戊午秋，张七兄亲家之夫人，继室也。即前病喉痛者之姑，年未四旬，得血崩疾。其家富甲一乡，因距城颇远，恐有仓猝病，医药不便，乃设药肆于家。而乡中贫苦者，辄造而请视疾。故亦时时观医书。以夫人病崩，自用血余散止之小效。更一医，又以为热，用寒凉清之，转益甚。乃嘱张俯求余治，余以路远辞，而张哀恳至再，不得已，随之去。入而视之，见病者面如石灰，唇指皆白，知为血虚之极。乃诊其脉，则微弱特甚。乃曰，此中气下陷，脾虚不能摄血，故崩不止。再服寒凉恐血脱也。此时不宜峻补，但提其中气。气能统血，则崩自止。涩之，截之皆非法。因为开补中益气汤，宋似嫌其平平无奇。乃告之曰，君曾读医书，不闻士材先生之言乎，其云："补气有行血之功，补血无行气之理。"二语极为明确。可见血随气行，气升则血升，气降则血降。若不摄其气而徒止其血，所谓扬汤止沸也。今升其气，使摄血而不下降，然后再用圣愈、养荣之类补其虚，气血相调，并可受孕，治病犹余事耳。宋豁然悟，首肯者数四。更为开大剂圣愈汤，告曰，服补中汤不四帖血当止，后以圣愈汤继之，如恐其烦，可易汤以丸。余去矣，不必再视也。归不数日，时将春夏之交，宋遣人担过牡丹二本。并道病已痊愈。再三申谢。余受而栽于盆，培植灌溉，以吾乡水土杂盐卤，其性极恶。除石榴。葡萄而外，凡花果皆不宜此水，宋所送之牡丹，来时正含苞欲吐，余遣人灌溉，不数日，苞痿而枝渐枯，拔而弃之，增惜焉尔。
妇人经闭一症，其因多端。而各有虚实之分。审其实而攻之，察其虚而补之。偶一不慎，致祸尤速。
友人王福友之妻，少以贫寒致痞疾，适王数年，面黄肌瘦，月事不至，至或淡少，久而腹痛增胀。延医视之，见其形症，皆以为虚，补之不应，而王固粗质，亦任之。半年腹大如鼓，见食辄吐，渐至不起，乃邀余治，诊其六脉坚大而迟，知为寒凝食积。问曰：胃中按之有坚块否？病者曰然。告曰，此自幼生冷风寒伤胃气，故甚则增痛，且四肢发厥，盖虚人实症也。不温胃以散其结，则气凝而血必闭，无怪补之增剧。乃以五积散投之，两服而腹稍舒。又以香砂平胃散合乌药散并用之。有邻人素看医书，见方诧曰，病属经闭，治当行血，乃用销食之剂，无乃非法。余曰，君自不信，看药后效验何如。王命其妻服之，越两日而下秽物，腹膈顿舒。又命常服香砂养胃丸，廿日余而月事至矣。
邻人请其故，告曰：人身之气血，相须而行。若置气而理血，断无效验。且人以胃气为主，乃一身生化之源，而胃经多气多血，气舒则血行；气结则血滞，气热则血凝；气寒则血少。前人调经诸方，理血无非理气也。今王某之妻，气为寒食凝滞，故血亦不行，非血本亏也。若用四物等类血药多凉性，转于胃气有碍而愈不行。今以祛寒销食之品投之，气温则行，食销则通。气行而通，血不通者，未之有也。闻者首肯再三，凡有疑，辄质问焉。
又邻人李寿昌之妻，年四十余，忽患经闭，其夫素务农，日用颇窘，兼无酒德，醉后辄加诟厉，妻久而郁结，遂成病。适夏间阴雨，李忽踏泥而至。问何为？曰，家人病甚，拟请诊视，余问何病?则曰：经闭数月矣，此时腹中胀痛，饮食不下，人皆以为蛊。请一视之，果不可治，亦听之矣。问身体肿否？曰，不肿。乃曰，不肿则非蛊也。问痛多乎?胀多乎?对曰：痛有止时，胀则时时如此，几乎大便不利。余曰，此气滞碍血也，无须诊脉，但服药三四付，则病愈。李曰：不如一诊，较为稳当。余曰：此病显而易见，何在诊脉，尔无非愿病愈，但能病愈，何必诊也。乃处以本事琥珀散（方：三棱、赤芍、刘寄奴、丹皮、熟地、蒲黄、当归、官桂、菊花、莪术等），命服四付。李持而去，余亦忘之。至中秋晚餐无事，余巡行田垅间，李忽携镰自禾黍中出而叩首，余惊问何故?对曰，内人服君药一服，即胸膈雷鸣下气而胀减，再服之，病全失矣。余以其病已愈，不必再服，至今月事不愆，饮食壮健，真仙方也。以农忙未得叩谢，兹遇君敢申意也。余笑而扶之起。说麻问稷，日瞑而归。
论绵山血见愁
绵山为吾介一巨观，峰峦秀美，洞壑幽深，而抱腹崖、蜂房泉尤为奇绝。夏秋间游人如织，其山产奇花异草、药材尤多，绵黄芪、汾甘草，载在本草，传之古今，卓然不朽。惜介人性不辨药，甘草尚有土人掘而市之，余则无采之者矣。其高山之阴，产一药，名"血见愁"，土人游绵者，辄携以归，治血症，无不奇效。余家常藏之。其枝杆类枯蒿，味色极其平淡。
余十岁后，得便血疾，更数十医无效。有老农以此药遗之，煎而当茶饮，不数日，血竟止。后服理脾药廿日遂瘥。乃珍视之。
后邻人有患吐血者，以少许服之，吐亦止。庚申秋，内人产后血晕，诸药无效，忽忆此药，服之遂醒。越数日，余在县署谈及此药，适比部刘麟甫在座，请曰，亲患吐血数月矣，参茸服斤许，而血不止，君盍赐一撮。乃封寄两许，数日而愈。又县幕钱席宾季刚先生之侄媳，产后血晕、百药无效，季刚已为置殓具矣，余以此药遗之亦愈。后与邻里谈及，凡得此药治血晕，无不愈。故妇人又呼为血晕草。
余以此药名问之药肆，持出，则自禹州来者，形类赤首乌，绝非绵产。后遍翻本草，亦无载此药者。因思奇才异品，护世无穷，而味不经神农之口，品不列金匮之书，遂至淹没深山穷谷，医林无知之者，亦此物之不幸也。噫！独血见愁也乎哉！附志于此，以补本草之缺，有心者，幸勿忽焉。
天花逆证
邻人赵楚仁，天津典商也，家小康而妇甚悍，生数女一男，极锺爱之。戊午夏，其五女，年六七岁，发天花。遣人邀余视之，见其形密如蚕种，平板细碎，几乎遍体。而口唇外，尤环绕无隙，且手足发厥，饮食不进。问几日?曰，两日矣。余曰：发热否?曰，不甚发热。问二便如常否?曰：大便溏，小便过多。告曰，痘症发热，三朝自头至足，渐次见点，须颗粒分明，形色红润，饮食二便如常方好。今令嫒之痘，不两日一齐拥出，且形色、饮食、二便如此，兼带锁口，真逆症也，恐治亦不效。其妇嫌余言唐突，语涉怨怼，其夫目怒之，乃止，余曰：来看病非生气，请待以十日，果有能治之者，余当师之，拂衣欲出。其夫力求一方，乃以升麻葛根汤加参芪付之曰，此敷衍法也。赵服之，越日而痘稍起，急遣人告余曰，痘有转机，可再视之，余力却之，赵似怨余，乃请他医。不十日，痘靥而毙。其家乃信余言，后遇赵于街，长揖作谢。余曰，病不能治，何谢为？赵曰：早听君言，可省药钱数贯。余曰，此亦有定数，不费此钱，恐不殁也。赵含泪而去。
小儿乳积
东邻李喜阳，与余往来甚契，庚申秋生一女，其夫人乳素壮，凡子女幼时，无不肥健。一日余至其家，见所生女昏睡不醒，喉中如锯，问何病？李曰，不知何故，早来忽得此疾，乳之不哺，二便亦闭，腹大如鼓，定是急惊，恐不救。余曰，何至如此。扪之浑身发热作汗，胸膈高起。告曰，此乳积也，下之可愈。李之表兄梁某、在李之前设药肆，命取笔研。开白玉饼方，急令取药捣而灌之，两刻许，胸间漉漉作声，下秽物数次，汗止热退，醒而啼矣。乳之似甚饿，告曰：寄语夫人乳须从容，勿令过急，且乳必坐起，切忌卧乳，永无此疾。其夫人闻之而笑。问何故？则前夕卧乳半夜之所致也。李痛戒之。
气郁成痰
医士郭梦槐之妻，以家道式微，抱郁而病，发则胸隔满闷，胃气增痛，转侧不食。郭以茂才设童蒙馆，而赀不给馔粥，见其妻病，以为虚而补之。病益甚。乃来求余，诊其六脉坚实，人迎脉尤弹指，因告之曰，此气郁而成痰也，则发头晕，且增呕逆，久而胃连脾病，恐成蛊。郭求一方，乃以香砂平陈汤加大黄、枳实以疏之，二服而大解，病若失矣。
误用失笑散致死
心胃痛一证，内经条目甚多，先辈名公，分为九等，极为详尽，金鉴遵之，编为歌诀而莫不有虚实之分，可谓无遗蕴矣。
曾忆邻村有医士姓王名维藩者，余同谱弟丹文茂才之族叔也，故业医，货药饵，邻有妇人病胃痛者请王治之，王用海上方中失笑散，服之立效。后凡有患心胃痛者，王辄以失笑散治之，效否各参半。王素食洋烟，一日自觉胃痛，亦自取失笑散服之，痛转甚，至夜半痛欲裂，捣枕椎床，天未明寂然逝矣。
因思失笑散为逐瘀之药，王之邻妇必因瘀血凝滞，故用之立效。其余风寒暑热、饮食气郁，皆能致之，若概以失笑散施治，又不求其虚实，几何不误人性命乎。
王用失笑散不知曾杀几人，故己亦以失笑死，殆冥冥中之报也。业医者，可不多读群书，以求其是乎。
里中相周庞兄之母，年五十余，得吐食症。始以为霍乱，吃塘西痧药数粒，吐如故。又请一医以为气郁，用四七散开之，仍如故。庞求余治，余细问形症，即非霍乱，亦非气郁。按其脉，则右关弦甚，余各平平，乃顿悟曰，此水积也。病必小便不利，好饮水，胸膈闷滞，时兼头晕，病者点头称是。因以五苓散加苍术、木通利之，越日吐止。庞又请视，告曰，不必再视，但常服香砂六君子丸，不但不能停水，且大益于脾胃，于老人甚相宜也。庞遵之，其母遂健。
审证与慎药
治病之道，如钥之启锁，无论显然相反，即相近者，辨之不明，治之不当而亦无效验。其间毫厘之差，千里之谬，如痰之与饮，皆水也，而有阴阳之分。温之与热，皆火也，而有微甚之别。其间或虚、或实、在腑、在脏，尤须详审。审之奈何?形、气、脉、证是也。合而参之，断无背谬。俗医知有心肝脾肺肾。而置六腑于不问，不知人生全以胃气为主，胃气盛，则脏腑皆盈，胃气衰则脏腑皆败。不但饮食谷气，全凭胃经生发，即病者服药，亦先入胃腑，而后达于它脏，故曰："得胃者生。"又诊脉以胃气为验。然则胃者生死之关也，不明乎此，而能达精妙者，未有也。且一病只有一法，故余治病未尝私自立方，所开皆古人成方，又不敢妄为增减。每见病者粗识字，则厌故喜新、求日易方药，不知药之为物，非五谷平和之气，利此则害彼，医士用之不当，必有诛伐无过之虑。久之，胸中混淆。病者非病病，乃药病也，富贵之家，尤易犯此，曾屡屡言之，以为以药饵调养者成。
水停不寐
不寐之病，厥有数端：食积则消导；水停则逐水；阴燥则安阴；脾虚则补脾；阳盛则敛阳。实证多而虚证少，治之极当分别。
余读书于城东之三道河，有友人李君香泉年四十许，未博一衿。素嗜茶，自早至晚，约饮茶数十碗。见炉鼎热沸，则喜形于色。久之面乏血色，食量减少。每至秋初，则彻夜不寐，天明益渴。一日由家至塾，携丸药来，朝夕服之。又常蓄熟枣仁一囊，不时咀嚼。余问何故?则谓医家云，枣仁能安神，苦不寐，故常嚼之。问服何药？则因不寐请医士习天主教者，名王凝泰，令服人参归脾丸，谓是读书劳心，心血亏损所致。余曰，药效否?香泉曰，并不见效，然尚无害。余请一诊，则脉多弦急。告香泉曰，此水停不寐，非血虚不寐也。就枕则心头颤动胸胁闷胀，小便不利，时时发渴，乃有余证，宜逐水则寐自安。若以归脾丸补之，久而水气上蒸，恐增头昏呕吐，年老恐成水肿。香泉曰，是是。急请一治。余以茯苓导水汤付之，二更许，小便五六次，启衾而卧，则沉沉作梦语曰，好爽快。须臾转侧至明始觉，则遗尿满席，被幞如泥，而饮自此少，食自此进。命常服六君丸以健睥胃。香泉逢人说项焉。
食积作吐
里中庞守愚茂才之子，年四岁，忽患痛，浑身发热，见食作吐，汗出不止，已昏昏不知人。庞以训蒙在外，其家乏人经纪，听之，病增甚，乃转人求余治。往而问之，则以未出天花，邻媪以西河柳、胡荽等发之。提其腕，则脉颇弦大。问饮食乎?曰；不食数日，且见食则吐，即粥不进矣。问二便乎？曰，小便赤如血，大便绝无。按其腹胀甚，按胸则张口作痛状。乃告曰，此停食也，不下之，何能愈。乃以平胃散加芩连大黄以进，服后时许，下黑粪数粒，又下赤色粪数次，腹减而醒。又视之，则脉已小，惟胃气尚滞，又用保和丸加槟榔末而进之，晚即呼食，其母以蒸馒头付之，狂啖数口，三更后，病复发矣。次早又请治，得其状，乃责其母曰，小儿何知，食积甫去，顿令食面，恐新积较旧积难去也。仍令服平胃散，重用莱菔籽投之，嘱曰，不必再看，一月内谨忌食面，只可以米粥调之，若再发，则不治矣。其母惭而听之。多方调摄，适值中秋，共父酒肉致谢，余以文字交固却之。
风寒暑热，饮食劳倦，内因外因，病各有一定之征，一定之脉。惟痰之为病，奇奇怪怪，实有千变万化之势。凡不可名状，无从考核者，大抵皆痰为之也。
【背景信息】
书名：醉花窗医案 章节：正文(6/9) 类别：医论
戊午年秋天，张七兄亲家的夫人（即前文患喉痛者的婆婆），四十岁不到，得了血崩病。她家富甲一方，因为距离县城很远，担心突发疾病时医药不便，于是家里开了药店。乡里的贫苦百姓，都去那里请她看病。因此她也时常翻阅医书。因夫人患血崩，自己用了血余散止血，效果不大。后来换了一位医生，又认为是热证，用寒凉药清热，病情反而加重。于是嘱咐张某恳求我治疗，我以路远推辞，但张某再三哀求，不得已，便随他去了。进去一看，见病人面色如石灰，嘴唇和手指皆白，知道是极度血虚。诊其脉象，微弱得厉害。我说：“这是中气下陷，脾虚不能统摄血液，所以崩漏不止。再服寒凉药恐怕会导致血脱。此时不宜峻补，只需提升其中气。气能统血，崩漏自然停止。收敛固涩、强行截断都不是正确的方法。”于是开具补中益气汤。宋姓医生似乎嫌此方平平无奇。我便告诉他：“您读过医书，没听过士材先生的话吗？他说：‘补气有行血之功，补血无行气之理。’这两句话非常明确。可见血随气行，气升则血升，气降则血降。如果不摄气而只止血的，这叫扬汤止沸。现在提升气机，使气能摄血而不下降，然后再用圣愈汤、养荣汤之类补其虚损，气血调和，甚至可以受孕，治病只是余事罢了。”宋医生豁然开朗，连连点头称是。我又给他开大剂量的圣愈汤，告诉他说：“服用补中益气汤不到四帖，血应当会止住，之后用圣愈汤接续治疗。如果怕麻烦，可以把汤剂改为丸剂。我回去了，不必再来看诊了。”回去没过几天，正值春夏之交，宋医生派人挑来两株牡丹送给我。并说病已痊愈。再三表示感谢。我收下种在盆里，培植灌溉，因为我们家乡水土含有盐卤，性质极恶劣。除了石榴、葡萄之外，所有花果都不适合这种水。宋医生送的牡丹，来时正含苞欲放，我派人灌溉，没过几天，花苞枯萎，枝条渐渐干枯，拔出来扔掉，心中十分惋惜。
妇人经闭这一症状，原因很多。而且各有虚实之分。审察其实证而攻伐它，观察其虚证而补益它。偶尔一不慎，招致祸患尤其迅速。
友人王福友的妻子，年轻时因贫寒导致痞疾，嫁给王家几年，面黄肌瘦，月经不来，或者量少色淡，时间久了腹痛加剧且腹部胀大。请医生诊治，看她的形症，都认为是虚证，用补法无效，而王某本来粗鲁质朴，也就听之任之。半年后腹大如鼓，看见食物就吐，逐渐发展到卧床不起，才邀请我去治疗。诊其六脉坚大而迟，知道是寒凝食积。问：“胃中按压有硬块吗？”病人说：“是的。”我说：“这是自幼吃生冷风寒伤了胃气，所以严重时疼痛加剧，且四肢发冷，这是虚人患实证。不温胃以散结，那么气凝滞而血必闭阻，难怪补益反而加重病情。”于是用五积散投药，服两帖后腹部稍舒。又用香砂平胃散合乌药散并用。有个邻居平时看医书，见到处方惊讶地说：“病属经闭，治疗应当行血，却用消食的药物，这难道不是非法吗？”我说：“您自己不信，看看服药后的疗效如何。”王某让妻子服药，过了两天排出了秽物，腹部膈膜顿时舒畅。又命令常服香砂养胃丸，二十多天后月经来了。
邻居请教其中的缘故，我说：“人身的气血，相互依存而行。如果置气于不顾而只调理血，肯定没有疗效。况且人以胃气为主，是一身生化之源，而胃经多气多血，气舒则血行；气结则血滞，气热则血凝；气寒则血少。前人调经诸方，调理血无非是调理气。如今王某的妻子，气被寒食凝滞，所以血也不行，并非血本亏虚。如果用四物汤等类血药，大多性凉，反而阻碍胃气，更加不行。现在用祛寒消食的药物投治，气温则行，食消则通。气行而通，血不通的，是没有的事。”听者连连点头，凡有疑问，就向我质问。
又是邻居李寿昌的妻子，四十多岁，忽然患经闭，她丈夫素务农，日用颇窘迫，兼无酒德，醉后辄加诟厉，妻子久而郁结，遂成病。适逢夏天阴雨，李突然踏泥而来。我问为什么？他说：“家人病重，打算请诊视，我问什么病？他说：‘经闭几个月了，这时腹中胀痛，饮食不下，大家都以为是蛊毒。请看一看，如果真的不可治，也听之任之。’我问身体肿吗？他说：‘不肿。’我说：‘不肿就不是蛊毒。’问痛多还是胀多？回答说：‘痛有止时，胀则时时如此，几乎大便不利。’我说：‘这是气滞碍血，无须诊脉，只要服药三四付，病就会好。’李说：‘不如诊一下脉，较为稳当。’我说：‘这病显而易见，何必诊脉，你无非希望病好，只要能治好，何必诊呢。’于是处以本事琥珀散（方：三棱、赤芍、刘寄奴、丹皮、熟地、蒲黄、当归、官桂、菊花、莪术等），命服四付。李拿着走了，我也忘了这事。到了中秋晚餐无事，我在田间巡行，李突然从禾黍中拿着镰刀出来叩首，我惊讶地问为什么？回答说：“内人服您的药一付，即胸膈雷鸣下气而胀减，再服之，病全失矣。”我认为病已好，不必再服，至今月经正常，饮食壮健，真是仙方啊。因为农忙没能去叩谢，现在遇到您，敢申意也。我笑着扶他起来，说着麻问稷，日暮而归。
论绵山血见愁
绵山是我们介休的一大景观，峰峦秀美，洞壑幽深，而抱腹崖、蜂房泉尤为奇绝。夏秋间游人如织，山上产奇花异草、药材尤多，绵黄芪、汾甘草，载在本草，传之古今，卓然不朽。可惜介休人性不辨药，甘草尚有土人掘而市之，我却无采之者矣。其高山之阴，产一药，名“血见愁”，土人游绵者，辄携以归，治血症，无不奇效。我家常藏之。其枝杆类枯蒿，味色极其平淡。
我十岁后，得便血疾，更数十医无效。有老农以此药遗之，煎而当茶饮，不数日，血竟止。后服理脾药廿日遂瘥。乃珍视之。
后邻人有患吐血者，以少许服之，吐亦止。庚申秋，内人产后血晕，诸药无效，忽忆此药，服之遂醒。越数日，余在县署谈及此药，适比部刘麟甫在座，请曰：“亲患吐血数月矣，参茸服斤许，而血不止，君盍赐一撮。”乃封寄两许，数日而愈。又县幕钱席宾季刚先生之侄媳，产后血晕、百药无效，季刚已为置殓具矣，余以此药遗之亦愈。后与邻里谈及，凡得此药治血晕，无不愈。故妇人又呼为血晕草。
余以此药名问之药肆，持出，则自禹州来者，形类赤首乌，绝非绵产。后遍翻本草，亦无载此药者。因思奇才异品，护世无穷，而味不经神农之口，品不列金匮之书，遂至淹没深山穷谷，医林无知之者，亦此物之不幸也。噫！独血见愁也乎哉！附志于此，以补本草之缺，有心者，幸勿忽焉。
天花逆证
邻居赵楚仁，天津典商也，家小康而妇甚悍，生数女一男，极锺爱之。戊午夏，其五女，年六七岁，发天花。遣人邀余视之，见其形密如蚕种，平板细碎，几乎遍体。而口唇外，尤环绕无隙，且手足发厥，饮食不进。问几日？曰：“两日矣。”余曰：“发热否？”曰：“不甚发热。”问二便如常否？曰：“大便溏，小便过多。”告曰：“痘症发热，三朝自头至足，渐次见点，须颗粒分明，形色红润，饮食二便如常方好。今令嫒之痘，不两日一齐拥出，且形色、饮食、二便如此，兼带锁口，真逆症也，恐治亦不效。”其妇嫌余言唐突，语涉怨怼，其夫目怒之，乃止，余曰：“来看病非生气，请待以十日，果有能治之者，余当师之，拂衣欲出。”其夫力求一方，乃以升麻葛根汤加参芪付之曰：“此敷衍法也。”赵服之，越日而痘稍起，急遣人告余曰：“痘有转机，可再视之。”余力却之，赵似怨余，乃请他医。不十日，痘靥而毙。其家乃信余言，后遇赵于街，长揖作谢。余曰：“病不能治，何谢为？”赵曰：“早听君言，可省药钱数贯。”余曰：“此亦有定数，不费此钱，恐不殁也。”赵含泪而去。
小儿乳积
东邻李喜阳，与余往来甚契，庚申秋生一女，其夫人乳素壮，凡子女幼时，无不肥健。一日余至其家，见所生女昏睡不醒，喉中如锯，问何病？李曰：“不知何故，早来忽得此疾，乳之不哺，二便亦闭，腹大如鼓，定是急惊，恐不救。”余曰：“何至如此。”扪之浑身发热作汗，胸膈高起。告曰：“此乳积也，下之可愈。”李之表兄梁某、在李之前设药肆，命取笔研。开白玉饼方，急令取药捣而灌之，两刻许，胸间漉漉作声，下秽物数次，汗止热退，醒而啼矣。乳之似甚饿，告曰：“寄语夫人乳须从容，勿令过急，且乳必坐起，切忌卧乳，永无此疾。”其夫人闻之而笑。问何故？则前夕卧乳半夜之所致也。李痛戒之。
气郁成痰
医士郭梦槐之妻，以家道式微，抱郁而病，发则胸隔满闷，胃气增痛，转侧不食。郭以茂才设童蒙馆，而赀不给馔粥，见其妻病，以为虚而补之。病益甚。乃来求余，诊其六脉坚实，人迎脉尤弹指，因告之曰：“此气郁而成痰也，则发头晕，且增呕逆，久而胃连脾病，恐成蛊。”郭求一方，乃以香砂平陈汤加大黄、枳实以疏之，二服而大解，病若失矣。
误用失笑散致死
心胃痛一证，内经条目甚多，先辈名公，分为九等，极为详尽，金鉴遵之，编为歌诀而莫不有虚实之分，可谓无遗蕴矣。
曾忆邻村有医士姓王名维藩者，余同谱弟丹文茂才之族叔也，故业医，货药饵，邻有妇人病胃痛者请王治之，王用海上方中失笑散，服之立效。后凡有患心胃痛者，王辄以失笑散治之，效否各参半。王素食洋烟，一日自觉胃痛，亦自取失笑散服之，痛转甚，至夜半痛欲裂，捣枕椎床，天未明寂然逝矣。
因思失笑散为逐瘀之药，王之邻妇必因瘀血凝滞，故用之立效。其余风寒暑热、饮食气郁，皆能致之，若概以失笑散施治，又不求其虚实，几何不误人性命乎。
王用失笑散不知曾杀几人，故己亦以失笑死，殆冥冥中之报也。业医者，可不多读群书，以求其是乎。
里中相周庞兄之母，年五十余，得吐食症。始以为霍乱，吃塘西痧药数粒，吐如故。又请一医以为气郁，用四七散开之，仍如故。庞求余治，余细问形症，即非霍乱，亦非气郁。按其脉，则右关弦甚，余各平平，乃顿悟曰：“此水积也。病必小便不利，好饮水，胸膈闷滞，时兼头晕，”病者点头称是。因以五苓散加苍术、木通利之，越日吐止。庞又请视，告曰：“不必再视，但常服香砂六君子丸，不但不能停水，且大益于脾胃，于老人甚相宜也。”庞遵之，其母遂健。
审证与慎药
治病之道，如钥之启锁，无论显然相反，即相近者，辨之不明，治之不当而亦无效验。其间毫厘之差，千里之谬，如痰之与饮，皆水也，而有阴阳之分。温之与热，皆火也，而有微甚之别。其间或虚、或实、在腑、在脏，尤须详审。审之奈何？形、气、脉、证是也。合而参之，断无背谬。俗医知有心肝脾肺肾。而置六腑于不问，不知人生全以胃气为主，胃气盛，则脏腑皆盈，胃气衰则脏腑皆败。不但饮食谷气，全凭胃经生发，即病者服药，亦先入胃腑，而后达于它脏，故曰：“得胃者生。”又诊脉以胃气为验。然则胃者生死之关也，不明乎此，而能达精妙者，未有也。且一病只有一法，故余治病未尝私自立方，所开皆古人成方，又不敢妄为增减。每见病者粗识字，则厌故喜新、求日易方药，不知药之为物，非五谷平和之气，利此则害彼，医士用之不当，必有诛伐无过之虑。久之，胸中混淆。病者非病病，乃药病也，富贵之家，尤易犯此，曾屡屡言之，以为以药饵调养者成。
水停不寐
不寐之病，厥有数端：食积则消导；水停则逐水；阴燥则安阴；脾虚则补脾；阳盛则敛阳。实证多而虚证少，治之极当分别。
余读书于城东之三道河，有友人李君香泉年四十许，未博一衿。素嗜茶，自早至晚，约饮茶数十碗。见炉鼎热沸，则喜形于色。久之面乏血色，食量减少。每至秋初，则彻夜不寐，天明益渴。一日由家至塾，携丸药来，朝夕服之。又常蓄熟枣仁一囊，不时咀嚼。余问何故？则谓医家云，枣仁能安神，苦不寐，故常嚼之。问服何药？则因不寐请医士习天主教者，名王凝泰，令服人参归脾丸，谓是读书劳心，心血亏损所致。余曰：“药效否？”香泉曰：“并不见效，然尚无害。”余请一诊，则脉多弦急。告香泉曰：“此水停不寐，非血虚不寐也。就枕则心头颤动胸胁闷胀，小便不利，时时发渴，乃有余证，宜逐水则寐自安。若以归脾丸补之，久而水气上蒸，恐增头昏呕吐，年老恐成水肿。”香泉曰：“是是。”急请一治。余以茯苓导水汤付之，二更许，小便五六次，启衾而卧，则沉沉作梦语曰：“好爽快。”须臾转侧至明始觉，则遗尿满席，被幞如泥，而饮自此少，食自此进。命常服六君丸以健睥胃。香泉逢人说项焉。
食积作吐
里中庞守愚茂才之子，年四岁，忽患痛，浑身发热，见食作吐，汗出不止，已昏昏不知人。庞以训蒙在外，其家乏人经纪，听之，病增甚，乃转人求余治。往而问之，则以未出天花，邻媪以西河柳、胡荽等发之。提其腕，则脉颇弦大。问饮食乎？曰：“不食数日，且见食则吐，即粥不进矣。”问二便乎？曰：“小便赤如血，大便绝无。”按其腹胀甚，按胸则张口作痛状。乃告曰：“此停食也，不下之，何能愈。”乃以平胃散加芩连大黄以进，服后时许，下黑粪数粒，又下赤色粪数次，腹减而醒。又视之，则脉已小，惟胃气尚滞，又用保和丸加槟榔末而进之，晚即呼食，其母以蒸馒头付之，狂啖数口，三更后，病复发矣。次早又请治，得其状，乃责其母曰：“小儿何知，食积甫去，顿令食面，恐新积较旧积难去也。”仍令服平胃散，重用莱菔籽投之，嘱曰：“不必再看，一月内谨忌食面，只可以米粥调之，若再发，则不治矣。”其母惭而听之。多方调摄，适值中秋，共父酒肉致谢，余以文字交固却之。
风寒暑热，饮食劳倦，内因外因，病各有一定之征，一定之脉。惟痰之为病，奇奇怪怪，实有千变万化之势。凡不可名状，无从考核者，大抵皆痰为之也。
In the autumn of the Wumu year, the wife of Mr. Zhang Qi's relative (who was also the mother-in-law of the patient with throat pain mentioned earlier), aged under forty, suffered from metrorrhagia (uterine bleeding). Her family was the wealthiest in the township. Because they lived far from the county town and feared sudden illnesses would make medical care inconvenient, they established a pharmacy at home. Poor villagers from the countryside often came there to consult her. Thus, she frequently read medical books. When the lady suffered from metrorrhagia, she used Xueyu San (Hair Ash Powder) to stop the bleeding with little effect. A subsequent physician diagnosed it as a heat syndrome and prescribed cold-natured herbs to clear heat, which aggravated the condition. Consequently, she instructed Mr. Zhang to earnestly request my treatment. I declined due to the long distance, but after Mr. Zhang pleaded repeatedly, I reluctantly accompanied him. Upon entering, I saw the patient's face was ashen like lime, and her lips and fingers were white, indicating extreme blood deficiency. Her pulse was extremely weak and thready. I said, "This is sinking of the Middle Qi, and Spleen deficiency failing to control the blood, hence the continuous bleeding. Continuing with cold-natured herbs risks blood collapse. At this stage, drastic tonification is not suitable; instead, we should raise the Middle Qi. Since Qi controls Blood, the bleeding will stop naturally. Astringents or methods to forcibly cut off the bleeding are incorrect." Therefore, I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Physician Song seemed to think this prescription was mediocre. I told him, "Have you read medical texts? Have you not heard Master Shicai say: 'Tonifying Qi has the function of moving Blood, but tonifying Blood lacks the principle of moving Qi'? These two sentences are very clear. It shows that Blood follows Qi; when Qi rises, Blood rises; when Qi descends, Blood descends. If one does not secure the Qi but merely tries to stop the bleeding, it is like stirring boiling water to stop it from boiling. Now, by raising the Qi, we enable it to control the Blood and prevent it from descending. Subsequently, we can use formulas like Shengyu Tang (Holy Salvation Decoction) or Yangrong Tang (Nourish the Vigor Decoction) to tonify the deficiency. Once Qi and Blood are harmonized, conception may even become possible; curing the disease becomes secondary." Physician Song suddenly understood and nodded several times in agreement. I then prescribed a large dose of Shengyu Tang, telling him, "After taking less than four doses of Buzhong Yiqi Tang, the bleeding should stop. Then continue with Shengyu Tang. If decoctions are too troublesome, they can be changed into pills. I am leaving now; no need for further consultations." Not long after returning, around the transition between spring and summer, Physician Song sent someone to bring me two peony plants as a gift, stating that the patient had recovered. He expressed his gratitude repeatedly. I planted them in pots and cultivated them. However, our local soil and water contained saline alkali, which was extremely detrimental. Except for pomegranates and grapes, all flowers and fruits did not thrive in this water. The peonies sent by Mr. Song were just budding when they arrived. After I had them watered, within a few days the buds withered and the branches gradually dried up. I pulled them out and discarded them, feeling great regret.
**Food Stagnation Amenorrhea**
Amenorrhea in women has many causes, each having excess or deficiency patterns. One must examine the excess pattern and attack it, observe the deficiency pattern and tonify it. Carelessness can lead to rapid disaster.
The wife of my friend Wang Fuyou had suffered from abdominal distension since youth due to poverty and cold. After marrying Mr. Wang for several years, she became sallow and emaciated, with absent menstruation, or scanty flow. Over time, abdominal pain increased and distension worsened. Physicians consulted thought it was a deficiency based on her signs and symptoms and prescribed tonics, but to no avail. Mr. Wang, being rough and uneducated, let it be. Half a year later, her abdomen was as large as a drum, she vomited upon seeing food, and eventually became bedridden. Only then did they invite me. Her six pulses were firm, large, and slow, indicating Cold coagulation and Food stagnation. I asked, "Is there a hard mass upon pressing the stomach?" The patient replied affirmatively. I said, "This injury to Stomach Qi from consuming raw/cold foods and exposure to Wind-Cold since childhood causes severe pain and cold limbs in extremities. This is an Excess syndrome in a Deficient person. Without warming the Stomach to dissipate the knot, Qi stagnation will cause Blood closure, explaining why tonification worsens the condition." I administered Wuji San (Five Accumulations Powder). After two doses, the abdomen relaxed slightly. I then combined Xiangsha Pingwei San (Amomum and Pinellia Stabilize the Stomach Powder) with Wuyao San (Lindera Powder). A neighbor who read medical books exclaimed, "The disease is amenorrhea; treatment should move Blood. Using food-resolving agents is illegal!" I said, "You do not believe it; see the effect after taking the medicine." Mr. Wang had his wife take it. Two days later, foul matter was discharged, and the abdominal discomfort instantly relieved. She was then instructed to regularly take Xiangsha Yangwei Wan (Amomum and Pinellia Nourish the Stomach Pills). After twenty-plus days, menstruation returned.
The neighbor asked for the reason. I explained, "Qi and Blood in the human body rely on each other. Ignoring Qi while treating Blood yields no effect. Moreover, the human body relies primarily on Stomach Qi, the source of transformation and production. The Stomach Meridian is rich in both Qi and Blood; when Qi flows freely, Blood moves; when Qi knots, Blood stagnates; when Qi is hot, Blood coagulates; when Qi is cold, Blood diminishes. Past prescriptions for regulating menstruation essentially regulated Qi. In Mrs. Wang's case, Qi was stagnant due to Cold and Food, causing Blood stagnation, not primary Blood deficiency. Formulas like Siwu Tang are mostly cooling and hinder Stomach Qi, making Blood movement worse. Now, using herbs to dispel Cold and resolve Food warms the Qi and clears the obstruction. With Qi flowing and obstruction cleared, Blood stagnation without resolution is impossible." Listeners nodded repeatedly and questioned me whenever doubts arose.
**Qi Stagnation Amenorrhea**
The wife of neighbor Li Shouchang, over forty, suddenly developed amenorrhea. Her husband was a farmer living in poverty and lacked moral restraint regarding alcohol; he abused her when drunk. Long-term depression led to illness. During a rainy summer day, Li arrived through the mud. I asked the reason. He said, "My family member is critically ill, intending to ask for a consultation." I asked what the illness was. He said, "She has been amenorrheic for months. Currently, she has abdominal pain and distension, cannot eat, and everyone thinks it is Gu poison (parasitic disease). Please look; if truly incurable, we will accept it." I asked if she was swollen. He said, "No." I said, "If not swollen, it is not Gu poison." I asked if pain or distension predominated. He replied, "Pain comes and goes, but distension is constant, almost causing constipation." I said, "This is Qi stagnation obstructing Blood. No need to check the pulse; three or four doses of medicine will cure her." Li said, "Checking the pulse is safer." I said, "The disease is obvious; why check the pulse? You only wish for recovery; if cured, why bother with a pulse diagnosis?" I prescribed Ben Shi Hupo San (Amber Powder from Essential Abilities) containing Sanleng (Sparganii Rhizoma), Chishao (Radix Paeoniae Rubra), Liu Jinu (Herba Siegesbeckiae), Danpi (Cortex Moutan), Shudi (Rehmanniae Radix Preparata), Puhuang (Pollen Typhae), Danggui (Angelicae Sinensis Radix), Guanzi Gui (Cinnamomi Ramulus), Juhua (Flos Chrysanthemi), Ezhu (Curcumae Rhizoma), etc., instructing four doses. Li left, and I forgot about it. On Mid-Autumn Festival evening, while walking in the fields, Li suddenly emerged from the crops holding a sickle and kowtowed. I asked surprisedly why. He replied, "My wife took your medicine once, and immediately felt rumbling in the chest/diaphragm, passing gas, and distension reduced. After the second dose, the illness completely disappeared." I believed the disease was cured and no further medication was needed. Her menstruation remained regular, and her diet and health were robust; it was truly a miraculous formula. Due to farm work, I couldn't visit to thank him properly. Now meeting you, I dare express my feelings. I smiled and helped him up, chatting about hemp and millet until dusk before returning.
**Discussion on "Blood Seeing Sorrow" from Mianshan**
Mianshan is a grand sight in Jiexiu, with beautiful peaks and deep caves, particularly Bao Fu Cliff and Beehive Spring. Tourists flock there in summer and autumn. The mountain produces rare flowers, grasses, and medicinal materials, including Mian Huangqi (Astragali Radix) and Fen Gancao (Glycyrrhizae Radix), recorded in Materia Medica, immortal throughout history. Unfortunately, people in Jiexiu do not distinguish herbs; although locals dig and sell Gancao, no one harvests mine. On the shady side of high mountains grows a herb named "Xue Jian Chou" (Blood Seeing Sorrow). Locals visiting Mianshan take it home; it treats blood disorders with miraculous efficacy. My family kept some stored. Its stems resemble withered mugwort, with a very plain taste and color.
After age ten, I suffered from hematochezia (blood in stool). Dozens of physicians failed. An old farmer gave me this herb; I boiled it and drank it as tea. Within days, the bleeding stopped. After taking Spleen-regulating herbs for twenty days, I recovered. I treasured it thereafter.
Later, a neighbor suffering from hematemesis (vomiting blood) took a small amount, and the vomiting stopped. In the autumn of Genshen year, my wife suffered postpartum syncope due to blood loss; various medicines failed. Suddenly remembering this herb, I gave it to her, and she regained consciousness. Days later, discussing this herb at the county office, Vice Minister Liu Linfu was present. He requested, "My relative has had hematemesis for months. Despite taking jin of Ginseng and Deer Antler, the bleeding continues. Could you grant a pinch?" I sealed and sent two qian. He recovered in days. Also, the niece-in-law of Mr. Qian Xibin Jigang, a clerk in the county office, suffered postpartum syncope; hundred medicines failed. Mr. Jigang had already prepared funeral items. I gave him this herb, and she also recovered. Later, discussing with neighbors, anyone using this herb for postpartum syncope recovered. Thus, women call it "Blood Syncope Grass."
I asked pharmacies about this herb's name. They produced samples from Yuzhou, resembling Chi Shouwu (Polygoni Multiflori Radix Rubra), definitely not local produce. I searched Materia Medica extensively but found no record. I pondered that extraordinary products protect the world endlessly, yet because they were not tasted by Shennong and not listed in the Golden Cabinet, they remain submerged in deep mountains and valleys, unknown to the medical community. This is the misfortune of such substances. Alas! Is it only "Blood Seeing Sorrow"? I record this here to supplement the gaps in Materia Medica. Those interested, please do not ignore it.
**Adverse Syndrome of Smallpox**
Neighbor Zhao Churen, a Tianjin pawnbroker, had a comfortable life but a fierce wife. They had several daughters and one son, whom they loved dearly. In the summer of Wumu year, their fifth daughter, aged six or seven, contracted smallpox. They sent for me. I saw the eruption was dense like silkworm eggs, flat, fine, and scattered, covering almost the entire body. Around the mouth and lips, the rash was continuous without gaps. Extremities were cold, and she could not eat or drink. I asked how many days. They said, "Two days." I asked, "Is there fever?" They said, "Not much." I asked about urination and defecation. They said, "Loose stools, excessive urination." I stated, "Smallpox typically presents with fever; by the third day, spots appear from head to toe, gradually becoming distinct, red, and vibrant. Diet and excretions should be normal. Your daughter's smallpox erupted all at once within two days, with abnormal appearance, diet, and excretions, plus 'locking mouth' (rash around lips). This is truly an adverse syndrome; even treatment may fail." His wife found my words abrupt and resentful; her husband glared at her to stop. I said, "Consulting is not for anger. Wait ten days. If there is indeed a cure, I will learn from them," and prepared to leave. Her husband begged for a prescription. I prescribed Shengma Gegen Tang (Cimicifugae and Puerariae Decoction) added with Renshen (Ginseng Radix) and Huangqi (Astragali Radix), saying, "This is perfunctory." Zhao took it. The next day, the pustules rose slightly. He urgently sent word, "There is a turning point; please consult again." I declined. Zhao seemed resentful and hired another physician. Within ten days, the scabs formed, and she died. The family then believed my words. Later, meeting Zhao on the street, he bowed deeply in thanks. I said, "The disease was incurable; why thank me?" Zhao said, "Had I listened to you earlier, I could have saved several strings of cash for medicine." I said, "This is also destiny. Had you not spent this money, perhaps she would not have died." Zhao left with tears.
**Infant Milk Accumulation**
East neighbor Li Xiyang was close friends with me. In autumn Genshen year, his wife gave birth to a daughter. The wife had abundant milk, and all her children were healthy in infancy. One day I visited and saw the newborn sleeping昏unrously, with a rattling sound in the throat like a saw. I asked the illness. Li said, "I don't know why, she suddenly got this illness early today. She refuses to nurse, urination and defecation are blocked, abdomen is large as a drum. It must be acute convulsion; I fear she won't survive." I said, "How could it be so serious?" Palpating her, she had whole-body fever and sweating, with high chest and diaphragm. I said, "This is Milk Accumulation. Purging it will cure her." Li's cousin Liang, who previously ran a pharmacy near Li, fetched pen and ink. I prescribed Baiyu Bing (White Jade Cake) formula. Urgently, medicine was taken, pounded, and administered. In about thirty minutes, gurgling sounds were heard in the chest, and foul matter was discharged several times. Sweating stopped, fever subsided, and she woke up crying. She seemed very hungry when nursing. I advised, "Tell your wife to nurse calmly, not too hurriedly. Nursing must be done sitting up; lying down to nurse is strictly forbidden, preventing this disease forever." The wife laughed. I asked why. It turned out she had nursed lying down halfway through the previous night. Li severely warned her.
**Qi Depression Transforming into Phlegm**
The wife of physician Guo Menghuai fell ill with depression due to declining family fortune. Attacks involved chest and diaphragm fullness, increased Stomach Qi pain, inability to turn over or eat. Guo, a scholar running a primary school, had insufficient funds for food. Seeing his wife's illness, he thought it was deficiency and tonified her. The illness worsened. She came to seek my help. Her six pulses were firm and solid, especially the Renying pulse (ST9) beating against the finger. I told him, "This is Qi depression transforming into Phlegm. It causes dizziness and increased vomiting. Over time, Stomach affects Spleen, risking Gu poisoning." Guo requested a prescription. I prescribed Xiangsha Pingchen Tang (Amomum and Pinellia Stabilize the Stomach and Resolve Phlegm Decoction) added with Dahuang (Rhei Radix et Rhizoma) and Zhishi (Aurantii Fructus Immaturus) to drain and disperse. After two doses, there was a large bowel movement, and the illness seemed gone.
**Fatal Misuse of Shixiao San**
Heart and Stomach pain syndromes are detailed in the Neijing, categorized into nine types by ancestors, thoroughly documented in Jinjian (Imperial Medical Repository) with songs distinguishing excess and deficiency, leaving nothing omitted.
I recall a physician named Wang Weifan from a neighboring village, a clan uncle of my cousin Dan Wen. He practiced medicine and sold herbs. A neighbor woman with stomach pain consulted Wang. Wang used Shixiao San (Painless Laugh Powder) from maritime formulas, which worked immediately. Thereafter, whenever patients had heart/stomach pain, Wang used Shixiao San. Effectiveness was mixed. Wang smoked opium. One day, he felt stomach pain himself and took Shixiao San. The pain intensified. By midnight, the pain was splitting; he beat his pillow and bed. Before dawn, he passed away silently.
Reflecting, Shixiao San is a blood-stasis expelling drug. Wang's neighbor likely had stasis, hence immediate effect. Other causes like Wind-Cold, Summer-Heat, Heat, Food, and Qi depression can also cause it. If one indiscriminately uses Shixiao San without distinguishing excess/deficiency, how many lives might be lost? Wang used Shixiao San unknowingly killing several; thus, he died by it. Perhaps it is retribution from the unseen. Physicians should read widely to seek truth.
**Water Accumulation Vomiting Food**
Mother of Pang Xiongxiang in the village, over fifty, suffered from vomiting food. Initially thought to be cholera; ate Tangle Xi Sha Medicine (Sha Poison Medicine), vomiting continued. Another physician diagnosed Qi depression, used Siqi San (Four Seven Powder) to open Qi, still no change. Pang sought my treatment. I carefully asked signs and symptoms. It was neither cholera nor Qi depression. Palpating the pulse, the Right Guan position was extremely wiry, others normal. Suddenly realizing, I said, "This is Water Accumulation. Symptoms must include difficult urination, desire to drink water, chest/diaphragm stuffiness, occasional dizziness." The patient nodded. I prescribed Wuling San (Five Ling Powder) added with Cangzhu (Atractylodis Rhizoma) and Mutong (Akebiae Caulis) to promote urination. The next day, vomiting stopped. Pang asked for follow-up. I said, "No need to revisit. Regularly take Xiangsha Liujunzi Wan (Amomum and Pinellia Six Gentlemen Pills). It not only stops water accumulation but greatly benefits Spleen and Stomach, suitable for the elderly." Pang followed advice, and his mother recovered.
**Examining Signs and Cautious Medication**
Treating disease is like unlocking a lock. Whether obviously opposite or similar, unclear differentiation leads to improper treatment and ineffectiveness. A millimeter's difference results in a thousand miles' error. For example, Tan (Phlegm) and Yin (Fluid) are both water but differ in Yin/Yang. Wen (Warmth) and Re (Heat) are both fire but differ in degree. One must carefully examine whether it is Deficiency or Excess, in Fu organs or Zang organs. How to examine? Through Shape, Qi, Pulse, and Signs. Combining them ensures no contradiction. Vulgar physicians know Heart, Liver, Spleen, Lung, Kidney but ignore the Six Fu organs. They do not know life depends entirely on Stomach Qi. Strong Stomach Qi fills all organs; weak Stomach Qi ruins all organs. Not only does dietary energy rely on Stomach Meridian generation, but medicines ingested by patients first enter the Stomach Fu before reaching other organs. Hence, "Those who gain Stomach Qi live." Pulse diagnosis also verifies Stomach Qi. Thus, Stomach is the gate of life and death. Without understanding this, achieving subtlety is impossible. Each disease has one method. I never arbitrarily create prescriptions; I use ancient established formulas and dare not add/subtract recklessly. I often see patients who can read slightly despise old formulas, preferring new ones daily. They do not know drugs are not mild grains; benefiting one harms another. Improper use by physicians risks punishing the innocent. Over time, confusion arises in the chest. Patients do not suffer from disease but from medication errors. Wealthy families are prone to this. I have stated this repeatedly. Recovery through careful medication management is key.
**Water Retention Insomnia**
Insomnia has several causes: Food stagnation requires digestion; Water retention requires draining; Yin dryness requires nourishing Yin; Spleen deficiency requires tonifying Spleen; Yang hyperactivity requires restraining Yang. Excess patterns are more common than deficiency; treatment must distinguish clearly.
I studied at Sandaohe east of the city. Friend Li Xiangquan, around forty, had not passed the imperial exam. He loved tea, drinking dozens of bowls daily. He enjoyed watching the kettle boil. Over time, his face lost color, appetite decreased. Every early autumn, he suffered insomnia all night, thirst increasing at dawn. One day, bringing pills to school, he took them morning and night. He also chewed cooked Zao Ren (Ziziphus Jujubae Semen). I asked why. He said doctors claimed Zao Ren calms the spirit; suffering insomnia, he chewed it. I asked what medicine he took. He said, seeking a doctor practicing Catholicism named Wang Ningtai for insomnia, who prescribed Renshen Guipi Wan (Ginseng Spleen-Tonifying Pills), attributing it to mental labor and Heart-Blood deficiency. I asked effectiveness. Xiangquan said, "No effect, but harmless." I checked his pulse; it was mostly wiry and rapid. I told Xiangquan, "This is Water Retention Insomnia, not Blood Deficiency Insomnia. Lying down causes heart trembling, chest/hypochondriac distension, difficult urination, and thirst. These are Excess signs. Draining water will ensure sleep. If tonified with Guipi Wan, long-term water Qi steaming upward may increase dizziness and vomiting; in old age, edema may result." Xiangquan agreed and urgently sought treatment. I prescribed Fuling Daoshui Tang (Poria Draining Water Decoction). Around second watch, he urinated five or six times. Lifting the quilt to sleep, he murmured in dreams, "So refreshing." Turning over until dawn, he woke to find urine soaking the sheets and blankets muddy. From then on, drinking decreased, eating improved. I ordered regular Liu Jun Zi Wan to strengthen Spleen and Stomach. Xiangquan praised me to everyone.
**Food Stagnation Vomiting**
Son of Pang Shouyu, a scholar in the village, aged four, suddenly had pain, whole-body fever, vomiting upon seeing food, profuse sweating, and unconsciousness. Pang was teaching outside; lacking household management, they let it be. Illness worsened, so they sought me. Asking details, I learned he hadn't had smallpox. A neighbor aunt tried to erupt it with Xihe Liu (Salix Capreae Ramulus) and Huisui (Coriandri Fructus). Pulsing the wrist, it was wiry and large. I asked about diet. They said, "No food for days; vomiting upon seeing food, even rice gruel refused." Asked about excretions. They said, "Urine red as blood, no stool." Pressing the abdomen, it was very distended; pressing the chest caused pain expression. I said, "This is Food Stagnation. Without purging, how can it heal?" I prescribed Pingwei San (Stomach-Stabilizing Powder) added with Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), and Dahuang (Rhei Radix et Rhizoma). After an hour, black feces were passed, then red feces several times. Abdomen reduced, and he woke. Pulse was smaller, but Stomach Qi still stagnant. I prescribed Baohe Wan (Preserve Harmony Pill) added with Betel Nut powder. Evening came, he called for food. Mother gave steamed buns; he ate greedily. After third watch, illness recurred. Next morning, consulting again, I blamed the mother, "How can a child know? Food stagnation just cleared, immediately feeding noodles/wheat. New stagnation is harder to clear than old." Ordered Pingwei San again, heavily using Laifu Zi (Raphani Semen), advising, "No need to revisit. Strictly avoid wheat/noodles for a month; only rice gruel. If it recurs, it is untreatable." Mother listened ashamed. Through various care, coinciding with Mid-Autumn, they thanked me with wine and meat. I declined due to literary friendship.
**Damp-Phlegm Flowing and Accumulating**
Wind, Cold, Summer-Heat, Heat, Food, and Fatigue have internal/external causes with fixed signs and pulses. Only Phlegm diseases are strange, possessing thousands of transformations. Anything indescribable and unverifiable is largely due to Phlegm.