甲申季春吴门表侄妇脾胃素热。因冒感风邪。目涩鼻干。自用姜汤。连三晨咯血数口。
又恣
饮藕汤益增烦胀。夫所谓外感者从外而入必令从外而出。姜汤独力。既难奏效藕汤凉涩复闭
外邪用解表剂人芩连天花粉。一服即愈。
癸未夏内弟陈克辉英年气盛。连宵痛饮。复啖炙爆。数日胃口嘈杂。呕血碗许。脉洪缓有神
。无别兼症投以犀角地黄汤。入天花川连。连三剂。仍令恣饮藕汤。得全愈切前汤寒凉泻火
本以治脾胃实热积热之症效如桴鼓时医不知谓其有验辄移以治虚劳失血遂致败胃泻阳陷人死
地犹然不悟。岂知年有老壮。体有虚实。症有寒热。随宜施治自当奏效。其可一概混投乎。
甲申夏庠友林鼎万长女适余内侄陈昌元者。年甫二十。元气虚寒。面色青白。肢体频冷
。呕
痰饱胀。小便清利。患大便脱血。数月不瘳。脉沉伏如无。着骨重寻。方见蠕动。余曰脉
症相
符。此藏气虚寒脱血也。投以十全大补汤。去川芎白芍。加熟附炮姜。少佐升麻。仅服四剂
便血顿止神思健爽。胃强亦喜纳食。若以为此症属热。妄投寒剂。必无幸矣。
戊寅中夏因访东胶殷州守与其同年朱明社孝廉同居停余见其面色青黄。日数赴厕。因询
之。
朱曰初为感寒过饮姜汤。患内热脱血。随治以芩连寒剂。即愈。及秋北上。劳顿复发。根据前
方修服。至次剂。拒吐不纳。遂辍药。惟茹澹静摄。两旬方瘥。顷为荒途寇警惊劳仍作。历
今三月。且复倦怠增剧。延数医皆力言须投寒剂畏而不敢从。余脉之。六部皆沉缓濡弱。此
亦易易治耳。但须广费杖头。朱曰得三载沉 顿瘳何惜铢锱。且圆珠环以酬明德。余曰公始
受辛热。投以苦寒对症之剂。宜乎即愈矣。但热气虽消而广肠血窍。尚未敛合。故每遇劳辄
发夫劳则伤脾脾伤便不能统血以致下陷循故窍而出实因于劳非出于热也因忆杨仁斋有云病久
热衰。则尊症不得为热明矣。奈何执投前剂。苦寒败胃。夫安得不吐。及病三发而元气愈虚
。是以愈虚愈脱。愈脱愈虚。淹延岁月。而增困也。治须纯王至静。固中滋补之剂。方可搏
刮生机耳。朱遽起席。拍案大呼曰。得公数言。便足起吾膏肪。奚翅藉笼中之授乎。吾三年
中。历游秦楚齐梁遍访炫名诸医。并未有如公之从本源发挥者。余以熟地为君。参 归术为
臣。丹皮炙草五味知母茯苓阿胶等药为佐。引用柴胡升麻为丸与服。仍令兼饮归脾汤。略用
加减。两旬血减半。胃气渐健。逾月面转红润。诸症如失。及临别浓遗金帛。余峻辞不受曰
。投欢倾盖。谊重金石。济人盛事。敢望报乎。后闻主鹾林金粟长郎年尚英壮。亦患前症。
历延名医。皆治以凉血清火之药。岁久弥剧。每斤丸剂。尚加川连至四五两竟至败胃泻阳而
死。可不痛哉。余以世谊往吊。始悉其详。虽方书有云脱于下者属阴为顺若如此错治是反逆
矣。
甲申年季春(三月),吴门表侄妇脾胃素来有热。因感受风邪,出现眼睛干涩、鼻子干燥的症状。自行饮用姜汤,连续三个早晨咯出数口血。
又放纵饮用藕汤,更加增加了烦闷和胀满感。所谓外感病邪,是从外部侵入的,必须让病邪从外部排出。姜汤药力单一,既难以奏效;藕汤性凉且收涩,反而闭塞了外邪。使用解表剂,加入黄芩、黄连、天花粉,服用一剂即痊愈。
癸未年夏季,内弟陈克辉正值壮年,气血旺盛。连续通宵痛饮,又吃烤炸食物。几天后胃口嘈杂不适,呕出一碗左右的血。脉象洪大缓和且有神气。没有其他兼夹症状,投以犀角地黄汤,加入天花粉、川黄连。连续服用三剂,仍让他大量饮用藕汤,得以完全痊愈。此前该方剂寒凉泻火,本是用来治疗脾胃实热积热的病症,效果如槌击鼓面般迅速。当时的医生不知此理,认为它有疗效,就随意移用来治疗虚劳失血的病症,导致败坏胃气、泻伤阳气,使人陷入死地,却仍然不觉悟。难道不知道人有老壮之分,体质有虚实之别,病症有寒热之异吗?应当根据适宜情况施治,自然能奏效。怎么可以一概混用呢?
甲申年夏季,庠友林鼎万的长女嫁给我内侄陈昌元。年纪刚二十岁。元气虚寒,面色青白,肢体频繁发冷,呕吐痰涎,饱胀,小便清长通畅。患大便脱血(便血)症,数月不愈。脉象沉伏若无,重按至骨才能见到蠕动之象。我说:脉症相符,这是脏腑之气虚寒导致的脱血。投以十全大补汤,去掉川芎、白芍,加入熟附子、炮姜,稍加升麻。仅服用四剂,便血立刻停止,精神健爽,胃气强盛也喜欢进食。如果认为此症属热,妄投寒凉药剂,必定没有生路了。
戊寅年中夏,因为拜访东胶殷州守,与其同年朱明社孝廉同住。我见其面色青黄,每天数次去厕所。于是询问他。朱某说:起初是因为感受寒邪,过量饮用姜汤,患内热脱血。随即用黄芩、黄连等寒凉药剂治疗,立即痊愈。到了秋天北上,因劳累顿挫而复发。依照前法修服(继续服用)。到第二剂时,拒绝服药并呕吐出来,于是停药。只吃清淡安静的饮食调养,二十天才好。近来因为荒途寇警惊吓劳累,旧病再次发作。至今三个月,而且倦怠加重。请了几位医生都极力主张须投寒凉药剂,因害怕而不敢听从。我诊其脉,六部皆沉缓濡弱。这也是容易治疗的。只是需要花费较多路费。朱某说:得了三年重病突然痊愈,何必吝惜钱财。并且用圆珠环来酬谢明德。我说:您起初受辛热之邪,投以苦寒对症的药剂,理应立即痊愈。但热气虽然消除,而大肠的血窍尚未收敛闭合,所以每次遇到劳累就会发作。因为劳累则伤脾,脾受伤就不能统摄血液,以致下陷循着旧有的血窍而出。实在是因为劳累,并非出于热邪。想起杨仁斋说过:病久热衰,那么您的病症不能认为是热邪。为何执着于投用前剂(寒凉药),苦寒败坏胃气,怎么能不呕吐呢?等到病发了三次而元气更加虚弱。因此越虚越脱血,越脱血越虚,拖延岁月,而增加困顿。治疗须纯用温补固中滋补的药剂,才可以搏取生机。朱某急忙起身离席,拍案大呼说:得到先生的几句话,就足以救活我的性命,何止是笼中之鸟得到传授啊。我这三年中,遍游秦楚齐梁,遍访著名医生,并没有像先生这样从本源发挥分析的。我以熟地为君药,人参、当归、白术为臣药,丹皮、炙甘草、五味子、知母、茯苓、阿胶等药为佐药,引用柴胡、升麻为引经药,制成丸剂服用。仍令兼饮归脾汤,略作加减。二十天后出血减半,胃气逐渐强健,超过一个月面色转为红润,各种症状消失。临别时赠送金银财物,我坚决推辞不接受说:初次见面倾盖相交,情谊重于金石。救人是一件盛事,敢奢望报答吗?后来听说盐政林金粟的长子年纪尚且英壮,也患前症。历经名医,都用凉血清火的药物治疗,年代久远病情更加严重。每斤丸剂,还加入川黄连至四五两,最终导致败胃泻阳而死。岂不可痛惜!我以世交关系前往吊唁,才详细了解详情。虽然医书有云:脱血在下者属阴为顺,像这样误治就是反逆了。
In the late spring of the Jia-Shen year, the wife of my cousin's nephew from Wu-men had a constitution with inherent heat in the Spleen and Stomach. After contracting wind-pathogens, she experienced dry eyes and a dry nose. She self-administered ginger soup, resulting in hemoptysis (coughing up blood) of several mouthfuls for three consecutive mornings.
She then indulged in drinking lotus root soup, which exacerbated her irritability and distension. The so-called exogenous pathogens enter from the exterior and must be expelled from the exterior. Ginger soup has a singular action and is ineffective; lotus root soup is cooling and astringent, thereby closing off the pathogen. A formula for releasing the exterior was used, adding Huangqin (Scutellariae Radix), Lianzi (Coptidis Rhizoma), and Tianhuafen (Trichosanthis Radix). One dose resulted in a cure.
In the summer of the Gui-Wei year, my brother-in-law Chen Kehui, in the prime of life with vigorous qi and blood, drank excessively throughout the night and consumed roasted and fried foods. Several days later, he suffered from gastric discomfort and vomited approximately one bowl of blood. His pulse was surging, slow, and spirited, with no other accompanying symptoms. He was prescribed Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), supplemented with Tianhuafen (Trichosanthis Radix) and Chuanlian (Coptidis Rhizoma). After three doses, while still allowing him to drink lotus root soup freely, he made a full recovery. Previously, this decoction, being cold and cooling to drain fire, was intended for treating excess heat and accumulated heat in the Spleen and Stomach, yielding results as swiftly as striking a drum. Contemporary physicians, unaware of this, assumed its efficacy could be universally applied to treat deficiency-consumption with hemorrhage, thereby damaging the stomach and draining yang, leading patients to death without realization. Do they not know that people vary in age (old vs. young), constitutions differ (deficiency vs. excess), and syndromes present as either cold or heat? Treatment must be tailored appropriately to be effective. How can one indiscriminately apply the same treatment?
In the summer of the Jia-Shen year, the eldest daughter of Lin Dingwan, a fellow student, married my nephew-in-law Chen Changyuan. She was only twenty years old. Her primordial qi was deficient and cold; her complexion was cyanotic and pale; her limbs were frequently cold; she vomited phlegm, felt bloated, and had clear, profuse urination. She suffered from rectal bleeding (hematochezia) that persisted for months without healing. Her pulse was deep and hidden, seemingly absent, becoming palpable only upon heavy pressure to the bone. I stated: The pulse and symptoms correspond. This is hemorrhage due to visceral qi deficiency and cold. I prescribed Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction), removing Chuanxiong (Ligustici Chuanxiong Rhizoma) and Baishao (Paeoniae Radix Alba), adding Shufu (Aconiti Lateralis Radix Preparata) and Paojiang (Zingiberis Rhizoma Preparatum), with a small amount of Shengma (Cimicifugae Rhizoma). After only four doses, the rectal bleeding stopped abruptly, her mental clarity improved, and her stomach strength increased, showing appetite. If this syndrome were mistakenly considered heat and treated with cold agents, survival would be unlikely.
In mid-summer of the Wu-Yin year, while visiting Yin Zhou Shou in Dongjiao, I stayed with his contemporary, Zhu Mingshe, a Xiao-liang degree holder. Observing his cyanotic-yellow complexion and frequent trips to the toilet, I inquired about his condition. Zhu replied: Initially, after contracting cold and drinking excessive ginger soup, he suffered from internal heat causing rectal bleeding. It was treated with cold agents like Huangqin (Scutellariae Radix) and Lianzi (Coptidis Rhizoma), resulting in an immediate cure. In autumn, upon traveling north, exhaustion triggered a relapse. He continued taking the previous prescription. Upon the second dose, he rejected the medicine and vomited, so he stopped. He managed by consuming bland, quiet dietary care, recovering after twenty days. Recently, due to alarm and fatigue from bandit warnings on desolate roads, the illness recurred. For three months, fatigue has worsened. Several physicians insisted on using cold agents, but he feared them and did not comply. I palpated his pulse; all six positions were deep, slow, soggy, and weak. This is easily treatable, though it requires considerable travel expenses. Zhu said: Having recovered from a three-year chronic ailment suddenly, why spare trifles? He offered a pearl ring to reward my virtue. I said: You initially contracted hot-warm pathogens and received bitter-cold agents matching the syndrome, hence the immediate cure. However, although the heat cleared, the blood vessels of the large intestine had not yet closed. Thus, every instance of labor triggers recurrence. Labor injures the Spleen; when the Spleen is injured, it cannot control blood, causing it to sink and exit through existing vessels. This is indeed due to labor, not heat. Recall Yang Renzhai's saying: When disease persists and heat declines, your syndrome cannot be classified as heat. Why persist with the previous agent? Bitter-cold damages the stomach, leading to vomiting. With three recurrences, primordial qi became increasingly deficient. Thus, the more deficient, the more bleeding; the more bleeding, the more deficient, dragging on for years and increasing debility. Treatment requires purely warm, stabilizing, and tonifying agents to secure vitality. Zhu rose hastily from his seat, slapped the table, and exclaimed: Your few words are sufficient to save my life, let alone teach me like a bird in a cage. In these three years, I traveled through Qin, Chu, Qi, and Liang, visiting famous physicians, but none analyzed from the root source like you. I used Shudi (Rehmanniae Radix Preparata) as the sovereign herb, Renshen (Ginseng Radix), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma) as ministers, Danpi (Moutan Cortex), Zhigancao (Glycyrrhizae Radix et Rhizoma Preparata), Wuweizi (Schisandrae Fructus), Zhimu (Anemarrhenae Rhizoma), Fuling (Poria), and Ejiao (Asini Corii Colla) as assistants, citing Chaihu (Bupleuri Radix) and Shengma (Cimicifugae Rhizoma) as guides, prepared as pills. He was also instructed to drink Guipi Tang (Restore the Spleen Decoction) with minor modifications. After twenty days, bleeding halved, stomach qi gradually strengthened, and within a month, his complexion turned ruddy and all symptoms vanished. At parting, he offered gold and silk, which I firmly declined, saying: Meeting briefly, our friendship is heavier than metal and stone. Saving lives is a great deed; do I dare expect reward? Later, I heard that the eldest son of Lin Jinshu, who managed salt administration, also suffered from this syndrome. Despite seeking famous doctors and treating with blood-cooling and fire-clearing medicines, the condition worsened over time. Each jin of pills contained 4-5 liang of Chuanlian (Coptidis Rhizoma), ultimately causing stomach damage and yang depletion, leading to death. Is this not painful? As a family friend, I went to mourn and learned the details. Although medical texts state that lower hemorrhage belongs to yin and is favorable, such mismanagement reverses this principle.