气）之品，此理非简单数语可以说明，兹故从略。今将余所经验，极有效之方论列下，以供参考。
①吐血及咯血，此症分为胃及肺二经之病，诊断时必须详审。大凡胃吐血，以前必有胃病征象，例如胃脘痛、背痛、吞酸、呕吐等，其诱因则多在食后，或食辛热之物，或常大便黑色，或大便干燥，所吐之血，多混有食物而无泡沫，且系多量血液，凡此种种，皆胃吐血也。肺病咯血，更易诊断，大率肺病患者，不可一诊即疑为肺结核。在中医既无细菌学，更不可冒袭新说，妄加推断。故遇肺病咯血，必细心查其病因、病状、脉象，然后随症用药，较西医治法，尚觉活动，于是肺咯血一症，不难治愈。此种论旨，余实确切实验，下知凡几也。盖肺咯血及吐血之症，必有肺疾患之特征，例如咳嗽、胸痛或痰喘，或觉胸内温暖上涌，或先有甜味，其所吐之血，多含泡沫，凡此种种，皆肺出血也。中医治法，凡胃病多吏通利，的是正规，然当大吐血时，往往以中药和平，缓不济急，此时自以西药止血为宜（例如麦角剂）。若系胃溃疡之吐血（此症以前胃部必有大痛），中药治疗实不如西药，可以根本治愈。（如次硝酸养铅、重曹、人工盐等，可参阅医验。）至若肺病之咯血，余曾历试西药止血剂，非无大效，然实不如中药之白芍为效验确实而永久，（参看医验）若再佐以理肺、滋阴、健脾之中药，治疗肺结核，实有惊人之效验，此非臆断，实有确验也。（参看医验）于此而有极应注意之一点，即凡遇咯血，万不可一律认为肺痨病。以余之经验，实有内有郁热，而致咯血者，大剂凉药（例如黄芩、栀子、天花粉、白茅根等）竟能治愈之。此虽例外，录此亦足以知此症之变化，不可不慎也。
②其次则为中医之治女子之经闭及血崩二症，根据余之经验，简单说明于下。大率经闭一症，十之八九，治法之有效阶段，分为第一养血，第二行血，第三大攻大破，而最有效者，厥为第三之攻下，治血闭唯一有效之法也。血崩一症（西医名子宫瘤）仅用西药止血多无效，余下病症编说明之，可参阅也，以上血证，寥寥数语，颇嫌简略，然皆确实记录，幸勿忽视。
呕吐（四）呕吐此症病理，姑以虚实二字总括说明之，1，实证呕吐凡热性病（例如伤寒、温病，胃痈、食滞等）之呕吐，皆属实证。（此类多新病不久，然亦有稍久者）其症状率皆（参有其他病状）呕吐之物，或胃脘痛，或吐酸水，胃觉糟杂，饱闷胀满，（胃溃疡之胃痛，每于食物吐出即减轻）此必联合其他症状诊断之（例如由恶寒之表证，渐渐岖吐，则知其邪渐入内，面为小陷胸症也。）不难认定。其治法大率多宜通降，或苦寒之品，（所谓胃以通为补也。）以此种实证呕吐，浅言之即胃内容物腐败，或因肠之消化不良（或因肠热有宿粪，）致胃内容物不能以次下降，因而上越，此种现象，以西药之重曹、泻盐等，从事中和胃酸、清理肠炎，更为釜底抽薪之计。普通呕吐（中毒除外）服此种西药，率可停止。余固粗工，原卑之勿甚高论也（胃之炎症，率分加答儿性、化脓性、义膜性、蜂窝织性，腐蚀性；结核性、霉毒性等症，中医则谓为胃热停滞。）唯有一种温邪逆传之呕吐，非常难治，亦非常危险，此必参看后列温病医验，以芳香逐秽，开窍苦降等法治之，方能起死回生，万不可以小陷胸汤及承气汤等（所谓攻伐无过），误人性命也。
2，虚证呕吐。中医之说，多谓之肝气上冲，或谓之胃阳不足，或连合肝脾二经并说，其理似颇玄虚，然根据此理，用中药治疗，亦实有特效。西医称此症为神经性呕吐，其症状率多无故呕吐，或只吐清水，或偶吐偶止，以上等症，均无其他原因可寻，常年累月，愈吐愈弱，甚或滴水不入，而吐仍不止，至此地步，往往西医之麻醉、洗胃、止呕等方法，不能根治，中药之补阳、顺气、健中、平肝、扬清抑浊等法，反觉妙不可言，能收奇效，此或由于是类之中药，颇能安定呕吐神经欤？；（胃癌一症，中医名噎隔反胃，以早用西医之外科手术为佳，内服药品及注射均无效也。）谵语（五）谵语中医论心神，与西医论脑神经，息息相通，故热必谵语，中医谓之邪入心包络，西医则谓为热度太高，侵；害脑神经，其现象则言语颠倒，精神错乱，其治法，中药则以牛黄，犀角、紫雪丹、至宝丹及承气汤之类为有效，西医则以退热（安基比林等药）、泻下药（或注射药）为有效。更有一种神经衰弱至于极点之病人，亦有谵语（例如将死之时），中医则必大补元气。又有破伤风、脑膜炎、急惊风、产褥热；（产后风）及疮症（血已中毒），亦有谵语，则必急速注射西药各种血清，方能有效，中药不必与也。
神经病：此类疾患，分末梢神经病最常见者，例如颜面神经麻痹（口眼歪斜），肋间神经痛（胁痛），坐骨神经痛（腰痛），振颤麻痹（痿症），神经官能病，神经衰弱症（虚弱），癫痫（羊角疯），偏头痛、狂病（风痰），神经性呕吐（已详前），歇斯的里（脏躁症），眩晕（头晕），神经性心悸亢进（怔忡）麻痹（痹症）等皆属之，此类疾患，率无一定实质，而且发作无常，时愈时病，因其不能有固定之情状，故其治法，西医率用麻醉镇静等药，确实有效（嗅素剂之类。）然此类药品，不可常服，吾人为病家健康计，不得不格外慎审，（防其中毒）。依余之经验，当病状剧烈时，不妨暂以西药（不可用大量），治其现状（或注射），病势稍减，则停止西药，仍以用中药较为和平。盖中药对于以上各症，虽不尽有效，然于偏头痛、呕吐，腰疼、虚弱、眩晕、怔忡等症，有时西药绝不能治者，中药则能大建奇功，其余各症，中药可谓多无灵效，不可不知。
泻（六）泻在肠之病理上，泻之一字。实为常见之病态，此泻症姑以中医之虚实二字说明之。凡实证之泻，大约多在热性病之过程中（此在西医多包括于肠炎类；其危及生命，则多由于肠穿孔，因而诱起腹膜炎<满腹皆肿>所致），其症之来源，或由于热及饮食物之积聚不下，因而诱起腹泻（西医病菌说属之），腹痛或胀或后重（下坠）为一定现象。所泻之物，或极臭之稀屎或水，或红白脓样物（痢疾），重则尽泻似脓血或血水之物（已近穿孔期）则危险至矣（凡泻症皮肤发热者，均较重之症，小便短赤亦必然。）。此症治法，必须参合该症之原病<例如伤寒、温病、痢疾等，皆有泻症。）而施以治疗，大法不外用，泻药，忽速刷清其肠胃之积垢，使其通利（消炎）。中医治此症，则于泻下药中，往往加以甘寒、苦寒、清热、利小便之品，颇为灵妙。然其泻药中，只有大黄、芒硝、瓜蒌等数味，不如西药之种种泻药，各有作用，例如甘汞乃有杀菌性之泻药，对于赤痢，甚为相宜‘此只论药性，不可误解。）依余之经验，对于热性病之泻症，虽系同一治疗目的（泻下），然用泻剂之时期及种类，则颇有分别。大率泻症未作之前（限于伤寒、温病），于相当时期（例如应下之象俱备）例用泻药，以资通利，西医惯用甘汞，然此时甘汞效力，实不如大黄、芒硝，再佐以苦清热（例如黄芩等）、护阴（例如生地等）等药，面面周到，收效亦速。若既经中药汗下之后，内热仍盛，仍泻极臭之稀粪，若再服大黄、芒硝，反致伤胃，不但病者服药困难，而且效验不能如预期之圆满。在此时期，硫苦一味，竟有不可思议之妙用（甘汞绝无大效），此药若在便结之前，绝无大效，而此时用之，则恰当其可，不可轻视、赤痢一症，以用甘汞为最相宜，然当大热、潮热之讨，屡服甘汞，则非所宜（谨防其速发作用，诱起口炎），硫苦、人工盐等，更无济于事。而中药中之白头翁汤（应作重剂，，稍加熟军、丹皮等药（重则用大黄、芒硝，不必迟疑）其效如神。不出三、：五剂，必获大效，实超过于各种西药之上也，此皆历经比较之所得，愿学者遇此场合一斌之（此段专论泻症，若便秘之症用泻药，必须掉换试服，不可拘泥于一种泻剂，大宁西药优于中药，不可不知。）。又大黄对于胃溃疡，绝不可用，以此药刺激性太大，反致诱其速溃。此虽不在于拐症范围以内，兹因论泻剂，故连类及之。（俗称心口疼，多系胃痛，但此症应与绞心症（心痛）鉴别，凡无胃病各症状者（例如吞酸等），即应注意诊断，盖心痛忌泻剂也。）凡虚证之泻，诊断上不难认定，中医因无细菌学，姑不论其病原菌为若何（例如肠结核杆菌等）？兹但就其泻症之病象，加以说明。大凡虚泻多系衰弱久病之人，然以实证日久，屡服苦寒及泻药，渐渐转变为虚泻者亦有之。例如伤寒、温症、疹痢之后，日渐衰弱；消化不良，往往演成虚泻。粗工临症，拘于既往各症多系实热，往往以余热未尽；病后劳复之理想，模棱立方，或则顾虑与个人以前立论处方前后矛盾，明知一误再误，不肯改弦易辙。此辈论症用药，看似不离本题，实则已与奉病大相径庭，此等见解，万不可存。须知病现虚象，即宜补养，症现极虚，即宜峻补，已往之病，尽可抛开，随机应变声为能手以上数语，系指自始认症，抑无错误者而言，非学问经验兼富者不能。若诊断不确，用药忽泻忽补，忽凉忽热，则是毫无知识，何足云医。
四十年前，余曾治一秦妪，初病本系霍乱（系另医诊治），数十日后，（已成虚证），余临诊时，已通体皆凉，脉停汗出，急以大剂参、芪、桂、附，大补元阳，竟得回生。继续服药至十余日，又现虚热象，结果又以生地、寸冬等滋阴药而治愈。设当危急之时，仍用治霍乱之方，而不用大热之药，则无以回将散之元阳，其后若见阴虚，仍再继续用温补，必致津液日涸，仍不免于死亡。此症演进凡三变，而症状各相反，医者若存顾全自己论症，始终丫致，不相矛盾之私见，表面上用药及治法，一贯无误，然此症必无生理。书云，医者意也，其是之谓乎此秦姓住德州柴市街略南，为秦德纯君之家族，记得介绍余者，友张松泉、徐仲甫两先生也。
西医认为炎症有五个征象，即：1．局部发红，2．肿胀（这里的肿胀指实证而言），3．灼热，4．疼痛，5．功能障碍。从以上两种说法来看，就可以了解生病时疼痛的病理机制。大概我们身体，无论何处疼痛，必定该处的血液循环有障碍，血管运动神经受到刺激，这是一定不变的真理。（这种病理不是这几句话所能完全说明的）所以病痛名目虽然多，总以这个说法最为可信，而且中西医两家的说法，也相互吻合，所以我采用这个理论。只是中医治疗疼痛，大纲细分为寒、热、虚、实，又进一步细分为气、血、风、湿、积聚、内痈（外科方面省略）、症瘕、蛔蛲、疝痹、痧胀、中恶等类别。其治疗方法大致分为温补、泻下、宣通、顺气、消导、祛风、祛湿、杀虫、破瘀等方法。与西药的消炎（使用泻药）、麻醉等方法相比（除外科手术外），似乎更加灵活。现将疼痛证治，举其概要如下：
1．实痛 这种疼痛，新得的病居多。例如伤寒初起时的头痛、腰痛、骨节痛。（这一定伴有恶寒，宜用发汗药，疏散表邪）温病初起时的头痛、骨节痛。（宜在清解药中兼用轻散药）热性病引起的肠炎、大便不通（或者泻下极臭的稀粪之类）。或者是虫积、食积，血瘀气滞引起的胃痛、腹痛、胁痛，（宜用泻下药或杀虫药，或舒气药，或破瘀消导等药）腰、腿、肩、臂诸痛（这里指痛痹而言，宜驱除风湿、活血）。这些都属实证。（实痛之中，又分寒证和热证，不可不知道。）
2．虚痛 这种疼痛久病的居多（例如心痛痉挛）。而且其疼痛多不剧烈；而是隐隐常痛（也有剧烈的，例如心痛），用手按压则减轻，有时痛有时止（西医所谓神经性疼痛），而且疼痛多没有固定的点（除了偏头痛、心痛之外，皆属虚证。这种疼痛，以西药的麻醉剂为有速效，然而中药的效力，则以持续长久取胜。虚寒和虚热，均有疼痛，应当详细审察。）
（三）血 这个“血”字，在中医里多连“气血”一起说，因为“气血”二字，原本就不能分立。这个“血”字似乎不宜列于病理部分，但我希望学者特别注意，且我对血证的实验也有特别的心得，所以记录于此。西医谈论病理，对于血的变态，则专门注重于有形之变，其说法的大概约分为四种：①动脉性充血，即由于身体内一部分血管运动神经作用障碍，或由于血管壁松弛，而引起的充血，这种充血，多为一时性的，随原因消失而消退。例如因长途步行，导致腿肿；因愤怒忧愁，导致脑充血是也。
②静脉性充血（即瘀血），一是由于心脏衰弱，二是由于静脉管闭塞狭窄或压迫。例如经闭、肝郁等症，都属于此类。
③贫血，即中医所称的血虚、血亏之类是也。
④出血，这则大体分为二种，一为外出血，一为内出血。例如咯血、吐血、衄血、尿血、便血（外出血）及脑膜等出血（内出血）都属于此类。
我们治疗血病，非常困难，中医方法，在治疗血的药物中，必须兼用顺气（或补气）的药物，这个道理不是简单几句话可以说明的，所以此处从略。现在将我经验中极其有效的方论罗列如下，以供参考。
①吐血及咯血，此症分为胃及肺两个经络的病，诊断时必须详细审察。大凡胃吐血，以前必有胃病的征象，例如胃脘痛、背痛、吞酸、呕吐等，其诱因多在食后，或食用辛热之物，或经常大便黑色，或大便干燥，所吐出的血，多混有食物而无泡沫，且是多量血液，凡此种种，都是胃吐血。肺病咯血，更容易诊断，大率肺病患者，不可一诊就怀疑为肺结核。在中医既没有细菌学，更不可冒然袭用新说，妄加推断。所以遇到肺病咯血，必须细心查其病因、病状、脉象，然后随症用药，较西医治法，尚觉灵活，于是肺咯血一症，不难治愈。这种论点，我确实经过实验，不知有多少次了。大概肺咯血及吐血的症，必有肺疾患的特征，例如咳嗽、胸痛或痰喘，或觉得胸内温暖上涌，或先有甜味，其所吐出的血，多含泡沫，凡此种种，都是肺出血。中医治法，凡是胃病多用通利之法，这是正规，然而在大吐血时，往往因为中药平和，缓不济急，此时自然以西药止血为宜（例如麦角剂）。若是胃溃疡的吐血（此症以前胃部必有大痛），中药治疗实在不如西药，可以根本治愈。（如次硝酸铋铅、重曹、人工盐等，可参阅医验。）至于肺病的咯血，我曾历试西药止血剂，并非没有大效，然而实在不如中药的白芍疗效确实而持久，（参看医验）如果再佐以理肺、滋阴、健脾的中药，治疗肺结核，实在有惊人的疗效，这不是臆断，确有确凿验证。（参看医验）于此有一点极应注意，即凡是遇到咯血，万万不可一律认为是肺痨病。以我的经验，实在有内有郁热，而导致咯血的，大剂量凉药（例如黄芩、栀子、天花粉、白茅根等）竟然能治愈它。这虽然是例外，记录在此也足以知道此症的变化，不可不慎。
②其次则是中医治疗女子的经闭及血崩二症，根据我的经验，简单说明如下。大率经闭一症，十之八九，治疗的有效阶段，分为第一养血，第二行血，第三大攻大破，而最有效者，就是第三的攻下，这是治疗血闭唯一有效的方法。血崩一症（西医名为子宫瘤）仅用西药止血多无效，其余病症编入说明中，可参阅。以上血证，寥寥数语，颇嫌简略，但都是确实记录，幸勿忽视。
（四）呕吐 此症的病理，姑且以虚实二字总括说明。1．实证呕吐 凡是热性病（例如伤寒、温病，胃痈、食滞等）的呕吐，都属实证。（这类多是新病不久，但也有稍久的）其症状通常伴有其他病状，呕吐物，或胃脘痛，或吐酸水，胃感觉嘈杂，饱闷胀满，（胃溃疡的胃痛，每于食物吐出即减轻）这必须联合其他症状来诊断（例如由恶寒的表证，渐渐出现呕吐，就知道邪气渐入体内，成为小陷胸汤证）。不难认定。其治法大多宜通降，或用苦寒之品，（所谓胃以通为补也）。以此种实证呕吐，浅言之即胃内容物腐败，或因肠消化不良（或因肠热有宿粪，）导致胃内容物不能依次下降，因而上越，这种现象，以西药的重曹、泻盐等，从事中和胃酸、清理肠炎，更为釜底抽薪之计。普通呕吐（中毒除外）服用此种西药，通常可以停止。我固然粗陋，原不敢高谈阔论（胃的炎症，大致分卡他性、化脓性、伪膜性、蜂窝织炎性、腐蚀性；结核性、霉毒性等症，中医则称为胃热停滞。）唯有一种温邪逆传的呕吐，非常难治，也非常危险，这必须参看后列温病医验，以芳香逐秽，开窍苦降等方法治疗，方能起死回生，万万不可以小陷胸汤及承气汤等（所谓攻伐无过），误人性命。
2．虚证呕吐。中医的说法，多称之为肝气上冲，或称之为胃阳不足，或连合肝脾二经并说，其理似乎颇为玄虚，然而根据此理，用中药治疗，也确实有特效。西医称此症为神经性呕吐，其症状大多无故呕吐，或只吐清水，或偶吐偶止，以上等症，均无其他原因可寻，常年累月，愈吐愈弱，甚至滴水不入，而吐仍不止，到了这种地步，往往西医的麻醉、洗胃、止呕等方法，不能根治，中药的补阳、顺气、健中、平肝、扬清抑浊等方法，反而觉得妙不可言，能收奇效，这或许是由于这类中药，颇能安定呕吐神经欤？；（胃癌一症，中医名为噎隔反胃，以早用西医的外科手术为佳，内服药品及注射均无效也。）
谵语（五）谵语 中医论述心神，与西医论述脑神经，息息相通，所以发热必谵语，中医称之为邪入心包络，西医则谓为热度太高，侵害脑神经，其现象则言语颠倒，精神错乱，其治法，中药则以牛黄、犀角、紫雪丹、至宝丹及承气汤之类为有效，西医则以退热（安基比林等药）、泻下药（或注射药）为有效。更有一种神经衰弱至于极点的病人，亦有谵语（例如将死之时），中医则必大补元气。又有破伤风、脑膜炎、急惊风、产褥热（产后风）及疮症（血已中毒），亦有谵语，则必须急速注射西药各种血清，方能有效，中药不必参与。
神经病：此类疾患，分末梢神经病最常见者，例如颜面神经麻痹（口眼歪斜），肋间神经痛（胁痛），坐骨神经痛（腰痛），震颤麻痹（痿症），神经官能病，神经衰弱症（虚弱），癫痫（羊角疯），偏头痛、狂病（风痰），神经性呕吐（已详前），歇斯底里（脏躁症），眩晕（头晕），神经性心悸亢进（怔忡），麻痹（痹症）等皆属之，此类疾患，大多无一定实质，而且发作无常，时愈时病，因其不能有固定之情状，故其治法，西医大多用麻醉镇静等药，确实有效（溴素剂之类。）然而此类药品，不可常服，我们为病家健康计，不得不格外审慎，（防其中毒）。依我的经验，当病状剧烈时，不妨暂以西药（不可用大量），治其现状（或注射），病势稍减，则停止西药，仍以用中药较为平和。盖中药对于以上各症，虽不尽有效，然而对于偏头痛、呕吐，腰疼、虚弱、眩晕、怔忡等症，有时西药绝不能治者，中药则能大建奇功，其余各症，中药可谓大多无灵效，不可不知。
泻（六）泻 在肠的病理上，泻一字，实为常见之病态，此泻症姑且以中医的虚实二字说明之。凡实证之泻，大约多在热性病的过程中（这在西医多包括于肠炎类；其危及生命，则多由于肠穿孔，因而诱起腹膜炎<满腹皆肿>所致），其症之源，或由于热及饮食物之积聚不下，因而诱起腹泻（西医病菌说属之），腹痛或胀或后重（下坠）为一定现象。所泻之物，或极臭之稀屎或水，或红白脓样物（痢疾），重则尽泻似脓血或血水之物（已近穿孔期）则危险至极（凡泻症皮肤发热者，均属较重之症，小便短赤亦必然。）。此症治法，必须参合该症之原病<例如伤寒、温病、痢疾等，皆有泻症。>而施以治疗，大法不外乎用泻药，迅速刷清其肠胃之积垢，使其通利（消炎）。中医治此症，则在泻下药中，往往加以甘寒、苦寒、清热、利小便之品，颇为灵妙。然而其泻药中，只有大黄、芒硝、瓜蒌等数味，不如西药之种种泻药，各有作用，例如甘汞乃有杀菌性之泻药，对于赤痢，甚为相宜‘此只论药性，不可误解。）依我的经验，对于热性病之泻症，虽系同一治疗目的（泻下），然而用泻剂的时期及种类，则颇有分别。大率泻症未作之前（限于伤寒、温病），于相当时期（例如应下之象俱备）例用泻药，以资通利，西医惯用甘汞，然而此时甘汞效力，实在不如大黄、芒硝，再佐以苦清热（例如黄芩等）、护阴（例如生地等）等药，面面周到，收效亦速。若已经中药汗下之后，内热仍盛，仍泻极臭之稀粪，若再服大黄、芒硝，反致伤胃，不但病者服药困难，而且效验不能如预期之圆满。在此时期，硫苦一味，竟有不可思议之妙用（甘汞绝无大效），此药若在便结之前，绝无大效，而此时用之，则恰当其可，不可轻视。赤痢一症，以用甘汞为最相宜，然而当大热、潮热之时，屡服甘汞，则非所宜（谨防其速发作用，诱起口炎），硫苦、人工盐等，更无济于事。而中药中之白头翁汤（应作重剂，，稍加熟军、丹皮等药（重则用大黄、芒硝，不必迟疑）其效如神。不出三、五剂，必获大效，实在超过于各种西药之上也，此皆历经比较之所得，愿学者遇此场合一试之（此段专论泻症，若便秘之症用泻药，必须掉换试服，不可拘泥于一种泻剂，大体西药优于中药，不可不知。）。又大黄对于胃溃疡，绝不可用，以此药刺激性太大，反致诱其速溃。这虽然不在于泻症范围以内，兹因论泻剂，故连类及之。（俗称心口疼，多系胃痛，但此症应与绞心症（心痛）鉴别，凡无胃病各症状者（例如吞酸等），即应注意诊断，盖心痛忌泻剂也。）凡虚证之泻，诊断上不难认定，中医因无细菌学，姑不论其病原菌为若何（例如肠结核杆菌等）？兹但就其泻症之病象，加以说明。大凡虚泻多系衰弱久病之人，然而以实证日久，屡服苦寒及泻药，渐渐转变为虚泻者亦有之。例如伤寒、温症、疹痢之后，日渐衰弱；消化不良，往往演成虚泻。粗工临症，拘于既往各症多系实热，往往以余热未尽；病后劳复之理想，模棱立方，或则顾虑与个人以前立论处方前后矛盾，明知一误再误，不肯改弦易辙。此辈论症用药，看似不离本题，实则已与奉病大相径庭，此等见解，万万不可存。须知病现虚象，即宜补养，症现极虚，即宜峻补，已往之病，尽可抛开，随机应变方为能手以上数语，系指自始认症，并无错误者而言，非学问经验兼富者不能。若诊断不确，用药忽泻忽补，忽凉忽热，则是毫无知识，何足云医。
四十年前，我曾治疗一位秦姓老妇人，初病本是霍乱（系另医诊治），数十日后，（已成虚证），我临诊时，已通体皆凉，脉停汗出，急以大剂参、芪、桂、附，大补元阳，竟得回生。继续服药至十余日，又现虚热象，结果又以生地、寸冬等滋阴药而治愈。假如当危急之时，仍用治霍乱之方，而不用大热之药，则无以回将散之元阳，其后若见阴虚，仍再继续用温补，必致津液日涸，仍不免于死亡。此症演进凡三变，而症状各相反，医者若存顾全自己论症，始终一致，不相矛盾之私见，表面上用药及治法，一贯无误，然而此症必无生理。书云，医者意也，其是之谓乎此秦姓住德州柴市街略南，为秦德纯君之家族，记得介绍我者，友张松泉、徐仲甫两先生也。
Western medicine posits five signs of inflammation, namely: 1. local redness (erythema), 2. swelling (here referring to excess syndrome), 3. burning heat, 4. pain, 5. functional impairment. From the above two perspectives, one can understand the pathology of pain during illness. Generally, wherever there is pain in our body, there must be an obstruction in blood circulation at that site, and the vasomotor nerves are stimulated; this is an immutable principle. (This pathology cannot be fully explained by these few words.) Therefore, although there are many names for pain, this explanation is the most credible, and the theories of both Chinese and Western medicine coincide. Hence, I adopt this theory. However, in Traditional Chinese Medicine (TCM), the treatment of pain is broadly categorized into Cold, Heat, Deficiency, and Excess, and further subdivided into Qi, Blood, Wind, Dampness, Accumulation, Internal Abscess (surgical aspects omitted), Masses, Roundworms and Pinworms, Hernia and Bi-syndrome, Sha-distension, and Zhong-e (sudden severe illness). The treatment methods generally include Warming and Tonifying, Purgation, Promoting Circulation, Regulating Qi, Digestion-promoting, Expelling Wind, Expelling Dampness, Killing Parasites, and Breaking Stasis. Compared with Western medicines such as anti-inflammatories (laxatives) and anesthetics (excluding surgical operations), TCM appears more flexible. Below is a summary of the diagnosis and treatment of pain:
1. Excess Pain This type of pain mostly arises from newly acquired diseases. For example, headache, lower back pain, and joint pain at the onset of Taiyang Disease (disease of the Taiyang channel). (This must be accompanied by aversion to cold; sweating-inducing herbs should be used to disperse exterior pathogens.) Headache and joint pain at the onset of Warm Disease. (Light dispersing herbs should be added to clearing and resolving formulas.) Enteritis caused by febrile diseases, or constipation (or passage of extremely foul-smelling loose stools). Or stomach pain, abdominal pain, and hypochondriac pain caused by parasitic accumulation, food stagnation, blood stasis, and Qi stagnation. (Purgatives, anthelmintics, Qi-regulating herbs, or blood-breaking and digestion-promoting herbs should be used.) Pain in the waist, legs, shoulders, and arms (referring to painful Bi-syndrome; wind-dampness should be expelled and blood circulation promoted). All these belong to Excess Syndrome. (Among excess pains, one must distinguish between Cold and Heat types.)
2. Deficiency Pain This type of pain mostly arises from chronic illnesses (e.g., cardiac spasms). The pain is usually not severe but rather a constant dull ache (though it can be severe, e.g., cardiac pain); it is relieved by pressure, or comes and goes (neuropathic pain in Western medicine). Moreover, the pain often lacks a fixed location (except for migraine and cardiac pain, all others belong to Deficiency Syndrome). While Western anesthetics provide rapid relief for such pain, the advantage of Chinese herbal medicine lies in its sustained efficacy. Both Deficient-Cold and Deficient-Heat conditions can cause pain, which requires careful examination.
(III) Blood In TCM, "Blood" is often discussed together with "Qi," as they are originally inseparable. Although "Blood" might seem out of place in a pathology section, I wish students to pay special attention to it, as I have particular insights from clinical practice regarding blood disorders. Thus, I record it here. Western pathology focuses mainly on tangible changes in blood, generally categorizing them into four types: ① Arterial hyperemia, caused by dysfunction of vasomotor nerves in a part of the body or relaxation of vessel walls. This hyperemia is usually temporary and subsides with the cause. For example, leg swelling after long-distance walking or cerebral congestion induced by anger and sorrow.
② Venous hyperemia (i.e., Blood Stasis), caused either by heart failure or by occlusion, narrowing, or compression of veins. Conditions such as amenorrhea and Liver Qi Stagnation fall into this category.
③ Anemia, corresponding to Blood Deficiency or Blood Insufficiency in TCM.
④ Hemorrhage, broadly divided into external bleeding (e.g., hemoptysis, hematemesis, epistaxis, hematuria, hematochezia) and internal bleeding (e.g., meningeal hemorrhage).
Treating blood diseases is very difficult. In TCM, herbs for blood disorders must be combined with Qi-regulating (or Qi-tonifying) agents. The rationale is complex and not easily explained in a few words, so it is omitted here. Below are some highly effective formulas based on my experience, provided for reference.
① Hematemesis and Hemoptysis This condition involves diseases of the Stomach and Lung meridians and requires careful diagnosis. For hematemesis originating from the Stomach, there are usually prior signs of stomach disease, such as epigastric pain, back pain, acid regurgitation, and vomiting. Triggers often occur after meals or after consuming spicy and hot foods. Patients may have black stools or dry stools. The vomited blood often contains food particles, lacks foam, and is voluminous. These are characteristics of Stomach hematemesis. Hemoptysis due to Lung disease is easier to diagnose. However, one should not immediately suspect Pulmonary Tuberculosis upon first diagnosis. Since TCM lacks bacteriology, one should not blindly adopt new theories or make rash inferences. When encountering hemoptysis from Lung disease, one must carefully investigate the etiology, symptoms, and pulse before prescribing according to the pattern. This approach is more flexible than Western treatment, making pulmonary hemoptysis relatively easy to cure. I have verified this through extensive practice. Symptoms characteristic of Lung disease in hemoptysis/hematemesis include cough, chest pain, or wheezing/phlegm; a sensation of warmth rising in the chest; or a sweet taste beforehand. The vomited blood often contains foam. These indicate Lung hemorrhage.
In TCM, treating Stomach diseases usually involves promoting free flow, which is orthodox. However, in cases of massive hematemesis, the mild nature of Chinese herbs may be too slow. In such emergencies, Western hemostatics (e.g., ergot preparations) are preferable. For hematemesis due to gastric ulcer (preceded by severe stomach pain), Western medicine offers a fundamental cure (e.g., bismuth subnitrate, sodium bicarbonate, artificial salts; see medical records). Regarding pulmonary hemoptysis, although I have tried Western hemostatics with some effect, White Peony Root (Bai Shao) has proven more reliable and lasting. (See medical records) Combined with herbs that regulate the Lung, nourish Yin, and strengthen the Spleen, the treatment of Pulmonary Tuberculosis yields astonishing results. This is not speculation but verified fact. (See medical records) A crucial point to note is that hemoptysis should never be uniformly diagnosed as Pulmonary Tuberculosis. Based on my experience, some cases of hemoptysis are caused by internal stagnant heat, which can be cured with large doses of cooling herbs (e.g., Scutellaria Root, Gardenia Fruit, Trichosanthes Root, Imperata Rhizome). Although exceptional, recording this illustrates the variability of the condition and warns against negligence.
② Amenorrhea and Metrorrhagia in Women Next, I briefly explain the TCM treatment for amenorrhea and metrorrhagia based on my experience. For amenorrhea, ten out of nine cases follow three stages of effective treatment: first, nourishing Blood; second, moving Blood; third, aggressive purgation/breaking. The most effective method is the third stage—purgation—which is the only effective way to treat blood closure. For metrorrhagia (uterine fibroids in Western medicine), Western hemostatics are often ineffective. Refer to other sections for detailed explanations. The above discussion on blood disorders is brief but accurate; do not overlook it.
(IV) Vomiting The pathology of vomiting can be summarized by Deficiency and Excess. 1. Excess Vomiting Vomiting associated with febrile diseases (e.g., Taiyang Disease, Warm Disease, Gastric Abscess, Food Stagnation) belongs to Excess Syndrome. (These are mostly recent illnesses, though some may persist.) Symptoms typically accompany other signs: vomiting, epigastric pain, sour regurgitation, gastric discomfort, fullness, and bloating. (Gastric ulcer pain often relieves after vomiting food.) Diagnosis must integrate other symptoms (e.g., if aversion to cold progresses to vomiting, it indicates pathogen entering interior, becoming Xiao Xian Xiong Tang syndrome). It is easy to identify. Treatment generally involves promoting descending function or using bitter-cold herbs ("the Stomach benefits from free flow"). Superficially, this type of vomiting results from putrefaction of gastric contents or indigestion in the intestines (due to intestinal heat and retained feces), causing gastric contents to reflux upward. Western treatments like sodium bicarbonate and Epsom salts neutralize gastric acid and clear intestinal inflammation, acting as a root-cause solution. Ordinary vomiting (excluding poisoning) usually stops with these Western drugs. I am a humble practitioner and dare not speak highly of myself. (Gastric inflammation is classified in Western medicine as catarrhal, purulent, pseudomembranous, phlegmonous, corrosive, tuberculous, and fungal types; TCM refers to this as Stomach Heat Stagnation.) However, vomiting caused by reverse transmission of Warm Pathogens is very difficult to treat and dangerous. One must refer to subsequent Warm Disease case studies and use aromatic turbidity-resolving, orifice-opening, and bitter-descending methods to save lives. Using Xiao Xian Xiong Tang or Cheng Qi Tang indiscriminately (under the guise of non-aggressive treatment) can be fatal.
2. Deficiency Vomiting. TCM attributes this to Liver Qi rushing upward, insufficient Stomach Yang, or combined Liver-Spleen meridian issues. The theory seems abstract, yet TCM treatment based on this principle is truly effective. Western medicine calls this neuropathic vomiting. Symptoms include unprovoked vomiting, vomiting only clear water, or intermittent vomiting without other identifiable causes. Over years, the patient becomes weaker, even unable to keep down water, yet vomiting persists. At this stage, Western anesthesia, gastric lavage, and antiemetics often fail to cure. Conversely, TCM methods like tonifying Yang, regulating Qi, strengthening the Middle, calming the Liver, and clearing turbidity yield miraculous effects, likely by stabilizing the vomiting center. (Stomach cancer, known as Yige Fanwei in TCM, is best treated with early Western surgery; internal medication and injections are ineffective.)
Delirium (V) Delirium. TCM's discussion of the Spirit (Shen) and Western discussion of the nervous system are closely related. Fever leads to delirium; TCM calls this "Pathogen entering the Pericardium," while Western medicine attributes it to high temperature damaging brain nerves. Symptoms include incoherent speech and mental confusion. Effective TCM treatments include Realgar, Rhinoceros Horn (now substituted), Zi Xue Dan, Zhi Bao Dan, and Cheng Qi Tang. Western treatments include antipyretics (e.g., Aminopyrine) and laxatives (or injections). Patients with extreme neurasthenia may also exhibit delirium (e.g., near death); TCM requires massive tonification of Yuan Qi. Tetanus, meningitis, acute infantile convulsions, puerperal fever (postpartum wind), and septicemia (blood poisoning) also cause delirium, requiring immediate injection of various Western serums for effectiveness; TCM is not suitable here.
Neurological Diseases: Among these, peripheral neuropathy is most common, including facial nerve paralysis (facial deviation), intercostal neuralgia (hypochondriac pain), sciatica (lower back pain), tremor paralysis (Wei syndrome), psychoneurosis, neurasthenia (weakness), epilepsy (sheep convulsion), migraine, mania (wind-phlegm), neuropathic vomiting (detailed earlier), hysteria (Zang Zao syndrome), vertigo (dizziness), neurogenic palpitations (Zheng Chong), and paralysis (Bi syndrome). These disorders lack fixed organic lesions, have unpredictable attacks, and fluctuate in severity. Western treatment relies on anesthetics and sedatives (e.g., bromides), which are effective but should not be taken long-term due to toxicity risks. For patient health, caution is required. Based on my experience, when symptoms are severe, short-term Western medication (small doses, or injections) can manage the acute phase. Once stabilized, stop Western drugs and switch to TCM, which is milder. Although TCM is not effective for all these conditions, it achieves remarkable results for migraine, vomiting, lower back pain, weakness, vertigo, and palpitations where Western medicine fails. For other conditions, TCM is often ineffective; this must be noted.
Diarrhea (VI) Diarrhea. In intestinal pathology, diarrhea is a common pathological state. I will explain it using TCM concepts of Deficiency and Excess. Excess Diarrhea usually occurs during febrile diseases (included in Western enteritis; life-threatening cases often result from intestinal perforation leading to peritonitis <generalized abdominal swelling>). Etiology includes accumulation of heat and undigested food/drink, triggering diarrhea (attributed to bacterial infection in Western medicine). Abdominal pain, distension, or tenesmus (bearing down) are constant phenomena. Stools may be extremely foul-smelling watery diarrhea, or red-and-white pus-like matter (dysentery). Severe cases involve profuse discharge resembling pus or bloody water (approaching perforation stage), which is extremely dangerous. (Skin fever and scanty dark urine indicate severe cases.) Treatment must address the primary disease (e.g., Taiyang Disease, Warm Disease, Dysentery all present with diarrhea). The general principle is to use purgatives to rapidly clear intestinal accumulations and promote free flow (anti-inflammatory). TCM adds sweet-cold, bitter-cold, heat-clearing, and diuretic herbs to purgatives, which is ingenious. However, TCM purgatives are limited to Rhubarb, Mirabilite, and Trichosanthes Fruit, whereas Western laxatives have diverse actions. For instance, Calomel (Mercurous Chloride) is a bactericidal laxative suitable for bacillary dysentery ('Discussing drug properties only; do not misunderstand.') Based on my experience, although the goal of treating febrile diarrhea is purgation, the timing and type of laxative vary. Before diarrhea starts (limited to Taiyang/Warm Disease), at the appropriate time (when indications for purgation are complete), laxatives are used to promote flow. Western doctors often use Calomel, but at this stage, Rhubarb and Mirabilite are more effective. Combined with bitter heat-clearers (e.g., Scutellaria) and Yin-protectants (e.g., Rehmannia), the effect is comprehensive and rapid. If, after sweating and purging with TCM, internal heat remains and foul loose stools continue, reusing Rhubarb and Mirabilite damages the Stomach, causing difficulty in taking medicine and suboptimal results. At this stage, Magnesium Sulfate (Epsom Salt) has miraculous effects (Calomel is ineffective). If used before constipation, it is useless; now it is perfectly timed. Do not underestimate it. For bacillary dysentery, Calomel is most suitable. However, during high or tidal fever, repeated Calomel use is inadvisable (risk of rapid action causing stomatitis). Magnesium Sulfate and artificial salts are useless. Instead, Bai Tou Weng Tang (Whitehead Powder Decoction) in heavy dosage, slightly modified with cooked Rhubarb and Moutan Bark (or heavy Rhubarb/Mirabilite without hesitation), works miraculously. Within three to five doses, great effects are achieved, surpassing all Western drugs. This is derived from comparative experience; scholars should try this in such situations. (This section discusses diarrhea; for constipation, change laxatives and test; do not stick to one type. Generally, Western drugs are superior to TCM for this purpose; do not ignore this.) Also, Rhubarb is absolutely contraindicated for gastric ulcers due to its strong irritation, which may induce rapid ulceration. Although outside the scope of diarrhea, it is mentioned here due to the discussion of laxatives. (Commonly called "heart mouth pain," mostly stomach pain, but must be distinguished from angina cordis (cardiac pain). If no stomach symptoms (e.g., acid regurgitation) are present, pay attention to diagnosis, as cardiac pain contraindicates purgatives.)
Deficiency Diarrhea is easy to diagnose. Lacking bacteriology, TCM ignores specific pathogens (e.g., tuberculosis bacilli) and describes symptoms. Deficiency diarrhea mostly affects chronically ill, weakened individuals, but can also result from prolonged excess syndromes treated repeatedly with bitter-cold and purgative herbs. For example, gradual weakening after Taiyang Disease, Warm Disease, or dysentery; indigestion often evolves into deficiency diarrhea. Incompetent practitioners, constrained by past diagnoses of excess-heat, often hesitate to change prescriptions due to residual heat or post-illness relapse theories, fearing contradiction with previous treatments. Even knowing they are wrong, they refuse to adapt. Their reasoning seems relevant but deviates significantly from the actual disease. Such views must be abandoned. When deficiency signs appear, tonification is indicated; for extreme deficiency, vigorous tonification is needed. Past diseases should be discarded; adaptability makes a skilled physician. The above remarks apply to correct initial diagnosis; only those rich in learning and experience can achieve this. Uncertain diagnosis with alternating purgation/tonification or cold/heat treatments shows a lack of knowledge and is unworthy of being called medicine.
Forty years ago, I treated an elderly woman surnamed Qin. Initially, she had Cholera (treated by another doctor). After dozens of days, she developed a deficiency syndrome. Upon my consultation, her whole body was cold, pulse was absent, and she was sweating. I urgently prescribed a large dose of Ginseng, Astragalus, Cinnamon Twig, and Aconite Root to massively tonify Yuan Yang, and she recovered. After continuing medication for over ten days, deficiency-heat signs appeared, and she was cured with Yin-nourishing herbs like Rehmannia Root and Ophiopogon Tuber. Had I continued the Cholera formula without hot herbs during the crisis, I could not have restored the dissipating Yuan Yang. Later, if Yin deficiency appeared and I continued warming tonification, fluids would dry up daily, leading inevitably to death. This disease evolved through three changes with opposite symptoms. If a doctor holds the selfish view of maintaining consistency in their own diagnostic theory, ensuring surface-level correctness without contradiction, the patient would certainly die physiologically. The book says, "The physician acts with intent/mind." This applies here. Ms. Qin lived slightly south of Chaishi Street in Dezhou, belonging to the family of Mr. Qin Dechun. I remember being introduced by friends Mr. Zhang Songquan and Mr. Xu Zhongfu.