嘉庆辛酉夏，立翁幼孙，伤暑发热，吐泻不止，神烦体躁，唇赤舌黄，口渴欲饮，饮后
即吐
。诊脉沉伏，手冷过肘，足冷过膝，料非寒厥。欲投凉剂，恐其吐泻，脾胃受伤，拟用六君
子汤，除白术加川连木瓜黄土稻花，安脾胃，祛暑邪。服药不效，维时赤日当空，暑气正酷
，偶见庭前花卉，枝叶枯萎，童子汲水溉之。因悟病机，乃与生脉地黄汤一服，吐泻即止，
再服，脉出肢温，未及旬而愈。思前脉伏肢厥者，乃童真未充，吐泻日频，津液顿伤，脉乃
血派，脾主四肢，脾不能为胃行其津液，四肢不得禀水谷之气故也。六味大培真阴，生脉保
金化液，小儿脏气易为虚实，是以效速。
噎隔一病，古人论之甚详，尚有似隔非隔之证，犹未言及。文兄令堂年届四旬，病经数
月，
初时不能食饭，后并米饮俱不能咽，强之即吐，隔证无疑。然每日尚可啖干面 数枚，思古
人论隔证，不出胃脘枯槁四字。又称阳气结于上，阴液衰于下，今既不能食饭，何独能食面
?且饮汤即吐，干食反安，理殊不解，与逍遥散，数服不应。考《张氏医通》有饮鹅血法，
行之又不验，更医多方图治，亦不效，因劝勿药，两载后可食面汤并精猪肉。今十余年，肌
肉不瘦，起居如常，亦奇证也。
郑鹤鸣，君平之流，冬月适患伤寒，初起寒热身痛，不以为意。延挨数日，陡然肢冷，
脉伏肌肉青紫，面赤烦躁，呃逆频频，请同道曹肖岩翁诊视，询知系欲事后起病，以为少阴
下亏
，寒邪乘之，逼其真阳外越，与六味回阳饮。服之不应，势已濒危，邀予商酌。予曰∶景岳
回阳二方，皆能救急，其中尚有分别。夫寒中阴经，审其阴阳俱伤，而病尚缓者，则从阴阳
两回之法。苟真阳飞越，重阴用事，须取单骑突入重围，搴旗树帜使，既散之阳，望帜争趋
。若加合阴药，反牵制其雄入之势。定方单用姜附参草四味，煎令冷服，外用葱艾炒热熨脐
，老姜附子皮煮汁蒸洗手足，于是一昼夜厥始回，脉始出，惟呃未止，每呃必至百声，知为
肾气上冲，于前药中参以熟地枸杞五味丁香，摄纳真元。诸恙渐减，改用右归饮，与服二日
，目辣舌燥，投六味地黄汤，浮阳顿平。复为调理脾胃及脾肾双补而起。
嘉庆辛酉年夏季，立亭老先生的幼孙，因感受暑邪而发热，呕吐腹泻不止，神情烦躁、身体躁动不安，嘴唇发红、舌苔发黄，口渴想喝水，但喝完水后立即呕吐。诊察脉搏沉伏，手脚冰冷超过肘部和膝盖，推测并非寒厥证。本想投用凉性药剂，又担心其呕吐腹泻会损伤脾胃，于是拟定使用六君子汤，去掉白术，加入黄连、木瓜、灶心土和稻花，以安顿脾胃、祛除暑邪。服药后无效，当时烈日当空，暑气正盛，偶然看见庭院前的花卉枝叶枯萎，童子汲水浇灌它们。由此领悟到病机所在，于是给予生脉地黄汤一剂，呕吐腹泻立即停止，再服用后，脉搏显现、四肢转温，不到十天便痊愈了。回想之前脉象伏匿、四肢厥冷的情况，是因为孩童先天元气未充，加上频繁呕吐腹泻，津液突然受损。脉是血的通道，脾主四肢，脾不能为胃输送津液，导致四肢无法获得水谷精微之气。六味地黄丸大补真阴，生脉散保肺化生津液，小儿脏腑之气容易虚实变化，所以见效迅速。
噎隔这一疾病，古人论述得很详细，但还有似噎非噎的证候，尚未提及。文彩兄的母亲年届四十，患病几个月，起初不能吃米饭，后来连米汤都咽不下去，强行喂食就会呕吐，显然是噎隔证。然而每天还可以吃几块干面条，思考古人论噎隔证，离不开“胃脘枯槁”四个字。又说阳气结滞于上，阴液衰少于下，现在既然不能吃米饭，为什么唯独能吃面条？而且喝汤就吐，吃干食反而安稳，道理非常令人不解，给予逍遥散，服用几剂没有反应。查阅《张氏医通》有饮用鹅血的方法，施行后又不灵验，更换医生多方治疗，也不见效，于是劝她不要服药，两年后可以吃面汤和瘦猪肉。如今十多年过去了，肌肉没有消瘦，起居如常，也是奇证。
郑鹤鸣，是君平一类的人，冬天恰好患伤寒，初起时恶寒发热、身体疼痛，不以为意。拖延数日，突然四肢冰冷，脉搏伏匿、肌肉青紫，面色红赤、烦躁不安，呃逆频频，请同道曹肖岩老先生诊视，询问得知是在房事后发病，认为是少阴肾精亏虚，寒邪乘虚而入，逼迫真阳外越，给予六味回阳饮。服用后没有反应，病情已接近危重，邀请我商量对策。我说：景岳的回阳二方，都能救急，其中还有区别。如果寒邪中于阴经，审察其阴阳俱伤，且病情尚缓的，则采用阴阳双回的方法。假如真阳飞越，重阴用事，必须采取单骑突入重围、搴旗树帜的策略，使已经散失的阳气，看到旗帜争相趋附。如果加入合阴的药物，反而会牵制其雄健深入的气势。于是定方单独使用干姜、附子、人参、甘草四味药，煎好后冷服，外用葱白、艾叶炒热熨烫肚脐，老姜、附子皮煮汁蒸洗手足，于一昼夜后厥冷才开始恢复，脉搏才开始显现，只有呃逆未止，每次呃逆多达百声，知道是肾气上冲，在前药中加入熟地、枸杞、五味子、丁香，以摄纳真元。各种症状逐渐减轻，改用右归饮，服用两天后，眼睛辣、舌头干燥，投用六味地黄汤，浮阳顿时平息。随后调理脾胃及脾肾双补而痊愈。
In the summer of Xinyou year during the Jiaqing reign, the young grandson of Mr. Liting suffered from heatstroke (Shangshu) with fever, incessant vomiting and diarrhea, mental restlessness and physical agitation, red lips, yellow tongue coating, thirst with desire to drink, but immediate vomiting after drinking. The pulse was deep and hidden (Chen Fu), with cold hands extending past the elbows and cold feet extending past the knees; it was deduced that this was not Cold Jue (Han Jue). Although one wished to administer cooling agents, there was concern that vomiting and diarrhea would damage the Spleen and Stomach. Thus, Liu Jun Zi Tang (Six Gentlemen Decoction) was proposed, removing Bai Zhu (Atractylodis Rhizoma), adding Huang Lian (Coptidis Rhizoma), Mu Gua (Chaenomelis Fructus), Zao Xin Tu (Caolistra Fossilia), and Dao Hua (Oryzae Spadix), to stabilize the Spleen and Stomach and dispel Summerheat. The medication proved ineffective. At that time, the sun blazed in the sky, and the Summerheat was intense. Seeing flowers and plants in the courtyard withered, and a child watering them, the pathogenesis was realized. Sheng Mai Di Huang Tang (Pulse-Generating Rehmannia Decoction) was administered. One dose stopped the vomiting and diarrhea; a second dose resulted in the emergence of the pulse and warming of the limbs, leading to recovery within ten days. Reflecting on the previous hidden pulse and limb Jue, it was due to the child's incomplete congenital essence. Frequent vomiting and diarrhea caused sudden injury to body fluids. The pulse is the pathway of blood; the Spleen governs the four limbs. When the Spleen cannot transport fluids for the Stomach, the limbs do not receive Qi from food and water. Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) greatly nourishes True Yin, while Sheng Mai San (Generate the Pulse Powder) protects Metal (Lung) and transforms fluids. Children's organ Qi is prone to deficiency and excess, hence the rapid effect.
The disease of Ye Ge (Dysphagia and Obstruction) has been discussed in detail by ancients, yet cases resembling obstruction without being true obstruction remain unmentioned. The mother of Brother Wencai, aged forty, had been ill for months. Initially, she could not eat rice; later, she could not even swallow rice water. Forcing food caused vomiting, confirming the diagnosis of Ye Ge. However, she could still eat several pieces of dry noodles daily. Ancients described Ye Ge as "withered and dried epigastrium," stating that Yang Qi knots above and Yin fluids decline below. If she could not eat rice, why could she eat noodles? Moreover, drinking soup caused vomiting, while dry food was tolerated. This was inexplicable. Xiao Yao San (Free and Easy Wanderer Powder) was given, but several doses were ineffective. Consulting *Zhang Shi Yi Tong* (Medical Insights by Zhang), the method of drinking goose blood was tried, but it failed. Other physicians attempted various treatments without success. It was advised to abstain from medicine; two years later, she could eat noodle soup and lean pork. Over ten years have passed, her muscles are not emaciated, and her daily life is normal; this is indeed a strange case.
Zheng Heming, a person of the Junping type, contracted Cold Damage (Shanghan) in winter. Initially presenting with aversion to cold, fever, and body pain, he disregarded it. After several days, his limbs suddenly became cold, the pulse hidden, muscles turned cyanotic, face red, irritability present, and frequent hiccups. Colleague Cao Xiaoyan examined him and learned the illness began after sexual intercourse. He diagnosed Kidney Essence deficiency at Shaoyin (Lesser Yin) with Cold Evil invading, forcing True Yang to float outward, and prescribed Liu Wei Hui Yang Yin (Six-Ingredient Decoction to Return Yang). It was ineffective, and the condition became critical. I was invited to consult. I stated: Jingyue's two formulas for returning Yang can both save emergencies, but they differ. If Cold invades Yin meridians, and both Yin and Yang are injured with a slow progression, the method of dual return of Yin and Yang should be used. However, if True Yang is flying away and Heavy Yin is dominant, one must adopt the strategy of a single rider charging into heavy encirclement, raising flags so that scattered Yang Qi converges upon seeing the flag. Adding Yin-nourishing drugs would restrain this vigorous momentum. Therefore, I prescribed only Gan Jiang (Zingiberis Rhizoma), Fu Zi (Aconiti Lateralis Radix Praeparata), Ren Shen (Ginseng Radix), and Gan Cao (Glycyrrhizae Radix), decocted and taken cold. Externally, Cong Bai (Allii Fistulosi Bulbus) and Ai Ye (Artemisiae Argyi Folium) were heated and applied to the umbilicus; Lao Jiang (Old Ginger) and Fu Zi Pi (Aconiti Lateralis Radix Cortex) decoction was used to steam and wash hands and feet. Within a day and night, the cold extremities recovered, and the pulse emerged. Only hiccups persisted, reaching up to a hundred times per episode, indicating Kidney Qi rushing upward. In the previous prescription, Shu Di Huang (Rehmanniae Radix Preparata), Gou Qi Zi (Lycii Fructus), Wu Wei Zi (Schisandrae Fructus), and Ding Xiang (Caryophylli Flos) were added to grasp and secure True Yuan. Symptoms gradually subsided. You Gui Yin (Right Restoration Decoction) was then used. After two doses, eyes felt spicy and tongue dry. Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Decoction) was administered, instantly calming floating Yang. Subsequent regulation of the Spleen and Stomach and dual tonification of Spleen and Kidney led to recovery.