同年李友兰，亦精医理。辛亥秋在会垣闲寓，得痛病，或手或足，或头或腹，或腰或胁，发无定时，亦无定处。自以为痹病，用续命汤不效。又以为寒，用麻黄汤亦不效，一日与余闲淡，告余曰：弟病实不可测。余请一诊，则缓而滞，乃告友翁曰：君之病乃湿痰流注也。欲再言，友兰顿悟曰，不差！不差！余已知之，君破题下文我自作也。相与一笑。越两日，病良已。问服何药，友兰曰：箇中人岂烦明言、君试言何药。余曰，不过二陈汤加苍术、姜黄、羌活、独活也。友兰出方示之，种种不谬。石虞琴广文在座，叹曰，二公可谓心心相印矣。
又司徒芝邻方伯藩秦时，体素肥。时各省提拔军饷，员弁充集会垣，而库款支绌，芝翁忧形於色。至夏，得痴呆病。坐卧不安，时而独言独语，时而浑身痒搔。又合眼则睡，睡则梦二鬼在前：一自缢者，索挂於项；一无首者，以手提头，发蓬蓬，血模糊。以是，不能独卧，不接属员者十余日。延医治之，皆曰冤业，恐不起。又易一医，则曰心血亏损，用天王补心丹，饮食顿减，及饬门者请余，余入见，则曰：病至此，恐不能治，但请君决之，果何经受病，须详悉言之，勿隐护也。按其脉，则六部弦缓而滑，寸部浮取尤甚，知是痰证，乃启芝翁曰，大人乃脾湿停痰，又加以劳倦伤脾，心火浮动，以致痰涎绕心包络，故时迷时悟，平时必喜唾痰，唾则胸腹宽舒。此时痰涎停结，必不能唾。且时而发烦，时而动躁，时而口渴，时而心颤并手足，时而二便不利，皆痰为之。芝翁曰：二鬼何物？余曰：二鬼亦神魂烦乱所致，其实无之，大人不必多虑。病虽多端，卑职保能愈也。芝翁喜，问服何药？余曰：大人病非汤药可疗，须先以矾郁丸吐之，次以控涎丹通之，再多服去痰健脾诸药则无虑矣。芝翁急索矾郁丸，余以此药市中多无，乃制而送之。服数粒，则刻许而吐痰絮胶粘，色兼青黑，自谓心境顿开，欲再服，余曰：痰已吐，再服恐伤胃气。继以控涎丹投之。两日后，设便饭邀余，扶杖告余曰，两夜二鬼不见，神气亦清，君之高名实所佩服，敢问不治成何症?余曰，若不治，不癫则痫，甚则成痰厥。其幕友皆来周旋，饭后面归。不数日，余以内艰、闻讣回籍辞丧。至八月，芝翁以官钱案发，奉旨革职。案定，其阍人黄五绞死，就刑之际，芝翁闻之，痰厥而殁于馆。后小梅来书，犹道芝翁之死如君言焉。
黄庚垣先生，江西人，以捐饷奉特旨议叙举人加藩司衔并赏花翎，补西安粮道。道缺甚优，兼家赀优厚，而观察性尚清廉，接下以宽，故属下皆颂之。年五十许，曾患遗精病。观察侍妾数人，幕友有善医者，以为许多姬妾，必致虚损。用三才封髓丹补之，而观察又讲颐养。日食燕窝、东参以调之，然遗精如故。幕友以为已成虚劳，不可救药。
一日午后无事，忽召余至署，且命便服，余急趋命，观察便衣而出，揖而延之上座，余惊问故，观察曰：患遗精数年矣，曾服汤药百余付，丸药数斤，而毫无效。余问饮食何如？观察曰：虽不能多，然尚非不能食者。老夫子以我为虚痨，故不敢多食也。问咳嗽气少、发热自汗乎?曰否。乃告之曰，既无此数者，恐有余症，非不足证也。观察惊曰，遗精尚有实症乎？余对曰，大人未窥医书，兼脾胃虚弱，不特医者不敢以实论，即大人亦自疑其虚也。岂知遗精之由有数端，相火太旺，夜梦失遗，阳必壮健，宜滋之；饮食厚味湿热内淫，则迫而失精，宜销导之；久旷气充，精满而溢，宜疏泄之。此外，中气下陷，清阳不升，则亦遗；色欲过度，心肾不交，则亦遗。又有恐惧暴怒，精窍滑而不涩，皆能致遗。若或坐或卧，无故遗精，则为虚极之症，最为危险。俗医不细求其故，不分虚寒实热，见遗精者，则曰色欲过度也；又曰年少好淫也。致病者，多受不白之冤，而治之多不效。遂归咎于病之不可治，不亦惑乎。
观察蹶然起曰：闻君讲解，无不确当晓畅，心为之开，然则我之遗精绝非虚症，请一视之。乃诊其脉，缓而坚，右关尤甚。告之曰，大人之病，所谓湿热内淫是也。胸膈常患闷滞，大便颇形后重，当消导之。进以震亨渗湿汤。观察阅方内有黄连恐不宜，且厚朴、苍术恐伤胃气。告曰，胃苓汤是湿热要药。平胃散者，培卑监而使之平，非削平之谓也，前辈言之甚明，此方用黄连川芎素亦疑之，细思其理，苦能燥湿用黄连而焦炒之，用其苦非用其凉也。湿热能瘀血，用川芎以行之，震亨此方，具有深意。大人成见在胸，一误岂容再误，他人必谓此方，非治遗之药，岂知治病必求其本，本治而末不治者，未之有也。请放心照服四付，常服香砂六君丸以调之，不但精不遗，即饮食亦当倍也。观察如言服之，五日后，约晚饭，至则告曰，前闻君言甚有理，而心窃疑之，今服君药，遗已止，果觉精神增健，食量亦佳，并阳事亦壮。非君妙达精微，几乎冤我，可见医道无方，在究其理而变通之耳。后余诸蒙奖许，即内艰而归，犹寄函问讯者数四。
诊脉如审案
昔人谓用药如用兵，余尝谓诊脉如审案。其微言妙旨，前辈论之详矣。惟仕才先生四言要诀，简明切当。其云：四时之脉，胃气为本，尤为诊家要着。盖胃气者，脉之神也。所谓神者，极力形容而总归之曰有力。窃谓有力二字，尚不足尽神字之义。盖有力而兼活动，不疾不徐，不软不硬，方是如春风弱柳气象。本此参之，百不失一。审时，有正凶，有左证，有致事之由，有受害之所，有连坐，有挂诬。审之既确，而刑罚之轻重随之。姑就一端言之，如脾湿停痰一证，脉必沉滑。则沉滑者，正凶也。而脾湿必便难，停痰必减食，此左证也。湿或饮水过多则兼弦，劳倦思虑则兼弱，此致事之由也。或因湿而泄泻，或因痰而咳嗽，则泄泻者，右尺必虚；咳嗽者，右寸亦滑，此连坐也。且脾湿者，饮食不能健运，精液必致不充，则左尺必涩，此挂诬也。但识定正凶，健脾销痰，病皆自己。若治泄泻而止之，治咳嗽而清之，则抛却正凶，诛伐无过，必至不能治病，而反增他病也。故用药不过古人成方数十，传之於世，而用之或效或不效者，非笔下之愦愦，实指下之未了了也。
吾尝谓诊脉，须合三部十二脏腑，参考而斟酌之，方有定见。若诊寸而忘尺，诊右而忘左；滑则治其痰，数则去其火，虽有小效，亦难去病，况审之不清，而未必效乎。俟高明斟酌之。
武芝田先生，崞县人，以名进士出宰陕西，后升榆林观察，以榆林地瘠，故在省遥领之。观察素豪於饮，以酒积得吐血疾。余在省候补，一日招余往视其病，谈及其病，观察曰：吐血数年矣，遇郁益甚。已更十数医。或曰思虑伤脾；或曰暴怒伤肝；或曰血热妄行。或效或否，而终未拔其根，可为吾一治也。余见其气体魁伟，面色红润，食饮兼人，知非虚证。为一诊之，则左部沉实，非病脉，右关沉弦而数。乃告曰，大人乃有余病，非不足病也。如思虑伤脾，则当忡怔健忘惊悸；如血热妄行，则当身热发渴，头晕目眩；如暴怒伤肝，则当两胁膨胀，胸膈不开，兼发呕逆。今无此诸证，则前医皆误也。以愚见参之，必是湿热内淫。热能瘀血，故所吐必血色紫黯，且时而成块。胃口多患刺痛，小便常赤，大便艰涩，时亦带血。观察曰，语语不谬，当作何治？余曰：先以葛花解酲汤清其胃，继用枳术胃苓丸行其瘀。再饮食淡泊以调之，不过一月，保不再犯矣。观察如言调摄。廿日而安。后观察内艰归里，以清风两袖，主讲吾汾之西河书院。余亦以内艰归籍。相隔六十里，文字往还甚密。
越数月，余送堂几府试，与观察日日见面。
谈及共如君云，癸水不调，脐腹常疼，精神委顿，饮食不思，偶受孕，三四月辄坠。前在崞，曾服药无数，兹又请教授齐老师治之，又请府幕钱老夫子治之，病仍不愈。皆以为痨矣，请一决之。如君出则荆钗裙布、寒素依然，向余展拜，余答之。诊其脉则六脉俱虚，而无数象，右关尤甚。告观察曰，此乃脾虚土衰之证，故精神少，饮食滞。至月事不调，怀孕辄坠，则中气不能健固之故。极可治。但须积日累月，非旦夕可愈之病也。若迟延不治，则久而泄泻，或久而咳嗽发热，面赤恶寒，真痨症矣。余先进以六君子汤加益智、干姜、芡实，命服八剂后，服资生健脾丸。观察问，丸药服几斤?余曰，多多益善。
后余归介，观察解帐归崞。二年后，在会垣见其长子，问前病状，则曰，迩来体甚壮硕，去年冬，竟举一女，家父犹时时道及而铭感焉。
痰之为病，甚则发厥，无故昏倒，一或误治，便不能起，最为危险。推原其故，大抵多由气郁，以致痰壅胃口，因而不省人事。旧法以三生饮吐之，攻标之急治也。若不壅於胃，而壅於肺，则痰入清道，尤难措手。其证不昏倒，能知人，惟胸膈间气，能出而不能入，时时作反张形，遂至汤水不能下咽，咽则气逆而哮。
里中布贾姓安名溶者，虽作商，人极推重。辛酉夏，其次子岁余而殇；其三女亦以痨症亡於家；未越月，其次女之婿与其甥男，一日间相继亡。其次女年幼，婿之族人恐席卷而他适，置死人於不问，互争产业。安知之，急与愤争，族人乃散，前丧子女，已抱忧郁，后次女事，又增其愤，故归而得胸满腹泻之疾。求余治之，诊其脉，弦而滞。告曰，此气滞水积也。用香砂胃苓丸消之，病早愈，安啬於财，不复服药，余亦忘之。越十余日，急遣人招余视其病，余以为泻之未愈也。急视之，则气格格作逆，口唾不能下咽。问膈与胸中作满否?曰否。提其腕，则两手如冰，六部伏不见，惟有寸带滑数。乃曰，此痰壅肺窍也。肺窍为气所出入，今为痰壅，故气不能入。如在胃，则卒然昏噤，三生饮吐之可也。今在肺管恐吐之不出，无可措手，急辞而出。安固请一方，乃以木香顺气饮敷衍之，出而告其伙曰：安某之病，必不起，可急为料理。其伙尚不信，因循至次早，乃来省视，安已口张气促而不能言矣。其堂兄见其危，又邀余治，余固辞。乃请邻人扶乩，服一方颇能言，遍召家人以身后属之，转侧而殁。
李赓堂先生以武进土为温州都司，后升江西参将，缺甚瘠，告而归里。其长子号东樵，以北元作户郎，次子号莲峰，屡荐未售，博极群书，在里中与余往来甚契，赓堂先生虽林下，而性情伉爽，排难解纷，里党中多赖之，庚申春，东樵以都中官钱铺案发，下刑部狱，越年许，案未结，赓翁在家忧之。辛酉夏，忽患胸膈满闷，饮食不进，遂致手足肿胀。延医视之，疑为水肿，用利水药不效。继更一医以为虚，用肾气丸仍不效，而肿益甚。适余以其族人丧葬遇莲峰，即请余治。诊其六脉坚实，右关硬欲搏指。乃告日，此饮食伤胃，有余病也。平日多食厚味，积滞胃中，胃主四肢，胃气和，则四肢安；胃气滞，则四肢胀。必至之势也。况胃气既滞，杯勺茶汤皆能停积，虽见小便不利，其实非水能泛滥发为水肿，徒利水，必不效。且此病由湿热内蕴，再用熟地以涩之，跗子以塞之，不增胀何待乎！惟年老阳虚，脾胃素弱，治无速效，但欲消肿，则易易耳。用渗湿汤加枳实、木通、牛膝销导之。莲峰似嫌其峻，余曰：此急则治标之法，但令胃气通，则积自销，肿自愈，不必专治小便，小便必无不利。后再用健脾养胃药治之，须三五月乃成功也。乃服之，一剂而肿皱，三服而十去其六。莲峰来书云：不意君久持文誉，出其余技，竟使顿失沉疴。昔人云：事亲者不可不知医，弟真赭颜无地矣。明日更烦一视，敬当执帚一待。余往视之，脉稍和，而右关如故。告曰，胃气已行，尚未通也。问小便利否?曰，未利，乃加葶苈，二丑疏之，即小便十余碗，肚腹宽舒，饮食亦进。继以资生健脾丸方，汤服之。告曰：必厌汤药，服丸可也。莲峰以秋试在即，欲赴省，恐再发肿。余曰：但令勿服附子、东参、熟地之类，渐而培养之，必无恐，惟老人气虚，多需时日耳。莲峰见无碍，遂束装赴试。赓翁之长女亦知医识字，又有旧仆亦业医，莲峰走后见其羸瘠不堪，力劝其服熟地、麦冬并燕窝、东参等，大补气血；又见其能食，以鸡鸭鱼肉日日调养之。未半月，肿虽不作，而胸腹仍滞，小便仍不利矣。
莲峰出闱而归，又邀余视，则两尺如丝，左关有促象，知非吉象，以六君子丸敷衍之，遂辞而不治焉。
保胎增乳二方
胎至三月而堕，非损伤也，大抵妇人多忧郁，乃肝脏结热，因而腐化耳。达生篇保胎无忧散，最为灵应，屡试屡验。初觉有胎，即按其方月服一付，不但无小产之患，即临娩时，亦无横生逆产，胞衣不下，产后血晕之症。诚仙方也。
至乳食不足，厥有数端，有气血本虚而不足者；有乳窍未通而不足者；有因香辣等物，触回不足者；有因愤怒气郁不足者；其它食积水停，风寒外搏，皆能致乳减少。盖乳者血也。血随气行，气盛则盈，气衰则少，气郁则滞，气热则结。医者但治其气，使之流通，乳汁断无不通之理。惟妇人年老，真气已虚，是真减少，虽服参茸，究竟草木鸟兽、枯槁之物不能添作乳汁也。
同年李友兰，也精通医理。辛亥年秋天在省会闲居时，得了疼痛病，有时在手，有时在脚，有时在头，有时在腹，有时在腰，有时在胁肋，发作没有固定时间，也没有固定部位。他自认为是痹病（肢体关节疼痛、麻木、重着、屈伸不利的疾病），服用续命汤无效。又以为是寒邪，服用麻黄汤也无效。一天与我闲聊，告诉我道：我的病实在难以揣测。我请求为他诊脉，发现脉象缓而滞涩，于是告诉李友兰说：您的病是湿痰流注（湿气与痰浊流窜经络脏腑所致的病证）。正要再解释，李友兰顿悟道：不错！不错！我心里已经知道了，您接下来的论述我自己来写吧。两人相视一笑。过了两天，病就好了。问他服用了什么药，李友兰说：懂行的人哪里需要明说？您试着说说是什么药。我说：不过是二陈汤加苍术、姜黄、羌活、独活罢了。李友兰拿出方子给我看，完全符合。石虞琴广文在座，感叹道：两位先生可谓心心相印了。
另外，司徒芝邻方伯藩秦时，身体向来肥胖。当时各省筹集军饷，官员和士兵聚集在省会，而国库资金短缺，芝翁忧虑表现在脸上。到了夏天，得了痴呆病。坐卧不安，时而自言自语，时而浑身瘙痒抓挠。只要闭上眼睛就睡觉，睡着后梦见两个鬼在前面：一个是上吊死的，绳索挂在脖子上；一个是无头的，用手提着脑袋，头发蓬乱，血迹模糊。因此，不能独自睡觉，不与下属接触已有十多天。请医生医治，都说是有冤业，恐怕治不好。又换了一个医生，说是心血亏损，服用天王补心丹，饮食突然减少。等到管家请我去，我进去见到他，他说：病到了这个地步，恐怕不能治了，只是请您判断一下，到底是哪条经脉生病，必须详细说出来，不要隐瞒庇护。按摸他的脉，六部脉都弦缓而滑，寸部轻取尤其明显，知道是痰证，于是对芝翁说：大人您是脾湿停痰，再加上劳倦伤脾，心火浮动，导致痰涎环绕心包络，所以时而迷糊时而清醒，平时一定喜欢吐痰，吐出来胸腹就会宽舒。现在痰涎停结，一定不能吐。而且时而烦躁，时而躁动，时而口渴，时而心慌并伴有手足颤抖，时而大小便不通畅，都是痰造成的。芝翁问：那两个鬼是什么？我说：两个鬼也是神魂烦乱所致，其实并没有，大人不必多虑。病虽然复杂，我保证能治好。芝翁高兴地问：服用什么药？我说：大人的病不是汤药能治疗的，必须先以矾郁丸催吐，接着用控涎丹通泄，再多服去痰健脾的各种药物就没有忧虑了。芝翁急忙索要矾郁丸，我说这药市面上大多没有，于是配制好送给他。服用几粒后，片刻之间吐出胶粘的痰絮，颜色兼有青黑，自己觉得心境顿时开朗，想再服用，我说：痰已经吐出来了，再服恐怕损伤胃气。接着用控涎丹投服。两天后，设便饭邀请我，拄着拐杖告诉我：两晚没见那两个鬼，神气也清爽了，您的高名确实令人佩服，敢问如果不治会成什么症？我说：如果不治，不是癫症就是痫症，严重的话会形成痰厥。他的幕僚们都来应酬，饭后回去。没过几天，我因父亲去世回家守丧。到了八月，芝翁因官钱案发，奉旨革职。案件定案后，他的门人黄五被绞死，就在受刑之际，芝翁听到消息，因痰厥而死在公馆。后来小梅来信，还说到芝翁的死正如我所预言的那样。
黄庚垣先生，江西人，因为捐纳军饷奉特旨议叙举人加藩司衔并赏戴花翎，补授西安粮道。粮道的职位很优厚，加上家资丰厚，而观察（对道员的尊称）性格崇尚清廉，对待下属宽厚，所以下属都称赞他。年纪五十岁左右，曾患遗精病。观察侍妾几人，幕友中有擅长医术的，认为有很多姬妾，必定导致虚损。用三才封髓丹进补，而观察又讲究颐养。每天吃燕窝、东参来调理，然而遗精依然如故。幕友认为已成虚劳，不可救药。
一天午后无事，忽然召我到衙署，并且命令便装，我急忙赶去听命，观察便衣出来，作揖延请我坐上座，我惊讶地问原因，观察说：患遗精几年了，曾服汤药一百多付，丸药几斤，却毫无效果。我问饮食怎么样？观察说：虽然不能多吃，但也并非不能吃。老夫子认为我是虚痨，所以不敢多吃。问有没有咳嗽气短、发热自汗？回答说：没有。于是告诉他：既然没有这几样症状，恐怕是余症（实邪），不是不足之证。观察惊讶地说：遗精还有实证吗？我回答说：大人未窥探医书，加上脾胃虚弱，不仅医者不敢以实证论断，就连大人自己也怀疑是虚证。哪里知道遗精的原因有好几种，相火太旺，夜间做梦失精，阳气必然壮健，适宜滋阴；饮食肥甘厚味，湿热内侵，则逼迫而失精，适宜消导；长期禁欲气充，精满而溢，适宜疏泄。此外，中气下陷，清阳不升，也会遗精；色欲过度，心肾不交，也会遗精。又有恐惧暴怒，精窍滑而不涩，都能导致遗精。如果或坐或卧，无故遗精，则是虚极之症，最为危险。庸医不仔细探究原因，不分虚寒实热，见到遗精者，就说色欲过度；又说年少好淫。致病者，多遭受不白之冤，而治疗大多无效。于是归咎于病不可治，不也很迷惑吗。
观察惊起说：听了您的讲解，无不确切恰当，心里豁然开朗，那么我的遗精绝非虚症，请为我诊治。于是诊其脉，缓而坚，右关部尤其明显。告诉他：大人的病，所谓湿热内淫是也。胸膈常感闷滞，大便颇显后重，应当消导。进用震亨渗湿汤。观察阅方内有黄连恐不宜，且厚朴、苍术恐伤胃气。我说：胃苓汤是治疗湿热的要药。平胃散的作用是培补卑监（土运不及）使之平和，并非削平之意，前辈说得非常明白，此方用黄连川芎我也曾怀疑，细思其理，苦能燥湿，用黄连而焦炒之，是用其苦而非用其凉性。湿热能致瘀血，用川芎以行之，震亨此方，具有深意。大人成见在心，一误岂容再误，别人一定会说此方不是治遗精的药，哪里知道治病必求其本，本治而末不治的，从未有过。请放心照服四付，常服香砂六君丸来调理，不但精不遗，即使饮食也会加倍。观察照此服药，五日后，约晚饭，到了之后告诉我：之前听您说话很有道理，但心里暗自怀疑，现在服您的药，遗精已止，果然觉得精神增健，食量也好，连阳事也壮盛。如果不是您妙达精微，几乎冤枉了我，可见医道无定方，在于究其理而变通罢了。后来我多次受到夸奖，随即因父丧回家，他还寄信问候数次。
诊脉如审案
古人说用药如用兵，我曾说诊脉如审案。其中的微言妙旨，前辈论述得很详细了。只有仕才先生的四言要诀，简明切当。他说：四时的脉象，以胃气为本，尤为诊家的关键。大概胃气，就是脉的神。所谓神，极力形容并总括起来叫有力。我认为“有力”二字，尚不足以尽“神”字的含义。大概有力而兼活动，不快不慢，不软不硬，才是像春风弱柳那样的气象。以此参考，百不失一。审案，有正凶，有旁证，有致事的原因，有受害的地方，有连坐，有挂诬。审查既确，刑罚轻重随之。姑且就一端来说，如脾湿停痰一证，脉必沉滑。那么沉滑者，就是正凶。而脾湿必大便难，停痰必食欲减，这是旁证。湿若饮水过多则兼弦，劳倦思虑则兼弱，这是致事的原因。或因湿而泄泻，或因痰而咳嗽，那么泄泻者，右尺脉必虚；咳嗽者，右寸脉亦滑，这是连坐。且脾湿者，饮食不能健运，精液必致不充，则左尺脉必涩，这是挂诬。只要识定正凶，健脾销痰，病自然痊愈。如果治泄泻而止之，治咳嗽而清之，则是抛却正凶，诛伐无过，必定不能治病，反而增加其他病。所以用药不过古人成方数十种，传之于世，而用之或效或不效的，不是笔下糊涂，实在是指下不明瞭。
我曾说诊脉，须合三部十二脏腑，参考而斟酌之，才有定见。如果诊寸而忘尺，诊右而忘左；滑则治其痰，数则去其火，虽有小效，也难去病，何况审查不清，未必有效呢。等待高明者斟酌。
武芝田先生，崞县人，以名进士出任陕西县令，后升任榆林观察，因为榆林地贫瘠，所以在省里遥领。观察素来豪饮，因酒积得吐血疾。我在省里候补，一天招我去看他病，谈及病情，观察说：吐血几年了，遇郁闷更甚。已换十多个医生。有的说是思虑伤脾；有的说是暴怒伤肝；有的说是血热妄行。有的有效有的无效，但最终未拔除病根，能为我一治吗。我看他体格魁伟，面色红润，饮食过人，知道不是虚证。为他诊脉，左部沉实，非病脉，右关沉弦而数。于是告诉他：大人是有余病，不是不足病。如思虑伤脾，则应当心悸健忘惊悸；如血热妄行，则应当身热发渴，头晕目眩；如暴怒伤肝，则应当两胁膨胀，胸膈不开，兼发呕逆。现在没有这些症状，则前医皆误。以愚见参酌，必定是湿热内淫。热能致瘀血，所以所吐必血色紫黯，且时常成块。胃口多患刺痛，小便常赤，大便艰涩，时也带血。观察说：语语不谬，当作何治？我说：先以葛花解酲汤清其胃，继用枳术胃苓丸行其瘀。再饮食淡泊来调理，不过一月，保证不再犯。观察照此调摄。二十日而安。后观察因父丧回家，以清风两袖，主讲吾汾之西河书院。我也因父丧回家籍。相隔六十里，文字往来很密。
过了几个月，我送堂弟参加府试，与观察日日见面。
谈及共如君说，癸水不调，脐腹常疼，精神委顿，饮食不思，偶尔受孕，三四月辄堕胎。前在崞县，曾服药无数，这次又请教授齐老师治，又请府幕钱老夫子治，病仍不愈。都认为痨症了，请决断一下。如君出来则荆钗裙布、寒素依然，向我拜见，我回礼。诊其脉则六脉俱虚，而无数象，右关尤甚。告诉观察说：这是脾虚土衰之证，所以精神少，饮食滞。至于月事不调，怀孕辄坠，则是中气不能健固的缘故。极可治。但须积日累月，非旦夕可愈之病。若迟延不治，则久而泄泻，或久而咳嗽发热，面赤恶寒，真痨症矣。我先进以六君子汤加益智、干姜、芡实，命服八剂后，服资生健脾丸。观察问，丸药服几斤？我说，多多益善。
后我回家介休，观察解账归崞。二年后，在省会见他长子，问前病状，则说：近来身体甚壮硕，去年冬，竟生一女，家父犹时时道及而铭感焉。
痰之为病，严重时发厥，无故昏倒，一旦误治，便不能起，最为危险。推究其原因，大抵多由气郁，以致痰壅胃口，因而昏迷不省人事。旧法以三生饮催吐，是攻标之急治。若不壅于胃，而壅于肺，则痰入清道，更难措手。其证不昏倒，能知人，惟胸膈间气，能出而不能入，时时作反张形，遂至汤水不能下咽，咽则气逆而哮。
乡里布商姓安名溶者，虽做商人，人极推重。辛酉夏，其次子一岁多夭折；其三女也因痨症亡于家；不到一个月，其次女的丈夫与其外甥男，一日间相继死亡。其次女年幼，丈夫的族人恐席卷财产而他适，置死人于不问，互争产业。安某知道，急与愤争，族人才散去，此前丧子女，已抱忧郁，后次女之事，又增其愤，所以回家得胸满腹泻之疾。求我治，诊其脉，弦而滞。告诉他：这是气滞水积。用香砂胃苓丸消之，病早愈，安某吝啬钱财，不复服药，我也忘了。过了十余日，急派人招我去看病，我以为泻之未愈。急视之，则气格格作逆，口唾不能下咽。问膈与胸中作满否？回答说：没有。提其腕，则两手如冰，六部伏不见，惟有寸带滑数。于是说：这是痰壅肺窍。肺窍为气所出入，今为痰壅，故气不能入。如在胃，则卒然昏噤，三生饮吐之可也。今在肺管恐吐之不出，无可措手，急辞而出。安某固请一方，乃以木香顺气饮敷衍之，出来告诉伙计：安某的病，必不起，可急为料理。其伙计尚不信，因循至次早，乃来省视，安某已口张气促而不能言矣。其堂兄见其危，又邀我治，我坚决推辞。乃请邻人扶乩，服一方颇能言，遍召家人以身后属之，转侧而殁。
李赓堂先生以武进土为温州都司，后升江西参将，缺甚瘠，告老归里。其长子号东樵，以北元作户郎，次子号莲峰，屡荐未售，博极群书，在乡里与我往来甚契，赓堂先生虽在家闲居，而性情伉爽，排难解纷，乡里多赖之，庚申春，东樵因都中官钱铺案发，下刑部狱，过了一年多，案未结，赓翁在家忧之。辛酉夏，忽患胸膈满闷，饮食不进，遂致手足肿胀。延医视之，疑为水肿，用利水药不效。继更一医以为虚，用肾气丸仍不效，而肿益甚。适我因其族人丧葬遇莲峰，即请我治。诊其六脉坚实，右关硬欲搏指。于是告诉他说：这是饮食伤胃，有余病。平日多食厚味，积滞胃中，胃主四肢，胃气和，则四肢安；胃气滞，则四肢胀。必至之势。况胃气既滞，杯勺茶汤皆能停积，虽见小便不利，其实非水能泛滥发为水肿，徒利水，必不效。且此病由湿热内蕴，再用熟地以涩之，附子以塞之，不增胀何待乎！惟年老阳虚，脾胃素弱，治无速效，但欲消肿，则易易耳。用渗湿汤加枳实、木通、牛膝销导之。莲峰似嫌其峻，我说：此急则治标之法，但令胃气通，则积自销，肿自愈，不必专治小便，小便必无不利。后再用健脾养胃药治之，须三五月乃成功也。乃服之，一剂而肿皱，三服而十去其六。莲峰来信说：没想到您久持文誉，出其余技，竟使顿失沉疴。古人云：事亲者不可不知医，弟真赭颜无地矣。明日更烦一视，敬当执帚一待。我去看望，脉稍和，而右关如故。告诉他：胃气已行，尚未通也。问小便利否？回答说：未利，乃加葶苈，二丑疏之，即小便十余碗，肚腹宽舒，饮食亦进。继以资生健脾丸方，汤服之。告诉他：必厌汤药，服丸可也。莲峰以秋试在即，欲赴省，恐再发肿。我说：但令勿服附子、东参、熟地之类，渐而培养之，必无恐，惟老人气虚，多需时日耳。莲峰见无碍，遂束装赴试。赓翁之长女亦知医识字，又有旧仆亦业医，莲峰走后见其羸瘦不堪，力劝其服熟地、麦冬并燕窝、东参等，大补气血；又见其能食，以鸡鸭鱼肉日日调养之。未半月，肿虽不作，而胸腹仍滞，小便仍不利矣。
莲峰出闱而归，又邀我视，则两尺如丝，左关有促象，知非吉象，以六君子丸敷衍之，遂辞而不治焉。
保胎增乳二方
胎至三月而堕，非损伤也，大抵妇人多忧郁，乃肝脏结热，因而腐化耳。达生篇保胎无忧散，最为灵应，屡试屡验。初觉有胎，即按其方月服一付，不但无小产之患，即临娩时，亦无横生逆产，胞衣不下，产后血晕之症。诚仙方也。
至乳食不足，厥有数端，有气血本虚而不足者；有乳窍未通而不足者；有因香辣等物，触回不足者；有因愤怒气郁不足者；其它食积水停，风寒外搏，皆能致乳减少。盖乳者血也。血随气行，气盛则盈，气衰则少，气郁则滞，气热则结。医者但治其气，使之流通，乳汁断无不通之理。惟妇人年老，真气已虚，是真减少，虽服参茸，究竟草木鸟兽、枯槁之物不能添作乳汁也。
Li Youlan, a fellow provincial graduate, was also proficient in medical principles. In the autumn of the Xinhai year, while residing idly in the provincial capital, he contracted a painful condition. The pain occurred sometimes in the hands, sometimes in the feet, sometimes in the head, sometimes in the abdomen, sometimes in the waist, and sometimes in the hypochondrium. It had no fixed time of onset and no fixed location. He considered it to be Bi syndrome (a disease characterized by pain, numbness, heaviness, and difficulty in movement of the limbs and joints) and took Xuming Tang without effect. He then thought it was caused by cold and took Mahuang Tang, also without effect. One day, while chatting with me leisurely, he told me: "My illness is truly unfathomable." I requested to take his pulse and found it slow and sluggish. I then said to him: "Your illness is due to Damp-Phlegm flowing and accumulating (a condition caused by dampness and phlegm circulating through meridians and organs)." Before I could continue, Li Youlan suddenly realized and said: "Correct! Correct! I already knew this; you can stop here, and I will write the rest myself." We laughed together. Two days later, his illness was completely cured. When asked what medicine he had taken, Li Youlan said: "Those who understand the art do not need explicit explanations. Try to guess what medicine it was." I said: "It was nothing more than Erchen Tang added with Cangzhu, Jianghuang, Qianghuo, and Duhuo." Li Youlan showed me the prescription, which matched my description exactly. Shi Yuqin, a literary official present, sighed and said: "The two gentlemen are indeed mind-melded."
Spleen Dampness Retaining Phlegm Disturbing the Pericardium
Furthermore, Si Tu Zhilin, Prefect Fan Qinshi, was generally obese. At that time, various provinces were raising military funds, and officials and soldiers gathered in the provincial capital, while the treasury funds were insufficient. Mr. Zhi's worry was evident on his face. By summer, he developed dementia. He was restless sitting or lying down, sometimes talking to himself, and sometimes scratching his whole body. Whenever he closed his eyes, he fell asleep and dreamed of two ghosts in front of him: one was a hanged man with a rope around his neck; the other was headless, holding its head in hand, with messy hair and blurred blood. Because of this, he could not sleep alone and did not meet with subordinates for over ten days. Doctors were invited to treat him, all saying it was karmic retribution and fearing he would not survive. Another doctor was consulted, who diagnosed Heart Blood deficiency and prescribed Tianwang Buxin Dan. His food intake suddenly decreased. When the gatekeeper invited me, I entered and saw him. He said: "The illness has reached this stage, and I fear it cannot be treated. I only ask you to judge it. Which meridian is affected? You must explain in detail, do not hide or protect." Palpating his pulse, I found all six positions string-slow and slippery, with the Cun position particularly prominent upon light pressure. Knowing it was a Phlegm syndrome, I said to Mr. Zhi: "Sir, your condition is Spleen Dampness retaining Phlegm, compounded by fatigue injuring the Spleen and floating Heart Fire, causing Phlegm-fluids to surround the Pericardium Collateral. Hence, you are sometimes confused and sometimes clear. Normally, you likely enjoy spitting up phlegm, and doing so brings relief to the chest and abdomen. Now, with Phlegm-fluids stagnant and knotted, you cannot spit them up. Moreover, your occasional irritability, agitation, thirst, palpitations accompanied by trembling of the hands and feet, and occasional difficulty in urination and defecation are all caused by Phlegm." Mr. Zhi asked: "What are the two ghosts?" I replied: "The two ghosts are also caused by chaotic Shen and Hun (Spirit and Ethereal Soul). They do not actually exist; Sir need not worry excessively. Although the symptoms are complex, I guarantee a cure." Mr. Zhi happily asked: "What medicine should I take?" I said: "Sir's illness cannot be treated with decoctions alone. First, use Fanyu Wan to induce vomiting, then Kongyan Dan to drain downwards, followed by various medicines to resolve Phlegm and strengthen the Spleen, and there will be no worries." Mr. Zhi urgently requested Fanyu Wan. I said it was mostly unavailable in the market, so I prepared it and sent it to him. After taking a few pills, within a moment, he vomited sticky phlegm strands, colored greenish-black. He felt his mental state suddenly open up and wanted to take more. I said: "The Phlegm has been vomited; taking more may damage Stomach Qi." Then I administered Kongyan Dan. Two days later, he hosted a casual meal for me, leaning on a cane, and told me: "I didn't see the two ghosts for two nights, and my spirit is clear. Your high reputation is truly admirable. May I ask what illness it would have become if untreated?" I said: "If untreated, it would become either Dian syndrome (mania) or Xian syndrome (epilepsy), or severely, Tan Jue (Phlegm Jue)." His assistants came to socialize, and I returned after the meal. Not long after, I had to return home to mourn my father's death. In August, Mr. Zhi was dismissed from office due to an official money case by imperial decree. After the case was settled, his gatekeeper Huang Wu was hanged. At the moment of execution, upon hearing the news, Mr. Zhi died of Tan Jue in his residence. Later, Xiao Mei wrote to me, still recounting Mr. Zhi's death just as I had predicted.
Damp-Heat Internal Invasion Excess Syndrome Seminal Emission
Mr. Huang Gengyuan, from Jiangxi, obtained the rank of Juren and the title of Fan Si (Provincial Administration Commissioner) with a red-tasseled hat through donation for military funds, and was appointed Intendant of Xi'an Grain Transport. The position was lucrative, and his family wealth was substantial. However, the Intendant valued integrity and was lenient with subordinates, so they all praised him. Around fifty years old, he had suffered from seminal emission. With several concubines, an assistant who was skilled in medicine believed that having many concubines must cause deficiency. Sancai Fengsui Dan was used to tonify him, and the Intendant also focused on health preservation. He ate bird's nest and Dongshen daily to regulate his health, yet seminal emission continued. The assistant thought it had become Xu Lao (consumptive disease) and was incurable.
One afternoon, when there was nothing to do, he suddenly summoned me to the yamen and instructed me to dress casually. I hurried to obey. The Intendant came out in casual clothes, bowed, and invited me to the seat of honor. Surprised, I asked why. He said: "I have suffered from seminal emission for years. I have taken over a hundred doses of decoctions and several jin of pills, but with no effect." I asked about his diet. He replied: "Although I cannot eat much, I am certainly not unable to eat. The old master thinks I have consumptive disease, so I dare not eat much." I asked: "Do you have cough, shortness of breath, fever, or spontaneous sweating?" He said: "No." I then told him: "Since you lack these symptoms, I fear it is an excess syndrome, not a deficiency syndrome." The Intendant exclaimed: "Is there an excess syndrome for seminal emission?" I answered: "Sir has not studied medical books thoroughly, and combined with weak Spleen and Stomach, not only do doctors dare not diagnose excess, but you yourself suspect deficiency. However, seminal emission has several causes. If Ministerial Fire is too strong, leading to nocturnal emissions during dreams, Yang Qi is robust, and nourishment is appropriate. If rich and greasy foods cause Damp-Heat to invade internally, forcing emission, resolution and guidance are appropriate. If long abstinence leads to full Qi and overflowing essence, venting is appropriate. Additionally, sinking of Middle Qi and failure of Clear Yang to ascend can cause emission; excessive sexual desire and disharmony between Heart and Kidney can also cause emission. Fear and sudden anger can make the essence aperture slippery rather than secure, also leading to emission. If one emits essence spontaneously while sitting or lying down, it is a critical deficiency syndrome, most dangerous. Quack doctors do not carefully investigate the cause, failing to distinguish between deficiency-cold and excess-heat. Upon seeing seminal emission, they say it is due to excessive sexual desire; or that the young man loves lust. Patients often suffer unjust accusations, and treatments are mostly ineffective. They then blame the illness as incurable, is this not confusing?"
The Intendant rose abruptly and said: "Listening to your explanation, everything is precise and clear. My heart is opened. Then my seminal emission is definitely not a deficiency syndrome. Please examine me." I palpated his pulse: slow and firm, especially at the Right Guan position. I told him: "Sir's illness is what we call Damp-Heat internal invasion. You often feel stifling in the chest and diaphragm, and your stool feels heavy. Resolution and guidance are indicated. I prescribe Zhenheng Shenshi Tang." The Intendant read the prescription and feared Huanglian might not be suitable, and Houpo and Cangzhu might damage Stomach Qi. I said: "Weiling Tang is a key medicine for Damp-Heat. Pingwei San aims to cultivate the deficient Earth element to bring it to balance, not to flatten it. This was explained clearly by predecessors. Regarding the use of Huanglian and Chuanxiong in this formula, I also doubted it initially. Upon careful reflection, bitterness dries Dampness. Using Huanglian charred uses its bitterness, not its coolness. Damp-Heat can cause blood stasis; Chuanxiong moves it. Zhenheng's formula has deep meaning. Sir, if preconceptions remain in your mind, how can another mistake be tolerated? Others will surely say this is not a medicine for treating seminal emission. But treating disease requires seeking the root. If the root is treated, the branches will not remain untreatable. Rest assured and take four doses. Regularly take Xiangsha Liujun Wan to regulate. Not only will emission cease, but your appetite will also double." The Intendant followed my advice. Five days later, at dinner, he told me: "Before, I found your words reasonable but secretly doubted them. Now, after taking your medicine, emission has stopped. I truly feel increased energy and good appetite, and even my virility is strong. If not for your profound understanding, I would almost have wronged you. This shows that medical practice has no fixed formulas; it lies in investigating principles and adapting accordingly." Later, I received several letters of inquiry from him even after I returned home to mourn.
Pulse Diagnosis Like Adjudicating Cases
Ancients said using medicine is like using troops. I once said diagnosing by pulse is like adjudicating cases. The subtle meanings and profound principles have been detailed by predecessors. Only Mr. Shicai's Four-Character Key Principles are concise and appropriate. He said: "In all four seasons, the Pulse Stomach Qi is the foundation, which is the crucial point for diagnosticians." Generally, Stomach Qi is the Spirit of the pulse. What is called Spirit, described to the utmost, is summarized as "forceful." I believe the word "forceful" is not enough to exhaust the meaning of "Spirit." Forcefulness combined with mobility, neither fast nor slow, neither soft nor hard, is like the aura of weak willows in spring breeze. Based on this reference, one misses rarely. Adjudicating a case involves identifying the principal culprit, corroborating evidence, the cause of the incident, the place of harm, accomplices, and false accusations. Once the investigation is accurate, the severity of punishment follows. Taking one aspect as an example: in the syndrome of Spleen Dampness retaining Phlegm, the pulse must be Deep-Slippery. Thus, Deep-Slippy is the principal culprit. Spleen Dampness implies difficult defecation; retained Phlegm implies reduced appetite; this is corroborating evidence. If Dampness comes from excessive water intake, the pulse may additionally be String-like; if from fatigue and overthinking, it may additionally be Weak; these are causes of the incident. If Dampness causes diarrhea, or Phlegm causes cough, then in diarrhea, the Right Chi pulse must be Deficient; in cough, the Right Cun pulse is also Slippery; this is complicity. And in Spleen Dampness, dietary intake cannot be transformed effectively, leading to insufficient Jing fluids, so the Left Chi pulse must be Choppy; this is false accusation. As long as the principal culprit is identified, strengthening the Spleen and resolving Phlegm will cure the disease. If one treats diarrhea by stopping it, or cough by clearing it, one abandons the principal culprit and punishes the innocent, inevitably failing to cure the disease and instead adding other illnesses. Therefore, the use of medicine relies on dozens of ancient established formulas passed down. Whether they work or not depends not on the writer's confusion, but on the practitioner's unclear finger diagnosis.
I once said that diagnosing by pulse requires integrating the three positions and twelve zang-fu organs, referencing and deliberating, to form a definite view. If one diagnoses the Cun but forgets the Chi, or the Right but forgets the Left; if Slippery means treating Phlegm, or Rapid means removing Heat, although there may be minor effects, it is difficult to cure the disease, let alone if the investigation is unclear and efficacy is uncertain. I leave this for the discerning to deliberate.
Damp-Heat Internal Invasion Excess Syndrome Hematemesis
Mr. Wu Zhitian, from Guoxian County, served as a county magistrate in Shaanxi after passing the Jinshi examination, and was later promoted to Intendant of Yulin. Since Yulin was poor, he held the post remotely from the province. The Intendant was known for his hearty drinking and developed hematemesis due to alcohol accumulation. While I was waiting for appointment in the province, he invited me to visit him one day. Discussing his illness, he said: "I have had hematemesis for years, worsening with depression. I have seen more than ten doctors. Some said it was Spleen injury from overthinking; some said Liver injury from sudden anger; some said reckless bleeding from Blood Heat. Some were effective, others not, but the root was never removed. Please treat me." Seeing his robust physique, ruddy complexion, and hearty appetite, I knew it was not a deficiency syndrome. I diagnosed his pulse: the Left side was Deep-Firm (not pathological); the Right Guan was Deep-String-Rapid. I told him: "Sir has an excess syndrome, not a deficiency syndrome. If it were Spleen injury from overthinking, there would be palpitations, amnesia, and fright. If it were reckless bleeding from Blood Heat, there would be fever, thirst, dizziness, and vertigo. If it were Liver injury from sudden anger, there would be distension in both hypochondria, stifling in the chest and diaphragm, and vomiting. Since none of these symptoms are present, the previous doctors were mistaken. In my opinion, it must be Damp-Heat internal invasion. Heat causes blood stasis, so the vomited blood must be purple-dark and often clotted. There is often stabbing pain in the stomach area, urine is often red, stools are dry and difficult, sometimes with blood." The Intendant said: "Your words are impeccable. How should it be treated?" I said: "First, use Gegua Jieying Tang to clear the Stomach, then use Zhizhu Weiling Wan to move stasis. Regulate with a bland diet. Within a month, I guarantee no recurrence." The Intendant followed the regimen. He recovered in twenty days. Later, he returned home to mourn his father, living frugally, and taught at Xihe Academy in Fen. I also returned home to mourn. We were separated by sixty li but maintained frequent correspondence.
Spleen Deficiency Food Stagnation Irregular Menstruation
Several months later, I escorted my cousin to the prefectural examination, meeting the Intendant daily.
Regarding Ms. Ru Jun, she said: "My menses are irregular, with constant pain in the umbilical and abdominal regions, lethargy, and loss of appetite. Occasionally conceiving, I miscarry at three or four months. Previously in Guoxian, I took countless medicines. Now I have asked Professor Qi and Assistant Qian Laofu to treat me, but the illness persists. All think it is consumption. Please judge." Ms. Ru appeared simply dressed, humble and plain, and bowed to me. I returned the bow. Her pulse was Deficient in all six positions, without any Rapid signs, especially at the Right Guan. I told the Intendant: "This is a syndrome of Spleen Deficiency and Earth Decline, hence low spirit and food stagnation. As for irregular menstruation and miscarriage, it is due to the inability of Middle Qi to consolidate. It is highly treatable. However, it requires accumulation of days and months; it is not a disease curable in a day or two. If treatment is delayed, prolonged diarrhea or chronic cough with fever, red face, and aversion to cold may develop, becoming true consumption. I first prescribe Liujunzi Tang added with Yizhi, Ganjiang, and Qianshi, instructing eight doses, followed by Zisheng Jianpi Wan." The Intendant asked: "How many jin of pills should be taken?" I said: "The more, the better."
Later, I returned to Jiezhou, and the Intendant settled accounts and returned to Guoxian. Two years later, I met his eldest son in the provincial capital and asked about her previous condition. He said: "Recently, her body has become very robust. Last winter, she gave birth to a daughter. My father often mentions this with gratitude."
Qi Stagnation Water Accumulation Phlegm Obstructing Lung Orifices
Phlegm diseases, when severe, cause Jue (fainting). Falling unconscious without cause, if misdiagnosed and mistreated, recovery is impossible, making it most dangerous. Tracing the cause, it is largely due to Qi Depression, causing Phlegm to obstruct the Stomach entrance, leading to unconsciousness. Old methods used Sansheng Yin to induce vomiting, a rapid treatment attacking the branch. If Phlegm does not obstruct the Stomach but obstructs the Lung, entering the clear orifices, it is even harder to handle. The syndrome involves no fainting, consciousness remains, but Qi in the chest and diaphragm can exit but not enter, constantly showing opisthotonos, until soup and water cannot be swallowed. Swallowing causes Qi rebellion and wheezing.
A cloth merchant named An Rong in our village, though a merchant, was highly respected. In the summer of Xinyou, his second son died at age one; his third daughter also died of consumption at home. Within a month, his second daughter's husband and nephew died successively in one day. The second daughter was young; the husband's clan members, fearing they would abscond with property, ignored the dead and disputed the estate. An knew this, angrily argued with them, and the clan dispersed. Having already harbored grief from losing children, the incident with the second daughter added to his anger. Returning home, he contracted chest fullness and diarrhea. Seeking my treatment, his pulse was String-like and sluggish. I told him: "This is Qi Stagnation and Water Accumulation." I used Xiangsha Weiling Wan to resolve it. The illness healed early. An was stingy with money and did not take further medicine, and I forgot about it. Over ten days later, he urgently sent someone to summon me. I thought the diarrhea was unresolved. Examining him quickly, I found Qi rebelling with a gurgling sound, unable to swallow saliva. I asked if there was fullness in the diaphragm and chest. He said: "No." Lifting his wrist, his hands were ice-cold, all six pulses were Hidden and invisible, except the Cun position which was Slippery-Rapid. I said: "This is Phlegm obstructing the Lung orifices." The Lung orifices are where Qi enters and exits. Now obstructed by Phlegm, Qi cannot enter. If it were in the Stomach, sudden coma and aphasia would occur, and Sansheng Yin could induce vomiting. Now in the Lung tube, vomiting may not expel it, and there is no easy solution. I hastily excused myself. An firmly requested a prescription. I gave him Muxiang Shunqi Yin perfunctorily. Coming out, I told his partners: "An's illness will certainly not recover; prepare for the worst." His partners did not believe it. Delaying until the next morning, they came to inspect, and An was already gasping with open mouth, unable to speak. Seeing his danger, his cousin invited me again. I firmly declined. They asked neighbors to perform Fuji (spirit writing). After taking a prescription, he could speak somewhat, summoned family members to settle affairs, and died turning over.
Stomach Accumulation Limb Swelling
Mr. Li Gengtang, originally from Wujin, served as Commander of Wenzhou, later promoted to Brigadier General of Jiangxi. The post was poor, so he retired and returned home. His eldest son, Hao Dongqiao, served as a clerk in the Ministry of Revenue. His second son, Hao Lianfeng, failed multiple examinations, was widely read, and had a close relationship with me in the hometown. Although Mr. Li was retired, his character was straightforward, resolving disputes, and relied upon by the community. In the spring of Gengshen, Dongqiao was implicated in the Beijing official money shop case and imprisoned by the Board of Punishments. Over a year later, the case was unresolved, and Mr. Li worried at home. In the summer of Xinyou, he suddenly suffered chest and diaphragm fullness, loss of appetite, leading to swelling of hands and feet. A doctor suspected Edema and used diuretics without effect. Another doctor thought it was Deficiency and used Shenqi Wan, also without effect, and the swelling worsened. Coincidentally, I met Lianfeng at a relative's funeral and was invited to treat him. His six pulses were Firm, with the Right Guan hard and pressing against the fingers. I told him: "This is Stomach injury from food, an excess syndrome. Usually eating rich foods, accumulation stagnates in the Stomach. The Stomach governs the four limbs. If Stomach Qi is harmonious, limbs are calm; if Stomach Qi is stagnant, limbs swell. This is inevitable. Moreover, since Stomach Qi is stagnant, even a cup of tea can accumulate. Although urination is difficult, it is not because water floods causing edema. Merely promoting urination will be ineffective. Furthermore, this illness is due to internal Damp-Heat. Using Shudi to astringe and Fuzi to block will only increase swelling! Only being elderly with Yang Deficiency and naturally weak Spleen and Stomach means no quick cure. But to reduce swelling is easy." I used Shenshi Tang added with Zhishi, Mutong, and Niuxi to resolve and guide. Lianfeng seemed to think it too harsh. I said: "This is treating the branch in acute situations. Let Stomach Qi flow, and accumulation will dissolve, swelling will heal. No need to specifically treat urination; urination will certainly improve." Later, use Spleen-strengthening and Stomach-nourishing medicines, requiring three to five months to succeed. He took it. After one dose, swelling subsided; after three doses, six-tenths disappeared. Lianfeng wrote: "Unexpectedly, your literary reputation yielded skills that suddenly cured my chronic illness. Ancients said: Those serving parents must know medicine. I am truly ashamed. Tomorrow, please examine me again; I will await you with broom in hand." I visited. Pulse was slightly harmonious, but Right Guan remained unchanged. I told him: "Stomach Qi has moved but is not yet unblocked." Asked if urination was smooth. He said: "Not yet." Added Tingli and Erchou to drain. Urination increased to over ten bowls, abdomen relaxed, and appetite returned. Subsequently, Zisheng Jianpi Wan formula was taken as decoction. I told him: "You must dislike decoctions; pills are fine." Lianfeng, facing the autumn examination, wanted to go to the province, fearing swelling recurrence. I said: "Just avoid taking Fuzi, Dongshen, Shudi, etc., and gradually nourish. No fear. Only the elderly with Qi Deficiency require more time." Seeing no obstacle, Lianfeng packed for the exam. Mr. Li's eldest daughter also knew medicine and could read. An old servant also practiced medicine. After Lianfeng left, seeing her emaciated, they strongly advised taking Shudi, Maidong, bird's nest, Dongshen, etc., to greatly tonify Qi and Blood; seeing she could eat, they nourished her daily with chicken, duck, pork, and fish. Within half a month, although swelling did not recur, chest and abdomen remained stagnant, and urination was still difficult.
Lianfeng returned from the examination and invited me again. Both Chi pulses were thread-like, and the Left Guan had a Hasty image, indicating an inauspicious sign. I gave Liujunzi Wan perfunctorily and declined further treatment.
Two Formulas for Preserving Fetus and Increasing Milk
Miscarriage at three months is not due to injury. Generally, women are prone to depression, causing Liver Heat knotting, leading to corruption and dissolution. Baotai Wuyou San from Dasheng Pian is most effective, tested repeatedly with success. Upon first feeling pregnant, take one dose monthly according to the formula. Not only will there be no risk of miscarriage, but also no difficult labor, malpresentation, retained placenta, or postpartum blood syncope. Truly an immortal formula.
Regarding insufficient milk, there are several causes: those with original Qi and Blood deficiency; those with unopened milk apertures; those inhibited by spicy foods; those due to anger and Qi depression; others with food accumulation and water retention, or external Wind-Cold attack, can all lead to reduced milk. Milk is Blood. Blood follows Qi. Abundant Qi means abundance; declining Qi means scarcity; depressed Qi means stagnation; hot Qi means knotting. Doctors only treat the Qi, making it flow freely. There is absolutely no reason for milk not to flow. Only in elderly women, with true Qi already deficient, is the reduction real. Even taking Ginseng and Deer Antler, ultimately, plants, birds, and beasts, being withered substances, cannot add to milk production.