因挽以一联云∶飘泊正无聊,感廿载神交。萍聚申江,将检残编求品鉴,考终原是福,径一
朝仙去,风凄秋夜,那堪衰鬓丧知音。
次女定宜年二十,体实耐劳,适同邑戴氏。初旬接女夫信云∶女于八月二十三日,忽患痛泻
,
形渐脱。又用附桂八味汤,遂于二十九日舌焦如炭而逝。弥留时语婿曰∶吾父在此,病不
至是也。噫!据此病情,是伏暑也。戴氏为积德世医家,余曩刻业书十种,渠处皆有,竟使
误药而亡,良可惨已。邮挽
游,说不
,试遍了燥热寒凉诸谬药,回忆昔年鞠育,徒倾我泪洒秋风。呜呼!良朋爱女,同病同日而
亡,斯重订之役,尤不可已矣。并附挽言,一以志交情,一以志药误也。
霜降前,水北族侄棋偕,邀勘所亲蒋君循庵之媳,患霍乱转筋,交三日矣。
厥逆目窜,膈闷无溺,苔黄苦渴,脉极弦细,屡进桂、附、姜、术,气逆欲死。予昌阳泻心汤加减,煎成徐
服。外以吴萸研末卤调,贴涌泉穴。服二剂,吐止足温。去苏朴,加楝、斛、蒲公英多剂,
始痊。盖伏暑挟素盛之肝阳为病,误服温补,以致遽难廓清也。禾中方氏女,播迁三载,秋
仲抵申。患吐泻,其戚钱伯声孝廉邀余视之,一药而瘥。既而患肿,因在旅寄,竟不调治。
交霜降,肿忽消,不数日。又患霍乱,即神气瞀乱,屋中盘走,口呼姊姊,乃姊强纳之卧,
两目旋转不停,泪涔涔下,牙关即紧,欲延余诊,竟不及也。伯声询故,余曰∶此流离困苦
,忧郁深沉,木土相乘,吐泻而肿,节交霜降,气肃肿消,郁无所宣,直凌脾胃,吐泻陡作
,木火勃升,狂走目张,阳从上越,此情志内伤霍乱也。故告危如是之速。
南浔沈春泉,年五十七,立冬前五日,食蟹面后,陡患霍乱转筋,所吐泻者皆水。初进桂附
药,筋转益甚,周身微汗,神倦懒言,指渐冷,脉渐伏,时欲太息。更方,用牡蛎一两,龟
版八钱,阿胶四钱,服后势较剧。延余视之,苔黄大渴,小便全无,泻出极热,心下拒按,
伏暑挟食之证,不知何所见而予燥补涩腻之药,乃病家谓其品学书画甚优,故深信而不疑,
竟以不起,可怜又可笑也。嗣闻其次郎,于立冬后亦患此证,医知伏暑,用黄连等药,吐泻
已止。因脉未遽起,不知为伏热不清,改投附桂等三帖而亡,尤可哀已。
上虞罗吉人,立冬前,患霍乱转筋,子耘知其阴素亏,病由伏暑也。服药已得转机,数日后
,渐有呃忒。延余视之,脉弦数,左甚,苔焦而渴,龈衄脘闷,便溏色酱,小便短赤,皆伏
暑未清,气机阻塞之象。既失清肃,乃当脐尚帖回阳膏,屡嘱揭去而不从,后闻不起,此非败
证,余深惜之。
南浔张二梅,年逾六旬,秋间患霍乱转筋,医见高年而厥逆多汗,拟进温补,张不敢服。但
用平淡单方,及外治法而瘥。然从此大便不坚,时时自汗,遍身疮疥,畏热异常。延至立冬
后,邀余诊之,脉甚滑数,口渴苔黄,便溺皆热,犹着袷衣。是赋质偏阳,湿热内盛。幸而
畏进温补,得以引年,与大剂清化法渐愈。又今年患疥者,举目皆是,所谓遍地疮痍,洵非虚
语。外治之方甚多,而平善者罕效。更有治不得法,疮骤愈而变证,遽陨其生者。毒陷内讧
也。子耘传一方颇佳,以麻黄一两,川椒五钱,蛇床子五钱,斑蝥七枚,雄猪油或地沥青熬透
去渣,另用明矾、黄柏各一两,蓖麻子、大枫子各四十粒,共研末,入油内,绢包,擦患处
,能拔蕴毒伏邪。未出旬日可愈。无后患,此与火酒摩转筋之义正同,勿以药猛而訾之,故附
无征不信,有法可师,爰采群书,南针是仰,然病情之幻伏,犹敌情之谲觚,似是而非,云非
倪。谬以身经,附为梦影。盖时移事易,境似炊粱,而比烛拟 ,
痴同扪龠。或竹头木屑,亦大匠所需。敢质通方,毋嗤琐陋,故列医案第三。
于是写了一副挽联说:漂泊无依正觉无聊,感念二十年的神交之谊。在申江(上海)萍水相逢,正准备翻阅残存的书稿请求品鉴,没想到寿终正寝原是福气,却突然一朝仙逝。秋风凄厉,怎忍心在这衰鬓之年丧失知音。
次女定宜年仅二十岁,身体结实能耐劳苦,嫁给了同县的戴家。月初接到女婿的信说:女儿在八月二十三日,忽然患上痛泻,身形逐渐消瘦脱力。又使用了附桂八味汤,结果在二十九日舌头焦黑如炭而去世。临终时对女婿说:我父亲在这里,病不至于到这个地步啊。唉!根据这个病情,这是伏暑证。戴家是积德的世代医家,我过去刻印的《王氏医书十种》,他们那里都有,竟然因为误药而死,实在令人悲惨啊。寄去邮资慰问游氏家族,说不尽的悲痛,试遍了燥热、寒凉等各种错误的药物,回忆往昔养育之恩,只能让我泪水洒向秋风。呜呼!良朋和爱女,同病同日而亡,这重订本书的工作,更加不可停止了。并附上挽词,一来表示交情,二来记录因误药导致的悲剧。
霜降前,水北族的侄子王棋偕,邀请我去查看亲戚蒋君循庵的儿媳,患有霍乱转筋,已经三天了。四肢厥冷,眼球上窜,胸膈闷塞无尿,舌苔黄且口苦口渴,脉象极弦细,多次服用桂枝、附子、干姜、白术等药后,气逆几乎致死。我开具昌阳泻心汤加减,煎好后慢慢服用。外用吴茱萸研末,用醋调匀,贴敷涌泉穴。服用两剂后,呕吐停止,双脚变暖。去掉紫苏、厚朴,加入川楝子、石斛、蒲公英等多剂,才痊愈。这是因为伏暑夹杂素来旺盛的肝阳致病,误服温补药,导致邪气难以迅速清除。
浙江嘉兴方家的女儿,流离迁徙三年,秋季中旬到达上海。患上吐泻,她的亲戚钱伯声孝廉邀请我去诊治,一服药就好了。随后又患上浮肿,因为寄居旅店,竟然没有调理治疗。到了霜降节气,浮肿忽然消退,没过几天,又患上霍乱,随即神志昏乱,在屋内盘旋走动,口中呼喊姐姐,于是姐姐强行让她躺下,双眼不停旋转,眼泪直流,牙关紧闭,想要请我去诊治,竟然来不及了。钱伯声询问原因,我说:这是流离失所困苦不堪,忧郁深沉,肝木乘脾土,导致吐泻和浮肿;节气到了霜降,肃杀之气使浮肿消退,但郁结之气无法宣发,直接侵犯脾胃,导致吐泻突然发作;肝火勃然上升,狂走瞪眼,阳气从上越出,这是情志内伤引起的霍乱。所以告知病危如此迅速。
南浔沈春泉,五十七岁,立冬前五日,吃完蟹面后,突然患上霍乱转筋,吐泻物都是水。起初服用桂枝、附子药,筋脉抽搐更严重,周身微汗,精神疲倦懒言,手指渐冷,脉象渐伏,时常想叹气。更换处方,使用牡蛎一两,龟板八钱,阿胶四钱,服用后病情反而加剧。请我去诊治,见舌苔黄大渴,小便全无,泻出物极热,心下拒按,这是伏暑挟食的证候,不知医生依据什么给予燥热、温补、收涩、滋腻的药物,病人家属认为该医生书画品学都很优秀,所以深信不疑,最终导致死亡,可怜又可笑啊。后来听说他的二儿子,在立冬后也患此证,医生知道是伏暑,使用黄连等药,吐泻已止。因为脉象没有立即回升,不知道是伏热未清,改投附子、桂枝等三帖后死亡,尤其令人哀叹。
上虞罗吉人,立冬前,患上霍乱转筋,子耘知道其阴液素来亏损,病由伏暑引起。服药后已有转机,数日后,渐渐出现呃逆。请我去诊治,脉象弦数,左侧更甚,舌苔焦黑且口渴,牙龈出血,胃脘闷堵,大便溏薄色如酱,小便短赤,都是伏暑未清,气机阻塞的现象。既然失去了清肃之机,肚脐上还贴着回阳膏,多次嘱咐揭掉却不听从,后来听说死亡,这不是败证,我深感惋惜。
南浔张二梅,六十多岁,秋天患霍乱转筋,医生见其年高且四肢厥冷多汗,打算进温补药,张二梅不敢服用。只用平淡的单方及外治法而痊愈。然而从此大便不坚硬,时时自汗,全身生疮疥,异常怕热。延至立冬后,邀请我去诊治,脉象很滑数,口渴舌苔黄,大小便皆热,还穿着夹衣。这是禀赋偏阳,湿热内盛。幸好畏惧进温补药,得以延年益寿,用大剂清热化湿法逐渐痊愈。又今年患疥疮的人,到处都是,所谓遍地疮痍,确实不是虚语。外治的方法很多,但平和有效的很少。更有治疗不得法,疮毒突然愈合却变生他证,迅速夺去性命的。这是毒邪内陷引发的内讧啊。子耘传给我一方颇佳,用麻黄一两,川椒五钱,蛇床子五钱,斑蝥七枚,雄猪油或地沥青熬透去渣,另用明矾、黄柏各一两,蓖麻子、大枫子各四十粒,共研为末,放入油中,用绢包裹,擦拭患处,能拔出蕴藏的毒邪伏气。不出十天可愈,无后患,这与用热酒摩擦治疗转筋的道理相同,不要因为药猛就指责它,所以附录于此。无凭据的不信,有方法可效法的,于是采集群书,以之为指南,然而病情的变幻潜伏,犹如图谋诡诈,似是而非,没有端倪。冒昧以自己亲身经历,附记为梦影。大概时移事易,境况似炊粱美梦,而比烛拟镜,痴同扪龠。或许竹头木屑,也是大匠所需。敢问通晓大方之家,不要嘲笑琐碎浅陋,故列为医案第三。
Thus, a couplet for mourning was written: "Drifting and homeless, I feel bored; moved by twenty years of spiritual communion. Meeting like duckweed in Shenjiang (Shanghai), just as I was about to examine the remaining manuscripts for your critique, passing away peacefully is originally a blessing, yet you departed suddenly one morning. The autumn night wind is desolate; how can I bear losing a kindred spirit with my graying hair."
My second daughter, Dingyi, was twenty years old, robust and enduring hardship, married to a man from the Dai family in our county. At the beginning of the month, I received a letter from her husband stating that on August 23rd, she suddenly suffered from painful diarrhea, and her condition gradually deteriorated into emaciation. Subsequently, *Fugui Bawei Tang* (Aconite and Cinnamon Eight-Ingredient Decoction) was used, leading to her death on the 29th with a tongue scorched black like charcoal. While dying, she said to her husband: "If my father were here, the illness would not have reached this state." Alas! Based on these symptoms, this was *Fu Shu* (Hidden Summerheat). The Dai family are physicians of accumulated virtue; they possessed all ten volumes of my previously published *Wangshi Yishu Shizhong* (Ten Medical Books of the Wang Family), yet she died due to erroneous medication, which is truly tragic. I sent postal condolences to the You family, expressing unspeakable grief, having tried various erroneous medicines—dry-hot, cold-cooling—and recalling past nurturing, only shedding tears in the autumn wind. Alas! A good friend and a beloved daughter, both perishing on the same day from similar causes, make the task of revising this book even more imperative. I attach mourning verses to record both our friendship and the tragedy of medical error.
Before Frost's Descent, Qiexie, a nephew from the Shuibei branch of my clan, invited me to examine the daughter-in-law of his relative, Mr. Jiang Xun'an, who had suffered from Huoluan with tendon spasms for three days. She presented with cold extremities (*Jue Ni*), protruding eyes, chest diaphragm fullness with anuria, yellow coating, bitter taste, thirst, and a very wiry and fine pulse. After multiple administrations of *Guizhi*, *Fuzi*, *Ganjiang*, and *Baizhu*, her qi rebellion became nearly fatal. I prescribed modified *Changyang Xiexin Tang* (Reed Rhizome Heart-Draining Decoction), to be taken slowly after decoction. Externally, *Wuzhuyu* powder mixed with vinegar was applied to the *Yongquan* acupoint. After two doses, vomiting ceased and feet warmed. Removing *Suzhe* and *Houpo*, and adding *Chuanlianzi*, *Shihu*, and *Pugongying* over several doses, she finally recovered. This case involved *Fu Shu* complicated by naturally hyperactive Liver Yang, where mistaken warm-tonifying herbs prevented the rapid clearance of pathogens.
The daughter of the Fang family in Hezhong migrated for three years, arriving in Shanghai in mid-autumn. She suffered from vomiting and diarrhea, which was cured with a single dose when examined by my relative, Scholar Qian Bosheng. Later, she developed edema but, being a lodger, received no treatment. When Frost's Descent arrived, the edema suddenly subsided. Within a few days, she contracted Huoluan again, followed by mental confusion, pacing around the room, calling for her sister. Her sister forced her to lie down, but her eyes continued to rotate, tears flowed profusely, and her jaw clenched. Before I could attend to her, she passed away. When asked for the cause, I explained: "This resulted from displacement and hardship, deep depression causing Wood (Liver) to overact on Earth (Spleen/Stomach), leading to vomiting, diarrhea, and edema. With Frost's Descent, the肃 (desiccating) qi cleared the edema, but the depression remained unvented, directly attacking the Spleen and Stomach, causing sudden vomiting and diarrhea. Liver Fire surged upward, causing wild running and staring eyes, with Yang floating upwards. This is Huoluan caused by emotional internal injury. Hence, the rapid declaration of critical condition."
Shen Chunquan from Nanxun, aged fifty-seven, suddenly developed Huoluan with tendon spasms five days before Start of Winter after eating crab noodles. His vomit and stool were watery. Initially given *Guizhi* and *Fuzi* preparations, the spasms worsened, accompanied by slight sweating, fatigue, reluctance to speak, cold fingers, sinking pulse, and frequent sighing. A new prescription of *Muli* (Oyster Shell), *Guiban* (Turtle Shell), and *Ejiao* (Donkey-hide Gelatin) made the condition worse. Upon examination, I found a yellow coating, extreme thirst, complete anuria, extremely hot stool, and abdominal tenderness. This was *Fu Shu* combined with food retention. I do not know why dry-hot, tonifying, astringent, and cloying herbs were prescribed. The family trusted the physician because he was excellent in calligraphy and painting, leading to his death—a pitiful and laughable situation. Later, I heard his second son suffered the same condition after Start of Winter. The physician recognized *Fu Shu* and used *Huanglian* etc., stopping vomiting and diarrhea. However, not knowing that the latent heat was not cleared because the pulse hadn't immediately risen, he switched to *Fuzi* and *Guizhi* for three doses, resulting in death. This is especially mournful.
Luo Jiren from Shangyu suffered from Huoluan with tendon spasms before Start of Winter. Ziyun knew his Yin was deficient and the disease stemmed from *Fu Shu*. Medication initially improved the condition, but eructation appeared days later. Upon examination, the pulse was wiry and rapid (stronger on the left), tongue coating scorched with thirst, gingival bleeding, epigastric fullness, loose dark-brown stool, and scanty red urine—all signs of unresolved *Fu Shu* and obstructed Qi mechanism. Despite the loss of clear-descending function, a *Huiyang Gao* (Return-Yang Plaster) was still applied to the navel. I repeatedly urged its removal without success. He subsequently died. This was not a terminal collapse; I deeply regretted it.
Zhang Ermei from Nanxun, over sixty, suffered from Huoluan with tendon spasms in autumn. Physicians, seeing his advanced age, cold extremities, and profuse sweating, proposed warm-tonifying herbs, but Zhang refused. He recovered using mild single-herb prescriptions and external treatments. However, thereafter, his stools were soft, he sweated spontaneously, developed widespread skin sores and scabies, and felt extreme aversion to heat. By Start of Winter, upon examination, his pulse was slippery and rapid, with thirst, yellow coating, hot urination and defecation, yet he wore lined clothing. This indicated a Yang-predominant constitution with abundant internal Damp-Heat. Fortunately, avoiding warm tonification allowed him to live longer. Large doses of clearing and resolving methods gradually healed him. This year, cases of scabies are everywhere, confirming the saying "wounds cover the land" is not false. There are many external treatments, but few effective ones. Some improper treatments cause sores to heal suddenly but lead to complications and rapid death due to toxin entrapment and internal conflict. Ziyun transmitted a good formula: *Mahuang* (Ephedrae Herba) 1 liang, *Chuanjiao* (Sichuan Pepper Fruit) 5 qian, *Shechuangzi* (Cnidii Fructus) 5 qian, *Banmao* (Meloides Insecta) 7 pieces, boiled in boar lard or asphalt until clear, filtered. Added *Mingfan* (Alumen) and *Huangbai* (Phellodendri Cortex) 1 liang each, *Bimazi* (Ricini Semen) and *Dafengzi* (Aleuritidis Fructus) 40 grains each, ground to powder, mixed into the oil, wrapped in silk, and rubbed on affected areas. It extracts hidden toxins and pathogens, curing within ten days without sequelae. This aligns with the principle of using hot wine massage for tendon spasms. Do not criticize it for being potent. Thus appended: Unverified claims are not believed; methods worth learning are collected from books as a guide. Yet, the elusive nature of diseases is like deceptive enemy tactics, appearing correct yet incorrect, with no clear pattern. Presuming upon personal experience, I append this as "Dream Shadows." Times change, events shift, circumstances resemble dreams, and attempts to understand are like groping for a lock in the dark. Perhaps even bamboo scraps and wood chips are needed by master craftsmen. I respectfully submit this to experts, asking not to despise its triviality, hence listed as the third set of medical cases.