崇祯壬申季秋家严因署临邛事竣乡先生天部杨丹房邀游鹤山。余亦预焉。越午公饮半酣
。欢
笑失音。昏 卒仆。喉声曳锯。手足散缓。脉沉伏。余令其从仆徐扶入僧房浓被密盖复令抵
家取参。少顷有儒医柳君至余曰此乃真气素虚。外邪因得乘入。非大剂参附。无以回将绝之
阳。柳虽以余言为是。但意疑用人参二两。附子三钱之多。余曰参多用有彻上彻下彻内彻外
之功若不急投。必至自汗遗尿。上下元气俱脱。便不可救矣。余力任之。促令前剂煎浓汤灌
入。饭许。目能转动再灌。吁气数声。脉渐复。次日全愈欲归。余令其且在寺调养旬日。方
可行。设遇此症。误以为风为火而投牛黄冰麝清气化痰之剂耗泄真阳必无幸矣同时蜀藩有内
江王亦患前症。医者执以为风。杂投牛黄丸活络丹苏合丸越九日而薨。
甲申冬西关外一村民年逾五旬。因中风瘥后。误食瘴牛。狂渴饮水不休。越数期。两腋
乖胁
下发肿出汗。肤出细虫如丝。睾丸偏重。尿血淋沥。耳燥痒不休。前医投宣虫利水药累治
不瘥。余曰此肝脾两经湿热所致。肝主风。脾主湿湿风相搏而成热湿热相生而成虫故见于肝部
。投小柴汤六一散入龙胆草生地。四剂而愈。
是冬南都孝廉查君球年可强仕。素恋帷幕赴闽谒选。行抵仙霞。绿林剽掠。惊愁隐郁甫
泊车
数日。病发寒热。背连左臂疼痛不堪。余适为其同寓友江右覃应楠疗阳虚伤寒。甫愈。闻左
壁号声如雷。覃往顾查呼救揖余代诊。查昏 卧榻。口绝不道其何病。余见其面色纯黯。左
颊略带紫黑。右微红白。遂诊脉左三部搏指。愈按愈实。右脾肺轻举。亦洪健。重按与右尺
全虚第此病既无三阳表症当必内患疮疡尚兼木侮金为厉也旁有朱姓者乃查内弟。问余曰。何
以言之。余曰此病得之肝肾两亏。朱又问曰肝肾主何病。余曰肾脉浮数而坚。此平昔色欲过
度。因致燎原火炽耳。肝部亦如之盖木伤土土亏而肾水枯涸无以养肝故致弦强真藏脉见也强
中见涩。又金刑木。当有郁结事。或悲哀悼亡。或遗丧赀重。或惊怒伤怀皆木伤也朱与三五
同行相抵掌叹曰。见亦神矣。始说前由。迫余主方。余又云纵有外疾显见。当固内滋本为要
。初投一剂。用参 归术各三钱。桂心一钱。佐忍冬阿胶甘草地黄白芍等药。顿觉健爽进食
。再剂背臂拱痛尤甚。速余再诊。见症剧脉缓。毒不内攻。可喜之兆。照前方只参 加至五
钱。桂加二钱。入牛蒡一钱。服毕觉患处热消痛减索粥碗许。思酒。余赞之饮。至四更溃黄
脓五六碗。次日再诊。脉见濡缓。余曰当无虑。但元气弱耳。仍以前方加参 各一两。术七
钱。甘草肉蔻各三钱。忍冬牛膝乳香陈皮为佐。桂心只用一钱。服一剂余脓渐少。新肉渐生
。饮食如常查始感悟曰微君吾其土矣。服八剂。疮已敛十之七八偶有一部郎乃查窗友。访查
见余方惊 曰奈何盛毒疮疡。而用参 术桂。以火济火耶。查亦疑信莫决。听延一疡医吕姓
者。吕至极辟余法之妄。乃更投大剂芩连连翘玄参枳朴苓泽之属。外敷以珠HT 生肌膏。初服
亦爽利。自是连五日不延余诊。余念其萍水孤踪。不邀自往。渠托故三辞。未及旬。则驰介
三请。予时已别往 溪。四日方归。归即趋晤。见查言语謇涩。疮流黑水。烦躁索水。饮食
不进。二便自遗。足冷如冰矣。脉疾散不一。令其急备后事。越五日殒。部郎时在坐。顾余
曰。奈何疮毒而用补剂乎。余曰疗病凭脉。此千古不易之定法也。第痈疽症大要有四。一年
少元气脉气健旺。饮食不减。或因误啖燥热所致者。则宜苦寒泻火之剂以治之。一年未甚老
。元气脉气未败。或因悲郁伤肝者。则宜清凉调气之剂以治之。一由平昔色欲过度。水枯木
横。或兼忧劳。致伤中气。发于强年老年元气胃气亏损者则宜温平补剂以治之今查君政合此
法也。反此则实实虚虚大命殉之。又有一种疽症内溃。蚀及脏腑。及发不痛不痒。此为元气
败绝。法不治也。第今匪类冒医。见病治病。动手杀人。至于疡师尤属污贱之流。一见疮疡
。不管虚实。大肆攻伐。安得不速人于死乎。今查君将亡。非独吕奴杀之也。部郎始惭然语塞。
崇祯壬申年深秋，家父因处理完临邛的公务，受到乡中前辈杨丹房先生的邀请去游览鹤山。我也一同前往。到了中午，大家饮酒半醉，欢笑声中突然失音，随即昏倒仆地，喉间发出如拉锯般的声响，手足松弛无力，脉象沉伏。我让仆人慢慢扶他进入僧房，用厚被严密覆盖，并派人回家取人参。不久，儒医柳先生到来，我说：“这是真气素来虚弱，外邪趁机侵入所致。不用大剂量的人参、附子，无法挽回将绝的阳气。”柳先生虽然认为我的话有道理，但心里怀疑用人参二两、附子三钱是否太多。我说：“人参多用具有贯通上下、内外之功，如果不紧急投药，必然导致自汗、遗尿，上下元气俱脱，那就不可救治了。”我独自承担这个责任，催促煎好浓汤灌入。大约一顿饭的时间，眼睛能转动了，再灌一次，叹息了几声，脉象逐渐恢复。第二天完全痊愈想要回去，我让他先在寺里调养十天，然后才能行动。假如遇到这种病症，误认为是风或火而投用牛黄、冰片、麝香等清气化痰的药物，耗泄真阳，必定没有生路了。
当时蜀王府的内江王也患同样的病症。医生坚持认为是风邪，杂投牛黄丸、活络丹、苏合丸，过了九天就去世了。
甲申年冬天，西关外有一个村民年过五十。因为中风病愈后，误食了染病的牛，疯狂口渴不停地喝水。过了几个周期，两腋和胁下开始肿胀出汗，皮肤长出细丝般的虫子，睾丸沉重，尿血淋漓，耳朵燥痒不止。之前的医生投用宣通虫积、利水的药物，多次治疗都没有好转。我说：“这是肝脾两经湿热所致。肝主风，脾主湿，风与湿相搏结而成热，湿热相生而成虫，所以表现在肝经部位。”投用小柴胡汤、六一散，加入龙胆草、生地，四剂就好了。
这年冬天，南都的孝廉查君球年纪刚满四十岁。他一向留恋女色，前往福建候补任职。走到仙霞岭时，遭遇强盗抢劫，惊恐忧愁抑郁，刚停下车几天，就发病出现寒热，背部连带左臂疼痛难忍。我正好在为他的同寓朋友江西人覃应楠治疗阳虚伤寒，刚刚痊愈，听到左边墙壁传来如雷般的呼救声，覃前去查看，发现查君呼救，便作揖请我代为诊治。查君昏迷躺在榻上，口不能言说是什么病。我看他面色纯暗，左脸颊略带紫黑，右脸微红白。于是诊脉，左手三部脉搏指有力，越按越实；右手脾肺脉轻取洪健，重按则右尺全虚。我想，此病既然没有三阳表证，应当是内部患有疮疡，并且兼有木侮金（肝木反克肺金）的厉害情况。旁边有个姓朱的人是查君的妻弟，问我为什么这么说。我说：“这病得自肝肾两亏。”朱又问：“肝肾主要导致什么病？”我说：“肾脉浮数而坚，这是平时色欲过度，导致燎原之火炽盛。肝部脉象也是如此。盖因木伤土，土亏而肾水枯涸，无法滋养肝木，所以导致脉弦强，真脏脉显现。脉象在强中带涩，又是金刑木（肺金克制肝木），应当有郁结的事情，或者是悲哀悼亡，或者丢失财产重物，或者惊怒伤怀，这些都是木受伤的表现。”朱某和同行的三五个人拍手感叹道：“看得太神了。”才说出前因后果，强迫我开方。我又说：“纵然有外在的疾病显现，巩固内在、滋养根本才是关键。”初投一剂，用人参、当归、白术各三钱，桂心一钱，佐以忍冬、阿胶、甘草、地黄、白芍等药。顿时觉得精神爽快，能够进食。第二剂后，背臂拱痛更加严重，急忙让我再次诊治。见症状加剧但脉象缓和，说明毒气没有内攻，这是可喜的征兆。照前方只将人参加至五钱，桂枝加二钱，加入牛蒡子一钱。服完后，感觉患处热消痛减，要了一碗粥，想喝酒，我赞许他饮用。到四更天，溃烂流出黄脓五六碗。第二天再诊，脉象见濡缓。我说：“应当不用担心，只是元气虚弱罢了。”仍然用前方，将人参、白术各加至一两，白术七钱，甘草、肉蔻各三钱，忍冬、牛膝、乳香、陈皮为佐，桂心只用一钱。服一剂后，余脓渐少，新肉渐生，饮食如常。查君才开始感悟说：“如果没有您，我大概已经变成泥土了。”服了八剂，疮口收敛了十分之七八。偶然有一位部郎是查君的同窗好友，来访见到我，惊讶地说：“怎么对待严重的毒疮疡，却用人参、白术、桂枝，以火济火呢？”查君也疑信参半，听从延请了一位姓吕的外科医生。吕某极力排斥我的方法荒谬，于是改投大剂量的黄连、连翘、玄参、枳壳、厚朴、茯苓、泽泻之类的药物，外用珠黄生肌膏敷贴。初服也觉得爽利，从此连续五天不再请我诊治。我念及他是萍水相逢的孤身一人，不请自来。他托故推辞三次，不到十天，就派人快马三请。我当时已经离开去往别处，四天回来。回来后立即赶去见面，见查君言语謇涩，疮流黑水，烦躁索水，饮食不进，二便失禁，脚冷如冰。脉象疾散不一，让他赶紧准备后事。过了五天就去世了。部郎当时在场，看着我问道：“为什么对疮毒使用补剂呢？”我说：“治病凭脉象，这是千古不变的定法。痈疽症大体有四种情况：一是年轻人元气脉气健旺，饮食不减，或因误吃燥热食物导致的，则宜用苦寒泻火的药剂治疗；二是年纪不太老，元气脉气未败，或因悲郁伤肝导致的，则宜用清凉调气的药剂治疗；三是平昔色欲过度，水枯木横，或兼忧劳，致伤中气，发于强年老年元气胃气亏损者，则宜用温平补剂治疗。现在查君正符合第三种情况。反之，则是实实虚虚，断送性命。还有一种疽症，内部溃烂，侵蚀脏腑，以及发作时不痛不痒，这是元气败绝，依法不可治。如今那些不法之徒冒充医生，见病治病，动手杀人。至于外科医生更是污贱之流，一见疮疡，不管虚实，大肆攻伐，怎么能不加速人的死亡呢？现在查君将死，不仅仅是那个姓吕的奴才杀了他。”部郎开始时惭愧无言以对。
In the late autumn of the Ren-Shen year of the Chongzhen era, my father, having completed his official duties in Linqiong, was invited by a senior gentleman from our hometown, Mr. Yang Danfang, to tour Heshan. I joined them. At noon, after drinking until half-drunk, amidst laughter and joy, he suddenly lost his voice, fainted, and collapsed. A sawing sound emanated from his throat, his limbs became flaccid, and his pulse was deep and hidden. I instructed servants to slowly help him into a monk's room, cover him tightly with thick quilts, and send someone home to fetch Ginseng Radix et Rhizoma (Renshen, 人参). Shortly after, the Confucian physician, Mr. Liu, arrived. I said, "This is due to inherent deficiency of True Qi, allowing external pathogens to invade. Without a large dose of Ginseng Radix et Rhizoma (Renshen, 人参) and Aconiti Lateralis Radix Praeparata (Fuzi, 附子), it is impossible to restore the nearly exhausted Yang." Although Mr. Liu agreed with my words, he doubted whether using two taels of Ginseng Radix et Rhizoma (Renshen, 人参) and three qian of Aconiti Lateralis Radix Praeparata (Fuzi, 附子) was too much. I replied, "A larger dose of Ginseng Radix et Rhizoma (Renshen, 人参) has the effect of penetrating up, down, inside, and outside. If not administered urgently, it will inevitably lead to spontaneous sweating and urinary incontinence, causing the collapse of Yuan Qi (Original Qi, 元气) both above and below, making it incurable." I took full responsibility and urged that the decoction be boiled strong and灌ed into him. After about the time it takes to eat a meal, his eyes could move. He was given another dose, sighed several times, and his pulse gradually recovered. The next day, he was completely cured and wished to return. I advised him to stay in the temple for ten days to recuperate before traveling. Had this condition been mistaken for Wind or Fire, and treated with clearing heat and resolving phlegm agents containing Calculus Bovis (Niuhuang, 牛黄), Borneolum Syntheticum (Bingpian, 冰片), and Moschus (Shexiang, 麝香), depleting True Yang, there would have been no hope for survival.
At that time, the Prince of Neijiang in the Shu Prefecture suffered from the same condition. Physicians insisted it was Wind and indiscriminately administered Pills of Calculus Bovis (Niuhuang Wan, 牛黄丸), Huoluo Dan (Live-Through Meridian Pill, 活络丹), and Suhexiang Wan (Styrax Pill, 苏合丸). Nine days later, he died.
In the winter of the Jia-Shen year, a villager west of the West Gate, over fifty years old, had recently recovered from stroke. Mistakenly eating diseased beef, he suffered from frantic thirst, drinking incessantly. After several cycles, swelling and sweating appeared under both armpits and along the hypochondrium. Fine worm-like threads emerged on the skin, the testicles felt heavy, urine contained blood and dribbled continuously, and the ears were dry and itchy without relief. Previous physicians treated him with herbs for expelling parasites and promoting urination, but multiple treatments failed. I said, "This is caused by Damp-Heat in the Liver and Spleen meridians. The Liver governs Wind, and the Spleen governs Dampness. When Wind and Dampness interact, Heat is generated; when Heat and Dampness generate each other, worms are formed. Thus, it manifests in the Liver region." I prescribed Xiao Chai Hu Tang (Minor Bupleurum Decoction, 小柴胡汤) and Liu Yi San (Six-to-One Powder, 六一散), added with Gentianae Radix (Longdancao, 龙胆草) and Rehmanniae Radix (Shengdi, 生地). After four doses, he was cured.
That winter, Zha Junqiu, a Xialiu (scholar-official candidate) from Nanjing, was around forty years old. Accustomed to indulging in sexual activities, he traveled to Fujian for an official appointment. Upon reaching Xianxia Ridge, he was robbed by bandits. Shocked, worried, and depressed, just a few days after stopping his carriage, he developed alternating chills and fever, with unbearable pain radiating from his back to his left arm. I happened to be treating his co-resident friend, Qin Yingnan from Jiangxi, for Yang Deficiency Cold Damage, who had just recovered. Hearing thunderous cries for help from the left wall, Qin went to check and found Zha calling out, so he bowed and asked me to diagnose him. Zha lay comatose on the couch, unable to speak about his illness. I observed his complexion was purely dark, with a slight purple-black tint on the left cheek and slightly red-white on the right. Palpating the pulse, the left three positions were forceful against the fingers, becoming more solid upon deeper pressure. The right Spleen and Lung pulses were superficially surging and robust, but upon deep pressure, the right Chi position was completely deficient. I reasoned that since this disease lacked Taiyang, Yangming, or Shaoyang exterior symptoms, it must involve internal carbuncles/ulcers, compounded by severe Wood insulting Metal (Liver insulting Lung). A surnamed Zhu, Zha's brother-in-law, standing nearby, asked why I thought so. I said, "This disease stems from deficiency of both Liver and Kidney." Zhu asked again, "What diseases do Liver and Kidney primarily cause?" I said, "The Kidney pulse is floating, rapid, and firm. This indicates habitual excessive sexual activity, leading to blazing fire. The Liver pulse is similar. Wood injures Earth, Earth becomes deficient, Kidney Water dries up, failing to nourish Liver Wood, resulting in a wiry and strong pulse, manifesting as True Organ Pulse. The strength mixed with choppy quality indicates Metal punishing Wood. There should be emotional stagnation, such as grief, mourning, loss of wealth, or shock and anger injuring the spirit, all of which injure Wood." Zhu and three or five companions clapped their hands in admiration, saying, "Your insight is divine." Only then did they reveal the preceding events and pressed me to prescribe. I added, "Even if external diseases are evident, consolidating the interior and nourishing the root is essential." The first dose used Ginseng Radix et Rhizoma (Renshen, 人参), Angelicae Sinensis Radix (Danggui, 当归), and Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) each at 3 qian, Cinnamomi Cortex (Guixin, 桂心) at 1 qian, assisted by Lonicerae Japonicae Flos (Jinyinhua, 忍冬), Asini Corii Colla (Ejiao, 阿胶), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草), Rehmanniae Radix Preparata (Shudi, 地黄), and Paeoniae Radix Alba (Baishao, 白芍). He immediately felt vigorous and able to eat. After the second dose, the arching pain in the back and arm worsened significantly. I was summoned again. Observing severe symptoms but a slow pulse, indicating the toxin was not attacking inward—a favorable sign—I kept the previous prescription but increased Ginseng Radix et Rhizoma (Renshen, 人参) to 5 qian, Cinnamomi Cortex (Guixin, 桂心) to 2 qian, and added Arctii Fructus (Niubangzi, 牛蒡子) at 1 qian. After taking it, the heat in the affected area subsided, pain decreased, and he requested a bowl of porridge. He desired wine, and I approved his drinking. By the fourth watch (10 PM - 2 AM), the ulcer burst, discharging five or six bowls of yellow pus. The next day, upon re-examination, the pulse was soggy and slow. I said, "Do not worry; it is merely weak Yuan Qi (Original Qi, 元气)." I continued with the previous formula, increasing Ginseng Radix et Rhizoma (Renshen, 人参) and Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) each to 1 liang, Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) to 7 qian, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) and Myristicae Semen (Roukou, 肉蔻) each to 3 qian, assisted by Lonicerae Japonicae Flos (Jinyinhua, 忍冬), Achyranthis Bidentatae Radix (Nixi, 牛膝), Boswelliae Resina (Ruxiang, 乳香), and Citri Reticulatae Pericarpium (Chenpi, 陈皮), while reducing Cinnamomi Cortex (Guixin, 桂心) to only 1 qian. After one dose, residual pus gradually decreased, new flesh grew, and appetite returned. Zha finally realized and said, "Without you, I would have turned to earth." After eight doses, the wound healed seventy to eighty percent. Occasionally, a Bu Lang (Ministry Official), a classmate of Zha, visited and saw me, exclaiming in surprise, "How can you use Ginseng Radix et Rhizoma (Renshen, 人参), Atractylodis Macrocephalae Rhizoma (Baizhu, 白术), and Cinnamomi Cortex (Guixin, 桂心) for a severe toxic ulcer, adding fire to fire?" Zha was also skeptical and followed the advice to hire a surgeon surnamed Lv. Mr. Lv strongly criticized my method as absurd and instead prescribed large doses of Scutellariae Radix (Huangqin, 黄芩), Forsythiae Fructus (Lianqiao, 连翘), Scrophulariae Radix (Xuanshen, 玄参), Aurantii Fructus Immaturus (Zhike, 枳壳), Magnoliae Officinalis Cortex (Houpo, 厚朴), Poria (Fuling, 茯苓), and Alismatis Rhizoma (Zexie, 泽泻), applying Zhuhu Shengji Gao (Pearl Yellow Regenerating Flesh Ointment, 珠黄生肌膏) externally. Initially, he felt better, but for five consecutive days, he did not invite me. Thinking of him as a lone traveler, I visited uninvited. He declined three times with excuses. Within ten days, he sent messengers galloping to invite me three times. I had already left for another place and returned four days later. Rushing to see him, I found Zha speaking with difficulty, the ulcer flowing black water, restless and craving water, unable to eat, incontinent of urine and feces, and feet cold as ice. The pulse was rapid and scattered. I told him to prepare for death. Five days later, he died. The Ministry Official present looked at me and asked, "Why use tonics for a toxic ulcer?" I said, "Treating disease based on pulse is an unchanging principle of eternity. Carbuncles and ulcers generally fall into four categories: First, young people with robust Yuan Qi (Original Qi, 元气) and pulse, normal diet, caused by mistakenly eating dry-hot foods, should be treated with bitter-cold purgatives to clear fire. Second, those not very old, with intact Yuan Qi (Original Qi, 元气) and pulse, caused by sorrow and depression injuring the Liver, should be treated with cooling and qi-regulating agents. Third, those with habitual excessive sexual activity, dried-up Water and rampant Wood, or combined with worry and fatigue injuring Middle Qi, presenting in middle-aged or elderly individuals with depleted Yuan Qi (Original Qi, 元气) and Stomach Qi, should be treated with warm and neutral tonics. Now, Zha Junqiu fits this third category. Reversing this leads to 'tonifying excess and draining deficiency,' costing one's life. Another type of ulcer involves internal rupture eroding viscera, or appearing without pain or itch, indicating exhaustion of Yuan Qi (Original Qi, 元气); these are incurable. Today, impostors pretend to be doctors, treating symptoms blindly, killing with every movement. Surgeons are particularly low-class; seeing any ulcer, regardless of deficiency or excess, they aggressively attack. How can this not hasten death? Zha Junqiu's impending death is not solely due to that servant Lv." The Ministry Official was initially ashamed and speechless.