常镇道刘公治效常镇道刘名载字竹湄，岭南人也。由山东济南府保举赴都，自都赴镇，于道光五年正月二十五日到任，二月初一谒圣庙行香，官属齐集，刘公言身有久病未愈，欲请一儒医诊治，未知有否。当有王惹山明府保举微名，谬谓文名久著，医理更深，惟不悬壶，必须礼请。刘公即烦王明府先容，随后差内使持贴延请，予因往诊，询其病源，乃泻泄已阅四月，天未明泻起至晚不过五六遍，而进京出京一路医治，总无效验。予诊其脉，诸脉皆平，肺脉独大，按之见数，予曰：此肺移热于大肠，乃热泻也。公曰：予一路来往皆值冬寒，屡遇风雪，反致热泻乎?予曰：据公言当为寒泻，据脉象实为热泻，右寸属肺，肺与大肠相表里，独见数大，故知其移热作泻也。脉象大于他脉数倍，自诊可知。且公一路所服，可系温燥药否?泄泻时可热而有声否?公曰；皆然。予曰：岂有寒泻服温燥而不减者?岂有在腹为寒泻出转热者?岂有寒泻急迫作声者?经云：暴注下迫，皆属于热。岂人止有寒泻而无热泻乎?公自诊其脉，亦觉肺部独大，辨论既明，疑团尽释。予乃用天冬三钱、麦冬三钱、孩儿参三钱，以养肺阴，加泻白散地骨皮二钱、桑白皮一钱、粉甘草五分以泻肺热，又加茯苓三钱以为分利，怀山药五钱以顾脾肾，定方后公问可服几剂，予曰：二剂后再诊。公服一帖，日间泻止，惟余天明一泻，服二帖而天明之泻亦止。第三日因公无暇未请诊，亦未服药，而次日天明之泻又来，又急请诊，问何以故?予曰一百念日之恙，可以一药而止，不能一药除根，再服二帖，病当霍然。虽然诊公之脉沉部颇有数象，似乎尚有伏热，泻不难止，恐春气大透，木来生火，变生他症，须预为调治，未可大意。公曰：予急欲赴扬关，月余乃还，再当请诊可也。十日即返镇署，且急延予，称有重症，予往视，见其面左部．白头至项半边全行红肿，左目肿合不能开，上下唇皆厚寸许，心烦意乱。自谓此次定当告病去官。予诊其脉洪数有力，而无浮象。予慰之曰：无妨也。此症似乎大头天行，而实非也。此久有郁热，热郁成毒，春透木旺，借肝气发生，热毒上达，肝位于左，气由左升，故病在左，所喜六脉根本甚固，尚能胜病，月余可痊，无庸告病而去。于是用东垣普济消毒饮子，而去其升、柴，以症无外感，火发于肝，延炽于胃，其势已甚，不敢再为升提也。且加犀角、羚羊角清肺胃以清肝，恐其上犯咽喉也，大便屡结异常，加调胃承气以下之。十日后火势渐平，肿亦渐消，知其血阴伤，加丹皮、生地以凉之，每帖药计四五两，始多苦寒，继加甘凉，而总不用发散。其始尚用桔梗、薄荷二味，取其辛凉疏解，后并此而去之。症虽日减，而刘公见予每曰：我病莫非有风寒，先生何不散之。予曰：无有也，不可散也。嗣后跟随诸人见予至，故扬言曰：主人之病，只要发散即愈，惜未发耳，予若弗闻也者。惟每至署，见辕外有医轿一顶，密询之，乃李某也，其人虽医生而不务医学，专务结交各衙门号房，巴结家人，希图引荐，今闻刘公有病，无门可入，访予方药不用辛散，乃扬言一散即愈，托其家人耸动其主，以图进见。刘公虽未之信，而未免有疑，啧啧者所由来也。至二十日症已全愈，惟偏左头内尚觉沉闷，刘公向予叹曰：症虽承先生治好，但将来未免头风之患耳。予问何故?曰：先生总末代我发散也。予曰：诺。今日竟用发散何如?公辗然色喜。予乃用小发散方，荆防不过数分，尚另加监制，谓之曰：公恙实不可发散，服必无效，今姑用之，以除公疑。又另开清凉养阴镇摄肝风一方，与之曰：服前方平平则已，设有不适，再进此药则安。次日进诊，公曰：予昨日了不得。问何故?公曰：人人皆说予症当发散，而先生独不然。予因前泄泻，先生辨论精微，一药而愈。又不敢请他人，然心中实不能无疑也。昨见肯用发散，欣然煎服，不意服无片时，即觉火势一轰，似觉头面复欲大肿，头晕眼花，急忙伏枕，犹然难过。幸后方亦已煎成，服下始定。看来不能发散，诚如先生之言。然窃闻风善肿，风宜散；又闻有大头瘟症，属乎风火，亦用发散，而予症似之，其风火独不可散何也?予笑曰：公之恙非风火，家人乃火风鼎也。风火者因风生火，风为本而火为标，散其风而火自平。火风者火为本，而风为标，泻其火而风自息。试观天地之道，热极生风，得大雨施行，天气清凉而风亦顿息，俗所谓煞风雨也。今火风之症，若误作风火论治，妄用发散，譬如炉火已旺，而又以大扇扇之，火岂有不更炽者哉?公二十日来服寒凉重剂，统计约五六斤，而始进发散小剂，即如此火上头轰，若初起误进发散，将火势焮腾，焦灼肌肉，蔓延咽喉，虽有善者奈之何哉!若夫大头瘟症，予岂不知，其初起也恶寒体重，头面俱肿，必兼表象。两目鼻面肿起者阳明也，耳前后并额肿起者少阳也，脑后项下肿起者太阳也，三阳多表症，故可先加表散。公恙初起毫未恶寒恶风，面肿于左肝部也。公岭南人，地气温热，秉赋偏阳，京官十数年，饮食皆用煤火，官山东六年亦用煤火，火毒积蕴已久，北地风土高寒积而未发，今至江南水土不同，又值春深肝旺肝火冲起，久郁之火上犯阳明，致成此症。故治法只宜消毒泻火，经所谓高者抑之，不可散也。公曰：己病不知，经先生之论恍然大悟，而今而后直以性命相托。调理十余日，头之沉闷亦愈。公嘱署中凡欲诊病，非予不可。嗣后往署诊病，亦无不应手。公意深为器重，秋七月前任观察钱益斋夫子请予至金陵诊病，适刘少君患时邪，请予不至，家人号房遂将李某荐进，三日无效，又延他医，缠绵五月。予亦有在家时并不过问。予知李某之必有谗间也，然不足校也。次年刘公请王九峰先生诊脉，一见即问李冠仙乃贵相契否?先生曰：然。且言医道精通。刘公曰：医道吾所深知，但其品行何如?先生曰：伊久在学中，品行并无不好，未免性傲，于同道中目空一切耳。刘公曰：果止性傲目空一切，尚是读书人本色。仅作半面语，后不复言。先生出以语予曰：似有人在刘公前谗汝。予曰：其人予久知之，虽然问心无疚，何恤乎人言。末几赵雨楼先生来守镇江，其号房早将李某荐进、诊病不效，复延予，予告赵公曰：子实不愿在本地衙门诊病，以后幸勿强予，反致害予。公问何故，告以刘公后来一节，公笑曰：是诚有之。李某初见即言兄乃讼师，万不可请。吾遍访毫无影响，且多称足下品学兼优，故敢奉屈。予乃恍然李某之在道署谤我者讼师也。刘公之所以绝迹也。未及一载，刘公已知李某之诬，复延予，予却之。又二载刘公卸事住扬，不知得何病症，复再三延予，予仍却之，而刘公死矣。此中殆亦有数焉。
陶文毅公治效宫保陶云汀夫子，于道光五年抚苏适办海运，夏秋间往来上海，亲至海隅相度机宜，旋又莅金陵监临乡试，是岁阳明燥金司天，少阴君火在泉，秋热更甚也。乃医者尽用伤寒辛温发散，且屡用桂枝，邪不能透其热，转加致成热疟，寒少热多。医者改用柴胡，亦仍加桂，而其佐使者无非厚朴、苍术、草果、青皮，一派温燥克伐，观察钱益斋夫子素知医道，时为监试，心窃非之。因在常镇道任内知予善于治疟，回明宫保，专差飞请，十八日晚予到行辕，随即进诊，细询疟在阴分，不过微寒，旋即发热，壮热六时许，解时无汗，热时烦躁，至不能受，渴欲冷饮，饮亦不多，脉则十分弦数，舌则红赤无苔，泄则其赤如血，且不寐者多日矣。予曰：此大热症，加以燥剂伤阴，阴虚作疟，阴虚不能化汗，无汗故热邪难解，阴虚故神烦不寐，治宜养阴化汗，以化邪。于是即据此立案开方，惟思进见之初，未便骤用大剂，姑以小柴胡去参，加大生地五钱、当归二钱、赤芍钱半、夜交藤三钱，三更后疟势减，进药竟安寐至天明，可谓小效。次日本地陈林二医至，知服予药，密告宫保曰：大人此症，不可服当归，服则热必重出。又谓予曰：尊方用何首乌何太早。予曰：未也。意者谓夜交藤乎?此乃首乌之藤，非首乌也。且此不过取夜交之意，为不寐而设。叶氏治疟亦尝用之，以交通阴阳用意之药，虚实皆宜，非如首乌之力能温补也。君得毋见《本草备要》不列夜交藤，其何首乌注内有曰一名交藤，遂认夜交藤为何首乌乎?伊掩饰曰：恐敞地药店止有何首乌，无此藤耳。予曰：昨药系余亲见，其藤甚佳，君等或未用过耳。予知道不同不相为谋，伊等亦公然开方，并不予让。惟是日尽去温燥，改用黄连、石膏，而宫保服之，躁热有加无已。盖伊等只知用寒以治热，不知黄连苦燥仍能伤阴，石膏虽能清热而不能养阴，虚人服之，转伐胃气，虽《本草备要》之语，伊等未能全觉也。然是时宫保未能信任，总服二人之方，予屡告辞，堂官不肯放行。予曰：如此治法，必不能愈，设有不测，而予在幕中，将毋留以为二人所归过耶。堂官转禀方伯张公，公进见宫保，病果沉重，出见二医，语言荒谬，遂往告唐陶山方伯，盖陶山方伯乃宫保之同乡兼戚谊，寓居金陵而精通医理者也。二十二日早，陶山方伯来，细切脉理，遍阅诸方，出与二医及予相见，先问二医曰：先生们看大人究系何症?陈医俯首不言，林医曰是疟疾。方伯曰：疟疾吾岂不知?但是何疟症?林医不能对。方伯转而问予，予对曰：据愚见乃阴虚作疟耳。方伯曰：诚然，此当用小柴胡合四物汤加减，去川芎，重用生地，何方药并不及此。林医曰：服此即能愈否?方伯曰：汝等治已半月有余，愈治愈坏，吾仅一言，即当全愈耶?虽然，如果重用养阴，症当大减，愈亦无难。譬如天气亢热已极，不得一场大雨，何以回凉?但可下雨而不可下冰雹，冰雹亦能伤人，如黄连、石膏，冰雹是也。林医语塞。予问曰：养阴必兼归地，或谓当归助热不可用，奈何?方伯曰：何来此不通之论也。阅诸方前所服者一派温燥，不知助热，而当归反助热耶?当归虽微温而养阴，设使方中早能助以当归，尚不至阴伤热重至此，且夫生地阴中之阴，当归阴中之阳，阴阳相辅，动静相生，用药之道也，何可偏废?此不过以生地为君，当归为佐耳。言毕扶杖而入。二医赧颜而去。方伯复出谓予曰：先生脉案方药皆极通，惟尚轻耳。吾已与大人说明，以后惟子是任，子好为之。予以医多论杂为虑。方伯曰：此我自当之。我当间日一至，以辟群疑。是日予用大生地二两、当归三钱、柴胡钱半、黄芩-钱、赤芍二钱、赤芩三钱、甘草五分、会皮一钱，服后疟来不过两时许，即大汗热清，较前减四个时辰，热时亦觉能受。后总本此法为加减，阴亏太甚，生地减至一两，即不复减，疟势渐轻，至月底不及一时，陶山方伯果常来，各处荐医虽多，宫保因已有效，一概辞去。予嗣闻方伯九月初三日回楚，恐又为他医所误，回明宫保，请九峰先生坐镇。先生九月初一到，诊后亦谓养阴为是，症愈在迩，不必更法。仍命主方稍为参酌，至初七日全愈。是役也，初赖益斋夫子之荐举，中蒙陶山方伯之赏识，终借九峰先生之名望，克终其事。由此受宫保知，遂相契合。究之此方亦不过本景岳归柴饮意变化而出，乃用此治愈阴虚疟症，不啻数十百人，法甚平平，不足奇也。惟陶山方伯议论高超，譬喻辟石破天惊，名言千古，予常志之不敢忘。
Treatment Efficacy of Liu, Daoist Commissioner of Changzhen
Liu, Daoist Commissioner of Changzhen, named Zai, courtesy name Zhumei, was from Lingnan. He was recommended from Jinan Prefecture in Shandong to proceed to the capital, and from the capital to Zhenjiang for his appointment. He assumed office on the 25th day of the first month in the fifth year of Daoguang. On the first day of the second month, he went to the Confucian Temple to offer incense, where all officials and subordinates gathered. Lord Liu stated that he had a chronic illness that had not healed and wished to invite a scholar-doctor for diagnosis and treatment, asking if there were any suitable candidates. At this time, Wang Reshan, the Magistrate (Mingfu), recommended me, falsely claiming that my literary reputation had long been renowned and my understanding of medical principles was profound, although I did not hang a signboard to practice medicine, requiring a formal invitation with proper etiquette. Lord Liu then asked Magistrate Wang to introduce me first, and subsequently sent an attendant with a letter to extend the invitation. I went to examine him and inquired about the origin of his illness. It turned out to be diarrhea that had persisted for four months, starting before dawn and occurring no more than five or six times until evening. Throughout his journey to and from the capital, various treatments had yielded no effect. Upon examining his pulse, I found all pulses to be calm, except for the Lung pulse which was distinctly large and rapid upon pressure. I said: "This is heat transferring from the Lung to the Large Intestine, constituting Heat Diarrhea (Re Xie)." Lord Liu said: "My journeys coincided with winter cold, frequently encountering wind and snow; could this have caused Heat Diarrhea?" I replied: "Based on your description, it should be Cold Diarrhea (Han Xie), but based on the pulse presentation, it is indeed Heat Diarrhea. The right Cun position corresponds to the Lung, and the Lung and Large Intestine are exteriorly-interiorly related. The distinct rapidity and largeness indicate heat transfer causing diarrhea. The pulse is several times larger than other pulses, which you can verify yourself. Moreover, were the medicines you took along the way warming and drying? Was the stool hot and accompanied by sounds during defecation?" Lord Liu said: "Both were true." I said: "How can Cold Diarrhea fail to improve with warming and drying herbs? How can diarrhea felt as cold in the abdomen become hot upon expulsion? How can Cold Diarrhea be urgent and noisy? The Classic states: 'Sudden violent purging and tenesmus all belong to Heat.' Can humans only have Cold Diarrhea and no Heat Diarrhea?" Lord Liu examined his own pulse and also perceived the distinct largeness of the Lung pulse. After clear discussion and analysis, his doubts were completely dispelled. I prescribed Tian Dong (Asparagi Radix) 3 qian, Mai Dong (Ophiopogonis Radix) 3 qian, and Hai Er Shen (Codonopsis Radix) 3 qian to nourish Lung Yin. I added Di Gu Pi (Lycii Cortex) 2 qian, Sang Bai Pi (Mori Cortex) 1 qian, and Fen Gan Cao (Glycyrrhizae Radix et Rhizoma Preparatum) 5 fen from Xie Bai San (Drain White Powder) to drain Lung heat. I further added Fu Ling (Poria) 3 qian to promote diuresis and separate turbidity, and Huai Shan Yao (Dioscoreae Rhizoma) 5 qian to support Spleen and Kidney. After finalizing the prescription, Lord Liu asked how many doses to take. I said: "Two doses, then re-examine." After taking one dose, daytime diarrhea ceased, leaving only one episode at dawn. After two doses, the dawn diarrhea also stopped. On the third day, due to official duties, I was not invited to examine him, nor did he take medicine. However, the dawn diarrhea recurred the next day, prompting an urgent request for examination. I asked for the reason. I said: "A hundred-day illness can be stopped by one medicine, but not eradicated by one medicine. Take two more doses, and the illness will likely resolve rapidly. Nevertheless, examining your pulse, the Chen (Deep) position shows signs of rapidity, suggesting latent heat remains. While diarrhea is easy to stop, when Spring Qi penetrates strongly, Wood generates Fire, potentially leading to other symptoms. Preventive regulation is necessary; do not be careless." Lord Liu said: "I am eager to go to Yangzhou for customs duties and will return in over a month; I will invite you again then." Ten days later, he returned to the Zhenjiang Yamen and urgently summoned me, reporting a severe condition. Upon visiting, I saw redness and swelling covering half of the left side of his face extending to the neck. His left eye was swollen shut, and both upper and lower lips were thickened by about one cun. He was restless and agitated, stating he would surely resign due to illness. I examined his pulse: Hong (Surging) and Shu (Rapid) with strength, but without a Fu (Floating) aspect. I reassured him: "No need to worry. This resembles Da Tou Tian Xing (Great Head Epidemic/Da Tou Wen), but it is not so. There has been long-standing stagnant heat, which condensed into toxicity. With Spring Wood Qi flourishing, borrowing the Liver Qi's ascending nature, heat-toxicity ascends. The Liver is located on the left, and Qi ascends from the left, hence the disease is on the left. Fortunately, the root of the Six Pulses is solid, indicating sufficient resistance to withstand the pathogen. Recovery within a month is expected; resignation is unnecessary." I used Pu Ji Xiao Du Yin Zi (Universal Benefit Decoction to Eliminate Toxin) from Dong Yuan, removing Sheng Ma (Cimicifugae Rhizoma) and Chai Hu (Bupleuri Radix) because there was no external contraction. The fire originated in the Liver and blazed in the Stomach; its momentum was already intense, so I dared not use ascending and dispersing methods. I added Xi Jiao (Rhinocerotis Cornu - *Note: now substituted with water buffalo horn in modern practice*) and Ling Yang Jiao (Caprae Hircus Cornu) to clear Lung and Stomach heat to pacify the Liver, fearing upward invasion of the throat. Due to frequent abnormal fecal impaction, I added Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction) to purge heat accumulation. After ten days, the fire gradually subsided, and swelling decreased. Recognizing injury to Blood and Yin, I added Mu Dan Pi (Moutan Cortex) and Sheng Di Huang (Rehmanniae Radix) to cool and nourish Yin. Each dose weighed approximately four to five liang. Initially, bitter-cold herbs predominated; later, sweet-cool herbs were added, but dispersing herbs were never used. Initially, Jie Geng (Platycodonis Radix) and Bo He (Menthae Haplocalycis Herba) were used for their acrid-cool dispersing properties, but these were eventually removed. Although symptoms decreased daily, Lord Liu often said to me: "Is my illness not due to Wind-Cold? Why does Sir not disperse it?" I replied: "There is none; it cannot be dispersed." Subsequently, attendants who saw me arrive deliberately claimed: "The master's illness would heal with dispersing herbs; it's a pity they weren't used." I pretended not to hear. However, whenever I arrived at the Yamen, I noticed a sedan chair for a doctor outside the gate. Secret inquiries revealed it belonged to Li Mou. Although a doctor, he neglected medical practice, focusing instead on networking with clerks and servants of various offices to seek recommendation. Hearing Lord Liu was ill and unable to gain access, and learning my prescriptions avoided acrid-dispersing herbs, he spread rumors that dispersing would cure him instantly, urging his contacts to influence the master to see him. Lord Liu did not believe it but harbored some doubt, leading to murmurs. By the 20th day, symptoms had completely resolved, except for a feeling of heaviness in the left side of the head. Lord Liu sighed to me: "Although cured by Sir, I fear future headaches (Tou Feng)." I asked why. He said: "Sir never dispersed it." I said: "Very well. How about using a dispersing method today?" Lord Liu smiled with pleasure. I prescribed a mild dispersing formula containing Jing Jie (Schizonepetae Spica) and Fang Feng (Saposhnikoviae Radix) in minute doses (several fen), specially processed, telling him: "Your illness truly cannot be treated with dispersing herbs; they would be ineffective. I use them now merely to alleviate your doubts." I additionally prescribed a formula for cooling, nourishing Yin, and calming Liver Wind, saying: "If the previous formula works smoothly, fine. If discomfort arises, take this one for safety." The next day, Lord Liu said: "Yesterday was terrible." I asked why. He explained: "Everyone said my illness required dispersing, yet Sir refused. Previously, regarding my diarrhea, Sir's analysis was precise, and one dose cured it. I dared not consult others, though I remained doubtful. Seeing you finally use dispersing herbs, I happily took them. Unexpectedly, within moments, I felt a surge of fire, as if my face and head were about to swell massively, with dizziness and blurred vision. I lay on my pillow, suffering greatly. Fortunately, the subsequent formula was ready; after taking it, I stabilized. Indeed, dispersing is impossible, as Sir said. Yet I heard that Wind causes swelling and requires dispersing; I also heard Great Head Plague belongs to Wind-Fire and uses dispersing. My symptoms seem similar; why can mine not be dispersed?" I laughed and said: "Your illness is not Wind-Fire, but Fire-Wind. In Wind-Fire, Wind is the root and Fire is the branch; dispersing Wind calms Fire. In Fire-Wind, Fire is the root and Wind is the branch; draining Fire extinguishes Wind. Consider nature: extreme heat generates Wind; heavy rain brings coolness and stops the wind, commonly called 'suppressing wind and rain.' If Fire-Wind is mistaken for Wind-Fire and treated with dispersing herbs, it is like fanning a roaring furnace fire; how could the fire not intensify? You have taken heavy cold-cooling agents for twenty days, totaling five or six jin. Taking even a small dose of dispersing herbs now caused such a reaction. Had dispersing herbs been used at the onset, the fire would have flared, burning muscles and spreading to the throat, leaving even skilled physicians helpless. Regarding Great Head Plague, do I not know it? Its onset involves aversion to cold, body heaviness, and facial swelling, always accompanied by exterior signs. Swelling of eyes, nose, and face indicates Yangming Meridian involvement; swelling around ears, temples, and forehead indicates Shaoyang Meridian involvement; swelling at the back of the head and neck indicates Taiyang Meridian involvement. Since these three Yang meridians often involve exterior patterns, exterior dispersing can be applied initially. Your illness began without any aversion to cold or wind; facial swelling was on the left, corresponding to the Liver region. As a native of Lingnan, your climate is warm, and your constitution is Yang-predominant. Serving as a Beijing official for over ten years, you consumed coal-heated food; serving in Shandong for six years, you also used coal fire. Heat-toxin accumulated for a long time. The high, cold climate of the North suppressed it without eruption. Now, in Jiangnan, with different water and soil, and deep Spring when Liver Qi is strong, Liver Fire surged. Long-stagnant heat attacked Yangming, causing this condition. Thus, treatment should only eliminate toxin and drain fire, as the Classic states: 'High things should be suppressed,' not dispersed." Lord Liu said: "Ignorant of my illness, I was enlightened by your analysis. From now on, I entrust my life to you." After ten days of regulation, the head heaviness also resolved. Lord Liu instructed that no one else could diagnose him in the Yamen. Subsequent visits were always successful. Lord Liu deeply valued me. In the seventh month of Autumn, Qian Yizhai, former Inspector, invited me to Jinling to treat Liu Shaojun who suffered from a seasonal pathogen. I declined. The clerks recommended Li Mou instead. After three days of ineffectiveness, another doctor was consulted, and the illness dragged on for five months. I stayed home and did not intervene. Knowing Li Mou would certainly slander me, I deemed it unworthy of attention. The following year, Lord Liu invited Mr. Wang Jiufeng to examine the pulse. Upon seeing him, Wang asked: "Is Li Guanxian [your courtesy name] a close friend?" Mr. Wang replied: "Yes," adding that Li was proficient in medicine. Lord Liu said: "I know much about medicine, but what is his character?" Mr. Wang said: "He has been in the academy for a long time; his character is generally good, though somewhat arrogant, looking down on colleagues." Lord Liu said: "If merely arrogant and dismissive, that is still characteristic of a scholar." He spoke only half-heartedly and dropped the subject. Mr. Wang told me: "It seems someone is slandering you before Lord Liu." I said: "I have known that person for a long time. Though my conscience is clear, why worry about gossip?" Soon, Mr. Zhao Yulou became Governor of Zhenjiang. His clerks had already recommended Li Mou. When Li failed to treat effectively, Lord Liu invited me again. I told Governor Zhao: "I really do not wish to practice in local government offices; please do not force me, or it may harm me." He asked why. I recounted the incident with Lord Liu. He laughed: "That is indeed true. When Li first met me, he called you a litigator and said you must not be hired. I investigated thoroughly and found no basis; moreover, many praised your virtue and learning, so I ventured to invite you." I suddenly realized Li Mou's slander in the Dao Yamen labeled me a litigator, which was why Lord Liu had distanced himself. Within less than a year, Lord Liu knew of Li Mou's falsehoods and invited me again; I declined. Two years later, Lord Liu retired to Yangzhou, fell ill with an unknown condition, and repeatedly invited me; I still declined, and Lord Liu passed away. Perhaps fate played a role here.
Treatment Efficacy of Tao Wenyi Gong
Gongbao Tao Yunting Fuzi served as Governor-General of Jiangsu in the fifth year of Daoguang. Coinciding with the management of sea grain transport, he traveled between Shanghai in summer and autumn, personally inspecting coastal strategies, and later supervised the provincial examinations in Jinling. That year, Yangming Dry Metal governed the Heaven (upper half of the year), and Shaoyin Sovereign Fire governed the Earth (lower half of the year), resulting in particularly severe autumn heat. Physicians exclusively used acrid-warm dispersing methods for Cold Damage (Shang Han), frequently employing Gui Zhi Tang (Cinnamon Twig Decoction). The pathogen could not be vented, and the heat intensified, transforming into Heat Malaria (Re Nue), characterized by less chills and more fever. Physicians switched to Chai Hu (Bupleuri Radix) formulas but still added Gui Zhi. Their assistant herbs were solely Hou Po (Magnoliae Officinalis Cortex), Cang Zhu (Atractylodis Rhizoma), Cao Guo (Tsaoko Fructus), and Qing Pi (Citri Reticulatae Pericarpium Viride), creating a regimen of warming, drying, and attacking qi. Inspector Qian Yizhai, knowledgeable in medicine and serving as examination supervisor, privately disapproved. Having known my proficiency in treating malaria during my tenure as Daoist Commissioner of Changzhen, he reported to Gongbao and sent a special messenger to summon me urgently. I arrived at the temporary residence on the evening of the 18th and immediately examined the patient. Detailed inquiry revealed Malaria in the Yin aspect: slight chills followed quickly by fever, high fever lasting about six hours, resolution without sweat, irritability during fever making it unbearable, thirst for cold drinks (though intake was small), pulse extremely Xuan (Wiry) and Shu (Rapid), tongue red and赤 (crimson) without coating, stools red like blood, and insomnia for many days. I said: "This is a major Heat syndrome. Coupled with damage to Yin by drying agents, this is Malaria due to Yin Deficiency. Yin deficiency fails to transform sweat; lack of sweat prevents heat resolution. Yin deficiency causes mental restlessness and insomnia. Treatment should nourish Yin and generate sweat to resolve the pathogen." Based on this, I drafted the prescription. Considering our first meeting, I avoided large doses initially, prescribing a modified Xiao Chai Hu Tang (Minor Bupleurum Decoction) removing Ren Shen (Ginseng Radix), adding Sheng Di Huang 5 qian, Dang Gui (Angelicae Sinensis Radix) 2 qian, Chi Shao (Paeoniae Radix Rubra) 1.5 qian, and Ye Jiao Teng (Polygoni Multiflori Caulis) 3 qian. After the third watch, malaria intensity decreased, and the patient slept soundly until dawn—a minor success. The next day, local doctors Chen and Lin visited, learned of my prescription, and secretly told Gongbao: "This illness cannot tolerate Dang Gui; taking it will cause heat to rebound." They also told me: "Using He Shou Wu (Polygoni Multiflori Radix) in your formula is too early." I said: "Not early. Do you mean Ye Jiao Teng? This is the vine of He Shou Wu, not the root itself. Moreover, this is merely to utilize the concept of 'night connection' to address insomnia. Ye Tianshi also used it for malaria as a herb to communicate Yin and Yang, suitable for both deficiency and excess, unlike He Shou Wu's warming tonification power. Did you confuse Ye Jiao Teng with He Shou Wu because 《Bencao Bei Yao》 lists He Shou Wu as having the alias Jiao Teng?" They covered up saying: "Perhaps our local pharmacies only stock He Shou Wu, not this vine." I said: "I saw yesterday's medicine myself; the vine was excellent. You probably haven't used it." Knowing we had different approaches, they openly prescribed without yielding to me. That day, they abandoned warming-drying herbs and used Huang Lian (Coptidis Rhizoma) and Shi Gao (Gypsum Fibrosum). Gongbao took them, but irritability and heat increased endlessly. They only knew to use cold to treat heat, unaware that Huang Lian's bitter dryness still damages Yin, and while Shi Gao clears heat, it does not nourish Yin. For deficient patients, it attacks Stomach Qi. Despite 《Bencao Bei Yao》 warnings, they failed to fully grasp this. However, Gongbao did not trust me then, continuing to take both doctors' prescriptions. I repeatedly requested to leave, but the chief clerk refused. I said: "This treatment will not cure. If something goes wrong, with me in the staff, won't I become the scapegoat for the two doctors?" The clerk reported to Prefect Zhang Gong. Gong Baojian visited Gongbao, finding the illness indeed serious. He met the two doctors, found their speech absurd, and went to inform Prefect Tao Taoshan. Prefect Tao Taoshan was Gongbao's fellow townsman and relative, residing in Jinling and proficient in medical theory. On the morning of the 22nd, Prefect Tao arrived, carefully checked the pulse, reviewed all prescriptions, and met the two doctors and me. He first asked the doctors: "What illness does the Duke have?" Doctor Chen bowed silently. Doctor Lin said: "Malaria." Prefect Tao said: "Do I not know it's malaria? But what type?" Doctor Lin could not answer. Prefect Tao turned to me. I replied: "In my opinion, it is Malaria due to Yin Deficiency." Prefect Tao said: "Indeed. This should be treated with Xiao Chai Hu Tang combined with Si Wu Tang (Four Substance Decoction), modifying by removing Chuan Xiong (Ligustici Chuanxiong Rhizoma) and heavily using Sheng Di Huang. No other prescription matches this." Doctor Lin asked: "Will taking this cure it?" Prefect Tao said: "You have treated for over half a month, getting worse each time. Will my single word ensure complete recovery? Nevertheless, if Yin-nourishing is heavily employed, symptoms should decrease significantly, making recovery easy. Imagine extreme scorching heat; without heavy rain, how can coolness return? Rain is possible, but hail is not; hail also harms people. Huang Lian and Shi Gao are like hail." Doctor Lin was speechless. I asked: "Nourishing Yin must include Dang Gui and Di Huang. Some say Dang Gui aids heat and should not be used. What then?" Prefect Tao said: "Where does this illogical argument come from? Reviewing previous prescriptions, they were all warming-drying, unknowingly aiding heat, yet Dang Gui is accused of aiding heat? Although Dang Gui is slightly warm, it nourishes Yin. If Dang Gui had been included earlier, Yin damage and severe heat would not have reached this extent. Furthermore, Sheng Di Huang is Yin within Yin, Dang Gui is Yang within Yin. Yin and Yang assist each other; motion and stillness generate each other—this is the way of medication. How can one be neglected? Here, Sheng Di Huang is the sovereign herb, and Dang Gui is the assistant." Saying this, he entered leaning on a cane. The two doctors left in shame. Prefect Tao came out and told me: "Your pulse records and prescriptions are very thorough, but still light. I have explained to the Duke that from now on, I rely entirely on you. Please proceed well." I worried about excessive medical debate. Prefect Tao said: "I will take responsibility. I will visit every other day to dispel doubts." That day, I used Sheng Di Huang 2 liang, Dang Gui 3 qian, Chai Hu 1.5 qian, Huang Qin (Scutellariae Radix) 1 qian, Chi Shao 2 qian, Chi Fu Ling (Poria with Red Coir) 3 qian, Gan Cao 5 fen, and Chen Pi (Citri Reticulatae Pericarpium) 1 qian. After taking it, the next malaria attack lasted only about two hours, followed by profuse sweating and clearance of heat, reducing duration by four hours compared to before. Fever was also bearable. Subsequently, modifications followed this principle. Due to severe Yin deficiency, Sheng Di Huang was reduced to 1 liang, but not further. Malaria intensity gradually lightened. By month-end, attacks lasted less than one hour. Prefect Tao Taoshan indeed visited regularly. Although many doctors were recommended from elsewhere, Gongbao dismissed them all due to efficacy. Later, I heard Prefect Tao returned to Chu on the 3rd day of the ninth lunar month. Fearing misdiagnosis by other doctors, I informed Gongbao and invited Mr. Jiufeng to oversee. Mr. Jiufeng arrived on the 1st day of the ninth month. After examination, he agreed that nourishing Yin was correct, recovery was imminent, and no change in method was needed. He instructed the main physician to make slight adjustments. Full recovery occurred on the 7th day. This case initially relied on Inspector Yizhai's recommendation, mid-way benefited from Prefect Taoshan's appreciation, and ultimately utilized Mr. Jiufeng's prestige to conclude successfully. Through this, I gained Gongbao's recognition and formed a close bond. Ultimately, this formula was merely a variation of Jingyue's Gui Chai Yin (Return and Bupleurum Decoction) intent. Using this to cure Yin-deficient malaria has succeeded in dozens or hundreds of cases. The method is quite ordinary and not remarkable. Only Prefect Taoshan's superior arguments and startling metaphors are eternal quotes, which I constantly remember and dare not forget.