甲申春王芝提先生次郎则奚素喜怒。屡患血症。仍不守禁。且恋帷 。面色青黯。骨蒸潮热。
因数宵剧饮。僮仆忤意。怒火升炎。迫血暴呕。初疗不愈。越四日延余察其六脉弦硬。且
少胃气。谓此症须参或可救。彼疑不服。姑投以静血顺气平缓之剂。四服。每旦仅唾血数口
。
喘胀亦平。余曰症虽渐减。脉全未复。非遵用葛可久独参法。必无瘥理。但恐尚迟耳。彼始
惊悟。缘杖头偶乏。索逋于邻友不能即应。拍案嗔呼。血复上涌不止。时在坐邵是龙善脉。
亦谓金水已败。法在不治。至夜而殁。
癸未春郡司马朱六间公年五旬。艰嗣。不慎酒色。饮食起居失宜。面目青黯。怒则晕HT 。大
便秘塞脱血。小便淋血如割。屡治皆清火通淋之剂。反加剧。脉沉迟两尺带涩。余曰此乃肾
水枯竭不能滋生肝血遂致虚火上炎移热二肠迫血下窜因而队道沥枯妨碍升降故每欲便
塞疼难堪须用甘温之剂滋益化源补养肝木使阴血盛则津液充而淋秘自解矣公曰善向未有谈及
此者令投补中益气汤。去柴胡倍人参加牛膝。少佐肉桂。丸用加减八味。入人参苁蓉远志服
逾月渐次而愈。
壬午孟秋余因访宁庠林馨公会间有同社郑友者云经月病魔侵缠不堪。屡治罔瘥。详言乃
知患
淋。余曰淋症有虚实寒热之殊。今公年未三旬。元气充实。而修途劳 。饮食不调。复喜火
酒。脾受积热矣。时当炎令。丁火司权丙火协应。故心移热小肠。五火因而内灼。上肺燥口
渴。下肾燥淋结。前剂八正五淋只专治淋而未知清水上源滋益肺金故不效授以二陈小柴加龙
胆知母麦冬木通一方与服。首剂知减。数剂全愈。未几入闱。神思爽然。
前汤小柴龙胆。乃清肝火之剂肝为心之母未有母安而子不静之理况龙胆善治实热诸淋敷
功极
速若人参知母麦冬黄芩皆益水上源清金润燥之要药也木通虽曰通淋。引药入心。不止散小肠
结热耳佐二陈则使健脾。而速于营运药力也。
甲申年春天，王芝提先生的次子王则奚平素性情喜怒无常。多次患有血症，但仍不遵守禁忌，并且沉溺于房事。面色青暗，出现骨蒸潮热（阴虚发热，感觉热自骨髓深处透发而出）。因为连续几个晚上剧烈饮酒，加上仆人不合心意，导致怒火升腾，逼迫血液暴发性呕吐。起初治疗没有见效，过了四天请我诊察，六脉弦硬，且缺乏胃气。我说这个病症必须用人参或许还能挽救。他怀疑而不肯服用，姑且投以静血顺气的平缓药剂。服了四剂后，每天早晨仅吐出几口血，气喘和腹胀也平息了。我说：病症虽然逐渐减轻，但脉象完全没有恢复，如果不遵照葛可久的独参法（单用大量人参补气摄血），必定无法痊愈。只是恐怕为时已晚罢了。他才开始惊悟，但因为手头偶尔缺钱，向邻居朋友索债不能立即得到回应，便拍案怒呼，导致血液再次上涌不止。当时邵是龙在座，善于诊脉，也说金水（肺肾）已经败坏，按照医理属于不治之症，到了夜晚就去世了。
癸未年春天，郡司马朱六间公五十岁。因生育困难，不慎节制酒色，饮食起居不合宜度。面目青暗，发怒时会晕厥，大便秘结并伴有脱血（便血或下血），小便淋血如刀割一般。多次治疗都使用清火通淋的药剂，反而加重病情。脉象沉迟，两尺部带涩象。我说：这是肾水枯竭，不能滋生肝血，导致虚火上炎，移热于大肠和小肠，逼迫血液下行，因而肠道干涸，妨碍气机升降，所以每次想排便时感到堵塞疼痛难忍。必须使用甘温的药剂，滋益化源，补养肝木，使阴血旺盛则津液充盈，淋证和秘结自然解除。他说：好。以前从未有人谈到这一点。于是投用补中益气汤，去掉柴胡，倍用人参，加入牛膝，稍加肉桂。丸药使用加减八味丸，加入人参、肉苁蓉、远志。服用一个多月后逐渐痊愈。
壬午年初秋，我因为拜访宁国府学廪生林馨公，中间有同社的朋友郑友说，被病魔缠身一个月，痛苦不堪，多次治疗都没有好转。详细询问才知道患的是淋证。我说：淋证有虚实寒热的不同。现在您年纪不到三十岁，元气充实，但在旅途劳顿，饮食不调，又喜欢喝烈性酒，脾脏受到积热。当时正值炎热季节，丁火（心火）当令，丙火（小肠火）相应协助，所以心将热邪移入小肠，五火在内灼烧，导致上焦肺燥口渴，下焦肾燥导致淋结。之前的方剂如八正散、五淋散只专门治疗淋证，而不知道清利水源、滋益肺金的方法，所以无效。传授给他二陈汤合小柴胡汤，加入龙胆草、知母、麦冬、木通的方子让他服用。第一剂见效减轻，数剂后完全痊愈。不久参加科举考试，精神清爽。
前面的汤剂“小柴胡加龙胆”，是清肝火的药剂。肝为心之母，没有母亲安宁而儿子不安静的道理。况且龙胆草善于治疗实热引起的各种淋证，功效极快。至于人参、知母、麦冬、黄芩都是益水上源、清金润燥的重要药物。木通虽然说是通淋，引导药力进入心脏，不仅仅是疏散小肠结热而已。配合二陈汤则能使脾胃健运，从而加速药力的运行。
In the spring of Jiashen year, Mr. Wang Zhití's second son, Wang Zexi, had a temperament prone to sudden anger and joy. He suffered repeatedly from blood disorders (Xue Zheng) but failed to observe dietary and lifestyle restrictions, indulging in sexual activity. His complexion was dark blue-black, accompanied by bone-steaming tidal fever (Gu Zheng Chao Re). Due to binge drinking for several consecutive nights and displeasure with his servants, his anger flared up, forcing blood to vomit violently. Initial treatments were ineffective. Four days later, I was invited to examine him; his six pulses were wiry and hard, lacking stomach qi (Wei Qi). I stated that this condition might be salvageable only with Ginseng (Renshen). Suspecting its use, he refused. I tentatively prescribed a mild formula to calm blood and regulate qi. After four doses, he only expectorated a few mouthfuls of blood each morning, and his wheezing and distension subsided. I remarked: "Although symptoms have gradually decreased, the pulse has not recovered at all. Without strictly following Ge Kejiu's method of using single Ginseng (Du Shen Fa), recovery is impossible. However, it may be too late." He then realized his error. However, due to a temporary lack of funds, when his request for debt repayment from neighbors was not immediately fulfilled, he slammed the table and shouted in anger, causing blood to surge upward uncontrollably. At that time, Shao Shilong, who was present and skilled in pulse diagnosis, also stated that Metal and Water (Lung and Kidney) had already failed, and according to medical principles, it was incurable. He died that night.
In the spring of Guiwei year, Commissioner Zhu Liu Jian, aged fifty, struggled with infertility. He neglected moderation in alcohol and sex, and his diet and daily routine were improper. His face and eyes appeared dark blue-black; upon anger, he would faint. He suffered from severe constipation accompanied by rectal bleeding, and dysuria with blood resembling knife-cutting pain. Previous treatments used fire-clearing and dampness-draining formulas, which exacerbated the condition. The pulse was deep and slow, with the two Chi positions showing a choppy quality. I said: "This is exhaustion of Kidney Water, failing to nourish Liver Blood, leading to deficiency fire flaming upward and transferring heat to the Large Intestine and Small Intestine, forcing blood downward. Consequently, the bowels become dry, hindering the ascent and descent of Qi, causing painful obstruction during defecation. One must use sweet-warm tonics to nourish the source and support Liver Wood. When Yin blood becomes abundant, body fluids will fill, and dysuria and constipation will resolve naturally." He agreed, noting no one had previously discussed this approach. I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), removing Chai Hu, doubling Renshen, adding Niuxi, and slightly adding Rougui. For pills, I used Jiawei Bawei Wan (Modified Eight-Ingredient Pill) with added Renshen, Congrong, and Yuanzhi. After more than a month of consumption, he gradually recovered.
In early autumn of Renwu year, while visiting Lin Xingong, a government-supported student (Xiangsheng) in Ningguo Prefecture, a fellow society member, Zheng You, mentioned being plagued by illness for a month, suffering greatly despite multiple treatments without improvement. Upon detailed inquiry, I learned he suffered from dysuria (Lin Zheng). I said: "Dysuria varies by deficiency/excess and cold/heat. You are under thirty, with robust primordial Qi, yet you endured travel fatigue, irregular diet, and enjoyed strong liquor, resulting in accumulated heat in the Spleen. It was the hot season, with Ding Fire (Heart Fire) ruling and Bing Fire (Small Intestine Fire) assisting. Thus, Heart transferred heat to the Small Intestine, and the five fires scorched internally, causing upper Jiao Lung dryness with thirst, and lower Jiao Kidney dryness leading to dysuria accumulation. Previous formulas like Bazheng San and Wulin San focused solely on treating dysuria, ignoring the need to clear the water source and nourish Lung Metal, hence their ineffectiveness." I prescribed Er Chen Tang combined with Xiaochaihu Tang, adding Longdancao, Zhimu, Maidong, and Mutong. After the first dose, symptoms reduced; after several doses, he fully recovered. Soon after, he took the imperial examination with clear mental clarity.
The aforementioned decoction, Xiaochaihu Tang with Longdancao, clears Liver Fire. Since the Liver is the mother of the Heart, if the mother is tranquil, the child cannot be restless. Moreover, Longdancao is highly effective for various excess-heat dysurias. Renshen, Zhimu, Maidong, and Huangqin are essential herbs for benefiting the water source, clearing Metal, and moistening dryness. Although Mutong is said to promote urination and guide herbs into the Heart, its function extends beyond merely dispersing heat stagnation in the Small Intestine. Paired with Er Chen Tang, it strengthens the Spleen, thereby accelerating the distribution of medicinal efficacy.