定襄西厅程裕堂，都中人，春初到任，而定缺苦甚，岁入不足二百金，而定俗尤鄙陋不堪，一切起居日用多不遂意。又以老母在京，迎养则不给，不迎又不可，忧思抑郁，手生一疔，延本处牛医治之，牛屡施针灸，半月而后愈。然程素有积滞，兼日来忧郁，遂胸膈张满，饮食不思，精神馁惰，面目瘦削，牛以为病后大虚，用桂附补之，二服而满益甚。知余在县署，急衣冠来拜，幼安问其病，即指余告之曰，润翁医道如神，山陕诸相好，无不服者，宜请治之。余诊其脉，六部沉数，右关坚欲搏指。笑曰，君腹中如塞井而下之石，积滞无隙，宜乎饮食之减少也。此有余之症，急下之，则舒畅。误认为虚，则相悖矣。程曰：精神馁困，肌肉消瘦，非虚而何？余曰，俗医但知书上病，不如身上病，焉有是处。精神不足者，气血不流通之故；肌肉消瘦，饮食不生发之故也。盖脾胃为容受转输之官，积则无所容受，滞则不能转输，胃气一停，百脉皆败，无怪其然也。程请一方，以对金饮合保和汤合进之。两服而胸腹作声。洞下秽物数次，顷刻间，饥不可忍，神气亦清。晚笼灯而来，伏地作叩曰：此方真灵丹妙药，前尚未深信，今乃知俗医之多误也。余曰，人腹中如常平仓，最须年年出陈易新方好，但旧积既去，胃气尚弱，新物入口，停滞尤易，须节俭也。程首颔之。即折柬相邀，余怜其苦力辞之。越日余束装归里，程乃饬差送数里外。时雨后多泥，凡难行处，即转轮负毂，余遣之去，则曰，家主之命不敢违。过十里而后返。
热病误治
余舅母王氏，守节三十年，苦而益笃，经纪家政，今已抱孙。体素弱而不甚服药。壬戌夏，忽得热症，烦躁不安，浑身如火。初请其族婿董某治之。董固寡术，以为风也，用小柴胡汤发之。次日，则热几如狂，时而昏不识人。表弟以农忙无暇顾，遣人告余，急往视之。则全家惊惧。诊之则两手沉数无他象，惟舌苔焦黑，语近蹇涩，而心甚清。因告曰：此热病也。董以温治，故错。此时必膈间胀闷，咽干口渴，大便秘，小便黄赤。幸血分尚清，无斑痧等类，形症虽危,尚易治也。因问思凉水否？曰思甚。乃命取新汲水两碗满饮之，顷刻间觉头目俱清，进以三黄解毒煎合犀角地黄汤。两服而热退。又以归芍地黄汤连进而清其血。五日后又视之，则病全清，惟思食过甚。乃告表弟曰，此时胃气初升，食难化之物，最易反复，宜节之，虽得罪，亦断不可任其多食也。
长夏热病
杨清礼之女，年六七岁亦得热症，请江湖士常治之，常以为温，用荆防败毒汤不效。又请朱医治之，朱素作贾，粗知药性，又以为风，用通圣散而热仍不退。杨不得已，邀余治之，见其脉象沉数，身热如火，告曰，此与余舅母同病，并非风，亦非温，但清其血，热自止。若用荆防等发之，要知春冬腠理为风寒所闭，故用散药解之。此时皮肤皆开，长夏酷热，散之不益耗其气乎。杨曰，医者意在发汗。余曰，无汗，汗之可也。有汗，何容发也。杨又谓，医以为此汗是热天之汗，非应出之汗也，故发之。乃晓之曰，汗无非人身精液，容有二乎。此时之汗从令爱身上流出，难道以药发出之汗，从他人身上出乎！必以为此时之汗为非汗，以药发出之汗为真汗，必使用麻黄柴葛，使汗出不已，真气耗竭而后已。医道不通至此，几何不误人性命耶。杨语塞。请一方，乃仍用三黄解毒汤。杨痴物，久不见，未知应效否，余不愿问之，然亦难保也。
阴亏血热
同谱张月翁之三弟，血燥食重，亦得热病兼喉痛。清张宝玉视之，张吓曰：此红痧蛤蟆瘟也，病甚险，治亦恐不效。其母惊而不安。月翁邀余治。余曰无碍，非痧，非瘟。不过阴亏血热四字耳，二药可愈。月翁疾索方，因以六味地黄汤加芩连进之。次日往见月翁，则其三弟已笑迎於门矣。问其病，则曰，药后酣睡至三更后，则心体具清；此时惟浑身稍软。余戒之日，病初退，尚未痊愈，须节饮食，省奔走方可。不然，再发则无救矣。尚知信从，数日后，入学而读矣。
蓄水喘嗽
月潭之女，年甫周岁，忽喘嗽交作，浑身发热。月潭以为寻常感冒，忽之，越日益甚。适余视其弟病，亦请一视，见其面发赤，身发热，喉中声如锯，臆断曰痰也。必乳母令睡时吃乳，兼膈间有火，故食为火壅而生痰，但得白玉饼两三枚则可矣。月潭令服之。热稍退而腹作胀，喘嗽仍旧。又请余视，以为已愈，细视之，两目昏闭，精神若无，喉间亦如故。月潭曰：看此形恐不救，余曰：何至此，乃视指纹，则红丝出风关，兼按其膈，则胸中作声漉漉然。顿悟曰，前以为痰，乃水也，必小便不利，眼胞虚肿，兼咳而作呕，乳母曰，是。遂开五苓甘露饮，令当茶饮之。次日，月潭邀同进城，问之，则小便十余次，腹减而精神作矣。因劝以再进一煎，两日如初。
大虚腹满梅核作喘
邻人杨本檀之岳母，贫不能自存，衣食悉仰给其婿，而杨亦失业家居，日用颇窘，面目相觑，日抱忧郁，以爱女故，遂增咳喘，肚腹胀满，饮食不思，杨不忍坐视，邀余治之。至则面目黄瘦，气息仅属。告余曰，不食数日，喉中如有物塞者，咽之不下，唾之不出，他人以为时气，请一决之。诊之则六脉沉弱，两尺如丝。告曰，此大虚证也，须大剂峻补之方可，且药必得数十付，再能节思忍气，可保万全。若喉中之物，即所谓梅核气，并非时气，药不三服可去之。杨曰，但使喉中通利，饮食能进，其余缓缓保养。至精神大虚，用药调补，弟近况实艰，药资无从出也。余曰：亦是，乃开四七汤加桔皮，香附以疏之，药入口至夜觉喉中之物如坠于腹者，呼吸通利，药两进则思食，而精神作矣。杨疾告余曰：家岳病似全愈。余曰：不然，四七汤只能疏通道路，与其本病毫无干涉。盖病日久，故觉爽快，若再迟数日，恐饮食仍不进也。且脉象甚不佳，不如听之，徒费银钱无益也。杨然之。
气郁胁痛
里中张士美之妻，以夫不自立，常抱抑郁，而性颇桀骜，一切衣食稍不遂意，辄负气相争。壬戌夏，其次子以食积胃热致喉肿，请邻人张宝玉治之，张不学无术，以针刺其喉，用新白布擦之。越日，益水汁不下，三日而殁。士美之妻因丧子而增病，乃胸膈作痛，饮食不思，终日昏睡，头目眩晕，适余至其家，请一视之。诊其六部沉郁，肝脏尤甚，乃告之曰，此气郁也，数药可愈。但须戒忿怒，不然虽愈将复发也。处以香砂四七汤，三服而痊。
暴怒伤肝热入血室
同谱弟李晓圃，以茂才得广文，后随其堂兄裕州牧理幕事。裕州多得其力，后其堂兄以捻匪滋扰罢任，晓圃随后任守城出力，保举五品衔。辛酉回介，与余往来甚契。一日余至其家，适其侄在坐，似有所求。晓圃代白曰，舍侄因侄孙妇病甚危，已阅十数医矣。愈治愈甚。而此时尚不知何病，拟请大兄一视，果不可为，好备一切。余以至好随入视之，见病者蒙衾侧卧，形如露骨鸡，而面唇甲爪俱白无色。即曰，此血脱象也，得毋产后乎。其母在旁曰，自四月小产后至今不起数月矣。因私计曰，此血大虚之症，用圣愈汤当有效。细视其头面，血络带紫色而棱起，又疑其血分有热，诊之，则六部沉数，左关肝坚欲搏指。乃顿悟曰，此暴怒伤肝，热入血室之候。其人必性情素暴，此病因忿怒而生，此时必两胁胀痛，目赤耳鸣。且土受木克，脾经大虚，脾虚则肺亦伤，当时而咳嗽，时而泄泻，时而发热，时而心惊，虽非痨瘵相离不远。赶紧施治尚有转机，若再迟延，恐无及也。病者就枕点首，妪婢亦以为然。出而告晓圃，大家皆称快，因以加味逍遥散合左金丸并处之。告曰，虽不全愈，亦当有效四服后再视也，越五日，遇晓圃于酒市，问之，则病人不愿服药，缘家务不齐，晓圃亦只听之而已。
食积胸满
间壁郝源林之继室，虽再醮而抚子孙如己出，内外无间言，里党咸重之。秋初忽得不食症，精神馁败，胸膈满闷。且年过五旬，素多辛苦，以子廷楷来求余治，视之，则气乏面枯。问头疼发热否？曰否。诊之，右关独大，余俱平平，知为食积。告曰，病极易治，药须三服必全愈。病者摆手曰！余素不能吃药，吃药则吐，余笑曰，既不服药，此病又非针可除，难道医者只眼一看而病去也?请易以丸何如？病者有难色。其子曰，请一试之，万一丸药亦吐，则听之矣。病者应允，乃令服保和丸不一两当愈。其子为入城买保和丸，劝服之才三四钱许，则膈间作声，晚则洞下数次，越日而起，精神作，且思食也。后遇其子於途，称神者再再。
气郁痰壅
同谱弟张月谭之姊，所适非人，贪而好气，以故时增烦闷，久而生痰，又久而积食，因之精神萎顿，饮食不思，膈满肚胀，自以为痨。一日同入城，月谭邀余诊之，则脉象沉伏，按之至骨而后见。告曰，此气郁痰也。胃气力痰气所壅，则清阳不升，浊阴不降，而头晕目眩，项粗口干，腹满便秘，诸症交作矣。病者称是。乃进以胃苓承气汤，二服后，下秽物十数次。又往视之，病者再三称快。命再一服，即继以香砂六君丸，不及半斤，当健壮倍於昔日矣。
小儿肝疳
里中段克宽之孙，得疳疾不起数日矣。遇野医视之曰：此痞也，割之可愈，乃割其耳根并割其手之虎口，而病不去。又数日，则两眼羞涩难间，头大颈细，腹有青筋，时时张口作睡态，无法可施，段乃抱而问余。余视其形状，告曰，野医以为痞良是，但俗之所谓痞，即古之所谓疳也。病有十余种，五脏六腑皆有此病。令孙所患，乃肝疳也。始而发呕，继而胁胀。肝火上冲于目，故流泪羞明，渐而起云翳。不三月，两目瞽矣。目瞽而病蚀其肝，命亦随之而去，此时尚可挽回，若再迟月余，则无救矣。段以仵作积财，家颇裕，而猥鄙特甚。又告曰：此病性命相关，若重财轻命，小效而中止，不如勿治也。段力表其不能，乃先施退翳散，并逍遥散清其肝服而后来，则翳已清，精神亦好，又处以化痞消疳汤服之。数日遇於途，谢曰，孙病已全愈，天太热不能多服药。余曰：固知尔之吝也，此时病虽去而元气未复，脾部尚虚，不力培之，将复作也，如不愿服药，宜买芦荟消疳丸（生芦荟、胡连、石膏、羚羊角、栀子、牛蒡子、银柴胡、桔梗、生大黄、元参、薄荷、甘草）过半斤而后可。否则再病，勿求余也。段笑而颔之。不知能听之否?乃知龌龊之流，不足与论病，并不足论事也。
食为气滞中脘不通
裕州牧莲舫兄之夫人，号杏云，灵石漪泉翁女也。工书画，善音律，一切博奕棋酒，无所不通。适李时，莲舫尚诸生，劝之读书，不数年得乡举，后以誉录议叙牧裕州。杏云随之往，日行事件，多经其手。而莲舫多萎靡，且好狎邪游，并取二妓。以防捻不力失官，后虽开复，而空坐省城，益不自释，日与夫人反目。辛酉秋，夫人不得已回介，家道式微，翁姑俱老，诸事赖之保全。余曾一次，即为余画桃花春燕扇幅，至足感也。壬戌夏，忽遣人邀余，问之，则杏云病矣。急随之往，则衣饰楚楚，诊其脉，则六部沉伏。余曰：此郁滞也，宜逍遥散。夫人亦知医，点头称是。二服而全。又隔月，余赴捕厅之饮，先见晓圃，晓圃曰，兄来正好，五嫂又病矣，何不一视。入而问之，杏云曰，以为感冒，但觉憎寒发热，肢体沉困，用柴胡四物汤，一服而腹作痛，昨夕犹缓，朝来无止时矣。时疫气流行，恐其为疫，故请大哥一视。诊之则余脉俱平，惟右关颇实而滞。告曰，此非外感，亦非瘟疫，仍是食为气滞，故中脘不通。不惟增痛，且多胀也。况胸间作闷，时时作嗳气，以霍香正气散疏之则无病矣。杏是之，称不谬。乃处一方。越二日，遇晓圃於酒市，问之，则日二服全愈，家五嫂命致谢焉。
定襄西厅程裕堂，是京都人，初春到任，但定襄的缺职极其贫困，年收入不足二百两银子，而且当地风俗尤其粗鄙落后，日常起居生活大多不顺心。又因为老母亲在京城，接来供养则财力不济，不接来又不行，因此忧思抑郁，手上长了一个疔疮，请当地的牛医生治疗，牛医生多次施以针灸，半个月后才痊愈。然而程裕堂素来有积滞，加上近日忧郁，导致胸膈胀满，不想饮食，精神萎靡倦怠，面目消瘦，牛医生认为是病后大虚，用桂枝、附子补益他，服了两剂后胀满更加严重。他知道我在县衙，急忙穿戴整齐来拜访，幼安询问他的病情，就指着我对他说：“润翁医术如神，山陕地区的各位好友，没有不佩服的，应该请他来治疗。”我诊察他的脉象，六部脉皆沉数，右关脉坚硬有力几乎搏指。我笑着说：“您腹中就像塞了一口井并投入石头，积滞没有空隙，当然饮食减少。这是有余的病症，急需攻下，就能舒畅。如果误认为是虚证，那就背道而驰了。”程裕堂说：“精神萎靡困顿，肌肉消瘦，不是虚证是什么？”我说：“庸医只知道书上的病，不知道身上的病，哪有这种道理？精神不足，是因为气血流通不畅；肌肉消瘦，是因为饮食不能化生精微的缘故。脾胃是受纳和转输的器官，有积滞就无法受纳，有停滞就不能转输，胃气一旦停歇，百脉都会败坏，难怪会这样。”程裕堂请求开一方，我用对金饮合保和汤一起给他服用。服了两剂后胸腹部发出声响，腹泻出秽物数次，顷刻间饥饿难忍，神气也清爽了。晚上提着灯笼前来，趴在地上叩头说：“这方子真是灵丹妙药，之前还不太深信，现在才知道庸医多误人。”我说：“人的腹中就像常平仓，最需要年年陈粮换新粮才好，只是旧积既去，胃气尚弱，新食物入口，更容易停滞，必须节俭饮食。”程裕堂点头称是。随即写信邀请我，我怜悯他困苦极力推辞。第二天我收拾行装回乡，程裕堂派差役送我到几里外。当时雨后泥泞，凡是难走的地方，就让人转轮背负车轮前行，我打发他们回去，他们说：“家主之命不敢违抗。”走了十里后才返回。
热病误治
我的舅母王氏，守节三十年，生活清苦且日益坚定，操持家政，如今已抱孙子。她体质素来虚弱但不怎么服药。壬戌年夏天，突然得了热症，烦躁不安，浑身像火一样烫。起初请她的族女婿董某治疗。董某本来医术平庸，以为是风邪，用小柴胡汤发汗。第二天，热势几乎像发狂一样，时而昏迷不认识人。表弟因农忙无暇顾及，派人告诉我，我急忙前往诊治。全家惊恐害怕。诊察后发现两手脉沉数无其他异常，只有舌苔焦黑，言语接近蹇涩，但心神很清醒。于是告诉他们：“这是热病。董某用温法治疗，所以错了。此时必然膈间胀闷，咽干口渴，大便秘结，小便黄赤。幸好血分尚清，没有斑疹痧痘等类症状，虽然形症危急，但尚易治疗。”于是问她想喝凉水吗？她说很想喝。于是命令取两碗新汲水让她满饮，顷刻间觉得头目都清爽了，接着给予三黄解毒煎合犀角地黄汤。服了两剂后热退。又用归芍地黄汤连续服用以清血分之热。五日后再次诊治，病全好了，只是想吃东西过多。于是告诉表弟：“此时胃气初升，难以消化的食物最容易导致反复，应当节制，即使得罪人，也绝对不可任由其多吃。”
长夏热病
杨清礼的女儿，六七岁，也得了热症，请江湖士人常某治疗，常某以为是温病，用荆防败毒汤无效。又请朱医生治疗，朱某向来做买卖，粗略知道药性，又以为是风邪，用通圣散而热仍不退。杨某不得已，邀请我治疗，见其脉象沉数，身热如火，告诉他：“这与我的舅母是同一种病，并非风邪，也不是温病，只要清血分之热，热自然停止。如果用荆芥、防风等发散药物，要知道春冬季节腠理被风寒闭塞，所以用散药解表。此时皮肤毛孔皆开，正值长夏酷热，再发散岂不是更耗伤正气吗？”杨某说：“医生的意图在于发汗。”我说：“无汗，可以发汗。有汗，何必再发呢？”杨某又说：“医生认为这汗是热天的汗，不是该出的汗，所以要发汗。”于是开导他说：“汗无非是人身的精液，难道有两种吗？此时这汗从令爱身上流出，难道用药发出的汗是从别人身上出来吗！如果一定认为此时的汗不是汗，用药发出的汗是真汗，必定使用麻黄、柴胡、葛根，使汗出不止，直到真气耗竭才罢休。医学道理不通到这个地步，有多少人会误人性命呢？”杨某语塞。请求开一方，我还是用三黄解毒汤。杨某痴迷于财物，很久不见，不知是否有效，我不愿过问，但也难保证疗效。
阴亏血热
同宗张月翁的三弟，血燥食重，也得了热病兼喉痛。清河县张宝玉诊治，张某吓唬说：“这是红痧蛤蟆瘟，病很危险，治疗恐怕无效。”他的母亲惊慌不安。月翁邀请我治疗。我说：“无碍，不是痧，不是瘟。不过是阴亏血热四个字罢了，两味药即可治愈。”月翁急忙索要方子，于是用六味地黄汤加黄芩、黄连给他服用。第二天去见月翁，他的三弟已经在门口笑着迎接了。询问病情，他说：“服药后酣睡到三更以后，身体就清爽了；此时只是浑身稍软。”我告诫他说：“病刚退，尚未痊愈，必须节制饮食，减少奔走才可以。否则，再发作就无救了。”他还知道听从，几天后，入学读书了。
蓄水喘嗽
月潭的女儿，刚满周岁，突然喘嗽交替发作，浑身发热。月潭以为是寻常感冒，忽视它，一天比一天严重。恰好我去看他弟弟的病，也请我看一眼，见她面发红，身发热，喉中声音像拉锯一样，我主观判断为痰。一定是乳母让她睡觉时吃奶，加上膈间有火，所以食物被火壅塞而生痰，只要吃两三枚白玉饼就可以了。月潭让她服用。热稍退但腹部胀气，喘嗽依旧。又请我去看，以为已经好了，仔细一看，两眼昏闭，精神若无，喉间依然如故。月潭说：“看这个情形恐怕救不活了。”我说：“怎么会这样？”于是查看指纹，红丝出于风关，兼按她的膈部，胸中发出漉漉声。顿时醒悟：“之前以为是痰，其实是水，必然小便不利，眼睑虚肿，兼咳嗽作呕。”乳母说：“是的。”于是开五苓甘露饮，让她当茶饮用。第二天，月潭邀我进城，问起病情，则小便十几次，腹部减消而精神恢复。于是劝她再进一剂，两天后如初。
大虚腹满梅核作喘
邻居杨本檀的岳母，贫穷无法自存，衣食全靠女婿供给，而杨本檀也失业在家，日用颇为窘迫，两人面面相觑，日日怀抱忧郁，因为疼爱女儿，于是增加咳喘，肚腹胀满，不想饮食，杨本檀不忍心坐视，邀请我治疗。到了那里，见她面目黄瘦，气息仅存。告诉我：“好几天不吃饭，喉中好像有东西堵塞，咽不下去，吐不出来，别人以为是时气，请您决断一下。”诊察发现六脉沉弱，两尺脉如丝。告诉她：“这是大虚证，必须用大剂峻补才可以，而且药必须得几十付，再加上能节制思虑、忍耐怒气，可以保全万无一失。如果喉中之物，就是所谓的梅核气，并不是时气，药不过三服就可以去除。”杨本檀说：“只要使喉中通畅，饮食能进，其余慢慢保养。至于精神大虚，用药调补，我近况确实艰难，药资无处出啊。”我说：“也是。”于是开四七汤加桔皮、香附以疏利，药入口至夜间感觉喉中之物如坠入腹中，呼吸通畅，药服两次就想吃东西，精神也恢复了。杨本檀急忙告诉我：“家岳的病似乎全愈了。”我说：“不然，四七汤只能疏通道路，与她的本病毫无关系。因为病日久，所以觉得爽快，如果再迟几天，恐怕饮食仍不进。而且脉象很不好，不如听之，徒费银钱无益。”杨本檀认为对。
气郁胁痛
乡里的张士美之妻，因为丈夫不自立，常怀抱抑郁，而且性格颇为桀骜，一切衣食稍不顺心，就负气争吵。壬戌年夏天，她的次子因食积胃热导致喉肿，请邻居张宝玉治疗，张某不学无术，用针刺其喉，用新白布擦拭。第二天，连水汁都喝不下，三天后死亡。士美的妻子因为丧子而加重病情，于是胸膈作痛，不想饮食，终日昏睡，头目眩晕，恰好我到他家，请我看一眼。诊察六部脉沉郁，肝脏尤甚，于是告诉她：“这是气郁，几服药可以治愈。但必须戒除愤怒，否则虽然痊愈也将复发。”处以香砂四七汤，三服后痊愈。
暴怒伤肝热入血室
同宗弟弟李晓圃，以茂才身份获得广文官职，后来跟随他的堂兄裕州牧处理幕僚事务。裕州多得他的助力，后来他的堂兄因为捻匪滋扰被罢任，晓圃随后任守城出力，保举五品衔。辛酉年回介休，与我往来甚为亲密。有一天我到他家，恰好他的侄子在场，似乎有所求。晓圃代为说明：“舍侄因为侄孙妇病得很危重，已经看了十几个医生了。越治越重。而此时还不知道是什么病，打算请大哥你看一眼，如果真的不可为，也好准备一切后事。”我以至好的身份随进去诊治，见病人蒙着被子侧卧，形体像露骨的鸡，而面唇指甲爪都苍白无色。就说：“这是血脱的征象，莫非是产后吗？”她的母亲在旁边说：“自从四月小产至今不起床几个月了。”于是私下想：这是血大虚的病症，用圣愈汤应当有效。仔细看她的头面，血络带紫色而棱起，又怀疑她血分有热，诊察发现六部脉沉数，左关肝脉坚硬欲搏指。于是顿悟：“这是暴怒伤肝，热入血室的征候。这个人必定性情素来暴躁，这个病因忿怒而生，此时必然两胁胀痛，目赤耳鸣。而且土受木克，脾经大虚，脾虚则肺也受伤，当时而咳嗽，时而泄泻，时而发热，时而心惊，虽然不是痨瘵，也不远了。赶紧施治尚有转机，如果再迟延，恐怕来不及了。”病人就枕点头，婆媳婢女也都以为然。出来告诉晓圃，大家都称快，于是用加味逍遥散合左金丸并处之。告诉他说：“虽然不能全愈，也应当有效，四服后再来看。”过了五天，在酒市遇到晓圃，问起病情，则病人不愿服药，因为家务不齐，晓圃也就听之而已。
食积胸满
隔壁郝源林的继室，虽然再嫁但抚养子孙如同己出，内外没有闲话，乡里人都尊重她。秋初突然得了不食症，精神萎靡败坏，胸膈满闷。而且年过五十，素来多辛苦，以儿子廷楷来求我治疗，看她，则气乏面枯。问她头疼发热吗？她说没有。诊察发现右关脉独大，其余平平，知道是食积。告诉她：“病极易治，药须三服必全愈。”病人摆手说：“我素来不能吃药，吃药则吐。”我笑着说：“既然不服药，这病又不是针可除，难道医者只眼一看而病去也？请改为丸药如何？”病人面露难色。她儿子说：“请试一试，万一丸药也吐，那就听之了。”病人应允，于是令服保和丸，不一两应当痊愈。她儿子进城买保和丸，劝服人才三四钱许，则膈间作声，晚上则腹泻数次，第二天起来，精神恢复，而且想吃东西了。后来在路上遇到她儿子，称赞神奇者一再。
气郁痰壅
同宗弟弟张月谭的姐姐，所嫁非人，贪婪而好气，因此时常增加烦闷，久了而生痰，又久了积食，因而精神萎顿，不想饮食，膈满肚胀，自以为患痨病。一天一同进城，月谭邀我诊脉，则脉象沉伏，按之至骨而后见。告诉他：“这是气郁痰阻。胃气被痰气所壅塞，则清阳不升，浊阴不降，而头晕目眩，项粗口干，腹满便秘，诸症交作矣。”病人说是。于是进以胃苓承气汤，二服后，下秽物十数次。又去探望，病人再三称快。命再服一剂，紧接着以香砂六君丸，不到半斤，应当健壮倍于昔日了。
小儿肝疳
乡里段克宽的孙子，得疳疾不起数日了。遇到野医诊治说：“这是痞块，割开可以治愈”，于是割了他的耳根并割开他手的虎口，而病不去。又几天，则两眼羞涩难睁，头大颈细，腹有青筋，时时张口作睡态，无法可施，段某乃抱来问我。我看他的形状，告诉他：“野医以为是痞良是，但俗世所说的痞，即古世所说的疳也。病有十余种，五脏六腑皆有此病。令孙所患，乃是肝疳也。始而发呕，继而胁胀。肝火上冲于目，故流泪羞明，渐而起云翳。不三月，两目瞽矣。目瞽而病蚀其肝，命亦随之而去，此时尚可挽回，若再迟月余，则无救矣。”段某以仵作积财，家颇富裕，而猥鄙特甚。我又告诉他：“此病性命相关，若重财轻命，小效而中止，不如勿治也。”段某极力表示不能（不治），于是先施退翳散，并逍遥散清其肝，服后来，则翳已清，精神亦好，又处以化痞消疳汤服之。数日在路上遇到，谢曰：“孙病已全愈，天太热不能多服药。”我说：“固知尔之吝也，此时病虽去而元气未复，脾部尚虚，不力培之，将复作也，如不愿服药，宜买芦荟消疳丸（生芦荟、胡连、石膏、羚羊角、栀子、牛蒡子、银柴胡、桔梗、生大黄、元参、薄荷、甘草）过半斤而后可。否则再病，勿求余也。”段某笑而颔之。不知能否听从？乃知龌龊之流，不足与论病，并不足论事也。
食为气滞中脘不通
裕州牧莲舫兄之夫人，号杏云，灵石漪泉翁之女也。工书画，善音律，一切博奕棋酒，无所不通。适李氏时，莲舫尚诸生，劝之读书，不数年得乡举，后以誉录议叙牧裕州。杏云随之往，日行事件，多经其手。而莲舫多萎靡，且好狎邪游，并取二妓。以防捻不力失官，后虽开复，而空坐省城，益不自释，日与夫人反目。辛酉秋，夫人不得已回介休，家道式微，翁姑俱老，诸事赖之保全。我曾一次，即为余画桃花春燕扇幅，至足感也。壬戌夏，忽遣人邀余，问之，则杏云病矣。急随之往，则衣饰楚楚，诊其脉，则六部沉伏。我说：“此郁滞也，宜逍遥散。”夫人亦知医，点头称是。二服而全。又隔月，余赴捕厅之饮，先见晓圃，晓圃曰：“兄来正好，五嫂又病矣，何不一视。”入而问之，杏云曰：“以为感冒，但觉憎寒发热，肢体沉困，用柴胡四物汤，一服而腹作痛，昨夕犹缓，朝来无止时矣。时疫气流行，恐其为疫，故请大哥一视。”诊之则余脉俱平，惟右关颇实而滞。告曰：“此非外感，亦非瘟疫，仍是食为气滞，故中脘不通。不惟增痛，且多胀也。况胸间作闷，时时作嗳气，以霍香正气散疏之则无病矣。”杏云是之，称不谬。乃处一方。越二日，遇晓圃於酒市，问之，则日二服全愈，家五嫂命致谢焉。
Cheng Yutang, the West Hall official of Dingxiang, was from Beijing. He took up his post in early spring but found the position extremely poor; his annual income was less than two hundred taels of silver. Moreover, local customs were particularly crude and backward, making daily life largely unsatisfactory. Since his elderly mother was in Beijing, he faced a dilemma: bringing her to support her was financially impossible, yet not bringing her was unthinkable. Burdened by worry and depression, a ding (a type of furuncle) developed on his hand. A local doctor named Niu treated him with repeated acupuncture sessions, and it healed after half a month. However, Cheng had a history of food stagnation, compounded by recent melancholy, leading to chest and diaphragm distension, loss of appetite, mental fatigue, and emaciation. Dr. Niu diagnosed this as severe deficiency after illness and prescribed Guizhi Tang (Cinnamon Twig Decoction) and Fuzi (Aconite Root) for tonification. After two doses, the distension worsened. Hearing that I was at the county yamen, he hurriedly dressed and came to visit. You'an asked about his condition and pointed to me, saying, "Dr. Run's medical skills are divine; all our friends in Shanxi and Shaanxi admire him. You should invite him to treat you." Upon examining his pulse, I found it deep and rapid in all six positions, with the right Guan position hard and forceful, almost pounding against the fingers. I smiled and said, "Your abdomen is like a well blocked with stones; the stagnation leaves no room, which explains your reduced intake. This is an excess syndrome requiring urgent purgation to restore comfort. Misdiagnosing it as deficiency would be contrary to the truth." Cheng replied, "My spirit is listless and my muscles wasted; how can this not be deficiency?" I said, "Quack doctors only know diseases from books, not those manifested on the body. Listlessness results from poor circulation of Qi and Blood; emaciation results from the inability of food to generate essence. The Spleen and Stomach are the officials of reception and transportation. With stagnation, they cannot receive; with blockage, they cannot transport. Once Stomach Qi halts, all meridians deteriorate, hence these symptoms." Cheng requested a prescription. I combined Duijin Yin (Golden Pair Drink) with Baohe Tang (Preserve Harmony Decoction). After two doses, sounds were heard in his chest and abdomen, followed by several evacuations of foul matter. Instantly, he felt intense hunger and his spirit cleared. That evening, he came carrying a lantern, prostrated himself, and said, "This prescription is truly a miraculous elixir. I did not fully believe it before, but now I see how often quacks err." I said, "The abdomen is like a granary; it must constantly exchange old grain for new. However, once old stagnation is removed, Stomach Qi is still weak, and new food easily stagnates again. You must eat sparingly." Cheng nodded. He then sent an invitation letter, which I declined out of pity for his poverty. The next day, as I packed to return home, Cheng sent an attendant to escort me several miles. Due to mud after rain, where carts could not pass, people carried the wheels. When I dismissed them, they insisted, "We dare not disobey our master's orders," and walked ten li before returning.
Mismanagement of Febrile Disease
My maternal aunt, Mrs. Wang, had observed widowhood for thirty years, living frugally and managing the household well, now having grandchildren. She was constitutionally weak but rarely took medicine. In the summer of Renxu year, she suddenly contracted a febrile disease, characterized by restlessness and a burning sensation throughout her body. Initially, her clan son-in-law, Dong, treated her. Lacking skill, Dong suspected wind pathogen and administered Xiaochaihu Tang (Minor Bupleurum Decoction) to induce sweating. The next day, her fever intensified to near-delirium, with periods of unconsciousness. My cousin, busy with farm work, sent for me urgently. Upon arrival, the family was terrified. Her pulses were deep and rapid in both hands without other abnormalities, except for a scorched black tongue coating and slightly slurred speech, though her mind remained clear. I stated, "This is a febrile disease. Dong used warming methods incorrectly. She likely suffers from diaphragmatic fullness, dry throat, thirst, constipation, and dark yellow urine. Fortunately, the blood level is clear without macules or petechiae. Though critical, it is treatable." I asked if she desired cold water; she did. I ordered two bowls of fresh well-water, which she drank completely. Immediately, her head and eyes felt clear. I then prescribed Sanhuang Jiedu Jian (Three-Yellow Detoxification Decoction) combined with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). After two doses, the fever subsided. Subsequently, Guishao Dihuang Tang (Rehmannia with Angelica and White Peony Decoction) was given continuously to clear heat from the blood. Five days later, she was fully recovered, except for an excessive desire to eat. I advised my cousin, "Stomach Qi is just rising; indigestible foods easily cause relapse. Restrain her diet, even if it causes offense, do not allow overeating."
Febrile Disease in Late Summer
Yang Qingli's daughter, aged six or seven, contracted a febrile disease. A wandering practitioner named Chang treated her, suspecting warm pathogen, and used Jingfang Baidu Tang (Schizonepeta and Saposhnikovia Decoction to Overcome Toxicity) without effect. Then Doctor Zhu was consulted. Zhu, formerly a merchant with rudimentary herbal knowledge, suspected wind pathogen and prescribed Tongsheng San (Universal Salvation Powder), but the fever persisted. Desperate, Yang invited me. Her pulse was deep and rapid, and her body burned like fire. I told him, "This is the same as my aunt's case, neither wind nor warm pathogen. Clear the blood heat, and the fever will stop. Using Jingjie and Fangfeng to disperse is wrong. In spring and winter, pores are closed by wind-cold, so dispersants are used. Now, in late summer heat, pores are open; dispersing further will consume Qi." Yang argued, "The doctor intends to induce sweat." I replied, "If there is no sweat, inducing it is acceptable. If there is sweat, why induce more?" Yang added, "Doctors consider this sweat merely due to hot weather, not physiological sweat, hence the need to induce." I enlightened him, "Sweat is essentially body fluids; there is no distinction. This sweat comes from your daughter's body; would induced sweat come from someone else? If you insist on using Mahuang (Ephedra), Chaihu (Bupleurum), and Gegen (Pueraria) to force endless sweating until Qi is exhausted, you risk killing patients. How many lives have been lost due to such ignorance?" Yang was speechless. I prescribed Sanhuang Jiedu Tang (Three-Yellow Detoxification Decoction). Yang, obsessed with wealth, never returned to check efficacy, which I did not inquire about, though success was uncertain.
Yin Deficiency with Blood Heat
Mr. Zhang Yueweng's third brother suffered from dry blood and heavy digestion, contracting a febrile disease with sore throat. Dr. Zhang Baoyu from Qing County examined him and frightened him by diagnosing Hongsha Hamawang (Red Rash Toad Plague), claiming it was dangerous and likely untreatable. His mother was anxious. Mr. Zhang invited me. I said, "No danger. It is neither rash nor plague, merely Yin deficiency with blood heat. Two herbs will cure it." Mr. Zhang urgently requested the prescription. I prescribed Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) modified with Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome). The next day, upon visiting Mr. Zhang, his brother was smiling at the door. He reported, "After taking the medicine, I slept soundly until midnight, after which my body felt clear; only slight weakness remains." I warned, "The disease has just receded; maintain dietary restraint and avoid exertion. Otherwise, relapse may occur, which would be incurable." He listened, and after a few days, returned to school.
Water Retention with Wheezing and Cough
Yu Tan's daughter, just one year old, suddenly developed alternating wheezing and coughing with fever. Yu Tan assumed it was a common cold and ignored it, but it worsened daily. While visiting her brother, I was asked to examine her. Her face was red, body hot, and throat sounded like sawing. I initially hypothesized phlegm, assuming the wet nurse fed her while sleeping and internal heat obstructed digestion, producing phlegm. I suggested giving two or three Baiyu Bing (White Jade Cakes). After administration, fever subsided slightly, but abdominal distension persisted, and wheezing continued. Re-examining her, I noted her eyes were dull and closed, spirit lethargic, and throat sounds unchanged. Yu Tan feared death. I checked her fingerprint, finding a red thread extending to the Wind Gate, and palpated her diaphragm, hearing gurgling sounds. I realized, "It is not phlegm, but water retention. There must be difficult urination, puffy eyelids, and vomiting with cough." The wet nurse confirmed this. I prescribed Wuling Ganlu Yin (Five-Ling Sweet Dew Decoction) to be drunk as tea. The next day, upon inquiry, she had urinated over ten times, abdominal distension resolved, and spirit improved. I recommended another dose, and within two days, she recovered fully.
Severe Deficiency, Abdominal Distension, and Plum-Pit Qi
The mother-in-law of neighbor Yang Bentan was impoverished, relying entirely on her son-in-law, who was also unemployed and struggling financially. Both lived in sorrow. Out of love for his daughter, Yang Bentan invited me to treat his mother-in-law, who suffered from increased coughing and wheezing, abdominal distension, and anorexia. Upon arrival, she appeared sallow and emaciated, with faint breathing. She reported days of not eating and a sensation of obstruction in the throat, unable to swallow or spit out, which others attributed to seasonal qi. Her pulses were deep and weak, with the Chi positions thread-like. I diagnosed severe deficiency requiring strong tonification with dozens of doses, along with emotional regulation. The throat sensation was Plum-Pit Qi (Meiheqi), not seasonal qi, and would resolve in three doses. Yang Bentan pleaded for relief of the throat and appetite first, citing financial hardship for expensive tonic prescriptions. I agreed and prescribed Siqi Tang (Four-Seven Decoction) with Jupi (Tangerine Peel) and Xiangfu (Cyperus Rhizome) to regulate Qi. By night, the throat obstruction felt like it had descended into the abdomen, breathing became smooth, and after two doses, appetite returned and spirit improved. Yang Bentan reported apparent recovery. I cautioned, "Siqi Tang only unblocks pathways and does not address the root deficiency. The temporary relief is due to long-standing stagnation. If delayed further, appetite may fail again. The pulse is poor; continuing treatment may waste money without benefit." Yang Bentan accepted this.
Qi Stagnation with Hypochondriac Pain
Mrs. Zhang Shimei, whose husband was unreliable, lived in constant depression and had a rebellious nature. Any dissatisfaction with food or clothing led to arguments. In the summer of Renxu year, her second son died of throat swelling caused by food stagnation and stomach heat, following improper treatment by neighbor Zhang Baoyu, who used acupuncture and cloth wiping. Mrs. Zhang's grief exacerbated her condition, causing chest pain, anorexia, drowsiness, and dizziness. Upon examination, her pulses were deep and stagnant, especially in the Liver position. I diagnosed Qi stagnation, curable in a few doses, provided she avoided anger. I prescribed Xiangsha Siqi Tang (Cyperi and Amomum Four-Seven Decoction). She recovered after three doses.
Violent Anger Injuring Liver and Heat Entering the Blood Chamber
My cousin Li Xiaopu, a scholar-official, served under his uncle, the Prefect of Yuzhou. After his uncle was dismissed due to Nian rebel disturbances, Xiaopu contributed to city defense and received a fifth-rank honor. Returning to Jiexiu in Xinyou year, we became close friends. One day, his nephew sought help for his niece-in-law, who had been critically ill for months despite seeing numerous doctors. I examined the patient, who lay wrapped in blankets, emaciated with pale lips and nails. I identified signs of Blood depletion and suspected postpartum complications. Her mother revealed she had suffered a miscarriage in April and had been bedridden since. Suspecting severe Blood deficiency, I considered Shengyu Tang (Holy to Restore Life Decoction). However, observing purple, raised blood vessels on her face and a deep, rapid pulse with a hard left Guan position, I realized this was violent anger injuring the Liver, with heat entering the Blood Chamber. The patient likely had a volatile temperament, experiencing hypochondriac pain, red eyes, tinnitus, and subsequent Spleen and Lung damage manifesting as cough, diarrhea, fever, and palpitations. Without immediate treatment, consumption (Laozai) might develop. I prescribed Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) combined with Zuojin Wan (Left Metal Pill). I warned that while full recovery was unlikely, improvement was expected in four doses. Five days later, Xiaopu informed me the patient refused medication due to household disputes, and the matter was dropped.
Food Stagnation with Chest Fullness
The second wife of Hao Yuanlin, a neighbor, managed the household well and was respected locally. In early autumn, she developed anorexia, mental fatigue, and chest fullness. At over fifty years old and accustomed to hard labor, her son Tingkai sought my help. She appeared Qi-deficient and sallow, denying headache or fever. Her right Guan pulse was prominent, indicating food stagnation. I assured her it was easily curable in three doses. She refused decoctions due to previous vomiting experiences. I offered pills instead. Her son consented to try Baohe Wan (Preserve Harmony Pills). She took only three or four qian, after which sounds arose in her diaphragm, followed by nocturnal diarrhea. The next day, she rose with restored spirit and appetite. Her son later praised the treatment repeatedly.
Qi Stagnation with Phlegm Obstruction
The sister of cousin Zhang Yuetan married poorly and was greedy and irritable, leading to chronic irritability, phlegm production, and food stagnation. She suffered from mental lethargy, anorexia, chest and abdominal distension, and suspected tuberculosis. Upon examination, her pulse was deep and hidden, visible only with heavy pressure. I diagnosed Qi stagnation with phlegm obstruction. The Stomach Qi was blocked by phlegm, preventing clear Yang from ascending and turbid Yin from descending, causing dizziness, thick neck, dry mouth, abdominal fullness, and constipation. I prescribed Weiling Chengqi Tang (Weiling and Dachengqi Decoction). After two doses, she evacuated foul matter multiple times and expressed great relief. A subsequent dose of Xiangsha Liujun Wan (Cyperi and Amomum Six-Gentleman Pill) restored her strength significantly.
Pediatric Liver Gan Disease
Duan Kekuan's grandson suffered from Gan disease (malnutrition/parasitic disorder) for several days. A folk healer misdiagnosed it as Pi (abdominal mass) and incised his earlobe and tiger's mouth, worsening the condition. Days later, the child exhibited sunken eyes, large head, thin neck, visible abdominal veins, and sleep-like mouth opening. Duan brought him to me. I explained that folk 'Pi' corresponds to ancient 'Gan'. There are various types affecting different organs; this was Liver Gan. Symptoms included initial vomiting, then hypochondriac distension. Liver fire rising caused tearing and photophobia, progressing to corneal opacity (cloudy film). Within three months, blindness would ensue, followed by liver destruction and death. Although salvageable, delay beyond a month would be fatal. Duan, wealthy but stingy, hesitated. I advised that prioritizing money over life leads to abandonment after minor improvements. He agreed to treatment. I applied Tu Yi San (Film-Removing Powder) and Xiaoyao San (Free and Easy Wanderer Powder) to clear the Liver. The cloudiness cleared, and spirit improved. I then prescribed Huapi Xiao Gan Tang (Abdominal Mass and Gan Disease Resolving Decoction). Days later, the grandson was cured, though Duan cited heat to limit medication. I warned that although the disease was gone, Yuan Qi (Original Qi) and Spleen were still weak. Without robust tonification, relapse was certain. I recommended Lubin Xiao Gan Wan (Aloe Vera Gan Resolving Pills) exceeding half a jin. Duan smiled but his compliance was doubtful, illustrating that petty individuals are unworthy of discussing health matters.
Food Stagnation Causing Middle Jiao Blockage
Madam Xingyun, wife of Prefect Lianfang, was the daughter of Mr. Yiquan from Lingshi. Skilled in calligraphy, music, and games, she assisted her husband, who rose from student to Prefect of Yuzhou through merit. She managed daily affairs efficiently. However, Lianfang became decadent, frequented prostitutes, and lost his post due to ineffective suppression of rebels. Although reinstated, he sat idly in the provincial capital, estranged from his wife. In autumn of Xinyou year, Madam Xingyun returned to Jiexiu due to declining family fortunes and aging parents. She once painted a peach blossom fan for me, which I deeply appreciated. In summer of Renxu year, she fell ill. Upon examination, her clothes were neat, but her pulse was deep and hidden in all positions. I diagnosed Qi stagnation and prescribed Xiaoyao San (Free and Easy Wanderer Powder). As she understood medicine, she agreed. She recovered after two doses. A month later, at a banquet, Xiaopu informed me that Sister Wu (Madam Xingyun) was ill again. She complained of chills, fever, and limb heaviness, suspecting epidemic disease. After taking Chaihu Siwu Tang (Bupleurum and Four Substance Decoction), she experienced abdominal pain that worsened throughout the day. Examination showed normal pulses except for a solid and stagnant right Guan position. I diagnosed food stagnation causing Qi blockage in the Middle Jiao, not external contraction or epidemic. Symptoms included pain, distension, chest oppression, and belching. I prescribed Huoxiang Zhengqi San (Agastache and Patchouli Powder to Rectify the Qi). She agreed, and after two doses, she fully recovered, sending thanks via Xiaopu.