东山水利同知，借余水利书，余往索出署，突有一人拦舆喊救命，谓我非告状，欲求神丹夺命耳。其家即对公署，因往视病者，死已三日，方欲入棺，而唇目忽动，按其心口尚温，误传余能起死回生，故泥首哀求。余辞之不获，乃绐之曰:余舟中有神丹可救。因随之舟中，与黑神丸二粒，教以水化灌之，非能必其效也。随即归家。后复至山中，其人已生。盖此乃瘀血冲心，厥而不返，黑神丸以陈墨为主，而以消瘀镇心之药佐之，为产后安神定魄去瘀生新之要品。医者苟不预备，一时何以奏效乎?
胎中毒火
南门陈昂发夫人怀娠三月，胎气上逆，舌肿如蛋，色紫黑，粒米不能下，医者束手，延余治。余曰：此胎中有毒火冲心，舌为心苗，故毒聚于舌，肿塞满口，则饮食绝矣。乃用珠黄散及解毒软坚之药，屡涂其舌，肿渐消而纳食;复用清凉通气之方，消息治之。或谓解毒清火，与胎有害。余曰不然。胎气旺甚，愈凉愈安，但热毒伤阴，当滋养其血气耳。乃专服余药，孪生二子。后询其得病之故，乃曾听邪人之言，服不经之药，几至伤生，可为戒也。
烂溪潘开于表弟，其夫人怀娠患痢，昼夜百余次，延余视。余以黄芩汤加减，兼养胎药饮之，利遂减，饮食得进，而每日尚数十次，服药无效。余曰：此不必治，名曰子利，非产后则不愈，但既产，恐有变证耳。病家不信，更延他医，易一方，则利必增剧。始守余言，止服安胎药少许，后生产果甚易，而母气大衰，虚象百出。适余从浙中来，便道过其门，复以产后法消息治之，病痊而利亦止。盖病有不必治而自愈，强求其愈，必反致害，此类甚多，不可不知也。 雄按:此所谓利，即是泄泻。古人名曰利下，非今之痢也。痢疾古名滞下，若胎前久痢不愈，产后其能免乎?
试 胎
余往候族兄龙友，坐谈之际，有老妪惶遽来曰：无救矣。余骇问故，龙友曰：我侄妇产二日不下，稳婆已回绝矣。问:何在?曰：即在前巷。余曰:试往诊之。龙友大喜，即同往。浆水已涸，疲极不能出声，稳婆犹令用力迸下。余曰:无恐，此试胎也。尚未产，勿强之，扶令安卧，一月后始产，产必顺，且生男。稳婆闻之微晒，作不然之态，且曰此何人，说此大话。我收生数十年，从未见有如此而可生者。其家亦半信半疑。余乃处以养血安胎之方，一饮而胎气安和，全无产意。越一月，果生一男，而产极易。众以为神，龙友请申其说。曰:凡胎旺而母有风寒劳碌等感动，则胎坠下如欲生之象，安之即愈。不知而以为真产，强之用力，则胎浆破而胎不能安矣。余诊其胎脉甚旺，而月份未足，故知不产。今已摇动其胎，将来产时必易脱，故知易产。左脉甚旺，故知男胎。此极浅近之理，人自不知耳。
西濠陆炳若夫人，产后感风热，瘀血未尽，医者执产后属虚寒之说，用干姜、熟地治之，且云必无生理，汗出而身热如炭，唇燥舌紫，仍用前药。余是日偶步田间看菜花，近炳若之居，趋迎求诊。余曰:生产血枯火炽，又兼风热，复加以刚燥滋腻之品，益火塞窍，以此死者，我见甚多。非石膏则阳明之盛火不解，遵仲景法，用竹皮、石膏等药。余归而他医至，笑且非之，谓自古无产后用石膏之理。盖生平未见仲景方也。其母素信余，立主服之，一剂而苏。明日炳若复求诊，余曰：更服一剂，病已去矣。无庸易方，如言而愈。医者群以为怪，不知此乃古人定法，惟服姜桂则必死。
苏州顾某继室，产后恶露不出，遂成血臌，医者束手，顾君之兄掌夫，余戚也，延余治之。余曰:此瘀血凝结，非桃仁等所能下，古法有抵当汤，今一时不及备，以唐人法，用肉桂、黄连、人参、大黄、五灵脂成剂，下其瘀血。群医无不大笑，谓寒热补泻并相犯之药合而成方，此怪人也。其家因平日相信，与服。明日，掌夫告余曰：病不可治矣。病者见鬼窃饮所服药，乃大呼曰：我不能食鬼之所吐也，先生可无治矣。余往验之，药本气味最烈之品，尝之与水无二，怪之。仍以前方煎成，亲往饮之，病者不肯饮，以威迫之，惧而饮，是夕下瘀血升余，而腹渐平，思食。余以事暂归，隔日复往，其门首挂榜烧褚，余疑有他故，入门见者皆有喜色，询之，则曰：先生去之夕，病者梦其前夫人怒曰:汝据余之室，夺余之财，虐余之女，余欲伤汝命，今为某所治，余将为大蛇以杀汝，即变为大蛇，大惊而醒，故特延僧修忏耳。盖前夫人以产后血臌亡，病状如一，而医者治不中病，遂致不起。盖一病有一病治法，学不可不博也。
洞庭某妇，产后小腹痛甚，恶露不止，奄奄垂毙。余诊之，曰：恶露如此多，何以其痛反剧?更询其所行之物，又如脓象。余曰:此乃子宫受伤，腐烂成痈也。宜令名手稳婆探之，果然。遂用绵作条，裹入生肌收口之药，而内服解毒消瘀之方，应手而愈。凡产后停瘀，每多外证，如此甚多，不可不知也。
吴超士家憧，已弱冠，随超士往戏馆观戏，因寒热作而先归，夜半呻吟不绝。至明旦往视，则匿于床下，口称群鬼欲杀之，拽出视之，细点如麸。余曰：此恶痘也。色暗紫，急以升麻、羌活、生地等药，煎汤灌之。三日而痘形出，遍体无毫孔，头面结聚重叠，始终用滋养气血之品，不用时下恶药一味。二十余日始结痂，焦黑成片，大如手掌，形如缸爿，剥去之后，非复本来面目，见者俱不相识，可知痘证之必死者绝少，皆医以寒凉克伐之药误之也。
毛履和之女患痘，医者曰:此闷痘也，五日而毙。举家扼腕，适余至，曰：先生亦治痘否?余曰:医者不肯治之痘则治。曰：已回绝矣。因入视，遍体大热，神昏不语，细点如鱼子，隐在肉中，余急以升麻羌活汤为主，而佐以养血透肌药饮之，三日而痘形显，前医群骇，告之以故。则又大笑曰：升麻、羌活等药，岂入痘科。不知升麻汤乃痘证初起之主方，而医者不知也。继以养血解毒补气之品。其结痂也，额如覆釜，身如树皮，发连痂脱，三年始生。时医见此等证，必用大黄、石膏及恶毒之物，虚其里而增其毒，五日而死之言必验。病家亦以为医者断期如神，孰知非其识之高，乃其药之灵也。呜呼惨哉!
余同学沈冠云之女，痘密黑陷而无浆，医者束手，冠云告以故。余曰:姑处以补托之法，用地黄、归身、黄芪、人参等药，闻者咸笑。一服而浆来，至明日以参贵停服。余曰:精力不充，毒发未尽，未尽必生痘毒，后果臂湾生二毒，复为治之而安。
余长孙女种痘，点密而色深赤，种痘之医束手。余用清发之药，并时含紫雪，赤色稍衰，将就寝，复往视，忽变灰白色而咬牙。余惊曰:证变虚寒矣。此所谓亢害承制也。即用人参、鹿茸等药托之，至三鼓而疮色复红，形渐高起，仍用清火养血之方而浆成。盖病变无常，顷刻转易，故凡属危险之证，医者当时时消息，不可片刻离也。但不明理之医，则偏僻固执，又方法绝少，不能肆应不穷耳。
流 注
苏州一小儿，甫九龄，颇聪慧，而患流注，肩背腰胁十余处，百端医治无效。余视之曰：此惟大活络丹能愈。服至三十余丸，未破者消，已破者收口。更服补气血之药而愈。盖流住一证，由风寒入膜所致，膜在皮中，旁通四达，初无定处，所以随处作患，此真脉络之病、故古人制大活络丹以治之。其余煎丸，皆非正治。所谓一病有一病之法，药不对证，总难取效也。
本邑刘近曾夫人，患虚痰流注，色（白光）脉虚，发无定处，病极危险，非旦夕可奏功，余辞不能治。郡中一医以百金包好，因留在家治之。闻余有不能治之说，笑曰：我医好后，更请徐君质之，当无言可对耳。月余，刘君之兄元谷招余诊，近曾出曰：流注之疾，虽向愈而未收口，托在相好，肯一观否?余因视之，肩后疮孔大如钱，内膜干空，与皮不连，气促脉微。诊毕而出，近曾求方，余笑不答，书“危在顷刻”四字。刘不信，少顷内呼，刘父子入，已气绝矣。群执包好之医，欲加以无礼。余晓之曰：此病本不治，非药误也。但不知生死，为无目耳。乃释之。盖流注之证，其类不同，大段皆津液枯而痰流膜内之证，当内外交治，而祛邪补虚，亦另有切病方药，蛮补无益也。
嘉善张卓舟，未弱冠，患流注五年，自胁及腰腿，连生七八孔，寒热不食，仅存人形，历年共服人参二三千金，万无生理。父母先亡，只有慈母，其伯悉收其田产文契，专待其毙而取之。其从兄汪千造余家哀恳，余颇怜之，破格往视，半身几成枯骨，此乃虚痰流注。医者不能治其经络之痰，徒费重赀而无一中病者，则药之误，而非病之真无治也。余用大活络丹为主，而外敷拔管生肌之药。医者闻之大笑曰：活络丹辛暴之药，岂可入口?盖彼惟知俗本所载乌头、蚯蚓之活络丹，而不知古方五十余味之大活络丹也。盖流注之痰，全在于络，故非活络丹不效。以后脓稀肉长，管退筋舒，渐能起立，不二年而肌肉丰肥，强健反逾于常。呜呼!不知对病施药，徒事蛮补，举世尽然，枉死者不知其几也。 雄按:大活络丹治虚痰流注，深为合法，而外科不知也。若实痰，则控涎丹最妙。
长兴朱季舫少子啸虎官，性极聪敏，年九岁，腹痛脚缩，抱膝而卧，背脊突出一疖，昼夜哀号，遍延内外科诊视，或云损证，或云宿食，或云发毒，当刺突出之骨以出脓血。其西席茅岂宿力荐余治，往登其堂，名医满座，岂宿偕余诊视，余曰：此缩脚肠痈也，幸未成脓，四日可消。闻者大笑，时季舫为滦州牧，其夫人孔氏，名族之女，独信余言。余先饮以养血通气之方，并护心丸，痛遂大减，诸医谓偶中耳。明日进消瘀逐毒丸散，谓曰:服此又当微痛，无恐。其夜痛果稍加，诸医闻之哗然，曰:果应我辈之言也。明早又进和营顺气之剂，痛止八九，而脚伸脊平，果四日而能步，诸医以次辞去。中有俞姓者，儒士也，虚心问故。余谓:杂药乱投，气血伤矣。先和其气血，自得稍安，继则攻其所聚之邪，安能无痛，既乃滋养而通利之，则脏腑俱安矣。
南濠徐氏女，经停数月，寒热减食，肌肉消烁，小腹之右，下达环跳，隐痛微肿。医者或作怯弱，或作血痹，俱云不治。余诊其脉，洪数而滑，寒热无次。谓其父曰:此瘀血为痈，已成脓矣。必自破，破后必有变证，宜急治。与以外科托毒方并丸散，即返山中。越二日，天未明，叩门甚急，启视则徐之戚也。云脓已大溃，而人将脱矣。即登其舟往视，脓出升余，脉微肤冷，阳随阴脱。余不及处方，急以参附二味，煎汤灌之，气渐续而身渐温。然后以补血养气之品，兼托脓长肉之药，内外兼治，两月而漏口方满，精神渐复，月事以时。大凡瘀血久留，必致成痈。产后留瘀，及室女停经，外证极多。而医者俱不能知，至脓成之后，方觅外科施治，而外科又不得其法，以致枉死者，比比然也。
横泾钱某之女，素有痞块，从腹入少腹，又从少腹入环跳之下，大腿外臁，变成大痈，脓水淋漓成管，管中有饭粒流出，真不可解，日渐狼狈，诸医束手。其父泣而告余曰：寒俭之家，服人参已费百金，而毫无效验，惟有立而视其死耳。余曰：人参不可长继，祛脓填漏，外科自有正方也。乃为合治漏之药，内服外敷，所服末药，亦有从疮口流出者，继乃渐少，胃气亦开，肌肉内生，数月之后，痂结筋舒。前此从未生育，期年怀孕生子。凡治病各有对证方药，非可以泛治之方，图侥幸也。
长兴周某之子，臂生疽，经年脓水不干，变为多骨。所食米粒，间有从疽中出者，奄奄待毙。余为内托外敷，所服末药，亦从疮口出，继而脓渐减少，所出碎骨，皆脓结成，出尽之后，肌肉日长，口收痂结而愈。
郡中朱姓患项疽，大痛彻心，时时出血。延医施治，漫肿滋甚，神思昏迷，束手待毙，延余视。急用围药裹住根盘，敷以止血散，饮以护心丸，痛缓血止，神安得寝。明日前医来，告以故。医谓同一金黄散，我用无效，彼用神验，此命运不同，非药异也。彼盖不知围药每病各殊耳。疮口已定，乃大托其脓，兼以消痰开胃之品，饮食渐进，坐卧皆安，两月而愈。凡治痈疽之法，在视其人之肥瘠，瘦弱之躯，尤忌见血。疮口若大，则肌肉难生，所以最重围药。其方甚多，不可不广求而预备也。
同学沈自求，丧子，优愁郁结，疽发于项，调治无效。项三倍疮口，环颈长尺余，阔三寸，惟近咽喉处二寸未连，而枕骨直下之筋未断，血流不止。余辞不治，坚恳不已。先进护心丸二粒，令毒不内攻。又付止血散止其血，外用围药厚涂束其根，更以珠黄等药，时时敷疮口上，其膏药长一尺三寸，再以黄芪四两煎汤，煎药服之。势定而饮食稍进，数日血止脓成，肌与腐肉，方有界限。疮口太大，皮肉不能合，以生肌等药，并参末厚涂而封之，月余口乃合。病家欲备人参斤许以待用，余曰：无庸也。诸痛痒疮，皆属于火;脓流肉腐，皆伤于阴。凡属外证，总以清火养阴为主而加开胃健脾之药，人参止用钱许，数剂即止，此从古一定之法。其用温补，乃后世讹传之术，无不阴受其害。余凡治大证，无不神效，时人多不之信也。
【背景信息】
书名：洄溪医案 章节：正文(5/6) 类别：医论
东山水利同知（官职名），向我借阅水利方面的书籍，我前往他的办公地点去取书。突然有一个人拦住我的轿子喊救命，说我不是来告状的，而是想求您用神丹妙药让他起死回生。他家就在官府对面，于是我前去查看病人。病人已经死了三天，正准备入殓，但嘴唇和眼睛忽然动了一下，按摸心口部位还有余温。人们误传我能起死回生，所以他磕头哀求。我推辞不掉，便骗他说：“我的船里有神丹可以救人。”于是跟着他上了船，给他两粒黑神丸，教他用温水化开灌下去，这并不能保证一定有效。随后我便回家。后来我又进山时，发现那个人还活着。原来这是瘀血上冲心脏，导致厥逆昏迷不醒。黑神丸以陈年墨汁为主药，配合消除瘀血、镇心安神的药物，是产后安神定魄、去除瘀血、生成新血的要药。医生如果不预先准备这些药物，一时之间怎么能奏效呢？
胎中毒火
南门陈昂发的夫人怀孕三个月，胎气上逆，舌头肿胀像鸡蛋一样大，颜色紫黑，一粒米都吃不下，医生们束手无策，请我去诊治。我说：“这是胎中有毒火冲撞心脏，舌为心之苗窍，所以毒邪聚集在舌头上，肿胀堵塞满口，导致饮食断绝。”于是使用珠黄散以及解毒软坚的药物，多次涂抹在舌头上，肿胀逐渐消退，开始进食；又改用清凉通气的方剂，根据病情变化调理治疗。有人说道：“解毒清火会对胎儿有害。”我说：“不对。胎气旺盛，越凉快越安稳，只是热毒伤了阴液，应当滋养其血气罢了。”于是她专门服用我的药，结果生下了双胞胎儿子。后来询问她得病的原因，是因为曾听信邪门歪道之言，服用了不合常理的药物，差点丧命，可以作为警戒。
烂溪潘开于的表弟媳，怀孕时患了痢疾，白天黑夜拉了一百多次，请我去看。我用黄芩汤加减，兼用养胎药给她喝，腹泻减少了，也能吃东西了，但每天还是几十次，服药无效。我说：“这个病不必特意去治，名叫子利，不是生完孩子就不会好，但既然生了孩子，恐怕会有变证。”病家不信，又请其他医生，换了个方子，结果腹泻必定加重。这才听从我的话，只服少许安胎药，后来生产果然很顺利，但母亲元气大衰，虚象百出。正好我从浙江回来，顺路经过她家门口，便再用产后法调理治疗，病好了，腹泻也停止了。大概疾病有不必治疗而自愈的情况，强行求愈，反而会导致危害，这类情况很多，不可不知道啊。
徐灵胎按语：这里所说的“利”，就是泄泻。古人称之为“利下”，不是现在的痢疾。痢疾古名“滞下”，如果胎前久痢不愈，产后难道能避免吗？
我去探望族兄龙友，坐谈之际，有个老妇人惊慌失措地跑来喊道：“没救了。”我很惊讶地问怎么回事，龙友说：“我侄妇产后两天孩子还没下来，稳婆（接生婆）已经回去拒绝接生了。”我问：“在哪里？”回答说：“就在前面的巷子里。”我说：“试着去诊察一下。”龙友非常高兴，就一同前往。羊水已经流干，产妇极度疲劳不能出声，稳婆还让她用力把孩子逼出来。我说：“不要怕，这是试胎（假临产）。还没有真正分娩，不要强迫她，扶着她安静躺下，一个月后才会分娩，分娩会顺利，而且生的是男孩。”稳婆听到后微微嘲笑，摆出不以为然的样子，并且说：“这是什么人，说这种大话。我接生几十年，从未见过这样还能生下来的。”家里人也半信半疑。于是我开了养血安胎的方子，喝了一次后胎气安定平和，完全没有生产的迹象。过了一个月，果然生下一个男孩，而且分娩非常容易。大家都认为是神迹，龙友请求我说明其中的道理。我说：“凡是胎气旺盛，而母亲受到风寒、劳累等影响，就会出现胎坠下如欲生的假象，安抚它就能痊愈。不知道这是假象而以为是真产，强迫用力，就会弄破胎浆，导致胎元不安。”我诊察她的胎脉非常旺盛，但月份未到，所以知道不会分娩。现在已经摇动了胎气，将来分娩时必然容易产出，所以知道易产。左脉非常旺盛，所以知道是男胎。这是极其浅显的道理，人们自己不知道罢了。
西濠陆炳若的夫人，产后感受风热，瘀血未尽，医生坚持认为产后属于虚寒，用干姜、熟地黄治疗，还说肯定没有生机。此时患者汗出且身体热得像炭一样，嘴唇干燥舌头紫绀，仍然使用前一种药物。那天我偶然步行田间看菜花，靠近炳若家，他急忙迎接求诊。我说：“生产导致血枯火炽，又兼感风热，再加上刚燥滋腻的药物，更加助长火势闭塞孔窍，因此死亡的，我见得太多了。不用石膏则阳明经的盛火不解，遵循张仲景的方法，使用竹茹、石膏等药物。”我回家后其他医生到了，笑着非议，说自古以来没有产后用石膏的道理。大概是生平没见过张仲景的方子吧。他的母亲一向信任我，坚决主张服用，一剂药后苏醒。第二天炳若又来求诊，我说：“再服一剂，病就好了。”不需要换方，照做果然痊愈。医生们都觉得很奇怪，不知道这是古人确定的法则，只有服用姜桂类温热药才必死无疑。
苏州顾某的继室，产后恶露不出，遂形成血臌（腹部因瘀血积聚而胀大），医生们束手无策。顾君的哥哥掌夫是我的亲戚，请我去诊治。我说：“这是瘀血凝结，不是桃仁等一般活血药所能攻下的，古法有抵当汤，现在一时来不及准备，用唐代的方法，用肉桂、黄连、人参、大黄、五灵脂组成方剂，攻下瘀血。”众医生无不大笑，说寒热补泻并相犯的药物合在一起成方，真是怪人。因为家属平日信任我，便给病人服用。第二天，掌夫告诉我：“病治不好了。”病人看见鬼魂偷喝所服的药，于是大喊：“我不能吃鬼吐出来的东西，先生您可以不用治了。”我去检查，发现药本来气味最猛烈，尝起来却和水一样，感到奇怪。仍用前方煎好，亲自送去让病人喝，病人不肯喝，用威势逼迫她，害怕之下喝了，当晚排出瘀血一升多，腹部逐渐平复，想吃东西。我因事暂时回家，隔天再去，门口挂着榜文烧纸钱，我怀疑有其他缘故，进门看到的人都有喜色，询问才知道，是我离开那晚，病人梦见前夫人发怒说：“你占据我的房间，抢夺我的财产，虐待我的女儿，我想杀你，现在被某人治疗，我将变成大蛇来杀你。”随即变成大蛇，大惊醒来，所以特地延请僧人修忏超度。原来前夫人也是因产后血臌去世，症状一模一样，而医生治不得法，最终致死。大概一种病有一种病的治法，学问不可不广博啊。
洞庭某妇，产后小腹痛得很厉害，恶露不止，奄奄一息快要死了。我诊察后说：“恶露这么多，为什么疼痛反而加剧？”又询问排出的东西，又像脓液的样子。我说：“这是子宫受伤，腐烂形成痈疽。”应该让有名的稳婆探查一下，果然如此。于是用绵条裹入生肌收口的药物塞入，内服解毒消瘀的方剂，应手而愈。凡是产后停瘀，往往多有外证，像这种情况很多，不可不知道啊。
吴超士家的僮仆，已经成年，跟随吴超士去戏馆看戏，因为寒热发作先回来了，半夜呻吟不停。到第二天早上我去看，他却藏在床底下，嘴里喊着群鬼要杀他，把他拽出来一看，身上细点如麸皮。我说：“这是恶痘。”颜色暗紫，急忙用升麻、羌活、生地等药，煎汤灌下去。三天后痘形发出，遍体没有毛孔，头面部结聚重叠，始终用滋养气血的药物，不用当时流行的那些恶毒药物。二十多天才结痂，焦黑成片，大如手掌，形状像缸片，剥去之后，不再是原来的面目，见到的人都不认识，可知痘证中必然死亡的极少，都是医生用寒凉克伐的药物误害的。
毛履和的女儿患痘，医生说：“这是闷痘，五天会死。”全家扼腕叹息，正好我到了，问：“先生也治痘吗？”我说：“医生不肯治的痘我就治。”回答说：“已经被回绝了。”于是进去查看，遍体大热，神志昏迷不说话，细点如鱼子，隐在肉中，我急忙用升麻羌活汤为主，配合养血透肌的药给她喝，三天后痘形显现，前医们都很震惊，我把原因告诉他们，却又大笑说：“升麻、羌活等药，岂能进入痘科？”不知道升麻汤乃是痘证初起的主方，而医生们却不知道。接着用养血解毒补气的药物。结痂时，额头像倒扣的锅，身体像树皮，头发连着痂脱落，三年才重新长出来。当时的医生见到这种证候，必定用大黄、石膏及恶毒之物，使里气虚弱而增加毒性，说五天会死的话必定应验。病家也以为医生断期如神，谁知道不是他们见识高，而是他们的药灵验呢！唉，太悲惨了！
我同学沈冠云的女儿，痘密黑陷而无浆，医生束手无策，冠云告诉我情况。我说：“暂且用补托的方法，用地黄、当归身、黄芪、人参等药，听到的人都笑了。”一服药后浆液就来，到第二天因为人参贵重而停止服用。我说：“精力不充，毒发未尽，未尽必生痘毒，后果手臂弯处生了两个毒疮，再次治疗才安好。”
我长孙女种痘，点密而颜色深赤，种痘的医生束手无策。我用清发的药物，并时常含服紫雪，赤色稍退，将要睡觉时，我又去查看，忽然变成灰白色且咬牙。我惊恐地说：“证候变为虚寒了。这就是所谓的亢害承制。”立即用人参、鹿茸等药托举，直到三更天疮色恢复红色，形态逐渐高起，仍用清火养血的方剂而成浆。大概病变无常，顷刻间转变，所以凡是属于危险的证候，医生必须时时斟酌处理，不可片刻离开。但不明理的医生，则偏僻固执，方法又少，不能随机应变罢了。
苏州一个小孩，刚九岁，很聪明，但患了流注，肩背腰胁十余处，百般医治无效。我看后说：“只有大活络丹能治愈。”服至三十多丸，未破溃的消散了，已破溃的收口了。再服用补气血的药而痊愈。大概流注这一证，是由风寒侵入膜原所致，膜在皮肤之中，旁通四达，初无固定位置，所以随处发病，这是真正的脉络之病，所以古人制大活络丹来治疗它。其余的煎丸药，都不是正治之法。所谓一病有一病的治法，药不对证，总难取效。
本县刘近曾的夫人，患虚痰流注，面色白光白，脉象虚弱，发病部位不定，病情极危险，不是短时间能见效的，我推辞说不能治。郡里一位医生承诺用百金包治好，于是留在家中治疗。听说我说不能治，笑着说：“我治好后，再请徐君（指作者）来质询，他当无言以对。”一个多月后，刘君的哥哥元谷招我去诊病，近曾说：“流注的病，虽然向愈但未收口，看在交情份上，肯看一眼吗？”我便去查看，肩后的疮孔大如铜钱，内膜干空，与皮肤不相连，气促脉微。诊毕出来，近曾求方，我笑着不回答，写下“危在顷刻”四个字。刘不信，过了一会儿里面呼喊，刘父子进去，已经气绝了。众人抓住包好的医生，想要对他无礼。我劝解他们说：“这病本来不治，不是药误。只是不知生死，如同盲人罢了。”于是放了他。大概流注的证，类别不同，大体都是津液枯竭而痰流注于膜内的证，应当内外兼治，而祛邪补虚，也有切合病情的方药，蛮补是无益的。
嘉善张卓舟，未满二十岁，患流注五年，从胁部到腰腿，连生七八个孔，寒热不吃东西，仅存人形，历年共服人参花费二三千金，万无生理。父母先亡，只有慈母，他的伯父收走了他的田产文契，专等他死而夺取。他的堂兄汪千造到我家哀恳，我很怜悯他，破格前往查看，半身几乎成了枯骨，这是虚痰流注。医生不能治经络之痰，徒费重金而没有一中病的，那是药的误用，而非病真的无法治疗。我用大活络丹为主，外用拔管生肌的药。医生听到后大笑说：“活络丹是辛烈暴烈的药，岂可入口？”大概他们只知道俗本所载乌头、蚯蚓的活络丹，而不知道古方五十余味的大活络丹。大概流注之痰，全在于络，所以非大活络丹不效。以后脓稀肉长，管退筋舒，渐渐能站立，不到两年肌肉丰肥，强健反超过常人。唉！不知道对病施药，徒事蛮补，举世皆然，枉死者不知有多少。徐灵胎按语：大活络丹治虚痰流注，深为合法，而外科医生不知道。若是实痰，则控涎丹最妙。
长兴朱季舫的小儿子啸虎官，性格极聪敏，九岁，腹痛脚缩，抱膝而卧，背脊突出一疖，昼夜哀号，遍延内外科诊视，有人说损证，有人说宿食，有人说发毒，应当刺破突出的骨头以出脓血。他的家庭教师茅岂宿极力推荐我去治，我前往登堂，名医满座，茅岂宿陪我诊视，我说：“这是缩脚肠痈，幸好未成脓，四天可消。”听到的人都大笑，当时季舫任滦州牧，其夫人孔氏，是名门之女，唯独相信我的话。我先喂以养血通气之方，并护心丸，疼痛遂大减，众医生谓我只是偶然中肯。第二天进消瘀逐毒丸散，对他们说：“服此药后又当微痛，不要怕。”那夜疼痛果稍加重，众医生闻之哗然，说：“果然应了我们说的话。”明早又进和营顺气之剂，痛止八九，而脚伸脊平，果然四天能走路，众医生依次辞去。其中有一位姓俞的，是儒士，虚心问我原因。我说：“杂药乱投，气血伤矣。先调和其气血，自然得稍安，继而攻其所聚之邪，安能无痛，既然后滋养而通利之，则脏腑俱安矣。”
南濠徐氏女，月经停数月，寒热减少食欲，肌肉消烁，小腹右侧，下达环跳穴，隐痛微肿。医生有的作怯弱治，有的作血痹治，都说不可治。我诊其脉，洪数而滑，寒热无定时。对其父说：“这是瘀血成痈，已成脓了。必定自破，破后必有变证，宜急治。”给予外科托毒方并丸散，随即返回山中。过了两天，天未亮，敲门很急，打开看则是徐家的亲戚。说脓已大溃，而人将脱阳了。即登上他的船去查看，脓出一升多，脉微肤冷，阳随阴脱。我来不及处方，急忙用参附二味，煎汤灌之，气渐续而身渐温。然后用补血养气之品，兼托脓长肉之药，内外兼治，两个月漏口才满，精神渐复，月事按时来潮。大凡瘀血久留，必致成痈。产后留瘀，及室女停经，外证极多。而医生都不能知，至脓成之后，方觅外科施治，而外科又不得其法，以致枉死者，比比皆是。
横泾钱某的女儿，素有痞块，从腹入少腹，又从少腹入环跳之下，大腿外侧，变成大痈，脓水淋漓成管，管中有饭粒流出，真不可解，日渐狼狈，诸医束手。其父哭着告诉我：“寒俭之家，服人参已费百金，而毫无效验，惟有站着看她死罢了。”我说：“人参不可长期继服，祛脓填漏，外科自有正方也。”于是为她合治漏之药，内服外敷，所服的末药，也有从疮口流出的，继乃渐少，胃气亦开，肌肉内生，数月之后，痂结筋舒。此前从未生育，一年后怀孕生子。凡治病各有对证方药，不可以泛治之方图侥幸。
长兴周某的儿子，臂生疽，经年脓水不干，变为多骨。所食的米粒，间有从疽中出者，奄奄待毙。我为之内托外敷，所服的末药，也从疮口出，继而脓渐减少，所出的碎骨，皆脓结成，出尽之后，肌肉日长，口收痂结而愈。
郡中朱姓患项疽，大痛彻心，时时出血。延医施治，漫肿滋甚，神思昏迷，束手待毙，延我视。急用围药裹住根盘，敷以止血散，饮以护心丸，痛缓血止，神安得寝。第二天前医来，告知情况。医生说同一金黄散，我用无效，彼用神验，这是命运不同，非药异也。他大概不知道围药每病各殊耳。疮口已定，乃大托其脓，兼以消痰开胃之品，饮食渐进，坐卧皆安，两月而愈。凡治痈疽之法，在视其人之肥瘠，瘦弱之躯，尤忌见血。疮口若大，则肌肉难生，所以最重围药。其方甚多，不可不广求而预备也。
同学沈自求，丧子，忧愁郁结，疽发于项，调治无效。项三倍疮口，环颈长尺余，阔三寸，惟近咽喉处二寸未连，而枕骨直下之筋未断，血流不止。我推辞不治，坚恳不已。先进护心丸二粒，令毒不内攻。又付止血散止其血，外用围药厚涂束其根，更以珠黄等药，时时敷疮口上，其膏药长一尺三寸，再以黄芪四两煎汤，煎药服之。势定而饮食稍进，数日血止脓成，肌与腐肉，方有界限。疮口太大，皮肉不能合，以生肌等药，并参末厚涂而封之，月余口乃合。病家欲备人参斤许以待用，我说：“无庸也。诸痛痒疮，皆属于火；脓流肉腐，皆伤于阴。凡属外证，总以清火养阴为主而加开胃健脾之药，人参止用钱许，数剂即止，此从古一定之法。其用温补，乃后世讹传之术，无不阴受其害。我凡治大证，无不神效，时人多不之信也。”
[Background Information]
Book: Huixi Medical Cases Chapter: Main Text (5/6) Category: Medical Treatises
The Director of Water Conservancy at Dongshan borrowed my books on water conservancy. I went to his office to retrieve them when suddenly a man blocked my sedan chair shouting for help, saying he was not there to file a complaint but to beg for a miraculous pill to restore life. His home was directly opposite the government office, so I went to examine the patient. The person had been dead for three days and was about to be placed in the coffin, but their lips and eyes suddenly moved. Palpating the chest area revealed residual warmth. Misinformation spread that I could bring the dead back to life, hence the kneeling plea. Unable to refuse, I deceived him by saying, "I have a miraculous pill in my boat that can save them." I followed him onto the boat, gave him two pills of Heishen Wan (Black Divine Pill), and instructed him to dissolve them in water and administer them orally, noting that efficacy was not guaranteed. I then returned home. Later, upon returning to the mountains, I found the person alive. This case involved blood stasis rushing to the heart, causing jue syndrome (cold extremities and loss of consciousness) without return. Heishen Wan uses aged ink as its main ingredient, assisted by herbs that resolve stasis and calm the heart spirit. It is a crucial preparation for calming the spirit, stabilizing the soul, removing blood stasis, and generating new blood postpartum. If physicians do not prepare such remedies in advance, how can they achieve immediate effects?
Toxic Fire in Pregnancy
The wife of Chen Angfa from Nanmen was three months pregnant when her fetal qi rebelled upwards. Her tongue swelled to the size of an egg, turning purple-black, preventing any food intake. Physicians were helpless and summoned me. I stated, "This is toxic fire within the fetus attacking the heart. The tongue is the sprout of the heart; thus, toxin accumulates there, swelling and blocking the mouth, cutting off nutrition." I applied Zhuhuang San (Pearl and Realgar Powder) along with detoxifying and softening-hardness medications to her tongue repeatedly. The swelling gradually subsided, allowing her to eat. I then used a cooling and qi-unblocking formula, adjusting treatment according to changes. Some argued that detoxifying and clearing fire would harm the fetus. I replied, "Incorrect. When fetal qi is vigorous, cooling promotes stability. However, since heat-toxin damages yin fluids, one must nourish blood and qi." She exclusively took my prescriptions and delivered twins. Later inquiry revealed she had listened to heterodox advice and taken irregular medicines, nearly costing her life—a cautionary tale.
Zili (Pregnancy Dysentery/Diarrhea)
The wife of Pan Kaiyu's cousin in Lanxi suffered from dysentery during pregnancy, defecating over a hundred times day and night. I examined her and prescribed modified Huangqin Tang (Scutellaria Decoction) combined with fetal-nourishing herbs. Defecation decreased, and appetite improved, yet it persisted dozens of times daily despite medication. I said, "This requires no specific treatment; it is called Zili. It will not heal until after delivery. However, postpartum complications may arise." The family disagreed and consulted another physician who changed the prescription, worsening the diarrhea. They finally reverted to my advice, taking only minor fetal-stabilizing herbs. Delivery proceeded smoothly, but the mother's vital energy collapsed, presenting numerous deficiency signs. Coincidentally, I returned from Zhejiang and passed by her home. I treated her using postpartum methods, curing the illness and stopping the diarrhea. Some diseases resolve spontaneously; forcing a cure often causes harm. Such cases are common and must be understood.
Xu Lingtai's Note: The term "li" here refers to diarrhea. Ancients called it "li xia," distinct from modern dysentery (ancient name: "zhi xia"). If prolonged dysentery persists before pregnancy, can it be avoided after childbirth?
Shitai (Testing Fetus / False Labor)
Visiting my clan brother Longyou, an old woman rushed in panicking, crying, "It's hopeless!" Startled, I asked why. Longyou explained, "My niece has been in labor for two days without delivering; the midwife has given up and left." I asked where she was. "In the front alley," came the reply. I suggested, "Let us go examine her." Longyou was delighted, and we went together. Amniotic fluid was exhausted, and the woman was too exhausted to speak, yet the midwife urged her to push. I said, "Do not fear. This is Shitai (false labor). True birth has not occurred; do not force her. Help her lie down calmly. She will deliver in a month, easily, and bear a boy." The midwife sneered, dismissing this as nonsense, claiming decades of experience never showed such a case. The family remained skeptical. I prescribed a blood-nourishing and fetal-stabilizing formula. After one dose, fetal qi stabilized, and no labor signs appeared. A month later, she indeed delivered a boy easily. Everyone considered it miraculous. Longyou asked for an explanation. I said, "When fetal qi is strong and the mother is affected by wind-cold or fatigue, the fetus descends mimicking labor. Calming it resolves the issue. Mistaking this for true labor and forcing effort ruptures amniotic fluid and destabilizes the fetus. My pulse diagnosis showed vigorous fetal pulses but insufficient gestational age, indicating no imminent birth. Having disturbed the fetus now, future delivery will be easy. A vigorous left pulse indicates a male fetus. This is simple logic, often overlooked."
Postpartum Wind-Heat
The wife of Lu Bingruo from Xihao contracted wind-heat postpartum with unresolved blood stasis. Physicians adhered to the dogma that postpartum conditions are always deficient-cold, prescribing Ganjiang (Dried Ginger) and Shudi (Prepared Rehmannia), declaring the prognosis hopeless. The patient sweated profusely, body hot as charcoal, lips dry, tongue purple, yet still received these warming drugs. That day, while inspecting rapeseed flowers in the fields near Bingruo's residence, I was summoned urgently. I stated, "Childbirth depletes blood and ignites fire; compounded by wind-heat, adding acrid-dry and cloying tonics exacerbates fire and blocks orifices. I have seen many deaths from this. Without Shigao (Gypsum), Yangming excess heat cannot be resolved. Following Zhang Zhongjing's method, I use Zhuru (Bamboo Shavings) and Shigao." Upon my return, other physicians mocked this, claiming no historical precedent for using Gypsum postpartum, likely due to ignorance of Zhang Zhongjing's formulas. The mother, trusting me, insisted on administration. One dose revived her. The next day, Bingruo requested follow-up. I advised continuing the same prescription until cured, which succeeded. Physicians deemed this strange, unaware it was an ancient standard; only ginger and cinnamon would ensure death.
Postpartum Blood Distension
The second wife of Mr. Gu from Suzhou developed blood distension (abdominal swelling due to blood stasis) because lochia did not exit. Physicians were helpless. Gu's brother, Zhangfu (my relative), invited me. I diagnosed coagulated blood stasis unyielding to standard herbs like Taoren (Peach Kernel). Although Didang Tang existed historically, it was unavailable. Using a Tang dynasty method, I formulated Rougui (Cinnamon Bark), Huanglian (Coptis), Renshen (Ginseng), Dahuang (Rhubarb), and Wulingzhi (Trogopterus Dung) to purge stasis. Physicians laughed at combining cold/hot and tonifying/purging agents. Trusting me, the family administered it. The next day, Zhangfu reported the patient saw ghosts drinking the medicine, screaming she wouldn't consume "ghost vomit," and told me to stop treating. Examining the potent herbs, they tasted like water—strange. I prepared more and forced administration under threat. That night, she expelled over a sheng of dark blood, abdomen flattened, and appetite returned. I left briefly and returned the next day to find paper money burning outside, suspecting trouble. Inside, everyone looked joyful. They explained that the previous wife (who died of similar symptoms due to misdiagnosis) appeared in a dream, threatening revenge as a snake because the current wife occupied her place and abused her daughter. The patient woke terrified, hiring monks for rituals. This highlights that each disease has specific treatments; broad learning is essential.
Postpartum Intestinal Abscess
A woman from Dongting suffered severe lower abdominal pain and continuous lochia postpartum, nearing death. I asked, "With so much lochia, why is pain intensified?" Inquiry about discharged material revealed pus-like consistency. I diagnosed uterine injury leading to abscess formation. I recommended examination by a skilled midwife, confirming the diagnosis. I inserted cotton strips soaked in tissue-regenerating herbs internally and prescribed oral detoxifying and stasis-resolving formulas. Recovery was swift. Postpartum stasis often presents with external signs; this is common knowledge.
Severe Smallpox
A young servant of Wu Chaoshi, recently adult, accompanied his master to a theater. Falling ill with chills and fever, he returned home, groaning all night. Next morning, I found him hiding under the bed, hallucinating ghosts killing him. Extracting him revealed smallpox spots fine as bran. I diagnosed severe smallpox with dark purple coloration. Urgently, I administered decoctions of Shengma (Cimicifuga), Qianghuo (Notopterygium), and Shengdi (Rehmannia). Within three days, eruption occurred, covering the body densely, especially on the head and face. Throughout, I used blood and qi nourishing herbs, avoiding harsh purgatives common at the time. Crusting took over twenty days, forming large black scabs. After shedding, his appearance was unrecognizable. Few smallpox cases are fatal; most deaths result from physicians' misuse of cold-purging drugs.
Mao Lühe's daughter suffered smallpox. Another doctor predicted "stifled smallpox" death in five days. Despairing, they sought me. Examining her, I found high fever, coma, and fish-roe-like spots hidden in the flesh. I prioritized Shengma Qianghuo Tang with blood-nourishing and muscle-releasing herbs. Eruption appeared in three days, shocking previous doctors who ridiculed using these herbs in smallpox treatment, unaware Shengma Tang is the primary early-stage formula. Subsequent treatment involved blood-nourishing, detoxifying, and qi-tonifying herbs. Scabbing resulted in forehead resembling an inverted pot and skin like bark; hair fell out with scabs, regrowing only after three years. Contemporary doctors would have used Dahuang (Rhubarb) and Shigao (Gypsum), weakening the interior and increasing toxicity, ensuring death. Families attribute survival to divine foresight, but it is actually the efficacy of correct medication. Alas, how tragic!
My student Shen Guanyun's daughter had dense, black, sunken smallpox without pus. Doctors were helpless. I prescribed Bu Tuo (Support and Push Out) method using Dihuang (Rehmannia), Dangshen (Codonopsis/Ginseng substitute contextually, though text says Guishen/Huangqi/Renshen), Huangqi (Astragalus), and Renshen (Ginseng). Listeners laughed. One dose produced pus. The next day, dosing stopped due to Ginseng's cost. I warned that insufficient energy and incomplete toxin expulsion would cause secondary boils, which indeed appeared on the arm flexure. Further treatment resolved them.
My eldest granddaughter underwent variolation. Spots were dense and deep red. The variolator was helpless. I used clearing and erupting herbs, plus Zi Xue (Purple Snow) paste held in the mouth. Redness faded slightly. As she slept, I re-examined her; spots turned gray-white, and she clenched her teeth. I alarmed, diagnosed transformation to deficiency-cold (Kang Hai Cheng Zhi principle). I immediately administered Renshen and Lurong (Deer Antler) to support. By midnight, color returned to red, lesions elevated. I switched to clearing fire and nourishing blood formulas to generate pus. Disease changes unpredictably; dangerous cases require constant vigilance. Ignorant physicians are rigid and ineffective.
Liuzhu (Flowing Abscess)
A nine-year-old boy in Suzhou, intelligent, suffered Liuzhu across ten+ sites on shoulders, back, waist, and ribs. All treatments failed. I diagnosed that only Da Huoluo Dan (Great Activate Collaterals Pill) could cure. After thirty-plus pills, unbroken lesions resolved, and broken ones healed. Follow-up with blood and qi tonics completed recovery. Liuzhu arises from wind-cold invading the membranes (between skin and muscle), which connect widely without fixed locations, causing random outbreaks. This is a meridian disease; thus, Da Huoluo Dan is indicated. Other decoctions/pills are incorrect. Each disease has specific treatments; mismatched drugs fail.
Mrs. Liu Jinzen's husband's wife suffered deficiency-phlegm Liuzhu with pale complexion and weak pulse, moving unpredictably. Highly dangerous, slow to respond, I declined treatment. A local physician promised a cure for 100 taels and treated her at home, mocking my refusal. A month later, Liu Yuanval invited me. Jinzen reported improvement but lack of closure. I examined her: shoulder wound coin-sized, inner membrane dry and detached, shortness of breath, faint pulse. Leaving, I wrote "Dangerous moment by moment" instead of a prescription. Liu doubted. Soon, cries ensued; Liu entered to find her dead. Crowd blamed the promising physician. I explained the disease was incurable, not due to error, but the physician lacked diagnostic insight into life/death boundaries. Liuzhu types vary; generally, dried fluids lead to phlegm in membranes. Internal/external treatment and targeted expelling/tonifying are needed; blind tonification is useless.
Zhang Zhuozhou from Jiashan, under twenty, suffered Liuzhu for five years from ribs to legs, seven+ holes, chills, anorexia, emaciated. Spent thousands on Ginseng with no hope. Parents dead; uncle seized assets waiting for his death. Cousin Wang Qianzao begged me. Pitying him, I visited: half-body skeletal, deficiency-phlegm Liuzhu. Previous doctors failed to treat meridian phlegm, wasting money. I used Da Huoluo Dan primarily, with external tube-draining and tissue-regenerating herbs. Doctors laughed, confusing this with common U tou/Qiu Yin versions, ignoring the complex fifty-ingredient ancient formula. Phlegm in Liuzhu resides in collaterals; only Da Huoluo Dan works. Pus thinned, flesh grew, tendons relaxed, standing resumed. Within two years, robust health exceeded normal. Alas! Blind tonification kills many. Xu Lingtai's Note: Da Huoluo Dan fits deficiency-phlegm Liuzhu perfectly; surgeons ignore this. For excess phlegm, Kongxian Dan is best.
Intestinal Abscess
Xiao Hugu, youngest son of Zhu Jifang from Changxing, nine years old, extremely smart. Abdominal pain, knees drawn up, hunched back with a boil. Howling day and night. Various doctors diagnosed trauma, retained food, or carbuncle, suggesting lancing the bone. Tutor Mao Qisu recommended me. Entering, surrounded by famous doctors, I diagnosed Suojiao Changyong (Leg-Curling Intestinal Abscess), un-suppurated, curable in four days. Laughter ensued. Only Mrs. Kong (noble birth) trusted me. I gave blood-nourishing and qi-unblocking formula plus Huxin Wan (Heart-Protecting Pill). Pain reduced significantly. Doctors claimed luck. Next day, Xieyu Zhudu pills/powders caused slight pain increase, as predicted. Doctors mocked, claiming validation. Next morning, Heying Shunqi agent stopped 80-90% pain. Legs extended, back straightened. Walked in four days. Doctors departed. Scholar Yu asked why. I explained chaotic medication damaged qi/blood. Harmonizing first brought relief; attacking accumulated邪 (pathogens) causes temporary pain; nourishing and unblocking thereafter restores organs.
Miss Xu from Nan Hao, amenorrheic for months, chills/fever, anorexia, emaciation. Right lower abdomen extending to Huantiao point, dull pain, slight swelling. Doctors dismissed as weakness or blood bi, declaring untreatable. Pulse: surging, rapid, slippery. Irregular chills/fever. I told father: blood stasis abscess, suppurated. Will rupture spontaneously, causing complications. Urgent treatment needed. Prescribed surgical Tuodu (Expel Toxin) formula and pills. Returned to mountains. Two days later, pre-dawn urgent knocking. Relative reported massive rupture, impending collapse. Boarded boat: pus overflowed a sheng, faint pulse, cold skin, yang collapsing with yin. No time for formula; urgently boiled Renshen and Fuzi (Aconite), administered. Qi recovered, warmth returned. Then blood/qi tonics and pus-expelling/flesh-growing herbs, internal/external, cured in two months. Menses resumed. Stasis long-standing forms abscesses. Postpartum stasis and maiden amenorrhea present many external signs. Physicians miss them, seeking surgery late, often fatally. Surgeons also lack proper methods. Countless die wrongly.
Leg Carbuncle
Daughter of Qian from Hengjing, chronic mass spreading from abdomen to hypogastrium, Huantiao, outer thigh. Became large carbuncle, dripping pus, forming tubes with rice grains inside. Inexplicable, worsening. Doctors helpless. Father wept: poor family spent 100 taels on Ginseng with no effect, facing death. I said: Stop Ginseng. Surgical methods exist for draining and filling defects. Combined internal/external treatment. Powdered medicine exited wounds, decreasing over time. Stomach qi opened, flesh grew. Months later, scabs formed, tendons relaxed. Previously barren, conceived and delivered a child a year later. Each disease needs specific prescriptions; generic remedies rely on luck.
Arm Chancre
Son of Zhou from Changxing, arm chancre, non-healing pus for a year, becoming multi-boned. Rice grains exiting wound, near death. Internal support and external application. Powdered medicine exited wound. Pus decreased. Bones, formed by pus, expelled. Flesh grew daily, wound closed and healed.
Neck Chancre
Mr. Zhu in the prefecture suffered neck chancre, excruciating pain, bleeding. Treatment worsened swelling, coma, awaiting death. I applied Wei Yao (Encircling Medicine) to contain base, Hemostatic powder, and Huxin Wan. Pain/blood stopped, spirit calmed, sleep restored. Next day, previous doctor claimed identical Jinhuang San worked for others but failed here, blaming fate. He ignored that encircling medicines vary by case. Once stable, I promoted pus drainage with phlegm-resolving and stomach-opening herbs. Appetite improved, comfort returned. Cured in two months. Treating carbuncles depends on body constitution. Thin/weak bodies fear bleeding. Large wounds hinder flesh growth; encircling medicine is critical. Many formulas exist; preparation is vital.
Student Shen Ziqiu, grieving son's death, depression-induced neck chancre. Untreated. Neck lesion tripled wound size, encircled neck foot-long, inch-wide, two inches near throat remaining, occipital tendon intact but bleeding profusely. I refused, but pleaded persisted. First, two Huxin Wan pills to prevent inward toxin attack. Then hemostatic powder. Thick encircling medicine bound the base. Zhuhuang etc. applied to wound. Paste strip one chi three cun long. Four liang Huangqi (Astragalus) decocted for oral use. Condition stabilized, diet improved. Days later, bleeding stopped, pus formed, boundary between healthy/fleshy tissue established. Wound too large for natural closure. Tissue-regenerating herbs and Ginseng powder sealed it. Closed in a month. Family wanted to stock a jin of Ginseng. I said unnecessary. "All pain, itching, sores belong to Fire; pus flow and flesh rot damage Yin. External diseases prioritize clearing fire and nourishing Yin, adding spleen/stomach opening herbs. Ginseng limited to a few qian for a few doses—this is ancient law. Warm tonification is a later error, causing hidden harm. My major cases succeed miraculously, though contemporaries doubt."