一原案概用单行。诠拟概用双行。
一治病最忌不分在气在血。各案注明在气在血。
一治病以辨证为要。辨证以熟病情为要。是书于病情不厌详注。
一切脉以沉脉为要。是书于沉脉之吻合病情者详注之。
一切脉病者正坐。尽前两手肘置案上。重按久按。方切得出沉脉脉情。
一病有正变。变病之要药。即正病之禁药。
一见气不治气。此指气病由于阳虚阴虚者而言。补阳补阴则气自静。
一见痰不治痰。此指阳虚阴虚之痰而言。补阳补阴则痰不作。
一见血不治血。此指气实气虚之血而言。气实清之则血不上行。气虚振之则经自下行。
一补阴难。补阳尤难。久病阳旺阴虚可治。阴阳两虚不治。气不运药。良方何益。
一看舌胎。虽妇女宜令张口看到舌根。不可但看舌尖。胃朊有无垢滞。以舌根胎形为主。若
医年老目昏。
看舌又在深房密室。宜洋烛。忌电灯洋灯。并须启窗细看。
夏令某登厕。忽然体冷汗出。气怯神疲。孟英视之曰。阳气欲脱也。猝不及得药。适有三
年
女佩姜一块。约重四五钱。急煎而灌之即安。后用培补药。率以参 术草为主。盖气分偏虚
也。（辨阳虚在气怯神疲三年及约重四五钱非闲字。阳虚宜温补忌辛散。辛窜伤阳。三年女
佩姜。姜得人气温养。佳于干姜。此证姜非四五钱不可。少则有病重药轻之弊。续方以参
术草为主药。其另有佐使之药可类推。宜用土炒潞党五钱。土炒西 四钱。土炒白术三钱。
土炒粉草一钱五分。参 多于术草者。参 为行补之品。术草则守补之品也。)
范庆簪年逾五十。素患痰嗽。乙酉秋在婺。骤然吐血。势颇可危。孟英诊曰。气虚而血无统
摄也。虽向来咳嗽阴亏。阴药切不可服。然非格阳吐血。附桂更为禁剂。乃以潞参 术苓草
山药扁豆橘皮木瓜酒炒芍药为方。五帖而安。（素患痰嗽。病在气分。不在血分。孟英诊断
气虚。必左右脉皆无力。右脉重按尤软。气虚忌用冬地阴药固己。但非格阳吐血。若用一毫
附桂。便伤其兼证之阴亏。宜用炒潞参五钱。炒西 四钱。炒白术三钱。云苓片三钱。炒粉
草一钱五分。炒山药三钱。炒扁豆三钱。陈橘皮一钱五分。陈木瓜一钱五分。酒炒白芍一钱
五分。此证注重气虚。但补气不可伤阴。方中甘草木瓜并用。于补气中取酸甘化阴之义。亦
即引阳入阴之法。但主要病情在气虚。参 少用不足补气。全方一时全服。亦恐非重药轻投
之义。宜仿仲景许叔微成法。分次徐服。此必孟英当日所有。)继去甘草木瓜。加熟地阿胶
紫石英麦冬五味子龙骨牡蛎熬膏。服之全愈。（更方系从阳引阴之义。除前方各加十倍外。
去甘
草木瓜。恐甘酸之性滞腻气分。不能摄阳入阴。使阴亏咳嗽之兼证并蠲。宜用熟地二两。阿
胶二两 紫石英一两。整麦冬一两。五味子一两杵。 龙骨二两。 牡蛎二两。石英龙牡先
煨。熟地阿胶麦冬治阴虚。石英五味龙牡敛镇。为阴药下行之使。)
郑德顺春患急证。时已二鼓。丐孟英视之。见其扒床拉席。口不能言。惟以两手指心抓舌而
已。孟英曰。中毒也。取绿豆二升。急火煎清汤澄冷灌之。果即霍然。诘期询其故。始言久
患臂痛。因饵草头药。下咽后即心闷不可耐。舌麻不能言。（绿豆为清凉解毒之品。用二升
及
急火煎清汤澄冷灌之。各有深义。阳动阴静。扒床拉席。是热证非寒证。口不能言。两手指
心抓舌。是病在气分不在血分。两手指心抓舌。毒重病急。急证急治。绿豆少用。则有杯水
车薪之祸。煎药文火药性入下焦。武火药性入上焦。故宜急火煎清汤。其澄冷灌之者。前项
病情。热毒虽在上焦气分。然煎成热服。则证热汤热。下咽后嫌与病势扦格。澄冷灌之。即
用寒远寒之义。)婺人罗元奎。夏令猝发寒热。旋即呕吐不能自立。自言胯间痛不可当。孟
英视其痛处。 赤肿硬。形如肥皂荚。横梗于毛际之左。乃曰。此证颇恶。然乘初起。可一
击去之。用金银花六两。生甘草一两。皂角刺五钱。水煎和酒服之。一剂减其势。再剂病若
失。（猝发寒热三句病在气。胯痛难当四句病在血。此证系血病及气。本病在血。标病在气
。若治血遗气。则本中标失。若徒治气病。则更与病情根键不合。此证颇恶三句。即急证急
治
。偏证偏治之义。暴病多热证实证。银花治血热血瘀君药。凡病偏于阳者。必不足于阴。且
血热贼气。气不降则气不治。血亦不治。故用生草一两以缓中顾阴。兼储作汗基本。角刺少
用则发外证。多用则散外证。银花生草缓上中以入血分。角刺五钱煎和酒服。引甘寒之银
花生草上入气分。合之为一升一降。且酒能引银花入血分凉血散瘀。陈酒和服。宜用一两。
高粮减半。)逾年患伤寒。孟英切脉虚细已极。曰。此不可徒攻其病者。以阴分太亏耳。予
景岳法。以熟地当归酒炒白芍炙甘草橘皮柴胡等药。一剂而瘳。（此证阴中之阳亦虚。故方
中参用当归炒芍。喻氏嘉言医门法律论治病三分内伤。七分外感。外感为重。七分内伤。三
分外感。内伤为重。实为万世南针。孟英深得力于喻氏。世医治伤寒满纸温散。无一药顾及
内伤。误人无限。宜用炒熟地一两。开水泡汤。去渣用汤煎药。当归身三钱。酒炒白芍一钱
五分。炙甘草三钱。橘皮一钱五分。柴胡三钱。橘柴均次入。)
某素患噫气。凡体稍不适。其病即至。既响且多。戊子冬发最甚。苦不可言。孟英曰。此阳
气式微而浊阴上逆也。先服理中汤一剂。随以旋复代赭汤投之。遂愈。嗣后
每发。如法服之辄效。（噫气有二。一阳虚。一邪实。此证辨阳虚在既响且多。冬发最苦。
肺如钟。撞则鸣。言肺为邪贼。则发音顿失其常，肺如钟。空则鸣。言肺气为实邪所窒。则
不能金声玉振。此证噫气如因肺阻实邪。断不能既响且多。冬发最苦。清阳虚则卫外之阳亦
虚。表阳不充于皮毛。故冬寒易发。浊阴上逆。由于阳气式微。当专治阳微。气为阳。气以
虚而上逆。补阳则气纳丹田。而上逆何有。先服理中者。阳虚致病。必脾阳肾阳两足。而后
中气升降适常。随以旋复代赭投之者。经云上病下取。浊阴上逆。必阳不归阴。故以代赭引
人参之力下行。以靖浮越。服理中宜用土炒潞党五钱。炒白术三钱。炒甘草二钱。炒浓附片
三钱。炒干姜四钱。服旋复代赭。宜用土炒潞党五钱。土炒甘草二钱。制半夏三钱。原方生
姜改煨姜三钱。大枣一枚。醋 赭石三钱。旋复花一钱五分。大枣赭石均先煨。半夏旋复均
次入。)有患阴虚火炎者。面赤常如饮酒。孟英主一味元参汤。其效若神。屡试皆验。（辨证
在面赤常如饮酒常字。宜用炒元参片一两。百沸汤泡。去渣分次炖温服。)
叶殿和秋患感旬日后汗出昏瞀。医皆束手。孟英勘之曰。比真阴素亏。过服升散。与伤寒误
发少阴
汗同例。下竭则上厥。岂得引亡阳为比。而以附桂速其毙耶。以元参地黄知母甘草白芍黄连
茯苓小麦龟板鳖甲牡蛎阿胶为大剂投之。得愈。（旬日后汗出昏瞀一语注意。旬日后汗出昏
瞀。则非甫病汗出昏瞀可知。始虽升散。真阴未竭。汗出不至昏瞀可知。病者已服升散药旬
日。真阴素亏者。劫阴已竭。上见厥逆。至于昏瞀可知。急证急治。元参片一两。大熟地八
钱。开水同泡汤。去渣。用汤煎药。炒知母一钱。川雅连五分。生甘草三钱。整白芍四钱杵
。云苓片三钱。北小麦四钱杵。血龟板一两。血鳖甲二两。 牡蛎四两。三味皆杵。先阿胶
二钱。炖和服。白芍小麦龟板鳖甲牡蛎同先煨六句钟。汗为阴液。下竭则上厥。当专治下竭
。元参地黄滋阴以止汗。知母黄连微泻其伤阴之热。下竭上厥。风火沸腾。生草白芍合用。
暂缓其如火燎原之势。阴伤者阳亦伤。阳伤则阴润之药不能孤立以自行。故以茯苓奠其中枢
。北地土性甘寒。北小麦夜吐花。麦皮最能凉人肌肤。汗止则阴渐复。龟板鳖甲牡蛎名三甲
。最能潜纳虚阳。汗出然后昏瞀。阳愈升则阴愈竭。阳潜则汗止。何昏瞀之有。元参地黄泡
煎去渣避其滞腻。三甲多煎则药色黑。取其沉敛。亦上病下取之义也。)
赵子升夏病疟。急延孟英视之。曰。暑热为患耳。不可胶守小柴胡也。予白虎汤一啜而瘥。
（此证必面赤大汗饮冷舌赤脉数重按有力。生石膏一两先煎。酒炒知母三钱。宜去原方甘草
粳米。加鲜竹叶二钱。黑栀皮三钱。冬瓜皮三钱。生冬瓜子四钱。鲜荷茎一尺五寸。)范丽
门患温疟。孟英用白虎加桂枝以痊之。（生石膏六钱先煎。酒炒知母一钱五分。川桂枝四分
。去草米。加丝瓜络三钱。晚蚕砂三钱。苦杏泥一钱。陈香薷五分。桂枝杏仁香薷同次入。
)盛少云夏病湿热疟。孟英以白虎汤加苍术汤而安。（此证湿虽化热。与湿未脱离关系。生石
膏五钱先煎。酒炒知母一钱五分。生茅苍术二钱。去米草加云茯苓一钱五分。生苡仁三钱。
鲜荷叶三钱。鲜芦根三钱。)某夏患疟。服柴胡药二三帖后。汗出昏厥。妄语遗溺。孟英切
其脉洪大滑数。曰。阳明暑疟也。与伤寒三阳合病同符。处竹叶石膏汤。两剂而瘳。（此必
阴
虚之体。柴胡汤劫汗伤阴。汗出昏厥。妄语者。胃脘部位与心相近。胃热侵心则妄语。遗溺
者。肺胃相近。热伤胃即伤肺。肺司周身气机升降。肺阴为热邪所伤。则肺阳亦失其宣摄之
用。故遗溺。脉洪大为阴虚。滑数为热实。生石膏八钱先煎。酒炒知母二钱。生甘草三钱
。
去粳米。加麦冬三钱。北沙参四钱。鲜竹叶二钱。黑栀皮三钱。冬瓜皮三钱。晚蚕砂三钱。
炒苦杏云茯苓各一钱五分。)黄肖农患暑疟。孟英投白虎汤加西洋参数帖始愈。（暑能伤阴。
生石膏八钱先煎。酒炒知母二钱。西洋参三钱。去米草。加元参片三钱。开水泡冲去渣鲜荷
梗三钱。鲜芦根五钱。冬瓜皮三钱。晚蚕砂三钱。鲜茅根三钱。苦杏泥一钱。陈香薷五分。
)顾味吾妻病瘅疟。亦主是方而效。庄芝阶妻年逾花甲。痰热甚炽。孟英审视再四。亦予竹
叶石膏汤而安。（人有阴脏阳脏之分。业医者不可不知。年逾花甲。痰热甚炽。必系阳脏。
亦名偏阳之体。生石膏一两先煎。酒炒知母三钱次入。鲜竹叶二钱。去米草。加陈胆星一
钱。炖和服。九节蒲六分研次入。川贝母三钱。姜竹茹三钱。生冬瓜子四钱。黑栀皮三钱。
鲜荷茎三钱。苦杏泥钱半。)
范蔚然八月患感旬余。诸医束手。孟英治之。见其气促音微。呃忒自汗。饮水下咽。随即倾
吐无余。曰。伏暑在肺。必由温散以致剧也。盖肺气受病。治节不行。一身之气。皆失其
顺降之机。即水精四布。亦赖清肃之权以主之。气既逆而上奔。水亦泛而上
溢矣。但清其肺。则诸恙自安。阅前服
诸方。始则柴葛羌防以升提之。火借风威。吐逆不已。犹谓其胃中有寒。改用桂枝干姜以温
燥之。火上添油。肺津欲绝。自然气促音微。疑其虚阳将脱也。径予参归蛤蚧柿蒂丁香以补
而纳之。愈补愈逆。邪愈不出。欲其愈也难矣。亟屏前药。以泻白散合清燥救肺汤。数服而
平
。（论证尽于原案。生桑白皮三钱。地骨皮四钱。生甘草三钱。去粳米。加姜炒川连八分。
北沙参八钱。花麦冬三钱。冬桑叶四钱。苦杏泥一钱五分。鲜枇杷叶三钱刷包。清阿胶二钱
炖和服。)
何叟年近八旬。冬月伤风。有面赤气逆烦躁不安之象。孟英曰。此喻氏嘉言所谓伤风亦有戴
阳证也。不可忽视。以东洋参细辛炙甘草熟附片白芍茯苓干姜五味胡桃肉细茶葱白一剂而瘳
。
孟英曰。此真阳素虚。痰饮内动。卫阳不固。风邪外入。有根蒂欲拔之虞。误投表散。一汗
亡阳。故以真武四逆诸法回阳镇饮。攘外安内以为剂。不可施之阳实邪实之伤寒。（戴阳
阳外阴内。外实内虚。面赤气逆。烦躁不安。孟英诊断戴阳。必脉重按无力。不嗜冷冻饮料。高
丽参三钱。北细辛八分次入。炒甘草三钱。熟附片五钱。炒白术三钱。酒炒白芍一钱五分。
白茯苓干切三钱。炒干姜四钱。北五味杵先三钱。连衣胡桃肉五钱先煎。陈细茶一钱。连须
鲜葱白三钱。去葱管次入。姜附分两重于参苓术草。则四君能动荡补阳。而无着滞不行之弊
。细辛为药入下焦之引导。干姜合四君坐镇中枢。五味胡桃潜纳浮阳。胡桃滋润得阳中之阴
。与病情有相悦以解之妙。白芍细茶反佐。葱白正治伤寒。)
某秋患疟。大为医人所误。初则表散。继则滋补。延及月余。肌肉尽削。寒热不休。且善呕
恶食。溺清畏冷。孟英诊视曰足太阴湿疟也。以金不换正气散三啜而安。（此病近
因在误于滋补。补住实邪。则肌肉尽削。寒热不休。滋补则败脾阳。故善呕恶食。溺清畏冷
。姜汁制茅苍术五钱。姜汁制根朴去粗皮三钱。广藿梗二钱。赖氏陈皮二钱。二味均次入。
姜制半夏米八钱。)
钟耀辉年逾花甲。在都患肿。起自肾囊。气逆便溏。诸治不效。孟英治之。切其脉微
【凡例】
一、原案一律使用单行排版。我的注解一律使用双行排版（夹注）。
一、治病最忌讳不区分病邪是在气分还是在血分。各个医案中均注明了病位在气分还是血分。
一、治病以辨证为关键。辨证以熟悉病情为关键。本书对于病情不厌其烦地详细注释。
一、切脉以沉脉最为重要。本书对于沉脉与病情相吻合的地方进行了详细注释。
一、切脉时患者应当正坐，将双手肘部完全置于案桌上。医生重按并久按，才能切出沉脉的真实情况。
一、疾病有正证和变证。治疗变证的关键药物，往往是治疗正证的禁忌药物。
一见气机失调就不单纯治气。这是指气病是由于阳虚或阴虚引起的而言。补阳或补阴，气机自然平静。
一见痰症就不单纯治痰。这是指由于阳虚或阴虚产生的痰而言。补阳或补阴，痰自然不再产生。
一见血证就不单纯治血。这是指由于气实或气虚导致的血证而言。气实则清热则血不上逆；气虚则升提则经血自然下行。
一、补阴很难，补阳尤其难。久病导致阳气偏旺而阴虚的可以治疗；阴阳两虚的难以治疗。因为气机不能运化药力，良方又有什么益处呢？
一看舌苔。即使是妇女，也应令其张口看到舌根，不可只看舌尖。胃脘是否有垢滞，主要看舌根的苔形。如果医生年老眼花，
看舌应在深房密室中进行，宜用洋烛，忌用电灯洋灯，并且必须开窗仔细观看。
【卷一医案】
夏季某天，某人上厕所时，突然身体冷汗出，气息怯弱，精神疲惫。孟英诊视后说：“这是阳气欲脱。”来不及抓药，恰好有一个三年未嫁的女子佩戴着一块生姜，大约重四五钱。急忙煎汤灌服，病人随即安定。后来用培补药物，主要以人参、白术、甘草为主。这是因为气分偏虚。（辨析：阳虚在“气怯神疲”持续三年以及“约重四五钱”并非闲笔。阳虚宜温补忌辛散，辛窜会伤阳。三年未嫁女子佩戴生姜，姜入人体能温养阳气，优于干姜。此证生姜非四五钱不可，少了则有病重药轻的弊端。续方以人参、白术、甘草为主药，其余佐使药可类推。宜用土炒潞党参五钱，土炒西洋参四钱，土炒白术三钱，土炒粉甘草一钱五分。人参、西洋参多于白术、甘草，是因为人参、西洋参是行补之品，白术、甘草则是守补之品。）
范庆簪年过五十，平素患痰嗽。乙酉年秋季在婺州，突然吐血，形势颇为危急。孟英诊察说：“这是气虚而不能统摄血液。”虽然向来咳嗽且阴亏，但滋阴药切不可服用。然而这并非格阳吐血，附子、肉桂更是禁忌之剂。于是用潞参、白术、茯苓、甘草、山药、扁豆、橘皮、木瓜、酒炒芍药作为方剂。五帖后病情安定。（平素患痰嗽，病在气分，不在血分。孟英诊断为气虚，必定左右脉皆无力，右脉重按尤其软弱。气虚忌用冬虫夏草、地黄等滋阴药固然正确。但这并非格阳吐血，若用一毫附子、肉桂，便会伤害其兼有的阴亏之证。宜用炒潞参五钱，炒西洋参四钱，炒白术三钱，云苓片三钱，炒粉甘草一钱五分，炒山药三钱，炒扁豆三钱，陈橘皮一钱五分，陈木瓜一钱五分，酒炒白芍一钱五分。此证注重气虚，但补气不可伤阴。方中甘草木瓜并用，取酸甘化阴之义，也就是引阳入阴的方法。但主要病情在于气虚，人参、西洋参少用不足以补气，全方一次性全部服用，也恐怕不符合重药轻投的意义。宜仿效张仲景、许叔微的成法，分次慢慢服用。这一定是孟英当日原本的想法。）随后去掉甘草木瓜，加入熟地黄、阿胶、紫石英、麦冬、五味子、龙骨、牡蛎熬膏服用，痊愈。（更方是从阳引阴的意思。除前方各药加十倍外，去掉甘草木瓜，担心甘酸之性滞腻气分，不能摄阳入阴，使阴亏咳嗽的兼证一并消除。宜用熟地黄二两，阿胶二两，紫石英一两，整麦冬一两，五味子一两捣碎，龙骨二两，牡蛎二两。石英、龙、牡先煅。熟地黄、阿胶、麦冬治阴虚，石英、五味子、龙、牡收敛镇潜，作为阴药下行的引导。）
郑德顺春季患急症，当时已是二更天，乞求孟英诊视。见他扒床拉席，口不能言，只用两只手指心抓舌头而已。孟英说：“这是中毒。”取绿豆二升，急火煎成清汤，澄清冷却后灌服，果然立刻霍然痊愈。过几天询问原因，才说是久患臂痛，因服用草头药（草药），下咽后即心闷不可忍受，舌麻不能说话。（绿豆为清凉解毒之品，用二升及急火煎清汤澄清冷却灌服，各有深意。阳动阴静，扒床拉席，是热证非寒证。口不能言，两手手指心抓舌，是病在气分不在血分。两手手指心抓舌，毒重病急，急证急治。绿豆少用，则有杯水车薪之祸。煎药文火药性入下焦，武火药性入上焦，故宜急火煎清汤。澄清冷却灌服，即用“用寒远寒”的意义——此处意指热毒在上焦，若热服则证热汤热，下咽后嫌与病势冲突，冷服则顺应病势。）婺州人罗元奎，夏季突然发作寒热，旋即呕吐不能自立。自述胯间疼痛难忍。孟英查看其痛处，红肿硬，形状如肥皂荚，横梗于阴毛左侧。于是说：“此证颇恶，但乘初起，可一击去之。”用金银花六两，生甘草一两，皂角刺五钱，水煎和酒服下。一剂减轻病势，再剂病若消失。（突然发作寒热三句病在气，胯痛难当四句病在血。此证系血病及气，本病在血，标病在气。若治血遗气，则本中标失。若徒治气病，则更与病情根本不合。“此证颇恶”三句，即急证急治、偏证偏治的意义。暴病多热证实证。银花治血热血瘀为君药。凡病偏于阳者，必不足于阴。且血热贼气，气不降则气不治，血亦不治。故用生草一两以缓中顾阴，兼储作汗基本。角刺少用则发外证，多用则散外证。银花生草缓上中以入血分，角刺五钱煎和酒服，引甘寒之银花生草上入气分，合之为一升一降，且酒能引银花入血分凉血散瘀。陈酒和服，宜用一两，高粮减半。）次年患伤寒，孟英切脉虚细已极，说：“此不可徒攻其病者，以阴分太亏耳。”给予景岳之法，以熟地黄、当归、酒炒白芍、炙甘草、橘皮、柴胡等药，一剂而愈。（此证阴中之阳亦虚，故方中参用当归炒芍。喻氏嘉言《医门法律》论治病三分内伤，七分外感。外感为重，七分内伤，三分外感，内伤为重，实为万世南针。孟英深得力于喻氏。世医治伤寒满纸温散，无一药顾及内伤，误人无限。宜用炒熟地黄一两，开水泡汤，去渣用汤煎药。当归身三钱，酒炒白芍一钱五分，炙甘草三钱，橘皮一钱五分，柴胡三钱。橘皮、柴胡均次入。）
某人平素患噫气（打嗝），凡是身体稍不适，病即发作，既响且多。戊子冬季发作最甚，痛苦不堪。孟英说：“这是阳气式微而浊阴上逆。”先服理中汤一剂，随即以旋复代赭汤投之，遂愈。此后每次发作，照法服用辄效。（噫气有二种，一为阳虚，一为邪实。此证辨阳虚在既响且多，冬季发作最苦。肺如钟，撞则鸣，言肺为邪贼，则发音顿失其常；肺如钟，空则鸣，言肺气为实邪所窒，则不能金声玉振。此证噫气如因肺阻实邪，断不能既响且多。冬季发作最苦，清阳虚则卫外之阳亦虚，表阳不充于皮毛，故冬寒易发。浊阴上逆，由于阳气式微，当专治阳微。气为阳，气以虚而上逆，补阳则气纳丹田，而上逆何有。先服理中者，阳虚致病，必脾阳肾阳两足，而后中气升降适常。随以旋复代赭投之者，经云上病下取，浊阴上逆，必阳不归阴，故以代赭引人参之力下行，以靖浮越。服理中宜用土炒潞党参五钱，炒白术三钱，炒甘草二钱，炒浓附片三钱，炒干姜四钱。服旋复代赭，宜用土炒潞党参五钱，土炒甘草二钱，制半夏三钱，原方生姜改煨姜三钱，大枣一枚，醋淬赭石三钱，旋复花一钱五分。大枣、赭石均先煅，半夏、旋复均次入。）有患阴虚火炎者，面赤常如饮酒。孟英主一味元参汤，其效若神，屡试皆验。（辨证在“面赤常如饮酒”之“常”字。宜用炒元参片一两，百沸汤泡，去渣分次炖温服。）
叶殿和秋季患感冒旬日后汗出昏瞀（昏迷目眩），医生都束手无策。孟英勘察后说：“比真阴素亏，过服升散，与伤寒误发少阴汗同例。下竭则上厥，岂得引亡阳为比，而以附桂速其毙耶？”以元参、地黄、知母、甘草、白芍、黄连、茯苓、小麦、龟板、鳖甲、牡蛎、阿胶为大剂投之，得愈。（“旬日后汗出昏瞀”一语注意。旬日后汗出昏瞀，则非甫病汗出昏瞀可知。始虽升散，真阴未竭，汗出不至昏瞀可知。病者已服升散药旬日，真阴素亏者，劫阴已竭，上见厥逆，至于昏瞀可知。急证急治。元参片一两，大熟地八钱，开水同泡汤，去渣，用汤煎药。炒知母一钱，川雅连五分，生甘草三钱，整白芍四钱捣碎，云苓片三钱，北小麦四钱捣碎，血龟板一两，血鳖甲二两，牡蛎四两，三味皆捣碎。先阿胶二钱，炖和服。白芍、小麦、龟板、鳖甲、牡蛎同先煨六句钟。汗为阴液，下竭则上厥，当专治下竭。元参地黄滋阴以止汗，知母黄连微泻其伤阴之热。下竭上厥，风火沸腾，生草白芍合用，暂缓其如火燎原之势。阴伤者阳亦伤，阳伤则阴润之药不能孤立以自行，故以茯苓奠其中枢。北地土性甘寒，北小麦夜吐花，麦皮最能凉人肌肤。汗止则阴渐复，龟板鳖甲牡蛎名三甲，最能潜纳虚阳。汗出然后昏瞀，阳愈升则阴愈竭，阳潜则汗止，何昏瞀之有。元参地黄泡煎去渣避其滞腻，三甲多煎则药色黑，取其沉敛，亦上病下取之义也。）
赵子升夏季患疟疾，急忙延请孟英诊视。说：“暑热为患耳，不可胶守小柴胡也。”予白虎汤一啜而瘥。（此证必面赤大汗饮冷舌赤脉数重按有力。生石膏一两先煎，酒炒知母三钱。宜去原方甘草粳米，加鲜竹叶二钱，黑栀皮三钱，冬瓜皮三钱，生冬瓜子四钱，鲜荷茎一尺五寸。）范丽门患温疟，孟英用白虎加桂枝以痊之。（生石膏六钱先煎，酒炒知母一钱五分，川桂枝四分，去草米，加丝瓜络三钱，晚蚕砂三钱，苦杏泥一钱，陈香薷五分。桂枝、杏仁、香薷同次入。）盛少云夏季患湿热疟，孟英以白虎汤加苍术汤而安。（此证湿虽化热，与湿未脱离关系。生石膏五钱先煎，酒炒知母一钱五分，生茅苍术二钱，去米草加云茯苓一钱五分，生苡仁三钱，鲜荷叶三钱，鲜芦根三钱。）某夏季患疟，服柴胡药二三帖后，汗出昏厥，妄语遗溺。孟英切其脉洪大滑数，说：“阳明暑疟也，与伤寒三阳合病同符。”处竹叶石膏汤，两剂而瘳。（此必阴虚之体，柴胡汤劫汗伤阴。汗出昏厥，妄语者，胃脘部位与心相近，胃热侵心则妄语。遗溺者，肺胃相近，热伤胃即伤肺，肺司周身气机升降，肺阴为热邪所伤，则肺阳亦失其宣摄之用，故遗溺。脉洪大为阴虚，滑数为热实。生石膏八钱先煎，酒炒知母二钱，生甘草三钱，去粳米，加麦冬三钱，北沙参四钱，鲜竹叶二钱，黑栀皮三钱，冬瓜皮三钱，晚蚕砂三钱，炒苦杏云茯苓各一钱五分。）黄肖农患暑疟，孟英投白虎汤加西洋参数帖始愈。（暑能伤阴。生石膏八钱先煎，酒炒知母二钱，西洋参三钱，去米草，加元参片三钱，开水泡冲去渣鲜荷梗三钱，鲜芦根五钱，冬瓜皮三钱，晚蚕砂三钱，鲜茅根三钱，苦杏泥一钱，陈香薷五分。）顾味吾妻病瘅疟，亦主是方而效。庄芝阶妻年逾花甲，痰热甚炽，孟英审视再四，亦予竹叶石膏汤而安。（人有阴脏阳脏之分，业医者不可不知。年逾花甲，痰热甚炽，必系阳脏，亦名偏阳之体。生石膏一两先煎，酒炒知母三钱次入，鲜竹叶二钱，去米草，加陈胆星一钱，炖和服。九节蒲六分研末次入，川贝母三钱，姜竹茹三钱，生冬瓜子四钱，黑栀皮三钱，鲜荷茎三钱，苦杏泥钱半。）
范蔚然八月患感冒旬余，诸医束手。孟英治之，见其气促音微，呃忒自汗，饮水下咽，随即倾吐无余。说：“伏暑在肺，必由温散以致剧也。盖肺气受病，治节不行，一身之气，皆失其顺降之机，即水精四布，亦赖清肃之权以主之。气既逆而上奔，水亦泛而上溢矣。但清其肺，则诸恙自安。”阅前服诸方，始则柴葛羌防以升提之，火借风威，吐逆不已，犹谓其胃中有寒，改用桂枝干姜以温燥之，火上添油，肺津欲绝，自然气促音微，疑其虚阳将脱也。径予参归蛤蚧柿蒂丁香以补而纳之，愈补愈逆，邪愈不出，欲其愈也难矣。亟屏前药，以泻白散合清燥救肺汤，数服而平。（论证尽于原案。生桑白皮三钱，地骨皮四钱，生甘草三钱，去粳米，加姜炒川连八分，北沙参八钱，花麦冬三钱，冬桑叶四钱，苦杏泥一钱五分，鲜枇杷叶三钱刷包，清阿胶二钱炖和服。）
何叟年近八旬，冬月伤风，有面赤气逆烦躁不安之象。孟英说：“此喻氏嘉言所谓伤风亦有戴阳证也。不可忽视。”以东洋参、细辛、炙甘草、熟附片、白芍、茯苓、干姜、五味子、胡桃肉、细茶、葱白一剂而瘳。孟英说：“此真阳素虚，痰饮内动，卫阳不固，风邪外入，有根蒂欲拔之虞。误投表散，一汗亡阳。故以真武四逆诸法回阳镇饮，攘外安内以为剂。不可施之阳实邪实之伤寒。”（戴阳阳外阴内，外实内虚，面赤气逆，烦躁不安。孟英诊断戴阳，必脉重按无力，不嗜冷冻饮料。高丽参三钱，北细辛八分次入，炒甘草三钱，熟附片五钱，炒白术三钱，酒炒白芍一钱五分，白茯苓干切三钱，炒干姜四钱，北五味杵先三钱，连衣胡桃肉五钱先煎，陈细茶一钱，连须鲜葱白三钱，去葱管次入。姜附分两重于参苓术草，则四君能动荡补阳，而无着滞不行之弊。细辛为药入下焦之引导，干姜合四君坐镇中枢，五味胡桃潜纳浮阳，胡桃滋润得阳中之阴，与病情有相悦以解之妙。白芍细茶反佐，葱白正治伤寒。）
某秋季患疟疾，大为医人所误。初则表散，继则滋补，延及月余，肌肉尽削，寒热不休，且善呕恶食，溺清畏冷。孟英诊视曰：“足太阴湿疟也。”以金不换正气散三啜而安。（此病近因在误于滋补，补住实邪，则肌肉尽削，寒热不休。滋补则败脾阳，故善呕恶食，溺清畏冷。姜汁制茅苍术五钱，姜汁制根朴去粗皮三钱，广藿梗二钱，赖氏陈皮二钱，二味均次入，姜制半夏米八钱。）
[General Rules]
1. The original cases are all printed in single lines. My annotations are all printed in double lines (interlinear notes).
2. In treating diseases, it is most taboo not to distinguish whether the pathogen is in the Qi level or the Blood level. Each case specifies whether the pathology is in the Qi level or the Blood level.
3. Treating disease hinges on syndrome differentiation (Bian Zheng). Syndrome differentiation hinges on familiarity with the patient's condition. This book provides detailed annotations for the patient's condition without sparing effort.
4. Pulse diagnosis focuses primarily on the Deep pulse (Chen Mai). This book provides detailed annotations where the Deep pulse corresponds to the patient's condition.
5. During pulse diagnosis, the patient should sit upright, placing both elbows fully on the table. The physician must press heavily and hold long enough to accurately perceive the true nature of the Deep pulse.
6. Diseases have standard presentations (Zheng) and variant presentations (Bian). The key herbs for treating variant presentations are often contraindicated for standard presentations.
7. When encountering Qi dysfunction, do not treat Qi alone. This refers to Qi disorders caused by Yang deficiency or Yin deficiency. Tonifying Yang or Yin will naturally calm the Qi mechanism.
8. When encountering Phlegm disorders, do not treat Phlegm alone. This refers to Phlegm generated due to Yang deficiency or Yin deficiency. Tonifying Yang or Yin will naturally stop Phlegm production.
9. When encountering Blood disorders, do not treat Blood alone. This refers to Blood disorders caused by Qi Excess or Qi Deficiency. If Qi is Excess, clearing heat prevents Blood from rising; if Qi is Deficient, lifting will cause menstruation to flow normally.
10. Tonifying Yin is difficult; tonifying Yang is even more difficult. Chronic illness resulting in relatively hyperactive Yang and deficient Yin can be treated; simultaneous deficiency of both Yin and Yang is difficult to treat because the Qi mechanism cannot transport the medicinal properties, rendering good prescriptions useless.
11. Observing the tongue coating. Even for women, one should ask them to open their mouths wide enough to see the root of the tongue, not just the tip. Whether there is turbid stagnation in the Stomach region depends mainly on the coating shape at the root of the tongue. If the physician is elderly with poor eyesight, tongue observation should be conducted in a dark room using oil lamps (yang zhu), avoiding electric lights, and windows should be opened for careful viewing.
[Volume 1 Medical Cases]
One summer day, while using the toilet, a certain patient suddenly experienced cold sweat, weak breath, and mental fatigue. Meng Ying examined him and said, "This is impending collapse of Yang Qi." There was no time to prepare medicine. Fortunately, an unmarried woman for three years happened to be wearing a piece of fresh ginger weighing about four or five qian. It was hastily decocted and administered, after which the patient immediately stabilized. Later, tonic medicines were used, primarily consisting of Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractylodis Rhizoma), and Gan Cao (Licorice Root). This is because the Qi level was predominantly deficient. (Analysis: The indication of Yang deficiency lies in "weak breath and mental fatigue" persisting for three years and the weight of "about four or five qian," which are not trivial details. For Yang deficiency, warming and tonification are indicated, while acrid dispersants are contraindicated as they damage Yang. Fresh ginger worn by the unmarried woman warms and nourishes Yang upon entering the body, superior to dried ginger. This case requires four or five qian of ginger; less would result in insufficient dosage for the severity of the illness. The follow-up prescription uses Ren Shen, Bai Zhu, and Gan Cao as main herbs; other adjuvant herbs can be inferred. Tu Chao Lu Dang Shen (Earth-fried Codonopsis Radix) 5 qian, Tu Chao Xi Yang Shen (Earth-fried American Ginseng Radix) 4 qian, Tu Chao Bai Zhu (Earth-fried Atractylodis Rhizoma) 3 qian, Tu Chao Fen Gan Cao (Earth-fried Glycyrrhizae Radix et Rhizoma) 1.5 qian are appropriate. The quantity of Ren Shen and Xi Yang Shen exceeds that of Bai Zhu and Gan Cao because Ren Shen and Xi Yang Shen are moving tonics, whereas Bai Zhu and Gan Cao are stationary tonics.)
Fan Qingzan, over fifty years old, had a chronic history of Phlegm-Cough. In autumn of the Yiyou year, while in Wuzhou, he suddenly vomited blood, presenting a critical situation. Meng Ying diagnosed, "This is Qi deficiency failing to control the Blood." Although he historically suffered from cough and Yin deficiency, Yin-nourishing medicines must absolutely not be taken. However, this is not regurgitant Yang vomiting; Fu Zi (Aconiti Lateralis Radix Praeparata) and Gui Zhi (Cinnamomi Ramulus) are strictly contraindicated. He prescribed a formula of Lu Shen (Codonopsis Radix), Bai Zhu (Atractylodis Rhizoma), Fu Ling (Poria), Gan Cao (Glycyrrhizae Radix et Rhizoma), Shan Yao (Dioscoreae Rhizoma), Bian Dou (Lablab Semen Album), Ju Pi (Citri Reticulatae Pericarpium), Mu Gua (Chaenomelis Fructus), and Jiu Chao Shao Yao (Wine-fried Paeoniae Radix Alba). After five doses, the condition stabilized. (Chronic Phlegm-Cough indicates pathology in the Qi level, not the Blood level. Meng Ying's diagnosis of Qi deficiency implies both left and right pulses were powerless, with the right pulse particularly soft upon deep pressure. Avoiding Dong Chong Xia Cao (Cordyceps) and Di Huang (Rehmanniae Radix) for Qi deficiency is correct. Since this is not regurgitant Yang vomiting, using even a trace of Fu Zi or Gui Zhi would harm the concurrent Yin deficiency. Appropriate dosages: Chao Lu Shen (Fried Codonopsis Radix) 5 qian, Chao Xi Yang Shen (Fried American Ginseng Radix) 4 qian, Chao Bai Zhu (Fried Atractylodis Rhizoma) 3 qian, Yun Ling Pian (Cloud Poria Slices) 3 qian, Chao Fen Gan Cao (Fried Licorice Root) 1.5 qian, Chao Shan Yao (Fried Dioscoreae Rhizoma) 3 qian, Chao Bian Dou (Fried Lablab Semen Album) 3 qian, Chen Ju Pi (Aged Tangerine Peel) 1.5 qian, Chen Mu Gua (Aged Chaenomelis Fructus) 1.5 qian, Jiu Chao Bai Shao (Wine-fried White Peony Root) 1.5 qian. This case emphasizes Qi deficiency, but tonifying Qi must not injure Yin. The combination of Gan Cao and Mu Gua in the formula takes the meaning of "Sour-Sweet transforming into Yin," which is also the method of guiding Yang into Yin. However, since the primary pathology is Qi deficiency, a small amount of Ren Shen/Xi Yang Shen is insufficient to tonify Qi. Taking the entire heavy dose at once may not align with the principle of light administration of heavy medication. It is advisable to imitate the methods of Zhang Zhongjing and Xu Shumi, administering slowly in divided doses. This likely reflects Meng Ying's original intent.) Subsequently, Gan Cao and Mu Gua were removed, and Shu Di Huang (Prepared Rehmanniae Radix), E Jiao (Colla Corii Asini), Zi Shi Ying (Psilomelane), Mai Dong (Ophiopogonis Radix), Wu Wei Zi (Schisandrae Fructus), Long Gu (Fossilia Ossis Mastodi), and Mu Li (Concha Ostreae) were added and decocted into a paste. The patient recovered completely. (The modification follows the principle of guiding Yin from Yang. Except for increasing the dosage of previous herbs tenfold, Gan Cao and Mu Gua were removed to prevent their sweet-sour nature from causing stagnation in the Qi level, hindering the guidance of Yang into Yin, thereby eliminating the concurrent symptoms of Yin-deficient cough. Appropriate dosages: Shu Di Huang 2 liang, E Jiao 2 liang, Zi Shi Ying 1 liang, Mai Dong 1 liang, Wu Wei Zi 1 liang (pounded), Long Gu 2 liang, Mu Li 2 liang. Shi Ying, Long Gu, and Mu Li should be calcined first. Shu Di Huang, E Jiao, and Mai Dong treat Yin deficiency; Shi Ying, Wu Wei Zi, Long Gu, and Mu Li astringe and anchor, serving as guides for Yin medicines to descend.)
Zheng Deshun suffered an acute condition in spring. It was already the second watch of the night when he begged Meng Ying to examine him. He was seen pulling at his bed and mat, unable to speak, only pointing to his heart and grabbing his tongue with both hands. Meng Ying said, "This is poisoning." He took two sheng of Mung Beans (Vigna radiata), decocted them quickly in clear water, clarified the liquid, cooled it, and administered it. The patient recovered instantly. Days later, upon inquiry, it was revealed that he had suffered from arm pain for a long time and had taken herbal remedies. Immediately after swallowing, he felt unbearable chest oppression and tongue numbness preventing speech. (Mung Bean is a cooling and detoxifying herb. Using two sheng and decocting quickly in clear water, then clarifying and cooling before administration, each has profound meaning. Yang moves, Yin is still. Pulling at the bed and mat indicates a Heat pattern, not Cold. Inability to speak and pointing to the heart/grabbing the tongue indicate pathology in the Qi level, not the Blood level. Pointing to the heart and grabbing the tongue signifies severe toxin and urgent condition, requiring urgent treatment. A small dose of Mung Bean would be like a drop of water on a cartload of burning firewood. Decocting with gentle fire directs medicinal properties to the Lower Jiao; vigorous fire directs them to the Upper Jiao. Hence, vigorous fire and clear decoction are suitable. Clarifying and cooling the administration aligns with the principle of "using cold away from cold"—here implying that although heat-toxin is in the Upper Jiao Qi level, hot administration would conflict with the pathological heat; cold administration harmonizes with the condition.) Luo Yuankui from Wuzhou suddenly developed chills and fever in summer, followed by vomiting and inability to stand. He reported unbearable pain in the groin. Meng Ying examined the painful area, which was red, swollen, and hard, resembling a soap pod, protruding horizontally to the left of the pubic hair line. He said, "This condition is quite malignant, but since it is in the initial stage, it can be eliminated with a single strike." He prescribed Liu Jin Hua (Lonicerae Japonicae Flos) 6 liang, Sheng Gan Cao (Raw Licorice Root) 1 liang, and Zao Jiao Ci (Gleditsiae Spina) 5 qian, decocted in water and taken with wine. The intensity decreased after one dose, and the illness vanished after two doses. (The first three sentences regarding sudden chills and fever indicate pathology in the Qi level; the four sentences regarding unbearable groin pain indicate pathology in the Blood level. This case involves Blood pathology affecting Qi; the root is in Blood, the branch is in Qi. If treating Blood neglects Qi, both root and branch are lost. If treating only Qi, it contradicts the fundamental pathology. "This condition is quite malignant" implies urgent treatment for acute conditions and specific treatment for lateral deviations. Acute illnesses often involve Heat and Excess patterns. Liu Jin Hua treats Blood-Heat and Blood-Stasis as the sovereign herb. Any pathology leaning towards Yang inevitably lacks Yin. Moreover, Blood-Heat harms Qi; if Qi does not descend, Qi is not regulated, and neither is Blood. Therefore, Sheng Gan Cao 1 liang is used to moderate the middle and protect Yin, storing the basis for sweating. Zao Jiao Ci in small amounts releases exterior pathogens; in large amounts disperses exterior pathogens. Liu Jin Hua and Sheng Gan Cao moderate the upper and middle to enter the Blood level; Zao Jiao Ci 5 qian decocted with wine guides the sweet-cold Liu Jin Hua and Sheng Gan Cao up to the Qi level, combining ascending and descending. Wine guides Liu Jin Hua into the Blood level to cool Blood and dissipate stasis. Old wine taken with the medicine: 1 liang is appropriate, half for sorghum wine.) The following year, he contracted Shang Han (Cold Damage). Meng Ying felt his pulse was extremely empty and fine, saying, "It is impossible to merely attack the pathogen here, as the Yin division is too deficient." He applied Jing Yue's method, prescribing Shu Di Huang (Prepared Rehmanniae Radix), Dang Gui (Angelicae Sinensis Radix), Jiu Chao Bai Shao (Wine-fried Paeoniae Radix Alba), Zhi Gan Cao (Honey-fried Licorice Root), Ju Pi (Citri Reticulatae Pericarpium), and Chai Hu (Bupleuri Radix). One dose resulted in recovery. (In this case, the Yang within Yin is also deficient, hence Dang Gui and Chao Shao are included. Yu Jiayan's *Yi Men Fa Lü* discusses treating diseases as one-third internal injury and seven-tenths external contraction. External contraction is heavy; seven-tenths internal injury and three-tenths external contraction make internal injury heavy. This is truly a compass for generations. Meng Ying benefited greatly from Yu Jiayan. Physicians today treat Shang Han with pages of warming and dispersing, ignoring internal injury, harming countless people. Appropriate dosages: Chao Shu Di Huang (Fried Prepared Rehmanniae Radix) 1 liang, soaked in boiling water, strained, and the water used to decoct other herbs. Dang Gui Shen (Body of Angelicae Sinensis Radix) 3 qian, Jiu Chao Bai Shao (Wine-fried White Peony Root) 1.5 qian, Zhi Gan Cao (Honey-fried Licorice Root) 3 qian, Ju Pi (Tangerine Peel) 1.5 qian, Chai Hu (Bupleuri Radix) 3 qian. Ju Pi and Chai Hu are added subsequently.)
A certain person chronically suffered from belching (Yi Qi). Whenever his body felt slightly unwell, the symptom would occur, sounding loud and frequent. In winter of the Wuzi year, it was most severe, causing unbearable suffering. Meng Ying said, "This is declining Yang Qi with turbid Yin counterflow." He first administered Li Zhong Tang (Regulate the Middle Decoction) for one dose, followed by Xuan Fu Dai Zhe Tang (Inula and Hematite Decoction). The patient recovered. Subsequently, every time it recurred, following this method yielded efficacy. (Belching has two types: one due to Yang deficiency, the other due to pathogenic excess. This case identifies Yang deficiency in the loudness/frequency and winter exacerbation. The lung is like a bell; striking it makes it ring, indicating pathogenic obstruction; an empty bell rings, indicating Qi deficiency obstructed by excess pathogens. If belching were due to lung obstruction by excess pathogens, it could not be both loud/frequent and worst in winter. Winter exacerbation occurs because deficient Clear Yang leads to deficient defensive Yang, which fails to fill the skin/hair, making winter cold easily trigger it. Turbid Yin counterflow results from declining Yang Qi. Treatment should focus solely on Yang decline. Qi belongs to Yang; Qi rises due to deficiency. Tonifying Yang causes Qi to settle in the Dantian, stopping counterflow. First taking Li Zhong Tang addresses Yang deficiency causing illness; both Spleen and Kidney Yang must be sufficient for normal middle Qi ascent/descent. Following with Xuan Fu Dai Zhe Tang applies the classic principle of "treating upper disease by taking from below"; turbid Yin counterflow means Yang does not return to Yin, so Dai Zhe Shi (Hematitum) guides Ren Shen's power downward to calm floating Yang. For Li Zhong Tang: Tu Chao Lu Dang Shen (Earth-fried Codonopsis Radix) 5 qian, Chao Bai Zhu (Fried Atractylodis Rhizoma) 3 qian, Chao Gan Cao (Fried Licorice Root) 2 qian, Chao Nong Fu Pian (Fried Thick Aconite Slice) 3 qian, Chao Gan Jiang (Fried Dried Ginger) 4 qian. For Xuan Fu Dai Zhe Tang: Tu Chao Lu Dang Shen (Earth-fried Codonopsis Radix) 5 qian, Tu Chao Gan Cao (Earth-fried Licorice Root) 2 qian, Zhi Ban Xia (Prepared Pinellia Tuber) 3 qian, replace raw Sheng Jiang (Fresh Ginger) with Wei Jiang (Baked Ginger) 3 qian, Da Zao (Jujubae Fructus) 1 piece, Cu Zhen Zhe Shi (Vine-processed Hematitum) 3 qian, Xuan Fu Hua (Inulae Flos) 1.5 qian. Da Zao and Zhe Shi should be calcined first; Ban Xia and Xuan Fu Hua added subsequently.) Another patient suffered from Yin deficiency with flaming fire, presenting with a red face constantly resembling drunkenness. Meng Ying prescribed a single-herb Yuan Shen Tang (Scrophulariae Decoction), with miraculous efficacy, verified repeatedly. (Syndrome differentiation lies in the character "constantly" in "face red constantly resembling drunkenness." Appropriate dosage: Chao Yuan Shen Pian (Fried Scrophulariae Radix Slices) 1 liang, soaked in boiling water, strained, and taken warm in divided doses.)
Ye Dianhe contracted a cold in autumn. Ten days later, he sweated and became comatose/dizzy. Doctors were helpless. Meng Ying analyzed, "Compared to constitutional True Yin deficiency, excessive use of ascending and dispersing agents is similar to mistakenly inducing sweating in Shaoyin Cold Damage. Exhaustion below leads to reversal above. How can this be compared to collapsing Yang, leading to death faster by using Fu Zi and Gui Zhi?" He prescribed a large dose of Yuan Shen (Scrophulariae Radix), Di Huang (Rehmanniae Radix), Zhi Mu (Anemarrhenae Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), Bai Shao (Paeoniae Radix Alba), Huang Lian (Coptidis Rhizoma), Fu Ling (Poria), Xiao Mai (Tritici Fructus), Gui Ban (Carapax et Plastrum Testudinis), Bie Jia (Carapax et Plastrum Trionycis), Mu Li (Concha Ostreae), and E Jiao (Colla Corii Asini). The patient recovered. ("Ten days later sweating and coma" is key. Sweating/coma ten days after onset differs from immediate onset. Initially, ascending/dispersing agents were used, but True Yin was not exhausted, so sweating did not lead to coma. Having taken these agents for ten days, a constitutionally Yin-deficient person has exhausted Yin through劫夺 (plundering). Upper reversal and coma are evident. Urgent condition requires urgent treatment. Yuan Shen Pian 1 liang, Da Shu Di 8 qian, soaked in boiling water together, strained, water used to decoct. Chao Zhi Mu 1 qian, Chuan Ya Lian 0.5 qian, Sheng Gan Cao 3 qian, Zheng Bai Shao 4 qian (pounded), Yun Ling Pian 3 qian, Bei Xiao Mai 4 qian (pounded), Xue Gui Ban 1 liang, Xue Bie Jia 2 liang, Mu Li 4 qian (all pounded). E Jiao 2 qian stewed separately and mixed in. Bai Shao, Xiao Mai, Gui Ban, Bie Jia, Mu Li simmered together for six hours. Sweat is Yin fluid; exhaustion below leads to reversal above, focusing on treating exhaustion below. Yuan Shen and Di Huang nourish Yin to stop sweating; Zhi Mu and Huang Lian slightly drain heat injuring Yin. Below exhaustion/above reversal, wind-fire boiling; Sheng Gan Cao and Bai Shao combined slow the raging fire. Yin injury damages Yang; damaged Yang cannot allow Yin-moistening medicines to act alone, hence Fu Ling stabilizes the center. Northern earth nature is sweet/cold; Bei Xiao Mai blooms at night, husk cools skin. Once sweat stops, Yin gradually restores. Gui Ban, Bie Jia, Mu Li are called "Three Shells," best at subduing floating Yang. Coma follows sweating; higher Yang leads to greater Yin exhaustion; subdued Yang stops sweat, preventing coma. Yuan Shen and Di Huang soaked/decocted/strained to avoid cloying; Three Shells decocted longer turn black, seeking sinking/astringent properties, also applying "treating upper disease from below.")
Zhao Zisheng suffered malaria in summer. Meng Ying was urgently consulted, stating, "This is caused by Summer-Heat Heat, not adhering rigidly to Xiao Chai Hu Tang." He gave Bai Hu Tang (White Tiger Decoction), and the patient improved after one sip. (This case must present with red face, profuse sweating, desire for cold drinks, red tongue, rapid pulse forceful upon deep pressure. Sheng Shi Gao (Raw Gypsum Fibrosum) 1 liang decocted first, Jiu Chao Zhi Mu (Wine-fried Anemarrhenae Rhizoma) 3 qian. Original Gan Cao and Geng Mi should be removed; add Xian Zhu Ye (Fresh Bamboo Leaf) 2 qian, Hei Zhi Pi (Black Gardenia Skin) 3 qian, Dong Gua Pi (Winter Melon Peel) 3 qian, Sheng Dong Gua Zi (Raw Winter Melon Seed) 4 qian, Xian He Jing (Fresh Lotus Stem) 1 chi 5 cun.) Fan Limen suffered Warm Malaria. Meng Ying cured him with Bai Hu Jia Gui Zhi Tang (White Tiger plus Cinnamon Twig Decoction). (Sheng Shi Gao 6 qian decocted first, Jiu Chao Zhi Mu 1.5 qian, Chuan Gui Zhi 0.4 qian, remove Gan Cao/Geng Mi, add Si Gua Luo 3 qian, Wan Can Sha 3 qian, Ku Xing Ni 1 qian, Chen Xiang Ru 0.5 fen. Gui Zhi, Xing Ren, Xiang Ru added subsequently.) Sheng Shaoyun suffered Damp-Heat Malaria in summer. Meng Ying stabilized him with Bai Hu Tang plus Cang Zhu Tang (White Tiger plus Atractylodes Decoction). (Although dampness transformed into heat, it remains related to dampness. Sheng Shi Gao 5 qian decocted first, Jiu Chao Zhi Mu 1.5 qian, Sheng Mao Cang Zhu 2 qian, remove Mi Cao, add Yun Fu Ling 1.5 qian, Sheng Yi Ren 3 qian, Xian He Ye 3 qian, Xian Lu Gen 3 qian.) Another patient suffered malaria in summer. After taking Chai Hu medicine for 2-3 doses, he sweated, fainted, spoke deliriously, and lost urine control. Meng Ying felt his pulse was surging, large, slippery, and rapid, stating, "Yangming Summer-Heat Malaria, consistent with San Yang Combined Disease in Cold Damage." He prescribed Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction), recovering after two doses. (This must be a Yin-deficient constitution; Chai Hu Tang plunders sweat and injures Yin. Sweating/fainting/delirium: stomach region is close to Heart; Stomach Heat invading Heart causes delirium. Urinary incontinence: Lung and Stomach are close; Heat injuring Stomach injures Lung. Lung governs Qi mechanism ascent/descent; Lung Yin injured by Heat causes Lung Yang to lose dissemination/control, hence incontinence. Surging/large pulse indicates Yin deficiency; slippery/rapid indicates Heat Excess. Sheng Shi Gao 8 qian decocted first, Jiu Chao Zhi Mu 2 qian, Sheng Gan Cao 3 qian, remove Geng Mi, add Mai Dong 3 qian, Bei Sha Shen 4 qian, Xian Zhu Ye 2 qian, Hei Zhi Pi 3 qian, Dong Gua Pi 3 qian, Wan Can Sha 3 qian, Chao Ku Xing Ren and Yun Fu Ling 1.5 qian each.) Huang Xiaonong suffered Summer-Heat Malaria. Meng Ying prescribed Bai Hu Tang plus Xi Yang Shen (American Ginseng), recovering after several doses. (Summer-Heat injures Yin. Sheng Shi Gao 8 qian decocted first, Jiu Chao Zhi Mu 2 qian, Xi Yang Shen 3 qian, remove Mi Cao, add Yuan Shen Pian 3 qian, soaked in boiling water/strained, Xian He Geng 3 qian, Xian Lu Gen 5 qian, Dong Gua Pi 3 qian, Wan Can Sha 3 qian, Xian Mao Gen 3 qian, Ku Xing Ni 1 qian, Chen Xiang Ru 0.5 fen.) Gu Weiwu's wife suffered Dan Malaria. Meng Ying also prescribed this formula with effect. Zhuang Zhijie's wife, over sixty, had intense Phlegm-Heat. Meng Ying examined her carefully and prescribed Zhu Ye Shi Gao Tang, stabilizing her. (Humans have Yin/Zang and Yang/Zang constitutions; physicians must know this. Over sixty with intense Phlegm-Heat must be Yang Zang, also called Yang-leaning constitution. Sheng Shi Gao 1 liang decocted first, Jiu Chao Zhi Mu 3 qian added subsequently, Xian Zhu Ye 2 qian, remove Mi Cao, add Chen Dan Xing 1 qian stewed/mixed in, Jiu Jie Pu 6 fen powdered added subsequently, Chuan Bei Mu 3 qian, Jiang Zhu Ru 3 qian, Sheng Dong Gua Zi 4 qian, Hei Zhi Pi 3 qian, Xian He Jing 3 qian, Ku Xing Ni 0.5 qian.)
Fan Weiran contracted a cold in August for over ten days. Doctors were helpless. Meng Ying treated him, observing shortness of breath, faint voice, hiccups, spontaneous sweating, drinking water swallowed then immediately vomited out. He said, "Latent Summer-Heat in the Lung, likely exacerbated by warming/dispersing. Lung Qi diseased, regulation fails, whole-body Qi loses smooth descent mechanism. Even distribution of fluids relies on clear/descending authority. Qi rebels upward, Water floods upward. Only clearing the Lung resolves all ailments." Reviewing previous prescriptions: initially Chai Ge Qiang Fang lifted Qi, Fire borrowing Wind's power caused persistent vomiting/regurgitation. They thought Cold in Stomach, switched to Gui Zhi Gan Jiang to warm/dry, adding Oil to Fire, Lung fluids nearly exhausted, naturally causing shortness of breath/faint voice, suspecting collapsing Yang. They directly used Shen Gui Ge Jie Shi Di Ding Xiang to tonify/nourish, but more tonification led to more rebellion, pathogen trapped, cure difficult. Quickly discard previous meds, use Xie Bai San combined with Qing Zao Jiu Fei Tang, recovered after several doses. (Argument complete in original case. Sheng Sang Bai Pi 3 qian, Di Gu Pi 4 qian, Sheng Gan Cao 3 qian, remove Geng Mi, add Jiang Chao Chuan Lian 0.8 fen, Bei Sha Shen 8 qian, Hua Mai Dong 3 qian, Dong Sang Ye 4 qian, Ku Xing Ni 1.5 qian, Xian Pi Pa Ye 3 qian wrapped, Qing E Jiao 2 qian stewed/mixed in.)
Old Man He, near eighty, caught a cold in winter, presenting with red face, rebellious Qi, irritability, and restlessness. Meng Ying said, "This is what Yu Jiayan calls Dai Yang Syndrome in catching a cold. Do not ignore it." He prescribed Dong Yang Shen, Xi Xin, Zhi Gan Cao, Shu Fu Pian, Bai Shao, Fu Ling, Gan Jiang, Wu Wei Zi, Hu Tao Rou, Xi Cha, Cong Bai. One dose recovered him. Meng Ying said, "True Yang is constitutionally deficient, Phlegm-Fluid moves internally, Defensive Yang not solid, Wind Pathogen enters externally, root threatens to pull out. Mistakenly using exterior dispersants caused one sweat to collapse Yang. Thus, Zhen Wu and Si Ni methods restore Yang, calm Fluids, repel exterior, secure interior. Not applicable to Yang-Excess/Pathogen-Excess Shang Han." (Dai Yang is Yang outside/Yin inside, Exterior Excess/Internal Deficiency, red face/rebellious Qi/irritability/restlessness. Meng Ying diagnoses Dai Yang only if pulse is powerless upon deep pressure and patient dislikes cold drinks. Gao Li Shen 3 qian, Bei Xi Xin 0.8 fen added subsequently, Chao Gan Cao 3 qian, Shu Fu Pian 5 qian, Chao Bai Zhu 3 qian, Jiu Chao Bai Shao 1.5 qian, Bai Fu Ling 3 qian, Chao Gan Jiang 4 qian, Bei Wu Wei Zi pounded first 3 qian, Lian Yi Hu Tao Rou 5 qian decocted first, Chen Xi Cha 1 qian, Lian Xu Xian Cong Bai 3 qian, tube removed added subsequently. Ginger/Aconite dosage heavier than Shen/Fu Ling/Bai Zhu/Gan Cao allows Si Jun to move Yang tonification without stagnation. Xi Xin guides drugs to Lower Jiao; Gan Jiang + Si Jun anchors center; Wu Wei Zi/Hu Tao subdue floating Yang; Hu Tao moistens obtaining Yin within Yang, resolving condition pleasantly. Bai Shao/Xi Cha act as counter-agents; Cong Bai treats Shang Han correctly.)
Another patient suffered malaria in autumn, severely misdiagnosed by doctors. Initially exterior dispersing, then tonifying/nourishing. Lasted over a month, muscles wasted, chills/fever unceasing, prone to vomiting, aversion to food, clear urine, fear of cold. Meng Ying diagnosed, "Taiyin Damp Malaria." Prescribed Jin Bu Huan Zheng Qi San, recovered after three doses. (Recent cause of illness is error in tonification; tonification traps excess pathogens, wasting muscles, unceasing chills/fever. Tonification destroys Spleen Yang, hence vomiting/aversion to food/clear urine/cold fear. Jiang Zhi Mao Cang Zhu 5 qian, Jiang Zhi Gen Po (bark removed) 3 qian, Guang Huo Geng 2 qian, Lai Shi Chen Pi 2 qian (added subsequently), Jiang Zhi Ban Xia Mi 8 qian.)
Zhong Yaohui, over sixty, suffered edema in the capital, starting from scrotum, rebellious Qi, loose stools, various treatments failed. Meng Ying treated him, feeling his pulse micro...