《正脉》以广其传。今择其要论数则，录于医论之末，俾后进知有其书，便于寻绎，济人疾厄，
共登仁寿之域，则吾之志矣。果斋识。
《芷园治验》云∶孟抒正君因怒发呃三日夜，急柬召予，以事夺，至未未往诊，盂抒愁容
怨语，泣涕嗟苦。予诊之曰∶来极迟，效极速！药进而寝。次日喜见曰∶昨心欲裂，方治后事，
以兄诙谐宽我耳，宁期一药而果效，真不解其故。予曰∶予开肝郁也，内君特怒之，未畅气
将入胃而不能，故发呃。予不治呃，用柴胡等条达木郁，郁解则止，暴病气全，故易愈耳。
积学日深，见病知源，况暴病正气未伤，故效骤速愈矣。
按∶呃由怒起，冲气欲入胃而不能，则发呃。卢先生用柴胡条达木郁而瘳，未将全方药
味示人，乃重道不肯轻泄治法，则后进未能效尤矣。今既用柴胡条达木郁，可隅反而知其余
之药，亦不外薄荷、苓、芍、归、草等味，即逍遥散一方，以解木郁而诸郁均解。予治验中，亦
仿鼓峰法师其意，不泥其方，用合欢皮、川郁金、枇杷叶、香附、橘络、金橘饼、玫瑰花等，随
宜加减变化其方，每多获效。惟原方有白术一味，有壅塞气机、浊而不宣之虞，斟酌去之为
宜。如苏梗、抚芎、茄楠、檀香、旋覆花等，皆可随症选用。至于名医用成方、必临症化裁，超越凡庸之上也。
又治白下∶缮部戴养吾夫人恙，召诊，寸
关不透，体常倦怠，眩运不食，胸膈痞满，予以为肝脾之气不伸，用八珍加升麻、柴胡，愈而
体实。每病取前方服之，即安。后之瑞安之滇南，十五年皆倚恃焉。若稍加减，便不获效，养
吾公解组林下，每过湘水，必得良晤，尝以夫人为信心此方也。夫人性静体浓，起居安适，
是以气血不振而消沮，故于补气药中，加开提之剂，盖得其性情，如布帛、菽粟，若将终身焉
者。所云信心二字，真为良药。世之任医，厌常喜新，安得恒守一方至十五年耶！
信心二字，真为卫身至宝。近人厌故喜新，朝张暮李，广征方药，贤愚不别，遂致轻者
重，重者危，是不知守信心之患矣。
来熙庵廉宪急柬召予诊。其侄力大，身体丰硕，伤寒已二十八日，人事不省，不能言语，
手足扬掷，腹胀如鼓而热烙手，目赤气粗，齿槁舌黑，参、附、石膏、硝、黄、芩、连无不服，诸
名公以言旋矣。予诊之，脉独鼓手，用大黄一两，佐以血药，一剂，下黑臭血一二斗，少苏，
四剂始清。熙庵公问予∶侄昏三日，所存唯一息耳，君何用剂且大且多，幸遂生全，敢问其
说。予曰∶治病用药，譬之饮酒，沧海之量，与之涓滴，则喉唇转燥矣。以若大躯壳，病邪甚
深，不十倍其药，何效之臻？且此恙寒邪入胃，蓄血在中，其昏沉、扬掷，是喜妄如狂之深者
也，不知为病，而望之为死，不弃之乎。夫大黄，未尝不用，苟投非其时，品剂轻小，一或不
应，用心惑矣，宁能放胆而用哉。
此为阳明蓄血症，用桃仁承气重剂，方能克敌。然非学识兼全者，不能如是。
湖墅史大正君呕吐之声远及百武，脉之佐关鼓指不连于寸，两尺滑搏，于左独加，水
饮不入唇七日矣，因为透肝之剂，断必孕男，药进而呕定，月足果产男。因问予曰∶内子寒
热大作，呕吐不食，人皆以伤寒治之，君独以为孕，其柴胡、白芍、吴萸、黄连虽未专用，何
一剂而呕遂平？予曰，医名方脉者，须察脉以定方也。人唯伺其证，而不循其因，是以失之。
今脉具在，不为证瞒，因病发药，故其言验也。
尺中脉搏固知为妊，其关不连寸者，盖肝志专而郁，善怒万不善发也，郁之之既久而自发，
振拉摧拔之象见焉。顺其性而伸之、调之，肝舒气平，恶自无阻而呕自定耳。
恶阻呕吐，其因尺中脉搏，固以恶阻断定，治以舒肝气，顺其性而谓之，则呕自平矣。
闻于将尊堂丙午冬月心忽然如散而沉下，便不得睡，几三月矣。召诊，独左关弱不能
应指，予以为肝虚须补其母，当立春始安，用熟地为君，茯苓、枣仁、当归、人参、防风、远志
佐之，服二十贴，至其而愈。子将问∶心散不寐，以属心经，何反以肾、肝药见效？而言立春
日始应，请为分疏。予曰∶此得之脉也。经曰∶肝不足则恐，恐则气下。虽情志无恐惧，而气
象似之，据脉按证，肝虚无疑矣。因肝不足，先其令而疾作，补母生脾，待时而元气乃复，岂得以心散。便属
心经，是非心散也，乃心见身中气散之象耳，则散非病。设心脏病则病矣，又何能自见其散哉。
补母以益子，是隔二之治。言立春始愈，乃肝脏正气旺而邪自退舍矣。
汤梅生病腹痛，痛则绕脐有形，甚至欲死。人皆谓生气独绝于内，似有不起之虑。予
诊之，关脉近尺有滑，拊之胀痛，气羸颇乏精彩，因用枸杞为君，白芍、茯苓、肉桂、吴萸佐
之，六剂痛止，服《瑞竹堂方》四制枸杞丸一料，竟愈。黎茂先举问何疾，予曰∶脐疝也。疝
气引阴，原无斯症，然疝考有形之痛而有所止之处，故字从山，不必定引阴也。疝本厥阴肝
疾；其状若死，亦厥阴证，故用温补肝药，生气自复，不致内绝。此案贪天之功，予为可作起死一则看也。
脐疝乃厥阴危险之候，治以温补，是从根底而治也。
李姓，口舌生疮，几三年矣。脉浮细急数，按之空虚，而尺尤甚。用薛立斋肾虚火不归经
法，以加减八味丸料，二剂即愈。此案初试立斋先生法纪，其捷效如此，为近世高明之家独
出奇见、欲超出规矩绳墨之表，不知视立斋为何如？
永嘉何介甫文学，性沉静，病脾数年，饮食少啖，精神萎悴，辛酉七月就诊。两关软弱，
不透于寸。用参、苓、归、芍、陈皮、防风、甘草数十剂，至九月始归、遂喜啖肥浓，数年之疾
脱然。壬戌春，再过钱塘，携美人蕉、佛桑花赠遗特盛，问曰∶子疾有年，补脾、补肾，法非不
详，而未之效，君何从平易得之？予曰∶君疾在肝，非脾、肾也。凡诊病者，当穷其源，无为证
惑。如饮食少，虽关脾胃，其所以致脾病者何？故此自当审考。今君两关脉弱不透于寸右，固
脾虚明矣，而左则何应此。盖脾体不足，而脾用不行也。何谓脾之用？肝也，星家取克我者
为用神，脾体无肝木为之用，则气血便不条畅，运化迟钝，而脾转困矣。自秋令金肃，肝更
不伸，予为补助肝木之气，使之扬溢，则脾土伸舒，精神油然外发，虽不治脾，实所以治也，
安用奇特之法哉！予正恐不能平易耳，平易之言，学之所未熊者，今请事斯语。
名医治病，必求其源而辨其脉，不为外证情势所惑。补不足，损有余，本经旨以立方。
吴叔显上舍庚申三月生疮，眼药疮愈，而喘急殊甚，十日不能就枕。予往诊之，先用开
肺发疮，次用降气补肾，断其二日当疮发，五日当足肿，六日当出水，十日可喘定、就睡。嗣
后足牛二毒，三月始复。秋之日，下就国学读书。次年七月，偶以伤风微热，左三部脉唯隐
隐见，饮大剂人参、归、木、甘草，十帖脉方起，二十帖如常。十月再感，左脉更不如秋，但微
热，而起居如故也。三月就枕，七日头痛如破。因告其兄，极道秋病之危，今若昏沉，决无生
理，彼尚疑余言。九日，果微昏谵语；十二日，不识人；再七三，死。其族昆问曰∶叔显昨岁垂
危，君言变证，历历如响，幸全生焉。今冬示微恙，果应君言而殁，其证、其因，为一为两？答
曰∶叔显骨气天弱，肾精不全，其疮亦从肾发焉；不知而用发散药，元气转耗，疮毒内逆于
肺而喘。予用四逆散使太阴气开，疮遂外出；用六味料，使少阴纳气，息遂内匀，清升浊降，
足肿生痈，病都外出，是以生也。今秋左脉不起，知元气内索，不堪左旋矣。比起而再，戕贼
之病，发于骨髓，所以脑痛，因之遂昏，乃内关之证，气独内绝，是以死也。论其根本，出皆于
肾，是一非两，不在证之轻重，为异同也。此案辨治精详，非深于《灵》、《素》之蕴，所不能道也。
少阴肾虚，元气内索，是内关危证，生气内绝，不治之症矣。
蜀富顺孝廉阮太和讳士肃，病疠吴山下，召予诊。披衣强坐，对语甚壮，神气则内索也；
身热进退，舌胎黄而浓，盖自吴门受寒，以肉羹为补，而对啜之，遂缠绵及月余。用疏散轻
剂，热退，又复强啖，再热，不能起坐。予时之富春，五日归诊之，谵妄呼笑、不识人已三日，
形骨立，汗雨下，内热特甚，而胸胁之热，扪之烙手，第脉尚有神。予用人参八钱加四逆散
中，一剂而谵妄定，三剂而热邪清矣。自言其神魂穷天之上、极地之下，飞扬奇变，得太乙
神符召之，始得返生。愈弥旬，方啜粥。病中自为之记别时间，药状。余谓此寒伤心气，荏
苒厥深，而凑于胸也。缘以不第南旋，病淹中道，骨肉之音，虽近实违；药石之给，既缺且
竭。心已伤矣，又反复再四，汗液多亡，内无主宰，热遂入胸。胸为心主之宫城，精神因而涣
散，是以游魂为变也。用四逆使热外出，加人参俾神内凝，气复邪散，是以生耳。
始由气郁不舒则伤肝，继则强啖伤脾，是以精神焕散，游魂为变。用四逆散退逐外热，加参以益元气。
富阳周妇、马女、皆少年，水肿，肢体洪盛，胪腹膨胀，水道不通，饮食绝口，有以为疸
者，为臌者，为气者。予往诊之，以药不克济，乃针足上，出水皆石余。次日胀小减，三日大
减。足尚肿，又针之。令服八味丸，以温其肾。期年皆孕，周善调护，子、母两全；马失调护，
子、母俱毙。此盖肾中阳气不足，阴气有余，遂聚水而病作。饮食、汤药用水，而不能导之，辗
转助长，乃致于此，非针去水，则菀陈之淤，何
从而泄。水去肾衰，非温补之则浊凝之阴，必致复聚，肾中之火大复。然周身之阳气有蒂，
天癸自行，生育可必。如流离之后、所宜爱养，得之则生聚，否斯待毙耳。
盖肾中阳气不足，阴气有余，遂聚水致病，是此病之源也，《内经》有聚水而成其类是也。
庚申腊月二十七夜，予患腹痛，恶寒，泄泻，平旦且止，至暮复作，明日又止。至改元五
日，肛左微痛。起因房室，意为肾泄，服四神丸一大剂，泄、痛竟止。早间肛左稍有核，其痛渐
近尾闾，暮痛不可反侧。次暮以水化熊胆涂之，立觉凉气直上肺左，痛亦渐缓，略堪展转。
中夜吐痰，痰内见血一二点，辰时痔出白浓脓，竟可起坐。十一日早，与人多话，方栉发，
血从咳至，作意忍之，气定且止，煎六味丸料服，亦以肾虚也。暮就枕，夜半睡觉，血即上涌
如潮，喘声如锯，进童便及六味煎药，气稍定，才闻姜汤，气触鼻，血即随涌，平旦始缓。夜再
发如前，凡假寐片响，背心蒸热，醒即血来咽喉，如截断，一涌盈掬，心躁急乱，欲多语言，
声一响而血 至矣。十三早议，下莫敢应，至晚势急，似无生理，乃用泻心配血药下之，不
应。夜方大雪，点水成冻，用水调大黄末服，转欲去衣被，啜芩、连苦药如甘旨。至五更，强进
清米饮、药力忽转，解黑粪瘀泥臭秽不可近，凡三次，血来之势少平。十五寅时交立春。建
宁老莲煎浓汤，呷之甚美，少间足心汗出，次手心出，次背心蒸蒸欲出，一日安和。至暮，以
多语言，吐鲜血数口，颐儿引仲景义，以赤小豆、连翘合泻心方法服之，觉上身气即开，脐
以下不动而闷，汗出似前者，三日血亦渐减，二十外，大便自解如青泥，次解如铁弹者二三
枚，血方净尽。嗟、嗟！未解之前，几至不免，汗出之后，始有生机。
追思病发之由，十足曾暴怒，顿足叫呼，气喘如食顷。腊月十七，围炉露坐大半夜，指
爪朝来尽折，方旬遂病。盖自十月，便不能构思，看书亦不深入，近觉神思昏瞀者，浃旬病
乃大重。余作医二十年，治吐血证众，往往起其危疑。及自罹此，便无主脑，如因房室起病，
泄泻在夜，服四神而病已，益信为肾虚不疑，岂知服四神、六味，反为助长，以致病甚（起病
始由暴怒气郁，凝其血脉；继因夜坐受寒，加以炉火外燔，是以寒气愈凝，血液受焚，留瘀
之源也。必用逐瘀，折其锐气以除病根，为探本之治。致祸之因，实为四神、六味之遗患耳，
所以用药不能偏执一经而论）。若非偶中仲景方法，死不免矣。原余之疾，本于寒伤阴分，而
寒水之气，当乘心火，阴分之邪，宜应迫血。用补肾、血剂，偏助寒气，愈凝血液，火故暴焚，
血留转瘀也。立春阴分汗出，势自然解，瘀秽下尽，血方始清。初以微寒，竟成大祸，用药之
难惯见，且误如脏毒之疼痛，吐血之喘急，须认其原从寒生。但当未解时，纵有人指出其端
倪，恐自亦不信也，而况不知医者乎！故审疾处方，不可执定规矩。今人知其吐血，便用止
血、行血、顺气、降气种种方法，岂非妙理，若不深中肯綮，反成毒害，慎之、慎之！
病愈四十日，方能策杖，盘 室中。出寄素芝禅室，静言思之，殊自可愧，简出成案，用供博采。
按成，客读之，难曰∶吐血之因，起自于寒，容或有之；血涌之状，以为非火，实难深
《正脉》用来广泛传播其学说。如今我挑选其中重要的论述几则，记录在医论的末尾，使后辈知道有这本书存在，便于他们寻根究底，救济人们的疾苦，共同达到仁爱与长寿的境界，这就是我的志向。果斋（王肯堂号）记。
《芷园治验》记载：孟抒正先生因为愤怒导致呃逆（打嗝）持续了三昼夜，急忙写信召唤我，但因事务缠身耽误了行程，直到未时（下午1-3点）才去诊治。孟抒面带愁容，言语抱怨，哭泣叹息，十分痛苦。我诊察后说：“您来得太迟，见效太快！服药后便入睡了。”第二天他高兴地见到我说：“昨天心里像要裂开一样，正准备处理后事，是因为哥哥你诙谐的话语宽慰了我罢了，没想到一服药就果然有效，真是不明白其中的缘故。”我说：“我是疏解肝气郁结。您特别愤怒，气机不畅，想要进入胃中却无法进入，所以引发呃逆。我并不是直接治疗呃逆，而是用柴胡等药物条达木郁（疏肝解郁），郁结解除则呃逆自止。因为是突发疾病，正气没有受损，所以容易痊愈。学问积累日深，见到病症就能知道根源，何况是突发疾病且正气未伤，所以见效迅速而痊愈。”
按语：呃逆由愤怒引起，冲气想要进入胃中却不能，所以发生呃逆。卢先生用柴胡条达木郁而治愈，没有将全方的药味示人，这是重视道义不肯轻易泄露治疗方法，导致后辈无法效仿。如今既然用了柴胡条达木郁，可以举一反三推知其余的药物，也不过是薄荷、茯苓、芍药、当归、甘草等味道，也就是逍遥散这一方剂，以解开木郁而各种郁结都得以解决。我在治验中，也模仿鼓峰法师的意思，不拘泥于原方，使用合欢皮、川郁金、枇杷叶、香附、橘络、金橘饼、玫瑰花等，根据情况加减变化方剂，大多获得疗效。只是原方中有白术一味，有壅塞气机、浊气不宣的担忧，斟酌去掉为宜。如苏梗、抚芎（川芎）、茄楠（沉香类）、檀香、旋覆花等，都可以随症状选用。至于名医使用成方，必须根据临证情况进行化裁，这超越了凡庸之上。
又治疗白带下注：缮部戴养吾夫人的病，召我去诊治，寸关脉象不透，身体经常倦怠，眩晕不能进食，胸膈痞满，我认为这是肝脾之气不能舒展，用八珍汤加升麻、柴胡，治愈后身体变得结实。每次生病服用前方，立即安宁。后来她去瑞安和滇南，十五年都依靠这个方子。如果稍微加减，就不能获得疗效。养吾公辞官隐居林下，每次经过湘水，必定得到良好的会晤，曾经认为夫人对这个方子深信不疑。夫人性格安静，体质丰腴，起居安适，因此气血不振而消损，所以在补气药中加入开提（升举）的药物，大概是顺应了她的性情，就像布帛、菽粟一样，如同终身依赖它一样。“信心”二字，真是良药。世上那些随意行医的人，厌恶平常喜欢新奇，早上张仲景晚上李时珍，广泛征引方药，不分贤愚，导致轻病变重，重病转危，这是不知道坚守“信心”的危害啊。
来熙庵廉宪紧急写信召唤我诊治。他的侄子力气大，身体肥胖壮实，患伤寒已经二十八天，人事不省，不能说话，手足挥舞投掷，腹部胀大如鼓且烫手，眼睛红赤呼吸粗重，牙齿干枯舌头黑，人参、附子、石膏、芒硝、大黄、黄芩、黄连没有不服用的，各位名医都已经离去。我诊察后，发现唯独脉搏鼓指有力，用大黄一两，辅以活血药物，一剂药后，排出黑臭血一二斗，稍微清醒，四剂后才完全清除。熙庵公问我：“侄子昏迷三天，仅存一口气，您为什么用药剂量大而且多，幸好让他保全生命，敢问其中的道理。”我说：“治病用药，好比饮酒，沧海般的酒量，只给他一滴，那么喉咙嘴唇就会干燥。以这样大的身躯，病邪很深，不用十倍于常人的药量，怎么能达到疗效？况且这个病是寒邪入胃，蓄血在中焦，那种昏沉、挥舞投掷，是喜妄如狂的严重表现，不知道是这种病，却希望它是死症，难道不是抛弃了他吗？大黄并非没用过，但如果投药时机不对，药量轻小，一旦没有反应，用心就会困惑，怎么敢放手大胆地使用呢？”
这是阳明蓄血症，用桃仁承气汤重剂，才能克敌制胜。然而如果不是学识兼备的人，不能做到这样。
湖墅史大正先生呕吐的声音远及百武（古代长度单位），诊脉时左关脉鼓指但不连于寸脉，两尺脉滑而搏指，左侧尤其明显，七天水饮不进嘴唇，因此给予透达肝气的药剂，断定必生男孩，服药后呕吐停止，月份足月果然产下男婴。于是问我：“内人寒热大作，呕吐不食，别人都用伤寒治疗，您唯独认为是怀孕，虽然柴胡、白芍、吴茱萸、黄连没有专门使用，为什么一剂药后呕吐就平息了？”我说：“医生名叫擅长脉诊的，必须通过诊察脉象来确定方剂。人们只是观察症状，而不遵循病因，所以失误。现在脉象具在，不被症状蒙蔽，因病发药，所以话语应验。”
尺中脉搏有力固然知道是妊娠，关脉不连于寸脉，这是因为肝志专注而郁结，善于愤怒而不善于发泄，郁结久了自然发作，出现振拉摧拔（剧烈动摇折断）的象。顺应它的本性而舒展它、调畅它，肝舒气平，恶心自然无阻而呕吐自定。
恶阻（妊娠呕吐）呕吐，其因尺中脉搏有力，固然是以恶阻断定，治疗以舒肝气，顺应它的本性而称之为，那么呕吐自然平息。
听说您的母亲丙午年冬月心忽然感觉涣散而下沉，大便不通睡不着觉，将近三个月了。召我去诊治，唯独左关脉弱不能应指，我认为肝虚必须补其母（水生木，补肾以养肝），应当等到立春才安宁，用熟地黄为君药，茯苓、枣仁、当归、人参、防风、远志为佐药，服用二十帖，到那时痊愈。儿子将来问：“心散不寐，属于心经，为什么反而用肾、肝药见效？而且说立春那天才开始应验，请为我分疏。”我说：“这是从脉象得出的结论。经书说：‘肝不足则恐，恐则气下。’虽然没有情志上的恐惧，但气象类似，依据脉象按察症状，肝虚无疑了。因为肝不足，先于时令而发病，补母（肾）以生脾（火生土，此处逻辑需结合上下文，通常补母生子是滋水涵木或培土制水，此处原文逻辑稍显跳跃，依原文直译：补母生脾，待时而元气乃复），等待时机元气才能恢复，怎么能说是心散和大便不通属于心经呢？这不是心散，而是心看到身体中气散的象罢了，那么散就不是病。如果是心脏病那就是病了，又怎么能自己看见它的散呢？补母以益子，这是隔二之治（间接治疗）。说立春才痊愈，是因为肝脏正气旺盛而邪气自然退避了。”
汤梅生患腹痛，痛时绕脐有形，甚至痛欲死。人都说是生气独绝于内，似乎有起不来的忧虑。我诊察后，关脉近尺处有滑象，按压胀痛，气力虚弱缺乏神采，因此用枸杞为君药，白芍、茯苓、肉桂、吴茱萸为佐药，六剂后疼痛停止，服用《瑞竹堂方》四制枸杞丸一料，竟然痊愈。黎茂先问是什么病，我说：“脐疝。”疝气牵引阴部，原本没有这个症状，然而疝考证是有形的疼痛且有固定的部位，所以字从山，不一定非要牵引阴部。疝本属厥阴肝疾；其状像死，也是厥阴证，所以用温补肝药，生气自然恢复，不至于内绝。此案贪天之功，我可以把它看作起死回生的一个案例。
脐疝乃厥阴危险之候，治疗以温补，是从根本上去治疗。
李姓患者，口舌生疮，将近三年了。脉浮细急数，按之空虚，而尺脉尤其甚。用薛立斋肾虚火不归经法，以加减八味丸料，两剂即愈。此案初次尝试立斋先生的法度，如此快捷的疗效，为近代高明之家独自出奇见，想要超出规矩绳墨之外，不知道视立斋为何如人？
永嘉何介甫文学，性格沉静，患脾病数年，饮食吃得少，精神萎靡憔悴，辛酉七月就诊。两关脉软弱，不透于寸脉。用人参、茯苓、当归、芍药、陈皮、防风、甘草数十剂，到九月才归家，于是喜欢吃肥厚浓味的食物，数年的病突然好了。壬戌春，再次经过钱塘，携带美人蕉、佛桑花赠送非常丰盛，问我说：“您的病多年，补脾、补肾，方法不是不详，却没有效果，您从哪里用平易的方法得到的？”我说：“您的病在肝，不在脾、肾。凡是诊病的人，应当穷究其源，不要被症状迷惑。如饮食少，虽然关乎脾胃，但导致脾病的原因是什么？所以这应当审慎考察。现在您两关脉弱不透于寸右，固然是脾虚明摆着的，那么左脉为什么这样呢？这是因为脾体不足，而脾的功能不行。什么是脾的功能？是肝。星家取克我者为用神，脾体没有肝木为之功能，那么气血就不条畅，运化迟钝，而脾转困顿。自从秋令金肃杀，肝更不舒展，我补助肝木之气，使之扬溢，那么脾土伸展舒畅，精神油然外发，虽然不治脾，实际上就是治脾，哪里用得着奇特的方法呢！我正担心不能平易罢了，平易之言，是我学习所未能做到的，现在请奉行这句话。”
名医治病，必须求其源而辨其脉，不被外在症状情势所迷惑。补不足，损有余，根据经典旨意来立方。
吴叔显上舍庚申三月生疮，眼药疮愈，而喘急非常严重，十天不能枕卧。我去诊治，先用开肺发疮的方法，次用降气补肾的方法，断定他两天当疮发出，五天当足肿，六天当出水，十天可喘定、入睡。此后足生毒疮，三个月才恢复。秋日，下到国学读书。次年七月，偶然因伤风微热，左三部脉唯隐隐可见，饮用大剂人参、当归、木通、甘草，十帖脉才起，二十帖如常。十月再感风寒，左脉更不如秋天，只是微热，而起居如故。三月就枕，七日头痛如破。于是告诉他的哥哥，极力陈述秋天病的危险，现在如果昏沉，绝对没有生机，他还怀疑我的话。九日，果然微昏谵语；十二日，不认识人；再过七天，死了。他的族兄问我说：“叔显去年垂危，您说变证，历历如响，幸好保全生命。今年冬天显示微恙，果然应验您的话而死，其证、其因，是一还是两？”回答说：“叔显骨气天生弱，肾精不全，他的疮也从肾发出来；不知道而用发散药，元气转耗，疮毒内逆于肺而喘。我用四逆散使太阴气开，疮遂外出；用六味丸料，使少阴纳气，息遂内匀，清升浊降，足肿生痈，病都外出，所以生还。今年秋天左脉不起，知道元气内索，不堪左旋了。比起而再，戕贼之病，发于骨髓，所以脑痛，因而遂昏，乃内关之证，气独内绝，所以死。论其根本，出皆于肾，是一非两，不在于证的轻重，作为异同。”此案辨治精详，不是深于《灵枢》、《素问》蕴义的，不能说得出。
少阴肾虚，元气内索，是内关危证，生气内绝，是不治之症。
蜀富顺孝廉阮太和名士肃，病疠于吴山下，召我去诊治。披衣勉强坐起，对话声音很壮，神气则内索（内部空虚）；身热进退，舌苔黄而浓，大概是从吴门受寒，以肉羹为补，并且对着吃肉羹，于是缠绵了一个多月。用疏散轻剂，热退，又再勉强吃，再发热，不能起坐。我当时在富春，五天后回去诊治，谵妄呼笑、不认识人已经三天，形体骨立，汗如雨下，内热特别甚，而胸胁之热，摸起来烫手，只有脉还有神。我用八钱人参加入四逆散中，一剂而谵妄定，三剂而热邪清矣。他自己说神魂穷尽于天之上、地之下，飞扬奇变，得太乙神符召之，才得以返生。痊愈过了十天，才喝粥。病中自己写记别时间，药状。我认为这是寒伤心气，逐渐深入，而凑于胸。因为落第南归，病淹留中途，骨肉之音，虽近实违；药石之给，既缺且竭。心已伤矣，又反复再三，汗液多亡，内无主宰，热遂入胸。胸为心主之宫城，精神因而涣散，是以游魂为变。用四逆散使热外出，加人参俾神内凝，气复邪散，所以生还。
始由气郁不舒则伤肝，继则强啖伤脾，所以精神焕散，游魂为变。用四逆散退逐外热，加参以益元气。
富阳周妇、马女，都是少年，水肿，肢体洪盛，胪腹膨胀，水道不通，饮食绝口，有人以为是疸，以为是臌胀，以为是气病。我去诊治，以为药不能济，于是针足上，出水皆石余（古代容量单位）。次日胀小减，三日大减。足尚肿，又针之。令服八味丸，以温其肾。期年皆孕，周善调护，子、母两全；马失调护，子、母俱毙。这大概是肾中阳气不足，阴气有余，遂聚水而病作。饮食、汤药用水，而不能导之，辗转助长，乃致于此，非针去水，则菀陈之淤，何从而泄。水去肾衰，非温补之则浊凝之阴，必致复聚，肾中之火大复。然周身之阳气有蒂，天癸自行，生育可必。如流离之后、所宜爱养，得之则生聚，否斯待毙耳。
盖肾中阳气不足，阴气有余，遂聚水致病，是此病之源也，《内经》有聚水而成其类是也。
庚申腊月二十七夜，我患腹痛，恶寒，泄泻，平旦且止，至暮复作，明日又止。至改元五日，肛左微痛。起因房室，意为肾泄，服四神丸一大剂，泄、痛竟止。早间肛左稍有核，其痛渐近尾闾，暮痛不可反侧。次暮以水化熊胆涂之，立觉凉气直上肺左，痛亦渐缓，略堪展转。中夜吐痰，痰内见血一二点，辰时痔出白浓脓，竟可起坐。十一日早，与人多话，方栉发，血从咳至，作意忍之，气定且止，煎六味丸料服，亦以肾虚也。暮就枕，夜半睡觉，血即上涌如潮，喘声如锯，进童便及六味煎药，气稍定，才闻姜汤，气触鼻，血即随涌，平旦始缓。夜再发如前，凡假寐片响，背心蒸热，醒即血来咽喉，如截断，一涌盈掬，心躁急乱，欲多语言，声一响而血至矣。十三早议，下莫敢应，至晚势急，似无生理，乃用泻心配血药下之，不应。夜方大雪，点水成冻，用水调大黄末服，转欲去衣被，啜芩、连苦药如甘旨。至五更，强进清米饮、药力忽转，解黑粪瘀泥臭秽不可近，凡三次，血来之势少平。十五寅时交立春。建宁老莲煎浓汤，呷之甚美，少间足心汗出，次手心出，次背心蒸蒸欲出，一日安和。至暮，以多语言，吐鲜血数口，颐儿引仲景义，以赤小豆、连翘合泻心方法服之，觉上身气即开，脐以下不动而闷，汗出似前者，三日血亦渐减，二十外，大便自解如青泥，次解如铁弹者二三枚，血方净尽。嗟、嗟！未解之前，几至不免，汗出之后，始有生机。
追思病发之由，十足曾暴怒，顿足叫呼，气喘如食顷。腊月十七，围炉露坐大半夜，指爪朝来尽折，方旬遂病。盖自十月，便不能构思，看书亦不深入，近觉神思昏瞀者，浃旬病乃大重。余作医二十年，治吐血证众，往往起其危疑。及自罹此，便无主脑，如因房室起病，泄泻在夜，服四神而病已，益信为肾虚不疑，岂知服四神、六味，反为助长，以致病甚（起病始由暴怒气郁，凝其血脉；继因夜坐受寒，加以炉火外燔，是以寒气愈凝，血液受焚，留瘀之源也。必用逐瘀，折其锐气以除病根，为探本之治。致祸之因，实为四神、六味之遗患耳，所以用药不能偏执一经而论）。若非偶中仲景方法，死不免矣。原余之疾，本于寒伤阴分，而寒水之气，当乘心火，阴分之邪，宜应迫血。用补肾、血剂，偏助寒气，愈凝血液，火故暴焚，血留转瘀也。立春阴分汗出，势自然解，瘀秽下尽，血方始清。初以微寒，竟成大祸，用药之难惯见，且误如脏毒之疼痛，吐血之喘急，须认其原从寒生。但当未解时，纵有人指出其端倪，恐自亦不信也，而况不知医者乎！故审疾处方，不可执定规矩。今人知其吐血，便用止血、行血、顺气、降气种种方法，岂非妙理，若不深中肯綮，反成毒害，慎之、慎之！
病愈四十日，方能策杖，盘 室中。出寄素芝禅室，静言思之，殊自可愧，简出成案，用供博采。
按成，客读之，难曰∶吐血之因，起自于寒，容或有之；血涌之状，以为非火，实难深
*Zhengmai* (Standard Pulse Diagnosis) is used to widely disseminate its theories. Now, I have selected a few important discussions from it and recorded them at the end of this medical treatise, so that future generations will know of this book and find it convenient to explore, thereby relieving people's suffering and helping everyone reach the realm of benevolence and longevity. This is my aspiration. Recorded by Guozhai (Wang Kentang's pseudonym).
*Zhiyuan Zhixian* (Verified Treatments from Zhiyuan) records: Mr. Meng Shuzheng suffered from hiccups for three days and nights due to anger. He urgently sent a letter summoning me, but I was delayed by other matters and did not arrive until Wei hour (1:00 PM - 3:00 PM). Meng appeared sorrowful, complained bitterly, wept, and sighed in pain. Upon examination, I said, "You came too late, yet the effect was extremely rapid! After taking the medicine, you slept." The next day, he happily saw me and said, "Yesterday, my heart felt as if it were splitting; I was preparing my final affairs. It was only because your humorous words comforted me who knew not why one dose of medicine worked so effectively." I replied, "I treated liver Qi stagnation. Your extreme anger caused Qi to fail to flow freely. The Qi attempted to enter the Stomach but could not, thus causing hiccups. I did not directly treat the hiccups; rather, I used Chai Hu (Bupleuri Radix) and other herbs to unblock Wood stagnation (soothe the Liver). Once the stagnation resolved, the hiccups stopped. Since it was an acute illness and the healthy Qi was not yet damaged, it was easy to cure. With deepening scholarly accumulation, one can see the source of the disease upon observing symptoms. Moreover, since it was an acute illness with undamaged healthy Qi, the effect was sudden and recovery swift."
Commentary: Hiccups arising from anger occur when rushing Qi attempts to enter the Stomach but cannot, thus triggering hiccups. Master Lu cured this by using Chai Hu to unblock Wood stagnation. He did not reveal the full prescription, valuing the Dao and unwilling to lightly disclose treatment methods, which prevented successors from imitating him. However, given the use of Chai Hu to unblock Wood stagnation, one can infer the remaining herbs are likely Bo He (Menthae Haplocalycis Herba), Fu Ling (Poria), Bai Shao (Paeoniae Radix Alba), Dang Gui (Angelicae Sinensis Radix), and Gan Cao (Glycyrrhizae Radix et Rhizoma)—essentially the formula Xiao Yao San (Free Wanderer Powder), which resolves Wood stagnation and thereby all stagnations. In my verified treatments, I also followed the intent of Master Gufeng, not adhering rigidly to the original formula. I used He Huan Pi (Albiziae Cortex), Chuan Yu Jin (Curcumae Radix), Pi Pa Ye (Loquat Leaf), Xiang Fu (Cyperi Rhizoma), Ju Luo (Citri Reticulatae Pericarpium Retinervum), Jin Ju Bing (Preserved Kumquat), and Mei Gui Hua (Rosae Rugosae Flos), modifying the formula according to circumstances, often achieving efficacy. The only concern with the original formula is Bai Zhu (Atractylodis Macrocephalae Rhizoma), which may obstruct Qi mechanism and cause turbidity without dispersion; it is advisable to omit it after careful consideration. Herbs such as Su Geng (Perillae Caulis), Fu Xiong (Ligusticum Chuanxiong Rhizoma), Qie Nan (Agarwood), Tan Xiang (Sandalwood), and Xuan Fu Hua (Inulae Flos) can be selected according to symptoms. Thus, famous physicians must modify established formulas based on clinical presentation, surpassing the mediocre.
Another case involved leukorrhea: Mrs. Dai Yangwu, wife of a Secretary, was summoned for diagnosis. The Cun and Guan pulses were not penetrating. She suffered from constant fatigue, dizziness, anorexia, and chest/epigastric stuffiness. I diagnosed this as inability of Liver and Spleen Qi to extend, and prescribed Ba Zhen Tang (Eight Treasure Decoction) plus Sheng Ma (Cimicifugae Rhizoma) and Chai Hu (Bupleuri Radix). She recovered and her constitution strengthened. Whenever she fell ill subsequently, taking this previous formula brought immediate relief. Later, when she went to Rui'an and Yunnan, she relied on this formula for fifteen years. If slightly modified, it would lose efficacy. Mr. Dai, having retired to live in seclusion, always met me when passing the Xiang River and often expressed his wife's firm faith in this formula. His wife had a calm temperament and a robust physique, living comfortably. Consequently, her Qi and Blood were weak and diminished. Therefore, in tonifying Qi, I added lifting agents, adapting to her nature, much like relying on cloth and grain throughout life. The term "firm faith" is truly good medicine. Physicians today who discard the ordinary for the novel, switching from Zhang Zhongjing to Li Shizhen daily, and indiscriminately collecting prescriptions, cause mild cases to become severe and severe cases critical. This stems from ignorance of the dangers of lacking firm faith.
Commissioner Lai Xi'an urgently summoned me to treat his nephew. The nephew was strong and robust. He had suffered from Shang Han (Cold Damage) for twenty-eight days, was unconscious, unable to speak, flailing his limbs, with a drum-like distended abdomen that was hot to the touch, red eyes, coarse breathing, dry teeth, and a black tongue. He had taken Ren Shen (Ginseng Radix), Fu Zi (Aconiti Lateralis Radix Praeparata), Shi Gao (Gypsum Fibrosum), Mang Xiao (Natrii Sulfas), Da Huang (Rhei Radix et Rhizoma), Huang Qin (Scutellariae Radix), and Huang Lian (Coptidis Rhizoma) without success, and many famous physicians had left. Upon diagnosis, I found only a surging pulse. I administered Da Huang (Rhei Radix et Rhizoma) in a dosage of one liang, assisted by blood-invigorating herbs. After one dose, he passed one or two dou of black, foul-smelling blood, and became slightly conscious. After four doses, he cleared completely. Lord Xi'an asked me, "My nephew has been comatose for three days, with only a breath remaining. Why did you use such large and heavy dosages? Fortunately, he survived. May I ask the rationale?" I replied, "Treating disease with medicine is like drinking wine. For someone with the capacity of the vast sea, giving a single drop would dry their throat and lips. With such a large body and deep pathogenic factors, how else could efficacy be achieved without ten times the usual dosage? Furthermore, this condition involves cold pathogen entering the Stomach and blood stasis accumulating in the middle jiao. The coma and flailing represent severe mania akin to madness. Not recognizing the disease and hoping for death is abandoning the patient. Da Huang was not unused; however, if administered at the wrong time or in light dosages, and failing to produce a response, one's mind becomes confused. How then could one dare to use it boldly?"
This is Yangming Blood Accumulation Syndrome. Only a heavy dose of Tao Ren Cheng Qi Tang (Peach Kernel Drains the Lower Jiao Decoction) can overcome the enemy. However, only those with both knowledge and skill can achieve this.
Mr. Shi Dazheng of Hushu vomited loudly enough to be heard a hundred wu away. The Zuo Guan pulse surged against the finger but did not connect to the Cun pulse. Both Chi pulses were slippery and forceful, especially on the left. Water and fluids had not entered his lips for seven days. I therefore prescribed a formula to penetrate Liver stagnation and predicted he would father a son. After taking the medicine, vomiting ceased, and at full term, he indeed delivered a male child. He asked me, "My wife suffered severe alternating chills and fever, vomiting, and anorexia. Others treated her as Shang Han, but you alone identified pregnancy. Although Chai Hu, Bai Shao, Wu Zhu Yu (Evodiae Fructus), and Huang Lian were not specifically used, why did vomiting cease after one dose?" I said, "Physicians claiming expertise in pulse diagnosis must determine the formula based on pulse findings. People merely observe symptoms without tracing the cause, leading to errors. Here, the pulses are present and not deceived by symptoms. Medication is prescribed according to the disease, hence the accuracy."
A slippery pulse at the Chi position certainly indicates pregnancy. The Guan pulse not connecting to the Cun suggests Liver Qi is focused and stagnant, prone to anger but poor at expressing it. Long-standing stagnation eventually erupts, showing signs of violent shaking and breaking. By following its nature to soothe and regulate it, Liver Qi becomes smooth and calm, nausea faces no obstruction, and vomiting ceases naturally.
For morning sickness (E Zu) vomiting, the slippery Chi pulse confirms pregnancy. Treatment focuses on soothing Liver Qi and following its nature, so vomiting subsides.
It is reported that your mother, in the winter of Bingwu year, suddenly felt her Heart Qi scattering and sinking, accompanied by constipation and insomnia for nearly three months. Upon diagnosis, only the Zuo Guan pulse was weak and failed to respond to pressure. I diagnosed Liver deficiency requiring tonification of its mother (Kidney/Water nourishing Liver/Wood). I predicted improvement would begin at Lichun (Start of Spring). I used Shu Di Huang (Rehmanniae Radix Praeparata) as the sovereign herb, assisted by Fu Ling (Poria), Suan Zao Ren (Ziziphi Spinosae Semen), Dang Gui (Angelicae Sinensis Radix), Ren Shen (Ginseng Radix), Fang Feng (Saposhnikoviae Radix), and Yuan Zhi (Polygalae Radix). After twenty doses, she recovered by the predicted time. Her son asked, "Insomnia and scattered Heart Qi belong to the Heart Meridian. Why did Kidney and Liver herbs work? And why did improvement start at Lichun? Please explain." I said, "This conclusion comes from the pulse. The Classics state: 'Liver deficiency leads to fear; fear causes Qi to sink.' Although there was no emotional fear, the physiological manifestation resembled it. Based on the pulse and symptoms, Liver deficiency is undeniable. Due to Liver insufficiency, the disease manifested ahead of its seasonal timing. Tonifying the mother (Kidney) generates Earth (Spleen); waiting for the appropriate time allows Yuan Qi (Original Qi) to recover. One cannot simply attribute this to Heart Qi scattering and constipation belonging to the Heart Meridian. This is not Heart Qi scattering, but the Heart perceiving the image of Qi scattering in the body. Thus, 'scattering' is not the disease itself. If it were a Heart disease, it would manifest differently. Tonifying the mother to benefit the child is a 'treatment across two organs' strategy. Predicting recovery at Lichun means Liver healthy Qi becomes prosperous while pathogens retreat."
Tang Meisheng suffered from abdominal pain, with palpable masses around the umbilicus during attacks, sometimes reaching unbearable levels. Others believed vital Qi was cut off internally, fearing death. My diagnosis revealed a slippery pulse near the Chi position at the Guan level, with distending pain upon palpation. His Qi was depleted and lacked luster. I used Gou Qi Zi (Lycii Fructus) as the sovereign herb, assisted by Bai Shao (Paeoniae Radix Alba), Fu Ling (Poria), Rou Gui (Cinnamomi Cortex), and Wu Zhu Yu (Evodiae Fructus). Pain ceased after six doses. He then took one batch of Si Zhi Gou Qi Wan (Four-Processed Lycium Pill) from *Ruizhutang Fang*, resulting in complete recovery. Li Maoxian asked what disease this was. I said, "Umbilical Hernia (Qi Hernia)." While hernias typically牵引 the genitals, this case lacks that symptom. However, 'hernia' refers to painful masses with fixed locations (characterized by the mountain radical), not necessarily involving the genitals. Hernias fundamentally belong to Jueyin Liver disorders. The severity resembling death is also a Jueyin syndrome. Thus, warming and tonifying Liver herbs restored vital Qi, preventing internal cutoff. This case, attributing success to Heaven, can be viewed as a resurrection example.
Umbilical hernia is a dangerous Jueyin condition; treating with warming and tonification addresses the root.
A patient surnamed Li suffered from mouth and tongue ulcers for nearly three years. The pulse was floating, fine, rapid, and urgent, feeling empty upon pressure, especially at the Chi position. Applying Xue Lizhai's method for Kidney deficiency with Fire not returning to its source, I prescribed modified Ba Wei Wan (Eight-Ingredient Pill with Rehmannia) ingredients. He recovered in two doses. This was my first trial of Master Lizhai's methodology, demonstrating such rapid efficacy. Modern brilliant physicians often seek unique approaches beyond standard rules, disregarding Lizhai. What do they think of him?
He Jiefu, a scholar from Yongjia, had a calm temperament and suffered from Spleen disease for years, eating little and appearing listless. He consulted me in July of Xinyou year. Both Guan pulses were weak and did not reach the Cun position. I prescribed Ren Shen (Ginseng Radix), Fu Ling (Poria), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Chen Pi (Citri Reticulatae Pericarpium), Fang Feng (Saposhnikoviae Radix), and Gan Cao (Glycyrrhizae Radix et Rhizoma) for dozens of doses. By September, he returned home and began enjoying rich foods. His years-long illness vanished. In spring of Renxu year, he visited Qiantang again, bringing generous gifts of Canna and Hibiscus flowers, asking, "Your illness lasted years. Tonifying Spleen and Kidney methods were detailed yet ineffective. How did you achieve results with such simple methods?" I replied, "Your disease lies in the Liver, not the Spleen or Kidney. Diagnosing requires tracing the source, not being misled by symptoms. Reduced appetite relates to the Spleen/Stomach, but what causes the Spleen disease? This must be examined. Your right Guan pulse weakness confirms Spleen deficiency. But what about the left? This indicates Spleen substance is insufficient, and Spleen function fails. What is Spleen function? The Liver. Astrology considers the element that controls me as the functional spirit. Without Liver Wood supporting Spleen Earth, Qi and Blood do not flow smoothly, digestion slows, and the Spleen suffers. During autumn's metal dominance, Liver Qi is further constrained. I supplemented Liver Wood Qi, allowing it to flourish, which relaxed Spleen Earth, causing spirit to emerge naturally. Though I did not treat the Spleen directly, I effectively treated it. Why use extraordinary methods? I fear I cannot be simple enough. Simple words are what I strive for."
Famous physicians seek the source and differentiate pulses, not confused by external symptoms. They tonify deficiency and reduce excess, establishing formulas based on classic principles.
Wu Shuxian developed sores in March of Gengshen year. After eye sores healed, he suffered severe asthma, unable to lie down for ten days. I treated him by first opening the Lungs and venting the sores, then descending Qi and tonifying the Kidneys. I predicted sores would appear in two days, foot swelling in five, fluid discharge in six, and asthma resolution/sleep restoration in ten. Subsequently, toxic sores appeared on his feet, recovering fully in three months. He studied at the Imperial Academy in autumn. In July of the following year, a slight wind-cold fever caused his left three-position pulse to vanish. Large doses of Ren Shen, Dang Gui, Mu Tong (Akebiae Caulis), and Gan Cao raised the pulse in ten doses and normalized it in twenty. In October, another infection made the left pulse even weaker, though he felt fine. In March, lying down caused severe headache. I warned his brother of the danger, predicting coma meant death, but he doubted me. On the ninth day, he became slightly comatose and delirious; on the twelfth, he lost recognition; seven days later, he died. His cousin asked, "Last year he was critical, and your predictions proved accurate, saving him. This winter, minor symptoms matched your prediction of death. Are the cause and syndrome one or two?" I answered, "Shuxian has innate weak bone Qi and incomplete Kidney Essence. His sores originated from the Kidney. Unknowingly using dispersing herbs consumed Yuan Qi, causing toxin to reverse into the Lungs, inducing asthma. I used Si Ni San (Frigid Extremities Powder) to open Taiyin Qi, venting sores outward; Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) helped Shaoyin grasp Qi, regulating respiration, clearing the upper and descending turbidity, causing foot swelling and abscesses, expelling disease outward, thus saving him. This autumn, the left pulse failed to rise, indicating internal depletion of Yuan Qi, unable to circulate. The disease attacking the marrow caused brain pain and coma, an 'Inner Closure' syndrome where Qi cuts off internally, leading to death. Fundamentally, both stem from the Kidney; it is one, not two. It depends not on symptom severity but on the underlying difference." This case demonstrates precise differentiation, achievable only through deep understanding of *Ling Shu* and *Su Wen*.
Shaoyin Kidney deficiency with internal depletion of Yuan Qi is a critical Inner Closure syndrome, representing internal cutoff of vital Qi, an untreatable condition.
Ruan Taihe, a Xiaolian from Fushun, Sichuan, contracted a severe epidemic illness under Mount Wu. Summoned for diagnosis, he sat up reluctantly, speaking strongly, but his spirit was internally depleted. He had alternating fever, thick yellow tongue coating, having caught cold in Wu men and nourished himself with meat broth, leading to a month-long lingering illness. Light dispersing herbs reduced the fever, but overeating caused recurrence and inability to rise. I was in Fuchun and returned after five days. He had been delirious, laughing/crying, and unrecognizing for three days, emaciated, sweating profusely, with intense internal heat, especially in the chest/hypochondrium, hot to the touch, though the pulse retained spirit. I added eight qian of Ren Shen to Si Ni San. Delirium ceased after one dose; heat cleared after three. He claimed his soul wandered heaven and earth, saved by divine talisman. Recovery took ten days before he could eat porridge. He wrote a record of his illness and medications. I believe cold injured Heart Qi, gradually deepening and gathering in the chest. Due to failing the imperial exams and returning south, illness lingered en route, separating him from family and lacking medication. Heart was injured, repeated sweating depleted fluids, internal mastery was lost, and heat entered the chest. The chest is the palace of the Heart Master; spirit scattered, causing wandering soul transformation. Si Ni San expelled heat outward; Ren Shen consolidated spirit inward. Qi recovered, pathogens dispersed, thus survival.
Initially, Qi stagnation injured the Liver; subsequent forced eating injured the Spleen, causing spirit scattering and wandering soul. Si Ni San expelled external heat; Ren Shen tonified Yuan Qi.
Zhou's wife and Ma's daughter, both young women, suffered edema, swollen limbs, abdominal distension, blocked urination, and anorexia. Diagnosed variously as jaundice, drum distension, or Qi disorder. I deemed medicine ineffective and needled the feet, draining stone-measures of water. Distension decreased slightly the next day and significantly by the third day. Feet remained swollen, so I needled again. Prescribed Ba Wei Wan (Eight-Ingredient Pill with Rehmannia) to warm the Kidneys. Within a year, both became pregnant. Zhou cared well, mother and child survived; Ma neglected care, both died. This resulted from insufficient Kidney Yang and excess Yin, causing water accumulation. Diet and medicine failed to guide water, exacerbating the condition. Needling drained water, releasing stagnation. Post-drainage Kidney decline required warming and tonification to prevent turbid Yin reaccumulation and restore Kidney Fire. With systemic Yang rooted, Tian Gui (menstruation/fertility) functions normally, ensuring childbirth. Like refugees needing nurturing, proper care ensures survival; neglect leads to death.
Insufficient Kidney Yang and excess Yin causing water accumulation is the source of this disease, as described in *Nei Jing*: "Accumulated water forms similar categories."
On the night of the 27th of the 12th lunar month in Gengshen year, I suffered abdominal pain, aversion to cold, and diarrhea, which stopped at dawn, returned at dusk, and stopped again the next day. On the fifth day of the new era, mild pain appeared on the left of the anus. Attributing this to sexual excess and Kidney diarrhea, I took a large dose of Si Shen Wan (Four Spirits Pill), stopping diarrhea and pain. Next morning, a small nodule appeared on the left anus, pain moving toward the tailbone, becoming unbearable at night. I applied bear bile dissolved in water, feeling coolness rising to the left Lung, easing pain slightly. Midnight: expectorated phlegm with a few drops of blood. Chen hour: hemorrhoids discharged white pus, allowing sitting. Eleventh day: talked excessively, bleeding occurred while combing hair. Endured it, calming Qi stopped bleeding. Took Liu Wei Wan (Six-Ingredient Pill) ingredients for Kidney deficiency. Evening: woke at midnight with blood gushing like a tide, sawing respiration. Consumed child's urine and Liu Wei decoction; Qi stabilized slightly. Smelling ginger soup triggered fresh bleeding. Dawn: eased. Night: recurrence. Brief sleep caused back heat; waking brought blood to throat, filling a handful. Heart anxious, wanting to talk, sound triggered bleeding. Thirteenth day: discussion, no one dared act. Evening: critical, seemingly hopeless. Used Heart-draining and blood-coagulating purgatives, ineffective. Night: heavy snow, freezing rain. Took Da Huang powder mixed with water. Wanted to remove blankets, drank bitter Huang Qin/Huang Lian tea as if sweet. Fifth watch: forced clear rice drink; drug power shifted. Passed black, foul stool/mucus three times, bleeding slowed. Fifteenth day, Yin hour: transitioned to Lichun (Start of Spring). Jian Ning lotus root decoction tasted good. Foot sweat appeared, then palm sweat, then back steaming. Day peaceful. Evening: talking caused hematemesis. Yi'er cited Zhang Zhongjing, prescribing Chi Xiao Dou (Vigna Angularis Semen) and Lian Qiao (Forsythiae Fructus) combined with Xie Xin Tang (Drain the Epigastrium Decoction). Upper body Qi opened, lower abdomen felt stuffy but immobile. Sweating similar to before. Three days: bleeding decreased. Beyond twentieth day: stool passed like green mud, then iron-ball-like stools, blood finally cleared. Alas! Before passage, near death; after sweating, vitality returned.
Reflecting on the cause: I had recently raged, stomping and shouting, panting briefly. Seventeenth of the twelfth month: sat exposed by the stove half the night, fingernails broke next morning. Ten days later, illness struck. Since October, mental clarity faded, reading depth decreased, spirit grew confused. Ten days later, illness worsened greatly. Twenty years treating hematemesis, I often rescued crises. Facing my own, I lost focus. Believing sexual excess caused night diarrhea, Si Shen Wan seemed curative, confirming Kidney deficiency. Who knew Si Shen and Liu Wei would aggravate it? (Initial cause: rage/Qi stagnation congealed blood vessels; subsequent night exposure to cold plus stove fire intensified cold congealing and blood burning, creating stasis. Must use blood-dispelling to break sharpness and remove root. Disaster stemmed from Si Shen and Liu Wei misuse, proving one cannot treat based on a single meridian theory.) If not for accidentally hitting Zhang Zhongjing's method, death was inevitable. My illness originated from cold injuring Yin division. Cold-water Qi should attack Heart Fire; Yin pathogens should force blood. Using Kidney-tonifying/blood-stopping herbs aided cold, congealing blood further, causing fire to burn violently and blood to stagnate. Lichun Yin-division sweating naturally resolved the pattern. Stasis/purging cleared, blood purified. Initially slight cold led to great disaster. Drug difficulty is common. Mistaking visceral toxin pain or asthma from hematemasis requires recognizing cold origin. When unresolved, even if pointed out, one may not believe it, let alone ignorant physicians. Thus, prescribing must not rigidly follow rules. Today, knowing hematemasis, people use hemostatic, blood-moving, Qi-smoothing, Qi-descending methods. Is this not profound logic? If not hitting the mark precisely, it becomes toxic. Caution! Caution!
Forty days post-recovery, I could walk with a cane, pacing the room. Leaving for Suzhi Zen Room, reflecting quietly, I felt ashamed. I compiled these cases for broad review.
Master An read the cases and questioned: "Hematemasis originating from cold may exist; but claiming blood gushing is not due to fire is hard to deeply accept..."