癸未仲夏善化杨我伤食中 。复饮冷水。疟痢并作。烦闷不食。前治柴芍清表之剂。转
增
狂谵。余察其六脉滑数有力。脾关尤甚。以二陈加曲 等物。服两剂诸症顿减。静睡二夜。
惟痢积未消。调理经旬全愈。
仲景治少阴脱血。用桃花汤内有干姜即此意也谁谓血症不用热剂乎。
癸未仲夏浦尾郑思年逾六十。素善饮啖。因醉卧当风。患头疼发热。面目青黯。呕吐拒
食
。心腹胀痛。两足逆冷。大便脱血。脉六七至。洪数鼓指。余曰风寒内攻阴络受伤故致脱血
非血痢也脉洪数。乃真气虚邪气胜也。急以大剂参术归苓加桂附炮姜为佐。木香陈皮炙草为
使。两服热退身凉。血止胀消。脉亦转静。此余取症不取脉也次日始下痢。杂色黄。白微红
。为宿积下泄不必虑。余因他往渠急于愈。别延一医治以槟榔粟壳诸涩剂。暴致胀满。二便
壅塞。余用二陈加大黄火麻防风枳壳与服。数日积尽。气复而愈。
甲申仲夏内弟陈克辉患感冒头痛发热。一老医用羌活汤。入麻黄撮许。投三剂。越数日
发黄
目睛皆黄小便亦赤涩不堪。余投以茵陈五苓散。加栀 至十剂始痊。夫麻黄汤。本为三冬正
伤寒而设。而乃用之于温暑之时。幸英年脉症俱实。不免斑黄之患。执方治病。谬滋大矣
。
癸未仲秋里人吴台外家弟。患劳力感寒。初投发表。连五剂不应。复更治之渐增剧。至十
三日
请余诊视。脉洪散参舂。昏不知人。惕 不止。余曰此本是劳力感寒。妄投表剂遂致气血两
虚气不卫外血不荣筋而然耳第此症医多不知误以为风。渠云昨东门一医果作风治余曰风药皆
散散既伤阳风药皆燥燥复伤阴前药欲以愈病是犹救焚而增薪也辞不治断越三日当殁。果然。
癸未年仲夏,善化人杨我因饮食积滞而患病。又饮用了冷水,导致疟疾和痢疾同时发作,心中烦闷且无法进食。之前医生使用柴胡、芍药等清解表邪的方剂治疗,病情反而加重,出现狂躁谵语的症状。我诊察发现他六脉滑数且有力,脾关部位的脉象尤为明显。于是用二陈汤加入神曲等药物,服用两剂后,各种症状顿时减轻,安静睡眠了两夜。只有痢疾中的积滞尚未消除,经过十天的调理后完全痊愈。
张仲景治疗少阴病脱血证,使用桃花汤,其中含有干姜,就是这个道理。谁说血症不能使用热性药剂呢?
癸未年仲夏,浦尾人郑思年年龄超过六十岁。平时喜欢饮酒和进食。因为醉酒卧于风口,患上了头痛发热,面目呈现青暗色,呕吐且拒绝进食,心腹胀痛,两脚逆冷,大便下血。脉搏跳动六七次一息,脉象洪大数急,搏指有力。我说这是风寒内攻,损伤了阴络,所以导致脱血,这并不是血痢。脉象洪数,是正气虚弱、邪气亢盛的表现。急忙用大剂量的人参、白术、当归、茯苓,加上肉桂、附子、炮姜作为佐药,木香、陈皮、炙甘草作为使药。服用两剂后,热退身凉,出血停止,腹胀消退,脉象也转为平静。这是我“取症不取脉”的治疗思路。第二天开始下痢,颜色杂有黄、白、微红,这是宿食积滞向下排泄,不必担忧。我因其他事情外出,病人急于痊愈,另外请了一位医生,医生使用了槟榔、粟壳等收敛固涩的药物,突然导致腹部胀满,大小便壅塞不通。我使用二陈汤加大黄、火麻仁、防风、枳壳给病人服用,几天后积滞排尽,气机恢复而痊愈。
甲申年仲夏,我的内弟陈克辉患感冒,出现头痛发热。一位老医生使用羌活汤,加入少许麻黄,投药三剂。过了几天,病人全身发黄,眼睛也都变黄,小便赤涩难忍。我给他投以茵陈五苓散,加入栀子,服至十剂才痊愈。麻黄汤,本是为深冬时节的正宗伤寒所设,却用在温暑之时。幸好他年轻力壮,脉症都属实证,还是不免出现发斑发黄的危害。拘泥于固定方剂治病,错误真是大了。
癸未年仲秋,同乡吴台外的家弟,患劳累后感寒。起初使用发汗解表的药物,连续五剂没有见效。又更换治疗方法,病情逐渐加重。到第十三日,请我诊视。脉象洪大散乱,如杵捣臼般无序,神志昏迷不知人事,肌肉跳动不止。我说这本来是劳累后感寒,误用发汗解表剂,导致气血两虚,气不能卫护体表,血不能濡养筋脉,所以才这样。只是这种病症,很多医生不知道,误以为是风邪。他说昨天东门的一位医生果然按风邪治疗。我说风药都是发散之品,发散既已损伤阳气,风药又多燥烈,燥烈又会损伤阴液。前面的药想要治病,这就好比救火却增加柴薪一样。我推辞不治,断言三天后病人会死亡。果然如此。
In the mid-summer of the Guiwei year, Yang Wo from Shan Hua suffered from food stagnation. He then drank cold water, which caused malaria and dysentery to occur simultaneously. He felt restless and stifled in his chest and was unable to eat. The previous treatment with formulas containing Chaihu (Bupleuri Radix) and Shaoyao (Paeoniae Radix) to clear the exterior instead exacerbated the condition, leading to manic delirium. Upon examination, I found his six pulses slippery, rapid, and forceful, with the pulse at the Pi Guan (Spleen Gate) position being particularly prominent. I prescribed Er Chen Tang (Two-Cured Decoction) added with Shen Qu (Massa Medicata Fermentata) and other substances. After taking two doses, all symptoms suddenly decreased, and he slept quietly for two nights. Only the accumulation in the dysentery had not yet been eliminated; after ten days of regulation, he fully recovered.
Zhang Zhongjing treated bleeding due to Shaoyin disease using Taohua Tang (Peach Kernel Decoction), which contains Ganjiang (Dried Zingiberis Rhizoma); this illustrates the same principle. Who says that blood diseases cannot be treated with hot-natured agents?
In the mid-summer of the Guiwei year, Zheng Sinian from Puwai, aged over sixty, usually enjoyed drinking and eating. Because he lay sleeping in a draft while drunk, he developed headache and fever, with a bluish-dark complexion, vomiting, refusal to eat, abdominal distension and pain, coldness in both feet, and hematochezia (bleeding from the rectum). His pulse beat six or seven times per breath, appearing surging, rapid, and striking the finger forcefully. I said, "This is wind-cold attacking internally, damaging the Yin collaterals, thus causing bleeding; it is not bloody dysentery. A surging and rapid pulse indicates deficiency of true Qi and excess of pathogenic factors." I urgently prescribed a large dose of Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), and Fuling (Poria), with Rougui (Cinnamomi Cortex), Fuzi (Aconiti Lateralis Radix Praeparata), and Paojiang (Prepared Zingiberis Rhizoma) as assistants, and Muxiang (Aucklandiae Radix), Chenpi (Citri Reticulatae Pericarpium), and Zhigancao (Glycyrrhizae Radix et Rhizoma Preparata cum Melle) as guides. After two doses, the heat subsided, the body became cool, bleeding stopped, abdominal distension resolved, and the pulse also became calm. This was my approach of prioritizing symptoms over the pulse. The next day, he began to pass dysenteric stools, mixed in color with yellow, white, and slight red; this was the discharge of old accumulations, so there was no need to worry. As I had other matters to attend to and the patient was anxious to recover, he consulted another doctor who used astringent agents such as Binglang (Arecae Semen) and Sukexiao (Papaveris Pericarpium), which suddenly caused severe abdominal distension and obstruction of urination and defecation. I prescribed Er Chen Tang (Two-Cured Decoction) added with Dahuang (Rhei Radix et Rhizoma), Huomaren (Cannabis Semen), Fangfeng (Saposhnikoviae Radix), and Zhike (Aurantii Fructus Immaturus). After several days, the accumulation was completely cleared, Qi was restored, and he recovered.
In the mid-summer of the Jiashen year, my wife's brother, Chen Kehui, suffered from a common cold with headache and fever. An old physician used Qianghuo Tang (Notopterygii Decoction) with a small amount of Mahuang (Ephedrae Herba). After three doses, several days later, the patient developed jaundice, with both eyes turning yellow and urine becoming dark, scanty, and difficult to pass. I prescribed Yinyin Wuling San (Yinchen Five-Ingredient Powder) added with Zhizi (Gardeniae Fructus). After ten doses, he finally recovered. Mahuang Tang (Ephedra Decoction) was originally designed for true Shanghan (Cold Damage) in the deep winter, but it was used during warm and summer seasons. Fortunately, he was young and his pulse and symptoms were both excess patterns, yet he still suffered from macules and jaundice. Adhering rigidly to fixed formulas for treating diseases leads to great errors.
In the mid-autumn of the Guiwei year, the younger brother of Wu Taiwai's family member from the same village suffered from cold contraction due to labor. Initially, exterior-releasing agents were administered, but five consecutive doses were ineffective. The treatment was changed again, and the condition gradually worsened. On the thirteenth day, I was invited to examine him. The pulse was surging, scattered, and irregular like pounding with a mortar; he was unconscious and experienced continuous muscle twitching. I said, "This was originally cold contraction due to labor, but the rash use of exterior-releasing agents led to deficiency of both Qi and Blood. Qi fails to protect the exterior, and Blood fails to nourish the sinews, hence these symptoms. However, many physicians do not understand this condition and mistakenly treat it as Wind syndrome." He said, "Yesterday, a physician from East Gate indeed treated it as Wind syndrome." I replied, "Wind-dispelling agents are all dispersing in nature; dispersion damages Yang Qi. Moreover, wind-dispelling agents are often drying; dryness further damages Yin fluids. The previous medicines intended to cure the illness are like adding firewood to a burning house." I declined to treat him, predicting that he would die in three days. It happened exactly as predicted.