族兄奏韩，年逾四旬，外腴内亏，邪乘虚入，寒热咳嗽，头身疼痛，脉大无力。予初投
温散
不解，转用补中益气汤加姜枣，辅正托邪。语其侄曰∶令叔病候不轻，慎勿泛视。旁人以为
病轻药重，更医漫不为意，迁延数日，势渐鸱张。延同道余朗亭先生延医，不肯立方，既而
曰∶程某现居比邻，胡不邀来同议。乃复相招，观其病状增剧，面红目赤，舌黑唇焦，神识
昏乱，脉息豁大空虚，势欲内陷。因与余君商，以壮中温托，伤六味回阳饮方法。无如渠家
皆系女流，其侄少不谙医理，或谓烦热，若此再投姜附，必致逾墙上屋。故此迟疑，药不敢
服。又复因循，病势更剧，再请余君不至，阖家张皇，其侄偕鲍履平兄来舍恳治，并乞扎邀
余君，予为作书余君始至。宾朋交集，时金融若兄在座，私谓予曰∶子可尽力举方，服药之
事，吾能任之。复与余君斟酌，仍用前方，融兄俟药煎熟，面督服下。次日神采稍回，脉象
渐敛，方除炮姜，加枸杞山萸，又服一剂，热退舌润。再将附子分两减半，加杜仲山药。继
进大补元煎，两月始康。
嘉庆甲子初秋，牧兄邀视伊芳母恙云，家慈年逾五旬，外腴内亏，病经八日，上热下冷，
痰多
汗少，咳嗽作呕。昔患淋痛，兹亦带发，医为散风清暑，治俱不应，又以为肝火，拟用龙胆
泻肝汤，求为决之。予曰∶淋证为本，感证为标，从本从标，当观病之缓急，未可臆断也。
比往诊视，脉细面青，身热足冷，时正酷热，病患犹盖毡被，舌苔白滑，胸腹胀闷，不饥不
渴。谓牧兄曰∶尊堂之病，乃寒湿内伏，加感外邪。治宜温中逐邪，淋痛无暇兼顾，方用苍
白二陈汤，加姜附、白蔻以温中燥湿，桂枝 、秦艽以彻其表。牧兄问服药以何为验?何期可
愈?予曰∶伤寒以舌为凭，舌苔退净，病邪自清，计非二候不可。初服舌苔稍退，再剂已退
其半，服至四剂，寒热全解，舌苔退净，淋痛亦止。惟腹闷食少，大便未行，次日忽便泻数
次，佥以伤寒漏底为虑。予曰∶无妨。仲圣云∶胃家实，秽腐当去也。方易六君子汤，加谷
芽苡仁泽泻神曲，健脾渗湿。三日内共泻二十余行，始得胸宽食进。越日忽又发热，诊脉浮
大。予曰∶此复感也。牧兄曰∶病患日来俱卧帐中，邪何由入。予曰∶想因日前便泻，夜间
下床，恙久体虚，易于感耳。仍用六君子汤，加姜附秦艽，一服即平。
族兄程奏韩，年龄超过四十岁，外表丰腴但体内正气亏虚，邪气趁虚而入，出现寒热往来、咳嗽、头痛及全身疼痛的症状，脉象宏大但按之无力。我起初使用温散法治疗，病情未解；随后改用补中益气汤加入生姜和大枣，以扶助正气、托举邪气外出。我对他的侄子说：“令叔的病情并不轻浅，切勿轻视。”旁人认为病轻药重，便更换医生，漫不经心，拖延了数日，病情逐渐加重。后来请同道余朗亭先生诊治，他不愿开方，过了一会儿说：“程某就住在隔壁，为何不邀请他来共同商议？”于是再次邀请我，我观察到他病情加剧，面色红赤、眼睛发红、舌苔发黑、嘴唇焦裂，神志昏乱，脉搏豁大而空虚，病势有内陷的趋势。我便与余君商量，采用壮中温托的方法，参考伤六味回阳饮的组方思路。无奈他家眷皆为女性，其侄子年少不懂医理，有人担心烦热症状，认为若再投用姜、附等大热之药，必会导致患者躁动不安（如逾墙上屋）。因此他们犹豫不决，不敢服药。又因循延误，病情更加严重，再次请余君，他不到场，全家惊慌失措。其侄子偕同鲍履平兄来到我家恳求诊治，并请求写信邀请余君，我为余君写了信，他才最终到来。宾客亲友聚集在一起，当时金融若兄也在座，私下对我说：“你可以尽力开出处方，服药的事情，我来承担责任。”我又与余君斟酌，仍沿用前面的方剂。金融若兄等候药煎好后，当面督促服用。第二天，患者的神采稍恢复，脉象逐渐收敛，于是去掉炮姜，加入枸杞子和山茱萸，又服一剂，热退舌润。再将附子的用量减半，加入杜仲和山药。继而又进服大补元煎，两个月后才痊愈。
嘉庆甲子年初秋，牧兄邀请我去看他母亲的病。他说家母年过五十，外表丰腴内部亏虚，患病八天，表现为上热下冷，痰多汗少，咳嗽且作呕。她过去患有淋证疼痛，此时也发作了。之前的医生用散风清暑法治疗，无效；后又认为是肝火，拟用龙胆泻肝汤，来征求我的意见。我说：“淋证是本，外感是标，从本治还是从标治，应当观察病情的缓急，不可主观臆断。”等到我去诊视时，发现脉象细弱、面色青暗，身体发热但脚冷，当时正值酷暑，病人却还要盖着毡被，舌苔白滑，胸腹胀闷，没有饥饿感也不口渴。我对牧兄说：“尊堂的病情，是寒湿内伏，加上感受外邪。治疗应当温中逐邪，淋痛暂时无暇兼顾。方药用苍白二陈汤，加入生姜、附子、白蔻仁以温中燥湿，桂枝、秦艽以解除表邪。”牧兄问服药后以什么为见效的标准？大概多久能痊愈？我说：“伤寒病以舌象为依据，舌苔退净，病邪自然清除，估计需要两个候（十天）的时间。”初服后舌苔稍退，再服已退去一半，服到第四剂，寒热全解，舌苔退净，淋痛也停止了。只是腹部闷胀、食欲不佳，大便未行。第二天忽然腹泻数次，大家都担心这是伤寒病的“漏底”现象（指真寒假热或误下导致的滑脱不禁）。我说：“不要紧。仲景说过：‘胃家实，秽腐当去也’。”于是方药改为六君子汤，加入谷芽、薏苡仁、泽泻、神曲，以健脾渗湿。三天内共腹泻二十多次，才感到胸部宽舒、食欲增进。过了几天忽然又发热，诊脉浮大。我说：“这是再次感受外邪。”牧兄说：“病人这几天都躺在帐子里，邪气从哪里进来呢？”我说：“想必是因为前几天腹泻，夜间下床，病久体虚，容易受邪侵袭。”仍然使用六君子汤，加入生姜、附子、秦艽，一服药后即平复。
Zu Xiong (Elder Brother of the same clan) Zou Han, aged over forty, appeared robust externally but was deficient internally. Pathogenic factors entered taking advantage of this deficiency, resulting in alternating chills and fever, cough, headache, and body pain. The pulse was large but powerless upon pressure. I initially prescribed a warming and dispersing method, but there was no improvement. I then switched to Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with added ginger and jujube, to support healthy qi and expel pathogenic factors. I told his nephew: "Your uncle's condition is not light; do not overlook it." Others thought the illness was mild and the medication too heavy, so they changed doctors and paid little attention. After several days of delay, the condition gradually worsened. They invited Mr. Yu Langting, a colleague, for consultation. He refused to prescribe medicine, saying later, "Mr. Cheng lives next door; why not invite him to discuss together?" Thus, I was invited again. Observing that the symptoms had intensified—red face, red eyes, black tongue coating, cracked lips, confused consciousness, and a pulse that was wide, large, empty, and hollow—I realized the pathogen was about to sink inward. I consulted with Mr. Yu and decided to use a method of strengthening the middle and warming to support the body, referencing the formula Shang Liu Wei Hui Yang Yin (Six-Ingredient Decoction to Restore Yang from Injury). However, his household consisted mainly of women, and his young nephew did not understand medical principles. Some worried about the irritant heat, fearing that administering ginger and aconite would cause the patient to become restless and agitated ("climb walls and roofs"). Therefore, they hesitated and dared not administer the medicine. Due to further delay, the condition worsened. When they tried to invite Mr. Yu again, he did not come, causing panic in the family. The nephew, accompanied by Brother Bao Liping, came to my house to plead for treatment and requested that I write to invite Mr. Yu. I wrote the letter, and Mr. Yu finally arrived. Guests and friends gathered. At that time, Brother Jin Rongruo was present and whispered to me privately: "You can prescribe freely; I will take responsibility for the administration of the medicine." I deliberated with Mr. Yu again, deciding to stick to the previous prescription. Brother Jin waited until the medicine was decocted and supervised its ingestion personally. The next day, the patient's spirit slightly recovered, and the pulse began to consolidate. We removed prepared ginger and added Gouqi (Lycium Fruit) and Shanzhuyu (Cornus Fruit), administering another dose. The fever subsided, and the tongue became moist. We then halved the dosage of Fuzi (Aconite Root Lateralis Preparata) and added Duzhong (Eucommia Bark) and Shanyao (Dioscorea Rhizome). Subsequently, we administered Da Bu Yuan Jian (Great Tonifying Decoction), and after two months, the patient fully recovered.
In early autumn of the Jiazi year of the Jiaqing reign, Brother Mu invited me to examine his mother. He stated that his mother, aged over fifty, appeared robust externally but was deficient internally. She had been ill for eight days, presenting with upper heat and lower cold, excessive phlegm, scanty sweating, cough, and vomiting. She had a history of painful stranguria (Lin syndrome), which had recurred. Previous physicians treated her with wind-dispersing and summerheat-clearing methods without success; later, they suspected Liver Fire and proposed Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction), seeking my judgment. I said: "Stranguria is the root, while the external contraction is the branch. Whether to treat the root or the branch depends on the urgency of the condition; one cannot make arbitrary judgments." Upon examination, her pulse was fine, her complexion was greenish-dark, her body was hot but her feet were cold. Despite the intense summer heat, she still covered herself with felt blankets. Her tongue coating was white and slippery, her chest and abdomen were distended and stuffy, and she had no appetite nor thirst. I told Brother Mu: "Your mother's condition is due to internal latent cold-dampness compounded by an external pathogenic invasion. Treatment should focus on warming the middle and expelling pathogens. The painful stranguria cannot be addressed simultaneously at this stage. The prescription is Cang Er Chen Tang (Atractylodes and Pinellia Two-Ingredient Phlegm-Resolving Decoction) modified with ginger, aconite, and Amomum fruit to warm the middle and dry dampness, along with Guizhi (Cinnamon Twig) and Qinjiao (Gentiana Macrophylla Root) to resolve the exterior." Brother Mu asked what signs would indicate efficacy and when she could expect recovery. I replied: "In Shaoyin/Taiyang diseases, the tongue is the key indicator. Once the tongue coating clears completely, the pathogen will naturally dissipate. This will likely take ten days (two 'hou')." After the first dose, the tongue coating slightly receded; after the second dose, half had cleared; by the fourth dose, chills and fever resolved completely, the tongue coating disappeared, and the stranguria ceased. However, abdominal fullness persisted, appetite remained poor, and bowel movements had not occurred. The next day, she suddenly experienced diarrhea several times. Everyone worried this was "Lou Di" (leakage at the bottom/slippage) associated with Cold Damage. I said: "No harm. As Master Zhongjing stated: 'When the stomach house is full, foul and rotten matter must be expelled.'" I changed the prescription to Liu Jun Zi Tang (Six-Gentlemen Decoction) with added Coix Seed, Ze Xie (Alisma Rhizome), Shen Qu (Medicated Leaven), and Gu Ya (Sprouted Grain) to strengthen the spleen and leach out dampness. Within three days, she defecated more than twenty times, after which her chest felt open and appetite returned. A few days later, she suddenly developed a fever, and her pulse was floating and large. I said: "This is a secondary infection." Brother Mu asked: "The patient has been lying in bed under curtains all these days; how could the pathogen enter?" I replied: "It is likely that due to the recent diarrhea, she got out of bed at night. Having been ill for a long time, her body is weak and susceptible to invasion." I used Liu Jun Zi Tang again, adding ginger, aconite, and Qinjiao. One dose brought immediate relief.