定海东山下翁姓子。年十二。丙戌夏患暑热病。内挟秽浊。身热如炽。十余日不解。乃邀余诊。脉极洪大。面色老
黄。
唇焦舌黑。舌本短缩。牙根舌心。鲜血盈口。渴饮不止。两目直视。不能出声。阅前方系正气散。余曰。症已至此。何
能
为也。病家再三请方。余思木被火焚。杯水车薪。终归无益。乃拟大剂辛甘咸寒之法。于是以西瓜汁、芦根汁、金汁
水、银花露、蔗浆、藕汁、各一茶钟。合置一甑。方用生石膏二两。连翘五钱。鲜竹叶一握。黑山栀四钱。细生地一两。
犀角一钱。磨汁。羚羊角三钱。西洋参。鲜石斛。丹皮。各三钱。滑石四钱。嘱其用大罐煎成。去渣。和入诸汁。候冷
恣饮。如
再口渴。西瓜任食可也。第一日服药尽。又啖西瓜一枚。次日复诊。脉症如故。仍用前法。石膏再加一两。第三日再
诊。热仍未退。津液略见濡润。而在旁之颐发赤。肿大如卵而痛甚。余曰。暑毒之邪。结聚于此。内恐烂穿。敷药无济。
仍用前法。石膏又加一两。至四两。又加元参、麦冬、生地。至五剂而热方退。更下黑矢数枚。诸恙尽解。胃亦渐动。
此
症转危为安。全赖病家之坚信不摇。而余得以一尽其技。否则难矣。
宁波张义干。秋间患湿热症。发热十余日不解。大肉脱尽肌肤甲错。右脚不能伸动。小腹右旁。突起一块。大如拳。
倍极疼痛。大便已十四五日不解。延医治之。皆谓肠内生痈。伊芳亲胡宝翁乃商治于余。余谓肠痈胀急。金匮以败。
浆散主治。今此草罕有。伊芳于第三日觅得。乃问余服法。余曰果尔。须同去诊视。瞑眩之药。岂堪悬拟因同至张家。
见张倚于床褥。张目摇头。病苦万状。面色青惨而枯。脉极坚实。沉部如弹石。尺愈有力。时或一快。余曰。此非肠痈
也。肠痈脉洪数。为脓已成。脉弦紧为脓未成。今浮部不洪数。而沉部实大。腹筋突起。目有赤缕。乃湿热之邪。结于
阳明。腹旁之块。乃燥矢之积聚也。但得大便一通。块即消散。而腹亦不痛矣。病者问之曰。曾与前医商论下法。医
云人已虚极。岂可妄下。余思胀痛不下。病何由除。今先生为我用下法。死且不怨。余遂书大承气方。大黄五钱。芒
硝三钱。旁视者惶徨未决。余曰。不下必死。下之或可望生。于是煎成置于几上。病患力疾起坐。一饮而尽。不超时
腹中大响。旋复登厕。先下结粪如弹丸者三四枚。既而溏泻半桶。块消。明日脚伸而胀痛俱失。继进增液汤二剂。
而热先退。再与益胃汤法。胃纳渐旺。津液渐濡。余便上郡。病者欲食羊肉。以问近地之医士云。病后胃气当复。羊
肉最能补胃。由是病者坦然无疑。恣意饱餐。次日身不发热。舌苔又浓浊。而脉又数。复来召余。余曰。湿热症初愈。
以慎口味为第一要务。何如是蒙蒙耶。乃与平胃散加神曲、焦查、谷芽。而分量降序。以胃气久虚。不任消耗之故
也果服二剂而安。按是症初则失于清解。至热已日久。津液枯涸。胃土燥烈。而犹日服运气之药。愈益其燥。迨至
结粪成块。腹旁突起。筋脉不能濡润。而脚挛急。医又误认为缩脚肠痈。或误投以败浆散。攻伐无功之血分。又将
何如耶。士君子涉猎医书。大忌悬拟开方。药不对症。生死反掌。可不慎哉。
Dongshanxia in Dinghai County, a Mr. Weng's son, aged twelve, suffered from summer-heat disease in the summer of Bingxu year. The interior was mixed with turbid pathogens. His body heat was blazing like fire. It did not resolve for more than ten days. He invited me to diagnose. The pulse was extremely surging and large (Hong Da). The complexion was old yellow. Lips were scorched, tongue black. The root of the tongue was shortened. At the gum roots and center of the tongue, fresh blood filled the mouth. Thirsty and drinking incessantly. Eyes staring straight ahead, unable to make sound. Reviewing previous prescriptions, it was Zhengqi San. I said, "The condition has reached this state, what can be done?" The family pleaded repeatedly for a prescription. I thought, "Wood being burned by fire, a cup of water cannot save a cartload of burning wood; ultimately it is futile." So I formulated a large dose of acrid-sweet-salty-cold method. Thus, using watermelon juice, reed rhizome juice, Jin Zhi Shui (Gold Juice Water), honeysuckle dew, sugarcane syrup, lotus root juice, each one tea cup. Mixed together in a steamer. The formula used raw gypsum (Shi Gao) two taels, Forsythia fruit (Lian Qiao) five qian, fresh bamboo leaf (Zhu Ye) one handful, black gardenia (Hei Shan Zhi) four qian, fine Rehmannia root (Xi Sheng Di) one tael, rhinoceros horn (Xi Jiao) one qian, ground into juice, antelope horn (Ling Yang Jiao) three qian, American ginseng (Yang Shen Shen), fresh Dendrobium (Xian Shi Hu), Moutan cortex (Dan Pi), each three qian, Talcum (Hua Shi) four qian. Instructed them to decoct in a large jar, strain, and mix with all the juices. Drink freely when cool. If thirsty again, eat watermelon at will. On the first day, finished the medicine, ate another watermelon. Second day follow-up visit, pulse and symptoms unchanged. Still used previous method, added one tael to gypsum. Third day re-diagnosis, heat still not retreated, fluids slightly moistened. But the cheek beside turned red, swollen like an egg and very painful. I said, "Summer-toxin pathogen gathered here, internally fearing perforation/rotting. External application is useless. Still use previous method." Added one tael to gypsum, up to four taels. Also added Scrophularia root (Yuan Shen), Ophiopogon tuber (Mai Dong), Rehmannia root (Sheng Di). After five doses, heat finally retreated. Passed several pieces of black hard stool. All ailments resolved. Stomach Qi gradually moved. This critical case turned safe. Entirely relied on the patient's firm belief without wavering, allowing me to fully exert my skills. Otherwise, it would have been difficult.
Zhang Yigan from Ningbo. In autumn, suffered from damp-heat syndrome. Fever unresolved for over ten days. Large muscles wasted away, skin rough like scales. Right foot could not extend. A lump protruded on the right side of the lower abdomen, size of a fist, extremely painful. Bowel movement had not occurred for 14-15 days. Consulted doctors, all said intestinal abscess (Chang Yong). His relative, Mr. Hu Bao, consulted me. I said, "Intestinal abscess with distension and urgency, *Jin Gui Yao Lue* uses Bai Jiang San as main treatment. Now this herb is rare." He found it on the third day, then asked me how to take it. I said, "If so, must go together to diagnose. Medicines causing Ming Xuan reaction (severe adverse reaction indicating efficacy) cannot be prescribed remotely." So went together to Zhang's house. Saw Zhang leaning on bed, eyes open, shaking head, suffering immensely. Complexion dark green, pale and withered. Pulse extremely solid, deep part like hitting stones, Chi position even stronger. Occasionally felt relief. I said, "This is not intestinal abscess. Intestinal abscess pulse is surging and rapid, indicating pus formed. Pulse wiry and tight indicates pus not formed. Now superficial part is not surging/rapid, but deep part is solid and large. Abdominal tendons protrude, eyes have red threads. This is damp-heat pathogen, binding in Yangming. The lump on abdomen side is accumulation of dry feces. Once bowel moves, lump dissipates, abdominal pain stops." Patient asked: "Discussed purgative method with previous doctor. Doctor said person is extremely deficient, how can we recklessly purge?" I thought, "Pain and distension not purged, how will illness remove? Now sir use purgative method for me, even if I die, I won't resent." So wrote Dachengqi Tang. Rhubarb (Da Huang) five qian, Mirabilite (Mang Xiao) three qian. Bystanders anxious and undecided. I said, "No purge means certain death, purge might hope for life." Decocted, placed on table. Patient forced himself up, drank in one gulp. Within one shichen (2 hours), belly made loud noises. Immediately went to toilet. First passed 3-4 pellets of hard stool like marbles. Then loose diarrhea half bucket. Lump dissipated. Next day leg extended, pain and distension gone. Continued with Zengye Tang two doses, heat retreated first. Then Yiwei Tang method, stomach appetite gradually strong, fluids gradually moist. I returned to Shangyu. Patient wanted to eat mutton, asked local doctor: "After illness, Stomach Qi should recover, mutton best tonifies stomach." Patient thus confident, ate heartily. Next day no fever, tongue coating thick/turbid, pulse rapid. Summoned me again. I said, "Damp-heat syndrome just recovered, guarding diet is first priority. Why so ignorant?" Prescribed Pingwei San plus Shen Qu, charred Hawthorn (Jiao Zha), rice sprout (Gu Ya), with reduced dosages because Stomach Qi long deficient, cannot bear consumption. Indeed took two doses and settled. Note: This case initially lost clearing/resolving. Heat lasted long, fluids dried up, Stomach Earth dry/hot. Yet daily taking Yunqi medicines, increasing dryness. Until hard stool formed mass, abdomen side protruded, sinews/tendons not moistened, leg cramped/spasmed. Doctors misidentified as Suojiao Chang Yong (Leg-shrinking Intestinal Abscess), or wrongly gave Bai Jiang San, attacking Blood level with ineffective methods. What then? Scholars dabbling in medical books, strictly avoid remote prescribing. Medicine not matching syndrome, life/death in palm flip. How can one not be cautious?