薛立斋治地官胡成甫之内,妊娠久痢。自用消导理气之剂,腹内重坠,胎气不安。又用阿胶、艾叶之类不
应。薛曰∶腹重坠下,元气虚也;胎动不安,内热甚也。遂用补中益气而安,又用六君子汤全愈。(何以遗却内
热?薛氏用药不惬人意,往往如此。)
盛用敬治陈杰妻,有胎而患痢数月,昏厥六日矣,所下若室漏水,棺敛已俱。盛诊之曰∶无虑。药之,痢
止而胎动,越数日生一子。(《吴江县志》。)
孙文垣表侄女,孕已七月,患赤痢,腹痛后重,体素弱,以白芍三钱,条芩一钱五分,白术、地榆各八分,
甘草三分,二帖而愈。后因稍劳,痢复作,以当归三钱,川芎一钱五分,真阿胶二钱,艾叶三分,一帖全愈。
(此非积滞为痢,故治法如此。)
朱丹溪治八婶将产患痢,脉细弦而稍数,后重里急。用滑石三钱,白芍二钱,枳壳炒一钱五分,木通二钱,
甘草五分,白术二钱,茯苓一钱,桃仁九枚,研同煎。
马元仪治张氏妇,孕八月患痢,昼夜四五十行,腹痛,胎气攻逆,不思饮食。诊之,两关尺沉细,下半彻
冷,曰∶据证亦湿热成痢,但脉沉则为寒,微细则为虚,又下半彻冷,乃火衰于下,土困于中。五阳之火,敷
布于上,则水谷之气,顺趋而下,津液血脉不充,胎元失养而攻逆。便脓脉沉,腹痛脉微,均属危险,当舍证
从脉,可以母子保全。用人参一两,合附子理中汤二剂,脉安和。四剂减半,调理而愈。
友人虞元静房中人,方孕五月,患滞下腹痛,日不下数十次,为定此方。甫服一钟,觉行至腹,即解一次,
痛亦随已,滞亦全愈。川黄连四钱,白芍、黄芩、枳壳各三钱,莲肉四十粒,橘红、干葛各一钱五分,扁豆、
红曲各二钱,升麻五分,炙草一钱,乌梅肉一个。(《广笔记》。)
魏玉横曰∶汪陛堂,邻居也,其室人病痢已久,未尝药。初下红白,后单下红,每甚于夜,腹痛后重。渠
岳翁乃儒而医者,与归脾合补中益气,持方问余。余曰∶此古人成法也,第虑服之转剧耳。不信,服二剂,果
下益频。乃延诊,脉沉细且驶,与枣仁、山药、杞子、地黄、当归、白芍、甘草、黄芩,六剂全愈。因问曰∶
君向谓归脾补中,服之必增剧,已而果然,此何故也?余曰∶久痢亡阴, 、术、升、柴令阳愈升,则阴必愈
降,理所必然。又问腹尚痛而后重未除,乃不用香、砂,此又何说?余曰∶用香、砂亦无大害,第不能速愈耳。
唐赤城内人,年二十余,孕月喜瓜果。夏间,腹痛下痢,以为胎气。冬尽,已分娩,而痛痢不减。一老医
谓产后虚寒,且久痢,与白术、炮姜、建莲、扁豆、香附、砂仁、木香、远志,诸温燥健脾,痢转甚。又加补
骨脂、肉豆蔻,痢益频。每粥食才下咽,粪秽即下出不及至圊,视之乃完谷不化,佥谓肠胃已直,泻若竹筒,
病必不起,将治木。诊之,脉细数而涩,额颊娇红,舌苔燥黑,曰∶此痢疾也。第服药二剂,必见红白。因告
以向医谓为虚寒将败之证,今以为痢,再下红白,宁望生乎?曰∶病缘过伤生冷,滞于回肠,久从热化。产后
腹空,其积将下,乃为燥热所劫,致积反留,而真阴愈伤,内热愈炽。今之频并急速,乃协热下痢之痢,非虚
寒下脱之痢也。试观其面红,阴虚可知;舌黑,内热可知。但先助其阴,则其下必缓,而积滞见矣。与熟地、
杞子各一两,枣仁五钱,服下面红顿减,舌黑渐退,食入遂不下迫。再服则里急后重,红白兼行。仍与前方入
芩、连、归、芍、甘草,出入加减,十余剂已愈八九矣。以岁除停药,新正邀诊,已饮食如常,起居复故。惟
便后微有淡血水,此脾络受伤之余证也。前方去芩、连,加乌梅,二剂可愈。乃云∶舍亲谓先生用补药太早,
致成休息痢。盖前医是其至戚,特令其邀予一次以相嘲耳。予因谓曰∶与其为直肠泻,毋宁为休息痢乎。一笑而别。
凌表侄妇素怯弱,孕数月,几成损证,以重剂滋养而愈。已十月,因时感发 ,专科投荆、防、枳、桔等
二剂,其师黄澹翁力止之,乃但服头煎,已而干咳咽痛,面赤口燥,夜热盗汗。因食生梨数片,遂泄泻如痢,
腹痛后重,日夜十余行。或曰∶立斋云,梨者利也。凡病后及孕产,皆不可食。今腹痛下痢,非伤生冷而何?
诊之,脉洪数,左寸鼓指,曰∶钱仲阳谓疹子无他症者,但用平药。今病患阴虚多火,滋养犹恐不及,乃用香
窜以鼓之,致三阴之火,乘虚上冲,肺既热甚,势必下迫大肠而为痢,于梨何与?盖立斋之言,言其常耳。合
脉与证,犹当以凉润取效也。询其小便热短而口臭,用生地、杞子、沙参、麦冬,川连、蒌仁、元参、牛蒡,
二剂痢止,后重除。忽肛门肿痛,谓欲作痔。曰∶非也,此肺火下传,病将愈耳。去黄连加黄芩,数剂诸证全愈。
薛立斋治疗地官胡成甫的妻子,她在怀孕期间患有长期痢疾。她自行服用消食导滞、理气的药物后,感到腹部沉重下坠,胎气不安。随后又使用阿胶、艾叶等药物,但未见成效。薛立斋说:“腹部沉重下坠,是元气虚弱所致;胎动不安,是因为体内热邪严重。”于是使用补中益气汤(具有补中益气、升阳举陷功效的方剂)使胎气安定,之后再用六君子汤(由人参、白术、茯苓、甘草、陈皮、半夏组成的方剂,具有健脾益气、燥湿化痰功效)完全治愈。(为何忽略了内热?薛氏用药有时不能令人满意,往往如此。)
盛用敬治疗陈杰的妻子,她有身孕却患痢疾数月,已经昏厥六天,拉出的东西像漏水的屋子一样淋漓不尽,甚至已经准备好了棺木寿衣。盛用敬诊脉后说:“不用担心。”服药后,痢疾停止但胎气动摇,过了几天生下一个孩子。(出自《吴江县志》。)
孙文垣的表侄女,怀孕七个月,患赤痢(痢疾的一种,大便带脓血),腹痛且肛门重坠,体质素来虚弱。医生用白芍三钱、黄芩一钱五分、白术和地榆各八分、甘草三分,服用两帖后痊愈。后来因为稍微劳累,痢疾复发,医生用当归三钱、川芎一钱五分、真阿胶二钱、艾叶三分,服用一帖后完全治愈。(这不是积滞引起的痢疾,所以治疗方法如此。)
朱丹溪治疗八婶在临产时患痢疾,脉象细弦而稍快,有肛门重坠和里急后重的症状。使用滑石三钱、白芍二钱、炒枳壳一钱五分、木通二钱、甘草五分、白术二钱、茯苓一钱、桃仁九枚,研碎同煎。
马元仪治疗张姓妇女,怀孕八个月患痢疾,昼夜排便四五十次,腹痛,胎气上逆冲犯,不想吃东西。诊脉发现两手关部和尺部脉象沉细,下半身彻骨寒冷。他说:“根据症状看也是湿热导致的痢疾,但脉象沉说明是寒证,脉微细说明是虚证,加上下半身彻冷,这是命门火衰于下,脾土被困于中。五脏阳气之火散布于上,水谷之气顺趋而下,津液血脉不充盈,胎元失去滋养而上逆冲犯。便脓血而脉沉,腹痛而脉微,都属于危险情况,应当舍弃症状而从脉象论治,这样可以保全母子。”用人参一两,配合附子理中汤(具有温中散寒、补气健脾功效的方剂)服用两剂,脉象平和。再服四剂减半剂量,调理后痊愈。
朋友虞元静房中的女子,刚怀孕五个月,患痢疾腹痛,每天排便数十次,为此定下此方。刚喝下一杯药,感觉药力行至腹部,就解了一次大便,疼痛随即消失,痢疾也完全痊愈。方用:川黄连四钱、白芍、黄芩、枳壳各三钱、莲子肉四十粒、橘红、干葛各一钱五分、扁豆、红曲各二钱、升麻五分、炙甘草一钱、乌梅肉一个。(出自《广笔记》。)
魏玉横说:汪陛堂是我的邻居,他的妻子患痢疾已久,未曾服药。起初大便红白相间,后来只下红色,每晚加重,腹痛且有肛门重坠感。她的岳父既是儒生又是医生,开了归脾汤(具有益气补血、健脾养心功效的方剂)合补中益气汤,拿着方子问我。我说:“这是古人的成法,只是担心服用后会病情加重。”他不信,服用两剂后,果然腹泻更加频繁。于是请我去诊治,脉象沉细且急促,我给予酸枣仁、山药、枸杞子、地黄、当归、白芍、甘草、黄芩,服用六剂后完全痊愈。他问:“你先前说归脾汤和补中益气汤服用后必会加重,结果果然如此,这是什么原因?”我说:“久痢导致阴液亡失,白术、升麻、柴胡等药令阳气愈升,那么阴液必然愈降,这是理所当然的。”他又问:“腹部仍然疼痛且肛门重坠未除,为什么不用木香、砂仁?”我说:“用木香、砂仁也没有大害,只是不能迅速痊愈罢了。”
唐赤城的居民,二十多岁,怀孕时喜欢吃瓜果。夏天出现腹痛下痢,以为是胎气不适。到了冬末,已经分娩,但腹痛下痢没有减轻。一位老医生认为产后体虚寒,且久痢,给予白术、炮姜、建莲、扁豆、香附、砂仁、木香、远志等温燥健脾的药物,痢疾反而加重。又加用补骨脂、肉豆蔻,痢疾更加频繁。每吃一点粥,食物还没消化完就排出来,来不及到厕所,观察粪便发现是不消化的完谷,大家都认为肠胃已直,泻下如竹筒,病必定无法救治,准备办理丧事。我诊脉,脉象细数而涩,额颊娇红,舌苔燥黑,说:“这是痢疾。”只服药两剂,一定会见到红白脓血。于是告诉他,之前的医生认为是虚寒将败的证候,现在认为是痢疾,如果再下红白脓血,还能希望存活吗?他说:“病因过食生冷,积滞停留在回肠,日久化热。产后腹部空虚,积滞本应下行,却被燥热所劫持,导致积滞反留,真阴进一步受伤,内热更加炽盛。现在的频繁急速,是协热下痢(伴随热邪的下痢),不是虚寒下脱(虚寒导致的滑脱不禁)的痢疾。试看他的面红,可知阴虚;舌黑,可知内热。只要先资助其阴液,那么下痢必然减缓,积滞就会显现出来。”给予熟地黄、枸杞子各一两,酸枣仁五钱,服用后面红顿时减退,舌黑逐渐消退,进食后不再急于下迫。再服用则出现里急后重,红白脓血兼行。仍在前方中加入黄芩、黄连、当归、白芍、甘草,出入加减,十余剂后好了八九成。因除夕停药,正月初一邀请诊治,已经饮食正常,起居恢复常态。只是便后微有淡血水,这是脾络受伤后的余证。前方去掉黄芩、黄连,加入乌梅,两剂可愈。但他亲戚说先生用补药太早,导致了休息痢(迁延不愈的痢疾)。因为前医是他的至亲,特意让他邀请我来嘲笑一番。我因此说:“与其得直肠泻(预后极差的泄泻),不如得休息痢呢。”大家一笑而别。
凌某的表侄妇素来怯弱,怀孕几个月,几乎成了虚损重症,用重剂滋养而痊愈。到了十个月时,因感受时邪发作,专科医生投用荆芥、防风、枳壳、桔梗等药两剂,他的老师黄澹翁极力阻止,于是只服用头煎药,随后干咳咽痛,面赤口燥,夜间发热盗汗。因为吃了几个生梨片,于是发生泄泻如同痢疾,腹痛后重,一天十多次。有人说:“薛立斋说过,梨者利也(梨有滑利作用)。凡是病后及孕产期间,都不可食用。现在腹痛下痢,难道不是伤于生冷吗?”诊脉,脉象洪数,左寸脉鼓指有力,说:“钱仲阳曾说,疹子没有其他症状的,只用平和的药物。现在病人阴虚多火,滋养还怕不够,却用香窜之药以鼓动它,导致三阴之火乘虚上冲,肺热甚盛,势必下迫大肠而为痢,这与梨有什么关系?薛立斋的话,说的是常理。结合脉象与症状,仍应用凉润之法取效。”询问得知小便热短且口臭,用生地黄、枸杞子、沙参、麦冬、黄连、瓜蒌仁、玄参、牛蒡子,两剂后痢止,后重消除。忽然肛门肿痛,说是快要长痔疮了。我说:“不是,这是肺火下传,病将要痊愈的表现。”去掉黄连加入黄芩,数剂后诸证全愈。
Xue Lizhai treated the wife of Hu Chengfu, a government official, who suffered from chronic dysentery during pregnancy. After self-medicating with digestive and qi-regulating agents, she experienced abdominal heaviness and sinking, along with fetal restlessness. Subsequent treatment with Ejiao (Donkey-hide Gelatin) and Aiye (Mugwort Leaf) proved ineffective. Xue stated: "Abdominal heaviness and sinking indicate deficiency of Yuan Qi (Original Qi); fetal restlessness indicates severe internal heat." He subsequently used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to stabilize the fetus, followed by Liujunzi Tang (Six Gentlemen Decoction) for complete recovery. (Why was the internal heat overlooked? Xue's prescriptions were sometimes unsatisfactory in this manner.)
Sheng Yongjing treated the wife of Chen Jie, who had been pregnant but suffered from dysentery for several months. She had been unconscious for six days, passing stool continuously like water leaking from a roof; her coffin and burial clothes were already prepared. Sheng palpated her pulse and said, "Do not worry." After administering medicine, the dysentery ceased but fetal movement increased, and she delivered a healthy child a few days later. (From *Wujiang County Annals*.)
Sun Wenyuan treated his cousin's daughter, who was seven months pregnant and suffered from bloody dysentery (dysentery characterized by pus and blood in the stool), abdominal pain, and tenesmus. Her constitution was generally weak. The physician prescribed Baishao (White Peony Root) 3 qian, Huangqin (Scutellaria Root) 1.5 qian, Baizhu (Atractylodes Macrocephala Rhizome) and Diyu (Sanguisorba Root) each 0.8 qian, and Gancao (Licorice Root) 0.3 qian. After two doses, she recovered. Later, due to slight overexertion, the dysentery recurred. The physician then used Danggui (Angelica Sinensis Root) 3 qian, Chuanxiong (Ligusticum Chuanxiong Rhizome) 1.5 qian, Zhen Ejiao (Authentic Donkey-hide Gelatin) 2 qian, and Aiye (Mugwort Leaf) 0.3 qian. After one dose, she fully recovered. (This was not dysentery caused by food stagnation, hence the treatment method differed.)
Zhu Danxi treated his eighth aunt, who developed dysentery near term. Her pulse was fine, wiry, and slightly rapid, accompanied by tenesmus and urgency. He used Huashi (Talcum) 3 qian, Baishao (White Peony Root) 2 qian, Zhike (Bitter Orange Fruit, stir-fried) 1.5 qian, Mutong (Akebia Stem) 2 qian, Gancao (Licorice Root) 0.5 qian, Baizhu (Atractylodes Macrocephala Rhizome) 2 qian, Fuling (Poria) 1 qian, and Taoren (Peach Seed) 9 pieces, ground and decocted together.
Ma Yuanyi treated a woman surnamed Zhang, who was eight months pregnant and suffered from dysentery, defecating forty to fifty times day and night. She experienced abdominal pain, rebellious fetal qi, and loss of appetite. Palpation revealed deep and fine pulses at both Guan (Bar) and Chi (Cun) positions, with cold penetrating through the lower body. Ma stated: "Based on symptoms, this appears to be dysentery caused by damp-heat. However, a deep pulse indicates cold, and a fine pulse indicates deficiency. Combined with the profound cold in the lower body, this signifies decline of Fire at the Lower Jiao (Lower Burner) and stagnation of Earth (Spleen/Stomach) in the Middle Jiao. When the Fire of the Five Yangs distributes upward, the Qi of water and grain flows downward smoothly. If Jingye (Body Fluids) and blood vessels are insufficient, the Taiyuan (Fetal Origin) loses nourishment and rebels upward. Pus and blood in stool with a deep pulse, and abdominal pain with a faint pulse, are both dangerous signs. One must discard the symptoms and follow the pulse to save both mother and child." He prescribed Ren Shen (Ginseng Root) 1 liang combined with Fuzi Lizhong Tang (Aconite Decoction to Regulate the Middle) for two doses, after which the pulse became harmonious. A fourth dose was halved, and she recovered after regulation.
The wife of Yu Yuanjing, a friend, was five months pregnant when she developed stagnation-type dysentery with abdominal pain, defecating dozens of times daily. This formula was prescribed for her. Upon drinking just one cup, she felt the medicine reach her abdomen, immediately passed stool, and the pain ceased; the stagnation completely resolved. The formula consisted of: Chuan Huanglian (Coptis Rhizome) 4 qian, Baishao (White Peony Root), Huangqin (Scutellaria Root), Zhike (Bitter Orange Fruit) each 3 qian, Lianrou (Lotus Seed Flesh) 40 grains, Juhong (Citrus Reticulata Peel) and Gange (Kudzu Root) each 1.5 qian, Biandou (Lablab Bean) and Hongqu (Red Yeast Rice) each 2 qian, Shengma (Cimicifuga Rhizome) 0.5 qian, Zhi Cao (Honey-fried Licorice Root) 1 qian, and Wumei Rou (Dark Plum Flesh) 1 piece. (From *Guang Biji*.)
Wei Yuheng stated: Wang Bitang was my neighbor. His wife had suffered from chronic dysentery without medication. Initially, she passed red and white stool, later only red, worsening at night, with abdominal pain and tenesmus. Her father-in-law, a scholar and physician, prescribed Guipi Tang (Restore the Spleen Decoction) combined with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and asked for my opinion. I said, "This follows ancient methods, but I fear it may worsen the condition." He did not believe me. After two doses, the frequency of diarrhea indeed increased. I was then summoned to examine her. Her pulse was deep, fine, and rapid. I prescribed Zaoren (Sour Jujube Seed), Shanyao (Chinese Yam), Qizi (Goji Berry), Dihuang (Rehmannia Root), Danggui (Angelica Sinensis Root), Baishao (White Peony Root), Gancao (Licorice Root), and Huangqin (Scutellaria Root). After six doses, she fully recovered. He asked: "You previously stated that Guipi Tang and Buzhong Yiqi Tang would worsen the condition, which proved true. Why?" I replied: "Chronic dysentery leads to Yin depletion. Baizhu (Atractylodes), Shengma (Cimicifuga), and Chaihu (Bupleurum) raise Yang. If Yang rises further, Yin must descend further, which is inevitable." He asked again: "Her abdomen still hurts and tenesmus persists. Why no Xiang (Costus Root) or Sha (Amomum Fruit)?" I replied: "Using them would not cause major harm, but they would not hasten recovery."
A resident of Tangchi, in her twenties, enjoyed fruits and melons during pregnancy. In summer, she developed abdominal pain and dysentery, attributed to fetal qi. By late winter, after delivery, the painful dysentery persisted. An old physician considered postpartum deficiency-cold and chronic dysentery, prescribing Baizhu (Atractylodes Macrocephala Rhizome), Paojiang (Prepared Ginger), Jianlian (Chinese Lotus Seed), Biandou (Lablab Bean), Xiangfu (Cyperus Rhizome), Sharen (Amomum Fruit), Muxiang (Aucklandia Root), and Yuanzhi (Polygala Root), all warming and drying to strengthen the Spleen. The dysentery worsened. Boguzhi (Psoralea Fruit) and Roudoukou (Myristica Seed) were added, causing even more frequent stools. Any porridge consumed was expelled undigested before reaching the toilet. Observing undigested food in the stool, everyone believed the intestines were straight and the diarrhea like a bamboo tube, deeming the prognosis fatal and preparing for burial. My pulse diagnosis revealed a fine, rapid, and choppy pulse, delicate redness on the forehead and cheeks, and dry black tongue coating. I said, "This is dysentery." I predicted that after two doses, red and white stool would appear. I warned him that since previous doctors deemed it a failing deficiency-cold syndrome, seeing red and white stool now might seem hopeless. He replied, "The illness originated from excessive raw/cold food, stagnating in the ileum, transforming into heat over time. Postpartum emptiness allowed stagnation to descend, but dry-heat intercepted it, causing retention, further injuring True Yin, and intensifying internal heat. The current frequency and urgency are 'xie-re xia-li' (dysentery accompanying heat), not 'xu-han xia-tuo' (slippage due to deficiency-cold). Observe her red face indicating Yin deficiency; black tongue indicating internal heat. First tonify Yin, and the diarrhea will slow, revealing the stagnation." I prescribed Shudi (Prepared Rehmannia Root) and Qizi (Goji Berry) each 1 liang, and Zaoren (Sour Jujube Seed) 5 qian. After taking it, facial redness subsided, tongue blackness faded, and food stayed down without urgency. Subsequent doses brought tenesmus and mixed red/white stool. I modified the formula by adding Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Danggui (Angelica Sinensis Root), Baishao (White Peony Root), and Gancao (Licorice Root), adjusting as needed. After more than ten doses, she improved significantly. Medication stopped on New Year's Eve. On New Year's Day, upon examination, her diet and routine had normalized. Only slight pale bloody water remained post-defecation, a residual sign of damaged Spleen collaterals. I removed Huangqin and Huanglian, added Wumei (Dark Plum), and prescribed two doses for cure. However, his relative claimed I used tonics too early, causing 'xiuxi li' (lingering dysentery). The previous doctor was a close relative, specifically instructing him to invite me to mock me. I replied, "Would you prefer straight-intestine diarrhea or lingering dysentery?" We parted with laughter.
Ling's cousin's wife was naturally timid and weak. During pregnancy, she nearly developed a consumptive disease, cured by heavy nourishing agents. At ten months, she contracted a seasonal pathogen. The specialist prescribed Jingjie (Schizonepeta Spike), Fangfeng (Saposhnikovia Root), Zhike (Bitter Orange Fruit), and Jiegeng (Platycodon Root) for two doses. Her teacher, Huang Dancheng, strongly opposed this, so she took only the first decoction. Subsequently, she developed dry cough, sore throat, facial redness, dry mouth, night sweats, and fever. After eating several slices of raw pear, she developed diarrhea resembling dysentery, with abdominal pain and tenesmus, occurring ten-plus times daily. Someone remarked: "Xue Lizhai said, 'Li means slippery.' Pears should never be eaten after illness or during pregnancy/postpartum. Now with abdominal pain and dysentery, isn't this injury from cold/raw food?" Pulse diagnosis showed a surging, rapid pulse, with the left Cun position beating forcefully against the finger. I said: "Qian Zhongyang stated that if rash has no other symptoms, use mild medicines. This patient has Yin deficiency with abundant fire; even nourishment might be insufficient. Using aromatic, dispersing drugs to stimulate her caused Fire of the Three Yin to rush upward vacuously. Lung heat became severe, inevitably pressing downward on the Large Intestine causing dysentery. What does the pear have to do with it? Xue Lizhai spoke of general principles. Combining pulse and symptoms, cooling and moistening methods are indicated." Inquiry revealed hot, short urination and bad breath. I prescribed Shengdi (Rehmannia Root), Qizi (Goji Berry), Shashen (Glehnia Root), Maidong (Ophiopogon Tuber), Huanglian (Coptis Rhizome), Louren (Trichosanthes Seed), Xuanshen (Scrophularia Root), and Niubangzi (Arctium Fruit). After two doses, dysentery ceased, and tenesmus disappeared. Suddenly, anal swelling and pain occurred, suspected to be hemorrhoids. I said, "No, this is Lung Fire transmitting downward; the disease is about to resolve." I removed Huanglian and added Huangqin (Scutellaria Root). After several doses, all symptoms resolved.