疟有中三阳者。有中三阴者。在太阳为寒疟，在阳明为热疟，在少阳为风疟，在三阴为湿疟，远者为痃疟。症有表里寒热虚实之分。己丑冬，余居里门，及门刘子铣患疟，间日一发，人见形体瘦弱，井有盗汗，疑为虚象，与以补剂。旬余，病益剧。余诊之，面色晦浊，脉象浮紧而弦，知是表邪尚盛，治不可补，补之适助其邪，用小柴胡汤去人参，合香苏散以疏解之，数剂即愈。丙申冬，余至天津，刘君斐然患三阴疟，已经数月，迭进疏解药，盗汗体疲，饮食减少，夜寐不安。来延余诊，脉象虚弦，知是正气亏极，阴分亦损，用补中益气汤加桂枝干姜地黄鳖甲，十数剂而治愈。以上二症，一表一里，一实一虚，表实则祛邪，里虚则补正，皆治疟常法，然又有始疟而不终于疟者，似疟而不得为疟者。壬辰冬，余客津门，周庚五观察之夫人，患疟七日，忽然神昏，气促汗多，谵语不已，来延余诊。脉虚微漏数，审是少阳客邪，袭入血室所致。用小柴胡汤去甘草、半夏，加生地，丹皮、桃仁，红花，一剂，谵语平，诸症减。再承前意加味补益之，数剂即安。其后周君谓余曰；当初诊之夕，药虽煎就，吾疑此方与疟邪不合，及既饮以后，乃知此药竟神效非常，道之所以异于人者，固如此乎。答曰：何异之有，不过随时论症耳。此症初起，邪在少阳，故寒热往来，继则少阳客邪，乘月水之来，潜入血室，所以神昏谵语，至气促汗多，非气虚所致，即药误使然，如法而治，应手何疑。所虑者，人之执一不通耳。丁酉四月杪余客津门，小站右营文案丁君铁臣，患病十余日，口渴烦躁，胸腹拒按，溺赤便结，寒热间日一发，症势颇危，以车速余往诊。际疾无伦，约有十至，知是温邪夹滞，由少阳侵入少阴，所以寒热如疟。用元丹汤、羚地枳实汤、承气汤等方，出入加减治之而愈。若以小柴胡常法治，其能转危为安乎。
内为胀，外为肿。其症，有气、有血、有虫、有单腹，不独水之一症也。而一症中，又有阴阳虚实新久之殊。治法总以健脾为主。余随症之所因，按症施治可矣。丙中秋，余客部门，有罗某患水肿半年，转重转剐。余治之，用五皮饮加白术等味，补益而愈。丁酉夏，余客天津，吕鹤孙别驾患水肿症，初从腹起，继则头面四肢皆肿。余切其脉，浮举缓大，沉按细弱，知是脾虚湿侵，用黄芪建中汤理中汤五皮饮五苓散加减治之而愈。此皆阴水为患，故治从乎阳，若系阳水为患，又治从乎阴。甲午，余客都门，正月初，叶茂如中翰邀余往，为温姓治一水肿症。据云：向有痰饮，时发时愈。去年秋冬之交，痰饮又发，初起咳嗽气喘，继而头面四肢浮肿，缠绵三阅月，愈治愈剧，今则胸闷腹胀，饮食不进，饮水即吐，溺涩便结，烦躁不寐，已十余日，诸医束手，以为不治，奄奄一息，将待毙矣。切其脉，细涩沉数，舌苔微腻而黄。余思此症，外象虽危，并非败象，不过正虚邪盛，治少专方耳，合加味肾气丸，舟车丸、五皮饮、麦门冬汤法，以意去取，配成一方。明日，主人贻余一纸书曰：昨晚服药后，至今晨，病已愈十之三四。并约再诊。余视之，病势果轻。仍用前方加减，又服三剂，病情大减。或问其故，余曰：此症始终不外脾土一藏，牌土之用，可借西医之说明之，西医言近胃处，有甜肉一条，甜肉汁入胃，饮食自化。夫甜肉即睥，脾本甘所生也，甜肉汁即脾中精汁。盖脾脉至舌本以生津液，便是精汁也。凡人饮食入胃，全赖牌中精汁，入胃为之运化。此汁苟亏，阴不济阳，阳气上蒸，痰饮发矣。令人一见痰饮，便用白术、半夏等药以燥土，土中精汁，被药却干，生气全无，堤防失职，肿胀成矣。又用猪苓、泽泻等药以导水，贼水未除，真水已竭，其始不过脾土阴伤，未几土不生金，金不能制木，木克土矣，又未几金不生水，水不能制火，火，刑金矣。睥肺肾三藏俱病，危症所以丛生。余以益睥土之阴为君，以养肺金为臣，以滋肾水为佐，更以通调二便为使，是即朱丹溪治肿胀之意，又即《内经》洁净府、去菀陈菀之意。盖治水之法，如治河然，既补虚以厚其堤，腹泻实以导其流，水自安澜，无虞泛溢矣，后承是方，随症轻重缓急治之，月余而痊。惟此等重症，痊后，当加意调补，务使起居如昔，饮食胜常，方为复元。否则正气未充，旧恙易泛，发一次，重一次，虽有神丹，恐难为力。慎之戒之。
自汗，有心肝脾肺肾之分，又有阳虚、阴虚、亡阳、卫不固、外感风湿、内因痰火、阴盛格阳诸症。而世之遇自汗者，概作阳虚治。虽曰古法，未免执一不通。辛卯春，余客济南，陈巽卿观察自汗不止，来延余诊。脉象虚微，是为阳虚，势将汗脱，以十全大补汤加味，温补收涩而愈。夏，又患自汗，复延余诊。脉象细数，是为阴虚，与前此阳虚迥别，即以洋参石斛汤加味，清理滋养而愈。拽前后症，出自一人，而前为阳虚，后为阴虚，不同如此。然则春秋寒暑，天时犹有常也，南北高下，地宜犹有常也，贫富劳逸，人事犹有常也。即如春夏有时暴寒，秋冬有时忽温，西北有地向阳，东南有地背阴，贫贱有事快心，富贵有事劳力，天地人虽错综变化，犹可以常理测也，独至随时论症，随症论治，诚有可意会不可言传者。若胶柱而鼓瑟，毫厘之差，即千里之谬矣。
盗汗血虚非祟证
盗汗，有血虚证，有血热证，有少阳证，有阳明证，有酒客睡中多汗证，或因汗出台目后，井见谵语等情，遂以邪祟疑之，愚甚矣。丁亥，同里俞道生之母，来乞《易经》一部。据云：儿病月余，初起头痛，继而盗汗，延今，神昏谵语，目上视，食不进，溺器如新，无秽浊气，病势已危。昨延巫问之，巫盲有鬼为祟，禳之不应，思有以镇之，并求治于余。余审是血虚所致，以十全大补汤去肉桂加五味麦冬为方，一剂，谵语乎，二剂，盗汗止，调养旬余而愈。愈后，或问巫言有鬼，信否?余曰，鬼胡为乎来哉，人苟此心常存，临天帝，质神明，魁将敬惮不遑，安得而祸福之。惟其人乞怜昏暮，蓄计阴私，无时不与鬼为缘，鬼于是侮之弄之，时而为福，时而为祸。若夫平人，疾痛疴痒，乃事之常，千鬼何与，而有时求神祷庙，亦足愈病者。盖病家藉此收心养性，较诸庸医误药，犹胜一筹也。此不服药为中医之说也。
厥逆血虚证
厥有寒厥、热厥、痿厥、痹厥、煎厥、薄厥、风厥、暴厥、骨厥，肝厥之分，或表或里，或气或血，或虚或实，辨清施治，危者可安，特恐躁心乘之，必多贻误。壬辰八月，天津有某姓子，病经月余，厥逆时作，而且两腮肿胀，饮食不进，来速余诊，脉象虚浮细数，知是阴虚生热，热甚生风，并感时气所致，以滋养兼清化法治之。两服后，肿消厥止，又用滋补法调理之。未及两旬，眠食俱安而愈。惟病愈后，两目有时昏暗。余云：此系真阴不足，非调养半年，不能如常，朱丹溪所谓阴虚难疗是也。主人以为迂阔，误听入言，求神可速效，设坛千家，专服乩方。又八阅月而殒。呜呼甚哉!邪说之足以惑众也。如神仙可召而来，丹药可求而得，则汉武诸人，虽至今存可矣。而不然者，书符弄鬼，直妖孽耳。驱而逐之，亦不为过，而人顾信此，以殒其身。命乎，非命乎。
《内经》论头眩，多属于木，以木能生风，风主运动，故时目旋而头眩也。其症有阴阳虚实之分。乙末舂，余寓上海，有程姓闺嫒，早起必头眩欲呕，甚至呕吐酸水，饮食不进，患已多年，医药罔效。曾请治于西入，饮以药水，似效又不甚效。来延余诊，脉象左部弦数，知是肝阴不足，与以益阴汤加味，投剂辄效。丙申冬，余至天津，陈特夫大令室，病经二年，转重转剧，头晕目干，胸胁攻痛，心中荡漾，不自主持。来延余诊，脉象洪数，知是肝阳有余，用羚羊清血汤法，出入加减，调治而愈。乙未冬，余客上海，钱君昕伯病偏中风，言蹇足痿，神疲食减，医治两月，忽患头眩甚重，卧不能转，稍动即旋，来延余诊。脉左三部虚细，右关尺数大，左象为阴虚，右象为阳盛，遂用羚芍地黄汤以益其阴，参连和中汤以治其阳，二剂，头眩若失，起坐自如。此三症也，或为不足，或为有余，或为不足中又有余邪未净，要皆风木为患，治法故大同小异。然更有太阳漏汗不止而头眩，阳明风病善食而头眩，汗吐下后气虚而头眩，素因怯弱血少而头眩，火载痰上而头眩，正气虚脱而头眩，妇人经水适来而头眩，易病真元耗脱而头眩。寒热虚实，各自不同，未可以一法尽矣。
目赤有三，一曰时眼，二曰热壅，三日气毒，古书用羌活吐湿汤、蝉化无比散、龙胆汤、蕤仁膏等方，大率辛凉苦寒之味为多，病久致虚。又有明目地黄汤，益气聪明汤，与一切养阴理气之剂，他若四生丸。补肾丸，夜光椒红丸等方。大抵治肾中火衰，目无精光之宿疾，非治新害赤眼也。而余谓病无定情，治无定法，目症亦然。丙申秋，余入都，吾友赵剑秋病目，红而不肿，溺赤便结，脉来软盘，知是暑火内伏，凤火外然所致，余用凉膈散去芒硝加元参、麦冬、僵蚕，数服即痊。越半月，圈劳复发，误饮人耗散之剂，以致流泪羞明，较前更剧，又延余诊。切其际，濡细而数，盖缘病后写作过劳，又因误药却伤真阴所致，是为重虚，非急与滋补不可。以羚羊、地黄、阿胶、白芍、麦冬、生草，蒺藜、花粉、车前为方。数剂，病势渐平，胃气不旺。仍前方去花粉、车前，加党参、白术，调理而愈。甲午秋，都中有戚某害眼颇重，潘君爽卿代延余诊。两胞赤肿，痛极羞明，珠旁有浮白痕，若生翳然，脉来虚迟细弱。审知此人气血本虚，由虚致寒，适因脑怒动肝，肝木虚火，上乘本窍以致赤肿，所谓真虚似实，真寒似热，此症是已。法当引之使下，非若外感之火，可用清下法析之也。遂以熟地、吴萸，干姜，肉桂、当归、牛膝为方，并嘱冷饮，两服即平。后又加黄芪，党参。白水、炙草，补益而愈。此二症也，前用古人目赤法治之，后取火衰宿疾意治之，病皆应手而效，可知症之寒热虚实有必辨，而新久之说，可不拘已。
咽喉虚实证
咽喉二窍，同出一脘，异途施化。喉在前，连接肺本，为气息之路，主出：咽在后，下接胃本，为饮食之路，主纳，故经云；咽喉者，水谷之道也，喉咙者，气之所以上下也。其症有寒热虚实之分。辛卯春，余客济南，高君仲闻之妾，患咽痈，饮食不进，夜寐不安，身热便闭，病势颇危，用符祝针砭法治之。不应，来延余诊。脉象洪大，审是温邪内蕴，不能下达，迫而上升所致。用三黄泻心汤加石羔，小生地，一剂，痛减，二剂，痛平。后以清养药，调理而愈。乙未夏，余寓上海，有张姓某喉辣心震，举发不时，病由劳怒后得，已经半年，问治于余。余切其脉，浮细而数，知是藏液不充，虚阳上乘所致。以四君子汤加白芍、山茱为方；数剂，症减，后更调治而愈。此二症也，一用苦降，一用甘温，俱应手奏效，乃咽喉病之轻者。他如缠喉风、走马喉风，双单乳蛾、喉疗、兜腮痈、喉疮、喉窟、肺绝喉痹，经闭喉肿、梅核气诸症，轻者亦易疗，重者则至险。考古治法，皆急于治标，而缓于治本。以咽喉为要隘之地，缓则伤人，故治标为急耳。
牙跟肿痛风火证
牙痛，不外风火虫虚，肿痛连腮，风火为多，时症常有之。世每疑为外症，误矣。丙申冬，余客都门，王荩臣大令左偏牙限，连腮肿痛，延余往诊，脉数，左尤有力，审是外风引动内风，兼挟痰火为患。泊以加味元丹汤，二剂，肿消痛止。惟牙跟有粒未消如豆，王君疑是外症，令外科治之。复肿如前，烦躁不安，又延余诊。脉象绝滞，舌苔灰腻，知为误药所致。仍用前法，二剂即平，再加调理而愈。盖病发于表，根则在里，无论非外症也。即遇外症，凭理立方，亦能奏效。丁亥，余授徒于家，及门李浩泉少腹生一疽，跟盘约四寸许，外科名为肚痈，贴以膏药。余知之，令去膏药，治以白虎涤邪汤法，二剂即消。乙未夏，余寓上海，有李姓某左腿生疽二，一大如碗，一小如杯，痛疼异常，坐卧不便。余切其脉，滑大而数，与以一甲黄龙汤法，一剂，已成脓者溃，未成脓者消。丁酉春季，余寓天津，有事至武备学堂，适崔君少和病海底肿痛不堪，有类悬痈。余诊之，脉右关尺数大沉实，知是肠胃湿热下注，治以黄龙解毒汤，二服即平。此三症也，均属外症，以内症法治之，随手奏功，可知外象悉本内因，内患既平，外虞自弭。凡事如是治病其小焉者耳。
阴症辨诬证
疟疾有侵犯三阳经的，也有侵犯三阴经的。在太阳经称为寒疟，在阳明经称为热疟，在少阳经称为风疟，在三阴经称为湿疟，病程迁延日久的称为痃疟（久疟成块）。症状表现有表证、里证、寒证、热证、虚证、实证的区分。己丑年冬天，我住在家乡，门生刘铣患疟疾，每隔一天发作一次。旁人见他形体消瘦虚弱，且有夜间盗汗，怀疑是虚证，便给他服用补益剂。过了十几天，病情反而加重。我诊察后，见他面色晦暗浑浊，脉象浮紧而弦，知道是表邪依然强盛，治疗不可进补，进补反而会助长邪气，于是用小柴胡汤去掉人参，合用香苏散来疏风解表，服几剂药后痊愈。丙申年冬天，我到天津，刘斐然患三阴疟，已经几个月了，多次服用疏解药物，导致盗汗、身体疲乏、饮食减少、夜间睡眠不安。请我去诊治，脉象虚弦，知道是正气极度亏损，阴分也受损，于是用补中益气汤加入桂枝、干姜、地黄、鳖甲，服十数剂后治愈。以上两个病例，一个是表证，一个是里证；一个是实证，一个是虚证。表实证则祛除邪气，里虚证则补益正气，这都是治疗疟疾的常规方法。然而又有开始像疟疾但最后不完全是疟疾的，或者看似疟疾却并非疟疾的情况。壬辰年冬天，我客居天津，周庚五观察大人的夫人，患疟疾七天，突然神志昏迷，气短急促，出汗多，胡言乱语不止，请我去诊治。脉象虚微且漏数（脉搏跳动不规则），仔细审察这是少阳客邪侵入血室所致。用小柴胡汤去掉甘草、半夏，加入生地、丹皮、桃仁、红花，服一剂后，胡言乱语平息，其他症状减轻。接着按原方意旨加味进行补益，服几剂后便安稳下来。后来周君对我说：“当初诊治那天晚上，药虽然煎好了，我怀疑这个方子与疟邪不合，等喝下去之后，才知道这药竟然神效非凡，所谓‘道’之所以不同于常人，大概就是这样吧。”我回答说：“有什么特别呢？不过是根据时机和症状来辨证施治罢了。”这个病症初起时，邪气在少阳，所以寒热往来；随后少阳客邪趁着月经来潮，潜入血室，所以出现神昏谵语。至于气促汗多，如果不是气虚造成，就是用药失误导致的。如果按照正确方法治疗，见效有何可疑？令人担忧的是人们固执一端，不知变通。丁酉年四月末，我客居天津，小站右营文案丁铁臣君，患病十多天，口渴烦躁，胸腹部拒按，小便赤红，大便干结，寒热每隔一天发作一次，病情相当危急，用车速召我去诊治。此时脉象急疾无伦，大约每息十至，知道是温邪夹带积滞，由少阳侵入少阴，所以寒热像疟疾一样。我用元丹汤、羚地枳实汤、承气汤等方剂，出入加减进行治疗而痊愈。如果用小柴胡汤的常规法治疗，怎么能转危为安呢？
内部胀满，外部浮肿。其症状表现，有气肿、血肿、虫积致肿、单腹胀等，不仅仅是水饮这一种病症。而在一种病症中，又有阴阳、虚实、新病久病的区别。治疗方法总以健脾为主。我根据病症的原因，按照具体症状施治即可。丙午年秋天，我客居京城，有个罗某患水肿半年，病情越来越重。我治疗他，用五皮饮加入白术等药味，通过补益而痊愈。丁酉年夏天，我客居天津，吕鹤孙别驾患水肿症，起初从腹部开始，随后头面四肢都肿了。我切他的脉，轻取缓大，重按细弱，知道是脾虚湿邪侵袭，用黄芪建中汤、理中汤、五皮饮、五苓散加减治疗而痊愈。这些都是阴水为患，所以治疗从阳气入手；如果是阳水为患，又治疗从阴分入手。甲午年，我客居京城，正月初，叶茂如中翰邀请我去，为温姓人家治疗一个水肿症。据说是向来有痰饮病，时发时愈。去年秋冬之交，痰饮又发作，起初咳嗽气喘，继而头面四肢浮肿，缠绵三个月，越治越重，现在胸闷腹胀，饮食不进，喝水就吐，小便涩滞，大便干结，烦躁失眠，已经十多天，众医束手无策，认为无法医治，气息奄奄，等待死亡。我切他的脉，细涩沉数，舌苔微腻而黄。我思考这个病症，外表虽然危急，并不是败象，不过是正气虚弱邪气强盛，治疗需要专一的方剂。我综合加味肾气丸、舟车丸、五皮饮、麦门冬汤的法度，斟酌去取，配成一方。第二天，主人送来一封信说：“昨晚服药后，直到今晨，病已好了三四成。”并约定再诊。我看他，病情果然减轻。仍然用前方加减，又服三剂，病情大减。有人问其中的缘故，我说：“这个病症始终离不开脾土这一脏。脾土的作用，可以用西医的理论来说明。西医说靠近胃的地方有一条甜肉（胰腺），甜肉汁进入胃，饮食自然消化。这甜肉就是脾，脾本是由甘味所生的。甜肉汁就是脾中的精汁。脾脉通达舌根以生津液，这就是精汁。凡是人饮食进入胃，全赖脾中精汁，在胃中进行运化。如果这汁液亏损，阴不能济助阳，阳气上蒸，痰饮就发作了。世人一见痰饮，就用白术、半夏等药来燥湿健脾，结果脾中精汁被药物烤干，生气全无，堤防失职，肿胀就形成了。又用猪苓、泽泻等药来利水，贼水未除，真水已竭。起初不过是脾土阴伤，不久土不生金，金不能制木，木克土了；又不久金不生水，水不能制火，火刑金了。脾、肺、肾三脏都病了，危症所以丛生。我以补益脾土之阴为君药，以养肺金为臣药，以滋肾水为佐药，更以通调大小便为使药，这就是朱丹溪治疗肿胀的意思，也就是《内经》‘洁净府、去菀陈莝’的意思。大概治水的方法，就像治理河流一样，既补虚以加厚堤坝，又泄实以疏导水流，水自然安定，不用担心泛滥了。”后来沿用这个方子，根据病症轻重缓急治疗，一个多月痊愈。只是这种重症，痊愈后，应当注意调补，务必使起居恢复常态，饮食胜过平时，这才是复原。否则正气未充，旧病容易复发，发作一次，严重一次，虽然有神丹妙药，恐怕也难以奏效。谨慎戒除啊。
自汗，有心、肝、脾、肺、肾之分，又有阳虚、阴虚、亡阳、卫气不固、外感风湿、内因痰火、阴盛格阳等各种证候。然而世上遇到自汗的人，一概当作阳虚来治。虽然说是古法，未免固执不通。辛卯年春天，我客居济南，陈巽卿观察大人自汗不止，请我去诊治。脉象虚微，这是阳虚，势将有汗脱的危险，用十全大补汤加味，温补收涩而痊愈。夏天，又患自汗，再次请我去诊治。脉象细数，这是阴虚，与此前的阳虚截然不同，即用洋参石斛汤加味，清理滋养而痊愈。看前后的病症，出自同一人，而前次为阳虚，后次为阴虚，差别如此之大。那么春秋寒暑，天时还有常规；南北高下，地理适宜还有常规；贫富劳逸，人事还有常规。就像春夏有时突发寒冷，秋冬有时忽然温暖，西北有向阳之地，东南有背阴之地，贫贱有顺心之事，富贵有劳力之事，天地人虽然错综变化，还可以用常理推测。唯独到了根据时机辨证、根据症状论治，确实有可以心领神会却无法言传的地方。如果拘泥固执而不知变通，毫厘之差，就会谬以千里。
盗汗的血虚非鬼祟证
盗汗，有血虚证，有血热证，有少阳证，有阳明证，有酒客睡中多汗证，或者因为出汗后受风，并且出现谵语等情况，就怀疑是邪祟作怪，真是太愚蠢了。丁亥年，同乡俞道生的母亲，来求一部《易经》。说儿子生病一个多月，起初头痛，继而盗汗，到现在，神志昏迷胡言乱语，眼睛向上翻，吃不进东西，小便器像新的一样，没有秽浊气味，病情已经危急。昨天请巫师询问，巫师说有鬼作祟，祈祷驱赶没有反应，想着有什么办法镇压它，并请求我治疗。我审察认为是血虚所致，用十全大补汤去掉肉桂，加入五味子、麦冬作为方剂，服一剂，胡言乱语平息，服二剂，盗汗停止，调养十几天后痊愈。痊愈后，有人问巫师说有鬼，是否相信？我说：“鬼为什么要来呢？人如果心中常存敬畏，面对天帝，质问神明，对魁星将帅敬惮还来不及，怎么会有祸福降临呢？只有那些人在黄昏时分乞怜，暗中蓄谋私利，无时无刻不与鬼结缘，鬼于是侮辱戏弄他，时而降福，时而降祸。至于普通人，疾病痛苦瘙痒，是事情的常态，跟鬼有什么关系？而有时求神拜庙，也足以治愈疾病。大概病人借此收敛心神修养性情，比起庸医误用药物，还要好一些。这就是‘不服药为中医’的说法。”
厥逆的血虚证
厥证有寒厥、热厥、痿厥、痹厥、煎厥、薄厥、风厥、暴厥、骨厥、肝厥之分，或表或里，或气或血，或虚或实，辨别清楚后施治，危重的可以平安，只怕急躁之心乘虚而入，必然多有误治。壬辰年八月，天津有个姓某的人的儿子，生病一个多月，厥逆时常发作，而且两腮肿胀，吃不进东西，急忙请我去诊治，脉象虚浮细数，知道是阴虚生热，热甚生风，并感受时气所致，用滋养兼清化的方法治疗。服两剂后，肿胀消退，厥逆停止，又用滋补法调理。不到二十天，睡眠饮食都安稳而痊愈。只是病愈后，两眼有时昏暗。我说：“这是真阴不足，不是调养半年，不能恢复正常，这就是朱丹溪所说的阴虚难疗。”主人认为我迂腐，听信他人之言，求神以求速效，设坛千家，专门服用乩方。又过了八个月而死。唉！邪说迷惑大众太严重了。如果神仙可以召唤而来，丹药可以求得，那么汉武帝那些人，即使到现在还活着也可以。然而事实并非如此，画符弄鬼，简直是妖孽罢了。驱逐他们并不过分，而人们却相信这些，以此丧命。是命运吗？还是非命运呢？
《内经》论述头晕目眩，多归属于木，因为木能生风，风主运动，所以时常眼旋头晕。其症状有阴阳虚实的区别。乙未年春天，我寓居上海，有个程姓女子的女儿，早起必头晕想吐，甚至呕吐酸水，吃不进东西，患病多年，医药无效。曾请西医诊治，喝药水，似乎有效又不甚有效。请我去诊治，脉象左部弦数，知道是肝阴不足，给予益阴汤加味，投药即见效。丙申年冬天，我到天津，陈特夫大令的妻子，患病两年，越来越重，头晕眼干，胸胁攻痛，心中荡漾，不能自主。请我去诊治，脉象洪数，知道是肝阳有余，用羚羊清血汤法度，出入加减，调治而痊愈。乙未年冬天，我客居上海，钱昕伯君患偏中风，言语蹇涩，足部痿软，精神疲惫，饮食减少，医治两个月，忽然患头晕非常严重，卧倒不能转身，稍动即旋转，请我去诊治。脉象左三部虚细，右关尺数大，左象为阴虚，右象为阳盛，于是用羚芍地黄汤以补益其阴，参连和中汤以治疗其阳，服二剂，头晕消失，起坐自如。这三个病症，有的是不足，有的是有余，有的是不足中又有残余邪气，总之都是风木为患，治疗方法大体相同略有差异。然而更有太阳经漏汗不止而头晕，阳明风病善食而头晕，汗吐下后气虚而头晕，素体怯弱血少而头晕，火载痰上而头晕，正气虚脱而头晕，妇人月经刚来而头晕，易病真元耗脱而头晕。寒热虚实，各自不同，不可以一种方法概括。
目赤有三种，一是时眼（传染性眼病），二是热壅，三是气毒。古书用羌活吐湿汤、蝉花无比散、龙胆汤、蕤仁膏等方，大多是用辛凉苦寒的药物，病久导致虚证。又有明目地黄汤、益气聪明汤，以及一切养阴理气的药剂。另外如四生丸、补肾丸、夜光椒红丸等方。大抵是治疗肾中火衰、目无精光的宿疾，不是治疗新发的赤眼。而我以为病没有固定的情状，治没有固定的方法，眼症也是如此。丙申年秋天，我入京，我的朋友赵剑秋患眼病，红而不肿，小便赤红，大便干结，脉来软滑，知道是暑火内伏，风火外燃所致，我用凉膈散去芒硝，加入玄参、麦冬、僵蚕，服几剂即痊愈。过了半个月，劳累复发，误饮发散之剂，以致流泪怕光，比之前更严重，又请我去诊治。切他的脉，濡细而数，大概是因为病后写作过劳，又因误药损伤真阴所致，这是双重虚损，不急于滋补不行。用羚羊、地黄、阿胶、白芍、麦冬、生甘草、蒺藜、花粉、车前子作为方剂。服几剂，病情逐渐平稳，但胃气不旺。仍用前方去掉花粉、车前子，加入党参、白术，调理而痊愈。甲午年秋天，京城有个亲戚患眼病颇重，潘爽卿君代请我去诊治。两眼睑赤肿，疼痛剧烈怕光，眼球旁边有浮白痕迹，好像生了翳，脉来虚迟细弱。审察知道此人气血本虚，由虚致寒，恰好因恼怒动肝，肝木虚火上炎，上乘本窍以致赤肿，这就是所谓的真虚似实，真寒似热，此症正是如此。治法应当引火下行，不像外感之火，可用清下法分解它。于是用熟地、吴茱萸、干姜、肉桂、当归、牛膝作为方剂，并嘱咐冷饮，服两剂即平复。后来又加黄芪、党参、茯苓、炙甘草，补益而痊愈。这两个病症，前者用古人治疗目赤的方法，后者取火衰宿疾的意思治疗，病都应手而效，可知症的寒热虚实必须辨别，而新病久病的说法，可以不拘泥。
咽喉的虚实证
咽喉两个窍道，同出一源，途径不同而功能各异。喉在前，连接肺本，是气息的道路，主出；咽在后，下接胃本，是饮食的道路，主纳，所以经书说：咽喉是水谷之道，喉咙是气之所以上下的地方。其症状有寒热虚实的区别。辛卯年春天，我客居济南，高仲闻君的妾，患咽痈，吃不进东西，夜间睡眠不安，身热便秘，病情相当危急，用符咒针砭法治疗。没有效果，请我去诊治。脉象洪大，审察是温邪内蕴，不能下达，逼迫而上行所致。用三黄泻心汤加石膏、小生地，服一剂，疼痛减轻，服二剂，疼痛平息。后用清养药，调理而痊愈。乙未年夏天，我寓居上海，有个张姓某人喉辣心痛，不时发作，病由劳怒后得，已经半年，向我求治。我切他的脉，浮细而数，知道是脏腑津液不充，虚阳上乘所致。用四君子汤加白芍、山茱萸作为方剂；服几剂，症状减轻，后更调治而痊愈。这两个病症，一个用苦降，一个用甘温，都应手奏效，这是咽喉病的轻症。其他的如缠喉风、走马喉风、双单乳蛾、喉疔、兜腮痈、喉疮、喉窟、肺绝喉痹、经闭喉肿、梅核气诸症，轻的也容易治疗，重的则极其危险。考察古代治疗方法，都急于治标，而缓于治本。因为咽喉是要隘之地，缓则伤人，所以治标为急务。
牙跟肿痛风火证
牙痛，不外乎风、火、虫、虚，肿痛连腮，多为风火，时令病症常有。世人常怀疑为外科病症，这是错误的。丙申年冬天，我客居京城，王荩臣大令左偏牙跟肿痛，连及腮部，请我去诊治，脉数，左侧尤其有力，审察是外风引动内风，兼挟痰火为患。随即用加味元丹汤，服二剂，肿胀消退疼痛停止。只是牙跟上有一颗未消如豆粒，王君怀疑是外科病症，让外科医生治疗。又肿得像以前一样，烦躁不安，又请我去诊治。脉象绝滞，舌苔灰腻，知道是误药所致。仍用前法，服二剂即平复，再加调理而痊愈。病发于表，根则在里，无论是不是外科病症。即使遇到外科病症，凭理立方，也能奏效。丁亥年，我在家里授徒，门生李浩泉小腹生一疽，根基盘约四寸左右，外科名为肚痈，贴膏药。我知道后，让他去掉膏药，用白虎涤邪汤法治疗，服二剂即消。乙未年夏天，我寓居上海，有个李姓某人左腿生疽两个，一个大如碗，一个小如杯，疼痛异常，坐卧不便。我切他的脉，滑大而数，给以一甲黄龙汤法，服一剂，已成脓的溃破，未成脓的消散。丁酉年春季，我寓居天津，有事到武备学堂，恰逢崔少和君病海底肿痛不堪，类似悬痈。我诊察他，脉右关尺数大沉实，知道是肠胃湿热下注，用黄龙解毒汤治疗，服两剂即平复。这三个病症，都属于外科病症，用内科病症的方法治疗，随手奏功，可知外表现象完全基于内在原因，内患既然平息，外忧自然消除。凡事都是这样，治病也是小事一桩。
阴症辨诬证
Malaria may involve the three Yang meridians or the three Yin meridians. When in the Taiyang (Greater Yang) meridian, it is called Cold Malaria; when in the Yangming (Bright Yang) meridian, it is called Heat Malaria; when in the Shaoyang (Lesser Yang) meridian, it is called Wind Malaria; when in the three Yin meridians, it is called Dampness Malaria; and when prolonged, it is called Xuan Malaria (malaria with palpable masses). Symptoms are classified into exterior and interior, cold and heat, deficiency and excess patterns. In the winter of the Jichou year, residing in my hometown, my student Liu Xi suffered from malaria, occurring every other day. Observers noted his emaciated and weak physique along with night sweats, suspecting a deficiency pattern, and administered tonifying agents. After more than ten days, the condition worsened. Upon examination, I observed a dull and turbid complexion and a floating, tight, and wiry pulse, indicating that the exterior pathogenic factor remained strong. Treatment should not involve tonification, as doing so would only assist the pathogen. I prescribed Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Ginseng removed, combined with Xiang Su San (Fragrant Perilla Powder) to disperse and resolve the exterior. After several doses, he recovered. In the winter of the Bing Shen year, I traveled to Tianjin, where Liu Feiran suffered from Three-Yin Malaria for several months. Repeated use of dispersing and resolving medications led to night sweats, fatigue, reduced appetite, and insomnia. Upon consultation, his pulse was deficient and wiry, indicating extreme depletion of righteous Qi and damage to the Yin aspect. I prescribed Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) supplemented with Gui Zhi (Cinnamon Twig), Gan Jiang (Dried Ginger), Di Huang (Rehmannia Root), and Bie Jia (Turtle Shell). After more than ten doses, he was cured. The above two cases represent one exterior and one interior, one excess and one deficiency. For exterior excess, expel the pathogen; for interior deficiency, tonify the righteous Qi. These are standard methods for treating malaria. However, there are cases that begin like malaria but do not conclude as such, or appear like malaria but are not. In the winter of the Ren Chen year, staying in Tianjin, the wife of Inspector Zhou Gengwu suffered from malaria for seven days. Suddenly, she experienced coma, shortness of breath, profuse sweating, and incessant delirium. Upon examination, her pulse was deficient, minute, and irregularly rapid. Careful analysis revealed that this was caused by a guest pathogen in the Shaoyang invading the Blood Chamber (Xue Shi). I used Xiao Chai Hu Tang (Minor Bupleurum Decoction) removing Gan Cao (Licorice Root) and Ban Xia (Pinellia Tuber), adding Sheng Di Huang (Rehmannia Root), Mu Dan Pi (Tree Peony Bark), Tao Ren (Peach Kernel), and Hong Hua (Safflower). After one dose, the delirium ceased and other symptoms subsided. Subsequently, following the original principle, I added ingredients to tonify, and after several doses, she stabilized. Later, Mr. Zhou told me: "On the night of the initial diagnosis, although the medicine was prepared, I doubted whether this formula matched the malaria pathogen. Only after drinking it did I realize its extraordinary efficacy. This is indeed how the 'Dao' differs from ordinary practice." I replied: "What difference is there? It is merely syndrome differentiation according to timing and presentation." Initially, the pathogen was in the Shaoyang, causing alternating chills and fever. Subsequently, the Shaoyang guest pathogen, taking advantage of menstruation, penetrated the Blood Chamber, causing coma and delirium. The shortness of breath and profuse sweating were not due to Qi deficiency but rather a result of incorrect medication. If treated correctly, efficacy is assured. What is worrying is people's rigidity and inability to adapt. At the end of April in the Ding You year, staying in Tianjin, Mr. Ding Tiechen, clerk of the Right Camp at Xiaozhan, had been ill for over ten days with thirst, irritability, abdominal tenderness, red urine, constipation, and alternating chills and fever every other day. The condition was critical, and he was summoned urgently. His pulse was extremely rapid, approximately ten beats per respiration, indicating warm pathogen complicated by stagnation, penetrating from Shaoyang to Shaoyin, hence the malaria-like chills and fever. I treated him using variations of Yuan Dan Tang, Ling Di Zhi Shi Tang, and Cheng Qi Tang (Order the Qi Decoction), and he recovered. Had I used the standard Xiao Chai Hu Tang method, could he have turned from critical to safe?
Edema: Yang Deficiency and Yin Deficiency Patterns
Internal distension and external swelling constitute edema. Symptoms include Qi edema, Blood edema, parasitic edema, and isolated abdominal distension; it is not solely water retention. Within this single symptom category, there are distinctions of Yin/Yang, deficiency/excess, and acute/chronic conditions. The treatment principle generally focuses on strengthening the Spleen. I treat according to the specific cause and symptoms. In autumn of the Bing Wu year, staying in the capital, a certain Mr. Luo suffered from edema for half a year, worsening progressively. I treated him with Wu Pi Yin (Five-Peel Decoction) plus Bai Zhu (Atractylodes Macrocephala Rhizome) and other herbs, achieving recovery through tonification. In summer of the Ding You year, staying in Tianjin, Lv Hesun, a local official, suffered from edema starting in the abdomen and spreading to the head, face, and limbs. His pulse was slow and large on superficial pressure, but fine and weak on deep pressure, indicating Spleen deficiency with damp invasion. I treated him with modifications of Huang Qi Jian Zhong Tang (Astragalus Decoction to Establish the Middle), Li Zhong Tang (Regulate the Middle Decoction), Wu Pi Yin (Five-Peel Decoction), and Wu Ling San (Five-Ingredient Powder with Poria), resulting in recovery. These were cases of Yin Water (cold-type edema), so treatment focused on Yang. If it were Yang Water (heat-type edema), treatment would focus on Yin. In spring of the Jia Wu year, staying in the capital, Ye Maoru invited me to treat an edema case for a Mr. Wen. He had a history of Phlegm-Fluid retention, recurring intermittently. In late autumn/winter last year, it recurred with cough and asthma, followed by edema of the head, face, and limbs, persisting for three months and worsening despite treatment. Currently, he had chest oppression, abdominal distension, inability to eat, vomiting upon drinking, scanty urination, constipation, irritability, and insomnia for over ten days. Physicians gave up, deeming it incurable, and he was near death. His pulse was fine, choppy, deep, and rapid; tongue coating was slightly greasy and yellow. I reasoned that although the exterior appearance was critical, it was not a collapse pattern, but rather righteous Qi deficiency with pathogenic excess, requiring a specialized formula. I synthesized principles from Jia Wei Shen Qi Wan (Modified Kidney Qi Pill), Zhou Che Wan (Boat Cart Pill), Wu Pi Yin (Five-Peel Decoction), and Mai Men Dong Tang (Ophiopogon Decoction), selecting appropriate components. The next day, the host sent a letter: "After taking the medicine last night, by morning, the illness had improved by 30-40%." Upon re-examination, the condition had indeed lightened. I continued with modified prescriptions, and after three doses, the condition significantly improved. When asked why, I said: "This case revolves entirely around the Spleen Earth organ. Its function can be explained via Western medicine concepts. Western medicine notes a 'sweet meat' (pancreas) near the stomach; its juice aids digestion. This 'sweet meat' is the Spleen, born of sweetness. Its juice is the Spleen's essence fluid. The Spleen meridian reaches the root of the tongue to generate fluids, which is this essence fluid. Food entering the stomach relies entirely on this Spleen essence fluid for transformation. If this fluid is depleted, Yin cannot nourish Yang, Yang steams upward, and Phlegm-Fluids arise. People seeing Phlegm-Fluids often use Bai Zhu and Ban Xia to dry dampness, drying out the Spleen's essence fluid, extinguishing vital Qi, causing the 'dam' to fail and edema to form. Using Zhu Ling and Ze Xie to drain water removes the pathogen but depletes true water. Initially, it is Spleen Yin injury; soon, Earth fails to generate Metal, Metal fails to control Wood, and Wood attacks Earth; then Metal fails to generate Water, Water fails to control Fire, and Fire scorches Metal. Spleen, Lung, and Kidney are all diseased, leading to critical symptoms. I used tonification of Spleen Yin as the sovereign herb, nourishment of Lung Metal as the minister, nourishment of Kidney Water as the assistant, and regulation of bowels/bladder as the courier. This follows Zhu Danxi’s method for swelling and the Nei Jing’s principle of 'cleansing the fu organs and removing accumulated matter.' Treating water is like managing a river: tonify deficiency to thicken the dam, drain excess to guide the flow, and the water will settle without flooding." Following this prescription, adjusted for severity, he recovered in over a month. Severe cases require careful post-recovery tonification to restore normal routine and diet; otherwise, insufficient righteous Qi leads to relapse, each time more severe. Caution is advised.
Spontaneous Sweating: Yin and Yang Deficiency Patterns
Spontaneous sweating involves the Heart, Liver, Spleen, Lung, and Kidney, and includes patterns of Yang deficiency, Yin deficiency, collapse of Yang, insecure Wei (Defensive) Qi, exterior wind-dampness, internal phlegm-fire, and Yin excess repelling Yang. Yet, spontaneous sweating is often universally treated as Yang deficiency. While this is an ancient method, it is rigid. In spring of the Xin Mao year, staying in Jinan, Inspector Chen Xunqing suffered from incessant spontaneous sweating. His pulse was deficient and minute, indicating Yang deficiency with risk of sweat collapse. I used Shi Quan Da Bu Tang (Great Tonifying Ten-Ingredient Decoction) with additions, applying warming, tonifying, and astringent methods, resulting in recovery. In summer, he suffered again. His pulse was fine and rapid, indicating Yin deficiency, distinct from the previous Yang deficiency. I used Yang Shen Shi Hu Tang (American Ginseng and Dendrobium Decoction) with additions, applying clearing and nourishing methods, resulting in recovery. The same patient presented differently: first Yang deficiency, then Yin deficiency. Thus, seasons, geography, and social status have constants, yet sudden weather changes and individual circumstances vary. While heaven, earth, and humanity follow general principles, syndrome differentiation according to timing and presentation requires intuitive understanding beyond words. Rigidity leads to error; a slight deviation causes great mistake.
Night Sweating: Blood Deficiency, Not Ghost Possession
Night sweating includes blood deficiency, blood heat, Shaoyang, Yangming, alcohol-induced night sweating, or post-sweat exposure leading to delirium, often mistakenly attributed to ghosts. In the Ding Hai year, Mrs. Yu Daosheng sought help for her son, ill for over a month with headache progressing to night sweating, coma, delirium, upward-gazing eyes, anorexia, and clear urine without odor. A shaman claimed ghost possession; prayers failed. I diagnosed blood deficiency and prescribed Shi Quan Da Bu Tang (Great Tonifying Ten-Ingredient Decoction) removing Rou Gui (Cinnamon Bark), adding Wu Wei Zi (Schisandra Berry) and Mai Dong (Ophiopogon Tuber). One dose stopped delirium; two doses stopped night sweating. Recovery occurred after ten days of care. Asked about the ghost claim, I replied: "Why would ghosts come? One who maintains reverence faces heaven and earth without fear of misfortune. Only those engaging in secret, shameful acts invite spiritual harassment. Illness is natural; seeking temples may aid mental peace, surpassing quackery. This aligns with the saying 'not taking medicine is the best medicine.'"
Cold Extremities: Blood Deficiency Pattern
Cold extremities (Jue) include cold, heat, flaccidity, obstruction, frying, pressing, wind, sudden, bone, and liver types, varying by exterior/interior, Qi/blood, deficiency/excess. Accurate differentiation ensures safety; impatience leads to error. In August of the Ren Chen year, a boy in Tianjin suffered monthly episodes of cold extremities with swollen cheeks and anorexia. His pulse was deficient, floating, fine, and rapid, indicating Yin deficiency generating heat, heat generating wind, compounded by seasonal qi. I used nourishing and resolving methods. Swelling and cold extremities resolved after two doses; subsequent tonification restored health within twenty days. However, vision remained dim due to true Yin insufficiency, requiring six months of care, as Zhu Danxi noted regarding difficult-to-treat Yin deficiency. The owner, dismissing my advice, sought quick fixes via spirit writing. The patient died eight months later. Heresy confuses the masses; if immortals and elixirs existed, historical figures would still live. Exorcism is mere superstition; belief in it costs lives. Is this fate or folly?
Vertigo: Yin and Yang Deficiency and Excess Patterns
The Nei Jing attributes vertigo primarily to Wood, as Wood generates Wind, which causes motion, leading to spinning sensations. Patterns vary by Yin/Yang and deficiency/excess. In spring of the Yi Wei year, in Shanghai, a young woman suffered morning vertigo and vomiting of sour fluid for years, unresponsive to treatments. Her left pulse was wiry and rapid, indicating Liver Yin deficiency. I prescribed Yi Yin Tang (Nourish Yin Decoction) with additions, yielding immediate results. In winter of the Bing Shen year, in Tianjin, Mrs. Chen Tefu suffered two years of worsening vertigo, dry eyes, chest/hypochondriac pain, and palpitations. Her pulse was surging and rapid, indicating Liver Yang excess. I used Ling Yang Qing Xue Tang (Antelope Horn Clearing Blood Decoction) with modifications, achieving recovery. In winter of the Yi Wei year, in Shanghai, Mr. Qian Xinbo suffered hemiplegia with speech difficulties and leg weakness. After two months of treatment, he developed severe vertigo. His left pulse was deficient and fine; right Guan/Cun pulses were surging and large, indicating Yin deficiency and Yang excess. I used Ling Shao Di Huang Tang (Antelope Horn, White Peony, and Rehmannia Decoction) to nourish Yin and Shen Lian He Zhong Tang (Ginseng, Coptis, and Middle-Harmonizing Decoction) to regulate Yang. Two doses eliminated vertigo. These cases, whether deficiency, excess, or mixed, involve Wind-Wood pathology, sharing similar treatments. Other causes include Taiyang leak sweating, Yangming wind-pathogen, post-emesis/purgation Qi deficiency, inherent blood deficiency, fire-carrying phlegm, righteous Qi collapse, menstruation onset, or chronic disease depletion. Cold/heat/deficiency/excess differ; one method cannot suffice.
Red Eyes: Cold, Heat, Deficiency, and Excess Patterns
Red eyes include epidemic eye disease, heat congestion, and qi toxicity. Ancient texts use Xin-Lian-Ku-Cold formulas like Qiang Huo Tu Shi Tang, Chan Hua Wu Bi San, Long Dan Tang, and Rui Ren Gao. Chronic cases become deficient. Formulas like Ming Mu Di Huang Tang and Yi Qi Cong Ming Tang nourish Yin/Qi. Others like Si Sheng Wan and Ye Guang Jiao Hong Wan treat Kidney fire deficiency and dull vision, not acute red eyes. Disease lacks fixed forms; treatment lacks fixed methods. In autumn of the Bing Shen year, friend Zhao Jianqiu had red, non-swollen eyes with red urine and constipation. Pulse was soft and slippery, indicating internal summer-heat/fire and external wind-fire. I used Liang Ge San (Cool the膈 Decoction) removing Mang Xiao, adding Xuan Shen, Mai Dong, and Jiang Can, curing him in several doses. Half a month later, recurrence due to labor and mistaken dispersing herbs caused tearing and photophobia. Pulse was soggy, fine, and rapid, indicating double deficiency from labor and erroneous medication. I used Ling Yang, Di Huang, E Jiao, Bai Shao, Mai Dong, Sheng Gan Cao, Ji Li, Hua Fen, and Che Qian Zi. Condition stabilized, but Stomach Qi was weak. I removed Hua Fen and Che Qian Zi, adding Dang Shen and Bai Zhu, achieving recovery. In autumn of the Jia Wu year, a relative had severe eye disease with red/swollen lids, pain, photophobia, and corneal opacity. Pulse was deficient, slow, fine, and weak, indicating Qi/Blood deficiency leading to cold, exacerbated by anger stirring Liver fire. This is true deficiency resembling excess, true cold resembling heat. I used Shu Di, Wu Zhu Yu, Gan Jiang, Rou Gui, Dang Gui, and Niu Xi, advising cold intake. Two doses resolved it. Later, Huang Qi, Dang Shen, Fu Ling, and Zhi Gan Cao restored health. Former case used classical red-eye methods; latter used fire-deficiency principles. Both succeeded, proving the necessity of differentiating cold/heat/deficiency/excess over rigid acute/chronic classifications.
Throat and Pharynx: Deficiency and Excess Patterns
The throat (Hou) connects to the Lung, governing respiration (exit); the pharynx (Yan) connects to the Stomach, governing ingestion (entry). Symptoms vary by cold/heat/deficiency/excess. In spring of the Xin Mao year, in Jinan, Concubine of Gao Zhongwen suffered throat abscess with anorexia, insomnia, fever, and constipation. Initial cupping/acupuncture failed. Pulse was surging and large, indicating internal warmth pathogen forcing upward. I used San Huang Xie Xin Tang (Three-Yellow Draining Heart Decoction) plus Shi Gao and Xiao Sheng Di Huang. Pain subsided in one dose, resolved in two, followed by clearing/nourishing herbs. In summer of the Yi Wei year, in Shanghai, Mr. Zhang suffered burning throat and heart pain after labor/anger for six months. Pulse was floating, fine, and rapid, indicating insufficient Yin fluids and floating Yang. I used Si Jun Zi Tang (Four-Gentlemen Decoction) plus Bai Shao and Shan Zhu Yu. Symptoms improved in several doses. These mild cases responded to bitter-draining and sweet-warming methods respectively. Severe cases like缠喉风 (Wind-Entangling Throat) or 走马喉风 (Running-Horse Throat) are dangerous. Ancient methods prioritize symptomatic relief (biao) over root treatment (ben) due to the throat's critical location.
Gum Swelling: Wind, Fire, and Toxin Patterns
Toothache stems from wind, fire, parasites, or deficiency. Swelling connecting to the cheek is usually wind-fire. In winter of the Bing Shen year, in Beijing, Magistrate Wang Jincheng had left-sided gum/tooth swelling and pain. Pulse was rapid, stronger on the left, indicating external wind triggering internal wind with phlegm-fire. I used Jia Wei Yuan Dan Tang. Swelling/pain resolved in two doses, but a bean-sized nodule persisted. Surgical intervention caused recurrence and irritability. Pulse became stagnant; tongue coating gray/greasy, indicating medication error. I repeated the internal method, resolving it in two doses. Disease appearing on the surface has internal roots; internal treatment works even for external appearances. In the Ding Hai year, student Li Haoquan had an abdominal carbuncle. I ordered removal of plaster and treatment with Bai Hu Di Xie Tang (White Tiger Eliminating Pathogen Decoction), resolving it in two doses. In summer of the Yi Wei year, in Shanghai, Mr. Li had two leg carbuncles (one bowl-sized, one cup-sized) with severe pain. Pulse was slippery, large, and rapid. I used Yi Jia Huang Long Tang (Yellow Dragon Decoction with Turtle Shell). One dose drained pus and resolved unripe ones. In spring of the Ding You year, in Tianjin, Cui He suffered painful perineal swelling resembling a suspended abscess. Pulse right Guan/Cun was surging, large, deep, and solid, indicating damp-heat sinking from intestines/stomach. I used Huang Long Jie Du Tang (Yellow Dragon Detoxification Decoction), resolving it in two doses. These external cases treated internally succeeded, proving external signs stem from internal causes. Healing the internal resolves the external.
Refutation of Misconceptions Regarding Yin Syndromes