灌以童便而苏。此等症候，皆火挟痰而作，又非三生饮可治者，并姜汤亦不相宜也。（此当与江选薛立斋治王进
士案同参。）
赵以德治陈学士敬初，因醮事，跪拜间就仆倒，汗注如雨。诊之，脉大而空虚。年当五十，新娶少妇，今
又拜跪致劳，故阳气暴散，急煎独参汤，连饮半日而汗止，神气稍定，手足俱 ，喑而无声。遂于独参汤中加
竹沥，开上涌之痰。次早，悲哭一日不止，因以言慰之，遂笑，复笑五七日无已时。此哭笑为阴火动其精神，
魂魄之脏相并故耳。正《内经》所谓五精相并者，心火并于肺则喜，肺火并于肝则悲是也。稍加连、柏之属泻
其火，八日笑止手动，一月能走矣。（出《医通》。）
陆养愚治吴少参，年五十，新得美宠荣归祭祖，跪拜间就倒仆，汗注如雨，浑身壮热，人事不省。或欲灌
以牛黄。脉之，关尺浮数而空，两寸透入鱼际，此阴虚甚而阳亢极也。若灌以牛黄则死矣。急用生地自然汁一
升，人参一两，麦冬五钱，五味子百粒，浓煎灌之。二三服，神气稍定，汗止，似睡非睡。至五更时，作恐惧
状，如人将捕之。至清晨，又作盛怒状，骂詈不止。至午间，又大笑一二时。至薄暮，又悲泣。自夜静日作，
病家以为鬼祟。此即《内经》所谓五精相并也。并于肾则恐，并于肝则怒，并于心则喜，并于肺则悲。刘河间
曰∶平时将息失宜，肾水不足，心火亢极，乃显此症。夜间阴盛，邪乃暂息，日中阳隆，遂游行五脏而无宁时
也。仍用前方减人参之半。旬日间，或但悲笑，或但骂詈恐惧，人事时省时不省，与之饮食，尽食方止，不与
不思索，大小便亦通。至半月后始宁静，乃调养气血，百剂始愈。
长兴林中尊，年逾五旬，因送按台回，觉身体倦怠，头目眩运，既而头振动摇，欲语不能，喉中喘逆，咸
与牛黄苏合丸、大小续命汤已旬日，病如故。脉之，沉缓而弱，左关尺尤甚，此肝肾虚，精气暴夺之候也。询
其由，乃因按院严厉，惟恐失错，烦劳之极，归而病作。《内经》云∶诸风掉眩，皆属于肝。刘河间曰∶
此非外来风邪，由将息失宜，肾水不足，心火亢甚所致。又经云∶诸逆冲上，皆属于火。今振动喘逆，职是故
也。人至中年之际，肾气原自不足，且经恐伤肾，今以矜持太过，损伤肾气。《内经》曰∶恐则气下。声者，气
之所发也。气下，故声不出。且肝肾之脉，俱挟舌本，法宜壮二经之气，以治其标；滋二经之血，以治其本。
用枸杞为君以补肾，天麻、川芎为臣以益肝，又用人参、少加附子以为佐，二冬以为使。二剂约数两，服后诸
症顿减。用八味丸间服，十剂全愈。
邹春元心泉，年未五旬，患中风，耳聋鼻塞，二便不通，四肢不随而厥，语言不出。或言∶皆说亡故之人，
已灌牛黄钱许矣。或曰∶经云脱阳者见鬼，脱阴者目盲。今口说亡人，目无所见，是见鬼与目盲也。又洁古云∶
中腑者着四肢，中脏者滞九窍。今手足不随，上下秘塞，是脏腑兼中也。且六脉弦数无伦，《脉诀》云∶中风之
脉迟浮吉，急实大数三魂孤。脉症俱危，恐无生理。立方人参五钱，熟地一两，桂、附各二钱半，未服。陆
至脉之，浮按果极急数，中按稍觉和缓，此犹有胃气，第两尺重按觉空耳。乃曰∶阴阳兼补，诚治本之法也，
第上下秘塞之时，恐不能奏效。宜先通二便，使浊阴降，则清阳之气得以上升，然后议补。经谓病发急则先标
而后本，先治其标，后治其本。咸谓病势已危急，恐不可虚缓，遂将前药灌之。连进数剂，俱停胸中，揉之作
声而不下腹。再促诊，脉仍前，即袖中出家制神佑丸数十粒，抉其口纳之，令灌以淡姜汤。药已下，即为灸百
会穴，使阳气上升，又灸关元穴，不使阳气下陷。一二壮，目即能开，眉频蹙。问痛否？能点头，四肢亦少动。
谓之曰∶忍至七壮可生矣，亦点头。灸将毕，腹欲便，既而前后俱通，去垢秽极多。少顷，又泻一行，令急以
前药倍人参煎候。及再便，有晕意，徐灌之，自苏。此后人事渐省，第手足振掉，左半身不遂，于大补气血药
中，少佐却风顺气消痰之品，如秦艽、全蝎、僵蚕、乌药、星、半之类，调治年余而愈。盖此症初起，气血不
足为本，九窍闭塞为标。先通其秘者，急则治其标也。迨后见风症，亦不足为本，风症为标，而专补气血，少
佐风药者，缓则治其本也。
范溪云患口 不正，四肢拘急，自汗恶风，凡针灸、涂、贴、诸风药遍尝不效，已半年。脉之，左手浮
紧，右手洪缓。此风客阳明，留而不出，郁而为热。虽宜解散，然邪在一经，杂进诸经之药，诛伐无过，徒虚
其表，而不能去邪，故反恶风自汗，而无救于口之 也。经曰∶胃足阳明之脉挟口环唇。兹病口 唇邪，是乃
阳明一经之症，麻、桂、羌活岂所宜哉？以葛根五钱，升麻二钱，以逐阳明固结之邪；白芷二钱，僵蚕一钱五
分，以达头面不正之气；黄 一钱五分，桂枝五分，以固周身疏漏之表；桔梗一钱，甘草五分，载诸药上行。
二剂便效，数剂全愈。后以养荣血，实腠理，少佐清热去痰之品调理之。（此宜与许叔微一案合参。）
李思瑭母，年六旬，体甚肥，正月间忽中风卒倒，不省人事，口噤喉鸣，手足不随，服牛黄丸、小续命不
效。脉之，浮洪而滑，右手为甚，缘奉养极浓，形气盛而脉有余。经云∶消瘅击仆，偏枯痿厥，气满发逆，肥
贵人则膏粱之痰也。又云∶土太过令人四肢不举。丹溪所谓湿生痰，痰生热，热生风也，当先用子和法涌吐之。
乃以稀涎散、齑汁调灌之，涌出痰涎碗许。少顷，又以三化汤灌之，至晚，泻两三行，喉声顿息，口亦能言。
但人事不甚者，知上下之障塞已通，中宫之积滞未去也，用二陈汤加枳实、黄连、莱菔子、木香、白蔻仁，每
日二服。数日，人事渐爽，腹中知饥，令进稀粥。大便结，每日以润字丸五分，白汤点姜汁送下。犹时有拘挛
燥结之患，知为血耗津衰，以四物加秦艽、黄芩、甘草数十帖，三月而愈。
陆祖愚治赵一阳，年过五旬，中风卒倒，牙关紧闭，戴眼上窜，手握而四肢振掉。或以稀涎散吹入鼻中，
吐稠痰数碗。投小续命汤二剂，反口开手撤，眼合遗溺，四肢厥逆，人事昏沉，喉鸣发热。脉之，洪滑而歇止。
症已危甚，勉力用方，二陈加南星、枳实以导其痰，四物以养其血，佐以牙皂、姜汁、竹沥，二剂，痰喘渐轻。
六剂，人事清爽。改用参、术、归、芍，大补气血而安。
李翠岩，年近七旬，肥盛多劳。一日，行至门外，视一人如两人，一路如两路，一门如两门，不知从何处
入，遂卒然仆倒。扶归，懒于言语，尚能道其病状。咸以中风治之，投消痰搜风十余剂，遂冷汗如雨，惊惕振
掉，昏不知人。脉左寸浮大，按之无神，余俱迟弱而空，已神色昏沉，不能言矣。此属虚脱，宜培补正气为主，
用四君加 、归、地、芍、天麻、杜仲、牛膝、枣仁，二剂汗止，五剂能言语识人，七八剂顿愈。每剂加人参
三钱，二十余剂，饮食步履如常。
马元仪治周某，神昏不语，状如中风，已半月。脉之，右虚微无力，乃阳虚之候也。胸中时满，或痴立如
呆，上焦之阳不用矣。足膝无力，转侧不能，下焦之阳不用矣。诸阳既微，阴乃用事，不行温补，阴日以长，
阳日以消，如气化有肃杀而无阳和，物其能久乎。遂与附桂理中汤，大培元气，半月而神始清，便乃行，一月
而食渐进，足可履。兼进八味丸，调理而安。
冯楚瞻治张铨部，先年以焦劳，遂得怔忡耳鸣诸症。医以痰治，涌出痰涎斗许，复用滚痰丸，痰势虽清，
精神内夺，初秋卒倒僵仆，痰涌 鼾，目窜口开，手足强直，自汗如雨，危甚。脉之，六部皆豁大无伦，其候
欲脱，刻不容缓矣。乃用人参三两，白术二两，附子五钱，浓煎灌之。日三剂，按时而进。服后，脉势渐敛，
身热渐和，溃汗渐收。次日，仍用前方，日二服，夜一服。至三日，诸症渐减，僵仆不省如故，此工夫未到，
故标症稍平，而元神未复也。仍照前服，服后必灌浓米汁半钟，以保胃气，助药力。或有劝入风药者，曰∶保
之不暇，敢散之乎？有劝加痰药者，曰∶保之实难，敢消之乎？有劝入清火者，曰∶尤误矣。元阳欲脱，挽之
犹恐不及，敢清之乎？余之重用白术、附子者，既壮人参培元之力，而消痰去风息火之义已在其中。若稍涉标
治，则虚证蜂起，势益难矣。违众勿用。三日所用人参计三十五两，附子六两，白术二十四两。至晚间，忽能
言语，稍省人事，进粥半碗而睡，其 鼾目窜诸症仍在。蚤间阳分，用大补心脾气血之药，如枣仁、当归、白
术、白芍、茯神、远志、人参、桂圆、五味之类。下午阴分，用八味汤冲人参浓汁。服之六七日后，诸症渐平。
每日人参尚用四五两，后蚤间，以生脉饮送八味丸，加牛膝、杜仲、鹿茸、五味子四五钱。日中，加减归脾与
八味汤，照前煎服。日渐轻强，饮食倍进，一月而起。大凡治危笃症候，全在根本调理得力，自然邪无容地。
先哲云，识中标，只取本，治千人，无一损也。
谭掌科，年六十余，卒然晕仆，痰涎涌盛，不省人事。顷之，吐痰碗许，少苏。长班用力拥之舆中，挟其
两腿而归。医与疏风清热豁痰，旬余痰涎不减，烦躁倍常，头痛、腿疼更甚。脉之，两寸甚洪大，两尺右关甚
沉微。此孤阳独亢于上，弱阴不能敛纳，且中宫脾土亦虚，阳无退藏之舍，上浮颠顶，为胀为疼。宜壮水以制
之，培土以藏之，补火以导之，佐以滋肺清金，以成秋降之令，则收敛蛰藏。熟地八钱为君，乳炒白术五钱为
臣，米炒麦冬三钱为佐，制附子一钱五分为使，煎成，另用人参五钱，熬汁冲服，头疼顿减，诸症渐痊。但腿
痛如故，盖长班用力挟之而伤也，视之，五指之痕在焉。此外因当外治，用猪肘生精肉捣烂，入肉桂细末，葱
白、食盐和匀，浓罨患处而安。后原素患晨泻，饮食不甘，令早晨空心参汤送八味丸。午间，食前以炒黄白术
三十两、制附子三两，共熬成膏，人参细末六两，收成细丸，白汤吞下三钱。半月后，脾胃顿强，精神倍长。
景氏妇，年近五旬，中风已五六日，汗出不止，目直口噤，遗尿无度。或以为坏症。脉之，虽甚微，而重
按尚有不疾不徐自然之势，此即胃气也。乃曰∶遗尿本属当时脱症，故不治。若多日，安得不尿，且坐视数日
而不脱，断非绝症也。投以参附汤二三剂渐苏，重服温补而愈。
金教谕，夏月壮热头疼咳嗽。医谓感冒，用羌、前、苏、橘、半、枳之类，未终剂，头疼如破，舌强不清，
溃汗粘手，左臂麻木，神气不堪，脉洪大，空缓而无力。知为气虚类中，误投发散，当此疏泄之时，几成脱症。
与熟地一两二钱，麦冬三钱，炒白术四钱，牛膝二钱四分，五味子八分，制附子一钱五分，人参八钱另煎冲服，
日三剂，不五日全安。时有李庠生，同日得病，症候无异，一剂发散，汗出彻夜，次日死矣。
张路玉治春榜赵明远，平时六脉微弱，患中风，经岁不痊。诊之，左手三部弦大而坚，知为肾脏阴伤，壮
火食气之候。且人迎斜内向寸，又为三阳经满溢入阳维之脉，是不能无颠仆不仁之虞。右手三部浮缓，而气口
以上微滑，乃痰涌于膈之象。以清阳之位，而为痰气占据，未免侵渍心主，是以神识不清，语言错误也。或者
以其兼口角微涎，目睛恒不易转，以为邪在经络，用祛风导痰之药，不知此本肾气不能上通于心，心脏虚热生
风之症，良非风燥药所宜。或者以其小便清利倍常，为肾气虚，而用八味壮火之剂，不知此症虽虚，而虚阳
伏于肝脏，所以阳事易举，饮食易饥，又非益火消阴药所宜。或者以其向患休息久痢，大便后常有痰红渍沫，
而用补中益气，不知脾气陷于下焦者，可用升举之药，此阴虚久痢之余，有何清气在下？若用升、柴，升动肝
肾，虚阳鼓激膈上痰饮，能保其不为喘胀逆满之患乎？今与河间地黄饮子，助其肾，通其心，一举而两得之。
但不能薄滋味，远房室，则药虽中病，终无益于治疗也。惟智者以善调摄为第一义。
侍卫金汉光外家中风，四肢不能举动，喘鸣肩息，声如曳锯，不能着枕，寝食俱废半月余。脉之数大，按久
无力，尺内愈虚，以上皆右手寸关也。至于左手，关尺弦数，按之渐小，惟寸口数盛。或时昏眩烦乱，所服皆
二陈、导痰，杂以秦艽、天麻之类不应。又与牛黄丸，痰涎愈逆，危殆益甚。因以六君子或加胆星、竹沥，或
加黄连、当归、甫四剂，喘顿除。再二剂，饮食渐进，堪就枕。又四剂，手足运动。十余剂后，可徐行矣。
汉川令顾莪在夫人，高年气虚痰盛，所以抑郁，忽然下体堕床，舌强不语，肢体不遂。以是日曾食湿面，
医用消导不应，转增困惫，人事不省，头项肿胀。诊之，六脉皆虚濡无力，医犹谓大便六七日不通，拟用攻下。
用童便灌服后苏醒。这类证候，都是火邪挟带痰浊所致，不是三生饮可以治疗的，连姜汤也不适宜。（此条应当与江选薛立斋治疗王进士的医案参照参看。）
赵以德治疗陈学士敬初，因为参加醮事，在跪拜之间突然仆倒在地，汗水像雨一样流淌。诊察脉象，脉大但空虚。患者年当五十岁，刚娶年轻妻子，现在又因拜跪导致劳累，所以阳气暴散，急忙煎煮独参汤，连续饮用半天后汗止住，神气稍微安定，手足都出现麻木（此处原文可能有缺字，意为麻木或无力），失音无声。于是在独参汤中加入竹沥，以开通上涌的痰涎。第二天早上，悲伤哭泣一天不止，于是用言语安慰他，他就笑了，接着又大笑五七天不停歇。这种哭笑是因为阴火扰动精神，魂魄所在的脏腑相互干扰的缘故。正是《内经》所说的“五精相并”，心火并入肺则喜，肺火并入肝则悲是也。稍加黄连、黄柏之类泻其火，八天后笑声停止，手能活动，一个月后能行走。（出自《医通》。）
陆养愚治疗吴少参，年龄五十岁，新得宠幸荣归祭祖，在跪拜之间突然仆倒，汗水像雨一样流淌，浑身壮热，人事不省。有人想用牛黄灌服。诊脉，关尺部浮数而空，两寸脉透入鱼际，这是阴虚严重而阳亢极致的表现。如果灌服牛黄就会死亡。急忙用地黄自然汁一升，人参一两，麦冬五钱，五味子一百粒，浓煎后灌服。二三剂后，神气稍微安定，汗止，似睡非睡。到了五更天，做出恐惧的样子，好像有人要抓捕他。到了清晨，又做出盛怒的样子，骂詈不止。到了中午，又大笑一二个时辰。到了傍晚，又悲伤哭泣。白天安静晚上发作，病家以为是鬼祟作怪。这就是《内经》所说的五精相并。并入肾则恐，并入肝则怒，并入心则喜，并入肺则悲。刘河间说：平时调养失宜，肾水不足，心火亢极，才显现出这种症状。夜间阴气盛，邪气暂时平息，日中阳气隆盛，于是邪气游行五脏而没有安宁的时候。仍然用前方减少一半的人参。十天内，有时只是悲笑，有时只是骂詈恐惧，人事时清醒时昏迷，给他饮食，吃完才停止，不给就不思考，大小便也通畅。半个月后才宁静，然后调养气血，服用百剂才痊愈。
长兴林中尊，年龄超过五十岁，因为送按台回，觉得身体倦怠，头目眩晕，随后头部振动摇晃，想说话不能，喉中喘逆，大家都用牛黄苏合丸、大小续命汤治疗已十天，病情如故。诊脉，沉缓而弱，左关尺尤其严重，这是肝肾虚，精气暴夺的征候。询问原因，是因为按院严厉，惟恐出错，烦劳之极，回家后发病。《内经》说：诸风掉眩，皆属于肝。刘河间说：这不是外来的风邪，由调养失宜，肾水不足，心火亢甚所致。又经云：诸逆冲上，皆属于火。现在振动喘逆，就是这个缘故。人到中年，肾气原本不足，况且惊恐伤肾，现在因为矜持太过，损伤肾气。《内经》说：恐则气下。声音，是气所发出的。气下，所以声音发不出。而且肝肾的脉，都挟持舌本，法度上应该壮二经之气，以治其标；滋二经之血，以治其本。用枸杞为君药以补肾，天麻、川芎为臣药以益肝，又用人参、少量附子作为佐药，二冬（天冬、麦冬）作为使药。两剂约几两，服用后各种症状顿时减轻。用八味丸间隔服用，十剂全愈。
邹春元心泉，年龄不到五十岁，患中风，耳聋鼻塞，二便不通，四肢不能随意运动且厥冷，语言不出。有人说：都说亡故之人，已经灌服牛黄一钱了。有人说：经云脱阳者见鬼，脱阴者目盲。现在口说亡人，眼睛看不见，这是见鬼和目盲。又说洁古云：中腑者着四肢，中脏者滞九窍。现在手足不能随意运动，上下闭塞，是脏腑兼中。而且六脉弦数无伦，《脉诀》云：中风之脉迟浮吉，急实大数三魂孤。脉症俱危，恐怕没有生机。立方人参五钱，熟地一两，桂枝、附子各二钱半，未服。陆至诊脉，浮取果然极急数，中取稍觉和缓，这还有胃气，只是两尺重按觉得空耳。于是说：阴阳兼补，确实是治本的方法，只是上下闭塞之时，恐怕不能奏效。应该先通二便，使浊阴下降，则清阳之气得以上升，然后再议补。经谓病发急则先标而后本，先治其标，后治其本。大家都认为病势已危急，恐怕不可虚缓，于是将前药灌服。连续进服数剂，都停在胸中，揉之作声而下不到腹部。再次催促诊脉，脉仍前，就从袖中拿出家制神佑丸几十粒，撬开他的嘴放入，令灌服淡姜汤。药已下去，随即灸百会穴，使阳气上升，又灸关元穴，不使阳气下陷。一二壮，眼睛就能睁开，眉头紧皱。问痛吗？能点头，四肢也稍微动。对他说：忍到七壮可以生了，也点头。灸快结束时，肚子想大便，随后前后都通了，排出污垢极多。一会儿，又泻一行，令急忙以前药倍用人参煎好等候。等到第二次排便，有晕意，慢慢灌服，自己苏醒。此后人事逐渐清醒，只是手足振掉，左半身不遂，在大补气血药中，少佐却风顺气消痰之品，如秦艽、全蝎、僵蚕、乌药、星（天南星）、半（半夏）之类，调治一年余而愈。大概这个病症初起，气血不足为本，九窍闭塞为标。先通其秘，是急则治其标。后来见到风症，也是不足为本，风症为标，而专补气血，少佐风药，是缓则治其本。
范溪云患口眼歪斜，四肢拘急，自汗恶风，凡针灸、涂、贴、诸风药遍尝不效，已半年。诊脉，左手浮紧，右手洪缓。这是风邪客于阳明，停留而出不去，郁结而为热。虽然宜解散，但邪在一经，杂进诸经之药，诛伐无过，徒虚其表，而不能去邪，所以反而恶风自汗，而无救于口眼歪斜。经曰：胃足阳明之脉挟口环唇。兹病口唇邪，乃是阳明一经之症，麻黄、桂枝、羌活岂所宜哉？用葛根五钱，升麻二钱，以逐阳明固结之邪；白芷二钱，僵蚕一钱五分，以达头面不正之气；黄芪一钱五分，桂枝五分，以固周身疏漏之表；桔梗一钱，甘草五分，载诸药上行。二剂便效，数剂全愈。后用养荣血，实腠理，少佐清热去痰之品调理之。（此条宜与许叔微一案合参。）
李思瑭母亲，年龄六十岁，身体很肥，正月间忽然中风卒倒，不省人事，口噤喉鸣，手足不随，服牛黄丸、小续命汤不效。诊脉，浮洪而滑，右手为甚，缘奉养极浓，形气盛而脉有余。经云：消瘅击仆，偏枯痿厥，气满发逆，肥贵人则膏粱之痰也。又云：土太过令人四肢不举。丹溪所谓湿生痰，痰生热，热生风也，当先用子和法涌吐之。于是用稀涎散、齑汁调灌服，涌出痰涎碗许。一会儿，又以三化汤灌服，到晚，泻两三行，喉声顿息，口也能言。但人事不甚清爽，知道上下之障塞已通，中宫之积滞未去也，用二陈汤加枳实、黄连、莱菔子、木香、白蔻仁，每日二服。数日，人事渐爽，腹中知饥，令进稀粥。大便结，每日以润字丸五分，白汤点姜汁送下。犹时有拘挛燥结之患，知道是血耗津衰，以四物汤加秦艽、黄芩、甘草数十帖，三月而愈。
陆祖愚治疗赵一阳，年龄超过五十岁，中风卒倒，牙关紧闭，戴眼上窜，手握而四肢振掉。有人用稀涎散吹入鼻中，吐出稠痰数碗。投小续命汤二剂，反而口开手撤，眼合遗溺，四肢厥逆，人事昏沉，喉鸣发热。诊脉，洪滑而歇止。症已危甚，勉力用方，二陈汤加南星、枳实以导其痰，四物汤以养其血，佐以牙皂、姜汁、竹沥，二剂，痰喘渐轻。六剂，人事清爽。改用参、术、归、芍，大补气血而安。
李翠岩，年龄近七十岁，肥盛多劳。一天，行至门外，视一人如两人，一路如两路，一门如两门，不知从何处入，遂卒然仆倒。扶归，懒于言语，尚能道其病状。大家都以中风治之，投消痰搜风十余剂，遂冷汗如雨，惊惕振掉，昏不知人。脉左寸浮大，按之无神，其余俱迟弱而空，已神色昏沉，不能言矣。这属虚脱，宜培补正气为主，用四君子汤加黄芪、当归、地黄、芍药、天麻、杜仲、牛膝、枣仁，二剂汗止，五剂能言语识人，七八剂顿愈。每剂加人参三钱，二十余剂，饮食步履如常。
马元仪治疗周某，神昏不语，状如中风，已半月。诊脉，右虚微无力，乃阳虚之候也。胸中时满，或痴立如呆，上焦之阳不用矣。足膝无力，转侧不能，下焦之阳不用矣。诸阳既微，阴乃用事，不行温补，阴日以长，阳日以消，如气化有肃杀而无阳和，物其能久乎。遂与附桂理中汤，大培元气，半月而神始清，便乃行，一月而食渐进，足可履。兼进八味丸，调理而安。
冯楚瞻治疗张铨部，先年以焦劳，遂得怔忡耳鸣诸症。医以痰治，涌出痰涎斗许，复用滚痰丸，痰势虽清，精神内夺，初秋卒倒僵仆，痰涌鼾，目窜口开，手足强直，自汗如雨，危甚。诊脉，六部皆豁大无伦，其候欲脱，刻不容缓矣。于是用人参三两，白术二两，附子五钱，浓煎灌服。日三剂，按时而进。服后，脉势渐敛，身热渐和，溃汗渐收。次日，仍用前方，日二服，夜一服。至三日，诸症渐减，僵仆不省如故，此工夫未到，故标症稍平，而元神未复也。仍照前服，服后必灌浓米汁半钟，以保胃气，助药力。或有劝入风药者，说：保之不暇，敢散之乎？有劝加痰药者，说：保之实难，敢消之乎？有劝入清火者，说：尤误矣。元阳欲脱，挽之犹恐不及，敢清之乎？我重用白术、附子的原因，既壮人参培元之力，而消痰去风息火之义已在其中。若稍涉标治，则虚证蜂起，势益难矣。违众勿用。三日所用人参计三十五两，附子六两，白术二十四两。到晚间，忽能言语，稍省人事，进粥半碗而睡，其鼾目窜诸症仍在。早晨阳分，用大补心脾气血之药，如枣仁、当归、白术、白芍、茯神、远志、人参、桂圆、五味子之类。下午阴分，用八味汤冲人参浓汁。服之六七日后，诸症渐平。每日人参尚用四五两，后早晨，以生脉饮送八味丸，加牛膝、杜仲、鹿茸、五味子四五钱。日中，加减归脾与八味汤，照前煎服。日渐轻强，饮食倍进，一月而起。大凡治危笃症候，全在根本调理得力，自然邪无容地。先哲云，识中标，只取本，治千人，无一损也。
谭掌科，年龄六十余岁，忽然晕仆，痰涎涌盛，不省人事。一会儿，吐痰碗许，稍醒。长班用力拥之舆中，挟其两腿而归。医与疏风清热豁痰，旬余痰涎不减，烦躁倍常，头痛、腿疼更甚。诊脉，两寸甚洪大，两尺右关甚沉微。这是孤阳独亢于上，弱阴不能敛纳，且中宫脾土亦虚，阳无退藏之舍，上浮颠顶，为胀为疼。宜壮水以制之，培土以藏之，补火以导之，佐以滋肺清金，以成秋降之令，则收敛蛰藏。熟地八钱为君药，乳炒白术五钱为臣药，米炒麦冬三钱为佐药，制附子一钱五分为使药，煎成，另用人参五钱，熬汁冲服，头疼顿减，诸症渐痊。但腿痛如故，盖长班用力挟之而伤也，视之，五指之痕在焉。此外因当外治，用猪肘生精肉捣烂，入肉桂细末，葱白、食盐和匀，浓罨患处而安。后原素患晨泻，饮食不甘，令早晨空心参汤送八味丸。午间，食前以炒黄白术三十两、制附子三两，共熬成膏，人参细末六两，收成细丸，白汤吞下三钱。半月后，脾胃顿强，精神倍长。
景氏妇人，年龄近五十岁，中风已五六日，汗出不止，目直口噤，遗尿无度。有人以为是坏症。诊脉，虽甚微，而重按尚有不疾不徐自然之势，此即胃气也。于是说：遗尿本属当时脱症，故不治。若多日，安得不尿，且坐视数日而不脱，断非绝症也。投以参附汤二三剂渐苏，重服温补而愈。
金教谕，夏月壮热头疼咳嗽。医生谓感冒，用羌活、前胡、紫苏、橘皮、半夏、枳壳之类，未终剂，头疼如破，舌强不清，溃汗粘手，左臂麻木，神气不堪，脉洪大，空缓而无力。知道为气虚类中，误投发散，当此疏泄之时，几成脱症。与熟地一两二钱，麦冬三钱，炒白术四钱，牛膝二钱四分，五味子八分，制附子一钱五分，人参八钱另煎冲服，日三剂，不五日全安。时有李庠生，同日得病，症候无异，一剂发散，汗出彻夜，次日死矣。
张路玉治疗春榜赵明远，平时六脉微弱，患中风，经岁不痊。诊之，左手三部弦大而坚，知为肾脏阴伤，壮火食气之候。且人迎斜内向寸，又为三阳经满溢入阳维之脉，是不能无颠仆不仁之虞。右手三部浮缓，而气口以上微滑，乃痰涌于膈之象。以清阳之位，而为痰气占据，未免侵渍心主，是以神识不清，语言错误也。或者以其兼口角微涎，目睛恒不易转，以为邪在经络，用祛风导痰之药，不知此本肾气不能上通于心，心脏虚热生风之症，良非风燥药所宜。或者以其小便清利倍常，为肾气虚，而用八味壮火之剂，不知此症虽虚，而虚阳伏于肝脏，所以阳事易举，饮食易饥，又非益火消阴药所宜。或者以其向患休息久痢，大便后常有痰红渍沫，而用补中益气，不知脾气陷于下焦者，可用升举之药，此阴虚久痢之余，有何清气在下？若用升、柴，升动肝肾，虚阳鼓激膈上痰饮，能保其不为喘胀逆满之患乎？今与河间地黄饮子，助其肾，通其心，一举而两得之。但不能薄滋味，远房室，则药虽中病，终无益于治疗也。惟智者以善调摄为第一义。
侍卫金汉光外家中风，四肢不能举动，喘鸣肩息，声如曳锯，不能着枕，寝食俱废半月余。脉之数大，按久无力，尺内愈虚，以上皆右手寸关也。至于左手，关尺弦数，按之渐小，惟寸口数盛。或时昏眩烦乱，所服皆二陈、导痰，杂以秦艽、天麻之类不应。又与牛黄丸，痰涎愈逆，危殆益甚。因以六君子汤或加胆星、竹沥，或加黄连、当归，甫四剂，喘顿除。再二剂，饮食渐进，堪就枕。又四剂，手足运动。十余剂后，可徐行矣。
汉川令顾莪在夫人，高年气虚痰盛，所以抑郁，忽然下体堕床，舌强不语，肢体不遂。以是日曾食湿面，医用消导不应，转增困惫，人事不省，头项肿胀。诊之，六脉皆虚濡无力，医犹谓大便六七日不通，拟用攻下。
Administered with child urine (Tongbian) and the patient regained consciousness. Such syndromes are all caused by Fire pathogen (Huoxie) clashing with Phlegm (Tan), and are not treatable with Sansheng Yin (Three Lives Decoction); even Ginger Decoction is inappropriate. (This case should be cross-referenced with Jiang Xuan's record of Xue Lizhai treating Scholar Wang Jinshi.)
Zhao Yi-de treated Academician Chen Jingchu, who collapsed while kneeling during a Daoist ritual, sweating profusely like rain. The pulse was large but empty. At fifty years old, having recently married a young wife and now exhausted by kneeling and bowing, his Yang Qi (Vital Energy) had suddenly scattered. A decoction of Dushen Tang (Single Ginseng Decoction) was urgently prepared; after drinking it continuously for half a day, the sweating stopped, and his Spirit (Shen) stabilized slightly. However, his limbs became numb/weak, and he lost his voice. Bamboo juice (Zhuli) was added to the Dushen Tang to clear the phlegm surging upwards. The next morning, he wept uncontrollably all day; upon verbal comfort, he laughed, then continued laughing excessively for five to seven days. This crying and laughing resulted from Yin Fire (Yinhuo) disturbing the Spirit, causing the organs associated with Hun (Ethereal Soul) and Po (Corporeal Soul) to interfere with each other. This corresponds to the *Neijing* saying "The Five Essences merge": when Heart Fire merges with Lung, there is laughter; when Lung Fire merges with Liver, there is sorrow. Slightly adding Coptidis Rhizoma (Lian) and Phellodendri Cortex (Bo) to drain the Fire, after eight days the laughter ceased and hand movement returned; within a month, he could walk. (From *Yitong*.)
Lu Yangyu treated Vice Minister Wu, aged fifty, who collapsed while kneeling during an ancestral worship ceremony upon returning home in honor, sweating profusely like rain, with intense body heat and unconsciousness. Some suggested administering Niuhuang Wan (Calculus Bovis Pill). The pulse at Guan and Chi positions was floating, rapid, and empty; the Cun positions penetrated into the fish-mouth area. This indicated severe Yin deficiency and extreme Yang hyperactivity. Administering Niuhuang would have been fatal. Urgently, one liter of fresh Rehmanniae Radix juice (Disheng Zhi), one liang of Ren Shen (Ginseng), five qian of Ophiopogonis Tuber (Maidong), and one hundred seeds of Schisandrae Fructus (Wuweizi) were decocted thickly and administered. After two or three doses, the Spirit stabilized slightly, sweating stopped, and he entered a state between sleep and wakefulness. At Wugeng (3-5 AM), he exhibited fear, as if being hunted. By dawn, he showed extreme anger, cursing incessantly. At noon, he laughed loudly for one or two hours. By dusk, he wept bitterly. The symptoms alternated between night and day, leading the family to suspect demonic possession. This is exactly what the *Neijing* calls "The Five Essences merging." Merging with Kidney causes fear; with Liver, anger; with Heart, joy; with Lung, sorrow. Liu Hejian stated: Improper daily regimen leads to insufficient Kidney Water and extreme Heart Fire, manifesting as this syndrome. At night, when Yin is abundant, the pathogen rests temporarily; at midday, when Yang is vigorous, the pathogen roams the five Zang organs without rest. The previous formula was used with half the amount of Ren Shen. Within ten days, he experienced only crying/laughing or only cursing/fear, alternating between consciousness and unconsciousness. He ate only when fed and did not think when not fed; bowel and bladder movements were unobstructed. Only after half a month did he become calm, followed by nourishing Qi and Blood for over a hundred doses until recovery.
Lin Zhongzun from Changxing, over fifty years old, felt bodily fatigue and dizziness after seeing off the Provincial Surveillance Commissioner. His head began to tremble and shake, he wanted to speak but could not, and experienced wheezing and counterflow qi. Everyone used Niuhuang Suheli Wan and Da/Xiao Xuming Tang for ten days with no improvement. The pulse was deep, slow, and weak, especially at the left Guan and Chi positions, indicating Liver-Kidney deficiency and sudden depletion of Essence and Qi. Inquiry revealed that due to the strictness of the Commissioner and fear of error, extreme mental labor led to illness upon return. The *Neijing* states: "All wind-induced tremors and dizziness belong to the Liver." Liu Hejian said: This is not external Wind pathogen, but results from improper regimen, insufficient Kidney Water, and excessive Heart Fire. Another classic says: "All counterflow and upward rushing belong to Fire." The current trembling and wheezing are due to this. In middle age, Kidney Qi is naturally insufficient; furthermore, fear injures the Kidneys, and excessive caution has damaged Kidney Qi. The *Neijing* says: "Fear causes Qi to sink." Voice is emitted by Qi; since Qi sinks, voice cannot emerge. Moreover, the pulses of Liver and Kidney both accompany the root of the tongue. The method should be to strengthen the Qi of these two meridians to treat the branch (symptoms); nourish the Blood of these two meridians to treat the root (cause). Use Gouqizi (Lycium Fruit) as Sovereign to tonify Kidney; Tianma (Gastrodia Rhizome) and Chuanxiong Rhizome (Chuanxiong) as Ministers to benefit Liver; add Ren Shen and a small amount of Fuzi (Aconite Lateral Root) as Assistants; and Dongdong (Tianmai and Maidong) as Envoys. Two doses, totaling several liang, significantly reduced all symptoms. Intermittent use of Bawei Wan (Eight-Ingredient Pill) for ten doses resulted in complete cure.
Zou Chunyuan (Ziquan), under fifty years old, suffered stroke: deafness, nasal congestion, obstruction of urination and defecation, paralysis and coldness of limbs, and aphasia. Some said: "He speaks of deceased persons," and he had already been given a coin's worth of Niuhuang. Others said: "The classics state those losing Yang see ghosts, those losing Yin go blind. Now he speaks of the dead and sees nothing, confirming ghost-sightings and blindness." Also, Jiegu said: Stroke affecting Fu organs involves the four limbs; affecting Zang organs obstructs the nine orifices. Now limbs are paralyzed and upper/lower orifices blocked, indicating simultaneous Zang-Fu involvement. Furthermore, the six pulses are wiry and rapid without order. The *Maijue* says: "Stroke pulses that are slow and floating are auspicious; urgent, solid, large, and rapid indicate isolated souls and peril." Both pulse and symptoms are critical, suggesting no hope of life. A prescription was made with five qian of Ren Shen, one liang of Shudi (Prepared Rehmannia), and two and a half qian each of Guizhi (Cinnamon Twig) and Fuzi, but not yet administered. Lu Zhi took the pulse: superficially extremely rapid and urgent, moderately slightly缓和 (soothing), indicating remaining Stomach Qi, though heavy pressure on Chi positions felt empty. He said: Simultaneous tonification of Yin and Yang is indeed the root treatment, but during upper/lower obstruction, it may not take effect immediately. One must first open the bowels and bladder so that turbid Yin descends, allowing Clear Yang to ascend, before discussing tonification. The classics say: In acute onset, treat the branch first, then the root. Everyone believed the condition was too critical to delay, so they administered the previous tonic. After several doses, the medicine remained in the chest, making noise when rubbed but not reaching the abdomen. Upon re-examination, the pulse remained the same. Lu took dozens of homemade Shenyue Wan pills from his sleeve, pried open the mouth, inserted them, and administered light ginger soup. Once the medicine went down, Baihui (GV20) acupoint was moxa-burned to raise Yang Qi, and Guanyuan (CV4) was moxa-burned to prevent Yang sinking. After one or two moxa cones, eyes opened, brows furrowed. Asked if painful? He nodded; limbs moved slightly. Told to endure up to seven cones for survival; he nodded again. Near the end of moxibustion, he needed to defecate; subsequently, both anterior and posterior passages opened, expelling much filth. Shortly after, another stool passed. He was instructed to quickly prepare the previous medicine with double the Ren Shen. When he had a second bowel movement and felt dizzy, the medicine was slowly administered, and he regained consciousness. Thereafter, consciousness gradually improved, but limb tremors and left-sided hemiplegia persisted. In major Qi-Blood tonifying medicines, small amounts of wind-dispelling, Qi-regulating, and phlegm-resolving herbs such as Qinjiao (Gentiana Macrophylla), Quanxie (Scorpion), Jiangcan (Bombyx Batryticatus), Wuyao (Lindera Root), Xing (Tian Nan Xing), and Ban (Ban Xia) were added. Treatment lasted over a year until recovery. Initially, Qi-Blood deficiency was the root, and orifice obstruction was the branch. Opening the obstruction first addressed the acute branch. Later, addressing wind symptoms while focusing on tonifying Qi-Blood with minor wind herbs addressed the chronic root.
Fan Xiyun suffered facial deviation, limb spasm, spontaneous sweating, and aversion to wind. Acupuncture, topical applications, and various wind-dispelling herbs failed for half a year. Pulse: left floating and tight, right洪缓 (surging and slow). This is Wind pathogen lodging in the Yangming channel, stagnating and transforming into Heat. Although dispersal is indicated, the pathogen is confined to one channel; mixing herbs from other channels attacks non-pathogenic areas, merely weakening the exterior without removing the pathogen, thus worsening aversion to wind and sweating without correcting facial deviation. The classics state: "The Foot-Yangming Stomach meridian flanks the mouth and circles the lips." This disease affects the mouth and lips, belonging solely to the Yangming channel; Mahuang (Ephedra), Guizhi, and Qianghuo (Notopterygium) are not suitable. Use Gegen (Pueraria Root) five qian and Shengma (Cimicifugae Rhizome) two qian to drive out stubborn Yangming pathogens; Baizhi (Angelica Dahurica) two qian and Jiangcan one qian five fen to correct head/face qi deviation; Huangqi (Astragalus Root) one qian five fen and Guizhi five fen to secure the loose exterior; Jiegeng (Platycodon Root) one qian and Gancao (Licorice Root) five fen to carry the herbs upward. Effective in two doses, cured in several doses. Later, nourished Ying Blood, fortified the interstices, and added minor clearing-heat and resolving-phlegm herbs for regulation. (Cross-reference with Xu Shumi's case.)
Li Sitang's mother, sixty years old, very obese, suddenly collapsed in January with stroke symptoms: unconsciousness, locked jaw, throat rattle, and limb paralysis. Niuhuang Wan and Xiao Xuming Tang were ineffective. Pulse: floating, surging, slippery, more pronounced on the right. Due to rich diet and strong constitution, the pulse was abundant. The classics state: "Diabetes, sudden falls, hemiplegia, atrophy, cold limbs, Qi fullness, and counterflow in fat nobles are due to Phlegm from rich food." Also: "Excess Earth causes inability to move limbs." Danxi said: "Dampness generates Phlegm, Phlegm generates Heat, Heat generates Wind." First, use Hezi's method of inducing vomiting. Administer Xixian San (Sputum-Expelling Powder) mixed with vinegar juice, expelling about a bowl of phlegm. Shortly after, Sanhua Tang was administered; by evening, two or three stools passed, throat sounds ceased, and speech returned. However, consciousness was not fully clear, indicating upper/lower blockage was cleared but middle Jiao accumulation remained. Erchen Tang (Two-Aged Decoction) with Zhishi (Immature Bitter Orange), Huanglian (Coptis), Laifuzi (Radish Seed), Muxiang (Aucklandia), and Baokouren (Cardamom) was given twice daily. Within days, consciousness improved, hunger returned, and thin porridge was allowed. For constipation, Runzi Wan (Moistening Pill) five fen with ginger juice in warm water was taken daily. Occasional spasms and dryness indicated blood consumption and fluid depletion; Siwu Tang (Four Substances Decoction) with Qiniao, Huangqin (Scutellaria), and Gancao for dozens of doses cured her in three months.
Lu Zuyu treated Zhao Yiyang, over fifty, who collapsed with stroke: locked jaw, eyes rolling up, clenched hands, and limb tremors. Xixian San blown into nose expelled bowls of thick phlegm. Two doses of Xiao Xuming Tang worsened condition: mouth open, hands relaxed, eyes closed, urinary incontinence, cold limbs, unconsciousness, throat rattle, and fever. Pulse: surging, slippery, with intermittent pauses. Condition critically dangerous. Prescribed Erchen Tang with Nanting (Arisaema), Zhishi to guide phlegm; Siwu Tang to nourish blood; assisted by Yazao (Gleditsia Spine), ginger juice, and Zhuli. Two doses reduced phlegm/wheezing; six doses cleared consciousness. Switched to Renshen, Baizhu (Atractylodes), Danggui (Angelica Sinensis), and Shaoyao (Peony) to greatly tonify Qi and Blood, resulting in stability.
Li Cuiyan, nearly seventy, obese and overworked. While walking outside, saw double images, doubled paths, and doubled doors, collapsed suddenly. Brought home, reluctant to speak but able to describe symptoms. Treated as stroke with phlegm-resolving and wind-dispelling herbs for over ten doses, leading to cold sweat like rain, fright, tremors, and unconsciousness. Left Cun pulse floating and large but empty on pressure; others slow, weak, and empty. Consciousness dim, unable to speak. This is deficiency collapse; primary treatment should tonify Zheng Qi (Upright Qi). Six Junzi Tang (Six Gentlemen Decoction) plus Huangqi, Danggui, Dihuang, Shaoyao, Tianma, Duzhong (Eucommia), Niuxi (Achyranthes), and Zaoren (Jujube Seed) stopped sweating in two doses; speech and recognition returned in five doses; cured in seven to eight doses. Added three qian of Ren Shen per dose; after twenty-plus doses, eating and walking normalized.
Ma Yuanyi treated Zhou Mou, unconscious and mute, resembling stroke for half a month. Right pulse deficient, minute, and powerless, indicating Yang deficiency. Chest fullness or staring blankly indicates Upper Jiao Yang dysfunction. Weak knees and inability to turn indicate Lower Jiao Yang dysfunction. With diminished Yang, Yin takes over; without warming tonification, Yin grows daily while Yang declines. Like seasonal change without warmth, how can life persist? Prescribed Fugui Lizhong Tang (Aconite and Cinnamon Regulate Middle Decoction) to greatly tonify Yuan Qi. After half a month, clarity returned, bowels moved; after one month, appetite improved, and walking resumed. Concurrent use of Bawei Wan aided regulation and stability.
Feng Chuzhan treated Zhang Quanbu, who developed palpitations and tinnitus from past overwork. Doctors treated phlegm, inducing a bucket of sputum, then used Guntan Wan (Rolling Phlegm Pill). Although phlegm cleared, Spirit was depleted. In early autumn, he collapsed stiffly, with phlegm rattle, eye deviation, mouth opening, limb rigidity, and profuse sweating—critical condition. All six pulse positions were vast and boundless, indicating impending collapse. Urgently, three liang of Ren Shen, two liang of Baizhu, and five qian of Fuzi were decocted thickly and administered. Three doses daily, timed appropriately. Pulse stabilized, body heat moderated, sweating decreased. Next day, two doses day, one night. By third day, symptoms lessened, but stiffness/unconsciousness persisted; effort was insufficient, branch symptoms calmed, but Yuan Shen (Original Spirit) not restored. Continue previous formula; after dosing, administer half cup of thick rice juice to protect Stomach Qi and assist medicine. Discouraged adding wind herbs ("How dare I disperse when preservation is hard enough?"), phlegm herbs ("How dare I resolve when preservation is difficult?"), or cooling herbs ("Even worse! Original Yang is collapsing; saving it is barely sufficient, how dare I cool it?"). My heavy use of Baizhu and Fuzi strengthens Ren Shen's Yuan Qi tonification; resolving phlegm, dispelling wind, and calming fire are inherent in this strategy. Touching on branch treatment would cause deficiency syndromes to swarm, making matters harder. Defying convention, I avoided them. Total usage in three days: 35 liang Ren Shen, 6 liang Fuzi, 24 liang Baizhu. Evening: sudden ability to speak, slight consciousness, ate half bowl porridge, slept; rattle and eye deviation persisted. Morning (Yang phase): Major Qi-Blood tonics for Heart/Spleen (Zaoren, Danggui, Baizhu, Shaoyao, Fushen, Yuanzhi, Ren Shen, Guiyuan, Wuweizi). Afternoon (Yin phase): Bawei Tang flushed with concentrated Ren Shen juice. After six-seven days, symptoms calmed. Daily Ren Shen 4-5 liang. Later mornings: Shengmai Yin with Bawei Wan, adding Niuxi, Duzhong, Lurong (Deer Antler), Wuweizi (4-5 qian). Midday: Modified Guipi Tang and Bawei Tang. Gradual strengthening, doubled appetite, recovered in one month. Treating critical conditions relies entirely on effective root regulation; naturally, pathogen has no place. Ancients said: Recognize branch, focus on root; treat thousands without harm.
Tan Zhangke, over sixty, suddenly fainted with surging phlegm and unconsciousness. Vomit一碗 (bowl) of phlegm, slightly revived. Porter forcefully carried him in sedan chair, gripping legs. Doctor gave wind-dispersing, heat-clearing, phlegm-resolving herbs; after ten days, phlegm undiminished, irritability doubled, headache and leg pain worsened. Pulse: Cun positions very surging and large; Chi and right Guan positions very deep and minute. Isolated Yang hyperactive above, weak Yin unable to grasp; Middle Jiao Spleen Earth also deficient, Yang has no storage, floats to vertex causing distension/pain. Method: Strengthen Water to control it, cultivate Earth to store it, tonify Fire to guide it, assist with Lung-nourishing/Metal-clearing to achieve Autumn descending function, thus gathering and storing. Shudi (Rehmannia) eight qian as Sovereign; milk-fried Baizhu five qian as Minister; rice-fried Maidong three qian as Assistant; processed Fuzi one qian five fen as Envoy. Decocted separately, five qian Ren Shen decocted juice mixed in. Headache instantly reduced, symptoms gradually resolved. Leg pain remained due to porter's grip injury; finger marks visible. External cause requires external treatment: raw pork loin mashed with cinnamon powder, scallion white, salt, applied thickly to site. Previously suffered morning diarrhea and poor appetite; morning empty stomach: Ren Shen soup with Bawei Wan. Noon before meals: Fried Baizhu thirty liang, processed Fuzi three liang boiled into paste, mixed with six liang Ren Shen powder, formed fine pills, swallow three qian with warm water. After half month, Spleen/Stomach strengthened, spirit increased.
Lady Jing, near fifty, stroke for five-six days, continuous sweating, fixed eyes, locked jaw, incontinence. Considered incurable. Pulse: very faint, but heavy pressure shows natural rhythm without haste/slowness—this is Stomach Qi. She said: Incontinence belongs to immediate collapse syndrome, hence untreatable. But after many days, how can one not urinate? Sitting idle for days without collapse proves not terminal. Administered Shenfu Tang (Ginseng and Aconite Decoction) two-three doses, gradually revived; heavy warming tonification led to cure.
Jin Jiaoyu, summer intense fever, headache, cough. Doctor diagnosed cold, used Qianghuo, Qianhu, Zisu, JuPi, Banxia, Zhike. Before finishing, headache shattered, tongue stiff, sticky sweat, left arm numb, Spirit exhausted. Pulse surging, large, empty, slow, powerless. Identified as Qi-deficiency stroke-like syndrome, mistakenly treated with dispersal. During this dissipating time, nearly became collapse syndrome. Prescribed Shudi one liang two qian, Maidong three qian, fried Baizhu four qian, Niuxi two qian four fen, Wuweizi eight fen, processed Fuzi one qian five fen, Ren Shen eight qian decocted separately and mixed. Three doses daily; cured in five days. Li Xiangsheng, same day illness, identical symptoms, one dose of dispersal, night-long sweating, died next day.
Zhang Luyu treated Zhao Mingyuan, spring exam winner, normally weak pulses, stroke unresolved for a year. Left hand three positions wiry, large, firm—Kidney Yin injury, vigorous Fire consuming Qi. Renying pulse slanting inward to Cun indicates Three Yang excess overflowing into Yangwei vessel, risking fall and insensitivity. Right hand three positions floating, slow, with slight slipperiness above Qikou indicates Phlegm surging in Diaphragm. Clear Yang position occupied by Phlegm-Qi, invading Heart Master, causing unclear consciousness and erroneous speech. Some noted corner-of-mouth saliva and fixed eyes, assuming pathogen in meridians, used wind-dispelling/phlegm-guiding herbs. Ignored that this is Kidney Qi failing to connect to Heart, Heart deficiency-Heat generating Wind; not suitable for wind-drying herbs. Some noted frequent clear urination, assuming Kidney deficiency, used Bawei Wan (strong Fire). Ignored that although deficient, deficient Yang hides in Liver, causing easy erection and hunger; not suitable for Fire-tonifying/Yin-consuming herbs. Some noted history of dysentery with phlegm-blood foam after stool, used Buzhong Yiqi. Ignored that Spleen Qi sinking in Lower Jiao can use lifting herbs, but this is residual Yin deficiency dysentery; what Clear Qi is below? Using Shengma/Chaihu lifts Liver/Kidney, agitates deficient Yang and Phlegm-Fluid in Diaphragm, risking wheezing/distension. Prescribed Hejian Dihuang Yinzi to assist Kidney, connect Heart, achieving both goals. Must avoid rich flavors and sexual activity; otherwise, medicine helps little. Wise people prioritize proper regulation.
Guard Jin Hanguang's relative, stroke: limbs immobile, wheezing with shoulder breathing, sound like sawing wood, unable to lie flat, no sleep/eat for half month. Pulse rapid-large, powerless on long pressure, Chi increasingly empty; above refers to right Cun/Guan. Left Guan/Chi wiry-rapid, shrinking on pressure; only Cun rapid-abundant. Occasional dizziness/confusion. Previous Erchen/Daotan with Qiniao/Tianma ineffective. Niuhuang Wan worsened phlegm/critical. Used Liujunzi Tang plus Dansing/Zhuli or Huanglian/Danggui. Four doses removed wheezing; two more doses improved eating/sleeping; four more doses enabled limb movement. Over ten doses, slow walking possible.
Gu E, Prefect of Hanchuan, elderly wife, Qi-deficient with abundant phlegm, depressed. Suddenly fell from bed, tongue stiff/mute, limb paralysis. Ate wet noodles that day; doctor used digestion-promoting herbs, ineffective, worsened exhaustion, unconsciousness, head/neck swelling. Pulse: six positions deficient, soft, powerless. Doctor still noted six-seven days no stool, planned purgatives.